Spinal cord injury is a devastating source of suffering in the spectrum of human pathophysiology; advancement for clinical therapy in this area has been stagnant in comparison to modern medical development. Current treatments are palliative, and functional recovery is minimal. During the first two weeks after injury, dense glial scar forms that is impenetrable by regenerating axons. Intervention is imperative to minimize scar formation and provide a supportive environment for axonal regeneration. Oligodendrocytes are critical to maintain the health of growing axons during development and after injury. Obtaining these cells through differentiation of neural progenitor cells (NPCs) is a viable option, but current clinical trials involving stem cells are plagued by poor cell survival and undirected differentiation. Research indicates that local extracellular matrix (ECM) is vital to progenitor differentiation and tissue regeneration. During development, spinal cord ECM is comprised of high concentrations of laminin and hyaluronic acid (HA), which provide essential cues to direct NPC migration and differentiation. The purpose of this research is to create a biomaterial optimized to direct NPC differentiation to oligodendrocytes. Natural biomaterials were optimized from distinct combinations of collagen I, HA, and laminin I to model the native ECM signals found during oligodendrocyte maturation. Four material combinations (collagen, collagen-HA-laminin, collagen-HA, and collagen-laminin) were fabricated into injectable hydrogels to mimic the range of compressive and shear mechanical properties present in neonatal central nervous system (CNS) tissue. Differentiation was assessed by culturing rodent fetal NPCs in these materials without specific soluble factors to direct cellular behavior. The three-component hydrogel performed optimally and achieved a 66% oligodendrocyte differentiation rate compared to approximately 15% in the collagen alone hydrogel. An in vivo study was then conducted using a rat contusion model of spinal cord injury with intervention using the injectable, three-component hydrogel seeded with rat NPCs. Functional recovery was assessed using six behavioral tests. Significant recovery was observed using two behavioral tests six weeks post-treatment. Lesion size was measured and correlated well with behavioral outcomes. The data obtained in this research indicate that a multi-component hydrogel mimicking native, developmental CNS tissue may address problems associated with current clinical practice. / text

Hip fracture in older adults may be the sentinel event leading to functional decline, long-term disability, and death. For the substantial number of older persons who fracture a hip each year, the chances of full functional recovery remains relatively low. The purpose of this study was to examine the differences between older persons with hip fracture who recover fully and those individuals who do not fully recover. A chronic disease trajectory framework guided the theoretical design of the research. Data were collected from the medical records of 102 persons aged 60 years and older who sustained a proximal hip fracture from 1993 to 1998 at a medical center in North Carolina. Data included personal characteristics, prefracture health status, hospital factors, rehabilitation features, and functional outcomes. The analysis consisted of a two-step hierarchical logistic regression model with the control variables of age, prefracture ambulation status, and prefracture cognitive status entered first and the variables of type of therapy program, frequency of therapy, number of therapy provider organizations, and location of therapy at 4 weeks entered second. Significance of the final model was observed, Chi-Square(7, n = 99)=43.55, p < .05. Significant individual predictors (p < .05) in the model were prefracture ambulation status (43.56 odds ratio) and cognitive status (6.44 odds ratio). Post-hoc analysis of the cases revealed a substantial lack of stability in ambulation status from three months post-fracture to the six-month and one-year follow-up. Findings support other research studies that indicate prefracture personal characteristics of older persons who fracture a hip are the most influential factors in predicting successful recovery. Linkage of the findings to the chronic disease trajectory model suggests that intervention efforts should focus on prevention, health promotion, and policies that extend the ability of health care providers to assist older persons with hip fracture in managing their conditions. / Ph. D.

<p>Uvod: Mikrodiskektomija je jedan od savremenih hirur&scaron;kih metoda u lečenju osoba sa lumbalnim sindromom, čiji je uzrok hernijacija intervertebralnog diska. Na postoperativni oporavak, ishod rehabilitacije i funkcionalno stanje, veliki uticaj imaju i biopsihosocijalni faktori. Cilj: Glavni cilj istraživanja je bio procena uticaja biopsihosocijalnih faktora na ishod lečenja i funkcionalni status bolesnika sa lumbalnim sindromom nakon mikrodiskektomije i sprovedenog rehabilitacionog tretmana. Materijal i metode: Sprovedena je prospektivna studija na 200 pacijenata (96 mu&scaron;karaca i 104 žene), različitih profesija, prosečne životne dobi 50.20 &plusmn; 10.26 godina (raspon 29&ndash;69 godina). U istraživanje su uključeni pacijenti nakon operativnog lečenja hernijacije diska, putem mikrodiskektomije, preme&scaron;teni sa Klinike za neurohirurgiju na Kliniku za medicinsku rehabilitaciju, Kliničkog centra Vojvodine u Novom Sadu. Stratifikacija ispitanika je izvr&scaron;ena prema njihovim biolo&scaron;ko-demografskim, socio-ekonomskim, psiholo&scaron;kim i funkcionalnim obeležjima, uz kori&scaron;ćenje podataka iz anamneze, kliničkog pregleda, raspoložive medicinske dokumentacije i odgovarajućih upitnika i testova. Kori&scaron;ćeni su sledeći upitnici: za procenu bola-vizuelna analogna skala (VAS), upitnik o bolu (Pain Detect Test), za procenu psiholo&scaron;kih karakteristika Spilbergerovi testovi za trenutnu i op&scaron;tu anksioznost (Spielberger Anxiety Inventory-State and Trait Test), Bekova skala depresije (BDI), upitnik za procenu prisustva straha od fizičke aktivnosti i posla i njihovog izbegavanja (The Fear-Avoidance Beliefs Questionnaire - Physical activity and Work), a za procenu funkcionalnog statusa Osvestrijev upitnik o onesposobljenosti (ODI) i Kvebek skala onesposobljenosti osoba sa lumbalnim sindromom. Fleksibilnost i indeks pokretljivosti lumbalnog segmenta kičme su procenjivani pomoću &Scaron;oberovog i Tomajerovog testa. Navedena ispitivanja su obavljena postoperativno pre početka sprovođenja rehabilitacionog tretmana (0. mesec), potom posle mesec dana i zatim 3 i 6 meseci posle mikrodiskektomije. Rezultati: Na doživljavanje bola i na funkcionalnu sposobnost imali su signifikantnog uticaja sledeći navedeni činioci. Pol: subjektivno doživljavanje bola je bilo jače kod žena nego kod mu&scaron;karaca, ali je stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali) bio signifikantno veći (p&lt;0.01) kod mu&scaron;karaca. Životna dob: Stepen oporavka pacijenata nakon mikrodiskektomije je tokom vremena u pojedinim starosnim grupama bio promenljiv, ali je u celini bio lo&scaron;iji kod starijih osoba. Navika pu&scaron;enja: intenzitet bola (VAS) i stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali ) su bili veći kod pu&scaron;ača nego kod nepu&scaron;ača (p&lt;0.01). Mehaničko opterećenje kičme: manji stepen oporavka su imali ispitanici čije zanimanje je povezano sa većim dinamičkim i statičkim opterećenjem kičmenog stuba. Socijalni faktori: redovno zaposlenje i novčana primanja su povezani sa boljim funkcionalnim oporavkom. Psiholo&scaron;ki status i stepen optimizma: anksioznost i strahovi od fizičke aktivnosti i posla, strah od gubitka posla, depresija, negativni stavovi i pesimizam su signifikantno če&scaron;će prisutni kod ispitanika koji su imali manji stepen funkcionalnog oporavka tokom praćenog perioda. Zaključci: Na doživljavanje bola i na funkcionalnu sposobnost i oporavak pacijenata nakon mikrodiskektomije imali su signifikantnog uticaja sledeći biopsihosocijalni faktori: pol, životna dob, navika pu&scaron;enja, mehaničko opterećenje kičme, socijalno-ekonomski faktori, psiholo&scaron;ki status i stepen optimizma pacijenta. Primenom odgovarajućih upitnika i registrovanjem ovih faktora, može se kreirati model za predviđanje stepena funkcionalnog oporavka i za primenu dopunskih terapijskih postupaka posle načinjene mikrodiskektomije.</p> / <p>Introduction: Microdiscectomy is one of the modern surgical methods for the treatment of people with low back pain, caused by a herniated intervertebral disc. On postoperative recovery, rehabilitation outcome and functional status, among others, great influence have also biopsychosocial factors. Goal: The main goal of the research was to assess which biopsychosocial factors have a significant impact on treatment outcome and functional status of patients with low back pain after lumbar microdiscectomy and the subsequent physical therapy. Material and methods: The research was conducted as a prospective study on 200 patients (96 men and 104 women), of various professions and mean age 50.20 &plusmn; 26.10 years (range 29-69 years). The study involved patients after surgical treatment of disc herniation by microdiscectomy, who were transferred from the Clinic for neurosurgery to the Clinic for medical rehabilitation, in Clinical center of Vojvodina, Novi Sad, in order to perform physical therapy and rehabilitation. Stratification of patients was performed according to their biological, demographic, socio-economic, psychological and functional characteristics, using data from the health history, clinical examination, the available medical records and appropriate questionnaires and tests. Among the questionnaires were those that are used for assessment of pain, psychological and psychosocial characteristics and functional status of patients with low back pain, including a visual analogue scale, Pain Detect Test, Spielberger Anxiety Inventory-State and Trait, Beck Depression Inventory, The Fear-Avoidance Beliefs Questionnaire (Physical activity and Work), Oswestry Low Back Pain Disability Questionnaire (ODI) and Quebec Back Pain Disability Scale. The flexibility of the lumbar segment of the spine and its movement index were assessed by Schober&#39;s and Thomayer&#39;s tests. All of these above mentioned assessments were carried out just before the start of the rehabilitation treatment (month 0), at the beginning of physical therapy (month 0), one month later and then 3 and 6 months after microdiscectomy. Results: On the pain and functional ability / disability the significant influences had following listed factors. Gender: subjective perception of pain was stronger among women than among men, but the degree of functional disability (ODI and Quebec Scale) was significant higher in the group of men (p&lt;0.01). Age: The degree of recovery among patients after microdiscectomy over time in different age groups was varying, but in general was worse in the group of older people. Smoking habits: pain intensity and degree of functional disability were higher among smokers than nonsmokers (p&lt;0.01). Mechanical loading of the spine: lower degree of recovery had subjects whose job is associated with a higher dynamic and static loading of the spine. Social factors: regular employment and cash income are associated with better functional recovery. Psychological status and the degree of optimism: anxiety and fear of physical activity and work as well as the possibility of job loss, depression, negative attitudes and pessimism, were significantly more often present in the group of patients who had a lower degree of functional recovery during the studied period. Conclusions: On the experience of pain, on functional ability and recovery of patients after microdisectomy, significant influences have the following biopsychosocial factors: gender, age, smoking habits, the mechanical loading of the spine, socio-economic factors, psychological status and the degree of optimism of the patient. Using the appropriate questionnaires and registering mentioned factors, it is possible to create a model for predicting the degree of functional recovery and for the application of additional therapeutic procedures after microdisectomy.</p>

Stroke is a major cause of death and disability worldwide. In Sweden, about 30 000 strokes occur each year. The aim of this thesis was to analyse survival, functional outcome and self-reported depression after stroke, and to explore possible differences between men and women in stroke care and outcome. These studies were based on Riks-Stroke, the Swedish national quality register for stroke care. Information on background variables and treatment were collected during the hospital stay. The patient’s situation and outcome after stroke were followed-up after 3 months. Long term survival was retrieved from the Swedish Population Register (Folkbokföringen). Possible sex-differences in stroke care and outcome 3 months after stroke were explored in 24 633 strokes, registered during 2006. In conscious patients, the proportions treated at stroke units were similar for men and women. Men and women had equal chance to receive thrombolytic therapy or secondary prevention with oral anticoagulants. Compared to men, women were less likely to develop pneumonia, but more likely to experience deep venous thromboses and fractures during hospital stay. Women had worse 3-month survival and functional outcome, differences that were explained by their higher age and impaired level of consciousness on admission. Women felt more depressed and perceived their health as worse than men did. Women were also less satisfied with the care they had received in the hospital. The agreement between self-reported functional outcome 3 months after stroke and the commonly used modified Rankin Scale (mRS) was explored in 555 stroke survivors from 4 hospitals during May-September 2005. Riks-Stroke’s self-reported questions classified 76% of the patients into correct mRS grade. The association between functional outcome 3 months after stroke and 3-year survival was assessed in 15 959 men and women who had had a stroke during 2001-2002. Patients with estimated mRS grades 3, 4 and 5 had hazard ratios for death of 1.7, 2.5 and 3.8, respectively, as compared with patients with lower grades, 0-2. Depressed mood, male sex, high age, diabetes, smoking, antihypertensive therapy at onset and atrial fibrillation were also identified as predictors of poor survival. Self-reported depression 3 months after stroke and use of antidepressants were analysed in 15 747 stroke survivors from 2002. Fourteen percent felt depressed 3 months after stroke. Female sex, age &lt;65, previous stroke, living alone or in institution, or being dependent in activities of daily living (ADL) were factors associated with self-reported depression. At the follow-up, 22% of the men and 28% of the women were using antidepressant medication, which were approximately twice as many as in the general population. Still, 8% of all patients in Riks-Stroke reported depressive mood but no treatment with antidepressants. In conclusion, men and women with stroke in Sweden experience similar treatment and outcome in most aspects. Patient-reported functional outcome can be reliably transformed to a standard disability scale. Impaired functional outcome three months after stroke is an independent predictor of poor long-term survival. Depressive mood is common after stroke and is associated with poor survival and impaired functional outcome.

Chronic denervation and chronic axotomy present independent barriers for axonal regeneration. Chronic denervation occurs when nerves are no longer connected to their neuronal cell bodies; chronic axotomy occurs when neurons are not connected to their targets for prolonged periods of time. The harmful effects of chronic denervation can be addressed by the side-to-side bridge surgical technique. Additionally, the negative effects of chronic axotomy can be reversed by GDNF delivery to the nerve. The experiments in this thesis were designed to evaluate nerve regeneration in a rat model of chronic injury after treatment with local GDNF delivery, side to-side bridge protection, or both. The GDNF delivery system consisted of poly(lactic-co-glycolic acid) microspheres embedded in fibrin for controlled delivery of GDNF. Overall, the side-to-side bridges technique was effective in protecting against the negative effects of chronic denervation regardless of treatment with or without GDNF. Local delivery of GDNF did not increase axonal regeneration or functional recovery.

Chronic denervation and chronic axotomy present independent barriers for axonal regeneration. Chronic denervation occurs when nerves are no longer connected to their neuronal cell bodies; chronic axotomy occurs when neurons are not connected to their targets for prolonged periods of time. The harmful effects of chronic denervation can be addressed by the side-to-side bridge surgical technique. Additionally, the negative effects of chronic axotomy can be reversed by GDNF delivery to the nerve. The experiments in this thesis were designed to evaluate nerve regeneration in a rat model of chronic injury after treatment with local GDNF delivery, side to-side bridge protection, or both. The GDNF delivery system consisted of poly(lactic-co-glycolic acid) microspheres embedded in fibrin for controlled delivery of GDNF. Overall, the side-to-side bridges technique was effective in protecting against the negative effects of chronic denervation regardless of treatment with or without GDNF. Local delivery of GDNF did not increase axonal regeneration or functional recovery.

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Em roedores, as vibrissas são detectores táteis que desempenham papel importante na exploração espacial do ambiente e na discriminação de texturas. No córtex somatosensorial, os campos receptivos de cada uma das vibrissas estão organizados no hemisfério contralateral em colunas discretas denominadas barris. A lesão unilateral dos barris produz um comportamento assimétrico caracterizado pela redução no uso da vibrissa contralateral à lesão na exploração do ambiente, assimetria esta que diminui progressivamente na medida em que os animais são repetidamente testados. Em ratos, este comportamento, normalmente medido pelo número de vezes que os animais encostam as vibrissas na parede de um campo aberto, tem se mostrado uma ferramenta importante em estudos de plasticidade e recuperação funcional após lesões corticais. Contudo, em camundongos com lesões unilaterais dos barris, o registro dos toques das vibrissas na parede tem levado a resultados contraditórios. Esse trabalho tem por objetivo principal o estabelecimento de um modelo comportamental para avaliação da recuperação funcional após lesões unilaterais dos barris do córtex somatosensorial em camundongos. Para tanto, o sentido dos deslocamentos realizados próximos às quinas do campo aberto foi registrado em camundongos Suíços machos submetidos à criolesão unilateral dos barris foi avaliado em três estudos independentes. No primeiro estudo, demonstramos que no grupo Criolesado houve um predomínio dos deslocamentos em sentido contralateral na primeira vez em que foram testados no campo aberto e este resultado foi independente do fato de na primeira sessão ter sido realizada um ou nove dias após a cirurgia. Além disso, demonstramos que o predomínio de deslocamentos em sentido contralateral foi diminuindo na medida em que os animais eram repetidamente testados no campo aberto. No segundo estudo, demonstramos que os animais do grupo Criolesado que foram previamente submetidos a cinco sessões experimentais no campo aberto não apresentaram, após a cirurgia, diferenças entre os deslocamentos realizados em sentido ipsolateral e contralateral à lesão. Já no terceiro estudo, demonstramos que os animais do grupo Criolesado que não foram previamente testados no campo aberto apresentam um predomínio de deslocamentos em sentido contralateral, mesmo quando o teste foi realizado 48 dias após a lesão unilateral dos barris. Nossos dados sugerem que o sentido dos deslocamentos próximo às quinas do campo aberto pode ser uma ferramenta importante para avaliar a recuperação das lesões unilaterais nos barris do córtex somatosensorial. Além disso, para avaliar a recuperação funcional após a lesão unilateral dos barris do córtex somatossensorial, sem o viés da habituação à situação do teste, os animais devem ser testados apenas uma vez / In rodents, the vibrissae are tactile detectors that have an important role in the spatial exploration of the environment and in texture discrimination. In the somatosensory cortex, the receptive fields of each of the vibrissae are organized into discrete columns, known as barrels, in the contralateral hemisphere. The unilateral lesions of the barrels results in an asymmetric behavior characterized by the reduction in the use of the vibrissae contralateral to the lesion during the exploration of the environment. This asymmetry progressively diminishes as the animal is repeatedly tested in the same environment. In rats, this behavior, usually assessed by the number of times the animals touch the walls of an open field arena with their vibrissae, has been considered a useful tool in studies addressing plasticity and functional recovery after cortical lesions. However, in mice with unilateral lesions of the barrels, the analysis of the number of times that the vibrissae touch the walls have lead to contradictory results. The present work aims to establish a behavioral model for the evaluation of functional recovery after unilateral lesions of the barrel field located in the somatosensory cortex of the mouse. To that end, the direction of movement near the corners of the open field of Swiss male mice subjected to unilateral cryolesion of the barrel was analyzed in three independent studies. In the first study, we demonstrated that the cryolesioned animals displayed a predominance of contralateral movements in the first time that they were tested in the open field and that this result was present whether the animals was first tested one or nine days after the lesion. Furthermore, we demonstrated that the predominance of movements toward the contralateral side of the lesion diminished as the animals were repeatedly tested in the open field. In the second study, we demonstrated that the cryolesioned animals that were, prior to barrel field lesioning, subjected to five sessions in the open field did not display, after lesioning, differences between the number of ipso and contralateral movements. In the third study, we demonstrated that the cryolesioned animals that were not previously tested in the open field displayed a predominance of contralateral movements even if the first test was carried out forty eight days after the unilateral lesion of the barrels. Our data suggest that the analysis of the direction of movement near the corners of the open field can be an important tool in the assessment of functional recovery after unilateral lesions of the barrels located in the somatosensory cortex of mice. Moreover, in order to properly assess functional recovery after unilateral lesion of the barrel field without the confounding factor of habituation, animals must be tested only once

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Em roedores, as vibrissas são detectores táteis que desempenham papel importante na exploração espacial do ambiente e na discriminação de texturas. No córtex somatosensorial, os campos receptivos de cada uma das vibrissas estão organizados no hemisfério contralateral em colunas discretas denominadas barris. A lesão unilateral dos barris produz um comportamento assimétrico caracterizado pela redução no uso da vibrissa contralateral à lesão na exploração do ambiente, assimetria esta que diminui progressivamente na medida em que os animais são repetidamente testados. Em ratos, este comportamento, normalmente medido pelo número de vezes que os animais encostam as vibrissas na parede de um campo aberto, tem se mostrado uma ferramenta importante em estudos de plasticidade e recuperação funcional após lesões corticais. Contudo, em camundongos com lesões unilaterais dos barris, o registro dos toques das vibrissas na parede tem levado a resultados contraditórios. Esse trabalho tem por objetivo principal o estabelecimento de um modelo comportamental para avaliação da recuperação funcional após lesões unilaterais dos barris do córtex somatosensorial em camundongos. Para tanto, o sentido dos deslocamentos realizados próximos às quinas do campo aberto foi registrado em camundongos Suíços machos submetidos à criolesão unilateral dos barris foi avaliado em três estudos independentes. No primeiro estudo, demonstramos que no grupo Criolesado houve um predomínio dos deslocamentos em sentido contralateral na primeira vez em que foram testados no campo aberto e este resultado foi independente do fato de na primeira sessão ter sido realizada um ou nove dias após a cirurgia. Além disso, demonstramos que o predomínio de deslocamentos em sentido contralateral foi diminuindo na medida em que os animais eram repetidamente testados no campo aberto. No segundo estudo, demonstramos que os animais do grupo Criolesado que foram previamente submetidos a cinco sessões experimentais no campo aberto não apresentaram, após a cirurgia, diferenças entre os deslocamentos realizados em sentido ipsolateral e contralateral à lesão. Já no terceiro estudo, demonstramos que os animais do grupo Criolesado que não foram previamente testados no campo aberto apresentam um predomínio de deslocamentos em sentido contralateral, mesmo quando o teste foi realizado 48 dias após a lesão unilateral dos barris. Nossos dados sugerem que o sentido dos deslocamentos próximo às quinas do campo aberto pode ser uma ferramenta importante para avaliar a recuperação das lesões unilaterais nos barris do córtex somatosensorial. Além disso, para avaliar a recuperação funcional após a lesão unilateral dos barris do córtex somatossensorial, sem o viés da habituação à situação do teste, os animais devem ser testados apenas uma vez / In rodents, the vibrissae are tactile detectors that have an important role in the spatial exploration of the environment and in texture discrimination. In the somatosensory cortex, the receptive fields of each of the vibrissae are organized into discrete columns, known as barrels, in the contralateral hemisphere. The unilateral lesions of the barrels results in an asymmetric behavior characterized by the reduction in the use of the vibrissae contralateral to the lesion during the exploration of the environment. This asymmetry progressively diminishes as the animal is repeatedly tested in the same environment. In rats, this behavior, usually assessed by the number of times the animals touch the walls of an open field arena with their vibrissae, has been considered a useful tool in studies addressing plasticity and functional recovery after cortical lesions. However, in mice with unilateral lesions of the barrels, the analysis of the number of times that the vibrissae touch the walls have lead to contradictory results. The present work aims to establish a behavioral model for the evaluation of functional recovery after unilateral lesions of the barrel field located in the somatosensory cortex of the mouse. To that end, the direction of movement near the corners of the open field of Swiss male mice subjected to unilateral cryolesion of the barrel was analyzed in three independent studies. In the first study, we demonstrated that the cryolesioned animals displayed a predominance of contralateral movements in the first time that they were tested in the open field and that this result was present whether the animals was first tested one or nine days after the lesion. Furthermore, we demonstrated that the predominance of movements toward the contralateral side of the lesion diminished as the animals were repeatedly tested in the open field. In the second study, we demonstrated that the cryolesioned animals that were, prior to barrel field lesioning, subjected to five sessions in the open field did not display, after lesioning, differences between the number of ipso and contralateral movements. In the third study, we demonstrated that the cryolesioned animals that were not previously tested in the open field displayed a predominance of contralateral movements even if the first test was carried out forty eight days after the unilateral lesion of the barrels. Our data suggest that the analysis of the direction of movement near the corners of the open field can be an important tool in the assessment of functional recovery after unilateral lesions of the barrels located in the somatosensory cortex of mice. Moreover, in order to properly assess functional recovery after unilateral lesion of the barrel field without the confounding factor of habituation, animals must be tested only once

Peripheral nerve fibers are a frequent lesion target because of its distribution around organism. These lesions create motor, sensitive and autonomic alterations. Several experimental studies demonstrate a relationship between physical exercise practice and functional regeneration after a peripheral nerve lesion. However, studies that relates the metabolic way predominantly used during exercise practice with gains on nerve functional recuperation and the evolution of inflammatory process in lesion macroenvironment are scarce. The present research investigates influence of predominantly aerobic and anaerobic exercises, initiated immediately after lesion, on functional and morphological recuperation of rat ischiatic nerve submitted to axonotmesis. The left ischiatic nerve crush was achieved in Wistar rats through a temporary surgical clip, by the period of three minutes. At first day after lesion, remained for four weeks, anaerobic group swam with crescent overload and aerobic swam in crescent periods, while sedentary group was exempt of any physical exercise practice. Functional recovery was evaluated through Sciatic Static Index obtained at first, seventh, fourteenth, twentieth-first and twentieth-eighth days postlesion, with morphological study conduced at twentieth-eighth days postaxonotmesis. Functional results demonstrated a significant statistical difference between exercise and sedentary groups at twentieth-eighth days after lesion, but there was no statistical difference in functional recovery between aerobic and anaerobic groups in any of evaluated periods, like there was no difference in morphological aspects observed at twentieth-eighth days post-lesion between aerobic, anaerobic and sedentary groups. / As fibras do sistema nervoso periférico são alvos freqüentes de lesões, por estarem distribuídas em toda extensão do organismo. Tais lesões culminam em alterações motoras, sensitivas e autonômicas. Inúmeros estudos experimentais demonstraram haver relação entre a prática de exercício físico e a recuperação funcional posterior a uma lesão nervosa periférica. Contudo, são escassos estudos que relacionam a via metabólica predominantemente utilizada durante a prática do exercício físico com os ganhos obtidos no processo de recuperação funcional do nervo lesionado e à evolução do processo inflamatório que se instala no macroambiente da lesão. Desta forma, o presente estudo se propôs a investigar a influência dos exercícios físicos predominantemente aeróbios e anaeróbios, iniciados na fase imediata após a lesão nervosa, sobre a recuperação funcional e morfológica do nervo ciático de ratos submetidos à axonotmese. O esmagamento do nervo ciático esquerdo de ratos Wistar foi realizado através da colocação de um clipe cirúrgico de uso temporário, pelo período de três minutos. Ao primeiro dia pós-lesão, perdurando-se por quatro semanas, o grupo anaeróbio realizou séries de natação com sobrecarga crescente e o grupo aeróbio realizou períodos crescentes de natação, enquanto o grupo sedentário ficou isento de qualquer tipo de exercício físico. A recuperação funcional foi avaliada através do Índice Ciático Estático obtidos ao primeiro, sétimo, décimo quarto, vigésimo primeiro e vigésimo oitavo dias pós-lesão, sendo o estudo morfológico conduzido ao vigésimo oitavo dia pós-axonotmese. Os resultados funcionais demonstraram que houve diferença estatisticamente significativa entre os grupos praticantes de exercício físico e o grupo sedentário ao vigésimo oitavo dia pós lesão, no entanto não houve diferença na recuperação funcional entre os grupos anaeróbio e aeróbio em nenhum dos períodos avaliados, assim como não houve diferença significativa entre os aspectos morfológicos observados ao vigésimo oitavo dia pós-lesão entre os grupos aeróbio, anaeróbio e sedentário.

Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG = 105, IG = 105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P, 0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.