Hemiparesia congênita e adquirida na criança: interrelação entre presença de crises epilépticas, os achados eletrencefalográficos e de neuroimagem por ressonância nuclear magnética

The purpose of this paper was to study patients with congenital and acquired hemiparesis, their clinical aspects, the presence or not of epileptic seizures, and electroencephalographic (EEG) and Magnetic Resonance Imaging (MRI) findings. We analyzed the interrelation between etiology, the presence and seriousness of epileptic seizures (ES) and the possible causes of refractoriness. This is a prospective study using the clinical diagnosis of a child neurologist, who attested to the presence of unilateral motor lesions. We compared the electroencephalographic findings in patients with or without epileptic seizures, and investigated if among the former, these seizures were controlled or not, their likely etiology and risks of refractoriness. EEG background activity on the lesion and contralateral side was analyzed, in addition to the presence of concomitant epileptiform activity. Encephalon MRIs of all the patients were studied to correlate etiology and the control or not of epileptic seizures. The disorganization of bilateral EEG activity correlated with the difficult-to-control epileptic seizures. Suitably organized background activity contralateral to the lesion is a good prognosis in relation to epileptic seizures. Focal epileptogenic activity does not necessarily predispose to epileptic manifestation. The MRI is more important in determining etiology than in prognosing epileptic seizures. This study used a multidisciplinary approach involving child neurologists, a physical therapist and a neuroradiologist. This meets the criteria of multidisciplinarity of the Postgraduate Program in Health Sciences

Dança Folclórica: um estudo das qualidades físicas básicas em universitários de diferentes níveis técnicos

Health and life quality can be preserved and improved by the regular practice of physical activity. Sedentarism is an undesirable condition and represents risk for the health. This study has as objective to analyze the caloric cost and the basic physical qualities in college students of different technical levels. The research was descriptive and applied to 35 students, volunteers, from 19 to 34 years old, from both sexes, participants of the Dance Body of State University of Piauí, in the city of Teresina, in the activities of folkloric dance and walking. The caloric cost was evaluated with the accelerometer Caltrac 100/100 Plan, the basic physical qualities through the sitting and reaching test (flexibility); the vertical impulsion test, crouch (inferior members strength); the abdominal test (located muscular resistance); and the Burpee test (motor coordination). The participants were separated in two groups according to their time of practice: group 1 (beginners), group 2 (advanced). The parametric tests t by Student and correlation by Pearson were used, observing a significance p<0,05 in the sense of comparing the observed results, which showed that there are no significant differences between the two groups of students, according to the time of practice, in which concerns the caloric cost. The results of Strength, Resistance and Co-ordination test did not differ so much between the two groups. On the other hand, in the variable flexibility significant differences were observed (sig.p = 0,0022 << 0,05) between the observed groups, being Group 1 (31,5 ± 6,3) meaningfully less than Group 2 (38,1 ± 4,9), which constitutes a difference of about 21%. Such results present relations of caloric cost compensation between the studied groups, the motivation to the beginners group and flexibility to tne advanced group, justifying the lack of significant distinctions. In this sense the folkloric dance, as a physical activity, appears to be efficient, for significant co-relations are still noticed between the caloric cost levels of the dance with the walking, besides not presenting expressive differences between them.

Avaliação do desempenho funcional de crianças com paralisia cerebral de acordo com níveis de comprometimento motor

Contextualization: Several studies have examined the mobility of this group of children, however little is known about the impact of motor function in activities of daily living, considering the seriousness of their neuromotor damage. Objective: Identify the functional differences of children with Cerebral Palsy with different levels of motor dysfunction and correlate these differences with the areas of mobility, self-care and social function in functional ability and caregiver´s assistance of these children. Methods: An l analytical cross-section search was developed, which were part 70 children / families aged from 4 to 7.5 years, in the Rehabilitation Center for Children. As tools were used the Pediatric Evaluation Disability Inventory (PEDI) and the Gross Motor Function Classification System (GMFCS). Data analysis was performed by ANOVA and Pearson's correlation tests. Results: The results show the functional variability of children CP in different severity levels of motor disfunction This variation was observed in the areas of mobility, self-care and social function. The results also showed a strong correlation between the domains mobility and self-care, mobility and social function. Conclusions: The variability shown by the children with CP, suggests the use of PEDI and GMFCS as this association appears to increase the understanding of how the gross motor functions are related to activities of daily living, describing the best commitments and their degree of impact on functional activities. This correlation demonstrates how mobility is crucial to evaluate the performance and guide the therapeutic practice, to develop the children´s potencial, and guide the caregiver in stimulation

Avaliação neuropsicológica de crianças com hemiparesia congênita e adquirida

A hemiparesia consiste no déficit da força muscular, com consequente debilidade na mão e no pé, afetando um dos lados do corpo. A literatura mostra poucos estudos enfocando detalhadamente as funções cognitivas e emocionais de crianças afetadas por essa condição neurológica. Este estudo teve como objetivo realizar avaliação neuropsicológica de 23 crianças e adolescentes, de ambos os gêneros, com idades entre 5 anos e 4 meses e 16 anos e 6 meses, com hemiparesia congênita e adquirida. Aplicou-se uma bateria de testes específica para avaliação de funções cognitivas superiores incluindo processos intelectuais, atenção, função perceptiva, função motora, praxias, gnosias, linguagem, memória e função visuomotora. Em relação aos aspectos emocionais, foi usado o teste do desenho da figura humana, visando-se a avaliação da percepção da imagem corporal dos pacientes. Os resultados mostraram que a hemiparesia da criança conduz a déficits em funções neuropsicológicas importantes, além de déficit motor e alterações na esfera emocional, mais precisamente aquelas relacionadas com a representação da imagem corporal. A abrangência multidisciplinar, envolvendo a neurologia pediátrica e a psicologia, engrandeceu o trabalho, referendando os resultados obtidos em todos os seus aspectos

Empreendedorismo ambiental e preservacionismo compensatório: o turismo e as unidades de conservação Parque Estadual das Dunas e Área de Proteção Ambiental Jenipabu-RN

This doctoral thesis addresses the environmental issues and its vinculum with the tourism through the protected natural areas, in particular the conservation units, which consists in territorial areas created and demarcated by the government in order to protect ecosystems that have a high ecological and scenic-landscaped representativeness designed to the contemplation and controlled public visitation. In regard to its use for the touristic activities, are conceived while socio-environmental and symbolic materiality built around an imagery view of a nature-show, designed to attract visitors, aiming ensure the maintenance and reproduction of the capital in an entrepreneurial and preservationist way in the Metropolitan Region of Natal. It s a study about the Dunes State Park Jornalista José Maria Alves and the Jenipabu Environmental Protected Area, both created with the purpose of favor the implantation and empowerment of the touristic area through the State intervention as the main articulator agent of a new process of urbanization that uses the city marketing and the ideological discuss of environmental sustainability to recreate the imaginary of lost paradise and incorporate into the daily universe of tourists visiting the state of Rio Grande do Norte. The unveiling of this empirical reality made possible the construction and defense of the terms environmental entrepreneurship and compensatory preservationism, to explain how the formatting and idealization of this paradisiacal scenarios produce the commoditization of nature in an efficient and competitive way

Itinerário educacional de uma aluna cega e a busca pela imagem adaptada

The scope of this study directs an investigation in search of how the blind person learns knowledge at school mediated by the image in context of an inclusive education and how it can be (or is) triggered by the adaptation of images to the tactile seizure of the blind person and his correlative process of reading. To achieve this intent we choose a qualitative approach of research and opted for the modality of case study, based on the empirical field of a public school in the city of Cruzeta, RN and as a the main subject a congenitally blind female student enrolled in high school there, focusing, often, on the discipline of geography in its words mapping. Our procedures for construction of data are directly involved to the documentary analysis of open reflective interview and observation. The base guiding theory of our assessments is located in the current understanding about the human psychological development of its educational process inside an inclusive perspective, of contemporary conceptions about the visual disability as well of image as a cultural product. Accordingly, the human person is a concrete subject, whose development is deeply marked by the culture, historically built by human society. This subject regardless of his specific features, grasping the world in an interactive and immediate way, internalising and producing culture. In this thinking, we believe that the blind person perceives in multiple senses the stimuli of his environment and acts in the world toward his integration into the social environment. The image as a product of culture, historically and socially determined, appears as a sign conventionally used as an icon that in itself concentrates knowledge of which the student who does not realize visually himself and his surroundings cannot be excluded. In this direction, the inclusive educational process must build conditions of access to knowledge for all students without distinction, including access to the interpretation of the images originally intended for the seizure strictly visual to other perceptive models. Based in this theory and adopting principles of content analysis, we circulated inside the interpretation of the data constructed from the analysis of documents, from the subject speeches, from records of the observation made in the classroom and other notes of the field daily. In the search for pictures on the school contents, adapted to the tactile seizure of blind student, was seen little and not systematic in practice and teaching at the school. It showed us the itinerary of the student life marked by a succession of supports, most of the time inappropriate and pioneers in cooling the construction of her autonomy. It also showed us the tensions and contradictions of a school environment, supposedly inclusive, that stumbles in search of its intent, in the attitudinal and cumulative barriers brought, because of its aggravating maintenance. These findings arose of crossing data around of a categorization that gives importance to 1) Concepts regarding the school inclusion, 2) Elements of the school organization, educational proposal and teaching practice, 3) Meaning of the visual image as the object of knowledge, 4) Perception in multiple senses and 5) Development and learning of the blind person before impositions of the social environment. In light of these findings we infer that it must be guaranteed to the disabled person removal of the attitudinal barriers that are against his full development and the construction of his autonomy. In that sense, should be given opportunity to the student with visual disability, similarly to all students, not only access to school, but also the dynamics of a school life efficient, that means the seizure of knowledge in all its modalities, including the imagery. To that end, there is a need of the continued training of teachers, construction of a support network in response to all needs of students, and the opportunity to development of reading skills beyond a perspective eminently focused in the sight

Iconografia humorística no ensino de História :modalidade de uso na sala de aula

Plongés dans le temps présent, les dessins humoristiques, par la capacité de représenter, de suggérer et de communiquer une idée, marquent présence à l école et dans la salle de classe. Caractérisés par l utilisation d éléments comiques, satiriques et irôniques, outre la nature persuasive, ces dessins possibilitent le lecteur de faire une lecture critique des événements sociaux et politiques de notre société. En tant que langage visuel, structuré dans les formes verbale et icônique, de même que par le caractère analogique de représentation, les dessins humoristiques constituent un excellent recours pédagogique. Toutefois, ils sont longtemps restés inaperçus par l école et, seul récemment, ils sont devenus objet d investigation de la part des historiens. Dans ce sens, nous nous sommes proposés, dans cette étude, à analyser l utilisation de ces dessins par les professeurs d histoire des écoles publiques nommées Centros Paraibanos de Educação Solidária (CEPES), de João Pessoa, capitale de l Etat de Paraíba, en vue d appréhender et de discuter la façon dont ces professeurs font usage de ces dessins dans leur pratique pédagogique. Par le moyen des actions des professeurs, conçues comme des arts de faire, selon Certeau, et par l identification des usages qui se caractérisent comme des tactiques, nous avons essayé de percevoir comment se réalise le rapport humour et histoire, en salle de classe. La systématisation, la catégorisation et la narration des pratiques pédagogiques observées ont été réalisées par l analyse des questionnaires et des interviews appliqués aux professeurs et élèves, ainsi qu à l observation des classes. Notre recherche s est fondée sur les théories de Roger Chartier et Michel de Certeau, dont les concepts de représentation et d appropriation, d usages et de tactiques nous ont aidé à comprendre la forme par laquelle les sujets incorporés au quotidien de la salle de classe se sont appropriés de la dimension imagétique à travers l humour. A partir des concepts d usage et d appropriation nous avons identifié dans les actions et les parlers, la façon dont les dessins humoristiques sont travaillés par les professeurs. Conçus comme des registres visuels qui relatent des questions sociales, politiques et économiques, ces dessins sont perçus comme des registres visuels qui relatent des questions sociales, politiques et économiques, identifant, ainsi, les adversités du présent, dans le monde social

Um olhar estético sobre o telespetáculo esportivo :contribuições para o ensino do esporte na escola

The sportive television spectacle shows up like a media phenomenon which evidence performances and techniques that further on the community realized in the quotidian sportive practices into a show and play mixer, that more and more, sensibility the viewers. In this scenery , this research is about the relation between sportive television spectacle and viewer by the aesthetics perspective, and discussed the sport in the Physical Education context with the focus in the contributions to teaching in the school. The research, to the methodological view, uses the discuss analysis and realizes a qualitative study in two interdependent moments. In the first, analysis the dada collated in the Education, sport and television workshop. In the second, turns about TV images of sportive television spectacle to appreciated, to support a discuss of these phenomenon s aesthetics elements, looking for the relation established between the sportive television spectacle and viewer. The analysis s emphasis is in the sensations by sportive television spectacle, as well in the aesthetic elements problems promoted by this experience, from the two basics concepts, to know: the aesthetic and the synaesthetic perception. The analysis s corpus is composed by Esporte Espetacular TV program. Identify, in the sportive television spectacle appreciation, four big discuss axis of great importance between sportive television spectacle and viewer understanding: the relation space and time, the belonging feeling, the language interlacing, and beauty models. Understand in the analysis that, in the sportive TV scenery, occurs a construction image that seduces and involves the viewer through the aesthetics elements. From that discuss axis reflect about teaching sport in the school, main concern to the materialization a sport model only. Aims unfolding about space and time construction yet, and about the multiplicity language for to work in the school. Positions that no absolute rules, but that check the TV sport by the seduction promoted in the viewers through the aesthetics elements transmit

Úlceras de pressão: um estudo com pacientes de unidade de terapia intensiva

To characterize patients according to gender, age category, internment time, diagnostical hypothesis and location of the pressure ulcer; to identify the susceptibility conditions, intrinsical and extrinsical factors present on ICU patients and to verify on the existence of association between the susceptibility conditions and the intrinsecal and extrinsecal factors on the occurrence of PU. Methods: It is a descriptive study, of longitudinal design of the panel type, with quantitative approach, performed on two ICU s of a private hospital located in Natal/RN, with 40 patients interned at these units. The data collection was performed on all three shifts through a structured observation and physical exam of the patients' skin form seeking to identify the presence of PU. Results: The greatest occurence of PU was on individuals of the male gender (70%) when compared to the female gender (30%), that difference being statistically significant (p=0,0267), with the male gender presenting 4,3 times greater chance of developing PU than the female; the predominant age category was from 60 years of age on (85%), 60,0% presented 1 to 2 PU s after 7 (seven) days of permanence in the ICU s, the predominant diagnostical hypothesis on the patients with PU were the respiratory diseases (42,3%) and the most frequent locations of PU were the sacral region (40,0%) and heels (36,0%). 25 PU s of stage I were diagnosed on 50,0% of the followed patients, with general incidence of 50,0% on both ICUs. from the 88 variables researched, 75 were identified on the patients from the study, being the predominant conditions (anemia, hypotension, leukocytosis, other diseases hypertension blood pressure, cardiac insuffience, pneumonia - and ansiolythic), the intrinsecal factors (diminished muscular strenght and/or mass, discrete edema, totally compromised mobile coordination and total inability for movement on the bed) and the extrinsecal factors (inadequate mattress type, permanence on a single position for >2 hours, shearing/friction force, bed clothes with folds that leave marks on the body, pressure force) predominated on patients with PU. The male gender variables (p=0,0267,OR=4,3), sedation (p=0,0006,OR=4,1), psychomotive agitation (p=0,0375,OR=5,8) and leukocytosis (p=0,0285,OR=5,0) presented a significant statistical diference when analyzed independently. We verified an association of 17,3%, statistically significant (p=0,0384), between the susceptibility conditions (anemia, leukocytosis and hypotension), the intrinsecal factors (age equal or above 60 years, diminished/absent pain sensibility and smooth, fine or delicate skin) and the extrinsecal factors (inadequate mattress, pressure forces, shearing/friction force, permanence on a single position for more than 2 hours, elevation between 30 to 45 degrees and inadequate bed clothes' conditions), with a chance ratio of 4,6 times the risk of occurrence of PU on the patients that presented the referred association. Conclusion: The incidence of PU detected on the ICU-interned patients was high and we made evident the existence of association between the susceptibility conditions, the intrinsecal and extrinsecal factors on the occurrence of PU s on the ICUinterned patients, and thus we accept the alternative hypothesis proposed on the study

Sistema de teleoftalmologia para auxílio ao pré-diagnóstico de disfunções oculomotoras

The vision is one of the five senses of the human body and, in children is responsible for up to 80% of the perception of world around. Studies show that 50% of children with multiple disabilities have some visual impairment, and 4% of all children are diagnosed with strabismus. The strabismus is an eye disability associated with handling capacity of the eye, defined as any deviation from perfect ocular alignment. Besides of aesthetic aspect, the child may report blurred or double vision . Ophthalmological cases not diagnosed correctly are reasons for many school abandonments. The Ministry of Education of Brazil points to the visually impaired as a challenge to the educators of children, particularly in literacy process. The traditional eye examination for diagnosis of strabismus can be accomplished by inducing the eye movements through the doctor s instructions to the patient. This procedure can be played through the computer aided analysis of images captured on video. This paper presents a proposal for distributed system to assist health professionals in remote diagnosis of visual impairment associated with motor abilities of the eye, such as strabismus. It is hoped through this proposal to contribute improving the rates of school learning for children, allowing better diagnosis and, consequently, the student accompaniment

A Transposição Didádica dos Gêneros do domínio do discursivo publicitários nos livros didáticos

Advertising text has been a subject of many investigations, because of its multimodal universe. Embodied by a linguistic and discursive materiality laying on scene persuasion, argumentation and power imagery of multissemiotics elements, the advertising text acts as an instrument of power, creating and destroying, promising and denying (CARVALHO, 2007). Advertising not only invites us to act for it, but directs us to look at it. It was under this moving look - of charm and interrogations - that discussions raised in this research were born. Investigations are directed to the school environment, in special, for the discursive advertising domain in Portuguese Language Textbook. It is from this environment that was born our research whose main objective is to analyze how does the didactic transposition of textual genres, described by Marcuschi (2008) as belonging to the "advertising" discourse domain (focusing on advertising genre) in didactic books teaching Portuguese Language before and after the advent of the PCN. Textbooks taken as reference for the study are historically situated in the 90s of the twentieth century and 10 century. Such books refer to elected 7th and 8th grades, currently corresponding to the 8th and 9th grades of elementary school. The choice is justified by the fact that in these Textbook teaching series the presence of advertising domain is recurrent and "didactized". In addition, we are also concerned in analyzing books that circulated around us and our regional reality. Hence, we elected books that were used by two public high schools: Municipal School Clementina Ana da Conceição in Jaçanã city in the Rio Grande do Norte state, State School for Elementary and High school Carlota Barreira in Areia city, Paraíba state. In our research the following categories of analysis were highlighted: (1) presence of advertising in DB, (2) fluctuation terminology: concepts and classifications; (3) The complexity of concepts facilitation, (4) what they propagate, and from which nature are the explored advertisements. From our analysis, we observe how the treatment of textual "advertising" genres have been inserted into Textbooks, and how occurs, in general, their didactic transposition. Focusing on the issue of fluctuating terminology, we noted the difficulty in drawing boundaries between the genres of advertising domain in the Textbooks. However, this also would result in the complexity - in the field of scientific knowledge - of delimiting genres of the same domain. To accomplish our studies, it was required a thorough and systematic dialogue with theories regarding the concept of "Didactic Transposition", due to the theoretical Chevallard Yves (1991), research on the textual genres - Bezerra (2005), Marcuschi (2008), Bazerman (2005), Swales (2004), among others - and studies involving the field of "Advertising" - Sandmann (2002), Carvalho (2007) and others

Desempenho de pacientes com acidente vascular encefalico em testes de reconhecimento de tividades de vida diaria com frequencia autocontrolada e pre- determinada Luciana Protásio de Melo Natal 2009

The stimulation of motor learning is an important component to a rehabilitation and type of practice used is de basic importance to Physiotherapy. The motor skills are the types more basic of behavior that subjects must acquire throughout its lives and observational learning one of forms for its acquisition. Objective: This study aimed to compare performance of patients post- stroke on test of recognition of activities of day life using self-controlled and externally determined practice. Intervention: Forty subjects had been evaluated, 20 stroke patients (the mean age was 57,9?}6,7 years, schooling 6,7?}3,09 years and time of injury 23,4?}17,2 months) and 20 health subjects (the mean age 55,4?}5,9 years and schooling 8?}3,7 years). All was evaluated about independence functional (FIM) and cognitive state (MMSE), and patients were also evaluated about neurologic state (NIHSS). Later, all realized a recognition of activities of day life test (drink water and speak to telephone) on self-controlled (PAUTO and CAUTO) and externally determined (P20 and C20) frequency. The stroke subjects also were examined for a three-dimensional system of kinematic analysis, when they have drink water. The statistic analysis was realized for chi-square and t Student tests. Results: This was not difference, about number of rightness, between groups of self-controlled and externally determined practice (p0,005), and also not between patients and control groups (p0,005). Patients mean velocity (PAUTO: 141,1mm/sec and P20: 141,6mm/sec) and peak velocity (PAUTO: 652,1mm/sec and P20: 598,6mm/sec) were reduced, as well as the angles reached for elbow (PAUTO: 66,60 and 124,40; P20: 66,30 and 128,50 extension e flexion respectively) regarding literature. Conclusions: The performance on recognition of activities of day life test was similar between on self-controlled and externally determined frequency, showing both technique may be used to stimulate motor learning on chronic patients after stroke

Efeitos imediatos da eletroestimulação nervosa transcutânea e crioterapia na espasticidade e na atividade eletromiográfica de sujeitos hemiparéticos

Cerebrovascular accident (CVA) is a term used to characterize an ischemic or hemorrhagic vascular injury, which has got as main clinic manifestations, the motor and reflex function disturbance. In the first stage there is flaccidity and loss of voluntary movements that afterwards is substituted by mass patterns and spasticity. The spasticity brings with itself functional deficits and can generate negative impacts in various motor patterns. The aim of this research was to investigate the hyperreflexia and identify the immediate effects of transcutaneous nervous stimulation (TENS) and cryotherapy in the spasticity and electromyographic activity of hemiparetic subjects. The study is characterized as an almost experimental type, in which were selected, to compose the sample, 16 patients of both sex with CVA sequel. These individuals were evaluated by collecting the amplitude peak to peak and H reflex latency, Motor response (M response) in solear muscle and the electromyography (EMG) of the injured and healthy legs anterior tibial muscles. In the injured limb the evaluations occurred in different days for cryotherapy, TENS and control, in two moments, before and after the interventions. The healthy limb was evaluated one single time to serve as baseline, for comparison with the injured limb. It was used an statistic analysis, the t paired student test to identify the H reflex differences, latency and EMG of the injured and healthy limbs and to compare the results before and after the recourses application. The ANOVA for related samples was used to identify the differences among the recourses used. It was attributed for the statistic tests a significance level of 5%. The amplitude peak to peak of normalized maximum H reflex through the maximum motor response (Hmax/Mmax), showed itself significantly increased in the injured limb (p=0.0245). The H reflex latency was presented reduced in the injured limb (p=0, 0375). The electromyographic activity was showed decreased in the injured limb (p< 0.0001). After the TENS there was a Hmáx/Mmáx ratio decrease (0.60±0.16 versus 0.49.±0.18; P = 0.0006). Nonetheless, Just after the cryotherapy application there was an increase of Hmáx/Mmáx ratio (0.58 ± 0,15 to 0.77 ± 0.13, P=0,0007) and increase of signal latency (30.41 ± 1.87 versus 33.24 ± 2.19; P=0.0001). The electromyographic activity wasn t altered significantly by any resource. It was met statistic significant differences when the Hmáx/Mmáx P<0.0001) ratio and H reflex latency (P<0.0001) were compared between the post TENS, cryotherapy and control. One can conclude that the TENS can be used to spasticity immediate reduction, and that the cryotherapy can increase the hyperreflexia state in spastic patients. Nonetheless, the spasticity decrease or increase didn t provoke lectromyographic activity change in the muscle that is opponent to the spastic one

Funcionalidade em pacientes após acidente vascular encefálico: relação com o sono e ritmo de atividade-repouso

It is known that sleep plays an important role in the process of motor learning. Recent studies have shown that the presence of sleep between training a motor task and retention test promotes a learning task so than the presence of only awake between training and testing. These findings also have been reported in stroke patients, however, there are few studies that investigate the results of this relationship on the functionality itself in this population. The objective of this study was to evaluate the relationship between functionality and sleep in patients in the chronic stage of stroke. A cross-sectional observational study was conducted. The sample was composed of 30 stroke individuals in chronic phase, between 6 and 60 months after injury and aged between 55 and 75 years. The volunteers were initially evaluated for clinical data of disease and personal history, severity of stroke, through the National Institute of Health Stroke Scale, and mental status, the Mini-Mental State Examination. Sleep assessment tools were Pittsburgh Sleep Quality Index, the Questionnaire of Horne and Ostberg, Epworth Sleepiness Scale, the Berlin questionnaire and actigraphy, which measures were: real time of sleep, waking after sleep onset, percentage of waking after sleep onset, sleep efficiency, sleep latency, sleep fragmentation index, mean activity score. Other actigraphy measures were intraday variability, stability interdiária, a 5-hour period with minimum level of activity (L5) and 10-hour period with maximum activity (M10), obtained to evaluate the activity-rest rhythm. The Functional Independence Measure (FIM) and the Berg Balance Scale (BBS) were the instruments used to evaluate the functional status of participants. The Spearman correlation coefficient and comparison tests (Student's t and Mann-Whitney) were used to analyze the relationship of sleep assessment tools and rest-activity rhythm to measures of functional assessment. The SPSS 16.0 was used for analysis, adopting a significance level of 5%. The main results observed were a negative correlation between sleepiness and balance and a negative correlation between the level of activity (M10) and sleep fragmentation. No measurement of sleep or rhythm was associated with functional independence measure. These findings suggest that there may be an association between sleepiness and xii balance in patients in the chronic stage of stroke, and that obtaining a higher level of activity may be associated with a better sleep pattern and rhythm more stable and less fragmented. Future studies should evaluate the cause-effect relationship between these parameters

Avaliação das variáveis cardiovasculares, capacidade de caminhar e nível de atividade física de obesos mórbidos antes e depois da cirurgia bariátrica

Morbidly obese patients present an increase in heart rate, blood pressure and perceived exertion besides lower walking ability compared to normal weight people. However, little is known about how these variables are presented after bariatric surgery. Moreover, despite the distance walked during the six-minute walk (6MWT) improve after surgery is not well established if the level of physical activity influences this improvement. Objective: To evaluate cardiovascular performance, perceived effort, ability of walking and physical activity level of patients with morbid obesity before and after bariatric surgery. Methods: The cardiovascular performance, perception of effort, the ability to walk and level of physical activity were assessed in 22 patients before (BMI = 50.4 kg/m2) and after (BMI = 34.8 kg/m2) bariatric surgery through the 6MWT. The heart rate, blood pressure and perceived exertion were assessed at rest, at the end of the 6MWT and in the second minute post-test (HR recovery). The ability to walk was measured by total distance walked at the end of the test while the level of physical activity was estimated by applying the Baecke questionnaire, analyzing domains occupation, leisure and locomotion and leisure and physical activity. Results: The HR at rest and recovery decreased significantly (91.2 ± 15.8 bpm vs. 71.9 ± 9.8 bpm, 99.5 ± 15.3 bpm vs 82.5 ± 11.1 bpm, respectively), as well as all the arterial pressure and perceived exertion after surgery. The distance achieved by the patients increased by 58.4 m (p = 0.001) postoperatively. Time postoperatively had correlation with the percentage of excess weight lost (r = 0.48, p = 0.02), BMI (r =- 0.68, p = 0.001) and the Baecke (r = 0.52, p = 0.01) which did not happen with the distance walked (r = 0.37, p = 0.09). Despite weight loss, patients showed no difference in the level of physical activity in any of the areas before and after surgery. Conclusion: The cardiovascular performance, the perception of effort and ability to walk seem to improve after bariatric surgery. However, despite improvement in the ability to walk by the distance achieved in the 6MWT after weight loss, this is not reflected in an increase in physical activity level of obese patients after surgery