Lesões na medula espinhal atingem um grande número de pessoas, devido a traumas, doenças congênitas ou adquiridas. Para estes tipos de lesões não há cura e os indivíduos lesados medulares dependem de tratamento através de fisioterapia ou órteses que auxiliem na recuperação de possíveis funções perdidas. A Estimulação Elétrica Neuromuscular (EENM) tem sido pesquisada com essa proposta: reabilitar pessoas portadoras de lesão medular ou disfunções do aparelho locomotor. Muitos estudos já foram desenvolvidos na área de estimulação elétrica neuromuscular, avaliando a marcha, o ato de levantar-se ou outros movimentos. Um ponto em comum entre estes estudos é a preocupação com os efeitos fisiológicos da EENM, como por exemplo o gasto energético. Diante disto, o objetivo deste projeto foi avaliar os efeitos da EENM sobre o gasto energético de lesados medulares. Foi observado o consumo de oxigênio durante o repouso, a marcha e a recuperação. A avaliação proposta foi realizada por método indireto e as análises estatísticas foram realizadas através do teste ANOVA ONE WAY. Os resultados sugerem os voluntários tiveram recuperação fisiológica. Entretanto novas pesquisas são necessárias, com outras variáveis sendo avaliadas. / Lesions in the spinal cord affect a great number of individuals, either due to traumas or to congenital or acquired diseases. Such lesions are incurable, and the injured patients depend on physiotherapy or orthosis to aid in the recovery of lost functions. The Neuromuscular Electrical Stimulation (NMES) has been researched with this purpose: rehabilitating spinal cord injured patients, or those with motor system dysfunction. Several studies have already been developed in the field of neuromuscular electrical stimulation, assessing gait, the act of getting up or other everyday movements. All these studies bear something in common: the concern with the physiologic effects of NMES, such as the energy consumption. Hence, the objective of this project was to evaluate the effects of NMES on the energy cost of spinal injured patients. The consumption of oxygen was assessed during rest, gait and the recovery period. The proposed evaluation was made through indirect method, and the statistical analyses through the ANOVA ONE WAY test. The results to suggest that the volunteers had phisyological recovery. However, news reserchs there are needs, with others variable to be estimated.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Indivíduos que permanecem longo tempo em cadeira de rodas apresentam importante perda de massa óssea, principalmente nos membros inferiores, possivelmente agravada pela baixa ingestão de cálcio dietético e pelo inadequado estado nutricional de vitamina D. O exercício físico pode contribuir para a manutenção ou aumento da massa óssea em diferentes populações e nos indivíduos com lesão medular pode contribuir para atenuar a perda de massa óssea. O objetivo do presente estudo foi avaliar a influência da prática regular de exercício físico sobre a adequação da massa óssea, indicadores bioquímicos do metabolismo ósseo e estado nutricional de vitamina D em indivíduos com lesão medular cervical há pelo menos um ano. Em vinte e cinco homens de 19 a 56 anos sendo 15 fisicamente ativos e 10 sedentários, foi realizada análise sérica de cálcio, PTH, 25(OH)D, IGF-1, osteocalcina e NTx. As medidas do conteúdo mineral ósseo, densidade mineral óssea (DMO), massa magra e massa gorda foram realizadas por DXA. A pigmentação da pele (constitutiva e por bronzeamento) foi determinada por colorimetria com o objetivo de investigar sua influência sobre o estado de vitamina D. A ingestão habitual de cálcio foi registrada em um questionário de frequência alimentar direcionado para alimentos fonte. As comparações entre os dois grupos foram realizadas pela aplicação do Teste t de Student exceto para as variáveis ósseas que foram realizadas após ajustes pela massa corporal total, tempo de lesão e ingestão de cálcio utilizando-se análise de co-variância. Associações entre as variáveis estudadas foram avaliadas através de análise de correlação de Pearson. Valores de p<0.05 foram considerados significativos. Não foram observadas diferenças estatisticamente significativas entre os grupos para nenhuma variável óssea com exceção do z-score da DMO da coluna lombar, que foi significativamente maior no grupo de indivíduos sedentários (0,9 1,7 vs -0,7 0,8; p<0,05). No entanto, entre os indivíduos ativos, aqueles que iniciaram a prática de exercício físico com menos tempo decorrido após a lesão apresentaram maior DMO do fêmur (r=-0,60; p<0,05). Nos indivíduos ativos, a freqüência do exercício apresentou associação negativa com a concentração sérica de i-PTH (r = -0,50; p =0,05) e positiva com a concentração de 25(OH)D (r= 0,58; p <0,05). Após ajustes pela massa corporal total e tempo de lesão foram observadas associações positivas entre a ingestão diária de cálcio e z-score da DMO da coluna lombar (r = 0,73 e p <0,01) e DMO do rádio (r = 0,56 e p <0,05). Os resultados do presente estudo apontam para um efeito benéfico do exercício físico sobre a massa óssea e o perfil hormonal relacionado ao metabolismo ósseo. O início da prática regular de exercício físico o quanto antes após a lesão parece contribuir para atenuar a perda de massa óssea nos membros inferiores. Além disso, os resultados deste estudo sugerem uma possível potencialização do efeito osteogênico do exercício físico quando combinado a uma adequada ingestão de cálcio. / Individuals who stay long time in a wheelchair have significant bone loss, especially in lower limbs that may be aggravated by low calcium intake and inadequate vitamin D status. Physical exercise contributes to maintain or increase bone mass in different populations and may be useful in reducing bone loss in spinal cord injured individuals. The aim of this study was to evaluate the influence of regular physical exercise on bone mass adequacy, biochemical markers of bone metabolism and vitamin D status in individuals with cervical spinal cord injury. Twenty five male adults (19-56 years) with cervical spinal cord injury for at least one year, were recruited and divided into physically active (n=15) and sedentary (n=10) groups. Fasting blood samples were collected and serum samples were stored at -20oC until analysis of calcium, PTH, 25(OH)D, IGF-1, osteocalcin and NTx. Bone mineral content and density (BMD), lean mass and fat mass were evaluated by DXA. Skin pigmentation (constitutive and facultative) was evaluated by reflectance colorimetry in order to investigate its influence on vitamin D status. Habitual calcium intake was recorded using a food frequency questionnaire directed to calcium food sources. Comparisons between groups were performed using Students t test except for bone variables that were performed after adjustments for total body mass, duration of injury and calcium intake by analysis of covariance. Associations between variables were evaluated using Pearson's correlation analysis. P values <0.05 were considered significant. There were no significant differences between groups for bone measurements except for lumbar spine Z-score, that was significantly higher in the sedentary group (0.9 1.7 vs -0.7 0.8; p< 0.05). However, in the active group, it was observed that subjects who initiated the practice of physical exercise with less time after injury had higher BMD at the femur (r=-0.60; p<0.05). In active subjects, exercise frequency was negatively associated with serum i-PTH (r = -0.50, p = 0.05) and positively associated with serum 25(OH)D (r= 0.58; p <0.05). After adjustments for total body mass and duration of injury daily calcium intake was positively associated with lumbar spine Z-score (r = 0.73 and p < 0.01) and with radius BMD (r = 0.56 and p <0.05). The results of this study suggest a beneficial effect of regular exercise practice on bone mass and bone-related hormonal profile. The earlier initiation of regular physical exercise after the injury appears to contribute to attenuate the loss of bone mass in lower limbs. Moreover, our results suggest that the osteogenic effect of exercise may be potentiated when combined with an adequate calcium intake.

Bakgrund: Inom fysioterapin ser man på individen utifrån ett bio-psyko-socialt perspektiv. ”International Classification of Function, Disability and Health” (ICF) är ett ramverk för att mäta hälsa ur ett bio-psyko-socialt perspektiv. Kunskapen om hur dans som fysisk aktivitet påverkat personer med ryggmärgsskada är bristfällig. Det saknas kvalitativa studier inom området. Syfte: Syftet med studien var att undersöka hur personer med ryggmärgsskada upplever dans ur ett bio-psyko-socialt perspektiv. Metod: Metoden var kvalitativ och induktiv, baserad på semistrukturerade intervjuer med fem informanter: två män och tre kvinnor i åldrarna 21–57 år som dansat i rullstol mellan 2–33 år. Data analyserades med innehållsanalys. Resultat: Informanterna upplevde kroppslig påverkan: Förbättrad styrka, kondition, rörlighet, koordination och balans. Ändrad kroppsuppfattning (fått mer kontakt med kroppen). De hade även fått minskad smärta. De upplevde personlig påverkan: Psykiskt välmående (ökad self-efficacy, förbättrad självkänsla och glädje) samt fysiskt välmående. Dansen hade även varit ångestframkallande. De upplevde att de hade påverkats omgivningsmässigt: Socialt (fått nya vänner, upplevt unik gemenskap och utvecklat socialt samspel). De hade mött acceptans, viss okunskap men fått stöd från närstående. De upplevde påverkan på aktivitets- och delaktighetsnivå: Mer självständig i vardagen (de hade blivit bättre på förflyttningar). Delaktig i samhället (deltar i fler aktiviteter, delaktig i att påverka samhället). Konklusion: Personer med ryggmärgsskada upplever att dans har många positiva effekter bio-psyko-socialt. Fysioterapeuter och andra yrkesverksamma inom vård och omsorg, samt personer med ryggmärgsskada behöver få kunskap om vinsterna av dans som fysisk aktivitet för personer med ryggmärgsskada så att fler kan få del av dansens fördelar. / Background: In physiotherapy you look at the individual through a bio-psycho-social perspective. “International Classification of Function, Disability and Health” (ICF) is an instrument to measure health from a bio-psycho-social perspective. The knowledge about how dance as a physical activity effects people with spinal cord injury is insufficient. Qualitative research in this area is nonexistent.     Purpose: The purpose with the study was to examine people with spinal cord injury’s experiences with dance as a physical activity in a bio-psycho-social manner. Method: The study design was qualitative and inductive, based on semi-structured interviews with five study-participants: two men and three women in the ages 21-57, who had been dancing in wheelchair 2-33 years. The data was analyzed with qualitative content analysis. Results: The participants experienced that dancing had an impact on bodily functions: improved strength, condition, flexibility, coordination and balance. Changes in body perception (more contact with the body). They had also reduced pain. They experienced effects in personal factors: Psychological wellbeing (improved self-efficacy, self-esteem and joy) and physical wellbeing. The dance had also been generating anxiety. They experienced impact on factors involving their surroundings: social (they got more friends, experienced a unique fellowship and developed social interaction skills). They had met acceptance, some ignorance but support from close ones. They experienced impact on their activity and participation: More independent in daily life (they had become better in locomotion). Participating in the community (participating in more activities, participating in having an impact on the community). Conclusion: People with spinal cord injury experience that dancing has many positive outcomes on bio-psycho-social factors.  Physiotherapists and other professionals in health care, and people with spinal cord injury need to get knowledge about the profits of dance as a physical activity for people with spinal cord injury so that more people can take part of the benefits of dancing.

L'escarre est une complication multifactorielle après lésion médullaire. Le profil des facteurs de risque diffère entre la phase initiale et la phase chronique. Lors de la phase chronique, le poids des facteurs liés aux comportements de santé – à risque ou protecteurs – reste à définir. Pour autant, la plupart des programmes d'éducation thérapeutique menés auprès des personnes lésées médullaires s'attachent à avoir une action sur ces facteurs de risque, en permettant au patient d'être un acteur central de sa prise en charge. Sur la thématique cutanée, le Skin Management Needs Assessement Checklist est le seul outil retrouvé dans la littérature pour évaluer le risque comportemental chez les personnes lésées médullaires. Il s'agit d'un questionnaire en langue anglaise composé de 12 items explorant la surveillance cutanée, la prévention de l'escarre et la prévention des plaies réalisées par les personnes lésées médullaires. Il nous a paru répondre à nos attentes sur le champ conceptuel et clinique. Ce travail s'est attaché à réaliser une traduction, une adaptation transculturelle et une validation complète de la version française du SMnac. Le SMnac révisé, obtenu à l'issu de la phase de traduction et d'adaptation transculturelle est composé de 19 items. La reproductibilité du questionnaire est excellente. La validité de construit, évaluée par 7 hypothèses de convergence et 3 hypothèses de divergence est satisfaisante. La cohérente interne est élevée, et la sensibilité de changement, évaluée à la phase initiale de la prise en charge, est élevée. / Pressure ulcer is a multi-factor complication after spinal cord injury. The risk factors are different between the acute stage and the chronic stage. During the chronic stage, the impact of health behavior risk factors still needs to be determined. Furthermore, most educational therapeutic programs conducted on persons with spinal cord injury are aimed to act on these risk factors allowing the patient to be in charge of his or her health. On a skin level the Skin Management Needs Assessment Checklist is the only tool found in the literature to assess behavioral risks in persons with spinal cord injury. It is a questionnaire in the English language including 12 items exploring skin monitoring, pressure ulcer and wound preventions. It met with our expectations both on conceptual and clinical levels. This work consisted in providing a translation, transcultural adaptation and complete validation of the French version of the SMnac. The revised SMnac obtained after the translation and transcultural adaptation is made of 19 items. Questionnaire's reproducibility is excellent. Construct validity was evaluated with 7 convergence hypotheses and 3 divergence hypotheses and is satisfactory. Internal coherence is high and responsiveness to change, evaluated during the acute phase of SCI management, is also high.

Following on from Rio de Janeiro 2016, the Tokyo 2020 Paralympic Games will present a unique challenge for athletes, needing to prepare and adapt to the potential challenging environmental conditions of 20-27°C and ~73% relative humidity. It is well known that during exercise in hot and/or humid climates, able-bodied athletes experience an increase in thermal strain and a reduction in performance compared to cooler/drier conditions. Yet these conditions prove even more problematic for athletes, who as a consequence of their impairment have a dysfunctional thermoregulatory system, such as athletes with a spinal cord injury (SCI). To date, the thermoregulatory responses of athletes with an SCI have been an under-studied area of research. To gain a greater understanding of how heat balance is altered in individuals with an SCI and the thermoregulatory consequences as a result, studies need to first be conducted at rest, removing the additional metabolic heat production from exercise. Although a large majority of athletes with an SCI compete indoors in wheelchair court sports (e.g. wheelchair basketball and rugby), exercising even in these climate-controlled environments has been shown to place these athletes under considerable thermal strain. In light of this, it is remarkable that existing research on the thermoregulatory responses of athletes with an SCI during exercise is scarce, especially studies encompassing real-world sporting environments. Athletes with high level lesions (tetraplegia, TP) are a particularly under-studied population group shown to have a greater thermoregulatory impairment than individuals with low level lesions (paraplegia, PA) during continuous exercise. Thus the aim of this thesis was to investigate the thermoregulatory responses of athletes with an SCI at rest and during real-world sporting scenarios, with specific focus on athletes with TP. Study 1 aimed to determine how evaporative heat loss is altered, as a result of an SCI, compared to the able-bodied (AB), and the effect lesion level has on this response. The results provide evidence that in individuals with TP, even at rest, evaporative heat loss is not large enough to balance the heat load, when evaporation is the primary source of heat dissipation. Even though in individuals with PA Tgi increased by a smaller magnitude and they possessed a greater sweating capacity than individuals with TP, at ambient temperatures above Tsk latent heat loss is insufficient to attain heat balance, compared to the AB. To investigate the thermoregulatory responses of athletes with an SCI during real-world sporting scenarios Study 2 examined athletes with TP compared to athletes with PA during 60 min of intermittent sprint wheelchair exercise on a wheelchair ergometer. The study was conducted in conditions representative of an indoor playing environment for wheelchair rugby and basketball (~21°C, 40% relative humidity). Results demonstrated that, despite similar external work, athletes with TP were under greater thermal strain than athletes with PA. Study 3 s novel approach investigated both physiological responses and activity profiles of wheelchair rugby players during competitive match play. Despite players with TP covering 17% less distance and pushing on average 10% slower, they were under a greater amount of thermal strain than players with non-spinal related physical impairments (NON-SCI). Furthermore, this study demonstrated that players with TP that had a larger body mass, larger lean mass, covered a greater relative distance and/or were a higher point player had a greater end Tgi. These data provide an insight for coaches and support staff regarding which players may need greater attention in regards to cooling strategies or breaks in play. The effectiveness of cooling practices currently employed by athletes with TP has not been previously investigated. Study 4 determined the effectiveness of pre-cooling, using an ice vest alone and in combination with water sprays between quarters, at attenuating thermal strain in athletes with TP. Using the activity profile data from Study 3, an intermittent sprint protocol, conducted on a wheelchair ergometer, was used to represent a wheelchair rugby match. The combination of cooling methods lowered Tgi and Tsk to a greater extent than pre-cooling only, despite neither cooling condition having a positive or negative effect on performance. Unexpectedly, the pre-cooling only condition lowered Tgi, compared to no cooling, throughout the subsequent exercise protocol, even though the reduction in Tsk was not long lasting. This thesis provides comprehensive evidence that athletes with TP experience heightened thermal strain during both rest and real-world sporting scenarios compared to the AB, athletes with PA, and within the sport of wheelchair rugby. Athletes with TP should employ practices, such as appropriate cooling methods or alter playing tactics to reduce thermal strain and the likelihood of attaining a heat related injury.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Indivíduos que permanecem longo tempo em cadeira de rodas apresentam importante perda de massa óssea, principalmente nos membros inferiores, possivelmente agravada pela baixa ingestão de cálcio dietético e pelo inadequado estado nutricional de vitamina D. O exercício físico pode contribuir para a manutenção ou aumento da massa óssea em diferentes populações e nos indivíduos com lesão medular pode contribuir para atenuar a perda de massa óssea. O objetivo do presente estudo foi avaliar a influência da prática regular de exercício físico sobre a adequação da massa óssea, indicadores bioquímicos do metabolismo ósseo e estado nutricional de vitamina D em indivíduos com lesão medular cervical há pelo menos um ano. Em vinte e cinco homens de 19 a 56 anos sendo 15 fisicamente ativos e 10 sedentários, foi realizada análise sérica de cálcio, PTH, 25(OH)D, IGF-1, osteocalcina e NTx. As medidas do conteúdo mineral ósseo, densidade mineral óssea (DMO), massa magra e massa gorda foram realizadas por DXA. A pigmentação da pele (constitutiva e por bronzeamento) foi determinada por colorimetria com o objetivo de investigar sua influência sobre o estado de vitamina D. A ingestão habitual de cálcio foi registrada em um questionário de frequência alimentar direcionado para alimentos fonte. As comparações entre os dois grupos foram realizadas pela aplicação do Teste t de Student exceto para as variáveis ósseas que foram realizadas após ajustes pela massa corporal total, tempo de lesão e ingestão de cálcio utilizando-se análise de co-variância. Associações entre as variáveis estudadas foram avaliadas através de análise de correlação de Pearson. Valores de p<0.05 foram considerados significativos. Não foram observadas diferenças estatisticamente significativas entre os grupos para nenhuma variável óssea com exceção do z-score da DMO da coluna lombar, que foi significativamente maior no grupo de indivíduos sedentários (0,9 1,7 vs -0,7 0,8; p<0,05). No entanto, entre os indivíduos ativos, aqueles que iniciaram a prática de exercício físico com menos tempo decorrido após a lesão apresentaram maior DMO do fêmur (r=-0,60; p<0,05). Nos indivíduos ativos, a freqüência do exercício apresentou associação negativa com a concentração sérica de i-PTH (r = -0,50; p =0,05) e positiva com a concentração de 25(OH)D (r= 0,58; p <0,05). Após ajustes pela massa corporal total e tempo de lesão foram observadas associações positivas entre a ingestão diária de cálcio e z-score da DMO da coluna lombar (r = 0,73 e p <0,01) e DMO do rádio (r = 0,56 e p <0,05). Os resultados do presente estudo apontam para um efeito benéfico do exercício físico sobre a massa óssea e o perfil hormonal relacionado ao metabolismo ósseo. O início da prática regular de exercício físico o quanto antes após a lesão parece contribuir para atenuar a perda de massa óssea nos membros inferiores. Além disso, os resultados deste estudo sugerem uma possível potencialização do efeito osteogênico do exercício físico quando combinado a uma adequada ingestão de cálcio. / Individuals who stay long time in a wheelchair have significant bone loss, especially in lower limbs that may be aggravated by low calcium intake and inadequate vitamin D status. Physical exercise contributes to maintain or increase bone mass in different populations and may be useful in reducing bone loss in spinal cord injured individuals. The aim of this study was to evaluate the influence of regular physical exercise on bone mass adequacy, biochemical markers of bone metabolism and vitamin D status in individuals with cervical spinal cord injury. Twenty five male adults (19-56 years) with cervical spinal cord injury for at least one year, were recruited and divided into physically active (n=15) and sedentary (n=10) groups. Fasting blood samples were collected and serum samples were stored at -20oC until analysis of calcium, PTH, 25(OH)D, IGF-1, osteocalcin and NTx. Bone mineral content and density (BMD), lean mass and fat mass were evaluated by DXA. Skin pigmentation (constitutive and facultative) was evaluated by reflectance colorimetry in order to investigate its influence on vitamin D status. Habitual calcium intake was recorded using a food frequency questionnaire directed to calcium food sources. Comparisons between groups were performed using Students t test except for bone variables that were performed after adjustments for total body mass, duration of injury and calcium intake by analysis of covariance. Associations between variables were evaluated using Pearson's correlation analysis. P values <0.05 were considered significant. There were no significant differences between groups for bone measurements except for lumbar spine Z-score, that was significantly higher in the sedentary group (0.9 1.7 vs -0.7 0.8; p< 0.05). However, in the active group, it was observed that subjects who initiated the practice of physical exercise with less time after injury had higher BMD at the femur (r=-0.60; p<0.05). In active subjects, exercise frequency was negatively associated with serum i-PTH (r = -0.50, p = 0.05) and positively associated with serum 25(OH)D (r= 0.58; p <0.05). After adjustments for total body mass and duration of injury daily calcium intake was positively associated with lumbar spine Z-score (r = 0.73 and p < 0.01) and with radius BMD (r = 0.56 and p <0.05). The results of this study suggest a beneficial effect of regular exercise practice on bone mass and bone-related hormonal profile. The earlier initiation of regular physical exercise after the injury appears to contribute to attenuate the loss of bone mass in lower limbs. Moreover, our results suggest that the osteogenic effect of exercise may be potentiated when combined with an adequate calcium intake.

A lesão medular está associada a uma série de alterações bioquímicas e decomposição corporal. O aumento da gordura corporal e seu acúmulo na regiãoabdominal aliados a processos infecciosos decorrentes da lesão medular podemacarretar o incremento da concentração plasmática da proteína c-reativa (PCR).Tanto a gordura corporal quanto a elevada concentração da PCR estimulam aprodução de espécies reativas de oxigênio, favorecendo o desequilíbrio oxidativo e odesencadeamento de doenças. É possível que a prática de atividade física regularpossa atuar de modo benéfico através da melhor distribuição da gordura corporal eadaptação dos sistemas antioxidantes nesses indivíduos. Considerando aimportância deste tema e a escassos estudos sobre o assunto, o objetivo desteestudo foi comparar, em indivíduos com lesão medular cervical a composiçãocorporal e indicadores bioquímicos de estado antioxidante em indivíduos fisicamenteativos e não ativos. Participaram do estudo 24 tetraplégicos do gênero masculino(3210 anos de idade e 108 anos de tempo de lesão), divididos em dois grupos,fisicamente ativos (n=15, com pratica de atividade física há pelo menos 3 meses, 3vezes/semana ou mais, totalizando tempo mínimo de 150 minutos/semana) e nãoativos (n=9). A composição corporal foi determinada por absorciometria de duplaemissão de raio-X. Amostras de sangue foram coletadas após jejum de 12 horaspara determinação dos indicadores bioquímicos: de capacidade antioxidante, ácidoúrico, bilirrubina, albumina, alfa-tocoferol, malondialdeído e PCR no plasma eatividade da superóxido dismutase em eritrócitos. O grupo não ativo apresentoumaior IMC (=0,003), gordura total (%) e de tronco (%) (=<0,001) do que o grupoppfisicamente ativo. Foi encontrada relação entre a PCR e a porcentagem de gorduratotal (r=0,72, p=<0,001), de tronco (r=0,70, p=<0,001), massa gorda total (r=0,73,p=<0,001) e de tronco (r=0,67, p=0,001). Não houve diferença significativa entre osindicadores bioquímicos de estado antioxidante, exceto a concentração da PCR quefoi maior no grupo não ativo (p=0,034). Considerando todos indivíduos, 50% apresentavam deficiência de alfa-tocoferol (concentração plasmática <11,6 mol/L).Foi observada relação negativa entre a concentração plasmática de alfa-tocoferol e aPCR (r=-0,18, =0,038).No grupo ativo houve correlação positiva entre a razãoptempo de atividade física:tempo de lesão e concentração plasmática demalondialdeido (r=0,38, =0,014). Nossos resultados, analisados em conjunto,psugerem que prática contínua de atividade física após a lesão atua auxiliando a umamelhor composição corporal e, possivelmente, a uma menor concentraçãoplasmática de PCR. O estado nutricional inadequado em alfa-tocoferol podecomprometer capacidade antioxidante, sendo necessárias medidas de apoionutricional para adequar a ingestão de alfa-tocoferol para este grupo. / Spinal cord injury is associated with body composition and biochemical changes. In addition an increase of body fat and the accumulation in the trunk together the infectious process due to spinal injury can cause the increase in plasma concentration of C-reactive protein (CRP). Fat mass and the high concentration of CRP can stimulate the production of reactive oxygen species, favoring the oxidative imbalance and the onset of disease. It is possible that the practice of regular physical activity can act beneficially by contributing to a better body fat distribution and adaptation of antioxidant systems in these subjects. Considering the importance of this theme and few studies about this topic, the aim of this study was to compare body composition and biochemical markers of antioxidant status, in subjects with cervical spinal cord injury, physically active and not active. The study included 24tetraplegic male (32 10 y and 10 8 y of injury time), divided in two groups, physically active (n = 15, with practice of physical activity for at least 3 months, 3times / week or more, totaling a minimum period of 150 minutes / week) and non-active (n = 9). Body composition was determined by dual energy X-ray absorptiometry. Blood samples were collected after overnight fasting (12 hours) for determination of biochemical parameters: antioxidant capacity, uric acid, bilirubin, albumin, alpha-tocopherol, malondialdehyde and CRP in plasma, and activity of superoxide dismutase in erythrocytes. The active group showed no higher BMI (p =0.003), total fat (%) and trunk (%) (p = <0.001) than the physically active group. Relationship was found between CRP and percentagem of total fat (r=0,72,p=<0,001), trunk (r=0,70, p=<0,001), total fat mass (r=0,73, p=<0,001) and trunk(r=0,67, p=0,001).There was no significant difference between the biochemical indicators of antioxidant status, except by the concentration of CRP that was higherin the non-active group (p = 0.034). Considering the all subjects, 50% had deficiency of alpha-tocopherol (plasma concentration <11.6 mmol / L). Negative relationship was found between plasma alpha-tocopherol and CRP (r=-0.18, p=0.038). In theactive group was a positive relationship between the ratio time physical activity: time of injury and plasma malondialdehyde (r=0.38; p= 0.014). Our results, taken together, suggest that continued practice of physical activity after injury acts helping to better body composition and, possibly, a lower plasma concentration of CRP. The inadequate nutritional status in alpha-tocopherol can affect the antioxidant capacity, so actions are necessary to adjust the nutritional status of alpha-tocopherol for this group.

During amniote embryogenesis, the segmented pattern characteristic of the vertebral column appears early during development through the sequential formation of multipotent structures called somites. Somites differentiate subsequently into dermomyotome (giving rise later to skin and skeletal muscles) and sclerotome (giving rise to vertebral bone structures and cartilage). In addition, sclerotomes subdivide following their rostro-caudal intrasegmental boundary into an axon growth-permissive region (anterior half) and an axon growth-repulsive region (posterior half). This binary system instructs motor and sensory axon navigation, as well as neural crest cell migration, to ensure that the peripheral nervous system develops without obstruction by the future cartilage and bones of the vertebral column. Repellent cues are expressed in posterior half-sclerotomes in order to exclude navigating axons from “no-go” areas and restrict their growth to specific exit points of the future vertebral column. Interestingly, similar repellent cues (e.g. Eph/Ephrins) are expressed in the adult central nervous system (CNS) and have been shown to control connectivity and plasticity throughout life. Following brain or spinal cord injury, these repellent molecules are upregulated by reactive astrocytes accumulating at the lesion site, and may impede axon regeneration in this region. In this dissertation, I am presenting the results of a differential gene expression analysis of anterior and posterior half-sclerotomes, based on RNA-sequencing data and using the chick embryo as a model organism. This study led to the identification of molecules, previously uncharacterized in this system, that may play a role in adhesive and mechanical properties of somites and in axon guidance and fasciculation. I focused on the functional analysis of one molecule of the posterior half-sclerotome, the extracellular matrix protein Fibulin-2. To look at its role in the segmentation of spinal axons, I used ectopic misexpression in a subset of segments based on somite electroporation. The width of spinal nerve bundle growth was restricted by Fibulin-2 overexpression in posterior and anterior half-sclerotomes, suggesting a role in sharpening/controlling the path of spinal axon growth. In addition, I showed that this could occur via an interaction with the axon growth repellent Semaphorin 3A. Then I looked at the expression of Fibulin-2 in two models of CNS injury: mouse cerebral cortical stab injury and rat dorsal crush spinal cord injury. In both cases, I observed an increase in Fibulin-2 protein level compared to control. I also used primary cultures of rat cortical astrocytes to show that the expression of Fibulin-2 after inflammatory cytokine-induced activation is increased. Finally, I studied a candidate axon growth repellent previously identified in the laboratory. I explored the hypothesis that this repellent molecule is an O-glycosylated, spliced variant form of a known protein. To characterize this repellent molecule, I used RNA-sequencing data from chick embryonic somites and 2D gel electrophoresis of an astrocytic cell line protein extract. Together, these results suggested that the developing vertebral column and the adult CNS share molecular features to control axon growth and plasticity. This type of study could lead to the characterization of molecular systems that regulate axon growth, and to the identification of novel therapeutic targets in brain or spinal cord injury.

A lesão medular está associada a uma série de alterações bioquímicas e decomposição corporal. O aumento da gordura corporal e seu acúmulo na regiãoabdominal aliados a processos infecciosos decorrentes da lesão medular podemacarretar o incremento da concentração plasmática da proteína c-reativa (PCR).Tanto a gordura corporal quanto a elevada concentração da PCR estimulam aprodução de espécies reativas de oxigênio, favorecendo o desequilíbrio oxidativo e odesencadeamento de doenças. É possível que a prática de atividade física regularpossa atuar de modo benéfico através da melhor distribuição da gordura corporal eadaptação dos sistemas antioxidantes nesses indivíduos. Considerando aimportância deste tema e a escassos estudos sobre o assunto, o objetivo desteestudo foi comparar, em indivíduos com lesão medular cervical a composiçãocorporal e indicadores bioquímicos de estado antioxidante em indivíduos fisicamenteativos e não ativos. Participaram do estudo 24 tetraplégicos do gênero masculino(3210 anos de idade e 108 anos de tempo de lesão), divididos em dois grupos,fisicamente ativos (n=15, com pratica de atividade física há pelo menos 3 meses, 3vezes/semana ou mais, totalizando tempo mínimo de 150 minutos/semana) e nãoativos (n=9). A composição corporal foi determinada por absorciometria de duplaemissão de raio-X. Amostras de sangue foram coletadas após jejum de 12 horaspara determinação dos indicadores bioquímicos: de capacidade antioxidante, ácidoúrico, bilirrubina, albumina, alfa-tocoferol, malondialdeído e PCR no plasma eatividade da superóxido dismutase em eritrócitos. O grupo não ativo apresentoumaior IMC (=0,003), gordura total (%) e de tronco (%) (=<0,001) do que o grupoppfisicamente ativo. Foi encontrada relação entre a PCR e a porcentagem de gorduratotal (r=0,72, p=<0,001), de tronco (r=0,70, p=<0,001), massa gorda total (r=0,73,p=<0,001) e de tronco (r=0,67, p=0,001). Não houve diferença significativa entre osindicadores bioquímicos de estado antioxidante, exceto a concentração da PCR quefoi maior no grupo não ativo (p=0,034). Considerando todos indivíduos, 50% apresentavam deficiência de alfa-tocoferol (concentração plasmática <11,6 mol/L).Foi observada relação negativa entre a concentração plasmática de alfa-tocoferol e aPCR (r=-0,18, =0,038).No grupo ativo houve correlação positiva entre a razãoptempo de atividade física:tempo de lesão e concentração plasmática demalondialdeido (r=0,38, =0,014). Nossos resultados, analisados em conjunto,psugerem que prática contínua de atividade física após a lesão atua auxiliando a umamelhor composição corporal e, possivelmente, a uma menor concentraçãoplasmática de PCR. O estado nutricional inadequado em alfa-tocoferol podecomprometer capacidade antioxidante, sendo necessárias medidas de apoionutricional para adequar a ingestão de alfa-tocoferol para este grupo. / Spinal cord injury is associated with body composition and biochemical changes. In addition an increase of body fat and the accumulation in the trunk together the infectious process due to spinal injury can cause the increase in plasma concentration of C-reactive protein (CRP). Fat mass and the high concentration of CRP can stimulate the production of reactive oxygen species, favoring the oxidative imbalance and the onset of disease. It is possible that the practice of regular physical activity can act beneficially by contributing to a better body fat distribution and adaptation of antioxidant systems in these subjects. Considering the importance of this theme and few studies about this topic, the aim of this study was to compare body composition and biochemical markers of antioxidant status, in subjects with cervical spinal cord injury, physically active and not active. The study included 24tetraplegic male (32 10 y and 10 8 y of injury time), divided in two groups, physically active (n = 15, with practice of physical activity for at least 3 months, 3times / week or more, totaling a minimum period of 150 minutes / week) and non-active (n = 9). Body composition was determined by dual energy X-ray absorptiometry. Blood samples were collected after overnight fasting (12 hours) for determination of biochemical parameters: antioxidant capacity, uric acid, bilirubin, albumin, alpha-tocopherol, malondialdehyde and CRP in plasma, and activity of superoxide dismutase in erythrocytes. The active group showed no higher BMI (p =0.003), total fat (%) and trunk (%) (p = <0.001) than the physically active group. Relationship was found between CRP and percentagem of total fat (r=0,72,p=<0,001), trunk (r=0,70, p=<0,001), total fat mass (r=0,73, p=<0,001) and trunk(r=0,67, p=0,001).There was no significant difference between the biochemical indicators of antioxidant status, except by the concentration of CRP that was higherin the non-active group (p = 0.034). Considering the all subjects, 50% had deficiency of alpha-tocopherol (plasma concentration <11.6 mmol / L). Negative relationship was found between plasma alpha-tocopherol and CRP (r=-0.18, p=0.038). In theactive group was a positive relationship between the ratio time physical activity: time of injury and plasma malondialdehyde (r=0.38; p= 0.014). Our results, taken together, suggest that continued practice of physical activity after injury acts helping to better body composition and, possibly, a lower plasma concentration of CRP. The inadequate nutritional status in alpha-tocopherol can affect the antioxidant capacity, so actions are necessary to adjust the nutritional status of alpha-tocopherol for this group.

En förvärvad ryggmärgsskada innebär att skadan inte är medfödd och skadan kan orsaka stora förändringar i livet. De som ofta drabbas av ryggmärgsskada är män, det är också de som får störst påverkan på sexualiteten. Detta gör att det finns begränsad forskning om kvinnors sexualitet vid en förvärvad ryggmärgsskada. Syftet med litteraturstudien var att belysa kvinnors erfarenheter av sexualitet efter förvärvad ryggmärgsskada. En allmän litteraturstudie genomfördes med systematiska sökningar med latent innehållsanalys som design. I resultaten framkom tre huvudteman: En förändrad kropp, Behov av stöd och Syn på sexualitet. Resultatet visar att kvinnors erfarenheter var att sexualiteten påverkades av den förvärvade ryggmärgsskadan. Såväl fysiska som emotionella konsekvenser av skadan påverkade sexualiteten negativt. Relationer var även något som påverkades. Synen på sexualitet blev förändrad och fick en ny betydelse. Bemötandet från människor som inte var funktionshindrade upplevdes som fördomsfullt och påverkade självkänslan. Informationen om sexualitet efter ryggmärgsskadan beskrevs som bristfällig och svår att prata om. Att uppmärksamma ryggmärgsskadade kvinnors sexualitet ger sjuksköterskan förståelse och kunskap för att ge god omvårdnad. / An acquired spinal cord injury means that the injury is not congenital, and the injury can cause big changes in life. Those who often suffer from spinal cord injuries are men, it is also them that will have the greatest impact on sexuality. This means that there is limited research on women's sexuality after an acquired spinal cord injury. The purpose of the literature study was to illuminate women's experiences of sexuality after an acquired spinal cord injury. A general literature review was conducted using systematic searches with latent content analysis as the design. In the results emerged three main themes: A changed body, Needs of support and Views on sexuality. The results demonstrate that women's experience was that sexuality was affected by the injury. Both the physical and emotional consequences of the injury affected sexuality negatively. Relationships were also affected. The view of sexuality was changed and got a new meaning. The response from people who were not disabled was perceived as prejudiced and affected self-esteem negatively. Information on sexuality after injury was described as deficient and difficult to talk about. To pay attention to spinal cord injured women's sexuality gives the nurse the understanding and knowledge to provide good care.