Ricky Watari
University of São Paulo
Network
Latest external collaboration on country level. Dive into details by clicking on the dots.
Publication
Featured researches published by Ricky Watari.
Clinical Biomechanics | 2008
Paula Marie Hanai Akashi; Isabel de Camargo Neves Sacco; Ricky Watari; Ewald M. Hennig
BACKGROUND We aimed at investigating the influence of diabetic neuropathy and previous history of plantar ulcers on electromyography (EMG) of the thigh and calf and on vertical ground reaction forces during gait. METHODS This study involved 45 adults divided into three groups: a control group (n=16), diabetic neuropathic group (n=19) and diabetic neuropathic group with previous history of plantar ulceration (n=10). EMG of the right vastus lateralis, lateral gastrocnemius and tibialis anterior were studied during the stance phase. The peaks and time of peak occurrence were determined and a co-activation index between tibialis anterior and lateral gastrocnemius. In order to represent the effect of the changes in EMG, the first and second peaks and the minimum value of the vertical ground reaction force were also determined. Inter-group comparisons of the electromyographical and ground reaction forces variables were made using three MANCOVA (peaks and times of EMG and peaks of force) and one ANCOVA (co-activation index). FINDINGS The ulcerated group presented a delayed in the time of the lateral gastrocnemius and vastus lateralis peak occurrence in comparison to controls. The lateral gastrocnemius delay may be related to the lower second vertical peak in diabetic subjects. However, the delay of the vastus lateralis did not cause any significant change on the first vertical peak. INTERPRETATIONS The vastus lateralis and lateral gastrocnemius delay demonstrate that ulcerated diabetic neuropathic patients have a motor deficit that could compromise their ability to walk, which was partially confirmed by changes on ground reaction forces during the push-off phase.
BMC Musculoskeletal Disorders | 2014
Cristina D. Sartor; Renata H. Hasue; Licia Cacciari; Marco K. Butugan; Ricky Watari; Anice de Campos Pássaro; Claudia Giacomozzi; Isabel de Camargo Neves Sacco
BackgroundFoot musculoskeletal deficits are seldom addressed by preventive medicine despite their high prevalence in patients with diabetic polyneuropathy.AIM: To investigate the effects of strengthening, stretching, and functional training on foot rollover process during gait.MethodsA two-arm parallel-group randomized controlled trial with a blinded assessor was designed. Fifty-five patients diagnosed with diabetic polyneuropathy, 45 to 65 years-old were recruited. Exercises for foot-ankle and gait training were administered twice a week, for 12 weeks, to 26 patients assigned to the intervention group, while 29 patients assigned to control group received recommended standard medical care: pharmacological treatment for diabetes and foot care instructions. Both groups were assessed after 12 weeks, and the intervention group at follow-up (24 weeks). Primary outcomes involved foot rollover changes during gait, including peak pressure (PP). Secondary outcomes involved time-to-peak pressure (TPP) and pressure–time integral (PTI) in six foot-areas, mean center of pressure (COP) velocity, ankle kinematics and kinetics in the sagittal plane, intrinsic and extrinsic muscle function, and functional tests of foot and ankle.ResultsEven though the intervention group primary outcome (PP) showed a not statistically significant change under the six foot areas, intention-to-treat comparisons yielded softening of heel strike (delayed heel TPP, p=.03), better eccentric control of forefoot contact (decrease in ankle extensor moment, p<.01; increase in function of ankle dorsiflexion, p<.05), earlier lateral forefoot contact with respect to medial forefoot (TPP anticipation, p<.01), and increased participation of hallux (increased PP and PTI, p=.03) and toes (increase in PTI, medium effect size). A slower COP mean velocity (p=.05), and an increase in overall foot and ankle function (p<.05) were also observed. In most cases, the values returned to baseline after the follow-up (p<.05).ConclusionsIntervention discreetly changed foot rollover towards a more physiological process, supported by improved plantar pressure distribution and better functional condition of the foot ankle complex. Continuous monitoring of the foot status and patient education are necessary, and can contribute to preserving the integrity of foot muscles and joints impaired by polyneuropathy.Trial registrationClinicalTrials.gov Identifier:NCT01207284, registered in 20th September 2010.
Gait & Posture | 2014
Isabel de Camargo Neves Sacco; Adriana Naomi Hamamoto; Lucas M.G. Tonicelli; Ricky Watari; Neli Regina Siqueira Ortega; Cristina D. Sartor
Inconsistent findings with regard to plantar pressure while walking in the diabetic population may be due to the heterogeneity of the studied groups resulting from the classification/grouping criteria adopted. The clinical diagnosis and classification of diabetes have inherent uncertainties that compromise the definition of its onset and the differentiation of its severity stages. A fuzzy system could improve the precision of the diagnosis and classification of diabetic neuropathy because it takes those uncertainties into account and combines different assessment methods. Here, we investigated how plantar pressure abnormalities evolve throughout different severity stages of diabetic polyneuropathy (absent, n=38; mild, n=20; moderate, n=47; severe, n=24). Pressure distribution was analysed over five areas while patients walked barefoot. Patients with mild neuropathy displayed an increase in pressure-time integral at the forefoot and a lower peak pressure at the heel. The peak and pressure-time integral under the forefoot and heel were aggravated in later stages of the disease (moderate and severe) compared with early stages of the disease (absent and mild). In the severe group, lower pressures at the lateral forefoot and hallux were observed, which could be related to symptoms that develop with the aggravation of neuropathy: atrophy of the intrinsic foot muscles, reduction of distal muscle activity, and joint stiffness. Although there were clear alterations over the forefoot and in a number of plantar areas with higher pressures within each severity stage, they did not follow the aggravation evolution of neuropathy classified by the fuzzy model. Based on these results, therapeutic interventions should begin in the early stages of this disease to prevent further consequences of the disease.
Journal of Neuroengineering and Rehabilitation | 2014
Ricky Watari; Cristina D. Sartor; Andreja P. Picon; Marco K. Butugan; Cesar Ferreira Amorim; Neli Regina Siqueira Ortega; Isabel de Camargo Neves Sacco
BackgroundElectromyography (EMG) alterations during gait, supposedly caused by diabetic sensorimotor polyneuropathy, are subtle and still inconsistent, due to difficulties in defining homogeneous experimental groups with a clear definition of disease stages. Since evaluating these patients involve many uncertainties, the use of a fuzzy model could enable a better discrimination among different stages of diabetic polyneuropathy and lead to a clarification of when changes in muscle activation start occurring. The aim of this study was to investigate EMG patterns during gait in diabetic individuals with different stages of DSP severity, classified by a fuzzy system.Methods147 subjects were divided into a control group (n = 30) and four diabetic groups: absent (n = 43), mild (n = 30), moderate (n = 16), and severe (n = 28) neuropathy, classified by a fuzzy model. The EMG activity of the vastus lateralis, tibialis anterior, and gastrocnemius medialis were measured during gait. Temporal and relative magnitude variables were compared among groups using ANOVA tests.ResultsMuscle activity changes are present even before an established neural involvement, with delay in vastus lateralis peak and lower tibialis anterior relative magnitude. These alterations suggest an impaired ankle shock absorption mechanism, with compensation at the knee. This condition seems to be more pronounced in higher degrees of neuropathy, as there is an increased vastus lateralis activity in the mild and severe neuropathy groups. Tibialis anterior onset at terminal stance was anticipated in all diabetic groups; at higher degrees of neuropathy, the gastrocnemius medialis exhibited activity reduction and peak delay.ConclusionEMG alterations in the vastus lateralis and tibialis anterior occur even in the absence of diabetic neuropathy and in mild neuropathic subjects, seemingly causing changes in the shock absorption mechanisms at the heel strike. These changes increase with the onset of neural impairments, and the gastrocnemius medialis starts presenting altered activity in the later stages of the disease (moderate and severe neuropathy). The degree of severity of diabetic neuropathy must be taken into account when analyzing diabetic patients’ biomechanical patterns of locomotion; we recommend the use of a fuzzy model for classification of disease stages.
Clinics | 2012
Andreja P. Picon; Neli Regina Siqueira Ortega; Ricky Watari; Cristina D. Sartor; Isabel de Camargo Neves Sacco
OBJECTIVE: This study proposes a new approach that considers uncertainty in predicting and quantifying the presence and severity of diabetic peripheral neuropathy. METHODS: A rule-based fuzzy expert system was designed by four experts in diabetic neuropathy. The model variables were used to classify neuropathy in diabetic patients, defining it as mild, moderate, or severe. System performance was evaluated by means of the Kappa agreement measure, comparing the results of the model with those generated by the experts in an assessment of 50 patients. Accuracy was evaluated by an ROC curve analysis obtained based on 50 other cases; the results of those clinical assessments were considered to be the gold standard. RESULTS: According to the Kappa analysis, the model was in moderate agreement with expert opinions. The ROC analysis (evaluation of accuracy) determined an area under the curve equal to 0.91, demonstrating very good consistency in classifying patients with diabetic neuropathy. CONCLUSION: The model efficiently classified diabetic patients with different degrees of neuropathy severity. In addition, the model provides a way to quantify diabetic neuropathy severity and allows a more accurate patient condition assessment.
Journal of Electromyography and Kinesiology | 2014
Marco K. Butugan; Cristina D. Sartor; Ricky Watari; Maria Cecília S. Martins; Neli Regina Siqueira Ortega; Vincent Vigneron; Isabel de Camargo Neves Sacco
This study compares muscle fiber conduction velocities estimated using surface electromyography during isometric maximal voluntary contraction in different stages of diabetic neuropathy. Eighty-five adults were studied: 16 non-diabetic individuals and 69 diabetic patients classified into four neuropathy stages, defined by a fuzzy expert system: absent (n=26), mild (n=21), moderate (n=11) and severe (n=11). Average muscle fiber conduction velocities of gastrocnemius medialis, tibialis anterior, vastus lateralis and biceps femoris were assessed using linear array electrodes, and were compared by ANOVA. Conduction velocities were significantly decreased in the moderate neuropathy group for the vastus lateralis compared to other groups (from 18% to 21% decrease), and were also decreased in all diabetic groups for the tibialis anterior (from 15% to 20% from control group). Not only the distal anatomical localization of the muscle affects the conduction velocity, but also the proportion of muscle fiber type, where the tibialis anterior with greater type I fiber proportion is affected earlier while the vastus lateralis with greater type II fiber proportion is affected in later stages of the disease. Generally, the muscles of the lower limb have different responsiveness to the effects of diabetes mellitus and show a reduction in the conduction velocity as neuropathy progresses.
Diabetes Technology & Therapeutics | 2015
Isabel de Camargo Neves Sacco; Andreja P. Picon; Diego Oliveira Macedo; Marcos Kenji Butugan; Ricky Watari; Cristina D. Sartor
BACKGROUND Changes in gait patterns in individuals with diabetes and neuropathy are still inconclusive. Our aim was to identify differences in the net intralimb moments distribution and lower limb kinematics during gait in different stage of diabetes. SUBJECTS AND METHODS This was an observational cross-sectional study that assessed 38 adults: a control group (n=12), a group with diabetes (n=12), and a group with diabetic neuropathy (n=14). The flexor and extensor joint moment peaks and kinematics of ankle, knee, and hip angles were compared among groups (by analysis of variance). RESULTS At initial contact, both diabetes groups present more hip flexion and smaller hip extensor moment. During late midstance, hip extension decreases, and flexion moment increases in both diabetes groups. For the same diabetes groups, during push off, the hip is more flexed, and the hip extensor moment decreases. Only for the diabetes group without neuropathy is the knee markedly more flexed, and the extensor moment is higher than in the other groups. At push off, the ankle is less extended in both diabetes groups, but the ankle extensor moment is significantly smaller only in neuropathic subjects. CONCLUSIONS The biomechanical modifications on the gait appeared to be a continuous process that was already revealed in patients without neuropathy. The use of the hip joint as a mechanism of forward progression of the body, instead of using the ankle, was more evident and consistent for the patients with diabetic neuropathy. The knee seems to have a major role in those with diabetes without neuropathy who presented higher extensor moments to support the body during early stance.
Revista Brasileira de Educação Física e Esporte | 2008
Isabel de Camargo Neves Sacco; Tatiana de Almeida Bacarin; Ricky Watari; Eneida Yuri Suda; Maíra Grizzo Canettieri; Ludmilla Carrijo Souza; Maria Fernanda de Oliveira; Suely Santos
Este estudo visou buscar relacoes entre caracteristicas antropometricas e de equilibrio funcional em uma amostra de 45 idosos fisicamente ativos, relacionando algumas variaveis selecionadas entre si - IMC, faixa etaria, tempo de pratica de atividade fisica, indice do arco longitudinal medial, alcance funcional e escore do teste de Tinetti. Estas relacoes foram investigadas com o intuito de verificar se as variaveis antropometricas, idade e pratica de atividade fisica tem influencia no equilibrio funcional de idosos. O arco longitudinal foi mensurado por meio da impressao plantar e entao classificado de acordo com o Indice do Arco de CAVANAGH E RODGERS (1987). O Indice do Arco apresentou significantes mudancas de acordo com o IMC, tendo uma maior incidencia de pes planos com o IMC ≥ 25 kg/m² (p = 0,0173). O tempo de pratica da atividade fisica ou a idade dos sujeitos nao influenciaram de maneira significativa nas variaveis de equilibrio. A faixa etaria tambem nao influenciou no tipo de pe. O equilibrio funcional de idosos fisicamente ativos nao sofreu influencia do tempo de pratica de atividade fisica, IMC e tipo de arco longitudinal plantar.
Diabetology & Metabolic Syndrome | 2015
Aline A. Gomes; Eneida Yuri Suda; Cristina D. Sartor; Neli Regina Siqueira Ortega; Ricky Watari; Vincent Vigneron; Isabel C. N. Sacco
Materials and methods Retrospective analysis of 195 patients. The fuzzy model determined a DPN degree score (0-10) by the combination of fuzzy sets derived from clinical variables (sensorial modalities and a set of DPN-related symptoms), using if-then rules to combine the inputs with the output sets (Mamdani process), with membership functions determined by a team of 4 DPN specialists. The MCA method grouped 16 DPNrelated categorical variables [sensorial modalities, symptoms, foot inspection characteristics] into micro and macro-classes (groups) after the algorithm learned the grouping pattern of the variables in the patients’ cohort. A Kohonen map was used to better represent the clusters of variables that could identify different DPN severities.
Clinics | 2011
Luciane Viola; Paula V. Nunes; Mônica Sanches Yassuda; Ivan Aprahamian; Franklin Santana Santos; Glenda Dias dos Santos; Paula Schimidt Brum; Sheila de Melo Borges; Alexandra Martini de Oliveira; Gisele F. S. Chaves; Eliane C. Ciasca; Rita C. R. Ferreira; Vanessa J. de Paula; Oswaldo Takeda; Roberta M. Mirandez; Ricky Watari; Deusivania Vieira da Silva Falcão; Meire Cachioni; Orestes Vicente Forlenza