1 Abstract The purpose of this study was to describe the degree of bilateral asymmetry of lower limbs' muscle activity in the dance movement Cha-cha-cha and to determine the cause of bilateral asymmetries of lower limbs' muscle activity. Differences in muscle activity of contralateral lower limbs might be caused by the factor of bilaterally asymmetrical movement patterns, the factor of neural pathways or the factor of training. We hypotetize that comparing the direction of bilateral asymmetry in muscle activity between asymmetrical dance movement and its mirror alternative can determine the cause of bilateral asymmetry in muscle activity of lower limbs within the movement. We studied 14 volunteers (7 men, 7 women), all were actively dancing at competitive level. We tested the muscle activity of musculus vastus lateralis (VL), musculus biceps femoris (BF), musculus tibialis anterior (TA) a musculus gastrocnemius lateralis (GL) using surface electromyography. The dance movement Cha-cha-cha was bilaterally asymmetrical in the muscle activity of VL, TA and GL. Direction of lower limbs' muscle activity indicates, that TA, being a muscle responsible for foot movement, might be affected by the factor of neural pathways and brain laterality, while VL and GL might be more affected by the factor of training. Key...

Title: Analysis of upper limbs muscles involvement during playing the drums. Objectives: The aim of this thesis is to compile information about playing the drums and summerize the most frequent musculosceletal disorders of upper extremities of these musicians. The main aim is analyzing and comparing the involvement of muscles or muscles groups of the right upper limb while drumming. Methods: The theoretical part follows up the given issue as a research and theoretical overview of the current findings based on czech and foreign literature. The practical part is dedicated to evaluation of surface electromyography and 3D kinematics analyses of movements while drumming under specified conditions of one single proband. Results: Results of measurement demonstrate that m. biceps brachii is the most active muscle during playing on hi-hat, snare drum and floor tom with forte dynamics and m. extenzor carpi uln. is is the most muscle active during play with piano dynamics. Wrist flexors were the least active during all measurements. M. extenzor carpi rad. was measured too and its activity was on second place. A close relation between changes of muscles activity and changes of angles of the elbow and wrist have not been established in this study. This research was implemented only with one proband so the...

AbstractIntroduction: Hand Arm Risk Assessment Method (HARM) is a tool to assess the risks of deve­lo­ping complaints of the arm, neck or shoulders during manual work. The method was developed in the Netherlands primarily for employers, but is also used as an aid to work environment in­spec­tors. The purpose of this study was to evaluate the HARM-method for assessment of biomecha­nical exposure of the upper limbs when performing manual tasks as well as its suitability to be used within work environment inspection. Methods: Ten labour inspectors conducted assessments of five video-recorded work tasks. Assess­ments made with HARM were compared with those made with the Assessment of Re­pe­titive Tasks (ART) tool and with ACGIH Hand Actvity Level (HAL) - both methods for assess­ment of bio­mecha­nical exposure of the upper limbs - and with the model for the assessment of re­pe­titive work in the pro­visions of the Swedish Work Environ­ment Autho­rity on ergonomics for the prevention of mus­culo­skeletal disorders, AFS 1998:1. HAL is based on a threshold limit value for hand activity. The method combines the assessment of hand activity with per­ceived effort in the hand and forearm. The assess­ments were made twice, two weeks apart. Following each assessment the inspec­tors answered questions about the suitability of each method. Three experts (X) made the same assess­­ments, first individually just like the inspectors’, and then they agreed upon a consensus estimation. Head and upper arm position were registered by inclinometer, wrist movements with electro goniometer. The observers' assessments were com­pared with a “gold standard” that was created by the results of the technical measure­ments which re­placed the consensus esti­mates for the head and arm positions as well as wrist motions in the HARM, ART and HAL assessments. Results: The inspectors' assessment of HARM and ART showed in comparison with the res­pective “gold standard” some under­esti­ma­tion of risks. Conformity in the test-retest was 68 % at appraisal with HARM and 66 % with ART. Based on the inspectors' observations it was re­vealed that force and frequency were experienced as the most difficult to assess. On the other hand the indi­vi­dual assess­ments indicated that the work position of the hand and forearm showed the lar­gest deviation. Hand activity was both over and undervalued in comparison with tech­nical measurements, suggesting that it is difficult to simply assess hand activity by ob­ser­va­tion. Fur­thermore, the model for identifying repetitive work in AFS 1998:1 was perceived to be the most difficult to use for performing assess­ments, as it has few criteria and no support for the assessment of hand/arm and hand inten­si­ve move­ments. This under­lines that there is a need for other models as a supplement to the pro­visions. Conclusions: The results showed that the HARM and ART are relatively similar in content and struc­ture and provided relatively similar results. HARM is more detailed than ART as it takes into account the vibration exposure as a single factor and shows more consideration to the duration of exposure. The HARM-method provides support for the assessment; it is easy to use, it needs pen and paper only and is in that sense readily available, it is fast and takes into account the whole of the assessment of biomechanical exposure of the upper limbs. ART is very similar to HARM; HAL is more limited and can be used as a rapid screening of hand load. / Sammanfattning Inledning: Hand Arm RiskbedömningsMetod (HARM) är ett verktyg för bedömning av be­last­ning på hand och arm vid manuellt arbete. Metoden är framtagen i Nederländerna, i första hand till arbets­gi­va­re, metoden används också som ett stöd för arbetsmiljöinspektörer. Syftet med den här studien var att utvärdera HARM-metodens tillförlitlighet och dess lämp­lig­het som hjälpmedel för arbetsmiljö­inspek­törer vid riskbedömning av belastning på hand, arm och axel vid ma­nuellt arbete. Metod: Tio observatörer tillika arbetsmiljöinspektörer genomförde bedömningar av fem video­inspe­la­de arbets­moment.  Bedömningar gjorda med HARM jämfördes med bedöm­ningar med Assessment of Repetitive Tasks (ART) och Hand Activity Level (HAL) samt modellen för bedömning av ensidigt upprepat arbete i Arbetsmiljöverkets föreskrifter om belastningsergonomi, AFS 1998:1. HAL bygger på ett gränsvärde för handaktivitet. Metoden kombinerar bedömning av handens aktivitet med upplevd ansträng­ning i hand och underarm. Bedömningarna gjordes två gånger med två veckors mellanrum. I anslutning till varje bedömning besvarades frågor om respektive metods användbarhet. Tre experter (X) gjorde först enskilt mot­sva­rande bedömningar som observatörerna och enades därefter i en kon­sen­sus­be­döm­ning. Huvudets- och över­armarnas position registrerades med inklinometer, hand­leds­rö­rel­ser med elektro­gonio­me­ter. En ”gyllene standard” som observatörernas mätningar kunde jämföras med, skapades genom att resultaten av de tekniska mätningarna ersatte konsensusbedömningen för huvud- och armposition samt handledsrörelserna för HARM, ART och HAL. Resultat: Observatörernas bedömningar med HARM och ART visade i jämförelse med respektive gyllene standard på en viss undervärdering av risker. Överensstämmelsen vid test-retest av arbets­momenten var 68 % vid bedömning med HARM och 66 % med ART. Av observatörernas synpunkter framkom att kraft­ och frekvens upplevdes svårast att bedöma. Av de enskilda bedömningarna framkom dock att det var arbets­ställning i hand och underarm som visade den största avvikelsen. Handaktivitet både över- och undervärderades i jämförelse med tekniska mätningar, vilket pekar på att det är svårt att enbart genom ob­ser­va­tion bedöma handaktivitet. Vidare framgick att AFS upplevdes vara svårast att an­vän­da som underlag till en belastnings­ergono­misk riskbedömning, då den har få kriterier och saknar bedömnings­stöd för hand/arm och hand­in­tensiva rörelser. Detta understryker att det kan behövas ett komplement till AFS. Slutsatser: Resultaten visade att HARM och ART är relativt lika till innehåll och struktur och gav förhållandevis likvärdiga resultat. HARM är mer nyanserad än ART då den dels tar hänsyn till vibrationsexponering som en enskild faktor och dels justerar för exponeringstid. HARM-metoden ger stöd vid bedömning, är snabb och lätt att använda, endast papper och penna krävs och den tar hänsyn till hel­heten vid be­döm­ning av nack- och arm belastning. ART är mycket lik HARM. HAL är mer begränsad och kan användas som en snabb screeningmetod för handbelastning.

Syfte: Syftet med denna studie var att undersöka vad kliniker upplever påverkar förskrivningsprocessen av mikroprocesstyrd knäkomponent (MPK) i de olika regionerna i Sverige. Metod: Kvalitativ analys med semistrukturerade intervjuer genomfördes. Intervjuerna genomfördes och spelades in med Zoom eller Teams programvara och data analyserades sedan tematiskt.  Resultat: 9 legitimerade ortopedingenjörer samt en legitimerad fysioterapeut från åtta olika regioner deltog i studien. Under dataanalysen identifierades fyra huvudteman samt 10 underteman. Huvudteman var: utvärdering av patientens lämplighet för MPK, utmaningar med att beräkna patientutfall, förskrivningsbarriärer och externa påverkande faktorer. Deltagarna upplevde att beräkning av patientutfall, budgetrestriktioner och att vara beroende av subjektiva bedömningar av patienter som stora utmaningar med förskrivningsprocessen av en MPK.  Slutsats: Deltagarna upplevde att förskrivningsprocessen av MPK påverkas av flertal olika faktorer; från regionala budgetar och ansökningsprocesser, till deltagarnas erfarenhet och förmåga att bedöma lämpliga MPK-kandidater. Deltagarna uttryckte utmaningar med att förskrivningsprocessen var känslobaserad och till stor del beroende av subjektiva och generella utvärderingar av patienten. Detta gjorde att ett stort ansvar av bedömningen om vem som bör få ett MPK förskrivet, låg på deltagarna själva, vilket ansågs kan bidra till inkonsekventa patientbehandlingar. Deltagarna upplevde att ett nationellt förskrivningssystem möjligen hade kunnat bidra till att processen var mer rättvis för patienterna samt underlätta processen för de själva. / Purpose: The study investigates clinicians’ experience of what is affecting the prescription of microprocessor-controlled prosthetic knees (MPKs) in different regions in Sweden. Method: Qualitative analysis with semi-structured interviews were conducted. The interviews were conducted and recorded using Zoom or Teams software and data was thereafter thematically analysed. Results: 9 certified prosthetists and a certified physiotherapist from eight different regions participated. During data analysis four main themes were identified along with ten subthemes. The key themes were: assessing candidate for MPK, challenges in estimating outcomes, barriers to prescribing and external influencing factors. Estimating patient outcomes, budget limitations and being dependent on subjective patient evaluations were expressed as major factors affecting the prescription of MPKs. Conclusion: The prescription of MPKs was found to be affected by several factors; from regional budgets and application processes to clinicians’ experience in assessing suitable MPK-candidates. The clinicians expressed challenges in that the prescribing process was emotionally based and relied on subjective and generalised patient assessments. This made decision-making regarding who to prescribe an MPK to, highly dependent on the clinicians’ own experience and knowledge which according to them, could lead to inconsistent treatments. Clinicians felt that a national prescription system could possibly ensure fairer patient evaluations and make the process easier for themselves.

No description available.

Title: The relevance of Bosco test for determination of healthy oriented efficiency adolescents Objective: The main objective is to find and describe the relationship of Bosco test (60 s) to a specific level of health-related fitness among adolescents based on the comparison of the output parameter of Bosco test and test items EUROFIT at physically active and inactive boys and girls. The partial objectives are to describe the influence of anthropometric parameters, gender and competence to physically active people on the current level of power parameters of the lower limbs. Methods: The dissertation has the character of empirical research, it is a descriptive study in which the research has a nature of the association, ie., that the required data are obtained by observation. The study was carried out on a group of purposefully selected probands n=100 age 18.40 ± 0.83 years, a period of adolescence. In the study group was equal representation of boys n=50 (age 18.50 ± 0.84 years) and girls n=50 (age 18.38 ± 0.82 years). Anaerobic capacity and power parameters of the lower extremities were determined by a standardized jumping Bosco test (60 s). The results of laboratory and anthropometric survey results were referenced by a test battery EUROFIT, which provides information on health-related fitness....

Energy Harvesting, also known as power harvesting or ambient power, is the process of obtaining small amounts of power from secondary sources, such as vibrations, light, temperature variations and even radio-frequency emissions. These systems have been uncommon in personal and wearable electronics in the past, however they are slowly gaining traction. With the increasing sophistication of prosthetic limbs and implants, devices that in some cases require a consistent and reliable power source, the potential field of application for energy harvesting grows wider. This thesis project evaluates whether energy harvesting methods could be implemented in future prosthetic limb designs without significantly affecting weight, user comfort, complexity of design etc., and whether the gains of such an implementation would be worth the effort and cost put into it. For reference the project used the RHEO KNEE® by Össur Hf., a microcontroller controlled prosthetic knee, as a device that such a system could be integrated with. Energy harvesting is still an emerging field and is a long time away from being a viable primary power source for most electronic devices. However, it still might have potential as a supplementary source for extending charge cycles or making smaller (and therefore more lightweight) power cells viable. This master’s thesis project was broad in scope and included 3D-design; mechanical, electrical and embedded software design; and setting up a miniature kinetic power generator as well as a photovoltaic harvesting system. No amputees were available for testing the designs so the system was tested with a 3D-printed model that was moved by hand to simulate the generation process. Due to some incorrect inital assumptions, the final electronic design was not optimal for this kind of system. However, a kinetic generator that harvested power from a modeled heel striking the ground 50 times a minute produced about 23mW of power. 53cm2 of photovoltaic panels produced 42μW of power in an ambient light setting. For comparison, a low-power microcontroller needed about 119μW of power on average to do some simple processing and send Bluetooth transmissions once every two seconds. / Energiinsamling (e. Energy Harvesting), är processen för att erhålla små mängder kraft från sekundära källor, såsom vibrationer, ljus, temperaturvariationer och utstrålning i radiofrekvens. Dessa system har varit ovanliga i hemelektronik och bärbar teknik, men de vinner sakta dragkraft. Med den ökande förfining av proteser och implantat, som i vissa fall kräver en jämn och pålitlig strömkälla, växer det potentiella användningsområdet för energiinsamling. Detta examensarbete utvärderar huruvida energiinsamlingsmetoder skulle kunna implementeras i framtida proteskonstruktioner utan att nämnvärt påverka vikt, användarkomfort, komplexitet i design etc., och om vinsterna med en sådan implementering skulle vara värd ansträngningen och kostnaden. Som exempel använde detta projekt en datoriserad knäprotes av Össur HF, RHEO KNEE®, som exempel på ett system som energiinsamling skulle kunna integreras med. Energiinsamling är fortfarande ett växande forskningsområde och är långt ifrån att en strömkälla för det mesta elektronik.. Det kan ändå ha potential som en kompletterande strömkälla som kan förlänga laddningscykler eller göra mindre (och därför lättare) batterier möjliga. Detta examensarbete var brett i omfattning och inkluderade 3D-design; mekanisk-, elektrisk- och mjukvara-design; och inrättning av en kinetisk kraftgenerator i miniatyr samt ett ljusdrivet energiinsamlingssystem. Inga amputerade var tillgängliga för att testa designen, därför så testades systemet med en 3D-printad modell som rördes för hand för att simulera strömförsörjelseprocessen. På grund av några felaktiga initiala antaganden var den slutliga elektroniska designen inte optimal för denna typ av system. Ändå lyckades en kinetisk generator som använde energiinsamlingsprinciper producera cirka 23mW ström genom en simulerad häl som träffade marken cirka 50 gånger i minuten. 53cm2 solcellspaneler producerade 42μW energi i en ljussatt miljö. Som jämförelse behövde en strömsnål styrkrets i genomsnitt cirka 119μW effekt för att genomföra enkla programprocesser och skicka Bluetooth-överföringar en gång varannan sekund. / Hliðarorkuöflun (e. energy harvesting), sem einnig bætti kalla umhverfisöflun, er ferlið við að fá lítið magn af orku frá óbeinum aflgjafa, svo sem frá hristingi, ljósi, hitabreytingum og jafnvel útvarpsbylgjum. Þessi kerfi hafa verið sjaldgæf í raftækjum hingað til, þó þau eru hægt og rólega að fá hlutdeild. Með nýrri og fágaðri gervilimum og ígræðslum, tæki sem í sumum tilvikum þurfa samfellda og áreiðanlega orkjugjafa, víkkar mögulegt notkunarsvið hliðarorkuöflunar. Þetta lokaverkefni metur hvort aðferðir við hliðarorkuöflun gætu verið notaðar í hönnun gervilima framtíðarinnar án þess að hafa neikvæð áhrif á þyngd, þægilegheit, flóknun hönnunar o.þ.h., og hvort hagur sé í samræmi við framlag og kostnað. Þetta verkefni notar RHEO KNEE® frá Össuri Hf. sem viðmið, sem er gervihné stjórnað af örtölvu. Viðmiðinu er ætlað að sýna notagildi kerfisins. Hliðarorkuöflun er ennþá svið í þróun og er nokkuð í að það geti orðið frumorkugjafi fyrir flest raftæki. Hins vegar þá gæti það enn átt möguleika á að vera aukaorkugjafi til að auka tímalengd hverrar hleðslu eða gera minni og léttari rafhlöður raunhæfari. Þetta meistaraverkefni var viðamikið að því leiti að það fól í sér þrívíddarhönnun; vél-, raf- og hugbúnaðarhönnun; og uppsetningu á hreyfirafal ásamt ljósorkuöflunarkerfi. Engir einstaklingar sem misst hafa fót voru til staðar til að prófa hannanir þessa verkefnis. Þ.a.l. voru þær prófaðar með þrívíddarprentuðum líkönum sem hreyfð voru með handafli til að líkja eftir orkuframleiðsluferlinu. Vegna rangrar upprunalegrar forsendu þá var endanleg rafhönnunin ekki ákjósanleg fyrir slíkt kerfi. Hreyfirafall tengdur við gervihæl sem sló jörðu 50 sinnum á mínútu framleiddi þó 23mW af orku. 53cm2 af ljósorkueiningum framleiddu 42μW af afli í meðal herbergisbirtu. Til samanburðar þá eyðir skilvirk örtölva u.þ.b. 119μW af afli í einfaldri tölvuvinnslu ásamt því að senda Bluetooth sendingu á tveggja sekúnda fresti.

Résumé: But : Les objectifs étaient de 1) décrire les profils de force musculaires aux membres inférieurs (MIs) et les capacités aux déplacements des personnes présentant les phénotypes adulte classique (DM1-AC) et adulte tardif (DM1-AT) de la dystrophie myotonique de type 1 (DM1), et 2) d’explorer l’influence de la faiblesse des MIs sur les capacités aux déplacements dans cette population. Méthode : Cette étude consiste en une analyse secondaire de données issues d’une plus large recherche qui visait à identifier les déterminants de la participation sociale et de la qualité de vie de personnes atteintes de DM1 (n = 158 DM1-AC et n = 42 DM1-AT). La force de quatre groupes musculaires des MIs a été mesurée à l’aide du bilan musculaire manuel (BMM) et du bilan musculaire quantitatif (BMQ) par dynamométrie manuelle. Les capacités aux déplacements ont été évaluées à l’aide de tests standardisés (échelle d’équilibre de Berg, vitesse de marche et Timed Up & Go). Résultats : Le phénotype DM1-AT présente moins de faiblesse et d’incapacités que le phénotype DM1-AC (p < 0,001 – 0,020). Le BMM ne détecte pas de faiblesse chez le phénotype DM1-AT mais des pertes de force au BMQ de 12 % à 20 % ont été identifiées chez ce phénotype, excepté pour les fléchisseurs du genou, entrainant des limitations aux déplacements chez 22 % à 48 % de ces individus. Dans le phénotype DM1-AC, l’atteinte musculaire était légèrement plus importante en distal qu’en proximal. Selon ces résultats, les phénotypes DM1-AC et DM1-AT présentent des portraits distincts et les données relatives à chacun devraient être analysées séparément. Une progression générale de la faiblesse au BMQ et des scores aux tests fonctionnels a été observée en fonction des cotes de l’échelle Muscular Impairment Rating Scale (MIRS). Un déficit de force au BMQ (excepté pour les fléchisseurs du genou) et des incapacités fonctionnelles ont aussi été observés dès les premières cotes de la MIRS. Finalement, les dorsifléchisseurs de la cheville et les extenseurs du genou semblent être de bons indicateurs de la fonction des membres inférieurs en DM1. Conclusion : Cette étude a permis de dresser un portrait des atteintes de la force musculaire aux MIs et des capacités fonctionnelles liées aux déplacements pour chacun des phénotypes DM1-AC et DM1-AT de la DM1, ainsi que d’explorer la contribution de la faiblesse des groupes musculaires évaluées sur les capacités aux déplacements dans cette population. Ces résultats contribueront à mieux déterminer les cibles d’évaluation et d’interventions en réadaptation et à mieux définir le processus d’évaluation dans le contexte des essais thérapeutiques à venir. / Abstract: Purpose: The purposes of this study were 1) to describe lower limbs muscle strength and mobility capacities, and 2) to explore the respective contribution of lower limb muscle weaknesses on mobility in the adult and late-onset phenotypes of myotonic dystrophy type 1 (DM1). Methods: This study is a secondary analysis of part of the results of a larger study, whose purpose was to identify social participation and quality-of-life determinants in 200 DM1 patients (158 adult and 42 late-onset). The strength of four lower limb muscle groups was assessed using manual muscle testing (MMT) and handheld dynamometry quantitative muscle testing (QMT). Mobility capacities were assessed using standardized tests (Berg balance scale, 10 Meter Walk Test and Timed Up & Go). Results: Although the late-onset phenotype showed less weaknesses and mobility limitations than the adult phenotype (p <0.001-0.020), and although MMT showed no weakness in the late-onset phenotype, quantitative strength losses of 12-20% were measured in this phenotype, with the exception of the knee flexors. These weaknesses led to mobility limitations in 22-48% of participants with the late-onset phenotype. In the adult phenotype, muscle strength impairment was slightly more important distally than proximally (2-2.5/10 and 5.8-8.2% for MMT and QMT, respectively) (p <0.001-0.002). According to those results, the adult and late-onset phenotypes show different profiles of lower limb impairment, and should not be pooled for data analysis. A general progression of quantitative muscle weakness and of mobility scores was observed according to the Muscular Impairment Rating Scale (MIRS) classification. Quantitative weaknesses, with the exception of the knee flexors, and mobility limitations were observed from the first MIRS grades. QMT is therefore definitely a more effective tool for measuring weakness in DM1. Finally, ankle dorsiflexors and knee extensors seem to be good indicators of lower limb function in DM1. Conclusion: This study allowed a better characterization of lower limb weaknesses and mobility limitations in the adult and late-onset phenotypes of DM1, and explored the contribution of lower limb weaknesses on mobility capacities in this population. These results will be useful for developing more specific rehabilitation programs and for optimizing the evaluation of these impairments in the context of the upcoming therapeutic trials. Keywords: Myotonic dystrophy type 1, phenotypes, muscle strength, mobility capacities, lower limbs, explanatory variables, physiotherapy.

Suite à un accident vasculaire cérébral (AVC), des déficits au membre controlatéral et ipsilatéral à la lésion cérébrale sont observés chez les personnes avec un AVC. La performance du membre ipsilatéral est déterminée par l’importance de la sévérité clinique du membre controlatéral ainsi que par l’adéquation du traitement bihémisphérique des informations sensori-motrices. L’objectif de la présente étude est de comparer la performance motrice de la main ipsilatérale lors de diverses tâches nécessitant un niveau plus ou moins complexe de traitement de l’information chez une clientèle hémiplégique ayant une faible sévérité clinique. Les résultats démontrent que les forces de pinces entre le pouce et l’index du membre ipsilatéral sont modulées et anticipées adéquatement chez les personnes avec un AVC ayant une faible sévérité clinique tel que démontré par des scores de cinq ou plus au Chedoke-McMaster Stroke Assessment (modules bras et main). La performance motrice du membre ipsilatéral lors de l’exécution d’une tâche de coordination bilatérale est comparable à celle du membre dominant des sujets sains lorsque la tâche est réalisée sans interaction entre les membres supérieurs (deux objets) et elle est perturbée lorsqu’elle implique une action coordonnée et réciproque des membres supérieurs sur un même objet. Ces personnes, ayant une bonne récupération motrice, ont donc une problématique centrale d’intégration et de traitement de l’information sensori-motrice lorsqu’il y a une complexification de la tâche à réaliser. Ces résultats suggèrent donc que les cliniciens devraient porter une attention plus particulière aux activités unilatérales et de coordination bilatérales lors le l’exécution de tâches complexes nécessitant un niveau d’intégration sensori-motrice élevé. / As a result of a cerebrovascular accident (CVA), deficits in the controlateral and ipsilateral limb of the brain lesion are observed in person who had had a CVA. The performance of the ipsilateral limb is determined by the clinical severity of the contralateral limb and by the adequacy of bi-hemispheral processing of information. The objective of the present study is to compare the motor performance of the ipsilateral hand during tasks implying different level of sensori-motor integration in patients with low clinical impairments. The results demonstrated that the pinch strengths between the thumb and the index finger of the ipsilateral limb are modulated and anticipated adequately in stroke persons who have a good motor recovery such as demonstrated by scores of five or more in the Chedoke-McMaster Stroke Assessment (arm and hand parts). The motor performance of the ipsilateral limb of stroke persons during the execution of a bilateral coordination task is comparable to the motor performance of the dominant limb of healthy subjects when the task is realized without interaction between upper limbs (two objects) and it is perturbed when it implies a coordinated and reciprocal action of upper limbs on the same object. Consequently, these stroke persons with a good motor recovery have a central problem of integration and processing of sensori-motor informations when a more complex task has to be realized. These results suggest that the clinicians should pay more attention during unilateral tasks and during tasks with bilateral coordination that require a higher level of sensori-motor integration.

La récupération optimale des amplitudes articulaires (AAs) et de la force musculaire est un objectif crucial de la réadaptation fonctionnelle intensive (RFI) à la suite d’une lésion médullaire (LM). Le but de la présente étude était de documenter les changements d’AAs des membres supérieurs durant la RFI chez des individus (n = 197) ayant subi une LM et d’établir le lien avec l’autonomie fonctionnelle. Les données (AA, force musculaire, spasticité, déficiences secondaires, autonomie fonctionnelle) ont été collectées à l’admission et au congé de la RFI. Des analyses descriptives, des tests d’association entre les changements d’AAs et des variables indépendantes (douleur, spasticité, déficiences secondaires, force) et des analyses multivariées ont été utilisées. Les individus ayant une paraplégie présentent peu de déficit d’AAs à l’épaule comparés à ceux ayant une tétraplégie. Parmi ces derniers, une majorité présente des AAs sous les valeurs de normalité en fin de RFI. Le groupe D, établi selon l’évaluation de l’American Spinal Injury Association (ASIA D) présente des pertes d’AAs plus importante qu’attendue. La douleur au niveau articulaire est un facteur influençant les changements d’AAs, particulièrement dans ce groupe. La force musculaire chez les personnes ayant une tétraplégie sévère (ASIA ABC) est plus faible que celle du groupe ayant une lésion moins sévère (ASIA D). Généralement, le gain de force corrèle avec le gain d’AA. La force musculaire, les AAs et le nombre de déficiences secondaires sont les principaux éléments influençant l’autonomie fonctionnelle. En conclusion, la perte d’AA est plus importante à l’articulation de l’épaule et, pour plusieurs individus, malgré un gain significatif, les AAs n’atteignent pas les valeurs de référence au congé de la RFI. La force musculaire et certaines déficiences secondaires sont des éléments à considérer pour expliquer les pertes d’AAs et d’autonomie fonctionnelle. Les études futures devront clarifier certains aspects dont l’atteinte de la rotation médiale qui semble montrer un patron différent de récupération en comparaison des autres mouvements de l’épaule. De plus, les études devront montrer si ces changements et résultats sont maintenus après le congé de la RFI. / Optimal recovery of range of motion (ROM) and strength are critical objectives of intensive rehabilitation following spinal cord injury (SCI). The aim of this study was to characterize the evolution of ROM and strength at the upper limb and analyze their relationship with functional independence during intensive rehabilitation. Data ROM, strength, spasticity, secondary impairments, functional independence) from 197 participants with SCI were collected at admission and discharge from intensive rehabilitation and were analyzed with descriptive statistics and multivariate analyses (regressions, ANOVA). Specific association analyses were used to determine the level of association between ROM, strength and independent variables such as pain, spasticity and secondary impairments. Lesser deficit in ROM was observed in participants with paraplegia compared to those with tetraplegia. The deficit in individuals with tetraplegia was larger to an extent that most of them did not reach normality in ROM at shoulder joint. Surprisingly, individuals with less severe injury according to the American Spinal Injury Association classification (ASIA D) showed larger deficit of ROM than expected. Joint pain was related to reduce ROM, particularly in participants with ASIA D lesion. Values of muscle strength in individuals with more severe tetraplegia (ASIA ABC) are lower than the ones observed in individuals with less severe injury (ASIA D). Overall, strength and ROM were correlated, except for medial rotation movement. ROM, strength, and secondary impairments are the major determinants of functional independence. In conclusion, shoulder joint was the most affected joint of the upper limb, and, despite of significant gains of ROM, abnormalities were greater than expected. Strength and some secondary impairment were related in loss of ROM and functional independence throughout rehabilitation. More study will be needed to understand the medial rotation movement at the shoulder that seems to evolve differently from other movements, and to determine whether or not changes observed during rehabilitation are maintained over time.