João Carlos Comel

Tai Chi Chuan for Cardiac Rehabilitation in Patients with Coronary Arterial Disease

Background Several studies have shown that Tai Chi Chuan can improve cardiac function in patients with heart disease. Objective To conduct a systematic review of the literature to assess the effects of Tai Chi Chuan on cardiac rehabilitation for patients with coronary artery disease. Methods We performed a search for studies published in English, Portuguese and Spanish in the following databases: MEDLINE, EMBASE, LILACS and Cochrane Register of Controlled Trials. Data were extracted in a standardized manner by three independent investigators, who were responsible for assessing the methodological quality of the manuscripts. Results The initial search found 201 studies that, after review of titles and abstracts, resulted in a selection of 12 manuscripts. They were fully analyzed and of these, nine were excluded. As a final result, three randomized controlled trials remained. The studies analyzed in this systematic review included patients with a confirmed diagnosis of coronary artery disease, all were clinically stable and able to exercise. The three experiments had a control group that practiced structured exercise training or received counseling for exercise. Follow-up ranged from 2 to 12 months. Conclusion Preliminary evidence suggests that Tai Chi Chuan can be an unconventional form of cardiac rehabilitation, being an adjunctive therapy in the treatment of patients with stable coronary artery disease. However, the methodological quality of the included articles and the small sample sizes clearly indicate that new randomized controlled trials are needed in this regard.

Prevalência de dor osteomuscular em profissionais de enfermagem de equipes de cirurgia em um hospital universitário

Dentre as profissoes da area da saude, a enfermagem, em particular, tem sido afetada pelos disturbios musculoesqueleticos produzindo alteracoes na vida desses trabalhadores, impossibilitando-os de realizarem atividades cotidianas e laborais. Objetivo: Investigar a prevalencia de dor osteomuscular e a associacao com a qualidade de vida em profissionais de enfermagem que atuam em equipes de cirurgia no Hospital de Clinicas de Porto Alegre. Metodo: Estudo transversal realizado entre marco de 2011 e janeiro de 2012, em um hospital universitario terciario do sul do Brasil. Foram avaliados 110 trabalhadores de enfermagem das equipes de cirurgia. Foram excluidos os trabalhadores em licenca saude, ferias ou outro tipo de afastamento durante o periodo de coleta dos dados. A dor osteomuscular foi avaliada atraves do questionario Nordico de Sintomas Osteomusculares e a qualidade de vida foi avaliada atraves do questionario Medical Outcomes Study 36 - Item Short-Form Survey (SF-36). As relacoes entre dor osteomuscular e qualidade de vida foram analisadas atraves do Teste U de Mann-Whitney, utilizando nivel de significância de 95%. Resultados: A prevalencia de dor osteomuscular encontrada neste estudo foi de 91,81%. Com relacao as regioes anatomicas, considerou-se as queixas de dor osteomuscular retroativo ha doze meses, onde o predominio foi de dor no pescoco (56%) e ombros (56%). Quando consideramos afastamento por dor osteomuscular encontramos a prevalencia de dor lombar (34%). O grupo que nao relatou dor osteomuscular apresentou melhores indices de qualidade de vida nos dominios de capacidade funcional, aspectos fisicos, dor, vitalidade, aspectos sociais e saude mental. Conclusao: A dor osteomuscular apresenta maior prevalencia nas regioes do pescoco e ombros. Alem disso, o maior numero de afastamentos ocorre por prevalencia de dor lombar entre os trabalhadores de enfermagem das equipes de cirurgia. A dor influenciou na qualidade de vida afetando seis dos dominios avaliados.

Comparison of the electrical activity in upper trapezius and wrist extensor muscles during two typewriting conditions

Introduction The proper use of the position of the arm and wrist while typing may reduce muscle overload and prevent musculoskeletal disorders.Objective To evaluate the electromyographic activity of upper trapezius and wrist extensor muscles during two typewriting conditions.Materials and methods : Six healthy females (Xage = 42 years,SD= 10), (Xheight = 1.65m, SD = 0.05) and (Xweight = 71kg, SD = 16) participated in this study. The task was performed with a newly developed arm support and without the support. A perceived exertion scale was used with all subjects. An ANOVA with repeated measures was used to verify differences in perceived exertion and root mean square (RMS).Results There were no statistically significant differences for the RMS between the typewriting tasks. The condition without arm support presented a significantly greater mean velocity and amount of words typed (P= 0.02; P= 0.03) and there was a significant difference in perceived exertion during the condition without arm support (P= 0.03). Electromyographic activity did not present differences.Conclusion The muscle electrical activity was not altered regardless the arm support and occurred the improvement of the perceived exertion after 10 minutes of typing without support. Long-term studies are needed.

A comparative study on the recruitment of shoulder stabilizing muscles and types of exercises

The shoulder is susceptible to disturbances caused by microtraumas due to direct contact of the surrounding skeletal structures or failure of the soft parts of the rotator cuff and other muscles inserted into the glenohumeral joint. The purpose of the study was to compare the electromyographic signal in the stabilizing muscles of the shoulder during the diagonal elevation exercise as recommended by the proprioceptive neuromuscular facilitation (PNF) method and dumbbell exercise. This study is classified as Quase-experiment. Subjects were instructed to perform diagonal standard exercises and the electromyographic signal was detected from pectoralis muscles, middle and upper trapezius of dominant limb in each subject. We observed greater muscular recruitment when the PNF method was adopted in comparison with the dumbbell workouts for the trapezius upper and middle fiber muscles and for the major pectoralis (267,30 μv/181,02 μv; 235,76 μv/;164,47 μv; 299,87 μv/148,69 μv; P<0.001). The PNF method promotes a greater recruitment of the shoulder dynamic stabilizing muscles during diagonal elevation exercises. Being so, such kinesiotherapeutic technique may be effectively used in the prevention, treatment and rehabilitation of shoulder disorders.

Electromyographic analysis of constraint-induced movement therapy effects in patients after stroke in chronic course

[Purpose] The purpose is to analyze the effects of Constraint-induced Movement Therapy in post stroke patients in chronic course. [Subjects and Methods] This is a Quasi-experiment study and the adopted protocol consisted of a three-hour therapy for ten consecutive working days applied to a constraint intact upper limb. Surface Electromyography, Motor Activity Log, Wolf Motor Function Test and Functional Independence Measure were used for evaluating the experiment. [Results] The individuals showed reduction in the degree of spasticity, confirmed by Surface Electromyography. In relation to Motor Activity Log this study showed an increase in amount and in quality of the paretic upper limb movement. The Wolf Motor Function Test showed reduction in the average time to perform the tasks and a functional improvement was identified through the Functional Independence Measure. [Conclusion] Constraint Induced Movement Therapy proved to be a relevant method to improve motor function in chronic hemiparesis post stroke reducing the spasticity, maximizing and improving the use of committed upper limb.