Em geral, indivíduos com disfunções motoras nos membros superiores apresentam dificuldades para executar a movimentação de objetos, a qual é essencial para a execução das atividades de vida diária. Dessa forma, esses indivíduos não a executam ou a fazem de maneira ineficiente. Para que essa manipulação seja realizada de maneira satisfatória, fazem-se necessários os movimentos de alcance e preensão de objetos controlados voluntariamente pelo indivíduo, e também a aquisição sensorial da força empregada durante a preensão. Portanto, este trabalho apresenta o desenvolvimento, a aplicação e a avaliação de um protótipo de sistema híbrido visando à reabilitação parcial da capacidade sensório-motora do membro superior direito de tetraplégicos. Tal sistema engloba uma órtese dinâmica para cotovelo utilizada em conjunto com a estimulação elétrica neuromuscular, e uma luva instrumentada que possibilita a realimentação qualitativa da força de preensão. Os resultados das avaliações clínicas mostraram que o sistema auxilia os tetraplégicos em tarefas que envolvem o alcance e a preensão de objetos, bem como trazê-los para próximo do corpo. O aumento da faixa de alcance, a geração de preensão e a restauração artificial da habilidade de movimentar um objeto para próximo do corpo representam esse auxílio proporcionado pelo sistema. Assim o protótipo de sistema híbrido representa uma estratégia alternativa para a reabilitação de lesados medulares (níveis C5-C6). / Generally, individuals with motor impairments in the upper limbs have difficulties performing the movement of objects, which is essential for the execution of activities of daily living. Thus, these individuals do not perform these activities or perform them inefficiently. Toward satisfactory manipulation, reach and grasp movements of objects performed with voluntary control, and grasp force feedback are necessary. Therefore, this work presents the development, application and evaluation of a hybrid system prototype aiming at partial rehabilitation of sensory-motor ability of quadriplegic\'s right upper limb. Such system includes an elbow dynamic orthosis combined with neuromuscular electrical stimulation, and an instrumented glove that allows the qualitative grasp force feedback. The results of clinical assessment showed that the system aids quadriplegic in tasks that involve reaching and grasping of objects, as well as bringing them close to the body. The improvement of reaching range, grasping generation and artificial restoration of the ability to move an object close to the body represent this aid provided by the system. Thus, the hybrid system prototype represents an alternative strategy for the rehabilitation of individuals with spinal cord injury (C5-C6 level).

La réalisation d’une action motrice implique l’activation simultanée des muscles agonistes et antagonistes contrôlés par le système nerveux central. Un traumatisme médullaire détériore la moelle épinière, entrainant une déficience motrice et des modifications du contrôle des activations musculaires. Ce travail étudie la réorganisation des activations musculaires, des activations corticales et des interactions corticomusculaires (ICM) d’un groupe traumatisé médullaire cervical (SCI) et d’un groupe contrôle (AB) lors de flexions et d'extensions isométriques autour de l’articulation du coude. En extension, nos résultats ont mis en évidence une altération des capacités de force maximale chez les SCI, associée à une augmentation des activations musculaires, une activation corticale identique aux AB et une diminution de l’implication du M1 dans le contrôle des activations musculaires. En flexion, la force développée, les activations corticales et les ICM étaient similaires chez les SCI et AB, mais les activations antagonistes et la difficulté à inhiber la contraction étaient plus importantes chez les SCI. Pour l’ensemble des participants, les ICM en flexion étaient différentes selon la fonction des groupes musculaires. Ces résultats suggèrent une altération du contrôle cortical des mécanismes inhibiteurs spinaux de la contraction musculaire après un traumatisme médullaire mais indiquent que le cortex moteur reste fonctionnel pour contrôler un acte moteur malgré l’atrophie des muscles extenseurs. Ces résultats pourraient trouver des applications cliniques pour l’élaboration de neuroprothèses nécessitant un contrôle simultané de différents groupes musculaires. / The realization of a motor action involves simultaneous activation of both agonist and antagonist muscles controlled by the central nervous system. Following spinal cord injury, damage to the spinal cord causes both a loss of motor efficiency and changes in the control of muscle activations. In the present work, we studied the reorganization of muscle activations, cortical activations and corticomuscular interactions (ICM) in spinal cord injured (SCI) and able-bodied (AB) participants during voluntary isometric contractions in flexion and extension around the elbow joint. In extension, our results showed altered capacity of maximum force production in SCI participants, associated with increased muscle activations, similar cortical activation and decreased involvement of M1 in the control of muscle activations when compared to AB participants. In flexion, the force capacities, cortical activations and ICM were similar between SCI and AB participants, but the activation of antagonistic muscles and the difficulty to inhibit the contraction were greater in SCI participants. For all participants in flexion, ICM were different depending on the function of the muscle groups. Taken together, these results suggest an alteration of the cortical control of spinal inhibitory mechanisms following a spinal cord injury, but suggest that the motor cortex remain functional to control a motor act despite the atrophy of the extensor muscles. These results could find clinical applications for the development of neuroprotheses involving simultaneous control of different muscle groups.

Os objetivos deste trabalho foram desenvolver um dispositivo apontador, com as mesmas funções de um mouse, controlado pelo movimento da cabeça, e comparar a eficiência do dispositivo proposto, utilizando o controle do cursor do computador no modo absoluto e relativo (joystick), operado por dez indivíduos tetraplégicos e por dez indivíduos sem acometimento neuromuscular. A maioria dos parâmetros estudados apresentou diferença significativa, entre as situações de controle absoluto e relativo, para os indivíduos de ambos os grupos, evidenciando que os parâmetros medidos no modo absoluto foram melhores que os medidos no modo relativo. O dispositivo apontador emula adequadamente as funções de deslocamento do cursor, mostrando que o modo de controle absoluto é mais eficiente que o modo de controle relativo / The objectives of this study were to develop a head controlled pointer device with mouse functions and compare its performance when operated in absolute versus relative (joystick like) modes by ten quadriplegic subjects and ten people without neuromuscular impairment. The device was composed of a video camera, a computer program and a reflective paper target attached to a cap which was then placed on the user´s head. Most of the measured parameters revealed a significant difference between the control modes, favouring the absolute one, for both studied groups. The developed head pointer adequately emulates the computer cursor displacement, with the absolute control mode being functionally more efficient than the relative control mode in this study.

Orientador: José Irineu Gorla / Tese (doutorado) ¿ Faculdade de Educação Física, Universidade Estadual de Campinas / Made available in DSpace on 2018-08-19T17:11:47Z (GMT). No. of bitstreams: 1 Flores_LucinarJupirForner_D.pdf: 1031561 bytes, checksum: bdd366b463afab5bb41f591f0bb99d60 (MD5) Previous issue date: 2012 / Resumo: O objetivo do presente estudo foi avaliar as respostas autonômicas e cardiovasculares em pessoas com lesão da medula espinhal (PLME) praticantes de Rugby em Cadeira de Rodas (RCR) em diferentes situações. A amostra foi composta de dez (10) tetraplégicos do sexo masculino com média de idade de 29,6 ± 6,5 anos. As coletas foram realizadas na UNICAMP, com a aprovação do Comitê de Ética em Pesquisa sob-protocolo nº 276/2010. Foram realizadas avaliações antropométricas. A potência aeróbia (PA) foi estimada por um teste máximo de quadra com duração de 12 minutos. A Pressão arterial (PAS) verificada pelo método auscultatório e o registro da variabilidade da PAS (VPAS) através do equipamento Finometer® (Finapress©). Avaliações da VFC foram realizadas com os sujeitos sentados nas cadeiras próprias (repouso, estresse mental e exercício). O Stroop Test foi utilizado como teste de estresse mental (TEM). Para o registro de informações da VFC foi usado o frequencímetro modelo RS800CX-POLAR© e posteriormente foi utilizado o software da Polar© para análise dos dados. Os dados foram apresentados em média±desvio padrão. Para análise estatística foi utilizado o software INSTAT®. Valores de p<0,05 foram considerados significativos para diferenças entre situações de avaliação. O tempo de lesão medular foi de 7,5 ± 4,1 anos. Quanto à massa corporal e estatura dos sujeitos, foi verificada média de 64,5 ± 6,2 kg e 1,75 ± 0,09 m. O índice de massa corporal foi de 21 ± 1,4 kg/m2. Já o percentual de gordura (DXA) foi de 21± 5,4%. O valor médio da distância percorrida no teste de 12 min, para a estimativa da PA foi de 1579,5 ± 439,1 m. O valor médio para a PA estimada correspondeu a 18,03 ± 8,1 ml/kg/min-1. Valores de FC e PAS foram significativamente maiores ao final do teste de 12 min quando comparados aos valores de repouso e recuperação. Resultados de FC ao longo do teste de estresse mental revelaram-se maiores que os valores de FC iniciais do registro. A PAS não apresentou diferenças entre as avaliações de repouso e estresse mental, assim como os valores de VFC não apresentaram diferenças significativas nestas situações. Valores do balanço autonômico da VFC também não apresentaram diferenças quando comparado valores iniciais e no teste de estresse mental (BF, AF e BF/AF). Já em exercício a VFC apresentou diferenças, assim como os valores de BF, AF e BF/AF quando comparado aos valores pré e pós exercício. A VPAS apresentou-se reduzida pós exercício físico, assim como a PASist e o índice de BF quando comparados aos valores pré exercício físico. Estes resultados indicam que a amostra estudada apresenta potência aeróbia dentro da normalidade para esta população. O % de gordura foi menor do que outros estudos com tetraplégicos. Ocorreram alterações durante o exercício físico nos componentes da VFC e VPAS semelhantes aos de outros estudos com tetraplégicos - (repouso x TEM x pós exercício físico). Há indícios de menores prejuízos neste grupo estudado em relação aos danos no controle autonômico da circulação, provavelmente por esta amostra participar de programa de treinamento físico / Abstract: The purpose of this work was to evaluate the autonomic and the cardiovascular responses in people with spinal cord injury (PLME) the players of Wheelchair Rugby (RCR) in different situations. The sample was composed of ten (10) tetraplegics male. The samples were collected in Campinas, with the approval of the Committee of Ethics in the Research with the protocol 276/2010. In this work was performed anthropometric evaluation. The aerobic power (AP) was estimated by a max court test that didn't exceed 12 minutes. The blood pressure (BP) verified by auscultation and registration of the BP variability (BPV) through an equipment called Finometer® (Finapress©).The evaluation of heart rate variability (HRV) were made with the individuals sitting on their chairs (rest, mental stress test and exercise). The Stroop Test was used as a test of mental stress. For recording of information of the HRV was used frequency counter model RS800CX-POLAR© and afterward was used Polar© software for data analysis. The data were expressed as average±standard deviation. To the statistical analysis was performed using the INSTAT® software. p values<0.05 were considered statistically significant differences between the situations of evaluation. The average age of the individuals was 29.6 ± 6.5 years old and the time of spinal cord injury was 7.5± 4.1 years. As for weight and height of them, there was an average of 64.5 ± 6.2 kg and 1.75 ± 0.09 m. The body mass index was 21 ± 1.4 kg/m2. The fat percentage (DXA) was 21 ± 5.4%. Results revealed that the test for 12 min, the distance rode to the PA estimate was 1579.5 ± 439.1 m. It was verified that the estimated value of AP is 18.03 ± 8.1 ml/kg/min-1. The HR and the BP values were significantly higher at the end of the test 12 min when compared to the values of resting and recovery. The results of FC along the mental stress test, proved to be larger than the values of initial HR of the record. The BPV did not show differences between the evaluations of rest and mental stress, as well as the values of HRV were not significantly different in these situations. Values of the autonomic balance of the HRV also showed no differences when compared to initial values and mental stress test (LF, AF e LF/HF). In the exercise the HRV presented discrepancies as well as the heart rate variability showed differences as well as the values of LF, HF e LF/HF when compared to pre and post exercise. The VBP presented the reduced as well as SBP and the values of BF compared before and after exercise. These results indicate that the sample presents aerobic power within the normal range for this population. The percentage of fat was lower than other studies with tetraplegics. Changes during exercise in HRV components and BPV similar to other studies with tetraplegics - (resting x TEM x post exercise). We can still consider that exist evidence of minor damage in relation to damage to the autonomic control of circulation, probably because this sample participate in physical training program / Doutorado / Atividade Fisica, Adaptação e Saude / Doutor em Educação Física

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

La préhension modifiée après tétraplégie repose sur la ténodèse. Ses caractéristiques cinématiques sont : un transport poignet fléchi, étendant les doigts puis une saisie poignet étendu, fléchissant les doigts et produisant les prises palmaires et latérales passives. Les deux phases de la préhension sont réalisées successivement après tétraplégie contrairement au maintien du couplage des deux phases du sujet sain. Les caractéristiques cinématiques des autres mouvements du membre supérieur en chaîne cinétique ouverte sont la conservation des invariants de précision et d'économie pour la programmation des gestes malgré la réduction du nombre de degrés disponibles après tétraplégie mais au détriment d'une réduction de la vitesse d'exécution. Le temps de mouvement augmente probablement pour maintenir la précision finale ou consécutivement au déficit moteur. L'extension du coude sans triceps repose sur l'augmentation des mouvements des articulations proximales de l'épaule. Cependant cette compensation est incomplète comme l'atteste la réduction de l'espace de capture supérieur où le déficit moteur des muscles agonistes, synergiques stabilisateurs de la scapulothoracique et du coude mais également la raideur et les douleurs de l'épaule sont impliqués. L'imagerie motrice (i) améliore la préhension par ténodèse, (ii) conduit une plasticité d'adaptation, (iii) améliore qualité et structure temporelle de l'imagerie. Ainsi, la préhension gagne en reproductibilité avec une réduction de la variabilité du temps de mouvement. L'extension du poignet augmente lors de la saisie attestant le renforcement du mécanisme de compensation par ténodèse pour réaliser les prises. L'imagerie motrice favorise une plasticité cérébrale adaptative avec réduction des activations des cortex prémoteur et moteur primaire anormalement augmentées après tétraplégie. Enfin, les hauts scores de vivacité sont associés à une imagerie ralentie révélant un contrôle de la qualité de la représentation mentale au détriment de sa structure temporelle. Après imagerie, la qualité de la reconstruction mentale se renforce et la structure temporelle s'améliore / Tetraplegia alters active prehension which relies on tenodesis. Its kinematic characteristics are flexion of the wrist during transport and extension of the wrist during grasping eliciting lateral and palmar grips. Transport and grasping are two consecutive movements as opposed to healthy reach-to-grasp where transport and grasping are coupled. Others open chain upper limb movements showed that despite the degrees of freedom reduction, the central nervous system still plan movements using kinematic invariants like endmovements accuracy and movement economy but at the cost of velocity that decrease. The increase of movement time can be due to the requierement of endmovement accuracy, motor deficit like inability to generate cocontraction at the elbow level being due to triceps paralysis. Despite triceps brachii paralysis, shoulder movements trigger elbow extension. However, this compensation is incomplete as shown by the decrease of superior maximal reaching. This could be due to the deficit of agonist muscles along with proximal and distal synergic stabilizer, shoulder range of motion decrease and shoulder pain. Motor imagery results in (i) prehension improvement attesting that the compensation is strengthened (ii) cortical adaptive plasticity (iii) increase in quality and temporal structure of mental reconstruction. Thereby, consistency of prehension increases as shown by the reduction of movement time variability. Wrist extension increased during grasping attesting a strengthening of tenodesis compensatory mechanism to produce grips. Motor imagery elicited adaptive brain plasticity with reduction of premotor and primary motor cortex activations that are abnormally increased after tetraplegia. Finally, motor imagery control is based on movement quality to the detriment of temporal structure. In response to motor imagery, movement quality is further enhanced and temporal structure is improved. Thereby, prehension is improved in response to motor imagery. Thus, corrective and adaptive plasticity could be promoted

No description available.

The impact on health, mental state and quality of life in people after spinal cord injury is enormous. Significant impairment occurs not only of sensorimotor functions. The autonomic nervous system is also disturbed to some extent, which is very closely related to the management of cardiovascular functions (and heart rate). The aim of this study is to evaluate the effect of different physical activities on heart rate in people after spinal cord injury. The study included 30 people in the chronic stage after spinal cord injury, which were divided into 3 groups according to the neurological level of the spinal cord lesion in tetraplegics (lesion C1-C8), paraplegics with high thoracic lesion (T1-T6), and paraplegics with lesion from T6 below. Each proband completed 4 exercise tests on sports simulators (rowing, kayaking and cross-country trainer and Rotren) and peak heart rate values (SFpeak) were measured after reaching the subjective maximum load (according to the Borg RPE scale). The values of SFpeak were then statistically processed, evaluated and compared - within groups between sports simulators and between groups. The results of the statistical processing show that the sports simulators are not different in terms of reaching the top SFpeak. Although differences between peak heart rate values...

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...

One of the most devastating effects of tetraplegia is the inability to grasp and manipulate everyday objects necessary to living an independent life. Currently surgery is widely accepted as the solution to improve hand functionality. However, surgery becomes difficult when the user has paralysed wrists as is the case with C5 tetraplegia. The aim of this research was to develop a solution which provided controlled wrist flexion and extension which, when combined with surgery, achieves a 'key pinch' grip. This particular grip is critically important for people with C5 tetraplegia as it is used for countless grasping activities, necessary on a day-to-day basis. A systematic design process was used to evolve the solution to provide controlled wrist flexion and extension. Concept brainstorming identified four alternative solutions which were evaluated to find the preferred concept. The chosen solution was called the Self Powered Wrist Extension Orthosis, more commonly referred to as the 'orthosis'. This concept contained a shoulder harness which provided both energy and control to the wrist harness, which in turn changed the wrist position. The orthosis was developed with the use of a mathematical model which theoretically predicted the functional performance by comparing the required force needed to move the wrist harness to the achievable force supplied by the user's shoulders. Using these parameters, the orthosis was optimized using the matlab Nelder-Mead algorithm which adjusted the wrist harness geometries to maximize the functional performance. A prototype was constructed and tested with the help of two participants who when combined, achieved an average of 18.5° of wrist rotation. The theoretical model however predicted an average range of motion of 28.4°. The discrepancy found between the theoretical and experimental result can be contributed to incorrect assumptions in the theoretical model. This included unaccounted friction and inaccurate modeling of the orthosis dynamics. The feedback from potential users of the orthosis was enthusiastic and encouraging especially towards the simplicity, usability and practicality of the design.