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A body of nursing knowledge in rehabilitation cannot be attained until the specific problems nurses encounter in their work are identified. The purpose of this study was the identification of some of the specific nursing problems in relation to the paraplegic. This study included interviews with seventeen nurses caring for paraplegics during the three stages of their rehabilitation, during the acute stage, during the time of intensive rehabilitation, and after returning to the community. A basically unstructured interview method was used, permitting the nurses a wide scope in identifying nursing problems they had encountered. The specific nursing problems were summarized within components of a typology developed during the study. A total of sixty-eight different specific nursing problems were identified a total of 247 times. The greatest number of different specific nursing problems, fourteen, were within the component of the typology of psychological-emotional problems. The psychological-emotional problem identified most frequently, twelve times, was that of trying to help the paraplegic face the future as a disabled person. The largest per cent of the total number of nursing problems identified, 35.22 per cent, were within the component of the typology of physical problems. The three most frequently identified nursing problems were within this component. These were, maintaining the bowel and bladder function, thirty-one times, maintaining the integrity of the skin, twenty times, and being alert for complications, sixteen times. The largest number of different nursing problems, thirty, and the greatest per cent of the total number of nursing problems, 63.56 per cent, concerned the paraplegic himself. Seventeen different nursing problems, 19.84 per cent of the total number of nursing problems identified, concerned the paraplegic's relationship to those outside of the health care system. There were sixteen different nursing problems, 12.96 per cent of the total number of nursing problems, concerned with the paraplegic's relationship to the health care system. The remaining 3.64 per cent of the total number of nursing problems, five different ones, concerned the paraplegic's inanimate surroundings. Research should be done to discover the best way of solving the specific nursing problems identified in this study. Many of them are currently being dealt with by intuition or trial and error, others are being ignored. It also would be well to discover what paraplegics identify as their needs or problems as they move through the various stages of the rehabilitation program. Nursing which is aimed at helping the paraplegic accomplish his goals should be alert to what he regards as his problems and help him arrive at a satisfactory solution to them. / Applied Science, Faculty of / Nursing, School of / Graduate

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Orientador: Alberto Cliquet Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T03:56:05Z (GMT). No. of bitstreams: 1 Cacho_EnioWalkerAzevedo_M.pdf: 5346795 bytes, checksum: 6e74c1ae0171c8a520aa3738fe6e1bc4 (MD5) Previous issue date: 2004 / Resumo: O efeito do treino de marcha através da estimulação elétrica neuromuscular (EENM) em pacientes com lesão da medula espinhal (LME) tem sido bem estabelecido. A medula espinhal humana reconhece apropriadas informações sensoriais e pode modular respostas motoras que facilitam a locomoção através do treinamento de marcha EENM assistido. Neste trabalho, dez pacientes (9 homens e uma mulher; 19 - 40 anos) com LME crônica (7 completas e 3 incompletas, nível neurológico abaixo de TI) foram avaliados no Laboratório de Biomecânica e Reabilitação do Aparelho Locomotor/Unicamp, no início e no fim de um programa de 30 sessões de treinamento de marcha assistido com EENM. Instrumentos utilizados para mensuração foram: American Spinal Injury Association (ASIA), Escala de Capacidade de Deambulação, Medida de Independência Funcional (MIF), Escala Modificada de Ashworth e o Registro Multicanais da Eletromiografia de superficie (EMG) dos músculos sóleos (SO), gastrocnêmios mediais (GA) e tibiais anteriores (TA) bilaterais. Os resultados demonstraram uma melhora do padrão EMG nos músculos GA e SO, durante a fase de apoio, e uma significante redução na fase de oscilação. A melhora no padrão EMG do TA ocorreu apenas à esquerda. Os resultados sugerem que o treino de marcha assistido com EENM pode induzir mudanças nos centros medulares espinhais / Abstract: The useful effect of locomotion training through neuromuscular electrical stimulation (NMES) in patients with spinal cord injury (SCI) has already been established. The human spinal cord recognizes the appropriate sensorial information and can modulate responses about the motor pool which facilitates walking under NMES training. In this series, ten patients (9 male and 1 female; 19 - 40 yrs-old) with chronic spinal cord injury (seven complete and three incompIete, neurologic leveI beIow T2) were evaluated at the Biomechanics & Rehabilitation Lab./University Hospital-Unicamp: first as soon as the patients joined the Programme and after 30 NMES based gait sessions. Clinical protocoIs of the American Spinal Injury Association (ASIA), Ability Ambulation Scale, Functional Independence Measure (FIM), Modified Ashworth Scale and the multichannel register surface of Electromyography (EMG) of muscIe soIeous (SO), gastrocnemious medialis (GA) and tibialis anterior (TA) were assessed. Results demonstrated an improvement in the EMG pattem of GA and TO muscles, during the stance phase and a significant decrease in the swing phase. Improvement in the EMG pattem in the TA muscle occurs just in the Ieft leg. Results suggest that gait training with NMES does induce changes in the spinal cord neural center, thus triggering the recovering of functional abilities/gait of paraplegics / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

Orientadores Vera Lúcia da Silveira Nantes Button, Percy Nohama / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Elétrica e de Computação / Made available in DSpace on 2018-08-22T09:56:14Z (GMT). No. of bitstreams: 1 NogueiraNeto_GuilhermeNunes_D.pdf: 3511169 bytes, checksum: eab59dd67c7bd6370efd2d475664860e (MD5) Previous issue date: 2013 / Resumo: A lesão medular afeta a condução dos sinais motores e sensoriais na medula. Com isso, a realização de movimentos voluntários por pessoas com lesão medular é prejudicada quando não impossível. A estimulação elétrica neuromuscular (EENM) é uma técnica que pode auxiliá-los a contornar essas dificuldades, pois possibilita ativar a musculatura de um membro paralisado. Embora a EENM em malha aberta seja capaz de produzir movimentos em um membro paralisado, ele não é capaz de compensar automaticamente desvios angulares devidos a distúrbios. Fenômenos supressores de desempenho muscular como a fadiga muscular e a adaptação neuronal podem comprometer a qualidade de um movimento funcional evocado artificialmente. Por isso, sistemas de controle são incorporados a estimuladores elétricos. A mecanomiografia (MMG) pode fornecer informações sobre a condição de um músculo em contração. Este trabalho investiga a viabilidade do emprego de sinais de MMG no controle da aplicação de EENM visando a sua incorporação em estratégias de controle de membros inferiores (MMII) em lesados medulares sem treinamento. Para isso, foi desenvolvido um sistema integrado de monitoração multiparamétrica e EENM com capacidade de incorporação do sinal de MMG na estratégia de controle. Um ensaio com voluntários hígidos e contrações isométricas de membros superiores (MMSS) apontou variações em parâmetros de MMG no início e final da contração. Outro ensaio analisou o sinal de MMG e de ângulo com controle de EENM em malha e cadeia abertas para indivíduos hígidos e lesados medulares. Sinais de MMG e EENM em contrações dinâmicas de MMII foram registrados. Com o sistema integrado, aplicou-se EENM com controle de ângulo de joelho em malha fechada obtendo- se estabilidade angular do joelho de um lesado medular. Finalmente, o sistema integrado aplicou controle para estabilizar o ângulo de joelho e monitorar sinais de MMG. Os resultados de ensaios experimentais mostraram que parâmetros espectrais, como a frequência média de potência, apresentaram variações entre o início e o fim da contração quando a amplitude de EENM apresentou taxas de incremento mais elevadas. Conclui-se que existe viabilidade no emprego de MMG em estratégias de controle de EENM para MMII de lesados medulares em estabilidade angular, observando-se a taxa de incremento/decremento da saída do estimulador / Abstract: Spinal cord injury affects conduction of motor and sensory signals that flow through the spinal cord. Therefore, the performance of voluntary movements by spinal cord injured (SCI) persons is impaired, if not impossible. Neuromuscular electrical stimulation (NMES) is a technique that aids SCI individuals to overcome these difficulties, because it allows activation of paralyzed limb muscles. Though NMES in open loop and in open chain tasks is able to generate movements in paralyzed limbs, it is not capable to automatically compensate for angle deviations due to disturbances. Suppressive phenomena of muscle performance, such as muscle fatigue and motor neuron adaptation, can compromise the quality of an artificially elicited functional moment. Thus, closed-loop control systems are merged with electrical stimulators. Mechanomyography (MMG) can provide information about a contracting muscle condition. This work proposes to investigate the feasibility of using MMG signals in the control of NMES application aiming its incorporation in lower limb control strategies of untrained spinal cord injured persons. An integrated system was built, comprising a multiparametric acquisition system and a closed-loop controlled neuromuscular electrical stimulator. The integrated system is able to incorporate MMG signals in the control strategy. A test with healthy volunteers performing upper limb isometric contractions indicated variations in MMG parameters between the beginning and end of contraction. Another test investigated MMG signals and joint angles with NMES in open loop and in open chain to healthy and SCI individuals. NMES and MMG signals during lower limb dynamic contractions were registered. Using the integrated system, NMES was applied to the control of knee angle in closed loop configuration ensuring angular stability of both knees on a single SCI volunteer. Finally, the integrated system applied closed loop control to stabilize the knee angle, and monitored MMG signals. Experimental results revealed that spectral parameters such as mean power frequency presented variations between the beginning and end of contraction when NMES amplitude showed higher amplitude increase rates. In conclusion, there is feasibility of using MMG signals in control strategies of NMES for lower limbs of SCI persons in reasonable angle stability. However, one must observe the stimulator output increase/decrease rate / Doutorado / Engenharia Biomedica / Doutor em Engenharia Elétrica

The aim of the study was to provide a platform for the male paraplegic to explore the implications of the disability on his sexuality. A qualitative research method was utilised. In-depth interviews were conducted during October 1995 and February 1996 using a sample often black male in-patients at the beginning of their rehabilitation program and during their initial hospitalisation at Kalafong Hospital in Pretoria. The results of the study indicated that the newly injured person has a great need to talk about the impact of the injury on his life. Three major areas of concern emerged: physical appearance, loss of control and independence and relationships. All three areas were perceived to have an impact on sexuality. Rejection of the redefined intimacy by the able-bodied spouse, was perceived as a threat to sexual adjustment. / Social Work

The aim of the study was to provide a platform for the male paraplegic to explore the implications of the disability on his sexuality. A qualitative research method was utilised. In-depth interviews were conducted during October 1995 and February 1996 using a sample often black male in-patients at the beginning of their rehabilitation program and during their initial hospitalisation at Kalafong Hospital in Pretoria. The results of the study indicated that the newly injured person has a great need to talk about the impact of the injury on his life. Three major areas of concern emerged: physical appearance, loss of control and independence and relationships. All three areas were perceived to have an impact on sexuality. Rejection of the redefined intimacy by the able-bodied spouse, was perceived as a threat to sexual adjustment. / Social Work

The purpose of this study was to document the effects that a regular yoga therapy practice has on the quality of life for a paraplegic individual. Due to the unique nature of spinal cord injury (SCI), this was a case study with one participant. For 5 weeks the subject practiced a standardized yoga routine three times a week with a yoga teacher, receiving private instruction. Interview questions were asked before and after the intervention to document the participant's quality of life. Each week, the subject completed a modified SF-36 questionnaire as well as Cohen's Perceived Stress Survey. Perceived pain and perceived stress were the two primary variables monitored in the study. The results of this study demonstrated a slight reduction in perceived stress, a reduction in perceived pain, and an improvement in overall quality of life. Additionally, the subject increased her strength significantly from the beginning to the end of the study. Based on the findings in this study, it appears that a regular adapted yoga routine is beneficial for paraplegic individuals.

The study was undertaken to deepen understanding of living with a spinal cord injury (SCI) in the rural communities of the Eastern Cape Province, South Africa (RSA). The OR Tambo District Municipality, which was selected for its accessibility to the researcher, is virtually rural, the infrastructure is poorly developed and there is low socio-economic activity in the rural areas of the old Transkei. In the RSA services for management and rehabilitation of SCIs varies from province to province. A Heideggerian phenomenological approach was used to interpret the meaning of living with SCI persons in a rural community. The purpose was to describe and interpret what being-in the-world as a spinal cord injured person meant to the particpants. A key assumption in phenomenology is that understanding human beings and their actions is best achieved through examination of human experiences. Experience, including experience with living with SCI, offers itself as a record of human encounters, the interface between persons and their world, and experience can only be understood in terms of background and the social context of the experience (Pateman & Johnson 2000: 51). Phenomenological interviews with ten people living with SCI explored their experience. The overall goal was to increase awareness of their experiences of living with SCI, and to encourage incorporation of knowledge gained into nursing practice. The central question in the study was `What is it like to live with a spinal cord injury in a rural community? Data were analysed according to Heideggerian hermeneutic phenomenology. Two main themes were identified, namely reconceptualising being-in-the-world as a person with a disability; and being-with-each-other: experiencing being excluded, objectified and marginalized. The participants engaged in a process of reconstructing their identities following the traumatic loss of sensory and motor functioning. Data reflect the social and economic context in which living with SCI is experienced. The respondents' life experiences were influenced by socio-political, economic and historical factors, namely geographic location, poor infrastructure, poverty, low educational status, and unemployment and the community at large. It was noted that participants experienced difficulties in several areas in their daily life realm; naming, coping with health and disability problems, family interactions and relationships, and non-accessibility of amenities, including their own dwellings. In addition, being a person living with an SCI in the rural communities of the OR Tambo District Municipality carries a high physical and social risk due to lack of resources. The inability to live up to generally expected social roles led to role dissatisfaction. There is an urgent need for social support to overcome the negative societal attitudes experienced. They are forced into isolation with a limited social life and are poorly integrated into the communities in which they live. Most of what the participants raised pointed towards inadequate preparation for the outside world. Therefore, a holistic approach to rehabilitation is recommended, as holism means addressing the physical, social, emotional and cognitive needs. Accordingly, the researcher developed guidelines for facilitating community integration. In conclusion, understanding how people experience living with SCI in a rural community is an essential prerequisite to the development of appropriate strategies to facilitate community integration. / Health Studies / D. Litt et Phil (Health Studies)

Text in Afrikaans / Indigenous literature about the experience of a couple, where one of the spouses experiences a spinal cord injury, is scarce in the frame of social work. The experience of 5 couples (10 participants), after a spinal cord injury of one of the spouses was researched in this qualitative study. The aim of this research study is: • to reconnoiter participants’ experience of a spinal cord injury of a spouse, through semi-structured interviews with a purposeful chosen sample • to subject the research findings to a literature control • to make recommendations about how spouses can support each other, as well as how professional people can support client systems, where one of the spouses experience a spinal cord injury From the data it was determined that a spinal cord injury had significantly influenced the couples: - emotions - needs - perceptions (origination of experiences) Recommendations to couples as well as to professional people have been made. / Social Work / Thesis (M. Diac.)