Decreased respiratory performance of children and adolescents with myelomeningocele who use a wheelchair - preliminary data.

Myelomeningocele (MMC) is a neural tube defect that often causes spinal cord injury at the thoracolumbar region, as well as sensory and motor paralysis in the lower limbs. This leads to continuous use of a wheelchair and, consequently, a sedentary lifestyle, predisposition to muscle weakness, cardiovascular and respiratory disorders, obesity, and structural alterations in the spine. We assessed the respiratory function and shoulder strength of MMC participants who were wheelchair-users and had no respiratory complaints and compared them to healthy children and adolescents. MMC (n=10) and healthy (n=25) participants of both genders with a mean age of 12.45 years (SD=2.1) were assessed for weight, height, respiratory performance, and isometric peak for shoulder flexors, extensors, abductors, and adductors, using an isokinetic dynamometer. Medullary lesion, functional levels, and abnormal curvatures of the spine were assessed for MMC participants. The level of spinal cord injury for the majority of the MMC participants was high lumbar and they had scoliosis. MMC showed lower values for forced vital capacity, forced expiratory volume at the first second, forced expiratory flow (25-75%), maximal voluntary ventilation, and isometric peak for shoulder flexors and adductors compared to healthy participants. This indicated a decreased vital capacity, respiratory muscle endurance, and shoulder muscle strength.

Decreased respiratory performance of children and adolescents with myelomeningocele who use a wheelchair - preliminary data

Myelomeningocele (MMC) is a neural tube defect that often causes spinal cord injury at the thoracolumbar region, as well as sensory and motor paralysis in the lower limbs. This leads to continuous use of a wheelchair and, consequently, a sedentary lifestyle, predisposition to muscle weakness, cardiovascular and respiratory disorders, obesity, and structural alterations in the spine. We assessed the respiratory function and shoulder strength of MMC participants who were wheelchair-users and had no respiratory complaints and compared them to healthy children and adolescents. MMC (n=10) and healthy (n=25) participants of both genders with a mean age of 12.45 years (SD=2.1) were assessed for weight, height, respiratory performance, and isometric peak for shoulder flexors, extensors, abductors, and adductors, using an isokinetic dynamometer. Medullary lesion, functional levels, and abnormal curvatures of the spine were assessed for MMC participants. The level of spinal cord injury for the majority of the MMC participants was high lumbar and they had scoliosis. MMC showed lower values for forced vital capacity, forced expiratory volume at the first second, forced expiratory flow (25-75%), maximal voluntary ventilation, and isometric peak for shoulder flexors and adductors compared to healthy participants. This indicated a decreased vital capacity, respiratory muscle endurance, and shoulder muscle strength.

[Transport of mucoid mucus in healthy individuals and patients with chronic obstructive pulmonary disease and bronchiectasis]. / Transporte de secreções mucóides de indivíduos saudáveis e pacientes com doença pulmonar obstrutiva crónica e bronquiectasias.

OBJECTIVE: To characterise and compare the in vitro transport properties of respiratory mucoid secretion in individuals with no lung disease and in stable patients with chronic obstructive pulmonary disease (COPD) and bronchiectasis. METHODOLOGY: Samples of mucus were collected, from 21 volunteers presenting no lung disease who had undergone surgery, from 10 patients presenting chronic COPD, and from 16 patients with bronchiectasis. Mucociliary transport (MCT), transport by cough (SCM), and contact angle (CAM) were evaluated. RESULTS: MCT was found to be greater in healthy individuals (1.0±0.19) than in COPD (0.91±0.17) and bronchiectasis (0.76±0.23) patients (p<0.05), whereas SCM was greater in COPD patients (16.31±7.35 cm) than in patients with bronchiectasis (12.16±6.64 cm) and healthy individuals (10.50±25.8 cm) (p<0.05). No significant differences were observed between the groups regarding CAM. CONCLUSION: Mucus from healthy individuals allows better mucociliary transport compared to that from patients with lung diseases. However, the mucus from COPD patients allows a better transport by coughing, demonstrating that these individuals have adapted to a defence mechanism compared to patients with bronchiectasis, who have impairment in their ciliary and cough transport mechanisms.

Benefícios da cinesioterapia respiratória no pós-operatório de colecistectomia laparoscópica / Benefits of postoperative respiratory kinesiotherapy following laparoscopic cholecystectomy

INTRODUÇÃO: Alterações da função pulmonar após cirurgia abdominal levam à redução do volume pulmonar, prejudicando as trocas gasosas. OBJETIVO: Avaliar os efeitos da cinesioterapia respiratória sobre a função pulmonar e a força muscular respiratória em pacientes submetidos à colecistectomia laparoscópica. MATERIAIS E MÉTODOS: Em estudo prospectivo, 20 mulheres e 16 homens (idade: 48,4 ± 9,55 anos), submetidos à colecistectomia laparoscópica, foram divididos aleatoriamente: 17 realizaram exercícios respiratórios (respiração diafragmática, sustentação máxima da inspiração e inspiração fracionada) e 19 participaram como Grupo Controle. Todos realizaram avaliação das pressões respiratórias máximas (PImax e PEmax), pico de fluxo expiratório (PFE) e espirometria, medindo capacidade vital (CV), capacidade vital forçada (CVF), volume expiratório no primeiro segundo (VEF1), relação VEF1/CVF no pré-operatório e diariamente até o sexto pós-operatório (PO). RESULTADOS: Os valores de pré-operatório não foram estatisticamente diferentes entre os dois grupos. Ambos os grupos apresentaram diminuição de todas as variáveis no 1º PO (p< 0,05). O Grupo Exercício permaneceu com diminuição até o 2º PO para CV, CVF e VEF1 (p< 0,05), 3º PO para PImax e PFE (p< 0,05) e 4º PO para PEmax (p< 0,05), enquanto que, no Grupo Controle, os valores de todas as variáveis retornaram a partir do 5º PO. Os valores de PImax e PEmax foram maiores no Grupo Exercício que no Grupo Controle desde o 3º e 2º PO (p< 0,05), respectivamente. CONCLUSÕES: A cinesioterapia respiratória contribuiu para a recuperação precoce da função pulmonar e da força muscular dos pacientes submetidos à colecistectomia laparoscópica.

INTRODUCTION: Pulmonary function changes following abdominal surgery lead to reduced pulmonary volume, thus compromising gas exchanges. OBJECTIVE: To evaluate the effects of respiratory kinesiotherapy on pulmonary function and respiratory muscle strength in patients who underwent laparoscopic cholecystectomy. METHODS: Twenty women and 16 men (age 48.4 ± 9.55 years) who underwent laparoscopic cholecystectomy were prospectively studied. They were randomly divided as follows: 17 subjects performed breathing exercises (diaphragmatic respiration, maximum sustained inspiration and fractional inspiration) and 19 participated as a Control Group. All of them underwent evaluations of maximal inspiratory and expiratory pressures (MIP and MEP), peak expiratory flow (PEF) and spirometry, with measurements of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and the FEV1/FVC ratio before the operation and daily until the sixth postoperative day (POD). RESULTS: The preoperative parameters were not statistically different between the two groups. Both groups presented decreases in all variables on the first POD (p< 0.05). The Exercise Group continued to present decreased values until the second POD for VC, FVC, and FEV1 (p< 0.05), until the third POD for MIP and PEF (p< 0.05) and the fourth POD for MEP (p< 0.05). For the Control Group, the values of all the variables began to normalize on the fifth POD. The MIP and MEP values in the Exercise Group were higher than those in the controls, from the third and second POD onwards, respectively. CONCLUSIONS: Respiratory kinesiotherapy contributed towards early recovery of pulmonary function and muscle strength among patients who had undergone laparoscopic cholecystectomy.

Avaliação da aptidão cardiorrespiratória de crianças com displasia broncopulmonar / Cardiorespiratory capacity assessment on children with bronchopulmonary dysplasia

OBJETIVO: Avaliar a aptidão cardiorrespiratória e verificar a presença de broncoespasmo induzido pelo exercício (BIE) em crianças com displasia broncopulmonar (DBP). MÉTODO: Foram realizadas prova de função pulmonar e análise de gases em um teste cardiopulmonar, em 46 crianças com idade entre 7 a 10 anos, formando três grupos: crianças nascidas pré-termo com DBP, (DBP, n= 13); crianças nascidas pré-termo sem DBP, (RNPT, n= 13); e crianças saudáveis nascidas a termo, (Controle, n= 20). RESULTADOS: A duração dos testes foi 7,70 ± 1,49; 9,1 ± 2,02 e 8,4 ± 2,12 min; o VO2máximo foi 35,98 ± 5,33; 38,99 ± 6,73 e 34,91 ± 6,09 ml/kg/min; e a VE foi 28,54 ± 7,39; 28,84 ± 5,98 e 28,96 ± 6,96 l/min para os grupos DBP, RNPT e Controle, respectivamente. Não foram encontradas diferenças significantes entre os grupos (p> 0,05). A FCmáxima foi 188 ± 9,37; 196 ± 5,15 e 197 ± 10,90 bpm; a taxa de troca gasosa máxima (R) foi 1,21 ± 0,22; 1,10 ± 0,06 e 1,05 ± 0,05 para os grupos DBP, RNPT e Controle, respectivamente, sendo esses valores diferentes entre o grupo Controle e DBP (p< 0,05). Os valores do VEF1 pré e VEF1 pós-exercício foram de 99 ± 12 por cento e 94 ± 14 por cento; 100 ± 14 por cento e 100 ± 15 por cento; e 102 ± 15 por cento e 101 ± 15 por cento, para os grupos DBP, RNPT e Controle, respectivamente. Na comparação do VEF1 pré e pós-exercício não houve diferenças significantes e nem caracterização de BIE nos grupos. CONCLUSÃO: A diferença encontrada no R pode ser relacionada a alterações ventilatórias e à difusão pulmonar. A aptidão cardiorrespiratória das crianças com DBP é semelhante à dos grupos RNPT e Controle.

OBJECTIVE: To assess cardiorespiratory capacity and investigate the presence of exercise-induced bronchospasm among children with bronchopulmonary dysplasia. METHOD: Pulmonary function tests and gas analyses were performed in a cardiopulmonary test on 46 children aged 7-10 years. Three groups were formed: children born prematurely with bronchopulmonary dysplasia (BPD; n= 13), children born prematurely without bronchopulmonary dysplasia (Preterm; n= 13) and healthy children born at full term (Control; n= 20). RESULTS: The test duration was 7.70 ± 1.49; 9.1 ± 2.02 and 8.4 ± 2.12 min; VO2max was 35.98 ± 5.33; 38.99 ± 6.73 and 34.91 ± 6.09 ml/kg/min; and VE was 28.54 ± 7.39; 28.84 ± 5.98 and 28.96 ± 6.96 l/min for the BPD, Preterm and Control groups respectively. There were no significant differences between the groups (p> 0.05). The maximum heart rate was 188 ± 9.37; 196 ± 5.15 and 197 ± 10.90 beats/min and the respiratory exchange ratio (RER) was 1.21 ± 0.22; 1.10 ± 0.06 and 1.05 ± 0.05, for the BPD, Preterm and Control groups respectively, and there was a significant difference between the BPD and Control groups (p< 0.05). The FEV1 values before and after exercise were 99 ± 12 percent and 94 ± 14 percent; 100 ± 14 percent and 100 ± 15 percent; and 102 ± 15 percent and 101 ± 15 percent, for the BPD, Preterm and Control groups respectively. Comparison of FEV1 before and after exercise did not show any significant differences and exercise-induced bronchospasm was not characterized, in any of the groups. CONCLUSION: The difference in RER may be related to abnormal ventilation and pulmonary diffusion. The cardiorespiratory capacity of children with BPD was similar to that of the Preterm and Control groups.

Avaliação das equações de referência para predição da distancia percorrida no teste de caminhada de seis minutos em idosos saudaveis brasileiros / Evaluation of the reference equations for predicting walking distances during six-minute walk tests among healthy elderly brazilian subjects

O objetivo deste estudo foi compara as distancias percorridas por idosos no teste de caminhada de seis minutos (TC6) com as distencias previstas pelas equacoesde Enrigh & Sherril, de Troosters et al. e de Enrigh et al. Metodo: 38 idosos saudaveis com idade entre 64 e 82 anos realizaram o TC6 duas vezes. A pressao arterial, as frequencias cardiaca e respiratoria e a saturacao de oxigenio foram mrnsuradas antes e ao final do teste. A analise estatistica empregou o coeficiente de correlacao de Pearson, sendo considerado significativo p<0,05. Resultados: os homens percorreram uma distancia de 410,5 metro e as mulheres, de 371,0 metros. As distancias previstas pelas equacoes de Enrigh & Sherril e Troosters et al. correlacionaram-se com as distancias caminhadas pelas mulheres (r=0,7), nao apresentando correlacao estatisticamente significativa com as distancias percorridas pelos homens. As distancias previstas pela equacao de Enrigh et al. correlacionaram-se com as distancias percorridas por homens (r=0,6) e mulheres (r=0,7). Conclusoes: os resultados demonstram que houve grande variacao entre as distancias percorridas por idosos brasileiros e as previstas pelas equacoes, sendo necessaria a realizacao de estudos adicionais para confirmar a aplicabilidade dessas equacoes para a populacao idosa brasileira

Mechanical evaluation of a respiratory device.

This article aims to characterize the mechanical behaviour of the Flutter VRP1, a respiratory physiotherapy device designed to aid sputum clearance of the airways of patients. The device resembles a smoking pipe with a conical cavity containing a stainless steel sphere which floats up and down while the patient comes with a forced expiration through it. The sphere's oscillatory movement is function of the air flow rate and angular orientation of the device. When the sphere's oscillatory frequency matches the natural frequency of the patient's chestwall+abdomen system, it will produce resonance which, in turn, will enhance sputum clearance. A dynamical model of the Flutter was formulated and an experimental setup was assembled in order to study the oscillatory frequency of the sphere under different conditions of air flow rate, fluid pressure, angular orientation and sphere's material and weight. Interesting results presented by this article point to eventual mechanical optimization of the device and show information that could be beneficial to the professional of the respiratory physiotherapy.

Influencia do peso corporal sobre as pressoes respiratorias maximas nas posicoes sentada, deitada e em pe / Body weight influence on respiratory pressures on sitting, supine and upright positions

Estudos anteriores demonstraram que a obesidade oferece sobrecarga mecanica ao sistema respiratorio e que, diante disso, algumas pessoas aumentam a atividade dos musculos inspiratorios. Entretanto, poucos estudos relacionaram o peso corporal com as pressoes respiratorias. Este estudo analisou a influencia do peso corporal na forca dos musculos respiratorios correlacionando indice de massa corporea (IMC) porcentual de gordura em relaao cintura/quadril (RC/Q) com as medidas de pressoes respiratorias (PI e PE )em tres diferentes posicoes corporais. Quarenta e seis universitarios sedentarios, idade entre 20 e 40 anos, foram distribuidos em cinco grupos, baseados mo IMC. Foram mensuradas pregas cutaneas e RC/Q as medidas de PI e PE foram realizadas nas posicoes sentada, deitada e em pe. Os valores obtidos de PI e PE nao foram diferentes daqueles previstos por Black & Hyatt. Na posicao deitada, os valores de PI foram menores que nas posicoes sentadas e em pe, enquanto os valores de PE foram menores na posicao sentada que em pe (p< 0,05). Nao foram observadas correlacoes entre os valores de PImax e PEmax e o IMC em nenhuma das posicoes. Foram encontradas, nas mulheres, correlacoes positivas entre medidas de PImax e pregas subescapular na posicao sentada (r=0,40) e coxa nas posicoes deitada e em pe (r=0,44 e 0,51, respectivamente). Nao foram encontradas correlacao entre os valores de PEmax e as pregas cutaneas e entre os valores de PImax e PEmax e a RC/Q. Conclui-se que a forca musular respiratoria, avaliada por PImax e PEmax de obesos, encontra-se dentro da normalidade. Novos estudos sao necessarios, ampliando a populacao estudada e os metodos de avaliacao

Teste de caminhada de seis minutos em adultos eutroficos e obesos / The six minute walk test in normal and obese adults

O teste de caminhada frequentemente e utilizado para demonstrar os efeitos das doencas cardiovasculares e respiratorias sobre a capacidade fisica, como tambem para tederminar os efeitos de tratamentos aplicados. Participaram do estudo 46 pessoas, divididas em 5 grupos por faixa de IMC. O grupo 1 foi constituido por 18 pesoas com IMC de 20 a 24,9 Kg/m o grupo 2, por 12 pessoas com IMC de 25 a 29,9 Kg/m, o grupo 3, por 6 pessoas com IMC de 30 a 34,9 Kg/m o grupo 4, por 1 pessoas com IMC de 35 a 39,9 Kg/m e o grupo 5, por 9 pessoas com IMC > 40 kg/m. Os voluntarios realizaram um total de quatro testes de caminhada, de forma padronizada com acompanhamento do avaliador durante a caminhada. Os resultados mostraram que no 4§ teste a distancia percorrida foi maior que no 1§ teste (p< 0,01) no intervalo de tempo de 0 a 2 minutos, a distancia caminhada foi maior que nos demais intervalos de tempo (p< 0,01) com o auento do peso corporal houve diminuicao da distancia caminhada (p < 0,01), em media, distancia caminhada de 760m +50,6m (grupo 1), 731 m +71,9m (grupo 2), 680 m +56,7 m (grupo 3), 663 m (grupo 4) e 596 m + 61,8 m (grupo 5). O porcentual de gordura foi a medida antropometrica que melhor se correlacionou com distancia caminhada (r= -0,85 e p < 0,05), seguindo pelo de massa corporal (r = -0, 65) e pela relacao cintura/quadril (r= -0,56),somente para o sexo masculino. Concluiu-se que o aumento do peso corporal interfere na capacida fisica, diminuindo a distancia caminhada. no intervalo de tempo de 0 a 2 minutos, ocorre o melhor desempenho fisico. o efeito aprendizado influencia a distancia percorrida. e o porcentual de gordura e a medida antropometrica que melhor se correlaciona com distancia percorrida

The influence of temperature and length of time of storage of frog mucus samples.

Frozen, stored mucus has been extensively used for transport studies but there is no clear evidence of the influence that the temperature and length of time of storage may have on the results. We stored frog mucus samples at -20 and -80 degrees C and analysed them on days zero, 2, 10, 30 and 90. At each temperature, a sample was thawed, studied and refrozen on each of the study days, at the same time that one sample was thawed only on the study day. Displacement in a simulated cough machine and on the frog palate, as well as contact angle measurements, were determined for the mucus samples on each study day. Mucus cytologic analyses on each of the study days were done with special regard to neutrophil counts and cell integrity. Friedman analysis of variance did not show any difference between the different periods of storage and the two temperatures for any of the parameters studied. The medians for the relative transport velocity on the frog palate varied between 0.88 and 1.03, for the contact angle between 21 and 28 degrees, and for the displacement in the simulated cough machine between 58 and 95 mm over the 90 days of the experiment. There were no cytologic alterations compatible with cell degeneration. We conclude that the storage of frog mucus either at -20 or -80 degrees C for periods up to 90 days does not lead to any significant differences in mucus transportability.