Magistrinio darbo tikslas yra įvertinti medicininės reabilitacijos sistemos reformos pagrindinius trūkumus ir privalumus, nustatyti pagrindinius tai įtakojančius veiksnius ir remiantis analizės duomenimis bei reabilitacijos sistemos kūrime dalyvaujančių ekspertų nuomone, pateikti pasiūlymus kaip gerinti reabilitacijos paslaugų teikimo kokybę ir prieinamumą Lietuvoje. Darbo teorinėje dalyje analizuojami reabilitacijos sistemos pokyčių teoriniai pagrindai. Nagrinėjami norminiai aktai, moksliniai darbai ir kiti literatūros šaltiniai , aprašantys reabilitacijos sistemos raidą, struktūrą, reabilitacijos etapus, paslaugų rūšis bei jų vietą Lietuvos Nacionalinėje sveikatos sistemoje. Praktinėje dalyje analizuojami reabilitacijos sistemos pokyčiai Lietuvoje nuo 1992 m. iki 2005 m. Analizę sudaro trys dalys. Pirmoje dalyje analizuojami teisės aktai turėję įtaką reabilitacijos sistemos pokyčiams, buvo įvertintas kiekvieno jų tiesioginis poveikis reabilitacijos paslaugų struktūrai bei sąsajos su Lietuvos reabilitacijos strategijoje įvardintais reabilitacijos sistemos kūrimo principais. Antroje dalyje buvo atlikta reabilitacijos efektyvumo statistinių rodiklių analizė. Analizuota reabilitacijos paslaugų struktūra jos rodiklių kitimai bei teisės aktų, įtaka šiems pokyčiams. Trečioje dalyje apibendrinami anketinės apklausos duomenys. Tam, kad įvertintume reabilitacijos sistemos paslaugų kitimą bei reabilitacijos sistemos reformos sėkmę Lietuvoje, atlikta ekspertų apklausa. Buvo... [to full text] / The purpose of the master paper is to evaluate the key advantages and drawbacks of the reform of the medical rehabilitation system, to establish its influencing factors and, based on the data of analysis and the opinion of the experts participating in the development of the rehabilitation system, to develop suggestions how to improve the quality and accessibility of the rehabilitation services in Lithuania. In the theory part of the paper the theoretical base of the changes in the rehabilitation system are analysed. Legal acts, scientific papers and other sources of literature dealing with the development, structure, steps of rehabilitation, types of services and their place in the National Health Care System in Lithuania. The practical part analysis the changes in the rehabilitation system in the period From 1992 to 2005. The analysis consists of three parts. The first part deals with the legal acts, which influenced the changes in the rehabilitation system, the direct impact of each of them on the structure of services and the correlation with the principles defined in the Lithuanian Rehabilitation System Development Strategy. The second part contains the analysis of the statistical data of the rehabilitation efficiency. The structure of the rehabilitation services, the changes in its indexes and the influence of the legal acts have been analysed. The third part summarise the data of the questionnaire. A survey among experts has been carried with the purpose to... [to full text]

The occurrence of total knee replacements is increasing in the United States for persons over the age of 45 because they are inexpensive and a very effective method for treating degenerative joint diseases. Rehabilitation requires regular access to a wide variety of resources and personnel and, as the demand for post-operative, rehabilitative care increases, the ability to marginally relieve the healthcare system by offloading resources to the patient is necessary. Tools to enable tracking a patient’s rehabilitative progress at home are an essential method to help unload the healthcare system. The purpose of this project is to design and develop a wearable home rehabilitation device for knee replacement. This thesis utilizes design ethnography tools such as expert interviews, rehabilitation observation, a participatory design workshop, iterative development, and an idea feedback study. Leveraging advancements in technology and the field of eTextiles, this study investigates the product feasibility and acceptance of discreet on-body sensors to provide a product that enables patients to better perform rehabilitation on their own, but also to allow for a feedback loop for physicians and therapists to view patient progress.

Context. In the forthcoming years Healthcare Systems will become better informed, more efficient and particularly focused on the patient through the integration of Information and Communication Technologies. Medical Rehabilitation is an example of a field prone for this evolution. Here, disciplines such as Software Engineering will play a key role during the transformation. Objectives. This study pursues to understand todays rehabilitation therapies and procedures, to conceive how future computer-aided rehabilitation systems should be constructed and to provide a coherent framework that conceptualizes the relationship of their main components and interactions. Methods. The overall thesis work involves a combination of different research methodologies, which vary from literature reviews, empirical observations and semi-structured ethnographic interviews, to constructive research, through software architectural designs. Results. FIAP-RT is a framework created to support the new paradigm on how future software tools oriented to Medical Rehabilitation should be constructed with views to achieve quality attributes such as interoperability, availability, security, accessibility, usability or reliability. Conclusions. This study reveals that it is generally hard to find a real socialization and dissemination of the know-how that is being constantly produced within rehabilitation centers. In addition, it is has been shown how applied Software Engineering can help to integrate advanced solutions even though further evaluation would be needed to validate the proposed framework. / Internet: http://about.me/victor_caslab Phone: (+34) 676026094

In order for stroke subjects to gain functional recovery of their hemiparetic limbs, facilitation techniques such as the repetitive facilitation exercise, or RFE, have been developed. Currently, there is a lack of understanding of the neural mechanisms associated with these types of facilitation techniques. To better understand the neural mechanisms associated with the RFE a functional magnetic resonance imaging (fMRI) study should be conducted. This thesis presents experimental results testing the feasibility of implementing an fMRI-compatible actuator to facilitate a myotatic reflex in synchronization with the subject’s intention to move their hemiparetic limb. Preliminary data from a healthy individual demonstrated the feasibility of overlapping the long latency component of the afferent myotatic reflex, created by electrical stimulation, with descending nerve impulses, created using transcranial magnetic stimulation, in a time window of 15ms. In addition, a pneumatic actuation time delay due to long transmission line was evaluated. The pneumatic actuator met the timing precision requirement for the rehabilitation device for varying transmission line lengths. Therefore a pneumatic actuation system was chosen for the rehabilitation device. This thesis will also presents on the design of an fMRI-compatible pneumatic actuator device to excite a stretch reflex response. Initial, experimental results with the device demonstrated that the designed pneumatic device can control the timing of the muscle response with a fixed signal within the required 15ms window required for cortical facilitation, which was found in the previous feasibility study. However, the device was unable to create a long latency reflex observable at the muscle. Finally, this thesis presents on the capability of the device in creating subthreshold long latency response with precision to overlap with a subthreshold descending nerve impulse, created using transcranial magnetic stimulation. The overlap of the two responses was evaluated by comparing the amplitude of the muscle response with and without the stretch reflex, created by the fMRI-compatible pneumatic actuator device. Varying time delays were analyzed.

Orientador: Alberto Cliquet Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T03:56:05Z (GMT). No. of bitstreams: 1 Cacho_EnioWalkerAzevedo_M.pdf: 5346795 bytes, checksum: 6e74c1ae0171c8a520aa3738fe6e1bc4 (MD5) Previous issue date: 2004 / Resumo: O efeito do treino de marcha através da estimulação elétrica neuromuscular (EENM) em pacientes com lesão da medula espinhal (LME) tem sido bem estabelecido. A medula espinhal humana reconhece apropriadas informações sensoriais e pode modular respostas motoras que facilitam a locomoção através do treinamento de marcha EENM assistido. Neste trabalho, dez pacientes (9 homens e uma mulher; 19 - 40 anos) com LME crônica (7 completas e 3 incompletas, nível neurológico abaixo de TI) foram avaliados no Laboratório de Biomecânica e Reabilitação do Aparelho Locomotor/Unicamp, no início e no fim de um programa de 30 sessões de treinamento de marcha assistido com EENM. Instrumentos utilizados para mensuração foram: American Spinal Injury Association (ASIA), Escala de Capacidade de Deambulação, Medida de Independência Funcional (MIF), Escala Modificada de Ashworth e o Registro Multicanais da Eletromiografia de superficie (EMG) dos músculos sóleos (SO), gastrocnêmios mediais (GA) e tibiais anteriores (TA) bilaterais. Os resultados demonstraram uma melhora do padrão EMG nos músculos GA e SO, durante a fase de apoio, e uma significante redução na fase de oscilação. A melhora no padrão EMG do TA ocorreu apenas à esquerda. Os resultados sugerem que o treino de marcha assistido com EENM pode induzir mudanças nos centros medulares espinhais / Abstract: The useful effect of locomotion training through neuromuscular electrical stimulation (NMES) in patients with spinal cord injury (SCI) has already been established. The human spinal cord recognizes the appropriate sensorial information and can modulate responses about the motor pool which facilitates walking under NMES training. In this series, ten patients (9 male and 1 female; 19 - 40 yrs-old) with chronic spinal cord injury (seven complete and three incompIete, neurologic leveI beIow T2) were evaluated at the Biomechanics & Rehabilitation Lab./University Hospital-Unicamp: first as soon as the patients joined the Programme and after 30 NMES based gait sessions. Clinical protocoIs of the American Spinal Injury Association (ASIA), Ability Ambulation Scale, Functional Independence Measure (FIM), Modified Ashworth Scale and the multichannel register surface of Electromyography (EMG) of muscIe soIeous (SO), gastrocnemious medialis (GA) and tibialis anterior (TA) were assessed. Results demonstrated an improvement in the EMG pattem of GA and TO muscles, during the stance phase and a significant decrease in the swing phase. Improvement in the EMG pattem in the TA muscle occurs just in the Ieft leg. Results suggest that gait training with NMES does induce changes in the spinal cord neural center, thus triggering the recovering of functional abilities/gait of paraplegics / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

Thesis (MScSportSc)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: The purpose of the study was to measure the responses of chronic obstructive pulmonary disease patients to an exercise programme in a South Africa setting. Nine subjects were evaluated before and after aerobic and resistance training three times a week for the total of 12 weeks. Each evaluation measured forced expiratory lung function; health-related quality of life; functional capacity; level of dyspnea; body composition; physician global evaluation; and the patient global evaluation. The exercise programme consisted of one-hour exercise sessions, three times a week for 12 weeks. The exercise sessions included elements of aerobic and resistance training of the upper and lower extremities. Functional capacity improved drastically (p < 0.01), as did the physician and the patient global evaluations (p < 0.01 and p < 0.01, respectively). Levels of dyspnea also improved (p < 0.01). Health-related quality of life improved marginally (p = 0.03). No significant change was noted in lung function and body composition. The study concluded that an exercise programme consisting of aerobic and resistance training improves chronic obstructive pulmonary disease patients' health-related quality of life, functional capacity and levels of dyspnea. Exercise also reduces the symptoms of chronic obstructive pulmonary disease as are perceived by the physician and patient alike. Exercise does not change lung function or body composition of chronic obstructive pulmonary disease patients. Exercise in conjunction with appropriate medical treatment has the potential to benefit all chronic obstructive patients in South Africa. Keywords: COPD, quality oflife, functional capacity, rehabilitation, exercise. / AFRIKAANSE OPSOMMING: Die doel van die studie was om die reaksies te meet van pasiënte met chroniese obstruktiewe pulmonêre siekte op 'n oefenprogram in 'n Suid-Afrikaanse konteks. Nege proefpersone is voor en na aërobiese en weerstandsoefening drie keer per week vir 'n totaal van 12 weke geëvalueer. Elke evaluering het die volgende gemeet: geforseerde ekspiratoriese longfunksie, gesondheidsverwante lewenskwalitiet, funksionele kapasiteit; dispneevlak, liggaamsamestelling; geneesheer algehele evaluering asook pasiënt algehele evaluering. Die oefenprogram het uit een-uur sessies bestaan, wat drie keer per week vir 12 weke plaasgevind het. Die oefensessies het elemente van aërobiese en weerstandsoefeninge van die boonste en onderste ledemate ingesluit. Funksionele kapasiteit het drasties verbeter (p < 0.01), net so ook die geneesheer en pasiënt algehele evaluerings (p < 0.01 en p < 0.01, respektiewelik). Dispneevlakke het ook verbeter (p < 0.01). Gesondheidsverwante lewenskwaliteit het marginaal verbeter (p = 0.03). Geen beduidende veranderinge is in die longfunksie en liggaamsamestelling gevind nie. Die studie het bevind dat 'n oefenprogram wat uit aërobiese en weerstandsoefening bestaan gesondheidsverwante lewenskwaliteit, funksionele kapasiteit asook dispneevlakke van pasiënte met chroniese obstruktiewe pulmonêre siekte verbeter. Oefening verminder ook die simptome van chroniese obstruktiewe pulmonêre siekte soos waargeneem deur beide die geneesheer en pasiënt. Oefening verander ook nie longfunksie of liggaamsamestelling van pasiënte met chroniese obstruktiewe pulmonêre siekte nie. Oefening tesame met die geskikte mediese behandeling kan voordelig wees vir chronies obstruktiewe pasiënte in Suid- Afrika. Keywords: KOPS, lewenskwaliteit, funksionele kapasiteit, rehabilitasie, oefening.

The diploma thesis deals with the coordinated rehabilitation. Coordinated rehabilitation is a coherent process of medical, educational, vocational and social rehabilitation, whose main objective is to minimalize the consequences, based on the individual's disability. Successful rehabilitation consists in ensuring early, continuous and coordinated efforts of the fastest and widest participation of persons with disabilities in the usual activities of life.The theoretical part consists of six basic chapters. The first one is devoted to the International Classification of Functioning, Disability and Health, which is followed by the subchapter dealing with disabilities and consequently mental disabilities. I have focused on people with mental disabilities, as an organization where research was conducted, providing services to these people. The second chapter contains information about coordinated rehabilitation. The remaining chapters deal with the individual components of a coordinated rehabilitation, which are medical, educational, vocational and social rehabilitation. The aims of this thesis is to determine how the system of coordinated rehabilitation is used in the Institute of social care Domečky. A partial aim is to determine the importance of a system of coordinated rehabilitation for clients of the Institute of social care Domečky. There are two research questions in the connection with the thesis aims. The main research question is: How are the individual components of a coordinated rehabilitation applied in the Institute of social care Domečky? The particular research question finds positives provides system of coordinated rehabilitation for clients of the Institute of social care Domečky.Qualitative research was chosen for the practical section of the thesis. I have used the questioning method and the technique of the semi-controlled dialoque, Results were evaluated using the method of make the clusters. The selected group consisted of 11 employees of the Institute of social care Domečky. The respondents have been chosen intentionally, according to the criterion of willingness to participate in research. The results are divided into two sections according to the research questions. The first section deals with the way the use of individual components of the coordinated rehabilitation in the Institute of social care Domečky. These results are also divided by the individual components of coordinated rehabilitation for greater clarity. The first part contains the identification of the respondents. Following parts: medical rehabilitation, educational rehabilitation, vocational rehabilitation and social rehabilitation.The second part of results includes the subjective opinions of the respondents on the benefits of coordinated rehabilitation and its benefit to the clients of the organization.The research has shown ignorance of the concept of coordinated rehabilitation. Within medical rehabilitation it was found that health care is provided by nurses and practical doctor. The organization also works with hospitals and polyclinics, which are next to the organization. The research, which is devoted to educational rehabilitation, results divided terminology used in special education. Vocational rehabilitation can be used by clients within a job in the kitchen and the laundry in the organization or employment in the civic association Pferda which offer a job in a cafe, a cleaning company and a bakery.Within the social rehabilitation it was described the relationship of key worker and client and the creation of individual planning. It was clarified the issue of social security benefits when clients receive invalidity pensions, care allowance, alternatively child benefit. From the perspective of respondents the benefit of coordinated rehabilitation is in complex care for clients that is devoted them.

Cerebrovascular accident (CVA, stroke) is a disease that affects the central nervous system. Many people, even younger in age, have suffered the stroke, and especially in developed countries. For adults it falls into the most common causes of disability. Greater attention is now focused on medical rehabilitation, but all the elements of rehabilitation are important. The status after stroke results in physical, psychological and social consequences. Therefore, early and coordinated rehabilitation is important, since it increases the possibility of the person´s integration. The diploma thesis aims to describe particular components of coordinated rehabilitation granted to the patients after the CVA in the treatment and rehabilitation centre Chvaly. More specifically, the author tries to analyse the coherence of the individual components of coordinated rehabilitation. In the theoretical part, the author focuses at first on the definition of the CVA, follows up with a general treatise about the coordinated rehabilitation, and then she specifies coordinated rehabilitation for patients after the CVA, and briefly describes the facility under examination. To achieve the objective there has been used qualitative research, the method of questioning, the technique of a semistructured interview. The research sample includes people after the CVA, and the staff of the treatment and rehabilitation centre Chvaly, applying specific elements of rehabilitation. Research indicates that in the examined centre they use therapeutic and social elements, where the treatment dominates. The treatment center puts emphasis on self-sufficiency of a person after the CVA, working with the family and a multidisciplinary team, which is also perceived by the clients after the CVA. The results of the diploma thesis can serve as a feedback for the examined treatment centre, they can be used to improve the quality of coordinated rehabilitation. This work can be used as a source of information for people after the CVA and their families.

As alterações neuro-motoras podem diminuir os movimentos, as atividades de vida diária e o convívio social. Dentro dessas alterações encontram-se as dispraxias ou apraxias dos movimentos que podem desequilibrar o movimento voluntário, principalmente dos músculos do tornozelo e desenvolver uma rigidez do movimento conhecida como "pé equino" diminuindo o apoio do calcanhar e consequentemente o controle do equilíbrio do corpo dificultando a deambulação. Como fonte de ajuda às pessoas acometidas por esse problema, desenvolveu-se um equipamento denominado Baropodômetro que utiliza o conceito de biofeedback, fornecendo informações audiovisuais, com o propósito de estimular e ou corrigir a falta de apoio do calcanhar no solo auxiliando na percepção do equilíbrio e correção da marcha. O equipamento faz a leitura da pressão aplicada pela parte da frontal e traseira dos pés sobre o solo por meio de sensores colocados em palmilhas e acomodados em calçados (e.g., sandálias). Essa ação é traduzida visualmente através de números mostrados em displays e por colunas de leds que acendem em sequência na medida em que a pressão sobre os sensores aumentam, bem como por um sinal de áudio com frequência variável e volume ajustável produzido por um alto-falante interno. O equipamento pode armazenar os dados coletados em um cartão de memória que pode ser lido em um microcomputador, permitindo montagens de tabelas e gráficos para análise posterior viabilizando o planejamento da ação de reabilitação. Com o auxilio de um método de reabilitação, o aparelho foi validado clinicamente com a participação de um grupo de dez pacientes voluntários que obtiveram um excelente resultado (i.e., todos os pacientes após 10 sessões conseguiram apoiar o pé comprometido) mostrando que é possível a reabilitação com a utilização do aparelho desenvolvido. / The neuro-motor changes can reduce the movements, activities of daily living and social life. Within these changes are the dyspraxia or apraxia of movements that can unbalance the voluntary movement, especially of the ankle muscles and develop a stiffness of movement known as "equinus foot". The equinus foot decreases the heel support and consequently the balance control of the body making it difficult to walking properly. As a source of help to people affected by this problem, we developed a device called Baropodometer that uses the concept of biofeedback, providing audiovisual information in order to stimulate and or correct the absence of heel strike on the ground assisting in the realization and correction of balance and gait. The device reads the pressure applied by the front and rear part of the foot on the ground by means of sensors placed in insoles and accommodated in shoes (e.g., sandals). This action is translated visually through numbers shown in displays and columns of LEDs that are illuminated according to the increase of the pressure on the sensors, as well as an audio signal with variable frequency and adjustable volume produced by an internal buzzer. The device can store the collected data in a memory card that can be read on a microcomputer, allowing creation of tables and graphs for further analysis enabling the planning of rehabilitation action. With the help of a method of rehabilitation, the device was clinically validated with the participation of ten volunteers who achieved an excellent result (i.e, all patients after 10 sessions were able to properly support the equinus foot) showing that the rehabilitation is possible with the use of the developed device.

Capes / A tetraplegia é uma lesão na medula espinhal, que compromete o tronco, os membros superiores e inferiores e músculos respiratórios. Nas lesões completas, a função motora e sensorial abaixo do nível da lesão apresenta-se comprometida. Nas lesões incompletas ou parciais, ocorre a preservação da função motora e sensitiva, não havendo padrões definidos de recuperação. A estimulação elétrica já vem sendo utilizada para indução respiratória diafragmática. Neste trabalho, foram avaliados 10 indivíduos tetraplégicos, de ambos os sexos, na faixa etária de 18 á 48 anos, durante 10 sessões onde foram aplicados anamnese, avaliação inicial constando sinais vitais, cintometria, manovacuometria, oximetria, avaliação do nível da lesão, e a avaliação do déficit motor e respiratório. Aplicaram-se dois métodos utilizando o sistema de Eletroestimulação sincronizada: o primeiro com sincronização manual, FESSM (Estimulação Elétrica Funcional) e o segundo, usando o MD2, com sincronização automática. A função muscular do Diafragma foi avaliada antes e depois das aplicações de estimulação elétrica, cuja intenção era potencializar a ação, possibilitando um melhor recrutamento muscular e, conseqüentemente, uma melhor reeducação muscular respiratória. Quanto a análise comparativa entre os métodos, após a intervenção com equipamento I observou-se melhores resultados em relação aos parâmetros sinais vitais e manovacuômetria. Com a intervenção do equipamento II, observou-se melhores resultados nos parâmetros oximetria e grau de dispnéia. O equipamento I apresentou resultados satisfatórios em relação a função do sistema digestório, principalmente em pacientes com lesão medular incompleta. / The tetraplegia is an injury in the spinal cord that compromises the motor and sensitive systems commanded by the spinal cord below of that damage level. Respiratory muscles are compromises too. In complete injuries, motor and sensorial function completely damaged. In the incomplete or partial injuries, motor and sensitive function occurs, but no recovery pattern is known. The electric stimulation is used nowadays for respiratory induction. In this work, 10 tetraplegic patients had been evaluated, both gender, ages range from 18 to 48 years, during 10 sessions where anamneses were applied. Vital signals motor respiratory disfunction, and injury level were evaluated. The system of synchronized electrostimulation was applied using two methods: the first one with manual synchronization; FESSM; and the second one, using the MD2, with automatic synchronization. The muscular function of the Diaphragm was evaluated before and after the applications of electrostimulation. The comparative analysis between the two methods, had shown better results after the intervention with equipment I regarding the parameters and vital signs of manovacuometry. With the intervention of equipment II, it was observed better results in the pulse parameters and degree of dyspnea. The equipment I had shown satisfactory results for the function of the digestive system, especially in patients with incomplete spinal cord injury.