O Acidente Vascular Encefálico (AVE) freqüentemente ocasiona alterações de equilíbrio, decorrentes de lesões no sistema nervoso central que afetam os aspectos motores, sensoriais e de integração do controle do movimento. Os objetivos deste estudo foram descrever as alterações de equilíbrio em indivíduos hemiparéticos que haviam sofrido AVEs isquêmicos nos 12 meses anteriores (grupo de estudo - GE), em comparação a um grupo de indivíduos saudáveis (grupo controle, GC), e correlacionar medidas observacionais (Escala de Equilíbrio de Berg: EEB; e Sub-Escala de Equilíbrio do teste de Fugl-Meyer: SEE-FM) e laboratoriais (resultados da Posturografia Dinâmica computadorizada - PDC) no GE. Na PDC, foram realizados o teste de organização sensorial e o teste de controle motor. Foram avaliados 21 pacientes que apresentavam alto nível de desempenho funcional (avaliado pelo Índice de Barthel e pela Categoria de Deambulação Funcional, CDF), e comprometimento neurológico leve (avaliado pela escala de AVE do National Institutes of Health, NIHSS) e sensório-motor dos membros inferiores (avaliado pela sub-escala motora de membros inferiores de Fugl-Meyer). O desempenho do GE foi inferior ao do GC em todas as avaliações de equilíbrio. Os resultados da PDC indicaram pior integração das informações visual e vestibular no GE, comparado ao GC. Adicionalmente, os indivíduos do GE apresentaram maior assimetria na distribuição de peso e na força empregada pelos membros inferiores para se recuperarem de desequilíbrios impostos pelo teste. A PDC foi o único instrumento cujos resultados foram associados a comprometimento da dorsiflexão ativa e da propriocepção na articulação do tornozelo. Houve correlação estatisticamente significativa entre o Índice de Barthel e as escalas de equilíbrio, mas não com a PDC. As pontuações na CDF e na sub-escala motora de membros inferiores de Fugl-Meyer se correlacionaram significativamente com todas as medidas de avaliação de equilíbrio. As pontuações na NIHSS não se correlacionaram significativamente com as medidas observacionais nem com os resultados da PDC. Os três instrumentos de avaliação do equilíbrio apresentaram correlação entre si, e com o antecedente de quedas. As informações obtidas através da PDC contribuíram para melhor caracterização das anormalidades de equilíbrio em doentes hemiparéticos após o AVE. / Abnormal balance after stroke can be a consequence of changes in motor, sensory and integrative aspects of motor control. The aims of this study were to describe balance impairments in hemiparetic patients with ischemic strokes in the last 12 months compared to healthy subjects, and to correlate observational scores (Berg Balance Scale and balance subscale of the Fugl-Meyer assessment scale) and laboratory measurements (results of the Computerized Dynamic Posturography CDP) in the stroke group. The Sensory Organization Test and the Motor Control Test were performed in PDC. Twenty-one patients were evaluated. They had high functional levels (evaluated with the Barthel Index and with the Functional Ambulatory Category, FAC), mild neurological deficits (evaluated with the National Institutes of Health Stroke Scale, NIHSS) and mild sensory and motor impairment in the lower limbs (evaluated with the motor subscale of the Fugl-Meyer assessment scale). Patients had lower scores than healthy volunteers in all balance evaluations. CDP results showed worse visual and vestibular integration in the stroke group compared to healthy subjects. Weight and strength asymmetries in the lower limbs were greater in the stroke group. Only CDP results were significantly correlated with ankle dorsiflexion and proprioception. The Barthel Index correlated significantly with balance scales but not with PDC results. FAC and the motor subscale of the Fugl-Meyer assessment scale correlated significantly with all types of balance assessment. NIHSS scores did not correlate with observational scores or CDP results. The three instruments of balance evaluation were significantly correlated with each other and with history of falls after stroke. Information provided by CDP contributed to better characterize balance abnormalities in hemiparetic stroke patients.

This thesis presents the design for a novel haptic interface for large-format touchscreens. Techniques such as electrovibration, ultrasonic vibration, and external braked devices have been developed by other researchers to deliver haptic feedback to touchscreen users. However, these methods do not address the need for spatial constraints that only restrict user motion in the direction of the constraint. This technology gap contributes to the lack of haptic technology available for touchscreen-based upper-limb rehabilitation, despite the prevalent use of haptics in other forms of robotic rehabilitation. The goal of this thesis is to display kinesthetic haptic constraints to the touchscreen user in the form of boundaries and paths, which assist or challenge the user in interacting with the touchscreen. The presented prototype accomplishes this by steering a single wheel in contact with the display while remaining driven by the user. It employs a novel embedded force sensor, which it uses to measure the interaction force between the user and the touchscreen. The haptic response of the device is controlled using this force data to characterize user intent. The prototype can operate in a simulated free mode as well as simulate rigid and compliant obstacles and path constraints. A data architecture has been created to allow the prototype to be used as a peripheral add-on device which reacts to haptic environments created and modified on the touchscreen. The long-term goal of this work is to create a haptic system that enables a touchscreen-based rehabilitation platform for people with upper limb impairments.

Stroke is a rapidly increasing disease worldwide, and speech and language impairments are common in stroke patients. A patient’s ability to speak, listen, read and write is reduced after stroke which affects the patient's independently living and quality of life. After an initial evaluation at the hospital, the stroke survivors are referred to the stroke rehabilitation centre where the speech therapists assist them in their challenging and long journey towards speech and language relearning. To enhance the patient's quality of life and to facilitate the speech therapists, technology-enhanced systems can play an important role. However, the currently used software applications such as online speech and language relearning applications are not specifically designed after the user’s need, and the user’s participation and empowerment are compromised. Medical caregivers and stroke patients are the main stakeholders and potential users of these software applications. Therefore, this study is aimed to understand the medical caregivers and the stroke patients’ needs for technology-enhanced speech and language relearning from medical caregivers’ viewpoint.  Design science research strategy was adopted to create, implement and evaluate the artefact. Some important stakeholders such as speech therapists, a stroke specialist doctor, information and technology professionals and one stroke survivor participated in this study. Following the speech therapist’s expert opinion, an application for speech and language assessment was developed as an artefact. The application was then evaluated for technology acceptance with the speech therapists. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used as the theoretical foundation for making the interview questions and data analysis.  The user's requirements for software application differ from one patient to another depending upon the patient's overall health after stroke, their age, social life, the level of speech and language loss, and previous experience with technology use. Stroke is common in adults and adults like to participate in designing their relearning process; therefore, adults should be involved in deciding the learning objectives, and adult learning principles are helpful to understate their needs for speech and language relearning. Due to impaired physical and cognitive conditions, the patients need a bigger interface with larger fonts and pictures and more constructive colours than usual. Tablets with touch pens are preferred hardware. The speech therapist should have the possibility to change the exercises runtime according to the patient's abilities and stamina to do the exercises.  The technology acceptance evaluation showed that the developed application was easy to use and efficient for speech therapists. The study participants also highlighted some critical issues for better usability and technology acceptance. The application should be synchronized with speech therapists’ existing workflow and routines, and it should directly be connected to the hospital records system so that the patients’ data can easily be transferred to their journals.  The role of facilitating conditions such as proper education and training about the system, and personalised support is also important in technology acceptance. The user’s trust in the system’s security and privacy and their personal integrity were also highlighted as main determinants for technology adoption and use. To achieve better coherence between the users and technology, all the tasks/exercises and sub-tasks in the application should be designed in close collaboration with speech therapists and stroke patients. Due to the Covid-19 pandemic, only one stroke survivor was interviewed in this study. However, the patients’ perspective is of utmost importance, and in future research, they will be involved in the design and development of such technology-enhanced systems.

No / To assess the reliability of duration of treatment time measured by physiotherapy staff in early-stage stroke patients. DESIGN: Comparison of physiotherapy staff's recording of treatment sessions and video recording. SETTING: Rehabilitation stroke unit in a general hospital. SUBJECTS: Thirty-nine stroke patients without trunk control or who were unable to stand with an erect trunk without the support of two therapists recruited to a randomized trial evaluating the Oswestry Standing Frame. Twenty-six physiotherapy staff who were involved in patient treatment. MAIN MEASURES: Contemporaneous recording by physiotherapy staff of treatment time (in minutes) compared with video recording. STATISTICAL ANALYSIS: Intraclass correlation with 95% confidence interval and the Bland and Altman method for assessing agreement by calculating the mean difference (standard deviation; 95% confidence interval), reliability coefficient and 95% limits of agreement for the differences between the measurements. RESULTS: The mean duration (standard deviation, SD) of treatment time recorded by physiotherapy staff was 32 (11) minutes compared with 25 (9) minutes as evidenced in the video recording. The mean difference (SD) was -6 (9) minutes (95% confidence interval (CI) -9 to -3). The reliability coefficient was 18 minutes and the 95% limits of agreement were -24 to 12 minutes. Intraclass correlation coefficient for agreement between the two methods was 0.50 (95% CI 0.12 to 0.73). CONCLUSIONS: Physiotherapy staff's recording of duration of treatment time was not reliable and was systematically greater than the video recording.

O objetivo deste estudo foi avaliar o efeito do biofeedback (BIO) associado à terapia ocupacional (TO) e à estimulação elétrica funcional (FES) na espasticidade, movimento ativo e função do membro superior de pacientes hemiplégicos. Este estudo foi realizado na Divisão de Medicina de Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Cinqüenta e nove pacientes acometidos por acidente vascular cerebral participaram do estudo por um ano; 31 receberam TO+FES duas vezes por semana + BIO uma vez por semana e 28 receberam somente TO+FES duas vezes por semana. Os pacientes foram avaliados inicialmente, após 6 meses e após 1 ano através da Avaliação da Função Manual, do Teste de Destreza Manual Minnesota, do Teste de Amplitude de Movimento e da Escala de Ashworth modificada. TO+FES+BIO melhoraram significativamente a amplitude de movimento e função dos membros superiores após 6 meses e 12 meses, quando comparado com somente TO+FES. Ambos os grupos melhoraram significativamente a espasticidade, após 6 meses e 12 meses, com diferença não significante entre eles. O uso adicional do biofeedback mostrou efeito positivo em amplitude de movimento e recuperação da função do membro superior no grupo estudado e pode representar uma importante ferramenta para a reabiltação de pacientes hemiplégicos / The objective of this was to study the effect of biofeedback (BIO) associated to occupational therapy (OT) and functional electrical stimulation (FES) on spasticity, range of motion and upper extremity function of hemiplegic patients. The study took part at the Division of Rehabilitation Medicine of the Hospital das Clínicas of the University of São Paulo School of Medicine. Fifty-nine stroke patients were studied for one year; 31 received OT+FES twice a week + BIO once-a-week and 28 received only OT+FES twice-aweek. The patients were evaluated initially, after six months and after one year with the use of Manual Function Evaluation, Minnesota Manual Dexterity Test, Range of Joint Motion Test and Modified Ashworth Scale. OT+FES+BIO significantly improved range of motion and upper extremity function after 6 months and 12 months, compared to only OT+FES. Both groups showed significant improvement of spasticity, after 6 months and 12 months, with no significant difference between them. The additional use of BIO had a positive effect in range of motion and function recovery of upper extremity in the studied group and may represent an important therapeutic tool for stroke rehabilitation

Made available in DSpace on 2015-07-22T20:49:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-07-30 / Introdução: A Terapia por Contensão Induzida (TCI) ou Constraint-induced Movement Therapy é uma intervenção que tem como objetivo a recuperação do membro superior afetado de pacientes hemiparéticos devido à lesão encefálica. É aplicada através de um tratamento intensivo durante duas semanas consecutivas, com seis horas diárias de exercícios e uso de uma tipóia, durante 90% do dia, no membro superior não-afetado. O ganho motor da TCI é validado através das escalas funcionais de avaliação do membro superior (EFAMS) Wolf Motor Function Test (WMFT) e Action Research Arm Test (ARAT). Objetivo: Realizar uma análise comparativa entre ambas as EFAMS. Métodos: As EFAMS foram aplicadas em quatro períodos distintos em 17 pacientes com o diagnóstico de acidente vascular cerebral isquêmico, que realizaram individualmente a TCI durante duas semanas com seis horas diárias de exercícios e após foi feito uma análise comparativa entre as EFAMS em relação ao tempo de aplicação, tempo de preparação da mesa, reprodutibilidade e análise fatorial. Resultados: Diminuição no escore da EFAMS WMFT e aumento no escore da EFAMS ARAT pós TCI, não houve variação significativa dos escores entre os períodos pré e pós TCI das EFAMS, diminuição do tempo de preparação da mesa e aplicação de ambas as EFAMS pós TCI e a análise fatorial detectou dois e três componentes qualitativos na EFAMS ARAT e WMFT, respectivamente. Conclusões: Ambas as EFAMS conseguem mensurar o ganho motor da TCI, com alta reprodutibilidade, sendo que o tempo de aplicação e preparação da mesa é menor na EFAMS ARAT e somente a EFAMS WMFT apresenta o componente qualitativo “lateralidade”. / The Constraint-induced Movement therapy (CIMT) is an intervention which main goal is the recuperation of affected upper extremity in hemiparetic patients with acquired encephalic lesion. Its protocol consists by an intensive treatment of two consecutive weeks with six hours of exercises and the wear of arm sling in non affected upper arm during 90% of daily activities. The motor improvement of CIMT is validity by the functional evaluation scales of upper extremity (FESUE) Wolf Motor Function Test (WMFT) and Action Research Arm Test (ARAT). Objective: Realize a comparative analysis between both scales. Methodology: The FESUE had been applied during four different times in 17 patients with diagnosis of ischemic stroke, who made individually the CIMT during two weeks and six hours of exercises and after made a comparative analysis between the FESUE by time for application, time for preparation of the table, reproducibility and factorial analysis. Results: Decreased in score of FESUE WMFT and increased in score of FESUE ARAT after CIMT, no significant variation in the score between before and after CIMT of the FESUE, decreased in time to preparation the table and application of FESUE in both scales and the factorial analysis showed two and three qualitative components in FESUE ARAT and WMFT, respectively. Conclusions: Both FESUE can measure the therapeutics gains of CIMT, with high reproducibility, but the time for application and preparation of the table are minor in FESUE ARAT and only the FESUE WMFT shows the qualitative component “laterality”. / TEDE / BV UNIFESP: Teses e dissertações

O objetivo deste estudo foi avaliar o efeito do biofeedback (BIO) associado à terapia ocupacional (TO) e à estimulação elétrica funcional (FES) na espasticidade, movimento ativo e função do membro superior de pacientes hemiplégicos. Este estudo foi realizado na Divisão de Medicina de Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Cinqüenta e nove pacientes acometidos por acidente vascular cerebral participaram do estudo por um ano; 31 receberam TO+FES duas vezes por semana + BIO uma vez por semana e 28 receberam somente TO+FES duas vezes por semana. Os pacientes foram avaliados inicialmente, após 6 meses e após 1 ano através da Avaliação da Função Manual, do Teste de Destreza Manual Minnesota, do Teste de Amplitude de Movimento e da Escala de Ashworth modificada. TO+FES+BIO melhoraram significativamente a amplitude de movimento e função dos membros superiores após 6 meses e 12 meses, quando comparado com somente TO+FES. Ambos os grupos melhoraram significativamente a espasticidade, após 6 meses e 12 meses, com diferença não significante entre eles. O uso adicional do biofeedback mostrou efeito positivo em amplitude de movimento e recuperação da função do membro superior no grupo estudado e pode representar uma importante ferramenta para a reabiltação de pacientes hemiplégicos / The objective of this was to study the effect of biofeedback (BIO) associated to occupational therapy (OT) and functional electrical stimulation (FES) on spasticity, range of motion and upper extremity function of hemiplegic patients. The study took part at the Division of Rehabilitation Medicine of the Hospital das Clínicas of the University of São Paulo School of Medicine. Fifty-nine stroke patients were studied for one year; 31 received OT+FES twice a week + BIO once-a-week and 28 received only OT+FES twice-aweek. The patients were evaluated initially, after six months and after one year with the use of Manual Function Evaluation, Minnesota Manual Dexterity Test, Range of Joint Motion Test and Modified Ashworth Scale. OT+FES+BIO significantly improved range of motion and upper extremity function after 6 months and 12 months, compared to only OT+FES. Both groups showed significant improvement of spasticity, after 6 months and 12 months, with no significant difference between them. The additional use of BIO had a positive effect in range of motion and function recovery of upper extremity in the studied group and may represent an important therapeutic tool for stroke rehabilitation

No description available.

Die technikgestützte Rehabilitation wird im Rahmen der Schlaganfallbehandlung als therapeutisches Verfahren zur Wiedererlangung der motorischen Bewegungsfähigkeit oberer Extremitäten eingesetzt. Zudem wächst durch die Digitalisierung des Alltags und den demographischen Wandel das Forschungsinteresse an telerehabilitativen Behandlungskonzepten, die die Schlaganfallversorgung durch den Einsatz von Informations- und Kommunikationstechnologien ergänzt sowie erweitert. Dabei wird das Ziel verfolgt, einen dauerhaften und nachhaltigen Therapieerfolg zu ermöglichen. Durch die Möglichkeit zur Vernetzung der stationären sowie ambulanten Rehabilitation mit der Nachsorge soll eine kontinuierliche, über die notwendigen Gesundheitssektoren der Schlaganfallbehandlung hinweg, eine Begleitung der Patient:innen durch die betreuenden Behandler:innen gewährleistet werden. Der erfolgreiche Einsatz entsprechender Therapiesysteme in der Nachsorge verlangt einen benutzerzentrierten Entwicklungsprozess. Ausgangspunkt sollten die von den beteiligten Nutzer:innengruppen gestellten Anforderungen an derartige Systeme sein. Das Ziel der vorliegenden Arbeit besteht darin, auf verschiedene Aspekte des Technikeinsatzes und die damit einhergehende Zufriedenheit sowie Akzeptanz der technikgestützten Schlaganfallrehabilitation und Nachsorge der beteiligten Nutzer:innengruppen einzugehen. Eine Kombination aus drei explorativen Untersuchungen, einer Grundlagenbefragung und zwei empirischen Feldstudien, analysieren abhängige Faktoren des Technikeinsatzes, um entsprechende Auswirkungen auf die Entwicklung und Praxis abzuleiten. Im Rahmen der Grundlagenbefragung werden das Nutzungsverhalten sowie die Nutzungsbereitschaft von Informations- und Kommunikationstechnologien von Schlaganfallpatient:innen und Behandler:innen analysiert. Daraus abgeleitet werden notwendige Ressourcen, die bereitgestellt werden müssen, um technikgestützte Verfahren sowohl in der Rehabilitation als auch Nachsorge zu ermöglichen. Die erste empirische Studie untersucht Veränderungen im Nutzer:innenerleben, der Zufriedenheit und Technikakzeptanz, zwischen zwei Therapiegeräten in der klassischen Versorgung mit zwei experimentellen Therapiesystemen mit visuellem und zum Teil haptischem Feedback. In einer zweiten Feldstudie werden zeitbezogene Veränderungen untersucht, die bei längerfristiger Nutzung über zehn Behandlungseinheiten mit dem Bi-Manu-Interact auftreten können. / Using technically assisted rehabilitation in stroke treatment as a therapeutic procedure to regain motor mobility of upper extremities. In addition, the digitalisation of everyday life and demographic change are increasing research interest in telerehabilitative treatment concepts, which supplement and expand stroke care by using information and communication technologies. The aim is to achieve lasting and sustainable therapeutic success. The possibility of integrating in-patient and out-patient rehabilitation with aftercare is intended to ensure that patients are continuously accompanied by the attending physicians across the necessary health sectors of stroke treatment. The successful use of appropriate therapy systems in aftercare requires a user-centered development process. The starting point should be the requirements placed on such systems by the user groups involved. The aim of the present study is to deal with different aspects of the use of technology and the associated satisfaction as well as acceptance of the technology-supported stroke rehabilitation and aftercare of the participating user groups. A combination of three explorative studies, a basic survey and two empirical field studies analyse dependent factors of the use of technology in order to determine corresponding effects on development and practice. The basic survey analyses the usage behaviour and readiness of stroke patients and therapists to use information and communication technologies. From this, resources are derived to enable technology-supported procedures in rehabilitation and aftercare. The first empirical field study investigates changes in user experience, satisfaction and technology acceptance between two therapy devices in classical care with two experimental therapy systems with visual and partly haptic feedback. The second field study investigates time-related changes that can occur with long-term use of more than ten therapy units with the therapy system "Bi-Manu-Interact".

Objectives: To investigate which spaces stroke patients visit in their free time while undergoing inpatient recovery in rehabilitation centers, what activities they engage in, and what kind of spaces they want. Background: Research studies consistently show that stroke patients are highly inactive during rehabilitation. Much remains unknown about what patients do in their free time and how the built environment might affect their behavior and activities. Methods: Patients’ free-time activities were recorded via patient shadowing (n = 70, 840 hr), and their spatial preferences were collected using a survey (n = 60) in seven rehabilitation centers. Each participant was observed over one typical day (12 consecutive hours). Their activities, durations, and locations were recorded using floor plans and time log sheets. Results: Six main themes emerged from the analysis of shadowing data and patient surveys: (1) spending most free time in their room, (2) corridor as the overlooked activity hub, (3) food and beverage stations as triggers of activity, (4) wanting to socialize, (5) variety of common spaces for different activities is desired, and (6) common room’s atmosphere, comfort, style, and view are important. Even though socializing with other patients was mentioned as a primary reason for visiting common spaces in the survey, patients spent most of their free time alone. Conclusions: Corridor emerged as a space with great potential to motivate and support various activities of patients. Patients’ free-time activities could contribute to their recovery, and the built environment may play a role in facilitating and supporting these activities.