This cross-sectional study examined differences in family needs (informational, social, financial, health, and household support), caregiver mental health (depression, satisfaction with life, vitality, social functioning, and emotional role limitations), and caregiver burden (personal life, guilt, and psychological) among caregivers of individuals with traumatic brain injury, spinal cord injury, multiple sclerosis, and dementia from cities in Colombia and Mexico (N = 343). The study also examined the connections among family needs, caregiver mental health, and caregiver burden in the combined sample of caregivers of individuals with neurological conditions. Many significant differences were identified among groups, and implications are discussed. Family needs, caregiver mental health, and burden were all robustly associated with each other, with financial and social support needs, depression, and burden-personal life and guilt emerging as particularly important. Clinicians should focus on helping caregivers meet financial and social support needs in order to positively influence caregiver burden and mental health.

The following project is a compilation of three separate articles all utilizing a database extracted from the UNUM/Provident Life Insurance Company, including all consecutive short-term disability (STD) claims filed with UNUM from January 1, 1994 to December 31, 1996 from claimants who were also insured for long-term disability (LTD) by UNUM. The resulting sample includes 77,297 claims.The results of these studies are part of a larger investigation that documented the Progression of Disability Benefits (PODB) phenomenon. PODB refers to the migration of workers with work-limiting disabilities through a system of economic benefits resulting in their placement onto Social Security Disability Insurance (SSDI). Claimant and employer demographics were found to influence the PODB. The following articles study three unique ways in which the PODB measure can be informative.The first of the articles tracts the experience of 400 individuals with neurological impairments through the PODB, and compares them with a general disability population on key demographic characteristics. In general, it is found that persons with neurological conditions have greater progression on to advanced disability levels than other types of disabilities. Individual claimants are also younger and male.The second article explores the relationship of integrated disability management(IDM) practices with PODB. It proposes that while the efficacy of IDM programs has been measured by the bottom line, that PODB can be used as an additional tool to assess effectiveness of DM programs. It finds that employers with higher levels of IDM activity will experience a reduced PODB rating.The third and final article examines one industry, Healthcare. It studies how demographics can be used to predict claimant industry as well as PODB performance. Findings reveal that men were more likely to move on to advanced disability benefits while workers in the Healthcare industry were less likely to move on to advanced statuses than employees in other industries. Furthermore, disability type is the greatest predictor of PODB, followed by age for all but one category in which employment sector was the next predictor of PODB. This finding leads to questions regarding how the workplace may contribute to disability and the PODB.

It is estimated that there are 12.5 million people in England living with neurological disorders (Neurological Alliance, 2014). People with neurological disorders as a result of acquired brain injury (ABI) are living with short and long-term disabilities. These include cognitive impairment, and physical and emotional distress. One of the most common complaints by individuals who have ABI is attention impairment. Attention difficulties can have serious ramifications for daily functioning. Although studies have explored the effects of evidence-based interventions such as mindfulness-based therapy on attention abilities, and have found that it improves individuals' attention skills (Moore et al, 2012), thus far research has been conducted mainly with non-clinical populations. This study set out to investigate whether a mindfulness-based intervention could prove beneficial for people with neurological disorders, particularly whether it could positively impact on attention impairment. The study employed a one group pre-test post-test design. The intervention was adapted from the MBSR programme developed by Kabat-Zinn. Twenty-two participants with ABI were recruited. The Conners Continuous Performance Test 3rd Edition (CPT-3), Mindful Attention Awareness Scale (MAAS), Attention Process Training-II Attention Questionnaire (APT-II AQ) and Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM) were utilised to measure outcomes. The results revealed that there was a clinical improvement in self reported measures of mindfulness (MAAS) (Cohen d=0.28), attention (APT-II AQ) (Cohen d=0.33), and psychological distress (CORE-OM) (Cohen d=0.72). This was not observed using the neuropsychological test of attention (CPT-3) for overall group scores, but further evaluation showed some individuals' scores improved. The study is promising as it indicates that mindfulness based treatment can be effective with attentional problems as well as in reducing psychological distress for individuals with ABI. This could be valuable in terms of providing treatment for this client group and adds to the expanding research base on mindfulness-based intervention with this population.

This thesis focuses on assistive and rehabilitation technology for restoring the function of the hand. It presents three different approaches to assistive technology: one in the form of an orthosis, one in the form of a brain-computer interface combined with functional electrical stimulation and finally one totally aiming at rehabilitating the nervous system by restoring brain function using the concept of neuroplasticity. The thesis also includes an epidemiological study based on statistics from the Swedish Hospital Discharge Register and a review on different methods for assessment of hand function. A novel invention of an orthosis in form of a light weight glove, the SEM (Soft Extra Muscle) glove, is introduced and described in detail. The SEM glove is constructed for improving the grasping capability of a human independently of the particular task being performed. A key feature is that a controlling and strengthening effect is achieved without the need for an external mechanical structure in the form of an exoskeleton. The glove is activated by input from tactile sensors in its fingertips and palm. The sensors react when the applied force is larger than 0.2 N and feed a microcontroller of DC motors. These pull lines, which are attached to the fingers of the glove and thus work as artificial tendons. A clinical study on the feasibility of the SEM glove to improve hand function on a group of patients with varying degree of disability has been made. Assessments included passive and active range of finger motion, flexor muscle strength according to the Medical Research Council (MRC) 0-5 scale, grip strength using the Grippit hand dynamometer, fine motor skills according to the Nine Hole Peg test and hand function in common activities by use of the Sollerman test. Participants rated the potential benefit on a Visual Analogue Scale. A prototype for a system for combining BCI (Brain-Computer Interface) and FES (Functional Electrical Stimulation) is described. The system is intended to be used during the first period of recovery from a TBI (Traumatic Brain Injury) or stroke that have led to paresis in the hand, before deciding on a permanent system, thus allowing the patients to get a quick start on the motor relearning. The system contains EEG recording electrodes, a control unit and a power unit. Initially the patients will practice controlling the movement of a robotic hand and then move on to controlling pulses being sent to stimulus electrodes placed on the paretic muscle. An innovative electrophysiological device for rehabilitation of brain lesions is presented, consisting of a portable headset with electrodes on both sides adapted on the localization of treatment area. The purpose is to receive the outgoing signal from the healthy side of the brain and transfer that signal to the injured and surrounding area of the remote side, thereby having the potential to facilitate the reactivation of the injured brain tissue. The device consists of a control unit as well as a power unit to activate the circuit electronics for amplifying, filtering, AD-converting, multiplexing and switching the outgoing electric signals to the most optimal ingoing signal for treatment of the injured and surrounding area. / <p>QC 20130403</p>

Magister Public Health - MPH / Background: Cerebral malaria (CM) kills up to 25% of its patients and about one third of its survivors develop neurological impairments (NIs). With advancements in diagnostic and management techniques for CM, more children are likely to survive. The increase in the number of CM survivors may increase the prevalence of children with NIs. In Malawi, rehabilitation for children with NIs is mostly institution-based with erratic community-outreach services, resulting in poor long-term outcomes. To date, community-based rehabilitation (CBR), a comprehensive rehabilitation approach that also addresses socio-economic impact of NIs and may supplement institution-based rehabilitation services, has not been well explored and documented. Presented here are experiences and perceptions on CBR programmes for NIs following CM in Blantyre, Malawi.

Des mutations du gène ARX (aristaless-related homeobox gene) ont été identifiées dans un large spectre de désordres neurologiques précoces, incluant ou non des malformations cérébrales, le plus souvent associés à des épilepsies. Il est proposé que le gène ARX, codant pour un facteur de transcription, joue un rôle primordial au cours du développement cérébral, notamment sur la migration des neurones GABAergiques, mais son implication au cours de la mise en place du système nerveux central reste cependant encore mal connue. L’objectif de ce travail a été d’étudier le rôle du gène ARX et les conséquences de ses mutations sur le développement cérébral dans le but de mieux comprendre ces pathologies. Dans un premier temps, nous avons étudié l’effet d’une mutation particulière du gène, la mutation ARX(CGC)7, une expansion polyalanine retrouvée principalement dans des pathologies sans malformation cérébrale mais avec des épilepsies, tels que les syndromes de West ou d’Ohtahara. Des analyses réalisées sur une lignée de souris knock-in pour cette mutation (GCG)7 et sur des rats après électroporation in utero ont montré que la migration neuronale des neurones glutamatergiques et GABAergiques ainsi que la maturation des neurones GABAergiques ne sont pas altérées par cette mutation. De façon intéressante, nos données suggèrent que les épilepsies observées chez les souris knock-in résulteraient plutôt d’une réorganisation du réseau glutamatergique. Etant donné que le gène ARX n’est pas exprimé dans les neurones glutamatergiques, l’ensemble de ce travail suggère donc que les épilepsies chez les souris knock-in pour la mutation (GCG)7 sont la conséquence d’une altération développementale secondaire à la mutation initiale du gène, et ceci aurait d’importantes répercussions thérapeutiques qui requièrent d’avantages d’études. Des expériences nous ont ensuite permis d’étudier l’effet de plusieurs mutations du gène ARX sur la morphologie des interneurones in vitro. Celles-ci ont montré que les mutations d’ARX n’engendrent pas une localisation subcellulaire anormale de la protéine dans les interneurones en culture. De façon intéressante, ces expériences suggèrent que la morphologie des interneurones est altérée seulement par certaines mutations, notamment les mutations P353R et Dup24. Ces données soulignent ainsi l’importance d’étudier de façon spécifique chaque mutation du gène pour expliquer les mécanismes engendrant l’hétérogénéité phénotypique liée aux mutations d’ARX. L’ensemble de ces travaux contribuent à une meilleure compréhension du rôle du gène ARX dans le développement cortical et à une meilleure caractérisation des mécanismes physiopathologiques des désordres neurologiques précoces liés aux mutations de ce gène. / Several mutations in ARX gene (aristaless-related homeobox gene) have been found in a large spectrum of infantile neurological disorders, with or without cerebral malformation, but frequently linked to epilepsy. It has been proposed that ARX, coding for a transcription factor, plays a crucial role in brain development, especially in migrating interneurons, but its involvement in nervous system development still remains to be clarified. The aim of this work has been to study the role of ARX gene and the consequences of ARX mutations on cerebral development in order to better understand these pathologies.We have first investigated the effects of an ARX polyalanine expansion, the mutation (GCG)7, which was found in pathologies without brain malformation but associated to epilepsy, such as West and Ohtahara syndromes. Analysis performed on knock-in mice for this mutation and in utero electroporated rat brains have shown that this mutation doesn’t alter neither glutamatergic and GABAergic neuronal migration, nor GABAergic neuron maturation. Interestingly, our data suggest that epilepsy observed in knock-in mice would result rather from a reorganization of glutamatergic networks. Since ARX gene is not expressed in excitatory neurons, our work suggests that epilepsy observed in knock-in mice is the consequence of developmental alterations secondary to the initial mutation, and this would have crucial therapeutic implications that require additional investigations. In vitro experiments have then allowed us to study the effect of several ARX mutations on interneurons morphology. These experiments have shown no abnormal subcellular localization of ARX protein following transfection of these different mutations in cultured interneurons. Interestingly, our data show that interneuron morphology is altered only by some mutations, particularly the P353R and the Dup24 ARX mutations. Our data underline the importance to study specifically each mutation in order to explain mechanisms generating phenotypic heterogeneity linked to ARX mutations.Taken together, this study contributes to a better understanding of ARX involvement in cerebral development and to a better characterization of pathophysiological mechanisms linked to ARX mutations.

Introdução: Penfigoide bolhoso (PB) resulta da produção de autoanticorpos contra proteínas hemidesmossomais BP (Bullous Pemphigoid) 180 e/ou 230, acomete os idosos, e está associado com doenças neurológicas (DN), especialmente com a demência (DEM). BP180/230 foram identificadas no Sistema Nervoso Central (SNC), aventando-se possível mimetismo antigênico entre moléculas da pele e do SNC. O fator neurotrófico derivado do cérebro (BDNF) participa da neurogênese, sinaptogênese e sobrevivência neuronal, e a sua diminuição sérica tem sido relacionada com DN. Objetivo: Quantificar o peptídeo BDNF e os anticorpos anti-BP180/230 na relação PB com DEM. Material e Métodos: Em estudo comparativo, 50 pacientes com PB, 50 com demência e 50 controles foram avaliados. A detecção dos anticorpos anti-BP180/P230 e do peptídeo BDNF foi determinada por ensaios ELISA. Imunofluorescência indireta (IFI) foi conduzida nas amostras de soro dos pacientes do grupo DEM e dos controles que apresentaram positividade para anti-BP180/230. Resultados: No grupo PB, a frequência de DN foi de 26%: DEM 16%, acidente vascular cerebral 6%, e epilepsia 4% - 5/8 (63%) pacientes apresentaram demência vascular e 3/8 (38%) demência por doença de Alzheimer. Positividade para anti-BP180/230 foi observada no grupo PB (74% e 40%, respectivamente), no grupo DEM (10% e 10%) e nos controles (14% e 0%). No grupo DEM, em 2/10 pacientes que apresentaram positividade para antiBP180/230, a IFI evidenciou depósito de IgG e C3 no lado epidérmico da clivagem, configurando quadro subclínico de PB. A mediana do BDNF resultou menor no grupo DEM (25,41 pg/ml) comparado aos controles (38,21 pg/mL), e o grupo PB apresentou os menores valores de BDNF (16,88 pg/mL). Não houve correlação dos títulos de anticorpos antiPB180/230 com a concentração do peptídeo BDNF no grupo PB. Os pacientes do grupo DEM foram alocados de acordo com a escala de demência - CDR1, CDR2 e CDR3; a mediana de BDNF do subgrupo CDR3 (23,37 pg/mL) foi inferior ao CDR1 (30,17 pg/ mL). Não houve diferença na concentração do BDNF segundo o tipo de demência. O grupo PB, quando estratificado em - com DEM, outras DN e sem DN, aqueles com associação com DEM apresentaram menores níveis de BDNF (9,1 pg/mL), comparados ao grupo sem DN e ao subgrupo CDR3 do grupo DEM. Conclusão: Marcadores para PB não são úteis para o diagnóstico de DEM. Valores sorológicos baixos de BDNF no grupo PB podem sugerir associação com DEM. BDNF pode ser utilizado como biomarcador de gravidade da DEM. / Introduction: Bullous pemphigoid (BP) is characterized by autoantibodies against the hemidesmossomal proteins BP180 and/or BP230, affects the elderly people and has been strongly associated with neurological disorders (ND), especially dementia. A possible antigenic mimicry hypothesis between the skin and the nervous system molecules is strong reasonable because BP peptides have also been identified in the central nervous system (CNS). Brain-derived neurotrophic factor (BDNF) plays a role in the synaptogenesis, neurogenesis, and neuronal survival, and some studies have been correlated the decreased serum BDNF levels with ND. The aim of this study was to quantify the BDNF peptide and the anti-BP180 and anti-BP230 antibodies in the BP and DEM relationship. Methods: AntiBP180/230 and BDNF quantification were analyzed in three groups: 50 patients with BP, 50 patients with dementia and 50 elderly individuals comprised a case-control study. Serum IgG anti-180/230, and the BDNF peptide were evaluated by using ELISA commercial kits; and immunofluorescence allied to salt split skin technique (SSS) was conducted in serum samples from patients of the dementia group and from controls who showed positive anti-BP180/230. Results: In BP group, 26% were associated with ND, and dementia was the most frequent (16%), followed by stroke (6%) and epilepsy (4%) - 5/8 (63%) patients showed vascular dementia and 3/8 (38%) patients presented dementia due to Alzheimer\'s disease. AntiBP180/230 positivity was observed in BP group (74%, 40%, respectively), in dementia group (10%, 10%) and in controls (14%, 0%). In 2/10 patients of the dementia group with positive anti-BP180/230, IIF showed IgG and C3 deposition in the epidermal side of cleavage, configuring a subclinical BP dermatosis. The medians of BDNF resulted lower in the patients of the dementia group (25.41 pg/mL) compared with controls (38.21 pg/mL), and the BP group presented the lowest BDNF values (16.88 pg/mL). There was no correlation between the anti-BP180/230 antibodies titres and the BDNF levels in BP group. There was no difference of BDNF levels accordingly with the clinical type of dementia in the dementia group. Patients of the dementia group were sub grouped accordingly with the clinical dementia severity - CDR1, CDR2 and CDR3 - being the median of BDNF in CDR3 (23.37 pg/mL) lower than in CDR1 (30.17 pg/mL) subgroup. BP group had lower levels of BDNF compared to CDR3 subgroup. BP patients when stratified with dementia, other ND and without ND, those with association with dementia presented the lowest levels of BDNF (9.1 pg/mL) compared to the PB patients without DN and to the CDR3 subgroup. Conclusion: BP biomarkers are not useful for the diagnosis of dementia. Low BDNF levels seen in BP patients may suggest an association with dementia. BDNF may be used as a biomarker of severity of dementia.

Esta dissertação analisa a aplicação de nanopartículas de prata na detecção de imunoglobulinas G reativas aos epítopos da glicoproteína oligodendrocítica da mielina e da proteína básica da mielina, que são duas proteínas que compõem a estrutura da bainha de mielina, alvo de processos inflamatórios em doenças desmielinizantes. Há uma busca por marcadores biológicos para a diferenciação das doenças dentro desse espectro em seus estágios iniciais, anteriormente à disseminação de placas de desmielinização no sistema nervoso central, estágio no qual a detecção é realizada por exames de imagem no diagnóstico clínico. Nessa fase, porém, a bainha de mielina já apresenta alterações em nível molecular. Assim, a nanotecnologia oferece a possibilidade de investigação de processos biológicos em nanoescala, por meio de nanoestruturas biocompatíveis. Neste trabalho, o sistema desenvolvido foi o de nanopartículas de prata conjugadas aos epítopos da bainha de mielina, para detecção de anticorpos reativos às sequências peptídicas, com o objetivo de estabelecer os protocolos de síntese, funcionalização e de interação molecular, utilizando epítopos que são imunogênicos nos modelos experimentais das doenças desmielinizantes. As nanopartículas de prata foram obtidas por um processo de redução química e suas superfícies foram quimicamente modificadas para a funcionalização covalente dos epítopos da bainha de mielina. Esse processo foi caracterizado por técnicas de espectroscopia e microscopia. Os resultados de morfologia e diâmetro das nanopartículas foram obtidos pelas técnicas de microscopia de força atômica e difratometria de raios-X. A atividade das nanopartículas funcionalizadas em resposta aos anticorpos foi avaliada por espectrofotometria na região do ultravioleta-visível e por espectroscopia de força atômica. Os resultados obtidos por essas técnicas mostraram que o processo de funcionalização dos epítopos nas superfícies das nanopartículas de prata foi efetivo, já que o complexo foi responsivo aos anticorpos de forma específica. A resposta do sistema foi observável por sinais ópticos detectáveis na espectrofotometria na região ultravioleta-visível, por alterações visíveis de cor da suspensão de nanopartículas e por meio da quantificação das forças de interação por espectroscopia de força atômica. O conjugado nanopartícula-peptídeo apresenta, portanto, potencial para ser aplicado em estudos de investigação de biomarcadores para as doenças desmielinizantes. / This dissertation addresses the immunoglobulins G detection using silver nanoparticles. The chosen molecules are reactive to myelin oligodendrocyte glycoprotein and myelin basic protein epitopes, which are important components of myelin sheath structure, the main target of inflammatory processes in demyelinating diseases. In the context of demyelinating disorder spectrum, there is an effort in searching for biological markers that enable early differential diagnosis, prior to the spread damage in the white matter of the central nervous system, when lesions are usually seen on magnetic resonance imaging. At this stage, however, the myelin sheath has already undergone changes at the molecular level. Thus, nanotechnology offers the possibility of investigating biological processes at the nanoscale, using biocompatible nanostructures. In this work, silver nanoparticles were functionalized with myelin sheath epitopes to detect the antibodies reactive to these peptide sequences, aiming to establish protocols for the synthesis, functionalization and molecular interaction processes, using the immunogenic epitopes of experimental autoimmune encephalomyelitis model. The silver nanoparticles were chemically synthesized using a reduction method and the peptide sequences were covalently conjugated to the modified nanoparticle surfaces. This process was characterized with spectroscopy and microscopy techniques. The nanoparticle morphology and diameter results were obtained by atomic force microscopy and X-ray diffraction techniques. The activity of the functionalized nanoparticles in response to the antibodies was evaluated by spectrophotometry in the ultraviolet-visible electromagnetic region and by atomic force spectroscopy. The results obtained by these techniques showed that the functionalization process was effective since the nanoparticle-peptide complexes were specifically responsive to the antibodies. This response was observable by detectable optical signals in spectrophotometry in the ultraviolet-visible region, by the suspensions visible color changes and by interaction forces quantification by atomic force spectroscopy. The nanoparticle-peptide conjugate has, therefore, the potential to be applied in researches for biomarkers involved in the demyelinating diseases.

O uso de técnicas de mineração de dados tem produzido resultados importantes em diversas áreas, tais como bioinformática, atividades de transações bancárias, auditorias de computadores relacionados à segurança, tráfego de redes, análise de textos, imagens e avaliação da qualidade em processos de fabricação. Em medicina, métodos de mineração de dados têm se revelado muito eficazes na realização de diagnósticos automáticos, ajudando na tomada de decisões por equipes médicas. Além do uso de mineração de dados, dados médicos podem ser representados por redes complexas, de modo a incluir conexões entre seus elementos. Por exemplo, no caso do cérebro, regiões corticais podem representar vértices em um grafo e as conexões podem ser definidas através das atividades corticais. Com isso, pode-se comparar a estrutura do cérebro de sujeitos sadios com a de pacientes que apresentam doenças mentais de modo a definir métodos para diagnóstico e obter conhecimento sobre como a estrutura do cérebro está relacionada com alterações comportamentais e neurológicas. Nesse trabalho, estamos interessados em usar métodos de mineração de dados e redes complexas para classificar pacientes portadores de quatro diferentes tipos de doenças mentais, isto é, esquizofrenia, autismo, déficit de atenção/desordem de hiperatividade e paralisia progressiva nuclear. / A data mining and knowledge discovery is in a field of research, with applications in different areas such as bioinformatics, customer transaction activity, security related computer audits, network traffic, text analysis and quality evaluation in manufacturing. In medicine, data mining methods have proven very effective in performing automatic diagnostics, helping in making decisions by medical teams. In addition to the use of data mining, medical data can be represented by complex networks in order to include connections between its elements. For example, in the case of the brain, cortical regions can represent vertices in a graph and the connections can be defined through cortical activities. Thus, we can compare the brain structure of healthy patients with those of patients with mental disorder in order to define methods for diagnosis and to obtain knowledge about how the structure of the brain is related to behavioral and neurological changes. Here, we are interested in using data mining methods and complex networks to classify patients with four different types of mental desorders, that is, schizophrenia, autism, attention deficit / hyperactivity disorder, and progressive supranuclear paralysis.

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