Impact of type of delivery on thoracoabdominal mobility of newborns / Impacto do tipo de parto sobre a mobilidade Toracoabdominal de recém-nascidos

INTRODUCTION: In newborns delivered by cesarean section, there is less chest compression and little amount of fluid is drained by gravity, which temporarily reduces thoracoabdominal mobility OBJETIVE: The objective of this study is to evaluate the impact of the type of delivery on newborns Thoracoabdominal Mobility METHODS: This is a cross-sectional study with newborns of gestational age between 37 and 41 weeks, of both sexes, with up to 72 hours of life, breathing in ambient air and born by normal delivery or cesarean section. The Thoracoabdominal Mobility was evaluated by videogrammetry using MATLAB Software and considered, in metric units (cm2), as the difference between the highest and lowest thoracoabdominal expansibility for each respiratory cycle RESULTS: Twenty-six infants were included, 11 were male and 50% were born by cesarean section. The mean gestational age was 39 ± 0,9 and 28 ± 18 hours of life. The mobility, difference between greater and lesser expansion, of the thoracic area in vaginal and cesarean delivery was 6 ± 3 cm2 and 7 ± 5 cm2 and the abdominal area was 29 ± 22 cm2 and 21 ± 14 cm2, respectively. This difference was not statistically significant between the two types of delivery for the thoracic area, but was statistically different for the abdominal area (p= 0.01). And the higher the respiratory rate, the lower the abdominal mobility (r= -0.57, p= 0.02 CONCLUSION: The data indicate that the type of delivery seems to influence abdominal mobility and respiratory rate. In the studied sample, newborns with cesarean section presented lower abdominal mobility

INTRODUÇÃO: Nos recém-nascidos de parto cesáreo, ocorre menor compressão torácica e pouca quantidade de líquido é drenada por ação da gravidade, o que diminui, transitoriamente, a mobilidade toracoabdominal OBJETIVO: O objetivo do estudo é avaliar o impacto do tipo de parto na mobilidade torácica e abdominal em recém-nascidos MÉTODO: Trata-se de um estudo transversal com recém-nascidos de idade gestacional entre 37 a 41 semanas, de ambos os sexos, com até 72 horas de vida, respirando em ar ambiente e nascidos de parto normal ou parto cesáreo. A mobilidade torácica e abdominal foram avaliadas pela videogrametria por meio do Software MATLAB e considerada, em unidades métricas (cm2), como a diferença da maior e menor expansibilidade toracoabdominal para cada ciclo respiratório RESULTADOS: Foram inclusos 26 recém-nascidos 11 do sexo masculino e 50% nascidos de parto cesáreo. A idade gestacional média foi de 39 ± 0,9 sem e tinham 28 ± 18 horas de vida. A mobilidade, diferença entre a maior e menor expansibilidade, da área torácica no parto vaginal e cesáreo foi 6 ± 3 cm2 e 7 ± 5 cm2 e da área abdominal foi de 29±22 cm2 e 21± 14 cm2, respectivamente. Esta diferença não foi estatisticamente significante entre os dois tipos de parto para a área torácica, mas mostrou-se diferente estatisticamente para a área abdominal (p = 0,01). E para os recém-nascidos de parto cesáreo, quanto maior a frequência respiratória, menor a mobilidade abdominal (r= -0,57; p = 0,02 CONCLUSÃO: Os dados indicam que o tipo de parto parece influenciar a mobilidade abdominal e a frequência respiratória. Na amostra estudada os recém-nascidos de parto cesáreo apresentaram menor mobilidade abdominal

Thoracoabdominal mobility evaluation by photogrammetry in newborns after expiratory flow increase technique / Avaliação da mobilidade toracoabdominal por fotogrametria em recém-nascidos após a técnica de aumento do fluxo expiratório

Abstract Introduction: Expiratory flow increase is a maneuver of respiratory physical therapy that promotes flow direction to the upper airways however, when applied in newborns, it may result in changes of thoracoabdominal mobility. Objective: To evaluate the thoracoabdominal mobility by photogrammetry in newborns after expiratory flow increase technique. Methods: Experimental blind study performed with newborns in supine position on a support table with upper limbs flexed, abducted and externally rotated and hip flexed at 110°. Adhesive markers were allocated for geometric delimitation of the thoracoabdominal compartment and expiratory flow increase technique was performed for 5 minutes with the therapist's hands on the thorax and abdomen. Newborns were filmed before and after the maneuver and the frames were analyzed in AutoCAD® software by a blinded investigator at the time of the procedure. The largest and the smallest thoracoabdominal area were expressed in cm2 and the mean values were compared between two moments (pre and post maneuver) by paired t test. Results: Twenty newborns with a mean age of 39 weeks were included. Before the maneuver, thoracoabdominal area was 56.1 cm2 during expiration and 59.7 cm2 during inspiration, and after the maneuver the value was 56.2 cm2 during expiration and 59.8 cm2 during inspiration, with no statistical difference between before and after (p = 0.97, p = 0.92, respectively). Conclusion: Results demonstrate that expiratory flow increase technique does not seem to change thoracoabdominal mobility of healthy newborns.

Resumo Introdução: O aumento do fluxo expiratório é uma manobra da fisioterapia respiratória que promove um direcionamento do fluxo para as vias aéreas superiores, entretanto, quando aplicada em recém-nascidos, pode resultar em uma variação da mobilidade toracoabdominal. Objetivo: Avaliar a mobilidade toracoabdominal pela fotogrametria em recém-nascidos após a manobra de aumento do fluxo expiratório. Métodos: Estudo experimental, cego, realizado com os recém-nascidos posicionados em supino sobre uma bancada de apoio com o membro superior em flexão, abdução e rotação externa e quadril flexionado a 110°. Foram alocados marcadores adesivos para a delimitação geométrica do compartimento toracoabdominal e o aumento do fluxo expiratório foi realizado por 5 minutos com as mãos do terapeuta sobre o tórax e abdome. Os recém-nascidos foram filmados pré e pós-manobra e os fotogramas foram analisados no software AutoCAD por um pesquisador cego ao momento do experimento. A maior e a menor área toracoabdominal foram expressas em cm 2 e os valores médios foram comparados entre os dois momentos (pré e pós manobra) pelo Teste t pareado. Resultados: Foram incluídos 20 recém-nascidos com idade média de 39 semanas. Antes da manobra a área toracoabdominal foi 56,1 cm2 durante a expiração e 59,7 cm 2 na inspiração e após a manobra o valor foi 56,2 cm 2 durante a expiração e 59,8 cm 2 durante a inspiração, sem diferença estatística entre o antes e o depois (p = 0,97, p = 0,92, respectivamente). Conclusão: Os resultados deste estudo demonstram que a técnica de aumento do fluxo expiratório parece não alterar a mobilidade toracoabdominal de recém-nascidos saudáveis.

Hip orthosis powered by pneumatic artificial muscle: voluntary activation in absence of myoelectrical signal.

Powered orthosis is a special class of gait assist device that employs a mechanical or electromechanical actuator to enhance movement of hip, knee, or ankle articulations. Pneumatic artificial muscle (PAM) has been suggested as a pneumatic actuator because its performance is similar to biological muscle. The electromyography (EMG) signal interpretation is the most popular and simplest method to establish the patient voluntary control of the orthosis. However, this technique is not suitable for patients presenting neurological lesions causing absence or very low quality of EMG signal. For those cases, an alternative control strategy should be provided. The aim of the present study is to develop a gait assistance orthosis for lower limb powered by PAMs controlled by a voluntary activation method based on the angular behavior of hip joint. In the present study, an orthosis that has been molded in a patient was employed and, by taking her anthropometric parameters and movement constraints, the adaptation of the existing orthosis to the powered orthosis was planned. A control system was devised allowing voluntary control of a powered orthosis suitable for patients presenting neurological lesions causing absence or very low quality of EMG signal. A pilot clinical study was reported where a patient, victim of poliovirus, successfully tested a hip orthosis especially modified for the gait test evaluation in the parallel bar system. The hip orthosis design and the control circuitry parameters were able to be set to provide satisfactory and comfortable use of the orthosis during the gait cycle.