Critical illness can lead to profound physical morbidity that persists for years post-intensive care unit (ICU) discharge. Rehabilitation started in ICU can mitigate morbidity and improve outcomes, however, there are gaps in existing research. This thesis includes manuscripts addressing three areas: primary research reporting, patient-reported outcome measures (PROM), and research intervention implementation. The first manuscript was a scoping review of ICU rehabilitation interventions. Previous systematic reviews assessed the effectiveness of ICU rehabilitation to improve functional outcomes, and identified conflicting results and deficiencies in study reporting. I conducted a scoping review to describe the types, amounts, and reporting of rehabilitation interventions in ICU studies. I identified 117 prospective ICU rehabilitation studies from database inception to 2016 and assessed the completeness of study and intervention reporting using standardized reporting guidelines. Results identified adequate overall study reporting, however important reporting deficiencies in intervention and control groups, limiting future trial development and clinical implementation. The second manuscript evaluated the psychometrics of the Patient-Reported Functional Scale-ICU (PRFS-ICU) – a new PROM for ICU survivors in acute care. I demonstrated the PRFS-ICU was feasible, reliable, responsive, and valid in medical-surgical ICU patients able to follow commands. Results suggest the PRFS-ICU warrants future research and may be useful to assess and monitor patient perceptions of their functioning over time. The final manuscript was a self-administered electronic survey of frontline therapists, assessing barriers and facilitators to implementing a novel rehabilitation intervention in the context of research. Respondents implementing CYCLE, a trial of in-bed cycling with mechanically ventilated patients, identified two primary barriers to implementing the protocol: time required to conduct the protocol and concerns for provision of equitable service to all patients on their caseload. Together these manuscripts provide an important foundation to guide development, implementation, and evaluation of future ICU rehabilitation trials. / Thesis / Doctor of Philosophy (PhD) / Critical illness requiring intensive care unit (ICU) admission can lead to physical disability lasting years post-ICU. Exercises started in ICU can reduce disability. However there are important gaps in the research addressed by my thesis: 1) Summaries of studies found different results on the effects of exercise on disability, and details of exercises were sparse. I reviewed over 3 decades of exercise research for ICU patients and determined reporting must improve; 2) ICU patients had no standard way to report their own level of movement in hospital. I evaluated a measure, which may be useful to assess how patients think they are functioning; 3) ICU therapists reported challenges delivering exercises to patients in research studies. I conducted a survey and learned therapists needed more time to provide these exercises. My findings can inform future ICU exercise studies, assess how patients feel they are functioning, and optimize exercise delivery.

The OQ-45.2 (Outcome Questionnaire-45.2) is a measure of psychological distress that examines patients' emotional states and level of functioning in society. This measure was administered at admission and discharge to inpatients at a level II trauma center with in- and outpatient populations in addition to the BBHI-2 (Brief Battery for Health Improvement-2) and FIM (Functional Independence Measure). Results suggested that patients demonstrated psychological improvements from admission to discharge. In addition, the OQ-45.2 was found to correlate with nearly all subtests of the BBHI-2. Finally, diagnosis, length of stay, and number of psychotherapy sessions were not predictive of improvements on the OQ-45.2 total score, suggesting that this measure can be appropriately used on a heterogeneous medical population.

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Title: Physical rehabilitation in Multiple Sclerosis- Questionnaire Objectives: The objective of the project is to map approach to physiotherapy of patients with multiple sclerosis (MS) using a questionnaire in three selected countries in Europe. We assume that the results objectively point out the diversity of approaches to physiotherapy among patients with MS. The data collection will be further used to prepare an international comparative study comparing the effectiveness of various physiotherapeutic approaches. Methods: The questionnaire, used in our study has been created by a team of experts from organizations RIMS, SIG on Mobility (Rehabilitation in Multiple Sclerosis, Special Interest Group) during the last two years. PhDr.Kamila Řasová, PhD., from whose initiative this study came, is a member of this organization. The questionnaire was sent to the coordinator in each country. Then the coordinator completed the questionnaire together with the experts in rehabilitation. Completed copies were sent to the Czech Republic, where they were statistically analysed. Results: We found out that in each country there are differences between knowledge and usage of examination and therapeutic techniques. Furthermore, the perception of the therapeutic content of the three basic models for physiotherapy...

Title: Physical rehabilitation in Multiple Sclerosis - Questionnaire Objectives: The objective of the project is to map approach to physiotherapy of patients with multiple sclerosis (MS) using a questionnaire in three selected countries in Europe. We assume that the results objectively point out the diversity of approaches to physiotherapy among patients with MS. The data collection will be further used to prepare an international comparative study comparing the effectiveness of various physiotherapeutic approaches. Methods: The questionnaire, used in our study has been created by a team of experts from organizations RIMS, SIG on Mobility (Rehabilitation in Multiple Sclerosis, Special Interest Group) during the last two years. PhDr.Kamila Řasová, PhD., from whose initiative this study came, is a member of this organization. The questionnaire was sent to the coordinator in each country. Then the coordinator completed the questionnaire together with the experts in rehabilitation. Completed copies were sent to the Czech Republic, where they were statistically analysed. Results: We found out that in each country there are differences between knowledge and usage of examination and therapeutic techniques. Furthermore, the perception of the therapeutic content of the three basic models for physiotherapy...

Lack of motivation has been highlighted as a major cause of adverse patients outcomes during the rehabilitation process.Thanks to the evolution in the way video games are controlled, from totally passive to active situation, clinicians have had the idea of integrating video games into rehabilitation to increase adherence to treatments, especially during at-home exercises.Specially developed games, the Serious Games (SG), must be created to fulfill the needs and specificities of clinicians and patients.As the rehabilitation exercises are performed in the SG, it is easy to record the movements performed by the patients with the gaming hardware.The aim of this thesis was to determine if the gaming hardware, the Kinect sensor and the Wii Balance Board, can be used to: i) perform functional evaluation of the patients, ii) monitor motions performed by the patients during the rehabilitation exercises and iii) assess the severity of the disease based on the performance during the SG.In order to validate this new approach several validation processes were done: from the strict controlled environment gait laboratory to the clinics.The different developments and validation phases are presented in this thesis. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

The loss of a hand or arm is a devastating life event that results in many months of healing and challenging rehabilitation. Technology has allowed the development of an electronic replacement for a lost limb but similar advancements in therapy have not occurred. The situation is made more challenging because people with amputations often do not live near specialized rehabilitation centres. As a result, delays in therapy can worsen common complications like nerve pain and joint stiffness. For children born without a limb, poor compliance with the use of their prosthesis leads to delays in therapy and may affect their development. In many parts of the world, amputation rehabilitation does not exist. Fortunately, we live in an age where advances in technology and engineering can help solve these problems. Virtual reality creates a simulated world or environment through computer animation much like what is seen in modern video games. An experienced team of rehabilitation doctors, therapists, engineers and computer scientists are required to realize a system such as this. A person with an amputation will be taught to control objects in the virtual world by wearing a modified electronic prosthesis. Using computers, it will be possible to analyze his or her movements within the virtual world and improve the wearer's skills. The goals of this system include making the system portable and internet compatible so that people living in remote areas can also receive therapy. The novel approach of using virtual reality to rehabilitate people with upper limb amputations will help them return to normal activities by providing modern and appropriate rehabilitation, reducing medical complications, improving motivation (via gaming modules), advancing health care technology and reducing health care costs. The use of virtual reality technology in the field of amputee rehabilitation is in its earliest stages of development world wide. A virtual environment (VE) will facilitate the early rehabilitation of a patient before they are clinically ready to be fitted with an actual prosthesis. In order to create a successful virtual reality rehabilitation system such as this, an accurate method of tracking the arm in real-time is necessary. A linear displacement sensor and a microelectromechanical system (MEMS) inertial measurement unit (IMU) were used to create a device for capturing the motion of a user's movement with the intent that the data provided by the device be used along with a VE as a virtual rehabilitation tool for new upper extremity amputation patients. This thesis focuses on the design and testing of this motion capture device in order to determine the suitability of current commercially available sensing components as used in this system. Success will be defined by the delivery of accurate position and orientation data from the device so that that data can be used in a virtual environment. Test results show that with current MEMS sensors, the error introduced by double integrating acceleration data is too significant to make an IMU an acceptable choice for position tracking. However, the device designed here has proven to be an excellent cable emulator, and would be well suited if used as an orientation tracker.

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Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-05-28T19:02:59Z No. of bitstreams: 1 Diss Fabiane Costa Santos. 2013.pdf: 2025697 bytes, checksum: 32d1940f46251b1cee721713af55a8bb (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-28T19:05:14Z (GMT) No. of bitstreams: 1 Diss Fabiane Costa Santos. 2013.pdf: 2025697 bytes, checksum: 32d1940f46251b1cee721713af55a8bb (MD5) / Made available in DSpace on 2013-05-28T19:05:14Z (GMT). No. of bitstreams: 1 Diss Fabiane Costa Santos. 2013.pdf: 2025697 bytes, checksum: 32d1940f46251b1cee721713af55a8bb (MD5) Previous issue date: 2013 / Segundo o Relatório Mundial sobre a Deficiência, mais de um bilhão de pessoas são acometidas pelo problema e destas, 200 milhões enfrentam alterações de funcionalidade que comprometem suas atividades de vida diária. No Brasil, o envelhecimento populacional, o aumento da incidência de acidentes e violências e ainda outros agravos - que conferem ao indivíduo algum grau de deficiência - representam um desafio para o SUS, pautado na organização da assistência à saúde, dos cuidados básicos à reabilitação. Os serviços de reabilitação física encontram-se entre os principais problemas do sistema e apesar das políticas que normatizam a criação destas unidades, poucas conquistas foram evidenciadas, faltando implantar os planos desenvolvidos. Precariedade da oferta de atendimento multiprofissional e domiciliar, carência de dispensação de órteses e próteses e dificuldade de acesso foram problemas dos serviços de cinco capitais estudadas, e despertaram curiosidade em relação à situação de Salvador. Realizou-se um diagnóstico de doze serviços, com utilização de dados secundários do CNES e entrevistas com gerentes dos serviços e técnico da SESAB. O diagnóstico administrativo e o momento explicativo do planejamento situacional foram as referências teórico-metodológicas adotadas. Os resultados apontaram para insuficiência de unidades e infraestrutura, inexistência de serviço da rede própria municipal, problemas de gestão, organização e prestação de serviços, e divergência entre dados do CNES e a realidade dos estabelecimentos. O propósito de mudança da situação evidenciada exige a formação de sujeitos transformadores, visando impulsionar um movimento que resulte na concretização de ações de melhoria da assistência em reabilitação física em Salvador, Bahia. / Salvador

Esta tesis fue estructurada con el fin de crear una nueva experiencia vivencial que brinde una mejor calidad de vida a mujeres diagnosticadas con cáncer de mama. Por esta razon, se propone romper con el típico concepto de un Centro de Rehabilitación y aportar con el desarrollo de una nueva estrategia de gestion interna de manera que el sistema sea tan flexible como las necesidades de las pacientes en tiempo real. Otro de los propósitos de este proyecto es que pueda ser ejecutado con el apoyo de una ONG y así, de la mano de psicologos especialistas en transtornos por cáncer de mama, expertos en nutricion y rehabilitacion física unir idea junto a especialistas en paisajismo, infraestructura y diseño. De esta manera poder desarrollar un modelo operativo funcional que rehabilite tanto directa como indirectamente a las pacientes desde su ingreso al centro. Para este proyecto, en primer lugar, se realizó un estudio sobre los efectos y consecuencias del cáncer de mama, así como también los posibles tratamientos para el proceso de rehabilitación independientemente de cada diagnostico u estadio. Debido a que en el país no existe un Centro de Rehabilitación Física y Psicológica para Mujeres con Cáncer de Mama, se realizó el análisis de su arquitectura, experiencia y funcionalidad de las instituciones existentes con el mismo objetivo en países como España, Colombia y Argentina. De esta manera se obtuvo la información necesaria para ejecutar un sistema estructurado por cada especialidad propuesta en esta tesis, fusionando el diseño interior y arquitectura con en el rubro de la medicina. En segundo lugar, se analizó la ubicación y perimetros a la redonda de la vivienda elegida donde se desarrollará el proyecto para posteriormente hacer una intervención estructural y seguidamente el diseño de cada ambiente de manera que puedan satisfacer las necesidades de nuestro público objetivo. Finalmente se plantea las conclusiones en relación con los objetivos propuestos en el inicio del proyecto. / This thesis was structured in order to create a new experience that provides a better quality of life for women diagnosed with breast cancer. For this reason, it is proposed to break with the typical concept of a Rehabilitation Center and contribute to the development of a new internal management strategy so that the system is as flexible as the needs of patients in real time. Another purpose of this project is that it can be executed with the support of an NGO and by the hand of specialists in breast cancer disorders specialists, experts in nutrition and physical rehabilitation join idea together with specialists in landscaping, infrastructure and design. In this way to develop a functional operational model that rehabilitates both directly and indirectly the patients from their admission to the center. For this project, firstly, a study was carried out on the effects and consequences of breast cancer, as well as the possible treatments for the rehabilitation process regardless of each diagnosis or stage. Since there is no Physical and Psychological Rehabilitation Center for Women with Breast Cancer in the country, the analysis of their architecture, experience and functionality of existing institutions with the same objective was carried out in countries such as Spain, Colombia and Argentina. In this way, the necessary information was obtained to execute a structured system for each specialty proposed in this thesis, merging interior design and architecture with that of medicine. Secondly, the location and perimeters around the chosen house where the project will be developed were analyzed to subsequently carry out a structural intervention and then the design of each environment so that they can meet the needs of our target audience. Finally, the conclusions are presented in relation to the objectives proposed at the beginning of the project. / Tesis