Efeitos do treinamento de marcha sobre superfícies inclinadas em indivíduos com hemiparesia crônica: ensaio clínico controlado randomizado

Among the therapeutic approaches that can be used to achieve this goal is the gait training on sloping surfaces, but there are few scientific findings that elucidate the results of this practice. OBJECTIVE: To evaluate the effects of training on sloping surfaces on the gait of subjects with chronic hemiparesis. MATERIALS AND METHODS: A controlled, randomized, blinded clinical trial was conducted. Concluded the study twenty-four subjects with age between 40 and 70 years (54,91±9,3). Their neurological function, functional independence, motor function and balance assessed, besides the gait evaluation through kinemetry. The subjects were allocated into two groups: control group (CG) underwent gait training on treadmill with partial body weight support (PBWS) without inclination; and the experimental group (EG) submitted to gait training on treadmill with PBWS and inclination of 10%. Twelve training sessions were performed. The paired t Student test and Wilcoxon test were used in statistical analysis to compare findings before and after training for each group, and the t student test for independent samples and Mann-Whitney.test were used to compare the to groups. RESULTS: After training within-group changes were observed on balance recovery, motor function and functionality, in both experimental conditions. The EG showed changes after training on speed, stride length, step length of paretic and non-paretic side, paretic single support, double support time and non-paretic swing time. The CG the differences were detected on double support, paretic single support and hip range of movement. The EG showed better results when compared to CG on the variables: speed (p=0,034), non-paretic single support (p=0,02) and paretic swing time (p=0,02). CONCLUSION: gait training on sloping surfaces represents a promising strategy for gait training of subjects with chronic hemiparesis since it is can influence a greater number of gait variables, when compared with gait training on flat surface

Efeitos da adição de carga no treino de marcha na esteira em indivíduos com Doença de Parkinson: ensaio clínico controlado randomizado

Introduction: The intrinsic gait disorders in individuals with Parkinson's disease (PD) are one of the most disabling motor symptoms. Among the therapeutic approaches used in attempts to improve the motor function, especially the gait pattern of individuals, stands out the treadmill gait training associated with the addition of load. However, there are few findings that elucidate the benefits arising from such practice. Objective: To assess the effects of adding load on the treadmill gait training in individuals with PD. Material and Methods: A controlled, randomized and blinded clinical trial, was performed with a sample of 27 individuals (18 men and 9 women) with PD, randomly assigned to three experimental conditions, namely: treadmill gait training (n=9), treadmill gait training associated with addition of 5% load (n=9) and treadmill gait training associated with addition of 10% load (n=9). All volunteers were assessed, during phase on of Parkinson's medication, regarding to demographic, clinical and anthropometric (identification form) data, level of disability (Hoehn and Yahr Modified Scale), cognitive function (Mini Mental State Examination), clinical functional - in those areas activity of daily living and motor examination (Unified Parkinson's Disease Rating Scale - UPDRS) and gait cinematic analysis was performed through Qualisys Motion Capture System®. The intervention protocol consisted of gait training in a period of 4 consecutive weeks, with three weekly sessions, lasting 30 minutes each. The post-intervention assessment occurred the next day after the last training session, which was performed cinematic analysis of gait and the UPDRS. Data analysis was performed using the software Statistical Package for Social Sciences® (SPSS) 17.0. Results: The age of volunteers ranged from 41 to 75 years old (62,26 ± 9,07) and the time of clinical diagnosis of PD between 2 to 9 years (4,56 ± 2,42). There was a reduction regarding the score from motor exam domain (p=0,005), only when training with the addition of a 5% load. As for the space-time variables there was no significant difference between groups (p>0,120); however, the training with addition of 5% load presented the following changes: increase in stride length (p=0,028), in step length (p=0,006), in time balance of the most affected member (p=0,006) and reduction in support time of the referred member (p=0,007). Regarding angular variables significant differences between groups submitted to treadmill gait training without addition load and with 5% of load were observed in angle of the ankle at initial contact (p=0,019), in plantar flexion at toe-off (p=0,003) and in the maximum dorsiflexion in swing (p=0,005). While within groups, there was a reduction in amplitude of motion of the ankle (p=0,048), the only workout on the treadmill. Conclusion: The treadmill gait training with addition of 5% load proved to be a better experimental condition than the others because it provided greater gains in a number of variables (space-time and angular gait) and in the motion function, becoming a therapy capable of effectively improving the progress of individuals with PD

Influência da adição de carga na marcha em esteira de crianças com paralisia cerebral hemiparética espástica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Efeitos da prática mental na marcha de indivíduos com doença de parkinson: ensaio clínico randomizado

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Administração repetida de baixas doses de reserpina: um possível modelo para o estudo de déficits cognitivos e motores associados à Doença de Parkinson

Parkinson's disease (PD) is one of the most common neurodegenerative brain disorders and is characterized primarily by a progressive degeneration of dopaminergic neurons nigroestriatais. The main symptoms of this disease are motor alterations (bradykinesia, rigidity, tremor at rest), which can be highly disabling in advanced stages of the condition. However, there are symptomatic manifestations other than motor impairment, such as changes in cognition, mood and sensory systems. Animal models that attempt to mimic clinical features of PD have been used to understand the behavioral and neural mechanisms underlying neurophysiological disturbance of this disease. However, most models promote an intense and immediate motor impairment, consistent with advanced stages of the disease, invalidating these studies for the evaluation of its progressive nature. The administration of reserpine (a monoamine depletor) in rodents has been considered an animal model for studying PD. Recently we found that reserpine (in doses lower than those usually employed to produce the motor symptoms) promotes a memory deficit in an aversive discrimination task, without changing the motor activity. It was suggested that the administration of this drug in low doses can be useful for the study of memory deficits found in PD. Corroborating this data, in another study, acute subcutaneous administration of reserpine, while preserving motor function, led to changes in emotional context-related (but not neutral) memory tasks. The goal of this research was to study the cognitive and motor deficits in rats repeatedly treated with low doses of reserpine, as a possible model that simulates the progressive nature of the PD. For this purpose, 5-month-old male Wistar rats were submitted to a repeated treatment with vehicle or different doses of reserpine on alternate days. Cognitive and motor parameters and possible changes in neuronal function were evaluated during treatment. The main findings were: repeated administration of 0.1 mg / kg of reserpine in rats is able to induce the gradual appearance of motor signs compatible with progressive features found in patients with PD; an increase in striatal levels of oxidative stress and changes in the concentrations of glutamate in the striatum were observed five days after the end of treatment; in animals repeatedly-treated with 0. 1 mg/kg, cognitive deficits were observed only after the onset of motor symptoms, but not prior to the onset of these symptoms; 0.2 mg / kg reserpine repeated treatment has jeopardized the cognitive assessment due to the presence of severe motor deficits. Thus, we suggest that the protocol of treatment with reserpine used in this work is a viable alternative for studies of the progressive appearance of parkinsonian signs in rats, especially concerning motor symptoms. As for the cognitive symptoms, we suggest that more studies are needed, possibly using other behavioral models, and / or changing the treatment regimen

Déficits de memória induzidos por baixas doses de reserpina em ratos: possível relação com prejuízos no processamento emocional na Doença de Parkinson

We have recently verified that the monoamine depleting drug reserpine at doses that do not modify motor function - impairs memory in a rodent model of aversive discrimination. In this study, the effects of reserpine (0.1-0.5 mg/kg) on the performance of rats in object recognition, spatial working memory (spontaneous alternation) and emotional memory (contextual freezing conditioning) tasks were investigated. While object recognition and spontaneous alternation behavior were not affected by reserpine treatment, contextual fear conditioning was impaired. Together with previous studies, these results suggest that mild monoamine depletion would preferentially induce deficits in tasks involved with emotional contexts. Possible relationships with cognitive and emotional processing deficits in Parkinson disease are discussed

Estudo clínico e eletromiográfico da dinâmica do sistema mastigatório em pacientes adultos com paralisia cerebral

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Investigação de contatos elétricos e propriedades de filmes finos de SnO2 dopados com os íons terras raras Eu3+ e Ce3+

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Farmacomagnetografia colônia: estudo in vitro da desintegração de comprimidos magnéticos revestidos

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

Avaliação da eficácia da prednisona na reurite hansênica aguda

Um dos maiores problemas da hanseníase é o desenvolvimento de neurite aguda, que pode resultar em dor, comprometimento da função neural e incapacidade física. Apesar de a prednisona ser o principal medicamento usado no tratamento deste processo, pouco se conhece sobre a sua real eficácia no controle da neurite. O objetivo principal deste trabalho é avaliar a evolução das neurites hansênicas durante o tratamento com prednisona, através do exame clínico-neurológico. O estudo foi realizado na Unidade de Referência Especializada em Dermatologia Sanitária do estado do Pará "Dr. Marcello Candia", com inclusão de 23 sujeitos com idade média de 40,5 anos, 65% do sexo masculino. Todos multibacilares, sendo 20 borderline e 3 lepromatosos. Sessenta e um por cento já haviam recebido alta da poliquimioterapia. Foram incluídos, no estudo, sujeitos com neurite, associada ou não a acompanhamento da função motora e/ou sensitiva, utilizando esquema padrão do Ministério da Saúde, com dose inicial de 60 mg de prednisona/dia e regressão a cada 15 dias. O exame clínico foi realizado nos principais nervos periféricos afetados pela hanseníase. Após 18 semanas de acompanhamento, 60,87% dos pacientes necessitaram de prednisona por um tempo superior ao inicialmente proposto. A dor teve uma evolução clínica melhor que a força muscular e a sensibilidade cutânea. Houve melhora da dor em 71,23% dos nervos (p<0,005); entretanto, 42,47% permaneceram com neurite; a função sensitiva melhorou em 63,16% dos nervos (p > 0,05); e a função motora melhorou em 50% (p < 0,05). Os resultados indicaram que as 18 semanas de uso de prednisona não foram suficientes para a resolução da neurite hansênica e do comprometimento da função neural, na maioria dos pacientes do estudo.

Efeitos do exercício voluntario na recuperação de hemissecção da medula espinhal: mudanças na rede perineuronal e acetilação de histonas

A prática regular de exercícios físicos previne e combate várias doenças ao longo do tempo, destacando-se como excelente ferramenta terapêutica para o tratamento de lesões no sistema nervoso central (SNC). Após uma transecção (completa ou incompleta/hemissecção) da medula espinhal, células gliais reativas secretam substâncias inibitórias à regeneração axonal como, por exemplo, as moléculas de proteoglicanas de sulfato de condroitina (PGSCs) que exercem papel importante na formação de uma barreira físico-química, chamada cicatriz glial, que impede o crescimento dos axônios danificados pela lesão. Pesquisas que envolvem modelo experimental de lesão da medula espinhal e reabilitação por exercício físico têm obtido promissores resultados. No entanto, os mecanismos fisiológicos e moleculares pelos quais promovem esses resultados positivos ainda são pouco conhecidos. O objetivo do presente trabalho foi analisar a recuperação da função motora da pata posterior após protocolo de exercício físico voluntario em modelo experimental de hemissecção da medula espinhal e investigar dois mecanismos moleculares envolvidos na recuperação funcional: a degradação de PGSCs nas redes perineuronais e acetilação de histonas. Para isso, vinte e quatro (24) ratos da linhagem Wistar (Rattus novergicus) foram utilizados e separados em 3 grupos (controle, treinados e não treinados). Com exceção do grupo controle, todos os animais foram habituados a rodas de corridas e em seguidas foram submetidos a uma cirurgia experimental de hemissecção da medula espinhal, na altura da 8a vertebra torácica. Nossos resultados demonstraram que o exercício voluntário em rodas de corrida após lesão experimental da medula espinhal promoveu recuperação da função motora da pata posterior afetada, porém não observamos diferenças qualitativas na acetilação de histonas e degradação de PGSCs entre os grupos.

Influência da terapia de contensão induzida na funcionalidade do membro superior de indivíduos hemiparéticos

Introduction: The Constraint-induced Movement Therapy (CIMT) is a therapeutic program which main goal is the functional recuperation of paretic upper extremity of stroke patients with motor deficits by an intensive treatment, practice of functional repetition and wear of restriction in non-paretic during 90% of the daily hours. Objective: The aim of this study was evaluate the CIMT influence on upper extremity function of hemiparetic individuals. Method: The CIMT was provided for 3 daily hours for 10 consecutive days. Besides, patients were asked to wear a restraint dispositive on the unaffected hand during 90% of their activities daily living hours. Before and after the intervention period, 2 tests were administered to evaluate motor function, the Motor Activity Log (MAL) and the Wolf Motor Function Test (WMFT). Results: The results of MAL showed significant difference in quantity (p=0,011) and quality (p=0,016) of paretic upper extremity movements. Analysis of WMFT indicated a significant reduction of time that patients performed the tasks (p= 0,042) and a difference for quality of movement (p<0,0001). Conclusion: The present results showed that CIMT improves upper extremity function in hemiparetic individuals.

Classificação do grau de comprometimento motor e do índice de massa corpórea em crianças com paralisia cerebral

Children with cerebral palsy due to movement and posture disorders might have an injured nutritional state. This study's objective was to classify the body mass index of children with cerebral palsy and verify its relation with the injury level of gross motor function. Twenty children, male and female sex, with cerebral palsy with ages between 2 and 14 years participated in the study. They were chosen from a rehabilitation center with physiotherapy, occupational and speech therapy accompaniment. Children were classified according to the gross motor function classification scale. The anthropometric measures of each child weight, heel-knee length, estimated stature and body mass index were gauged. The body mass index was classified according to the Center for Disease Control and Prevention's body mass index percentile calculator for children and teenagers. The obtained data didn't show any relation between the gross motor function and body mass index. The reduced number of participants and the fact of all children be accompanied in dysphagia clinics and, when necessary, nutrition clinics, might have influenced these results.

Desempenho motor de escolares com dislexia, transtornos e dificuldades de aprendizagem

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

Estudo da cinética da tirosinase imobilizada em nanopartícula de sílica com obtenção de revestimento de eumelanina

Melanina é um polímero constituído por uma grande heterogeneidade de monômeros tendo como característica comum a presença de grupos indóis. Por outro lado, a eumelanina produzida pela oxidação enzimática da tirosina é um polímero mais simples constituído principalmente de monômeros 5,6-dihidroxindol (DHI) e de indol-5,6-quinona (IQ). Tirosinase é a enzima chave na produção de melanina, sendo que a sua atividade cinética é medida em função da formação do intermediário dopacroma. Nanopartículas (NPs) de sílica são partículas nanométricas compostas de oxido de silício e são obtidas pelo processo sol-gel desenvolvido por Stöber de hidrólise e condensação de tetraetilortosilicato (TEOS), usando etanol como solvente em meio alcalino. As NPs foram funcionalizadas com 3-Aminopropiltrietoxissilano (ATPES) e depois com glutaraldeído. Este último permitiu a imobilização da tirosinase na superfície da sílica. Caracterizamos as NPs antes e após a reação da enzima, a atividade catalítica da enzima ligada à NP e o mecanismos de formação de melanina na superfície da sílica. As NPs foram caracterizadas por espectrofotometria de absorção e de reflectância, termogravimetria e microscopia eletrônica. A síntese da NP de sílica retornou partículas esféricas com 55nm de diâmetro e a funcionalização da partícula mostrou modificar eficientemente a sua superfície. A imobilização da tirosinase por ligação covalente foi de 99,5% contra 0,5% da adsorção física. A atividade da tirosinase foi caracterizada pela formação de dopacroma. O Km da enzima imobilizada não sofreu alteração em comparação com a tirosinase livre, mas a eficiência catalítica - que considera a eficiência recuperada - foi de apenas 1/3 para a enzima ligada covalentemente, significando que 2/3 das enzimas ligadas não estão ativas. Obtivemos NPs revestidas com melanina a partir de oxidação de tirosina solubilizada em duas preparações: NP com tirosinase ligada covalentemente na superfície e NP funcionalizada com glutaraldeido dispersa em solução de DHI e IQ. O revestimento de melanina foi na forma de um filme fino com espessura ~1,9nm, conferindo perfil de absorção luminosa equivalente ao da própria melanina. Mostramos que o mecanismo de polimerização passa pela oxidação da tirosina pela tirosinase, que gera intermediários oxidados (principalmente DHI e IQ) que vão para solução (mesmo quando a tirosinase está ligada covalentemente na sílica). Estes intermediários ligam-se ao glutaraldeido e a superfície da sílica passa a funcionar como ambiente de polimerização da melanina.