A importância da intervenção do fisioterapeuta na manutenção e/ou regressão dos défices nas funções motoras nos principais tipos de demência

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Fisioterapia

Efeitos da realidade virtual na reabilitação em indivíduos pós-AVE

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia

Análise baropodométrica do apoio plantar em idosos e sua relação com as quedas

O presente estudo teve como principal objetivo a descrição, a análise e a comparação de parâmetros relacionados com o apoio plantar em idosos, através do método da baropodometria eletrónica, que oferece a avaliação das variáveis temporais e espaciais na postura estática e na marcha. Ademais, teve a finalidade de medir e comparar a distribuição da pressão plantar num grupo de idosos, institucionalizados e não institucionalizados, com e sem historial de quedas nos últimos 12 meses, para verificar se há um padrão comum ou divergente de apoio plantar, aspetos biomecânicos e diferenças significativas na marcha entre estes dois grupos e sua relação com a ocorrência de quedas. A amostra foi composta por 160 idosos, 80 institucionalizados e 80 não institucionalizados, onde foi realizado um levantamento das variáveis sociodemográficas como: idade, género, o índice de massa corporal (IMC), a ocorrência de quedas nos últimos 12 meses, a existência de patologias e a prática de atividade física. Foram analisadas, através da plataforma de pressão, a distribuição das pressões plantares, os picos de pressão plantar média e máxima, área de superfície plantar e a largura da base de sustentação na postura estática e, relativamente às variáveis temporais na postura dinâmica, foram avaliadas a duração do passo e o tempo de contato plantar, no momento da fase de apoio e propulsão da marcha. Foi analisada a correlação destas variáveis com a ocorrência de quedas. Foram identificados maiores valores de pressão média e máxima, na postura estática e dinâmica, nos idosos não institucionalizados. Na comparação entre os grupos, foram encontradas diferenças estatisticamente significativas em grande parte das variáveis na postura estática, especialmente aumento da largura da base (p=0,048) e, na postura dinâmica, a duração do passo e do tempo de contato do pé no solo (p=0,000) foram maiores nos idosos institucionalizados. O avançar da idade, o aumento na duração do passo e do tempo de contato do pé no solo, bem como a diminuição dos valores das pressões plantares apresentaram correlação com a ocorrência de quedas na amostra total de idosos, especialmente nos idosos institucionalizados. Entretanto, as variáveis índice de massa corporal e largura da base de sustentação não influenciaram na ocorrência de quedas na amostra total de idosos. Estes resultados demonstram a importância da análise do apoio plantar em idosos, pois alterações na distribuição das pressões plantares podem constituir um fator de risco para quedas.

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.

Melhoria da Carga Psicológica de um Auxiliar de Marcha para Crianças com Mobilidade Reduzida através do Design Emocional

A presente dissertação retrata o desenvolvimento de um auxiliar de marcha para crianças com mobilidade reduzida, mais propriamente um andarilho. Foi escolhido este tema devido à carga negativa que é associada a todos os produtos de apoio existentes no mercado. Esta proposta pretende fazer uma inclusão da criança com o meio que a rodeia, permitir uma maior interação com as outras crianças e até certo ponto fazê-las esquecer que o andarilho é um produto obrigatório e apenas com fins terapêuticos, mas sim uma extensão do corpo que lhe vai permitir brincar e explorar o mundo que a rodeia de uma forma mais divertida. Os andarilhos existentes atualmente continuam com o aspeto frio e hospitalar que sempre tiveram, e é necessário ter consciência que os utilizadores são crianças e como todas as crianças identificam-se com formas orgânicas e cores apelativas. A modelação 3d assim como os desenhos técnicos do andarilho foram desenvolvidos com recurso aos softwares Solid Works e Autocad. O produto desenvolvido atingiu o objetivo inicial proposto. É um andarilho em alumínio revestido a ABS, obtendo assim formas mais orgânicas, fazendo esquecer que se trata de um produto necessário e terapêutico e lembrando um brinquedo, o que o faz corresponder às expectativas propostas.

De la revolución en marcha al MRL. Estudio de caso: reivindicaciones de la revolución en marcha en la construcción de la política agraria del MRL

El interés de este estudio de caso es evaluar el tema de la retoma de los elementos sustantivos de la política agraria de la Revolución en Marcha durante el proceso de construcción del MRL. Se analiza y demuestra cómo el MRL, con Alfonso López Michelsen a la cabeza, pretendió retomar las reivindicaciones hechas durante la Revolución en Marcha de Alfonso López Pumarejo, para la construcción de la política agraria del movimiento político disidente con los ajustes y giros necesarios para la época. Siguiendo finalmente el desarrollo de cada una de estas revoluciones desde sus influencias hasta su formulación, buscando sus semejanzas y diferencias en el planteamiento de sus respectivas reformas agrarias.

Carazo: Tiempo y marcha

IntroducciónLa obra titulada CARAZO: TIEMPO Y MARCHA,  nos presenta una narración fluída: bellamente escrita, sobre la acción política del autor de la época contemporánea de nuestro devenir histórico. En su aspecto formal, es una obra voluminosa, documentada y acertadamente ilustrada, con fotografías de aquellos momentos históricos de mayor relevancia en la vida de su protagonista...

Marcha de absorção de nutrientes em pimenta-de-cheiro (Capsicum chinense Jacquin).

O objetivo deste estudo é avaliar a absorção de nutrientes nos diferentes estádios fenológicos da pimenta-de-cheiro.

Loading applied on prosthetic knee of transfemoral amputee: comparison of inverse dynamics and direct measurements

Inverse dynamics is the most comprehensive method that gives access to the net joint forces and moments during walking. However it is based on assumptions (i.e., rigid segments linked by ideal joints) and it is known to be sensitive to the input data (e.g., kinematic derivatives, positions of joint centres and centre of pressure, inertial parameters). Alternatively, transducers can be used to measure directly the load applied on the residuum of transfemoral amputees. So, the purpose of this study was to compare the forces and moments applied on a prosthetic knee measured directly with the ones calculated by three inverse dynamics computations - corresponding to 3 and 2 segments, and « ground reaction vector technique » - during the gait of one patient. The maximum RMSEs between the estimated and directly measured forces (i.e., 56 N) and moment (i.e., 5 N.m) were relatively small. However the dynamic outcomes of the prosthetic components (i.e., absorption of the foot, friction and limit stop of the knee) were only partially assessed with inverse dynamic methods.

Magnitude and variability of loading on the osseointegrated implant of transfemoral amputees during walking

This study directly measured the load acting on the abutment of the osseointegrated implant system of transfemoral amputees during level walking, and studied the variability of the load within and among amputees. Twelve active transfemoral amputees (age: 54±12 years, mass:84.3±16.3 kg, height: 17.8±0.10 m) fitted with an osseointegrated implant for over 1 year participated in the study. The load applied on the abutment was measured during unimpeded, level walking in a straight line using a commercial six-channel transducer mounted between the abutment and the prosthetic knee. The pattern and the magnitude of the three-dimensional forces and moments were revealed. Results showed a low step-to-step variability of each subject, but a high subject-to-subject variability in local extrema of body-weight normalized forces and moments and impulse data. The high subject-to-subject variability suggests that the mechanical design of the implant system should be customized for each individual, or that a fit-all design should take into consideration the highest values of load within a broad range of amputees. It also suggests specific loading regime in rehabilitation training are necessary for a given subject. Thus the loading magnitude and variability demonstrated should be useful in designing an osseointegrated implant system better able to resist mechanical failure and in refining the rehabilitation protocol.

The neuro-muscular and musculo-skeletal characterization of children with joint hypermobility

In children, joint hypermobility (typified by structural instability of joints) manifests clinically as neuro-muscular and musculo-skeletal conditions and conditions associated with development and organization of control of posture and gait (Finkelstein, 1916; Jahss, 1919; Sobel, 1926; Larsson, Mudholkar, Baum and Srivastava, 1995; Murray and Woo, 2001; Hakim and Grahame, 2003; Adib, Davies, Grahame, Woo and Murray, 2005:). The process of control of the relative proportions of joint mobility and stability, whilst maintaining equilibrium in standing posture and gait, is dependent upon the complex interrelationship between skeletal, muscular and neurological function (Massion, 1998; Gurfinkel, Ivanenko, Levik and Babakova, 1995; Shumway-Cook and Woollacott, 1995). The efficiency of this relies upon the integrity of neuro-muscular and musculo-skeletal components (ligaments, muscles, nerves), and the Central Nervous System’s capacity to interpret, process and integrate sensory information from visual, vestibular and proprioceptive sources (Crotts, Thompson, Nahom, Ryan and Newton, 1996; Riemann, Guskiewicz and Shields, 1999; Schmitz and Arnold, 1998) and development and incorporation of this into a representational scheme (postural reference frame) of body orientation with respect to internal and external environments (Gurfinkel et al., 1995; Roll and Roll, 1988). Sensory information from the base of support (feet) makes significant contribution to the development of reference frameworks (Kavounoudias, Roll and Roll, 1998). Problems with the structure and/ or function of any one, or combination of these components or systems, may result in partial loss of equilibrium and, therefore ineffectiveness or significant reduction in the capacity to interact with the environment, which may result in disability and/ or injury (Crotts et al., 1996; Rozzi, Lephart, Sterner and Kuligowski, 1999b). Whilst literature focusing upon clinical associations between joint hypermobility and conditions requiring therapeutic intervention has been abundant (Crego and Ford, 1952; Powell and Cantab, 1983; Dockery, in Jay, 1999; Grahame, 1971; Childs, 1986; Barton, Bird, Lindsay, Newton and Wright, 1995a; Rozzi, et al., 1999b; Kerr, Macmillan, Uttley and Luqmani, 2000; Grahame, 2001), there has been a deficit in controlled studies in which the neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility have been quantified and considered within the context of organization of postural control in standing balance and gait. This was the aim of this project, undertaken as three studies. The major study (Study One) compared the fundamental neuro-muscular and musculo-skeletal characteristics of 15 children with joint hypermobility, and 15 age (8 and 9 years), gender, height and weight matched non-hypermobile controls. Significant differences were identified between previously undiagnosed hypermobile (n=15) and non-hypermobile children (n=15) in passive joint ranges of motion of the lower limbs and lumbar spine, muscle tone of the lower leg and foot, barefoot CoP displacement and in parameters of barefoot gait. Clinically relevant differences were also noted in barefoot single leg balance time. There were no differences between groups in isometric muscle strength in ankle dorsiflexion, knee flexion or extension. The second comparative study investigated foot morphology in non-weight bearing and weight bearing load conditions of the same children with and without joint hypermobility using three dimensional images (plaster casts) of their feet. The preliminary phase of this study evaluated the casting technique against direct measures of foot length, forefoot width, RCSP and forefoot to rearfoot angle. Results indicated accurate representation of elementary foot morphology within the plaster images. The comparative study examined the between and within group differences in measures of foot length and width, and in measures above the support surface (heel inclination angle, forefoot to rearfoot angle, normalized arch height, height of the widest point of the heel) in the two load conditions. Results of measures from plaster images identified that hypermobile children have different barefoot weight bearing foot morphology above the support surface than non-hypermobile children, despite no differences in measures of foot length or width. Based upon the differences in components of control of posture and gait in the hypermobile group, identified in Study One and Study Two, the final study (Study Three), using the same subjects, tested the immediate effect of specifically designed custom-made foot orthoses upon balance and gait of hypermobile children. The design of the orthoses was evaluated against the direct measures and the measures from plaster images of the feet. This ascertained the differences in morphology of the modified casts used to mould the orthoses and the original image of the foot. The orthoses were fitted into standardized running shoes. The effect of the shoe alone was tested upon the non-hypermobile children as the non-therapeutic equivalent condition. Immediate improvement in balance was noted in single leg stance and CoP displacement in the hypermobile group together with significant immediate improvement in the percentage of gait phases and in the percentage of the gait cycle at which maximum plantar flexion of the ankle occurred in gait. The neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility are different from those of non-hypermobile children. The Beighton, Solomon and Soskolne (1973) screening criteria successfully classified joint hypermobility in children. As a result of this study joint hypermobility has been identified as a variable which must be controlled in studies of foot morphology and function in children. The outcomes of this study provide a basis upon which to further explore the association between joint hypermobility and neuro-muscular and musculo-skeletal conditions, and, have relevance for the physical education of children with joint hypermobility, for footwear and orthotic design processes, and, in particular, for clinical identification and treatment of children with joint hypermobility.

Apparatus for monitoring load bearing rehabilitation exercises of a transfemoral amputee fitted with an osseointegrated fixation : a proof-of-concept study

The purpose of this proof-of-concept study was to determine the relevance of direct measurements to monitor the load applied on the osseointegrated fixation of transfemoral amputees during static load bearing exercises. The objectives were (A) to introduce an apparatus using a three-dimensional load transducer, (B) to present a range of derived information relevant to clinicians, (C) to report on the outcomes of a pilot study and (D) to compare the measurements from the transducer with those from the current method using a weighing scale. One transfemoral amputee fitted with an osseointegrated implant was asked to apply 10 kg, 20 kg, 40 kg and 80 kg on the fixation, using self-monitoring with the weighing scale. The loading was directly measured with a portable kinetic system including a six-channel transducer, external interface circuitry and a laptop. As the load prescribed increased from 10 kg to 80 kg, the forces and moments applied on and around the antero-posterior axis increased by 4 fold anteriorly and 14 fold medially, respectively. The forces and moments applied on and around the medio-lateral axis increased by 9 fold laterally and 16 fold from anterior to posterior, respectively. The long axis of the fixation was overloaded and underloaded in 17 % and 83 % of the trials, respectively, by up to ±10 %. This proof-of-concept study presents an apparatus that can be used by clinicians facing the challenge of improving basic knowledge on osseointegration, for the design of equipment for load bearing exercises and for rehabilitation programs.

Load on osseointegrated fixation of a transfemoral amputee during a fall : loading, descent, impact and recovery analysis

Falling represents a health risk for lower limb amputees fitted with an osseointegrated fixation mainly because of the potential damage to the fixation. The purpose of this study was to characterise a real forward fall that occurred inadvertently to a transfemoral amputee fitted with an osseointegrated fixation while attending a gait measurement session to assess the load applied on the residuum. The objective was to analyse the load applied on the fixation with an emphasis on the sequence of events, the pattern and the magnitude of the forces and moments. The load was measured directly at 200 Hz using a six-channel transducer. Complementary video footage was also studied. The fall was divided into four phases: loading (240 ms), descent (620 ms), impact (365 ms) and recovery (2495 ms). The main impact forces and moments occurred 870 ms and 915 ms after the heel contact, and corresponded to 133 %BW and 17 %BWm, or 1.2 and 11.2 times the maximum forces and moments applied during the previous steps of the participant, respectively. This study provided key information to engineers and clinicians facing the challenge to design equipment, and rehabilitation and exercise programs to restore safely the locomotion of lower limb amputees.

Spontaneous pacing during overground hill running

Purpose: To investigate speed regulation during overground running on undulating terrain. Methods: Following an initial laboratory session to calculate physiological thresholds, eight experienced runners completed a spontaneously paced time trial over 3 laps of an outdoor course involving uphill, downhill and level sections. A portable gas analyser, GPS receiver and activity monitor were used to collect physiological, speed and stride frequency data. Results: Participants ran 23% slower on uphills and 13.8% faster on downhills compared with level sections. Speeds on level sections were significantly different for 78.4 ± 7.0 seconds following an uphill and 23.6 ± 2.2 seconds following a downhill. Speed changes were primarily regulated by stride length which was 20.5% shorter uphill and 16.2% longer downhill, while stride frequency was relatively stable. Oxygen consumption averaged 100.4% of runner’s individual ventilatory thresholds on uphills, 78.9% on downhills and 89.3% on level sections. 89% of group level speed was predicted using a modified gradient factor. Individuals adopted distinct pacing strategies, both across laps and as a function of gradient. Conclusions: Speed was best predicted using a weighted factor to account for prior and current gradients. Oxygen consumption (VO2) limited runner’s speeds only on uphill sections, and was maintained in line with individual ventilatory thresholds. Running speed showed larger individual variation on downhill sections, while speed on the level was systematically influenced by the preceding gradient. Runners who varied their pace more as a function of gradient showed a more consistent level of oxygen consumption. These results suggest that optimising time on the level sections after hills offers the greatest potential to minimise overall time when running over undulating terrain.