Suhaila Mahmoud Smaili Santos

Dual task performance: a comparison between healthy elderly individuals and those with Parkinson’s disease

Introduction The dual tasks (DT) is learned during the whole life and a prerequisite in functional performance in different activities of daily living. Healthy elderly have reduced ability to perform motor activities and cognitive tasks simultaneously, compared to young adults. Parkinson’s disease (PD) is the second most common neurodegenerative disease in the elderly and classic motor symptoms coexist with prejudice in cognitive domains. Objective To compare balance, gait and performance in dual tasks of individuals with Parkinson’s disease and healthy elderly. Material and method Transversal study consisted of 21 individuals with PD, classified between 1.5 to 3 in Hoehn and Yahr scale and 21 healthy individuals. To evaluate the performance on simple tasks and dual tasks the participants were submitted to five simple tasks (motor) and each was associated with a cognitive task, featuring a DT. To balance and gait evaluation was used the following instruments: Berg Balance Scale, Tinetti Scale and Dynamic Gait Index. Results In respect to gait and performance in dual tasks, there was a statistically significant difference with the worst performance for the group of individuals with PD. Conclusion It was found that the group of elderly people with PD has lower performance in the execution of concurrent tasks when compared with healthy elderly, so the DT can be introduced in rehabilitation programs to improve the performance of these patients.

The Effect of An Exercise-Based Intervention to the Quality of Life of Patients Suffering From Parkinson's Disease: Prospective Study

Parkinson’s disease is a progressive, degenerative neurological disorder associated to profound changes in the quality of life of its survivors. This study was designed to investigate the effectiveness of a 16-week program of exercise-based interventions aiming to [1] improve motor symptoms and [2] provide social integration of PD patients. To achieve this goal, we analyzed the scores recorded by the Parkinson’s disease Quality of Life questionnaire (PDQL) before and after the intervention. Results revealed significant improvement in overall quality of life of our group of patients (p=0.002). The results also revealed significant improvements in scores recorded from two specific domains of the PDQL assessment tool; Parkinson Symptoms (p=0.002) and Social Functions (p=0.045). These findings are consistent with the hypothesis that the 16-week exercise-based protocol proposed was effective to promote improvement in measurements of mobility and social integration of PD patients.

Funções executivas, atividades da vida diária e habilidade motora de idosos com doenças neurodegenerativas

Objetivo: Analisar as funcoes executivas de idosos com doenca de Parkinson (DP – com e sem quadro demencial) e doenca de Alzheimer (DA), e confrontar os escores dos participantes no que se refere as atividades funcionais da vida diaria e a habilidade motora em situacoes de dupla tarefa. Metodos: Sob um desenho transversal, 54 idosos foram divididos em quatro grupos: G1, composto por 11 sujeitos com DP; G2, formado por 10 sujeitos com demencia de Parkinson; G3, composto por 13 participantes com DA; e G4, formado por 20 idosos saudaveis. Os procedimentos metodologicos envolveram analise das funcoes cognitivas pre-frontais dos sujeitos, da realizacao das atividades da vida diaria e da habilidade motora em situacoes de dupla tarefa. A analise dos dados envolveu a estatistica descritiva (media e erro-padrao) e inferencial (teste ANOVA e pos-teste de Scheffe), admitindo significância de 5% (p < 0,05) e intervalo de confianca de 95%. Resultados: As funcoes cognitivas pre-frontais apresentaram diferenca significativa entre os grupos, sobretudo nas comparacoes envolvendo G2 e G3, em relacao a G1 e G4 (p = 0,001). Os grupos com deficit cognitivo apresentaram pior rendimento na realizacao das atividades da vida diaria, com menor escore do G2, na qual ha juncao de deficit cognitivo e motor (p = 0,001). Em situacoes de dupla tarefa, G2 e G3 apresentaram maiores dificuldades que os demais grupos (p < 0,05). Conclusao: Disturbios pre-frontais repercutem negativamente nas atividades funcionais e na habilidade psicomotora dos individuos. Quando nao vinculado a quadro demencial, os pacientes com DP apresentaram escores cognitivos pre-frontais e independencia funcional semelhantes aos de idosos saudaveis.

Study on the characteristics of pain in patients with spinal cord injury

Alem da perda da funcionalidade apos a lesao medular (LM), a dor e tida como uma das principais complicacoes mais incapacitantes e vivenciadas no processo de reabilitacao, mesmo com o avanco significativo na compreensao da fisiopatologia e tratamento da dor, a abordagem desse sintoma ainda e precaria na lesao medular. Objetivo: Descrever as caracteristicas do quadro algico nessa populacao e associar a dor com o tipo de lesao, interferencia nas atividades de vida diaria (AVD’s) e o seu aparecimento. Metodo: Trata-se de estudo transversal com um roteiro de entrevista semiestruturado aplicado a 77 pacientes. Foram calculadas a media e desvio padrao, frequencias absolutas e relativas, para a associacao entre as variaveis qualitativas foi utilizado teste Qui-quadrado (χ²). Resultados: A idade foi de 38,26 ± 12,43 anos, sendo 84,4% homens e 80,5% de paraplegicos. Trinta e um foram por acidente automobilistico e 29 por ferimento de arma de fogo, sendo 61,0% com lesao medular completa. Quanto a dor, 44,2% relataram dor severa e 29,8% a moderada, em 50,6% nao sentiam dor acima da lesao e 58,4% sentiam-na abaixo. Trinta e nove relataram sentir dor em queimacao, 40,0% relataram que a dor surgiu no primeiro ano apos a LM. A intensidade da dor foi de 5,44 ± 3,18 pontos, sendo 5,20 ± 3,07 nos homens, 6,75 ± 3,54 nas mulheres, 4,13 ± 3,18 nos tetraplegicos e 5,76 ± 3,12 nos paraplegicos. Para 27 pacientes a dor piorou permanecendo na mesma posicao, para 22 melhorou realizando fisioterapia e para 21 com a mudanca de posicao. Para 68,8% a dor nao interferiu nas AVD’s. Vinte e oito utilizaram medicacao analgesica. Houve associacao significativa de que a presenca de dor abaixo da lesao interfere nas AVD’s (p = 0,04) e surge no primeiro ano apos a lesao acima e abaixo da lesao (p = 0,05 e p = 0,01), respectivamente. Conclusao: A dor foi prevalente nos lesados medulares, mais evidenciada nas mulheres e na maioria surgiu no primeiro ano apos a lesao e interfere AVD’s. A fisioterapia e a mudanca de posicao diminuiram a dor. Portanto, as orientacoes e intervencoes por parte da equipe multiprofissional devem ser imediatas apos a lesao, pois a prevencao ou diminuicao desta complicacao refletira na melhoria da qualidade de vida e na readaptacao do paciente a sua vida familiar e social.

Efetividade da fisioterapia associada à dança em idosos saudáveis: ensaio clínico aleatório

Objective: Verify the physical therapy associated with dance effectiveness in terms of balance, flexibility and agility in healthy seniors. Methods: Randomized controlled trial whose sample was divided into two groups: control (GC; 7W/4M; age= 74.1±7.3; n=11) and intervention (GI; 9W/2M; age= 75.7±7.8; n=11). Participants underwent the following types of evaluation in pre and post intervention phases: balance assessment by Berg balance scale, agility according to the Timed Up and Go test and flexibility according to the Wells Bank. A program consisting of 16 therapies with 60 minutes long twice a week followed a protocol of evolution based on the complexity of the exercises and with the aim of stimulating balance, functional independence and muscle stretching. The statistical analysis was performed using software SPSS 15.0 and were used the Mann-Whitney test to compare the groups and Wilcoxon tests to compare pre and post intervention, with significance level of 5%. Results: The intervention group showed improved balance (p=0.04), flexibility (p=0.01) and agility (p=0.03) when compared to the control group. The control group showed improvement in the flexibility levels (p=0.01). Conclusion: The proposed program was effective in terms of improving balance, flexibility and agility among participants. It is expected that this study can contribute to future research and clinical practice about the association of physical therapy and dance, as a preventive and rehabilitative treatment options.

O perfil e as adaptações sexuais de homens após a lesão medular

Lesao medular (LM) consiste em qualquer tipo de lesao nos elementos neurais do canal medular, acarretando inumeros comprometimentos, sendo a alteracao nos padroes da resposta sexual um deles, condicionada por fatores fisicos, psiquicos e sociais. Em funcao destas alteracoes, os pacientes necessitam realizar adaptacoes sexuais para manterem a atividade sexual. Objetivo: Verificar o perfil e adaptacoes sexuais de homens apos a LM e associar o diagnostico neurofuncional com frequencia sexual, erecao, uso de adaptacao, tipo de adaptacao, e a utilizacao de adaptacao com frequencia e satisfacao sexual apos a lesao. Metodo: Trata-se de um estudo transversal com 36 homens lesados medulares que foram entrevistados por meio do questionario (QSH-LM). Resultados: Media de idade e 36,64 anos com prevalencia decorrente de acidente de trânsito, de paraplegia e de lesao medular completa. Apos a LM, 52,8% estao casados, 75,5% mantem atividade sexual sendo que 44,4% tem menos de 1 relacao sexual/semana, 80,6% estao satisfeitos sexualmente, 50,0% tem erecao, 38,9% ejaculacao e 44,4% orgasmo. Quanto ao uso de adaptacao para ter/manter a erecao, 61,1% utilizam, sendo 25,5% por nao conseguirem manter a erecao e 22% optam pelo anel peniano. Houve associacao significativa de que paraplegicos utilizam adaptacoes com mais frequencia e preferem o anel peniano e pacientes que utilizam adaptacao sexual tem maior frequencia sexual e estao satisfeitos sexualmente (p = 0,02). Conclusao: Atraves deste trabalho podem-se conhecer o perfil sexual dos pacientes apos a LM e as adaptacoes sexuais mais utilizadas, resultados que subsidiam informacoes que poderao auxiliar os profissionais de saude a acompanharem e orientarem de maneira adequada os seus pacientes.

Efetividade da Fisioterapia Associada à Dançaterapia na Melhora da Capacidade Aeróbia e Flexibilidade de Mulheres Idosas com Histórico de Quedas

Current essay focuses on research with regard to pregnancy. Pregnancy brings about huge physical and psychological transformations in the female with a great variety of emotional oscillations, such as fear, anxiety, insecurity, doubts, happiness and others, which, because of the prevailing imbalance, contribute towards the start of post-partum depression symptoms. Scientific registers focusing on PPD prevention methods already demonstrate the use of psycho-social, psycho-pharmacological and hormonal strategies even though no single isolated intervention is sufficiently efficacious in the development of the disease. A review of the literature, based on on-line access to abstracts from databases, is provided. The psychotherapeutic approach is of fundamental importance in treatment, coupled to family support and follow-up.

Desenvolvimento e validação de um questionário de qualidade de vida em indivíduos com lesão da medula espinal

172 ABSTRACT Objective: Create and test the psychometric proprieties of the specific instrument for the quantification of the quality of life in subjects with spinal cord injuries. Methods: From the existing consensus methods was chosen the Delphi technique for the creation of the questionnaire and the SF-36 for criteria method. Results: The internal consistence was α=0,827. The intra and inter evaluators confidence shows itself high by the intra class correlation coefficient and the Brand and Altman test by the difference of average. Can be observed strong correlations between the QVLM and SF-36 in the functional capacity and physical aspects domains and moderate correlation in the health state and emotional aspects domains. There was a significant difference between the four applications of QVLM, demonstrating that the questionnaire is sensible to change. Conclusion: The QVLM was created with a suitable methodology and the evaluation of the psychometrics proprieties turn out to be on a valid, reliable, consisting and sensible to changes instrument.Objective: Create and test the psychometric proprieties of the specific instrument for the quantification of the quality of life in subjects with spinal cord injuries. Methods: From the existing consensus methods was chosen the Delphi technique for the creation of the questionnaire and the SF-36 for criteria method. Results: The internal consistence was α=0,827. The intra and inter evaluators confidence shows itself high by the intra class correlation coefficient and the Brand and Altman test by the difference of average. Can be observed strong correlations between the QVLM and SF-36 in the functional capacity and physical aspects domains and moderate correlation in the health state and emotional aspects domains. There was a significant difference between the four applications of QVLM, demonstrating that the questionnaire is sensible to change. Conclusion: The QVLM was created with a suitable methodology and the evaluation of the psychometrics proprieties turn out to be on a valid, reliable, consisting and sensible to changes instrument

Impacto de la enfermedad de Parkinson en el equilibrio en distintas situaciones propuestas

| This study aimed to evaluate the balance of Parkinson’s disease (PD) patients in Tandem stance 410 with eyes open (EO), eyes closed (EC), and in dual task condition (DT). This is a cross-sectional study, composed of 19 individuals with mild to moderate PD. Patients were evaluated in a BIOMEC400 force platform. The parameters analyzed were: area of the foot center of pressure (COP), COP amplitude and speed, in the anteroposterior (AP) and mediolateral (ML) directions. We found statistically significant results for AP and ML amplitude of the COP and COP area, with higher values for the stances EC Tandem and DT Tandem, when compared with EO Tandem. The values of AP and ML average speed were higher in EC Tandem when compared with EO Tandem (P=0.009 and P=0.000), respectively. We concluded that, when individuals with PD undergo cognitive challenges, they behave as if they were with eyes closed regarding balance changes. This reinforces the need to introduce, in the therapeutic plan of these individuals, activities that require the practice of these skills.This study aimed to evaluate the balance of Parkinson’s disease (PD) patients in Tandem stance with eyes open (EO), eyes closed (EC), and in dual task condition (DT). This is a cross-sectional study, composed of 19 individuals with mild to moderate PD. Patients were evaluated in a BIOMEC400 force platform. The parameters analyzed were: area of the foot center of pressure (COP), COP amplitude and speed, in the anteroposterior (AP) and mediolateral (ML) directions. We found statistically significant results for AP and ML amplitude of the COP and COP area, with higher values for the stances EC Tandem and DT Tandem, when compared with EO Tandem. The values of AP and ML average speed were higher in EC Tandem when compared with EO Tandem (P=0.009 and P=0.000), respectively. We concluded that, when individuals with PD undergo cognitive challenges, they behave as if they were with eyes closed regarding balance changes. This reinforces the need to introduce, in the therapeutic plan of these individuals, activities that require the practice of these skills.

Impacto da doença de Parkinson na performance do equilíbrio em diferentes demandas atencionais

| This study aimed to evaluate the balance of Parkinson’s disease (PD) patients in Tandem stance 410 with eyes open (EO), eyes closed (EC), and in dual task condition (DT). This is a cross-sectional study, composed of 19 individuals with mild to moderate PD. Patients were evaluated in a BIOMEC400 force platform. The parameters analyzed were: area of the foot center of pressure (COP), COP amplitude and speed, in the anteroposterior (AP) and mediolateral (ML) directions. We found statistically significant results for AP and ML amplitude of the COP and COP area, with higher values for the stances EC Tandem and DT Tandem, when compared with EO Tandem. The values of AP and ML average speed were higher in EC Tandem when compared with EO Tandem (P=0.009 and P=0.000), respectively. We concluded that, when individuals with PD undergo cognitive challenges, they behave as if they were with eyes closed regarding balance changes. This reinforces the need to introduce, in the therapeutic plan of these individuals, activities that require the practice of these skills.This study aimed to evaluate the balance of Parkinson’s disease (PD) patients in Tandem stance with eyes open (EO), eyes closed (EC), and in dual task condition (DT). This is a cross-sectional study, composed of 19 individuals with mild to moderate PD. Patients were evaluated in a BIOMEC400 force platform. The parameters analyzed were: area of the foot center of pressure (COP), COP amplitude and speed, in the anteroposterior (AP) and mediolateral (ML) directions. We found statistically significant results for AP and ML amplitude of the COP and COP area, with higher values for the stances EC Tandem and DT Tandem, when compared with EO Tandem. The values of AP and ML average speed were higher in EC Tandem when compared with EO Tandem (P=0.009 and P=0.000), respectively. We concluded that, when individuals with PD undergo cognitive challenges, they behave as if they were with eyes closed regarding balance changes. This reinforces the need to introduce, in the therapeutic plan of these individuals, activities that require the practice of these skills.