Introdução: As doenças cerebrovasculares são consideradas atualmente a segunda principal causa de óbito no mundo e a terceira causa de anos de vida perdidos por mortalidade1,2. A aterosclerose de grandes artérias é uma das principais condições subjacentes associadas ao AVC isquêmico (AVCi) e correlaciona-se com maiores taxas de recorrência. A detecção e a estratificação da estenose extracraniana podem ser feitas através do Doppler, da angiotomografia computadorizada (ATC), da angiorressonância magnética (ARM) e da angiografia intra-arterial digital (AIA), sendo esta última considerada o método padrão-ouro. Objetivo: Avaliar a acurácia diagnóstica e a concordância entre os métodos de ATC, ARM com contraste (AM CC) e AIA na análise da estenose extracraniana. Determinar a frequência e caracterizar a estenose extracraniana em população brasileira sintomática. Metodologia: Foram avaliados retrospectivamente os exames AIA, ATC e ARM, de pacientes adultos sintomáticos admitidos na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (UE HCFMRP) no período 03/2014-03/2015, para detecção e estratificação da estenose extracraniana. Foram coletados ainda dados demográficos, clínicos e laboratoriais desses pacientes. Resultados: Observou-se alta acurácia da ATC e da ARM na avaliação de segmentos carotídeos, com sensibilidade de 100% e especificidade variando entre 78% e 100% para estenoses >=50%. Para segmentos vertebrais, observou-se menor acurácia dos métodos, sobretudo da ARM, com valores de sensibilidade e especificidade variando entre 60%-85% e 33-62%, respectivamente, para estenoses >=50%. A prevalência de estenose extracraniana >=50% em nossa população foi de 38,6% e de 23,4% para estenoses >=70%. O segmento vascular mais acometido foi a origem das artérias vertebrais. Os fatores de risco associados a estenose extracraniana foram: sexo masculino, idade avançada, tabagismo e elevada pressão arterial sistólica na admissão. Conclusão: A ATC e ARM representam métodos adequados para investigação de estenoses extracranianas, sobretudo carotídeas. Ambos os métodos, sobretudo a ARM, têm acurácia limitada na avaliação dos óstios vertebrais. / Introduction: Cerebrovascular diseases are considered the second cause of death worldwide and the third cause of years of life lost (YLL)1,2. Large arteries atherosclerosis is one of the main conditions associated with stroke and correlates with higher recurrence rates. Imaging methods such as Doppler, computed tomography angiography (CTA), magnetic resonance angiography (MRA) and intra-arterial angiography (IAA) are available for extra cranial vascular study. Intra-arterial angiography remains the gold standard. Objectives: Evaluate diagnostic accuracy and concordance between CTA, MRA (contrast enhanced) and IAA for extracranial stenosis analysis. Determine frequency and distribution of extra cranial stenosis in a brazilian symptomatic population. Methods: IAA, CTA and MRA exams from adult symptomatic patients admitted between 03/2014 and 03/3015 at the Emergency Unit of Clinics Hospital of Ribeirão Preto\'s School of Medicine were retrospectively reviewed for detection and grading of extra cranial stenosis. Clinical and laboratorial information from patients was obtained. Results: Both CTA and MRA showed high sensitivity (100%) and specificity (78%-100%) in the evaluation of carotid vessels for stenosis >=50%. However, lower sensitivity (60-85%) and specificity (33-62%) were obtained for vertebral segments, Extra cranial stenosis prevalence was 38,6% for stenosis >=50% and 23,4% for stenosis >=70% among our patients. Vertebral artery origins were the most affected segments. Risk factors identified for extra cranial stenosis were: male gender, age, smoking and high systolic blood pressure on admission. Conclusions: CTA and MRA are considered adequate methods for extra cranial stenosis, specially for carotid segments. Both methods have lower accuracy in the investigation of vertebral artery origins.

Com a transição epidemiológica no Brasil, as doenças crônicas passaram a ser responsáveis pelo maior número de óbitos entre homens e mulheres. Entre os componentes que definem o estado de saúde humana, alguns do contexto geográfico, como clima local e fatores socioeconômicos, parecem influenciar na mortalidade por doenças do aparelho circulatório, tais como no acidente cerebral vascular (AVC) e na embolia pulmonar (EP). O objetivo principal deste trabalho foi verificar a influência do contexto geográfico (variáveis meteorológicas, índice climático e fatores socioeconômicos) na mortalidade por doenças do aparelho circulatório (AVC e EP) no município de São Paulo, no período de 2002 a 2011. Para analisar a associação da mortalidade com as variáveis meteorológicas foi utilizado um modelo linear generalizado empregando-se o método de Poisson e os modelos de lags distribuídos. Espacialmente a associação da mortalidade com as variáveis socioeconômicas foram testadas utilizando-se os modelos de regressão espacial OLS e GWR. Como resultado encontramos que tanto o frio quanto o calor são fatores de risco para todos os tipos de AVC e EP, com risco maior dependendo do tipo em homens e mulheres. Espacialmente os valores mais elevados do risco relativo (RR) da mortalidade por AVC estavam concentrados nas regiões periféricas do municipio de São Paulo, o que coincidiu com as áreas de menor renda per capita e vegetação e maior porcentagem de população preta. Já com relação à distribuição espacial dos altos valores de RR por EP esses estavam presentes principalmente na região central do município. Concluindo, a nossa pesquisa gerou grande quantidade de resultados que mostram que tanto as variáveis ambientais como socioeconômicas têm influência na mortalidade por algumas doenças do aparelho circulatório. Tendo em vista que o atendimento de urgência para os casos de AVC e EP pode evitar óbitos e sequelas graves, a melhor compreensão da importância do contexto geográfico pode permitir o desenvolvimento de sistemas de alertas junto aos serviços de atendimento de urgência e o direcionamento de campanhas para a prevenção dos fatores de risco evitáveis. / With the epidemiological transition in Brazil, chronic diseases are now responsible for more deaths among men and women. Among the components that define the state of human health, some geographical context, as local climate and socioeconomic factors appear to influence the mortality from circulatory diseases, such as in stroke and pulmonary embolism (PE). The main objective of this study was to investigate the influence of the geographical context (meteorological variables, climate index and socioeconomic factors) in mortality from cardiovascular diseases (stroke and PE) in São Paulo, between 2002 to 2011. In order to analyze the association of mortality with the meteorological variables we used a generalized linear model using the Poisson distribution and distributed lag non linear models. Spatially the association of mortality with socioeconomic variables were tested using the spatial regression models OLS and GWR. As a result we found that both the cold and the heat are risk factors for all types of stroke and PE with a higher risk depending on the type of men and women. Spatially the highest values of relative risk (RR) for stroke mortality were concentrated in the outskirts of the city of São Paulo, which coincided with areas of lower per capita income and vegetation and higher percentage of black population. In relation to spatial distribution of high values of RR PE by these were present mainly in the inner area. In conclusion, our research has generated a lot of results that show that both environmental and socioeconomic variables influence on mortality from some diseases of the circulatory system. In view of the urgent care for stroke and PE cases can avoid serious sequelae and deaths, a better understanding of the importance of geographic context may allow the development of warning systems at the urgent care services and targeting campaigns for the prevention of avoidable risk factors.

To provide universal multimedia experience, multimedia streaming services need to transparently handle the variation and heterogeneity in operating environment. From the standpoint of streaming application, video adaptation techniques are intended to cope with the environmental variations by utilizing manipulations of the video content itself. Scalable video coding (SVC) schemes, like that suggested by the standards H.264 and its SVC extension, is highly attractive for designing a self-adaptive video streaming system. When SVC is employed in streaming system, the produced video stream can be then easily truncated or tailored to form several sub-streams which can be decoded separately to obtain a range of preferable picture size, quality and frame rate. However, questions about how to perform the adaptation using SVC and how much adaptation SVC enables are still remaining research issues. We still lack a thorough understanding of how to automate the scaling procedure in order to achieve an optimal video Quality-of-Experience for end users. Video QoE, depends highly on human perception. In this thesis, we introduce several video QoE studies around the usability of H.264 SVC. Several factors that contribute significantly to the overall QoEs have been identified and evaluated in these studies. As an example of application usage related factor, playback smoothness and application response time are critical performance measures which can benefit from temporal scalability. Targeting on applications that requires frequent interactivity, we propose a transcoding scheme that fully utilizes the benefits of Switching P and Switching I frames specified in H.264 to enhance video stream's temporal scalability.  Focusing on visual quality related factors, a series of carefully designed subjective quality assessment tests have been performed on mobile devices to investigate the effects of multi-dimensional scalability on human quality perception. Our study reveals that QoE degrades non-monotonically with bitrate and that scaling order preferences are content-dependent. Another study find out that the flickering effect caused by frequent switching between layers in SVC compliant bit-streams is highly related to the switching period. When the period is above a certain threshold, the flickering effect will disappear and layer switching should not be considered as harmful. We have also examined user perceived video quality in 3D virtual worlds. Our results show that the avatars' distance to the virtual screen in 3D worlds contribute significant to the video QoE, i.e., for a wide extent of distortion, there exists always a feasible virtual distance from where the distortion is not detectable for most of people, which makes sense to perform video adaptation. The work presented in this thesis is supposed to help improving the design of self adaptive video streaming services that can deliver video content independently of network technology and end-device capability while seeking the best possible experience for video. / Ardendo småföretagsdoktorand

Un nombre non négligeable de patients ayant subi un accident vasculaire cérébral (AVC) vont développer une démence parfois associée à un handicap fonctionnel résiduel. Mon travail a pour but de mettre en place un suivi à long terme de l’ischémie cérébrale chez le rat afin de suivre et d’identifier de manière concomitante l’évolution des lésions cérébrales, les déficits fonctionnels afin d’explorer les mécanismes sous-jacents au développement de la démence post-ischémique. Des rats mâles de souche Wistar ont subi une ischémie cérébrale transitoire. Ces rats sont suivis par IRM à 24 heures, 7 jours, puis 1, 2, 4 et 6 mois de post-ischémie. En parallèle de ces examens, les animaux subissent une batterie de tests comportementaux, comprenant à la fois une étude des fonctions motrices et mnésiques. Après le sacrifice, les cerveaux sont récupérés à des fins histologiques et moléculaires. Des déficits moteurs et mnésiques sont décelés durant notre étude au sein du groupe I/R. L’étude in vivo par IRM a démontré une différenciation de la lésion et du tissu associé, dès 7 jours de reperfusion ainsi que l’apparition de différentes zones d’atrophie apparaissant au niveau de l’hippocampe et du cortex entorhinal dès 1 mois post-ischémie et perdurant le long de l’étude. L’étude histologique montre une diminution significative de la surface cellulaire dans les différentes zones hippocampiques associée à une moindre expression du facteur neurotrophique BDNF qui expliquerait le phénomène d’atrophie. Ces résultats prouvent la pertinence du modèle d’étude préclinique à long terme chez le rat pour reproduire des troubles du comportement en post-AVC. / Patients who have had a stroke have a higher prevalence of dementia associated with functional handicap affecting the quality of life and creating a loss of autonomy. My work aims to develop a long term model of stroke in rat to identify cerebral lesions and the associated behavior deficits as well as the involved cellular mechanisms. Male Wistar rats undergo transient ischemia/reperfusion. MRI was performed at 24 hours, 7 days, 1, 2, 4 and 6 months after operation. In parallel, behavioral tests were assessed to follow motor and mnesic functions. After sacrifice, brains are removed to made histological and molecular studies. Motor and mnesic deficits appeared during our study. MRI studies showed that lesion differentiated at 7 days of reperfusion and T2-MRI evidenced atrophies appearing since 1 month post-ischemia in entorhinal cortex and hippocampus. Histological studies evidenced a decreased cellular surface in hippocampal regions associated to a decreased expression of the neurotrophic factor BDNF which could explain atrophies. These results proved that this long-term ischemic model in rat is a good one to induce behavioral deficits like functional problems appearing at distance in post-stroke patients.

In recent years camera prototypes based on Integral Imaging (II) have emerged that are capable of capturing three-dimensional (3D) images. When being viewed on a 3D display, these II-pictures convey depth and content that realistically change perspective as the viewer changes the viewing position. The dissertation concentrates on three restraining factors concerning II-picture progress. Firstly, there is a lack of digital II-pictures available for inter alia comparative research and coding scheme development. Secondly, there is an absence of objective quality metrics that explicitly measure distortion with respect to the II-picture properties: depth and view-angle dependency. Thirdly, low coding efficiencies are achieved when present image coding standards are applied to II-pictures. A computer synthesis method has been developed, which enables the production of different II-picture types. An II-camera model forms a basis and is combined with a scene description language that allows for the describing of arbitrary complex virtual scenes. The light transport within the scene and into the II-camera is simulated using ray-tracing and geometrical optics. A number of II-camera models, scene descriptions, and II-pictures are produced using the presented method. Two quality evaluation metrics have been constructed to objectively quantify the distortion contained in an II-picture with respect to its specific properties. The first metric models how the distortion is perceived by a viewer watching an II-display from different viewing-angles. The second metric estimates the depth-distribution of the distortion. New aspects of coding-induced artifacts within the II-picture are revealed using the proposed metrics. Finally, a coding scheme for II-pictures has been developed that inter alia utilizes the video coding standard H.264/AVC by firstly transforming the II-picture into a pseudo video sequence. The properties of the coding scheme have been studied in detail and compared with other coding schemes using the proposed evaluation metrics. The proposed coding scheme achieves the same quality as JPEG2000 at approximately 1/60th of the storage- or distribution requirements. / De senaste åren har kameraprototyper som kan fånga tredimensionella (3D) bilder presenterats, baserade på 3D-tekniken Integral Imaging (II). När dessa II-bilder betraktas på en 3D-skärm, delger de både ett djup och ett innehåll som på ett realistiskt sätt ändrar perspektiv när tittaren ändrar sin betraktningsposition. Avhandlingen koncentrerar sig på tre återhållande faktorer gällande II-bilder. För det första finns det en mycket begränsad allmän tillgång till II-bilder för jämförande forskning och utveckling av kodningsmetoder. Det finns heller inga objektiva kvalitetsmått som uttryckligen mäter distorsion med avseende på II-bildens egenskaper: djup och betraktningsvinkelberoende. Slutligen uppnår nuvarande standarder för bildkodning låg kodningseffektivitet när de appliceras på II-bilder. En metod baserad på datorrendrering har utvecklats som tillåter produktion av olika typer av II-bilder. En II-kameramodel ingår som bas, kombinerat med ett scenbeskrivningsspråk som möjligör att godtydligt komplexa virtuella scener definieras. Ljustransporten inom scenen och fram till II-kameran simuleras med strålföljning och geometrisk optik. Den presenterade metoden används för att skapa ett antal II-kameramodeller, scendefinitioner och II-bilder. Två kvalitetmått har tagits fram för att objektivt kvantifiera distorsion som kan uppträda i en II-bild med avseende på dess specifika egenskaper. Det första måttet modellerar hur distortionen uppfattas av en tittare som betraktar en 3D-skärm ur olika betraktningsvinklar. Det andra måttet beräknar distorsionens djupdistribution inom II-bilden. Nya aspekter av kodningsinducerade artefakter påvisas med de föreslagna kvalitetsmåtten. Slutligen har en kodningsmetod för II-bilder utarbetats som bland annat utnyttjar videokodningsstandarden H.264/AVC genom att först transformera II-bilden till en pseudovideosekvens (PVS). Kodningsmetodens egenskaper har studerats i detalj och jämförts med andra kodningsmetoder, bland annat med hjälp av de föreslagna kvalitetsmåtten. Den föreslagna kodningsmetoden åstadkommer samma kvalitet som JPEG2000 till ungefärligen 1/60-del av kraven på lagring och distribution.

L’accident vasculaire cérébral ischémique reste un problème majeur de santé publique, contre lequel l’arsenal thérapeutique reste très limité. L’atorvastatine (AT), utilisée en prévention cardiovasculaire, possède des effets pléiotropes lui conférant un pouvoir protecteur dans l’AVC. Les objectifs de cette thèse étaient d’évaluer et de caractériser les effets neuro- et vasculoprotecteurs de l’AT dans l’ischémie cérébrale, et la part jouée par le récepteur nucléaire PPARα. Des souris C57BL/6J sauvages et KO-PPARα ont été soumises à ischémie-reperfusion (I/R) cérébrale. Elles étaient traitées par AT préventivement pendant 14 jours ou après I/R pendant 24 ou 72 heures. L’effet neuroprotecteur est évalué histologiquement et par des tests fonctionnels moteurs. L’effet vasculoprotecteur est évalué sur l’artère cérébrale moyenne par étude de la fonction endothéliale et sur les microvaisseaux cérébraux par étude de leur structure et des interactions leucocytes-endothélium. Le traitement préventif et aigu par AT induit une diminution du volume lésionnel, et une amélioration de la récupération fonctionnelle chez les animaux traités à la phase aiguë. Le traitement aigu permet de préserver la fonction endothéliale et l’intégrité des microvaisseaux cérébraux, et de limiter les interactions leucocytes-endothélium. PPARα est nécessaire aux effets neuro- et vasculoprotecteurs de l’AT dans l’ischémie cérébrale. Ce travail met en évidence l’intérêt de l’atorvastatine en tant qu’agent neuroprotecteur pléiotrope dans l’ischémie cérébrale. / Ischemic stroke still is a heavy public health burden, as effective therapeutic means remain scarce. Atorvastatin (AT), widely used as a preventive treatment in the cardiovascular field, possesses pleiotropic effects that give it protective properties in stroke. The goals of this work were to assess and characterize the neuro- and vasculoprotective effects of AT in cerebral ischemia, and the part played by PPARα. Wild-type and PPARα-KO C57BL/6J mice were submitted to cerebral ischemia-reperfusion (I/R). They were treated with AT before I/R for 14 days or acutely after I/R for 24 or 72 hours. Neuroprotection is assessed histologically and by a motor functional evaluation. Vasculoprotection is assessed on the middle cerebral artery by evaluating the endothelial function and on cerebral microvessels by evaluating their structure and the interactions between leukocytes and the vascular wall. Preventive and acute treatments with AT induce a reduction in lesion volumes, functional recovery was improved in acutely treated animals. The acute treatment with AT preserves the endothelial function and the microvascular integrity, and reduces the interactions between leukocytes and the endothelium. PPARα is necessary for AT neuro- and vasculoprotective effects to take place. This works highlights the interest of atorvastatin as a pleiotropic neuroprotective agent in ischemic stroke.

Nos últimos anos, o treinamento aeróbio vem sendo empregado como forma de recuperação da marcha em pessoas pós-acidente vascular cerebral. O objetivo desta Tese foi avaliar os efeitos do treinamento aeróbio em piscina e em esteira rolante na marcha de indivíduos hemiparéticos crônicos. Participaram 12 pessoas, randomizadas por sorteio para Grupo Piscina e Grupo Esteira. Para as avaliações funcionais, os testes e escalas foram divididos de acordo com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde: Avaliação Fugl-Meyer; a Escala de equilíbrio de Berg, Escala de avaliação do controle postural para pacientes pós-acidente vascular cerebral, Timed Up and Go Test e o Questionário de qualidade de vida SF-36. Na avaliação biomecânica foram avaliados os parâmetros cinemáticos de amplitude de movimento, ângulo mínimo e máximo da articulação do joelho e tornozelo e parâmetros eletromiográficos (EMG) dos músculos tibial anterior, gastrocnêmio lateral, reto da coxa, vasto lateral, bíceps da coxa, semitendíneo. Foi realizada análise de variância para inferir o efeito do treinamento aeróbio em ambos os grupos. Para estudar o comportamento das variáveis eletromiográficas em função das avaliações funcionais foi realizada a análise de regressão linear múltipla. O treinamento aeróbio melhorou o comprometimento sensório-motor, equilíbrio, agilidade e qualidade de vida relacionada à saúde dos participantes de ambos os grupos, como alterações nos padrões eletromiográficos dos músculos na locomoção dos participantes de ambos os grupos. Não houve efeito do treinamento aeróbio para os parâmetros cinemáticos das articulações analisadas. Houve a fraca relação entre os parâmetros EMG e as variáveis funcionais. Os participantes foram beneficiados pela prática do treinamento aeróbio que propiciou a melhora da funcionalidade dos participantes, independente do meio o qual foi realizado / Stroke is the leading cause of adult disability in the world. Clearly, walking retraining is a major goal in a rehabilitation program for person with stroke. Our study was designed to evaluate the effect of a training program involving both treadmill and aquatic walking to reduce the disability due to poor walking performance in chronic stroke persons. Twelve participants were randomly assigned to treadmill group and aquatic group for the 9 week program (3 days/week) progressive graded, high-intensity aerobic treadmill exercise or aquatic exercise. Data from functional assessments were selected according to levels of the International Classification of Functioning, Disability and Health: Fulg-Meyer scale to body function, Brazilian Berg balance scale, Timed and up & go test and The Postural Assessment Scale for Stroke Patients to activity and Medical Outcomes Study short-form 36-item questionnaire (SF-36) to participation. Biomechanical data were the lower limb kinematic variables (peak and minimal angle and maximal range) and surface electromyogram signals was recorded from tibialis anterior, lateral gastrocnemius, rectus femoris, vastus lateralis, biceps femoris and semitendinosus bilaterally during gait. A five-way analysis of variance was performed to test for differences among groups, phases, muscles, sides and gait phases. Multiple linear regression models were ran to examine the relationships between functional assessment and the electromyography variables. The aerobic training improved the functional variables in both groups. The electromyography variables showed influence of the training program in both groups. Weak relationship exists between functional assessment and the electromyography variables. The aerobic training programs in chronic hemiparetic stroke were beneficial and improving functional status in stroke person for both groups

O acidente vascular cerebral (AVC) é a principal causa de mortes no Brasil entre os óbitos por doenças cerebrovasculares e a principal causa de incapacidade no mundo. Este é um problema substancial de saúde pública e econômico, representa mais da metade dos pacientes neurológicos hospitalizados e muitos apresentam sequelas como hemiparesia, dependência completa ou parcial, afasias e dificuldade na deambulação. Um recurso para potencializar a reabilitação é a \"Telereabilitação\" (TR), que usa as tecnologias de informação e comunicação (TIC\'s) para acompanhamento à distância. Inúmeros benefícios da telessaúde e TR já foram descritos, incluindo um melhor acesso aos serviços de saúde, custo-eficácia, mais oportunidades educacionais, melhoria dos resultados na recuperação, melhor qualidade dos cuidados, melhor qualidade de vida e reforço dos suportes sociais. O presente trabalho realizou um levantamento da percepção dos profissionais e das ferramentas utilizadas por terapeutas ocupacionais para acompanhamento à distância de pacientes com seqüelas de AVC, assim como introduziu ferramentas de TR (mensagens de texto, telefonemas, chats online, etc) em serviços de reabilitação da cidade de Ribeirão Preto e verificou sua viabilidade de uso com estes pacientes. O estudo se desenvolveu em duas partes: 1) levantamento da percepção dos profissionais e das tecnologias usadas nos serviços de terapia ocupacional através de um questionário semi-estruturado; 2) implantação de ferramentas de acompanhamento à distância integradas ao acompanhamento convencional. A parte de implantação foi dividida em duas fases. Na primeira com o uso de somente uma ferramenta para acompanhamento do paciente (por exemplo a mensagem de texto via celular) e a segunda com o uso de duas ferramentas em conjunto (telefonemas e mensagens de texto). O acompanhamento dos pacientes em cada fase foi pelo período de no máximo dois meses. A viabilidade de uso das tecnologias foi avaliada nos aspectos de tempo dispensado para uso, facilidade, percepção de utilidade e adesão à ferramenta, que foram analisados através de questionários estruturados aplicados com o terapeuta do serviço e o paciente. Obteve-se como resultado da primeira parte do estudo um levantamento com 27 terapeutas ocupacionais. Na segunda parte as ferramentas foram introduzi das no tratamento de 9 pacientes. Foi verificado que muitos profissionais já utilizam na clínica as tecnologias de informação e comunicação para acompanhamento à distância. Pôde-se discutir sobre a importância da ética no uso de tecnologias para acompanhamento à distância, da consideração de aspectos como da confiabilidade da informação fornecida pela tecnologia, avaliação das habilidades do paciente para uso, uso de tecnologias de uso prévio do paciente, avaliação da sua rotina e hábitos de vida no momento da escolha da ferramenta. Os pacientes acompanhados não apresentaram dificuldades no uso das ferramentas introduzidas, relataram satisfação com uso e foi observado pelos terapeutas a facilitação do processo de reabilitação através da maior adesão das orientações, monitoramento do paciente e motivação na terapia. / Stroke is the leading cause of death in Brazil between deaths due to cerebrovascular disease and the leading cause of disability worldwide. This is an issue of substantial public health and economic accounts for more than half of patients hospitalized and many have neurological sequelae such as hemiparesis, partial or complete dependence, aphasia and difficulty in walking. A resource for enhancing rehabilitation is \"Telereabilitação\" (TR), which uses communication technologies for distance care. Numerous benefits of telehealth and TR have been described, including improving access to health services, cost-effective, more educational opportunities, improved results in recovery, better quality of care, better quality of life and strengthening social supports. This study conducted a survey of the perceptions of professionals and the tools used by occupational therapists for remote monitoring of patients with sequelae of stroke, as well as introduced the TR (text messages, phone calls, online chats, etc.) tools in rehabilitation services the city of Ribeirão Preto and verifted its feasibility of use with these patients. The study was conducted in two parts: 1) raising the awareness of professionals and technology used in occupational therapy services through a semi-structured questionnaire; 2) implementation of the integrated monitoring to conventional monitoring tools away. The deployment part was divided into two phases. At first only with the use of a tool for monitoring the patient (e.g. via mobile text message), and the second using two tools together (phone calls and text messages). Monitoring of patients in each phase was the period of maximum two months. The feasibility of using technology was evaluated in the aspects of time allocated for use, ease, perceived usefulness and adherence to the tool, which were analyzed using structured questionnaires with the therapist and the patient service. Obtained as a result of the first part of the study a survey of 27 occupational therapists. In the second part the tools were made in the treatment of patients 9. It was found that many professionals now use in clinical information technology and communication for remote monitoring. We can discuss about the importance of ethics in the use of technology for remete monitoring, the consideration of aspects such as the reliability of the information provided by the technology, skills assessment of the patient to use, use of prior patient use technologies, assessment of your routine and lifestyle in their choice of tool. The patients monitored had no difficulties in using the tools introduced, reported satisfaction with use and was observed by the therapists facilitating the rehabilitation process through greater adherence to the guidelines, patient monitoring and motivation in therapy.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-19T17:49:49Z No. of bitstreams: 1 Maria Helena Gomes de Sousa.pdf: 938639 bytes, checksum: 60ae02f298c21e9935dfa190fc6ea44b (MD5) / Made available in DSpace on 2018-07-19T17:49:49Z (GMT). No. of bitstreams: 1 Maria Helena Gomes de Sousa.pdf: 938639 bytes, checksum: 60ae02f298c21e9935dfa190fc6ea44b (MD5) Previous issue date: 2018-02-28 / Ergospirometric test, gold standard evaluation of cardiorespiratory fitness, is not an economically accessible and easy to apply test, especially for patients with Cerebral Vascular Accident (CVA) sequelae. Thus, field tests such as the Shuttle Walk Test Incremental (SWTI) may be another option for evaluation of cardiorespiratory function. Objective: compare the ventilatory, metabolic and cardiovascular responses obtained by the SWT and ergospirometric test, in hemiparetics due to stroke. Secondary objective was compared with the results of the ventilation evaluations with mild, moderate, marked and severe motor impairment of hemiparetic patients. Methodology: transversal study, with 20 hemiparetic subjects, motor impairment (05 mild, 04 moderate, 05 severe, 06 severe), 58 ± 10 years old, 08 women and 12 men. The VO2maximum (VO2), ventilatory (VE), desaturation, heart rate (HR) and blood pressure (BP), during the SWTI and ergospirometry, were evaluated in two days, 48h interval. Results: SpO2 was similar (97 [96-98]; 97 [94-97]) respectively in SWT and ergospirometry. VO2Pico metabolic variables (18 ± 4, 24 ± 4), cardiac FCPic (101 ± 17, 115 ± 15), systolic BP (140 [140-147], 160 [140-160]) and diastolic (2 ± 1, 3 ± 1), fatigue (2 [1-4], 4 [2-6]) and distance traveled (248 ± 154, 409 ± 1) 216). Comparison between groups of motor severity: ergospirometry showed variance in VO2peak and distance traveled between the light and severe group (p <0.05); others did not show significant differences. No SWTI, VO2Pico presented the difference between the moderate and striking groups (p <0.05) and the distance traveled between the light, striking and severe groups (p <0.05). Conclusion: SWTI is not similar to ergospirometry in the hemiparetic population due to stroke. Severe patients have poorer performance in both tests compared to the mild and moderate group, according to a Fugl-Meyer scale. / Teste ergoespirométrico, avaliação padrão ouro da aptidão cardiorrespiratória, não é um teste economicamente acessível e de fácil aplicabilidade, especialmente para pacientes com sequela de Acidente Vascular Cerebral (AVC). Assim, testes de campo como o Shuttle Walk Test Incremental(SWTI) podem ser outra opção de avaliação da função cardiorrespiratória. Objetivo: Comparar as respostas ventilatórias, metabólicas e cardiovasculares, obtidas pelo SWT e teste ergoespirométrico, em hemiparéticos decorrente de AVC. Objetivo secundário foi comparar os resultados das avaliações ventilatórias com o comprometimento motor leve, moderado, marcante e severo, dos pacientes hemiparéticos. Metodologia: estudo transversal, com 20 indivíduos hemiparéticos, comprometimento motor (05 leves, 04 moderados, 05 marcantes, 06 severos), 58±10 anos, 08 mulheres e 12 homens. Foram avaliados o consumo do VO2máximo(VO2), ventilação(VE), dessaturação, frequência cardíaca(FC) e pressão arterial(PA), durante o SWTI e ergoespirometria, realizados em dois dias, intervalo de 48h. Resultados: SpO2 foi semelhante (97[96-98]; 97[94-97]) respectivamente no SWT e ergoespirometria. Foram diferentes: as variáveis metabólicas VO2Pico (18±4; 24±4), cardíacas FCPico(101±17; 115±15), PA Sistólica(140[140-147]; 160[140-160]) e diastólica(85±6; 90±12), esforço percebido dispnéia (2±1; 3±1), fadiga(2[1-4]; 4[2-6]) e distância percorrida(248±154; 409±216). Comparação entre grupos de gravidade motora: ergoespirometria mostrou variância no VO2pico e distância percorrida entre o grupo leve e severo (p<0,05); demais não mostraram diferenças significativas. No SWTI, o VO2Pico apresentou diferença entre os grupos moderado e marcante(p<0,05) e na distância percorrida entre os grupos leve, marcante e severo(p<0,05). Conclusão: O SWTI não é similar à Ergoespirometria na população hemiparética decorrente de AVC. Os paciente severos tem menor desempenho em ambos os testes em comparação com o grupo leve e moderado, de acordo com a escala de Fugl-Meyer.

L’inflammation est un processus essentiel à prendre en compte dans la pratique clinique. Nous avons montré durant cette thèse que le statut (neuro)inflammatoire précédant la survenue d’une pathologie cérébrale est à prendre en compte nécessairement puisqu’il modifie drastiquement la réponse inflammatoire suite à un deuxième stimulus comme la survenue d’un AVC. Il est d’autant plus important que 90% des AVC sont associés à des comorbidités comme l’hypertension artérielle, le diabète ou la consommation chronique d’alcool, qui ont d’ores et déjà été décrites comme des maladies avec une composante inflammatoire. Nous avons caractérisé ce statut neuroinflammatoire silencieux, aussi appelé priming, dans le cadre de la consommation chronique d’alcool et dans le traumatisme crânien léger. De plus, nous avons identifié les macrophages périvasculaires comme participants à l’effet aggravateur du priming inflammatoire sur les lésions ischémiques. Ils semblent alors être une cible thérapeutique de choix et feront l’objet de futures études. Il est donc nécessaire de trouver des techniques d’imagerie non invasives pour détecter le priming. L’autoradiographie ciblant le TSPO nous a permis de révéler le priming inflammatoire dans le cadre du traumatisme crânien léger. Nous proposons, au vu de nos résultats obtenus durant cette thèse, la tomographie par émission de positons pour la détection de la neuroinflammation invisible dans les atteintes cérébrales aigüe(s) et chronique(s). / Inflammation is an essential process to be considered in clinical practice. We have shown during this thesis that the (neuro)inflammatory status preceding the occurrence of a cerebral pathology must necessarily be taken into account since it drastically modifies the inflammatory response following a second stimulus such as stroke. This is even more important given that 90% of strokes are associated with comorbidities such as chronic hypertension, diabetes or chronic alcohol consumption, for which inflammation is an important pathophysiological feature. We have characterized this silent inflammatory status, also called priming, in the context of chronic alcohol consumption and in mild traumatic brain injury. We have identified perivascular macrophages (PVM) as mediators of the aggravating effect of inflammatory priming on ischemic stroke. PVM appear to be potential therapeutic targets and will be the subject of future investigations. It is therefore necessary to find non-invasive imaging techniques to detect inflammatory priming. We show that autoradiography targeting TSPO reveals the inflammatory priming provoked by a single mild traumatic brain injury. We propose, in light of the results obtained during this thesis, the positron emission tomography imaging to detect the invisible neuroinflammation in acute and chronic brain diseases.