Guilherme Carlos Brech

Gait analysis following treadmill training with body weight support versus conventional physical therapy: a prospective randomized controlled single blind study

Study design:Single-blind randomized, controlled clinical study.Objectives:To evaluate, using kinematic gait analysis, the results obtained from gait training on a treadmill with body weight support versus those obtained with conventional gait training and physiotherapy.Setting:Thirty patients with sequelae from traumatic incomplete spinal cord injuries at least 12 months earlier; patients were able to walk and were classified according to motor function as ASIA (American Spinal Injury Association) impairment scale C or D.Methods:Patients were divided randomly into two groups of 15 patients by the drawing of opaque envelopes: group A (weight support) and group B (conventional). After an initial assessment, both groups underwent 30 sessions of gait training. Sessions occurred twice a week, lasted for 30 min each and continued for four months. All of the patients were evaluated by a single blinded examiner using movement analysis to measure angular and linear kinematic gait parameters. Six patients (three from group A and three from group B) were excluded because they attended fewer than 85% of the training sessions.Results:There were no statistically significant differences in intra-group comparisons among the spatial–temporal variables in group B. In group A, the following significant differences in the studied spatial–temporal variables were observed: increases in velocity, distance, cadence, step length, swing phase and gait cycle duration, in addition to a reduction in stance phase. There were also no significant differences in intra–group comparisons among the angular variables in group B. However, group A achieved significant improvements in maximum hip extension and plantar flexion during stance.Conclusion:Gait training with body weight support was more effective than conventional physiotherapy for improving the spatial–temporal and kinematic gait parameters among patients with incomplete spinal cord injuries.

Age does not affect exercise intensity progression among women.

Ciolac, EG, Brech, GC, and Greve, JMD. Age does not affect exercise intensity progression among women. J Strength Cond Res 24(11): 3023-3031, 2010-It has been recommended that the intensity of exercise training (ET) should progress slowly with lower increments in older than in young people. However, scientific evidence supporting this recommendation is lacking. Our aim was to examine possible influences of age on exercise intensity progression in healthy women. Seventeen young (29.1 ± 5.7 years) and 16 older women (64.5 ± 4.5 years) underwent 13 weeks of ET consisting of cycle ergometry (CE, 65-75% of reserve heart rate), whole-body resistance exercise (RE, 60% of 1 repetition maximum [1RM]), and stretching. Muscle strength was assessed before and after ET by the 1RM. Cycle ergometry and RE workloads were recorded for each exercise session, and increases of 5-10% were made whenever adaptation occurred. Absolute muscle strength after ET improved (p < 0.001) in both groups, and there were no significant differences between groups. Relative exercise intensity progression was not significantly different between groups for RE (Pearsons correlation = 0.98 ± 0.01), but it was greater in older women for CE (p = 0.047). The ET was safe because no injuries or major muscle pain was observed in either group. These results suggest that healthy older women are capable of exercising and increasing exercise intensity in the same way as young women.

Evaluation of physiotherapy in the treatment of Legg-Calvé-Perthes disease

INTRODUCTION Physiotherapy using muscle strengthening and stretching exercises is claimed to have beneficial effects in the treatment of Legg-Calvé-Perthes disease; however, no scientific evidence is available concerning effectiveness of treatment. PURPOSE The purpose of the present study was to clinically evaluate possible effects of the proposed physiotherapeutic effects compared to observational follow-up in patients with Legg-Calvé-Perthes disease. METHOD A prospective follow-up study was conducted in 17 patients with unilateral Legg-Calvé-Perthes disease, divided into 2 groups: Group A (observational follow-up) and Group B (physiotherapeutic follow-up). In order to evaluate the outcome of the adopted treatments, the following parameters were assessed: articular range of motion, level of muscular strength, level of articular dysfunction, and radiographic status, both before and after the treatment. RESULTS Group B exhibited significant improvement in articular range of motion concerning hip flexion, extension, abduction, adduction, medial rotation, and lateral rotation, while in Group A an equally significant worsening occurred concerning abduction, adduction, and medial rotation. Muscular strength also improved in Group B, mainly in the set of hip flexor muscles, while Group A showed no changes. Articular dysfunction after therapy compared to pretherapy was significantly reduced in Group B and increased in Group A. Patients undergoing physiotherapy exercises showed no changes in their radiographic features. CONCLUSION Physiotherapy produced significant improvement in articular range of motion, muscular strength, and articular dysfunction in patients with Legg-Calvé-Perthes disease, but these improvements were not evident on radiographs.

Relationship between Anthropometric Factors, Gender, and Balance under Unstable Conditions in Young Adults

The objective of this study was to evaluate the relationship between the anthropometric factors of height, body mass, body mass index and postural balance and to compare the balance indices between genders in the upright standing position, in healthy adult subjects under conditions of instability. Forty individuals were subjected to functional tests of body stability using the Biodex Balance System, and the resulting indices were correlated with body mass, height, and body mass index, and also compared between genders. Body mass was the main anthropometric factor that influenced variations in postural balance, with a high correlation between groups and with all variables. A linear regression analysis showed that body mass associated with BMI explained 66% of the overall stability, and body mass explained 59% of the anteroposterior stability index and 65% of the mediolateral stability index. In the female group, body mass explained 72% of the overall balance, 66% of the anteroposterior, and 76% of the medio-lateral stability index. Increased body mass requires greater movements to maintain postural balance. Height and BMI presented moderate correlations with balance. Women showed less movement than men on the Biodex Balance System.

Evaluation of the association between osteoporosis and postural balance in postmenopausal women

The incidence of osteoporosis has been increasing, as have fractures resulting from falls. Postural balance was evaluated in postmenopausal women with and without lumbar osteoporosis. One hundred and twenty-six postmenopausal women aged 55-65 years were evaluated and separated into two groups according to the bone mineral density values of their lumbar spine: the osteoporosis group and the control group, paired by age (P = 0.219) and physical activity (P = 0.611). There was no difference between the groups (P = 0.139) regarding falls reported in the previous 12 months. Functional mobility was evaluated through the Timed Up and Go Test. Postural balance was evaluated using a portable force platform in standard standing position, with eyes open and closed, for 60s. Muscle strength was evaluated through an isokinetic dynamometer. This study shows that there is no difference in knee muscle strength and functional mobility (P = 0.121), postural balance with eyes open [mediolateral displacement (P = 0.286) and mean velocity of the center of pressure (COP) (P = 0.173)] and with eyes closed [mediolateral displacement (P = 0.163), and the mean velocity of displacement of the COP (P = 0.09)] in both groups. Subjects reporting falls had greater mediolateral displacement (P = 0.028) in both groups. Postmenopausal women aged between 55 and 65 years do not present changes in postural balance irrespective of lumbar osteoporosis. Greater COP mediolateral displacement is related to the occurrence of falls in postmenopausal women in the previous year.

One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy.

OBJECTIVE: To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up. METHOD: This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly. RESULTS: At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster. CONCLUSION: Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment.

The effects of motor learning on clinical isokinetic performance of postmenopausal women

OBJECTIVE To analyze the effects of motor learning on knee extension-flexion isokinetic performance during clinical isokinetic evaluation of postmenopausal women. METHODS One-hundred and twenty postmenopausal women (60.3±3.2 years; BMI=27.6±4.7 kg/m(2)) without knee pain or injury and that never underwent isokinetic testing, were submitted to two bilateral knee extension-flexion (concentric-concentric) isokinetic evaluation (5 repetitions) at 60°/s (Biodex™ Multi-Joint System 3 dynamometer). The tests were first performed in the dominant leg, with a 1-min recovery between them, and after a standardized warm-up that included 3 submaximal isokinetic repetitions. The same procedure was repeated in the non-dominant leg. Peak torque (PTQ) was adjusted for body weight (PTQ/BW), total work (TW), coefficient of variation (CV) and agonist/antagonist (agon/antag) ratio was compared between tests. RESULTS Subjects showed greater levels (P<0.001) of PTQ, PTQ/BW and TW, and lower CV levels (P<0.01) in test 2 of both legs. Agon/antag ratio did not change significantly between tests. CONCLUSIONS PTQ, PTQ/BW, TW and CV improved in the second knee extension flexion isokinetic testing of postmenopausal women. The results suggests that performing two tests, even with a short period of recovery between them, could be considered for reducing motor learning effects on clinical isokinetic evaluation of knee joint in postmenopausal women.

Correlation of disability and pain with postural balance among women with chronic low back pain

Low back pain is one of the most common musculoske-letal complaints and, from a public health perspective, is themost costly (1,2). In most cases, it is benign and disappearswithin six weeks, but approximately 20% of individualswith lumbar pain do not show any improvement in theircondition, which may progress to chronic low back pain.This chronic condition is difficult to manage and iscorrelated with many mechanical alterations (3).Maintenance of postural balance under static or dynamicconditions is essential for any functional activity (4). Inindividuals with chronic low back pain, the degree of controlmay change such that performing daily tasks becomescompromised and the chronic nature of the disease issustained (4-7). The mechanisms that lead to such abnorm-alities of postural control remain unclear. Pain is animportant factor in mechanical and neural alterations, butthe extent to which it influences postural balance still cannotbe determined. One of the hypotheses of this study is that thegreater the lumbar pain and physical disability, the worse thepatient’s maintenance of both static and dynamic posture.Thus, the aim of this study was to investigate thecorrelations between lumbar pain and the degree of disabilityand postural balance among women with chronic low backpain.

Anthropometric and musculoskeletal assessment of patients with Marfan syndrome.

BACKGROUND Marfan 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. OBJECTIVES The aim of the present study was to assess anthropometry, musculoskeletal alterations and the prevalence of physical therapy treatments among patients with MS. METHODS Twenty-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. RESULTS In 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. CONCLUSIONS Patients 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.

A avaliação inicial de pacientes com doença de Legg-Calvé-Perthes internados

A retrospective study on 52 Legg-Calve-Perthes disease patients was performed, with the objective of identifying the initial characteristics of the patients according to registration files data, such as: clinical status, radiographic classification and physical examination. The outcomes noted were as follows: 22 patients (42%) reported the presence of pain and limping, 21 patients (40%) reported only pain, 2 patients (4%) reported only limping, and 7 patients (14%) reported no pain or limping. During evaluation for range of motion, we found the numerical description for 16 (31%) patients, 28 (54%) patients the decrease in the range of motion was just described, but no numerical value assigned, and in 8 patients (15%) such decrease - either with or without numerical value - was not reported. Regarding the radiological picture, we found that Catterall classification was used most of the times (64%), followed by Salter-Thompson (27%) and Herring (9%). We concluded that the baseline clinical status of these patients is similar to what is found in literature, with pain, limping, and decreased range of motion of the hip involved. Catteralls is the radiographic classification mostly used.