Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-03T17:58:33Z No. of bitstreams: 1 Elciana de Paiva Lima Vieira.pdf: 2734767 bytes, checksum: 2012314a94d9af7c5d04bfe60feb71ac (MD5) / Made available in DSpace on 2015-12-03T17:58:33Z (GMT). No. of bitstreams: 1 Elciana de Paiva Lima Vieira.pdf: 2734767 bytes, checksum: 2012314a94d9af7c5d04bfe60feb71ac (MD5) Previous issue date: 2014 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / O processo de envelhecimento acarreta uma série de mudanças anatômicas, fisiológicas, biomecânicas, psicológicas, afetivas e sociais. Essas alterações podem levar ao comprometimento da execução das atividades cotidianas e aumentar o risco de acidentes por queda. Atualmente, a queda no idoso é um episódio preocupante devido à alta incidência e suas consequências, afetando sua qualidade de vida. Entre os diversos fatores de risco, a debilidade do sistema de controle postural e a perda da flexibilidade foram escolhidas para estudo devido à possível relação entre eles. Desse modo, este trabalho teve como objetivo verificar o efeito crônico do treinamento de flexibilidade sobre o controle postural de idosas praticantes de hidroginástica participantes do projeto Prev-Quedas. A amostra foi composta por idosas participantes somente da hidroginástica, selecionadas de forma não probabilística, atendendo aos critérios de elegibilidade. Foram formados dois grupos: o grupo intervenção (GI) composto por 25 idosas que participaram de um programa com exercícios de flexibilidade, além da hidroginástica e o grupo controle (GC), formado por 21 idosas que realizaram apenas a hidroginástica. As idosas foram submetidas às avaliações: antropométrica, da capacidade cognitiva, da força de preensão manual, do controle postural e da amplitude articular máxima. O tratamento estatístico foi feito por meio do software BIOESTAT. 5.2. Foram aplicados testes de comparação e correlação inter e intragrupos. Para analisar a distribuição dos dados foi utilizado o teste de Shapiro-Wilk com o objetivo de designar testes paramétricos e não paramétricos para cada ocasião. Nas comparações foram utilizados os testes t de Student para amostras dependentes e independentes não paramétricas, Mann-Whitney para as independentes paramétricas e Wilcoxon para as amostras dependentes não paramétricas. Para correlacionar os dados foram utilizados o teste de correlação de Pearson para as amostras paramétricas e Spearman para não paramétricas. O nível de significância adotado foi p ≤ 0,05. Os resultados revelaram que o treinamento de flexibilidade associado à prática da hidroginástica, apesar de promoverem aumento na amplitude articular, não acarretou resultados positivos significativos nos indicadores de controle postural em idosas participantes do projeto Prev-Quedas. O grupo controle apresentou melhora significativa da velocidade média, deslocamento total do COP no eixo ântero-posterior, além da capacidade de alcance lateral para ambos os lados e uma redução no tempo de permanência em apoio unipodal. Não foram encontradas correlações significativas entre os valores de Δ goniométricos com aqueles referentes aos testes de controle postural para ambos os grupos. Portanto, o treinamento de flexibilidade associado à prática da hidroginástica não acarretou resultados significativos nos indicadores de controle postural em idosas, embora tenha promovido aumento da amplitude articular máxima nas articulações do quadril e tornozelo. As descobertas expostas sugerem a elaboração de estudos transversais ou longitudinais que abordem o efeito de um programa de exercícios de flexibilidade sobre o controle postural em idosas ativas para contribuir com futuras discussões sobre essa temática. / The aging process involves a series of anatomical, physiological, biomechanical, psychological, emotional and social changes. These changes may lead to impairment performance daily activities and increase the risk of accidents from falls. Currently, the fall in the elderly is a worrying episode due to the high incidence and consequences, affecting their quality of life. Among the many risk factors, the weakness of the balance control system and the loss of flexibility were chosen for study because of the possible relationship between them. Thus, this study aimed to determine the chronic effect of flexibility training on balance control in elderly women engaged in water aerobics participants in Prev-Quedas project. The sample consisted of participants only the elderly water aerobics, selected nonprobabilistically manner, meeting the eligibility criteria. Two groups were formed: the intervention group (IG) consisting of 25 elderly that participated in a program with flexibility exercises, in addition to water aerobics and the control group (CG) consisting of 21 elderly women who underwent only water aerobics. Older underwent evaluation: anthropometric, cognitive ability, handgrip strength, postural balance and maximum range of motion articular. Statistical analysis was performed using the BioStat 5.2 software. Comparison and correlation inter and intra-groups tests were applied. To analyze the distribution of data, the Shapiro-Wilk test aiming to describe parametric and non-parametric tests for each occasion was used. In comparisons the Student t test for non parametric dependent and independent samples was applied, Mann-Whitney test for independent parametric and Wilcoxon tests for non parametric dependent samples were used. To correlate the data the Pearson correlation test were used for parametric samples and Spearman non parametric. The level of significance was p ≤ 0,05. The results revealed that training of flexibility associated with the practice of water aerobics, despite promote increased on the range of motion, not had significant positive results in indicators of postural balance in elderly participants in Prev-Quedas project. The control group showed significant improvement in average speed, total displacement in anteroposterior axis of the COP, and the ability to reach for both lateral sides and a reduction in time spent on one foot. No significant correlations between the values of Δ goniometric those related to postural control tests for both groups were found. Therefore, flexibility training associated with the practice of water aerobics has not resulted in significant indicators of postural balance in older adults, although promoted increased on maximum range of motion in the hip and ankle. The findings suggest the development of exposed transverse or longitudinal studies that address the effect of a program of flexibility exercises on balance control in active elderly to contribute to future discussions on this topic.

INTRODUÇÃO: Estudos com mulheres na faixa dos 50 anos justificam-se porque nesta etapa da vida os declínios fisiológicos são bastante evidentes e relacionados ao climatério e período pós-menopausa. Apesar de viverem mais do que os homens, adoecem mais frequentemente e registram índices mais baixos de saúde percebida do que eles. Melhoras funcionais foram evidenciadas com exercícios na água, todavia são raros os estudos que utilizam a caminhada em imersão como método exclusivo ou principal recurso de intervenção para promoção de saúde. OBJETIVO: Avaliar os efeitos de um programa de 12 meses de caminhada em imersão em mulheres quinquagenárias saudáveis. MÉTODOS: Participaram 59 mulheres em grupos de 10 a 12 participantes que configuraram um único grupo caracterizando-se como um estudo quase-experimental. A intervenção foi realizada 2 vezes por semana em sessões de 30 minutos, por um ano, em piscina aquecida em aproximadamente 310. O programa foi dividido em 4 etapas de 3 meses cada, com evolução crescente na dificuldade dos exercícios. Foram realizadas 5 avaliações: inicial (t0), após 3 meses (t1), 6 meses (t2), 9 meses (t3) e no final do programa - 12 meses (t4). Para a avaliação subjetiva sobre o estado de saúde, mobilidade e humor, foi utilizada uma escala mista de zero a dez. Um breve relato sobre os principais efeitos do programa, com base em questão aberta, também foi analisado. Para a avaliação da força isométrica dos músculos flexores e extensores do quadril e do tornozelo utilizou-se um dinamômetro portátil e para a avaliação da flexibilidade foi utilizado o teste de sentar e alcançar. Para avaliação do equilíbrio foram utilizados os testes de apoio unipodal com olhos abertos (TAU-OA) e fechados (TAU-OF) e o teste \"timed up and go\" (TUG). RESULTADOS: Os resultados observados entre a avaliação inicial e final (t0-t4) do programa mostraram que houve melhora de 16,13% na percepção de saúde (p < 0,001), de 22,15% na mobilidade (p < 0,001) e de 9,69% no humor (p=0,003). Na análise de conteúdo, 49,4% das falas relacionaram-se com a melhora da saúde; 22,9% com a autoestima e satisfação e 19,3% foram relacionadas à capacidade física. A força dos extensores do quadril melhorou 27,67% (p < 0,001), dos flexores do quadril 48,81% (p < 0,001), dos flexores plantares 32,59% (p < 0,001) e dos dorsiflexores 40,75% (p < 0,001). A melhora observada na flexibilidade foi de 54,55% (p < 0,001). O equilíbrio estático avaliado pelo TAU-OA melhorou 35,51% e pelo TAU-OF 261,96% ambos com p < 0,001. Houve melhora de 31,78% no equilíbrio dinâmico (p < 0,001); O equilíbrio, tanto estático como dinâmico e a flexibilidade tiveram melhora em todas as etapas. CONCLUSÃO: O estudo mostrou que esta forma de atividade, realizada em grupos com programa de longa duração, porém de fácil replicação, em 4 etapas progressivas melhorou o estado de saúde, a mobilidade e o estado de humor; a força dos músculos do quadril e do tornozelo, a flexibilidade, bem como o equilíbrio estático e dinâmico das mulheres participantes. Com isto ressaltamos a relevância de políticas públicas que favoreçam e incentivem a prática dos exercícios físicos prazerosos visando um envelhecimento natural e com autonomia funcional / INTRODUCTION: Studies with 50 year-old women are justified because in this stage of life physiological declines are quite evident and related to climacteric and postmenopausal period. Although women live longer than men they fall sick more often and register lower perceived health indices than men do. Functional improvements were observed with immersion exercises, however, studies that use immersion walk as the only method or main intervention resource to promote health are rare. OBJECTIVE: To evaluate the effects of a 12-month immersion walk program in healthy 50 year-old women. METHOD: 59 women participated in groups of 10 to 12 participants which constituted a unique group thus characterized as a quasi-experimental study. The intervention was conducted twice a week, in 30 minute-sessions, for a year, in a pool heated at approximately 31ºC. The program was divided into 4 phases of 3 months each, with increasing evolution in exercise difficulty. 5 evaluations were carried out: initially (t0), after 3 months (t1), 6 months (t2), 9 months (t3) and at the end of the program, 12 months (t4). For the subjective assessment of the health status, mobility and mood, a mixed scale from zero to ten was used. A brief report of the main effects of the program, based on an open question, was also analysed. To evaluate the isometric strength of the flexion and extension muscles of the hip and ankle, a portable dynamometer was used and to evaluate flexibility the sit and reach test was used. To evaluate balance the one-legged stance-open eyes (OLS-OE), the one-legged stance-closed eyes (OLS-CE), and the timed up and go (TUG) tests were used. RESULTS: The results observed between the initial and final evaluation of the program (t0-t4) showed 16.13% improvement in the perception of health (p < 0,001), 22.15% in mobility (p < 0,001) and 9.69% in mood (p= 0,003). In the content analysis, 49.4% of speeches were related to health improvement; 22.9% to self-esteem and satisfaction and 19.3% were related to physical capacity. The strength of hip extensors improved 27.67% (p < 0,001), hip flexors 48.81% (p < 0,001), plantar flexors 32.59% (p < 0,001), and dorsiflexors 40.75% (p < 0,001). Improvement observed in flexibility was 54.55% (p < 0,001). Static balance assessed by OLS-OE improved 35.51% and by OLS-CE 261.96%, both with (p < 0,001). There was a 31.78% improvement in dynamic balance (p < 0,001). Both static and dynamic balance as well as flexibility improved in all phases. CONCLUSION: The study showed that this form of activity, developed in groups with a long-term program, but easily replicated, in 4 progressive stages has improved health status, mobility and mood; hip and ankle muscle strength flexibility, as well as static and dynamic balance of participating women. Thus, we emphasize the relevance of public policies that favour and encourage the practice of pleasurable physical exercises, aiming at a natural aging process with functional autonomy

The purpose of this study was to investigate the effects of different strength training modes on joint range of motion. The problem of the study was to compare Nautilus to free-weight training modes in terms of selected joints' ranges of motion before and after an eight-week strength training program. The hypothesis asserted was that there was no difference between pre-test and post-test scores when comparing Nautilus to free-weight training modes. Subjects were thirty college-age students enrolled in beginning weight-training classes at the University of the Pacific. The subjects were acquired from intact classes and comprised two groups of 9 males and 6 females each. Pre-test and post-test flexibility measures were acquired by use of a Leighton Flex-o-meter and sit-and-reach protocols. Single joint measures of shoulder flexion, extension and abduction, hip flexion, extension and abduction, elbow flexion, knee flexion, and low back flexion were acquired. For eight weeks, two times per week, each class completed an 8 to 12 repetitions per each exercise protocol following the principles of training asserted by Nautilus. Pre-test data for all bilateral joints were statistically analyzed with paired t-tests in order to determine any differences. No significant bilateral differences were found; consequently, these data were converted to eight single measures of average range of motion of the joints respectively. Pretest data then were analyzed with two-factor ANOV A (group x gender) in order to determine if the two intact classes initially represented the same population. The only measure in which a group difference was found was shoulder extension (p

Bakgrund: I Sverige är den generella uppfattningen att det vid val av vardagssko är rekommenderat att välja en sportsko framför en canvas tennissko. Tidigare studier har jämfört hur olika skomodeller påverkar gången, men ingen har studerat skillnader mellan sportskor och canvas tennisskor. Syfte: Undersöka hur en sko med instabil läst och platt bindsula (canvas tennissko) samt en sko med en stadig läst, en sula med bra stötdämpning och avrullning (sportsko) påverkar den mediolaterala stabiliteten olika under stödfasen. Metod: Gånganalys på fem kvinnliga deltagare. Kinetisk och kinematisk data samlades in med hjälp av ett 3D-rörelseanalyssystem. Resultat: Rörelseomfånget skiljer sig mer mellan deltagare än skomodeller. Sportskor har ett försumbart lägre rörelseomfång än canvas tennisskor. Sportskor ger mer inverterad gång än Canvas tenniskor. Steglängden och stödfasen (stance time) skiljer inte mellan de två skomodellerna. Slutsats: Fotens rörelseomfång i frontalplanet skiljer sig inte mellan canvas tennisskor och sportskor under stödfasen, men sportskon har en mer inverterad rörelse. / Background: In Sweden it is a general perception that a sports shoe is a better choice than a canvas tennis shoe for everyday use. Previous studies have investigated how different shoe models affect the gait, but none have studied the differences between sport shoes and canvas tennis shoes. Aim: Investigate how a shoe with unstable last and a flat insole (canvas tennis shoe) and a shoe with steady last, a sole with good shock absorbing and roll off (sport shoe) affect the mediolateral stability differently during stance. Methods: Gait analysis on five female participants. Kinetic and kinematic data collected with3D-modionanalysis system. Results: The range of motion differs more between participants than between shoe models. The sport shoe have a negligible lower range of motion than the canvas tennis shoe. Walking in sport shoe shows a more inverted gait than gait in canvas tennis shoe. Step length and stance time are the same in both shoe models. Conclusion: The range of motion and motion pattern of the foot in the coronal plane does not differ between canvas tennis shoes and sport shoes during stance phase, but the sport shoe has a more inverted motion.

Die Biomechanik der kaninen Lendenwirbelsäule wird durch die Durchführung von Partiellen Lateralen Korpektomien beeinflusst, so dass die Range of Motion bei Extension und Flexion sowie bei links- und rechtslateraler Biegung signifikant zunimmt. Werden in vitro an kaninen Lendenwirbelsäulensegmenten zwei Partielle Laterale Korpektomien an unmittelbar benachbarten Zwischenwirbelspalten durchgeführt, so hat die zweite Partielle Laterale Korpektomie bei einem Großteil der untersuchten Wirbelsäulensegmente einen kleineren Einfluss auf die Range of Motion als die erste Partielle Laterale Korpektomie.:1. Einleitung 1 2. Literaturübersicht 2 2.1 Bandscheibenvorfälle in der Tiermedizin 2 2.2 Die Bandscheibe 3 2.2.1 Anulus fibrosus 3 2.2.2 Nucleus pulposus 4 2.2.3 Endplatten 4 2.3 Diskopathie 4 2.3.1 Ein Überblick 4 2.3.2 Hansen Typ I Diskopathie – Extrusion des Nucleus pulposus 5 2.3.3 Hansen Typ II Diskopathie – Protrusion des Anulus fibrosus 6 2.3.4 Akute, nicht kompressive Nucleus pulposus Extrusion 6 2.3.5 Akute, kompressive Hydrated Nucleus pulposus Extrusion 6 2.3.6 Schmorl Knoten 7 2.4 Operationsmethoden an der Brust- und Lendenwirbelsäule des Hundes 7 2.4.1 Hemilaminektomie 7 2.4.2 Mini-Hemilaminektomie und Pedikelektomie 8 2.4.3 Foraminotomie 8 2.4.4 Dorsale Laminektomie 8 2.4.5 Partielle Laterale Korpektomie 9 2.4.5.1 Operationstechnik und Slot-Morphometrie bei der Durchführung einer Partiellen Lateralen Korpektomie 9 2.4.5.2 Ziele und Risiken der Partiellen Lateralen Korpektomie 11 2.4.5.3 Prognostische Faktoren und Outcome nach der Durchführung einer Partiellen Lateralen Korpektomie 13 2.5 Biomechanik der Wirbelsäule nach chirurgischen Eingriffen 15 2.5.1 Ventral Slot 16 2.5.2 Hemilaminektomie 19 2.5.3 Mini-Hemilaminektomie und Pedikelektomie 21 2.5.4 Dorsale Laminektomie 22 2.5.5 Partielle Laterale Korpektomie 23 3. Tiere, Material und Methoden 27 3.1 Arbeitshypothese 27 3.2 Patientengut 27 3.3 Präparation der Lendenwirbelsäulen 28 3.4 Einbettung der präparierten Lendenwirbelsäulen 29 3.5 Biomechanische Messung 32 3.5.1 Der Wirbelsäulenprüfstand 32 3.5.2 Nicht destruktive Tests 33 3.5.2.1 Testreihe 1: Biomechanische Messungen an den nativen Wirbelsäulensegmenten (ohne gefräste Partielle Laterale Korpektomie) 34 3.5.2.1.1 Extension und Flexion 34 3.5.2.1.2 Links- und rechtslaterale Biegung 34 3.5.2.1.3 Torsion nach links und rechts 35 3.5.2.2 Testreihe 2: Biomechanische Messungen an den operierten Wirbelsäulensegmenten mit einer Partiellen Lateralen Korpektomie zwischen L2 und L3 von rechts 35 3.5.2.3 Testreihe 3: Biomechanische Messungen an den operierten Wirbelsäulensegmenten mit zwei Partiellen Lateralen Korpektomien zwischen L2 und L3 sowie L3 und L4 von rechts 36 3.5.3 Destruktive Tests - Versagenstests 37 3.6 Postoperative Computertomographie 37 3.7 Statistische Auswertung 37 4. Ergebnisse 38 4.1 Nicht destruktive Tests 38 4.1.1 Gesamt-Range of Motion 38 4.1.2 Gegenüberstellung der Teil-Ranges of Motion: Extension vs. Flexion, linkslaterale Biegung vs. rechtslaterale Biegung und Torsion nach links vs. Torsion nach rechts 47 4.2 Einfluss der biomechanischen Testung auf die Range of Motion der Wirbelsäulensegmente 51 4.3 Destruktive Tests - Versagenstest 52 5. Diskussion 53 5.1 Hauptaussagen 53 5.1.1 Nicht destruktive Tests 53 5.1.1.1 Gesamt-Range of Motion 53 5.1.1.2 Teil-Ranges of Motion 55 5.1.2 Destruktive Tests - Versagenstests 56 5.2 Biomechanik der kaninen Lendenwirbelsäule nach Partiellen Lateralen Korpektomien – Ein Studienvergleich 57 5.3 Limitationen der Studie 61 5.4 Spinale Instabilität 65 5.5 Klinische Relevanz der Studienergebnisse und Schlussfolgerungen 69 6. Zusammenfassung 71 7. Summary 73 8. Literaturverzeichnis 75 9. Abbildungsverzeichnis 90 10. Tabellenverzeichnis 93 11. Finanzielle Förderung und Veröffentlichung der Studienergebnisse 94 12. Danksagung 95 / Einleitung Ziel neurochirurgischer Eingriffe zur Versorgung von Bandscheibenvorfällen ist es, das Rückenmark bei nur geringgradiger Manipulation möglichst vollständig zu dekomprimieren. Bei thorakolumbalen chronischen Bandscheibenvorfällen mit ventraler Myelokompression findet die Partielle Laterale Korpektomie ihren Einsatz. Bei dieser Operationsmethode wird das Rückenmark durch Einfräsen eines Spaltes (Slots) im Bereich der betroffenen Bandscheibe und ihrer benachbarten Wirbelkörper untertunnelt. Im Rahmen verschiedener biomechanischer Studien konnte nachgewiesen werden, dass die Partielle Laterale Korpektomie zu einer Verminderung der Wirbelsäulenstabilität führt. Deswegen wurde in der Literatur bisher davon abgeraten, multiple Partielle Laterale Korpektomien durchzuführen. Gelegentlich ist es aufgrund der Lähmung eines Patienten infolge einer Myelokompression durch mehrere Bandscheibenvorfälle jedoch notwendig, multiple Partielle Laterale Korpektomien anzuwenden. Ziele der Untersuchungen In dieser Studie sollten die biomechanischen Konsequenzen von einer und einer zusätzlichen zweiten Partiellen Lateralen Korpektomie auf ein kanines Lendenwirbelsäulensegment evaluiert werden, um Schlüsse hinsichtlich der Durchführbarkeit multipler Partieller Lateraler Korpektomien bei Hunden ziehen zu können. Tiere, Material und Methoden Im Rahmen dieser Kadaverstudie wurden 11 kanine Lendenwirbelsäulensegmente (bestehend jeweils aus dem ersten bis fünften Lendenwirbel) untersucht. Nach Entfernung der paraspinalen Muskulatur und Einbettung der Wirbelsäulensegmente an ihren kranialen und kaudalen Enden in eine Halterung aus Gießharz und Metallringen wurde mithilfe eines eigens entwickelten Wirbelsäulenprüfstandes die Range of Motion bei Extension und Flexion, links- und rechtslateraler Biegung sowie Torsion nach links und rechts unter Anlegung eines Drehmoments von 2 Nm in drei verschiedenen Testreihen getestet. Während einer ersten Testreihe wurden alle Wirbelsäulensegmente in nativem Zustand untersucht. Für eine zweite Testreihe wurde eine Partielle Laterale Korpektomie zwischen dem zweiten und dritten Lendenwirbel von rechts eingefügt. Vor der dritten Testreihe wurde eine zweite Partielle Laterale Korpektomie zwischen dem dritten und vierten Lendenwirbel von rechts eingefügt. Eine Testreihe bestand aus jeweils 10 Bewegungszyklen, von denen die ersten fünf Bewegungszyklen zur Präkonditionierung des Gewebes und die darauffolgenden fünf für die statistische Auswertung genutzt wurden. Die entstandenen Messwerte wurden aggregiert und aufbereitet. Die weitere statistische Auswertung erfolgte unter Durchführung des Friedman- und Wilcoxon-Vorzeichen-Rang-Tests. Ergebnisse Sowohl bei Extension und Flexion als auch bei links- und rechtslateraler Biegung konnte im Vergleich zu den nativen Wirbelsäulensegmenten nach der Durchführung einer Partiellen Lateralen Korpektomie eine signifikante Zunahme der Range of Motion um einen Mittelwert von 22,6 % (Standardabweichung (SD) 16,1 %), bzw. 9,2 % (SD 7,4 %) festgestellt werden. Auch der Zuwachs der Range of Motion nach einer weiteren Partiellen Lateralen Korpektomie war für diese beiden Bewegungsrichtungen signifikant und betrug einen Mittelwert von weiteren 7,8 % (SD 14 %) bei Extension und Flexion sowie weiteren 6,1 % (SD 6,2 %) bei links- und rechtslateraler Biegung. Die Range of Motion nahm über die drei Testreihen hinweg nicht linear zu; so resultierte die größere Zunahme der Range of Motion bei einem Großteil der Wirbelsäulensegmente aus der Durchführung der ersten Partiellen Lateralen Korpektomie. Diese Tendenz konnte jedoch nicht als signifikant identifiziert werden. Die Range of Motion bei Torsion nach links und rechts nahm über die drei Testreihen hinweg nicht signifikant zu. Schlussfolgerungen In der vorliegenden Studie konnte nachgewiesen werden, dass jede Durchführung einer Partiellen Lateralen Korpektomie an einem kaninen Lendenwirbelsäulensegment mit zwei Zwischenwirbelspalten zu einer signifikanten Zunahme der Range of Motion bei Extension und Flexion sowie links- und rechtslateraler Biegung führt. Die Zunahme der Range of Motion ist Zeichen einer Verminderung der Stabilität der Wirbelsäulensegmente. Die Reduktion der spinalen Stabilität nimmt jedoch nicht mit jedem Einbringen einer weiteren Partiellen Korpektomie und denselben Faktor zu, sondern die zweite Partielle Laterale Korpektomie scheint einen kleineren destabilisierenden Effekt auf die Lendenwirbelsäulensegmente zu haben als die erste. Aufgrund dessen und da ein positives klinisches Outcome nach der Durchführung multipler Partieller Lateraler Korpektomien in vivo bereits in mehreren Studien gezeigt werden konnte, kann die Durchführung multipler Partieller Lateraler Korpektomien dennoch empfohlen werden.:1. Einleitung 1 2. Literaturübersicht 2 2.1 Bandscheibenvorfälle in der Tiermedizin 2 2.2 Die Bandscheibe 3 2.2.1 Anulus fibrosus 3 2.2.2 Nucleus pulposus 4 2.2.3 Endplatten 4 2.3 Diskopathie 4 2.3.1 Ein Überblick 4 2.3.2 Hansen Typ I Diskopathie – Extrusion des Nucleus pulposus 5 2.3.3 Hansen Typ II Diskopathie – Protrusion des Anulus fibrosus 6 2.3.4 Akute, nicht kompressive Nucleus pulposus Extrusion 6 2.3.5 Akute, kompressive Hydrated Nucleus pulposus Extrusion 6 2.3.6 Schmorl Knoten 7 2.4 Operationsmethoden an der Brust- und Lendenwirbelsäule des Hundes 7 2.4.1 Hemilaminektomie 7 2.4.2 Mini-Hemilaminektomie und Pedikelektomie 8 2.4.3 Foraminotomie 8 2.4.4 Dorsale Laminektomie 8 2.4.5 Partielle Laterale Korpektomie 9 2.4.5.1 Operationstechnik und Slot-Morphometrie bei der Durchführung einer Partiellen Lateralen Korpektomie 9 2.4.5.2 Ziele und Risiken der Partiellen Lateralen Korpektomie 11 2.4.5.3 Prognostische Faktoren und Outcome nach der Durchführung einer Partiellen Lateralen Korpektomie 13 2.5 Biomechanik der Wirbelsäule nach chirurgischen Eingriffen 15 2.5.1 Ventral Slot 16 2.5.2 Hemilaminektomie 19 2.5.3 Mini-Hemilaminektomie und Pedikelektomie 21 2.5.4 Dorsale Laminektomie 22 2.5.5 Partielle Laterale Korpektomie 23 3. Tiere, Material und Methoden 27 3.1 Arbeitshypothese 27 3.2 Patientengut 27 3.3 Präparation der Lendenwirbelsäulen 28 3.4 Einbettung der präparierten Lendenwirbelsäulen 29 3.5 Biomechanische Messung 32 3.5.1 Der Wirbelsäulenprüfstand 32 3.5.2 Nicht destruktive Tests 33 3.5.2.1 Testreihe 1: Biomechanische Messungen an den nativen Wirbelsäulensegmenten (ohne gefräste Partielle Laterale Korpektomie) 34 3.5.2.1.1 Extension und Flexion 34 3.5.2.1.2 Links- und rechtslaterale Biegung 34 3.5.2.1.3 Torsion nach links und rechts 35 3.5.2.2 Testreihe 2: Biomechanische Messungen an den operierten Wirbelsäulensegmenten mit einer Partiellen Lateralen Korpektomie zwischen L2 und L3 von rechts 35 3.5.2.3 Testreihe 3: Biomechanische Messungen an den operierten Wirbelsäulensegmenten mit zwei Partiellen Lateralen Korpektomien zwischen L2 und L3 sowie L3 und L4 von rechts 36 3.5.3 Destruktive Tests - Versagenstests 37 3.6 Postoperative Computertomographie 37 3.7 Statistische Auswertung 37 4. Ergebnisse 38 4.1 Nicht destruktive Tests 38 4.1.1 Gesamt-Range of Motion 38 4.1.2 Gegenüberstellung der Teil-Ranges of Motion: Extension vs. Flexion, linkslaterale Biegung vs. rechtslaterale Biegung und Torsion nach links vs. Torsion nach rechts 47 4.2 Einfluss der biomechanischen Testung auf die Range of Motion der Wirbelsäulensegmente 51 4.3 Destruktive Tests - Versagenstest 52 5. Diskussion 53 5.1 Hauptaussagen 53 5.1.1 Nicht destruktive Tests 53 5.1.1.1 Gesamt-Range of Motion 53 5.1.1.2 Teil-Ranges of Motion 55 5.1.2 Destruktive Tests - Versagenstests 56 5.2 Biomechanik der kaninen Lendenwirbelsäule nach Partiellen Lateralen Korpektomien – Ein Studienvergleich 57 5.3 Limitationen der Studie 61 5.4 Spinale Instabilität 65 5.5 Klinische Relevanz der Studienergebnisse und Schlussfolgerungen 69 6. Zusammenfassung 71 7. Summary 73 8. Literaturverzeichnis 75 9. Abbildungsverzeichnis 90 10. Tabellenverzeichnis 93 11. Finanzielle Förderung und Veröffentlichung der Studienergebnisse 94 12. Danksagung 95

Introduktion: Anatomiska variationer i det muskuloskeletala systemet är vanliga bland oss människor och behöver inte nödvändigtvis medföra ökad risk för besvär, men kan påverka en individs funktion. Inom fysioterapi är det viktigt med vetskapen om anatomiska variationers påverkan för att optimalt individanpassa behandling. En typ av anatomisk variation är vinkeln av lårbenshalsen gentemot frontalplanet. Det finns en stark evidens för hur lårbenshalsens vinkel påverkar höftens inåt- och utåtrotation, men det finns begränsad information om hur det påverkar rörligheten i andra rörelseriktningar.   Syfte: Att undersöka om höfter med ‘femoral neck retroversion’ (FNR) har en större grad av passiv flexion i kombination med utåtrotation och abduktion jämfört med enbart passiv flexion i sagittalplan.    Metod: För att avgöra om höfter mötte inklusionskriteriet att en retroversion fanns användes Craig ́s test. Interbedömarreliabilitet av Craig´s test undersöktes med ‘intraclass correlation coefficient’ (ICC). Passiv inåt/utåtrotation mättes sittande på brits och passiv flexion i sagittalplan utfördes ryggliggandes. Vid mätning av passiv flexion i kombination med utåtrotation och abduktion letades det potentiella läget där låret kunde nå närmast bröstet. Goniometer av typ Brodin med 31 cm skänklar användes vid samtliga mätningar. Wilcoxons icke-parametriska test användes för att analysera differensen mellan passiv flexion i kombination med utåtrotation och abduktion och passiv flexion i sagittalplan.  Resultat: 23 personer mellan 18 och 48 år rekryterades, varav 10 kvinnor och 13 män. Därmed undersöktes 46 ben. ICC vid Craig´s test blev 0.73, vilket klassas som moderat reliabilitet. En signifikant skillnad mellan passiv flexion i sagittalplan och passiv flexion i kombination med utåtrotation och abduktion sågs för inkluderade ben (p &lt;0.001). Medianen för denna skillnad var 19o.  Slutsats: Retroverterade höfter har en större grad av passiv flexion i ett mer abducerat och utåtroterat läge jämfört med enbart passiv flexion i sagittalplan. Vidare forskning bör undersöka om det finns ett samband mellan den exakta FNR-vinkeln och differensen mellan flexion i sagittalplan och flexion i kombination med utåtrotation och abduktion. Vidare kan även differensen i flexion jämföras mellan olika grupper med FNR, ‘femoral neck anteversion’ (FNA) och normalspann. Validitet och reliabilitet bör undersökas närmare för metoden att bestämma flexionsvinkel i ett mer abducerat och utåtroterat läge.

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Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Forward head posture (FHP) is a common postural abnormality, often associated with myofascial trigger points which can result in head and neck pain. The craniovertebral (CV) angle lies between a horizontal line running through C7 spinous process and a line connecting C7 spinous process to the tragus of the ear. The smaller the angle the greater the FHP. Cervical musculoskeletal abnormalities have often been linked to headache types, most especially episodic tension-type headache (ETTH) and cervicogenic headaches (CGH). Objectives: To determine whether an association exists between FHP, distance of the external auditory meatus (EAM) from the plumbline and cervical range of motion and the presentation of ETTH and CGH. Method: This was a quantitative comparative study (n=60) comparing three equal groups, one with ETTH, CGH and healthy controls. The FHP of the Subjects FHP was assessed by measuring the CV angle. A lateral digital photograph was taken to assess the distance of the external auditory meatus from the plumbline. Lastly, cervical range of motion was measured. The two symptomatic groups also received a headache diary for a fourteen day period monitoring frequency, intensity and duration of their headaches. Result: The two symptomatic groups had a smaller CV angle and a greater distance from the plumbline (p<0.05) than the asymptomatic group. The asymptomatic group had a significantly greater flexion (p=0.009), extension (p=0.038) and left rotation (p=0.018) range of motion than the two symptomatic groups. The CGH group had a significant positive correlation between the distance of the EAM from the plumbline and the intensity of headaches. The ETTH group had a significant positive correlation between the right craniovertebral angle and the mean duration of headaches. Conclusion: Therefore, it can be concluded that patients presenting with ETTH and/or CGH may have associated postural abnormalities that may act as a trigger or a contributory factor to the presenting headache. / Durban University of Technology

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Forward head posture (FHP) is a common postural abnormality, often associated with myofascial trigger points which can result in head and neck pain. The craniovertebral (CV) angle lies between a horizontal line running through C7 spinous process and a line connecting C7 spinous process to the tragus of the ear. The smaller the angle the greater the FHP. Cervical musculoskeletal abnormalities have often been linked to headache types, most especially episodic tension-type headache (ETTH) and cervicogenic headaches (CGH). Objectives: To determine whether an association exists between FHP, distance of the external auditory meatus (EAM) from the plumbline and cervical range of motion and the presentation of ETTH and CGH. Method: This was a quantitative comparative study (n=60) comparing three equal groups, one with ETTH, CGH and healthy controls. The FHP of the Subjects FHP was assessed by measuring the CV angle. A lateral digital photograph was taken to assess the distance of the external auditory meatus from the plumbline. Lastly, cervical range of motion was measured. The two symptomatic groups also received a headache diary for a fourteen day period monitoring frequency, intensity and duration of their headaches. Result: The two symptomatic groups had a smaller CV angle and a greater distance from the plumbline (p<0.05) than the asymptomatic group. The asymptomatic group had a significantly greater flexion (p=0.009), extension (p=0.038) and left rotation (p=0.018) range of motion than the two symptomatic groups. The CGH group had a significant positive correlation between the distance of the EAM from the plumbline and the intensity of headaches. The ETTH group had a significant positive correlation between the right craniovertebral angle and the mean duration of headaches. Conclusion: Therefore, it can be concluded that patients presenting with ETTH and/or CGH may have associated postural abnormalities that may act as a trigger or a contributory factor to the presenting headache. / Durban University of Technology / M

La récupération optimale des amplitudes articulaires (AAs) et de la force musculaire est un objectif crucial de la réadaptation fonctionnelle intensive (RFI) à la suite d’une lésion médullaire (LM). Le but de la présente étude était de documenter les changements d’AAs des membres supérieurs durant la RFI chez des individus (n = 197) ayant subi une LM et d’établir le lien avec l’autonomie fonctionnelle. Les données (AA, force musculaire, spasticité, déficiences secondaires, autonomie fonctionnelle) ont été collectées à l’admission et au congé de la RFI. Des analyses descriptives, des tests d’association entre les changements d’AAs et des variables indépendantes (douleur, spasticité, déficiences secondaires, force) et des analyses multivariées ont été utilisées. Les individus ayant une paraplégie présentent peu de déficit d’AAs à l’épaule comparés à ceux ayant une tétraplégie. Parmi ces derniers, une majorité présente des AAs sous les valeurs de normalité en fin de RFI. Le groupe D, établi selon l’évaluation de l’American Spinal Injury Association (ASIA D) présente des pertes d’AAs plus importante qu’attendue. La douleur au niveau articulaire est un facteur influençant les changements d’AAs, particulièrement dans ce groupe. La force musculaire chez les personnes ayant une tétraplégie sévère (ASIA ABC) est plus faible que celle du groupe ayant une lésion moins sévère (ASIA D). Généralement, le gain de force corrèle avec le gain d’AA. La force musculaire, les AAs et le nombre de déficiences secondaires sont les principaux éléments influençant l’autonomie fonctionnelle. En conclusion, la perte d’AA est plus importante à l’articulation de l’épaule et, pour plusieurs individus, malgré un gain significatif, les AAs n’atteignent pas les valeurs de référence au congé de la RFI. La force musculaire et certaines déficiences secondaires sont des éléments à considérer pour expliquer les pertes d’AAs et d’autonomie fonctionnelle. Les études futures devront clarifier certains aspects dont l’atteinte de la rotation médiale qui semble montrer un patron différent de récupération en comparaison des autres mouvements de l’épaule. De plus, les études devront montrer si ces changements et résultats sont maintenus après le congé de la RFI. / Optimal recovery of range of motion (ROM) and strength are critical objectives of intensive rehabilitation following spinal cord injury (SCI). The aim of this study was to characterize the evolution of ROM and strength at the upper limb and analyze their relationship with functional independence during intensive rehabilitation. Data ROM, strength, spasticity, secondary impairments, functional independence) from 197 participants with SCI were collected at admission and discharge from intensive rehabilitation and were analyzed with descriptive statistics and multivariate analyses (regressions, ANOVA). Specific association analyses were used to determine the level of association between ROM, strength and independent variables such as pain, spasticity and secondary impairments. Lesser deficit in ROM was observed in participants with paraplegia compared to those with tetraplegia. The deficit in individuals with tetraplegia was larger to an extent that most of them did not reach normality in ROM at shoulder joint. Surprisingly, individuals with less severe injury according to the American Spinal Injury Association classification (ASIA D) showed larger deficit of ROM than expected. Joint pain was related to reduce ROM, particularly in participants with ASIA D lesion. Values of muscle strength in individuals with more severe tetraplegia (ASIA ABC) are lower than the ones observed in individuals with less severe injury (ASIA D). Overall, strength and ROM were correlated, except for medial rotation movement. ROM, strength, and secondary impairments are the major determinants of functional independence. In conclusion, shoulder joint was the most affected joint of the upper limb, and, despite of significant gains of ROM, abnormalities were greater than expected. Strength and some secondary impairment were related in loss of ROM and functional independence throughout rehabilitation. More study will be needed to understand the medial rotation movement at the shoulder that seems to evolve differently from other movements, and to determine whether or not changes observed during rehabilitation are maintained over time.