The purpose of this Master thesis was to evaluate the effects of the Mirror program on upper- limb motor recovery, self-sufficiency and active range of wrist movement in patients after brain injury. It was included sixteen participants within maximal four months after stroke. Patients were separated into experimental and control group, both with eight members. Experimental group underwent Mirror therapy. Both group participated in a standard rehabilitation program included Physiotherapy, Occupational therapy, physical therapy and movement practice on device. Experimental group patients additionally participated in Mirror therapy program for 30 mins, four times a week, for three weeks. The Fugl-Meyer Assessment, Functional Independence Measure and goniometric measurement of active movement were used to assess recovery of upper-limb movement. Mirror therapy improve upper-limb motor recovery in patients after brain injury. This research demonstrates it with significant difference between both groups, where the experimental group have improved (0,02). I have also proved Mirror therapy, when included in occupational therapy, improves the self-sufficiency of people with neurological deficit. Comparing the data from Functional Independence Measurement, I found the difference between groups statistically...

The aim of this study was to develop methodics of occupational therapy for patients with moelectric prosthesis, which is used by patients with amputation of upper limbs as well as patients with congenital problems. In the Czech republic there are no complex methodics about occupational therapy and myoelectric prosthesis, despite the huge mount of foreign studies of this topic. Myoelectric prosthesis uses the principle of sensing myoelectrical signals which are then transformed to the motor output in the terminal portion of the prosthesis. Occupational therapy intervention begins at the preprosthetic phase, the occupational therapist assesses the general potential for the use of myoelectric prosthesis and picks up myoelectric signals from the stump. In interprosthetic phase occupational therapist is dedicated to the training of activities of daily living with myoelectric prosthesis and training residual stump on the basis of myotest. The phase after prosthetic content of occupational therapy evaluation and assessment, which focus on patients ability of myoelectric control and prosthesis involvement in activities of daily living and training of grip. Within the training of grip, occupational therapist is dedicated to training proper grip within the pace, grip strength and targeted movements. The...

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

La paralysie obstétricale du plexus brachial (POPB) est une parésie d’un ou des membres supérieurs causée le plus souvent par un étirement excessif des racines nerveuses à la naissance. Les enfants sans récupération complète garderont des séquelles à vie, comprenant une diminution de force et des mouvements, des déformations osseuses, impactant leurs activités quotidiennes. L'atteinte de l’épaule est la principale cause de morbidité. Les muscles gléno-huméraux sont au coeur de la pathologie de l’épaule. L’IRM permet l’évaluation de l’atteinte des muscles de l’épaule. Les volumes musculaires, intéressants du fait de leur corrélation avec la force, peuvent être obtenus par différentes techniques de segmentation dont les propriétés métrologiques sont inégales. Chez l’enfant avec POPB, l’utilisation d’une technique de segmentation sur un grand nombre de coupes a montré une atrophie variable des muscles glénohuméraux menant à des déséquilibres musculaires dans les trois plans de l’espace. Des corrélations entre les volumes musculaires et la force, significatives mais plus faibles que chez les enfants à développement typique étaient retrouvées. Du fait de l’atteinte osseuse et musculaire, la mobilité de l’articulation gléno-humérale est limitée. Dans une étude utilisant l’analyse quantifiée du mouvement, cette limitation, majeure en rotation externe d’épaule ainsi que des compensations au niveau de l’ensemble du membre supérieur ont été objectivées. La performance du mouvement était bonne. A partir des résultats obtenus différents objectifs et cibles thérapeutiques sont discutés. La lutte contre le déséquilibre musculaire rotateurs internes-externes apparaît comme une priorité. / Obstetric Brachial Plexus Palsy (OBPP) is the paralysis of one or both upper limbs. It is most often caused by excessive traction on cervical nerve roots during a difficult birth. The children without incomplete recovery will have long-term impairment, including loss of active and passive mobility, loss of strength, bony deformities, activity limitation and participation restriction. The loss of shoulder function is the main cause of morbidity in this population.Glenohumeral muscles involvement is a key element of the pathology of the shoulder. MRI allows evaluation of the shoulder muscle involvement. Muscle volumes in particular, well correlated with muscle strength, can be modified by different segmentation techniques whose metrological properties are unequal.In children with OBPP, the use of a segmentation technique on a large number of slices has shown a variable atrophy of the gleno-humeral muscles leading to three-dimensional muscular imbalances.Correlations between muscle volumes and strength were significant but lower than in children with typical development.Because of the bone deformity and muscle involvement, the mobility of the glenohumeral joint is limited. In a study using 3D motion analysis of the movement, this limitation, which is large in external shoulder rotation, as well as compensations on the whole upper limb, were shown. The performance of the movement was good.From these results, different objectives and therapeutic targets are discussed. Internal-external rotator muscular imbalance correction appears as a priority.

As próteses de membros superiores atualmente disponíveis no mercado não atendem a muitos dos requisitos dos seus usuários, em especial devido à funcionalidade insuficiente e a seu alto peso e custo. Este fato, aliado à importância do assunto, foi a motivação deste trabalho, que utiliza a Análise do Valor no projeto deste tipo de próteses. Para isto, propõe uma metodologia de projeto, que utiliza a mencionada Análise, e aplica a mesma às próteses de membros superiores com o objetivo de obter configurações das mesmas que contenham vantagens comparando-se com as disponíveis atualmente. A Análise do Valor trabalha com funções, e por isto, as próteses, neste trabalho, foram vistas através das funções que deveriam executar. Para a obtenção destas funções e das suas especificações, foram consultados usuários de próteses, de quem as opiniões foram consideradas as mais importantes. Após estas consultas, foi executado um brainstorming com voluntários para a obtenção de idéias de novos componentes e novos tipos de próteses. A partir do resultado das entrevistas com usuários e do brainstorming, e com base nas pesquisas realizadas, foram propostas novas configurações de próteses que procurassem atender ao máximo possível das especificações que tinham sido obtidas. Em suma, esta dissertação pretende fornecer mais subsídios para se entender o que é necessário para que as próteses de membros superiores tenham uma aceitação maior e auxiliem mais seus usuários. A metodologia proposta, por sua vez, mostrou que tem potencial para ser útil na obtenção de produtos cada vez melhores, visto que ela pode ser aplicada a produtos em geral, não somente às próteses. / The available upper limb prosthesis in the market at this moment don’t correspond to many of the users’ requirements, mainly because of the insufficient functionality and the high weight and cost. This fact, allied to the importance of the subject, was the motivation of this work, which uses the Value Analysis in this kind of prosthesis design. For this purpose, it proposes a design method, which uses the mentioned Analysis, and applies it to the upper limb prosthesis aiming to obtain this product configurations with advantages, comparing to the available prosthesis at this moment. The Value Analysis works with functions, and, because of that, the prosthesis, in this work, were seen through the functions they should execute. To obtain these functions and its specifications, prosthesis users were consulted – their opinions were considered the most important. After these consultations, it was executed a brainstorming with volunteers to obtain new prosthesis’ kinds and components ideas. With the interviews and brainstorming results, and supported by the research made, they were proposed new prosthesis configurations, which had the goal to correspond to the maximum possible of the obtained specifications. In short, this dissertation intend to provide more subsidies to comprehend what is necessary to the upper limb prosthesis to have a bigger acceptance and help more its users. The proposed design method, at its side, showed that has potential to be useful in the more and more better products obtaining, because it can be applied to the products in general, not only to the prosthesis.

Através dos dispositivos e técnicas desenvolvidas na área da Instrumentação Biomédica é possível oferecer um tratamento ou de forma geral soluções que permitam uma vivência mais plena em sociedade para pessoas que possuem algum tipo de deficiência ou doença. Com o aumento da capacidade computacional nos últimos anos foi possível desenvolver muitas técnicas e dispositivos apoiados em processamento digital de sinais e há um grande interesse pelo desenvolvimento de interfaces mais naturais, como sinais biológicos para o controle de próteses e dispositivos. Este trabalho tem por objetivo apresentar o desenvolvimento de um método de Inteligência Computacional baseado em Regressão Logística capaz de classificar 17 movimentos do segmento mão-braço realizados pelos voluntários do estudo através do processamento do sinal mioelétrico (SME) adquiridos dos sujeitos em questão. Adicionalmente é realizada uma avaliação da influência de alguns dos canais, características do sinal e movimentos executados na taxa de acerto global. Para a realização do sistema foi utilizado um aparato experimental capaz de adquirir os SME através de 12 canais utilizando eletrodos não invasivos e posteriormente digitalizá-los. Logo após efetua-se a extração das três características utilizadas no trabalho, que servem de entrada para o método de Regressão Logística. Para este estudo foram processados três bancos de dados que perfazem um total de 50 voluntários. A taxa média de acerto alcançada foi de 70,1%, considerando todas as variações de testes realizados enquanto a média para os melhores casos de cada variação de entrada realizada foi de 92,5%. / Through the devices and techniques developed in the field of Biomedical Instrumentation commonly is possible to offer treatment or solutions to provide a more pleasurable experience in society for people who have a disability or illness. With increasing computing capability in recent years, it has been possible to develop many techniques and devices supported by digital signal processing, and there is a great interest in the development of more natural interfaces, such as biological signals for the control of devices and prostheses. This work aims to present the development of a computational intelligence method based on Logistic Regression able to classify 17 movements of the hand-arm segment performed by the subjects of this study through the processing of the myoelectric signal (SME) acquired from the subject in question. Additionally, an assessment of the influence of some of the combination of the channels, signal characteristics and movements performed in the overall hit rate is additionally performed. To conduct the system has built an experimental apparatus able to acquire the SME through 12 channels using non-invasive electrodes and scan them. Thereafter there is a three features extraction from the signal which serves as input to the Logistic Regression method. For this study were processed three databases that compose 50 volunteers. The average hit rate achieved was 70.1%, considering all tests variations while the average for the best cases for each input variation performed was 92,5 %.

Este trabalho visa contribuir para redução do grau de rejeição de próteses para membros superiores, tornando-as mais funcionais e eficientes. Tais propósitos são almejados por meio do estudo centrado no desenvolvimento de uma plataforma eletrônica de controle e nos demais constituintes de uma prótese. Dentre eles estão os atuadores, sensores, mecanismos e o programa de gerenciamento, que integra todos os componentes para as ações da prótese. Para esse trabalho foi usado somente um dedo para a execução de todos os testes, sendo esse dedo compatível com o desenvolvimento de uma prótese antropomórfica multifunção. O paciente comanda as ações da prótese ao enviar suas decisões à ela por meio de sinal mioelétrico, mas as ações da mesma são executadas de forma inconsciente. Isto é possível devido ao programa de gerenciamento, que controla os movimentos antropomórficos a partir de trajetórias definidas e também pelas informações de sensações de força e temperatura para o paciente, realimentação proprioceptiva. / This work contributes to minimize the rejection level of upper limb prosthesis, keeping it more function and efficient. This achieved by the development of a control electronic platform and the others prosthesis components, like actuators, sensors, mechanisms and the management program, that integrate all the components to actions of prosthesis. In this work was used only one finger to perform of all tests, and this finger is compatible with the development of a multifunction anthropomorphic prosthesis. The user command comes from myoelectric signal, but the actions in the prosthesis are executed unconsciously. The management program control the anthropomorphic movements based on defined trajectory and create information of force and temperature sensation to the user, proprioceptive feedback.

Submitted by Franciele Moreira (francielemoreyra@gmail.com) on 2018-04-18T18:05:45Z No. of bitstreams: 2 Dissertação - Eliezer Pires Ferreira - 2018.pdf: 34300915 bytes, checksum: a0c7653a5d9dbfa93b926dc02dd33c8d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-04-19T12:26:12Z (GMT) No. of bitstreams: 2 Dissertação - Eliezer Pires Ferreira - 2018.pdf: 34300915 bytes, checksum: a0c7653a5d9dbfa93b926dc02dd33c8d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-04-19T12:26:12Z (GMT). No. of bitstreams: 2 Dissertação - Eliezer Pires Ferreira - 2018.pdf: 34300915 bytes, checksum: a0c7653a5d9dbfa93b926dc02dd33c8d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-03-29 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Factors that cause loss of total or partial movement of upper limbs are common as neuropathies (diseases graves in the nerve), myopathies (diseases affecting the muscle), trauma and stroke. Even so, motor and functional patients return after the stroke, patients still advanced functional mobility difficulties that enable personal care and normal life. In many cases, a loss of movement can be reversed, or at least minimized, through rehabilitation exercises, but very slowly and almost always costly. The high price of assistive technology equipment from inactive communities for people with disabilities, especially in underdeveloped countries. Aiming for a superior limb rehabilitation, this paper presents a model and development of an upper limb exoskeleton prototype with two degrees of freedom, low cost, with a structure made of printer 3D. The study presents several existing models, and exhibits a mathematical model of an exoskeleton for flexion and extension movements, with simulation and subsequent prototyping. / Os fatores que causam a perda da movimentação total ou parcial de membros superiores mais comuns são as neuropatias (doenças graves no nervo), miopatias (doenças que afetam o músculo), traumas e o acidente vascular encefálico (AVE). Mesmo que algumas funções motoras e funcionais retornem após o AVE, os pacientes ainda apresentam dificuldades funcionais de mobilidade que possibilitem cuidado pessoal e vida normal. Em muitos casos, a perda de movimento pode ser revertida, ou pelo menos minimizada, por meio de exercícios de reabilitação, porém, de forma muito lenta e quase sempre, onerosa. O alto preço dos equipamentos de tecnologias assistivas os torna inacessíveis às pessoas com deficiência, principalmente nos países subdesenvolvidos. Visando a reabilitação de membro superior, este trabalho apresenta a modelagem e desenvolvimento de um protótipo de exoesqueleto para membro superior com dois graus de liberdade, de baixo custo, com estrutura fabricada em impressora 3D. O estudo apresenta vários modelos existentes, e exibe um modelo matemático de um exoesqueleto para realização dos movimentos de flexão e extensão, com posterior simulação e prototipagem.

OBJETIVO: A espasticidade de membro superior pós AVE é um grande desafio na medicina de reabilitação. O objetivo deste estudo foi avaliar a eficácia de um protocolo de tratamento composto de quadro modalidades de terapêuticas físicas na reabilitação de pacientes com espasticidade de membro superior pós AVE, avaliando desfechos clínicos, neurológicos e funcionais. MATERIAIS E MÉTODOS: Trinta e dois (32) pacientes com pelo menos seis meses de diagnóstico de AVE com espasticidade de membro superior foram aleatorizados para receber dez sessões de um protocolo que consistiu em estimulação elétrica transcraniana de baixa frequência usando-se agulhas subcutâneas no escalpo, bloqueios paraespinhosos, agulhamento de musculatura espástica e estimulação elétrica funcional, ou intervenções simuladas. Espasticidade, amplitude de movimento, dor, funcionalidade e qualidade de vida foram avaliados usando-se a Escala de Ashworth Modificada (EAM), goniometria, Escala Visual Análoga (VAS), Medida de Independência Funcional (MIF) e o questionário de qualidade de vida SF-36. Os pacientes e os avaliadores não possuíam conhecimento sobre o alocamento dos grupos. RESULTADOS: Os resultados mostraram uma diferença significativa em melhora da funcionalidade, amplitude de movimento e qualidade de vida no grupo de intervenções ativas. Ambos os grupos tiveram uma melhora significativa em dor. CONCLUSÃO: O protocolo composto é um tratamento válido para espasticidade de membro superior em pacientes hemiplégicos pós AVE, levando a resultados promissores em funcionalidade, qualidade de vida e espasticidade. Mais estudos devem ser realizados para melhor entender e aprimorar esta nova técnica observando seus efeitos por um período de tempo maior e em mais pacientes / Objective: Post-stroke upper limb spasticity is a major challenge in the rehabilitation field. The objective of this study was to evaluate the efficacy of a comprehensive four therapeutic modalities treatment protocol in the recovery of patients with upper limb spasticity after chronic stroke by evaluating clinical, neurological and functional outcomes. SUBJECTS AND METHODS: Thirty-two (32) subjects, at least six months post diagnosis of stroke with upper limb spasticity, were randomized to receive ten sessions of a protocol consisting of transcranial low frequency electric stimulation using subcutaneous needles over the scalp, paraspinous blocks, spastic muscle needling and functional electric stimulation, or sham interventions. Spasticity and range of motion, pain, functionality and quality of life were evaluated using the Modified Ashworth Scale (MAS), goniometry, Visual Analogue Scale (VAS), Functional Independence Measurement (FIM) and SF-36 quality of life questionnaires. The patients and the outcome assessor were blinded regarding the allocation group. RESULTS: Results showed that there was a significant difference in functionality improvement, range of motion and quality of life in the active group. Both groups had a significant improvement in pain. CONCLUSION: The comprehensive protocol is a valid treatment for post-stroke upper limb spasticity leading to promising results in functionality, quality of life, and spasticity itself. Further studies should be conducted to better understand and improve this novel technique by observing its effects for longer periods and in larger sample sizes

OBJETIVO: A espasticidade de membro superior pós AVE é um grande desafio na medicina de reabilitação. O objetivo deste estudo foi avaliar a eficácia de um protocolo de tratamento composto de quadro modalidades de terapêuticas físicas na reabilitação de pacientes com espasticidade de membro superior pós AVE, avaliando desfechos clínicos, neurológicos e funcionais. MATERIAIS E MÉTODOS: Trinta e dois (32) pacientes com pelo menos seis meses de diagnóstico de AVE com espasticidade de membro superior foram aleatorizados para receber dez sessões de um protocolo que consistiu em estimulação elétrica transcraniana de baixa frequência usando-se agulhas subcutâneas no escalpo, bloqueios paraespinhosos, agulhamento de musculatura espástica e estimulação elétrica funcional, ou intervenções simuladas. Espasticidade, amplitude de movimento, dor, funcionalidade e qualidade de vida foram avaliados usando-se a Escala de Ashworth Modificada (EAM), goniometria, Escala Visual Análoga (VAS), Medida de Independência Funcional (MIF) e o questionário de qualidade de vida SF-36. Os pacientes e os avaliadores não possuíam conhecimento sobre o alocamento dos grupos. RESULTADOS: Os resultados mostraram uma diferença significativa em melhora da funcionalidade, amplitude de movimento e qualidade de vida no grupo de intervenções ativas. Ambos os grupos tiveram uma melhora significativa em dor. CONCLUSÃO: O protocolo composto é um tratamento válido para espasticidade de membro superior em pacientes hemiplégicos pós AVE, levando a resultados promissores em funcionalidade, qualidade de vida e espasticidade. Mais estudos devem ser realizados para melhor entender e aprimorar esta nova técnica observando seus efeitos por um período de tempo maior e em mais pacientes / Objective: Post-stroke upper limb spasticity is a major challenge in the rehabilitation field. The objective of this study was to evaluate the efficacy of a comprehensive four therapeutic modalities treatment protocol in the recovery of patients with upper limb spasticity after chronic stroke by evaluating clinical, neurological and functional outcomes. SUBJECTS AND METHODS: Thirty-two (32) subjects, at least six months post diagnosis of stroke with upper limb spasticity, were randomized to receive ten sessions of a protocol consisting of transcranial low frequency electric stimulation using subcutaneous needles over the scalp, paraspinous blocks, spastic muscle needling and functional electric stimulation, or sham interventions. Spasticity and range of motion, pain, functionality and quality of life were evaluated using the Modified Ashworth Scale (MAS), goniometry, Visual Analogue Scale (VAS), Functional Independence Measurement (FIM) and SF-36 quality of life questionnaires. The patients and the outcome assessor were blinded regarding the allocation group. RESULTS: Results showed that there was a significant difference in functionality improvement, range of motion and quality of life in the active group. Both groups had a significant improvement in pain. CONCLUSION: The comprehensive protocol is a valid treatment for post-stroke upper limb spasticity leading to promising results in functionality, quality of life, and spasticity itself. Further studies should be conducted to better understand and improve this novel technique by observing its effects for longer periods and in larger sample sizes