Gerson Cipriano Junior

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.

Anthropometric and musculoskeletal assessment of patients with Marfan syndrome.

BACKGROUNDnMarfan syndrome (MS) is an autosomic dominant condition of the connective tissue that involves the ocular, cardiovascular and musculoskeletal systems. MS is caused by mutations in the fibrillin-1 gene, leading to joint ligaments flaccidity, joint hypermobility and an overgrowth of the long bones.nnnOBJECTIVESnThe aim of the present study was to assess anthropometry, musculoskeletal alterations and the prevalence of physical therapy treatments among patients with MS.nnnMETHODSnTwenty-six patients were included in this study [17 females (age: 13.23±2.77 years; body mass 51.5±24-68 Kg; height 1.70±1.40-1.81 m; arm span: 1.73±0.12 m) and 9 males (age: 14.44±2.18; body mass: 61.0±42-72 Kg; height: 1.83±1.66-1.97 m; arm span: 1.93±0.13 m)]. Anthropometric measurements and musculoskeletal abnormalities were determined in a standardized fashion: pectus and scoliosis were assessed through radiography and angulation (â) of the scoliosis curve using the Cobb method; arachnodactyly was assessed through the thumb sign and Walker-Murdoch test and dolichostenomelia was assessed by arm span in relation to height. Patients also responded to a questionnaire addressing participation in physical therapy.nnnRESULTSnIn comparison to values estimated for the Brazilian population, mass and height were greater among the patients with MS (females: p=0.001 e p<0.0005 e males p=0.019 e p=0.0001, respectively). The following musculoskeletal abnormalities were found: pectus in 3 patients (11%), pectus and scoliosis in 19 (73%), dolichostenomelia in 11 (42%) and arachnodactyly in 21 (80%). Eleven patients (42%) with MS had previously undergone physical therapy.nnnCONCLUSIONSnPatients with MS exhibit altered musculoskeleto and anthropometry and have infrequent physical therapy treatment.CONTEXTUALIZACAO: A Sindrome de Marfan (SM) e uma doenca autossomica dominante do tecido conjuntivo que envolve os sistemas ocular, cardiovascular e musculoesqueletico, causada por mutacoes no gene da fibrilina1, gerando flacidez nos ligamentos articulares, favorecendo a hipermobilidade articular e reducao na contencao do crescimento osseo. OBJETIVOS: Avaliar as medidas antropometricas, alteracoes musculoesqueleticas e a frequencia do tratamento fisioterapeutico nos pacientes com SM. METODOS: Participaram deste estudo 26 pacientes, sendo 17 do genero feminino, com idade de 13,23±2,77 anos, massa corporea de 51,5±24-68 Kg, altura de 1,70±1,40-1,81 m e envergadura de 1,73±0,12 cm, e nove do genero masculino, com idade de 14,44±2,18, massa corporea de 61,0±42-72 Kg, altura de 1,83±1,66-1,97 m e envergadura de 1,93±0,13. Foram obtidas medidas antropometricas, alteracoes ME de forma padronizada, sendo o pectus e a escoliose, por avaliacao radiologica, e a angulacao (â) da curva escoliotica, pelo metodo de Cobb; a aracnodactilia, pelo sinal do polegar e teste de Walker-Murdoch, e a dolicostenomelia, pela envergadura em relacao a altura. Os pacientes responderam a um questionario quanto a participacao em tratamento de fisioterapia. RESULTADOS: Quando comparados com a estimativa brasileira, a massa corporea e a altura apresentaram valores maiores no genero feminino (p=0,001 e p<0,0005) e masculino (p=0,019 e p=0,0001). Das alteracoes musculoesqueleticas, encontrou-se pectus em 3 (11%), pectus e escoliose em 19 (73%), dolicostenomelia em 11 (42%) e aracnodactilia em 21(80%). Onze (42%) pacientes com SM ja haviam realizado tratamento de fisioterapia. CONCLUSOES: As alteracoes antropometricas e musculoesqueleticas estao presentes na SM, e o tratamento fisioterapeutico e pouco frequente.

Effect of transcutaneous electrical nerve stimulation on peripheral to central blood pressure ratio in healthy subjects

To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on the arterial stiffness in healthy young adult and middle‐aged men using the augmentation index (AI‐x) and hemodynamic measures.

Impact of Intensive Physiotherapy on Cognitive Function after Coronary Artery Bypass Graft Surgery

Background Coronary artery bypass graft (CABG) is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders. Objective This study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG. Methods Neuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control) – 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy) – 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ≤ 0.05 were considered significant. Results Changes in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ≤ 0.01). Conclusion Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity.

Osteopathic manual therapy in heart failure patients: A randomized clinical trial

BACKGROUNDnHeart Failure (HF) patients usually present with increased arterial resistance and reduced blood pressure (BP) leading to an impaired functional capacity. Osteopathic Manual Therapy (OMT) focused on myofascial release techniques (MRT) and in the balancing of diaphragmatic tensions, has been shown to improve blood flow in individuals using the resistive index (RI). However, its effects in HF patients have not been examined.nnnPURPOSEnTo evaluate the acute response of selected osteopathic techniques on RI, heart rate (HR), and BP in patients with HF.nnnMETHODSnRandomized-controlled clinical trial of HF patients assigned to MRT (six different techniques with three aimed at the pelvis, two at the thorax, and one at the neck for 15xa0min) or Control group (subjects in supine position for 15xa0min without intervention). The RI of the femoral, brachial and carotid arteries was measured via doppler ultrasound while HR and BP were measured via sphygmomanometry before and after a single MRT or control intervention.nnnRESULTSnTwenty-two HF patients equally distributed (50% male, mean age 53 years; range 32-69 years) (ejection fractionxa0=xa035.6%, VO2peak: 12.9xa0mL/kg-1 min-1) were evaluated. We found no intra or inter group differences in RI of the carotid (ΔMRT: 0.07% vs Δ Control:11.8%), brachial (ΔMRT:0.17% vs ΔControl: 2.9%), or femoral arteries (ΔMRT:1.65% vs ΔControl: 0.97%) (Pxa0>xa00.05) and no difference in HR or BP (ΔMRT:0.6% vs ΔControl: 3%), (Pxa0>xa00.05).nnnCONCLUSIONnA single MRT session did not significantly change the RI, HR, or BP of HF patients.

Evaluation of the best environment for the six-minute walk test

Introduction The purpose of the six-minute walk test (6MWT) is to evaluate cardiopulmonary capacity using a low-cost test that is easy to administer, generally well tolerated by different populations and reflects one’s performance on activities of daily living. However, few studies have been conducted to determine the difference between performing the 6MWT indoors and outdoors.Objective The aim of the present study was to compare the distance covered on the 6MWT performed indoors and outdoors and evaluate the following physiological variables: heart rate, blood pressure and the subjective sensation of shortness of breath, using the Borg perceived exertion scale.Materials and methods A prospective, randomized, clinical trial was conducted involving eight healthy females not engaged in regular physical activity, with mean age 23.75 ± 1.67 years. Each subject performed the 6MWT indoors and outdoors with a 30-minute interval between tests. The order of the tests was determined randomly.Results The mean distance traveled was 578 ± 50.07 m on the outdoor trial and 579.95 ± 45.35 m on the indoor trial (p = 0.932). The mean physiological variables were 82.25 ± 11.02 bpm (indoors) versus 84.38 ± 9.42 bpm (outdoors) for heart rate, 121.88 ± 10.28 mmHg (indoors)versus 118.75 ± 19.40 mmHg (outdoors) for systolic blood pressure, 81.88 ± 9.74 mmHg (indoors) versus 80.50 ± 7.89 mmHg (outdoors) for diastolic blood pressure and a mean score of 12 on the perceived exertion score in both environments.Conclusions The present data demonstrate no differences in the distance walked on the 6MWT or the physiologic variables of participants between the indoor and outdoor trials.

Translation and cross-cultural adaptation of the Duke activity status index to Brazilian Portuguese

Abstract Introduction : The limited number of valid and reliable questionnaires for the evaluation of exercise tolerance has stimulated the development of simple international assessment tools for this purpose, one of the most widely used of which is the Duke Activity Status Index (DASI). However, this index has not yet been translated and adap-ted to the Portuguese language. Objective : To develop a Brazilian version of the DASI and cross-culturally adapt it for the evaluation of cardiorespiratory fitness among patients with cardiovascular disease in Brazil. Materials and methods : The translation process involved four stages: initial translation, back-translation, multidisciplina-ry committee review and pre-test with 16 subjects (8 cardiac patients and 8 healthy individuals). Patients were screened from outpatient Cardiac Surgery, Sao Paulo Hospital. The Mann-Whitney and chi-square tests were em-ployed to determine differences between controls and individuals with heart disease. Results