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京都大学 / 新制・課程博士 / 博士(理学) / 甲第23461号 / 理博第4755号 / 新制||理||1682(附属図書館) / 京都大学大学院理学研究科生物科学専攻 / (主査)教授 高田 昌彦, 准教授 宮地 重弘, 教授 古市 剛史 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DGAM

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O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) é caracterizado por caracterizado por desconcentração frequente, falta de controle dos impulsos e comportamento hiperativo iniciados na infância que permanecem por toda a vida em até 75% dos casos. O transtorno está associado a adversidades como baixo desempenho escolar e outras condições comórbidas, como ansiedade, depressão, uso de substâncias psicoativas e problemas de coordenação motora, principalmente destreza manual, este último mais descrito na infância e nomeado por Transtorno do Desenvolvimento da Coordenação (TDC). O presente estudo teve duas fases: na primeira, o objetivo foi investigar a frequência de autorrelato de sintomas de TDAH em uma população de estudantes de Odontologia; na segunda, confirmar clinicamente o diagnóstico desse transtorno, avaliar história pregressa de problemas motores (se presença do TDC) e aplicar instrumentos para avaliar destreza manual e aspectos psicossociais. Material e Métodos. Foram incluídos 408 estudantes do curso de Odontologia da Universidade de São Paulo na primeira fase, com idade média de 22± 4,06 anos, aplicada a escala de autorrelato para sintomas de TDAH - Adult Self Report Scale (ASRS). Na segunda fase, foram identificados os casos considerados risco para TDAH (47 estudantes) e convocados para entrevista clínica para avaliação de diagnóstico do TDAH e de Transtorno do Desenvolvimento da Coordenação, conforme critérios do Manual de Diagnóstico e Estatística para Transtornos Mentais quarta edição (DSM-IV). Foram incluídos 10 estudantes com TDAH e 19 controles sem TDAH, pareado para gênero e idade. Houve um estudante com diagnóstico de TDAH+TDC. Instrumentos aplicados: escala de Beck-ansiedade, Escala de Beck-depressão, ASSIST, WHOQOL-bref, teste Grooved- Pegboard e Pick-up teste de Moberg. Foi formado um grupo controle sem diagnóstico de TDAH, pareado para gênero e idade. A estimativa de TDAH foi baseada na proporção de casos com escores elevados na escala ASRS; para o estudo de caso controle, foram feitas análises utilizando testes não paramétricos (Qui-quadrado, Wilcox, Mann-Whitney). O nível de significância considerado foi <5%. Resultados: para a primeira fase, 11,5% tiveram altos escores para sintomas de TDAH; na segunda fase, diagnóstico clínico em 10 sujeitos e 19 controles. Houve um estudante com diagnóstico de TDAH+TDC. O grupo TDAH apresentou-se diferente do controle para as seguintes variáveis: autorrelato de sintomas depressivos (p=0,027), desempenho acadêmico (p= 0,009), destreza manual (p=0,017) e qualidade de vida no domínio físico (p=0,01). Conclusão: Universitários com TDAH apresentam mais adversidades em relação a seus pares não TDAH, como mais sintomas depressivos, mais prejuízo acadêmico e pior qualidade de vida, assim como pior destreza manual. / Attention Deficit Hyperactivity Disorder (ADHD) is characterized by difficulties in concentration, by hyperactivity and impulsive control, which remain throughout life by up to 75% of cases. The ADHD is associated with many adversities such as poor school performance and other comorbidities, including anxiety, depression, substance abuse, and motor coordination problems (predominantly manual dexterity). The latter is more common in childhood and is called Developmental Coordination Disorder (DCD). The present study consisted of two phases: the first phase investigated the frequency of self-reported ADHD symptoms in a population of college students; the second phase aimed to clinically confirm the diagnosis of ADHD and to evaluate the past history of motor coordination problems (when the presence of TDC). Material and Methods: 408 students of the School of Dentistry of the University of São Paulo were included in the first phase, with a mean age of 22 ± 4.06 years and the scale of self-reported ADHD symptoms was applied - Adult Self Report Scale (ASRS). In the second phase, the cases considered at risk for ADHD (47 students) were identified and called for a clinical interview for the diagnostic assessment of ADHD and Developmental Coordination Disorder (DCD). Ten students were clinically diagnosed with ADHD and 19 controls. Only one student was diagnosed with ADHD + DCD. In cases in which ADHD and DCD were confirmed, according to criteria of the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV), instruments were applied: Beck Scale-anxiety, depression-Beck scale, ASSIST, WHOQOL-BREF, Grooved-Pegboard test and Pick-up Moberg Test. A control group consisting of individuals without diagnosis of ADHD, matched for sex and age, was formed. Estimation of ADHD was based on the proportion of cases with high scores on the ASRS scale; for case-control analyses using nonparametric tests (chi-square, Wilcox, Mann-Whitney). The significance level was set at 5%. Results: In the first phase, including 408 students, 11.5% presented high scores for symptoms of ADHD. The group that received a clinical diagnosis of ADHD showed greater psychosocial impairment compared with the control group, as the worst quality of life in the physical domain (p = 0.01), more depressive symptoms (p = 0.027), greater impairment in academic performance (p = 0.009) and worst quality manual dexterity related to task performance (p = 0.017). Conclusion: College students with ADHD have more adversities in relation to their non-ADHD peers, as more depressive symptoms, poor school performance and poor quality of life and manual dexterity, which can be even more impactful because the Dentistry course requires great dexterity of its students.

O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) é caracterizado por caracterizado por desconcentração frequente, falta de controle dos impulsos e comportamento hiperativo iniciados na infância que permanecem por toda a vida em até 75% dos casos. O transtorno está associado a adversidades como baixo desempenho escolar e outras condições comórbidas, como ansiedade, depressão, uso de substâncias psicoativas e problemas de coordenação motora, principalmente destreza manual, este último mais descrito na infância e nomeado por Transtorno do Desenvolvimento da Coordenação (TDC). O presente estudo teve duas fases: na primeira, o objetivo foi investigar a frequência de autorrelato de sintomas de TDAH em uma população de estudantes de Odontologia; na segunda, confirmar clinicamente o diagnóstico desse transtorno, avaliar história pregressa de problemas motores (se presença do TDC) e aplicar instrumentos para avaliar destreza manual e aspectos psicossociais. Material e Métodos. Foram incluídos 408 estudantes do curso de Odontologia da Universidade de São Paulo na primeira fase, com idade média de 22± 4,06 anos, aplicada a escala de autorrelato para sintomas de TDAH - Adult Self Report Scale (ASRS). Na segunda fase, foram identificados os casos considerados risco para TDAH (47 estudantes) e convocados para entrevista clínica para avaliação de diagnóstico do TDAH e de Transtorno do Desenvolvimento da Coordenação, conforme critérios do Manual de Diagnóstico e Estatística para Transtornos Mentais quarta edição (DSM-IV). Foram incluídos 10 estudantes com TDAH e 19 controles sem TDAH, pareado para gênero e idade. Houve um estudante com diagnóstico de TDAH+TDC. Instrumentos aplicados: escala de Beck-ansiedade, Escala de Beck-depressão, ASSIST, WHOQOL-bref, teste Grooved- Pegboard e Pick-up teste de Moberg. Foi formado um grupo controle sem diagnóstico de TDAH, pareado para gênero e idade. A estimativa de TDAH foi baseada na proporção de casos com escores elevados na escala ASRS; para o estudo de caso controle, foram feitas análises utilizando testes não paramétricos (Qui-quadrado, Wilcox, Mann-Whitney). O nível de significância considerado foi <5%. Resultados: para a primeira fase, 11,5% tiveram altos escores para sintomas de TDAH; na segunda fase, diagnóstico clínico em 10 sujeitos e 19 controles. Houve um estudante com diagnóstico de TDAH+TDC. O grupo TDAH apresentou-se diferente do controle para as seguintes variáveis: autorrelato de sintomas depressivos (p=0,027), desempenho acadêmico (p= 0,009), destreza manual (p=0,017) e qualidade de vida no domínio físico (p=0,01). Conclusão: Universitários com TDAH apresentam mais adversidades em relação a seus pares não TDAH, como mais sintomas depressivos, mais prejuízo acadêmico e pior qualidade de vida, assim como pior destreza manual. / Attention Deficit Hyperactivity Disorder (ADHD) is characterized by difficulties in concentration, by hyperactivity and impulsive control, which remain throughout life by up to 75% of cases. The ADHD is associated with many adversities such as poor school performance and other comorbidities, including anxiety, depression, substance abuse, and motor coordination problems (predominantly manual dexterity). The latter is more common in childhood and is called Developmental Coordination Disorder (DCD). The present study consisted of two phases: the first phase investigated the frequency of self-reported ADHD symptoms in a population of college students; the second phase aimed to clinically confirm the diagnosis of ADHD and to evaluate the past history of motor coordination problems (when the presence of TDC). Material and Methods: 408 students of the School of Dentistry of the University of São Paulo were included in the first phase, with a mean age of 22 ± 4.06 years and the scale of self-reported ADHD symptoms was applied - Adult Self Report Scale (ASRS). In the second phase, the cases considered at risk for ADHD (47 students) were identified and called for a clinical interview for the diagnostic assessment of ADHD and Developmental Coordination Disorder (DCD). Ten students were clinically diagnosed with ADHD and 19 controls. Only one student was diagnosed with ADHD + DCD. In cases in which ADHD and DCD were confirmed, according to criteria of the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV), instruments were applied: Beck Scale-anxiety, depression-Beck scale, ASSIST, WHOQOL-BREF, Grooved-Pegboard test and Pick-up Moberg Test. A control group consisting of individuals without diagnosis of ADHD, matched for sex and age, was formed. Estimation of ADHD was based on the proportion of cases with high scores on the ASRS scale; for case-control analyses using nonparametric tests (chi-square, Wilcox, Mann-Whitney). The significance level was set at 5%. Results: In the first phase, including 408 students, 11.5% presented high scores for symptoms of ADHD. The group that received a clinical diagnosis of ADHD showed greater psychosocial impairment compared with the control group, as the worst quality of life in the physical domain (p = 0.01), more depressive symptoms (p = 0.027), greater impairment in academic performance (p = 0.009) and worst quality manual dexterity related to task performance (p = 0.017). Conclusion: College students with ADHD have more adversities in relation to their non-ADHD peers, as more depressive symptoms, poor school performance and poor quality of life and manual dexterity, which can be even more impactful because the Dentistry course requires great dexterity of its students.

Transferring a unimanual motor skill to the untrained hand, a phenomenon known as cross-limb transfer, was shown to deteriorate as a function of age. While transcranial direct current stimulation (tDCS) ipsilateral to the trained hand facilitated cross-limb transfer in older adults, little is known about the contribution of the contralateral hemisphere to cross-limb transfer. In the present study, we investigated whether tDCS facilitates cross-limb transfer in older adults when applied over the motor cortex (M1) contralateral to the trained hand. Furthermore, the study aimed at investigating short-term recovery of tDCS-associated cross-limb transfer. In a randomized, doubleblinded, sham-controlled setting, 30 older adults (67.0 4.6 years, 15 female) performed a short grooved-pegboard training using their left hand, while anodal (a-tDCS) or sham-tDCS (s-tDCS) was applied over right M1 for 20 min. Left (LHtrained) - and right-hand (RHuntrained) performance was tested before and after training and in three recovery measures 15, 30 and 45 min after training. LHtrained performance improved during both a-tDCS and s-tDCS and improvements persisted during recovery measures for at least 45 min. RHuntrained performance improved only following a-tDCS but not after s-tDCS and outlasted the stimulation period for at least 45 min. Together, these data indicate that tDCS over the M1 contralateral to the trained limb is capable of enhancing cross-limb transfer in older adults, thus showing that cross-limb transfer is mediated not only by increased bi-hemispheric activation.

La dextérité manuelle est au centre de notre interaction physique avec le monde. La sophistication des mouvements des doigts chez l’homme nécessite le contrôle de plusieurs composants clés comme la force, l’indépendance, le timing et le séquençage des mouvements des doigts. La dextérité est souvent affectée dans de nombreuses pathologies impactant l’indépendance et la vie quotidienne des patients. Le but global de cette thèse est d’améliorer la rééducation de la dextérité chez ces patients par une meilleure mesure et compréhension de la dextérité et de ses composants. Nous avons développé le Finger Force Manipulandum (FFM), un outil permettant de quantifier les principaux composants de la dextérité chez des sujets sains et des patients. Afin de valider cet appareil, nous avons testé la faisabilité de son utilisation chez des patients souffrant d’un important déficit de dextérité après un accident vasculaire cérébral. Le FFM permet, chez ces patients (N= 10 vs N= 10 sujets sains), de quantifier les différents composants de la dextérité et d’identifier des déficits dans chacun d’entre eux (exemple : les patients font trois fois plus d’erreur que les témoins pour le contrôle de force ; P=0,0002). Les mesures sont plus sensibles que certains tests cliniques comme l’ARAT : elles permettent de détecter des déficits de la dextérité même chez des patients atteignant le score maximum de l’ARAT. Le FFM permet également de créer un profil de dextérité affectée chez chaque patient permettant ainsi de détecter quel composant est significativement affecté et permet aussi de suivre la récupération. Dans une maladie affectant légèrement la dextérité, comme la schizophrénie, lorsque l’on compare les scores FFM des patients stabilisés (N= 35) avec ceux des témoins (N= 20) on constate que les patients ont une performance diminuée de façon significative dans chacun des quatre composants de la dextérité. Certaines des mesures du FFM corrèlent avec des échelles cliniques comme la PANSS (R=0,53, P=0,0019) mais aussi avec des échelles neuropsychologiques. Ces mesures FFM sont également assez sensibles pour détecter une évolution au cours du temps : certains composants restent stables après une remédiation cognitive alors que d’autres s’améliorent. En conclusion, le FFM est un nouvel outil qui permet de quantifier les différents composants de la dextérité. Il est utilisable même chez des patients avec un important déficit manuel et permet d’identifier des profils individuels de dextérité affectée. Il est également assez sensible pour détecter de faibles diminutions de performances motrices comme celles retrouvées chez des patients schizophrènes et pourrait permettre d’identifier certains marqueurs moteurs ayant trait au background neuro-développemental des patients schizophrènes (détection précoce) et à l’évolution de la maladie. / Manual dexterity is essential for our physical interaction with the world. The high degree of dexterity in humans requires sophisticated control of several key components such as the control of force, of independence, timing and sequencing of finger movements. Manual dexterity is affected in various pathologies, impacting activities of daily living and leading to loss of independence. The main purpose of this thesis is to improve rehabilitation of dexterity in these patients by a better behavioral quantification and a clearer understanding of manual dexterity and its components of control. We developed the Finger Force Manipulandum (FFM), a new tool allowing for the quantification of the main components of the dexterity in healthy subjects and in patients. To validate this device, we tested the feasibility of its use with stroke patients suffering from moderate-to-severe deficits of dexterity. In these patients, the FFM allowed for quantification of four components of dexterity and for identification of deficits in each of them (example: patients (N=10) made three times more error than controls (N=10) in force control; P=0.0002). These measures (components) are more sensitive than clinical tests, such as the ARAT: patients reaching the maximum ARAT score still showed deficits of dexterity with the FFM. Based on the four FFM scores, individual profiles of affected dexterity were calculated, highlighting the individual deficit of each patient. This allowed for quantitative longitudinal follow up during recovery. In a disease affecting dexterity mildly, such as schizophrenia, the FFM scores of stabilized patients (N = 35) indicated a significantly lower performance compared to control subjects (N = 20) in each of the four dexterity components. Some of the FFM measures correlated with clinical scales, such as the PANSS (R=0.53, P=0.0019), and also with some neuropsychological scales. These FFM measures also provide indicators for the evolution of dexterity over time: certain components remained stable after cognitive remediation, while others improved. In conclusion, the FFM is a new tool, which allows for quantification of manual dexterity (by measuring various underlying components). It is suitable for patients with moderate-to-sever manual deficits and allows for identification of individual profiles of affected dexterity. It also detects minor manual deficits in schizophrenic patients, and may allow for identification of potential behavioral markers related to the neurodevelopmental background of schizophrenic patients (early detection) and to the evolution of the disease.

Aim: The aim of this study is to assess benefits of therapy by Vojta method and by using the active videogame Nintendo Wii. The manual dexterity and gross motor function were evaluated. Methodology: The study was attended by 14 children aged 6 - 18 years. They were divided into two equal groups. The Vojta method was applied for the first group and exercising with Nintendo Wii for the second group. Each therapy took 30 days. After a 6 months break the two groups were changed. During those 6 months no targeted physiotherapy was done. The manual dexterity and gross motor functions were measured before and after the therapy and 8 weeks after finishing the therapy. The Box and Block test and the Nine Hole Peg test were used for assessment of manual dexterity and GMFM was used for testing of gross motor function. The children completed the PACES questionnaire after each of the interventions. Results: Statistics showed a significant change in the manual dexterity over the time when the Box and Block test was used. A difference between the two types of therapy has not been proven. Results of the Nine Hole Peg test were not statistically significant, neither in time nor when comparing the therapies. GMFM was not statistically significant either. The PACES did not show any difference between the therapies....

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-28T14:47:52Z No. of bitstreams: 1 elaineandrademoura.pdf: 2353135 bytes, checksum: 1a7548b8dc672e66f70878d9f5b2e57d (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-29T10:55:42Z (GMT) No. of bitstreams: 1 elaineandrademoura.pdf: 2353135 bytes, checksum: 1a7548b8dc672e66f70878d9f5b2e57d (MD5) / Made available in DSpace on 2016-01-29T10:55:42Z (GMT). No. of bitstreams: 1 elaineandrademoura.pdf: 2353135 bytes, checksum: 1a7548b8dc672e66f70878d9f5b2e57d (MD5) Previous issue date: 2014-02-20 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O envelhecimento é um processo complexo que envolve as dimensões física, psicológica e sociocultural do indivíduo. Uma compreensão mais aprofundada desse período da vida permite mudar a visão de decrepitude associada a esse processo de envelhecimento e adensar os princípios para garantir um envelhecimento saudável. A cada dia, vêm surgindo estudos com enfoque na visão positiva do envelhecimento, transmutando aquela visão estereotipada da velhice. Desta forma, esta pesquisa objetivou avaliar os aspectos motores, habilidade manual e mobilidade corporal, e os aspectos psicológicos, satisfação com a vida e percepção do envelhecimento, em idosos que frequentam o Centro de Convivência Dona Itália Franco e o Polo de Enriquecimento Cultural para a Terceira Idade. Como metodologia, optou-se por um estudo transversal, descritivo, correlacional e quantitativo. A seleção dos participantes foi feita por meio da amostragem aleatória simples, feita com base no cadastro inicial dos idosos que frequentam os locais. A fim de alcançar os objetivos traçados, foram aplicados 7 (sete) instrumentos: o questionário sociodemográfico, o Mini Exame do Estado Mental para avaliar a capacidade cognitiva, o índice de Barthel para avaliar a independência em atividades diárias; o Nine Hole Peg Test para avaliar a habilidade manual fina; o Timed up and go test para avaliar a mobilidade corporal; o Ìndice de Satisfação com a vida para a terceira idade, um questionário que avalia a satisfação com a vida e por fim, o Questionário de Percepção do Envelhecimento para avaliar como os idosos percebem esse período da vida. Para análise dos dados foi utilizado o programa Statistical Package for the Social Sciences (SPSS) versão 20.0, com nível de significância de 0,05 para todos os testes. Constatou-se por meio desse estudo que locais como o Centro de Convivência e o Polo de Enriquecimento Cultural da cidade de Juiz de Fora, MG, são locais propícios para promover um envelhecimento bem-sucedido. Diante disso, os idosos que frequentam tais estabelecimentos apresentam uma manutenção da capacidade funcional em idades mais avançadas, estão satisfeitos com a vida independente da idade, da classe econômica, da escolaridade e do estado civil, e percebem o processo de envelhecimento de uma forma positiva. / Ageing is a complex process involving the physical, psychological and sociocultural dimensions of the individual. A deeper understanding of this period of life lets one change the view of decrepitude associated with this ageing process and thicken the principles to ensure a healthy ageing. There are new studies focusing on the positive view of ageing coming every single day, transmuting the stereotypical view of old age. Thus, this study aims to evaluate the motor aspects, manual dexterity, body mobility, as well as psychological aspects, life satisfaction and the perception of ageing in the elderly who attend the Centro de Convivência Dona Itália Franco the Polo de Enriquecimento Cultural para a Terceira Idade. As regards methodology, a cross-sectional, descriptive, quantitative and qualitative study has been chosen. The selection of subjects was made through a simple random sampling taken based on the initial registration of the elderly who attend the aforementioned places. In order to achieve the objectives outlined, seven (7) tools were applied: sociodemographic questionnaire, the Mini Mental State Examination to assess the cognitive ability, the Barthel index to assess independence in daily activities, the Nine Hole Peg Test to assess the fine manual dexterity, the Timed up and go test to assess body mobility, the Life Satisfaction Index for Senior Citizens, a questionnaire which assesses satisfaction with life and, lastly, the Ageing Perception Questionnaire, to evaluate how the elderly perceive this period of life. For data analysis, the Statistical Package for the Social Sciences (SPSS) software, version 20.0, was used with a significance level of 0.05 for all tests. It was found through this study that places like the Centro de Convivência and Polo de Enriquecimento Cultural of Juiz de Fora, MG, are good places for the promotion of successful ageing. Due to the findings in this dissertation, the elderly who attend such establishments showed a maintenance of the functional capacity in older ages, are satisfied with life regardless of age, social class, education and marital status, and perceive the ageing process in a positive way.