Neuseli Marino Lamari

Analysis of joint mobility patterns among preschool children

CONTEXT AND OBJECTIVE Standardization of normal joint mobility criteria is complex, especially for preschool children, for whom differentiation from hypermobility (JH) is even more difficult. This study aimed to investigate joint mobility of the fifth finger, wrist, elbow, knee and trunk among preschool children, estimate the incidence of JH and evaluate the effect of gender and age and the applicability of standard criteria for identifying JH among preschool children. DESIGN AND SETTING Cross-sectional descriptive and quantitative study, at São José do Rio Preto medical school. METHODS 1,120 healthy children (534 boys, 47.7%; 586 girls, 52.3%; age range: 4-7 years) were evaluated using Beighton scores. Passive extension of fifth finger (> 90 degrees), passive apposition of thumb to forearm, active extension of elbow and knee (> 10 degrees) and anterior trunk flexion placing flat hand on ground were assessed. One point was scored for each positive result (maximum: 9). Scores > 4 were considered to be JH. Students t test and variance analysis were used for statistical analysis. RESULTS JH was observed in 80% of wrists, 53.3% of fifth fingers, 36.6% of elbows, 14% of trunks and 12.5% of knees. Scores > 4 were found for 64.6% of the children. Females had higher angular values. Lower scores were associated with greater age. CONCLUSIONS JH is a common condition among preschool children and currently available methods are inadequate. New parameters and criteria should be developed for identifying JH among these children.CONTEXTO E OBJETIVO: A padronizacao dos criterios de mobilidade articular e complexa e nenhum estudo na literatura avaliou exclusivamente criancas pre-escolares, idade em que a diferenciacao entre a mobilidade articular normal e a hipermobilidade torna-se ainda mais dificil. Objetivamos investigar a mobilidade articular no quinto dedo, punho, cotovelo, joelho e tronco em pre-escolares; estimar a incidencia da hipermobilidade articular; avaliar o efeito da idade e do sexo nos resultados e a aplicabilidade dos criterios de Beighton e cols.3 para identificar a hipermobilidade articular em pre-escolares. TIPO DE ESTUDO E LOCAL: Transversal, descritivo e qualitativo, na Faculdade de Medicina de Sao Jose do Rio Preto. METODOS: 1.120 criancas saudaveis, 534 (47,7%) meninos e 586 (52,3%) meninas (idade entre quatro e sete anos), foram avaliadas de acordo com os escores de Beighton et al.3 para extensao passiva do quinto dedo (> 90°), posicao passiva do polegar ao antebraco, extensao ativa do cotovelo e do joelho (> 10°) e flexao anterior do tronco (colocacao das maos espalmadas no solo). Considerou-se um ponto para cada resultado positivo. O escore maximo foi 9. Foi considerado hipermovel a crianca com escore > 4. A hipermobilidade foi estimada e comparada com a idade e o sexo. O teste t de Student e a analise da variância foram usados para analise estatistica. RESULTADOS: A hipermobilidade articular foi identificada em 80% (punho), 53,3% (quinto dedo), 36,6% (cotovelo), 14% (tronco) e 12,5% (joelho). O escore > 4 foi encontrado em 64,6% das criancas, as meninas tiveram maiores valores angulares e menores escores foram associados com o aumento da idade. CONCLUSOES: A hipermobilidade articular e uma condicao comum neste grupo de idade e o metodo correntemente utilizado para avaliar e inadequado. Portanto, novos parâmetros e criterios devem ser desenvolvidos para identificar a hipermobilidade articular em pre-escolares.

Fisioterapia respiratória no pré e pós-operatório de cirurgia de revascularização do miocárdio

The cardiovascular diseases are among the main death causes in the developed world. They have been increasing epidemically in the developing countries. In spite of several alternatives for the treatment of the coronary artery disease; the surgery of the myocardial revascularization is an option with proper indications of medium and long-term with good results. It provides the remission of the angina symptoms contributing to the increase of the expectation and improvement of the life quality. Most of patients undergoing myocardial revascularization surgery develop postoperative lung dysfunction with important reduction of the lung volumes, damages in the respiratory mechanism, decrease in the lung indulgence and increase of the respiratory work. The reduction of volumes and lung capacities can contribute to alterations in the gas exchanges, resulting in hypoxemia and decrease in the diffusion capacity. Taking this into account, the Physiotherapy has been requested more and more to perform in the pre as well as in the postoperative period of this surgery. This study aimed at updating the knowledge regarding the respiratory physiotherapy performance in the pre and postoperative period of the myocardial revascularization surgery enhancing the prevention of lung complications. The Physiotherapy uses several techniques in the preoperative period; such as: the incentive spirometry, exercises of deep breathing, cough, inspiratory muscle training, earlier ambulation and physiotherapeutic orientations. While in the postoperative period, the objective is the treatment after lung complications took place, performed by means of physiotherapeutic maneuvers and noninvasive respiratory devices, aiming at improving the respiratory mechanism, the lung reexpansion and the bronchial hygiene. Respiratory physiotherapy is an integral part in the care management of the patient with cardiopathy, either in the pre or in the postoperative period, since it contributes significantly to a better prognosis of these patients with the use of specific techniques.

Importância da fisioterapia no pré e pós-operatório de cirurgia cardíaca pediátrica

Lung complications during postoperative of pediatric heart surgery are frequently highlighting atelectasis and pneumonia. Physiotherapy has an important role in the treatment of these complications. We reviewed and update the physiotherapy performance in the preoperative and in the postoperative lung complication of pediatric cardiac surgery. We noted efficacy of physiotherapy treatment through different specific techniques and the need for development of new studies.

Bronquiectasia e fisioterapia desobstrutiva: ênfase em drenagem postural e percussão

Bronchiectasis consists of abnormal, permanent and irreversible dilation of bronchi and bronchia, with recurrent infections, inflammation, hypersecretion and reduction of mucus clearance. It predominantly affects women of between 28 and 48 years old and more frequently affects the inferior lobes. Clinical manifestations are chronic cough, fever and voluminous expectoration, with a fetid odor. The etiology is

Flexibilidade anterior do tronco no adolecente após o pico da velocidade de crescimento em estatura

Trunk anterior flexibility (TAF) is a major component of clinical and physical ability tests and it is used as an indicative of vertebral function. The most used test for its quantification is the seat-and-reach (SRT), which considers hands touching feet as normality standard, with analysis criteria and parameters that are independent of variables. In this study, TAF was investigated in teenagers, after the occurrence of the height growth speed peak compared to gender, performance speed, and anthropometric data. Rates were provided as centimeters; body weight in kg. One hundred two adolescents took part of the study, being 45 females and 57 males, with ages between 16 and 20 years. The results suggest that gender factor, anthropometric data, and test performance speed influence flexibility rates; the evaluation of vertebral function cannot have SRT for reaching feet as a normality criterion, and that fast speeds lead to better results. In brief, results suggest that touching feet is a criterion ruling out a normal vertebral function in approximately 50% of the adolescents. Thus, the criterion used for making a decision regarding referring a teenager to recover higher flexibility rates must be reviewed.

Physiotherapeutic conduct in amyotrophic lateral sclerosis

Amyotrophic Lateral Sclerosis (ALS) is a fatal progressive neurodegenerative disease with multifactorial etiology for which, so far, there is no effective medicinal treatment. However, by means of kinesiotherapy intervention and patient guidance and care, physiotherapy can delay physical functional losses, muscle fatigue and immobility of the joint-muscle system, thereby improving the quality of life. This survey had the aim of reviewing the physiotherapeutic conduct currently used in ALS cases. Monthly monitoring is recommended, with changes in goals and conduct at each stage of the disease, activities to be pursued around the home, and emphasis on stretching, muscle strengthening, posture adequacy and respiratory kinesiotherapy.

Afecção do tendão supra-espinal e afastamento laboral

As afeccoes do manguito rotador, dentre elas as relacionadas ao tendao supra-espinal, sao problemas comuns na populacao, sobretudo devido a sobrecarga ocupacional, o que leva a altos indices de afastamento do trabalho. Buscou-se, entao, comparar a necessidade de afastamento de trabalho entre os diferentes estados da afeccao do tendao supra-espinal e entre cinco diferentes grupos profissionais, tendo a participacao de pacientes que apresentavam diagnostico da afeccao. Os individuos foram agrupados quanto ao estado da doenca (tendinite, ruptura parcial, ruptura total) e quanto aos aspectos biomecânicos da ocupacao (ramo de servicos, construcao civil, trabalhadores domesticos, lavradores e segurancas). Teste qui-quadrado de Pearson, analise de dependencia e teste exato para uma proporcao foram realizados. Os resultados apontaram que 62 (55%) estavam afastados da atividade laboral e que os grupos com maior numero de afastados foram o do ramo de servicos (38,71%) e lavradores (22,58%), segundo Pearson. A maior frequencia de casos de afastamento foi registrada no estagio de tendinite (p<0,05) pela analise de dependencia e a ocupacao de lavrador parece deixar o individuo por mais tempo afastado (p=0,02), segundo teste de Pearson.

Joint hypermobility in patients with mitral valve prolapse

Studies on hypermobility have aroused great interest in the last decades, as they are associated to musculoskeletal disorders, as well as abnormalities in several organic systems, such as the mitral valve prolapse. Therefore, in this study, data on the association between joint hypermobility and the mitral valve prolapse were investigated and reviewed. Studies in the literature have shown that genetic alterations in the collagen composition seem to be the main cause of this association.Studies on hypermobility have aroused great interest in the last decades, as they are associated to musculoskeletal disorders, as well as abnormalities in several organic systems, such as the mitral valve prolapse. Therefore, in this study, data on the association between joint hypermobility and the mitral valve prolapse were investigated and reviewed. Studies in the literature have shown that genetic alterations in the collagen composition seem to be the main cause of this association.

Rotator cuff Disease: Aspects and Implications

El objetivo del estudio fue analizar las caracteristicas de los portadores de la afeccion del manguito rotador y sus implicancias por el cuadro de la lesion. Fueron entrevistadas 112 personas, con diagnostico inicial de afeccion del manguito rotador, la mayoria compuesta por mujeres de alrededor de 51 anos, siendo el lado derecho mas afectado, con evidencia de ser el mas perjudicado (p=0,00) y con gran incapacidad de mover los miembros superiores (p<0,05). La patologia mas frecuente fue la ruptura parcial del tendon del musculo supraespinal, con tratamiento de 26,16 meses y sin asociacion con los estados de la patologia. La mayoria de los casos fueron tratados con fisioterapia, y solo el 19% fue sometido a procedimiento quirurgico. Se verifico que esta patologia provoca grandes perjuicios funcionales, afectando tanto el ambito social como laboral, produciendo altas incapacidades en los miembros superiores, aun despues del tratamiento

Hipermobilidade articular em pacientes com prolapso da valva mitral

Studies on hypermobility have aroused great interest in the last decades, as they are associated to musculoskeletal disorders, as well as abnormalities in several organic systems, such as the mitral valve prolapse. Therefore, in this study, data on the association between joint hypermobility and the mitral valve prolapse were investigated and reviewed. Studies in the literature have shown that genetic alterations in the collagen composition seem to be the main cause of this association.Studies on hypermobility have aroused great interest in the last decades, as they are associated to musculoskeletal disorders, as well as abnormalities in several organic systems, such as the mitral valve prolapse. Therefore, in this study, data on the association between joint hypermobility and the mitral valve prolapse were investigated and reviewed. Studies in the literature have shown that genetic alterations in the collagen composition seem to be the main cause of this association.