Este trabalho descreve o desenvolvimento de um equipamento de biofeedback para utilização por fisioterapeutas no tratamento de pacientes portadores de pé equino. Normalmente o pé equino está relacionado a uma das sequelas de um acidente vascular cerebral e é caracterizado pela dificuldade no controle motor do membro afetado, muitas vezes apresentando limitações relacionadas à sensibilidade e dificuldade em manter o calcanhar em contato com o solo durante a marcha. O equipamento foi construído com base no conceito de biofeedback, apresentando ao paciente, em tempo real, informações relacionadas à intensidade de força aplicada nos membros inferiores. O equipamento é composto de sensores de força flexíveis alojados em um par de sandálias, ligados a um circuito eletrônico microcontrolado. Todo o processamento é realizado por um MSP430, e a comunicação é feita por sinais de rádio através de um módulo CC1101. Os dados são apresentados em uma interface de software em um computador portátil a uma taxa de atualização de 20 Hz. O software possui diversas funcionalidades para atender tanto as necessidades dos fisioterapeutas quanto dos pacientes. Do ponto de vista do paciente, a interface apresenta um visual simples e objetivo, facilitando o entendimento das variações de força, apresentadas na forma de barras verticais. Foram utilizados também recursos visuais e sonoros para enfatizar aos pacientes quando os objetivos estipulados para seu tratamento foram atingidos. Outras funcionalidades foram desenvolvidas para que os fisioterapeutas tenham a opção de customizar a interface de biofeedback de acordo com a necessidade de cada paciente, além de possibilitar o armazenamento de todos os dados dos sensores para análises posteriores. O protótipo foi testado em 20 voluntários durante 10 sessões de fisioterapia, sendo 10 portadores da disfunção pé equino e outros 10 normais para compor um grupo de controle. O objetivo principal do protocolo fisioterapêutico foi melhorar a manutenção do contato como o solo no calcanhar afetado. Os valores de pressão no calcanhar afetado de todas as das sessões foram adquiridos a uma taxa de 20 Hz, armazenados e analisados segundo as seguintes métricas: média, máximos e somas acumuladas. Também foi realizada a avaliação de Berg para todos os voluntários. Os resultados demonstraram que, para as métricas analisadas e também para a avaliação de Berg, houve uma evolução em todos os pacientes. / This work describes the development of a biofeedback device to be used by physiotherapists during treatment of patients with equinus foot. Normally the equinus foot is related to one of the sequelae of a stroke and is characterized by difficulty in motor control of the affected limb, often resulting in limitations on sensitivity. The equipment was built on the concept of biofeedback, presenting to the patient, in real time, information related to the intensity of the forces applied to the lower limbs. The equipment consists of flexible force sensors accommodated in a pair of sandals, connected to a microcontrolled electronic circuit. The whole processing is performed by an MSP430, and the communication is done by radio signals through a CC1101 module. The data is presented in a software interface on a laptop computer at a refresh rate of 20 Hz. The software has many features to meet both the needs of physiotherapists as patients. From the point of view of patients, the interface was designed to be simple and objective, facilitating the understanding of force variations that change dynamically at the exact moment when the sensors are pressed. Visual signs and sound were also used to emphasize to patients when the goals established for their treatment has been reached. Other features were developed specifically for physicaltherapists, giving them the option to customize the biofeedback interface according to the needs of each patient, and also allowing the storage of all data transferred by the sensors for further analysis. A prototype was developed and tested on 20 volunteers over 10 sessions of physical therapy, 10 patients with equinus foot dysfunction, and 10 normal people to compose a control group. At the end of the treatment period, the data were analyzed by session, according to the average forces, the maximum values reached, the accumulated sums and Berg assessments. The results revealed an evolution in all patients, some of them in a greater degree and others in lower degree of progress.

M.A. / "Stroke is one of the leading causes of death and disability in all races in South Africa" (Fritz & Penn, 1992, p 1). It has devastating effects, and may impact on every aspect of the person's functioning. Research shows that depression is common after stroke, becoming more of a problem with time, and having a greater effect on quality of life than the actual disability (Lezak, 1995). Despite such evidence psychologists have played a very limited role in the rehabilitation of this group. Those with communication problems especially have been excluded from research and therapy, which usually require competence with language to be successful. This study attempts to find an alternative method of research and therapy in order to include this group. Following the model of learned helplessness (Seligman, in, Bleiberg, 1986), it was proposed that the unavoidable, inescapable effects of stroke lead to feelings of helplessness, which are also impossible to escape, and the person soon looses the motivation to attempt to control the situation. This then leads to depression. A method of therapy which breaks this cycle, and allows for the person to experience how their actions do have an effect on their lives is needed. In addition to this, an alternative means of self expression for those with communication difficulties needs to be provided. Art therapy was found to address the problems presented by this group (Dailey, 1984). It has proved useful with other populations that have not been able to benefit from traditional psychotherapy. It becomes an alternative means of self expression for those whose communication ability is compromised. It is accessible to most people, as it only requires the ability to make marks on paper. A theme centred, art therapy approach was therefore chosen for the study. The aims of the study were; to create a therapeutic milieu which allowed for self expression, specifically the expression of emotions, which included all the participants; to investigate the effects of introducing an opportunity for self expression on self concept and group process; and to look at the themes which emerge from the art. The participants were members of a pre-existing support group for stroke survivors. A quasiexperimental design was used. The Draw a Person Test, was administered pre and post intervention. Additional information was gathered using the Beck's Depression Inventory and a demographic questionnaire. This study uses a qualitative method, which includes information regarding the researcher's experience, and is interpreted from the researcher's perspective. It was found that art therapy had a positive effect on self concept. It influenced group process, as participants who were previously marginalised became more central. Numerous themes emerged, some which were specific to individuals, but others that were of relevance to the group as a whole. It proved rewarding for the researcher, both as a therapist and in terms of her relationship with her father who is a stroke survivor with aphasia. Art therapy therefore seems to be a useful tool to be used with this group that has traditionally been excluded from therapy and research. It is suggested that further research would be useful, and suggestions regarding future research are discussed.

In ischaemic stroke a disruption of cerebral blood flow leads to impaired metabolism and the formation of an ischaemic penumbra in which tissue at risk of infarction is sought for clinical intervention. In stroke trials, therapeutic intervention has largely been based on perfusion-weighted measures, but these have not been shown to be good predictors of tissue outcome. The aim of this thesis was to develop analysis techniques for magnetic resonance imaging (MRI) of chemical exchange saturation transfer (CEST) in order to quantify metabolic signals associated with tissue fate in patients with acute ischaemic stroke. This included addressing robustness for clinical application, and developing quantitative tools that allow exploration of the in-vivo complexity. Tissue-level analyses were performed on a dataset of 12 patients who had been admitted to the John Radcliffe Hospital in Oxford with acute ischaemic stroke and recruited into a clinical imaging study. Further characterisation of signals was performed on stroke models and tissue phantoms. A comparative study of CEST analysis techniques established a model-based approach, Bloch-McConnell model analysis, as the most robust for measuring pH-weighted signals in a clinical setting. Repeatability was improved by isolating non-CEST effects which attenuate signals of interest. The Bloch-McConnell model was developed further to explore whether more biologically-precise quantification of CEST effects was both possible and necessary. The additional model complexity, whilst more reflective of tissue biology, diminished contrast that distinguishes tissue fate, implying the biology is more complex than pH alone. The same model complexity could be used reveal signal patterns associated with tissue outcome that were otherwise obscured by competing CEST processes when observed through simpler models. Improved quantification techniques were demonstrated which were sufficiently robust to be used on clinical data, but also provided insight into the different biological processes at work in ischaemic tissue in the early stages of the disease. The complex array of competing processes in pathological tissue has underscored a need for analysis tools adequate for investigating these effects in the context of human imaging. The trends herein identified at the tissue level support the use of quantitative CEST MRI analysis as a clinical metabolic imaging tool in the investigation of ischaemic stroke.

Indiana University-Purdue University Indianapolis (IUPUI) / Stroke is the main cause of disability in the United States. Individuals with stroke commonly report sensory impairment affects their recovery. Motor recovery and sensory impairment are related and impact individuals’ ability to perform valued occupations. Despite the prevalence of sensation impairment after stroke, many occupational therapists fail to include sensation assessment and intervention in treatment planning. The exclusion of sensation in occupational therapy interventions during stroke rehabilitation may be due to the lack of literature supporting the association between sensation and occupational performance. The current study aimed to determine the relationship between touch sensation of the affected hand and occupational performance and satisfaction in individuals with chronic stroke. Using a cross-sectional study design, this study associated factors related to hand sensation and function in individuals with chronic stroke. Fifty individuals with chronic stroke participated in a one-time testing session in which assessments related to sensation, movement of the hand and engagement in daily activities were administered. Correlation analyses were utilized to determine relationships between touch sensation of the affected hand with individuals’ abilities to engage in valued daily activities, arm and hand disability, and manual abilities. The main finding of the study was that individuals with intact sensation reported greater ability to perform valued occupations and satisfaction with their performance, as compared with individuals with touch sensation impairment. For individuals with impaired touch sensation of the affected hand, impairment of touch sensation of the hand did not correlate with individuals’ performance or satisfaction with valued occupations, arm or hand movement, or manual abilities. Collectively, the results of this study reflect the complex interaction between touch sensation, occupational performance, motor functioning, and manual abilities of the affected hand for individuals’ who have experienced a stroke. This study informs therapists, rehabilitation scientists, and other healthcare professionals that client-centered, individualized approaches, including a wide array of clinical assessments and intervention, including assessment of occupational performance and sensation, remain important components in stroke rehabilitation.