Anti-pronation taping is commonly used by clinicians in the management of lower limb musculoskeletal pain and injury. Despite its frequent use in the clinical setting the mechanism(s) underlying its efficacy is not completely understood. For example, there is evidence that anti-pronation taping produces a biomechanical effect, but there has been little investigation of other mechanisms such as neurophysiological or psychological effects. Additionally, studies to date have been performed in mostly asymptomatic populations and have focused on the initial effect of tape (i.e. immediately following application and through a short duration of activity). Improved understanding of the underlying physiological mechanism(s) of anti-pronation tape is likely to facilitate improved knowledge of the technique, which may optimise its clinical application and contribute to clinical selection guidelines. The aims of this thesis were developed to address several of the limitations in the current anti-pronation taping literature. To facilitate an investigation of the comparative initial physiological effect of anti-pronation tape in a symptomatic and asymptomatic population, the first aim of this thesis was to compare neuromotor control (control of muscle activation and movement patterns) of gait, foot posture and foot mobility between asymptomatic individuals and individuals with a history of exercise related leg pain. The second aim of this thesis was to investigate the initial physiological effects of anti-pronation tape, specifically its neurophysiological (i.e. effect on muscle activation patterns) and biomechanical (i.e. effect on movement patterns, foot posture, foot mobility) effects. Thirdly this thesis aimed to investigate the duration of these initial physiological effects following tape removal. The fourth and fifth aims were to investigate the long term biomechanical and neurophysiological effects of anti-pronation taping i.e. following continual use over a clinically relevant period. In the first instance our aim was to investigate the effect of continual use on neuromotor control of gait, foot posture and foot mobility, and secondly to investigate the effect of continual use on the technique’s initial neurophysiological and biomechanical effects. Individuals with exercise related leg pain demonstrated lower activation of gluteus medius and lateral gastrocnemius during gait, but we observed no differences in lower limb movement patterns or foot posture and foot mobility between the two groups. The initial effect of tape was similar in individuals with and without exercise related leg pain. Specifically application of tape produced a reduction in activation of tibialis posterior, tibialis anterior and medial gastrocnemius, and increased activation of peroneus longus. There was a reduction in foot mobility, ankle plantarflexion and abduction excursion and an increase in ankle dorsiflexion and adduction excursion. Reduced muscle activation and increased motion was also observed at more proximal segments (knee, hip, pelvis), but were of smaller magnitude than at the foot and ankle. Changes in foot mobility, ankle kinematics and leg muscle activity did not continue following the removal of tape, but at more proximal segments (i.e. pelvis, hip and knee) small changes in kinematics and muscle activity were observed following the removal of tape. In regards to long term effects, continual use of tape for approximately 12 days produced a small increase in arch height when compared to a control. We did not observe a change in muscle activation or motion patterns, nor did continual use of the technique influence its initial neurophysiological or biomechanical effects (i.e. reduction in muscle activity, reduction in foot mobility, altered lower limb motion). The studies from this thesis provide evidence that anti-pronation tape should be considered in the management of individuals where reduced midfoot mobility, control of ankle motion or reduced activation of the leg muscles is desired, regardless of symptomatic status. When applied for approximately 12 days, anti-pronation tape produced a small increase in arch height ratio, but no alteration in neuromotor control. We are not aware of any definitive data on what constitutes a clinically meaningful increase in arch height, but results from a published case series suggests that our findings of a small increase in arch height may be clinically relevant for the treatment of lower extremity overuse injuries. Continual use of tape for a clinically relevant period does not alter its initial effects on foot posture and mobility or neuromotor control during gait. It would appear that the initial effects of anti-pronation tape are robust even after continuous use over a period of 11 days.

[Truncated abstract] In cricket, the bowler propels a ball using a straight arm (permitted minimal extension) in an overhead fashion to a batsman situated approximately 20m away, who attempts to strike the ball in order to score runs for their team. Cricket bowling can be generalised by two types of bowlers; fast bowlers, who primarily use high ball speed, and spin bowlers that attempt to impart spin on the ball causing it to bounce in different directions. There has been numerous studies investigating the kinematics of fast bowling in cricket, but there is a paucity of objective literature on the spin bowling action due to the complex rotations of the upper limb necessary to develop ball velocity and rotation. One primary reason is that three dimensional (3D) analysis of upper limb movement is difficult due to the high degrees of freedom and ranges of motion of the associated joints. Furthermore, existing methods do not allow measurement of the kinematics of this highly dynamic task to be performed in an ecologically sound environment. The complexity is further compounded as the upper limb does not perform regular cyclical movements like the lower limb does with gait. Therefore, this makes it difficult to determine what

Anti-pronation taping is commonly used by clinicians in the management of lower limb musculoskeletal pain and injury. Despite its frequent use in the clinical setting the mechanism(s) underlying its efficacy is not completely understood. For example, there is evidence that anti-pronation taping produces a biomechanical effect, but there has been little investigation of other mechanisms such as neurophysiological or psychological effects. Additionally, studies to date have been performed in mostly asymptomatic populations and have focused on the initial effect of tape (i.e. immediately following application and through a short duration of activity). Improved understanding of the underlying physiological mechanism(s) of anti-pronation tape is likely to facilitate improved knowledge of the technique, which may optimise its clinical application and contribute to clinical selection guidelines. The aims of this thesis were developed to address several of the limitations in the current anti-pronation taping literature. To facilitate an investigation of the comparative initial physiological effect of anti-pronation tape in a symptomatic and asymptomatic population, the first aim of this thesis was to compare neuromotor control (control of muscle activation and movement patterns) of gait, foot posture and foot mobility between asymptomatic individuals and individuals with a history of exercise related leg pain. The second aim of this thesis was to investigate the initial physiological effects of anti-pronation tape, specifically its neurophysiological (i.e. effect on muscle activation patterns) and biomechanical (i.e. effect on movement patterns, foot posture, foot mobility) effects. Thirdly this thesis aimed to investigate the duration of these initial physiological effects following tape removal. The fourth and fifth aims were to investigate the long term biomechanical and neurophysiological effects of anti-pronation taping i.e. following continual use over a clinically relevant period. In the first instance our aim was to investigate the effect of continual use on neuromotor control of gait, foot posture and foot mobility, and secondly to investigate the effect of continual use on the technique’s initial neurophysiological and biomechanical effects. Individuals with exercise related leg pain demonstrated lower activation of gluteus medius and lateral gastrocnemius during gait, but we observed no differences in lower limb movement patterns or foot posture and foot mobility between the two groups. The initial effect of tape was similar in individuals with and without exercise related leg pain. Specifically application of tape produced a reduction in activation of tibialis posterior, tibialis anterior and medial gastrocnemius, and increased activation of peroneus longus. There was a reduction in foot mobility, ankle plantarflexion and abduction excursion and an increase in ankle dorsiflexion and adduction excursion. Reduced muscle activation and increased motion was also observed at more proximal segments (knee, hip, pelvis), but were of smaller magnitude than at the foot and ankle. Changes in foot mobility, ankle kinematics and leg muscle activity did not continue following the removal of tape, but at more proximal segments (i.e. pelvis, hip and knee) small changes in kinematics and muscle activity were observed following the removal of tape. In regards to long term effects, continual use of tape for approximately 12 days produced a small increase in arch height when compared to a control. We did not observe a change in muscle activation or motion patterns, nor did continual use of the technique influence its initial neurophysiological or biomechanical effects (i.e. reduction in muscle activity, reduction in foot mobility, altered lower limb motion). The studies from this thesis provide evidence that anti-pronation tape should be considered in the management of individuals where reduced midfoot mobility, control of ankle motion or reduced activation of the leg muscles is desired, regardless of symptomatic status. When applied for approximately 12 days, anti-pronation tape produced a small increase in arch height ratio, but no alteration in neuromotor control. We are not aware of any definitive data on what constitutes a clinically meaningful increase in arch height, but results from a published case series suggests that our findings of a small increase in arch height may be clinically relevant for the treatment of lower extremity overuse injuries. Continual use of tape for a clinically relevant period does not alter its initial effects on foot posture and mobility or neuromotor control during gait. It would appear that the initial effects of anti-pronation tape are robust even after continuous use over a period of 11 days.

Impairments of upper limb function can negatively impact an individual???s ability to carry out everyday tasks. Children with cerebral palsy can have limitations of upper limb movement due to physiological and structural changes in their body. Current treatment regimes for children with upper limb involvement of cerebral palsy are assessed using a variety of qualitative assessment tools. These measures rely on subjective input from the assessor, and can be insensitive to significant functional improvements. Research methods in upper limb motion analysis are developing towards use as clinical tools. To date, there is a paucity of knowledge on the quantitative measures of range of motion (ROM) and function of upper limbs in healthy children. There is also lack of agreement on repeatable functional tasks of the upper limb for 3D measurement. The identification of a repeatable task in healthy children would facilitate the use of upper limb 3D motion analysis to guide clinical practice and improve patient outcomes. This thesis aims to describe upper limb joint range of movement in each degree of freedom and present normative three dimensional kinematic data of upper limb movement in healthy children during a repeatable upper limb functional task. This will provide a basis for comparison to children with movement disorders for future research and clinical practice. The UNSW kinematic upper limb model was found to successfully measure three dimensional upper limb anatomical and functional movements in healthy children. Normative kinematic data are reported for anatomical movements and two functional tasks. The results of the studies undertaken showed that differences in dominant and non-dominant limbs were present during anatomical and functional movements. Joint angles measured were found to be repeatable in healthy children. The results suggest that methods used were reliable for investigating upper limb kinematics. Functional movement time-series data were found to be repeatable for the group with the exception of wrist flexion/extension during the hand to mouth movement for both the dominant and non-dominant limbs. These findings improve current knowledge on upper limb kinematics in healthy children. This knowledge can assist the investigation of movement disorders in children to facilitate clinical decision making.

Impairments of upper limb function can negatively impact an individual???s ability to carry out everyday tasks. Children with cerebral palsy can have limitations of upper limb movement due to physiological and structural changes in their body. Current treatment regimes for children with upper limb involvement of cerebral palsy are assessed using a variety of qualitative assessment tools. These measures rely on subjective input from the assessor, and can be insensitive to significant functional improvements. Research methods in upper limb motion analysis are developing towards use as clinical tools. To date, there is a paucity of knowledge on the quantitative measures of range of motion (ROM) and function of upper limbs in healthy children. There is also lack of agreement on repeatable functional tasks of the upper limb for 3D measurement. The identification of a repeatable task in healthy children would facilitate the use of upper limb 3D motion analysis to guide clinical practice and improve patient outcomes. This thesis aims to describe upper limb joint range of movement in each degree of freedom and present normative three dimensional kinematic data of upper limb movement in healthy children during a repeatable upper limb functional task. This will provide a basis for comparison to children with movement disorders for future research and clinical practice. The UNSW kinematic upper limb model was found to successfully measure three dimensional upper limb anatomical and functional movements in healthy children. Normative kinematic data are reported for anatomical movements and two functional tasks. The results of the studies undertaken showed that differences in dominant and non-dominant limbs were present during anatomical and functional movements. Joint angles measured were found to be repeatable in healthy children. The results suggest that methods used were reliable for investigating upper limb kinematics. Functional movement time-series data were found to be repeatable for the group with the exception of wrist flexion/extension during the hand to mouth movement for both the dominant and non-dominant limbs. These findings improve current knowledge on upper limb kinematics in healthy children. This knowledge can assist the investigation of movement disorders in children to facilitate clinical decision making.

Impairments of upper limb function can negatively impact an individual???s ability to carry out everyday tasks. Children with cerebral palsy can have limitations of upper limb movement due to physiological and structural changes in their body. Current treatment regimes for children with upper limb involvement of cerebral palsy are assessed using a variety of qualitative assessment tools. These measures rely on subjective input from the assessor, and can be insensitive to significant functional improvements. Research methods in upper limb motion analysis are developing towards use as clinical tools. To date, there is a paucity of knowledge on the quantitative measures of range of motion (ROM) and function of upper limbs in healthy children. There is also lack of agreement on repeatable functional tasks of the upper limb for 3D measurement. The identification of a repeatable task in healthy children would facilitate the use of upper limb 3D motion analysis to guide clinical practice and improve patient outcomes. This thesis aims to describe upper limb joint range of movement in each degree of freedom and present normative three dimensional kinematic data of upper limb movement in healthy children during a repeatable upper limb functional task. This will provide a basis for comparison to children with movement disorders for future research and clinical practice. The UNSW kinematic upper limb model was found to successfully measure three dimensional upper limb anatomical and functional movements in healthy children. Normative kinematic data are reported for anatomical movements and two functional tasks. The results of the studies undertaken showed that differences in dominant and non-dominant limbs were present during anatomical and functional movements. Joint angles measured were found to be repeatable in healthy children. The results suggest that methods used were reliable for investigating upper limb kinematics. Functional movement time-series data were found to be repeatable for the group with the exception of wrist flexion/extension during the hand to mouth movement for both the dominant and non-dominant limbs. These findings improve current knowledge on upper limb kinematics in healthy children. This knowledge can assist the investigation of movement disorders in children to facilitate clinical decision making.

No description available.

Contrairement aux mammifères adultes, l’amputation d’un membre de vertébrés capables de régénérer, est suivie de la formation d’une structure hautement proliférative et hétérogène : le blastème. Les conditions de formation de ce blastème sont encore mal connues. La sécrétion de facteurs par les cellules dérivées de la crête neurale CCN, seraient à l’origine de la prolifération du blastème. De plus, les macrophages sont recrutés sur le site d’amputation et participeraient à la régénération mais leurs mécanismes d’actions et interactions avec les CCN n’ont jamais été étudiés dans ce contexte. Mon projet de thèse avait pour but d’élucider ces mécanismes en s’appuyant sur deux modèles de régénération : la régénération de la nageoire chez la larve de zebrafish et le membre supérieur de l’embryon de souris au stade E10.5. Ces travaux ont permis :• Chez la larve de zebrafish : d’identifier deux sous-types de macrophages recrutés de manière séquentielle au cours de la régénération, de montrer que l’activation de la voie TNFa/TNFR1 par les macrophages était nécessaire à la prolifération du blastème, d’identifier une population de CCN foxd3+ dans la nageoire dont la présence est indispensable au recrutement et à la polarisation des macrophages ainsi qu’à la prolifération des cellules du blastème.• Chez l’embryon de souris : d’identifier un stade régénératif (E10.5) et non régénératif (E12.5), de montrer l’accumulation de CCN au niveau du site d’amputation au stade E10.5 et de démontrer le rôle de ces cellules dans le processus de régénération. / Unlike in adult mammals, in regenerative species, appendage amputation is followed by the formation of a highly proliferative and heterogeneous structure called the blastema. The required conditions for its formation are still not completely understood. Paracrine factors produced by neural crest derived cells (NCC) have been proposed to be responsible for blastemal cell proliferation. Moreover, macrophages are recruited to the wound site and could participate to the regeneration process. However, their exact functions and interactions with NCC during regeneration have never been investigated. My thesis project consisted in deciphering those mechanisms using two different models: zebrafish larva caudal fin regeneration and forelimb bud regeneration of the E10.5 mouse embryo. This work allowed us:• In zebrafish larva: to identify two subpopulations of macrophages, to highlight their roles during regeneration, to demonstrate the role of the TNFa/TNFR1 axis in the blastemal cell proliferation and to identify a new foxd3+ NCC population in the caudal fin, which is required for macrophage recruitment, polarization and for blastemal cell proliferation. •In mouse embryo: to identify a regenerative (E10.5) and non-regenerative (E12.5) stage of development, to demonstrate the accumulation of NCC at the wound site in E10.5 embryos and demonstrate the crucial role of NCC during epimorphic regeneration in mammals.

Orientador: Antonio Guilhermo Borges Neto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas. / Made available in DSpace on 2018-08-12T03:50:01Z (GMT). No. of bitstreams: 1 Oliveira_Robertade_D.pdf: 4460655 bytes, checksum: f3f50fd7e512e461cbe4b77ba1053ad9 (MD5) Previous issue date: 2008 / Resumo: O acidente vascular cerebral (AVC) é reconhecido como uma das maiores causas de morbidade e mortalidade. Seqüelas decorrentes deste evento podem levar à incapacidade motora e déficits de leves a severos. Para classificar melhor a disfunção sensitivo-motora, o equilíbrio e as habilidades para as atividades de vida diária (AVD's), escalas de avaliações quantitativas e qualitativas estão sendo amplamente utilizadas. O objetivo do Artigo 1 foi verificar a correlação existente entre a Escala de Fugl-Meyer (FM), Escala de Equilíbrio de Berg (EEB) e Índice de Barthel (IB). Foram recrutados 20 pacientes com diagnóstico de AVC crônico, que passaram pelas avaliações por cerca de uma hora. Os resultados demonstraram que a FM se correlaciona positivamente com o IB e a EEB, mostrando que, quando utilizadas em conjunto, classificam de forma esclarecedora o quadro físico geral do paciente com AVC. Após o AVC, o comprometimento da função do membro superior é a seqüela mais comum, podendo ser permanente. Os movimentos de alcance feitos com o membro superior hemiparético são freqüentemente acompanhados por movimentos compensatórios de tronco e cintura-escapular. O uso da terapia de restrição de tronco visa evitar a movimentação compensatória de tronco, propiciando o desenvolvimento de padrões motores mais próximos do normal no braço afetado. Através do uso de escalas de mensuração clínica, foram observados os benefícios da terapia de restrição de tronco em 11 sujeitos com seqüela de AVC que passaram por 20 sessões de treinamento (Artigo 2). Em um segundo estudo (Artigo 3), 20 sujeitos foram recrutados e divididos em dois grupos de treinamento (20 sessões): Grupo com Tronco Restrito (GTR - treinamento de alcance com o tronco restrito) e o Grupo com Tronco Livre (GTL - treinamento de alcance sem restrição de tronco, enfatizando o uso da orientação verbal). O objetivo foi verificar os benefícios a longo prazo do treinamento de alcance tarefa-específica associado à terapia de restrição de tronco, utilizando como instrumentos de medida as escalas clínicas (Escala Modificada de Ashworth, FM, IB e EEB) e a avaliação cinemática do movimento (deslocamento, velocidade, angulação). As avaliações foram divididas em três momentos: a primeira foi realizada na admissão (PRÉ); a segunda, no final do período total de treinamento (PÓS) e a terceira, três meses após o término do tratamento (RET). O treinamento tarefa-específica associado à terapia de restrição de tronco (GTR) mostrou-se eficaz a longo prazo para a melhora dos movimentos articulares ativos de ombro e cotovelo, além de propiciar melhora no planejamento interno do movimento. Em contrapartida, o uso contínuo da restrição provocou dependência aos pacientes e não foi eficaz na redução dos graus adicionais de liberdade (tronco) a longo prazo. Apesar do treinamento baseado em orientações verbais (GTL) ter sido mais eficaz na retenção do tronco, não houve melhora significativa nas amplitudes articulares voluntárias de membro superior. Acredita-se que os pacientes que passaram por este tipo de tratamento ficaram mais atentos ao recrutamento anormal de graus adicionais de liberdade e não exploraram de forma efetiva as combinações multiarticulares presentes membro superior. / Abstract: Stroke is recognized as one of the major causes of morbidity and mortality. Sequels deriving from this event may lead to motor disability and from mild to severe deficits. In order to better classify sensory-motor dysfunction, balance and ability to perform activities of daily living (ADL), quantitative and qualitative evaluation scales have been used. The aim of Article 1 was to verify the correlation between the Fugl-Meyer Assessment Scale (FM), Berg Balance Scale (BBS) and Barthel Index (BI). Twenty chronic stroke patients were submitted to an evaluation that spent approximately one hour. The results demonstrated that the FM was positively correlated with the BBS and BI, showing that when they are employed together, make it possible to design the general clinical performance of the stroke patient. After stroke, upper limb function impairment is the most common sequel that could lead to permanent dysfunction. Reaching movements made with hemiparetic upper limbs are often followed by compensatory trunk and shoulder-girdle movements. The use of the trunk restraint therapy aims at avoiding the compensatory trunk movement providing the development of normal motor patterns in the affected upper limb. The benefits of the trunk restraint therapy could be observed through the clinical measures scales in eleven stroke subjects that performed twenty training sessions (Article 2). In another study (Article 3), twenty patients were recruited and divided into two training groups (20 sessions): Trunk restraint group (TRG - reaching training with trunk restraint) and trunk free group (TFG - reaching training without trunk restraint, providing emphasis in the verbal cue). The aim was to verify the long term benefits of the task-specific training with trunk restraint using the clinical scales (Modified Ashworth Scale, FM, BI and BBS) and the kinematic analysis (displacement, velocity, angles) like evaluation tools. The evaluations were performed in three phases: the first, in admission time (PRE test); the second, after the end of the treatment (POST test); and the third, three months after the completed treatment (retention test - RET test). Task-specific training associated with the trunk restraint therapy (TRG) proved to be a long-term effective treatment in the enhancement of shoulder and elbow active joint range, as well as in the improvement of the internal planning of the movement. However, the continuous use of restraint may have caused dependence to the patients and was not efficient in long term reduction of the additional degrees of freedom (trunk). Although the verbal cue training (TFG) was more effective in the trunk retention, there was no significant improvement in the upper limb joint ranges. Therefore patients who sustained this type of treatment developed more attention in the abnormal recruitment of the additional degrees of freedom, and did not efficiently explore the multi-joint combinations presented in the upper limb. / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas

Correct number and pattern of digits is determined in a time and concentration-dependent manner by a gradient of Sonic Hedgehog (SHH) across the anterior-posterior axis of the embryonic limb bud. Owing to the potent morphogenic/mitogenic capabilities of SHH, transcription of the SHH gene in the limb is tightly regulated by feedback loops with other signalling pathways and by the Zone of Polarising Activity regulatory sequence (ZRS). The ZRS is a long-range, cis-regulatory limb-specific enhancer of SHH, and is essential for correct limb SHH expression. The Silkie, a polydactylous breed of chicken, possesses a C > A mutation in the ZRS, resulting in ectopic SHH expression in the anterior limb and hindlimb-specific polydactyly. We employ the Silkie mutant to investigate how SHH is regulated by the ZRS, and how Hedgehog signalling can modulate SHH expression in an autoregulatory manner. We further characterise the effects that the Silkie mutation has on subsequent limb development; investigating the dependence of increased posterior SHH, increased Hedgehog-dependent growth and necessary genotype in both the posterior and anterior limb bud. Several fundamental questions regarding SHH during limb development have yet to be fully addressed: how much SHH protein is present, and does it form a gradient as hypothesised by Wolpert’s Morphogen Gradient Model? By developing a standard curve-based method to assess absolute quantities of processed SHH protein, N-SHH, we find that the quantity of N-SHH protein increases through limb development, and does indeed form a quantifiable gradient across the posterior limb. By comparing quantity of N-SHH protein in equivalently staged mouse, rat, emu and chicken limbs, we find that there is no significant link between N-SHH protein quantity and digit number between mammalian and avian species, and investigate how digit number is modulated in the late limb. A number of species exhibit reduced numbers of digits, including the wings of the emu, cassowary and kiwi. Unlike in mammalian examples of digit loss (i.e. cow, pig) the emu wing has delayed and significantly reduced SHH expression. Through sequencing and functional in vivo testing of ZRS sequences of ratite bird species, we investigate whether the ZRS has a role in evolutionary digit loss. We also demonstrate the aspects of digit loss and Hh signalling are shared with examples of mammalian digit loss. This thesis presents novel research into multiple aspects of genetic regulation, limb development, and evolutionary developmental biology; elucidating both long held dogmas and upcoming areas of limb development.