Made available in DSpace on 2013-08-07T19:09:00Z (GMT). No. of bitstreams: 1 000449212-Texto+Parcial-0.pdf: 2913871 bytes, checksum: 1b5c92db8b6cb9f3e32d917f83605009 (MD5) Previous issue date: 2013 / The Montreal-Toulouse Language Assessment Battery (MTL-BR) has been adapted, extensively revised and redesigned from French to Brazilian Portuguese to assess components of spoken and written language, praxis and mathematical ability after brain injury. The aim of this thesis was to collect evidence toward the validity and reliability of this instrument, verifying the role of age, education, aphasia and unilateral brain injury on performance in the MTL-BR Battery through three empirical studies. The first study aimed at analyzing the effects of age and education on the performance of 463 healthy adults in the MTL-BR, so as to contribute to normative data. Mean group scores were compared using a two-way ANOVA with post-hoc Bonferroni tests. Descriptive analyses for the normative data were also conducted. The second study looked for evidence toward the construct/convergent validity and reliability of the instrument in clinical and non-clinical adults. Test-retest reliability (correlation and repeated measure) and internal consistency (Cronbach’s alpha) were analyzed. Validity was analyzed by correlating performance across subtests. The third study investigated criterion-related validity. One hundred and four adults divided into clinical (with three groups: left hemisphere damaged – LHD with aphasia, LHD without aphasia and right hemisphere damaged -RHD) and control (healthy adults) groups participated in this study. Performance was compared between groups with a one-way ANCOVA with depression as a covariate, and post-hoc Bonferroni tests. Both education and age influenced performance in the MTL-BR Battery, but the effect of education was more important.The MTL-BR Battery presented adequate indicators of reliability and validity, adequate internal reliability and testretest correlations, as well as satisfactory correlations with similar instruments. As expected, patients with aphasia had lower scores than controls on all tasks except in the spoken word comprehension subtask. The LHD group without aphasia underperformed the control group only in phonological verbal fluency. There were no significant differences in any subtasks between LHD patients without aphasia and RHD, or RHD versus controls. The findings of all three studies suggested that the MTL-BR has adequate external validity. The data obtained contribute to clinical assessment of aphasia in Brazil and to reflections upon the implications of linguistic-communicative changes on diagnosis and rehabilitation. / A Bateria Montreal-Toulouse de Avaliação da Linguagem (Bateria MTL-BR) é um instrumento adaptado e amplamente revisado e reformulado do Francês para o Português Brasileiro para avaliar o funcionamento de diferentes componentes de linguagem oral e escrita, de praxias e de calculias, após lesão cerebral. Esta tese objetivou buscar evidências de validade e de fidedignidade verificando-se o papel da idade, da escolaridade, da afasia e da lesão cerebral unilateral no desempenho da MTL-BR por meio de três estudos empíricos. O primeiro estudo visou a analisar os efeitos de idade e da escolaridade no desempenho linguístico de 463 indivíduos adultos neurologicamente saudáveis na Bateria MTL-BR, procurando contribuir com dados normativos. Os escores médios foram comparados entregrupos por uma two-way ANOVA, com procedimento post-hoc Bonferroni, além de análises descritivas para normas. O segundo estudo avaliou evidências de validade de construto/convergente e de fidedignidade do instrumento em amostras clínicas e neurologicamente saudáveis. A fidedignidade foi analisada a partir das técnicas teste-reteste (correlação e medidas repetidas) e consistência interna (alpha de Cronbach). Quanto à validade, analisaram-se correlações entre desempenhos de diferentes tarefas de exame da linguagem. O terceiro estudo averiguou evidências de validade com relação a critérios externos clínicos. Participaram deste estudo 104 adultos, divididos em quatro grupos: clínicos (com três subgrupos, indivíduos com lesão de hemisfério direito - LHD, lesão de hemisfério esquerdo - LHE - sem afasia e LHE com afasia) e controle (sem lesão neurológica).Compararam-se desempenhos médios entre grupos pelo teste ANCOVA One-way, tendo o nível de depressão como covariante, com post-hoc Bonferroni. A escolaridade e a idade influenciaram no desempenho da Bateria MTL-BR, sendo que o efeito da educação foi mais importante. A Bateria MTL-BR apresentou adequados indicadores de fidedignidade e validade, adequadas confiabilidade interna e correlações teste-reteste, além de ter boa correlação com o desempenho de instrumentos semelhantes. Conforme esperado, pacientes com afasia apresentaram escores inferiores aos controles em todas as tarefas, exceto na subtarefa de compreensão oral de palavras. O grupo LHE sem afasia apresentou desempenho inferior ao grupo controle apenas na tarefa de fluência verbal fonológica. Os grupos clínicos LHD e LHE sem afasia não diferenciaram entre si em nenhuma tarefa, assim como LHD de controles. Os achados dos três estudos sugeriram índices de validade por relação com variáveis externas. Os dados obtidos contribuem para avaliação clínica de afasiologia brasileira, para a reflexão sobre implicações diagnósticas e de reabilitação de alterações linguístico-comunicativas.

Orientador: Donizeti Cesar Honorato / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T13:51:18Z (GMT). No. of bitstreams: 1 Mota_LucasBrino_M.pdf: 1462710 bytes, checksum: b2e1fbb17a6de58bc91748c2bcb073f8 (MD5) Previous issue date: 2009 / Resumo: A escala de avaliação de Acidente Vascular Cerebral (AVC) da Chedoke McMaster (CM) foi desenvolvida baseada nos estágios de recuperação motora de Brunnstrom, 1970 e avalia o paciente hemiplégico em duas partes: Inventário do comprometimento Físico e Inventário de capacidades. O primeiro determina a presença e a gravidade de incapacidades físicas comuns em seis dimensões: dor no ombro, função do braço, mão, perna, pé e tronco. O segundo avalia as atividade funcionais e é divida em dois índices: função motora grossa e caminhada. O objetivo do presente estudo foi elaborar uma versão brasileira da escala de avaliação de AVC da Chedoke McMaster e avaliar a concordância inter e intra-examinador, a validade concorrente e a consistência interna. Realizou-se a tradução e adaptação cultural, treinamento dos avaliadores e pré teste. Posteriormente a escala foi testada em 26 pacientes que apresentavam hemiplegia secundária ao AVC. O nível de concordância inter-examinador e intra-examinador foi excelente (CCI>0,75; p<0,001) para todos os itens e apresentou alta consistência interna (0,79). O item total da Escala de Fugl Meyer (EFM) mostrou forte correlação com o item total do instrumento de medida estudado (r=0,715; p=0,001), bem como com o inventário de capacidades da CM com a Escala de Equilíbrio de Berg (EEB) (r=0,943; p<0,001), Índice de Barthel (r=0,919; p<0,001) e Medida de Independência Funcional (MIF) (r=0,717; p<0,001). Houve alta consistência interna para todos os itens com exceção do domínio ombro, este apresentou valor inferior a 0,4. Houve efeito teto para o domínio ombro e efeito solo para mão, braço e ombro. O presente instrumento traduzido e adaptado apresentou concordância assim como sua versão original, mostrou-se de fácil aprendizagem e aplicabilidade, além de avaliar o paciente em toda sua abrangência física, especialmente no desempenho de suas funções e não apenas na sua incapacidade física / Abstract: The Chedoke McMaster Assessment Stroke (CMAS) was developed based on the Brunnstrom motor recovery stages, and it is a two part measure consisting of a Physical Impairment Inventory and a Disability Inventory. First the impairment inventory determines the presence and severity of common physical impairments in six dimensions: shoulder pain, postural control, Arm, Hand, Leg and Foot; according to the seven stages of motor recovery (Brunnstrom). Then the Disability Inventory measures functional outcomes, and is made up of two indices, the gross motor function index and the walking index. The objective of the study was to develop a Brazilian version of the Chedoke McMaster Assessment Stroke and to evaluate the intra rater and inter rater reliability and the validity of the internal consistence of this version scale. The translations, cultural adaptations, evaluator training and pre-test were performed, and then a test evaluation of 26 stroke subjects. There was a high level of intra rater and inter rater reliability (CCI>0,75; p<0,001) and high internal consistency (0,79) for all the measures of the scale. The total Fugl-Meyer score showed strong correlation with the total score of the Chedoke McMaster Stroke Assessment (r= 0,715; p=0,001). The impairment and disability inventory of the CM showed strong correlation with the Berg Balance Scale (r=0,943; p<0,001), Barthel Index (r=0,919; p<0,001) and Functional Independence Measure (r=0,717; p<0,001). There was also a high internal consistency for all the dimensions of the CM, with exception of the shoulder dimension, that showed a value lesser than 0,4. There was a ceiling effect for the left shoulder dimension and a floor effect for the hand, arm and shoulder. The adaptation and translation of the CM scale in the present study showed agreement with the original version, demonstrated to be easy of learn and apply, and also to be able to evaluate the patient physical condition in a complete way, not only the physical impairment but also its functional performance / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

La disfagia es un problema común en los pacientes tras un accidente cerebro vascular (ACV). En la presente investigación se evaluaron 14 pacientes con disfagia neurogénica producto de ACV de distintos recintos hospitalarios de la Región Metropolitana, mediante el Protocolo de Evaluación de la deglución de González y Toledo con los objetivos de: (1) describir clínicamente el proceso de deglución en pacientes vasculares agudos que presentan disfagia y (2) relacionar las características clínicas del proceso de deglución de pacientes vasculares agudos con variable neurológicas del cuadro y variable de alimentación.

When the research, which forms the basis of this thesis was started in 1979, the theoretically attractive situation of transient focal cerebral ischaemia simulating a cerebral vessel occlusion followed by re-vascularization, had not been specifically investigated with barbiturate treatment. Cerebral infarction is progressive and evolves over hours, proceeding from ischaemia and functional loss to cell death. Sundt et al (1969), Crowell et al (1970), Hayakawa and Waltz (1975). Complete recovery is possible if re-vascularization is instituted in time. This time interval depends on the regional cerebral bloodflow during the period of the vessel occlusion and this bloodflow is provided by the collateral circulation. Thus, whether infarction results and the extent of it, becomes a factor of the period of ischaemia and the collateral circulation present. Dujovny et al (1976), Morawetz et al (1978), Ojeman et al (1979), Kieck and Crowell (1979), Jones et al (1981). This ischaemic period may vary tremendously from less than an hour to as much as 5 hours and occlusion times of up to an hour can be tolerated without infarction at very low regional cerebral bloodflow levels. Morawetz et al (1978), Kieck and Crowell (1979), Jones et al (1981). In the clinical situation there would be an obligatory delay from the onset of ischaemia to the institution of barbiturate treatment and completion of re-vascularization. Treatment during this period would thus be a major contribution if it could afford protection so as to allow restitution of cerebral bloodflow before irreversible infarction took place. The South African Vervet monkey was chosen for the investigation of the effect of barbiturate treatment on transient focal cerebral ischaemia in a model simulating the clinical event. In this experiment pentobarbital therapy would be delayed for 1 hour to provide for the expected delay that would occur from the onset of ischaemia to the institution of treatment. Similarly, ischaemia was to last 4 hours to allow for a minimum time interval necessary to complete the re-vascularization. It was also borne in mind that many stroke patients would be older people; the barbiturate dose of 30mg/kg would be such as to induce prolonged coma but not major cardiovascular disturbances with a fall in blood pressure and/or cardiac arrest.

Antecedentes y propósito.- La hiperglicemia postictal puede encontrarse hasta en un 28% de los pacientes sin historia de diabetes y diversos estudios reportan una morbimortalidad mayor que en los normoglicémicos. Nuestro objetivo fue determinar si la hiperglicemia incrementa la morbimortalidad en los pacientes no diabéticos con ECV aterotrombótica aguda. Métodos.- Se realizó un estudio prospectivo, analítico y longitudinal en pacientes no diabéticos, edad entre 40 a 80 años de edad, atendidos en el Hospital Nacional Daniel A. Carrión con diagnóstico de ECV aterotrombótica aguda a los cuales se les realizó seguimiento hasta los 3 meses de evolución. Resultados.- Reunieron los criterios para el estudio 10 pacientes, de los cuales el 40% cursaron con hiperglicemia en la fase aguda. No existieron fallecidos en ninguno de los grupos. En los controles con la escala NIHSS a los 90 días (tercer control) el 30% presentó evolución favorable (10% hiperglicémicos y 20% normoglicémicos); pero, sin diferencia estadística significativa. Conclusiones.- La hiperglicemia en la fase aguda de la ECV isquémica aterotrombótica en pacientes no diabéticos no incrementa la morbimortalidad hasta los 3 meses de evolución. Sin embargo, es necesario considerar que la reducida muestra estudiada no permite plantear conclusiones generalizadas. / Tesis de segunda especialidad

INTRODUCTION: Myocardial infarction causes parasympathetic dysfunction in cardiovascular tissue, where central parasympathetic drive decreases but local acetylcholine levels are unchanged. The muscarinic acetylcholine receptor M3 (AChM3R) is shown to have mediating effects in cardiac tissue and vasculature, such as regulation of heart rate and vasodilation of coronary arteries. The objective of this study is to determine the association between AChM3R levels in the heart wall and in the coronary vasculature with self-reported disease states from cadaver donor records. METHODS: Biopsies of the left anterior descending (LAD) artery and the underlying anterior interventricular septum (AIVS) were taken from 14 cadavers. A 5 mm biopsy of the LAD and its underlying AIVS were harvested 2.54-3.81cm from the bifurcation point of the left coronary artery, depending on the tissue integrity of the cadaver specimen. The tissues were immunostained for AChM3R (CHRM3 NB100-58975 at 1:2000) and visualized using a DAB chromogen. Slides were digitally scanned into a virtual image at 20x using the Motic Easyscan (Motic, Inc.). Images were segmented for tunica media and myocardium using Adobe Photoshop CS (Adobe, Inc.). We developed code in Python to calculate the strong positive and positive staining of the tissues. The number of pixels stained was normalized to the tissue area. The donors from which tissue was biopsied were classified into cardiovascular, cerebrovascular, Alzheimer’s disease dementia (AD), or both cerebrovascular and AD disease categories based on self-reported donor declarations. We used SPSS (v27, IBM, Inc.) to run a Pearson correlation to determine the association of staining positivity in the anatomical regions and a MANOVA to determine significant differences in the amount of pixel positivity in the tunica media and myocardium as a function of disease classification. RESULTS: Strong positive and positive staining of the myocardium were not correlated with strong positive in the tunica media. There was a significant positive relationship between strong myocardium staining and positive tunica media staining (r =.727, n=14, p=.003) as well as positive myocardium and positive tunica media staining (r=.674, n=14, p=.008). There was no significant difference between the amount of AChM3R staining and disease classification. CONCLUSIONS: The lack of correlation between strong positive in the myocardium and positive and strong positive in the tunica media suggests that the AChM3R state in the heart wall is independent of changes in the AChM3R of coronary vascular smooth muscle. However, significant correlation between strong positive in the myocardium and positive in the tunica media indicates that changes in AChM3R in the myocardium could be dependent on the presence of a baseline amount of AChM3R in the coronary vascular smooth muscle. Categorization of donor disease states may be too broad to provide statistical significance. Many donors reported co-morbid diseases, which could have affected the influence of cardiovascular disease and dementia on AChM3R modulation. These findings highlight that interventions targeting parasympathetic dysfunction of coronary vasculature may leave the underlying heart wall unaffected. Future studies should consider cardiovascular disease diagnoses to assess AChM3R distribution in the heart wall and coronary vasculature.

Chang Anne Marie. / "April 1999." / Thesis (Ph.D.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (p. 245-280). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Thesis (Ph. D.)--University of Washington, 1984. / Vita. Bibliography: leaves [124]-128.

Stroke is the third leading cause of death and survivors suffer motor impairments. The rodent sensorimotor system is similar to the human's, making rodents a good model to study the effects of stroke. Transgenic technology makes the mouse a desirable stroke model, however, there are few behavioural tests to assess behavioural outcome. This thesis evaluates mice subjected to permanent or temporary occlusion focal motor cortex strokes in a skilled reaching task. The first experiment documents changes in skilled movements in mice with a permanent occlusion focal motor cortex stroke. The second experiment is identical but uses a temporary occlusion focal motor cortex stroke. The third experiment compares the two strokes. The results indicate permanent occlusion mice suffer great impairments, and a larger injury, than temporarily occluded animals. The mice with the largest insults were most impaired. Mice make an excellent behavioural and genetic model for studying motor system stroke. / viii, 115 leaves : ill. ; 29 cm.

The purpose of this thesis is to describe the organization of the movements of skilled reaching. Our knowledge of reaching behaviour has been limited to an understanding of specific actions. Results from this thesis describe how reaching is the product of interactions of various parameters that assemble in an integrative way in ontogeny, yet can become dismantled on one level, or generally, throughout multiple levels of what constitutes the behaviour after stroke in adults. These findings demonstrate that skilled reaching constitutes motor parameters that may not be visible in a healthy adult, but that function through development, and by inhibitory systems in adults, to create a smooth and finely articulated action. An examination of the movement patterns of reaching within the full context of the behaviour can be applied to therapeutic strategies for motor disorders and, most importantly, deepen our understanding of the relations between reaching and cognition. / xiii, 254 leaves : ill. (some col.) ; 29 cm