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Dissertations |
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RAFAELLA SILVA DOS SANTOS AGUIAR GONÇALVES
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COMPARISON OF DIAGNOSTIC CRITERIA OF SARCOPENIA BY DIFFERENT CONSENSUSES IN WOMEN LIVING IN COMMUNITY: A CROSS-SECTIONAL STUDY
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Advisor : ALVARO CAMPOS CAVALCANTI MACIEL
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COMMITTEE MEMBERS :
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ALVARO CAMPOS CAVALCANTI MACIEL
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DANIELE SIRINEU PEREIRA
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RICARDO OLIVEIRA GUERRA
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Data: Feb 15, 2018
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Show Abstract
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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.
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2
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BARTOLOMEU FAGUNDES DE LIMA FILHO
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BURDEN OF FRAGILITY IN ELDERLY WITH DIABETES MELLITUS TYPE 2 AND RELATED FACTORS
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Advisor : JULIANA MARIA GAZZOLA
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COMMITTEE MEMBERS :
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DANIELE SIRINEU PEREIRA
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JULIANA MARIA GAZZOLA
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RICARDO OLIVEIRA GUERRA
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Data: Feb 16, 2018
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Show Abstract
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Introduction: Chronic Non Transmissible Diseases (CNTD) are the main causes of loss of quality of life in the elderly and entail important functional limitations. Among them, type 2 Diabetes Mellitus (DM2) and Fragility Syndrome (FS) stand out due to the high prevalence and associated comorbidities. The fragility burden is an elementary measure in the measurement of this condition and can be associated with several variables. Objective: To determine the sociodemographic, clinical-functional and depressive symptoms related to the frailty burden in the elderly with type 2 Diabetes Mellitus. Methodology: This is an observational, analytical cross-sectional study conducted in Natal/RN. Elderly patients aged ≥ 60 years diagnosed with T2DM, with independent ambulation and not amputated participated. They were evaluated for socio-demographic data, clinical-functional, depressive symptoms and fragility phenotype. Descriptive statistics and the chi-square test were performed, followed by multivariate logistic regression analysis (p<0,05 and 95% CI). Results: The sample consisted of 125 elderly, mostly female (36,8%), overweight (62,4%), five or more diseases (65,6%) and depressive symptoms (53,2% ), reaching a mean of 68,76 (± 6,52) years old. The group with the lowest fragility burden prevailed (56,0%) and the low level of physical activity was the most cited phenotype item (72,0%). The final regression model showed that the fragility burden was significantly associated with age (p=0,016; [1,316-8,794]), schooling (p=0,002; [1,680-10,623]), lower limb pain (p<0.001; [1,935-11,766]) and TUGT (p=0.031; [1,145-15,659]) and this multivariate model presented 80,9% accuracy. Conclusion: the elderly with greater age, lower educational level, lower limb pain and worse functional mobility presented a 3,40, 4,22, 4,77 and 4,23 times greater risk of having a greater fragility load, respectively.
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3
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RAYSA VANESSA DE MEDEIROS FREITAS
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VALIDITY AND RELIABILITY OF THE ORIGINAL AND SHORT VERSIONS OF THE ACTIVITIES-SPECIFIC BALANCE CONFIDENCE (ABC-16 E ABC-6) IN COMMUNITY-DWELLING BRAZILIAN OLDER ADULTS
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Advisor : RICARDO OLIVEIRA GUERRA
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COMMITTEE MEMBERS :
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ALVARO CAMPOS CAVALCANTI MACIEL
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DANIELE SIRINEU PEREIRA
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RICARDO OLIVEIRA GUERRA
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Data: Feb 16, 2018
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Show Abstract
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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.
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4
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THAYLA AMORIM SANTINO
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TRANSLATION, CROSS-CULTURAL ADAPTATION AND PSYCHOMETRIC EVALUATION OF THE PEDIATRIC ASTHMA CONTROL AND COMMUNICATION INSTRUMENT - PACCI
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Advisor : KARLA MORGANNA PEREIRA PINTO DE MENDONCA
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COMMITTEE MEMBERS :
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JOAO CARLOS ALCHIERI
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KARLA MORGANNA PEREIRA PINTO DE MENDONCA
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SÉRGIO LEITE RODRIGUES
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Data: Feb 22, 2018
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Show Abstract
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Introduction: Under the need to evaluate the clinical control of asthma in children and adolescents, the importance of the availability of validated instruments for use in the Brazilian population was observed. However, few specific instruments have culturally adapted and validated versions for Portuguese. Objectives: To perform a translation, cross-cultural adaptation and evaluation of psychometric properties of the Pediatric Asthma Control and Communication Instrument (PACCI) for use in the Brazilian population. Methods: An exploratory methodological and psychometric study, which involves the process of translation, cross-cultural adaptation and evaluation of psychometric properties. Transcultural translation and adaptation followed the recommendations internationally described and used, involving translation procedures, back translation, multiprofessional committee of experts and pre-test in a representative sample of the new population. The psychometric properties were analyzed through the application of the adapted questionnaire in a sample of children and adolescents with clinical diagnosis of asthma and their parents/caregivers. Socioeconomic assessments were performed (Brazil Economic Classification Criteria); evaluation of clinical control, with the Childhood Asthma Control Test (c-ACT), Asthma Control Test (ACT); evaluation of the caregiver’s quality of life with the Pediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ), and test of pulmonary function (spirometry). It was investigated the content validity, construct, concurrent, reliability (considering the internal consistency) and the cutoff, through receiver operator characteristic curve analysis. The instruments and pulmonary function test was correlated through Spearman correlation test, and their association was verified through ANOVA and Bonfferoni post-test. Results: The multiprofessional committee of experts indicated that the items of the questionnaire were clear and compreesible, with agreement ranging from 0.78 to 1.00. Considering the pre-test procedure, parents/caregivers did not present comprehension difficulties (agreement above 0.90). The Brazilian version of PACCI showed an internal consistency of 0.80. The internal structure of the PACCI was evaluated through exploratory factorial analysis. From the acceptable adjustment indexes (KMO=0.81 and Bartlett sphericicity test, p<0,001), the exploratory factorial analysis was performed with the extraction of 4 pre-determined factors and orthogonal rotation (varimax). Considering the items grouped into factors, it was verified that each of these factors presented adequate reliability. The following factors were identified: clinical control, risks, perception of asthma status and severity. The factor asthma control showed, through its total score and problem index, correlation with c-ACT/ACT, PACQLQ. Scores for the control domain greater than 4 points (sum of the score) and above 1 point (problem index) were indicative of uncontrolled asthma. Conclusion: The PACCI questionnaire is properly translated and cross-cultural adapted for Brazilian pediatric population. Furthermore, the Brazilian version showed to be able to provide valid and reliable measures to assess the clinical control of asthma in children and adolescents.
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5
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FABIELI PEREIRA FONTES
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Probability of falls in elderly patients with type 2 diabetes mellitus
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Advisor : JULIANA MARIA GAZZOLA
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COMMITTEE MEMBERS :
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JULIANA MARIA GAZZOLA
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LIDIANE MARIA DE BRITO MACEDO FERREIRA
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ALINE DO NASCIMENTO FALCAO FREIRE MONTE
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Data: Feb 23, 2018
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Show Abstract
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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.
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6
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DIEGO VILLAR TAVARES
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RELATIONSHIP BETWEEN PAIN AND FEAR OF FALLING AMONG RESIDENTS OF HOMES FOR AGED: A CROSS-SECTIONAL STUDY
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Advisor : ALVARO CAMPOS CAVALCANTI MACIEL
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COMMITTEE MEMBERS :
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ALVARO CAMPOS CAVALCANTI MACIEL
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MAYLE ANDRADE MOREIRA
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RICARDO OLIVEIRA GUERRA
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Data: Feb 23, 2018
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Show Abstract
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Introduction: The aging process causes health problems such as the emergence of various chronic and degenerative diseases and geriatric syndromes, significantly increasing the presence of pain in the elderly. Pain, in its various contexts, causes several limitations and can be related to the fear of falls, especially in the elderly residing in homes for aged. Objective: To analyze the relationship between pain and fear of falls among residents of homes for aged. Methodology: A transversal survey was conducted involving 108 residents of homes for aged in the state of Paraíba, Brazil. The instruments utilized to collect data were the Geriatric Pain Measure form (GPM), to evaluate pain, and the Falls Efficacy Scale-International (FES-I), to evaluate the concern with falls. The statistical program SPSS version 20.0 was used to analyze the data, and the t-test and Spearman’s test were used in the bivariate analysis. Also, three multiple linear regression models were applied. In all the statistical tests, the confidence interval (CI) was 95%, or p < 0.05. Results: The average age of the respondents was 78.8 (±7.19) years, with predominance of women (64.8%), and 42.1% of the respondents were single. With respect to pain, chronic pain was reported by 44.8% of the respondents, while episodes of acute pain were reported by 18.1%. In the evaluation of pain by the adjusted Geriatric Pain Measure, the average score was 28.81 (±30.67) points. The pain intensity was slight (43,6%) in the large majority of the sample. A moderately positive and significant correlation was obtained between the adjusted values of the GPM and FES-I (ρ = 0.31: p < 0.001). The multivariate analysis indicated that in the three regression models applied, the variables sex, use of psychotropic drugs and GDS score had influence on the FES-I score. It was also observed that in the dichotomous model adjusted for pain, the report of pain implied 5.47 points on the FES-I. Conclusion: The present study identified a high prevalence of pain as well as great concern about the fear of falling among residents of homes for aged. When investigating the relationship between pain measures and fear of falling, a positive and significant correlation was observed between these variables.
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7
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CAROLINA BEZERRA COE
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EFFECTS OF AN ANTENATAL EDUCATION PROGRAM ON THE EMPOWERMENT OF PREGNANT WOMEN
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Advisor : ELIZABEL DE SOUZA RAMALHO VIANA
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COMMITTEE MEMBERS :
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ELIZABEL DE SOUZA RAMALHO VIANA
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LAIANE SANTOS EUFRASIO
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Vanessa Patrícia Soares de Sousa
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Data: Feb 23, 2018
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Show Abstract
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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.
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8
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TACITO ZAILDO DE MORAIS SANTOS
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PERCEPTIONS OF BARRIERS TO CARDIOVASCULAR REHABILITATION IN PATIENTS OF PUBLIC AND PRIVATE HEALTH SERVICES
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Advisor : GARDENIA MARIA HOLANDA FERREIRA
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COMMITTEE MEMBERS :
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IVAN DANIEL BEZERRA NOGUEIRA
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JOCELINE CASSIA FEREZINI DE SA
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SÉRGIO LEITE RODRIGUES
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Data: Feb 23, 2018
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Show Abstract
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Background: Brazil is a country of continental dimensions marked by peculiarities in the health system and regional inequities in the financing of services. Despite strong national and international recommendations for cardiovascular rehabilitation (CVR), the availability of programs is uneven and the barriers to participation are known in an incipient way in the Brazilian scenario. Therefore, it is necessary to investigate these barriers in different regions, health services and treatment stages. Aims: describe and compare barriers to participation in RCV in public and private health services. Methods: it’s an observational-analytical cross-sectional study conducted according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) between May and December 2017. In this study, CVR participants and eligible inpatient and outpatient were matched by type of service they used. The level of barriers to CVR was evaluated by the Barrier Scale for Cardiac Rehabilitation (CRBS) and U Mann-Withney and Kruskal Wallis tests were used in the comparisons between service types and treatment stages, respectively. Results: a total of 140 patients participated in the study. The mean total barrier score was 1.98 ± 0.48 and differed only between inpatients and CVR participants (p <0.05). Some barriers in access and perceived needs domains were higher in public than in private services (p <0.05). The domain perceived needs had the highest score of the sample (2.31 ± 0.71). Not knowing about CVR (3.75 ± 1.66) and lack of medical referral (2.32 ± 1.53) were the major barriers in this domain. Conclusion: there were no differences in the overall scores between public and private services, as well as between inpatients and outpatients. However, some barriers differed significantly between these groups. Therefore, approaches for dissemination of knowledge in RCV and implementation of strategies for reference of eligible should be encouraged in both services.
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9
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ISABELLE ANANDA OLIVEIRA REGO
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ANALYSIS OF CORTICAL ACTIVATION DURING MOTOR TASK CARRIED OUT IN A VIRTUAL ENVIRONMENT: A COMPARATIVE STUDY AMONG GENDER
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Advisor : FABRICIA AZEVEDO DA COSTA CAVALCANTI
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COMMITTEE MEMBERS :
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FABRICIA AZEVEDO DA COSTA CAVALCANTI
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ELIZABEL DE SOUZA RAMALHO VIANA
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KLIGER KISSINGER FERNANDES ROCHA
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Data: Feb 26, 2018
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Show Abstract
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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.
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10
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GENTIL GOMES DA FONSECA FILHO
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Evaluation the motor developmental and the generalized movements of low birth weight preterm infants submitted to the Kangaroo Method
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Advisor : ANA RAQUEL RODRIGUES LINDQUIST
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COMMITTEE MEMBERS :
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ANA RAQUEL RODRIGUES LINDQUIST
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CIBELLE KAYENNE MARTINS ROBERTO FORMIGA
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CLAUDIA RODRIGUES SOUZA MAIA
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Data: Feb 27, 2018
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Show Abstract
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Introduction: The Kangaroo Method, implemented by many developing countries, is a strategy for improving neonatal care. This method seeks an organization of the immature physiological systems of the low weight premature, through the insertion of the parents into the care to the baby and the kangaroo position. Despite the already existing benefits of its development, little is known about the motor patterns and the movements generated by the premature infants undergoing this method. Aim: To evaluate the motor patterns and the generalized movements of low birth weight preterm infants submitted to the Kangaroo Method. Methodology: This is a cross-sectional study, carried out at the Januário Cicco Maternity School. The study included newborns with gestational age of less than 37 weeks, weighing less than 2500g, who were submitted to the Kangaroo Method (KM) in the first week of life. Clinical information about the baby and the mother's gestation was collected during hospitalization; the time of kangaroo position, during the second stage of the KM. In the first consultation of the third stage of the KM, the evaluation of the generalized movements and the Test Infant Motor Performance (TIMP) were applied. For statistical analysis, the significance level of 5% and 95% confidence interval were assigned for all analyzes. The descriptive analysis was presented in mean and standard deviation (SD). The normality of the study variables was verified using Shapiro Wilk test. Mann-Whitney was used to compare the means between the groups and the chi-square test was used for the categorical variables. Results: The sample consisted of 30 babies, to evaluate the generalized movements and 27 to evaluate the motor development. Of the studied population, 50% (15) presented altered spontaneous movement and 22.22% (6) presented atypical motor pattern. When comparing the means between the groups of the babies with normal and altered generalized movements, there was no significant difference between the samples regarding clinical variables and time of kangaroo position. Among the babies with typical motor pattern and atypical, there was a significant difference between the number of previous pregnancies (p = 0.04), the maximum total bilirubin level (p = 0.03) and the presence of grade I intraventricular hemorrhage (p = 0.05). Conclusion: Despite the strategies offered by the Kangaroo Method, the rate of babies with generalized motor and atypical motor patterns is still high, demonstrating the importance of this type of evaluation in the follow-up of low-weight preterm infants. In addition, it was observed that the number of pregnancies and the level of bilirubin negatively influenced the motor pattern of the babies and that the presence of grade I intraventricular hemorrhage might not influence the atypical motor pattern. Therefore, it is necessary to study the generalized movements and the motor pattern of the premature babies submitted to the Kangaroo Method to evaluate the causes of these changes and the effect of this method on these outcomes.
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11
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LAYANA MARQUES DE OLIVEIRA
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Acute effects of different postures on peak cough flow and electromyographic activation of respiratory muscles in with Duchenne muscular dystrophy
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Advisor : VANESSA REGIANE RESQUETI FREGONEZI
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COMMITTEE MEMBERS :
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VANESSA REGIANE RESQUETI FREGONEZI
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MARIO EMILIO TEIXEIRA DOURADO JUNIOR
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VERÔNICA FRANCO PARREIRA
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Data: Feb 27, 2018
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Show Abstract
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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 45o (45o) and supine with head elevated at 80o (80o) 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 80o 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 80o (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 80o was observed compared to the 45o 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 80o 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 80o 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.
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12
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ANA ALINE MARCELINO DA SILVA
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REFERENCE VALUES FOR SNIFF NASAL INSPIRATORY PRESSURE IN HEALTHY CHILDREN: A MULTICENTER STUDY
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Advisor : VANESSA REGIANE RESQUETI FREGONEZI
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COMMITTEE MEMBERS :
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JOCELINE CASSIA FEREZINI DE SA
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VANESSA REGIANE RESQUETI FREGONEZI
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VERÔNICA FRANCO PARREIRA
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Data: Feb 28, 2018
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Show Abstract
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Introduction: The sniff nasal inspiratory pressure (SNIP) is an easy to perform test that estimates esophageal pressure and predicts inspiratory muscle strength, being complementary to maximal inspiratory and expiratory pressure measurements (MIP and MEP, respectively). In Brazil, its reference values for children have not yet been proposed. Objective: To propose SNIP prediction equations for healthy Brazilian children and determine the reference values for this population. Methods: A multicenter (Natal, Recife e Belo Horizonte), cross-sectional observational study was carried out to evaluate healthy children 6 to 12 years of age incomplete, of both sexes. They were stratified into three subgroups (6-7, 8-9, 10-11 years) within each sex. All performed after anamnesis with sociodemographic and anthropometric evaluation (percentile), the spirometry test, followed by the measurement of respiratory muscle strengths, composed of MIP (Functional Residual Capacity (FRC) and Residual Volume (RV)), MEP and SNIP. Finally, two 6-minute walk tests (6MWT) were performed to assess functional exercise capacity. Statistical analysis: We used the Kolmogorov-Smirnov test for normality of the data, and the t test to test the intergroup relations and one-way ANOVA for intragroup analyzes. Linear regression analysis was used to obtain predictive equations for the independent variables that correlate with nasal inspiratory pressure. Results: A total of 135 children were evaluated in the Natal center, of which 118 were included in the study. Girls achieved slightly higher SNIP values in boys (91.3 ± 21.2 vs 89.4 ± 19.6), but without statistical significance. While the values of MIPFRC, MIPVR and MEP were significantly higher in males (p = 0.039, p = 0.009 and p = 0.025, respectively). In boys, the SNIP correlated positively with height (cm) (r = 0.254)., while in girls, with weight and percentile (r = 0.233, r = 0.276) respectively. Thus, the following equations were generated for the male and female, respectively: SNIP = 21,257 + 0,497 * heightcm; SNIP = 72.12% + 0.230 * weightkg + 0.167 * percentile. Conclusions: According to what was found from linear regression, the variables that influenced SNIP in girls were weight and percentile, and in boys only height, results found for healthy Brazilian children in the city of Natal.
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13
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RONNIE PETERSON ANDRADE DE SOUSA
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COMPARISON OF THE BODY PATTERN IN THE PREPARATION AND EXECUTION OF THE GAMES OF REAL AND VIRTUAL DARTS IN PATIENTS WITH STROKE
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Advisor : TANIA FERNANDES CAMPOS
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COMMITTEE MEMBERS :
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TANIA FERNANDES CAMPOS
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ALINE BRAGA GALVAO SILVEIRA FERNANDES
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LUCIANA PROTASIO DE MELO
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Data: Feb 28, 2018
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Show Abstract
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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.
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14
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LIVIA OLIVEIRA BEZERRA
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COMPARATIVE EVALUATION OF THE EFFECTIVENESS OF PELVIC FLOOR MUSCULATURE TRAINING AND GAMETERAPY IN THE TREATMENT OF MIXED URINARY INCONTINENCE: Randomized clinical trial.
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Advisor : MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI
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COMMITTEE MEMBERS :
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ADRIANA GOMES MAGALHAES
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GABRIELA MARINI PRATA
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MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI
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Data: Mar 26, 2018
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Show Abstract
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Introduction: Urinary incontinence is defined as any involuntary loss of urine; your treatment may be surgical or conservative. The surgical approach involves invasive procedures that can lead to complications. Thus, conservative treatments are of increased interest, and pelvic floor muscle rehabilitation programs are the first intervention option. Objective: To compare the efficacy of pelvic floor muscle training and game therapy in the treatment of mixed urinary incontinence. Methods: A randomized, blind clinical trial, conducted at the Hospital Universitário Onofre Lopes. A total of 32 women aged 45 to 70 years with the diagnosis of mixed urinary incontinence were randomly divided into two groups: Pelvic Floor Muscle Training Group (PFMTG - n = 16) and Game Therapy Group (GG - n = 16). Participants were assessed before the intervention and eight weeks after, in relation to the functionality of the pelvic floor muscles: muscle strength (measured by modified Oxford scale) and muscle pressure (measured by manometry); amount and degree of urinary loss (measured by the Pad test); classification of urinary loss (measured by the International Consultation on Incontinence Questionnaire - ICIQ-SF Short Form); and the evaluation of the intervention (measured by the Patient Global Impression of Improvement - PGI-I). The sample data were analyzed using the statistical software SPSS (version 20.0). The Komolgorov-Smirnov test was used to test the normality of the data, and Levene Test, to analyze the variance homogeneity. The descriptive statistics were used to present the means, standard deviation and percentages of the data. According to the data distribution, a mixed-variance analysis (ANOVA Two-Way) was performed, followed by Tukey post-hoc. The time-group interaction and inter and intragroup differences were analyzed for the studied variables. Sphericity was tested using the Mauchly test, and if violated, the Greenhouse-Geisser correction was used. Results: The mean age of the sample was 50.12 (± 8.62) in the PFMTG and 54.43 (± 9.96) in the GG, most of whom had completed elementary education. All volunteers had children, had no regular menstrual cycles, were sexually active, and were overweight. There was no intergroup-time interaction or statistically significant intergroup difference in manometry (p = 0.871), pad-test 1h (p = 0.740) and ICIQ-SF (p = 0.053) when comparing the two treatments. Intragroup differences were observed in these variables mentioned above after the end of the intervention. Conclusion: Both treatments proved to be effective for the treatment of mixed urinary incontinence in the study population.
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15
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RONAN ROMENO VARELA DE MELO
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High intensities of stretch increase ROM without altering the functional performance of amateur soccer players.
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Advisor : WOUBER HÉRICKSON DE BRITO VIEIRA
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COMMITTEE MEMBERS :
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WOUBER HÉRICKSON DE BRITO VIEIRA
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TULIO OLIVEIRA DE SOUZA
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JOSÉ JAMACY DE ALMEIDA FERREIRA
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Data: Apr 11, 2018
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Show Abstract
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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.
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16
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BRUNO HENRIQUE FERREIRA DA SILVA
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ANALISYS OF THE SLEEP PROFILE, SLEEPINESS INDEX AND SLEEP QUALITY IN HEART DISEASE PATIENTS
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Advisor : SELMA SOUSA BRUNO
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COMMITTEE MEMBERS :
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SELMA SOUSA BRUNO
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ROSIANE VIANA ZUZA DINIZ
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THALITA MEDEIROS FERNANDES DE MACEDO LINS
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Data: Apr 20, 2018
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Show Abstract
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Background: Sleep disorders can be considered a negative impact on the cardiovascular diseases and could contribute for worsening nocturnal cardiac arrhytmias. Investigation about this, is essential in the heart diseases clinical follow-up, however, there are few studies documeting this disorders and analyzing the associated factors.
Objectives: To analyze the profile and sleep quality, excessive sleepiness and insomnia gravity in diferente groups of heart disease and to associate with related factors.
Methods: Two hundred seven patients (57,27±13,41 years), of both genders, with previous heart disease diagnosis and assisted by Cardiologia Ambulatory-HUOL/UFRN, were evaluated at 2017 April to September. They were analyzed according harte disease groups (Insuficiência Cardíaca, Arritmia, Coronariopatia, Combinadas), and Hipertensão Arterial Sistêmica, and they were subjectively evaluated by four questionnaires for sleep quality by Pittsburgh Sleep Quality Index (PSQI), excessive daytime sleepiness (SED), Insomnia Severity Index (IGI) and risk for developing sleep obstructive apnoea syndrome, in addition to sociodemographic data and clinical factors associated with heart disease. Data analysis were structured in Arquivos Brasileiros de Cardiologia article format. Furthermore, cientific abstracts were developed and exposed in cientific congress and yet healthy orientations were given by structured guideline about sleep hygiene and sleep quality improvement in people with heart disease who participated in the study.
Results: 106 women and 101 men were evaluated, of which 65,7% of the patients were poor sleepers; the mean sleep time/night was 396 minutes. Between the groups, there were no significant differences in PSQI (p=0,362), SED (p=0,644) and IGI (p=0,085). There were correlation between the body mass index and variables PSQI (r= 0,133; p=0,05), SED (r=0,160; p=0,02) and IGI (r=0,189; p=0,01). A logistic regression model showed significant association between PSQI and associated factors (hypertension, obesity, dyslipidemia, sedentary lifestyle, smoking e alcoholism), in which presence of obesity (p=0,050; β=2,365; IC=1,00-5,61), sedentary lifestyle (p=0,038; β=1,938; IC=1,04-3,62) and smoking (p=0,010; β=2,222; IC=1,21-4,08) determined worse sleep quality in this patients. In addiction, participants were oriented about sleep hygiene and sleep quality improvement in people with heart disease as an action to promote good health.
Conclusion: Patiens with heart disease have poor sleep quality with excessive sleepiness and some degree of insomnia, indepedently of cardiac disease, and health education politics linked to good sleep quality should be instigated to improve the heart disease follow up.
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17
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ISAÍRA ALMEIDA PEREIRA DA SILVA NASCIMENTO
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Effects of mental practice training associated with physical practice of gait in individuals with Parkinson's disease: protocol for a randomized trial
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Advisor : ANA RAQUEL RODRIGUES LINDQUIST
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COMMITTEE MEMBERS :
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ADRIANA CARLA COSTA RIBEIRO CLEMENTINO
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ANA RAQUEL RODRIGUES LINDQUIST
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CLECIO DE OLIVEIRA GODEIRO JUNIOR
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Data: Jun 7, 2018
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Show Abstract
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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.
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18
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IDALIANA FAGUNDES DE SOUZA
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Cortical activation and functional performance of healthy elderly submitted to dual-task
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Advisor : FABRICIA AZEVEDO DA COSTA CAVALCANTI
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COMMITTEE MEMBERS :
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FABRICIA AZEVEDO DA COSTA CAVALCANTI
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THAIZA TEIXEIRA XAVIER NOBRE
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KLIGER KISSINGER FERNANDES ROCHA
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Data: Jun 15, 2018
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Show Abstract
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Introduction: In daily tasks the individuals need to perform simultaneous tasks such as walking and watching for obstacles, preventing accidents. However, morphological findings in elderly demonstrated a reduction in the gray matter of the frontal lobe, an important region for the execution of tasks that requires the executive function, like dual task performance. The electroencephalogram is used in the observation of brain dynamics by the capture of electrical flux. This flux is related to the activation of specific brain areas, responsible for specific functions. Bearing in mind this relationship, it can be said that the dual task training is an important tool to obtain motor and cognitive gains in elderly. Nevertheless, studies that demonstrate the brain patterns during the dual task performance are scarce. Thus, it is relevant to deploy an investigation of how the dual task performance can influence the brain activation pattern in elderly. Methodology: descritive observational study of transversal type, where 23 individuals between 65 and 75 years old were investigated. The subjects were submitted to a dual task activity through the Functional Ambulation Test, using the Emotiv EPOC for electroencephalographical analysis to observe the cortical activation during the dual task. Statistical analysis: the data were prepared by the statistical software SPSS-20. The analysis was made by the calculation of average, standard deviation and frequency. After the application of Shapiro-Wilk test – to verify the data normality – the data was submitted into the inferential statistical analysis under the Student T-test and Mann-Whitney, for parametrical and non-parametrical approaches, respectively. In correlation analysis, it was used the Pearson and Spearman tests.
Results: the duration of TDF1 test has average of 106.11±72.88 seconds. There was found a significant positive correlation between the TDF time and the age (p=<0,001; r= 0,49) and with MEEM (p<0,05; r=- 0,47). The comparative analysis between alpha and beta wave spectra highlighted slightly higher potentials in alpha frequency band (p=<0,001). The channels of cortical areas were the most activated ones. Conclusion: The obtained data points toward the fact that the dual task performance activated more the motor areas that contributes to executive functions to the detriment of the other cortical areas.
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19
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VINÍCIUS VIEIRA DE ALENCAR CALDAS
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CRYOTHERAPY COMBINED TRANSCUTANEOUS ELECTRIC NERVE STIMULATION OF LOW FREQUENCY (BURST) IN PATIENTS WITH NONSPECIFIC CHRONIC LOW BACK PAIN:
CONTROLLED, RANDOMIZED AND BLIND CLINICAL TRIAL
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Advisor : WOUBER HÉRICKSON DE BRITO VIEIRA
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COMMITTEE MEMBERS :
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RICHARD ELOIN LIEBANO
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TULIO OLIVEIRA DE SOUZA
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WOUBER HÉRICKSON DE BRITO VIEIRA
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Data: Jun 18, 2018
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Show Abstract
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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.
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20
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MARIANA GALVAO DE MEDEIROS
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Immediate effects of NIV on peripheral muscle function and aerobic performance in patients with chronic obstructive pulmonary disease.
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Advisor : PATRICIA ANGELICA DE MIRANDA SILVA NOGUEIRA
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COMMITTEE MEMBERS :
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DIANA AMÉLIA DE FREITAS
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MARCELA ABBOTT GALVAO URURAHY
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PATRICIA ANGELICA DE MIRANDA SILVA NOGUEIRA
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Data: Aug 24, 2018
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Show Abstract
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Introduction:Objective: To evaluate the acute effect of BINV on peripheral muscle function without isokinetic exercise and non-TC6 aerobic performance in COPD. Methods: Non-probabilistic sample, totaling 14 individuals with moderate to very severe COPD, without exacerbations. Procedures carried out in two days. Initially all criteria preceded clinical evaluation, disease severity, questionnaires to explain and quality of life, spirometry and manovacuometry. Secondarily taken for collection biochemistry, 6MWT, and isokinetic evaluation of the quadriceps, all basal. Then they underwent the intervention with 30 minutes of NIV Binible / placebo, according to randomization; submitted to new TC6 and test protocol in the isokinetic dynamometer, ending with a new biochemical collection. Before and after the assessment was quantified to a relative perception of dyspnea and fatigue in After washing the nobility days, participants returned, re-developing all procedures, and altering NIV according to randomization. Results: 14 participants, 57% with severe COPD and moderate COPD, a NIV showed significant improvement in the performance of lower and lower actions, isokinetic post-exercise (p≤0.02 * and ≤0.05 *), improvement in values peak torque (p≤0.00 *), total work (p≤0.00 *), fatigue index (p≤0.00 *) and power (p≤0.01 *), the NIV group walked approximately 16 meters more than the 6MWT, and obtained better in blood lactate levels (p≤0.00 *). Conclusion: A NIV directly improves the perception of dyspnea and scores assessed in isokinetic exercise. It presents clinical results on non-TC6 sub-percolation, and improvement of the blood lactate level, in patients with COPD.
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21
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JACKSON CLÁUDIO COSTA DE LIMA
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Development and clinical characterization of new measurement of muscular expiratory strength: nasal expiratory pressure (SNEP)
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Advisor : GUILHERME AUGUSTO DE FREITAS FREGONEZI
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COMMITTEE MEMBERS :
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ANTONIO JOSÉ SARMENTO DA NÓBREGA
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GUILHERME AUGUSTO DE FREITAS FREGONEZI
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SELMA SOUSA BRUNO
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Data: Aug 27, 2018
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Show Abstract
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Objectives:
To test the applicability of the nasal expiratory pressure test (SNEP) as a method of assessing
expiratory muscle strength in healthy young adults, describing the pattern of muscular activation and
technical procedures for its performance.
Methods:
After pilot studies with 6 subjects, the technical procedures for the testing of the SNEP
measurement for healthy individuals were defined. Subsequently, 28 individuals were evaluated, 4 were
excluded due to technical difficulties of evaluation. All subjects underwent pulmonary function tests,
maximal respiratory pressures, nasal inspiratory pressure and nasal expiratory pressure. The order of
respiratory muscle strength assessments was randomized, however specific procedures were followed to
ensure the technical quality of the evaluations. The final sample consisted of 24 subjects, 13 women and 11
men.
Results:
The assessment of nasal expiratory pressure was shown to be viable and with a pattern of
behavior of the pressure curve and electromyographic signals significantly different from PEmax.
Conclusion:
The method of evaluation of expiratory muscles through nasal expiratory pressure (SNEP)
can be used as a complementary method of evaluation of this muscle group.
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22
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KAREN DE MEDEIROS PONDOFE
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Externally cadenced heel-rise test with bilateral support: reproductivity and reference values in healthy adults
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Advisor : VANESSA REGIANE RESQUETI FREGONEZI
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COMMITTEE MEMBERS :
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RENCIO BENTO FLORENCIO
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TATIANA SOUZA RIBEIRO
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VANESSA REGIANE RESQUETI FREGONEZI
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Data: Dec 10, 2018
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Show Abstract
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Introduction: Muscle endurance is an important feature for the prevention of musculotendinous lesions and peripheral vascular system. The heel-rise test (HRT) currently aids in the clinical findings of strength and endurance of the triceps surae muscle during repetitions of the plantar flexion movement. However, the protocols of the test described in the literature have great variability, differing in several parameters such as initial position, achieved height, cadence of execution, balance support, type of foot support, knee positioning, criteria and outcome measures. We believe that the elaboration of a protocol with external cadence (HRTEC) and bilaterl support can be a sensitive and safe instrument to identify the functional limitations. Objectives. The present study had as main objective to elaborate a protocol for applying HRTEC with bilateral support in healthy adults and to evaluate its reliability and intra-rater reproducibility. Secondly, determine the reference values of the bilateral support HRTEC and propose prediction equations for this population. Methods. The study was characterized as observational and transversal, with healthy adults of both sexes, aged between 20 and 59 years, with BMI <30 kg / m2. For the collection of reference values, the application was multicentric (Natal / RN, Curitiba / PR and Belo Horizonte / MG). The analysis of the measurement properties of the test were performed with the data collected in a subgroup of the metropolitan region of Natal / RN. All subjects included in the study were submitted to the protocol with a rate of 60 elevations / minute, starting from 10º of dorsiflexion, to evaluate the number of elevations, the perception of pain before and after the test, pain with 24 hours and 48 hours after the test and the perception of initial and final effort. The test-retest was performed with an interval of one week, for the reliability and reproducibility analysis of the HRTEC protocol. Statistical analysis. The Kolmogorov-Smirnov and Shapiro-Wilk tests were used for data normality. The Mann-Whitney test and the Kruskall-Wallis test with Dunn post-hoc for comparisons between the variables. The Intraclass Correlation Coefficient for intra-rater reliability analysis. The Bland-Altman comparison method for agreement analysis and the Pearson correlation for association between the tests. Results. 140 healthy adults from the metropolitan region of Natal / RN were evaluated, but only 112 (52 men) volunteers, aged 25 (23-33) years for men and 25 (23.2-34) years for women and BMI <25.0 kg / m 2. The test proved to be easy to understand, safe and simple to perform in clinical practice. In the performance outcomes of the total sample, the men presented a better performance with a higher number of elevations (p <0.02), especially in the age group of 20 to 29 years (p = 0.03), compared with the women. The main symptoms reported were burning sensation (54.5%) and fatigue (22.3%). Participants related to the end of the test of moderate intensity 4 (3-6) and graduated with mild intensity 2 (1-3) after 24 hours. Despite this, interest rates increase to 3 (1-5), being more uncomfortable. For the entire sample, the limiting test fatigue had a moderate level of intensity 3 (2-4), with significance before and after the p <0.0001 test. For reliability and reproducibility analysis, we used a sample of 21 adults and found a ICC=0.98, with excellent reliability. Pearson's correlation was r = 0.98, with a coefficient of determination r2 = 0.96 (p <0.0001). The Bland-Altman dispersion model presented a bias of -0.76, with 85% of the sample included within the limits of agreement. Conclusions. HRTEC with bilateral support was considered an easy to perform evaluative method, with clinical practice and standardization of the most adequate and safe positioning for adults, the cadence was adequate to promote the frequency of the movement of plantar flexion and to reach maximum fatigue. In addition, the study showed a good reproducibility of the analyzed variables, confirming the reliability of the test. It was not possible to obtain the reference values and prediction equations due to the small representativeness of the sample from 40 to 59 years old.
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23
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CANDICE SIMOES PIMENTA DE MEDEIROS
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VALIDATION OF A SERIUS GAME VirtuAlter FOR POSTURAL BALANCE REHABILITATION IN ELDERLY BY VIRTUAL REALITY
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Advisor : FABRICIA AZEVEDO DA COSTA CAVALCANTI
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COMMITTEE MEMBERS :
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FABRICIA AZEVEDO DA COSTA CAVALCANTI
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THAIZA TEIXEIRA XAVIER NOBRE
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DEBORA CARVALHO DE OLIVEIRA
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Data: Dec 17, 2018
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Show Abstract
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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.
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1
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JULIANA FERNANDES DE SOUZA BARBOSA
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Physical Performance, body composition and disability in older adults from different epidemiologic contexts: Results from the International Mobility in Aging Study (IMIAS)
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Advisor : RICARDO OLIVEIRA GUERRA
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COMMITTEE MEMBERS :
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ALINE DO NASCIMENTO FALCAO FREIRE MONTE
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ALVARO CAMPOS CAVALCANTI MACIEL
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ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA
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DANIELE SIRINEU PEREIRA
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RICARDO OLIVEIRA GUERRA
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Data: Feb 15, 2018
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Show Abstract
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Introduction: Aging is characterized by a gradual and long-term accumulation of molecular and cellular damage that results in progressive and widespread impairment in many body functions. Among the most clinically significant changes are the muscular strength and mass (defined as sarcopenia) and increase in body adiposity that are related to the greater risk of disabilities, leading to the loss of the i functional independence. The IMIAS study aimed to analyze the difference in mobility and associated factors in older adults from different social, economic and cultural contexts. Therefore, it offers a great opportunity to examine aspects related to the aging of the musculoskeletal system, as well as factors related to functional disability in older populations that differ widely. Objectives: a) To estimate the ability of handgrip strength cut points to identify slowness in different populations of older adults; b) To identify which physical performance measures proposed for Sarcopenia screening could predict most the muscle mass in community dwelling older adults after 4 years of follow up; c) to explore the longitudinal relationship between abdominal obesity with mobility and mobility-related ADL disability controlling for physical performance and depression in older adults free from disability. Methods: This is an analytical, observational longitudinal study, where 2002 older adults were followed for 4 years of follow-up. Baseline data were collected in the year 2012. New evaluations occurred with the interval of 2 years between them, in the years 2014 and 2016. The measures of physical performance were handgrip strength and gait speed. The muscle mass was measured by of the bio impedance analysis. Functional disability measures were self-reported difficulties in tasks related to mobility and daily living activities related to mobility; the measure of obesity was defined by waist circumference. Results: The handgrip strength cut-off points of <26 kg for men and <16 kg for women were able to identify slowness in walking speed in older adults participants of the IMIAS. In addition, handgrip strength measured at baseline was significantly related to muscle mass measured 4 years later (β= 0.003, p-value <0.05). Finally, the presence of abdominal obesity, was a risk factor for disability in mobility (OR = 1.47, 95% CI 1.01-2.15) after 4 years of follow-up, however was not associated with the risk of the onset of ADL disability (OR: 1.40, 95% CI 0.90-2.18). Conclusions: The proposed cutoff points for handgrip strength can be designed to be a useful tool to screening the older adults at risk of functional problems. Further, handgrip strength can be used as a simple method for screening sarcopenia in the community dwelling older adults. Finally, the presence of abdominal obesity is associated longitudinally and predicts the risk of disability in mobility, even over a short period of time (4 years) in community dwelling older adults from different epidemiological contexts.
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2
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LIANE DE BRITO MACEDO
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THE EFFECT OF KINESIO TAPING ON CHRONIC NONSPECIFIC LOW BACK PAIN
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Advisor : JAMILSON SIMOES BRASILEIRO
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COMMITTEE MEMBERS :
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JAMILSON SIMOES BRASILEIRO
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JOSÉ JAMACY DE ALMEIDA FERREIRA
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KARYNA MYRELLY OLIVEIRA BEZERRA DE FIGUEIREDO RIBEIRO
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NEY ARMANDO DE MELLO MEZIAT FILHO
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WOUBER HÉRICKSON DE BRITO VIEIRA
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Data: Feb 19, 2018
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Show Abstract
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Background:Low back pain is one of the most common health problems in the world population, leading individuals who suffer from this condition too seek for different treatments for their pain including the Kinesio Taping® (KT). Objective: Investigate the effects of Kinesio Taping® on chronic nonspecific Low Back Pain (LBP). Methods: This is an assessor blinded prospective randomised controlled trial, composed by 108 women with chronic nonspecific low back pain. All the participants were initially submitted to an evaluation of the pain sensation, disability, trunk range of motion and neuromuscular performance. After the initial evaluation they were randomly allocated into four different groups for the intervention: control group (it will not apply any tape), KT with tension group (apply the Kinesio Taping® with tension in the erector spine muscles), KT without tension group (apply the Kinesio Taping® without tension in the erector spine muscles) and Micropore® group (apply Micropore® in the erector spine muscles). Three days after intervention a new evaluation was performed, similar to the first one; soon after, the KT was removed and a third evaluation was done, ten days after intervention. Results: Pain relief was observed for KTT group (mean difference=1,963; CI 95%=0,501 - 3,425; p=0,003) and KTNT group (mean difference=1,926; CI 95%=0,464 - 3,388; p=0,004) compared to control group at 3 days after intervention. For disability there was difference between control group and KTT group at 3 (mean difference=3,481; CI 95%=0,825 – 6,138; p=0,004) and 10 days (mean difference=3,185; CI 95%=0,395 - 5,975; p=0,016). For all the others variables, there was no differences between group. Conclusion: KT with or without tension reduces pain and disability in LBP patients.
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3
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ANTONIO JOSÉ SARMENTO DA NÓBREGA
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New assessment and intervention in amyotrophic lateral sclerosis (ALS) patients
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Advisor : VANESSA REGIANE RESQUETI FREGONEZI
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COMMITTEE MEMBERS :
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ANDREA ALIVERTI
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FERNANDO AUGUSTO LAVEZZO DIAS
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GEORGE CARLOS DO NASCIMENTO
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GUILHERME AUGUSTO DE FREITAS FREGONEZI
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VANESSA REGIANE RESQUETI FREGONEZI
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Data: Feb 23, 2018
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Show Abstract
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Introduction: The assessment and early detection of respiratory muscle weakness resulting from amyotrophic lateral sclerosis (ALS) have gained more interest in the field of research in the recent decades. As the disease progresses, the decrease in respiratory muscle strength leads to a reduction in lung volume and consequent ventilatory insufficiency, making essential the use of bronchial hygiene techniques and the early detection of respiratory muscle weakness in order to monitor the progression of the disease as well as to anticipate the introduction of interventions.
Objectives: 1) To estimate the amount of gas compression (Vcomp) during the application of the air stacking technique in healthy subjects and to verify if the simultaneous measurements of chest wall volume changes (ΔVCW) and changes in lung volume (ΔVao), combined with pressure variation at the airways opening (ΔPao) during air stacking are able to provide reliable data on absolute lung volumes; 2) To assess thoracoabdominal asynchrony and the presence of paradoxical movement in patients with ALS and its relations with VCW, respiratory pattern and peak cough flow; 3) To analyze the relaxation rates and contraction properties of the inspiratory muscles of patients with ALS and compare with healthy matched-paired subjects. In addition, patients with ALS were divided into three subgroups in order to determine the best parameter linked to inspiratory muscle weakness.
Materials and Methods: 1) Twenty healthy subjects were studied during a protocol that included slow vital capacity maneuvers and application of the air stacking technique. Vcomp was calculated by subtracting ΔVao(measured by pneumotachograph) and ΔVCW (measured by optoelectronic plethysmography) during air stacking and total lung capacity was estimated by applying Boyle-Mariote's law; 2) Phase angle (θ) between pulmonary ribcage (RCp), abdominal ribcage (RCa) and abdomen (AB), as well as the percentage of inspiratory time (IP) in which RCa and AB moved in opposite directions were quantified in 12 patients with ALS through optoelectronic plethysmography during quiet spontaneous breathing and cough using control data from 12 paired-matched healthy subjects to define the normal range of movement; 3) The relaxation rates and contraction properties of the inspiratory muscles were extracted from the sniff nasal inspiratory pressure (SNIP) curve, performed non-invasively in 39 patients with ALS and compared with 39 matched-paired healthy subjects.
Results: 1) During air stacking, 0.140±0.050 L of gas was compressed with an average ΔPao of 21.78±6.18 cmH2O. No significant differences between the estimated total lung capacity (−0.03±3.0% difference, p=0.6020), estimated functional residual capacity (−2.0±12.4% difference, p=0.5172), measured inspiratory capacity (1.2±11.2% difference, p=0.7627) and predicted values were found. 2) During quiet spontaneous breathing, a higher RCa and AB θ (p<0.05), IPRCa (p=0.001) and IPAB (p=0.02) were found in patients with ALS as well as correlations between RCp and AB θ with forced vital capacity (r = −0.773, p<0.01) and vital capacity (r = −0.663, p<0.05), and between RCa and RCp θ and peak cough flow (r = −0.601, p<0.05). During cough, correlations between AB and RCp θ and peak cough flow (r = −0.590, p<0.05), peak expiratory flow (r = −0.727, p<0.01) and VCW (r = −0.608, p<0.05); as well as between RCa and AB θ and peak cough flow (r = −0.590, p=0.01) and peak expiratory flow (r = −0.713, p=0.01) were observed. Moreover, a lower forced vital capacity (p<0.05) and a greater shortening velocity of the inspiratory muscles (p<0.05) were observed in patients with paradoxical movement of the rib cage; 3) When compared to healthy ix
subjects, patients with ALS had a significantly lower (p<0.0001) maximum relaxation rate (MRR) and maximum rate of pressure development (MRPD), as well as a greater (p<0.0001) contraction time, tau (τ) and half-relaxation time (½RT). The results of the ROC curves showed that ½RT (AUC 0.720, p=0.01), forced vital capacity (AUC 0.700, p=0.03), τ (AUC 0.824, p<0.0001) and MRPD (AUC 0.721, p=0.01) were the most sensitive parameters in detecting a 3-point fall in the respiratory subscale of the ALS functional capacity questionnaire. In addition, the MRPD (AUC 0.781, p<0.001), τ (AUC 0.794, p=0.0001) and the peak pressure generated during the SNIP test (AUC 0.769, p=0.002) were the parameters capable of detecting a 30% decrease in forced vital capacity of the patients studied.
Conclusions: During AS, a significant gas compression occurs and absolute lung volumes can be estimated by simultaneous measurements of ΔVCW, ΔVao and ΔPao. In addition, the identification of altered parameters, such as thoracoabdominal asynchrony and the presence of paradoxical movement between the chest wall compartments, τ, MRPD, and ½RT, represent an early sign of inspiratory muscle weakness in subjects with ALS.
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4
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DEBORA CARVALHO DE OLIVEIRA
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ACTIMETRY OF THE SLEEP-WAKE PATTERN OF PATIENTS STROKE
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Advisor : TANIA FERNANDES CAMPOS
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COMMITTEE MEMBERS :
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TANIA FERNANDES CAMPOS
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FABRICIA AZEVEDO DA COSTA CAVALCANTI
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ALINE BRAGA GALVAO SILVEIRA FERNANDES
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ANA AMÁLIA TORRES SOUZA GANDOUR DANTAS
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LUCIANA PROTASIO DE MELO
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Data: Feb 28, 2018
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Show Abstract
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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.
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5
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NICOLE SOARES OLIVER CRUZ
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Comparison of cardiopulmonary and metabolic performance, oxygen and ventilatory kinetics of obese women during cardiopulmonary exercise test protocols on treadmill and bicycle
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Advisor : SELMA SOUSA BRUNO
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COMMITTEE MEMBERS :
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ANTONIO JOSÉ SARMENTO DA NÓBREGA
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GERSON FONSECA DE SOUZA
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SELMA SOUSA BRUNO
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SHIRLEY LIMA CAMPOS
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VANESSA REGIANE RESQUETI FREGONEZI
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Data: Apr 26, 2018
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Show Abstract
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xii
Introduction: Maximum cardiopulmonary exercise tests (CPX) performed on a bicycle or treadmill objectively measure functional capacity and quantify exercise limitation. In these tests, the analysis of peak oxygen consumption (VO2PICO) and ventilatory threshold (VT) are useful measures to evaluate cardiorespiratory performance in several populations. Several exercise protocols using a bicycle or treadmill are used for performance evaluation, however, for obese individuals, it is not known which ergometer promotes greater physical stress and the one that better evaluates the physical performance of these subjects and has greater acceptability for these individuals. Moreover, for this population, less is known about the behavior of oxygen kinetics and ventilation, i.e. its rate of increase (VO2 and VE kinetics) and the understanding of energy systems during an exercise using different types of exercise (cycling x pedaling). Objectives: To compare the cardiorespiratory, metabolic performance, oxygen kinetics and ventilation of obese women during cardiopulmonary exercise tests using a conventional treadmill and ergometric bicycle through incremental ramp protocols and constant load tests at two different exercise intensities. Materials and Methods: The sample consisted of 40 obese volunteers, based on sample calculations, randomized into two groups of 20 obese individuals, each of whom performed treadmill or bicycle CPX. We assessed the clinical, anthropometric and adiposity (weight, height, BMI-body mass index, BAI-body adiposity index, WBC-waist-hip ratio, HC-hip circumference, WC- waist circumference, NC- neck circumference) and spirometry (FVC-forced vital capacity, FEV1-forced expiratory volume in the 1st second, PEF-peak expiratory flow, MVV-maximum voluntary ventilation). In both tests, ventilatory measures (VE-ventilation per minute, VE/VO2-ventilatory equivalent of oxygen, VE/VCO2-ventilatory equivalent of carbon dioxide, RER-gas exchange ratio) and metabolic (VO2-consumption of oxygen, VCO2-carbon dioxide production) of breath-by-breaths with respiratory gases (Cortex-Biophysik-Metamax3B), in addition to the variables of effort perception (fatigue and dyspnea - Borg6-20 ), HRmax (maximum heart rate) and systolic and diastolic blood pressures. Continuing with the evaluation protocol, 30 obese performed two constant load tests with different intensities (25% <VT and 25%> VT), with a 30-minute rest between the tests, to evaluate oxygen kinetics and ventilation. In these, measurements of the kinetics were taken as the time delay (TD), rate of increase (τ) of VO2 and VT and amplitude (A). Sigma Plot 11.0 software for kinetic analysis and Statistic 10.0 software were used for the statistical analysis of the other outcomes, with a significance level of 5% being assigned to test the hypotheses. Results:The studied sample presented a high degree of obesity (BMI = 43.5± 6.6 kg/m², but without ventilatory disorders.) Both groups presented homogeneity in relation to their anthropometric and ventilatory characteristics.
During incremental CPX, the obese women in the treadmill group (TG) had the highest cardiopulmonary and metabolic response seen by VO2peak (18.1±3.3 ml/kg/min x 12.2±2.1 ml/kg/min) and VEpeak (62.9±13.5L x 42.1±8.3L), with p <0.05. However, it was the same group that interrupted CPX earlier (153.4s), and with a lower ventilatory reserve (42.3±19.4L x 58.7±27.1L) when compared to the bicycle group (BG). Correlations between the anthropometric measurements and the performance variables between the groups, observed that only the TG had the final performance of the test influenced by the anthropometric measures as weight r= -0.56, p=0.01) and BMI (r= -0.55, p=0.02). Analyzing oxygen kinetics and ventilation, (p<0.05) for the VO2 stable state (VO2SS), where the TG presented an increase in VO2SS in relation to BG (TG= 1.144 L/min, BG= 0.905 L/min; p<0.05). In the above VT test, we observed an additional ventilatory component (SLVE) for the obese women of the TG (TG= 10.0 L.min-1, BG= 5.2L.min-1; p = 0.02). Conclusion: In our study, it was evident in our sample that obesity seems to influence the test performed on a treadmill more negatively, causing obese women to stop this test earlier, requiring a higher oxygen consumption and a ventilatory response to complete the exercise. For oxygen kinetics and ventilation, apparently the type of exercise performed did not influence the response of the VO2 and VE curve when exercise was performed below VT. However, for the above VT test, an additional ventilatory component (SLVE) was required so that the obese could finish the activity, suggesting that this activity becomes more difficult for this population.
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RODRIGO MARCEL VALENTIM DA SILVA
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EFFECTS OF EXTRACORPORAL SHOCK WAVE THERAPY (ESWT) IN MIOFASCIAL PAIN: CLINICAL, RANDOMIZED AND BLIND TEST
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Advisor : JAMILSON SIMOES BRASILEIRO
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COMMITTEE MEMBERS :
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CAIO ALANO DE ALMEIDA LINS
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CIRO FRANCO DE MEDEIROS NETO
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JAMILSON SIMOES BRASILEIRO
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KARYNA MYRELLY OLIVEIRA BEZERRA DE FIGUEIREDO RIBEIRO
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PATRICIA FROES MEYER
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Data: May 22, 2018
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Show Abstract
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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.
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7
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CRISTIANO DOS SANTOS GOMES
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FRAILTY PREVALENCE IN ELDERLY AND ASSOCIATED FACTORS UNDER THE LIFECOURSE PERSPECTIVE: INTERNATIONAL MOBILITY IN AGING STUDY ANALYSIS
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Advisor : RICARDO OLIVEIRA GUERRA
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COMMITTEE MEMBERS :
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ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA
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ETIENE OLIVEIRA DA SILVA FITTIPALDI
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LILIAN LIRA LISBOA
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MARIA DAS GRAÇAS RODRIGUES DE ARAÚJO
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RICARDO OLIVEIRA GUERRA
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Data: Jul 20, 2018
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Show Abstract
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The growth of the elderly population is a global reality that brings direct repercussions to society. Although the aging process is not necessarily related to diseases and disabilities, many pathological processes also occur as part of it. Frailty syndrome, a state of vulnerability and deficient homeostatic responses after a stressful event that occurs as a consequence of the cumulative decline of multiple physiological systems throughout life, is one of the most problematic expressions of population aging. This syndrome is an important topic from a social perspective because it identifies groups of people in need of additional medical attention and at high risk of becoming dependent. In this context, life-course epidemiology studies the long-term health effects of biological, behavioral, and psychosocial experiences throughout life. The International Mobility In Aging Study (IMIAS) draws on the lifelong approach to contribute to knowledge about health outcomes in the elderly in four countries with different epidemiological profiles. Objectives: To estimate the prevalence of frailty in the elderly participants of the study; To analyze the relationship between adversities throughout the life course and the fragility syndrome in old age. Methods: These are cross-sectional studies associated with a larger cohort study (IMIAS) in which the elderly (65%) aged 65-74 years in the community participated in the first evaluation (n = 2002) in 5 different locations (Kingston and Saint-Hyancinthe, Canada, Tirana, Albania, Manizales, Colombia and Natal, Brazil). Information was collected on sociodemographic, economic and health variables experienced during the lifecourse. The frailty syndrome was operationalized according to the criteria proposed by Linda Fried for the physical phenotype of frailty. Dispersion and central tendency measures were used to characterize the sample, bivariate, multivariate and mediation analyzes were used when appropriate in order to achieve the proposed objectives. Results: The prevalence of frailty varied according to the study sites being lower in Canada and higher in Brazil. In Tirana and Natal women were more frail than men. After multivariate analysis adjusted by covariables, the elderly who reported having suffered childhood physical abuse had a higher prevalence of frailty in old age (OR = 1.68, 95% CI: 1.01, 2.78) and the same was observed among those exposed to psychological violence perpetrated by intimate partner (OR = 2.07, 95% CI: 1.37, 3.12). The effects of childhood physical abuse were fully mediated by the presence of chronic conditions and depressive symptomatology, while the effects of psychological intimate partner violence were partially mediated by these same variables. Among women, give birth before 20 years old was associated with higher prevalence of frailty (OR 2.15, 95% CI: 1.24-3.72), those with 1-2 children had lower pre-frailty status (OR 0.54, 95 (CI 0.36-0.82) and frailty (OR 0.43 95% CI 0.22-0.86) and having performed hysterectomy was considered a factor contributing independently to higher prevalence of frailty in all models. Conclusions: Childhood physical abuse and experiences of psychological violence in adult life leave marks on the path of life leading to adverse health outcomes in old age. Age at first birth, parity and hysterectomy are factors that should be considered as indicators of women's health and seem to contribute to the greater prevalence of frailty in women when compared to men.
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8
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RAQUEL EMANUELE DE FRANCA MENDES ALVES
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PEDSQLTM ASTHMA MODULE - SHORT FORM 22: translation, cross-cultural adaptation and evaluation of psychometric indicators of the Brazilian version.
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Advisor : KARLA MORGANNA PEREIRA PINTO DE MENDONCA
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COMMITTEE MEMBERS :
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KARLA MORGANNA PEREIRA PINTO DE MENDONCA
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RICARDO OLIVEIRA GUERRA
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JOAO CARLOS ALCHIERI
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BRENDA NAZARÉ GOMES ANDRIOLO
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HELOISA KARMELINA CARVALHO DE SOUSA
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Data: Jul 26, 2018
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Show Abstract
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Objectives: To translate, transculturally adapt and evaluate the psychometric indicators of the Brazilian version of the PedsQLTM 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 PedsQLTM 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 PedsQLTM Asthma Module SF 22 and PedsQLTM 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 PedsQLTM 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 PedsQLTM 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.
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9
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CATHARINNE ANGELICA CARVALHO DE FARIAS
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EFFECTS OF RESPIRATORY MUSCLE TRAINING WITH DIFFERENT MODALITIES IN PATIENTS WITH OBSTRUCTIVE PULMONARY DISEASE (COPD) - CONTROLLED RANDOM CLINICAL TRIAL
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Advisor : GUILHERME AUGUSTO DE FREITAS FREGONEZI
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COMMITTEE MEMBERS :
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GUILHERME AUGUSTO DE FREITAS FREGONEZI
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VANESSA REGIANE RESQUETI FREGONEZI
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GERSON FONSECA DE SOUZA
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ANTONIO JOSÉ SARMENTO DA NÓBREGA
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SHIRLEY LIMA CAMPOS
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Data: Aug 31, 2018
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Show Abstract
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Introduction: Respiratory Muscular Training (RMT) in patients with Chronic Obstructive Pulmonary Disease (COPD), does not yet have consensus about the effects that could add to Pulmonary Rehabilitation (PR). Objective: Our objective was to propose a PR protocol associated with different RMT modalities and to evaluate its additional effects on primary endpoints of exercise capacity and dyspnea in individuals with COPD. Methods: This was a blinded randomized clinical trial composed of patients diagnosed with COPD randomly assigned to three groups: Pulmonary Rehabilitation (PR), PR associated with inspiratory muscle training with conical flow resistance load (PR+RMTCFR) and PR associated with RMT endurance modality by normocapnic hyperpnea (PR+RMTNH). The protocol lasted 10 weeks, with a frequency of 3 supervised weekly and 2 days without supervision, composed of health education, energy conservation techniques, individual aerobic training on treadmill with a load of 70% of the maximum speed reached in the incremental test and peripheral muscle strengthening for all groups. The PR+RMTCFR group underwent training with an initial load of 35% of maximal inspiratory pressure (MIP) obtained in the initial evaluation with 5% progressions each week, up to a limit of 80% of MIP, reassessed and adjusted weekly. The PR+RMTNH group underwent training with a rehousing pocket equivalent to 50% of vital capacity, a respiratory rate of 35 times the value of forced expiratory volume in the first second, with increments of 2 to 3 minutes per week, until the maximum time of 20 minutes. The anthropometric characteristics, pulmonary function, respiratory muscle strength and endurance (MIP, SMIP, SNIP, MEP and MVV), exercise capacity (6MWT and ISWT), thoracic wall volumes in the endurance test, peripheral muscle strength, dyspnea and fatigue (BORG0-10), health status (CAT), risk of exacerbation and mortality of the subjects (BODE), before and after the intervention period. Statistical analysis was performed using the Shapiro-Wilk test, Anova One-way, Chi square and Anova Two-way with Bonferroni Pos hoc, according to the data distribution. A p <0.05 was considered and GraphPad Prism, 6.0 software was used. Results: A total of 34 subjects were evaluated and 33 patients (51.5%), 66.2 (± 4.9) years and BMI 28.0 (± 4.3) kg / m2 were evaluated. In the primary outcomes, we found, after 10 weeks, increased exercise capacity in the PR+RMTCFR and PR+RMTNH (p˂0.0001) groups, and in the intergroup analysis, the PR+RMTNH group was higher in the ISWT group RP (Pos hoc of p <0.005). We also found a reduction in the sensations of dyspnea and fatigue after 6MWT and ISWT, in all three groups (p <0.001), with no difference between them. In addition, there was an increase in PImax in all groups (p <0.0001), in SPImax only in the PR+RMTCFR group (p <0.0001) and improvement in SNIP in the groups that performed PR+RMT, with p<0.0001. In the PR+RMTNH group we observed an improvement in MEP (p<0.0001) with Pos hoc of 0.004 in relation to the PR group, and in the manual grip strength (p˂0.0001). It was also verified that in all three groups, there was a reduction in the risk of mortality (p˂0.0001), with an improvement in the health status in PR+RMTNH (p<0.001). The PR+RMTCFRgroup presented a reduction in the risk of exacerbation (p=0.0006) and an improvement in CAT (p=0.0001). Conclusions: The association of RMT to PR programs provided additional gains on exercise capacity, health status, respiratory and peripheral muscle strength, and the benefits found in all groups with reduced risk of exacerbation, mortality, dyspnea and fatigue. Although we can´t differentiate which RMT modality was superior, we believe that PR should be emphasized and RMT added to PR in future programs for this population.
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10
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HELOISA MARIA JACOME DE SOUSA BRITTO
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CONTEXTUAL ASPECTS ASSOCIATED WITH MOBILITY AND LIFE SPACE IN COMMUNITY-DWELLING OLDER PEOPLE: SYSTEMATIC REVIEW AND RESULTS OF THE IMIAS STUDY (International Study on Mobility in Aging)
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Advisor : RICARDO OLIVEIRA GUERRA
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COMMITTEE MEMBERS :
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RICARDO OLIVEIRA GUERRA
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JULIANA MARIA GAZZOLA
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TANIA FERNANDES CAMPOS
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ARMELE DE FATIMA DORNELAS DE ANDRADE
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ETIENE OLIVEIRA DA SILVA FITTIPALDI
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Data: Dec 14, 2018
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Show Abstract
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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.
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11
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ELIS EMMANUELLE CABRAL DA NÓBREGA
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Respiratory evaluation: evidence on electromyography and perspectives onnew inspiratory muscle training devices and their effects onthoracic wall volumes
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Advisor : GUILHERME AUGUSTO DE FREITAS FREGONEZI
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COMMITTEE MEMBERS :
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GUILHERME AUGUSTO DE FREITAS FREGONEZI
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VANESSA REGIANE RESQUETI FREGONEZI
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ILLIA NADINNE DANTAS FLORENTINO LIMA
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CATHARINNE ANGELICA CARVALHO DE FARIAS
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RENCIO BENTO FLORENCIO
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Data: Dec 19, 2018
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Show Abstract
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For several decades the evaluation of the electrical activity of respiratory muscles has
been used in clinical and physiological studies. On the other hand recently, new inspiratory
muscle training devices have been introduced in the commercially like electronic kinetic
valves. This thesis includes in its development a study of Health Technology Assessment,
systematic review and a clinical study. The aim of this thesis was to synthesize and
systematize a through systematic review methodologies used in the evaluation of surface
electromyography of extradiaphragm inspiratory muscles during the use of inspiratory
overloads and to evaluate the pattern of changes in thoracic wall volumes during use of
two forms of inspiratory muscle load: pressure-loading threshold (mechanical valve-MV)
versus resistive load to conical flow (electronic valve-EV) with loads (light, moderate and
high) in healthy individuals. A systematic review was conducted on the use of EMG for the
evaluation of extradiaphragm inspiratory muscles during the application of respiratory
muscle load, which was published in the Journal of Electromyography and Kinesiology.
The clinical study was performed 2 days where the use of the valves was randomized as
well as the loads with resistance that offered loads 30%; 50% and 70% of MIP. In both
valves the subjects breathed against the resistances for 3 minutes in each of the steps:
quiet breathing, loading and recovery. Among each load there was a rest period of 15
minutes. During the protocol, the evaluation of chest wall volumes through Optoelectronic
Plethysmography was performed concomitantly with evaluation of flow and pressure at the
mouth level. Fifteen volunteers were included in the study. An increase in chest wall
volumes was observed in the comparison between the loads with calm breathing and
recovery, but this increase was higher when using EV. The respiratory cycle was also
influenced during the use of both valves and in all loads with higher increments observed
during the use of the EV. In both valves the compartment that increased the most volume
was the pulmonary rib cage, but this increase was not statistically significant. The
application of inspiratory muscle load influences both the volumetric variables and the time
variables of the breath. The electronic valve tends to better optimize the effects on thoracic
wall volumes and make breathing more efficient.
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12
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CAMILA ROCHA SIMÃO
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Surface electromyography as a tool to identify preservation of afferent and efferent pathways in complete and chronic spinal cord injury
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Advisor : ANA RAQUEL RODRIGUES LINDQUIST
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COMMITTEE MEMBERS :
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ANA RAQUEL RODRIGUES LINDQUIST
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ANGELO RAIMUNDO DA SILVA NETO
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LÍRIA AKIE OKAI DE ALBUQUERQUE NÓBREGA
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SUELLEN MARY MARINHO DOS SANTOS ANDRAD
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TATIANA SOUZA RIBEIRO
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Data: Dec 20, 2018
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Show Abstract
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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.
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