Programa de pós-graduação em Ciências da Reabilitação
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Master Thesis Avaliação da interferência imediata após intervenção com dupla tarefa em idosos(2019-01-16) Pessoa, Raynara Maritsa Cavalcante; Lima, Nubia Maria Freire Vieira; ; ; Oliveira, Cláudia Santos; ; Cacho, Enio Walker Azevedo; ; Farias, Kelly Soares; ; Câmara, Saionara Maria Aires da;Introduction: With aging, there is a decline in the adaptive responses necessary to perform daily activities, thus increasing susceptibility to diseases and functional limitations. Cognitive motor interference is the simultaneous performance of a motor task and a cognitive one. However, despite the vast literature in the area, there are no types of tasks and established duration that shows the immediate effects for this training. Objective: To investigate the immediate interference of an intervention proposal with different dual cognitive-motor and motor-motor tasks on the balance of the elderly. Methods: Eight questionnaires / tests were used, besides the evaluation in the force platform, the subjects were divided by randomization into two groups, one group was submitted to a single intervention proposal with Simple Tasks (TS) and the other with Double Task (DT) after the intervention were reassessed. Results: We evaluated 30 elderly people who were distributed between two groups. Regarding the sociodemographic data, motor evaluation, cognitive performance and self report of difficulty for two tasks, there was no difference between the groups. Compared to the simple test, there was an increase in the time of accomplishment of the figure-of-eight walking (F8W) motor and cognitive and Timed and Go (TUG) cognitive tests. After the intervention the DT group maintained its performance in the tests and presented improvement in the cognitive performance of the activities of semantic fluency, calculation and figures during the posturography, whereas the TS group demanded more time for execution of the simple and motor TUG and presented greater oscillation in postural control in the condition of open eyes, semantic fluency and figures, without increase in the number of hits. Conclusions: The secondary tasks caused an increase in the time in the performance of the functional tests, except for the motor TUG. Immediately after the intervention, the performance in the DT group tests was superior to the TS group, the number of correct answers was similar. In the posturographic evaluation, there was improvement of the cognitive performance for the DT group, whereas the TS group presented greater oscillation for some activities, without improvement in their cognitive performance. There was no difference between the groups regarding the self report of the frequency of difficulty to perform double task.Master Thesis Estimulação transcraniana por corrente contínua melhora dor e qualidade de vida em pacientes com Polineuropatia diabética: ensaio clínico randomizado(2018-07-31) Ferreira, Galeno Jahnssen Bezerra de Menezes; Freitas, Rodrigo Pegado de Abreu; ; ; Gualdi, Lucien Peroni; ; Lixandrão, Maíra Carolina;Introduction: Diabetes Mellitus is Classified as a chronic disease that as a characteristics peripheral nerve injury and neuropathic pain. It is a disease that effects several organs and systems and can generate serious vascular complication, being the main cause of painful diabetic neuropathic (PDN). In the long run for patients with diabetes, PDN is considered one of the major complications. It is characterized by constants pain that greatly affects the quality of life (QoL) of diabetic patients. The treatment is a challenge for the multiprofessional team, since in some cases the pain presents no significant pattern of improvement or is partially resolved with the use of medication. Objective: This study aimed to evaluate the effects of anodal tDCS of the M1 on QoL, physical fitness and pain in patients with diabetic polyneuropathy. Subjects and methods: It was conducted a two arms, parallel, sham, randomized, double-blind trial with twenty patients with diabetic polyneuropathy. Five consecutive sessions of C3/Fp2 tDCS montage were done. Quality of life according to SF-36 and pain were used to assess the primary outcome. Secondary outcomes measures was physical fitness level according to lower and upper body strength, flexibility and submaximal level of functional capacity. All outcomes were measured in 3 different times (baseline, 1 week and 2 week). Results: Generalized estimating equations (GEE) showed significant main effects of time x group on SF-36 score (x2 = 48.79; p < 0.001) with significant difference between baseline to 1 week (p = 0.001) and 2 week (p = 0.001). SF-36 score showed significant difference between group only on 2 week (p = 0.05). Mental health, physical health, emotional, general health, physical function and functional capacity showed significant interaction time x group with increase in Active-tDCS group. Bodily pain differ between groups in 2 week (p = 0.001). TUG and 6MWT have shown significant improvement only in Active-tDCS group (p = 0.0075; p = 0.0001 respectively, according to ANOVA). Conclusions: Five sessions of anodal M1 tDCS improve QoL, pain and functionality in patients with diabetic polyneuropathy.Master Thesis Análise do efeito da dupla tarefa sobre o equilíbrio estático, controle postural e mobilidade em neurogeriatria: um estudo transversal(2018-07-19) Gomes, Wildja de Lima; Lima, Nubia Maria Freire Vieira; ; ; Lindquist, Ana Raquel Rodrigues; ; Lucena, Larissa Coutinho de;Introduction: The aging process together with pathological processes have an impact on cognitive and motor function and generate intense physiological changes that can lead to the impairment of physical and cognitive capacities in the elderly and that tend to decrease mobility and restrict daily activities. Memory is one of the first functions to regress in aging, with difficulties in activities involving evocation and visuospatial recognition in double task (TD) conditions. The interaction between aging and pathological processes can profoundly impact cognitive and physical function, as seen in mild cognitive impairment (CCL), dementia and idiopathic Parkinson's disease (PD), which affect the elderly. Objectives: To analyze the interference of the cognitive and motor task on static postural control and mobility performance in the curvilinear lane, as well as to propose a double task evaluation form for the elderly. Methods: The study presents a cross-sectional and analytical design, with a non-probabilistic sample and for convenience. The participants were submitted to clinical-functional evaluation through 13 measurement instruments and evaluation of static postural control through computerized posturography with evaluation protocol composed of 16 conditions, 14 conditions of dual motor-cognitive task. Results: A total of 35 elderly patients were included in three groups: healthy elderly (n = 15), mild cognitive impairment (n = 9) and Parkinson's disease group (n = 11). For the mobility tests, there was a temporal increase during the performance of dual motor and cognitive tasks for the three groups compared to the simple p-value tests (<0.01). Conclusions: The elderly without commitment are more functional and independent; those with cognitive impairment present greater difficulty to perform tasks involving cognitive aspects, while the elderly with Parkinson's disease present greater embarrassment for the motor tasks. The use of TD affects motor performance in aspects of functional mobility and increases the risk of falls among elderly individuals with some degree of cognitive decline. The dual task application allowed the verification of the interference of the cognitive task on the postural control, especially the tasks of verbal fluency.Master Thesis Estudo de lesões esportivas em um centro de formação de atletas da primeira divisão do futebol brasileiro: uma abordagem epidemiológica com enfoque prospectivo nas lesões musculares(2018-07-27) Cezarino, Leandro Gonçalves; ; ; Bittencourt, Natalia Franco Neto; ; Câmara, Saionara Maria Aires da;Introduction: in spite of the popularity of soccer at the youth level, data on the incidence of injuries in Brazil is limited. Muscle injuries are the most frequent in soccer, accounting for about 30% of all injuries. Although scientific knowledge on muscle injuries has increased in the last decade, the prevalence of these injuries has not decreased. Few studies on this field were dedicated to young soccer players, which highlights the need for further research. Objectives: to describe the incidence of injuries sustained by male elite youth soccer players over the 2017 season; to investigate the interaction between age, previous injury, match and training exposure and strength imbalances in the occurrence of muscle injuries in this population. Methods: demographic and anthropometric data, history of injuries, match and training exposure, and strength variables were recorded and analyzed. Injury incidence was calculated as the number of injuries occurred, divided by the number of hours of exposure on match play and training sessions, times 1,000. Players who sustained a non-contact muscle injury composed the injured group (IG) and players who suffered no non-contact injuries composed the uninjured group (UG). The relative risk was calculated and independent t-tests, the chi-square test and a multivariate logistic regression model were also conducted in the statistical analysis, considering P<.05. Results: one hundred and eighty seven injuries were documented in 122 players (65.2%). The overall incidence of injuries was 1.86 per 1,000 hours of exposure, with a rate six times higher in matches compared to training (P < .0001). The U-20 players were at a higher risk of sustaining injuries during match play [Relative Risk (RR): 2.96, 95% Confidence Interval (95% CI) = 2.47, 3.54). Muscle injuries were the most prevalent, followed by sprains and contusions. Forty-five muscular injuries occurred in 34 players: 16 (36%) hamstring; 12 (27%) quadriceps; 14 (31%) adductor; and 3 (6%) calf injuries. The IG had a greater exposure to training [Mean Difference (MD) = 25.70 hours, 95% CI = 1.12, 50.27] and a greater overall exposure (match plus training) (MD = 32.97 hours, 95% CI = 6.22, 59.73) than the UG. Regarding the time of arrival at the club, the IG presented a significantly smaller time of arrival in comparison to the UG (MD = - 6.57 months, 95% CI = 11.99, -1.18). The muscle strength tests revealed that the IG had greater eccentric quadriceps strength (MD = 3.29 N / kg.100, 95% CI = 1.41, 5.17), compared to the UG. The IG also had a lower hamstring:quadriceps strength (H:Q) ratio than the UG (MD = - 5.24, CI95% = - 8.84, - 1.65). Previous lower limb injury significantly increased the chance of sustaining a muscle injury (OR: 3.027, 95% CI = 1.133, 8.086). Conclusion: this study emphasize the importance of identifying the injury profile and pattern in young soccer players through prospective studies. The results show that risk of injury was higher during match play than during training and older players (U-20 years old) were the most likely to sustain injuries. Muscle injuries were the most prevalent, followed by sprains and contusions. Athletes with a previous history of lower limb injury, lower values of H:Q ratio and smaller time of arrival at the club, presented a higher risk of suffering muscle injuries. The interaction of both modifiable and non-modifiable risk factors seems to better explain the occurrence of injuries and this type of analysis should be continuously performed in the attempt to prevent injuries in adolescents.Master Thesis Respostas fisiológicas do teste de caminhada incremental e de resistência em indivíduos com DPOC: uma revisão sistemática e metanálise(2018-07-31) Silva, Gabriely Azevedo Gonçalo; ; ; Fernandes, Ana Tereza do Nascimento Sales Figueiredo; ; Dantas, Diego de Sousa;Introduction: The incremental (ISWT) and Endurance shuttle walk tests (ESWT) are an alternative in assessing the functional capacity of individuals with chronic obstructive pulmonary disease (COPD), but the physiological responses produced by them are still poorly understood. Objective: To produce a systematic review to evaluate the physiological responses before, during and after the ISWT and ESWT in patients with COPD. Method: The databases searched were: Medical Literature Library of Medicine (Medline), Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Central Register of Controlled Trials (Central), Web of Science and Scopus. The inclusion criteria were: assessment of the physiological effects, studies in which participants had age ≥ 18 years, of both genders and diagnosed with COPD; publications in English, and observational or interventional studies published in indexed journals. Of 4,071 abstracts identified, 15 articles were included. Quality of the studies was assessed by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Results: 73% (n = 11) of the articles presented quality B and 27% (n = 4), quality C. 836 individuals with mild to severe COPD were evaluated. The majority of the studies performed ISWT (2 tests), and the main physiological responses were: the pre and post ISWT heart rate was, respectively, 86 ± 16 x 103 ± 21 bpm, indicating a significant difference when compared to the baseline values, the Systolic Blood Pressure (136 ± 16 mmHg x 149 ± 22 mmHg - test 1; 134 ± 19 mmHg x 149 ± 18 mmHg - test 2), Peripheral Oxygen Saturation (SpO2) (95,1±1,8% x 86,5±4,8%), (95,6±1,6 x 90,7±5.2%), (95,7± 1,8% x 92,4± 6% - teste 1; 95,1± 1,9% x 91,8± 6% - teste 2) and dyspnea (1.1±0.9 x 4,6±2,1 - test 1; 1,2±1,2 x 5,1±2,2 - test 2). The Distance Walked (DW) assessed in two ISWTs was 88.2 ± 96.7 m in test 1 and 102.3 ± 100.4 m in test 2, with a significant increase of 14.1 ± 8.4 m in the second test. Conclusion: Only 15 studies met the inclusion criteria and mostly showed poor methodological quality with lack of control groups, randomization, and blinding of researchers, which compromises the quality of the research. The tests produce similar responses, but knowledge about the physiological responses during the tests is limited since most of the included studies did not assess the variables before, during and after the test – for comparison purposes. The ISWT is the most used test when compared to the ESWT; however, there are not many studies that compare the responses produced by these, making it difficult to make more precise statements about the two tests.Master Thesis Vinculando conteúdo dos questionários de qualidade de vida para crianças com doença pulmonar obstrutiva crônica com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde(2018-08-03) Gomes, Danielle Cristina; ; ; Hull, Egmar Longo; ; Ribeiro, Luciana Castaneda;Purpose: To identify the principal health-related quality of life (HRQoL) questionnaires specific for Chronic Obstructive Pulmonary Disease in children, translated and validated for Brazilian children; and to examine how the reflected content in these tools are represented in the categories that compose the International Classification of Functioning, Disability and Health (ICF). Methods: This is a methodological study developed in two stages. The first stage comprehended a literature review for identification and selection of the questionnaires and the second consisted of linking the contents to ICF. For such purpose was followed the widely used Cieza and colleagues methodology, with the identification of meaningful concepts of questionnaires items and linking to correspondent categories on ICF, by two independent reviewers. Results: In the cystic fibrosis questionnaire (Cystic Fibrosis Questionnaire - CFQparents6-13 and CFQ6-11; and versions of DISABKIDS ® - Cystic Fibrosis), 130 significant concepts were identified from 112 questions. Forty-seven different categories of ICF were linked to the concepts, most of which were 21 (44.7%) related to the "body function" component, 20 (42.6%) "activity and participation" and 6 (12.8% ) to "environmental factors". Thirteen concepts (10%) could not be linked because they represent personal factors (fp) or are not covered (nc) by the ICF. In the asthma questionnaires (Pediatric Asthma Quality of Life - Pediatric Quality of Life Asthma Module - PedsQLAsthma), from 77, we identified 114 significant concepts. Thirty-five different categories of ICF were linked to the concepts, most of them 16 (45.7%) related to the "body function" domain, 13 (37.1%) "activity and participation" and 6 (17.1% ) to "environmental factors". Two concepts (1.7%) could not be linked because they represent personal factors (fp) or are not covered (nc) by the ICF. Conclusion: Four instruments were identified and analyzed (Pediatric Asthma Quality of Life (PAQLQ; Pediatric Quality of Life Asthma Module - PedsQL-Asthma; CysticFibrosisQuestionnaire-Revised - CFQ-R and DISABKIDS ® - Cystic Fibrosis Module - DISABKIDS ® - CFM). In the CFQ and DISABKIDS versions, the linked categories represented predominantly body functions, except for CFQ6-11, where the activity and participation component was the most depicted. Environment factors were poorly described, and there were no categories related to body structures in any of the instruments. PedsQL-Asthma allowed a greater comprehensiveness of the components of the ICF, addressing three of the six components that compose it, however, its content presented a greater focus on the body's function component and did not address important categories of "activity and participation" and "environmental factors" linked to quality of life. PAQLQ, in addition to presenting most of its content linked to the body's function component, did not cover categories of environmental factors, making it impossible to identify the impact of this component on the HRQOL of children with asthma.Master Thesis Relação entre o autorrelato de saúde e o desempenho físico em mulheres de meia-idade e idosas residentes na comunidade no nordeste do Brasil(2018-07-31) Fernandes, Sabrina Gabrielle Gomes; ; ; Maciel, Alvaro Campos Cavalcanti; ; Moreira, Mayle Andrade;Introduction: Self-rated Health (SRH) is one of the most used outcome measures in social epidemiology, public health research and clinical practice, and has been associated with morbidity and mortality in different populations. Physical performance measures are largely determined by physiological functions that typically decrease with age. Some evidence shows that SRH is associated with objective measures of physical performance; however, studies investigating association in low- and middle-income settings are rare, especially for middleaged populations. Objective: To verify the relationship between SRH and physical performance measures, through tests that assess balance and upper and lower limb strength in middle-aged and elderly women in a low-income setting of Brazil. Methods: This is a crosssectional study of 571 middle-aged women (40-59 years old) and elderly women (60-80 years old) living in the municipalities of Parnamirim and Santa Cruz, Rio Grande do Norte. Participants who reported their health status as "excellent," "very good," or "good" were allocated to the "SRH good" group, and those who reported their health as "fair" or "poor" composed the group "SRH poor". The physical performance evaluation consisted of 4 tests: handgrip strength, one-legged balance with eyes open and closed, and chair stand test. The relationship between SRH and physical performance for middle-aged and older women was assessed by multiple linear regression adjusted for covariates (age, education, family income, BMI, physical activity, comorbidities, menopausal status, and reproductive history). Results: Middle-aged women who reported good SRH had better physical performance, such as stronger handgrip strength (β = 1,927, p <0.001), greater balance time with eyes closed (β = 1.339, p = 0.041) and were faster in the chair stand test (β = -0.770, p = 0.003) when compared to those who reported their health as "poor." For the group of elderly women there is no association between physical performance measures and SRH. Conclusion: This study showed that SRH is significantly associated with objective measures of physical performance in a sample of lowincome middle-aged women and is therefore a useful tool for assessing the physical health of this population, besides assisting in decision making for the health professional inserted in this context of low income.Master Thesis Efeitos da estimulação transcraniana por corrente contínua em variáveis físicas e comportamentais em mulheres com fibromialgia - ensaio clínico controlado randomizado(2018-07-25) Mescouto, Karime Andrade; Freitas, Rodrigo Pegado de Abreu; ; ; Lins, Caio Alano de Almeida; ; Hazime, Fuad Ahmad;Background:Fibromyalgia (FM) is a syndrome characterized by chronic widespread pain, fatigue, cognitive behavioral impairments, mood disorders and sleep problems. Although the etiology of FM is unknown, it has been recognized as a centralized pain state where the patient’s Central Nervous System (CNS) is hyperactive, phenomenon known by Central Sensitization. Transcranial Direct Current Stimulation (tDCS) is a non-invasive, safe andcost-effective brain stimulation techniquethat modulates cortical excitability and has been showing positive effects in FM patients. However, there is no consensus on which method and exactly location of stimulation is most effective and presents with more significant benefits in this patients population. Objective: The aim of this study is to evaluate whether a 5 consecutive day treatment with active tDCS stimulation results in better outcome for physical and behavior variables when compared to sham, or placebo in women with FM. Methods: This randomized controlled trial had forty-five participants with FM, which were randomized in one of three groups: active tDCS in the primary motor cortex (M1; n=15) and dorsolateral prefrontal cortex (DLPFC; n=15) and sham stimulation (SHAM; n=15). All the data were collected 7 days prior to the begging of the intervention (baseline), on the 5th day of treatment, with 7 and 21 days of follow-up. A constant current of 2 mA intensity was administered during 5 consecutive days for 20min. Results: The results showed there was no statistical significant improvement in pain, pressure pain threshold and tolerance, neither in depression, anxiety, function or affectivity in any of the groups (p> 0.05). Conclusion: The results of this study suggests that tDCS treatment of 5 consecutive days in cortical areas M1 and DLPFC of 2mA intensity for 20min have no significant results in physical or behavior variables in patients with FM with no immediate or sustained effects after treatment.Master Thesis Efeito do treinamento físico associado a prática mental em hemiparéticos: um estudo simples cego randomizado(2018-06-29) Cirne, Gabriele Natane de Medeiros; ; ; Cacho, Enio Walker Azevedo; ; Farias, Kelly Soares; ; Clementino, Adriana Carla Costa Ribeiro;Introduction: Mental Practice (MP) allows the individual to perform tasks repeatedly without fatigue or any risk to safety. Studies show the efficacy of PM in stroke patients by improving motor skills and performance learning. Objective: to investigate the effect of a MP program associated to physical practice, assessing the moment of insertion of the practice during therapy, and estimating motor and imaging functions. Methods: This is a single-blind randomized controlled trial that evaluated the efficacy of mental practice conducted in patients diagnosed with chronic stroke. Patients were randomly assigned to the following groups: G1 (PM + Physical Training (PT)), G2 (PT + MP) and G3 (PT) (FIM), Theory of Mind Inventory (ToM), Surface Electromyography (EMGs), as well as the Action Research Arm test (ARAT) and Box and Block test (BBT). Results: Thirty-five subjects fulfilled the eligibility criteria, 21 accepted to participate in the study and were enrolled for the study, but only 10 completed the study. Thus, a variance test was performed between the groups, showing no statistical significance. Comparing the moments of the same group, there was a statistically significant difference in G1 in the Fugl Meyer (Hand and Total Upper Limb) variables, limb affected in ARAT and limb affected in BBT, the latter two with evidence for evaluation and follow up. Conclusion: The Mental Practice associated with physical training is an effective protocol. Our results suggest a possible indication that mental practice performs better when performed prior to physical training.Master Thesis Efeitos da dupla tarefa em variabilidades de marchas em idosos(2018-04-24) Souza, Felipe Heylan Nogueira de; ; ; Lima, Nubia Maria Freire Vieira; ; Paz, Leonardo Petrus da Silva;Objective: To investigate the deterioration of gait in different conditions associated with cognitive planning in healthy elderly. Methods: This is a cross-sectional study involving 17 elderly women with age between 60-75 years (66.00 ± 4.67). Individuals were clinically described by the following instruments: Dynamic Gait Index, Berg Balance Scale, Mine Mental State Examination and Leganés Cognitive Test. The experimental protocol consisted of performing the three cognitive tasks of the Stroop test - Word (Pal), Color (Co) and Word-Color (Pal-Co) - during four gait conditions: treadmill gait (TR), ground gait without disturbance (GR), straight ground gait with disturbances (GRGD), and ground gait at eight (GG8). Each task was performed three times, with duration of 20 seconds and intervals of three minutes. The kinematic variables, number of steps (NS), cadence (Ca) and velocity (VL) was collected through with pressure sensors on the treadmill for TR, was collected through with pressure sensors on the treadmill for TR, and sensors Foot Switch fixed in soles in the GR, GRGD and GG8. The normality of the data was analyzed and the one-way ANOVA and Pearson's correlation were used through SPSS 2.0 software. Results: The cognitive tasks of the Stroop test presented a deterioration in the final score of the test, presenting a significant effect of the reduction of number of Words and number of Colors (p <0.05) in all conditions when compared TR (Pal 33 , 78 ± 6.31, Co 23.19 ± 5.78) to GR (Pal 26.76 ± 6.59, Co 16.84 ± 5.55), GG 8 (Pal 25.72 ± 6.53; 15,17 ± 5,76) and GRGD (Pal 22,94 ± 7,22, Co 16,11 ± 6,00), whereas for word color there was a significant effect on the reduction in the number of items (p <0, 05) only when compared TR (13.58 ± 3.16) to GRGD (9.88 ± 3.50) and GG 8 (9.84 ± 3.50). When comparing the cost of the Stroop task in the steps and cadence in ME wit a different conditions ground gait , a significant change in gait observed from the usual to the slower (p <0.05), already in soil situations only the GR x GG8 demonstraram haver essas diferenças (p> 0.05), whereas the cadence was not significant in color item in soil situations (p>0,05), for the words item there was a change in the score only between GR x GR8 (p<0,05), and for the item Words-Color there was significance between GR x GRGD and GR x GR8 (p> 0.05). Conclusion: The findings suggest that the cognitive task during gait variability was altered, suffering a negative impact as the load was increased, and that patterns of gait kinematics produced different measures in the steps and cadence being larger viewed only between revolving activities.