Pé torto congênito: método de Ponseti e sua aplicabilidade pelo fisioterapeuta / Congenital clubfoot: Ponseti method and its applicability by the physiotherapist

O pé torto congênito é uma das deformidades mais frequentes de membro inferior que, por sua complexidade com relação às alterações anatômicas, é alvo de dúvidas e divergência de opinião dos profissionais da área quanto ao tratamento mais eficaz. No entanto, o método mais utilizado atualmente e que vem apresentando resultados positivos é o de Ponseti. O objetivo deste trabalho é analisar a eficácia do método de Ponseti e sua aplicabilidade pelo fisioterapeuta. Tratou-se de pesquisa do tipo revisão, com abordagem qualitativa por meio de consulta a publicações das bases de dados Scielo, Lilacs, Medline e Bireme, preferencialmente dos últimos dez anos, e a coleta de dados no mês de outubro de 2016. Foram encontradas 248 publicações e, após análise, foram selecionados 23 artigos para a pesquisa, distribuídas em duas categorias: Eficácia do método Ponseti e Eficácia das técnicas fisioterapêuticas. Diante do exposto, percebese que o método de Ponseti tem se mostrado o mais eficaz no tratamento do pé torto congênito, e suas técnicas são compatíveis com as utilizadas por fisioterapeutas, sendo possível sua aplicabilidade por este profissional, com exceção da tenotomia do calcâneo. Portanto, este trabalho abre espaço para novas pesquisas que corroborem esta temática. (AU)

The congenital club foot is one of the most frequent lower limb deformities that, due to its complexity in relation to anatomical changes, is the subject of doubts and divergence of opinion of professionals in the area regarding the most effective treatment. However, the method most used currently and that has presented positive results is that of Ponseti. The aim of this study was to analyze the effectiveness of the Ponseti method and its applicability by the physiotherapist. This research was a literature review, with a qualitative approach, through consultation of publications of Scielo, Lilacs, Medline and Bireme databases, preferably in the last ten years, and data collection in October 2016. We found 248 publications and after analysis, 23 articles were selected for the research, distributed in two categories: Efficacy of the Ponseti method and Efficacy of physiotherapeutic techniques. The Ponseti method has been shown to be the most effective in the treatment of congenital clubfoot, and its techniques are like those used by physiotherapists, being possible its applicability by this professional, except for tenotomy of the calcaneus. Therefore, this work opens space for new research that corroborates this theme. (AU)

Efeitos do treinamento de força sobre a função pancreática e a sensibilidade tecidual à insulina em ratos / Strength training on the pancreatic function and tissue sensitivity to insulin in rats

Estudos têm demonstrado que o exercício aeróbio promove elevação na sensibilidade tecidual à insulina (SI) e na tolerância à glicose (TG), porém a análise de tais variáveis após treinamento de força (TF) tem sido pouco explorada. Assim, o objetivo deste estudo foi avaliar os efeitos do TF sobre a TG e SI em ratos. Foram estudados 20 ratos Wistar, pareados por peso e aleatoriamente distribuídos em 2 grupos: G1 ? Sham e G2 ? TF. Todos os animais foram submetidos a 3 dias de adaptação e, subsequentemente, treinados com cargas progressivas por 3 vezes por semana, durante 8 semanas numa escada de madeira. Para avaliar SI e TG foram realizadas coletas de sangue e avaliada a cinética da glicemia pelo teste de tolerância à insulina (% de decaimento da curva; B) e o teste de tolerância à glicose (área sob a curva; AC), antes da adaptação e após o 24º dia de treinamento. A análise estatística foi realizada pelo teste t de Student pareado e não-pareado, sendo o p ? 0,05. Apenas G2 mostrou significativo aumento no B após treinamento, sendo que o delta do B entre os grupos mostrou diferenças significativas (p ? 0,05), com maiores valores no G2. Em contraste, AC não apresentou alteração significativa entre os grupos nem entre os deltas (p > 0,05). O TF promoveu benefícios adaptativos na sensibilidade tecidual à insulina, sugerindo que o TF pode ser um recurso interessante durante programas de fisioterapia cardiovascular em doenças crônicas.

Experimental studies have demonstrated that aerobic exercise promotes an increase of tissue insulin sensitivity (IS) and glucose tolerance (GT), however the analysis of such variables after strength training (ST) have been little explored. So the objective of this issue was to investigate the effects of ST on GT and IS in rats submitted to strength training (ST). We studied 20 male Wistar rats, paired by weight and randomly assigned to one of two groups: G1? training without load (Sham) and G2 ? strength training (ST). All animals were submitted to 3 days of adaptation and subsequently were trained with progressive loads 3 times a week for 8 weeks, in a wooden stair of height-1,1m and inclination-80º with a rest area on the top. To measure the IS and GT were collected blood samples and evaluated glycemic kinetic by insulin tolerance tests (% of decay-B) and glucose tolerance tests (area under the curve-AC), before the adaptation and after the 24th day of training. Statistical Analysis was performed by Kolmogorov-Smirnov test and paired and unpaired Student t-tests, with p?0.05. Only G2 showed significant increase in B after training and the delta of B showed significant differences (p?0.05) with higher values in G2. In contrast, the AC did not change between groups or deltas (p>0.05). The ST promoted beneficial adaptations in the tissue sensitivity to insulin, suggest that ST can be an interesting resource during cardiovascular physiotherapy programs in chronic diseases.

Deep breathing heart rate variability is associated with respiratory muscle weakness in patients with chronic obstructive pulmonary disease

BACKGROUND: A synchronism exists between the respiratory and cardiac cycles. However, the influence of the inspiratory muscle weakness in chronic obstructive pulmonary disease (COPD) on cardiac autonomic control is unknown. The purpose of the present investigation was to evaluate the influence of respiratory muscle strength on autonomic control in these patients. METHODS: Ten chronic obstructive pulmonary disease patients (69±9 years; FEV1/FVC 59±12 percent and FEV1 41±11 percent predicted) and nine age-matched healthy volunteers (64±5 years) participated in this study. Heart-rate variability (HRV) was obtained at rest and during respiratory sinusal arrhythmia maneuver (RSA-M) by electrocardiograph. RESULTS: Chronic obstructive pulmonary disease patients demonstrated impaired cardiac autonomic modulation at rest and during RSA-M when compared with healthy subjects (p<0.05). Moreover, significant and positive correlations between maximal inspiratory pressure (MIP) and the inspiratory-expiratory difference (ΔIE) (r = 0.60, p<0.01) were found. CONCLUSION: Patients with chronic obstructive pulmonary disease presented impaired sympathetic-vagal balance at rest. In addition, cardiac autonomic control of heart rate was associated with inspiratory muscle weakness in chronic obstructive pulmonary disease. Based on this evidence, future research applications of respiratory muscle training may bring to light a potentially valuable target for rehabilitation.