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Brazilian Journal of Physical Therapy, Volume: 18, Número: 2, Publicado: 2014
  • Propriedades de medida e de aplicabilidade de testes clínicos para avaliação do levantar/sentar em cadeira em indivíduos com doença neurológica: revisão sistemática da literatura Systematic Review

    Silva, Paula F. S.; Quintino, Ludmylla F.; Franco, Juliane; Faria, Christina D. C. M.

    Resumo em Português:

    CONTEXTUALIZAÇÃO: Indivíduos acometidos por doença neurológica (DN) comumente apresentam limitação no desempenho do levantar/sentar em cadeira, com consequente redução do nível de mobilidade. OBJETIVO: Determinar as propriedades de medida/aplicabilidade de testes clínicos que avaliam o levantar/sentar em cadeira em indivíduos com DN. MÉTODO: Trata-se de revisão sistemática da literatura, seguindo o PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). As bases de dados (MEDLINE/SCIELO/LILACS/PEDro) foram pesquisadas pela combinação de termos referentes aos testes e propriedades. Os critérios de inclusão foram: investigar propriedade de medida/aplicabilidade de testes clínicos que avaliem o levantar/sentar em cadeira em indivíduos com DN, publicado em qualquer idioma até dezembro/2012; qualidade metodológica avaliada pelo COSMIN. RESULTADOS: Foram incluídos onze estudos. Grande parte das propriedades investigadas foi para o "teste de cinco repetições de levantar/sentar", que apresentou principalmente boa confiabilidade teste-reteste (coeficiente de correlação intraclasse: CCI=0,94-0,99) para acidente vascular encefálico (AVE), paralisia cerebral e demência e, para esse último, obteve valores de CCI superiores aos do "teste de número de repetições de levantar/sentar em 30s" (CCI=0,84). O teste de cinco repetições apresentou ainda boa confiabilidade inter/intraexaminador (CCI=0,97-0,99) para AVE e inter (CCI=0,99) para Doença de Parkinson e lesão medular incompleta (LMI), validade de critério para AVE, paralisia cerebral, LMI e esclerose múltipla, com resultados predominantemente moderados (correlação=0,4-0,77), e boa aplicabilidade clínica/segurança para Doença de Alzheimer. CONCLUSÕES: O "teste de cinco repetições de levantar/sentar" foi o mais utilizado em indivíduos com DN e boa parte das suas propriedades foi investigada e considerada adequada.

    Resumo em Inglês:

    BACKGROUND: Subjects with neurological disease (ND) usually show impaired performance during sit-to-stand and stand-to-sit tasks, with a consequent reduction in their mobility levels. OBJECTIVE: To determine the measurement properties and feasibility previously investigated for clinical tests that evaluate sit-to-stand and stand-to-sit in subjects with ND. METHOD: A systematic literature review following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) protocol was performed. Systematic literature searches of databases (MEDLINE/SCIELO/LILACS/PEDro) were performed to identify relevant studies. In all studies, the following inclusion criteria were assessed: investigation of any measurement property or the feasibility of clinical tests that evaluate sit-to-stand and stand-to-sit tasks in subjects with ND published in any language through December 2012. The COSMIN checklist was used to evaluate the methodological quality of the included studies. RESULTS: Eleven studies were included. The measurement properties/feasibility were most commonly investigated for the five-repetition sit-to-stand test, which showed good test-retest reliability (Intraclass Correlation Coefficient:ICC=0.94-0.99) for subjects with stroke, cerebral palsy and dementia. The ICC values were higher for this test than for the number of repetitions in the 30-s test. The five-repetition sit-to-stand test also showed good inter/intra-rater reliabilities (ICC=0.97-0.99) for stroke and inter-rater reliability (ICC=0.99) for subjects with Parkinson disease and incomplete spinal cord injury. For this test, the criterion-related validity for subjects with stroke, cerebral palsy and incomplete spinal cord injury was, in general, moderate (correlation=0.40-0.77), and the feasibility and safety were good for subjects with Alzheimer's disease. CONCLUSIONS : The five-repetition sit-to-stand test was used more often in subjects with ND, and most of the measurement properties were investigated and showed adequate results.
  • Effectiveness of muscle strengthening and description of protocols for preventing falls in the elderly: a systematic review Systematic Review

    Ishigaki, Erika Y.; Ramos, Lidiane G.; Carvalho, Elisa S.; Lunardi, Adriana C.

    Resumo em Inglês:

    Background: Falls are a geriatric syndrome that is considered a significant public health problem in terms of morbidity and mortality because they lead to a decline in functional capacity and an impaired quality of life in the elderly. Lower limb muscle strengthening seems to be an effective intervention for preventing falls; however, there is no consensus regarding the best method for increasing lower limb muscle strength. Objectives: To analyze the effectiveness of lower limb muscle strengthening and to investigate and describe the protocols used for preventing falls in elderly subjects. Method: We performed a systematic review of randomized and controlled clinical trials published between 2002 and 2012 in the databases PubMed, EMBASE, Scopus, Web of Science, and PEDro that cited some type of lower limb muscle strengthening protocol and that evaluated the incidence of falls as the primary outcome exclusively in elderly subjects. Twelve studies met the inclusion criteria. Qualitative analysis was performed by independent reviewers applying the PEDro scale. Results: The data obtained from the selected studies showed lower fall rates in the intervention groups compared to controls. Six studies described the lower limb muscle strengthening protocol in detail. High methodological quality was found in 6 studies (PEDro score ≥7/10 points). Conclusions: The methodological quality of the studies in this area appears to leave little doubt regarding the effectiveness of lower limb strengthening exercises for preventing falls in elderly subjects, however the interventions in these studies were poorly reported.
  • Postural alignment in children with Duchenne muscular dystrophy and its relationship with balance Original Articles

    Baptista, Cyntia R. J. A.; Costa, Andreia A.; Pizzato, Tatiana M.; Souza, Francine B.; Mattiello-Sverzut, Ana C.

    Resumo em Inglês:

    Background: In Duchenne muscular dystrophy, functional deficits seem to arise from body misalignment, deconditioning, and obesity secondary to weakness and immobility. The question remains about the effects of postural deviations on the functional balance of these children. Objectives: To identify and quantify postural deviations in children with DMD in comparison to non-affected children (eutrophic and overweight/obese), exploring relationships between posture and function. Method: This case-control study evaluated 29 participants aged 6 to 11 years: 10 DMD (DG), 10 eutrophic (EG), and 9 overweight/obese (OG). Digital photogrammetry and SAPo program were used to measure postural alignment and the Pediatric Balance Scale (PBS) was used to measure balance. The Kruskall-Wallis and Dunn post-hoc tests were used for inter-group comparison of posture and balance. Spearman's coefficient tested the correlation between postural and balance variables. Results: The horizontal pelvic alignment data indicated that the anteversion of the DG was similar to that of the OG and twice that of the EG (p<0.05). Compared to the EG, the DG and OG showed an increased forward position of the center of mass (p<0.05). There was a moderate and weak correlation between the PBS score and horizontal pelvic alignment (0.58 and 0.47-left/right). The PBS showed a weak correlation with asymmetries in the sagittal plane (-0.39). The PBS scores for the OG and EG suggest that obesity did not have a deleterious effect on balance. Conclusions: The balance deficit in children with DMD was accompanied by an increased forward position of the center of mass and significant pelvic anteversion that constitutes a compensatory strategy to guarantee similar performance to the children not affected by the disease.
  • Determinação dos preditores de exacerbação nos pacientes com DPOC em tratamento fisioterapêutico - estudo longitudinal Original Articles

    Marino, Diego M.; Marrara, Kamilla T.; Arcuri, Juliano F.; Candolo, Cecília; Jamami, Maurício; Lorenzo, Valéria A. Pires Di

    Resumo em Português:

    Contextualização: A doença pulmonar obstrutiva crônica (DPOC) normalmente cursa com condições clínicas características de exacerbação e, quanto maior o número delas, maior é a ocorrência de perda funcional e, consequentemente, menores são as chances de sobrevida dos pacientes. Objetivos: Determinar os preditores de exacerbação, isoladamente ou em interação, em pacientes com DPOC em tratamento fisioterapêutico ao longo de seis meses. Método : Trata-se de um estudo observacional, longitudinal e prospectivo, no qual foram avaliados 63 pacientes com DPOC estágios II e III, do município de São Carlos, SP, Brasil, inseridos em um programa fisioterapêutico, por meio de três períodos de avaliação ao longo de seis meses, quanto à ocorrência de exacerbação, bem como quanto ao índice de massa corpórea (IMC), massa magra (MM), índice de massa magra (IMM), volume expiratório forçado no primeiro segundo (VEF1), dispneia, distância percorrida (DP) no teste de caminhada de seis minutos (TC6) e força de preensão palmar. Resultados: Ao aplicar os ajustes de Cox com cada uma das covariáveis separadamente, observou-se significância de 5% apenas para a DP no TC6, a qual demonstrou interação com o IMC e também com a MM. Na comparação dos três períodos de avaliação quanto às covariáveis avaliadas, observou-se diferença significativa apenas para a DP entre as avaliações do 3º e 6º mês. Conclusão: Ao longo de seis meses de acompanhamento dos pacientes com DPOC quanto aos preditores de risco, pode-se observar que a DP no TC6 é um determinante no risco de exacerbação, no entanto depende das covariáveis IMC e MM.

    Resumo em Inglês:

    Background: Chronic obstructive pulmonary disease (COPD) typically presents the characteristic clinical condition of exacerbation, with more intense symptoms associated with greater functional loss and consequently lower chances of patient survival. Objectives: This study sought to determine the predictors of exacerbation, alone or in combination, in patients with chronic obstructive pulmonary disease (COPD) who received physical therapeutic treatment over 6 months. Method: This was an observational, longitudinal and prospective study in which 63 COPD patients residing within the municipality of São Carlos, SP, Brazil were evaluated. These patients had COPD stages II and III and were entered into a physical therapy program, consisting of 3 periods of assessment over 6 months. We evaluated the occurrence of acute exacerbation as well as the patients' body mass index (BMI), fat-free mass (FFM), fat-free mass index, forced expiratory volume in 1 second (FEV1), dyspnea, distance walked (DW) in the 6-minute walk test (6MWT) and handgrip strength. Results: When applying Cox settings with each covariate separately, the results revealed 5% significance only for the DW in the 6MWT, which demonstrated an interaction between BMI and FFM. Comparison of the 3 periods of assessment across the covariates measured showed a significant difference only for the DW between evaluations in the 3rd and 6th months. Conclusion: Upon analyzing the predictors of risk over 6 months of follow-up in patients with COPD, we found that the DW in the 6MWT was associated with the risk of exacerbation, although this risk also depended on the covariates BMI and FFM.
  • Fatores de risco e prevenção de lesões em atletas de elite: estudo descritivo da opinião de fisioterapeutas, médicos e treinadores Original Articles

    Saragiotto, Bruno T.; Di Pierro, Carla; Lopes, Alexandre D.

    Resumo em Português:

    Introdução: Lesões musculoesqueléticas ocorrem frequentemente na população de atletas de elite. Entender o que os profissionais que atuam com esporte de alto rendimento pensam sobre lesão e prevenção tem sido sugerido como um importante aspecto para se aumentar a eficácia de programas de prevenção de lesões no esporte. Objetivos: Descrever e caracterizar a opinião de fisioterapeutas, médicos e treinadores sobre fatores de risco e prevenção de lesões em atletas de elite. Método: Estudo qualitativo, realizado com entrevistas semiestruturadas numa parcela dos integrantes dos departamentos técnico e médico da delegação brasileira que participaram dos Jogos Pan-Americanos de Guadalajara 2011. A entrevista foi realizada a partir de duas perguntas: 1) O que você acha que pode causar lesões nos atletas da sua modalidade?, e 2) O que vocês fazem para a prevenção de lesões na sua modalidade?. As entrevistas foram analisadas em duas etapas, identificação das unidades temáticas, seguida da categorização e agrupamento de unidades temáticas. Resultados: Foram entrevistados um total de 30 profissionais. Em relação à pergunta 1, os principais fatores atribuídos como responsáveis pela lesão foram o excesso de treinamento e a técnica esportiva incorreta. Em relação à pergunta 2, as principais estratégias de prevenção de lesões utilizadas relatadas foram o fortalecimento muscular, o acompanhamento nutricional e orientações. Conclusões: Os principais fatores apontados para o surgimento de lesões foram excesso de treinamento, técnica esportiva incorreta, nutrição inadequada e fatores relacionados ao comportamento dos atletas. As principais estratégias de prevenção de lesões utilizadas foram fortalecimento muscular, acompanhamento nutricional e orientações.

    Resumo em Inglês:

    Background: Musculoskeletal injuries occur frequently in elite athletes. Understanding what professionals who work with patients with sports injuries think about prevention has been suggested as an important aspect to improve the effectiveness of programs to prevent sports injuries. Objectives: To describe and characterize the opinions of physical therapists, physicians and trainers on 'risk factors' and 'prevention of injury' in elite athletes. Method: This is a qualitative study with semi-structured interviews with members of the medical and technical department of the Brazilian delegation who participated in the Pan American Games of Guadalajara 2011. The interview was conducted using two questions: 1) "What do you think can cause injuries in athletes participating in your sport?" 2) "What do you do to prevent injuries in your sport?" The interviews were analyzed in two stages, the identification of thematic units, followed by the categorization and grouping of thematic units. Results: We interviewed a total of 30 professionals. Regarding question 1, the main factors attributed as responsible for injury were over-training and incorrect sports techniques. Regarding question 2, the main reported strategies used to prevent injuries were muscle strengthening, nutritional counseling and guidance. Conclusions: The main factors affecting the appearance of lesions were over-training, incorrect sports technique, inadequate nutrition and factors related to the athlete's behavior. The main injury prevention strategies were muscle strengthening, nutritional counseling and guidance.
  • Differences in muscle strength after ACL reconstruction do not influence cardiorespiratory responses to isometabolic exercise Original Articles

    Andrade, Marília S.; Lira, Claudio A. B.; Vancini, Rodrigo L.; Nakamoto, Fernanda P.; Cohen, Moisés; Silva, Antonio C.

    Resumo em Inglês:

    Objectives: To investigate whether the muscle strength decrease that follows anterior cruciate ligament (ACL) reconstruction would lead to different cardiorespiratory adjustments during dynamic exercise. Method: Eighteen active male subjects were submitted to isokinetic evaluation of knee flexor and extensor muscles four months after ACL surgery. Thigh circumference was also measured and an incremental unilateral cardiopulmonary exercise test was performed separately for both involved and uninvolved lower limbs in order to compare heart rate, oxygen consumption, minute ventilation, and ventilatory pattern (breath rate, tidal volume, inspiratory time, expiratory time, tidal volume/inspiratory time) at three different workloads (moderate, anaerobic threshold, and maximal). Results: There was a significant difference between isokinetic extensor peak torque measured in the involved (116.5±29.1 Nm) and uninvolved (220.8±40.4 Nm) limbs, p=0.000. Isokinetic flexor peak torque was also lower in the involved limb than in the uninvolved limb (107.8±15.4 and 132.5±26.3 Nm, p=0.004, respectively). Lower values were also found in involved thigh circumference as compared with uninvolved limb (46.9±4.3 and 48.5±3.9 cm, p=0.005, respectively). No differences were found between the lower limbs in any of the variables of the incremental cardiopulmonary tests at all exercise intensities. Conclusions: Our findings indicate that, four months after ACL surgery, there is a significant deficit in isokinetic strength in the involved limb, but these differences in muscle strength requirement do not produce differences in the cardiorespiratory adjustments to exercise. Based on the hypotheses from the literature which explain the differences in the physiological responses to exercise for different muscle masses, we can deduce that, after 4 months of a rehabilitation program after an ACL reconstruction, individuals probably do not present differences in muscle oxidative and peripheral perfusion capacities that could elicit higher levels of peripheral cardiorepiratory stimulus during exercise.
  • Comparação dos efeitos de protocolos de manuseio mínimo em parâmetros fisiológicos de prematuros submetidos à terapia de surfactante exógeno Original Articles

    Cabral, Laura A.; Velloso, Marcelo

    Resumo em Português:

    CONTEXTUALIZAÇÃO: A prática de manuseio mínimo é recomendada a recém-nascidos pré-termo. Contudo, há escassez de estudos, na literatura, sobre os efeitos da utilização dessa prática nesses recém-nascidos e sobre o tempo necessário para garantir maior estabilidade fisiológica a eles, principalmente após terapia com surfactante exógeno. OBJETIVO: Comparar o efeito de dois protocolos de manuseio mínimo em variáveis fisiológicas de recém-nascidos pré-termo após terapia com surfactante. MÉTODO: Foi realizado um estudo observacional prospectivo exploratório com 40 recém-nascidos, menores que 1500g, distribuídos em dois grupos que foram monitorizados e seguidos durante 72 horas. Um grupo permaneceu em manuseio mínimo padrão durante as primeiras 12 horas após surfactante; o outro grupo, denominado grupo modificado, ficou em manuseio mínimo por 72 horas após surfactante. As variáveis de frequência cardíaca, saturação periférica de oxigênio e temperatura axilar e eventos adversos associados a essas variáveis foram monitorados de dez em dez minutos. RESULTADOS: Não houve diferenças significativas na ocorrência de eventos adversos associados às variáveis estudadas, entre os grupos, em relação ao tempo de manuseio mínimo (p>0,05). CONCLUSÃO: A prática de manuseio mínimo em recém-nascidos de muito baixo peso não alterou a estabilidade fisiológica quando executada durante 12 horas ou 72 horas após administração surfactante.

    Resumo em Inglês:

    BACKGROUND: The practice of minimal handling is recommended for preterm infants (PTIs). However, few studies have investigated the effects of this practice among these infants or the time needed to ensure greater physiological stability, especially after exogenous surfactant treatments. OBJECTIVE: The current study compared the effects of two protocols of minimal handling on the physiological variables of PTIs after surfactant therapy. METHOD : An exploratory prospective observational study was performed with 40 PTIs weighing less than 1,500 g. The infants were divided into two groups and monitored for 72 hours. One group received the standard minimal handling procedure during the first 12 hours after surfactant therapy; the other group (i.e., the modified group) received minimal handling within 72 hours after surfactant therapy. Infant heart rate (HR), oxygen saturation, body temperature, and the adverse events associated with changes to these variables were monitored every 10 minutes. RESULTS : Significant between-group differences were not found with regard to the occurrence of the adverse events associated with physiological changes (p>0.05). CONCLUSION: The practice of minimal handling among very low birth weight infants did not alter their physiological stability when performed either 12 or 72 hours after surfactant therapy.
  • Costs and benefits of Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: a randomized controlled trial Original Articles

    Farias, Catharinne C.; Resqueti, Vanessa; Dias, Fernando A. L.; Borghi-Silva, Audrey; Arena, Ross; Fregonezi, Guilherme A. F.

    Resumo em Inglês:

    Objective: The current study evaluated the costs and benefits of a simple aerobic walking program for patients with chronic obstructive pulmonary disease (COPD). Method: This was a blinded randomized controlled clinical trial that recruited 72 patients diagnosed with COPD, 40 of whom were included in the study and divided into two groups [control group (CG) and pulmonary rehabilitation group (GPR)]. We assessed pulmonary function, distance covered during the 6-minute walk test (6MWT), respiratory and peripheral muscle strength, health-related quality of life (HRQOL), body composition, and level of activities of daily living (ADLs) before and after an 8-week walking program. The financial costs were calculated according to the pricing table of the Brazilian Unified Health System (SUS). Results: Only 34 of the 40 patients remained in the final sample; 16 in the CG and 18 in the GPR (FEV1: 50.9±14% predicted and FEV1: 56±0.5% predicted, respectively). The intervention group exhibited improvements in the 6MWT, sensation of dyspnea and fatigue, work performed, BODE index (p<0.01), HRQOL, ADL level (p<0.001), and lower limb strength (p<0.05). The final mean cost per patient for the GPR was R$ 148.75 (~US$ 75.00) and no patient significantly exceeded this value. However, 2 patients in the CG did exceed this value, incurring a cost of R$ 689.15 (~US$ 345.00). Conclusion: Aerobic walking demonstrated significant clinical benefits in a cost-efficient manner in patients with COPD.
  • Evaluation of properties of the Vestibular Disorders Activities of Daily Living Scale (Brazilian version) in an elderly population Original Articles

    Ricci, Natalia A.; Aratani, Mayra C.; Caovilla, Heloisa H.; Cohen, Helen S.; Ganança, Fernando F.

    Resumo em Inglês:

    Background: The Vestibular Disorders Activities of Daily Living Scale (VADL) is considered an important subjective assessment to evaluate patients suffering from dizziness and imbalance. Although frequently used, its metric characteristics still require further investigation. Objective: This paper aims to analyze the psychometric properties of the Brazilian version of the VADL in an elderly population. Method: The sample comprises patients (≥65 years old) with chronic dizziness resulting from vestibular disorders. For discriminant analysis, patients were compared to healthy subjects. All subjects answered the VADL-Brazil by interview. To examine the VADL validity, patients filled out the Dizziness Handicap Inventory (DHI) and the ABC scale and were tested on the Dynamic Gait Index (DGI). To evaluate the VADL responsiveness, 20 patients were submitted to rehabilitation. Results: Patients (n=140) had a VADL total score of 4.1±1.6 points. Healthy subjects scored significantly less than patients in all the subscales and in the VADL total score. The VADL-Brazil was weakly correlated with the DHI and moderately to the ABC scale and the DGI. Instead of the original 3 subscales, factor analysis resulted in 6 factors. The VADL was capable of detecting changes after rehabilitation, which means that the instrument has responsiveness. Conclusions: This study provided more data about the psychometric properties and usefulness of the VADL-Brazil. The use of such a reliable and valid instrument increases the knowledge about disability in patients with vestibular disorders.
  • Influência do envelhecimento na força muscular isométrica, na massa livre de gordura e na potência do sinal eletromiográfico dos membros superiores e inferiores de mulheres Original Articles

    Amaral, Josária F.; Alvim, Felipe C.; Castro, Eliane A.; Doimo, Leonice A.; Silva, Marcus V.; Novo Júnior, José M.

    Resumo em Português:

    Contextualização: O envelhecimento é um processo multifatorial que provoca mudanças na quantidade e na qualidade da musculatura esquelética, ambas contribuindo para a diminuição dos níveis de força muscular. Objetivo: Investigar se a força muscular isométrica, a massa livre de gordura (MLG) e a potência do sinal eletromiográfico dos membros superiores e inferiores de mulheres são afetadas na mesma magnitude pelo envelhecimento. Método: A amostra foi constituída por 63 mulheres subdividas em três grupos (JO, n=33 jovens, 24,7±3,5 anos; MI, n=15, 58,6±4,2 anos; ID, n=15, 72,0±4,2 anos). A força isométrica foi registrada simultaneamente à captação da atividade elétrica dos músculos flexores dos dedos e vasto lateral durante os testes de preensão manual e de extensão do joelho, respectivamente. A MLG foi avaliada por meio da absortometria radiológica de dupla energia. Resultados: A força de preensão manual foi semelhante entre os grupos (p=0,523), a MLG do membro superior foi menor no grupo ID em relação ao JO (p=0,108), e os valores da variável root mean square normalizados pela MLG do membro dominante (RMSn) foram semelhantes entre os grupos (p=0,754). Entretanto, a força dos extensores do joelho, a MLG do membro inferior e os valores RMSn foram menores nos grupos MI (p=0,014, p=0,006 e p=0,013, respectivamente) e ID (p=0,000, p=0,000 e p<0,000, respectivamente). Conclusões: Os resultados deste estudo demonstram que as alterações na força muscular isométrica, na MLG e na atividade eletromiográfica dos membros inferiores são mais pronunciadas com o processo de envelhecimento do que a dos membros superiores.

    Resumo em Inglês:

    Background: Aging is a multifactorial process that leads to changes in the quantity and quality of skeletal muscle and contributes to decreased levels of muscle strength. Objective: This study sought to investigate whether the isometric muscle strength, fat-free mass (FFM) and power of the electromyographic (EMG) signal of the upper and lower limbs of women are similarly affected by aging. Method: The sample consisted of 63 women, who were subdivided into three groups (young (YO) n=33, 24.7±3.5 years; middle age (MA) n=15, 58.6±4.2 years; and older adults (OA). n=15, 72.0±4.2 years). Isometric strength was recorded simultaneously with the capture of the electrical activity of the flexor muscles of the fingers and the vastus lateralis during handgrip and knee extension tests, respectively. FFM was assessed using dual-energy X-ray absorptiometry. Results: The handgrip strength measurements were similar among groups (p=0.523), whereas the FFM of the upper limbs was lower in group OA compared to group YO (p=0.108). The RMSn values of the hand flexors were similar among groups (p=0.754). However, the strength of the knee extensors, the FFM of the lower limbs and the RMSn values of the vastus lateralis were lower in groups MA (p=0.014, p=0.006 and p=0.013, respectively) and OA (p=0.000, p=0.000 and p<0.000, respectively) compared to group YO. Conclusions : The results of this study demonstrate that changes in isometric muscle strength in MLG and electromyographic activity of the lower limbs are more pronounced with the aging process of the upper limb.
  • Avaliação da força muscular com o teste do esfigmomanômetro modificado: qual o melhor método e forma de operacionalização? Original Articles

    Souza, Lucas A. C.; Martins, Júlia C.; Moura, Juliana B.; Teixeira-Salmela, Luci F.; Paula, Fátima V. R. De; Faria, Christina D. C. M.

    Resumo em Português:

    CONTEXTUALIZAÇÃO: Testes comumente utilizados para a avaliação clínica da força muscular apresentam importantes desvantagens. O Teste do Esfigmomanômetro Modificado (TEM) é promissor para esse fim, por ser barato e fornecer medidas objetivas. OBJETIVOS: Investigar o método e a forma de operacionalização mais adequados para avaliação da força muscular com o TEM. MÉTODO: Estudo metodológico, com 40 adultos saudáveis (22,98±2,26 anos), não praticantes de atividade física regular. A força dos músculos flexores/extensores de cotovelo e joelho e preensores palmares do lado dominante e flexores anteriores de tronco foi avaliada com os dinamômetros portáteis e diferentes métodos do TEM (adaptações da bolsa, da braçadeira e não adaptado) por um único examinador, em ordem aleatória, com leitura e registro dos valores por outro examinador. As operacionalizações investigadas foram: primeira repetição e médias de duas e três repetições. One-way ANOVA e Coeficientes de Correlação de Pearson foram utilizados para análises (α=0,05). RESULTADOS: Para todo os métodos do TEM, utilizados para avaliar os grupos musculares, foram encontrados valores similares para todas as formas de operacionalização(0,01<F<0,26;0,77<p<1,00) e correlações significativas e positivas com as medidas dos dinamômetros(0,51<r<0,94; p<0,003). CONCLUSÕES: Estatisticamente, os diferentes métodos do TEM se mostraram igualmente adequados para avaliação da força muscular de adultos saudáveis, e apenas uma repetição, após familiarização, foi suficiente para obtenção de resultados adequados. Nenhuma demanda de tempo para realizar a adaptação e a capacidade de mensuração de valores maiores de força muscular favorece o esfigmomanômetro não adaptado. Facilidade de treinamento para uso e estabilização favorecem o método da bolsa.

    Resumo em Inglês:

    BACKGROUND : Tests that are usually employed for the clinical assessment of muscular strength have notable disadvantages. The Modified Sphygmomanometer Test (MST) is a promising method because it is low-cost and provides objective measures. OBJECTIVES : To investigate the most adequate method and sources of outcome values for the assessment of strength with the MST. METHOD : Methodological study with 40 healthy adults (22.98±2.26 years), who did not practice physical activity regularly. The strength of the flexors and extensors of the elbow and knee, the handgrip of the dominant side and anterior trunk flexors were randomly assessed with portable dynamometers and the MST (bag and cuff adaptations, and sphygmomanometer without adaptation) by a single examiner. An independent examiner read and recorded the values. The sources of the investigated outcome values were the first trial and the means of two and three trials. One-way ANOVAs and Pearson Correlation Coefficients were used for the analyses (α=0.05). RESULTS : For the MST methods applied to assess all muscular groups, similar values were found for all sources of outcome values (0.01<F<0.26; 0.77<p<1.00) with significant and positive correlations between the measures obtained with the dynamometers (0.51<r<0.94; p<0.003). CONCLUSIONS : All MST methods showed adequate results for the assessment of strength in healthy individuals, and after familiarization, only one trial was sufficient to provide reliable measures. The sphygmomanometer without adaptation is not time consuming, compared to the other adaptations, and showed the capability of measuring higher values of strength. The bag method was easily trained to be used and stabilized.
  • Influência da prática mental e observação do movimento sobre a memória motora, função cognitiva e desempenho motor em idosos Original Articles

    Altermann, Caroline D. C.; Martins, Alexandre S.; Carpes, Felipe P.; Mello-Carpes, Pâmela B.

    Resumo em Português:

    CONTEXTUALIZAÇÃO: Com o envelhecimento, é importante a manutenção da função motora e cognitiva para garantir autonomia e qualidade de vida. Durante a aquisição de habilidades motoras é necessário que o idoso seja capaz de compreender o objetivo das atividades propostas e, para isso, a prática física e mental, assim como a demonstração, são estratégias usadas para o indivíduo aprender os movimentos. OBJETIVOS: Verificar a influência da prática mental e da observação do movimento sobre a memória motora e a relação entre a função cognitiva e o desempenho motor na execução de uma sequência de movimentos digitais em idosos. MÉTODO: Estudo transversal, realizado com 45 jovens e 45 idosos. Foram utilizados: Miniexame do Estado Mental (MEEM); Inventário de Preferência Manual de Edinburgh e Tarefa Motora Digital (composta por fase de treino, intervalo e teste). Os sujeitos foram divididos em três subgrupos: controle, prática mental e observação do movimento. RESULTADOS: Observou-se que idosos parecem depender mais da prática mental para a aquisição de uma memória motora e, na comparação do desempenho entre as faixas etárias, houve diferença no tempo de execução; nos idosos, observou-se correlação negativa entre o escore do MEEM e o tempo de execução e o número de erros na tarefa motora. CONCLUSÕES: Para idosos, a prática mental parece favorecer o desempenho motor, assim como existe uma relação significativa entre a função cognitiva e o aprendizado e execução de novas habilidades motoras.

    Resumo em Inglês:

    BACKGROUND: With aging, it is important to maintain cognitive and motor functions to ensure autonomy and quality of life. During the acquisition of motor skills, it is necessary for the elderly to understand the purpose of the proposed activities. Physical and mental practice, as well as demonstrations, are strategies used to learn movements. OBJECTIVES: To investigate the influence of mental practice and the observation of movement on motor memory and to understand the relationship between cognitive function and motor performance in the execution of a sequence of digital movements in the elderly. METHOD: This was a cross-sectional study conducted with 45 young and 45 aged subjects. The instruments used were Mini-Mental State Examination (MMSE), Manual Preference Inventory and a Digital Motor Task (composed of a training of a sequence of movements, an interval and a test phase). The subjects were divided into three subgroups: control, mental practice and observation of movement. RESULTS: The elderly depend more strongly on mental practice for the acquisition of a motor memory. In comparing the performances of people in different age groups, we found that in the elderly, there was a negative correlation between the MMSE score and the execution time as well as the number of errors in the motor task. CONCLUSIONS: For the elderly, mental practice can advantage motor performance. Also, there is a significant relationship between cognitive function, learning and the execution of new motor skills.
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