Introdução: Tem sido demonstrada uma associação entre a variabilidade da pressão arterial avaliada por diferentes índices e lesão em órgão-alvo, independentemente dos valores de pressão arterial. O índice tornozelo-braquial (ITB) é útil no diagnóstico de doença arterial oclusiva periférica, sendo reconhecido como marcador de aterosclerose sistêmica. Objetivo: Avaliar a associação entre três diferentes métodos de estimar a variabilidade da pressão arterial sistólica (taxa de variação da pressão no tempo - índice "time-rate", coeficiente de variabilidade, desvio padrão das médias da pressão arterial sistólica de 24 horas) e o índice tornozelo-braquial (ITB). Métodos: Em um estudo transversal, pacientes atendidos no ambulatório de hipertensão realizaram medida de ITB e Monitorização Ambulatorial da Pressão Arterial de 24 horas (MAPA). Três parâmetros de variabilidade foram avaliados: o índice "time-rate" definido como a primeira derivada da pressão arterial sistólica em relação ao tempo; desvio padrão (DP) das médias da pressão arterial sistólica (PAS) de 24 horas e coeficiente de variabilidade (CV=DP/média pressóricaX100%). O ITB aferido por doppler foi obtido pela razão entre a maior pressão arterial sistólica do tornozelo ou pediosa e a maior pressão sistólica dos braços. O ponto de corte para o diagnóstico de doença arterial periférica foi ITB <= 0,90 ou>= 1,40. Resultados: A análise incluiu 425 pacientes: 69,2% eram do sexo feminino, com idade média de 57±12 anos, 26,1% eram tabagistas e 22,1% tinham diabetes mellitus. ITB alterado foi detectado em 58 pacientes (13,6%). Para os grupos ITB normal e anormal o índice "time-rate", DP das médias e CV foram: 0,469±0,119 mmHg/min e 0,516± 0,146 mmHg/min (p=0,007); 12,6±3,7 mmHg e 13,2±4,7 mmHg (p=0,26); 9,3±2,9% e 9,3±2,6 % (p=0,91), respectivamente. No modelo de regressão logística, o "time-rate" foi associado com ITB, independentemente da idade (RR=6,9; 95% IC= 1,1-42,1; P=0,04). Em modelo de regressão linear múltipla demonstrou-se uma associação independente da idade, PAS de 24 horas e presença de diabetes mellitus. Conclusão: O índice "time-rate" foi o único parâmetro de variabilidade da pressão arterial sistólica associado com índice tornozelo-braquial e pode ser utilizado na estratificação de risco em hipertensos. Este parâmetro de variabilidade obtido por método não invasivo deve ser melhor investigado em estudos prospectivos. / Introduction: An association between the Blood Pressure Variability, estimated by different indexes, and target-organ damage has been established independently of blood pressure levels. The Ankle-Brachial Index (ABI) is useful in the diagnosis of peripheral arterial disease and it is recognized as a cardiovascular risk marker. Purpose: To evaluate the association between three different methods in estimating the variability of systolic blood pressure (rate of change of pressure over time - time rate index, coefficient of variability, standard deviation of the average 24-hour systolic blood pressure) and the ankle-brachial index (ABI). Methods: In a cross-sectional study, patients of a hypertension clinic underwent ABI measurement and 24-hour Ambulatory Blood Pressure Monitoring (ABPM). Variability was estimated according to three parameters: the time rate index, defined as the first derivative of systolic blood pressure at the time; standard deviation (SD) of 24-hour systolic blood pressure (SBP); and coefficient of variability of 24-hour SBP (CV = SD / mean value X 100%). The ABI was measured by Doppler and obtained by dividing the systolic blood pressure on the ankle or foot (whichever was higher) by the higher of the two systolic blood pressures on the arms. The cutoff point for diagnosis of peripheral arterial disease was ABI<= 0.90 or>= 1.40. Results: The analysis included 425 patients: 69.2% were female, mean age was 57±12 years, 26.1% were current smokers and 22.1% diabetics. Abnormal ABI was detected in 58 patients (13.6%). For the normal and abnormal ABI groups the time rate index, the average SD and CV were 0.469 ± 0.119 mmHg/min and 0.516 ± 0.146 mmHg/min (p = 0.007), 12.6±3.7 mmHg and 13.2±4.7 mmHg (p = 0.26), 9.3±2.9% and 9.3±2.6% (p = 0.91), respectively. In the logistic regression model, time rate was associated with ABI, regardless of age (RR = 6.9, 95% CI = 1.1- 42.1; P = 0.04). The multiple linear regression model showed an association that was independent of age, 24-hour SBP and presence of diabetes. Conclusion: The time rate index was the only measurement of variability of systolic blood pressure associated with ankle-brachial index, and might be used for risk stratification in hypertensive patients. This measurement of variability was obtained by a non-invasive method and should be better investigated in prospective studies.

INTRODUÇÃO: A recuperação de sensibilidade protetora na mão deve fazer parte da estratégia na reconstrução cirúrgica das lesões completas do plexo braquial. Existem poucos nervos doadores de fibras sensitivas disponíveis e há poucos trabalhos relacionados na literatura. Um possível doador é o nervo intercostobraquial (NICB), que é o ramo cutâneo lateral do segundo nervo intercostal que inerva a pele da região póstero-medial do braço e da axila. OBJETIVOS: Avaliar a viabilidade anatômica de utilização do NICB como doador de fibras sensitivas para a contribuição do cordão lateral para o nervo mediano (CLNM) e comparar o número de fibras do NICB e da CLNM, para analisar a compatibilidade anatômica entre esses nervos. MÉTODOS: Trinta cadáveres adultos não fixados foram dissecados no Serviço de Verificação de Óbitos da Capital da Universidade de São Paulo, São Paulo, Brasil. Dados de sexo, altura e peso foram registrados. O NICB e o plexo braquial infraclavicular à direita foram expostos e parâmetros anatômicos como número de ramos na origem, diâmetro e divisões no curso do NICB foram mensurados, caracterizados e registrados, assim como o diâmetro da CLNM. As distâncias entre a origem do NICB e seu ponto de divisão e ponto de coaptação com a CLNM também foram medidas e registradas. Fragmentos de nervos foram retirados dos últimos dez espécimes para análise histomorfométrica com contagem do número de fibras de quatro nervos: NICB, nervo supraclavicular (NSC), terceiro nervo intercostal (3ºNIC) e CLNM. RESULTADOS: Oito cadáveres eram do sexo feminino e 22 do masculino. A média de idade, altura e peso foram, respectivamente, 62 anos, 166 cm e 59,5 Kg. O diâmetro médio do NICB na sua origem foi de 2,1 mm e no seu ponto de coaptação de 2,7 mm. O diâmetro médio da CLNM foi de 3,7 mm. Vinte e oito (93,3%) NICBs apresentaram-se como tronco único em sua origem e, em seu trajeto na axila, 22 deles (73,3%) se dividiram em 2 ramos, sete (23,3%) dividiram-se em três ramos e um atingiu o braço como tronco único. As distâncias médias entre a origem do NICB e o seu ponto de ramificação e de coaptação à CLNM foram 23,8 mm e 54 mm, respectivamente. Todos os NICBs dissecados tinham extensão suficiente para alcançar a CLNM. Os números médios de fibras do NICB, NSC, 3ºNIC e CLNM foram 984, 693, 470 e 5273, respectivamente. A análise estatística mostrou diferença significativa entre o NICB e o 3ºNIC, e entre a CLNM (receptor) e os outros potenciais nervos doadores (NICB, NSC e 3ºNIC). CONCLUSÕES: A transferência do NICB como um doador de axônios sensitivos para a CLNM foi anatomicamente viável. O NICB apresenta número de fibras maior do que o 3ºNIC, mas sem diferença significativa em comparação com o NSC. Considerando a importância da recuperação da sensibilidade protetora na mão, esta técnica pode se tornar importante contribuição em doentes com lesões completas do plexo braquial / INTRODUCTION: Restoration of protective sensory function in the hand should be mandatory in the surgical reconstruction of complete brachial plexus lesions. There are few available donors and related papers in the literature are scanty. One possible donor is the intercostobrachial nerve (ICBN), which is the lateral cutaneous branch of the second intercostal nerve that supplies the skin of the medial and posterior parts of the arm and the skin of the axilla. OBJECTIVES: To evaluate the anatomical viability of using the ICBN as a donor of sensitive axons to the lateral cord contribution to the median nerve (LCMN) and to compare the number of fibers of the ICBN, and the LCMN, to analyze the anatomical compatibility between these nerves. METHODS: Thirty non-fixed adult cadavers were dissected at the Serviço de Verificação de Óbitos da Capital of University of São Paulo, São Paulo, Brazil. Data of sex, height and weight were registered. The right ICBN and infraclavicular brachial plexus were exposed and measurements of diameters of the ICBN and of the LCMN were performed. Number of branches at ICBN origin and number of divisions were registered. Distances between the origin of the ICBN and its point of division and point of coaptation to the LCMN were also measured. Histomorphometric analysis of the last ten specimens was performed with fibers counting of four distal nerves: ICBN, supraclavicular nerve (SCN), third intercostal nerve (3rdICN) and LCMN. RESULTS: Eight cadavers were female and 22 male. The mean age, height and weight were, respectively, 62 yo, 166 cm and 59,5 Kg. The mean diameter of the ICBN at its origin was 2,1 mm and at its point of coaptation was 2,7 mm, and the mean diameter of the LCMN was 3,7 mm. Twenty eight (93,3%) ICBNs had only one branch at their origin and, in their axillary course, 22 of them (73,3%) divided in 2 branches, seven (23,3%) divided in 3 branches and one reached the arm as a single nerve. The divisions of the ICBN occurred in a mean distance of 23,8 mm from their origin. The mean distance between the origin of the ICBN and its point of coaptation to the LCMN was 54 mm. All the ICBNs dissected had enough extension to reach the LCMN. The mean numbers of fibers of the ICBN, SCN, 3rdICN and LCMN were 984, 693, 470 and 5273, respectively. Statistical analysis demonstrated significant difference between the ICBN and the 3rdICN, and between the LCMN (recipient) and the other potential donor nerves (ICBN, SCN and 3rdICN). CONCLUSIONS: This study demonstrated the anatomical feasibility of the transfer of the ICBN as a donor of sensitive axons to the LCMN. The ICBN has a number of fibers greater than that of the ICN, but without significant difference in comparison to the SCN. Considering the importance of the recovery of protective sensibility in the hand, this technique may become an important contribution in the treatment of patients with complete lesions of the brachial plexus

Orientador: Luiz Cláudio Martins / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T00:45:51Z (GMT). No. of bitstreams: 1 Coelho_ThaisCristina_M.pdf: 3269478 bytes, checksum: 5e326edaaa0674d80421fe3a0d0f7f0e (MD5) Previous issue date: 2013 / Resumo: A presença da hipertensão arterial sistêmica, doença arterial periférica e de outras comorbidades, podem potencializar as chamadas síndromes geriátricas, como a síndrome da fragilidade. Embora seja um fator de risco modificável para doenças cardiovasculares, o percentual de controle da pressão arterial é baixo, sendo uma das causas, a baixa adesão ao tratamento. Tendo em vista que estas condições estão relacionadas ao desenvolvimento de incapacidades, piora da qualidade de vida dos idosos e aumento dos custos para os serviços de saúde, o objetivo desse trabalho foi investigar as relações entre hipertensão arterial, risco cardiovascular e adesão ao tratamento medicamentoso anti-hipertensivo na fragilidade do idoso. Participaram do estudo 111 idosos hipertensos, usuários de um ambulatório de atenção secundária. Foram realizadas medidas da pressão arterial e do índice tornozelo-braço (ITB), índice de massa corporal, avaliação da adesão ao tratamento medicamentoso anti-hipertensivo através do Teste de Morisk-Green e dos critérios de fragilidade (perda de peso não intencional, fadiga, diminuição da força de preensão manual, lentidão de marcha e inatividade física). Idosos que apresentaram 3 ou mais critérios de fragilidade foram considerados frágeis, 1 ou 2 critérios foram considerados pré-frágeis e os que não apresentaram critério, não-frágeis. A média de idade foi de 73,4 ± 7,37 anos, sendo 85,6% dos idosos do sexo feminino. As médias da pressão arterial sistólica sentado e em pé foram de 129,96 ±20,46 mmHg e 139,37± 22,58 mmHg, respectivamente. A médias da pressão arterial diastólica sentada e em pé foram 68,12 ± 11,24 e 76,78 ± 10,91 mmHg. A média da pressão de pulso foi 61,84 ± 17,19 e do ITB foi de 1,10±0,10. A adesão ao tratamento medicamentoso foi de 56,7%. Foram considerados frágeis 13,5%, pré-frágeis 64% e não-frágeis 22,5% dos indivíduos. Houve diferença significativa entre os 3 grupos de fragilidade para as variáveis idade (p<0,001) e pressão arterial sistólica (p<0,041). Não foram encontradas diferenças significativas com relação ao índice tornozelobraço, índice de massa corporal e adesão ao tratamento medicamentoso. Maior faixa etária e maiores valores de pressão arterial sistólica foram encontrados em idosos hipertensos frágeis do que em idosos hipertensos não-frágeis. É necessário aprimorar o conhecimento sobre a relação entre doenças cardiovasculares e fragilidade para elaboração de estratégias de prevenção e controle de desfechos adversos nessa população / Abstract: Hypertension, peripheral arterial disease and other comorbidities, can potentiate the geriatric syndromes such as frailty. Although it is a modifiable risk factor for cardiovascular disease and even with evidence that antihypertensive treatment is effective, the percentage of blood pressure control is low due to poor adherence to treatment. Considering that these conditions are related to development of disabilities, decreased quality of life of older people and increased costs for health services, the objective of this study is to investigate the relationship between hypertension, cardiovascular risk and adherence to antihypertensive drug treatment in the frailty. The study included 111 hypertensive elderly users of an outpatient secondary care. There were performed blood pressure, ankle-brachial index and body mass index measurements, evaluation of adherence to antihypertensive drug treatment through the Morisk-Green test and frailty criteria (unintentional weight loss, fatigue, decreased grip strength, slowness of gait and physical inactivity). Elderly who presented three or more characteristics were considered frail, 1 or 2 characteristics were considered prefrail and none characteristics were not frail. The mean age was 73.4 ± 7.37 years, and 85.6% were women. As average systolic blood pressure sitting and standing were 129.96 ± 20.46 mmHg and 139.37 ± 22.58 mmHg, respectively. The average diastolic blood pressure sitting and standing were 68.12 ± 11.24 and 76.78 ± 10.91 mmHg. The average pulse pressure was 61.84 ± 17.19 and the ABI was 1.10 ± 0.10. Adherence to medication was 56.7%. 13.5% were considered frail, 64% pre-frail and 22.5% non-frail. There was significant differences among the 3 groups of frailty for age (p <0.001) and for systolic blood pressure (p <0.041). Significant differences were not found in the ankle brachial index, neither in body mass index nor in medication adherence. Higher age and higher systolic blood pressure were found in frail hypertensive elderly than in not frail hypertensive's elderly. It is necessary to improve the knowledge about the relationship between cardiovascular disease and frailty to develop strategies for prevention and control of adverse outcomes in this population / Mestrado / Gerontologia / Mestra em Gerontologia

Le vieillissement de la population mondiale s’accompagne de l’augmentation de la prévalence des maladies non transmissibles, dont certaines liées à l’athérosclérose. Les études épidémiologiques sur l’artériopathie oblitérante des membres inférieurs (AOMI) ont été majoritairement menées dans les pays occidentaux. Peu d’entre elles sont conduites dans les pays à faible et moyen revenu, comme les pays africains alors que la rapide transition socio-économique de ces pays entraîne une modification épidémiologique importante. Le programme EPIDEMCA (Épidémiologie des Démences en Afrique Centrale), enquête épidémiologique transversale multicentrique en population générale âgée de 65 ans et plus, a été mené en zones rurales et urbaines de deux pays d’Afrique Centrale: la République Centrafricaine (RCA) et la République du Congo (RDC), entre 2011 et 2012. Durant la première phase, l’enquête épidémiologique a permis de déterminer la prévalence de l’AOMI et d’analyser les facteurs de risque associés. L’AOMI a été définie par un Index de Pression Systolique (IPS) ≤ 0,9. Parmi les 1871 participants évalués sur le plan vasculaire, la prévalence de l’AOMI a été de 14,8% et atteignant 22,2% pour les sujets âgés de 80 ans et plus. Une prévalence plus importante de l’AOMI a été retrouvée dans les zones urbaines en RDC (20,7% versus 14,4% dans la zone rurale, p=0,0114). Cette différence n’a pas été retrouvée en RCA (11,5% urbain versus 12,9%, rural p=NS). Après ajustement à tous les possible facteurs confondants, des facteurs de risque associés avec l’AOMI ont été décrits : l’âge (OR: 1,03 ; p=0,0039), l’hypercholestérolémie (OR: 1,88 ; p=0,0034), le tabac (OR: 1,78 ; p=0,0026). Plus particulièrement, cette première étude en population générale ayant analysé spécifiquement le rôle de la dénutrition (Index de Masse Corporelle <18) dans l’AOMI met en évidence une association significative (OR: 2,09; p=0,0009) et ceci autant chez les hommes que chez les femmes (OR: 2,82; p= 0,0038 et respectivement OR: 1,75; p= 0,0492). Lors de la deuxième phase de l’étude, ayant permis la confirmation de l’atteinte cognitive, nous avons analysé l’association entre l’IPS et la présence des troubles cognitifs. La prévalence des troubles cognitifs s’est avérée être de 13,6%, plus importante chez les sujets avec IPS≤0,9 et IPS≥1,4 que chez les sujets avec 0,9<IPS<1,4 (20,1% et 17% versus 12%, p=0,0024). La présence des troubles cognitifs a été significativement associée avec l’âge (OR: 1,09; p<0,0001), le sexe féminin (OR: 2,36; p<0,0001), la consommation de tabac (OR: 1,78; p=0,0026) et l’IPS <0,90 (OR: 1,52; p=0,0359). Ce travail, s’inscrivant dans le cadre du programme EPIDEMCA, contribue à une meilleure connaissance de l’épidémiologie de l’AOMI sur le continent Africain. Il souligne la haute prévalence de cette pathologie, comparable aux pays occidentaux décrit les facteurs de risque spécifiques associés et met en évidence l’importance des outils de diagnostic de l’athérosclérose (IPS), fiables, peu coûteux et d’utilisation facile dans le dépistage des sujets à risque polyvasculaire. / With the aging of the global population, the prevalence of non-communicable, including cardiovascular, diseases is increasing. While epidemiological studies on peripheral artery disease (PAD) have been mainly conducted in high-income countries, a few have been carried out in low-and middle-income countries, including in Africa. EPIDEMCA (Epidemiology of Dementia in Central Africa) is a cross-sectional population-based study in rural and urban areas of two countries of Central Africa: Central African Republic (CAR) and the Republic of Congo (ROC). Overall, its aim was to investigate the health status in aging population in Central Africa, with a special focus on cognitive disorders, PAD (Ankle-Brachial Index (ABI) ≤0.90). and cardiovascular risk factors as well as their inter-relationship. The EPIDEMCA program was carried out, among people aged 65 years and over, between 2011 and 2012. Among 2002 subjects who agreed to participate, reliable demographic and vascular data were available in 1871 subjects.Overall, the prevalence of PAD was 14.8% reachting 22.2% after the age of 80. The prevalence was higher in ROC than in CAR (17.4% vs. 12.2%, p=0.0071) and in females than males (16.6% vs. 11.9%, p=0.0122). Higher rates of PAD were found in urban area in ROC (20.7% vs. 14.4% in rural area, p=0.0114), not in CAR (11.5% vs. 12.9%, p=ns). In the multivariate analysis, PAD significantly associated factors were described: age (OR: 1.03; p=0.0039), dyslipidemia (OR: 1.88; p=0.0034), smoking (OR: 1.78; p=0.0026), and more specifically undernutrition (OR: 2.09, p=0.0009). Undernutrition was still significantly associated with PAD after adjustment to all potential confounding factors in males as well as in females (OR: 2.82, p= 0.0038 respectively OR: 1.75, p= 0.0492). As epidemiological research on the implication of atherosclerosis in the development of cognitive impairment in general population is lacking in Africa, we focused on the role of ABI as an available marker of atherosclerosis, providing independent and incremental information on subjects’ susceptibility to present cognitive disorders.The prevalence of cognitive impairment among the study participants was 13.6%, higher in subjects with ABI≤0.9 and ABI≥1.4 than those with 0.9<ABI<1.4 (20.1% and 17% vs. 12%, p=0.0024). Cognitive impairment was significantly associated with age (OR: 1.09; p<0.0001), female gender (OR: 2.36; p<0.0001), smoking (OR: 1.78; p=0.0026) and low (≤0.90) ABI (OR: 1.52; p=0.0359). The EPIDEMCA program contributes to a better understanding of PAD in general African population. It highlights the the high prevalence of PAD on the African continent, describes specifically associated risk factors and underlines the importance of an available, inexpensive marker of atherosclerosis in order to detect risk populations in these countries.

O uso de robôs como auxiliares na reabilitação, tanto para ganho de função, como para auxiliar na realização de atividades, é encontrado na literatura em estudos envolvendo acidente vascular encefálico. Diversos dispositivos robóticos têm sido desenvolvidos ao longo da última década para oferecer treinamento sensório-motor direcionado para pacientes com doenças neurológicas, como acidente vascular encefálico, propiciando melhora no desempenho motor dos membros superiores nesta população. Poucos estudos são encontrados sobre o uso de robôs em lesão do plexo braquial ou lesão na medula espinhal. Além disso, há pouca produção nacional relacionada a esse tema. Esse trabalho objetivou-se avaliar o uso de um instrumento robótico, Robô MOREw, que foi desenvolvido pela Escola de Engenharia de São Carlos - EESC - USP com o intuito de facilitação e ganho nos movimentos de flexão e extensão de punho. Dessa forma, pretendia-se a verificação do funcionamento do robô como auxiliar de reabilitação através de testes clínicos e sua aplicabilidade com indivíduos que sofreram lesão do plexo braquial ou lesão na medula espinhal. A metodologia escolhida é de Projeto de Produto que utiliza como proposta a divisão do projeto em quatro fases, sendo estas: projeto informacional, projeto conceitual, projeto preliminar e projeto detalhado. Foi dado enfoque ao projeto detalhado em testes de laboratório e clínicos para verificação do funcionamento e aplicabilidade do robô com voluntários. O estudo foi composto por 2 fases: FASE 1 - Adequação do MOREw: 10 participantes sem comprometimentos nos membros superiores e sem lesões associadas verificaram o funcionamento do robô. Após isso, modificações necessárias foram efetuadas. FASE 2 - Aplicabilidade do MOREw: Teste com 5 participantes que apresentaram diminuição do movimento no Membro Superior, sendo 3 com lesão do plexo braquial e 2 com lesão na medula espinhal que jogaram por 30 minutos uma vez por semana, durante 12 semanas. Nos resultados notou-se que as adequações do robô MOREw foram de extrema importância para o funcionamento adequado do equipamento robótico utilizado por sujeitos com limitação dos movimentos de membros superiores, tanto em relação à ergonomia, funcionamento do jogo e possibilidades de ajustes em programas de reabilitação. Os sujeitos que fizeram uso por 3 meses referiram grande satisfação, motivação e demonstraram maior empenho na reabilitação com o auxílio robótico, que foram corroborados pelos testes funcionais que apresentaram discreta melhora em relação à Amplitude de Movimento e Força Muscular dos membros superiores, além da melhora na pontuação na Escala Específica do Paciente. Assim, MOREw é uma opção a ser utilizada na reabilitação com sujeitos com LM e LPB. / The use of robots as aid in rehabilitation to gain function or to assist in activities performance is found in the literature involving stroke. Several robotic devices have been developed over the last decade to provide sensory-motor training in patients with neurological diseases such as stroke, leading to improvement in motor performance of the upper limbs in this population. Few studies using robot assistance are found in injuries like brachial plexus (BPI) or spinal cord (SCI). In addition, there is little national production related to this topic. The aim of this work was to evaluate the use of a robotic instrument, Robot MOREw, which was developed by the Engineering School of São Carlos - EESC - USP with the purpose to facilitate and/or gain wrist flexion and extension movements. Thus, it was intended to verify the functioning of the robot as a rehabilitation aid through clinical tests, and its applicability with individuals who suffered BPI or SCI. The methodology chosen was the Project Product Design that consists of four phases: informational, conceptual, preliminary and detailed project. This study focuses on the detailed project, which was tested at laboratory as well as with volunteers in clinical trials to verify the robot applicability and operation. The study consisted of 2 phases: Phase 1 - Adequacy: 10 participants with no involvement in the upper limbs and without associated lesions verified the robot functionality. After that, changes were made to the equipment. Phase 2 - Applicability: Tested with 5 participants who had decreased movement in the Upper Limb, 3 with BPI and 2 with SCI, using it 30 min once a week for 12 weeks. It was noticed that the MOREw adjustments were of extreme importance for the correct functionality of the equipment that was used by clients with upper limb deficit movements, regarding ergonomics aspects, game functioning and rehabilitation programs adjustments. The clients who used it for 3 months reported great satisfaction, motivation and demonstrated greater commitment to rehabilitation with robotic assistance, confirmed by functional tests that showed a slight improvement in relation to the range of motion and muscular strength of the upper limbs, besides the improvement on the Patient Specific Scale. MOREw can be an option for BPI and SCI rehabilitation.

No description available.

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Deep brain stimulation (DBS) is a neurosurgical intervention now established for the treatment of movement disorders. For the treatment of chronic pain refractory to medical therapies, several prospective case series have been reported, but few centres worldwide have published findings from patients treated during the last decade using current standards of technology. This thesis seeks to survey the current clinical status of DBS for pain, investigate its mechanisms and their interactions with autonomic function, its clinical limitations and ablative alternatives. Presented first is a review of the current status of analgesic DBS including contemporary clinical studies. The historical background, scientific rationale, patient selection and assessment methods, surgical techniques and results are described. The clinical outcomes of DBS of the sensory thalamus and periventricular / periaqueductal grey (PAVG) matter in two centres are presented including results from several pain and quality of life measures. A series of translational investigations in human subjects receiving DBS for pain elucidating mechanisms of analgesic DBS and its effects upon autonomic function are then presented. Single photon emission tomography comparing PAVG, VP thalamus and dual target stimulation is described. Somatosensory and local field potential (LFP) recordings suggesting PAVG somatotopy are shown. ABPM results demonstrating changes with PAVG DBS are given and Portapres studies into heart rate variability changes with ventral PAVG DBS are detailed. Investigations using naloxone are then shown to hypothesise separate dorsal opioidergic and ventral parasympathetic analgesic streams in the PAVG. Finally, cingulotomy in lung cancer to relieve pain and dyspnoea results are discussed in the context of altering pain and autonomic function by functional neurosurgery. Pain and autonomic interactions and mechanisms in deep brain surgery for pain are then discussed alongside its limitations with proposals made for optimising treatment and improving outcomes.

The aim of the study was to examine adolescents’ experiences of having brachial plexus birth palsy, which is impaired arm function due to a birth injury. Psychosocial focal points were how the adolescent’s experience their lives concerning studies, spare time activities and relationships, experiences of limitations in comparison to their peers, and how they experience health care. Eight adolescents who had surgery of the injury were interviewed. Through qualitative phenomenological analysis the following meaning units were identified: ‘Me and others’; ‘Professional medical contacts and experiences’; and ‘Adjustment and strategies to solutions and obstacles’ with essences ‘Disabled or have a disability’; ‘Then and now’ and ‘Lack of references’. The result showed that the adolescents did not identify themselves as disabled, and did not focus on their arm, but wished for improved physical function. They had good support from health care, although wanted more follow-ups and more aimed information. They had adjusted well to their injury, but did not have any comparisons as they had their injury since birth. Understanding the experiences adolescents with BPBP have is essential for advancing the care of these individuals. Further research is necessary regarding the experience people with this injury have. / Syftet med studien var att studera ungdomars erfarenheter av att leva med en plexusskada, det vill säga nedsatt armfunktion på grund av en förlossningsskada, ur ett psykosocialt perspektiv med fokus på hur ungdomarna upplever sina liv beträffande studier, fritid och relationer, upplevelser av begränsningar i jämförelse med generationskamrater på grund av skadan, samt erfarenheter av sjukvården. Åtta ungdomar som opererats för skadan intervjuades. Genom kvalitativ fenomenologisk analys kunde följande meningsbärande enheter urskiljas: ’Jag och andra’; ’Professionella kontakter och erfarenheter’ och ’Anpassningar och strategier till lösningar och hinder’ där ’Funktionshindrad eller ha funktionshinder’; ’Då och nu’ samt ’Brist på referenser’ var gemensamma samtalsämnen. Resultatet visade att ungdomarna inte betraktade sig som handikappade, de fokuserade inte på sin arm i sin vardag, och önskade klara av mer fysiska aktiviteter. De upplevde gott stöd från sjukvården, men önskade uppföljningar och mer riktad information. De hade anpassat sig till skadan, men upplevde att de inte kunde jämföra med andra eftersom de haft skadan sedan födseln. Att kunna förstå ungdomars erfarenheter av att leva med en plexusskada, är nödvändigt för att förbättra vården och bemötandet för dessa individer.

Les prothèses myoélectriques modernes peuvent être dotées de plusieurs degrés de liberté ce qui nécessite plusieurs signaux musculaires pour en exploiter pleinement les capacités. Pour obtenir plus de signaux, il nous a semblé prometteur d'expérimenter si les 6 compartiments du biceps brachial pouvaient être mis sous tension de façon volontaire et obtenir ainsi 6 signaux de contrôle au lieu d'un seul comme actuellement. Des expériences ont donc été réalisées avec 10 sujets normaux. Des matrices d'électrodes ont été placées en surface au-dessus du chef court et long du biceps pour recueillir les signaux électromyographiques (EMG) générés par le muscle lors de contractions effectuées alors que les sujets étaient soit assis, le coude droit fléchi ~ 100 ° ou debout avec le bras droit tendu à l'horizontale dans le plan coronal (sur le côté). Dans ces deux positions, la main était soit en supination, soit en position neutre, soit en pronation. L'amplitude des signaux captés au-dessus du chef court du muscle a été comparée à ceux obtenus à partir du chef long. Pour visualiser la forme du biceps sous les électrodes l'imagerie ultrasonore a été utilisée. En fonction de la tâche à accomplir, l'activité EMG a était plus importante soit dans un chef ou dans l'autre. Le fait de pouvoir activer préférentiellement l'un des 2 chefs du biceps, même si ce n'est pas encore de façon complètement indépendante, suggère que l'utilisation sélective des compartiments pourrait être une avenue possible pour faciliter le contrôle des prothèses myoélectriques du membre supérieur. / The latest myoelectric prostheses have several degrees of freedom and therefore require a large number of myoelectric signals to fully exploit their capabilities. Muscle compartments, which are intra-muscular subdivisions innervated by an individual muscle nerve branch, can be exploited to provide additional independent muscle control sites to operate such prostheses. This research presents a work to investigate the activation of the 6 biceps brachii compartments in healthy subjects to see if they have the ability to activate those compartments voluntarily. Therefore, electromyographic (EMG) signals were recorded from an array of seven and ten pairs of equally spaced surface electrodes positioned across the short and long head of the biceps of ten healthy subjects. The EMG signals are collected in two positions: 1) with the subject seated, right elbow flexed ~100°, and 2) with the subject standing with the right arm extended horizontally in the coronal plane (90°shoulder abduction). In both positions, the hand is either fully supinated, neutral, or fully pronated. The average root mean square value of the EMG signals obtained from the pairs of electrodes positioned over the short head are compared with the average obtained for the other pairs placed over the biceps long head. Ultrasound imaging also used to visualize the long and short heads of the biceps in flexed and extended arm while the hand was in different postures. Depending on the task to be accomplished, activity was larger in one head or in the other. Being able to activate either head of the biceps, while not yet completely independently, suggests that the selective use of compartments could be a possible avenue for controlling upper limb myoelectric prostheses.