New tools for cognitive and motor rehabilitation: development and clinical validation

Nervous system disorders are associated with cognitive and motor deficits, and are responsible for the highest disability rates and global burden of disease. Their recovery paths are vulnerable and dependent on the effective combination of plastic brain tissue properties, with complex, lengthy and expensive neurorehabilitation programs. This work explores two lines of research, envisioning sustainable solutions to improve treatment of cognitive and motor deficits. Both projects were developed in parallel and shared a new sensible approach, where low-cost technologies were integrated with common clinical operative procedures. The aim was to achieve more intensive treatments under specialized monitoring, improve clinical decision-making and increase access to healthcare. The first project (articles I – III) concerned the development and evaluation of a web-based cognitive training platform (COGWEB), suitable for intensive use, either at home or at institutions, and across a wide spectrum of ages and diseases that impair cognitive functioning. It was tested for usability in a memory clinic setting and implemented in a collaborative network, comprising 41 centers and 60 professionals. An adherence and intensity study revealed a compliance of 82.8% at six months and an average of six hours/week of continued online cognitive training activities. The second project (articles IV – VI) was designed to create and validate an intelligent rehabilitation device to administer proprioceptive stimuli on the hemiparetic side of stroke patients while performing ambulatory movement characterization (SWORD). Targeted vibratory stimulation was found to be well tolerated and an automatic motor characterization system retrieved results comparable to the first items of the Wolf Motor Function Test. The global system was tested in a randomized placebo controlled trial to assess its impact on a common motor rehabilitation task in a relevant clinical environment (early post-stroke). The number of correct movements on a hand-to-mouth task was increased by an average of 7.2/minute while the probability to perform an error decreased from 1:3 to 1:9. Neurorehabilitation and neuroplasticity are shifting to more neuroscience driven approaches. Simultaneously, their final utility for patients and society is largely dependent on the development of more effective technologies that facilitate the dissemination of knowledge produced during the process. The results attained through this work represent a step forward in that direction. Their impact on the quality of rehabilitation services and public health is discussed according to clinical, technological and organizational perspectives. Such a process of thinking and oriented speculation has led to the debate of subsequent hypotheses, already being explored in novel research paths.

The analysis of political will and its role in leadership: a study of portuguese mayors

This thesis analyses the concept of Political Will, suggests its operationalization and establishes a typological theory that provides the necessary support for the diverse strategies of action of a leader. It claims that political leadership styles articulate a choice of action that results from the Political Will of a leader, which is determined by his intention and his discerned possibilities to act. One main research question guided our research: How does a political leader select and change his leadership style? The most illustrative literature on political leadership is reviewed and the characteristics of democratic governance are analyzed. This is followed by an overview of the most noteworthy theories on the theme and a claim for the need of concept coherence, given the multiplicity of the existent standpoints. After that, we concentrate on leadership styles, with a focus on the local governance context. Human action and intentionality are addressed with particular attention, as well as the motivational drivers for action, in order to advance a conceptualization of Political Will through two dimensions: intention and possibility. This analysis led to a number of relevant propositions: (1) Political Will ‘exists’ when the agent has the intent and the possibility to act; (2) these two dimensions ‘translate’ simultaneously what the agent believes he must do and can do; (3) Intention and possibility reflect diverse but limited worldviews; (4) political leadership styles result from the agent’s Political Will; (5) different combinations of the expected and actual worldviews result in different leadership styles; and (6) political leadership styles can change accordingly to several strategies which allow conformity or reflect reaction to worldviews. We suggested the operationalization of the two dimensions of Political Will through the analytical tool of Grid-group Theory, which provided the identification of the heuristic devices that allowed further comprehension on the subjectivity of the agent’s choice. Four standard property spaces – representing four types of leadership styles – result from a preliminary approach to this process. Afterwards, and because these dimensions operate simultaneously, we advance on the analysis and suggest some plausible heuristical conflicts to happen and describe which consequences, strategies and type migrations are conceivable. An inclusive and more complete set of resulting property spaces renders fourteen different types of leadership styles and sixty different predictable causal paths that result from the expected migration strategies. Case-studies were conducted as plausibility probes designed to provide improvements to our theoretical claims and addressed the cases we selected for research purposes: Portuguese Mayors. The findings from five case studies are discussed and the probable impact and congruence of each with the theoretical claims are assessed. The communalities of the causal mechanisms related to the function of intention and possibility as the dimensions of Political Will and their role in explaining different leadership styles are, finally, addressed. To conclude, we advance some repercussions, mainly in the public policies field of research, and suggest a number of different and necessary paths for further work.