假肢矫形用新材料有机硅的特性

目的：介绍近些年来在假肢矫形领域广泛应用有机硅材料．对其配方设计和材料特性做深入探讨，并探讨有机硅及其制品在应用中的相关问题。 资料来源：应用计算机检索Medline1979—01／2005-12相关有机硅材料的文献，检索词“silicone，organosilicone，silastie，siloxane，silicone lines”等并限定文献语言种类为English。 资料选择：对资料进行初选，选取有机硅材料配方设计．性能研究．以及假肢矫形方面硅橡胶的应用方面的文献。纳入标准：①有机硅材料配方设计。②有机硅材料性能研究。③假肢矫形用有机硅材料及制品研究。④医学康复及生物医学方面有机硅及制品的研究。排除标准：综述文献、重复研究、Meta分析类文章。 资料提炼：粗选有几百篇关于有机硅的文章，最后精选得到14篇文章，其中4篇是研究假肢矫形方面有机硅材料及制品，其余10篇为研究医学康复及生物学方面有机硅材料及制品。 资料综合：有机硅高分子材料品种丰富，具有不同的制备方法和物理特性，易于制作成型。其与人体皮肤接触，透气性好，无毒，无害，而且还有一定的治疗作用。有机硅材料作为体外接触材料在假肢矫形行业中应用非常广泛，有机硅材料主要是做体外接触材料，以硅橡胶为主，少量用到硅凝胶。有机硅材料在假肢矫形器行业的应用：大腿、小腿假肢硅胶套，制作高档次假体，制作柔性接触垫，人体烧伤或损坏处的敷料。 结论：有机硅材料具有一系列优良的特性，在假肢矫形中广泛应用。需要具有般肢矫形专业知识和高分子材料专业知识的复合型人才，来开展研发工作，将有机硅这个新型材料国产化、普及化。     

组织化工程血管的现状与发展

目的:动脉狭窄或闭塞导致的组织缺血坏死应用血管旁路移植是重要的功能修复重建方法.当自体血管存在病变或缺陷时,需要人工血管作为移植物.回顾血管组织工程的一般原理,对种子细胞、支架和血管的体外构建3个方面研究的现状和存在的问题进行综述.资料来源:应用计算机检索Medline 1985-01/2004-09的人工血管和组织工程材料方面的相关章,检索词为“endothelium cell,tissue engineering,cell source,small-diameter vascular graft”,并限定章语言种类为英语.资料选择:对资料进行初审,选取包括上述内容的献,然后筛除明显非随机对照的试验研究,对剩余的献开始查找全.纳入标准为随机、对照实验.排除标准为非随机对照,重复实验和综述.资料提炼:共收集到33篇关于组织工程血管研究方面的献,22篇符合纳入标准.排除的11篇中,7篇为重复研究,4篇为综述.资料综合:22篇献包括对内皮细胞,天然和合成材料及细胞种植等方面的研究.采用脱细胞基质或人工合成材料等作为支架复合种植种子细胞的组织工程血管在强度、通畅性和相容性等方面进行了实验研究.结论:寻找力学与生物学性能和人体血管组织完全匹配的替代材料,目前是血管组织工程科学研究的热点.组织工程化血管植入体内后,随着组织的长人和支架的降解,最终可形成完全意义上的自体血管.但种子细胞来源、支架的构建和血管的三维培养仍有待进一步深入细致的研究.     

国际假肢矫形学会课程认证对我国假肢矫形专业教育的启示

我国近代假肢事业始于20世纪40年代左右,大陆地区假肢矫形专业教育起步于1987年。假肢矫形专业作为一门新兴科学,目前,其行业发展很大程度上受到高级专业人才缺乏的限制。据推算,2010年末我国残疾人总人数8502万人,其中肢体残疾2472万人。中国康复器具协会在2012年公布的全国注册假肢矫形执业制作师不足800人次,平均每位执业制作师需要为3万余人提供服务,其中不少人员是双证执业制作师。以上数据足以显示出社会对假肢矫形专业人才的需求迫在眉睫,故增大人才培养规模和保证教学质量已成为开办假肢矫形专业的院校或培养机构千钧重负的社会使命。     

国内外假肢的发展历程

背景：假肢问题是康复工程研究中的重要内容之一。目的：综述国内外假肢的发展历史。方法：应用计算机检索2001-01/2011-01中国期刊全文数据库相关文章,检索词为＂假肢,假肢发展,分类,产品＂,并限定文章语言种类为中文。同时计算机检索1980-01/2011-01IEEE/IETE lectronic Library（IEL）数据库相关文章,检索词为＂prosthetics,prosthetic development,product＂,并限定文章语言种类为English。共检索到文献206篇,最终纳入符合标准的文献16篇。结果与结论：20世纪前半期,以美国为代表的工业发达国家对假肢技术开展了大规模的研究,使得假肢的理论和实践都有了重大进展。随着工业的发展,采用合金、塑料等新型材料成功研制了各式现代假肢。由于起步较晚,中国假肢产品与国外相比还有一些差距。且由于其行业的特殊性,要求假肢工作人员必须要在多学科的协作组里与外科医生、物理治疗师、作业治疗师、心理治疗师、社会工作者等其他专业人员一起工作,从而更好的为患者服务。     

国内外假肢的发展历程

背景:假肢问题是康复工程研究中的重要内容之一。目的:综述国内外假肢的发展历史。方法:应用计算机检索2001-01/2011-01中国期刊全文数据库相关文章,检索词为"假肢,假肢发展,分类,产品",并限定文章语言种类为中文。同时计算机检索1980-01/2011-01IEEE/IETE lectronic Library(IEL)数据库相关文章,检索词为"prosthetics,prosthetic development,product",并限定文章语言种类为English。共检索到文献206篇,最终纳入符合标准的文献16篇。结果与结论:20世纪前半期,以美国为代表的工业发达国家对假肢技术开展了大规模的研究,使得假肢的理论和实践都有了重大进展。随着工业的发展,采用合金、塑料等新型材料成功研制了各式现代假肢。由于起步较晚,中国假肢产品与国外相比还有一些差距。且由于其行业的特殊性,要求假肢工作人员必须要在多学科的协作组里与外科医生、物理治疗师、作业治疗师、心理治疗师、社会工作者等其他专业人员一起工作,从而更好的为患者服务。     

组织化工程血管的现状与发展

目的:动脉狭窄或闭塞导致的组织缺血坏死应用血管旁路移植是重要的功能修复重建方法。当自体血管存在病变或缺陷时,需要人工血管作为移植物。回顾血管组织工程的一般原理,对种子细胞、支架和血管的体外构建3个方面研究的现状和存在的问题进行综述。资料来源:应用计算机检索Medline1985-01/2004-09的人工血管和组织工程材料方面的相关文章,检索词为“endotheliumcell,tissueen-gineering,cellsource,small-diametervasculargraft”,并限定文章语言种类为英语。资料选择:对资料进行初审,选取包括上述内容的文献,然后筛除明显非随机对照的试验研究,对剩余的文献开始查找全文。纳入标准为随机、对照实验。排除标准为非随机对照,重复实验和综述。资料提炼:共收集到33篇关于组织工程血管研究方面的文献,22篇符合纳入标准。排除的11篇中,7篇为重复研究,4篇为综述。资料综合:22篇文献包括对内皮细胞,天然和合成材料及细胞种植等方面的研究。采用脱细胞基质或人工合成材料等作为支架复合种植种子细胞的组织工程血管在强度、通畅性和相容性等方面进行了实验研究。结论:寻找力学与生物学性能和人体血管组织完全匹配的替代材料,目前是血管组织工程科学研究的热点。组织工程化血管植入体内后,随着组织的长入和支架的     

截肢与假肢治疗过程中的心理问题

20世纪后半期假肢技术迅速发展,现代假肢技术的代表是以符合生理解剖原理的吸着式接受腔和以先进工业技术生产的组件式下肢假肢,随着大量新技术和新材料引入假肢领域,实现了假肢的钛合金化、碳纤维化和计算机智能化控制,极大的提高了截肢患者的生存质量。而随着科学技术的发展和以人为本社会理念的进步,使截肢和假肢治疗过程中的心理问题逐渐得到重视。在截肢与假肢治疗中常见的相关心理问题有抑郁、焦虑恐惧、自我概念的改变、强迫的敏感性增高、社会适应力改变、残疾认同心理问题。截肢与假肢治疗康复不是单纯的假肢装配和训练,而是一个复杂的系统工程,包括从截肢手术到重返社会的全过程。截肢与假肢治疗康复理想的流程应包括躯体和心理两个方面。截肢与假肢治疗中心理问题的干预对策包括心理康复、职业前训练,一直到回归家庭和社会的各个环节。     

组织工程皮肤的最新研究

构建一种理想的组织工程皮肤,无论是对急性烧(创)伤患者,还是伤后要求皮肤修复重建的患者都有重大作用。但是,迄今为止,尚无一种持久、合适耐用的皮肤代用品。目前从组织工程学的观点来看,人工皮肤主要有3类:①培养的表皮膜。②真皮替代物。③具有表皮、真皮双层结构的复合皮肤替代物。前两类都有一定的局限性。理想的皮肤替代物应同时修复表皮和真皮组织,因为这两种成分不仅影响皮肤的功能和外形,而且具有相互影响的机制,促进彼此的分化。文章就临床上使用的各种组织工程皮肤的特性、使用情况、作用机制和目前存在的问题及其未来的发展方向进行展望。     

赛姆假肢制作的矫形技术和对线原则

截肢和赛姆 (Ｓｙｍｅ)截肢是临床上应用较多的截肢手术形式。随着全面康复日益受到重视 ,残疾者要求假肢具有更好的代偿功能 ,因而矫形技术人员越来越关注赛姆假肢装配中的矫形技术问题。1假肢的功能赛姆截肢术后 ,患者失去了踝关节 ,但残肢一般具有残端承重能力。所以 ,即使不装配假肢 ,部分患者也能行走 ,但在步态周期的站立中相至蹬离相内 ,缺乏前足的蹬离运动 ,导致病理步态。同时 ,由于手术截骨 ,理论上截肢侧较健侧短 7ｃｍ左右 ,所以 ,赛姆截肢患者往往希望假肢装配能达到以下目的 :①平衡双侧下肢的高度 ;②假肢能够穿着正常的鞋 ;…     

组织工程支架材料的研究现状

20世纪80年代，美国学者Langer和Vaeanti提出组织工程(Tissue Engineering)的再生医学的新概念，现正在形成组织工程学这门新学科。该学科利用生命科学与工程学的原理与方法，研究和开发具有修复或改善人体组织功能的新一代临床应用结构物，用于替代器官的一部分或全部功能。组织工程提高了组织缺损的治疗水平和患者的生活质量。降低了医疗费用，正在形成高新技术产业。组织工程研究主要有4个方面：种子细胞、支架材料、器官构建、临床使用。其中支架材料和种子细胞是组织工程目前研究的重要内容。介绍人工合成可降解聚合物如聚乳酸、聚乙醇酸及其共聚物、聚丁酸、聚偶磷氮、聚酸酐、聚磷腈、聚酯尿烷等和天然高分子聚合物胶原、纤维蛋白、甲壳素以及透明质酸等作为组织工程支架材料的研究进展概况，包括各自的优缺点和一些改进措施。并指出了今后的研究方向。     

Control strategies for active lower extremity prosthetics and orthotics: a review

Technological advancements have led to the development of numerous wearable robotic devices for the physical assistance and restoration of human locomotion. While many challenges remain with respect to the mechanical design of such devices, it is at least equally challenging and important to develop strategies to control them in concert with the intentions of the user.This work reviews the state-of-the-art techniques for controlling portable active lower limb prosthetic and orthotic (P/O) devices in the context of locomotive activities of daily living (ADL), and considers how these can be interfaced with the user’s sensory-motor control system. This review underscores the practical challenges and opportunities associated with P/O control, which can be used to accelerate future developments in this field. Furthermore, this work provides a classification scheme for the comparison of the various control strategies.As a novel contribution, a general framework for the control of portable gait-assistance devices is proposed. This framework accounts for the physical and informatic interactions between the controller, the user, the environment, and the mechanical device itself. Such a treatment of P/Os – not as independent devices, but as actors within an ecosystem – is suggested to be necessary to structure the next generation of intelligent and multifunctional controllers.Each element of the proposed framework is discussed with respect to the role that it plays in the assistance of locomotion, along with how its states can be sensed as inputs to the controller. The reviewed controllers are shown to fit within different levels of a hierarchical scheme, which loosely resembles the structure and functionality of the nominal human central nervous system (CNS). Active and passive safety mechanisms are considered to be central aspects underlying all of P/O design and control, and are shown to be critical for regulatory approval of such devices for real-world use.The works discussed herein provide evidence that, while we are getting ever closer, significant challenges still exist for the development of controllers for portable powered P/O devices that can seamlessly integrate with the user’s neuromusculoskeletal system and are practical for use in locomotive ADL.     

Biomechanical assessment and treatment in lower extremity prosthetics and orthotics: a clinical perspective

Biomechanical treatment is like a jigsaw puzzle with two complex counterparts having many pieces. The physical and mechanical components are equally important and cannot be separated from each other. The patient with a prosthesis or an orthosis represents a biomechanical system; total treatment is essential. All of the pieces to the puzzle must be used to complete the picture. Given the present structure of the educational system, there is a separation of disciplines necessary to provide one truly biomechanical treatment. Physical therapists are educated in the bio aspect of treatment, whereas prosthetists/orthotists are educated in the mechanical aspect. Biomechanical treatment requires the direct interaction and integration of the two disciplines. Physical therapists and prosthetists/orthotists need each other. One without the other can provide only half of the treatment necessary for optimal outcomes. The patient needs both. Physical therapists need to become more familiar with mechanical treatment and learn how to integrate this into their physical treatment program. Prosthetists/orthotists must become more familiar with the importance of physical treatment and the internal corrective forces necessary for efficient ambulation. The traditional label of orthotics and prosthetics and related technology as products must be replaced with biomechanical treatment that includes orthotics and prosthetics services. Professionals working with each other is a positive step, but they need to be working together as a team toward a common goal. They need to be in the same place at the same time and work together consistently to provide total treatment. This is more than a multidisciplinary approach. It is one treatment. In this way, each benefits the other as they teach and learn simultaneously. At present, this teaching and learning can be done only on an individual basis. It is the author's hope that experienced prosthetists/orthotists and physical therapists reading this article will see the need to combine their efforts to provide truly biomechanical treatment. By working together, they can expand their present knowledge and skills. In this way, treatment and outcomes can improve and serve as the guiding force for a new generation of rehabilitation specialists. This process can be expedited through the educational system by offering advanced clinical degrees specializing in biomechanical treatment specifically designed for clinical practice rather than research, administrative, or academic positions. For this idea to become reality, educational institutions representing the physical and mechanical aspects of biomechanical treatment also must work together; this would expedite the learning curve so that it would not take so long to put the pieces of the puzzle together.     

Experiences of attitudes in Sierra Leone from the perspective of people with poliomyelitis and amputations using orthotics and prosthetics

Purpose: The aim of this study was to describe experiences of attitudes in the society of Sierra Leone from the perspective of individuals with poliomyelitis and people with amputations using orthotic or prosthetic devices.

Methods: Individual interviews were conducted using open-ended questions. Twelve participants with amputations or polio were included. Content analysis was applied to the data.

Results: The following six themes emerged during data analysis: Experience of negative attitudes; Neglected and respected by family; Traditional beliefs; The importance of assistive devices; People with disability struggle with poverty; and The need for governmental and international support.

Conclusions: In Sierra Leone, people with disabilities face severe discrimination. They need to be included, recognized, and supported to a greater extent by the society, the community, and the family, as well as by the government and international organizations. Traditional beliefs have a negative impact on people with physical disabilities and are an important cause of discrimination in Sierra Leone. Prosthetic and orthotic devices are vital for people with physical disability and offer increased dignity. Prosthetic and orthotic services need to be accessible and affordable. Poverty affects access to education, employment, and health care for Sierra Leoneans with physical disabilities, forcing them to resort to begging to cover basic living needs.

• Implications for Rehabilitation

• In Sierra Leone, traditional beliefs related to disability and public attitudes need to change in order to protect the human rights of people with disabilities.

• Increased public awareness of disability and implementation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) at different levels in society is needed.

• To increase access to prosthetic and orthotic services in Sierra Leone, these services need to be affordable and related costs, such as transport, need to be covered by support.

• Increased access to education, employment, and financial support could contribute to an improved standard of living for people with physical disabilities.

• Governmental and international support is needed to decrease attitudinal and environmental barriers for people with disabilities in Sierra Leone.

     

Validation of the orthotics and prosthetics user survey upper extremity functional status module in people with unilateral upper limb amputation.

OBJECTIVE: To evaluate the measurement properties of the Upper Extremity Functional Status module of the Orthotics and Prosthetics User Survey (OPUS). DESIGN: Methodological research on an outcome measure administered by clinical interview. PATIENTS: A convenience sample of 61 adults who had unilateral upper limb amputations and completed rehabilitation at the Institute for Rehabilitation in Ljubljana, Slovenia, at least one year prior to interview. Thirty-four patients had undergone amputation of the dominant hand. Four patients did not use a prosthesis. METHODS: Rating scale analysis (Rasch model) was used to evaluate functioning of the rating scale categories, the validity of the measure by examining fit of items to the latent trait, and the hierarchy of item difficulties compared with expectations of the construct. RESULTS: Rasch analysis allowed us to improve the Upper Extremity Functional Status by rescoring to reduce the response categories from 5 to 4, and identifying 19 of 23 items that are useful to measure upper extremity function. The results allow us to have high confidence in the consistency of both person-ability and item-difficulty estimates. CONCLUSION: This revised Upper Extremity Functional Status is a promising instrument to measure the degree of manual functioning after a unilateral upper limb amputation.     

Triplanar control dynamic response orthoses based on new concepts in lower limb orthotics

With new insight and solution development backed with evidence, new medical tools for individuals in need of orthotic treatment are available. More research is needed to validate further and improve techniques and outcomes. More clinicians need to be trained and develop the skills to master the techniques. Outcome-driven results will keep raising the bar of quality and proficiency to enhance the lives of individuals who depend on orthotists.