Reflexión sobre los problemas a la reincorporación laboral tras incapacidades médicas largas

Las dolencias lumbares, la patología psiquiátrica y el cáncer de mama son las tres principales causas de incapacidad médica prolongada. Las incapacidades laborales largas suponen ante todo elevados costes en "capital humano" y costes en "capital salud" del trabajador de graves consecuencias; las incapacidades médicas largas son un tema de salud pública con enormes repercusiones en el sistema económico y de prestaciones del sistema público de salud y de prestaciones de la seguridad social. Es urgente la elaboración de un Mapa de la Incapacidad en España, para conocer población de riesgo, marcadores de riesgo, factores de riesgo y evolución de las incapacidades médicas de larga duración, es decir el propio riesgo protegido. Si conocemos el impacto incapacitante de la pérdida de salud en la población trabajadora se procederá a una mejor gestión y adecuación de recursos públicos destinados a la atención, promoción, prevención, reintegración, y prestaciones en torno a la incapacidad temporal y permanente. Entre los riesgos derivados de las incapacidades médicas prolongadas se encuentran el riesgo de pérdida de trabajo, aumento del riesgo de incapacidad permanente, disminución de calidad de vida, riesgos en la salud, deterioro de la vida familiar y de relación, gastos en apoyo a su situación, gastos sanitarios no públicos y una situación de precariedad y conflicto para la vuelta al trabajo. La mejor prevención es conocer por qué enfermamos y la mejor protección social es saber en qué gastamos. Para evitar los problemas a la reincorporación laboral tras larga incapacidad es preciso conocer cuántos factores la causan, así como las circunstancias personales, laborales, sociales y demográficas que la modulan y conocer la evolución de las situaciones incapacitantes tanto temporales como permanentes, más allá del gasto, para conocer realmente el estado de la salud laboral en cada momento y poder adoptar políticas de mejora. Y es preciso adecuación de los procesos de incapacidad, facultar la reincorporación parcial, conocimiento compartido de limitaciones y evolución del proceso y capacidades que requiere el trabajo. Conclusiones: Es urgente la elaboración de un mapa de la incapacidad en España, para conocer la población de riesgo, conocer no sólo el cuánto (el coste o su número) sino las causas de las incapacidades prolongadas. Adopción de medidas para evitar o paliar los problemas al retorno laboral tras incapacidades médicas laborales largas. Dentro de las bajas de larga duración, las que ocasionan de verdad problemas a la reincorporación laboral son las que duran más de 6 meses, o se prolongan hasta el período máximo del año, o las que están en fase de prórroga o a las incapacidades permanentes revisadas. Para acortar las incapacidades largas, primero y principal, que la baja corresponda a situación indicada o adecuada, tanto en el inicio como en su final, que no se amparen situaciones de refugio protegido. Que la atención sanitaria se preste en tiempo y forma, sin listas de espera. Protocolizar unidades de atención temprana, sobre todo en patologías psíquicas o del aparato locomotor. Es imprescindible una mayor comunicación, coordinación y cooperación entre el ámbito médico sanitario (prestación y atención sanitaria), el ámbito médico evaluador (prestaciones económicas) y el ámbito médico laboral (atención, prevención y vigilancia salud laboral), creando un flujo de información entre estas tres áreas, propiciando acceso a la historia clínica y al conocimiento de las capacidades que requiere el trabajo mediante el uso de fichas de valoración ocupacional para trabajadores en incapacidad temporal. Hay que favorecer la adecuación de las situaciones de incapacidad médica larga y la adaptación en el retorno al trabajo, así como posibilitar la reintegración paulatina del trabajador" con "altas parciales" que faciliten el reingreso al trabajo y prevengan recaídas.

Le rôle des acides gras oméga-3 sur la balance énergétique, la régulation de l’appétit, l’état émotionnel et l’implication du récepteur GPR120

L’obésité est un facteur de risque lié à des problèmes physiques, émotionnels et comportementaux. Aujourd’hui, l’alimentation est composée d’un régime typiquement occidental «Western diet» qui est riche en acides gras saturés (AGS) et pauvre en acides gras polyinsaturés (AGPI) tel que les oméga-3 (N-3) et occasionnant un déséquilibre du ratio alimentaire N-6/N-3. Ce déséquilibre est une des causes de la prévalence des maladies mentales y compris celles des troubles de l'humeur et de l’anxiété. L’acide docosahexaénoïque (ADH, 22: 6 n-3) est l’acide gras (AG) le plus abondant dans le cerveau et son accumulation est particulièrement élevée pendant la période périnatale. Il joue un rôle important dans le développement neuronal et d'autres fonctions du cerveau tel l'apprentissage et la mémoire. Des perturbations de l’environnement périnatal peuvent influencer à très long terme l’avenir de la descendance en la rendant plus susceptible de développer des problèmes d’obésité dans un contexte nutritionnel riche. On ignore cependant si le déficit alimentaire chez la mère et particulièrement en ADH aura un impact sur la motivation alimentaire de la progéniture. L’objectif principal de cette thèse est d’étudier le rôle potentiel des N-3 sur la balance énergétique, la motivation alimentaire, la dépression et le niveau d’anxiété des descendants de souris mâles adultes assujetties à une alimentation riche en gras. Nos données ont démontré qu‘un régime maternel déficitaire en ADH durant la période périnatale incitait la descendance à fournir plus d’effort afin d’obtenir un aliment palatable. Ceci entraînerait un dérèglement de l’homéostasie énergétique en augmentant le gain de poids et en diminuant l’activité locomotrice tout en exacerbant le comportement de type anxieux dès que les souris sont exposées à un milieu obésogène. Les acides gras libres (AGL) sont des nutriments essentiels fonctionnant comme des molécules de signalisation dans le cerveau en ayant des récepteurs qui jouent un rôle important dans le contrôle du métabolisme énergétique. Parmi eux, on distingue un récepteur couplé à la protéine G (GPCR), le GPR120. Ce récepteur activé par les AGPI ω-3 intervient dans les mécanismes anti-inflammatoires et insulino-résistants via les N-3. Une mutation dans le gène GPR120 occasionnée par une réduction de l’activité de signalisation du gène est liée à l’obésité humaine. L'objectif premier de cette deuxième étude était d’évaluer l'impact de la stimulation pharmacologique de GPR120 dans le système nerveux central (SNC) sur l'alimentation, les dépenses d'énergie, le comportement de type anxieux et la récompense alimentaire. Nos résultats démontrent qu’une injection centrale aiguë d'agoniste GPR120 III réduit la prise alimentaire ad libitum et la motivation alimentaire pour un aliment riche en gras et en sucre; ainsi que les comportements de type anxieux. L’injection centrale chronique (21 jours) de ce même agoniste GPR120 III transmis par une pompe osmotique a démontré que les souris placées sous diète hypercalorique (HFD n’ont présenté aucune modification lors de la prise alimentaire ni de gain de poids mais qu’il y avait comparativement au groupe de véhicule, une réduction du comportement de type anxieux, que ce soit dans le labyrinthe en croix surélevé (LCS) ou dans le test à champ ouvert (OFT). L’ADH est reconnu pour ses propriétés anorexigènes au niveau central. De plus, la stimulation des récepteurs de GPR120 au niveau du cerveau avec un agoniste synthétique peut produire un effet intense intervenir sur le comportement lié à l'alimentation des rongeurs. Trouver une approche visant à contrôler à la fois la neuroinflammation, la récompense alimentaire et les troubles émotionnels aiderait assurément au traitement de l'obésité et du diabète de type 2.

Behavioural studies on the ethanol leaf extract of Grewia carpinifolia in Wistar rats.

Background: Grewia carpinifolia is a plant commonly used in the tropics to manage various central nervous system (CNS) disorders. However, despite its widespread use no scientific work has been reported to validate these claims. Objectives: To evaluate the activity of G. carpinifolia as it affects behaviour using animal model. Methods: Twenty five adult Wistar rats were randomly divided into five groups (A-E). Group A served as control (given only distilled water), Groups B,C, D and E were administered with single oral dose of ethanol extract of G. carpinifolia leaf at 100, 200, 400 and 800 mg/kg body weight respectively for twenty eight days consecutively. Subsequently, open field test, negative geotaxis and hanging wire test were performed. Body and brain weights were measured and histological examination of the brain was also performed. Results: At the tested doses, the extract significantly increased the time spent on the hanging wire and decreased locomotor activity at 800 mg/kg. No significant difference was observed in body and brain weights of extract treated groups when compared with the control. No visible histological lesion was also observed. Conclusion: The plant extract may improve muscular strength at tested doses and possess CNS depressant activity at 800 mg/ kg.

Granulocyte-colony stimulating factor in experimental stroke and its effects on infarct size and functional outcome: a systematic review

Background Granulocyte-colony stimulating factor (G-CSF) shows promise as a treatment for stroke. This systematic review assesses G-CSF in experimental ischaemic stroke. Methods Relevant studies were identified with searches of Medline, Embase and PubMed. Data were extracted on stroke lesion size, neurological outcome and quality, and analysed using Cochrane Review Manager using random effects models; results are expressed as standardised mean difference (SMD) and odds ratio (OR). Results Data were included from 19 publications incorporating 666 animals. G-CSF reduced lesion size significantly in transient (SMD -1.63, p<0.00001) but not permanent (SMD -1.56, p=0.11) focal models of ischaemia. Lesion size was reduced at all doses and with treatment commenced within 4 hours of transient ischaemia. Neurological deficit (SMD -1.37, p=0.0004) and limb placement (SMD -1.88, p=0.003) improved with G-CSF; however, locomotor activity (>4 weeks post ischaemia) was not (SMD 0.76, p=0.35). Death (OR 0.27, p<0.0001) was reduced with G-CSF. Median study quality was 4 (range 0-7/8); Egger’s test suggested significant publication bias (p=0.001). Conclusions G-CSF significantly reduced lesion size in transient but not permanent models of ischaemic stroke. Motor impairment and death were also reduced. Further studies assessing dose-response, administration time, length of ischaemia and long-term functional recovery are needed.

A marketing plan for Lightning Bolt

This project had as main goal to improve the perception of male surfers about the surf brand Lightning Bolt. It was proposed the creation of a collection of wetsuits as well as the “A Pure Source” Project to show the commitment of the brand with the surf community. To promote both several promotional activities are suggested such as the use of magazines, radio, banners and social media. To complement the distribution chain of the brand, a concept store and a mobile store are also recommended. With this project the brand will be able to double the number of current surfers that buy the brand in a profitable and effective way. The project is expected to generate a net profit of 91,294€ in year 1.

Informe de práctica rotatoria: manejo clínico de la enfermedad articular degenerativa en felinos

Tesis (Médico Veterinario). -- Universidad de La Salle. Facultad de Ciencias Agropecuarias. Programa de Medicina Veterinaria, 2014

Capacidad resolutiva del primer nivel de atención: experiencia de la Unidad Docente-Asistencial de Medicina Familiar y Comunitaria de Paysandú (2014)

Introducción: la resolutividad del primer nivel de atención (PNA) es una cualidad fundamental de los sistemas de salud porque repercute en el funcionamiento de los otros niveles y en los servicios de urgencia. En nuestro país se ha insistido sobre la necesidad de contar con un PNA resolutivo, sustentado en la sobrecarga asistencial que soportan los servicios del segundo nivel de atención (SNA) y las puertas de emergencia de los hospitales o sanatorios, atribuida, entre otros aspectos, a la baja resolutividad del PNA. Objetivos: evaluar las consultas que requirieron traslado a los servicios de emergencia de la Administración de los Servicios de Salud del Estado (ASSE) o de la Corporación Médica de Paysandú (COMEPA), y las referencias realizadas a especialistas del SNA por la Unidad Docente - Asistencial (UDA) N°74 de Paysandú durante 2014. Método: estudio observacional, descriptivo y de corte realizado en cinco servicios del PNA de Paysandú, usando instrumentos de registro específicos. Resultados: de un total de 8.265 consultas realizadas,75 requirieron traslado al servicio de emergencia (0,9%), predominando en adultos jóvenes, en meses de junio y setiembre, debido principalmente a patologías respiratorias, y requiriendo ambulancia en el 49% de los casos. El 5% (n=415) del total de consultas realizadas fueron derivadas al SNA, predominando en adultos mayores de 45 años, y debido a patologías de ojos y anexos, aparato circulatorio y locomotor. Conclusiones: la resolutividad de la UDA de Medicina Familiar y Comunitaria de Paysandú es alta; se valora especialmente las competencias de dicha disciplina en ese sentido, y es posible mejorarla dotando de mayores recursos materiales al PNA (por ejemplo, oftalmoscopio).

Development of motor competence in childhood and adolescence

This dissertation aimed to investigate the development of motor competence in childhood and adolescence. As a starting point, a systematic review was conducted to investigate the instruments used for the evaluation of motor competence. This review identified a gap in the literature regarding the existence of an instrument to assess motor competence based on the three theoretical constructs (stability, locomotor, manipulative). In an attempt to fill this gap, a valid quantitative instrument was proposed. To meet this purpose, 584 children, between 6 and 14 years of age, were evaluated in nine motor tasks, three for each construct. The final instrument comprised two motor tasks for each construct (stability, locomotor, manipulative) and presented very good fit indexes. This instrument was used to analyse the motor competence behaviour by gender in different age groups, indicating that generally boys outperformed girls and both genders increased their performance across age groups. However, different motor competence growth rates appear in both genders across age groups. In addition, children with high and low motor competence were compared regarding some of their health related fitness variables. We found that, regardless of age and gender, the group with better motor proficiency always showed better results in health related fitness. We found positive moderate to high correlations between motor competence and the variables of cardiovascular fitness and muscular fitness, and an inverse correlation with body composition across the four age groups. We also found that motor competence explained 75% of the variance of the health related fitness for the total sample, with locomotion as the primary predictor. However, when analysing the four age groups, stability skills seem to play an important role in health related fitness in the transition from childhood to adolescence. In conclusion, educational and health policies should consider the development of motor competence as an essential strategy to promote healthy development throughout life.

Characterization of the behavioural phenotype of calpain-knockout mice

Dissertação de Mestrado, Ciências Biomédicas, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 2016

Galanin N-Terminal fragment (1-15) enhances the antidepressant effects of the 5-HT1A receptor agonist 8-OH-DPAT in the Forced Swimming Test.

Galanin and Galanin (1-15) [GAL(1-15)] are implicated in anxiety- and depression related behaviors. Moreover, Galanin modulates 5-HT1A receptor (5-HT1AR) function at autorreceptor and postsynaptic level in the brain. In this study, we have analysed the ability of GAL(1-15) to modulate the effects of the 8-OH-DPAT agonist in the Forced Swimming Test (FST). Groups of rats were assessed in the FST. In the first set of experiments, to evaluate the interactions of 8-OH-DPAT and GAL(1-15), rats received subcutaneously (s.c) the effective doses of 8-OH-DPAT (0.25mg/Kg) 60min before the test and intracerebroventricularly (icv) GAL(1-15)1nmol 15min before the tests alone or in combination. In the second set of experiments, groups of rats received s.c. 8-OH-DPAT (0.125mg/Kg), icv GAL(1-15) 1nmol and icv the GALR2 antagonist M871 3 nmol alone or in combination. The locomotor activity was analysed in the open field test. GAL(1-15) 1nmol enhanced the antidepressant-like effects mediated by the effective dose of the 8-OH-DPAT. GAL(1-15) significantly decreased the immobility (p<0.05) and climbing (p<0.05) and increased the swimming (p<0.01) behaviour induced by an effective dose of 8-OH-DPAT (0.25mg/Kg) in FST. Moreover, after coadministration of GAL(1-15) and threshold dose of 8-OH-DPAT (0.125mg/Kg) a significant decreased appeared in immobility (p<0.01) and climbing (p<0.01) and increased the swimming behavior (p<0.001) vs 8-OH-DPAT group. Moreover, M871 blocked completely this interaction. These results indicate that GAL(1-15) enhances the antidepressant effects induced by 8-OH-DPAT in the FST. These findings may give the basis for the development of novel therapeutic drugs. This study was supported by Junta de Andalucía CVI6476.

The Outcome of Infantile Onset Pompe Disease in South of Iran

Background: Infantile Onset Pompe Disease (IOPD) is a rare autosomal recessive neuromuscular disorder. It is associated with cardiomegaly, hypotonia, paresis, and death in the first year of life. Since 2006, following the use of Alglucosidase alfa as Enzyme Replacement Therapy (ERT), the patients’ survival is improved to a noticeable extent. Objectives: The purpose of this study is to examine the outcome of IOPD patients in South of Iran and the degree of responsiveness to ERT. Patients and Methods: All patients who were diagnosed with IOPD on the bases of clinical symptoms, and enzyme assay on dried blood spot, were included in the study; and were followed up regarding cardiac function, locomotor activity, and cognition. Results: Six patients with IOPD were identified. All these six patients suffered from Hypertrophic Cardiomyopathy (HCM). Four (67%) of them also had generalized hypotonia. Three patients expired during the first weeks due to severe respiratory infection. One of them also got involved with Acute Cardiopulmonary Failure while receiving the fifth dose of ERT; and expired. However, the remaining two patients had a significant improvement after the maximum of 117 weeks of following up both cardiac and locomotor findings. These two patients were the same patients who showed cardiac symptoms from the beginning but did not have generalized hypotonia. Conclusions: Although ERT has a significant effect on enhancing the survival of IOPD patients, it should be associated with meticulous heart-respiratory cares during the first months of treatment and preventing infection especially nosocomial infections.

Cuminum cyminum Linn (Apiaceae) extract attenuates MPTP-induced oxidative stress and behavioral impairments in mouse model of Parkinson’s disease

Purpose: To evaluate the protective effects of Cuminum cyminum Linn (Apiaceae, CCY) against 1- methyl-4 phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP)-induced oxidative stress and behavioral impairments in mouse model of Parkinson’s disease (PD). Methods: MPTP-intoxicated mice model of PD was used for evaluating the effect of CCY extract on behavioral deficits through rota rod, passive avoidance and open field tasks. The effect of CCY extract on oxidative stress levels were assessed by estimating enzyme status, including superoxide dismutase (SOD), catalase (CAT) and lipid peroxidation(LPO) in brain tissues of MPTP-induced mice. Results: MPTP (25 mg/kg, i.p.)-treated mice resulted in a significant (p < 0.001) behavioral deficit in locomotor behavior (from 56.24 ± 1.21 to 27.64 ± 0.94) and cognitive functions (from 298 ± 3.68 s to 207.28 ± 4.12 s) compared with their respective control groups. Administration of CCY extract (100, 200 and 300 mg/kg, p.o.) for three weeks significantly and dose-dependently improved (p < 0.001 at 300 mg/kg) locomotor and cognitive deficits in MPTP-treated mice. CCY treatment also significantly (p < 0.001 at 300 mg/kg) inhibited MPTP-induced decrease in antioxidant enzyme levels (superoxide dismutase and catalase) and lipid peroxides in mice brain tissues. Conclusion: CCY extract exhibits strong protection against MPTP-induced behavioral deficit through enhancement of antioxidant defense mechanisms. Therefore, CCY may be developed as a therapeutic strategy in the treatment of neurodegeneration seen in PD.

Dose-dependent protection of reseveratrol against spinal cord ischemic-reperfusion injury in rats

Purpose: To examine the protective effects of resveratrol (RESV) against spinal cord ischemic reperfusion (SCIR) injury. Methods: Forty-eight male rats were divided into six groups: sham-operated (control-I), SCIR-treated (SCIR-II), rats receiving 20 mg/kg of RESV with SCIR (RESV 20+SCIR-III), rats receiving 40 mg/kg of RESV with SCIR (RESV 40+SCIR-IV), rats receiving 60 mg/kg of RESV with SCIR (RESV 60+SCIR-V), and rats receiving 50 mg/kg of methylprednisolone (MP) with SCIR (MP + SCIR-VI), for 7 days prior to IR (pre-treatment) and 7 days after IR (post-treatment). Results: The levels of oxidative markers (TBARS, MPO) and inflammatory markers (IL-1β, IL-6, TNF-α, and NF-p65) were concomitantly suppressed in RESV-treated rats, which showed improved locomotor function. A pronounced increase in the activities of antioxidant enzymes (SOD, CAT and GSH) was noted in the RESV group compared with the MP and SCIR groups. RESV and MP supplementation increased neuronal count with decreased nuclear degeneration. RESV (40 mg) exhibited greater protective effect than 20 mg and 60 mg of RESV and 50 mg of MP. Conclusion: The results show the neurotherapeutic potential of RESV (40 mg) to attenuate oxidative stress and the inflammatory response to SCIR injury.

Anticonvulsant and sedative effect of Fufang Changniu pills and probable mechanism of action in mice

Purpose: To investigate the anticonvulsant and sedative effects of Fufang Changniu Pills (FCP) and its probable mechanism of action in mice. Methods: The water decoction of FCP was prepared and the main constituents were determined by high performance liquid chromatography (HPLC). The anticonvulsant activities of FCP were evaluated by maximal electroshock (MES) and pentylenetetrazole (PTZ)-induced seizures in mice. Pentobarbital sodium-induced sleeping time and locomotor activity measurements were performed to evaluate the sedative effects of FCP in mice. Finally, PTZ-induced chronic seizures were established, and expressions of gamma-aminobutyric acid A receptor (GABA-A) and glutamic acid decarboxylase 65 (GAD65) in the brains of the mice were assayed by western blot in order to explore the probable mechanisms of action of the drug. Results: Gallic acid, liquiritin, cinnamyl alcohol, cinnamic acid and glycyrrhizic acid were detected in FCP decoction. FCP (50, 100 and 200 mg/kg) showed significant anticonvulsant and sedative effects on epileptic mice induced by MES (p < 0.05) and PTZ (p < 0.05). Moreover, pentobarbital sodium-induced sleeping time and locomotor activity tests showed that FCP possesses sedative effect (p < 0.05). Western blot data indicate that FCP significantly up-regulated GABA-A and GAD 65 in the brains of chronic epileptic rats (p < 0.05). Conclusion: FCP has significant anticonvulsant and sedative effects, and the mechanism of its action may be related to the up-regulation of GABA-A and GAD 65 in mice brain.

Kinematics and Local Motion Planning for Quasi-static Whole-body Mobile Manipulation

This thesis studies mobile robotic manipulators, where one or more robot manipulator arms are integrated with a mobile robotic base. The base could be a wheeled or tracked vehicle, or it might be a multi-limbed locomotor. As robots are increasingly deployed in complex and unstructured environments, the need for mobile manipulation increases. Mobile robotic assistants have the potential to revolutionize human lives in a large variety of settings including home, industrial and outdoor environments.

Mobile Manipulation is the use or study of such mobile robots as they interact with physical objects in their environment. As compared to fixed base manipulators, mobile manipulators can take advantage of the base mechanism’s added degrees of freedom in the task planning and execution process. But their use also poses new problems in the analysis and control of base system stability, and the planning of coordinated base and arm motions. For mobile manipulators to be successfully and efficiently used, a thorough understanding of their kinematics, stability, and capabilities is required. Moreover, because mobile manipulators typically possess a large number of actuators, new and efficient methods to coordinate their large numbers of degrees of freedom are needed to make them practically deployable. This thesis develops new kinematic and stability analyses of mobile manipulation, and new algorithms to efficiently plan their motions.

I first develop detailed and novel descriptions of the kinematics governing the operation of multi- limbed legged robots working in the presence of gravity, and whose limbs may also be simultaneously used for manipulation. The fundamental stance constraint that arises from simple assumptions about friction and the ground contact and feasible motions is derived. Thereafter, a local relationship between joint motions and motions of the robot abdomen and reaching limbs is developed. Baseeon these relationships, one can define and analyze local kinematic qualities including limberness, wrench resistance and local dexterity. While previous researchers have noted the similarity between multi- fingered grasping and quasi-static manipulation, this thesis makes explicit connections between these two problems.

The kinematic expressions form the basis for a local motion planning problem that that determines the joint motions to achieve several simultaneous objectives while maintaining stance stability in the presence of gravity. This problem is translated into a convex quadratic program entitled the balanced priority solution, whose existence and uniqueness properties are developed. This problem is related in spirit to the classical redundancy resoxlution and task-priority approaches. With some simple modifications, this local planning and optimization problem can be extended to handle a large variety of goals and constraints that arise in mobile-manipulation. This local planning problem applies readily to other mobile bases including wheeled and articulated bases. This thesis describes the use of the local planning techniques to generate global plans, as well as for use within a feedback loop. The work in this thesis is motivated in part by many practical tasks involving the Surrogate and RoboSimian robots at NASA/JPL, and a large number of examples involving the two robots, both real and simulated, are provided.

Finally, this thesis provides an analysis of simultaneous force and motion control for multi- limbed legged robots. Starting with a classical linear stiffness relationship, an analysis of this problem for multiple point contacts is described. The local velocity planning problem is extended to include generation of forces, as well as to maintain stability using force-feedback. This thesis also provides a concise, novel definition of static stability, and proves some conditions under which it is satisfied.