Although a vast literature attests to the belief that psychosocial disturbance is an important component of functional gastrointestinal disorders (FGID), the relation of life stress, psychological distress and personality to the development of these disorders is poorly understood. The broad objective of this thesis is to provide data on relations between psychosocial factors and FGID, especially irritable bowel syndrome (IBS) and functional dyspepsia (FD), in representative outpatient samples. Issues not previously addressed are examined in a series of studies. The first two studies are concerned with relations between psychosocial factors, extraintestinal (somatic) symptoms and the number and type of FGID syndromes present at consultation and, in IBS patients, the prospective relation of psychosocial factors to changes in symptom intensity over 16 months. The last three studies relate psychosocial factors to gastrointestinal (GI) transit, motor, and sensory function in FGID, abnormalities in these parameters representing the putative origin of symptoms in FGID. In total, 350 patients participated, representing a 95% participation rate. Important features of the methodology include the use of a recently standardised symptom-based classification system for FGID, an objective and reliable interview-based life stress instrument (The Life Events and Difficulties Schedule), and sophisticated and sensitive technologies to assess GI transit, motor and sensory function. Novel measures, which conceptually take into account the chronic, fluctuating and recurrent course of IBS and FD syndromes, and the tendency of these syndromes to coexist, are also included. Thus, measures of symptom outcome assess the number of syndromes present, while the symptom intensity variable reflects the severity and frequency of both FD and IBS symptoms, if both are present. Similarly, with respect to altered transit, and motor and sensory function, physiological outcome variables reflect not only the presence of an abnormality but the number of regions affected, and the type and number of abnormalities present. Cross-sectional findings showed for the first time that psychosocial disturbance is associated with FGID symptomatology in a quantitative manner, that chronic life stress threat is central to this process and this stress-related process is a prominent feature of a particular group of syndromes (ie IBS/FD) defined primarily by the presence of pain and discomfort. A combination of psychological, social and biological factors combined to predict the number of FGID syndromes present at entry into the study. Prominent among them was an angry, reactive and anxious (neurotic) personality, chronic life stress threat, increased coping, poor emotional support and increased age. In addition to a greater number of FD/IBS syndromes, individuals with an anger-reactive response style had experienced more intense pain and discomfort, and displayed more complete sensorimotor disturbance. Longitudinal data demonstrated (also for the first time) the strength, consistency and unequivocal direction of the relation of chronic threat to symptom intensity over time. Almost all of the within subject variance in symptom intensity levels (assessed on 3 occasions over a 16 month period) was explained by the severity of chronic threat during the previous 6 months or more. For 76% of IBS patients, the presence vs the absence of one or more highly threatening chronic stressors predicted with considerable precision, the long-term clinical outcome. Thus, no patient exposed to even one such stressor improved clinically (ie by at least 50%) over the follow-up period, while in contrast, all patients who improved clinically did so in the absence of such a stressor. For 24% of patients, however, failure to improve clinically could not be explained by any psychological, social (including life stress) or demographic factor included in this study. Key risk indicators of a poor outcome at 16 months were identified - chronic life stress threat, the severity of baseline GI symptomatology, and female gender. Life stress is important because it alone determined the magnitude and direction of change in symptom intensity over time, while the severity of baseline GI symptomatology revealed the extent of improvement required to achieve a recovery, and female gender predicted the presence of a larger number of FD/IBS syndromes in women long-term. Widespread hypomotility, which was almost exclusive to women in this study, represents one factor that may inhibit improvement (or rate of improvement) for women over time. Finally, these findings have identified a psychophysiological subgroup, with underlying psychosocial, motor (and perhaps also sensory) dysfunctions that are more specific for women than men, and which does not seem to be distinctive of any particular FGID subgroup.

Although a vast literature attests to the belief that psychosocial disturbance is an important component of functional gastrointestinal disorders (FGID), the relation of life stress, psychological distress and personality to the development of these disorders is poorly understood. The broad objective of this thesis is to provide data on relations between psychosocial factors and FGID, especially irritable bowel syndrome (IBS) and functional dyspepsia (FD), in representative outpatient samples. Issues not previously addressed are examined in a series of studies. The first two studies are concerned with relations between psychosocial factors, extraintestinal (somatic) symptoms and the number and type of FGID syndromes present at consultation and, in IBS patients, the prospective relation of psychosocial factors to changes in symptom intensity over 16 months. The last three studies relate psychosocial factors to gastrointestinal (GI) transit, motor, and sensory function in FGID, abnormalities in these parameters representing the putative origin of symptoms in FGID. In total, 350 patients participated, representing a 95% participation rate. Important features of the methodology include the use of a recently standardised symptom-based classification system for FGID, an objective and reliable interview-based life stress instrument (The Life Events and Difficulties Schedule), and sophisticated and sensitive technologies to assess GI transit, motor and sensory function. Novel measures, which conceptually take into account the chronic, fluctuating and recurrent course of IBS and FD syndromes, and the tendency of these syndromes to coexist, are also included. Thus, measures of symptom outcome assess the number of syndromes present, while the symptom intensity variable reflects the severity and frequency of both FD and IBS symptoms, if both are present. Similarly, with respect to altered transit, and motor and sensory function, physiological outcome variables reflect not only the presence of an abnormality but the number of regions affected, and the type and number of abnormalities present. Cross-sectional findings showed for the first time that psychosocial disturbance is associated with FGID symptomatology in a quantitative manner, that chronic life stress threat is central to this process and this stress-related process is a prominent feature of a particular group of syndromes (ie IBS/FD) defined primarily by the presence of pain and discomfort. A combination of psychological, social and biological factors combined to predict the number of FGID syndromes present at entry into the study. Prominent among them was an angry, reactive and anxious (neurotic) personality, chronic life stress threat, increased coping, poor emotional support and increased age. In addition to a greater number of FD/IBS syndromes, individuals with an anger-reactive response style had experienced more intense pain and discomfort, and displayed more complete sensorimotor disturbance. Longitudinal data demonstrated (also for the first time) the strength, consistency and unequivocal direction of the relation of chronic threat to symptom intensity over time. Almost all of the within subject variance in symptom intensity levels (assessed on 3 occasions over a 16 month period) was explained by the severity of chronic threat during the previous 6 months or more. For 76% of IBS patients, the presence vs the absence of one or more highly threatening chronic stressors predicted with considerable precision, the long-term clinical outcome. Thus, no patient exposed to even one such stressor improved clinically (ie by at least 50%) over the follow-up period, while in contrast, all patients who improved clinically did so in the absence of such a stressor. For 24% of patients, however, failure to improve clinically could not be explained by any psychological, social (including life stress) or demographic factor included in this study. Key risk indicators of a poor outcome at 16 months were identified - chronic life stress threat, the severity of baseline GI symptomatology, and female gender. Life stress is important because it alone determined the magnitude and direction of change in symptom intensity over time, while the severity of baseline GI symptomatology revealed the extent of improvement required to achieve a recovery, and female gender predicted the presence of a larger number of FD/IBS syndromes in women long-term. Widespread hypomotility, which was almost exclusive to women in this study, represents one factor that may inhibit improvement (or rate of improvement) for women over time. Finally, these findings have identified a psychophysiological subgroup, with underlying psychosocial, motor (and perhaps also sensory) dysfunctions that are more specific for women than men, and which does not seem to be distinctive of any particular FGID subgroup.

Made available in DSpace on 2014-12-17T14:13:41Z (GMT). No. of bitstreams: 1 RosangelaLMVpdf.pdf: 6510729 bytes, checksum: 435b94e7e33b4eb16da0dd5749f0716b (MD5) Previous issue date: 2009-09-29 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Contextualization: Several studies have examined the mobility of this group of children, however little is known about the impact of motor function in activities of daily living, considering the seriousness of their neuromotor damage. Objective: Identify the functional differences of children with Cerebral Palsy with different levels of motor dysfunction and correlate these differences with the areas of mobility, self-care and social function in functional ability and caregiver?s assistance of these children. Methods: An l analytical cross-section search was developed, which were part 70 children / families aged from 4 to 7.5 years, in the Rehabilitation Center for Children. As tools were used the Pediatric Evaluation Disability Inventory (PEDI) and the Gross Motor Function Classification System (GMFCS). Data analysis was performed by ANOVA and Pearson's correlation tests. Results: The results show the functional variability of children CP in different severity levels of motor disfunction This variation was observed in the areas of mobility, self-care and social function. The results also showed a strong correlation between the domains mobility and self-care, mobility and social function. Conclusions: The variability shown by the children with CP, suggests the use of PEDI and GMFCS as this association appears to increase the understanding of how the gross motor functions are related to activities of daily living, describing the best commitments and their degree of impact on functional activities. This correlation demonstrates how mobility is crucial to evaluate the performance and guide the therapeutic practice, to develop the children?s potencial, and guide the caregiver in stimulation / Contextualiza??o: Diversos estudos t?m avaliado a fun??o motora de crian?as com Paralisia Cerebral (PC), entretanto pouco se sabe sobre as inter-rela??es entre comprometimentos da mobilidade, autocuidado e fun??o social, relacionadas ?s habilidades funcionais da crian?a e ? assist?ncia do cuidador. Objetivo: identificar diferen?as funcionais de crian?as com PC, em diferentes n?veis de disfun??o motora, e correlacion?-las com os dom?nios mobilidade, autocuidado e fun??o social, na habilidade funcional e assist?ncia do cuidador. M?todo: Realizou-se uma pesquisa anal?tica de corte transversal, com 70 crian?as/fam?lias, idade de 4 a 7,5 anos, atendidas no Centro de Reabilita??o Infantil, por meio do Pediatric Evaluation Disability Inventory (PEDI) e do Gross Motor Function Classification System (GMFCS). A an?lise dos dados foi realizada atrav?s da ANOVA e teste de correla??o de Pearson. Resultados: Os resultados indicaram importante variabilidade funcional das crian?as com PC, em diferentes n?veis de severidade da disfun??o motora. Esta varia??o foi observada nos dom?nios mobilidade, auto-cuidado e fun??o social. Os resultados apresentaram tamb?m forte correla??o entre os dom?nios mobilidade e auto-cuidado e mobilidade e fun??o social. Conclus?o: Diante da variabilidade apresentada pelas crian?as, percebe-se a necessidade de aplica??o do PEDI e GMFCS, o que parece aumentar o entendimento sobre a rela??o entre fun??es motoras grossas e atividades da vida di?ria. Esta correla??o demonstra o quanto a mobilidade ? determinante para avaliar o desempenho funcional e orientar a pr?tica terap?utica, no sentido de desenvolver as potencialidades das crian?as, bem como orientar o cuidador na estimula??o

O tratamento de reabilitação motora compreende o emprego de um conjunto de técnicas terapêuticas que visam incitar a ocorrência da plasticidade cerebral, atividade fisiológica na qual o sistema nervoso central busca estabelecer novas ligações sinápticas para promover a recuperação da função neuromuscular. Observando-se as técnicas atualmente empregadas e fundamentando-se no fato da criança apresentar alta capacidade de sofrer plasticidade neural, decidiu-se desenvolver um sistema mecatrônico interativo como ferramenta de auxílio ao tratamento de reabilitação de crianças com deficiência motora nas pernas. O presente trabalho descreve a implementação deste sistema, composto por uma bicicleta instrumentada, integrada a um ambiente virtual de aparência lúdica, desenvolvidos com o objetivo de proporcionar a execução dos exercícios físicos de forma divertida e cativante, estimulando a ocorrência de uma plasticidade neural mais rápida e eficiente. Ao final do trabalho são relatadas algumas demonstrações práticas realizadas, onde foram avaliados os níveis de motivação das crianças, além de alguns depoimentos médicos a respeito das expectativas do projeto. / The rehabilitation treatment consists in a set of therapeutic techniques that try to stimulate cerebral plasticity. Cerebral plasticity is a physiologic phenomenon where the brain searches for new neural connections to supply the deficient function. lt is known that the young brain has a high cerebral plasticity capacity. Based on this, an interactive mechatronic system was developed to assist the rehabilitation treatment of children with motor disturbances in their legs. This system is composed of an instrumented bicycle and an entertaining virtual world generated by computer, developed to stimulate the child to accomplish the physical activities in a captivating and fun way and, consequently, increasing the cerebral plasticity performance. ln the end of this document some practical experiments were reported, showing the motivation of the children. Some medical opinions regarding the expectations of the project were also reported.

O tratamento de reabilitação motora compreende o emprego de um conjunto de técnicas terapêuticas que visam incitar a ocorrência da plasticidade cerebral, atividade fisiológica na qual o sistema nervoso central busca estabelecer novas ligações sinápticas para promover a recuperação da função neuromuscular. Observando-se as técnicas atualmente empregadas e fundamentando-se no fato da criança apresentar alta capacidade de sofrer plasticidade neural, decidiu-se desenvolver um sistema mecatrônico interativo como ferramenta de auxílio ao tratamento de reabilitação de crianças com deficiência motora nas pernas. O presente trabalho descreve a implementação deste sistema, composto por uma bicicleta instrumentada, integrada a um ambiente virtual de aparência lúdica, desenvolvidos com o objetivo de proporcionar a execução dos exercícios físicos de forma divertida e cativante, estimulando a ocorrência de uma plasticidade neural mais rápida e eficiente. Ao final do trabalho são relatadas algumas demonstrações práticas realizadas, onde foram avaliados os níveis de motivação das crianças, além de alguns depoimentos médicos a respeito das expectativas do projeto. / The rehabilitation treatment consists in a set of therapeutic techniques that try to stimulate cerebral plasticity. Cerebral plasticity is a physiologic phenomenon where the brain searches for new neural connections to supply the deficient function. lt is known that the young brain has a high cerebral plasticity capacity. Based on this, an interactive mechatronic system was developed to assist the rehabilitation treatment of children with motor disturbances in their legs. This system is composed of an instrumented bicycle and an entertaining virtual world generated by computer, developed to stimulate the child to accomplish the physical activities in a captivating and fun way and, consequently, increasing the cerebral plasticity performance. ln the end of this document some practical experiments were reported, showing the motivation of the children. Some medical opinions regarding the expectations of the project were also reported.