Estágio profissional de intervenção em fisioterapia neurológica com pacientes adultos após aciente vascular cerebral

Mestrado em Fisioterapia NeurológicaIntrodução: A Fisioterapia Neurológica é uma área de intervenção essencial na medida em que existem cada vez mais doentes com sequelas resultantes de lesões do sistema nervoso central a necessitar de cuidados de fisioterapia, nomeadamente doentes com Acidente Vascular Cerebral já que as taxas de incidência são altas e a mortalidade tem vindo a decrescer com os avanços da medicina. Por outro lado, os conhecimentos atuais da área da neurociência permitem que a intervenção do fisioterapeuta seja baseada na evidência. Objetivos: Aprofundar conhecimentos, capacidades e competências em Fisioterapia Neurológica em pacientes adultos; intervindo essencialmente, em pacientes com sequelas de Acidente Vascular Cerebral, desenvolvendo o modelo de raciocínio clínico e investigando a efetividade do conceito de Bobath na funcionalidade de pacientes pós Acidente Vascular Cerebral. Metodologia: O estágio articulou a vertente de investigação, a dimensão pedagógica e a prática clínica; decorreu no Hospital Curry Cabral (Centro Hospitalar Lisboa Central) com pacientes adultos a realizar fisioterapia, em regime de internamento ou ambulatório, devido a patologia neurológica e mais especificamente com pacientes com sequelas de AVC; teve a duração de 200h. Foram selecionadas três escalas de funcionalidade (o Indicador de Barthel Modificado, a Medida de Independência Funcional e a Motor Assessement Scale) para a avaliação dos casos clínicos acompanhados e a abordagem em fisioterapia foi baseada no Conceito de Bobath. Resultados: Este estágio favoreceu a aquisição e consolidação de conhecimentos na área da Fisioterapia Neurológica, nomeadamente sobre o Conceito de Bobath e a avaliação da funcionalidade. São apresentados três casos clínicos de pacientes com sequelas de AVC que permitiram treinar a aplicação das escalas de funcionalidade, desenvolver o raciocínio clínico, aplicar as estratégias selecionadas e refletir sobre a eficácia da intervenção. Discussão: Embora não exista evidência robusta da superioridade do Conceito de Bobath em relação a outras abordagens, a sua filosofia facilita a avaliação e a tomada de decisão numa perspetiva holística sem menosprezar a individualidade de cada paciente. Das três escalas de funcionalidade aplicadas a Motor Assessement Scale é a única a levar em consideração a qualidade do movimento, o que a torna mais sensível a pequenas evoluções facilitando a mensuração adequada dos objetivos da intervenção. Conclusão: A realização deste estágio foi um período de aprendizagem importante e uma experiência enriquecedora no aspeto clínico, científico e académico.ABSTRACT - Introduction: Neurological Physiotherapy is an essential intervention area as there are more and more patients with sequelae resulting from injuries to the central nervous system requiring physiotherapy care, namely patients with stroke as the incidence rates are high and mortality has been decreasing with medical advances. On the other hand, current knowledge in the field of neuroscience allows the intervention of the physiotherapist to be based on evidence Objectives: To deepen knowledge, skills, and competencies in Neurological Physiotherapy in adult patients; essentially intervening in patients with sequelae of stroke, developing the model of clinical reasoning and investigating the effectiveness of the Bobath Concept in the functionality of patients after stroke. Methodology: The internship articulated the research aspect, the pedagogical dimension, and the clinical practice; it took place at Hospital Curry Cabral (Centro Hospitalar Lisboa Central) with adult patients undergoing physical therapy, inpatient or outpatient, due to neurological pathology and more specifically with patients with stroke sequelae; lasted 200 hours. Three scales of functionality were selected (the Barthel modified indicator the Functional Independence Measure and the Motor Assessment Scale) for the evaluation of the clinical cases followed and the approach in physiotherapy was based on the Bobath Concept. Results: This internship allowed the acquisition and consolidation of knowledge in the area of Neurological Physiotherapy, namely on the Bobath Concept and the evaluation of functionality. Three clinical cases of patients with stroke sequelae are presented, which allowed to train the application of the selected functionality scales, develop clinical reasoning and reflect on the effectiveness of the intervention. Discussion: While there is no robust evidence of the superiority of the Bobath Concept over other approaches, its philosophy facilitates assessment and decision-making from a holistic perspective without underestimating the individuality of each patient. Of the three scales of functionality applied the Motor Assessment Scale, is the only one to consider the quality of the movement, which makes it more sensitive to small developments, facilitating the adequate measurement of the intervention goals. Conclusion: This internship was an important learning period and an enriching experience in the clinical, scientific, and academic aspects.N/

Brain monoaminergic neurons and ventilatory control in vertebrates

Monoamines (noradrenaline (NA), adrenaline (AD), dopamine (DA) and serotonin (5-HT) are key neurotransmitters that are implicated in multiple physiological and pathological brain mechanisms, including control of respiration. The monoaminergic system is known to be widely distributed in the animal kingdom, which indicates a considerable degree of phylogenetic conservation of this system amongst vertebrates. Substantial progress has been made in uncovering the participation of the brain monoamines in the breathing regulation of mammals, since they are involved in the maturation of the respiratory network as well as in the modulation of its intrinsic and synaptic properties. On the other hand, for the non-mammalian vertebrates, most of the knowledge of central monoaminergic modulation in respiratory control, which is actually very little, has emerged from studies using anuran amphibians. This article reviews the available data on the role of brain monoaminergic systems in the control of ventilation in terrestrial vertebrates. Emphasis is given to the comparative aspects of the brain noradrenergic, adrenergic, dopaminergic and serotonergic neuronal groups in breathing regulation, after first briefly considering the distribution of monoaminergic neurons in the vertebrate brain. (C) 2008 Elsevier B.V. All rights reserved.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq

Physiology of temperature regulation: Comparative aspects

Few environmental factors have a larger influence on animal energetics than temperature, a fact that makes thermoregulation a very important process for survival. In general, endothermic species, i.e., mammals and birds, maintain a constant body temperature (Tb) in fluctuating environmental temperatures using autonomic and behavioural mechanisms. Most of the knowledge on thermoregulatory physiology has emerged from studies using mammalian species, particularly rats. However, studies with all vertebrate groups are essential for a more complete understanding of the mechanisms involved in the regulation of Tb. Ectothermic vertebrates-fish, amphibians and reptiles-thermoregulate essentially by behavioural mechanisms. With few exceptions, both endotherms and ectotherms develop fever (a regulated increase in Tb) in response to exogenous pyrogens, and regulated hypothermia (anapyrexia) in response to hypoxia. This review focuses on the mechanisms, particularly neuromediators and regions in the central nervous system, involved in thermoregulation in vertebrates, in conditions of euthermia, fever and anapyrexia. (c) 2006 Elsevier B.V. All rights reserved

Chicken hatchlings prefer ambient temperatures lower than their thermoneutral zone

We investigated whether or not the preferred ambient temperature (Tapref) of the 1-day old chicken hatchling, a precocial neonate with excellent locomotory capacity, clearly identifiable thermogenesis and independence from maternal care, coincides with the lower critical temperature (LCT) of thermoneutrality and minimal oxygen consumption ((V) over dot(O2)). Tapref of single chicks measured in a thermocline (N = 16) averaged 33.5 +/- 0.3 degrees C (mode, 33.3 +/- 0.4 degrees C). The same value was obtained in hatchlings studied in pairs. LCT was computed from the ambient temperature (Ta)-(V) over dot(O2) relationship, constructed by slowly decreasing the Ta of a respirometer from 38 to 29 degrees C over 2.5 h, while continuously measuring (V) over dot(O2) by an open-flow methodology; LCT averaged 36.4 degrees C +/- 0.3 or 36.8 degrees C +/- 0.4, depending on the method of computation. In all hatchlings Tapref was lower than LCT (P < 0.001), by a magnitude that depended on the method of computation of the two variables, 2.8 degrees C +/- 0.3 (P < 0.001) or 3.9 degrees C +/- 0.5. The Tapref-LCT difference implied that, at Tapref, (V) over dot(O2) was higher than at thermoneutrality. We conclude that in the chicken hatchling thermal preference does not coincide with thermoneutrality, probably because during development what seems optimal from a thermoregulatory viewpoint may not necessarily be so for other regulatory functions. (C) 2014 Elsevier Inc All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Locus coeruleus noradrenergic neurons and CO2 drive to breathing

The Locus coeruleus (LC) has been suggested as a CO2 chemoreceptor site in mammals. In the present study, we assessed the role of LC noradrenergic neurons in the cardiorespiratory and thermal responses to hypercapnia. To selectively destroy LC noradrenergic neurons, we administered 6-hydroxydopamine (6-OHDA) bilaterally into the LC of male Wistar rats. Control animals had vehicle (ascorbic acid) injected (sham group) into the LC. Pulmonary ventilation (plethysmograph), mean arterial pressure (MAP), heart rate (HR), and body core temperature (T-c, data loggers) were measured followed by 60 min of hypercapnic exposure (7% CO2 in air). To verify the correct placement and effectiveness of the chemical lesions, tyrosine hydroxylase immunoreactivity was performed. Hypercapnia caused an increase in pulmonary ventilation in all groups, which resulted from increases in respiratory frequency and tidal volume (V-T) in sham-operated and 6-OHDA-lesioned groups. The hypercapnic ventilatory response was significantly decreased in 6-OHDA-lesioned rats compared with sham group. This difference was due to a decreased V-T in 6-OHDA rats. LC chemical lesion or hypercapnia did not affect MAP, HR, and T-c. Thus, we conclude that LC noradrenergic neurons modulate hypercapnic ventilatory response but play no role in cardiovascular and thermal regulation under resting conditions

Gaseous neurotransmitters and their role in anapyrexia

Mammals keep their body temperature (Tb) relatively constant even under a wide range of ambient temperature variation. However, in some particular situations it may be beneficial to increase or to decrease Tb. For instance, under hypoxic conditions, a regulated drop in Tb (anapyrexia) takes place which has been reported to be crucial for survival in a number of different species. This review highlights major advances in the research about nitric oxide (NO) and carbon monoxide (CO-where data are relatively less abundant), before focusing on the role played by these gaseous neuromediators in thermoregulation, under the conditions of euthermia and anapyrexia. Available data are consistent with the notion that both NO and CO, acting on the CNS, participate in thermoregulation, with NO decreasing Tb and CO increasing it. However further studies are required before definitive conclusions can be made as to their physiological mechanisms of action

Role of Locus coeruleus noradrenergic neurons in cardiorespiratory and thermal control during hypoxia

We investigated the specific role of LC noradrenergic (NA) neurons in the cardiorespiratory and thermal responses to hypoxia. Aiming this, LC NA neurons were selectively destroyed by microinjecting 6-OHDA bilaterally in the LC of male rats. Pulmonarl ventilation ((V) over dotE, plethysmograph), core body temperature (Tc, dataloggers), mean arterial pressure (MAP) and heart rate (fH) were measured during normoxia followed by 7% O(2) in air. Tyrosine hydroxylase (TH) immunoreactivity was performed to verify the chemical lesions effectiveness. Hypoxia caused increase in (V) over dotE, decrease in Tc and did not affect fH in both sham-operated and 6-OHDA-lesioned groups. In addition, hypoxia decreased MAP in the sham-operated group and did not affect MAP in the 6-OHDA-lesioned group. LC lesion did not affect (V) over dotE, MAP, fH and Tc. Thus, these results indicate that LC noradrenergic neurons do not play a role in cardiorespiratory control and thermoregulation under basal and hypoxic conditions. (C) 2009 Elsevier B.V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq