Marco Aurélio Benedetti Rodrigues

Use of virtual reality in gait recovery among post stroke patients – a systematic literature review

Abstract Purpose: To conduct a systematic literature review focusing on the use of virtual reality (VR) for the improvement of gait in post-stroke patients. Methods: We performed a search of Randomized-controlled trials published from 1966 to 2011 in the databases: Medline, Lilacs, CINAHL, Cochrane and SciELO. Keywords used in the selection were: Virtual reality in combination with (AND) “Nervous System Diseases”, (OR) “Motor Skill Disorders” (OR) “neurologic impairments” (OR) “motor function” (OR) function* (OR) locomotion (OR) ambulation (OR) gait (OR) “motor activity” (OR) Stroke. Selected articles were evaluated using the individual’s components of methodological quality assessment and analysis of outcomes of each study was based on the domains of the International Classification of Functioning, Disability and Health (ICF). Results: A total of 6520 references were found, however, based on the inclusion and exclusion criteria only four studies were considered and analyzed. These articles demonstrated that the use of VR promotes changes in gait parameters, despite the diversity of protocols, participants’ characteristics, as well as the number of participants included in each study. Conclusions: The research studies analyses suggest that VR is a promising method to improve the gait of patients with stroke. Nevertheless, some questions still need to be answered. Some aspects should be investigated to confirm the true benefits and application of VR in this population. Implications for Rehabilitation: Stroke is the second cause of death and the leading cause of disability worldwide. The loss or impairment of ambulation is one of the most devasting sequelae of stroke. Restoration of gait can be considered the main goal of rehabilitation after stroke. Conventional interventions tend to be tedious, providing few opportunities to increase the difficulty level of the proposed tasks and do not encourage adaptive postural reactions. There is evidence to support the use of virtual reality for the promotion of walking in people with sequelae of stroke. Virtual reality is a feature that has been used in clinical practice, however, the details on how to use this instrument must be set according to the therapeutic goals.

Sustained Reduction of the Dengue Vector Population Resulting from an Integrated Control Strategy Applied in Two Brazilian Cities

Aedes aegypti has developed evolution-driven adaptations for surviving in the domestic human habitat. Several trap models have been designed considering these strategies and tested for monitoring this efficient vector of Dengue. Here, we report a real-scale evaluation of a system for monitoring and controlling mosquito populations based on egg sampling coupled with geographic information systems technology. The SMCP-Aedes, a system based on open technology and open data standards, was set up from March/2008 to October/2011 as a pilot trial in two sites of Pernambuco -Brazil: Ipojuca (10,000 residents) and Santa Cruz (83,000), in a joint effort of health authorities and staff, and a network of scientists providing scientific support. A widespread infestation by Aedes was found in both sites in 2008–2009, with 96.8%–100% trap positivity. Egg densities were markedly higher in SCC than in Ipojuca. A 90% decrease in egg density was recorded in SCC after two years of sustained control pressure imposed by suppression of >7,500,000 eggs and >3,200 adults, plus larval control by adding fishes to cisterns. In Ipojuca, 1.1 million mosquito eggs were suppressed and a 77% reduction in egg density was achieved. This study aimed at assessing the applicability of a system using GIS and spatial statistic analysis tools for quantitative assessment of mosquito populations. It also provided useful information on the requirements for reducing well-established mosquito populations. Results from two cities led us to conclude that the success in markedly reducing an Aedes population required the appropriate choice of control measures for sustained mass elimination guided by a user-friendly mosquito surveillance system. The system was able to support interventional decisions and to assess the program’s success. Additionally, it created a stimulating environment for health staff and residents, which had a positive impact on their commitment to the dengue control program.

Image segmentation of ovitraps for automatic counting of Aedes Aegypti eggs

The Aedes Aegypti mosquito is the vector of the most difficult public health problems in tropical and semi-tropical world: the epidemic proliferation of dengue, a viral disease that can cause human beings death specially in its most dangerous form, dengue haemorrhagic fever. One of the most useful methods for mosquito detection and surveillance is the ovitraps: special traps to collect eggs of the mosquito. It is very important to count the number of Aedes Aegypti eggs present in ovitraps. This counting is usually performed in a manual, visual and non-automatic form. This work approaches the development of automatic methods to count the number of eggs in ovitraps images using image processing, particularly color segmentation and mathematical morphology-based non-linear filters.

A new algorithm for segmenting and counting aedes aegypti eggs in ovitraps

Dengue fever has become a major international public health concern in recent decades. As dengue fever not have available vaccine or specific treatment, the only known form to prevent the illness is by applying strategies to control its vector, the Aedes aegypti mosquito. Ovitraps, special traps to collect mosquito eggs, are used to detect Aedes aegypti presence and to approximate the gauge of the adult mosquitoes population in the environment by counting the number of eggs laid in an trap. This counting is usually performed in a manual, visual and non-automatic form. This work proposes a new automatic method to automatically count the number of eggs in digital images of ovitraps based on image processing techniques (color systems exploration) and k-Means clustering algorithm. The proposed method performs an improvement on the results when compared with previous studies.

Aedes aegypti egg counting system

New monitoring methods of dengue vector and evaluation of public policies on dengue control are major concerns for several tropical countries. Drawback on monitoring methods base on oviposition surveys are the counting process of mosquito eggs, information store and analysis. Here we present a new automated egg counting system for remote Aedes aegypti population survey. The system is base on an optical scanning platform, a man-machine interface, and a software for mosquitoes eggs counting. Acquired information are sent over the internet and remotely analyzed. Prototypes of the device were installed and implement in two different cities.

Acute effects of incremental inspiratory loads on compartmental chest wall volume and predominant activity frequency of inspiratory muscle.

AIM This research aims to analyze the acute effect of incremental inspiratory loads on respiratory pattern and on the predominant activity frequency of inspiratory muscle, taking into account differences in gender responses. Optoelectronic Plethysmography was performed during loads in 39 healthy subjects (20 women), placing 89 markers on the thoracic-abdominal wall to obtain total and regional volumes. Surface electromyography (SEMG) was taken simultaneously on the Sternocleidomastoid and Diaphragm muscles, to calculate the predominant muscle activity frequency through wavelet analysis. Inspiratory loads were performed using Threshold(®)with 2 min of breathing at different levels, ranging from a load of 10 cmH(2)O plus 5 cmH(2)O to 40 cmH(2)O or fatigue. RESULTS Inspiratory Time increased during loads. Total and compartmental volumes increased with different regions, changing at different loads. These changes in volume occur earlier in women (20 cmH(2)O) than in men (30 cmH(2)O). The predominant activity frequency of Sternocleidmastoid muscle decreased at 30 cmH(2)O, while Diaphragm activity decreased at 40 cmH(2)O. CONCLUSION The acute effects of incremental inspiratory loads are increases of total and regional volumes and inspiratory time. As for muscle activity, the predominant activity frequency declined in Sternocleidomastoid and Diaphragm muscles, but at different loads. Such respiratory and SEMG patterns and gender differences should be considered when clinical interventions are performed.

Whole body vibration improves maximum voluntary isometric contraction of knee extensors in patients with chronic kidney disease: A randomized controlled trial

ABSTRACT Background: Whole body vibration (WBV) training improves maximum voluntary isometric contraction (MVIC) of knee extensors, postural balance, functional capacity, and quality of life (QOL) in several diseases. The objective was to assess the efficacy of WBV training in patients with chronic kidney disease (CKD) on hemodialysis (HD) in the interdialytic period. Method: A randomized, controlled trial study with concealed allocation, intention-to-treat analysis, and triple blinding. Sixteen patients with CKD of both genders aged over 40 years were allocated in two groups, the WBV group or the sham group, training 2 times a week for 12 weeks. The primary outcome was knee extensor muscle strength, and the secondary outcomes were quadriceps thickness, distance walked, balance, and QOL. Results: The WBV group improved MVIC of knee extensors with a difference between groups in improvement of 117.29 N (95% CI, 32.25–202.24) at the end of training. The other outcomes were not different between groups. Practical applications: The WBV program has shown to be effective and may be able to help in prescribing the appropriate training program for CKD. Conclusion: WBV training improves MVIC of knee extensors in patients with CKD on HD in the interdialytic period. WBV training could be considered in the management of patients with CKD.

Aedes Aegypti Web-based proliferation and analysis monitor system

This work aims to create a Web platform in order to assist in the Aedes Aegypti mosquitos proliferation. The Geographic Information System SAPIO (SIG-SAPIO) is part of a project denominated Acquisition and Image Processing Ovitraps System (SAPIO). It is being used for obtaining and processing ovitraps — traps where the mosquitos eggs are deposited — and automate the counting of eggs. The analysis of the results here by far obtain, shows that the proliferation of the mosquito obtained by SAPIO are to be shown thru Web by SIG-SAPIO. This technique is being great interest to help prevent Dengue in real time.

Development of mobile virtual application to increase consciousness and relaxation of the pelvic floor muscles

The aim of this research was to develop a mobile virtual application to increase consciousness and relaxation of the pelvic floor muscles.

Automatic pressure support reduction is effective in weaning postoperative patients in the intensive care unit

Automatic pressure support reduction based on a targeted respiratory frequency or MRV is disposable in the TAENA ventilator for an automatic reduction of pressure support during weaning of patients in the intensive care unit (ICU). We studied 23 patients (63.52 years) in the postoperative period (14 cardiac, two thoracic and seven abdominal surgeries) in a prospective, randomized protocol comparing automatic pressure support weaning with the traditional manual reduction of pressure support to 5–7 cmH2O in our ICU. After arriving in the ICU after cardiac, thoracic or abdominal surgery, the patients were randomly assigned to traditional weaning consisting of manual reduction of pressure support (the pressure support was decreased every 30 min, keeping the RR/TV(L) < 80 until 5–7 cmH2O pressure support ventilation) or to the automatic pressure support reduction (MRV) with a respiratory frequency target of 20/min (the TAENA ventilator automatically decreased the pressure support ventilation level by 1 cmH2O every four respiratory cycles if the patients RR was less than 16/min). Twelve patients were assigned to manual weaning whereas 11 patients were assigned to the automatic pressure support reduction weaning. The weaning mean time for the manual group was 3.18 hours while the weaning mean time for the automatic pressure support reduction group was 2.24 hours. There was no reintubation in both groups.