Confiabilidade interobservador da escala do equilíbrio de Berg entre fisioterapeutas com extensa e escassa prática clínica

This study aimed at assessing the interobserver reliability of the Brazilian-Portuguese version of the Berg Balance Scale (BBS). The assessment was made by physiotherapists with extensive or little clinical experience in non-institutionalized elderly individuals. Participants comprised 12 elderly subjects (10 women and 2 men) with mean ages of 75.8 ± 8.4 years (range = 63-87) and 18 physiotherapists with varying clinical experience. Inter-examiner reliability obtained for each scale item yielded weighted kappa value > 0.75 in 11 of the 14 items (varying from 0.37 to 1.0). The intra-class correlation coefficient (ICC) for the total sum of BBS scores between the two groups of physiotherapists was 0.996 (95% confidence interval, 0.987 0.999) with a Cronbach alpha coefficient of 0.996. We found no difference between the rater groups when we compared the sum score means obtained with the student s T-test (p = 0.86). Although some items had low reliability values, in general our results suggest that the Brazilian Version of the BBS showed good levels of interrater reliability and agreement when used by physiotherapists with different clinical practice levels and without previous training on non-institutionalized elderly patients. We concluded that the BBS can be useful as an important evaluation instrument on a protocol for Rehabilitation clinics. It may be used by various health professionals, as: Physicians, Physical therapists, Physical educators, Occupational therapists, Nurses and Phonoaudiologists, so confirming the interdisciplinary character of this study

As covinhas: práticas, conflitos e mudanças em um santuário popular

Cette thèse est une étude ethnographique sur un temple populaire, connue comme As Covinhas, situé dans Rodolfo Fernandes, une municipalité de Rio Grande do Norte. L'objectif de cette étude est d'analyser la formation et la dynamique de l'espace des rapports sociaux et symboliques que les établir et les promouvoir comme référence religieuse de la région où il se trouve. Dans cette intention, est exploré trois dimensions: de les pratiques, quand c‟est activités permit rituellement la (re)produisant de les significations que mis la dévotion aux Meninas das Covinhas em marche ; de les conflits, que suggérant la qualité polyphonique du sanctuaire, quand les différentes sujects impliquées dans ce lieu mettre em relation les sens et les intérêts qui recueillent souvent ; et les changements, qui aboutissent à des degrés divers des perceptions, des disposions et des opérations des sujects qui vivant le sanctuaire dans la pratique, afin de le maintenir dans le processus constant de l'invention

OBALUAIÊ: um estudo sobre o estigma no convívio com o HIV/Aids em terreiros de Umbanda na cidade de Fortaleza-Ceará

The tradition and living in African-Brazilian religious spaces, called yards, reveal how dynamic the reproduction and exchange of knowledge are, and that through their worldview, reveal ways of dealing with health and disease. The yards are culturally rich territories, in which people shape concepts, practices, and beliefs about health, disease and forms of healing, passed on from generation to generation through oral tradition. With the advent of HIV/AIDS from the 80s, a new challenge is established in the community of the yards and in the individual trajectories of people affected by the disease, who since an early age participate in this religious practice. The objective of this research is the analysis on the stigma in living with HIV/AIDS in yards of Umbanda in Fortaleza-Ceará, considering the (re)production of social dramas experienced by the community in question. During the investigation we adopted two basic parameters: the first one considers the understanding of the reproduction of stigma (or deteriorated identity) in relation to HIV/AIDS in its socio-historical dimension and its effects in the investigated context (Goffman, 1988). And the second one refers to the creation and reproduction of social dramas as a social experience carried through learning, handling and symbolic performance, which is reproduced in four stages: rupture, crisis, corrective action and reintegration (Turner, 1971)

Os processos comunicacionais na festa de São Sebastião Bairro do Alecrim Natal/RN

Parties are one of the most communicative languages, full of contents and symbolic meanings. The devotion to the saints is a kind of communication. In this thesis communicational processes, its languages and its flows are sought at the Saint Sebastian s party, at Alecrim neighborhood, in Natal/RN. The view is focused on the individuals and collective behaviors, in a dynamic which involves the saint s interlocutors at the party space, which supports the pre-novena, the novena and the procession. It tries to show through observation, ethnography and interviews the elements that composes the symbolic language present on the gestures, on the performances and bodies movements, on the clothing colors, as well as on what is said orally or in silence, on the spontaneous prayers or pre-elaborated ones, on the written messages that the devout addresses to the saint at the patron s festivity

A construção de um estilo de vida: família e relações de gênero na participação do projeto ético-político renovado

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Dores e cores nas mal traçadas linhas dos devotos do Padre Cícero: as trocas linguísticas instauradas entre o discurso eclesial e o discurso epistolar dos romeiros

This study is concerned with analyzing the letters sent by the devotees tothe religious patriarch, Father Cicero, checking as is the relationship of linguistic exchanges between the pilgrims and the Father Cicero through the issuance of letters; and, between the Church and the pilgrims, through homilies uttered these devotees, focusing on the appeals contained therein, for, then, to define a parameter between the requirements contained in the letters and the religious discourse of the Church workers in the liturgical celebrations in view of social and religious demands of the market in question. Our purposes resided in understanding the causes that lead to the production of the letters by devotees, holding us in prayers of intercession to the Father Cicero. Finally, check and understand how is the process of inter - relationship between the writing of devotee and the clerical discourse, with regard to meeting this demand, noting especially the game force a religious field, based on postulates of Pierre Bourdieu (2008), to conceive the communicative act as linguistic exchanges, surpassing the sign and therefore decipherable speech character as well as the interactive strength of the wording and voice advocated by Paul Zumthor (2010) e Bakhtin (2006). Regarding the composition of the corpus, were determined, as the universe of research, letters of pilgrims, sent to Father Cicero, deposited in his own tomb, as well as in the Church of the Horto (Gethsemane) in Juazeiro do Norte-CE (Brazil); beyond religious sermons intended for pilgrims during the massin pilgrimage time

Desempenho muscular e equilíbriu postural em idosas frágeis residentes na comunidade

Human aging is physiological process causes alterations in several systems of the organism. In the musculoskeletal system, a main change is the decreased muscle strength, that in the lower extremity, compromises the ability to respond quickly with enough strength to prevent falls, causing alterations in postural balance. Currently, many researchers have study the human frailty, defined as a multifactorial syndrome, with excess of vulnerability to stressors, reducing ability in maintaining or regulating homeostasis. Its characteristics are directly related to physical function. Aim: To analyze muscle performance and postural balance in frail and pre-frail elderly women, and to compare them according with the frailty phenotypes criteria proposed by Fried 2001. Method: 39 frail elderly women living in the community, aged 65 years and older, were assessed muscle performance of lower extremity using isokinetic dynamometer and postural balance using Berg s balance scale and computerized baropodometry. Results: There was significant difference in plantar flexor, knee flexor and knee extensor strength, in anteroposterior (AP) oscillation with eyes open and on Berg s scores between groups. A weak correlation was observed between strength and balance. Conclusion: The results suggest that the frail elderly present worse muscle performance in lower extremity and worse postural balance compared to the pre-frail elderly. There were correlations between muscle performance and balance impairments in these elderly, but several variables are also involved in maintaining postural balance

Efeitos da inclinação da esteira na marcha de indivíduos hemiparéticos crônicos

Objective: To examine the effects of treadmill inclinations on the walking of hemiparetic chronic subjects. Design: Observational descriptive study. Location: Laboratory of human movement analysis. Participants: Eighteen subjects, 10 men and 8 women were evaluated, with a mean age of 55.3 ± 9.3 years and the time since the injury of about 36 ± 22.8 months. Intervention: Not applicable. Main Outcome Measures: All subjects were evaluated for functional independence (Functional Independence Measure - FIM) and balance (Berg Balance Scale). Angular variations of the hips, knees and ankles in the sagittal plane were observed, as well as the speed of the movement (m/s), cadence (steps/min), stride length (m), cycle time (s), step time on the paretic leg and on the non-paretic leg (s), support phase time and balance phase time on the paretic leg (s) and the ratio of symmetry inter-limb as subjects walked on a treadmill at three conditions of inclination (0%, 5% and 10% ). Results: There were angular increases in the initial contact of the hip, knee and ankle, amplitude increase in the hip between 0% and 10% (37.83 ± 5.23 versus 41.12 ± 5.63, p < 0,001) and 5% and 10% (38.80 ± 5.96 versus 41.12 ± 5.63, p = 0,002), amplitude increases in the knee between 0% and 10% (47.51 ± 15.07 versus 50, 30 ± 12.82, p = 0,040), extension decreases in the hip, dorsiflexion increases in the balance phase and in the time of support phase from 0% to 5% (0.83 ± 0.21 versus 0.87 ± 0, 20, p = 0,011) and 0% and 10% (0.83 ± 0.21 versus 0.88 ± 0.23, p = 0,021). Conclusion: The treadmill inclination promoted angle changes as such as the increase of the angle of the hip, knee and ankle during the initial contact and the balance phase and the increase of the range of motion of the hip and knee; furthermore, it also promoted the increase of the support time of the paretic lower limb

Efeitos da inclinação da esteira na marcha de crianças com síndrome de down

Background: Down syndrome (DS) is a genetic alteration characterized by being a nonprogressive congenital encephalopathy. Children with DS have hypotonia and developmental delays that interfere in the movement`s acquisition for these children. Objective: Analyze the effects of treadmill inclination on angle and spatiotemporal gait characteristics of these individuals. Methodology: We studied 23 subjects of both sexes, with ages ranged between 05 and 11 years, they presented ability to walk on level 5 classified according to the Functional Ambulation Category (FAC). Initially held a subjective evaluation of balance through a questionnaire (Berg Balance Scale-BBS) then the kinematic gait analysis was realized on a treadmill first, without inclination and then, with inclination of 10%, using the motion system analysis Qualisys System. Data analysis was done using BioStat 5.0 attributing significance level of 5%. Normality of data was verified using D'Agostino test and later was applied paired t-test to compare data in two experimental conditions. Results: There was a statistically significant difference in the spatiotemporal variables: reduction in the cadence (from 108.92 ± 39.07 to 99.11 ± 27.51, p <0.04), increase in cycle time (from 1.24 ± 0.27 to 1.36 ± 0.34, p = 0.03 ) and increase in time to take stock (from 0.77 ± 0.15 to 0.82 ± 0.18, p <0.001). Angular variables that showed statistically significant increasing were: the hip in the initial contact (12.23 ± 4.63 to 18.49 ± 5.17, p <0.0001) and max. flexion in balance (12.96±4:32 to 19.50 ± 4.51, p <0.0001 ), knee in the initial contact (15.59 to ± 6.71 to 21.63 ± 6.48, p <0.0001), the ankle in the initial contact (-2.79 ± 9.8 to 2.25 ± 8.79, p <0.0001), max dorsiflexion in stance (4.41 ± 10.07 to 7.13 ± 11.58, p <0.0009), maximum plantar flexion in the pre-assessment of the ankle joint (increase of -6.33 ± 8.77 to -2.69 ± 8.62, p <0.0004).Conclusions: The inclination acts in a positive way for angular and spatiotemporal features gait of children with Down syndrome, demonstrating possible benefit of using this surface in the gait rehabilitation of children with Down Syndrome

Efeitos do treinamento de dupla tarefa no controle do equilíbrio dinâmico e estático de idosas pré-frágeis: um estudo piloto

The increasing world population of older individuals has become a subject of growing research for prevention and reversibility of the frailty because it is a major risk factor for the occurrence of falls, especially when it involves everyday situations of dual task. Some rehabilitation programs have already used the methods of dual-task with general exercises for improving gait and postural control, but has been reported that these interventions have little specificity with limited success to improve certain aspects of static and dynamic position during the performance of functional tasks. This study aimed to verify the measures of postural control in a group of elderly women with fragility phenotype after physical therapy intervention program based on dual-task treadmill training. We selected six pre-frail elderly subjects, with a minimum age of 65, female, living in the community and randomly assigned to two groups. The survey was conducted twice a week for 45 minutes, for four weeks. The simple task intervention consisted only in training on a treadmill and the dual task consisted of in treadmill training associated with visual stimuli. The assessments were made with the use of the Berg Balance Scale (BBS) and the Balance Master® computerized posturography, static and dynamically. The effects of retention were observed after one month, using the same instruments earlier used. The results showed a tendency toward improvement or maintenance of the balance after training on a treadmill, especially with respect to static equilibrium. Both groups showed the most notable changes in the variables related to gait, as the length and speed. The BBS scores and the baropodometric variables showed that the experimental group could keep all values similar or better even one month after completion of training unlike the control group. We concluded that the dual-task performance had no additional value in relation to the improvement of balance in general, but we observed that the effectiveness of visual stimulation occurred in the maintenance of short term balancevariables

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

Comparação e mobilidade, equilíbrio corporal e desempenho muscular segundo a auto-eficácia para quedas em idosas

The aging process modifies various systems in the body, leading to changes in mobility, balance and muscle strength. This can cause a drop in the elderly, or not changing the perceived self-efficacy in preventing falls. Objective: To compare the mobility, body balance and muscle performance according to self-efficacy for falls in community-dwelling elderly. Methods: A cross-sectional comparative study with 63 older (65-80 years) community. Were evaluated for identification data and sociodemographic, cognitive screening using the Mini Mental State Examination (MMSE), effective for the fall of Falls Efficacy Scale International Brazil (FES-I-BRAZIL), Mobility through the Timed Up and Go Test , the balance Berg Balance Scale (BBS) and the Modified Clinical Test tests of Sensory Interaction on Balance (mCTSIB), tandem walk (TW) and Sit to Stand (STS) of the Balance Master® System. Finally, muscle performance by using isokinetic dynamometry. Statistical analysis was performed Student t test for comparison between groups, with p value ≤ 0.05. Results: Comparing the elderly with low-efficacy for falls with high-efficacy for falls, we found significant differences only for the variable Timed Up and Go Test (p = 0.04). With regard to data on balance tests were significant differences in the speed of oscillation firm surface eyes open modified Clinical Test of Sensory Interaction on Test of Balance (p = 0.01). Variables to isokinetic dynamometry were no significant differences in movement knee extension, as regards the variables peak torque (p = 0.04) and power (p = 0.03). Conclusion: The results suggest that, compared to older community with low-and high-efficacy for falls, we observed differences in variables related to mobility, balance and muscle function

Avaliação de métodos de análises para determinação da contagem de células somáticas no leite cru, mantido em tanque de resfriamento

We analyzed the quality of raw milk from eight dairy farms in Rio Grande do Norte stored in a cooling tank , in order to evaluate methods for determining somatic cell counts (SCC). The Somaticell® kit and a portable Direct Cell Counter (DCC) were compared with each other and with the MilkoScanTM FT+ (FOSS Denmark), which uses Fourier Transform Infrared (FTIR) spectroscopy). Direct cell counter data were processed for somatic cell scores (log-transformed somatic cell count) and analyzed with the SAS®, statistical package , Statistical Analysis System, (SAS, INSTITUTE, 1998). Comparison of means and correlation of somatic cell scores were conducted using Pearson s correlation coefficient and the Tukey Test at 1 %. No significant difference was observed for comparison of means. The correlation between somatic cell scores was significant, that is, 0.907 and 0.876 between the MilkoScanTM FT+ and the Somaticell® kit and Direct Cell Count (DCC) respectively, and 0.943 between the Somaticell® kit and Direct Cell Count (DCC). The methods can be recommended for monitoring the quality of raw milk kept in a cooling tank in the production unit

Fatores de influência na produção de leite bovino sobre os níveis da contagem bacteriana total

The objective of this study was to evaluate the influence of milking procedures on the levels of total bacterial count (TBC) in bovine milk. In the first study the influences of procedures for hygienic milking, cleaning of milking equipment and milk cooling tanks on the TBC levels were evaluated. Four bulk samples of milk were collected from each tank in eight properties for TBC analysis, employing the flow cytometry method. A questionnaire was applied in each property to assess the current situation of milking procedures on each production system that took part on this research, followed by training of employees in good agricultural practices in the production of milk and monitoring of the TBC measurements. The methodology for analysis of longitudinal data was considered, focusing on random effects models. The results showed that the handling procedures for milking and the cleanliness of the cooling tank contributed to a further reduction in the levels of TBC raw milk cooling tanks. The second study aimed to describe the percentage of the properties that comply with the Normative Instruction Nº 51 (Brazil s IN 51) with regard to total bacterial count (TBC) in bovine milk. The study was conducted from January 2010 to July 2011. Milk samples were collected from the eight properties selected for TBC analysis by the flow cytometry method. Again, on each property a questionnaire was applied to assess the current situation of milking procedures on each production system that took part on this research, followed by training of employees in good agricultural practices in the production of milk and monitoring of the TBC measurements. The methodology of marginal models based on Generalized Estimate Equations (GEEs) was followed in the statistical analysis. The results showed that the handling procedures of the milking and the cleanliness of the cooling tanks contributed to a considerable percentage of the properties that reached the limits of TBC established by IN 51