L'encéphalopathie hypoxique ischémique néonatale (EHI) reste la cause principale de mortalité chez le nouveau-né à terme. Un tiers des survivants vont développer des séquelles neurologiques, dont la paralysie cérébrale (PC), l'épilepsie et un retard intellectuel. Afin d'améliorer leur pronostic, ces nouveau-nés sont soumis à l'hypothermie thérapeutique (HT) qui débute au plus tard 6 heures après la naissance, pour une durée totale de 72 heures, suivie d'un réchauffement graduel (0.5°C/h). Il a été démontré que cette thérapie à effet neuroprotecteur diminue considérablement l'étendue des lésions cérébrales et la fréquence des séquelles neurologiques. Or, des études animales suggèrent que l'hypothermie sans sédation avec opioïdes n'est pas bénéfique. Selon les observations qui ont été réalisées, les porcelets traités avec la thérapie, mais sans l’administration d’analgésique ont manifesté des signes d’instabilités et de tremblements exagérés. On ignorait jusqu’à présent dans quelle mesure ces résultats tirés des expérimentations animales pouvaient être généralisables au nouveau-né. Ainsi, mon projet de maîtrise vise à mieux comprendre les facteurs qui risquent de compromettre les effets bénéfiques de la thérapie de refroidissement, dans le but d’optimiser la neuroprotection et d’améliorer le développement des nourrissons atteints d’EHI. Nous avons comme objectif principal d’évaluer l’association entre les doses d’opioïdes consommées pendant l’HT, le degrée de tremblement, et l’évolution de l’index de discontinuité à l’EEG au fil des 72h de l’HT, du réchauffement et jusqu’à 12 heures post-HT. Pour répondre à l’objectif, nous avons conduit une étude chez 21 nouveau-nés avec EHI soumis à l’HT, et dont les principaux résultats ont montré des associations significatives entre les fortes doses d’opioïdes administrés à l’enfant (r = - 0.493, p = 0.023), les frissons réduits pendant l’HT (r = 0.513, p = 0.017) et l’amélioration du rythme cérébrale d’EEG. Ces résultats sont décrits de manière plus approfondie dans le Chapitre 2 qui présente la version de l’article soumis à la revue Journal of Pediatrics, et le Chapitre 3 qui présente un retour sur la littérature à la lumière de nos trouvailles. Quant au Chapitre 4, nous y élaborons les possibilités de perspectives futures et les retombées cliniques de nos résultats. À long terme, nous espérons que nos travaux permettront l’ouverture d’une nouvelle piste d’amélioration de la neuroprotection, en favorisant systématiquement une meilleure prise en charge de la douleur et du stress induit par le refroidissement. / Neonatal hypoxic-ischemic encephalopathy (HIE) remains the leading cause of death and mortality in the term infant. A third of the survivors will develop neurological sequelae including cerebral palsy (CP), epilepsy and mental retardation. In order to improve their prognosis, these newborns undergo therapeutic hypothermia (TH), which begins no later than 6 hours after birth, maintained for a total duration of 72 hours and followed by gradual rewarming (0.5°C/h). This neuroprotective therapy has been shown to significantly decrease the extent of brain injury and the frequency of neurological sequelae. Results from animal studies revealed that ongoing hypothermia without proper anesthesia is not beneficial. Based on the observations that have been reported, piglets treated with TH with no analgesics have shown signs of instability and excessive tremors. Until now, the extent to which these results from animal experiments could be generalized to the newborn remained unknown. Thus, the purpose of my master’s project was to better understand the clinical factors that may compromise the beneficial effects of TH, in an attempt to optimize neuroprotection and improve the neurological outcome of HIE infants. Our main objective was to assess the associations between opioid doses consumed during TH, shivering recorded during TH, and the evolution of EEG discontinuity index over the course of TH, rewarming and up to 12 hours post-TH. To meet the objective, we conducted a study in 21 newborns with HIE undergoing TH, and the results have shown significant associations between high doses of opioid administered (r = - 0.493, p = 0.023), reduced shivering stress (r = 0.513, p = 0.017) and improved EEG background activity. The key findings of the study are described in more detail in Chapter 2, which presents the original manuscript submitted for publication to the “Journal of Pediatrics”, and Chapter 3, which presents a review of the literature in light of our results. In Chapter 4, we discuss future perspectives and the clinical significance of our results. At last, we hope that our study will open up new avenues for improving neuroprotection, by systematically promoting a better management of pain and cooling-induced stress.

Title: The reflection kinesiology analyse of cross country skiing Purposes: To compare coordination of chosen muscles on leg during reflection of cross country skiing classic technique, skating and herringbone. Methods: Comparative analysis: the dates were measured by surface electromyography and 2-D video-analysis. Results: We founded statistical significance by comparisons muscle activation on right leg during kick during cross country skiing: classic technique, diagonal stride and herringbone and V-1 skating and herringbone. In case the left leg the statistical significance was disprove by: m. peroneus longus sin during comparison of diagonal stride and herringbone and m. gastrocnemius medialis sin V-1 skating and herringbone. We founded high level of laterality of diagonal stride and herringbone. In case V-1 skating, the significant similarity was not founded for m. vastus lateralis and m. gluteus medialis. Key words: Cross country skiing, classical technique, skating, herring bone, kinesiology, surface electromyography (EMG), muscles activation

Despite a high proportion of the population experiencing traumatic events within their lifetime, the number of individuals who go on to develop posttraumatic stress disorder (PTSD) is comparatively small; herein highlighting the importance of individual differences in imparting risk and resilience towards the development and maintenance of PTSD. Existing literature illustrates that biological and ecological factors are important in predicting PTSD development, with pathological vulnerabilities excepting their effects at pre- peri- and post trauma stages. Whilst cognitive and emotion based models of PTSD account for the role of a minority of known pre-trauma risk factors, individual differences in peri- and post trauma processes are held as critical to the development of PTSD. The broad range of risk factors implicated in the empirical literature, and necessity of traumatic exposure to PTSD, implicates the utility of a diathesis-stress conceptualisation of PTSD development. The current thesis employed an analogue VR-trauma paradigm to investigate the respective importance of vulnerability factors at each stage, in the prediction of analogue PTSD symptoms (memory problems, startle responses, re-exposure fear habituation), whilst measuring affective and electrophysiological concomitance. Findings supported the importance of peri-traumatic responses in the prediction of PTSD, where present, showing increased predictive capacities over pre- and post-trauma factors. Biological and ecological factors also illustrated important predictive associations, with genetic SNPs implicated in reflex startle and cardiac responses towards intrusive memories. Moreover, peri-traumatic HR decelerations and accelerations mediated the association between pre-trauma factors and cued recall inaccuracy and intrusion severity respectively. Results support existing cognitive and emotional models in their emphasis on peri-traumatic processes but suggest the added utility of a diathesis stress conceptualisation of the development of PTSD, in highlighting the importance of pre-trauma biological and ecological risk and resilience factors.

Ο στόχος αυτής της εργασίας ήταν η αναγνώριση έξι βασικών κινήσεων του χεριού με χρήση δύο συστημάτων. Όντας θέμα διεπιστημονικού επιπέδου έγινε μελέτη της ανατομίας των μυών του πήχη, των βιοσημάτων, της μεθόδου της ηλεκτρομυογραφίας (ΗΜΓ) και μεθόδων αναγνώρισης προτύπων. Παράλληλα, το σήμα περιείχε αρκετό θόρυβο και έπρεπε να αναλυθεί, με χρήση του EMD, να εξαχθούν χαρακτηριστικά αλλά και να μειωθεί η διαστασιμότητά τους, με χρήση των RELIEF και PCA, για βελτίωση του ποσοστού επιτυχίας ταξινόμησης. Στο πρώτο μέρος γίνεται χρήση συστήματος ΗΜΓ της Delsys αρχικά σε ένα άτομο και στη συνέχεια σε έξι άτομα με το κατά μέσο όρο επιτυχημένης ταξινόμησης, για τις έξι αυτές κινήσεις, να αγγίζει ποσοστά άνω του 80%. Το δεύτερο μέρος περιλαμβάνει την κατασκευή αυτόνομου συστήματος ΗΜΓ με χρήση του Arduino μικροελεγκτή, αισθητήρων ΗΜΓ και ηλεκτροδίων, τα οποία είναι τοποθετημένα σε ένα ελαστικό γάντι. Τα αποτελέσματα ταξινόμησης σε αυτή την περίπτωση αγγίζουν το 75%. / The aim of this work was to identify six basic movements of the hand using two systems. Being an interdisciplinary topic, there has been conducted studying in the anatomy of forearm muscles, biosignals, the method of electromyography (EMG) and methods of pattern recognition. Moreover, the signal contained enough noise and had to be analyzed, using EMD, to extract features and to reduce its dimensionality, using RELIEF and PCA, to improve the success rate of classification. The first part uses an EMG system of Delsys initially for an individual and then for six people with the average successful classification, for these six movements at rates of over 80%. The second part involves the construction of an autonomous system EMG using an Arduino microcontroller, EMG sensors and electrodes, which are arranged in an elastic glove. Classification results in this case reached 75% of success.

<p>Surface electromyography (sEMG) has been used to monitor muscle activity and predict fatigue in the workplaces. However, objectively measuring fatigue is challenging in complex work with unpredictable work cycles, where sEMG may be influenced by the dynamically changing posture demands. The sEMG is affected by various variables and substantial change in mean power frequencies (MPF), and a decline over 8-9% is primarily considered musculoskeletal fatigue. These MPF thresholds have been frequently used, and there were limited efforts to test their appropriateness in determining musculoskeletal fatigue in live workplaces (which predominantly consist of complex tasks). In addition, the techniques that consider both muscular and postural measurements that incorporate dynamic posture changes observed in complex work have not yet been explored. The overall objective of this work is to leverage both postural and muscular cues to identify musculoskeletal fatigue in complex tasks/jobs (i.e., tasks involving different levels of exertions, durations, and postures). The work was completed in two studies.</p> The first study aimed to (1) predict subjective fatigue using objective measurements in non-repetitive tasks, (2) determine whether the musculoskeletal fatigue thresholds in non-repetitive tasks differed from the previously reported threshold, and (3) utilize the empirically calculated thresholds to test their appropriateness in determining musculoskeletal fatigue in live surgical workplaces. The findings showed that the multi-modal measurements indicate better sensitivity than single-modality (sEMG) measurements in detecting decreases in MPF, a predictor of fatigue. In addition, the results showed that the thresholds in dynamic non-repetitive tasks, like surgery, are different than the previously reported 8% threshold. Additionally, implementing muscle-specific thresholds increased the likelihood of more accurately reporting subjective fatigue. The second study aimed to develop a multi-modal fatigue index to detect musculoskeletal fatigue. A controlled laboratory study was performed to simulate the non-repetitive physical demands at different postures. A series of experiments were conducted to test the effectiveness of various metrics/models to identify subjective fatigue in complex tasks. Next, the composite fatigue index (CFI) function was developed using the time-synced integration of both muscular signals (measured with sEMG sensors) and postural signals (measured with Inertial Measurement Unit (IMU) sensors). The variables from sEMG (amplitude, frequency, and the number of muscles showing signs of fatigue) and IMU (the prevalence of static and demanding postures and the number of shoulders in static/demanding posture) sensors were integrated to generate the CFI function. The prevalence of static/demanding postures was developed using the cumulative exposures to static/demanding postures based on the material fatigue failure theory. The single value fatigue index was obtained using the resultant CFI function, which incorporates both muscular and postural variables, to quantify the muscular fatigue in dynamic non-repetitive tasks. The findings suggested that the propagation of musculoskeletal fatigue can be detected using the multi-modal composite fatigue index in complex tasks. The resultant CFI function was then applied to surgery tasks to differentiate the fatigued and non-fatigued groups. The findings showed that the multi-modal fatigue assessment techniques could be utilized to incorporate the muscular and postural measurements to identify fatigue in complex tasks beyond single-modality assessment approaches.

Arbeitswissenschaftliche digitale Menschmodelle werden als Werkzeuge virtueller Ergonomie zur Gestaltung menschengerechter Produkte und Arbeitsplätze genutzt. Der bislang nur qualitativ beschriebene Praxiseinsatz wird durch theoretische Analysen und eine empirische Studie systematisiert und darauf aufbauend werden die Schwachstellen der Systeme erörtert. Ein wesentlicher Ansatzpunkt für Weiterentwicklungen ist die Erarbeitung ergonomischer Bewertungsverfahren bzw. -modelle, insbesondere für Belastungen aufgrund von Bewegungen. Digitale Menschmodelle bieten das Potenzial, aus simulierten Bewegungsdaten und den damit zusammenhängenden Belastungen eine Bewertung der Arbeitsvorgänge zu generieren. In dieser Arbeit wird daher ein neues arbeitswissenschaftliches Bewertungsmodell für muskuläre Beanspruchungen erforscht, d.h. methodisch hergeleitet und evaluiert. Dazu ist ein Versuchsstand zur Standardisierung und Belastungserzeugung notwendig. In der darauffolgenden Laborstudie werden die Belastungsparameter statischer Momentanteil, Winkelgeschwindigkeit und Momentrichtung variiert und die daraus entstehende Veränderung der muskulären Beanspruchung von Probanden erforscht. Ein dafür benötigtes, neues Verfahren zur Normalisierung wird vorgestellt. Die Laborstudie zeigt, dass der statische Momentanteil linear steigend mit der Arbeitsbeanspruchung zusammenhängt. Die durchschnittliche Winkelgeschwindigkeit beeinflusst die Arbeitsbeanspruchung je nach Muskeltyp entweder linear steigend oder ohne Zusammenhang. / Digital human models for human factors are used as tools for virtual ergonomics and the design of products and workplaces. In this work the use of the systems is analysed with theoretical models and an empirical study. Therefore, disadvantages of the systems are identified. A main idea for further developments is the research on ergonomic approaches and models, especially for movements and the strain caused by movements. Digital human models are capable to assess work processes based on data from simulations. In this work a new human factors orientated rating model for muscular strains is developed and evaluated. A test stand generates and standardizes the stress. In a laboratory survey the stress parameters are analysed. The variation of the static torque part, the angular velocity and the torque direction cause changes in the muscular strains. Hence, these muscular strains are measured electromyographically. A new normalisation method, the normalized standard movement, is introduced. The survey shows the existence of a correlation of static torque part and work strain. Depending on the muscle type, the angular velocity either affects the work strain linear increasing or does not affect it.