Dissertations / Theses on the topic 'Disordered Locomotion'

The kinematic motor redundancy of the human legs provides more local degrees of freedom than are necessary to achieve low degree of freedom performance variables like leg length and orientation. The purpose of this dissertation is to investigate how the neuromuscular skeletal system simplifies control of a kinematically redundant system to achieve stable locomotion under different conditions. I propose that the neuromuscular skeletal system minimizes step to step variance of leg length and orientation while allowing segment angles to vary within the set of acceptable combinations of angles that achieves the desired leg length and orientation. I find that during human hopping, control of the locomotor system is organized hierarchically such that leg length and orientation are achieved by structuring segment angle variance. I also found that leg length and leg orientation was minimized for a variety of conditions and perturbations, including frequency, constrained foot placement, and different speeds. The results of this study will give valuable information on interjoint compensation strategies used when the locomotor system is perturbed. This work also provides evidence for neuromuscular system strategies in adapting to novel, difficult tasks. This information can be extended to give insight into new and different areas to focus on during gait rehabilitation of humans suffering from motor control deficits in movement and gait.

Locomotor disability is a problem, reported prevalence ranging from 1% to 8.6%. Only a limited number of studies have been done in South Africa. They used different methodologies and definitions, thus leading to the variation in prevalence reported. A further factor influencing prevalence is that some locomotor disabilities are area-specific. This study aimed to determine the prevalence and rehabilitation needs of individuals with locomotor disability in Mitchell's Plain, for planning intervention strategies as part of this community based rehabilitation service. A cross sectional study design was employed. A stratified proportional cluster sampling technique was used to select 36 clusters resulting in a sample size of2424 people. Screening questions recommended by the WHO were used to identify people with impairments (Phase I). Further screening (Phase II), of those identified with impairments, using a questionnaire based on the ICIDH categories, identified people with disabilities. People with locomotor disabilities were grouped together and qualitative analysis through case studies was done on sub-groups where common themes manifested. 12.9% reported some form of impairment; 3.9% adults could be classified as having disabilities. Amongst adults with disabilities, 2.7% had locomotor disabilities. Consistent with the literature, disability increased with age, was more frequently reported amongst females, and was associated with lower socio-economic class. Multiple impairments were frequently reported, with the most common impairment being musculo-skeletal conditions. Use of health services occurred in the public sector with the local Day Hospital used as frequently as more distant tertiary hospitals. The study revealed the need for improved and accessible medical and rehabilitation services in the community. Their poor ability to integrate functionally and economically into the community, was reflected in the high proportion of people with mobility and occupational handicap categories. Low levels of education worsened the impact on occupational handicap. It was further evident that multiple impairments amongst the elderly lead to greater dependence of people with locomotor disability on their care-givers. Even though the need for assistive equipment was high, much of assistive equipment owned was not being used. A further handicapping factor for the disabled using assistive equipment was their environment which restricted the use of assistive equipment. High locomotor disability prevalence was confirmed in this study. Major unmet needs were identified in the handicap categories of physical mobility and economic self-sufficiency. Domiciliary based intervention was recommended as the most appropriate rehabilitative intervention for the severely physically disabled persons.

O objetivo deste estudo foi comparar os efeitos de dois protocolos de intervenção para o treino de marcha robótica no Lokomat em indivíduos pós acidente vascular cerebral crônico. O primeiro protocolo foi estabelecido com a diminuição progressiva da velocidade da marcha e da assistência do robô durante o treino de marcha. O outro protocolo foi estabelecido com o aumento progressivo da velocidade da marcha e a diminuição progressiva da assistência do robô durante o treino de marcha. Este é um ensaio clínico duplo cego, controlado e randomizado realizado no Instituto de Reabilitação Lucy Montoro em São Paulo com indivíduos em regime de internação. Participaram deste estudo 18 individuos com apenas um episódio de acidente vascular cerebral crônico acima de 06 meses de lesão, classificados com escore 1-2 pela Escala de Deambulação Funcional EDF. Os participantes foram randomizados no grupo experimental (N= 10): com o protocolo da diminuição progressiva da velocidade da marcha e da assistência do robô e no grupo controle (N=08): com o protocolo do aumento progressivo da velocidade da marcha e a diminuição progressiva da assistência do robô. Cada sujeito realizou 30 sessões de treino de marcha robótica, 5 dias por semana, com duração de 30 minutos cada treino, por 6 semanas. As medidas de avaliação foram: Time Up and Go (TUG), teste de caminhada de 6 minutos (6M), teste de caminhada de 10 metros (10M), escala de equilíbrio de Berg (EEB), Fugl-Meyer de função motora de extremidade de membros inferiores (FMMI), Escala de Deambulação Funcional (EDF) e medida de independência funcional (MIF) com escore total e item locomoção. A análise estatística foi realizada com o teste MANOVA e Wilcoxon por meio da comparação dos dados inicias e finais e as diferenças entre os grupos. Posteriormente foi realizado um pós teste para comparar a diferença entre os grupos com aplicação do teste Anova e Ancova. Foram analisados 18 indivíduos e, ao final deste estudo, houve diferença estatistica do grupo experimental para as - 8 - mensurações EDF (p=0,004), TUG (p=0,03), 6M (p=0,04), EEB(p<0,0001), FMMI(p=0,02), MIF (p=0,01) e MIF item Locomoção (p=0,04). Já no grupo controle observou-se diferenças nas mensurações EEB (p=0,02), MIF (p= 0,0002) e MIF item Locomoção (p=0,04). Os resultados demostram que o grupo experimental pode mostrar maiores benefícios do que o grupo controle, porém estudos com maior número de participantes e diferentes instrumentos de avaliação são necessários para estabelecer evidências conclusivas para o treino de marcha robótica. Este estudo teve suporte de financiamento da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior CAPES
The aim of this study was to compare the effects of two intervention protocols for robotic gait training in Lokomat with individuals chronic stroke: novel versus conventional protocol. The Novel protocol was established with the progressive decrease in gait velocity and assistance robot for gait training and the Conventional protocol was established with the progressive increase in gait velocity and the progressive decrease of robot assistance during gait training. This is a clinical double-blind, randomized controlled trial conducted at Lucy Montoro Rehabilitation Institute in São Paulo with inpatients. The study included 18 subjects with only one episode of chronic stroke above 06 months of injury, classified by the score 1-2 Functional Ambulation Category FAC. Subjects were randomized in the Novel group (N = 10) and Conventional group ( N = 08). Each subject performed 30 robotic gait training sessions, 5 days a week, lasting 30 minutes each training for 6 weeks. The initial and final evaluation measures were: Time Up and Go (TUG), 6-minute walk test (6MWT), 10 meter walk test (10MWT), Berg Balance Scale (BBS), Fugl-Meyer motor function of the lower limbs (FM), Functional ambulation category (FAC) and Functional Independence Measure (FIM ) with total score and locomotion item. Statistical analysis was performed with the MANOVA and Wilcoxon test comparing the initial and final data and differences between groups, after this was performed a post-test comparing the difference between the groups with application of Anova and ANCOVA test. In all were analysed 18 individuals in this study, there was statistical difference in the Novel group for measurements: FAC (p = 0.004), TUG (p = 0.03) , 6MWT (p = 0.04) , BBS (p < 0.0001), FM (p = 0.02), MIF (p = 0.01) and MIF Locomotion item (p = 0.04). In the conventional group was observed differences in measurements: BBS (p = 0.02), MIF (p = 0.0002) and MIF Locomotion item (p = 0.04). The results show that the Novel group can show greater benefits than the Conventional group, but studies with larger numbers of participants and different - 10 - evaluation tools are needed to establish conclusive evidence for the robotic gait training . This study was funded support by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Alterações locomotoras são incomuns em cães com leishmaniose visceral. Embora a origem dos sinais clínicos permaneça obscura, a poliartrite deve ser considerada como um potencial diagnóstico nestes casos. Muitos agentes etiológicos podem causar poliartropatias, sendo estas classificadas em não inflamatórias e inflamatórias. Acredita-se que a poliartrite induzida por Leishmania spp. seja decorrente de uma reação inflamatória granulomatosa, causada pela presença de parasitos ou por uma resposta celular e humoral. O diagnóstico clínico ainda é um desafio para os profissionais de saúde, devido à grande variedade de sinais inespecíficos em decorrência da leishmaniose visceral. Desta forma, o presente trabalho teve como objetivos avaliar radiotomograficamente as articulações umeroradioulnares, radiocarpicametacárpicas, femurotibiopatelares e tibiotarsicametatársicas, a fim de caracterizar as lesões osteoarticulares, fornecendo subsídios para os clínicos que atuam em áreas endêmicas. Para tanto, foram utilizados 46 cães, naturalmente infectados, com diagnóstico firmado por meio dos exames imunocromatográfico (95,65%), ELISA (97,82%) e/ou parasitológico direto (95,65%), provenientes do Centro de Controle de Zoonoses de Bauru. Não houve predileção quanto ao sexo (1:1). A maioria dos animais não apresentava precisa definição racial (78,26%). A idade variou entre um a 12 anos, com mediana igual a três anos. Sinais clínicos compatíveis com poliartrite foram observados em 32,60%. Alterações radiográficas e tomográficas importantes foram observadas em 77% e 91% dos caninos, respectivamente, sendo as articulações tibiotarsicametatársicas a mais afetada em ambos os testes, acomentendo cães sintomáticos e assintomáticos. Os sinais imaginológicos foram variados, não sendo possível determinar um padrão específico para a doença, porém a presença de trabeculado ósseo evidente, ...
Locomotor alterations are uncommon in dogs with visceral leishmaniasis (VL). Although the origin of clinical signs remain unclear, polyarthritis should be considered as a potential diagnosis in these cases. Many etiological agents may cause polyarthropathies, which are classified into inflammatory and non-inflammatory. It is believed that the polyarthritis induced by Leishmania spp. may be due to a granulomatous inflammatory reaction caused by the presence of parasites or by cellular and humoral response. Clinical diagnosis is still a challenge for health professionals, due to the great variety of nonspecific clinical signs on VL. Thus, the aim of the present study were to evaluate radiographically and tomographically elbows, carpal, stifle and tarsal joints, in order to characterize the osteoarticular lesions, providing subsidies for veterinary practitioners in endemic areas. For this, 46 dogs were used, naturally infected, with diagnosis confirmed by immunochromatography (95.65%), ELISA (97.82%) and/or cytological (95.65%) methods, from the Zoonoses Control Center of Bauru. There was no preference to gender (1:1). The majority of animals were mixed breed (78.26%). Ages varied from 1 to 12 years, with a median of 3 years. Clinical signs consistent with polyarthritis were observed in 32.60%. Radiographic and tomographic alterations were observed in 77% and 91% of dogs, respectively, with tarsal joints the most affected on both methods, on asymptomatic and symptomatic dogs. Imaging signs varied, and it was not possible to establish a pattern for the disease, however the presence of apparent trabecular bone, bone sclerosis and osteolysis were the most frequently observed. Furthermore, we noticed a tendency for bilateral and symmetric involvement. It was observed a lack of significance when comparing the radiographic and tomographic lesions between symptomatic and asymptomatic ...
FAPESP: 12/02484-2

Orientador: Maria Jaqueline Mamprim
Banca: Sheila Canavese Rahal
Banca: Maria Lúcia Gomes Lourenço
Banca: Luciana Del Rio Pinoli Ciarlini
Banca: Priscilla Macedo de Souza
Resumo: Alterações locomotoras são incomuns em cães com leishmaniose visceral. Embora a origem dos sinais clínicos permaneça obscura, a poliartrite deve ser considerada como um potencial diagnóstico nestes casos. Muitos agentes etiológicos podem causar poliartropatias, sendo estas classificadas em não inflamatórias e inflamatórias. Acredita-se que a poliartrite induzida por Leishmania spp. seja decorrente de uma reação inflamatória granulomatosa, causada pela presença de parasitos ou por uma resposta celular e humoral. O diagnóstico clínico ainda é um desafio para os profissionais de saúde, devido à grande variedade de sinais inespecíficos em decorrência da leishmaniose visceral. Desta forma, o presente trabalho teve como objetivos avaliar radiotomograficamente as articulações umeroradioulnares, radiocarpicametacárpicas, femurotibiopatelares e tibiotarsicametatársicas, a fim de caracterizar as lesões osteoarticulares, fornecendo subsídios para os clínicos que atuam em áreas endêmicas. Para tanto, foram utilizados 46 cães, naturalmente infectados, com diagnóstico firmado por meio dos exames imunocromatográfico (95,65%), ELISA (97,82%) e/ou parasitológico direto (95,65%), provenientes do Centro de Controle de Zoonoses de Bauru. Não houve predileção quanto ao sexo (1:1). A maioria dos animais não apresentava precisa definição racial (78,26%). A idade variou entre um a 12 anos, com mediana igual a três anos. Sinais clínicos compatíveis com poliartrite foram observados em 32,60%. Alterações radiográficas e tomográficas importantes foram observadas em 77% e 91% dos caninos, respectivamente, sendo as articulações tibiotarsicametatársicas a mais afetada em ambos os testes, acomentendo cães sintomáticos e assintomáticos. Os sinais imaginológicos foram variados, não sendo possível determinar um padrão específico para a doença, porém a presença de trabeculado ósseo evidente, ...
Abstract: Locomotor alterations are uncommon in dogs with visceral leishmaniasis (VL). Although the origin of clinical signs remain unclear, polyarthritis should be considered as a potential diagnosis in these cases. Many etiological agents may cause polyarthropathies, which are classified into inflammatory and non-inflammatory. It is believed that the polyarthritis induced by Leishmania spp. may be due to a granulomatous inflammatory reaction caused by the presence of parasites or by cellular and humoral response. Clinical diagnosis is still a challenge for health professionals, due to the great variety of nonspecific clinical signs on VL. Thus, the aim of the present study were to evaluate radiographically and tomographically elbows, carpal, stifle and tarsal joints, in order to characterize the osteoarticular lesions, providing subsidies for veterinary practitioners in endemic areas. For this, 46 dogs were used, naturally infected, with diagnosis confirmed by immunochromatography (95.65%), ELISA (97.82%) and/or cytological (95.65%) methods, from the Zoonoses Control Center of Bauru. There was no preference to gender (1:1). The majority of animals were mixed breed (78.26%). Ages varied from 1 to 12 years, with a median of 3 years. Clinical signs consistent with polyarthritis were observed in 32.60%. Radiographic and tomographic alterations were observed in 77% and 91% of dogs, respectively, with tarsal joints the most affected on both methods, on asymptomatic and symptomatic dogs. Imaging signs varied, and it was not possible to establish a pattern for the disease, however the presence of apparent trabecular bone, bone sclerosis and osteolysis were the most frequently observed. Furthermore, we noticed a tendency for bilateral and symmetric involvement. It was observed a lack of significance when comparing the radiographic and tomographic lesions between symptomatic and asymptomatic ...
Doutor

Orientador: Irenilza de Alencar Naas
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Agrícola
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Resumo: O Brasil é hoje um dos maiores produtores e exportadores de carne de frango no mundo, mas para continuar nessa posição é necessário respeitar o bem-estar animal e manter baixos custos de produção. Problemas locomotores impedem que a ave se movimente livremente e, com isso, acesse os equipamentos necessários a sua sobrevivência: comedouro e bebedouro, prejudicando seu bem- estar e sua produtividade. A hipótese dessa pesquisa é que frangos de corte produzidos em condições de estresse apresentam problemas locomotores. O objetivo desse trabalho foi avaliar deficiências locomotoras em frangos de corte alojados em condições de estresse. Para tanto, foram realizados dois experimentos, sendo o primeiro a determinação da pressão plantar de aves de 28, 35, 42, e 49 dias, o qual foi realizado no Centro de Tecnologia da Universidade estadual de Campinas, São Paulo, Brasil. Essa medida foi determinada por sensores localizados sob uma esteira enquanto as aves caminhavam sobre ela, nesta ocasião também foi determinado o gait score dessas aves. As mais pesadas tiveram mais dificuldade de andar e tiveram maior valor de gait score. Não houve diferença significativa (p = 0,05) no pico da força das patas direito e esquerdo para aves com gait score 0 e 1; entretanto, para frangos mais pesados com gait score 2 houve desbalanço severo no pico das forças entre as patas. A força total expressa em porcentagem do peso vivo aumentou com a idade como esperado, mostrando uma correlação positiva com o gait score para as aves selecionadas. A deficiência de locomoção foi automaticamente detectada devido ao movimento desigual, como seu peso não foi distribuído igualmente nas patas durante caminhada. O segundo experimento constou de observação visual no campo, em granjas da região de Campinas-SP, com determinação do gait score em aves de 28, 35, e 42 dias. Neste experimento o gait score foi avaliado por três metodologias, aves estimuladas a andar, aves sem estímulo para andar e em 10 aves ao acaso dentro do galpão. Não foram encontradas evidências de interação entre os fatores Metodologia e Idade. Há influencia significativa da Metodologia sobre a determinação do gait score. A metodologia de 10 aves ao acaso foi a que se apresentou menos confiável. Os resultados de gait score foram menores na metodologia com estímulo para as aves andar. Entretanto nas três avaliações realizadas e em todas as idades, os resultados de gait score foram piores que o aceitável, sendo que a maior freqüência para gait score 0 (padrão normal) encontrada nesta pesquisa foi de 50%. Estes resultados poderiam ser atribuídos as condições de estresse ambiental inapropriadas em que os frangos foram produzidos.
Abstract: Brazil is today one of the largest poultry meat producer and exporter of the world; however, in order to continue in this production level and quality it is needed to apply animal welfare principles maintaining the same production costs. Locomotors problems keep away the bird from moving freely and to access the needed equipments for its survival: feeder and drinker, reducing their welfare and productivity. The hypothesis of this research it is that Brazilian poultry production presents locomotors problems. The objective of this research was is to evaluate locomotors deficiencies in broiler chicken housed under stressful conditions. For that two experiment were done, the first was the determination of the feet pressure of broiler with the ages of 28, 35, 42 and 49 days. This first experiment was carried out at the Center for Technology, State University of Campinas, SP. The feet force measurement was determined by sensors over a mat while the birds walked over it, and at the same time the gait score was also determined. The heavier birds had more difficult in walking and presented higher gait score. No significant difference was found (p = 0.05) in the force peak of the right and left feet for the birds with gait score 0 and 1; however, older broilers with gait score 2 presented severe unbalance in the peak of force in both feet. The total force expressed as the percentage of the live weight increased with age as expected showing a positive correlation with the gait score of the tested broilers. The locomotion deficiency was automatic detected due to the unbalanced movement as the weight was not equally distributed in both legs during walking. The second experiment constituted of a visual observation in the field, in commercial broiler farms in the region of Campinas, SP, for determining the gait score of birds 28, 35 and 42 days old. In this trial the gait score was estimated in three ways, broilers stimulated to walking, birds without stimulus for walking and broilers chosen randomly inside the housing. No evidence of interaction between the factor Methodology and Age. Significant influence of Methodology over the determination of gait score was found. The methodology of chosen 10 bird at random was the one least reliable. The results of gait score were lower when using the methodology that stimulated the birds to waking. However, in the three evaluations and in all ages the results of gait score were worst than the acceptable, since the frequency of gait score 0 (normal pattern) found in this research was 50%. These results could be accredited to the inappropriate ambient harsh conditions the broilers were reared.
Mestrado
Construções Rurais e Ambiencia
Mestre em Engenharia Agrícola

Anxiety disorders commonly emerge during adolescence, and girls are diagnosed with these disorders more frequently than boys. Understanding why anxiety disorders emerge and why non-clinical anxiety symptoms increase during adolescence is important for understanding this sex difference and how to treat adolescent sufferers. Potential mechanisms, such as puberty or cognitive biases, can be investigated both in humans and in rodent models of anxiety. This thesis aimed to characterise sex differences and changes in anxiety-like behaviour across adolescence and into adulthood in the rat, and to examine anxiety and interpretive bias in adolescent humans. In rats, we examined performance on common tests of anxiety-like behaviour: the emergence test, open field and elevated plus-maze. Exploration on these tests increased from mid-adolescence into adulthood, and greater exploration by females was apparent from late adolescence. While the behaviours themselves remain interesting, caution on interpreting these behaviours as anxiety-related warranted and is discussed throughout the thesis. Potential effects of the ovarian cycle and testing order on EPM performance were also examined. In humans, 12-14 year old adolescents complete visual and written interpretive bias tasks, this bias being considered to be a cognitive vulnerability for anxiety. The results showed that, when imagining themselves in ambiguous scenarios, girls were more negative in their interpretations than boys. Additionally, both sexes also interpreted social scenarios more negatively than non-social scenarios. As puberty is thought to be important to the emergence of disorder during adolescence, interpretive bias could potentially mediate the puberty-anxiety relationship. While more interpretive bias work is needed in both species, the recent development of interpretive bias tasks for rodents provides an opportunity to move away from difficult to interpret tests of anxiety-like behaviour in rodents, and should allow for greater convergence of the human and rodent anxiety research.

Introdução: A doença de Parkinson (DP), caracterizada por ser crônica, progressiva e neurodegenerativa, é uma das enfermidades neurológicas mais frequentes na atualidade. Pacientes com DP apresentam prejuízos motores, como rigidez muscular, tremor de repouso, lentidão de movimentos, instabilidade postural, e alterações na marcha e no equilíbrio; e distúrbios não-motores, como fatores cognitivos e neuropsiquiátricos, depressão, e uma consequente diminuição da qualidade de vida (QV). Apesar de a caminhada ser considerada tradicionalmente uma recomendação médica no tratamento não farmacológico da DP, a dança vem surgindo como uma importante ferramenta no tratamento complementar destes pacientes, quando somada a terapias medicamentosas tradicionais. Objetivo: Verificar e comparar os efeitos de um programa de dança e de caminhada na mobilidade funcional, nos parâmetros motores e na QV de pessoas com DP. Métodos: foi elaborado um protocolo de aulas de dança inspirado em ritmos musicais brasileiros: forró e samba. A amostra foi composta por 18 participantes com DP, divididos de forma não randomizada, em dois grupos: grupo dança (GD; n = 12) e grupo caminhada (GC; n = 6), expostos a 24 aulas de dança ou caminhada, com duração de uma hora e frequência de duas vezes por semana. Os instrumentos de coletas de dados utilizados foram uma ficha de dados pessoais dos pacientes, a Escala de Hoehn e Yahr (H&Y), o teste Timed Up and Go (TUG), a parte motora da Escala Unificada de Avaliação da DP (UPDRS III), o Índice de reabilitação (IR), a análise cinemática da caminhada e o Parkinson Disease Questionnaire (PDQ-39). A normalidade dos dados descritivos no momento inicial da pesquisa foi verificada através do Teste Shapiro-Wilk, foi utilizado o Teste Wilcoxon para dados não paramétricos e o Teste t pareado para dados paramétricos. Para os desfechos da pesquisa foram utilizados a análise de Equações de Estimativas Generalizadas (GEE), para a comparação entre os grupos GD e GC, os tempos PRÉ e PÓS intervenção, e interação tempo*grupo. Foi utilizado um posthoc de Bonferroni, para identificar as diferenças entre as médias em todas as variáveis. Para a análise dos dados foi utilizado o software Statistical Package for Social Sciences (SPSS) versão 20.0. O nível de significância adotado para ambos os testes foi de α<0,05. Resultados: Foi realizado um protocolo detalhado das intervenções. Os dois grupos apresentaram melhorias significativas após a intervenção em relação a mobilidade funcional na velocidade autosselecionada (VAS) (p = 0,02) e na velocidade rápida (VR) (p = 0,02), ao tempo de contato (TC) (perna esquerda VAS, p = 0,0028; perna direita VR, p = 0,009; perna esquerda, VR p = 0,025), ao tempo de balanço (TB) (perna esquerda VAS, p = 0,0028), a fase de duplo apoio (FDA) (perna direita VR, p < 0,001), a QV geral (p = 0,004), e aos domínios de bemestar emocional (p = 0,001), cognição (p = 0,020) e desconforto corporal (p = 0,008). O GD apresentou melhores resultados em comparação com o GC para os desfechos de Frequência de passos (FP) (p = 0,011) e o domínio de atividades de vida diária (AVDs) (p = 0,049). Conclusão: Ambos os grupos, GD e GC, apresentaram melhorias significativas após o período de intervenção, demonstrando que a dança é tão eficiente quanto a caminhada para a mobilidade funcional, parâmetros motores e a qualidade de vida de indivíduos com DP.
Background: Parkinson's disease (PD), characterized as progressive and neurodegenerative, is one of the most frequent neurological diseases of the present time. Patients with PD present motor impairment, such as muscle stiffness, rest tremor, slow movements, postural instability, and gait and balance alterations; And non-motor factors, such as cognitive and neuropsychiatric disorders, depressive symptoms, and a consequent decrease in quality of life (QL). Although walking is traditionally considered a medical recommendation in the non-pharmacological treatment of PD, dance has emerged as an important tool in the complementary treatment of these patients when added to traditional drug therapies.Objective: Verify and compare the effects of a program of dance and walking in functional mobility, motor parameters and QL of people with PD. Methods: the sample was composed of 18 participants with PD, divided into two non-randomized groups: dance group (DG; n = 12) and walking group (WG; n = 6). The data collection instruments used were be a personal data sheet of the patients, the Hoehn and Yahr Scale (HY), the Timed Up and Go test (TUG), the motor part of the Unified PD Rating Scale (UPDRS III), locomotor rehabilitation index (LRI), the kinematic walk analysis and the Parkinson's Disease Questionnaire (PDQ- 39). The normality of the descriptive data at the initial time of the research was verified through the Shapiro-Wilk Test, using the Wilcoxon Test for non-parametric data and the paired t-test for parametric data. For the research outcomes, the Generalized Estimating Equations (GEE) analysis was used to compare the GD and GC groups, the pre and post intervention moments, and the time group interaction. A Bonferroni post-hoc was used to identify the differences between means in all variables. Statistical Package for Social Sciences (SPSS) software version 20.0 was used to analyze the data. The significance level adopted for both tests was α <0.05. Results: A detailed protocol of interventions was performed. The two groups showed significant improvements after the intervention in relation to functional mobility in comfortable velocity (CV) (p = 0.02) and in fast velocity (FV) (p = 0.02), at stance time (StT) (Left leg CV, p = 0.0028); right leg FV, p = 0.009; left leg, FV p = 0.025), and swing time (SwT) (left leg CV, p = 0,0028), at double support phase (DSF) (rigth leg FV, p < 0,001), a general QL (p = 0,004), and to emotional well-being (p = 0.001), cognition (p = 0.020) and body discomfort (p = 0.008). The DG presented better results in comparison to the WG for the outcomes of Frequency of steps (FS) (p = 0.011) and the domain of activities of daily living (ADLs) (p = 0.049). The two interventions showed significant improvements regarding functional mobility, time of contact (TC), time of balance (TB), the perception of general QL, and domains of emotional well-being, cognition and body discomfort. The DG presented better results compared to the WG for the step frequency, double support phase and the domain of daily living activities. Conclusion: Both groups, DG and WG, showed significant improvements after the intervention period, demonstrating that dance is as efficient than walking for functional mobility, motor parameters and the QL for individuals with PD.

El recién nacido prematuro y los bebés de bajo peso al nacer frecuentemente presentan retrasos/anomalías en el desarrollo motor, cognitivo y emocional(1). Son una población que será clasificada como niños con riesgo de retraso en el desarrollo psicomotor(2). Uno de los diagnósticos más frecuentes en esta población es el de parálisis cerebral (PC)(3), que suele establecerse a partir de los 12 meses de edad del niño(4). El tapiz rodante se ha utilizado en población pediátrica con diferentes diagnósticos para estimular la adquisición de la marcha autónoma, como aspecto clave del desarrollo motor del niño, dada la relación que tiene con aspectos cognitivos y emocionales(5). Estudios en niños con PC(6,7) han resultado en una mejora de sus capacidades globales de desarrollo después de recibir la intervención. El impacto del entrenamiento con el tapiz rodante se desconoce en el caso de población clasificada como con riesgo. Esta tesis, que se presenta como compendio de publicaciones, plantea dos objetivos principales en relación a esta población: (1) explorar el estado actual de la evidencia científica respecto a la respuesta al tapiz rodante de los niños con riesgo de retraso en el desarrollo motriz, y (2) estudiar los efectos del entrenamiento de la marcha con el tapiz, en relación al desarrollo motriz y a la adquisición de la marcha autónoma. Para responder al primero de los objetivos, se realizó una revisión sistemática de la literatura publicada sobre las intervenciones con tapiz rodante en niños con riesgo de retraso en el desarrollo motriz, con edades comprendidas de los 0 hasta los 6 años. Las conclusiones principales encontradas en esta revisión fueron que faltaban ensayos clínicos controlados con muestras mayores en población con riesgo, sobre todo en relación al estudio de los efectos del entrenamiento de la marcha con el tapiz. En relación al segundo de los objetivos de esta tesis, se presentan los resultados de un ensayo clínico controlado realizado con una muestra de 28 niños con riesgo de retraso en el desarrollo motriz. Aproximadamente la mitad recibieron un entrenamiento protocolizado de la marcha con el tapiz. Al inicio del estudio los niños tenían edades comprendidas entre los 8 y los 11 meses. En este estudio no se observaron diferencias entre grupos en cuanto a la edad de inicio de la marcha autónoma, pero sí se vio una mejora en la calidad de los pasos en el tapiz, en aquellos sujetos que habían recibido el entrenamiento. Asimismo, se estableció una relación significativa entre la frecuencia de pasos en el tapiz y la edad de inicio de la marcha autónoma. Finalmente, se hizo un tercer estudio de caso con unas mellizas con antecedentes de prematuridad leve, en el cual se implementó un entrenamiento individualizado a partir de los 8 meses de edad, a la melliza que mostró mayor retraso motriz. Las conclusiones de este estudio fueron que, posiblemente, el entrenamiento con el tapiz tuvo un impacto positivo sobre la velocidad de desarrollo motriz de la melliza entrenada. En relación a aspectos de locomoción y la respuesta al tapiz rodante, se observó una mejora en la calidad de los pasos, y un aumento en la frecuencia de pasos alternos sobre el tapiz. Esto ocurrió en ambas mellizas, pero de una manera más acentuada en la melliza que recibió el entrenamiento. Como síntesis final, el tapiz rodante es una herramienta en uso creciente en el ámbito de la pediatría para potenciar aspectos relacionados con la locomoción. La evidencia científica disponible hasta la fecha indica que el entrenamiento de la marcha con el tapiz puede tener efectos positivos en niños con riesgo de retraso en el desarrollo motriz, tanto para la detección de retrasos o anomalías en el desarrollo, como para la prevención de retrasos más severos en relación a la adquisición de la marcha autónoma. Conseguir este hito motriz es de gran importancia, ya que conllevará la autonomía del niño, la cual es fundamental dada la relación de la misma con el desarrollo cognitivo y con la calidad de vida de las personas. Referencias 1. Almond D, Chay KY, Lee DS. The costs of low birth weight. Q J Econ. 2005;120(3):1031-1083. 2. Angulo-Barroso R, Tiernan CW, Chen L, Ulrich D, Neary H. Treadmill responses and physical activity levels of infants at risk for neuromotor delay. Pediatr Phys Ther. 2010;22(1):61-68. 3. Korvenranta E, Lehtonen L, Peltola M, et al. Morbidities and hospital resource use during the first 3 years of life among very preterm infants. Pediatrics. 2009;124(1):128-134. 4. Wood E. The child with cerebral palsy: Diagnosis and beyond. Semin Pediatr Neurol. 2006;13(4):286-296. 5. Campos JJ, Anderson DI, Barbu-Roth MA, Hubbard EM, Hertenstein MJ, Witherington D. Travel broadens the mind. Infancy. 2000;1(2):149-219. 6. Richards CL, Malouin F, Dumas F, Marcoux S, Lepage C, Menier C. Early and intensive treadmill locomotor training for young children with cerebral palsy: A feasibility study. Pediatr Phys Ther. 1997;9(4):158-165. 7. Mattern-Baxter K, McNeil S, Mansoor JK. Effects of home-based locomotor treadmill training on gross motor function in young children with cerebral palsy: A quasi-randomized controlled trial. Arch Phys Med Rehabil. 2013;94(11):2061-2067. 8. Begnoche DM, Pitetti KH. Effects of traditional treatment and partial body weight treadmill training on the motor skills of children with spastic cerebral palsy. A pilot study. Pediatr Phys Ther. 2007;19(1):11-19. 9. Day JA, Fox EJ, Lowe J, Swales HB, Behrman AL. Locomotor training with partial body weight support on a treadmill in a nonambulatory child with spastic tetraplegic cerebral palsy: A case report. Pediatr Phys Ther. 2004;16(2):106-113. 10. Valentin-Gudiol M, Mattern-Baxter K, Girabent-Farres M, Bagur-Calafat C, Hadders-Algra M, Angulo-Barroso RM. Treadmill interventions with partial body weight support in children under six years of age at risk of neuromotor delay. Cochrane Database Syst Rev. 2011;(12):CD009242. 11. Angulo-Barroso RM, Tiernan C, Chen LC, Valentin-Gudiol M, Ulrich D. Treadmill training in moderate risk preterm infants promotes stepping quality--results of a small randomised controlled trial. Res Dev Disabil. 2013;34(11):3629-3638.
Low birth-weight and premature infants are considered to be at risk for neuromotor, cognitive and emotional developmental delays(1). Some of these infants are diagnosed with cerebral palsy (CP), while others with early motor behaviour problems do not develop CP(2). Locomotor difficulties have been demonstrated in children with CP. Studies in children with CP have used a paediatric treadmill to improve functional gait and ambulation. Treadmill training (TT) has been shown to improve ambulatory capability in children with CP6(8,9). However, little is known about the impact of such training in infant populations at risk for neuromotor delay. This thesis aimed to: (1) assess the current state of scientific evidence regarding treadmill interventions in infants at risk for neuromotor delays (ND), and (2) to study the effects of TT in relation to motor development and the onset of independent walking. First, a systematic review about treadmill interventions in children under 6 years of age at risk of ND was carried out. The findings indicated that task-specific training (TT for independent walking acquisition) might be a useful tool to promote development in children at risk for ND. However, the number of studies found was limited and fairly heterogeneous, especially regarding the type of population studied (different diagnoses), treadmill parameters and training protocols(10). A controlled clinical trial was then conducted with a sample of 28 infants at risk for ND. The experimental group, which received TT (entry age 8-11 months), demonstrated an improvement in step quality. Although no differences were found between groups regarding age of onset of independent walking, a significant relationship between treadmill step frequency and onset of independent walking was established(11). Finally, an individualised TT protocol was implemented in a case study of twins with a history of mild prematurity. At 8 months corrected age, the twin who showed greater motor delays started to receive TT. An increase in the rate of gross motor development was shown in the trained twin 2 months after training had started. Improvement in step quality and frequency of alternate treadmill steps occurred in both twins, but was more accentuated on the trained one. In conclusion, TT may be considered as a useful tool to potentiate aspects related to locomotion in infants with or at risk for ND. Locomotion and walking acquisition is a key milestone for all children since it is associated with cognitive and emotional development(5), as well as quality of life. Referencias 1. Almond D, Chay KY, Lee DS. The costs of low birth weight. Q J Econ. 2005;120(3):1031-1083. 2. Angulo-Barroso R, Tiernan CW, Chen L, Ulrich D, Neary H. Treadmill responses and physical activity levels of infants at risk for neuromotor delay. Pediatr Phys Ther. 2010;22(1):61-68. 3. Korvenranta E, Lehtonen L, Peltola M, et al. Morbidities and hospital resource use during the first 3 years of life among very preterm infants. Pediatrics. 2009;124(1):128-134. 4. Wood E. The child with cerebral palsy: Diagnosis and beyond. Semin Pediatr Neurol. 2006;13(4):286-296. 5. Campos JJ, Anderson DI, Barbu-Roth MA, Hubbard EM, Hertenstein MJ, Witherington D. Travel broadens the mind. Infancy. 2000;1(2):149-219. 6. Richards CL, Malouin F, Dumas F, Marcoux S, Lepage C, Menier C. Early and intensive treadmill locomotor training for young children with cerebral palsy: A feasibility study. Pediatr Phys Ther. 1997;9(4):158-165. 7. Mattern-Baxter K, McNeil S, Mansoor JK. Effects of home-based locomotor treadmill training on gross motor function in young children with cerebral palsy: A quasi-randomized controlled trial. Arch Phys Med Rehabil. 2013;94(11):2061-2067. 8. Begnoche DM, Pitetti KH. Effects of traditional treatment and partial body weight treadmill training on the motor skills of children with spastic cerebral palsy. A pilot study. Pediatr Phys Ther. 2007;19(1):11-19. 9. Day JA, Fox EJ, Lowe J, Swales HB, Behrman AL. Locomotor training with partial body weight support on a treadmill in a nonambulatory child with spastic tetraplegic cerebral palsy: A case report. Pediatr Phys Ther. 2004;16(2):106-113. 10. Valentin-Gudiol M, Mattern-Baxter K, Girabent-Farres M, Bagur-Calafat C, Hadders-Algra M, Angulo-Barroso RM. Treadmill interventions with partial body weight support in children under six years of age at risk of neuromotor delay. Cochrane Database Syst Rev. 2011;(12):CD009242. 11. Angulo-Barroso RM, Tiernan C, Chen LC, Valentin-Gudiol M, Ulrich D. Treadmill training in moderate risk preterm infants promotes stepping quality--results of a small randomised controlled trial. Res Dev Disabil. 2013;34(11):3629-3638.

This PhD thesis is based on the Spanish sample of the International “Cultural and Psychosocial Influences on Disability” (CUPID) study. This multicentre study is coordinated by Professor David Coggon at the University of Southampton (UK) and the project focuses on 47 occupational groups (nurses, office workers and manual workers) from 18 countries. At the beginning, it was planned that each participating country would include the three occupational groups mentioned before. However, the Spanish sample of the study was composed only by nurses and office workers; due to logistic reasons, it was not possible to access local postal workers who carried out sorting mail tasks. This dissertation aims to assess the importance of health beliefs, mental health, and somatising tendency as predictors of incidence and persistence of musculoskeletal pain and to investigate if these psychological risk factors primarily influence the development and persistence of pain, or whether their impact is more on the disability that musculoskeletal pain causes. Dataset was collected in the workplace, both at baseline (between November 2007 and February 2010), and again after a follow-up interval of 12 months, at four hospitals (Badalona Serveis Assistencials, Consorci Sanitari Integral, Consorci Hospitalari Parc Taulí and Parc de Salut Mar) and a university (Universitat Pompeu Fabra) in Barcelona. To be included in the study, participants had to be aged 20–59 years and been in their current job for ≥12 months. Written informed consent was obtained from all who agreed to take part, and the Parc de Salut Mar Ethics Committee of Barcelona and the Health and Safety Committee of each participating centre approved the study. The baseline and follow-up questionnaires were originally drafted in English, translated into Spanish, and then checked by independent back-translation. Participants were asked at baseline about socio-demographic and lifestyle characteristics, current working conditions, health beliefs concerning pain, mental health, somatising tendency and musculoskeletal pain in the past month and past year at six different anatomical areas (back, neck, and shoulders, elbows, wrists/hands, and knees). Pain was classed as disabling if it made ≥1 specified everyday activities difficult or impossible. At 12-month follow-up, pain in the past month and associated disability was again ascertained. Log binomial and multilevel multinomial logistic regression models were used to explore associations of baseline risk factors with pain outcomes at follow-up.
Esta tesis doctoral está basada en la muestra española del Estudio Internacional “Cultural and Psychosocial Influences on Disability” (CUPID) Este estudio multicéntrico es coordinado por el Profesor David Coggon de la Universidad de Southampton (Reino Unido), y el proyecto se centra en 47 grupos ocupacionales (enfermeras, trabajadores de oficina y trabajadores manuales) de 18 países. Al principio estaba previsto que cada país participante incluiría los tres grupos de trabajo antes mencionados. Sin embargo, la muestra española del estudio CUPID está compuesta sólo por enfermeras y trabajadores de oficina; por razones logísticas, no fue posible acceder a los trabajadores de correos que realizaban tareas de clasificación de correo. Esta tesis doctoral tiene como objetivo evaluar la importancia de las creencias sobre la salud, salud mental, y la tendencia a somatizar como predictores de la incidencia y persistencia de dolor músculo-esquelético y para investigar si estos factores de riesgo psicológicos influyen principalmente en el desarrollo y la persistencia del dolor, o si su impacto es más en la discapacidad que provoca el dolor músculo-esquelético. El conjunto de datos del estudio se recogió en el lugar de trabajo, tanto al inicio del estudio (entre Noviembre de 2007 y Febrero de 2010), como después de un intervalo de seguimiento de 12 meses, en cuatro hospitales (Badalona Serveis Assistencials, Consorci Sanitari Integral, Consorcio Hospitalario Parc Taulí y el Parc de Salut Mar) y una universidad (Universitat Pompeu Fabra) en Barcelona. Para ser incluidos en el estudio, los participantes debían tener entre 20 a 59 años y haber estado en su puesto de trabajo por lo menos los últimos 12 meses. Se obtuvo consentimiento informado escrito en todos aquellos que aceptaron participar, y proyecto fue aprobado por el Comité de Ética del Parc de Salut Mar en Barcelona y el Comité de Seguridad y Salud de cada centro participante. Tanto los cuestionarios basales como del seguimiento fueron redactados originalmente en Inglés, traducido al español, y luego retro-traducido al inglés. Los participantes fueron entrevistados al inicio del estudio sobre sus características socio-demográficas y de estilo de vida, condiciones de trabajo actuales, salud mental y tendencia a somatizar, creencias sobre la salud aplicables al dolor y la presencia de dolor músculo-esquelético en el último mes y en el último año en seis zonas anatómicas diferentes (espalda, cuello, hombros, codos, muñecas/manos y rodillas). El dolor fue clasificado como discapacitante si se reportaban 1 o más actividades cotidianas difíciles o imposibles de realizar. A los 12 meses de seguimiento, se volvió a entrevistar a los participantes sobre la presencia de dolor en el último mes y la discapacidad asociada. Se utilizaron modelos de regresión log-binomial y logística multinomial multinivel para explorar las asociaciones de los factores de riesgo basales con el dolor al seguimiento.

La pronation et les pieds plats ont longtemps été considérés conjointement, notamment dans leur relation avec la blessure. Or, cette relation, au regard des résultats divergents de la littérature, a été remise en question. Récemment, la dissociation entre la typologie et la fonctionnalité du pied a permis de mettre en évidence une possible association entre la pronation et la lombalgie. L’étude de la locomotion de sujets pronateurs identifiés par des tests fonctionnels pourrait exposer les facteurs de risques biomécaniques associés à la lombalgie. L’objectif général était d’identifier et d’étudier l’impact cinématique et baropodométrique de la pronation à la marche. Puis d’évaluer l’effet de traitements préventifs visant à limiter la biomécanique à risque dans un but de prévention primaire. Trois études ont été menées. Une étude de concordance entre différents tests d’identification de la pronation a été réalisée, dans des conditions différentes, afin de sélectionner un test approprié à l’étude de la marche. La cinématique et la baropodométrie de la marche de 159 sapeurs-pompiers professionnels, pronateurs vs non-pronateurs, ont été comparées. Deux protocoles d’un mois visant à réduire la pronation (renforcement musculaire du pied ou port de semelles) ont été proposés chez les sujets pronateurs. La concordance des différents tests de fonctionnalité a été jugée faible. Une combinaison de tests fonctionnels a été utilisée pour affiner le diagnostic de pronation. Les sujets pronateurs ont exposé des différences baropodométriques et cinématiques de l’avant et de l’arrière-pied, du genou et du bassin à la marche. Cette cinématique pourrait constituer un facteur de risque de lombalgie. La pronation a été réduite par les deux protocoles préventifs et accompagnée de modifications cinématiques du pied et de la hanche. Bien que nos protocoles préventifs ne témoignent pas d’une incidence sur le bassin, ils exposent une modification cinématique du membre inférieur, qui pourrait modifier la biomécanique du bassin et constituer un moyen de prévention des lombalgies
Pronation and flat feet have, for a long time, been associated, particularly in their relationship to injury. However, this relationship has been questioned in view of the divergent results in writings. Recently, the dissociation between foot-type and foot-function has highlighted a possible link between pronation and low back pain. The study of pronator subjects' way of moving, identified by foot function tests, could highlight the biomechanical risk factors associated with low back pain. The general objective was to identify and study the kinematic and plantar pressure impact of pronation while walking. Then to evaluate the effect of preventive treatments aimed aimed to limit the biomechanics at risk while keeping primary prevention in mind. Three studies were conducted. A concordance study between different pronation identification tests, under different conditions, was carried out in order to select an appropriate test for the study of gait. Gait kinematic and baropodometric analyses of 159 pronator vs non-pronator professional firefighters were then compared. Then, the effects of two one-month protocols aimed at reducing pronation (foot muscle strengthening or wearing insoles) were suggested to pronator subjects. Agreement between the different tests of foot-function identification was found to be low. A combination of functional tests was used to refine the identification of pronation. Pronator subjects showed plantar pressure and kinematic differences in the forefoot, hindfoot, knee and pelvis. These kinematic effects may reflect a risk factor for low back pain. Pronation was reduced by both preventive protocols wich were accompanied by kinematic changes in the foot and hip. Although our preventive protocols do not show an impact on the pelvis, they do show a kinematic change in the lower limb that could modify the biomechanics of the pelvis and provide a mean of preventing low back pain

Drug addiction and some eating disorders present striking similarities in their behavioural symptoms. It has been postulated that excessive consumption of drugs of abuse and palatable food could lead to the development of similar neuronal alterations in the brainreward circuit that may account for the resemblance of these pathologies. In the present thesis, we demonstrate that repeated operant training with palatable food promotes behavioural alterations and structural plasticity changes in the esocorticolimbic circuit that are reminiscent to those observed with drugs of abuse. Furthermore, we identify the cannabinoid receptor 1 as a common neurobiological substrate underlying these alterations. Finally, we uncover several synaptic proteins commonly implicated in the retrieval of drug and palatable food rewarding memories that may represent part of the common neurobiological basis underlying drug and palatable food craving.
La adicción a las drogas de abuso y determinados trastornos alimentarios comparten varios síntomas comportamentales. Algunos estudios han sugerido que el consumo excesivo de drogas y de comida palatable podrían producir alteraciones neuronales similares en el circuito cerebral de recompensa. En esta tesis, hemos demostrado que un aprendizaje operante prolongado con comida palatable provoca la aparición de alteraciones comportamentales y cambios de plasticidad estructurales en el circuito mesocorticolimbico que son reminiscentes de los observados con las drogas de abuso. Así mismo, hemos identificamos al receptor cannabinoide 1 como un sustrato neurobiológico común a estas alteraciones. Finalmente, hemos caracterizado varias proteínas sinápticas implicadas en la reactivación de la memoria asociada a los efectos placenteros de las drogas y la comida palatable. Nuestras observaciones contribuyen a definir las bases neuronales subyacentes a la necesidad de consumir drogas y comida palatable.

La Classification Internationale du Fonctionnement (CTF) a été élaborée dans les années 1990 afin de proposer un langage commun et un cadre pour la description et l'organisation relatives au fonctionnement et au handicap. Le fonctionnement et le handicap sont des concepts multidimentionnels qui permettent de mettre en avant l'interaction dynamique entre plusieurs composantes : les fonctions organiques et les structures anatomiques des individus, les activités des individus et les domaines de vie auxquels ils participent, les facteurs environnementaux qui influencent leur participation et les facteurs personnels. La logique de prise en charge des personnes en Médecine Physique et de Réadaptation (MPR), spécialité de la fonction, s'inscrit pleinement dans la démarche proposée par la CTF. En effet, le médecin de MPR possède la culture médicale lui permettant d'appréhender les déficiences. Sa formation ultérieure sur le fonctionnement et son positionnement sur les conséquences des maladies le placent au cœur d'une réflexion multidimensionnelle. La marche humaine s'est construite progressivement au cours de l'histoire de l'humanité et son fonctionnement bipède est unique chez les mammifères. Cette organisation reposant sur une succession de simples et de doubles appuis, nécessite une organisation reposant sur une construction neurologique complexe impliquant de nombreuses structures Les structures les plus anciennes dans le développement phylogénétique (la moelle spinale, le tronc cérébral, le cervelet) permettent de générer une activité automatisée par la personne au cours de son existence. Le cortex cérébral permet de modifier les patterns basiques de la marche en fonction des informations environnementales. L'harmonisation des mouvements locomoteurs nécessitent une communication entre ces différentes structures, celle-ci passe par les axones cheminant dans la substance blanche. Cette complexité organisationnelle rend la marche très sensible aux atteintes pathologiques du système nerveux central. Ses troubles en sont donc un mode de révélation fréquent. La démarche nécessaire pour l'étude des troubles de la marche s'inscrit dans la logique de la CIF, la marche étant une fonction essentielle aux activités et aux participations des citoyens au sein de la société. Une étude multimodale de la marche nous a permis de nous placer dans la logique de la CIF. Nous avons donc abordé l'étude des troubles de la marche à travers des modèles pathologiques qui touchent le système nerveux. La diffusion des troubles (lésionnels et fonctionnels) de la sclérose en plaques (SEP) nous a amené à aborder l'étude des dysfonctionnements de la marche induits par celle-ci à travers le prisme des activités et participations. La variabilité de la vitesse de marche est étudiée par une étude de reproductibilité. Nous avons déterminé le pourcentage de temps d'appui comme paramètre le plus reproductible en l'absence d'intervention thérapeutique. L'impact dans les conditions de vie réelle, est abordé par l'actimétrie et la qualité de vie. Comparé à un groupe de sujet sains, les personnes avec une SEP présentent une activité moindre et une stratégie hebdomadaire différente, sans augmentation de l'activité le samedi. La qualité de vie des personnes avec une SEP peut être améliorée, de façon modérée par un traitement médicamenteux: la fampridine. Le caractère focalisé des lésions des infarctus cérébraux nous a amené à aborder les troubles de la marche induits par le lien possible avec la déficience, même minime. Une mise au point sur les troubles moteurs induits par les infarctus dans le territoire irrigué par les branches perforantes de l'artère cérébrale moyenne a été proposée avant de construire une évaluation fonctionnelle chez les patients n'ayant pas d'atteinte de la voie cortico-spinale
The International Classification of Functioning (ICF) was developed in the 1990s to provide a common language and framework for the description and organization offonctioning and disability. Functioning and disability are multidimensional concepts that highlight the dynamic interaction between several components: the organic fonctions and anatomical structures of individuals, the activities of individuals and the areas of life in which they participate, environmental factors that influence their participation and persona! factors. The logic of taking care of people in Physical Medicine and Rehabilitation (MPR), specialty of the function, is fully in line with the approach proposed by the ICF. Indeed, the practitioner in PMR has the medical culture allowing him to apprehend the deficiencies. His professional experience and his overview of the consequences of diseases puts him at the heart of a multidimensional reflection. In the course of mankind history, human gait has progressively evolved. Its bipedal characteristic is unique in mammals. This organization based on a succession of simple and double supports, requires an organization based on a complex neurological construction involving many structures. The automated activity generated during gait is supported by the oldest structures in the phylogenetic development (the spinal marrow, the brainstem, the cerebellum). The cerebral cortex makes it possible to modify the basic patterns of walking according to environmental information. Harmonization of locomotor movements requires communication between these different structures, this one goes through axons moving in the white matter. This organizational complexity makes. gait very sensitive to pathological attacks of the central nervous system. This troubles are therefore a frequent mode of revelation. The process need for the study of gait disorders is part of the ICF, as walking is an essential fonction for the activities and participation of citizens in society. A multimodal study of walking allowed us to place ourselves in the logic of the ICF. We therefore approached the study of gait disorders through pathological models that affect the nervous system. The spread of disorders of multiple sclerosis (MS) led us to address the study of dysfonctions of walking induced by it through the prism of activities and participation. The variability of walking speed is studied by a reproducibility study. We determined the percentage of support time as the most reproducible parameter in the absence of therapeutic intervention. The impact in real life conditions is addressed by actimetry and quality of life. Compared to a group of healthy subjects, people with MS have less activity and a different weekly strategy, with no increase in activity on Saturdays. The quality of life of people with MS can be improved, moderately by drug therapy: fampridine. The focussed nature of brain infarction lesions has led us to address the disorders of walking induced by the possible link with the deficiency, even minimal. A review of motor dysfonction induced by infarction in the territory irrigated by the perforating branches of the middle cerebral artery was proposed before constructing a functional evaluation in patients without involvement of the cortico-spinal way

This work corresponds to an exploratory study into the reasons why different stakeholders of clase interest to gardeners have an explanation on the musculoskeletal disorders affecting them . lts objectives seek to respond, to the questions of what kinds of reasons are offered by these groups against this problem, what do they do to prevent musculos keletaldisorders, what do they consider the major causes and what preventive measures do they propose .This study has been developed employing a qualitative research methodology, with selected samples of participatory-intent manner,using questionnaires and focus group interviewing as data collection techniques aided by the ATLAS.TI program for the analysis and interpretation of data . The results of this study may constitute a contribution to the knowledge of this activity in order to develop further programs in preventing musculoskeletal disorders in gardeners whilst engaging the various stakeholders to enable an improvement in the working conditions
El presente trabajo corresponde a un estudio de carácter exploratorio acerca de las razones o cogniciones que diferentes grupos de interés cercanos a los jardineros tienen como explicación a los trastornos musculoesqueléticos que sufren estos. Sus objetivos buscan responder a la interrogante de qué tipo de razones ofrecen estos grupos frente a dicha problemática, qué hacen que evitar los trastornos musculoesqueléticos en jardineros, cuáles consideran que son las principales causas y qué medidas preventivas proponen. Se desarrolla bajo una metodología cualitativa de investigación, con muestras seleccionadas de manera participativo­ intencíonal, utilizando el cuestionario y la entrevista grupal como técnicas de recolección de datos y el programa ATLAS.TI para el análisis e interpretación de los mismos. Los resultados de este estudio pueden constituir un aporte al conocimiento de la jardinería para el desarrollo de ulteriores programas de prevención de trastornos musculoesqueléticos en jardineros, que comprometan a los diferentes grupos de interés a fin de permitir una mejora en las condiciones de trabajo de estos.
El present treball correspon a un estudi de caràcter exploratori sobre les raons o cognicions que diferents grups d'interès propers als jardiners tenen com a explicació als trastorns musculoesquelètics que sofreixen aquests. Els seus objectius busquen respondre a la interrogant de quin tipus de raons ofereixen aquests grups enfront d'aquesta problemàtica, què fan que evitar els trastorns musculoesquelèticos en jardiners, quins consideren que són les principals causes i quines mesures preventives proposen. Es desenvolupa sota una metodologia qualitativa de recerca, amb mostres seleccionades de manera participativa-intencional, utilitzant el qüestionari i l’entrevista grupal com a tècniques de recol·lecció de dades i el programa ATLAS.TI per a l'anàlisi i interpretació dels mateixos. Els resultats d'aquest estudi poden constituir una aportació al coneixement de la jardineria per al desenvolupament d'ulteriors programes de prevenció de trastorns musculoesquelèticos en jardiners, que comprometin als diferents grups d'interès a fi de permetre una millora en les condicions de treball d'aquests

The objective of this study was to evaluate the occurrence of locomotive organs disorders in sports horses. The locomotive organs condition is one of the determining factors of horse{\crq}s performance, thus it is also very important economical factor. The occurrence of the disorders is important not only for the given individual, but it can be used e.g. as the genetic information or the indicator of breeding management. The results of 151 horses in the age from 3 to 24 years were observed. Total of 10 radiographic images were evaluated in each horse. With respect to frequency and importance, following disorders were emphasized: occurrence and degree of modifications of navicular bone (navicular syndrome) and hock joint (bone spavin). Others modifications were observed on a smaller range. The results showed that only 11% of horses were free of any disorder. 89% of horses had at least one of the disorders, whereas 83% of them showed the disorder of navicular bone and 52% of them showed the disorder of bone spavin.

Title: Functional disorders of the musculoskeletal system on individuals after kindey transplantation Defining of the problem: Renal transplantation is a method to treat patients with renal failure,which is associated to a prolonged survival of patients compared to a dialysis method (Viklický et al., 2008). After a successful renal transplantation the renal function is restored and complications caused by dialysis treatment disappear . However, complications due to the transplant, not only in terms of surgical intervention, but also from the point of a lifelong immunosuppressive therapy remain at risk. Functional changes on the locomotor system can occur as a concequence of a long-term renal disease or kidney transplant. This could further reduce the quality of life on patients due to self-sufficiency, being the main role of the locomotor system. Objectives: The aim of this study is to valuate functional disorders of the musculoskeletal system on individuals after kindey transplantation up to one year after a transplant. Methods: This thesis is elaborated in the form of an analytical - experimental study in which 2 groups of selected individuals were tested. Testing was conducted by using suitable tests focused on functional disorders of the locomotor system and parameters in each group and time...

PLAYING SAXOPHONE AND ITS POTENTIAL HEALTH RISKS Objectives: Main purpose of this study is to provide comprehensive review of health issues related to saxophone playing. The aim of this study is to collect available resources focused on saxophone players teaching methods, analyse them and compare them with existing findings of medical science. Also to try to find answers to asked research questions and to verify or disprove stated hypotheses, on the basis of acquired datas and principles eventually trying to arrange some possible outlines to complement teaching methods or preventative-compensational excercises for saxophone players. Methods: Method of this thesis is literature research using available Czech and foreign literary resources. For this purpose there have been used electronic archives as Pubmed, Ebsco, Springer, Wiley and Science Direct, monographic publications and scholarly papers from periodicals. This work is divided into few main parts. Introductional part contains basic review of health issues related to instrumental musicians, methodics contained in saxophone schools written in the Czech language, aims and methods of this thesis. Theoretical part is more widely focused on methodics, principles and mechanics of saxophone players' education. The main part is dedicated to possible...

The diploma thesis deals with muskuloskeletal system disorders in hemodialysis pacients with chronic renal failure. Theoretic informations about the most frequent disorders of musculoskeletal system in uremic patients, patophysiologic consequences, clinical symptoms, posibility of investigations and common therapeutic management. Secondly this thesis interests about of annamnestic data, physiotherapeutic investigation and evaluation of the data. Aim of this study was supported importance of the physiotherapeutic intervention. Should be important complete the multidisciplinary team following long therm hemodialysis patients with physiotherapeut. Powered by TCPDF (www.tcpdf.org)

Title: Playing-related musculoskeletal disorders in drummers Objectives: The aim of this study is to collect literature resources focusing on the field of performing arts medicine in musicians with a special focus on drummers. The main focus will be directed on the therapeutic, preventive, educational and ergonomic influence of musculoskeletal disabilities. Methods: This is a literature review, written mainly from foreign sources in English. Electronic databases like Pubmed, Pedro, Science Direct, Springer and Wiley were used. Special attention was given to studies that describe health problems of musicians associated with playing drums. Instrument ergonomics, prevention and education in this field is also described. Results: 128 studies corresponded to the entry criteria. 88 of these studies were devoted to health problems of playing a musical instrument in general, 5 studies were directly addressing particular health risks associated with playing drums. Another 11 studies were describing percussionists within a larger sample of musicians. Conclusion: There are not many studies dealing with health issues associated with playing the drums. Their authors are often speaking from personal experience. On the internet, there is a number of websites containing information about the most common ailments...