INTRODUCTION: Amyotrophic Lateral Sclerosis (ALS) is an acquired, neurodegenerative and disabling disease of the nervous system, causing motor and extra-motor symptoms. It is described by a functional decline in affected people. In ALS, studies related to tDCS present consolidated results on the hypotheses of hyperexcitability in the corticomotor neural system, with some interesting aspects in its mechanisms of action that could minimize this hyperexcitability. According to the assembly in target areas, tDCS' main action is to act on the resting membrane potential and produce a prolonged suppression of neuronal excitability. This effect is determined by the modulation of dependent synaptic plasticity, which induces a return of the cell to its physiological conditions. The main objective of this study is to evaluate the effects of a HighDefinition Transcranial Direct Current Stimulation (HD-tDCS) protocol on the motor performance of the upper limbs of people with ALS.METHODOLOGY: This is a randomized controlled, parallel, double-blind clinical trial protocol with 2 arms, 1:1 allocation, following the recommendations of the Consolidated Standards of Reporting Trials (CONSORT), based on the Standard Protocol Items Recommendations for Interventional Trials (SPIRIT). Subjects will be included if they have been diagnosed with ALS according to the revised El Escorial criteria, are aged between 18 and 80, have a good cognitive level on the ALS Cgntv Bhvrl Srn sl (≥17 pnts), nd r able to understand and perform simple motor actions based on verbal commands. Participants will be recruited from the Neuromuscular Diseases Outpatient Clinic at the Onofre Lopes University Hospital (HUOL) and assessed before the intervention (PRE), one week after the intervention (POS1) and 2 weeks after the intervention (POS2). The experimental group will undergo an initial assessment, and if they meet the inclusion criteria, they will undergo five sessions of HD-TDCS on consecutive days (one session each day), which will last 20 minutes and have an intensity of 3mA. The Sham group will receive simulations of the application of high-definition tDCS, with the device providing an acceleration period of 30 s up to the full 3 mA, followed immediately by a 30 s reduction. In addition to describing the protocol, this study describes a case report of a participant diagnosed with ALS since September 2022 who underwent the HD-tDCS intervention protocol described. Results: It was found that in a functional activity protocol, most of the characteristics of the analyzed muscle activation signals were higher in POS1 and POS2 compared to PRE. Discussion: Changes were found in the electromyographic signals after the intervention was applied, which indicates that the protocol is viable; however, the clinical trial described above is necessary to validate the protocol's efficacy and safety.

Abstract: The effects of CBD and THC on the human body are due to the endocannabinoid system, which includes cannabinoid receptors type 1 (CB1) and type 2 (CB2), present in several types of cells throughout the body, including in the cardiovascular system, lungs and pulmonary vessels in animals and humans, however, little is known about the action on respiratory mechanics. Given the above, the objective of this study is to analyze the action of cannabis oil in removing full spectrum and THC on respiratory mechanics, muscular electrical activity and cardiovascular hemodynamics. This is a randomized, controlled, crossover, double-blind clinical trial. Therefore, individuals were allocated to a single group that participated in three phases with distinct interventions: Intervention-Full Spectrum (I-fs), Intervention-THC (I-THC) and Placebo Intervention (IP). The sample size and dosage used were defined based on pharmacological information available in the literature and finally confirmed in a pilot study with 10 subjects. The study included young men and women between 18 and 50 years old, who declared themselves healthy, with a body mass index (BMI) within the normal range, who did not present changes in respiratory function (confirmed in previous spirometry), did not present psychological or uncontrolled/treated psychiatric patients, do not use regular medications or have been exposed to cannabis in the last 6 months prior to the first day of assessment. The collection is carried out over three assessment days, and the team consists of a researcher responsible for randomization, and three others responsible for the baseline assessment with strength and lung function tests (spirometry), drug administration and evaluation of the intervention, which occurs in three stages: 1-Pre Intervention (Pre-IN); 2-Intervention (IN) and 3-Post-Intervention (Post-IN). All participants in the three assessment stages consist of: Assessment of respiratory mechanics using a Pneumotachograph, Electromyography of the Sternocleidomastoid, Scalenes, Parasternal and Rectus Abdominis muscles, and Assessment of cardiovascular hemodynamics (PhysioFlow) where 8 minutes will be recorded, with 2 minutes in Quiet breathing, 2 minutes of breathing with an inspiratory resistance of 30% of your MIP and an expiratory resistance of 10% of your MEP, and another 4 minutes of recovery in each stage for later analysis, in addition to the presence and severity of anxiety symptoms in the participant through Hamilton Anxiety Scale (HAM-A). The results of this research, carried out with 09 subjects, 04 women and 05 men, aged 24 ± 3.29 years, BMI 23.12 ± 2.11 kg/m2, declared an expected increase in ECOM muscular electrical activity, ESC, PARA and RA at the time of load pressure limits of 30% of the MIP and 10% of the MEP of the participants compared to the moment in Quiet breathing, with a difference between this increase in relation to the substances used, observing ΔQB/valve of ECOM of Δ=22.22 (placebo), Δ=17.94 (full spectrum) and Δ=23.04 (thc), ESC of Δ=11.33 (placebo), Δ=10.56 (full - spectrum) and Δ=16.25 (thc), TO of Δ=15.29 (placebo), Δ=10.67 (full spectrum) and Δ=17.05 (thc), and RA of Δ=1.34 (placebo), Δ=0.15 (full spectrum) and Δ=0.95 (thc). Despite the widespread use of full spectrum cannabis oil, safety studies regarding its administration are scarce, with a phase 1 study seeking to establish the effects of the substance on the respiratory and cardiovascular system as the first analysis for the safety of its use and enhancing rehabilitation techniques in respiratory and cardiovascular physiotherapy.

Introduction: The kinematic analysis of hemiparetic gait has demonstrated an increasingly important role in the recovery of individuals after stroke; therefore, new technologies are being developed in this regard. One of these technologies is wearable sensors, a more affordable and simpler-to-use alternative to non-wearable devices. Objective: The main objective of this study is to evaluate the feasibility of a portable device for analyzing kinematic gait parameters in post-stroke individuals in an outpatient setting. Methods: This proof-of-concept study tested a device named DAMA, which consists of two inertial sensors with accelerometer, gyroscope, and magnetometer functions used to measure ankle angular parameters during gait. The testing was conducted on 5 healthy individuals and 5 post-stroke individuals, using the Qualisys Motion Capture System® as a reference measure. Feasibility was assessed based on the device's performance (using a proprietary questionnaire) and participants' satisfaction with its use (using the B-QUEST 2.0 questionnaire). The Mann-Whitney test was used to compare performance and usability outcomes between the two groups, and the Wilcoxon test was used to compare ankle angular measurements between the study groups. Results: The majority of participants were men in late adulthood (mean age 59, SD 8.4). The device's performance and usability were considered satisfactory for both groups, achieving an average score above 4 points on both questionnaires. Regarding the angular data, initial contact was the most significantly different measurement between the two groups, with the post-stroke group showing the greatest deviations. Conclusion: The device proved to be feasible, demonstrating satisfactory operational performance and usability. However, the ankle angular data showed a low degree of agreement, particularly in measures of gait events.

Introduction: The growing scientific development enables humans to
experience various therapies through new technological resources.
Among these resources is Virtual Reality (VR), which has spread in the
last decade due to technological advancements, allowing individuals to
interact in real-time with a computer-generated reality. Objective: To
develop and validate the immersive prototype of a serious game aimed
at the rehabilitation of seated postural balance. Methodology:

Descriptive study conducted in two stages: 1) Development of the
immersive prototype of a serious game (VirtualTer) focused on seated
postural balance, carried out at the Assistive Educational Technologies
and Multimedia Laboratory at the Federal University of Rio Grande do
Norte (UFRN). This stage involved a series of periodic meetings
involving professionals from game development and physiotherapy; 2)
Content validation of the developed game by gathering the opinions of
11 professionals using the instruments: Dimensions of the content
validation of the serious game VirtualTer and the System Usability
Scale (SUS). Statistical analysis: The data were tabulated and
analyzed using the Statistical Package for the Social Sciences (SPSS)
version 22.0. Sociodemographic variables were analyzed through
descriptive statistics. The Content Validity Index (CVI) was calculated,
the exact binomial distribution test was used, and Cronbach's Alpha
coefficient was calculated. Results: After a period of analysis of the
Oculus Quest (functionality and existing games) and discussions with
the multidisciplinary team, there was a change in the game's
perspective (from third to first person). The game changed its main
objective to "dynamic seated postural balance" with an average
duration of 5 to 7 minutes. Regarding validation, the overall CVI value
was 0.8, indicating a satisfactory value and strong agreement among
evaluators. Cronbach's alpha showed a value of 0.683, corresponding to
moderate internal consistency, indicating the need for future
adjustments in the game. Professionals rated the immersive prototype
with good usability and applicability of the technological resource.
Conclusion: The game is easy to execute and has the potential to be
used as a complement in the treatment of individuals with postural
balance deficits, but adjustments are needed for applicability in clinical
practice. The contributions from different professional perspectives
were crucial for the development of the immersive prototype of
VirtualTer.

Inglês Introduction: Exercise-based cardiac rehabilitation (CR-ex) is a non-drug procedure already clinically incorporated with a grade AI recommendation for post-acute myocardial infarction (AMI) patients in the outpatient phase. Despite the scientific UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE CENTRO DE CIÊNCIAS DA SAÚDE PROGRAMA DE PÓS-GRADUAÇÃO EM FISIOTERAPIA Av. Campus Universitário – Lagoa Nova - Natal-RN, CEP 59078-970 Telefax: (84) 3342-2003 E-mail: ppgfis@ufrn.br growth of RC-ex in the hospital phase and early after the event, its efficacy and safety require clarification with more robust methodological designs. Objective: To analyze the effectiveness of a CR-ex protocol on physical demand and cardiac function, in addition to cardiohemodynamic safety after recent AMI. Materials and methods: Inpatients with AMI and successful percutaneous coronary intervention (PCI) were included in the clinical trial and planned in two groups: Intervention Group (IG) and Control Group (CG). Both groups received the initial phase of in-hospital RC-ex, optimized drug treatment and guidance for self-managed ambulation, however, the GI continued RC-ex with progression in the in-hospital phase and the semi-supervised home phase. Participants underwent the same clinical and functional assessments, with maximal and submaximal physical effort tests (ergometer test and 30s sit-tostand test) and heart rate variability (HRV) analysis. Results: Chapter 1 presents the publication of the protocol of this clinical trial in the journal Plos One. Chapter 2 contains the validation of the theoretical content of the RC-ex protocol. In Chapter 3, a longitudinal analysis carried out during the pilot study obtained low rates of adverse events in 129 RC-ex sessions, even with significant increases in heart rate, systolic blood pressure and the double product, immediately after the sessions. Chapter 4 describes the clinical trial that showed a significant increase in HRV indices (SDNN, RMSSD, SD1 and HF) in the IG compared to the CG in the reevaluation. The physical collection evaluated by ET showed an increase of 2.07 MET's in the IG compared to the CG, however, without a statistically significant difference. The 30s Sit and Stand Test (TSL 30s) showed a similar increase between the groups with no statistical difference. Conclusion: RC-ex with an estimated final dose of 845 METmin after AMI was effective in improving cardiac autonomic balance. This study provides important guidance on a safe and effective therapeutic window for early CRex in patients with AMI

Introduction: Helicopter pilots often experience chronic low back pain and muscle performance alterations due to exposure to the vibration produced by the aircraft, as well as the asymmetric posture adopted during flight. Supervised physiotherapeutic exercise is considered one of the most effective treatment options for improving disability associated with nonspecific chronic low back pain. However, few studies have used the Pilates Method as a training program in this population. Objectives: Study I = To analyze the effects of a Pilates-based exercise program on low back pain among helicopter instructors of the Brazilian Air Force at Natal Air Base.

Study II: To observe electromyographic behavior related to fatigue among trained and untrained helicopter pilot instructors before and after flight. Methods: Study I: This is a single-blinded randomized controlled trial. Fifteen helicopter pilots of the Brazilian Air Force were assessed for pain intensity (Numerical Pain Rating Scale - NPRS), disability associated with low back pain, and spinal muscle endurance in three positions: trunk extension (Ito test) and right and left side bridge. Individuals were randomly allocated to the regular exercise group (REG, n = 7), instructed to maintain their normal exercise routine, or to the Pilates group (PG, n = 8), which followed a Pilates-based exercise program twice a week for 12 weeks. Reassessments occurred after 6 and 12 weeks. Assessments and reassessments were conducted by a blinded researcher. Data analysis was performed using SPSS 20.0 software, with a significance level of 5%.

Study II: This is a cross-sectional analytical observational study conducted with 14 Brazilian Air Force helicopter pilot instructors. The fatigue resistance of the multifidus muscles was observed bilaterally in trained and untrained pilots. Evaluation was performed before and immediately after the flight, using the median frequency recorded during the Ito test. Results: Study I: The PG showed a significant reduction in low back pain after 12 weeks of training (mean difference of 3.5 points on the NPRS, p = 0.015), compared to the REG (p < 0.0001). We also observed an increase in trunk extensor endurance (p = 0.002) and right (p = 0.001) and left (p = 0.001) lateral muscle endurance in the PG compared to the REG. However, disability scores did not change between the groups.

Study II: Significant differences were observed for the variable median frequency (Fmed) between trained and untrained groups before the flight. After the flight, this condition varied between the groups. In the analysis of the percentage drop in median frequency during fatigue induction, no significant difference was observed between the groups at any of the evaluated times. Conclusions: Study I: Pain intensity was significantly reduced, while spinal muscle endurance increased in the PG compared to the REG after the intervention. Thus, Pilates-based exercises should be included in physical conditioning programs for helicopter pilots.

Study II = Trained individuals exhibited a higher median frequency in the multifidus muscles than untrained individuals, as revealed by electromyography, in the pre-flight condition and showed less variation in this variable after the flight. However, no difference was observed in the percentage drop of this variable during fatigue induction when the groups were compared.

Introduction: Amyotrophic Lateral Sclerosis (ALS) causes significant impairment of motor abilities. Among the professionals involved in treating the condition, physical therapists stand out for designing intervention plans aimed at optimizing functionality. However, physical therapists often face challenges in creating personalized and appropriate treatment plans for individuals with ALS. Objective: To analyze aspects related to motor symptoms of individuals with ALS, in terms of motor evolution and the best evidence for motor care for this population. Methodology: This thesis comprises three methodological designs, namely a systematic review, a clinical practice guideline, and a longitudinal study. Results: In total, five articles compose this thesis: 1) A systematic review protocol; 2) A systematic review with meta-analysis; 3) A clinical practice guideline; 4) A cross-sectional study; and 5) a mixed-methods study. Conclusion: Evidence analysis indicates that physical therapy practices can improve the functionality of individuals with ALS; however, benefits for other symptoms remain uncertain. We also found that fatigue is related to functionality, cognition, and pain symptoms in a sample of Brazilian individuals with ALS.

ABSTRACT

Introduction: Portable devices based on inertial sensors can be useful in assessing the kinematic gait parameters of post-stroke individuals. However, information on their psychometric properties is still scarce. Objectives: To investigate the accuracy of currently available portable devices with inertial sensors in evaluating post-stroke kinematic gait outcomes and to develop a valid and reliable portable device to assess these parameters. Methods: Two studies were conducted comprising three articles (one published, one submitted, and one for immediate submission). Study 1 consists of a systematic review (SR) encompassing a protocol (published) and the final results of a systematic review (submitted). The SR followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), assessed the psychometric properties, reliability, and measurement error of wearable technologies used to evaluate post-stroke gait, and investigated which portable devices have been used to assess angular measures during post-stroke gait. Study 2 involved the development and preliminary testing of the "DAMA - Portable Device for Kinematic Gait Assessment of Post-Stroke Individuals" in evaluating ankle angular measures during gait. Results and Conclusions: The systematic review identified three main psychometric properties of the evaluated devices: validity, reliability, and measurement error. The devices showed good reliability in measuring step count and gait speed, but the quality of this evidence is low. Therefore, methodologically rigorous studies are needed to assess these properties. Additionally, few studies have analyzed angular measures, indicating the need for more studies that evaluate this topic. Study 2 demonstrated that the DAMA is capable of obtaining ankle measurements comparable to a gold standard, including initial contact (IC) angle, toe-off (TO) angle, maximum dorsiflexion (DF) angle, and maximum plantarflexion (PF) angle. A high positive correlation was found for PF (r=1.000; p<0.01) and a high negative correlation for IC (r=-1.000; p<0.01). However, the limited sample size prevents definitive conclusions about the DAMA's performance, requiring additional studies with larger samples. The high negative correlation for IC suggests the need for adjustments in the device. These studies are essential to guide clinicians and researchers in choosing accurate assessment tools, which are fundamental for developing effective protocols to improve the gait of post-stroke patients.

Introduction: After a Stroke (AVC), patients often exhibit various sensorimotor impairments that are frequently assessed during the rehabilitation process. However, changes in social biological rhythm are rarely investigated in patients with neurological disorders, as well as the impact these changes may have on the patients' functional capacity. Objective: To investigate the characteristics of social biological rhythm and associate it with functional capacity in post-stroke patients. Methodology: Initially, a scoping review was conducted to identify alterations in social biological rhythm that might occur in individuals with mental and neurological disorders, serving as a basis for the subsequent cross-sectional analytical observational study. The scoping review was performed using electronic databases, including articles in all languages and without publication date restrictions, following the PRISMA guidelines. The descriptors used were: social rhythm measurement, SRM, and disruption of social rhythm. Studies involving mental and neurological disorders were analyzed. In the observational study, the sample comprised 73 patients (41 men and 32 women), with a mean age of 60 years (±10) and an average time since sequelae of 19 months (±22). The characteristics of social biological rhythm were assessed using the Social Rhythm Metric (SRM), and its association with functional capacity was evaluated through the International Classification of Functioning, Disability, and Health (ICF). Over seven consecutive days, patients recorded the time at which they performed 17 SRM activities: getting out of bed, first contact with a person, having a morning drink, having breakfast, leaving home, starting work, having lunch, napping, having dinner, doing physical exercises, having a snack, watching evening news, watching other television programs, returning home, going to bed, and two additional activities chosen by the patients. The characteristics of social biological rhythm analyzed included: regularity, intensity, frequency, and period of activities. Subsequently, SRM activities were associated with ICF domains and categories. Data were analyzed using the Student's t-test, ANOVA, and Chi-square tests. Results: In the scoping review, 696 articles were identified. Of these, 15 articles were included in the final listing, with a sample size of 10,374 individuals with mental and neurological disorders, with 

a mean age of 38 years. Lower scores on the Social Rhythm Metric (SRM), indicating reduced social rhythm regularity, were directly associated with depression, anxiety, increased vulnerability to bipolar disorder, and neurological impairment following Parkinson's disease and stroke. Higher scores on the SRM were associated with normal health conditions or a reduction in the frequency, intervals, and intensity of clinical disruptions. In the observational study, the mean SRM score was 5.1 ± 0.9 and the mean International Classification of Functioning (ICF) score was 58.3 ± 14.9. In the studied sample, 40% of patients exhibited low regularity and low intensity of activities. Five SRM activities were performed infrequently: working, exercising, having a snack, watching other television programs, and returning home, which tended to have longer or shorter periods than 24 hours. The ICF domains most associated with the SRM were: “General tasks and demands,” “Communication,” “Mobility,” “Self-care,” “Major life areas,” and “Community, social, and civic life.”. Conclusion: The review provided important evidence of disruptions in social rhythm associated with mental and neurological disorders. Similarly, the observational study highlighted changes in social biological rhythm that have implications for patients' functional capacity. Identifying disruptions in social rhythm could be an integral part of the clinical assessment during the rehabilitation process for post-stroke patients.

INTRODUCTION: Disability is a dynamic process that represents the decline in functionality in the physical and mental domains of individuals. In turn, Intrinsic Capacity (IC), according to the World Health Organization, is a composite of an individual's physical and mental abilities that can estimate healthy aging in elderly populations. Both concepts can be influenced by the sociocultural environment, differences between men and women, and inflammatory processes present in the aging process. This thesis aims to assess the associations between levels of functional disability and intrinsic capacity in elderly populations with different socioeconomic profiles of aging.

OBJECTIVES: #Paper 01: To estimate IC levels in a community-dwelling elderly population and identify factors associated with the decline in IC in both genders. #Paper 02: To investigate whether the cross-sectional and longitudinal associations between blood biomarkers related to inflammation and neurodegeneration and IC differ by sex. #Paper 03: To determine whether the associations between socioeconomic status (SES) and late-life disability differ by gender in a multicultural sample.

METHODS: This thesis is composed of three Papers. #Paper 01 and #Paper 03 used cross-sectional data from the third wave of the International Mobility and Aging Study (IMIAS), collected in 2016. Specifically, #Paper 01 analyzed data from 1,484 older adults. Based on a reflective methodology, four functions were selected from the IMIAS database to assess IC domains: i. locomotion (Short Physical Performance Battery), ii. cognition (Leganes Cognitive Test), iii. vitality (Handgrip Strength), and iv. psychological well-being (Center for Epidemiologic Studies Depression). A composite IC score was calculated (ranging from 0 to 100; higher is better). Socioeconomic and health-related factors included: age, marital status (single, married, divorced/widowed), educational level (low, medium, and high), income sufficiency (not/not very well, reasonably well, very well), occupation (manual and non-manual), number of chronic conditions (≤1, 2-3, and ≥4), body mass index (underweight/normal weight, overweight, obesity), and history of falls in the last year (yes and no). Multiple linear regression analyses were used to investigate factors associated with the decline in IC in both genders. #Paper 03 assessed late-life disability in 1,362 older adults using the frequency and limitation components of the Late-Life Function Disability Instrument (LLFDI). SES was collected through self-report using the following variables: i. educational level (elementary, secondary, higher education), ii. income sufficiency (not/not very well, reasonably well, very well), and iii. occupation (manual and non-manual). Multiple linear regression models were used to examine gender-specific associations between late-life disability (frequency and limitation subscales) and SES. Finally, #Paper 02 used longitudinal data from 1,117 older adults (<70 years, 63.8% female) from the Multidomain Alzheimer Preventive Trial (MAPT). IC domains were operationalized using the following functions: i. cognition (Mini-Mental State Examination), ii. locomotion (Short Physical Performance Battery), iii. vitality (Handgrip Strength), and iv. psychological well-being (Geriatric Depression Scale), each scaled from 0 (worst possible IC) to 100 (best possible IC). Biomarkers related to inflammation and neurodegeneration included: i. Interleukin 6 (IL-6, pg/mL), ii. Growth Differentiation Factor 15 (GDF15, pg/mL), iii. Tumor Necrosis Factor Receptor 1 (TNFR1, pg/mL), iv. Neurofilament Light Chain (NfL, pg/mL), v. Progranulin (PGRN, ng/mL), and vi. Beta-Amyloid protein (Aβ42/40). Linear mixed models were conducted to examine whether sex modified the cross-sectional and longitudinal association between biomarkers and IC.

RESULTS: The results of #Paper 01 indicated that women exhibited significantly lower IC scores compared to men (M = 77.43, SD = 9.06 vs. M = 72.26, SD = 9.31, p < 0.001). Age, study sites, marital status, multiple chronic conditions, and history of falls were negatively associated with IC scores in both genders. Additionally, insufficient income (B = -2.130, p = 0.043) and obesity (B = -1.645, p = 0.039) were negatively associated with IC scores in women, while low educational level (B = -2.124, p = 0.012) was negatively associated with IC scores in men. For #Paper 02, no significant interaction effect was observed at baseline. Longitudinal analyses revealed a significant interaction between sex and IL-6 (p = 0.005), such that higher levels of IL-6 tended to be associated with a faster decline in IC score for men (B = -0.385; p = 0.055; 95% CI = -0.778; 0.008), but not for women (B = 0.287; p = 0.041; 95% CI = 0.011; 0.563). In #Paper 03, low educational level (B = −3.11 [95% CI −4.70; −1.53]) and manual occupation (B = −1.79 [95% CI −3.40; −0.18]) were associated with a decrease in participation frequency for men, while insufficient income (B = −3.55 [95% CI −5.57; −1.52]) and manual occupation (B = −2.25 [95% CI −3.89; −0.61]) played a negative role in participation frequency for women. For both men (B = −2.39 [95% CI −4.68; −0.10]) and women (B = −3.39 [95% CI −5.77; −1.02]), insufficient income was the only factor associated with greater perceived limitation during daily tasks.

CONCLUSIONS: It is concluded that: #Paper 01: Women exhibited lower IC scores compared to men. Age, study sites, multiple chronic conditions, and history of falls were factors associated with the reduction in IC in both genders. Educational level seems to particularly influence IC in men, while insufficient income and obesity are more significant factors for women. These findings highlight the need for gender-specific strategies to address the distinct determinants of IC, aiming to promote healthier aging in older adults. #Paper 02: Among all biomarkers, only IL-6 showed sex-dependent associations; over 4 years, it tended to be associated with a rapid decline in IC in men, but not in women. A possible sex-dependent effect of inflammatory status on IC should be further investigated. #Paper 03: Men and women experienced different late-life disability trajectories. For men, occupation and education were associated with a decrease in participation frequency, while for women, this reduction was associated with income and occupation. Income was associated with perceived limitation during daily tasks for both genders.

Low back pain is the musculoskeletal disorder responsible for the highest rate of years lived with disability worldwide and is the most common form of chronic pain. Low back pain management comprises different intervention strategies, including transcranial direct current stimulation (tDCS), which can produce beneficial effects in patients with musculoskeletal pain, such as, for example, improvement in clinical outcomes. This study aimed to verify the effects of tDCS on pain, disability and quality of life of individuals with chronic non-specific low back pain (NCLP). This is a randomized, double-blind, controlled clinical trial. The sample consisted of 37 individuals of both sexes, aged between 18 and 60 years old with NELD. Participants were randomly allocated into two groups: Group 1 who received sham tDCS; Group 2 that received active tDCS. The intervention was performed twice a week for 5 weeks, totaling 10 sessions using the protocol (20 minutes, 2mA, in the dorsolateral prefrontal cortex (DLPFC). Pain assessments were performed (VAS and algometry), disability (Disability Questionnaire). Roland-Morris Disability and Oswestry Disability Index) and quality of life (SF-36). The primary outcome (pain) was measured 1 week before baseline, after each session, and 1 week after completion of the 5-week intervention Secondary outcomes (disability and quality of life) were measured 1 week before the start of the study and 1 week after completion of the 5-week intervention. At the end of the study, it is expected that tDCS will be able to reduce pain, disability and improve the quality of life of individuals with chronic non-specific low back pain.

The assessment of asthma control in Brazil has been carried out using measurement instruments originally studied in English, translated and validated into Portuguese. These are important tools for early detection of the level of asthma control, delaying symptoms and helping to manage the disease. Objective: To adapt and test the content validity, for the adult population, of the instruments for assessing asthma control called the Asthma Support and Monitoring Assessment Questionnaire (qASMA) and the Asthma Assessment, Support and Monitoring Diary (dASMA), which make up the electronic system for Asthma Support Assessment and Monitoring (e-ASMA). Methods: This is an exploratory methodological study, evaluating measurement properties, with adults from 18 years of age, who present a diagnosis of asthma at any level of control, according to the Global Initiative for Asthma (GINA). The present study was approved by the UFRN Ethics and Research Committee (CAAE: 35771920.2.0000.5537 and OPINION: 4.895.038) and is linked to the project “Development and validation of an electronic system for Asthma Assessment, Support and Monitoring (e- ASMA)” approved in Call CNPq/MCTI/FNDCT No. 18/2021 – UNIVERSAL in order to support scientific and technological development and innovation in the country. This followed the international recommendations of the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) and comprised 2 phases: (1) initial adaptation of the qASMA and dASMA for the adult population and obtaining preliminary versions of the instruments; (2) evaluation of conceptual and semantic adaptation and content validation of qASMA and dASMA. The qASMA and dASMA instruments developed and validated for Brazilian adolescents originated their respective versions for adults. The adaptation of the qASMA and dASMA versions for adults and their respective content validations were obtained from the initial adaptation of the items through the consensus of the researchers, followed by their judgment by a committee of judges and a pre-test carried out from interviews in depth with adults with asthma. Results: The items that make up the qASMA and dASMA were initially adapted by three study researchers. After the initial adaptation, the instruments were judged by a committee of 10 judges, who followed the COSMIN criteria for assessing the relevance and scope of the items. Initially, five qASMA items and one dASMA item had fleiss kappa values lower than adequate (0.70). These items were adapted and again sent and approved by the committee of judges. Subsequently, in-depth interviews were conducted with 15 representatives of the target audience. After analyzing the participants' discourse, five thematic categories were listed, demonstrating the scope of the instruments. All participants considered the items of the instruments relevant and understandable, as well as indicating that the instructions for completing them, the period of time to be taken into account and the response options were adequate. Some participants suggested minor changes in the wording of some items. These suggestions were accepted by the researchers in order to facilitate the understanding of the items for the final version of the instruments. Conclusion: The adaptation steps of the instruments supported their content validation and suggest that the qASMA and dASMA items are relevant, understandable and comprehensive for the target population. The qASMA and dASMA versions have adequate content validity for tracking information about asthma control in Brazilian adults. Finally, the results of this content adaptation and validation study will support the other psychometric validations of the qASMA and dASMA instruments for Brazilian adults.

Introduction: Virtual reality games are promising tools for gait and balance rehabilitation in the elderly. These games use challenge, narrative and interactivity to generate intrinsic motivation in the patient. Strategies that increase intrinsic motivation may be more effective with regard to learning transfer and behavior changes. In this context, the potential of the game is mainly due to the motivational factor that they awaken in their users. However, there is an important aspect that must be considered when thinking about clinical practice: the usability of the game. In this sense, it is important to investigate the home usability and the intrinsic motivation of healthy elderly people after using a serious game for balance rehabilitation at home.Objective: To analyze the usability of the home version of the VirtualTer serious game and the intrinsic motivation of healthy elderly people after using the system. Method: This is a descriptive and cross-sectional study, with a sample of 25 healthy elderly recruited in a non-probabilistic way and for convenience. The home version of the VirtualTer serious game, developed for the rehabilitation of postural balance in the elderly, was used. The game had VirtualTer challenge stages (forest, mountain and desert), which stimulate the lateral reach of the trunk. The game was run using a notebook and the PoseNet motion capture interface, a pose recognition software via webcam. The game was applied in the home environment, and each elderly person performed three repetitions. An evaluation of sociodemographic data was carried out, in addition to the application of the Short Physical Performance Battery (SPPB); International Physical Activity Questionnaire (IPAQ); and the WHODAS 2.0 Disability Rating Scale. After applying the game, the elderly answered the Intrinsic Motivation Inventory (IMI) and the System Usability Scale (SUS). Results: The study included 25 elderly people, with moderate physical performance, a high degree of physical inactivity and sedentary behavior, 68% of whom were female. The median age was 69 (IQ 61 – 76.5) years. The WHODAS 2.0 analysis showed a median score of 55 (IQ 42.5 – 69) points, indicating a population with moderate disability. The total score of the SUS scale obtained a median of 72.50 (IQ 95 – 28); which classifies a good usability of the home version of VirtualTer. The variables gender (p=0.04), marital status (p=0.03) and education (p=0.01) indicated statistical significance with the usability scale. The intrinsic motivation measured by the IMI resulted in a median of 87 (IQ 96 – 56) points, which indicates greater motivation of the players. Conclusion: The home version of VirtualTer is a serious game with good usability and good intrinsic motivation, from the patient's point of view, which indicates the effectiveness of the system as a rehabilitation tool for postural balance in the elderly.

Introduction: Menopause marks the end of a woman's reproductive
period and occurs on average between 48 and 52 years old. It can be
classified as early before age 45 and late after age 55. Previous studies
have suggested that early menopause is associated with worse
functional outcomes in postmenopausal women, but conflicting results
have been reported. Objective: This study aims to investigate the
association between age at menopause and functionality of elderly
women based on data from the National Health Survey. Methods: This is
a cross-sectional study with a sample of 5,148 women aged 60 years or
older. Participants were classified according to age at menopause
(younger than 45 years old, between 45 and 49 years, 50 and 54 years
and 55 years or older) and the presence of difficulty in performing
Activities of Daily Living (ADL) (bathing, lie down-stand up, sit-stand up,
walking and going out alone). The participants were also evaluated regarding socioeconomic data, lifestyle habits and the presence of chronic diseases. The association between age at menopause and ADL difficulties was assessed using binary logistic regression with adjustment for covariables (age, education, income, race/color,smoking, alcohol consumption, practice of physical exercises, diagnosis of chronic diseases and hormone replacement therapy). A sensitivity analysis was performed dividing participants according to age at the time of assessment (60-74 years old and 75 years old or older). Data were analyzed by adjusting the sample weights resulting from complete samples, considering p<0.05. Results: There was no association between age at menopause and difficulty in ADL considering the complete sample or the sample of younger elderly women only. Considering the sample over 74 years old, those with menopause before 45 years old and between 45 and 49 years old had a greater chance of difficulty in ADL compared to the reference group (menopause between 50 and 54 years old) (OR=1.85; CI95% = 1.10;3.10 and OR=1.54; CI95%= 1.12;2.13, respectively). Conclusion: The present study indicates the need for greater attention to the functional health of women who stop menstruating younger, as well as encouraging healthy habits that may contribute to maintaining independence for a longer period

Abstract: Introduction: Osteosarcopenia is a unique geriatric syndrome that can be understood as the concomitant presence of reduced bone mass and reduced muscle mass, amplifying the possible clinical repercussions and the main risk factors of two of the main musculoskeletal disorders that affect the older population. Osteopenia/osteoporosis and sarcopenia have common risk factors, involving modifiable factors, such as lifestyle habits, and non-modifiable factors, such as gender and genetic factors. Objective: To identify the association between osteosarcopenia and physical performance measures in a sample of osteosarcopenic and non-osteosarcopenic community-dwelling older women from an urban center in the Northeast of Brazil. Methods: This is a cross-sectional analytical observational study that evaluated 32 community-dwelling older women with osteosarcopenia and 32 with no osteosarcopenia. Sociodemographic, anthropometric, concern about falls, level of physical activity, depressive symptomatology and functional health assessment data were collected. Body composition was accessed by Dual Energy X-ray Absorptiometry (DXA) and sarcopenia defined based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Physical performance was obtained by Short Physical Performance Battery (SPPB) and Grip Strength (GS). Pearson's Chi-square was used to identify associations in the sample distributions. Binary Logistic Regression adjusted for age, Body Mass Index, SPPB, and GS was developed to estimate the prediction on osteosarcopenia. Results: GS (OR = 0.7, CI 0.58 to 0.86, p-value < 0.001) was significantly associated with presence of osteosarcopenia. There were no significant associations on the SPPB domains.

Background: Alterations in muscle activation and force production in the scapulohumeral joint are frequently associated with Subacromial Pain Syndrome (SPS). However, studies that evaluate variables related to the onset of the firing time of the scapular stabilizing muscles in these subjects, comparing them to an asymptomatic control group, are still scarce. Thus, comparing muscle strength and static and dynamic muscle activity between individuals with SPS and asymptomatic individuals may provide information on normal and altered muscle aspects in this patient population, which should be considered in the exercise planning approach for the rehabilitation of these individuals. Objective: To compare muscle strength and electromyographic activity of the shoulder muscles between asymptomatic individuals and individuals with SPS. Methodology: Cross-sectional study. Individuals of both sexes aged between 35 and 60 years diagnosed with SPS were recruited and compared to asymptomatic individuals, matched for age, weight, height, sex, limb dominance and level of physical activity. Muscle strength was measured with a Lafayette Instrument® hand-held digital dynamometer and electromyographic amplitude was checked with a TeleMyo signal conditioning module (Noraxon®, USA) using passive self-adhesive surface electrodes. Results: Reduction of internal and external rotation strength and flexion was found in the shoulder of the SPS group, compared to the asymptomatic subjects (p< 0.05).  The serratus anterior muscle in the SPS group showed decreased activity at all evaluated humeral elevation angles and a delayed onset of firing time during full shoulder elevation when compared to the control group. Conclusion: The strength of the flexors, lateral and medial rotators of the shoulder and the function of the serratus anterior muscle are important to consider in the rehabilitation of patients with symptoms of subacromial pain syndrome.

ABSTRACT
Introduction: Patellar tendinopathy is a common cause of knee pain that
affects young and physically active individuals in addition to athletes.
Patellar tendinopathy can lead to interruption of physical activity and
early retirement of athletes. Despite the ease and abundance of
information available, physical therapists struggle to properly manage
this condition. Information overload, lack of time, language, and
difficulties in critically appraising scientific evidence are some of the
barriers physiotherapists face in adopting evidence-based practice.
Objective: To develop an online toolkit based on the best scientific evidence to enable physiotherapists to improve their skills in diagnosing, assessing and treating patients with patellar tendinopathy.

Methodology: The development of the toolkit occurred in 3 phases: (I)
definition of the toolkit content through a literature review on patellar
tendinopathy; (II) development of the toolkit prototype; (III) evaluation of
the toolkit by physiotherapists through focus groups.
Results: In Phase 1, the content of the toolkit was defined and presented
in the form of text, infographics, videos and quizzes, and was divided
into three main modules with their respective sub-modules. The
prototype of the toolkit was developed in phase 2. In phase 3 the focus
group (n = 6 physiotherapists) took place, which allowed the
improvement of the content and provided improvements for the usability
of the toolkit. The toolkit is available at
https://tendinopatiapatelar.trekeducation.org/.
Conclusions: The toolkit shows potential to be a good option for a
source of quality information for physiotherapists involved in the care of
patellar tendinopathy. The Patellar Tendinopathy Toolkit has content
based on the best available scientific evidence and user-friendly tools.
Future studies should investigate the actual impact of the toolkit on
clinical outcomes of patients with patellar tendinopathy.

INTRODUCTION: Aging is a natural process that implies gradual and inevitable changes related to health. Studies indicate that one of the most important challenges arising from the aging process is managing to control the progressive decline of the musculoskeletal system, called sarcopenia. First described in 1989 by Rosenberg, the concept of sarcopenia is not established in the literature, therefore, in order to determine operational criteria, different study’s groups around the world came together to facilitate its identification and measurement, presenting methods and assessment tools that are valid for screening for sarcopenia. However, taking into account the difficulties encountered in Primary Health Care (PHC), the use of easier, simpler and cheaper alternatives is indicated, and an example of this is the use of prediction equations based on anthropometric measurements.  Despite being a method that has been gaining ground in epidemiological research, there are still few studies that aim to validate and/or develop these equations in the Brazilian population, so it is evident the need to carry out a cross-validation of the prediction equations in community-dwelling older people living in Brazilian northeast. OBJECTIVE: To verify the cross-validity of SMM prediction equations in an Community-dwelling older people, using bioelectrical impedance (BIA) as a comparative method. METHODS: A methodological study, comprising 682 older people aged ≥ 60 years, of both gender, living in the city of Parnamirim. Data were collected through a standardized protocol containing questions about sociodemographic variables and lifestyle habits (present in the Caderneta de Saúde da Pessoa Idosa - CSPI). For the variables used in the 5 anthropometric equations analyzed, weight, height, calf circumference and hand grip strength were evaluated, and for the evaluation of the SMM, the BIA was used, which was considered in this study as a comparator criterion. As for the data analysis, the paired t-student test and Pearson's correlation were performed to compare the means and the relationship between the variables and verify the cross-validity between the measures. In order to verify the validity of the prediction equations, a linear regression was performed, and the assumptions of Lohman (1992) were followed to confirm this validity. Finally, the Bland & Altman method was used to verify the agreement between the assessment methods. RESULTS: The sample consisted of older people with a mean age of 70.06 (±7,06) years and mostly women (60.7%). When comparing the criterion measure and the anthropometric equations, it was seen that the Baumgartner Equation presented a greater mean and a greater difference (-6.06kg). As for the cross-validity analysis, only the Visvanhatan Equation 02 met the validity criteria proposed by Lohman (p-value > 0.05, estimated standard error = 0.602 and R²= 0.74), in addition to presenting a lower bias (0.04) and a smaller interval between the limits of agreement when compared to BIA. EXPECTED RESULTS: Based on the preliminary results, it was observed that the use of simpler equations is valid for use in community-dwelling older people, proving to be reliable for use within the daily assessment of the elderly person, thus helping to identify them early. of such a significant decline, minimizing the adverse effects in later years of the life of this population group.

Introduction: Diabetes is characterized by a metabolic disease group that
can cause several changes. One of them occurs in the sensorimotor function,
which generates alterations in gait execution, such as longer stance phase,
shorter steps and inadequate plantar pressure distribution. Quantitative
methods for assessing changes in gait patterns can be decisive in designing
treatment strategies. In addition, they can help prevent diabetes
complications. With advances in machine learning (ML) techniques,
automated pattern recognition in the face of large amounts of data has
become an essential tool in the medical field due to the ability to predict
clinical complications before the disease gets worse. Objectives: to apply ML
models on gait evaluation data of type 2 diabetic patients to identify patterns
of gait performance that may predict diabetes clinical complications.
Methods: The study involved two methodological modalities: 1) Protocol
elaboration and Systematic Review; 2) Development and improvement of
predictive models of unsupervised and supervised BF for exploratory data
analysis, diabetes detection and detection of clinical complications in diabetes
based on glycated hemoglobin levels. The data for the execution of the study
was provided through a partnership with the International University of Florida
(FIU) during a sandwich doctorate (Edital No. 02/2020 – CAPES/PRINT)
between September 2021 and June 2022. The data were pre-processed and
implemented in different ML models. The ML models used efficiency were
evaluated based on the silhouette analysis for unsupervised ML, the
confusion matrix for supervised ML metrics, and conventional statistics,
adopting a significance level of 5%. Results: 1) Resulted in two articles:
Article 1 - The protocol defined the systematic review methodology; Article 2 -
The review included four studies (208 participants). Two used ML as a
predictive method, one used conventional statistics based on multiple
stepwise regression, and the last used the uncertainty method Fuzzy
classifier. Studies achieved at least 75% in adequately reporting 19 TRIPOD 

items. Three of the included studies were classified as high risk of bias. 2)
Resulted in three articles: Article 3 – K-Means separated the dataset into two
groups (silhouette = 0.47). Gait speed, step length and plantar pressure
distribution patterns were statistically different (p < 0.05) between diabetics
and non-diabetics. Furthermore, among diabetic patients, a statistically
significant difference (p < 0.05) was observed in plantar pressure distribution
patterns. Article 4 – Supervised ML algorithms using gait data showed high
sensitivity in the distribution of plantar pressure in the heel region to classify
diabetes from non-diabetics. Article 5 – The XGB classifier presented better
results, reaching an AUC of 0.99, a precision of 0.91, a recall of 0.90 and an
f1-score of 0.89. The three most relevant gait characteristics in the
classification of diabetes complications found were left support base, mean
left pressure over time in the metatarsal region (I-III) and mean active sensor
area in the III-IV phalanges region. Conclusion: The use of ML has been
growing more and more, making it necessary to have more rigorous
methodological studies to improve the evidence regarding the development
and application of predictive tools, mainly concerning the gait performance
data of diabetic patients. ML in medical applications has been helping to
develop new skills and approaches in the way of treating. Regarding diabetic
patients, the use of ML in the early detection of alterations in gait performance
may be fundamental in clinical practice for directing treatments, which may be
crucial in preventing the appearance of neurological disorders.

Amyotrophic lateral sclerosis (ALS) is characterized by signs and symptoms of upper and lower motor neuron degeneration. This leads to progressive weakness of the bulbar, limb, thoracic, and abdominal muscles, causing loss of ambulation and functionality, swallowing difficulties, respiratory muscle dysfunction, and death due to ventilatory failure. It is one of the most disabling neuromuscular diseases, with a considerably rapid and fatal progression. Median survival from the onset of symptoms is approximately 3 to 5 years, but some patients survive longer, with slow disease progression. Since there is no medical treatment that reverses or significantly alters the progression of the disease, the treatment of ALS remains symptomatic, performed by a multidisciplinary team, even requiring the aid of mechanical ventilation when respiratory failure sets in. Other important aspects of optimizing respiratory care must be considered, such as the prevention and treatment of respiratory infections that contribute to improving the quality of life of patients. Currently, many Brazilian states do not offer, along with NIV, a program to optimize patient care in general. Therefore, care for patients with ALS involves a care model, as well as health education for their families. From a clinical point of view and in the scope of respiratory care, we propose the implementation of a respiratory care program with comprehensive care for patients with ALS, extending to their homes, seeking to increase their survival. This thesis is an integral part of the RevELA project, an initiative of the Federal University of Rio Grande do Norte (UFRN), through the Laboratory of Technological Innovation in Health (LAIS), financed by the Ministry of Health and in partnership with the Pneumocardiovascular LAB. In order to meet the needs of patients with Amyotrophic Lateral Sclerosis (ALS) in a multidisciplinary and technological way. Related to respiratory physiotherapy, the goals set include a clinical trial for the implementation of a home care program in ALS, a systematic review on the effects of respiratory physiotherapy in ALS, with the publication of articles, Guidelines for recommendations for respiratory management in these patients and education in health through training and guidance for caregivers and physiotherapists with the development of booklets and courses in person and via virtual platform, which are part of the care in interventions.

INTRODUCTION: Heart Rate Variability (HRV) has been the subject of study within the field of gerontology in recent years, considering that several studies suggest an intimate relationship between changes in HRV, age, and cardiovascular risk. Studies indicate the need to monitor individuals for prolonged periods, highlighting that the identification of cardiovascular risk is dependent on the measurement time. However, several studies use only short-term records and measurements for HRV analysis due to the difficulties encountered in submitting the individual to the use of devices for 24 hours, such as electrocardiogram and Holter. On the other hand, these short records are often unable to identify risks and adverse health outcomes. In this context, wearable devices, such as smartwatches, have been incorporated as a tool within the perspective of remote, continuous, and longitudinal monitoring, and can be used as a new form of data acquisition for HRV analysis. However, as they use photoplethysmography sensors to obtain heart rate (HR) data, the time series obtained by the sensor may present failures, and missing data are often observed, requiring the development of intelligent models to create HRV indices.

OBJECTIVES: #Paper 01: To present the strategies adopted for the development of a software solution, entitled Senior Mobile Health (SMH), for HRV analysis, based on a photoplethysmography sensor embedded in a commercial smartwatch. #Paper 02: To validate the Senior Mobile Health software for HRV analysis through a study with 231 participants. In addition, the paper aims to present the architecture and main functionalities of the Senior Mobile Health platform. #Paper 03: To establish HRV reference values in community-dwelling Brazilian elderly through a solution developed using a smartwatch.

METHODS: #Paper 01: Seeking to develop a software solution for HRV analysis for a smartwatch, the following techniques were mainly used: (1) interpolation to fill in the missing data in the time series; (2) modeling of the HRV algorithm, to approximate the data obtained by smartwatches with the data obtained by the gold standard (Polar H10) through several smart models; (3) methods for removing artifacts and inconsistencies from the series; (4) statistical tests to analyze the difference between the HRV values obtained by the solution created in this research and the values obtained by the gold standard. #Paper 02: The second paper presents the validation process of the software solution developed in paper 01. For this, 231 individuals over 60 years of age were recruited and asked to use a smartwatch on their non-dominant arm for 24 hours. The time series extracted from the smartwatch was analyzed using the software solution (SMH0 developed and presented in paper 01 and using the Kubios® software. The values obtained through the two tools were compared and through the Wilcoxon test, it was observed the existence or not of statistically significant differences, between the SSM and Kubios, for each of the HRV indices, establishing the significance level of α 0,05. Then, Bland-Altman graphs were constructed to calculate the limits of agreement between the two methods (SSM and Kubios®). Finally, to evaluate the HRV metrics resulting from the SSM and measure how far the predicted values were from the reference value, that is, those generated by Kubios, we calculated the MSE, defined as the mean squared difference between actual values and the estimated values. #Paper 03: It has a study with 220 community-dwelling seniors who used a smartwatch for 24 hours. The time series was extracted and the HRV algorithm developed in this thesis was applied to propose HRV reference values in individuals over 60 years old, divided into age groups, using a smartwatch.

RESULTS: #Paper 01: To fill in the missing data of the time series, several techniques were applied, and it was possible to observe that Piecewise Cubic Hermite Interpolating Polynomial (PCHIP) presented a lower error measured by the Root Mean Square Error (RMSE) when compared to the other selected techniques. For the process of modeling the HRV algorithm with the objective of generating the approximation of the data obtained by Fitbit with the data of the gold standard (Polar H10), several intelligent models were applied. The intelligent model that presented the lowest RMSE was the Long Short-Term Memory (LSTM) neural network, showing good long-term learning ability. To remove artifacts and inconsistencies from the created time series, the Kamath method was applied, since this method provided the results most similar to those of Kubios®. Each step of the workflow was validated individually. And, finally, the evaluation of the process was carried out using the paired Student's t-test to determine whether the paired observations (software developed and data obtained by the Kubios® software) are significantly different from each other. As a result, it was possible to observe that there is no statistically significant difference between the HRV indices generated by the solution developed in the research and the indices generated by Kubios®. #Paper 02: The results of the Wilcoxon test showed that there was no statistically significant difference between the data obtained by the SSM software developed in this research and the data generated by the Kubios® software for all HRV indices (SDNN: p = 0.08; RMSSD: p = 0.59; pNN50: p = 0.53). The graphic results of the Bland Altman test, for the three HRV indices, showed the means of the differences close to zero and the narrow limits, thus resulting that the data evaluated by the two methods are essentially equivalent. Finalizing the validation process, we applied the MSE to evaluate the differences between the values predicted by the algorithm and the real values generated by Kubios®. The obtained MSE was 0.256 for SDNN, 0.211 for RMSSD, and 0.191 for pNN50. A small MSE value indicates that our model adequately fits the gold standard data. In short, the results found suggest that there is no significant difference between the SMH platform compared to Kubios®.

#Paper 03: The reference values of mean and standard deviation observed for men were: SDNN 127(15), RMSSD 24(7.7), and pNN50 4.1(3.5), while the following values were observed for women: SDNN 111(36.6), RMSSD 19(6.8) and pNN50.4(2.9). In this paper, statistically significant differences were observed in the HRV indices between men and women, with men presenting higher HRV indices when compared to women. Regarding the change in HRV over age, women showed a significant increase in parasympathetic indices in the age group of 70 to 79 years. Through correlation analyses, it was possible to observe a strong correlation between heart rate at rest and all HRV indices in men and women. When observing the correlation between mean heart rate and HRV indices, only women maintain strong correlations. Regarding the physical activity variables, a strong and positive correlation was found between the number of steps and the SDNN among men and a moderate and positive correlation for women.

CONCLUSIONS: We conclude that: #Paper 01: The software solution developed for HRV, through the techniques and methods adopted, did not present statistically significant differences with the Polar H10, adopted here as the gold standard and real value to be achieved. Thus, the values predicted by our solution showed a good fit with the target values. #Paper 02: The SSM platform can provide reliable results associated with HRV metrics and therefore healthcare professionals can incorporate this platform during the remote monitoring process of their patients for HRV follow-up. #Paper 03: An increase in HRV values in parasympathetic indices was observed mainly among women aged 70 to 79 years, indicating that, in this period, among females, there is an increase in vagal activity, a cardioprotective mechanism against cardiovascular problems. We also highlight the strong correlation found between HRV and HRV in both men and women, however, when observing the correlation between average HR and HRV, the correlation becomes weak in the men's group, however, it remains strong in the women's group.

Introduction: nasal inspiratory pressure (SNIP) and nasal expiratory pressure (SNEP) tests are important methods used to assess inspiratory and expiratory muscle strength in different populations. Precision rehabilitation requires that the tests used to assess respiratory pressures are reliable and reproducible. Low reliability and reproducibility methods cannot be presented as an evaluation alternative. The reliability and reproducibility of SNIP and SNEP in adults are still unknown. Objective: to establish the reliability of the SNIP and SNEP tests in healthy young adults and discuss the necessary number of maneuvers for each test to obtain reproducible data. Methods: an observational analytical cross-sectional study was carried out with healthy individuals, of both sexes, between 18 and 29 years of age. The protocol used consisted of two evaluation sequences, according to the simple randomization of the tests. Sequence 1 - (PImax + SNIP 1-20 ) and (MEP + SNEP 1-20 ). Sequence 2 - (PEmax + SNEP 1-20 ) and (PImax + SNIP 1-20 ). Each volunteer performed 20 SNIP and SNEP tests with a 30-second interval between maneuvers. Reliability was measured using the intraclass correlation coefficient (ICC), standard error of measurement (SEM) and the minimum detectable change (MDC) between the highest measurement and the first reproducible maneuver. Results: 49 participants were recruited, of which 17 were excluded. The sample of this study consisted of 32 subjects, median age of 23 years, with equal distribution of men and women. The ICC SNIP in both sexes was 0.992. Men had SEM 2.074 and MDC 5.747. Women had SEM 1.152 and MDC 3.193. Considering the total sample, the ICC was 0.994 with SEM 1.820 and MDC 5.043. The ICC SNEP was 0.877 in men (SEM 7.660 and MDC 21.231) and 0.957 in women (SEM 6.115 and MDC 16.950). Considering the sample, the CCI was 0.950 with SEM 6.031 and MDC 16.716. Also, 60% of the highest SNIPs occurred among the 11th and 20th maneuvers in men and women. In men, 55% of the highest SNEPs occurred among the 11th and 20th maneuvers; this value was 50% in women. Conclusion: SNIP showed excellent reliability in both sexes. SNEP presented good reliability in men and excellent in women. The results show that SNIP and SNEP are reliable and reproducible and can be applied in different populations.

Background: Therapeutic exercise has been the primary intervention in managing
clinical and functional repercussions for individuals with rotator cuff tendinopathy
(RCT). Resisted exercises, both eccentric and concentric, have proven effective in
improving overall shoulder function. However, few studies have been conducted to
evaluate the effects of isometric exercise on pain, function, and neuromuscular
control in individuals with RCT. Additionally, there remains uncertainty about the
extent to which Brazilian physiotherapists are employing resisted exercises in
rehabilitating patients with RCT. Consequently, this doctoral thesis consists of two
studies. Objectives: Study I - To investigate the effects of an isometric exercise
protocol for the muscles of the rotator cuff, combined with stretching and
strengthening exercises for scapular muscles, on shoulder pain and function,
muscle strength, and electromyographic (EMG) activity of the rotator cuff and
shoulder muscles in individuals with RCT. Study II - To investigate the utilization of
therapeutic exercises by Brazilian physiotherapists in managing RCT. Methods:
Study I: Characterized by a case series of eleven individuals (8 women and 3 men,
aged 37.9 ± 5.6 years) diagnosed with RCT, who underwent isometric MR
exercises combined with stretching and strengthening of the scapular muscles over
a period of 6 weeks. Treatment effects were assessed based on patient-reported
shoulder pain and function, isometric muscle strength, EMG activity during arm
elevation and shoulder internal and external rotation, as well as pain during arm
elevation before and at the end of the first session and after 6 weeks of intervention.
Study II: An online survey with Brazilian physiotherapists. The survey comprised a
combination of 62 open and closed-ended questions, divided into three sections:
participants' demographic data, professional experience, and clinical practice in the
rehabilitation of patients with RCT. Results: Study I: Following six weeks of
intervention, there was a reduction in resting pain by 1.72 points (CI = -2.99 -0.44,
d = 1.20), during normal activities by 3.80 points (CI = -5.72 -1.88, d = 1.76), and
during strenuous activities by 3.10 points (CI = -5.02 -1.18, d = 1.44), assessed by

the Penn Shoulder Score. Improvement in shoulder function was observed as
measured by the Penn Shoulder Score (MD = 15.7, CI = -27.3 -4.1, d = 1.29) and
the Western Ontario Rotator Cuff Index (MD = 410.9, CI = -76.0 -58.8, d = 0.46)
after 6 weeks of intervention. There was an increase in isometric muscle strength
for arm elevation (MD = 3.24BW%, CI = 0.17 6.31, d = 0.45) and internal rotation
(MD = 3.98BW%, CI = 0.31 7.65, d = 0.49), increased muscle activity of the
infraspinatus (MD = 8.6%, CI = 1.30 15.90, d = 0.51) and serratus anterior (MD =
12.1%, CI = 4.34 17.86, d = 0.60), along with a reduction in pain during arm
elevation (MD = 1.99, CI = -3.64 -0.33, d = 0.33). No changes were noted after the
first intervention session. Study II: A total of 159 physiotherapists participated in the
survey, with 76% reporting a specific interest in shoulder rehabilitation. The majority
of physiotherapists advocated for isometric exercises (69.9%) in the initial
rehabilitation phase and eccentric exercises (47.4%) in the advanced phase.
However, substantial variability was observed in determining exercise volume,
particularly concerning isometric exercises. In establishing and progressing
exercise loads, most physiotherapists took into account patient pain and comfort,
irrespective of exercise type, and reported that they would not cease exercises in
case of pain during the early and late rehabilitation phases, despite pain being
considered the primary adverse effect of exercise and a discharge criterion. A
majority (48.4%) recommended weekly reassessment and modification of
exercises. In addition to resistance exercises, physiotherapists also advocated for
various other exercises and techniques in both the initial and advanced stages of
rehabilitation. Conclusions: The case series demonstrated that a protocol involving
isometric MR exercises combined with stretching and strengthening of the scapular
musculature may improve shoulder pain, isometric strength, as well as function and
electromyographic activity of the infraspinatus and serratus anterior muscles after a
6-week intervention period. Our online survey revealed that the majority of Brazilian
physiotherapists incorporate MR strengthening exercises into their rehabilitation
programs. Despite some consensus gaps, our findings suggest that the clinical
practice of Brazilian physiotherapists is in line with current literature and practices
observed in other countries.

Introduction: With the population aging, the prevalence of diseases that lead to functional impairment of the elderly increases, generating the need for a caregiver, a role normally performed by a family member, that is, informal. Among the diseases that can even lead to functional disability, we have dementias, the most common being Alzheimer's Disease (AD). The HCoV is responsible for causing the disease COVID-19, being characterized by the WHO, in March 2020, as a pandemic. Thus, social isolation measures were taken, making this care for the elderly with AD even more difficult. Objective: To verify the relationship between the total score of the Caregiver Burden Scale (CBS) and each of its dimensions and the 1) characteristics of caregivers, 2) of the care provided and 3) of the characteristics of the elderly with AD in the context of the COVID-19 pandemic. Method: An analytical cross-sectional study was carried out with 40 primary caregivers of elderly people with probable AD treated at the Centro Especializado de Atenção à Saúde do Idoso (CEASI), in the city of Natal/RN, Brazil, from March 2020 to March 2021. To measure the subjective impact of the disease on the primary caregiver, the CAREGIVER BURDEN SCALE (CBS) was applied, an instrument composed of 22 questions, grouped into five dimensions (General Tension, Isolation, Disappointment, Emotional Involvement, and Environment), with the highest subjective impact the higher the scores. Simple descriptive and inferential analyzes were performed using Student's T-tests and ANOVA, followed by Tukey's test and Pearson's Correlation Coefficient (r), α=0.05. Results: Most caregivers were female (95.0%), with a mean age of 52.85 years and a standard deviation (SD) of 11.23. The sample of patients had a female majority (85.0%), with a mean age of 83.60 years and SD of 7.63. Regarding caregiver characteristics, there was a significant negative correlation only between the Environment dimension and age (p=0.010; -ρ = 0.405). There were significant relationships between the Emotional Involvement dimension and the variables related to the caregiver: marital status (p=0.008), work or study abroad (p=0.042), perform tasks such as helping with hygiene (p=0.044), and dressing (p=0.044). p=0.036); and between the Environment dimension and the time dedicated to the elderly (p=0.009). Regarding patient characteristics, there was a significant negative correlation between the Emotional Involvement dimension and age (p=0.018; ρ= -0.372) and the number of activities involved (p=0.023; ρ= -0.0360). There was a significant relationship between the Isolation dimension and the patient's marital status (p=0.006). Conclusions: In the context of the COVID-19 Pandemic, the subjective impact on the caregiver of elderly people with probable AD was considered relevant. The most affected dimension of CBS was Emotional Engagement younger caregivers, who do not help with hygiene and dressing, with less time of dedication, who work or study abroad, and single/divorced had higher scores in the CBS dimensions. These are also higher when patients are married/stable union, and the younger the patient the lower the number of compromised activities of the same. Such knowledge allows directing interdisciplinary guidelines and strategies in care and therapies, to minimize the difficulties and quality of life of all those involved.

Introduction: Cognition is a bodily function that decreases with aging and its alterations are characterized by impairment of memory, judgment, language and attention. It can occur due to neurodegenerative, vascular and dysthymia/dysphoria problems. Reduced cognitive abilities can affect physical performance, functionality and social and occupational activities, and can be a marker of dementia, being a critical clinical condition for the elderly and a growing challenge to global health. Objective: To assess the relationship between cognitive impairment and physical performance in community-dwelling elderly. Methods: This is an observational, analytical and cross-sectional study, composed of community elderly, residents in the municipality of Parnamirim (Rio Grande do Norte), aged ≥ 60 years. Sociodemographic and anthropometric data were collected, as well as data on comorbidities, cognitive deficit and physical performance, through the Elderly Health Handbook, the Leganés Cognitive Test (PCL) and the Short Physical Performance Battery (SPPB). In the statistical analysis, the normality of the variables was assessed using the Kolmogorov-Smirnov test. Student's t-test and chi-square test were performed to compare elderly people with low and good physical performance in relation to the mean of PCL and covariates. A logistic regression analysis was performed to identify all factors associated with poor physical performance. Results: 760 elderly people were evaluated, with a mean age of 70.18 (±7.11) years old. The cognitive function obtained a mean score of 25.35 (±4.30). As for physical performance, an average of 9.74 (±2.26), of which 85%, was classified as good performance. There was a statistically significant association between cognitive impairment and physical performance (p<0.001). The covariates that were related to physical performance were PCL score (p = <0.001), cognitive function (p = <0.001), age (p = <0.001), sex (p = <0.001), psychotropic drugs (p = 0.001 ), diabetes mellitus (p = 0.040) and stroke (p = 0.036). Predictive factors for decline in physical performance were age (p = <0.001), female gender (p = <0.001), use of psychotropic drugs (p = 0.025), diagnosis of diabetes mellitus (p = 0.028) and the presence of cognitive deficit (p = 0.001).

Background: Treadmill training has been widely used for gait rehabilitation in individuals after stroke. However, there’s still a shortage of aerobic training protocols on an inclined treadmill, which analyze the safety related to the cardiovascular and functional impact of this training in this population. Objective: To evaluate the cardiovascular and functional repercussions of a treadmill training protocol at different inclines in individuals with chronic stroke. Methodology: Randomized clinical trial, in which 26 individuals with chronic stroke were randomized into a Control Group (CG) - which performed gait training on a treadmill without incline, Experimental Group 1 (EG1) - which performed training on a treadmill with 5% anterior incline and Experimental Group 2 (EG2) - which performed training on a treadmill with 10% of anterior incline. In all groups, training sessions lasted 30 minutes, with a frequency of 3 times a week for 6 weeks, totaling 18 sessions. Participants were evaluated immediately before, during and after each training session regarding cardiovascular parameters, obtaining the following outcomes: heart rate [HR], blood pressure [BP], metabolic equivalents [METs], double product [SD]; in addition to measures of internal load: perceived exertion [PE] and muscle fatigue [FM]. In each session, functional variables were evaluated: gait speed and distance covered on the treadmill. In article 1, functional and cardiovascular data from the 1st, 9th and 18th sessions were compared between groups using Mixed Analysis of Variance with repeated measures (α=5%). In article 2, descriptive statistics were used to verify the behavior of cardiovascular parameters in each session, and mixed analysis of variance with repeated measures were applied to compare the groups in each session regarding these parameters (α=5%). Results: In article 1, no time*group interaction was observed in any of the cardiovascular outcomes (HR and BP), as well as for the functional outcomes. Regarding the BP variable, there seems to have been an effect of time over the training sessions (F=3.482; P=0.040). A similar effect of time could be observed in relation to the outcomes of gait speed and distance covered (F=21.618; P<0.001; F=22.402; P<0.001). Perceived exertion and muscle fatigue were not different between groups. In article 2, no time*group interaction was observed in the SBP, DBP and HR variables, with no difference between the groups in each training session. Regarding the SBP and DBP variables, there seems to have been an effect over time in some training sessions; of SBP in sessions 9 (P=0.027); 15 (P=0.027) and 18 (P=0.027) and DBP in sessions 4 (P=0.026); 5 (P=0.014); 9 (P=0.005); 12 (P=0.022); 14 (P=0.008) and 17 (P=0.038). Conclusion: Training performed with increased intensity from the anterior incline of the treadmill was not different from training without incline, in relation to cardiovascular and functional parameters seen during training. The control group performed training on a treadmill with light intensity (62% of HRmax) and the experimental groups performed training on a treadmill with moderate intensity (both with 69% of HRmax), with inclines of 5% and 10% being safe and replicable for the rehabilitation of individuals with chronic stroke.

Scientific and clinical evidence points to a persistent impairment of functional capacity in post-COVID-19 individuals, however the cause of functional limitation and symptomatology still need to be elucidated. Thus, the objective of this study was to evaluate and compare functional capacity in post-Covid-19 patients versus a control group, in addition to analyzing cardiac hemodynamics and tissue muscle oxygenation response during the assessment protocols in both groups. This is a cross-sectional study in patients diagnosed with COVID-19 who were hospitalized or not, older than 18 years of both sexes compared to a control group. We used two functional tests for performance analysis and comparison: the 6-minute walk test (6MWT) and the 1-min sit-and-stand test (1-STS). In addition to the performance variables, heart rate, peripheral O2 saturation and symptoms (dyspnea and fatigue), we evaluated the cardiac hemodynamic response by impedance (systolic volume, stroke volume index (SVi), cardiac output, cardiac index (CI), Systemic Vascular Resistance (SVR), Systemic Vascular Resistance Index, Ejection Fraction (EF), End Diastolic Volume, Ventricular Filling Time and Contractility Index (TCI)) during the 1-STS protocol. Tissue perfusion responses to vastus lateralis muscle oxygenation (oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb), total hemoglobin (tHb) and tissue saturation index (TSI)) were recorded before, during and after two minutes (recovery) in both tests. For data analysis, we used the statistical program GraphPad Prism 8.0 with significance levels p<0.05 and a confidence interval of 95% and for the intragroup comparisons of the variables, we performed the Friedman test while in the Mann-Whitney intergroup comparisons. Thirty-six patients were included in the study, 13 (36.11%) women and 23 (63.88%) men, with a median age of 36.00 (29.00-51.00) years old and with a BMI of 26. 51(24.06-30.32) in the post-COVID-19 group and 11 individuals in the control group, 8 (72.72%) women and 3 (27.27%) men, with a median age of 25.00(23) .00-39.00) years and with a BMI of 23.71(22.54-28.28). When comparing the groups, the post-COVID-19 group showed a 20% reduction in performance versus control in the distance covered in the 6MWT (p=0.0001) and of 28% in the number of repetitions of the 1-STS (p=0.01 ). Furthermore, there were intergroup differences in cardiac hemodynamics variables during the 1-STS protocol, where the post-COVID-19 group showed a reduction of 18% in VSi (p=0.004), of 21% in CI (p=0.0009), of 78% in ICT (p=0.0001) and 29% in EF (p=0.0003) and an increase in SVR by 25% (p=0.03) and 27% in RVSi (p=0, 0007). Despite the lower functional performance, the tissue oxygenation variables during the 6MWT and 1-STS tests and in the recovery phase showed responses of similar magnitude between people with COVID-19 and healthy controls, with no statistically significant intergroup difference in the variables studied. Thus, our results suggest that the post-COVID-19 group, when compared to uninfected subjects, present (I) a reduction in functional capacity identified by both tests, by 28% in the 1-STS and 20% in the 6MWT, (II) changes in the Cardiac hemodynamic responses and systemic vascular resistance (III) similar pattern of muscle oxygen supply and consumption in both tests similar in both groups. We suggest that a study with a larger sample size and stratification of groups post COVID-19 to complement these findings.

Objective: To investigate the risk of developmental delay in infants born to mothers exposed to the COVID-19 pandemic. Method: This cross-sectional study was conducted with 54 infants of both sexes aged between 1 and 12 months. Twenty-seven infants born to mothers diagnosed with COVID-19 during pregnancy between March and November 2021 composed the COVID pandemic group. Control group included infants evaluated before pandemic. Neonatal and prenatal data were extracted from medical records and child health booklets. Screening for risk of developmental delay was performed using the Survey of Wellbeing of Young Children during a phone interview or home visit. Chi-squared, Mann-Whitney test, and binary logistic regression were applied. Results: The risk of motor developmental delay was identified in 15 infants (12 in the COVID pandemic group), and 36 were at risk of behavioral alteration (22 in the COVID pandemic group). Regarding families of infants of the COVID pandemic group, 63% of mothers were at risk of depression, 51.9% were at risk of substance abuse, 40.7% of food insecurity, and 7.4% of domestic violence. Infants from mothers exposed to the COVID-19 pandemic during pregnancy increased up to 6.3-fold the risk of motor developmental delay. Motor developmental delay was significantly associated with socioemotional alterations (odds ratio = 6.4, p = 0.01). Inflexibility was a statistically relevant variable for socioemotional impairments. Conclusion: The environmental context lived by the mother, such as prolonged social isolation and psychosocial vulnerability, may negatively impact motor and socioemotional development of infants.

Covid-19 is a disease a multisystemic, inflamatory caused by the coronavirus, what affects mainly the respiratory and cardiac systems, causing respiratory distress syndrome, which consequently alters the physiological signs, usually identified late, increasing the risk of cardiorespiratory arrest and even death. Thus, there are instruments that can assess vital signs in the face of imminent risk. NEWS was developed as an easy-to-apply tool with the objective of standardizing and standardizing the assessment and response to deteriorating patients in view of the physiological signs presented during the assessment. Objective: the primary objective is to evaluate the predictive capacity of the National Early Warning Score (NEWS) for stratification of severity risk at admission of patients diagnosed with covid-19, in addition to analyzing physical therapy clinical decision-making based on this score. Method: the present study is cross-sectional, retrospective and analytical, exploratory of medical records of inpatients in a field hospital facing Covid-19. The sample will consist of physical/electronic medical records of patients who were regulated and admitted to Hospital Solidário, with a minimum age of 18 years, of both genders, with signs, symptoms and clinically diagnosed and with positive rapid testing for covid-19, referred and admitted to the field hospital, who underwent physiotherapeutic interventions, from June to October 2020. The exclusion criteria will be: patients in palliative care or surgical cases, acute stroke, COPD and exacerbated asthma. To the collection, data will be accessed from the electronic medical record system (TiMed) and a data collection form composed of blocks with the variables of interest: demographic data, admission and hospital stay, epidemiological data, variables and physiological parameters measured in the NEWS score and the indicated physiotherapeutic decision making. The main outcome variables will be analyzed and will be taken in terms of the NEWS severity risk score and their relationship with the physiotherapeutic clinical decision making. 195 medical recorders were indentifided with NEWS assesssment in the patients, however 21 were excluded by COPD acute, ageded 61yr (61,37±19,9), 59,9% men, sistolic hypertention (39%) and cardiovascular disease were (8,9%) the most commun, by the NEWS score, 30,5 and 26,4% of patients presented mediun and high risk respectively of having acute deterioration, beeing the respiratory rate and oxigen peripheral saturation the signs more affected. The NEWS was positively associated with oxigen supplemantation (p=0,005) and no invasive ventilation (p=0,035) by the physioterapist team in patients with low risk. 

Introduction: Several validated instruments are available to assess asthma control, all in a traditional format, with the purpose of assisting in the care and management of the disease. However, measuring instruments in online format and others also available for mobile devices are becoming more in clinical practice. For the Brazilian population, electronic questionnaires are not yet available to assess asthma control in children and adolescents. The electronic format allows remote and simple care for the disease to be guaranteed. Objective: To analyze the psychometric properties for validation in electronic format of the Pediatric Asthma Control and Communication Instrument – e-PACCI. Methods: This study followed the recommendations of the Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN). Reliability measures (internal consistency and test-retest), correlation tests for criterion validity (PACCI x e-PACCI) and construct validity (e-PACCI x Pediatric Quality of Life InventoryTM Asthma Module – PedsQLTM Asthma Module) were analyzed. The Statistical Package for the Social Science (SPSS) software, version 22.0 was used for data analysis. Results: The sample consisted of 62 participants, parents of children and adolescents with asthma. They answered the questionnaires in the interview and electronic format, whose sequence was randomized, respecting an interval of 14 days between assessments. Reliability measures indicate adequate internal consistency (Cronbach's α = 0.84) and good agreement in the ICC test-retest: 0.87 (0.81-0.91) (p= 0.00). The Spearman correlation test indicates a moderate correlation for the asthma control domain when correlating the traditional version with the electronic version r= 0.52 (p = 0.00), for the electronic version and the concern domain of the PedsQLTM Asthma Module was also found moderate correlation r= 0.63 (p = 0.00) and weak correlation with the domain treatment problems r= 0.28 (p = 0.02). Conclusion: The electronic format of the PACCI questionnaire has reliable and valid psychometric properties to be applied to the population of interest.

Introduction: One of the consequences of aging is elder abuse. The types of abuse include financial, psychological or emotional, as well as physical, this has serious consequences for public health systems and a high risk of mortality for the elderly. Objective: To describe the prevalence of financial abuse in the elderly and its impact on mobility. Materials and methods: This is an epidemiological multicenter longitudinal study. The sample will be composed of individuals of both sexes aged between 65 and 74 years, residents of the cities surveyed. In Tirana, Manizales and Natal, a random sample of elderly people registered in primary health care units will be used; in Kingston and Saint-Hyacinthe, data from participants who received a letter from their family physicians, inviting them to contact the research field coordinator will be used. During data collection, individuals are evaluated using instruments to measure violence, socioeconomic status, health conditions and mobility limitations. Data will be analyzed using the Statistical Package for the Social Sciences Software - SPSS version 20.0 tool and for all analyses, a p≤0.05 will be considered. Results: The prevalence of financial abuse varies between cities, being lowest in Saint-Hyacinthe and Kingston and highest among women in Natal and Tirana. Adjusting for age, sex, education level, and research city, those who reported financial abuse had greater mobility impairment (β= 0.08; 95% CI: 0.31; 0.88). Those residing in Kingston had better mobility scores (β= 0.12; 95% CI: 0.10; 0.28). The effect of financial abuse on mobility was mediated by chronic conditions and symptoms of depression. Conclusion: Financial abuse and adverse factors contributes to negative outcomes in the mobility of the elderly.

Shoulder pain is a multifactorial origin symptom that may be related to structures that are part of the kinetic chain. The general objective of this thesis is to analyze the relationships between the shoulder and the kinetic chain referring to joint mobility, muscular endurance and neuromuscular control of individuals with and without shoulder pain. The study included 102 sedentary or irregularly active individuals (51 with and 51 without shoulder pain). The range of motion (ROM) and the time of muscular resistance of the cervical, thoracolumbar and hip spine, and the neuromuscular control of the lower limbs were evaluated using the Star Excursion Balance Test - SEBT. The results are presented in three studies: 1 - Motor alterations in the kinetic chain in individuals with chronic shoulder pain; 2 - Evaluation of joint mobility and muscle resistance of the cervical spine and its discriminative capacity for shoulder pain; and 3 - Factors related to resistance of periscapular muscles in shoulder pain. Study 1 found that, in general, individuals with shoulder pain presented a lower ROM in all movements evaluated, reduced resistance time of the thoracolumbar and hip spine muscles; and lower neuromuscular control of the lower limbs on the ipsilateral and contralateral sides to pain. A greater pain perception was observed in individuals with pain during all evaluations of ROM and muscle endurance. In addition, neuromuscular control in the anterior range of the limb contralateral to the painful shoulder presented excellent ability to discriminate individuals with shoulder pain. In study 2, a reduction in ROM and resistance time of cervical spine muscles was observed, with increased pain perception of the evaluated regions. Mobility in contralateral cervical flexion and rotation and resistance of ipsilateral lateral flexors demonstrate acceptable ability to discriminate individuals with shoulder pain. In study 3, a positive correlation was observed between the resistance of the periscapular muscles and kinetic chain muscles (spine and hip). The resistance of cervical extensors, thoracolumbar extensors, bilateral hip abductors, and contralateral hip extensors to shoulder pain explained the variation in resistance of the periscapular muscles. Age, time and intensity of pain, shoulder function and resistance of thoracolumbar lateral flexors and flexors did not present significant correlation with resistance of periscapular muscles. Our results show the importance of analyze the elements of the kinetic chain in the physical therapy approach of individuals with chronic shoulder pain, determining that factors such as central sensitization and regional interdependence may interfere in these biomechanical interrelationships.

Anterior cruciate ligament (ACL) rupture and knee osteoarthritis (KOA) are the most prevalent musculoskeletal disorders of the knee. Rehabilitation with progressive training is recommended for both disorders. Rating of perceived effort (RPE) is used to prescribe, assess, and control exercise load. However, the lack of detailed methodological description and the variability in the use of the PSE may hamper its validity. This review summarizes the methodological aspects of using RPE in resistance exercise during ACL maintenance and KOA rehabilitation. This scoping review was developed following the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement for Scoping Reviews extension. The search was performed in Medline/PubMed, Embase, CINAHL, PEDro, Central and SPORTDiscus databases. The terms “rehabilitation of the anterior cruciate ligament of the knee”, “osteoation of the cruciate ligament arthrosis- Two review reviewers are independent in the selection of titles and evaluation titles and evaluation of independent full-text manuscripts. Data related to study design, sample, intervention characteristics and RPE results were extracted, summarized and qualitatively. Methodological aspects such as “scale type”, “terms” and “exercise intensity” are frequently reported (75%-87% of studies). However, “familiarization”, “anchoring”, “instructions”, “estimate x production paradigm”, “local x global PSE” and the “registration moment” are poorly known (maximum of 22% of the studies). The description of the use of RPE in ACL-R and KOA rehabilitation studies is poor. Methodological aspects should be better reported to ensure standardization, improve the validity of the scale and allow for the reproduction of the study.

Background: The assessment and routine monitoring of asthma control are essential aspects for an adequate management and treatment of the disease, especially in childhood and adolescence. Despite the existence of adapted questionnaires to assess asthma control in the Brazilian pediatric population, these have limitations mainly related to the lack of structural adequacy for its applicability in different age groups from childhood to adolescence. Objectives: To provide novel instruments for assessing, supporting, and monitoring pediatric asthma control for Brazilian population. Methods and results: Three studies were carried out, resulting in 5 papers (1 published, 3 for immediate submission after implementing the suggestions provided the committee and 1 manuscript for further finalization). Study 1 comprises a systematic review of measurement properties of existing measures for asthma control assessment. The methods of this study followed the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). This review summarizes 79 studies, covering 39 instruments. Study 2 comprises the process of translation, cross-cultural adaptation, and evaluation of the measurement properties of the Pediatric Asthma Therapy Assessment Questionnaire (ATAQ) for the Brazilian population. This study was conducted according to international recommendations. The translated questionnaire, considering its instructions, items and response options, was considered adequate by the multidisciplinary committee of experts (Fleiss’ kappa > 0.70) and by the target population (30 parents/caregivers of children or adolescents with asthma between 5 and 17 years). The Brazilian version of the ATAQ presented evidence of validity and reliability investigated in a sample of 118 participants. Study 3 comprises the development and content validation of an electronic system for the Assessment, Support and Monitoring of Asthma (e-ASMA), which includes measurement instruments in health (questionnaire and diary) in three versions to children, adolescents and parents/caregivers and the prototype of a mobile app. The development and analysis of the content validity of these instruments were performed according to COSMIN. Focus groups were held with representatives of the target population (5 children, 5 adolescents and their parents/guardians) to build the theoretical conceptual model and support the generation of items. The systematic review carried out in study 1 allowed the identification of 229 items and of these, 36 items were initially listed as relevant to the questionnaire and 14 items to the diary. Subsequent refinement steps resulted in the generation of 32 items for the questionnaire and 5 items for the diary that were later analyzed, modified, and approved by a panel of experts (n=6), resulting in the exclusion of 12 items. In sequence, these items were administered through in-depth interviews with a sample of 10 children (7-11 years) and 6 adolescents (12-18 years) and 21 parents/guardians, of which 6 parents/guardians for children aged 4-6 years. Conclusions: The systematic review identified that several measurement instruments were developed to assess asthma control in limited age ranges. These instruments use different response scales, and most were mostly developed in English. The Brazilian version of the ATAQ is cross-culturally adapted and presents evidence of validity and reliability for Brazilian Portuguese. The versions of the questionnaire and diary that comprises the e-ASMA system showed evidence of content validity. The studies that comprise this thesis can guide future research related to the control of pediatric asthma, and additionally, support the investigation of others measurement properties of the proposed instruments for the e-ASMA and its prototype.

Introduction: Population growth and aging is a global phenomenon that affects all countries in the world and has repercussions on social assistance and protection, in addition to the organization of health systems. Population aging, the epidemiological transition, the reduction in mortality rates, especially among the older adults over 80 years of age, changes in family structures and the increase in functionally dependent older adults demand the need to establish long-term care for the elderly. In this scenario, there is a growing demand for Nursing Homes - NHs, which have a high prevalence of physical frailty and mortality. Objectives: to verify whether physical frailty and physical performance are predictors of mortality in the older adults in NHs through a five-year survival analysis. Methods: this is a five-year longitudinal study with the initial baseline collection of 133 elderly residents of ILPI in the State of Paraíba - Brazil. The study started in 2014 and data collection ended in 2019. In addition to data on physical frailty (Fried Frailty Syndrome) and physical performance (Short Physical Performance Battery), sociodemographic information and health conditions were collected. The relationship between physical frailty and physical performance with mortality was evaluated using Kaplan Meier Survival Curves and Cox Proportional Risk Regression models. A confidence interval (CI) of 95% and p < 0.05 was considered. Results: Of the 133 participants at baseline, 114 were evaluated during the follow-up of the study. Of these, 41.22% died by the end of the cohort. The main results of Article 1, entitled “How does the physical frailty phenotype predict mortality in older adults in nursing homes? A 5-year survival study” showed that life expectancy among the non-frail older adults was significantly higher, with a mean survival of 7.5 months longer compared to the frail older adults (49.1%) (p = 0.01). There was a 36% increase in the risk of dying (adjusted HR 1.36; 95% CI 1.02 - 1.68; p=0.03) for each additional point on the Fried frailty count, and frail subjects had a 2.1-fold increased risk of dying. compared with non-frail subjects (adjusted HR 2.01; 95% CI 1.11 - 3.62; p=0.02). The main results of Article 2, entitled “Physical performance as a predictor of mortality in nursing home residents: A five-year survival analysis”, found that 61.40% of the participants had low physical performance. Low physical performance increased the chance of dying by 2.77 times (adjusted HR 2.77; 95% CI 1.38 – 4.83; p < 0.001). Low performance on the gait speed test also represented a 2.58-fold increased risk of dying (adjusted HR 2.58; 95% CI 1.38 - 4.83; p < 0.01). The survival time of the older adults with low physical performance was significantly shorter, with a mean survival of less than 12 months in relation to the mean survival time of the older adults with better physical performance (p < 0.01). Conclusion: The results of this study showed that both physical frailty and low physical performance can predict the mortality of older adults in nursing home residents over five years.

Introduction: The decline in physical performance of lower limbs is one of the main factors responsible for the increase in falls and disabilities in the elderly population. The literature points out that there are several factors associated with the decline in physical performance, such as physical inactivity, obesity, and advanced age. However, there are still gaps regarding the relationship between women's urogynecological and obstetric history and their relationship with the physical performance of lower limbs. Objective: To analyze the relationship between variables of urogynecological and obstetric history and the physical performance of lower limbs in middle-aged and elderly women. Methods: Analytical, observational, cross-sectional study conducted in the municipality of Santa Cruz and Parnamirim-RN. The sample consisted of women from the community, between 40 and 80 years old. Participants were assessed for socioeconomic and demographic aspects, clinical evaluation (BMI and comorbidities), urogynecological and obstetric history, and physical performance of the lower limbs (Short Physical Performance Battery (SPPB), flexion strength, and knee extension). In the statistical analysis, the normality of the data was verified using the Kolmogorov-Smirnov test. To assess the relationship between the independent variables and the physical performance variables, Student's T-tests and Analysis of variance were used, in addition to Pearson's correlation. Linear regression analyzes were performed to observe the relationship between urogynecological and obstetric history and physical performance of lower limbs, adjusted for covariates. The data were analyzed using the Statistical Package for Social Sciences (SPSS) software, version 22.0. Results: 581 women participated in the study, with a mean age of 54.8 ± 9.4 years. The only variable with a urogynecological and obstetric history that was associated with physical performance of the lower limbs was the number of deliveries for the variables knee extension (β= -0.41; p= 0.009) and SPPB (β= -0.08; p= 0.002). Conclusion: The factors associated with the worse physical performance of lower limbs were age, family income, stable union, physical activity, and a number of deliveries, the latter being the only pelvic health variable that was associated with the worst performance of lower limbs.

Exercise-induced muscle damage (DMIE) occurs when the individual performs unusual or very intense physical activities, being characterized by loss of strength and range of motion, delayed muscle soreness, swelling and increased creatine kinase concentrations, which can generate performance reduction. Among the techniques used to reduce the effects of muscle damage, blood flow restriction (BFR) has been used both before DMIE, as ischemic preconditioning (IPC), and after. However, the effects of BFR in the attenuation of muscle damage are still controversial in the literature, with studies showing improvements in the attenuation of the damage and in the recovery process, while others demonstrate that there is no difference compared to the control or the sham group. Objective: The objective of this review was to systematically analyze the evidence on the effects of passive blood flow restriction performed before or after exercise in the attenuation of muscle damage. Methods: This systematic review was conducted in accordance with the PRISMA recommendations. Two researchers independently and blindly searched the electronic databases: National Library of Medicine (PubMed), Scopus, Web of Science, SPORTdicus, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Pedro and Clinicaltrias.gov. Randomized clinical trials, published in English until January 2021, with samples composed by humans and that evaluated the effects of passive blood flow restriction performed before or after exercise on DMIE measurements. The risk of bias assessment was performed using the RoB2 tool. Results: After reading titles, abstracts and full texts, a total of 12 papers (4 papers using the RFS before DMIE and 8 with use after) published between 2012 to 2021 were eligible for this review, comprising 221 individuals (213 men and 8 women). Delayed muscle soreness, perceived exertion and perceived recovery and serum creatine kinase levels were the most used variables to measure DMIE. The damage protocols were quite varied, as were the variables used to verify the effects of the RFS on the DMIE and the protocols used in the RFS and sham. In addition, most studies had methodological quality with some concerns, indicating that the studies had considerable methodological bias. Conclusion: The studies present many methodological differences, especially the type of exercise used in the damage, DMIE markers and protocols used to apply the RFS, some showing that the RFS can be an effective technique to mitigate the DMIE, while others show no difference of RFS compared to control or sham. It is suggested that new articles be made on the subject using better methodological qualities and protocols to generate DMIE with greater damage magnitudes.

Temporomandibular disorder (TMD) is a broad term that involves different clinical conditions that affect the 

temporomandibular joint (TMJ), masticatory muscles and adjacent structures. The main symptom of this 

dysfunction is local or diffuse orofacial pain, however, otological symptoms may also be present. Among 

otological symptoms, the most commonly associated with TMD is tinnitus. Objective: to evaluate the 

effectiveness of physical therapy modalities in individuals diagnosed with TMD associated with tinnitus, 

compared to other interventions, no treatment or placebo, in the intensity and impact of tinnitus; the 

intensity of pain in the masticatory and cervical muscles; disability and quality of life. Methods: this study 

will follow the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis 

Protocols (PRISMA-p). Controlled and randomized clinical trials that performed some physical therapy 

intervention with individuals over 18 years of age who have TMD associated with tinnitus will be included. 

The systematic electronic search will be carried out in the following electronic databases: MEDLINE, EMBASE, 

WEB OF SCIENCE, SCOPUS, PEDro and CENTRAL. There will be no restriction of language restrictions or 

publication date. As a primary outcome, the intensity and impact of tinnitus will be assessed. The stages 

of study selection, data extraction and risk of bias assessment will be carried out in pairs. The risk of bias

 assessment will follow the Cochrane Risk of Bias Tool and the level of evidence will be determined using 

the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Expected results: 

this systematic review is intended to identify, evaluate and summarize the current evidence on the

 effectiveness of physical therapy modalities in individuals with TMD associated with tinnitus. 

Thus, favoring the understanding and applicability of these interventions to clinicians, in addition to 

support future research on this matter.

Introduction: Amyotrophic lateral sclerosis (ALS) is a neuromuscular disease marked by progressive motor losses and consequent functional decline. In addition to functional weakness, these patients have a greater susceptibility to respiratory infections due to the UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE CENTRO DE CIÊNCIAS DA SAÚDE PROGRAMA DE PÓS-GRADUAÇÃO EM FISIOTERAPIA Av. Campus Universitário – Lagoa Nova - Natal-RN, CEP 59078-970 Telefax: (84) 3342-2003 E-mail: ppgfis@ufrn.br impairment of respiratory muscles. Because of these factors, these patients require evaluation and follow-up by a multidisciplinary team on a regular basis. With the Covid-19 pandemic in Brazil, this care routine was certainly interrupted leading to possible clinical and functional losses in these patients. Objectives: To observe functionality, disease progression rate, disease staging in addition to respiratory evolution in ALS patients by telemedicine during the Covid-19 pandemic in Brazil, comparing it to previous times. Methods: This is a case series type longitudinal study that followed 11 patients diagnosed with ALS from January 2019 to June 2021. During this period, 5 evaluations were performed: A1, A2, A3, A4 and A5, being A1 and A2 from January 2019 to March 2020 in a face-to-face manner pre-pandemic and A3, A4 and A5 from April 2020 to June 2021 by telemedicine. The A1 and A2 assessments relied on pulmonary function testing, respiratory muscle strength, functionality by ALS Functional Rating Scale-Revised (ALSFRS-R/BR) and disease staging according to the stages of the King's College system, where stage 1 reflects involvement of one area of the Central Nervous System (CNS), stage 2 the involvement of 2 CNS areas, stage 3 the involvement of 3 CNS areas, stage 4 is when the patient is on ventilatory support and/or gastrostomy and stage 5 corresponds to the patient's death. Assessments A3, A4 and A5 were performed remotely with clinical evaluation, questionnaire on the use of non-invasive ventilation (NIV), in addition to the ALSFRS-R scale and disease staging (King's College). We used the rate of disease progression to quantify the difference between the total ALSFRS-R score between assessments divided by the time (in months) between assessments and considered 0.77 as the cut-off point to characterize the speed of progression, where values above this point reflect a rapid speed of progression. Results: The eleven followed patients were 8 men (72.7%), with a median age of 51 (43-55) years, Forced Vital Capacity (FVC%predicted) of 69.6 (56.5-96.7) and Forced expiratory volume in the first second (FEV1%predicted) of 74 (55.8-89.2) A significant reduction in the total score of the ALSFRS-R scale was observed in functionality [X2 (4)= 22.01; p≤ 0.001], where assessments A4 and A5 differed from the pre-pandemic assessments (A1 and A2). A similar behavior was also observed in the motor domain of the scale [X2 (4)= 21.68; p≤ 0.001], with no modification in the respiratory domain. Moreover, the rate of progression showed a slow decline in 90.9% of patients, less than 0.77, and at the end of 14 months, 81.8% of patients presented this characteristic. As for respiratory evolution, 54.4% of the patients presented ventilatory support in A1 (King's College stage 4) and in the final evaluation (A5) 72.7% of the patients were on ventilatory support (King's College stage 4). Of the patients who did not have a prescription for NIV at the beginning of the study, 40% of them started ventilatory support by clinical decision after the A4 assessment. In addition, at the end of the study, 7 NIV devices were adjusted remotely. Conclusion: Telemedicine proved to be an auxiliary tool, able to remotely follow the functional evolution, the progression rate and adjustments in ventilatory support in patients with ALS. Moreover, it enabled an adequate control in a moment of limitation with social isolation due to the COVID-19 pandemic. We suggest that this model can be adopted whenever it does not impair the on-site evaluation of patients.

Background: Combining action observation (AO) and motor imagery (MI) training may induce greater brain activity in areas usually involved in Parkinson’s disease (PD) and lead to greater behavioral and neurophysiological effects than when used separately. Aim: To determine the effects of combining AO, MI, and gait training on balance and freezing of gait in individuals with PD. Methods: This randomized controlled clinical trial was conducted with 39 individuals with PD, divided into experimental (EG = 21) and control groups (CG = 18). EG performed 12 sessions of AO, MI, and gait training, whereas CG watched PD-related educational videos and performed 12 sessions of gait training. Balance (measured using the Mini Balance Evaluation Systems Test [MiniBESTest]) and freezing of gait (measured using the Freezing of Gait Questionnaire) were reassessed one day after the end of the intervention. Results: We did not observe significant intra- and intergroup differences in freezing of gait. For the EG, we observed a significant intragroup difference in the total score of MiniBESTest (F = 5.2; p = 0.02), and sensory orientation (F = 4.5; p = 0.04) and dynamic gait (F = 3.6; p = 0.03) domains. MiniBESTest domains were not different between groups. Conclusion: Combining AO, MI, and gait training was not more effective than isolated gait training for balance and freezing of gait in individuals with PD.

Industry workers are affected, with high frequency, by musculoskeletal diseases that can be related to work and that have pain as the main symptom. These diseases can lead to incapacity for work and absenteeism, which, in combination with the granting of social benefits, lead to an increase in public expenditure on social security and health. In this context, ergonomic interventions have been developed in the work environment in order to control the signs and symptoms of injuries that include Work-related Musculoskeletal Disorders (WMSD). For this Doctoral Thesis, two studies were carried out, whose objectives were: 1) To analyze the factors related to the granting of different types of benefits to workers impeded from working due to WMSD; 2) Investigate the effects of ergonomic interventions in the workplace to reduce the effects of pain on workers in the industry. Study 1 is a cross-sectional retrospective study with a quantitative approach. The data from the evaluation forms of the workers of the industry admitted to a Reference Center in Occupational Health because they were diagnosed with WMSD. Descriptive statistical analysis was conducted and logistic regression was used to estimate the factors related to the type of assistance granted to the worker. Were evaluated 108 medical records of industrial workers, where 56.5% received the aid for accidental illness (B-91). The majority in the sample are women (72.2%) from the industry with a light demand for work (95.4%) and the shoulder was the segment most frequently affected (85.2%). The factors related to the granting of social security sickness benefits: have undergone a dismissal exam (OR = 0.22) and previous work with exposure to chemical risk (OR = 0.21). For the granting of accidental sickness benefits: the time in the current occupation (OR = 1.01), work with flexion of the cervical spine (OR = 4.68), participation in the rehabilitation program of the National Institute of Social Security (OR = 31.27) and referral for consultation with specialists (OR = 3.10). Study 2 is a systematic review of controlled and randomized studies with meta-analysis. 15 studies involving 4,286 industry workers were included. There was a greater prevalence of the inclusion of physical exercises in the work environment that allowed moderate evidence for cervical pain control (-0.66; -1.12 to -0.20; p = 0.005) and strong evidence for control of shoulder pain (-0.84; -1.26 to -0.41; p = 0.0001) in industry workers with a light demand for work after this intervention. There was very poor evidence for cervical, lumbar and shoulder pain control for the inclusion of physical exercises in heavy industry. No positive results were finding in studies with ergonomic training, however, there were positive results in studies that modified the physical structure of the workplace. The insertion of physical exercises in the industrial work environment can reduce shoulder and neck pain in light industry workers. Is necessary to create institutional programs at industry and to implement public health and social security politics as strategy to control factors related to illness and the granting of benefits.

Background:

Individuals after a stroke present alterations in several physiological systems such as the musculoskeletal and cardiopulmonary systems. These systemic changes have important repercussions such as a significant reduction in the distance covered in the 6-minute walk test, respiratory function and in the distribution of lung volumes. These patients also show a reduction in their level of physical activity, which in turn leads to a negative impact on mobility, inability to perform activities of daily living and quality of life.

Cardiorespiratory training (CRT) is considered one of the means of improving cardiorespiratory capacity in this population, however, as it is a population that presents important changes in respiratory mechanics, the isolated use of CRT may be insufficient. Thus, the addition of the Proprioceptive Neuromuscular Facilitation (PNF) technique, which emphasizes stretching in the various diameters of the trunk would imply greater awareness and harmony of the functions performed by the trunk, focusing on the respiratory muscles of that individual, thus promoting an improvement in function respiratory capacity of these patients and helping to increase the cardiorespiratory capacity of these individuals.

Objectives:

a) Develop a randomized clinical trial protocol designed to verify the effects of adding PNF to a TCR on the respiratory function of post-stroke individuals;

b) To investigate whether changes in the volume of the rib cage (at rest and during inspiratory maneuver) in post-stroke patients are related to functional changes in the distance covered in the 6-minute walk test, respiratory muscle strength and lung function.

c) Evaluate the effects of the breathing and trunk patterns of Proprioceptive Neuromuscular Facilitation associated with cardiorespiratory training on quality of life, gait, distance covered, peak oxygen consumption, respiratory muscle strength, chest volumes, of individuals with post-stroke.

Materials and methods: Firstly, a protocol for the clinical trial was developed, with the evaluations and interventions to be carried out by the volunteers. It also established the eligibility criteria for subsequent studies. Individuals diagnosed with primary stroke for more than 6 months and with hemiparesis, of both sexes and aged between 21-65 years were evaluated regarding outcome measures measured by: Specific Quality of Life Scale - Stroke ( SSQoL); Maximum volume of Oxygen; 6-minute walk test (6MWT); Berg's Balance Scale (BBS); spirometry and manovacuometry; compartmental volumes of the rib cage with optoelectronic plethysmography. From the initial evaluations, a cross-sectional observational study and a clinical trial, randomized, blinded and with allocation confidentiality, were carried out, all developed at the Laboratory of Cardiopulmonary Physiotherapy Department of Physiotherapy at the Federal University of Pernambuco (UFPE). In the clinical trial, post-stroke individuals were randomized into four groups: Experimental LLLL (subjected to lower limb CRT associated with PNF); LLLL Control Group (submitted to LL CRT associated with breathing). Experimental UULL (submitted to upper limb CRT associated with PNF) and UULL Control Group (submitted to UULL CRT associated with breathing). The subjects were evaluated before and immediately after 20 sessions of the treatment program and one month after the end of treatment. For the four groups, the treatment program consisted of performing PNF breathing patterns or breathing, followed by 30 minutes of aerobic treatment and repetition of the respiratory part, being performed in 20 sessions, three times a week. The determination of the referral for the techniques was made by means random form, being maintained until the end of the intervention period. For therapy with the CRT, a cycle ergometer for lower or upper limbs was used, based on the criteria of the American College of Sports Medicine and constant monitoring of blood pressure, oxygen saturation, heart rate and perceived exertion. PNF patterns were performed in the sitting, supine, ventral and lateral positions. Breathing exercises were performed for the same time and in the same positions as the PNF.

Results:

Clinical trial protocol: Addition of proprioceptive neuromuscular facilitation to cardiorespiratory training in patients poststroke: study protocol for a randomized controlled trial (https://doi.org/10.1186/s13063-019-3923-1)

In the cross-sectional study, 17 volunteers were evaluated, aged 55 (7.5) years, 22 (17) months after stroke, 207 (119) meters covered in the 6MWT, and tidal volumes in quiet breathing and inspiratory capacity of 460 (160) and 1,790 (460) ml respectively. No correlation was found between the distance in the 6MWT and the volume distribution of chest wall at rest. During the inspiratory capacity maneuver, an increased abdominal volume was related to a shorter distance covered.

Sixteen individuals underwent training in the pilot of the clinical trial. The analyzes were performed using ANOVA of repeated measure LLLL with and without PNF. There was no significant difference between the groups of different interventions, except for compartmental volumes of abdominal and abdominal ribs in the lower limbs groups, in the control group. The values of Forced Expiratory Volume in the 1st second (FEV1) and FEV1 / Forced Vital Capacity in the upper limbs groups were significantly higher in the control group.

Conclusion - Individuals after stroke show a reduction in the distance covered on the 6MWT when there is an increase in the volume of the abdominal compartment.

The FNP and control groups showed similar behaviors in relation to functional, respiratory, and quality of life variables of the individuals in the sample.

BACKGROUND: Musculoskeletal disorders are common and can impair physical performance, physical function and quality of life. Among interventions that can be used in the management of musculoskeletal disorders, blood flow restriction (BFR) modalities have been gaining space in the scientific literature. AIMS: In general, the objective of this doctoral thesis is to investigate physiological aspects, prescription methods and clinical applications of different BFR modalities. METHODS AND RESULTS: BFR modalities considered were the BFR without concomitant exercise (passive BFR), pre-exercise BFR (ischemic preconditioning - IPC) and BFR combined with exercise. As musculoskeletal disorders, conditions that caused some type of functional impairment were considered. The present doctoral thesis consists of five chapters. Chapters 1 and 5 are, respectively, the background and final considerations of the thesis. Chapters 2, 3 and 4 consist of nine scientific articles involving four study models: systematic reviews (with and without meta-analysis), letters to the editor, narrative review and randomized clinical trials. Chapter 2 is a systematic review (article 1) on the effects of passive BFR to minimize losses of strength and muscle mass (disuse atrophy) in individuals subjected to unloading in the lower limbs. In chapter 2 we observed that although potentially useful, the high risk of bias presented in the original studies limits the indication of passive BFR as an effective modality against the atrophy following immobilization. Chapter 3 is a randomized and controlled clinical trial (article 2) that investigated the effects of IPC on protection against exercise-induced muscle damage in healthy people. Article 2 pointed out that PCI was not superior to sham to protect against exercise-induced muscle damage. Chapter 4 deals with physiological, methodological and clinical aspects of BFR combined with physical exercise. The first manuscript of chapter 4 (article 3) is a systematic review with meta-analysis that analyzed muscle excitation (by surface electromyography) during resistance exercise with BFR taken until. Article 3 indicated that muscle excitation during low load exercise with BFR was greater than low-load exercise without BFR only when muscle failure is not achieved. Additionally, low-load exercise with BFR showed less muscle excitation than high-load exercise, regardless of whether muscle failure was achieved or not. The second manuscript of chapter 4 (article 4) is a systematic review with meta-analysis that investigated whether the BFR pressure level influences the time to achieve voluntary muscle failure during a fatiguing task. In article 4 we showed that muscle failure is anticipated during low-load exercises with high-, but not low-BFR pressures. The third manuscript of chapter 4 (article 5) is a narrative review that discusses the possible need to adjust the BFR pressure over weeks of training. In article 5 we observed that the literature is contradictory and makes it difficult to recommend whether such adjustments in the BFR pressure are necessary. The last four articles of chapter 4 deal with resistance training combined with BFR in the chronic knee pain treatment. Articles 6 and 7 are letters to the editor about recent systematic reviews with meta-analysis and point out the need for greater methodological rigor in systematic reviews on BFR to treat chronic knee pain. Article 8 is a protocol for a randomized clinical trial proposed to investigate the effects of low-load and reduced total volume exercise with BFR versus high-load training without BFR in the treatment of knee osteoarthritis. Article 9 is the randomized clinical trial that presents the results of article 8 and shows that low-load training with reduced total volume and with BFR had an effect similar to high-load training without BFR on knee pain, muscle performance, physical function and quality of life of patients with knee osteoarthritis, although the magnitude of strength gains was greater after high-load training. CONCLUSIONS: Overall, with the exception of IPC to protect against muscle damage induced by exercise, blood flow restriction modalities are potentially useful in the management of musculoskeletal disorders studied herein. Additionally, we conclude that it is necessary to advance in the understanding of the physiological mechanisms and in the study of the prescription methods of the different modalities of blood flow restriction.

Introduction: Obstructive conditions, such as asthma, can cause respiratory muscle overload due to excessive use of accessory muscles, resulting in functional impact and muscle length changes. Objective: Assess posture and biomechanics (range of motion and muscle strength) of the spine of children with asthma. Methods: This is an exploratory comparative study that evaluated children aged 7 to 12 years with a clinical diagnosis of asthma and healthy children, matched for age, sex, and height. Anthropometric, posture, range of motion, cervical and thoracolumbar muscle strength, spirometry, assessment of clinical control and asthma severity were performed. Results: The study consisted of 41 children with asthma and 21 healthy schoolchildren. There was no difference (p>0.05) in posture (sagittal head angle, cervical angle, shoulder angle and thoracic kyphosis) between groups. Variables, cervical spine extension range of motion and thoracolumbar spine extension range of motion were statistically significant (p < 0.05). Conclusions: The variables of posture of the cervical and thoracolumbar spine did not differ between children with asthma and healthy schoolchildren. Children with controlled/partially controlled and uncontrolled asthma have a lower range of motion of cervical spine extension when compared to healthy children and children with uncontrolled asthma have a lower range of motion of the thoracolumbar spine compared to children with controlled/partially controlled asthma and schoolchildren healthy.

Objectives: To compare the efficacy and degree of satisfaction after isolated pelvic floor muscle training and associated transcutaneous tibial nerve stimulation (TTNS) in women with mixed urinary incontinence (MUI). Study Design: A randomized, single-blinded clinical trial was conducted. 24 women diagnosed with MUI were equally divided into two groups: pelvic floor muscle training isolated and associated to TTNS. The study occurred in four stages: 1) evaluation: general information, pelvic floor manometry, the International Consultation on Incontinence Questionnaire – Urinary Incontinence - Short Form (ICIQ-UI-SF) and International Consultation on Incontinence Questionnaire – Overactive Bladder (OAB) application; 2) intervention: carried out over 2 months twice a week; 3) post-intervention evaluation: vaginal manometry, reapplication of the questionnaires and the Patient Global Impression (PGI) application at the end of the 2-month intervention; and, 4) follow-up: evaluation after 1 month of the end of the intervention. The primary outcome was the ICIQ-UI-SF and the secondary outcomes were ICIQ-OAB, vaginal manometry, and PGI. The repeated measures ANOVA was used to assess the time-to-group interaction by assigning a significance level of 5%. Results: There was no interaction between time and group for ICIQ-UI-SF (p = 0.17) and manometry (p = 0.56). There was interaction for ICIQ-OAB (p < 0.01). PGI was reported as ‘‘much better” with 41.67% in the PFMTG + TTNS and 16.67% in the PFMTG after the intervention (p = 0.04). Conclusions: The results showed weak evidence that TTNS, in combination with PFMT, may be an intervention that can be used to treat MUI. The satisfaction degree was better with associated intervention.

Chronic Obstructive Pulmonary Disease (COPD) is a major public health problem that is caused by exposure to harmful gases, genetic changes or changes in lung development, in addition to the accelerated aging process. Thus, it may be associated with chronic diseases, increasing morbidity and contributing to the incapacity and mortality of these associates. For this Doctoral thesis two studies were carried out, objectives were: 1) Systematically assess as evidence from the Cochrane trial reviews to summarize the evidence on the effectiveness and safety of rehabilitation capacities for people with COPD and highlight current gaps in knowledge; 2) Translate, cross-culturally adapt and assess the psychometric properties of the Rapid Assessment of Physical Activity (RAPA) instrument. Study 1 is an overview of systematic reviews of randomized clinical trials published in the Cochrane Database of Systematic Reviews. We searched that database until August 2020 to identify how reviews assess the effectiveness of pulmonary rehabilitation (PR) actions in COPD. The risk of bias was assessed using the risk of bias tool in systematic reviews (ROBIS). Methodological quality was analyzed using the Multiple Systematic Review Assessment (R-AMSTAR), and a quality of evidence included in the analyzes was assessed using the GRADE framework. Overall, we included 13 publications published in the Cochrane Library, comprising 245 randomized controlled trials, with a total of 19,148 participants. Included reviews evaluated a wide range of RP interventions alone or associated with another intervention in stable disease and acuteness, including: RP / exercise training; physical activity counseling; self-management; pharmacological treatment; nutritional supplementation; oxygen therapy; Non-invasive conditions; inspiratory muscle training; telerehabilitation; active mind-body movement therapies (AMBMT); neuromuscular electrical stimulation (NMES) and Tai Chi. We assessed all reviews as being of high to moderate methodological quality, based on the R-AMSTAR criteria. High-quality evidence suggested that PR after exacerbation improved quality of life and functional capacity. Moderate to high quality evidence suggested that integrated disease management (IDM) functions, aquatic exercise compared to no exercise improved quality of life and functional capacity, respectively. Moderate-quality evidence suggested that after high-intensity interval exercise training, IDM improved functional capacity. Poor quality evidence suggested that there is little or no difference with telerehabilitation, no difference when comparing aquatic and terrestrial physical training, oxygen supplementation during exercise, comparing continuous and interval training for the quality of life outcome. Evidence does not show the difference in risk for mortality with the techniques: NMES, IDM, RP after a COPD exacerbation. A small improvement in dyspnea was reported in the MMSS training group when compared to no training or sham training. No review reported cost-effectiveness as an outcome. No adverse events were observed in the following procedures: telerehabilitation, NMES, IDM, NIV during exercise, Tai Chi and exercise. We have summarized a wide range of PR interventions, mostly in individual studies. Future studies should focus on determining which components of lung recovery are optimal, the type and intensity of associated actions, and cost-effectiveness are needed to fill current knowledge gaps. Study 2 involves the process of cross-cultural adaptation and adaptation, through translation, reverse translation, review by a multidisciplinary committee of 5 experts and 2 members of the target population. The analysis of the psychometric properties of validity and reliability is being developed by our research group and will be exhibited as a master's dissertation.

Introduction: Respiratory muscles play as the main function pulmonary ventilation, functionally dividing into three groups: the diaphragm, the rib cage muscles, and the abdominal muscles. In clinical practice, this musculature strength is measured by the pressures generated mainly in voluntary and non-invasive maneuvers, such as through the maximum inspiratory and expiratory pressures (PImax and PEmax, respectively) and sniff nasal inspiratory pressure (SNIP). Aims: 1) To analyze the reliability of the SNIP maneuver in a single evaluation and determine the number of maneuvers necessary to reach the maximum SNIP peak in healthy children 6-11 years old; 2) Determine reference values for maximum respiratory pressures in healthy children of the same previous age group; and 3) To compare the reference values of maximal respiratory pressures between two Brazilian studies in this population. Materials and Methods: 1) This cross-sectional study included 121 healthy children with normal lung function who performed 12 to 20 SNIP maneuvers, with 30 seconds of rest between them. Reliability was tested using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change (MDC) and Bland-Altman analysis for concordance. 2) At least three tests of each maximum respiratory pressure, PImax and PEmax, were performed on 121 healthy children, with a minimum duration of 1.5 seconds, plateau of one second and one minute rest between tests. Was applied a stepwise multiple linear regression analysis for PImax and PEmax taking into account the correlations observed with the independent variables: age, weight and sex. 3) The methodology used by Marcelino et al. is the same methodology as in study 2. While Lanza et al. developed the reference equations through a multicenter study, with a sample of 318 children aged 6 to 11 years. Maximum respiratory pressures were measured with an aneroid manometer. To compare both methodologies, the mean differences in pressures between the studies were compared and differences between genders and age groups were observed through p value and effect size. Results: 1) ICC and the corresponding confidence interval (CI) between the highest measure and the first reproducible maneuver were 0.752 (0.656 - 0.824), SEM = 10.37 cmH₂O and MDC = 28.74 cmH₂O. For children aged 6-7 years, the ICC was 0.699 (0.427 - 0.822), SEM = 10.76 cmH₂O and MDC = 29.82 cmH₂O; for children aged 8-11 years, the ICC was 0.774 (0.662 - 0.852), SEM = 9.74 cmH₂O and MDC = 26.05 cmH₂O.  For girls, the ICC was 0.817 (0.706 - 0.889), SEM = 9.40 cmH₂O and MDC = 26.05 cmH₂O; for boys, the ICC was 0.671 (0.477 - 0.798), SEM = 11.51 cmH₂O and MDC = 31.90 cmH₂O. Approximately 80% of the total sample reached the highest SNIP before the 10^th maneuver. 2) Boys achieved higher values of maximum respiratory pressures about girls. Associations of pressures between ages showed an increase according to the age groups studied (6-7, 8-9 and 19-11 years) with a moderate effect size for both. Independent variables height, weight, age and sex were positively correlated with PImax, but age and sex persisted in the equation (PImax = 24.630 + 7.044 * age (years) + 13.161 * sex (0 for girls and 1 for boys)). PEmax was positively correlated with height, weight and age, making the equation the variables age in girls and weight in boys [PEmax (girls) = 55.623 + 4.698 * age (years) and PEmax (boys) = 82.617 + 0.612 * weight (kg)]. 3) Close mean differences were found between absolute data from each study and the values found by the developed equations. Furthermore, in the comparisons between sexes and age groups in the studies, medium to wide effect sizes were identified. Lanza et al. had lower 95% confidence intervals for both sexes. Conclusions: 1) SNIP demonstrated moderate reliability between the maneuvers in children aged 6-11 years; older children and girls reached SNIP peak faster. Therefore, the results indicated that 12 maneuvers were sufficient for healthy children to reach the maximum SNIP peak. 2) This study determined new reference equations for maximum respiratory pressures in healthy children aged 6-11 years, including variables such as age, sex and weight, using the specific methodology recommended by ATS/ERS and BSPT. 3) Studies analyzed presented similar reference values in healthy Brazilian children, despite the different methodologies adopted. Thus, we can conclude that this thesis presents studies with important clinical significance in healthy children so that we can reliably assess respiratory muscle strength in this population using reliable methodologies.

Introdution: Frailty in the older people represents a state of physiological vulnerability related to age, produced by the reduction of homeostatic reserve and the body's ability to face a varied number of negative health outcomes. Early recognition of this syndrome is important, as it identifies older people at higher risk of unfavorable outcomes. Objective: Map valid instruments in the literature for screening and stratification of frailty in community-dwelling older people, in addition to comparing them to find the best option. Methods: Article 1 - This is a scoping review carried out through the search for instruments available in the literature for assessment and frailty stratification in community-dwelling older people. The searches were carried out in 5 Medline, LILACS, Scopus, Web of Science and CINAHL databases, with the following search strategy: frail OR frailty AND “independent living” OR “community dwelling” AND aging OR elderly AND “Observational Study”. A search of the gray literature was also performed in order to identify additional relevant studies. Data were presented and analyzed descriptively. Article 2 – This is a methodological study to assess the discriminative validity of the Vulnerable Elderly Survey-13 (VES-13) and Clinical Functional Vulnerability Index-20 (CFVI-20) instruments compared to the Frailty Phenotype. It was carried out with community elderly aged 60 years and over, of both genders, residing in Parnamirim, in the northeast region of Brazil. The comparison of frail and non-frail groups, identified through the Frailty Phenotype, was analyzed using Student's t test and effect size for each instrument score. To investigate the correlation between the three instruments, Pearson's correlation was performed. Discriminative validity was tested by analyzing the ROC curve, in addition to calculating the accuracy of the instruments. Results: Article 1 - 55 studies were selected for the final analysis of this research. Seventeen instruments were analyzed, with Fried's frailty criteria being the most used method, being present in 25 studies (45.5%). Regarding the assessment domains, 6 instruments assess only physical issues, four assess physical, psychological and social issues, and the other instruments have more than three domains for assessing frailty. Article 2 - A total of 732 elderly people were evaluated, among which 17.1% presented themselves as frail according to the Frailty Phenotype. The Pearson correlation found between Frailty Phenotype and CFVI-20 was 0.53 (p<0.001), whereas for VES-13 this value was 0.42 (p-value<0.001). The difference between the means of the frail and non-frail groups in the VES-13 and CFVI-20 scores with the Phenotype were significant (p<0.001), with an effect size of 0.95 and 1.26, respectively. The instruments proved to be valid to discriminate frail from non-frail elderly (p<0.001), the FCVI-20 had an AUC of 0.81 and the VES-13 of 0.75. Conclusions: The assessment of frailty in community-dwelling older people can be performed using several instruments. The scope review serves as a guiding guide for professionals in the field of geriatrics, demonstrating 17 instruments applicable to the context of community-dwelling older people, pointing out advantages and disadvantages in deciding on the instrument to be used. The instruments VES-13 and CFVI-20 have good discriminative validity for assessing frailty in community-dwelling older people, being better for identifying frail than non-frail elderly. When comparing these tools, the CFVI-20 proved to be better than the VES-13.

Background: Changes in movement and muscle activation of scapulohumeral joint are related to Subacromial Pain Syndrome.  Electromyography biofeedback during exercise may enhance muscle activation and coordination, and consequently improve pain and shoulder function.

Methods: This study compared the effects of an exercise protocol with and without using electromyographic biofeedback on pain, function and movement of the shoulder complex in subjects with Subacromial Pain Syndrome. A total of 24 volunteers of both genders were randomized into the therapeutic exercises and Biofeedback groups in the trapezius and serratus muscles. Pain and shoulder function were evaluated as the primary outcome and range of motion, muscle strength, electromyographic activity and scapulohumeral kinematics as secondary outcomes. The subjects underwent eight weeks of intervention and comparisons were made between groups in baseline, at 4 weeks, 8 weeks, and at 4 weeks post intervention.

Findings: There were no differences between groups for pain (p= 0.11; CI: -1.57 to 0.41) and shoulder function (p = 0.33; CI: - 6.89 to 11.33), muscle strength, range of motion, and electromyographic variables. Significant differences were observed in upward scapular rotation at 60° of arm elevation (P = 0.006; CI: 0.9 to 9.3) in the Biofeedback group. There was no difference for the other variables of scapular kinematics.

Interpretation: Therapeutic exercises have been shown to be effective in reducing pain and improving function in patients with SPS. The addition of EMG-biofeedback to exercise protocols did not influence the analyzed variables.

Background: Temporomandibular disorders (TMD) are conditions that affect the temporomandibular joint (TMJ), the masticatory muscles and associated structures. Common signs and symptoms include TMJ and muscle pain, limited mouth opening, joint noises, headaches, earache, and altered jaw movement. In addition, studies suggest direct associations between TMD and alterations of the cervical spine. The coexistence of neck pain and TMD is common and it can be associated with weakness and lack of endurance of the neck muscles. Earache, tinnitus and vertigo are also reported as commom complaints of otological origin in patients with TMD. Objective: The aim of this study was to evaluate pain, neuromotor control and head and neck posture in individuals with TMD with and without otological complaints. Methods: In this cross-sectional study, individuals with TMD between 18 and 59 years of age and both genders were evaluated. Subjects with TMD were divided into two groups: a group with otological complaints (GCQ) and a group without otological complaints (GSQ). Otological complaints considered symptoms of dizziness, vertigo, tinnitus, earache or hearing loss. Self reported pain, masticatory and neck muscles pain threshold, head and neck posture, neck disability and neuromotor control and muscular endurance of deep neck flexors (DNF) were evaluated in both groups. All descriptive and inferential analyzes were performed using the statistical software SPSS 22.0 for Windows. A 95% confidence interval and significant level of p<0.05 was adopted. Results: The TMD group with otological complaints presented less muscle activation scores (GCQ 24 mmHg [24 - 26]; GSQ 26 mmHg [24 - 28]), endurance (GCQ 44 [28 - 78]; GSQ 105 [46 - 140]) and greater neck disability (GCQ 13.32 ± 6.36 points; GSQ 8.15 ± 5.89 points) (p<0.05) when compared to the group of TMD without otological complaints. There were no significant differences in pressure pain thresholds, self-reported pain and head posture between groups. Conclusion: Individuals with TMD with otologic complaints present diminished neuromotor control of the deep neck flexors, greater neck disability and same pain levels and head and neck posture compared to individuals with TMD without otological complaints.

INTRODUCTION: Fatigue is generally characterized when the muscle has a decrease in its ability to generate force and / or speed, this phenomenon is due to a muscle activity under load and is reversible upon rest. Inspiratory muscle fatigue (IMF) has been classified as central fatigue when it is induced by changes in neural drive, or peripheral fatigue that is characterized by changes in inspiratory muscle contractile properties from the imposition of high loads. OBJECTIVE: To evaluate and compare the physiological behavior of respiratory muscles during two respiratory endurance tests, normocapnic hyperpnea and inspiratory pressure threshold load in healthy subjects. METHODOLOGY: The research is a crossover study with a quantitative approach, in which healthy individuals of both genders were studied. The subjects were initially submitted to pulmonary function test and respiratory muscle strength evaluation. Then two respiratory endurance tests were performed. The protocol consisted of 10 pre sniff maneuvers, endurance test and 10 post sniff maneuvers. The test was performed with the Powerbreathe valve at 80% of maximal inspiratory pressure and Spirotiger at 70% of the maximum voluntary ventilation test, respecting a time period of 7 days between each test. During the protocol the subject was monitored by optoelectronic plethysmography, surface electromyography and NIRS for evaluation of tissue oxygenation of the sternocleidomastoid muscle. RESULTS: A total of 18 subjects participated in the study, 9 men and 9 women, with a mean age 23.94 ± 1.70 years, BMI 22.63 ± 1.95 kg / m². For the CLPI test, the load used was around 85.64 ± 15.78 CmH2O and a mean duration of the test was 157s, while for the HN test the subjects had a minute volume of 105, 1 ± 19.91 L / s and a time of 197s. In the intragroup comparison, regarding the BORG effort scale, there was an increase in the post value compared to the pre for both groups (p <0.0001), while in the intergroup comparison there was no difference (p> 0.05). Regarding the relaxation variables obtained from the sniff curve, in the intragroup comparison in relation to the pre values, there was a statistically significant increase only in the time finding (τ) in the first and third maneuver post test with NH, (p = 0 , 0067 and p = 0.0049), respectively. In the CLPI test, there was also an increase in the time constant (τ) in the first four post-test maneuvers (p <0.005). Regarding the other relaxation variables (MRR and 1 / 2RT) there was no statistically significant difference in the intragroup comparison in both test modalities. The contraction variables, also obtained from the sniff test, showed no statistical difference in the intragroup comparison of post-pre (P> 0.05) maneuvers. Regarding intergroup comparisons, no variable showed any difference. During the CLPI test there was a decrease in the median frequency, obtained from the surface electromyography of the inspiratory muscles, with a slope of -0.013 and r2 = 0.055. In the HN test there was also a fall of this variable with slope of -0.035 and r2 = 0.025. CONCLUSION: From the results found, it can be stated that inspiratory muscles behave similarly in relation to these different endurance test modalities. Additionally, inspiratory muscle fatigue causes changes in the relaxation variables, especially in the time constant rather than in the contraction variables.

Introduction: Cardiac rehabilitation (CR) promotes a substantial increase in cardiorespiratory fitness (RCA) in the short term associated with a reduction in morbidity and mortality rates. However, evaluation of ACR through MET in long-term follow-up of CR is scarce in the literature. Objective: The objective of this study was to verify the magnitude of cardiorespiratory fitness by measuring the long-term metabolic rate of the task (MET) of patients who underwent cardiac rehabilitation (CR) and to analyze the factors correlated to such changes. Materials and methods: This is a longitudinal retrospective and cross-sectional cohort study carried out between 2015 and 2019 in the cardiac rehabilitation sector (CORE-HUOL). The assessment of cardiorespiratory fitness was collected by reviewing medical records with data from pre and post cardiac rehabilitation and measured in a follow-up of 12 to 24 months after CR through the exercise test (ET) to assess the metabolic equivalent of the task (MET) peak, in addition, through the DASI questionnaire, the peak MET was estimated based on daily life activities. These data were correlated with covariables in the clinical record. Results: The magnitude of ACR modification in METs after CR was 3.43, while the follow-up follow-up after CR showed a reduction of 1.87 in the peak MET, but without statistical significance. The MET estimated by the DASI scale showed a moderate and positive correlation (r = 0.63, p = 0.003) with the MET verified in the ET. The variables that showed a moderate and positive correlation to the MET of the follow-up test were the pre-RC MET (r = 0.67, p = 0.004) and the final weekly aerobic training dose (r = 0.66, p = 0.009). The regression model performed was valid only for dose of aerobic training with adjusted r square of 0.43 (p = 0.006). Conclusion: In this study, there was a higher than usual increase in ACR through peak MET and a non-significant but clinically relevant reduction in long-term follow-up MET after cardiac rehabilitation, raising the importance of monitoring ACR that can be performed even with simple prediction tools such as the DASI scale and the need for strategies for maintaining the ACR after CR.

Introduction: Alterations present in trunk region seem to be related to symptoms of motor and non-motor nature, such as postural balance, gait and intestinal constipation (IC) in individuals with Parkinson's disease (PD); however, few studies have used physical exercises directed at this region. Objective: To evaluate the effects of a home-based exercise program on motor and non-motor symptoms of individuals with PD. Methodology: randomized controlled clinical trial, with a sample of 28 individuals with PD who presented symptoms of IC, deficits in postural balance and gait. Sample was randomly distributed into Experimental Group (EG, n = 14) and Control Group (CG, n = 14). Participants were assessed for outcome measures: bowel function - The Bowel Function in the Community and Bristol Scale; gait variables - Qualisys Motion Capture System®; variables of postural balance, through a force platform, and quality of life - Parkinson Disease Questionnaire-39 - PDQ-39. The protocol was carried out daily for three consecutive weeks. Control group performed simple activities: diaphragmatic breathing; stretching of the main muscle groups of the upper and lower limbs; myolymphokinetic exercises on the feet; and active exercises free of upper limbs. The EG performed the exercise protocol focused on the trunk region: abdominal strengthening; strengthening of the erector muscles of the spine; pelvic tilt exercises; and contraction of the pelvic floor muscles. Data analysis was performed using Analysis of Variance (ANOVA) mixed with repeated measures to compare outcome measures between groups and between initial assessment, reassessment and follow-up. Correlation tests were applied between the non-motor variable “IC” and motor variables “postural balance” and “gait”. The level of significance adopted was 5%. Results: Article 1 - Data from the The Bowel Function in the Community questionnaire did not show significant interaction time * group (F = 0.235; P = 0.746), with a difference in the outcome over time (F = 6.576; P = 0.005), with reduced scores in both groups, indicating improvement in the IC outcome. For the General Intestinal Habit, there was no time * group interaction (F = 0.396; P = 0.688), and the data showed no change in the outcome over time (F = 0.526; P = 0.588). In the Bristol Scale, there was no time * group interaction (F = 0.611; P = 0.538), with no change in the outcome over time (F = 0.440; P = 0.635), demonstrating the maintenance of the feces consistency. In PDQ-39, there was no time * group interaction for this outcome (F = 0.452; P = 0.621), and there was no change in quality of life over time (F = 0.376; P = 0.699). There was a moderate correlation between the questionnaire The Bowel Function in the Community and self-reported mobility (P = 0.032, r = 0.407). Article 2 - For gait speed, data showed that there was no significant interaction between time and group (F = 1.820; P = 0.179), with no change in the outcome over time (F = 0.207; P = 0.778). The same occurred for the outcomes: stride length (time * group: F = 0.179; P = 0.799; time: F = 0.694; P = 0.482); double support time (time * group: F = 2.483; P = 0.120; time: F = 0.612; P = 0.468); hip extension (time * group: F = 0.207; P = 0.800; time: F = 0.527; P = 0.583); knee range of motion (time * group: F = 1.810; P = 0.183; time: F = 2.243; P = 0.130); ankle range of motion (time * group: F = 4.153; P = 0.045; time: F =0.037; P = 0.880). Balance data could not be finalized, and therefore will not be presented. Conclusion: It can be inferred that the exercise protocol composed of stretches, myolymphokinetic exercises, and free active exercises (control group) has a similar influence to the protocol of exercises to strengthen the trunk and pelvic floor (experimental group) on the outcome of IC. And, although the kinematic gait variables did not show significant differences, the correlation found between the IC and the patients' self-reported mobility demonstrates the existing interaction between the motor and non-motor symptoms of these individuals.

Introduction: low back pain is globally presented as a symptomatology of high prevalence, incidence and recurrence and is considered a public health problem. In military aviators, this is common condition and relates primarily to the high acceleration forces on the spinal  column and inadequate positioning in the cockpit. As a consequence, there are frequent absences at work, decreased concentration and performance during flight, changes in work function, and fear of aviators in the emergence of future pathologies. Objective: to analyze the risk factors associated with low back pain in fighter pilots of Air Brazilian Force (FAB). Methods: This is an observational, cross-sectional study of 30 FAB fighter pilots, who will be submitted to an evaluation consisting of strength and resistance tests and trunk mobility, postural evaluation, lumbar spine magnetic resonance imaging and questionnaires for the identification of clinical risk factors. The data will be analyzed in the software SPSS 20.0, with a level of significance of 5%. The normality and homogeneity of the variances will be verified by the Kolmogorov-Smirnov and Levene tests, respectively, and then the corresponding statistical tests will be applied to analyze the correlation and comparison of the data.

Introduction: Volume incentive spirometry (VIs) and positive expiratory pressure (PEP) are two low-cost physiotherapeutic resources that are easy to transport and use and that promote pulmonary expansion in subjects after a stroke. Objective: To evaluate the effects of 3 pulmonary reexpansion protocols in stroke patients submitted to three pulmonary expansion protocols: a) Volume Incentive Spirometry (VIs), b) Positive Expiratory Pressure (PEP) and c) both devices (PEP + VIs ). Methodology: This is an observational analytical study that included individuals affected by an episode of stroke, for at least three months, of both sexes, aged over 18 years. The evaluations took place over two days, with a minimum interval of one week. On the first day, participants were assessed for respiratory muscle strength (MIP and MEP) and lung function (spirometry) as well as completing the Mini Mental State Examination (MMSE) and the National Institutes of Health Stroke Scale (NIHSS). The evaluation of the variation in the volumes of the chest wall and its compartments (ribcage pulmonary (RCp); ribcage abdominal (RCa) and abdomen (AB)) was performed by optoelectronic plethysmography (OEP) on the second day. The evaluation took place in 3 consecutive steps: 2 minutes of rest (spontaneous breathing - QB), 2 minutes of the randomized intervention technique (protocol) and 2 minutes of recovery. The rest time between the devices was defined by stabilizing vital signs. The sample calculation was performed in a pilot study of 5 individuals, by the tidal volume in the chest wall, with effect size 1.09 and power of 0.90, totaling 15 subjects for the study. Results: 18 individuals (12M), age 56.11 ± 12.28 years, were analyzed. Although the volume variation in the chest wall was greater when using PEP + VIs compared to isolated devices, there was no significant difference between the valves for these variables. When we divided the rib cage into hemiparetic and normoparetic sides, there was a significant difference (p <0.05) when analyzing the hemipathic sides in the ribcage pulmonary compartment (RCp) between PEP 0.24 [0.15-0.32] and VIs 0.37 [0.25-0.43]. The percentage of contribution was higher, comparing the hemithorax, on the normoparetic side, being statistically significant in PEP (19%) when compared to the hemiparetic side (14%). In addition, when comparing only the affected sides, there was a statistical difference in RCp greater in VIs (22%) when compared to the other two devices (PEP - 19%) and PEP + VIs - 20%) and in the abdomen (AB) , being higher in PEP (26%) when compared to VIs (20%) and in PEP + VIs (24%) when compared to VIs (20%). In the analysis of asynchrony, the study showed that there is an increase in the phase angle <0.05 with the use of the PEP and PEP + VIs protocols between the QB-valve and valve-recovery, with no change in the use of the isolated VIs. In addition, significantly higher values were obtained in PEP + VIs compared to VIs in the abdominal ribcage versus abdomen (θCTAxAB) and in PEP when compared to VIs in the pulmonary ribcage versus abdomen (θCTPxAB). Conclusion: The use of isolated volume incentive spirometry had superior effects on pulmonary reexpansion and less asynchrony when compared to the use associated with positive expiratory pressure and the use of isolated PEP in post-stroke patients.

The effects of Cardiac Rehabilitation (CR) in patients with chronic heart failure (HF) are assessed by changes in oxygen uptake at peak effort (VO2peak). However, it has limitations, such as the need for maximum exercise, which is not possible in severely limited patients. In this way, other variables, since they are employed independent of the maximum effort, have been studied, such as the Anaerobic Limit - LA, relationship between minute ventilation and carbon dioxide production -VE / VCO2Slope, oxygen consumption efficiency - OUES and ventilatory oscillation - OV and to assess the effects of physical exercise, in addition to the use of these variables in addition to other TECP variables that can be used together and provide important clinical data about the patient such as risk stratification. Objective: To evaluate the effects of CR in the independent variables of maximum effort (LA, VE / VCO2slope, OUES and OV), risk stratification and the metabolic equivalent of the task in patients with chronic HF. . Materials and methods: This is a retrospective analysis composed of patients with chronic HF. The individuals underwent a clinical, spirometric cardiopulmonary evaluation. Then they were submitted to an exercise protocol (aerobic and resistance), 3 times / week, for 12 weeks, being reassessed at the end of the CR period. Results: 45 patients with chronic HF with a mean age of 49.8 ± 12.97 years and an Ejection Fraction of 39.0 ± 15.8% were evaluated. An increase of 2 min and 4 seconds (p <0.001) in its mean and 24.1% in MET was identified. Regarding the metabolic analysis, we had an increase of 18.3% in VO2peak after CR, as well as an increase of 12.9% VO2 at the time of LA and 20.14% in OUES75%, in addition to the reduction in the mean VE / VCO2slope and the presence of OV, which led to an improvement in the risk stratification of 4 patients. In addition, the results of the ROC curves showed that OUES is able to identify patients with severe chronic HF with different aerobic capacities (<or> 70% predicted VO2) such as LA (ASC = 0.865, p = <0.0001; ASC = 0.800, p = 0.002 respectively), and there is no significant difference in the comparison between the receiver operating characteristic (ROC) curves. The regression analysis identified cardiovascular and pulmonary factors related to both variables. Conclusion: It is concluded that the CR with an individualized dose of exercise and readjusted whenever necessary was efficient in improving the aerobic capacity and risk stratification of the patient with chronic HF and that the independent variables of the maximum effort were effective in identifying these results. Therefore, they are an alternative for those in whom the VO2peak assessment may be impaired by their clinical condition. Among the independent variables of effort, OUES was as effective as VO2LA to identify patients with different aerobic capacities. Therefore, effort-independent variables are an alternative for those in which VO2peak assessment may be impaired by their clinical condition.

Abstract Estudo 1 Introduction: Cystic fibrosis is a multisystem disease, but with pulmonary
involvement as the main cause of death. Objective: To investigate the repercussions of home
inspiratory muscle training on posture, quality of life and the possible adverse effects reported by
individuals with cystic fibrosis. Materials and methods: In a double-blind randomized controlled clinical
trial (NCT03737630), patients of both sexes with a diagnosis of cystic fibrosis confirmed by the
sweat test underwent pulmonary function test, respiratory muscle strength, postural assessment,
quality of life and 3-minute step test. After that, they were divided into two groups (G40% and G20%).
For the training protocol, everyone received a POWERBREATHE © and the G40% group trained with 40%
of the MIP load, with load progression every week and the G20% with 20% of the MIP load without load
progression for 4 weeks, 2x a day, 30 breaths. After four weeks, the individuals were reevaluated.
The data were analyzed using SPSS 20.0, with a 5% significance level. The Shapiro-Wilk test was used
and, according to the data distribution, the unpaired t ’test was used to compare the means between
the groups. Results: Ten patients (6 men and 4 women) with a mean age of 19 ± 3.2 years were
evaluated. There was a significant reduction of 6.8 cm in the T1 / T2 angle of postural assessment with
a 95% confidence interval: 8.2 (0.01 - 16.3) and clinical FVC gains for both groups and FEV1 for the
group G20%, considering the respective minimally important clinical differences (MCID). No major
adverse effects have been reported. The other variables did not present clinical and / or significant
changes. Conclusion: The protocol proposed by this study was not sufficient to generate positive
effects on all variables, however due to the absence of adverse effects, it can be considered safe to
be performed at home.


Abstract estudo 2 Introduction: The experience of stigma is present in all stages of an individual's
life with cystic fibrosis, requiring the availability of instruments to assess this psychosocial aspect.
However, there are few of these instruments validated and adapted to the Portuguese language.
Objective: Translate, make the cross-cultural adaptation and evaluate the psychometric properties
of the Cystic Fibrosis (CF) stigma scale. Materials and methods: Exploratory methodological study
that involved the process of translation and crosscultural adaptation through translation,
back-translation, revision by a multiprofessional committee composed of 10 specialists and 30 
individuals with cystic fibrosis in the pre-test phase. Subsequently, the psychometric properties 
were analyzed through the application of the adapted instrument in a sample of 52 Brazilian 
individuals over 18 years old and with cystic fibrosis. A stigma assessment was carried out using 
the CF stigma scale adapted to Portuguese, generic quality of life by The Short Form 12v2, anxiety 
by The Generalized Anxiety Disorder Questionnaire and specific quality of life for cystic fibrosis by 
the quality of life questionnaire in cystic fibrosis and a reevaluation 3 weeks later. The data were 
analyzed using the SPSS26.0 software, with a significance level of 5%. The normality of the data
 was verified by the Kolmogorov-smirnov test. Two types of reliability were considered in the total
 score and in the subscales: internal consistency using Cronbach's alpha and test-retest reliability
 using paired t-test and Pearson's correlation. Results: The process of translation and cross-cultural
 adaptation obtained kappa indexes higher than 0.61 in the multiprofessional committee phase and
 varied between 0.48 and 0.72 in the pre-test. The Brazilian version of the CF Stigma Scale showed
 excellent psychometric properties: 1) Internal consistency: α = 0.836 2) Test-retest: r = 0.886, 
p <0.0001 3) Convergent validity of p = 0.3. The CF Stigma Scale score correlated positively with
 the anxiety scale (r = 0.384, p = 0.005) and negatively with the scores for general quality of life
 (r = -0.430, p = 0.001) and specific for cystic fibrosis (r = -0.484, p <0.001). Conclusion: The CF
 Stigma Scale questionnaire was properly translated and adapted to the Brazilian reality, which has
 good psychometric properties and can be used in the Brazilian territory for future studies involving
 the experience of stigma in patients with cystic fibrosis. 

Introduction: the subacromial pain syndrome is known as a compression of the subacromial tissues, mainly due to the narrowing of this space. Its etiology is wide, however, imbalances in muscle relationships and in the time of activation of these muscles can influence the functional prognosis of these patients. Objective: The aim of this study was to compare a sensory motor training protocol with a muscle strengthening protocol in patients with subacromial pain syndrome. Methods: this is a randomized, blinded trial, composed of 22 volunteers of both genders, with a mean age of 48.9 ± 7.9 years. All volunteers are submitted to a previous evaluation (Av1) where they were measured: pain, function (SPADI), range of motion, muscle strength, relationship between electromyographic activities and kinematics of the shoulder complex. After the initial evaluation, the volunteers were randomly divided into two groups to perform the interventions: exercise group (GE - muscle strengthening exercises, n = 11) and motor sensory group (GSM - motor control training, n = 11). The intervention protocols were perfomed for 8 weeks. After four weeks of intervention, the second evaluation (AV2) was perfomed, identical to AV1, adding, however, the global change perception questionnaire in this and in the following evaluations. At the end of the intervention protocols, the third evaluations (AV3) was performed and, finally, a follow-up was performed 4 weeks after the end of the intervention protocols. Statistical Analysis: was performed using the Statistical Package for the Social Sciences (SPSS) version 20.0 for Windows, following the principles of analysis by intention to treat. In the descriptive analysis we used the mean as a measure of central tendency and the standard deviation as a measure of dispersion. A mixed model ANOVA was performed for intra and intergroup comparisons. Results: both groups had a reduction in painful sensation. Still in relation to pain, at follow-up, there is an intergroup difference for the sensory motor group, when compared to the muscle strengthening group. For the SAPDI variables, range of motion, joint strength, muscle strength and the relationship between electromyographic activity between the evalueted muscles, there was no difference between the groups. In the kinematic evaluation of the upper scapular rotation, the results showed intergroup differences in 30 and 60 degrees, with increased scores for the sensory motor group. Conclusion: both intervention protocols produced clinically important responses for patients with SIS, however, it was observed that gains in GSM last for a longer time, when compared to GE.

Introduction: Alzheimer's disease (DA) is the most common among the elderly and represents 60% of the dementias diagnosed. Many investigations were conducted on the cognitive sequelae of DA, but few concentrated on the extent to which deficiencies in cognitive abilities are reflected in difficulties in performing daily activities. Objective: To verify the factors related to impairment of functional capacity and its influences in relation to socio-demographic, clinical, staging, mobility, postural and cognitive balance of elderly with Alzheimer's disease (DA). Methods: This is an observational, analytical, cross-sectional study conducted in Natal-/rn. Participants were 40 elderly individuals aged 60 years or older with Alzheimer's disease in the mild (CDR1) or moderate (CDR2) phase, with independent ambulation. The instruments were utilized: questionnaire for the evaluation of sociodemographic and anthropometric data; Mini Mental Health Examination; Clock drawing test (TDR);  Verbal fluency Test (TFV) Timed Up and Go test (TUG) and Clinical test of Sensory Organization and Balance (CTSIB). Simple descriptive analyses, Man Witney test, Spearman correlation test, linear regression model and prediction equation (p < 0.05 and CI of 95%) were performed. Results: The median age of the sample was 80 years; The majority of women (77.5%), the functional capacity had a median of 22.5 and the majority presented postural imbalance (62.5%), according to the ctsib, eight linear regression models were generated and the latter was chosen for the analysis, by the method " and elaborate the prediction equation and possible interpretations. The variables assumed in this model were: CDR, verbal fluency and ctsib.

Background and Objective: Pain in the region of the cesarean incision is the main complaint of women in the immediate postpartum and considered post-cesarean morbidity for the mother and the baby, characterized as postoperative pain that presents difficult recovery. This study aimed to evaluate the effect of Low Level Laser Therapy (LLLT) for pain relief in the region of the surgical incision of women undergoing cesarean section. Desing/Materials and Methods: A randomized, double-blind clinical trial with 74 women in the immediate postpartum randomized into for groups: control group (no LLLT, n = 20), placebo group (LLLT without radiation emission, n = 20), experimental group I (LLLT with dosage of 4J/cm², n = 17) and experimental group II (LLLT with dosage of 2J/cm², n = 17). The pain was recorded at three different times: 8-12 hours, 20-24 hours, and 44-48 hours after cesarean section. The evaluation with the Patient Global Impression of Change Scale (PGICS) occurred at the second and third moment of the evaluation of the pain. For the groups intervention, the LLLT with wavelengths of 660nm was performed in two sessions, at 8-12 hours and 20-24 hours after cesarean section. In the statistical analysis, data were analyzed using SPSS software 20.0 for Windows 23.0, giving a level of significance of <5%. The normality of the data of each group was evaluated by the Shapiro-Wilk test. Descriptive statistics were presented through measures of central tendency. One-way ANOVA and repeated measures ANOVA. The size of the effect was demonstrated by Cohen's d. Results: There was a statistically significant difference between the groups in the third numerical evaluation of pain (p = 0.03) and algometry (p = 0.04). There was also a significant difference between the groups in the first PGICS evaluation (p = 0.04) and in the second evaluation (p = 0.04). Considering the numerical scale of pain, the effect size was 11% (placebo group), 43% (control group), 71% (experimental group I) and 68% (experimental group II). Conclusion: The use of LLLT appears to have promoted beneficial effects in the decrease the intensity pain in postpartum women after cesarean section.

Introduction: Exercise-induced muscle damage usually occurs with the usual practice of physical exercise, and its magnitude is directly related to the type, intensity, mode or duration of the exercise. The evaluation of DMIE by indirect methods has been increasingly used and more recently, infrared thermography has been used as another instrument to measure muscle damage, however, the physiological behavior of the superficial temperature is not known before different DMIE. Objective: To evaluate the physiological behavior of superficial skin temperature after high and low volume induced muscle damage in the elbow flexors, analyzing if there is difference between different magnitudes of damage and if the temperature is related to the main indirect markers. Methods: This was a short longitudinal study in which 30 healthy, active men who did not perform any strength and / or endurance training were randomly assigned to the low (gBV) and high-volume groups (gAV). Subjects were evaluated for skin temperature (thermography), clinical indicators (subjective perception of pain, range of motion, subjective perception of effort), biochemical indicators (CK blood concentration), and neuromuscular indicators by means of an isometric variable of torque). The evaluations occurred 48 hours pre-protocol, immediately before and after, plus 30 minutes, 24, 48 and 72 hours after the DMIE protocol. The gBV group performed 10 eccentric contractions of elbow flexors on the isokinetic dynamometer with the angular velocity of 60 ° / s in a range of elbow flexion / elbow extension of 120 ° and gAV performed the same exercise, however with 30 contractions eccentric Data were analyzed using the statistical software SPSS 20.0, and the significance level was set at 5%. Results: There was a temperature increase at the moment immediately after the stimulus in both groups (p <0.05), but returning after 30 minutes and without differences between them (p> 0.05). Regarding the markers (Peak torque, Pain, CK, ROM, Threshold of pressure pain and Circumference), all presented change over time, with a difference between the groups in some moments evaluated. There was no correlation of temperature with the main indirect markers of muscle damage (Pico Torque, Pain and CK) (p> 0.05). Conclusion: The skin surface temperature increases only at the moment immediately after the stimulus, with no differences between magnitudes of muscle damage and no relation to the main indirect markers of muscle damage. Therefore, skin surface temperature can not be considered an indirect marker for assessing muscle damage

ABSTRACT

Introduction: Scapular dyskinesis is defined as a abnormal of position and/or motion of the scapula. The scapula is the connection between the trunk and the upper superior, an analysis of transmission variables is important for a better understanding of the kinetic chain. Purpose: to evaluate the head, shoulders, and thoracic spine; muscle flexibility; range of motion and strength of the cervical and thoracolumbar spine musculature in asymptomatic individuals. Methods: Fifty-two individuals were divided into two groups: with scapular dyskinesis (22.95 ± 2.86) and without scapular dyskinesis (age 22.06 ± 2.73). Dyskinesis was assessed using the Scapular Dyskinesia Test. A biophotogrammetry was used for a postural analysis. The Pectoralis Minor Index and the Levator Scapulae Index were used to assess muscle flexibility. The digital inclinometer was used to evaluate the range of motion of flexion, extension, lateral flexion and rotation of the cervical spine; and flexion, extension and flexion of the thoracolumbar spine. The handheld dynamometer was used to evaluate the muscle strength of the flexor, extensor and flexor lateral cervical and thoracolumbar muscles. The inter-examiner variable samples were a concordance that varied from good to almost perfect. Results: The difference (p> 0.05) between the groups was not observed for any of the variables. Conclusion: This results can be used as a growing doby of evidence that scapular dyskinesis to be prevalent and can be classified as a normal variation of human movement for this population.

INTRODUCTION: The phase angle (PhA) is a measure of great clinical relevance provided through of the bioelectrical impedance assessment (BIA). PhA is related to health status of individuals, similarly physical performance measures are also associated to the health status of older individuals, however, studies that examine the relationship between those two measure are scarce. OBJECTIVE: To identify the relationship between PhA and physical performance measures in community dwelling older adults in a Brazilian sample. METHODOLOGY: This was a crosssectional study which 200 community dwelling older adults of both sex, were recruited. The physical performance was evaluated by walking speed and Handgrip Strength, and the PhA was derived from BIA. Linear regression models were used to estimate the associations between PhA and physical performance measures. Two models were build, the first model was adjusted by handgrip and walking speed, the second one was added number of chronic disease, sex, age and BMI. RESULTS: 200 individuals, were evaluated through BIA. Men have mean age of 72.13 ± 3.42 and women 71.94 ± 3.35. Among men, mean PhA was 5.99 ± 0.67 while women the mean obtained was 5.43 ± 0.70. In the linear regression we can observe that handgrip strength (β: 0.415; p-value < 0.001; β: 0.205; p-value: 0.006) and the walking speed (β: 0.162; p-value: 0.012; β: 0.190, p-value: 0.002) as correlated with the PhA in both models. CONCLUSION: The results of this study revealed that PhA of BIA is a good marker of the physical performance in the older adults community-dwelling.

Introduction Participating in leisure activities allows children to explore the environment in which they live, experiencing situations that help their development. children and adolescents participate less in socialization and leisure activities than their non-disabled peers. The International Classification of Functioning, Disability and Health (ICF) points out that several factors can influence participation. To make best practices it is important to identify the barriers that difficult participation. Objective: Identify the perception of disabled children and their ceregivers regarding facilitators and barriers to their participation in leisure activities. Materials and Methods: This is a qualitative study involving 7 focus groups. 80 individuals participated in the study (40 disabled childrens and 40 caregivers). The groups of disabled children and their caregivers occurred independently. The discussions were recorded and the recordings were later transcribed. The analysis was based on ICF, following the Linking Rules. 3 judges read the transcripts of the discussions independently. While reading the discussions, the judges identified the significant points (barriers and facilitators) associated with the ICF categories. The differences were resolved with a meeting and discussion between the judges. Results: Both groups pointed out that environmental factors are the main barriers, especially with regard to peers colleagues attitudes (children's perception) or strangers (caregivers' perception) and products and technology for personal indoor and outdoor mobility and transportation (children's perception) or products used in the construction and building products and technology of buildings for public use (caregivers' perception). For the disabled childrens, the support and attitudes of the immediate family, followed by the attitudes of the friends were the biggest facilitators for their participation in leisure activities. For parents, in addition to the attitudes and support of the immediate family, social attitudes also facilitate the participation of their children. Conclusion: The perception of disabled children and their caregivers show that environmental factors were the primary facilitators and barriers to disabled children’s participation in leisure activities. Professionals need to broaden their action plans in order to identify these factors and devise strategies to increase participation of disabled children in leisure activities.

Abstract

Introduction: Obesity is responsible for triggering several systemic alterations, increasing the severity and morbidity of existing pathologies. Obese individuals with respiratory diseases, such as chronic obstructive pulmonary disease (COPD), have higher rates of dyspnea, worse overall health, higher consumption of medications and a lower effectiveness of inhaled medications compared to patients with normal weight. To date, there is no data in the literature that defines what would be the factors responsible for the low effectiveness in the use of this type of medication in the obese population. In addition, the possibility of implementing aerosol therapy via a high-flow nasal cannula to improve the deposition pattern in this population has not yet been described.

Objectives:

1- To analyze the association between anatomic variables of the upper airways of healthy obese individuals and the percentage of pulmonary deposition of inhaled radiopharmaceuticals. Find predictors for this deposition.

2 - To analyze inhaled aerosol pulmonary deposition via High Flow Nasal Cannula (CNAF) in patients with COPD (obese and non-obese).

Method: The study was performed in two parts: the first part (study 1) was a non-randomized controlled clinical trial with obese and non-obese individuals. The following were evaluated: upper airway anatomical and anatomical characteristics (Computed Tomography and modified Mallampati score). All volunteers inhaled radiopharmaceutical (99mTc-DTPA; 1mci), with bronchodilator Fenoterol hydrobromide and ipratropium bromide using membrane inhaler (MESH) during quiet breathing (tidal volume). Deposition comparisons were performed between obese group and the non-obese groups. The second part of the study was a crossover trial where patients with COPD inhaled radiopharmaceutical (99mTc-DTPA; 1mci), with bronchodilator Fenoterol hydrobromide and ipratropium bromide on two different days (at least two days apart). One day, inhalation occurred simply using membrane inhaler (MESH), while in the other day the inhalation occurred via the CNAF. The sequence of the intervention was previously randomized.

Study results 1: Participated in the study 17 non-obese individuals and 12 obese individuals. The volunteers of the obese group had 30% lower pulmonary deposition than non-obese patients (p = 0.01, 95% CI 0.51 to 4.91). Anatomical variables related to airway shape differed between groups. The anteroposterior diameter of the obese retroglossal region was 29% higher (p <0.01, 95% CI -5.44 to -1.1), while the lateral diameter was 42% lower (p = 0.03, 95% CI % 0.58 to 11.48), compared to non-obese individuals. The cross-sectional area of the retropalatar region and its relationship with the cross-sectional area in the retroglossal region were also lower in obese (p <0.05). None of these variables correlated with pulmonary deposition of the inhaled aerosol. Meanwhile, BMI was responsible for 32% of the variance of pulmonary deposition (p <0.001; β -0.28; 95% CI -0.43 to -0.11). When analyzed under the subdivision of modified Mallampati grades, obese class 4 subjects had 44% less pulmonary deposition of inhaled radiopharmaceuticals than non-obese subjects in the same classification.

Conclusion of study 1: The anatomical alterations of upper airways, due to obesity, seem to not interfere in pulmonary deposition more than BMI alone. However, obesity associated with modified Mallampati class 4 was responsible for an exacerbation of the difference in pulmonary deposition between obese and non-obese individuals, which may be a detrimental factor to the offer of inhaled medication in the obese population.

Results of study 2: Eleven volunteers with COPD (5 obese) participated in this crossover study. They have comprised the following groups: Simple Inhalation (n = 11) and Inhalation via High Flow Nasal Cannula HFNC (n = 11). On average, the participants had FEV1 of 43%; FVC of 58%; FEV1 / FVC 70% and PEF 30% (based on predicted values). The mean inhalation group, mean lung deposition percentage of 2.8% (IQR3) of the total count, meanwhile, used a 3.0% HFNC (IQR 1.3, p> 0.05; Wilcoxon's test The analysis stratified by BMI (eg, obese and non-obese) were submitted to HFNC and Simple Inhalation (4.1%), and 3.1%, respectively), but not significant (2,8% IQR 2 and 2,7% IQR 4, respectively).
The conclusion of the study 2: The option of high flow inhalation with a nasal cannula favored a pulmonary aerosol deposition, similar to a simple inhalation in patients with COPD, without further benefits to the obese patients.

Study 1: Effects of high-intensity interval training on glucose tolerance in children and adolescents with cystic fibrosis: a randomized controlled trial

Aim: To verify the effects of high intensity interval training on the glucose tolerance of children and adolescents with cystic fibrosis. Methodology: Controlled, randomized and blinded clinical trial, performed from June/2018 to June/2019, at the Child and Adolescent Unit of the University Hospital Onofre Lopes, Natal-RN. There were included 10 individuals, male and female, diagnosed with CF, from 6 to 18 years old. They were allocated and randomized into blocks: control group (CG) and experimental group (EG). Both received educational intervention and the EG performed high intensity interval training for 3x/week for 8 weeks at home. The primary outcome was glucose tolerance. Results: There was no intragroup control and intergroup difference of all outcomes. There was a difference between the pre and follow-up evaluations only of the area under the curve of the glucose (p = 0.04) intragroup experimental. Conclusion: High intensity interval training was not able to increase glucose tolerance in children and adolescents aged 6 to 18 years with CF.

Study 2: Translation, cross-cultural adaptation and psychometric evaluation of the Brazilian version of the Cystic Fibrosis Knowledge Scale (CFKS)

Aim: To translate, cross-culturally adapt and analyze the psychometric properties of the Cystic Fibrosis Knowledge Scale (CFKS). Methodology: Exploratory and psychometric methodological study that involved translation, cross-cultural adaptation and evaluation of the following psychometric properties: reliability, viability, construct, predictive, concurrent and discriminant validity. Results: The Brazilian version of CFKS showed high internal consistency (α = 0.91), moderate floor and ceiling effects, with no differences in test-retest scores. The results of the Kaiser-Meyer-Olkin test (KMO = 0.93) and the Barlett sphericity test (χ² = 3737.54; p = 0.00) indicated an adequate adjustment of the data, allowing the exploratory factorial analysis. Factorial exploration identified three dimensions: "medicinal, physiotherapeutic and social interaction aspects", "gastrointestinal, genetic and reproductive aspects", and "nutritional aspects". There was good predictive validity, with a difference in the scores of the Brazilian version of the CFKS among all the evaluated groups (p <0.001), good discriminant validity, since individuals with asthma had greater knowledge of asthma compared to CF (r = 0.401, p = 0.005). However, there was no difference between the time of diagnosis and knowledge on CF (r = -0.25, p = 0.11) neither between treatment adherence and knowledge on CF (r = -0.04 ; p = 0.77). Conclusion: The translation, cross-cultural adaptation and evaluation of the psychometric properties of the Brazilian version of the CFKS indicated that the scale is able to provide valid, reliable and reproducible measures in the evaluation of the knowledge about CF.

Dual-task activities are characterized by associating cognitive and motor tasks, leading to a greater demand of the neuromotor system for the perception, association and elaboration of an adequate response. Considering the physical, physiological and behavioral changes inherent in the aging process, it is believed that the performance of dual-task activities in the elderly has worse results when compared to younger subjects. In addition, dual-task activities in the elderly are linked to a greater predisposition to falls, a fact that configures a serious public health problem due to the high rates of mortality and morbidity in this population. But despite the several characteristic losses of aging. Thus, knowledge of the brain behavior of the elderly during performance in dual-task activities and the elucidation of an intervention with a better ability to modify their brain activation pattern becomes relevant to improve functional independence in this population. The present study aimed to investigate the influence of an exercise program based on virtual reality on the pattern of brain activation and on the performance of dual task activity in the elderly. A quasi-experimental comparative study with an elderly population (65-75 years), whose sample consisted of 13 subjects of both genders who underwent brain mapping evaluation using the Emotiv EPOC Electroencephalography device during the performance of the Functional Ambulation Test (PTO). After the evaluation, the subjects were randomized into 2 groups, being the experimental group (virtual reality exercises) and the control group (conventional exercises), and completed a 12-week exercise program twice a week. After the protocol was concluded, the subjects were reevaluated following the same criteria of the pre-intervention evaluation. The data captured by the EEG were processed and considered the potential values for the alpha and beta waves. The potentials were tabulated in the SPSS-19 and considering the normalization of the data, the paired t-test was used to compare the means in the pre and post intervention conditions. The data obtained in the performance of the dual task activity (performance time and number of errors) were compared using the Wilcoxon test, considering the non-normal distribution by the Shapiro Wilk test. For the performance in the dual task activities, the results show that: In the DT1 activity, the control group showed a significant reduction in the performance time; For DT2 activity, the experimental group showed a significant reduction in the number of errors. Regarding brain mapping, the results showed a significant increase in the alpha wave in the FC6 area, equivalent to the primary motor cortex, and a significant reduction in the beta wave in the right prefrontal (AF4) and left somatosensory and association cortex (P7) areas. , for the control group, only during the performance of DT1. Thus, from the results found, we conclude that the conventional exercise program was able to express a more significant change in the cortical activation pattern of the investigated subjects when compared to the virtual reality exercise program.

ABSTRACT

Aims: 1) The aim of this study was to evaluate the acute effects of different inspiratory loads and different interfaces on the breathing pattern and activity of the respiratory muscles. 2) The aim of this study was to evaluate the acute effects of different inspiratory resistance devices and intensity of loads via nasal airway on the breathing pattern and activity of the respiratory muscles in children with mouth breathing syndrome. Methods: 1) Twenty healthy adults were recruited and assigned to two groups (20 and 40% of the Maximal Inspiratory Pressure) by way of randomized crossover allocation. Subjects were evaluated during quiet breathing, breathing against inspiratory load, and recovery. The measurements were repeated using two different interfaces (nasal and oral). Chest wall volumes and respiratory muscle activity were assessed with optoelectronic plethysmography and surface electromyography, respectively. 2) Children with mouth breathing syndrome (MBS) were randomized into two groups based on inspiratory load intensity (20% and 40% of the Maximal Inspiratory Pressure). These children were assessed during quiet breathing, breathing against inspiratory load via nasal airway and recovery. The measurements were repeated using two different devices (pressure threshold (PT) and flow resistance (FR)). Chest wall volumes and respiratory muscles activity were evaluated by optoelectronic plethysmography and surface electromyography, respectively. Results: 1) During the application of inspiratory load, significant changes were observed in the respiratory rate (p < 0.04), inspiratory time (p < 0.02), minute ventilation (p < 0.04), tidal volume (p < 0.01), end-inspiratory volume (p < 0.04), end-expiratory volume (p < 0.03), and in the activity of the scalene, sternocleiomastoid, and parasternal portion of the intercostal muscles (RMS values, p < 0.01) when compared to quiet breathing, regardless of the load level or the interface applied. Inspiratory load application yielded significant differences between using nasal and oral interfaces with an increase in the tidal volume (p < 0.01), end-inspiratory volume (p < 0.01), and electrical activity of the scalene and sternocleiomastoid muscles (p < 0.01) seen with using the nasal interface. 2) : During the application of inspiratory load, significant changes occurred in respiratory rate (p<0.04), inspiratory time (p<0.02), total time of respiratory cycle (p<0.02), minute volume (p<0.03), tidal volume (p<0.01) and scalene and sternocleidomastoid muscles activity (RMS values, p<0.01) when compared to quiet spontaneous breathing and recovery, regardless of load level or device applied. The application of inspiratory load using the FR device showed an more increase in the tidal volume (p<0.02) and end-inspiratory volume (p<0.02) when compared to PT. Conclusion: 1) The addition of an inspiratory load has a significant effect on the breathing pattern and respiratory muscle electrical activity, and the effects are greater when the nasal interface is applied. 2) The addition of inspiratory loads using a nasal interface has a positive effect on the breathing pattern and electrical activity of the inspiratory muscles, and the FR device is more effective for lung volume generation.

Abstract

Introduction: Dyspnea is one of the most common symptoms of exertion in chronic heart failure with reduced left ventricular ejection fraction (rEFI) and relentlessly progresses with disease progression, leading to reduced functional capacity. Therefore, investigations into the use of noninvasive ventilation (NIV) or respiratory muscle training (RMT) may optimize exercise tolerance during Cardiovascular. NIV use has shown encouraging results in reducing cardiorespiratory work, while new protocols involving the combination of inspiratory muscle training (IMT) and expiratory muscle training (EMT) may be innovative and have an additive effect, further improving performance outcomes exercise after TMR, but evidence of the effectiveness of such an approach is not well established at this time. Although ventilatory inefficiency in HF may be aggravated as a result of expiratory muscle weakness, EMT is unclear in the literature, there are only a number of case reports showing improvement in ventilatory parameters and these beneficial effects have not yet been confirmed by randomized studies. We hypothesized that the modality combining EMT plus IMT plus CR may have superior or similar effects to the use of NIV plus CR. Objectives: The first study aimed to analyze the effects of EMT plus IMT plus CR versus CR plus NIV on exercise tolerance, respiratory muscle performance and quality of life in the HFrEF. The 2nd study; The objective was to evaluate the additional benefit of EMT plus IMT associated with aerobic exercise (AE) when compared to IMT plus AE alone in HFrEF. The third study was a systematic review that aimed to evaluate the effects of IMT on oxygen uptake (VO₂) kinetics in individuals with HF compared to healthy individuals. Methods: The research was divided into three stages. Initially, a randomized clinical trial was conducted involving 17 patients with CHF who were allocated to Group 1 RC-control (n = 6), Group 2 - RC + NIV (n = 5), Group 3 - TME + IMR plus CR (n = 6). = 6). All patients were evaluated before and after 12 weeks of the structured supervised CR program three times a week. Group 1- RC supervised. Group 2 - RC + NIV with Continuous Positive Airway Pressure (CPAP) mode using the VPAP TM Auto 25 ResMed System (ResMed® USA). The CPAP was gradually adjusted to 8 cmH2O for 20 minutes. CR plus RMT, for 30 minutes, being 15 minutes with inspiratory load up to 40% of maximal inspiratory pressure (MIP) and 15 minutes with expiratory load between 5 and 15% of MEP. according to the protocol performed in the study by Cahalin et al. The second study: was a randomized controlled trial; Fourteen patients with rFRIF and respiratory muscle weakness were randomized into three groups: Group 1: Aerobic exercise (AS; control); Group 2: AE plus IMT (40% MIP load), Group 3; EA + IMT plus EMT (5-15% MEP load), and received exercise program for 12 weeks. And the third study; the systematic review; The search included the MEDLINE, PEDRo, Embase, Cinahl and Cochrane Central bases to evaluate the effects of IMT on VO₂ kinetics. Results: Therefore, in the first study: when compared to NIV versus EMT + IMT, these complementary therapies associated with CR were similar for six-minute walk distance (6MWD) and VO₂peak, but there was a significant difference in the Minnesota Living with Heart Failure Questionnaire. (MLHFQ) compared to control (24.6 vs. 19.2 in CR plus NIV, P = 0.0001; and 26.6 vs. 19.2 in CR + EMT plus IMT, P <0.0001). CR plus NIV led to further increase in forced vital capacity (FVC). CR plus TME + IMR showed additional benefit in maximal inspiratory and expiratory pressures (p <0.0001) when compared to both NIV plus CR and control group. Both CR plus NIV or CR associated with EMT plus IMT can provide additional quality of life benefits. However, the combination of EMT plus IMT and CR has been shown to be better in improving ventilatory muscle performance in CHF patients. In the second stage; Training combining IMT plus EMT demonstrated further improvement  in DC6M, (339 ± 39 vs. 434 ± 31; P = 0.037); maximal voluntary ventilation (MVV; 69.6 ± 2.7 vs.77.4 ± 4.0; P = 0.021), compared to AE alone. And in PEmax; (75 ± 13 vs. 115 ± 16; p = 0.002); when compared to either IMT plus EA or isolated EA. The study suggests that AE plus IMT + MST may contribute to additional MEP gain; compared to IMT + AE and to optimize exercise tolerance in patients with HFrEF compared to isolated AE. And in the third stage the systematic review that included three randomized trials evaluating the effects of IMT on VO₂ kinetics; demonstrated that IMT in HF can significantly improve VO₂ recovery kinetics, meaning differences in VO₂ kinetics of -0.66mL / kg / mi (95% CI, -0.84 to -0.47; n = 56). However, there is no significant difference in VO₂ peak for participants in the IMT group compared to the control group. Bailey et al .; They also did not observe significant changes in VO₂max in healthy subjects during the incremental test after the IMT or Sham intervention, but the amplitude of the slow oxygen uptake kinetics was 

reduced and the initial maximal inspiratory pressure increased significantly. However, in the analysis of VO₂ kinetics there were a small number of participants and, according to the GRADE approach, the quality of evidence presented by this result was low due to limitations in methodology, inaccuracy and inconsistency of results.

Introduction: Women tend to be more vulnerable than men to aging due to social, biological and hormonal factors, favoring the onset of sarcopenia (muscle mass reduction with advancing age and may be associated to impairment in function and strength). The International Working Group on Sarcopenia (IWGS), the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS) are the main consensuses in studying sarcopenia around the world; which has developed different diagnostic criteria for the sarcopenia. Objective: To compare the diagnostic criteria of sarcopenia by different consensuses in women living in community. Materials and Methods: This is a cross-sectional analytical study composed of 472 women between 40 to 80 years old, divided into three groups (40 to 50 years, 51 to 60 and 61 to 80). Socio-demographic and socioeconomic data, regular physical exercise and anthropometric measurements were collected. Muscle mass, handgrip strength and walking speed were evaluated. Following the standardization established in the consensuses, cutoff values were generated for muscle mass, walking speed and handgrip strength, and from these cutoff values, prevalence of sarcopenia were found using the diagnostic criteria of the three protocols. Results: The cutoff values found for muscle mass, walking speed and handgrip strength were 5.92 kg/m², 0.78 m/s and 21.33 kgf, respectively. The lowest prevalence of sarcopenia in all three age groups was observed in the IWGS diagnostic criteria (group 1 - 3.00%, group 2 - 1.30%, group 3 - 15.70%). The highest prevalence of sarcopenia was equally observed in both the EWGSOP and AWGS consensuses (group 1 - 5.00%, group 2 - 6.00%, group 3 - 23.10%). Conclusion: In all three age groups, the prevalence of sarcopenia using the EWGSOP diagnostic criteria was exactly the same as for the AWGS, being much different and higher than the prevalence results using the IWGS diagnostic criteria.

Introduction: Balance confidence is described as “a person’s ability to maintain balance while performing activities of daily living” and is affected by an individual’s beliefs. Therefore, an individual who report a low confidence in balance may present lower postural balance performances. One of the most used tools to quantify the balance confidence of the community-dwelling individual is the Activities-specific Balance Confidence (ABC) scale, in its original (ABC-16) and short (ABC-6) versions. The ABC scale was translated and adapted to the Brazilian older adults. However, the study of the psychometric properties is still required and also cut-off points for both scales have not been provided yet. Objectives: To investigate the psychometric properties of the ABC-16 and ABC-6, and to determine cut-off points capable to identity community-dwelling older adults with deficits in postural balance and higher risk of falling. Methods: This is a psychometric study that followed the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). This study took place from April 2017 to November 2017. The level of balance confidence was assessed by the ABC-16 and ABC-6. To assess the interrater reliability, two evaluations with a 30-minute interval was performed by distinct evaluators. After one week, one of the evaluators re-applied the ABC-16 to verify the intrarater reliability. The order of the evaluators was chosen randomly. A third examiner assessed the postural balance of the individuals through the Berg Balance Scale (BBS), the modified Clinical Test of Sensory Interaction on Balance (mCTSIB) and the Unilateral Stance (US), the fear of falling through the Falls Efficacy Scale-International (FES-I), and mobility through the 4-m walk test (4MWT). Results: The ABC-16 and ABC-6 showed a statistically significant correlation with most of the measures of postural balance, FES-I and 4MWT. The ABC-6 also presented statistically significant correlation with the gold standard, the ABC-16 (r=0.958, p<0,001). The internal consistency analysis of the ABC-16 and ABC-6 yielded a Cronbach’s α value 0.943 and 0.901, respectively. Both ABC-16 and ABC-6 presented excellent intra and interrater reliability. The Receiver Operating Characteristics (ROC) curve indicated a value of ≤67% as the best cut-off point to identify older adults with balance impairments in the ABC-16 (sensitivity: 81%; specificity: 77.4%), and ≤44% (sensitivity: 87.5%; specificity: 82.1%) in the ABC-6. Conclusion: Both ABC-16 and ABC-6 have an overall good validity, and excellent internal consistency, and intra and inter-rater reliability. Therefore, these scales are suitable tools for assessing balance confidence in the Brazilian community-dwelling elderly people.

Objective: to evaluate the probability of the risk of falls in the elderly with DM2. Methodology: a cross-sectional observational study with a sample of 111 elderly patients aged 60 years or older, diagnosed with T2DM, of both sexes, attended at the outpatient clinics of the University Hospital from UFRN, Natal, Brazil. They were evaluated for sociodemographic, clinical-functional, psycho-cognitive data (through the Mini Mental State Exam-MEEM and Geriatric Depression Scale-GDS), postural balance (through the Mini BEST test), functional performance (WHODAS 2.0) and the risk assessment for falls with the Quick Screen Clinical Falls Risk Assessment (QuickScreen). The inferential analyzes were performed using Kruskall-Wallis and Chi-square tests or Fisher's exact test, with a significance level of 5% (p<0,05).Results: The mean age of the sample was 68,6 (± 6,5) years, the age range was 60-69 years (64,9%), the majority were female (64%), married (68,5%), schooling up to the "fundamental I complete or fundamental post (64%), participants in community activities (58,6%), housing arrangement "with company" (96,4%), salary of "3 or more minimum wages" (51,4%), non-practitioners of physical activity (73,9%), subjective perception of general health (58,6%) and vision (55,0%) as "excellent, very good or good", pain in lower limbs (48,6%). There were between 1 and 10 comorbidities, with predominance of circulatory disease (78,4%), five or more medications used (67,6%), on what 91,0% were oral medications for DM2 and the minority required insulin (30,6%).The time of diagnosis of DM2 was over than five years (61,3%). They did not suffer fall events in the last year (70,3%), with reports of fear of falls (80,2%) and tendency (50,5%) to falls. Prevalence was 13% with 2-3 risk factors for falls (35,1%), with a minimum of 0 and a maximum of 8 factors (mean of 3.45 ± 1,99 factors) and a minimum probability of 7% and maximum of 49% (mean 21,64% ± 13,55%). There was statistical significance between "probability of risk of falls" and variables: schooling (p=0,005), general health (p=0,001), vision (p=0,017), number of diseases (p<0,0001), number of medications (p=0,0001), disease of the circulatory system (p=0,021), time of DM2 (p<0,0001), insulin (p=0,038), pain in lower limbs (p<0,0001),cutaneous-protective sensitivity (p<0,0001),  GDS (p<0,0001), TUGT (p=0,022), decreased palmar grip strength (p<0,0001), WHODAS 2.0 (p<0,0001) and Mini Best (p<0,0001).Conclusion: Elderly patients with DM2 are more likely to be at risk of falls when associated with lower education, worse general perception of health and vision, greater number of diseases and medications, longer diagnosis of DM2, presence of pain in lower limbs, cutaneous protection sensitivity altered, history of one or more falls in the last year, perception of falling tendency, presence of depressive symptoms, decrease in palmar grip strength, worse performance on TUGT, worse functional performance and worse postural balance.

Introduction: Pregnancy and childbirth are unique in a woman’s life and for these moments to be lived integrally and have positive closures it is important that the pregnant woman is empowered about her process. Multidisciplinary antenatal educational programs have a fundamental task on the supply of information about the pregnancy-birth-postpartum cycle, on the strengthening of the female autonomy and consequent pregnant woman empowerment. Objective: Analyze the effects of an antenatal educational program on the empowerment of pregnant women related to their gestational process and childbirth. Methods: It is a quasi-experimental, longitudinal study. The pregnant women subscribed voluntarily on the educational program for pregnancy, childbirth and postpartum and passed through a series of evaluations before and after the intervention and after childbirth. Data was collected in the Physical Therapy Department of the Federal University of Rio Grande do Norte. Results: 62 pregnant women were included (mean age: 30,39 ± 5,3 years old and gestational age: 24,1 ± 5,8 weeks. There was no significant results on the empowerment, fear of childbirth and fear of pain. 53,8% felt discommodity during childbirth, and 100% of the participants who had been through labor related that the antenatal education has helped them to deal with pain in childbirth. Conclusion: Antenatal education helps pregnant women to cope better with pain during the parturition process.

Introduction: Although there are many similarities in brain structure and function in healthy men and women, there are important differences that distinguish the male brain from the female brain, leading to distinct neuroelectric brain responses. Nowadays, one of the techniques that has allowed the monitoring of the brain in activity is the electroencephalography, from non-invasive interfaces and wireless. Thereby, it becomes possible to understand the process of brain activation in a motor task based on virtual reality, which is a therapeutic resource increasingly used. Objective: To investigate the influence of a motor task performed in a virtual environment on the brain activity of healthy young men and women. Methodology: This is a comparative study, involving 30 individuals who were divided into two groups: female (A) and male (B). After undergoing a physical therapy assessment and cognitive status, through the Mini Mental State Examination, they were submitted to a session (20 minutes) of balance training in virtual reality (VR) during which the electroencephalic activity was recorded by Emotiv Epoc for evaluation of cortical activity. Finally, they were asked about their experience with VR. Results: In the Penguim Slide, Soccer Heading and Table Tilt games the means of activation potential in all channels were higher in the men group. In the game Balance Bubble the women presented greater activation. Already in the game Tight Rope, men and women presented similar pattern of cerebral activation. Conclusion: it was verified that virtual reality, in situations of immediate exposure, is capable of leading to a different brain activation, according to the chosen game.

Introduction: Duchenne Muscular Dystrophy (DMD) is the most common form of myopathy affecting children of the male gender. As the disease progresses, respiratory muscle involvement leads to muscle weakness and reduced lung and chest expansion, with retention of secretions, due to the inability to generate an effective cough. Several factors determine the effectiveness of coughing. Since posture acts on peak cough flow (CPF) and respiratory muscle activity in DMD is not yet established. Objective: To evaluate and compare the acute effects of different postures on CPF variations and electromyographic activation of respiratory muscles in subjects with DMD versus healthy paired subjects. Methods: CPF, tidal volume (VT) of the chest wall compartments (pulmonary thoracic cavity and the abdominal thoracic cavity) and abdomen (AB) were evaluated through Optoelectronic Plethysmography and respiratory muscle activation: sternocleidomastoid (SCM) scalene (ESC), abdominal rectus (RA) and external oblique (EO) through surface electromyography (EMGs). The evaluation was performed in three positions: supine, supine with head elevated at 45^o (45^o) and supine with head elevated at 80^o (80^o) in subjects with DMD, Duchenne group (DG), paired with healthy subjects, control group (CG). Results: 35 individuals with DMD were assessed (23 excluded), of whom 12 subjects composed the DG being paired with 12 healthy subjects, who composed the CG. It was observed a significant increase of the CPF in 80^o in the DG when compared to the supine position (4.89 ± 2.11 vs 3.59 ± 1.59, p <0.01), without differences in the CG. The intergroup analysis showed that the DG presented lower CPF values (p <0.001) compared to the control group, in the respective positions: supine (3.59 ± 1.91 vs 10.11 ± 4.63, p <0.001); 45° (3.92 ± 1.59 vs 9.18 ± 4.36, p <0.01); and 80^o (4.89 ± 2.11 vs 10.35 ± 3.79, p <0.01), respectively. In the inspiratory phase of cough, an increase in inspiratory air volume of the chest wall (p <0.05) at position 80^o was observed compared to the 45^o position of the CG, with no significant differences in the DG. In the expiratory phase of cough, an increase in inspiratory air volume (p <0.05) was observed in 80^o compared to supine position of the DG, with no statistical differences in the CG. Both the inspiratory and expired chest wall volume were higher at the 80^o position of the CG (p <0.05) compared to the respective DG position. During the inspiratory phase of cough, intragroup analysis of EMGs showed an increase in SCM activation by 80o (p <0.01) in relation to supine position in both groups, and an increase in ESC (p <0, 05) was observed at position 80o to position 45o, only in the GD. Intergroup analysis showed a greater activation of ESC at 80o (p <0.05) and RA and EO at the three positions (p <0.001) in the DG compared to the respective CG positions, during the inspiratory phase of the cough . During the expiratory phase, greater ECM activation was observed in the supine position (p <0.05) in the DG compared to the respective CG position, with no intergroup differences. Our results show that cough is favored the more erect the positioning, with greater activation of the inspiratory muscles in individuals with DMD in the inspiratory phase. While the healthy posture did not influence the PFT values, only the activation of the inspiratory muscles during the inspiratory phase of the cough.

Introduction: Sroke has been presenting with great incidence, occupying the second place in mortality. Most survivors have significant functional limitations in the upper limbs, even after an intense and prolonged rehabilitation program. In view of this situation, virtual reality has been increasingly used in Neurorehabilitation, but the evidence on the influence of this training on the body pattern of patients affected by stroke is still scarce. Objective: To compare the body standard in the preparation and execution of real and virtual data games in stroke patients. Method: The sample consisted of 8 hemiparetic individuals, aged 42-62 years and injury time from six months to three years. The virtual darts game was held in the XBOX 360 Kinect and the actual in the professional darts game, where participants performed 15 attempts of each game. During the preparation and execution of the games, the patients were filmed and kinematic analysis of the head, shoulder and trunk was performed by Kinovea Software. Statistical analysis was performed using the chi-square test, in order to compare the percentage frequency of patients who performed the neutral, anterior and posterior position of the head, shoulder and trunk in the virtual and real games. Results: There was a predominance of head anteriorization in individuals with right-hand impairment, in the preparation and execution, in both games. Among individuals with left-sided impairment, the virtual play had higher values for head anteriority (p <0.001) and head in the neutral position (p <0.001) in the preparation. In the execution, head anteriority  in the real game was higher (p <0.001) and the virtual game provided more posterior position of the head (p <0.001) and in the neutral position (p <0.001). Both games presented a trunk and shoulder posteriorisation pattern for individuals with left and right impairment in the preparation and the same pattern in the execution. The results will be discussed taking into account the decision to include real and virtual darts in neurorehabilitation of stroke patients.

Objectives: To verify the effects of different intensities of static passive stretching (SPS) on ROM, passive torque and functional performance in amateur soccer players. Methods:  41 male subjects, soccer players, randomly divided into 4 groups: Control Group (CG), Comfort Zone Stretching Group (GAC), Discomfort Group (GDES) and Pain Group (GDOR). Ten sessions were performed, divided in 3 weekly sessions, with 3 maneuvers of 30 s, with different intensities established from PERFLEX. ADM evaluations of knee extension andhip flexion of non-dominant  lower limbs, passive and active (KAE, KPE, HAF and HPF), passive peak torque (PT), PT peak ROM (ROM TP),  viscoelastic relaxation stress (SRV) and shuttle run test, performed before and immediately after the first session, and 48h after the last session. Results: GDOR and GDES presented increases in KAE variables (+ 8.17 ± 1.8, + 7.1 ± 2.7%, p <0.001), KPE (+ 8.6 ± 2.1, +6, (P <0.001, p <0.001), HAF (+10.3 ± 3.2, +10.8 ± 5.8%, p <0.001 and p = 0.031) and HPF (+ 11.7 ± 3, 6, + 8.9 ± 6.4%, p <0.0001) at the 48th hour after the 10th session, however, did not present any differences between them. There were no differences in the variables of TP, ROM TP, SRV and shuttle run test in any of the evaluated moments. Conclusions: Pain and discomfort improve ROM without negatively interfering with the functional performance of soccer amateur athletes. Improvements in ROM may be related to increased elongation tolerance rather than changes in PT.

Introduction: The mental practice (MP) is a cognitive strategy that enable serial mental training of a motor task without its physical implementation. This practice has been applied in a sort of neurological disorders rehabilitation and it has been revealed positive effects in planning and motor learning. Generally, individuals with Parkinson Disease (PD) show neurophysiological, motor and cognitive alterations since the disease progression makes necessary external strategies to assist the neuronal and motor organization. One of those strategies is the MP although there are no clear evidences in the literature about its applicability in PD patients yet. Therefore, the need arose to create protocols of effective and comprehensive trainings to direct and to introduce the best therapeutic approaches in clinical practice to optimize the PD patients’ rehabilitation process. Objective: To elaborate a MP training protocol associated with physical practice (PP) of gait on soil. In addition, to verify its appropriateness and applicability in PD individuals. Methods: It is a controlled, randomized and single blind clinic trial with 40 PD patients aged between 45 and 75 years, which have no cognitive deficit diagnosed, they are at a light to moderate stage of the disease and have the capacity to generate mental image. All participants will be evaluated by their cognitive level, physical disability level, mental image clarity, mobility and kinematic variables of gait on soil (spatiotemporal and angled). The individuals will be randomly distributed into experimental group (EG) and control group (CG). The EG will perform mental practice and physical practice of gate on soil. There will be held 12 training sessions of 1 hour in duration each, 3 times a week for 4 weeks. Then, one and seven days after the last training session, the patients will be revaluated by the kinematic variables of gait and mobility. Data analysis will be verified using Shapiro-Wilk. A ANOVA 2x3 repeated measures will analyse the interaction between the groups at some moments of observation. Results: The preliminary results reveal no significant differences between those groups. However, there is an intragroup (EG) difference about the support and swing total time of the most affected limb. Conclusion: The original protocol of MP associated with PP on PD individuals’ gait training demonstrated to be unfeasible.

Introduction: Chronic low back pain (DLC) is defined by persistent pain occurring on most days and staying for more than 3 months. Many pathological conditions may lead to the onset of this pain, but the vast majority of DLC cases do not present anatomopathological or radiological alterations. Among the non-pharmacological resources for the treatment of this disorder are electrophysiological resources, such as Cryotherapy and Transcutaneous Electrical Nerve Stimulation (TENS) in Burst mode. Objective: To observe the influence of the combination: Cryotherapy and TENS Burst on the pain sensation, functional capacity and quality of life of patients with chronic nonspecific low back pain. Materials and methods: This is a randomized, blinded, controlled clinical trial conducted at Hospital Universitário Onofre Lopes. Fourty-four individuals of both sexes were randomly divided into four groups: control-placebo group (gCP), cryotherapy group (gCrio), TENS-Burst group (gTENSb) and cryotherapy + TENS Burst (gCrioTENSb). All the subjects were submitted to the measures of evaluation of: Pain through the Visual Analogue Scale (EVA) and pain threshold by pressure by the Algometer; Functional ability by the questionnaire  Roland-Morris and the sit-up test; Quality of life through questionnaire SF 36; besides the feeling of pleasure / displeasure of the intervention by Felling Scale. Pain was assessed before and immediately after the first session, after week 1, week 2, week 3 and after 48 h of week 3 of the protocol. The functional capacity and quality of life were evaluated before and 48h after the end of the protocol, on the last day of evaluation the pleasure / displeasure sensation was also evaluated. The intervention protocol was 40 minutes, being 10 minutes of education about the disease and 30 minutes of intervention: Cryotherapy, TENS, placebo or Burst, or the combination of resources depending on the group allocated. Data were analyzed using the statistical software SPSS 20.0, assigned the level of significance of 5% and presented in mean and standard deviation. The Kolmogorov-Smirnov test was used to test the normality of the data. As the data presented a normal distribution, the one-way ANOVA test was used to evaluate baseline between groups (initial data) and feeling scale, mixed ANOVA among the four groups studied ANOVA (gCP, gCrio, gTENSb and gCrioTENSb) in both evaluations. The ANOVA of repeated measures for pain sensation, skin temperature and intensity of electrical stimulation. Results: There was no statistical difference between the groups on VAS, pressure pain threshold, MRI, sit-up test, SF-26 and Felling Scale (p> 0.05). Conclusion: This study showed that all groups achieved improvement: pain immediately after the first session and post treatment protocol, functional capacity, quality of life domains and felling scale post treatment protocol without difference between groups in patients with non-specific.

Introduction: Fisiologic changes resulting aging alter postural balance and various approaches have been increasingly used for its maintenance or improvement, highlighting Virtual Reality (VR). VR enables an interactive experience through using games with enriched and complex environments. Most commercial games are used as treatment strategies, however, they were not designed to stimulate motor and cognitive domains. Serious games emerge with a purpose that goes beyond entertainment. Their development in the VR environment enables sensory, motor and cognitive training, in addition to providing content and feedback with personalized goals for the user's specificities, providing adjustments with therapeutic purpose involving learning, adherence and challenges. Objective: To perform content validation of the VirtuAlter serious game for postural balance rehabilitation in elderly by virtual reality. Methodology: This is a descriptive study that contemplates two integrated modalities: 1) Identification of upper limb lateral reach reference values in healthy elderly subjects – Analysis of the lateral reach of 20 healthy elderly people who underwent an assessment with the instruments: Socio-demographic evaluation, Berg Balance Scale, Short Physical Performance Battery; Lateral Reach Test (TAL); Lateral reach analysis using the Microsoft® Kinect motion capture system (AL Kinect). 2) Content validation of the VirtuAlter serious game by the analysis of eleven expert judges physiotherapists and professionals in the area of science and technology or correlated areas – The Delphi technique will be implemented where judges will play the game as many times as needed and express their opinions about the game content and filling the tools: Dimensions of content validation of the serious game VirtuAlter and System Usability Scale (SUS). Results: In the stage 1, it was observed values in TAL and AL Kinect of 23.2±4.77; 21.1±5.47 on the right side and 22.9±4.86; 22.7±6.42 on the left side, respectively. The Balnd-Altman dispersion model showed bias of 0.19 for left side and 2.02 for the right side. In stage 2, five physiotherapists and six professionals in the area of science and technology participated of the validation. The total IVC value of the game was 0.8 and the Cronbach alpha coefficient was 0.924. The technical elements, clarity of the game narrative, image quality and speed of motion capture need modifications and adjustments. The judges identified the game with a satisfaction score of 67.73 on the SUS scale. Conclusion: The mean values of the lateral reach in healthy elderly will be adopted with the game parameters in its applicablity in elderly with balance impairment. It is necessary the technical elements improvement before clinical execution. The VirtuAlter content is validated and corresponds to a proper technological tool for the training of postural balance of elderly with good usability.

Stroke is a pathology that causes several motor and functional impairments. The aim of the study was to evaluate the sleep-wake pattern in stroke patients. The sample consisted of 10 patients (3 women and 7 men, mean age = 51 ± 6 years) and 10 healthy subjects (3 women and 7 men, mean age 52 ± 7 years). Participants were assessed by a sociodemographic and clinical evaluation sheet, National Institute of Health Stroke Scale for neurologic evaluation, Fugl- Meyer scale for motor function evaluation, Pittsburgh Sleep Quality Index for sleep quality evaluation and sleep-wake pattern objective evaluation by Actigraphy (Actiwatch 2, Philips Respironics®, Andover, MA, USA) for 7 consecutive days. Data analysis was performed using the unpaired t'Student test and Pearson's correlation test. The findings revealed a significant difference between patients and healthy individuals in the IQSP, with patients presenting poor sleep quality (patients=6±4, healthy=4±2, p=0.044). Actigraphic analysis demonstrated that stroke patients showed lower level of activity both the wake phase (patients=142315±64367 counts, healthy=304392±88192 counts, p<0.0001) and the sleep phase (patients=3874±3279 counts, healthy=7812±4732; p<0.0001); longer sleep duration (patients=480±101 minutes, healthy=426±70 minutes, p=0.020); lower wake time (patients=896 ± 91 minutes, healthy=972±93 minutes, p=0.002). Additionally, it was verified that in relation to the variables of circadian rhythmicity that patients presented higher Interdaily Stability (IS) (patients=0.4±0.1, healthy=0.3±0.2, p=0.028), and higher Intradaily Variability (IV) (patients=0.7±0.1, healthy=0.6±0.1, p<0.001); lower values of M10 (patients=32.3±11.7, healthy=62.6±14.9, p<0.0001) and of L5 (patients=17.5±6.8, healthy=41.2±12.6, p<0.0001). We found a significant correlation between the IQSP and the activity level during wake phase (r=-0.32, p=0.007) and IQSP and IV (r=0.53, p=0.017). The results suggest that the activity level, stability and fragmentation of the activity rhythm may alter the sleep-wake pattern and cause problems on sleep quality in stroke patients, which may be a temporal marker for the planning of therapeutic intervention during neurorehabilitation.

Objective: To investigate the effects of extracorporal shock wave therapy (ESWT) on on triggers point myofascial, pain and performance neuromuscular of upper trapezius muscle fibers.  Materials and methods: A randomized, blinded clinical trial of 60 women (22.8 ± 2.95 years, mean weight of 55.68 ± 7.35 kg, height of 1.61 ± 0.59 cm and mass index body weight of 21.37 ± 2.39 kg / cm2) with presence of trigger points in the upper fibers of the trapezius muscle. They were submitted to an initial evaluation (AV1), composed of the subjective report of pain (through the visual analogue scale), evaluation of pain threshold (through algometry), number of active and latent trigger points and activity electromyography of the upper trapezius muscle at rest and during contraction.Instead, volunteers were allocated randomly into three groups: Control (n = 20), without intervention; placebo (n = 20), simulation of the application of ESWT and ESWT (n = 20). The ESWT was performed with the Master Plus 200® Storz Medical equipment, radial emission of 2000 pulses, frequency of 15 Hz and pressure of 2 Bar, tip of 6 mm². All volunteers were reassessed immediately and 48 hours after the intervention protocol (evaluation 48 hours).A mixed ANOVA of repeated measures and used for intragroup and intergroup comparisons, by Tukey post hoc. Significance was set at 5%. Results: There was a reduction of pain due to VAS in the placebo group and ESWT, the after 48 h was lower in all groups when compared to control. In the variable number of total trigger points, we observed a difference between the ESWT and placebo groups, also in the 48 h evaluation. No significant difference was observed in pain threshold, electromyographic amplitude and peak torque analyzes. Conclusion: A ESWT in the treatment of myofascial pain in women has the same result as the placebo treatment.

Objectives: To translate, transculturally adapt and evaluate the psychometric indicators of the Brazilian version of the PedsQL^TM Asthma Module - Short Form 22. Materials and methods: An exploratory methodological study carried out in two stages: linguistic validation (translation, back translation, multiprofessional committee review and pre-test) and and evaluation of the psychometric indicators of the instrument (reliability, reproducibility, content validity, construct validity, and concurrent validity). Socioeconomic status (Brazil Economic Classification Criteria); clinical control (Childhood Asthma Control Test (c-ACT) and Asthma Control Test (ACT)); health-related quality of life (HRQOL) (Pediatric Asthma Quality of Life Questionnaire (PAQLQ) e PedsQL^TM Asthma Module) and spirometry were used for evaluation. The feasibility, reliability, and reproducibility of the measurements obtained with the Brazilian version of the instrument were evaluated through the floor and ceiling effect, Cronbach's alpha coefficient and test-retest (subgroups "with change" and "without change"), respectively. The construct validity was evaluated by the exploratory factorial analysis (EFA) and the concurrent validity by the correlation between the Brazilian version of PedsQL^TM Asthma Module SF 22 and PedsQL^TM Asthma Module, PAQLQ, c-ACT/ACT and FEV₁ and FEV₁/FVC. Results: The first step included 57 participants (26 patients between 5 to 18 years and 31 parents/guardians). In the second step participated 234 individuals, of which 117 were patients between 2 to 18 years and 117 parents/guardians. All items of the questionnaire were clear and understandable (agreement ranging from 0.78 to 1.00). In the pre-test (n = 57), no participants had difficulty understanding (agreement above 0.90). The Brazilian version of the instrument had an internal consistency of 0.83 and 0.77 for the version of children/adolescents and parents/guardians, respectively. The test-retest indicated moderate/strong correlations between measures, in the groups with and without change. The internal structure of the Brazilian version of PedsQL^TM Asthma Module SF 22 was evaluated through exploratory factorial analysis (EFA). From the acceptable adjustment indexes, the EFA was performed. Pre-determined 03 factors of orthogonal rotation (varimax) were identified for each domain (asthma symptoms and treatment problems) in the children/adolescents and parents/guardians versions to which they explained an adequate cumulative total variance. The main HRQOL indicators of children and adolescents with asthma were those related to shortness of breath, emotional function and difficulties in adhering to treatment. Conclusion: The PedsQL^TM Asthma Module SF22 is translated and transculturally adapted for the Brazilian population. In addition, the Brazilian version was able to provide valid and reliable measures for the assessment of the HRQOL of children and adolescents with asthma.

Introduction: Mobility in the elderly is the ability to move from home environment to beyond the community where they live. Preservation of mobility is considered essential for active aging, being closely linked to health status and quality of life. The Life-space Mobility (LSM) restriction of community-dwelling elderly can predict the need for future health care. Contextual factors such as life history, social, environmental and personal aspects are considered determinants for the maintenance of the living space in the elderly.
Objectives: To know through a systematic review about contextual aspects that interfere or modify the LSM, and to identify the associations between Life-Space Assessment (LSA) and Life course adversities in old age in five populations with different epidemiological contexts.
Methods: A systematic review was performed according to PROSPERO protocol, previously published. A cross-sectional study, lined up to cohort, was conducted with a sample of 1995 elderly individuals living in 5 distinct sites (Kingston and Saint Hyacinthe in Canada, Tirana in Albania, Manizales in Colombia and Natal-RN in Brazil). The Life Space Assessment (LSA) were analyzed through multivariate analysis (multiple linear regression), adjusted for variables of physical health, mental health, social support and adversities in the course of life.
Results: The systematic review identified 3484 studies, only 41 were considered by inclusion criteria, and classified with better methodological quality. The literature highlights associations between life space mobility and environmental contextual factors (products / technology and physical characteristics of the environment) and personal (sociodemographic characteristics, life experience, individual psychological characteristics, health and quality of life perception, and mortality index). The cross-sectional study identified that life-space mobility was significantly related to contextual aspects, such as: social support (β = 0.041, p-value = 0.035), community barriers (β = -0,128, p-value = 0.000), perception of safety (β = 0.093, p-value = 0.000) and social capital (β = 0.045, p-value = 0.026). In addition, we highlight that the total LSA score is inversely related to adulthood adversities (β = -0.114, p-value= 0.000) and directly related to old age adversities (β = 0.073, p-value= 0.001), but there was no association with childhood adversities (economic adversities: p-value = 0.607 and social adversities: p-value = 0.899).
Conclusion: Low life space mobility rates are related to environmental and personal contextual factors. We identified that life space mobility is influenced by adulthood and old age adversities, but not by childhood adversities. Positive contextual factors such as social support and a favorable environment, as well as old age adversities (insufficient income and living alone) can be motivating aspects of better life space mobility. The adversities in adulthood as low schooling and semi-skilled manual occupation are predictors of mobility restriction in older people.

Introduction: It is known that even after a complete spinal cord injury (cSCI) there may be preserved axonal pathways below the lesion level, which can be demonstrated by surface electromyography (sEMG). However, little is known about the transverse and longitudinal behavior of the signal and its spectral properties in response to sensory afferent due to the load associated with the supraspinal descending commands during attempted steps. Objectives: 1) To investigate the presence of preserved efferent axonal pathways in individuals with cSCI by analyzing the temporal and spectral behavior of the EMG signal of muscles below the level of the lesion during attempted voluntary movement in orthostatism; 2) To analyze the behavior of the temporal and spectral properties of the signal sEMG of muscles below the lesion in individuals with cSCI and the presence of afferent and efferent modulation during execution of locomotor tasks. Methods: It is an observational analytical study in which 3 individuals with cSCI and chronic (more than 1 year after injury) participated. The sEMG signal of muscles located below the lesion was recorded by repeated measurements during two steps. In the first stage, the EMG signal was recorded in the assisted orthostatic posture concomitant with the attempt to take steps according to 4 verbal cues (FAST, SLOW, HIGH, and LONG). In the second stage, the EMG signal of the same muscle groups was recorded during the Lokomat® robotic orthosis-assisted gait training without commands, concomitant to the attempt to take steps according to 2 verbal commands (HIGH and LONG). It was analyzed the behavior of the EMG signal of the following muscles rectus femoris (RF), biceps femoral (BF), tibialis anterior (TA) and medial gastrocnemius (MG) bilaterally. The collapsed and filtered EMGs signal and the linear envelope were plotted. The representation of the spectral characteristics over time was determined by the spectrogram. From the identification of muscle contractions and myoelectric activity in each cycle of assisted gait, it was determined: duration, RMS, amplitude peak, mathematical integral and median frequency of the EMG signal for each experimental condition. Friedman test was used to compare the dependent variables between the different commands, between measures repeated in orthostatism, over time during assisted walking training and between gait conditions with and without a verbal command. The statistical significance was set at 5 %. Results: 1) It was observed efferent modulation of the left RF and right BF signal EMGs coinciding with the commencement of the voluntary movement attempt was observed. It was identified muscle contractions in the EMG signal, even in the absence of visible muscle contraction, and the amplitude and median frequency of the signal behaved differently according to the verbal command used; 2) It was observed that the efferent modulation of the EMG signal of the left RF and right BF during attempt of voluntary movement of the participant 1 was systematic finding in the longitudinal analysis of the data demonstrating an increase in amplitude (mathematical integral) concomitant to decrease of the median frequency over time; 3) It was identified the afferent modulation of the EMG signal in the three study participants during the assisted gait training. Muscles that did not show modulation during orthostatism with attempt of voluntary movement, presented modulation by the rhythmic sensorial afferent offered by the assisted gait training; 4) The mathematical integral and the median frequency behaved as properties that vary according to the modulations of afferent or efferent origin of the signal sEMG; 5) The graphic visual inspection of the sEMG signal as well as the statistical analysis allowed to identify the presence of afferent and efferent modulation in participants with cSCI confirming the importance of this tool for the evaluation of this population. Conclusion: The presence of afferent and efferent modulation of the sEMG signal suggests the preservation of intact supraspinal and spinal pathways which interfere in the motor output of individuals with cSCI. Such findings direct towards a new paradigm in the process of evaluation and rehabilitation of this population which establishes possible perspectives of neuroplasticity below in the lesion. Therefore, it is considered important the analysis of the EMG signal and its spectral and temporal properties for the development of resources that can optimize the neuroplasticity process in this population.

Introduction: During the aging process, physiological changes occur that lead to a decrease in brain processing speed. In recent years virtual reality (VR) has been increasingly applied in rehabilitation centers, so knowing the influence of VR under brain activity, in these populations is necessary. Within this context, Electroencephalography is considered as one of the main means of capturing brain activity. By obtaining the brain activity, we can study it in several ways, one of them is the study of coherence between pairs of electrodes, allowing to analyze the relations of different brain areas and how they exchange information. Objective: This study aims to investigate the immediate influence of exposure to a balance session in a virtual environment on the coherence between the frontal lobes of young and old adults, measured using Emotiv EPOC. Methodology: A comparative study involving 20 individuals divided into the groups: young (GJ) and elderly (GI). After undergoing an evaluation of the general condition, the necessary support for the gait (FAC) and the cognitive state (MEEM), the participants performed during 4 minutes, the penguin slide game of the balancing category of Nintendo Wii, whose effects on the activity Were collected through COPD. Results: The GJ presented similar inter-hemispheric coherence values in the alpha band and in the beta band in comparison to the GI. Regarding phase coherence, the GI presented an anticipation of the right hemisphere while, the GJ presented of the left hemisphere. Conclusion: Virtual reality seems to stimulate both GJ and GI. However, the GJ presented patterns of activation and phase coherence, which suggest compatibility with prior learning to VR, justifying the differences found in phase coherence between the groups.

Introduction: Stroke is the leading cause of long-term disability resulting in sensorimotor impairments that compromise functionality in the individuals' ADLs. Thus, virtual reality technologies have been used increasingly aimed at motor rehabilitation. However, there is little evidence that the movements performed in virtual environments are similar to those made in physical environments. Objective: Analyze kinematics components of the upper limb in stroke patients during a game of darts in virtual and real environment. Methodology: The comparative transversal study with a sample of 11 chronic hemiparesis. The virtual environment was presented at the XBOX 360 Kinect® and the real environment used a professional dart game.Participants performed 15 trials of each game and the kinematics of the upper limb was recorded on video for analysis in Kinovea Software.The environments were compared using the t-Student test. Results: There were significant differences between the virtual and real environments.The real game showed higher elbow extension angle (p = 0.008), greater shoulder flexion (p = 0.008) and a higher mean speed of the shoulder (p = 0.001), elbow (p = 0.0001) and wrist (p = 0.001) path. As to velocity and acceleration peaks, maximum values were found in the real game shoulder (p = 0.04), elbow (p = 0.002) and wrist (p = 0.002) velocity, and elbow (p = 0.004) and wrist (p = 0.028) acceleration. The flexion and extension speeds were higher in the real game shoulder (p = 0.021), elbow (p = 0.004; p = 0.005) and wrist (p = 0.009; p = 0.039). The virtual game got longer flexion (p = 0.0001) and extension (p = 0.021) and a higher performance (p <0.0001).Conclusions: The dart game can be used in the rehabilitation of the upper limb after stroke according to the objectives that therapy wants to achieve. If the main goal is precision of movement, control of degrees of freedom and postural adjustments the virtual game shows to be more effective. If the goals is to improved coordination interarticular and refine the motor control, then the real game is a good option.

During pregnancy, hemodynamic, hormonal, and biomechanical changes occur in the female body that result in changes in maternal body systems. Changes in sleep pattern and deprivation, characteristics of this period, can affect the postural stability of these women. The aim of this study was to compare the variables of postural balance (static and dynamic) among pregnant women, with and without alteration of the sleep pattern (excessive sleepiness, hours of sleep per night and latency) according to the gestational trimesters. A total of 236 pregnant women with a gestational age ranging from 16 to 32 weeks (M = 25.03; SD = ± 4.49) participated in the study. Of these, 124 (52.4%) were in the second and 112 (47.5%) in the third gestational trimester. The volunteers were assessed for sleep pattern using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Balance Master was used to evaluate postural balance. Data were analyzed by Student's t-test for independent samples. A significance level of p <0.05 was adopted. The results showed that 56 pregnant women (27.7%) considered it as good and 171 (72.5%) rated sleep quality as poor. It was also verified that 132 pregnant women (55.9%) did not present excessive drowsiness, as opposed to 93 volunteers (39.4%) who demonstrated such condition. Regarding the relationship between sleep variables and postural balance, it was observed that there were no statistically significant differences between the postural balance of pregnant women, with and without alterations in the aspects related to sleep, in both quarters.