Orientador: Donizeti Cesar Honorato / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T10:38:27Z (GMT). No. of bitstreams: 1 Lima_NubiaMariaFreireVieira_D.pdf: 2259312 bytes, checksum: 39bc49e5fb60f586b16aa8bfa15bd3cc (MD5) Previous issue date: 2014 / Resumo: Mais da metade das vítimas de Acidente Vascular Cerebral (AVC) apresentará algum grau de incapacidade, especialmente na extremidade superior (ES), e esta pode ser agravada pelos déficits sensoriais protopáticos e/ou epicríticos. Astereognosia, déficits das sensações táteis, dolorosas, térmicas e proprioceptivas são frequentes e podem afetar ambas as ES, resultando em prejuízos no alcance/preensão e dependência da orientação visual (OV). A redução do input sensorial da ES ipsilateral ao AVC é realizada para avaliar as conexões interhemisféricas e os efeitos na função sensório-motora das ES¿s. A crioterapia pode reduzir a velocidade de condução nervosa e minimizar o input sensorial da ES ipsilateral ao AVC. O objetivo do artigo 1 foi descrever o desempenho sensório-motor da ES de paciente pós-AVC crônico, na presença e ausência de OV. A ES foi avaliada pelo Protocolo de Desempenho Físico de Fugl-Meyer (FM), Avaliação Sensorial de Nottingham (ASN), 10 testes funcionais (TF) e testes de sequência motora (SM). A paciente apresentou déficits táteis, proprioceptivos e astereognosia na ES contralateral ao AVC e, a despeito do leve comprometimento motor, demonstrou lentidão/incapacidade de realização dos TF e SM na ausência da OV, caracterizando a paresia aferente. O objetivo do artigo 2 foi investigar as alterações sensoriais no complexo punho-mão ipsilateral de 28 sujeitos pós-AVC crônico e correlacioná-las com as disfunções sensório-motoras contralaterais à lesão, testes funcionais (com e sem OV), lateralidade do AVC e dominância manual. Foram aplicados a estesiometria, ASN, subescalas sensorial e motora de FM e testes funcionais. Os resultados revelaram distúrbios sensoriais ipsilaterais protopáticos e epicríticos em 64% dos indivíduos. Aqueles com lesão em hemisfério cerebral direito mostraram melhor sensação tátil na ES ipsilateral ao AVC e houve perda sensorial significativa na ES ipsilateral em dois sujeitos canhotos. Não houve correlação entre os déficits sensoriais das ES nem correlação entre os déficits sensoriais ipsilaterais e o comprometimento motor contralateral ao AVC. Os objetivos do artigo 3 foram aplicar a hipotermia por imersão da ES ipsilateral ao AVC (punho-mão) associada à intervenção sensorial (IS) na ES contralateral ao AVC crônico e avaliar os efeitos imediatos e em longo prazo. Foram acompanhados 27 sujeitos pós-AVC crônico nos grupos 1 (n=14) e 2 (n=13). O grupo 2 foi submetido à hipotermia por imersão do punho e mão ipsilaterais ao AVC com IS e o grupo 1 realizou IS (10 sessões). Foram mensurados estesiometria, FM, ASN, TF, SM, discriminação tátil, de peso, nível de desconforto e parâmetros hemodinâmicos. Os efeitos imediatos foram estabilidade hemodinâmica durante e após a hipotermia, ausência de alterações sensoriais na ES contralateral ao AVC, hipoestesia na ES ipsilateral (dermátomos C6 e C8) (p<0,05) e níveis de desconforto aceitáveis. Em longo prazo, tem-se a melhora nos TF (com e sem OV) e localização tátil, propriocepção consciente e função tátil nos dermátomos C6 e C7 na mão contralateral ao AVC do grupo 2 (p<0,05). O uso da hipotermia de imersão da ES ipsilateral associado à intervenção sensorial na ES contralateral ao AVC conduziu à melhora sensório-motora da ES oposta ao AVC crônico / Abstract: More than half the stroke victims will present some degree of disability, especially in the upper extremity (UE), and this may be influenced by somatosensory deficits. Astereognosis, deficits of tactile, painful, thermal and proprioceptive disturbances are frequent and can affect both ES, resulting in losses in the reach/grasp and dependence on visual guidance (VG). The reduction of ipsilesional UE¿s sensory input is performed to evaluate the interhemispherics connections and effects on sensorimotor function in stroke subjects. Cryotherapy can reduce the conduction velocity of sensory fibres and can minimise sensory input to the ipsilesional UE. The purpose of Article 1 was to describe the UE¿s sensorimotor performance in chronic post-stroke subject, in the presence and absence of VG. The contralesional UE was assessed by the Fugl-Meyer Assessment (FMA), Nottingham Sensory Assessment (NSA), 10 functional tests (FT) and motor sequence (MS). Despite the mild motor impairment, the patient presented tactile, proprioceptive dysfunctions and astereognosis in contralesional UE and slowness/failure to achieve FT and MS test in the absence of VG, characterizing the afferent paresis. The Article 2 investigated the changes in the ipsilesional wrist and hand of 28 stroke chronic stroke subjects and correlate them with the sensory-motor dysfunction contralateral to the lesion, functional tests (with and without VG), stroke laterality and hand dominance. The subjects were evaluated by esthesiometry, ASN, sensory and motor subscales FMA and FT. The results showed sensory disorders in 64% of individuals. Those with lesions in the right cerebral hemisphere showed better tactile sensation in the ipsilesional UE and significant sensory loss was found in the ipsilesional UE in two left-handed subjects. There was no correlation between sensory deficits of UE¿s or correlation between ipsilesional sensory deficits and contralesional motor impairment. The Article 3 applied immersion hypothermia of an ipsilesional upper extremity (UE) and sensorial intervention of contralesional UE of chronic post-stroke patients to evaluate the immediate hemodynamic, sensorimotor and long-term effects. The sample included 27 stroke patients allocated into group 1 (n=14), which received conventional physiotherapy for the contralesional UE, and group 2 (n=13), which was submitted to immersion hypothermia of the ipsilesional wrist and hand in ten sessions. Assessments were performed pre- and post-treatment and at follow-up using esthesiometry, FMA, NSA, FT, tactile and weight discrimination, MS, level of comfort and hemodynamic parameters. The immediate effects of immersion hypothermia were hemodynamic stability during and after each session, an absence of sensory changes in the UE and hypoesthesia in dermatomes, C6 and C8, of the ipsilesional UE (p<0.05), which maintained acceptable levels of comfort. Significant long-term improvements in test scores with and without visual guidance, using tactile localization, conscious proprioception and in tactile function of the C6 and C7 dermatomes of the contralesional hand in group 2 (p<0.05). Immersion hypothermia of the ipsilesional UE in chronic stroke patients is a safe, inexpensive and practical, with good patient adherence to the technique. The use of immersion hypothermia on the ipsilesional UE improved motor and sensitivity functions in the contralesional UE of chronic stroke patients / Doutorado / Ciencias Biomedicas / Doutora em Ciências Médicas

Bakgrund: Att genomgå en amputation är en livsomvälvande händelse som bjuder på utmaningar både fysiskt och psykiskt för den drabbade personen inte minst efter utskrivning från sjukhus. Syfte: Syftet med den här litteraturstudien var att sammanställa tidigare kvalitativ forskning om patienters erfarenheter av rehabilitering efter amputation av nedre extremitet efter utskrivning från sjukhus. Metod: Scoping review. Resultat: Resultatet av den här studien byggde på tolv artiklar och fem huvudteman identifierades samt femton subteman. Studien visade bland annat på hur informationsbrist råder från sjukvårdspersonalen till patienten på olika nivåer och att tilliten till personalen är viktig. Bristande ekonomi minskade följsamheten till rehabiliteringen av olika anledningar, men har även en direkt korrelation till patientens överlevnad. Kostnaden för sjukvården beskrevs även som en fråga om liv och död där fri sjukvård var avgörande för socioekonomiskt utsatta grupper. Konklusion: Konklusionen belyste att partner och familj är viktiga för hur patienten tacklar själva rehabiliteringsprocessen. Därför är det viktigt att sjuksköterskan är lyhörd vid vårdövergång från sjukhus till hemmiljö eftersom vårdbördan för familjen ökar och patienten är som mest sårbar. / Background: Going through an amputation is a life-changing event followed by challenges physically and mentally for the affected person not least after discharge from hospital. Aim: The aim of this literature review was to compile previous qualitative research of patients’ experience of rehabilitation after amputation of lower extremity after discharge from hospital. Method: Scoping review. Result: Based on twelve scientific articles five main themes and fifteen subthemes were identified. This study illustrated how lack of information exists from healthcare professionals to the patient on different levels and trust towards the staff is important. Lack of financial resources reduced the adherence to rehabilitation and had a direct correlation to patient survival. The cost of medical care was described as a matter of life and death where free health care was crucial for socio-economically vulnerable groups. Conclusion: The conclusion illuminated the importance of the partner and family for how the patient deal with the rehabilitation process. It is important that the nurse is responsive when care transition occurs from hospital to home environment as the burden of care for the family increases and the patient is the most vulnerable.

The purpose of this study was to examine cognitive complexity, extremity, and the relationship between social repertory grids and life events repertory grids (LERG) in people who report a history of trauma. Effects of type of trauma on complexity and extremity scores of each type of grid were examined. Prior research into repertory grids and trauma has used only one type of grid, predominantly social grids or LERGs. Therefore, a natural, progressive step in the grid research involved investigating how individuals integrate social and life event constructs. It was hypothesized, and results show, that there is a positive correlation between complexity scores and extremity scores of social grids and LERGs. However it was not found that there was a negative correlation between trauma history and complexity scores, and that trauma acts as a moderator for cognitive complexity. Instead, it appears that the social facet of experience is key to understanding perception of traumatic experiences. Additionally, number of traumas experienced might affect social construct elaboration.

Flutists have reported musculoskeletal pain from practicing and performing their instrument. This study was a statistical approach to investigate potential causal risk factors for flute related pain among high school and college students. The study focused on the relationship between flute related pain and musical background or anthropometric measurements including size, strength and flexibility. Subjects included thirty high school and college-aged flutists who were assessed using a questionnaire, bi-lateral anthropometric measurements of the upper-extremities, upper-extremity performance tests for range of motion, isometric strength and rotation speed, and instrument specific questions. Four questions regarding pain associated with flute playing were treated as dependent variables and used for correlation and regression analyses with other independent variables. A six-factor regression model was created and each model was statistically significant. Results of this study show that strength, flexibility, pain spots, and exposure are risk factors for flute related pain. Both left and right pinch strength and right isometric pronation strength were significantly correlated to flutists experiencing pain while playing. Knowledge of these factors in relationship to pain is needed in flute pedagogy to help teachers and performers understand why flutists report pain during and after playing. Additional studies are warranted for replication of this study and for determining the clinical and pedagogical relevance of these findings.

Syfte: Syftet med denna litteraturöversikt var att sammanställa och beskriva arbetsterapeutiska interventioner vid hand-och arm träning för vuxna män och kvinnor med stroke, samt att undersöka interventionernas effekt och studiernas beviskraft. Metod: Datainsamling utfördes via litteratursökning i fyra databaser inom hälsa och medicin. Inklusionskriterier och kvalitetsgranskning resulterade i att 13 kvantitativa studier inkluderades. Analysen genomfördes via kvalitetsgranskning av valda studier samt en kvalitativ sammanställning. Vidare inspirerades författarna av Fisher och Marterellas (2019) interventions former. Resultat: Resultatetredovisas i två delar. I den första delen presenteras de olika interventionsformerna som erbjuds vuxna personer med stroke. Utifrån inspirationen av Fisher och Marterella (2019) framkom fem kategorier, Interventioner med fokus på att återfå eller upprätthålla förmågor, Interventioner med fokus på stärkande aktiviteter, Interventioner som simulerar en aktivitet, Träning i motorisk funktion och Stimulerande interventioner.Interventioner med fokus på stärkande aktiviteter förekom i samtliga analyserade studier. Den andra delen beskriver effekten av interventionerna och bevisvärde i studierna. Resultatet visade att flertalet av studiernas interventioner bidrog till förbättringar med avseende på motoriska funktioner och förmågor hos klienter med stroke. Dock framkom det att vidare forskning på interventionerna behövs för att tydliggöra resultatet ytterligare. Slutsats: Resultatet visade att interventioner relaterade till att förbättra motorisk funktion och förmåga efter stroke påvisade positiva resultat både i termer av upplevd motorisk funktion och förmåga att utföra aktiviteter. Dock återfanns begränsat med forskning som undersökt teknisk utrustning och tekniska hjälpmedel och dess effekt för vuxna personermed stroke. Slutligen visade litteraturöversikten att det finns behov av ytterligare forskning på interventioner förenande med teknik och hjälpmedel då det i dagsläget fanns relativt små studier inom det området.

BACKGROUND: In order to maintain non-weight bearing restrictions of the lower extremity, an assistive device must be utilized. Currently most devices require the restricted limb to be held in a static position while the contralateral extremity provides forward propulsion. Atrophy and disuse conditions ensue rapidly, slowing healing and prolonging recovery. A hands-free single crutch (HFSC) utilizes both lower extremities, potentially reducing atrophy. The purpose of this study was to examine the Electromyography (EMG) differences between a HFSC and standard axillary crutches (SAC). METHODS: A prospective, crossover study was performed using 21 healthy volunteers from an active duty foot and ankle clinic. Demographic data was obtained and then subjects were fitted with a HFSC and SAC. Wireless surface EMG sensors were applied to the belly of the rectus femoris (RF), vastus lateralis (VL), lateral gastrocnemius (LG), and the gluteus maximus (GM) by a board-certified orthopedic surgeon. Subjects then ambulated at a self-selected velocity for 30 meters, while 15 seconds of the gait cycle was recorded for each device. Mean muscle activity and the maximum voluntary isometric contraction (MVIC) were recorded. RESULTS: The RF, GM, and LG showed statistically significant increased levels of muscle activity while using the HFSC compared to SAC (respectively P = 0.05, P = 0.03, P = 0.03). The VL did not show statistically higher muscle activity while using the HFSC (P = 0.051). The RF, GM, and VL showed statistically significant higher MVIC percentages while using the HFSC compared to using SAC (respectively P = 0.005, P = 0.005, P = 0.013). The LG did not show statistically higher MVIC percentage while using the HFSC (P = 0.076). CONCLUSION: The HFSC subjects demonstrated increased muscle recruitment and intensity while maintaining cyclic contractions consistent with bipedal gait pattern. SAC demonstrated less recruitment and intensity with an isometric pattern regardless of the phase of gait. / 2022-06-04T00:00:00Z

PURPOSE: This study investigated the risk factors for cellulitis infection, the median time to onset of low volume swelling (5 to 10% relative volume change (RVC) and breast cancer-related lymphedema (BCRL) (≥10% RVC) after an incidence of cellulitis, and the impact of common risk factors of both cellulitis and lymphedema on low volume swelling and BCRL. METHODS: We reviewed electronic medical records of 98 patients who underwent unilateral breast cancer (BC) surgery in the year 2011, who had a presurgical baseline perometry measurement and at least two postsurgical follow-up measurements. Clinicopathologic data, edema, and cellulitis incidence were obtained by medical record review. RESULTS: 18.37% of patients (18/98) experienced at least one incidence of cellulitis at a median of 1.03 years postoperatively. Of those 18 patients, 44.44% (eight out of 18) developed low volume swelling and 11.11% (two out of 18) developed BCRL at a median of 1.08 years and 2.33 years postoperatively, respectively. The median time to cellulitis incidence was 0.94 years and 2.91 years after the onset of low volume swelling and BCLR, respectively. Univariate logistic regression revealed that regional lymph node radiation (RLNR) (OR 4.4; p = 0.032) and low volume swelling (OR 6.56; p = 0.004) are significant risk factors for BCRL. RLNR remained a significant risk factor for the development of BCRL by multivariate logistic regression (OR 9.43; p = 0.031). CONCLUSION: Cellulitis may not incite or worsen pre-existing BCRL or affect the median time to BCRL development. However, lymphedema may put patients at risk of cellulitis infection. Sample size may have precluded statistical significance and further research is required to definitively identify the effect of cellulitis infection on lymphedema risk. / 2022-06-04T00:00:00Z

Tai Chi Chuan is a safe alternative for those who wish to improve balance and physical wellbeing. It is a popular form of exercise that is supported by a growing body of research aimed towards improving the health of a sedentary elderly population. The purpose of this study was to examine the biomechanical features of the lower extremity during performance of two Tai Chi movements, the “Repulse Monkey (RM)” and “Wave-hands in clouds (WHIC).” The study’s parameters included quantitative measures of the temporospatial, kinematic, and kinetic characteristics of the lower extremities. A group of experienced male Tai Chi practitioners (n = 15) between the ages of 65 to 75, performed “Repulse Monkey (RM)”, “Wave-hand in Cloud (WHIC)”, and forward walking. Three-dimensional (3-D) kinematic and kinetic data was collected using VICON motion analysis system with 10 infrared cameras and 4 force plates. The following variables were examined: stride width, step length, step width, single- and double-support times, centre of mass (COM) displacement, peak joint angles, range of motion, peak joint moments, time to peak moment, and ground reaction force (GRF). The differences in the measurements of the two Tai Chi movements were compared with walking using two-way ANOVA. The study’s results showed that the two Tai Chi movements elicit gentle and fluid changes to position of the upper body mass and the joints in the lower extremity. In terms of joint kinematics, the knee remained flexed throughout RM and WHIC. Unlike walking, RM had larger abduction and adduction angles at the knee joints and large plantar- and dorsiflexion ROM at the ankle. Reduced posterior, mediolateral, and vertical GRF were seen; the loading joints at the ankle and hip were gentle and smaller than walking. Varus/valgus moments were notably larger at the knee joint during RM and eversion moment was larger at the ankle joint during WHIC movement. A large, but slow loading rate at the knee joint has implication towards the viscoelastic properties of the knee. A better understanding of RM and WHIC would facilitate the improvement of balance, physical capacity, and joint flexibility for the elders.

Appropriate sampling strategies for estimation of exposure to physical risk factors require knowledge of exposure variability over time. Limited information is available about the variability of exposure to physical risk factors for upper extremity musculoskeletal disorders, especially during non-cyclic work activities. We investigated the magnitude and relative contributions of several sources of variance to the total exposure variance among office, custodial, or maintenance workers (N = 5 per group). In addition, we examined the homogeneity of exposure within each group of workers and exposure contrast between groups of workers. Activation of the flexor carpi radialis and upper trapezius muscle groups was assessed with surface electromyography (EMG) and wrist motion was assessed with electrogoniometry. Exposure information was collected continuously over a complete work shift on two occasions. We observed a substantial contribution of the within-day-within-subject variance component to the total exposure variance for all EMG and electrogoniometer summary measures. We also observed limited exposure contrast between the occupational groups in summary measures of upper trapezius EMG and most electrogoniometry summary measures. The large within-day-within-subject variance suggests the need for prolonged measurement durations (e.g., more than 1 hr) in future epidemiologic investigations of associations between exposure to physical risk factors and upper extremity musculoskeletal disorders.

Title: Analysis of the motion of dominant upper extremity during offensive stroke in badminton performed by elite female players Objectives: Objective of my master thesis is to analyse movement of a dominant upper extremity during offensive stroke in badminton and to point out possible risk factors for injuries and soft tissue overload problems in the region of the upper limb. Methods: The theoretical part deals with anatomical and kinesiological description of upper extremities. Then there is a description of the motion on the court and upper strokes in badminton and movements of upper extremity during the strokes. The practical part deals with measuring of rotations in shlouder joints and with analysis of motion of upper extremity during offensive stroke in badminton. It is focused on measuring the range of motion, angular velocity and angular acceleration in joints of dominant upper extremity. The Xsens MVN was used to record motion. Results: The results showed that the internal rotation in the shoulder joint on the dominant upper limb during active movement examination is reduced in elite female badminton players. When an offensive strike is played, the players come to the extreme inner rotation in the shoulder joint. Next we found out that the risky movement during the offensive stroke is...