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The proposed research will investigate the effects of self-reported anger expression style on cerebrally lateralized physiological responses to a neuropsychological stressor and a painful stimulus. Specifically, this research examined changes in systole and grip strength in response to a verbal fluency task, a figural fluency task and exposure to a cold pressor. Significant group by trial interaction effects were found for mean number of perseverative errors on neuropsychological measures (F(1,54) = 10.89, p < 0.05), systolic blood pressure following administration of a verbal fluency measure(F(1,54) = 5.86, p < 0.05), and non-verbal fluency measure (F(1,54) = 13.68, p<.001), heart rate following administration of verbal (F(1,54) = 5.86, p < 0.05), and non verbal fluency measures (F(1,54) = 13.68, p<.001), and grip strength following exposure to the cold pressor (F(1,54) = 13.69, p < 0.001). Results are discussed in terms of functional cerebral systems and potential implications for physiological models of anger. / Ph. D.

There is a small but growing population of people who suffer from impaired balance. The causes range from old age to stroke to cerebral palsy. For those with only minor problems staying upright, a cane or walker is all that is needed. For some it is so debilitating that they are confined to a wheel chair. The precise cause of impairment can vary. In some, the vestibular, proprioceptive or visual impairments affect balance. In others, muscle weakness or brain damage is the cause. In another group, the brain never learned to balance in the first place. Relearning how to balance can be a struggle requiring months of costly physical therapy with a physical therapist. A machine that could help teach them how to balance would be a great help in the improvement of their lives. This thesis presents a set of control models for an exoskeleton that will stabilize and restore stability to those with impaired balance. The control models are designed for an exoskeleton to initially force the wearer into a known profile for balancing and moving. There will then be a steady reduction in the authority of the exoskeleton over time, requiring the patient to assert more control over his or her own movement. As the authority of the exoskeleton is reduced, the patient will have to increase his or her own authority and develop his or her own control law or the patient will become less stable and eventually unbalanced. We expect this treatment method will increase the stability of patients, allowing them to steadily adapt to standing and walking. This will then allow them mobility without the use of a wheel chair and decrease their risk of falling. Further, the use of this device will enable the patients to receive therapy at home and in their normal life without the need to visit a physical therapist for rehabilitation, enabling the patients to receive therapy at home and for a longer period of time than they currently do. / Master of Science

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Conducted within a critical disability studies framework, this study explored the experience of communicative participation by adults with cerebral palsy who live with severe communication impairments. The concept of the participation of communicatively disabled people is relatively new, and the theoretical understanding of communicative participation is underdeveloped although participation is increasingly recognised as a central goal in rehabilitation. In addition, there is a paucity of information with reference to the trajectory of lifelong communication disability. Little is known about the communicative participation of adults with cerebral palsy in South Africa. Nine adults with cerebral palsy, who lived with significant communication impairments, participated in the study. They were between 32 and 49 years of age, and had lived South Africa all their lives. They were observed in social interactions in their daily lives on multiple occasions and took part in serial interviews over a six-month period. Using a pragmatist grounded theory approach, the data were analysed from an interpretive basis. Four main categories were constructed. The first category was “being misrecognised as a communicator”, which showed that the participants were not acknowledged as having equal moral participatory status in communicative exchanges. The second category, “contexts for communicating”, indicated that the participants lived with significant communication impairments which resulted in their experiencing limitations in a broad spectrum of life’s activities. The third category, “an embedded communicative self”, illuminated that the participants saw their communicative disabilities as embedded within a broader picture of being disabled, and that their communication impairments had a marked effect on their identity development. Through an analysis of lifetime contributions to communicative participation, the final category, “dynamic participation” revealed how communicative participation is a fluid, ever-changing process. Extending Ikäheimo’s (2010) model of social participation and recognition, a “dynamic recognition-theoretical model of communicative participation” is presented. Communicative participation is defined as a dynamic social process. It is undergirded by the moral recognition of the interactants as communicative partners, and is influenced by time as the dimension through which all communication takes place. / AFRIKAANSE OPSOMMING: Die studie, vanuit `n kritiese benadering, het serebraalgestermde volwassenes (wie se vermoë om te kommunikeer ernstig aangetas is) se ervaringe met betrekking tot hul deelname aan kommunikasie of situasies waarin daar gekommunikeer word, verken. Die konsep wat fokus op die deelname aan kommunikasie deur diegene wie se vermoë om te kommunikeer ernstig aangetas is, is `n relatief nuwe begrip. Die teoretiese grondslag van die konsep is onderontwikkeld, maar die konsep word toenemend gereken as een van die belangrikste doelwitte van die rehabilitasie-proses. Daar is ook`n gebrek aan inligting wat handel oor die verloop van mense se lewenslange ervaringe wie se vermoë om te kommunikeer ernstig aangetas is. Daar bestaan beperkte kennis oor volwassenes met serebraalgestremdheid in Suid-Afrika se deelname aan kommunikasie. Nege volwassenes met serebraalgestremdheid, wie se vermoë om te kommunikeer ernstig aangestas is, het deelgeneem aan die studie. Die deelnemers se ouderdomme (gedurende die tydperk waarin data-insameling plaasgevind het) het gewissel van 32 tot 49 jaar, en die deelnemers het nog altyd in Suid-Afrika gewoon. Die deelnemers se kommunikasie-gedrag gedurende verskeie sosiale situasies is waargeneem. Die deelnemers het ook oor `n periode van ses maande aan `n reeks onderhoude deelgeneem. Pragmatiese, gegronde teoretiese benadering (ook verwys na as ‘grounded theory’) is gebruik om die data te analiseer. Die bevindinge dui op vier hoof temas. Die eerste tema verwys na bevindinge wat handel oor ‘om misken te word as as iemand wat deelneem aan kommunikasie’. Die bevindinge dui daarop dat deelnemers van mening is dat hulle nie as `n gelykke beskou word gedurende situasies waarin daar gekommunikeer word. Die tweede tema verwys na ‘die konteks van kommunikasie’, en dui daarop dat weens die feit dat deelnemers se vermoë om te kommunikeer ernstig aangestas is, word hulle ook op `n verskeidenheid van lewensaktiwiteite ingeperk. Die derde tema verwys na die volgende: ‘die aantasting van die vermoë om te kommunikeer gesetel in die self’. Die tema dui daarop dat deelnemers die aantasting van hulle vermoë om te kommunikeer, sien as deel van die geheelbeeld van gestremdheid en dat die vermoë om te kommunikeer `n betekenisvolle impak op hul identiteitsontwikkel gehad het. Die lewenslange ervaringe van die deelnemers het aanleiding gegee tot die vierde en laaste tema, naamlik ‘dinamiese deelname’. Dit dui daarop dat die deelname aan kommunikasie nie staties is nie, maar voortdurend verander. Die studie bevindinge suggereer dat Ikäheimo’s (2010) se model van sosiale deelname en erkenning, uitgebrei kan word tot `n dinamiese teoretiese model wat die deelname aan kommunikasie erken. Die deelname aan kommunikasie word gedefiniëer as `n dinamiese sosiale proses. Die grondslag van die model behels die erkenning van diegene wat kommunikeer as deelgenote wat beïnvloed word deur tyd as die dimensie waardeur alle kommunikasie plaasvind.

Estudamos a relação entre local e tipo da lesão cerebral com a gravidade da disfagia, e a relação entre o grau de comprometimento motor com a gravidade da disfagia em crianças com paralisia cerebral. Foi um estudo retrospectivo de exames de videofluoroscopia da deglutição e ressonância magnética cerebral de crianças com diagnóstico de paralisia cerebral e disfagia, atendidas do Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP), Universidade de São PauloBrasil, de 2008 a 2016. Foi realizada analise descritiva dos dados e utilizado o teste exato de Fisher para verificar a relação entre as variáveis estudadas. Foram incluídos na pesquisa exames de 20 crianças com idades ao exame de ressonância magnética entre 2 anos e 1 mês de vida a 10 anos e 2 meses, e ao exame de videofluoroscopia da deglutição entre 9 meses a 16 anos e 2 meses. Quanto ao gênero, seis crianças eram do sexo feminino, e 14 do sexo masculino. Com relação à classificação da função motora grossa, duas crianças eram do nível III, cinco do nível IV e 13 do nível V. Quanto a gravidade da disfagia, sete crianças apresentaram disfagia leve/moderada, três com disfagia moderada e 10 crianças com disfagia moderada/grave. As principais alterações evidenciadas na ressonância magnética, quanto à localização da lesão, foram em corpo caloso (60%), ventrículos cerebrais (60%), substancia branca (55%), tronco encefálico (35%) e cerebelo (15%). Os tipos de lesões cerebrais mais freqüentes foram encefalopatia hipóxico-isquêmica (35%), leucomalacia periventricular (25%) e encefalomalacia multicistica (15%). Não houve relação entre o local da lesão cerebral e gravidade da disfagia, entretanto houve relação entre o tipo de lesão cerebral e a gravidade do distúrbio de deglutição (p=0,02). Além disso, houve relação entre a gravidade da disfagia e o grau de comprometimento da função motora grossa. Deste modo, a gravidade da disfagia foi relacionada com encefalomalacia multicística e com o comprometimento da função motora grossa, e nossos resultados mostram a importância da avaliação de deglutição tão logo, nestes pacientes, seja realizado o diagnóstico médico. Além disso, ressaltamos a importância da avaliação da deglutição em todos graus de lesão, devido à presença de disfagia leve a intensa. / We studied the relationship between site and type of brain injury with the severity of dysphagia, and the relationship between the degree of motor impairment and the severity of dysphagia in children with cerebral palsy. It was a retrospective study of videofluoroscopy examinations of swallowing and magnetic resonance imaging of children diagnosed with cerebral palsy and dysphagia, attended at Hospital das Clinicas of the Ribeirão Preto Medical School (HCFMRP), University of São Paulo-Brazil, from 2008 to 2016. A descriptive analysis of the data was performed and Fisher\'s exact test was used to verify the relationship between the variables studied. Included in the study were examinations of 20 children aged between 2 years and 1 month of life to 10 years and 2 months, and videofluoroscopy of swallowing between 9 months and 16 years and 2 months. Six children were female, and 14 were male. Regarding the classification of gross motor function, two children were of level III, five of level IV and 13 of level V. Regarding the severity of dysphagia, seven children presented mild/moderate dysphagia, three with moderate dysphagia and 10 children with moderate/severe dysphagia. The most freqeunt lesions seen in magnetic ressonance imaging (MRI) were in the corpus callosum (60%), cerebral ventricles (60%), white matter (55%), brainstem (35%) and cerebellum (15%). The most frequent types of brain lesions were hypoxicischemic encephalopathy (35%), periventricular leukomalacia (25%) and multicystic encephalomalacia (15%). There was no relationship between the site of the brain lesion and the severity of dysphagia, however, there was a relationship between the type of brain injury and the severity of the swallowing disorder (p = 0.02). In addition, there was a relationship between the severity of dysphagia and the degree of impairment of gross motor function. Thus, the severity of dysphagia was related to multicystic encephalomalacia and the involvement of gross motor function, and our results show the importance of swallowing assessment as soon as the medical diagnosis is made in these patients. In addition, we emphasize the importance of evaluating swallowing in all degrees of injury, due to the presence of mild to severe dysphagia

Orientador: Silméia Garcia Zanati Bazan / Resumo: Introdução: O acidente vascular cerebral (AVC) isquêmico pode ser dividido etiologicamente em cinco tipos de acordo com a classificação TOAST e sua adequada investigação e caracterização pode auxiliar no manejo clínico e prevenção de novos eventos. O ecocardiograma transtorácico (ETT) é peça fundamental na investigação etiológica e cerca de um terço dos pacientes permanece sem definição adequada da etiologia ou são classificados como TOAST indeterminado. Objetivos: Avaliar se o percentual de indeterminação do TOAST diminui em função da realização do ecocardiograma transtorácico; avaliar se o prognóstico após o AVC isquêmico é pior entre pacientes que apresentam TOAST indeterminado e verificar a capacidade preditiva das variáveis ecocardiográficas sobre o prognóstico após AVC isquêmico. Metodologia: Coorte retrospectiva, na qual foram realizadas avaliações clínica, neurológica e ecocardiográfica durante internação por AVC e avaliação da mortalidade intra-hospitalar e da capacidade funcional no momento da alta hospitalar e após 90 dias. Foram realizados modelos de regressão linear múltipla e regressão logística múltipla ajustados pelos fatores confundidores. O nível de significância foi de 5%. Resultados: Foram incluídos 1100 pacientes, maioria do sexo masculino, 606 (55,09%), média de 68,1±13,3 anos de idade, em 977 (88,82%) pacientes foi realizado ETT e 448 (40,7%) tiveram classificação de TOAST indeterminado. Pacientes submetidos ao ecocardiograma transtorácico tiveram 3,1 v... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: Ischemic stroke can be divided etiologically into five types according to the TOAST classification, and its adequate investigation and characterization can aid in the clinical management and prevention of new events. Transthoracic echocardiography (TTE) plays a key role in etiological investigation, and about onethird of patients remain without adequate definition of the etiology or are classified as undetermined TOAST. Objectives: To evaluate if the percentage of indetermination of TOAST decreases according to the performance of the transthoracic echocardiography; to evaluate whether the prognosis after ischemic stroke is worse among patients with undetermined TOAST and to verify the predictive capacity of the echocardiographic variables on the prognosis after ischemic stroke. Methods: Retrospective cohort, in which clinical, neurological and echocardiographic evaluations were performed during stroke hospitalization and evaluation of in-hospital mortality and functional capacity at hospital discharge and after 90 days. Multiple linear regression and multiple logistic regression models were adjusted for confounding factors. The level of significance was 5%. Results: A total of 1100 patients were included, mostly male, 606 (55.09%), mean of 68.1 ± 13.3 years of age, and 977 (88.82%) patients were submitted to TTE and 448 (40.7%) had undetermined TOAST classification. Patients submitted to transthoracic echocardiography were 3.1 times less likely to have TOAST class... (Complete abstract click electronic access below) / Mestre

OBJETIVO: Investigar e comparar a aprendizagem de uma habilidade motora de alta demanda de planejamento em sujeitos pós-Acidente Vascular Encefálico (AVE) em função do lado da lesão. MÉTODO: Participaram do estudo 22 indivíduos pós-AVE para compor o grupo experimental (GE), sendo 10 LD e 12 LE, e 14 sujeitos saudáveis para o grupo controle (GC). Os critérios de inclusão foram: 40 a 75 anos de idade, lesão em circulação anterior, crônicos, único evento vascular, destros e Mini Exame de Estado Mental (MEEM) com pontuação acima de 23. A tarefa consistiu em realizar a inserção de uma barra em um orifício, o mais rapidamente possível. O estudo foi composto de duas fases, sendo de aquisição (AQ) com 50 tentativas e de testes de retenção em curto (RET1), longo prazo (RET2) e transferência (TR) com 10 tentativas cada. Foram realizadas análises intra (GC, GE, LD e LE) e intergrupos por meio da ANOVA two-way (grupos X blocos) com medidas repetidas no segundo fator, seguida do post hoc de Tukey. O nível de significância adotado foi de 0,05. RESULTADOS: Houve déficit na aprendizagem do GE nas comparações do nível de desempenho entre o último bloco da AQ com os testes de RET2 e TR, que se apresentou dependente do lado da lesão. Quando comparado com o GC e com LD, o LE apresentou deterioração na RET2. CONCLUSÃO: Há diferença entre o GE e GC no que se refere à aprendizagem de uma habilidade motora com alta demanda de planejamento, mensurada por meio do teste de RET em longo prazo, sendo esta diferença dependente do lado da lesão. O grupo com LE apresentou os maiores déficits na aprendizagem / OBJECTIVE: To investigate and compare the motor learning of a motor skill with high planning demand in post-stroke subjects according to the hemisphere side damage. METHOD: The study comprised twenty-two post-stroke individuals in the experimental group (EG), 10 right hemisphere damaged (RHD) and 12 left hemisphere damaged (LHD), and 14 health subjects in the control group (CG). The inclusion criteria were: age between 40 and 75 years old, anterior circulation damage, chronic stage, single stroke, right-handed and Mini Mental State Exam (MMSE) with score over 23 points. The task consisted of inserting a bar into a hole, as fast as possible. The study consisted of two phases, acquisition (ACQ) with 50 trials and retention tests in short-term (RET1), long-term (RET2) and transfer (TR), with 10 trials each. Analyses within group (CG, EG, RHD and LHD) and between groups were performed by ANOVA two-way (groups x blocks) with repeated measures in the second factor followed by post-hoc of Tukey test. The significant level adopted was 0,05. RESULTS: There was a decrease in the EG learning when the level of performance on the last ACQ block was compared with RET 2 and TR tests, dependent on the hemisphere damage side. CONCLUSION: There are differences on motor learning of a motor skill with high planning demand between EG and CG, especially measured at the RET2. LHD subjects showed significant deterioration in motor learning at the RET2

Object Rupture of intracranial arteriovenous malformations is a leading cause of stroke in children and young adults. Treatment options include surgery and highly focused radiation (stereotactic radiosurgery). For large and deep seated lesions, the risks of surgery may be prohibitively high, while radiosurgery has a disappointingly low efficacy and long latency. Radiosurgery carries the most promise for significant advances, however the process by which radiosurgery achieves obliteration is incompletely understood. Inflammation and thrombosis are likely to be important in the radiation response and may be amenable to pharmacological manipulation to improve radiosurgical efficacy. Materials and methods Immunohistochemistry and electron microscopy were used to study normal cerebral vessels, cavernous malformations and AVMs, some of which had previously been irradiated. An attempt was made to culture AVM endothelial cells to study the immediate response of AVM endothelium to radiosurgery. The effects of radiosurgery in a rat model of AVM were studied using immunohistochemistry and the results used to determine the choice of a pharmacological strategy to enhance the thrombotic effects of radiosurgery. Results Vascular malformations have a different endothelial inflammatory phenotype than normal cerebral vessels. Radiosurgery may cause long term changes in inflammatory molecule expression and leads to endothelial loss with exposure of pro-thrombotic molecules. Ultrastructural effects of irradiation include widespread cell loss, smooth muscle cell (SMC) proliferation and thrombosis. Endothelial culture from AVMs proved difficult due to SMC predominance in initial cultures. Radiosurgery upregulated several endothelial inflammatory molecules in the animal model and may induce pro-thrombotic cell membrane alterations. The administration of lipopolysaccharide and soluble tissue factor to rats following radiosurgery led to selective thrombosis of irradiated vessels. Conclusions Inflammation and thrombosis are important in the radiosurgical response of AVMs. Lumen obliteration appears to be mediated by proliferation of cells within the vessel wall and thrombosis. Upregulation of inflammatory molecules and perhaps disruption of the normal phospholipid asymmetry of the endothelial and SMC membranes are some of the earliest responses to radiosurgery. The alterations induced by radiation may be harnessed to selectively initiate thrombus formation. Stimulation of thrombosis may improve the efficacy of radiosurgery, increasing treatable lesion size and reducing latency.

Made available in DSpace on 2015-12-06T23:05:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2005 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundo de Auxílio aos Docentes e Alunos (FADA) / Objetivo: Este estudo piloto procurou revisar a metodologia e discutir a aplicação da Terapia por Contensão Induzida (TCI) nos pacientes com acidente vascular cerebral isquêmico (AVCI) crônico, em um centro de reabilitação brasileiro. Método: Uma ampla revisão da literatura médica foi realizada para adaptar esta técnica em nosso meio. Foram selecionados 10 pacientes que se submeteram a 6 horas de tratamento por duas semanas consecutivas. Entre os critérios de seleção destacam-se AVCI em território da artéria cerebral média. Nestes 14 dias os pacientes foram submetidos a atividades motoras repetitivas utilizando o membro superior parético, enquanto o membro não parético era mantido com um dispositivo de contenção. Resultados: Houve melhora significativa no déficit motor do membro superior parético e concomitante melhora na resposta ao Teste de Função Motora de Wolf. Conclusão: Esta nova técnica de reabilitação específica para pacientes com déficit motor moderado em membro superior parético é viável em nosso país. Nosso estudo sugere que a dominância e tempo de lesão têm um efeito modificador sobre o tratamento em pacientes com lesão isquêmica crônica no território da artéria cerebral média. / Purpose: The purpose of this pilot study is to review evidence and discuss the aplly of Constraint Induced Movement Therapy (CIMT) protocol in a brazilian center of rehabilitation in chronic patients with isquemic stroke. Methods: A wide revision of the medical literature was accomplished to adapt this technique for our population. Ten patients were selected and submitted at 6 hours of treatment for 2 weeks. Among the selection criteria they stand out schemic stroke in the middle cerebral artery territorry. On these 14 days the patients were submitted to repetitive motor activities using the paretic upper-limb while the unaffected limb was maintained with a constraint device. Results: There was a significant improvement of function of the affected upper-limb in the motor deficit of the paretic upper-limb and concomitant improvement in the answer to the Wolf Motor Function Test. Conclusions: This new technique of specific rehabilitation for patients with moderate motor deficit in paretic upper limb is feasible in Brazil. Our study suggest that the dominance and the time of lesion have a modifier effect on the treatment in patients with chronic schemic lesion in the middle cerebral artery territory. / BV UNIFESP: Teses e dissertações

Intracranial monitoring after severe traumatic brain injury offers the possibility for early detection and amelioration of physiological insults. In this thesis, I explore cerebral insults due raised intracranial pressure, decreased cerebral perfusion pressure and impaired cerebral pressure reactivity after traumatic brain injury. In chapter 2, the importance of intracranial pressure, cerebral perfusion pressure and pressure reactivity in regulating the cerebral circulation is elucidated along with a summary of the existing evidence supporting intracranial monitoring in traumatic brain injury. In chapter 4, intracranial pressure, cerebral perfusion pressure, and pressure reactivity insults are demonstrated to be common, prognostically important, and responsive to long-term changes in management policies. Further, while these insults often occur independently, coexisting insults portend worse prognosis. In chapter 5, I examine possible imaging antecedents of raised intracranial pressure and demonstrate that initial subarachnoid haemorrhage is associated with the subsequent development of elevated intracranial pressure. In addition, elevated glucose during the intensive care stay is associated with worse pressure reactivity. Cortical blood flow and brain tissue oxygenation are demonstrated to be sensitive to increases in intracranial pressure in chapter 6. In chapter 7, a method is proposed to estimate the cerebral perfusion pressure limits of reactivity in real-time, which may allow for more nuanced intensive care treatment. Finally, I explore a recently developed visualisation technique for intracranial physiological insults and apply it to the cerebral perfusion pressure limits of reactivity. Taken together, this thesis outlines the scope, risk factors and consequences of intracranial insults after severe traumatic brain injury. Novel signal processing applications are presented that may serve to facilitate a physiological, personalised and precision approach to patient therapy.