Submitted by Automação e Estatística (sst@bczm.ufrn.br) on 2018-06-05T22:02:03Z No. of bitstreams: 1 YannaFerreiraDaSilva_DISSERT.pdf: 3121429 bytes, checksum: ecdcae6edae50ed9e569d23fe103749b (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-06-11T22:05:27Z (GMT) No. of bitstreams: 1 YannaFerreiraDaSilva_DISSERT.pdf: 3121429 bytes, checksum: ecdcae6edae50ed9e569d23fe103749b (MD5) / Made available in DSpace on 2018-06-11T22:05:27Z (GMT). No. of bitstreams: 1 YannaFerreiraDaSilva_DISSERT.pdf: 3121429 bytes, checksum: ecdcae6edae50ed9e569d23fe103749b (MD5) Previous issue date: 2016-12-02 / INTRODUÇÃO: Crianças com Paralisia Cerebral (PC) diferentemente de crianças com desenvolvimento motor típico apresentam distintos padrões motores compensatórios mediante as demandas exigidas durante a marcha. Existe ainda uma lacuna para a diferenciação da marcha normal e a patológica entre crianças mediante o uso de uma perturbação externa durante a locomoção, havendo a necessidade de estudos que possibilitem melhor entendimento a respeito de tais diferenças. OBJETIVO: Comparar os efeitos imediatos da adição de carga sobre a marcha de crianças com PC e crianças com desenvolvimento motor típico durante a marcha. MATERIAIS E MÉTODOS: Trata-se de um estudo quase experimental. A amostra foi constituída por 39 crianças com idades de cinco a 12 anos, divididas em dois grupos: Grupo PC (n=20) formado por crianças com PC do tipo hemiplégica espástica; e o Grupo DT (n=19) formado por vinte crianças com desenvolvimento motor típico. As crianças do grupo DT foram pareadas quanto à idade e sexo com as crianças do grupo PC. As crianças com PC foram classificadas quanto ao seu nível de funcionalidade (Gross Motor Function Classification System - GMFCS), avaliadas em relação a função motora grossa (Gross Motor Function Measure - GMFM), ao grau de espasticidade muscular do membro inferior parético (Escala Modificada de Ashworth) e quanto aos dados antropométricos. A marcha foi avaliada pelo sistema de análise cinemática Qualisys e todos os voluntários executaram o protocolo do treino, na esteira Gait Trainner System 2 ® , dividido em 3 fases: antes da adição da carga (fase PRÉ), imediatamente após a remoção da carga (fase IME) e 8 minutos após a remoção da carga (fase RET). A carga foi de 60% do peso do membro inferior e imposta em ambos tornozelos. O protocolo avaliativo da marcha consistiu em uma única sessão de treino. As medidas de desfechos foram as variáveis angulares das articulações do quadril e joelho, a altura máxima do pé e as variáveis espaço temporais. Os dados foram analisados pelo programa SPSS 20.0, atribuindo nível de significância de 0,05. Para a comparação entre as fases foi realizada a ANOVA one way para medidas repetidas em ambos os grupos. Os testes t não pareados foram realizados para comparação entre membro parético das crianças com PC e o membro não dominante das crianças típicas em cada fase do protocolo. RESULTADOS: Na comparação entre as fases do protocolo, os resultados mostraram que as crianças PCs apresentaram aumento da flexão máxima (P<0,001) e amplitude do movimento (P=0,013) do joelho parético e da altura do pé (P=0,001) parético imediatamente após a retirada da carga. Os efeitos não foram retidos após os cinco minutos de repouso. As crianças típicas apresentaram aumento das amplitudes do quadril (P=0,037) e do joelho (P=0,019) do membro não dominante e maior altura do pé do membro não dominante (P=0,009), entre as fases PRÉ e IME. Na comparação intermembros, foi observada maior flexão do quadril no membro parético na fase PRÉ (P=0,001), na fase IME (P<0,001) e na fase RET (P=0,001) quando comparado ao membro não dominante. A extensão do quadril parético também foi maior na fase PRÉ (P=0,015), na fase IME (P=0,002) e na fase RET (P=0,005). A articulação do pé parético mostrou maior altura do que o pé do membro não dominante das crianças típicas, na fase PRÉ (P<0,001), na fase IME (P<0,001) e na fase RET (P<0,001). CONCLUSÃO: As crianças com PC e as crianças com desenvolvimento motor típico apresentaram ajustes motores mediante a carga imposta no membro parético e no membro não dominante, respectivamente. As crianças com PC demonstraram que apesar de um padrão motor alterado decorrente da lesão, um novo comportamento motor emergiu a partir das capacidades remanescentes e das demandas da tarefa, enquanto que nas crianças típicas as respostas à carga refletiram o repertório de estratégias com controle motor intacto que estas crianças poderiam adotar para vencer a resistência imposta aos membros. / INTRODUCTION: Children with Cerebral Palsy (CP) differently from children with typical motor development have different compensatory motor patterns through the demands during gait. There is also a gap for the differentiation of normal and pathological gait among children through the use of an external disturbance during locomotion, and there is a need for studies that allow a better understanding of such differences. PURPOSE: To compare the immediate effects of loading on the gait of children with CP and children with typical motor development during gait. MATERIALS AND METHODS: This is a quasi-experimental study. The sample consisted of 39 children aged five to 12 years, divided into two groups: PC group (n = 20) composed of children with PC of type spastic hemiplegic; and the DT Group (n = 19) comprised of twenty children with typical motor development. The children in the DT group were matched for age and sex with children in the CP group. Children with CP were classified for their level of functionality (Gross Motor Function Measure System - GMFCS), evaluated in relation to gross motor function (Gross Motor Function Measure - GMFM), the degree of muscle spasticity of the paretic lower limb (Ashworth Modified Scale) and anthropometric data. The gait was evaluated by Qualys kinematic analysis system and all volunteers performed the training protocol on the Gait Trainner System 2® treadmill, divided into three phases: before the addition of the load (PRÉ phase) immediately after the removal of the load (IME phase ) and 8 minutes after the removal of the load (RET phase). The load was 60% of the weight of the lower limb and imposed on both ankles.The gait assessment protocol consisted of a single training session. The measures of outcomes were the angular variables of the hip and knee joints, the maximum height of the foot and the temporal space variables. The data were analyzed by the SPSS 20.0 program, assigning a level of significance of 0.05. For the comparison between the phases, the ANOVA with repeated measurements was performed in both groups. Unpaired ttests were performed to compare the paretic limb of children with CP and the nondominant limb of typical children at each phase of the protocol. RESULTS: In the comparison between the phases of the protocol, the results showed that the PC children had increased maximal flexion (P<0,001) and range of motion (P=0,013) of the paretic knee and paretic foot height (P=0,001) immediately after removal of the load. The effects were not retained after five minutes of rest. The typical children showed increased amplitudes of the hip (P=0,037) and knee (P=0,019) of the nondominant limb and greater height of the foot of the non-dominant limb (P=0,009), between phases PRE and IME. In the inter-limb comparison, greater hip flexion was observed in the paretic limb in the PRE (P=0,001), IME (P<0,001) and RET (P=0,001) phases when compared to the non-dominant limb. Paretic hip extension was also higher in the PRE (P=0,015), IME (P=0,002) and RET (P=0,005) phases. The paretic foot joint showed higher height than the foot of the non-dominant limb of typical children, in the PRE (P<0,001), IME (P<0,001) and RET phases (P<0,001) phases. CONCLUSION: Children with CP and children with typical motor development presented motor adjustments through the load imposed on the paretic limb and the non - dominant limb, respectively. Children with CP showed that despite an altered motor pattern due to injury, new motor behavior emerged from the remaining abilities and demands of the task, while in typical children the responses to the load reflected the repertoire of strategies with intact motor control that these children could adopt to overcome the resistance imposed on the limbs.

Chez la personne atteinte d'hémiplégie, la restauration des capacités posturales est considérée comme un des objectifs majeurs du processus de réhabilitation. Aujourd'hui, les grandes caractéristiques de la posture érigée chez le patient hémiplégique sont bien connues. Cependant, un certain nombre d'interrogations, relatives à la nature des mécanismes déficitaires et au type de rééducation à développer, subsiste. Au cours de ce travail doctoral, nous avons utilisé les concepts et les outils de l'approche dynamique des systèmes sensori-moteurs pour étudier les déficits posturaux de cette population. Dans ce cadre, ces déficits sont assimilés aux anomalies spatio-temporelles observables dans les coordinations hanche/cheville. Dans un premier temps, nous avons cherché à quantifier la nature des modifications de la dynamique posturale consécutives à une lésion cérébrale. Nous avons étudié, d'une part, la dynamique spontanée lors d'une tâche de poursuite de cible, et d'autre part, la dynamique intentionnelle en présence d'une information comportementale spécifiant la coordination à produire. A travers ces deux expérimentations, une disparition de l'attracteur en phase et une diminution de la stabilité de l'attracteur en anti-phase ont pu être mises en évidence. Dans un second temps, sur la base de ces résultats, nous avons proposé un (ré)apprentissage des deux modes de coordination préférentiels à l'aide d'un dispositif de biofeedback. L'objectif était de déterminer si la restauration d'une dynamique posturale dite "normale" était possible en dépit de la pathologie. Les résultats montrent un (ré)apprentissage du patron en phase suite au protocole; (ré)apprentissage qui s'accompagne d'une amélioration du niveau d'indépendance fonctionnelle des patients. Dans leur ensemble, ces résultats contribuent à une plus grande compréhension des déficits posturaux du patient hémiplégique et proposent des pistes de réflexion intéressantes pour la mise en place de futurs protocoles de rééducation. / The improvement of postural capacities is regarded as one of the major goals of rehabilitation of hemiplegic patients. Today, the main characteristics of the upright posture are well-known. However, many questions concerning the nature of affected mechanics and possible physical therapies remain open. In this work, we studied postural deficits in a hemiplegic population following the concepts and tools of the dynamical approach of sensori-motor systems. Deficits were considered as spatio-temporal anomalies of the organization of the postural system and analyzed through ankle/hip coordination patterns. First, we investigated modifications of postural dynamics following stroke in two different experiments. We observed both spontaneous dynamics during a tracking task and intentional dynamics using behavioral information specifing the to be produced coordination pattern. Results of both studies showed disappearance of the in-phase pattern and less stable performance in the anti-phase pattern. Second, based on gained knowledge, we proposed a (re)learning task of the two preferred postural patterns using a biofeedback design. The aim was to assess the success of this protocol for the recovery of "normal" dynamics and to explore the effect of this (re)learning on postural and functional abilities. Results suggested that the recovery of the in-phase pattern is possible and seemed to improve independence of patients. Summarized, this work proposes a new way to investigate postural deficits in post-stroke population and provided a base for the development of new therapies.

No description available.

Made available in DSpace on 2014-06-11T19:22:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-04-27Bitstream added on 2014-06-13T20:08:24Z : No. of bitstreams: 1 sanches_maa_me_ilha.pdf: 1862589 bytes, checksum: e3625c1d280204f136503179cec091dd (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Este trabalho descreve um sistema eletrônico implementado com o objetivo de monitorar os esforços exercidos pelos membros superiores e inferiores de pacientes. O sistema é constituído por transdutores, circuitos de condicionamento de sinais, circuito de comunicação e um software para a aquisição de dados, além da visualização em um microcomputador. São descritos dois tipos de transdutores, construídos com extensômetros metálicos, um para conexão em muletas e o outro projetado para ser inserido em palmilhas. Os fundamentos teóricos necessários para o projeto destes transdutores são apresentados, bem como os esquemas dos circuitos implementados. É descrita a metodologia utilizada para a determinação das características estáticas e dinâmicas dos transdutores. Estes apresentaram respostas lineares, excelente repetibilidade, e faixa dinâmica que atende às finalidades do projeto. Foi desenvolvido um software com interface gráfica contendo várias telas que possibilitam diferentes análises e armazenamento de informações. Utilizando o sistema, foram realizadas, com êxito, medições de forças exercidas pelos membros inferiores e superiores de pacientes normais e hemiplégicos. / This work describes the development of a computer-based system able for monitoring forces acting on patients’ upper and lower limbs. The system consists of insoles and crutches instrumented with load cells, signal conditioning circuits, data acquisition system, and a computer. The results of the static and dynamic measurements can be presented in the screen of a computer through graphs and tables, and stored in a data base, to follow-up the development of a patient treatment. The program was developed in Visual Basic, and the communication uses the USB port. All transducers presented linear response, small hysteresis, excellent repeatability and resolution. Static and dynamic measurements performed with the transducers are presented as well as the visualization of the forces exerted on the plantar area and upper limbs of healthy and hemiplegic patients.

Orientador: Aparecido Augusto de Carvalho / Banca: Augusto Cesinando de Carvalho / Banca: Cláudio Kitano / Resumo: Este trabalho descreve um sistema eletrônico implementado com o objetivo de monitorar os esforços exercidos pelos membros superiores e inferiores de pacientes. O sistema é constituído por transdutores, circuitos de condicionamento de sinais, circuito de comunicação e um software para a aquisição de dados, além da visualização em um microcomputador. São descritos dois tipos de transdutores, construídos com extensômetros metálicos, um para conexão em muletas e o outro projetado para ser inserido em palmilhas. Os fundamentos teóricos necessários para o projeto destes transdutores são apresentados, bem como os esquemas dos circuitos implementados. É descrita a metodologia utilizada para a determinação das características estáticas e dinâmicas dos transdutores. Estes apresentaram respostas lineares, excelente repetibilidade, e faixa dinâmica que atende às finalidades do projeto. Foi desenvolvido um software com interface gráfica contendo várias telas que possibilitam diferentes análises e armazenamento de informações. Utilizando o sistema, foram realizadas, com êxito, medições de forças exercidas pelos membros inferiores e superiores de pacientes normais e hemiplégicos. / Abstract: This work describes the development of a computer-based system able for monitoring forces acting on patients' upper and lower limbs. The system consists of insoles and crutches instrumented with load cells, signal conditioning circuits, data acquisition system, and a computer. The results of the static and dynamic measurements can be presented in the screen of a computer through graphs and tables, and stored in a data base, to follow-up the development of a patient treatment. The program was developed in Visual Basic, and the communication uses the USB port. All transducers presented linear response, small hysteresis, excellent repeatability and resolution. Static and dynamic measurements performed with the transducers are presented as well as the visualization of the forces exerted on the plantar area and upper limbs of healthy and hemiplegic patients. / Mestre

Orientador: Antonio Guilherme Borges Neto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T05:06:26Z (GMT). No. of bitstreams: 1 Beinotti_Fernanda_M.pdf: 9201808 bytes, checksum: d609b11e7e91baf9efe4ad77f7a31d67 (MD5) Previous issue date: 2010 / Resumo: O objetivo deste estudo foi avaliar a influência da Hipoterapia no treino de marcha em indivíduos hemiparético pós-AVC. O estudo constou de 20 indivíduos divididos em dois grupos (A e B), o grupo A realizou tratamento convencional e o grupo B, tratamento convencional e Hipoterapia, durante 16 semanas. Os pacientes foram avaliados pela Escala Modificada de Aswhorth, Escala de Fugl-Meyer, Escala de Equilíbrio de Berg, Escala de Deambulação Funcional, a Cadência e o Questionário genérico de Qualidade de Vida -SF36, no início e no final do tratamento. Nos resultados melhoras significativas foram observadas no grupo experimental incluindo melhora do tônus apenas dos flexores plantares (p=0,0268), comprometimento motor em membros inferiores (p= 0,004), o equilíbrio, em relação ao tempo (p= 0,007) e a independência na marcha apresentou uma tendência à significância (p = 0.0519). A cadência e a velocidade não apresentaram relevância estatística em ambos os grupos (p = 0,69 e 0,44). Em relação à qualidade de vida, no total da pontuação da escala, houve significância entre os grupos. O experimental melhorou significativamente (p=0,007), já o controle não (p-valor= 0,80). Nos itens Capacidade Funcional, Aspectos Físicos e Saúde Mental houve diferença entre os grupos (p= 0,0273; 0,0156 e 0,0410). No grupo experimental houve melhora significativa nos Aspectos Físicos (p= 0,0019), no item Saúde Mental houve uma tendência a significância (p=0,0619) e na Capacidade Funcional não existiu melhora (p= 0,08). No controle não houve melhora significativa na Capacidade Funcional (p= 0,1828) e nos Aspectos Físicos e Saúde Mental houve piora, porém sem significância (p= 0,3078 e 0,4297). Os domínios, Dor, Estado Geral de Saúde, Vitalidade, Aspectos Sociais e Limitação por Aspecto Emocional não apresentaram melhoras significativas. Com os achados no estudo conclui-se, que a Hipoterapia associada à fisioterapia convencional mostrou ser um bom recurso para a melhora da marcha e da qualidade de vida dos indivíduos hemiparéticos / Abstract: the objective of this study was to evaluate the influence of Hippotherapy in gait training in post-stroke hemiparetic individuals. The study consisted of 20 individuals divided into two groups (A and B). Group A performed a conventional treatment, and group B a conventional treatment along with Hippotherapy, during 16 weeks. The patients were evaluated by the Modified Scale of Aswhorth, Fugl-Meyer Scale, only the lower limbs and balance sub items, Balance Scale of Berg, Functional Ambulation Category Scale, Cadence and the Medical Outcomes Study 36-item Short-Form Health Survey - SF-36, in the beginning and end of treatment. In the results, significant improvements were observed in the experimental group including spasticity improvement, only in the plantar flexors (p=0,0268), motor impairment in lower limbs (p = 0.004), balance, over time (p = 0.007), the gait independence showed a significant trend over time (p = 0.0519). The cadence and speed were not significantly in both groups (p = 0.69 and 0.44). As to life quality, there was significance between groups in scale score total. The experimental group improved significantly (p=0.007), yet the control group not (p= 0.80). In the Functional Capacity, Physical Aspects and Mental Health item there was a difference between the groups (p= 0.0273; 0.0156 e 0.0410). In the experimental group there was a significant improvement in Physical Aspects (p= 0.0019), the Mental Health item showed a significant trend (p=0.0619) and Functional Capacity did not present significant improvements (p= 0.08). In the control group the Functional Capacity item did not show significant improvements (p= 0.1828) and Physical Aspects and Mental Health items presented worsening, but not significant (p= 0.3078 e 0.4297). The domains Pain, General Health State, Vitality, Social Aspects and Limitation by Emotional Aspect did not present significant improvements. With the findings of this study, it is possible to conclude that Hippotherapy associated to conventional physical therapy proved to be a good resource to improve gait and the quality of life of hemiparetic individuals / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

Stroke is now a well-recognised risk factor for hip fracture. The aim of this study was to elucidate the pathophysiological mechanisms by which hip bone loss occurs in hemiplegia and to test the efficacy of a novel pharmaceutical strategy for preserving bone in stroke patients. Patients who were admitted acutely with a first-ever stroke and who remained unable to walk one week later were studied prospectively for 12 months, with a series of bone mineral density measurements of the hips (dual energy X-ray absorptiometry) in the context of a randomised controlled trial. Untreated patients (n=13) experienced a decline in bone mineral density at the hemiplegic hip that was rapid, with the greatest losses in the trochanteric region of the affected side. This bone loss was prevented by the administration of a single 4 mg dose of the intravenous bisphosphonate, zoledronate (n=14) within 35 days of stroke onset. Computed tomography of the hips in 8 untreated patients more than a year after stroke confirmed that the greatest difference between sides was in the trochanteric region. Serum vitamin D measurements in 44 patients with acute stroke were substantially lower than healthy elderly controls, with 77% of patients in the insufficient range, suggesting that vitamin D insufficiency preceded stroke. Histomorphometric analysis of iliac bone biopsies from hemiplegic patients 10 weeks following stroke showed normal erosion parameters, but a striking decrease in the surface extent of osteoid when compared with healthy reference values. Unexpectedly, treatment with zoledronate was associated with a significantly higher osteoid surface compared with placebo treated subjects in cancellous, endocortical and cortical bone. Sclerostin, a newly discovered osteocyte-derived protein was studied using immunohistochemical staining of the bone biopsies. Sclerostin is known to be an inhibitor of active osteoblasts, which led to the hypothesis that in stroke, the proportion of osteocytes expressing sclerostin would be inversely associated with the surface extent of bone formation. Histological analysis revealed widespread expression of sclerostin in osteocytes and their canaliculi in all subjects. However, examining individual osteocytes in relation to bone forming surfaces revealed that newly embedded osteocytes did not express sclerostin until after primary mineralisation. It is proposed that this precise pattern and timing of sclerostin expression by osteocytes allows bone formation to continue locally (during remodelling), but prevents excessive new bone formation elsewhere, as seen in the single gene disorder sclerosteosis.

L'hémiplégie est une préoccupation mondiale pour la santé; C'est une partie de la Paralysie Cérébrale (PC) où une moitié verticale du corps est affectée. Cela peut avoir un impact significatif sur le niveau du handicap. Les déficiences motrices concernant les membres supérieurs, sont fréquentes chez les personnes hémiplégiques. Ces handicaps surviennent en raison de la perte de la communication entre le cerveau et le côté affecté du corps. Dans cette thèse, une stimulation visuelle, audio et tactile a été fournie aux patients pour une réhabilitation de ces membres affectés. La stratégie de contrôle haptique a été développée en utilisant des dispositifs haptiques, qui sont moins coûteux. Des scénarios de Réalité Virtuelle (RV) pour la thérapie haptique-RV, ont été développés afin de s'assurer la cohérence entre les flux visuels, audio et tactiles. Un dispositif haptique à 3 degrés de liberté (DDL) (Novint Falcon) que nous avons associé à un dispositif de rotation avec 1 DDL, que nous avons réalisé, a été utilisé pour appliquer cette stratégie de contrôle en mode-actif. La stratégie développée fournit des trajectoires libres dans des scènes RV et force feed-back dans d'autres directions, autrement dit modèle ‘résistant aux besoins’. Deux méthodes ont été développées pour évaluer les performances des membres supérieurs ciblés. La première méthode a été développée en utilisant une kinectTM pour Windows. Cet appareil a été choisi et utilisé dans notre système en raison sa portabilité, de son espace de travail, de sa facilité d'utilisation et de son prix bas. Le but principal de cette méthode d'évaluation est de valider la relation entre les différents scénarios de RV et le type de mouvement effectué par les membres supérieurs affectés des enfants. La deuxième méthode d'évaluation a été développée en utilisant les données collectées du système lui-même afin de fournir aux thérapeutes la qualité et la quantité de performance à chaque type de mouvements. Cette méthode a été construite en utilisant l'approche de la logique floue. Enfin, trois expériences ont été réalisées. Deux expériences de thérapie et une expérience d'évaluation. Les résultats illustrent la faisabilité de notre approche. Des perspectives ont été données en vue d’une validation au près d’un groupe d’enfant hémiplégique plus important dans l’avenir. Ce travail nécessite une préparation importante et une coordination sur le très long terme avec le corps médical et les familles des enfants atteints. / Hemiplegia is a global concern for health; it is a part of Cerebral Palsy (CP) where a vertical half of the body is affected. This can have a significant impact on the level of disability. Upper extremity motor impairments are common in hemiplegic patients. These disabilities occur because of the loss of communication between the brain and the affected side of the body. In this thesis, visual, audio and tactile stimulation was provided to patients for rehabilitation of these affected limbs. The haptic control strategy has been developed using haptic devices, which are less costly. Virtual Reality (VR) scenarios for haptic-VR therapy have been developed to ensure coherence between visual, audio and tactile flows. A 3-degree-of-freedom (DOF) haptic device (Novint Falcon) which we have associated with a rotation device with 1 DOF, which we have realized, has been used to apply this active-mode control strategy. The developed strategy provides free trajectories in VR scenes and forces feedback in other directions, 'resistant when needed' model. Two methods have been developed to evaluate the performance of the targeted upper limbs. The first method was developed using a kinectTM for Windows. This device was chosen and used in our system because of its portability, workspace, ease of use and low price. The main purpose of this evaluation method is to validate the relationship between the different VR scenarios and the type of movement performed by the affected upper limbs of children. The second evaluation method was developed using the collected data from the system itself in order to provide the therapists with the quality and the quantity of the performance for each type of movements. This method was constructed using the fuzzy logic approach. Finally, three experiments were carried out. Two therapy experiments and one evaluation experiment. The results illustrate the feasibility of our approach. Prospects have been given for validation with a larger group of hemiplegic children in the future. This work requires considerable preparation and coordination over the very long term with the medical profession and the families of affected children.

Bakgrund: Stroke drabbar miljontals människor världen över varje år och medför ofta ensidiga motoriska nedsättningar som allvarligt reducerar förmågan till självständighet i vardagen. Fysioterapin efter stroke sker därför vanligen genom uppgiftsorienterad träning riktad mot att rehabilitera den motoriska förmågan på den affekterade sidan så att patienten kan återgå till ett självständigt liv. Men processen ställer stora krav på patienten som inte alltid kan förväntas uppnå bästa resultat med sin rehabilitering. Därför forskas det alltmer på innovativa teknologiska hjälpmedel med potential att assistera strokepatient såväl som fysioterapeut i rehabiliteringen. Exoskelett och hjärndatorgränssnitt (BCI) är två sådana hjälpmedel som undersöktes i denna studie. Syfte: Studien hade syftet att sammanställa det vetenskapliga stödet för tillämpning av BCI-styrda exoskelett (BCI-Exo) vid rehabilitering av motorisk arm- och handfunktion efter stroke i dess subakuta samt kroniska fas. Metod: Litteratursökningar utfördes i databaserna PEDRO, PUBMED, AMED och CINAHL vilket gav 22 träffar som efter granskning och sållning resulterade i att fyra artiklar inkluderades i studien. Resultat: Samtliga studier redovisade statistiskt signifikanta förbättringar av motorisk handfunktion i interventionsgruppen jämfört med kontrollgruppen utifrån de utfallsmått som tillämpades. Konklusion: Resultatet indikerade att BCI-Exo kan främja återhämtning och neuroplasticitet för strokepatienter oavsett vilken fas de infinner sig i. Dock är teknologin fortfarande relativt ny varvid fler studier behöver utföras för att bättre specificera och förstå för- och nackdelar jämfört med konventionella behandlingsmetoder. / Background: Stroke affects millions of people around the world each year and often results in unilateral motor impairments that severely reduce the ability for independence in everyday life. Physiotherapy after stroke is therefore usually performed through task-oriented training aimed at rehabilitating the motor functional ability of the affected side so that the patient can return to an independent life. But the process places great demands on the patient who cannot always be expected to achieve the best results from their rehabilitation. Therefore, innovative technologies are increasingly being researched with the potential to assist stroke patients as well as physical therapists in the rehabilitation process. Exoskeletons and brain-computer interfaces (BCI) are two such rehabilitative tools that were investigated in this study. Objective: The study aimed to compile the scientific support for the use of BCI-controlled exoskeletons (BCI-Exo) in motor functional arm and hand rehabilitation after stroke in its subacute and chronic phase. Method: Literature searches were conducted in the databases PEDRO, PUBMED, AMED and CINAHL, which resulted in 22 hits which, after review and screening, resulted in four articles being included in the study. Results: All studies reported statistically significant improvements regarding motor function in the hemiplegic hand in the intervention group compared to the control group based on the outcome measures used. Conclusion: The results indicated that BCI-Exo can promote recovery and neuroplasticity after stroke regardless of its phase. However, the technology is still in its early stages and more studies need to be performed to better specify and understand the advantages and disadvantages compared to conventional treatment methods.

Young children with HCP experience difficulties performing age-appropriate daily activities such as self-care and play. Research in neuroplasticity has shown that intensive, task-specific training in early development is ideal to maximize functioning in children with HCP. The aim of this study was to analyze the feasibility of a new manualized clinical guideline, Family Activity Adaptation Model (FAAM), via Telehealth to coach families to develop daily activities and routines that facilitate functional bimanual skills in young children with hemiplegic cerebral palsy (HCP). Ten caregivers and children with HCP (3-7 years) received virtual training on how to embed bimanual intensive training (HABIT) into their everyday activities and routines on their own at home for 90 minutes a day, 5 days a week over 8 weeks. Caregivers and children received virtual coaching using the FAAM method 2 times per week. FAAM Activity Analysis was used to describe manual development. Daily activity logs were used to assess family adherence and home program feasibility. Bimanual functional goal performance and satisfaction was measured using the Canadian Occupational Performance Measure (COPM). Perceived changes in overall bimanual functional skills were evaluated using the Mini-Children’s Hand Use Experience Questionnaire (Mini-CHEQ). Caregiver stress, burden and program satisfaction was monitored using the Parenting Stress Index (PSI-4-SF), the Ease of Caregiving for Children measure and a caregiver satisfaction survey. The measures were assessed immediately prior to (pretest), midpoint (burden measures only, repeated measures ANOVA) and immediately after (posttest, Wilcoxon Sign Rank Test) the intervention. All families made statistically and clinically significant improvements in goal performance (p=.008) satisfaction (p=.007), and overall bimanual hand use (p=.035). All families completed daily logs and practiced strategies for an average of 81.37 (SD=7.069) minutes a day. Caregiver burden and stress remained consistent throughout the study and all caregivers reported satisfaction with the program. This is the first study to manualize a family centered, telehealth-delivered intensive motor training program. This study adds a continuum of care and access to services for children and families with limited resources. The study supports clinicians with home program design and meets the individual needs of families using resources in their natural environment.