Orientador: Maria de Fátima de Campos Françozo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T06:11:47Z (GMT). No. of bitstreams: 1 Rinaldi_LiduinaMariaSolon_M.pdf: 1695692 bytes, checksum: 577a1f1b0b8329aed88221f3c9472332 (MD5) Previous issue date: 2012 / Resumo: Paralisia Cerebral é a condição mais frequente com a qual o fisioterapeuta infantil se depara no seu dia a dia. Este estudo buscou conhecer as famílias de crianças com Paralisia Cerebral e elencar aspectos que devem ser considerados ao se elaborar um Programa de Intervenção Centrado na Família para o Sistema Único de Saúde. Realizou-se uma pesquisa exploratório-descritiva a partir de abordagem qualitativa desenvolvida por meio de entrevista semi-estruturada, realizada nos domicílios das famílias, e pesquisa documental. Participaram do trabalho, representantes de famílias de crianças com Paralisia Cerebral, residentes na região noroeste da cidade de Campinas, tendo em vista a inserção do pesquisador nesta área. Os prontuários das famílias foram previamente selecionados pelas equipes locais de saúde, a partir da solicitação do pesquisador e orientação das coordenadoras das unidades básicas envolvidas. Os resultados do trabalho indicaram que as famílias encontram-se satisfeitas com o modelo de intervenção recebido, que suas participações nas tomadas de decisão relacionadas às intervenções da fisioterapia são limitadas e que recebem pouca informação sobre a Paralisia Cerebral. A pesquisa apontou para a necessidade de estudos que possam subsidiar uma proposta de Intervenção Centrada na Família para o Sistema Único de Saúde como: discutir a formação atual do fisioterapeuta e dos demais profissionais da saúde nesta área; os resultados obtidos com os modelos atuais de intervenção; os programas sociais existentes voltados ao suporte social e empoderamento das famílias para os cuidados da criança com Paralisia Cerebral e como as atuais políticas públicas se relacionam com esta proposta de intervenção / Abstract: Cerebral Palsy is the most common condition seen by the pediatric physiotherapist. This study sought to get to know the families of children with Cerebral Palsy and list aspects that should be considered in the development of a family-centered intervention program for Unified Healthcare System. This exploratory, descriptive study with a qualitative approach was based on a semi-structured interview done at the homes of the study families and on document research. The study participants were family members of children with Cerebral Palsy living in the northwest region of the city of Campinas sine the researcher's work is in this area. The coordinators of the primary healthcare units located in the study area previously selected the medical records of the families according to the researcher's instructions. The results of the study indicate that the families are satisfied with the intervention model but their participation on the choice of interventions administered by the therapist is limited and little information is given to them about Cerebral Palsy. The study also indicated the need of new studies that can found a family-based intervention proposal for Unified Healthcare System. Such studies should discuss the current academic curriculum of the physiotherapist and other health professionals that work in this area, results obtained by the current intervention models, social programs that provide social support and empowerment for families that care for children with Cerebral Palsy and how public policies relate with this intervention proposal / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

Orientador: Maria Valeriana Leme de Moura Ribeiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T12:23:12Z (GMT). No. of bitstreams: 1 Airoldi_MarinaJunqueira_M.pdf: 5702275 bytes, checksum: 3c2bd8bd99c4abe1bd021c54e7de91e9 (MD5) Previous issue date: 2012 / Resumo: Objetivos: O Objetivo deste estudo foi descrever apresentação clínica da doença, a evolução neuromotora, assim como a epilepsia. Métodos: Foram incluídas no estudo 18 crianças nascidas a termo. A avaliação ocorreu nas idades entre 6 e 16 anos utilizando se o teste EB Teste. O estudo foi retrospectivo quanto aos dados relacionados a antecedentes, diagnóstico do AVC e evolução quanto à epilepsia e transversal quanto à avaliação neuromotora. Resultados: Das 18 crianças estudadas, 4 (22%) foram diagnosticadas com AVCI depois dos 3 meses de idade, principalmente pelos sinais de assimetria; 14 crianças (77%) foram diagnosticadas na fase aguda, sendo que 11 (79%) apresentaram convulsões, 5 (36%), hipotonia e 3 (21%) sucção débil. Na evolução das 18 crianças, 11 (61%) desenvolveram epilepsia. As crianças que tiveram crises na fase aguda apresentaram probabilidade significativamente maior de evoluir com epilepsia (p <0.05). Em relação à neuroimagem, 17 indivíduos apresentaram comprometimento na Artéria Cerebral Média, com acometimento do hemisfério esquerdo em 13. Foram diagnosticadas com Paralisia Cerebral com hemiparesia 16 crianças. Em relação à escala neuromotora aplicada, EB teste, todas as crianças avaliadas apresentaram déficit em todas as dimensões estudadas. Crianças com lesões mais extensas apresentaram pior desempenho motor. Não houve recorrência do AVC. Conclusão: É importante identificar sintomas e sinais na fase aguda, permitindo que profissionais confirmem com imagem o comprometimento vascular no período perinatal. É necessário valorizar acompanhamento ambulatorial, identificando anormalidades neuromotoras e epilepsia na evolução, promovendo tratamento adequado para melhora da qualidade de vida destas crianças / Abstract: Objectives: The aim of this study was to describe clinical presentations, neurodevelopmental and epilepsy outcomes of IPS in children. Methods: A retrospective study was conducted in a children population and it was evaluated term infants ! 38 weeks gestational age, aged between 6 and 16 years, with diagnosis of IPS. The diagnosis was confirmed in 18 cases by Neuroradiology (CT or MRI). We studied the neuroimaging and data from acute phase as well as the evolution of these children through neuromotor scale IB Test. Results: In 18 cases, 4 (22%) was diagnosed with brain infarction after 3 months of age, especially for signs of asymmetry. Of the 14 remaining patients (77%) diagnosed early, 11(79%) had seizures, 5 (36%) had hypotonia and 3 (21%) had signs of low suction. In the group of 18, 11 (61%) evolved with epilepsy and children with seizures in the acute phase were more likely to develop epilepsy (p <0.05). Large cortically based infarcts were the most common pattern and, in 17 cases, it affected the middle cerebral artery territory involving the left size in 13. 16 children were diagnosed with cerebral palsy hemiparetic. In neuromotor scale applied, IB Test, all children presented deficit in all dimensions studied. Children with more extensive lesions had worse motor performance. There was no recurrence of stroke. Conclusion: It is important to understand symptoms and signs of acute allowing professionals to carry out identification of vascular involvement in the perinatal period. It is necessary to enhance outpatient identifying neuromotor abnormalities and epilepsy in the evolution promoting appropriate treatment to improve quality of life for these child / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

Abstract Cessation of the blood circulation for some time during surgery of the aortic arch and repair of congenital heart defects is normally required to allow a bloodless operation field. Hypothermia is the most important mechanism for end-organ protection, particularly the brain, during such operations. Cardiopulmonary bypass is used for core cooling before total hypothermic circulatory arrest (HCA) or selective cerebral perfusion (SCP) are initiated. During hypothermic cardiopulmonary bypass, pH can be managed according to either pH- or alpha-stat principles. In the present work, the optimal pH management strategy for operations requiring HCA or SCP was explored. An experimental porcine model was used. Firstly, outcome was evaluated in a HCA model using either the α- or pH-stat perfusion strategy (I). Secondly, we sought to determine which acid-base management is more effective in attenuating ischemic brain injury during combined HCA and embolization conditions (II). In the third study, the impact of propofol anesthesia and α-stat perfusion strategy on outcome was explored (III). Finally, the acute effects of perfusion strategies in a SCP porcine were compared (IV). Hemodynamics, temperature, EEG (I-III), brain microdialysis, intracranial pressure (I-III), brain tissue oxygen partial pressure (I-III), and intravital microscopy (IV) were monitored intraoperatively. In the chronic studies, survival, postoperative neurologic recovery and brain histopathologic examination were evaluated (I-III). pH-stat strategy was associated with superior outcome compared to the α-stat strategy during a 75-minute period of deep HCA (I). In addition, despite the pH-stat strategy-related cerebral vasodilatation, this method provided better neuroprotection in a setting of cerebral particle embolization prior to a 25-minute period of deep HCA (II). Propofol anesthesia combined with α-stat perfusion strategy was observed to deteriorate the brain injury during HCA evaluated by key brain microdialysis parameters (III). Finally, when employing moderately hypothermic SCP, the differences between pH- and α-stat strategies in cerebral metabolism and microcirculation were minimal. These findings are clinically relevant since α-stat perfusion strategy is still the most commonly used acid-base perfusion strategy during hypothermic cardiopulmonary bypass in adults, and propofol one of the most used anesthetics in clinical practice. It is also noteworthy that the pH-stat strategy is not currently used in adults because of the perceived increased risk of atherosclerotic embolization. However, the advantage of pH-stat strategy over α-stat strategy could not be observed when employing SCP.

Abstract In the repair of complex congenital heart defects or in surgery of the aortic arch, normal circulation may be temporarily halted to ensure a clean, bloodless operation field. The brain is the organ most vulnerable to ischemic injury during this no-flow period, and the mortality and morbidity of these procedures today consists mostly of neurological complications. Hypothermia decreases the need for oxygen and other metabolites, and cooling the patient with an extracorporeal heart-lung machine can provide enough time to perform the necessary surgical procedures during a circulatory standstill. This procedure is referred to as hypothermic circulatory arrest (HCA). Sometimes the cerebral circulation can be maintained even if the rest of the body undergoes circulatory arrest, and this strategy, involving separate catheterization of brain-destined vessels, is referred to as selective cerebral perfusion (SCP). In this work, four separate brain protection strategies were evaluated. Two studies were performed on a surviving porcine model (I, II) to evaluate neurological recovery as well as cerebral metabolism and histopathology, and two were acute in design (III, IV), employing the modern technology of intravital microscopy to examine cerebral microcirculation. The first study (I) showed that the administration of hypertonic saline dextran (HSD) led to a decrease in intracranial pressure, improved brain metabolism, better neurological recovery and less histopathological injury of the brain tissue in association with HCA. In the second study (II) a novel pharmacological molecule, levosimendan, reduced the intracranial pressure during the operation, but no improvement in terms of cerebral metabolism, neurological recovery or histopathological brain injury was observed after HCA. In the third study (III), real-time intravital microscopy showed that in association with HCA, a leukocyte depleting filter (LDF) attached to the cardiopulmonary bypass circuit reduces the number of activated leukocytes in cerebral microcirculation. In the fourth study (IV), cerebral metabolism and microcirculation were similar during SCP independent of the acid-base management strategy. The results of this work suggest that HSD could be assessed in human trials, that levosimendan needs further studies to optimize its potential, that the LDF functions as designed and that the differences between the α- and the pH-stat acid-base management strategies with SCP did not differ in moderate hypothermia.

The P300 component of the average evoked potential was recorded at Pz during two divided visual field tasks. During a lexical decision task, reaction time and P300 latency were faster to stimuli in the right visual field, indicating that the latency of the P300 may be a useful measure in laterality research. A right visual field advantage was obtained for reaction time in a face perception task and the P300 latency difference showed a similar but non-significant advantage. Use of the P300 latency to assess the validity of the assumptions underlying the application of an additive factors model to divided visual field studies of cerebral assymetry was discussed. The present evidence suggests that the assumptions are valid. / Arts, Faculty of / Psychology, Department of / Graduate

Orientador: Yvens Barbosa Fernandes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T09:26:09Z (GMT). No. of bitstreams: 1 Zullo_JoaoFlavioDaniel_M.pdf: 4994617 bytes, checksum: 7f874ff0599b4cec270f92a8010dc856 (MD5) Previous issue date: 2014 / Resumo: As hemorragias intracerebrais supratentoriais espontâneas, correspondem a cerca de 10 a 20% de todos os acidentes vasculares cerebrais (AVC), acometendo mais de 4 milhões de pessoas por ano em todo o mundo(13). Apresenta as mais altas taxas de morbi-mortalidade dentre os diferentes tipos de AVC, sendo que a mortalidade desta patologia alcança índices ao redor de 30-40% dos doentes, além de grande número de pacientes com seqüelas graves, sendo que seu principal fator de risco é a hipertensão arterial sistêmica (HAS). Desde o trabalho de McKissock(1) at al em 1961, vem se tentando descobrir qual a melhor maneira para tratar pacientes que apresentam tais hemorragias. Com esse intuito, avaliamos 67 pacientes atendidos no HC/Unicamp e no Hospital Estadual de Sumaré/Unicamp (HES) entre os anos de 2007 e 2012, sendo 41 com hemorragias de núcleos da base e 26 com hematomas lobares. Estudamos a influência de vários fatores no prognóstico dos pacientes com hemorragias intracerebrais supratentoriais espontâneas, como idade, nível de consciência à admissão hospitalar (usando-se a escala de coma de Glasgow), profundidade do hematoma em relação à superfície cerebral, volume do hematoma, presença de hemorragia intraventricular, desvio de linha média, tempo entre ictus hemorrágico e cirurgia e tipo de tratamento (craniotomia ou conservador). O nível de consciência na chegada ao hospital é fator determinante com relação ao prognóstico funcional avaliado em 30 dias após o ictus, independente da modalidade de tratamento adotada, porém com diferentes nuances dependendo da localização da lesão (núcleos da base ou lobar). Algumas particularidades, como tamanho do hematoma, podem determinar o resultado prognóstico funcional, assim como o tratamento cirúrgico, hemoventrículo e desvio de linha média (DLM) tendem a influenciar o prognóstico / Abstract: Spontaneous supratentorial intracerebral hemorrhages correspond to 10 to 20% of all stroke cases, affecting more than 4.000.000 people/year worldwide(13). It shows the highest rates of morbidity and mortality among the different types of stroke. The mortality of this disease achieves around 30- 40% of all patients, besides a large number of pacientes with severe sequels. Its main risk factor is high blood pressure. Since McKissock(1) at al published his work in 1961, researchers are trying to figure out the best way to treat patients with this type of hemorrhage. Aiming this situation, we evaluated 67 patients treated at HC/Unicamp and State Hospital of Sumaré (HES)/Unicamp between 2007 and 2012, with 41 basal ganglia and 26 lobar hematomas. We studied the influence of several factors on the prognosis of patients with spontaneous supratentorial intracerebral hemorrhage, such as age, consciousness at hospital admision (using the Glasgow Coma Scale), hematoma depth, hematoma volume, intraventricular hemorrhage, midline shift, time between bleeding and surgery and treatment option (craniotomy or conservative). The consciousness on arrival at the hospital is a determinant factor relative to functional outcome in 30 days after bleeding, regardless of treatment modality adopted, but with different nuances depending on the lesion location (basal ganglia or lobar). Some special features, like the size of the hematoma, can determine the funcional outcome, as well as surgery, ventricular hemorrhage and midline shift have a trend to influence prognosis / Mestrado / Neurologia / Mestre em Ciências Médicas

Orientador: Sylvia Maria Ciasca / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-07-31T21:10:28Z (GMT). No. of bitstreams: 1 Tabaquim_MariadeLourdesMerighi_D.pdf: 41956577 bytes, checksum: 0fd82f81a946a050e07d0334d8bac163 (MD5) Previous issue date: 2002 / Resumo: Este trabalho teve por objetivo o levantamento e a análise de dados relativos a avaliação neuropsicológica de crianças na faixa etária de sete a doze anos de idade, ambos os sexos, nível sócio-econômico médio e médio-baixo, freqüentando o ensino acadêmico regular e especializado da rede pública, nas cidades de Bauru e Campinas. O estudo analisou a relação dos processos de aprendizagem em crianças com lesões neurológicas, do tipo paralisia cerebral na forma hemiparética, com e sem deficiência mental, e em crianças sem deficiência neurológica e mental, com queixa de aprendizagem. O grupo de controle, formado por crianças sem queixa acadêmica e de desenvolvimento, teve como objetivo referenciar o instrumento não padronizado, ENP - Exame Neuropsicológico. Oitenta e cinco crianças, formaram quatro categorias distintas: Grupo I-PC/SDM, Grupo II-PC/CDM, Grupo III-N/CDA e Grupo IV-N/SDM. Os procedimentos avaliativos, constaram de testes padronizados de nível mental, pedagógico, viso-motor, e não padronizados, como o ENP -Exame Neuropsicológico, Inventário Escolar e Anamnese. Foram utilizados na análise, os dados da Avaliacão Neurológica e de neuro-imagem, estatísticamente comparados à luz da literatura, considerando-se suas implicações no conceito, classificação e referencial dos distúrbios da aprendizagem. Os resultados permitiram evidenciar que a condição lesional da criança hemiparética não constituiu desvantagem no desenvolvimento e aquisição das funções corticais, relacionadas à aprendizagem. Padrões correlatos de respostas entre os grupos, sugeriram a ocorrência de conexões neurológicas decorrentes da plasticidade neuronal, nos grupos lesionados. O conteúdo desta pesquisa atestou significativo grau de convergência entre as áreas especializadas de Psicologia, Neurologia, Pedagogia e Fonoaudiologia, evidenciando a importância da relação interdisciplinar, partilhando do mesmo interesse na Avaliação Neuropsicológica / Abstract: The objective of this study was to survey and analyze data related to the neuropsychological evaluation of children from seven to twelve years of age, male and female coming from lower-middle and middle class, attending regular and specialized public schools in the cities of Bauru and Campinas. The study analyzed the relationship of the learning process of children with neurological damages such as cerebral palsy in the hemiparethic convulsive way, with and without mental deficiency, and of children without neurological deficiency but with learning problems reporto The control-group, which was formed by children without learning and development report, aimed to refer to the non-standardized tool ENP - Neuropsychological Test. Eighty-five children formed four distinct categories: Group I (PC/SDM), Group II (PC/CDM), Group III (N/CDA) and Group IV (N/SDM). The evaluation procedures consisted of standardized tests of mental, pedagogical, and visuomotor level, neuropsychological test, questionnaires to the child and to the teacher, anamnesis, and a complimentary neuroimage test. The data were statistically analyzed and compared in the light of literature, by considering their implications in the concept, classification and reference to the learning disorders. The results have allowed to highlight that the damaging condition of the hemiparethic child does not constitute impairment in the development and acquisition of cortical functions related to the learning processo Correlate standards of answers among the groups suggest the occurrence of neurological connections coming from the neuronal plasticity as far as the damaged groups are concerned. The content of this research has attested a meaningful degree of convergence among the areas of Psychology, Neurology, Pedagogy and Speech Therapy, highlighting the importance of an interdisciplinary relationship sharing the same interest in the Neuropsychological Evaluation / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas

Orientador: Rodrigo Bazan / Resumo: Objetivo: Uma revisão sistemática para investigar o impacto da estimulação cerebral não-invasivas (i.e., estimulação transcraniana de corrente direta (ETCC), estimulação magnética transcraniana repetitiva (EMTr) e Theta-Burst (TBS)) em comparação com placebo para negligência espacial unilateral após acidente vascular encefálico (NEU). Bases de dados: Pesquisas na MEDLINE, EMBASE, CENTRAL, CINAHL e LILACS até julho de 2017. Seleção de estudos: Ensaios controlados randomizados (ECRs) e não-ECRs. Extração de dados: Dois pares de revisores examinaram de forma independente artigos potencialmente elegíveis, extraíram dados dos estudos incluídos sobre populações, intervenções e resultados e avaliaram seu risco de viés. Utilizamos a abordagem GRADE para avaliar a certeza geral da evidência por resultado. Síntese de dados: 12 ensaios randomizados, incluindo 273 participantes, e quatro não- ECRs, incluindo 94 participantes, mostraram ser elegíveis. Os resultados fornecidos pelos ECR sugerem um benefício no NEU geral medido pelo Teste de Bissecção de Linhas com estimulação cerebral não invasiva em comparação com placebo (SMD – 2,35, IC 95% -3,72, -0,98; p = 0,0001; I2 = 85%); particularmente a EMTr produziu resultados que foram consistentes com a meta-análise geral (SMD -2,82, IC 95% -3,66, -1,98; p = 0,09; I2 = 0%). Os resultados de dois ECRs que comparam o EMTr com placebo também sugeriram um benefício no NEU geral medido pelo Motor Free Perception Test com EMTr 1Hz(SMD 1,46, IC 95% 0... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: A systematic review to investigate the impact of non-invasive brain stimulations (i.e., transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and theta-burst (TBS)) compared to sham for unilateral spatial neglect after stroke. Data sources: Searches of MEDLINE, EMBASE, CENTRAL, CINAHL, and LILACS up to July 2017. Study selection: Randomized controlled trials (RCTs) and non-RCTs. Data extraction: Two pairs of reviewers independently screened potentially eligible articles, extracted data from included studies on populations, interventions and outcomes, and assessed their risk of bias. We used the GRADE approach to rate overall certainty of the evidence by outcome. Data synthesis: 12 randomized trials including 273 participants, and four non-RCTs including 94 participants proved eligible. Results provided by RCTs suggest a benefit in overall USN measured by Line Bisection Test with non-invasive brain stimulations in comparison to sham (SMD -2.35, 95% CI -3.72, -0.98; p = 0.0001; I2=85%); particularly the rTMS yielded results that were consistent with the overall meta-analysis (SMD -2.82, 95% CI -3.66, -1.98; p = 0.09; I2=0%). Results from two RCTs comparing rTMS with sham also suggested a benefit in overall USN measured by Motor Free Visual Perception Test with 1 Hz (SMD 1.46, 95% CI 0.73, 2.20; p < 0.0001; I2=0%). There was also a benefit in overall USN measured by Albert test and Line crossing test with 1 Hz rTMS compar... (Complete abstract click electronic access below) / Mestre

Cerebral palsy is the most common physical disability among children. Children diagnosed with bilateral cerebral palsy (BCP) have limited mobility and hand use due to a neurological insult in utero or during the first year of life, resulting in hypertonicity or uncontrolled movements which impede upon optimal performance and participation in daily life. Although occupational therapists evaluate and provide interventions throughout a child’s development, only two validated assessment tools exist for children with BCP: Melbourne Assessment 2 and Both Hands Assessment, and ABILHAND-Kids questionnaire. The purpose of this study was to (a) develop an observational tool to evaluate upper extremity functioning in children with BCP during everyday tasks, and (b) determine the tool’s content validity, preliminary inter-rater reliability, and internal consistency. The Hand-object Observation Tool (HOOT) was developed, standardized, and evaluated for content validity via expert review and feedback regarding relevance for children with BCP. Following pilot administration to three children and content validation by expert clinicians (n = 8), the HOOT was administered to six children diagnosed with BCP, GMFCS III, IV, and V. Three licensed occupational therapists and the primary investigator observed and scored video-recordings of the administration. Cohen’s kappa was used to determine inter-rater reliability among three pairs of clinician raters and the gold standard. Internal consistency of items was analyzed using Cronbach’s alpha coefficient. The content of the HOOT is consistent with expert opinions and the Content Validity Index results met criteria for retaining items. This study further suggests that HOOT scores are reliable indicators of upper extremity functioning in children with BCP. Rater agreement between occupational therapy raters and the gold standard was almost perfect when scoring hand-object interaction (touch, grasp, transport, manipulate, place, and release). Rater agreement was substantial to almost perfect for hand use and poor to almost perfect for maintenance of posture during tasks. Further research is required to (a) gather additional data from trained clinicians administering the HOOT in community-based settings to more than 30 children with BCP, and (b) analyze scores and performance to determine internal consistency of HOOT items and complete tool refinement and dissemination.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12888号 / 論医博第2088号 / 新制||医||1007(附属図書館) / 31642 / (主査)教授 小泉 昭夫, 教授 平家 俊男, 教授 福山 秀直 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM