PROPRIOCEPTION, BODY BALANCE AND FUNCTIONALITY IN INDIVIDUALS WITH ACL RECONSTRUCTION

ABSTRACT Objective: To evaluate and compare proprioception, body balance and knee functionality of individuals with or without unilateral anterior cruciate ligament (ACL) reconstruction. Methods: Forty individuals were divided in two groups: Experimental group, 20 individuals with ACL reconstruction at six months postoperative, and control group, 20 individuals with no history of lower limb pathologies. In the experimental group, we assessed lower limbs with reconstructed ACL and contralateral limb; in the control group the dominant and the non-dominant lower limbs were assessed. All subjects were submitted to joint position sense test to evaluate proprioception, postural control measure in single-limb, and step up and down (SUD) test for functional assessment. Results: There were no deficits in proprioception and postural control. In the SUD test, a 5% decrease in lift up force was found in reconstructed ACL lower limbs, however, a statistically not significant difference. The impact and step down force during the course of test were 30% greater in anatomic ACL than in control lower limbs. Conclusion: The individuals with ACL reconstruction at six months postoperative did not show changes in proprioception and postural control, but showed motor control changes, influencing knee functionality. Level of Evidence IV, Prognostic Studies

A different brace model to retrain hemiparetic gait with genu recurvatum: effects on plantar pressure distribution

En una rodillera de neoprene se desarrolló un tipo de rodillera ortopédica, que lleva un manguito inflable, puesto en la región poplítea de la rodilla, y que les proporciona estímulos a las estructuras articulares, así como mejora la alienación biomecánica durante la fase de apoyo de la marcha. El propósito del estudio es cuantificar las alteraciones y adaptaciones producidas por el entrenamiento con este dispositivo ortótico en pacientes hemiparéticos. Se trata de un estudio casi experimental de tipo antes y después, del cual participaron doce adultos hemiparéticos debido al accidente cerebrovascular. Se utilizaron como marcadores los picos de presión plantar para comparar tres momentos del estudio: el inicio del estudio; el momento en que utilizaban la rodillera y tras entrenar la marcha. Después de las sesiones de rehabilitación de la marcha con ayuda de la rodillera, en la redistribución de las presiones plantares ocurrió un aumento en la simetría durante la fase de apoyo, principalmente disminución de la presión sobre el antepié parético (p=0,024) y aumento en el retropié en el lado parético (p=0,010). Además, estas alteraciones se las asociaron a la disminución de la presión sobre todas las regiones del pie no alterado, especialmente en el retropié en el momento posterior al tratamiento. Los resultados del estudio muestran un cambio en el patrón de marcha de los participantes después de utilizar este tipo de rodillera. Hubo una mayor simetría de los valores de los picos de presión plantar cuando se comparó el lado alterado con el no alterado. El entrenamiento con este tipo de rodillera ayudó en el proceso de rehabilitación, puesto que presentó valores baropodométricos cerca del patrón prestablecido de distribución plantar.The model of brace developed consists of a neoprene kneepad that has an inflatable cuff positioned over the popliteal region of the knee. It provides stimuli on joint structures as well as a better biomechanical alignment during the stance phase of the gait. The aim of this study was to quantify the changes and adaptations induced by gait training with the use of orthotic device in hemiparetic patients. A quasi-experimental before-after study was held with twelve adult patients with hemiparesis due to cerebrovascular accident. The peaks of plantar pressure were the markers used to compare the three moments of the study: the baseline, when they were using the brace, and post-gait training. After the sessions of gait retraining with the orthosis, the redistribution of plantar pressures showed increased symmetry during the stance phase, mainly by reducing the pressure on the paretic forefoot (p=0.024) and by the increase in the rearfoot in the paretic side (p=0.010). In addition, these changes were associated with a decrease in pressure on all regions of the foot not affected, especially in the rearfoot after training. The results of the study suggest a change in the gait pattern of participants after using the brace. There has been greater symmetry of the values of the plantar pressure peaks when the affected side was compared with the nonaffected side. Training with the brace helps in the rehabilitation process, since it provides baropodometric values approaching the normal pattern of plantar distribution.O modelo de brace desenvolvido consiste em uma joelheira de neoprene que apresenta um balonete inflável posicionado sobre a região poplítea do joelho. Ele proporciona estímulos sobre estruturas articulares, bem como um melhor alinhamento biomecânico durante a fase de apoio da marcha. O objetivo do estudo foi quantificar as alterações e adaptações induzidas pelo treinamento da marcha com a utilização do dispositivo ortótico em pacientes hemiparéticos. Realizou-se um estudo quase-experimental do tipo antes e depois com doze pacientes adultos com hemiparesia decorrente de acidente vascular encefálico. Os picos de pressão plantares foram os marcadores utilizados para comparar os três momentos do estudo: na linha de base, quando estivessem utilizando o brace e após o treinamento da marcha. Depois das sessões de reeducação da marcha com auxílio da órtese, a redistribuição das pressões plantares evidenciou aumento na simetria durante a fase de apoio, principalmente pela diminuição da pressão sobre o antepé parético (p=0,024) e pelo aumento no retropé no lado parético (p=0,010). Além disso, essas alterações foram associadas a uma diminuição da pressão sobre todas as regiões do pé não afetado, especialmente no retropé no momento de pós-treinamento. Os resultados do estudo sugerem uma mudança no padrão de marcha dos participantes depois da utilização do brace. Houve maior simetria dos valores dos picos de pressão plantar quando se comparou o lado afetado com o não afetado. O treino com o brace contribui no processo de reabilitação, uma vez que forneceu valores baropodométricos que se aproximaram ao padrão normal de distribuição plantar

Thermographic evaluation of hind paw skin temperature and functional recovery of locomotion after sciatic nerve crush in rats

INTRODUCTION: Peripheral nerves are often damaged by direct mechanical injury, diseases, and tumors. The peripheral nerve injuries that result from these conditions can lead to a partial or complete loss of motor, sensory, and autonomic functions, which in turn are related to changes in skin temperature, in the involved segments of the body. The aim of this study was to evaluate the changes in hind paw skin temperature after sciatic nerve crush in rats in an attempt to determine whether changes in skin temperature correlate with the functional recovery of locomotion. METHODS: Wistar rats were divided into three groups: control (n = 7), sham (n = 25), and crush (n = 25). All groups were subjected to thermographic, functional, and histological assessments. RESULTS: DT in the crush group was different from the control and sham groups at the 1st, 3rd and 7rd postoperative days (p,0.05). The functional recovery from the crush group returned to normal values between the 3rd and 4th week post-injury, and morphological analysis of the nerve revealed incomplete regeneration at the 4th week after injury. DISCUSSION: This study is the first demonstration that sciatic nerve crush in rats induces an increase in hind paw skin temperature and that skin temperature changes do not correlate closely with functional recovery

The effect of training programs for the treatment of Sarcopenia in elderly people: a systematic review.

Objetivo: O objetivo deste trabalho foi analisar o efeito da intervenção de programas de exercícios na massa muscular como tratamento de indivíduos idosos com sarcopenia. Método: Revisão sistemática de ensaios clínicos comparando idosos sarcopenicos em grupo submetido a um programa de exercício (grupo intervenção) em relação à um grupo de controle. Os Critérios de seleção para esta revisão são: ensaios clínicos (tipo de estudo); indivíduos idosos, com idade igual ou superior a 60 anos, sedentários com sarcopenia (tipo de participante); programa de exercícios que tivessem, no mínimo, 04 semanas de duração e 8 sessões de treino; a intensidade média das sessões (mínimo) deveria ser de moderada à alta (igual ou maior a 60% da capacidade máxima) (Tipo de intervenção); e variação percentual da massa muscular (Tipo de desfecho). A estratégia de busca se desenvolveu nos bancos de dados virtuais como Medline, Pubmed; Bireme; Lilacs, PEDro; Science Direct; e a Biblioteca Cochrane. As buscas ocorreram no período de 2012 à 2013, sem considerar limite de tempo de publicação dos artigos incluídos. Os descritores/termos de pesquisa utilizados foram exercise, sarcopenia e clinical trial. Não houve restrições de linguagem ou ano de publicação. Resultados: Foram identificadas 1.580 referências. Após a primeira etapa da revisão, 92 estudos foram considerados elegíveis para inclusão e selecionados para a análise do texto integral. Ao final, 23 estudos foram incluídos para a revisão. Os resultados indicaram um aumento de massa muscular em vinte e dois (22) grupos de intervenção com programas de exercícios físicos. Conclusões: Os resultados da análise sugerem uma associação positiva do efeito de programas de exercício sobre a massa muscular de idosos e redução da sarcopenia.Objective: The objective of this study was to analyze the effect of exercise program intervention on muscle mass as treatment of elderly individuals with sarcopeniaMethod: Systematic review of clinical trials comparing elderly sarcopenics in a group undergoing an exercise program (intervention group) in relation to a control group. The selection criteria for this review were: clinical trials (type of study); Elderly individuals, aged 60 years or older, sedentary with sarcopenia (type of participant); Program of exercises that had at least 04 weeks of duration and 8 sessions of training; The mean intensity of the sessions (minimum) should be moderate to high (equal to or greater than 60% of maximum capacity) (Type of intervention) and percentage variation of muscle mass (Type of outcome). The search strategy was developed in virtual databases such as Medline, Pubmed; Bireme; Lilacs, PEDro; Science Direct and the Cochrane Library. The searches occurred in the period from 2012 to 2013, without considering the time limit for publication of the articles included. The descriptors/search terms used were exercise; Sarcopenia and clinical trial. There were no language restrictions or year of publication.Results: 1,580 references were identified. After the first stage of the review, 92 studies were considered eligible for inclusion and selected for full text analysis. At the end, 23 studies were included for review. The results indicated an increase in muscle mass in twenty-two (22) intervention groups with exercise programs.Conclusion: The results suggest a positive association of exercise programs effect on muscle mass and reduction of sarcopenia

Body weight distribution under the rearfoot and forefoot wearing high heels shoes and block simulators

The aim of this work was to investigate the relation of the vertical component of the ground reaction forces and the plantar pressure distribution during standing position, acting under the forefoot and the rearfoot, using high heel shoes and high heel simulators (wooden blocks of different heights and angles of heel support). The subjects were 30 symptom-free volunteer women, with no apparent foot and leg pathologies, with body mass index (BMI) up to 30 (Pollock, 1993) who are used to wear high heel shoes at least once a week. To obtain the relations on the weight force application and the pressure distribution under the feet the subjects were positioned standing over two force plates AMTI (Massachusetts, EUA, 1991) at 60Hz, synchronized with a pair of pedar mobile insoles (pedar® novelgmbh © 2005) at 50Hz. The foot was divided in two areas and data was acquired in 10 seconds of self balanced position. Significant differences between the means of vertical force and plantar pressure were found related to the heights differences and angle differences (p< 0,001), at the wearing shoes situation and with the simulators. The results of force and pressure did not follow a linear relation but increased as the heel height support got higher in both situations.Este trabalho visou investigar a aplicação da força peso relativo ao peso corporal em retropé através da componente vertical da força de reação do solo (Fz) e a distribuição de pressão plantar nas regiões do retropé e antepé, na posição estática, em apoio bipodal, através do uso de calçados de salto e simuladores de altura e de ângulo de apoio do calcâneo. Participaram deste estudo 30 mulheres voluntárias, sem histórico de patologias em membros inferiores nos últimos 12 meses, sem índices de massa corporal que indicassem padrões de obesidade, segundo Pollock, (1993) e habituadas a utilizar calçado de salto pelo menos uma vez por semana. Os indivíduos utilizando calçados variados e blocos simuladores se posicionaram sobre duas plataformas de força AMTI (Massachusetts, EUA, 1991) dispostas em série adquirindo dados a uma freqüência de 60 Hz de forma sincronizada a um sistema de medição de distribuição de pressão plantar através de palmilhas sensorizadas (pedar® novelgmbh © 2005) adquirindo a uma freqüência de 50 Hz pelo tempo de 10 segundos. Verificou-se para a variável força vertical (Fz) diferenças significativas entre as médias tanto em relação às alturas (p< 0,001), como entre os ângulos (p< 0,001), obtendo-se similarmente nas situações real e simulada, ao nível de significância de 5%, um padrão não linear de diminuição da força vertical (Fz) em retropé e da pressão plantar nesta mesma região à medida que a altura do apoio no calcâneo aumenta.Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

Qualitative evaluation of physical effort in bass drum pedal drive by thermography

The bass drum is driven by a pedal that promotes muscle fatigue and can cause injuries. In order to provide engineers with valuable tools, this research aimed at analyzing the use of the drum pedal and to evaluate qualitatively the muscle groups involved and their possible relationship with any injuries resulting from fatigue. Through the analysis, it was found that striking the drum pedal provides health risks; therefore, some actions were suggested to avoid injuries to drummers. All data collected can be used as parameters for the development of products that would prevent health problems or improve the drummers´ performance

Reduced peripheral and respiratory muscle strength in pediatric patients after kidney transplantation

Abstract Introduction: Reduced muscle strength and low-exercise capacity are well documented in adults, but there are few studies examining those impairments in children and adolescents after kidney transplantation. The objective of this study was to evaluate peripheral and respiratory muscle strength and the association with submaximal exercise capacity in children and adolescents after kidney transplant. Methods: Forty-seven patients between six and 18 years of age clinically stable after transplantation were included. Peripheral muscle strength (isokinetic and hand-grip dynamometry), respiratory muscle strength (maximal inspiratory and expiratory pressure), and submaximal exercise capacity (six-minute walk test – 6MWT) were assessed. Results: Patients had a mean age of 13.1 ± 2.7 years and an average of 34 months had elapsed since the transplantation. Flexors of the knee showed a significant reduction in muscle strength (77.3% of predicted) and knee extensors had normal values (105.4% of predicted). Hand-grip strength and maximal respiratory pressures (inspiratory and expiratory) also were significantly lower than expected (p < 0.001). Although distance walked in the 6MWT was significantly lower than predicted (p < 0.001), no significant correlation was found with peripheral and respiratory muscle strength. Conclusion: Children and adolescents after kidney transplantation have reduced peripheral muscle strength of knee flexors, hand-grip, and maximal respiratory pressures. No associations were found between peripheral and respiratory muscle strength and submaximal exercise capacity

Evaluation of knee proprioception and factors related to parkinson’s disease

Background.Changes in proprioception may contribute to postural instability in individualswith neurological disorders. Objectives. Evaluate proprioception in the lower limbs of patients with Parkinson’s disease (PD) and the association between proprioception and cognitive ability, motor symptoms, postural instability, and disease severity. Methods.This is a cross-sectional, controlled study that evaluated proprioception in PD patients and healthy age- and sex-matched individuals. Kinetic postural proprioception of the knee was evaluated using an isokinetic dynamometer (Biodex Multi-Joint System 4 Pro). Participants were evaluated using the Montreal Cognitive Assessment (MoCA), the Hoehn and Yahr rating scale and postural instability (pull test and stabilometric analysis), and motor function (UPDRS-III) tests. Results. A total of 40 individuals were enrolled in the study: 20 PD patients and 20 healthy controls (CG).The PD patients had higher angular errors on the proprioceptive ratings than the CG participants ( = 0.002). Oscillations of the center of pressure ( = 0.002) were higher in individuals with PD than in the controls. Proprioceptive errors in the PDpatients were associated with the presence of tremors as the dominant symptomandmore impaired motor performance. Conclusion. These findings show that individuals with PD have proprioceptive deficits, which are related to decreased cognitive ability and impaired motor symptoms