Imagiologia da articulação temporomandibular

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Adaptation of motor control to training and disuse : contribution of muscle synergy analysis and movement variability

The well-known degrees of freedom problem originally introduced by Nikolai Bernstein (1967) results from the high abundance of degrees of freedom in the musculoskeletal system. Such abundance in motor control have two sides: i) because it is unlikely that the Central Nervous System controls each degree of freedom independently, the complexity of the control needs to be reduced, and ii) because there are many options to perform a movement, a repetition of a given movement is never the same. It leads to two main topics in motor control and biomechanics: motor coordination and motor variability. The present thesis aimed to understand how motor systems behave and adapt under specific conditions. This thesis comprises three studies that focused on three topics of major interest in the field of sports sciences and medicine: expertise, injury risk and fatigue. The first study (expertise) has focused on the muscle coordination topic to further investigate the effect of expertise on the muscle synergistic organization, which ultimately may represent the underlying neural strategies. Studies 2 (excessive medial knee displacement) and 3 (fatigue) both aimed to better understand its impact on the dynamic local stability. The main findings of the present thesis suggest: 1) there is a great robustness in muscle synergistic organization between swimmers at different levels of expertise (study 1, chapter II), which ultimately indicate that differences in muscle coordination is mainly explained by peripheral adaptations; 2) injury risk factors such as excessive medial knee displacement (study 2, chapter III) and fatigue (study 3, chapter IV) alter the dynamic local stability of the neuromuscular system towards a more unstable state. This change in dynamic local stability represents a loss of adaptability in the neuromuscular system reducing the flexibility to adapt to a perturbation.

Biomechanics of the trunk and lower limbs during gait in individuals with and without chronic low back pain

Combining information on kinetics and kinematics of the trunk during gait is important for both clinical and research purposes, since it can help in better understanding the mechanisms behind changes in movement patterns in chronic low back pain patients. Although three-dimensional gait analysis has been used to evaluate chronic low back pain and healthy individuals, the reliability and measurement error of this procedure have not been fully established. The main purpose of this thesis is to gain a better understanding about the differences in the biomechanics of the trunk and lower limbs during gait, in patients and healthy individuals. To achieve these aims, three studies were developed. The first two, adopted a prospective design and focused on the reliability and measurement error of gait analysis. In these test-retest studies, chronic low back pain and healthy individuals were submitted to a gait assessment protocol, with two distinct evaluation moments, separated by one week. Gait data was collected using a 13-camera opto-electronic system and three force platforms. Data analysis included the computation of time-distance parameters, as well as the peak values for lower limb and trunk joint angles/moments. The third study followed a cross sectional design, where gait in chronic low back pain individuals was compared with matched controls. Step-to-step variability of the thoracic, lumbar and hips was calculated, and step-to-step deviations of these segments from their average pattern (residual rotations) were correlated to each other. The reliability studies in this thesis show that three-dimensional gait analysis is a reliable and consistent procedure for both chronic low back pain and healthy individuals. The results suggest varied reliability indices for multi-segment trunk joint angles, joint moments and time-distance parameters during gait, together with an acceptable level of error (particularly regarding sagittal plane). Our findings also show altered stride-to-stride variability of lumbar and thoracic segments and lower trunk joint moments in patients. These kinematic and kinetic results lend support to the notion that chronic low back pain individuals exhibit a protective movement strategy.

Effect of firefighter boots and viscoelastic insoles on the impact force of the ground reaction force’s vertical component

The aims of the present study were to determine the effect of firefighter's boots on the vertical component of the ground reaction force (GRF) at heel strike, also known as heel strike transient and to analyze the effect of the viscoelastic insoles placed into the firefighter’s boots on this force during the gait. The magnitude of the impact force (FZI) from the vertical ground reaction force, the time to the production of this force (TZI) and the loading rate (GC) were registered. 39 firefighters without any pathology during 2 years before the study were recruited. Three different walking conditions were tested: 1) gait with firefighter's boots, 2) gait with firefighter's boots and viscoelastic insoles and 3) gait with sport shoes. The results showed a higher production and magnitude of the impact force during gait with firefighter's boots than during gait with sport shoes (13,1 vs. 2,6 % of occurrence of the impact force and 61,39 ± 35,18 %BW (body weight) vs. 49,38 ± 22,99 %BW, respectively). The gait with viscoelastic insoles placed into the firefighter's boots did not show significant differences in any of the parameters characterizing the impact force compared to the gait without insoles. The results of this study show a lower cushioning of the impact force during the gait with firefighter's boots in comparison to the gait with sport shoes and the inefficiency of the viscoelastic insoles placed inside the firefighter's boots to ameliorate the cushioning of the impact force at natural walking speed.

Gravidez ativa – Adaptações fisiológicas e biomecânicas durante a gravidez e o pós-parto

info:eu-repo/semantics/publishedVersion

Gravidez ativa – Adaptações fisiológicas e biomecânicas durante a gravidez e o pós-parto

info:eu-repo/semantics/publishedVersion

Las lesiones por sobrecarga en las extremidades inferiores desde el punto de vista biomecánico

Este trabajo realiza un recorrido por las principales lesiones deportivas por sobrecarga de las extremidades inferiores desde el punto de vista biomecánico. Al mismo tiempo, repasa los principales paradigmas biomecánicos en podología y la aplicación de las teorías biomecánicas emergentes en el estudio de estas lesiones. Con la legislación actual, los estudios biomecánicos clínicos de la marcha deben de realizarse en centros sanitarios y los únicos profesionales sanitarios que pueden realizarlos son los podólogos y los médicos (porque ambas tienen la capacidad de diagnosticar), quedando reservado para los licenciados en educación física, los estudios que se realizan en el terreno de juego o en la pista con la finalidad exclusiva de mejorar el rendimiento deportivo, pero nunca con finalidad de tratar una patología por sobrecarga.

Dolor osteo-muscular y factores asociados en el personal de enfermería de un centro hospitalario de alta complejidad en Colombia

Antecedentes: Los trastornos musculo-esqueléticos son una de las primeras causas de ausentismo laboral y afectan con mayor frecuencia columna y miembros. El personal de enfermería está expuesto a riesgo biomecánico superior dado por la manipulación manual de pacientes. Estimar la magnitud de asociación entre dolor osteo-muscular y carga biomecánica por movilización de pacientes en personal de enfermería y, los factores que modifican tal efecto, es de gran importancia en el ámbito laboral en busca de estrategias de prevención de enfermedades de origen laboral. Objetivo: determinar los factores predictores de dolor osteo-muscular en trabajadores de enfermería en un centro hospitalario de alta complejidad. Materiales y métodos: Estudio analítico transversal, en el que participaron 141 personas, quienes otorgaron su consentimiento informado. Los criterios de inclusión fueron: edad≥ 18 años, estudiantes, practicantes, auxiliares y jefes de enfermería asistenciales de salas de cirugía y hospitalización, antigüedad mínima de 2 meses en el cargo. Se utilizaron como criterios de exclusión: personal de enfermería en cargos administrativos y de las áreas de urgencias y cuidados intensivos, trabajadores con diagnóstico establecido artrosis, osteoartritis o artritis reumatoide, mujeres gestantes. Para lograr los objetivos aplicó el Cuestionario Nórdico, el cuestionario internacional de actividad física IPAQ y la metodología MAPO. Resultados: La frecuencia global de dolor osteo-muscular en el último año fue de 55%, implicando más frecuentemente columna lumbar, columna dorsal y miembro superior. Se evaluaron los servicios de onco-hematología, hospitalización y salas de cirugía y las clasificaciones de MAPO fueron medio a alto, no hubo áreas con riesgo irrelevante. Mediante análisis de regresión logística multivariada, se pudo determinar que los principales predictores de dolor osteo-muscular son trabajar en un área con MAPO nivel alto (OR=2,236, con respecto a MAPO medio) y en el turno de la mañana (OR=2,355, con respecto a turno en la tarde/noche).

Cinemática do trauma

Inicialmente o objeto destaca que um tratamento bem-sucedido de traumatizado está diretamente ligado à identificação das lesões ou das possíveis lesões e de uma avaliação bem realizada. A não compreensão dos princípios da biomecânica, dos mecanismos envolvidos em uma colisão ou das características de uma queda contribui para que lesões passem despercebidas. E a não identificação e o não tratamento das lesões podem contribuir para a morbidade e mortalidade decorrentes do trauma. Na sequência, é explanado sobre os conceitos de traumas causados por colisão e seus possíveis efeitos, com traumas de cavitação e fechados. Po r fim, é tratado sobre traumas originados por quedas com suas possíveis conseqüências para as diferentes posições em que o paciente atinge o solo. Destacando que nas quedas, é de extrema importância inteirar-se sobre a altura a vítima caiu, a relação dessa altura com a altura da vítima, que tipo de superfície a vítima caiu, se a vítima sofreu múltiplos impactos e que parte do corpo sofreu o primeiro impacto. Unidade 1 do módulo 15 que compõe o Curso de Especialização em Saúde da Família.