Caracterização da criança com infecção por H1N1 e da intervenção fisioterapêutica: relato de casos em série

A infecção por influenza A, subtipo H1N1, é considerada uma doença viral aguda e importante causa de doença respiratória. As crianças foram consideradas como um dos grupos de risco, devido à imaturidade do sistema imunológico. A fisioterapia pode atuar na prevenção e no tratamento das doenças respiratórias em crianças, utilizando-se de diversas técnicas e procedimentos terapêuticos. Assim, o presente estudo teve como objetivo descrever o atendimento de fisioterapia em crianças internadas em um hospital-escola com diagnóstico/suspeita de infecção por H1N1. Estudo do tipo descritivo de relato de casos em série realizado por meio de análise de prontuário. Investigados 14 prontuários de crianças com mediana de idade de 1 ano e 5 meses, 10 do sexo masculino e 4 do feminino. A manifestação clínica mais frequente foi esforço respiratório, seguida por tosse, febre, coriza, vômitos e dor no corpo. As técnicas de fisioterapia mais realizadas foram respiratórias, seguidas de cinesioterapia, orientações para os pais, suporte de oxigênio e estímulo ao (DNPM). O tempo médio de internação foi de 4,57 dias. Algumas crianças somavam ao diagnóstico/suspeita de infecção por H1N1 diagnósticos e doenças associadas. A fisioterapia realizada foi principalmente no sentido de melhorar a mecânica respiratória por meio de técnicas desobstrutivas e outras condutas respiratórias, porém preocupação com mobilizações, orientações para os pais e desenvolvimento motor também foi destacada.

Fisioterapia respiratória e sua aplicabilidade no período pré-operatório de cirurgia cardíaca

Procedimentos cirúrgicos torácicos podem alterar a mecânica respiratória, repercutindo na função pulmonar. A presença de profissionais fisioterapeutas é fundamental no preparo e na reabilitação dos indivíduos que são submetidos à cirurgia cardíaca, visto que dispõem de um grande arsenal de técnicas. O objetivo foi verificar a efetividade de exercícios respiratórios, com e sem a utilização de dispositivos, e o treinamento muscular respiratório pré-cirurgia cardíaca na redução das complicações pulmonares pós-operatórias. Mesmo existindo controvérsias a respeito de qual técnica utilizar, estudos demonstram a eficácia da fisioterapia respiratória pré-cirúrgica na prevenção e na redução de complicações pulmonares pós-operatórias.

Análise do equilíbrio em pacientes hemiparéticos após o treino com o programa Wii Fit

OBJETIVO: A hemiparesia é um comprometimento parcial do hemicorpo que altera o equilíbrio, sendo este essencial para as atividades funcionais. OBJETIVO: Avaliar o equilíbrio em pacientes hemiparéticos submetidos ao treino de equilíbrio com o programa Wii Fit, que atuou como um recurso de biofeedback visual. MÉTODO: Foram selecionados 12 pacientes hemiparéticos pós AVE, 5 do sexo masculino e 7 do sexo feminino, com idade média de 58 ± 12,57 anos, divididos aleatoriamente em dois grupos. Um deles realizou a fisioterapia convencional (GC) pelo período de uma hora, o outro realizou por trinta minutos e mais trinta minutos de treino de equilíbrio com auxílio do Wii Fit (GW), duas vezes por semana durante cinco semanas, completando dez sessões. O equilíbrio foi avaliado antes e após as intervenções, por meio da aplicação da Escala de Equilíbrio de Berg (EEB) e pela estabilometria, que mensura a oscilação do centro de pressão (COP), nos eixos ântero-posterior (AP) e médio-lateral (ML), por uma plataforma de pressão em duas condições: de olhos abertos (OA) e olhos fechados (OF). RESULTADOS: de acordo com a EEB, os pacientes, tanto do GC quanto o do GW, obtiveram maior controle do equilíbrio estático e dinâmico. Na avaliação do COP no eixo ML, os indivíduos do GC e do GW tiveram diminuição na oscilação ML após a intervenção proposta para cada grupo, nas condições de OA e OF. No eixo AP do COP, o GC não teve diminuição na oscilação AP de OA e OF, e o GW apresentou diminuição na oscilação AP de OA e OF. CONLUSÃO: O presente estudo demonstra que a fisioterapia associada ao treino de equilíbrio com o Wii Fit apresenta resultados significantes na reabilitação dos indivíduos hemiparéticos, obtendo, assim, mais um recurso terapêutico na fisioterapia.

Estudo das relações anatômicas e suas variações entre o nervo ciático e o músculo piriforme

CONTEXTO: A síndrome do músculo piriforme pode ter como causa a passagem anormal do nervo ciático ou de uma de suas partes pelo ventre do músculo piriforme. OBJETIVO: Analisar as relações anatômicas e métricas entre o músculo piriforme e o nervo ciático, contribuindo com o conhecimento anátomo-clínico da região glútea. MÉTODO: Foram utilizados 20 cadáveres adultos de ambos os sexos. O nervo ciático e o músculo piriforme foram dissecados, medidos e fotodocumentados. RESULTADOS: Observou-se que 85% das 40 regiões glúteas apresentaram o nervo como tronco único, passando pela borda inferior do músculo piriforme, e 15% mostraram uma variação bilateral, caracterizada pela passagem do nervo fibular comum através do músculo piriforme. Os dados obtidos não revelaram diferenças estatisticamente significantes.

Influência do biofeedback respiratório associado ao padão quiet breathing sobre a função pulmonar e hábitos de respiradores bucais funcionais

OBJETIVOS: Avaliar os efeitos da utilização do biofeedback respiratório (BR) associado ao padrão quiet breathing sobre a perimetria torácica, função pulmonar, força dos músculos respiratórios e os seguintes hábitos de respiradores bucais funcionais (RBF): vigília de boca aberta, boca aberta durante o sono, baba no travesseiro, despertar difícil, ronco e sono inquieto. MÉTODOS: Foram avaliadas 20 crianças RBF, as quais foram submetidas a 15 sessões de BR por meio do biofeedback pletsmovent (MICROHARD® V1.0), o qual proporciona o biofeedback dos movimentos tóraco-abdominais. Perimetria torácica, espirometria e medidas das pressões respiratórias máximas estáticas foram realizadas antes e após a terapia. Questões respondidas pelos responsáveis foram utilizadas para avaliar os hábitos dos RBF. Os dados foram analisados por meio de teste t de Student para dados pareados e testes não paramétricos. RESULTADOS: O uso do BR associado ao padrão quiet breathing não produziu alterações significativas na perimetria torácica e nos valores de volume expiratório forçado no primeiro segundo (VEF1), capacidade vital forçada (CVF), pico de fluxo expiratório (PFE), índice de Tiffeneau (IT) e na pressão expiratória máxima (PEmáx). Entretanto, a pressão inspiratória máxima (PImáx) apresentou diferença estatisticamente significativa (-53,6 ± 2,9 cmH2O vs. -65,0 ± 6,0 cmH2O; p< 0,05) e ocorreram mudanças significativas nos hábitos avaliados. CONCLUSÃO: Os resultados permitem concluir que o BR associado ao padrão quiet breathing melhora a força da musculatura inspiratória e hábitos em RBF, podendo ser, portanto, utilizado como uma das formas de terapia nesses indivíduos.

Muscle strength assessment among children and adolescents with growing pains and joint hypermobility

OBJETIVO: Avaliar, por meio de teste quantitativo, a força muscular em crianças e adolescentes com dores de crescimento, associada ou não com hipermobilidade articular e comparadas com controles saudáveis. MÉTODO: Quarenta e sete casos de crianças e adolescentes acompanhados por dores de crescimento, sendo 24 com hipermobilidade articular (DC-HA), 23 sem hipermobilidade articular (DC) e 47 controles saudáveis pareados por idade e gênero foram submetidos a dois testes quantitativos para a avaliação da força muscular, o Childhood Myositis Assessment Scale (CMAS) e o Manual Muscle Strength Test (MMT). Os dados antropométricos como altura, peso, índice de massa corporal, prega cutânea tricipital, circunferência média do braço e a área muscular do braço foram comparados entre os três grupos. RESULTADOS: Os três grupos não apresentaram diferença estatística entre as medidas antropométricas. Houve diferença significante entre a mediana da pontuação do CMAS, sendo menores no grupo DC (47, mínimo e máximo 39-52) e DC-HA (46, mínimo e máximo 40-51), comparados com controles (50, mínimo e máximo 45-52; p<0,0001). Dois dos exercícios cronometrados do CMAS, a elevação da cabeça e a duração da elevação das pernas, tiveram menor pontuação nos pacientes comparados aos controles (p<0.0001). A pontuação mediana do MMT no grupo DC (79, mínimo e máximo 73-80) e DC-HA (78, mínimo e máximo 32-80) também apresentou diferença significante, sendo menor nos pacientes que nos controles (80, mínimo e máximo 78-80; p<0,0001). A melhor correlação entre a pontuação do CMAS e MMT foi no grupo DC-HA (Spearman r=0,65; p=0,0007). A aplicação do CMAS e MMT em duas ocasiões apresentou boa concordância e coeficiente de correlação intraclasse de 0,87 (IC 95% 0,64-0,96; p<0,0001) e 0,92 (IC 95% 0,76-0,97; p<0,0001), respectivamente. CONCLUSÃO: Os pacientes com dores de crescimento com ou sem hipermobilidade articular apresentaram fraqueza muscular de leve a moderada quando comparados com controles saudáveis.

Diferenças sensoriais e motoras entre jovens e idosos: contribuição somatossensorial no controle postural

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of continuous and pulsed therapeutic ultrasound in the appearance of local recurrence of mammary cancer in rats

Purpose: Ultrasound (US) therapy is an elect rot hermotherapeutic modality that uses US energy to provoke physical and chemical alterations. US therapy has been widely used in physical therapy. However in clinical practice, it is contra-indicated in cancer patients due to the possibility of exacerbating tumor growth.Methods: Sixty-eight female Sprague-Dawley rats bred in UNIFAE vivarium were studied. At 50 days of age, 7, 12-dimetylbenz(a)anthracene (7, 12-DMBA) was administered to 35 rats by gastric gavage to induce mammary cancer After 90 days the mammary glands of the rats belonging to the group with mammary cancer induction and stimulated by US were removed. Animals received either continuous or pulsed US. US waves were generated at a frequency of 1 MHz during 10 days, with an intensity dose of 0.5 W in the continuous group, and 0.9 W (duty cycle: 20%) in the pulsed group.Results: Among the rats treated with continuous US, 44.4% developed local recurrence, while among the rats treated with pulsed US, 22.2% had local tumor recurrence (p < 0.05). No evidence of distant metastases was shown in any of the rats studied.Conclusion: The use ofcontinuous and pulsed therapeutic US promoted the development of local recurrence of mammary cancer in female Sprague-Dawley rats in the postoperative period.

Static balance and function in children with cerebral palsy submitted to neuromuscular block and neuromuscular electrical stimulation: Study protocol for prospective, randomized, controlled trial

Background: The use of botulinum toxin A (BT-A) for the treatment of lower limb spasticity is common in children with cerebral palsy (CP). Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist). Neuromuscular electrical stimulation (NMES) is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT-A.Methods/Design: Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System) between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae). The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1) one week prior to the administration of BT-A; 2) one week after the administration of BT-A; and 3) four months after the administration of BT-A (end of intervention). Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale.Discussion: The aim of this protocol study is to describe the methodology of a randomized, controlled, clinical trial comparing the effect of motor physical therapy combined with NMES on the tibialis anterior muscle or motor physical therapy alone on static and functional balance in children with CP submitted to BT-A in the lower limbs. This study describes the background, hypotheses, methodology of the procedures and measurement of the results.

Acupuntura e implante de fragmentos de ouro em pontos de acupuntura e pontos Acupuntura e implante de fragmentos de ouro em pontos de acupuntura e pontos gatilho para o tratamento de displasia coxo-femoral em Pastor Alemão

Background: Canine hip dysplasia (HD) is characterized by hip joint laxity and subluxation. It is the most common cause of osteoarthritis in dogs, especially in larger breeds. Its management includes nutritional supplements, nonsteroidal anti-inflammatory drugs, physical therapy, acupuncture or surgical procedures. Implantation of gold beads in acupuncture points and trigger points around a joint has been used in the treatment of osteoarthritis in dogs for at least 30 years. Gold bead implants(GBI) acts as continuous acupuncture stimulation and trigger point treatment in canine HD with long lasting results. Electrophysiological investigations of trigger points reveal dysfunctional muscle spindles which indicate that the electrical activity of active loci arises from extrafusal motor endplates.Case: This is a report on the use of acupuncture and GBI for bilateral HD in a nine year old female German Shepherd. The patient has a HD non-responsive to anti-inflammatory drugs and was unable to stand up or walk by its own. Radiographs showed marked dysplasia, significant subluxation with the femoral head partly out of a shallow acetabulum and massive secondary arthritic bone changes, mainly on the right side. The animal was submitted to eight acupuncture sessions with seven days interval. After the first acupuncture session the use of NSAID was interrupted. After eight weeks the dog was considered rehabilitated and underwent GBI in acupoints and trigger points as maintenance treatment. During the one-year follow-up period the improvement remained unchanged with no need of analgesics.Discussion: It has been suggested that acupuncture or GBI can treat the chronic pain resulting from osteoarthritis induced by HD. According to AP theory, GBI is permanent and long-lasting acupoint stimulation. Moreover, the method is inexpensive, quick and easy to perform, with no postoperative pain or need of exercise restriction. Although gold is extremely corrosion-resistant, the surface of the gold implants stimulates a reaction from the immune system causing an oxidative liberation of gold ions with anti-inflammatory actions. It is well known that gold ions are effective inhibitors of the respiratory burst of neutrophils and monocytes and the proliferation of lymphocytes. These findings suggest that gold implantation, on a local scale, mimics the anti-inflammatory and pain-relieving effect of drugs with chemically bound gold ions. The relatively slow speed of the process results in a limited liberation of gold ions securing that they are taken up almost exclusively by cells close to the implant. The nine year old female German shepherd had a positive response to acupuncture with pain relieve and locomotor rehabilitation. For the nine year old female German shepherd previous acupuncture sessions to GBI resulted in no post-implant worsening period. Indeed, the association acupuncture/GBI does not have the anti-inflammatory drugs undesirable effects and brings long lasting results. In conclusion, GBI therefore should be considered for canine HD when conservative or medical treatments fail to give the desired effect.

Effects of motor intervention in elderly patients with dementia: An analysis of randomized controlled trials

The objective of this study was to analyze randomized controlled trials published in the last decades involving motor intervention as a treatment for dementia, based on Physiotherapy Evidence Database (PEDro) criteria. A database search was performed using the following keywords: randomized controlled trial, dementia, physiotherapy, physical therapy, occupational therapy, physical education, motor approach, exercise, and physical activity. Ten trials were found: 4 related to physiotherapy, 3 to occupational therapy, 1 to physical education, and 2 to interdisciplinary motor intervention. The efficacy of motor intervention was confirmed in the following variables: psychosocial function, physical health and function, affective status, and caregiver's distress (P < .05). Results related to mobility were not significant (P > .05). Behavior, cognitive performance, activities of daily living, and risk of falls were not similar among the articles. From a total score of 10 points, with excellence characterized as the highest punctuation, the articles were classified between 3 and 7 by PEDro. Motor intervention was shown to be an alternative for minimizing physical and mental decline. PEDro has been confirmed as a very reliable tool to analyze studies and as an evaluation criteria, both qualitative and quantitative, allowing the establishment of motor intervention strategies for the treatment of patients with dementia. © 2007 Lippincott Williams & Wilkins, Inc.

Equilíbrio em indivíduos com acidente vascular encefálico: Clínica Escola de Fisioterapia da Uniararas

Objective. To describe balance of stroke patients in the UNIA-RARAS Physical Therapy clinic school evaluating the correlation with age and time of lesion. Method. It was an observational study with 22 subjects, both genders, with diagnosis of stroke, ages ranged from 23 to 86 years old. The subjects were submitted to balance evaluation with Berg's Scale of Functional Balance (BSFB), Brazilian version, composed by fourteen tasks. Results. Stroke patients had an average punctuation of 37 points, showing a high risk of falls. There was no significant correlation between the patient's age and time of lesion with BSFB punctuation. Conclusion. This study showed that stroke patients present high risks of falls, independently of age and time of lesion.

Fisioterapia no tratamento da dor orofacial de pacientes com disfunção temporomandibular crônica

Recent studies have shown consistent results using the physical therapy in cases of pain and limitation of movement from temporomandibular dysfunction. Thus, our objective was to assess the effect of ten sessions of physical therapy and laser therapy in treatment of muscular pain and arthralgias in a woman with temporomandibular dysfunction. The painful symptoms relief achieved by session was over 20 %, up to zero at the end of treatment. Results demonstrated that the treatment protocol used was effective to reduce the temporomandibular joint and the masseter muscle tension and a decreased of drugs by patient. However, more studies are needed to define with more accuracy the effect of other physiotherapy programs and its interaction with other treatment modalities.

Postural control under visual and proprioceptive perturbations during double and single limb stances: Insights for balance training

Single Limb Stance under visual and proprioceptive disturbances is largely used in clinical settings in order to improve balance in a wide range of functional disabilities. However, the proper role of vision and proprioception in SLS is not completely understood. The objectives of this study were to test the hypotheses that when ankle proprioception is perturbed, the role of vision in postural control increases according to the difficulty of the standing task. And to test the effect of vision during postural adaptation after withdrawal of the somesthetic perturbation during double and single limb stance. Eleven males were submitted to double (DLS) and single limb (SLS) stances under conditions of normal or reduced vision, both with normal and perturbed proprioception. Center of pressure parameters were analyzed across conditions. Vision had a main effect in SLS, whereas proprioception perturbation showed effects only during DLS. Baseline stability was promptly achieved independently of visual input after proprioception reintegration. In conclusion, the role of vision increases in SLS. After proprioception reintegration, vision does not affect postural recovery. Balance training programs must take that into account. © 2011 Elsevier Ltd.

Distribuição de fisioterapeutas entre estabelecimentos públicos e privados nos diferentes níveis de complexidade de atenção à saúde

Background: The Brazilian Health System is organized on a regional and hierarchical form with three levels of complexity of health care. The Primary Care represents the first element of a continuing health care process, complemented by specialized actions. However, the centrality of the specialized care is still a problem in Brazil, especially in the private sector. Studies on the distribution of professionals in the health system allowing the formulation of appropriate policies are needed. Objectives: To investigate the distribution of physical therapists in the levels of complexity of health care and between public and private establishments, according to data from the National Register of Health Service Providers (NRHSP). Method: A descriptive cross-sectional study was performed considering NRHSP-national bank data collected in March 2010 and demographic census 2010 data. Data were analyzed through descriptive statistics techniques. Results: We identified 53,181 registries of physical therapists, 60% linked to the private sector. Only 13% of all entries were linked to primary care. The predominance in specialized care occurred in the public sector (65%) and private sector (100%). The specialized establishments of private sector linked to the southeast region (16,043) were the main sites of physical therapists. Only the public sector in the south had a majority in the Primary Care. When considering the sizes of the cities, there is focus on specialist care in bigger cities. Conclusions: This study identified the concentration of physical therapists in the specialized care, mostly in metropolis and big cities and in the private sector, with restricted to participation in the primary care.