Orientador: Antônio Guilherme Borges Neto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T19:11:36Z (GMT). No. of bitstreams: 1 Scalha_ThaisBotossi_D.pdf: 4661592 bytes, checksum: 22dd3d1e90578a09ed9428e79f83f094 (MD5) Previous issue date: 2013 / Resumo: O déficit somatossensorial está entre os resultados mais frequentes das lesões cerebrais, em especial após o acidente vascular cerebral (AVC), a alteração se torna importante, pois danifica a exploração eficaz do ambiente e o desempenho de tarefas diárias, afetando adversamente a qualidade de vida, a segurança pessoal, e a recuperação motora. Instrumentos de medida quantitativos e qualitativos capazes de projetar o perfil neurológico dos pacientes pós-AVC são amplamente utilizados e auxiliam os profissionais de saúde a avaliarem o nível de comprometimento das funções sensório-motoras e capacidades funcionais, quando estas são empregadas em conjunto garantem a projeção elucidativa do desempenho geral do paciente. O objetivo do Artigo 1 foi descrever a função somatossensorial do membro superior afetado de hemiparéticos crônicos pós-AVC e verificar as correlações entre instrumentos de medida das funções motora e sensorial, realizadas com e sem privação visual. Foram aplicadas as seguintes avaliações: Protocolo de Desempenho Físico de Fugl-Meyer (FM), Avaliação Sensorial de Nottingham (ASN), e os testes de: Manipulação de Papel (MP), Sequência Motora (SM), Alcance e Preensão (AP), Testes Funcionais (TF), Discriminação Tátil (DT), Discriminação de Peso (DP) e Reconhecimento Tátil de Objetos (RO) em 20 pacientes. Os resultados apontaram correlações moderadas entre a FM motora e itens da subescala sensação tátil da ASN (pressão, temperatura, toque bilateral e propriocepção); a FM sensibilidade correlacionou-se a ASN total; e o teste DP se correlacionou com itens da ANS (pressão, picada e localização tátil). Além disso, durante os testes realizados com privação visual os pacientes demonstraram pior desempenho, fortalecendo o fato de que pacientes pós- AVC se tornam mais dependentes de informações visuais para compensar a perda sensório-motora. O objetivo do Artigo 2 foi avaliar os efeitos de um programa de reabilitação somatossensorial em paciente hemiparéticos crônicos pós-AVC e propor metas para a reabilitação sensorial. Foram recrutados 20 pacientes que foram avaliados por duas escalas, sete testes específicos, e um teste diagnóstico. Todos os pacientes realizaram uma avaliação Inicial (aplicação dos instrumentos de medida); Tratamento Convencional (sem estímulo sensorial) segunda avaliação; Tratamento Específico (com estímulo sensorial); terceira avaliação; período de follow-up e; quarta avaliação. A intervenção consistiu no estímulo sensorial contínuo de objetos com texturas e com características superficiais diferentes; no treinamento de propriocepção para o membro superior afetado; e no treinamento de reconhecimento de objetos. Durante cada sessão, houve o treinamento dessas três atividades sensoriais. Os efeitos da intervenção com o tratamento específico através da exposição de estímulos sensoriais apresentou resultados expressivos da melhora da função sensorial nas duas escalas funcionais, em quatro dos sete testes realizados de olhos fechados, e em um dos quatro testes realizados de olhos abertos quando comparados ao do treinamento convencional. A proposta da reabilitação inclui o fato de que a apresentação de repetidos estímulos sensoriais maximiza o uso da função sensorial residual e se aproveita da recuperação sensória. Os programas de treinamento que incluem exercícios de estimulação com diferentes modalidades somatossensoriais podem ser mais adequados para a reabilitação do déficit somatosensorial e, além disso, podem proporcionar ganhos na função motora. A abordagem visa melhorar habilidades perdidas ao invés de focar sobre a compensação / Abstract: Somatosensory deficit is among the most frequent outcome of brain injury, especially after the stroke, the change becomes important because it damages the effective exploitation of the environment and the performance of daily tasks, adversely affecting the quality of life, personal safety, and motor recovery. Instruments for measuring quantitative and qualitative able to design the neurological profile of patients with stroke are widely used and help health professionals to assess the level of impairment of sensorimotor functions and functional abilities, when they are used together ensure the projection illuminating the of the patient performance. The aim of Article 1 was describe the somatosensory function of the affected upper limb of hemiparetic stroke patients and investigate the correlations between measurements of motor and sensory functions in tasks with and without visual deprivation. We applied the Fugl-Meyer Assessment (FMA), Nottingham Sensory Assessment (NSA), and motor and sensory tests: Paper manipulation (PM), Motor Sequences (MS), Reaching and Grasping (RG) Functional Tests (TF), Tactile Discrimination (TD), Weight Discrimination (WD) and Tactile Recognition of Objects (RO) in 20 patients. The results indicated moderate correlations between the FMA motor subscale and the tactile sensation score of the NSA. Additionally, the FMA sensitivity was correlated with the NSA total; and performance on the WD test items correlated with the NSA. Moreover, during the tests with visual deprivation patients demonstrated lower performance, reinforcing the fact that individuals who suffered from a stroke become more dependent on visual information to compensate for the loss sensory-motor. The aim of Article 2 was to evaluate the effects of a sensorimotor rehabilitation program for upper limb stroke in patients with chronic and somatosensory deficit and propose targets for sensory rehabilitation. We recruited 20 patients who were evaluated by two scales, seven specific tests, and a diagnostic test. All participants underwent an Initial Evaluation (application of measuring instruments); Conventional Treatment (without sensory stimulation); Second Assessment; Specific Treatment (with sensory stimulation); Third Evaluation; Follow-up period and, Fourth Assessment. The intervention consisted of continuous sensory stimulation with textures and objects that had different surface characteristics, proprioception training for the affected upper limb, and object recognition. Each session consisted of these three activities. The effects of intervention with specific treatment by exposing sensory stimulus showed significant improvement in sensory function in the two functional scales in four of the seven tests performed with eyes closed, and one of the four tests performed with eyes open compared to conventional training. The proposal includes rehabilitation of the fact that the repeated presentation of sensory stimuli maximizes the use of residual sensory function and takes advantage of sensory recovery. The training programs that include exercises with different modalities somatosensory stimulation may be more appropriate for the rehabilitation of somatosensory deficits and, in addition, can provide gains in motor function. The approach aims to improve lost abilities rather than focusing on compensation / Doutorado / Ciencias Biomedicas / Doutora em Ciências Médicas

Orientador: Maria Valeriana Leme de Moura Ribeiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T12:23:12Z (GMT). No. of bitstreams: 1 Airoldi_MarinaJunqueira_M.pdf: 5702275 bytes, checksum: 3c2bd8bd99c4abe1bd021c54e7de91e9 (MD5) Previous issue date: 2012 / Resumo: Objetivos: O Objetivo deste estudo foi descrever apresentação clínica da doença, a evolução neuromotora, assim como a epilepsia. Métodos: Foram incluídas no estudo 18 crianças nascidas a termo. A avaliação ocorreu nas idades entre 6 e 16 anos utilizando se o teste EB Teste. O estudo foi retrospectivo quanto aos dados relacionados a antecedentes, diagnóstico do AVC e evolução quanto à epilepsia e transversal quanto à avaliação neuromotora. Resultados: Das 18 crianças estudadas, 4 (22%) foram diagnosticadas com AVCI depois dos 3 meses de idade, principalmente pelos sinais de assimetria; 14 crianças (77%) foram diagnosticadas na fase aguda, sendo que 11 (79%) apresentaram convulsões, 5 (36%), hipotonia e 3 (21%) sucção débil. Na evolução das 18 crianças, 11 (61%) desenvolveram epilepsia. As crianças que tiveram crises na fase aguda apresentaram probabilidade significativamente maior de evoluir com epilepsia (p <0.05). Em relação à neuroimagem, 17 indivíduos apresentaram comprometimento na Artéria Cerebral Média, com acometimento do hemisfério esquerdo em 13. Foram diagnosticadas com Paralisia Cerebral com hemiparesia 16 crianças. Em relação à escala neuromotora aplicada, EB teste, todas as crianças avaliadas apresentaram déficit em todas as dimensões estudadas. Crianças com lesões mais extensas apresentaram pior desempenho motor. Não houve recorrência do AVC. Conclusão: É importante identificar sintomas e sinais na fase aguda, permitindo que profissionais confirmem com imagem o comprometimento vascular no período perinatal. É necessário valorizar acompanhamento ambulatorial, identificando anormalidades neuromotoras e epilepsia na evolução, promovendo tratamento adequado para melhora da qualidade de vida destas crianças / Abstract: Objectives: The aim of this study was to describe clinical presentations, neurodevelopmental and epilepsy outcomes of IPS in children. Methods: A retrospective study was conducted in a children population and it was evaluated term infants ! 38 weeks gestational age, aged between 6 and 16 years, with diagnosis of IPS. The diagnosis was confirmed in 18 cases by Neuroradiology (CT or MRI). We studied the neuroimaging and data from acute phase as well as the evolution of these children through neuromotor scale IB Test. Results: In 18 cases, 4 (22%) was diagnosed with brain infarction after 3 months of age, especially for signs of asymmetry. Of the 14 remaining patients (77%) diagnosed early, 11(79%) had seizures, 5 (36%) had hypotonia and 3 (21%) had signs of low suction. In the group of 18, 11 (61%) evolved with epilepsy and children with seizures in the acute phase were more likely to develop epilepsy (p <0.05). Large cortically based infarcts were the most common pattern and, in 17 cases, it affected the middle cerebral artery territory involving the left size in 13. 16 children were diagnosed with cerebral palsy hemiparetic. In neuromotor scale applied, IB Test, all children presented deficit in all dimensions studied. Children with more extensive lesions had worse motor performance. There was no recurrence of stroke. Conclusion: It is important to understand symptoms and signs of acute allowing professionals to carry out identification of vascular involvement in the perinatal period. It is necessary to enhance outpatient identifying neuromotor abnormalities and epilepsy in the evolution promoting appropriate treatment to improve quality of life for these child / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

Respiratory complications in dogs with cervical myelopathies can be life-threatening and are attributed to spinal cord morbidity secondary to cervical disease or decompressive surgery causing diaphragmatic dysfunction. However, diaphragmatic dysfunction in these dogs has not been described. Thirtyive client-owned dogs were recruited with 14 control and 21 test dogs. Dogs were evaluated for the presence of diaphragmatic dysfunction using radiography, M-mode ultrasonography, and fluoroscopy (gold standard) before and after an anesthetic or surgical event. Diaphragmatic dysfunction was observed more frequently in dogs with cervical disease prior to surgery (8/21 dogs, 38.1%) compared to control dogs (3/14 dogs, 21.4%) but was not statistically significant (odds ratio, 2.3; 95% confidence interval, 0.48-10.6; P = 0.30). Further, the frequency of diaphragmatic dysfunction did not significantly increase following surgical decompression in either group. Thus, dogs in this study with cervical disease and undergoing decompressive surgery were not considered to have a higher probability of diaphragmatic dysfunction compared to the control dogs.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Made available in DSpace on 2015-12-06T23:05:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2005 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundo de Auxílio aos Docentes e Alunos (FADA) / Objetivo: Este estudo piloto procurou revisar a metodologia e discutir a aplicação da Terapia por Contensão Induzida (TCI) nos pacientes com acidente vascular cerebral isquêmico (AVCI) crônico, em um centro de reabilitação brasileiro. Método: Uma ampla revisão da literatura médica foi realizada para adaptar esta técnica em nosso meio. Foram selecionados 10 pacientes que se submeteram a 6 horas de tratamento por duas semanas consecutivas. Entre os critérios de seleção destacam-se AVCI em território da artéria cerebral média. Nestes 14 dias os pacientes foram submetidos a atividades motoras repetitivas utilizando o membro superior parético, enquanto o membro não parético era mantido com um dispositivo de contenção. Resultados: Houve melhora significativa no déficit motor do membro superior parético e concomitante melhora na resposta ao Teste de Função Motora de Wolf. Conclusão: Esta nova técnica de reabilitação específica para pacientes com déficit motor moderado em membro superior parético é viável em nosso país. Nosso estudo sugere que a dominância e tempo de lesão têm um efeito modificador sobre o tratamento em pacientes com lesão isquêmica crônica no território da artéria cerebral média. / Purpose: The purpose of this pilot study is to review evidence and discuss the aplly of Constraint Induced Movement Therapy (CIMT) protocol in a brazilian center of rehabilitation in chronic patients with isquemic stroke. Methods: A wide revision of the medical literature was accomplished to adapt this technique for our population. Ten patients were selected and submitted at 6 hours of treatment for 2 weeks. Among the selection criteria they stand out schemic stroke in the middle cerebral artery territorry. On these 14 days the patients were submitted to repetitive motor activities using the paretic upper-limb while the unaffected limb was maintained with a constraint device. Results: There was a significant improvement of function of the affected upper-limb in the motor deficit of the paretic upper-limb and concomitant improvement in the answer to the Wolf Motor Function Test. Conclusions: This new technique of specific rehabilitation for patients with moderate motor deficit in paretic upper limb is feasible in Brazil. Our study suggest that the dominance and the time of lesion have a modifier effect on the treatment in patients with chronic schemic lesion in the middle cerebral artery territory. / BV UNIFESP: Teses e dissertações

This diploma thesis deals with the issue of the eradication of infectious polio and its current problems. Polio is a highly infectious disease of viral origin. The most effective form of protection from the disease is vaccination. The main aim of this work was to determine the major issues in polio surveillance in the Pilsen region at present. Intermediate goals were determined in relation to the main aim: to ascertain the awareness of practicing paediatricians about the principles of poliomyelitis surveillance with an emphasis on diagnosing and reporting cases of acute palsy and further to ascertain the quality of the cooperation between the locally competent public health authority and practicing paediatricians in the field of poliomyelitis surveillance. The work is divided into two parts, theoretical and practical. The practical part was elaborated using a qualitative method based on semi-structured interviews with practicing paediatricians and with the locally competent public health authority. The research was participated in by 9 practicing paediatricians and one public health authority worker from the Pilsen region, with an average length of practice of 20 years. The resulting data was then evaluated by a coding method and divided into schemes according to Švaříček and Šeďová (2007). Three research questions were defined based on the set aims: RQ1: What do practising paediatricians see as the prime problems in polio surveillance? RQ2: How many cases of acute palsy do practising paediatricians record and subsequently report to the competent public health authority? RQ3: What is the quality of the cooperation between practising paediatricians and the locally competent public health authority? The research revealed that, according to the practising paediatricians, the problem in poliomyelitis surveillance is refusal of the vaccination and the associated decreasing immunisation coverage of the population. The next most commonly reported problem was population migration. Furthermore, it was found that not one practising paediatrician recorded or reported cases of acute palsy in their surgery. Only one respondent encountered acute palsy 10 years ago. The answer to the last research question is also apparent from the information obtained. More than half of the respondents agreed that so far there is no cooperation on this issue. Although four respondents stated that the cooperation is at a high level and is of very good quality.

Orientador: Donizeti Cesar Honorato / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T10:38:27Z (GMT). No. of bitstreams: 1 Lima_NubiaMariaFreireVieira_D.pdf: 2259312 bytes, checksum: 39bc49e5fb60f586b16aa8bfa15bd3cc (MD5) Previous issue date: 2014 / Resumo: Mais da metade das vítimas de Acidente Vascular Cerebral (AVC) apresentará algum grau de incapacidade, especialmente na extremidade superior (ES), e esta pode ser agravada pelos déficits sensoriais protopáticos e/ou epicríticos. Astereognosia, déficits das sensações táteis, dolorosas, térmicas e proprioceptivas são frequentes e podem afetar ambas as ES, resultando em prejuízos no alcance/preensão e dependência da orientação visual (OV). A redução do input sensorial da ES ipsilateral ao AVC é realizada para avaliar as conexões interhemisféricas e os efeitos na função sensório-motora das ES¿s. A crioterapia pode reduzir a velocidade de condução nervosa e minimizar o input sensorial da ES ipsilateral ao AVC. O objetivo do artigo 1 foi descrever o desempenho sensório-motor da ES de paciente pós-AVC crônico, na presença e ausência de OV. A ES foi avaliada pelo Protocolo de Desempenho Físico de Fugl-Meyer (FM), Avaliação Sensorial de Nottingham (ASN), 10 testes funcionais (TF) e testes de sequência motora (SM). A paciente apresentou déficits táteis, proprioceptivos e astereognosia na ES contralateral ao AVC e, a despeito do leve comprometimento motor, demonstrou lentidão/incapacidade de realização dos TF e SM na ausência da OV, caracterizando a paresia aferente. O objetivo do artigo 2 foi investigar as alterações sensoriais no complexo punho-mão ipsilateral de 28 sujeitos pós-AVC crônico e correlacioná-las com as disfunções sensório-motoras contralaterais à lesão, testes funcionais (com e sem OV), lateralidade do AVC e dominância manual. Foram aplicados a estesiometria, ASN, subescalas sensorial e motora de FM e testes funcionais. Os resultados revelaram distúrbios sensoriais ipsilaterais protopáticos e epicríticos em 64% dos indivíduos. Aqueles com lesão em hemisfério cerebral direito mostraram melhor sensação tátil na ES ipsilateral ao AVC e houve perda sensorial significativa na ES ipsilateral em dois sujeitos canhotos. Não houve correlação entre os déficits sensoriais das ES nem correlação entre os déficits sensoriais ipsilaterais e o comprometimento motor contralateral ao AVC. Os objetivos do artigo 3 foram aplicar a hipotermia por imersão da ES ipsilateral ao AVC (punho-mão) associada à intervenção sensorial (IS) na ES contralateral ao AVC crônico e avaliar os efeitos imediatos e em longo prazo. Foram acompanhados 27 sujeitos pós-AVC crônico nos grupos 1 (n=14) e 2 (n=13). O grupo 2 foi submetido à hipotermia por imersão do punho e mão ipsilaterais ao AVC com IS e o grupo 1 realizou IS (10 sessões). Foram mensurados estesiometria, FM, ASN, TF, SM, discriminação tátil, de peso, nível de desconforto e parâmetros hemodinâmicos. Os efeitos imediatos foram estabilidade hemodinâmica durante e após a hipotermia, ausência de alterações sensoriais na ES contralateral ao AVC, hipoestesia na ES ipsilateral (dermátomos C6 e C8) (p<0,05) e níveis de desconforto aceitáveis. Em longo prazo, tem-se a melhora nos TF (com e sem OV) e localização tátil, propriocepção consciente e função tátil nos dermátomos C6 e C7 na mão contralateral ao AVC do grupo 2 (p<0,05). O uso da hipotermia de imersão da ES ipsilateral associado à intervenção sensorial na ES contralateral ao AVC conduziu à melhora sensório-motora da ES oposta ao AVC crônico / Abstract: More than half the stroke victims will present some degree of disability, especially in the upper extremity (UE), and this may be influenced by somatosensory deficits. Astereognosis, deficits of tactile, painful, thermal and proprioceptive disturbances are frequent and can affect both ES, resulting in losses in the reach/grasp and dependence on visual guidance (VG). The reduction of ipsilesional UE¿s sensory input is performed to evaluate the interhemispherics connections and effects on sensorimotor function in stroke subjects. Cryotherapy can reduce the conduction velocity of sensory fibres and can minimise sensory input to the ipsilesional UE. The purpose of Article 1 was to describe the UE¿s sensorimotor performance in chronic post-stroke subject, in the presence and absence of VG. The contralesional UE was assessed by the Fugl-Meyer Assessment (FMA), Nottingham Sensory Assessment (NSA), 10 functional tests (FT) and motor sequence (MS). Despite the mild motor impairment, the patient presented tactile, proprioceptive dysfunctions and astereognosis in contralesional UE and slowness/failure to achieve FT and MS test in the absence of VG, characterizing the afferent paresis. The Article 2 investigated the changes in the ipsilesional wrist and hand of 28 stroke chronic stroke subjects and correlate them with the sensory-motor dysfunction contralateral to the lesion, functional tests (with and without VG), stroke laterality and hand dominance. The subjects were evaluated by esthesiometry, ASN, sensory and motor subscales FMA and FT. The results showed sensory disorders in 64% of individuals. Those with lesions in the right cerebral hemisphere showed better tactile sensation in the ipsilesional UE and significant sensory loss was found in the ipsilesional UE in two left-handed subjects. There was no correlation between sensory deficits of UE¿s or correlation between ipsilesional sensory deficits and contralesional motor impairment. The Article 3 applied immersion hypothermia of an ipsilesional upper extremity (UE) and sensorial intervention of contralesional UE of chronic post-stroke patients to evaluate the immediate hemodynamic, sensorimotor and long-term effects. The sample included 27 stroke patients allocated into group 1 (n=14), which received conventional physiotherapy for the contralesional UE, and group 2 (n=13), which was submitted to immersion hypothermia of the ipsilesional wrist and hand in ten sessions. Assessments were performed pre- and post-treatment and at follow-up using esthesiometry, FMA, NSA, FT, tactile and weight discrimination, MS, level of comfort and hemodynamic parameters. The immediate effects of immersion hypothermia were hemodynamic stability during and after each session, an absence of sensory changes in the UE and hypoesthesia in dermatomes, C6 and C8, of the ipsilesional UE (p<0.05), which maintained acceptable levels of comfort. Significant long-term improvements in test scores with and without visual guidance, using tactile localization, conscious proprioception and in tactile function of the C6 and C7 dermatomes of the contralesional hand in group 2 (p<0.05). Immersion hypothermia of the ipsilesional UE in chronic stroke patients is a safe, inexpensive and practical, with good patient adherence to the technique. The use of immersion hypothermia on the ipsilesional UE improved motor and sensitivity functions in the contralesional UE of chronic stroke patients / Doutorado / Ciencias Biomedicas / Doutora em Ciências Médicas

The purpose of this Master thesis was to evaluate the effects of the Mirror program on upper- limb motor recovery, self-sufficiency and active range of wrist movement in patients after brain injury. It was included sixteen participants within maximal four months after stroke. Patients were separated into experimental and control group, both with eight members. Experimental group underwent Mirror therapy. Both group participated in a standard rehabilitation program included Physiotherapy, Occupational therapy, physical therapy and movement practice on device. Experimental group patients additionally participated in Mirror therapy program for 30 mins, four times a week, for three weeks. The Fugl-Meyer Assessment, Functional Independence Measure and goniometric measurement of active movement were used to assess recovery of upper-limb movement. Mirror therapy improve upper-limb motor recovery in patients after brain injury. This research demonstrates it with significant difference between both groups, where the experimental group have improved (0,02). I have also proved Mirror therapy, when included in occupational therapy, improves the self-sufficiency of people with neurological deficit. Comparing the data from Functional Independence Measurement, I found the difference between groups statistically...

A total of 12 multicomponent solutions of various compositions were developed in which we attempted to blend calcium and phosphoric salts, which usually precipitate and form sediments. Among the medicines of similar composition and purpose registered in Lithuania, there is none containing all three important macroelements: Ca, Mg, and P. After the tests, one of the solutions tested – C2 – was registered in Lithuania and was manufactured by AB Ukmergės Biofabrikas (Lithuania) for several years. Production technology of the developed preparation – Kamavetas – is patented (patent No. LT 4509 B. 1999 05 25). Kamavetas is the first preparation created and manufactured in Lithuania, which contains Ca, Mg, and P salts and glucose. It is convenient to use, because the animal receives several mineral substances within a single infusion.

This thesis summes up findings concerning the pathogenesis, clinical picture, diagnostic, and the therapy of peripheral paresis of the facial nerve, with accent on physiotherapeutical methods of treatment of such disorder. Here is also a description of Polyelectromyography that could become one possibility how to objectively judge the differences in the activation of mimical muscles in patients diagnosed with peripheral paresis of the facial nerve during various kinds of mimical movements. The practical part is concerned with and is talking about the use and application of my knowledge of the theory in practice with providing therapy to my patients suffering from peripheral paresis of the facial nerve by applying Vojta's reflex locomotion. The immediate effect of the therapy is here objectively and in detail analysed and described. Powered by TCPDF (www.tcpdf.org)