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Os marcadores de estresse músculo-esqueletal (MSMs), assim denominados, surgem pela primeira vez em 1995 no trabalho pioneiro de Hawkey e Merbs. De lá pra cá, diversos estudos se prestaram a aprimorar o método desenvolvido pelos pesquisadores e, ainda, associar de maneira mais concreta os graus de desenvolvimento de enteses a atividades desenvolvidas ao longo da vida de um indivíduo. Sob tais circunstâncias, buscamos neste trabalho a verificação da implementação de uma metodologia de análise revisada, testada e aprimorada dos marcadores de estresse músculo-esqueletal e a possibilidade de correlação entre os graus de desenvolvimento das enteses estudadas com as possíveis atividades desenvolvidas pelos indivíduos analisados, provenientes do sambaqui costeiro catarinense Jabuticabeira II (JAB-II). A escolha pela análise dos remanescentes ósseos deste sítio decorreu da vasta informação disponível em relação aos mesmos e ao sítio em si, provindos de outros trabalhos desenvolvidos previamente. Assim, estudos de paleopatologia e arqueologia possibilitaram melhores interpretações dos resultados obtidos pelas análises de MSMs. Neste trabalho procuramos adaptar a metodologia desenvolvida por Mariotti (2004,2007) para amostras antigas (mais de 2000 anos atrás) e de baixa conservação. Além disso, realizamos inferências sobre as atividades desenvolvidas pelos indivíduos sepultados em JAB-II, a divisão de tais atividades baseada em sexo e faixa etária, a avaliação dos graus de entesopatias (lesões na região entesal que vão além do desenvolvimento saudável de uma entese) e sua frequência na população estudada, a correlação do grau de desenvolvimento de entese com outro marcador muito comum em estudos de paleopatologia, a osteoartrose e, por fim, estabelecer, ainda que de forma tímida, o perfil físico típico do indivíduo de JAB-II, baseado na avaliação de todas as enteses disponíveis para estudo (1067 enteses disponíveis entre homens e mulheres adultos). A metodologia de estudo se mostrou eficaz, feitas às devidas adaptações metodológicas, com aprovação da proponente do método original. O erro intra-observacional, valor de erro de concordância calculado entre duas análises para o mesmo conjunto de enteses, com intervalo de tempo longo (3 meses), pelo mesmo avaliador, ficou dentro dos padrões aceitáveis pela comunidade científica (20%). Verificou-se, ainda, grande prevalência de alta robustez para a totalidade de enteses avaliadas. Quando analisados os complexos funcionais (conjunto de músculos e articulações envolvidas na realização de um movimento) verificou-se também alta prevalência de robustez elevada, com destaque para os complexos dos membros inferiores, antes tidos como pouco requisitados devido à baixa prevalência de osteoartrose nos mesmos. A avaliação de complexos funcionais é mais efetiva para a correlação dos graus de robustez com atividades realizadas no dia-a-dia já que várias destas envolvem a ação de mais de um músculo para a sua realização. Homens e mulheres apresentaram diferenças estatisticamente significantes com relação ao desenvolvimento de suas enteses, sendo os homens mais robustos que as mulheres. O mesmo verificou-se em relação às faixas etárias, sendo os indivíduos mais velhos mais robustos. Com relação às entesopatias, não verificamos diferenças na prevalência de entesofitóses tanto quanto a sexo quanto a faixas etárias. Com relação às lesões líticas (outra entesopatia analisada) verificaram-se diferenças estatisticamente significantes entre os sexos, com maior prevalência de tal marcador na parcela masculina. Já em relação às faixas etárias, não se verificaram diferenças estatisticamente relevantes. Por fim, por ser um traço esqueletal associado à atividade física, procuramos relacionar as osteoartroses previamente estudadas na amostra com os graus de desenvolvimento de entese avaliados neste trabalho. Não foram encontradas correlações de qualquer natureza entre os dois marcadores mas, devemos chamar atenção ao elevado número de enteses nas quais se verificaram alta robustez com baixo nível de osteoartrose. Tal observação poderia indicar possíveis relações de proteção da articulação devido à atividade física intensa, inferida indiretamente pelo grau de desenvolvimento da entese. Podemos assim supor que o indivíduo sepultado em JAB-II, independentemente de sexo e idade, seria um indivíduo robusto, de musculatura avantajada, compatível com o grau de atividade física desempenhada possivelmente em seu dia a dia e com seus possíveis hábitos alimentares / The so called Musculo-Skeletal Stress markers (MSM) enriched the wealth of possibilities to infer past life styles since 1995 with the Hawkey and Merbs work on Inuit populations. Since then, many studies tried to improve the method developed by these two researchers and associate the development of the entheses to certain physical activities . Under these circumstances, in this work we tested, modified and adapted this method to analyze MSM, and the possibility to correlate the degrees of development of the entheses with the possible activities performed by the individuals of individuals excavated from the costal Shellmound of Santa Catarina (BR) called Jabuticabeira II (JAB-II). We choose to analyze the osteological collection from this site due to extensive previous information available on its burials and on the site itself, because palaeopathology and archaeology studies render better interpretations of the results obtained by the MSM analyses. In this work, we adapt the methodology developed by Mariotti (2004,2007) to ancient samples (more than 2000 years old), with low state of preservation. We also used MSM to infer about the daily activities performed by the people buried at JAB-II, the division of labour based on sex and age, the evaluation of the severity of enthesopaties (pathological lesions on the enthesis) and it´s frequency in the population studied, the correlation between the enthesis´ severity and osteoarthrosis, and, finally, establish, even if in a very cautious way, the typical body type profile of the JAB-II population, based on the evaluation of the 1067 entheses available for analysis. The method adopted was effective as long as adapted to our sample, with the acceptance of the method developer (Mariotti). The intra-observer error, concordance error value between two analyses, three months apart, of the same set of enthesis, performed by the same observer is acceptable by the scientific community (20%). Were observed a high prevalence of increased robusticiy for all entheses evaluated individually and grouped into functional complexes (set of muscles and joints involved in the performance of a given movement). However, contrary to earlier interpretations based on osteoarthritis, the lower limbs must have been more requested than the upper ones. The evaluation of functional complexes is more effective for the correlation between robusticity and daily activities, given the requirement of more than one muscleusually used to perform one single movement. We found statistically significant differences between the male and female samples for the development of the entheses, with the male portion presenting more entheses with high robusticity than females. The same was observed within age classes, where older adults present higher enthesis robusticiy. We did not find significant statistical differences in the prevalence of enthesophytic formations between sexes and age classes. For the osteolytic formations we found significant statistical differences between the sexes, with higher prevalence among males, whereas no differences were observed between the age classes. Finally, for being an skeletal marker associated to physical activity, we tried to correlate osteoarthrosis (previously studied in this sample) with the developmental degrees of the entheses. No correlations of any nature were found between the two markers. Nevertheless,the elevated number of entheses with high robusticity and low levels of osteoarthrosis suggest that frequent and/or intense physical activity may protect the joints from osteoarthritis

Os marcadores de estresse músculo-esqueletal (MSMs), assim denominados, surgem pela primeira vez em 1995 no trabalho pioneiro de Hawkey e Merbs. De lá pra cá, diversos estudos se prestaram a aprimorar o método desenvolvido pelos pesquisadores e, ainda, associar de maneira mais concreta os graus de desenvolvimento de enteses a atividades desenvolvidas ao longo da vida de um indivíduo. Sob tais circunstâncias, buscamos neste trabalho a verificação da implementação de uma metodologia de análise revisada, testada e aprimorada dos marcadores de estresse músculo-esqueletal e a possibilidade de correlação entre os graus de desenvolvimento das enteses estudadas com as possíveis atividades desenvolvidas pelos indivíduos analisados, provenientes do sambaqui costeiro catarinense Jabuticabeira II (JAB-II). A escolha pela análise dos remanescentes ósseos deste sítio decorreu da vasta informação disponível em relação aos mesmos e ao sítio em si, provindos de outros trabalhos desenvolvidos previamente. Assim, estudos de paleopatologia e arqueologia possibilitaram melhores interpretações dos resultados obtidos pelas análises de MSMs. Neste trabalho procuramos adaptar a metodologia desenvolvida por Mariotti (2004,2007) para amostras antigas (mais de 2000 anos atrás) e de baixa conservação. Além disso, realizamos inferências sobre as atividades desenvolvidas pelos indivíduos sepultados em JAB-II, a divisão de tais atividades baseada em sexo e faixa etária, a avaliação dos graus de entesopatias (lesões na região entesal que vão além do desenvolvimento saudável de uma entese) e sua frequência na população estudada, a correlação do grau de desenvolvimento de entese com outro marcador muito comum em estudos de paleopatologia, a osteoartrose e, por fim, estabelecer, ainda que de forma tímida, o perfil físico típico do indivíduo de JAB-II, baseado na avaliação de todas as enteses disponíveis para estudo (1067 enteses disponíveis entre homens e mulheres adultos). A metodologia de estudo se mostrou eficaz, feitas às devidas adaptações metodológicas, com aprovação da proponente do método original. O erro intra-observacional, valor de erro de concordância calculado entre duas análises para o mesmo conjunto de enteses, com intervalo de tempo longo (3 meses), pelo mesmo avaliador, ficou dentro dos padrões aceitáveis pela comunidade científica (20%). Verificou-se, ainda, grande prevalência de alta robustez para a totalidade de enteses avaliadas. Quando analisados os complexos funcionais (conjunto de músculos e articulações envolvidas na realização de um movimento) verificou-se também alta prevalência de robustez elevada, com destaque para os complexos dos membros inferiores, antes tidos como pouco requisitados devido à baixa prevalência de osteoartrose nos mesmos. A avaliação de complexos funcionais é mais efetiva para a correlação dos graus de robustez com atividades realizadas no dia-a-dia já que várias destas envolvem a ação de mais de um músculo para a sua realização. Homens e mulheres apresentaram diferenças estatisticamente significantes com relação ao desenvolvimento de suas enteses, sendo os homens mais robustos que as mulheres. O mesmo verificou-se em relação às faixas etárias, sendo os indivíduos mais velhos mais robustos. Com relação às entesopatias, não verificamos diferenças na prevalência de entesofitóses tanto quanto a sexo quanto a faixas etárias. Com relação às lesões líticas (outra entesopatia analisada) verificaram-se diferenças estatisticamente significantes entre os sexos, com maior prevalência de tal marcador na parcela masculina. Já em relação às faixas etárias, não se verificaram diferenças estatisticamente relevantes. Por fim, por ser um traço esqueletal associado à atividade física, procuramos relacionar as osteoartroses previamente estudadas na amostra com os graus de desenvolvimento de entese avaliados neste trabalho. Não foram encontradas correlações de qualquer natureza entre os dois marcadores mas, devemos chamar atenção ao elevado número de enteses nas quais se verificaram alta robustez com baixo nível de osteoartrose. Tal observação poderia indicar possíveis relações de proteção da articulação devido à atividade física intensa, inferida indiretamente pelo grau de desenvolvimento da entese. Podemos assim supor que o indivíduo sepultado em JAB-II, independentemente de sexo e idade, seria um indivíduo robusto, de musculatura avantajada, compatível com o grau de atividade física desempenhada possivelmente em seu dia a dia e com seus possíveis hábitos alimentares / The so called Musculo-Skeletal Stress markers (MSM) enriched the wealth of possibilities to infer past life styles since 1995 with the Hawkey and Merbs work on Inuit populations. Since then, many studies tried to improve the method developed by these two researchers and associate the development of the entheses to certain physical activities . Under these circumstances, in this work we tested, modified and adapted this method to analyze MSM, and the possibility to correlate the degrees of development of the entheses with the possible activities performed by the individuals of individuals excavated from the costal Shellmound of Santa Catarina (BR) called Jabuticabeira II (JAB-II). We choose to analyze the osteological collection from this site due to extensive previous information available on its burials and on the site itself, because palaeopathology and archaeology studies render better interpretations of the results obtained by the MSM analyses. In this work, we adapt the methodology developed by Mariotti (2004,2007) to ancient samples (more than 2000 years old), with low state of preservation. We also used MSM to infer about the daily activities performed by the people buried at JAB-II, the division of labour based on sex and age, the evaluation of the severity of enthesopaties (pathological lesions on the enthesis) and it´s frequency in the population studied, the correlation between the enthesis´ severity and osteoarthrosis, and, finally, establish, even if in a very cautious way, the typical body type profile of the JAB-II population, based on the evaluation of the 1067 entheses available for analysis. The method adopted was effective as long as adapted to our sample, with the acceptance of the method developer (Mariotti). The intra-observer error, concordance error value between two analyses, three months apart, of the same set of enthesis, performed by the same observer is acceptable by the scientific community (20%). Were observed a high prevalence of increased robusticiy for all entheses evaluated individually and grouped into functional complexes (set of muscles and joints involved in the performance of a given movement). However, contrary to earlier interpretations based on osteoarthritis, the lower limbs must have been more requested than the upper ones. The evaluation of functional complexes is more effective for the correlation between robusticity and daily activities, given the requirement of more than one muscleusually used to perform one single movement. We found statistically significant differences between the male and female samples for the development of the entheses, with the male portion presenting more entheses with high robusticity than females. The same was observed within age classes, where older adults present higher enthesis robusticiy. We did not find significant statistical differences in the prevalence of enthesophytic formations between sexes and age classes. For the osteolytic formations we found significant statistical differences between the sexes, with higher prevalence among males, whereas no differences were observed between the age classes. Finally, for being an skeletal marker associated to physical activity, we tried to correlate osteoarthrosis (previously studied in this sample) with the developmental degrees of the entheses. No correlations of any nature were found between the two markers. Nevertheless,the elevated number of entheses with high robusticity and low levels of osteoarthrosis suggest that frequent and/or intense physical activity may protect the joints from osteoarthritis

Ces pages font un état des lieux des travaux réalisés au sein du département de médecine générale de 2004 à 2011 sur l'hypovitaminose D, sa fréquence, ses facteurs de risques, son lien avec les douleurs musculo-squelettiques diffuses et chroniques chez les adultes jeunes. De ces travaux et de la revue de la litéérature, il ressort quelques notions importantes et méconnues. Les personnes qui cnsultent un médecin généraliste ont des taux sérique de vitamine D beaucoup plus bas que les taux trouvés dans les groupes de volontaires sains recrutés pour les grandes études comme Suvimax ou l'enquête nationale nutrition santé (ENNS). Les taux retrouvés dans nos travaux sont identiques à ceux trouvés dans les populations émigrées des pays développés et dans les populations des pays où le soleil est évité, mais nos populations, elles, sont ordinaires hommes comme femmes.Les facteurs de risques de l'hypovitaminose sont retouvés dasn nos populations : les vêtements couvrants, le phototype, l'obésité, pas d'exposition solaire, pas de sport en extérieur, pas de vacances au soleil, la CMU marqueur de précarité. Une des conséquences sont des douleurs musculaires et osseuses, chronqiues, diffuse avec une moindre qualité de vie physique. Le traitement des déficits améliore les patients douloureux que nous avons trouvé très carencés. Ces patient consomment beaucoup de soisns et leur prise en charge pourrait réduire d'au moins 50 % leur consommation de soins. Il y a urgence à prendre en considération ce p^roblème de santé publique car 100% des consultants adultés âgés entre 18 et 50 ans, homme et femme, douloureux chroniques, ont un déficit (vitamine D <20 ng/ml ou 50 nmol/l), et plus de 25% ont un déficit sévère (vitamine D <10 ng/l ou 25 nmol/l). / Hypovitaminosis D is common in populations which consult GP's. Manu studies have been conducted which revealed high prevalence of severe hypovitaminosis in young people. risk factors were covered clothes, high BMI, dark phottype, precarity, no sunhbathing, no sun holidays, no sport outdoor. Quality of life was correlated with vitamin D levels. Patients with chronic musculo skeletal pains had very low level of vitamin D < 10 ng/ml for 25%. The supplementation cured the pains for more than 50 % of the patients and decreased the consumption of medicines and care. It will be be very important to consider this problem of public health for young people.

Musculo – skeletal stress in nursing staff and its association with health disorders Aim of the study was to investigate health complaints and work pressure among nursing staff, and to evaluate the associations of musculo - skeletal stress with their health disorders. Methods. During October - December, 2003, 300 employees of one Kaunas hospital were interviewed. In this case - control study, 100 respondents were included into the case group, and 200 were controls. The main criterion for the selection of controls was no engagement in activities characteristic of a nurse and an assisting nurse. The questionnaire was anonymous. Statistical analysis of the obtained findings was performed using SPSS 12 statistical software package. Results. Nurses whose work was not related to lifting weights (the control group) more frequently complained of pains in the neck (87,5 %), the shoulder girdle (91,7 %), and the back (93,2 %), whereas those whose work was related to lifting weights, more frequently complained of pains around the waist (73,0 %) and in the legs (94,9 %). The study showed that the pain syndrome in the arms by two times more frequently occurred in the control group (12,1 % compared to 6,0 % in the case group), which is characteristic of the sedentary job, especially computer work. Pain syndrome in the legs by four times more frequently occurred in the case group, compared to controls, which is typical of work related to weight lifting. The evaluation of the activities... [to full text]

Made available in DSpace on 2014-12-17T14:13:37Z (GMT). No. of bitstreams: 1 KarynaMOBF.pdf: 5534733 bytes, checksum: 530fbd079356df5078e7d3aeb2952942 (MD5) Previous issue date: 2008-12-16 / This study aimed at assessing the interobserver reliability of the Brazilian-Portuguese version of the Berg Balance Scale (BBS). The assessment was made by physiotherapists with extensive or little clinical experience in non-institutionalized elderly individuals. Participants comprised 12 elderly subjects (10 women and 2 men) with mean ages of 75.8 ? 8.4 years (range = 63-87) and 18 physiotherapists with varying clinical experience. Inter-examiner reliability obtained for each scale item yielded weighted kappa value > 0.75 in 11 of the 14 items (varying from 0.37 to 1.0). The intra-class correlation coefficient (ICC) for the total sum of BBS scores between the two groups of physiotherapists was 0.996 (95% confidence interval, 0.987 0.999) with a Cronbach alpha coefficient of 0.996. We found no difference between the rater groups when we compared the sum score means obtained with the student s T-test (p = 0.86). Although some items had low reliability values, in general our results suggest that the Brazilian Version of the BBS showed good levels of interrater reliability and agreement when used by physiotherapists with different clinical practice levels and without previous training on non-institutionalized elderly patients. We concluded that the BBS can be useful as an important evaluation instrument on a protocol for Rehabilitation clinics. It may be used by various health professionals, as: Physicians, Physical therapists, Physical educators, Occupational therapists, Nurses and Phonoaudiologists, so confirming the interdisciplinary character of this study / O presente trabalho objetivou avaliar a confiabilidade interobservador da Vers?o Brasileira da Escala do Equil?brio de Berg (EEB), entre fisioterapeutas com extensa e escassa pr?tica cl?nica em uma popula??o idosa n?o-institucionalizada. Participaram do estudo 12 idosos (10 mulheres e 2 homens), com m?dia de idade de 75,8 anos ? 8,39 (varia??o de 63-87) e 18 fisioterapeutas com diferentes n?veis de experi?ncia cl?nica. A confiabilidade interexaminador obtida em cada item da escala, apresentou um valor de Kappa ponderado (Kw) de > 0,75 em 11 dos 14 itens (varia??o de 0,37 a 1,0). O coeficiente de correla??o intraclasses (ICC) da soma da pontua??o total da EEB entre os dois grupos de fisioterapeutas foi de 0,996 (IC 95%, 0,987 - 0,999) e com o coeficiente de Cronbach de 0,996. N?o encontramos diferen?as entre os grupos de avaliadores quando comparadas as m?dias da pontua??o total obtida por meio do teste T-student (p=0,86). Embora alguns itens tenham apresentado baixos valores de confiabilidade, em geral nossos resultados sugerem que a Vers?o Brasileira da EEB apresenta bons n?veis de confiabilidade interobservador quando utilizada por fisioterapeutas com diferentes n?veis de pr?tica cl?nica e sem treinamento pr?vio em idosos que vivem na comunidade. Conclu?mos que a EEB pode servir como um importante instrumento de avalia??o dentro de um protocolo sistematizado para servi?os de Reabilita??o, onde sua utiliza??o pode ser realizada por diferentes profissionais de sa?de, tais como: M?dicos, Fisioterapeutas, Educadores f?sicos, Terapeutas ocupacionais, Enfermeiros e Fonoaudi?logos, confirmando assim o car?ter interdisciplinar dessa pesquisa

Title: Musculoskeletal assessment analysis of triathletes Objectives: The main aim of this master degree thesis is the diagnostics of the current condition of the complex kinesiological examination of musculo-skeletal system in elite performance triathtletes of the Czech National Team level (Junior and U23 categories), including compensational exercises specifically devised for triathlets. Futhermore with the help of the selected data this study is expected to draw some basic conclusions and establish the typical postural characteristics of athletes related to the sport of triathlon. Methods: In this thesis we have used following testing methods: complex musculo skeletal examintation including evaluation of medical history, an antropometrical screening, standing static postural assessment, gait assessment, soft-tissue palpation exam, assessment of the fundamental movement patterns of an individua, examination of neurological reflexes, flexibility and range of motion screening. Based on the above mentioned tests we have received a complete functional and musculo skeletal system profile of each triathlete's. For collection we have used the SPSS 22 data analysis software. For the gender diferentiation we have used non-pairred T-Test and for perofrmance variability within the 3 levels we have used...

Conception et évaluation d’un modèle biomécanique, éléments finis, patient-spécifique, du pied humainApplications en podologie, orthopédie et diabétologieLe pied est une des structures les plus complexes du corps humain. Avec 28 os, 33 articulations et une centaine de structures ligamentaires, cette entité poly articulée est le résultat d’une hyperspécialisation ayant contribué à faire de l’homme l’unique primate totalement bipède. Quelque soit le relief, quelque soit le mouvement en cours, le pied transmet au tibia le bon vecteur force afin de finaliser le geste de la manière la plus précise et économe en énergie possible dans l’objectif de préparer l’action des segments sus jacents. Ainsi, en cas de lésion d’une des structures, l’ensemble du complexe pied doit pouvoir s’adapter, si ce n’est pas le cas, les tissus mous, les articulations ou les os seront fragilisés et verront leur fonction propre au sein de ce complexe altérée.Prédire l’adaptation du pied à une modification structurelle, tissulaire, neurologique ou fonctionnelle est un enjeu important dans l’estimation du risque lésionnel.Afin d’initier une réponse à ces problématiques, nous avons décidé au cours de cette thèse de modéliser le pied humain avec des outils mathématiques de simulation biomécanique. Dans un premier temps, un modèle tridimensionnel musculo-squelettique du pied a été reconstruit à partir d’imagerie scanner. Le pied polyarticulé en multicorps rigides obtenu possède des articulations uniquement contraintes par les ligaments et contacts osseux. Les muscles ont été implémentés afin de piloter le modèle en dynamique directe. Enfin, les tissus mous comme les volumes musculaires, le gras et la peau ont été maillés en éléments finis. L’utilisation d’un environnement de programmation multi-physique open source (Artisynth) a permis de coupler la modélisation musculo-squelettique et éléments finis.• L’adaptation du pied au sol en orthostatisme a été évaluée par comparaison des cartographies de pression d’une mise en charge simulée avec la mise en charge réelle du sujet.• Le contrôle moteur du pied en chaine ouverte par l’activation des muscles extrinsèques a été évalué en comparant la cinématique du modèle biomécanique pilotée par électromyographie avec la cinématique capturée en laboratoire sur un mouvement d’abduction – adduction.• Nous avons ensuite cherché à comprendre comment une arthrodèse de cheville modifie la cinématique du pied à la contraction musculaire, l’objectif étant d’aider au réglage chirurgical du geste.• Enfin nous avons utilisé les dernières avancées sur la physiologie de la plaie de pression afin de prédire le risque d’ulcération sur un pied neuroarthropatique diabétique par simulation numérique.Le modèle ainsi que les routines de simulations mis en place nous permettent d’avoir un des modèles les plus aboutis du pied humain utilisant aussi bien des données physiques externes comme les données baropodométriques, les données d’analyse quantifiée du mouvement ou encore les données électromyographiques. Ce modèle permettra par l’intermédiaire d’outils de mesh-matching d’obtenir des modèles patients spécifiques. Les domaines d’applications porteront sur l’aide au geste chirurgical, la prévention des risques d’ulcération, l’analyse avancée des relations entre le pied et le membre inférieur, mais aussi l’aide à la conception de prothèse en orthopédie classique et en mécatronique. / Biomechanical modeling of the human foot. Application to the healthy and pathological subject.The foot is one of the more complex structures of the human body. With 28 bones, 33 joints and a hundred ligamentous structures, this articulated entity is the result of a hyper specialization that makes humans the only obligate bipedal primates. Whatever the terrain, whatever the current movement, the foot transmits to the tibia the right force vector to finalize the gesture in the most precise and efficient manner and prepares the action of the lower limb. Thus, in case of injury to one of the structures, the whole foot complex must adapt if it is not the case, soft tissues, joints or bones are fragile and will have their own function within this complex altered .Predicting the foot’s adaptation of a structural, tissue, neurological or functional modification is an important issue in estimating the risk lesion on locomotion, in the design of therapeutic footwear and orthotics of the degenerative foot, but also in the future of this complex in situations where the boundary conditions change like working in microgravity or foot exoskeleton coupling.To initiate a response to these problems, we decided during this thesis to model the human foot with mathematical tools for biomechanical simulation. Initially, a musculoskeletal three-dimensional model of the foot was reconstructed from computed tomography. The multi-articulated foot joints constraints obtained by ligaments and bone contact. The muscles have been implemented to control the model in direct dynamic. Finally, the soft tissues such as muscle volume, fat and skin were meshed into finite elements. Using a multi-physics open source programming environment (Artisynth) allowed to couple musculoskeletal modeling and finite elements.• Adapting the foot on the ground in upright posture was evaluated by comparing the pressure maps at a simulated load setting with the actual loading pressure map of the subject.• The motor control of foot in opened chain by activation of the extrinsic muscles was assessed by comparing the kinematics of the biomechanical model piloted by electromyography with kinematics captured in the laboratory on a movement of abduction - adduction.• We then sought to understand how an ankle arthrodesis alter the kinematics of the foot muscle contraction, with the aim of helping the surgical setting gesture.• Finally, we used the latest advances in the physiology of a pressure ulcer to predict the risk of ulceration on diabetic foot with Charcot neuro arthropathy by numerical simulation.The model and simulation routines in place allow us to have one of the most successful models of the human foot using both external physical data like pedobarographic data, motion analysis data or electromyography data. This model will allow through mesh-matching tool to obtain specific patient models. The fields of applications will focus on assisted surgery, prevention of ulceration, advanced analysis of relations between the foot and the leg, but also will help the prosthesis design in orthopedic and mechatronics.

Made available in DSpace on 2015-05-08T14:53:37Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 958288 bytes, checksum: 96e8f893e65870e14e2f18b157219114 (MD5) Previous issue date: 2013-12-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The objective of this study is to analyze the influence of risk factors on exposure to WMSD workers in repetitive activities in the footwear sector. Therefore, we analyzed the data for 71 workplaces in the productive area of a shoe company which are characterized by having a defined task cycle, and had the index of exposure to WMSD upper limbs calculated through the OCRA method. Data analysis was accomplished using the exploratory data analysis of WMSD and construction of a Generalized Linear Model (GLM). This model identified the factors that influence the rate of exposure the most and made it possible to quantify the possible chance of raising this index when risk factors are present in the workplaces. The factor indicated as the most influential one was the "sudden movements" factor, the presence of this factor increases the chance of raising the level of exposure in 2.12 times more than when this factor is not present. / O objetivo deste trabalho foi analisar os fatores de risco e o índice de exposição a LER/DORT dos trabalhadores em atividades repetitivas no setor calçadista.Para tanto foram analisados dados referentes a 71 postos de trabalho da área produtiva de uma empresa calçadista que se caracterizam por possuir um ciclo de tarefa definido, e que tiveram calculados o índice de exposição a LER/DORT nos membros superiores através do método OCRA. O tratamento dos dados foi realizado através da análise exploratória dos dados de LER/DORT e da construção de um Modelo Linear Generalizado (MLG).Este modeloidentificou os fatores que mais influenciam o índice de exposição e possibilitouquantificar a chance de elevação deste índice quando os fatores de risco estão presentes nos postos de trabalho. O fator indicado como o mais influente foi o fator movimentos bruscos , a presença deste fator aumenta a chance de se elevar o índice de exposição em 2,12 vezes a mais do que quando este fator não está presente.

La robotique constitue une solution prometteuse pour développer des systèmes d'assistance visant à améliorer l'autonomie et les conditions de vie des personnes dépendantes. Ainsi, de nombreuses recherches sont menées actuellement à travers le monde pour concevoir et développer des robots portables ou exosquelettes, en tant que dispositifs d'aide à la mobilité pour augmenter les capacités motrices des sujets porteurs, ou comme auxiliaires de rééducation neuro-musculaire. Cette thèse vise le développement des modèles de connaissances nécessaires pour la mise en oeuvre de commandes assistives d'un exosquelette de l'articulation du genou, notamment celles basées sur l'intention du sujet porteur. Cet exosquelette est destiné à l'assistance des mouvements de flexion/extension du genou pour des personnes souffrant de pathologies du genou, ou pour le renforcement musculaire et la rééducation de sujets âgés ou hémiparétiques. Pour l'estimation de l'intention de mouvement du porteur, nous proposons modèle musculo-squelettique polynomial, complété par un modèle muscle-tendons de type Hill et le modèle bi-linéaire de Zajac pour modéliser la dynamique d'activation et de désactivation musculaire. Le modèle musculo-squelettique polynomial proposé offre le même niveau de réalisme et de précision qu'un modèle musculo-squelettique générique anatomique, sans nécessiter l'emploi de méthodes d'optimisation gourmandes en temps de calcul. Dans cette thèse, nous proposons un ensemble de trois commandes assistives destinées à guider ou à assister, via l'exosquelette, un sujet dans un contexte d'assistance à la rééducation en mode actif-aidé: La première, basée sur la passivité, exploite les propriétés physiques de l'exosquelette et du sujet porteur pour stabiliser asymptotiquement l'ensemble exosquelette-membre inférieur du porteur. Les paramètres du contrôleur sont ajustés automatiquement en fonction de la contribution du sujet au mouvement. A travers cette commande, l'exosquelette développe un couple correctif pour guider le genou vers la trajectoire de référence ou son voisinage. La seconde commande introduit une saturation pour maintenir le couple d'assistance dans un intervalle donné, garantissant ainsi la sécurité du sujet porteur. Cette commande garantit aussi des mouvements à des vitesses raisonnables et une convergence vers la trajectoire de référence. La deuxième loi de commande est complétée par une fonction permettant de moduler le couple d'assistance en fonction de la phase de rééducation. Enfin, la troisième commande proposée vise à maximiser la transparence de l'exosquelette pour éviter d'altérer les mouvements naturels du sujet porteur. Elle exploite la dynamique d'interaction induite par les mouvements relatifs du sujet porteur par rapport à l'exosquelette dus aux compliances intrinsèques de l'ensemble exosquelette-membre inférieur. Ces commandes ont été évaluées sur un sujet volontaire sain âgé de 29 ans, en considérant les modes d'assistance passif et actif-aidé. L'analyse des résultats expérimentaux montre de bonnes performances en termes de précision de poursuite de trajectoire, de robustesse vis-à-vis des incertitudes paramétriques et des perturbations externes. Ces résultats montrent également des propriétés importantes comme la sécurité du sujet porteur, le suivi précis de l'intention du porteur, l'assistance adaptative pour la rééducation active et la transparence de l'interaction exosquelette-porteur / Nowadays, robotics constitutes a promising solution to develop assistive systems to improve autonomy of dependent people during everyday activities. Thus, much research is being conducted currently worldwide to design and develop wearable robots or exoskeletons as assistive devices for mobility in order to improve the capabilities of the wearer. These devices can also be used during neuromuscular rehabilitation processes. This thesis aims to develop models necessary for the implementation of subject's intention wearer assistive control strategies using a knee joint exoskeleton. In order to estimate the movement intention of the wearer, we propose a Hill- Zajac based musculoskeletal model. This musculoskeletal model provides a high level of realism and accuracy compared to an anatomical generic musculoskeletal model without requiring the use of optimization methods techniques that are generally computational effort consuming. Three assistive control strategies are developed in this thesis to assist the wearer in a context of assistance and rehabilitation. In this thesis, we propose a set of three assistive commands to guide or assist through the exoskeleton, a subject in the context of rehabilitation assistance to active-assisted method: The first, based on passivity, operates the physical properties of the exoskeleton about the wearer and to stabilize the lower assembly asymptotically exoskeleton-member carrier. The first one is based on passivity and uses the physical properties of the exoskeleton and the wearer to stabilize asymptotically the human- lower-limb exoskeleton system. The second one introduces a saturation threshold to maintain the assistive torque in a given interval, ensuring the safety of the wearer. The third one aims to maximize the transparency of the exoskeleton to avoid altering the natural movements of the wearer. It uses the interaction dynamics induced by the relative movements between the wearer and the exoskeleton. These control strategies were evaluated on a 29-year-old healthy volunteer subject. The analysis of the experimental results shows satisfactory performances in terms of trajectory tracking accuracy, robustness with respect to parametric uncertainties and external disturbances. The results show also a good accuracy in the human intention detection and an adaptive support for active rehabilitation and transparent human-robot interaction