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Os objetivos deste estudo foram investigar os significados das práticas do turismo por sujeitos portadores de esclerose múltipla (EM) em seu tempo de lazer, desvelando as reais condições desses portadores de EM, quanto à efetiva prática de lazer diante das possibilidades e limites desse sujeito. Nesse sentido, foi realizada uma revisão teórica e a dissertação foi dividida em capítulos que tratam da dialética do corpo na modernidade e o lazer, a realidade social dos sujeitos portadores de EM, os significados do lazer para sujeitos portadores de EM. Foi realizado um estudo preliminar exploratório ao tema e, a partir de uma amostra por tipicidade, o processo investigatório compreendeu movimentos reflexivos e críticos. As categorias de análise: lazer, turismo e qualidade de vida foram ressignificadas a partir do referencial proposto, reconstruindo a realidade vivenciada pelos sujeitos portadores de EM, por meio de estudo do comportamento manifesto em seu tempo de lazer. O estudo revelou que as práticas de lazer e de turismo significaram atividades prazerosas e condição de normalidade para ser e estar-no-mundo. / Submitted by Marcelo Teixeira (mvteixeira@ucs.br) on 2014-05-05T17:56:24Z No. of bitstreams: 1 DISSERTACAO HELOISA SANTINI.pdf: 775618 bytes, checksum: 66f216dbbeffa18cab1337d76c25206a (MD5) / Made available in DSpace on 2014-05-05T17:56:24Z (GMT). No. of bitstreams: 1 DISSERTACAO HELOISA SANTINI.pdf: 775618 bytes, checksum: 66f216dbbeffa18cab1337d76c25206a (MD5) / The purposes of this paper were to investigate the meanings of practices of tourism for people with Multiple Sclerosis (MS) in their leisure time, revealing the real conditions of them as in the effective practice of leisure facing the possibilities and limits of the subject. That way, it was done a theory review and the essay was divided in chapters that deal with the dialectic of the body in the modern times and the leisure itself, the social reality of the MS people, and the meanings of leisure for those people. It was done a preliminary exploratory study of the theme and, from a sample by type; the investigatory process has enclosed reflexive and critical movements. The categories of analyzes: leisure, tourism and quality were remeant from the proposed referential, rebuilding the living reality of the people with MS by a study of behavior in their time of leisure. The paper has revealed that practices of leisure and tourism have meant pleasure activities and conditions of normality to be and to be in the world.

No description available.

Background: Pain is frequently reported by people with multiple sclerosis (MS). It has been associated with decreased quality of life, psychiatric morbidity, interference with day to day activities, and frequent healthcare attendance. It has been reported by people with multiple sclerosis to be one of their most important symptoms, and available treatments are limited in their effectiveness. Despite this, our understanding of the epidemiology and mechanisms of pain in people with MS are limited. Our understanding of the interactions of central nervous system mechanisms and pain states overall is growing. However, the application of this knowledge to MS is incomplete. Previous studies have shown that the descending pain modulatory system (DPMS) is an endogenous network of cortical and subcortical brain structures which act to limit, or accentuate, an individual’s perception of pain, via descending brainstem pathways. Associated clinical measures include depression, anxiety, and cognitive flexibility. Our understanding of the function or dysfunction of this system in MS is limited. We do not know if the MS disease process may adversely affect the structure or function of the DPMS. Hypothesis: In people with neuropathic limb pain in relapsing remitting MS (RRMS), compared to people with RRMS who do not have pain, there will be disruption of the endogenous descending pain modulatory system. This will manifest as impaired descending inhibition of pain. Aims and Methods Establishing the background using systematic reviews: The first aim of this thesis was to establish the prevalence, natural history and associations of pain (and pain syndromes) occurring in people with MS. The second aim was to explore existing knowledge of how the MS disease process may contribute to pain states, using a systematic review of neuroimaging studies. Prospective clinical study: A case-control study of 47 people with RRMS was then carried out. 31 of these had neuropathic pain in the limbs, and 16 did not have pain. Using targeted assessments, function of the descending pain modulatory system was assessed in the following ways: First: Detailed clinical, behavioural and neuropsychological assessment, focussing on cognitive, behavioural and affective features known to be closely related to the DPMS. Second: MRI imaging of brain structure, focussing on the volume and location of MS lesions, as well as the volume of key grey-matter structures involved in the DPMS. Third: Resting state functional MRI imaging of the brain, focussing on functional connectivity between the rostral anterior cingulate cortex and two other key DPMS structures (dorsolateral prefrontal cortex, and periaqueductal gray). Results: Systematic reviews: Meta-analysis of existing prospective studies confirmed that pain is very common in MS, affecting about 63% of people with MS on average (95%CI between 55 and 70%). Many different types of pain contribute to this overall estimate. No significant associations with disease course or stage emerged. Several neuroimaging studies have assessed people with MS-associated pain using MRI. These studies were often small, and with associated methodological issues. It is likely that location of MS lesions is implicated in aetiology of pain syndromes in some cases, though our overall knowledge is limited. Prospective study: In a prospective study, people with and without pain were matched for age and gender. Furthermore, groups were balanced for a range of other variables. The pain group more frequently received gabapentinoid medications. The presence of pain was significantly associated with increased scores for depression, fatigue and catastrophising, as well as with specific impairments at neuropsychological assessment, including cognitive flexibility. Many of these impairments are directly relevant to existing models of the DPMS. Overall volume of MS lesions was not different in people with pain, though lesions were more likely to occur in the brainstem. Some alterations of grey-matter volumes in people with pain which mirrored studies of pain disorders outside MS were found, but these did not involve structures key to the DPMS. Affected structures included trigeminothalamic nucleus (relative volume increase in pain group), posterior cingulate cortex and parahippocampal gyrus (volume decrease in pain group). Functional connectivity of the rostral anterior cingulate cortex to the periaqueductal grey matter, a key structure in the descending modulation of pain, was stronger in the group without pain. Conversely, functional connectivity to the dorsolateral prefrontal cortex, repeatedly implicated in the DPMS and thought to be involved in cognitive evaluation and flexibility, was stronger in the pain group. MS lesion volume appeared to account for some of this difference in a multivariate analysis. Limitations: Key limitations of this work include cross-sectional design, small sample size, and number of statistical comparisons carried out. Conclusions: Systematic reviews examined the prevalence, natural history and associations of pain in MS, as well as examining existing neuroimaging studies which investigated how the MS disease process could contribute to pain states. A prospective study found evidence of both emotional/affective and cognitive dysfunctions relevant to the hypothesis of dysfunction in the DPMS. Higher likelihood of MS lesions in the brainstem could be relevant to DPMS function. Separately, there were structural grey-matter volume alterations reflecting those found in many pain studies outside MS. Importantly, however, these did not affect key DPMS structures. Resting state functional MRI however demonstrated altered connectivity of core DPMS structures, which may be partly mediated by MS lesion volume. Functional connectivity findings could be consistent with the hypothesis of impaired descending pain inhibition, in people with relapsing remitting MS affected by neuropathic limb pain.

Introdução: Esclerose múltipla (EM) é uma doença de caráter geralmente progressivo na qual a inflamação e a desmineralização da substância branca do sistema nervoso central resultam em vários sinais e sintomas neurológicos. É considerada uma doença de incapacidade, sendo que os pacientes podem apresentar distúrbios de marcha e sintomas motores que afetam a Qualidade de Vida (QV). Os imunomoduladores (betainterferons (ß-INF) 1A, 1B e acetato de glatirâmer (AG)) reduzem a frequência e a gravidade dos surtos e se espera que proporcione uma melhora sintomática, diminuição da frequência e gravidade das recorrências, consequentemente o número de internações. Estes medicamentos, dentre outros, são fornecidos pelo Ministério da Saúde (Protocolos Clínicos e Diretrizes Terapêuticas – EM). É uma doença de alta relevância, no Brasil ainda existem poucos trabalhos de avaliação da QV desta patologia e o MSQOL-54 é um questionário específico bastante utilizado pela comunidade científica internacional. Objetivos: O objetivo principal foi a tradução e validação do MSQOL-54 para o português do Brasil e o secundário de avaliar QV na coorte gaúcha de EM. Métodos: Os pacientes com em tratamento foram recrutados de uma amostra de conveniência de pacientes atendidos no Hospital das Clínicas de Porto Alegre e da Secretaria do Estado (SES-RS). Para coleta de dados foram utilizados: Formulário Sociodemográfico, MSQOL-54-Português, WHOQOL-Bref, Escala de Depressão de Beck e a Escala Expandida do Estado de Incapacidade (EDSS). Exceto o EDSS que foi aplicado por um neurologista, os demais questionários foram aplicados por pesquisadores treinados. Para análise de reprodutibilidade o MSQOL-54-Português foi aplicado em dois momentos distintos (teste-reteste). Resultados: Os 100 pacientes que participaram do estudo levaram em média 19 minutos para responder o MSQOL-54. O coeficiente alfa de Cronbach dos Componentes Saúde Física (CSF) e Mental (CSM) foi 0,85 e 0,80; respectivamente e entre as 12 escalas a variação foi de 0,63-0,94. O BDI teve boa correlação com CSF e CSM (MSQOL-54 Português), moderada (r=-0,61) e forte (r=-0,78), respectivamente. O WHOQOL-Bref apresentou correlação moderada com o CSF em quase todos seus domínios, forte com o CSM e com os demais, (r=-0,252), na função cognitiva (r=0,214) e no LDF (r=-0,220). O EDSS teve uma correlação moderada no domínio saúde física (r=-0,545), fraca no CSF fraca com a LDM (=-0,240) e com a função cognitiva (=-0,198). O resultado da comparação entre as médias dos escores das escalas do MSQOL-54 dos indivíduos em tratamento com ß-INF ou AG, somente o domínio função social apresentou diferença significativa, pacientes que utilizaram o ß-INF apresentaram escore médio mais elevado em relação ao AG. Conclusão: Os resultados permitem considerar satisfatória a adaptação do MSQOL-54-Português, tendo sido eficaz a avaliação da QV relacionada à saúde dos pacientes com EM. Em comparação com o artigo original em inglês a validação do MSQOL-54 na versão brasileira pode ser aceita. / Background: Multiple sclerosis (MS) is a disease of progressive character generally in which the inflammation and the demineralization of the white matter from the central nervous system result in several signals and neurological symptoms. It is considered as an incapacitating disease, in which patients may present motion disorders and motor symptoms that affect the Quality of Life (QL). The immunomodulatory drugs (interferons beta (ß-INF) 1A, 1B and glatiramer acetate (GA)) reduce the frequency and the severity of the surges and it is expected that they provide a symptomatic improvement, decreasing frequency and severity the recurrences, and consequently the number of hospitalizations. It is a disease of high relevance, in Brazil there are still few evaluation studies on the QL of this pathology and the MSQOL-54 is a specific questionnaire much used by international scientific community. Objectives: The main objective is to evaluate QL in the cohort of MS from Rio Grande do Sul region. 1) Performing the cultural adaptation of MSQOL-54 translated for Portuguese and validating it. 2) Evaluating the outcome of QL under the different alternatives of MS treatment. Methods: The patients under treatment were recruited from a convenience sample of patients attended at Hospital das Clínicas de Porto Alegre (HCPA) and from the State’ Secretariat. For the data collection, it was used: a sociodemographical form, Portuguese MSQOL-54 questionnaires, WHOQOL-Bref, Beck’s Depression Inventory and the Expanded Disability Status Scale (EDSS). Except to the EDSS, which was applied by a neurologist, the other forms were applied by trained researchers. For the reproducibility analysis, the MSQOL-54 was applied in two distinct moments. Results: The 100 patients who participated in the study took an average of 19 minutes to answer the MSQOL-54. Cronbach’s alpha coefficients of the components “physical health” (PHC) and “mental health” (MHC) were of 0.85 and 0.80 respectively and among the 12 scales the variation was from 0.63 up to 0.94. BDI had good correlation with PHC and MHC (MSQOL-54 Portuguese), moderate (r=-0.61) and strong (r=-0.78) respectively. WHOQOL-Bref presented moderate correlation with PHC in almost all domains, a strong one with MHC and a moderate one with the others. EDSS had a moderate correlation in physical health domain (r=-0.545), weak in PHC (r=-0.252), in the cognitive function (r= 0.214) and in PPL (r=-0.220). In diagnosis time the correlation was weak with LDM (=-0.240) and with the cognitive function (=-0.198). Considering that in June 2012 there were 947 patients registered in the States Secretariat who received these drugs’ there direct monthly cost with MS drugs US$ 1,075,016.70. Not considering deaths or new cases, the annual cost was US$ 12,900,200.00. Conclusion: The results indicate that the adaptation of MSQOL-54 Portuguese is satisfactory, being effective the quality of life evaluation related to the health of patients with MS. In comparison with the original essay in English, the validity of MSQOL-54 in Brazilian version can be accepted.

Title: Effect of yoga on postural stability in patients with multiple sclerosis Objectives: The aim of this theses is to determine the effect of yoga practice on postural stability and potential influence on stability during gait in patients with multiple sclerosis. Secondary aim of the theses is to evaluate the effect of pranayama, asana and relaxation practice on fatigue and anxiety in these patients. Methods: There were 8 patients with clinically diagnosed multiple sclerosis and EDSS ≤ 5 without any previous experience with yoga in the research. Patients participated in 3-month yoga program, which contained 90 minutes guided classes once a week. Each class consists of pranayama, asana sequence and relaxation. In addition patients also practice at home twice a week at least for 30 minutes. The following evaluations were performed at study entry and after 3 months of yoga practice. Postural stability was evaluated using computerized dynamic posturography Smart EquiTest Neurocom and its test protocols: Adaptation Test (ADT), Sensory Organisation Test (SOT), Motor Control Test (MCT), Limits Of Stability (LOS) and Unilateral Stance (US). Subjective perception of stability was evaluated using standardized questionnaires Falle Efficacy Scale International (FES-I) and Activities specific Balance...

Title: The effect of rhythmic auditory stimulation on gait in patients with Multiple Sclerosis Objectives: We aimed to evaluate the effect of rhythmic auditory stimulation on gait in patients with multiple sclerosis using GAITRite and Timed 25-Foot Walk test (T25FW). Furthermore, we investigated the effect of rhythmic auditory stimulation on the patients' subjective perception of their gait using the standardised MSWS-12 questionnaire. Methods: Twenty-eight individuals were recruited for the study. The intervention group comprised 14 patients (2 men, 12 women, average age - 34 years) with the diagnosis of multiple sclerosis of ≤ 6.0 on Kurtzke Expanded Disability Status Scale. The control group comprised 14 healthy individuals (2 men, 12 women, average age - 36 yrs). All recruited individuals must have been older than 18 years old. The intervention group walked for 20 minutes a day for 6 weeks while listening to rhythmic music with cadence set 15% higher than the cadence of their gait. The control group had no intervention. Individual gait parameters in both groups were measured before and after the 6 weeks using the GAITRite device. The following parameters were analysed: step duration, step length, step velocity, cadence, length of double support, length of single support. Walking speed was...

La sclérose en plaques est une maladie inflammatoire et démyélinisante chronique du système nerveux central présentant une expression clinique très variable d'un patient à l'autre. Face à cette hétérogénéité, l'identification de biomarqueurs issus de la neuro-imagerie capables de refléter les dommages responsables des déficits cognitifs et moteurs retrouvés chez ces patients est cruciale pour l'évaluation de l'efficacité de nouvelles thérapies. Lors de ce travail de thèse, nous avons étudié et mis en avant l'atteinte morphologique (changements de volume et de forme) du thalamus, structure cérébrale centrale, au travers de populations représentant l'ensemble des formes cliniques de la maladie. Nous avons ensuite évalué l'effet d'un traitement lors d'une analyse volumétrique longitudinale menée sur 12 mois. La répétabilité des résultats concernant la mesure du volume thalamique atteste alors de la qualité de la méthode utilisée. / Multiple sclerosis is a chronic inflammatory and demyelinating disease of the central nervous system having a highly variable clinical expression from patient to another. Given this heterogeneity, the identification of neuroimaging biomarkers able to reflect damages responsible for cognitive and motor deficits found in these patients is crucial for evaluating the efficacy of new therapies. In this thesis, we studied and highlighted the morphological damages (changes in volume and shape) of the thalamus , a central brain structure, through populations representing all clinical forms of the disease. We then evaluated the effect of treatment in a longitudinal volumetric analysis conducted over 12 months. Repeatability of thalamic volume results attests the quality of the method used.

Basic science and early clinical trial evidence suggest the safe diuretic drug amiloride, may exert a neuroprotective effect in multiple sclerosis (MS) through blockade of the acid sensing ion channel. Neuroprotective treatments are a key unmet need in multiple sclerosis. Optic neuritis (ON) is a discrete CNS inflammatory event leading to neuro-axonal injury in the optic nerve and retina. The optic nerve is part of the visual system, one of the most functionally and structurally eloquent systems in the central nervous system, which affords a number of unique modalities to assess neurodegeneration and neuroprotection. The visual system can be classified into two parts, the anterior and posterior visual systems, which are defined by the lateral geniculate nucleus, where the two components synapse. The extent of neurodegeneration following ON in the anterior visual system can be imaged in vivo through scanning laser polarimetry (GDx) and optical coherence tomography (OCT). The posterior visual system can be imaged by quantitative and functional magnetic resonance imaging (MRI) of the brain, giving insights into white matter structural integrity and cortical plasticity over time. Combining these modalities in a longitudinal study, allows assessment of the impact of neurodegeneration in the anterior visual system on neurodegeneration downstream in the posterior visual system and on changes in functional connectivity over time in the visual cortex. Furthermore, in the clinical trial setting the neuroprotective effect of any intervention both on direct anterior neurodegeneration and downstream processes can be assessed. The functional relevance of changes in all of these biomarkers can be tested through a number of visual measures, including low contrast visual acuity. In MS, the contribution of transsynaptic neurodegeneration to the global neuronal loss experienced by patients is an area of incomplete understanding. In addition, the role of the visual cortex, through neuroplasticity, in aiding visual recovery from optic neuritis, is unclear. To address these issues, this thesis reports the results of the first clinical trial of amiloride in ON, and shows that despite the pre- and early clinical evidence of neuroprotection of amiloride, no neuroprotective benefit was found. It goes on to explore reasons for this lack of effect including the finding of early retinal neurodegeneration in ON, and the need for early recruitment windows in the future. From there, it makes a detailed assessment of the longitudinal changes in retinal OCT for 12 months following ON, including a novel finding of the temporal evolution of inner nuclear layer swelling, previously reported only cross-sectionally. Next, for the first time macular retinal neurodegeneration is shown to influence diffusion tensor MRI derived measures of white matter integrity in the optic radiations, indicating transsynaptic neurodegeneration. Finally, longitudinal changes in resting state functional connectivity following ON are found in the visual system for the first time. The interaction between this cortical functional, retinal neurodegeneration and visual recovery is probed.