Efeitos da reabilitação vestibular em idosos com vertigem posicional paroxística benigna (VPPB): ensaio clínico controlado e randomizado

Introdução: a Vertigem Posicional Paroxística Benigna (VPPB) é uma das principais causas de tontura em idosos. O tratamento mais empregado para essa afecção é a Manobra de Reposicionamento Canalítico (MRC). Apesar de útil na resolução clínica da sintomatologia vertiginosa e do nistagmo, os pacientes podem continuar demonstrando prejuízo na estabilidade postural após serem submetidos à MRC. Outra opção não farmacológica disponível são os exercícios de Reabilitação Vestibular (RV) que podem ser direcionados à melhora do equilíbrio postural dos idosos, porém há escassez de estudos que avaliem a efetividade da RV no equilíbrio postural de idosos com VPPB. Objetivo: analisar a efetividade da Terapia de Reabilitação Vestibular associada às Manobras de Reposicionamento Canalítico em comparação às Manobras de Reposicionamento Canalítico no tratamento de idosos com Vertigem Posicional Paroxística Benigna (VPPB) crônica. Métodos: participaram do presente ensaio clínico controlado, randomizado e cego 14 idosos de ambos os sexos e idade igual ou superior a 65 anos e com diagnóstico de VPPB crônica. Os idosos foram randomizados em dois grupos, sendo sete (mediana: 69 anos, 65-78) para o grupo experimental e sete (mediana: 73 anos, 65-76) para o grupo controle. Ambos os grupos foram submetidos a Manobras de Reposicionamento Canalítico (MRC) para VPPB e somente o grupo experimental à Terapia de Reabilitação Vestibular (TRV) associada às MRC. Os efeitos da TRV foram mensurados em relação à conversão do teste de Dix-Hallpike de positivo para negativo, recorrência da VPPB, número de manobras para obter a negativação do teste de Dix-Hallpike, sintomatologia da tontura, qualidade de vida e ao equilíbrio estático e dinâmico. Os idosos foram submetidos a uma avaliação inicial (T0), em uma semana (T1), cinco (T5), nove (T9) e treze semanas (T13). Em todas as avaliações o teste de Dix-Hallpike foi realizado com o auxílio do sistema de Videonistagmoscopia (SVNC) da Contronic - Brasil, e em caso positivo, nova MRC foi empregada. As diferenças entre os grupos foram analisadas pelos testes de Mann Whitney e exato de Fisher e para elucidar as diferenças intra-grupo os testes não paramétricos de Friedman e Wilcoxon foram usados. Resultados: nenhuma diferença significativa foi encontrada na conversão do teste de Dix-Hallpike de positivo para negativo, na recorrência da VPPB e no número de manobras para a negativação do teste de Dix-Hallpike, entre os grupos ao longo do ensaio. Também não foram encontradas diferenças entre os grupos na sintomatologia da tontura, qualidade de vida e equilíbrio estático. Contudo, diferenças significativas foram observadas nos aspectos do equilíbrio dinâmico entre os grupos (p< 0,05). Na análise intra-grupo ambos os grupos obtiveram melhora em todas as medidas de desfecho, porém o grupo controle não obteve melhora no equilíbrio dinâmico. Conclusões: a TRV adicional não influenciou na conversão do teste de Dix-Hallpike de positivo para negativo, na recorrência da VPPB, no número de manobras para a negativação do teste de Dix-Hallpike, na redução da sintomatologia da tontura e na qualidade de vida dos idosos com VPPB crônica. Porém, os participantes que receberam a TRV adicional demonstraram melhores resultados no equilíbrio dinâmico do que aqueles que foram submetidos somente às MRC. Os resultados desse estudo deverão repercutir nas estratégias de reabilitação baseadas em evidências nos pacientes idosos com disfunções otoneurológicas.

Reabilitação Oclusal com Prótese Parcial Removível Provisória Tipo “Overlay” – Relato de Caso

An appropriate design of a prosthetic rehabilitation should not impute the restoration of occlusal vertical dimension (OVD) to new prostheses, at the risk of the patient does not adapt to a new condition, since a certain amount of time is often necessary for adaptation to a new OVD. This article performed prosthetic rehabilitation with an overlay provisional removable partial denture prior to definitive treatment because the patient showed a considerable decrease in the OVD. Three techniques for OVD determination were used. It is possible to conclude that the use of interim removable partial dentures is of great importance at the beginning of the rehabilitation treatment in order to adapt the patient to a new occlusal condition.

Reabilitação Oclusal com Prótese Parcial Removível Provisória Tipo “Overlay” – Relato de Caso

An appropriate design of a prosthetic rehabilitation should not impute the restoration of occlusal vertical dimension (OVD) to new prostheses, at the risk of the patient does not adapt to a new condition, since a certain amount of time is often necessary for adaptation to a new OVD. This article performed prosthetic rehabilitation with an overlay provisional removable partial denture prior to definitive treatment because the patient showed a considerable decrease in the OVD. Three techniques for OVD determination were used. It is possible to conclude that the use of interim removable partial dentures is of great importance at the beginning of the rehabilitation treatment in order to adapt the patient to a new occlusal condition.

Observação da ação na reabilitação do membro superior de pacientes com acidente vascular cerebral: uma revisão sistemática com metanálise

Background: stroke causes long-term impairments, limitation of activities and restriction in participation in daily life situations, especially for upper limb impairment (UL). Action Observation (AO) has been used for the rehabilitation of UL in these patients. It's a multisensory therapy which consists in observing a healthy subject performing a motor task, followed by physical practice. Objectives: assess whether the AO improves motor function of UL and dependence for activities of daily living (ADLs) of stroke patients or cause any adverse effects. Search methods: a search strategy was words and terms used for the identification of articles, in the following scientific basis Cochrane Central Register of Controlled Trials; MEDLINE; PsycINFO; CINAHL and LILACS. In addition to manual search of the references of articles and search for theses and dissertations in Portal Capes and LILACS. The identification of the studies was conducted from October to December 2015, being the last search on December 3. Selection criteria: randomised controlled trials (RCT) involving adults with stroke who had deficits in upper limb function and used AO as an intervention. Data collection and analysis: the data extracted from the studies were used to analyze the risk of bias, the effect of the treatment and the quality of the body of evidence. Main results: 6 studies were included, totaling 270 patients. The primary outcome analyzed was the motor function of MS. Were combined in meta-analyzes studies comparing AO versus placebo or an active control, considering the immediate and long-term effect (n=241). Regarding the motor function of the arm (5 trials), the estimated effect for the therapy was not significant. However, when considering the hand function estimating the effect was favorable to the group that conducted the AO, in short (mean difference = 6.93, 95% CI 1.48 to 12.39; P = 0.01) and long-term (mean difference = 7.57; 95% CI 1.34 the 13.80; p = 0.02). Unable to perform the analysis for functional dependency. The studies showed a low or uncertain risk of bias, but the quality of evidence the body was considered low and very low quality. Authors’ conclusions: AO was effective in improving hand function of stroke patients. Despite the low quality evidence that the use of OA in clinical practice should not be discouraged. RCT new studies should be conducted with greater methodological rigor and larger samples, covering important outcomes such as functional dependence for ADLs.

O centro de Fortaleza como lugar de moradia

The present study has the objective of analyzing how the ways of dwelling influences the uses and the functional and symbolic appropriations of the urban space in Fortaleza city center, through the perspective of the residents and their relation with the living place. Scenarios of development and degradation of its urban space have marked the city center of Fortaleza. The intensification of the commercial and services occupation promoted through the years, paradoxically, the valorization of the land price and the devalorization of the residential use. Thus, the residential occupation was consolidated in a discontinuous way, being concentrated mainly in the external limits of the historical core of the neighborhood. The research is structured over the delimitation of an area and the selection of multifamily residential buildings, built since the 1960s, close to the central core of the neighborhood. The spatial configuration analysis of the selected residential buildings, and their relations with the urban surroundings and the land uses, reveals different aspects related to the urban vitality, producing impacts over the ways of dwelling constituted by the daily life of the residents. The study of the ways of dwelling involves the comprehension that the dwelling is beyond the private residential boundaries and the functional occupation. The conceptual base of this research is developed over the perspective that the dwelling represents a fundamental aspect of the human condition, allowing the person to relate with the space in an essential way (HEIDEGGER, 2012). In this perspective of the dwelling, the space reunites the mental and the cultural, the social and the historical, being marked by simultaneous logics of the conceived, the perceived and the lived space (LEFEVBRE, 2006). The development of this study, over the point of view of the neighborhood residents, is inserted in the perspective of the lived space, related to the concept of place, understood as a qualitative phenomenon, giving essence and identity to the space. The place of dwelling, marked by coexistences, is one of the structural elements of the urban land use, and potential for the rehabilitation of the central areas in big cities. Therefore, the study starts from the hypothesis that the location, the nearby land uses and the spatial configuration of the residential buildings affect the ways of dwelling, in other words the residents dissolve the boundaries of the shelter and experience the urban space, from the dwelling place. The requalification of the dwelling is opposed to the residential space based in functionality, in hierarchy, in self sufficiency, in standardization and in the reproduction of the urban space, materialized in the dense contemporary residential buildings, that are unrelated to the city. The stages of the research involved the spatial configuration analysis of the selected residential buildings and their surrounding, the land use mapping and interviews with the residents. The collected data allowed verifying that the buildings are located in areas presenting heterogeneous land uses, with a great number of residents and users. However, these aspects are not sufficient to promote the vitality of the public spaces in the neighborhood, since the people movement in the streets is controlled by the opening hours of the predominant commercial use in the area. The word of the residents, collected in interviews, indicate that the conservation conditions of the public spaces and the insecurity influences their everyday relations with the place of dwelling, affecting fundamental aspects for the dwelling requalification in the central area of Fortaleza.

O centro de Fortaleza como lugar de moradia

The present study has the objective of analyzing how the ways of dwelling influences the uses and the functional and symbolic appropriations of the urban space in Fortaleza city center, through the perspective of the residents and their relation with the living place. Scenarios of development and degradation of its urban space have marked the city center of Fortaleza. The intensification of the commercial and services occupation promoted through the years, paradoxically, the valorization of the land price and the devalorization of the residential use. Thus, the residential occupation was consolidated in a discontinuous way, being concentrated mainly in the external limits of the historical core of the neighborhood. The research is structured over the delimitation of an area and the selection of multifamily residential buildings, built since the 1960s, close to the central core of the neighborhood. The spatial configuration analysis of the selected residential buildings, and their relations with the urban surroundings and the land uses, reveals different aspects related to the urban vitality, producing impacts over the ways of dwelling constituted by the daily life of the residents. The study of the ways of dwelling involves the comprehension that the dwelling is beyond the private residential boundaries and the functional occupation. The conceptual base of this research is developed over the perspective that the dwelling represents a fundamental aspect of the human condition, allowing the person to relate with the space in an essential way (HEIDEGGER, 2012). In this perspective of the dwelling, the space reunites the mental and the cultural, the social and the historical, being marked by simultaneous logics of the conceived, the perceived and the lived space (LEFEVBRE, 2006). The development of this study, over the point of view of the neighborhood residents, is inserted in the perspective of the lived space, related to the concept of place, understood as a qualitative phenomenon, giving essence and identity to the space. The place of dwelling, marked by coexistences, is one of the structural elements of the urban land use, and potential for the rehabilitation of the central areas in big cities. Therefore, the study starts from the hypothesis that the location, the nearby land uses and the spatial configuration of the residential buildings affect the ways of dwelling, in other words the residents dissolve the boundaries of the shelter and experience the urban space, from the dwelling place. The requalification of the dwelling is opposed to the residential space based in functionality, in hierarchy, in self sufficiency, in standardization and in the reproduction of the urban space, materialized in the dense contemporary residential buildings, that are unrelated to the city. The stages of the research involved the spatial configuration analysis of the selected residential buildings and their surrounding, the land use mapping and interviews with the residents. The collected data allowed verifying that the buildings are located in areas presenting heterogeneous land uses, with a great number of residents and users. However, these aspects are not sufficient to promote the vitality of the public spaces in the neighborhood, since the people movement in the streets is controlled by the opening hours of the predominant commercial use in the area. The word of the residents, collected in interviews, indicate that the conservation conditions of the public spaces and the insecurity influences their everyday relations with the place of dwelling, affecting fundamental aspects for the dwelling requalification in the central area of Fortaleza.

Reabilitação cardíaca na insuficiência cardíaca crônica: efeitos de 12 semanas de treinamento intervalado x contínuo na função cardiopulmonar e qualidade de vida

Background: Cardiac Rehabilitation (CR) has effect on mortality in patients with heart failure (HF) chronic, and the exercise of the treatment of this patient. The most common exercise is ongoing training. Recently we have been studying the effects of interval training, but there is no consensus on the optimal dose of exercise. Objective: To evaluate the effects of interval aerobic training are superior to continuous aerobic training in patients with chronic HF. Methods: The clinical trial evaluated patients through cardiopulmonary test (CPX) and quality of life before and after the RC (3 times / 12 weeks). Patients were randomized into Group Interval Training (GTI - 85% of heart rate reserve - FCR), Continuous Training Group (GTC - 60% of HRR) and control group (CG) who received guidelines. Results: 18 patients were evaluated (mean age 44.7 ± 13.2 years and 35.2 ± 8.9% of left ventricular ejection fraction [LVEF]). Both groups were efficient to increase the peak VO2 and 15.1% (P = 0.02) in GTI and 16.1% (P = 0.01) GTC. As for the quality of life the GTI GTC showed improvement compared to the control group (P = 0.006). Hemodynamic mismatch events during the CPX were reduced after training in more GTC (patients 1 to 4) than in the GTI (5 to 3). Cardiac risk also decreased in the GTC (3 patients left the severe risk to take after training). Conclusion: Continuous training becomes more appropriate for improving fitness with little chance of developing cardiac event patients with chronic HF.

Análise da concepção arquitetural à luz da arquiteturologia: um estudo da produção de edifícios de uso não-residencial do arquiteto João Maurício Fernandes de Miranda, entre 1961 e 1981

This study explores the architectural conception process using the Architecturologie as an instrument of analysis, based on Enseigner la Conception Architecturale (2000), developed by Boudon - architect, lecturer and French researcher. It begins with the selection of local architect´s works, João Maurício Fernandes de Miranda, which resulted in six non residential projects developed between 1961 and 1981. Architectural readings were developed, with emphasis in the identification of architecturological scales, their functions, relationship and modality of occurrence

Qualificação de edifícios residenciais verticais em Natal/RN à luz do regulamento técnico da qualidade para o nível de eficiência energética de edificações residenciais (RTQ-R)

The goal of the research was to investigate the energy performance of residential vertical buildings envelope in the hot and humid climate of Natal, capital of Rio Grande do Norte, based in the Technical Regulation of Quality for Energy Efficiency Level in Residential Buildings (RTQ -R), launched in 2010. The study pretends to contribute to the development of design strategies appropriate to the specific local climate and the increasing of energy efficiency level of the envelope. The methodological procedures included the survey in 22 (twenty two) residential buildings, the formulation of representative prototypes based on typological and constructives characters researched and the classification of the level of energy efficiency in the envelopment of these prototypes, using as a tool the prescriptive method of the RTQ-R and the parametric analyzes from assigning different values of the following variables: shape of the pavement type; distribution of housing compartments; orientation of the building; area and shading of openings; thermal transmittance, and solar absorptance of opaque materials of the frontage in order to evaluate the influence of these on the envelopment performance. The main results accomplished with this work includes the qualification of vertical residential buildings in Natal/RN; the verification of the adequacy of these buildings to local climate based from the diagnosis of the thermal energy of the envelopment performance, the identification of variables with more significant influence on the prescriptive methodology of RTQ-R and design solutions more favorable to obtain higher levels energy efficiency by this method. Finally, it was verified, that some of these solutions proved contradictory in relation to the recommendations contained in the theoretical approaches regarding environmental comfort in hot and humid weather, which indicates the need for improvement of the prescriptive method RTQ-R and further research on efficient design solutions

Indicações para o projeto arquitetônico de edifícios multifamiliares: uma análise pósocupação em Natal/RN

Confirming the Brazilian tendency in the field, the multifamily vertical condominium habitats in Natal are defined as buildings with three or more floors which have been an increasingly used solution. In the mentioned project, the connection between the projectarchitects and the user/ buyers are spread out, by which the first people conceive the realestate property as a creation for the market and not the individual client in specific. Such situation along with technical and financial limitations of the project lead to the adoption of standard solutions to be utilized by clients with different profiles. Besides that, there are various legal and urban parameters by the City Director Plan showing elements of great influence in the final solution adopted by the mentioned edifices. Moving to this subject in general, this project is focused on the case study of the Ed. Ville de Montpellier, having as a base of Post Occupancy Evaluation (POE), considered an efficient tool to analyze and keep up with the progress of the construction of the building, including technical approvals, the application of surveys with the local residents and the creation of informal interviews. The data shows that with time some items that initially motivated the acquisition of the realestate property (with a social common area) move to being less valued, and that the residents quickly alter the pre constructed space, thus seeking to alter the property in a more personal and conforming manner. The possibility of a new emphasis for projects on the mentioned space should also be in discussion, the created project calls for the attention of projected conceptual aspects and interdependence within project and construction which permits the indication of some recommendations for the projection of multifamily residential buildings within the studied realm

Simulação computacional como ferramenta de auxílio ao projeto: aplicação em edifícios naturalmente ventilados no clima de Natal/RN

Natural air ventilation is the most import passive strategy to provide thermal comfort in hot and humid climates and a significant low energy strategy. However, the natural ventilated building requires more attention with the architectural design than a conventional building with air conditioning systems, and the results are less reliable. Therefore, this thesis focuses on softwares and methods to predict the natural ventilation performance from the point of view of the architect, with limited resource and knowledge of fluid mechanics. A typical prefabricated building was modelled due to its simplified geometry, low cost and occurrence at the local campus. Firstly, the study emphasized the use of computational fluid dynamics (CFD) software, to simulate the air flow outside and inside the building. A series of approaches were developed to make the simulations possible, compromising the results fidelity. Secondly, the results of CFD simulations were used as the input of an energy tool, to simulate the thermal performance under different rates of air renew. Thirdly, the results of temperature were assessed in terms of thermal comfort. Complementary simulations were carried out to detail the analyses. The results show the potentialities of these tools. However the discussions concerning the simplifications of the approaches, the limitations of the tools and the level of knowledge of the average architect are the major contribution of this study

A contribuição de técnicas modernas de reabilitação estrutural para autenticidade e integridade de edificações patrimoniais

This work discusses the study of the application of structural reinforcement and rehabilitation using modern techniques for interventions in repair works of historical buildings as well as the verification of the behavior of works that have already undergone different structural intervention techniques, with the objective of obtaining data to allow a comparative analysis of the advantages/disadvantages of techniques adapted in each case, regarding the interferences related the authenticity and integrity of the buildings belong to the constructed patrimony so as to obtain a basis for the theoretical foundation for choosing the best solution to be adopted in the case study which consists in an intervention of structural rehabilitation of the old historic building in the primary school "Augusto Severo"

Desenvolvimento de argamassa para restauração utilizando resíduo do polimento do porcelanato

The coatings mortars are essential elements of building structures because they execute an important role in protecting walls and are particularly exposed to aggressive action responsible for its degradation over time. The importance of wall coverings has been the subject of discussion and analysis in the conservation and rehabilitation of old buildings. Are sometimes removed and replaced with inappropriate solutions of constructive point of view or architecture. The most commonly used coatings on walls of old buildings is based on traditional hydraulic lime mortars. The present study aims at the formulation of new lime- based mortars and aerial fine aggregate, in order to contribute to a better field of conservation and restoration mortar coating of old buildings. Residue was used for polishing porcelain as fine aggregate, replacing the aggregate (sand), in percentages 05-30% by mass. We conducted a thorough evaluation of the mortar properties in fresh and hardened state by comparing the performance of the same with a reference mortar. The residue used was characterized as the density, bulk density, and particle size laser, scanning electron microscopy, X-ray diffraction and X-ray fluorescence. Formulations were produced 7, 6 with residue and one commonly used formulation, which served as a reference. In the formulations of lime mortars air (hydrated lime powder CH-I) has been adopted a stroke volume (1:3) with constant binder, was varied and the water / binder and aggregate and waste. For evaluation of mortars fresh, proceeded to consistency analysis, specific gravity, water retention and air content embedded. In the hardened state assays were performed in specific gravity, water retention, modulus of elasticity, tensile strength in bending, compressive strength, water absorption by capillary action, adhesion, tensile strength, resistance to shrinkage and salts by of crystallization trials with resources chloride solution, nitrate and sulfate all sodium in prismatic at 90 days of age, in addition to the micro structural analysis of mortars. Based on the results we can see that the mortar formulated with 10% content of waste and the reference free retraction feature more stable closer to neutrality. The composition of 10% was obtained better performance against the action of the salt crystallization. The mortar with 15% residue obtained better density, lower air content embedded and high capacity for water retention developing good workability. The replacement of 20% of waste generates a satisfactory utilization of resistance to compression, flexion and traction grip the base. And, finally, it can be seen that the mortar with 10, 15 and 20% residual show, in principle, good suitability as coatings, thus enabling a final result consistent with durability, workability and aesthetics developing therefore a material with better performance to repair or replace existing mortars in old buildings

Estudo do resíduo fosfogesso na formulação de uma pasta para revestimento interno de edifícios

Universidade Federal do Rio Grande do Norte

Avaliação da política pública de acessibilidade no período de 1992 a 2002 na Cidade do Natal

Este estudio tiene como objetivo evaluar los avances y límites de las políticas de accesibilidad en la ciudad de Natal. Se investigan las políticas publicas municipales de accesibilidad implantadas en los diez años subsecuentes, a partir de la sanción de la Ley Municipal de Accesibilidad Nº 4.090 del 03 de junio de 1992, que torna obligatorio la eliminación de las barreras arquitectónicas para personas con discapacidades en los lugares de circulación de peatones y edificios de uso público de la ciudad. Accesibilidad, en los proyectos de arquitectura y urbanismo es la condición esencial para asegurar a cualquier ciudadano su derecho a ir y venir con seguridad, dignidad y autonomía. Esta investigación se concentra en los barrios de: ciudad alta, Petrópolis y Ribeira, ya que esta área, en el período ya mencionado, fue la que tuvo una mayor concentración del presupuesto de inversiones públicas municipales de la ciudad de Natal, en la eliminación de barreras arquitectónicas en vías urbanas. El método adoptado fue el hipotético deductivo, a partir de la formulación de dos hipótesis de trabajo: la primera, una divergencia entre los objetivos propuestos por la Ley Nº 4.090 y sus aplicaciones prácticas y, la segunda, de las diferencias que existen en el grado de entendimiento del concepto de accesibilidad, para eso, se realizó una colecta y análisis de datos tanto empíricos como teóricos. Este estudio también retrata en el año de 2004, con el uso de la técnica de la fotografía, la realidad actual de la ciudad sirviendo como un parámetro comparativo con los proyectos asociados a la Coordinación para integración de las personas con discapacidades. Se utiliza la técnica de entrevista con especialistas en accesibilidad envueltos a lo largo del proceso de implantación de las políticas públicas en la ciudad de Natal, durante los años mencionados, obteniendo así un testimonio sobre las directrices adoptadas en ese período, con base en la legislación vigente. En la investigación documental y fotográfica se realiza una evaluación de la dimensión real de lo propuesto y ejecutado en un periodo de diez años, y se concluye sobre todos los avances y retrocesos de las políticas de gestiones públicas adoptadas con relación a la accesibilidad en la ciudad de Natal