Formål: Formålet med undersøgelsen har været at få indsigt i og viden om, hvordan nytilskadekomne rygmarvsskadede patienter oplever og opfatter at deltage i tværfaglige patientkonferencer, hvor deres rehabiliteringsforløb tilrettelægges. Metode: Undersøgelsesmetoden er kvalitativ med en fænomenografisk forskningstilnærmelse. Dataindsamlingen er foretaget ved hjælp af kvalitative semistrukturerede interview. Der er gennemført 15 interview blandt otte indlagte patienter, tre kvinder og fem mænd i alderen fra 28 til 75 år Resultat: Analysen viste at patienterne fandt, at det var meningsfuldt at deltage i patientkonferencer om eget rehabiliteringsforløb og for de fleste en nødvendig og selvfølgelig del af rehabiliteringen. Der blev identificeret fire beskrivende hovedkategorier: Patientkonferencer oplevedes støttende i en rehabiliteringsproces; Forskellige følelser var i spil; Pårørendes deltagelse havde betydning; Mødekultur og deltageres betydning Konklusion: Denne undersøgelse viste, at nytilskadekomne rygmarvsskadede og sorgfyldte patienter oplevede, at de var i stand til og gerne ville deltage aktivt i beslutninger i forhold til eget rehabiliteringsforløb. Tværfaglige patientkonferencer blev opfattet som et forum, hvor patienter og pårørende kunne få overblik og kontrol i en situation, hvor patienternes livssituation var kaotisk i relation til komplekse og omfattende fysiske funktionstab. Undersøgelsen har afdækket områder, som har vist sig at have haft betydning for, om patienterne oplevede disse konferencer som meningsfulde og tilfredsstillende / Aim: This study aimed to increase understanding of how patients newly injured with spinal cord lesion experience rehabilitation planning conferences with their clinicians and therapists. Method: I used a qualitative methodology within a phenomenographic research approach. Data was collected during 15 qualitative and semi-structured interviews with eight hospitalized patients (three women and five men) ranging in age between 28 to 75 years. Results: The data suggests that patients view participation in rehabilitation conferences as essential. Indeed, some patients deemed participation a necessary and natural part of their rehabilitation. Four main categories were identified: patient conferences support rehabilitation; emotional vulnerability; family participation matters; and atmosphere and location of conferences are critically important. Conclusion: The results show that patients newly injured by spinal cord lesion can and want to participate in decisions about their own rehabilitation, even when they are grieving and in a state of shock. Interdisciplinary patient conferences that include relatives provide an ideal environment and help patients gain oversight and control in an often chaotic life situation resulting from complex and substantial physical disabilities. The data also revealed areas for improvement that will help ensure meaningful and satisfactory patient conferences / <p>ISBN 978-91-86739-14-0</p>

Résumé : Une coordination appropriée entre les pattes antérieures et postérieures chez les mammifères terrestres est essentielle pour maintenir une stabilité pendant la locomotion quadrupède. Il a été fortement suggéré que les voies propriospinales et le retour sensoriel pourraient jouer un rôle important dans la coordination antéropostérieure. Cependant, les mécanismes neurophysiologiques impliqués dans la coordination entre les membres antérieurs et les membres postérieurs pendant la marche demeurent méconnus. Suite à une lésion partielle de la moelle épinière, plusieurs déficits de la coordination antéropostérieure ont pu être dénotés chez l’animal non-humain et chez l’humain. Malgré tout, les effets d’une lésion partielle sur la coordination antéropostérieure n’ont pas encore été clairement caractérisés. Au regard du nombre considérable de blessés médullaires présentant des troubles de l’équilibre et de la coordination entre les bras et les jambes après avoir récupéré la marche, il semble essentiel de mieux comprendre ces mécanismes. L’objectif du projet était d’offrir une meilleure caractérisation de la coordination antéropostérieure chez le chat intact et suite à une hémisection latérale de la moelle épinière. Pour ce faire, un tapis roulant partitionné transverse permettant de dissocier les vitesses de locomotion entre les pattes antérieures et postérieures a été utilisé. Huit chats implantés chroniquement pour réaliser des enregistrements électromyographiques ont été entrainés dans diverses conditions de locomotion partitionnée et non-partitionnée. Parmi ces 8 chats, 6 ont subi une hémisection latérale du côté droit de la moelle épinière entre la 5ème et la 6ème vertèbre thoracique (T6). Des analyses cinématiques et électromyographiques ont été réalisées chez les chats intacts et 8 semaines après la lésion partielle de la moelle épinière. Les résultats obtenus démontrent que la coordination antéropostérieure est contrôlée par des influences bidirectionnelles et asymétriques entre les pattes antérieures et postérieures. De plus, lorsque la vitesse de locomotion des pattes antérieures était plus élevée que celle des pattes postérieures, une dissociation du rythme était observée avec les pattes antérieures réalisant davantage de pas chez le chat intact. Suite à la lésion, cette dissociation était également observée lors de la locomotion non-partitionnée. Cependant, que ce soit avant ou après la lésion, quand une telle dissociation apparaissait, une nouvelle forme stable de coordination antéropostérieure apparaissait consistant à réaliser deux pas des pattes antérieures pendant un pas des pattes postérieures (coordination 2-1). Finalement, la coordination antéropostérieure pouvait être modulée par l’utilisation du tapis roulant partitionné et une coordination 1-1 pouvait être restaurée suite à la lésion en faisant marcher les pattes postérieures à une vitesse plus élevée. À partir de ces résultats, nous avons proposé un nouveau modèle théorique du contrôle neurophysiologique de la coordination antéropostérieure. Qui plus est, un raffinement des échelles d’évaluation de la récupération locomotrice suite à des lésions de la moelle épinière s’avère indispensable afin d’inclure une caractérisation détaillée de la coordination antéropostérieure. Finalement, d’un point de vue clinique, ces résultats suggèrent que de nouvelles stratégies thérapeutiques basées sur la coordination antéropostérieure pourraient être envisagées afin de renforcer la récupération locomotrice suite à des lésions de la moelle épinière. / Abstract : An appropriate coordination between the forelimbs and the hindlimbs in terrestrial mammals is essential to maintain stability during quadrupedal locomotion. It is thought that propriospinal pathways and sensory feedback contribute to the control of forelimbhindlimb coordination. However, the neurophysiological mechanisms involved in this coordination during locomotion remain poorly defined. After a partial spinal cord injury, several impairments of interlimb coordination have been observed in non-human animal models and human patients. Despite this, the effects of a partial lesion on forelimb-hindlimb coordination have not been clearly characterised. Patients with spinal cord injury have pronounced deficits with their equilibrium and a deficient control of interlimb coordination could be a main contributor. The purpose of these studies was to better characterize forelimb-hindlimb coordination in intact cats and following a lateral hemisection of the spinal cord. A transverse split-belt treadmill was used to independently control the speed of the forelimbs and of the hindlimbs. Eight cats were chronically implanted for e;ectromyography and trained to perform various tied-belt and transverse split-belt locomotor conditions. Among these 8 cats, 6 were hemisected at the 6th thoracic segment of the spinal cord on the right side. Electromyographic and kinematic analyses were performed in the intact state and 8 weeks post-hemisection. The results demonstrate that interlimb coordination is controlled by bidirectional and asymmetrical influences between the forelimbs and the hindlimbs. Moreover, when the forelimbs stepped faster than the hindlimbs, dissociation of the forelimb and hindlimb rhythms occurred, with the forelimbs taking more steps. After the lesion, this dissociation was observed, even during tied-belt locomotion. However, in both intact and injured cats, when such dissociation occurred, a new stable form of forelimb-hindlimb coordination appeared, consisting of two forelimb steps for one hindlimb step (2-1 forelimb-hindlimb coordination). Finally, the transverse split-belt treadmill could modulate forelimb-hindlimb coordination and 1-1 coordination could be restored after the lesion during transverse split-belt locomotion with a faster hindlimb speed. From these results, we propose a theoretical model of the neurophysiological control of interlimb coordination. Moreover, a refinement of performance scales evaluating the locomotor recovery after spinal cord injury is necessary to include a detailed characterisation of interlimb coordination. Finally, from a clinical perspective, these results suggest that new therapeutic strategies based on interlimb coordination could be used to strengthen locomotor recovery after spinal cord injuries.

Human induced pluripotent stem cells (hiPSCs) have two main properties: pluripotency and self-renewal. Physical cues presented by biomaterial scaffolds can stimulate differentiation of hiPSCs to neurons. In this work, we develop and analyze a mathematical model of aggregate growth and neural differentiation on melt electrospun biomaterial scaffolds. An ordinary differential equation model of population size of each cell state (stem, progenitor, differentiated) was developed based on experimental results and previous literature. Analysis and numerical simulations of the model successfully capture many of the dynamics observed experimentally. Analysis of the model gives optimal parameter sets, that correspond to experimental procedures, to maximize particular populations. The model indicates that a physiologic oxygen level (~5%) increases population sizes compared to atmospheric oxygen levels (~21%). Model analysis also indicates that the optimal scaffold porosity for maximizing aggregate size is approximately 63%. This model allows for the use of mathematical analysis and numerical simulations to determine the key factors controlling cell behavior when seeded on melt electrospun scaffolds. / Graduate

Experiencing a physical health condition can have wide ranging physical and psychological outcomes for an individual, impacting on many aspects of daily living. The psychological outcomes can vary widely, from extreme psychological distress to psychological growth, and are complex and dynamic. Traditionally, research has focused on those experiencing psychological distress, despite evidence showing that many individuals are able to achieve positive psychological outcomes. The literature is unclear in defining different positive psychological outcomes, and indeed distinguishing different outcomes and processes from one another. Attention needs to be paid to the definition applied to individuals who are reporting positive psychological outcomes following physical health difficulties and further understanding the process through which individuals achieve these outcomes. This empirical study aimed to address some of the gaps in the literature, by exploring how six individuals reporting positive psychological outcomes following spinal cord injury described and explained these outcomes. Interpretative phenomenological analysis was used to investigate the experience of these individuals. Three superordinate themes were extracted: "Living a normal life, just doing things differently", "Overcoming challenges: Determination to succeed" and "Using the resources available to me". The research supported the idea that positive psychological outcomes arise through a complex interplay between personality, cognitive and environmental factors. Theoretically, this research has implications for defining positive psychological outcomes following spinal cord injury, in addition to contributing towards future theoretical frameworks that aim to provide a basis for understanding the process through which positive psychological outcomes following spinal cord injury are achieved. Clinically, this research provides a narrative that can be used with people following spinal cord injury and also provides evidence for the use of cognitive screening measures such as appraisal style, to identify individuals who may be showing less adaptive cognitions.

Les lésions spinales cervicales sont au premier rang de l'épidémiologie des lésions spinales. Ce type de lésion porte atteinte aux commandes motrices bulbo-spinales respiratoires et entraîne des insuffisances respiratoires mettant en jeu le pronostic vital du patient. L'étude de la récupération spontanée de la fonction respiratoire et le développement de stratégies réparatrices constituent un enjeu majeur. Les stratégies thérapeutiques par greffe de cellules engainantes olfactives sont les plus prometteuses. Nous exposons l'effet de la transplantation de cellules gliales olfactives d'origine nasale au niveau spinal dans le cadre d'une hémi-contusion spinale cervicale chez le rat adulte et de la récupération de la fonction respiratoire. Nous montrons également, pour la première fois, qu'une lésion spinale a un impact sur les foyers de neurogenèse du cerveau et qu'un phénomène de neuroprotection se met en place dans la medulla du tronc cérébral suite à une lésion spinale. Nos travaux se replaçent dans une thématique clinique très actuelle, riche en publications. Il est impératif de prendre en compte les conséquences sus-lésionnelles d'une lésion spinale notamment pour la médecine régénératrice. / Cervical spinal cord injuries are the most frequent type of spinal cord injury. It interrupts motor bulbospinal respiratory pathway inducing respiratory deficits bringing into play the vital diagnostic of patients. The study of spontaneous recovery of respiratory function and the development of reparing strategies are a major issue. Therapeutic strategies by olfactory enseathing cells are the most promising. We show the effect of nasal olfactory enseathing cells transplantation at the spinal level considering a cervical spinal cord hemicontusion in adult rat and the recovery of respiratory function. We also demonstrate, for the first time, that spinal cord injury has an impact on adult brain neurogenesis niches and that a neuroprotective phenomenon appears after spinal cord injury in the medulla of the brainstem. Our results concerns an actual clinical research theme, well-referenced in publications. It is of high importance to consider supralesional consequences of spinal cord injury, especially for the regenerative medicine

TITLE: Coping with sudden motility limitation and its implication - coping strategies among young people with spinal cord injury and with multiple sclerosis SUMMARY: This thesis is focused on process of adjustment of motility limitation, caused by spinal cord injury or by attack of multiple sclerosis, among young people. The motoric ability limitation affects their mobility as well as their social interaction, interests, plans and especially their independence. Thus, in age of gaining emancipation from nuclear family, they become dependant on their home-folks again. The theoretical part of the thesis acquaints with spinal cord injuries and multiple sclerosis from biological and psychosocial point of view, thereinafter it's engaged in coping generally and coping in relation to these two groups. Furthermore it's dealt with developmental periods characterization of adolescence and young adulthood, consequences of health turnover in self-concept in social context. The empirical part is based on semi-structured interviews with six young people (3 with spinal cord injury, 3 with multiple sclerosis). The important findings gained from interviews are presented in form of casuistries. On the basis of the interviews analysis it's demonstrated problematic domains, that are affected by motility limitation, and ways of...

The aim of this thesis is to determine the use of surface electromyography for functional diagnostic of upper limb in spinal cord injury patients from an occupational therapy perspective. Functional diagnostic is focused on personal activities of daily living (pADL). So far, no one has commented this topic from an occupational therapy perspective in the Czech Republic. The thesis should offer another possibility of objective evaluation. The theoretical part deals with the description of upper limb, including kinesiology, the types of grasps of quadriplegic patients and the muscles involved in performing personal activities of daily living. There are problem areas of activities of daily living in spinal cord injury patients and their classification. At the end of the theoretical part is described electromyography, interconnection with occupational therapy and use of surface electromyography. There is also described interdisciplinary team. The practical part consists of six case reports, in which subjects were measured muscle activity during performing personal activities of daily living using surface electromyography. This section presents a diverse use of application of surface electromyography both in terms of graphical imaging and wide age dispersion of patients. Keywords: surface...

<div> <div> <div> <p>Patients with Spinal Cord Injury (SCI) have limited time with supervised therapy in rehabilitation hospitals. This makes it imperative for them to continue regular therapy at home so they can maximize motor recovery especially for performing Activities of Daily Living (ADL). However, physical therapy can be tedious and frustrating leading to a lack of motivation. A novel upper extremity movement measurement tool was developed using a commercial VR system to rapidly and objectively measure an individual’s range of motion, velocity of movement on an individual gesture basis, and frequency of movements in a three-dimensional space. Further, an exergame with varied and customizable gameplay parameters was developed. Through the analysis of participant interaction with the exergame, we identified gameplay parameters that can be adjusted to affect the player’s perceived and physiological effort. We observed that VR has a significant motivational effect on range of motion of upper limbs in individuals with tetraplegia. The motion data and kernel density estimation is used to determine areas of comfort. Moreover, the system allowed calculation of joint torques through inverse kinematics and dynamics to serve as an analysis tool to gauge muscular effort. The system can provide an improved rehabilitation experience for persons with tetraplegia in home settings while allowing oversight by clinical therapists through analysis of mixed reality videos or it could be used as a supplement or alternative to conventional therapy. </p> </div> </div> </div>

L’escarre est une pathologie liée à l’immobilité des patients, accidentelle ou associée à des comorbidités. Les premières lésions apparaissent dans le muscle avant de se développer en plaie cutanée sans que les mécanismes physiopathologiques de cette atteinte ne soient encore connus. L’objectif principal de cette thèse était d’identifier des voies de signalisation intervenant de manière précoce dans le développement des escarres au travers d’une étude transversale. Nous formulons l’hypothèse qu’une compression musculaire induit une altération de l’homéostasie calcique musculaire par atteinte des canaux calciques du réticulum sarcoplasmique (les récepteur de la ryanodine de type 1, RyR1) conduisant à la lésion du tissu musculaire et une inflammation du tissu sous-cutané.Sur un modèle animal de compression de 2 heures, à 100 mmHg, nous avons identifié une initiation des voies apoptotiques et une augmentation du stress oxydant des muscles de la paroi abdominale. Le RyR1 y est hyper-nitrosylé et hyper-oxidé et sa protéine régulatrice, calstabin1 se dissocie sous l’action de ce remodelage, ce qui entraîne une fuite calcique du réticulum sarcoplasmique vers le cytosol. Cette dysfonction n’est pas réversible à 3 jours post-compression mais il est possible de la prévenir en traitant les souris avec un rycal qui bloque la déplétion de la calstabin1. En clinique, chez une cohorte de patients paraplégiques, porteurs d’escarres, nous avons identifiés un remodelage du RyR1 dans les muscles paralysés (comparaison intra patient avec une biopsie saine) et une hypoxie des tissus sous la lésion médullaire. La dissociation de la calstabin1 au RyR1 a pu être corrélée à la pression moyenne et maximale exercée sur la peau de la zone sacrée du patient allongé en regard du muscle biopsié.Ce travail de thèse a permis de préciser les voies de signalisation intervenant de manière précoce dans le développement des escarres dans le muscle squelettique. Une compression mécanique induit une augmentation du stress oxydant, un remodelage du RyR1 et une dysfonction du canal à cause de la perte de l’interaction RyR1/calstabin1. Ces résultats ouvrent des perspectives intéressantes sur des traitements préventifs pharmacologiques et de suivi non-invasif qui permettront de retarder l’apparition des premières lésions musculaires. / Pressure ulcer is a pathology related to patient immobility, which can be either accidental or incidental to comorbidities. The first damage are located in muscle tissue before developing in cutaneous breakdown per an unclear pathophysiology. The core objective of my PhD was to identify the early signaling pathways involved in pressure ulcer development, through a transversal study. We hypothesized that muscle compression will induce a calcium imbalance in muscles by a dysfunction of calcium channels from the sarcoplasmic reticulum (Ryanodine receptor isoform 1, RyR1) which will lead to muscle damage and sub-cutaneous inflammation.Mice model of a 100 mmHg, 2 hours compression of abdominal muscles was used to identify the apoptotic pathway initiation and a rise of oxidative stress. RyR1 is hyper-nitrosylated and hyper-oxydated thus this remodeling induces depletion of RyR1 stabilizing protein, calstabin1, and the resulting leaky phenotype increases intracellular calcium concentration. This channel functional impairment was not reversible up to 3 days post-compression but it was possible to prevent it through rycal treatment, protecting the binding calstabin1/RyR1. In a clinical trial, we identified from a paraplegic population with existing pressure ulcers, a RyR1 remodeling in paralyzed muscles (intra patient comparison with a healthy muscle biopsy) and a hypoxia of tissues below the spinal cord injury. Calstabin1 dissociation was correlated to the mean and peak pressure intensity of interface pressure applied over the sacrum skin of the bedridden patient directly above the biopsy location.This thesis project focused on early signaling pathways participating in pressure ulcer in skeletal muscle. A mechanical strain induces an increase of the intracellular redox state, post translational RyR1 modifications and a channel dysfunction because of calstabin1 depletion. The significance of my work is to propose both pharmacology and non-invasive monitoring solutions to prevent first muscle damage in pressure ulcer development.

A estimulação elétrica neuromuscular é um recurso reabilitacional funcional que tem como propósito a recuperação dos movimentos dos membros superiores ou inferiores. Com este recurso, é possível a pessoas que possuem uma lesão medular e que vêem suas vidas modificadas pelo advento da lesão, executarem ações que possam facilitar a sua independência nas habilidades diárias, uma vez que mudanças em seu esquema corporal e limitações reais às suas atividades cotidianas são observadas nestes casos. Acredita-se que seja comum a presença de reações psicológicas a este tratamento, porém, poucos estudos foram registrados até o momento. Considerando-se que uma intervenção que aborde aspectos físicos, psicológicos e sociais destas pessoas é indispensável a qualquer processo reabilitacional, esta pesquisa teve como objetivos identificar e analisar características psicossociais de usuários do programa de estimulação elétrica neuromuscular realizado no Hospital das Clínicas da Universidade Estadual de Campinas, Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas, Laboratório de Biomecânica e Reabilitação do Aparelho Locomotor. Suas concepções, reações e expectativas frente a este tipo de reabilitação também foram investigados, além da identificação das principais necessidades destas pessoas, oferecendo subsídios para a condução de um tratamento psicoterápico adequado ao quadro caracterológico das pessoas com lesão medular submetidas à estimulação elétrica neuromuscular, de forma a favorecer a realização de um processo reabilitacional que os contemplem em sua dinâmica biopsicossocial. Para isso, os participantes desta pesquisa foram divididos em dois grupos distintos. Os que se encontravam no primeiro ano de tratamento e os que o realizavam há mais de um ano. Foi utilizado um roteiro de entrevista semi estruturada que teve como propósito conhecer aspectos, tais como, a visão da pessoa com lesão medular sobre sua própria deficiência, formas de enfrentamento, vida social e familiar, bem como, suas concepções e expectativas no que diz respeito à reabilitação por meio da estimulação elétrica neuromuscular. Os entrevistados consideraram como uma de suas metas, a recuperação total ou parcial das funções que lhes foram subtraídas com a lesão medular, considerando efeitos positivos com a utilização deste tratamento, no alcance de melhorias físicas e psicossociais. Não obstante, eles procuram investir em vários outros aspectos de suas vidas, que não somente o reabilitacional, como por exemplo, os profissionais, familiares, sociais e afetivos / Neuromuscular electrical stimulation is a functional resource for rehabilitation, which aims recover the motions of inferior and superior limbs. With this resource, it is possible for spinal cord injury patients, who had their lives changed due to this injury, to execute actions that can make their independency to every day abilities easier, once changes in their body structure and real limitations to daily activities were noticed in this case. It is believed that the remark of psychological reactions are usual for this treatment, however, a few studies were registrated until the moment. In regarding to an intervention that deals with this patients’ physical and social aspects is essential to any rehabilitation process, this research aims to identify and analyze users’ psycho-social characteristics of neuromuscular electrical stimulation program made at Campinas State University hospital, Orthopedic and Traumatology Department of Medical Science School, Laboratory of Biomechanics and Rehabilitation of Inferior Limbs. Its concepts, reactions and expectations toward this kind of rehabilitation were also investigated, as well as the identification for the leading of a psychotherapeutic treatment appropriate to the characterization of the process of spinal cord injury patients who were subjected to neuromuscular electrical stimulation in order to be biased toward the achievement of a rehabilitational process, which gives to the spinal cord injured person in his/her biopsycho social dynamic. For this, subjects of this research were divided in two different groups. The first group, people who were in the first year of treatment and the second group, people who had been in treatment for more than one year. A schedule of a half-standard interview was used and aimed to know aspects such as spinal cord injured person´s point of view about his/her own disability, how he/she faces it, social and family life as well as his/her concepts and expectations regarding to rehabilitation through neuromuscular electrical stimulation. The total or partial recovering of the functions that were taken by the spinal cord injury was had as one of the patients´ goals, which were worried about the positive effects by using this treatment, within reach physical and psychosocial improvement. They tried to invest in many other aspects of life, such as professional, family, social and affective aspects