Orientador: Sebastião Gobbi / Banca: Paulo Renato Canineu / Banca: Florindo Stella / Resumo: As demências consistem em doenças de natureza crônica e degenerativa responsáveis por causar alterações corticais superiores, como memória, pensamento, orientação, compreensão, cálculo, aprendizagem e julgamento. A característica fundamental é o marcado déficit de memória, associado a perturbações das aptidões cognitivas, pensamento, fala e coordenação motora. O diagnóstico é clínico e apresenta desafios: não existem marcadores biológicos de fácil obtenção. O tratamento é sobretudo sintomático e visa minimizar os declínios cognitivo e físico e o isolamento social característicos da doença. Há evidências científicas, ainda que raras, indicando que a abordagem motora regular apresenta benefícios na proteção e no tratamento da doença. O presente estudo teve como objetivo analisar os efeitos da abordagem motora sobre as funções cognitivas e o equilíbrio de idosos institucionalizados com demência. Esta pesquisa apresentou delineamento longitudinal, com duração de 6 meses. Participaram deste estudo 54 sujeitos com demência, divididos em três grupos: G1, G2 e G3. O G1 foi submetido à abordagem motora interdisciplinar, composta por Fisioterapia, Terapia Ocupacional e Educação Física. A intervenção foi realizada com freqüência de 5 dias/semana, durante 2 horas/dia. A abordagem motora do G2 consistiu exclusivamente na intervenção fisioterápica. Este grupo foi submetido a atividades durante 3 dias/semana, 1 hora/dia. Já o G3, por não realizar atividade motora regular orientada por profissionais, foi classificado como grupo controle. A vii medicação foi mantida nos três grupos / Abstract: Dementia consists in a disease, usually as of chronic and progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity and judgment. Its main feature is the accentuated impairment of memory that is associated with disorders of motor coordination and balance. Its diagnosis is clinic and it does not present any biological marker that can be assessed easily. The treatment is usually symptomatic and it aims to minimize the cognitive and physical decline inherent to the illness. Although scarce, a few scientific evidences have been indicating benefits of motor interventions performed on a regular basis in patients with dementia. This study aimed to analize the effects of two motor interventions on the cognitive functions and on the balance of institutionilized elderly people with dementia. A 6-month longitudinal research design comprised 54 participants assigned into three groups: G1, G2 and G3. The first group (G1) was assisted by an interdisciplinary program, comprising Physiotherapy, Occupational Therapy and Physical Education intervention. The intervention was held in 2-hour sessions for 5 days per week. A physiotherapist alone carried out the intervention in G2, 1-hour sessions for 3 days per week. The G3 was considered as control because its participants were not assisted by any motor intervention. Medication was kept unchanged for the three groups / Mestre

Made available in DSpace on 2014-06-11T19:22:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-14Bitstream added on 2014-06-13T19:08:24Z : No. of bitstreams: 1 christofoletti_g_me_rcla.pdf: 893182 bytes, checksum: 615c941207893594728a1e4633c7debd (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / As demências consistem em doenças de natureza crônica e degenerativa responsáveis por causar alterações corticais superiores, como memória, pensamento, orientação, compreensão, cálculo, aprendizagem e julgamento. A característica fundamental é o marcado déficit de memória, associado a perturbações das aptidões cognitivas, pensamento, fala e coordenação motora. O diagnóstico é clínico e apresenta desafios: não existem marcadores biológicos de fácil obtenção. O tratamento é sobretudo sintomático e visa minimizar os declínios cognitivo e físico e o isolamento social característicos da doença. Há evidências científicas, ainda que raras, indicando que a abordagem motora regular apresenta benefícios na proteção e no tratamento da doença. O presente estudo teve como objetivo analisar os efeitos da abordagem motora sobre as funções cognitivas e o equilíbrio de idosos institucionalizados com demência. Esta pesquisa apresentou delineamento longitudinal, com duração de 6 meses. Participaram deste estudo 54 sujeitos com demência, divididos em três grupos: G1, G2 e G3. O G1 foi submetido à abordagem motora interdisciplinar, composta por Fisioterapia, Terapia Ocupacional e Educação Física. A intervenção foi realizada com freqüência de 5 dias/semana, durante 2 horas/dia. A abordagem motora do G2 consistiu exclusivamente na intervenção fisioterápica. Este grupo foi submetido a atividades durante 3 dias/semana, 1 hora/dia. Já o G3, por não realizar atividade motora regular orientada por profissionais, foi classificado como grupo controle. A vii medicação foi mantida nos três grupos. / Dementia consists in a disease, usually as of chronic and progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity and judgment. Its main feature is the accentuated impairment of memory that is associated with disorders of motor coordination and balance. Its diagnosis is clinic and it does not present any biological marker that can be assessed easily. The treatment is usually symptomatic and it aims to minimize the cognitive and physical decline inherent to the illness. Although scarce, a few scientific evidences have been indicating benefits of motor interventions performed on a regular basis in patients with dementia. This study aimed to analize the effects of two motor interventions on the cognitive functions and on the balance of institutionilized elderly people with dementia. A 6-month longitudinal research design comprised 54 participants assigned into three groups: G1, G2 and G3. The first group (G1) was assisted by an interdisciplinary program, comprising Physiotherapy, Occupational Therapy and Physical Education intervention. The intervention was held in 2-hour sessions for 5 days per week. A physiotherapist alone carried out the intervention in G2, 1-hour sessions for 3 days per week. The G3 was considered as control because its participants were not assisted by any motor intervention. Medication was kept unchanged for the three groups.

O Programa de Enriquecimento Instrumental (PEI) é um programa psicoeducativo que busca, por meio de instrumentos apropriados, estimular funções cognitivas de forma que o aluno otimize seu pensamento e torne-o mais reflexivo. O objetivo desta pesquisa foi realizar uma avaliação da influência do Programa de Enriquecimento Instrumental sobre algumas funções cognitivas dos idosos, quais sejam: resolução de problemas, memória, atenção e concentração. Participaram 66 indivíduos voluntários de ambos os sexos, com idade igual ou superior a 60 anos, fisicamente independentes e saudáveis, com escolaridade mínima 4ª série do ensino fundamental I (atual 5º ano) e máxima 8ª série do ensino fundamental II (atual 9º ano), sem restrições quanto ao nível socioeconômico, subdivididos em dois grupos: experimental e controle. Os sujeitos de ambos os grupos foram avaliados antes do início do programa de intervenção (fase pré-teste) e ao seu final (fase pós-teste) por meio dos seguintes testes: Teste Wisconsin de classificação de cartas versão para idosos, subescala memória do Exame Cognitivo de Addenbrooke, Teste de Memória de Lista de Palavras, Teste de Repetição de Pseudoplavaras, subescala atenção e orientação do Exame Cognitivo de Addenbrooke e teste de Trilhas parte A e parte B. Com o objetivo de rejeitar a hipótese de que a melhora do desempenho do grupo experimental, que recebeu a intervenção cognitiva, pudesse ser devida a aprendizagem dos testes na primeira fase em que foram aplicados, outros testes para avaliação das mesmas funções investigadas foram realizados nas fases pós e reteste, esta última realizada após três meses do término do programa de intervenção. Os testes com este objetivo foram: subteste cubos da Escala Wechsler Abreviada de Inteligência, testes de extensão de dígitos em ordem direta e em ordem inversa da Escala de Memória Wechsler de Inteligência para Adultos, Bateria Psicológica para Avaliação da Atenção. A escala de autoestima foi aplicada nas fases pré, pós e reteste apenas para o grupo experimental. As aulas do Programa de Enriquecimento Instrumental foram ministradas ao grupo experimental pela pesquisadora durante cinco meses e meio, uma vez por semana com a duração de 90 minutos cada, totalizando 21 aulas. A avaliação dos resultados mostrou que o Programa de Enriquecimento Instrumental levou a um maior desempenho do grupo experimental quando comparado ao grupo controle em todas as funções cognitivas analisadas, as quais ou se mantiveram ou apresentaram melhoras no desempenho mesmo após três meses do término do programa. Na discussão dos resultados procurou-se identificar e relacionar os instrumentos do PEI com as funções cognitivas avaliadas / The Instrumental Enrichment Program (IEP) is a psycho-educative program that seeks, through appropriate instruments, to stimulate cognitive functions so the student optimizes her/his thinking and makes it more reflective. The objective of this research was to conduct an assessment of the Instrumental Enrichment Program influence on some cognitive functions of the elderly, such as: problem solving, memory, attention and concentration. Sixty-six volunteers from both sexes participated, aged 60 years or older, physically independent and healthy, schooled until the 4th grade of elementary school (currently 5th year) at minimum and until the 8th grade of secondary school (currently 9th year) at maximum, without restrictions on the socioeconomic level, subdivided into two groups: experimental and control. The subjects from both groups were assessed before the intervention program (pre-test phase) and its ending (post-test phase) through the following tests: Wisconsin Card Sorting Test version for the elderly, memory subscale of Addenbrookes Cognitive Examination, Word List Memory Test, Pseudowords Repetition Test, attention and guidance subscale of Addenbrooke\'s Cognitive Examination, and Trails Test parts A and B. In order to reject the hypothesis that improvement in the experimental group performance, that received cognitive intervention, could be due to the learning of tests during the first phase in which they have been applied, other tests for evaluation of the same investigated functions were performed in post-test and retest phases, the latter performed after three months of the intervention program completion. The tests used for this purpose were: Wechslers Abbreviated Scale of Intelligence cubes subtest, digit extension tests in direct and in reverse order from Wechslers Adult Intelligence Memory Scale, and Psychological Battery for Attention Assessment. The self-esteem scale was applied in the pre, post and retest phases only for the experimental group. The Instrumental Enrichment Program classes were given to the experimental group by the researcher for five and a half months, once a week, lasting 90 minutes each, totaling 21 classes. Evaluation of the results showed that the Instrumental Enrichment Program has led to a higher performance by the experimental group compared to the control group in all cognitive functions analyzed, which either remained or showed improvement in performance even after three months of program completion. The discussion of results sought to identify and relate the IEP instruments with the assessed cognitive functions

In both the private and work spheres, multitasking among three or more activities has become and is continuing to evolve as a pervasive element of everyday life, and recent technological advances only seem to be exacerbating the process. Despite attempts to understand the mental processes that let humans successfully multitask, little is known about the functional cognitive level at which these mental processes take place. This thesis makes a case for the involvement of spatial ability (among other cognitive abilities) in successful multitasking behavior. It focuses on the importance of the cognitive off-loading of executive control demands onto spatial ability, due to the inherent complexity of relationships between task goals and deadlines in multitasking scenarios. Importantly, it presents a working hypothesis—the spatiotemporal hypothesis of multitasking—as a tool for making specific predictions about multitasking performance, based on individual and sex differences in spatial ability. In Study 1, individual differences in spatial ability and executive functions emerged as independent predictors of multitasking performance. When spatial ability was decomposed into its subcomponents, only the coordinate (metric), but not categorical (nonmetric), processing of spatial relations was related to multitasking performance. Males outperformed females in both spatial ability and multitasking, and the effects were moderated by menstrual changes, in that sex differences in coordinate spatial processing and multitasking were observed between males and females in the luteal phase of the menstrual cycle, but not between males and females at menses. In Study II, multitasking performance reflected age- and sex-related differences in executive functioning and spatial ability, suggesting that executive functions contribute to multitasking performance across the adult life span, and that reliance on spatial skills for coordinating deadlines is reduced with advancing age. The results of Study III, in which the spatiotemporal hypothesis was directly scrutinized, suggest that the spatial disruption of multiple deadlines interferes with multitasking performance. Overall, these findings suggest that multitasking performance, under certain conditions, reflects independent contributions of spatial ability and executive functioning. Moreover, the results support the distinction between categorical and coordinate spatial processing, suggesting that these two basic relational processes are selectively affected by female sex hormones and are differentially effective, even across the age span, in transforming and handling temporal patterns as spatial relations in the context of multitasking. Finally, fluctuations of sex hormones exhibit a modulating effect on sex differences in spatial ability and multitasking performance. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 3: Manuscript.</p>

This thesis focuses on cognitive functions in patients after methanol poisoning. The theoretical part consists of a description of methanol, characteristics of methanol poisoning and its neurological sequelae. Methanol poisoning affects the basal ganglia, therefore we describe them and their role in cognitive processes. The theoretical part also describes a case of mass methanol poisoning in the Czech Republic in 2012-2013. The practical part compares results of a control group and a group of patients poisoned with methanol in cognitive assessment. Results show that the patients after methanol poisoning have significantly lower scores in tasks testing memory and executive functions than the control group.

The diploma thesis deals with the topic of limited normative data and its aim is to report the norms of the Clock Drawing Test (CDT) in a large sample of cognitively healthy Czech elderly (N = 501; aged 60 to 99). The CDT is a commonly used tool for screening of cognitive functions. We worked with the following version of test: clock drawing with pre- drawn circle and time setting 13.45 using three different scoring systems (Babins, Slater, Whitehead, & Chertkow, 2008; Cohen, Ricci, Kibby, & Edmonds, 2000; Shulman, Pushkar Gold, Cohen, & Zucchero, 1993). As a result, we found a significant effect of age and education, but non-significant effect of gender on CDT performance in old age. Therefore normative data was calculated considering those two demografical variables; the tables present means, standard deviations and t-scores based on defined subgroups. The results indicate that CDT performance of cognitively healthy elderly is negatively influenced by age, while directly proportional effect of education. Moreover it seems that the range of scores of the test grows with increasing age. Data collected in this thesis may be used for a more effective and standardized interpretation of CDT performance in old age in both clinical context and research. We also confirmed high inter-rater reliability...

The aim of this thesis is to examine the effects of indvidualized teaching on selected aspects of cognition and motivation. Research issues focus on changes in cognitive and executive functions, clients' attitude to tutored subjects, the difference between the attitude of clients to tutoring and school education and changes in length of clients' preparation for school lessons and changes in school results. The research sample consisted of 8 clients aged 14-18 who were involved in the individual tutoring programme. The applied methods were interview and the CAS2, assessment battery. The most important findings of the research include improvement in the performance of executive functions and increased perceived entertainment of school subjects. Compared to school education, tutoring was considered more useful, especially the individual and friendly approach of lecturers was evaluated more positively than teachers' approach. School results improved by at least one grade for all clients in at least one tutored subject.

This study investigated the effectiveness of Feuerstein’s mediated intervention programme on a sample of the Grade Five population, in a remedial school. The participants (n=20) were systematically sampled and they constituted two groups, namely, Individual Mediation (n=10) and Group Mediation (n=10). It was hypothesised that participants exposed to this programme would yield significant improvement in cognitive functioning as measured by the (Raven’s Coloured Progressive Matrices (RCPM). As a result of the intensity and the duration of the mediation that was provided to the participants within the Individual Mediation, it was hypothesised that they would perform significantly better than those within the Group Mediation. Set Variations B-8 to B-12 from Feuerstein’s Learning Potential Assessment Device served as vehicle for mediating cognitive deficiencies. Following the intervention, a significant improvement on the RCPM was only obtained within the Individual Mediation. Although there was significant improvement, no significant difference was found between the Individual Mediation and the Group Mediation. The pre-post-test results of the Individual Mediation corroborate existing literature that provision of adequate and appropriate mediated learning experience is effective in improving cognitive functioning. However, non-significant results between the two groups suggest that a pre-post significant finding within the Individual Mediation was as an effect of pre-test differences. These findings are therefore inconclusive. It might be helpful to further replicate this investigation in order to determine whether support is found for the previous or for the present findings.

O objetivo do presente estudo foi comparar os efeitos de dois tipos de programas de treinamento do equilíbrio e marcha, um baseado no Nintendo Wii Fit® e o outro baseado em exercícios convencionais sem a utilização do videogame, na eficiência da marcha, funções cognitivas e funcionalidade de idosos saudáveis. Trata-se de um ensaio clínico, cego e randomizado realizado no Departamento de Fonoaudiologia, Fisioterapia e Terapia Ocupacional no Laboratório de Aprendizagem Sensório-Motora (LASM) da Universidade de São Paulo. Participaram do estudo 32 idosos saudáveis que foram randomizados em grupo experimental (n=16) e grupo controle (n=16). Ambos os grupos realizaram 14 sessões individuais de treinamento, duas vezes na semana por sete semanas. As sessões eram divididas em duas partes: a primeira parte era composta de 30 minutos de exercícios globais que incluíam alongamento e fortalecimento muscular além de mobilidade axial; a segunda parte era composta de 30 minutos de exercícios de equilíbrio e marcha. O grupo experimental realizou os exercícios de equilíbrio e marcha por meio de 10 jogos do vídeogame Nintendo Wii Fit®, que promoviam a estimulação cognitiva e motora por meio da realimentação visual e auditiva. Já o grupo controle realizou os exercícios sem nenhuma estimulação cognitiva associada. As principais medidas do estudo foram: (1) Functional Gait Assessment (FGA); (2) Montreal Cognitive Assessment (MoCA); (3) Índice do Andar Dinâmico (IAD); (4) Falls Efficacy Scale (FES-I); (5) Teste da marcha de 30 segundos em condição de simples tarefa e dupla tarefa. A análise estatística foi realizada por meio da ANOVA de medidas repetidas e pós hoc teste de Tukey para a verificação de possíveis diferenças entre grupos e avaliações, que foram realizadas antes, depois e após 60 dias do término do treinamento. Apenas o grupo experimental apresentou melhora na FGA, MoCA, IAD, FES-I e Teste da marcha 30 segundos em simples e dupla tarefa. Concluiu-se que o treino de equilíbrio e marcha associado ao Nintendo Wii Fit® mostrou-se mais eficiente na melhora da eficiência da marcha, das funções cognitivas e da funcionalidade de idosos saudáveis em comparação ao treinamento convencional / The aim of this study was to compare the effects of two types of balance and gait training programs, one based on Nintendo Wii Fit® and the other based on conventional exercises without the use of video games, in the gait efficiency, cognitive functions and functionality in healthy elderly. This is a blind and randomized clinical trial, conducted at the Department of Speech-Language Pathology, Physiotherapy and Occupational Therapy at the Laboratory for Sensory-Motor Learning (LASM) at the University of São Paulo. The study included 32 healthy elderly individuals who were randomized into an experimental group (n = 16) and control group (n = 16). Both groups underwent 14 sessions of individual training, twice a week for seven weeks. The sessions were divided into two parts: the first part consisted of 30-minute global exercise that included stretching and muscular strengthening exercises as well as axial mobility; the second part consisted of 30 minutes of balance and gait exercises. The experimental group performed balance and gait exercises through 10 Nintendo Wii Fit® video games, which promoted cognitive and motor stimulation through visual and auditory feedback. The control group performed the exercises without any cognitive stimulation associated. The main measures of the study were: (1) Functional Gait Assessment (FGA), (2) Montreal Cognitive Assessment (MoCA), (3) Dynamic Gait Index (DGI), (4) Falls Efficacy Scale (FES-I); (5) 30-second gait test in simple and dual-task condition. Statistical analysis was performed by repeated measures ANOVA and post hoc Tukey test to check for possible differences among groups and evaluations, which were performed before, after and 60 days after the end of the training. Only the experimental group showed improvement in FGA, MoCA, DGI, FES-I and 30-second gait test in simple and dual-task. It was concluded that balance and gait training associated with Nintendo Wii Fit® was more efficient in improving the gait efficiency, cognitive function and functionality of healthy elderly compared to conventional training

Galvos smegenų insultas (GSI) yra viena pagrindinių sergamumo, mirtingumo ir neįgalumo priežasčių ne tik pasaulyje, bet ir Lietuvoje (1,2,3). Be to, insultas yra pagrindinė staiga išsivysčiusio neįgalumo priežastis, taip pat demencijos ir viena dažniausių depresijos priežasčių(4). Tyrimo uždaviniai: įvertinti ligonių segančiųjų GSI savarankiškumą bei pažintines funkcijas; nustatyti amžiaus, lyties, GSI rūšies įtaką savarankiškumo bei pažintinių funkcijų atstatymui; nustatyti ergoterapijos įtaką sergančiųjų GSI atstatyme reabilitacijos eigoje Tyrimas buvo atliekamas Kauno Medicinos Universiteto Neuroreabilitacijos poskyryje ir Kauno Panemunės senelių namuose. Tiriamąją grupę sudarė 20 pacientų, kurie buvo gydyti Neuroreabilitacijos poskyryje ir kuriems buvo taikyta ir ergoterapija, o 20 pacientų buvo kontrolinė grupė, iš Kauno Panemunės senelių namų. Reabilitacijos pradžioje ir pabaigoje ligonių funkcinę būklę vertinome: trumpuoju protinės būklės vertinimo testu ir funkcinio nepriklausomumo testu. Apibendrinus tyrimo rezultatus buvo padarytos šios išvados: 1. Sergančiųjų GSI savarankiškumas, pažintinės funkcijos reabilitacijos pradžioje yra žymiai sutrikę. 2. Reabilitacijos eigoje tiriamosios grupės pacientams po taikytos ergoterapijos tiek protinė tiek funkcinė būklė statistiškai reikšmingai pagerėjo(p<0,0001), o kontrolinės grupės ligoniams statistiškai reikšmingo pokyčio (p>0,05) nenustatėme. 3. Statistiškai patikimai geresnių rezultatų pasiekė moterys (p<0,05) lyginant... [toliau žr. visą tekstą] / Stroke is one of the main reasons of morbidity, disability and death in the world and in Lithuania too(1,2,3). Besides stroke is the main reason of sudden disability and often is the reason of dementia(4). The goals of the research was: to evaluate independence of stroke patients and cognitive functions; to estimate what influence do age, gender and stroke type for independence and cognitive functions recovery; to identify the influence of occupational therapy in rehabilitation for stroke patients. The research was performed in department of Neurorehabilitation of Kaunas Medicine University and in Kaunas Panemunės old people house. The impact group were twenty patients from the department of Neurorehabilitation. The control group were from Kaunas Panemunės old people house . For impact group occupational therapy was included. The state of patients were estimated with MMSE and FIM, at the start of rehabilitation and in the end of rehabilitation. Several conclusions were made in summary of results of his study: 1. The independency of stroke patients and cognitive functions was widly disordered, at the start of rehabilitation. 2. After rehabilitation mental status were statistically significant better (p<0,0001) .for impact group and for control group there were no statistically significant change (p>0,05). 3. Statistically significant better results achieved women(p<0,05) than men, age, stroke type didn’t had significant influence for patients independence . 4. Patients... [to full text]