Effect of different Volumes of exercise on skin temperature responses over the following 24 hours.

Skin temperature responses have been advocated to indicate exercise-induced muscle soreness and recovery status. While the evidence is contradictory, we hypothesize that the presence of muscle damage and the time window of measurement are confounding factors in the skin temperature response. The objective was to determine whether skin temperature is influenced by different workloads and the time course of temperature measurements over the following 24 h. 24 trained male military were assigned to one of three groups: GC group (n = 8) serving as control not performing exercises, GE group (n = 8) performing a simulated military combat protocol in an exercise track with different obstacles but designed not to elicit muscle damage, and the GEMD group (n = 8) performing the simulated military combat protocol plus 5 sets of 20 drop jumps, with 10-sec between repetitions and with 2-min of rest between sets aiming to induce muscle damage. Skin temperature was measured using infrared thermography before exercise (Pre) and 4 (Post4h), 8 (Post8h) and 24h (Post24h) post-exercise. Perception of pain (DOMS) was evaluated Pre, Post24h, and Post48h, and countermovement jump height was evaluated at Pre and Post24h. DOMS did not differ between groups in the Pre and Post24h measures but GEMD presented higher DOMS than the other groups at Post48h (p < 0.001 and large effect size). Jump height did not differ for GEMD and GC, and GE presented higher jump height at Post24h than GC (p = 0.02 and large effect size). Skin temperature responses of GEMD and GG were similar in all measurement moments (p > 0.22), and GE presented higher skin temperature than the GC and the GEMD groups at Post24h (p < 0.01 and large effect sizes). In conclusion, although physical exercise elicits higher skin temperature that lasts up to 24 h following the efforts, muscle soreness depresses this response.

Local experience of laboratory activities in a BS physical therapy course: integrating sEMG and kinematics technology with active learning across six cohorts.

Introduction: Integrating technology and active learning methods into Laboratory activities would be a transformative educational experience to familiarize physical therapy (PT) students with STEM backgrounds and STEM-based new technologies. However, PT students struggle with technology and feel comfortable memorizing under expositive lectures. Thus, we described the difficulties, uncertainties, and advances observed by faculties on students and the perceptions about learning, satisfaction, and grades of students after implementing laboratory activities in a PT undergraduate course, which integrated surface-electromyography (sEMG) and kinematic technology combined with active learning methods. Methods: Six cohorts of PT students (n = 482) of a second-year PT course were included. The course had expositive lectures and seven laboratory activities. Students interpreted the evidence and addressed different motor control problems related to daily life movements. The difficulties, uncertainties, and advances observed by faculties on students, as well as the students' perceptions about learning, satisfaction with the course activities, and grades of students, were described. Results: The number of students indicating that the methodology was "always" or "almost always," promoting creative, analytical, or critical thinking was 70.5% [61.0-88.0%]. Satisfaction with the whole course was 97.0% [93.0-98.0%]. Laboratory grades were linearly associated to course grades with a regression coefficient of 0.53 and 0.43 R-squared (p < 0.001). Conclusion: Integrating sEMG and kinematics technology with active learning into laboratory activities enhances students' engagement and understanding of human movement. This approach holds promises to improve teaching-learning processes, which were observed consistently across the cohorts of students.

Can infrared thermography serve as an alternative to assess cumulative fatigue in women?

Muscle fatigue can limit performance both in sports and daily life activities. Consecutive days of exercise without a proper recovery time may elicit cumulative fatigue. Although it has been speculated that skin temperature could serve as an indirect indicator of exercise-induced adaptations, it is unclear if skin temperature measured by infrared thermography (IRT) could be an outcome related to the effects of cumulative fatigue. In this study, we recruited 21 untrained women and induced cumulative fatigue in biceps brachii over two consecutive days of exercise. We measured delayed onset muscle soreness (DOMS, using a numeric rate scale), maximal strength (using a dynamometer), and skin temperature (using IRT) in exercise and non-exercise muscles. Cumulative fatigue reduced muscle strength and increased DOMS. Skin temperature in the arm submitted to cumulative fatigue was higher for minimum and mean temperature, being asymmetrical in relation to the control arm. We also observed that the variations in the minimum and mean temperatures correlated with the strength losses. In summary, skin temperature measured by IRT seems promising to help detect cumulative fatigue in untrained women, being useful to explain strength losses. Future studies should provide additional evidence for the potential applications not only in trained participants but also in patients that may not be able to report outcomes of scales or precisely report DOMS.

Short-term foot warming impacts foot sensitivity and body sway differently in older adults.

BACKGROUND: Aging is accompanied by loss of foot skin sensitivity and reduced postural control. Increasing foot temperature can improve both skin sensitivity and postural control in adults. However, it remains unclear whether similar effects can be observed in older adults. RESEARCH QUESTION: Can foot warming improve postural control in older adults, similar to observations in younger adults? METHODS: Two foot warming protocols were conducted in 18 older adults (14 women, 4 men) to increase foot temperature by using infrared radiation to (1) warm the plantar aspect and (2) the skin of the entire foot and ankle area. We assessed the foot skin sensitivity before and after warming, considering tactile stimulation and center of pressure (CoP) displacement during 30-s standing with eyes open and closed. RESULTS AND SIGNIFICANCE: Both foot warming protocols led to similar increases in skin temperature (∼6 °C) compared to the basal condition, but only warming the entire foot and ankle area increased foot sensitivity for the different regions assessed. No main effects or interactions were found for CoP variables in response to the two warming protocols. The short-term effects identified after warming the entire foot and ankle region suggest that this might be a strategy to improve skin sensitivity in older adults as observed in younger adults, but this was not the case for CoP. Future research should clarify whether the magnitude and long-lasting effects of warming could be determinant of CoP results.

Reproducibility of skin temperature analyses by novice and experienced evaluators using infrared thermography.

Infrared thermography (IRT) has become popular in several areas of knowledge. However, the analyses of thermal images often request manual actions, and little is known about the effect of the evaluator's experience on analysis thermal images. Here, we determine the reproducibility of IRT images analysis performed by evaluators with different levels of experience. Eight evaluators (GE, group experienced, n = 4; GN, group novice, n = 4) analyzed thermograms from 40 healthy participants recorded before and after exercise to determine the mean, minimum, maximum, standard deviation, and range of skin temperature in the anterior thigh and posterior leg. Before and after exercise, mean temperature showed excellent reproducibility for both groups for the anterior thigh (ICC >0.98) and posterior leg (ICC >0.94), and maximum temperature showed excellent reproducibility for both groups in the posterior leg (ICC >0.91). The influence of experience level was not significant considering the anterior thigh. Similarly, experience level did not affect the mean, maximum, and standard deviation temperature determined for the posterior leg. For the posterior leg, minimum temperature presented lower values and the range was higher among novice evaluators. Mean skin temperature showed narrower 95% limits of agreement than minimum and maximum for both regions and moments. Caution is advised when temperature ranges and minimums are determined by different evaluators. We conclude that for IRT analysis by evaluators with different levels of experience, the mean and maximum temperatures should be prioritized due to their better reproducibility.

Effects of different hydration supports on stride kinematics, comfort, and impact accelerations during running.

BACKGROUND: Different supports for hydration can influence total body mass and affect running biomechanics. RESEARCH QUESTION: Do different hydration supports affect the perceived exertion and comfort, stride kinematics, and impact accelerations during running? METHODS: This was a crossover study design. Thirteen trail runners completed a treadmill running test divided into four different durations and randomized hydration supports conditions, lasting 8 min each at moderate intensity: A) waist bag (0.84 kg); B) medium load backpack (0.84 kg); C) full load backpack (3.40 kg); and D) a control condition without water support. Impact accelerations were measured for 30 s in 4, 6, and 8 min. The rate of perceived exertion and heart rate were registered on minutes 4 and 8. At the last minute of each condition, comfort perception was registered RESULTS AND SIGNIFICANCE: No condition affected the stride kinematics. Full load backpack condition reduced head acceleration peak (-0.21 g; p = 0.04; ES=0.4) and head acceleration magnitude (-0.23 g; p = 0.03; ES=0.4), and increased shock attenuation (3.08 g; p = 0.04; ES=0.3). It also elicited higher perceived exertion (p < 0.05; ES>0.8) being considered heavier (p < 0.01; ES > 1.1). The waist bag condition was more comfortable in terms of noise (p = 0.006; ES=1.3) and humidity/heat (p = 0.001; ES=0.8). The waist bag was the most comfortable support. On the other hand, the full backpack elicited lower comfort and was the only generating compensatory adjustments. These results may help to improve design of full load backpack aiming at comfort for runners.

Effects of increasing temperature in different foot regions on foot sensitivity and postural control in young adults.

Despite controversial evidence, foot sensitivity may influence postural control. Since skin temperature changes may induce changes in skin sensitivity, it remains unclear whether this also affects postural control. Here we examined the effects of increasing foot temperature on foot sensitivity and postural control responses. It is hypothesized that increases in foot temperature would improve foot sensitivity and enhance postural control. Furthermore, it was investigated whether warming a larger foot area provides additional benefits. Our hypothesis was tested by warming the foot plantar and the whole foot and ankle area (including foot plantar and instep) using infrared radiation and evaluated the center of pressure (CoP, bilateral, in two conditions: eyes open and eyes closed) and foot tactile sensitivity (Semmes-Weinstein Monofilaments) in 22 young participants. Both warming protocols significantly increased foot temperature by ∼5-6 °C and improved sensitivity, whereas more considerable improvements happened after warming the whole foot and ankle. CoP mediolateral oscillation and velocity with eyes open, and CoP area and velocity with eyes closed reduced after both warming protocols. Foot sensitivity seems to depend on the foot area warmed, whereas postural control improved equally regardless of the warmed regions. These results may support interventions based on the manipulation of foot temperatures to improve postural control with potential clinical applications in populations with impaired foot sensitivity and balance.

Relationship between exercise-induced muscle soreness, pain thresholds, and skin temperature in men and women.

Infrared thermography (IRT) has gained popularity in sports medicine for determining whether changes in skin temperature relate to pain and muscle damage. Such a relationship would support IRT as a non-invasive method to monitor these physiological responses. However, the literature remains controversial. Here, we determine the relationship between exercise-induced muscle soreness (DOMS), pain, and skin temperature in men and women before and after exercise. Twenty-two physically active adults (10 men and 12 women) completed a squat exercise protocol to induce muscle damage. Skin temperature, DOMS, and pressure pain threshold (PPT) were assessed in the quadriceps pre, post-exercise, and 48 h post-exercise. DOMS increased similarly in men and women post-exercise and 48 h post-exercise. PPT was lower in women compared to men. PPT decreased 48 h post-exercise for men but did not differ between the moments for women. Skin temperature responses were sex-dependent. Mean and maximum temperatures increased post-exercise for men, and maximum temperature reduced 48 h post-exercise. In women, the minimum temperature increased 48 h post-exercise. DOMS was not predicted by skin temperature but showed a direct association between pre and 48 h post-exercise variation of maximum skin temperature and PPT. We conclude that there is a sex-dependent effect in analyzing skin temperature changes in response to exercise, something that seems to not have been addressed in previous studies. To date, inferences are generally assumed as similar for both men and women, which we show may not be the case.

Effects of 24 h Compression Interventions with Different Garments on Recovery Markers during Running.

Compression and temperature manipulation are discussed as strategies to improve performance markers and recovery in sports. Here, we investigate the effects of compression stockings made with fabric, either combined or not with heating and cooling substances, on variables related to running performance and recovery. Ten trained runners (mean ± standard deviation age 45 ± 9 years old, body mass 69 ± 7 kg, height 166 ± 4 cm) with no experience of using compression garments performed an intense running session of 10 km, then wore a stocking for 24 h (randomized; without compression, compression, compression with camphor, and compression with menthol), and were evaluated on the following day, after running 5 km. The different types of compression stockings used 24 h before exercise did not affect running kinematics (p > 0.14), skin temperature (p > 0.05), heart rate (p > 0.12; mean value of maximal heart rate 156 bpm), comfort perception (p = 0.13; mean value of 7/10 points), or perception of recovery (p = 0.13; mean value of 7/10 points). In general, there were no effects of 24 h pre-exercise lower leg compression, including those treated with menthol and camphor applications on running kinematics, skin temperature, heart rate, or recovery perception in athletes undertaking consecutive running exercises.

Functional data analysis reveals asymmetrical crank torque during cycling performed at different exercise intensities.

Pedaling asymmetry is claimed as a factor of influence on injury and performance. However, the evidence is still controversial. Most previous studies determined peak torque asymmetries, which in our understanding does not consider the pattern of movement like torque profiles. Here we demonstrate that asymmetries in pedaling torque at different exercise intensities can be better described when the torque profiles are considered using functional analysis of variance than when only the peak values are analyzed. We compared peak torques and torque curves recorded while cyclists pedaled at submaximal intensities of 60%, 80%, and 95% of the maximal power output and compared data between the preferred and non-preferred legs. ANOVA showed symmetry or rather no difference in the amount of peak torque between legs, regardless of pedaling intensity. FANOVA, on the other hand, revealed significant asymmetries between legs, regardless of cycling intensity, apparently for different sections of the cycle, however, not for peak torque, either. We conclude that pedaling asymmetry cannot be quantified solely by peak torques and considering the analysis of the entire movement cycle can more accurately reflect the biomechanical movement pattern. Therefore, FANOVA data analysis could be an alternative to identify asymmetries. A novel approach as described here might be useful when combining kinetics assessment with other approaches like EMG and kinematics and help to better understand the role of pedaling asymmetries for performance and injury risks.

Influence of infrared camera model and evaluator reproducibility in the assessment of skin temperature responses to physical exercise.

Infrared thermography (IRT) has been gaining in popularity in clinical and scientific research due to the increasing availability of affordable infrared cameras. This study aims to determine the similarity of measurement performance between three models of IRT camera during assessment of skin temperature before and after physical exercise. Three models of FLIR thermographic cameras (E60bx, Flir-One Pro LT, and C2) were tested. Thermal images were taken of the foot sole, anterior leg, and anterior thigh from 12 well-trained men, before and after a 30-min run on a treadmill. Image files were blinded and processed by three evaluators to extract the mean, maximum, and standard deviation of skin temperature of the region of interest. Time for data processing and rate of perceived effort was also recorded. Data processing was slower on the E60bx (CI95% E60 vs C2 [0.2, 2.6 min], p = 0.02 and ES = 0.6); vs. Flir-One [0.0, 3.4 min], p = 0.03 and ES = 0.6) and was associated with lower effort perception (E60 3.0 ± 0.1 vs. Flir-One 5.6 ± 0.2 vs C2 7.0 ± 0.2 points; p < 0.001 and ES > 0.8). The C2 and Flir-One cameras underestimated the temperature compared with the E60. In general, measuring mean temperature provided higher camera and examiner intra-class correlations than maximum and standard deviation, especially before exercise. Moreover, post exercise mean skin temperatures provided the most consistent values across cameras and evaluators. We recommend the use of mean temperature and caution when using more than one camera model in a study.

Winter School on sEMG Signal Processing: An Initiative to Reduce Educational Gaps and to Promote the Engagement of Physiotherapists and Movement Scientists With Science.

The application of surface electromyography (sEMG) in neurology is sometimes limited by a scientific background in the use of sEMG. Students frequently use sEMG only when developing their graduate studies. To reduce these barriers, we promoted a free Winter School on sEMG to Latin American students. The school was a 3-day event with theoretical classes and computer programming in Matlab. Lectures were delivered in Portuguese and Spanish to 50 participants. All lectures were recorded and made available on YouTube®. After the School, participants completed a written exam to receive a certificate. The written exam revealed the average effectiveness of 71 ± 20% in the comprehension of topics addressed during the school. Participants rated the School as "excellent" and considered the event as having changed their thoughts about the use of sEMG. Limited mathematical skills or background were the main barriers identified to follow the lectures and to make use of sEMG. We conclude that the Winter School had a positive impact on participant's formation, especially by showing them the importance of continuous involvement with the concepts related to sEMG to become proficient in its use. From the participant's point of view, the activity was excellent and the follow up of the school on YouTube® suggests that combining face-to-face activities followed by the online availability of lectures is a valid strategy to reinforce the learning process and to reduce barriers in the use of sEMG. Whether similar results would be achieved for a paid registration event in an economically developing region, still requires further investigation.

Acute responses to barefoot 5 km treadmill running involve changes in landing kinematics and delayed onset muscle soreness.

BACKGROUND: Barefoot running has gained popularity among physical activity practitioners, but there is a lack of information regarding the acute adaptations to this running technique without supervision. Information about acute adaptations can help to define the best way to insert barefoot running in the routine of runners willing to, and also provide orientation for those people who want to experience this technique. RESEARCH QUESTION: What acute adaptations can be observed among recreational runners exposed to barefoot running? METHODS: Sagittal 2D kinematics, plantar pressure, foot sensitivity and delayed onset muscle soreness were compared between conditions of shod and barefoot running in 13 recreational runners who performed two trials of 5 km treadmill running. RESULTS: We found an acute effect of barefoot running on foot landing that changes from a rearfoot strike to a forefoot strike pattern. This change most likely contributed to the increase in neuromuscular recruitment of calf muscles (i.e. gastrocnemius and soleus) resulting in higher perception of delayed onset muscle soreness. Barefoot running also elicited higher stride cadence. Plantar pressure before and after running revealed higher pressure in the different foot regions after barefoot running. Foot sensitivity increased after running regardless of the footwear condition. CONCLUSION: Barefoot running has acute effects on running technique including higher perception of delayed onset muscle soreness in the 48 h following the exercise. SIGNIFICANCE: Our results highlight the importance of following participants for days after a first session of barefoot running in order to properly manage the acute adaptation periods as well provide precise advices for those trying the barefoot technique.

Can exercise-induced muscle damage be related to changes in skin temperature?

OBJECTIVE: Measurement of skin temperature using infrared thermography has become popular in sports, and has been proposed as an indicator of exercise-induced muscle damage after exercise. However, the relationship between skin temperature and exercise-induced muscle damage is still unclear. Here we set out to investigate the relationship between skin temperature and exercise-induced muscle damage. APPROACH: Twenty untrained participants completed a protocol of exercise for calf muscles. Before and after exercise blood samples were collected to determine creatine kinase and acetylcholinesterase activity. Thermal images were recorded from the exercised muscles to determine skin temperature. Delayed onset muscle soreness was quantified. Correlations between skin temperature and exercise-induced muscle damage were analyzed considering thermal data, creatine kinase and acetylcholinesterase activity at different time moments. MAIN RESULTS: We found delayed onset muscle soreness and an increased creatine kinase activity 48 h after exercise (P < 0.01). Skin temperature parameters (average, maximal, amplitude and difference pre- and post-exercise, immediately after and 48 h after) did not correlate with the creatine kinase responses (P > 0.05). Acetylcholinesterase activity remained stable (P = 0.59). SIGNIFICANCE: We recommend caution when considering changes in skin temperature as dependent on the level of localized and symmetric muscle damage considering calf muscles in untrained participants.

Green Tea Extract Preserves Neuromuscular Activation and Muscle Damage Markers in Athletes Under Cumulative Fatigue.

A main implication of cumulative fatigue is the muscle damage that impairs neuromuscular function and training adaptations. These negative effects may limit performance when athletes exercise in consecutive days. In this regard, antioxidant supplementation has gain popularity among athletes. Green tea supplementation has been advocated as a strategy to improve exercise recovery due to the activity of its catechins with high antioxidant and anti-inflammatory potential. Here we performed a triple blinded placebo control experiment to determine the effect of green tea extract (GTE) from Camellia sinensis on muscle damage, oxidative stress, and neuromuscular activity in athletes submitted to consecutive sessions of exercise and fatigue. Sixteen trained amateur male athletes were randomly assigned to a GTE supplemented (500 mg/day) or placebo group during 15 days. Effects of supplementation were tested during repeated trials of submaximal cycling at 60% of peak power output performed after a protocol for cumulative fatigue of knee extensors. Muscle damage and oxidative stress showed lower magnitudes in response to fatigue after GTE supplementation. Placebo group showed impaired neuromuscular activity and higher muscle damage and oxidative stress compared to the GTE group during the cycling trials under fatigue. In summary, GTE supplementation showed positive effects on neuromuscular function in response to a condition of cumulative fatigue. It suggests GTE supplementation may have potential to serve as a strategy to improve performance and recovery in conditions of cumulative exercise.

Effect of green tea extract supplementation on exercise-induced delayed onset muscle soreness and muscular damage.

Previous studies addressed the antioxidant and anti-inflammatory role of compounds from green tea in different human tissues. Positive antioxidant and anti-inflammatory effects were described for brain tissues. Whether similar effects are observed in the skeletal muscle, green tea supplementation could be a strategy to reduce delayed onset muscle soreness resultant of exercise. Here we determine the effect of green tea extract supplementation on exercise-induced muscle soreness, muscle damage and oxidative stress. We performed a randomized triple blind placebo control study. Twenty non-trained men performed sessions of exercise to induce delayed onset muscle soreness in the triceps sural muscle group before and after 15 days of supplementation (500 mg/day) with green tea extract (n = 10) or a placebo (n = 10). Muscle soreness was evaluated using a visual scale. Blood samples were taken at different moments to determine serum blood markers of muscle damage, oxidative stress and antioxidant status. We found that exercise induced delayed onset muscle soreness. Supplementation reduced muscle damage but muscle soreness did not change. Plasma oxidative damage marker and antioxidant status did not show an effect of supplementation. As a conclusion, green tea extract supplementation did not reduce the sensation of delayed onset muscle soreness but reduces the marker of muscle damage after exercise. It suggests the green tea extract supplementation has positive effects on muscle recovery after strenuous exercise.

Post-stroke psychosis: how long should we treat?

OBJECTIVE:: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. CASE DESCRIPTION:: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone). At 2-year follow-up, he no longer had delusional activity and the antipsychotic treatment was gradually discontinued over the following year. However, 1 week after full cessation, the patient once more became agitated and suspicious and was put back on risperidone at 0.25 mg/day, resulting in rapid clinical remission. One year after the return to low-dose risperidone, the patient's psychopathology is still under control and he is free from psychotic symptoms. COMMENTS:: Psychosis is a relatively rare complication after stroke. To our knowledge, no cases of post-stroke psychosis that apparently require continuous low-dose antipsychotic treatment have been reported to date. Our case suggests that low-dose maintenance antipsychotic therapy may be needed for certain patients with post-stroke psychosis, especially for those with risk factors and non-acute onset.

Post-stroke psychosis: how long should we treat? / Psicose após acidente vascular cerebral: até quando devemos tratar?

Abstract Objective: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. Case description: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone). At 2-year follow-up, he no longer had delusional activity and the antipsychotic treatment was gradually discontinued over the following year. However, 1 week after full cessation, the patient once more became agitated and suspicious and was put back on risperidone at 0.25 mg/day, resulting in rapid clinical remission. One year after the return to low-dose risperidone, the patient's psychopathology is still under control and he is free from psychotic symptoms. Comments: Psychosis is a relatively rare complication after stroke. To our knowledge, no cases of post-stroke psychosis that apparently require continuous low-dose antipsychotic treatment have been reported to date. Our case suggests that low-dose maintenance antipsychotic therapy may be needed for certain patients with post-stroke psychosis, especially for those with risk factors and non-acute onset.

Resumo Objetivo: Descrever o caso raro de um paciente que desenvolveu sintomas psicóticos após um acidente vascular cerebral (AVC) no nível do hemisfério direito que remitiram com tratamento antipsicótico, mas parece precisar de uma terapêutica de manutenção com antipsicótico em baixa dosagem. Descrição de caso: Um homem de 65 anos apresentou-se no serviço de urgência psiquiátrica por um quadro persistente de delírio de ciúmes, ilusões visuais e agitação com início cerca de 1 mês após AVC isquêmico no nível da artéria cerebral posterior direita. Esses sintomas só desapareceram com doses terapêuticas de antipsicótico (risperidona 3 mg/dia). Após 2 anos de seguimento, o paciente não mais apresentava atividade delirante, e o tratamento antipsicótico foi progressivamente descontinuado durante o ano seguinte. No entanto, 1 semana após a suspensão total, o paciente começou a ficar agitado e desconfiado, tendo-se reiniciado a risperidona 0,25 mg/dia, com rápida remissão clínica. O paciente está medicado com esta baixa dose de antipsicótico há um ano, permanecendo psicopatologicamente compensado e sem sintomas psicóticos. Comentários: A psicose é uma complicação relativamente rara após AVC. Segundo nosso conhecimento, não há casos descritos até ao momento de psicose após AVC que, aparentemente, requerem uma dose baixa contínua de antipsicótico. Nosso caso sugere que uma terapêutica de manutenção com antipsicótico em baixa dosagem pode ser necessária para determinados pacientes com psicose após AVC, especialmente para aqueles com fatores de risco e início não agudo dos sintomas.

Effects of plantar foot sensitivity manipulation on postural control of young adult and elderly.

INTRODUCTION: Subjects with sensorial losses present balance deficits. Although such condition is often observed among elderly, there is discussion concerning the dependence on sensorial information for body sway control in the elderly without sensorial losses. PURPOSE: We investigated the effects of foot sensitivity manipulation on postural control during upright standing in young adults and independent elderly (n=19/group). METHODS: Plantar sensitivity was evaluated by esthesiometry, and speed of center of pressure shift data during upright posture were evaluated for each foot using a baropodometer while the subjects were standing with eyes open or closed. The young adult group was evaluated for center of pressure in normal conditions and after plantar sensitivity disturbance, by immersing their feet in water and ice. RESULTS: Young adults did not show alterations in their center of pressure after sensorial perturbation and presented, even under sensorial perturbation, better postural control than elderly subjects. The elderly showed lower foot sensitivity and greater center of pressure oscillation than young adults. CONCLUSION: Elderly subjects seem to rely more on foot sensitivity for control of body sway than young adults. In the elderly, a clinical intervention to improve foot sensitivity may help in upright posture maintenance.

Effects of plantar foot sensitivity manipulation on postural control of young adult and elderly / Efeitos da manipulação da sensibilidade plantar sobre o controle da postura ereta em adultos jovens e idosos

ABSTRACT Introduction: Subjects with sensorial losses present balance deficits. Although such condition is often observed among elderly, there is discussion concerning the dependence on sensorial information for body sway control in the elderly without sensorial losses. Purpose: We investigated the effects of foot sensitivity manipulation on postural control during upright standing in young adults and independent elderly (n = 19/group). Methods: Plantar sensitivity was evaluated by esthesiometry, and speed of center of pressure shift data during upright posture were evaluated for each foot using a baropodometer while the subjects were standing with eyes open or closed. The young adult group was evaluated for center of pressure in normal conditions and after plantar sensitivity disturbance, by immersing their feet in water and ice. Results: Young adults did not show alterations in their center of pressure after sensorial perturbation and presented, even under sensorial perturbation, better postural control than elderly subjects. The elderly showed lower foot sensitivity and greater center of pressure oscillation than young adults. Conclusion: Elderly subjects seem to rely more on foot sensitivity for control of body sway than young adults. In the elderly, a clinical intervention to improve foot sensitivity may help in upright posture maintenance.

RESUMO Introdução: Pessoas com perdas sensoriais apresentam déficits de equilíbrio. Embora esse quadro seja comum em idosos, ainda se discute o quanto idosos sem doenças que afetam as vias sensoriais dependem dessa informação para controlar oscilações corporais durante o controle da postura. Objetivo: Investigar os efeitos da perturbação da sensibilidade plantar sobre o controle da postura ereta em adultos jovens e idosos independentes (n = 19/grupo). Métodos: A sensibilidade plantar foi avaliada com estesiômetro e dados de velocidade e deslocamento do centro de pressão durante a postura de pé foram avaliados para cada pé com um baropodômetro, em condições de olhos abertos e fechados. O grupo de adultos jovens foi avaliado quanto ao centro de pressão nas condições normal e pós-perturbação da sensibilidade plantar, pela imersão dos pés em água e gelo. Resultados: Adultos não apresentaram alterações no centro de pressão em resposta à perturbação sensorial e tiveram, mesmo na condição de perturbação sensorial, melhor controle postural do que idosos. Idosos apresentaram menor sensibilidade plantar e maior oscilação do centro de pressão do que os adultos jovens. Conclusão: Idosos pareceram depender mais da sensibilidade plantar para manter o controle postural do que adultos jovens. Em idosos, intervenções clínicas que melhorem a sensibilidade plantar podem auxiliar na tarefa de manter a postura de pé.