RESUMO
AIM: To evaluate bone metabolism in newborn preterm infants before and after a physical therapy protocol. METHOD: This randomized controlled clinical trial included 30 newborn preterm infants with gestational age ≤ 35 weeks and appropriate weight for gestational age, who were randomized into control group (CG) and physiotherapy group (PG). The PG protocol consisted of 15 minutes of daily passive movements with gentle joint compression 5 days a week. Daily data were obtained on feeding and body weight. Measurements of bone-specific alkaline phosphatase (BAP) and urinary deoxypyridinoline (DPD) were collected before and after intervention in both groups. The analysis of covariance test was performed to compare the means of both groups. RESULTS: At baseline, gestational age and corrected gestational age, birth weight, and gender were similar between both groups. Nutrient supply, length of total parenteral nutrition, and mechanical ventilation were also similar. BAP level increase in PG was 22.44 ± 3.49 U/L, whereas in CG was 2.87 ± 3.99 U/L (p = 0.003). There was a reduction of DPD levels in PG of 28.21 ± 11.05 nmol/mmol, and an increase of 49.95 ± 11.05 nmol/mmol (p < 0.001) in GC. CONCLUSION: The benefits of prevention and treatment of metabolic bone disease of prematurity, in addition to an adequate diet, should include these passive exercises with gentle joint compressions to improve the quality of premature infant's bones.
Assuntos
Reabsorção Óssea/prevenção & controle , Técnicas de Exercício e de Movimento , Osteogênese , Fosfatase Alcalina/sangue , Aminoácidos/urina , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Osteogênese/fisiologia , Estações do Ano , Deficiência de Vitamina D/epidemiologiaRESUMO
OBJECTIVES: To evaluate the effects of aquatic physical therapy on pain and on the cycle of sleep and wakefulness among stable hospitalized premature infants. METHODS: This study was characterized as an uncontrolled clinical trial on a time series and included 12 clinically stable newborns of gestational age less than 36 weeks who were hospitalized in a neonatal intensive care unit (NICU). After selection, the newborns were placed in a liquid medium for aquatic physical therapy lasting 10 minutes. Movements to stimulate flexor posture and postural organization were performed. The sleep-wakefulness cycle was assessed using the adapted Brazelton (1973)* scale and pain was assessed by the occurrence of signs of pain according to the Neonatal Facial Coding System (NFCS) scale; and physiological parameters. RESULTS: In relation to states of sleep and wakefulness, before the physical therapy, the newborns' behavior varied from fully awake with vigorous body movements to crying. After the physical therapy, the states of sleep ranged from light sleep with closed eyes to some body movement. These values presented statistically significant differences (p<0.001). The score on the pain assessment scale also decreased from 5.38+/-0.91 to 0.25+/-0.46, with p<0.001 after the intervention. The vital signs remained stable. CONCLUSIONS: It is suggested that aquatic physical therapy can be a simple and effective method for reducing pain and improving sleep quality among preterm infants in NICUs. Controlled studies with larger numbers of subjects are needed in order to generalize the results. Article registered of the Clinical Trials under the NCT00785837.
Assuntos
Hidroterapia , Recém-Nascido Prematuro , Manejo da Dor , Modalidades de Fisioterapia , Sono/fisiologia , Vigília/fisiologia , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , MasculinoRESUMO
OBJETIVOS: Avaliar os efeitos da fisioterapia aquática na dor e no ciclo de sono e vigília de bebês prematuros estáveis hospitalizados. MÉTODOS: A pesquisa caracterizou-se como ensaio clínico não controlado de séries temporais. Foram incluídos 12 recém-nascidos clinicamente estáveis com idade gestacional inferior a 36 semanas internados em unidade de terapia intensiva neonatal. Após serem selecionados, os recém-nascidos foram colocados no meio líquido, onde foi iniciada a fisioterapia aquática, com duração de 10 minutos, na qual foram realizados movimentos que estimulam as posturas flexoras e a organização postural. Foram avaliados os ciclos sono e vigília por meio da escala de avaliação do ciclo de sono e vigília adaptada de Brazelton (1973)*, a presença de sinais de dor por meio da escala Sistema de Codificação da Atividade Facial Neonatal (NFCS), além de parâmetros fisiológicos. RESULTADOS: Em relação aos estados de sono e vigília, antes da fisioterapia, os recém-nascidos apresentaram comportamentos que variaram entre totalmente acordados, com movimentos corporais vigorosos e choro. Após a fisioterapia, os estados de sono variaram entre sono leve com olhos fechados e algum movimento corporal. Esses valores apresentaram diferenças estatisticamente significativas (p<0,001). O escore da escala de avaliação de dor também diminuiu de 5,38±0,91 para 0,25±0,46 com p<0,001 após a intervenção. Os sinais vitais mantiveram-se estáveis. CONCLUSÕES: Sugere-se que a fisioterapia aquática pode ser um método simples e efetivo na redução da dor e na melhora da qualidade do sono de bebês prematuros em UTI Neonatal. Tornam-se necessários estudos controlados e com maior número de indivíduos para a generalização dos resultados.
OBJECTIVES: To evaluate the effects of aquatic physical therapy on pain and on the cycle of sleep and wakefulness among stable hospitalized premature infants. METHODS: This study was characterized as an uncontrolled clinical trial on a time series and included 12 clinically stable newborns of gestational age less than 36 weeks who were hospitalized in a neonatal intensive care unit (NICU). After selection, the newborns were placed in a liquid medium for aquatic physical therapy lasting 10 minutes. Movements to stimulate flexor posture and postural organization were performed. The sleep-wakefulness cycle was assessed using the adapted Brazelton (1973)* scale and pain was assessed by the occurrence of signs of pain according to the Neonatal Facial Coding System (NFCS) scale; and physiological parameters. RESULTS: In relation to states of sleep and wakefulness, before the physical therapy, the newborns' behavior varied from fully awake with vigorous body movements to crying. After the physical therapy, the states of sleep ranged from light sleep with closed eyes to some body movement. These values presented statistically significant differences (p<0.001). The score on the pain assessment scale also decreased from 5.38±0.91 to 0.25±0.46, with p<0.001 after the intervention. The vital signs remained stable. CONCLUSIONS: It is suggested that aquatic physical therapy can be a simple and effective method for reducing pain and improving sleep quality among preterm infants in NICUs. Controlled studies with larger numbers of subjects are needed in order to generalize the results.
Assuntos
Feminino , Humanos , Recém-Nascido , Masculino , Hidroterapia , Recém-Nascido Prematuro , Modalidades de Fisioterapia , Dor/terapia , Sono/fisiologia , Vigília/fisiologia , Unidades de Terapia Intensiva NeonatalRESUMO
A aprendizagem baseada em problemas (Problem-Based Learning PBL) tem sido reconhecida mundialmente como uma abordagem capaz de promover a aquisição de conhecimentos pelos alunos ao mesmo tempo em que os ajuda a desenvolver habilidades e atitudes profissionais desejáveis. Diferentemente dos métodos convencionais de ensino, que utilizam problemas de aplicação após a apresentação da teoria, o PBL utiliza um problema para iniciar, enfocar e motivar a aprendizagem de novos conceitos. Nessa abordagem, o aluno utiliza diferentes processos mentais, como capacidade de levantar hipóteses, comparar, analisar, interpretar e avaliar, desenvolvendo a habilidade de assumir responsabilidade por sua formação. A metodologia PBL tem se mostrado um instrumento valioso na formação do profissional de saúde, com vantagens sobre o método de ensino tradicional. No entanto, para a sua implantação, há necessidade de um considerável esforço institucional. São necessárias adaptações, tais como mudanças na forma de avaliação, mudanças na forma de ver o papel do docente no processo ensino/aprendizagem, investimentos em infraestrutura, adaptações do ambiente, melhoria das bibliotecas, entre outros. O processo de mudança da educação traz inúmeros desafios como, por exemplo, romper com modelos de ensino tradicional e formar profissionais de saúde com competências que lhes permitam recuperar a dimensão essencial do cuidado: a relação entre humanos.
Problem-Based Learning (PBL) has been recognized worldwide as an approach that promotes the acquisition of knowledge by students at the same time that it helps them develop desirable skills and professional attitudes. Unlike the conventional teaching methods, which use problem-solving after the theory has been presented, PBL uses a problem to start, focus and motivate the learning of new concepts. According to this approach, students use different mental processes, such as ability to suggest hypotheses, compare, analyze, interpret, and evaluate, to develop the ability to take responsibility for their education. PBL methodology has been a valuable tool in the education of health professionals, with advantages over the traditional teaching method. However, in order to implement such methodology, considerable institutional effort is necessary. Adjustments must be made, including changes in the methods of evaluation, changes in mind-set on the role of teachers in the teaching/learning process, investments in infrastructure, adaptations of the environment, improvement of libraries, among others. The process of change in education brings many challenges, such as breaking with traditional models of education and training health professionals so that they acquire skills to recover the essential dimension of care: the relationship between people.