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Artikel ; Online: Postoperative risks of stoma formation in patients with dementia.

Jarratt Barnham, Isaac / Kent, Niall

BMJ case reports

2022 Band 15, Heft 5

Abstract: Stoma formation for patients with dementia presents an increasing problem in a global ageing population. While potentially lifesaving, stomas impose significant, long-term postoperative burdens on patients, and may particularly challenge those with ... ...

Abstract	Stoma formation for patients with dementia presents an increasing problem in a global ageing population. While potentially lifesaving, stomas impose significant, long-term postoperative burdens on patients, and may particularly challenge those with cognitive impairment.In this case, a patient was considered for colostomy to manage a colovesical fistula. The patient's cognitive status significantly influenced clinicians' beliefs concerning suitability for stoma formation.The relevance of dementia to stoma formation is underdiscussed within the literature. In this report, we outline the postoperative risks to which those with dementia undergoing stoma formation are particularly vulnerable. These include increased risk of psychological harm, of relocation to a nursing home, and of stoma-related complications.We hope an increased appreciation of these postoperative challenges will inform decisions concerning suitability for stoma formation in this patient group.
Mesh-Begriff(e)	Colostomy/adverse effects ; Dementia/complications ; Humans ; Ileostomy/adverse effects ; Postoperative Complications/etiology ; Surgical Stomas/adverse effects
Sprache	Englisch
Erscheinungsdatum	2022-05-13
Erscheinungsland	England
Dokumenttyp	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-246037
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: The effects of postural support padding modifications to child restraints for children with disability on crash protection.

Cook, Lyndall / Brown, Julie / Kent, Nicholas / Whyte, Tom / Bilston, Lynne E

Traffic injury prevention

2024 , Seite(n) 1–9

Abstract: Objective: Many children with physical disabilities need additional postural support when sitting and supplementary padding is used on standards approved child restraints to achieve this when traveling in a motor vehicle. However, the effect of this ... ...

Abstract	Objective: Many children with physical disabilities need additional postural support when sitting and supplementary padding is used on standards approved child restraints to achieve this when traveling in a motor vehicle. However, the effect of this padding on crash protection for a child is unknown. This study aimed to investigate the effect of additional padding for postural support on crash protection for child occupants in forward facing child restraints. Methods: Forty frontal sled tests at 49 km/h were conducted to compare Q1 anthropometric test device (ATD) responses in a forward-facing restraint, with and without additional padding in locations to increase recline of the restraint, and/or support the head, trunk and pelvis. Three padding materials were tested: cloth toweling, soft foam, and expanded polystyrene (EPS). The influence of padding on head excursion, peak 3 ms head acceleration, HIC15, peak 3 ms chest acceleration and chest deflection were analyzed. Results: The influence of padding varied depending on the location of use. Padding used under the restraint to increase the recline angle increased head injury metrics. Toweling in multiple locations which included behind the head increased head excursion and chest injury metrics. There was minimal effect on injury risk measures with additional padding to support the sides of the head or the pelvis position. Rigid EPS foam, as recommended in Australian standards and guidelines, had minimal effect on injury metrics when used inside the restraint, as did tightly rolled or folded toweling secured to the restraint at single locations around the body of the child. Conclusions: This study does not support the use of postural support padding to increase recline of a forward-facing restraint or padding behind the head. Recommendations in published standards and guidelines to not use foam that is spongy, soft or easily compressed, with preference for secured firm foam or short-term use of tightly rolled or folded toweling under the child restraint cover is supported. This study also highlights the importance of considering the whole context of child occupant protection when using additional padding, particularly the change in the child's seated position when adding padding in relation to the standard safety features of the restraint.
Sprache	Englisch
Erscheinungsdatum	2024-04-15
Erscheinungsland	England
Dokumenttyp	Journal Article
ZDB-ID	2089818-6
ISSN	1538-957X ; 1538-9588
ISSN (online)	1538-957X
ISSN	1538-9588
DOI	10.1080/15389588.2024.2334400
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Finite Element Analysis of Transhumeral and Transtibial Percutaneous Osseointegrated Endoprosthesis Implantation.

Taylor, Carolyn E / Henninger, Heath B / Bachus, Kent N

Frontiers in rehabilitation sciences

2022 Band 2

Abstract: Cadaveric mechanical testing of a percutaneous osseointegration docking system (PODS) for osseointegration (OI) prosthetic limb attachment revealed that translation of the exact system from the humerus to the tibia may not be suitable. The PODS, designed ...

Abstract	Cadaveric mechanical testing of a percutaneous osseointegration docking system (PODS) for osseointegration (OI) prosthetic limb attachment revealed that translation of the exact system from the humerus to the tibia may not be suitable. The PODS, designed specifically for the humerus achieved 1.4-4.8 times greater mechanical stability in the humerus than in the tibia despite morphology that indicated translational feasibility. To better understand this discrepancy, finite element analyses (FEAs) modeled the implantation of the PODS into the bones. Models from cadaveric humeri (
Sprache	Englisch
Erscheinungsdatum	2022-02-14
Erscheinungsland	Switzerland
Dokumenttyp	Journal Article
ISSN	2673-6861
ISSN (online)	2673-6861
DOI	10.3389/fresc.2021.744674
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Mitigating fuel tank syndrome pelvic injuries - is there potential for rider worn protectors?

Whyte, Tom / Kent, Nicholas / Cernicchi, Alessandro / Brown, Julie

Traffic injury prevention

2022 Band 23, Heft sup1, Seite(n) S50–S55

Abstract: Objective: The aim of this study was to investigate the feasibility of rider-worn pelvis protection for mitigating injury risk when contacting the motorcycle fuel tank in a crash.: Methods: A newly developed test apparatus was designed and ... ...

Abstract	Objective: The aim of this study was to investigate the feasibility of rider-worn pelvis protection for mitigating injury risk when contacting the motorcycle fuel tank in a crash. Methods: A newly developed test apparatus was designed and constructed to simulate the interaction between a rider's pelvis and the motorcycle fuel tank in a frontal crash. Impacts were performed at a velocity of 18 km/h into four motorcycle fuel tanks. Further testing used a rigid fuel tank surrogate and the pelvis surrogate in an unprotected condition and with a series of impact protector prototypes. A subset of prototype samples was also tested at varying tank angles (30°, 37.5°, 45°) and impact speeds (8.5 km/h, 13 km/h, 18 km/h). Analysis of variance was used to determine whether the protector prototypes reduced pelvis response compared to unprotected. Results: Resultant peak pelvis acceleration was reduced by three pelvis impact protector prototypes compared to an unprotected condition. The reduction in peak acceleration occurred without a significant change in the peak pelvis rotational velocity. The pattern of protector performance was consistent at varying fuel tank angles but only reduced the pelvis response at the highest impact speed tested of 18 km/h. Conclusions: The results indicate that there may be potential for using pelvis impact protection to mitigate injury risk by absorbing and/or distributing impact energy that would otherwise be transmitted to the rider's pelvis. However, due to the current paucity in understanding of pelvis biomechanics to anteroposterior loading, it is unknown whether the pelvis acceleration reductions achieved would prevent injury.
Mesh-Begriff(e)	Humans ; Accidents, Traffic ; Pelvis/physiology ; Motorcycles ; Biomechanical Phenomena ; Acceleration
Sprache	Englisch
Erscheinungsdatum	2022-06-10
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2089818-6
ISSN	1538-957X ; 1538-9588
ISSN (online)	1538-957X
ISSN	1538-9588
DOI	10.1080/15389588.2022.2072834
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Finite Element Analysis of Transhumeral and Transtibial Percutaneous Osseointegrated Endoprosthesis Implantation

Carolyn E. Taylor / Heath B. Henninger / Kent N. Bachus

Frontiers in Rehabilitation Sciences, Vol

2021 Band 2

Abstract	Cadaveric mechanical testing of a percutaneous osseointegration docking system (PODS) for osseointegration (OI) prosthetic limb attachment revealed that translation of the exact system from the humerus to the tibia may not be suitable. The PODS, designed specifically for the humerus achieved 1.4–4.8 times greater mechanical stability in the humerus than in the tibia despite morphology that indicated translational feasibility. To better understand this discrepancy, finite element analyses (FEAs) modeled the implantation of the PODS into the bones. Models from cadaveric humeri (n = 3) and tibia (n = 3) were constructed from CT scans, and virtual implantation preparation of an array of endoprosthesis sizes that made contact with the endosteal surface but did not penetrate the outer cortex was performed. Final impaction of the endoprosthesis was simulated using a displacement ramp function to press the endoprosthesis model into the bone. Impaction force and maximum first principal (circumferential) stress were recorded to estimate stability and assess fracture risk of the system. We hypothesized that the humerus and tibia would have different optimal PODS sizing criteria that maximized impaction force and minimized first principal stress. The optimal sizing for the humerus corresponded to implantation instructions, whereas for the tibia optimal sizing was three times larger than the guidelines indicated. This FEA examination of impaction force and stress distribution lead us to believe that the same endoprosthesis strategy for the humerus is not suitable for the tibia because of thin medial and lateral cortices that compromise implantation.
Schlagwörter	osseointegration ; finite element ; endoprosthesis ; humerus ; tibia ; Other systems of medicine ; RZ201-999 ; Medical technology ; R855-855.5
Thema/Rubrik (Code)	621
Sprache	Englisch
Erscheinungsdatum	2021-11-01T00:00:00Z
Verlag	Frontiers Media S.A.
Dokumenttyp	Artikel ; Online
Datenquelle	BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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Artikel ; Online: Extended physiological proprioception is affected by transhumeral Socket-Suspended prosthesis use.

Dunn, Julia A / Wong, Bob / Sinclair, Sarina K / Henninger, Heath B / Bachus, Kent N / Foreman, K Bo

Journal of biomechanics

2024 Band 166, Seite(n) 112054

Abstract: The objective of this study was to define targeted reaching performance without visual information for transhumeral (TH) prosthesis users, establishing baseline information about extended physiological proprioception (EPP) in this population. Subjects ... ...

Abstract	The objective of this study was to define targeted reaching performance without visual information for transhumeral (TH) prosthesis users, establishing baseline information about extended physiological proprioception (EPP) in this population. Subjects completed a seated proprioceptive targeting task under simultaneous motion capture, using their prosthesis and intact limb. Eight male subjects, median age of 58 years (range 29-77 years), were selected from an ongoing screening study to participate. Five subjects had a left-side TH amputation, and three a right-side TH amputation. Median time since amputation was 9 years (range 3-54 years). Four subjects used a body-powered prosthetic hook, three a myoelectric hand, and one a myoelectric hook. The outcome measures were precision and accuracy, motion of the targeting hand, and joint angular displacement. Subjects demonstrated better precision when targeting with their intact limb compared to targeting with their prosthesis, 1.9 cm2 (0.8-3.0) v. 7.1 cm2 (1.3-12.8), respectively, p = 0.008. Subjects achieved a more direct reach path ratio when targeting with the intact limb compared to with the prosthesis, 1.2 (1.1-1.3) v. 1.3 (1.3-1.4), respectively, p = 0.039 The acceleration, deceleration, and corrective phase durations were consistent between conditions. Trunk angular displacement increased in flexion, lateral flexion, and axial rotation while shoulder flexion decreased when subjects targeted with their prosthesis compared to the intact limb. The differences in targeting precision, reach patio ratio, and joint angular displacements while completing the targeting task indicate diminished EPP. These findings establish baseline information about EPP in TH prosthesis users for comparison as novel prosthesis suspension systems become more available to be tested.
Mesh-Begriff(e)	Humans ; Male ; Adult ; Middle Aged ; Aged ; Upper Extremity ; Prosthesis Implantation ; Artificial Limbs ; Amputation, Surgical ; Proprioception ; Prosthesis Design
Sprache	Englisch
Erscheinungsdatum	2024-03-20
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	218076-5
ISSN	1873-2380 ; 0021-9290
ISSN (online)	1873-2380
ISSN	0021-9290
DOI	10.1016/j.jbiomech.2024.112054
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Virtual implantation technique to estimate endoprosthetic contact of percutaneous osseointegrated devices in the tibia.

Taylor, Carolyn E / Henninger, Heath B / Bachus, Kent N

Medical engineering & physics

2021 Band 93, Seite(n) 1–7

Abstract: Percutaneous osseointegrated (OI) devices have an endoprosthesis attached to the residual bone of an amputated limb, then pass permanently through the skin to be connected to the distal prosthetic componentry outside of the body. Whether the bone- ... ...

Abstract	Percutaneous osseointegrated (OI) devices have an endoprosthesis attached to the residual bone of an amputated limb, then pass permanently through the skin to be connected to the distal prosthetic componentry outside of the body. Whether the bone-anchoring region of current OI endoprostheses are cylindrical, and/or conical, they require intimate bone-endoprosthesis contact to promote stabilizing bone attachment. However, removing too much cortical bone to achieve more contact leads to thinner and, subsequently, weaker cortical walls. Endoprostheses need to be designed to balance these factors, namely maximizing the contact, while minimizing the volume of bone removed. In this study, 27 human tibias were used to develop and validate a virtual implantation method. Then, 40 additional tibias were virtually implanted with mock cylindrical and conical bone-anchoring regions at seven residual limb lengths to measure resultant bone-endoprosthesis contact and bone removal. The ratio of bone-endoprosthesis contact to bone volume removed showed the conical geometry had more contact area per volume bone removed for all amputation levels (p ≤ 0.001). In both mock devices, cortical penetration of the endoprosthesis at 20% residual length occurred in 74% of cases evaluated, indicating that alternative endoprosthesis geometries may be needed for clinical success in that region of bone.
Mesh-Begriff(e)	Amputation ; Amputees ; Cortical Bone ; Humans ; Osseointegration ; Prostheses and Implants ; Prosthesis Design ; Prosthesis Implantation ; Tibia/surgery
Sprache	Englisch
Erscheinungsdatum	2021-05-24
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	1181080-4
ISSN	1873-4030 ; 1350-4533
ISSN (online)	1873-4030
ISSN	1350-4533
DOI	10.1016/j.medengphy.2021.05.011
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Exploration of the synergistic role of cortical thickness asymmetry ("Trabecular Eccentricity" concept) in reducing fracture risk in the human femoral neck and a control bone (Artiodactyl Calcaneus).

Skedros, John G / Cronin, John T / Dayton, Michael R / Bloebaum, Roy D / Bachus, Kent N

Journal of theoretical biology

2023 Band 567, Seite(n) 111495

Abstract: The mechanobiology of the human femoral neck is a focus of research for many reasons including studies that aim to curb age-related bone loss that contributes to a near-exponential rate of hip fractures. Many believe that the femoral neck is often loaded ...

Abstract	The mechanobiology of the human femoral neck is a focus of research for many reasons including studies that aim to curb age-related bone loss that contributes to a near-exponential rate of hip fractures. Many believe that the femoral neck is often loaded in rather simple bending, which causes net tension stress in the upper (superior) femoral neck and net compression stress in its inferior aspect ("T/C paradigm"). This T/C loading regime lacks in vivo proof. The "C/C paradigm" is a plausible alternative simplified load history that is characterized by a gradient of net compression across the entire femoral neck; action of the gluteus medius and external rotators of the hip are important in this context. It is unclear which paradigm is at play in natural loading due to lack of in vivo bone strain data and deficiencies in understanding mechanisms and manifestations of bone adaptation in tension vs. compression. For these reasons, studies of the femoral neck would benefit from being compared to a 'control bone' that has been proven, by strain data, to be habitually loaded in bending. The artiodactyl (sheep and deer) calcaneus model has been shown to be a very suitable control in this context. However, the application of this control in understanding the load history of the femoral neck has only been attempted in two prior studies, which did not examine the interplay between cortical and trabecular bone, or potential load-sharing influences of tendons and ligaments. Our first goal is to compare fracture risk factors of the femoral neck in both paradigms. Our second goal is to compare and contrast the deer calcaneus to the human femoral neck in terms of fracture risk factors in the T/C paradigm (the C/C paradigm is not applicable in the artiodactyl calcaneus due to its highly constrained loading). Our third goal explores interplay between dorsal/compression and plantar/tension regions of the deer calcaneus and the load-sharing roles of a nearby ligament and tendon, with insights for translation to the femoral neck. These goals were achieved by employing the analytical model of Fox and Keaveny (J. Theoretical Biology 2001, 2003) that estimates fracture risk factors of the femoral neck. This model focuses on biomechanical advantages of the asymmetric distribution of cortical bone in the direction of habitual loading. The cortical thickness asymmetry of the femoral neck (thin superior cortex, thick inferior cortex) reflects the superior-inferior placement of trabecular bone (i.e., "trabecular eccentricity," TE). TE helps the femoral neck adapt to typical stresses and strains through load-sharing between superior and inferior cortices. Our goals were evaluated in the context of TE. Results showed the C/C paradigm has lower risk factors for the superior cortex and for the overall femoral neck, which is clinically relevant. TE analyses of the deer calcaneus revealed important synergism in load-sharing between the plantar/tension cortex and adjacent ligament/tendon, which challenges conventional understanding of how this control bone achieves functional adaptation. Comparisons with the control bone also exposed important deficiencies in current understanding of human femoral neck loading and its potential histocompositional adaptations.
Mesh-Begriff(e)	Humans ; Animals ; Sheep ; Femur Neck ; Calcaneus ; Deer ; Adaptation, Physiological ; Acclimatization
Sprache	Englisch
Erscheinungsdatum	2023-04-15
Erscheinungsland	England
Dokumenttyp	Journal Article
ZDB-ID	2972-5
ISSN	1095-8541 ; 0022-5193
ISSN (online)	1095-8541
ISSN	0022-5193
DOI	10.1016/j.jtbi.2023.111495
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Strain-mode-specific mechanical testing and the interpretation of bone adaptation in the deer calcaneus.

Skedros, John G / Dayton, Michael R / Bloebaum, Roy D / Bachus, Kent N / Cronin, John T

Journal of anatomy

2023 Band 244, Heft 3, Seite(n) 411–423

Abstract: The artiodactyl (deer and sheep) calcaneus is a model that helps in understanding how many bones achieve anatomical optimization and functional adaptation. We consider how the dorsal and plantar cortices of these bones are optimized in quasi-isolation ( ... ...

Abstract	The artiodactyl (deer and sheep) calcaneus is a model that helps in understanding how many bones achieve anatomical optimization and functional adaptation. We consider how the dorsal and plantar cortices of these bones are optimized in quasi-isolation (the conventional view) versus in the context of load sharing along the calcaneal shaft by "tension members" (the plantar ligament and superficial digital flexor tendon). This load-sharing concept replaces the conventional view, as we have argued in a recent publication that employs an advanced analytical model of habitual loading and fracture risk factors of the deer calcaneus. Like deer and sheep calcanei, many mammalian limb bones also experience prevalent bending, which seems problematic because the bone is weaker and less fatigue-resistant in tension than compression. To understand how bones adapt to bending loads and counteract deleterious consequences of tension, it is important to examine both strain-mode-specific (S-M-S) testing (compression testing of bone habitually loaded in compression; tension testing of bone habitually loaded in tension) and non-S-M-S testing. Mechanical testing was performed on individually machined specimens from the dorsal "compression cortex" and plantar "tension cortex" of adult deer calcanei and were independently tested to failure in one of these two strain modes. We hypothesized that the mechanical properties of each cortex region would be optimized for its habitual strain mode when these regions are considered independently. Consistent with this hypothesis, energy absorption parameters were approximately three times greater in S-M-S compression testing in the dorsal/compression cortex when compared to non-S-M-S tension testing of the dorsal cortex. However, inconsistent with this hypothesis, S-M-S tension testing of the plantar/tension cortex did not show greater energy absorption compared to non-S-M-S compression testing of the plantar cortex. When compared to the dorsal cortex, the plantar cortex only had a higher elastic modulus (in S-M-S testing of both regions). Therefore, the greater strength and capacity for energy absorption of the dorsal cortex might "protect" the weaker plantar cortex during functional loading. However, this conventional interpretation (i.e., considering adaptation of each cortex in isolation) is rejected when critically considering the load-sharing influences of the ligament and tendon that course along the plantar cortex. This important finding/interpretation has general implications for a better understanding of how other similarly loaded bones achieve anatomical optimization and functional adaptation.
Mesh-Begriff(e)	Animals ; Sheep ; Calcaneus ; Deer ; Lower Extremity ; Stress, Mechanical ; Biomechanical Phenomena
Sprache	Englisch
Erscheinungsdatum	2023-11-12
Erscheinungsland	England
Dokumenttyp	Journal Article
ZDB-ID	2955-5
ISSN	1469-7580 ; 0021-8782
ISSN (online)	1469-7580
ISSN	0021-8782
DOI	10.1111/joa.13971
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Transhumeral prosthesis use affects upper body kinematics and kinetics.

Dunn, Julia A / Gomez, Nicholas G / Wong, Bob / Sinclair, Sarina K / Henninger, Heath B / Foreman, K Bo / Bachus, Kent N

Gait & posture

2024 Band 112, Seite(n) 59–66

Abstract: Background: Transhumeral (TH) limb loss leads to loss of body mass and reduced shoulder range of motion. Despite most owning a prosthesis, prosthesis abandonment is common. The consequence of TH limb loss and prosthesis use and disuse during gait may be ...

Abstract	Background: Transhumeral (TH) limb loss leads to loss of body mass and reduced shoulder range of motion. Despite most owning a prosthesis, prosthesis abandonment is common. The consequence of TH limb loss and prosthesis use and disuse during gait may be compensation in the upper body, contributing to back pain or injury. Understanding the impact of not wearing a TH prosthesis on upper body asymmetries and spatial-temporal aspects of gait will inform how TH prosthesis use and disuse affects the body. Research question: Does TH limb loss alter upper body asymmetries and spatial-temporal parameters during gait when wearing and not wearing a prosthesis compared to able-bodied controls? Methods: Eight male TH limb loss participants and eight male control participants completed three gait trials at self-selected speeds. The TH limb loss group performed trials with and without their prosthesis. Arm swing, trunk angular displacement, trunk-pelvis moment, and spatial-temporal aspects were compared using non-parametric statistical analyses. Results: Both TH walking conditions showed greater arm swing in the intact limb compared to the residual (p≤0.001), resulting in increased asymmetry compared to the control group (p≤0.001). Without the prosthesis, there was less trunk flexion and lateral flexion compared to the control group (p≤0.001). Maximum moments between the trunk and pelvis were higher in the TH group than the control group (p≤0.05). Spatial-temporal parameters of gait did not differ between the control group and either TH limb loss condition. Significance: Prosthesis use affects upper body kinematics and kinetics, but does not significantly impact spatial-temporal aspects of gait, suggesting these are compensatory actions. Wearing a prosthesis helps achieve more normative upper body kinematics and kinetics than not wearing a prosthesis, which may help limit back pain. These findings emphasize the importance of encouraging at least passive use of prostheses for individuals with TH limb loss.
Sprache	Englisch
Erscheinungsdatum	2024-05-11
Erscheinungsland	England
Dokumenttyp	Journal Article
ZDB-ID	1162323-8
ISSN	1879-2219 ; 0966-6362
ISSN (online)	1879-2219
ISSN	0966-6362
DOI	10.1016/j.gaitpost.2024.05.007
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Verfügbar in ZB MED Köln/Königswinter

Über subito bestellen

Zusatzmaterialien

Kategorien

Verfügbar in ZB MED Köln/Königswinter

Über subito bestellen