No description available.

Cerebrovascular accidents (CVAs) are a leading cause of morbidity and mortality in the United States. Metabolic derangements such as hypoglycemia, infections, brain masses or lesions, neurodegenerative disorders, neuropathies, myelopathies, seizures, syncope, types of migraines, and many other disorders may mimic CVA. Our case presents a 38-year-old female who was evaluated in the emergency department with a three- hour history of headache, lethargy, left- sided upper extremity weakness, facial droop, and dysarthria. A CVA workup was initiated and she immediately underwent a computed tomography (CT) scan of the head which revealed no intracranial hemorrhage. She was unable to provide a thorough medical history due to lethargy, however she was able to answer yes/no questions to screen for tissue plasminogen activator (tPA) qualification. She qualified based on her screening results and was administered tPA for her presumed ischemic CVA. She was then monitored in the intensive care unit for twenty-four hours. Due to reoccurrence of headache and left-sided weakness, as well as recent administration of tPA increasing risk of hemorrhage, she underwent two subsequent negative non- contrast head CT scans to rule out bleeding during that time. On hospital day two, magnetic resonance imaging (MRI) of the head, neck, and spine were performed which were also negative for infarct or hemorrhage. A more detailed history from our patient revealed previous migraine headaches, but her left sided weakness and dysarthria were new symptoms. With this information, it was suspected that she was suffering from a hemiplegic migraine, a rare mimic of CVA. Prochlorperazine, diphenhydramine, valproic acid, and corticosteroids were administered for migraine treatment, which aborted her symptoms entirely. Topiramate was then started for migraine prophylaxis. Daily low-dose aspirin was also initiated due to inability to fully rule out CVA/transient ischemic attack (TIA). An outpatient neurology follow up was scheduled on discharge. In clinical practice, hemiplegic migraines and CVA/TIA may be difficult to differentiate as symptoms often overlap. A detailed history and physical exam with careful attention to associated symptoms and timing of symptom onset is essential to formulating a correct diagnosis. This must be done quickly, as tPA is a high-risk medication with a narrow time window for administration. In conclusion, not all disease processes have an available “gold standard” diagnostic test to differentiate similar diagnoses. MRI of the brain is usually performed to differentiate ischemic CVA from TIA; however, imaging is not useful to differentiate hemiplegic migraine from TIA. Therefore, performing a thorough history, physical exam, and chart review is paramount to provide patients with the correct treatment as well as prevent adverse outcomes. It is the responsibility of the clinician to make difficult decisions weighing the risks and benefits of providing various treatments or interventions, and to know the complications of those treatments. Disease processes mimicking CVA must be considered in all patients, as treating an incorrect diagnosis can have devastating effects.

Constraint-induced movement therapy (CIMT) has been demonstrated to yield functional improvements for children with spastic hemiplegic cerebral palsy (CP); however, many studies have reported inconsistent findings with regards to the extent of the benefits observed following the intervention. This study sought to examine the effects of CIMT in the context of a day camp in this population; it also examined the child-therapist (C-T) interaction during the assessment sessions as a potential factor influencing the child’s scores on tests of motor performance. This interaction has not yet been formally measured in the literature, and may influence the perceived outcomes of CIMT. Motor Outcomes: Results demonstrated significant improvements in quality of use of the upper extremity following the intervention; the improvements were maintained at the 3-month follow-up. Analysis of each individual participant yielded additional information on clinically significant improvements. C-T Outcomes: Results demonstrated that the strength of the C-T interaction was significantly and positively correlated with the scores obtained by participants on motor assessments. The results of this study indicate that modified CIMT is effective in inducing lasting and meaningful changes in children with spastic hemiplegic CP. They also suggest that the C-T interaction may contribute to a participant’s performance during the assessment session, which may ultimately affect the perceived outcomes of CIMT. / UOIT

Orientador: Aparecido Augusto de Carvalho / Banca: Antônio de Pádua Lima Filho / Banca: Augusto Cesinando de Carvalho / Resumo: Neste trabalho descreve-se um sistema constituído por duas plataformas de forças e seus respectivos circuitos de condicionamento e interfaceamento de sinais, projetado para medir a distribuição de descarga de peso na região plantar de pacientes. Em cada plataforma de força foram acopladas 24 células de carga construídas com extensômetros. As características estáticas do sistema foram determinadas em laboratório utilizando pesos conhecidos. O sistema apresentou linearidade, com coeficiente de determinação de 0,9997, baixa histerese, precisão de 0,84% e resolução de 0,5 N. As medidas são apresentadas na tela de um computador facilitando a visualização para especialistas da área, principalmente médicos, fisioterapeutas e terapeutas ocupacionais. Utilizando o sistema foram medidas as distribuições de peso na região plantar de 87 indivíduos sem hemiplegia (sem histórico de queixas de dores ou problemas no sistema neuromusculoesquelético) e de 10 hemiplégicos crônicos, com mais de um ano de hemiplegia. Estes foram submetidos à avaliação utilizando a Escala de Equilíbrio de Berg. Entre os indivíduos se hemiplegia, estudou-se mais detalhadamente um grupo de 15 bailarinos e um de 12 ginastas rítmicas. Determinou-se a relação entre a distribuição de pesos nos antepés esquerdo e direito de indivíduos sem hemiplegia e hemiplégicos com o sistema implementado. Através do sistema constatou-se que a relação entre a distribuição de pesos no antepé esquerdo e direito dos indivíduos hemiplégicos é muito mais elevada que a dos indivíduos sem hemiplegia. Este resultado era de se esperar, uma vez que o hemiplégico descarrega seu peso predominantemente no lado não plégico / Abstract: This work describes a system consisting of two force platforms and their conditioning circuits and interfacing signals, designed to measure the distribution of weight load on the plantar region of patients. Each force platform was constructed with 24 load cells with strain gages. The static characteristics of the system were determined in laboratory using known weights. The system showed linearity with determination coefficient of 0.9997, low hysteresis, accuracy of 0.84% and resolution of 0.5 N. The measurements are presented in a computer screen in a friend way for specialists in the health field, mainly doctors, physiotherapists and occupational therapists. Using the system we measured the weight distributions in the plantar region of 87 normal patients (no history of complaints of pain or problems in the neuromuscular system) and 10 hemiplegic, with more than a year of hemiplegia. The latter were evaluated using the Berg Balance Scale. Among normal subjects, we studied a further group of 15 dancers and one of 12 rhythmic gymnasts. The relationship between the distribution of weights in the left and right forefeet of patients with normal and hemiplegic was determined with the implemented system. Through the system we found that the relationship between weight distribution on the left and right forefoot of hemiplegic patients is much higher than that of normal patients. This result was expected, since the hemiplegic unloads his weight predominantly in non-paralyzed side / Mestre

Orientador: Aparecido Augusto de Carvalho / Banca: Erica Regina Marani Daruichi Machado / Banca: Ernane José Xavier da Costa / Resumo: Por décadas, a aplicação de Estimulação Elétrica Neuromuscular (EENM) em pacientes paraplégicos e hemiplégicos tem melhorado significativamente sua qualidade de vida. Entretanto, comercialmente, essa técnica é aplicada sem o uso de uma lei de controle em malha fechada, o que limita sua eficiência. Assim, neste trabalho, projetou-se e implementouse um controlador PID embarcado para o uso com estimuladores elétricos neuromusculares. O projeto desse controlador se baseou em um modelo matemático linear de segunda ordem, que representa o comportamento da força muscular devido a um estímulo elétrico. Posteriormente, desenvolveram-se algoritmos na linguagem de programação Python que possibilitam o projeto automático de controladores PID com diferentes especificações para diferentes pacientes. Dessa forma, o usuário informa os parâmetros do paciente e as especificações desejadas para obter a configuração do controlador PID adequada. Além disso, desenvolveuse um programa em linguagem C para o microcontrolador PIC18F4520 que implementa este controlador utilizando o seu conversor A/D interno de 10 bits e um conversor D/A externo de 10 bits. Este controlador pode ser configurado via comunicação serial de forma simples e rápida, permitindo alterar os parâmetros do controlador PID e o tempo de amostragem. Por fim, os resultados obtidos a partir da simulação deste sistema no ambiente Proteus provou a viabilidade do controlador PID projetado. / Abstract: For decades the quality of life of hemiplegic and patients with spinal cord injuries has been improving through the research and use of Neuromuscular Electrical Stimulation (NMES) in rehabilitation engineering. However, most of the times it has been used without closed loop techniques, which is the approach used in this project, where an embedded PID controller has been designed and implemented to control the NMES. The plant to be controlled, i.e., the behaviour of the muscle response to an electrical stimulus, was represented using a secondorder linear model. The language Python was then used to develop PID control algorithms allowing the use of different specifications so that the user can supply the patient parameters to properly configure the PID controller for different patients. Later, these algorithms were implement in a PIC18F4520 microcontroller using C language, exploiting its internal 10 bit A/D converter and an external 10 bit D/A. The final circuit can be configured serially via a PC, adjusting the controller parameters and the sampling rate. The whole system was simulated in the Proteus environment, proving its viability. / Mestre

Made available in DSpace on 2014-06-11T19:22:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-04-27Bitstream added on 2014-06-13T20:08:24Z : No. of bitstreams: 1 sanches_maa_me_ilha.pdf: 1862589 bytes, checksum: e3625c1d280204f136503179cec091dd (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Este trabalho descreve um sistema eletrônico implementado com o objetivo de monitorar os esforços exercidos pelos membros superiores e inferiores de pacientes. O sistema é constituído por transdutores, circuitos de condicionamento de sinais, circuito de comunicação e um software para a aquisição de dados, além da visualização em um microcomputador. São descritos dois tipos de transdutores, construídos com extensômetros metálicos, um para conexão em muletas e o outro projetado para ser inserido em palmilhas. Os fundamentos teóricos necessários para o projeto destes transdutores são apresentados, bem como os esquemas dos circuitos implementados. É descrita a metodologia utilizada para a determinação das características estáticas e dinâmicas dos transdutores. Estes apresentaram respostas lineares, excelente repetibilidade, e faixa dinâmica que atende às finalidades do projeto. Foi desenvolvido um software com interface gráfica contendo várias telas que possibilitam diferentes análises e armazenamento de informações. Utilizando o sistema, foram realizadas, com êxito, medições de forças exercidas pelos membros inferiores e superiores de pacientes normais e hemiplégicos. / This work describes the development of a computer-based system able for monitoring forces acting on patients’ upper and lower limbs. The system consists of insoles and crutches instrumented with load cells, signal conditioning circuits, data acquisition system, and a computer. The results of the static and dynamic measurements can be presented in the screen of a computer through graphs and tables, and stored in a data base, to follow-up the development of a patient treatment. The program was developed in Visual Basic, and the communication uses the USB port. All transducers presented linear response, small hysteresis, excellent repeatability and resolution. Static and dynamic measurements performed with the transducers are presented as well as the visualization of the forces exerted on the plantar area and upper limbs of healthy and hemiplegic patients.

Made available in DSpace on 2014-06-11T19:22:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-07-03Bitstream added on 2014-06-13T19:48:52Z : No. of bitstreams: 1 prado_ta_me_ilha.pdf: 795913 bytes, checksum: 9cef172cb872d59f74ed69d272a2753f (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Por décadas, a aplicação de Estimulação Elétrica Neuromuscular (EENM) em pacientes paraplégicos e hemiplégicos tem melhorado significativamente sua qualidade de vida. Entretanto, comercialmente, essa técnica é aplicada sem o uso de uma lei de controle em malha fechada, o que limita sua eficiência. Assim, neste trabalho, projetou-se e implementouse um controlador PID embarcado para o uso com estimuladores elétricos neuromusculares. O projeto desse controlador se baseou em um modelo matemático linear de segunda ordem, que representa o comportamento da força muscular devido a um estímulo elétrico. Posteriormente, desenvolveram-se algoritmos na linguagem de programação Python que possibilitam o projeto automático de controladores PID com diferentes especificações para diferentes pacientes. Dessa forma, o usuário informa os parâmetros do paciente e as especificações desejadas para obter a configuração do controlador PID adequada. Além disso, desenvolveuse um programa em linguagem C para o microcontrolador PIC18F4520 que implementa este controlador utilizando o seu conversor A/D interno de 10 bits e um conversor D/A externo de 10 bits. Este controlador pode ser configurado via comunicação serial de forma simples e rápida, permitindo alterar os parâmetros do controlador PID e o tempo de amostragem. Por fim, os resultados obtidos a partir da simulação deste sistema no ambiente Proteus provou a viabilidade do controlador PID projetado. / For decades the quality of life of hemiplegic and patients with spinal cord injuries has been improving through the research and use of Neuromuscular Electrical Stimulation (NMES) in rehabilitation engineering. However, most of the times it has been used without closed loop techniques, which is the approach used in this project, where an embedded PID controller has been designed and implemented to control the NMES. The plant to be controlled, i.e., the behaviour of the muscle response to an electrical stimulus, was represented using a secondorder linear model. The language Python was then used to develop PID control algorithms allowing the use of different specifications so that the user can supply the patient parameters to properly configure the PID controller for different patients. Later, these algorithms were implement in a PIC18F4520 microcontroller using C language, exploiting its internal 10 bit A/D converter and an external 10 bit D/A. The final circuit can be configured serially via a PC, adjusting the controller parameters and the sampling rate. The whole system was simulated in the Proteus environment, proving its viability.

Orientador: Aparecido Augusto de Carvalho / Banca: Augusto Cesinando de Carvalho / Banca: Cláudio Kitano / Resumo: Este trabalho descreve um sistema eletrônico implementado com o objetivo de monitorar os esforços exercidos pelos membros superiores e inferiores de pacientes. O sistema é constituído por transdutores, circuitos de condicionamento de sinais, circuito de comunicação e um software para a aquisição de dados, além da visualização em um microcomputador. São descritos dois tipos de transdutores, construídos com extensômetros metálicos, um para conexão em muletas e o outro projetado para ser inserido em palmilhas. Os fundamentos teóricos necessários para o projeto destes transdutores são apresentados, bem como os esquemas dos circuitos implementados. É descrita a metodologia utilizada para a determinação das características estáticas e dinâmicas dos transdutores. Estes apresentaram respostas lineares, excelente repetibilidade, e faixa dinâmica que atende às finalidades do projeto. Foi desenvolvido um software com interface gráfica contendo várias telas que possibilitam diferentes análises e armazenamento de informações. Utilizando o sistema, foram realizadas, com êxito, medições de forças exercidas pelos membros inferiores e superiores de pacientes normais e hemiplégicos. / Abstract: This work describes the development of a computer-based system able for monitoring forces acting on patients' upper and lower limbs. The system consists of insoles and crutches instrumented with load cells, signal conditioning circuits, data acquisition system, and a computer. The results of the static and dynamic measurements can be presented in the screen of a computer through graphs and tables, and stored in a data base, to follow-up the development of a patient treatment. The program was developed in Visual Basic, and the communication uses the USB port. All transducers presented linear response, small hysteresis, excellent repeatability and resolution. Static and dynamic measurements performed with the transducers are presented as well as the visualization of the forces exerted on the plantar area and upper limbs of healthy and hemiplegic patients. / Mestre

The computational musculoskeletal models that are used to study muscle moment-generating capacities of persons with movement disorders and planning treatment options must be accurate, and take into account the inter-individual variability of musculoskeletal geometry. In Paper I the methods of creating the subject-specific musculoskeletal model of the lower extremities from magnetic resonance images (MRIs) were developed. The subject-specific model was used to analyze hip, knee and ankle muscle moment arms (MALs) and muscle-tendon lengths (MTLs) during gait in a subject with unilateral cerebral palsy (CP), and to evaluate the accuracy of widespread and commonly-used scaled generic model. It was found that the scaled generic model delivered accurate values for changes in MTLs in most muscles. However, the scaled generic and the subject-specific lower extremity musculoskeletal models showed substantial differences in MALs calculated during gait. In Paper II subject-specific musculoskeletal models of nine subjects with unilateral CP were created to study muscles volumes, MTLs and MALs; and to examine the accuracy of MALs calculated by the scaled generic models. It was shown that the scaled generic model significantly underestimated hip MALs discrepancies between the affected and the non-affected sides of the lower extremities. However, it significantly overestimated hip adduction/abduction of gluteus maximus, gluteus medius, gluteus minimus, tensor fascia latae and biceps femoris long head; and hip flexion of adductor longus and rectus femoris in the affected and the non-affected sides. It was also found that muscle volumes and hip abduction MALs in gluteus medius and gluteus minimus, hip flexion MALs in iliacus and hip rotation in gluteus maximus were smaller in the affected side of lower extremities. MTLs in the affected and the non-affected sides throughout the range of hip motion were similar. This thesis suggests the need for the subject-specific musculoskeletal models that can account for variability of muscle attachments and musculoskeletal geometry of persons with movement disorders. Based on inaccuracies of the scaled generic model reported here, the generic models that are used to guide treatment decisions must be tested, and interpreted with care. / QC 20110901

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24095号 / 人健博第102号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 市橋 則明, 教授 稲富 宏之, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM