Made available in DSpace on 2011-11-09T14:45:34Z (GMT). No. of bitstreams: 1 license.txt: 1648 bytes, checksum: e095249ac7cacefbfe39684dfe45e706 (MD5) Previous issue date: 2004 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil / A instabilidade atlanto-axial(IAA) é o excesso de mobilidade do atlas sobre o áxis, tendo sido descrita uma prevalência de 10 a 30 por cento dentre os pacientes com Síndrome de Down Este estudo teve como objetivo consolidar um protocolo de investigação da IAA através da revisão da literatura e do estudo radiológico de 745 pacientes com faixa etária de 2 meses a 19 anos, atendidos pelo Departamento de Genética Médica do Instituto Fernandes Figueira (IFF-FIOCRUZ),em 2001.Dentre estes 40 pacientes foram submetidos a pelo menos um exame radiográfico da coluna cervical, onde a prevalência da IAA foi de 17,2 (IC 95 por cento-14,2 a 20,7), de forma assintomática em 95 por cento dos casos. Em segundo exame radiográfico, realizado em 121 pacientes com idade mediana de 8 anos, a prevalência da IAA foi de 17,5(IC 95 por cento -11,1 a 25,3). Tomografia computadorizada cervical em 95 pacientes com idade mediana de 4 anos confirmou 4 casos de IAA diagnosticados na primeira radiografia. A revisão da literatura revelou controvérsias e a análise destes artigos não forneceu fortes evidências sobre qual seria o melhor processo de investigação. Apesar destes limites, foi possível destacar alguns aspectos comuns a diferentes trabalhos para definir um protocolo: o screening radiográfico inicial para IAA deve ser realizado a partir dos 3 anos de idade, conforme rotina proposta pelo Comitê Parolímpico Americano e pela Academia Americana de Pediatria; não há necessidade de outros exames se este screening inicial for normal; pacientes com IAA e sintomas de compressão medular precisam de complementação com tomografia computadorizada (TC) ou ressonância magnética (RM); exames neurológicos deverão ser freqüentes.

Ce travail de thèse porte sur l’étude de la cinématique 3D du rachis cervical supérieur ainsi que<p>sur l’analyse des bras de levier des muscles sous-occipitaux postérieurs, par le développement<p>de différentes méthodes contribuant à la modélisation anatomique du mouvement.<p>La première partie de ce travail s’oriente vers l’étude des mouvements de flexion extension, de<p>rotation axiale et de flexion latérale ainsi que des axes qui y sont rapportés. Pour ce faire, deux<p>protocoles ont été développés sur préparations anatomiques, l’un visant à analyser les<p>mouvements discrets à partir de différentes attitudes du rachis cervical supérieur et l’autre<p>s’intéressant aux mouvements instantanés. Ceux-ci ont permis de mettre en évidence une<p>orientation et une position de l’axe hélicoïdal dépendantes du mouvement, du segment étudié<p>et de sa position spatiale.<p>En deuxième intention, nous nous sommes intéressés aux propriétés biomécaniques musculaires<p>de cette région, et en particulier à l’étude des bras de levier. Deux méthodes de calcul<p>distinctes ont été utilisées, montrant chacune des résultats différents d’un point de vue<p>quantitatif mais relativement similaires au niveau qualitatif.<p>Pour terminer, nous avons exploité ces méthodes afin d’apprécier leur faisabilité dans le cadre<p>d’une évaluation fonctionnelle in vivo. Il en ressort une concordance de résultats cinématiques<p>par rapport aux études susmentionnées, permettant d’entrevoir des perspectives cliniques<p>encourageantes.<p>Par ailleurs, la modélisation musculo-squelettique 3D pourrait également contribuer à la<p>compréhension du dysfonctionnement cinématique du rachis cervical supérieur./ <p><p>This thesis concerns 3D kinematics analysis of the upper cervical spine (UCS) and computation of the posterior suboccipital muscle moment arms as well the development of different methods contributing to anatomical modeling and motion representation. The first part of this work is focused on the kinematics of flexion extension, axial rotation and lateral bending of the UCS. Two protocols were developed and applied in anatomical specimens, one to analyze discrete movements in different attitudes of upper cervical spine and the second concerned instantaneous motions. In addition to usual range of motion data, orientation and position of helical axes was computed for each motion type and UCS joint segment.<p>In the second part, we were interested in posterior suboccipital muscle biomechanical properties, particularly in the study of moment arms. Two different calculation methods were used, each showing different results from a quantitative point of view but quite similar in quality. Finally, we used these methods to assess their feasibility for in vivo functional assessment. The latter showed a concordance of kinematic results compared to the above studies, offering insight and clinical perspectives. In addition, musculoskeletal modelling 3D could also contribute to understanding of the kinematic features of upper cervical spine disorders.<p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

Este trabalho avaliou a incidência de pacientes com lesão traumática da coluna cervical causada por mergulho em águas rasas, que foram atendidos nos Hospitais da cidade de Ribeirão Preto-SP, entre janeiro de 1989 a dezembro de 1996. O estudo epidemiológico foi realizado mediante investigação feita nos prontuários médicos desses pacientes. Complementou-se as informações por meio de uma entrevista realizada com 12 deles. Com base nos números apresentados, elaborou-se um programa de prevenção decorrente desses traumatismos a implantou-se uma Campanha de prevenção das lesões cervicais por mergulho em águas rasas em Ribeirão Preto. Um Programa de Campanha foi encaminhado à Assembléia Legislativa do Estado e transformado em Projeto de Lei. Os resultados mostraram que, dos 355 casos estudados, 69 deles foram por acidentes em águas rasas, a dentre estes, 58% tiveram danos neurológicos. Os locais mais freqüentes dos acidentes foram rios, córregos, lagos, cachoeiras,com a ocorrência de 75,4% dos casos, enquanto que a incidência em piscinas foi de 24,6%. A média de idade variou entre 10 a 30 anos, havendo diferença significativa com outras faixas etárias. Quanto ao sexo, 92,8% ocorreram em homens a 7,2% com mulheres. Em relação ao estado civil, 68,2% eram solteiros e 31,9% eram casados. O período do ano em que houve um número mais elevado dos traumatismos da coluna cervical causado pelo mergulho nas chamadas águas rasas foi nos meses de estações mais quentes na região (primavera, verão a outono). Dos 17,4% dos pacientes entrevistados de um total de 40 que tiveram lesão medular, todos mostraram desconhecimento desse tipo de acidente, bem como suas conseqüências. A Campanha de prevenção teve início em setembro de 1996 e está em fase de desenvolvimento em Ribeirão Preto. O Projeto de Lei estadual nº 183 aguarda aprovação da Assembléia. Conclui-se que, a incidência de acidentes com lesão traumática da coluna cervical por mergulho em águas rasas é elevada, sendo a terceira causa de danos traumáticos. A desinformação da população no que diz respeito ao perigo de um mergulho em águas rasas é elevado. A redução deste tipo de acidente pode acontecera partir de um processo educacional da população a da atuação decisiva do poder público. / This study is an evaluation of the incidence of patients treated in the hospitals in Ribeirão Preto - SP for traumatic injury of the cervical cord caused by diving in shallow waters. The epidemiological study was held by means of an investigation of the medical charts of patients who underwent treatment from January 1989 to December 1996. The information on the charts was complemented through interviews held with 12 of these patients. Based on the results of these investigations, a campaign to prevent cervical injury caused by diving into shallow waters was elaborated and sent to the State Legislature, where it was transformed into a bill. The study revealed that in the 355 cases of cervical injury investigated, 69 were the result of accidents in shallow waters, and of these, 58% suffered neurological dysfunction. Rivers, lakes and waterfalls were most frequently cited as locations for the occurrence of these injuries (75,4% of the cases), with the incidence of accidents in swimming pools at 24,6%. The average age of patients varied between 10 to 30 years of age, with a significant difference in other age groups. In relation to sex, 92,8% of the accidents occurred in men, and only 7,2% in women. As to marital status, 68,2% were single and only 31,9% were married. The greatest number of cases of trauma of the cervical cord caused by diving in shallow waters occurred in the warmer seasons of the year (spring summer and fall). 17,4% of the patients interviewed out of a total of 40 with medullar injury, claimed not to know about this kind of accident and its consequences. The Prevention Campaign began in September 1996 and is presently being carried out in the city of Ribeirão Preto. The Bill of Law no. 183 awaits approval from the State Legislature. One may conclude that the incidence of traumatic injury of the cervical cord due to diving in shallow waters is high (third place as the cause of injury). The lack of information on the part of the population regarding the dangers of this type of accident may be one of the reasons behind these high statistics. The reduction of this type of accident may occur as the result of an educational process involving the population as well as decisive action on the part of the government.

Author: Bc. Veronika Valášková Title of thesis: Physiotherapy after cervical spine surgery - literature research. Aims: The aim of my diploma thesis is to give an overview of physiotherapeutic care after cervical intervertebral disc herniation surgery. Methods: The diploma thesis is processed as a research of literacy sources. Fifteen studies were selected that met the required study selection criteria. All studies focused on postoperative physiotherapy in patients after cervical spine surgery by the anterior approach. The diploma thesis is divided into two parts. The first part is theoretical, deals with anatomy, kinesiology, biomechanics of the cervical spine, surgical techniques and subsequent complications that may occur after surgery. The second part is the methodology itself, which processes the available information about postoperative physiotherapy. Results: The results of the diploma thesis show that in the early phase after the operation, active exercise in the shoulder joints, respiratory physiotherapy, strengthening the deep flexors of the cervical spine are most recommended. In the long term, emphasis is placed on strengthening the muscles of the cervical spine, increasing the stability of the cervical spine and increasing the overall condition. The cervical collar is not primarily...

Im Rahmen der szintigraphischen Untersuchung der Halswirbelsäule gibt es unterschiedliche Aussagen zum physiologischen Speicherungsverhalten, insbesondere der kaudalen Facettengelenke. Eine Objektivierung der Szintigramme und Ermittlung von Normalbereichen der entsprechenden Speicherquotienten ist daher wichtig und stellt das Ziel dieser Arbeit dar. Zur Untersuchung kamen dafür 31 Pferde, bei denen es sich um Patienten der Chirurgischen Tierklinik in Leipzig aus dem Jahr 2008 handelte. Falls bei einem Pferd eine Lahmheit der Vordergliedmaße vorhanden war, wurde mit Hilfe der klinischen und szintigraphischen Untersuchung, sowie mittels diagnostischer Anästhesien als deren Ursache die Halswirbelsäule ausgeschlossen. Alle Pferde wiesen eine freie Beweglichkeit des Halses in alle Richtungen auf. Zur Bildung von Speicherquotienten wurden die als Interessenareale dienenden Facettengelenke C3/C4 bis C7/Th1, sowie der Wirbelkörper des sechsten Halswirbels zu verschiedenen Referenzarealen ins Verhältnis gesetzt. Als Referenzareale wurden dabei der Wirbelkörper des dritten und des vierten Halswirbels, sowie das auch als Interessenareal dienende Facettengelenk C3/C4 getestet. Anschließend wurden Normalbereiche für die Speicherquotienten ermittelt. Nach sonographischer Muskeldickenmessung über den Facettengelenken wurden deren Speicherquotienten mit Hilfe einer Formel auf einen Nullwert korrigiert, und für diese korrigierten Werte wurden ebenfalls Normalbereiche ermittelt. Es zeigte sich, dass die Speicherquotienten nach der Muskeldickenkorrektur gegenüber den nativen Speicherquotienten eine größere Streuung aufwiesen und somit größere und ungenauere Normalbereiche hervorbrachten. Dementsprechend sollten die nativen Speicherquotienten bevorzugt werden. Als das am besten geeignete Referenzareal für die Interessenareale C4/C5 bis C7/Th1 erweist sich hierbei die Isokontur-ROI auf dem Facettengelenk C3/C4. Für das Interessenareal C3/C4 eignet sich sowohl der Vergleich mit dem Referenzareal C3, als auch der mit dem Referenzareal C4. Das Interessenareal auf dem Wirbelkörper C6 wird am besten zum Referenzareal C4 ins Verhältnis gesetzt. Hervorzuheben sind die nativen Werte der Normalbereiche für die Gelenke C5/C6 und C6/C7, da hier am häufigsten röntgenologische Veränderungen zu finden sind. Sie betragen für das Gelenk C5/C6 auf der linken Halsseite 0,82-1,10 und auf der rechten Halsseite 0,86-1,10. Für das Gelenk C6/C7 beträgt der Normalbereich für die linke Halsseite 0,75-1,23 und für die rechte Halsseite 0,81-1,17. Zusammenfassend ist zu sagen, dass die quantitative Auswertung mittels der „Regions of Interest“-Technik an der Halswirbelsäule durchaus möglich ist und mit dieser Arbeit akzeptable Normalbereiche für die Facettengelenke C3/C4 bis C7/Th1 und für den Wirbelkörper C6 ermittelt werden konnten. Es fehlen nun noch Werte von Pferden mit einer klinischen Halswirbelsäulenproblematik, um die Aussagekraft der hier ermittelten Normalbereiche zu überprüfen.

RIPPLY2 is an essential part of the formation of somite patterning during embryogenesis and in establishment of rostro-caudal polarity. Here, we describe three individuals from two families with compound-heterozygous variants in RIPPLY2 (NM_001009994.2): c.238A > T, p.(Arg80*) and c.240-4 T > G, p.(?), in two 15 and 20-year-old sisters, and a homozygous nonsense variant, c.238A > T, p.(Arg80*), in an 8 year old boy. All patients had multiple vertebral body malformations in the cervical and thoracic region, small or absent rib involvement, myelopathies, and common clinical features of SCDO6 including scoliosis, mild facial asymmetry, spinal spasticity and hemivertebrae. The nonsense variant can be classified as likely pathogenic based on the ACMG criteria while the splice variants must be classified as a variant of unknown significance. With this report on two further families, we confirm RIPPLY2 as the gene for SCDO6 and broaden the phenotype by adding myelopathy with or without spinal canal stenosis and spinal spasticity to the symptom spectrum.

La proprioception cervicale joue un rôle important dans le contrôle postural, mais la nature exacte de sa contribution est controversée. Dans certains cas de « coup du lapin », une atteinte posturale a été démontrée, sans que l'atteinte du rachis cervical puisse être tenue pour seule responsable. Malgré la forte prévalence des pathologies cervicales dégénératives, leurs conséquences posturales ont été peu étudiées dans la littérature scientifique. Il n'existe aucune publication centrée sur les deux types de pathologie responsables de névralgies cervicobrachiales : les hernies discales cervicales et l'arthrose cervicale. Cette étude a eu pour but d'évaluer le contrôle postural de deux groupes de patients présentant une pathologie cervicale dégénérative avec et sans stimulation optocinétique avant et après traitement chirurgical. Dix-sept patients présentant une radiculalgie ont été inclus dans cette étude et répartis en deux groupes selon l'origine arthrosique ou discale de la compression neurologique. Tous les patients ainsi que 31 témoins ont été soumis à un examen de posturographie statique comprenant 12 enregistrements : les quatre premiers enregistrements ont été réalisés la tête dans l'axe (à 0°) : yeux fermés, yeux ouverts sans stimulation optocinétique, yeux ouverts avec stimulation optocinétique dans le sens horaire, puis antihoraire. Ces quatre situations sensorielles ont été répétées tête tournée 30° à gauche, puis 30° à droite. Les patients ont à nouveau été soumis à ces 12 enregistrements six semaines après l'intervention. Aucun patient ne s'est plaint de sensations vertigineuses que ce soit en pré ou en postopératoire. Avant intervention, les yeux fermés, le groupe hernie discale était plus stable que le groupe arthrose. Après intervention, la contribution visuelle au contrôle postural avait diminué dans les deux groupes dans un environnement visuel dynamique, alors que dans un environnement visuel stable, elle n'avait diminué que dans le groupe arthrose. L'importance relative des informations visuelles et proprioceptives pour le contrôle postural varie selon le type de pathologie et la chirurgie tend à réduire la contribution visuelle surtout pour les patients présentant une arthrose cervicale / Cervical proprioception plays a key role in postural control, but its specific contribution is controversial. Postural impairment was shown in whiplash injuries without demonstrating the sole involvement of the cervical spine. The consequences of degenerative cervical spine diseases are underreported in posture-related scientific literature in spite of their high prevalence. No report has focused on the two different mechanisms underlying cervicobrachial pain: herniated discs and spondylosis. This study aimed to evaluate postural control of two groups of patients with degenerative cervical spine diseases with or without optokinetic stimulation before and after surgical treatment. Seventeen patients with radiculopathy were recruited and divided into two groups according to the spondylotic or discal origin of the nerve compression. All patients and a control population of 31 healthy individuals underwent a static posturographic test with 12 recordings; the first four recordings with the head in 0° position: eyes closed, eyes open without optokinetic stimulation, with clockwise and counter clockwise optokinetic stimulations. These four sensorial situations were repeated with the head rotated 30° to the left and to the right. Patients repeated these 12 recordings 6 weeks postoperatively. None of the patients reported vertigo or balance disorders before or after surgery. Prior to surgery, in the eyes closed condition, the herniated disc group was more stable than the spondylosis group. After surgery, the contribution of visual input to postural control in a dynamic visual environment was reduced in both cervical spine diseases whereas in a stable visual environment visual contribution was reduced only in the spondylosis group. The relative importance of visual and proprioceptive inputs to postural control varies according to the type of pathology and surgery tends to reduce visual contribution mostly in the spondylosis group

Title of the thesis: The influence of exercise on subjective perception of our own body in participants of the Feldenkrais method course Aims of the thesis: The aim of this thesis was to deepen the theoretical knowledge of the Feldenkrais method, the basic anatomy of the cervical spine and the construction of the eye. Furthermore, the aim was to clarify the connection of eye movements and cervical spine, and define cervicoocular reflex, vestibuloocular reflex and whiplash syndrome. Then apply this knowledge and explain how one lesson of the Feldenkrais method affects the subjective perception of our own body, and how it can affect the magnitude of the cervical spine ranges. Method: It is a quantitative, experimental research. In the first part of the research, the questionnaire of own design monitored the effect of one lesson of the Feldenkrais method on the subjective perception of our own body in a group of 56 people aged 24 to 79 years, the lesson took part during a three-day course. In the second part of the research, the effect of one Feldenkrais method focused on the movement of eyes and cervical spine was studied in a group of 20 people aged 19 to 27 years. Data to this section was obtained based on input and output measurements using a measuring tape and a goniometer. In addition, a...

No description available.

No description available.