Emerson Fachin Martins

Correlação entre simetria corporal na descarga de peso e alcance funcional em hemiparéticos crônicos

BACKGROUND Postural control is often impaired in hemiparetic patients. During upright stance, hemiparetic subjects sway more than subjects with an unaffected hemibody, and they assume asymmetrical postures to place less weight on the affected side. OBJECTIVE To analyze functional reach and dependence on support devices among people with chronic hemiparesis and to investigate the relationships between displacements of functional reach and weight-bearing symmetry during upright stance. METHODS Fourteen participants with hemiparesis, classified as dependent on support devices or independent from them, were included in experimental procedures to record functional reach displacements and symmetry values. RESULTS No significant differences were found between the dependent and independent participants for any variable. However, when weight-bearing occurred on the unaffected side, the greatest displacements were significantly correlated with the most asymmetrical hemiparetic participants. CONCLUSION Symmetry did not contribute to functional reach or independence from support devices among participants with hemiparesis. Article registered in the Australian New Zealand Clinical Trials Registry under the number ACTRN12609000267257.

Tecnologia baropodométrica utilizada para analisar tipos de suporte de peso durante postura ortostática hemiparética

INTRODUCTION: Although baropodometric analysis has been published since the 1990s, only now it is found a considerable number of studies showing different uses in the rehabilitation. OBJECTIVE: To amplify the use of this technology, this research aimed to analyze baropodometric records during upright position of subjects with hemiparesis, describing a way to define weight-bearing profiles in this population. METHOD: 20 healthy subjects were matched by gender and age with 12 subjects with chronic spastic hemiparesis. This control group was formed to establish the limits of symmetry during weight-bearing distribution in the hemiparesis group. Next, hemiparesis group was submitted to procedures to measure baropodometric records used to provide variables related to the weight-bearing distribution, the arch index and the displacements in the center of pressure (CoP). Data were used to compare differences among kinds of weight-bearing distribution (symmetric, asymmetric toward non-paretic or paretic foot) and coordination system for CoP displacements. RESULTS: Hemiparesis group was compounded by eight symmetrics, eight asymmetrics toward non-paretic foot and four asymmetric toward paretic foot. Significant differences in the weight-bearing distributions between non-predominantly and predominantly used foot did not promote differences in the other baropodometric records (peak and mean of pressure, and support area). Mainly in the asymmetry toward non-paretic foot it was observed significant modifications of the baropodometric records. CONCLUSION: Baropodometric technology can be used to analyze weight-bearing distribution during upright position of subjects with hemiparesis, detecting different kinds of weight-bearing profiles useful to therapeutic programs and researches involving subjects with this disability.

Is it correct to always consider weight-bearing asymmetrically distributed in individuals with hemiparesis?

Injuries may cause unilateral deterioration of brain areas related to postural control resulting in lateralized motor disability with abnormal asymmetry in weight-bearing distribution. Although overloading toward the nonaffected limb has been described as the preferred posture among individuals with hemiparesis, characterization of the weight-bearing asymmetry is poorly and indirectly described. Therefore, this study aimed to describe weight-bearing distribution during upright stance, establishing criteria to consider asymmetry in hemiparesis when analyzed within the limits defined by controls matched by age and gender. Forty subjects with (n = 20) or without hemiparesis (n = 20) were included in procedures to record weight-bearing values between hemibodies, and these values were used to calculate a symmetry ratio. Control presented 95% confidence interval (CI) of the mean for symmetry ratio ranging from 0.888 to 1.072, defining limits to symmetry. Four subjects with hemiparesis (20%) had symmetry ratios inside limits defined by controls (i.e., weight-bearing symmetrically distributed), and 11 (55%) subjects without hemiparesis showed symmetry ratios outside the limits, suggesting asymmetrical weight-bearing distribution. It was concluded that asymmetry, when present in a control group, was more frequently overloading nonpredominantly used hemibody (nondominant side), differing from a hemiparesis group commonly forced to assume the nonaffected side as the predominantly used hemibody and where the overload was observed.

Projeto pedagógico do curso de Fisioterapia da Universidade de Brasília

INTRODUCTION: The visible exhaustion of the traditional teaching model for physiotherapy, along with a new professional profile and a change in the approach to the health-illness process (which has come to include functionality), has stimulated the need for new pedagogical projects for teaching physiotherapy. This should include a perspective of social and economic transformation of the regional population (in this case, the administrative region of Ceilândia, in the Federal District, Brasilia, Brazil). OBJECTIVE: To present a pedagogical project for the undergraduate course in physiotherapy stressing education focused on human functionality in scenarios of professional practice,e proposed by the Brazilian public healthcare system. METHODS: The curriculum is being constructed in an innovating perspective with proposals regarding the general realm (lifestyle centers, biological systems, physiotherapy skills and scenarios of physiotherapy practices), specific realm (health maintenance, health-illness process, healthcare, human functionality, process of permanent education) and complementary realm (research and extension activities). RESULTS: The pedagogical project proposal was carried out in such a way as to complement the expected general and specific goals as well as professional and social profiles. The indissociability of teaching-research-extension presumes a reference in the professor-student relationship for the comprehension of research and extension activities as fundamental elements of the teaching-learning process linked to experience in the actual context, thereby concretizing the relationship between theory and practice, focusing on the public healthcare system. CONCLUSION: The diversification of practices in the context of the public healthcare system includes a perspective of social and economic transformation in the population within the social and political scenario of the Federal District. In this context, priority is given to the education/training of generalist, reflexive, critical physiotherapists, involved from the beginning with community service on different levels of healthcare, addressing aspects of human functionality in accordance with the needs of the Brazilian public healthcare system.

Reliability of the Functional Reach Test and the influence of anthropometric characteristics on test results in subjects with hemiparesis

First designed as an alternative method of assessing balance and susceptibility to falls among elderly, the Functional Reach Test (FR) has also been used among patients with hemiparesis. Then this study aimed to describe the intra- and inter-rater and the test/re-test reliability of the FR measure in subjects with and without hemiparesis while verifying anthropometric influences on the measurements. The FR was administered to a sample of subjects with hemiparesis and to a control group that was matched by gender and age. A two-way analysis of variance was used to verify the intra-rater reliability. It was calculated using the differences between the averages of the measures obtained during single, double or triple trials. The intra-class correlation coefficient (ICC) was utilized and data plotted using the Bland-Altman method. Associations were analyzed using Pearsons correlation coefficient. In general, the intra-rater analysis did not show significant differences between the measures for the single, double or triple trials. Excellent ICC values were observed, and there were no significant associations with anthropometric parameters for the hemiparesis and control subjects. FR showed good reliability for patients with and without hemiparesis and the test measurements were not significantly associated with the anthropometric characteristics of the subjects.

Comparação entre medidas de descarga, simetria e transferência de peso em indivíduos com e sem hemiparesia

Avaliacao da Simetria e Transferencia de Peso (ASTP) foi indicada para se fazer associacao entre simetria e atividades funcionais nas hemiparesias, apontando simetricos como mais capacitados. Contudo, tais relacoes nao sao claras e divergem com evidencias que sugerem assimetrias como estrategias funcionais. Assim, objetivou-se verificar se as medidas subjetivamente determinadas pela ASTP concordam com medidas calculas pela descarga de peso entre os pes. Realizou-se estudo observacional do tipo transversal para amostra de sujeitos com hemiparesia (n=20) pareados por idade e genero a controles (n=20). Os participantes submeteram-se a procedimentos para obtencao de escore determinado pela ASTP e para calculo da razao de simetria (RS) na descarga de peso entre os pes obtido por meio de duas balancas digitais. Os resultados obtidos pela ASTP identificaram apenas um sujeito com hemiparesia apresentando simetria, dentre os quatro sujeitos identificados pela RS como simetricos. Ainda, a ASTP nao diferenciou assimetrias com sobrecarga para o lado afetado e apresentou correlacao significativa somente quando os escores foram analisados com os valores de RS<1(sobrecarga para o lado nao afetado). Conclui-se que a ASTP nao foi concordante em identificar sujeitos hemipareticos com descarga de peso compativel com simetria. Ainda, nao identificou sobrecargas para o lado afetado que poderia conduzir a analises equivocadas da associacao entre simetria e desempenho funcional.

Código de ética para fisioterapeutas e terapeutas ocupacionais revela conteúdos relacionados à autonomia do profissional

Apesar de ja existir codigo mais recente, estudo que revele os conteudos do antigo pode contribuir para melhor compreensao do papel social do fisioterapeuta. Assim, este estudo procurou verificar as proporcoes de enfoques deontologicos e bioeticos presentes no codigo, identificando predominios de conteudos para subsidiar interpretacoes deste documento. Utilizou-se analise textual e interpretativa do codigo comparando-o com dois conjuntos de textos. O primeiro apresentava referencial teorico deontologico e o segundo referencial bioetico. Para o codigo de etica e para cada conjunto de textos foram identificadas unidades textuais em categorias de enfoques bioetico (principialismo) e/ou deontologico (tecnica e virtude). Para conteudos textuais do codigo de etica e para os dois respectivos conjuntos de textos identificou-se 54,4, 55,7 e 57,7% de unidades com enfoque deontologico nos seus conteudos. No codigo de etica, para as unidades de enfoque bioetico, considerando unidades de autonomia separadas entre profissional e cliente, observou-se razao de 2,15:1 (profissional:cliente). Esta razao foi menor que a observada nos textos de referencial deontologico (5,07:1 - profissional:cliente) e inversa a razao de 1,32:1 (cliente:profissional) dos textos de referencial bioetico. Conclui-se que o predominio de conteudos, tanto no codigo de etica quanto nos textos deontologicos, mostraram concepcoes corporativistas e legalistas, prevalecendo uma visao de autonomia profissional. Esta caracteristica divergiu dos textos com referencial teorico bioeticos em que se constatou predominância de valor para autonomia focada no cliente.