Postura sentada de crianças com paralisia cerebral: influência da utilização do apoio de membros superiores

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

Risco de desordens músculo-esqueléticas nos membros superiores de graduandos de Odontologia

Este estudo teve por objetivo avaliar o risco de desenvolvimento de desordens músculo-esqueléticas nos membros superiores de graduandos de Odontologia considerando as variáveis sexo, tipo de procedimento clínico executado, região da boca tratada e prática do trabalho a quatro mãos. Foram avaliados alunos, de ambos os sexos, matriculados no oitavo semestre do curso de graduação da Faculdade de Odontologia de Araraquara - UNESP. Foram efetuadas tomadas fotográficas durante a realização de 283 procedimentos clínicos, utilizando-se máquina fotogrática digital. Para análise das fotografias, utilizou-se o programa Image Tool. As posturas de trabalho adotadas por cada estudante na sua atuação como “operador” foram observadas pelo método RULA (Rapid Upper Limb Assessment), o qual inclui o uso de um diagrama de análise de postura do indivíduo e três tabelas de escores que permitem a avaliação da exposição aos fatores de risco para o desenvolvimento de desordens músculo-esqueléticas. As fotografias foram analisadas por um professor da área de ergonomia calibrado (_=0,91). Para cada procedimento foi atribuído um escore de risco final. Os procedimentos executados foram classificados em duas grandes categorias: procedimentos preparatórios e procedimentos restauradores/reabilitadores. Os dados de risco de desordens músculoesqueléticas nos membros superiores foram apurados, e sua prevalência foi estimada por ponto e por intervalo de confiança de 95%. O estudo da associação do risco de desordens músculo-esqueléticas às variáveis de interesse foi realizado por meio do Teste de Qui-quadrado (_ 2). O nível de significância adotado foi de 5%. Observou-se que na maioria dos procedimentos executados o risco de desordens músculo-esqueléticas segundo a classificação... (Resumo completo, clicar acesso eletrônico abaixo)

The association between restorative pre-clinical activities and musculoskeletal disorders

Objective: To evaluate the risk of development of musculoskeletal disorders in the upper limbs of undergraduate dentistry students during the execution of pre-clinical laboratory activities based on gender, type of dental procedure and area of the mouth under treatment.Methods: Male and female undergraduate students in the second year of the Araraquara Dental School, UNESP, were enrolled in this study. Digital photographs were obtained whilst the subjects performed laboratory activities. The working postures adopted by each student were evaluated using the Rapid Upper Limb Assessment (RULA). The photos were analysed by a calibrated researcher (k = 0.89), and a final risk score was attributed to each analysed procedure (n = 354). Descriptive statistical analyses were performed, and the associations of interest were analysed by the chisquare test (P = 0.05).Results: During most of the laboratory procedures performed, the risk of developing musculoskeletal disorders was high (64.7%; - IC95%: 59.7-69.7%), with no significant association between the RULA final score and gender (chi(2) = 1.100; P = 0.577), type of dental procedure (chi(2) = 5.447, P = 0.244) and mouth area treated (chi(2) = 4.150; P = 0.126).Conclusions: The risk of developing musculoskeletal disorders was high in undergraduate dentistry students; this risk was not related to gender, type of dental procedure and region of the mouth being treated.

O controle de preensão em pinça em adultos jovens: efeito da posição do punho

The human hand is the focus of inumerous research studies. Human individuals are capable of performing manual tasks beyond the ability of any other animal. Such large motor ability is due in part to contact surface of the pulp thumb in opposition to the other fingers. Evidences in the literature show that the position of the upper limb influences the ability of hand strength and control. Specifically, the position of the wrist has great influence on the production of pinch strength. The main objective of this study was to investigate the influence of wrist position on the pinch grip with the thumb in opposition to the index finger. Participants of the present study were 21 undergraduate students, 10 men and 11 women. Participants performed a pinch grip task in three wrist positions - maximum flexion, maximum extension and neutral - on two force conditions - 20% and 40% of maximum voluntary contraction (MVC). MVC was measured in two attempts in each of the three positions of the wrist for a period of three seconds, and the trial of the best result was used as the parameter for task performance. In each trial participants maintained the force production at position for 10 seconds. All participants performed each test condition four times, and the first was used as a familiarization trial and discarded from further analysis. In all trials visual feedback online was provided. Results of both group gender showed variability was similar for force production. Men were stronger than women, but this difference was not significant and both produced on the average more strength in the neutral wrist position than in flexion or extension. In the extended position participants were significantly less variable than in the flexion and neutral positions. We obtained a significant positive correlation between weight and pinch force...(Complete abstracts click electronic access below)

Efeito protetor após sessões de exercício excêntrico: comparação entre membros superiores e inferiores

The objective of the present study was to compare in which part (lower limb or upper limb) the repeated bout effect has the greatest magnitude. Twelve males individuals with no recent (6 months) experience with resisted training participated in this study. The subjects were randomly divided into two groups (legs and arms) and came to the laboratory 5 times. 1st) adaptation to the dynamometer. 2nd) to perform one bout of eccentric exercise (EE) and provide markers such as isometric peak torque (IPT), delayed onset muscle soreness (DOMS) (both collected before and after the bout) and concentration of the creatine kinase (CK) enzyme in the blood (only before the bout). 3rd) 48 after the first bout the same markers were collected again. After 14 days, the methodologies used in the 2nd and 3rd visits to the laboratory were repeated respectively to determine the repeated bout effect. A significant decrease of IPT and a significant increase of CK and DOMS were found immediately after and 48 hours after the first bout of EE for the arms group. The legs group showed a significant increase in CK (48 hours after the EE) and DOMS (immediately after the EE) resulting from the first bout. In the arms group, the second bout did not cause significant increase in CK or DOMS on any of the situations, however, it provoked a decrease in force production immediately after the EE. The legs group showed a significant increase of DOMS immediately after the second bout of EE, which caused no significant increase in CK. The only marker in which the repeated bout effect happened for both groups was CK. No significant difference was found between the protections for both groups. Taking into account the results, it’s been discussed whether there is a relation between the susceptibility to muscle damage and the repeated bout effect, and also...(Complete abstract click electronic access below)

Comparação da força de preensão palmar e composição corporal entre mulheres mastectomizadas ou não

Introduction: Loss of muscle strength may represent a burden on everyday tasks significantly compromising the quality of life for mastectomy patients. In addition to the reduced strength of the upper limb, has been shown in mastectomy patients and difficulties in reducing grip. Objectives: To analyze the possible differences in grip strength among women undergoing breast cancer surgery and to compare the body composition. Methods: In the control group (CG n = 46) women participated in the community of FCT / UNESP aged 35 to 70 years without acute orthopedic pathologies. In the experimental group (EG n = 49) participated in women undergoing surgery for breast cancer, without bilateral lymphedema and independent of time and type of surgery. Were evaluated by dynamometer, by Dual Energy X-ray absorptiometry (DEXA) and physical assessment. Results: We observed significant differences in grip strength (p = 0.000), when the group after mastectomy compared with the control group and the radical mastectomy surgery left and quandrandectomia left (p = 0.004). Regarding the presence of lymphedema, statistical difference was observed in the composition of lean mass and trunk fat (p = 0.05). Conclusion: The results of this study suggest that the experimental group are lower grip strength and trunk lean body mass when compared with the control group. The experimental group showed higher values of fat mass when there was presence of lymphedema

Evaluation of rotator cuff muscle strength in healthy individuals

OBJECTIVE: To compare the strength generated by the rotator muscles of the shoulder joint between the right upper limb and left upper limb among healthy individuals. METHODS: To evaluate the muscle strength of upper limbs from isometric contractions in the horizontal direction (rotation) an isometric dynamometer was used, equipped with transducers, signal conditioning, a data acquisition board, and finally, a computer. Study participants were 22 male military subjects, aged between 18 and 19 years old, body mass between 57.7 and 93.0 kg (71.8 ± 9.45 kg) and height between 1.67 and 1.90 m (1.75 ± 0.06 m), healthy and without clinical diseases or any type of orthopedic injury in the muscle skeletal system. RESULTS: The internal rotation in the right upper limb (RUL) was higher than the average strength of internal rotation in the left upper limb (LUL) (p = 0.723). The external rotation strength in RUL was lower than the average strength of external rotation in the LUL (p=0.788). No statistical difference was observed by comparing the strength values of all isometric strength tests. CONCLUSION: For the sample and methodology used to assess muscle strength, there was no statistical difference between the strength generated by the muscles of the rotator cuff of the right and left upper limbs. Experimental Study.

Factors associated with sarcopenia in subjects aged 80 years and over

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A relação das tendinopatias do manguito rotador com as atividades cotidianas: uma contribuição para o design ergonômico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Gender characterization in a large series of Brazilian patients with spondyloarthritis

An increasing number of women have been diagnosed with spondyloarthritis (SpA) in recent decades. While a few studies have analyzed gender as a prognostic factor of the disease, no studies have addressed this matter with a large number of patients in South America, which is a peculiar region due to its genetic heterogeneity. The aim of the present study was to analyze the influence of gender on disease patterns in a large cohort of Brazilian patients with SpA. A prospective study was carried out involving 1,505 patients [1,090 males (72.4%) and 415 females (27.6%)] classified as SpA according to the European Spondyloarthropaties Study Group criteria who attended at 29 reference centers for rheumatology in Brazil. Clinical and demographic variables were recorded and the following disease indices were administered: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiologic Index (BASRI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and Ankylosing Spondylitis Quality of Life (ASQoL). Ankylosing spondylitis (AS) was the most frequent disease in the group (65.4%), followed by psoriatic arthritis (18.4%), undifferentiated SpA (6.7%), reactive arthritis (3.3%), arthritis associated to inflammatory bowel disease (3.2%), and juvenile SpA (2.9%). The male-to-female ratio was 2.6:1 for the whole group and 3.6:1 for AS. The females were older (p<0.001) and reported shorter disease duration (p=0.002) than the male patients. The female gender was positively associated to peripheral SpA (p<0.001), upper limb arthritis (p<0.001), dactylitis (p=0.011), psoriasis (p<0.001), nail involvement (p<0.001), and family history of SpA (p=0.045) and negatively associated to pure axial involvement (p< 0.001), lumbar inflammatory pain (p=0.042), radiographic sacroiliitis (p<0.001), and positive HLA-B27 (p=0.001). The number of painful (p<0.001) and swollen (p=0.006) joints was significantly higher in the female gender, who also achieved higher BASDAI (p<0.001), BASFI (p=0.073, trend), MASES (p=0.019), ASQoL (p=0.014), and patient's global assessment (p=0.003) scores, whereas the use of nonsteroidal anti-inflammatory drugs (p<0.001) and biological agents (p=0.003) was less frequent in the female gender. Moreover, BASRI values were significantly lower in females (p<0.001). The female gender comprised one third of SpA patients in this large cohort and exhibited more significant peripheral involvement and less functional disability, despite higher values in disease indices.

Saphenofemoral arteriovenous fistula as hemodialysis access

Abstract Background An upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF. Methods SFAVFs were evaluated using the following variables: immediate results, early and late complications, intraoperative and postoperative complications (up to day 30), efficiency of the fistula after the onset of needling and complications associated to its use. Results Fifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10 transplanted (20%), 12 deaths (24%), 1 low flow (2%) and 20 thrombosis (39%) (first two months of preparation). One patient had severe hypotension during surgery, which caused thrombosis of the fistula, which was successfully thrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the first postoperative day. After 59 months of follow-up, primary patency was 44%. Conclusion SFAVF is an adequate alternative for patients without the possibility for other access in the upper limbs, allowing efficient dialysis with good long-term patency with a low complication rate.

Spinal cord injury as a trigger to develop periodic leg movements during sleep: an evolutionary perspective

The primary trigger to periodic limb movement (PLM) during sleep is still unknown. Its association with the restless legs syndrome (RLS) is established in humans and was reported in spinal cord injury (SCI) patients classified by the American Spinal Injury Association (ASIA) as A. Its pathogenesis has not been completely unraveled, though recent advances might enhance our knowledge about those malfunctions. PLM association with central pattern generator (CPG) is one of the possible pathologic mechanisms involved. This article reviewed the advances in PLM and RLS genetics, the evolution of CPG functioning, and the neurotransmitters involved in CPG, PLM and RLS. We have proposed that SCI might be a trigger to develop PLM.

Biomeccanica del servizio e del diritto nel tennis: confronto fra atleti di livello di gioco differente

Il tennis è uno sport molto diffuso che negli ultimi trent’anni ha subito molti cambiamenti. Con l’avvento di nuovi materiali più leggeri e maneggevoli la velocità della palla è aumentata notevolmente, rendendo così necessario una modifica a livello tecnico dei colpi fondamentali. Dalla ricerca bibliografica sono emerse interessanti indicazioni su angoli e posizioni corporee ideali da mantenere durante le varie fasi dei colpi, confrontando i giocatori di altissimo livello. Non vi sono invece indicazioni per i maestri di tennis su quali siano i parametri più importanti da allenare a seconda del livello di gioco del proprio atleta. Lo scopo di questa tesi è quello di individuare quali siano le variabili tecniche che influenzano i colpi del diritto e del servizio confrontando atleti di genere differente, giocatori di livello di gioco diverso (esperti, intermedi, principianti) e dopo un anno di attività programmata. Confrontando giocatori adulti di genere diverso, è emerso che le principali differenze sono legate alle variabili di prestazione (velocità della palla e della racchetta) per entrambi i colpi. Questi dati sono simili a quelli riscontrati nel test del lancio della palla, un gesto non influenzato dalla tecnica del colpo. Le differenze tecniche di genere sono poco rilevanti ed attribuibili alla diversa interpretazione dei soggetti. Nel confronto di atleti di vario livello di gioco le variabili di prestazione presentano evidenti differenze, che possono essere messe in relazione con alcune differenze tecniche rilevate nei gesti specifici. Nel servizio i principianti tendono a direzionare l’arto superiore dominante verso la zona bersaglio, abducendo maggiormente la spalla ed avendo il centro della racchetta più a destra rispetto al polso. Inoltre, effettuano un caricamento minore degli arti inferiori, del tronco e del gomito. Per quanto riguarda il diritto si possono evidenziare queste differenze: l’arto superiore è sempre maggiormente esteso per il gruppo dei principianti; il tronco, nei giocatori più abili viene utilizzato in maniera più marcata, durante la fase di caricamento, in movimenti di torsione e di inclinazione laterale. Gli altri due gruppi hanno maggior difficoltà nell’eseguire queste azioni preparatorie, in particolare gli atleti principianti. Dopo un anno di attività programmata sono stati evidenziati miglioramenti prestativi. Anche dal punto di vista tecnico sono state notate delle differenze che possono spiegare il miglioramento della performance nei colpi. Nel servizio l’arto superiore si estende maggiormente per colpire la palla più in alto possibile. Nel diritto sono da sottolineare soprattutto i miglioramenti dei movimenti del tronco in torsione ed in inclinazione laterale. Quindi l’atleta si avvicina progressivamente ad un’esecuzione tecnica corretta. In conclusione, dal punto di vista tecnico non sono state rilevate grosse differenze tra i due generi che possano spiegare le differenze di performance. Perciò questa è legata più ad un fattore di forza che dovrà essere allenata con un programma specifico. Nel confronto fra i vari livelli di gioco e gli effetti di un anno di pratica si possono individuare variabili tecniche che mostrano differenze significative tra i gruppi sperimentali. Gli evoluti utilizzano tutto il corpo per effettuare dei colpi più potenti, utilizzando in maniera tecnicamente più valida gli arti inferiori, il tronco e l’arto superiore. I principianti utilizzano prevalentemente l’arto superiore con contributi meno evidenti degli altri segmenti. Dopo un anno di attività i soggetti esaminati hanno dimostrato di saper utilizzare meglio il tronco e l’arto superiore e ciò può spiegare il miglioramento della performance. Si può ipotizzare che, per il corretto utilizzo degli arti inferiori, sia necessario un tempo più lungo di apprendimento oppure un allenamento più specifico.

The risk of musculoskeletal disorders for workers due to repetitive movements during tomato harvesting

Tomatoes are the most common crop in Italy. The production cycle requires operations in the field and factory that can cause musculoskeletal disorders due to the repetitive movements of the upper limbs of the workers employed in the sorting phase. This research aims to evaluate these risks using the OCRA (occupational repetitive actions) index method This method is based firstly on the calculation of a maximum number of recommended actions, related to the way the operation is performed, and secondly on a comparison of the number of actions effectively carried out by the upper limb with the recommended calculated value. The results of the risk evaluation for workers who manually sort tomatoes during harvest showed a risk for the workers, with an exposure index greater than 20; the OCRA index defines an index higher than 3.5 as unacceptable. The present trend of replacing manual sorting onboard a vehicle with optical sorters seems to be appropriate to reduce the risk of work-related musculoskeletal disorders (WMSDs) and is supported from both a financial point of view and as a quality control measure.

[Endoscopic decompression of the ulnar nerve in the cubital tunnel syndrome: about 55 patients]

Sulcus ulnaris syndrome is the second most common neurocompression syndrome in the upper limb after carpal tunnel syndrome. Its severity can be appreciated by the Dellon Classification. We present our experience and results after endoscopic decompression.