Claudia Morais Trevisan

Efeito das terapias associadas de imagem motora e de movimento induzido por restrição na hemiparesia crônica: estudo de caso

This study assessed the efficacy of the association of motor imagery and constraint-induced movement therapies in functional rehabilitation of the upper limb in a patient with somatosensory and motor deficits following stroke. Motor imagery (MI) therapy, i.e., mental simulation of body image, consisted in: 1st, mirror visual stimulus, at three 30-60-minute weekly sessions for four weeks; and 2nd, MI with mental practice, at three 15-minute sessions per week for three weeks. Lastly, constraint-induced movement therapy was applied for 14 days, in 10 of which the patient underwent 6 hours daily of paretic limb functional training. The patient was assessed at baseline and at the end of each therapy modality as to clinical examination of sensation; hand grip strength; shoulder, elbow and wrist range of motion; and the motor assessment scale (MAS) was applied. Scores obtained at the four assessment moments were statistically compared. Results showed significant differences (p<0.05) after treatment: increased range of motion at all upper limb joints, increased hand grip strength, decrease in time of task performance at MAS, and recovery of clinical sensation, especially tactile detection and pressure sense. The association of IM and constraint-induced therapies thus proved effective in functional rehabilitation of the upper limb of the poststroke patient with chronic hemiparesis.This study assessed the efficacy of the association of motor imagery and constraint-induced movement therapies in functional rehabilitation of the upper limb in a patient with somatosensory and motor deficits following stroke. Motor imagery (MI) therapy, i.e., mental simulation of body image, consisted in: 1st, mirror visual stimulus, at three 30-60-minute weekly sessions for four weeks; and 2nd, MI with mental practice, at three 15-minute sessions per week for three weeks. Lastly, constraint-induced movement therapy was applied for 14 days, in 10 of which the patient underwent 6 hours daily of paretic limb functional training. The patient was assessed at baseline and at the end of each therapy modality as to clinical examination of sensation; hand grip strength; shoulder, elbow and wrist range of motion; and the motor assessment scale (MAS) was applied. Scores obtained at the four assessment moments were statistically compared. Results showed significant differences (p<0.05) after treatment: increased range of motion at all upper limb joints, increased hand grip strength, decrease in time of task performance at MAS, and recovery of clinical sensation, especially tactile detection and pressure sense. The association of IM and constraint-induced therapies thus proved effective in functional rehabilitation of the upper limb of the poststroke patient with chronic hemiparesis.

Correlação entre postura da cabeça, intensidade da dor e índice de incapacidade cervical em mulheres com queixa de dor cervical

Neck pain is the most common symptom of cervical dysfunctions often being related to the maintenance of postures. Postural changes of the head are often associated with the occurrence of neck pain with an anterior approach was the most frequent. The purpose was to investigate the correlation between head posture, pain intensity and neck disability index. The study group (SG) was composed of women, aged between 20 and 50 years who complained of neck pain for more than three months, and the control group (CG) for asymptomatic women. Pain intensity was assessed by visual analogue scale (VAS), disability by neck disability index (NDI) and the head posture by the craniovertebral angle (CV). Normality of the data was verified by the Lilliefors test and the comparison between groups by the Students t-test for independent samples, and the association between variables by Spearman correlation test. Significance level was 5%. The SG had lower average CV for the angle (p=0.02). The CV angle was negatively correlated with the VAS (r=-0.48) and NDI (r=-0.15) suggesting that the smaller the angle, the greater the intensity of neck pain and disability. The NDI and VAS showed a positive correlation (r=0.59). The angle CV in subjects with neck pain was significantly lower than in healthy individuals association with the neck disability index and pain.

Efeito da equoterapia na estabilidade postural de portadores de esclerose múltipla: estudo preliminar

OBJETIVO: El objetivo de este estudio fue identificar los efectos de la hipoterapia sobre el control postural en pacientes con esclerosis multiple (EM). METODO: Hicieron parte de este estudio 11 portadores de EM divididos en Grupo Intervencion (GI) y Grupo Control (GC). El GI fue insertado en un programa de hipoterapia durante cuatro meses, siendo realizadas dos sesiones semanales con duracion de 50 minutos cada una. La estabilidad postural fue evaluada utilizando una plataforma de fuerza (para calcular el desplazamiento del centro de presion (COP), durante 30 segundos en postura erecta casi-estatica, con ojos abiertos y cerrados, antes y despues del entrenamiento con hipoterapia. El tratamiento estadistico fue realizado a traves de ANOVA y Post hoc de Tukey con p<0,05. RESULTADOS: la amplitud de oscilacion antero-posterior se redujo significativamente en el GI despues de la estimulacion, mientras que el GC mantuvo un comportamiento sin cambios entre las evaluaciones. En ambos grupos la estabilidad postural fue reducida con la supresion de la informacion visual. CONCLUSIONES: la adaptacion funcional proporcionada por la hipoterapia fue capaz de mejorar la estabilidad postural de los portadores de EM. Los resultados corroboran la literatura que soporta el uso de la hipoterapia como una potencial intervencion en los desordenes del control postural en portadores de EM.OBJECTIVE: This study intended to identify the effects of hippotherapy on the postural control of multiple sclerosis (MS) patients. METHODS: Eleven MS patients were separated into two groups: Intervention Group (IG) and Control Group (CG). Hippotherapy consisted of two 50-minute sessions each week for four months. Postural stability was evaluated before and after hippotherapy using a force plate to calculate the center of pressure (COP), when subjects stood still for 30 seconds, with eyes open and closed. Statistical analysis was performed by ANOVA and post hoc Tukey tests, p<0.05. RESULTS: Hippotherapy significantly reduced the amplitude of oscillation in the anteroposterior direction in IG while CG remained unaltered. In both groups postural stability was reduced after the suppression of visual information. CONCLUSIONS: Hippotherapy induced functional adaptations that resulted in better postural stability of subjects with MS. This study corroborates literature supporting the use of hippotherapy as a possible intervention for balance disorders in patients with MS.

Effect of hippotherapy on the postural stability of patients with multiple sclerosis: a preliminary study

OBJETIVO: El objetivo de este estudio fue identificar los efectos de la hipoterapia sobre el control postural en pacientes con esclerosis multiple (EM). METODO: Hicieron parte de este estudio 11 portadores de EM divididos en Grupo Intervencion (GI) y Grupo Control (GC). El GI fue insertado en un programa de hipoterapia durante cuatro meses, siendo realizadas dos sesiones semanales con duracion de 50 minutos cada una. La estabilidad postural fue evaluada utilizando una plataforma de fuerza (para calcular el desplazamiento del centro de presion (COP), durante 30 segundos en postura erecta casi-estatica, con ojos abiertos y cerrados, antes y despues del entrenamiento con hipoterapia. El tratamiento estadistico fue realizado a traves de ANOVA y Post hoc de Tukey con p<0,05. RESULTADOS: la amplitud de oscilacion antero-posterior se redujo significativamente en el GI despues de la estimulacion, mientras que el GC mantuvo un comportamiento sin cambios entre las evaluaciones. En ambos grupos la estabilidad postural fue reducida con la supresion de la informacion visual. CONCLUSIONES: la adaptacion funcional proporcionada por la hipoterapia fue capaz de mejorar la estabilidad postural de los portadores de EM. Los resultados corroboran la literatura que soporta el uso de la hipoterapia como una potencial intervencion en los desordenes del control postural en portadores de EM.OBJECTIVE: This study intended to identify the effects of hippotherapy on the postural control of multiple sclerosis (MS) patients. METHODS: Eleven MS patients were separated into two groups: Intervention Group (IG) and Control Group (CG). Hippotherapy consisted of two 50-minute sessions each week for four months. Postural stability was evaluated before and after hippotherapy using a force plate to calculate the center of pressure (COP), when subjects stood still for 30 seconds, with eyes open and closed. Statistical analysis was performed by ANOVA and post hoc Tukey tests, p<0.05. RESULTS: Hippotherapy significantly reduced the amplitude of oscillation in the anteroposterior direction in IG while CG remained unaltered. In both groups postural stability was reduced after the suppression of visual information. CONCLUSIONS: Hippotherapy induced functional adaptations that resulted in better postural stability of subjects with MS. This study corroborates literature supporting the use of hippotherapy as a possible intervention for balance disorders in patients with MS.

RASTREAMENTO DOS PROGRAMAS DE SAÚDE VOLTADOS PARA A CRIANÇA ELABORADOS PELAS TRÊS ESFERAS DE GOVERNO

As politicas publicas de saude constituem-se como resposta do Estado as necessidades da populacao. Aquelas voltadas para crianca promovem tanto o seu desenvolvimento integral, como tambem o da sociedade. Os objetivos do estudo foram verificar os programas de saude voltados para a crianca elaborados a nivel Federal, Estadual e Municipal; identificar quais estao implantados no Municipio e os que atuam nas escolas. A pesquisa foi descritiva exploratoria, cujos dados foram coletados atraves de entrevista semi-estruturada aplicada aos responsaveis pela area infantil das Secretarias Municipal de Educacao e de Saude de Santa Maria entre os meses de junho a agosto de 2006. Foram encontrados 30 programas, sendo 13 a nivel Federal, 10 a nivel Estadual e sete a nivel Municipal. No municipio estao implantados 25 programas, oito deles atuando nas escolas. Conclui-se que ainda existem poucas politicas publicas de saude destinadas a crianca, principalmente as que visam atuacao no ambiente educacional.

AVALIAÇÃO DA CAPACIDADE FUNCIONAL EM PACIENTES PORTADORES DE SEQÜELAS DE AVC PARTICIPANTES DO PROJETO DE HIDROCINESIOTERAPIA APLICADA ÀS PATOLOGIAS NEUROLÓGICAS DO IDOSO

Os comprometimentos funcionais decorrentes do AVC prejudicam o desempenho das Atividades Basicas de Vida Diaria (ABVDs) e das Atividades Instrumentais de Vida Diaria (AIVD), predispondo o individuo a incapacitância funcional. O objetivo desta pesquisa foi avaliar o nivel de capacidade funcional na realizacao das ABVDs e AIVDs nos idosos portadores de sequelas de AVC que participam de um projeto academico de extensao. Para a coleta de dados foi utilizada a Avaliacao Funcional das escalas de Kats e Lawton, apud Netto (1996), aplicada atraves de um questionario aos participantes. Em relacao as ABVDs, todos os participantes (n=10) levantam-se da cama, tomam banho, realizam os cuidados de higiene e controlam seu intestino sem ajuda. Em relacao as AIVDs, 40% (n=4) dos participantes conseguem preparar, planejar e servir suas refeicoes sem auxilio. Conclui-se que a maioria dos pacientes e independente para a realizacao de ABVDs e as maiores limitacoes encontram-se nas AIVDs.

Distribuição da pressão plantar e morfologia do pé de crianças com paralisia cerebral e crianças com desenvolvimento típico

Cerebral Palsy (CP) is characterized as movement and posture disorders that cause performance limitations in activities easily performed by children with typical development (TD). Our study aimed to compare plantar pressure distribution and foot morphology between children with CP and TD, using an observational analytical research, of cross-sectional and comparative type, with 32 children between 6 and 11 years old, paired by gender and age, distributed in study group (SG) and control group (CG). We assessed the plantar distribution with the Footwork electronic baropodometry system and classified foot type by the Chippaux-Smirak Index. The SG obtained greater values on anterior weight-bearing and lower on posterior weight-bearing (p=0.02). In addition, SG showed lower mean pressure values for right (p=0.00) and left feet (p=0.01), when compared with the CG. Most children showed the same type of foot bilaterally, with the prevalence of flat feet in SG and cavus feet in the CG. Children with spastic CP who presented preserved locomotor performance, or with some dysfunction, revealed antepulsion posture, smaller mean plantar pressures, and flat foot prevalence when compared with children with TD.

Distribution of plantar pressure and body posture in spastic cerebral palsy

Introduction: cerebral palsy (CP) describes a group of permanent disorders of movement and posture due to a non-progressive disorder that occurs during the fetal or infant brain, may contribute to limitations in the functionality. Objective: to investigate the distribution of plantar pressures and the body posture in spastic CP. Methods: a descriptive case series study conducted at the Sector Outpatient Pediatric Rehabilitation Neurofunctional the University Hospital of Santa Maria - RS. Seven children with spastic CP, level I and II were included in the Gross Motor Function Classification System. Plantar pressures were analyzed using a baropodometry system – Footwork - and the type of the foot was calculated by index-ChipauxSmirak. Postural alignment was assessed subjectively in anteroposterior and lateral views. Data were analyzed using descriptive statistics. Results: The asymmetric distribution of plantar pressures were evidenced in hemiparetic, diparetic and quadripareticos PC evaluated and the prevalence of flat foot occurred. The most frequent postural changes were the forward and head tilt, elevation, tilt and protrusion of shoulder, cervical and lumbar lordosis, thoracic kyphosis, the anterversion and unevenness of the hip and pronation of the feet. Conclusions: In this group of children plantar pressures and posture proved to be altered. These findings may influence the prognosis of deformities and functional rehabilitation outcomes. The use of photometry and baropodometry may assist in a more efficient therapeutic intervention.

A EQUOTERAPIA NO EQUILÍBRIO POSTURAL DE PESSOAS COM ESCLEROSE MÚLTIPLA

Multiple sclerosis (MS) is a chronic and progressive disease induced by autoimmune inflammatory responses that attack myelin of the nerve tissue, with changes in postural balance being common manifestations in MS. Objective: Verify if the hippotherapy, inserted as a complementary activity, influences the postural balance of MS patients. Method: A total of six cases were evaluated. The performance of postural balance was assessed by the Berg Balance Scale (BBS) before and after 30 sessions of hippotherapy, performed twice a week, over a period of four months. Results: After the intervention, there was an increase in scores on BBS in four individuals and two of them maintained their scores. Conclusions: The stimulation of hippotherapy as a complementary activity proved to be able to improve the results of performance in functional tasks that require static and dynamic balance, assessed by BBS.

Efecto de la hipoterapia en la estabilidad postural de portadores de esclerosis múltiple: estudio preliminar

OBJETIVO: El objetivo de este estudio fue identificar los efectos de la hipoterapia sobre el control postural en pacientes con esclerosis multiple (EM). METODO: Hicieron parte de este estudio 11 portadores de EM divididos en Grupo Intervencion (GI) y Grupo Control (GC). El GI fue insertado en un programa de hipoterapia durante cuatro meses, siendo realizadas dos sesiones semanales con duracion de 50 minutos cada una. La estabilidad postural fue evaluada utilizando una plataforma de fuerza (para calcular el desplazamiento del centro de presion (COP), durante 30 segundos en postura erecta casi-estatica, con ojos abiertos y cerrados, antes y despues del entrenamiento con hipoterapia. El tratamiento estadistico fue realizado a traves de ANOVA y Post hoc de Tukey con p<0,05. RESULTADOS: la amplitud de oscilacion antero-posterior se redujo significativamente en el GI despues de la estimulacion, mientras que el GC mantuvo un comportamiento sin cambios entre las evaluaciones. En ambos grupos la estabilidad postural fue reducida con la supresion de la informacion visual. CONCLUSIONES: la adaptacion funcional proporcionada por la hipoterapia fue capaz de mejorar la estabilidad postural de los portadores de EM. Los resultados corroboran la literatura que soporta el uso de la hipoterapia como una potencial intervencion en los desordenes del control postural en portadores de EM.OBJECTIVE: This study intended to identify the effects of hippotherapy on the postural control of multiple sclerosis (MS) patients. METHODS: Eleven MS patients were separated into two groups: Intervention Group (IG) and Control Group (CG). Hippotherapy consisted of two 50-minute sessions each week for four months. Postural stability was evaluated before and after hippotherapy using a force plate to calculate the center of pressure (COP), when subjects stood still for 30 seconds, with eyes open and closed. Statistical analysis was performed by ANOVA and post hoc Tukey tests, p<0.05. RESULTS: Hippotherapy significantly reduced the amplitude of oscillation in the anteroposterior direction in IG while CG remained unaltered. In both groups postural stability was reduced after the suppression of visual information. CONCLUSIONS: Hippotherapy induced functional adaptations that resulted in better postural stability of subjects with MS. This study corroborates literature supporting the use of hippotherapy as a possible intervention for balance disorders in patients with MS.