Background: Play is the child’s natural world. According to psychoanalytical studies, play has an important role in children’s development, and the absence of play during a child’s life could lead to severe pathological implications. Based on this theory and being aware that physiotherapy treatment programs could be long lasting, tiresome and lacking motivation for children, this literature review presents a perspective regarding the integration of play within physiotherapy programs and examines the physical and emotional outcomes during this integration. Aim: To investigate the outcomes of integrating play in physiotherapy for children with chronic health conditions. Method: The research strategy for this review was a thorough search of peer-reviewed articles in the databases CINAHL and AMED which include articles from the fields of allied and complementary medicine, as well as the database Scope Med. Participants were children with chronic health conditions, ranging from 2-18 years old. In the term ‘play’ virtual reality and video game activities were included due to the lack of research. In addition, articles from a previous literature review conducted by the author were also included in the present paper. Results: The focus of researchers on children with CP and the lack of evidence for children with other health conditions, the persistence of physiotherapists to assess mainly physical outcomes and not emotional needs of children, and the measurement tools used for this purpose are presented. Conclusions: For children with chronic health conditions who attend physiotherapy sessions, play could serve as a mediate and an appropriate developmental approach in order to achieve physical and emotional changes. There is a need for physiotherapists to balance physical and emotional needs, and have a more ‘human’ relationship, rather than a ‘bodily’ - strict professional relationship with children. Although the information presented in this review is not considered as sufficient to draw conclusions, it could serve as a first step for researchers to study this integration in greater depth, and to focus on children with conditions other than CP.

A thesis presented in partial fulfillment of the requirements for the degree of M.Sc. in Physiotherapy at the Stellenbosch University. / Thesis (MSc (Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Background Albeit Virtual Reality (VR) has been shown to be a useful adjunct in the reduction of pain during burn care and therapy, the current VR systems are expensive and may not be economically feasible for developing countries such as South Africa, where health budgets are stringent. Objective The purpose of this study was to ascertain the effect of a lowcost VR system (eMagin Z800 3DVisor), used in conjunction with pharmacologic analgesics, on reducing pain and anxiety in adult burn injury patients undergoing physiotherapy treatment, compared to pharmacologic analgesics alone at a South African hospital. Study design Single-blinded, within-subject study design. Methods Pain and anxiety outcome measures were measured by a blinded assessor using the Numeric Pain Rating Scale and Burn Specific Pain and Anxiety Scale. Descriptive statistics, Chi-square tests as well as the Student’s paired t-test were used to analyze data. Main findings Eleven eligible adult burn injury patients consented to participate in this study (3 female, 8 male; median age 33 years: range 23-54 years). A marginal (p=0.06) to insignificant (p=0.13) difference between the two conditions (analgesics with VR and analgesics alone) in reducing pain was found. No significant difference (p=0.58) was found between the two conditions (analgesics with VR and analgesics alone) for anxiety. Interpretation There is a trend that a low-cost VR system, when added to routine pharmacologic analgesics, is an economically feasible and safe adjunct therapy and could be of considerable benefit if implemented into the current pain management regimen of burn injury patients at a South African Hospital. / AFRIKAANSE OPSOMMING: Agtergrond Ofskoon dit al bewys is dat Virtuele Realiteit (VR) ’n nuttige hulpmiddel is om pyn tydens die versorging en behandeling van brandslagoffers te verlig, is die huidige VR stelsels duur en dalk nie uitvoerbaar in ontwikkelende lande soos Suid-Afrika waar die gesondheidsbegrotings beperk is nie. Doel Om die uitwerking te bepaal van ’n laekoste VR stelsel (eMagin Z800 3DVisor) op die vermindering van pyn en angs by volwasse pasiënte met brandwonde wat fisioterapeutiese behandeling in ’n Suid-Afrikaanse hospitaal ondergaan. Studieplan ’n Enkel-blinde, binnesubjek-ontwerp. Metodes Volwasse proefpersone is opeenvolgend gewerf by die brandeenheid van die Tygerberg-hospitaal. Die laekoste VR stelsel, tesame met pynstillers, is ewekansig aan een helfte van die pasiënte in’n fisioterapeutiese behandelingsessie toegewys en die proefpersone is slegs een keer getoets. Die pyn en angs se resultaatmetings is deur ’n blinde meting gedoen deur die numeriese pynskattingskaal en die brandspesifieke pyn- en angsskaal te gebruik. Beskrywende statistieke, Chi-kwadraat-toetse en studente se gepaarde t-toets is gebruik om die data te analiseer. Bevindings Elf geskikte volwasse pasiënte met brandwonde het ingestem om aan die studie deel te neem, drie was vroulik en agt was manlik (mediaan-ouderdom 33; reeks 23-54). ’n Marginale (p=0.06) tot onbeduidende verskil (p=0.13) is gevind tussen die twee kondisies om pyn te verlig (met of sonder die toediening van VR). Wat angs betref, is geen beduidende verskille (p=0.58) tussen die twee kondisies (met of sonder die toediening van VR) gevind nie. Interpretasie Daar is ’n neiging dat ’n laekoste VR-stelsel, wanneer dit saam met die gewone farmakologiese pynstillers gebruik word, ’n veilige en ekonomiese praktiese adjunk therapie is en beduidend voordelig kan wees wanneer dit geïmplementeer word as deel van die huidige pynbeheerregimen van brandslagofferpasiënte by ’n Suid-Afrikaanse hospitaal.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Home-based rehabilitation (HBR) in under-resourced areas in a primary health care context exposes students to the real life situations of clients. The educational experience of HBR, underpinned by the theory of situated learning, promotes experiential and transformative learning. HBR leads not only to academic learning and personal development, but also to an understanding of social accountability and responsibility. Physiotherapy students and their clients frequently have diverse lingual, socio-economic and cultural backgrounds which may hinder the provision of appropriate treatment to clients in their residences. Increased knowledge of HBR in the physiotherapy context could result in an enhanced experience for both student and client. This study sought to explore the perceptions of physiotherapy students and their clients regarding HBR as part of clinical training in resource-constrained settings. Whether the students felt adequately prepared to perform HBR was also explored. A qualitative research design in the interpretivist paradigm was used. An exploratory case study was performed. Semi-structured interviews were conducted with clients (N=7) living in an under-resourced setting who had received HBR from physiotherapy students. Paired interviews were conducted with final year physiotherapy students (N=6) after their HBR placement. The data were subjected to inductive thematic analysis and themes developed. The findings showed that while clients appreciated the students’ services, there were communication barriers and unmet expectations. Students reported difficulty in adapting to the unfamiliar context, resulting in interventions not being sufficiently client-centred. They voiced a need for language competency to assist in communication. Earlier facilitated exposure to under-resourced contexts in the early clinical phase was suggested to reduce culture shock. An awareness of home environments in under-resourced areas influenced the students’ interventions in other contexts. To gain maximum benefit from the learning opportunities available through HBR, students require support for client management and client-centred problem solving in an under-resourced setting. Guided reflection should form part of the HBR placement to facilitate the construction of new knowledge, to promote deep transformative learning and to increase the students’ awareness of their role as change agents. Exposure to real life situations in under-resourced settings in the form of HBR provides valuable situated and authentic learning opportunities for physiotherapy students. The experience can be useful in preparing graduates to address the needs of the populations they will serve during community service. / AFRIKAANSE OPSOMMING: Tuisgebaseerde rehabilitasie (TBR) in ondervoorsiende gebiede in die primêre gesondheidsorg-konteks stel studente bloot aan die werklike lewensomstandighede van kliënte. Die opvoedkundige ondervinding van TBR, gerugsteun deur die teorie van gesitueerde leer, bevorder ervarings- en transformasionele leer. TBR lei nie net tot akademiese leer en persoonlike ontwikkeling nie, maar bevorder ook insig in maatskaplike verantwoordbaarheid en verantwoordelikheid. Fisioterapie-studente en hul kliënte het dikwels verskillende taal-, sosio-ekonomiese en kulturele agtergronde wat kan verhinder dat die toepaslike behandeling vir kliënte tuis verskaf word. ’n Toename in kennis van TBR in die fisioterapie-konteks kan lei tot ’n beter ondervinding vir beide die student en die kliënt. Die doel van die studie is om die persepsies van die fisioterapie-studente en hul kliënte met betrekking tot TBR, as deel van die kliniese opleiding in omgewings waar daar beperkte hulpbronne is, na te vors. Daar is ook nagegaan of die studente gevoel het dat hulle genoegsaam voorberei is om die TBR toe te pas. ’n Kwalitatiewe navorsingsontwerp in die interpreterende paradigma is gebruik. ’n Verkennende gevalle-studie is gedoen. Semi-gestruktureerde onderhoude is met die kliënte (N=7) wat in ondervoorsiende omstandighede leef en wat TBR van fisioterapie-studente ontvang het, gevoer. Onderhoude is in pare met fisioterapiestudente in hul finale jaar (N=6) gevoer nadat hulle hul TBR-plasing voltooi het. ’n Induktiewe tematiese analise van die data is gedoen en temas is ontwikkel. Die resultate het getoon dat, alhoewel die kliënte waardering gehad het vir die dienste wat deur die studente gelewer is, daar kommunikasiegapings en onvervulde verwagtinge was. Die studente het gerapporteer dat hulle gesukkel het om aan te pas by die onbekende omgewing met die gevolg dat die intervensies nie genoegsaam kliëntgerig was nie. Hulle het ook aangedui dat daar ’n behoefte is om die nodige taalvaardigheid te ontwikkel om kommunikasie te verbeter. Die kultuurskok wat beleef is, kan moontlik in die vroeë kliniese fase reeds gefasiliteer word deur die studente aan ondervoorsiende kontekste bloot te stel. Die kennis van die tuisomgewings in ondervoorsiende areas het ’n invloed gehad op die studente se intervensies in ander kontekste. Studente benodig ondersteuning in kliëntebestuur en kliëntgesentreerde probleemoplossing in ondervoorsiende omgewings ten einde maksimum voordeel te verkry uit leergeleenthede wat beskikbaar is deur TBR. Begeleide refleksie behoort deel te vorm van die TBR-plasing om die opbou van nuwe kennis te fasilliteer, diepgaande transformatiewe leer te bevorder en die student se bewustheid van hul rol om verandering teweeg te bring, op te skerp. TBR voorsien nie net waardevolle, outentieke leergeleenthede ter plaatse nie, maar gee ook die fisioterapie-studente blootstelling aan die werklike situasies waarin mense hulle in ondervoorsiende omgewings bevind. Hierdie ondervinding kan waardevol wees om graduandi voor te berei om die behoeftes aan te spreek van die bevolkingsgroepe wat hulle tydens hul gemeenskapsdiensjaar sal bedien.

Bibliography / Thesis (PhD ( Interdisciplinary Health))--University of Stellenbosch, 2010. / Bibliography / ENGLISH ABSTRACT: Introduction: It is increasingly being recognized that how intensive care services are delivered may have a greater impact on patient outcome than the individual therapies. Uncertainty regarding the optimal physiotherapy service provision model in a surgical intensive care unit (ICU) exists. Methodology: The aims of this study were to 1) develop an evidence-based physiotherapy protocol; 2) validate the content of the protocol; and 3) conduct an explorative intervention trial to compare usual care to the estimated effects of providing a physiotherapy service guided by an evidence-based physiotherapy protocol by a dedicated physiotherapist. A systematic review process was used to synthesize the evidence in eight subject areas. The GRADE system was used to formulate best practice recommendations and algorithm statements. Forty-two experts from a variety of disciplines were invited to participate in a Delphi process. Finally, the evidence-based physiotherapy protocol was implemented in a surgical ICU over four three-week intervention periods by a group of research therapists. The outcomes measured included ventilator time, ventilation proportions, failed extubation proportions, length of ICU and hospital stay, mortality, functional capacity, functional ability and cost (using nursing workload as proxy). Results: Fifty-three research reports in eight subject areas were identified, 23 draft best-practice recommendations and 198 algorithm statements were formulated. The draft protocol consisted of five clinical management algorithms. Fifteen international research experts and twelve national academics in the field of critical care agreed to participate in the Delphi process. Consensus was reached on the formulation of 87% (20/23) recommendations and the rating of 66% (130/198) statements. The risk of an adverse event during the protocol care intervention period was 6:1000 treatment sessions (p=0.34). Patients admitted to the unit during the protocol care intervention period were less likely to be intubated (RR 0.16 95%CI 0.07 – 0.71; RRR 0.84 NNT 5.02; p=0.005) or fail extubation (RR 0.23 95%CI 0.05 – 0.98; RRR =0.77 NNT 6.95; p=0.04). The mean difference in the daily unit TISS-28 score between the two condition periods was 1.99 95%CI 0.65 – 3.35 (p=0.04). Patients managed by the protocol tended to remain in the hospital for a shorter time after unit discharge (p=0.05). There was no difference in the time spent on the ventilator (p=0.50), mortality (p=0.52) or in the six minute walk distance (p=0.65). In addition there was no difference in the proportion of patients who reached independence in any of the Barthel Index activities measured within 48 hours of discharge from the unit. Conclusions: The use of an evidence-based physiotherapy protocol for the comprehensive physiotherapeutic management of patients in a surgical ICU was feasible and safe. The preliminary results of this study suggest that a physiotherapy service, which is guided by an evidence-based protocol and offered by a dedicated unit therapist, has the potential to lower the cost of ICU care and facilitate the functional recovery of patients after unit discharge. This information can now be considered by administrators to optimize the physiotherapy service provided in ICU. / AFRIKAANSE OPSOMMING: Inleiding: Daar word toenemend erken dat die wyse waarop dienste gelewer word, ‘n groter impak mag hê op die uitkoms van pasiënte as die spesifieke modaliteite in gebruik. Onsekerheid heers tans oor die optimale fisioterapie diens model om te volg in ‘n chirurgiese intensiewe sorg eenheid (ISE). Metodologie: The doel van hierdie projek was om 1) ‘n bewysgesteunde protokol te ontwikkel; 2) die geldigheid van die protokol te bevestig; en 3) om deur middel van ‘n eksploratiewe studie die uitkoms van pasiënte te vergelyk wanneer die fisioterapie diens gelewer word aan die hand van die bewysgesteunde protokol deur ‘n toegewyde fisioterapeut, teenoor wanneer die gewone fisioterapie diens gelewer word. Die empiriese bewyse in agt onderwerp areas is gesintetiseer na afloop van ‘n sistematiese literatuur oorsig proses. Die GRADE sisteem is gebruik om beste praktyk aanbevelings en algoritme stellings te formuleer. Twee en veertig kundige persone van verskeie disiplines is genooi om deel te neem aan die Delphi proses om die geldigheid van die protokol te bevestig. Uiteindelik is die geldige bewysgesteunde protokol oor ‘n tydperk van vier drie weke intervensie periodes deur ‘n groep navorsings terapeute in ‘n chirurgiese ISE geïmplementeer. Die tyd wat pasiënte geventileer is, die proporsie pasiënte wat geïntubeer en geherintubeer is in die tydperk, die lengte van ISE en hospitaal verblyf, mortaliteit, funksionele kapasiteit asook funksionele vaardigheid en koste (deur die verpleeg werkslading te gebruik as ‘n indikasie van koste) is gemeet. Resultate: Drie en vyftig navorsings verslae in agt onderwerp areas is geïdentifiseer, 23 konsep aanbevelings en 198 algoritme stellings is geformuleer. Die konsep protokol het uit vyf algoritmes bestaan. Vyftien internasionale en twaalf nasionale kundiges het die uitnodiging aanvaar om aan die delphi proses deel te neem. Konsensus is bereik vir die formulering van 87% (20/23) van die aanbevelings en die gradering van 66% (130/198) van die algoritme stellings. Die risiko vir ‘n ongunstige episode tydens die protokol intervensie periode was 6:1000 sessies (p=0.34). Pasiënte wat tydens die protokol intervensie periode tot die eenheid toegelaat is was minder geneig om geïntubeer te word (RR 0.16 95%CI 0.07 – 0.71; RRR 0.84 NNT 5.02; p=0.005) of om ‘n ekstubasie te faal (RR 0.23 95%CI 0.05 – 0.98; RRR =0.77 NNT 6.95; p=0.04). Die gemiddelde verskil in die daaglikse eenheid TISS-28 telling tussen die twee intervensie periodes was 1.99 95%CI 0.65 – 3.35 (p=0.04). Patiente wat tydens die protokol intervensie periode behandel is was geneig om vinniger uit die hospitaal ontslaan te word nadat hul uit die eenheid ontslaan is (p=0.05). Daar was geen verskil in die ventilasie tyd, (p=0.50) die mortaliteit (p=0.52) of die afstand wat pasiente in ses minute kon aflê binne 48 uur na ontslag uit die eenheid (p=0.65) nie. Daar was ook geen verskil in die proporsie pasiente wat onafhanklikheid bereik het in enige van die kategorieë van die Barthell Index instrument nie. Gevolgtrekking: Die gebruik van die protokol vir die omvattende hantering van pasiënte in ‘n chirurgiese eenheid is haalbaar en veilig. Die voorlopige resultate van hierdie studie dui daarop dat wanneer ‘n fisioterapie diens in ‘n chirurgiese ISE gelewer word aan die hand van ‘n bewysgesteunde protokol deur ‘n toegewyde fisioterapeut dit die potensiaal het om ISE koste te verminder en die funksionele herstel van pasiente na ontslag uit die eenheid te fasiliteer. Hierdie inligting kan nou deur administrateurs oorweeg word om ‘n optimale fisioterapie diens in ‘n chirurgiese ISE te verseker.

Tyrimo objektas — vaikų pusiausvyra, raumenų jėga ir ištvermė. Hipotezė: manome, kad vaikų, turinčių autizmo sutrikimą pusiausvyra, raumenų jėga bei ištvermė turėtų būti prastenė nei sveikų vaikų, o 4 savaičių kryptingos kineziterapijos pratybos turėtų reikšmingai pagerinti visus vertintus rodiklius. Tyrimo tikslas — nustatyti kineziterapijos poveikį 7-11 metų vaikų, sergančių autizmu, pusiausvyrai, raumenų jėgai ir raumenų ištvermei. Tyrimo uždaviniai: 1.Nustatyti ir palyginti vaikų, turinčių autizmo sutrikimą ir sveikų vaikų pusiausvyros, raumenų jėgos ir ištvermės rodiklius. 2.Įvertinti 4 savaičių kineziterapijos poveikį vaikų, turinčių autizmo sutrikimą, pusiausvyros, raumenų jėgos ir ištvermės rodikliams. 3.Palyginti vaikų, turinčių autizmo sutrikimą, pusiausvyros, raumenų jėgos ir ištvermės rodiklius, gautus po 4 savaičių intervencijos su sveikų vaikų rodikliais. Rezultatai: Tyrimo rezultatai parodė, kad po kineziterapijos taikymo vaikams, turintiems autizmo sutrikimą pagal modifikuotą Berg skalę, pusiausvyra padidėjo 6 balais. Plaštakos raumenų jėga po kineziterapijos vaikams padidėjo dešinėje rankoje 2 kg, kairėje rankoje 2,2 kg. Šuolio į tolį iš vietos testo rezultatai padidėjo 36,2 cm. Sėstis ir gultis testo rezultatai per 30 sekundžių padidėjo 4,5 karto. Po kineziterapinės intervencijos pritūpimai iki 90° kampo per 30 sekundžių padidėjo 5,7 karto. Lyginant rodiklius prieš kineziterapiją ir po jos, pusiausvyros, raumenų jėgos ir ištvermės rodikliai reikšmingai... [toliau žr. visą tekstą] / Object of the study — children balance, muscle strength and endurance. Hypothesis: We believe that the muscle strength, endurance and balance of children with autism disorder should be worse than the normal healthy children, and that a 4 weeks of targeted physical therapy exercises should significantly improve all evaluated indicators. The aim: determine the effects of physical therapy for children from 7 to 11 years old with the autism of balance, muscular strength and endurance. Goals of the study: 1. To identify and compare balance, muscle strength and endurance characteristics of children with autism disorder and healthy children. 2. To evaluate the effects of 4 weeks physical therapy for the children with autistic disorder of their balance, muscle strength and endurance characteristics. 3. To compare balance, muscle strength and endurance characteristics of children with autistic disorder, after 4 weeks of intervention, with the characteristics of healthy children. Results: The results showed that after physical therapy children with autistic spectrum disorder in accordance with the modified Berg score balance improved by 6 points. Hand muscle strength after physical therapy for children has improved to 2 kg in the right hand and 2.2 kg in the left hand. Standing long jump improved by 36.2 cm. Sit and lie down test results for 30 seconds improved 4.5 times. After physical therapy intervention, the 90° squats for 30 seconds improved 5.7 times. In comparison with the... [to full text]

Tyrimo objektas — vaikų pusiausvyra, raumenų jėga ir ištvermė. Hipotezė: manome, kad vaikų, turinčių autizmo sutrikimą pusiausvyra, raumenų jėga bei ištvermė turėtų būti prastenė nei sveikų vaikų, o 4 savaičių kryptingos kineziterapijos pratybos turėtų reikšmingai pagerinti visus vertintus rodiklius. Tyrimo tikslas — nustatyti kineziterapijos poveikį 7-11 metų vaikų, sergančių autizmu, pusiausvyrai, raumenų jėgai ir raumenų ištvermei. Tyrimo uždaviniai: 1.Nustatyti ir palyginti vaikų, turinčių autizmo sutrikimą ir sveikų vaikų pusiausvyros, raumenų jėgos ir ištvermės rodiklius. 2.Įvertinti 4 savaičių kineziterapijos poveikį vaikų, turinčių autizmo sutrikimą, pusiausvyros, raumenų jėgos ir ištvermės rodikliams. 3.Palyginti vaikų, turinčių autizmo sutrikimą, pusiausvyros, raumenų jėgos ir ištvermės rodiklius, gautus po 4 savaičių intervencijos su sveikų vaikų rodikliais. Rezultatai: Tyrimo rezultatai parodė, kad po kineziterapijos taikymo vaikams, turintiems autizmo sutrikimą pagal modifikuotą Berg skalę, pusiausvyra padidėjo 6 balais. Plaštakos raumenų jėga po kineziterapijos vaikams padidėjo dešinėje rankoje 2 kg, kairėje rankoje 2,2 kg. Šuolio į tolį iš vietos testo rezultatai padidėjo 36,2 cm. Sėstis ir gultis testo rezultatai per 30 sekundžių padidėjo 4,5 karto. Po kineziterapinės intervencijos pritūpimai iki 90° kampo per 30 sekundžių padidėjo 5,7 karto. Lyginant rodiklius prieš kineziterapiją ir po jos, pusiausvyros, raumenų jėgos ir ištvermės rodikliai reikšmingai... [toliau žr. visą tekstą] / Object of the study — children balance, muscle strength and endurance. Hypothesis: We believe that the muscle strength, endurance and balance of children with autism disorder should be worse than the normal healthy children, and that a 4 weeks of targeted physical therapy exercises should significantly improve all evaluated indicators. The aim: determine the effects of physical therapy for children from 7 to 11 years old with the autism of balance, muscular strength and endurance. Goals of the study: 1. To identify and compare balance, muscle strength and endurance characteristics of children with autism disorder and healthy children. 2. To evaluate the effects of 4 weeks physical therapy for the children with autistic disorder of their balance, muscle strength and endurance characteristics. 3. To compare balance, muscle strength and endurance characteristics of children with autistic disorder, after 4 weeks of intervention, with the characteristics of healthy children. Results: The results showed that after physical therapy children with autistic spectrum disorder in accordance with the modified Berg score balance improved by 6 points. Hand muscle strength after physical therapy for children has improved to 2 kg in the right hand and 2.2 kg in the left hand. Standing long jump improved by 36.2 cm. Sit and lie down test results for 30 seconds improved 4.5 times. After physical therapy intervention, the 90° squats for 30 seconds improved 5.7 times. In comparison with the... [to full text]

Tyrimo objektas — vaikų pusiausvyra, raumenų jėga ir ištvermė. Hipotezė: manome, kad vaikų, turinčių autizmo sutrikimą pusiausvyra, raumenų jėga bei ištvermė turėtų būti prastenė nei sveikų vaikų, o 4 savaičių kryptingos kineziterapijos pratybos turėtų reikšmingai pagerinti visus vertintus rodiklius. Tyrimo tikslas — nustatyti kineziterapijos poveikį 7-11 metų vaikų, sergančių autizmu, pusiausvyrai, raumenų jėgai ir raumenų ištvermei. Tyrimo uždaviniai: 1.Nustatyti ir palyginti vaikų, turinčių autizmo sutrikimą ir sveikų vaikų pusiausvyros, raumenų jėgos ir ištvermės rodiklius. 2.Įvertinti 4 savaičių kineziterapijos poveikį vaikų, turinčių autizmo sutrikimą, pusiausvyros, raumenų jėgos ir ištvermės rodikliams. 3.Palyginti vaikų, turinčių autizmo sutrikimą, pusiausvyros, raumenų jėgos ir ištvermės rodiklius, gautus po 4 savaičių intervencijos su sveikų vaikų rodikliais. Rezultatai: Tyrimo rezultatai parodė, kad po kineziterapijos taikymo vaikams, turintiems autizmo sutrikimą pagal modifikuotą Berg skalę, pusiausvyra padidėjo 6 balais. Plaštakos raumenų jėga po kineziterapijos vaikams padidėjo dešinėje rankoje 2 kg, kairėje rankoje 2,2 kg. Šuolio į tolį iš vietos testo rezultatai padidėjo 36,2 cm. Sėstis ir gultis testo rezultatai per 30 sekundžių padidėjo 4,5 karto. Po kineziterapinės intervencijos pritūpimai iki 90° kampo per 30 sekundžių padidėjo 5,7 karto. Lyginant rodiklius prieš kineziterapiją ir po jos, pusiausvyros, raumenų jėgos ir ištvermės rodikliai reikšmingai... [toliau žr. visą tekstą] / Object of the study — children balance, muscle strength and endurance. Hypothesis: We believe that the muscle strength, endurance and balance of children with autism disorder should be worse than the normal healthy children, and that a 4 weeks of targeted physical therapy exercises should significantly improve all evaluated indicators. The aim: determine the effects of physical therapy for children from 7 to 11 years old with the autism of balance, muscular strength and endurance. Goals of the study: 1. To identify and compare balance, muscle strength and endurance characteristics of children with autism disorder and healthy children. 2. To evaluate the effects of 4 weeks physical therapy for the children with autistic disorder of their balance, muscle strength and endurance characteristics. 3. To compare balance, muscle strength and endurance characteristics of children with autistic disorder, after 4 weeks of intervention, with the characteristics of healthy children. Results: The results showed that after physical therapy children with autistic spectrum disorder in accordance with the modified Berg score balance improved by 6 points. Hand muscle strength after physical therapy for children has improved to 2 kg in the right hand and 2.2 kg in the left hand. Standing long jump improved by 36.2 cm. Sit and lie down test results for 30 seconds improved 4.5 times. After physical therapy intervention, the 90° squats for 30 seconds improved 5.7 times. In comparison with the... [to full text]

La profession de masseur-kinésithérapeute est située à un tournant de son histoire. Les réformes en cours conduisent à questionner les savoirs enseignés et les compétences des masseurs-kinésithérapeutes pour garantir la sécurité du patient et la qualité des soins. Il a été cherché à connaître l'origine des savoirs en masso-kinésithérapie et à évaluer les dispositifs d'enseignements et d'appropriation de ces savoirs par les étudiants et par les professionnels de santé. Les résultats des études montrent que les écarts aux compétences attendues sont liés aux modalités d'enseignement et d'évaluation utilisées par les formateurs en formation initiale et en formation continue. Il apparait que les modalités pédagogiques utilisées par les formateurs sont souvent basées sur un socle théorique behavioriste, un modèle d'évaluation contrôle et des pratiques dogmatiques qui empêchent l'accès à la pensée et à la pratique « complexe » du soin. La formation n'optimise pas le développement des compétences de réflexivité, d'esprit critique et d'innovation nécessaires à la relation humaine de soin et à la sécurité idéale du patient. Cette thèse montre l'intérêt majeur de réaliser les enseignements en masso-kinésithérapie par des enseignants-chercheurs qui pensent, écrivent, discourent, agissent différemment des formateurs en formation initiale et en formation continue. Il est donc indispensable pour la sécurité du patient et pour la qualité des soins que la formation initiale et la formation continue en masso-kinésithérapie soient réalisées dans le cadre d'une discipline en masso-kinésithérapie sous la responsabilité d'enseignants-chercheurs en masso-kinésithérapie. / The profession of physiotherapist is located at a crossroads. Ongoing reforms lead to questioning the knowledge and skills taught physiotherapists to ensure patient safety and quality of care. It was sought to know the origin of knowledge in physiotherapy devices and evaluate teaching and ownership of such knowledge by students and health professionals. The study results show that the differences are expected to skills related to teaching methods and assessment used by teachers in initial training and continuing education. It appears that the teaching methods used by teachers are often based on a theoretical foundation behaviorist model evaluation and control practices that prevent access dogmatic thinking and practice "complex" care. Training of physiotherapists does not optimize the skills development of reflexivity, critical thinking and innovation needed in the human relationship of care and patient safety ideal. This thesis shows the major interest to carry out physiotherapy lessons by teachers and researchers who think, write, discoursing, act differently trainers in initial training and continuing education. It is therefore essential for patient safety and quality of care that initial training and continuing education in physiotherapy are carried out within the framework of a discipline physiotherapy under the responsibility of teachers researchers in physiotherapy.

A partir de la conception d'un simulateur dans le domaine de la kinésithérapie respiratoire, il a été cherché à connaître les conditions pour que la réingénierie de la formation des masseurs-kinésithérapeutes favorise un développement professionnel de qualité, conformément à la loi n° 2002-303 du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé. La recherche documentaire a permis d'inscrire les travaux dans le champ de l'anthropologie du développement des adultes. Puis, une analyse de pratique professionnelle de cinq experts kinésithérapeutes a été effectuée pour identifier les savoirs mobilisés au cours de leurs pratiques et les didactiser. Enfin, une étude auprès de cent cinquante-sept masseur-kinésithérapeutes a repéré la représentation de la notion de qualité en santé de ceux-ci. Les résultats font apparaître les schèmes qui structurent l'action des experts et l'importance du raisonnement clinique pour passer d'une compétence d'exécution à une compétence d'adaptation indispensable à la qualité des soins et à la sécurité du patient. Il est montré que les représentations des masseurs-kinésithérapeutes en matière de qualité en santé pourraient faciliter ce changement de compétence. Les résultats de la thèse montrent que, pour développer les compétences nécessaires d'adaptation des professionnels, la production des savoirs en masso-kinésithérapie, la didactisation et l'enseignement de ceux-ci doivent être réalisés par des enseignants-chercheurs. Les travaux de recherche en masso-kinésithérapie doivent se dérouler au sein de laboratoires dédiés, dans le cadre d'une discipline universitaire en masso-kinésithérapie. / From the conception of a simulator in the infant respiratory physiotherapy domain, we searched the ideal conditions to bring the re-ingeneering training of physiotherapists to support a good professional development, in accordance with the law 2002-303 of march 4th, 2002, concerning the patients' rights and the quality of the health system. The documentary research permitted to identify the work as the adults development anthropology sector.A professional practical analysis of five physiotherapist experts was then realized in order to identify the knowledge that was used during the practice and to didactise it. Finally, their representation of the health quality notion was noticed in a survey realized with a hundred and fifty seven physiotherapists. The study results show the schemes that build the experts' actions and the importance of the clinical reasoning to move from an accomplishment skill to an adjustment skill necessary for the aid's quality and the patients' security. It was showed that the physiotherapists' representations concerning the health quality could make the change easier. The thesis results show that in order to develop the necessary adaptation skills of the professionals, the production of knowledge in physiotherapy, the didactisation and the teaching of these must be realized by researchers' instructors. The research in physiotherapy must occur in dedicated laboratories, in a university discipline context in physiotherapy

O objetivo deste trabalho é tornar possível a inserção de um robô humanoide para auxiliar pacientes em sessões de fisioterapia. Um sistema robótico é proposto que utiliza um robô humanoide, denominado NAO, visando analisar os movimentos feitos pelos pacientes e corrigi-los se necessário, além de motivá-los durante uma sessão de fisioterapia. O sistema desenvolvido permite que o robô, em primeiro lugar, aprenda um exercício correto de fisioterapia observando sua execução por um fisioterapeuta; em segundo lugar, que ele demonstre o exercício para que um paciente possa imitá-lo; e, finalmente, corrija erros cometidos pelo paciente durante a execução do exercício. O exercício correto é capturado por um sensor Kinect e dividido em uma sequência de estados em dimensão espaço-temporal usando k-means clustering. Estes estados então formam uma máquina de estados finitos para verificar se os movimentos do paciente estão corretos. A transição de um estado para o próximo corresponde a movimentos parciais que compõem o movimento aprendido, e acontece somente quando o robô observa o mesmo movimento parcial executado corretamente pelo paciente; caso contrário o robô sugere uma correção e pede que o paciente tente novamente. O sistema foi testado com vários pacientes em tratamento fisioterapêutico para problemas motores. Os resultados obtidos, em termos de precisão e recuperação para cada movimento, mostraram-se muito promissores. Além disso, o estado emocional dos pacientes foi também avaliado por meio de um questionário aplicado antes e depois do tratamento e durante o tratamento com um software de reconhecimento facial de emoções e os resultados indicam um impacto emocional bastante positivo e que pode vir a auxiliar pacientes durante tratamento fisioterapêuticos. / This dissertation develops a robotic system to guide patients through physiotherapy sessions. The proposed system uses the humanoid robot NAO, and it analyses patients movements to guide, correct, and motivate them during a session. Firstly, the system learns a correct physiotherapy exercise by observing a physiotherapist perform it; secondly, it demonstrates the exercise so that the patient can reproduce it; and finally, it corrects any mistakes that the patient might make during the exercise. The correct exercise is captured via Kinect sensor and divided into a sequence of states in spatial-temporal dimension using k-means clustering. Those states compose a finite state machine that is used to verify whether the patients movements are correct. The transition from one state to the next corresponds to partial movements that compose the learned exercise. If the patient executes the partial movement incorrectly, the system suggests a correction and returns to the same state, asking that the patient try again. The system was tested with multiple patients undergoing physiotherapeutic treatment for motor impairments. Based on the results obtained, the system achieved high precision and recall across all partial movements. The emotional impact of treatment on patients was also measured, via before and after questionnaires and via a software that recognizes emotions from video taken during treatment, showing a positive impact that could help motivate physiotherapy patients, improving their motivation and recovery.