Observative prospektive Kohortenstudie mit 22 Patienten über 3 Jahre. Wir untersuchten, ob die intensive Schulung der Diskrimination des Hüftgelenks von Beckenbewegungen Auswirkungen auf die Harmonisierung des Gangbilds in der postoperativen Rehabilitation habe. Es wurde anhand der videogestützten Ganganalyse auf dem Laufband ein Score der Gangharmonie gebildet, der neben dem Gang als Ganzkörperbewegung auch koordinative Faktoren wie den Bewegungsfluß berücksichtigt. Faktoren wie Schmerz und Erfahrung in übenden Verfahren wurden in einer Regressionsanalyse auf ihre Assoziation mit der Gangharmonie überprüft. Modelle des Bewegungslernens wurden auf langfristige Strategien der Rehabilitation angewendet. / Prospective observative cohort study over 3 years. A cohort of people with OA of the hip due to CDH was followed up over 3 years. The discrimination of hip movements from pelvis movements was measured and compared with the gait harmony. A Gait Harmony Score reflecting total body movement and coordinative factors has been developed and validated. In a regression analysis we measured the association between confounding variables like preoperative pain and experience in exercise with gait harmony and hip proprioception. Models of motor learning in rehabilitation have been applied to the postoperative development of the gait in order to establish models for longterm rehabilitation strategies.

Orientador: José Celso Freire Junior / Resumo: Algumas necessidades específicas da Fisioterapia, área que estuda o Equilíbrio Postural e a Análise da Marcha Humana estão entre as principais razões para o desenvolvimento deste trabalho de pesquisa. Ele, tem por base uma plataforma de força, desenvolvida em 2016 por pesquisadores da UNESP e do Laboratório G-SCOP, da instituição Grenoble INP da França. A esta solução foram adicionadas duas interfaces eletrônicas. A primeira, com objetivo de fornecer informações sobre as forças de reação do solo, de um paciente que está sobre a plataforma e a segunda para controlar a estabilidade da plataforma, simulando dois níveis de dificuldades para o paciente se manter em equilíbrio. Aplicativos foram desenvolvidos para fazer a captura de dados e a análise gráfica dos resultados. Além de calcular informações sobre o deslocamento dos centros de pressão e de massa do paciente, eles asseguram o sincronismo entre os dados capturados por sensores de força, instalados na plataforma e um sensor de movimento Kinect. O tratamento dos dados do sensor de movimento possibilita a criação de um modelo tridimensional detalhado, na forma de um esqueleto digital, que apresenta a cinemática de várias articulações do corpo humano e o seu respectivo comportamento posicional, em função do tempo. O trabalho apresenta também um estudo comparativo entre o sistema desenvolvido e um ambiente de referência padronizado, que utiliza um sistema de filmagem, com várias câmeras infravermelho de alta definição, disponív... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Some specific needs of Physiotherapy, an area that studies the Postural Equilibrium and the Gait Analysis are among the main reasons for the development of this research work. It is based on a force platform, developed in 2016 by researchers from UNESP and the G-SCOP Laboratory of the Grenoble INP institution in France. Two electronic interfaces were added to this solution. The first one, to provide information about the ground reaction forces, from one patient on the platform and the second to control the stability of the platform, simulating two levels of difficulty for the patient to keep in balance. Applications were developed to capture data and graphically analyze the results. In addition to calculating information about the displacement of the patient's pressure and mass centers, they ensure synchronization between the data captured by force sensors installed on the platform and a Kinect motion sensor. The treatment of motion sensor data allows the creation of a detailed three-dimensional model, in the form of a digital skeleton, which presents the kinematics of various joints of the human body and their respective positional behavior, as a function of time. The work also presents a comparative study between the developed system and a standardized reference environment, using a multi-camera high-definition infrared camera system, available in a dedicated room of the University Hospital of Grenoble. This analysis evaluates the possibility of creating new products for th... (Complete abstract click electronic access below) / Doutor

Introduction : L’influence de l’Index de Masse Corporelle (IMC) sur la récupération des paramètres de la marche après prothèse totale de hanche (PTH) et de genou (PTG) est méconnue. Peu d' étude se sont intéressées à l'influence de l’IMC sur la récupération des amplitudes articulaires actives à la marche (AAA) ou de la vitesse de marche après PTH et PTG. Notre objectif était d’évaluer cet impact en préopératoire et en post-opératoire par une évaluation clinique et biomécanique. Notre hypothèse était que l’obésité (IMC>30kg/m2) serait un facteur péjoratif de récupération des paramètres de marche.Matériel et méthodes : Après avoir effectué une revue systématique de la littérature sur la récupération fonctionnelle après prothèses totales du membre inférieur (PTH et PTG) afin de nous assurer de l’originalité de notre travail et de sa pertinence nous avons réalisé 2 études prospectives indépendantes : en incluant 76 PTH chez des patients coxarthrosiques d’une part et 79 PTG chez des patients gonarthrosiques d’autre part. Tous les patients bénéficiaient d’une analyse quantifiée de la marche en préopératoire et en post-opératoire (à 6 mois pour les PTH et à un an pour les PTG). Un groupe de témoins sains appariés suivait le même protocole. La vitesse de la marche, l’AAA de hanche et de genou, ainsi que des scores fonctionnels et de qualité de vie étaient évalués, pour tous les paramètres le gain était calculé. Les patients étaient répartis en 2 groupes : patients non-obèses (G1) : IMC<30 et patients obèses (G2) : IMC≥30 dans chacune des cohortes. Des t-tests appariés étaient utilisés pour évaluer (1) les différences pré- et post-opératoires entre G1 et G2, puis les différences de gain entre G1 et G2. Enfin une régression linéaire uni- et multivariée recherchait les associations entre l’IMC, la vitesse de la marche et les AAA.Résultats Pour les 2 cohortes : en préopératoire, la vitesse de la marche et les AAA étaient significativement plus bas chez les obèses. En post-opératoire la vitesse de la marche et les AAA étaient significativement plus bas pour tous les patients opérés d’une PTG ou d’une PTH comparativement au groupe témoin. En pré-opératoire les obèses étaient plus symptomatiques. Une différence significative était retrouvée entre G1 et G2 concernant l’amélioration de la douleur en faveur des obèses (sur le gain de WOMAC douleur pour les PTG et d’EVA pour les PTH). Pour tous les autres paramètres les gains n’étaient pas différents entre G1 et G2. La régression uni- et multivariée ne montrait pas de relation significative entre la vitesse de la marche, les AAA et l’IMC.Conclusion : L’IMC n’a pas d’effet délétère direct sur la récupération des paramètres de marche après une PTH ou une PTG. En effet malgré une symptomatologie pré-opératoire plus forte les patients obèses présentent une amélioration comparable en termes de gain aux patients non-obèses. Cependant les paramètres de marche post-opératoire après une PTH ou une PTG demeurent significativement plus bas que ceux des témoins et ce quel que soit l’IMC des patients opérés, sans récupération ad integrum clinique ou biomécanique de leur fonction de la hanche ou du genou. Ainsi l’obésité semble présenter un effet similaire sur la récupération des paramètres de marche après une PTH ou une PTG. / Introduction : Body Mass Index (BMI) impact on gait recovery after total hip and total knee arthroplasty (THA and TKA) remains misunderstood. Few studies have analyzed the influence of BMI on the recovery of hip and knee range of motion (ROM) during gait or walking speed after THA and TKA. Our objective was to assess this impact preoperatively and post-operatively using both 3D gait analysis and clinical assessment. Our hypothesis was that obesity (BMI> 30kg /m2) would be a negative factor in the recovery of gait parameters.Material and methods: After conducting a systematic review of the literature on functional recovery after total prostheses of the lower limb (THA and TKA) to ensure the originality of this work and its relevance we conducted 2 independent prospective studies: including 76 THA in hip osteoarthritis patients on the one hand and 79 TKA in knee osteoarthritis patients on the other hand. All patients had a quantified gait analysis of preoperatively and postoperatively (at 6 months for THA and 1 year for TKA). A control group of matched healthy people followed the same protocol. The gait speed, ROM hip and knee, as well as functional and quality of life scores were evaluated, for all parameters the gain was calculated. Patients were divided into 2 groups in each cohort: non-obese patients (G1): BMI <30kg/m2 and obese patients (G2): BMI≥30kg/m2. Paired t-tests were used to evaluate the pre- and post-operative differences between G1 and G2, then the differences in gain between G1 and G2. Finally, a uni- and multivariate linear regression sought associations between BMI, gait speed, and ROM.Results: In both cohorts: preoperatively, gait speed and ROM were significantly lower in obese patients. Postoperatively, walking speed and ROM were significantly lower for all patients undergoing TKA or THA compared with the control group. Preoperatively obese patients were more symptomatic. A significant difference was found between G1 and G2 regarding pain improvement in favor of the obese (on the gain of WOMAC pain for TKA and analogic pain scale for THA). For all other parameters the gains were not different between G1 and G2. Uni- and multivariate regression showed no significant relationship between gait speed, ROM and BMI.Conclusion: BMI has no direct negative effect on recovery of walking parameters after THA or TKA. Indeed despite a higher preoperative symptomatology obese patients show a comparable improvement in terms of gain to non-obese patients clinically and biomechanically. However, postoperative gait parameters after THA or TKA remain significantly lower than those of controls, regardless of the BMI of patients without full clinical or biomechanical recovery. Though, obesity appears to have a similar effect on the gait parameters recovery after THA or TKA.

La croissance et le vieillissement sont inévitables pour la race humaine. Chez les personnes âgées, le vieillissement est souvent accompagné par de nombreuses formes de maladies et de dangers dont les chutes qui affectent la qualité de vie et qui posent un enjeu socio-économique. Mais les chutes sont évitables. Les acteurs de santé, les scientifiques et les chercheurs combinent actuellement des efforts pour développer des systèmes de détection et de prédiction des chutes. Dans le contexte de la prédiction des chutes, l'objectif de cette thèse est d'élaborer le profile actimétrique des patients sensibles aux chutes afin de les alerter d'une possible chute. Ceci consiste principalement à développer un système capable de surveiller les paramètres de la marche des personnes durant leurs activités quotidiennes avec un minimum d'intrusivité. Dans une première contribution, nous avons proposé une classification générique des systèmes liés à la chute en fonction du déploiement de leurs capteurs. Nous avons distingué les systèmes portables, les systèmes non-portables et les systèmes qui combinent les deux. En se basant sur cette classification, nous avons proposé notre plateforme WMFL v1.0 dans une deuxième contribution. WMFL combine une chaussure équipée par des capteurs de force avec des dalles où nous avons intégrés des capteurs optiques infrarouges. La fusion de ces deux systèmes assure une prévention à l'intérieure et à l'extérieure des locaux. WMFL peut être aussi déployées dans une clinique. Dans une troisième contribution, nous avons proposé une méthode de prédiction des chutes en se basant sur l'analyse du déplacement du centre de pression (projeté du centre de masse) sur la surface plantaire du pied durant la marche. La méthode utilise la fenêtre glissante spatio-temporelle pour alerter le patient d'une chute potentielle et pour déterminer le risque de chute à la fin de la marche. / Growth is the normal change of the human body and getting old is inevitable to human race. As a result, elderly people are subject to many forms of diseases and dangers among which falls are considered very serious in terms of quality of life and socio-economic costs. But falls can be manageable. Health practitioners, scientists and researchers currently combine efforts to develop systems capable of detecting and predicting falls. In the context of fall prediction, the goal of this thesis is to elaborate the actimetric profile of fall sensitive patients to alert them from a potential fall. It mainly consists of developing a system capable of monitoring gait and balance parameters during their daily activities with minimum intrusiveness. These are usually assessed in clinical settings using high-cost tools. In our first contribution, we proposed a generic classification of fall-related systems based on their sensors deployment. These are classified as Wearable, Non-Wearable and Fusion Systems. Based on the generic classification, we proposed the WMFL v1.0 platform in our second contribution. WMFL fuses a Foot Wear Force Sensing device with an Ambient system using IR-sensing floor tiles. The platform can be deployed at homes or in clinics. It ensures an indoor-outdoor protection. In a third contribution, we proposed an early fall detection approach to determine the risk of falling by analyzing the displacement of the Center of Pressure projecting the amount of sway of the Center of Mass on the foot plantar surface. The method uses the spatio-temporal sliding window to alert the patient of a potential fall.

Einleitung: Die Ellbogengelenkdysplasie (ED) stellt eine der häufigsten Lahmheitsursachen bei jungen Hunden mittelgroßer und großer Rassen dar. Dabei wird der radioulnaren Inkongruenz eine maßgebliche Rolle in der Pathogenese zugesprochen. GUILLOU und Mitarbeiter (2011) konnten zeigen, dass eine axiale radioulnare Translation von bis zu 1 mm in gesunden kaninen Ellbogengelenken in vivo auftritt. Auf dieser Basis entstand die Hypothese einer vermehrten radioulnaren Beweglichkeit in dysplastischen Gelenken, die zu einer dynamischen Inkongruenz führen könnte, da ca. 40 % der Patienten keine messbare Stufe aufweisen. Ziele der Untersuchungen: Ziel der Studie war der Vergleich der dynamischen radioulnaren Inkongruenz bei orthopädisch gesunden und dysplastischen Hunden in vivo. Material und Methoden: Sieben dysplastische Ellbogengelenke von sechs Hunden und sechs orthopädisch gesunde Ellbogengelenke von fünf Hunden sind in die Studie eingegangen. Alle Probanden der ED Gruppe zeigten einen fragmentierten Processus coronoideus medialis ulnae. Nach Implantation von jeweils mindestens drei Markern in Humerus, Radius und Ulna erfolgte die biplanare, fluoroskopische Untersuchung der Gelenke, während die Hunde im Schritt auf einem Laufband geführt wurden. Die gewonnenen Röntgenvideoaufnahmen wurden aufgearbeitet und die gemessene Bewegung der Marker auf rekonstruierte dreidimensionale Knochenmodelle jedes Probanden übertragen. Alle Animationen wurden visuell beurteilt und anschließend die relative radioulnare und humeroulnare Bewegung an den animierten Knochenmodellen gemessen und als Translation in Millimeter und Rotation in Grad angegeben. Weiterhin wurden die Kontaktflächenmuster für die ulnare Gelenkfläche in dysplastischen und gesunden Gelenken bestimmt und gegeneinander visuell verglichen. Ergebnisse: Für die relative radioulnare Translation konnten in der Kontrollgruppe 0,7 mm und in der ED Gruppe 0,5 mm gemessen werden. Beide Werte unterschieden sich nicht signifikant voneinander (P= 0,2092; Konfidenzintervall -0,6 – 0,2). Die relative humeroulnare Rotation lag in der Kontrollgruppe bei 2,9 Grad und in der ED Gruppe bei 5,3 Grad. Damit lag ein signifikanter Unterschied zwischen beiden Gruppen vor (P= 0,0229; Konfidenzintervall 0,4 – 4,4). Die Kontaktflächenmuster zeigten in der Kontrollgruppe, während der dargestellten Fußungsphase, eine homogene Verteilung des Kontaktes über das gesamte mediale Koronoid. Hingegen konnte in dysplastischen Gelenken eine Reduktion des Kontaktes im kraniolateralen Anteil des Koronoids beobachtet werden. Schlussfolgerung: Die radioulnare Bewegung zeigt zwischen gesunden und dysplastischen Gelenken keinen signifikanten Unterschied auf. Die Hypothese einer ausgeprägten Translation zwischen Radius und Ulna in Gelenken erkrankter Hunde, die während der Bewegung zu einer dynamischen RUI führt kann damit widerlegt werden. Allerdings zeigt der Humerus in dysplastischen Gelenken eine vermehrte Rotationsbewegung, die zu einer Verlagerung der Trochlea humeri gegen den medialen Kronfortsatz führt. Dieser visuell und quantitativ erfasste Effekt spiegelt sich auch in den Kontaktflächenmustern wieder. Da Pathologien im Sinne des FPC typischerweise im Bereich des dargestellten, konzentrierten Kontaktes auftreten, ist davon auszugehen, dass es durch die humerale Rotation zu einer vermehrten Belastung des Koronoids kommt, welche zur Fragmentation des Kronfortsatzes führen kann. Die Ursache dieser vermehrten Bewegung ist derzeit nicht bekannt. Möglicherweise spielen Weichteilpathologien eine Rolle, ähnlich der Pathogenese der Hüftgelenksdysplasie. Neben der bereits bekannten und beschriebenen statischen RUI scheint die Rotationsinstabilität des Humerus eine entscheidende Rolle in der Pathogenese der ED zu spielen, insbesondere in kongruent erscheinenden Gelenken. / Introduction: Elbow dysplasia (ED) is one of the most frequent reasons for forelimb lameness especially in young large breed dogs. Radio-ulnar incongruence is discussed to be one of the main factors in the pathogenesis of ED. GUILLOU et al. (2011) described an axial translation between the radius and the ulna up to 1 mm in sound canine elbow joints in vivo. Based on this study we developed the hypothesis that pronounced radio-ulnar movement in dysplastic joints leads to a dynamic radio-ulnar incongruence. This dynamic incongruence might explain why 40 % of dysplastic dogs show no measurable step formation. Objective: The aim of the study was to compare the dynamic radio-ulnar incongruence in sound and dysplastic dogs in vivo. Material and Methods: Seven dysplastic joints in six dogs and six sound joints in five dogs were evaluated. All dysplastic joints showed a fragmented coronoid process and a radio-ulnar incongruence and cartilage lesions on the ulnar and humeral joint surface in a varying degree. A minimum of three Tantalum markers were implanted into the Humerus, Radius and Ulna each. Afterwards biplanar fluoroscopic gait analysis was performed while the dogs were walking on a treadmill. Gained marker movement was transferred onto reconstructed three dimensional CT bone models of each dog. The 3D animations were visually assessed and relative movement between the radius and ulna as well as between the humerus and ulna was measured and expressed as translation (millimeter) and rotation (degree). Further the joint contact patterns of the ulnar joint surface were determined for all dysplastic and sound joints and visually compared to each other. Results: Relative radio-ulnar translation was 0.7 mm in sound joints and 0.5 mm in dysplastic joints. There was no significant difference between these two groups (P= 0.2092; convidence interval -0.6 to 0.2). A significant difference between the dysplastic and the sound group was present in the relative humeral rotation (P= 0.0229; convidence interval 0.4 to 4.4). Humeral rotation relative to the ulna was 2.9 degree in sound and 5.3 degree in dysplastic joints. Humero-ulnar contact at the medial coronoid process was evenly distributed over the medial coronoid process in control elbows, while contact area in dysplastic elbows was reduced and shifted to the lateral aspect of the medial coronoid process Conclusion: Radio-ulnar movement is not significantly different between dysplastic and sound elbow joints. So the hypothesis of a pronounced axial translation between the radius and the ulna in dysplastic joints, leading to dynamic RUI can be neglected. However the humerus shows a significantly pronounced rotational movement in dysplastic joints compared to sound elbows. The trochlea humeri moves towards cranio-lateral and hits the medial coronoid process at its cranio-lateral aspect. The effect of this rotational movement can be shown in the joint contact patterns of the ulnar joint surface. Contact is shifted towards the tip and the lateral aspect of the coronoid process. In that area fragmentation of the medial coronoid process is typically observed. It seems that rotation of the humerus relative to the ulna leads to reduced contact and mechanical overload of the coronoid process. The cause of this increased rotational movement remains unknown. Maybe the documented movement could be interpreted as joint instability similar to the pathogenesis of hip dysplasia in which soft tissue laxity results in joint instability and degenerative joint disease. Besides the already described static radio-ulnar incongruence humeral rotational instability seems to play a role in the pathogenesis of elbow dysplasia, especially in congruent joints.

Cette thèse s’intéresse à définir de nouvelles méthodes cliniques d’investigation permettant de juger de l’impact de l’avance en âge sur la motricité. En particulier, cette thèse se focalise sur deux principales perturbations possibles lors de l’avance en âge : la chute et l’altération de la marche.Ces deux perturbations motrices restent encore mal connues et leur analyse en clinique pose de véritables défis technologiques et scientifiques. Dans cette thèse, nous proposons des méthodes originales de détection qui peuvent être utilisées dans la vie courante ou en clinique, avec un minimum de contraintes techniques. Dans une première partie, nous abordons le problème de la détection de la chute à domicile, qui a été largement traité dans les années précédentes. En particulier, nous proposons une approche permettant d’exploiter le volume du sujet, reconstruit à partir de plusieurs caméras calibrées. Ces méthodes sont généralement très sensibles aux occultations qui interviennent inévitablement dans le domicile et nous proposons donc une approche originale beaucoup plus robuste à ces occultations. L’efficacité et le fonctionnement en temps réel ont été validés sur plus d’une vingtaine de vidéos de chutes et de leurres, avec des résultats approchant les 100% de sensibilité et de spécificité en utilisant 4 caméras ou plus. Dans une deuxième partie, nous allons un peu plus loin dans l’exploitation des volumes reconstruits d’une personne, lors d’une tâche motrice particulière : la marche sur tapis roulant, dans un cadre de diagnostic clinique. Dans cette partie, nous analysons plus particulièrement la qualité de la marche. Pour cela nous développons le concept d’utilisation de caméras de profondeur pour la quantification de l’asymétrie spatiale au cours du mouvement des membres inférieurs pendant la marche. Après avoir détecté chaque pas dans le temps, cette méthode réalise une comparaison de surfaces de chaque jambe avec sa correspondante symétrique du pas opposé. La validation effectuée sur une cohorte de 20 sujets montre la viabilité de la démarche. / This thesis is concerned with defining new clinical investigation method to assess the impact of ageing on motricity. In particular, this thesis focuses on two main possible disturbance during ageing : the fall and walk impairment. This two motricity disturbances still remain unclear and their clinical analysis presents real scientist and technological challenges. In this thesis, we propose novel measuring methods usable in everyday life or in the walking clinic, with a minimum of technical constraints. In the first part, we address the problem of fall detection at home, which was widely discussed in previous years. In particular, we propose an approach to exploit the subject’s volume, reconstructed from multiple calibrated cameras. These methods are generally very sensitive to occlusions that inevitably occur in the home and we therefore propose an original approach much more robust to these occultations. The efficiency and real-time operation has been validated on more than two dozen videos of falls and lures, with results approaching 100 % sensitivity and specificity with at least four or more cameras. In the second part, we go a little further in the exploitation of reconstructed volumes of a person at a particular motor task : the treadmill, in a clinical diagnostic. In this section we analyze more specifically the quality of walking. For this we develop the concept of using depth camera for the quantification of the spatial and temporal asymmetry of lower limb movement during walking. After detecting each step in time, this method makes a comparison of surfaces of each leg with its corresponding symmetric leg in the opposite step. The validation performed on a cohort of 20 subjects showed the viability of the approach. / Réalisé en cotutelle avec le laboratoire M2S de Rennes 2

Tyrimo objektas: asmenų, patyrusių galvos smegenų infarktą, eisenos kokybė. Tyrimo problema. Pagrindiniai eisenos kokybę įtakojantys veiksniai yra liemens funkcija ir kojų raumenų jėga. Patyrus galvos smegenų infarktą sutrinka gebėjimas eiti, eisena tampa asimetrinė, sumažėja ėjimo greitis ir padidėja energijos sąnaudos. Kompensuojant pažeistą kojų raumenų ir liemens funkciją naudojami neoptimalūs ėjimo modeliai. Darbo tikslas: Nustatyti, kokio tipo pratimai – liemens funkcijos lavinimo ar kojų raumenų stiprinimo - turi didesnį poveikį asmenų, patyrusių galvos smegenų infarktą, kokybiniams ėjimo fazių rodikliams. Uždaviniai: 1) įvertinti liemens funkciją lavinančių pratimų poveikį ligonių ėjimo fazių rodikliams; 2) įvertinti kojų raumenų stiprinimo pratimų poveikį ligonių ėjimo fazių rodikliams; 3) palyginti skirtingų kineziterapijos programų poveikį ligonių ėjimo fazių rodikliams. Tyrimo metodika: Penkiasdešimt tiriamųjų – asmenų, prieš 2 savaites patyrusių galvos smegenų infarktą - buvo suskirstyti į dvi grupes po 25 ligonius. Pirmosios grupės ligoniams didžiausią dėmesį kineziterapijos metu skyrėme liemens funkcijos lavinimui, antrosios grupės ligoniams - ėjime dalyvaujančių kojų raumenų stiprinimui. Eisenos rodiklių pokyčius vertinome Brunel pusiausvyros testu (angl. BBA) ir Wiskonsino eisenos skale (angl. WGS). Rezultatai ir išvados. 1. Liemens funkciją lavinantys pratimai statistiškai reikšmingai pagerino asmenų, patyrusių galvos smegenų infarktą, eisenos kokybę. 2... [toliau žr. visą tekstą] / Research object: gait quality of people who sustain the stroke. Research problem. The main factors of gait quality are a trunk control and a force of lower limbs muscular tissues. The stroke affects the ability to walk, the walking becomes asymmetric, and walking speed is slower consequently it increases the expenditure of energy. Non-optimal walking models are used to compensate touched lower limbs muscles and trunk control. The aim of this paper is to determine what kind of training and strenghening exercises after a stroke for a trunk control and lower limbs muscles have more intense influence for qualitative indexes of gait phases. Objectives: 1. to estimate trunk control training exercises effect on a patient’s gait phases; 2. to estimate strengthening exercises of lower limbs muscular tissues effect on a patient’s gait phases; 3. to compare various physical therapy programs effect on a patient’s gait phases. Research methods: fifty patients who had sustained a stroke two weeks ago were divided into two equal groups. During the physical therapy one patients group granted attention to a trunk control training and another group to lower limbs muscular tissues strengthening by some walking exercises. The factors of changed gait were measured by Brunel balance assessment and Wisconsin gait scale. Conclusions. 1. Trunk control training exercises significantly improve patient’s gait quality. 2. Lower limbs muscles strengthening exercises significantly improve patient’s who... [to full text]

Made available in DSpace on 2016-12-06T17:07:17Z (GMT). No. of bitstreams: 1 PAMELA.pdf: 2668750 bytes, checksum: 96752be9e4cc22aee9368d301b2b09b4 (MD5) Previous issue date: 2008-09-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This is a descriptive search that has a general objective the evaluation of the clinic-functional and dynamic of the gait in elderly with knee osteoarthrosis. The specific objectives were to verify the clinic-functional characteristic of the knee in elderly with osteoarthrosis; verify the kinetics characteristics of the gait in elderly with knee osteoarthrosis; compare the kinetic characteristics of the vertical ground reaction forces with normal parameters and identify the morphologic characteristics of the ground reaction forces curve. Twelve elderly subjects with medical knee osteoarthrosis diagnosis were intentionally chosen. The clinic-functional and kinetics variables were measured through the Q angle of the knee, active and passive flexion and extension amplitude of the knee, habitual and maximal velocity of the gait and vertical ground reaction forces. The kinetics data were collected in habitual speed with frequency of sampling of 600Hz. The data were processed through SPSS 11.0 and SAD 32 programs. The statistic used was descriptive, with average, standard deviation and coefficient of variation. Analyzing the results, the observations were that the subjects showed high intensity of the pain (8,2 ± 1,5), obesity in 5/6 of the subjects, diminution of the active and passive amplitude of the flexion and extension of the knee, decreased velocity of the gait (2,7 ± 0,43 km/h), and postural varo and valgus deviation in . of the subjects. More than these, there were a significant increase in the median support force (87% ± 0,039 BW) and a diminution of the first peak of force (96% ± 0,03 BW), second peak of force (99% ± 0,02 BW) and in body weight acceptance tax (71° ± 3,4), suggesting that the subjects of this study do not have enough muscular and ligament forces to control the flexion (shock absorber) and stabilization of the knee during the stance phase of the gait. And the pain, must be doing by chronic repetitive movement occasioned by the articular dysfunction, altered alignments and obesity that accompanying these subjects. This paper demonstrates that the objective analysis of the gait in association with the clinic-functional parameters of the knee can be used to document the gait adaptations of the subjects with knee osteoarthrosis, and to plan best therapeutics interventions. / Esta e uma pesquisa descritiva que teve como objetivo geral avaliar as alterações clínico-funcionais e dinâmicas da marcha de idosos com osteoartrose de joelho. Os objetivos específicos foram verificar as características clínico-funcionais dos joelhos de idosos com osteoartrose de joelho; verificar as características cinéticas da marcha dos idosos com osteoartrose de joelhos; comparar as características cinéticas da componente vertical da força de reação do solo da marcha de indivíduos com osteoartrose de joelho, com valores normais de referência e analisar as características morfológicas da curva da força de reação do solo. Participaram da pesquisa 12 idosos com diagnóstico médico de osteoartrose de joelhos, escolhidos de forma não probabilística intencional. As variáveis de estudo foram medidas do angulo Q do joelho, amplitude articular ativa e passiva de extensão e flexão do joelho, velocidade habitual e máxima da marcha, e forças verticais de reação do solo. Os dados cinéticos foram coletados na velocidade habitual de cada sujeito com freqüência de amostragem de 600hz. O processamento dos dados foi no programa SPSS 11.0 e SAD 32. A estatística utilizada foi a descritiva, com média, desvio padrão e coeficiente de variação. Analisando os resultados pôde-se observar que os sujeitos apresentaram alta intensidade de dor (8,2 ± 1,5), obesidade em 5/6 dos sujeitos, diminuição da amplitude ativa e passiva de movimento articular de flexão e extensão do joelho, diminuição da velocidade habitual da marcha (2,7 ± 0,43), alteração postural em varo ou valgo em ¾ dos sujeitos. Além disso, houve um significativo aumento da média da força de suporte médio (87% ± 0,039 PC) e uma diminuição do primeiro pico de força (96% ± 0,03 PC), do segundo pico de força (99% ± 0,02 PC) e da taxa de aceitação do peso (71° ± 3,4), sugerindo que os indivíduos deste estudo apresentam disfunção articular dos joelhos e não apresentam força muscular e ligamentar suficiente para controlar a flexão (amortecimento) e estabilidade do joelho durante a fase de apoio. E ainda, que a dor pode estar sendo gerada pelas cargas crônicas de movimentos repetitivos ocasionadas pela disfunção articular, alteração postural e excesso de peso que acometem estes sujeitos. Este estudo demonstra que a análise objetiva da marcha associada aos parâmetros clínico-funcionais do joelho, pode ser usada para documentar as adaptações na marcha de idosos com osteoartrose de joelhos e para o planejamento de intervenções terapêuticas mais eficazes.

Made available in DSpace on 2014-12-17T15:16:05Z (GMT). No. of bitstreams: 1 LucianaAM.pdf: 1360792 bytes, checksum: a53d6091c0577b68061a06469713e2cf (MD5) Previous issue date: 2009-07-07 / The purpose of the study was to compare hemiparetic gait overground and on the treadmill. Seventeen chronic stroke patients were included in the study. They walked overground and on a treadmill level at the same speed. The Qualisys Medical AB motion analysis system was used to quantify the joint kinematic of the paretic lower limb and the spatio-temporal parameters on the two conditions: overground walking and treadmill walking on three samples of 5-minutes. During the first sample, the subjects walked on the treadmill with greater cadence, shorter stride length, shorter step time on the lower paretic limb, greater range of motion in the hip and knee, greater knee flexion at the initial contact, more extension of the knee and lower dorsiflexion of the ankle at the stance phase. It is important to emphasize that the maximal knee flexion and ankle dorsiflexion just occurred later on the treadmill. Comparisons between each walking sample on the treadmill hadn t revealed any changes on the gait parameters over time. Nonetheless, when analyzing the third walking sample on the treadmill and overground, some variables showed equivalence as such as the total range of motion of the hip, the knee angle at the initial contact and its maximal extension at the stance phase. In summary, walking on a treadmill, even thought having some influence on the familiarization process, haven t demonstrated a complete change in its characteristics of hemiparetic chronic patients / Este estudo teve como objetivo comparar a marcha de indiv?duos hemipar?ticos no solo e em diferentes per?odos na esteira. Foram inclu?dos 17 indiv?duos hemipar?ticos cr?nicos, os quais deambularam sobre a esteira e solo com a mesma velocidade. O sistema se an?lise do movimento Qualisys Medical AB foi utilizado para quantificar as vari?veis angulares referentes ao membro inferior par?tico e as vari?veis espa?o-temporais nas duas condi??es: marcha no solo e marcha na esteira, sendo esta ?ltima realizada em 3 coletas de 5 minutos. Durante a primeira coleta os sujeitos deambularam na esteira com maior cad?ncia, menor comprimento da passada, menor tempo de passo com o membro inferior par?tico, maior amplitude de movimento para as articula??es do quadril e joelho, maior flex?o do joelho no contato inicial, maior extens?o do joelho e menor dorsoflex?o do tornozelo no apoio. Vale ressaltar que a m?xima flex?o do joelho e a m?xima dorsoflex?o do tornozelo no balan?o ocorreram tardiamente na esteira. Compara??es entre as coletas sobre esteira n?o demonstraram mudan?a na marcha no decorrer do tempo, entretanto, quando confrontada a terceira coleta na esteira com o solo, algumas vari?veis revelaram equival?ncia entre os meios como a amplitude total do quadril, o ?ngulo do joelho no contato inicial e sua m?xima extens?o no apoio. Desta forma, a marcha em esteira mesmo demonstrando uma certa influ?ncia do processo de familiariza??o, n?o apresentou uma mudan?a completa em suas caracter?sticas em indiv?duos com hemiparesia cr?nica

Submitted by Erika Demachki (erikademachki@gmail.com) on 2017-04-06T21:16:20Z No. of bitstreams: 2 Dissertação - Paulo Fernando Lôbo Corrêa - 2017.pdf: 4897829 bytes, checksum: f11299d83a926cb84d2249cf49b4ad74 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-07T11:19:32Z (GMT) No. of bitstreams: 2 Dissertação - Paulo Fernando Lôbo Corrêa - 2017.pdf: 4897829 bytes, checksum: f11299d83a926cb84d2249cf49b4ad74 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-04-07T11:19:32Z (GMT). No. of bitstreams: 2 Dissertação - Paulo Fernando Lôbo Corrêa - 2017.pdf: 4897829 bytes, checksum: f11299d83a926cb84d2249cf49b4ad74 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-10 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Background: Multiple sclerosis (MS) causes gait disturbances that interfere in the independence and activities of daily living. For Understand the cause of these gait disturbances this study focused on the kinetics analysis of these patients gait, more specifically in the analysis of the vertical component of the ground reaction force (VCGRF). It permits estimate loss in the capacity to accelerate or decelerate the body center of mass upwards and downwards during gait. To make the analysis of this component more objective, the Ben Lomonding classification has been proposed. However, so far, it has only been tested in children with cerebral palsy (CP). Objective: To analyze the kinetics of gait disorders in MS and its repercussions on patient performance in different levels of impairment Method: A cross-sectional Control case study was developed and evaluated the gait in selfselected speed of 50 healthy adult (25 women and 25 men) and 49 adult patients (42 women and 7 men) with MS and EDSS between 1.5 and 6.0. Recruited at a Reference in MS and accomplished the three-dimensional and instrumented evaluation of the gait in a Movement Analysis laboratory of the Rehabilitation. In which, the data collection was accomplished through the VICON® system and 4 force platforms of the brand AMTI®. The speed fast analysis performed through the Timed 25-foot Walk (T25FW) test. Patients’ gait was assessed by a single rater, always in the morning, in an air-conditioned room. The VCGRF analysis was performed through Ben Lomonding’ s classification. Results: Analyzing VCGRF and possible decrease in FZ2 using Ben Lomonding classification permitted categorize VCGRF of patients with MS in five of its eight levels, since types 0, 1, 2, 3, and A were found. Of the limbs assessed, 47.0% presented alteration in VCGRF, and of these, 19.4% presented a decrease in FZ2. In patients with worse EDSS score, decrease in FZ2 was more frequent. Patients with more severity types of Ben Lomonding had higher depletion in the patient’ s performance measured by the test T25FW, cadence, speed, step and stride length, double support time and stance time. Also they presented worse performace cerebellar. Conclusion: Ben Lomonding classification can be applied to adults with MS. Additionally, the decrease in FZ2 was more frequent in patients with more severe MS, which suggests influence of MS severity on decrease in FZ2. The FZ2 reductions seem to worsen the performance of the patient gait. / A Esclerose Múltipla (EM) provoca distúrbios de marcha que interferem na independência e no desempenho nas atividades de vida diária. Por isso, para compreender as suas causas biomecânicas este estudo focou na análise Cinética da marcha, especificamente na análise do componente vertical da força de reação ao solo (CVFRS). Pois, este permite estimar os prejuízos na capacidade de impulsionar o centro de massa para cima, o que repercute na capacidade de propulsão e estabilização do membro, e consequentemente no desempenho da marcha como um todo. Componente que pode ser avaliado de forma mais objetiva com o uso da classificação de Ben Lomonding, que a categoriza em níveis de alterações. Porém, esta classificação foi testada apenas em crianças com Paralisa Cerebral. Objetivos: Analisar a cinética dos distúrbios de marcha na EM e suas repercussões sobre o desempenho nos parâmetros temporais e espaciais da marcha, em pacientes com diferentes níveis de comprometimento. Métodos: Estudo transversal caso controle que avaliou a marcha em velocidade autoselecionada de 50 adultos saudáveis (25 homens e 25 mulheres) e 49 pacientes adultos (42 mulheres e 7 homens) com EM cuja nota na Expanded Disability Status Scale (EDSS) variou entre 1.5 e 6.0. Recrutados no Centro de Referência e Investigação em Esclerose Múltipla do serviço de neurologia do Hospital das Clínicas da Universidade Federal de Goiás e avaliados no Laboratório de Análise do Movimento do Centro de Reabilitação Dr.º Henrique Santillo. A análise instrumentada da marcha foi realizada pelo sistema VICON® e 4 plataformas de força da marca AMTI®. A análise da “speed fast” realizada por meio do teste Timed 25-foot Walk (T25FW). As avaliações ocorreram no período matutino e foram executadas por apenas um avaliador durante todo o estudo. A categorização do CVFRS adotou a Classificação de Ben Lomonding. Resultados: Foi possível categorizar o CVFRS de todos os pacientes com EM de acordo com a classificação de Ben Lomonding, pois as alterações encontradas estavam de acordo com os tipos 0 a 3, e A. Observou-se que pacientes com maior gravidade da doença apresentaram maior redução do segundo pico do CVFRS (FZ2). Pacientes com maior redução de FZ2 apresentaram pior desempenho no teste T25FW, na cadência, velocidade, comprimento de passo e passada, tempo de suporte duplo e tempo total de apoio. Também, tiveram maior comprometimento cerebelar. Conclusões: A classificação de Ben Lomonding pode ser aplicada em adultos com EM e por meio dela foi possível verificar que quanto pior o nível de incapacidade da EM pior a redução de FZ2. Na análise dos sistemas funcionais, quanto maior o comprometimento cerebelar pior a redução de FZ2. Por sua vez os pacientes deste estudo tiveram pior desempenho na marcha quando havia uma maior redução de FZ2.