DESENVOLVIMENTO DE UM CLASSIFICADOR PARA ANÁLISE BIOMÉTRICA DE UM COLETE INSTRUMENTADO PARA REEDUCAÇÃO POSTURAL

Ao longo dos tempos tem existido um avanço, nas empresas, dirigido à preocupação com o bemestar dos trabalhadores, adotando por isso medidas preventivas. A formação especializada em Medicina do Trabalho é indispensável para o exercício de atividades de prevenção dos riscos profissionais e de promoção da saúde. A postura corporal pode ser definida como a posição e a orientação global do corpo e membros relativamente uns aos outros. Qualquer desvio na forma da coluna vertebral pode gerar solicitações funcionais prejudiciais que ocasionam um aumento de fadiga no trabalhador e leva ao longo do tempo a lesões graves. Cada vez mais surgem doenças profissionais provocadas pela adoção de más posturas, na realização de tarefas diárias dos trabalhadores. A boa postura corporal é uma tarefa específica que representa uma interação complexa entre a função biomecânica e neuromuscular. No presente plano de dissertação foram estudados diferentes classificadores tendo como objetivo classificar boas e más posturas corporais de trabalhadores em contexto de trabalho. Assim foram estudados diferentes classificadores de machine learnig, redes neuronais artificiais, support vector machine, árvores de decisão, análise discriminante, regressão logística, treebagger e naíve bayes. Para treino de classificadores foi realizada a aquisição tridimensional da postura da espinha a 100 pessoas, passando por uma parametrização e treino de diferentes classificadores para a determinação automática do tipo de postura corporal. O classificador que obteve melhor desempenho foi o Treebagger com uma classificação para True Positive de 93,3% e True Negative de 96,2%.

Avaliação dos efeitos da reeducação postural global (rpg) em pacientes com espondilite anquilosante

The Ankylosing Spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton, leading to limitation of spine mobility and functional disability. Physical therapy, especially exercise, is an important part in your treatment. The Global Postural Reeducation(GPR),a method that uses stretching based on evaluation of muscular chains, with significant interference in postural changes may be a complementary alternative for the treatment of this disease. The aim was to evaluate the effects of Global Postural Reeducation (GPR) in patients with Ankylosing Spondylitis (AS) and compare GPR with group conventional segmental self-stretching and breathing exercises. This is a controlled interventional study of 38 patients divided into 2 groups: a GPR group (n = 22) and a control group (n = 16). Both groups were treated over four months. With the GPR group patients, positions that stretched the shortened muscle chains were used. With the control group patients, conventional segmental self-stretching and breathing exercises were performed. The variables analyzed were: pain intensity, morning stiffness, spine mobility, chest expansion, functional capacity (Health Assessment Questionnaire - Spondyloarthropathies - HAQ-S), quality of life (Medical Outcome Study Short Form 36 Healthy Survey-SF-36), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index - BASDAI). Statistical analysis was used with a significance level of p < 0.05. There was a statistically significant difference for all the parameters analyzed between pre and post-treatment in both groups. In the inter-group comparison the GPR group showed a statistically significant improvement in morning stiffness (p = 0.01), spine mobility parameters, except finger-floor distance (p = 0.11), in chest expansion (p = 0.02), and in the physical aspect component of the SF-36 (p = 0.00).Finally, we observed that this sample of patients with AS ,treatment with RPG 60 seems to have a better response in some clinical measures, than the conventional self stretching performed in groups. Further studies are needed to further evaluate this therapeutic alternative in the EA

Efeito da reeducação postural global (RPG) sobre a distribuição do peso corporal e atividade eletromiográfica na postura sentada

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos da Reeducação Postural Global na Hipercifose e nas Variáveis Respiratórias de Idosos Relato de Dois Casos

Examine the effects Global Postural Reeducation, (GPR) in hyperkyphosis and respiratory variables in the elderly was the objective in the research. For this, two elderly participated, one is 62 years old (voluntary 1) and another is 66 years old (voluntary 2), without lung, heart, kidney and/or skeletal-muscle diseases diagnosed. The volunteer have been assessed for Quality of Life (QOL) through the questionnaire SF-36, the degree of toracic kyphosis, the muscular respiratory strength and the thoracic-abdominal mobility. The GRP treatment consisted in eight sessions applied, once one hour each session. After the eight sessions the volunteer were reevaluated. The data concerning assessments before and after treatment were analysed describly. According to the results there was an improvement in the degree of kyphosis in both volunteers, highlighting voluntary 2. Respiratory variables also improvements after treatment. In relation to the Quality of life in most areas there has been an increase in scores indicating improved QOL. These data showed that the GPR has been effective to decrease the level of kyphosis, improves respiratory variables and the quality of life in the elderly treated. However, further work with a greater number of subjects must be carried out to analyze the effectiveness of therapy in the elderly.

Colete Instrumentado para reeducação postural

A coluna vertebral é um dos elementos do corpo humano que mais lesões e danos irreparáveis sofre. Segundo a organização mundial de saúde, 85% da população mundial sofre de dores na coluna e estas representam mais de 50% das causas de incapacidade física transitória ou perma-nente em idade laboral. Uma das principais causas desses danos prende-se com uma postura cor-poral incorreta o que provoca alterações nas estruturas da coluna. Nesse contexto, a existência de um dispositivo capaz de avaliar em tempo real a postura corporal, e que simultaneamente, alerte para a ocorrência de posturas incorretas assume-se como uma mais-valia para a prevenção deste tipo de situações. Neste trabalho é proposto um “colete” instrumentado para reeducação postural, capaz de dotar os utilizadores de informação relativa à sua postura ao nível da coluna vertebral. O dispositivo é com-posto por um conjunto de sensores IMU, estrategicamente colocados para melhor caraterização do perfil da coluna. Os dados sensoriais são classificados por uma unidade de processamento central. Nesta unidade, além de outras funcionalidades, está implementado um classificador cujos dados de treino foram obtidos numa outra tese de mestrado desenvolvida paralelamente. Em caso de postura incorreta, os utilizadores serão alertados através de um sinal sonoro e vibratório. O sistema funciona como um wearable, stand-alone, ou seja, não necessita de qualquer tipo de aplicação ou componente externo. Contudo, foi desenvolvida uma API cujo objetivo é potenciar a utilização do dispositivo noutro tipo de aplicações. Para demonstrar a aplicabilidade da API, foram desenvolvidas duas aplicações, uma para computador e outra para dispositivos móveis Android. Estas permitem monitorizar em tempo real o perfil da coluna, lançar notificações de postura incor-reta, entre outros. O protótipo e as aplicações foram testados em contexto de aula por 10 indivíduos em dois momentos de monitorização distintos, um primeiro momento sem qualquer tipo de feedback ativo e um segundo com feedback ativo. Estes testes serviram para validação de usabilidade, fiabilidade e depuração de erros. Os testes demonstraram que o sistema possui elevado nível de fiabilidade na classificação da postura promovendo a reeducação postural. A totalidade dos sujeitos apresentaram um decrés-cimo percentual no tempo passado com postura incorreta no segundo dia de testes face ao dia de referência em que os sistemas de feedback se encontravam desligados. Em alguns casos, a diminuição atingiu valores próximos de 80%.

A Reeducação Postural Global (RPG) e as Autoposturas Respiratórias de Philippe Souchard, implicações na prática vocal/coral

A Investigação científica que se apresenta enquadra-se no âmbito do Projeto Educativo, integrado no Mestrado em Ensino da Música, especialidade em Música de Conjunto, realizado no Conservatório Superior de Música de Gaia (CSMG). Esta Investigação-ação, de análise qualitativa, centrou-se na implementação de um Programa de Intervenção: A Reeducação Postural Global (RPG) e As Autoposturas Respiratórias, na Produção Sonora Musical no Canto (Philippe Souchard, 1987; 1997; 2011). Assente no modelo de Relação Pedagógica (RP) de Renald Legendre (2005), teve como Sujeitos (S) de aprendizagem dois grupos das Classes de Conjunto de Coro, da Fundação Conservatório de Música de Gaia: o Grupo de Ação (GA) e o Grupo de Controlo (GC). Aplicadas sessões de fisioterapia ao GA, ambos os grupos interpretaram a Obra Coral Pange Lingua, de Zoltán Kodály. Pelos registos apresentados na análise de dados, ditos em diários de bordo dos Sujeitos (S) e do Agente (A) professor da Classe de Conjunto, e em imagens fílmicas e fotográficas realizadas, verificamos a eficácia deste Programa. À luz dos exercícios da Reeducação Postural Global (RPG) e das Autoposturas Respiratórias, de Philippe Souchard, aplicados ao estudo da obra mencionada, pudemos verificar que os Sujeitos (S) do Grupo de Ação apresentaram progressos vocais de significativa importância.

Características biomecânicas, ergonômicas e clínicas da postura sentada: uma revisão

A posição sentada é a mais adotada nos ambientes de trabalho, na escola e nas atividades de lazer. Porém, a manutenção prolongada dessa posição ocasiona a adoção de posturas inadequadas e sobrecarrega as estruturas do sistema musculoesquelético, o que pode acarretar dor e lesão na coluna lombar. A presente revisão teve como objetivo identificar os fatores biomecânicos, ergonômicos e clínicos envolvidos na sustentação da postura sentada. Para isso, foram consultadas as bases de dados ISI Web of Knowledge, Medline, Pubmed e EBSCO Host, sendo selecionados 72 artigos publicados entre 1965 e 2010. Foi possível identificar que na posição sentada não existe uma postura ideal a ser sustentada, mas algumas posturas são mais recomendadas do que outras, tal como a postura sentada ereta e a postura lordótica. As cadeiras influenciam o padrão da posição sentada: conforme seu design, pode permitir maior variedade de posturas. Modificações na cadeira e a utilização de exercícios para o aumento da resistência muscular e da propriocepção, bem como a reeducação postural, são intervenções úteis para reduzir o impacto causado pela posição sentada prolongada no sistema musculoesquelético.

Tratamento fisioterapêutico na síndrome do respirador bucal

Introdução: A síndrome do respirador bucal é caracterizada pelo indivíduo que substitui o padrão correto da respiração nasal por um padrão inadequado, de maneira bucal ou mista. É definida por um conjunto de sintomas que constitui um quadro geral de doenças e pelas alterações que podem acontecer nas vias aéreas superiores, modificando o padrão respiratório e levando a alterações faciais e corporais. Objetivo: Apresentar um caso e demonstrar o tratamento fisioterapêutico de um paciente com a síndrome do respirador bucal, permitindo possível melhora da condição respiratória, do padrão postural e das atividades de vida diárias do paciente. Método: Estudo de caso de uma paciente com 10 anos, sexo feminino, com síndrome do respirador bucal. A paciente foi submetida a uma avaliação inicial que constava de anamnese e exame físico, além de avaliação postural, índice de massa corpórea, manuvacuometria, peak-flow e espirometria. O tratamento constou de técnicas de reeducação postural global (RPG), exercícios respiratórios e orientações, com frequência de três vezes na semana, por 60 minutos, num período de dois meses, totalizando 20 sessões. Resultados: Na avaliação inicial a paciente apresentou mais alterações em fechamento – cadeia anterior, portanto no tratamento foram realizadas posturas para abertura. Após o tratamento observou-se melhora da postura; da condição respiratória com melhora nos testes de manuvacuometria, peak-flow e espirometria; melhora também das atividades diárias. Conclusão: O tratamento fisioterapêutico proposto, RPG e exercícios respiratórios, contribuiu para melhora global da condição respiratória, do padrão postural e das atividades diárias.

Ivaldo Bertazzo: além do movimento

Study of the method developed by the dancer, choreographer and physiotherapist Ivaldo Bertazzo (Bertazzo Method), describing their proposal postural re-education that seeks to understand the human being in its entirety. From this study we are interested in describe his work with a group of youngs, the Company TeatroDança Ivaldo Bertazzo. Finally, this study aims at describes the researcher personal experiences in practices of Movement Reeducation for two consecutive years. The study was conducted by reviewing several works of Ivaldo Bertazzo in order to identify his trajectory, as well as the major modifications and applications developed by the author in his Human Movement Theory

Visual impairment, postural stability and falls among older adults with glaucoma

Purpose: To investigate the impact of glaucomatous visual impairment on postural sway and falls among older adults.Methods: The sample comprised 72 community-dwelling older adults with open-angle glaucoma, aged 74.0 5.8 years (range 62 to 90 years). Measures of visual function included binocular visual acuity (high-contrast), binocular contrast sensitivity (Pelli- Robson) and binocular visual fields (merged monocular HFA 24-2 SITA-Std). Postural stability was assessed under four conditions: eyes open and closed, on a firm and on a foam surface. Falls were monitored for six months with prospective falls diaries. Regression models, adjusting for age and gender, examined the association between vision measures and postural stability (linear regression) and the number of falls (negative binomial regression). Results: Greater visual field loss was significantly associated with poorer postural stability with eyes open, both on firm (r = 0.34, p < 0.01) and foam (r = 0.45, p < 0.001) surfaces. Eighteen (25 per cent) participants experienced at least one fall: 12 (17 per cent) participants fell only once and six (eight per cent) participants fell two or more times (up to five falls). Visual field loss was significantly associated with falling; the rate of falls doubled for every 10 dB reduction in field sensitivity (rate ratio = 1.08, 95% CI = 1.02–1.13). Importantly, in a model comprising upper and lower field sensitivity, only lower field loss was significantly associated with the number of falls (rate ratio = 1.17, 95% CI = 1.04–1.33). Conclusions: Binocular visual field loss was significantly associated with postural instability and falls among older adults with glaucoma. These findings provide valuable directions for developing falls risk assessment and falls prevention strategies for this population.

The effect of monocular and binocular cataract blur on postural stability among older adults

Purpose: First-eye cataract surgery can reduce the rate of falls among older adults, yet the effect of second-eye surgery on the rate of falling remains unclear. The present study investigated the effect of monocular and binocular simulated cataract blur on postural stability among older adults. Methods: Postural stability was assessed on 34 healthy older adults (mean 68.2 years, SD 3.5) with normal vision, using a portable force platform (BT4, HUR Labs, Finland) which collected data on centre of pressure (COP) displacement. Stability was assessed on firm and foam surfaces under four binocular viewing conditions using Vistech filters to simulate cataract blur: [1] best-corrected vision both eyes; [2] blur over non-dominant eye, [3] blur over dominant eye and [4] blur over both eyes. Binocular logMAR visual acuity, Pelli-Robson contrast sensitivity and stereoacuity were also measured under these viewing conditions and ocular dominance measured using the hole-in-card test. Generalized estimating equations with an exchangeable correlation structure examined the effect of the surface and vision conditions on postural stability. Results: Visual acuity and contrast sensitivity were significantly reduced under monocular and binocular cataract blur compared to normal viewing. All blur conditions resulted in loss of stereoacuity. Binocular cataract blur significantly reduced postural stability compared to normal vision on the firm (COP path length; p=0.013) and foam surface (anterior-posterior COP RMS, COP path length and COP area; p<0.01). However, no significant differences in postural stability were found between the monocular blur conditions compared to normal vision, or between the dominant and non-dominant monocular blur conditions on either the firm or foam surfaces. Conclusions: Findings indicate that binocular blur significantly impairs postural stability, and suggests that improvements in postural stability may justify first-eye cataract surgery, particularly during somatosensory disruption. Postural stability was not significantly impaired in the monocular cataract blur conditions compared to the normal vision condition, nor was there any effect of ocular dominance on postural stability in the presence of monocular cataract blur.

Functional status, postural stability and falls among older adults with glaucoma

Visual impairment is an important contributing factor in falls among older adults, which is one of the leading causes of injury and injury-related death in this population. Visual impairment is also associated with greater disability among older adults, including poorer health-related quality of life, increased frailty and reduced postural stability. The majority of this evidence, however, is based on measures of central visual function, rather than peripheral visual function. As such, there is comparatively limited research on the associations between peripheral visual function, disability and falls, and even fewer studies involving older adults with specific diseases which affect peripheral visual function, the most common of which is glaucoma. Glaucoma is one of the leading causes of irreversible vision loss among older adults, affecting around 3 per cent of adults aged over 60 years. The condition is characterised by retinal nerve fibre loss, primarily affecting peripheral visual function. Importantly, the number of older adults with glaucomatous visual impairment is projected to increase as the ageing population grows. The first component of the thesis examined the cross-sectional association between glaucomatous visual impairment and health-related quality of life (Study 1a), functional status (Study 1b) and postural stability (Study 1c) among older adults. A cohort of 74 community-dwelling adults with glaucoma (mean age 74.2 ± 5.9 years) was recruited and completed a baseline assessment. A number of visual function measures was assessed, including central visual function (visual acuity and contrast sensitivity), motion sensitivity, retinal nerve fibre analysis and monocular and binocular visual field measures (monocular 24-2 and binocular integrated visual fields (IVF): IVF-60 and IVF-120). The analyses focused on the associations between the outcomes measures and severity and location of visual field loss, as this is the primary visual function affected by glaucoma. In Study 1a, we examined the association between visual field loss and health-related quality of life, measured by the Short Form 36-item Health Survey (SF-36). Greater binocular visual field loss, on both IVF measures, was associated with lower SF-36 physical component scores, adjusted for age and gender (Pearson's r =|0.32| to |0.36|, p<0.001). Furthermore, inferior visual field loss was more strongly associated with the SF-36 physical component than superior field loss. No association was found between visual field loss and SF-36 mental component scores. The association between visual field loss and functional status was examined in Study 1b. Functional status outcomes measures included a physical activity questionnaire (Physical Activity Scale for the Elderly, PASE), performance tests (six-minute walk test, timed up and go test and lower leg strength) and an overall functional status score. Significant, but weak, correlations were found between binocular visual field loss and PASE and overall functional status scores, adjusted for age and gender (Pearson's r =|0.24| to |0.33|, p<0.05). Greater inferior visual field loss, independent of superior visual field loss, was significantly associated with poorer physical performance results and lower overall functional status scores. In Study 1c, we examined the association between visual field loss and postural stability, using a swaymeter device which recorded body movement during four conditions: eyes open and closed, on a firm and foam surface. Greater binocular visual field loss was associated with increased postural sway, both on firm and foam surfaces, independent of age and gender (Pearson’s r =|0.44| to |0.46|, p <0.001). Furthermore, inferior visual field was a stronger contributor to postural stability, more so than the superior visual field, particularly on the foam condition with the eyes open. Greater visual field loss was associated with a reduction in the visual contribution to postural sway, which underlies the observed association with postural sway. The second component of the thesis examined the association between severity and location of visual field loss and falls during a 12-month longitudinal follow-up. The number of falls was assessed prospectively using monthly fall calendars. Of the 71 participants who successfully completed the follow up (mean age 73.9 ± 5.7 years), 44% reported one or more falls, and around 20% reported two or more falls. After adjusting for age and gender, every 10 points missed on the IVF-120 increased the rate of falls by 25% (rate ratio 1.25, 95% confidence interval 1.08 - 1.44) or every 5dB reduction in IVF-60 increased the rate of falls by 47% (rate ratio 1.47, 95% confidence interval 1.16 - 1.87). Inferior visual field loss was a significant predictor of falls, more so than superior field loss, highlighting the importance of the inferior visual field area in safe and efficient navigation. Further analyses indicated that postural stability, more so than functional status, may be a potential mediating factor in the relationship between visual field loss and falls. Future research is required to confirm this causal pathway. In addition, the use of topical beta-blocker medications was not associated with an increased rate of falls in this cohort, compared with the use of other topical anti-glaucoma medications. In summary, greater binocular visual field loss among older adults with glaucoma was associated with poorer health-related quality of life in the physical domain, reduced functional status, greater postural instability and higher rates of falling. When the location of visual field loss was examined, inferior visual field loss was consistently more strongly associated with these outcomes than superior visual field loss. Insights gained from this research improve our understanding of the association between glaucomatous visual field loss and disability, and its link with falls among older adults. The clinical implications of this research include the need to include visual field screening in falls risk assessments among older adults and to raise awareness of these findings to eye care practitioners and adults with glaucoma. The findings also assist in developing further research to examine strategies to reduce disability and prevent falls among older adults with glaucoma to promote healthy ageing and independence for these individuals.

Postural balance under normal and altered sensory conditions in normal-weight and overweight children

Background Little or no research has been done in the overweight child on the relative contribution of multisensory information to maintain postural stability. Therefore, the purpose of this study was to investigate postural balance control under normal and experimentally altered sensory conditions in normal-weight versus overweight children. Methods Sixty children were stratified into a younger (7–9 yr) and an older age group (10–12 yr). Participants were also classified as normal-weight (n = 22) or overweight (n = 38), according to the international BMI cut-off points for children. Postural stability was assessed during quiet bilateral stance in four sensory conditions (eyes open or closed, normal or reduced plantar sensation), using a Kistler force plate to quantify COP dynamics. Coefficients of variation were calculated as well to describe intra-individual variability. Findings Removal of vision resulted in systematically higher amounts of postural sway, but no significant BMI group differences were demonstrated across sensory conditions. However, under normal conditions lower plantar cutaneous sensation was associated with higher COP velocities and maximal excursion of the COP in the medial-lateral direction for the overweight group. Regardless of condition, higher variability was shown in the overweight children within the 7–9 yr old subgroup for postural sway velocity, and more specifically medial–lateral velocity. Interpretation In spite of these subtle differences, results did not establish any clear underlying sensory organization impairments that may affect standing balance performance in overweight children compared to normal-weight peers. Consequently, it is believed that other factors account for overweight children's functional balance deficiencies.