VERTICAL AND HORIZONTAL FORCES DURING CUTIING IN BASKETBALL UNDER DIFFERENT CONDITIONS

The purpose of this study is to evaluate ground reaction force responses in professional basketball athletes while executing this sport's typical cutting maneuver with and without ankle bracing: taping, aircast-type orthosis and basketball shoes. Eight athletes were dynamically analyzed during a basketball cutting maneuver with a force platform. We collected vertical and medial-lateral forces under these three conditions and analyzed force peaks of foot contact with the ground and propulsion and growth gradient for these forces. Results show that bracing did not significantly change Fymax1 and GCFymax1; significantly reduced Fymax2 and GG Fymax2. With respect to the medial-lateral component, there were no significant differences in relation to force magnitudes between the three study conditions. However, GG Fzmax1 was significantly greater for the sport shoe condition than for the taping condition. Bracing decreased ground reaction force at some instances, but increased in others

The effects of biofeedback therapy by surface electromyography on knee flexion in hemiparetic gait

The main objective of this paper was to evaluate the effects of biofeedback therapy by surface electromyography (EMG) on knee flexion in hemiparetic gait. A 58 years old male patient was selected for this study, 11 months after a stroke resulting in left side hemiparesis. Initially, he was subjected to a physical examination and observational gait analysis. Before treatment, the patient was also referred to the movement laboratory of the institution (DMR HC FMUSP). The patient underwent a treatment plan comprising twelve sessions of biofeedback therapy by surface EMG during seven weeks. Right after the end of the therapy the evaluation was repeated. The results showed that gait asymmetry was diminished. Left hip circumduction during swing was decreased. Pelvic obliquity during the whole gait cycle was lower than that of the initial evaluation. Lower values for right hip abduction during initial contact and mid swing were also measured. Left ankle dorsiflexion during the swing phase of gait was increased. Although biofeedback therapy was focused on knee flexion, the gait pattern of the patient showed global improvements. For example, left ankle dorsiflexion during the swing phase was increased while hip circumduction was less apparent. This can probably be explained by the fact that therapy was delivered while the patient was performing a functional activity, gait. These results show that biofeedback therapy by surface EMG seems to be a promising technique in the management of stroke patients.O objetivo deste trabalho foi avaliar o efeito da terapia de biofeedback por eletromiografia (EMG) de superfície na flexão de joelho na marcha hemiparética. Foi avaliado um paciente do sexo masculino, 58 anos com hemiparesia esquerda, após acidente vascular encefálico (AVE) e 11 meses de lesão. Foi realizada avaliação física e análise observacional da marcha, seguida da avaliação tridimensional da marcha no Laboratório de Análise do Movimento da Divisão de Medicina de Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (DMR HC FMUSP), pré e pós intervenção terapêutica. Foram realizadas 12 sessões de biofeedback por EMG de superfície durante sete semanas. Os resultados mostraram melhora na simetria da marcha, com diminuição da circundução do quadril esquerdo, redução da obliqüidade pélvica durante todo o ciclo da marcha, diminuição da abdução do quadril no contato inicial e balanço médio à direita e aumento da dorsiflexão esquerda durante a fase de balanço. Embora o enfoque inicial tenha sido o movimento de flexão de joelho, os resultados demonstraram melhoras globais na marcha, como o aumento da dorsiflexão e a diminuição da circundução do quadril no membro inferior parético. Isso pode ser explicado pelo fato do treinamento ter sido realizado dentro de uma atividade funcional, a marcha. A terapia de biofeedback por EMG de superfície parece ser uma técnica promissora no tratamento de pacientes com alterações da marcha após AVE

Development of a protocol for the assessment of patients with pressure ulcers through telemedicine and digital images

Introduction: Pressure ulcers are frequent complications in patients with spinal cord injuries. These ulcers need an early diagnosis and a strict follow-up to prevent a more severe evolution and delays in the rehabilitation process. Unfortunately, patients do not always have access to a center specialized in the treatment of wounds, and thus, telemedicine can be useful in such cases. Objective: To evaluate the effectiveness of a protocol for the assessment of pressure ulcers through digital images. Methods: 15 patients were selected, totaling 33 ulcers. The patients were separately assessed by 2 on-site physiatrists, who filled out the first part of the protocol (patients’ clinical data) at the time of the consultation and took the photographs. These were sent to the physiatrists at-distance, who evaluated the wounds through the photographs and the data sent by the on-site physician. The similarities and differences between the two on-site physicians, between the on-site physicians and the physicians at-distance and between the two physicians at-distance were compared regarding the degree, necrosis, infection, fistula, secretion, wound border and depth aspect and conduct. The statistical analysis was based on Kappa calculations, a confidence interval and P value. Results: The highest Kappa values were observed when the on-site assessments were compared. For necrosis, degree and infection, the On-site Assessment (S) x Assessment at distance (D) Kappas were substantial and moderate. For the item conduct, the Kappa varied from weak to almost perfect. As for the evaluations of the borders, depth, secretion and fistula, there were divergences. Conclusion: The protocol is effective to assess wound necrosis, degree and infection. There is some difficulty in using the method to evaluate the border and depth aspect, secretion and fistula. The method showed to be more satisfactory for the assessment of pressure ulcers grade I and II.Introdução: As úlceras de pressão são complicações freqüentes em pacientes com lesão medular. Estas precisam de um diagnóstico precoce e um acompanhamento rigoroso para que não evoluam para um quadro mais grave e para não retardar o processo de reabilitação. Infelizmente, não é sempre que o paciente consegue acesso a um centro especializado no tratamento de feridas e, por isso, a telemedicina pode ser útil nesses casos. Objetivo: Avaliar a eficácia de um protocolo de avaliação de úlceras de pressão através de fotografias digitais. Métodos: Selecionamos 15 pacientes, totalizando 33 úlceras. Os pacientes foram avaliados por 2 médicos fisiatras presenciais, separadamente, que no momento do exame, preencheram a primeira parte do protocolo (dados clínicos do paciente) e tiraram as fotografias. Estas foram encaminhadas aos médicos fisiatras à distância, que avaliaram as feridas através das fotos e dos dados enviados pelo médico presencial. Comparamos as semelhanças e diferenças das avaliações entre os dois médicos presenciais, entre presencial e a distancia e entre os dois médicos à distância nos quesitos grau, necrose, infecção, fístula, secreção, aspecto da borda e do fundo e conduta. A Análise estatística se baseou nos cálculos de Kappa, intervalo de confiança e P valor. Resultados: Encontramos os maiores valores de Kappa quando comparamos as avaliações presenciais. Para necrose, grau e infecção, os kappas Avaliação Presencial (P) x Avaliação à distância (D) foram substantial e moderate. No item conduta, o Kappa variou de fraco a almost perfect. Nas avaliações das bordas, fundo, secreção e fístula foram encontradas divergências. Conclusão: O protocolo é eficaz para avaliar necrose, grau e infecção das úlceras. Existe dificuldade no uso do método para avaliar o aspecto de borda, fundo, secreção e fístula. Houve maior satisfação com o método para úlceras de pressão grau I e II

Ground reaction force in basketball cutting maneuvers with and without ankle bracing and taping

CONTEXT AND OBJECTIVE: In basketball, the most common injuries are ankle sprains. For this reason, players frequently use external ankle devices or taping as prophylactic and rehabilitation measures. The purpose of this study was to evaluate ground reaction force (GRF) responses in basketball players while performing typical cutting maneuvers with and without ankle bracing and ankle taping. DESIGN AND SETTING: Comparative study with experimental design of single-group repeated measurements, at Medical Rehabilitation Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. METHODS: Vertical (Fy) and medial-lateral (Fz) GRF measurements were made under three conditions (taping, Aircast-type orthosis and basketball shoes alone), with analysis of peak forces at foot contact (Fymax1, Fzmax1, Fymax2 and Fzmax2), growth gradient (peak/time) (GG Fymax1, GG Fzmax1, GG Fymax2 and GG Fzmax2) and impulse after foot contact. RESULTS: Bracing significantly reduced Fymax2 and GG Fymax2. GG Fzmax1 was significantly higher for the sport shoe condition than for the taping condition. Taping increased Fy in relation to the sport shoe at foot contact, but over a longer time interval, without increasing excessive ankle loading. Fz reached a peak in less time, which might generate greater inversion/eversion loading on a player's foot. The Aircast exerted better shock-absorbing effect than did the other two conditions, since it generated less vertical force over longer time intervals and smaller medial-lateral forces in relation to taping. CONCLUSIONS: Ankle bracing and ankle taping action mechanisms are still unclear and therefore should be carefully prescribed. More studies are needed to clarify taping and bracing effects on sporting activities