Le foot-fauteuil est la seule activité sportive collective proposée aux personnes utilisatrices d’un fauteuil électrique. Née en France au milieu des années 1980, cette pratique a connu un essor important et c’est aujourd’hui une des activités « handisport » qui compte le plus de compétiteurs. Paradoxalement, c’est également l’une des moins connues. L’objectif de cette thèse est de mettre au jour l’expérience de ces sportifs dits « lourdement handicapés ». Un regard praxéologique posé sur la pratique nous permettra de comprendre l’une des facettes de cette expérience : le corps agissant en situation sportive. Puis, dans un second temps, un regard « socio-phénoménologique » sera l’occasion de saisir le vécu « en première personne » de ces athlètes. Pour ce faire, nous avons observé et participé à la vie de deux clubs de foot-fauteuil de région parisienne pendant plus de deux ans. Nous avons également réalisé 16 entretiens approfondis auprès des joueurs et des entraîneurs. L’analyse phénoménologique de ces données nous permettra de reconstituer le « monde collectif » vécu par les joueurs de foot-fauteuil. Ainsi, des enjeux centraux seront mis en exergue. La problématique de la classification des joueurs et de la mise en jeu des différences sera interrogée. Nous porterons ensuite une attention particulière au rapport entre l’individu et son fauteuil. Nous verrons, pour finir, que la pratique du foot-fauteuil est un espace de socialisation particulier, où il s’agit parfois de questionner le genre et la dichotomie valide/handicapé. / Powerchair football is the only team sport for people using a powered wheelchair daily. Born in France in the mid 1980s, this practice expanded, and today it is one of the "handisport" activities with the highest numbers of competitors. Paradoxically, it is also one of the least known. The objective of this thesis is to uncover the sports experience of these "severely disabled" athletes. A praxeological view on this practice will enable us to understand one aspect of this experience: the acting body in sporting situation. Then, in a second step, the socio-phenomenological view will be an opportunity to capture the experience "in first person" of these athletes. To do this, we have observed and participated in the life of two football clubs of the Paris area for more than two years. We also conducted 16 in-depth interviews with players and coaches. The phenomenological analysis of these data will allow us to reconstruct the "world" experienced by powerchair football players. Thus, central issues will be highlighted. The problem of classification of the players will be examined. Then, we will pay particular attention to the relationship between the individual and his wheelchair. We finally see that the practice of powerchair football is a particular socialization place, where gender and abled/disabled relationships are questioned.

Cette recherche traite la question de l’infirmité en tant qu’objet historique et d’analyse. Le terrain et l’époque choisis représentent un banc d’essai afin d’analyser la longue sédimentation et le renouvellement de certains mécanismes fondés sur l’infériorisation de l’infirme.La biographie et les parcours sociaux de certains individus provenant de différents milieux sociaux constituent des instruments pour saisir quelques mécanismes parmi ceux qui m’ont conduit à formuler la notion de dette symbolique. Inspirée par la sociologie de P. Bourdieu et par son concept de violence symbolique, cette notion est utile pour saisir la longue histoire des lectures sociales et de l’imaginaire qui infériorisent l’infirme par un mécanisme de renversement des causes et des effets. Ce n’est pas le déficit corporel qui produit cette infériorisation, mais plutôt cette vision infériorisante qui lit le fait corporel en décrétant le statut d’infériorité de l’individu. Cette lecture, cherche et trouve, dans l’objectivité corporelle de l’infirme des appuis qui la justifient.Dans la deuxième partie, nous nous confrontons à certains mécanismes, entre pratiques et discours, qui nous mettent face au renouvellement de ces schémas de pensée et d’action. D’abord, un certain nombre de cas de dispenses pour irrégularités par défaut corporel à laquelle doit se soumettre le prêtre qui, à cause de son infirmité, devient indigne et irrégulier dans l’exercice de son ministère. La construction religieuse de l’infirmité est également analysée à partir de la médecine pastorale, discipline du cursus de formation des prêtres, ainsi que de l’élaboration théologique. Les silences qui entourent les individus rendus infirmes par les accidents à l’intérieur du système industriel, associés à l’opacité et à l’insuffisance du développement des dispositifs qui devraient fournir les premières formes de réparation, constituent, au cours de la période historique retenue, de nouvelles formes qui contribuent à l’infériorisation du statut de l’infirme.La troisième partie porte sur l’analyse de certaines pratiques discursives avec un fort pouvoir pour construire l’opinion publique et un imaginaire sur l’infirmité : les chroniques d’un quotidien et un corpus de plus de cents textes littéraires. Dans les conclusions, se pose à nouveau la question de la construction de l’objet de recherche au sein du champ d’études du handicap, un champ très articulé, très conflictuel et aussi très orienté par l’action et l’engagement. / This research deals with the topic of infirmity as a historical subject matter and for analysis. The age and the field chosen are an opportunity to analyze the sedimentation and renewal of some mechanisms based on the inferiorization of the infirm. The life and social paths of individuals from different social backgrounds are a means of understanding some dynamics, which has led me to formulate the concept of symbolic debt. Inspired by P. Bourdieu’s theory of sociology and his concept of symbolic violence, this idea is a useful tool to help understand the long history of social and imaginary conceptions that inferiorize an invalid through a mechanism of reversal of causes and effects. It is not the physical corporeal deficit which produces this inferiorization, but it is this inferiorizing vision that reads the physical data by decreeing the statute of inferiority of the individual. This social qualification seeks and finds reasons justifying it in the corporeal objectivity of the infirm.In the second part, we are faced with certain mechanisms, between practices and speech, which put us in front of the long history and the renewal of these plans of thought and action. At first, a number of cases of dispensation for irregularities by physical defect. The priest, who has to submit himselft because of his infirmity, becomes unworthy and irregular in the exercise of his ministry. The religious construction of the infirmity is also analyzed from the pastoral medicine, the discipline of the program of training of the priests, as well as from the theological elaboration. The silences which surround the individuals cause incidents within the industrial system, together with the opaqueness and the insufficiency of the development of the devices which should supply the first form of repair, establish, during the chosen historic period, new forms which contribute to the inferiorization of the status of the infirm.The third part is concerned with the analysis of certain discursive practices with a strong power to build public opinion and an image of the infirm: the chronicles of a daily paper and a corpus of more than a hundred literary texts. In conclusion, it raises again the question of the construction of the object of research within the study of disability, a field very articulated, very conflicting and strongly oriented toward action and involvement.

La visée d’une société pour tous est souvent remise en question dès qu’il s’agit des personnes présentant un handicap mental. Notre recherche s’empare de cette question et étudie une ingénierie coopérative dans un établissement et service d’aide par le travail (ESAT) du secteur médico-social. Notre cadre théorique s’ancre dans la théorie de l’action conjointe en didactique. Notre méthodologie est qualitative, ethnographique et clinique. Pour donner à voir et à comprendre la construction progressive d’un collectif de pensée, nous nous appuyons sur des exemples emblématiques. Nous les analysons dans un mouvement ascendant et compréhensif. Le dispositif étudié s’appuie sur les compétences de tous dans deux actions complémentaires et liées : un travail d’enquête collectif et une activité didactique dans les ateliers. Nous entendons les savoirs comme des puissances d’agir. Au cours de douze réunions de l’ingénierie coopérative, le collectif (les professionnels et le chercheur) élabore des hypothèses de travail, en réponse à des systèmes de questionnements issus du travail en atelier. Dans les ateliers de l’ESAT, au cours de l’activité ingénierique, ces hypothèses sont éprouvées par un petit groupe spécifique, composé d’un moniteur d’atelier, de travailleurs et du chercheur. De nouveaux problèmes émergent alors. L’analyse de ces actions tend à montrer qu’en travaillant ensemble, le collectif s’institue progressivement en une ingénierie coopérative, avec un style de pensée qui lui est propre. Ce faisant, dans un mouvement du comprendre/transformer, la perception et la conceptualisation de chacun (travailleurs, professionnels, chercheur) se trouvent transformées. / The idea of a society for everyone is often questioned as soon as mentally disabled persons are implied.Our research seizes this matter and studies cooperative engineering in a medico social institution(ESAT: Etablissement Service d’Aide par le Travail: institution for help to disabled adults through work).Our theoretical frame is anchored in the Joint Action Theory in Didactics. Our methodology is qualitative, ethnographic and clinical. To make visible and understandable the progressive construction of thought collective, we draw on emblematic examples. We analyse them in an ascending and understanding movement.The studied device is relying on everyone's skills in two complementary and linked actions: a collective inquiry work and a didactical activity in the workshops. We understand knowledge as power of action.Throughout twelves meetings of the cooperative engineering, the collective (professionals and the researcher) elaborates work hypotheses, in response to questioning systems derived from work in the workshops. In the ESAT workshops, during the engineering activity, these hypotheses are tested by a specific small group, comprised of one workshop instructor, workers and the researcher. New problems then arise.Analysis of these actions tends to demonstrate that by working together, the collective establishes itself as a cooperative engineering, with its own thought style. In doing so, in the understanding/transforming movement, the perception and conceptualisation of everyone (workers, professionals, and researcher)find themselves transformed.

Purpose: To determine whether symptoms of dizziness and fall rates change due to routine cataract surgery and to determine the influence of visual and refractive factors on these common problems in older adults. Methods: Self-reported dizziness and falls were determined in 287 subjects (mean age of 76.5±6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Six-month falls rates were determined using self-reported retrospective data. Dizziness was determined using the short-form of the Dizziness Handicap Inventory. Results: The number of patients with dizziness reduced significantly after cataract surgery (52% vs. 38%; χ2 = 19.14 , p < 0.001), but the reduction in number of patients who fell in the 6-months post surgery was not significant (23% vs. 20%; χ2= 0.87, p=0.35). Multivariate logistic regression analyses found significant links between post-operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post-operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction. Conclusions: Dizziness is significantly reduced by cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery.

Estudo cujo objeto tratou da inclusão do cliente estomizado no mundo do trabalho. Os objetivos foram: identificar as dificuldades e facilidades dos clientes estomizados para inclusão no mundo do trabalho; analisar as possibilidades de inclusão no mundo do trabalho; discutir, a partir do ponto de vista do cliente estomizado, as orientações fornecidas pelos enfermeiros com vistas à inclusão no mundo do trabalho. O referencial teórico baseou-se no campo da Saúde do Trabalhador, enfocando a reabilitação profissional e o capítulo de bases conceituais abordou o conhecimento da estomaterapia, do mundo do trabalho, da deficiência física e aspectos legais que envolvem a reabilitação do estomizado no mundo laboral. O desenho metodológico foi de uma pesquisa descritiva, exploratória, de natureza qualitativa, realizada com 20 clientes estomizados definitivos, aos quais se aplicou uma entrevista semiestruturada. O método de análise dos dados foi a Análise Temática de Conteúdo, a qual fez emergir quatro categorias: a) Sentidos do Trabalho para o Ser Estomizado; b) O Estomizado e Sua Problemática Biopsicossocial; c) Contexto Social e Aspectos Legais Envolvendo a Inclusão do Estomizado no Mundo Laboral; d) O Enfermeiro e Sua Participação na Reabilitação do Cliente Estomizado. Os resultados revelaram que a maioria dos sujeitos trabalhava informalmente e recebia ao mesmo tempo algum auxílio governamental. Ressalta-se que eles reconheciam a ilegalidade desta situação, porém, julgavam-na necessária devido aos baixos valores dos benefícios, enfatizando-se a sensação de utilidade causada pelo fato de trabalharem. Referiram que o retorno ao trabalho era prejudicado devido a empecilhos encontrados nas dimensões psíquica, física e social, as quais estavam articuladas intimamente. Enfatizaram grande dificuldade em encontrarem empregos adequados às suas especificidades, e que não prejudicassem sua condição de saúde, pois há necessidade de banheiros adaptados, de não exposição ao calor na região do estoma e nem a esforços físicos severos, sem contar com a necessidade de um emprego que lhes permita flexibilidade para irem às consultas da equipe multiprofissional. Os maiores empecilhos sociais referiram-se ao desconhecimento e descaso social e governamental a respeito do que é ser estomizado, pois esta problemática não é divulgada, e nem conhecida pela maioria da população. Em relação aos enfermeiros, os sujeitos foram quase unânimes em referirem falta de orientação por parte desses profissionais, acerca de esclarecerem sobre sua inclusão no mundo do trabalho. Este fato caracterizou-se como preocupante, pois os enfermeiros são educadores por excelência e a orientação está intimamente ligada ao processo de reabilitação. Concluiu-se que o retorno ao trabalho foi considerado essencial, mas existem inúmeras dificuldades para que este retorno e manutenção no universo laboral. Estes empecilhos os levam a adquirirem aposentadorias precoces ou auxílios-doença. Há de se rever o processo de reabilitação da pessoa com estoma, especialmente no que se refere a sua inclusão no mundo do trabalho, no sentido de melhor prepará-la para suas potencialidades e limitações, destacando-se que ela não é incapaz e que existem atividades formais em que elas podem ser produtivas e felizes. / This is a study which considered the inclusion of the colostomy clients into the labor world. The objectives were: to identify the difficulties and also the facilities of these clients for the inclusion in job field; to analyze such possibilities of inclusion, to discuss, from the point of view of the client the orientation provided by the nurses who aim to inclusion their clients into the job world. The theoretical reference was based on the field of Employee Health, focusing o the professional rehabilitation and the chapter for supporting the theory has approached the knowledge of colostomy , job- or employment world, physical handicap and the legal aspects which involve the rehabilitation of colostomyzed client in labor world. The methodology drawing was a qualitative descriptive, exploratory survey accomplished with 20 definitive colostomyzed clients, to whom were prepared semi-structured interviews. The data analysis method was the Thematic Content Analysis, which emerged four categories: a)Meanings of the Work for the Colostomyzed Being; b) The Colostomy patient and his/her Biopsychosocial problem; c) Social Context and Legal Aspects Involving his/her the Inclusion in Labor World; d) The Nurse and the Participation in the Rehabilitation of Such Client. The results have shown that most subjects worked informally and at the same time they had been receiving some type of government aid. It is also important to highlight that they recognized such illegal situation, however, they considered it important due to the poor payment of the aid, emphasizing the sensation of usefulness emerging from job opportunities. They have referred to the return to work as an impaired opportunity due to the obstacles set in psychic, physical and social dimensions which were close articulated. They have emphasized great difficulty in finding jobs that would fit their specific needs and that would not cause troubles to their health conditions, because there has to be an adapted bathroom, non exposure to heat in the stoma area neither severe physical efforts. In addition to this, they need a job that allows them the flexibility to leave work in order to see the multiprofessional staff. The greatest obstacles referred to the lack of knowledge and social as well as government disregard in relation to the concept of what is, in fact a colostomy patient, once this problem is not spread neither known from most part of the population. In relation to the nurses, the subjects were almost unanimous referring to the lack of orientation from the part of these professionals about the explanation on how to inclusion this group of client in the labor world. This fact had been characterized as a worry, because nurses are educators and orientation is closely linked to the rehabilitation process. It was concluded that the return to job was essential, but there are several difficulties related to such return and the maintenance in labor word. These obstacles lead them to early retirement or sickness aids. It is important to analyze once again such inclusion in order to prepare the client to his limitations and potentials, highlighting he is not an incapable person and that there are many formal activities and they can be productive and happy.

La sclérose en plaques est une maladie inflammatoire du système nerveux central, ayant plusieurs phénotypes cliniques, caractérisée par la coexistence de phénomènes inflammatoires focaux et d’une neurodégénérescence diffuse, dont la physiopathologie est actuellement inconnue. L’apparition de troubles cognitifs marque un tournant évolutif pour les patients, est en lien avec la progression de la maladie, et notamment l’atrophie cérébrale. Néanmoins le statut cognitif de certains patients reste préservé malgré la progression de la maladie. Le concept de réserve cognitive rendrait compte de cette absence de corrélation entre statut cognitif et lésions cérébrales en lien de la maladie, mais ses bases physiologiques sont à l’heure actuelle inconnues. Trois techniques d’imagerie : L’étude de la perfusion cérébrale en arterial spin labelling, de la vasoréactivité cérébrale grâce à l’inhalation d’un gaz enrichi en CO2, et des anomalies de substance blanche cérébrale en tenseur de diffusion sont utilisées dans ce manuscrit pour répondre aux questions suivantes :- Existe-t-il des anomalies vasculaires pouvant expliquer la neurodégénérescence diffuse observée dans la sclérose en plaques, et notamment dans les formes progressives ?- Existe-t-il en tenseur de diffusion des anomalies de certains faisceaux de substance blanche qui serait corrélées au statut cognitif ou au phénotype clinique des patients? La réserve cognitive est-elle médiée par des phénomènes de plasticité de la substance blanche dans la sclérose en plaques? / Multiple sclerosis in an inflammatory and dysimmune condition of the central nervous system, with different clinical patterns. This disease involves patchy area of demyelination and of a diffuse axonal loss and neurodegeneration. The pathophysiology of this diffuse neurodegeneration remains currently unknown. The apparition of a cognitive impairment dramatically changes the clinical prognosis in patients. This cognitive impairment seems to be linked to a diffuse dysconnexion of normal appearing white matter, and to grey matter atrophy. Cognitive reserve could explains a lack of correlation between the cognitive status in patients and the cerebral lesion load due to the disease. Anatomical basis of cognitive reserve are unclear. Three methods of imaging : arterial spin labelling, measure of the cerebral vasoreactivity with the inhalation of a gas enriched in dioxid, and diffusion tensor imaging are employed to answer to these questions in multiple sclerosis : Are there vascular abnormalities related to neurodegeneration, in particular in progressive forms of multiple sclerosis? Could we find white matter differences in tracts related to cognitive impairment or clinical form in patients? Is Cognitive reserve linked to a cerebral white matter plasticity in this condition ?

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-31T19:22:27Z No. of bitstreams: 1 DeusamarSilvaSantos.pdf: 5885761 bytes, checksum: 5d6e47fe8e7ca202c2a62ed594c0b62c (MD5) / Made available in DSpace on 2017-05-31T19:22:27Z (GMT). No. of bitstreams: 1 DeusamarSilvaSantos.pdf: 5885761 bytes, checksum: 5d6e47fe8e7ca202c2a62ed594c0b62c (MD5) Previous issue date: 2016-08-29 / Cet travail analyse l'accessibilité dans les transports en commun (bus de ville) à São Luís - MA, dédié aux personnes ayant un handicap physique. Plus précisément : il est une historicisation concernant l'expression personne handicappée, et en ce que le temps a passé pour inclure les questions relatives à ce thème dans les enquêtes statisques brésiliennes; l'accessibilité est analysé que les moyens de transport sur la base de la législation, alors que l'accès aux transports est un droit essentiel à l'exercice de la citoyenneté. En dépit de cette prérogative, l'étude a révélé que le transport public urbain est un moyen de locomotion encore assez exclusive, que de nombreuses mesures sont assurées que dans les textes des lois, décrets, etc., mais dans la pratique ne prennent effet dans la perception de ces sujets; le document aborde également les multiples points de vue sur les politiques publiques pour promouvoir l'acessibilité que les moyens de transport, à la fois dans la perception des organismes publics, le secteur privé et les organisations de la societé civile d'entretiens avec des représentants de ces groupes sociaus; Il présent les perceptions des obstacles et les aspects à améliorer pour promouvoir des politiques d'acessibilité dans les transports en commun dans la capitale du Maranhão. Cette étude a révélé également qu'il ya des actions promues par la mairie el la SMTT, tels que l'achat de nouveaux véhicles adaptés, installations de nouveaux points d'abris (arrêts), appel d'offres pour la sélection des enterprises qui fonctionnera dans le système de transport urbain dans la capitale du Maranhão. Cependant, les résultats nous permettent de conclure que, bien que certaines mesures prises par le gouvernement, en particular la SMTT, nous ne pouvons pas dir que les transports en commun dans la capitales du Maranhão fournir l'accessibilité aux personnes ayant un handicap physique. / O presente trabalho analisa a acessibilidade nos transportes coletivos urbanos (ônibus urbanos) em São Luís – MA, voltada para as pessoas com deficiência física. Em termos específicos: faz-se uma historicização concernente ao termo pessoa com deficiência, e em que momento passou-se a incluir questionamentos relativos à essa temática nos levantamentos estatísticos brasileiros; analisa-se a acessibilidade nesse meio de transporte com base nas legislações, considerando que o acesso ao transporte é um direito essencial para o exercício da cidadania. Apesar dessa prerrogativa, o estudo constatou que o transporte coletivo urbano é um meio de locomoção ainda bastante excludente, pois muitas medidas estão asseguradas apenas nos textos de Leis, Decretos, etc., mas que na prática não são efetivadas, na percepção desses sujeitos; o trabalho também discorre sobre os múltiplos olhares sobre as políticas públicas de promoção da acessibilidade nesse meio de transporte, tanto na percepção dos órgãos públicos, do setor privado, como da sociedade civil organizada, a partir de entrevistas realizadas com representantes desses segmentos sociais; apresenta as percepções sobre os entraves e os aspectos a serem melhorados para a promoção de políticas de acessibilidade nos transportes coletivos urbanos na capital maranhense. O presente estudo constatou, ainda, que existem algumas ações promovidas pela prefeitura e pela SMTT, a exemplo da compra de novos veículos adaptados, instalações de novos pontos de abrigos (paradas), licitação para escolha das empresas que vão operar no sistema de transporte urbano na capital maranhense. Todavia, os resultados nos permitem concluir que, apesar de algumas ações realizadas pelo poder público, especialmente pela SMTT, não podemos afirmar que os transportes coletivos urbanos na capital maranhense proporcionam acessibilidade às pessoas com deficiência física.

Un des enjeux sociétal important concerne le vieillissement des personnes en situation de handicap mental. L’allongement de l’espérance de leur vie a pour conséquence que les établissements spécialisés pour l’accueil des personnes âgées (comme les EPHAD) se retrouvent à accueillir des personnes souffrant des maladies du vieillissement (démence par exemple) en plus d’un handicap mental. Se pose alors le problème de l’accès aux soins pour cette population à travers l’usage des dispositifs médicaux adaptés aux caractéristiques des personnes âgées.  La présence d’un handicap mental a plusieurs conséquences : difficulté de compréhension des usages des dispositifs médicaux, personnels peu formés aux conséquences de cette handicap). En effet, les dispositifs médicaux sont spécifiques soit pour les situations de handicaps ou soit pour le contexte du vieillissement (avec des normes, des règles de remboursement différents). Que se passe t-il dans le cas d’un dispositif médical qui doit être adapté non seulement aux contraintes dues au vieillissement et à celles dues à un handicap mental ? Nous proposons donc de partir des questions de départ suivantes comme objectif pour ce sujet de thèse : Y a t-il des difficultés d'accès aux soins pour les personnes âgées en situation de handicap? Quels sont les manques exprimés par les usagers eux-mêmes et par les professionnels du sanitaire? Quel Dispositif Médical faudrait-il "améliorer" ou créer pour faciliter l'accès aux soins pour cette population spécifique ? / One og the biggest challenge for our societies is the aging of the population. One is getting particularly important : the ageing of people with mental disorder. The increase of their life expectancy has several consequences in their access to care. Establishment which are specialized in the welcolme of elderly people are now welcoming people with mental disorder. The access to care is one of the most problematic aspect in this phenomenum : what medical devices are adapted for this new population ? Indeed, medical devices are adapted either for people with mental disorder, either for elderly people. For people with mental disorder getting older, there is a need to adapt the tools for them, to adapt the way of communicating with them and the way to monitore them. We are trying to propose new solutions to answer all these questions.

No description available.

No description available.