Constraint Induced Movement Therapy Increases Functionality and Quality of Life after Stroke.

This blind randomized clinical trial evaluated the effect of CIMT on the functionality and quality of life (QOL) of chronic hemiparetics. Thirty volunteers were divided into two groups: Control (CG) and CIMT (CIMTG); evaluated before and after 12 and 24 intervention sessions. The scales used were: adapted Fugl-Meyer Motor Assessment (FMA), Modified Ashworth, Stroke Specific Quality Of Life (SS-QOL) and the Functional Reach Test (FRT). The scores for all FMA variables in the CIMTG increased until the 24th session, differing from the pre-treatment. In the CG, the scores increased for pain, coordination/ speed and sensitivity. In the FRT there was an increase in the scores in both groups; after the 12th and 24th sessions, the result of the CIMTG was superior to the CG. For the SS-QOL in the CIMTG, the general score and most of the variables increased, as well as in the CG. Muscle tone in CIMTG was lower compared to CG after 24 sessions. Both protocols used in the study were effective, the CIMT protocol showed benefits in recovering the functionality of the paretic upper limb, in the functional range and in reducing muscle tone, with a consequent improvement in quality of life.

Impact of physical activity levels on musculoskeletal symptoms and absenteeism of workers of a metallurgical company.

INTRODUCTION: Physical inactivity is the fourth biggest risk factor for global mortality. In Brazilian metallurgical industries, workers present a high incidence of musculoskeletal symptoms as one of the main causes of absenteeism. OBJECTIVES: To investigate the impact of physical activity levels and leisure-time physical exercise on musculoskeletal symptoms and absenteeism among administrative and production workers of a metallurgical industry. METHODS: This is a transversal study that included 206 workers. We applied the Modified Baecke Questionnaire, leisure-time physical activity and leisure-time physical exercise domains), as well as the Nordic Musculoskeletal Questionnaire regarding symptom occurrence and severity scores (1-4), and compared levels of absenteeism. Our sample was divided into 2 groups: production and office workers. RESULTS: We observed a significant difference between the groups regarding symptom severity score 3 (p = 0.03) and absenteeism (p = 0.02); the production group presented higher results. There was a correlation between leisure-time physical exercise and absenteeism (r = -0.57, p = 0.01) and between leisure-time physical activity and absenteeism (r = -0.55, p = 0.01) in the production worker group, whereas in the office worker group, leisure-time physical activity and symptom severity score 4 were correlated (r = 0.63, p = 0.02). CONCLUSIONS: Production workers presented higher occurrences of symptom severity score 3 and absenteeism; increased levels of leisure-time physical activity and physical exercise reduced absenteeism. Leisure-time physical activity was correlated with severity score 4 in the office worker group.

Maximum voluntary muscle contraction and fatigue in multibacillary leprosy / Contração voluntária máxima e fadiga no paciente com hanseníase multibacilar / Contracción voluntaria máxima y fadiga en el paciente con hanseniasis multibacilar

Abstract Introduction: The impairment of muscle strength and fatigue in leprosy remains a problem that requires careful attention to avoid or minimize its progression, as well as prevention of disabilities and deformities. Objective: To investigate the maximum voluntary contraction and time to muscle fatigue in leprosy patients. Method: A total of 21 leprosy patients and 21 healthy subjects completed the sample. The method used to determine the maximum voluntary contraction (MVC) of the handgrip followed the recommendation of the American Society of Hand Therapists with the use of a hydraulic hand grip dynamometer. The test was performed three times with each hand, with a time interval of 60 seconds between successive trials. The subject was instructed to perform a maximal isometric force against the dynamometer for 5 seconds. The peaks were recorded and used for the fatigue test. For the fatigue test, we recorded the electromyogram of the forearm muscles to offline determine the onset time for the muscle contraction (14 bits, Miograph 2 USB®, Miotec, Brazil). Results: Leprosy patients had lower MVC compared with healthy subjects (p > 0.05), both in the dominant and the non-dominant hands. The time to fatigue in the leprosy and control groups was similar (p < 0.05). We observed that leprosy patients had more contractions than the healthy subjects (22.6 ± 11.8 contractions for the leprosy group vs. 12.3 ± 6.9 contractions for the control group, p > 0.05). Conclusion: Multibacillary leprosy patients lost muscle force without modifying the resistance to fatigue.

Resumo Introdução: O comprometimento da força muscular e a fadiga na hanseníase continuam sendo problemas que requerem cuidadosa atenção para evitar ou minimizar sua progressão, bem como prevenir incapacidades e deformidades. Objetivo: Avaliar a força muscular e o tempo até a fadiga em pacientes com hanseníase Método: Vinte e um pacientes com hanseníase e 21 indivíduos saudáveis completaram a amostra. O método utilizado para determinar a contração voluntária máxima (CVM) da força de preensão palmar seguiu a recomendação da Sociedade Americana de Terapeutas da Mão com o uso de um dinamômetro de preensão manual. O teste foi realizado três vezes em cada mão, com intervalo de tempo de sessenta segundos entre tentativas sucessivas. O sujeito foi instruído a realizar força isométrica máxima contra o dinamômetro durante cinco segundos. Os picos foram registrados e usados para o teste de fadiga. Para o teste de fadiga, registrou-se o eletromiograma dos músculos do antebraço para determinar off-line o tempo de início da contração muscular (14 bits, Miograph 2 USB ® , Miotec, Brasil). Resultados: Os pacientes com hanseníase apresentaram menor CVM em relação aos saudáveis (p < 0,05) nas mãos dominante e não dominante. Não houve diferença no tempo de fadiga entre os grupos hanseníase e controle (p > 0,05). Foi observado que os pacientes com hanseníase tinham mais contrações do que os saudáveis (22,6 ± 11,8 contrações para o grupo com hanseníase vs. 12,3 ± 6,9 para o grupo controle, p < 0,05). Conclusão: Pacientes com hanseníase multibacilar apresentaram perda de força muscular sem modificação da resistência à fadiga.

Resumen Introducción: El compromiso de la fuerza muscular y la fatiga en la lepra sigue siendo un problema que requiere atención cuidadosa para evitar o minimizar su progresión, así como la prevención de incapacidades y deformidades. Objetivo: Evaluar la fuerza muscular y el tiempo hasta la fatiga de pacientes con lepra. Método: Veintiún pacientes con lepra y 21 sujetos sanos completaron la muestra. El método utilizado para determinar la contracción voluntaria máxima (CVM) de la fuerza de asimiento palmar siguió la recomendación de la Sociedad Americana de Terapeutas de la Mano con el uso de un dinamómetro de asimiento manual. La prueba se realizó tres veces con cada mano, con un intervalo de tiempo de 60 segundos entre intentos sucesivos. El sujeto fue instruido a realizar una fuerza isométrica máxima contra el dinamómetro durante 5 segundos. Los picos se registraron y se utilizaron para la prueba de fatiga. Para la prueba de fatiga, registramos el electromiograma de los músculos del antebrazo para determinar fuera de línea el tiempo de inicio de la contracción muscular (14 bits, Miograph 2 USB ® , Miotec, Brasil). Resultados: Los pacientes con lepra presentaron menor CVM con relación a los sanos (p < 0,05) en las manos dominante y no dominante. No hubo diferencia en el tiempo de fatiga entre los grupos de lepra y control (p > 0,05). Se observó que los pacientes con lepra tenían más contracciones que los sanos (22,6 ± 11,8 contracciones para el grupo con hanseniasis frente a 12,3 ± 6,9 para el grupo control, p < 0,05). Conclusión: Pacientes con hanseniasis multibacilar presentaron pérdida de fuerza muscular sin modificación de la resistencia a la fatiga.

Ergonomic risk and work-related musculoskeletal disorder in machine and equipment manufacturing workers / Risco ergonômico e distúrbio osteomuscular relacionado ao trabalho em trabalhadores de fabricação de máquinas e equipamentos

Introduction: Workers of the metallurgical industry are constantly exposed to occupational risk factors that can lead to the development of work-related musculoskeletal disorders (WMSDs). These disorders are highly debilitating, generating losses to workers, companies and the State. Objective: To identify and verify the connection between risk factors and WMSDs in metallurgical workers in the manufacture of machinery and equipment. Method: This is a cross-sectional epidemiological study that involves registered workers of the Occupational Health Reference Service (Cerest) in São Paulo state. The survey was conducted through review of electronic medical records. Results: 2116 electronic medical records were analyzed, from these, 36 were considered for the sample. We observed that 91.6% (n = 33) of the participants were men, age range from 29 to 62 years and the most prevalent occupational status was unemployment (47.3% (n = 17)). The WMSDs were found in the upper limbs and spine region, predominantly spine. Repetitiveness was the most prevailing risk factor (94.4% (n = 34)). A connection between repetitiveness (p = 0.0046) and physical exertion (p = 0.001) with symptoms in the spine was detected. Conclusion: The spine is the main body region affected in these workers. There was a link between repetitiveness and physical exertion with the symptoms of spine pain. The results strengthen the need for interventions in the workplace to minimize repetitive work and excessive physical exertion seeking prevention and workers' health promotion.

Introdução: O trabalhador do setor de metalurgia está constantemente exposto a fatores de risco no ambiente de trabalho que podem levar ao surgimento de distúrbios relacionadas ao trabalho (Dort). Esses distúrbios são altamente incapacitantes, trazendo prejuízos para os trabalhadores, empresas e para o Estado. Objetivo: Identificar e verificar associação entre os fatores de risco e as DORT nos trabalhadores do setor de metalurgia, na atividade de fabricação de máquinas e equipamentos. Método: Trata-se de um estudo epidemiológico transversal, envolvendo trabalhadores cadastrados em um Centro de Referência em Saúde do Trabalhador (Cerest) do interior do Estado de SP. A pesquisa foi realizada por meio de avaliação de prontuários eletrônicos. Resultados: Foram analisados 2116 prontuários eletrônicos, desses, 36 foram considerados na amostra. Observou-se que 91,6% (n = 33) dos sujeitos eram homens, a faixa etária variou entre 29 - 62 anos. A situação ocupacional mais prevalente foi a de desemprego, 47,3% (n = 17). Os Dort foram encontrados em membros superiores e região de coluna. A repetitividade foi o fator de risco mais prevalente (94,4% (n = 34)). Foi encontrada associação entre repetitividade (p = 0,0046) e esforço físico (p = 0,001) com sintomas na coluna vertebral. Conclusão: Conclui-se que a coluna vertebral é a principal região corporal acometida nesses trabalhadores. Houve uma associação entre repetitividade e esforço físico com os sintomas de dor na região da coluna. Isso reforça a necessidade de intervenções no ambiente de trabalho, visando minimizar o trabalho repetitivo e o esforço físico excessivo, buscando a prevenção e promoção na saúde do trabalhador.

Avaliação da sobrecarga de trabalho e da qualidade de vida de cuidadores de idosos institucionalizados / Evaluation of work overload and quality of life in caregivers of institutionalized elderly

O aumento do número de idosos dependentes é uma realidade global e pode estar associado à diminuição progressiva das aptidões e capacidades físicas e mentais dessa população. Por isso, torna-se importante a figura do cuidador, que auxilia os idosos em suas atividades de vida diária. Este estudo objetivou avaliar a sobrecarga de trabalho e a qualidade de vida de cuidadores de idosos institucionalizados. Doze participantes foram avaliados por meio de questionário de caracterização do cuidador, WHOQOL-BREF e Escala de Sobrecarga do Cuidador de Zarit. Utilizou-se o coeficiente de Spearman (rs) para correlacionar a sobrecarga e qualidade de vida, considerando p ≤ 0,05. Os voluntários apresentaram sobrecarga moderada a leve (58,33 ± 3%; n = 7) sendo o domínio meio-ambiente o mais afetado na qualidade de vida (13,3 ± 2.9%). Não houve correlação significativa entre a sobrecarga e qualidade de vida (rs = - 0,3023; p > 0,05). As condições do ambiente de trabalho promoveram sobrecarga aos cuidadores e comprometimento de sua qualidade de vida, sugerindo a necessidade de uma análise dos fatores de risco para definição de recomendações e/ou adequações para evitar agravos à saúde destes trabalhadores. (AU)

The increasing number of dependent elderly is a global reality and can be associated with the progressive decrease of the aptitudes and physical and mental capabilities of this population. Therefore, the figure of the caregiver assisting the elderly in their daily life activities becomes important. This study aimed to evaluate the burden and quality of life of caregivers of institutionalized elderly. Twelve participants were evaluated through caregiver's characterization questionnaire, WHOQOL-BREF and Zarit Burden Interview. We used Spearman coefficient (rs) to correlate the burden and quality of life, considering p ≤ 0.05. The volunteers showed moderate to slight overload (58.33 ± 3%; n = 7) being the domain environment the more affected in quality of life (13.3 ± 2.9%). There was no significant correlation between burden and quality of life (rs = -0.3023; p > 0.05). The conditions of the work environment led to a burden for the caregivers and the compromise of their quality of life, suggesting the necessity of an analysis of the risk factors for the definition of recommendations and/or adaptations to avoid damages to workers' health. (AU)

Constraint-induced movement therapy in the rehabilitation of chronic hemiparetic patients in the Amazonia / Terapia de restrição e indução do movimento na reabilitação de pacientes hemiparéticos crônicos na Amazônia

Introduction: The stroke is one of the incident diseases in the world, causing numerous changes to the functionality especially those related to upper limb functions. Objective: To evaluate the influence of modified Constraint-Induced Movement Therapy (mCIMT) on functional recovery, range of motion (ROM) and muscle tone of chronic hemiparetic upper limb (UL). Methods: Seven subjects (52.75 ± 6.63 years old) were evaluated before, straightaway and one month after 12 sessions of mCIMT, by goniometry, modified Fugl-Meyer Assessment (mFMA) and modified Ashworth Scale (MAS). Results: Functionality improved 74.7% after treatment and 79.5% one month after the end of treatment. There was improvement in passive motion (p = 0.01), in pain (p = 0.004) and UL motor function (p ≤ 0.001), increased range of flexion, extension, abduction and adduction of the shoulder and flexion and radial deviation of the wrist (p = 0.05) and muscle tone reduction (p < 0.05). Conclusion: mCIMT was effective for recovery of ROM in shoulder and wrist; recovery of the paretic UL functionality and spasticity reduction, and the results remained after the end of treatment.(AU)

Introdução: O AVE é uma das doenças mais incidentes no mundo, provocando inúmeras alterações para a funcionalidade, principalmente relacionadas às funções do membro superior. Objetivos: Avaliar a influência da Terapia de Restrição e Indução do Movimento (TRIM) na recuperação da funcionalidade, amplitude de movimento (ADM) e tônus do membro superior (MS) de pacientes hemiparéticos crônicos. Material e métodos: Sete voluntários (52,75 ± 6,63 anos) foram avaliados antes, imediatamente após e um mês após 12 sessões de TRIM, pela goniometria, Modified Fugl-Meyer Assessment e Modified Ashworth Scale. Resultados: A funcionalidade melhorou 74,7% após intervenção e 79,5% um mês após o término do tratamento. Houve melhora da movimentação passiva (p = 0,01), da dor (p = 0,004) e da função motora do MS (p ≤ 0,001); aumento da ADM de flexão, extensão, abdução e adução do ombro e flexão e desvio radial do punho (p  0,05) e redução do tônus muscular (p < 0,05). Conclusão: A TRIM foi eficaz para recuperação da ADM do ombro e punho; retorno da funcionalidade do MS parético e redução da espasticidade, tendo os resultados se mantido após o término do tratamento. (AU)

Achilles Tendon Vascularization of Proximal, Medial, and Distal Portion Before and After Partial Lesion in Rats Treated with Phototherapy.

BACKGROUND: The Achilles tendon is one of the tendons most commonly injured by microtraumas and overuse during sports practice. This tendon is especially fragile because of the low blood supply in its central part. Nevertheless, the literature does not offer enough scientific support to explain the composition and vascular dynamic of animal tendons, despite the relevance of being able to observe if the animal tendon undergoes the same processes of vascularization in different regions, as occurs in humans. METHODS: We used 28 rats weighing 280 ± 20 g, which were divided into four groups with seven animals each (control, sham, 830 nm, 660 nm). The laser parameters were: power output 60 mW for both lasers, 40 J/cm(2) of energy density, total energy 1.1 J, power density 2.14 W/cm(2), and application time 18.6 sec. This study evaluated the vascular constitution of healthy and injured calcaneous tendons. The tendons of each animal were processed to be embedded in Paraplast and, after that, they were divided into three parts: proximal, medial, and distal. Afterwards, they were cut in slices of 6 µm were made, then they were stained with hematoxylin and eosin. Using an ocular lens reticulated with magnification × 400, we analyzed the number and the area density of the blood vessels using morphometric methods. Data were analyzed with the Shapiro-Wilk test, followed by Tukey, considering p as <0.05. RESULTS: The area density and the number of blood vessels in the proximal part were 36% and 42%, respectively, of the values found in the medial part. The distal part had 64% more vessels and 52.8% more area density (p < 0.05) than the medial part. CONCLUSIONS: Low-level laser therapy (LLLT) had no effect on the studied parameters. The vascularization of rat tendon is similar to that of humans, which contributes to the studies of therapies that have been applied in humans.

Perfil sociodemográfico e ocupacional de trabalhadores com LER/DORT: estudo epidemiológico / Perfi sociodemoggráfico y laboral de los trabajadores con LER/TMOL: estudio epidemiológico / Sociodemographic and occupacional profile of workers with RSI/WRMSD: epidemiological study

Analisou-se o perfil sociodemográfico e ocupacional de trabalhadores com lesões por esforços repetitivos (LER) ou disfunções osteomusculares relacionados ao trabalho (DORT) em Piracicaba, São Paulo, avaliando-se a associação desse perfil com a ocorrência de dor, bem como a associação de risco para LER/DORT. Dados de 1.007 prontuários foram submetidos à análise descritiva (p<0,05). A LER/DORT predominou em mulheres, na idade produtiva, com baixo grau de instrução e baixos salários, com função de doméstica, cozinheira, serviços gerais, auxiliar de produção e costureira; a dor predominou no membro superior e estava associada à função, ao gênero feminino, ao baixo grau de instrução e ao estado civil; houve associação de risco entre organização e ergonomia no trabalho e dor no membro superior. A compreensão das relações do trabalhador com o ambiente de trabalho e com o trabalho pode favorecer medidas de vigilância e promoção de saúde.

The socio-demographic and occupational profile of workers with repetitive strain injury (RSIs) or work-related musculoskeletal disorders (WRMSDs) in Piracicaba, São Paulo, Brazil, were analyzed. The association of this profile with the occurrence of pain as well as the risk association for RSI/WRMSD were evaluated. Data from 1,007 medical records underwent descriptive analysis (p<0.05). RSI/WRMSD was predominant in women in their productive age, with low education level and low wages, working mainly in domestic roles, cook, general services, production assistant and seamstress; pain was predominant in the upper limb and it was associated with the function, the female gender, low education level and marital status; there was risk association between organization and workplace ergonomics and pain in upper limb. The understanding of the relationship between the worker, the work environment, and the work may favor surveillance measures and health promotion.

Se analizó el perfil sociodemográfico y laboral de los trabajadores con lesiones por esfuerzo repetitivo (LER) o trastornos musculoesqueléticos de origen laboral (TMOL) en Piracicaba, São Paulo, Brasil, evaluando la asociación de ese perfil con la aparición de dolor, así como la asociación de riesgo de LER/TMOL. Los datos de 1.007 manuales se sometieron a análisis descriptivo (p<0,05). Las LER/TMOL predominaron en las mujeres en edad productiva, con bajo nivel educativo y bajos salarios, que trabajaban principalmente en los roles domésticos, cocinera, servicios generales, asistente de producción y costurera; el dolor predominó en la extremidad superior y se asoció con la función, el género femenino, el bajo nivel de educación y el estado civil; hubo asociación de riesgo entre la organización y la ergonomía en el trabajo y el dolor en la extremidad superior. La comprensión de las relaciones del trabajador con el ambiente de trabajo y con el trabajo puede favorecer las medidas de vigilancia y promoción de la salud.

Autonomic modulation of heart rate in paraplegic wheelchair basketball players: Linear and nonlinear analysis.

This study aimed to evaluate the autonomic modulation of heart rate in sedentary paraplegics and paraplegic wheelchair basketball players with thoracic spinal cord injury below T6. Seven paraplegic wheelchair basketball players (active paraplegic group), five paraplegics who were not involved in regular exercise (sedentary paraplegic group) and 10 able-bodied participants (control group) took part in the study. The heart rate variability was evaluated by linear (low frequency and high frequency band in normalised units and low frequency/high frequency ratio) and nonlinear methods (Shannon entropy, corrected conditional entropy, and symbolic analysis). The sedentary group presented significantly higher values for low frequency, low frequency/high frequency ratio and symbolic index with no significant variations (0V%), and also lower values for the high frequency and symbolic index with two significant unlike variation (2ULV%) compared to active paraplegic group. Shannon entropy and corrected conditional entropy analyses revealed significantly lower values in the sedentary group than in the control or active paraplegic groups. Paraplegic individuals who regularly undertake physical exercise have higher complexity of R-R interval time series, lower sympathetic modulation, and higher parasympathetic modulation than sedentary paraplegic participants.

Immediate effects of bilateral grade III mobilization of the talocrural joint on the balance of elderly women.

OBJECTIVE: The purpose of this study was to evaluate the immediate effects of a single treatment session of bilateral grade III mobilization of the talocrural joint on the balance of elderly women. METHODS: Thirty-two elderly women (age, 65-80 years) with low physical activity levels completed balance evaluation using baropodometry, the Functional Reach Test and the Timed Up and Go Test, and plantar flexion and dorsiflexion range of motion (ROM), before and immediately after the mobilization (n = 16) or sham (n = 16). Each subject was submitted to a total of twelve 30-second grade III mobilizations, 6 for each ankle, in a single treatment session. RESULTS: No significant difference was found for intragroup and intergroup comparisons in the balance of elderly women during the following evaluations: Functional Reach Test (P = .851), Timed Up and Go Test (P = .653), anteroposterior oscillation with eyes opened (P = .333) and with eyes closed (P = .652), and mediolateral oscillation with eyes opened (P = .486) and with eyes closed (P = .602). In addition, no significant difference was observed in right (P = .881) and left (P = .060) plantar flexion ROM and in right (P = .540) and left (P = .341) dorsiflexion ROM. CONCLUSION: The results of this study suggest that a single session of bilateral grade III mobilization of the talocrural joint does not immediately improve balance and ROM in elderly women with low physical activity levels.

Effects of wheelchair sports on respiratory muscle strength and thoracic mobility of individuals with spinal cord injury.

OBJECTIVE: The aim of this study was to evaluate the effects of wheelchair sports on respiratory muscle strength and the thoracic mobility of individuals with spinal cord injury. DESIGN: Thirty male subjects with chronic spinal cord injury (American Spinal Injury Association Impairment Scale grade A) took part in the study and were divided into four groups: sedentary subjects with quadriplegia (S-QUAD, n = 7), wheelchair rugby athletes with quadriplegia (A-QUAD, n = 8), sedentary subjects with paraplegia (S-PARA, n = 6), and wheelchair basketball athletes with paraplegia (A-PARA, n = 9). The main outcome measures were maximal inspiratory and expiratory pressure and the respiratory coefficients at the axillary and xiphoid levels. RESULTS: A-QUAD group presented values significantly higher for all respiratory variables studied compared with the S-QUAD group. No significant differences in any of the respiratory variables were observed between S-PARA and A-PARA groups. There was a negative correlation between spinal cord injury level and respiratory variables for the S-QUAD and S-PARA groups. There were positive correlations in the A-QUAD group between time of training and maximal inspiratory pressure (adjusted R = 0.84; P = 0.001) and respiratory coefficients at the axillary level (adjusted R = 0.80; P = 0.002). CONCLUSIONS: Physical training seems to have a positive influence on respiratory muscle strength and thoracic mobility, especially in subjects with quadriplegia.

Swimming exercise in the acute or late phase after sciatic nerve crush accelerates nerve regeneration.

There is no consensus about the best time to start exercise after peripheral nerve injury. We evaluated the morphological and functional characteristics of the sciatic nerves of rats that began to swim immediately after crush nerve injury (CS1), those that began to swim 14 days after injury (CS14), injured rats not submitted to swimming (C), and uninjured rats submitted to swimming (S). After 30 days the number of axons in CS1 and CS14 was lower than in C (P < 0.01). The diameter of axons and nerve fibers was larger in CS1 (P < 0.01) and CS14 (P < 0.05) than in C, and myelin sheath thickness was lower in all crushed groups (P < 0.05). There was no functional difference between CS1 and CS14 (P > 0.05). Swimming exercise applied during the acute or late phase of nerve injury accelerated nerve regeneration and synaptic elimination after axonotmesis, suggesting that exercise may be initiated immediately after injury.

Adaptações do sistema respiratório referentes à função pulmonar em resposta a um programa de alongamento muscular pelo método de reeducação postural global / Respiratory system adaptations relative to pulmonary function in response to a muscle stretching program using the Global Posture Reeducation method

A proposta deste estudo foi analisar as adaptações do sistema respiratório referentes à função pulmonar em resposta ao alongamento da cadeia muscular respiratória pelo método de reeducação postural global (RPG). Foram estudados 20 homens, sedentários, de antropometria semelhante, sem antecedentes de doenças musculoesqueléticas ou cardiorrespiratórias. Os voluntários foram divididos aleatoriamente em dois grupos de dez, sendo um grupo controle (GC), que não participou do protocolo de alongamento, e o outro submetido à intervenção pelo método de RPG, denominado grupo tratado (GT). O alongamento foi realizado duas vezes por semana, durante oito semanas, totalizando 16 sessões. Os dois grupos foram submetidos à prova de função pulmonar, medindo-se a capacidade vital lenta, capacidade vital forçada e ventilação voluntária máxima, antes e após o período de intervenção. Os valores obtidos em todas as variáveis dos voluntários do GC na avaliação inicial não apresentaram diferença estatisticamente significante quando comparados aos obtidos na avaliação final (p0,05). No GT os valores finais apresentaram-se significativamente maiores que os iniciais (p0,05). O protocolo de alongamento da cadeia muscular respiratória proposto pelo método de RPG mostrou pois ser eficiente para promover aumento das variáveis espirométricas, sugerindo que pode ser utilizado como um recurso fisioterapêutico coadjuvante às condutas de fisioterapia respiratória..

The aim of this study was to analyse the respiratory system adaptations concerning pulmonary function in response to stretching the respiratory muscle chain, by means of global posture reeducation (GPR). Twenty sedentary young men with similar anthropometry and no history of musculoskeletal or cardiorespiratory disease were randomly divided into two groups of ten each: control group (CG), who did no stretching, and treated group (TG), submitted to GPR. Stretching was carried out twice a week for 8 weeks, in a total of 16 sessions. The two groups were submitted to pulmonary function tests to assess slow vital capacity, forced vital capacity and maximal voluntary ventilation, before and after the intervention period. The initial values of all spirometric variables measured in CG volunteers showed no statistically significant differences when compared to those of the final evaluation (p>0.05), whereas in TG all values increased after intervention (p<0.05). The GPR respiratory muscle chain stretching protocol thus proved efficient to promote an increase in spirometric variables, suggesting that it may be used as an auxiliary resource in respiratory physical therapy...

Muscle and nerve responses after different intervals of electrical stimulation sessions on denervated rat muscle.

OBJECTIVE: Electrical stimulation is a procedure used to treat denervated muscles. The number of electrical stimulation sessions varies across muscle rehabilitation protocols, from daily to certain days throughout the week. The purpose of this study was to evaluate how muscle and nerve respond to different intervals of electrical stimulation applied to denervated muscle. DESIGN: Denervation of rat gastrocnemius muscle was imposed via nerve crush, and electrical stimulation was applied to the muscle either daily (Monday through Friday) or on alternate days (Monday, Wednesday, and Friday). Four experimental groups were studied: denervated, denervated plus daily electrical stimulation, denervated plus alternate-day electrical stimulation, and control. RESULTS: On the 12th day after nerve crush, levels of MyoD, myostatin, and atrogin-1 gene expression, as well as muscle fiber and nerve morphometry, were evaluated. Expression levels of all three genes were higher in the denervated group when compared with control. Also, expression levels of MyoD and myostatin were higher in denervated plus alternate-day electrical stimulation and denervated plus daily electrical stimulation groups when compared with denervated. The denervated plus daily electrical stimulation group had lower atrogin-1 expression, lower density of intramuscular connective tissue, and better morphometric nerve characteristics when compared with the denervated and denervated plus alternate-day electrical stimulation. CONCLUSIONS: These results indicate that the responses of both muscle and nerve to electrical stimulation after muscle denervation depend on the intervals of electrical stimulation application.

Avaliação de um treinamento estático de carga parcial de peso / Evaluation of partial static weight load training

O treinamento da marcha com carga parcial é comum na prática do fisioterapeuta, entretanto, na área hospitalar, o tempo para esse treinamento é limitado, durando somente o tempo da internação. Dessa forma, este estudo tem como objetivo verificar o efeito do treinamento prévio de carga parcial de peso, em voluntárias sem lesões ortopédicas buscando direcionar esse treinamento para pacientes submetidos a cirurgias ortopédicas nos membros inferiores. Participaram deste estudo 32 voluntárias sem alterações posturais ou história de traumas nos membros inferiores. O treinamento de carga parcial foi realizado distribuindo-se 20 por cento da massa corporal total no membro inferior direito em uma balança digital antropométrica. As voluntárias foram divididas em dois grupos, sendo que o grupo I repetiu o treinamento 6 vezes e o grupo II, 12 vezes. Os dados da distribuição estática da carga foram coletados em uma plataforma de pressão Matscan-Tekscan® e comparados no pré e pós-treinamento. Foi verificado que houve diferença significativa no treinamento repetido 12 vezes (p< 0,015). O treinamento prévio de carga parcial mostrou-se eficaz para ser realizado no paciente durante a fase hospitalar, pois com apenas a realização do treinamento uma única vez, repetido 12 vezes, foi observado o aprendizado da carga parcial.

Gait training with partial load is common in a physical therapist practice; however, in the hospital environment, the time for this training is limited, lasting only for the time of hospitalization. Therefore, this study was aimed to check on the effects of previous partial weight load training in volunteers without orthopaedic injuries seeking to indicate it to patients submitted to orthopaedic surgeries on lower limbs. 32 volunteers showing no postural changes or history of trauma on lower limbs were included in this study. The partial load training was carried out by distributing 20 percent of the total body mass on the right lower limb in an anthropometric digital scale. The volunteers were divided into two groups, with group I repeating the drill 6 times, and group II 12 times. Data about the static load distribution were collected by a pressure platform Matscan-Tekscan® and compared on the pre- and post-training periods. A significant difference was found for 12-repetitions drills (p<0.015). Pre-training with partial weight load was shown to be effective to be applied on patients during hospitalization period, because with only a single drill repeated 12 times, partial load learning was noticed.

Efeito de um programa de alongamento muscular pelo método de Reeducação Postural Global sobre a força muscular respiratória e a mobilidade toracoabdominal de homens jovens sedentários / Effect of a muscle stretching program using the Global Postural Reeducation method on respiratory muscle strength and thoracoabdominal mobility of sedentary young males

OBJETIVO: Avaliar o efeito do alongamento da cadeia muscular respiratória, pelo método de Reeducação Postural Global (RPG), sobre a força muscular respiratória e a mobilidade toracoabdominal de homens jovens sedentários. MÉTODOS: Estudo randomizado, realizado com 20 voluntários sedentários, idade 22,65 ± 2,5 anos, divididos em dois grupos de 10: grupo controle, que não participou do alongamento, e grupo submetido à intervenção pelo método de RPG. O protocolo foi constituído por um programa de alongamento da cadeia muscular respiratória na postura 'rã no chão com os braços abertos' realizado com a regularidade de duas vezes por semana, durante 8 semanas, totalizando 16 sessões. Os dois grupos foram submetidos à avaliação da medida da pressão inspiratória máxima, pressão expiratória máxima e cirtometria toracoabdominal, antes e após o período de intervenção. RESULTADOS: Os valores das pressões respiratórias máximas e da cirtometria do grupo controle antes e após o período de intervenção não apresentaram alterações significativas (p > 0,05). No grupo RPG, os valores de todas as variáveis apresentaram diferenças estatisticamente significativas após o protocolo de intervenção (p < 0,05). CONCLUSÕES: O protocolo de alongamento da cadeia muscular respiratória proposto pelo método de RPG mostrou ser eficiente para promover o aumento das pressões respiratórias máximas e das medidas da cirtometria toracoabdominal, sugerindo que pode ser utilizado como um recurso fisioterapêutico para o desenvolvimento da força muscular respiratória e da mobilidade toracoabdominal.

OBJECTIVE: To evaluate the effect that respiratory muscle stretching using the global postural reeducation (GPR) method has on respiratory muscle strength, thoracic expansion and abdominal mobility in sedentary young males. METHODS: This was a randomized study involving 20 sedentary volunteers, aged 22.7 ± 2.5 years, divided into two groups of 10: a control group, composed of subjects not performing any exercises, and a group of subjects submitted to the GPR method. The protocol consisted of a program to stretch the respiratory muscles with participants in the 'open-arm, open hip joint angle' position, which was regularly performed twice a week for 8 weeks, totaling 16 sessions. The two groups were submitted to measurements of maximal inspiratory pressure, maximal expiratory pressure, thoracic expansion and abdominal mobility, prior to and after the intervention period. RESULTS: The initial and final values for maximal respiratory pressures, thoracic expansion and abdominal mobility for the control group showed no significant differences (p > 0.05). However, for the GPR group, all values increased after the intervention (p < 0.05). CONCLUSIONS: Respiratory muscle stretching using the GPR method was efficient in promoting an increase in maximal respiratory pressures, thoracic expansion and abdominal mobility, suggesting that it could be used as a physiotherapy resource to develop respiratory muscle strength, thoracic expansion and abdominal mobility.

[Effect of a muscle stretching program using the Global Postural Reeducation method on respiratory muscle strength and thoracoabdominal mobility of sedentary young males]. / Efeito de um programa de alongamento muscular pelo método de Reeducação Postural Global sobre a força muscular respiratória e a mobilidade toracoabdominal de homens jovens sedentários.

OBJECTIVE: To evaluate the effect that respiratory muscle stretching using the global postural reeducation (GPR) method has on respiratory muscle strength, thoracic expansion and abdominal mobility in sedentary young males. METHODS: This was a randomized study involving 20 sedentary volunteers, aged 22.7 +/- 2.5 years, divided into two groups of 10: a control group, composed of subjects not performing any exercises, and a group of subjects submitted to the GPR method. The protocol consisted of a program to stretch the respiratory muscles with participants in the 'open-arm, open hip joint angle' position, which was regularly performed twice a week for 8 weeks, totaling 16 sessions. The two groups were submitted to measurements of maximal inspiratory pressure, maximal expiratory pressure, thoracic expansion and abdominal mobility, prior to and after the intervention period. RESULTS: The initial and final values for maximal respiratory pressures, thoracic expansion and abdominal mobility for the control group showed no significant differences (p > 0.05). However, for the GPR group, all values increased after the intervention (p < 0.05). CONCLUSIONS: Respiratory muscle stretching using the GPR method was efficient in promoting an increase in maximal respiratory pressures, thoracic expansion and abdominal mobility, suggesting that it could be used as a physiotherapy resource to develop respiratory muscle strength, thoracic expansion and abdominal mobility.

Estudo baropodométrico em idosos submetidos à intervenção fisioterapêutica / Pedobarometric study in elderly after physical therapy intervention

Alterações durante o envelhecimento podem promover mudanças no controle postural. O objetivo deste trabalho foi verificar os efeitos de um programa regular de intervenção fisioterapêutica sobre a distribuição da pressão plantar. A intervenção foi aplicada a 29 idosos com idade média de 63,06 +/- 2,84 anos, durante 3 meses, a qual constou de exercícios de aquecimento, flexibilidade, estimulação proprioceptiva e estimulação sensorial cutânea plantar. Os exames de baropodometria foram realizados antes e após a intervenção, utilizando-se de uma plataforma de pressão computadorizada 9MatScan-Tekscan). Os resultados foram analisados pelos softwares Statistica 6.0 e Graph Pad Instat. As médias foram comparadas pelo teste t de Student com significância de 5 por cento. Após intervenção verificou-se que a área de contato da superfície plantar aumentou significativamente para as posições bipodais, tanto com os olhos abertos 7 por cento, quanto com os olhos fechados 6,5 por cento. Para as posições unipodais com olhos abertos ou fechados não houve diferença significativa. Com relação ao pico de pressão, somente a posição bipodal com os olhos abertos apresentou diminuição significativa de 8,5 por cento. Os resultados demonstraram que a intervenção proposta foi efetiva quando os voluntários foram examinados na condição bipodal. Estas mudanças sobre a distribuição dapressão plantar podem permitir melhora no controle postural em indivíduos idosos, tornando-os menos propensos a quedas.

Prevalência de lombalgia no setor de fisioterapia do município de Cosmópolis-SP e o papel da fisioterapia na sua prevenção e recuperação / Low-back pain prevalence in the unit of physical therapy in Cosmópolis-SP and the role of physical therapy in prevention and functional recovery

A incidência, prevalência e conseqüências da lombalgia nos países ocidentais merecem uma abordagem epidemiológica, pois a lombalgia pode causar limitações funcionais, internações, cirurgias, afastamento do trabalho e, muitas vezes, impossibilidade para a atividade profissional. Esses problemas geram ônus ao Estado, às empresas e aos próprios trabalhadores, afetando diretamente o aspecto bio-psicosocial do indivíduo. No Setor de Fisioterapia de Cosmópolis- SP, a prevalência de lombalgia no período de março de 2001 a março de 2002 foi de 22,2%, havendo significativa discrepância em sua distribuição, em relação às outras doenças que ocorreram no mesmo período (p<0,05). Nesse contexto, discute-se o panorama nacional das alterações que envolvem a coluna vertebral (de 2000 a 2002), no que se refere aos encargos com internações hospitalares e número de acidentes de trabalho, que levam ao afastamento do trabalhador. Discute-se, também, aspectos da intervenção fisioterapêutica no âmbito da promoção de saúde, prevenção e recuperação funcional.

The incidence, prevalence and consequences of low back pain in the western countries deserve an epidemiological approach, due to the functional limitations that they promote, such as internments, surgeries, absence of the work and, a lot of times, impossibility for the professional activity. These problems generate obligation to the State, to the companies and to the own workers, affecting directly the individual biopsico- social aspects. In the physical therapy unit of Cosmópolis- SP, the low-back pain prevalence in the period of March/2001 to March/2002 was 22.2% in respect to the other diseases that happened in the same period (p<0.05). In this context, the national panorama of the alterations that involves the spine (from 2000 to 2002) is discussed, pondering the responsibilities with hospital internments and number of work accidents that lead to the worker’s removal. In this study, the feature of physical intervention on health promotion, prevention and functional recovery is discussed too.

Distribuição da pressão plantar e localizaçãodo centro de força após intervenção pelométodo de reeducação postural global: um estudo de caso / Plantar pressure distrbution and center force location after postural global reeducation: a case relate

Aferências de receptores plantares e proprioceptivos fornecem ao sistema nervoso informações necessárias ao controle postural. Alterações desses mecanismos neuromusculares provocadas por traumas podem causar dano articular e alterações posturais permanentes. Este estudo avaliou as modificações na distribuição da pressão plantar e localização do centro de força em sujeito com história de entorse de tornozelo direito, utilizando uma plataforma de pressão Tekscan-Matscan, cujo apoio bipodal livre e com os olhos abertos. Após constatação de assimetria na distribuição da pressão plantar, realizou-se uma sessão de Reeducação PosturaL Global (RPG), seguida de avalições em plataforma de pressão imediatamente após a intervenção e após 7, 14 e 30 dias da mesma. Os resultados mostraram recuperação evidente da simetria, que se manteve por 7 dias. Após esse período, houve tendência à recuperação gradativa da assimetria, não alcançando, no entanto, os valores iniciais após 30 dias. Conclui-se que uma única sessão de RPG foi eficiente para reequilibrar a distribuição das pressões de contato e isso interferiu positivamente na localização do centro de força, porém, não promoveu a correção definitiva, sugerindo a necessidade de maior número de sessões para promover a adaptação do sistema nervoso às novas entradas proprioceptivas e, consequentemente, de sessões para promover a adaptação do sistema nervoso às novas entradas proprioceptivas e, consequentemente, uma resposta sustentada. Os resultados sugerem ainda que a frequência de uma intervenção semanal na prática clínica para esse tipo de alteração seria suficiente par aum programa de tratamento