ABSTRACT
O condicionamento físico supervisionado por profissionais de Educação Física inserido em um programa de reabilitação para pacientes com distúrbios neuromusculares e musculoesqueléticos visa o aumento da força muscular, melhora da coordenação motora, equilíbrio dinâmico, capacidade aeróbia, capacidade funcional e da aptidão física voltada à saúde. Trata-se de importante intervenção para prevenir e atenuar a sinergia entre a perda de função física e a exacerbação de várias comorbidades que comprometem a independência funcional, modificar fatores de risco, aumentar a qualidade de vida e longevidade com redução da mortalidade. O objetivo desse artigo é apresentar o protocolo de assistência do Serviço de Condicionamento Físico do Instituto de Medicina Física e Reabilitação do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (IMREA-HCFMUSP), elaborado para que a intervenção de exercícios físicos seja adequada, respeitando o perfil e limitações físicas desses pacientes, bem como na observação de seus marcadores clínicos.
The Physical Conditioning Department supervised by physical education professionals included in the rehabilitation program for neuromuscular and musculoskeletal disorders aims to increase muscular strength, improve motor capacity, dynamic balance, aerobic capacity, functional capacity and physical fitness for health. It is an important function to prevent and attenuate a synergy between physical function and the exacerbation of several comorbidities, compromising functional independence, removing risk factors, increasing quality of life and longevity with mortality. The objective of this article is to present the physical conditioning protocol of the Institute of Physical Medicine and Rehabilitation of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (IMREA-HCFMUSP), elaborated so that the intervention of physical exercises is adequate, respecting the profile and physical limitations of these patients, as well as in the observation of their clinical markers.
Subject(s)
Exercise , Physical Fitness , Musculoskeletal Diseases/rehabilitation , Muscle Strength , Physical Conditioning, Human/instrumentation , Neuromuscular Diseases/rehabilitationABSTRACT
Introducción: la enfermedad de Steinert es una enfermedad neuromuscular crónica y progresiva de carácter autosómico dominante. Debido a que puede afectar a los músculos respiratorios, los pacientes se benefician de distintas técnicas de fisioterapia con el fin de evitar complicaciones. Caso clínico: paciente con enfermedad de Steinert que fue tratada en un hospital público de la provincia de Buenos Aires durante un cuadro de insuficiencia respiratoria aguda, de manera no invasiva. Comentarios: esta experiencia muestra que estos pacientes pueden ser tratados de manera no invasiva, fuera de la unidad de cuidados intensivos, y ser controlados ambulatoriamente luego de su egreso pudiendo reinsertarse en la comunidad. Asimismo, cabe destacar que esto fue posible en un hospital público, dentro de un contexto institucional y socioeconómico desfavorable(AU)
Introduction: Steinert's disease is a chronic and progressive autosomal dominant neuromuscular disease. Because this disease can affect respiratory muscles, these patients benefit from different physiotherapy techniques in order to avoid complications. Case presentation: patient with Steinert's disease who was treated in a Public Hospital of the Province of Buenos Aires during an acute respiratory failure with non-invasive way. Comments: This experience shows that these patients can be treated non-invasively, outside the intensive care unit, and be controlled outpatient after discharge, being able to be reinserted in the community. It should also be noted that this was possible in a public hospital, within an unfavorable institutional and socio-economic context(AU)
Subject(s)
Humans , Female , Adolescent , Respiration, Artificial/adverse effects , Respiratory Insufficiency/rehabilitation , Myotonic Dystrophy/epidemiology , Physical Therapy Modalities/adverse effects , Neuromuscular Diseases/rehabilitationABSTRACT
El desarrollo cognitivo del niño requiere de la exploración del entorno. En niños con enfermedades neuromusculares, esta exploración está limitada, dificultando su desarrollo. El objetivo de este estudio es evaluar un modelo de estimulación audiovisual de bajo costo. Se desarrollaron dos vehículos de estimulación audiovisual portátiles (VEP), usados para presentar la intervención, y que eran apropiados para la población participante. En la intervención se incluyó a 9 niños(mediana edad=42,6 meses; rango = 16-99 meses) con enfermedades neuromusculares. El programa de estimulación duró 20 días. Para evaluar la intervención, se usó un lector de movimientos oculares que registró la actividad en una tarea de rastreo visual. Además, se evaluó la frecuencia de respuesta en una tarea de causa-efecto. En la tarea de rastreo visual, tres pacientes (42,8 por ciento) disminuyeron el tiempo de ejecución, en magnitud del 61,9 por ciento (mediana: 13s; rango: 9-54,5 s). Con respecto al número de errores: 5 de 7 participantes (71,4 por ciento) disminuyeron los errores, en magnitud del 56 por ciento (mediana: 5 errores; rango: 2,3-5,8 errores). Respecto a la tarea de causa-efecto, dos de cuatro pacientes mostraron un mejor rendimiento, siendo mas responsivos a la estimulación ambiental. Los resultados muestran que los niños se beneficiaron de la intervención, incluso, los más pequeños. Estas intervenciones deben ser parte de la atención de niños con limitaciones del movimiento...
The cognitive development of children requires the exploration of the environment. In children with neuromuscular diseases this exploration is limited, compromising their development.The aim of this study is to assess a model of low-cost audiovisual stimulation. Two audiovisual stimulation portable vehicle (VEP, in Spanish), were used to apply the intervention, as they were appropriate for the patients. In the intervention, 9 children (age median=42.6 months; range= 16.99) with muscular disease were included. The program of stimulation lasted 20 days. In order to assess the intervention, an eye-tracker device was used to register the performance in a visual pursuit task. In addition, responsiveness was assessed. In the visual pursuit task, three patients (42,8 per cent) diminished the latency in 61,9 per cent (median: 13s; range: 9-54,5 s). Regarding the amount of errors: 5 out 7 participants (71,4 per cent) diminished the amount of errors in 56 per cent (median: 5 errors; range: 2,3-5,8 errors). In regards of the cause-effect task, two out of four subjects showed a better performance, being more responsive to the environmental stimulation. The results show that children are benefited from the intervention, even the younger ones. This intervention should be part of the attention of children with mobility limitations...
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Acoustic Stimulation , Attention/physiology , Neuromuscular Diseases/rehabilitation , Mobility Limitation , Photic StimulationABSTRACT
Background: The pulmonary rehabilitation (PR) has acquired an important role in neuromuscular patient treatment. The aim was to investigate the effects of PR program on 6-minute walking test variables (6MWT) and respiratory muscle function (RMF) in patients with neuromuscular disease. Patients and Methods: In the study were included 13 patients, age 12.5 +/- 2.8 years old. Seven of them were able to walk (2 Facioscapulohumeral Muscular Dystrophy (FSHD), 1 Becker Muscular Dystrophy, 1 Congenital Myopathy, 1 Bethlem Syndrome, 2 Duchenne Muscular Dystrophy); and 6 were unable to walk (4 Duchenne Muscular Dystrophy, 1 Spinal Muscular Atrophy (SMA) type III and 1 SMAII). The results of RMF and 6MWT before and after 13 weeks of respiratory muscle training (RMT) (40-50 percent Pimax and 60-70 percent Pemax) and aerobic training (AT) (50 percent heart rate reserve) were analyzed. Wilcoxon test with 95 percent confidence interval was used to assess statistical significance. Results: Significant changes (p < 0.05) were observed in the averages of dyspnea score that decreased in 1.8 points (from 4.4 to 2.6; -40.9 percent) and in sustained inspiratory pressure (Pims) that increased in 14.3 cm H2O (from 16 to 30.3; +89.4 percent). Other variables that assessed aerobic capacity (6 MWT, heart rate and leg fatigue) and RMF (Pimax and Pemax) showed a trend towards improvement, but did not reach statistical significance. Conclusion: In patients with neuromuscular diseases significant changes in dyspnea after cardiopulmonary training protocol were observed. Moreover, the moderate intensity respiratory muscle training was well tolerated and an effective method to generate significant increases in Pims, constituting an alternative to previously established protocols.
Introducción: La rehabilitación respiratoria (RR) ha adquirido un papel importante en el manejo del paciente con enfermedad neuromuscular. El objetivo de este estudio fue investigar los efectos de un programa de rehabilitación respiratoria (RR) sobre variables del test de caminata de 6 min (C6M) y función muscular respiratoria (FMR) en pacientes con patología neuromuscular. Pacientes y Métodos: En el estudio se incluyeron 13 pacientes, edad: 12,5 +/- 2,8 años, de los cuales 7 son ambulantes (2 distrofia muscular (DM) fascio-escápulo-humeral, 1 DM de Becker, 1 miopatía congénita, 1 síndrome de Bethlem, 2 DM de Duchenne); y 6 no son ambulantes (4 DM de Duchenne, 1 atrofia espinal (AT) tipo 3 y 1AT 2). Se analizaron los registros de FMR y C6M al inicio y posterior a 13 semanas de entrenamiento muscular respiratorio (40-50 por ciento Pimax y 60-70 por ciento Pemax) y cardiopulmonar (50 por ciento de FCR). Se utilizó el test no paramétrico de Wilcoxon con un intervalo de confianza de 95 por ciento. Resultados: Se observaron cambios significativos (p < 0,05) en el puntaje de disnea que disminuyó 1,8 puntos (de 4,4 a 2,6; -40,9 por ciento) y en la presión inspiratoria máxima sostenida (Pims) que aumentó 14,3 cm de H2O (de 16 a 30,3 cm H(2)0; +89,4 por ciento). Las otras variables que evaluaron capacidad aeróbica (C6M, frecuencia cardíaca y fatiga de las piernas) y función de los músculos respiratorios (Pimax y Pemax) mostraron una tendencia a la mejoría, sin embargo, no alcanzaron significación estadística. Conclusiones: En pacientes con enfermedades neuromusculares se observan cambios significativos en la disnea posterior a un protocolo de entrenamiento cardiopulmonar. Por otra parte, el entrenamiento muscular respiratorio de moderada intensidad fue un método bien tolerado y efectivo para generar incrementos significativos en la Pims, constituyendo una alternativa a los protocolos previamente establecidos.
Subject(s)
Humans , Male , Adolescent , Female , Child , Breathing Exercises , Neuromuscular Diseases/rehabilitation , Breath Tests , Exercise Tolerance , Neuromuscular Diseases/physiopathology , Forced Expiratory Volume , Gait , Respiratory Insufficiency/rehabilitation , Prospective Studies , Vital CapacityABSTRACT
A lesion of the anterior cruciate ligament [ACL] is a major trauma of the knee. Neuromuscular control is believed to be a critical factor in dynamic knee stability in ACL deficient [ACLD] patients. Neuromuscular training programs [in particular perturbation training] are increasingly integrated into clinical practice for ACL lesion rehabilitation. The purpose of this study was to investigate the effect of the modified perturbation training on neuromuscular control system and functional improvement in ACLD. 10 professional male athletes with an average of 6.7 +/- 3.19 months after their unilateral ACL rupture participated in this study. Surface Electromyographic [EMG] data were recorded during a cross hop task, from the rectus femoris, vastus medialis, medial head of the gastrocnemius, biceps femoris and gluteus maximus muscles. Muscle activation patterns before and after 10 sessions of perturbation training were compared. Treatment outcome was determined from scores of questionnaires and functional tests. Scores of IKDC subjective questionnaire and functional tests were significantly improved [P<0.05]. Muscle activation patterns were modified. The significant earlier onset and late peak of the rectus femoris resulted in the longer duration from onset-to-peak activity in both of the involved and non involved limbs [P<0.05]. Perturbation training has a central effect that modifies neuromuscular control system through the change in feed-forward control for ACL deficient patients. Rectus femoris activation is not harmful to ACL and causes a protective effect. Optimum activity of this muscle is important for ACL injury prevention and rehabilitation
Subject(s)
Humans , Male , Electromyography , Treatment Outcome , Rehabilitation , Neuromuscular Diseases/rehabilitation , MusclesABSTRACT
A Esclerose Lateral Amiotrófica (ELA) é uma doença inexorável e degenerativa que afeta os neurônios motores superiores e inferiores, levando à morte cerca de dois a quatro anos após o início das primeiras manifestações. A proposta do presente artigo será apresentar, com base naliteratura vigente, um panorama das principais técnicas utilizadas e resultados de estudos acerca da reabilitação física desses pacientes. Os exercícios terapêuticos devem ser prescritos e encarados como uma maneira de melhorar a qualidade de vida dos pacientes, sendo os objetivosdirecionados para um melhor desempenho nas atividades básicas e instrumentais da vida diária. Os profissionais engajados na reabilitação física devem auxiliar os pacientes e os cuidadores na luta diária contra as perdas proporcionadas pela doença, decorrentes do comprometimento damotricidade voluntária.
Amyotrophic Lateral Sclerosis (ALS) is a fatal degenerative disease that affects upper and lower neurons and takes approximately two to four years between the first sign and symptoms to death. The aim of the present study is to present the main interventions used in physicalrehabilitation and their results in patients with ALS. The therapeutic exercises should be prescribed with the objective to improve the patient?s quality of life and enhance the performance during basic and instrumental daily activities. The professionals involved in physical rehabilitationshould aid patients and caregivers to overcome their difficulties, especially those related to voluntary motor impairments.
Subject(s)
Neuromuscular Diseases/rehabilitation , Amyotrophic Lateral Sclerosis/rehabilitation , Physical Therapy Modalities/adverse effectsABSTRACT
Este estudo teve o propósito de analisar dados de funcionalidade e qualidade de vida, além de informações sobre idade, diagnóstico e tempo de diagnóstico, por meio de três avaliações fisioterapêuticas, no período de um ano e meio, dos pacientes portadores de doenças neuromusculares da ASCADIM (Associação Sul Catarinense de Amigos, Familiares e Portadores de Distrofias Musculares Progressivas). Os pacientes avaliados apresentaram queda da funcionalidade e qualidade de vida no decorrer do tempo, em todas as avaliações realizadas, sendo que a DMD (Distrofia Muscular de Duchenne) apresentou diferença significativa estatisticamente na avaliação da funcionalidade e na qualidade de vida quando comparada com os demais grupos de DNM (Doenças Neuromusculares). Sugere-se que o profissional fisioterapeuta, em sua rotina diária, esteja apto e ciente para avaliar a funcionalidade e a qualidade de vida desses pacientes, de forma seqüencial, para obter um diagnóstico preciso, possibilitando estruturar as intervenções de reabilitação, para assim avaliar e garantir bons resultados, além de melhorar a qualidade de vida de portadores de DNM.
This study aims at analyzing functioning and quality of life as well as age, diagnosis and the time of diagnosis of patients with neuromuscular disorders from ASCADIM (Sul Catarinense Association of Friends, Family and Patients with Progressive Muscular Dystrophy), through three physical therapy evaluations during a period of eighteen months. It was observed that patients functionality and quality of life was reduced in the course of time, in the three performed evaluations; however the DMD (Duchenne Muscular Dystrophy) showed a statistically significant difference in functioning and quality of life when compared with other groups with NMD (Neuromuscular Disorders). It is suggested that physical therapy professional, in daily routine, should be qualified and conscious to evaluate functioning and quality of life in a sequential way, in order to get an accurate diagnosis, making possible to organize rehabilitations interventions aiming to evaluate and obtain good results, and also improve quality of life of NMD patients.
Subject(s)
Neuromuscular Diseases/classification , Neuromuscular Diseases/complications , Neuromuscular Diseases/pathology , Neuromuscular Diseases/rehabilitation , Neuromuscular Diseases/therapy , Neuromuscular Manifestations , Physical Therapy Department, HospitalABSTRACT
Este capitulo describe los fundamentos e indicaciones del equipo electromecánico de tos asistida, in-exsufflator, en pacientes con enfermedades neuromusculares u otras condiciones que comprometen la eficacia en la remoción de las secreciones traqueobronquiales relacionadas a mecanismos de tos ineficiente. Se señalan los criterios de selección para la entrega de esta terapia kinésica y el funcionamiento básico de este dispositivo. Además se propone un protocolo complementario de manejo kinésico para pacientes neuromusculares usuarios de asistencia ventilatoria no invasiva e invasiva.