Upper-limb hemiparesis caused by stroke can severely limit a survivor's ability to perform activities of daily living. Treatment involves intensive, repetitive therapy that can strain limited resources. Rehabilitation devices have been developed to help reduce therapist burden and increase access to therapy. However, adoption is complicated due to their expense and use of complex actuators. A rehabilitation tool without actuators was developed to perform reaching under varying resistance in the transverse plane and measure the reaction force at the handle. Force measurements from the device were validated through comparison with a standard force plate. A new method to calculate the center of applied pressure on a spherical handle mounted on a load cell was developed and validated using 3D modeling. Finally, a study conducted on healthy subjects demonstrated directional effects on the trajectory length and straightness, while resistance effects were seen for the maximum force, time-to-peak velocity and time-to-peak force.

Upper-limb hemiparesis caused by stroke can severely limit a survivor's ability to perform activities of daily living. Treatment involves intensive, repetitive therapy that can strain limited resources. Rehabilitation devices have been developed to help reduce therapist burden and increase access to therapy. However, adoption is complicated due to their expense and use of complex actuators. A rehabilitation tool without actuators was developed to perform reaching under varying resistance in the transverse plane and measure the reaction force at the handle. Force measurements from the device were validated through comparison with a standard force plate. A new method to calculate the center of applied pressure on a spherical handle mounted on a load cell was developed and validated using 3D modeling. Finally, a study conducted on healthy subjects demonstrated directional effects on the trajectory length and straightness, while resistance effects were seen for the maximum force, time-to-peak velocity and time-to-peak force.

Recent studies have suggested the biomechanical subtasks of walking can be produced using a reduced set of co-excited muscles or modules. Individuals post-stroke often exhibit poor inter-muscular coordination characterized by poor timing and merging of modules that are normally independent in healthy individuals. However, whether locomotor therapy can influence module quality (timing and composition) and whether these improvements lead to improved walking performance is unclear. Further, it is unknown whether the same modules that produce self-selected walking can also produce the execution of different mobility tasks. In this study, experimental analyses were used to compare module quality pre- and post-therapy. In subjects with four modules pre- and post-therapy, locomotor training resulted in improved timing of the ankle plantarflexor module and a more extended paretic leg angle that allowed the subjects to walk faster with more symmetrical propulsion. In addition, subjects with three modules pre-therapy increased their number of modules and improved walking performance post-therapy. Thus, locomotor training was found to influence module composition and timing, which can lead to improvements in walking performance. Experimental and simulation analyses were then used to characterize modular organization in specific mobility tasks (walking at self-selected speed with maximum cadence, maximum step length, and maximum step height). We found that the same underlying modules (number and composition) in each subject that contribute to steady-state walking also contribute to the different mobility tasks. In healthy subjects, module timing, but not composition, changed when the task demands were altered. This adaptability in module timing, in addition to the ability to adapt to the changing task demands, was limited in the post-stroke subjects. The primary difference in the execution of the walking biomechanical subtasks occurred in the control of the leg during pre-swing and swing. To increase cadence, the ankle plantarflexors and dorsiflexors contributed more power to the ipsilateral leg in pre-swing and swing, respectively. To increase step height, the hamstrings provided energy to the ipsilateral leg that accelerated the leg into swing in pre-swing and swing. These results provide a first step towards linking impaired module patterns to mobility task performance in persons post-stroke. / text

Post-stroke hemiparesis usually leads to slow and asymmetric gait. Improving walking ability, specifically walking speed, is a common goal post-stroke. To develop effective post-stroke rehabilitation interventions, the underlying mechanisms that lead to changes in walking ability need to be fully understood. The overall goal of this research was to investigate the deficits that limit hemiparetic walking ability and understand the influence of post-stroke rehabilitation on walking ability in persons with post-stroke hemiparesis. Forward dynamics walking simulations of hemiparetic subjects (and speed-matched controls) with different levels of functional walking status were developed to investigate the relationships between individual muscle contributions to pre-swing forward propulsion, swing initiation and power generation subtasks and functional walking status. The analyses showed that muscle contributions to the walking subtasks are indeed related to functional walking status in the hemiparetic subjects. Increased contributions from the paretic leg muscles (i.e., plantarflexors and hip flexors) and reduced contributions from the non-paretic leg muscles (i.e., knee and hip extensors) to the walking subtasks were critical in obtaining higher functional walking status. Changes in individual muscle contributions to propulsion during rehabilitation were investigated by developing a large number of subject-specific forward dynamics simulations of hemiparetic subjects (with different levels of pre-training propulsion symmetry) walking pre- and post-locomotor training. Subjects with low paretic leg propulsion pre-training increased contributions to propulsion from both paretic leg (i.e., gastrocnemius) and non-paretic leg muscles (i.e., hamstrings) to improve walking speed during rehabilitation. Subjects with high paretic leg propulsion pre-training improved walking speed by increasing contributions to propulsion from the paretic leg ankle plantarflexors (i.e., soleus and gastrocnemius). This study revealed two primary strategies that hemiparetic subjects use to increase walking speed during rehabilitation. Experimental analyses were used to determine post-training biomechanical predictors of successful post-stroke rehabilitation, defined as performance over a 6-month follow-up period following rehabilitation. The strongest predictor of success was step length symmetry. Other potential predictors of success were identified including increased paretic leg hip flexor output in late paretic leg single-limb stance, increased paretic leg knee extensor output from mid to late paretic leg stance and increased paretic leg propulsion during pre-swing. / text

A análise da integração sensório-motora em crianças com hemiparesia é necessária para a escolha de estratégias terapêuticas eficientes para a recuperação da funcionalidade. Os objetivos deste estudo foram: i) comparar três instrumentos de avaliação da sensibilidade tátil; ii) descrever as alterações da sensibilidade tátil em crianças com hemiparesia. O Grupo Estudo (GE) foi composto por 11 crianças hemiparéticas, de ambos os gêneros, Sistema de Classificação da Função Motora Grossa (GMFCS)= 1 ou 2 (idade = 9,1 anos + 2,1), e o Grupo Controle (GC) por 24 crianças sem alterações sensoriais ou motoras (idade = 8,8 anos + 1,4). A comparação da sensibilidade tátil foi feita com a Avaliação Sensorial de Nottingham (ASN), o teste de discriminação entre dois pontos (D2P) e o teste de estereognosia. Os resultados foram submetidos à ANOVA e ao post hoc de Duncan para comparar as variáveis paramétricas e o Mann-Whitney U e o Wilcoxon matched pairs para as não paramétricas. Adotou-se = 0,05 para diferenças significativas e 0,05 < < 0,10 para as diferenças marginalmente significativas. A ASN revelou diminuição da sensibilidade tátil no GE tanto no lado hemiparético (p<0,01) quanto no preservado (p<0, 01); e diminuição da resolução espacial apenas no lado hemiparético (p=0,01). O teste de D2P foi capaz de detectar a diminuição da resolução espacial na palma de ambas as mãos da criança hemiparética (p<0,01). Mesmo que a precisão em identificar objetos, detectada pela estereognosia, esteja intacta nas crianças hemiparéticas, elas levaram mais tempo para completar a tarefa com a mão acometida quando comparada à mão preservada (p<0,01) e ao GC (p=0,03). Apesar de a ASN ter revelado alterações táteis em ambos os dimídios da criança hemiparética, o teste de D2P foi mais sensível para detectar as alterações na resolução espacial da informação tátil. A percepção, avaliada pelo teste da estereognosia, mostrou-se preservada apesar de as crianças hemiparéticas terem levado mais tempo para completar a tarefa com a mão acometida, o que pode estar relacionado a problemas motores / The analysis of sensorimotor integration in children with hemiparesis is necessary for choosing of efficient therapeutic strategies to functionality recovery. The objectives of this study were: i) to compare three instruments of tactile sensibility assessment; ii) to describe the alterations of tactile sensibility in children with hemiparesis. The Study Group (SG) had 11 boys and girls with hemiparesis, Gross Motor Function Classification System (GMFCS) = 1 or 2 (age = 9,1 years + 2,1) and the Control Group (CG) had 24 children without motor or sensorial alterations (age = 8,8 years + 1,4). The comparison of tactile sensibility was done with the Nottingham Sensory Assessment of (NSA), the two-point discrimination test (2PD) and the six-object stereognosis test. The results were submitted to ANOVA and Duncan´s test to compare the parametric variables and the Mann-Whitney U, and the Wilcoxon matched pairs were used for the non-parametric variables. = 0,05 was considered significant difference and 0,05 < < 0,10 was considered marginally significant. The NSA showed a reduction on tactile sensibility in SG in the hemiparetic side (p<0,01) and in the non-affected side (p<0,01); and a decrease in spatial resolution only in the hemiparetic side. The 2PD was capable of detecting the impairment of spatial resolution in the palm of both hands of the children with hemiparesis (p<0,01). Although the precision on identifying objects is intact in children with hemiparesis, they took more time to complete the stereognosis test with the affected hand when compared with their non-affected hand (p<0,01) and when compared with the CG (p=0,03). In spite of the fact that the NSA had indicated tactile alteration in both sides of children with hemiparesis, the 2PD was more sensitive to detect problems of the spatial resolution of tactile information. The perception assessed by six-object stereognosis test was preserved in children with hemiparesis, although they had taken more time to finish the task with the affected hand. This result can be related to motor problems

A análise da integração sensório-motora em crianças com hemiparesia é necessária para a escolha de estratégias terapêuticas eficientes para a recuperação da funcionalidade. Os objetivos deste estudo foram: i) comparar três instrumentos de avaliação da sensibilidade tátil; ii) descrever as alterações da sensibilidade tátil em crianças com hemiparesia. O Grupo Estudo (GE) foi composto por 11 crianças hemiparéticas, de ambos os gêneros, Sistema de Classificação da Função Motora Grossa (GMFCS)= 1 ou 2 (idade = 9,1 anos + 2,1), e o Grupo Controle (GC) por 24 crianças sem alterações sensoriais ou motoras (idade = 8,8 anos + 1,4). A comparação da sensibilidade tátil foi feita com a Avaliação Sensorial de Nottingham (ASN), o teste de discriminação entre dois pontos (D2P) e o teste de estereognosia. Os resultados foram submetidos à ANOVA e ao post hoc de Duncan para comparar as variáveis paramétricas e o Mann-Whitney U e o Wilcoxon matched pairs para as não paramétricas. Adotou-se = 0,05 para diferenças significativas e 0,05 < < 0,10 para as diferenças marginalmente significativas. A ASN revelou diminuição da sensibilidade tátil no GE tanto no lado hemiparético (p<0,01) quanto no preservado (p<0, 01); e diminuição da resolução espacial apenas no lado hemiparético (p=0,01). O teste de D2P foi capaz de detectar a diminuição da resolução espacial na palma de ambas as mãos da criança hemiparética (p<0,01). Mesmo que a precisão em identificar objetos, detectada pela estereognosia, esteja intacta nas crianças hemiparéticas, elas levaram mais tempo para completar a tarefa com a mão acometida quando comparada à mão preservada (p<0,01) e ao GC (p=0,03). Apesar de a ASN ter revelado alterações táteis em ambos os dimídios da criança hemiparética, o teste de D2P foi mais sensível para detectar as alterações na resolução espacial da informação tátil. A percepção, avaliada pelo teste da estereognosia, mostrou-se preservada apesar de as crianças hemiparéticas terem levado mais tempo para completar a tarefa com a mão acometida, o que pode estar relacionado a problemas motores / The analysis of sensorimotor integration in children with hemiparesis is necessary for choosing of efficient therapeutic strategies to functionality recovery. The objectives of this study were: i) to compare three instruments of tactile sensibility assessment; ii) to describe the alterations of tactile sensibility in children with hemiparesis. The Study Group (SG) had 11 boys and girls with hemiparesis, Gross Motor Function Classification System (GMFCS) = 1 or 2 (age = 9,1 years + 2,1) and the Control Group (CG) had 24 children without motor or sensorial alterations (age = 8,8 years + 1,4). The comparison of tactile sensibility was done with the Nottingham Sensory Assessment of (NSA), the two-point discrimination test (2PD) and the six-object stereognosis test. The results were submitted to ANOVA and Duncan´s test to compare the parametric variables and the Mann-Whitney U, and the Wilcoxon matched pairs were used for the non-parametric variables. = 0,05 was considered significant difference and 0,05 < < 0,10 was considered marginally significant. The NSA showed a reduction on tactile sensibility in SG in the hemiparetic side (p<0,01) and in the non-affected side (p<0,01); and a decrease in spatial resolution only in the hemiparetic side. The 2PD was capable of detecting the impairment of spatial resolution in the palm of both hands of the children with hemiparesis (p<0,01). Although the precision on identifying objects is intact in children with hemiparesis, they took more time to complete the stereognosis test with the affected hand when compared with their non-affected hand (p<0,01) and when compared with the CG (p=0,03). In spite of the fact that the NSA had indicated tactile alteration in both sides of children with hemiparesis, the 2PD was more sensitive to detect problems of the spatial resolution of tactile information. The perception assessed by six-object stereognosis test was preserved in children with hemiparesis, although they had taken more time to finish the task with the affected hand. This result can be related to motor problems

As doenças cerebrovasculares, incluindo o acidente vascular encefálico (AVE), são a segunda causa de morte no mundo, e o principal causador das incapacidades na população adulta. Devido à reorganização cortical, quanto mais precoce a reabilitação é realizada, melhores são os resultados. Desta forma, novos tratamentos e soluções tecnológicas foram desenvolvidos para enfrentar os desafios da reabilitação pós AVE, por exemplo, aumento da intensidade e duração da terapia incluindo manipulação externa, treinamento do movimento bilateral, e reabilitação robótica. Os dispositivos robóticos possibilitam a realização de tarefas específicas repetidas vezes, de forma controlada e confiável, fator determinante para a facilitação da reorganização cortical, com aumento da habilidade motora e melhora do desempenho das atividades funcionais. O objetivo principal deste trabalho foi verificar a adequação e usabilidade da Plataforma Robótica de Reabilitação de Tornozelo - PRRT em indivíduos que precisam de reabilitação de tornozelo decorrente de sequela de AVE, a fim de realizar eventuais ajustes antes que o equipamento seja incorporado na prática clínica. A metodologia consistiu em verificar a adequação ergonômica e técnica do equipamento, e avaliar a satisfação do usuário após o seu uso por meio de questionário. O aparelho foi avaliado tanto em pacientes com déficit motor de hemiparesia, como em indivíduos sem deficiências. Os resultados experimentais mostram que o equipamento é adequado como um recurso auxiliar na avaliação da amplitude de movimento articular do tornozelo e da força muscular, beneficiando os terapeutas na avaliação dos ganhos reais obtidos com as terapias. A partir das respostas ao questionário, verifica-se que os indivíduos sentiram-se satisfeitos com o recurso. Portanto, conclui-se que a PRRT é um recurso auxiliar promissor no tratamento do tornozelo de indivíduos que sofreram lesão neurológica, podendo trazer benefícios em relação à amplitude de movimento e ganho de força, além de proporcionar uma terapia prazerosa e estimulante aos pacientes. / Cerebrovascular diseases, including stroke, are the second leading cause of death worldwide and the leading cause of disability in the adult population. Due to cortical reorganization, the earlier rehabilitation is performed, the better the results. In this way, new treatments and technological solutions were developed to meet the challenges of rehabilitation after stroke, for example, increase of intensity and duration of therapy including external manipulation, bilateral movement training, and rehabilitation robotics. Robotic devices allow performing specific tasks repeatedly in a controlled and reliable way, a key factor for cortical reorganization, with increase of motor skills and improvement of functional activities performance. The main objective of this work was to verify the adequacy and usability of the Robotic Platform for Ankle Rehabilitation in post-stroke patients who need ankle rehabilitation, in order to make any necessary adjustments before the equipment be incorporated into clinical practice. The methodology consisted in verifying ergonomic and technical adequacy, and evaluates user satisfaction after use through a questionnaire. The device was evaluated in patients with motor deficit of hemiparesis, as well as in individuals without disabilities. Experimental results show the proposed equipment is suitable as an auxiliary resource in evaluating the range of motion and muscle strength of the ankle, assisting therapists in the evaluation of real gains obtained with the therapies. From the questionnaire responses, the individuals said they were satisfied with the resource. Therefore, it is concluded that the PRRT is a promising auxiliary resource in the treatment of individuals who have suffered neurological damage, bringing benefits with relation to range of motion and muscle strength, as well as providing pleasurable and stimulating therapy to patients.

No description available.

As doenças cerebrovasculares, incluindo o acidente vascular encefálico (AVE), são a segunda causa de morte no mundo, e o principal causador das incapacidades na população adulta. Devido à reorganização cortical, quanto mais precoce a reabilitação é realizada, melhores são os resultados. Desta forma, novos tratamentos e soluções tecnológicas foram desenvolvidos para enfrentar os desafios da reabilitação pós AVE, por exemplo, aumento da intensidade e duração da terapia incluindo manipulação externa, treinamento do movimento bilateral, e reabilitação robótica. Os dispositivos robóticos possibilitam a realização de tarefas específicas repetidas vezes, de forma controlada e confiável, fator determinante para a facilitação da reorganização cortical, com aumento da habilidade motora e melhora do desempenho das atividades funcionais. O objetivo principal deste trabalho foi verificar a adequação e usabilidade da Plataforma Robótica de Reabilitação de Tornozelo - PRRT em indivíduos que precisam de reabilitação de tornozelo decorrente de sequela de AVE, a fim de realizar eventuais ajustes antes que o equipamento seja incorporado na prática clínica. A metodologia consistiu em verificar a adequação ergonômica e técnica do equipamento, e avaliar a satisfação do usuário após o seu uso por meio de questionário. O aparelho foi avaliado tanto em pacientes com déficit motor de hemiparesia, como em indivíduos sem deficiências. Os resultados experimentais mostram que o equipamento é adequado como um recurso auxiliar na avaliação da amplitude de movimento articular do tornozelo e da força muscular, beneficiando os terapeutas na avaliação dos ganhos reais obtidos com as terapias. A partir das respostas ao questionário, verifica-se que os indivíduos sentiram-se satisfeitos com o recurso. Portanto, conclui-se que a PRRT é um recurso auxiliar promissor no tratamento do tornozelo de indivíduos que sofreram lesão neurológica, podendo trazer benefícios em relação à amplitude de movimento e ganho de força, além de proporcionar uma terapia prazerosa e estimulante aos pacientes. / Cerebrovascular diseases, including stroke, are the second leading cause of death worldwide and the leading cause of disability in the adult population. Due to cortical reorganization, the earlier rehabilitation is performed, the better the results. In this way, new treatments and technological solutions were developed to meet the challenges of rehabilitation after stroke, for example, increase of intensity and duration of therapy including external manipulation, bilateral movement training, and rehabilitation robotics. Robotic devices allow performing specific tasks repeatedly in a controlled and reliable way, a key factor for cortical reorganization, with increase of motor skills and improvement of functional activities performance. The main objective of this work was to verify the adequacy and usability of the Robotic Platform for Ankle Rehabilitation in post-stroke patients who need ankle rehabilitation, in order to make any necessary adjustments before the equipment be incorporated into clinical practice. The methodology consisted in verifying ergonomic and technical adequacy, and evaluates user satisfaction after use through a questionnaire. The device was evaluated in patients with motor deficit of hemiparesis, as well as in individuals without disabilities. Experimental results show the proposed equipment is suitable as an auxiliary resource in evaluating the range of motion and muscle strength of the ankle, assisting therapists in the evaluation of real gains obtained with the therapies. From the questionnaire responses, the individuals said they were satisfied with the resource. Therefore, it is concluded that the PRRT is a promising auxiliary resource in the treatment of individuals who have suffered neurological damage, bringing benefits with relation to range of motion and muscle strength, as well as providing pleasurable and stimulating therapy to patients.

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