Orientador: Alberto Cliquet Júnior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T01:33:18Z (GMT). No. of bitstreams: 1 Alonso_KarinaCristina_M.pdf: 1360725 bytes, checksum: ef5853f896fca8b4d6065d76c5ba5352 (MD5) Previous issue date: 2011 / Resumo: A lesão medular é umas das mais graves e incapacitantes síndromes neurológicas que acomete o ser humano gerando distúrbios motores, sensitivos e neurovegetativos. A cadeira de rodas maximiza a locomoção funcional, a confiança, a independência e o conforto de seu utilizador e, portanto são utilizadas por grande parte dos deficientes físicos. Os indivíduos com lesão medular, aptos a transferir independentemente, possuem, normalmente, um lado preferencial para realizar suas transferências, o que pode gerar desequilíbrios musculares, futuras patologias e/ou lesões nos ombros. O objetivo do estudo foi avaliar a estratégia das transferências de paraplégicos da cadeira de rodas. Participaram do estudo doze sujeitos lesados medulares (T2 a T12), aptos a realizar independentemente a transferência da cadeira de rodas para um tablado com um metro quadrado de área por meio metro de altura. As imagens dos marcadores reflexivos nos pontos anatômicos foram capturadas por seis câmeras de infravermelho ProReflex e processadas através de um software específico (QTrac). Parâmetros cinemáticos do tronco, cabeça e ombros foram avaliados. A comparação das medidas entre os fatores estudados utilizou a ANOVA para medidas repetidas com transformação por postos. O nível de significância adotado para os testes estatísticos foi 5% ou ? 0,05. A pesquisa comparou três fatores: alturas da lesão (alta e baixa), lado de preferência e não para transferir e as duas primeiras fases da transferência (pré-levantamento e levantamento) para duração das fases da transferência, velocidade angular máxima e aceleração angular, índice de curvatura e deslocamento angular de cabeça, porém para deslocamento angular de ombros foi associado à comparação ombro líder e contralateral. A tarefa de transferência foi dividida em três fases: prélevantamento, levantamento e pós-levantamento. A duração das três fases e o índice de curvatura do esterno e da cabeça apresentaram significância estatística (p<0,05) na comparação das fases analisadas. O deslocamento angular dos ombros nos planos (x-y) e (y-z) mostraram significância estatística no efeito altura da lesão e lado da transferência (x-y: p=0.0470; y-z: p=0.0134) e o deslocamento angular da cabeça no plano (x-z) apresentou p=0.0274 no efeito lado da transferência. Os resultados obtidos com o estudo facilitaram a compreensão biomecânica e a descrição das características dos movimentos dos ombros, cabeça e tronco de sujeitos com lesão medular torácica, durante as transferências da cadeira de rodas. Embora, algumas variáveis não tenham atingido valores significativos, observou-se que há diferenças nas estratégias de transferências para as alturas das lesões / Abstract: Spinal Cord injury is one of the most severe and impairing neurological syndrome that causes motor, sensitive and central neural system disorders in humans. Wheelchair maximizes functional locomotion, the reliance, independence and the comfort of theirs users, so it is very used for the persons with physical deficiencies. These subjects usually perform their independent transfers using one side of their preference which may lead to a muscle unbalancing and future injuries. The objective of this study was to assess the wheelchair transfer strategies of paraplegic subjects. Twelve thoracic spinal cord injured subjects participated in this study (T2 to T12), and they were able to independently perform the transfers from a wheelchair to a table with an area of one square meter by half meter height. Images of reflexive anatomic markers were captured by six ProReflex infrared cameras and processed through a QTRac Capture software. Kinematics parameters of the trunk, head and shoulders were assessed. The comparison of the variables among the evaluated factors used ANOVA for repetitive measures with segmented factors. The significance adopted level for statistical tests was 5% or ? 0,05. This research compared three factors (injury height, preference and nonpreference side and phases) for transfer time of phases, maximum angular speed and angular acceleration, curve index and head angular displacement. And also besides the comparisons cited above, the shoulder angular displacement were compared the leading and contralateral shoulders. The transfer task was divided in three phases: pre-lift, lift and post-lift. Three phases duration and curve index had statistical significance (p<0.05). The shoulder angular displacements on x-y and yz plans showed statistical significance on injury height effect and transfer side (x-y: p=0.0470; y-z: p=0.0134) and head angular displacement on x-z plan showed p=0.0274 on transfer side effect. The obtained results with this research make easy the biomechanical understanding and the description of shoulder head and trunk movement characteristics of spinal cord injury subjects on their transfer tasks from wheelchair. Although some variables did not reach significant scores, it was observed that there are differences on transfer strategies for the heights of injuries / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

In 2011, a team of senior engineering students at Utah State University, in connection with the university’s Center for Persons with Disabilities, designed and prototyped an assistive technician creeper. Building on successful features and resolving issues discovered in design validation testing of the initial prototype, this thesis includes the refined development of a fully assistive technician creeper with emphasis on improvement of kinematic functionality, overall manufacturability, and integration of system safety features. The final design solution is a creeper that transforms a user bi-directionally between the seated position, and a maneuverable supine position, while requiring only simple manual actuation. New design requirements were established including specifications for user height, weight, and body mass distribution, driven by census and medical data suitable for 95% of individuals. Using 3D modeling software, an iterative design approach was used in conjunction with kinematic, and structural analyses, to generate an improved feature set that can be easily manufactured and assembled. Of particular interest is the modification to the kinematic system, which produces multiple single-degree-of-freedom kinematic motions from a single multi-degree-of-freedom kinematic mechanism. This promotes the use of a single motor to produce separate motions for adjusting upper body inclination, and raising the seat surface. The revised design adheres to principles of design for manufacturability and assembly, by using common economical manufacturing processes, minimizing part asymmetry and maximizing part reuse. Employment of engineering analyses, including kinematic, finite element, and failure modes and effects analyses quantified design validation and risk mitigation. Static force analysis and computations of fatigue and life expectancy of critical components supplement the analysis set. Analysis suggests all structural components were designed to meet a safety factor of 3.0 or better. This combined with the addition of safety features and system protection redundancies provide confidence in structural integrity and system reliability. This creeper will contribute to the world of assistive technologies by providing new mobility opportunities, improving the quality of life of individuals with certain physical disabilities. It is also well suited for users of all abilities and has potential to become a premium creeper for professionals.

Este trabalho consiste no projeto mecânico de um exoesqueleto robótico para paraplégicos com lesões medulares entre T2 a L1, ou seja, sem mobilidade da cintura para baixo e com mobilidade do peito para cima, inclusive das mãos. A utilização do equipamento necessita da utilização de muletas ou andadores. O mecanismo possui seis graus de liberdade, sendo quatro atuados por motorredutores (joelhos e quadris) e dois suportados por molas (tornozelos). Os motorredutores são projetados especialmente para o exoesqueleto, sendo compostos de um motor de corrente continua de imã permanente e um redutor harmônico do tipo panqueca acoplados de forma adequada para minimizar peso e volume. Para calcular os esforços solicitados em cada articulação foi desenvolvido um modelo dinâmico do corpo humano para simular os movimentos que o exoesqueleto é capaz de realizar, que são: marchar, sentar, levantar e subir e descer escadas. O modelo utilizado do corpo humano possui cinco ligamentos rígidos e é capaz de simular movimentos no plano vertical. Os resultados obtidos da simulação são comparados com resultados experimentais da literatura e são considerados satisfatórios. / This work presents a mechanical design of a robotic exoskeleton for paraplegics with spinal cord injuries between T2 to L1, that means, without mobility from the waist down and with mobility from the chest up, including the hands. For using the equipment the paraplegic needs the aid of crutches or walkers. The mechanism has six degrees of freedom, with four degrees actuated by gear motors (knees and hips), and two degrees supported by springs (ankles). The gear motors are designed especially for the exoskeleton. They are composed by an permanent magnet brushless electric motor conveniently coupled with an pancake harmonic speed reducer to minimize weight and volume. For calculating the efforts in each joint a model for the human body is developed to simulate the movements the exoskeleton can perform, which are: walk, sit, standup and climb up and down stairs. The human body model has five rigid links and it is capable to simulate movements in the vertical plane. The results obtained in the simulations are compared very well with experimental results from the literature.

Este trabalho consiste no projeto mecânico de um exoesqueleto robótico para paraplégicos com lesões medulares entre T2 a L1, ou seja, sem mobilidade da cintura para baixo e com mobilidade do peito para cima, inclusive das mãos. A utilização do equipamento necessita da utilização de muletas ou andadores. O mecanismo possui seis graus de liberdade, sendo quatro atuados por motorredutores (joelhos e quadris) e dois suportados por molas (tornozelos). Os motorredutores são projetados especialmente para o exoesqueleto, sendo compostos de um motor de corrente continua de imã permanente e um redutor harmônico do tipo panqueca acoplados de forma adequada para minimizar peso e volume. Para calcular os esforços solicitados em cada articulação foi desenvolvido um modelo dinâmico do corpo humano para simular os movimentos que o exoesqueleto é capaz de realizar, que são: marchar, sentar, levantar e subir e descer escadas. O modelo utilizado do corpo humano possui cinco ligamentos rígidos e é capaz de simular movimentos no plano vertical. Os resultados obtidos da simulação são comparados com resultados experimentais da literatura e são considerados satisfatórios. / This work presents a mechanical design of a robotic exoskeleton for paraplegics with spinal cord injuries between T2 to L1, that means, without mobility from the waist down and with mobility from the chest up, including the hands. For using the equipment the paraplegic needs the aid of crutches or walkers. The mechanism has six degrees of freedom, with four degrees actuated by gear motors (knees and hips), and two degrees supported by springs (ankles). The gear motors are designed especially for the exoskeleton. They are composed by an permanent magnet brushless electric motor conveniently coupled with an pancake harmonic speed reducer to minimize weight and volume. For calculating the efforts in each joint a model for the human body is developed to simulate the movements the exoskeleton can perform, which are: walk, sit, standup and climb up and down stairs. The human body model has five rigid links and it is capable to simulate movements in the vertical plane. The results obtained in the simulations are compared very well with experimental results from the literature.

Rating of Perceived Exertion (RPE) relates to how ‘hard’ or ‘easy’ an exercise feels. The Borg 6-20 RPE scale is the most widely used scale to estimate the overall, peripheral and central perception of effort. To date, there are a limited number of studies on the use and efficacy of perceived exertion in persons with spinal cord injury and/or disease. The findings from these studies are also equivocal. Therefore, the aims of this thesis were to assess: i) the relationship between the RPE and physical and physiological markers of exercise intensity during arm cranking exercise in able-bodied and individuals with spinal cord disease, ii) the efficacy of sub-maximal RPE values to predict peak oxygen uptake during arm cranking exercise in able-bodied and paraplegic individuals using different exercise protocols, iii) the scalar property of the RPE during arm cranking exercise in able-bodied and paraplegic individuals. To achieve these goals, the thesis has been broken down to a series of seven studies. In each of these studies, except study 6, a group of able-bodied and a group of paraplegic participants were recruited to asses these hypotheses. Paraplegic individuals had spinal cord injury with neurological levels at or below the sixth thoracic vertebra (T6) or flaccid paralysis as a result of poliomyelitis infection. These individuals were physically active and participated in sports like wheelchair basketball, weightlifting, wheelchair racing and table tennis at both professional and recreational levels. Able-bodied participants were healthy and free from pre-existing injuries and physically active but not arm-trained. There were strong relationships between the RPE and each of the physiological and physical indices of exercise intensity during arm cranking exercise regardless of group or gender. Peak oxygen uptake can be predicted with reasonable accuracy from sub-maximal oxygen uptake values elicited during a sub-maximal perceptually-guided, graded exercise test for paraplegic individuals but not for able-bodied participants. It has also been shown that peak oxygen uptake can be predicted from power output using the equation prescribed by the American College of Sports Medicine (ACSM, 2006). Furthermore, for able-bodied participants using estimation procedures, a passive process in which an individual is asked to rate how ‘hard’ or ‘easy’ an exercise feels, the ramp exercise test provided more accurate prediction of peak oxygen uptake compared to the graded exercise test. For paraplegic persons using estimation procedures, the graded exercise test provided more accurate prediction of peak oxygen uptake compared to the ramp exercise test. Finally, the scalar property of the RPE (i.e., similar proportions of time at a given RPE) was evident during arm cranking exercise regardless of group. In conclusion, the prediction of peak oxygen uptake from sub-maximal exercise tests would provide a safer environment of exercise testing. In addition, using a sub-maximal protocol would make peak oxygen uptake more available for sedentary and clinical population compared to the graded exercise test to volitional exhaustion. Prediction of peak oxygen uptake from power output using the ACSM equation would make the estimation of peak oxygen uptake more available for large groups of people. Similar proportions of time were observed at a given RPE regardless of group or exercise intensity. The early RPE responses will give an indicator for how long a participant is going to exercise. This has important implications for rehabilitation settings. Based on the RPE responses the tester or the observer can increase or decrease the work rate to enable the participant to exercise for the desired duration.

O estudo foi realizado com pessoas do sexo masculino e que viveram a experiência de sofrer um trauma que acarretou a lesão da medula espinal. Teve como objetivos: - compreender os significados que a pessoa atribui a sua experiência de ser lesado medular; - compreender a maneira como a dimensão atribuída ao significado de ser lesado medular se manifesta nas ações da pessoa; - desenvolver um modelo teórico representativo da experiência da pessoa que sofreu uma lesão traumática na medula espinal. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico, a Teoria Fundamentada nos Dados. A estratégia para a obtenção dos dados foi a entrevista. Dos resultados emergiram dois fenômenos - Sobrevivendo ao Acidente e Vivendo uma Nova Realidade. Destes, identificou-se a categoria central - Re dimensionando limitações e possibilidades. A compreensão da experiência da pessoa que adquire uma lesão da medula espinal possibilitou reconhecer como as vivências, que ocorrem após a constatação da deficiência física, são percebidas por esses indivíduos, e como redimensionam os significados que vão atribuindo às situações diferentes que passam a vivenciar. O modelo teórico mostra que a experiência de ter se tornado um paraplégico ou um tetraplégico, é permeada pela vivência de limitações, e dependências, sentimentos e reações que vão sendo dimensionados e redimensionados à medida que vai re elaborando significados e valores, e desenvolvendo ações que lhe apontam possibilidades, as quais toma posse mediante as escolhas que faz para dar continuidade ou sentido à vida preservada, porém modificada / A study conducted with adult males who had undergone the experience of suffering trauma causing spinal cord injury (SCI). The aim was to: - understand the meaning patients gave to their experience of being an SCI bearer; - understand how the dimensions attributed to being a SCI bearer manifested itself in the person\'s behavior; - develop a theoretical model representative of the experience of the person who suffered SCI. The study used as a theoretical reference Symbolic Interactionism and used the Grounded Theory methodology. Data was collected through interviews. Two phenomena emerged from the findings: \"Surviving the Accident\" and \"Living a New Reality\". Of these the central category was identified as Re defining limits and possibilities. Understanding of the experience of SCI bearers made it possible to recognize how the events that occurred after the diagnosis of the physical deficiency is perceived by the persons and how they redefine the meaning attributed to the different situations they came to experience after suffering the acquired physical deficiency. The theoretical model reveals that the experience of having become a paraplegic or tetraplegic involved a lot of coping with limitations and dependency, emotions and reactions that go on being defined and redefined as the individual restructured values and developed actions that led to possibilities of overcoming, which were adopted through the choices made, so as to give continuity of meaning to the life that remained, although in its modified state

This study explored the meaning people with spinal cord injuries give to physical activity and recreation participation as they make the transition from the protected environment of hospital rehabilitation to the reality of returning to their homes and communities. The experiences of 4 individuals between 15 and 24 years of age who had sustained spinal cord injuries within the previous five years were captured using the phenomenological methods of semi-structured individual interviews, focus group interviews, photographs, and field notes. Rimmers (1999) model of health promotion for people with disabilities combined with Peters (1996) model of disablement provided the conceptual framework for the study and facilitated the interpretation of the findings. The participants indicated that physical activity was a very important component to living a psychologically, socially and physically healthy lifestyle following a spinal cord injury. A thematic analysis revealed three themes: (a) as my body heals, (b) learning to be me, and (3) getting back to life. The importance of physical activity in maintaining a healthy lifestyle following a spinal cord injury was reflected in stories of physical activity as a component of hospital rehabilitation, the importance of physical activity during the transition from the hospital to the challenges of returning home, and finally, engagement in community based physical activity. A gap in the continuity of physical activity opportunities during the transition from in-hospital rehabilitation to the return to the community was identified.

This study explored the meaning people with spinal cord injuries give to physical activity and recreation participation as they make the transition from the protected environment of hospital rehabilitation to the reality of returning to their homes and communities. The experiences of 4 individuals between 15 and 24 years of age who had sustained spinal cord injuries within the previous five years were captured using the phenomenological methods of semi-structured individual interviews, focus group interviews, photographs, and field notes. Rimmers (1999) model of health promotion for people with disabilities combined with Peters (1996) model of disablement provided the conceptual framework for the study and facilitated the interpretation of the findings. The participants indicated that physical activity was a very important component to living a psychologically, socially and physically healthy lifestyle following a spinal cord injury. A thematic analysis revealed three themes: (a) as my body heals, (b) learning to be me, and (3) getting back to life. The importance of physical activity in maintaining a healthy lifestyle following a spinal cord injury was reflected in stories of physical activity as a component of hospital rehabilitation, the importance of physical activity during the transition from the hospital to the challenges of returning home, and finally, engagement in community based physical activity. A gap in the continuity of physical activity opportunities during the transition from in-hospital rehabilitation to the return to the community was identified.

Made available in DSpace on 2014-06-11T19:30:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-26Bitstream added on 2014-06-13T20:40:34Z : No. of bitstreams: 1 gaino_r_dr_ilha.pdf: 1468994 bytes, checksum: 221bcdeb2914e752b9067cea45ecab96 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Foram realizados estudos, projetos e simulações do controle não-linear da posição da perna de um paraplégico, com eletroestimulação, utilizando modelos fuzzy Takagi- Sugeno (T-S). Nessa pesquisa, foi adotado um modelo matemático que utiliza uma relação empírica do torque do músculo com a largura de pulso, representada por uma função de transferência de primeira ordem. A modelagem da dinâmica do modelo do paciente paraplégico foi realizada com variáveis de estado. Projetou-se um regulador fuzzy (T-S), inicialmente no ponto de operação com a posição da perna em 30o, utilizando-se a teoria de Lyapunov para o estudo da estabilidade dos sistemas dinâmicos e o projeto do controlador baseado em desigualdades matriciais lineares (Linear Matrix Inequalities, LMI). As especificações consideradas neste projeto foram a estabilidade, a taxa de decaimento e restrições nos sinais de entrada e saída. Foi também projetado um observador de estado e regulador com observador de estado, todos não-lineares e contínuos no tempo, para o paciente paraplégico, também baseado em LMI, no ponto de operação com a posição da perna em 60o. Devido a necessidade de implementação em hardware, um modelo discretizado foi proposto, para a obtenção de modelos fuzzy Takagi-Sugeno discretos no tempo, a partir de modelos fuzzy Takagi-Sugeno contínuos no tempo, considerando períodos de amostragem suficientemente pequenos. Análises te´oricas e simulações digitais comprovaram a sua eficácia. Reguladores com observadores contínuos no tempo, considerando o rastreamento da posição da perna de um paraplégico e uso de variáveis virtuais foram também propostos. Neste projeto, pôde-se variar a posição angular desejada sem a necessidade do cálculo do novo ponto de operação e do projeto de um novo controlador para cada ponto de operação. Um método de identificação de modelos locais... / This thesis presents studies, designs and simulations about the use of functional electrical stimulation, to control the leg position of a paraplegic patient. The plant is described by a nonlinear system using Takagi-Sugeno fuzzy models and a closed-loop control is presented. A transfer function represents the mathematical model related to the muscle torque and the pulse width. Considering the operation point at 30◦ and all state variables available, then a fuzzy regulator was designed. This design was based on the Lyapunov stability, Linear Matrix Inequalities (LMI), and considered the following specifications: decay rate, and input and output constraints. Moreover, the design of a state observer, also based on LMIs, to obtain a continuous-time regulator with an observer in the operation at 60◦ was presented. Due to the necessity of implementation in hardware, a new method to obtain a discrete-time T-S model of plants described by continuous-time nonlinear T-S models, considering small sampling periods was proposed. Another new methodology was proposed to design continuous-time regulators and observers, through the signal tracking (leg position of paraplegics) and the use of virtual variables. This procedure allows the tracking of the angular position, without the design of a new controller for each operation point. A new method for the identification of T-S local models, where the input is a step and the system operates around the operation point of the wanted local model was proposed. This procedure is based on LMI. Other new method, using state-derivative feedback, was proposed for the control of the leg position of a paraplegic patient, described by a T-S model, using only accelerometers as sensors. All the simulated results in this thesis show that the proposed procedures are efficient and offer good results to this control problem class.

Submitted by RICARDO GOUVEIA TEODORO (ricardo.teodoro@unesp.br) on 2018-10-16T20:04:29Z No. of bitstreams: 1 Tese - Ricardo Gouveia Teodoro 13-10-2018.pdf: 17108638 bytes, checksum: 32a3e14ede25e327e8ff29fb9d267225 (MD5) / Approved for entry into archive by Cristina Alexandra de Godoy null (cristina@adm.feis.unesp.br) on 2018-10-18T12:11:00Z (GMT) No. of bitstreams: 1 teodoro_rg_dr_ilha.pdf: 17108638 bytes, checksum: 32a3e14ede25e327e8ff29fb9d267225 (MD5) / Made available in DSpace on 2018-10-18T12:11:00Z (GMT). No. of bitstreams: 1 teodoro_rg_dr_ilha.pdf: 17108638 bytes, checksum: 32a3e14ede25e327e8ff29fb9d267225 (MD5) Previous issue date: 2018-08-13 / A Estimulação Elétrica Funcional tem sido utilizada para auxiliar no restabelecimento de funções motoras em paraplégicos. Neste trabalho é proposto um procedimento experimental para identificar as incertezas politópicas de um modelo dinâmico do movimento do membro inferior, produzido por estimulação elétrica aplicada no quadríceps. Foram realizadas comparações entre controle em malha aberta e dois controladores em malha fechada. O projeto dos controladores foi baseado em desigualdades matriciais lineares (LMIs). Os resultados experimentais foram obtidos para 5 voluntários hígidos e 4 voluntários paraplégicos. Devido à incerteza dos parâmetros da planta, os resultados experimentais mostraram que o sinal de controle é incerto para um ponto de operação. Pela primeira vez aplicou-se controle chaveado com incerteza e estimulação elétrica para controlar o movimento do membro inferior. O controlador chaveado u_(σ,ξ) (t)apresentou o menor valor da derivada temporal da função de Lyapunov e compensou a incerteza do sinal de controle. / Functional Electrical Stimulation has been used to aid and restore motor functions in paraplegics. In this work, we propose an experimental procedure to identify the polytopic uncertainties of a dynamic model of the lower limb movement produced by electrical stimuli applied to the quadriceps. A comparison between open-loop control and two closed-loop controllers was performed. The controller design was based on linear matrix inequalities (LMIs). Experimental results were obtained for 5 healthy volunteers and 4 paraplegic volunteers. Due to plant parameters uncertainties, the experimental results showed that the control signal is uncertain for an operating point. For the first time, a robust switched controller and electrical stimulation were applied to control the movement of the lower limb. The switched controller u_(σ,ξ) (t)presented the smallest time-derivative value of the Lyapunov function and compensated the uncertainty in the control signal.