Abstract in English:BACKGROUND: Cystic fibrosis (CF) is a multisystem disease that affects the cardiorespiratory system and the cardiac autonomic control may be altered at rest and after a submaximal exercise. OBJECTIVE: To assess the cardiac autonomic control by heart rate variability (HRV) analysis before and after a 6-minute walk test (6MWT). METHOD: Thirteen children diagnosed with Cystic Fibrosis (CFG) aged 12±2.7 years (FEV1/FVC: 0.83±0.11, FEV1: 71.4±21 %pred) and 12 healthy children (control group-CG) aged 11.4±2.4 years (FEV1/FVC: 0.91±0.12, FEV1: 91.6±17.4 %pred) were included in the study. HRV was evaluated prior to and immediately after the 6MWT and the heart rate recovery assessed on the first and second minute after test. RESULTS: Prior to exercise, CF patients presented higher values for the variables LFnu (53.2±15.0 vs. 32.8±7.9, p=0.0003) and LF/HF (1.25±0.72 vs. 0.49±0.18, p<0.006) as well as lower values of HF% (25.4±18.4 vs. 53±9.6, p=0.002) and HFnu (47.3±14.7 vs. 68.3±8.7, p0.001) when compared to CG. After the 6MWT, both groups demonstrated HRV recovery to baseline levels; however, the differences between CFG and CG were maintained for the variables LF(ms 2) (846.7±754.8 vs. 345.6±197.2, p=0.02); LF% (35.4±8.1 vs. 25.9±6.2, p=0.002); LFnu (60.0±16.3 vs. 34.9±8.7, p<0.0001); HF% (27.4±13.7 vs. 48.1±6.3, p=0.0003); HFnu (40.4±15.8 vs. 65.6±8.2, p=0.0003) and LF/HF (1.9±1.7 vs. 0.5±0.2, p=0.0001). CONCLUSIONS: Children with cystic fibrosis exhibited predominance of sympathetic activity at rest that persisted after the 6-minute walking test when compared to the control group.
Abstract in English:BACKGROUND: Muscles are innervated exclusively by a nerve branch and possess definite actions. However, mammalian skeletal muscles, such as the trapezius, the medial gastrocnemius, and the peroneus longus, are compartmentalized. In the peroneus longus muscle, multiple motor points, which innervate individual neuromuscular compartments (NMC), the superior (S-NMC), anteroinferior (AI-NMC), and posteroinferior (PI-NMC), have been described. The contribution of each neuromuscular compartment to the final action of the muscle is fundamental for the rehabilitation of patients afflicted by neurological and muscle dysfunctions. Interventions are often based on electrical principles that take advantage of the physiological characteristics of muscles and nerves to generate therapeutic effects. OBJECTIVE: To compare the effects of stimulating the different neuromuscular compartments (NMCs) of the peroneus longus muscle on the motor threshold (MT) and acceleration of the foot. METHOD: This is a cross-sectional study comprising 37 subjects. The three NMCs of the peroneus longus muscle were stimulated, and the acceleration of the foot and the motor threshold of each NMC were evaluated. A repeated measures analysis of variance with Bonferroni corrections of two intra-subjects factors was performed. RESULTS: The stimulation of the different NMCs did not result in any differences in MT (F=2.635, P=0.079). There were significant differences between the axes of acceleration caused by the stimulation of the different NMCs (F=56,233; P=0.000). The stimulation of the posteroinferior compartment resulted in the greatest acceleration in the X-axis (mean 0.614; standard deviation 0.253). CONCLUSIONS: The posteroinferior compartment primarily contributes to the eversion movement of the foot. NMCs have specific functional roles that contribute to the actions of the muscles to which they belong.
Abstract in Portuguese:CONTEXTUALIZAÇÃO: Pico de fluxo expiratório (PFE) é uma das medidas de função pulmonar definida como o maior fluxo obtido em uma expiração forçada a partir de uma inspiração completa ao nível da capacidade pulmonar total (CPT). Essa medida é dependente do esforço, da força dos músculos expiratórios, do calibre das vias aéreas e do volume pulmonar. OBJETIVO: Comparar os resultados de PFE em homens e mulheres saudáveis, obtidos na posição sentada, com decúbito dorsal (DD), decúbito lateral direito (DLD) e esquerdo (DLE). MÉTODO: Participaram 30 indivíduos, com média de idade de 22,7 anos, saudáveis e não fumantes, sendo 15 do sexo masculino. Todos realizaram espirometria e responderam ao questionário IPAQ para caracterizar a normalidade da função pulmonar e o nível de atividade física. As medidas de PFE foram realizadas nas quatro posições, sendo realizadas três medidas em cada posição, em ordem aleatória. Para análise estatística, foi utilizado o teste t de Student, com nível de significância estabelecido em 5%. RESULTADOS: Houve diferença entre os valores obtidos na posição sentada (481±117, 1 L/min) com o DD (453,2±116,3 L/min) e DLD (454±112,9 L/min) (p<0,05), porém, não encontramos diferença significativa entre as posições sentada e DLE (469±83 L/min). CONCLUSÕES: A posição corporal afeta os valores de PFE, com diminuição dos valores em DD e DLD. O DLE pode ser uma alternativa para otimizar o fluxo expiratório em situações de restrição à posição sentada.
Abstract in English:BACKGROUND: One of the measures of the pulmonary function is the peak expiratory flow (PEF) that can be defined as the major flow obtained in an expiratory pressure after a complete inspiration to the level of the total lung capacity. This measure depends on the effort and strength of expiratory muscles, the airway diameter and the lung volume. OBJECTIVE: To compare the results of the peak expiratory flow in healthy male and female obtained in a seated position and dorsal decubitus (DD), right lateral decubitus (RLD) and left lateral decubitus (LLD). METHOD: Thirty young subjects with mean age 22.7 years, healthy and non-smokers were included at the study, 15 of male sex. They did spirometry and IPAQ questionnaire to check the normal pulmonary function and physical activity level. The measures of PEF were performed in four positions, being performed 3 measures in which position, in a random order. Statistical analysis was performed according to Student's t test, with significance level set at 5%. RESULTS: There was a difference between the values obtained in sitting position(481±117.1 L/min) with DD(453.2±116.3 L/min) and RLD (454±112.9 L/min) (p<0.05), however, did not find a significant difference between the sitting position and LLD (469±83 L/min). CONCLUSIONS: Body position affects the values of PEF, with decreasing values in DD and RLD. The LLD can be an alternative to optimize the expiratory flow in situations of constraint to the sitting position.
Abstract in Portuguese:OBJETIVO: Verificar a influência de uma intervenção fisioterapêutica semanal e de curta duração sobre a musculatura do assoalho pélvico e sobre a incontinência urinária (IU) em usuárias da rede pública de saúde. MÉTODO: Estudo quase-experimental do tipo antes e depois. Foi realizada anamnese e avaliação da função perineal por meio da manobra bidigital e perineometria. A intervenção consistiu em eletroestimulação transvaginal e cinesioterapia pélvica. Os dados foram analisados por meio do teste t pareado ou Wilcoxon, regressão linear de Pearson ou Spearman. Um valor de P<0,05 foi considerado como significativo. RESULTADOS: Foram avaliadas 82 mulheres com idade de 55,1±10,9 anos. Incontinência urinária mista (IUM), incontinência urinária de esforço (IUE) e incontinência urinária de urgência (IUU) foram observadas em 52,4%, 36,6% e 11%, respectivamente. A duração da IU foi de 6,0 anos (3,0-10). Foram realizadas, em média, 13,64 sessões fisioterapêuticas. Não houve diferença, após a intervenção, nas medidas da perineometria (40,6±24,1 versus 41,7±25,4, P=0,098). Na manobra bidigital, a função muscular aumentou significativamente (P<0,01). Em 88,9% dos casos, as pacientes informaram estar continentes ou satisfeitas com o tratamento. CONCLUSÕES: Os resultados mostraram aumento da função muscular e obtenção da continência urinária ou satisfação com o tratamento na maioria dos casos.
Abstract in English:OBJECTIVE: To assess the effect of a weekly, short-term physical therapy intervention on the pelvic floor muscles and urinary incontinence (UI) among patients of the public health system. METHOD: Quasi-experimental before-and-after study. Clinical history and function evaluation were performed using perineal bidigital maneuvers and perineometry. The intervention consisted of transvaginal electrical stimulation and pelvic floor kinesiotherapy. Data were analyzed using the paired t test or Wilcoxon signed-rank test, Pearson product-moment correlation coefficient or Spearman's rank correlation coefficient. A value of P<0.05 was considered significant. RESULTS: Eight-two women 55.1±10.9 years-old were evaluated. Mixed urinary incontinence (MUI), stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were observed in 52.4%, 36.6% and 11%, respectively. The length of UI was 6.0 years (3.0-10). Approximately 13.64 physical therapy sessions were held on average. There was no difference in perineometry measurements following the intervention (40.6±24.1 versus 41.7±25.4, P=0.098). Muscle function significantly increased (P<0.01) in the bidigital maneuver. The patients reported being continent or satisfied with the treatment in 88.9% of cases. CONCLUSIONS: The results demonstrated an increase in muscle function and the attainment of urinary continence or treatment satisfaction in most cases.
Abstract in English:BACKGROUND: Cystic fibrosis (CF) is a hereditary condition in which lung disease affects all patients. In addition to pulmonary involvement, the multisystemic components of CF cause significant physical limitations. However, the impact of lung function on balance control in CF has not been studied. OBJECTIVE: To assess body balance in adults with CF and to test its possible associations with lung function, nutritional status, and functional capacity. METHOD: This was a cross-sectional study in which 14 adults with CF underwent pulmonary function testing (spirometry, body plethysmography, and carbon monoxide diffusing capacity (DLco), respiratory muscle strength, 6-min walking distance (6MWD), Berg balance scale (BBS), nutritional analysis (body mass index and bioelectrical impedance), and stabilometry. Body balance was quantified using stabilometry; all participants performed the following two trials: opened base, eyes open (OBEO); closed base, eyes closed (CBEC). RESULTS: In stabilometry, the median for the lateral range and anterior-posterior range in the CBEC trial was 0.10 (0.08-0.11) and 0.13 (0.11-0.22), respectively (p<0.05). The maximal inspiratory pressure (MIP) correlated inversely with the lateral standard deviation (ρ=–0.61; p<0.05) as the DLco correlated positively with the anterior-posterior range (ρ=0.54; p<0.05). There were significant relationships between body composition indexes and almost all stabilometric variables measured. There were no relationships of the BBS and 6MWD with the stabilometric variables. CONCLUSIONS: In adults with CF, imbalance occurs mainly in the anterior-posterior direction and is especially associated with body composition.
Abstract in English:BACKGROUND: Several studies have demonstrated the importance of using the Gross Motor Function Classification System (GMFCS) to classify gross motor function in children with cerebral palsy, but the reliability of the expanded and revised version has not been examined in Brazil (GMFCS E & R). OBJECTIVE:: To determine the intra- and inter-rater reliability of the Portuguese-Brazil version of the GMFCS E & R applied by therapists and compare to classification provided by parents of children with cerebral palsy. METHOD: Data were obtained from 90 children with cerebral palsy, aged 4 to 18 years old, attending the neurology or rehabilitation service of a Brazilian hospital. Therapists classified the children's motor function using the GMFCS E & R and parents used the Brazilian Portuguese version of the GMFCS Family Report Questionnaire. Intra- and inter-rater reliability was obtained through percentage agreement and Cohen's unweighted Kappa statistics (k). The Chi-square test was used to identify significant differences in the classification of parents and therapists. RESULTS: Almost perfect agreement was reached between the therapists [K=0.90 (95% confidence interval 0.83-0.97)] and intra-raters (therapists) with K=1.00 [95% confidence interval (1.00-1.00)], p<0.001. Agreement between therapists and parents was substantial (k=0.716, confidence interval 0.596-0.836), though parents classify gross motor impairment more severely than therapists (p=0.04). CONCLUSIONS: The Portuguese version of the GMFCS E & R is reliable for use by parents and therapists. Parents tend to classify their children's limitations more severely, because they know their performance in different environments.
Abstract in Portuguese:OBJETIVO: Analisar o efeito da fadiga muscular induzida por exercício isotônico ativo-resistido de extensão de joelhos em intensidade moderada na resposta estabilométrica em apoio unipodal em universitários saudáveis, praticantes de treinamento resistido. MÉTODO: Para tanto, 11 jovens universitários saudáveis foram submetidos ao teste de 1-RM, avaliação estabilométrica pré e pós-intervenção e protocolo de indução à fadiga muscular utilizando a extensão do joelho como tarefa fatigante. Utilizou-se o teste de Shapiro-Wilk para verificação da normalidade dos dados e o teste de Wilcoxon para as comparações entre os parâmetros estabilométricos pré e pós-indução à fadiga muscular com nível de significância estipulado em p≤0,05, enquanto a estatística descritiva foi aplicada para caracterizar a idade, estatura, massa corporal e o índice de massa corporal (IMC). RESULTADOS: O grupo apresentou 23,1±2,7 anos; 1,79,2±0,07 m; 75,6±8,0 Kg; 23,27±3,71 Kg.m-2; 3,36±1,12 número de dias de atividade/semana; 1RM: 124,54± 22,07 kg; 60% de 1-RM: 74,72±13,24 Kg. A oscilação do centro de pressão (CP) médio-lateral pré e pós-fadiga, respectivamente, foi de 2,89±0,89 mm e 4,09±0,59 mm, enquanto a oscilação ântero-posterior foi de 2,5±2,2 mm e 4,09±2,26 mm. Encontrou-se diferença na largura de oscilação do CP nas direções ântero-posterior e médio-lateral entre as condições pré e pós-fadiga, p=0,04 e p=0,05, respectivamente. CONCLUSÕES: Portanto, o estudo demonstrou que a fadiga muscular altera o controle postural, especialmente na excursão médio-lateral e ântero-posterior do CP.
Abstract in English:OBJECTIVE: This study sought to analyze the effect of muscle fatigue induced by active isotonic resistance training at a moderate intensity by measuring the knee extension motion during the stabilometric response in a single-leg stance among healthy university students who perform resistance training on a regular basis. METHOD: Eleven healthy university students were subjected to a one-repetition maximum (1RM) test. In addition, stabilometric assessment was performed before and after the intervention and consisted of a muscle fatiguing protocol, in which knee extension was selected as the fatiguing task. The Shapiro-Wilk test was used to investigate the normality of the data, and the Wilcoxon test was used to compare the stabilometric parameters before and after induction of muscle fatigue, at a significance level of p≤0.05. Descriptive statistics were used in the analysis of the volunteers' age, height, body mass, and body mass index (BMI). RESULTS: The sample population was 23.1±2.7 years of age, averaged 1.79.2±0.07 m in height and 75.6±8.0 Kg in weight, and had a BMI of 23.27±3.71 Kg.m-2. The volunteers performed exercises 3.36±1.12 days/week and achieved a load of 124.54±22.07 Kg on 1RM and 74.72±13.24 Kg on 60% 1RM. The center of pressure (CoP) oscillation on the mediolateral plane before and after fatigue induction was 2.89±0.89 mm and 4.09±0.59 mm, respectively, while the corresponding values on the anteroposterior plane were 2.5±2.2 mm and 4.09±2.26 mm, respectively. The CoP oscillation amplitude on the anteroposterior and mediolateral planes exhibited a significant difference before and after fatigue induction (p=0.04 and p=0.05, respectively). CONCLUSIONS: The present study showed that muscle fatigue affects postural control, particularly with the mediolateral and anteroposterior CoP excursion.
Abstract in Portuguese:CONTEXTUALIZAÇÃO: O componente de participação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) foi apontado como o mais complexo de ser caracterizado a partir de instrumentos já existentes. Atualmente, indica-se o uso de questionários de qualidade de vida relacionada à saúde (QVRS) para avaliação da participação após acidente vascular encefálico (AVE), sendo indicado o Nottingham Health Profile (NHP) e o Stroke Specific Quality of Life (SS-QOL). No entanto, QVRS e participação são construtos distintos, assim, não está claro se esses instrumentos são os mais adequados para essa avaliação. OBJETIVO: Investigar se o NHP e SS-QOL são apropriados para avaliação do componente de participação da CIF. MÉTODO: Estudo transversal com amostra de 35 indivíduos nos quais foram aplicados o SS-QOL e o NHP com intuito de correlacionar o escore total dos questionários com o escore dos itens que avaliam os códigos do componente de participação da CIF utilizando o Coeficiente de Correlação Spearman (r). RESULTADOS: Houve correlação estatisticamente significante, positiva e de forte magnitude entre o escore total do SS-QOL e do NHP com os escores específicos do componente de participação, (r=0,8; p=0,001) e (r=0,9; p=0,001), respectivamente. CONCLUSÕES: Tanto o NHP quanto o SS-QOL apresentaram correlação forte entre o escore total e o escore dos itens que avaliam as categorias de participação da CIF. No entanto, o SS-QOL pareceu ser o questionário mais completo para essa avaliação por avaliar mais domínios distintos e apresentar o maior número de itens relacionados à participação.
Abstract in English:BACKGROUND: According to the International Classification of Functioning, Disability and Health (ICF), the participation component is considered to be the most complex component characterized in existing instruments that assess quality of life related to health (HRQoL). Questionnaires such as the Nottingham Health Profile (NHP) and the Stroke-Specific Quality of Life (SS-QOL) are currently used to evaluate the participation of individuals in life activities after stroke. However, because participation and HRQoL are different constructs, it is unclear whether these instruments are best suited to this evaluation. OBJECTIVE: To investigate whether the NHP and SS-QOL are suitable instruments for assessing the participation component of ICF. METHOD: A cross-sectional study was conducted in which a sample of 35 individuals completed the SS-QOL and NHP. The study correlated the total score on the questionnaires with the scores on items that evaluate the participation component of the ICF. Both analyses used the Spearman correlation coefficient (r). RESULTS: There was a statistically significant, positive and strong correlation between total score on the SS-QOL and NHP and the score on specific components related to participation (r=0.8, p=0.001 and r=0.9, p=0.001, respectively). CONCLUSIONS: Both the NHP and the SS-QOL show strong correlations between the total score and the score on items that assess the participation categories of the ICF. However, the SS-QOL questionnaire appeared to be the most complete for this assessment because it evaluates more distinct domains and contains the largest number of items related to participation.
Abstract in English:BACKGROUND: Although a number of studies have compared the influence of different electrical pulse parameters on maximum electrically induced torque (MEIT) and discomfort, the role of phase duration has been poorly investigated. OBJECTIVE: To examine the variation in muscle torque and discomfort produced when electrically stimulating quadriceps femoris using pulsed current with three different phase durations in order to establish whether there are any advantages or disadvantages in varying the phase duration over the range examined. METHOD: This is a two repeated-measures, within-subject study conducted in a research laboratory. The study was divided into 2 parts with 19 healthy young adults in each part.In part 1, MEIT was determined for each phase duration (400, 700, and 1000 µs), using a biphasic pulsed current at a frequency of 50 Hz. In part 2, stimulus amplitude was increased until the contractions reached 40% of maximum voluntary isometric contraction (MVIC) and the associated discomfort produced by each phase duration was measured. RESULTS: In part 1 of the study, we found that the average MEITs generated with each phase duration (400, 700, and 1000 µs) were 55.0, 56.3, and 58.0% of MVIC respectively, but the differences were not statistically significant (p=.45). In part 2, we found a statistically significant increase in discomfort over the same range of phase durations. The results indicate that, for a given level of torque production, discomfort increases with increasing phase duration (p=.008). CONCLUSIONS: Greater muscle torque cannot be produced by increasing the stimulus phase duration over the range examined. Greater discomfort is produced by increasing the stimulus phase duration.
Abstract in English:BACKGROUND: The assessment of strength and its relationships with functional capacity could contribute to more specific and effective disability management of stroke survivors. OBJECTIVE: To compare and investigate associations between measures of strength and functional capacity of 98 chronic stroke survivors, stratified into three groups, according to their physical activity levels. METHOD: The physical activity levels were classified as impaired, moderately active, and active, based on their Human Activity Profile (HAP) scores. Strength was assessed by the maximal inspiratory (MIP) and expiratory (MEP) pressures and by the residual deficits (RDs) of work of the lower limb and trunk muscles, whereas functional capacity was evaluated by the distance covered during the six-minute walking test (6MWT). RESULTS: One-way analyses of variance revealed significant differences between the groups, except between the active and moderately active groups regarding the RDS of the hip and knee flexors/extensors and ankle dorsiflexors (2.91<F<8.62; 0.001<p<0.01). Differences between the groups were found for the 6MWT (F=10.75; p<0.001), but no differences were found for the MIP and MEP measures (0.92<F<2.13; 0.13<p<0.40). Significant, negative, and fair correlations were observed between the RDS of the hip and knee muscles and the 6MWT (0.30<r<-0.43; p<0.01) and the HAP (-0.28<r<-0.41; p<0.01). Moderate to good correlations were found between the 6MWT and the HAP (r=0.50; p<0.0001). There were no significant correlations between measures of respiratory strength and any of the investigated variables (-0.11<r<0.12; 0.26<p<0.56). CONCLUSIONS: Lower strength deficits and higher functional capacity were associated with higher physical activity levels. However, the moderately active and active groups demonstrated similar strength deficits.
Abstract in English:BACKGROUND: The SRS-22r questionnaire is a well-accepted instrument used to measure health-related quality of life in patients with idiopathic scoliosis. No validated tool exists in Brazil for idiopathic scoliosis, and the use of the SRS-22r in non-English Laguage contries requires its transcultural adaptation. OBJECTIVE: The objective of this study was to culturally adapt the translated Brazilian version of the SRS-22r questionnaire and to determine its reliability using statistical tests for internal consistency and test-retest reliability. METHOD: The transcultural adaptation process was carried out according to the recommendations of the American Academy of Orthopedic Surgeons. The pre-final version was administered to 44 patients with idiopathic scoliosis. The mean age of the participants was 18.93 years and the mean curve magnitude was 54.6°. A subgroup of 30 volunteers completed the questionnaire a second time one week later to determine the scale's reproducibility. Internal consistency was determined using Cronbach's alpha coefficient, and the test-retest reliability was determined using the Intraclass Correlation Coefficient (ICC). RESULTS: No floor effects were observed using the Brazilian version of the SRS-22r. Ceiling effects were observed in the Pain and Satisfaction with Management domains. The internal consistency values were very good for 3 domains and good for 2 domains. The ICC values were excellent for all domains. CONCLUSIONS: The high values of internal consistency and ICC reproducibility suggest that this version of the questionnaire can be used in Brazilian patients with idiopathic scoliosis.
Abstract in English:BACKGROUND: Aging leads to low functional capacity and this can be reversed by safe and adequate exercise prescription. OBJECTIVE: The aim of this study was to identify the anaerobic threshold (AT) obtained from the V-slope method as well as visual inspection of oxyhemoglobin ( O2Hb) and deoxyhemoglobin (HHb) curves and compare findings with the heteroscedastic (HS) method applied to carbon dioxide production ( CO2), heart rate (HR), and HHb data in healthy elderly men. A secondary aim was to assess the degree of agreement between methods for AT determination. METHOD: Fourteen healthy men (61.4±6.3 years) underwent cardiopulmonary exercise testing (CPX) on a cycle ergometer until physical exhaustion. Biological signals collected during CPX included: ventilatory and metabolic variables; spectroscopy quasi-infrared rays - NIRS; and HR through a cardio-frequency meter. RESULTS: We observed temporal equivalence and similar values of power (W), absolute oxygen consumption (O2 - mL/min), relative O2 ( mL.Kg - 1.min -1), and HR at AT by the detection methods performed. In addition, by the Bland-Altman plot, HR confirmed good agreement between the methods with biases between -1.3 and 3.5 beats per minute. CONCLUSIONS: (i) all detection methods were sensitive in identifying AT, including the HS applied to HR and (ii) the methods showed a good correlation in the identification of AT. Thus, these results support HR as valid and readily available parameter in determining AT in healthy elderly men.