Full text
| |
| Author(s): |
Enio Walker Azevedo Cacho
Total Authors: 1
|
| Document type: | Doctoral Thesis |
| Press: | Campinas, SP. |
| Institution: | Universidade Estadual de Campinas (UNICAMP). Faculdade de Ciências Médicas |
| Defense date: | 2010-08-24 |
| Examining board members: |
Alberto Cliquet Junior;
Oswaldo Horikawa;
Nivaldo Antonio Parizotto;
Maurício Etchebehere;
Venâncio Pereira Dantas Filho
|
| Advisor: | Alberto Cliquet Junior |
| Abstract | |
Several assessment tools are dedicated to understanding tetraplegics. The understanding of their relationships has a fundamental importance for the development and elaboration of therapeutic approaches aiming rehabilitation of the upper extremity of these individuals. The objective of this study is to analyze the correlations between clinical, functional and kinematics assessments of upper extremity during reaching-grasping movements in tetraplegics. Twenty chronic tetraplegic patients and 20 control participants were selected for this study. The instruments used for evaluation were the standard classification of the American Association of Spinal Cord Injury - ASIA, the Functional Independence Measure - FIM, the Spinal Cord of Independence Measurement - SCIM II and the kinematics evaluation of the reach-grasp movement. The following kinematic variables were used: anterior displacement of the trunk and protraction of the shoulder, joint range of motion of shoulder, elbow and wrist in sagittal and horizontal planes, curvature index, peak speed, ratio of peak speed, movement time and peak number. The anterior displacement of the trunk, shoulder protraction and range of motion of shoulder and elbow showed no significant differences between groups of tetraplegic patients and controls. Only the flexion-extension amplitude of the wrist was significantly greater in tetraplegics. The movements in quadriplegic patients were slower, targeted and less harmonious when compared with controls. There was a positive correlation between the total motor index and functional FIM (r = 0.6089; p = 0.0044) and SCIM II (r = 0.5229; p = 0.018). Both functional scores showed positive correlation within each other (r = 0.8283; p < 0.0001). There was also correlation between the right and left motor indices, the motor FIM and the SCIM with most of the kinematics studied (peak of velocity, movement time, index of curvature, number of peaks and peak velocity ratio of the maximum velocity). On the other hand, for the joint range of motion (shoulder, elbow and wrist), only the wrist in the horizontal plane demonstrated correlation with clinical variables. This study demonstrates that muscle strength assessed by the ASIA motor index correlates moderately with the kinematic variables related to the harmony and the trajectory of the reaching-grasping movement in tetraplegics. Yet, functional assessments showed strong correlation among themselves, and moderate correlation with right, left and total motor index, but did not show a constant correlation with kinematic variables measured on the right and left. (AU) | |