Introdução: A exposição ambiental ao chumbo é uma questão séria do ponto de vista de saúde pública, pois quando ocorre nos primeiros meses e anos de vida pode levar a sequelas neurológicas e comportamentais graves. Objetivos: 1- Determinar a concentração de chumbo obtida por meio de microbiópsias de esmalte realizadas in vivo em esmalte de dentes permanentes ou decíduos de pacientes com problemas neurológicos em tratamento ambulatorial no HCFMRP-USP e comparar os resultados em diferentes grupos de acordo com o diagnóstico. 2- Verificar o perfil dos valores de chumbo segundo informações relacionadas à exposição a esse metal dos referidos pacientes. Método: Uma microbiópsia foi realizada in vivo na superfície do esmalte de crianças de 5 a 12 anos, de ambos os gêneros, atendidas sequencialmente, sem conhecimento sobre a doença, em dois ambulatórios da área de Neurologia do HCFMRP-USP. O chumbo foi medido por espectrometria de absorção atômica com forno de grafite, e o fósforo foi medido colorimetricamente para determinarmos a profundidade da microbiópsia. Uma vez que a profundidade da microbiopsia não pode ser prevista, mas é um factor que influencia o resultado e que temos conhecimento que as concentrações de chumbo diminuem a partir da superfície para o interior do esmalte uma fórmula matemática foi utilizada para calcular a quantidade de chumbo que seria teoricamente encontrada em cada dente à mesma profundidade, e à profundidade seleccionada foi a média de todas as profundidades. As mães ou acompanhantes responderam a um questionário sobre fatores de risco de exposição ao chumbo. Os diagnósticos neurológicos foram obtidos por análise dos prontuários, posteriormente às microbiópsias, sendo criados cinco grupos independentes de crianças, com base na queixa principal: 1 - síndrome motora, SM (N=31); 2 - epilepsia, E (N=25); 3 - cefaléia, C (N=13); 4 - dificuldade escolar, DE (N=11); 5 - distúrbio do comportamento, DC (N=32). Resultados: A profundidade média das microbiópsias foi 3,16 m. Nas concentrações de chumbo obtidas não houve distribuição de Gauss, assim os valores de média, valores máximos e mínimos obtidos em cada grupo foram: 1 - 103,0, 395,0; 2,0. 2 - 64,8, 233,0; 4,0. 3 - 140,3, 434,0; 10,0. 4 - 135,8, 366,0; 38,0. 3 - 158,3, 476,0; 1,9. A análise dos valores de chumbo evidenciou que não houve correlação entre a idade das crianças e os valores de chumbo (Pearson r = -0,016; p = 0,86). Não se observou diferença significativa entre os gêneros (t-test p = 0,55) e também entre os dentes decíduos e permanentes (t-test p= 0,11). Quanto aos grupos com diagnósticos neurológicos, comparando os cinco grupos (ANOVA oneway), houve significância com valor de p= 0,004. O pós teste de Tukey evidenciou diferença significativa, sendo menores os valores de chumbo no grupo com epilepsia em relação aos grupos com dificuldade escolar e distúrbio de comportamento. Na análise dos fatores de risco, ocorreu maior número de crianças que brincam com pilhas no grupo cuja queixa principal era cefaléia em relação ao grupo com deficiência motora (p= 0,002). Não houve diferenças significativas, em nível de 5%, quanto aos valores de chumbo entre os casos com respostas positivas (p=0,53) ao questionário, nem entre as negativas (p=0,99) e nem entre ambos, comparando-se cada um dos fatores. O mesmo ocorreu na análise intragrupo para cada um dos cinco grupos de diagnósticos e entre os grupos. Conclusões: No presente estudo, encontramos maiores valores de chumbo no esmalte superficial em grupos de crianças com dificuldade escolar e distúrbio do comportamento em relação àquele com epilepsia; e ainda, o achado de que os fatores ambientais de risco estudados não tiveram relação com as diferenças observadas entre esses grupos suscita indagações e necessidade de aprofundamento em pesquisas sobre os efeitos danosos do chumbo no tecido neural, mesmo quando se trata de uma população que vive em áreas consideradas sem risco ambiental e com valores de chumbo no sangue (quando são medidos, o que não é o caso deste estudo) abaixo do limite de intervenção. / Background: The environmental exposure to lead is a serious issue from the standpoint of public health, because when it occurs in the first months and years of life it can lead to serious neurological and behavioral consequences. Objectives: 1 - To determine the concentration of lead obtained by an micro biopsy in vivo on permanent teeth enamel or deciduous teeth of patients with neurological problems in outpatient treatment in HCFMRP-USP and compare results in different groups according to diagnosis. 2 - To check the profile of the values of lead according to information related to exposure to the metal of these patients. Method: A micro biopsy was performed in vivo on enamel of children 5-12 years of both genders, attended sequentially, without knowledge of the disease in two clinics in the area of Neurology, USP-HCFMRP. Lead was measured by graphite-furnace atomic absorption spectrometry, and phosphorus was measured colorimetrically to determine the depth of the micro biopsy. Since the micro biopsy depth cannot be anticipated, but is a factor that does influence the result, since lead concentrations are known to decrease from the surface to the inner enamel, a mathematical formula was used to calculate how much lead would be theoretically found in each tooth at the same depth, and the depth selected was the mean of all depths obtained. The mothers or caretakers answered a questionnaire on risk factors for lead exposure. The neurological diagnoses were obtained by analyzing the charts, then the micro biopsy, and created five independent groups of children based on chief complaint: 1 - motor impairment, MI (N = 31), 2 - epilepsy, E (N = 25), 3 - headache, H (N = 13), 4 - school difficulties, SD (N = 11), 5 - behavioral disorder, BD (N = 32). Results: The mean micro biopsy depth of all tests was 3.16 m. The lead concentrations obtained did not follow Gaussian distribution, and median, maximal and minimum values for each group are as follows: 1 - 103,0, 395,0; 2,0. 2 - 64,8, 233,0; 4,0. 3 - 140,3, 434,0; 10,0. 4 - 135,8, 366,0; 38,0. 3 - 158,3, 476,0; 1,9. The analysis of lead values showed no correlation between the age of the children and the values of lead (Pearson r = -0.016, p = 0.86). There was no significant difference between genders (t-test p = 0.55) and also between the primary and permanent teeth (t-test p = 0.11). As for the groups with neurological disorders, comparing the five groups (one-way ANOVA) showed significant p-value = 0.004. The post Tukey test showed significant differences, with smaller values of lead in the group with epilepsy compared to those with school difficulties and behavior disorders. In the analysis of risk factors, a greater number of children playing with piles in the group whose main complaint was headache in the group with motor disabilities (p = 0.002). There were no significant differences in the 5% level, about the values of lead among the cases with positive responses (p = 0.53) to the questionnaire or between the negative (p = 0.99) nor between the two, comparing each of the factors. The same is true for the intragroup each of the five diagnostic groups and between groups. Conclusions: In the present study, we found higher values of lead in the enamel surface in groups of children with school difficulties and behavioral disturbances in relation to that with epilepsy, and also the finding that environmental risk factors studied were not associated with the differences observed between these groups raises questions and need for further research on the harmful effects of lead on neural tissue, even when the population leaves in an environment with no known contamination with lead and shows blood lead concentrations (which is not the case of this study) that are lower than the values considered harmful to health.

Este trabalho teve como objetivo tentar compreender, conceituar e apresentar o trabalho psicológico realizado com pacientes neurológicos por meio da clínica do acompanhamento terapêutico (AT), orientado psicanaliticamente. Esta intervenção clínica, ainda inédita na literatura especializada em acompanhamento terapêutico, foi desenvolvida junto às minhas atividades como docente em um curso de graduação em Psicologia. Em função deste outro aspecto inerente ao trabalho, também abordei a atividade de supervisão e procurei enfocar as particularidades do ensino de AT a estudantes de Psicologia, em um estágio profissionalizante. A orientação teórica a sustentar a atividade clínica e docente foi psicanalítica, tendo como principal chave de leitura as produções da Teoria dos Campos, por sua contribuição ao resgate do método psicanalítico. Esta orientação teórica nos levou a outras questões, relativas ao ensino da técnica psicanalítica e sua adequação à prática do AT. Com isso, investigamos certos parâmetros técnicos, discutidos segundo a clínica do AT, como o setting terapêutico, a atenção flutuante, a postura em reserva, o uso da transferência e da contratransferência, além da pertinência do brincar no acompanhamento terapêutico. A abordagem dessas questões clínicas partiu da análise do filme O escafandro e a borboleta e de dois casos clínicos. O tratamento dado ao filme, bem como aos pacientes atendidos, foi o mesmo: uma discriminação dos aspectos psicanalíticos e próprios à técnica do AT, relacionados à experiência de supervisão dos alunos. Nesse sentido, os casos trabalhados foram abordados em três planos simultâneos: teórico, clínico e didático. A partir da análise desse corpus de trabalho, surgiram algumas recomendações técnicas aos acompanhantes terapêuticos que utilizam a psicanálise, não sendo possível fazer uma transposição direta da técnica psicanalítica à clínica do AT. Além disso, formamos uma apreensão em conjunto de certos aspectos do trabalho dos acompanhantes terapêuticos com os pacientes neurológicos, indicando a necessária relação interdisciplinar em uma clínica na qual as questões corporais requerem, simultaneamente, um cuidado analítico. Por seu caráter híbrido, em que articula um manejo do vínculo e uma escuta à subjetividade no cotidiano do paciente, o AT mostrou-se uma ferramenta bastante útil no trabalho de reabilitação dos pacientes neurológicos, constituindo-se, assim, um novo e promissor campo de intervenção a esses profissionais / The purpose of this research is to understand, conceptualize and present the psychological work done with neurological patients by means of psychoanalytically oriented therapeutic accompaniment (TA). This clinical intervention, still unheard of in the specialized literature on therapeutic accompaniment, was developed simultaneously with my activities as lecturer at an undergraduate course in Psychology. Due to this other feature inherent to TA work, I also started work as clinical supervisor, focusing on the teaching of the specificities of TA work to Psychology students, in a professionalizing internship. The theoretical orientation on which the clinical and professorial work was based on was psychoanalytical, using the works of Multiple Field Theory as the main reading key, given its contribution to the recovery of the psychoanalytic method. This theoretical orientation led us to other issues, regarding the teaching of psychoanalytic technique and how to adapt it to TA practices. As such, we investigated certain technical parameters, discussed in view of clinical TA work, such as the therapeutic setting, free floating attention, a reserved posture, the use of transference and counter-transference, and also the pertinence of play in therapeutic accompaniment. The discussion of these issues was based on the analysis of a film and two clinical cases. The treatment given to the film The diving bell and the butterfly and to the patients cases was the same: a discrimination of the psychoanalytical aspects specific to TA technique, in regards to the students supervision experience. In this sense, the cases analyzed were approached in three simultaneous planes: the theoretical, the clinical and the didactic. From the analysis of this body of work, we were able to reach some technical recommendations for those working with TA in a psychoanalytical context, given the impossibility of directly transposing psychoanalytical technique to clinical TA work. Furthermore, we achieved a more global understanding of certain aspects of TA work with neurological patients, pointing towards the necessary interdisciplinary relations in a clinic in which physical issues also require simultaneous subjective care. Given its hybrid nature, in which one must articulate a management of the therapeutic bond with a listening of the subjectivity in the patients everyday life, TA has shown itself to be a useful tool in the rehabilitation of neurological patients, asserting itself as a new and promising field of intervention to these professionals

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This thesis involves the study of compressive and infectious neurological diseases in dogs, including the evaluation of functional recovery with intervertebral disc disease (IVD) thoracolumbar paraplegics and without deep pain perception (DPP) underwent surgical treatment, dogs with neurological signs associated to distemper (NSAD) and neoplasms of the central nervous system (CNS). Retrospective studies were conducted by reviewing the records of Veterinary neurology department (Veterinarian Hospital), of Federal University of Santa Maria. 208 cases were analyzed between March 2003 and June 2014. The satisfactory functional recovery of paraplegic dogs without DPP was observed in 73.3% (11/15) of the dogs. Recovery time after surgery occurred in one day [9% (01)], between 15 and 30 days [63.7% (07)] and over than 30 days [27.3% (03)]. 134 dogs with NSSD were studied, 39 definitive diagnosis (Group A) and 95 presumptive diagnosis (Group B). Adults were affected in 60.4%, followed by 31.3% of young and 8.2% old dogs. Neurological signs were varied according to the site of lesions in the CNS. According to the owners, the vaccine was applied only by veterinarians in 68% of dogs and clinical examination was performed in 56%, increasing the risk of vaccine failure. The CNS neoplasms occurred mainly in Boxers (35%), and the predominantly affected age-group was 5-year-old or older (92.3%). The course of clinical signs was higher for spinal cord (7-420 days) than for intracranial neoplasms (7-115 days). The most frequently neurological signs observed in dogs with brain and spinal cord neoplasms were, respectively, changes in the conscience level (58%) and hyperesthesia (57%) in neoplasms of the spinal cord. The cortico-thalamic region and T3-L3 spinal cord segment were the most frequently anatomical sites involved (58% and 43% respectively). Meningioma was the most frequently primary neoplasms affecting the brain and the spinal cord of dogs, consisting respectively of 40% and 75% of the cases. / Esta tese envolveu o estudo de doenças neurológicas compressivas e infecciosa em cães, incluindo a avaliação da recuperação funcional com doença do disco intervertebral (DDIV) toracolombar, paraplégicos e sem percepção à dor profunda (PDP) submetidos ao tratamento cirúrgico, cães com sinais neurológicos associados à cinomose (SNAC) e com neoplasmas do sistema nervoso central. Os estudos retrospectivos foram realizados por meio de revisão dos registros neurológicos de cães atendidos pelo Setor de Neurologia Veterinária, do Hospital Veterinário Universitário (HVU) da Universidade Federal de Santa Maria. Foram analisados 208 casos, entre março de 2003 e junho de 2014. De acordo com nossos resultados, a recuperação funcional de cães paraplégicos sem PDP em decorrência da DDIV toracolombar ocorreu em 73.3% (11/15). O tempo de recuperação funcional após a cirurgia foi de um dia [9% (01)], entre 15 e 30 dias [63.7% (07)] e maior do que 30 dias [27.3% (03)]. Foram incluídos 134 cães com SNAC, sendo 39 com diagnóstico definitivo (Grupo A) e 95 com diagnóstico presuntivo (Grupo B). Os cães adultos foram acometidos em 60.4% das vezes, seguido de 31.3% dos filhotes e 8.2% dos idosos. Os SNAC variaram de acordo com a fase de infecção e distribuição das lesões no sistema nervoso central (SNC). Os resultados normais do líquido cerebroespinhal e hemograma não excluíram o diagnóstico definitivo. A vacina foi aplicada por médicos veterinários em 68% dos cães e a avaliação clínica prévia à vacinação foi realizada em 56% dos pacientes. Os neoplasmas do SNC foram observados principalmente em cães Boxer (35%), com idade entre cinco e 10 anos (92.3%). A evolução dos sinais clínicos foi maior para medula espinhal (ME) (7-420 dias) do que para os intracranianos (7- 115 dias). O sinal neurológico predominante foi a alteração do nível de consciência (58%) em cães com neoplasma encefálico e a hiperestesia espinhal (57%) naqueles com neoplasmas da ME. As regiões tálamo-cortical e segmento medular entre T3-L3 foram as mais acometidas por neoplasias do SNC (58% e 43% respectivamente). O meningioma foi o neoplasma primário mais frequente no encéfalo (40%) e na ME (75%) dos cães avaliados.

Title: Functional assessment after experiemantally induced focal cerebral ischemia in rat. Objectives: The aim of this diploma thesis was to design and test a set of motor tests, which provide an effective assessment of motor deficit, which forms after small ischemic lesion of primary motor cortex. Methods: Experiment was performed in 16 Long Evans rats from breeding in Institute of Physiology, Academy of Sciences of the Czech Republic. Rats were devided into two groups (experimental and control). Ischemic lesion was induced by a photothrombotic stroke model to affect a small area - a motor cortex. For functional assessment we used five motor tests - Reaching test, Bar holding test, Rotarod test, Ladder rung walking test and Oper field test. For data analysis we used program Sigma Stat3.5®SPSS and Microsoft Excel 2010. Results: Our findings demonstrate that a small lesion of motor cortex is objectively measurable by Reaching test, which focuses on grip and fine motor skills. Other tests assess mainly gross motor skills and there we did not find a significant difference between experimental and control group. Our findings show that functional deficit manifests mostly in funkction of upper limb. During the time of the experiment we can see an improvement and increasing success in Reaching test and...

Background A cerebral cavernous malformation (CCM) is a small cluster of thin-walled, dilated blood vessels within the brain which is prone to bleed. Although the quantity of blood leaking tends to be small, even a small intracranial haemorrhage (ICH) can result in a clinically significant neurological deficit. Because some focal neurological deficits (FND) may in fact be haemorrhages that were undetected by imaging, FND were also included in the analysis wherever possible. In Scotland, between 2006 and 2010, the annual CCM detection rate was 0.8 per 100,000 people. Since estimates of prognosis inform decisions about whether to treat CCM, it is crucial that the untreated clinical course of the disease is fully understood. Aim The aims of this thesis are (i) to quantify the risk of ICH (or ICH or FND, referred to as ‘clinical event’) for an untreated adult within five years of CCM diagnosis, (ii) to identify prognostic factors for ICH (clinical event), and (iii) to create a model to predict, at the time of diagnosis, an individual’s risk of a subsequent ICH (clinical event). Methods Initially, a literature review was undertaken. Then data from adults diagnosed with CCM in the Scottish Intracranial Vascular Malformation Study (SIVMS) were analysed. SIVMS is a prospective, population-based cohort study: it includes all adults resident in Scotland at the time of diagnosis of a first-ever intracranial vascular malformation during the two five-year periods 1999–2003 and 2006–2010. Time-to-event methods were employed to compare the estimated risk of ICH (clinical event) for those who experienced a first ICH (clinical event) during untreated five-year follow-up with those who experienced a second ICH (clinical event). A statistical challenge when analysing clinical outcomes from patients with CCM is that the outcome event of ICH or FND is comparatively rare; therefore a larger cohort of CCM patients was required to identify more robustly potential predictors of ICH (clinical event) and to create a prognostic model to predict, at the time of diagnosis, an individual’s risk of a subsequent ICH (clinical event). Three research groups agreed to contribute their data to enable an individual patient data meta-analysis (IPDMA) to be undertaken. Results In the two SIVMS cohorts, 136 (1999–2003) and 165 adults (2006–2010) were diagnosed with CCM. In the earlier cohort, the estimated risk of a first ICH within five years of presentation (2.4%, 95% CI 0.0% to 5.7%) was significantly lower (p < 0.0001) than the risk of a recurrent ICH (31.9%, 95% CI 4.5% to 59.3%), but the annual risk of a recurrence declined over the five-year period. In the same cohort, women had an increased risk of a second clinical event (log-rank χ2(1) = 6.2, p = 0.01). The IPDMA was based on 988 adults, 62 of whom suffered a first ICH within five years of CCM diagnosis. When the data were pooled, the estimated adjusted hazard ratio for first ICH for clinical presentation (ICH/FND vs other presentation) was 4.5 (95% CI 1.5 to 13.4) and for brainstem location (brainstem vs other location) the adjusted hazard ratio was 3.3 (95% CI 1.5 to 7.2); age, sex and CCM multiplicity did not add any additional prognostic information. Conclusion In this thesis two risk factors have been identified that are independently associated with increased likelihood of experiencing an ICH (or clinical event) within five years of diagnosis. A prognostic model has been built and evaluated, based on these factors. Other areas to be explored in the future include external validation of the model and investigating the effects of (i) antithrombotic therapy and (ii) pregnancy on the progression of the disease.

M.Cur. / From out the researchers experience of the critical care nursing practice, a need for clinical learning outcomes was identified. There are no listed guidelines or outcomes of what the critical care learner should be able to do at the end of the program, to function as a competent critical care-nursing practitioner. From the above mentioned problemstatement the following question were asked namely: Which knowledge's, skills, attitudes and values do the critical care learner need to function as a compatend critical care nursing practitioner? The main aim of this study was to compile a manual with clinical learning outcomes for the following disciplines within the critical care practice + Cardiology and cardio-thorasic surgery + General surgery and Pulmonary + Neuro-surgery and trauma From out the constructivistic learning approach a contextual, qualitative and describing study was done.The first objective namely the formulation of clinical learning outcomes from out the literature was done by means of a extensive literature survey. The second and third objective of the study namely the formulation of clinical learning outcomes for the different disciplines within the critical care practices. And compiling a manual for the preceptor in the critical care practice was done simultaneously. The clinical learning outcomes was written directly into the format of a manual. Eighty questioners was handed out to critical care trained registered nurses. The data gathered from out the questioners was used in identifying learning outcomes. There are generic clinical learning outcomes, these outcomes are universal for al the disciplines within the critical care practice. Specific clinical learning outcomes where identified for • Coronary and thoracic surgery • Neuro-surgery and • Trauma Specific learning outcomes are outcomes that are only applicable within that specific discipline. If effective clinical guidance are facilitated by means of the clinical learning outcomes and the learner has reached al the outcomes, he/she should be able to function as a competend critical nursing practitioner.

>Magister Scientiae - MSc / There is a high incidence of dropout in the first year of university studies. Some of the main reasons were attributed to adjustment or adaptation difficulties experienced by the new students which impacted on academic achievement. Much of this difficulty relates to the need to find their identity in relation to the new university environment with new rules, peers, and expectations. The acquisition of a sensory integrative (SI) profile could shed light on an element of the student’s identity. However, very little is known about the relationship between the SI profile and academic achievement. Therefore, the aim of the study was to determine the SI profiles of students and whether there was a relationship between the SI profiles and academic achievement of first year students from the Faculty of the Community and Health Sciences (FCHS) at the University of the Western Cape (UWC).The study followed the quantitative research paradigm and was more specifically a descriptive, cross-sectional study. Measurements included a demographic questionnaire to gather socio-demographic data, as well as the Adolescent and Adult Sensory Profile questionnaire to determine the SI profiles of the students.These instruments were administered to a sample of 357 registered first year students from the FCHS at UWC. Matriculation academic marks, as well as first year university academic marks were obtained and utilised for analysis. The SPSS statistical package was utilised for descriptive and inferential statistical analyses of the data. The results of the study indicated that the SI profiles of the first year FCHS students were that they responded "similarly to most people" on each of the four sensory quadrants of Dunn's (1997) Model of Sensory Processing. Secondary analyses were implemented by means of a collapsing mechanism to denote more specific results of the SI profiles. This analysis revealed that the students tended to have low thresholds for their neurological and behavioural continua of sensory processing.The inferential analyses that were implemented to determine whether there was a relationship between the SI profiles and academic achievement of the first year students yielded no statistical relationship between those variables. The analyses revealed relationships between the SI profiles and certain socio-demographic factors, such as age, race, and course of study.In conclusion, the research study uncovered the SI profiles of the first year university student sample, relationships between the SI profiles and sociodemographics and disproved a relationship between SI profiles and academic achievement. The study was therefore of value to the professions of occupational therapy and higher education and has opened avenues for further exploration. Furthermore the study has portrayed that occupational therapy tools and SI profiles could have a place in higher education and in relation to student development, teaching and learning. / National Research Foundation (NRF)

abstract: Speech is known to serve as an early indicator of neurological decline, particularly in motor diseases. There is significant interest in developing automated, objective signal analytics that detect clinically-relevant changes and in evaluating these algorithms against the existing gold-standard: perceptual evaluation by trained speech and language pathologists. Hypernasality, the result of poor control of the velopharyngeal flap---the soft palate regulating airflow between the oral and nasal cavities---is one such speech symptom of interest, as precise velopharyngeal control is difficult to achieve under neuromuscular disorders. However, a host of co-modulating variables give hypernasal speech a complex and highly variable acoustic signature, making it difficult for skilled clinicians to assess and for automated systems to evaluate. Previous work in rating hypernasality from speech relies on either engineered features based on statistical signal processing or machine learning models trained end-to-end on clinical ratings of disordered speech examples. Engineered features often fail to capture the complex acoustic patterns associated with hypernasality, while end-to-end methods tend to overfit to the small datasets on which they are trained. In this thesis, I present a set of acoustic features, models, and strategies for characterizing hypernasality in dysarthric speech that split the difference between these two approaches, with the aim of capturing the complex perceptual character of hypernasality without overfitting to the small datasets available. The features are based on acoustic models trained on a large corpus of healthy speech, integrating expert knowledge to capture known perceptual characteristics of hypernasal speech. They are then used in relatively simple linear models to predict clinician hypernasality scores. These simple models are robust, generalizing across diseases and outperforming comprehensive set of baselines in accuracy and correlation. This novel approach represents a new state-of-the-art in objective hypernasality assessment. / Dissertation/Thesis / Masters Thesis Electrical Engineering 2020

No description available.

Bakgrund Patienter med neurologiska sjukdomar är ofta i behov av rehabiliterande insatser för att kunna bibehålla kroppsliga funktioner och klara av dagliga aktiviteter. I vissa fall får dessa patienter möjlighet att delta i rehabiliteringsperioder i ett varmt klimat (klimatvård). En rehabiliteringsperiod pågår oftast i 3-4 veckor och inkluderar multidisciplinär vård med bland annat fysioterapi. Det finns en begränsad kännedom gällande upplevelser av fysioterapeutiska insatser vid klimatvård och dess effekter. Syfte Syftet med denna intervjustudie var att undersöka och beskriva erfarenheter och upplevelser av fysioterapeutiska insatser vid klimatvård bland patienter med neurologiska sjukdomar. Design och metod Studien var kvalitativ med en explorativ design där data inhämtades genom fem semistrukturerade intervjuer. Vid databearbetning användes kvalitativ innehållsanalys med induktiv ansats. Resultat Studiens resultat tyder på att den fysioterapeutiska behandlingen var central och att individanpassad intensivträning upplevdes som fördelaktigt av studiens deltagare. Ett patientcentrerat arbetssätt framkom som viktigt för rehabiliteringens resultat. Andra faktorer som beskrevs som värdefulla och påverkade den totala rehabiliteringen var det varma klimatet, det sociala utbytet med andra deltagare samt att komma ifrån sin vardagliga kontext. Ökad motivation till fysisk aktivitet framkom som en viktig effekt av att få klimatvård. Konklusion Socialt stöd, det varma klimatet och lyhörd rehabiliteringspersonal bidrog till en positiv upplevelse av de fysioterapeutiska insatserna vid klimatvård. Upplevelser av ökad motivation till fysisk aktivitet och fler positiva hälsoeffekter innebär att klimatvård skulle kunna betraktas som ett värdefullt komplement till rehabiliterande vård. / Background Patients with neurological diseases are often in need of rehabilitative medical care in order to sustain body-function and manage activities in daily life. In some cases, rehabilitation in a warm climate is offered to patients within this group. The rehabilitation period often includes multidisciplinary medical care and will go on for 3-4 weeks. Physiotherapy is commonly a central part of the period. There is limited knowledge in regard to the experiences of receiving physiotherapy during a rehabilitation period in a warm climate and its effects. Purpose/Aim of the study The aim of the present study was to explore and describe experiences of receiving physiotherapy during a rehabilitation stay in a warm climate among patients with neurological diseases. Design &amp; Method This study had a qualitative and exploratory design were data was collected through five semi-structured interviews. To analyze the data a qualitative, inductive approach was used. Result The result of this study suggest that physiotherapy was a central part of the rehabilitation stay and that intensive and individually designed exercise programs were beneficial. Patient-centered care was described as important to the result of the stay. Factors such as the warm climate, social support and being away from one’s daily environment were reported to be crucial in regard to the total rehabilitation experience. An enhanced level of motivation to physical activity was described as an important effect of receiving medical care in a warm climate. Conclusion Social support, a warm climate and responsive health care professionals contributed to a positive experience of receiving physiotherapy as a part of a rehabilitation stay. Experiences of enhanced motivation towards physical activity and more positive health outcomes suggest that a rehabilitation stay in a warm climate could be considered as a medical care complement.