Postítulo en terapias de arte, mención musicoterapia / En el presente trabajo se dará a conocer la experiencia musicoterapéutica con L3, un adolecente de 15 años quién presenta Parálisis cerebral. Ésta experiencia tuvo una duración de cuatro meses entre los meses de agosto a noviembre del año 2012 realizándose una sesión semanal de 1 hora de duración, en la Escuela Especial a la cual L asiste. La experiencia musicoterapéutica realizada con L se dividió en tres etapas: la etapa de diagnostico, la etapa de desarrollo y por último la etapa de cierre. En la etapa de diagnóstico se realizaron actividades que le brindaran libertad a L para expresarse a través de los sonidos, gestos y expresión corporal con el fin de conocerlo y crear vínculo con él. En la etapa de desarrollo se sumo la actividad de relajación y se fue ampliando el tiempo de exploración y ejecución instrumental con el fin de disminuir la tensión corporal que se observo en la etapa previa. Y por último en la etapa de cierre se fue consolidando el proceso con las actividades favoritas de L y se preparo para despedida. A lo largo de la experiencia se dieron fenómenos importantes en relación a la ejecución instrumental por parte de L y también se construyeron vínculos fuertes que estimularon su trabajo de sesión en sesión, brindándole a L un espacio de bienestar y libre expresión.

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El Atlas de Mortalidad por enfermedades Cardiovasculares, presenta una distribución desigual a nivel regional de la mortalidad por accidentes cerebrovasculares. El proyecto PISCIS mostró que la incidencia del tipo hemorrágico en Chile fue de 20.0 por 100.000 habitantes al año 2002. Sin embargo, no existe un estudio a nivel país con sectorización regional, enfocado específicamente en la hemorragia intracerebral. A partir de esto, nuestro objetivo recae en estudiar la incidencia de Hemorragia Intracerebral Espontánea a través de tasas y su distribución en las distintas regiones del país, mediante un estudio descriptivo obtenido de la base de datos del Ministerio de Salud a partir de egresos hospitalarios en las categorías diagnósticas según los códigos de la Clasificación Internacional de Enfermedades 10°: I-61 (0-6), entre los años 2003 al 2007. Los resultados obtenidos correspondieron a 21051 egresos hospitalarios durante 5 años, de los cuales se identificaron 18347 pacientes. De los identificados, el 52,44% correspondieron al sexo masculino, con una relación hombre: mujer similar con rangos entre 1,06:1 y 1,31:1. La edad promedio de los pacientes fue de 62 ± 17,56 años. El promedio de días hospitalizados fue de 12 ± 17,13 días. Las incidencias encontradas entre el año 2003 y 2007 son de 21,50 (20,79 – 22,21) y 25,20 (24,43 - 25,9) respectivamente. La región de Magallanes presenta la tasa más alta con respecto al resto del país y la menor se encontró en Atacama. El sexo femenino presentó un mayor porcentaje de letalidad que los hombres con una diferencia de 2,88%. Los ingresos hospitalarios se registraron mayormente durante invierno, y la menor cantidad, en verano. Con esto, podemos concluir que las hospitalizaciones se mantuvieron dentro de rangos similares a nivel nacional, sin embargo, se produjo un aumento considerable en el último año. La hemorragia intracerebral presentó en las tasas de incidencia una distribución regional desigual. La importancia de este estudio recae en que es el primero de este tipo que se realiza a nivel nacional. / The Atlas of Mortality from cardiovascular diseases, has an uneven distribution of regional stroke mortality. The PISCES project showed that the incidence ofhemorrhagic type in Chile was 20.0 per 100,000 by 2002. However, there is nocountry-wide study regional sectoring, focused specifically on intracerebralhemorrhage. That’s why we want to study the incidence of Spontaneous Intracerebral Hemorrhage through rates and distribution in different regions of the country, by a descriptive study obtained from the database of the Ministry of Health from hospital discharges with the diagnostic categories according to the codes of the International Classification of Diseases 10: I-61 (0-6), from 2003 to 2007. The results corresponded to 21051 hospitalizations during five years, 18347 individuals were identified, 52,44% male, ratio male:female was between 1,06:1 and 1,31:1. The mean age was 62 years (SD 17,56). Mean hospitalization days were 12 (SD 17,13). The national hospitalization incidence rates per year 2003 to 2007 were 21,50 (95% CI 20,79-22,21) and 25,20 (24,43-25,97) respectively. The Magallanes region has the highest rate compared to the rest of the country and the lowest was found in the Atacama. Females had a higher death rate than men with a difference of 2.88%. Hospital admissions were recorded mostly during winter, and fewer in summer. With this we can conclude that the admissions were within similar ranges nationwide, however, there was a considerable increase in the last year. Intracerebral hemorrhage occurred in the incidence rates of uneven regional distribution. The importance of this study lies in its being the firs of it kind conducted nationally.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Occupational Therapy. 2012 / This study investigated the effects of a five-day “block” of intensive NDT on the gross motor function and occupational performance of 34 children with CP from an under resourced rural area of South Africa, functioning at GMFCS Levels I-V. The repeated measures research design used two preintervention (baseline of change) and two post-intervention (immediate and sustained change) assessments. The GMFM–66 and PEDI–Modified Functional Skills Scale (MFSS) were used to assess change in motor skills and occupational performance in self-care, mobility and social function over a 21 week period. The intervention included individual NDT therapy, caregiver training and provision of adapted equipment. Participants showed significant positive improvement in scores postintervention compared with the pre-intervention period, in: GMFM-66 total score (p=0.050); PEDI-MFSS: self-care skills (p=0.001), mobility (p=0.002) and social (p=0.000). The greatest gains were made in the self-care domain. In this sample, positive change was effected by a five-day intensive NDT programme.

D. Phil., School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, 2011 / Whether the neuropil is a static, optimally wired entity, whose components must be balanced in a certain way, is an open question. Are the proportions of the components of the neuropil consistent across different mammalian cortices, especially in primates where the cerebral cortex is complexly organized? This question is interesting because the actual biological underpinnings of complex behaviours and intelligence in big-brained primates remain enigmatic and why they seem qualitatively different from other animals in terms of their cognitive abilities. Understanding changes that may have occurred in the brain, especially at the level of neuropil organization, during the evolution in primates is important to our growing understanding of the intellectual abilities and behaviours exhibited by members of this group. The current series of quantitative studies was aimed at investigating variations in the proportionality of the “wire fraction” in three primate species, the olive baboon (Papio anubis), vervet monkey (Cercopithecus aethiops) and the common chimpanzee (Pan troglodytes), in a range of higher and lower order cortical areas, using a newly developed method that involves standard and immunohistochemical staining techniques to reveal and quantify the various profiles of the fine structures of the cerebral cortex. The results of these studies demonstrate clear layer differences in the wire fraction of the cerebral cortex, and for the most part, consistency in the neuropil wire fraction of the same layer across areas of the cerebral cortex within and between individuals of the same species; however, differences in the wire fraction of the neuropil were associated with changes in brain size. It is apparent that the neuropil is not static, as wiring “optimality” changes with layers and brain size and this has functional implications regarding neuronal processing and behavioural outcomes. The adaptive rationale adopted by evolutionary psychology studies to explain behaviours may be erroneous, as adaptation does not always explain sufficiently the emergence of complex behaviours related to brain size increases, especially in primates.

A Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science (Physiotherapy). Johannesburg 2017 / Aim: The aim of this study was to evaluate the applicability of an existing behavioural observation tool and assess whether it could be used to quantify and define physiotherapeutic actions (PA) as implemented during treatment sessions of children between the ages of one and 16 years with a diagnosis of Cerebral Palsy (CP). If the tool was found to be unsuitable a more appropriate measure would need to be developed. Method: This study consisted of three phases and was exploratory in nature with one phase leading to the next. Phase 1: A panel of experts evaluated the Original Observation Protocol (OOP) by implementing it on treatment videos of children from different Gross Motor Function Classification System (GMFCS) levels, thereby testing its usefulness in a different context to its original intended purpose. Phase 2: The OOP’s content validity was evaluated with the help of the same panel of experts. The recommended adaptations were based on the feedback collected during a series of modified Nominal Group Technique (NGT) sessions. Phase 3: The Adapted Observation Protocol (AOP) was piloted on five treatment videos, each with different GMFCS levels, by a sample group of six experienced physiotherapists (PT’s). Inter-rater and intra-rater reliability were determined to start unpacking some of the psychometric properties of the AOP. Results: Phase 1: The mutual exclusivity of the OOP was found to be unsatisfactory and hence unsuitable for use with older children within the South African context where adaptation was deemed necessary. Phase 2: Content validity for an adapted version was established by achieving 80% agreement between the experts for the inclusion and adaptation of items from the OOP. The AOP consisting out of three sections was developed as the end result of this phase. Phase 3: Some of the preliminary results of the psychometric properties of the AOP looked promising. In Section 3 a high to very high positive correlation were found when looking at both inter- and intra-rater reliability for relative duration of the therapeutic activities across all videos. The ICC values ranged from α= 0.68 to α=0.94 for the inter-rater reliability and α=0.65 to α=0.99 for the intra-rater reliability with a confidence level of 95%. In contrast, the incidence of therapeutic activities scored in Section 3 had slightly lower correlation, ICC ranging from α=0.43 to 0.76. In Sections 1 and 2 a negligible to moderately positive level of correlation was predominantly observed. This might be ascribed to a lack of training amongst other reasons. Conclusion: Further research is needed to develop the psychometric properties of the AOP. However, it does have the potential to be a tool that defines and quantifies therapeutic input in children with CP and an invaluable free resource that can be implemented across a variety of practice settings within South Africa. / MT2017

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Made available in DSpace on 2019-03-30T00:23:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-11-29 / Cerebral palsy is an injury caused, in most cases, by the lack of oxygenation of the brain cells, occurring during the gestation period, at the time of delivery or after birth, still in the process of maturing the child's brain (up to 3 years of age), thus affecting motor function directly. There are several conventional treatments for the rehabilitation of these patients, often tiring and costly, thus causing disinterest in the continuity of treatment. In this sense, a study on the influence of the legomindstorm robot, as an alternative and complementary tool to the conventional treatment, on the motor coordination, the cognition, the memory and the attention level of the children, is proposed in this work in order to complement the activities performed in the Neuropsychomotor Rehabilitation program of the Occupational Therapy Nucleus of NAMI / UNIFOR. The interaction between the child and the robot occurs through a remote control application installed on a smartphone. In order to validate the proposed method, five children were submitted to sessions of activities with the robot for two months, monitoring the level of concentration in each activity through a brain wave sensor. During the activities, the children presented different levels of performance and evolution, being possible to verify a stimulation related to the motor and cognitive coordination, related to the level of attention. In addition, health professionals and responsible family members completed a questionnaire to assess the advantages and disadvantages of the proposed approach, making the application very promising and, consequently, accelerating the evolution of the clinical picture of each child. Therefore, it can be concluded that playful treatment using legomindstorm robot is an effective and very promising alternative and complementary tool for the rehabilitation of children with cerebral palsy. Keywords: Robotics. Lego. Remote Control. Cerebral palsy. Rehabilitation. Motor limitations. Brain stimulation. Cognitive stimulation. Motor stimulation. Functional activities. / Paralisia cerebral é uma lesão provocada, na maioria dos casos, pela falta de oxigenação das células cerebrais, ocorrida durante o período da gestação, no momento do parto ou após o nascimento, ainda no processo de amadurecimento do cérebro da criança (até 3 anos de idade), afetando, desse modo, diretamente a função motora. Existem diversos tratamentos convencionais para a reabilitação destes pacientes, sendo estes muitas vezes cansativos e onerosos, o que causa desinteresse na continuidade do tratamento. Neste sentido, é proposto, neste trabalho, um estudo sobre a influência do robô legomindstorm, como uma ferramenta alternativa e complementar ao tratamento convencional sobre a coordenação motora, a cognição, a memória e o nível de atenção das crianças, de modo a complementar as atividades realizadas no programa Reabilitação Neuropsicomotora do Núcleo de Terapia Ocupacional do NAMI/UNIFOR. A interação entre a criança e o robô ocorre por meio de um aplicativo de controle remoto instalado em um smartphone. Para validar o método proposto, cinco crianças foram submetidas às sessões de atividades com o robô durante dois meses, neste período, foi monitorado o nível de concentração em cada atividade através de um sensor de ondas cerebrais. Durante as atividades, as crianças apresentaram diferentes níveis de desempenho e evolução, sendo possível constatar uma estimulação relacionada à coordenação motora e cognitiva, relacionada ao nível de atenção. Além do mais, profissionais da área da saúde e familiares responsáveis preencheram um questionário para avaliar as vantagens e as desvantagens da abordagem proposta, tornando a aplicação bastante promissora e, consequentemente, acelerando a evolução do quadro clínico de cada criança. Portanto, pode-se concluir que o tratamento lúdico usando robô legomindstorm é uma ferramenta alternativa e complementar eficaz e bastante promissora para a reabilitação de crianças com paralisia cerebral. Palavras-chave: Robótica. Lego. Controle remoto. Paralisia cerebral. Reabilitação. Limitações motoras. Estimulação cerebral. Estimulação cognitiva. Estimulação motora. Atividades funcionais.

Made available in DSpace on 2019-03-30T00:18:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-12-19 / INTRODUCTION: Stroke is a third cause of death and disability in developed countries, being one of the major health problems worldwide. Intravenous thrombolysis with alteplase, alone or later endovascular thrombectomy, is an effective treatment for acute ischemic stroke, and should be administered within up to 4.5 hours and takes into account a number of factors, including the ¿weekend effect¿. OBJECTIVE: To evaluate the parameters of initial care for patients undergoing intravenous thrombolytic therapy treated at a tertiary center. METHODS: Retrospective cohort study, conducted at the General Hospital of Fortaleza (HGF), Ceará, Brazil. We analyzed all records of Emergency Nursing and the medical records of patients who underwent thrombolytic therapy from May 2015 to April 2016. Initially, all available data were cataloged on the form and, based on this initial strategy A review of all medical records of those who possibly underwent thrombolysis was performed. RESULTS: A total of 1361 files of patients with suspected stroke were analyzed, and it was designed to analyze 201 patients who underwent thrombolysis. The mean age was 66 years, the majority of males (58%), as major comorbidities such as hypertension (73%) and diabetes (29%), regarding the classification of BAMFORD, more common for a syndrome of total circulation above (48%). The time of onset of the clinical picture in turn with an average of 143 minutes, the time of installation to the computed tomography in the media of 15 minutes and the time of the needle had an average of 51 minutes. (P <0.04) and the time of the needle-holder was shorter without daytime (49 ± 18 minutes, p <0.04). The time of onset of the clinical condition was new at night time (133 ± 52 minutes, p <0.04). CONCLUSION: The times related to thrombolysis are within the international prayers, with influence of the period of the day on them. The "weekend effect" was not found. Key words: stroke; thrombolytic therapy; weekend effect. / INTRODUÇÃO: O acidente vascular cerebral é a terceira causa de morte e incapacidade nos países desenvolvidos, sendo um dos principais problemas de saúde em todo o mundo. A trombólise intravenosa com alteplase, sozinha ou seguida de trombectomia endovascular, é um tratamento eficaz para o acidente vascular encefálico isquêmico agudo, devendo ser administrada dentro de até 4,5 horas e leva em conta uma série de fatores, dentre eles o ¿efeito de final de semana¿. OBJETIVO: Avaliar os parâmetros do atendimento inicial a pacientes submetidos à terapia trombolítica endovenosa atendidos em um centro terciário. METODOLOGIA: Estudo do tipo coorte retrospectiva, realizado no Hospital Geral de Fortaleza (HGF), Ceará, Brasil. Foram analisadas todas as fichas de acolhimento da Enfermagem da Emergência e os prontuários dos pacientes que realizaram a terapia trombolítica no período de maio de 2015 a abril de 2016. Inicialmente, foram catalogados todos os dados presentes na ficha e, a partir dessa triagem inicial, foi realizado uma revisão de todos os prontuários daqueles que possivelmente realizaram a trombólise. RESULTADOS: Foram analisadas 1361 fichas de pacientes com suspeita de acidente vascular cerebral, sendo considerados para análise os 201 pacientes que realizaram trombólise. A média de idade foi de 66 anos, a maioria do sexo masculino (58%), as principais comorbidades foram hipertensão arterial (73%) e diabetes (29%), quanto à classificação do BAMFORD, a mais comum foi a Síndrome da circulação anterior total (48%). O tempo do início do quadro clinico à chegada teve média de 143 minutos, o tempo de chegada à tomografia computadorizada foi, em média, de 15 minutos e o tempo porta-agulha apresentou média de 51 minutos. O tempo do início do quadro clinico à chegada foi menor no período noturno (133±52 minutos, p<0,04) e o tempo porta-agulha foi menor no período diurno (49±18 minutos, p<0,04). CONCLUSÃO: Os tempos relacionados à trombólise estão dentro das recomendações internacionais, havendo influência do período do dia sobre os mesmos. Não foi encontrado o ¿efeito de final de semana¿. Palavras-chaves: acidente vascular cerebral; terapia trombolítica; efeito de final de semana.

Thesis (Ed.D.)--Boston University.