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Orientador: Cesar Renato Foschini / Resumo: Desenvolvimento de uma ortese personalizada para subluxação de ombro por manufatura aditiva a partir de escaneamento corporal. A órtese é um dispositivo aplicado à superfície externa do corpo para: controlar o alinhamento biomecânico, corrigir ou acomodar a deformidade, proteger e suportar uma lesão, auxiliar na reabilitação, reduzir a dor, aumentar a mobilidade e a independência. Nos últimos anos, o desenvolvimento de órteses usando manufatura aditiva tem se incrementado tanto para membros superiores como inferiores devido a sua capacidade de reposicionar o membro de maneira mais precisa e personalizada. Este trabalho teve como objetivo desenvolver uma metodologia para projetar e fabricar uma órtese de subluxação de ombro utilizando escaneamento corporal e manufatura aditiva. O usuário foi submetido ao escaneamento 3D para obtenção do modelo digital sólido em formato 3D, operações elementares espaciais foram aplicadas ao modelo escaneado do usuário para a obtenção da órtese a fim de gerar uma silhueta tridimensional adequada ao ombro/tórax do paciente. Finalmente, a silhueta foi evoluída a órtese pela agregação de espessura, furos e contornos. Uma vez obtida a órtese, foi impressa, ajustada e testada no paciente. Uma primeira versão foi proposta em função do relato do paciente quanto à adaptação do ombro e conforto, e outras duas versões evolutivas foram desenvolvidas e avançaram para outros aspectos importantes como a redução de peso, graus de liberdade nos ombros saudávei... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Development of a custom shoulder orthosis by additive manufacturing from body from body scan. Orthotics is a device applied to the external surface of the body to control biomechanical alignment, correct or accommodate the deformity, protect and support an injury, assist in rehabilitation, reduce pain, increase mobility and independence. In recent years, the development of orthosis using additive manufacturing has been increasing for both upper and lower limbs because of their ability to more accurately and custom reposition the limb. This work aimed to develop a methodology to design and manufacture a shoulder subluxation orthosis using body scanning and additive manufacturing. The user underwent 3D scanning to obtain the solid digital model in 3D format, spatial elemental operations were applied to the user's scanned model to obtain the orthosis to generate a three-dimensional silhouette suitable for the patient's shoulder / chest. Finally, the silhouette was evolved into orthosis by aggregating thickness, holes, and contours. Once the orthosis was obtained, it was printed, adjusted and tested on the patient. A first version was proposed based on the patient's report on shoulder adaptation and comfort, and two other evolutionary versions were developed and advanced to other important aspects such as weight reduction, degrees of freedom in healthy shoulders and comfort gain. In each of the three prototypes, an evaluation questionnaire was applied to the user to improve diffe... (Complete abstract click electronic access below) / Mestre

Upper extremity splinting is a popular treatment method for a range of conditions, such as rheumatoid arthritis. The intent of this treatment approach is multifaceted, but fundamentally, the provision of tools to enable and encourage patients to carry out everyday activities and to improve their quality of life is paramount. However, the aesthetic and functional limitations of wrist immobilisation splints demonstrate various weaknesses in terms of wear duration and frequency. Patient compliance is often compromised due to a number of factors, including the perceived stigma associated with assistive devices. Additive Manufacturing (AM) has proved its worth in a number of applications relating to the design of assistive devices; builds of complex, bespoke fitting geometries make AM an ideal fabrication method for upper extremity splints. However, recent advances in system technology to enable multi-material builds have been limited in this field, and a distinct need for a specialised three-dimensional (3D) Computer Aided Design (CAD) software approach is required to allow therapists to design splints for AM. Furthermore, the intent to keep practising therapists at the forefront of splint prescription is of utmost importance. This research proposes a digitised splinting approach, specifically through development of a 3D CAD software strategy to allow therapists to capture their design intent without compromising creativity. Furthermore, the approach proposes the exploration of AM build capabilities by allowing the integration of more creative features, such as aesthetically pleasing lattice structures for increased skin ventilation. The approach also proposes the integration of multiple materials to replicate and improve upon current splint design and fabrication practises. The approach therefore explores an exciting new paradigm for upper extremity splinting, the driving characteristics of which have not been proposed before as a collective medium. This research describes the feasibility of capturing therapists design intent in a 3D CAD virtual environment, whilst capturing therapists opinions of the approach with suggestions for future research and development. Results concluded that therapists were excited by the proposed transition in AM splinting, but that significant development is required elsewhere to establish a supporting infrastructure in order to make the approach a viable option in future upper extremity splinting.

Le nombre croissant de personnes âgées dans le monde exige de relever de nouveaux défis sociétaux, notamment en termes de services d'aide et de soins de santé. Avec les récents progrès technologiques, la robotique apparaît comme une solution prometteuse pour développer des systèmes visant à faciliter et améliorer les conditions de vie de cette population. Cette thèse vise la proposition et la validation d'une approche de commande robuste et référencée intention d'une orthèse active, destinée à assister des mouvements de flexion/extension du genou pour des personnes souffrant de pathologies de cette articulation. La commande par modes glissants d'ordre 2 que nous proposons permet de prendre en compte les non-linéarités ainsi que les incertitudes paramétriques résultant de la dynamique du système équivalent orthèse-membre inférieur. Elle permet également de garantir d'une part, un bon suivi de la trajectoire désirée imposée par le thérapeute ou par le sujet lui-même, et d'autre part, une bonne robustesse vis-à-vis des perturbations externes pouvant se produire lors des mouvements de flexion/extension. Dans cette thèse, nous proposons également un modèle neuronal de type Perceptron Multi-Couches pour l'estimation de l'intention du sujet à partir de la mesure des signaux EMG caractérisant les activités musculaires volontaires du groupe musculaire quadriceps. Cette approche permet de s'affranchir d'un modèle d'activation et de contraction musculaire complexe. L'ensemble des travaux a été validé expérimentalement avec la participation volontaire de plusieurs sujets valides / The increasing number of elderly in the world reveals today new societal challenges, particularly in terms of healthcare and assistance services. With recent advances in technology, robotics appears as a promising solution to develop systems that improve the living conditions of this aging population. This thesis aims at proposing and validating an approach for robust control of an active orthosis, based on the subject intention. This orthosis is designed to assist flexion/ extension movements of the knee for people suffering from knee joint deficiencies. The proposed second order sliding mode control allows to take into account the nonlinearities and parametric uncertainties resulting from the dynamics of the equivalent lower limb-orthosis system. It also ensures on one hand, a good tracking performance of the desired trajectory imposed by the therapist or the subject itself, and on the second hand, a satisfactory robustness with respect to external disturbances that may occur during flexion and extension of the knee joint. In this thesis, a neural model based on Multi-Layer Perceptron is used to estimate the subject's intention from the measurement of the EMG signals characterizing the voluntary activities of the quadriceps muscle group. This approach overcomes the complex modeling of the muscular activation and contraction dynamics. All the proposed approaches in this thesis have been validated experimentally with the voluntary participation of several healthy subjects

Bakgrund: I dagsläget finns det brist på studier som innefattar hur vårdnadshavare upplever barnens korsettbehandling. Behandlingen är effektiv men barnens psykiska- och fysiska hälsa påverkas negativt. Vårdnadshavare har en essentiell roll i korsettbehandlingen, därför är det betydelsefullt att identifiera de problem som upplevs av dem.   Syfte och frågeställningar: Syftet med studien är att redogöra för barnens upplevelse av korsettbehandlingen, ur vårdnadshavarnas perspektiv. Genom att identifiera det som anses vara mest problematiskt och vilka aspekter som kan åtgärdas kan upplevelsen av korsettbehandlingen förbättras.   Metod: En kvalitativ innehållsanalys i form av semistrukturerade intervjuer utgjorde studien. Fem vårdnadshavare intervjuades i Jönköping. Inklusionskriterierna innefattade vårdnadshavare till barn som behandlats med korsett samt som inte har några funktions- eller kognitiva nedsättningar.   Resultat: Ur analysen identifierades fyra olika huvudteman: destruktiva faktorer, konstruktiva faktorer samt information och tillgänglighet. Vårdnadshavarna uttryckte att korsettens design var den mest problematiska faktorn som påverkade barnets upplevelse av behandlingen.               Slutsats: Samtliga vårdnadshavare upplevde korsettbehandlingen olika. Det genomgående temat för samtliga var destruktiva faktorer som påverkat upplevelsen. Identifiering av problematiken kan förbättra upplevelsen av korsettbehandlingen. / Background: There is a lack of studies that include how parents experience their children's brace treatment. The treatment is effective but contributes to negative impact on children's mental and physical health. Parents have an essential role in the brace treatment, therefore it is important to explore their experience.  Purpose: The purpose of the study is to evaluate the children's experience of the brace treatment, from the parent’s perspective. By addressing what is considered most problematic and what aspects that can be changed, it may improve the experience of the brace treatment.    Method: A qualitative analysis based on semi-structured interviews composed the study. Five parents were interviewed in Jönköping. The inclusion criteria included parents of children treated with brace who had no functional or cognitive impairments.   Results: Four main themes appeared from the analysis: destructive factors, constructive factors, information and accessibility. The design of the brace was expressed as the most problematic factor that affected children's experience of the treatment according to the parents.   Conclusion: All parents experienced the brace treatment differently. The main topic was destructive factors that affected their experience. Future studies should identify problems associated with the treatment so the experience can be improved.

Les orthèses cognitives peuvent améliorer l'autonomie des traumatisés craniocérébraux (TCC) sévères, tout en intégrant en continu le processus de réadaptation cognitive aux AIVQ au sein de leur domicile. Dans une démarche de conception participative interdisciplinaire, nos travaux ont permis de passer de la pratique des ergothérapeutes à la spécification formelle de plans d'intervention et à l'implémentation de cette pratique dans des orthèses cognitives. Dans cette thèse, une approche reposant sur les personae illustre d'abord les dysfonctionnements chez les TCC, leurs besoins d'assistance, ainsi que les besoins de leurs aidants. Ensuite, deux modèles sont élaborés. Le premier « Gestion dynamique de la réadaptation cognitive » s'intéresse en particulier au choix, à l'adaptation et à l'application d'interventions cognitives fondées sur les données probantes. Le second modèle « Assistance préventive » permet, en situation de danger potentiel, d'assister un TCC de manière progressive et adaptée pour écarter ce danger. Ces modèles sont utilisés de deux manières. D'une part, leur implémentation sous forme d'ontologie OWL illustre comment l'assistance peut être rendue sensible au contexte, dynamique et personnalisée. D'autre part, ils guident la conception et l'implémentation de COOK, une orthèse cognitive pour la préparation de repas, et d'un système de sécurité autonome (SSA) dédié à la prévention et à la sécurité des TCC lors de la préparation de repas. Finalement, une architecture logicielle pour la construction d'orthèses cognitives et dérivée.COOK et SSA ont été déployés au sein d'une résidence pour TCC. Trois résidents peuvent maintenant cuisiner de manière autonome. / Severe traumatic Brain Injury (TBI) is considered a public health problem. ; Indeed, severe TBI causes significant cognitive, emotional and behavioral repercussions that impact the lives of these individuals, particularly their independence in Instrumental Activities of Daily Living (IADLs). Individuals who have experienced severe TBI frequently return to live in their homes despite the severe difficulties associated with their condition, though the need for assistance to perform IADLs frequently persists. The objective of this thesis is to design, represent, formalize and implement a context-aware and adaptive structure of cognitive assistance. This assistance is created according to the general needs of individuals with severe TBI for IADL performance. The proposed assistance will promote their independence to perform IADL in a home environment. The design of this cognitive assistance technology involves an interdisciplinary collaboration between occupational therapy and computer science, to evolve from the assistance provided by the clinicians to a formal computer science formulation and implementation. This design is based on a participative design approach that mainly involves TBI residents of a smart alternative housing unit.A prototype of a cognitive orthotic for meal preparation (COOK) was created and deployed within an alternative housing unit. Implementation of this cognitive orthotic lifted the prohibition on use of a stove for meal preparation that had previously been place on their residents. By allowing these residents to cook independently, COOK has contributed to helping them become more independent in cooking and more confident in their ability to do so.

Avaliou-se a tipificação das fibras musculares e determinou-se parâmetros morfoquantitativos dos efeitos da imobilização por 2 e 4 semanas. Após o período experimental, os músculos (mm.) foram corados por HE e Picro-sírius. Para a tipificação das fibras, utilizou-se as reações da ATPase e NADH-tr; a análise ultraestrutural procedeu-se com microscopia eletrônica de transmissão. Nos resultados, alguns mm. imobilizados (Im) exibiram núcleos centralizados e fibras tipo IIB com formas elusivas. O perimísio destes mm. se espessou, sendo constituído por fibras colágenas tipo III. Os fusos musculares apresentaram espessamento da cápsula. Houve alterações nas linhas Z e modificação de outras ultraestruturas como as mitocôndrias. A área de secção transversa dos mm. Im por 4 semanas foi menor. As fibras do tipo IIB reduziram a área de perfil e aumentaram a densidade, além disso, se ampliou a porcentagem das fibras do tipo IIA. Portanto, a imobilização promoveu alterações nos fusos e esqueleto fibroso muscular, assim como transformou fibras do tipo IIB em IIA. / The effects of muscle immobilization for 2 and 4 weeks were studied by determining morphoquantitative parameters and muscle fiber-typing. After the trial period the muscles (mm.) were subject to HE and Picrosirius stain. The reactions of ATPase and NADH-tr were used for muscles fiber-typing. The ultrastructural analyses were made by transmission electron microscopy. The results showed changes in some of immobilized (Im) mm., it exhibited centralized nuclei cells and type IIB fibers took indefinite forms. The perimisium of Im mm. thicker up, and consisted of type III collagen fibers. Also the muscle spindles capsule thickened. Changes in the Z lines and other ultrastructures such as mitochondria were noticed. The cross-section area of Im mm. for 4 weeks was lower. The type IIB fibers reduced the profile area and density increased. Also the percentage of type IIA fibers expanded. Therefore the immobilization promoted changes in muscle spindles, fibrous skeleton morphology and provide an interconversion of muscle fibers type IIB into IIA.

Rocker profiles are one of the most commonly prescribed footwear modifications provided to individuals with impaired rollover. Impaired rollover is caused due to loss of neuromuscular function (i.e. stoke) or orthotic ankle constraint. When rollover is impaired, continued forward progression is interrupted and walking gait becomes less efficient (i.e. increased energy expenditure). Rocker profile footwear modifications are designed to mimic the functions of the anatomical ankle-foot rockers and provide its users with a smooth and efficient rollover. However, while there is theory governing the design of a rocker profile and subjective descriptions of rocker profile function, the extent to which a rocker profile footwear provides rollover has not yet been quantified. The aim of this study was to quantify effective and ineffective rollover and test whether our rocker profile provides effective rollover. We hypothesized that healthy subjects (n=4) walking with orthotic ankle constraint and the rocker profile (STOP) would have no change in rollover and energy expenditure outputs compared to walking with orthotic ankle free and rocker profile (FREE); but that healthy subjects (n=4) walking in STOP would have a change in rollover and energy expenditure outputs compared to walking with orthotic ankle constraint and no rocker profile (STOP-NR). To test this hypothesis, rollover was quantified as stance phase duration, cadence and radius of curvature and energy expenditure was quantified as heart rate and rating of perceived exertion. In addition to these outputs, we analyzed the ground reaction forces and duration of stance in early, middle and late stance period to determine the effects of the rocker profile footwear components. Through the rollover and energy expenditure outputs of the STOP, FREE and STOP-NR conditions, we quantified effective rollover as 0.29 (0.01) radius of curvature with a heart rate of 110.5(6.7) bpm and ineffective rollover as 0.69(0.12) radius of curvature with a heart rate of 131.5 (8.1) bpm. By creating this scale, we were able to determine that our rocker profile provided effective rollover (0.34[0.04] radius of curvature with a heart rate of 111.3[8.3] bpm). However, a future study with a greater sample size is needed to confirm these results.

Avaliou-se a tipificação das fibras musculares e determinou-se parâmetros morfoquantitativos dos efeitos da imobilização por 2 e 4 semanas. Após o período experimental, os músculos (mm.) foram corados por HE e Picro-sírius. Para a tipificação das fibras, utilizou-se as reações da ATPase e NADH-tr; a análise ultraestrutural procedeu-se com microscopia eletrônica de transmissão. Nos resultados, alguns mm. imobilizados (Im) exibiram núcleos centralizados e fibras tipo IIB com formas elusivas. O perimísio destes mm. se espessou, sendo constituído por fibras colágenas tipo III. Os fusos musculares apresentaram espessamento da cápsula. Houve alterações nas linhas Z e modificação de outras ultraestruturas como as mitocôndrias. A área de secção transversa dos mm. Im por 4 semanas foi menor. As fibras do tipo IIB reduziram a área de perfil e aumentaram a densidade, além disso, se ampliou a porcentagem das fibras do tipo IIA. Portanto, a imobilização promoveu alterações nos fusos e esqueleto fibroso muscular, assim como transformou fibras do tipo IIB em IIA. / The effects of muscle immobilization for 2 and 4 weeks were studied by determining morphoquantitative parameters and muscle fiber-typing. After the trial period the muscles (mm.) were subject to HE and Picrosirius stain. The reactions of ATPase and NADH-tr were used for muscles fiber-typing. The ultrastructural analyses were made by transmission electron microscopy. The results showed changes in some of immobilized (Im) mm., it exhibited centralized nuclei cells and type IIB fibers took indefinite forms. The perimisium of Im mm. thicker up, and consisted of type III collagen fibers. Also the muscle spindles capsule thickened. Changes in the Z lines and other ultrastructures such as mitochondria were noticed. The cross-section area of Im mm. for 4 weeks was lower. The type IIB fibers reduced the profile area and density increased. Also the percentage of type IIA fibers expanded. Therefore the immobilization promoted changes in muscle spindles, fibrous skeleton morphology and provide an interconversion of muscle fibers type IIB into IIA.

Orientadores: Alberto Cliquet Junior, Luis Alberto Magna / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T18:03:51Z (GMT). No. of bitstreams: 1 Ferrigno_IracemaSerratVergotti_D.pdf: 2039256 bytes, checksum: 490b0a3b26f1e38aae5a8c5e2e403a93 (MD5) Previous issue date: 2009 / Resumo: Com o advento da tecnologia de informação tem-se observado o aparecimento de problemas de saúde relacionados ao uso excessivo do computador, especialmente no que se refere às disfunções músculo-esqueléticas da região cervical e do membro superior. O objetivo deste estudo foi examinar o efeito das órteses de punho na atividade eletromiográfica dos músculos extensor ulnar do carpo, flexor superficial dos dedos e fibras superiores do trapézio durante o uso do computador. Vinte três estudantes universitários saudáveis, entre 18 e 26 anos realizaram tarefas padronizadas, randomizadas, de digitação em teclado e com o uso do mouse, quer sem órteses ou com dois tipos de órteses para o punho. Utilizou-se eletromiografia de superfície e considerou-se 100% da contração voluntária máxima como referência para representar a amplitude da atividade eletromiográfica. Observou-se um aumento na atividade miolétrica do trapézio (P<0,05) com o uso de órteses. Nenhuma diferença significativa foi observada no flexor superficial dos dedos ou no extensor ulnar do carpo durante a digitação, com ou sem órteses. No entanto, quando os participantes usaram o mouse, o músculo extensor ulnar do carpo apresentou aumento da sua atividade mioelétrica com as duas órteses e o mesmo padrão foi observado para o músculo flexor superficial dos dedos com o uso da órtese feita sob medida. Concluiu-se que as órteses de punho, nos modelos testados, afetam certas atividades musculares do membro superior em adultos saudáveis durante o uso do computador. / Abstract: With the advent of information technology, health problems related to the excessive use of the computer have appeared, mainly in what it refers to musculoskeletal overuse of the cervical region and upper limbs. The objective this study was to examine the effect of wrist orthoses on the electromyographycal activities of the extensor carpi ulnaris, flexor digitorum superficialis, and fibers of the upper trapezius muscles during computer work. Twenty-three healthy university students, ranging from 18 to 26 years of age, performed standardized tasks, randomized, such as typing and using the mouse while wearing one of two types of wrist orthoses or without orthosis. Surface electromyography was used considering 100% the maximum voluntary contraction to represent the amplitude of electromyographic activity. A significant increase in the electromyographic activity of the trapezius (P<0.05) was found when either of the orthoses was used. No significant difference was observed in the activities of the flexor digitorum superficialis or extensor carpi ulnaris whether or not orthoses were used in participants who typed. However, upon mouse use, the extensor carpi ulnaris activities was increased with both orthoses, and the same pattern was observed in the flexor digitorum superficialis when the volunteers used the custom-made orthosis. It was concluded that the studied models of wrist orthoses may affect the some muscle activities in the upper limbs of healthy adults when using a computer. / Doutorado / Pesquisa Experimental / Doutor em Cirurgia