No description available.

This thesis investigated whether different textured surfaces have a role to play in changing balance performance in healthy young and older adults. A review of the literature showed that balance may be improved by standing on surfaces, or wearing foot insoles, with texture compared to those that are smooth, possibly by providing enhanced plantar tactile stimulation. It also showed that textured footwear interventions can influence lower limb muscle activity during functional activities. However, some major gaps in current literature were identified. There was limited evidence relating to the effect of texture in older adults: a population known to show poor balance and at high risk of falling. The importance of the geometric textured pattern in changing balance had not been investigated. It was also unclear whether textured interventions altered lower limb muscle activity, as a component of sensorimotor function of balance control. The purpose of this thesis was to address these important areas of research and contribute novel evidence to the field. In two separate studies, 24 young and 50 older healthy adults conducted tests of bilateral quiet standing with eyes open and closed on two different textured surfaces and a smooth surface as control. Centre of pressure based sway variables were extracted from a force platform and lower limb muscle activity was collected using surface electromyography, over 30 seconds. Textured surfaces did not significantly alter sway variables or lower limb muscle activity in healthy young adults. Closer observation of the data tentatively suggested texture may have the capacity to alter anterior-posterior sway and centre of pressure velocity in young adults. These findings supported the aims of this thesis to explore the possibility of a textured effect in people with poor balance ability: older adults. Textured surfaces significantly changed mediolateral sway range and centre of pressure velocity in healthy older adults, in the absence of visual information. No significant changes were observed for lower limb muscle activity, between the textured conditions. Exploratory sub-group analysis for gender generated speculative data suggesting the effect of texture on balance and muscle activity may be more marked in older females. Evidence from both studies suggests that relative to control, the two textured conditions have opposite effects on postural sway. There may be an optimal textured pattern which could be therapeutically beneficial for enhancing balance performance in healthy and pathological groups. Further investigation is required.

Balance ist als die koordinative Fähigkeit anzusehen, die am meisten durch das Sinnes- und Nervensystem determiniert ist. Damit könnte sie als Indikator für Funktionseinschränkungen des Nervensystems - etwa bei Lernstörungen - von Wert sein. Aussagen über Zusammenhänge zwischen Balance und Kognition werden vielfach diskutiert, sind jedoch noch nicht hinreichend wissenschaftlich gesichert. Hieraus wird die zentrale Zielstellung der Arbeit abgeleitet, das Wissen über somatische und psychische Determinanten von Balance zu erweitern. Betrachtet werden daher bei Vorschulkindern mögliche Zusammenhänge mit dem Geschlecht, mit den anthropometrischen Parametern Körperhöhe und Fußgröße, mit Statikstörungen des Beckens und der Intelligenzleistung. <br><br> An der Studie nahmen insgesamt 201 drei- bzw. vierjährige Kinder sowie 148 fünf- bzw. sechsjährige Kinder teil. Die Balancefähigkeit wurde mit Hilfe einer Kraftmomentenplattform sowie eines klinischen Tests erfasst und mit anthropometrischen Parametern, qualitativen statischen Befunden bzw. den Ergebnissen des BIVA-Intelligenztests nach SCHAARSCHMIDT verglichen. Für die Auswertung der Balanceparameter wurden sowohl lineare als auch nichtlineare Verfahren eingesetzt, die zum Teil gegenläufige Trends in Bezug auf Zusammenhänge lieferten. <br><br> Im Ergebnis konnte ein starker Einfluss des Geschlechts nachgewiesen werden. Mädchen zeigten eine bessere Balanceleistung als Jungen sowohl bei 3-Jährigen als auch bei 6-Jährigen. Dies wird als Beleg für den geschlechtsspezifischen Vorsprung der sensomotorischen Entwicklung bei den Mädchen im Alter von 3 bis 6 Jahren angesehen. Außerdem gab es einige Hinweise auf einen Zusammenhang mit der Körperhöhe bzw. Fußlänge. Ein Zusammenhang mit den Umstellungen des ersten Gestaltwandels wird vermutet. Die Daten sprechen für einen statistisch schwachen Einfluss von Störungen der Beckenstatik (Beckenverwringung) auf die Balance bei den Kindern. Es wird vermutet, dass die Verrechnung Balance relevanter Inputs durch nozizeptive Impulse beeinträchtig werden kann. Dies könnte Anlass sein, diesen Aspekt bei Funktionsstörungen mit zu berücksichtigen. Signifikante Zusammenhänge mit Ergebnissen des BIVA-Intelligenztests konnten kaum gefunden werden. Allerdings fallen überzufällig viele Mittelwertvergleiche in Richtung der Hypothese aus, erreichen jedoch nicht Signifikanzniveau. Dies könnte ein Hinweis auf einen schwachen Zusammenhang darstellen, der jedoch mit einer größeren Gruppe noch bestätigt werden müsste. Weitere Forschung auf diesem Gebiet ist erforderlich. Sollte hinreichende Evidenz erreicht werden können, so könnte in der Förderung koordinativer Fähigkeiten und insbesondere der posturalen Balance eine wichtige pädagogische Reserve liegen. / Balance is considered a coordinative ability, which is mostly affected by the sensory and nervous systems. It can be used as an indicator for the functional ability of the nervous system, such as learning disability. Although the relationship between balance and cognition has long been postulated, this interaction has not yet been scientifically well established. The aim of this study is to examine the somatic and psychological determinants of balance. Preschool children were used to analyse the balance-cognition relationship with respect to gender, anthropometric parameters of body height and foot length, pelvic static and intelligence ability. <br><br> 201 three to four years old children, as well as 148 five to six years old children, were used in this study. A clinical test involving a force moment platform was used to examine the balance ability. Results obtained were compared with specific anthropometric parameters and findings obtained from the BIVA-intelligent tests (SCHAARSCHMIDT). <br><br> In the results, there is a strong effect of gender on balance. Girls showed a better balance ability than boys in the age groups of three and six years old. This finding provides evidence of an earlier gender specific advantage of sensor-motor development in girls between the ages of 3 to 6 years old. A relationship between postural balance and body height/ foot length was found. This may be attributed to the transposition of the body developmental changes. The results show a weak statistical effect of pelvic static disorders on balance in children. It can be suggested that inputs through the nociceptive impulse pathway can have a negative effect on balance. This can be factored as an aspect of a function disorder. Slight significant relationship could be found from the results of BIVA-intelligent tests. This can provide information on the weak relationship, which might show in larger group size. Further studies in this research area are necessary. Sufficient evidence should be reached, regarding the support of coordination ability and particularly postural balance, and the relationship could play an important role in education

Bakgrund: Distal radiusfraktur (DRF) är en vanligt förekommande fraktur med en incidens i Sverige på 31-32 per 10000 personår. Många personer upplever kvarstående besvär efter utläkt fraktur och i dagsläget saknas evidens kring optimal behandling och rehabilitering. Fler studier har konstaterat kvarstående symtom som nedsatt greppstyrka och rörlighet samt smärta. Syfte: Syftet med aktuell studie varatt undersöka specifik rörlighet 6 månader efter distal radiusfraktur. Jämförelser gjordes med andra utfallsmått på rörlighet, styrka och funktion. Metod:Utifrån en tvärsnittsdesign undersöktes 11 personer över 18 år som ådragit sig en DRF och behandlats för den under mars-maj 2016. Utfallsmått var specifik ledrörlighet testat utifrån Kaltenborns metod för ledundersökning. Detta jämfördes med uppmätt greppstyrka, angulär aktiv och passiv rörlighet samt subjektiv funktionsskattning DASH och PRWE. Sensomotorik och upplevelse av denna adresserades också. Resultat:Hos samtliga personer sågs hög grad av funktionsinskränkningar i samtliga utfallsmått, förutom hos de två av deltagarna som uppgav att de i princip var återställda. Hos dessa personer noterades inga nedsättningar i specifik ledrörlighet trots att även de hade nedsatt greppstyrka och inskränkt angulär rörlighet. Slutsats:Trots ett litet deltagarantal fanns en indikation på att specifik ledrörlighet kan vara en faktor i kvarstående funktionsinskränkning. Inget samband noterades mellan funktion, rörlighet och greppstyrka. Fler studier bör framöver utforska detta samband samt undersöka effekten av specifik behandling av rörelseinskränkningarna. Personer som ådragit sig en DRF bör följas upp närmare avseende rörelseförutsättningar och behandlingen därefter behöver vara mer specifik än idag. Här bör fysioterapeuter med utbildning inom OMT vara en självklar del i vårdkedjan.

No description available.

A Lesão Medular incompleta (LMi) é uma condição gerada por processos lesionais que afetam parcialmente a integridade da medula espinhal, ocasionando comprometimento na função sensório-motora devido ao declínio do funcionamento das vias medulares. Tal comprometimento impacta diretamente em aspectos físicos, psicológicos e sociais, com consequente redução da qualidade de vida e da independência funcional. Dessa forma, uma reabilitação efetiva requer a redução dos danos ocasionados ela LMi e, portanto, depende de técnicas capazes de favorecer a neuroplasticidade dos circuitos medulares remanescentes. A Estimulação Magnética Transcraniana repetitiva (EMTr) de alta frequência é uma técnica capaz de induzir aumento na excitabilidade do córtex motor primário, trato córtico-espinhal e medula espinhal, facilitando o desenvolvimento da conectividade responsável pela melhora sensório-motora e funcional. Objetivou-se avaliar os efeitos da EMTr de alta frequência aplicada sobre a área dos membros inferiores em M1 na função sensório-motora e nos níveis de espasticidade em indivíduos com LMi crônica. Esse estudo duplo-cego, placebo controlado avaliou quinze indivíduos com LMi crônica (35.3 ± 7.9 anos, média ± desvio padrão) incluídos sequencialmente em cinco sessões de EMTr placebo e cinco sessões de EMTr ativa à 5Hz, separadas por um período de repouso de uma semana. Avaliações clínicas foram feitas antes e depois de da EMTr placebo e ativa. Foram observadas mudanças estatisticamente significativas nos escores motores do International Standards for Neurological Classification of Spinal Cord Injury Patients/Padrões Internacionais para Classificação Neurológica de Pacientes com Lesão Medular (ISNCSCI) (T(1, 14) = 5.359, P < 0.001), as quais foram acompanhadas de tamanhos de efeito clinicamente significativos. A sensibilidade superficial avaliada pelo ISNCSCI também apresentou mudanças estatisticamente significativas nos escores após EMTr ativa (T(1, 14) = 2.223, P < 0.043). Não foram observadas mudanças nos níveis de espasticidade. Nenhum participante relatou efeitos adversos graves, com exceção de dor de cabeça transitória após algumas sessões. O presente estudo encontrou mudanças estatísticas e clinicas consistentes na função sensório-motora em indivíduos com LMi crônica após EMTr ativa. Dessa forma, essa técnica pode ser uma forma efetiva de reabilitação em indivíduos com LMi / Incomplete Spinal Cord Injury (iSCI) is a condition generated by lesional processes that partially affect the integrity of the spinal cord, causing impairment in the sensorimotor function due to the decline in the functioning of the spinal cord. Such impairment directly impacts on physical, psychological and social aspects, with consequent reduction of quality of life and functional independence. Thus, effective rehabilitation requires the reduction of the damage caused by iSCI and, therefore, depends on techniques capable of favoring the neuroplasticity of the remaining medullary circuits. High frequency repetitive transcranial magnetic stimulation (rTMS) is a technique capable of inducing increased excitability of the primary motor cortex, corticospinal tract and spinal cord, facilitating the development of connectivity responsible for sensorimotor and functional improvement . The objective of this study was to evaluate the effects of high frequency applied rTMS on the lower limbs area in M1 on sensorimotor function and on spasticity levels in individuals with chronic iSCI. This double-blind, placebo-controlled study evaluated fifteen subjects with chronic iSCI (35.3 ± 7.9 years, mean ± standard deviation) included sequentially in five placebo rTMS sessions and five sessions of active rTMS at 5Hz separated by a washout period of one week. Clinical evaluations were done before and after the placebo and active rTMS. Statistically significant changes in the International Standards for Neurological Classification of Spinal Cord Injury Patients (ISNCSCI) motor scores (T (1, 14) = 5,359, P <0.001) were observed, which were accompanied by clinically significant effect sizes. The superficial sensitivity assessed by the ISNCSCI also showed statistically significant changes in the scores after active rTMS (T (1,14) = 2,223, P <0.043). No changes in spasticity were observed. No participant reported severe adverse events, except for transient headache after a few sessions. The present study found consistent statistical and clinical changes in sensorimotor function in individuals with chronic iSCI after active rTMS. Thus, this technique can be an effective form of rehabilitation in individuals with iSCI

A Lesão Medular incompleta (LMi) é uma condição gerada por processos lesionais que afetam parcialmente a integridade da medula espinhal, ocasionando comprometimento na função sensório-motora devido ao declínio do funcionamento das vias medulares. Tal comprometimento impacta diretamente em aspectos físicos, psicológicos e sociais, com consequente redução da qualidade de vida e da independência funcional. Dessa forma, uma reabilitação efetiva requer a redução dos danos ocasionados ela LMi e, portanto, depende de técnicas capazes de favorecer a neuroplasticidade dos circuitos medulares remanescentes. A Estimulação Magnética Transcraniana repetitiva (EMTr) de alta frequência é uma técnica capaz de induzir aumento na excitabilidade do córtex motor primário, trato córtico-espinhal e medula espinhal, facilitando o desenvolvimento da conectividade responsável pela melhora sensório-motora e funcional. Objetivou-se avaliar os efeitos da EMTr de alta frequência aplicada sobre a área dos membros inferiores em M1 na função sensório-motora e nos níveis de espasticidade em indivíduos com LMi crônica. Esse estudo duplo-cego, placebo controlado avaliou quinze indivíduos com LMi crônica (35.3 ± 7.9 anos, média ± desvio padrão) incluídos sequencialmente em cinco sessões de EMTr placebo e cinco sessões de EMTr ativa à 5Hz, separadas por um período de repouso de uma semana. Avaliações clínicas foram feitas antes e depois de da EMTr placebo e ativa. Foram observadas mudanças estatisticamente significativas nos escores motores do International Standards for Neurological Classification of Spinal Cord Injury Patients/Padrões Internacionais para Classificação Neurológica de Pacientes com Lesão Medular (ISNCSCI) (T(1, 14) = 5.359, P < 0.001), as quais foram acompanhadas de tamanhos de efeito clinicamente significativos. A sensibilidade superficial avaliada pelo ISNCSCI também apresentou mudanças estatisticamente significativas nos escores após EMTr ativa (T(1, 14) = 2.223, P < 0.043). Não foram observadas mudanças nos níveis de espasticidade. Nenhum participante relatou efeitos adversos graves, com exceção de dor de cabeça transitória após algumas sessões. O presente estudo encontrou mudanças estatísticas e clinicas consistentes na função sensório-motora em indivíduos com LMi crônica após EMTr ativa. Dessa forma, essa técnica pode ser uma forma efetiva de reabilitação em indivíduos com LMi / Incomplete Spinal Cord Injury (iSCI) is a condition generated by lesional processes that partially affect the integrity of the spinal cord, causing impairment in the sensorimotor function due to the decline in the functioning of the spinal cord. Such impairment directly impacts on physical, psychological and social aspects, with consequent reduction of quality of life and functional independence. Thus, effective rehabilitation requires the reduction of the damage caused by iSCI and, therefore, depends on techniques capable of favoring the neuroplasticity of the remaining medullary circuits. High frequency repetitive transcranial magnetic stimulation (rTMS) is a technique capable of inducing increased excitability of the primary motor cortex, corticospinal tract and spinal cord, facilitating the development of connectivity responsible for sensorimotor and functional improvement . The objective of this study was to evaluate the effects of high frequency applied rTMS on the lower limbs area in M1 on sensorimotor function and on spasticity levels in individuals with chronic iSCI. This double-blind, placebo-controlled study evaluated fifteen subjects with chronic iSCI (35.3 ± 7.9 years, mean ± standard deviation) included sequentially in five placebo rTMS sessions and five sessions of active rTMS at 5Hz separated by a washout period of one week. Clinical evaluations were done before and after the placebo and active rTMS. Statistically significant changes in the International Standards for Neurological Classification of Spinal Cord Injury Patients (ISNCSCI) motor scores (T (1, 14) = 5,359, P <0.001) were observed, which were accompanied by clinically significant effect sizes. The superficial sensitivity assessed by the ISNCSCI also showed statistically significant changes in the scores after active rTMS (T (1,14) = 2,223, P <0.043). No changes in spasticity were observed. No participant reported severe adverse events, except for transient headache after a few sessions. The present study found consistent statistical and clinical changes in sensorimotor function in individuals with chronic iSCI after active rTMS. Thus, this technique can be an effective form of rehabilitation in individuals with iSCI