Relatório de estágio: intervenção em fisioterapia na sindrome da cirurgia lombar falhada

Introdução: A síndrome da cirurgia lombar falhada (SCLF) caracteriza-se pela persistência ou recidiva da dor ou aparecimento de novos sintomas após discectomia, descompressão de canal estreito ou artrodese lombares. Objectivos: O objectivo deste estudo foi descrever a abordagem em fisioterapia de um caso com Síndrome da Cirurgia Lombar Falhada e avaliar os seus efeitos na funcionalidade e sintomatologia dolorosa neste indivíduo. Metodologia: A amostra foi constituída por um sujeito com 41 anos, trabalhador da construção civil, apresentando dor lombar com irradiação para o membro inferior, após ter sido submetido a discectomia lombar e artrodese, que realizou sessões de fisioterapia convencional antes e depois da cirurgia, e que apresentava sinais compatíveis com compressão radicular. A intensidade da dor foi medida através da escala visual analógica (EVA), as amplitudes com o goniómetro universal, a funcionalidade foi avaliada utilizando o Questionário de Incapacidade Roland-Morris (RMDQ), o estado psicológico foi avaliado através da “Escala de Desânimo Associado à Dor” e do “Inventário de Convicções e Percepções Relacionadas com a Dor”. Resultados: A dor era inicialmente em média de 5,5/10 EVA, sendo de 3,4/10 EVA no final do tratamento. Quanto à funcionalidade (RMDQ) esta variou de 14/24 no início para 17/24 no final. De uma forma geral, após a aplicação de técnicas para diminuir a tensão do piriforme, técnicas neuurodinâmicas e um programa de exercícios para melhoria do controlo motor, o paciente apresentou alívio das queixas de dor na nádega esquerda e anca, aumento da amplitude de rotação medial da coxo-femoral, ausência das parestesias na face plantar do pé esquerdo e melhoria das queixas de dor na face anterior e lateral da coxa. Verificamos que houve diminuição dos índices de dor e melhorias dos níveis de funcionalidade. Conclusão: Neste estudo de caso, foi salientado o processo de raciocínio clínico desenvolvido pelo fisioterapeuta: a interpretação dos dados da história e levantamento das primeiras hipóteses e a realização dos testes no exame objectivo, permitiram estabelecer um diagnóstico funcional e elaborar um plano de intervenção através do qual o utente recuperou parcialmente a sua funcionalidade e diminuiu os seus índices de dor.

O impacto do uso da tala nocturna na qualidade de vida do indivíduo com Síndrome do Túnel Carpiano

Síndrome do Túnel Carpiano (STC) é uma neuropatia compressiva do nervo mediano ao nível da articulação rádio-cubital inferior. Caracteriza-se fisiologicamente pelo aumento da pressão ao nível do canal carpiano o que desencadeia a diminuição da função do nervo a esse nível. Independentemente da fase de evolução da patologia, o indivíduo apresenta défices motores e sensoriais que interferem com o desempenho dos seus diversos papéis ocupacionais e, concomitantemente, com a sua Qualidade de Vida (QV). Como forma de reduzir esse impacto, existem várias abordagens possíveis, entre as quais se destaca o uso da tala nocturna de repouso. Este trabalho tem como objectivo principal definir quais os benefícios do uso da tala nocturna e o impacto manifesto na QV do indivíduo com STC. Simultaneamente pretende-se definir em que medida a relação benefício/melhoria da dor e normalização sensitiva se relaciona com o uso da tala. Por último, identificar quais as variáveis sociodemográficas que estão relacionadas ao problema em estudo e aos valores obtidos com as escalas SF-36 e PDI, nos indivíduos dos grupos controlo e experimental. Para a realização deste estudo, utilizou-se uma amostra de 46 indivíduos do sexo feminino aos quais aplicouse as escalas referidas anteriormente e os Monofilamentos de Semmes-Weinstein. Os resultados obtidos com o SF-36 revelaram uma maior percepção do estado de saúde no domínio Saúde Geral, no grupo ao qual se aplicou a tala, sugerindo que esta intervenção permite uma melhoria da QV. Simultaneamente, o PDI permitiu inferir que a aplicação da tala nocturna tem um impacto positivo no que concerne à percepção do nível da dor nas diversas actividades da vida diária e, consequentemente, na QV. No que se refere à sensibilidade, os resultados obtidos não permitem afirmar que existem melhoras a este nível. Relativamente às variáveis socio-demográficas, apenas os casos classificados como ligeiros apresentam uma melhor percepção do nível de Saúde Geral o que é sugestivo de que com o evoluir da patologia há perda de QV.

Tipologia, instalação, funcionamento e manutenção de diversos tipos de juntas de dilatação em obras de arte

Dissertação para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização de Estruturas

Reading performance in children with visual function anomalies

Aims - To compare reading performance in children with and without visual function anomalies and identify the influence of abnormal visual function and other variables in reading ability. Methods - A cross-sectional study was carried in 110 children of school age (6-11 years) with Abnormal Visual Function (AVF) and 562 children with Normal Visual Function (NVF). An orthoptic assessment (visual acuity, ocular alignment, near point of convergence and accommodation, stereopsis and vergences) and autorefraction was carried out. Oral reading was analyzed (list of 34 words). Number of errors, accuracy (percentage of success) and reading speed (words per minute - wpm) were used as reading indicators. Sociodemographic information from parents (n=670) and teachers (n=34) was obtained. Results - Children with AVF had a higher number of errors (AVF=3.00 errors; NVF=1.00 errors; p<0.001), a lower accuracy (AVF=91.18%; NVF=97.06%; p<0.001) and reading speed (AVF=24.71 wpm; NVF=27.39 wpm; p=0.007). Reading speed in the 3rd school grade was not statistically different between the two groups (AVF=31.41 wpm; NVF=32.54 wpm; p=0.113). Children with uncorrected hyperopia (p=0.003) and astigmatism (p=0.019) had worst reading performance. Children in 2nd, 3rd, or 4th grades presented a lower risk of having reading impairment when compared with the 1st grade. Conclusion - Children with AVF had reading impairment in the first school grade. It seems that reading abilities have a wide variation and this disparity lessens in older children. The slow reading characteristics of the children with AVF are similar to dyslexic children, which suggest the need for an eye evaluation before classifying the children as dyslexic.

Radiographers practice concerning breast compression in mammography: gradual versus no gradual

Purpose: Evaluate the type of breast compression (gradual or no gradual) that provides less discomfort to the patient. Methods and Materials: The standard projections were simulated [craniocaudal/(CC) and mediolateral-oblique/(MLO)] with the two breast compressions in 90 volunteers women aged between 19 and 86. The women were organised in groups according to the breast density. The intensity of discomfort was evaluated using the scale that have represented several faces (0-10) proposed by Wong Baker in the end of each simulation. It was also applied an interview using focus group to debate the score that were attributed during pain evaluation and to identify the criteria that were considered to do the classification. Results: The women aged between 19-29y (with higher breast density) classified the pain during no gradual compression as 4 and the gradual compression as 2 for both projections. The MLO projection was considered the most uncomfortable. During the focus group interview applied to this group was highlighted that compression did not promoted pain but discomfort. They considered that the high expectations of pain did not correspond to the discomfort that they felt. Similar results were identified for the older women (30-50y; > 50y). Conclusion: The radiographers should considerer the technique for breast compression. The gradual compression was considered for the majority of the women as the most comfortable regardless of breast density. The MLO projection was considered as uncomfortable due to the positioning (axila and inclusion of pectoral muscle) and due to the higher breast compression compared to the CC projection.

Penalty fuzzy function for derivative-free optimization

Penalty and Barrier methods are normally used to solve Nonlinear Optimization Problems constrained problems. The problems appear in areas such as engineering and are often characterised by the fact that involved functions (objective and constraints) are non-smooth and/or their derivatives are not know. This means that optimization methods based on derivatives cannot net used. A Java based API was implemented, including only derivative-free optimizationmethods, to solve both constrained and unconstrained problems, which includes Penalty and Barriers methods. In this work a new penalty function, based on Fuzzy Logic, is presented. This function imposes a progressive penalization to solutions that violate the constraints. This means that the function imposes a low penalization when the violation of the constraints is low and a heavy penalisation when the violation is high. The value of the penalization is not known in beforehand, it is the outcome of a fuzzy inference engine. Numerical results comparing the proposed function with two of the classic penalty/barrier functions are presented. Regarding the presented results one can conclude that the prosed penalty function besides being very robust also exhibits a very good performance.

Logarithmically proportional objective function for planar surfaces recognition in 3D point cloud

3D laser scanning is becoming a standard technology to generate building models of a facility's as-is condition. Since most constructions are constructed upon planar surfaces, recognition of them paves the way for automation of generating building models. This paper introduces a new logarithmically proportional objective function that can be used in both heuristic and metaheuristic (MH) algorithms to discover planar surfaces in a point cloud without exploiting any prior knowledge about those surfaces. It can also adopt itself to the structural density of a scanned construction. In this paper, a metaheuristic method, genetic algorithm (GA), is used to test this introduced objective function on a synthetic point cloud. The results obtained show the proposed method is capable to find all plane configurations of planar surfaces (with a wide variety of sizes) in the point cloud with a minor distance to the actual configurations. © 2014 IEEE.

Fitness function evaluation through fractional algorithms

This paper proposes a Genetic Algorithm (GA) for the design of combinational logic circuits. The fitness function evaluation is calculated using Fractional Calculus. This approach extends the classical fitness function by including a fractional-order dynamical evaluation. The experiments reveal superior results when comparing with the classical method.

Fractional describing function of systems with nonlinear friction

This paper studies the describing function (DF) of systems consisting in a mass subjected to nonlinear friction. The friction force is composed in three components namely, the viscous, the Coulomb and the static forces. The system dynamics is analyzed in the DF perspective revealing a fractional-order behaviour. The reliability of the DF method is evaluated through the signal harmonic content and the limit cycle prediction.

Describing function of two masses with backlash

This paper analyzes the dynamical properties of systems with backlash and impact phenomena based on the describing function method. It is shown that this type of nonlinearity can be analyzed in the perspective of the fractional calculus theory. The fractional dynamics is compared with that of standard models.

Fractional describing function of systems with Coulomb friction

This paper studies the describing function (DF) of systems constituted by a mass subjected to nonlinear friction. The friction force is decomposed into two components, namely, the viscous and the Coulomb friction. The system dynamics is analyzed in the DF perspective revealing a fractional-order behavior. The reliability of the DF method is evaluated through the signal harmonic contents.

Visual function assessment in medical imaging research

Background - Medical image perception research relies on visual data to study the diagnostic relationship between observers and medical images. A consistent method to assess visual function for participants in medical imaging research has not been developed and represents a significant gap in existing research. Methods - Three visual assessment factors appropriate to observer studies were identified: visual acuity, contrast sensitivity, and stereopsis. A test was designed for each, and 30 radiography observers (mean age 31.6 years) participated in each test. Results - Mean binocular visual acuity for distance was 20/14 for all observers. The difference between observers who did and did not use corrective lenses was not statistically significant (P = .12). All subjects had a normal value for near visual acuity and stereoacuity. Contrast sensitivity was better than population norms. Conclusion - All observers had normal visual function and could participate in medical imaging visual analysis studies. Protocols of evaluation and populations norms are provided. Further studies are necessary to understand fully the relationship between visual performance on tests and diagnostic accuracy in practice.

Evaluation of lung function abnormalities prevalence in poultry workers

Introduction - Poultry workers can be at an increased risk of occupational respiratory diseases, like asthma, chronic obstructive pulmonary disease and extrinsic allergic alveolitis. Spirometry screening is fundamental to early diagnosis trough the identification of related ventilatory defects. Purpose - We aimed to assess the prevalence of lung function abnormalities in poultry workers.