During the past few decades quality of life assessment has become one central outcome in treatment of patients with chronic lowerlimbischaemia. Different generic quality of life instruments such as the Nottingham Health Profile (NHP) and the Short Form 36 Health Survey (SF-36) [1,2] have previously been tested, revealing conflicting results in these patients according to psychometric attributes in short-term evaluations. The strengths and weakness of the NHP and the SF-36 scales are not extensively examined and further research is needed to establish which is the more appropriate and responsive quality of life instru- ment for patients with chronic lowerlimbischaemia in the long term. The main goal of vascular surgical treat- ment is the relief of symptoms and improvement in patients quality of life. A majority of the patients are eld- erly and have generally widespread arterial disease with numbers of symptoms due to the chronic lowerlimbischaemia, which may affect the patients' quality of life [3- 5]. Intermittent claudication (IC) means leg pain con- stantly produced by walking or muscular activity and is relieved by rest, while critical leg ischaemia (CLI) means pain even at rest and problems with non-healing ulcers or gangrene . It is important to identify dimensions which are influenced by the severity and nature of the disease when selecting a suitable quality of life instrument . The World Health Organization QOL group  has iden- tified and recommended five broad dimensions – physi- cal and psychological health, social relationship perceptions, function and well-being – which should be included in a generic quality of life instrument. Generic instruments cover a broad range of dimensions and allow comparisons between different groups of patients. Dis- ease-specific instruments, on the other hand, are specially designed for a particular disease, patient group or areas of function . The functional scale, Walking Impairment Questionnaire (WIQ)  and quality of life instruments such as Intermittent Claudication Questionnaire (ICQ)  and Claudication Scale (CLAU-S)  are examples of disease-specific instruments which have been devel- oped in recent years for patients with IC. However, at present there is no accepted disease-specific questionnaire for quality of life assessment in patients with CLI. Never- theless, the TransAtlantic Inter-Society Consensus (TASC)  recommended that quality of life instruments should be used in all clinical trials and preferably include both generic and disease-specific quality of life measures. Outcome measures need to satisfy different criteria to be useful as a suitable health outcome instrument in clinical practice. Construct validity is one of the most important characteristics and is a lengthy and ongoing process . An essential consideration is the instrument's ability to discriminate between different levels of the disease;
critical ümb ischaemia (European Consensus on critical limbischaemia. 1989), this states that a patient with critical ümb ischaemia wiU have had persistently recurring rest pain requiring regular analgesia for more than two w eeks, or ulceration of the foot, or gangrene of the foot and a Doppler ankle systoüc pressure of less than 50 mmHg (in a patient with diabetes meUitus absence of ankle pulses su ffice. ) Two further discussion documents were pubüshed by this group; the Second European consensus document on chronic critical leg ischaemia (1991) and the European consensus on critical ümb ischaemia (1992), setting out minimum standards for the investigation and management of a patient with critical lowerlimbischaemia. The definition aims to include aü Umbs with critical ümb ischaemia, and impües that un less the limb undergoes a revascularisation procedure major ümb amputation will be required. Despite these carefuüy defined criteria a few patients with true critical ümb ischaemia wül be excluded from reported series of patients with critical ümb ischaemia. Also a different group of patients fulfiUing the criteria for critical ümb ischaemia, who are not suitable for revascularisation wiU maintain a useful functional ümb despite no active intervention.
For both these experiments done at two different ambient temperatures, our predictive model using Gaussian process provides a simple, effective , practical and probabilistic approach to determine the unknown skin temperature of the subject within the prosthetic device from the actual liner measurements. The predictive model we developed leads to results which are in 95% confidence interval which translates to an accuracy of ± 0.8°C. However this approach has certain limitations as well. Although this study was conducted on one amputee subject over a number of times to verify the influence of ambient temperatures on the in-socket temperatures, there is a need to extend it on a greater population in order to define a generic behaviour. Since the residual limb temperature profile varies with changes in environmental temperatures, the Gaussian model has to be trained with individual datasets corresponding to changes in the ambient temperatures.
Such simplified design means that there is a motion mismatch between the robot and human, which is mani- fested in the mismatch between the joint centers of the robot and human. Designing an innovative mechanism can offer a solution to this problem. For hip joints, a parallel structure is adopted to realize three rotational motions and automatic centering with the human hip [52–54] as shown in Figure 5. When a 3-UPS paral- lel mechanism is mounted on the human waist and thigh, the thigh of the human and the mechanism are connected as a whole, which can be considered as a 3-UPS/1-S parallel mechanism  (Figure 5(a)). A novel metamorphic parallel mechanism was applied for lowerlimb rehabilitation using two configurations, 3-UPS/S and 2-RPS/UPS/S, by taking into account the human hip joint to satisfy different demands of patients at different phases of rehabilitation therapy  (Figure 5(b)). An asymmetric fully constrained parallel mechanism proto- type is designed for hip joint assistance and rehabilitation and employs pantographs as three-rotation constrained legs instead of using three serial rotation joints-leg to avoid disadvantages such as singularity, uncertainty, or interference with other legs  (Figure 5(c)).
These findings support the notion that lowerlimb injury or discomfort does not represent a substantial short-term problem, especially within this sample group, after a 2 hour treadmill march with 20 kg. Any pain or discomfort was only mild and was not stated as restricting. This is supported by subjective data collected showing only one participant rating discomfort in the thigh (which was used as a control) as greater than 1. Lowerlimb injuries may represent a greater problem when looking towards the medium and long-term with tendonitis, joint degradation and particularly stress fractures of the tibia and metatarsals being major causes of injury. Increased vertical impact forces at heel strike during walking are a risk factor for the development of overuse injuries 6-8 , the forces generated can be increased by a number of factors including load carriage 9-12 . Load carriage may also aggravate or cause the onset of previous injuries, especially in the knee or ankle.
A novel method to provide an objective visual guide during lowerlimb prosthetic alignment is proposed. A customized ambulatory device was built to collect kinematic and temporal gait data from 3 subjects walking in four different experiment setups. Multiple gait events within a gait cycle and stride time were derived as feature variables and were pre-processed using Principle Component Analysis (PCA). Distinctive clusters due to different walking setups were noticed in a PCA plot in two dimensions. Dispersion of each clusters and distances amongst each other explains the walking variability and differences under different setups.
Class 5 Skin changes as defined above with healed ulceration Class 6 Skin changes as defined above with active ulceration Limbs in higher categories have more severe signs of chronic venous disease and may have some or all of the findings defining a less severe clinical category. Each limb is further characterized as asymptomatic (A), for example, or symptomatic (S), for example, symptoms that may be associated with telangiectatic, reticular or varicose veins include lower extremity aching, pain, and skin irritation. Therapy may alter the clinical category of chronic venous disease. Limbs should therefore be reclassified after any form of medical or surgical treatment.
Backward transfer off the bed into a suitable wheel chair is taught. All bilateral amputees will require a wheelchair, irrespective of their age, condition and level of amputation. This wheel chair must have the rear wheels set back 7.5 cm to compensate for the alteration in weight distribution of the patient in the chair, owing to the loss of both lower limbs.
Crash Simulation of Lower Limb with Motorcycle Basket ORIGINAL ARTICLE I Crash Simulation of Lower Limb with Motorcycle Basket C K How, B Eng *, M M H Megat Ahmad, Ph D **, R S Radin Umar, Ph D *, A M[.]
Rheumatoid arthritis (RA) is a chronic systemic connect- ive tissue disease and is the third most common indica- tion for lowerlimb joint replacement in Northern Europe and North America . The aetiology of the dis- ease remains unclear but there are strong associations with Human Leukocyte Antigens (DRB1) . The prog- nosis is poor with 80% of patients being disabled 20 years from primary diagnosis . The medical treatment of RA has improved during the last 25 years, which is reflected by a 40% decrease in the rate of hip and knee surgery since a peak that was observed in the mid 1990s . Anaemia, raised erythrocyte sedimentation rate and a high disease activity score have all been identified as risk factors for requirement of large joint arthroplasty . Seventeen percent of patients with RA undergo an
comprehension at the semantic level, standard picture naming and lexical decision tasks were not used. In a picture naming task, participants are presented with a picture and asked to name the depicted object or action. Generating pictures that depict psych verbs would be extremely difficult. In a lexical decision task, participants are presented with a series of words and non- words and must distinguish between the two. The task necessarily requires word processing at the orthographic level (and most likely the phonological level as well), but does not necessarily require the use of word meaning. In contrast, action decisions in a go/no-go task in which participants respond to targets that denote a mental or physical action (“go” trials) and refrain from responding on filler “no-go” trials, featuring adjectives (e.g., green) or noun targets referring to concrete objects (e.g., chair), accomplishes these two aims. By using printed words as stimuli and having participants respond only when presented items denote a mental or physical action, psych verbs can be tested, and responses unambiguously require processing of word meaning. Second, because PD patients with greater upper and greater lowerlimb
The main requirements for a child orthosis are: to have a simple construction and a reduced weight, easy to achieve the angular amplitude for knee flexion in the walking activity, easy to adjust the dimensions, especially when it is used for children, easy to wear. This knee orthosis model will be used for children locomotion recovery through kinetotherapeutic procedures after some bone fractures or surgical interventions at the lower limb’s level. Also this will be a passive one. For these, an orthosis modular structure was designed in order to add or remove modules for increase or decrease in size. The material which will be used for components is aluminum alloys. For this modular orthosis’ command and control a step by step actuator will be used, and an Arduino microcontroller board. These two elements will form the command and control unit and will be placed in a special box with a backpack. The module design was achieved by taking into account the knee modular orthosis cinematic scheme from figure 5. The orthosis cinematic model has a single mobility degree. The virtual model with all the geometric parts was created in SolidWorks and is shown in figures 5 and 6. A link between the command-control unit and the modular orthosis will be made through flexible cables, one for pull up – cable no: 1 and the other for roll back – cable no: 2. For a 4 years old child, the intermediate module was eliminated from his structure in order to decrease his size. For this, as a geometric model remains only primary and final module, and it will be simulated in MSC ADAMS. An interface between SolidWorks and MSC ADAMS/Autoflex was created, for this model. For simulations, the right limb
Even though these are statistic in US, the problems still no exception in other countries. This problem also faced by Malaysia. Among of disabled people, some of them have impairment leg at one side of their lower limbs. In order to help these people, one of the solution ways is to build the lowerlimb assistive using contralateral motion. Lowerlimb assistive device using contralateral motion is a device that used to enhance people who have disabilities at one side of lower limbs to move by using healthy leg side gait pattern. The synonym word for contralateral is opposite side. By developing this device, people who have disabilities which have leg impairment on one side of lower limbs can move like normal healthy person. This will help them a lot in their daily lives.
No adverse effect or discomfort was reported by sub- jects. Tables 3, 4, 5 and 6 shows the evaluation results of outcome measures. Significant timeXgroup interaction was found in WICSI II (p = 0.02), mobility sub-score of SCIM III (p < 0.001), bilateral symmetry(p = 0.048), max- imal oxygen consumption (p = 0.014) and PEF (p = 0.048). Wilcoxon signed-rank test with Bonferroni cor- rection showed significant improvements in RABWSTT group in the abovementioned outcomes (p < 0.025) ex- cept for WISCI II which also reached marginal signifi- cance (p = 0.027), but none of these outcome measures were found to be improved in control group. No signifi- cant timeXgroup interaction was found in other out- comes with no significant between group difference(p > 0.05). On the other hand, however, there was no signifi- cant timeXgroup interaction or between group differ- ence detected after the intervention period for L-stiff and Modified Ashworth Scale over lower limbs muscles (p > 0.05).
suspicion can be confirmed with CT and iliac venography . Similar compression syndrome may also happen due to compression of underling venous structures by distal left tibioperoneal trunk which has abnormal bifurcation. Since the underlying corresponding vein gets compressed, similar mechanism of May-Thurner syndrome, Cockett syndrome could have occurred. This is the only possible anatomical anomaly of lowerlimb arteries which can predispose to multiple venous thrombosis in my patient (Figure 4).
Upper limb injuries accounted for only 9.5% of inju- ries and were all contact injuries. It is suspected that many of the injuries to the upper limb did not cause an absence from training and hence were not recorded in this study. Studies on other sports report upper limb injures contributing a higher proportion of overall injury, in hurling (18.6%), 9 in women’s collegiate field
This study explores the experiences of patients in acute care who had a severe open fracture of the lowerlimb 1, 2 . Quality standards for open fractures of the lowerlimb identify optimal pathways for surgical intervention and peri-operative care 3 . There is a gap in the literature regarding patients’ experience of this injury during hospitalization. Qualitative evidence suggests later on in their rehabilitation they struggle to recover. Tricket, Mudge 4 followed patients up to 2.8 years post injury. The participants identified: a range of different types of pain including stiffness and discomfort; reduced mobility and flexibility; the impact of temperature on their body; frustration and fear; anxiety around their appearance; concerns about getting back to work; a fear of falling; reduced finances and the impact of injury on family and friends. Up to 12 years post injury participants managed their injury by using approaches to coping, problem solving practical difficulties and cognitive restructuring to identify positive aspects of experience 5 . Studies of a broader variety of traumatic injury also identify experiences of pain, difficulties with mobility, psychological issues, and social and financial concerns 6-8 .