The purpose of this study was to explore the psychosocial problems encountered by Black patients with tetralpegia once discharged from the hospital. Phenomenology as a research strategy was used with the aim of understanding the worldview of patients. The medical aspects of spinal cord injury were discussed, firstly with emphasis placed on the incidence of spinal cord injury, causes of spinal cord injury, different levels of tetraplegia and the management of patients with tetraplegia. The psychosocial problems encountered by black patients with tetralpegia once discharged from the hospital were discussed. The emphasis was placed on the patients’ emotional reaction to the injury, adjustment towards the injury and the guidelines for social work intervention with regard to the patient with tetraplegia. Ten respondents participated in the study after they were selected by using availability sampling and the study revealed the following. Tetraplegia results in a variety of psychosocial problems for both the patient and his/her family, which are: Negative marital relationships and desertion by the healthier spouse. Disturbed family relationships. Negative self-esteem and lack of self-confidence due to physical limitations. Poor quality of life, stigmatization by the community and inaccessibility in as far as public transport is concerned. Tetraplegia triggers psychological, social and financial problems. It is therefore concluded that social work intervention in the initial phase of the injury will ensure that the patients’ psychosocial problems are explored and attended to, to prepare the patients for the difficult life thereafter. / Dissertation (MA (SW) Health Care)--University of Pretoria, 2007. / Social Work and Criminology / MA (SW) / unrestricted

This thesis studies problematics of healthy partners of physically handicapped people, more precisely of people after spinal cord injury. The theoretical part is focused on the relationship satisfaction of these couples. It is structured into relationship areas which should be a potential source of conflicts and which can influence less or more the relationship satisfaction. These areas were selected on the basis of literature focusing on partner and marital couples. The empirical part was created in cooperation with organizations providing services to people after spinal injury where quantitative data were collected to measure levels of satisfaction of partners in relationship with people after spinal cord injury also levels of intimacy and commitment in these relationships. The data obtained are compared with the comparative group of respondents from the general population. Keywords: spinal cord injury, relationship satisfaction, social support, household chores, finances, leisure, sexuality, intimacy, commitment.

Le GABA et la glycine, principaux neurotransmetteurs inhibiteurs de la moelle épinière adulte, jouent un rôle clé dans la plasticité neuronale. Ils peuvent être excitateurs selon la concentration en chlorure du neurone cible. Celle-ci est principalement régulée par les co-transporteurs, KCC2, spécifique des neurones et NKCC1, ubiquitaire. Ces protéines font respectivement sortir et entrer les ions chlorure. Au cours du développement, l’expression de KCC2 augmente alors que celle de NKCC1 diminue, au moment où l’effet des potentiels post-synaptiques inhibiteurs sur le potentiel de membrane des neurones passe d’une dépolarisation à une hyperpolarisation. Une lésion médullaire à P0 bloque cette augmentation développementale. Cela est corrélé à une perte de fonction de KCC2, laquelle est restaurée après traitement avec un agoniste des récepteurs 5-HT2, indiquant que les voies descendantes issues du tronc cérébral, en particulier sérotoninergique, sont essentielles à la maturation du système inhibiteur. Une lésion chez l’adulte, induit une diminution de l’expression KCC2, en particulier à la surface des motoneurones et de ce fait, de la force de l’inhibition post-synaptique. Le BDNF est impliqué dans cette diminution mais son effet s’inverse 15 jours après la lésion, permettant le réacheminement de KCC2 à la surface des cellules. La phosphorylation des tyrosines et sérines serait impliquée dans l’adressage et la stabilisation de KCC2 dans la membrane plasmique alors que celle des thréonines jouerait un rôle dans son activation fonctionnelle. Ces résultats indiquent que KCC2 est une cible de choix pour restaurer l’inhibition neuronale dans la moelle épinière après traumatisme. / Le GABA et la glycine, principaux neurotransmetteurs inhibiteurs de la moelle épinière adulte, jouent un rôle clé dans la plasticité neuronale. Ils peuvent être excitateurs selon la concentration en chlorure du neurone cible. Celle-ci est principalement régulée par les co-transporteurs, KCC2, spécifique des neurones et NKCC1, ubiquitaire. Ces protéines font respectivement sortir et entrer les ions chlorure. Au cours du développement, l’expression de KCC2 augmente alors que celle de NKCC1 diminue, au moment où l’effet des potentiels post-synaptiques inhibiteurs sur le potentiel de membrane des neurones passe d’une dépolarisation à une hyperpolarisation. Une lésion médullaire à P0 bloque cette augmentation développementale. Cela est corrélé à une perte de fonction de KCC2, laquelle est restaurée après traitement avec un agoniste des récepteurs 5-HT2, indiquant que les voies descendantes issues du tronc cérébral, en particulier sérotoninergique, sont essentielles à la maturation du système inhibiteur. Une lésion chez l’adulte, induit une diminution de l’expression KCC2, en particulier à la surface des motoneurones et de ce fait, de la force de l’inhibition post-synaptique. Le BDNF est impliqué dans cette diminution mais son effet s’inverse 15 jours après la lésion, permettant le réacheminement de KCC2 à la surface des cellules. La phosphorylation des tyrosines et sérines serait impliquée dans l’adressage et la stabilisation de KCC2 dans la membrane plasmique alors que celle des thréonines jouerait un rôle dans son activation fonctionnelle. Ces résultats indiquent que KCC2 est une cible de choix pour restaurer l’inhibition neuronale dans la moelle épinière après traumatisme.

The study purposes were to identify changes in resilience, satisfaction with life (SWL), depression, spirituality, and functional independence (FI) and to examine the relationship between these variables, during the inpatient rehabilitation for a spinal cord injury (SCI). The sample included 42 individuals with a SCI, 33 males and 9 females, who were inpatients with a mean stay of 52 days (SD = 15.78). A repeated measures design was employed with questionnaires completed at three times during rehabilitation. Results indicated that there were significant changes in depression, satisfaction with life, spirituality, and FI during inpatient rehabilitation. Findings also indicated significant correlations between resilience, SWL, spirituality, and depression. Future studies developing interventions, and examining factors that predict resilience could help build resilience and may improve rehabilitation outcomes.

Orientador: José Irineu Gorla / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Física / Made available in DSpace on 2018-08-24T08:38:24Z (GMT). No. of bitstreams: 1 Santos_LuizGustavoTeixeiraFabriciodos_M.pdf: 995550 bytes, checksum: 7115161769458ab4cae8606165777d80 (MD5) Previous issue date: 2014 / Resumo: Em decorrência da lesão da medula espinhal nível cervical, os indivíduos apresentam bradicardia alterando o balanço autonômico em relação ao sistema cardiovascular, comprometendo a modulação da pressão arterial, resistência periférica, frequência e débito cardíaco. Sendo assim, o presente estudo teve por objetivo mensurar a variabilidade de frequência cardíaca em indivíduos com lesão da medula espinhal. O grupo avaliado foi composto por indivíduos do sexo masculino, tetraplégicos completos e incompletos com idades entre 26 e 39 anos e tempo médio de lesão de 10,38±8,34 anos e com carga horária de treino igual ou superior a 20 horas/semanais. A avaliação da variabilidade da frequência cardíaca ocorreu nos momentos pré e pós a execução de um exercício submáximo incremental em ciclo ergômetro de braços. Para o registro da Variabilidade de Frequência Cardíaca optou-se pela posição sentada, durante um período de 20 minutos em cadeira de passeio para os dois momentos. Os intervalos R-R foram registrados e transferidos para um notebook utilizando o software Polar Pro Trainer® e analisados através do software Kubios® para a análise das variáveis no domínio do tempo e da frequência. Observando valores referentes às variáveis, RR e RMSSD, no domínio da frequência, para os grupos, percebe-se um aumento na situação pós-exercício em relação ao repouso. Para as variáveis relacionadas ao domínio do tempo, LFun, HFun e Razão LFun/HFun, é observado em ambos grupos uma redução para os valores relacionados ao LFun, enquanto para a Razão LFun/HFun, observou-se reduzida apenas para o grupo completo e refletido no grupo geral. Porém, o fato de nosso estudo ser um dos pioneiros na área, permitirá a utilização dos valores descritos como referência para investigações futuras. Nossos achados poderão auxiliar profissionais que atuam na reabilitação de pessoas com lesão cervical da medula espinhal através do Rugby em Cadeira de Rodas e preparadores físicos objetivando a otimização do desempenho físico, visto que a modalidade atua predominantemente no sistema cardiorrespiratório / Abstract: As a result of spinal cord injury in cervical level, individuals have bradycardia altering autonomic balance in relation to the cardiovascular system, affecting the modulation of blood pressure, peripheral resistance and cardiac output frequency. Therefore, this study aimed to measure the heart rate variability in individuals with spinal cord injury. The studied group consisted of male, complete and incomplete quadriplegic aged between 26 and 39 years and mean duration of injury of 10.38 ± 8.34 years and hours of training equal to or greater than 20 hours / week. The assessment of heart rate variability occurred in the moments before and after the implementation of an incremental submaximal exercise on cycle ergometer in arms. For the record the heart rate variability was chosen by the sitting position for a period of 20 minutes in the stroller for two moments. The RR intervals were recorded and transferred to a notebook using Polar Pro Trainer ® software and analyzed through Kubios ® software for the analysis of the variables in the time domain and frequency. Noting values for the variables, RR and RMSSD, the frequency domain, for groups, one sees an increase in post-exercise condition compared to rest. For the variables related to the time domain , LFun , HFun and LFun / HFun , is observed for both groups reduced for related LFun values , while for LFun / HFun , there was reduced only for the whole group and reflected in the overall group. However, the fact that our study is one of the pioneers in the field, will allow the use of the values described as a reference for future investigations. Our findings may help professionals working in the rehabilitation of people with cervical spinal cord injury through Rugby Wheelchair and trainers aiming at optimizing physical performance, since the mode acts predominantly on the cardiorespiratory system / Mestrado / Atividade Fisica Adaptada / Mestre em Educação Física

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

Este trabalho avaliou a incidência de pacientes com lesão traumática da coluna cervical causada por mergulho em águas rasas, que foram atendidos nos Hospitais da cidade de Ribeirão Preto-SP, entre janeiro de 1989 a dezembro de 1996. O estudo epidemiológico foi realizado mediante investigação feita nos prontuários médicos desses pacientes. Complementou-se as informações por meio de uma entrevista realizada com 12 deles. Com base nos números apresentados, elaborou-se um programa de prevenção decorrente desses traumatismos a implantou-se uma Campanha de prevenção das lesões cervicais por mergulho em águas rasas em Ribeirão Preto. Um Programa de Campanha foi encaminhado à Assembléia Legislativa do Estado e transformado em Projeto de Lei. Os resultados mostraram que, dos 355 casos estudados, 69 deles foram por acidentes em águas rasas, a dentre estes, 58% tiveram danos neurológicos. Os locais mais freqüentes dos acidentes foram rios, córregos, lagos, cachoeiras,com a ocorrência de 75,4% dos casos, enquanto que a incidência em piscinas foi de 24,6%. A média de idade variou entre 10 a 30 anos, havendo diferença significativa com outras faixas etárias. Quanto ao sexo, 92,8% ocorreram em homens a 7,2% com mulheres. Em relação ao estado civil, 68,2% eram solteiros e 31,9% eram casados. O período do ano em que houve um número mais elevado dos traumatismos da coluna cervical causado pelo mergulho nas chamadas águas rasas foi nos meses de estações mais quentes na região (primavera, verão a outono). Dos 17,4% dos pacientes entrevistados de um total de 40 que tiveram lesão medular, todos mostraram desconhecimento desse tipo de acidente, bem como suas conseqüências. A Campanha de prevenção teve início em setembro de 1996 e está em fase de desenvolvimento em Ribeirão Preto. O Projeto de Lei estadual nº 183 aguarda aprovação da Assembléia. Conclui-se que, a incidência de acidentes com lesão traumática da coluna cervical por mergulho em águas rasas é elevada, sendo a terceira causa de danos traumáticos. A desinformação da população no que diz respeito ao perigo de um mergulho em águas rasas é elevado. A redução deste tipo de acidente pode acontecera partir de um processo educacional da população a da atuação decisiva do poder público. / This study is an evaluation of the incidence of patients treated in the hospitals in Ribeirão Preto - SP for traumatic injury of the cervical cord caused by diving in shallow waters. The epidemiological study was held by means of an investigation of the medical charts of patients who underwent treatment from January 1989 to December 1996. The information on the charts was complemented through interviews held with 12 of these patients. Based on the results of these investigations, a campaign to prevent cervical injury caused by diving into shallow waters was elaborated and sent to the State Legislature, where it was transformed into a bill. The study revealed that in the 355 cases of cervical injury investigated, 69 were the result of accidents in shallow waters, and of these, 58% suffered neurological dysfunction. Rivers, lakes and waterfalls were most frequently cited as locations for the occurrence of these injuries (75,4% of the cases), with the incidence of accidents in swimming pools at 24,6%. The average age of patients varied between 10 to 30 years of age, with a significant difference in other age groups. In relation to sex, 92,8% of the accidents occurred in men, and only 7,2% in women. As to marital status, 68,2% were single and only 31,9% were married. The greatest number of cases of trauma of the cervical cord caused by diving in shallow waters occurred in the warmer seasons of the year (spring summer and fall). 17,4% of the patients interviewed out of a total of 40 with medullar injury, claimed not to know about this kind of accident and its consequences. The Prevention Campaign began in September 1996 and is presently being carried out in the city of Ribeirão Preto. The Bill of Law no. 183 awaits approval from the State Legislature. One may conclude that the incidence of traumatic injury of the cervical cord due to diving in shallow waters is high (third place as the cause of injury). The lack of information on the part of the population regarding the dangers of this type of accident may be one of the reasons behind these high statistics. The reduction of this type of accident may occur as the result of an educational process involving the population as well as decisive action on the part of the government.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-19T19:06:04Z No. of bitstreams: 1 Fernanda Cordeiro da Silva.pdf: 1381976 bytes, checksum: fbe6ec859374d855f93a0382db62b771 (MD5) / Made available in DSpace on 2018-07-19T19:06:04Z (GMT). No. of bitstreams: 1 Fernanda Cordeiro da Silva.pdf: 1381976 bytes, checksum: fbe6ec859374d855f93a0382db62b771 (MD5) Previous issue date: 2017-11-30 / Background: Spinal injury is a devastating condition with physical, emotional, psychological, social and financial repercussions for affected individuals and their families. This type of injury impedes the performance of functional activities due to the partial or complete interruption of ascending sensory and descending motor pathways. Photobiomodulation is a noninvasive treatment that has been widely used in neurotrauma and neurodegenerative diseases. In the present study, low-level laser therapy was administered in cases of spinal cord injury to investigate the sensory responses and perceptions of patients. The aim of the present study was to investigate the sensory and motor response and perception of the patients with spinal cord injuries submitted to photobiomodulation therapy. Methods/Design: The 25 volunteers were randomly allocated in the control group-placebo more physical therapy or group photobiomodulation more physical therapy. Photobiomodulation was performed three times per week for a total of 12 sessions. A wavelength of 810 nm was used, 5 points being 25 J per point, exactly on the region of the cord where it was injured, radiant power, 120 mW, 208 seconds per point and Radiant Exposure 983 J/cm2. All individuals were evaluated using the ASIA scale, a sensory perception questionnaire and electromyography to assess the motor response before, immediately after and 30 days after photobiomodulation. The control group-placebo was subjected to photobiomodulation simulated, that is, without emission of radiation. The data were analyzed statistically, with α < 0.05 considered indicative of statistical significance. Results: Thirteen types of sensorimotor changes were reported, with a significant difference between groups in relation to "trait contractions." In the intragroup analysis of the photobiomodulation group, statistically significant differences were found between the pre-intervention and immediate post-sensory sensory evaluations, as well as between sensory evaluations after immediate intervention and 30 days after photobiomodulation. No significant differences were found in the control group between any of the evaluation times. In the intra-group analysis of the laser group, median frequency values of the brachial biceps and femoral quadriceps muscles were higher at rest and during isotonic contraction 30 days after photobiomodulation. Conclusion: In the present study, phototherapy was effective in promoting a motor and sensory response in individuals with spinal cord injuries, so the results suggest that photobiomodulation may be a promising approach for the treatment of sensorimotor changes in patients with lesions of the spinal cord. / Introdução: A lesão medular é uma condição devastadora com repercussões físicas, emocionais, psicológicas, sociais e financeiras para os indivíduos afetados e suas famílias. Este tipo de lesão impede o desempenho de atividades funcionais devido à interrupção parcial ou total das vias motoras sensoriais e descendentes e ascendentes. A fotobiomodulação é um tratamento não invasivo amplamente utilizado em neurotrauma e doenças neurodegenerativas. No presente estudo, a fotobiomodulação foi administrada na medula espinhal lesada com objetivo de investigar as respostas sensório-motoras e as percepções dos pacientes após o tratamento. Métodos: Os 25 voluntários foram alocados aleatoriamente no grupo controle-placebo mais fisioterapia ou grupo fotobiomodulação mais fisioterapia. A fotobiomodulação foi realizada três vezes por semana com um total de 12 sessões. Foi utilizado o comprimento de onda de 810 nm, 5 pontos sendo 25 J por ponto, exatamente sobre a região da medula onde foi lesada, potencia radiante 120 mW, 208 segundos por ponto, exposição radiante 983 J/cm². Todos os indivíduos foram avaliados utilizando a escala ASIA, a entrevista de percepção sensorial e eletromiografia para avaliar a resposta motora antes, imediatamente após e 30 dias após a fotobiomodulação. O grupo controle-placebo foi submetido à fotobiomodulação simulada, ou seja, sem emissão da radiação. Os dados foram analisados estatisticamente, com um α <0,05 considerado indicativo de significância estatística. Resultados: Foram relatados 13 tipos de alterações sensório-motoras, com uma diferença significativa entre os grupos em relação aos esboços de contrações. Na análise intragrupo, no grupo fotobiomodulação, foram encontradas diferenças estatisticamente significantes entre as avaliações sensoriais pré-intervenção e pós imediata, bem como, entre avaliações sensoriais após intervenção imediata e 30 dias após a fotobiomodulação. Não foram encontradas diferenças significativas no grupo controle em quaisquer uns dos tempos avaliados. Na análise intragrupo, no grupo fotobiomodulação, os valores de freqüência mediana do bíceps braquial e do quadríceps femoral foram maiores em repouso e durante a contração isotônica 30 dias após a fotobiomodulação. Conclusão: No presente estudo, a fototerapia foi efetiva na promoção de uma resposta motora e sensorial em indivíduos com lesões da medula espinhal, sendo assim, os resultados sugerem que a fotobiomodulação pode ser uma abordagem promissora para o tratamento de alterações sensório-motoras em pacientes com lesões da medula espinhal.

Ce travail de thèse avait pour objectif principal d’étudier l’influence de certains paramétrages deslogiciels de prédiction de mots et d’un programme d’entraînement ciblé sur la vitesse de saisie detexte chez des personnes tétraplégiques. Six études ont été menées. L’étude 1 nous a permis demettre en évidence des vitesses de saisie de texte chez les personnes tétraplégiques et d’étudierl’influence de leurs aides techniques d’accès à l’outil informatique sur cette vitesse. L’étude 2 nous apermis de mettre en avant l’hétérogénéité des résultats d’un logiciel de prédiction de mots sur lavitesse de saisie de texte sur une population hétérogène et sans paramétrage de ces logiciels.L’étude 3 nous a permis d’étudier les habitudes de préconisations et de paramétrages des logiciels deprédictions de mots par les professionnels. Les études 4 et 5 nous ont permis d’évaluer l’influencedes paramétrages (nombre de mots affichés dans la liste de prédiction et l’adaptation du logiciel auvocabulaire de l’utilisateur) sur cette saisie de texte. Enfin, l’étude 6 nous a permis d’étudierl’influence d’un entraînement dirigé par des professionnels sur les logiciels de prédictions de motschez des personnes tétraplégiques, sur la vitesse de saisie de texte.Les résultats montrent que seule l’aide technique d’accès à l’outil informatique influence la vitessede saisie de texte. Les logiciels de reconnaissance vocale permettent une vitesse de saisie de texteéquivalente à celle des personnes valides utilisant un clavier standard. Les paramétrages (nombre demots affichés dans la liste de prédiction et l’adaptation du logiciel au vocabulaire de l’utilisateur) ontune influence différente en fonction du niveau lésionnel des personnes tétraplégiques sur la vitessede saisie de texte, le nombre d’erreurs ou le confort. De plus, une différence entre l’importancedonnée aux paramétrages par les professionnels préconisateurs et les paramétrages effectivementréglés a été mise en évidence. Enfin, l’influence d’un entraînement dirigé sur la vitesse de saisie detexte a été mise en évidence sur la vitesse de saisie de texte. Au regard de l’ensemble de cesrésultats, il apparait nécessaire de paramétrer les logiciels de prédictions de mots, mais aussi deconnaitre l’influence des différents réglages et de diffuser cette information au sein des réseauxprofessionnels. La recherche doit être poursuivie pour améliorer les logiciels de prédiction de mots,mais aussi pour favoriser de nouveaux outils tels les tablettes tactiles et les logiciels dereconnaissance vocale. Une systématisation des entraînements dirigés sur les logiciels de prédictionde mots nécessite une réflexion et une validation sur les modalités et la nature de cesaccompagnements. / The main objective of this work was to study the influence of key settings of word predictionsoftware as well as a training program on the use of word prediction, on text input speed in personswith cervical spinal cord injury.Study 1 determined text input speed in persons with cervical spinal cord injury and the influence ofpersonal characteristics and type of computer device on text input speed. Study 2 evaluated theeffect of a dynamic virtual keyboard coupled with word prediction software on text input speed inpersons with functional tetraplegia. Study 3 analysed the word prediction software settingscommonly prescribed by health-related professionals for people with cervical spinal cord injury.Studies 4 and 5 evaluated the influence of the number of words displayed in the prediction list andthe frequency of use setting on text input speed. Finally, study 6 evaluated the influence of a trainingprogram on the use of word prediction software for persons with cervical spinal cord injury on textinput speed.The results showed that only the type of computer device influenced text input speed; voicerecognition software increased the text input speed of persons with cervical spinal cord injury to thatof able-bodied people using a standard keyboard. The influence of the different word predictionsoftware settings (number of words displayed in the prediction list and the frequency of use) on textinput speed, the number of errors or comfort of use, differed depending on the level of injury. Wealso found differences between the perception of the importance of some settings by healthprofessionalsand data in the literature regarding the optimization of settings. Moreover, althoughsome parameters were considered as very important, they were rarely configured. Finally, trainingpersons with cervical spinal cord injury in the use of word prediction software increased text inputspeed.The results of this work highlighted that word prediction software settings influence text input speedin persons with cervical spinal cord injury, however not all professionals are aware of this.Information should therefore be disseminated through professional networks. Further studies shouldaim to improve word prediction software and should also focus on new devices such as tablets andvoice recognition software. Persons with cervical spinal cord injury training programs in the use ofword prediction software need to be developed and validated.

Les lésions médullaires traumatiques (LMT) conduisent à une atteinte des voies nerveuses sensitives et motrices. Leur taux de mortalité reste très élevé, d'où la nécessité de trouver de nouveaux traitements. Les Cellules Gliales Olfactives (CGOs) représentent un candidat intéressant de par leur fonction au sein du système olfactif primaire. La découverte d'une population de cellule souche neurale bordant le canal central de la moelle spinale (MS) adulte, appelées cellules épendymaires, suscite un nouvel espoir dans le domaine des biothérapies. Ce travail de thèse a permis d'étudier l'effet d'une transplantation de CGOs sue le comportement des cellules résidentes de la moelle spinale et notamment les cellules souches épendymaires qui, en association avec les astrocytes et les péricytes, participent aux mécanismes de guérison des LMT. L'utilisation du modèle murin hFoxJ1-CreERT2::YFP (permettant le suivi spécifique des cellules épendymaires et de leur progénie), a montré que les CGOs augmentaient in vitro le potentiel d'auto-renouvellement des cellules souches de la MS et modifiaient leur voie de différenciation vers un type neural. In vivo, la transplantation de CGOs augmente la prolifération des cellules épendymaires ainsi que leur différenciation en astrocytes hypo-réactifs conduisant à la formation d'un environnement post-lésionnel bénéfique à la survie neuronal et l'établissement d'une neurogenèse. Nos travaux ont montré pour la première fois que la transplantation de CGOs après LMT permettait la génération de nouveaux neurones. Ceci constitue un nouvel espoir dans l'établissement de stratégies thérapeutiques pour le traitement des LMT chez l'Homme. / The spinal cord injuries (SCI) lead to the damages of the spinal cord or nerves and often cause permanent changes in body functions leading to the death. Cell therapies have raised great hope for regenerative medicine. Clinical data showed that the olfactory ensheathing cells (OECs) enhanced functional recovery after SCI and could be a very attractive therapeutic approach. Moreover, the discovery of a new endogenous resident stem cell population, lining the central canal of the spinal cord, named ependymal stem cells, represents a new hope for the therapy. This thesis analyzed the role of OECs transplantation, on the behaviour of ependymal stem cells since these cells, together with astrocytes and pericytes significantly contribute to the recovery of SCI. The use of the mouse model hFoxJ1-CreERT2::YFP (allowing to specifically follow the ependymal stem cells ant their progeny) showed that OECs increased in vitro the self-renewal potential of spinal cord stem cells and modified their differentiation pathway towards a neural type. In vivo, OECs transplantation significantly increases the proliferation of ependymal cells and their differenciation into hypo-reactive astrocytes leading to the formation of a beneficial environment to neuronal survival and the neurogenesis establishment. Our results also showed for the first time that OECs transplantation after SCI allows the generation of new neurons by non-ependymal cell-derived progenitors. These results represent a new hope in the establishment of therapeutic strategies for the treatment of SCI in humans.