This diploma thesis deals with the issue of robotic-assisted therapy, namely with the mechanical exoskeleton robotic device Armeo Spring, and it is focused on an acute stroke population. The aim of this study is to evaluate the efficiency of a robotic-assisted therapy using Armeo Spring device and to compare it with the efficiency of a common individual occupational therapy focused on improving motor function of upper extremity of patients with the acute stroke. There were 19 patients involved in the research, who were hospitalized in early rehabilitation acute beds. They were selected on the basis of entry criteria and further divided into two groups. An experimental group included 10 participants (n=10), a control group included 9 participants (n=9). The patients in the experimental group using Armeo Spring device underwent four to five 30-minutes therapies per week for three week period, the control group underwent the same amount of individual occupational therapies focused on improving motor function of a paretic upper limp. Each participant, evaluated before and after the intervention, underwent the total number of 12 therapy sessions. In the face of the determined hypothesis, following methods were used to evaluate the sample of patients: Function Independence Measure (FIM) for evaluating...

Work-related musculoskeletal disorders (MSDs) account for more than 350,000 occupational illnesses and injuries in the United States. Many job risk factors for developing MSDs are found in the automotive industry and the United Automobile Workers (UAW)-Ford Ergonomics Surveillance Tool (EST) has been designed to screen these jobs into high, moderate or low risk for work-related musculoskeletal disorders affecting the distal upper extremity (DUE), lower back (LB) and/or neck and shoulders (NS). The purpose of this effort was to examine the predictive validity of the EST against a sample of target jobs at four Ford plants. Individual jobs for this study were selected by a stratified random assignment. Health records from Ford were reviewed in order to identify first time office visits (FTOVs), which were symptomatic complaints made by individual workers. Jobs that were associated with FTOVs were defined as case jobs for the three body regions. These case jobs were compared with predictions for injury by EST. Sensitivity and specificity were used to test predictive validity. While the sensitivity was poor for all body regions tested, the specificities were fairly strong for DUE and NS when looking at low risk compared to moderate/high risk. The low risk DUE specificity was 0.67 and increased to 0.78 when looking at low/moderate risk compared to high. Low back specificity for low risk was 0.51 but increased to 0.85 when looking at low/moderate risk compared to high. The NS specificity score was 0.81, increasing to 0.85 when looking at low/moderate risk. While the EST does not predict which jobs are high risk for injury, it does screen out safe jobs. Therefore, jobs identified by the EST as low/moderate risk are likely to be safe.

Introdução: O ombro é a região mais acometida por lesões em atletas competitivos de esportes aquáticos, e a principal causa dessas lesões é o uso repetitivo do membro superior à cima da cabeça. Dentre as modalidades dos esportes aquáticos, o polo aquático e a natação são as modalidades que apresentam uma maior prevalência de lesão no ombro. O Déficit de Rotação Interna da Glenoumeral (GIRD) é a alteração biomecânica mais frequente em atletas \"overhead\". Vários estudos têm relacionado o GIRD com a avaliação clínica do ombro, como avaliação de amplitude de movimento e força em atletas de beisebol. Entretanto, poucos estudos têm avaliado o efeito que o GIRD exerce na articulação glenoumeral de atletas competitivos de esportes aquáticos. Objetivos: O objetivo é estudar os fatores associados ao Déficit de Rotação Interna da Glenoumeral (GIRD) e sua correlação com a avaliação funcional do ombro em atletas competitivos de esportes aquáticos. Desenho do estudo: estudo observacional com corte transversal. Amostra: Foram avaliados 44 atletas competitivos de duas modalidades de esportes aquáticos, natação e polo aquático, de ambos os sexos, com média de idade de 15 (±1,6) anos e índice de massa corpórea de 22,38 (±2,95) Kg/m². Métodos: Avaliamos o GIRD e o arco total de amplitude de movimento de rotação do ombro com a goniometria. Avaliação da funcionalidade do membro superior com \"Closed Kinetic Chain Upper Extremity Stability test\" (CKCUES). Avaliação do índice do comprimento do peitoral menor, medindo o comprimento do músculo peitoral menor com uma fita métrica. A avaliação do torque dos rotadores internos com o dinamômetro isocinético. E a avaliação da percepção de função do ombro com \"Shoulder Pain and Disability Index\" (SPADI-Br), e a Escala de Avaliação dos Resultados do Ombro do Esportista\" (EROE), traduzidos e validados para a população brasileira. Análises estatística: Foi utilizado a análise de regressão linear múltipla, considerando o GIRD como variável dependente (de saída) e a arco total de amplitude de movimento de rotação da glenoumeral, índice do comprimento do peitoral menor e pico de torque dos rotadores internos como as variáveis independentes (preditores). Análise de correlação de Pearson bilateral, considerando o GIRD como variável dependente e os escores do CKCUES, do SPADI-Br e do EROE como variáveis independentes. Resultados: Na análise de regressão linear múltipla foi encontrado uma associação significante entre o GIRD e o arco total do movimento de rotação (R² ,30). E a análise de correlação de Pearson, encontrou uma correlação pobre e no sentido negativo com o escore total do SPADI-Br (-,382). Conclusão: O único fator que se associou ao déficit de rotação interna da glenoumeral (GIRD), foi amplitude de movimento total de rotação da glenoumeral e o GIRD não se correlacionou com a avaliação funcional do ombro em atletas de esportes aquáticos. / Background: The shoulder is the region most affected by injuries in competitive athletes of aquatics sports, and the main cause of these injuries is the overuse of the upper limb in to overhead. Among the modalities of aquatics sports, water polo and swimming are the modalities that have the higher prevalence of shoulder injury. The Glenohumeral Internal Rotation Deficit (GIRD) is the most frequent biomechanical change in overhead athletes. Have been done many studies relating the GIRD with clinical shoulder evaluations, as evaluation of range of motion and strength in baseball athletes. However, few studies have assessed the effect that the GIRD exerts on the glenohumeral joint of competitive athletes of aquatics sports. Objectives: This study aims to analyze the factors associated with the Glenohumeral Internal Rotation Deficit (GIRD) and its correlation with functional assessment of the shoulder in competitive athletes of aquatics sports. Study Design: observational crosssectional study. Sample: We evaluated 44 competitive athletes from two modalities of aquatics sports, swimming and water polo, of both sex, with a mean age of 15 (± 1.6) years old and body mass index (BMI) of 22.38 (± 2 95) kg/m². Methods: We assessment the GIRD and total arc of motion of rotation with goniometry. Assessment of functionality of the upper limb with Closed Kinetic Chain Upper Extremity Stability test (CKCUES). The evaluation of the pectoralis minor length index was measuring the length of pectoralis minor with a tape measure. The assessment of the torque of internal rotators with the isokinetic dynamometer. The assessment of perception of shoulder function with Shoulder Pain and Disability Index (SPADI-Br), and Athletic Shoulder Outcome Rating Scale (ASORS) questionnaires. Statistical Analyzes: Multiple linear regression analysis, considering the GIRD as the dependent variable (output) and total arc of motion of rotation, the pectoralis minor length index, and peak torque of internal rotators as the independent variables (predictors). Bilateral Pearson correlation analysis, considering the GIRD as the dependent variable and the scores of CKCUES, the SPADI-Br and ASORS as independent variables. Results: In multiple linear regression analysis was identified a significant association between the GIRD and total arc of motion of rotation (R² .30). And Pearson correlation analysis found a poor and negative correlation with the total score of SPADI- Br (-.382). Conclusion: The total arc of motion of rotation was the only factor associated with GIRD, and the GIRD did not correlated with functional assessment of the shoulder in aquatics athletes.

A estimulação somatossensitiva através da estimulação repetitiva de nervos da mão parética é uma abordagem promissora na recuperação motora do membro superior de pacientes com acidente vascular cerebral (AVC) na fase crônica e habitualmente é realizada em ambiente hospitalar. A dificuldade de comparecimento frequente de pacientes com AVC ao hospital pode prejudicar a implementação desta estratégia terapêutica em nosso meio. A reabilitação domiciliar pode ser uma alternativa interessante, além de ser menos dispendiosa do que a reabilitação hospitalar. O atual estudo teve como objetivo principal verificar a melhora em desempenho na função do membro superior parético após uma intervenção de estimulação somatossensitiva associada a treino motor, em ambiente domiciliar. Foi realizado um ensaio clínico aleatorizado, com mascaramento duplo e dois tipos de intervenção: ativa ou controle. Os pacientes do grupo ativo foram instruídos a utilizar um dispositivo de estimulação elétrica do nervo mediano, por duas horas. Os pacientes do grupo controle também foram instruídos a usar o dispositivo durante duas horas, porém sem que houvesse estimulação do nervo. Imediatamente após a utilização do dispositivo, todos os pacientes foram orientados a realizar um treino motor baseado no teste de Jebsen-Taylor. O tratamento foi realizado diariamente, ao longo de um mês. O desfecho primário foi o efeito da estimulação somatossensitiva (ativa versus controle) associada a treino motor sobre a melhora da função do membro superior parético avaliada pelo teste de Jebsen-Taylor. Os desfechos secundários foram: 1) melhora na independência funcional, avaliada pela Medida de Independência Funcional (MIF); 2) aderência às intervenções propostas, avaliada através de registros em uma agenda, e de relatos orais dos pacientes; 3) eventos adversos decorrentes dessas intervenções. O desempenho no teste de Jebsen-Taylor e na Medida de Independência Funcional (MIF) foi avaliado antes das intervenções (D0), ao seu término (D30) e quatro meses após o seu término (D150). Para a comparação da melhora em desempenho no teste de Jebsen-Taylor e da melhora em pontuação na MIF no grupo ativo e no grupo controle, foi utilizada análise de variância com medidas repetidas (ANOVAMR) com fatores grupo (ativo e controle) e tempo (D30 e D150). Foi observado um efeito significativo de grupo (F=5,02; p=0,038) na ausência de efeitos significativos de tempo ou interação grupo*tempo (p>0,05) em relação à melhora em desempenho no teste de Jebsen-Taylor. Não houve diferenças estatisticamente significantes entre os grupos em relação à pontuação na MIF após o tratamento. O grupo ativo apresentou maior aderência ao tratamento do que o grupo controle, porém esta conclusão foi baseada em informações fornecidas pelos pacientes, sem observação direta da pesquisadora. Não observamos eventos adversos relevantes. Este estudo é pioneiro por demonstrar efeitos benéficos, em longo prazo, da estimulação somatossensitiva associada a treino motor realizado em ambiente domiciliar, sem a supervisão de um terapeuta. Para a realização de estudos futuros, sugerimos algumas modificações em relação ao protocolo de estimulação somatossensitiva e treino motor, assim como combinações da técnica utilizada a outras técnicas de neuroestimulação / Somatosensory stimulation in the form of peripheral nerve stimulation is a promising strategy to improve motor function of the upper limb in chronic stroke patients and is usually administered in research laboratories. The usual difficulty in commutting to and from the hospital in a regular basis at short intervals of time is an obstacle for implementation of this therapeutic approach in our country. Home-based rehabilitation may be an interesting alternative, in addition to being less expensive than hospital-based rehabilitation. The current study aims to evaluate the improvement in performance of the paretic upper extremity after an experimental intervention consisting of somatosensory stimulation associated with motor training, performed at home. This study is a randomized, double-blind clinical trial, with two different types of interventions: active or control. Patients in the active group were instructed to use a device of electrical stimulation of the median nerve, for two hours. Patients in the control group were also instructed to use the device for two hours, and sham stimulation was administered. Immediately after the use of the device, all patients were instructed to train tasks that are part of the Jebsen-Taylor test. Treatment was performed daily, for one month. The primary outcome was improvement in performance of the paretic hand, evaluated by the Jebsen-Taylor test. Secondary outcomes were: 1) improvement in the Functional Independence Measure (FIM); 2) compliance with the proposed interventions, assessed through a daily written log, and oral reports of the patients; 3) possible adverse events from these interventions. Performance in the Jebsen-Taylor test and FIM scores were assessed before the interventions (D0), immediately after its end (D30) and four months after its end (D150). Analysis was performed with repeated- measures ANOVA (ANOVARM) with factors GROUP (active and control) and TIME (D30 and D150). Regarding Jebsen-Taylor test improvement, there was a significant effect of GROUP (F=5.02; p=0.038) in the absence of significant effects of TIME or interaction GROUP*TIME (p>0.05). There were no significant differences in FIM scores in either group after treatment. Compliance with treatment was greater in the active than in the control group, but conclusions about this finding are limited because data were collected solely based on information provided by patients. No relevant adverse events were observed. This study pioneered home-based somatosensory stimulation combined with motor training, without direct supervision of a therapist. We suggest changes to be made in the protocol in future studies, as well as investigation of effects of somatosensory stimulation combined with other neurostimulation techniques

Orientador: Bruno Livani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T13:03:57Z (GMT). No. of bitstreams: 1 Zogaib_RodrigoKallas_M.pdf: 9326160 bytes, checksum: a09bd895633ff41c62b544b7b84de884 (MD5) Previous issue date: 2013 / Resumo: Entre novembro de 2000 e abril de 2011, 22 pacientes com 23 fraturas transversas da diáfise umeral foram tratados com redução indireta e fixação com placa e parafusos através de técnica minimamente invasiva. A seguimento pós-operatório variou de 6 a 126 meses ( media 51.6 meses). Quinze pacientes, eram do sexo masculino e sete feminino. A idade dos pacientes variou de 18 a 66 (media 33.5) anos. Todas as fraturas consolidaram, e nenhuma apresentou lesão neurovascular associada. As fraturas consolidaram em até 2.7 meses. O arco de movimento do ombro e cotovelo foram simétricos quando comparado ao lado não envolvido, salvo em um paciente que apresentou-se com déficit de extensão do cotovelo, mas tinha fratura de olecrano ipsilateral, e foi tratado com redução e fixação com banda de tensão. Houve complicações sem repercussão clínica em sete casos, que foram o cúbito varo de aproximadamente 5 graus em cinco pacientes e falha dos parafusos proximais em 2 casos. Não houve ocorrência de infeção ou lesão iatrogênica do nervo radial A avaliação da função pós operatória do braço, ombro, e mão (DASH SCORE) foi testada e variou de 0 a 12.5 ( media de 5.45) Em conclusão, osteossíntese minimamente invasiva com placa em ponte (MIPO) , pode ser considerada uma opção segura e eficaz para o tratamento de fraturas transversas da diáfise do úmero / Abstract: Between November 2000 and April 2011, 22 patients with 23 transverse mid-shaft humeral fractures were treated with minimally invasive plate osteosynthesis techniques. Follow-up duration ranged from 6 to 126 (mean 51.6) months. Fifteen patients were male and seven were female. The age of the patients ranged from 18 to 66 (mean 33.5) years. All fractures healed and no associated neurovascular lesion developed. All fractures united within an average of 2.5 months. Ranges of shoulder and elbow motion were symmetric with those of the uninjured extremity. Complications occurred in seven cases, in five cases, comprising 5° cubitus varus with no functional repercussion, and in two cases, the proximal screw failed, but the fracture healing in the same mean time. Disabilities of the arm, shoulder, and hand (DASH) scores ranged from 0 to 12.5 (mean 5.45). One patient who presented with lack of elbow extension was found to have an ipsilateral olecranon fracture, which was treated with tension-band osteosynthesis. No infection or iatrogenic injury of the radial nerve occurred. In conclusion, minimally invasive bridging-plate osteosynthesis may be considered an option for the treatment of transverse mid-shaft humeral fractures / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Orientador: Alberto Cliquet Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T15:29:18Z (GMT). No. of bitstreams: 1 Ferreira_VanessaMariadeVargas_M.pdf: 2494774 bytes, checksum: 74419f732c2e800ecd68ccd1416acbcf (MD5) Previous issue date: 2012 / Resumo: Pacientes com lesão medular cervical apresentam disfunção dos membros superiores com grande perda de funcionalidade. A eletroestimulação neuromuscular (EENM) é considerada uma ferramenta importante para a reabilitação desses pacientes. O presente estudo tem como objetivo avaliar a função de pacientes tetraplégicos na tarefa mimética de beber e comparar com a utilização de EENM e um sistema híbrido (órtese dinâmica e EENM) para membros superiores, por meio de análise clínica e cinemática. Participaram desta pesquisa 14 pacientes com tetraplegia com nível motor entre C4 a C7 e 5 voluntários saudáveis. Foram aplicadas escalas clínicas para definir o nível de acometimento neurológico e funcional do paciente (AIS e MIF) e foi realizada avaliação cinemática da tarefa mimética de beber, sendo que os pacientes realizaram a atividade em 3 situações: movimento livre, com EENM e com o sistema híbrido. As variáveis cinemáticas utilizadas foram: tempo do movimento, razão do pico de velocidade máxima, índice de curvatura, trajetória do esterno, distância punho-esterno e abertura da mão. Também foi computado o número de acertos para a realização da tarefa. Os resultados indicam que pacientes que realizam a preensão por tenodese possuem maior independência funcional pela MIF (p=0,0008). Na tarefa mimética de beber houve 60% de acertos no movimento livre, 72,8% com EENM e apenas 47,6% com o sistema híbrido. Pela análise cinemática o uso da EENM não foi diferente do movimento livre, no entanto, os pacientes apresentaram maior tempo e menor suavidade no movimento e realizaram maior trajetória do punho e esterno durante a atividade quando comparado com o controle. O uso do sistema híbrido alterou o padrão de movimento dos pacientes, apresentando um aumento na trajetória do esterno e diminuição da suavidade do movimento. Em suma, a EENM promoveu uma melhor atividade funcional para os pacientes com nível C5, no entanto, o uso do sistema híbrido não parece facilitar a manipulação de objetos por pessoas com tetraplegia / Abstract: Patients with cervical spinal cord injury have dysfunction of the upper limbs with great loss of motor function. Neuromuscular electrical stimulation (NMES) is considered an important tool in rehabilitation. The aim of the present study is to evaluate the function of patients with tetraplegia in the mimetic task of drinking and compare with the use of NMES and a hybrid system (NMES and dynamic orthosis) through clinical evaluation and kinematic analysis. Fourteen patients with tetraplegia level C4 to C7 and 5 able-bodied volunteers participated in the study. Clinical tests were applied to verify the neurological and functional impairment (AIS and FIM) and the mimetic task of drinking was assessed with kinematic during three situations: free movement, with NMES and with the hybrid system. The kinematic variables used were: movement time, peak velocity ratio, index of curvature, sternum trajectory, wrist-sternum distance and hand opening. We also computed the number of successes to perform the task. The results indicate that patients that are able to perform tenodesis grip have greater functional independence through FIM (p=0.0008). The rate of success of the free movement was 60%, 72.8% with NMES and only 47.6% with the hybrid system. In the kinematic analysis the NMES was not different from the free movement, however, patients performed the task in a longer time, the movement was less smooth and the sternum and wrist trajectories were greater than the control group. The use of the hybrid system modified the pattern of movement of the patients, with an increase of the sternum trajectory and decrease of the smoothness. In conclusion, NMES improved the functional activity of patients with C5 level; on the other hand, the use of the hybrid system does not appear to facilitate the prehension of persons with tetraplegia / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

OF DIPLOMA THESIS Author: Bc. Kateřina Hodboďová Supervisor: Mgr. Anna Krulová Title: Clinical utility of the QUEST test in occupational therapy for evaluation of the upper extremities function in children with cerebral palsy Subtitle: QUEST - Quality of Upper Extremity Skills Test This diploma thesis engages in description of the QUEST (Quality of Upper Extremity Skills Test) test and its practical contribution to the practice of occupational therapy. The main aim of the thesis is to demonstrate the utility of the QUEST test as an evaluation of functional capabilities of upper extremities in children with cerebral palsy in Czech occupational therapy practice. The theoretical part provides basic information about cerebral palsy in children, about the possibilities of intervention in occupational therapy focussed on upper extremities, about the importance of assessment in occupational therapy, with an emphasis on the use of standardized evaluation tools in occupational therapy. Big part is also devoted to the characteristics of the foreign test QUEST. It includes information about the origin of the test, psychometric properties and normative data. Furhtermore, the description of the test items, the method of administration and evaluation, as an interpretation of the results are included. The...

Constraint induced movement therapy is one of many neurorehabilitation methods, based on principle of overcoming the learned non-use phenomenon by a specific therapeutic protocol including some behavioral techniques. A classification of currently available studies on the topic have been made on the model of literature review, with an in-depth focus on using Constraint induced movement therapy in occupational therapy for adult patients after stroke who have upper limb motor disorders. The present study is structured into two sections: a theoretical part and an analytic-descriptive one. In theoretical part history of the method is presented together at Basic method principles and detail contents of a therapeutic protocol. The analytical and descriptive section is aimed to analyse international studies important and relevant with respect to an occupational therapy practice. In this second section are also proposed many possible activities of shaping and task practice techniques which can be used by occupational therapists. Translation of the most widely used test (Motor Activity Log and Wolf Motor Function Test) into Czech language is included. Keywords: constraint induced movement therapy, stroke, upper extremity, occupational therapy

The shoulder is one of the most complex joints in the body. It has a large range of motion and has active, as well as passive, components to its stabilization. Many injuries occur every year due to overexertion and strain on the shoulder. Musculoskeletal models can be used as a proactive ergonomics tool for shoulder specific job task design, and to help prevent these injuries before they occur. The purpose of this thesis was to critically evaluate the performance of four optimization criteria (sum of squared activation, sum of cubed activation, sum of quartic activation, and entropy assisted) using the open source modeling platform OpenSIM. Experimental torque, kinematic, and EMG data were collected using ten participants for a variety of dynamic arm movements, and static arm postures, in different planes of action. The kinematic and torque data were processed and used as inputs to OpenSIM to calculate predicted muscle activations and joint reaction forces. Experimental EMG was cross correlated with the predicted muscle activity of 8 muscles, and RMSD was calculated between experimental and predicted muscle activity for evaluation. A co-contraction index was also used to assess the model’s ability to predict co-activation between muscle pairs. Overall, the sum of cubed activation and sum of quartic activation model predictions explained significantly more variance (38 ±2.5%, p<0.01) than the sum of squares and entropy models, when compared with experimental EMG. In conclusion, the type of optimization criterion chosen had an effect on the accuracy of the model predictions. Future research, in the development of optimization criterions for the shoulder, will create better model predictions of muscle forces and joint reaction forces, enabling musculoskeletal models to be more useful as a tool to the clinical and ergonomic populations. / Thesis / Master of Science (MSc) / The shoulder is one of the most complex joints in the body. It has a large range of motion and has muscles and ligaments to support the stability of the complex. Many injuries occur every year due to overexertion and strain on the shoulder. Proactively modelling can help reduce these injuries by evaluating a job's likelihood to injure a worker before the worker does the job. The purpose of this thesis was to evaluate the performance of several different shoulder models. Experimental torque, kinematic, and EMG data were collected using ten participants for a variety of dynamic arm movements, and static arm postures, in different planes of action. The kinematic and torque data were used by the model to predict muscle activations and joint reaction forces. Experimental EMG was cross correlated with the predicted muscle activity of 8 muscles, and RMSD was calculated between experimental and predicted muscle activity for evaluation. A co-contraction index was also used to assess the model’s ability to predict co-activation between muscle pairs. Overall, the sum of cubed activation and sum of quartic activation model predictions explained significantly more variance (38 ±2.5%, p<0.01) than the sum of squares and entropy models, when compared with experimental EMG. In conclusion, the type of model chosen had an effect on the accuracy of the model predictions. Future research, in the development of optimization criterions for shoulder models, will create better model predictions of muscle forces and joint reaction forces, enabling musculoskeletal models to be more useful as a tool to the clinical and ergonomic populations.

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