Comparação do equilíbrio e qualidade de vida entre idosos institucionalizados e não-institucionalizados

Introduction: the improvements on the health area increased the brazilians life expectative. Because of it, more people becomes elder, passing through various common processes of aging, as the balance decrease. Resulting form this the risk of fall increase, and this has a negative impact on the quality of life. As more people become elder the institutionalization tax increase. Objectives: compare the balance and quality of life between institutionalized and non-institutionalized elders; correlate the Berg Balance Scale (BBS) with the Timed Up and Go test (TUG) and with the questionnaire “The Medical Outcome Study 36 – Item Short-Form Health Survey” (SF-36). Methods: were evaluated 20 elders, ten institutionalized (GI) and ten non-institutionalized (GNI). To the balance assessment were used the BBS and the TUG, the quality of life was evaluated using the SF-36. The signifi cance level was set to 5% (p<0,05). The GraphPad Prism 5# was used to analyze the data. To identify the distribution of the data was applied the Shapiro-Wilk test. In the comparison between groups, the normal distributed data were analyzed with the Unpaired Student t test. The non-normal distributed data were analyzed with the Mann-Whitney non-parametric test. The correlations were analyzed with the Pearson (normal data) and Spearman’s (non-normal data) tests. Results: the age average for each group was 72,8±8,36 years (GI) e 67,4±3,53 years (GNI). The GNI had a better performance than the GI in the BBS (*p=0,0017) as in the TUG (*p<0,0002). There wasn’t difference between the quality of life. There was correlation between EEB and TUG (-0,8907 for the GI and -0,7180 for the GNI) and between EEB and the functional capacity domain from the SF-36 (0,7657). Conclusion: the non-institutionalized elders presented best balance. It was found good correlation between TUG and BBS. In the studied sample, to be institutionalized didn’t infl uenced the quality of life.

Comparação da flexibilidade, qualidade de vida e capacidade funcional entre idosos ativos e sedentários dos meios urbano e rural

Introduction:The regular practice of physical activity is being used as a therapeutic resource to the elderly population, with the objective of reduction of the losses provoked by the growing old process. The home place (urban or rural) is still little explored in literature about your infl uence in the physical capacity of the elderly people. Objective: The aim of this study was to value and compare the quality of life, motion and functional capacity between physically active and sedentary elderly people, residents in the urban and rural area. Methods: Sixty people with age above 60 years old were valued, 20 physically active residents in the urban area (66,5 ± 4,32 years), 20 sedentary residents in the urban area (68,8± 7,24 years), 10 physically active residents in the rural area (64,4±2,46 years) and 10 sedentary residents in the rural area (68±5,78 years). It was realized the evaluation of the fl exibility (previous fl exon of the trunk), mobility (timed up and go test), a six-minute walk test and answered a quality of life’s questionnaire SF-36. To compare the results obtained by the two groups was used the Kruskal-Wallis test, and the signifi cant presence of the test was performed post hoc Newman-Keuls. The level of signifi cance used in statistical analysis was 5% (p<0,05).Results: It was observed that the physically active elderly people obtaine better performance on the six-minutes walk test. It wasn’t found difference in the mobility among the groups. In relation to the quality of life, the elderly residents in the rural area, were better in the component Vitally. In relation to the fl exibility the elderly residents in the urban area obtained the best results. So, we can conclude that the practice of physical activity realized by the volunteers contributed to a better functional capacity, observed by the biggest distance gone through on the walk test. The rural home place positively infl uenced the vitality control, while the fl exibility was worse presented in these elderly people.

Avaliação do equilíbrio, mobilidade e flexibilidade em idosas ativas e sedentárias

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

Efeitos do Square Stepping Exercise nas capacidades funcionais e funções executivas em frequentadores do Centro do Idoso de Rio Claro - SP

With aging process, there is a natural biological decline that eventually may lead to a functional and cognitive decrease. It is important that older people preserve these functions so they can live an independent life. Some declines in old people who attend Geriatric Day-Care tend to be more severe and recurrent. The Square Stepping Exercise (SSE) is a program created by Shigematsu & Okura (2006), in order to improve the balance of its practitioners, thereby decreasing the risk of falls. It is also believed that the SSE stimulates cognition, and thus, executive functions. The present study, with a longitudinal design, evaluated the effects of SSE in balance performance and executive functions of elderly from the “Centro-Dia do Idoso Padre Casagrande” from Rio Claro – SP. A group of 15 people (GT, n = 15), which performed a four month SSE intervention, and a control group (GC; n = 17) answered the following evaluations.: Questionnaire Registration Data and Anamnesis, Questionnaire Baeck Modified for Elderly, Mini-Mental State Examination, Modified Card Sorting Test, Geriatric Depressive Scale, Questionnaire Pfeffer for Instrumental Activities, Berg Balance Scale and Time Up and Go Test. Although significant improvements have not been observed in GT, the results showed a decline in instrumental activities performance in GC, as well as maintenance in executive functions and balance, and also an improvement in depressive symptoms in GT. This way, Square Stepping Exercise can be considered an activity that helps maintaining functional capacity, among them balance, and executive function in elderly people.

Estudo do efeito de diferentes protocolos fisioterapêuticos no tratamento da osteoartrite de joelho

Pós-graduação em Saúde Coletiva - FMB

Balance and ankle muscle strength predict spatiotemporal gait parameters in individuals with diabetic peripheral neuropathy

The aims of this study were to evaluate aspects of balance, ankle muscle strength and spatiotemporal gait parameters in individuals with diabetic peripheral neuropathy (DPN) and verify whether deficits in spatiotemporal gait parameters were associated with ankle muscle strength and balance performance. Thirty individuals with DPN and 30 control individuals have participated. Spatiotemporal gait parameters were evaluated by measuring the time to walk a set distance during self-selected and maximal walking speeds. Functional mobility and balance performance were assessed using the Functional Reach and the Time Up and Go tests. Ankle isometric muscle strength was assessed with a handheld digital dynamometer. Analyses of variance were employed to verify possible differences between groups and conditions. Multiple linear regression analysis was employed to uncover possible predictors of gait deficits. Gait spatiotemporal, functional mobility, balance performance and ankle muscle strength were affected in individuals with DPN. The Time Up and Go test performance and ankle muscle isometric strength were associated to spatiotemporal gait changes, especially during maximal walking speed condition. Functional mobility and balance performance are damaged in DPN and balance performance and ankle muscle strength can be used to predict spatiotemporal gait parameters in individuals with DPN.

Effectiveness of an exercise program on postural control in frail older adults

Background: Exercise programs have proved to be helpful for frail older adults. This study aimed to investigate the effects of an exercise program with a focus on postural control exercises in frail older adults. Method: Twenty-six older adults (76.7 +/- 4.9 years) deemed clinically stable, chosen from the Falls Unit, University Hospital Mutua Terrassa, Barcelona, Spain, participated in this single-group study. Volunteers' postural control was evaluated using the Timed Up and Go test (TUG) and the Guralnik test battery, and their static and dynamic posturography were evaluated using the Synapsys Posturography System (R). These evaluations were performed before and after the intervention program, which included an educational session and two weekly 1-hour sessions over an 8-week period of stretching exercises, proprioception, balance, and motor coordination. Data were analyzed using the Student's t-test or the Wilcoxon test, with a significance level of 5%. Results: The TUG and Guralnik tests did not show significant differences. Concerning static posturography, there was improvement in the base of support (P = 0.006), anteroposterior displacement with eyes open (P = 0.02) and closed (P = 0.03), and the total amplitude of the center of pressure with eyes closed (P = 0.02). Regarding dynamic posturography, a decrease of the oscillation speed in the anteroposterior direction (P = 0.01) was observed in individuals with their eyes open. Conclusion: The program used in this study was safe and was able to promote some improvement in postural control, especially in the anteroposterior direction and in the base of support. However, it is noteworthy that further improvements could be obtained from a program of longer duration and greater frequency.

Modified constraint-induced movement therapy and modified forced-use therapy for stroke patients are both effective to promote balance and gait improvements

Background: Previous studies show that chronic hemiparetic patients after stroke, presents inabilities to perform movements in paretic hemibody. This inability is induced by positive reinforcement of unsuccessful attempts, a concept called learned non-use. Forced use therapy (FUT) and constraint induced movement therapy (CIMT) were developed with the goal of reversing the learned non-use. These approaches have been proposed for the rehabilitation of the paretic upper limb (PUL). It is unknown what would be the possible effects of these approaches in the rehabilitation of gait and balance. Objectives: To evaluate the effect of Modified FUT (mFUT) and Modified CIMT (mCIMT) on the gait and balance during four weeks of treatment and 3 months follow-up. Methods: This study included thirty-seven hemiparetic post-stroke subjects that were randomly allocated into two groups based on the treatment protocol. The non-paretic UL was immobilized for a period of 23 hours per day, five days a week. Participants were evaluated at Baseline, 1st, 2nd, 3rd and 4th weeks, and three months after randomization. For the evaluation we used: The Stroke Impact Scale (SIS), Berg Balance Scale (BBS) and Fugl-Meyer Motor Assessment (FM). Gait was analyzed by the 10-meter walk test (T10) and Timed Up & Go test (TUG). Results: Both groups revealed a better health status (SIS), better balance, better use of lower limb (BBS and FM) and greater speed in gait (T10 and TUG), during the weeks of treatment and months of follow-up, compared to the baseline. Conclusion: The results show mFUT and mCIMT are effective in the rehabilitation of balance and gait. Trial Registration ACTRN12611000411943.

Valutazione preoperatoria del rischio chirurgico in pazienti onco-geriatrici (studio PREOP)

La maggior parte dei pazienti che vengono sottoposti a interventi chirurgici per tumori solidi hanno un’età superiore a 70 anni1. Circa il 30% di questi pazienti vengono considerati “fragili”. Questi infatti presentano numerose comorbidità ed hanno un più elevato rischio di sviluppare complicanze postoperatorie con perdita della riserva funzionale residua. Per questo non esistono sistemi semplici di screening che permettano ai medici responsabili del trattamento di identificare questi pazienti con aumentato rischio postoperatorio. Identificare i pazienti a rischio è infatti il primo passo nel processo attraverso il quale è possibile prevenire in necessarie complicanze postoperatorie come delirio, eventi cardiovascolari e perdita della funzionalità complessiva con conseguente perdita di autonomia. Scopo di questo studio è quello di confrontare l’accuratezza nella previsione di mortalità e morbidità a 30 giorni dei tre test preditivi “Groningen Frailty Index” (GFI); “Vulnerable Elders Survey” (VES-13); “timed up and go test” con alcune componenti del Preoperative Assessment of Cancer in the Elderly (PACE). Lo studio verrà effettuato sui pazienti con età maggiore di 70 anni che dovranno essere sottoposti a intervento chirurgico in anestesia generale per la presenza di una neoplasia solida.

A randomised double-blind, cross-over trial of 4-aminopyridine for downbeat nystagmus--effects on slowphase eye velocity, postural stability, locomotion and symptoms

Objective The effects of 4-aminopyridine (4-AP) on downbeat nystagmus (DBN) were analysed in terms of slow-phase velocity (SPV), stance, locomotion, visual acuity (VA), patient satisfaction and side effects using standardised questionnaires. Methods Twenty-seven patients with DBN received 5 mg 4-AP four times a day or placebo for 3 days and 10 mg 4-AP four times a day or placebo for 4 days. Recordings were done before the first, 60 min after the first and 60 min after the last drug administration. Results SPV decreased from 2.42 deg/s at baseline to 1.38 deg/s with 5 mg 4-AP and to 2.03 deg/s with 10 mg 4-AP (p<0.05; post hoc: 5 mg 4-AP: p=0.04). The rate of responders was 57%. Increasing age correlated with a 4-AP-related decrease in SPV (p<0.05). Patients improved in the ‘get-up-and-go test’ with 4-AP (p<0.001; post hoc: 5 mg: p=0.025; 10 mg: p<0.001). Tandem-walk time (both p<0.01) and tandem-walk error (4-AP: p=0.054; placebo: p=0.059) improved under 4-AP and placebo. Posturography showed that some patients improved with the 5 mg 4-AP dose, particularly older patients. Near VA increased from 0.59 at baseline to 0.66 with 5 mg 4-AP (p<0.05). Patients with idiopathic DBN had the greatest benefit from 4-AP. There were no differences between 4-AP and placebo regarding patient satisfaction and side effects. Conclusions 4-AP reduced SPV of DBN, improved near VA and some locomotor parameters. 4-AP is a useful medication for DBN syndrome, older patients in particular benefit from the effects of 5 mg 4-AP on nystagmus and postural stability.

Effects of subthalamic nucleus stimulation on cognition and mood in Parkinson’s disease (PD)

Objective: To assess the neuropsychological outcome as a safety measure and quality control in patients with subthalamic nucleus (STN) stimulation for PD. Background: Deep brain stimulation (DBS) is considered a relatively safe treatment used in patients with movement disorders. However, neuropsychological alterations have been reported in patients with STN DBS for PD. Cognition and mood are important determinants of quality of life in PD patients and must be assessed for safety control. Methods: Seventeen consecutive patients (8 women) who underwent STN DBS for PD have been assessed before and 4 months after surgery. Besides motor symptoms (UPDRS-III), mood (Beck Depression Inventory, Hamilton Depression Rating Scale) and neuropsychological aspects, mainly executive functions, have been assessed (mini mental state examination, semantic and phonematic verbal fluency, go-no go test, stroop test, trail making test, tests of alertness and attention, digit span, wordlist learning, praxia, Boston naming test, figure drawing, visual perception). Paired t-tests were used for comparisons before and after surgery. Results: Patients were 61.6±7.8 years old at baseline assessment. All surgeries were performed without major adverse events. Motor symptoms ‘‘on’’ medication remained stable whereas they improved in the ‘‘off’’ condition (p<0.001). Mood was not depressed before surgery and remained unchanged at follow-up. All neuropsychological assessment outcome measures remained stable at follow-up with the exception of semantic verbal fluency and wordlist learning. Semantic verbal fluency decreased by 21±16% (p<0.001) and there was a trend to worse phonematic verbal fluency after surgery (p=0.06). Recall of a list of 10 words was worse after surgery only for the third attempt of recall (13%, p<0.005). Conclusions: Verbal fluency decreased in our patients after STN DBS, as previously reported. The procedure was otherwise safe and did not lead to deterioration of mood.

Normal values of balance tests in women aged 20-80

OBJECTIVES: To determine normal values for four commonly used clinical functional balance tests from community-dwelling women aged 20 to 80 and to identify any significant decline due to aging. DESIGN: A cross-sectional study was undertaken to provide normative values for four clinical balance tests across 6 decade cohorts. SETTING: The Betty Byrne-Henderson Center for Women and Aging, Royal Womens' Hospital, Brisbane, Australia. PARTICIPANTS: Four hundred fifty-six community-dwelling, independently ambulant women with no obvious neurological or musculoskeletal-related disability, aged 20 to 80, were randomly recruited from a large metropolitan region. MEASUREMENTS: The clinical balance measures/tests were the Timed Up and Go test, step test, Functional Reach test, and lateral reach test. Multivariate analysis was used to test the effect for age, height, and activity level. RESULTS: Normal data were produced for each test across each decade cohort. Gradual decline in balance performance was confirmed, with significant effect for age demonstrated. CONCLUSION: New normative data across the adult age decades are available for these clinical tests. Use of clinical balance tests could complement other balance tests and be used to screen women aged 40 to 60 whose performance is outside the normal values for age and to decrease later falls risk.

Impact of a community-based exercise programme on physical fitness in middle-aged and older patients with type 2 diabetes

Objectives: Physical fitness is related to all-cause mortality, quality of life and risk of falls in patients with type 2 diabetes. This study aimed to analyse the impact of a long-term community-based combined exercise program (aerobic + resistance + agility/balance + flexibility) developed with minimum and low-cost material resources on physical fitness in middle-aged and older patients with type 2 diabetes. Methods: This was a non-experimental pre-post evaluation study. Participants (N = 43; 62.92 ± 5.92 years old) were engaged in a community-based supervised exercise programme (consisting of combined aerobic, resistance, agility/balance and flexibility exercises; three sessions per week; 70 min per session) of 9 months' duration. Aerobic fitness (6-Minute Walk Test), muscle strength (30-Second Chair Stand Test), agility/balance (Timed Up and Go Test) and flexibility (Chair Sit and Reach Test) were assessed before (baseline) and after the exercise intervention. Results: Significant improvements in the performance of the 6-Minute Walk Test (Δ = 8.20%, p < 0.001), 30-Second Chair Stand Test (Δ = 28.84%, p < 0.001), Timed Up and Go Test (Δ = 14.31%, p < 0.001), and Chair Sit and Reach Test (Δ = 102.90%, p < 0.001) were identified between baseline and end-exercise intervention time points. Conclusions: A long-term community-based combined exercise programme, developed with low-cost exercise strategies, produced significant benefits in physical fitness in middle-aged and older patients with type 2 diabetes. This supervised group exercise programme significantly improved aerobic fitness, muscle strength, agility/balance and flexibility, assessed with field tests in community settings.

Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: the RECOVER randomized clinical trial.

Importance: critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. Objective: to evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post–intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. Design, Setting, and Participants: a parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. Interventions: during the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. Main Outcomes and Measures: the Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). Results: median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, −0.2 [95% CI, −1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, −0.1 [95% CI, −3.3 to 3.1; P = .96]; and in the Mental Component Summary score, 0.2 [95% CI, −3.4 to 3.8; P = .91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. Conclusions and Relevance: post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery.

Atividade física e saúde:benefícios de um programa combinado de exercício com visualização mental em doentes com Parkinson

Projeto de Investigação apresentado para a obtenção do grau de Mestre em Psicologia do Desporto e do Exercício