Influência do kinesio taping® no desempenho neuromuscular do quadríceps femoral e na função do membro inferior em sujeitos saudáveis: ensaio clínico, controlado, randomizado, cego

Objective:To analyze the immediate effects of the Kinesio Taping® application on the quadriceps neuromuscular performance, postural balance and lower limb function in healthy subjects. Materials andmethods:This is a randomized, controlled, blinded clinical trial. Sixtyfemale volunteers(age: 23.3±2.5 years old, BMI: 22.2±2.1kg/m2)wererandomly assigned intothreegroups with20memberseach,and performedone of these threeprotocols: control -10 minutesof rest,experimental 1- patch application ontherectusfemoris (RF), vastuslateralis(VL) and vastusmedialis(VM) and experimental 2-KT application on the same muscles. Allunderwent an evaluationfor singleand triple hop distance, postural balance (baropodometry), joint position sense(JPS), peak torque (concentric and eccentricevaluation at 60°/s)and electromyographic activityof VL,before andafter intervention.Results: There wasasignificant increasein the jump distanceof thethreestudied groups,with no differencebetween groups.There were nosignificant changesin postural balance,JPS, concentricpeak torqueand RMSof the VLin none of the groups. There was a reduction ineccentricpeak torquein all groups, without differencesbetween groups.Conclusion:The KT application on the RF, VL and VMmusclesis not able tosignificantly improvelower limbfunction and postural balance, as well as the kneeextensor peaktorque, JPSand the VL muscleactivation amplitudeof healthy women.

Desempenho motor de pacientes com acidente vascular cerebral em um jogo baseado em realidade virtual

The Cerebral Vascular Accident (CVA) is the leading cause of motor disability in adults and elderly and that is why it still needs effective interventions that contribute to motor recovery. Objective: This study was aimed to evaluate the performance of stroke patients in chronic stage using a virtual reality game. Method: 20 patients (10 with injury to the left and 10 to the right side), right-handed, average age 50.6 ± 9.2 years, and 20 healthy subjects with average age of 50.9 ± 8.8, also right-handed participated. The patients had a motor (Fugl-Meyer) and muscle tone assessment (Ashworth). All participants made a kinematic evaluation of the drinking water activity and then underwent training with the table tennis game on XBOX 360 Kinect®, 2 sets of 10 attempts for 45 seconds, 15 minutes rest between sets, giving a total of 30 minutes session. After training the subjects underwent another kinematic evaluation. The patients trained with the right and left hemiparect upper limb and the healthy ones with the right and left upper limb. Data were analyzed by ANOVA, t Student test and Pearson correlation. Results: There was significant difference in the number of hits between the patients and healthy groups, in which patients had a lower performance in all the attempts (p = 0.008), this performance was related to a higher level of spasticity (r = - 0.44, p = 0.04) and greater motor impairment (r = 0.59, p = 0.001). After training, patients with left hemiparesis had improved shoulder and elbow angles during the activity of drinking water, approaching the pattern of motion of the left arm of healthy subjects (p < 0.05), especially when returning the glass to the table, and patients with right hemiparesis did not obtain improved pattern of movement (p > 0.05). Conclusion: The stroke patients improved their performance over the game attempts, however, only patients with left hemiparesis were able to increase the angle of the shoulder and elbow during the functional activity execution, better responding to virtual reality game, which should be taken into consideration in motor rehabilitation

Prevalência de doença arterial obstrutiva periférica (DAOP) e alterações sensoriais em pacientes diabéticos tipo 2: impacto da DAOP sobre a qualidade de vida, nível de atividade física e composição corporal

Diabetes Mellitus (DM) affected approximately 171 million people in the world in the year 2000 as described by the World Health Organization (WHO). Because DM is a multisystem disease it can cause several complications especially those related to the cardiovascular system. The Peripheral Arterial Disease (PAD) of the lower limbs and the Diabetic Distal Symmetric Polyneuropathy (DDSP) can affect the DM patient causing consequences as the diabetic foot and eventually amputations. The main objective of this study was to determine the prevalence of PAD and sensorial impairment in 73 type 2 DM (DM2) patients and also assess the impact of PAD on quality of life, level of physical activity and body composition. For clinical assessment it was used: the ankle-brachial index (ABI); quantitative sensorial test for tactile sensibility (ST), pain (SD), vibration (SV); Achilles tendon reflex (RA); quality of life questionnaire (SF-36); modified Baecke physical activity questionnaire and bioelectric impedance. Prevalence of PAD in the studied population was 13.7%. ABI was inversely correlated to age (p=0,03; rhô= -0,26), diabetes duration (p=0,02; rhô= -0,28) and blood pressure (p= 0,0007; rhô= -0,33). There were lower scores for physical health summary on the SF-36 in DM2 patients; however, the presence of PAD predominantly mild did not significantly impact quality of life, body composition or physical activity level assessed by questionnaire. Fourteen patients (19.2%) present bilateral and symmetrical alterations in two or more sensorial tests compatible to DPN diagnosis. Abnormalities in ST, SD and SV were present in 27.3%, 24.6% and 8.2%; respectively. There was association of results from ST abnormalities with RA and mainly with SD, suggesting the importance of 10g monofilament use in DM2 routine assessment. In conclusion, the prevalence of PAD in subclinical DM2 was slightly higher compared to the general population and in agreement to previously published data in DM patients. The PAD severity was predominantly mild and still without repercussion on quality of life and body composition. Our study demonstrated a significant prevalence of both PAD and DPN in DM2 without previous diagnosis of these complications and indicates the necessity of early preventive and therapeutic interventions for this population

Controle circadiano e homeostático do sono-virgília em pacientes com acidente vascular encefálico e correlações com a qualidade de vida e o nível de atividade física

The cerebral vascular accident is a neurological dysfunction of vascular origin that leds to development of motor sensibility, cognitive, perceptive and language deficits. Despite the fact that the main sleep disorders in stroke patients are well known, it is still necessary to analyze which mechanisms of regulation of sleep and wakefulness are affected. The objective of this study was to evaluate the changes in the circadian and homeostatic control of sleep-wakefulness in stroke patients and the correlations with quality of life and level of physical activity. The study analyzed 22 stroke patients (55± 12 years old) and 24 healthy subjects (57 ±11 years old). The instruments used in this study were questionnaires on sleep quality, daytime sleepiness, quality of life, physical activity level and the actigraphy. The data were analyzed using the Student `t test, Mann-Whitney test, ANOVA and Spearman's correlation tests. The results showed stability in the sleep-wake circadian expression with changes in the amplitude of the rhythm. However, significant changes were found related to the homeostatic component characterized by increased sleep duration, increased latency, fragmented sleep and lower sleep efficiency. Additional data showed decreased quality of sleep and increased daytime sleepiness, as well as decreased quality of life and level of physical activity. The results indicate that the interaction of circadian and homeostatic control of sleep-wake is compromised and the main reason might be because of the homeostatic component and the lower activity level resulting from the brain damage. Thus, further studies may be developed to evaluate whether behavioral interventions such as increased daytime activity and restriction of sleep during the day can influence the homeostatic process and its relation to circadian component, resulting in improved quality of nocturnal sleep in stroke patients

Efeitos imediatos da laserterapia sobre o desempenho neuromuscular após fadiga muscular induzida: ensaio clínico controlado, randomizado e cego

The aim of this study was to investigate the immediate effects of laser therapy on neuromuscular performance in healthy subjects after a muscle fatigue. This is a clinical trial, controlled, randomized, blinded, attended by 80 volunteers of both genders, healthy, with ages between 18 to 28 years. Initially the volunteers performed an initial evaluation (EV1) using electromyography in the biceps muscle, associated with assessment in isokinetic dynamometry with 5 concentric contractions (60 °/s) for elbow flexion. The subjects were randomly allocated into 4 groups: G1 (control, n = 20), G2 (placebo, n = 20), G3 (pre-fatigue laser, n = 20), and G4 (post fatigue laser, n = 20). The muscular fatigue protocol had 30 concentric isokinetic contractions (120 °/s). We used a 808 nm laser, power of 100 mW, applied at the belly of the biceps muscle. After the speeches the volunteers performed a final evaluation (EV2). Test was applied to two-way ANOVA with post hoc Turkey, with a significance level of 5%. There was no significant difference in electromyographic evaluation. In dynamometric evaluation showed a drop in peak torque, peak torque normalized to body weight (p <0.001) and average power (p <0, 05) between the initial and final evaluations in control. Among the groups there was a significant difference between the control and the other groups in relation to peak torque (p <0.05), peak torque to body weight (p <0.001) and average power (p <0.05). Therefore, the low intensity laser therapy does not alter the immediate neuromuscular performance after fatigue

Fisioterapia respiratória em crianças com pneumonia: revisão sistemática

Introduction: Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial. Objectives: To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia. Methods: We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013). We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies. We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia. Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data. Results: Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in respiratory rate and oxygen saturation whereas the other included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure decrease the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were xvi described. Due to the different characteristics of the trials, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia, as well as differences in their statistical presentation, we were not able to pool data. Two included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias. Conclusion: Our review does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data. The number of included studies is small and they differed in their statistical presentation

Estágio menopausal e níveis hormonais no desenvolvimento muscular e funcional em mulheres de meia idade: um estudo transversal

Introduction: Hypoestrogenism is the main characteristic of female aging. It promotes significant changes in body composition, both in fat mass as in lean body mass, leading to a decrease in muscle strength and physical performance. Objective: The aim of this study was to test whether menopausal status and hormone levels are associated with muscular strength and physical performance in middle-aged women. Methods: In a cross-sectional study it was collected sociodemographic data, gynecological history, anthropometric and biochemical measures in women aged 40 to 65 years in Parnamirim-RN. The menopause status (pre, peri and post menopause) was determined by menstrual history. All women underwent three dimensions of physical performance assessment: handgrip dynamometry, gait speed and chair stands test - Short Physical Performance Battery (SPPB). Categorical data were presented as absolute and relative frequencies. Quantitative data were showed as mean and standard deviation and the normality of distribution was verified with Kolmogorov-Smirnov (KS) test. Biochemical measures of estradiol and follicle-stimulating hormone (FSH) were transformed to log10. ANOVA with Tukey post-test for comparison of variables between the groups pre, peri and post-menopausal was performed and then multiple linear regression analyzes. Results: Two hundred and seventy eight women aged 50.2 (±5.58) years composed this study, being 50 women in premenopausal status (18%), 122 in perimenopausal (43.9%), and 106 postmenopausal stage (38.1%). The groups were different in age (p=0.001), marital relationship duration (p <0.001), number of pregnancies (p=0.001) and parity (p=0.001). Differences in biochemical measures were observed among the groups: estradiol (p<0.001), FSH (p<0.001), total cholesterol (p=0.001). There were no differences in gait velocity between menopausal status. Values in mean of grip strength decreased by postmenopausal women to perimenopausal and premenopausal ones (24.5 ± 5.1, 25.6 ± 5.4, 26.9 ± 4.9 for post-stage, pre and peri menopausas, respectively, p = 0.02) and the performance of chair stands test was better in premenopausal women compared with that in peri and postmenopausal status (p = 0.02). In multiple linear regression for muscle strength, the variables that remained were: age, estradiol and somatic symptoms measured by Menopause Rating Scale-MRS (R2=0.15). While for the xiv chair-stands test the predictors were number of births and FSH values (R2=0.04). Conclusion: There is a relationship between the stages of menopause and muscle performance in measures of grip strength and sit-up test and these are influenced by the fall of estrogens levels. Data suggest that the decrease in muscle strength and physical performance already appear in the transition to menopause stage, pointing to the need for more research in this area and appropriate preventive interventions

Efeitos da prática mental na marcha de indivíduos com doença de parkinson: ensaio clínico randomizado

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Análise dos fatores responsáveis pela alta salinidade do aqüífero fissural da microbacia da Riacho do Feijão - Pedro Avelino/RN

The fissures aquifer northeast semi-arid Brazilian, present high text frequently of leave, with of low a hídric availability. The research has as objective main to analyze the components that inside influence in the salinity of the waterbearing fissures of an evaluation physicist-chemistry of the water, leading in consideration the physical interventions of the environment. One used techniques of interpretation of image of Landsat satellite -1999 and delimitation of the micro basin through the topographical map SUDENE. One identified waters of the NaCl type with Ca++ and Mg++ in secondary concentrations. The analyzed wells (15), had presented an average salinity of 5.147 mg/L of STD and a well only supplies drinking waters with 319 mg/L of STD. The recharge of the aquifer one if carries through for infiltration in the open fracture of ortognaisse it migmatization. The type and directions of the fracture do not control the STD. Relations between salinity and out let do not exist. The quality of the well of low salinity is identical the superficial waters (aquifer dam and alluvial). The studies of the meteoric erosion processes had evidenced that in the transformations of the rock in ground, the Ca++ and Na+ are taken for superficial waters. The treatment of the data chemical showed that the grade of Na+, Ca++, Mg++ and Cl-are controlled for the evaporation process, from only water that would have the qualities of superficial waters or the well of low salinity. Already the HCO3-grade is controlled for the precipitation of the dolomite. The STD of this aquifer one would be consequence of the high tax of evaporation of dams constructed in regions of plain topography. You leave them precipitated in deep argillaceous ones dry dams are led for the aquifer in first rains. The research suggests some recommendations for the use and exploitation of the water salinity in piscicultura, carcinicultura, culture of the grass-salt (Atriplex sp), among others

A eletricidade chega à cidade: inovação técnica e a vida urbana em Natal (1911-1940)

Dans les premières décennies du XXème siècle, un groupe d intellectuels brésiliens a pris pour soi la mission de conduire la nation aux chemins du progrès, en réfléchissant sur les transformations des villes et, souvent, en proposant et en mettant en avant des actions et mesures qui dirigeraient la modernisation du pays. Dans ce contexte, la ville apparaissait comme un synonyme de progrès en opposition à la campagne, en donnant emphase à la construction du Brésil urbain. À Natal, celui-ci a été une période de sensible modification dans l espace urbain, en suivant les préceptes de l hygiénisme et de l esthétique racionaliste, qui ont orienté les réformes entreprises dans beaucoup de villes brésiliennes. Les élites politiques et socioéconomiques de la capitale du Rio Grande do Norte ont developpé le discours en faveur de la modernisation qui avait pour objectif de justifier les interventions dans la ville et l introduction de l infra-structure de services urbains, par exemple, les services d illumination et de transport, qui à partir de 1911, ont commencé à être stimulés par l électricité. Cette modernisation est matérialisée par de nouveaux équipements et services, par des espaces remodelés en accord avec la rationalité technique de l urbaniste, pour l utilisation de nouvelles sources d énergie (gaz, électricité), en plus de la croissance de la population résidente en ville. Cependant, nous ne pouvons pas oublier que la construction de la ville moderne est passée tant par des transformations physiques, matérielles, comme par l absorption de valeurs, symboles, gestes, vocabulaires, objets, adoptions de nouvelles normes de comportement et par la formation de nouvelles sensibilités sur l espace urbain et la vie en ville. De cette manière, les nouvelles normes technologiques, comme l électricité, ont rendu possible des transformations dans la structure matérielle de la ville et en vie urbaine dans ses plus divers aspects. Ce travail propose d analyser la relation entre énergie électrique et la vie urbaine à Natal entre 1911 et 1940, en prenant en compte, pour cela, les actions d intervention de l État sur l espace urbain et les perceptions d intellectuels face aux transformations urbaines dont ils étaient les témoins. À partir de cette analyse, nous cherchons à préciser les efforts gouvernementaux pour la manutention des services d électricité et conservation des équipements urbains; comprendre comment l utilisation d énergie électrique a aidé à produire de nouvelles situations quotidiennes et comment elle a été perçue, traduite en sentiments et perceptions fondées dans la cohabitation avec cette innovation technique. Les élites locales désiraient diffuser des habitudes considerées modernes, en construisant une identification avec la manière de vie urbaine, fortement inspirée dans la vie dans les villes Européennes et Américaines. L électricité a rendu possible des expériences et sensations qui allaient caractériser l habitant de la ville

A criança e a cidade: as transformações da infância numa Natal moderna

The first years of the twentieth century in Natal is characterized by several urban interventions that aim was to change the feature of the city basically rural to another that was in line with cities as models of modernity and civilization. In this case all individuals would have to play important social roles, which included men, women and especially children. It was in this atmosphere of bright future that the children were taken as key parts of an idealized society. Some processes were essential in triggering changes in natal s childhood, among them, operated within the families, that this historic moment in public life sought other possibilities of existence, the school education and the construction of which would be the model for urban education the School Groups, propagators of science as mediators of all knowledge, and finally, the medical interventions that disseminating health and hygiene practices has enabled not only the conservation of child life, but also the possibility of building their individuality in a body healthy. If these processes on the one hand tried to crystallize an ideal image of a child making a child identity directly linked to education and the "body hygiene" on the other, giving specific reflexive autonomy to children, providing them see the world through eyes of subject.

Engenharia nos sertões nordestinos: o Gargalheiras, a Barragem Marechal Dutra e a comunidade de Acari, 1909-1958

In Brazil, between the late nineteenth and early decades of the twentieth, polytechnic engineers assumed an important role in discussing the establishment of a modern country. The problem of drought in northeastern Brazil gave the professionals performance, within an interventional process more mounts, the conception plans and measures for the purposeful integration of the territory afflicted. With the foundation of Inspetoria de Obras Contra as Secas (IOCS), in 1909, the actions to combat drought and would be institutionalized, them, studies performed out by technical and scientific committees would be systematically applied in the Brazilian Northeast. So, This work was central objective understand the historical process inplantation of a whole infrastructure of modern character by professional technical and their consequences within the Northeast Geographic space, in specific, in the municipality of Acari in the State of Rio Grande do Norte, in the first half of the twentieth century. The politics of the government, through technical education and scientific engineers polytechnics, would emphasize, during the twentieth century, the building of dams, and irrigation canals, wells, railways, highways, between other elements, that would soon transform the physical space-northeast, specifically, the territory acariense. These works began to contribute to the setting of man backcountry their land, promote the regular practice of agriculture even in periods of drought and, the integration, especially, economic of territory acariense the other producing regions of Rio Grande do Norte and the Northeast as well as promoting the modification of the landscape of the world backcountry. These actions functioned as elements of modernity and progress that transformed the space by favoring by favoring the formation of urban networks (urban) in this space

A capitania de São José do Piauhy na racionalidade espacial Pombalina (1750-1777)

Em meio às intervenções políticas, econômicas e administrativas realizadas no Brasil a partir de 1750, é possível observar como se deram as tentativas de organização da capitania de São José do Piauhy e até mesmo o seu reconhecimento como importante área pecuarista da colônia. Neste trabalho, realizou-se um recorte espacial priorizando a região em que a apropriação territorial teria se dado de forma mais diversa em tal capitania, pois além dos procedimentos de aquisição de sesmarias, existiram ainda os processos de herança e confisco. Sobre estes últimos, os mesmos incidiram sobre as fazendas que pertenceram ao sertanista baiano Domingos Afonso Mafrense, e que após serem deixadas de herança para os religiosos da Companhia de Jesus (1711), foram confiscadas pela Coroa Portuguesa (1759). Isso aconteceu em meio ao planejamento e execução de medidas governamentais que atingiram todos os domínios portugueses durante esse período, a chamada Política Pombalina. Tais intervenções administrativas, por sua vez, puderam ser analisadas tomando-se como referência a confecção da primeira representação cartográfica destinada a tal capitania, o Mappa Geográfico da Capitania do Piauhy, produzido pelo engenheiro italiano Henrique Antônio Galúcio. Deste modo, considerando-se as particularidades da política portuguesa destinada ao interior do Brasil, em meados do séc. XVIII, com destaque para as medidas incidentes sobre os modos de vida indígena e rural, observou-se a tentativa de implantar-se uma nova forma de organização espacial, a partir de modos e instalações urbanas. Neste contexto, São José do Piauhy passa a ser alvo de intensas investidas enquanto área oficialmente pertencente ao Estado do Grão-Pará e Maranhão

Condições de saúde bucal e capacidade funcional em idosos

Population aging is one of the greatest challenges to contemporary public health and, in this perspective, the functional capacity emerges as an important feature in geriatric assessment. The oral health of elderly, in turn, deserves special attention because, historically, in the dental services, this population group was not considered a priority for attention, which is verified by high rates of edentulism found even among these individuals. The present study proposes to examine the relationship between oral health status and functional capacity in an elderly population. To this end, intra-oral epidemiological examination was performed to assess the degree of dental caries, periodontal status, use and need of prosthesis and the presence of lesions. Functional capacity was assessed by the Independence in Activities of Daily Living, which considers the independence or not in the performance of six self-care functions. Socioeconomic and demographic characteristics and general health status were also investigated, in view of the possibility of intervention of these variables in the investigated relation. An factor analysis of the principal components was conducted which resulted four indicators of oral health conditions, representative of the population studied. 441 seniors were enrolled with mean age of 71.7 (± 8.7) years, the majority being female (68%). Functional capacity was dichotomized into completely independent individuals (89.6%) and dependent on at least one of the functions considered (10.4%). There was an association between functional capacity and the indicators related to the presence of many teeth and dental caries, and to that associated with the use and need of prostheses. These associations in turn, lost statistical significance when adjusting for confounding variables, combined in separate models for each indicator. Some of these variables, however, remained associated with functional capacity. It is considered that the study of oral health status of elderly, associeted with the search for an association with functional capacity is important in the construction of indicators necessary for planning preventive and therapeutic interventions that reduce the risk for loss of ability in daily physical functions and their consequences, as the harm in the oral self-care

Bem-estar psicológico de servidores e funcionários técnico-administrativos das Instituições de Ensino Superior Públicas e Privadas : indicadores e antecedentes

The elaboration of this thesis aimed at getting to know the structure of the psychological well-being (PWB) at work and analysing the differences in the PWB levels among technical-administrative servants in public and private Institutions of Higher Education (IES) in the municipality of João Pessoa. Two hundred and thirty-three public and private IES male and female servants of João Pessoa participated in the research, replying to an instrument composed of questionnaires referring to the elaborated model. Factorial and regression analyses were accomplished in order to test the hypotheses in respect of the proposed model. The results showed that the PWB related with the work is composed of indicators such as affection, vitality, anxiety, depression, satisfaction at work and aspiration for accomplishment and reduction of the self-efficiency. The observed PWB predictors at work were the IES type, presence of children, age and the escape and back-out facing strategy. These predictors possess relationship of moderation among them in the explanation of PWB. On comparing the PWB experienced by the technical-administrative servants, it was observed that those linked to private IES showed higher PWB rates. Furthermore, there are differences among PWB predictors in accordance with the IES type. The applicability of the results of this thesis is wide as regards social interventions in the search of health improvement under a psycho-sociological perspective. Eventually, the thematic of this thesis intends to reinforce the studies on the worker s health, since by knowing what would lead him into a feeling of accomplishment and well-being will result in more chances of promoting him, while creating opportunities of a sounder life for these people in psychological terms