Grado de magíster en informática / ANTECEDENTES: El desafío en el desarrollo de interfaces computacionales para la toma de decisiones clínicas es facilitar la interacción usuario – computador. Con el objetivo de mejorar la presentación de datos y facilitar el manejo de información médica se han estudiado y comparado interfaces escritas y gráficas. Una propuesta gráfica es el lenguaje icónico “Visualización de Conceptos en Medicina” (VCM/Mister) utilizado para representar conceptos médicos, situaciones clínicas, síntomas, riesgos y morbilidades, tratamientos, procedimientos, entre otros conceptos médicos. El presente estudio considera comparar la diferencia en Error de Respuesta y Tiempo empleado para responder, frente a la exposición a datos clínicos relacionados con Accidente Vascular Encefálico expresados tanto en interfaz gráfica VCM/Mister como en escrita. METODOLOGÍA: Se aplicó un diseño de carácter experimental, aleatorio de ensayo cruzado tipo “crossover” en el que 10 kinesiólogos fueron expuestos aleatoriamente a 10 casos clínicos ficticios relacionados con Accidente Vascular Encefálico expresados tanto en lenguaje escrito como gráfico. Cada caso se asoció a una pregunta con una respuesta dicotómica. Se midió el tiempo utilizado para responder y la proporción de error de respuesta. Para análisis estadístico en el caso del tiempo se aplicó la prueba no paramétrica de Mann Whitney, y para la proporción de error de respuesta la prueba de MacNemar Chi-cuadrado. RESULTADOS: En este estudio el análisis de las variables utilizadas con un nivel de significancia de 0.05 no evidenciaron diferencias estadísticamente significativas para el Tiempo de Respuesta (p-valor = 0.3067) y para el Error de Respuesta (p-valor = 1) frente a la exposición a datos clínicos expresados tanto en interfaz gráfica VCM/Mister como en escrita. / BACKGROUND: The challenge in developing computational interfaces for clinical decision making is to facilitate user - computer interaction. In order to improve the presentation of data and facilitate the management of medical information, written and graphical interfaces have been studied and compared. A graphic proposal is the iconic language "Visualization of Concepts in Medicine" (VCM/Mister) used to represent medical concepts, clinical situations, symptoms, risks and morbidities, treatments, procedures, among other medical concepts. The present study considers comparing the difference in Response Error and Time used to respond, as opposed to exposure to clinical data related to Stroke expressed in both VCM/Mister graphical interface and in writing. METHODS: An experimental, random cross-over design was applied in which 10 physical therapists were randomly exposed to 10 clinical cases related to Stroke expressed in both written and graphical language. Each case was associated with a question with a dichotomous answer. The time used to respond and the proportion of response error were measured. For statistical analysis in the case of time the non-parametric test of Mann Whitney was applied, and for the error response ratio the MacNemar Chi-square test. RESULTS: In this study, the analysis of the variables used with a significance level of 0.05 did not show statistically significant differences for the Response Time (p-value = 0.3067) and for the Response Error (p-value = 1) exposure to clinical data expressed both in VCM/Mister graphical interface and in writing.

Twenty-five patients with a mean age of 59.7 ± 11.8 (SD) years who were hemiparetic due to a cerebrovascular lesion of the cortex were assessed to determine the degree of neuromuscular dysfunction produced in the affected lower limb. Dysfunction was postulated to be the result of a secondary lower motoneuron lesion precipitated by the primary upper motoneuron lesion. The effects of cerebrovascular disease on skeletal muscle were assessed through an evaluation of the motor unit which involved assessment of excitable muscle mass (M-wave amplitudes), motor unit counts, peripheral nerve conduction velocities, evoked contractile properties of the dorsiflexor muscles (tibialis anterior) of the lower limb and degree of motor dysfunction expressed as a function of motor unit activation and maximum voluntary contraction (twitch interpolation method). Results showed preservation of the skeletal muscle with normal contraction times (108 ± 33 ms and 106 ± 35 ms, affected limb versus unaffected limb) and half relaxation times (119.3 ± 41 ms and 114 ± 32 ms respectively). Twitch torque was maintained and did not show significant differences between limbs (2.3 ± 1.6 N.m and 2.4 + 1.5 N.m., paretic vs. non-paretic limb). Voluntary force production of the affected limb, (10 ± 12.1 N.m) however, was 38% of that produced by the unaffected limb (26 + 1.4 N.m.) and measures of mean percent motor unit activation of the paretic limb were 58% of that produced by the unaffected limb. Interpolated twitch results showed that mean percent motor unit activation was significantly different in the affected limb (46 ± 36%) than the unaffected limb (79 + 19.6%). These results indicate that some motoneurone in hemiplegic patients were healthy but not readily activated. No effect was seen for age, sex of the subject and time post stroke. No significant difference in the pattern of results was observed between initial and final test results for subjects examined more than once. Conclusions were that skeletal muscle integrity was preserved probably due to spinal reflex activity and force production was depressed due, in part, to an inability to fully activate motor units. The inability to activate motoneurone may occur because some motoneurone are in a dysfunctional state. The following data from the present experimental work revealed several trends suggesting the possibility of a sick motoneuron hypothesis due to transynaptic motoneuron degeneration and the existence of a secondary lower motoneuron lesion in stroke syndrome. These trends are: 1) decreased motor unit counts of a sub-group of the total sample consisting of subjects under 60 years of age approached conventional levels of significance. Mean values for the affected limb were 73.8 ± 52 and 130.0 ± 61 for the unaffected limb (P < 0.05, F =5.05, critical F =5.59) In addition, M-wave amplitudes showed significant differences between limbs in the sub-group (4.0 + 2.3 mV and 5.7 ± 2.2 mV affected vs unaffected limb p<0.05), indicating that transynaptic motoneuron loss may have occurred; 2) decreased nerve conduction velocities and prolonged terminal latencies in the motor nerves of the paretic limbs also suggest sick motoneurone and the possibility of a dying back phenomenon of the terminal nerve endings; 4) normal M-wave amplitudes and twitch torque values of the tibialis anterior muscle coupled with the prolonged terminal latencies may be indicative of collateral sprouting of terminal axons which have taken over previously denervated muscle fibres. Future studies are needed to confirm or refute these observations. / Thesis / Master of Science (MS)

Research interest in cerebral small vessel disease, which is manifested as lacunar infarct and white matter changes, has surged in the last decade. Small vessel disease has been increasingly recognized via neuroimaging to be highly prevalent among the elderly and more importantly; it is associated with cognitive impairment. Since the population worldwide is ageing, the cognitive burden associated with small vessel disease is foreseen to rise. This burden will be particularly great in China where the population is vast. However, data of cognitive impairment related to small vessel disease among Chinese is scarce. / The methods and results of these studies will be presented in the thesis. In brief, the author concluded that (1) among Chinese stroke patients with relevant subcortical lacunar infarct, underlying intracranial large artery disease should be looked for before attributing that the lacunar infarct is due to small vessel disease because of its not uncommon association with lacunar infarcts among Chinese; (2) half of the patients with stroke associated with small vessel disease complain of varying severity levels of cognitive impairment 3 months poststroke and executive dysfunction also affects functional activities; (3) thalamic lacunar infarct and left frontal lobe atrophy have small yet significant influences on cognitive performances; (4) cerebral atrophy predicts prestroke cognitive impairment; and (5) Chinese frontal assessment battery is a moderately valid, while executive clock drawing test is not a valid test in the evaluation of executive dysfunction among Chinese with small vessel disease. / This thesis aimed to present studies that were conducted by the author among Chinese stroke patients on this particular field. The aims of the studies were to evaluate the (1) frequency of relevant intracranial large artery disease among Chinese stroke patients having subcortical lacunar infarcts; (2) frequency and impact of cognitive impairment after stroke associated with small vessel disease; (3) neuroimaging determinants of cognitive performances after stroke associated with small vessel disease; (4) determinants of prestroke cognitive impairment in stroke associated with small vessel disease; and the (5) validity of frontal assessment battery and executive clock drawing test in assessing executive dysfunction among Chinese patients with small vessel disease. / Mok Chung Tong Vincent. / "April 2005." / Adviser: Lawrence Ka Sing Wong. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3695. / Thesis (M.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 180-197). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

<p>Stroke is the world&rsquo / s third highest cause of death and a major cause of disability. In order to define optimal management for stroke, reliable data are needed. Although Ruhengeri Hospital in Rwanda receives many stroke patients, no in-depth study has been carried out on stroke patients admitted at the hospital. This study, therefore, identified the profile of stroke patients admitted at Ruhengeri Hospital in Rwanda and explored the challenges that they experienced. A concurrent mixed model design was used to collect data. With a data gathering instrument which was developed by the researcher, a quantitative retrospective approach was used to review existing patients&rsquo / records to collect information related to demographic characteristics, documented clinical features and risk factors for stroke, stroke onset-admission interval, length of hospital stay and the process of hysiotherapy for stroke patients. In-depth face-toface interviews were also used to collect data regarding the challenges experienced by stroke patients. The sample for the quantitative phase consisted of medical records of stroke patients admitted at Ruhengeri Hospital from January 1st, 2005 up to December 31st, 2008. In the qualitative phase, a purposive sample of 10 participants was selected.</p>

Thesis (Ph. D.)--University of Oregon, 2002. / Includes bibliographical references (leaves 178-188). Also available online.

<p>Stroke is the world&rsquo / s third highest cause of death and a major cause of disability. In order to define optimal management for stroke, reliable data are needed. Although Ruhengeri Hospital in Rwanda receives many stroke patients, no in-depth study has been carried out on stroke patients admitted at the hospital. This study, therefore, identified the profile of stroke patients admitted at Ruhengeri Hospital in Rwanda and explored the challenges that they experienced. A concurrent mixed model design was used to collect data. With a data gathering instrument which was developed by the researcher, a quantitative retrospective approach was used to review existing patients&rsquo / records to collect information related to demographic characteristics, documented clinical features and risk factors for stroke, stroke onset-admission interval, length of hospital stay and the process of hysiotherapy for stroke patients. In-depth face-toface interviews were also used to collect data regarding the challenges experienced by stroke patients. The sample for the quantitative phase consisted of medical records of stroke patients admitted at Ruhengeri Hospital from January 1st, 2005 up to December 31st, 2008. In the qualitative phase, a purposive sample of 10 participants was selected.</p>

Introduction: Balance dysfunction, particularly in standing, is a devastating sequel to stroke since the ability to balance is one of the most critical motor control factors in daily life. Physiotherapists use a variety of balance and stability techniques as a part of treatment programmes to improve functional independence in patients following a stroke. However more scientific evidence for the effectiveness of these techniques or programs is required. Purpose: The purpose of this study was to quantify the effect of a balance and stability training program on stability, balance and functional independence in stroke patients. Method: The aims of this study were achieved using a randomised controlled trial. A questionnaire allowed the collection of demographic data from fifty participants who had suffered the first stroke, regardless of gender or race. The Postural Assessment Scale for Stroke patients (PASS), Berg Balance Scale (BBS), Barthel Index (BI) and questionnaire were administered to all fifty participants on the first and last weeks of a twelve week physiotherapy program. For ten weeks twenty five randomly assigned participants in each of the control and experimental groups underwent either normal physiotherapy or stability and balance intervention exercise program respectively. Data Analysis: The raw data was normalized by calculating percent changes for each item for each participant and the pooled data subjected to Wilcoxon signed ranks testing, paired samples signed tests and Pearson’s correlations. Results: PASS, BBS and BI scores increased significantly from pre-test to post-tests in both groups, with greater changes noted in the experimental group, showing improvements in stability, balance and function. In addition a strong and significant correlation between stability scores and balance scores suggested that stability is important to improve balance. Similarly a strong and significant correlation between stability and balance scores with function scores confirms the value of stability and balance in improving function. It was further noted that in addition to a certain degree of spontaneous recovery, traditional physiotherapy programs also result in improvement in stability, balance and function but not to the same extent as with the program of treatment which emphasizes stability and balance exercises. Conclusion: A significant improvement in the stability, balance and function in stroke patients was achieved with the balance and stability intervention program. Conventional physiotherapy methods also improved stability, balance and function, but to a lesser extent than the balance and stability training. / Thesis (M.Physio.)-University of KwaZulu-Natal, Westville, 2012.

Diskettes comprise Appendix N andO. / System requirements: IBM compatible, requires Word for windows 6 or higher. / Bibliography: leaves 400-428. / xix, 428 leaves ; 30 cm. + 2 diskettes (3 1/2 in.) / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Psychology, 1997?

Diss. (sammanfattning) Linköping : Univ., 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.