Effects of three physical exercise modalities on respiratory function of older adults with Parkinson's disease: A randomized clinical trial.

INTRODUCTION: Deficits in respiratory function of patients with Parkinson's disease contribute to aspiration pneumonia, one of the main causes of mortality in this population. The aim of this study was to evaluate the effects of functional training, bicycle exercise, and exergaming on respiratory function of elderly with Parkinson's disease. METHODS: A randomized clinical trial with single blinding was conducted in a public reference outpatient clinic for the elderly. The participants were randomly assigned to three groups. Group 1 was submitted to functional training (n = 18); group 2 performed bicycle exercise (n = 20), and group 3 trained with Kinect Adventures exergames (n = 20). The sessions performed lasted 8 weeks with a frequency of three 50-min sessions per week. The primary outcome was the forced expiratory volume in the first second; and the secondary outcomes were forced vital capacity, peak expiratory flow, and maximum inspiratory and expiratory pressures. RESULTS: The interventions performed did not improve the forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow. However, group 2 improved (p = 0.03) maximum expiratory pressure (from 65.5cmH2O to 73.1cmH2O) (effect size 0.47), and group 3 increased (p = 0.03) maximum inspiratory pressure (from -61.3cmH2O to -71.6cmH2O) (effect size 0.53). CONCLUSIONS: No effect was found on lung volume, forced respiratory flow and capacity of the participants with Parkinson's disease submitted to three different modalities of motor training. However, bicycle exercise and exergaming have improved expiratory and inspiratory muscle strength, respectively. NCT02622737.

Prevalence of temporomandibular disorders in the Brazilian population: A systematic review and meta-analysis.

This systematic review aimed to assess the prevalence of temporomandibular disorders (TMD) in the Brazilian population, with studies that used the RDC/TMD or DC/TMD as diagnostic tools. A total of 6365 people from 11 studies were included. Sample mean age ranged from 12 to 69.5 years. The pooled prevalence of TMD was 33.6% (95% CI 31.5-35.8; I2 = 37.2). Prevalence of TMD was higher in females (37.0%) than in males (29.3%). Our results indicate that TMD is a prevalent condition across Brazil's territories. The results from this meta-analysis can help calculate more accurate sample sizes for future studies.

Discharge outcomes as predictors of social participation in the community after a stroke: a cohort study.

The mapping of possible predictors of restrictions in the social participation of people after stroke in the community can be an essential tool to support the development of rehabilitation strategies even in the hospital environment. This study aimed to identify whether mobility, functional balance and dependence on functionality at hospital discharge can predict restrictions on social participation 1 year after stroke in the community. This is a hospital-based cohort study, with individuals over 18 years old admitted with a diagnosis of acute stroke included. People with dementia, previous functional limitations and cancer patients were omitted. Mobility, balance and functional independence were the predictor variables at hospital discharge, and the outcome of interest was social participation assessed 1 year after a stroke in the community. Forty-eight patients were included after a 1-year follow-up. The degree of functional independence at hospital discharge ( ß = 0.813; P < 0.01) was the independent predictor of social participation, specifically the locomotion ( ß = 0.452; P < 0.001) and social cognition ( ß = 0.462; P < 0.001) related to functional independence. Mobility ( ß = 0.040; P = 0.777) and functional balance ( ß = 0.060; P = 0.652) did not show an independent association. Cognitive functional independence was a predictor of daily activities ( ß = 0.786; P < 0.001), social roles ( ß = 0.390; P = 0.014) and satisfaction ( ß = 0.564; P < 0.001) of social participation. The degree of functional independence of people after a stroke at hospital discharge was able to predict the level of social involvement in the community one year after the stroke.

Stickiness and recurrence plots: An entropy-based approach.

The stickiness effect is a fundamental feature of quasi-integrable Hamiltonian systems. We propose the use of an entropy-based measure of the recurrence plots (RPs), namely, the entropy of the distribution of the recurrence times (estimated from the RP), to characterize the dynamics of a typical quasi-integrable Hamiltonian system with coexisting regular and chaotic regions. We show that the recurrence time entropy (RTE) is positively correlated to the largest Lyapunov exponent, with a high correlation coefficient. We obtain a multi-modal distribution of the finite-time RTE and find that each mode corresponds to the motion around islands of different hierarchical levels.

Body structure/function impairments and activity limitations of post-stroke that predict social participation: a systematic review.

BACKGROUND: Stroke is the leading cause of death and disability in Brazil, and its prognostic indicators of social reintegration are not well established yet. OBJECTIVE: To identify body structure/function impairments and activity limitations in post-stroke that predict social participation restrictions in the community. METHODS: cohort studies were selected, involving adult post-stroke participants, which investigated body structure and function impairments or activity limitations of post-stroke individuals as predictors of social participation in the community. Studies that included individuals with subarachnoid hemorrhage, other neurological disorders and participants in long-term care facilities were excluded. The Newcastle-Ottawa quality assessment scale was applied to assess the methodological quality. The results were synthesized according to the found exposures, considering the used statistical models. RESULTS: Eleven articles were included, with a total of 2,412 individuals, 58.4% men, 83.7% ischemic stroke. Seven exposures were assessed across studies, in which 10 studies assessed body structure and function exposures (stroke severity, cognitive, executive, emotional and motor function), and 8 studies assessed activity exposures (daily living activity and walking ability). CONCLUSION: There is some evidence that stroke severity, mental and motor deficits, limitations in activities of daily living and the ability to walk after a stroke can predict social participation in the community. PROSPERO registration CRD42020177591.

Dynamics, multistability, and crisis analysis of a sine-circle nontwist map.

We propose a one-dimensional dynamical system, the sine-circle nontwist map, that can be considered a local approximation of the standard nontwist map and an extension of the paradigmatic sine-circle map. The map depends on three parameters, exhibiting a simple mathematical form but with a rich dynamical behavior. We identify periodic, quasiperiodic, and chaotic solutions for different parameter sets with the Lyapunov exponent and Slater's theorem. From the bifurcation analysis, we determine two bifurcation lines, those that depend on just two of the control parameters, for which the bifurcation that occurs is of the saddle-node type. In order to investigate multistability, we analyze the bifurcation diagrams in the two directions of parameter variation and we observe some regions of hysteresis, representing the coexistence of different attractors. We also analyze different multistable scenarios, as single attractor, coexistence of periodic attractors, coexistence of chaotic and periodic attractors, chaotic behavior, and coexistence of different chaotic bands, by the Lyapunov exponent and the analysis of the domain occupied by the solutions. From the parameter spaces constructed, we observe the prevalence of single attractor and only chaotic behavior scenarios. The multistable scenario is, mostly, formed by different periodic attractors. Lastly, we analyze the crisis in chaotic attractors and we identify the interior and the boundary crisis. From our results, the boundary crisis plays a key role for the extinction of multistability.

Spasticity distribution and severity in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis.

In individuals with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), spasticity is one of the main symptoms. The neurological signs of the disease are well defined, but details of how spasticity appears in these individuals have not been well explored. To describe spasticity location and severity of HAM/TSP individuals. Cross-sectional study with individuals older than 18 years, diagnosed with HAM/TSP and with lower limb spasticity. Pregnant women, individuals with other associated neurological diseases, and those using antispastic drugs were not included. Spasticity was assessed by the Modified Ashworth Scale (MAS), applied to the abductor, adductor, flexor, and extensor muscles of the hips, flexors, and extensors of the knees, dorsiflexors, plantiflexors, evertors, and inverters of the foot. Thirty participants were included. The plantiflexor muscles (90%), knee extensors (80%), knee flexors (63,3%), and adductors (50%) were most frequently affected by spasticity. Twenty-three (76.7%) individuals had mixed spasticity, 5 (16.7%) with distal spasticity and 2 (6.7%) with proximal spasticity. MAS was similar between the lower limbs in at least 6 of the 10 muscle groups of each individual. Spasticity was mostly mixed in the lower limbs, with more frequently mild severity. The individuals were partially symmetrical between the lower limbs. The most affected muscle groups were the plantiflexors, knee extensors and flexors and the hip adductors, consecutively, being predominantly symmetrical.

Eficácia da combinação do Nintendo Wii® e fisioterapia convencional na independência funcional de indivíduos hemiparéticos pós-acidente vascular cerebral: ensaio clínico randomizado / The effectiveness of the combination of Nintendo Wii® and conventional physical therapy in functional independence of post-stroke patients with hemiparesis: a randomized clinical trial

Introdução: Nos últimos anos, nota-se crescente interesse na utilização da realidade virtual não imersiva (RVNI) em pacientes pós-acidente vascular cerebral. Objetivo: O objetivo deste estudo é analisar a eficácia da combinação da realidade virtual não imersiva através do console Nintendo Wii® e cinesioterapia na independência funcional de indivíduos hemiparéticos pósacidente vascular cerebral. Métodos: Trata-se de um ensaio clínico randomizado cego. 48 sujeitos foram randomizados, sendo 57,5 % do sexo masculino com idade média de 55,6 anos, alocados em três grupos de tratamento: grupo Realidade Virtual (GRV), grupo Cinesioterapia (GCT) e grupo Realidade Virtual e Cinesioterapia (GRVCT). Cada grupo com 16 participantes realizaram 16 sessões com duração de 50 minutos cada, duas vezes por semana, durante 8 semanas. A avaliação da independência funcional foi realizada pelo Índice de Barthel Modificado pré e pós-tratamento. Resultados: Não foram encontradas diferenças significativas entre os grupos com relação à idade, gênero, tempo de acidente vascular cerebral e hemicorpo afetado; os grupos foram homogêneos com relação a essas variáveis. Não foram encontradas diferenças estatisticamente significantes entre nenhum dos três grupos (intergrupo) antes do tratamento em comparação com o pós-tratamento nas variáveis do Índice de Barthel Modificado. Na comparação intragrupo, em alguns domínios do Índice de Barthel Modificado foram observadas alterações positivas consideráveis, principalmente no grupo que realizou apenas realidade virtual não imersiva. Conclusão: A realidade virtual não imersiva como terapia para reabilitação não apresentou diferença no grau de independência funcional dos pacientes analisados, porém a RVNI em combinação com a cinesioterapia ou isolada, ou apenas a cinesioterapia, podem ser utilizadas sem prejuízos em pacientes hemiparéticos após AVC. (AU)

Background: In recent years, there has been a growing interest in the use of non-immersive virtual reality (NIVR) treatment in post-stroke patients. Objective: The objective of this study is to analyze the efficacy of the combination of non-immersive virtual reality through the Nitendo Wii® console and kinesiotherapy in the functional independence of post-stroke hemiparetic individuals. Methods: Blind randomized clinical trial; 48 volunteers randomly grouped, being 57.5% male with an average age of 55.6 years. These were allocated into 3 treatment groups: Virtual Reality Group (VRG), Cinesiotherapy Group (CG) and Virtual Reality and Cinesiotherapy Group (VRCG). Each group with 16 participants, held 16 sessions of 50 minutes each, twice a week for 8 weeks. Functional independence was assessed by the Barthel Modified Index (BMI) pre and post treatment. Results: No significant differences were found with respect to age, gender, stroke time and affected hemibody. The groups were homogeneous in relation to these variables. No statistically significant differences were detected between any of the 3 groups (among groups) before treatment compared to the post-treatment in BMI variables. In the intra-group comparison, in some areas of BMI, positive changes were observed, mainly in the groups that used only nonimmersive virtual reality. Conclusion: Non-immersive virtual reality as a rehabilitation therapy showed no difference in the level of functional independence of the patients, but this technique in combination with kinesitherapy or alone, or only kinesitherapy, can be used without damage in post stroke hemiparetic patients. (AU)

Atendimento fonoaudiológico no pré e pós-operatório de cirurgia bariátrica em um hospital de referência / Speech-language therapist care in the pre and postoperative of bariatric surgery in a reference hospital

Objetivo: O objetivo do presente estudo é descrever o serviço de fonoaudiologia no pré e pósoperatório dos usuários candidatos à cirurgia bariátrica e/ou metabólica em um hospital especializado. Método: Trata-se de um estudo longitudinal, descritivo, realizado com os usuários acompanhados pelo Programa de Controle e Cirurgia da Obesidade do Hospital Estadual Geral de Goiânia "Dr. Alberto Rassi", no período de janeiro a setembro de 2019. Resultados e discussão: Foram selecionados 47 participantes para o estudo. O perfil do paciente atendido no serviço é predominante do sexo feminino, com idade média de 39,5 anos. A comorbidade prevalente é a hipertensão arterial sistêmica. São realizados, em média, três atendimentos no pré-operatório da cirurgia bariátrica, contemplando anamnese e avaliação. Nos demais atendimentos, até alta fonoaudiológica para cirurgia, são realizados treinos mastigatórios, exercícios oromiofuncionais para ronco e apneia do sono, e orientações pertinentes ao procedimento cirúrgico. O primeiro atendimento no pós-operatório ocorre com 25 dias de cirurgia e os retornos são agendados mensalmente até o quarto mês e trimestralmente até completar um ano de cirurgia. Conclusão: O atendimento fonoaudiológico no pré-operatório de cirurgia bariátrica mostrou uma população com ausência de elementos dentários que, por consequente, apresenta prejuízo na função mastigatória. No segundo e terceiro mês de pós-operatório a queixa mais recorrente é com arroz, 27% e 30%, respectivamente, em que os participantes referem sensação de bolos, repercutindo negativamente na deglutição

Purpose: The purpose of the present study is to describe the speech therapy care in pre and postoperative in candidates of bariatric/metabolic surgery. Methods: This is a descriptive longitudinal study, managed in patients accompany by the Obesity Control and Surgery Program of the Hospital Estadual Geral de Goiânia "Dr. Alberto Rassi", of January to September 2019. Results: The patient profile treated at the service is predominantly female, with a mean age of 39.5 years. The most noted comorbidity is systemic arterial hypertension. On mean, there are three preoperative visits to bariatric surgery, in the first visit anamnesis, evaluation, masticatory training and exercises for snoring and sleep apnea. In other visits, until speech therapy authorization for surgery, masticatory training, oromiofunctional exercises for snoring and sleep apnea are fulfilled, and guidelines to the surgical procedure. The first postoperative care takes place 25 days after surgery and returns are scheduled monthly until the fourth month and quarterly until one year of surgery. Conclusion: Speech-language therapy in the preoperative of bariatric surgery showed a population with dental problem that cause prejudice in the masticatory function, especially when has an absence of premolars and molars tooth on both dental arches. In the second and third month after surgery, the most common complaint is with rice, 27% and 30%, respectively, which these participants report feeling of bolus, what causes swallowing difficulty