The overall goal of my research was to advance our understanding of the potential for novel compliant flooring systems to reduce the risk for fall-related injuries in older adults, including fall-related traumatic brain injury (TBI). This entailed an assessment of how these floors affect the competing demands of fall-related TBI – impact severity attenuation in concert with minimal concomitant impairments to balance control and postural stability. Two studies are included as part of this thesis. The first study used a mechanical drop tower to assess the effects of four traditional flooring systems and six novel compliant flooring conditions on the impact dynamics of a surrogate headform during the impact phase of simulated ‘worst- case’ head impacts. The second study entailed an assessment of the effect of two traditional and three novel compliant floors on the initial phase of the compensatory balance reactions of older adult men and women living in a residential-care facility environment following an externally induced perturbation using a tether-release paradigm. Overall, this thesis demonstrates that novel compliant floors substantially attenuate the forces and accelerations applied to the head during simulated worst- case impacts when compared to traditional flooring surfaces such as vinyl and carpet with underpadding. These benefits are achieved without compromising indices of balance control, supported by the finding that parameters characterizing early compensatory balance reactions were unaffected by the novel compliant floors tested. This work supports the introduction of pilot installations of novel compliant flooring systems into environments with high incidences of falls to test their effectiveness at reducing fall-related injuries in clinical settings.

Fundação de Apoio a Pesquisa e à Inovação Tecnológica do Estado de Sergipe - FAPITEC/SE / Dynamic postural control (DPC) during basketball pull-up jump shot (PJS) movement depends on the strength of the core and custom with the natural situations of the game. A training method that spans both physical and technical-tactical training sessions (multi-component training - MCT) can be an effective tool to improve performance. It is not clear, however, to what extent the MCT can favor DPC. So, the purpose of this study is to investigate the effect of MCT on DPC on athletes of a male amateur basketball team during the PJS movement. The sample consisted of nine male amateur male basketball players (age: 23.3 ± 2.9 years, height: 181.5 ± 7.7 cm, body mass: 76.4 ± 5.0 kg). The athletes were evaluated before and after a 12-week period of MCT contemplating physical preparation (functional training) associated to technical-tactical training (small-sided games). Training sessions took place twice a week with a duration of 90 min. For the PJS assessment, each athlete started the zig-zag speed dribble movement, around cones located equidistantly (5.5 m), then performing the PJS. The entire procedure was filmed for later scanning of the images by a specific software for determination of the displacement of the center of gravity (CG). Data were analyzed by descriptive statistics, paired t-test, Cohen’s effect size, Pearson's correlation and magnitude based inference analysis (ɑ = 0.05). The reduction of CG displacement (19.4 ± 13.5 cm vs. 13.8 ± 12.6 cm, pre- and post-intervention, respectively, p = 0.08) and the final GC acceleration (0.96 ± 1.53 m/s2 vs. -0.56 ± 1.04 m/s2, pre and post-intervention, respectively, p = 0.06) bordered the level of significance. There was no difference in the initial (12.4 ± 14.8 J vs. 8.8 ± 9.54 J, pre- and post-intervention, respectively, p = 0.76) and final kinetic energy values (13.1 ± 15.7 J vs. 6.6 ± 8.64 J, pre- and post-intervention, respectively, p = 0.86). Magnitude based inference analysis indicated that MCT was probably beneficial for reducing GC displacement on the anteroposterior axis and for final kinetic energy. It is concluded that the MCT is able to reduce the variation of the CG displacement in the anteroposterior axis during PJS, indicating a higher DPC in university basketball amateur athletes. / O controle postural dinâmico (CPD) durante o movimento “drible, parada e jump” (DPJ) do basquetebol depende da força do core e do costume com as situações naturais do jogo. Um método de treinamento que abranja em uma mesma sessão treinos físico e técnico-tático (treinamento multicomponente – TMC) pode ser uma eficaz ferramenta para aprimorar a performance. Não é claro, contudo, em que medida o TMC pode favorecer o CPD. O objetivo deste estudo é investigar o efeito do TMC sobre o CPD em atletas de uma equipe amadora masculina de basquetebol universitário durante o movimento DPJ. A amostra foi composta por nove jogadores amadores universitários de basquetebol masculino (idade: 23,3 ± 2,9 anos, estatura: 181,5 ± 7,7 cm, massa corporal: 76,4 ± 5,0 kg). Os atletas foram avaliados antes e depois de um período de 12 semanas de TMC contemplando preparação física (treinamento funcional) associado ao treino técnico-tático (jogos reduzidos). Os treinos ocorriam duas vezes por semana com duração de 90 min. Para a avaliação do DPJ, cada atleta individualmente iniciava o movimento driblando em velocidade em deslocamento zig-zag, contornando cones localizados de forma equidistante (5,5 m), para em seguida, executarem uma parada brusca e salto para o arremesso. Todo o procedimento foi filmado para posterior digitalização das imagens em software específico e determinação do deslocamento do centro de gravidade (CG). Os dados foram analisados por estatística descritiva, teste t emparelhado, tamanho do efeito, correlação de Pearson e análise de inferência baseada na magnitude (ɑ = 0,05). A redução do deslocamento do CG (19,4 ± 13,5 cm vs. 13,8 ± 12,6 cm, pré e pós-intervenção, respectivamente; p = 0,08) e da aceleração final do CG (0,96 ± 1,53 m/s2 vs. -0,56 ± 1,04 m/s2, pré e pós-intervenção, respectivamente; p = 0,06) margearam o nível de significância. Não houve diferença nos valores de energia cinética inicial (12,4 ± 14,8 J vs. 8,8 ± 9,54 J, pré e pós-intervenção, respectivamente; p = 0,76) e final (13,1 ± 15,7 J vs. 6,6 ± 8,64 J, pré e pós-intervenção, respectivamente; p = 0,86). A análise da inferência baseada na magnitude indicou que o TMC foi provavelmente benéfico para reduzir o deslocamento do CG no eixo anteroposterior e para energia cinética final. Conclui-se que o TMC é capaz de reduzir a variação do deslocamento do CG no eixo anteroposterior, indicando maior CPD em atletas amadores de basquetebol universitário. / São Cristóvão, SE

xiii, 109 p. : ill. / Falls are a significant source of physical, social, and psychological suffering among elderly adults. Falls lead to morbidity and even mortality. Over one-third of adults over the age of 65 years will fall within a calendar year, with almost 10,000 deaths per year attributed to falls. The direct cost of falls exceeds $10 billion a year in the United States. Fall incidents have been linked to multiple risk factors, including cognitive function, muscle strength, and balance control. The ability to properly identify balance impairment is a tremendous challenge to the medical community, with accurate assessment of fall risk lacking. Therefore, the purpose of this study was to assess balance control during gait among young adults, elderly adults, and elderly fallers; determine which biomechanical measures can best identify fallers retrospectively; demonstrate longitudinal changes in elderly adults and prospectively assess fall risk; and provide a method for mapping clinical variables to sensitive balance control measures using artificial neural networks. The interaction of the whole body center of mass (CoM) in relation to the base of support (BoS) assessed static and dynamic balance control throughout gait. Elderly fallers demonstrated reduced balance control ability, specifically a decreased time to contact with the boundary of the BoS, when compared to young adults at heel strike. This decreased time might predispose older adults to additional falls due to an inability to properly respond to perturbations or slips. Inclusion of these balance control measures along with the Berg Balance Scale and spatiotemporal measures demonstrated sensitivity and specificity values of up to 90% when identifying 98 elderly fallers and non-fallers, respectively. Additionally, 27 older adults were followed longitudinally over a period of one year, with only the interaction of the CoM with the BoS demonstrating an ability to differentiate fallers and non-fallers prospectively. As the collection and analysis of these biomechanics measures can be time consuming and expensive, an artificial neural network demonstrated that clinical measures can accurately predict balance control during ambulation. This model approached a solution quickly and provides a means for assessing longitudinal changes, intervention effects, and future fall risk. This dissertation includes both previously published and unpublished co-authored material. / Committee in charge: Dr. Li-Shan Chou, Chair; Dr. Andrew Karduna, Member; Dr. Marjorie Woollacott, Member; Dr. Ronald Stock, Member; Dr. Arthur Farley, Outside Member

Made available in DSpace on 2016-06-02T20:18:19Z (GMT). No. of bitstreams: 1 4848.pdf: 2222922 bytes, checksum: cfbc4d52ea6d0f3d385cdda225ec2ba8 (MD5) Previous issue date: 2012-11-12 / Financiadora de Estudos e Projetos / Postural stability is an important ability of the human body in standing position as well as in dynamic activities like locomotion. It influences all motor and muscle aspects related to the execution of a motor task and is achieved by appropriate support conditions, coordinated muscle activity and proprioceptive information. The center of pressure behavior can be studied under different conditions, providing information on how the body reacts to postural instabilities. Thus the main purpose of this study is to propose a methodology for the study of the center of pressure behavior in order to evaluate static and dynamic equilibrium conditions of the human body. In order to achieve the goals, the structure of this thesis is composed of three studies. The equilibrium control during single leg ballet poses and the anticipatory postural adjustments prior to the first step in gait were discussed in the first and second study respectively. In the third study, methodological aspects were reviewed and a data processing standardization to study the center of pressure behavior during gait initiation was proposed. Dynamometry with force platforms was the measurement method used for all studies. The results allow to identify balance control strategies in ballet dancers and anticipatory postural adjustments existing during the transition from standing still to the cyclic gait steps. Some clinical applications of the results are presented and also directions for future studies. / A estabilidade postural é uma capacidade necessária ao corpo humano na posição parada em pé e nas atividades dinâmicas, como a locomoção, que influencia todos os aspectos motores e musculares relacionados à realização de uma tarefa. Esta é garantida através de formas de apoio, de ação coordenada dos músculos e atividade proprioceptiva, formando a base essencial para a realização de movimentos. O comportamento do centro de pressão pode ser estudado em diferentes condições, fornecendo informações sobre como o corpo reage a instabilidades posturais. Assim, o objetivo principal deste estudo é propor uma metodologia para o estudo do comportamento do centro de pressão tanto em condições estáticas quanto dinâmicas. A fim de alcançar os objetivos, a estrutura desta tese é composta de três estudos. São discutidos em estudos independentes os processos de controle do equilíbrio durante atividades estáticas, como as poses unipodais do ballet, e também dinâmicas, como os ajustes posturais antecipatórios prévios à inicialização do passo. No primeiro estudo foram estudados aspectos relacionados ao controle da estabilidade e de estratégias para a manutenção do equilíbrio durante três posições de apoio unipodal do ballet, executadas em posição de meia-ponta. No segundo estudo, avaliou-se os ajustes posturais antecipatórios em diferentes faixas etárias e foram discutidas suas relações com o processo de inicialização do passo em condições fisiológicas e patológicas. No terceiro estudo, sugeriu-se uma padronização metodológica para o cálculo das variáveis examinadas nos estudos que envolvem o comportamento do centro de pressão na inicialização do passo. A dinamometria com plataformas de força foi o método de medição empregado para todos os estudos. Os resultados permitem determinar estratégias para o controle do equilíbrio em bailarinas e para os ajustes posturais antecipatórios que ocorrem na transição da posição em pé parada para a marcha cíclica. São apresentadas algumas implicações clínicas dos resultados e perspectivas para estudos futuros.

As alterações do equilíbrio postural representam um dos principais sintomas relatados pelos pacientes com Esclerose Múltipla (EM), surgem logo no início da doença em pacientes minimamente comprometidos e são consideravelmente incapacitantes . Esses déficits são muitas vezes pouco valorizados pelas avaliações clínicas neurológicas convencionais. Os objetivos desse estudo foram descrever as alterações de equilíbrio em pacientes com diagnóstico de EM e diferenciar as alterações clínicas entre pacientes com e sem queixa de desequilíbrio. Foram avaliados 98 pacientes, classificados através da Escala Expandida do Estado de Incapacidade (EDSS) entre 0 e 4,5. Os pacientes foram divididos em 2 grupos de acordo com a presença da queixa de desequilíbrio (Grupo sem queixa - GS; Grupo com queixa - GQ). O protocolo de avaliação constou de escalas observacionais do equilíbrio (Escala de equilíbrio de BERG: EEB e Índice de marcha dinâmica: DGI), avaliação da percepção de vertical visual subjetiva (VVS), Escala de Severidade da Fadiga (FSS) e através do Inventário Beck de Depressão (BDI). Os grupos GS e GQ foram compostos por 49 pacientes cada um. Não houve diferença estatística na idade dos indivíduos entre os grupos, porém encontramos diferença significativa entre o tempo de diagnóstico da EM entre ambos. Foram encontradas diferenças significativas entre GS e GQ para os valores de EDSS, no entanto ambos os grupos permaneceram dentro da classificação de incapacidade leve da escala. Esse dado reforça a ideia de que o EDSS é insensível para detectar déficits funcionais sutis. Também foram encontradas diferenças significativas nos testes clínicos de equilíbrio, refletindo que o GQ apresenta pior equilíbrio estático e dinâmico, EEB e DGI, respectivamente. O GQ apresentou pior percepção da vertical gravitacional, VVS, com valor estatisticamente significativo, além de um pior relato nas avaliações de fadiga (FSS), e depressão (BDI). Adicionalmente, observamos correlações negativas significantes entre os valores de EDSS os testes de equilíbrio (EEB e DGI), e correlações positivas significantes entre o EDSS e a avaliação da VVS e FSS. Não observamos correlação entre o EDSS e BDI. A relação entre o teste da VVS e os testes observacionais do equilíbrio também se mostrou estatisticamente significante. Os resultados do nosso estudo evidenciaram que vários aspectos devem ser considerados para caracterizarmos adequadamente as alterações de equilíbrio em indivíduos com EM. Os testes clínicos do equilíbrio postural e a avaliação da fadiga devem ser adicionados à avaliação funcional de pacientes com EM, permitindo dessa forma, que os déficits funcionais mais sutis sejam detectados. Nenhum teste clínico isolado é capaz de avaliar com precisão tais alterações. Sendo assim, concluímos que os testes propostos contemplam a avaliação da complexa rede de informações responsáveis pela manutenção do controle postural e contribuem para a melhor caracterização das alterações do equilíbrio postural na EM, facilitando a elaboração de protocolos individuais de reabilitação física e o seguimento do curso clínico da doença. / Abnormal balance in patients with Multiple Sclerosis (MS) represents one of the major symptoms reported and emerging since the onset of the disease in MS patients with subtle impairments. These deficits are usually underestimated by common neurological clinical evaluation. In this study, our objective was to report balance alteration in MS patients and distinguish clinical alterations between MS patients with and without balance disorders complaints. Ninety eight MS patients were evaluated, with Expanded Disability Status Scale (EDSS) score between 0 and 4.5. Patients were divided into two groups according to their complaint about balance disorders (Without complaint - GS; with complaint - GQ). Patients were evaluated by qualitative balance assessments (Berg Balance Scale - BERG and Dynamic Gait Index - DGI), perception of subjective visual vertical test (SVV), fatigue severity scale (FSS) and Beck depression inventory (BDI). Both groups were constituted by forty-nine patients. GQ patients had higher EDSS score than GS patients, however, both were classified with mild impairments by the scale. These data reinforce the concept that EDSS is not sensitive to detect subtle impairments. GQ had worse performance in balance clinical tests (BERG and DGI) than GS patients. They had also worse perception of verticality and high levels of fatigue and depression than patients without balance disorders complaints. In addition, significant correlations were found between EDSS and BERG, DGI, SVV test and FSS. EDSS and BDI were not significantly correlated. These results showed that several clinical features must be considered to characterize balance disorders in MS. Balance clinical assessments and fatigue evaluation must be added to functional classification, allowing subtle impairments to be detected. Better characterization of balance disorders in MS improves the development of individual rehabilitation programs and allows the clinical course of disease follow-up

Parmi les nombreuses recherches en matière de planification et de contrôle des mouvements pour des applications robotiques, l'humanité n'a jamais atteint un point où les robots seraient parfaitement fonctionnels et autonomes dans des environnements dynamiques. Bien qu'il soit controversé de discuter de la nécessité de ces robots, il est très important d'aborder les problèmes qui nous empêchent de réaliser un tel niveau d'autonomie. Ce travail de recherche tente de résoudre ces problèmes qui séparent ces deux modes de fonctionnement avec un accent particulier sur les incertitudes. Les impossibilités pratiques de capacités de détection précises entraînent une variété d'incertitudes dans les scénarios où le robot est mobile ou l'environnement est dynamique. Ce travail se concentre sur le développement de stratégies intelligentes pour améliorer la capacité de gérer les incertitudes de manière robuste dans les robots humanoïdes et industriels. Premièrement, nous nous concentrerons sur un cadre dynamique d'évitement d'obstacles proposé pour les robots industriels équipés de capteurs de peau pour la réactivité. La planification des chemins et le contrôle des mouvements sont généralement formalisés en tant que problèmes distincts de la robotique, bien qu'ils traitent fondamentalement du même problème. Les espaces de configuration à grande dimension, l'environnement changeant et les incertitudes ne permettent pas la planification en temps réel de mouvement exécutable. L'incapacité fondamentale d'unifier ces deux problèmes nous a amené à gérer la trajectoire planifiée en présence de perturbations et d'obstacles imprévus à l'aide de différents mécanismes d'exécution et de déformation de trajectoire. Le cadre proposé utilise «Stack of Tasks», un contrôleur hiérarchique utilisant des informations de proximité, grâce à un planificateur de chemin réactif utilisant un nuage de points pour éviter les obstacles. Les expériences sont effectuées avec les robots PR2 et UR5 pour vérifier la validité du procédé à la fois en simulation et in-situ. Deuxièmement, nous nous concentrons sur une stratégie pour modéliser les incertitudes des paramètres inertiels d'un robot humanoïde dans des scénarios de tâches d'équilibre. Le contrôle basé modèles est devenu de plus en plus populaire dans la communauté des robots à jambes au cours des dix dernières années. L'idée clé est d'exploiter un modèle du système pour calculer les commandes précises du moteur qui entraînent le mouvement désiré. Cela permet d'améliorer la qualité du suivi du mouvement, tout en utilisant des gains de rétroaction plus faibles, ce qui conduit à une conformité plus élevée. Cependant, le principal défaut de cette approche est généralement le manque de robustesse aux erreurs de modélisation. Dans ce manuscrit, nous nous concentrons sur la robustesse du contrôle de la dynamique inverse à des paramètres inertiels erronés. Nous supposons que ces paramètres sont connus, mais seulement avec une certaine précision. Nous proposons ensuite un contrôleur basé optimisation, rapide d'exécution, qui assure l'équilibre du robot malgré ces incertitudes. Nous avons utilisé ce contrôleur en simulation pour effectuer différentes tâches d'atteinte avec le robot humanoïde HRP-2, en présence de diverses erreurs de modélisation. Les comparaisons avec un contrôleur de dynamique inverse classique à travers des centaines de simulations montrent la supériorité du contrôleur proposé pour assurer l'équilibre du robot. / Amidst a lot of research in motion planning and control in concern with robotic applications, the mankind has never reached a point yet, where the robots are perfectly functional and autonomous in dynamic settings. Though it is controversial to discuss about the necessity of such robots, it is very important to address the issues that stop us from achieving such a level of autonomy. Industrial robots have evolved to be very reliable and highly productive with more than 1.5 million operational robots in a variety of industries. These robots work in static settings and they literally do what they are programmed for specific usecases, though the robots are flexible enough to be programmed for a variety of tasks. This research work makes an attempt to address these issues that separate both these settings in a profound way with special focus on uncertainties. Practical impossibilities of precise sensing abilities lead to a variety of uncertainties in scenarios where the robot is mobile or the environment is dynamic. This work focuses on developing smart strategies to improve the ability to handle uncertainties robustly in humanoid and industrial robots. First, we focus on a dynamical obstacle avoidance framework proposed for industrial robots equipped with skin sensors for reactivity. Path planning and motion control are usually formalized as separate problems in robotics. High dimensional configuration spaces, changing environment and uncertainties do not allow to plan real-time motion ahead of time requiring a controller to execute the planned trajectory. The fundamental inability to unify both these problems has led to handle the planned trajectory amidst perturbations and unforeseen obstacles using various trajectory execution and deformation mechanisms. The proposed framework uses ’Stack of Tasks’, a hierarchical controller using proximity information to avoid obstacles. Experiments are performed on a UR5 robot to check the validity of the framework and its potential use for collaborative robot applications. Second, we focus on a strategy to model inertial parameters uncertainties in a balance controller for legged robots. Model-based control has become more and more popular in the legged robots community in the last ten years. The key idea is to exploit a model of the system to compute precise motor commands that result in the desired motion. This allows to improve the quality of the motion tracking, while using lower feedback gains, leading so to higher compliance. However, the main flaw of this approach is typically its lack of robustness to modeling errors. In this paper we focus on the robustness of inverse-dynamics control to errors in the inertial parameters of the robot. We assume these parameters to be known, but only with a certain accuracy. We then propose a computationally-efficient optimization-based controller that ensures the balance of the robot despite these uncertainties. We used the proposed controller in simulation to perform different reaching tasks with the HRP-2 humanoid robot, in the presence of various modeling errors. Comparisons against a standard inverse-dynamics controller through hundreds of simulations show the superiority of the proposed controller in ensuring the robot balance.

As alterações do equilíbrio postural representam um dos principais sintomas relatados pelos pacientes com Esclerose Múltipla (EM), surgem logo no início da doença em pacientes minimamente comprometidos e são consideravelmente incapacitantes . Esses déficits são muitas vezes pouco valorizados pelas avaliações clínicas neurológicas convencionais. Os objetivos desse estudo foram descrever as alterações de equilíbrio em pacientes com diagnóstico de EM e diferenciar as alterações clínicas entre pacientes com e sem queixa de desequilíbrio. Foram avaliados 98 pacientes, classificados através da Escala Expandida do Estado de Incapacidade (EDSS) entre 0 e 4,5. Os pacientes foram divididos em 2 grupos de acordo com a presença da queixa de desequilíbrio (Grupo sem queixa - GS; Grupo com queixa - GQ). O protocolo de avaliação constou de escalas observacionais do equilíbrio (Escala de equilíbrio de BERG: EEB e Índice de marcha dinâmica: DGI), avaliação da percepção de vertical visual subjetiva (VVS), Escala de Severidade da Fadiga (FSS) e através do Inventário Beck de Depressão (BDI). Os grupos GS e GQ foram compostos por 49 pacientes cada um. Não houve diferença estatística na idade dos indivíduos entre os grupos, porém encontramos diferença significativa entre o tempo de diagnóstico da EM entre ambos. Foram encontradas diferenças significativas entre GS e GQ para os valores de EDSS, no entanto ambos os grupos permaneceram dentro da classificação de incapacidade leve da escala. Esse dado reforça a ideia de que o EDSS é insensível para detectar déficits funcionais sutis. Também foram encontradas diferenças significativas nos testes clínicos de equilíbrio, refletindo que o GQ apresenta pior equilíbrio estático e dinâmico, EEB e DGI, respectivamente. O GQ apresentou pior percepção da vertical gravitacional, VVS, com valor estatisticamente significativo, além de um pior relato nas avaliações de fadiga (FSS), e depressão (BDI). Adicionalmente, observamos correlações negativas significantes entre os valores de EDSS os testes de equilíbrio (EEB e DGI), e correlações positivas significantes entre o EDSS e a avaliação da VVS e FSS. Não observamos correlação entre o EDSS e BDI. A relação entre o teste da VVS e os testes observacionais do equilíbrio também se mostrou estatisticamente significante. Os resultados do nosso estudo evidenciaram que vários aspectos devem ser considerados para caracterizarmos adequadamente as alterações de equilíbrio em indivíduos com EM. Os testes clínicos do equilíbrio postural e a avaliação da fadiga devem ser adicionados à avaliação funcional de pacientes com EM, permitindo dessa forma, que os déficits funcionais mais sutis sejam detectados. Nenhum teste clínico isolado é capaz de avaliar com precisão tais alterações. Sendo assim, concluímos que os testes propostos contemplam a avaliação da complexa rede de informações responsáveis pela manutenção do controle postural e contribuem para a melhor caracterização das alterações do equilíbrio postural na EM, facilitando a elaboração de protocolos individuais de reabilitação física e o seguimento do curso clínico da doença. / Abnormal balance in patients with Multiple Sclerosis (MS) represents one of the major symptoms reported and emerging since the onset of the disease in MS patients with subtle impairments. These deficits are usually underestimated by common neurological clinical evaluation. In this study, our objective was to report balance alteration in MS patients and distinguish clinical alterations between MS patients with and without balance disorders complaints. Ninety eight MS patients were evaluated, with Expanded Disability Status Scale (EDSS) score between 0 and 4.5. Patients were divided into two groups according to their complaint about balance disorders (Without complaint - GS; with complaint - GQ). Patients were evaluated by qualitative balance assessments (Berg Balance Scale - BERG and Dynamic Gait Index - DGI), perception of subjective visual vertical test (SVV), fatigue severity scale (FSS) and Beck depression inventory (BDI). Both groups were constituted by forty-nine patients. GQ patients had higher EDSS score than GS patients, however, both were classified with mild impairments by the scale. These data reinforce the concept that EDSS is not sensitive to detect subtle impairments. GQ had worse performance in balance clinical tests (BERG and DGI) than GS patients. They had also worse perception of verticality and high levels of fatigue and depression than patients without balance disorders complaints. In addition, significant correlations were found between EDSS and BERG, DGI, SVV test and FSS. EDSS and BDI were not significantly correlated. These results showed that several clinical features must be considered to characterize balance disorders in MS. Balance clinical assessments and fatigue evaluation must be added to functional classification, allowing subtle impairments to be detected. Better characterization of balance disorders in MS improves the development of individual rehabilitation programs and allows the clinical course of disease follow-up

Title: Evaluation of postural stability of athletes - a literature review Objectives: Thesis will address retrieval processing rating Dynamic Postural Stability of athletes . Compares analysis or results of research or investigations of different laborers working with this theme. It also mentions tests and machines used in clinical practice. It also investigates in what sports was postural stability tested and how or with what results. The most advanced, currently the most recognized dynamic posturography with impartial value is EquiTest device from NeuroCom. Therefore, the practical part focuses primarily on the results of examination of this device and make statistics about that. Methods: The diploma thesis has descriptive and analytical character. It is elaborate as a literary review . Results: The study includes 142 studies, of which only 11 concern the assessment of postural stability of athletes. Sports disciplines include tennis, football, baseball, tai-chi, taekwondo, gymnastics, basketball, softball. Entire EquiTest testing battery (which contains 7 test in total - Sensory Organization Test, Motor Coordination and Control Test, Adaptation Test, Unilateral Stance Test, Limits Of Stability Test, Rhytmics Weight Shift, Weight Bearing Squat) is almost never used in assessments although it's a...

In children, joint hypermobility (typified by structural instability of joints) manifests clinically as neuro-muscular and musculo-skeletal conditions and conditions associated with development and organization of control of posture and gait (Finkelstein, 1916; Jahss, 1919; Sobel, 1926; Larsson, Mudholkar, Baum and Srivastava, 1995; Murray and Woo, 2001; Hakim and Grahame, 2003; Adib, Davies, Grahame, Woo and Murray, 2005:). The process of control of the relative proportions of joint mobility and stability, whilst maintaining equilibrium in standing posture and gait, is dependent upon the complex interrelationship between skeletal, muscular and neurological function (Massion, 1998; Gurfinkel, Ivanenko, Levik and Babakova, 1995; Shumway-Cook and Woollacott, 1995). The efficiency of this relies upon the integrity of neuro-muscular and musculo-skeletal components (ligaments, muscles, nerves), and the Central Nervous System’s capacity to interpret, process and integrate sensory information from visual, vestibular and proprioceptive sources (Crotts, Thompson, Nahom, Ryan and Newton, 1996; Riemann, Guskiewicz and Shields, 1999; Schmitz and Arnold, 1998) and development and incorporation of this into a representational scheme (postural reference frame) of body orientation with respect to internal and external environments (Gurfinkel et al., 1995; Roll and Roll, 1988). Sensory information from the base of support (feet) makes significant contribution to the development of reference frameworks (Kavounoudias, Roll and Roll, 1998). Problems with the structure and/ or function of any one, or combination of these components or systems, may result in partial loss of equilibrium and, therefore ineffectiveness or significant reduction in the capacity to interact with the environment, which may result in disability and/ or injury (Crotts et al., 1996; Rozzi, Lephart, Sterner and Kuligowski, 1999b). Whilst literature focusing upon clinical associations between joint hypermobility and conditions requiring therapeutic intervention has been abundant (Crego and Ford, 1952; Powell and Cantab, 1983; Dockery, in Jay, 1999; Grahame, 1971; Childs, 1986; Barton, Bird, Lindsay, Newton and Wright, 1995a; Rozzi, et al., 1999b; Kerr, Macmillan, Uttley and Luqmani, 2000; Grahame, 2001), there has been a deficit in controlled studies in which the neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility have been quantified and considered within the context of organization of postural control in standing balance and gait. This was the aim of this project, undertaken as three studies. The major study (Study One) compared the fundamental neuro-muscular and musculo-skeletal characteristics of 15 children with joint hypermobility, and 15 age (8 and 9 years), gender, height and weight matched non-hypermobile controls. Significant differences were identified between previously undiagnosed hypermobile (n=15) and non-hypermobile children (n=15) in passive joint ranges of motion of the lower limbs and lumbar spine, muscle tone of the lower leg and foot, barefoot CoP displacement and in parameters of barefoot gait. Clinically relevant differences were also noted in barefoot single leg balance time. There were no differences between groups in isometric muscle strength in ankle dorsiflexion, knee flexion or extension. The second comparative study investigated foot morphology in non-weight bearing and weight bearing load conditions of the same children with and without joint hypermobility using three dimensional images (plaster casts) of their feet. The preliminary phase of this study evaluated the casting technique against direct measures of foot length, forefoot width, RCSP and forefoot to rearfoot angle. Results indicated accurate representation of elementary foot morphology within the plaster images. The comparative study examined the between and within group differences in measures of foot length and width, and in measures above the support surface (heel inclination angle, forefoot to rearfoot angle, normalized arch height, height of the widest point of the heel) in the two load conditions. Results of measures from plaster images identified that hypermobile children have different barefoot weight bearing foot morphology above the support surface than non-hypermobile children, despite no differences in measures of foot length or width. Based upon the differences in components of control of posture and gait in the hypermobile group, identified in Study One and Study Two, the final study (Study Three), using the same subjects, tested the immediate effect of specifically designed custom-made foot orthoses upon balance and gait of hypermobile children. The design of the orthoses was evaluated against the direct measures and the measures from plaster images of the feet. This ascertained the differences in morphology of the modified casts used to mould the orthoses and the original image of the foot. The orthoses were fitted into standardized running shoes. The effect of the shoe alone was tested upon the non-hypermobile children as the non-therapeutic equivalent condition. Immediate improvement in balance was noted in single leg stance and CoP displacement in the hypermobile group together with significant immediate improvement in the percentage of gait phases and in the percentage of the gait cycle at which maximum plantar flexion of the ankle occurred in gait. The neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility are different from those of non-hypermobile children. The Beighton, Solomon and Soskolne (1973) screening criteria successfully classified joint hypermobility in children. As a result of this study joint hypermobility has been identified as a variable which must be controlled in studies of foot morphology and function in children. The outcomes of this study provide a basis upon which to further explore the association between joint hypermobility and neuro-muscular and musculo-skeletal conditions, and, have relevance for the physical education of children with joint hypermobility, for footwear and orthotic design processes, and, in particular, for clinical identification and treatment of children with joint hypermobility.

Title: Falls in the eldery Objectives: The aim of this diploma thesis is to analyze and classify knowlage about falls in the eldery during usual daily activities with focus on prevencion and detection of falls by useing wearable and non wearable systems for detecting falls in the eldery. Methods: This diploma thesis is wrote with the metod of literary research through professional literature, books and articles in both Czech and English was used in the work. To meet the objectives that have been provided were selected examples that helped analyze and clarify the issue of falls in eldery. Results: The sources of professional literature have shown that the falls in the eldery are very serious issue of society. At the same time, it is important to be aware of their possible health and economic impacts, as well as how to prevent them. The correct use of fixation shoes has been shown to reduce the risk of fall. Many fall detection devices are able to call for timely help. Last but not least, knowlage of this issue could help to improve and innovate the fall detecion and prevention systems. Keywords: falls in eldery, senior immobilization, biomechanics of falls, detection and prevention of senior falls, osteoporosis, senior bone aging, senior cartilage aging, biomechanics of senior walking, walking...