Konsistensen på en gel bestående av tvärbunden hyaluronsyra beror av tre faktorer: total koncentration hyaluronsyra, gelningsgrad och tvärbindningsdensitet. För att utföra detta projekt erhölls tre olika geler med olika tvärbindningsdensitet. Dessa geler späddes dels med lösning av fri, icke tvärbunden, HA från 100 % gelningsgrad till 90 % och 80 %. De olika gelningsgraderna späddes också med natriumkloridlösning från den totala koncentrationen HA, 35 mg HA/g gel, till 25 mg/g och 15 mg/g. Projekts huvudfråga är att kartlägga gelens reologiska egenkaper då både total koncentration HA och gelningsgrad varieras. För att kunna kartlägga detta har en reometer brukats där följande tre tester körts: tidssvep, frekvenssvep och amplitudsvep. Från erhållen data har sedan två parametrar som representerar gelkompositionernas viskösa egenskaper (G'') och elastiska egenskaper (G') observerats. Även mätning av extruderingskraft har genomförts för att dra vidare paralleller och slutsatser mellan extruderingskraften och de reoligiska egenskaperna. Ur resultaten ses att förlusttangenten tenderar att sjunka när gelningsgraden ökar, d.v.s. gelerna blir då mer viskösa och mindre elastiska. Förlusttangenten sjunker även vid ökande total koncentration HA vilket betyder att G’ ökar mer än G’’ i vardera punkt som gör att förlusttangenten minskar.Det gick även att avläsa att de viskösa egenskaperna i gelen ökar då total koncentration hyaluronsyra minskar samt att de viskösa egenskaperna i gelerna minskar vid en sjunkande gelningsgrad. Mellan gelningsgrad 90-100 % och total koncentration HA 25-35 mg HA/g har analyserna som gjorts i detta projekt gett följande slutsatser. Konsistensen på gel A och C är mer påverkade av gelningsgraden än total koncentration HA. För gel B kan ingen dominerande parameter utläsas. / The softness of a gel made of crosslinked HA (HA = hyaluronic acid) depends onthree factors. One is the amount of free hyaluronic acid in the gel. Another is thedensity of the crosslinked network, which is the molecular entanglements in the gel.The third is the total concentration of HA. In this project a rheometer is used to measure the rheological properties by runningthe following tests: time sweep, frequency sweep and amplitude sweep. From theobtained data, parameters related to viscous properties (G’’) and elastic properties(G’) of the gels were observed. 27 different compositions of gels with three differentconcentrations (35 mg HA/g, 25 mg HA/g, 15 mg HA/g), three different gel contents(100%, 90%, 80%) and three different densities of crosslinked network (A, B, C) wereanalyzed. To draw further conclusions an analysis of extrusion force was performedas well. The results from the frequency sweeps show that the loss tangent for a gel increasedas the total concentration of HA was reduced and that the loss tangent for a gelincreased as the gel content was decreased. This indicates that the gels become moreviscous when either the concentration of HA or the gel content was decreased. Anincrease in concentration of HA results in an increase of G' and an increase of gelcontent also results in an increase of G'. The results from the amplitude sweeps showthat xG' (xG' = storage modulus at the crossover point between G' and G'') increasesas either the concentration of HA or the gel content is increased. For xStrain (xStrain= deformation of the gel at the crossover point) and xStress (xStress = the stressapplied to the gel at the crossover point) no clear trend can be seen regarding the gelcontent. But an increase in concentration of HA results in an increase of both xStrainand xStress. The results from the analysis of extrusion force show that an increase intotal concentration HA increases the force.

An experimental investigation of an M level (M = 16, 64 and 256) Quadrature Amplitude Modulation (QAM) transmission system suitable for video transmission is presented. The communication system is based on layered video coding and unequal error protection to make the video bitstream robust to channel errors. An implementation is described in which H.264 video is protected unequally by partitioning the compressed data into two layers of different visual importance. The partition scheme is based on a separation of the group of pictures (GoP) in the intra-coded frame (I-frame) and predictive coded frame (P frame). This partition scheme is then applied to split the H.264-coded video bitstream and is suitable for Constant Bit Rate (CBR) transmission. Unequal error protection is based on uniform and non-uniform M-QAM constellations in conjunction with different scenarios of splitting the transmitted symbol for protection of the more important information of the video data; different constellation arrangements are proposed and evaluated to increase the capacity of the high priority layer. The performance of the transmission system is evaluated under Additive White Gaussian Noise (AWGN) and Rayleigh fading conditions. Simulation results showed that in noisy channels the decoded video can be improved by assigning a larger portion of the video data to the enhancement layer in conjunction with non-uniform constellation arrangements; in better channel conditions the quality of the received video can be improved by assigning more bits in the high priority channel and using uniform constellations. The aforementioned varying conditions can make the video transmission more successful over error-prone channels. Further techniques were developed to combat various channel impairments by considering channel coding methods suitable for layered video coding applications. It is shown that a combination of non-uniform M-QAM and forward error correction (FEC) will yield a better performance. Additionally, antenna diversity techniques are examined and introduced to the transmission system that can offer a significant improvement in the quality of service of mobile video communication systems in environments that can be modelled by a Rayleigh fading channel.

Une nouvelle méthode de tomographie est décrite (PRIAM~2D). C'est une méthode géométrique itérative. Au cours de l'inversion, des zones d'influence sont définies pour chacune des cases prises en compte. La taille de ces zones est choisie a priori (à partir de considérations physiques). Leur existence transforme la méthode géométrique en une technique d'inversion sans blocs. Le calcul au sein de chacune des zones comporte des pondérations visant à discriminer les rais entre eux. Celles- ci permettent également de discriminer certaines parties de l'image les autorisant ainsi à varier plus librement que d'autres. Les rais utilisés sont analytiques. Des évaluations de la résolution et des erreurs sont introduites. Ces techniques permettent d'obtenir des résultats comparables à ceux fournis par des méthodes matricielles tout en conservant des temps de calcul nettement inférieurs. Dans le domaine du Génie Civil plusieurs applications sont envisagées. Des sols, ainsi que certaines parties d'ouvrages d'Art, peuvent être auscultés. Il est possible d'obtenir des cartes de la vitesse des ondes de compression ou du facteur de qualité, à partir de mesures de durées de propagation, de temps de montée ou d'amplitudes. En outre, Une chaine de mesure spéciale a été mise au point de manière à minimiser le temps de la mesure.

Coherent detection together with multilevel modulation formats has the potential to significantly increase the capacity of existing optical communication systems at no extra cost in signal bandwidth. However, these modulation formats are more susceptible to the impact of different noise sources and distortions as the distance between its constellation points in the complex plane reduces with the modulation index. In this context, digital signal processing (DSP) plays a key role as it allows compensating for the impairments occurring during signal generation, transmission and/or detection relaxing the complexity of the overall system. The transition towards pluggable optical transceivers, offers flexibility for network design/upgrade but sets strict requirements on the power consumption of the DSP thus limiting its complexity. The DSP module complexity however, scales with the modulation order and, in this scenario, low complex yet high performance DSP algorithms are highly desired. In this thesis, we mainly focus on the impact of laser phase noise arising from the transmitter and local oscillator (LO) lasers in coherent optical communication systems employing high order modulation formats. In these systems, the phase noise of the transmitting and LO lasers translate into phase noise in the received constellation impeding the proper recovery of the transmitted data. In order to increase the system phase noise tolerance, we firstly explore the possibility of re-arranging the constellation points in a circularly shaped mQAM (C-mQAM) constellation shape to exploit its inherent phase noise tolerance. Different low-complex carrier phase recovery (CPR) schemes applicable to these constellations are proposed along with a discussion on its performance and implementation complexity. Secondly, the design guidelines of high performance and low complex CPR schemes for conventional square mQAM constellations are presented. We identify the inherent limitation of the state-of-the-art blind phase search (BPS) carrier phase recovery algorithm which hinders its achievable performance and implementation complexity and present a low complex solution to overcome it. The design guidelines of multi-stage CPR schemes for high order modulation formats, where the BPS algorithm is employed at any of the stages, are also provided and discussed. Finally, the interplay between the received dispersed signal and the LO phase noise is analytically investigated to characterize the origin of the equalization enhanced phase noise phenomena. / <p>QC 20170516</p> / EU project ICONE, gr. #608099

La récupération optimale des amplitudes articulaires (AAs) et de la force musculaire est un objectif crucial de la réadaptation fonctionnelle intensive (RFI) à la suite d’une lésion médullaire (LM). Le but de la présente étude était de documenter les changements d’AAs des membres supérieurs durant la RFI chez des individus (n = 197) ayant subi une LM et d’établir le lien avec l’autonomie fonctionnelle. Les données (AA, force musculaire, spasticité, déficiences secondaires, autonomie fonctionnelle) ont été collectées à l’admission et au congé de la RFI. Des analyses descriptives, des tests d’association entre les changements d’AAs et des variables indépendantes (douleur, spasticité, déficiences secondaires, force) et des analyses multivariées ont été utilisées. Les individus ayant une paraplégie présentent peu de déficit d’AAs à l’épaule comparés à ceux ayant une tétraplégie. Parmi ces derniers, une majorité présente des AAs sous les valeurs de normalité en fin de RFI. Le groupe D, établi selon l’évaluation de l’American Spinal Injury Association (ASIA D) présente des pertes d’AAs plus importante qu’attendue. La douleur au niveau articulaire est un facteur influençant les changements d’AAs, particulièrement dans ce groupe. La force musculaire chez les personnes ayant une tétraplégie sévère (ASIA ABC) est plus faible que celle du groupe ayant une lésion moins sévère (ASIA D). Généralement, le gain de force corrèle avec le gain d’AA. La force musculaire, les AAs et le nombre de déficiences secondaires sont les principaux éléments influençant l’autonomie fonctionnelle. En conclusion, la perte d’AA est plus importante à l’articulation de l’épaule et, pour plusieurs individus, malgré un gain significatif, les AAs n’atteignent pas les valeurs de référence au congé de la RFI. La force musculaire et certaines déficiences secondaires sont des éléments à considérer pour expliquer les pertes d’AAs et d’autonomie fonctionnelle. Les études futures devront clarifier certains aspects dont l’atteinte de la rotation médiale qui semble montrer un patron différent de récupération en comparaison des autres mouvements de l’épaule. De plus, les études devront montrer si ces changements et résultats sont maintenus après le congé de la RFI. / Optimal recovery of range of motion (ROM) and strength are critical objectives of intensive rehabilitation following spinal cord injury (SCI). The aim of this study was to characterize the evolution of ROM and strength at the upper limb and analyze their relationship with functional independence during intensive rehabilitation. Data ROM, strength, spasticity, secondary impairments, functional independence) from 197 participants with SCI were collected at admission and discharge from intensive rehabilitation and were analyzed with descriptive statistics and multivariate analyses (regressions, ANOVA). Specific association analyses were used to determine the level of association between ROM, strength and independent variables such as pain, spasticity and secondary impairments. Lesser deficit in ROM was observed in participants with paraplegia compared to those with tetraplegia. The deficit in individuals with tetraplegia was larger to an extent that most of them did not reach normality in ROM at shoulder joint. Surprisingly, individuals with less severe injury according to the American Spinal Injury Association classification (ASIA D) showed larger deficit of ROM than expected. Joint pain was related to reduce ROM, particularly in participants with ASIA D lesion. Values of muscle strength in individuals with more severe tetraplegia (ASIA ABC) are lower than the ones observed in individuals with less severe injury (ASIA D). Overall, strength and ROM were correlated, except for medial rotation movement. ROM, strength, and secondary impairments are the major determinants of functional independence. In conclusion, shoulder joint was the most affected joint of the upper limb, and, despite of significant gains of ROM, abnormalities were greater than expected. Strength and some secondary impairment were related in loss of ROM and functional independence throughout rehabilitation. More study will be needed to understand the medial rotation movement at the shoulder that seems to evolve differently from other movements, and to determine whether or not changes observed during rehabilitation are maintained over time.

Les temps de trajet, amplitudes et angles à la source des ondes sismiques sont utilisés dans de nombreuses applications telles que la migration, la tomographie, l'estimation de la sensibilité de détection et la localisation des microséismes. Dans le contexte de la microsismicité, il est nécessaire de calculer en quasi temps réel ces attributs avec précision. Nous avons développé ici un ensemble d'algorithmes rapides et précis en 3D pour des modèles à fort contraste de vitesse.Nous présentons une nouvelle méthode pour calculer les temps de trajet, les amplitudes et les angles à la source des ondes correspondant aux premières arrivées. Plus précisément, nous résolvons l'équation Eikonal, l'équation de transport et l'équation des angles en nous basant sur une approche par différences finies pour des modèles de vitesse en 3D. Nous proposons une nouvelle méthode hybride qui bénéficie des avantages respectifs de plusieurs approches existantes de résolution de l'équation Eikonal. En particulier, les approches classiques proposent généralement de résoudre directement les équations et font l'approximation localement d'une onde plane. Cette approximation n'est pas bien adaptée au voisinage de la source car la courbure du front d'onde est importante. Des erreurs de temps de trajet sont alors générées près de la position de la source, puis propagées à travers tout le modèle de vitesse. Ceci empêche de calculer correctement les amplitudes et les angles à la source puisqu'ils reposent sur les gradients des temps. Nous surmontons cette difficulté en introduisant les opérateurs sphériques ; plus précisément nous reformulons les temps de trajet, amplitudes et angles à la source par la méthode des perturbations.Nous validons nos nouvelles méthodes pour différents modèles à fort contraste de vitesse en 2D et 3D et montrons notre contribution par rapport aux approches existantes. Nos résultats sont similaires à ceux calculés en utilisant la modélisation de la forme d'onde totale alors qu'ils sont bien moins coûteux en temps de calcul. Ces résultats ouvrent donc de nouvelles perspectives pour de nombreuses applications telles que la migration, l'estimation de la sensibilité de détection et l'inversion des mécanismes au foyer. / Traveltimes, amplitudes and take-off angles of seismic waves are used in many applications such as migration, tomography, detection sensitivity estimation and microseism location. In the microseismicty context it is necessary to compute in near real time accurately these attributes. Here we developed a set of fast and accurate algorithms in 3D for highly contrasted velocity models.We present a new accurate method for computing first arrival traveltimes, amplitudes and take-off angles; more precisely we solve the Eikonal, transport and take-off angle equations based on a finite difference approach for 3D velocity models. We propose a new hybrid method that benefits from the advantages of several existing Eikonal solvers. Common approaches that solve directly these equations assume that we are locally propagating a plane wave. This approximation is not well adapted in the neighborhood of the source since the wavefront curvature is important. Travel times errors are generated near the source position and then propagated through the whole velocity model. This prevents from properly calculating the amplitudes and the take-off angles since they rely on the travel time gradients that are not accurate. We overcome this difficulty by introducing spherical operators. Indeed we reformulate the traveltimes, amplitudes and take-off angles with the perturbation method.We validate our new methods on various highly contrasted velocity models in 2D and 3D and show our contribution compared to other existing approaches. Our results are similar to those computed using full waveform modeling while they are obtained in a much shorter CPU time. These results open thus new perspectives for several applications such as migration, detection sensitivity estimation and focal mechanism inversion.

Tato disertační práce vychází z výzkumu v rámci francouzsko-českého programu doktorátu pod dvojím vedením na pracovišti Institut français de mécanique avancée v Clermont-Ferrand a na Ústavu fyziky materiálu AV v Brně. Úvodní výzkumný úkol na brněnském pracovišti se zabýval numerickou analýzou pole napětí v okolí čela trhliny v tenké kovové fólii. Zvláštní pozornost byla zaměřena na vliv speciálního typu singularity v průsečíku čela trhliny s volným povrchem. Těžiště disertační práce spočívá v numerickém modelování a stochastické analýze problémů šíření trhlin se složitou geometrií v dvojrozměrném prostoru. Při analýze těchto problémů se dříve zřídka používaly numerické metody, a to z důvodu vysoké náročnosti na výpočtový čas. V této disertaci je ukázáno, že aplikací moderních metod numerické mechaniky a vhodných technik v analýze spolehlivosti lze tyto problémy řešit s pomocí numerických metod i na PC. Ve spolehlivostní analýze byla využita lineární aproximační metoda FORM. Pro rychlost šíření trhlin se vycházelo z Parisova-Erdoganova vztahu. Pro parametry tohoto vztahu byl použit dvourozměrný statistický model, který postihuje vysokou citlivost na korelaci obou parametrů. Mechanická odezva byla počítána rozšířenou metodou konečných prvků (XFEM), která eliminuje výpočetní náročnost a numerický šum související se změnou sítě v klasické metodě konečných prvků. Prostřednictvím přímé diferenciace bylo odvozeno několik vztahů pro derivace funkce odezvy, čímž se dosáhlo lepší numerické stability a konvergence spolehlivostní analýzy a výrazného zkrácení doby výpočtu. Problém zatížení s proměnou amplitudou byl řešen aplikací transformace zatížení metodou PREFFAS. Využití distribuce výpočtů v síti PC umožnilo další zrychlení analýzy.

A Distrofia Muscular Congênita (DMC) se caracteriza clinicamente por hipotonia e fraqueza muscular, retardo do desenvolvimento motor e retrações fibrotendíneas. Instrumentos de avaliação clínica, como as escalas funcionais, motoras e de qualidade de vida, têm como objetivo quantificar o impacto da doença sobre as atividades diárias da vida do paciente, além de auxiliarem na caracterização de grupos de estudo heterogêneos. Sendo a DMC altamente heterogênea, traçar o perfil funcional dos pacientes com diferentes subtipos seria útil para caracterizar padrões funcionais e auxiliar no tratamento em equipe multidisciplinar. Objetivos: Caracterizar o perfil de funcionalidade e qualidade de vida de pacientes com DMC de diferentes subtipos e correlacioná-lo com a força muscular e grau de amplitude de movimento. Metodologia: Em uma amostra de 18 pacientes com DMC com idade de 12 + 3,2 anos e 13 pacientes com outras miopatias congênitas com idade de 13 + 2,6 anos foram aplicados em três visitas (V1, V2 e V3) os questionários SF-36 e Índice de Barthel (IB), além de realizada avaliação físico-motora (goniometria, força muscular) seguido de correlação com a escala funcional MFM-32 (Medida de Função Motora). Resultados: Houve significativa queda na qualidade de vida em pacientes Merosina (-) e em outras formas de DMC. O índice de Barthel (IB) apontou \"grave dependência\" final em pacientes merosina (-) e \"moderada dependência\" em outras formas de DMC. A goniometria mostrou diminuição da movimentação global em todos os grupos articulares avaliados em pacientes com merosina (-). Em outras formas de DMC, houve exceção de diminuição apenas em articulação distal de membros superiores. A força de todos os grupos musculares é significativamente afetada em ambos os grupos. Pacientes merosina (-) mostram diminuição significativa de funcionalidade nas três dimensões da escala MFM-32 (D1, D2 e D3), e em outras formas de DMC, apenas diminuição em D2 e D3. Houve moderada correlação positiva entre força muscular e D1 da escala MFM-32, forte correlação positiva entre goniometria e D2 e D3 em pacientes com merosina (-), não havendo correlação entre nenhuma variável e MFM-32 em outras formas de DMC. Conclusão: Pacientes com DMC apresentaram perfil funcional \"gravemente dependente\", com diminuição da qualidade de vida, observada em cinco de oito quesitos do questionário SF-36. A força muscular e a amplitude de movimento articular foram afetadas de forma generalizada em ambos os grupos de pacientes. Pacientes com merosina (-) mostraram-se mais afetados funcionalmente em posturas eretas e transferências, sendo correlacionada positivamente com a força muscular dos grupos dessa tarefa / Congenital Muscular Dystrophy (CMD) is characterized by hypotonia and weakness, motor development delay and muscular contractures. Instruments of clinical assessment, such as functional motor and quality of life scales are essential to quantify the impact of the disease on daily activities of the patient\'s life in addition to helping in the characterization of heterogeneous study groups. As the DMC highly heterogeneous, trace the functional profile of patients with different subtypes would be useful to characterize functional patterns and aid in the treatment by a multidisciplinary team. Objectives: To characterize the functionality and quality of life of children with different subtypes of DMC and to correlate them with the degree of muscle strength and range of motion. Methods: In a sample of 18 patients with CMD (aged 12 + 3.2 years) and 13 patients with other congenital myopathies (aged 13 ± 2.6 years) were applied in three visits (V1, V2 and V3) the SF-36 and Barthel Index (BI), and performed physical-motor assessment (goniometry, muscle strength) followed by correlation with functional scale MFM-32 (motor Function Measure. ). Results: There was a significant decrease in the quality of life in patients Merosin (-) and other forms of CMD. IB indicated \"severe dependence\" final in Merosin patients (-) and \"moderate dependence\" in other forms of CMD. Goniometry showed a decrease of the overall joint movement in all groups evaluated in patients with merosin (-).In other forms of DMC was decreased joint movement in all joint groups, except for the distal joint of the upper limbs. The strength of each muscle group was significantly affected in both groups. Patients merosin (-) show a significant decrease in the functionality on the 3 dimensions of MFM-32 scale (D1, D2, D3) in patients with other forms of DMC only reduction in D2 and D3. There was a moderate positive correlation between muscle strength and D1 of the SF-32 scale, strong positive correlation between goniometry and D2 and D3 in patients with Merosin (-), there was no correlation between this variable and MFM-32 in other forms of CMD. Conclusion: Patients with CMD showed functional profile \"severely dependent\" to low quality of life observed in five of eight areas of the SF-36 questionnaire. Muscle strength and range of motion were affected in a generalized manner in both patient groups. Patients with Merosin (-) are even more affected functionally in standing and transfers being positively correlated with muscle strength of the groups of this task postures

A síndrome fêmoro-patelar (SFP) acomete adultos jovens e caracteriza-se por dor no joelho durante a realização de atividades funcionais. Os fatores etiológicos incluem o aumento do ângulo Q e desequilíbrios musculares e para seu tratamento normalmente são realizados exercícios de fortalecimento do músculo quadríceps femoral, não sendo encontradas referências quanto ao uso de alongamento muscular no reequilíbrio da articulação fêmoro-patelar. Dessa forma, os objetivos deste estudo foram comparar a eficácia de exercícios de fortalecimento do músculo quadríceps femoral e alongamento dos músculos da cadeia posterior na recuperação funcional de pacientes com SFP. Para isso, foram selecionadas 40 mulheres sedentárias com idade entre 18 e 32 anos com SFP. Antes do tratamento foram avaliados: medida da flexibilidade, do encurtamento dos músculos isquiotibiais, do ângulo Q, aplicação de escalas da capacidade funcional (escala de contagem de Lysholm e escala de avaliação para a articulação fêmoro-patelar) e eletromiografia (EMG) dos músculos vasto medial (VM), vasto lateral (VL), bíceps femoral (BF) e gastrocnêmio porção lateral (GT) durante contrações isométricas de flexão e extensão da perna. Posteriormente, os pacientes foram divididos em quatro grupos de tratamento: o Grupo 1 (G1) realizou alongamento dos músculos da cadeia posterior pela técnica de reeducação postural global, o Grupo 2 (G2) realizou alongamento segmentar dos músculos isquiotibiais e gastrocnêmio, o Grupo 3 (G3) fortaleceu o músculo quadríceps femoral em cadeia cinética aberta e o Grupo 4 (G4) fortaleceu o mesmo músculo em cadeia cinética fechada, ambos com aumento progressivo da carga. Antes e após cada sessão de tratamento, as pacientes preenchiam a intensidade da dor no joelho numa escala visual analógica. O tratamento durou oito semanas com freqüência de duas vezes semanais. As variáveis obtidas antes e após o tratamento para cada grupo foram analisadas pelo teste de Wilcoxon e entre os grupos pela Anova e teste de Duncan ou Anova de Friedman ou Manova (&#945; < 0,05). Comparando as variáveis antes e após o tratamento, os resultados mostram que a intensidade da dor apresentou melhora significante no G1 e G3 e o ângulo Q diminuiu no G1 e G2. Para a atividade EMG, o músculo VM não sofreu alteração após o tratamento, o músculo VL aumentou no G2 e G3, o músculo BF aumentou apenas no G3 e o músculo GT aumentou no G3 e G4. Em todos os grupos, as escalas mostram melhora da capacidade funcional, diminuição do encurtamento dos músculos isquiotibiais e aumento da flexibilidade. Entre os grupos, o G1 tendeu a apresentar maior flexibilidade, o G4 maior atividade EMG do músculo BF, enquanto o G1 e G3 mostraram maior ativação do músculo GT. Os dados sugerem que os exercícios de alongamento muscular, em especial o global, também devem ser indicados no tratamento de pacientes com SFP, principalmente nas fases iniciais, onde se objetiva uma redução efetiva da intensidade da dor. Além disso, também possibilitou maior realinhamento do joelho (redução do ângulo Q) e aumento da flexibilidade, o que pode facilitar o fortalecimento muscular. / The patellofemoral syndrome (PFS) affects young adults and is characterized by knee pain during functional activities. PFS etiology includes bigger Q angle and muscular imbalances. For treatment, quadriceps femoris strengthening are normally performed, but we were unable to locate documentation about the application of stretching exercises in the patellofemoral joint rehabilitation. The aim of this study was to compare the efficacy of quadriceps femoris muscle strengthening and posterior chain stretching exercises in the functional recovery of PFS patients. Forty female nonathletes aged between 18 and 32 years old were recruited. Before treatment, it was measured: flexibility, hamstring tightness, Q angle, functional injury level of the knee by the application of questionnaires and electromyography (EMG) of the vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF) and lateral gastrocnemius(LG) muscles during isometric contractions of leg flexion and extension. After this initial evaluation, patients were divided into four treatment groups: Group 1 (G1) performed posterior chain global stretching exercises, Group 2 (G2) segmentary stretching exercises of hamstring and gastrocnemius muscles, Group 3 (G3) quadriceps femoris strengthening exercises in open kinetic chain and Group 4 (G4) quadriceps femoris strengthening exercises in closed kinetic chain, with progressively resistance increases. This treatment lasted eight weeks, twice a week. Before and after each treatment session, the visual analogue scale accessed pain intensity. The data obtained before and after treatment for all groups were analyzed by Wilcoxon test, and the data between groups by Anova and Duncan test or Friedman Anova or Manova (&#945; < 0.05). Comparing the data before and after treatment, the results showed a significant improvement in pain intensity in G1 and G3 and a decreased Q angle in G1 and G2. For the EMG activity, VM muscle activity was not modified after treatment, VL activity increased in G2 and G3, BF activity increased only in G3 and LG activity increased in G3 and G4. Between groups, G1 showed greatest flexibility, G4 greatest EMG activity of BF muscle, while G1 and G3 showed greatest activity of LG muscle. Based on these results, we suggest that stretching exercises, specifically in global modality, can be prescribed in PFS treatment, especially in its initial phases, for an effective reduction of pain intensity. Moreover, this treatment caused a knee alignment (by reducing Q angle)and flexibility improvement, which may facilitate muscular strengthening.

Objetivos: Este trabalho objetivou avaliar e comparar a incidência de linfedema, dor, restrição na amplitude de movimento e déficit sensorial 1 dia, 15 dias, 3 meses, 6 meses e 18 meses no membro superior homolateral, após linfadenectomia axilar total (LAT) e biópsia de linfonodo sentinela (BLS) para tratamento do câncer de mama. MÉTODOS: Neste estudo incluiu-se pacientes que realizaram ressecção segmentar de mama e LAT ou BLS. As pacientes foram avaliadas entre Dezembro de 2003 e Dezembro de 2004 e foram constituídos por dois grupos, o grupo A (n=100) foi formado por casos submetidos à LAT e o Grupo B, por casos submetidos à BLS (n=50). As pacientes foram analisadas através de questionário com respostas afirmativas e negativas, onde foram incluídas questões avaliando os sintomas de linfedema, dor, restrição da amplitude de movimento e déficit sensorial 1 dia (n=30), 15 dias (n=30), 6 meses (n=30) e 18 meses (n=30), após o procedimento cirúrgico. Além disto efetuou-se avaliação fisioterapêutica na qual foi realizada perimetria de membros superiores, mensuração da amplitude de movimento através da goniometria, os testes de sensibilidade cutânea através dos monofilamentos de Semmes-Weinstein e teste eletrodiagnóstico, utilizando-se gerador universal de correntes. RESULTADOS: No grupo A houve diferenças significantes (p < 0,05) em todos os sintomas subjetivamente avaliados, existindo maior queixa de edema (31%), dor (58%), restrição do movimento (52%) e dormência (57%). No grupo B houve menor prevalência da sensação de edema (2%), dor (26%), restrição do movimento (24%) e dormência (20%), em todos os tempos estudados. No exame clínico, o exame sensorial com monofilamentos apresentou 82% de diminuição da sensibilidade tátil na região axilar e 73% na região braquial proximal no grupo de mulheres submetidas à LAT e no grupo de mulheres submetidas à BLS houve diminuição da sensibilidade tátil nas duas regiões avaliadas em 40% (p<0.05). Nas provas cronaximétricas, a sensibilidade estava diminuída no grupo de mulheres submetidas à LAT em 56% na região axilar e 48% na região braquial proximal medial e no grupo BLS a sensibilidade estava diminuída em 39% e 14% respectivamente. CONCLUSÕES: A morbidade é maior a e funcionalidade do braço é menor em mulheres submetidas à LAT, quando comparadas à BLS, em mulheres operadas por câncer de mama / OBJECTIVES: The aim of this study was to evaluate and compare occurrence of lymphedema, pain, motion restriction and sensory deficit in the upper homolateral limb at 1 day, 15 days, 3 months, 6 months and 18 months after axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) after breast cancer surgery. METHODS: A controlled study was designed to include patients who underwent breast conservative surgery and ALND or SLNB. Patients were evaluated between December 2003 and December 2004, and they were divided into two groups, group A (n=100) consisted who had ALND and group B, with patients after only SLNB (n=50). All of them subjectively answer a \"yes\" or \"no\" questionnaire in which were included questions about incidence of lymphedema, pain, motion restriction and arm numbness at 1day (n=30), 15 days (n=30), 3 months (n=30), 6 months (n=30) and 18 months (n=30) after surgery. Besides this a physiotherapy examination was performed measuring circunference, shoulder adbuction range by a goniometer, sensibility tests by pressure Semmes-Weinsten monofilaments and by eletrodiagnostic tests using an universal stimulator. RESULTS: In the group A significant differences (p < 0,05) were seen in subjectively sensations, with significantly higher incidence of subjective swelling (31%), pain (58%), motion restriction (52%), arm numbness (57%). In group B there were less symptoms of subjective swelling (2%), pain (58%), motion restriction (24%), arm numbness (20%). In clinical examination sensory deficit using monofilaments the occurrence of numbness was 82% on axillary fold and 73% on medial part of upper arm after ALND and in 40% on axillary fold and medial part of upper arm after SLNB, with significantly different between the groups (p < 0.05). At cronaximetric proofs the sensibility was decreased in 56% in the axillary fold and 48% in the medial part of upper arm for ALND and 39% in the axillary fold and 14% at medial part of upper arm on patients who underwent SLNB. CONCLUSIONS: Arm morbidity is higher and function is lower after ALND compared to SLNB, in women submitted to breast cancer surgery