It has been postulated that occupational therapists when choosing an appropriate intervention method, use theoretical and practical knowledge (factors), based upon identifying client's goals to guide their clinical reasoning. The overall aim of this study was to identify factors and their relative contributions to the decisions occupational therapists make in the management of upper limb (UL) hypertonicity of children and adolescents with cerebral palsy (CP). Studies about general factors which influence occupational therapists' decision making have been addressed widely in the literature. However, studying influential factors in specific areas such as in the management of UL hypertonicity of clients with CP is limited. The information obtained from studies of decision making with other client groups can not readily be generalised as it has been demonstrated that specific task characteristics induce different types of cognitive thinking. For example, working with clients with orthopaedic problems may induce logical thinking, while practicing with clients with neurological problems promotes intuitive thinking. The management of UL hypertonicity of clients with CP was chosen as the focus of this study for two main reasons. First, the incidence of CP is high, manifesting in between 1.4 and 2.4 of 1000 live births. Second, people with CP are one of the major client groups referred to occupational therapy (OT) clinics as outpatients. The literature reviewed highlighted a lack of evidence about what therapists attend to when making decisions about the management of UL hypertonicity for clients with CP. To identify and evaluate these factors, the current research employed Social Judgment Theory (SJT). This methodology was selected because it had the capacity to access intuitive thought or tacit knowledge that is very difficult for experienced therapists to explain. Furthermore, SJT is most relevant in situations where there is no optimal decision. The current study proceeded in five phases. Phases One to Three were conducted to identify the most relevant factors to be used in the case vignettes necessary for the application of SJT. This process involved a review of the literature, consultation with clinical experts and then involved twelve experienced therapists in a process of identifying, refining, and ranking the relevant factors in order of priority. As a result of the processes in Phases One to Three 37 factors and their ranked importance were identified. The identified factors were reduced from 37 to 12 on the basis of ranking, cluster analysis and consultation with experts and appropriate scales identified for their measurement. These factors formed the basis of Phase Four of this study. In Phase Four 10 sample case vignettes as well as an administration manual were developed and four therapists were asked to make decisions for these cases. On the basis of therapists' comments, some changes were made in case vignettes and administration manual. Finally, 110 case vignettes were generated randomly (20 were repeated to examine consistency) for Phase Five of the study. In Phase Five, eighteen occupational therapists (16 females and 2 males), mean age of 36.7 years (SD = 7.6 years) who had worked with people with CP for a mean of 10.4 years (SD = 6.0 years) made decisions for the generated case vignettes. The findings of Phase Five revealed that therapists used three factors mainly in their decisions including severity of spasticity, wrist and finger posture, and client and family background. They had poor insight into their decision making (r = 0.36) and demonstrated only moderate consistency (r = 0.46). When therapists were divided into two groups based on their level of performance in respect to therapists' consistency and their ability to discriminate between cases, both groups used severity of spasticity and wrist and finger posture in their decision making. However, the higher performing group used limitation in passive range of movement and previous intervention in their decision making, and the low performing group used client and family background.

It has been postulated that occupational therapists when choosing an appropriate intervention method, use theoretical and practical knowledge (factors), based upon identifying client's goals to guide their clinical reasoning. The overall aim of this study was to identify factors and their relative contributions to the decisions occupational therapists make in the management of upper limb (UL) hypertonicity of children and adolescents with cerebral palsy (CP). Studies about general factors which influence occupational therapists' decision making have been addressed widely in the literature. However, studying influential factors in specific areas such as in the management of UL hypertonicity of clients with CP is limited. The information obtained from studies of decision making with other client groups can not readily be generalised as it has been demonstrated that specific task characteristics induce different types of cognitive thinking. For example, working with clients with orthopaedic problems may induce logical thinking, while practicing with clients with neurological problems promotes intuitive thinking. The management of UL hypertonicity of clients with CP was chosen as the focus of this study for two main reasons. First, the incidence of CP is high, manifesting in between 1.4 and 2.4 of 1000 live births. Second, people with CP are one of the major client groups referred to occupational therapy (OT) clinics as outpatients. The literature reviewed highlighted a lack of evidence about what therapists attend to when making decisions about the management of UL hypertonicity for clients with CP. To identify and evaluate these factors, the current research employed Social Judgment Theory (SJT). This methodology was selected because it had the capacity to V access intuitive thought or tacit knowledge that is very difficult for experienced therapists to explain. Furthermore, SJT is most relevant in situations where there is no optimal decision. The current study proceeded in five phases. Phases One to Three were conducted to identify the most relevant factors to be used in the case vignettes necessary for the application of SJT. This process involved a review of the literature, consultation with clinical experts and then involved twelve experienced therapists in a process of identifying, refining, and ranking the relevant factors in order of priority. As a result of the processes in Phases One to Three 37 factors and their ranked importance were identified. The identified factors were reduced from 37 to 12 on the basis of ranking, cluster analysis and consultation with experts and appropriate scales identified for their measurement. These factors formed the basis of Phase Four of this study. In Phase Four 10 sample case vignettes as well as an administration manual were developed and four therapists were asked to make decisions for these cases. On the basis of therapists’ comments, some changes were made in case vignettes and administration manual. Finally, 110 case vignettes were generated randomly (20 were repeated to examine consistency) for Phase Five of the study. In Phase Five, eighteen occupational therapists (16 females and 2 males), mean age of 36.7 years (SD = 7.6 years) who had worked with people with CP for a mean of 10.4 years (SD = 6.0 years) made decisions for the generated case vignettes. The findings of Phase Five revealed that therapists used three factors mainly in their decisions including severity of spasticity, wrist and finger posture, and client and family background. They had poor insight into their decision making (r = 0.36) and demonstrated only moderate consistency (r = 0.46). When therapists were divided into two groups based on their level of performance in respect to therapists’ consistency and their ability to discriminate between cases, both groups used severity of spasticity and wrist and finger posture in their decision making. However, the higher performing group used limitation in passive range of movement and previous intervention in their decision making, and the low performing group used client and family background. To conclude, factors identified as most important (specifically by therapists who performed consistently) could be considered to be the most critical when confronted by a large amount of information. These factors can be used to assist occupational therapy students and new practitioners to focus on relevant information to help support their clinical decisions.

It has been postulated that occupational therapists when choosing an appropriate intervention method, use theoretical and practical knowledge (factors), based upon identifying client's goals to guide their clinical reasoning. The overall aim of this study was to identify factors and their relative contributions to the decisions occupational therapists make in the management of upper limb (UL) hypertonicity of children and adolescents with cerebral palsy (CP). Studies about general factors which influence occupational therapists' decision making have been addressed widely in the literature. However, studying influential factors in specific areas such as in the management of UL hypertonicity of clients with CP is limited. The information obtained from studies of decision making with other client groups can not readily be generalised as it has been demonstrated that specific task characteristics induce different types of cognitive thinking. For example, working with clients with orthopaedic problems may induce logical thinking, while practicing with clients with neurological problems promotes intuitive thinking. The management of UL hypertonicity of clients with CP was chosen as the focus of this study for two main reasons. First, the incidence of CP is high, manifesting in between 1.4 and 2.4 of 1000 live births. Second, people with CP are one of the major client groups referred to occupational therapy (OT) clinics as outpatients. The literature reviewed highlighted a lack of evidence about what therapists attend to when making decisions about the management of UL hypertonicity for clients with CP. To identify and evaluate these factors, the current research employed Social Judgment Theory (SJT). This methodology was selected because it had the capacity to V access intuitive thought or tacit knowledge that is very difficult for experienced therapists to explain. Furthermore, SJT is most relevant in situations where there is no optimal decision. The current study proceeded in five phases. Phases One to Three were conducted to identify the most relevant factors to be used in the case vignettes necessary for the application of SJT. This process involved a review of the literature, consultation with clinical experts and then involved twelve experienced therapists in a process of identifying, refining, and ranking the relevant factors in order of priority. As a result of the processes in Phases One to Three 37 factors and their ranked importance were identified. The identified factors were reduced from 37 to 12 on the basis of ranking, cluster analysis and consultation with experts and appropriate scales identified for their measurement. These factors formed the basis of Phase Four of this study. In Phase Four 10 sample case vignettes as well as an administration manual were developed and four therapists were asked to make decisions for these cases. On the basis of therapists’ comments, some changes were made in case vignettes and administration manual. Finally, 110 case vignettes were generated randomly (20 were repeated to examine consistency) for Phase Five of the study. In Phase Five, eighteen occupational therapists (16 females and 2 males), mean age of 36.7 years (SD = 7.6 years) who had worked with people with CP for a mean of 10.4 years (SD = 6.0 years) made decisions for the generated case vignettes. The findings of Phase Five revealed that therapists used three factors mainly in their decisions including severity of spasticity, wrist and finger posture, and client and family background. They had poor insight into their decision making (r = 0.36) and demonstrated only moderate consistency (r = 0.46). When therapists were divided into two groups based on their level of performance in respect to therapists’ consistency and their ability to discriminate between cases, both groups used severity of spasticity and wrist and finger posture in their decision making. However, the higher performing group used limitation in passive range of movement and previous intervention in their decision making, and the low performing group used client and family background. To conclude, factors identified as most important (specifically by therapists who performed consistently) could be considered to be the most critical when confronted by a large amount of information. These factors can be used to assist occupational therapy students and new practitioners to focus on relevant information to help support their clinical decisions.

It has been postulated that occupational therapists when choosing an appropriate intervention method, use theoretical and practical knowledge (factors), based upon identifying client's goals to guide their clinical reasoning. The overall aim of this study was to identify factors and their relative contributions to the decisions occupational therapists make in the management of upper limb (UL) hypertonicity of children and adolescents with cerebral palsy (CP). Studies about general factors which influence occupational therapists' decision making have been addressed widely in the literature. However, studying influential factors in specific areas such as in the management of UL hypertonicity of clients with CP is limited. The information obtained from studies of decision making with other client groups can not readily be generalised as it has been demonstrated that specific task characteristics induce different types of cognitive thinking. For example, working with clients with orthopaedic problems may induce logical thinking, while practicing with clients with neurological problems promotes intuitive thinking. The management of UL hypertonicity of clients with CP was chosen as the focus of this study for two main reasons. First, the incidence of CP is high, manifesting in between 1.4 and 2.4 of 1000 live births. Second, people with CP are one of the major client groups referred to occupational therapy (OT) clinics as outpatients. The literature reviewed highlighted a lack of evidence about what therapists attend to when making decisions about the management of UL hypertonicity for clients with CP. To identify and evaluate these factors, the current research employed Social Judgment Theory (SJT). This methodology was selected because it had the capacity to V access intuitive thought or tacit knowledge that is very difficult for experienced therapists to explain. Furthermore, SJT is most relevant in situations where there is no optimal decision. The current study proceeded in five phases. Phases One to Three were conducted to identify the most relevant factors to be used in the case vignettes necessary for the application of SJT. This process involved a review of the literature, consultation with clinical experts and then involved twelve experienced therapists in a process of identifying, refining, and ranking the relevant factors in order of priority. As a result of the processes in Phases One to Three 37 factors and their ranked importance were identified. The identified factors were reduced from 37 to 12 on the basis of ranking, cluster analysis and consultation with experts and appropriate scales identified for their measurement. These factors formed the basis of Phase Four of this study. In Phase Four 10 sample case vignettes as well as an administration manual were developed and four therapists were asked to make decisions for these cases. On the basis of therapists’ comments, some changes were made in case vignettes and administration manual. Finally, 110 case vignettes were generated randomly (20 were repeated to examine consistency) for Phase Five of the study. In Phase Five, eighteen occupational therapists (16 females and 2 males), mean age of 36.7 years (SD = 7.6 years) who had worked with people with CP for a mean of 10.4 years (SD = 6.0 years) made decisions for the generated case vignettes. The findings of Phase Five revealed that therapists used three factors mainly in their decisions including severity of spasticity, wrist and finger posture, and client and family background. They had poor insight into their decision making (r = 0.36) and demonstrated only moderate consistency (r = 0.46). When therapists were divided into two groups based on their level of performance in respect to therapists’ consistency and their ability to discriminate between cases, both groups used severity of spasticity and wrist and finger posture in their decision making. However, the higher performing group used limitation in passive range of movement and previous intervention in their decision making, and the low performing group used client and family background. To conclude, factors identified as most important (specifically by therapists who performed consistently) could be considered to be the most critical when confronted by a large amount of information. These factors can be used to assist occupational therapy students and new practitioners to focus on relevant information to help support their clinical decisions.

[Truncated abstract] This thesis consists of five experimental studies from seven data collection periods. The first two studies quantitatively analyse children with and without cerebral palsy using upper limb three dimensional (3D) motion analysis. Upper limb angular kinematics and sub-structures were measured and analysed, both of which were utilised during subsequent studies. The final three studies assess the efficacy of lycra® arm splints using clinical assessments, 3D dimensional upper limb kinematics and 3D sub-structures. Study 1 analysed 3D movement sub-structures in children with and without cerebral palsy ... The aim of the study was to quantitatively analyse movement sub-structures in children with and without cerebral palsy during four functional tasks taken from the Melbourne Assessment of Unilateral Upper Limb Function (Melbourne Assessment - Randall, Johnson & Reddihough, 1999) ... Results demonstrated significant differences in angular kinematics in children with and without cerebral palsy, while the methodology developed in this study provided improved insight into the movement of the upper limb and trunk during functional tasks. Study 3 reported a randomised controlled trial of lycra® arm splints in children with cerebral palsy across all levels of the International Classification of Functioning Disability and Health (ICF) ... Lycra® arm splints were shown to have a statistically significant impact at the level of participation, whereas no significant difference was seen at the level of impairment and activity. Study 4 reported a randomised controlled trial of the effects of lycra® arm splints on 3D movement sub-structures during functional tasks in children with cerebral palsy ... This research demonstrated that movement sub-structures (including movement time) can be quantified and are amenable to change with intervention. Study 5 reported a randomised controlled trial of the effects of lycra® arm splints on angular kinematics (thorax, shoulder and elbow) during functional tasks in children with cerebral palsy ... The benefits of the splint on angular kinematics were only apparent when worn for the 3 month period, as minimum evidence was established for the short-term (1hour) and long term (3 month post splint wear) carry-over effects.

Através dos dispositivos e técnicas desenvolvidas na área da Instrumentação Biomédica é possível oferecer um tratamento ou de forma geral soluções que permitam uma vivência mais plena em sociedade para pessoas que possuem algum tipo de deficiência ou doença. Com o aumento da capacidade computacional nos últimos anos foi possível desenvolver muitas técnicas e dispositivos apoiados em processamento digital de sinais e há um grande interesse pelo desenvolvimento de interfaces mais naturais, como sinais biológicos para o controle de próteses e dispositivos. Este trabalho tem por objetivo apresentar o desenvolvimento de um método de Inteligência Computacional baseado em Regressão Logística capaz de classificar 17 movimentos do segmento mão-braço realizados pelos voluntários do estudo através do processamento do sinal mioelétrico (SME) adquiridos dos sujeitos em questão. Adicionalmente é realizada uma avaliação da influência de alguns dos canais, características do sinal e movimentos executados na taxa de acerto global. Para a realização do sistema foi utilizado um aparato experimental capaz de adquirir os SME através de 12 canais utilizando eletrodos não invasivos e posteriormente digitalizá-los. Logo após efetua-se a extração das três características utilizadas no trabalho, que servem de entrada para o método de Regressão Logística. Para este estudo foram processados três bancos de dados que perfazem um total de 50 voluntários. A taxa média de acerto alcançada foi de 70,1%, considerando todas as variações de testes realizados enquanto a média para os melhores casos de cada variação de entrada realizada foi de 92,5%. / Through the devices and techniques developed in the field of Biomedical Instrumentation commonly is possible to offer treatment or solutions to provide a more pleasurable experience in society for people who have a disability or illness. With increasing computing capability in recent years, it has been possible to develop many techniques and devices supported by digital signal processing, and there is a great interest in the development of more natural interfaces, such as biological signals for the control of devices and prostheses. This work aims to present the development of a computational intelligence method based on Logistic Regression able to classify 17 movements of the hand-arm segment performed by the subjects of this study through the processing of the myoelectric signal (SME) acquired from the subject in question. Additionally, an assessment of the influence of some of the combination of the channels, signal characteristics and movements performed in the overall hit rate is additionally performed. To conduct the system has built an experimental apparatus able to acquire the SME through 12 channels using non-invasive electrodes and scan them. Thereafter there is a three features extraction from the signal which serves as input to the Logistic Regression method. For this study were processed three databases that compose 50 volunteers. The average hit rate achieved was 70.1%, considering all tests variations while the average for the best cases for each input variation performed was 92,5 %.

Orientadora: Profa. Dra. Léia Bernardi Bagesteiro / Dissertação (mestrado) - Universidade Federal do ABC, Programa de Pós-Graduação em Neurociência e Cognição, 2014. / A maioria das amputações traumáticas do membro superior ocorre em níveis do punho e da mão. O uso de sinais bioelétricos, como os capturados pela eletromiografia de músculos residuais no segmento mão-braço amputado, já é uma realidade, porém as taxas de rejeição das próteses mioelétricas ainda são elevadas. Um dos maiores desafios atuais é melhorar o desempenho das próteses robóticas a fim de que a interface homem-máquina seja o mais natural possível. O presente estudo teve por objetivo avaliar a intensidade elétrica dos músculos residuais do coto durante movimentos do segmento mão-braço de indivíduos amputados de membro superior. Foram caracterizados diferentes movimentos-alvo a fim de auxiliar no conhecimento da ação muscular após amputação. Oito canais de eletromiografia foram posicionados no membro superior e coto: quatro no braço e quatro no antebraço. Nove movimentos-alvo contínuos foram realizados duas vezes em cada uma das duas séries de movimentos avaliadas. Foram analisados o coto (grupo experimental membro amputado), o membro contralateral à amputação (grupo experimental membro não amputado) e um grupo controle. Todos os grupos apresentaram as mesmas etapas de coleta, desde o posicionamento dos eletrodos até a análise do sinal eletromiográfico. Os dados foram comparados para maior compreensão dos movimentos do membro superior nesses grupos. Os resultados apresentaram diferença entre os grupos. A musculatura de braço teve maior intensidade de ativação elétrica no grupo controle. Por sua vez, o grupo experimental membro amputado teve maior intensidade de ativação em musculaturas extensoras e maior diferenciação dos canais do antebraço. Contudo, o grupo experimental membro não amputado foi o que mais se diferenciou nas diferentes análises, sendo observado menor intensidade de ativação elétrica no braço e antebraço. Conclui-se que a intensidade de ativação dos músculos residuais do coto difere do membro não amputado. / Most traumatic upper-limb amputations occur at the wrist and hand levels. Bioelectric signals, such as the ones captured by electromyography at the amputated hand-arm segment are already a reality, yet rejection rates of myoelectric prostheses are still high. The main challenge is to improve the performance of robotic prostheses enabling a more natural man-machine interface. This study evaluated the electrical magnitude of residual muscles during hand-arm movements of upper limb amputee. Different movements were chosen to promote muscle activation knowledge after amputation. Eight electromyography channels were positioned on the upper-limb and stump: four at the upper arm and four at the forearm. Nine continuous movements were performed twice on each of the two series evaluated. Three groups were analyzed: amputee group (experimental group: amputated limb), contralateral limb amputation (experimental group: non-amputated limb) and control group. All groups had the same data collection phases, electrodes positioning and eletromyographic signals analysis. Data were compared for better understanding of upper limb movements. The results showed difference between groups. The upper arm muscles had greater magnitude of electrical activation in the control group. The experimental group: amputated limb had greater magnitude of electrical activation in the extensor musculature and greater difference from the forearm channels. Moreover the experimental group: non-amputated limb was the most distinguished in comparison with the other two groups on different analyzes, with lower magnitude of electrical activation observed in the upper arm and forearm. It is concluded that the magnitude of activation of the residual muscles in the amputated limb differs from non-amputated limb.

Submitted by JULIANA LAHR null (ju_lahr@hotmail.com) on 2016-01-08T17:34:37Z No. of bitstreams: 1 Lahr, Juliana_dissertação.pdf: 4300978 bytes, checksum: c8f51cad4332528f3754c1d768464c48 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-01-11T18:03:07Z (GMT) No. of bitstreams: 1 lahr_j_me_rcla.pdf: 4300978 bytes, checksum: c8f51cad4332528f3754c1d768464c48 (MD5) / Made available in DSpace on 2016-01-11T18:03:07Z (GMT). No. of bitstreams: 1 lahr_j_me_rcla.pdf: 4300978 bytes, checksum: c8f51cad4332528f3754c1d768464c48 (MD5) Previous issue date: 2015-12-17 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Background: Parkinson’s disease (PD) presents asymmetric early motor symptoms, and those symptoms affect the processing and the integration of proprioceptive information. Due to that, the upper limb motor control is impaired even on single task (isolated manual task) and dual task (manual task and posture control). Because these sort of tasks are performed during activities of daily living, the role of asymmetry on those task must be clarified to elucidate the effects of disease on PD functionality and thus guide the therapists choose more effective interventions. Among strategies of intervention on PD motor impairments, two strategies that deserve special attention are the instruction of external focus of attention and mirror therapy (MT). Both interventions might be potentially effective to facilitate motor learning. Aims: to assess the role of PD asymmetry on upper limbs motor control and postural control in conditions of single versus dual task; and tasks with attentional focus with instructions versus external focus as well as to verify the effect of MT on upper limbs motor control more affected on postural control of PD patients. Methods: Twenty PD patients were submitted to assessments on: Upper Limb motor control (kinematic analysis) and postural control (kinetics analysis), in single and dual task conditions, with and without external focus of attention. Posteriorly, the subjects were distributed in two different groups: GI1 and GI2. The MT protocol consisted in a unilateral home therapy on less affected upper limb, performed 30 minutes a day, five days a week, during 6 consecutives weeks. To assist the subjects of GI1, they performed this protocol using a visual feedback (mirror therapy). Both groups were assessed before and after therapy protocol. Results: performance was not different between upper limbs and single and dual tasks, both in single and in dual task. After protocol period, both groups showed improvements on kinematic outcomes (manual dexterity, movement frequency of the hand, hesitation and task performance time improvements, independent of the sort of focus of attention that was used). Conclusion: Manual task is not affected by PD asymmetry on single and dual task. The external focus of attention was not effective to improve the task performance in PD patients, and it is not recommended to be performed during dynamic tasks. The therapy protocol with or without visual feedback promotes extended benefits on execution and planning of manual task of more affected upper limb independently of focus of attention, but it is not able to decrease the functional and motor impairments neither improve postural control. Therefore MT seems to be equally effective on manual tasks benefits, however more studies are necessary to confirm this efficacy. / Introdução: a doença de Parkinson (DP) tem o início assimétrico dos sintomas motores e afeta o processamento e a integração das informações proprioceptivas, comprometendo o controle motor dos membros superiores tanto em tarefa singular (tarefa manual isolada) quanto em tarefa dupla (tarefa manual e controle postural). Por estas tarefas serem frequentemente exigidas nas atividades de vida diária, esclarecimentos quanto ao papel da assimetria da doença nessas tarefas podem elucidar sobre os efeitos da doença na funcionalidade dos pacientes e nortear a decisão sobre estratégias de intervenção mais pertinentes. Dentre as estratégias de intervenção para esses comprometimentos encontram-se a instrução de foco de ação externo e a terapia do espelho (TE). Ambas as intervenções podem ser potencialmente eficazes na DP por facilitar a aprendizagem motora. Objetivos: avaliar o papel da assimetria da doença no controle dos membros superiores e do controle postural nas condições de tarefa singular versus dupla e de tarefa com instrução de foco de atenção livre versus foco externo, assim como verificar o efeito da TE no controle motor do membro superior afetado e no controle postural de pacientes com DP. Método: 20 pacientes foram avaliados quanto ao controle dos membros superiores (análise cinemática) e ao controle postural (análise cinética), nas condições de tarefa singular e dupla, foco de atenção livre e externo. Posteriormente, os pacientes foram distribuídos nos grupos GI1 e GI2 e realizaram a intervenção que consistiu de treino unilateral do membro superior menos afetado, com duração de 30 minutos diários, 5 dias consecutivos na semana, durante 6 semanas, em domicílio. Na intervenção somente o GI1 utilizou o feedback visual - TE. Os grupos foram avaliados pré- e pós-intervenção. Resultados: o desempenho não diferiu entre os membros superiores e entre as condições de tarefa singular e dupla. O foco de atenção externo reduziu o desempenho da tarefa manual, tanto na tarefa singular quanto na dupla. Após o período de intervenção, ambos os grupos melhoraram o desempenho nas variáveis cinemáticas – aumentaram a destreza manual e a frequência de movimento da mão, diminuíram a hesitação na realização do movimento e o tempo para realizar a tarefa, independente do foco de atenção empregado. Conclusão: a assimetria da doença não interfere no desempenho da tarefa manual nas condições de tarefa singular e dupla. O foco de atenção externo não foi eficaz em melhorar o desempenho da tarefa manual em pacientes com DP, não devendo ser utilizado em tarefas dinâmicas. A intervenção, com ou sem feedback visual, melhora a execução e o planejamento da tarefa manual do membro superior afetado independente do foco atencional empregado, mas não é capaz de reduzir o comprometimento funcional e motor, nem de melhorar o desempenho do controle postural. Portanto, a TE parece ser igualmente eficaz na melhora do desempenho da tarefa manual, porém, mais estudos são necessários para afirmar sua efetividade. / CNPq: 157894/2013-4

Made available in DSpace on 2016-12-06T17:07:29Z (GMT). No. of bitstreams: 1 Fabio.pdf: 1333634 bytes, checksum: ba66af05f0145d83e4b237a603a81d74 (MD5) Previous issue date: 2011-03-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study aimed to examine the influence of the postural control in the handgrip strength modulation of the non paretic upper limb during activity to pick up an object and in individuals with hemiparesis after Stroke. We evaluated 15 subjects with hemiparesis (EG) and 15 healthy subjects (CG) aged 57.3 ± 55.5 and 10.17 ± 11.27 years old respectively. To characterize the EG, tests were performed for maximum grip strength, Fugl-Meyer, Semmes-Weinstein monofilament (SWM), sensitivity test moving touch-pressure (MTP) and balance testing BERG. The parameters for the control of grip strength were: force at the time of lifting the cup (Grip lift off), peak grip force (PGF), peak velocity (Pvel), latency (LT), static force (SF) and difference time (DT), made through an instrumented glass with a force sensor and a three axial accelerometer. The subjects performed a task of picking and lifting an object at a predetermined height and keep it statically suspended for a time and reposition it back on the table. For the parameter EF, LT and DT, any significant data was found. Grip strength parameters Grip lift off, Pvel were different between positions. The grip force modulation (PGF) was different between groups. When asked to raise the object the EG didn´t modulate the grip force in response to the withdrawal additional object weight. Through this study it was possible to determine the possible involvement in the control parameters of grip strength of non-paretic upper limb of subjects with hemiparesis. / Este trabalho teve como objetivo analisar a influência da condição postural sentado e em pé na adaptação do controle da força de preensão manual do membro superior não parético durante a atividade de pegar e levantar um objeto, em indivíduos com hemiparesia após acidente vascular encefálico (AVE). Foram avaliados 15 indivíduos com hemiparesia (GE) e 15 indivíduos saudáveis (GC) com idade de 57,3 ±10,17 e 55,5±11,27 anos respectivamente. Para caracterização do GE foram realizados os testes de força de preensão máxima, Fugl-Meyer, monifilamento de Semmes-Weinstein (MSW), teste de sensibilidade moving touch-pressure (MTP) e o teste de equilíbrio de BERG. Os parâmetros para o controle da força de preensão foram: força no momento de levantar o copo (FNML), pico da força de preensão (PFP), pico de velocidade (Pvel), latência (LT), força estática (FE) e diferença temporal (DT) realizado através de um copo instrumentado com um sensor de força e um acelerômetro triaxial. Os indivíduos realizaram uma tarefa de pegar e levantar um objeto uma altura pré-estabelecida, mantê-lo por um tempo e reposicioná-lo novamente a mesa realizaram 7 repetições com carga e 7 sem carga. A modulação da força de preensão nos parâmetros FNML e Pvel ocorreu de forma diferente nas posições sentado e em pé em ambos os grupos. A modulação da PFP foi diferente entre grupos. Ao levantar o objeto o GE não modulou a força de preensão em resposta a retirada do peso adicional do objeto. Para o parâmetro FE, LT e DT, não foram encontrados dados significantes. Através deste estudo foi possível verificar o possível comprometimento nos parâmetros do controle da força de preensão do membro superior não parético de indivíduos com hemiparesia.

Através dos dispositivos e técnicas desenvolvidas na área da Instrumentação Biomédica é possível oferecer um tratamento ou de forma geral soluções que permitam uma vivência mais plena em sociedade para pessoas que possuem algum tipo de deficiência ou doença. Com o aumento da capacidade computacional nos últimos anos foi possível desenvolver muitas técnicas e dispositivos apoiados em processamento digital de sinais e há um grande interesse pelo desenvolvimento de interfaces mais naturais, como sinais biológicos para o controle de próteses e dispositivos. Este trabalho tem por objetivo apresentar o desenvolvimento de um método de Inteligência Computacional baseado em Regressão Logística capaz de classificar 17 movimentos do segmento mão-braço realizados pelos voluntários do estudo através do processamento do sinal mioelétrico (SME) adquiridos dos sujeitos em questão. Adicionalmente é realizada uma avaliação da influência de alguns dos canais, características do sinal e movimentos executados na taxa de acerto global. Para a realização do sistema foi utilizado um aparato experimental capaz de adquirir os SME através de 12 canais utilizando eletrodos não invasivos e posteriormente digitalizá-los. Logo após efetua-se a extração das três características utilizadas no trabalho, que servem de entrada para o método de Regressão Logística. Para este estudo foram processados três bancos de dados que perfazem um total de 50 voluntários. A taxa média de acerto alcançada foi de 70,1%, considerando todas as variações de testes realizados enquanto a média para os melhores casos de cada variação de entrada realizada foi de 92,5%. / Through the devices and techniques developed in the field of Biomedical Instrumentation commonly is possible to offer treatment or solutions to provide a more pleasurable experience in society for people who have a disability or illness. With increasing computing capability in recent years, it has been possible to develop many techniques and devices supported by digital signal processing, and there is a great interest in the development of more natural interfaces, such as biological signals for the control of devices and prostheses. This work aims to present the development of a computational intelligence method based on Logistic Regression able to classify 17 movements of the hand-arm segment performed by the subjects of this study through the processing of the myoelectric signal (SME) acquired from the subject in question. Additionally, an assessment of the influence of some of the combination of the channels, signal characteristics and movements performed in the overall hit rate is additionally performed. To conduct the system has built an experimental apparatus able to acquire the SME through 12 channels using non-invasive electrodes and scan them. Thereafter there is a three features extraction from the signal which serves as input to the Logistic Regression method. For this study were processed three databases that compose 50 volunteers. The average hit rate achieved was 70.1%, considering all tests variations while the average for the best cases for each input variation performed was 92,5 %.