General movements (GMs) are the spontaneous gross motor movements involving the whole body. GMs progressively develop as an infant ages. Several recent research studies involving the qualitative assessment of the GMs in infants have validated that GMs, or the lack of, are an accurate way diagnosing a neurological dysfunction in the early stages of infancy. One study has shown that definitely abnormal movements occurring between 10-20 weeks post-term accurately predicted cerebral palsy in infants with an accuracy of 85 to 98 percent [1]. The qualitative method of assessing an infant's GMs is an accurate way of predicting a neurological dysfunction, however, requires the review of hours of video footage by a trained physician. This process is not only time consuming and costly but is subjective in the sense that the results cannot be easily transferred among different institutions. It is also difficult to conduct longitudinal studies without first reviewing the entire history of video footage of the infant's GMs. Improvements can be made to the qualitative GMs assessment method by utilizing recent advances in technology that "can make data collection and analysis more efficient, without compromising competency" [2]. In particular, preliminary research has shown that data collected from"wired" micro-electrical-mechanical systems (MEMS) accelerometers attached to the wrist and ankles of an infant is a feasible way of collecting and characterizing the motion patterns that infants display during GMs [3]. The work presented in this thesis is directed towards improving the past research that used "wired" accelerometers to acquire acceleration signals from the limbs of infants. This thesis describes the process of transitioning the "wired" accelerometers to the wireless level, designing a user-friendly interface to graphically interpret the acceleration data, and assessing the designed system through clinical trials on normal and at-risk infants using the design system. / Master of Science

Objective: There is growing evidence that therapeutic hypothermia and other post-resuscitation care improves outcomes in out-of-hospital cardiac arrest (OHCA). Thus, transporting patients with return of spontaneous circulation (ROSC) to specialized facilities may increase survival rates. However, it is unknown whether prolonging transport to reach a designated facility would be detrimental. Methods: Data from OHCA patients treated in EMS systems that cover approximately 70% of Arizona's population were evaluated (October 2004-December 2006). We analyzed the association between transport interval (depart scene to ED arrival) and survival to hospital discharge in adult, non-traumatic OHCA patients and in the subgroup who achieved ROSC and remained comatose. Results: 1846 OHCA occurred prior to EMS arrival. Complete transport interval data were available for 1177 (63.8%) patients (study group). 253 patients (21.5%) achieved ROSC and remained comatose making them theoretically eligible for transport to specialized care. Overall, 70 patients (5.9%) survived and 43 (17.0%) comatose ROSC patients survived. Mean transport interval for the study group was 6.9 min (95% CI: 6.7, 7.1). Logistic regression revealed factors that were independently associated with survival: witnessed arrest, bystander CPR, method of CPR, initial rhythm of ventricular fibrillation, and shorter EMS response time interval. There was no significant association between transport interval and outcome in either the overall study group (OR = 1.2; 0.77, 1.8) or in the comatose, ROSC subgroup (OR 0.94; 0.51, 1.8). Conclusion: Survival was not significantly impacted by transport interval. This suggests that a modest increase in transport interval from bypassing the closest hospital en route to specialized care is safe and warrants further investigation.

Made available in DSpace on 2016-06-02T19:46:05Z (GMT). No. of bitstreams: 1 2429.pdf: 663520 bytes, checksum: eade8a60f2b578a2652f567441b6cffa (MD5) Previous issue date: 2009-03-06 / Motivation is usually defined as an inner strength or will, followed by an action towards a goal. Its importance to rehabilitation is established by its positive relation with better and faster functional recovery. Individuals with pathologies or injuries in the Central Nervous System may present motivational disorders. Apathy is the most common and the least intense motivational disorder. The general purpose of this research is to investigate the factors which would distinguish motivated people with physical disability from those demotivated, by using apathy as a reference of demotivation. The study was conducted in two studies. The first one, dealing with the cultural adaptation of the Apathy Evaluation Scale, and the second using all the tools selected to identify intrinsic and extrinsic factors that would influence the participants´ motivation. 14 participants were selected for the first study and 51 for the second, together with their caretakers. The participants were 33 to 89 years old and presented stroke sequelae, traumatic brain injury, Parkinson's disease and Alzheimer's disease. The caretakers responded to the Apathy Evaluation Scale and the patients completed the general characterization questionnaire, WHOQol-100 World Health Organization Quality of Life (WHOQOL-100) scale and Beck Depression Inventory (BDI). The data was analyzed through SPSS, with descriptive statistics, Pearson correlation test and Student´s t-test (regressive and inferential). The analysis of the Brazilian version of the Apathy Evaluation Scale, obtained in the first study, revealed its suitability to be used in the sample of this investigation. The final results demonstrated that Apathy is significantly correlated with age, degenerative diseases, right hemisphere lesions, general comorbidity, lack of energy, lack of leisure opportunities, and also lack of capacity to undertake physical and cognitive daily activities, and low self-esteem. Differences in self-esteem, work capacity, quality of sleep, day-to-day energy, personal relationship, leisure and physical domains were detected between apathetic and non-apathetic participants. Self-esteem, presence of general comorbidity and work capacity were the main factors to predict apathy. Therefore, both, intrinsic and extrinsic features determine apathy in this kind of population. Drug intervention and familiar guidance may help the rehabilitation professionals increase motivation to functional rehabilitation, which may lead patients to physical, psychological and social benefits. / A motivação tem sido comumente definida como uma força interior ou desejo seguido de uma ação para alcançar um objetivo. A sua importância na reabilitação é estabelecida pela relação positiva com uma recuperação funcional melhor e mais rápida. Indivíduos com patologias ou lesões no sistema nervoso central podem apresentar desordens motivacionais. A Apatia é a desordem motivacional menos intensa e mais comum. O objetivo geral da presente pesquisa foi investigar fatores que distinguiriam indivíduos portadores de deficiência física motivados daqueles não motivados, utilizando a apatia como referência de desmotivação. A pesquisa foi dividida em dois estudos, sendo o primeiro voltado à adequação cultural da Apathy Evaluation Scale e o segundo constituído da aplicação de todos os instrumentos escolhidos para coleta dos fatores intrínsecos e extrínsecos que poderiam influenciar a motivação dos participantes. No Estudo 1 foram selecionados 14 indivíduos e para o Estudo 2, 51, juntamente com seus cuidadores. Os participantes tinham idade entre 33 e 89 anos, e seqüelas de acidente vascular encefálico, traumatismo crânio encefálico, doença de Parkinson e demência de Alzheimer. Os cuidadores responderam à Escala de Avaliação da Apatia. Os clientes responderam ao questionário de caracterização geral, instrumento de qualidade de vida WHOQol-100 e Inventário de Depressão de Beck. Os dados foram analisados através do SPSS, com estatística descritiva, correlacional de Pearson, regressiva e inferencial (Teste t). A análise da versão brasileira da Escala de Avaliação da Apatia, descrita no Estudo 1, parece demonstrar a adequação da mesma para aplicação na amostra dessa pesquisa. Os resultados finais parecem indicar que a apatia está significativamente correlacionada à idade, doenças degenerativas, lesões do hemisfério direito, comorbidades gerais, falta de energia, de oportunidades de lazer, capacidade para realização das atividades cotidianas, físicas e cognitivas, e baixa auto-estima. Entre apáticos e não apáticos, houve diferença na auto-estima, capacidade para o trabalho, qualidade do sono, energia para o dia-adia, relações pessoais, lazer e domínio físico. A auto-estima, presença de comorbidades gerais e capacidade para o trabalho foram os principais fatores preditivos da apatia. Portanto, tanto características extrínsecas quanto intrínsecas ao indivíduo são determinantes da apatia nesse tipo de população. Intervenções medicamentosas e orientações à família de pessoas apáticas podem auxiliar os profissionais de reabilitação a aumentar a motivação para a recuperação funcional, que pode trazer, por sua vez, benefícios à dimensão física, psicológica e social dos indivíduos.