Programa de pós-graduação em Ciências da Reabilitação
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Master Thesis Efeitos imediatos de instruções verbais na qualidade de movimento durante o teste do degrau lateral e correlação da avaliação visual com dados de cinemática, força e flexibilidade do membro inferior(2019-11-18) Silva, Rômulo Lemos e; Silva, Rodrigo Scattone da; ; ; Serrão, Fábio Viadanna; ; Vieira, Wouber Hérickson de Brito;Introduction: Abnormal lower limb movement patterns during closed kinetic chain activities seem to contribute to the occurrence of knee injuries. The Lateral Step-Down test (LSD) is a simple test for the assessment of lower limb movement patterns. Verbal instructions may result in immediate improvements in movement patterns in certain functional activities; however, it remains unknown whether these instructions can cause these same improvements during the LSD. Objectives: the purposes of this dissertation were: 1) to conduct a narrative review regarding the assessment of quality of movement during the LSD, 2) to determine the immediate effects of a verbal instructions intervention in the quality of movement and trunk, pelvis and lower limb kinematics in healthy females during the LSD, 3) to verify possible associations between lower limb muscle strength and flexibility and the results of quality of movement and 3D kinematics during the LSD. Methods: For the first study, two independent reviewers conducted a literature review in different databases. For the experimental study, thirtyfour healthy females performed the LSD and were assessed both visually and using a 3D kinematics analysis before and after receiving verbal instructions for movement correction. Participants were divided into Good Movement Group (GG) and Poor Movement Group (PG) according to their scores. Lower limb flexibility was measured using the Lunge Test and the assessment of passive hip stiffness. Muscle strength was measured using a handheld dynamometer. Verbal intervention included instructions aimed at improving the alignment of the trunk, pelvis, hip and knee during the LSD. Results: The narrative review identified a few confounding factors in the included studies that may interfere with the LSD results, such as step height and instructions given prior to the test. It was also found that the LSD is considered a simple test for clinical use, with moderate reliability (κ=0.59–0.81). Results from the experimental study showed that quality of movement during the LSD was positively correlated with kinematic measures of hip adduction, hip flexion and pelvic drop. Verbal instructions improved quality of movement of the volunteers in general, with the GG showing greater improvement in quality of movement after the instructions than the PG. In group comparisons, the PG presented greater pelvic drop, greater hip adduction and decreased hip flexion when compared to GG. Conclusions: The LSD has adequate reliability and should be standardized in order to minimize possible confounding factors. In the experimental investigation, the visual assessment of the LSD presented a significant association with pelvic drop and hip adduction during the 3D analysis in healthy females. Factors such as decreased ankle flexibility and increased hip flexibility are related to greater hip movements during the LSD. Verbal instructions caused an immediate improvement in lower limb quality of movement in healthy women during the LSD.Master Thesis A especialização hemisférica na avaliação do alcance e preensão em pacientes pós-AVC: um estudo observacional analítico transversal(2019-12-20) Nóbrega, Viviane Tavares Bezerra; Cacho, Roberta de Oliveira; Cacho, Ênio Walker Azevedo; ; ; ; Farias, Kelly Soares; ; Câmara, Saionara Maria Aires da;Introduction: Unilateral brain lesions affecting the left hemisphere bring different clinical conditions than those affecting the right hemisphere. It is postulated that the left hemisphere is more responsible for the acceleration phase (reach) and the right hemisphere for the deceleration phase (grip). This statement stems from kinematic studies of human movement, and there is a gap in the lack of evidence on clinical studies evaluating range and grip movement. The aim of this study was to analyze, through clinical instruments, whether patients with right hemisphere injury differ from patients with left hemispheric injury for reach and grasp movement. Methods: This is an observational cross-sectional analytical study conducted with patients who had stroke for more than six months and had unilateral impairment. Fifteen patients (nine with right injuries and six with left injuries) were selected and evaluated in the reach and bilateral grasp movements using the Box and Block test (BBT), the Action Research Arm Test (ARAT), the functional range (REACH) and dynamometry. Comparisons of clinical measurements (ARAT, BBT and Reach) and hand dynamometry were performed between the two groups studied (GR x GL- intergroup), and between individuals in the same group (comparison between the healthy side versus the side affected by each individual). In addition, in order to observe the relationship between the measurements obtained, a correlation test was performed. Results: Fifteen subjects met the eligibility criteria for the study and, thus, the individuals were divided into two groups, DR and GL. As for the intra-group analysis, statistically significant differences were found for the BBT, Reach-AD and ARAT instruments for the DG, and BBT, Reach-AD and dynamometry for the EG. In the intergroup evaluation, statistically significant results were found for the BBT, ARAT and dynamometry scales Conclusion: It was not possible to obtain evidence that hemispheric specialization can be measured using clinical evaluation scales.Master Thesis Effects of attentional focus on improving upper limb motor performance on post-stroke patients(2019-12-12) Gomes, Camila Lobo de Aguiar; Cacho, Ênio Walker Azevedo; ; ; Fernandes, Aline Braga Galvão Silveira; ; Ortolan, Rodrigo Lício;Background: Rehabilitation is an important process in the recovery of upper limb motor function after stroke. In addition, studies show that therapist verbal instruction during treatment is an effective strategy in this process. One way for the therapist to facilitate the command to be given to the learner is to use verbal cues for guidance. They are called focus of attention: internal focus - IF (own body) and external focus - EF (consequence of movement in the environment). For this, it is necessary to evaluate the reach and grasp movements of these individuals, this analysis can be performed using conventional clinical instruments or by high cost kinematic analysis devices. Objective: To evaluate the effects of attention focus types on upper extremity motor performance after stroke by means of a kinematic assessment instrument developed by the authors (Temporal Data Acquisition Instrument (TDAI) as a low cost alternative and simple application. Methods: This study recruited twelve subjects, randomly assigned on two groups by simple draw, where they were asked to perform two motor tasks with the affected limb (16 repetitions), using verbal commands directed by a trained therapist. In the first phase, group 1 received commands with internal focus, while group 2 was instructed with commands with external focus. After one week, the command type changed between groups. To obtain the variables (time of movement, average speed and number of speed peaks), a device developed by the authors (Temporal Data Acquisition Instrument - TDAI) and free kinematic software - CVMob version 4.0 were used. Results: Both attentional focus (internal and external focus) promoted significant differences in time and speed of movement, however, only internal focus provided significant results in both tasks. Discussion: The benefits of one focus of attention over another are not fully confirmed. However, not receiving any kind of attention guidance induces the patient to adopt their own strategies, compromising motor performance. It is pertinent that during the rehabilitation the therapist is aware of the importance of choosing the verbal commands that will be oriented to the patients. Conclusion: Both focuses provided similar motor enhancements and the results support the hypothesis that the benefits of external focus are enhanced when preceded by internal focus.Master Thesis Young Children's Participation and Environment Measure (YCPEM): tradução e adaptação transcultural para o uso no Brasil(2019-10-29) Silva Filho, João Antônio da; Hull, Egmar Longo; ; ; Cazeiro, Ana Paula Martins; ; Lindquist, Ana Raquel Rodrigues;Introduction: The International Classification of Functioning, Disability and Health (ICF), published in 2001 by the World Health Organization (WHO), describes participation as the involvement of the individual in a real life situation. Being involved and participative in activities at home, at school and in the community is an important part of childhood and wellbeing indicator, as it improves health and quality of life, and is linked to social development outcomes and is a important rehabilitation objective. The Young Children's Participation and Environment Measure (YC-PEM) is a tool that assesses the frequency, involvement and impact of the environment on the participation of children between zero and five years of age, with and without disabilities, in home, daycare / pre-school environments. - school and community. Because it is a tool developed according to the ICF model, which has been extensively used in different contexts, the availability of translation and cross-cultural adaptation of this tool will be very useful to support future Brazilian validation. Objective: To translate and culturally adapt YC-PEM for use in Brazil. Method: The process was authorized by the authors of the original instrument. This is a methodological and multicenter study composed of 6 steps: (1) Translation from English - North American to Portuguese - Brazil; (2) Synthesis of translations; (3) Expert Committee Review; (4) Cognitive interview with parents / guardians; (5) back translation; (6) Consolidation of the final version. Results: Some terms, after the initial translation, had to be adapted to bring them closer to the cultural reality of the country. In step 2, all discrepancies found were carefully analyzed and the terms considered most common in Brazil were chosen. In steps 3 and 4, the item descriptions were replaced by better comprehension items and the examples were included in the questions, as well as a supplementary instruction material for self-application of the tool. In step 5 the final version was back-translated and sent to CanChild for evaluation and final approval (step 6). Conclusion: YC-PEM was translated into Brazilian Portuguese and cross-culturally adapted for this country and the final product, YC-PEM Brazil (Measurement of Participation and Environment - Small Children), was considered satisfactory. YC-PEM Brazil is expected to be able to help parents, guardians, and rehabilitation professionals identify the participation levels and environment characteristics of children aged zero to five, thus enabling the planning and implementation of rehabilitation interventions focused on these factors of great relevance to Brazilian children.Master Thesis Modelos de protocolo e estratégias de periodização de exercícios da mobilização precoce na Unidade de Terapia Intensiva: uma revisão sistemática(2019-10-10) Santos, Juliana Simonelly Felix dos; Lima, Illia Nadinne Dantas Florentino; ; ; Dantas, Diego de Sousa; ; Gualdi, Lucien Peroni;The mortality reduction in intensive care unit (ICU) has been accompanied by comorbidities for at least five years after hospital discharge. Early mobilization is the main intervention to prevent hospitalization-related declines. The prescription of physical exercise for this population is still poorly explored regarding dose response and exercise periodization. The aim of this study was to conduct a systematic review of the scientific literature to describe protocol models and periodization strategies of early mobilization prescription in ICUs in critical patients. Methods: The Preferred Reporting Itens for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were followed. Medical Subject Headings (MeSH) was used for the search strategy: with combined concepts and boolean operators adapted to the databases: Medline, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Scopus. After searching, 6,392 resumes were found and after screening, 121 complete articles were read and 13 were included in the systematic review. No study has shown inferior quality according to the Physiotherapy Evidence Database (PEDro) scale. It was analyzed 1,380 individuals who participated of the included papers in this review. The mobilization protocols found presented a duration of 10 to 30 minutes, 2x / day for 7x / week, with weekly accumulated volume equal to or greater than 200 minutes/week, consisting of mobility and progressive exercises based on sedation level and patient tolerance. The lack of data on protocols damage the periodization strategy use, however, based on the most commonly used progress statistics, the periodization of early mobilization resembles the wavy strategy. The studies still present an incipient presentation regarding the use of these systematized strategies in Intensive Care Units, despite the large number of available studies, an exercise prescription, dose response and periodization of ICU exercise.Master Thesis Avaliação da validade convergente e reprodutibilidade do core set da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) para a saúde física de idosos comunitários(2019-08-29) Monteiro, Isabel Oliveira; Câmara, Saionara Maria Aires da; ; ; Dantas, Diego de Sousa; ; Ruaro, João Afonso;Introduction: The International Classification of Functioning, Disability and Health (ICF) is presented as a classification strategy that may be useful for the identification of multidimensional aspects related to the physical health of the elderly. Due to the extension of the ICF, the Core Sets are presented as strategies that facilitate its application. A Core Set of the ICF was proposed to classify the physical health of the elderly, but it is necessary to know its validity in relation to measures recognized for this purpose, as well as its reproducibility. Objective: To evaluate the convergent validity of the core set for the physical health of the elderly in relation to validated measures for the evaluation of this domain, as well as its reproducibility. Methods: This is a validity study, composed of a population of elderly residents in the city of Santa Cruz, Rio Grande do Norte, Brazil. A total of 101 elderly individuals over 60 years old, of both sexes, without cognitive alterations were included. We evaluated palmar grip strength, physical performance in the Short Physical Performance Battery (SPPB) and physical activity level by International Physical Activity Questionnaire (IPAQ) long version. The Core Set of the ICF was also applied, which is composed of 30 categories (14 body functions, 4 body structures, 9 activity and participation, and 3 environmental factors), from which the each component. To evaluate the reproducibility, the Intraclass Correlation Coefficient (ICC) was used between two measurements performed in a range of 5-8 days. The association between the core set results and the other research instruments was evaluated using the Kruskal-Wallis, Mann-Whitney and Spearman correlation tests. In all the steps were considered 5% alpha and 95% CI. Results: It was observed that elderly individuals with higher levels of physical activity in IPAQ had lower impairment index in the components body functions (p = 0.012) and in the performance (p = 0.002) and capacity (p = 0.005) constructs of the component activity and participation. For SPPB, it was observed that better results are related to lower impairment index in the body functions (p <0.001), body structures (p = 0.006), activity and participation (p <0.001), and lower use of aid devices and medications (p <0.001). A higher palmar grip strength was related to a lower impairment index in the body functions (p = 0.001), body structures (p = 0.004) and activity and participation (p <0.001), and the categories that treated of medication use (p = 0.002) and of aid devices (p = 0.004). The ICC analysis indicated good reproducibility for most components evaluated, with a minimum of 0.59 for the category of access to health services and a maximum of 0.95 for the category of medication use. Conclusion: The results show that the core set is valid in relation to the manual grip strength, lower limbs performance and physical activity level, and reproducible, indicating that the data obtained through this tool can be used with confidence by clinicians and researchers.Master Thesis Estimulação transcraniana por corrente contínua no transtorno de ansiedade generalizada: um estudo randomizado duplo cego(2019-06-27) Lima, Ana Lúcia de; Freitas, Rodrigo Pegado de Abreu; ; ; Brunoni, André Russowsky; ; Belchior, Hindiael Aeraf;Introduction: Anxiety is a disorder that has been affecting a substantial number of individuals, presenting a prevalence of 9.3% of people affected in Brazil, being the country with the highest prevalence of this pathology among the countries of the Americas. Among the anxiety disorders are Generalized Anxiety Disorder (GAD), characterized mainly by tremors, muscular hypotonia, hyperventilation, sweating, palpitations, apprehension, restlessness, distractibility, loss of concentration and insomnia, causing impairment in the functional, social, affective and cognitive life of the individual, thus, there is a need for an effective treatment that can minimize these effects that GAD brings to affected individuals. One of the techniques that has been used with positive results for treatments of some psychiatric disorders is Transcranial Direct Current Stimulation (TDCS), which is a noninvasive neuromodulation technique that, through a 1 to 1 electric microcurrent 2 mA causes stimulation or inhibition of neuronal activity. This stimulation causes specific changes in the behavior and motor activity of individuals by modulating specific areas of the brain. Despite many studies of TDCS in mood disorders, such as depression, and some studies in anxiety disorders such as panic, TDCS studies with GAD are still incipient. Thus, there is a need to evaluate the effects that TDCS can have on people affected by GAD, which is a recurrent disorder in society. Objectives: To analyze the effects of TDCS in people affected by GAD, presenting possible improvements in the symptoms of the disease. Materials and methods: The study will be based on a Triple-Blind Randomized Clinical Trial, with a sample of 30 participants, of both sexes, aged between 20 and 40 years, who had the clinical diagnosis of GAD, according to the criteria of the American Psychiatric Association (DSM-V) and was performed at Climaf (Mossoró-RN), in a reserved and restricted place. Participants were divided into two groups, sham (placebo) and experiment, and the allocation was performed in a randomized, doubleblind fashion. The instruments used to assess anxiety were BAI and the Hamilton Scale. For the evaluation of depressive symptoms, BDI. For stress symptoms, Lipp's stress inventory. And for assessment of affectivity, the PANAS scale. Parametric tests were used, with a significance level of p≤0.05. Results: No differences were found for the primary and secondary outcomes. However, a significantly greater improvement was found in the active group for the physical symptoms of stress. Although intragroup analyzes showed decreases in anxiety, stress, negative affectivity, and depression scores, no intergroup comparison showed significant difference. Improvement in physical aspects of GAD stress can improve life satisfaction, cognitive function, and psychological well-being. Conclusion: The main results of this placebo-controlled study indicate that five sessions of anodic ECCT on Dorsolateral Frontal Frontex did not improve anxiety and mood symptoms in patients with GAD. However, the protocol showed improvement in the physical symptoms of stress.Master Thesis Terapia por contensão induzida em formato de grupo para recuperação da função motora do membro superior pós-AVC: comparando dois protocolos(2019-06-26) Silvestre, Maria Cecília de Araújo; Cacho, Roberta de Oliveira; ; ; Oliveira, Alyne Kalyane Câmara de; ; Cacho, Ênio Walker Azevedo;Constraint induced movement therapy (CIMT) has been recommended as an effective intervention to promote positive upper limb rehabilitation outcomes in a number of clinical guidelines internationally. However, the implementation of CIMT in practice remains a challenge, despite strong evidence supporting its use. Objective: To compare an original protocol of 6 hours and a 3 hours modified protocol of CIMT in the neurofunctional recovery of post-stroke patients in a group format. Methods: Eleven stroke patients from the Physiotherapy School Clinic of UFRN / FACISA were selected to attended a group based CIMT program. Of these 11 patients, 8 participated in the first phase consisting of the a 3 hours CIMT protocol application for 10 treatment days, 5 months later 5 patients from the 8 patients who participated in the first phase and 3 new patients participated in a CIMT group program for 6 hours daily for 10 treatment days. In both protocols all the traditional CIMT components were used (shaping, task practice and behavioral package). In both phases the group of patients was supervised by a multidisciplinary team. The motor and functional recovery of the patients were evaluated through the Wolf Motor Function Test, the Motor Activity Log and the Canadian Occupational Performance Measure by an independent evaluator in six moments: immediately before the 3h program, immediately after the 3h program, 3 months after the program of 3, immediately before the program of 6h, immediately after the program 6h and 3 months after the program of 6h. Results: The protocol demonstrated a motivating reinforcement for the study participants. Participants achieved statistically and clinically significant improvements in motor and functional recovery and were maintained over a 3- month follow-up period in both protocols, however the results were better in the 3-hour protocol. Conclusion: CIMT in a group format produces favorable results and the application of a protocol with a shorter duration (3 hours) presents more significant results, thus the most viable application.Master Thesis Qualidade do sono, funcionalidade e suas associações clínicas em mulheres sobreviventes ao câncer de mama(2019-06-27) Lourenço, Adriano; Dantas, Diego de Sousa; ; ; Lima, Illia Nadinne Dantas Florentino; ; Ferraiz, Nadja Vanessa de Almeida;Background: Breast cancer (CM) is one of the main health problems among women, which can have an impact on morbidity and mortality. Currently breast cancer has great chances of cure, due to the early diagnosis and the less aggressive and more effective treatments, which still provoke deleterious effects. These include impairments in sleep quality and functionality, which contribute negatively to the health of women surviving CM. There was a lack of similar studies related to the subject. Objective: To identify sleep problems and functional impairments and their clinical associations in women survivors of breast cancer and out of clinical treatment. Methodology: This is a cross-sectional study of 32 women who survived CM at least one year after the clinical treatment between January and September 2018. Data collection instruments consisted of general and clinical information of the disease and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaires; Pittsburgh Sleep Quality Index (PSQI); Functional Assessment of Cancer Therapy-Fatigue (FACT-F); Disabilities of the arm and Shoulder (DASH); International Physical Activity Questionnaire (IPAQ, short version), plus the six-minute walk test (6MWT). Statistical analysis was performed using SPSS 20.0. The Shapiro-Wilk test was applied for the normality of the data and the Cronbach's alpha test (α), Spearman's and Pearson's correlation, the Student's t test and the Mann Whitney U test were used. The clinical effect was analyzed by Cohen's d and to verify the association of the data the bivariate linear regression test was used. We adopted p <0.05 for all tests. Results: Among the main outcomes, it is worth noting that there is a prevalence of women who survived breast cancer with sleep problems (71.9%) and functional limitations for the upper limb (90.6%), even after the end of clinical treatment and throughout the disease-free survival. Poor sleep is correlated with subjective sleep quality (rs = 0.769), sleep disturbances (rs = 0.624), sleep latency (rs = 0.625), sleep duration (rs = 0.581), and sleep disturbances during the day (rs = 0.654), and functional limitation with cognition (rs = 0.758), mobility (rs = 0.709), domestic activity / labor (rs = 0.718) and participation (r = 0.701). We observed a significant difference in sleep quality with worse scores for the FACT-F, DASH and WHODAS 2.0 scales, as well as the functional limitation with the worst scores for the DASH, FACT-F and PSQI scales (p <0.05). It was also observed that poor sleep was a predictor of worse scores for FACT-F, DASH and WHODAS 2.0 (p <0.05). Conclusions: The findings demonstrate that poor sleep is a predictor of worse scores for fatigue, quality of life, functional performance of the upper limbs and functionality, and that higher levels of deficiency affect lower scores for functional performance of the upper limbs, fatigue, quality of life and quality of sleep, demonstrating the negative impacts of sleep precarisation and the functionality of these women, denoting the relevance and urgency of inclusion of aspects related to sleep and functionality and their clinical associations in the clinical evaluations and therapeutic behaviors directed at women surviving cancer of breast.Master Thesis Efeito do Kinesio Taping® na dor, edema, desempenho físico e percepção global de mudança em idosas com osteoartrite de joelho: ensaio clínico, controlado, randomizado e cego(2019-05-31) Pinheiro, Yago Tavares; Lins, Caio Alano de Almeida; Souza, Marcelo Cardoso de; ; ; ; Brasileiro, Jamilson Simoes; ; Locks Neto, Francisco;INTRODUCTION: Osteoarthritis (OA) is one of the most common diseases in the elderly population and the knee is the most affected joint, representing a potential cause of disability and reduced quality of life. Kinesio taping® (KT) appears as a therapeutic alternative for the treatment of these individuals. However, the current evidence on this technique is limited and conflicting, which makes its effects on the symptomatology of the disease still uncertain. OBJECTIVE: To analyze the effects of KT application on pain, physical performance, edema and overall perception of change in elderly women with knee OA (KOA). MATERIALS AND METHODS: This is a controlled, randomized, blinded clinical trial of 45 elderly women. Initially, all subjects underwent pain evaluation by the Visual Analogue Scale, quadriceps muscle strength by dynamometry, physical function by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and by the 6-Minute Walk Test (6MWT) and edema by means of perimetry. After the initial evaluation, the volunteers were randomly assigned to one of the three intervention groups: G1 (control group), who underwent an educational class on OAJ; G2 (KT group without tension) in which KT was applied without tension on the rectus femoris and knee joint; and G3 (KT group with tension) where two KT techniques were applied with 30% and 10% tension, respectively, on the rectus femoris and the knee joint. Immediately after the intervention, volunteers were reevaluated for pain and muscle strength, and 72 hours after the initial evaluation all variables were reevaluated, including the Global Perception of Change. The Kolmogorov-Smirnov and Levene tests were used to verify the normality and homogeneity of the data, respectively. Comparisons between groups were analyzed using analysis of variance (ANOVA) of the mixed model. For all statistical analyzes a significance level of 5% (p <0.05) and 95% confidence interval (95% CI) were adopted. RESULTS: In the analysis between groups, no significant differences were observed for any of the analyzed variables, in any of the moments. Volunteers allocated to the KT group with tension and KT without tension reported to have experienced beneficial change with treatment. CONCLUSION: KT was not able to reduce pain and edema, as well as improve the physical performance of elderly women with OAJ. However, those who receive the bandage independently of the tension had a self-perception of improvement.