Thesis (M.S.)--Brock University, 2009. / Includes bibliographical references (leaves 63-72).

An innovative Partially Immersed Approach, based on mixed principles of land and aquatic therapy theories was developed to enhance sitting adaptation and functioning in an Aquatics Therapy environment, thus improving quality of life for children with Cerebral Palsy. The approach aimed to enhance motor adaptation, engendering adaptation in psychosocial domains of quality of life. It employed a specially developed therapeutic treatment chair, in an unloading toward loading strategy, to regulate and control percentage of weight-bearing by manipulation of buoyancy (Archimedes principle). Participants were bilateral spastic hypertonia, Cerebral Palsy children, aged 10-15 years. Mixed-method methodology was used to investigate effectiveness of treatment, employing a small sample in a multiple case study. In conclusion, the developed approach enables aquatic therapy to be employed to improve motor function adaptation on land and consequently enhancing adaptation in other psychosocial domains - perceived competence, empowerment and motivation - thus improving quality of life for children with cerebral palsy, sustained at a one-year post-intervention test.

Reaching a target quickly and accurately with a robotic arm containing multiple joints while avoiding moving and fixed obstacles can be a daunting (and sometimes impossible) task for any user behind the remote control. Current existing solutions are often hard to use and to scale for all user body types and robotic arm configurations. In this work, we propose a vision-based gesture recognition approach to naturally control the overall posture of a robotic arm using human hand gestures and an inverse kinematic exploration approach using the FABRIK algorithm. Three different methods are investigated to intuitively control a robotic arm's posture in real-time using depth data collected by a Kinect sensor. Each of the posture control methods are users scalable and compatible with most existing robotic arm configurations. In the first method, the user's right index fingertip position is mapped to compute the inverse kinematics on the robot. The inverse kinematics solutions are displayed in a graphical interface. Using this interface and the left hand, the user can intuitively browse and select a desired robotic arm posture. In the second method, the user's right index fingertip position and finger direction are respectively used to determine the end-effector position and an attraction point position. The latter enables the control of the robotic arm posture. In the third method, the user's right index finger is mapped to compute the inverse kinematics on the robot. Using static gesture with the same hand, the user's right index finger can be transformed into a virtual pen that can trace the form of the desired robotic arm posture. The trace can be visualized in real-time on a graphical interface. A search is then performed using an inverse kinematic exploration and the Dynamic Time Warping algorithm to select the closest matching possible posture. In the last two proposed methods, different search strategies to optimize the speed and the inverse kinematic exploration coverage are proposed. Using a combination of Greedy Best First search and an efficient selection of input postures based on the FABRIK's algorithm characteristics, these optimizations allow for smoother and more accurate posture control of the robotic arm. The performance of these real-time natural human control approaches is evaluated for precision and speed against static (i.e. fixed) and dynamic (i.e. moving) obstacles in a simulated experiment. An adaptation of the vision-based gesture recognition system to operate the AL5D robotic arm was also implemented to conduct further evaluation in a real-world environment. The results showed that the first and third methods were better suited for obstacle avoidance in static environments not requiring continuous posture changes. The second method gave excellent results in the dynamic environment experience and was able to complete a challenging pick and place task in a difficult real-world environment with static constraints.

Les études neurophysiologiques de la locomotion ont été en très grande majorité conduites chez l’animal. Elles ont permis de mettre en évidence une région locomotrice dans le mésencéphale, dans laquelle le noyau pédonculopontin (NPP) joue un rôle prépondérant. Des troubles de la marche et de l’équilibre dans la maladie de Parkinson sont en lien avec la perte de neurones cholinergiques dans le NPP, mais également avec la dysfonction dopaminergique dans les ganglions de la base. L’activité du noyau subthalamique (NST) est impactée par la perte dopaminergique. Recevant de nombreuses afférences corticales et ayant une connectivité réciproque forte avec le PPN, la connectivité du NST suggère son importance pour le contrôle locomoteur. Néanmoins, il existe peu de données sur le rôle du NST et du NPP dans le contrôle de la marche et de l’équilibre chez l’Homme. Ce manuscrit regroupe des enregistrements électrophysiologiques du NST pendant l’initiation de la marche, une étude de l’effet de la fréquence de la stimulation cérébrale profonde du NST sur l’initiation de la marche en contexte de charge cognitive, une étude par immunohistochimie de la région du NPP chez l’Homme, et des données préliminaires d’activité électrophysiologique du NPP pendant une tâche de marche imaginaire et l’initiation de la marche. Ensemble, ces données participent à une meilleure compréhension des bases anatomo-fonctionnelles du contrôle de la marche et de l’équilibre chez l’Homme. De plus, la mise en évidence de marqueurs électrophysiologiques des troubles de la marche et de l’équilibre laisse à penser que la prise en charge de ces troubles est possible par stimulation cérébrale profonde. / Neurophysiological studies of locomotion have been in majority driven on animal models. These approaches led to the identification of a mesencephalic locomotor region in which the pedonculopontin nucleus (PPN) plays a preponderant role. Gait and posture disabilities in Parkinson’s disease were linked with a loss of cholinergic neurons in the PPN as well as a dopaminergic dysfunction in the basal ganglia. The activity in the subthalamic nucleus (STN) is impacted by the dopaminergic loss. The STN receives numerous cortical inputs and is reciprocally connected with the PPN, suggesting an important role of the STN in the locomotor control. However, few data exist on the role of the STN and the PPN in gait and balance control in humans. This manuscript regroups electrophysiological recordings of the STN during gait initiation, a study of the effect of deep brain stimulation frequency of gait initiation in the context of cognitive load, an immunochemistry study of the region of the PPN in human, and preliminary results of the electrophysiological activity of the PPN during virtual gait and real gait initiation. Together, these data participate to a better understanding of the anatomo-functional basis of the gait and balance control in human. Moreover, the identification of electrophysiological markers of gait and balance dysfunction suggest that a deep brain stimulation may be relevant for their alleviation.

Title: Postural stabilization and balance - theoretical background and definitions (literature review) Objectives: The aim of this theses is to investigate the present situation of theoretical background of postural stabilization and balance and find out the differences between both of these phenomenons. The theses should summarize the current literature including the newest studies. Furthermore, it discusses the most used computerized measurements methods for assessing balance and postural control. Methods: The theses has character of literature review. It is divided into several parts. The beginning introduces the theoretical background. The descriptive and analytical chapter discuss the most used computerized measurement methods for assessing balance and postural control. The discussion summarizes the current situation and results of the theses. Results: The total amount of the 104 studies was found, but only 12 of them met the criteria of the theses. Currently the most used methods for assessing balance and postural control are the computerized dynamic posturography and the visual feedback posturography. In the published studies there were found several differences in the methods of posturography. Even, there was revealed ideological diversity in the authors' opinions and disunity in...

Orientador: Cesar Renato Foschini / Resumo: Desenvolvimento de uma ortese personalizada para subluxação de ombro por manufatura aditiva a partir de escaneamento corporal. A órtese é um dispositivo aplicado à superfície externa do corpo para: controlar o alinhamento biomecânico, corrigir ou acomodar a deformidade, proteger e suportar uma lesão, auxiliar na reabilitação, reduzir a dor, aumentar a mobilidade e a independência. Nos últimos anos, o desenvolvimento de órteses usando manufatura aditiva tem se incrementado tanto para membros superiores como inferiores devido a sua capacidade de reposicionar o membro de maneira mais precisa e personalizada. Este trabalho teve como objetivo desenvolver uma metodologia para projetar e fabricar uma órtese de subluxação de ombro utilizando escaneamento corporal e manufatura aditiva. O usuário foi submetido ao escaneamento 3D para obtenção do modelo digital sólido em formato 3D, operações elementares espaciais foram aplicadas ao modelo escaneado do usuário para a obtenção da órtese a fim de gerar uma silhueta tridimensional adequada ao ombro/tórax do paciente. Finalmente, a silhueta foi evoluída a órtese pela agregação de espessura, furos e contornos. Uma vez obtida a órtese, foi impressa, ajustada e testada no paciente. Uma primeira versão foi proposta em função do relato do paciente quanto à adaptação do ombro e conforto, e outras duas versões evolutivas foram desenvolvidas e avançaram para outros aspectos importantes como a redução de peso, graus de liberdade nos ombros saudávei... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Development of a custom shoulder orthosis by additive manufacturing from body from body scan. Orthotics is a device applied to the external surface of the body to control biomechanical alignment, correct or accommodate the deformity, protect and support an injury, assist in rehabilitation, reduce pain, increase mobility and independence. In recent years, the development of orthosis using additive manufacturing has been increasing for both upper and lower limbs because of their ability to more accurately and custom reposition the limb. This work aimed to develop a methodology to design and manufacture a shoulder subluxation orthosis using body scanning and additive manufacturing. The user underwent 3D scanning to obtain the solid digital model in 3D format, spatial elemental operations were applied to the user's scanned model to obtain the orthosis to generate a three-dimensional silhouette suitable for the patient's shoulder / chest. Finally, the silhouette was evolved into orthosis by aggregating thickness, holes, and contours. Once the orthosis was obtained, it was printed, adjusted and tested on the patient. A first version was proposed based on the patient's report on shoulder adaptation and comfort, and two other evolutionary versions were developed and advanced to other important aspects such as weight reduction, degrees of freedom in healthy shoulders and comfort gain. In each of the three prototypes, an evaluation questionnaire was applied to the user to improve diffe... (Complete abstract click electronic access below) / Mestre

In children, joint hypermobility (typified by structural instability of joints) manifests clinically as neuro-muscular and musculo-skeletal conditions and conditions associated with development and organization of control of posture and gait (Finkelstein, 1916; Jahss, 1919; Sobel, 1926; Larsson, Mudholkar, Baum and Srivastava, 1995; Murray and Woo, 2001; Hakim and Grahame, 2003; Adib, Davies, Grahame, Woo and Murray, 2005:). The process of control of the relative proportions of joint mobility and stability, whilst maintaining equilibrium in standing posture and gait, is dependent upon the complex interrelationship between skeletal, muscular and neurological function (Massion, 1998; Gurfinkel, Ivanenko, Levik and Babakova, 1995; Shumway-Cook and Woollacott, 1995). The efficiency of this relies upon the integrity of neuro-muscular and musculo-skeletal components (ligaments, muscles, nerves), and the Central Nervous System’s capacity to interpret, process and integrate sensory information from visual, vestibular and proprioceptive sources (Crotts, Thompson, Nahom, Ryan and Newton, 1996; Riemann, Guskiewicz and Shields, 1999; Schmitz and Arnold, 1998) and development and incorporation of this into a representational scheme (postural reference frame) of body orientation with respect to internal and external environments (Gurfinkel et al., 1995; Roll and Roll, 1988). Sensory information from the base of support (feet) makes significant contribution to the development of reference frameworks (Kavounoudias, Roll and Roll, 1998). Problems with the structure and/ or function of any one, or combination of these components or systems, may result in partial loss of equilibrium and, therefore ineffectiveness or significant reduction in the capacity to interact with the environment, which may result in disability and/ or injury (Crotts et al., 1996; Rozzi, Lephart, Sterner and Kuligowski, 1999b). Whilst literature focusing upon clinical associations between joint hypermobility and conditions requiring therapeutic intervention has been abundant (Crego and Ford, 1952; Powell and Cantab, 1983; Dockery, in Jay, 1999; Grahame, 1971; Childs, 1986; Barton, Bird, Lindsay, Newton and Wright, 1995a; Rozzi, et al., 1999b; Kerr, Macmillan, Uttley and Luqmani, 2000; Grahame, 2001), there has been a deficit in controlled studies in which the neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility have been quantified and considered within the context of organization of postural control in standing balance and gait. This was the aim of this project, undertaken as three studies. The major study (Study One) compared the fundamental neuro-muscular and musculo-skeletal characteristics of 15 children with joint hypermobility, and 15 age (8 and 9 years), gender, height and weight matched non-hypermobile controls. Significant differences were identified between previously undiagnosed hypermobile (n=15) and non-hypermobile children (n=15) in passive joint ranges of motion of the lower limbs and lumbar spine, muscle tone of the lower leg and foot, barefoot CoP displacement and in parameters of barefoot gait. Clinically relevant differences were also noted in barefoot single leg balance time. There were no differences between groups in isometric muscle strength in ankle dorsiflexion, knee flexion or extension. The second comparative study investigated foot morphology in non-weight bearing and weight bearing load conditions of the same children with and without joint hypermobility using three dimensional images (plaster casts) of their feet. The preliminary phase of this study evaluated the casting technique against direct measures of foot length, forefoot width, RCSP and forefoot to rearfoot angle. Results indicated accurate representation of elementary foot morphology within the plaster images. The comparative study examined the between and within group differences in measures of foot length and width, and in measures above the support surface (heel inclination angle, forefoot to rearfoot angle, normalized arch height, height of the widest point of the heel) in the two load conditions. Results of measures from plaster images identified that hypermobile children have different barefoot weight bearing foot morphology above the support surface than non-hypermobile children, despite no differences in measures of foot length or width. Based upon the differences in components of control of posture and gait in the hypermobile group, identified in Study One and Study Two, the final study (Study Three), using the same subjects, tested the immediate effect of specifically designed custom-made foot orthoses upon balance and gait of hypermobile children. The design of the orthoses was evaluated against the direct measures and the measures from plaster images of the feet. This ascertained the differences in morphology of the modified casts used to mould the orthoses and the original image of the foot. The orthoses were fitted into standardized running shoes. The effect of the shoe alone was tested upon the non-hypermobile children as the non-therapeutic equivalent condition. Immediate improvement in balance was noted in single leg stance and CoP displacement in the hypermobile group together with significant immediate improvement in the percentage of gait phases and in the percentage of the gait cycle at which maximum plantar flexion of the ankle occurred in gait. The neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility are different from those of non-hypermobile children. The Beighton, Solomon and Soskolne (1973) screening criteria successfully classified joint hypermobility in children. As a result of this study joint hypermobility has been identified as a variable which must be controlled in studies of foot morphology and function in children. The outcomes of this study provide a basis upon which to further explore the association between joint hypermobility and neuro-muscular and musculo-skeletal conditions, and, have relevance for the physical education of children with joint hypermobility, for footwear and orthotic design processes, and, in particular, for clinical identification and treatment of children with joint hypermobility.