This dissertation aimed to investigate the relationship between posture and reaching in both healthy and pathological conditions, approaching the trunk as a multi-segmented structure. For this purpose, neuromuscular and kinematic profiles were recorded from trunk and arm during seated reaches providing mid-rib vs pelvic levels of trunk support. Healthy adults with mature postural and reaching abilities displayed invariant arm kinematics during the reach. However, participants displayed increased anticipatory control and earlier activation of cervical muscles with mid-rib support. Participants also presented increased compensatory responses of paraspinal muscles when responding to the increased trunk balance demands with pelvic support. Children with moderate/severe cerebral palsy (CP) cannot maintain an upright sitting position and thus cannot create a stable postural frame around which upper limb movements are planned and executed. A second set of studies examined postural and reaching characteristics in these children, while applying axillae, mid-rib or pelvic levels of support. Participants were classified according to their intrinsic level of trunk control as mild, moderate and severe. With higher levels of support children with moderate to severe impairments in trunk control showed improvements of head and trunk control along with enhanced reaching performance. Participants with mild trunk dysfunction were able to sit independently and thus did not demonstrate significant changes in postural and reaching proficiency across levels of external trunk support. Electromyographic profiles were more variable depending on the severity of intrinsic trunk control. Overall, participants in the mild group presented more refined timing mechanisms for both anticipatory (closer to reaching onset) and compensatory (reduced latency) postural adjustments during the reach across all levels of support. Participants in the moderate group displayed earlier muscle onsets and more efficient arm/trunk muscle amplitudes with higher levels of support. Participants in the severe group showed very limited capability of anticipatory control of paraspinal muscles, delayed muscle onsets and variable muscle amplitudes across levels of support. These results emphasize the complex neuro-anatomical nature of trunk control during reaching. Also, they highlight that inefficient postural control while sitting significantly impacts children with CP and trunk dysfunction. This dissertation includes previously unpublished co-authored material.

This dissertation aimed to investigate the relationship between posture and reaching in both healthy and pathological conditions, approaching the trunk as a multi-segmented structure. For this purpose, neuromuscular and kinematic profiles were recorded from trunk and arm during seated reaches providing mid-rib vs pelvic levels of trunk support. Healthy adults with mature postural and reaching abilities displayed invariant arm kinematics during the reach. However, participants displayed increased anticipatory control and earlier activation of cervical muscles with mid-rib support. Participants also presented increased compensatory responses of paraspinal muscles when responding to the increased trunk balance demands with pelvic support. Children with moderate/severe cerebral palsy (CP) cannot maintain an upright sitting position and thus cannot create a stable postural frame around which upper limb movements are planned and executed. A second set of studies examined postural and reaching characteristics in these children, while applying axillae, mid-rib or pelvic levels of support. Participants were classified according to their intrinsic level of trunk control as mild, moderate and severe. With higher levels of support children with moderate to severe impairments in trunk control showed improvements of head and trunk control along with enhanced reaching performance. Participants with mild trunk dysfunction were able to sit independently and thus did not demonstrate significant changes in postural and reaching proficiency across levels of external trunk support. Electromyographic profiles were more variable depending on the severity of intrinsic trunk control. Overall, participants in the mild group presented more refined timing mechanisms for both anticipatory (closer to reaching onset) and compensatory (reduced latency) postural adjustments during the reach across all levels of support. Participants in the moderate group displayed earlier muscle onsets and more efficient arm/trunk muscle amplitudes with higher levels of support. Participants in the severe group showed very limited capability of anticipatory control of paraspinal muscles, delayed muscle onsets and variable muscle amplitudes across levels of support. These results emphasize the complex neuro-anatomical nature of trunk control during reaching. Also, they highlight that inefficient postural control while sitting significantly impacts children with CP and trunk dysfunction. This dissertation includes previously unpublished co-authored material.

The relationship between the development of sitting postural control and of reaching during infancy has not been addressed in detail. It has recently been shown that trunk control develops starting with the head, then the upper trunk and subsequently the lower/pelvic regions. However, previous studies on infant reaching evaluated infants during supported supine or reclined sitting positions, failing to address the contributions of distinct regions of the trunk to reaching. This dissertation explores the relationship between the progression of trunk control and reaching performance in healthy infants. The effects of stabilizing the upper and lower regions of the trunk were assessed by providing vertical trunk fixation at two levels of support (thoracic and pelvic). Documentation of postural and reaching performance reflected how control of the free regions of the trunk modulated both behaviors. First, kinematic data were collected in infants aged 4-6 months who were grouped according to their sitting ability and extent of trunk control. Second, a longitudinal study was implemented in which kinematic and electromyographic recordings were collected bi-monthly from 2.5-8 months. Results from the cross-sectional study showed that postural stability and reaching kinematics of the two groups were similar when they received support at the thoracic level but differed when the support was limited to the pelvic level. Infants who were able to sit independently outperformed the infants who were unable to sit without help. These data were further expanded with the results obtained from the longitudinal study, showing that during the months prior to independent sitting, infant reaches were impoverished and were associated with a lack of postural stability when provided with pelvic, in comparison to thoracic, support. In addition, infants displayed inefficient muscle patterns in response to the instability. Differences between levels of support were not observed once infants acquired independent sitting. Taken together, these results offer detailed measures of the progression of trunk control and its relation to reaching. This raises important questions regarding whether this more specific approach may create the foundation for evaluating and improving trunk control in atypically developing populations. This dissertation includes previously published and unpublished co-authored material.

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Submitted by Ronildo Prado (ronisp@ufscar.br) on 2017-09-05T19:45:54Z No. of bitstreams: 1 DissNTSS.pdf: 3402830 bytes, checksum: 00ff2b842c3bea94aa14e85bf96cd5fd (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-09-05T19:46:07Z (GMT) No. of bitstreams: 1 DissNTSS.pdf: 3402830 bytes, checksum: 00ff2b842c3bea94aa14e85bf96cd5fd (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-09-05T19:46:21Z (GMT) No. of bitstreams: 1 DissNTSS.pdf: 3402830 bytes, checksum: 00ff2b842c3bea94aa14e85bf96cd5fd (MD5) / Made available in DSpace on 2017-09-05T19:46:29Z (GMT). No. of bitstreams: 1 DissNTSS.pdf: 3402830 bytes, checksum: 00ff2b842c3bea94aa14e85bf96cd5fd (MD5) Previous issue date: 2017-02-13 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Aims: To identify the level of trunk control and to analyse the influence of sitting posture in a ring and seated with flexion at 90º in infants born late preterm infants with corrected age, and at term between 6 and 8 months with the support manual exact of trunk during reaching. Methods: A longitudinal study was performed with 36 full- term infants and 20 infants born preterm infants at 6-8 months of corrected age. The infants were submitted to three evaluations monthly: 1) Segmental Assessment of Trunk Control (SATCo), to identify the exact level of trunk control of infants; 2) assesssment of reaching movement, using kinematics; And 3) Alberta Infant Motor Scale (AIMS) to assess motor control of infants and to ensure the minimum 25th percentile for full-term infants. For the kinematic analysis, the infants were placed on a table in the sitting posture in a ring and seated with flexion at 90º of hip, knee and ankle. All infants during the reaching analysis received the exact and necessary manual support in the trunk according to the control level of each infant evaluated through the SATCo. To elicit reaching, an attractive, malleable or rigid object was presented on the midline, 45 ° to the right and 45 ° to the left of the infant's body. The total time of evaluation in each sitting posture was 2 minutes. It was considered variable full reaching frequency on the right, left and midline, and spatio-temporal variables to the right, left and midline (movement unit, straightness index, deceleration index, duration of movement, mean velocity, velocity peak, and trunk displacement. Results: Late preterm infants with corrected age were found to have lower trunk control compared to full-term infants at all ages evaluated. The level of trunk control presented a progressive and descending (cephalo-caudal) order with increasing age in both groups. The reaching frequency was greater at 6 months in the seated ring posture and at 7 and 8 months in the seated posture with 90 ° flexion in both groups. The sitting posture in a ring and with 90 ° flexion did not influence the kinematic variables, except for the right and midline velocity peak, and the trunk displacement to the right. On the other hand, significant differences between group and time were observed. The preterm group presented a higher number of movement units, lower, straightness index, higher average velocity and peak velocity, and lower trunk displacement in comparison to infants full term. In both groups, the spatio-temporal reaching variables improved over time, that is, older infants (8 months) presented lower number of movement units and higher straightness índex compared to younger infants (6 months). Conclusion: Late preterm infants had lower levels of trunk control compared to full-term infants. The postures seated in a ring and seated with 90 ° flexion did not influence the reaching behavior in the late term and preterm infants, since, the exact and necessary manual support was provided in the trunk of the infants, according to the level of control, evaluated through of SATCo. Thus, when the infant received the necessary manual trunk support, the different sitting postures did not influence the reaching behavior. Finally, preterm infants with corrected age, had less rectilinear, non-fluid and immature reaches compared to full-term infants at all ages evaluated. Reaches have become more mature over time, especially in full- erm infants. / Objetivo: Identificar o nível de controle de tronco e analisar a influência da postura sentada em anel e sentada em flexão a 90° em lactentes nascidos pré-termo tardios com idade corrigida, e a termo entre 6 e 8 meses de idade com o suporte manual exato de tronco durante o alcance. Métodos: Foi realizado um estudo longitudinal, com 36 lactentes nascidos a termo e 20 lactentes nascidos pré-termo tardios com idade corrigida aos 6-8 meses de idade. Os lactentes foram submetidos a três avaliações mensalmente: 1) Segmental Assessment of Trunk Control (SATCo), para identificar o nível exato de controle de tronco dos lactentes; 2) avaliação do movimento de alcance, por meio da análise cinemática; e 3) Alberta Infant Motor Scale (AIMS) para avaliar o controle motor dos lactentes e assegurar o percentil mínimo de 25 para os lactentes nascidos a termo. Para a análise cinemática, os lactentes foram posicionados em um tablado na postura sentada em anel e sentada com flexão a 90º de quadris, joelhos e tornozelos. Todos os lactentes durante a análise do alcance receberam o suporte manual exato e necessário no tronco de acordo com o nível de controle de cada lactente avaliado por meio da SATCo. Para eliciar o alcance um objeto atrativo, maleável ou rígido foi apresentado na linha média, 45º à direita e 45° à esquerda do corpo do lactente. O tempo total da avaliação em cada postura sentada foi de 2 minutos. Foi considerada variável frequência total de alcance à direita, esquerda e linha média, e as variáveis espaço-temporais à direita, esquerda e linha média (unidade de movimento, índice de retidão, índice de desaceleração, duração do movimento, velocidade média, pico de velocidade, e deslocamento do tronco. Resultados: constatou-se que lactentes pré-termo tardios, com a idade corrigida, apresentaram menor nível de controle de tronco em comparação aos lactentes a termo em todas as idades avaliadas. O nível de controle de tronco apresentou uma ordem progressiva e descendente (céfalo-caudal) com o aumento da idade em ambos os grupos. A frequência de alcance foi maior aos 6 meses na postura sentada em anel e aos 7 e 8 meses na postura sentada com flexão a 90° em ambos os grupos. A postura sentada em anel e flexão a 90° não influenciou as variáveis cinemáticas do alcance, exceto o pico de velocidade à direita e linha média, e o deslocamento do tronco à direita. Por outro lado, observou-se diferenças significativas entre os grupos e tempo. O grupo pré-termo tardio apresentou maior número de unidades de movimento, menor índice de retidão, maior velocidade média e pico de velocidade, e menor deslocamento de tronco em comparação aos lactentes a termo. Em ambos os grupos, as variáveis espaço-temporais do alcance melhoraram com o tempo, ou seja, lactentes mais velhos (8 meses de idade) apresentaram menor número de unidades de movimento e maior índice de retidão em comparação a lactentes mais novos (6 meses de idade). Conclusão: lactentes pré-termo tardios apresentaram menor nível de controle de tronco em comparação aos lactentes a termo. As posturas sentada em anel e sentada com flexão a 90° não influenciaram no comportamento do alcance nos lactentes a termo e pré-termo tardios, uma vez que, foi fornecido o suporte manual exato e necessário no tronco dos lactentes, de acordo com o nível de controle, avaliado por meio SATCo. Desta forma, quando o lactente recebeu o suporte manual de tronco necessário, as diferentes posturas sentadas não influenciaram no comportamento do alcance. Por fim, lactentes pré-termo tardios, com a idade corrigida, apresentaram alcances menos retilíneos, não fluentes e imaturos em comparação aos lactentes a termo em todas as idades avaliadas. Os alcances se tornaram mais maduros ao longo do tempo, principalmente nos lactentes a termo.

Submitted by Caroline Periotto (carol@ufscar.br) on 2016-09-21T12:34:23Z No. of bitstreams: 1 DissALRG.pdf: 1763985 bytes, checksum: 44e9557e40a8e57acc525d2b2627f4b5 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-23T18:24:34Z (GMT) No. of bitstreams: 1 DissALRG.pdf: 1763985 bytes, checksum: 44e9557e40a8e57acc525d2b2627f4b5 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-23T18:24:39Z (GMT) No. of bitstreams: 1 DissALRG.pdf: 1763985 bytes, checksum: 44e9557e40a8e57acc525d2b2627f4b5 (MD5) / Made available in DSpace on 2016-09-23T18:24:44Z (GMT). No. of bitstreams: 1 DissALRG.pdf: 1763985 bytes, checksum: 44e9557e40a8e57acc525d2b2627f4b5 (MD5) Previous issue date: 2016-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Aims: Identify the level of trunk control (Study 1) and relationship the level of trunk control with the reaching (Study 2) in infants at 6 and 9 months of age. Method: This is an observaciotinal and cross-sectional study. Fifty five healthy infants at 6 – 9 months of age were assessed in Study 1 and thirty one healthy infants were assessed in Study 2. The level of trunk control was assessed by Segmental Assessment of Trunk Control (SATCo). The motor development was assessed by Alberta Infant Motor Scale (AIMS). The reaching was assessed by kinematic analysis. During this assessment, the infants were seated in a baby chair reclined. A toy was presented at his/her midline within reaching distance for 2 minutes. The variables analyzed were: frequency uni and bimanual, trunk of support frequency in the chair, grasping and trunk control level, and kinematic variables: movement duration, peak velocity, mean velocity, deceleration index and movements units. Results: Study 1: There was a significant difference among ages 6 to 8 months (p = 0.001), 6 and 9 months (p = 0.000), 7 and 8 months (p = 0.002), and 7 to 9 months (p = 0.001). Study 2: There was no relationship between the kinematic parameters and trunk control levels at each age. There was a higher frequency with an trunk support for the infants at 6 and 7 months old. At 8 and 9 months, there was a higher frequency ranges performed without trunk support. However, there was not relationship between the trunk control level shown by SATCo and the trunk support in the chair during performance reaching for any age. Conclusion: The infants at 6 and 7 months of age had trunk control in the thoracic level while at 8 and 9 months, infants had full control trunk. Furthermore, it is suggested that the trunk control level is not related with reaching in typical infants aged between six and nine months, possibly because this infants had sufficient trunk control to carry out reaching movements. The infants used medium or no trunk support in the chair of assessment during the carry out reaching movements. / Objetivos: Identificar o nível de controle de tronco (Estudo 1) e relacionar o nível de controle de tronco com o alcance manual (Estudo 2) de lactentes saudáveis nascidos a termo saudáveis entre seis e nove meses de idade. Método: Tratam-se de estudos observacionais, de caráter transversal. Para o Estudo 1, participaram 55 lactentes nascidos a termo saudáveis entre seis e nove meses de idade. Destes, 31 lactentes participaram do Estudo 2. Para definir o nível de controle do tronco dos lactentes, foi utilizado o instrumento de avaliação Segmental Assessment of Trunk Control (SATCo). Para avaliar o desempenho motor grosso dos lactentes, foi utilizada a avaliação Alberta Infant Motor Scale (AIMS). Para avaliação cinemática do alcance manual, os lactentes permaneceram sentados em uma cadeira reclinada a fim de que realizassem o movimento de alcance manual quando um objeto era oferecido em sua linha média. Esta avaliação teve duração de dois minutos. As variáveis analisadas foram: frequência de alcances uni e bimanuais, frequência de apoio de tronco na cadeira, preensão, nível de controle de tronco, e cinemáticas: duração do movimento, pico de velocidade, velocidade média, índice de desaceleração e unidades de movimento. Resultados: Estudo 1: Houve diferença significativa do nível de controle de tronco entre as idades seis e oito meses (p=0.001), seis e nove meses (p=0.000), sete e oito meses (p=0.002), e sete e nove meses (p=0.001). Estudo 2: Não foi observada relação entre os parâmetros cinemáticos e os níveis de controle de tronco apresentado em cada idade. Observou-se maior frequência de alcances com médio apoio de tronco para os lactentes aos seis e sete meses de idade. Aos oito e nove meses, observou-se maior frequência de alcances realizados sem apoio de tronco. Entretanto, não houve relação entre o nível de controle de tronco avaliado pela SATCo e a quantidade de apoio de tronco na cadeira durante o desempenho do alcance para nenhuma das idades. Conclusão: Os lactentes aos seis e sete meses de idade apresentaram controle de tronco na região torácica enquanto aos oito e nove meses, os lactentes apresentaram controle total de tronco. Além disso, sugere-se que o nível de controle de tronco não apresentou relação com o alcance manual em lactentes típicos entre seis e nove meses de idade, possivelmente porque os lactentes avaliados apresentaram controle de tronco suficiente para realizar o movimento de alcance. Assim, utilizaram médio ou nenhum apoio de tronco na cadeira de avaliação durante o desempenho do alcance.

No description available.

Tyrimo objektas: pacientų, persirgusių galvos smegenų insultu pusiausvyra. Problema: Lietuvoje klinikinėje praktikoje nėra plačiai taikomi pusiausvyrą vertinantys testai ar skalės. Darbo tikslas: įvertinti pusiausvyros testų informatyvumą pacientams, persirgusiems galvos smegenų insultu. Uždaviniai: įvertinti pacientų pusiausvyros sutrikimus Bergo, Brunelio pusiausvyros bei liemens kontrolės įvertinimo skalėmis praėjus 2, 4, 6 savaitėm po insulto bei palyginti šių skalių rodiklius. Tyrimo metodika: naudojant Bergo ir Brunelio pusiausvyros bei liemens kontrolės įvertinimo skales buvo vertinama pacientų, persirgusių išeminiu smegenų insultu, pusiausvyros sutrikimai ir jos pokyčiai reabilitacijos eigoje. Tyrimo duomenys statistiškai buvo apdoroti naudojantis kompiuterine programa SPSS 13,0 for Windows. Rezultatai: testuojant ligonius liemens kontrolės įvertinimo skale po 2 savaičių nagrinėjamos funkcijos vidutiniškai sudarė 48,2%, po 4 savaičių 76,8%, o po 6 – 91,8% maksimalios balų sumos (p<0,05). Bergo skalės rezultatai po 2 savaičių tesudarė 17,8%, po 4 savaičių nagrinėjamo rodiklio vidutinė reikšmė ženkliai padidėjo ir tapo lygi 37,3%, o po 6 savaičių registruota reikšmė buvo didesnė (p<0,05) nei po 4 savaičių ir sudarė 59,2%. Brunelio skalės vertinimo rezultatų kaita po 2 savaičių buvo 26,3%, po 4 savaičių tiriamųjų pateiktų užduočių vertinimas siekė 54,2%, o tyrimo pabaigoje – 72,5% (p<0,05). Išvados: 1. Liemens kontrolės įvertinimo skalės didžiausias pusiausvyros... [toliau žr. visą tekstą] / Object of the study: balance of patients after stroke. Problem of the study: there are no widely used balance tests and scales in the clinical practice in Lithuania. Aim of the study: to evaluate informative of balance scales for patients after stroke. Objectives: to evaluate balance disability of patients after stroke during 2, 4, 6 weeks with Brunel, Berg balance and postural assessment scales and compare their indexes. Methods: balance disability was measured with the use of the trunk control and balance items of the Postural Assessment, Berg’s and Brunel’s balance scales for patients after stroke. Research data was analyzed using SPSS 13,0 for Windows. Results: the results of postural assessment scale for stroke patients after 2 weeks post stroke average makes 48,2%, after 4 weeks it was 76,8%, and the last – 91,8% of maximal total points (p<0,05). Evaluation of Berg balance scale after 2 weeks reach 17,8%, after 4 weeks indexes value improve a lot and makes 37,3%, after 6 weeks this value was bigger and makes 59,2% (p<0,05). The results fluctuation of Brunel balance scale after 2 weeks were 26,3%, after 4 weeks improve twice – 54,2% and 72,5% in the end of evaluation. Conclusions: 1. The biggest improvement of balance of postural assessment scale for stroke patients observed after 2 stroke weeks, between 2-6 weeks – gradually slow down, but approach maximal indexes in the end of the search. 2. Berg balance scale indexes during three evaluations improve gradually, though... [to full text]

Tyrimo objektas: asmenų, patyrusių galvos smegenų infarktą, eisenos kokybė. Tyrimo problema. Pagrindiniai eisenos kokybę įtakojantys veiksniai yra liemens funkcija ir kojų raumenų jėga. Patyrus galvos smegenų infarktą sutrinka gebėjimas eiti, eisena tampa asimetrinė, sumažėja ėjimo greitis ir padidėja energijos sąnaudos. Kompensuojant pažeistą kojų raumenų ir liemens funkciją naudojami neoptimalūs ėjimo modeliai. Darbo tikslas: Nustatyti, kokio tipo pratimai – liemens funkcijos lavinimo ar kojų raumenų stiprinimo - turi didesnį poveikį asmenų, patyrusių galvos smegenų infarktą, kokybiniams ėjimo fazių rodikliams. Uždaviniai: 1) įvertinti liemens funkciją lavinančių pratimų poveikį ligonių ėjimo fazių rodikliams; 2) įvertinti kojų raumenų stiprinimo pratimų poveikį ligonių ėjimo fazių rodikliams; 3) palyginti skirtingų kineziterapijos programų poveikį ligonių ėjimo fazių rodikliams. Tyrimo metodika: Penkiasdešimt tiriamųjų – asmenų, prieš 2 savaites patyrusių galvos smegenų infarktą - buvo suskirstyti į dvi grupes po 25 ligonius. Pirmosios grupės ligoniams didžiausią dėmesį kineziterapijos metu skyrėme liemens funkcijos lavinimui, antrosios grupės ligoniams - ėjime dalyvaujančių kojų raumenų stiprinimui. Eisenos rodiklių pokyčius vertinome Brunel pusiausvyros testu (angl. BBA) ir Wiskonsino eisenos skale (angl. WGS). Rezultatai ir išvados. 1. Liemens funkciją lavinantys pratimai statistiškai reikšmingai pagerino asmenų, patyrusių galvos smegenų infarktą, eisenos kokybę. 2... [toliau žr. visą tekstą] / Research object: gait quality of people who sustain the stroke. Research problem. The main factors of gait quality are a trunk control and a force of lower limbs muscular tissues. The stroke affects the ability to walk, the walking becomes asymmetric, and walking speed is slower consequently it increases the expenditure of energy. Non-optimal walking models are used to compensate touched lower limbs muscles and trunk control. The aim of this paper is to determine what kind of training and strenghening exercises after a stroke for a trunk control and lower limbs muscles have more intense influence for qualitative indexes of gait phases. Objectives: 1. to estimate trunk control training exercises effect on a patient’s gait phases; 2. to estimate strengthening exercises of lower limbs muscular tissues effect on a patient’s gait phases; 3. to compare various physical therapy programs effect on a patient’s gait phases. Research methods: fifty patients who had sustained a stroke two weeks ago were divided into two equal groups. During the physical therapy one patients group granted attention to a trunk control training and another group to lower limbs muscular tissues strengthening by some walking exercises. The factors of changed gait were measured by Brunel balance assessment and Wisconsin gait scale. Conclusions. 1. Trunk control training exercises significantly improve patient’s gait quality. 2. Lower limbs muscles strengthening exercises significantly improve patient’s who... [to full text]