Abstract Background Congenital hemiplegia is the most common form of cerebral palsy accounting for 1 in 1300 live births. Children usually present with greater upper limb than lower limb involvement. Impaired unimanual capacity of the involved upper limb and deficits in bimanual performance contribute to difficulties with day to day activities and participation in home, school and community life. Interventions to address these deficits in upper limb unimanual capacity and bimanual performance have recently shifted focus to address limitations in activity performance rather than underlying impairments. One intensive intervention approach is constraint induced movement therapy, which entails placing a constraint on the unimpaired upper limb to focus intense and repetitive training of the impaired upper limb. To date, it is unclear whether constraint induced movement therapy is superior to a more traditional bimanual therapy to improve activity performance and participation outcomes for children with congenital hemiplegia, as there has been no direct comparison of the two approaches. Aim The primary aim of this research was to determine whether constraint induced movement therapy was more effective than bimanual training to improve activity performance and participation for children with congenital hemiplegia. The specific aims were to: i) determine the efficacy of therapeutic upper limb interventions on activity and participation outcomes for children with congenital hemiplegia, ii) systematically review the clinimetric properties (psychometric properties and clinical utility) of participation assessment tools for children with congenital hemiplegia, iii) examine the relationship between impairments, unimanual capacity and bimanual performance in children with congenital hemiplegia and, iv) determine whether constraint induced movement therapy is more effective than bimanual training to improve activity and participation outcomes for children with congenital hemiplegia. Research Design A matched pairs randomised design was chosen with children matched for age, gender, side of hemiplegia and upper limb function. Children were randomised within pairs to receive either constraint induced movement therapy or bimanual training in equal dosages. Both interventions used a day camp model, with groups receiving the same dosage and content of intervention delivered in the same environment. A novel circus theme was used in the camps to enhance children’s engagement and motivation. Children in the constraint induced movement therapy group wore a tailor made glove on their unimpaired hand during the intervention camp. Outcomes were measured across all domains of the International Classification of Functioning, Disability and Health at baseline, 3 and 26 weeks post intervention. The primary outcome measure for unimanual capacity of the impaired upper limb was the Melbourne Assessment of Unilateral Upper Limb Function, and bimanual performance was the Assisting Hand Assessment. A secondary outcome measure for unimanual capacity was the Jebsen Taylor Test of Hand Function. The Canadian Occupational Performance Measure was used as the primary outcome for participation and three measures, the Assessment of Life Habits, Children’s Assessment of Participation and Enjoyment and the School Function Assessment were included to explore their research utility and responsiveness to change. Results Two systematic reviews were performed prior to the commencement of the randomised trial. The first systematic review and meta-analysis of all upper limb interventions for children with congenital hemiplegia identified four treatment approaches with varying evidence to support their efficacy. Interventions included the use of intramuscular Botulinum toxin A injections to the upper limb augmenting upper limb training, neurodevelopmental treatment, constraint induced movement therapy and hand arm intensive bimanual training. Data were pooled for upper limb, self care and individualised outcomes. Results indicated a small to medium treatment effect favouring all four interventions on upper limb outcomes. Large treatment effects favoured intramuscular Botulinum toxin A injections combined with upper limb training for individualised outcomes. Overall, the systematic review and meta-analysis found no upper limb training approach to be superior although Botulinum toxin A injections appeared to provide a consistent supplementary benefit to a variety of upper limb training approaches. However it was unclear which type of upper limb training was optimal. Findings suggested that the two intensive intervention approaches that are the focus of this randomised controlled trial, constraint induced movement therapy and bimanual intensive training, required further research to support their efficacy. The second systematic review was performed to inform choice of participation measures for the randomised comparison trial. The review identified five specific measures of participation suitable for school aged children with congenital hemiplegia (Assessment of Life Habits, Children’s Assessment of Participation and Enjoyment, School Function Assessment (participation domain), Children Helping Out: Responsibilities and Expectations, School Outcome Measure) and two measures of individualised outcomes that could include specific participation goals (Goal Attainment Scaling and Canadian Occupational Performance Measure). Results suggested that no one measure adequately captured all aspects of participation as outlined in the International Classification of Functioning, Disability and Health, and a combination of assessments would be required to broadly assess children’s participation in home, school and community life. The Canadian Occupational Performance Measure was selected as the primary outcome measure in the randomised trial as it had strong evidence for validity and reliability, had been used in paediatric clinical trials and was responsive to change. Three measures of participation, the Assessment of Life Habits which was completed by the parent/caregiver, the Children’s Assessment of Participation and Enjoyment which was completed by the child, and the School Function Assessment, which was completed by the child’s teacher, were selected to explore the research utility of the measures and their responsiveness to change. Analysis of cross-sectional data collected during screening and baseline assessments for the randomised trial found a strong relationship between bimanual performance and unimanual capacity. Scores on the Melbourne Assessment of Unilateral Upper Limb Function and stereognosis accounted for a significant amount of variance in scores on the Assisting Hand Assessment. There were only moderate associations between impairments (eg. sensory deficits and reduced grip strength) and bimanual performance and unimanual capacity. Age, gender, grip strength and two-point discrimination did not significantly influence bimanual performance. Results of the randomised controlled trial found no differences between groups on any baseline measure. A significant difference between groups favouring the constraint induced movement therapy group was found at 26 weeks on the Melbourne Assessment of Unilateral Upper Limb Function. There were no differences between groups on any other measure at either immediately post intervention at 3 weeks or in the medium term at 26 weeks. The constraint induced movement therapy group made significant gains in unimanual capacity (Melbourne Assessment of Unilateral Upper Limb Function and Jebsen Taylor Test of Hand Function) from baseline to 3 and 26 weeks. The bimanual group demonstrated significant improvement in movement efficiency (Jebsen Taylor Test of Hand Function) by 26 weeks. Significant gains in bimanual performance (Assisting Hand Assessment) were evidenced for both groups from baseline to 3 weeks. These gains were maintained at 26 weeks by the bimanual group only. There were no differences between groups on any participation measures. Both constraint induced movement therapy and bimanual training groups made statistically and clinically significant changes in perceived performance and satisfaction of identified functional goals from baseline to 3 and 26 weeks. Significant gains were made by both groups in personal care on the Assessment of Life Habits from baseline to 26 weeks. There were no changes for either group on the School Function Assessment and Children’s Assessment of Participation and Enjoyment. Conclusions This study found minimal differences between the two training approaches. Outcomes achieved by children reflected the mode of upper limb training, that is, improved and sustained gains in unimanual capacity were achieved with a unimanual approach (constraint induced movement therapy), and significant change in bimanual performance was achieved following bimanual training. The constraint induced movement therapy group made initial improvements in bimanual performance that were not sustained at 26 weeks, suggesting that intensive unimanual training may need to be followed by bimanual training in order to retain effects. Both interventions resulted in significant improvements in the achievement of individualised outcomes. Small gains in participation appeared to correspond with specific goal areas identified by children and their caregivers and highlighted the importance of goal directed training and measuring individualised outcomes. Regardless of the type of approach, intervention needs to be goal-directed, focusing on areas of central importance for children and their families.

As órteses de membro superior são dispositivos que auxiliam na reabilitação da mão e que tem como objetivo estabilizar, imobilizar, prevenir e corrigir deformidades, melhorando assim a função. O processo tradicional de confecção de órteses é realizado por meio do uso de termoplásticos de baixa temperatura, material moldado diretamente sobre o membro do usuário, sendo neste processo relatados inúmeros problemas, que envolvem desconforto durante o processo, alto custo e baixa adesão do paciente ao uso. O presente trabalho, portanto, teve por objetivo propor a construção de um framework com abordagem metodológica projetual para a produção de órteses de membro superior baseada no processo de design e design colaborativo, com auxílio de recursos de fabricação digital, como digitalização tridimensional e manufatura aditiva (impressão 3D). Através de uma pesquisa exploratória, foram discutidas questões relativas ao projeto de órteses de membro superior (MMSS) pela forma tradicional, utilizando termoplástico de baixa temperatura, e questões do processo de design no desenvolvimento de novos produtos a serem aplicadas do desenvolvimento de órteses utilizando a manufatura aditiva A coleta de dados contou com a participação dos principais personagens envolvidos no processo, usuários de órteses, Terapeutas Ocupacionais e Designers. Com base na técnica de card sorting e entrevistas, foi elaborado um framework da abordagem projetual para a criação de órteses utilizando processos de fabricação digital, de forma colaborativa. O framework ainda foi aplicado no desenvolvimento de uma órtese a fim de avaliar os resultados e melhorias levantadas durante a fase de entrevistas com profissionais e usuários. Ao final do processo, obteve-se uma órtese funcional em que foram atendidos os requisitos necessários para a produção de uma órtese levantada pelo trabalho, além da criação do framework servindo como um guia para o desenvolvimento de órteses utilizando a manufatura aditiva. / Upper limb orthoses are devices that assist in the rehabilitation of the hand and that aim to stabilize, immobilize, prevent and correct deformities, thus improving the function. The traditional process of making orthotics is accomplished through the use of thermoplastics of low temperature, molded material directly on the member of the user, being in this process reported numerous problems, that involve discomfort during the process, high cost and low adhesion of the patient to the use. The present work, therefore, aimed to propose the construction of a framework with a design methodological approach for the production of upper limb orthosis based on the process of design and collaborative design, with the aid of digital manufacturing resources such as three - dimensional digitization and additive manufacturing (3D printing). Through an exploratory research, questions regarding the design of upper limb orthoses (MMSS) in the traditional way, using low-temperature thermoplastic, and design process issues in the development of new products to be applied in the development of orthoses using the additive manufacture The data collection was attended by the main characters involved in the process, users of orthoses, Occupational Therapists, and Designers. Based on the technique of card sorting and interviews, a framework of the design approach for the creation of orthoses using digital manufacturing processes was developed in a collaborative way. The framework was also applied in the development of a bracing in order to collaborate with the results and improvements raised during the interviews phase with professionals and users. At the end of the process, a functional orthosis was obtained, in which the necessary requirements for the production of an orthosis were obtained by the work, besides the creation of a framework serving as a guide for the development of orthoses using the additive manufacture.

Made available in DSpace on 2016-12-12T17:32:55Z (GMT). No. of bitstreams: 1 Daniele Peres - resumo.pdf: 11413 bytes, checksum: 4febb8b048c11a9c669b0e5e67711780 (MD5) Previous issue date: 2013-07-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O Chedoke Arm and Hand Activity Inventory (CAHAI) é um instrumento de avaliação da capacidade do membro superior de indivíduos com hemiparesia em atividades bilaterais. Este estudo objetivou traduzir, adaptar transculturamente e avaliar as propriedades psicométricas do CAHAI. O processo de tradução e adaptação transcultural consistiu em oito etapas: tradução do CAHAI do inglês para o português por dois tradutores e mescla das duas traduções (T1 e T2) resultando em uma versão traduzida (T12), que passou por uma revisão de layout, gramática e tipografia. Retrotradução de T12 por dois tradutores independentes, com língua materna inglesa. Avaliação por um comitê de especialistas, envio da versão final para os autores da versão original e aplicação do pré-teste. Para avaliação das propriedades psicométricas da versão CAHAI-Brasil, participaram 24 adultos (56,5±12,3 anos) com hemiparesia de 44,2±32,8 meses pós Acidente Vascular Encefálico (AVE). A destreza manual (Box and Block Test ), a força de preensão (dinamômetro manual) e a sensibilidade tátil, (Moving Touch Pressure) foram avaliadas para caracterização da amostra. O coeficiente de correlação intraclasse (CCI) foi utilizado para avaliar a confiabilidade teste-reteste e interobservadores dos itens individuais e da pontuação total. A validade concorrente do CAHAI foi avaliada através da correlação de Pearson com as atividades bilaterais do Test d Évaluation des Membres Supérieurs des Personnes Agées (TEMPA). A validade discriminante entre os indivíduos com comprometimento motor leve, moderado ou severo (segundo os escores da Escala de Fugl-Meyer) foi avaliada com a ANOVAoneway. A confiabilidade teste-reteste e interobservadores do escore total foi excelente (respectivamente CCI = 0,96 e 0,97). A pontuação do CAHAI apresentou forte correlação com as tarefas bilaterais do TEMPA (r= - 0,86). O CAHAI discrimina os indivíduos com comprometimento motor leve, moderado e grave (p<0.05 para todos). A versão traduzida e adaptada do CAHAI (o Inventário Chedoke de Atividades do Braço e da Mão) apresentou validade concorrente, discriminante e confiabilidade adequadas.

As órteses de membro superior são dispositivos que auxiliam na reabilitação da mão e que tem como objetivo estabilizar, imobilizar, prevenir e corrigir deformidades, melhorando assim a função. O processo tradicional de confecção de órteses é realizado por meio do uso de termoplásticos de baixa temperatura, material moldado diretamente sobre o membro do usuário, sendo neste processo relatados inúmeros problemas, que envolvem desconforto durante o processo, alto custo e baixa adesão do paciente ao uso. O presente trabalho, portanto, teve por objetivo propor a construção de um framework com abordagem metodológica projetual para a produção de órteses de membro superior baseada no processo de design e design colaborativo, com auxílio de recursos de fabricação digital, como digitalização tridimensional e manufatura aditiva (impressão 3D). Através de uma pesquisa exploratória, foram discutidas questões relativas ao projeto de órteses de membro superior (MMSS) pela forma tradicional, utilizando termoplástico de baixa temperatura, e questões do processo de design no desenvolvimento de novos produtos a serem aplicadas do desenvolvimento de órteses utilizando a manufatura aditiva A coleta de dados contou com a participação dos principais personagens envolvidos no processo, usuários de órteses, Terapeutas Ocupacionais e Designers. Com base na técnica de card sorting e entrevistas, foi elaborado um framework da abordagem projetual para a criação de órteses utilizando processos de fabricação digital, de forma colaborativa. O framework ainda foi aplicado no desenvolvimento de uma órtese a fim de avaliar os resultados e melhorias levantadas durante a fase de entrevistas com profissionais e usuários. Ao final do processo, obteve-se uma órtese funcional em que foram atendidos os requisitos necessários para a produção de uma órtese levantada pelo trabalho, além da criação do framework servindo como um guia para o desenvolvimento de órteses utilizando a manufatura aditiva. / Upper limb orthoses are devices that assist in the rehabilitation of the hand and that aim to stabilize, immobilize, prevent and correct deformities, thus improving the function. The traditional process of making orthotics is accomplished through the use of thermoplastics of low temperature, molded material directly on the member of the user, being in this process reported numerous problems, that involve discomfort during the process, high cost and low adhesion of the patient to the use. The present work, therefore, aimed to propose the construction of a framework with a design methodological approach for the production of upper limb orthosis based on the process of design and collaborative design, with the aid of digital manufacturing resources such as three - dimensional digitization and additive manufacturing (3D printing). Through an exploratory research, questions regarding the design of upper limb orthoses (MMSS) in the traditional way, using low-temperature thermoplastic, and design process issues in the development of new products to be applied in the development of orthoses using the additive manufacture The data collection was attended by the main characters involved in the process, users of orthoses, Occupational Therapists, and Designers. Based on the technique of card sorting and interviews, a framework of the design approach for the creation of orthoses using digital manufacturing processes was developed in a collaborative way. The framework was also applied in the development of a bracing in order to collaborate with the results and improvements raised during the interviews phase with professionals and users. At the end of the process, a functional orthosis was obtained, in which the necessary requirements for the production of an orthosis were obtained by the work, besides the creation of a framework serving as a guide for the development of orthoses using the additive manufacture.

A Terapia de Uso Forçado (TUF) e uma técnica se propõe a reverter o desuso aprendido e assim conduzir a plasticidade encefálica pós-AVE. Por se tratar de uma terapia restritiva, que força a utilização de um dos membros superiores e detrimento do outro essa modalidade terapêutica é passível de críticas. Sendo assim, o nosso trabalho foi estruturado para investigar se existem prejuízos no MS não acometido e ainda se propõe a analisar de maneira instrumentalizada os benefícios produzidos no MS parético. Participaram deste estudo 32 indivíduos que sofreram AVE isquêmico e que apresentavam hemiparesia. Os indivíduos foram randomizados em dois grupos de tratamento por quatro semanas consecutivas: TUF (imobilização do MS não acometido por 24 horas, durante 4 semanas) e FC (fisioterapia convencional, duas vezes por semana). A avaliação foi realizada antes do início, 2 semanas após, no final do protocolo e três meses após o término. Foram utilizadas as escalas: National Institute of Health Stroke Scale (NIHSS), Teste Motor de Wolf (WMFT), dinamometria (preensão palmar) e eletromiografia de superfície (músculos extensores do punho). Os dados do grupo TUF foram analisados por uma análise de variância de uma via e os dados da FC por um teste em t para amostras pareadas. Para a comparação intergrupos foi utilizado o teste t de Student. Foram consideradas diferenças significativas p 0,05. A análise das pontuações da NIHSS não revelou diferenças significativas na comparação intra e intergrupos. A análise dos dados da dinamometria intra e intergrupos do lado não parético, não revelou diferenças estatísticas. Para o lado parético os dados da TUF mostraram um aumento na % Kgf em relação aos dados iniciais para o lado parético (F: 2,90) e parético a direita (F:2,70). A análise dos dados de eletromiografia intra e intergrupo, do lado não parético não revelou diferenças estatísticas. Já para o lado parético, os dados da TUF mostraram um aumento de % RMS em relação aos dados iniciais para o lado parético (F:2,43) e parético a direita (F:1,67). Para os dados da WMFT, não observamos diferenças para o lado não parético no grupo TUF. Entretanto o para a FC, observamos uma diminuição do tempo de execução das atividades no lado não parético e a esquerda (t=3,26). Em relação ao lado parético, parético a direita e parético a esquerda, o grupo TUF apresentou modificações em todos as comparações (F:10,08), (F:4,24;) e (F:6,75), respectivamente. Já no grupo FC, somente para a comparação no lado parético (t=2,21). Ambos os grupos apresentam um melhor desempenho nas tarefas individuais no lado não parético. Entretanto, o grupo FC no lado não parético esquerdo apresenta uma redução do tempo na atividade cotovelo estendido em relação ao tempo final do grupo TUF (t=2,45). Em relação ao lado parético, o grupo TUF apresenta uma redução do tempo de atividade para um grande número de tarefas individuais, o que não acontece com o grupo FC. Ainda, o grupo TUF tem uma redução do tempo de execução significativa em relação ao grupo FC no lado parético, para as tarefas cotovelo estendido com peso (t=2,45) e girar chave na fechadura (t=2,67).Nosso trabalho mostra que a TUF melhora o desempenho motor do lado parético. Ainda, é segura uma vez que não observamos prejuízos motores do lado não parético. / The Forced Used Therapy (FUT) is a technique proposes to reverse learned nonuse and thus lead to brain plasticity after stroke. Because it is a restrictive therapy that forces the use of an upper limb in the detriment of another this therapeutic modality is subjected to criticism. Thus, our work was structured to investigate if there are impairments in not paretic UL and aims intends to analyze the possible benefits produced in paretic UL. The study included 32 subjects who experienced ischemic stroke and who had hemiparesis. Subjects were randomized in two treatment groups for four consecutive weeks: FUT (non-paretic UL immobilization for 24 hours to 4 weeks) and SP (standard physiotherapy twice a week). The evaluation was performed at baseline, 2 weeks after, at end of the protocol and three months follow up. We used the scales: National Institute of Health Stroke Scale (NIHSS), Wolf Motor Function Test (WMFT), dynamometer (handgrip) and surface electromyography (extensor muscles of the wrist). Data from the FUT group were analyzed by one way ANOVA and data the SP by a t-test for paired samples. For comparisons between groups, Student\'s t test was used. Significant values were considered by p 0.05. The analysis of the NIHSS scores revealed no significant differences in intragroup and intergroup comparison. Dynamometry data analysis of intra and inter group in the non-paretic side showed no statistical differences. For the paretic side, FUT data showed an increase in % Kgf relate to the initial to paretic side (F: 2.90) and paretic at the right (F: 2.70). Electromyography data analysis of intra- and intergroup, in the non-paretic side, showed no statistical differences. As for the paretic arm, the data showed an increase in % RMS of FUT compared to the initial for the paretic (F: 2.43) and right paretic (F: 1.67). For WMFT data, there were no differences for the non-paretic side in the FUT group. However, for the SP, we observed a reduction of the execution time of activities in the non-paretic side and paretic at the left (t = 3.26). In relation to the paretic, paretic, paretic to right and left, the FUT group showed changes in all comparisons (F: 10,08), (F: 4.24) and (F: 6.75), respectively. In the SP group, only for comparison in paretic (t = 2.21). Both groups perform better on individual tasks in the non-paretic side. However, the SP group in the left non-paretic side showed a reduction of time in the elbow extended activity in relation to the FUT final (t = 2.45). The FUT group for paretic side compared to the SP group has a less duration of activity for a large number of individual tasks, which does not happen with the SP group. Still, the FUT group has a significant reduction in execution time compared to the SP group in paretic hand for tasks elbow extended with weight (t = 2.45) and turn key in the lock (t = 2.67). Our work shows that the FUT improves motor performance of the paretic hand. Still, it is safe since no observed loss of the non-paretic arm.

Ce travail de thèse s’intéresse à l’estimation des angles articulaires et des positions segmentaires du membre supérieur à partir de capteurs inertiels (MIMU). Malgré l’intérêt grandissant de la communauté scientifique pour cette technologie, plusieurs questions de recherche restent en suspens. Ce travail de thèse contribue à l’avancée de connaissances scientifiques à la fois au niveau de la modélisation cinématique du membre supérieur associée aux capteurs inertiels et au niveau de la validation même des données cinématiques de sortie (angles articulaires et positions segmentaires). Au travers d’une approche méthodologique complète, des recommandations de calibration anatomique sont avancées. De plus, des valeurs clefs de caractérisation sont proposées, telles qu’une reproductibilité des données angulaires de l’ordre de 5-10° et une erreur de positionnement de la main de 7-15 cm. La finalité de ce travail de thèse est la mise à disposition d’un système ambulatoire pour l’évaluation des postures et des mouvements du membre supérieur dans une optique d’évaluation des risques de troubles musculo-squelettiques en milieu professionnel. Une modélisation cinématique avancée prenant en compte un capteur inertiel sur la scapula et la caractérisation du système en milieu perturbé magnétiquement apparaissent comme une suite logique à ce travail de thèse / This PhD work is focused on the estimation of joint angles and segment positions of the upper limb based on inertial sensor technology (MIMU). Despite much interest from the scientific community in this topic, several aspects of research deserve more investigation. This work contributes to the enhancement of scientific knowledge related to (1) the kinematic modeling associated to MIMU and (2) the validation of final kinematic outputs (joint angles and segment positions). Based on an exhaustive methodological approach, recommendations related to the anatomical calibration of MIMU are highlighted. Moreover, key-values related to the characterization of kinematic outputs are proposed, such as a precision of joint angles of 5-10° and a hand positioning error of 7-15 cm. The aim of this study is the development of an ambulatory system for the assessment of postures and movements of the upper limb, in a general context of musculoskeletal disorders risk assessment at work. From now on, an advanced kinematic modeling that uses a MIMU placed on the scapula as well as a characterization of the system under magnetic disturbances represent two of the main scientific questions to explore

Le travail de thèse exposé dans ce manuscrit s'intéresse à la simulation d'un mouvement de manipulation d'objet, plus particulièrement à la saisie suivie de la rotation d'une sphère selon un axe fixe. Le but ici est, à partir d'une analyse de mouvements réels, d'être capable de proposer un algorithme de simulation reproduisant des mouvements comparables aux données expérimentales, en fournissant en entrée le moins d'informations possibles et en essayant d'introduire de la variabilité dans le mouvement simulé. 12 sujets volontaires ont participé à l'expérimentation. Nous leur avons demandé de saisir et de tourner une sphère de 60mm de diamètre avec des amplitudes allant de 45° à 360°, dans les deux sens. L'analyse de ces données expérimentales, complétée par des simulations de l'effet des limites articulaires sur le mouvement nous ont permis d'étudier plusieurs hypothèses sur le contrôle de mouvement telles que l'hypothèse de confort final (« end-state comfort ») et le principe de travail minimum. Une des conclusions majeures est que l'anticipation posturale au moment de saisie semble être expliquée davantage par le confort en fin de mouvement qu'au moment de saisie. Basé sur ces observations, nous proposons un algorithme de simulation avec pour nouveautés la prise en compte de l'espace de mouvements admissibles par les limites articulaires ainsi que l'introduction de la variabilité au choix de la posture de saisie. Les premiers résultats semblent être en accord en grande partie avec les observations expérimentales donnant une base de travail pour aller vers des outils de simulation se rapprochant de plus en plus vers un comportement "humain" / The thesis work presented in this manuscript focuses on the simulation of an handling motion, more specifically on the grasp followed by the rotation of a sphere along a fixed single axis. The aim here is, from the analysis of actual motions, to be able to propose an simulation algorithm reproducing motions comparable to experimental data, with the less input as possible and trying to introduce some variability into the simulated motion. 12 volunteers participated to the experiment. Subjects were asked to grasp and turn a sphere of 60mm of diameter. Amplitudes of rotations were ranged from 45° to 360°, in both directions. Experimental data analysis, completed with some simulations of the effect of joint limits on motion, allowed us to investigate several motion control hypothesis as the end-state comfort hypothesis or the minimum work principle. One of the main conclusions is that postural anticipation when grasping seems to be more explained by the comfort at the end of the motion than when grasping. Based on these observations, we proposed a simulation algorithm being original by the way of how it takes into account possible motions allowed by joint limits and by the introduction of variability into the simulated grasp posture. The first results seem to follow most part of the experimental observations giving a strong basis to go towards simulation tools that will come closer to a “human” behavior

Objective To investigate the effect a supination splint would have on upper limb function of cerebral palsy children for six months after receiving Botox® injections. Design Ten children attending weekly therapy enrolled in this prospective Quasi-experimental design where each child acted as his own control. Intervention was a supination splint and stretch massage. Assessment was based on pre- and post-intervention records of Modified Ashworth Scale, goniometry, Quality of Upper Extremity Skills Test (QUEST), and an independent panel assessment of videotaped records of hand function. Results Results show that spasticity declined in the forearm pronators, wrist flexors and thumb adductors. Active movement improved significantly in forearm supination and wrist extension. The QUEST demonstrated a significant change. Improvement in the hand function assessment was evident from the second month. Conclusion Findings support the premise that the supination splint is effective in improving upper limb function of cerebral palsy children after Botox® injections. / Dissertation (M (Occupational Therapy))--University of Pretoria, 2007. / Occupational Therapy / M (Occupational Therapy) / unrestricted

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As órteses de membro superior são dispositivos que auxiliam na reabilitação da mão e que tem como objetivo estabilizar, imobilizar, prevenir e corrigir deformidades, melhorando assim a função. O processo tradicional de confecção de órteses é realizado por meio do uso de termoplásticos de baixa temperatura, material moldado diretamente sobre o membro do usuário, sendo neste processo relatados inúmeros problemas, que envolvem desconforto durante o processo, alto custo e baixa adesão do paciente ao uso. O presente trabalho, portanto, teve por objetivo propor a construção de um framework com abordagem metodológica projetual para a produção de órteses de membro superior baseada no processo de design e design colaborativo, com auxílio de recursos de fabricação digital, como digitalização tridimensional e manufatura aditiva (impressão 3D). Através de uma pesquisa exploratória, foram discutidas questões relativas ao projeto de órteses de membro superior (MMSS) pela forma tradicional, utilizando termoplástico de baixa temperatura, e questões do processo de design no desenvolvimento de novos produtos a serem aplicadas do desenvolvimento de órteses utilizando a manufatura aditiva A coleta de dados contou com a participação dos principais personagens envolvidos no processo, usuários de órteses, Terapeutas Ocupacionais e Designers. Com base na técnica de card sorting e entrevistas, foi elaborado um framework da abordagem projetual para a criação de órteses utilizando processos de fabricação digital, de forma colaborativa. O framework ainda foi aplicado no desenvolvimento de uma órtese a fim de avaliar os resultados e melhorias levantadas durante a fase de entrevistas com profissionais e usuários. Ao final do processo, obteve-se uma órtese funcional em que foram atendidos os requisitos necessários para a produção de uma órtese levantada pelo trabalho, além da criação do framework servindo como um guia para o desenvolvimento de órteses utilizando a manufatura aditiva. / Upper limb orthoses are devices that assist in the rehabilitation of the hand and that aim to stabilize, immobilize, prevent and correct deformities, thus improving the function. The traditional process of making orthotics is accomplished through the use of thermoplastics of low temperature, molded material directly on the member of the user, being in this process reported numerous problems, that involve discomfort during the process, high cost and low adhesion of the patient to the use. The present work, therefore, aimed to propose the construction of a framework with a design methodological approach for the production of upper limb orthosis based on the process of design and collaborative design, with the aid of digital manufacturing resources such as three - dimensional digitization and additive manufacturing (3D printing). Through an exploratory research, questions regarding the design of upper limb orthoses (MMSS) in the traditional way, using low-temperature thermoplastic, and design process issues in the development of new products to be applied in the development of orthoses using the additive manufacture The data collection was attended by the main characters involved in the process, users of orthoses, Occupational Therapists, and Designers. Based on the technique of card sorting and interviews, a framework of the design approach for the creation of orthoses using digital manufacturing processes was developed in a collaborative way. The framework was also applied in the development of a bracing in order to collaborate with the results and improvements raised during the interviews phase with professionals and users. At the end of the process, a functional orthosis was obtained, in which the necessary requirements for the production of an orthosis were obtained by the work, besides the creation of a framework serving as a guide for the development of orthoses using the additive manufacture.