Les problèmes d’équilibre associés aux déficits sensorimoteurs chez les personnes hémiparétiques après un accident vasculaire cérébral (AVC) sont un facteur de risque de chutes lors d’activités locomotrices. Cette thèse avait pour but d’approfondir les connaissances sur les capacités d’équilibre de ces personnes dans des tâches de marche et de les comparer avec celles des personnes en santé. Le premier objectif visait à quantifier la difficulté à maintenir l’équilibre dynamique (c.-à.-d. lié au déplacement du corps) et postural (c.-à.-d. lié à l’alignement des segments du corps) des personnes hémiparétiques lors de la marche sur tapis roulant. Le second objectif était de mieux comprendre les relations entre l’équilibre et les modifications du patron de marche liées aux déficits associés à l’AVC telles que la réduction de la vitesse de marche et l’asymétrie, ou liées à certaines interventions de réadaptation, telles que l’utilisation d’un tapis roulant à double courroie avec des vitesses inégales ou l’ajout d’une charge à la cheville. Les résultats ont montré que les personnes hémiparétiques avaient moins de difficulté à maintenir leur équilibre que les personnes en santé lorsqu’elles marchaient à leur vitesse confortable (étude no1). Cependant, à vitesse équivalente, la difficulté à maintenir l’équilibre était plus grande pour les personnes hémiparétiques que pour celles en santé (étude no1). L’évaluation de l’effet sur le patron de marche et l’équilibre d’une marche sur un tapis roulant avec des vitesses de courroies inégales puis égales a montré que les personnes âgées en santé avaient des capacités d’adaptation et de désadaptation, objectivées par des changements des forces de réaction du sol, similaires à celles de jeunes adultes en santé (étude no2). Toutefois, l’équilibre des personnes âgées, mesuré par la différence des forces de réaction au sol lors des phases de freinage et de propulsion, était plus affecté par les vitesses de courroie inégales que celui des jeunes adultes (étude no2). Chez les personnes hémiparétiques, une marche plus symétrique ne modifiait pas la difficulté à maintenir l’équilibre (étude no3). Toutefois, l’équilibre était plus affecté lors de l’appui sur le membre inférieur qui avait été placé sur la courroie lente lors de la marche avec les vitesses de courroies inégales (étude no3). Finalement, l’ajout d’une charge à la cheville, placée du côté non parétique puis du côté parétique, lors de la marche n’affectait pas l’équilibre dynamique des personnes hémiparétiques, mais facilitait leur équilibre postural (étude no4). En résumé, ces résultats suggèrent que les personnes hémiparétiques réduisent leur vitesse de marche pour maintenir leur équilibre. De plus, leur équilibre est affecté par le protocole de marche sur tapis roulant avec des vitesses de courroies inégales, mais il ne l’est pas parce que le patron de marche est devenu plus symétrique. Enfin, l’ajout d’une charge à la cheville reste une approche pertinente pour améliorer la marche, toutefois elle n’est pas indiquée pour entraîner l’équilibre des personnes hémiparétiques. La prise en compte de la vitesse de marche lors de l’évaluation de l’équilibre et un entraînement à des vitesses de marche plus rapides que la vitesse confortable sont des facteurs importants à considérer pour la réadaptation des personnes post-AVC. / Balance problems associated with sensorimotor impairments in individuals with hemiparesis post-stroke are a risk factor for falls during locomotion. This thesis aimed to foster knowledge on balance ability in this post-stroke population during locomotor tasks compared to healthy individuals. The first objective was to quantify difficulty in maintaining dynamic (i.e. related to body displacements) and postural (i.e. related to segment alignment) balance among individuals post-stroke walking on a treadmill. The second objective was to better understand the relationship between balance and gait pattern changes associated with stroke-related deficits such as reduced gait speed and asymmetry, or those associated with certain rehabilitation interventions such as using a split-belt treadmill with asymmetrical belt speeds or adding a load on the ankle. The results showed that individuals post-stroke had less difficulty in maintaining balance than their healthy counterparts when they walked at a self-selected speed (study #1). However, at a similar speed, the stroke group experienced greater difficulty in maintaining balance than the healthy group (study #1). Assessment of how walking on a split-belt treadmill with both asymmetrical and symmetrical belt speeds affects gait pattern and balance showed that healthy older individuals had similar ability in adapting and de-adapting, as demonstrated by changes in ground reaction forces, compared to healthy young adults (study #2). However, balance among older individuals, as measured by the difference in ground reaction forces during the braking and propulsive phases, was more affected by asymmetrical belt speeds than young adults (study #2). In individuals post-stroke, a more symmetrical gait pattern did not alter difficulty in maintaining balance (study #3). However, balance was more affected during the stance phase of the leg on the slow belt when walking with asymmetrical belt speeds (study #3). Finally, adding a load on the ankle, placed on the non-paretic side then on the paretic side, when walking did not affect dynamic balance among individuals post-stroke, but it did improve their postural balance (study #4). In summary, these results suggest that individuals post-stroke reduce their gait speed in order to maintain their balance. Moreover, the split-belt treadmill protocol does affect their balance but not as a result of their gait pattern becoming more symmetrical. Finally, adding a load on the ankle remains a relevant approach to improve gait function, however, it is not recommended to train balance in individuals post-stroke. Lastly, adding a load on the ankle is not a recommended balance training method. Gait speed when assessing balance and gait training at speeds faster than a self-selected gait speed are important factors to consider during rehabilitation of individuals post-stroke.

Made available in DSpace on 2016-08-19T18:15:55Z (GMT). No. of bitstreams: 1 Adriana Oliveira Dias.pdf: 555801 bytes, checksum: 0f2424f9290e9f1b9ea770b2562d66c3 (MD5) Previous issue date: 2007-10-16 / Study of representations about quality of the women s life with hemiparesis after stroke. It presents an overview on the history of physical disability, emphasizing the meanings throughout history. It addresses the various concepts and meanings of quality of life as well as the impact of the stroke on quality of life. It was used for the definition of quality of life the conceptual model of Ferrans and Powers (1992). It is defined quality of life as a sense of well-being, a person who comes from the satisfaction or dissatisfaction with the areas of life. This is a research of a qualitative methodology. Participated of this study women with Hemiparesis, age among 20 and 59 years, with an average time of occurrence of the stroke of 12 months to 18 months and that receive attendance of rehabilitation in the Clinic-school Santa Edwiges-APAE. Opted for the feminine sex, because the historical review of the literature showed significantly the man as the greatest victim of stroke, leaving the research back in women, a fact that this contradicts the expectations on the part of women on a broader approach the quality of life that will help them. It was used the semi-structured interview and the questionnaire for the characterization of the studied group. The analysis was based information as reasons the analysis of contents of Bardin (1977). Identified the following thematic nucleus: meaning of the changes in the quality of women s life after the stroke and, the second thematic nucleus, re-meaning the quality of the women s life after stroke: rescue of citizen s rights. It was verified, with the research, reflections about the life quality of the women interviewed, referenced to several objective and subjective aspects of the human life. It is confirmed, in this study, the multidimensional nature of the studied phenomena, referencing, that the presence of diseases, impairment and disability, don t necessarily, lead a reduction on quality of life. It follows that, for women, the quality of life is related to all the life aspects that should be reflected in the principle of access to citizenship. / Estudo das representações sobre qualidade de vida das mulheres com hemiparesia após o Acidente Vascular Encefálico. Apresenta-se uma visão panorâmica sobre a historicidade da deficiência física, ressaltando os significados ao longo da história. Abordam-se os diversos conceitos e significados de qualidade de vida, bem como a repercussão do Acidente Vascular Encefálico na qualidade de vida. Utilizou-se para a definição de qualidade de vida o modelo conceitual de Ferrans e Powers (1992). Define-se qualidade de vida como a sensação de bemestar de uma pessoa que deriva da satisfação ou insatisfação com as áreas da vida. Trata-se de uma pesquisa de metodologia qualitativa. Participaram deste estudo mulheres com Hemiparesia, idade entre 20 e 59 anos, com tempo médio de ocorrência do AVE de 12 meses à 18 meses e que recebem atendimento reabilitacional na Clínica-escola Santa Edwiges- APAE. Optou-se pelo sexo feminino, porque a revisão histórica da literatura apontou expressivamente o homem como a maior vítima de AVE, deixando para trás a pesquisa em mulheres, fato este que contraria as expectativas por parte das mulheres sobre uma abordagem mais ampla da qualidade de vida que venha ajudá-las. Utilizou-se a entrevista semi-estruturada e o questionário para a caracterização do grupo estudado. Analisaram-se as informações conforme a fundamentação da análise de conteúdo de Bardin (1977). Identificaram-se os seguintes núcleos estruturadores: significado das mudanças na qualidade de vida das mulheres após o AVE e re-significando a qualidade de vida das mulheres após o AVE: resgate dos direitos de cidadão. Constataram-se, com a pesquisa, reflexões sobre a qualidade de vida das mulheres entrevistadas, referenciadas a diversos aspectos objetivos e subjetivos da vida humana. Confirma-se, neste estudo, o caráter multidimensional dos fenômenos estudados, referenciando-se que a presença de doenças, deficiências e incapacidades, não necessariamente, conduzem a uma qualidade de vida baixa. Concluiu-se que, para as mulheres, a qualidade de vida está relacionada a todos os aspectos da vida que devem ser traduzidos no princípio do acesso à cidadania.

Made available in DSpace on 2016-12-06T17:06:49Z (GMT). No. of bitstreams: 1 Nayara Correa Farias.pdf: 2128658 bytes, checksum: 8da7fce7f2e36cad58a5230e6ed98bca (MD5) Previous issue date: 2012-03-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / After stroke, most of the different resources for the paretic upper limb (UL) rehabilitation are effective for patients with mild to moderate motor impairment. Treatments for patients with severe motor impairment little is known about the benefits of these interventions. Also, severely impaired patients show little changes in motor performance for achieve unilateral tasks with the paretic UL. However to become more functional, patients with severe arm paresis can use de paretic UL to stabilizing actions during functional bilateral tasks. This study aimed to assess the effect of progressive bilateral functional training in the recovery of bilateral UL function in individuals with chronic hemiparesis and severe motor impairment compared to conventional physiotherapy. It is characterized randomized controlled clinical trial that included 16 adult patients (55.3 ± 11.6 years) with 8 patients in the experimental group (EG) (Fugl-Meyer UL = 16 ± 5.8) with training for the UL bilateral functional tasks with a systematic method of progression and 8 patients in the control group (CG) (Fugl-Meyer UL= 13 ± 5.0) conventional training for UL. Both groups received the same intensity of intervention, ten days, with 60 minutes each session. The assessments were divided into before starting the training (PRE), immediately after intervention (POS) and two weeks after the intervention (Follow-up). The Test instrument Arm Bilateral Functional Test (ABIT) significant effect of time (p = 0.02) and group (p <0.01), with no interaction between time and group significant. The comparison in pairs showed that the value of POS was higher than in the total result for PRE TEBIM (p = 0.01). Subscales of the TEBIM bilateral manipulative tasks and tasks asymmetrical bilateral, significant effect of time (p = 0.05 and p = 0.03 respectively) and group (p <0.01 and p <0.01 respectively). The scores of manipulative tasks were higher in the posttest compared to pretest (p = 0.05) and higher in EG compared to controls (p = 0.02). In asymmetrical tasks of GE scores were higher than those of both the GC and post-test follow-up (respectively p = 0.02 and p = 0.003). For symmetrical bilateral tasks there was no significant effect of time or group.Secondary outcome measures in the Motor Activity Log (MAL) was no statistically significant time (p <0.01) for the amount of use with the POST and the mean follow-up greater than in PRE (both p <0.01), whereas Fugl-Meyer- UL had no significant effect of time or group. It follows the patient with chronic hemiparesis severe motor impairment for MS can benefit from task-oriented training for the bilateral upper limbs following parameters of progression in the tasks, gain of function compared with conventional physiotherapy bilateral. / Muitos dos diferentes recursos propostos na pesquisa sobre a reabilitação do membro superior (MS) em pessoas com hemiparesia crônica são relevantes para os pacientes com comprometimento motor leve a moderado, pouco se sabe sobre os benefícios para pacientes com comprometimento motor grave. Além disso, pacientes graves mostram pequenas mudanças no desempenho motor para realizar tarefas unilaterais com o MS parético, mas podem se tornar mais funcionais usando o MS parético como auxiliar de tarefas funcionais bilaterais. Este estudo teve como objetivo avaliar o efeito do treinamento orientado a tarefa bilateral progressivo na recuperação da função bilateral dos MMSS em pacientes graves, comparativamente à fisioterapia convencional. Caracteriza-se por ser um ensaio clínico randomizado controlado, que incluiu 16 pacientes adultos (55,3 ± 11,6 anos) com o 8 pacientes no grupo experimental (GE) (Fugl-Meyer-MS =16± 5,8) com treinamento para o MS em tarefas funcionais bilaterais com um método sistemático de progressão e 8 pacientes no grupo controle (GC) (Fugl-Meyer-MS =13± 5,0) de treinamento convencional para o MS. Ambos os grupos receberam a mesma intensidade de intervenção, de dez dias, com 60 minutos cada sessão. As avaliações foram divididas em antes de iniciar o treinamento (PRE), imediatamente após as intervenções (POS) e duas semanas após a intervenção (Seguimento). Para o desfecho principal - Teste de Função Bilateral de Membros Superiores (TEBIM) houve efeito significativo de tempo (p= 0,02) e de grupo (p< 0,01), sem apresentar interação entre tempo e grupo significativa. A comparação aos pares mostrou que o valor do POS foi maior que no PRE para resultado total do TEBIM (p=0,01). Nas sub-escalas do TEBIM as tarefas bilaterais manipulativas e as tarefas bilaterais assimétricas, apresentaram efeito significativo de tempo (p=0,05 e p=0,03 respectivamente) e grupo (p< 0,01 e p< 0,01 respectivamente). Os escores das tarefas manipulativas foram maiores no pós teste comparativamente ao pré teste (p=0,05) e maiores no GE em relação ao controle (p=0,02). Nas tarefas assimétricas os escores do GE foram maiores que os do GC tanto no pós teste como no seguimento (respectivamente p=0,02 e p= 0,003). Para as tarefas bilaterais simétricas não houve efeito significativo de tempo ou de grupo. Nas medidas de resultados secundário Motor Activity Log (MAL) houve diferença estatisticamente significativa de tempo (p<0,01) para a quantidade de uso, com as médias no POS e Seguimento maiores que no PRE (ambos p<0,01); O Fugl-Meyer-MS não apresentou efeito significativo de tempo ou grupo. Conclui-se que o paciente com hemiparesia crônica de comprometimento motor grave para o MS pode se beneficiar com o treinamento orientado a tarefa bilateral para os MMSS, seguindo parâmetros de progressão nas tarefas, para o ganho da função bilateral comparativamente a fisioterapia convencional.

Made available in DSpace on 2016-12-06T17:07:19Z (GMT). No. of bitstreams: 1 Vanessa Herber.pdf: 2070207 bytes, checksum: 249e6056643655f931fa3aebf9693642 (MD5) Previous issue date: 2009-04-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The backward walking (BW) has been used in protocols for rehabilitation and training in individuals with stroke, however little is known about their characteristics in terms of kinematic variables and motor pattern. The literature describes that for the execution of BW it is necessary to combine hip extension with knee flexion, components that are compromised in this population. The aim of this study is to compare the spatial, temporal and angular variables between the BW and forward walking (FW) and between the lower limbs [affected (AF) and non affected (NA)] in the BW in individuals with hemiparesis following stroke. Participated in the study 10 adults (56.4±8.4 years) with chronic hemiparesis (30.6±25.1 months after the stroke onset), with lower limb motor score of 25±4.4 in the Fugl-Meyer Scale, and gait speed of 0,92±0.3 m/s. Reflexive markers were placed in the acromion, greater trochanter, lateral condyle of the knee and lateral malleolus, on both sides of lower limb. The subjects were instructed to walk at comfortable speed and five trials on each side of the sagital plane (right and left) were captured with a digital camcorder with a frequency of 30 Hz, in both tasks, FW and BW. The Kinematics variables analyzed were the stride length, duration and speed and stance phase duration, and angular variables of knee and kip. For statistical analyses the ANOVA 2X2 (2 directions BW and FW and 2 legs AF and NF lower limbs) was used. In addition, it was used contrasts with T Student test and Bonferroni correction. The angular variables were submitted to the ANCOVA, and the speed was the co-variable. The individuals with hemiparesis have shown a decreased stride length and speed (p=0,001 e p=0,001) and increased duration and percentage of support in the stride (p=0,001) in BW compared to FW. The NA lower limb remained longer in stance in both conditions (BW and FW). Both lower limbs have presented a decrease in maximum knee flexion (p=0,001 e p=0,005) and maximum hip extension (p=0,001 e p=0,001) in BW. In general, the differences in the hip kinematics between the FW and BW remained when the speed was used as a co-variable. Regarding the comparison between the lower limbs during the BW, the NA lower limb has shown increased angular values (p values between p=0,006 e p=0,009) except for the maximum knee extension, where the AF lower limb showed increased extension values, probably because of a hyperextension which is typical in this population. Qualitative analyses of the coordination has shown a different behavior between legs, with a preference to simultaneous movements between hip and knee in 8 of the 10 participants, and anterior inclination of the trunk during swing in the BW. The BW could be and appropriate way of treatment that could be added to conventional gait rehabilitation programs in individuals with hemiparesis. We suggest further investigation on the effects of a BW training on the intra joint coordination between hip and knee. / O andar para trás (AT) tem sido utilizado corno forma de treinamento locomotor em indivíduos com hemiparesia pós acidente vascular encefálico (AVE). No entanto pouco se sabe sobre as características cinemáticas do AT nesta população. A literatura descreve que na execução do AT é necessária a extensão do quadril combinada com a flexão do joelho, componentes que estão comprometidos nesta população. O objetivo deste estudo é comparar em indivíduos com hemiparesia as variáveis espaço-temporais e angulares entre o andar para frente (AF) e o AT e entre membros inferiores (MMII) no AT. Participaram do estudo 10 indivíduos (56.4±8.4 anos) com hemiparesia crônica (30.6±25,1 meses pós AVE). Os participantes apresentaram comprometimento motor de 25±4.4 pontos no Fugl-Meyer-MI velocidade de marcha de 0.92±0.3 m/s. Marcadores foram colocados no acrômio, trocânter maior do fêmur; côndilo lateral do joelho e maléolo lateral em ambos os lados. Os participantes foram filmados caminhando em uma velocidade confortável em cinco tentativas no plano sagital direito e cinco no esquerdo, nas tarefas do AF e AT. com uma câmera filmadora digital com freqüência de 60 Hz. As variáveis cinemáticas analisadas foram comprimento, duração e velocidade da passada e duração do apoio, além das variáveis angulares do joelho e quadril. Os dados foram submetidos a ANOVA 2X2 [2 direções e 2 lados - MI não afetado (naf) e MI afetado (af)] e posterior contrastes com teste t de Student com correção de Bonferroni. As variáveis angulares foram em seguida submetidas a ANCOVA utilizando-se a velocidade do andar como co-variável. Os indivíduos com hemiparesia apresentam redução do comprimento e velocidade da passada e aumento da duração e do percentual de apoio da passada (p=0,001 para todos) no AT comparativamente ao AF. O MInaf permaneceu mais tempo apoiado tanto no AT quanto no AF. Ambos os MMII apresentaram valores de máxima flexão de joelho (p=0,001 e p=0,005) e máxima extensão de quadril significativamente menor (p=0,001 para ambos) no AT. Em geral, as diferenças na cinemática do quadril entre AF e AT permanecem quando a velocidade é utilizada como co-variável. Com relação à comparação entre os MMII no AT, observou-se que o MInaf apresentou maiores valores angulares (valor de p entre p=0,006 e p=0,009), exceto para máxima extensão do joelho. onde o MIaf apresentou valores maiores dc extensão, isso devido a hiperextensão característica nesta população. A análise qualitativa da coordenação evidenciou um comportamento diferente entre MMII com uma preferência para movimentos simultâneos entre o quadril e joelho para 8/10 participantes assim como uma inclinação anterior do tronco durante o balanço no AT. O AT pode ser utilizado como recurso terapêutico apropriada para somar aos programas convencionais de reabilitação da marcha em indivíduos com hemiparesia. Sugere-se investigar o efeito do treinamento do AT sobre coordenação inter-articular entre quadril e joelho.

Made available in DSpace on 2016-12-06T17:07:19Z (GMT). No. of bitstreams: 1 Andre Rocha.pdf: 2659050 bytes, checksum: ab889033d038c34c38a4e174f6d78945 (MD5) Previous issue date: 2009-04-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Hemiparesis following stroke reduces the ability to use the involved lower extremity during the sit-to-stand (STS) transfer, thus affecting the performance. This study investigated in hemiparetic subjects the combined effects of the non-affected lower limb (NA) constraints by supporting it on a step and the seat height for the weight-bearing on the affected lower limb (AF) and the reduction of asymmetry during STS. Thirteen adult subjects (60,4 ± 5,7 years) were selected, of both sexes, with hemiparesis due to stroke in chronic stage (43,7 ± 50 months). They had mild to moderate impairments on the Fugl-Meyer Scale (24,7 ± 4,9 points). The participants underwent clinical evaluations and biomechanical analyses of the kinetics and kinematics of the movements of interest. Individuals stood up from a instrumented bench at two seat heights, 100% (normal) and 130% (elevated) from the knee height (KH). There were four conditions of the feet: (1) spontaneous (SPO), (2) symmetric (SYM), (3) asymmetrical (ASS) with the NA limb in front of the AF, and (4) step (STP) of the NA limb supported on a step. Force plates and a kinematic system were used for analyses of the vertical component (Fz) of the ground reaction forces and the kinematic behaviors of the resulting movement. The results showed significant decreases of the asymmetry in the step condition compared to the positions of the SPO (p<0001), SYM (p<0001) and ASS (p=0023). The angles of hip, knee and ankle reached normal values. With the elevation of the seat height at 130%, KH had significant reductions in the time of movement and the anterior displacement of the trunk (p<0001 both). The restriction of the AF by the step was efficient in reducing the asymmetry in the STS and may be a therapeutic resource to be used in reversing the learned non-use. Raising the seat height reduced the time and displacement of the trunk, there facilitated reaching the upright position even with the use of step. The use of constraint as a strategy for training is suggested to reduce the asymmetry in the STS. / A hemiparesia após um Acidente Vascular Encefálico (AVE) compromete a capacidade de usar a extremidade inferior acometida durante transição de sentado para de pé (ST-DP), afetando o desempenho funcional. Este estudo investigou, em indivíduos hemiparéticos, o efeito combinado da restrição do membro inferior não-afetado (MINA) apoiado em um step e da altura do assento, sobre a transferência de peso para o membro inferior afetado (MIAF) e redução da assimetria durante o movimento ST-DP. Foram selecionados 13 indivíduos adultos (60,4 ± 5,7 anos), de ambos os sexos, com seqüela de hemiparesia devido a AVE na fase crônica (43,7 ± 50 meses) e comprometimento de leve a moderado na Escala de Fugl-Meyer (24,7 ± 4,9 pontos). Os participantes realizaram avaliações clínicas e biomecânicas através de análise cinética e cinemática do movimento de interesse. Os indivíduos levantaram de um banco instrumentado a partir de duas alturas de assento, 100% (normal) e 130% (elevada) da altura do joelho (AJ), e em 4 condições dos pés: (1) espontânea (ESP); (2) simétrica, SIM; (3) assimétrica (ASS) - membro não-afetado à frente; e (4) step (STP) - membro não-afetado apoiado em um step. Plataformas de força e sistema de cinemetria foram empregados respectivamente para análise da componente vertical (Fz) da força de reação do solo e do comportamento cinemático resultantes do movimento. Os resultados mostraram uma diminuição significativa da assimetria na condição step em relação as posições ESP (p < 0,001), SIM (p <0,001) e ASS (p =0,023), influenciando positivamente os ângulos de quadril, joelho e tornozelo para valores mais próximos dos normais. Com a elevação da altura do assento à 130%AJ foi observada uma redução significativa do tempo de movimento e deslocamento anterior do tronco (p < 0,001para ambos). A restrição do MINAF pelo step mostrou-se eficiente na diminuição da assimetria durante o ST-DP e pode ser um recurso terapêutico utilizado na reversão do desuso aprendido. Elevar a altura do assento diminuiu as demandas de tempo e deslocamentos do tronco, facilitando a aquisição da postura em pé mesmo com o emprego do step. Sugere-se o uso da restrição como uma estratégia de treinamento visando reduzir a assimetria durante o ST-DP.

Made available in DSpace on 2016-12-08T15:59:06Z (GMT). No. of bitstreams: 1 Resumo Angelica Ovando.pdf: 84448 bytes, checksum: cfab87cffb34ca33c7e791843dd67006 (MD5) Previous issue date: 2015-06-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The recovery of the community mobility (CM) after a stroke is one of the main goals during the rehabilitation process, however, about 62% of affected individuals report restriction to community life. Thus, it is estimated that the factors that contribute to the recovery of post-stroke CM are complex, reflecting not only gait speed and distance, as it has been pointed out by previous studies. Therefore, the primary aim of this study was to identify body functions and structures (BFS) and activity variables predictors of CM in individuals with hemiparesis. The study included 70 individuals affected by chronic stroke who were evaluated with specific instruments for lower limb function analysis in the areas of body functions and structures (BFS), activities and participation of the International Classification of Functionality, Disability and Health (ICF). The variables related to BFS included motor recovery (motor section of the Fugl-Meyer Assessment-FMA), muscle tone (Tardieu Scale), muscle strength (hand-held dynamometer), proprioceptive sensitivity (Section sensitivity - direction of movement FMA), lower limb coordination (LEMOCOTtest), balance (Test Step), fatigue (Fatigue Severity Scale-FSS) and symptoms of anxiety and depression (HADS). Activity domain included walking adaptability (WA) (Functional Gait Assessment, mobility Timed Up and Go), confidence in balance (ABC Scale), gait speed (10-meter walk test), gait endurance (six minute walk test). Participation was evaluated by the Stroke Impact Scale (SIS), the Frenchay Activity Index (FAI), the Life Space Assessment (LSA), which evaluated the CM, and a Trip Activity Log. Spearman correlation coefficients assessed relations between variables related to BFE, activity and participation and CM. Multiple linear regression analysis using the stepwise method identified the group of independent variables o BFS and activity that significantly explained the dependent variable CM. ROC curves were calculated to determine cutoff points to variables of interest for CM, measured by the LSA. Finally, comparative tests were carried out to distinguish independent CM at different levels. CM was correlated with all BFS and activity variables. In the participation domain, CM was correlated with all domains of SIS, with the exception of memory and communication domains, and strongly associated with the Frenchay Activities Index, number or trips taken in a week and total number of activities in a week (p<0.01 to all correlation). Regarding the regression analysis, in the model for the BFS, balance (ST), depression and fatigue explained 80% of the variation in the CM. In the model including the activity domain variables, WA and endurance explained 73% of the variation in CM (p<0.001). The analysis of ROC curves showed good diagnostic accuracy for the endurance, WA, balance, mobility and comfortable gait speed in their ability to discriminate the independent CM at different levels. Practically all study variables showed significant differences among individuals who had independent mobility at different levels. The results confirm the hypothesis that community mobility requires complex skills, and balance, endurance, ability to adapt the gait to different conditions, fatigue and depression are important factors that might explain community mobility more than gait speed alone. / A recuperação da mobilidade comunitária (MC) após um acidente vascular encefálico (AVE) é uma das principais metas no processo de reabilitação, embora cerca de 62% dos indivíduos acometidos apresentem restrição à vida comunitária. Estima-se que os fatores que contribuam para a recuperação da MC pós-AVE sejam complexos, refletindo não apenas a velocidade da marcha e a distância, como tem sido apontado por alguns estudos. O objetivo primário desse estudo foi identificar as variáveis de funções e estruturas do corpo (FEC) e atividade preditoras da MC de indivíduos com hemiparesia. Foram incluídos 70 indivíduos pós-AVE crônicos, que foram avaliados com instrumentos específicos para análise da função do membro inferior nos domínios de FEC, atividade e participação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). As variáveis de FEC incluíram a recuperação motora (Seção motora da Escala de Fugl-Meyer - EFM), tônus muscular (Escala de Tardieu), força muscular (dinamômetro manual), sensibilidade proprioceptiva (Seção sensibilidade da EFM), coordenação do membro inferior (LEMOCOT), equilíbrio (Teste do Degrau), fadiga (Escala de Gravidade da Fadiga) e sintomas de ansiedade e depressão (HADs). No domínio da atividade, foi avaliada a capacidade de adaptação da marcha (CAM) pela Functional Gait Assessment, mobilidade (Timed up and Go), confiança no equilíbrio (Escala ABC), velocidade de marcha (teste de caminhada de 10 metros) e resistência (Teste de caminhada de seis minutos). A participação foi avaliada pela Stroke Impact Scale (SIS), Índice de Atividades de Frenchay (FAI), Life Space Assessment (LSA), que avaliou a MC e diário de saídas. Coeficientes de correlação de Spearman foram calculados para avaliar as relações entre variáveis de FEC, atividade, participação e a MC. A análise de regressão linear múltipla método Stepwise identificou o grupo de variáveis independentes de FEC e atividade que explicaram significativamente a variável dependente MC. Foram calculadas curvas ROC para determinar pontos de corte para MC para variáveis de interesse. Por fim, foram realizados testes comparativos entre os diferentes níveis de MC para as variáveis do estudo. A MC esteve relacionada a todas as variáveis de FEC e às variáveis de atividade. No domínio participação, a MC esteve relacionada a praticamente todos os domínios da SIS e fortemente relacionada com o FAI, número total de saídas e número total de atividades (p<0,01 para todas as correlações). No modelo de regressão com variáveis de FEC, as variáveis de equilíbrio, depressão e fadiga explicaram 80% da variação na MC. No modelo que incluiu variáveis de atividade, a CAM e resistência explicaram 73% da variação na MC (p<0,001). As análises das curvas ROC demonstraram uma boa acurácia diagnóstica para a CAM, resistência, mobilidade funcional, e velocidade de marcha habitual na sua capacidade de discriminar a MC independente em diferentes níveis. Praticamente todas as variáveis do estudo apresentaram diferença significativa entre os níveis de MC. Esses resultados confirmam a hipótese de que a MC apresentou-se como uma habilidade complexa, onde o equilíbrio, resistência, habilidade de adaptar a marcha, fadiga e depressão foram variáveis importantes que explicaram a MC mais do que a velocidade de marcha.

Made available in DSpace on 2014-12-17T14:13:34Z (GMT). No. of bitstreams: 1 AnaMCS.pdf: 1887892 bytes, checksum: 05f9c6bffc3d95915a924712e4e7b5c7 (MD5) Previous issue date: 2007-12-19 / The purpose of this paper was to study patients with congenital and acquired hemiparesis, their clinical aspects, the presence or not of epileptic seizures, and electroencephalographic (EEG) and Magnetic Resonance Imaging (MRI) findings. We analyzed the interrelation between etiology, the presence and seriousness of epileptic seizures (ES) and the possible causes of refractoriness. This is a prospective study using the clinical diagnosis of a child neurologist, who attested to the presence of unilateral motor lesions. We compared the electroencephalographic findings in patients with or without epileptic seizures, and investigated if among the former, these seizures were controlled or not, their likely etiology and risks of refractoriness. EEG background activity on the lesion and contralateral side was analyzed, in addition to the presence of concomitant epileptiform activity. Encephalon MRIs of all the patients were studied to correlate etiology and the control or not of epileptic seizures. The disorganization of bilateral EEG activity correlated with the difficult-to-control epileptic seizures. Suitably organized background activity contralateral to the lesion is a good prognosis in relation to epileptic seizures. Focal epileptogenic activity does not necessarily predispose to epileptic manifestation. The MRI is more important in determining etiology than in prognosing epileptic seizures. This study used a multidisciplinary approach involving child neurologists, a physical therapist and a neuroradiologist. This meets the criteria of multidisciplinarity of the Postgraduate Program in Health Sciences / O objetivo do nosso trabalho foi estudar pacientes com hemiparesia, cong?nitas e adquiridas, seus aspectos cl?nicos e epidemiol?gicos, a presen?a ou n?o de crises epil?pticas e os achados eletrencefalogr?ficos e de neuroimagem por Resson?ncia Nuclear Magn?tica. Tentando relacionar a etiologia ? presen?a e gravidade de crises epil?pticas e as poss?veis causas de refratariedade. Trata-se de um estudo prospectivo a partir do diagn?stico cl?nico por um neurologista infantil que atestou a presen?a de les?o motora unilateral. Compararam-se os achados eletrencefalogr?ficos em pacientes sem ou com crises epil?pticas, e dentre esses ?ltimos, se h? ou n?o controle das crises, sua prov?vel etiologia e riscos de refratariedade. Analisou-se a atividade de base do EEG do lado da les?o e contra lateral a esta, al?m da presen?a de atividade epileptiforme concomitante. Estudaram-se as RNM do enc?falo realizadas em todos os pacientes, tentando relacionar a etiologia e controle ou n?o de crises epil?pticas. A desorganiza??o da atividade de base bilateral no EEG correlacionou-se com crises epil?pticas de dif?cil controle. A atividade de base adequadamente organizada contra lateral a les?o ? de bom prognostico em rela??o ?s crises epil?pticas. A atividade epileptog?nica focal n?o necessariamente predisp?e a manifesta??o epil?ptica. A RNM ? mais importante na determina??o da etiologia do que no progn?stico das crises epil?pticas. A realiza??o deste estudo foi concretizada pela abordagem multidisciplinar, envolvendo neurologistas infantis, fisioterapeuta e neurorradiologista. Este aspecto preenche os requisitos de multidisciplinaridade do programa de p?s-gradua??o em Ci?ncias da Sa?de

6 Abstract The rehabilitation of patients with brain damage is an interprofessional, complex, intensive, long-lasting and individually oriented process. One frequent consequence of brain damage is hemiparesis, which also causes a disorder of the upper extremity movement pattern. The movement ability of the upper extremity is essential for an individual's self-sufficiency, the performance of common daily activities, and thus for an independent life in a family setting. Special therapeutic rehabilitation approaches should involve the training of new activities, including the motor learning mechanism that activates brain plasticity. A functional reorganization of the motor cortex occurs along with the activation of reserve neurons and the replacement of damaged synapses. One of the aims of this work was to demonstrate, using objective function methods, the possibility of influencing the movement patterns of a paretic upper extremity by means of intensive interprofessional rehabilitation even several years after the brain damage. The second aim was to demonstrate that the monitoring of motor functions in patients after brain damage leads to improved motivation, thereby improving motor functions. A study was conducted among 55 selected patients after brain damage with central hemiparesis who participated in the...

Rehabilitation of patients after brain damage is an multidisciplinary, complex, intensive, long- term and individual process. Standardized functional instruments for the assessment of the degree of disability and functional abilities of patients are not usually used in rehabilitation in the Czech Republic. Often, motor disorder post brain damage results in hemiparesis and causes impairment of upper arm movement pattern. Movement ability of the upper arm is vital for self-sufficiency, activities of daily life and maintaining an independent family life. Special rehabilitation therapeutic techniques must involve the training of new activities including the mechanism of motor learning which is responsible for functional reorganization of the motor cortex regions, and the activation of reserve neurons for reparation. The aim of the study is to demonstrate that an accelerometer is a suitable instrumet for objective monitoring of impairment of the upper arm movement pattern. Another aim of the study is to demostrate if the FIM test (Functional Independence Measures) and Jebsen-Taylor (JT) test are appropriate instruments for detecting changes of the upper arm movement pattern after intensive, individual and multidisciplinary rehabilitation brain damage patients. Clinical study was undertaken with selected...

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