A progressão da distrofia muscular de Duchenne (DMD) resulta no surgimento de múltiplas e variadas sinergias para compensar a fraqueza muscular e para lidar com as demandas de tarefas funcionais, como por exemplo, a marcha. Alguns instrumentos de avaliação funcional para pessoas com DMD permite a análise subjetiva (descrição) e objetiva (escore) sem levar em consideração os movimentos compensatórios. Por esta razão, os médicos e os fisioterapeutas enfrentam dificuldades na avaliação clínica e tomada de decisão. Este estudo teve como objetivo elaborar o domínio marcha da Escala de Avaliação Funcional para DMD / Functional Evaluation Scale (FES-DMD-D4), testar sua confiabilidade intraexaminador e interexaminadores e sua relação com a idade, escala Vignos e tempo de desempenho da marcha. Uma amostra de 120 vídeos da marcha de 30 crianças com DMD foi analisada. Os movimentos detectados foram classificados considerando suas características cinesiológicos e padrões de compensações. FES-DMD-D4 foi criada e submetida à avaliação de 10 especialistas. Após a incorporação das sugestões propostas, a escala foi utilizada no total da amostra para avaliação por três examinadores. Foi calculada a confiabilidade intraexaminador e interexaminadores utilizando ICC. As relações entre o FES-DMD-D4 e a idade, a escala Vignos e o tempo de desempenho foram testadas com teste de correlação de Spearman (p < 0,05). A FES-DMD-D4 foi composta por três fases, e 14 itens. Coeficientes de correlação intraclasse variaram de aceitável (0,79) a excelente (0,98). A pontuação total da FES-DMD-D4 correlacionou-se com a idade e o tempo de desempenho, mas não com a escala Vignos / The progression of Duchenne Muscular Dystrophy (DMD) results in the emergence of multiple and varied synergies to compensate muscle weakness and to deal with the demands of functional tasks, such as gait. Few functional evaluation instruments for people with DMD allows for subjective analysis (description) and objective (score) without taking into account the compensatory movements. For this reason, clinicians and physiotherapists face difficulties in clinical assessment and decision-making. This study aimed to elaborate the gait domain of the Functional Evaluation Scale for DMD, gait domain (FES-DMD-D4) and to test its reliability intraexaminer and interexaminers and its relationship with age, Vignos score and timed motor performance. A sample of 120 gait videos of 30 children with DMD was analyzed. The detected movements were classified, considering the kinesiological characteristics of the compensation movements. FES-DMD-D4 was created and submitted to the review of 10 experts. After the incorporation of the suggestions proposed by the experts, the scale was used to analyse a total sample by 3 examiners. The reliability intraexaminer and interexaminers was calculated using ICC. The relationships between FES-DMD-D4 and age, Vignos score and timed motor performance was tested with Spearman correlation test (p < 0.05). The FES-DMD-D4 was composed of 3 phases, and 14 items. Intraclass correlation coefficients ranged from acceptable (0.79) to excellent (0.98). The scores on FES-DMD-D4 correlated to age and timed motor performance, but not to Vignos score

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

Objetivo: Avaliar a responsividade da escala de avaliação funcional para pacientes com distrofia muscular de Duchenne (DMD), domínio 1 - sentar e levantar da cadeira (FES-DMD-D1). Método: Estudo observacional, retrospectivo e longitudinal (seguimento por um ano). Foi estudada, utilizando o software FES-DMD-DATA, uma amostra de 150 avaliações da atividade de sentar e levantar da cadeira, a partir de um banco de imagens com filmes de 30 crianças com DMD, executando atividades funcionais, avaliadas a cada três meses, em um período de um ano. A avaliação da FES-DMD-D1 foi aplicada por fisioterapeuta treinado, considerando os escores das fases de flexão, de contato e de extensão da atividade de sentar na cadeira e, das fases de flexão, de transferência e de extensão da atividade de levantar da cadeira. Para avaliar a responsividade da FES-DMD-D1 foram analisadas as avaliações dos períodos de seguimento de três, seis, nove e doze meses, por meio do tamanho do efeito (TE) e da média de resposta padronizada (MRP). Resultados: A responsividade da atividade de sentar na cadeira foi considerada de pequena a moderada nas avaliações a cada três meses (TE de 0,22 a 0,49 e MRP de 0,32 a 0,54), de pequena a moderada a cada seis meses (TE de 0,50 a 0,61 e MRP de 0,41 a 0,61), de pequena a grande a cada nove meses (TE de 0,69 a 1,11 e MRP de 0,49 a 0,79) e grande no período de um ano (TE de 1,07 e MRP de 0,80). Na atividade de levantar da cadeira, a responsividade foi pequena a cada três meses (TE de 0,21 a 0,35 e MRP de 0,28 a 0,45), de pequena a grande a cada seis meses (TE de 0,45 a 0,62 e MRP de 0,50 a 0,96), de moderada a grande a cada nove meses (TE de 0,76 a 0,89 e MRP de 0,74 a 1,47) e grande em um ano (TE de 1,28 e MRP de 1,24). Conclusão: A FES-DMD-D1 mostrou responsividade de moderada a grande, aumentando gradativamente nos intervalos de seis, nove e doze meses. Dessa forma, é indicado o uso da FES-DMD-D1 a partir de seis meses / Objective: To evaluate the responsiveness of the functional evaluation scale for patients with Duchenne muscular dystrophy (DMD) - domain 1: sitting and standing from the chair (FES-DMD-D1). Method: Observational, retrospective and longitudinal study with one year follow-up. A sample of 150 evaluations of sitting and rising from the chair was studied, using the FES-DMD-DATA software, from a bank of images of 30 children with DMD performing functional activities, evaluated every three months in a period of one year. FES-DMD-D1, which explores the scores of the phases of flexion, contact, extension of the activity of sitting on the chair, and of the phases of flexion, transference, extension of the activity of rising from the chair was applied by a trained physiotherapist. To evaluate the responsiveness of FES-DMD-D1 we considered the follow-up evaluations after three, six, nine and twelve months. The analysis used the effect size (ES) and standardized response mean (SRM). Results: The responsiveness of sitting on the chair was considered low to moderate in evaluations with three months intervals (ES from 0.22 to 0.49 and SRM from 0.32 to 0.54), low to moderate with six months intervals (ES from 0.50 to 0.61 and SRM from 0.41 to 0.61), low to high in nine months intervals (ES from 0.69 to 1.11 and SRM from 0.49 to 0.79) and high in the reassessment after one year (ES from 1.07 and SRM from 0.80). The responsiveness of the rising from the chair was low in three months (ES from 0.21 to 0.35 and SRM from 0.28 to 0.45), from low to high in six months (ES from 0.45 to 0.62 and SRM from 0.50 to 0.96), moderate to high in nine months (ES from 0.76 to 0.89 and SRM from 0.74 to 1.47) and high in a year (ES from 1.28 and SRM from 1.24). Conclusion: FES-DMD-D1 showed moderate to high responsiveness, gradually increasing for intervals of six, nine and twelve months. Thus, the use of FES-DMD-D1 is indicated from six months

OBJETIVO: 1- Avaliar e comparar o tempo de frenagem medido no simulador de direção virtual entre motoristas com e sem paraplegia; 2- Identificar e descrever as variáveis preditoras do tempo de frenagem no simulador de direção para os motoristas com paraplegia. METODOLOGIA: Motoristas do sexo masculino com paraplegia (n = 20 com idade média de 38,1 ± 3,6 anos) e motoristas sem paraplegia (n = 20 com idade média de 38,0 ± 5,8) com carteira de habilitação válida tiveram o tempo de frenagem medido no simulador de direção virtual. Os motoristas sem paraplegia foram avaliados com controles convencionais de pedais de freio e aceleração e os motoristas com paraplegia usaram controles manuais. O teste t de Student comparou os resultados do entre os grupos. A correlação do tempo de frenagem foi realizada com as variáveis selecionadas para o estudo nos motoristas com paraplegia. RESULTADOS: As diferenças do tempo de frenagem do simulador entre os grupos não foram estatisticamente significativas (motoristas sem paraplegia = 0,90 segundos; motoristas com paraplegia 0,92 segundos, p > 0,05). A experiência de dirigir correlaciona-se significativamente com o tempo de frenagem dos motoristas com paraplegia (r = -58, p = 0,009). Análises de regressão linear indicaram que anos de escolaridade, experiência de direção e o teste neuropsicológico MOCA (variáveis explicativas) explicaram 60,2% da resposta do tempo de frenagem do simulador de direção para os motoristas com paraplegia. CONCLUSÃO: A experiência de condução, anos de escolaridade e o teste neuropsicológico MOCA foram identificadas como preditoras do tempo de frenagem do simulador de direção para motoristas com paraplegia / Objective: (1) To identify differences in driving simulator braking time response between paraplegic and able-bodied drivers (2) To determine the contributions of age, driving experience, length of disability, handgrip strength and, neuropsychological tests, as selected factors, to driving simulator braking time response of drivers with paraplegia. Design: Two groups of male able-bodied and paraplegic drivers had their braking time response evaluated in an automatic transmission car simulator. Able-bodied drivers were tested with conventional controls and paraplegic drivers used hand controls. Drivers with paraplegia performed simple, choice and go-no-go reaction time tests as neuropsychological evaluation. Student\'s t test compared results of driving simulator braking time response between groups. Persons\' correlation verified the association between driving simulator braking time responses and selected variables of the drivers with paraplegia. Subjects: Able-bodied drivers (n=20 mean age 38.0±5.8) and paraplegic drivers (n=20 mean age 38.1±3.6) with valid driver license accepted to be part of this study. Results: Differences of simulator braking time response between groups were not statistically significant (able-bodied=0.90 seconds; paraplegic drivers 0.92 seconds, p>0.05). Driving experience significantly correlates with braking time response of the drivers with paraplegia (r= -58, p=0.009). Linear regression analyses indicated that years of education and driving experience (explanatory variables) explained 60.2% of driving simulator braking time response for the drivers with paraplegia. Conclusion: Driving experience, years of education and MOCA neuropsychological test were predictors variables of driving simulator braking time for paraplegic drivers

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-05-04T18:42:35Z No. of bitstreams: 1 Clayton Moraes.pdf: 1030173 bytes, checksum: 1d93c460abbbbe47ccf71647da2775b1 (MD5) / Made available in DSpace on 2015-05-04T18:42:35Z (GMT). No. of bitstreams: 1 Clayton Moraes.pdf: 1030173 bytes, checksum: 1d93c460abbbbe47ccf71647da2775b1 (MD5) Previous issue date: 2014-01-17 / Nenhuma / A análise dos modos de falhas e efeitos (FMEA) na área da saúde vem sendo buscada por gestores, desse segmento de prestação de serviços, como uma forma consistente de se trabalhar eventos adversos antes que os mesmos aconteçam ou tenham um impacto direto sobre a assistência dos pacientes. Um dos processos de trabalhos desses ambientes é a prática médica com órteses, próteses e materiais especiais (OPME), que acontece invariavelmente dentro de áreas críticas das instituições de saúde, podendo ser desencadeadora de riscos assistenciais aos pacientes. O processo de OPME é crítico desde a definição dos materiais indicados para a intervenção, passando pelos processos administrativos de orçamentos e autorizações, pelas ações assistenciais de solicitação, recebimento, preparo e finalizando na utilização desse insumo. Assim sendo, todo esse processo deve estar plenamente ajustado e adequado para atender as necessidades específicas de cada usuário. O objetivo desse trabalho foi avaliar as falhas potenciais no processo de OPME através da utilização da metodologia FMEA em um hospital de grande porte de Porto Alegre . A fim de atingir esse objetivo se formou um grupo de avaliação para revisão e redefinição do fluxograma do processo de OPME e após levantamento de modos de falhas em cada etapa desse processo. Foram verificadas ao todo 16 falhas nas etapas e a partir delas, foram levantadas 19 possíveis causas para sua ocorrência, bem como oito efeitos potenciais das falhas sobre a assistência dos pacientes. Após esse levantamento o grupo classificou o índice de risco, conforme a gravidade, ocorrência e detecção de falha, para cada efeito elencado e foram levantadas ações passíveis de implementação com vistas a redução do risco assistencial representados por falhas no processo de OPME. Entende-se que esse estudo possa auxiliar instituições hospitalares na implantação de ações para redução do risco assistencial aos pacientes imputado por falhas no processo de OPME. / The failure modes and effects analysis (FMEA) in heal thcare area is being sought by managers that service segment as a consistent way to work adverse events before they happen or have a direct impact on the patient care. One of these processes work environments is the medical practice with orthosis, prostheses and special materials, that happens invariably within critical areas of health institutions, can be a trigger for patient care risks. The orthosis, prostheses and special materials process is critical since definition materials indicated for the intervention, passing by the administrative processes of budgets and authorizations, care actions by request, receipt, preparation and finishing in the use of these materials. Thus, the entire process should be fully adjusted and suited to attend the specific needs of each user. The aim of this study was to evaluate the potential flaws in the orthosis, prostheses and special materials process through the use of FMEA methodology. In order to achieve this goal it has formed an analysis group for review and redefinition of the flowchart of orthosis, prostheses and special materials and after survey of failure modes at each stage of that process. 16 failures in the steps were observed in all and from those, 19 were raised possible causes for their occurrence, as well as 8 potential effects of failures on the patients care. Following this survey group rated the risk index, depending on the severity, occurrence and detection of failure for each part listed effect and actions capable of implementation in order to reduce healthcare risk represented by failures in the orthosis, prostheses and special materials process were raised. It understands that this study may assist hospitals in implementing actions to reduce risk to patients care imputed by orthosis, prostheses and special materials flaws in the process.

Diss. (sammanfattning) Göteborg : Univ., 2003. / Härtill 5 uppsatser. Del av upplagan utan uppsatser.

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

No / To enable improved interpretation of the total score and faster scoring of the Rivermead Mobility Index (RMI) by studying item ordering or hierarchy and formulating start-and-stop rules in patients after stroke. DESIGN: Cohort study. SETTING: Rehabilitation center in the Netherlands; stroke rehabilitation units and the community in the United Kingdom. PARTICIPANTS: Item hierarchy of the RMI was studied in an initial group of patients (n=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 304 [49%] left hemisphere lesion, and 269 [43%] right hemisphere lesion), and the adequacy of the item hierarchy-based start-and-stop rules was checked in a second group of patients (n=237; mean age +/- SD, 60.0+/-11.3y; 139 [59%] men; 103 [44%] left hemisphere lesion, and 93 [39%] right hemisphere lesion) undergoing rehabilitation after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate the fit of the double monotonicity model, indicating hierarchical item ordering. The percentages of patients with a difference between the RMI total score and the scores based on the start-and-stop rules were calculated to check the adequacy of these rules. RESULTS: The RMI had good fit of the double monotonicity model (coefficient H(T)=.87). The interpretation of the total score improved. Item hierarchy-based start-and-stop rules were formulated. The percentages of patients with a difference between the RMI total score and the score based on the recommended start-and-stop rules were 3% and 5%, respectively. Ten of the original 15 items had to be scored after applying the start-and-stop rules. CONCLUSIONS: Item hierarchy was established, enabling improved interpretation and faster scoring of the RMI.