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Design of lower-limb prostheses
Koutecký, Tomáš ; Ždímal, Pavel (referee) ; Paloušek, David (advisor)
The goal of this bachelor's thesis is to give an overview of the current state of lower limb prostheses after amputation between the hip and the knee. It deals with the human gait, its analysis and with deviations in gait with the prosthesis. It also describes basic division of lower limb prostheses. The main part is the description of these prostheses designs and especially the design of main components and general overview of available types.
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The issue of care of a patients with the critical ischemia of lower limbs.
SVATOŠOVÁ, Gabriela
Peripheral arterial disease (PAD) is a disease which may cause gradual narrowing and possibly congestion of arteries that are responsible for nourishing the lower limbs. Most often this condition develops consequently with atherosclerosis. The most advanced stage of PAD is called critical limb ischemia. The changes induced by atherosclerosis affect not only the lower limb arteries, but at the time of the diagnosis of PAD all arteries in the body are already affected. Therefore PAD belongs among cardiovascular diseases and its diagnosis is a negative prognostic factor of the overall cardiovascular risk. The aim of treatment interventions is to reduce complications that accompany this ailment and their impact on the patient's life. The aim of the thesis was to find out to what extend the patients are informed about the causes of PAD, options of its treatment and the impact of prevention and life style on the overall prognosis of the disease. The first objective of the thesis is to find out if patients are aware of the risks of PAD treatment, one of which is leg amputation. The second objective is to find out whether the patients are sufficiently informed about their condition. The third objective is to evaluate whether patients follow the prescribed treatment. The fourth objective is to find out whether patients are willing to change their life style in order to eliminate the risk of lower limb amputation. A part of interviews with patients was to educate them about their condition, the necessity of following the treatment regimen and the impact of lifestyle on the affected leg prognosis. At the end, the interviewed received educational handouts with information about the most important suggested procedures to follow. The practical part of the thesis is based on qualitative research. The data was collected in semi-structured interviews. The interviews were conducted in two steps. The first step was to educate patients about PAD and distribute informational handouts. The second round of interviews took place intentionally several months after the first ones. Their purpose was to assess the impact of education on patients' compliance with treatment and regimen. The research shows the majority of the interviewed were well-informed about the crucial aspects of their condition and treatment procedures. The participants understood the given information and considered it satisfactory. However, it was surprising that patients had not looked for information themselves. Simultaneously, it was ascertained that most of the respondents were aware of the prognosis and risks related to the treatment. The two-step interviews showed some respondents were not aware of the causes of their disease. It can be therefore assumed that their ignorance of the risk factors and their impact on the development of the disease is the reason why patients do not give enough importance to the suggested treatment regimen. Furthermore, it was found out that they had not look for a substitute solution if they are not able to follow the recommended treatment regimen. The results of this thesis show that although the elimination of the risk factors is crucial for patients' future they do not pay enough attention to them. There are two aspects to it; either patients trivialize the potential risks or are apathetic or are not sufficiently informed. It is hard to have some impact on patients' apathy and trivialization of their condition. Nevertheless, it is possible to influence the second aspect, which is the subject of the final part of the thesis and the educational handout. As was discovered during the interviews, the information provided by doctors during ambulatory treatment is not thorough and does not include practical advice how to follow treatment regimen. Patients should be informed by nurse either personally or during the sessions. In this way the patient should be also selfmotivated in their treatment.
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The role of a nurse during a postoperative period supporting patient's independence after an amputation lower limb.
ZRZAVECKÝ, Martin
Having studied medical literature and having gained practical experience in taking care of patients with amputation in the Surgery Ward of the Hospital České Budějovice a.s., I decided to focus my bachelor thesis on: The role of nurses in promoting self-sufficiency in patients with amputation during postoperative period. Lower-extremity amputation can be defined as the removal of a peripheral body part resulting from an injury or surgical operation. Currently, road transport in particular accounts for a high accident frequency. Many young people experience the loss of a body part due to injuries. As a planned surgical procedure, amputation of the lower extremity is performed in order to relieve or eliminate pain or in order to prevent infection or metastases from spreading. Lower-extremity amputation changes the life quality of most people. Health professionals provide the care for amputations according to the standards and lead the patients towards gaining self-sufficiency. The qualitative research was aimed at: 1. mapping the role of nurses in promoting self-sufficiency in the patients with amputation during postoperative period, as viewed by both the nurses and the patients, and 2. determining the degree of successful practising self-sufficiency in the patients with amputation during postoperative period. The relevant research questions were set as follows: 1. What is the role of nurses in promoting self-sufficiency in the patients with lower-extremity amputation, as viewed by nurses? 2. What is the influence of nursing on the self-sufficiency of the patients with lower-extremity amputation? 3. How do nurses practise self-sufficiency in the patients with lower-extremity amputation during postoperative period? The qualitative research was based on the use of in-depth interviews with the nurses and patients. The research sample included patients with lower-extremity amputation and nurses of the Surgery and Traumatology Wards in the Hospital České Budějovice a.s.. As regards the promotion of self-sufficiency in the patients with lower-extremity amputation, the results indicate that the nurses from the Surgery and Traumatology Wards performed mainly activities aimed at satisfying patients´ physiological needs (hygiene, food and fluid intake, excretion, assistance in moving and in the need to be pain-free). Nurses of the Surgery Ward consider practising self-sufficiency in these patients more demanding in view of the patient´s age and the type of amputation related to a chronic disease. Patients believe that nursing care during the hospitalization has a significant influence on their self-sufficiency. The nurses of both the Surgery and Traumatology Wards consider practising self-sufficiency to be of great importance and can observe different effects as related to the patient´s age and the cause of amputation. Both the nurses and the patients agree that practising self-sufficiency includes hygiene, assistance with food intake and excretion, getting up from bed to assume vertical position, practising movability and managing pain. The investigation objectives were fulfilled and the obtained results may help nurses improve the quality of nursing, which will contribute to the improvement of the quality of life in the patients with amputation.
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Special features of nursing care for the patients after fingers replantation.
KREBSOVÁ, Terezie
Abstract As a relatively high number of amputation injuries of fingers leading to subsequent replantation occur recently, and the nursing care about these patients is very specific in some spheres, I chose the topic ?specifics of nursing care for patients after replantation of fingers? for my bachelor thesis. As duly and professionally provided nursing care is very important and contributes to successful treatment and patient recovery to normal life after replantation I am convinced that it is necessary for nurses caring about the patients affected this way know the correct treatment principles. The goal of the thesis was to identify the specifics of nursing care for patients after finger replantation, and another goal was to find out how nurses cope with nursing care about patients after finger replantation. The research was based on combination of quantitative and qualitative methods and was focused on some fields of the care about these patients on one hand and on the fact whether nurses apply the nursing approach focused on patient needs on the other. The quantitative research was based on an anonymous questionnaire, the qualitative research on observation. The combination was chosen to enable comparison of theoretical knowledge of nurses with the practical activity. The research sample consisted of nurses from the accident and plastic surgery ward. Nurses from the standard treatment section, from the outpatient surgery and from the ICU were asked for cooperation. Hypothesis 1: Nurses know the principles of stump and amputate treatment ? was confirmed. Hypothesis: Nurses know the principles of nursing care about patients after finger replantation ? was confirmed. Hypothesis 3: Nurses plan the care process focused on patient needs after finger replantation ? was not confirmed. Question 1/ What problems do nurses have in providing nursing care for patients after finger replantation? Nurses do not have problems with providing nursing care for patients after finger replantation. Question 2/ To what extent do nurses caring about patients after finger replantation apply the nursing care process? Not all the nurses apply the nursing care process to the full extent. I found during working on the thesis that very few available materials intended for nurses existed on this topic. This is why a brochure including the principles of due nursing care for patients after finger replantation was issued upon the thesis for nurses caring for patients with this problem. A nursing standard, which is still unavailable, could also be elaborated.
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Nursing care in patients after amputations
DOPITOVÁ, Pavla
The amputation is currently quite a common measure, the most common cause of which is complications of people who suffer form diabetes; it is so called a diabetic foot. Another group of people involves people with severe limb injuries. The sick people who are expected to undergo amputation are admitted to hospitals at surgical ortraumatology standard wards or intensive care units, and it is necessary that nurses have theoretical knowledge as well as practical nursing skills related to those patients because if a sick person wants to start a full-value life after the amputation, he or she needs to be provided with a quality nursing care. The nursing care is multidisciplinary because it involves care provided not only by medical professionals at emergencies, rehabilitation wards and ambulances but also by technical orthopaedic professionals. The thesis has two objectives. The first objective was find out whether the nurses can care of the patients with an amputated limb. The second objective was to find out whether the nurse apply a holistic approach to care. These objectives were given three hypotheses. Hypotheses 1: The nurse follow correct procedures while taking care of the client after the amputation. Hypotheses 2: The nurses have enough information on care of the client after the amputation. Hypothesis 3: The nurses focus on physical needs of the client. All three hypotheses have not been confirmed. The objectives of the thesis have been fulfilled. The Bachelor´s thesis could be used during at the surgery and traumatology wards. Further on it can serve as a material for students of health care or as a standard in nursing care of the sick people after the amputations. This thesis includes an educational material concerned with orthopaedic prosthesis.
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Physiotherapy at high amputations as a complication of diabetes mellitus
HAJNÁ, Štěpánka
A topic of this bachelor thesis is "Physiotherapy at high amputations as a complication of diabetes mellitus." Diabetes mellitus is a chronic, etiopathogenically heterogeneous disease. It arises from the lack of an insulin action at its absolute or relative absence and it is accompanied by a complex metabolic disorder of sugars, fats and proteins. Long-term vascular complications, which can lead to an amputation, gradually develop on the basis of this disease. An introductory part of the current state is focused on the characteristic of diabetes mellitus, its classification, risk factors, pathogenesis, course and its complications. The other part is focused on the problem of amputations and the last part of the current state is focused on used examination methods and physiotherapeutic procedures. A goal of the research part was to evaluate a usage of physiotherapeutic methods at patients with the high amputation as a complication of diabetes mellitus and a possibility to integrate these patients into a life in the highest possible quality. I used, for the practical part of the bachelor thesis, methods of the qualitative research, the case study and an analysis of personal documents. The tested sample consisted of two patients with the high amputation, which was indicated because of complications of diabetes mellitus. The patients were monitored during their hospitalization in the rehabilitation ward or in the successive care ward of the hospital in České Budějovice. The results have been worked up in the form of case reports. The health status of all patients was at least partially improved and it came about their better integration into the society. It is therefore possible to say that rehabilitation goals were met. The bachelor thesis can be used in the actual work of physiotherapists or as a basis for their further scientific research. Then it can be used by patients themselves or by their close people in dealing with this handicap.
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Possible procedures as part of physiotherapy treatment in patients with lower limb amputation
SAVVINOVÁ, Kristýna
My bachelor thesis seeks to provide an insight into the issues associated with amputation of lower extremities. Amputation is an extensive surgical intervention which removes peripheral parts of the body. The objective of the theoretical part of my thesis was to present to the general public the issues associated with the return of patients after the amputation of a lower limb back to the normal life and the objective of the practical part was to make the return easier by means of a comprehensive and multidisciplinary approach to the patient. The research was performed using a qualitative method, by means of case studies of two male probands who underwent an amputation of the right lower limb at the thigh. The two probands were of similar age and with the same type of amputation. The first patient was hospitalized in the hospital Nemocnice sv. Zdislavy s.r.o., Mostiště, where I was involved in early postsurgery physiotherapy. The second patient was in the therapeutic center (Hamzova odborná léčebna pro děti a dospělé), in Luže {--} Košumberk, where I concentrated on physiotherapeutic procedures suitable for a prosthetic stage of rehabilitation. I selected the two probands also in order to demonstrate that it is important not only to provide early postsurgery rehabilitation but also rehabilitation in the prosthetic stage with a subsequent continuation of autotherapy. Both the patients experienced a major improvement of their physical and mental condition; this was undoubtedly supported by the comprehensive and multidisciplinary approach throughout the entire period of the provided care. In terms of taking care of themselves, the patients are now nearly self-sufficient, which is very important for their return back to the regular life. The thesis may be further used in clinical practice of physiotherapists and medical personnel. It may also serve as an educational material for patients.
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Health Related Quality of Life (HRQoL) in patients with phantom pain
BEŤÁKOVÁ, Zuzana
Health Related Quality of Life (HRQoL) in patients with phantom post-amputation pain Phantom pain is pain that relates to surgically or traumatically amputated parts of human body, usually already in its integrity. Pathophysiological mechanism allowing occurrence of phantom pain has not been discovered yet. It is a very complex, multifactorial phenomenon. In case phantom pain becomes a chronic disorder, it decreases subjecťs quality of life. The bachelorľs thesis titled "Health Related Quality of Life (HRQoL) in patients with phantom post-amputation pain" is divided into two parts. The theoretical part dwells on pain, its origins, types, ethics, and research done in the area of pain. The theoretical part also deals with amputation, origins, and help provided in social sphere of an individual. The last section of the theory is concerned with quality of life. The practical part introduces the objective of the thesis and defines hypotheses, which marks the actual beginning of the research. The chapter named "Methodology" provides a description of the research procedure and tools used in order to confirm or rule out the defined objective and hypotheses. The following chapter titled "Outcomes" comprises of graphs and tables showing resulting values and their verbal descriptions. Information collected in the research is confronted in the discussion. The aim of the thesis was to find out whether phantom pain influences quality of life in patients in case it develops within 1 month following the amputation or months after the amputation; and to observe whether younger subjects show better tolerance of phantom post-amputation pain. The data retrieved from selected subjects were collected by a method of interview. The objective was reached by using the method of standardized questionnaire SF-36 on Health Related Quality of Life, which focuses on 8 domains. In conclusion, the research showed that subjects over 65 years of age have better quality of life in domains SF - social function and P - Pain. In all 6 remaining domains, subjects under 65 years of age showed better quality of life. The research also came to the conclusion that if the pain starts 1 month and later from the amputation, such subjects show better quality of life in 7 out of 8 domains than subjects who start suffering from the pain within 1 month following the amputation. The only exception is the domain of SF - social function.
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