Capes / A tetraplegia é uma lesão na medula espinhal, que compromete o tronco, os membros superiores e inferiores e músculos respiratórios. Nas lesões completas, a função motora e sensorial abaixo do nível da lesão apresenta-se comprometida. Nas lesões incompletas ou parciais, ocorre a preservação da função motora e sensitiva, não havendo padrões definidos de recuperação. A estimulação elétrica já vem sendo utilizada para indução respiratória diafragmática. Neste trabalho, foram avaliados 10 indivíduos tetraplégicos, de ambos os sexos, na faixa etária de 18 á 48 anos, durante 10 sessões onde foram aplicados anamnese, avaliação inicial constando sinais vitais, cintometria, manovacuometria, oximetria, avaliação do nível da lesão, e a avaliação do déficit motor e respiratório. Aplicaram-se dois métodos utilizando o sistema de Eletroestimulação sincronizada: o primeiro com sincronização manual, FESSM (Estimulação Elétrica Funcional) e o segundo, usando o MD2, com sincronização automática. A função muscular do Diafragma foi avaliada antes e depois das aplicações de estimulação elétrica, cuja intenção era potencializar a ação, possibilitando um melhor recrutamento muscular e, conseqüentemente, uma melhor reeducação muscular respiratória. Quanto a análise comparativa entre os métodos, após a intervenção com equipamento I observou-se melhores resultados em relação aos parâmetros sinais vitais e manovacuômetria. Com a intervenção do equipamento II, observou-se melhores resultados nos parâmetros oximetria e grau de dispnéia. O equipamento I apresentou resultados satisfatórios em relação a função do sistema digestório, principalmente em pacientes com lesão medular incompleta. / The tetraplegia is an injury in the spinal cord that compromises the motor and sensitive systems commanded by the spinal cord below of that damage level. Respiratory muscles are compromises too. In complete injuries, motor and sensorial function completely damaged. In the incomplete or partial injuries, motor and sensitive function occurs, but no recovery pattern is known. The electric stimulation is used nowadays for respiratory induction. In this work, 10 tetraplegic patients had been evaluated, both gender, ages range from 18 to 48 years, during 10 sessions where anamneses were applied. Vital signals motor respiratory disfunction, and injury level were evaluated. The system of synchronized electrostimulation was applied using two methods: the first one with manual synchronization; FESSM; and the second one, using the MD2, with automatic synchronization. The muscular function of the Diaphragm was evaluated before and after the applications of electrostimulation. The comparative analysis between the two methods, had shown better results after the intervention with equipment I regarding the parameters and vital signs of manovacuometry. With the intervention of equipment II, it was observed better results in the pulse parameters and degree of dyspnea. The equipment I had shown satisfactory results for the function of the digestive system, especially in patients with incomplete spinal cord injury.

Os objetivos deste trabalho foram desenvolver um dispositivo apontador, com as mesmas funções de um mouse, controlado pelo movimento da cabeça, e comparar a eficiência do dispositivo proposto, utilizando o controle do cursor do computador no modo absoluto e relativo (joystick), operado por dez indivíduos tetraplégicos e por dez indivíduos sem acometimento neuromuscular. A maioria dos parâmetros estudados apresentou diferença significativa, entre as situações de controle absoluto e relativo, para os indivíduos de ambos os grupos, evidenciando que os parâmetros medidos no modo absoluto foram melhores que os medidos no modo relativo. O dispositivo apontador emula adequadamente as funções de deslocamento do cursor, mostrando que o modo de controle absoluto é mais eficiente que o modo de controle relativo / The objectives of this study were to develop a head controlled pointer device with mouse functions and compare its performance when operated in absolute versus relative (joystick like) modes by ten quadriplegic subjects and ten people without neuromuscular impairment. The device was composed of a video camera, a computer program and a reflective paper target attached to a cap which was then placed on the user´s head. Most of the measured parameters revealed a significant difference between the control modes, favouring the absolute one, for both studied groups. The developed head pointer adequately emulates the computer cursor displacement, with the absolute control mode being functionally more efficient than the relative control mode in this study.

Orientador: José Irineu Gorla / Tese (doutorado) ¿ Faculdade de Educação Física, Universidade Estadual de Campinas / Made available in DSpace on 2018-08-19T17:11:47Z (GMT). No. of bitstreams: 1 Flores_LucinarJupirForner_D.pdf: 1031561 bytes, checksum: bdd366b463afab5bb41f591f0bb99d60 (MD5) Previous issue date: 2012 / Resumo: O objetivo do presente estudo foi avaliar as respostas autonômicas e cardiovasculares em pessoas com lesão da medula espinhal (PLME) praticantes de Rugby em Cadeira de Rodas (RCR) em diferentes situações. A amostra foi composta de dez (10) tetraplégicos do sexo masculino com média de idade de 29,6 ± 6,5 anos. As coletas foram realizadas na UNICAMP, com a aprovação do Comitê de Ética em Pesquisa sob-protocolo nº 276/2010. Foram realizadas avaliações antropométricas. A potência aeróbia (PA) foi estimada por um teste máximo de quadra com duração de 12 minutos. A Pressão arterial (PAS) verificada pelo método auscultatório e o registro da variabilidade da PAS (VPAS) através do equipamento Finometer® (Finapress©). Avaliações da VFC foram realizadas com os sujeitos sentados nas cadeiras próprias (repouso, estresse mental e exercício). O Stroop Test foi utilizado como teste de estresse mental (TEM). Para o registro de informações da VFC foi usado o frequencímetro modelo RS800CX-POLAR© e posteriormente foi utilizado o software da Polar© para análise dos dados. Os dados foram apresentados em média±desvio padrão. Para análise estatística foi utilizado o software INSTAT®. Valores de p<0,05 foram considerados significativos para diferenças entre situações de avaliação. O tempo de lesão medular foi de 7,5 ± 4,1 anos. Quanto à massa corporal e estatura dos sujeitos, foi verificada média de 64,5 ± 6,2 kg e 1,75 ± 0,09 m. O índice de massa corporal foi de 21 ± 1,4 kg/m2. Já o percentual de gordura (DXA) foi de 21± 5,4%. O valor médio da distância percorrida no teste de 12 min, para a estimativa da PA foi de 1579,5 ± 439,1 m. O valor médio para a PA estimada correspondeu a 18,03 ± 8,1 ml/kg/min-1. Valores de FC e PAS foram significativamente maiores ao final do teste de 12 min quando comparados aos valores de repouso e recuperação. Resultados de FC ao longo do teste de estresse mental revelaram-se maiores que os valores de FC iniciais do registro. A PAS não apresentou diferenças entre as avaliações de repouso e estresse mental, assim como os valores de VFC não apresentaram diferenças significativas nestas situações. Valores do balanço autonômico da VFC também não apresentaram diferenças quando comparado valores iniciais e no teste de estresse mental (BF, AF e BF/AF). Já em exercício a VFC apresentou diferenças, assim como os valores de BF, AF e BF/AF quando comparado aos valores pré e pós exercício. A VPAS apresentou-se reduzida pós exercício físico, assim como a PASist e o índice de BF quando comparados aos valores pré exercício físico. Estes resultados indicam que a amostra estudada apresenta potência aeróbia dentro da normalidade para esta população. O % de gordura foi menor do que outros estudos com tetraplégicos. Ocorreram alterações durante o exercício físico nos componentes da VFC e VPAS semelhantes aos de outros estudos com tetraplégicos - (repouso x TEM x pós exercício físico). Há indícios de menores prejuízos neste grupo estudado em relação aos danos no controle autonômico da circulação, provavelmente por esta amostra participar de programa de treinamento físico / Abstract: The purpose of this work was to evaluate the autonomic and the cardiovascular responses in people with spinal cord injury (PLME) the players of Wheelchair Rugby (RCR) in different situations. The sample was composed of ten (10) tetraplegics male. The samples were collected in Campinas, with the approval of the Committee of Ethics in the Research with the protocol 276/2010. In this work was performed anthropometric evaluation. The aerobic power (AP) was estimated by a max court test that didn't exceed 12 minutes. The blood pressure (BP) verified by auscultation and registration of the BP variability (BPV) through an equipment called Finometer® (Finapress©).The evaluation of heart rate variability (HRV) were made with the individuals sitting on their chairs (rest, mental stress test and exercise). The Stroop Test was used as a test of mental stress. For recording of information of the HRV was used frequency counter model RS800CX-POLAR© and afterward was used Polar© software for data analysis. The data were expressed as average±standard deviation. To the statistical analysis was performed using the INSTAT® software. p values<0.05 were considered statistically significant differences between the situations of evaluation. The average age of the individuals was 29.6 ± 6.5 years old and the time of spinal cord injury was 7.5± 4.1 years. As for weight and height of them, there was an average of 64.5 ± 6.2 kg and 1.75 ± 0.09 m. The body mass index was 21 ± 1.4 kg/m2. The fat percentage (DXA) was 21 ± 5.4%. Results revealed that the test for 12 min, the distance rode to the PA estimate was 1579.5 ± 439.1 m. It was verified that the estimated value of AP is 18.03 ± 8.1 ml/kg/min-1. The HR and the BP values were significantly higher at the end of the test 12 min when compared to the values of resting and recovery. The results of FC along the mental stress test, proved to be larger than the values of initial HR of the record. The BPV did not show differences between the evaluations of rest and mental stress, as well as the values of HRV were not significantly different in these situations. Values of the autonomic balance of the HRV also showed no differences when compared to initial values and mental stress test (LF, AF e LF/HF). In the exercise the HRV presented discrepancies as well as the heart rate variability showed differences as well as the values of LF, HF e LF/HF when compared to pre and post exercise. The VBP presented the reduced as well as SBP and the values of BF compared before and after exercise. These results indicate that the sample presents aerobic power within the normal range for this population. The percentage of fat was lower than other studies with tetraplegics. Changes during exercise in HRV components and BPV similar to other studies with tetraplegics - (resting x TEM x post exercise). We can still consider that exist evidence of minor damage in relation to damage to the autonomic control of circulation, probably because this sample participate in physical training program / Doutorado / Atividade Fisica, Adaptação e Saude / Doutor em Educação Física

Title: The BanalFatal program in spinal cord injury prevention Objectives: The main objective of this diploma thesis is to examine the subjective impressions of participants after the completion of this program (lesson) so that it is possible to assess the emotional impact of the program and its impact on the further behavior of children. Methods: A quantitative strategy was used for the research part of the thesis. For the purposes of the research, two original questionnaires were created. 6 primary schools were contacted, in which the BanalFatal program previously took place. The questionnaire, aimed at school prevention methodologists, was filled in by all addressed school staff, but only in 4 school facilities, it was possible to interview school pupils. Thus, 6 school prevention methodologists and 164 pupils from 4 selected primary schools (Prague 11, 4, Litoměřice, Dačice) were interviewed. The questionnaire for prevention methodologists contains closed, semi-closed, and open questions. The questionnaire for pupils was created in the form of a survey and contained only closed questions. Results: All school methodologists presume that attending the BanalFatal lecture will have a certain effect on students' change in behavior during risky activities. "Certainly yes" was stated by 1 and "rather...

One of the most devastating effects of tetraplegia is the inability to grasp and manipulate everyday objects necessary to living an independent life. Currently surgery is widely accepted as the solution to improve hand functionality. However, surgery becomes difficult when the user has paralysed wrists as is the case with C5 tetraplegia. The aim of this research was to develop a solution which provided controlled wrist flexion and extension which, when combined with surgery, achieves a 'key pinch' grip. This particular grip is critically important for people with C5 tetraplegia as it is used for countless grasping activities, necessary on a day-to-day basis. A systematic design process was used to evolve the solution to provide controlled wrist flexion and extension. Concept brainstorming identified four alternative solutions which were evaluated to find the preferred concept. The chosen solution was called the Self Powered Wrist Extension Orthosis, more commonly referred to as the 'orthosis'. This concept contained a shoulder harness which provided both energy and control to the wrist harness, which in turn changed the wrist position. The orthosis was developed with the use of a mathematical model which theoretically predicted the functional performance by comparing the required force needed to move the wrist harness to the achievable force supplied by the user's shoulders. Using these parameters, the orthosis was optimized using the matlab Nelder-Mead algorithm which adjusted the wrist harness geometries to maximize the functional performance. A prototype was constructed and tested with the help of two participants who when combined, achieved an average of 18.5° of wrist rotation. The theoretical model however predicted an average range of motion of 28.4°. The discrepancy found between the theoretical and experimental result can be contributed to incorrect assumptions in the theoretical model. This included unaccounted friction and inaccurate modeling of the orthosis dynamics. The feedback from potential users of the orthosis was enthusiastic and encouraging especially towards the simplicity, usability and practicality of the design.

The subject of this thesis is spasticity in individuals with spinal lesions. The aim is to evaluate and compare a short-term effect of selected physio-therapeutic methods on spasticity of lower limbs in spinal patients. Two methods of comparison were chosen - passive stretching and the Vojta's reflex therapy. The work consists of two parts. The theoretical part describes the problems of spinal lesions, central motoneuron syndrome and spasticity, including its pathophysiology and investigation and therapeutic approaches. The practical part contains an attempt to verify and subsequently compare the immediate antispastic effect of the chosen methods, which is an important prerequisite for the following active exercises as an inseparable part of a physiotherapeutic exercise unit. Clinical evaluation scales are used to evaluate spasticity, namely Modified Ashworth Scale (MAS) and Muscle Excitability Scale (MES). The results are then compared with other studies and literature. Keywords spinal lesions, quadriplegia, Modified Ashworth Scale, Muscle Excitability Scale, Vojta's method, stretching

Problématique. L'utilisation d'un chien d'assistance à la mobilité (CAM) représente une option novatrice pour préserver l’intégrité des membres supérieurs (MSs) chez les utilisateurs de fauteuil roulant manuel (FRM). Aucune étude biomécanique n’a quantifié les effets du CAM sur les efforts aux MSs lors de la montée d’un plan incliné. Objectif. Cette étude quasi-expérimentale vise à comparer les efforts aux MSs lors de la montée d’un plan incliné avec et sans l’assistance d’un CAM. Méthodologie. Dix participants avec une lésion de la moelle épinière (LME) qui utilisent un FRM et possèdent un CAM ont monté un plan incliné à trois reprises avec et sans l’assistance du CAM. Les forces appliquées sur les cerceaux, mesurées avec des roues instrumentées, et les mouvements du FRM et des MSs, enregistrés avec un système d'analyse du mouvement, ont permis de mesurer les efforts mécaniques aux MSs. Simultanément, l'activité électromyographique (EMG) des muscles grand pectoral, deltoïde antérieur, biceps et triceps a été enregistrée et normalisée avec sa valeur maximale pour mesurer les efforts musculaires aux MSs. Résultats. En général, le CAM réduit significativement les valeurs moyennes et maximales de la force totale appliquée aux cerceaux et de sa composante tangentielle, des moments nets de flexion, de rotation interne et d’adduction aux épaules et des taux d’utilisation musculaire du deltoïde antérieur, du biceps et du triceps. Conclusion. L’assistance d’un CAM réduit les efforts aux MSs lors de la montée d’un plan incliné chez les utilisateurs d’un FRM ayant une LME. / Problematic. The use of a mobility assistance dog (ADMob) represents an innovative option to preserve upper limb (U/Ls) integrity in manual wheelchair (MWC) user population. No biomechanical studies have quantified the effects of ADMob on U/Ls efforts when climbing an incline. Objective. This quasi-experimental study compares the U/Ls efforts when climbing an incline with and without the assistance of an ADMob for MWC traction. Methodology. Ten participants with spinal cord injury (SCI) using a MWC and owning an ADMob climbed an incline 3 times with and without the use of an ADMob. The forces applied to the handrims, captured with instrumented wheel and movements of the MWC and the U/Ls, recorded with a three-dimensional motion analysis system, were used to measure the U/Ls mechanical efforts. Simultaneously, the electromyographic (EMG) activity of the pectoralis major muscle, anterior deltoid, biceps and triceps were recorded during the tasks and normalized with its maximum value to measure the U/Ls muscular efforts. Results. Typically, ADMob significantly reduces the mean and peak values of the total force applied to the rings and the tangential component, the mean and peak values of flexion, internal rotation and adduction net joint moments at the shoulder and the mean and peak values of muscular utilization ratio of anterior deltoid, pectoralis major, biceps and triceps. Conclusion. The assistance of an ADMob for MWC traction when climbing an incline reduces the effort to U/Ls among MWC users with a SCI.

The diploma thesis deals with the field of the care after quadriplegics in the Czech Republic and the United Kingdom. The aim of the diploma thesis is to describe positive and negative aspects of the care provided to quadriplegics both in Great Britain and the Czech Republic from the point of view of the care users, and subsequently to propose possibilities of improvement of the care in the Czech Republic. The theoretical part explains quadriplegia and outline social and health systems for quadriplegics in the Czech Republic as well as in the United Kingdom. This part includes the description of compensatory aids available for clients, conditions of health and social insurance, rehabilitation care options and financial support in both countries. In the research part, based on data interpretation of the data collected by qualitative research technique (interviews that were implemented with quadriplegics living the Czech Republic and United Kingdom), I analyze the situation of the clients of both social and health systems. These interviews revealed several areas of positive and negative evaluation of the existing situation and highlight possibilities of potential future improvement of the care in the Czech Republic.