Thesis (M.S.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 44 pages. Includes Vita. Includes bibliographical references.

Thesis (M.Sc.)--York University, 2005. Graduate Programme in Kinesiology and Health Science. / Typescript. Includes bibliographical references (leaves 46-52). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url%5Fver=Z39.88-2004&res%5Fdat=xri:pqdiss &rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR11898

Made available in DSpace on 2013-08-07T19:04:33Z (GMT). No. of bitstreams: 1 000438586-Texto+Completo-0.pdf: 851444 bytes, checksum: 4403bec36e79f61219a752dde80a37db (MD5) Previous issue date: 2012 / Introduction: Spasticity is an incapacitating condition resultant from central nervous system injury such as the cerebral vascular accident, commonly known as stroke (STK). It is usually associated with hypertony and with a reduction in skeletal muscle force production. This condition may generate imbalance between antagonistic muscles at the ankle joint, which can be evaluated by torque ratios (TR). Purpose: to compare the dorsiflexor/plantarflexor (DF/PF) torque ratios between a post-stroke hemiparetic spastic group (STK) and a healthy control group (CON) and to evaluate STK group functionality. Methods: an isokinetic dynamometer was used to obtain maximal PF and DF torques at an angular velocity of 60°/s of hemiparetic spastic subjetcs (59. 7 ± 13. 74 years of age) and twelve healthy subjects (59. 0 ± 13. 64 years of age). TR were obtained through the division between the maximal DF and maximal PF torques. The STK group had their functionality evaluated through the Berg Balance Scale (BBS), the Barthel Index (BI), and the Timed Up and Go test (TUG). A Mann Whitney U test was used for the within group (spastic x non-spastic limbs) and for the between group (spastic x control) comparisons of the scale results and TR, whereas an independent T-test was used for the between groups comparison of the anthropometric variables (p ≤0. 05).Results: The within STK group comparison revealed higher TR in the spastic side compared to the non-spastic contralateral side (0,81±0,25 and 0,43±0,41 respectively; p=0. 01). The inter-group comparison revealed that the TR of the spastic side of the STK group was higher compared to the dominant side of the CON group (0,81±0,25 and 0,30± 0,10 respectively; p≤0. 01). No differences were observed for the TR between the non-spastic side of the STK group and the dominant side of the CON group (0,43±0,41 and 0,30± 0,10 respectively; p=0. 56). In addition, no changes in functionality were observed in the STK patients. Discussion: These results indicate that both limbs of the STK group show muscle imbalance, which might be explained by the smaller PF torque in both limbs, resulting on an elevated TR. The elevated TR found in the CON group is probably related to the fact that all subjects were sedentary. The STK group showed normal values for functionality, suggesting that the time post injury and the spasticity degree probably influence the results of these scales. Conclusion: Muscle imbalance is present in both lower limbs of post-STK patients, although the TR are more affected in the spastic side. / Introdução: a espasticidade é uma condição incapacitante decorrente de lesões do sistema nervoso central como o acidente vascular cerebral (AVC), podendo estar associada com a hipertonia e diminuição da força nos músculos. Tal condição pode gerar desequilíbrios entre as musculaturas da articulação do tornozelo, podendo estes serem avaliados pelas razões de torque. Objetivos: avaliar a funcionalidade e comparar as razões de torque (RT) dos flexores dorsais e plantares (FD/FP) entre indivíduos com hemiparesia espástica decorrente de AVC isquêmico e indivíduos controle.Métodos: participaram do estudo 9 indivíduos com hemiparesia espástica (59,7 ± 13,74 anos) e 12 indivíduos controles (59,0 ± 13,64 anos). As escalas funcionais utilizadas foram: escala modificada de Ashworth, índice de Barthel, escala de Berg e o teste Timed Up Go. Um dinamômetro isocinético foi utilizado para a obtenção do torque máximo em uma velocidade angular de 60°/s. Para a obtenção das razões, o torque máximo dos FD foi dividido pelo torque máximo dos FP. Foi utilizado o Teste U de Mann Withney para comparação intra e entre grupos e Teste T independente para comparação das medidas antropométricas entre os grupos (p ≤0,05).Resultados: na comparação intra-indivíduos, houve uma diferença significativa entre as médias das RT no grupo AVC (lado afetado 0,81±0,25 e não afetado 0,43±0,41) (p=0,01). Para a comparação inter-grupos, o lado afetado 0,81±0,25 do grupo AVC foi significativamente diferente do lado dominante 0,30±0,10 dos indivíduos controle (p≤0,01). Não houve diferença significativa entre o lado não afetado do grupo AVC 0,43±0,41 e o lado dominante do grupo controle 0,30± 0,10 (P=0,56). Não houve alterações da funcionalidade dos indivíduos do grupo AVC. Discussão: estes resultados indicam que tanto a perna acometida como a contralateral do grupo AVC apresentam desequilíbrios musculares podendo ser explicado pelo menor torque produzido pelos FP, ocasionando uma RT aumentada. O grupo controle também apresentou RT alterada, possivelmente por serem sedentários. Quanto à funcionalidade, o grupo AVC apresentou resultados de normalidade, sugerindo que o tempo de lesão e o grau de espasticidade podem influenciar nestas variáveis. Conclusão: os desequilíbrios musculares estão presentes em ambos os membros inferiores no grupo AVC, porém as RT são mais alteradas no hemicorpo espástico.

中風後抑鬱症（ Post-strok Depression, PSD ）的發生率，在中風後患者中佔有較大比例，嚴重影響患者的康復。國外研究結果顯示中風後抑鬱症的發病率為28%-56%而國內臨床相關文獻提示中風後抑鬱的患病率大致為20% - 50%。臨床中存在有許多繼發於中風的抑鬱患者，診療未受到關注的現狀。而一些接受治療的病人，也因長期口服抗抑鬱藥導致副作用愈發突出。與此同時，針灸治療抑鬱的臨床優勢已經得到國內外醫學界的重視與肯定。本文著重以近10 年來針灸治療中風後抑鬱症的文獻為主進行研究，總結關於該病因病機及有特色針灸療法的最新研究進展，歸納選穴處方的規律特點，進而在已有研究基礎上融人自己的見解，對於PSD 這種身心疾病的治療提出相關值得探討的問題與對今後研究的展望。新近的國內外研究提示，在針灸治療中風後抑鬱領域目前主要有毫針針刺和特種針法，並結合電針、配合藥物以及心理健康教育等方法，可以促進中風後患者抑鬱情緒的調整，且一定程度上也加強其他肢體功能以及神經功能的康復。同時針刺在治療的臨床研究方面也已取得較大進展，部分實驗已設立自身前後對照研究及其他藥物或針刺對照比較觀察，在診斷及評定療效標準時使用了量表及統計分析，增強了療效的可信度及可比性。一些課題也已進入實驗室研究，從神經遞質、神經內分泌方面探求針刺治療PSD 的機制，並取得一定的進展。本研究得出今後應該加強隨機大樣本對照的前瞻性設計實驗的結論，認為中風後抑鬱症的臨床分型、穴位配伍、針刺手法、刺激量大小以及療效評價等方面，均將成為針灸治療本病的繼續研究之探索方向。

Made available in DSpace on 2013-08-07T19:09:03Z (GMT). No. of bitstreams: 1 000440217-Texto+Parcial-0.pdf: 692116 bytes, checksum: abbec9d9fd8c250126a9250a789fb232 (MD5) Previous issue date: 2012 / Communication abililities are often impaired in patients with right hemisphere damage (RBD). This dissertation investigates the profile of cognitive and communication processing following a RBD. In addition, it characterizes neural correlates of brain reorganization of RBD case by means of neuropsuchological assessment and functional magnetic resonance imaging (fMRI). Thus, the first study included 39 adults with RBD and 39 healthy controls, evaluated by the Brazilian Brief Neuropsychological Assessment Battery NEUPSILIN. The performance of the groups was compared by ANCOVA, as well as the frequency of deficits in LHD group was calculated. RBD group showed poorer performance on visual perception, recognition memory, arithmetic and written language processes. There is evidence that brief neuropsychological tools can be useful for the initial diagnostic hypotheses of cognitive functioning within the RBD. The second study included 50 adults with RBD, 25 adults with LBD (clinical control) and 50 healthy controls, examined by the Montreal Communication Evaluation Battery, abbreviated version. Adults with RBD showed an inferior performance compared to healthy controls in 89% of the tasks (one-way ANOVA). No differences were observed between adults with RBD and LBD.The results suggest evidence of hemispheric specialization (emotional prosody and lexical-semantic) and cooperation (discursive and pragmatic-inferential). The third study evaluated an adult with RBD (case CR) and a matched healthy control by means of a neuropsychological battery and an fMRI task of phonemic and semantic verbal fluency. CR showed different areas of activation in comparison to healthy control, suggesting an increased demand for bilateral activation towards a functional reorganization. This study presents initial evidence of brain reorganization after RBD for lacunar infarction. / As habilidades comunicativas frequentemente encontram-se alteradas em pacientes com lesão de hemisfério direito (LHD). Em função disso, esta dissertação, composta por quatro estudos, busca investigar o perfil de habilidades comunicativas e cognitivas pós-LHD e de caracterizar correlatos neurais de reorganização cerebral de um caso pós-LHD a partir de avaliação por ressonância magnética funcional (fMRI). Dessa forma, o Estudo 1 contou com 39 adultos com LHD e 39 controles saudáveis, avaliados pelo Instrumento de Avaliação Neuropsicológica Breve NEUPSILIN. O desempenho dos grupos foi comparado através de ANCOVA, assim como a frequência de déficits do grupo LHD foi calculada. O grupo com LHD apresentou pior desempenho em percepção visual, memória de reconhecimento, habilidades aritméticas e linguagem escrita. Há indícios de que recursos de avaliação neuropsicológica breve podem ser úteis para a formulação inicial de hipóteses diagnósticas do funcionamento cognitivo no quadro de LHD. O Estudo 2 contou com 50 adultos com LHD, 25 adultos com lesão em hemisfério esquerdo (LHE) (controle clínico) e 50 adultos neurologicamente preservados (controle saudável) examinados com a Bateria Montreal de Avaliação da Comunicação, versão abreviada. Na comparação entre grupos por One-way ANOVA, os adultos com LHD diferenciaram-se significativamente dos controles saudáveis em 89% das tarefas.Não foram observadas diferenças entre adultos com LHD e com LHE. Os resultados sugerem evidências de especialização (prosódia emocional e léxico-semântico) e cooperação hemisférica (discursivo e pragmático-inferencial). No Estudo 3 participaram um adulto com LHD (caso CR) e um controle saudável que foram avaliados por uma bateria neuropsicológica e por um protocolo de fluência verbal fonêmica e semântica em fMRI, com uma tarefa de evocação de meses (controle). CR demonstrou diferentes áreas de ativação em comparação ao controle saudável, sugerindo maior demanda de ativação bilateral para sua reorganização funcional. Esse estudo apresenta evidências iniciais de reorganização cerebral pós-LHD por infarto lacunar.

Abstract Depression is a common consequence of stroke and it is known to be associated with deterioration of quality of life. However, only limited information is available on the relationships between depression and communicative and cognitive disorders. Moreover, the present knowledge of the determinants of the domains of quality of life is limited, and little is known of e.g. the changes in sexual behaviour of stroke patients and their spouses. This prospective study was carried out to evaluate the prevalence of post-stroke depression and aphasia and to study their interrelationships and neuropsychological and functional correlates. The particular aim of the study was to investigate the domain-specific quality of life, and to assess its clinical and sociodemographic correlates, and to study the impact of stroke on the sexual functions of stroke patients and their spouses. The study consisted of 156 first-ever stroke patients. Depression was diagnosed in 53% of the patients at 3 months and in 42% of the patients at 12 months post-stroke according to DSM-III-R-criteria. One third of the patients were aphasic, 70% of them at 3 months and 62% at 12 months after stroke suffering from depression. Among the aphasic patients the prevalence of major depression increased from 11% to 33% during the 12 months follow-up. There was an association between post-stroke depression and cognitive impairment, the domains most likely to be defective being memory, non-verbal problem solving, and attention and psychomotor speed. The non-verbal neuropsychological test performance in the aphasic patients was significantly inferior to that of the patients with dominant hemisphere lesion without aphasia. The quality of life of the patients was low at 3 months after the stroke, and it did not improve during the follow-up of a year. The test domains most often impaired were Physical functioning, Physical role limitations, Vitality and General health. Depression, although mostly minor, and being married emerged as significant independent contributors to low score value of Vitality and Physical role limitations. All the analyzed aspects of sexuality were commonly decreased as a consequence of stroke both in the patients and their spouses. Nocturnal erections were impaired in 21 (55%) of the male patients. The present results demonstrate that more than half of the patients after stroke suffer from depression and the frequency of major depression seems to increase over time, especially among the aphasic patients. Both depression and aphasia increase the liability of cognitive deficits. Stroke affects various dimensions of quality of life extensively, and the most important determinants entailing low quality of life seem to be depression, and, interestingly, being married. As a part of quality of life, sexual function and satisfaction with sexual life are impaired both in stroke patients and spouses. These findings call for multidimensional evaluation of stroke patients and provide new challenges for stroke rehabilitation.

Determina la prevalencia de depresión en la fase aguda del ictus y los factores asociados en pacientes del Hospital Nacional Edgardo Rebagliati Martins hospitalizados desde diciembre del 2012 a mayo del 2013. Se reclutaron 51 pacientes durante 6 meses, los cuales cumplían los criterios de inclusión y firmaron el consentimiento para participar en el estudio. Los pacientes fueron evaluados en el área de hospitalización, durante los cuatro primeros días tras el ictus, se procedió a recolectar: datos generales, puntaje según test minimental, puntaje de la escala de NIHSS y además la aplicación de las escalas: Rankin modificada, Montgomery y Asberg y comorbilidad de Charlson. De 51 pacientes, 74.5% presentaron ictus isquémico, siendo la causa más frecuente aterotrombótica 53.7%. El 61% de los pacientes fueron hombres. El 94% de los pacientes mostró algún sintoma depresivo en su etapa aguda. El 29.4% de los pacientes mostró signos de depresión moderada-severa según la escala de Montgomery y Aberg. Se encontró relación estadísticamente significativa entre la presencia de depresión y la presencia de comorbilidad, la escala de NIHSS y la escala de Rankin. Se concluye que la prevalencia de depresión moderada severa fue de 29.4%. Los factores que estuvieron asociados de forma consistente con depresión post accidentes cerebrovasculares fueron de limitación para realizar actividades diarias, severidad del ictus, presencia de comorbilidad y deterioro cognitivo. / Trabajo de investigación

Publicación a texto completo no autorizada por el autor / El documento digital no refiere asesor / Determina el compromiso funcional post ECV, en los pacientes atendidos en el departamento de Rehabilitación de lesiones centrales. Es un estudio descriptivo transversal, retrospectivo observacional. Los datos se recogieron de la historia clínica, en un modelo de ficha que incluye datos epidemiológicos, comorbilidad, etiología, déficit y discapacidades encontradas, y compromiso funcional según el índice de Barthel. Se obtienen estadísticos descriptivos y de correlación. Se recopiló la información de 95 pacientes, siendo 50 de sexo masculino (52.6%). El grupo etario afectado fue personas entre los 40-50 años (45.3%). Las variables asociadas a dependencia fueron: compromiso orofacial (ORa=4.1; IC95%:1.35-12.38; p<0.05), disfagia (ORa=4.33; IC95%:1.71-10.95; p<0.05) disartria (ORa=3.09; IC95% 1.31-7.26; p=0.05), Compromiso de las reacciones automáticas (ORa=9.2; IC95%:1.10- 76-76; p<0.05), afasia (ORa=4.5; IC95%:1.59-12.73, p<0.05), e incontinencia de esfinteres (ORa=6.56; IC95% 1.74-24.76; p=0.05). Los pacientes acudían para realizar un programa de rehabilitación integral, antes de los 3 meses, y pasado el año de ocurrido el evento, es decir de forma tardía; el compromiso funcional predominante fue leve a moderado; entre los factores de Riesgo cardiovascular más importantes destaca la hipertensión arterial y la dislipidemia; factores asociados a mayor dependencia están:, mayor déficit motor, compromiso para hablar o entender el lenguaje, incontinencia de esfínteres y la incapacidad para realizar marcha de forma independiente. / Trabajo de investigación

Cerebrovascular accidents are a leading cause of morbidity and mortality in the United States. Many conditions exist which may mimic this disease process including seizures, migraines, metabolic derangements, infections, space-occupying lesions, neurodegenerative disorders, peripheral neuropathy, cervical myelopathy, syncope, other vascular disorders, and functional neurologic disorder. Timely diagnosis and treatment are important in order to preserve functional status in these patients. A 48-year-old male presented to the emergency department with a 28-hour history of worsening left sided numbness, tingling, weakness, and feeling off balance. The patient stated that for the past several months he had noticed these symptoms, but they suddenly became worse the day prior. He also described shooting pains down the left arm with certain movements of his neck. The patient denied any difficulty with speaking, understanding words, performing mental tasks, bowel or bladder incontinence, or right sided symptoms. Physical exam showed intact cranial nerves II-XII, 5/5 strength of upper and lower extremities on the right side, 4/5 strength of upper and lower extremities on the left side. Romberg test was normal, heel to shin and finger to nose were intact bilaterally. Foot drop was noted on the left side and placement of the foot on the ground was noted to be clumsy. Initial head CT in the emergency department showed a frontal lobe hypodensity and was without intracranial hemorrhage. Computed tomography angiography of the head and neck showed no large vessel thrombosis or stenosis. Echocardiography revealed normal chamber sizes, normal left ventricular ejection fraction, no patent foramen ovale, and no left atrial or left ventricular thrombus. Telemetry monitoring throughout the stay remained sinus rhythm. Magnetic resonance imaging of brain and cervical spine was performed showing multifocal acute infarcts of the right and left frontal lobes and severe cervical spondylosis at C4-C6 with spinal cord edema in T2 sequences slightly below that level. The patient subsequently underwent a cervical spine decompression for the spinal cord compression during the hospital stay. Due to the multifocal lesions noted on the brain MRI, a vasculitis workup was performed which returned negative for any abnormal test findings. The patient was also diagnosed with diabetes mellitus type 2 during the stay as he was found to have a glycosylated hemoglobin A1C of >12. He was initially hypertensive during hospitalization, but this resolved on its own after day three of the hospitalization so anti-hypertensives were not required. The patient was discharged home on high intensity statin therapy, dual oral hypoglycemic therapy for his diabetes mellitus, home physical therapy, and he was scheduled to start dual antiplatelet therapy seven days after cervical spine surgery. This dual antiplatelet therapy with clopidogrel and aspirin was to be continued for three weeks after which continuation with low dose aspirin was advised. As seen in this case, patients that present with a cerebrovascular accident should always be evaluated for other etiology behind his or her symptoms and having a low threshold for pursing other additional diagnoses is reasonable.

Thesis (M.S.)--Boston University