Ajustes Posturais dos músculos da tibiotársica em indivíduos com Doença de Parkinson durante o sit-to-stand

Introdução: Os ajustes posturais antecipatórios (APAs) são essenciais para o movimento típico, estando alterados nas doenças neuro degenerativas como a doença de Parkinson (DP) Objectivo(s): Estudar os early postural adjustments e os APAs em indivíduos com DP durante o sentar para levantar (STS), com e sem dupla tarefa. Métodos: Foi recolhida a atividade eletromiográfica (EMG) dos músculos tibial anterior, solear e gastrocnémio medial, em indivíduos com e sem DP (9 em cada grupo), durante o STS. Este foi determinado pelo deslocamento antero posterior do centro de pressão através da plataforma de forças, sendo a tarefa cognitiva dada pelo stroop colour word interference test. Os ajustes posturais foram avaliados pelo tempo de ativação e pela atividade EMG relativa, bem como pela análise da co ativação agonista/antagonista. Resultados: Não foram encontradas diferenças estatisticamente significativas entre o grupo de controlo e o grupo com DP em nenhuma das variáveis analisadas Há uma tendência para o grupo com DP apresentar APAs mais cedo na tarefa simples, mantendo atividade muscular durante mais tempo e com maior atividade EMG relativa que o grupo controlo. Na dupla tarefa mantém-se essa tendência, exceto o tempo de ativação ser mais próximo do levante. Conclusão: Os défices posturais decorrentes da doença de Parkinson parecem não ser evidenciados na primeira fase do sit-to-stand.

Activation timing of soleus and tibialis anterior muscles during sit-to-stand and stand to sit in post-stroke vs healthy subjects

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Reorganização de componentes do controlo postural na sequência sit-to-stand em indivíduos com acidente vascular encefálico.

Introdução: O controlo postural (CP) constitui um dos requisitos indispensáveis para a execução de muitas tarefas funcionais, tendo sido demonstrado que após um acidente vascular encefálico (AVE) este esteja severamente alterado. Os mecanismos de neuroplasticidade evidenciam capacidade de mudança no CP através de uma intervenção em Fisioterapia. Objetivo: Avaliar a influência da modificação de componentes do membro inferior/tronco inferior (TI) na modificação de componentes da cintura escapular/tronco superior (TS), e a sua influência em variáveis representativas do CP no Sit-to-Stand (STS). Metodologia: O estudo apresenta três casos após AVE, que realizaram intervenção em fisioterapia baseada no conceito de Bobath, durante 11 semanas. Antes e após a intervenção, foi avaliado o alinhamento do tronco e o postural setting da escápula; variáveis associadas ao deslocamento e velocidade do Centro de Pressão (CoP); força, área de contacto e pressão média, durante a sequência do STS, recorrendo ao software SAPo e à plataforma de pressões EMED . Avaliou-se ainda os itens da Classificação Internacional de Funcionalidade (CIF). Resultados: Após a intervenção, os indivíduos em estudo apresentaram um melhor alinhamento do tronco, associado a um melhor postural setting da escápula, no conjunto postural sentado; bem como uma diminuição do deslocamento e velocidade máxima do CoP, no período estável (posição de sentado) e um aumento global da velocidade do CoP, no seat-off, o que parece refletir uma melhoria do CP. Quanto à CIF também se verificou uma diminuição da restrição na participação e limitação na atividade. Conclusão: A modificação de componentes neuro-motores através de uma intervenção baseada no conceito de Bobath teve efeitos positivos do ponto de vista do CP, relacionado com uma melhor relação entre membro inferior/TI e cintura escapular/TS, evidenciando uma melhor relação entre TS/TI nos três indivíduos após AVE.

Influence of dual-task on sit-to-stand-to-sit postural control in Parkinson's disease

Postural control deficits are the most disabling aspects of Parkinson's disease (PD), resulting in decreased mobility and functional independence. The aim of this study was to assess the postural control stability, revealed by variables based on the centre of pressure (CoP), in individuals with PD while performing a sit-to-stand-to-sit sequence under single- and dual-task conditions. An observational, analytical and cross-sectional study was performed. The sample consisted of 9 individuals with PD and 9 healthy controls. A force platform was used to measure the CoP displacement and velocity during the sit-to-stand-to-sit sequence. The results were statistically analysed. Individuals with PD required greater durations for the sit-to-stand-to-sit sequence than the controls (p < 0.05). The anteroposterior and mediolateral CoP displacement were higher in the individuals with PD (p < 0.05). However, only the anteroposterior CoP velocity in the stand-to-sit phase (p = 0.006) was lower in the same individuals. Comparing the single- and dual-task conditions in both groups, the duration, the anteroposterior CoP displacement and velocity were higher in the dual-task condition (p < 0.05). The individuals with PD presented reduced postural control stability during the sit-to-stand-to-sit sequence, especially when under the dual-task condition. These individuals have deficits not only in motor performance, but also in cognitive performance when performing the sit-to-stand-to-sit sequence in their daily life tasks. Moreover, both deficits tend to be intensified when two tasks are performed simultaneously.

Multi-parametric evaluation of sit-to-stand and stand-to-sit transitions in elderly people.

The aim of this study was to extract multi-parametric measures characterizing different features of sit-to-stand (Si-St) and stand-to-sit (St-Si) transitions in older persons, using a single inertial sensor attached to the chest. Investigated parameters were transition's duration, range of trunk tilt, smoothness of transition pattern assessed by its fractal dimension, and trunk movement's dynamic described by local wavelet energy. A measurement protocol with a Si-St followed by a St-Si postural transition was performed by two groups of participants: the first group (N=79) included Frail Elderly subjects admitted to a post-acute rehabilitation facility and the second group (N=27) were healthy community-dwelling elderly persons. Subjects were also evaluated with Tinetti's POMA scale. Compared to Healthy Elderly persons, frail group at baseline had significantly longer Si-St (3.85±1.04 vs. 2.60±0.32, p=0.001) and St-Si (4.08±1.21 vs. 2.81±0.36, p=0.001) transition's duration. Frail older persons also had significantly decreased smoothness of Si-St transition pattern (1.36±0.07 vs. 1.21±0.05, p=0.001) and dynamic of trunk movement. Measurements after three weeks of rehabilitation in frail older persons showed that smoothness of transition pattern had the highest improvement effect size (0.4) and discriminative performance. These results demonstrate the potential interest of such parameters to distinguish older subjects with different functional and health conditions.

Force determinants of sit-to-stand transfer in patients with haemophilic arthropathy: Cross-sectional study

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Relationship Between Lower-limb Muscle Strength And Functional Independence Among Elderly People According To Frailty Criteria: A Cross-sectional Study.

Muscle strength and functional independence are considered to be determinants of frailty levels among elderly people. The aim here was to compare lower-limb muscle strength (LLMS) with functional independence in relation to sex, age and number of frailty criteria, and to ascertain the influence of these variables on elderly outpatients' independence. Quantitative cross-sectional study, in a tertiary hospital. The study was conducted on 150 elderly outpatients of both sexes who were in a cognitive condition allowing oral communication, between October 2005 and October 2007. The following instruments were used: five-times sit-to-stand test (FTSST), Functional Independence Measurement (FIM) and Lawton's Instrumental Activities of Daily Living Scale (IADL). Descriptive, comparative, multivariate, univariate and Cronbach alpha analyses were performed. The mean time taken in the FTSST was 21.7 seconds; the mean score for FIM was 82.2 and for IADL was 21.2; 44.7% of the subjects presented 1-2 frailty criteria and 55.3% > 3 criteria. There was a significant association between LLMS and functional independence in relation to the number of frailty criteria, without homogeneity regarding sex and age. Functional independence showed significant influence from sex and LLMS. Elderly individuals with 1 or 2 frailty criteria presented greater independence in all FTSST scores. The subjects with higher LLMS presented better functional independence.

Telehealth system (e-CUIDATE) to improve quality of life in breast cancer survivors: rationale and study protocol for a randomized clinical trial.

BACKGROUND Breast cancer survivors suffer physical impairment after oncology treatment. This impairment reduces quality of life (QoL) and increase the prevalence of handicaps associated to unhealthy lifestyle (for example, decreased aerobic capacity and strength, weight gain, and fatigue). Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival. Nowadays, technological support using telerehabilitation systems is a promising strategy with great advantage of a quick and efficient contact with the health professional. It is not known the role of telerehabilitation through therapeutic exercise as a support tool to implement an active lifestyle which has been shown as an effective resource to improve fitness and reduce musculoskeletal disorders of these women. METHODS / DESIGN This study will use a two-arm, assessor blinded, parallel randomized controlled trial design. People will be eligible if: their diagnosis is of stages I, II, or IIIA breast cancer; they are without chronic disease or orthopedic issues that would interfere with ability to participate in a physical activity program; they had access to the Internet and basic knowledge of computer use or living with a relative who has this knowledge; they had completed adjuvant therapy except for hormone therapy and not have a history of cancer recurrence; and they have an interest in improving lifestyle. Participants will be randomized into e-CUIDATE or usual care groups. E-CUIDATE give participants access to a range of contents: planning exercise arranged in series with breathing exercises, mobility, strength, and stretching. All of these exercises will be assigned to women in the telerehabilitation group according to perceived needs. The control group will be asked to maintain their usual routine. Study endpoints will be assessed after 8 weeks (immediate effects) and after 6 months. The primary outcome will be QoL measured by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire. The secondary outcomes: pain (algometry, Visual Analogue Scale, Brief Pain Inventory short form); body composition; physical measurement (abdominal test, handgrip strength, back muscle strength, and multiple sit-to-stand test); cardiorespiratory fitness (International Fitness Scale, 6-minute walk test, International Physical Activity Questionnaire-Short Form); fatigue (Piper Fatigue Scale and Borg Fatigue Scale); anxiety and depression (Hospital Anxiety and Depression Scale); cognitive function (Trail Making Test and Auditory Consonant Trigram); accelerometry; lymphedema; and anthropometric perimeters. DISCUSSION This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer. If this treatment option is effective, telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01801527.

Eficácia de um programa de exercícios específicos no domicílio em idosos

Introdução: As quedas são um dos mais sérios problemas de saúde pública associado à idade. Objectivo: Analisar a influência de um programa de exercícios específicos, realizado no domicílio, em idosos, na força muscular dos membros inferiores, no equilíbrio, no medo de cair e na autonomia. Métodos: Foi realizado um estudo quase-experimental, com a duração de 3 meses, em dois grupos de mulheres idosas, o grupo experimental (n=6), que foi submetido ao programa de exercícios e o grupo controlo (n=6), que apenas recebia visitas mensais para ser submetido às avaliações. Para avaliar os factores de risco de queda foram utilizados o Five-Times-Sit-to-Stand-Test para avaliar a força muscular dos membros inferiores, o Functional Reach Test para avaliar o equilíbrio, a Falls Efficacy Scale para avaliar o medo de cair e a Medida de Independência Funcional para avaliar a autonomia das participantes. Resultados: Verificou-se uma melhor prestação do grupo experimental na realização do FTSST, conseguindo melhorar cerca de 9 segundos em média ao longo do estudo. Os resultados obtidos através do FRT demonstraram uma melhoria da média e mediana entre o 1º e 2º momento de avaliação, nos dois grupos, piorando progressivamente após esse momento. Inicialmente, o número de participantes com medo de cair era superior no grupo experimental (66,7%), sendo apenas 33% no final do estudo, verificando-se um aumento na média das pontuações no grupo experimental até ao 3º momento de avaliação,. Através dos resultados da MIF verificou-se que os dois grupos se encontravam na classificação de independência completa, não se tendo observado influência do programa de exercícios na independência das idosas. Conclusão: O exercício físico específico melhorou a força muscular dos membros inferiores e o medo de cair.

Wii-Workouts on Chronic Pain, Physical Capabilities and Mood of Older Women: A Randomized Controlled Double Blind Trial

Chronic Low Back Pain (CLBP) is a public health problem and older women have higher incidence of this symptom, which affect body balance, functional capacity and behavior. The purpose of this study was to verifying the effect of exercises with Nintendo Wii on CLBP, functional capacity and mood of elderly. Thirty older women (68 ± 4 years; 68 ± 12 kg; 154 ± 5 cm) with CLBP participated in this study. Elderly individuals were divided into a Control Exercise Group (n = 14) and an Experimental Wii Group (n = 16). Control Exercise Group did strength exercises and core training, while Experimental Wii Group did ones additionally to exercises with Wii. CLBP, balance, functional capacity and mood were assessed pre and post training by the numeric pain scale, Wii Balance Board, sit to stand test and Profile of Mood States, respectively. Training lasted eight weeks and sessions were performed three times weekly. MANOVA 2 x 2 showed no interaction on pain, siting, stand-up and mood (P = 0.53). However, there was significant difference within groups (P = 0.0001). ANOVA 2 x 2 showed no interaction for each variable (P > 0.05). However, there were significant differences within groups in these variables (P < 0.05). Tukey's post-hoc test showed significant difference in pain on both groups (P = 0.0001). Wilcoxon and Mann-Whitney tests identified no significant differences on balance (P > 0.01). Capacity to Sit improved only in Experimental Wii Group (P = 0.04). In conclusion, physical exercises with Nintendo Wii Fit Plus additional to strength and core training were effective only for sitting capacity, but effect size was small.

Muscular function and functional mobility of faller and non-faller elderly women with osteoarthritis of the knee

Falls are a major concern in the elderly population with chronic joint disease. To compare muscular function and functional mobility among older women with knee osteoarthritis with and without a history of falls, 15 elderly women with a history of falls (74.20 ± 4.46 years) and 15 without a history of falls (71.73 ± 4.73 years) were studied. Muscular function, at the angular speed of 60, 120, and 180º/s, was evaluated using the Biodex Isokinetic Dynamometer. The sit-to-stand task was performed using the Balance Master System and the Timed Up and Go test was used to determine functional mobility. After collection of these data, the history of falls was investigated. A statistically significant difference was detected in the time taken to transfer the center of gravity during the sit-to-stand test (means ± SD; non-fallers: 0.35 ± 0.16 s; fallers: 0.55 ± 0.32 s; P = 0.049, Student t-test) and in the Timed Up and Go test (medians; non-fallers: 10.08 s; fallers: 11.59 s; P = 0.038, Mann-Whitney U-test). The results indicated that elderly osteoarthritic women with a history of falls presented altered functional mobility and needed more time to transfer the center of gravity in the sit-to-stand test. It is important to implement strategies to guarantee a better functional performance of elderly patients to reduce fall risks.

Perception d’effort et de mise en charge et asymétrie motrice lors du passage assis à debout chez le sujet hémiparétique

L’asymétrie de mise en charge (MEC) lors du passage assis à debout (PAD) chez les personnes hémiparétiques est une observation clinique connue mais peu expliquée. Ce projet visait donc le développement de connaissances sur les facteurs explicatifs de l’asymétrie de MEC chez cette clientèle en s’intéressant plus spécifiquement au lien entre la distribution des efforts aux genoux lors du PAD et l’asymétrie de MEC observée ainsi qu’à la perception de ces deux éléments lors de cette tâche. Ainsi, les objectifs généraux étaient de : 1) déterminer si l’exécution spontanée asymétrique du PAD des sujets hémiparétiques est expliquée par une distribution des efforts symétriques aux genoux en quantifiant ces efforts par le Taux d’utilisation musculaire électromyographique (TUMEMG) et, 2) déterminer si les individus hémiparétiques sont conscients des stratégies motrices qu’ils utilisent en évaluant leurs perceptions de MEC et d’efforts aux genoux durant le PAD. La première étude a évalué la capacité des personnes hémiparétiques à percevoir leur distribution de MEC aux membres inférieurs lors du PAD. Par rapport aux participants sains, leur distribution de MEC fut davantage asymétrique et leurs erreurs de perception plus élevées. La deuxième étude a quantifié la distribution des efforts aux genoux chez les sujets sains et hémiparétiques lors du PAD spontané. Les deux groupes ont montré une association entre leur distribution de MEC et leur distribution d’effort. Toutefois, la relation était plus faible chez les patients. Le classement des participants hémiparétiques en sous-groupes selon leur degré d’asymétrie de force maximale des extenseurs des genoux (faible, modéré, sévère) a révélé une similarité des efforts aux genoux parétique et non parétique chez le groupe ayant une atteinte sévère. La troisième étude a déterminé si la perception de la distribution des efforts aux genoux des sujets hémiparétiques était reliée à leur distribution réelle d’effort mesurée lors de PAD exécutés dans différentes positions de pieds. En plus d’être incapables de percevoir les changements de distribution d’effort induits par les différentes positions de pieds, leurs erreurs de perception d’effort furent plus élevées que celles de MEC. Par le biais du test fonctionnel assis-debout de cinq répétitions, la dernière étude a déterminé l’influence du nombre de répétitions du PAD sur les distributions de MEC et d’efforts aux genoux chez les sujets sains et hémiparétiques. Contrairement aux contrôles, les distributions des sujets hémiparétiques furent plus asymétriques à la première répétition du test fonctionnel que lors de l’exécution spontanée unique du PAD. En somme, les résultats de cette thèse ont démontré que la distribution des efforts aux genoux doit être considérée parmi les facteurs explicatifs de l’asymétrie de MEC des individus hémiparétiques lors du PAD et qu’il y a un besoin de mieux documenter la perception des personnes hémiparétiques lorsqu’elles exécutent des tâches fonctionnelles.

Relationship between lower-limb muscle strength and frailty among elderly people

CONTEXTO E OBJETIVO: A sarcopenia é o principal fator envolvido no desenvolvimento da síndrome de fragilidade. O objetivo foi investigar a relação entre força muscular de membros inferiores e as variáveis sexo, idade e critérios de fragilidade; comparar a força muscular de membros inferiores com cada critério de fragilidade e verificar seu poder de estimativa do risco para fragilidade em idosos ambulatoriais. TIPO DE ESTUDO E LOCAL: Estudo transversal no Ambulatório de Geriatria de um hospital universitário de Campinas. MÉTODO: Foi avaliada uma amostra de conveniência não-probabilística de 150 idosos de ambos os sexos em acompanhamento ambulatorial, com coleta de dados sócio-demográficos (sexo e idade) e de saúde física (critérios de fragilidade e teste de levantar e sentar da cadeira cinco vezes consecutivamente). Foram realizadas análises descritivas, de comparação e de regressão logística multivariada. RESULTADOS: A maioria dos idosos (77,3%) apresentou idade igual ou superior a 70 anos, com predomínio do sexo feminino (64,0%) e baixo escore no teste de levantar e sentar da cadeira cinco vezes consecutivas (81,4% escore 0 ou 1), 55,3% dos idosos apresentaram três ou mais critérios de fragilidade. Verificou-se associação significativa entre a força muscular de membros inferiores e as variáveis idade e número de critérios de fragilidade. CONCLUSÕES: Menores níveis de força muscular de membros inferiores estão associados a idade avançada e maior presença de sinais de fragilidade. Além disso, a força muscular de membros inferiores também está associada com os critérios redução da velocidade de marcha e da força de preensão palmar.

Benefits of Multimodal Exercise Intervention for Postural Control and Frontal Cognitive Functions in Individuals with Alzheimer's Disease: A Controlled Trial

Objective To verify the effects of a systematized multimodal exercise intervention program on frontal cognitive function, postural control, and functional capacity components of individuals with Alzheimer's disease (AD).DesignNonrandomized controlled trial with pre- and posttraining tests in a training group and a control group.SettingKinesiotherapy program for seniors with AD, SAo Paulo State University.ParticipantsConvenience sample of older adults with AD (n=30) were assigned to a training (n=14; aged 78.67.1) and a control (n=16; aged 77.06.3) group.InterventionThe intervention program was structured with the aim of simultaneously promoting better balance and frontal cognitive capacity. The participants attended a 1-hour session three times a week for 16weeks, whereas the control group did not participate in any activity during the same period.MeasurementsFrontal cognitive function was evaluated using the Montreal Cognitive Assessment, the Clock Drawing Test, the Frontal Assessment Battery, and the Symbol Search Subtest. Postural control (center of pressure area) was analyzed under four dual-task conditions. Functional capacity components were analyzed using the Timed Up and Go Test, the 30-second sit-to-stand test, the sit-and-reach test, and the Berg Functional Balance Scale.ResultsIntervention group participants showed a significant increase in frontal cognitive function (P<.001, partial (2)=0.838), with less body sway (P=.04, partial (2)=0.04) during the dual tasks, and greater functional capacity (P=.001, partial (2)=0.676) after the 16-week period.ConclusionIntervention participants performed better on dual-task activities and had better postural balance and greater functional capacity than controls.

Efeito de um tratamento com auriculoterapia na dor, funcionalidade e mobilidade de adultos com dor lombar crônica

Pós-graduação em Desenvolvimento Humano e Tecnologias - IBRC