Avaliação isocinética no joelho do atleta Isokinetic evaluation of athletes' knee

A avaliação isocinética tem sido usada nas últimas três décadas como método para se determinar o padrão funcional da força e do equilíbrio muscular. No nosso meio cresceu nos últimos 10 anos. É possível quantificar valores absolutos do torque, do trabalho e da potência de grupos musculares, bem como valores relativos, ou seja, da proporção agonista/antagonista de tais grupos. Outro recurso valioso consiste como método auxiliar na reabilitação das lesões esportivas. O exame é realizado com velocidade angular constante e predeterminada, seja lenta, intermediária e/ou rápida. O joelho é a articulação em que se observa maior aplicação e estudos isocinéticos. Na prática esportiva, temos por um lado a importância da proporção do equilíbrio muscular agonista/antagonista, ou seja, do equilíbrio flexor/extensor representado, respectivamente, pelos isquiotibiais/quadríceps. De outro, a comparação dos valores absolutos da função muscular entre os lados direito e esquerdo, quer seja para o quadríceps, ou para os isquiotibiais. Resultados alterados estão relacionados, geralmente, às lesões esportivas ou suas seqüelas. De interesse para o atleta e para a equipe multidisciplinar é poder dispor de um método de avaliação funcional muscular objetivo e seguro, que forneça dados confiáveis e reprodutíveis. Aspecto relevante reside no fato do resultado do teste isocinético poder ser útil nos critérios de retorno a atividade esportiva pós-lesão. Este artigo de revisão consiste em abordar alguns aspectos práticos da avaliação isocinética no joelho e sua utilização para os indivíduos que realizam atividade física.<br>The isokinetic evaluation has been used in the last three decades as a method to determine both the strength functional pattern and the muscle balance. In our environment, this evaluation has been spread over the last 10 years. It is possible to quantify absolute values of torque, effort, and power of muscle groups, and to determine relative values, that is, the agonist/antagonist proportion of such groups. Another valuable resource of this evaluation may be used as an auxiliary method in the rehabilitation of sports lesions. The examination is performed with a constant and preset angular speed, that is, low, intermediate, and/or high speed. Most isokinetic studies are applied to the knee. In the sports practice, the agonist/antagonist muscle balance, that is, the flexor/extensor balance represented, respectively, by the ischiotibial muscle/quadriceps plays an important role. On the other hand, the comparison between the absolute values of the muscle function for the left and right sides is also relevant. Changed results usually relate to sports lesions or their sequels. The development of an objective and safe method to evaluate the muscle functionality which provides for reliable and reproducible results is of utmost importance to athletes and to multidisciplinary teams. Also significant are the results obtained from isokinetic tests, which may be useful to establish criteria for athletes to resume and practice sports activities after lesions. This review aims at addressing some practical aspects of the isokinetic evaluation in the knee and its use in individuals performing sports activities

Auditory neuropathy--neural and synaptic mechanisms.

Sensorineural hearing impairment is the most common form of hearing loss, and encompasses pathologies of the cochlea and the auditory nerve. Hearing impairment caused by abnormal neural encoding of sound stimuli despite preservation of sensory transduction and amplification by outer hair cells is known as 'auditory neuropathy'. This term was originally coined for a specific type of hearing impairment affecting speech comprehension beyond changes in audibility: patients with this condition report that they "can hear but cannot understand". This type of hearing impairment can be caused by damage to the sensory inner hair cells (IHCs), IHC ribbon synapses or spiral ganglion neurons. Human genetic and physiological studies, as well as research on animal models, have recently shown that disrupted IHC ribbon synapse function--resulting from genetic alterations that affect presynaptic glutamate loading of synaptic vesicles, Ca(2+) influx, or synaptic vesicle exocytosis--leads to hearing impairment termed 'auditory synaptopathy'. Moreover, animal studies have demonstrated that sound overexposure causes excitotoxic loss of IHC ribbon synapses. This mechanism probably contributes to hearing disorders caused by noise exposure or age-related hearing loss. This Review provides an update on recently elucidated sensory, synaptic and neural mechanisms of hearing impairment, their corresponding clinical findings, and discusses current rehabilitation strategies as well as future therapies