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Plusieurs champs de recherche ont été combinés - mettant en évidence l'utilité de l'analyse cinématique, non seulement afin d'évaluer le comportement moteur, mais aussi afin de contribuer à la compréhension de la récupération motrice post-AVC. Au travers d'analyses cinématiques, les mouvements du membre supérieur hémiplégique ont été décomposés dans le temps et l'espace, afin d'en extraire l'échelle et les composantes structurelles. Cette décomposition systématique, d'abord connue pour son bien-fondé clinique, nous a permis d'identifier les marqueurs les plus pertinents du contrôle du membre supérieur parétique : i.e., la fluidité, la rectitude et la vitesse. Subséquemment, il a été démontré que i) les changements cinématiques se stabilisent au cours de la phase de rééducation, indiquant potentiellement la nécessité de modifier la stratégie thérapeutique; ii) les patient post-AVC sont capables de percevoir la fluidité du mouvement en réalité virtuelle, cette perception étant meilleure lorsque le feedback visuel ne concerne que le point du travail du membre; iii) l'espace de travail post-AVC n'est pas isotrope pour un patient hémiplégique; iv) chez les patients post-AVC, le niveau de ‘bruit neuromoteur' est augmenté; et v) la cinématique reflète la conséquence des stratégies d'adaptation à l'augmentation du bruit, ces stratégies étant basées sur un compromis entre des modes de contrôle d'erreur en feedforward et en feedback des actions motrices. Ainsi, il peut être conclut que la décomposition du mouvement dans le temps et l'espace est un moyen simple et efficace d'appréhender contrôle moteur chez l'Homme en situation normale et âpres AVC. L'enjeu est maintenant d'implémenter ces méthodes d'analyse cinématique dans les protocoles de rééducation post-AVC quotidienne afin de développer de larges bases de données permettant, à l'aide de méthodes de modélisation, de définir des profils de récupération et ainsi personnaliser de façon optimale la rééducation à chaque patient particulier. / Multiple research fields were combined – highlighting the value of kinematic analysis, not only to evaluate motor behaviour, but also to contribute to the understanding of motor recovery post-stroke. By means of kinematics, hemiplegic upper-limb movements were unfolded in time and space, to extract the scaling and structural components of the movement. This systematic decomposition, first proven to have clinical relevance, allowed us to identify the most pertinent markers of paretic upper-limb control: i.e. smoothness, directness and velocity. Subsequently it was shown that i) change in kinematics levels off over rehabilitation, possibly indicating that treatment may profit from change; ii) people post-stroke are able to perceive movement fluency in virtual realities, whereby simple end-point displays facilitate perception; iii) the workspace post-stroke is heterogeneous; iv) stroke patients have increased levels of neuromotor noise; and v) kinematics reflect the outcome of adaptation strategies to the increased noise in relation to the automaticity of error-corrections on the trade-off between feedforward and feedback based motor control. It may thus be concluded that unfolding the movement in space and time, is a simple and powerful way to define human motor control. The challenge is to implement kinematic analysis in daily post-stroke practice to develop a large database enabling the definition of recovery profiles contributing to provide each individual patient with the right therapy at the right time.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-01-10T11:30:11Z No. of bitstreams: 1 Carla Regina Boldrini.pdf: 1316208 bytes, checksum: 2af12b29af4289c4ecbd9ffae2dd13d1 (MD5) / Made available in DSpace on 2017-01-10T11:30:11Z (GMT). No. of bitstreams: 1 Carla Regina Boldrini.pdf: 1316208 bytes, checksum: 2af12b29af4289c4ecbd9ffae2dd13d1 (MD5) Previous issue date: 2016-12-07 / Neurological disorders can let sequelae that make affected person to be unable to have independence in their daily activities, but rehabilitation can provide a partial or total recovery of lost skills. The Behavior Analysis provides useful basis for the application of procedures in a program of rehabilitation of neurological patients and has offered grants to effective interventions. This review intended to continue and expand other reviews about neurological rehabilitation, using the analysis of studies from 2011 to 2015, with single-subject design and procedures based on Behavior Analysis. This research was conducted in the databases: PsycINFO, PePSIC, Medline, LILACS, Science Direct, Wiley Online Library and SciELO BRAZIL. 20 articles were found and were defined 18 variables for analysis. The reliability index was 91%. The results indicated that there was a predominance of elderly participants diagnosed with dementia and sequelae related to cognitive difficulties and performing daily living activities. The most widely used design was a reversal and multiple baseline among participants. Few studies conducted functional analysis of behavior. Among the procedures that manipulated the background stimuli and consequences, are included: prompting, blocking and response redirection, verbal script, fading. Some studies manipulated only reinforcing consequence. Many of the procedures were classified as practice based on evidence of moderate level. Most authors reported effectiveness of the procedures applied, although few have been concerned with the implications of intervention in the daily lives of patients, failing to perform maintenance measures and social validity and to plan generalization. With the results of this review it was evident the need for future studies to deepen on the social impact of rehabilitation interventions / As patologias neurológicas podem deixar sequelas que impossibilitam a pessoa acometida de ter independência nas suas atividades cotidianas, porém um trabalho de reabilitação pode proporcionar uma recuperação parcial ou total de habilidades perdidas. A Análise do Comportamento apresenta fundamentação útil para a aplicação de procedimentos em um programa de reabilitação de pacientes neurológicos e tem oferecido subsídios para intervenções eficazes. A presente revisão pretendeu continuar e ampliar outras revisões sobre reabilitação neurológica, utilizando a análise de estudos de 2011 a 2015, com delineamento de sujeito único e com procedimentos embasados na Análise do Comportamento. A investigação foi realizada nos bancos de dados: PsycINFO, PePSIC, Medline, Lilacs, Science Direct, Wiley Online Library e SciELO Brasil. Foram encontrados vinte artigos, e definidas 18 variáveis para análise. O índice de fidedignidade foi de 91%. Os resultados indicaram que houve um predomínio de participantes idosos com diagnóstico de demência e com sequelas referentes a dificuldades cognitivas e de realização de atividades de vida diária. O delineamento mais utilizado foi de reversão e de linha de base múltipla entre participantes. Poucos artigos realizaram uma análise funcional do comportamento. Entre os procedimentos que manipularam os estímulos antecedentes e as consequências, destacaram-se: Prompting, Bloqueio e Redirecionamento de Resposta, Roteiro Verbal, Fading. Alguns estudos manipularam apenas a consequência reforçadora. Grande parte dos procedimentos foi classificada como uma prática baseada em evidência de nível moderado. A maioria dos autores relatou eficácia dos procedimentos aplicados, embora poucos tenham demonstrado preocupação com as implicações da intervenção na vida diária dos pacientes, deixando de realizar medidas de manutenção e de validade social e de planejar a generalização. Com os resultados desta revisão ficou evidente a necessidade de realizar estudos futuros que se aprofundem sobre o impacto social das intervenções de reabilitação

This thesis is focused on the problematics of aftercare in patients with brain damage. The thesis has an informative character and its aim is to introduce the problematics to the readers and give them valuable advices. This topic has come to the fore of the interest of the professional and general public especially in recent years. Partly because numbers of brain damage especially those of the traumas are increasing, but also because of the development of acute medicine, which is nowadays at a very high level, there is an increase in the number of patients who survive brain damage. However, the problem is a large quantity of these patients have permanent consequences, and they and their closest neighbors have to deal with. These permanent consequences are manifested as cognitive impairment, impairment of sensory functions, physical disability and changes in behavior and emotions. Following care in patients with brain damage is a major problem in our country. We see the problem especially in the continuity and availability of care for locally available services and rehabilitation care for these individuals. The continuity of care after the patient is released from the acute bed is very low and sometimes chaotic. To obtain the necessary informations for thesis and to achieve the goals, it was necessary to study a large amount of professional literature. Used sources are specialized Czech and foreign literature, professional journals and articles searched in professional databases. This thesis should show the possible problems of patient aftercare with brain damage. The results of the thesis can be used as a subsidy to professional conferences, seminars or courses to deal with the issue. The thesis could increase public interest about this topic.

Neurorehabilitation is a multidisciplinary rehabilitation process used in patients with neurological diseases. These patients have not only movement disorders but also cognitive and neurobehavioral problems as well as aphasias. Their rehabilitation is a long term process and the results are often unsatisfactory. Neuroplasticity - physiological basis for neurorehabilitation induces functional restitution or recovery after secondary brain damage. Various neuroprotective substances (e.g. erythropoietin - EPO) are tested to empower mechanisms of plasticity after brain injury. Preclinical studies testing efficacy of those substances in animal brain damage models are essential to prepare clinical trials. The aim of the study was to reveal the influence of EPO combined with rehabilitation on functional outcomes after global cerebral hypoxia. FIM (Functional independence measure) test was used for functional evaluation and Meilli test for visual memory of the patients who attended special program for rehabilitation in clinical part. Patients who came earlier had better prognosis than patients who came later. In experimental part three-months old male Wistar albino rats were exposed to hypobaric hypoxia for 60 minutes in an experimental chamber, simulating an altitude of 8000 m. Half of the animals received...

Neurorehabilitation is a multidisciplinary rehabilitation process used in patients with neurological diseases. These patients have not only movement disorders but also cognitive and neurobehavioral problems as well as aphasias. Their rehabilitation is a long term process and the results are often unsatisfactory. Neuroplasticity - physiological basis for neurorehabilitation induces functional restitution or recovery after secondary brain damage. Various neuroprotective substances (e.g. erythropoietin - EPO) are tested to empower mechanisms of plasticity after brain injury. Preclinical studies testing efficacy of those substances in animal brain damage models are essential to prepare clinical trials. The aim of the study was to reveal the influence of EPO combined with rehabilitation on functional outcomes after global cerebral hypoxia. FIM (Functional independence measure) test was used for functional evaluation and Meilli test for visual memory of the patients who attended special program for rehabilitation in clinical part. Patients who came earlier had better prognosis than patients who came later. In experimental part three-months old male Wistar albino rats were exposed to hypobaric hypoxia for 60 minutes in an experimental chamber, simulating an altitude of 8000 m. Half of the animals received...

Introduction: Multiple sclerosis is a chronic autoimmune neurodegenerative affection of the central nervous system with various neurological symptoms. Disability of upper extremities with other symptoms leads to impaired ability to work and ADL-activities of daily living. The purpose of the pilot study was to evaluate the effect of hand training with the Hand Tutor® rehabilitation system. Methods: The study involved 9 probands, completed 6 probands (2 females and 4 males) at an average age of 36 (SD 4), with a mean disease duration of 13 years (SD 4). Patients received a series of 10 Hand Tutor® therapies, 1-2 times a week. The effect of the therapy was evaluated using the Nine Hole Peg Test (9HPT), the Modified Frenchay Scale and the subjective evaluation of the probands. Results: Before the therapies, the average performance in the 9HPT test was 85 seconds and 83 points in the Modified Frenchay scale. After the therapies, the average 9HPT performance was 67 seconds and 86 points in the Modified Frenchay scale. According to the subjective evaluation of probands, the therapy had a positive effect on the tremor of the upper limb and on the use of the upper limb in the ADL. Conclusion: Therapy with a special rehabilitation system provides patients with MS with more intensive hand training using...

Ein Schlaganfall ist für die betroffenen Patienten häufig mit motorischen Einschränkungen der oberen Extremitäten verbunden. Neue Therapieverfahren können bestehende Verfahren ergänzen. Im Rahmen dieser kumulativ angefertigten Forschungsarbeit wurde der Roboterball „Sphero 2.0“ als potenziell geeignetes Therapiemittel im Rahmen der Neurorehabilitation nach Schlaganfall identifiziert. Auf dieser Basis wurde ein innovatives, spielerisch- motivierendes Therapiekonzept entwickelt und im Rahmen der Rehabilitation bei Schlaganfallpatienten erprobt. Die Arbeit begann mit einer umfassenden Literaturrecherche zum Effekt neuer Technik-gestützter Rehabilitationskonzepte in der Schlaganfallrehabilitation. In der Folge wurden der Roboterball und Elemente des Therapiekonzepts erstmalig bei Schlaganfallpatienten erprobt. Nach erfolgreicher Machbarkeitsstudie zur technischen und therapeutischen Eignung folgte die langfristige Anwendung des Therapiekonzepts in einer randomisierten, kontrollierten Crossover Studie. Im Mittelpunkt der Untersuchungen standen die Überprüfung eines motorischen und alltagsrelevanten Benefit sowie Fragen zur Usability, Eignung und zu möglichen Limitierungen bei einer Anwendung des neuen Therapiekonzepts im Rahmen der Neurorehabilitation nach Schlaganfall.

The Aim of the Study: The aim of this diploma thesis is to capture the change of clinical state of patients with spinal cord injury while watching videos of virtual reality fot three 3 months using ASIA assessment. The goal is to determine the effect of the change of clinical state on the patient's quality of life while using SQUALA and on their imagery ability (WIAQ) while a therapeutic video of virtual reality is regularly played through virtual reality headset. Methods: The research was conducted with 7 probands (n=7, 5 males, 2 females) aged between 31 and 61 years (the average age of 49,6 years), which regular visitors of Centrum Paraple, o. p. s. The propands who participated in research suffer with incomplete spinal lesion. Before any intervention the probands were assessed by ASIA, standardised assessment to estimate neurological level of spinal lesion by assigning the number of motor and sensitive points in each segment. The assessment was conducted by proffessional and specificly trained staff of Centrum Paraple, o. p. s. Furthermore the probands completed the psychological questionnaires to evaluate their quality of life (SQUALA) and imagery ability of the movement (WIAQ) in the pacient with spinal cord injury. As in the beginnig, so in the end of the research the ASIA was conducted once...

OF MASTER THESIS Author: Bc. Tereza Sádlová Supervisor: Mgr. Barbora Vaculíková, MBA Expert guarantor: plk. MUDr. Michal Říha, PhD., MBA Title of master thesis: Quality management of rehabilitation in patients with cerebrovascular accident This master thesis deals with quality management of rehabilitation in patients with cerebrovascular accident and we can also seen her as a basic summary of everything what is connected with quality rehabilitation understood as a service provided in medical devices. The main goal of this master thesis was determined as a presentation of possible form for monitoring and evaluating quality of rehabilitation using Indicator of quality stroke rehabilitation in patients with cerebrovascular accident. For the complex assessment of functional status of patient before and after stroke rehabilitation was reflected all items which are trained during physiotherapy, occupational theray, speech therapy etc. This master thesis is divided into two parts - theoretical and empirical. Theoretical part provides basic information of cerebrovascular accident, system of stroke rehabilitation and quality management of health care, which si relative to stroke rehabilitation. Empirical part describes a process of creating of Indicator of quality management of rehabilitation in patients...