Name: Effectivness of Basic Life Support in Children Provided by Wheelchair Users Objectives: The aim of this diploma thesis is to evaluate the effectiveness of elementary emergency resuscitation children under 1yr of age with three selected positions of resuscitation manikin in persons using a wheelchair for their movement. Based on the comparison of the results when positioning the manikin on a lap, on a mat and on the ground, aim is to evaluate the most suitable position for performing elementary emergency resuscitation. Method: The research group consisted of ten people with spinal cord injury (four with tetraplegia and six with paraplegia), who use wheelchair for their movement. Three methods of data collection were used in this work. A survey was used for the first method, which obtained anamnestic data of the research group. The second method of data collection was the observation of probands during first aid. The third selected method was a measurement using a SimPad SkillReporter and a Resusci Baby QCPR resuscitation manikin. The measurement was used to evaluate the effectiveness of elementary emergency resuscitation of children for five minutes in three selected positions. Results: Based on observations and measurements, it was found that all probands are able to lift and manipulate a...

An autonomic dysfunction caused by spinal cord injury may have a significant impact on quality of life, especially in cases of lesions occuring above the sixth spinal segment. In these cases also cardiovascular system control is damaged in a different extent, which is subsequently presented by e.g. persisting bradycardia, heart frequency inadequate reaction to strain and stress or by huge variations of blood pressure values, which the situation complicate even more. The fact that cardiovascular diseases take now the frontmost place in causes of mortality of people with spinal cord injury is another evidence how important this topic is. The main aim of my thesis was to describe impacts of autonomic injury on cardiovascular functions and to try to objectify them using heart rate and blood pressure variability. Twenty-one patients of Motol University Hospitalv Spinal Unit with spinal cord lesion above Th6 segment and ten healthy people as a control group participated in the study. We created suitable conditions for highlighting disrupted cardiovascular functions of urgent spinal patients by modification of the standardized Head Up Tilt Test (HUTT). The heart rate and blood pressure values were continuously monitored by Finapres device before, during and also after verticalization on a tilt table....

Les exosquelettes robotisés de marche (ERM) représentent une intervention prometteuse dans le domaine de la réadaptation locomotrice. Sur le plan clinique, les ERM facilitent la mise en application de principes de neuroplasticité. Jusqu'à présent, la majorité des études analysant les effets de l’ERM a été menée avec des ERM fournissant une assistance robotique complète le long d’une trajectoire de mouvements prédéfinie des membres inférieurs (MI) de façon à reproduire la marche de façon quasi parfaite à très basse vitesse. La nouvelle génération d’ERM, maintenant disponible sur le marché, propose de nouveaux modes de contrôles qui permettent, entre autres, une liberté de mouvement accrue aux MIs (c.-à-d. trajectoire non imposée) et une possibilité d’offrir une assistance ou résistance aux mouvements de différentes intensités surtout pendant la phase d’oscillation du cycle de marche. Cependant, les effets de ces modes de contrôles sur la coordination musculaire des MI pendant la marche au sol avec l’ERM, caractérisé via l’extraction de synergies musculaires (SM), restent méconnus. Cette thèse mesure et compare les caractéristiques des SM (c.-à-d. nombre, profils d’activation, composition musculaire et contribution relative des muscles) pendant la la marche au sol sans ou avec un ERM paramétré avec six différents modes de contrôle chez des individus en bonne santé (articles #1 et #2) et d’autres ayant une lésion médullaire incomplète (LMI) (article #3). Les signaux électromyographiques (EMG) des différents muscles clés des MI, enregistrés lors de la marche, ont été utilisés afin d’extraire les SM avec un algorithme de factorisation matricielle non négative. La similarité des cosinus et les coefficients de corrélation ont caractérisé les similitudes entre les caractéristiques des SM. Les résultats montrent que: 1) les profils d'activation temporelle et le nombre de SM sont modifiés en fonction de la vitesse de marche avec, entre autres une augmentation de la vitesse de marche entrainant une fusion de SM, chez les individus en bonne santé marchant sans ERM ; 2) lorsque ces derniers marchent avec un ERM, les différents modes de contrôle testés ne dupliquent pas adéquatement les SM retrouvées lors de la marche sans ERM. En fait, uniquement le mode de contrôle libérant la contrainte de trajectoire de mouvements des MIs dans le plan sagittal lors de la phase d’oscillation reproduit les principales caractéristiques des SM retrouvées pendant la marche sans ERM ; 3) le nombre et la composition musculaire des SM sont modifiés pendant la marche sans ERM chez les personnes ayant une LMI. Cependant, parmi tous les modes de contrôle étudiés, seul le mode de contrôle libérant le contrôle de la trajectoire de mouvements des MI et assistant l’oscillation du MIs (c.-à-d. HASSIST) permets l’extraction de SM similaire à celles observées chez des individus en santé lors d'une marche sans ERM. Dans l’ensemble, cette thèse a mis en évidence le fait que différentes demandes biomécaniques liées à la marche (c.-à-d. vitesse de marche, modes de contrôle de l’ERM) modifient le nombre et les caractéristiques de SM chez les personnes en santé. Cette thèse a également confirmé que la coordination musculaire, mise en évidence via l’analyse de SM, est altérée chez les personnes ayant une LMI et a tendance à se normaliser lors de la marche avec l’ERM paramétré dans le mode de HASSIST. Les nouvelles preuves appuieront les professionnels de la réadaptation dans le processus de prise de décision concernant la sélection du mode de contrôle des MIs lors de l’entrainement locomoteur utilisant avec un ERM. / Wearable robotic exoskeletons (WRE) represent a promising rehabilitation intervention for locomotor rehabilitation training that aligns with activity-based neuroplasticity principles in terms of optimal sensory input, massed repetition, and proper kinematics. Thus far, most studies that investigated the effects of WRE have used WRE that provide full robotic assistance and fixed trajectory guidance to the lower extremity (L/E) to generate close-to-normal walking kinematics, usually at very slow speeds. Based on clinicians’ feedback, current commercially-available WRE have additional control options to be able to integrate these devices into the recovery process of individuals who have maintained some ability to walk after an injury to the central nervous system. In this context, WRE now offer additional degrees of movements for the L/E to move freely and different strategies to assist or resist movement, particularly during the gait cycle’s swing phase. However, the extent that these additional WRE control options affect L/E neuromuscular control during walking, typically characterized using muscle synergies (MSs), remains unknown. This thesis measures and compares MSs characteristics (i.e., number, temporal activation profile, and muscles contributing to a specific synergy [weightings]) during typical overground walking, with and without a WRE, in six different control modes, in abled-bodied individuals (Articles #1 and #2) and individuals with incomplete spinal cord injury (iSCI; Article #3). Surface EMG of key L/E muscles were recorded while walking and used to extract MSs using a non-negative matrix factorization algorithm. Cosine similarity and correlation coefficients characterized, grouped, and indicated similarities between MS characteristics. Results demonstrated that: 1) the number of MSs and MS temporal activation profiles in able-bodied individuals walking without WRE are modified by walking speed and that, as speed increased, specific MSs were fused or merged compared to MSs at slow speeds; 2) In able-bodied individuals walking with WRE, few WRE control modes maintained the typical MSs characteristics that were found during overground walking without WRE. Moreover, freeing the L/E swing trajectory imposed by the WRE best reproduced those MSs characteristics during overground walking without the WRE; and 3) After an iSCI, alterations to the number and the composition of MSs were observed during walking without WRE. However, of all WRE control modes that were investigated, only HASSIST (i.e., freeing WRE control over L/E swing trajectory while assisting the user’s self-selected trajectory) reproduced the number and composition of MSs found in abled-bodied individuals during overground walking without WRE. Altogether, the results of this thesis demonstrated that different walking-related biomechanical demands (i.e., walking speed) and most of the WRE control modes can alter some MSs, and their characteristics, in able-bodied individuals. This research also confirmed that impaired muscle coordination, assessed via MSs, can adapt when walking with a WRE set with specific control options (e.g., HASSIST). These MS adaptations mimicked typical MS characteristics extracted during overground walking. The evidence generated by this thesis will support the decision-making process when selecting specific L/E control options during WRE walking, allowing rehabilitation professionals to refine WRE locomotor training protocols.

As previously shown, transplantation of Wharton's jelly-derived mesenchymal stem cells in the experimental model of spinal cord injury leads to the motor and sensory functions improvement, supports neuroregeneration, angiogenesis and provides immunomodulation. On the other hand, these cells have limited migration and survival capacity, and their therapeutic effect is mediated mostly by their secretome. Therefore, application of mesenchymal stem cells derived conditioned medium is studied as an alternative option for cell therapy. In this thesis, therapeutic effect of repeated intrathecal delivery of human Wharton's jelly-derived mesenchymal stem cells and their conditioned media in the treatment of spinal cord injury was compared. After induction of a balloon ischemic compression lesion, stem cells or conditioned media were administered weekly in three doses. Behavioral analyses were carried out up to nine weeks after spinal cord injury and revealed significant improvement of both treated groups compared to the untreated saline control. Application of stem cells and conditioned media also resulted in a higher amount of spared tissue and enhanced expression of genes related to neuroregeneration, although the size of glial scar was not reduced. Compared to application of stem cells, application of...

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...

Title: Virtual Reality in Comprehensive Rehabilitation of People with Spinal Cord Injury Objectives: The main aim of this work was to find out how the virtual reality in comprehensive rehabilitation affects individuals with spinal cord injury who took part in social rehabilitation stay at Centrum Paraple, o.p.s. The research was focused on the awareness of virtual reality, probands' subjective reactions to therapeutic video, and comparison of these reactions between individuals with complete and incomplete spinal cord injury. Furthermore, potential interest in this form of therapy within the future comprehensive rehabilitation of probands was investigated. Methods: Twenty seven probands in the 18-70 age range, with complete or incomplete spinal cord injury took part in the quantitative research. During their social rehabilitation stay at Centrum Paraple, o.p.s., probands were shown three and half minute long therapeutic video through VR headset. Probands completed an input and output questionnaire. The input questionnaire mapped previous experience with virtual reality and inquired about probands' interest to try out virtual reality during social rehabilitation stay. The output questionnaire focused on subjective evaluation of perceptions and feelings as well as closer information about probands....

[ES] Los receptores tipo Toll, TLR, son receptores clave en la defensa contra los patógenos capaces de iniciar la respuesta inmunitaria innata para proteger al huésped. Su papel no solo se relega a responder a estímulos foráneos, sino que también pueden detectar daños en los tejidos o células lesionadas induciendo su respuesta a lo que se conoce como "inflamación estéril". Las células del sistema inmunitario no son las únicas que presentan TLR; también se encuentran en células de la glía, neuronas y precursores neurales (NPC). Concretamente, TLR2 y TLR4 en NPC en cerebro contribuyen a la determinación del destino celular y plasticidad neuronal durante el desarrollo. Sin embargo, sus funciones en la fisiología y patología de la médula espinal no están bien definidas, así como en procesos críticos como la neurogénesis, autorrenovación o proliferación. Esta tesis doctoral, distribuida entre tres capítulos, se ha centrado 1) en el estudio del papel de TLR2 y TLR4 en precursores derivados de medula espinal neonatal (Capítulo 1); 2) en evaluar el papel de ambos, TLR2 y TLR4 en el proceso de regeneración espontánea o tras trasplante ectópico de NPC, en un modelo de lesión medular inducida (Capítulo 2); 3) en el estudio del papel de TLR4 en la modulación del fenotipo inflamatorio en respuesta al proteoglicano condroitín sulfato (CSPG) secretado tras la lesión medular con actividad inhibitoria del recrecimiento axonal tras lesión medular (Capítulo 3). / [CA] Els receptors tipus Toll, TLR, són receptors clau en la defensa contra els patògens capaços d'iniciar la resposta immunitària innata per a protegir l'hoste. El seu paper no sols es relega a respondre a estímuls forans, sinó que també poden detectar danys en els teixits o cèl·lules lesionades induint la seua resposta al que es coneix com a "inflamació estèril". Les cèl·lules del sistema immunitari no són les úniques que presenten TLR; també es troben en cèl·lules de la glia, neurones i precursors neurals (NPC). TLR2 i TLR4 en NPC en cervell contribueixen a la determinació del destí cel·lular i plasticitat neuronal. No obstant això, les seues funcions en la fisiopatologia de la medul·la espinal no estan ben definides, així com en processos crítics com la neurogènesi, autorenovació o proliferació. Aquesta tesi doctoral, distribuïda entre tres capítols, s'ha centrat: 1) En l'estudi del paper de TLR2 i TLR4 en precursors derivats de medul·la espinal neonatal (Capítol 1); 2) A avaluar el paper de tots dos, TLR2 i TLR4, en el procés de regeneració espontània o després de trasplantament ectòpic de NPC, en un model de lesió medul·lar induïda (Capítol 2); 3) En l'estudi del paper de TLR4 en la modulació del fenotip inflamatori en resposta al proteoglicà condroití sulfat (CSPG) secretat després de la lesió medul·lar amb activitat inhibitòria del recreixement axonal després de lesió medul·lar (Capítol 3). / [EN] Toll-like receptors, TLRs, are key receptors in the defence against pathogens capable of initiating the innate immune response to protect the host. Their role is not only limited to responding to foreign stimuli, but they can also detect damage to injured tissues or cells, inducing their response to what is known as 'sterile inflammation'. Immune system cells are not the only cells that display TLRs; they are also found in glial cells, neurons and neural precursors cells (NPCs). TLR2 and TLR4 NPCs from brain contribute to cell fate determination and neuronal plasticity. However, their roles in spinal cord pathophysiology and in critical processes such as neurogenesis, self-renewal or proliferation are not well defined. This doctoral thesis, distributed among three chapters, has focused: 1) on the study of the role of TLR2 and TLR4 in neonatal spinal cord-derived precursors (Chapter 1); 2) on evaluating the role of both TLR2 and TLR4 in the process of spontaneous regeneration or after ectopic transplantation of NPC, in a model of induced spinal cord injury (Chapter 2); 3) to study the role of TLR4 in modulating the inflammatory phenotype in response to chondroitin sulphate proteoglycan (CSPG) secreted after spinal cord injury with inhibitory activity on axonal regrowth after spinal cord injury (Chapter 3). / The student has been granted with a PhD fellowship from a predoctoral program at the CIPF and with International Research and Training Exchange Programme at the CIPF. This work has been supported by the Spanish Ministry of Economy and Competitiveness (projects RTI2018-095872-B-C21; MAT2015-66666-C3-R; SAF2015-69187R) and Spanish Ministry of Heath, PNSD2018 I003. / Sánchez Petidier, M. (2022). Toll-like receptors in spinal cord derived neural precursor cells: implications on spinal cord injury and cell transplantation [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/180753 / TESIS

Indiana University-Purdue University Indianapolis (IUPUI) / Healthcare workers are responsible for providing evidence-based care to patients; however, many patients receive unnecessary or harmful care. Successful implementation of evidence-based guidelines can improve patient outcomes, particularly among vulnerable neuroscience patients. Focused efforts to improve nursing knowledge of and adherence to these guidelines are warranted. The purpose of this dissertation was to determine the most effective strategies for implementing evidence-based guidelines into nursing practice. First, an integrative review of the literature was conducted to explore studies addressing implementation of evidence-based guidelines in nursing. Implications from the review suggested further research to better understand which strategies should be utilized to best implement evidence-based nursing practices. Two pre- and posttest studies were then designed to identify a bundle of implementation strategies to improve neurocritical care nurses' knowledge of and adherence to stroke and spinal cord injury guidelines. The tailored, multi-faceted strategies consisted of local opinion leaders, printed educational materials, and educational outreach. Improvements in nursing knowledge of and adherence to these guidelines were noted. Lastly, program evaluations were conducted using a mixed-methods study to understand neurocritical care nurses' perceptions of the usefulness of the strategies employed during the two studies. Findings from this research provided support for the most effective implementation strategies to enhance knowledge development and guideline adherence among neurocritical care nurses for implementation of stroke and spinal cord guidelines.

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Spinal cord injury is a serious trauma and despite intensive research there is still no effective treatment for patients. The aim of this thesis is to study new possibilities of spinal cord injury therapy in animal models. We have focused on the use of natural materials, stem cells, gene therapy and the possibility of combining these approaches. The effect of extracellular matrix (ECM) based materials prepared by decellularization of porcine spinal cord and porcine urinary bladder on tissue regeneration after acute hemisection of the spinal cord was investigated. Another tested material was a hydrogel based on hyaluronic acid modified with RGD adhesion peptide, which was applied acutely and subacutely into the hemisection lesion. We have shown that both types of biomaterials have positive effect on regeneration of the spinal cord tissue by bridging the lesion and promotion of axonal ingrowth. In addition, ECM hydrogels promote the growth of blood vessels into the lesion site. The combination of hydrogels with mesenchymal stem cells derived from human umbilical cord (hWJ-MSCs) had synergistic effect, but since only a limited number of cells could be incorporated into hydrogels, this effect was not associated with improvement in motor skills. The limitation of ECM hydrogels is their rapid...