Materiale diviso per argomento di Valutazione Funzionale e Riabilitazione Motoria per il corso di Biomedical Engineering presso Politecnico di Milano. Il documento tratta: MOTOR SYSTEM REHABILITATION LO MAURO 10/03/2026 Assistive Devices and Orthoses Impairment, disability, and handicap are often used interchangeably. They have very different meanings, definitions provided by the World Health Organization (1980) in The International Classification…
Materiale diviso per argomento di Valutazione Funzionale e Riabilitazione Motoria per il corso di Biomedical Engineering presso Politecnico di Milano. Il documento tratta: MOTOR SYSTEM REHABILITATION LO MAURO 10/03/2026 Assistive Devices and Orthoses Impairment, disability, and handicap are often used interchangeably. They have very different meanings, definitions provided by the World Health Organization (1980) in The International Classification…
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MOTOR SYSTEM REHABILITATION LO MAURO 10/03/2026 Assistive Devices and Orthoses Impairment, disability, and handicap are often used interchangeably. They have very different meanings, definitions provided by the World Health Organization (1980) in The International Classification of Impairments, Disabilities, and Handicaps: - Impairment → any loss or abnormality of psychological, physiological or anatomical structure or function. It refers to a problem with a structure or organ of the body; - Disability → any restriction or lack (resulting from an impairment) of the ability to perform an activity in the manner or within the range considered normal for a human being. It is a functional limitation with regard to a particular activity. - Handicap → a disadvantage for a given individual that limits or prevents the fulfilment of a role that is normal. It refers to a disadvantage in filling a role in life relative to a peer group. Examples: 1. David is a 4-yr.-old who has a form of cerebral palsy that causes his legs to be stiff, tight, and difficult to move. He cannot stand or walk. Impairment → inability to move the legs easily at the joints and inability to bear weight on the feet → without intervention the level of impairment may increase → imbalanced muscle contraction over time can cause hip dislocation and deformed bone growth. Disability → inability to walk → the level of disability can be improved with physical therapy and special equipment (for example the use of a walker or a wheelchair) Handicap → prevention from fulfilling a normal role at home, in preschool, and in the community → getting older, his handicap will increase as certain sports and physical activities (move about the classroom and from one activity to another outside the classroom) are considered…
→ The diagrams of the shear forces applied to the entire lower limb, considered as a single rod: depending on whether the central point is moved above or below the knee, the shear forces that develop at the knee, and that load the ligaments, are quite different. → It is important to understand the ideal position of the principal force for the patient (over, below or exactly at the level of the knee) NB: even if the support point is centered on the knee, in the practical realization of the padded shell or the containment band it is difficult to check that the load is equally distributed on the two segments that join in the joint, so there is a risk that the orthosis, intended to reduce muscle load, overloads the joint ligaments. The problem of torsion → If the orthosis has two bars on either side of the limb, it can be reasonably assumed that the forces act on the sagittal plane of the limb itself and that on the orthosis rods they only induce bending stresses. → If the orthosis is built with a single lateral bar to achieve the objectives of greater lightness and wearability, important to consider that it will be stressed not only by the bending moment but also by a considerable torque → a problem is that could arise excessive deformation of the bar which would make the function of the orthosis less effective. Control of normal joint forces: While uncontrolled rotational joint movements can occur (in the absence of the normal stabilizing actions performed by the muscles) in the presence of even small joint moments, translational instabilities occur only in the presence of considerable shear forces. a) Active and reactive forces of two body segments with normal joints subjected to load, at an instant in which the longitudinal axes are vertical. The segments are subjected…
Mid-Swing: the limb swings forward with gravity/momentum, while the anterior tibialis maintains dorsiflexion to clear the ground. Terminal Swing (Deceleration): hamstrings contract eccentrically to slow down the leg, while the quadriceps extend the knee in preparation for heel strike. Key Muscle Function Summary: Dorsiflexors (Anterior Tibialis): control foot drop at contact + ground clearance during swing. Plantarflexors (Gastrocnemius/Soleus): control tibial advancement (mid-stance) and push-off (terminal stance). Quadriceps: absorb shock (loading response) and stabilize the knee. Hamstrings: prevent knee hyperextension (initial contact) and decelerate the swing leg (terminal swing). Hip Abductors (Gluteus Medius): stabilize the pelvis to prevent drops. During amputation, many of the original muscles are completely lost. The muscles that insert near a joint can be preserved, but they are shortened and reattached, altering their geometry; as a result, their contraction properties and functional performance change. Amputation affects the actions of residual muscles: • Mono-articular: span and act upon only a single join → totally lose their function. • Biarticular: detached from their distal insertion and fixed to the remaining bone part. This modify their contractile properties (dependent on the new muscle length) and their ability to generate momentum (dependent on the lever arm of the force developed) → the ability to move the joint proximal to which they act will be modified. • Remaining muscles and joints must compensate for the absence of muscle function distal to the level of amputation. For example, patients with transfemoral amputation adapt to limb loss with trunk and pelvic movement asymmetries to facilitate weight transfer during walking. •…
socket off with the other hand. Several variants of locking mechanisms → some produce an audible “click” to indicate that the pin has engaged. Evaluation of the Prosthesis The height of the prosthesis is evaluated when the wearer stands with weight equally distributed on both feet. The pelvis should be level. The height of the prosthesis should approximate that of the sound limb. 1. Compare the heights of the iliac crests. 2. Checking the pelvis using a levelling device. The pelvis should remain relatively horizontal during the prosthetic stance phase, with a maximum drop of 5 degrees on the intact swing side. The walking base and path of the swinging legs should be approximately 2 to 4 inches between the heel centres → a wide base increases energy expenditure and is less attractive. Compensation Normal gait results from symmetric relationships of the head, trunk, and upper and lower limbs. A transfemoral prosthesis markedly alters these relationships. Asymmetry imposed by amputation increases the demand for postural and balance adaptations → the more asymmetric the pattern, the greater the energy cost of walking and it increases significantly as the length of the residual limb decreases. Lateral trunk bending: common compensation for failure to stabilize the femur in the socket. If the lateral prosthetic wall does not stabilize the femur in adduction, the femur abducts, causing pelvic drop on the swinging side OR wearers lean toward the stance (prosthetic) side to ensure toe clearance OR to avoid uncomfortable pressure in the perineum. Lateral and Medial Whip: a whip occurs when forward progression of the distal parts of the prosthesis follows a semicircular path. With a lateral whip the lateral arc made by the prosthetic heel → the knee unit may be aligned in…
Clinical Indications → prioritizing high-frequency wave interaction over depth of penetration for treatment of soft tissue pathologies and the promotion of scarring to promote blood circulation and reduce inflammatory states, reduce edema with the ultimate aim of relieving pain. Safety Protocols → irradiation must be administered through specialized mats or bandages. It acta as a buffer to prevent potential side effects or unpleasant sensations, ensuring a controlled and harmful- free delivery of HF waves The main differences: Low Frequency High Intensity Magnetotherapy → Measured in Gauss → Focus on the intensity of the electromagnetic flux → greater depth of action → Mainly used for bone diseases High Frequency and Low Intensity Magnetotherapy → Measured in Hertz → Focus on the frequency of electromagnetic waves → more repeated stimulation → Mainly used for the treatment of soft tissue diseases For both therapies → the parameters of frequency, intensity and application time must be calibrated and customized based on the specific pathology being treated and the individual clinical needs of each patient. Absolute contraindications → strictly prohibited for patients in the following categories: wearers of pacemakers, metal valve or vascular prostheses, during pregnancy, in paediatric age and patients with older-generation ferromagnetic hip or knee prostheses (implanted over 30 years ago) but modern, latest-generation titanium prostheses are safe for treatment Abstract → Magnetotherapy utilizes the propagation of electromagnetic waves to interact directly with the cells of the bone and soft tissues. Its primary mechanism of action involves the restoration of the resting membrane potential. When cellular damage occurs, this electrical potential is altered, compromising…
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