Walderi Monteiro da Silva Junior

The use of the virtual reality as intervention tool in the postoperative of cardiac surgery

INTRODUCTION Cardiac surgery has been the intervention of choice in many cases of cardiovascular diseases. Susceptibility to postoperative complications, cardiac rehabilitation is indicated. Therapeutic resources, such as virtual reality has been helping the rehabilitational process. The aim of the study was to evaluate the use of virtual reality in the functional rehabilitation of patients in the postoperative period. METHODS Patients were randomized into two groups, Virtual Reality (VRG, n = 30) and Control (CG, n = 30). The response to treatment was assessed through the functional independence measure (FIM), by the 6-minute walk test (6MWT) and the Nottingham Health Profile (NHP). Evaluations were performed preoperatively and postoperatively. RESULTS On the first day after surgery, patients in both groups showed decreased functional performance. However, the VRG showed lower reduction (45.712.3) when compared to CG (35.0612.09, P<0.05) in first postoperative day, and no significant difference in performance on discharge day (P>0.05). In evaluating the NHP field, we observed a significant decrease in pain score at third assessment (P<0.05). These patients also had a higher energy level in the first evaluation (P<0.05). There were no differences with statistical significance for emotional reactions, physical ability, and social interaction. The length of stay was significantly shorter in patients of VRG (9.410.5 days vs. 12.2 1 0.9 days, P<0.05), which also had a higher 6MWD (319.9119.3 meters vs. 263.5115.4 meters, P<0.02). CONCLUSION Adjunctive treatment with virtual reality demonstrated benefits, with better functional performance in patients undergoing cardiac surgery.

Acute effects of physiotherapeutic respiratory maneuvers in critically ill patients with craniocerebral trauma

OBJECTIVE: To evaluate the effects of physiotherapeutic respiratory maneuvers on cerebral and cardiovascular hemodynamics and blood gas variables. METHOD: A descriptive, longitudinal, prospective, nonrandomized clinical trial that included 20 critical patients with severe craniocerebral trauma who were receiving mechanical ventilation and who were admitted to the intensive care unit. Each patient was subjected to the physiotherapeutic maneuvers of vibrocompression and increased manual expiratory flow (5 minutes on each hemithorax), along with subsequent airway suctioning with prior instillation of saline solution, hyperinflation and hyperoxygenation. Variables related to cardiovascular and cerebral hemodynamics and blood gas variables were recorded after each vibrocompression, increased manual expiratory flow and airway suctioning maneuver and 10 minutes after the end of airway suctioning. RESULTS: The hemodynamic and blood gas variables were maintained during vibrocompression and increased manual expiratory flow maneuvers; however, there were increases in mean arterial pressure, intracranial pressure, heart rate, pulmonary arterial pressure and pulmonary capillary pressure during airway suctioning. All of the values returned to baseline 10 minutes after the end of airway suctioning. CONCLUSION: Respiratory physiotherapy can be safely performed on patients with severe craniocerebral trauma. Additional caution must be taken when performing airway suctioning because this technique alters cerebral and cardiovascular hemodynamics, even in sedated and paralyzed patients.

Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study

Introduction Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors) at three different times: preoperatively (M1), the day of discharge (M2) and hospital discharge (M3). Participants received physiotherapy pre and postoperatively during the days of hospitalization during the morning and afternoon. Results Twenty-two patients were evaluated. The values of peripheral muscle strength of knee extensors preoperative found were about 50% lower than those predicted for the healthy population. When comparing muscle strength prior (M1), with the remaining evaluation, found himself in a fall of 29% for the movement of knee extension and 25% for knee flexion in M2 and a decrease of 10% movement for knee extension and 13% for knee flexion in M3 when comparing with M1. Conclusion The values of peripheral muscle strength prior of the study patients were lower than predicted for the healthy population of the same age. After the surgical event this reduction is even more remarkable, being reestablished until the time of discharge, to values close to baseline.

Respiratory muscle strength and pulmonary function in children with rhinitis and asthma after a six-minute walk test

ABSTRACT Objective: Rhinitis and asthma decrease quality of life. Few studies have assessed the performance of children with asthma or rhinitis under submaximal exercise. We evaluated maximal respiratory pressures, spirometric parameters, and ability to sustain submaximal exercise in these children before and after the 6-minute walk test (6MWT), compared to healthy children. Methods: This cross-sectional, analytical study included 89 children aged 6–12 years in outpatient follow-up: 27 healthy (H), 31 with rhinitis (R), and 31 with mild asthma under control (A). Pulmonary function parameters and maximal respiratory pressures were measured before and 5, 10, and 30 minutes after the 6MWT. Wilcoxon test was used to compare numerical numerical variables between two groups and analysis of variance or Kruskal–Wallis test for comparison among three groups. Results: Total distance traveled in the 6MWT was similar among the three groups. Compared to pre-test values, VEF1 (Forced Expiratory Volume in 1 second), VEF0.75 (Forced Expiratory Volume in 0.75 second), and FEF25–75 (Forced Expiratory Flow 25–75% of the Forced Vital Capacity – CVF – curve) decreased significantly after the 6MWT in group A, and VEF0.75, FEF25–75, and VEF1/CVF decreased significantly in group R. Groups A and R had lower Maximum Inspiratory Pressure values than group H before and after the 6MWT at all time points assessed. Conclusions: The findings suggest that children with rhinitis and mild asthma present with alterations in respiratory muscle strength and pulmonary function not associated with clinical complaints, reinforcing the concept of the united airways.

Effect of radiotherapy on pulmonary function and fatigue of women undergoing treatment for breast cancer

El presente estudio comparo la funcion pulmonar y la fatiga de mujeres antes y despues de la radioterapia (RT) como ayudante para el tratamiento del cancer de mama, y se correlaciono la funcion pulmonar con la dosis de radiacion y fatiga. Fue realizado un estudio observacional longitudinal involucrando 20 mujeres. La funcion pulmonar fue evaluada por espirometria (ClementClarke®) y manovacuometria (GlobalMed®, modelo MVD 300) y, la fatiga fue evaluada por la Functional Assessment of Cancer Therapy Fatigue (FACT-F). Todas las evaluaciones fueron realizadas antes de la primera sesion y una semana despues del termino de la RT. Para el analisis estadistico fueron utilizados los tests Wilcoxon Signed Rank Test y correlacion de Spearman, adoptando un nivel de significancia p<0,05. En la espirometria, se encontro reduccion significativa de la capacidad vital forzada (23,52%), del volumen espiratorio forzado en el primer segundo (26,23%) y del peak de flujo espiratorio (10,12%) (p=0,001). Las presiones espiratorias e inspiratorias maximas tambien disminuyeron significativamente (25,45 y 32,92%, respectivamente). Se observo disminucion significativa del bienestar fisico y del bienestar funcional, y un aumento significativo de la fatiga en el FACT-F (p=0,001). No fueron observadas correlaciones entre las variables de la funcion pulmonar con la dosis de radiacion y fatiga. En corto plazo, la RT promueve la reduccion de la funcion pulmonar, pero los valores son considerados similares a los normales. Se observo aumento significativo de la fatiga y disminucion de los puntajes en los dominios de bienestar fisico y funcional.

ANÁLISE DO DESEMPENHO FÍSICO E DO EQUILÍBRIO SOB INFLUÊNCIA DA CRIOTERAPIA EM ATLETAS DE FUTSAL

Introducao Crioterapia e a aplicacao de modalidades de frio com temperatura de 0oC a 18,3oC, podendo interferir no desempenho fisico e equilibrio, dependendo da capacidade do individuo em manter a estabilizacao, direcionar padroes de movimentos, controlar a postura e posicao articular. Objetivo Avaliar o desempenho fisico, a frequencia cardiaca e o equilibrio estatico com olhos abertos, em atletas de futsal (futebol de salao), antes e depois da crioimersao nos membros inferiores. Metodos Trinta e dois individuos do genero masculino participaram do estudo, distribuidos aleatoriamente em dois grupos: (A) grupo controle, imersao em agua a 24°C por 10 min; (B) grupo intervencao, crioimersao em agua com gelo a 10°C por 10 min. Os voluntarios realizavam a avaliacao do equilibrio no baropodometro, em seguida corriam em linha reta e em ziguezague por 100 m, entravam na crioimersao, terminando com uma nova avaliacao. Foram analisados o desempenho fisico, atraves dos tempos das corridas, a frequencia cardiaca, por meio de um frequencimetro e o equilibrio, atraves da baropodometria e estabilometria em apoio bipodal de olhos abertos. Resultados O desempenho fisico foi alterado apos a crioimersao quando das analises intra e intergrupos. A frequencia cardiaca apresentou diferenca ao comparar-se antes e apos a crio, porem sem diferencas em comparacao ao controle. O equilibrio nao foi alterado apos a crioimersao e nem em comparacao com o grupo controle. Conclusao A crioimersao prejudicou o desempenho fisico, quando a atividade foi imediatamente apos a mesma, sendo desta forma o gelo nao aconselhavel quando se deseja desempenho na atividade desportiva. Porem nao apresentou interferencia na frequencia cardiaca e no equilibrio de atletas de futsal, que podem nao ter sido alterados devido ao tempo da crioimersao.

Análisis del ángulo Q, durante el entrenamiento de resistencia en cadena cinética abierta y cadena cinemática cerrada intermedia mediante Microfotografía

To examine the Q angle, during the resistance training by “Leg Press 45” and the “extensor chair”. 14 female subjects practitioners gym carried out exercises at OKC and ICKC, ranging from 0° to 90° of flexion, where images were recorded each 10°. Through SAPO v.068, the Q angles were measured; and conducted a T-test for independent samples with p<0.05. The resistance training should include muscle exercises in OKC and ICKC, with special attention to the last one, contradicting the view of some authors. The Q angle, when compared to OKC and ICKC, changed with the increase of bending the knee for both knees to normal as the valgus, validating the combination of exercises in OKC and ICKC in muscle strengthening, for possible trend to the pathologic valgus.

The Q angle analysis, during resistance training, on open kinematics chain and intermidiate closed kinematics chain, through photogrametry

To examine the Q angle, during the resistance training by “Leg Press 45” and the “extensor chair”. 14 female subjects practitioners gym carried out exercises at OKC and ICKC, ranging from 0° to 90° of flexion, where images were recorded each 10°. Through SAPO v.068, the Q angles were measured; and conducted a T-test for independent samples with p<0.05. The resistance training should include muscle exercises in OKC and ICKC, with special attention to the last one, contradicting the view of some authors. The Q angle, when compared to OKC and ICKC, changed with the increase of bending the knee for both knees to normal as the valgus, validating the combination of exercises in OKC and ICKC in muscle strengthening, for possible trend to the pathologic valgus.

Análise do ângulo Q, durante o treinamento resistido, em cadeia cinemática aberta e cadeia cinemática fechada intermediária através de fotomiografia

To examine the Q angle, during the resistance training by “Leg Press 45” and the “extensor chair”. 14 female subjects practitioners gym carried out exercises at OKC and ICKC, ranging from 0° to 90° of flexion, where images were recorded each 10°. Through SAPO v.068, the Q angles were measured; and conducted a T-test for independent samples with p<0.05. The resistance training should include muscle exercises in OKC and ICKC, with special attention to the last one, contradicting the view of some authors. The Q angle, when compared to OKC and ICKC, changed with the increase of bending the knee for both knees to normal as the valgus, validating the combination of exercises in OKC and ICKC in muscle strengthening, for possible trend to the pathologic valgus.

Efecto de la radioterapia en la función pulmonar y en la fatiga de mujeres en tratamiento para el cáncer de mama

El presente estudio comparo la funcion pulmonar y la fatiga de mujeres antes y despues de la radioterapia (RT) como ayudante para el tratamiento del cancer de mama, y se correlaciono la funcion pulmonar con la dosis de radiacion y fatiga. Fue realizado un estudio observacional longitudinal involucrando 20 mujeres. La funcion pulmonar fue evaluada por espirometria (ClementClarke®) y manovacuometria (GlobalMed®, modelo MVD 300) y, la fatiga fue evaluada por la Functional Assessment of Cancer Therapy Fatigue (FACT-F). Todas las evaluaciones fueron realizadas antes de la primera sesion y una semana despues del termino de la RT. Para el analisis estadistico fueron utilizados los tests Wilcoxon Signed Rank Test y correlacion de Spearman, adoptando un nivel de significancia p<0,05. En la espirometria, se encontro reduccion significativa de la capacidad vital forzada (23,52%), del volumen espiratorio forzado en el primer segundo (26,23%) y del peak de flujo espiratorio (10,12%) (p=0,001). Las presiones espiratorias e inspiratorias maximas tambien disminuyeron significativamente (25,45 y 32,92%, respectivamente). Se observo disminucion significativa del bienestar fisico y del bienestar funcional, y un aumento significativo de la fatiga en el FACT-F (p=0,001). No fueron observadas correlaciones entre las variables de la funcion pulmonar con la dosis de radiacion y fatiga. En corto plazo, la RT promueve la reduccion de la funcion pulmonar, pero los valores son considerados similares a los normales. Se observo aumento significativo de la fatiga y disminucion de los puntajes en los dominios de bienestar fisico y funcional.