Dissertations / Theses on the topic 'Upper motor neuron syndrome'

Hand exoskeletons are wearable robotic devices which are used to compensate for impaired handmovements in patientswith impaired upper-limbs. These devices can either help patients to grasp objects for a therapeutic purpose or to performactivities of daily living. This Thesis describes the development of a novel hand exoskeleton, with a focus on the user, based on the product development methodology "the V-Model". Therefore, user needs are identified through interviews and a thorough literature review. Three potential concepts are developed and sub-sequential a concept is selected based on a logical decision process. A mathematical model of the selected concept is generated and then used for dimensioning the hand exoskeleton. Moreover, three variants of the hand exoskeleton are built as prototypes. Finally, the variants of the device are tested on a bench top. The result of the development process is a novel hand exoskeleton for the rehabilitation of upper motor neuron syndrome patients. Force and range of motion tests revealed, that a design with a higher level of underactuation is favourable. The design presented in this thesis does not reach the defined range of motion and force augmentation. However, the defined target values are the results of a conservative approach, thus are a challenge to reach. The augmented closing force and range of motion surpass other state of the art hand exoskeletons. Nevertheless, the augmented opening force under-performs in comparison with other designs. Decisively, a validation with users is needed for a usability assessment.
Exoskelett för händer är robotiska hjälpmedel som kan användas för att kompensera nedsatt muskelstyrka och rörlighet hos patienter med nedsatt muskelfunktion i armarna. Dessa hjälpmedel kan hjälpa patienter att greppa föremål i ett terapeutiskt syfte eller för att utföra vardagliga sysslor. Examensarbetet beskriver utvecklingsarbetet av ett nytt exoskelett med fokus på användaren genom att tillämpa produktutvecklingsmotodikens V-modell. Användarens krav och behov identifieras genom intervjuer och en gedigen litteraturstudie. Tre koncept utvecklas och ett vidareutvecklat koncept väljs slutligen baserat på en logisk beslutsprocess. En matematisk modell genereras och används för att dimensionera exoskelettet. Dessutom tillverkas tre prototyper av exoskelettet i olika utföranden för att slutligen utvärderas i en testrigg. Resultatet av utvecklingsprocessen är ett nytt handexoskelett ämnat för rehabilitering av patienter med övre motorneuronsjukdom. Tester som genomfördes för att mäta Kraft och rörlighet visade att en design med en högre grad av underaktuering är gynnsamt. Designen som presenteras här når inte upp till de krav som ställs på kraft och rörlighet, de målvärden som definieras är dock baserade på ett konservativt synsätt och är därmed svåra att uppnå. Exoskelettet producerar en högre stängningskraft och uppvisar bättre rörlighet än andra toppmoderna exoskelett. Exoskelettet underpresterar dock vad gäller den producerade öppningskraften jämfört med andra modeller och designen behöver valideras hos användarna för att användarbarheten ska kunna bestämmas.

Wearable assistive robotics have the potential to address an unmet medical need of reducing disability in individuals with chronic hand impairments due to neurological trauma. Despite myriad prior works, few patients have seen the benefits of such devices. Following application experience with tendon-actuated soft robotic gloves and a collaborator's orthosis with novel flat-spring actuators, we identified two common assumptions regarding hand orthosis design. The first was reliance on incomplete studies of grasping forces during activities of daily living as a basis for design criteria, leading to poor optimization. The second was a neglect of increases in muscle tone following neurological trauma, rendering most devices non-applicable to a large subset of the population. To address these gaps, we measured joint torques during activities of daily living with able-bodied subjects using dexterity representative of orthosis-aided motion. Next, we measured assistive torques needed to extend the fingers of individuals with increased flexor tone following TBI. Finally, we applied this knowledge to design a cable actuated orthosis for assisting finger extension, providing a basis for future work focused on an under-represented subgroup of patients.

The prevalence of spasticity after first-ever stroke is approximately 20%, but there are no data on the prevalence of disabling spasticity.The reported prevalence of pain after stroke varies between 19% and 74%, whether pain is associated with spasticity is not known. Until now, there is no health economic analysis of patients with spasticity after stroke. Methods: Two groups of patients were studied. Cohort I was a cross-sectional survey. A representative sample of 140 patients was investigated 1 year after their first-ever stroke. Spasticity was defined as ≥ 1 score on the modified Ashworth scale, disabling spasticity was defined as spasticity having such an impact that intervention, e.g. intensive physiotherapy, orthoses or pharmacological treatment, should be offered. Pain was assesed with the Visual Analogue Scale. All direct costs during one year were identified and converted into Purchasing Power Parities US dollar (PPP$). Cohort II was a prospective cohort study. Forty-nine patients were examined at day 2–10, at one month, and at six months after their first-ever stroke. Assessment and definitions were similar as for cohort I. Results: Spasticity occurs within 1 month and disabling spasticity occur within 6 months. After one year, the prevalence of spasticity was 17% and that of  disabling spasticity 4%. Disabling spasticity was more frequent in the upper extremity. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9–125) and age below 65 years (OR 9.5, CI 1.5–60). The prevalence of stroke-related pain was 21% after one year. Stroke-related pain was associated with paresis (OR 3.1, 95% CI 1.2–7.7), sensory disturbance (OR 3.1, 95% CI 1.1–8.9) and depression (OR 4.1, 95% CI 1.4–13), but not with spasticity as an independent variable. The majority of the direct costs for one year (78%) were associated with hospitalization, whereas 20% was associated with municipality services. Only 1% of all direct costs were related to primary health care and 1% to medication. The mean (median, inter-quartile range) direct cost for stroke patients with spasticity was PPP$ 84 195 (72 116, 53 707) compared to PPP$ 21 842 (12 385, 17 484) for stroke patients without spasticity (P < 0.001).

À la suite d’une lésion du système nerveux central tel qu’un accident vasculaire cérébral ou une lésion médullaire incomplète un ensemble de symptômes tel que la parésie, l’hyperactivité musculaire et l’hypo-extensibilité des tissus vont perturber l’organisation locomotrice du patient. Depuis quelques années, l’utilisation de méthodes mathématiques permet d’extraire à partir de l’activité électrique des muscles la commande à l’organisation locomotrice du sujet. L’objectif de ce travail de thèse est d’utiliser ces méthodes pour caractériser les spécificités du patient hémiparétique et paraparétique. Une première étude sur le sujet asymptomatique a permis de valider notre méthodologie..La deuxième étude portant sur les patients paraparétiques montre que l’asymétrie de marche est plutôt expliquée par une expression différente des symptômes plutôt qu’une réelle asymétrie provenant de la commande. Pour conclure, la troisième étude portant sur l’effet d’une anesthésie d’un muscle chez le patient hémiparétique a montré que le cerveau était en mesure de modifier la commande locomotrice pour pallier les perturbations induites par cette anesthésie. En conclusion nos travaux soulignent l’intérêt de ces méthodes comme un outil pertinent dans l’évaluation de l’organisation locomotrice chez le patient présentant une lésion du système nerveux central
Following a central nervous system injury such as a stroke or incomplete spinal cord injury, a set of symptoms such as paresis, muscle hyperactivity and hypo-extensibility will disrupt the patient’s locomotor organization. In recent years, the use of mathematical methods has made it possible to extract, from the electrical muscle activities, the command of the locomotor organization. This thesis aimed at using these methods to characterize the specificities of the post-stroke patient and the patient with incomplete spinal cord injury. The first study of healthy individuals allowed to validate our methodology.The second study in patients with incomplete spinal cord injury showed that gait asymmetry may be explained by a different expression of symptoms rather than a real asymmetry originating from the control. Finally, the third study has investigated the effect of muscle anesthesia on the post-stroke patient. The results showed that the central nervous system was able to adapt locomotor control to compensate for the disturbances induced by this anesthesia. In conclusion, our work underlines the interest of these methods as a relevant tool in the evaluation of locomotor organization in patients with central nervous system lesions

Obiettivo: Lo studio ha l’obiettivo di indagare quali siano le scale di valutazione caratterizzate dalle migliori proprietà psicometriche per la misurazione dei disturbi del tono in seguito a GCA. Metodi: La revisione sistematica ha incluso studi osservazionali cross sectional relativi ad un campione di pazienti adulti dopo GCA di varia eziologia e in cui gli outcome indagati fossero le proprietà psicometriche delle scale di valutazione dell’ipertono muscolare. I database consultati sono PubMed, Cochrane Central Register of Controlled Trials e PEDro. La valutazione del rischio di bias e dell’applicabilità degli studi è stata eseguita tramite l’utilizzo dello strumento QUADAS-2. Risultati: I risultati prodotti dalla ricerca sono 1056, di cui solo 13 inclusi in seguito all’analisi del full text. Il disegno di tutti gli studi reclutati è osservazionale cross sectional e i principali outcome indagati sono l’affidabilità e la validità. Dagli studi inclusi nella revisione sono emerse una serie di scale di valutazione dell’ipertono muscolare: AS/MAS/MMAS, MTS, HAT, BADS, UDRS e BFMMS. La AS e MAS hanno dimostrato un’affidabilità inter-operatore da scarsa a moderata e una bassa validità. La MMAS ha rivelato un’elevata affidabilità inter-operatore nella valutazione dei distretti dell’arto superiore e la MTS un’affidabilità inter-operatore da scarsa a moderata e intra-operatore da moderata ad alta. HAT, BADS, UDRS e BFMMS, studiate su campioni di bambini con PCI, hanno mostrato un’affidabilità inter-operatore da moderata a buona e una buona consistenza interna. Conclusioni: Lo studio ha permesso di individuare una serie di scale di valutazione dell’ipertono muscolare e di analizzarne le relative proprietà psicometriche. I limiti dello studio riguardano l’inclusione di 4 studi relativi a pazienti pediatrici con PCI, l’analisi da parte di un solo revisore indipendente e la mancanza di confronto con il gold standard diagnostico in diversi studi inclusi nella revisione.

Les Paraplégies Spastiques Héréditaires (PSHs) sont un groupe de maladies neurodégénératives rares qui surviennent suite à la dégénérescence progressive des voies corticospinales, entraînant une spasticité des membres inférieurs, signe distinctif de la pathologie. Elles se caractérisent par une extrême hétérogénéité qui concerne à la fois les facteurs génétiques et cliniques, ainsi que d’autres aspects de la maladie, tels que l’âge d’apparition et la sévérité des signes. Cette variabilité est typiquement observée chez les patients porteurs de mutations pathogènes dans SPAST, le gène le plus fréquemment muté dans les PSHs. Après avoir réuni une cohorte de 842 patients mutés dans SPAST, nous avons utilisé une combinaison de différentes approches de Séquençage de Nouvelle Génération (NGS) afin de mieux comprendre les causes de l’hétérogénéité observée chez les patients, afin d’identifier des facteurs génétiques responsables de variations de l’âge au début de la maladie. Les données résultantes du génotypage de l’ensemble du génome ont ainsi été utilisées pour effectuer des analyses d’association et de liaison qui, combinées aux données de séquençage de l’ARN, ont permis d’identifier différents variantes/gènes candidats, potentiellement impliqués comme facteurs modificateurs de l’âge de début des SPAST-PSHs
Hereditary Spastic Paraplegias (HSPs) are a group of rare, inherited, neurodegenerative disorders that arise following the progressive degeneration of the corticospinal tracts, leading to lower limbs spasticity, the disorder hallmark. HSPs are characterized by an extreme heterogeneity that encompasses both genetic and clinical features, extending to additional disorder’s features, such as age of onset and severity. This phenotypic variability is typically observed among HSP patients carrying pathogenic mutations in SPAST, the most frequently mutated HSP causative gene. After assembling a cohort of 842 SPAST-HSP patients, a combination of different Next Generation Sequencing approaches was used to dig deeper into the causes of the observed heterogeneity, especially focusing on the identification of age of onset genetic modifiers. Sequencing data resulting from Whole Genome Genotyping were used to perform both association and linkage analysis that, combined with RNA sequencing expression data, allowed to identify different candidate variants/genes, potentially acting as SPAST-HSP age of onset modifiers

Title: The Use of Physiotherapy in Spasticity Management Objectives: The purpose of this thesis is to provide a summary of present findings on spasticity, with particular regard to its pathophysiological mechanisms and clinical manifestations, and to present an overview of medical and physiotherapeutic approaches applied in its treatment. Furthermore, it aims at making a research in physiotherapeutic methods and techniques used for reduction of spasticity. The thesis shall present relevant studies, provide their comparison and critically evaluate the effect of methods and techniques examined in them. Methods: This thesis is a descriptive analysis based on a literature review. Results: Based on the research findings, it may be concluded that physiotherapy has proven to be effective in reducing spasticity. However, it is not possible to determine whether the techniques to reduce spasticity are more effective than techniques without this primary purpose. The examined studies have shown that the choice of physiotherapeutic practices to reduce spasticity was not influenced by disease etiology. Moreover, the same techniques and methods were applied in pediatric and adult patients, regardless of diagnosis. The relationship between reduced spasticity and change in motor function is unclear and our research...

碩士
長庚大學
機械工程研究所
90
Patients with writer’s cramp or upper motorneuron disease (ex. Parkinson’s disease, stroke, and other brain injuries) often have difficulty in processing upper arm movement because of involuntary muscle contraction or neuron regression. This often results in trembling of the involved extremity. Most patients , still experience palm/arm movement obstacles even after treatment/surgery. Therefore, clinical evaluation and rehabilitation training for writing with a pen and arm movement are important parts of the postoperative management.. In this research , clinical testing and quantitative evaluation of the writing function of the patients was done. A series of robotic manipulators for arm movement assessment and rehabilitation was designed and its applications were tested quantitatively and diagrammatically. In the first part of this research , an evaluation system was developed which aimed to quantitatively measure the patients’ arm function using four parameters : the contact pressure between paper and pen, the time delay before start of writing, the hesitation time spent between words, and the total written words in a given time. An evaluation standard for quantitative writing was set-up, clinical testing and subsequent statistical analysis of the results was done. A total of 26 patients and 13 control subjects were studied. The results were analyzed using the SPSS statistical software and showed that t test values of the four estimation parameters were all less than 0.05. This means that there was a significant difference between the evaluation parameters of the patients and normal control subjects. These results can provide a reference for clinicians when diagnosing patients. The second part of the research was aimed to decrease the time and energy spent by therapists who usually have to repeatedly say or demonstrate the correct motions for arm rehabilitation. A mechanical device was designed to manipulate the arm movement and provide the patient with a continuous passive rehabilitation. The machine used was a SCARA type robotic manipulator with four degrees of freedom. This was connected to a computer with a software based on Windows 2000 and Visual Basic 6.0. Also designed for this project to adjust the rehabilitation parameters (i.e. velocity, circle/ellipse movement locus size, etc.). This set up enables the doctor or therapist to choose the proper rehabilitation parameters and patterns for patients who will undergo a continuous upper arm continuous passive rehabilitation. The third part of the research was aimed to consolidate the mechanical 3-D Digitizer already existing in the market and the interface software we developed into a manipulator for the evaluation of upper arm movement function in order to improve the defects noted during initial rehabilitation. This would also provide diagrammatic (arm movement locus radial error, distribution diagram) and quantitative (radial error of normal value, radial error of absolute value, average drawing circle rate, etc.) evaluation indicators and clinical test standards. This consolidated robotic manipulator was further tested on 11 stroke paralysis patients, 5 normal elders, and 6 normal youths. The results showed that there was a significant difference between the three test groups. From the quantitative evaluation indicators, it is shown that the radial error of absolute value was 2 to 3 times more among the stroke patients compared to that of the normal elders, and 3 to 4 times more compared to that of the normal youths. From the diagrammatic evaluation indicators, we found that in the arm movement locus radial error distribution diagram, stroke paralysis patient had the widest area of radial error of absolute value compared to the rest. The error value was about 4 to 9 times more than the normal elder group and 9 to 16 times more than the normal youth group. This objectively result shows that the stroke patients had more serious functional defects. These results can provide a reference for clinicians in the diagnosis of functional defects of patients. The hand writing function evaluation system for using a pen and the manipulator for the assessment of arm function will be able to provide assistance to the clinician as new tools to evaluate patients’ palm/arm motor function. The robotic manipulator can be used for the postoperative rehabilitation the training of the patient. The standards and quantitative evaluation indicators developed in this research can be used as new tool and methods of the treatment for upper motorneuron or palm/arm movement dysfunction patients.

Rett Syndrome (RTT) is a neurodevelopmental disorder primarily caused by mutations in the X-linked gene methyl-CpG-binding protein 2 (MECP2). The mosaic brain environment in heterozygous (MECP2+/-) females consists of both MeCP2-wildtype (MeCP2+) and Mecp2-mutant (MeCP2-) neurons. To separate possible cell autonomous and cell non-autonomous effects three-dimensional morphological analysis was performed on individually genotyped layer V pyramidal neurons in the primary motor cortex of heterozygous (Mecp2+/-) and wild-type (Mecp2+/+) mature female mice (>8 months old) from the Mecp2tm1.1Jae line. Mecp2+/+ neurons and Mecp2+ were found to be indistinguishable while Mecp2- neurons have significantly reduced basal dendritic length (p<0.05), predominantly in the region 70-130 μm from the cell body, culminating in a total reduction of 15%. Mecp2- neurons have three (17%) fewer total branch points, lost specifically at the second and third branch orders. Thus the reduced total dendritic length in Mecp2- neurons is a result of fewer higher-order branches. Soma and nuclear areas of 30 Mecp2+/- female mice (5-21 months) with X chromosome inactivation (XCI) ratios ranging from 12% to 56% were analyzed. On average Mecp2- somata and nuclei were 15% and 13% smaller than Mecp2+ neurons respectively. The variation observed in the soma and nuclear sizes of Mecp2- neurons was not due to age, but was found to be correlated with the XCI ratio. Animals with a balanced XCI ratio (approximately 50% Mecp2-) were found to have Mecp2- neurons with a less severe cellular phenotype (11-17% smaller than Mecp2+). Animals with a highly skewed XCI ratio favouring expression of the wild-type allele (less than 30% Mecp2-) were found to have a more severe Mecp2- cellular phenotype (17-22% smaller than Mecp2+). These data support indicate that mutations in Mecp2 exert both cell autonomous and cell non- autonomous effects on neuronal morphology.
Graduate

Spasticity is highly prevalent in neurological conditions involving upper motor neuron lesions (UMNL). Lower limb spasticity is known to impair gait and limit participation in physical activity. Multimodal interventions including botulinum toxin A, orthoses, and physiotherapy have shown longer lasting improvements compared to unimodal interventions. Studies to date, however, have not examined the long term efficacy of this multimodal intervention nor have they examined the impact across a breadth of domains necessary to comprehensively and fully understand its impact. The aim of this study was to investigate the efficacy of a multimodal intervention to treat lower limb spasticity in adults using a longitudinal mixed-methods approach, including a comprehensive set of outcome measures spanning the domains of the International Classification of Functioning, Disability and Health (ICF) model. Seven-teen participants with chronic UMNL were included in the analysis as per inclusion criteria and showed improvements at 6 and 12 months, compared to baseline, within all domains of the ICF model.
Graduate
2015-04-24
0571
0382
0384
jazkim@uvic.ca