Gustavo de Azevedo Carvalho

Relação entre cifose dorsal, densidade mineral óssea e controle postural em idosas

OBJECTIVES To verify the relationship between the angle of thoracic kyphosis, bone mineral density, and postural control in elderly women. METHODS Through a cross-sectional study, 95 elderly participants were subdivided into four groups according to the thoracic kyphosis angle (obtained by the flexicurve method) and to bone densitometry results. On the force platform and through the dynamic test, stabilometric data were obtained. For statistical analysis, we assessed the performance of each group on the force platform by non-parametric tests: between group comparison (Mann-Whitney) and within group comparison according to the condition of the eyes - open or closed (Signed Rank). RESULTS On the force platform, the only statistically significant difference was found between groups 1 (loss of bone mass and increased thoracic kyphosis) and 3 (no loss of bone mass or increase in thoracic kyphosis) in the anteroposterior direction (p=0.0124). All groups presented different performances with the eyes open and closed in the mediolateral direction, except for group 3 (p=0.4263), whereas in the anteroposterior direction, we did not observe differences. CONCLUSION The results suggest an influence of the angle of thoracic kyphosis and bone mineral density on the postural control of our sample in the anteroposterior direction and in the standing position.

Relação entre o ângulo quadriciptal (ÂQ) e a distribuição da pressão plantar em jogadores de futebol

OBJECTIVES: To determine whether there is an association between the Q-angle (Q) and the distribution of plantar pressure in football players, and to compare the characteristics of these athletes with non-practitioners of this sport. METHODS: 121 male participants were selected: 50 football practitioners (FP) and 71 non-practitioners (NP). We concurrently evaluated the Q-angle and the plantar pressure through the software of postural assessment (SPA) and the F-Mat System, respectively. To verify the correlation between the Q-angle and peak pressure values in four segments of the foot (medial and lateral forefoot, medium-foot and hind-foot), the Pearson coefficient (r) for parametric analysis was used. The independent t-test was used to compare these variables between the groups. Data normality was verified by the skewness values, adopting a significance level of 5%. RESULTS: A negative and weak correlation was found (r=-0.32) between the Q-angle and the plantar pressure in the right medium-foot. The groups differed with regards to the right Q-angle (11.36o in FP versus 13.80o in NP) and the left Q-angle (11.03o in FP versus 13.96o in NP). Plantar pressure was also different between the groups, with FP showing higher mean values for the right side and for the left side of the forefoot (0.77 kg/cm2 in FP versus 0.63 kg/cm2 in NP, and 0.65 kg/cm2 in FP versus 0.54 kg/cm2 in NP, respectively). However, mean peak pressure values for the left medium-foot were higher among NP (0.37 kg/cm2 in FP versus 0.46 kg/cm2 in NP). CONCLUSIONS: There was no evidence of an association between the Q-angle and the distribution of plantar pressure in FP. The athletes showed reduced Q-angle values and higher mean peak pressure values for the right and left aspects of the forefoot, suggesting a varus malalignment and a supine distribution of plantar bases.

Influência da resolução e da distância da câmera nas medidas feitas pelo software de avaliação postural (sapo)

O erro na medida de um sistema de avaliacao da postura esta relacionado com a digitalizacao, a resolucao da câmera, a distância da câmera em relacao ao voluntario estudado, entre outros. Estes erros somam-se no procedimento metodologico e muitos deles nao sao possiveis evitar, porem devem ser conhecidos e quantificados. OBJETIVO: Quantificar o erro na medida realizada pelo SAPO (Software para avaliacao postural) em diferentes situacoes experimentais. METODOS: Foram realizadas 16 fotos de um manequim de 1,40m articulado nos planos anterior, posterior, lateral direita e lateral esquerda com câmeras de 3,2 e 12,0 megapixels, posicionadas a 3,0m e a 5,0m de distância do manequim. Para a quantificacao do erro, foram calculadas as diferencas das medidas obtidas por meio do SAPO com as medidas feitas diretamente no manequim. Apenas um avaliador realizou o registro das imagens, porem a digitalizacao no software dos pontos demarcados no manequim foi realizada por tres digitalizadores, sendo dois inexperientes e um experiente. RESULTADOS: Os valores medios das medidas horizontais, verticais, angulares e de distância sao proximos de zero, embora algumas variaveis angulares apresentem valores maiores, como nas medidas de ângulo Q direito e esquerdo. A câmera com resolucao de 3,2 megapixels posicionada a 3m apresentou o menor erro. CONCLUSAO: O SAPO e um metodo acurado para uso clinico; sao necessarios estudos para verificar a influencia do plano de posicionamento do voluntario em relacao a câmera, o efeito do reposicionamento e da palpacao nas medidas oferecidas pelo software.

Accuracy and reliability of the Pfeffer Questionnaire for the Brazilian elderly population

The aging population calls for instruments to assess functional and cognitive impairment in the elderly, aiming to prevent conditions that affect functional abilities. Objective To verify the accuracy and reliability of the Pfeffer (FAQ) scale for the Brazilian elderly population and to evaluate the reliability and reproducibility of the translated version of the Pfeffer Questionnaire. Methods The Brazilian version of the FAQ was applied to 110 elderly divided into two groups. Both groups were assessed by two blinded investigators at baseline and again after 15 days. In order to verify the accuracy and reliability of the instrument, sensitivity and specificity measurements for the presence or absence of functional and cognitive decline were calculated for various cut-off points and the ROC curve. Intra and inter-examiner reliability were assessed using the Interclass Correlation Coefficient (ICC) and Bland-Altman plots. Results For the occurrence of cognitive decline, the ROC curve yielded an area under the curve of 0.909 (95%CI of 0.845 to 0.972), sensitivity of 75.68% (95%CI of 93.52% to 100%) and specificity of 97.26%. For the occurrence of functional decline, the ROC curve yielded an area under the curve of 0.851 (95%CI of 64.52% to 87.33%) and specificity of 80.36% (95%CI of 69.95% to 90.76%). The ICC was excellent, with all values exceeding 0.75. On the Bland-Altman plot, intra-examiner agreement was good, with p>0.05consistently close to 0. A systematic difference was found for inter-examiner agreement. Conclusion The Pfeffer Questionnaire is applicable in the Brazilian elderly population and showed reliability and reproducibility compared to the original test.

Efeitos da imersão em gelo na força de preensão palmar em adultos jovens

Objetivo: Avaliar os efeitos da imersao em gelo por 30 segundos na forca de preensao palmar (FPP) em academicos do curso de fisioterapia. Metodo: Foi realizado um estudo transversal e a amostra foi por conveniencia realizada com 30 sujeitos adultos, sendo 15 homens e 15 mulheres, onde foi avaliada a FPP por meio de um dinamometro em tres momentos distintos: pre-imersao, imediatamente apos a imersao e uma hora apos a imersao em gelo. A imersao foi feita em um balde com capacidade de 30 litros, com temperatura controlada de ate 5o C, sendo o membro superior imerso ate a linha interarticular de cotovelo por 20 segundos. Resultados: Observou-se alteracoes altamente significativas entre a pre imersao e imediatamente apos a imersao em gelo em ambos os grupos, masculino e feminino (p < 0,01) e, mesmo apos uma hora, ainda observou-se diferencas significativas na FPP. Conclusao: A imersao em gelo durante 30 segundos a uma temperatura de ate 5 oC diminuiu de forma significativa a FPP.

Development of an application for mobile devices to evaluate the balance and risk of falls of the elderly

No campo da saude, o desenvolvimento tecnologico permitiu o aperfeicoamento de praticas como o prontuario eletronico do paciente, acesso a bando de dados, monitoracao de sinais biologicos, exames de imagem, treinamento e planejamento de procedimentos bem como ferramenta de apoio diagnostico. Sendo assim, o uso de dispositivos moveis como o smartphone e uma area com grande potencial devido a facilidade do manejo e sua capacidade computacional. Este trabalho trata do desenvolvimento e teste de um aplicativo para dispositivos moveis capaz de captar as oscilacoes do corpo humano na posicao estatica atraves de um acelerometro embutido em um smartphone para uso de profissionais da saude como ferramenta de avaliacao do equilibrio e risco de queda de idosos. A revisao literaria apresentada neste trabalho confirma a competencia destes instrumentos na avaliacao funcional postural de idosos, do equilibrio e analise de marcha. Com base nos resultados do presente estudo, o aplicativo desenvolvido foi capaz de realizar o teste do equilibrio e classificar os avaliados em dois grupos de baixo e alto risco de queda.

Old Women Body Balance: Does the Pelvic Organ Prolapse Matter?

Pelvic organ prolapse (POP) is a common condition in older women. We have observed that patients with advanced POP complain of body imbalance. The purpose of this study was to investigate impact of advanced POP on older womens body balance. Thirty-eight consecutive women were selected. Body balance was assessed by stabilometric measures (SM) and the Berg Balance Scale (BBS). Groups, nonadvanced versus advanced POP, were statistically similar on the BBS and all SM, but median center of pressure displacement speed (COPd-speed) was P = .04. A univariate analysis did not confirm any association between advanced POP and increased COPd-speed. Advanced POP may have no impact on older womens body balance.

Teste de monofilamento não identifica idosos com neuropatia diabética

two validated screening instrument scores. METHODS: A descriptive cross-sectional study with a convenience sample in which 50 patients diagnosed with NPD by the instruments score of neuropathic symptoms (ESN), score neuropathic commitments (ECN), and protective sensation plant using the 10-g Semmes-Weinstein monofilament (orange) were evaluated. RESULTS: 50 olders were diagnosed with NPD by ESN and ECN instruments and the presence or absence of the 10-g monofilament was compared. There was no statistically significant correlation using the Kruskal-Wallis test including. In many patients the monofilament were preserved. CONCLUSION: The isolated 10-g monofilament was not able to indicate the diagnosis of diabetic neuropathy. It is possible that elderly diabetics with neuropathy have the feeling plant preserved.

Assessment of muscle mass, risk of falls and fear of falling in elderly people with diabetic neuropathy

Objective : To assess muscle mass, risk of falls and fear of falling in elderly adults with diabetic neuropathy (DNP). Methods : 50 elderly patients with diabetes mellitus (DM) and diabetic neuropathy (NPD) participated in this study. Risk of falling was assessed using the Berg Balance Scale (BBS). Fear of falling was assessed by means of the Falls Efficacy Scale-International (FES-I). Muscle mass was assessed by tetrapolar bioimpedance analysis (BIA) and Janssens equation. Subjects were divided into two groups: one with a history of falls in the six months before study enrollment (G1) and the other without history of falls (G2). Results : There were statistically significant differences between G1 and G2 regarding lean body mass (p < 0.05), risk of falls as measured by the BBS (p < 0.01), and fear of falling as measured by the FES-I (p < 0.01). In addition, there was a significant correlation between the BBS and BIA (r = 0.45 and p < 0.01), showing that the greater the lean body mass, the lower the risk of falling. Conclusions : We found an association between lean mass, risk of falls and fear of falling in elderly adults with DNP and a history of falls from own height.

Estabilidad postural, riesgo de caídas y miedo de caer en ancianos con neuropatía diabética que realizan ejercicios terapéuticos

Este estudo objetivou analisar a estabilidade postural, o risco de quedas e o medo de cair em idosos com neuropatia diabetica (NPD) que realizam exercicios terapeuticos. Realizou-se uma triagem para rastreio de idosos com NPD por meio dos instrumentos Escore de Sintomas Neuropaticos (ESN) e Escore de Comprometimento Neuropatico (ECN). Os 50 pacientes selecionados para participar do estudo foram divididos em dois grupos: 24 do G1 (os que estavam realizando exercicios terapeuticos) e 26 do G2 (o grupo controle). Para avaliar a estabilidade postural, risco de quedas e o medo de cair entre os grupos foram utilizadas a plataforma de pressao, a Escala de Equilibrio de Berg (EEB) e a Escala de Eficacia de Quedas (FES-I). Nao foram observadas diferencas significativas no resultado das escalas EEB (p=0,16) e FES-I (p=0,15) entre o G1 e o G2; pela plataforma de pressao, foram encontradas diferencas entre G1 e G2 nos parâmetros comprimento da trajetoria (CT) e estabilidade medio-lateral (ML), ambos com os olhos fechados (OF). Os idosos com NPD que realizam exercicios terapeuticos apresentam melhor estabilidade ML e no CT com OF que idosos sedentarios; contudo, nao foram observadas associacoes com o exercicio terapeutico, risco de quedas e medo de cair.