Predição da independência funcional baseada na força relativa em homens adultos com lesão medular traumática

Tese (doutorado)—Universidade de Brasília, Faculdade de Educação Física, Programa de Pós-Graduação em Educação Física, 2017.A independência funcional é um dos principais objetivos de um processo de reabilitação de indivíduos com lesão medular (LM) traumática e é influenciada, em proporções diferentes, por um grande número de variáveis. Algumas destas variáveis podem ser modificadas pela atuação de profissionais da saúde, enquanto outras, como idade e nível de lesão, por exemplo, apresentam alterações em virtude do tempo ou pela evolução do trauma. Dentre as variáveis passíveis de serem desenvolvidas e treinadas por exercícios físicos, a força muscular apresenta grande importância, pois interfere positivamente na independência funcional. No entanto, três aspectos ainda precisam ser melhor elucidados para o treinamento adequado dessa variável em um processo de reabilitação. Primeiramente, os estudos que verificaram a relevância da força muscular na independência funcional realizaram correlações e comparações diretas, não sendo possível estabelecer se a força muscular influencia a independência funcional dentro de um conjunto de variáveis preditoras. Outro aspecto a ser considerado nessas análises é a utilização de grupos musculares totalmente preservados nos testes de força de pessoas com paraplegia. Embora os resultados encontrados tenham evidenciado boas associações com a independência funcional, músculos parcialmente comprometidos apresentam grande relevância para a independência funcional. A musculatura de tronco apresenta comprometimento a depender do nível de LM e é fundamental para o equilíbrio postural e estabilização do corpo, necessários à produção de força em situações cotidianas. Em testes de força realizados nos músculos totalmente preservados, o tronco é estabilizado e a transferência dos resultados para as atividades diárias pode apresentar distorções. Por fim, é imprescindível quantificar a força muscular para se estabelecer metas concretas de reabilitação a serem alcançadas nos diversos níveis de LM. Esses três aspectos estão intrinsecamente relacionados aos principais objetivos dessa tese e, para atingi-los, foram conduzidos dois estudos prévios. O primeiro consistiu na elaboração de um protocolo de familiarização para o teste de força no dinamômetro isocinético em pessoas com LM. Neste, demonstrou-se que uma sessão composta por 2 séries com 10 repetições submáximas, em uma classificação de “2” de percepção de esforço, pode ser utilizada como protocolo padrão para a familiarização em um teste de força máxima em exercícios de cotovelo e ombro. O segundo estudo teve como intuito principal adaptar e validar um circuito de habilidades em cadeira de rodas para o Português-Brasileiro. Como não existe padrão ouro para avaliação de independência funcional, normalmente utilizam-se questionários, tais como o de medida de independência em LM (SCIM-III) e os circuitos de habilidade em cadeira de rodas. Assim, foram analisadas a validade de critério e de constructo para elaborar a versão brasileira do circuito adaptado de habilidades em cadeira de rodas (AMWC-Brasil). Com a instrumentação metodológica estabelecida, o objetivo dessa tese foi verificar a capacidade preditiva da força muscular relativa e absoluta na independência funcional e nas habilidades em cadeira de rodas em homens adultos com LM traumática. Foram avaliados 54 indivíduos com LM nos testes de força de ombro (em musculatura totalmente preservada) e de tronco (em musculatura com comprometimentos de força a depender do nível de LM). Para analisar a relação da força muscular com a independência funcional, além do pico de torque absoluto e relativo, foi utilizada a eficiência neuromuscular (ENM) que associa o recrutamento muscular (RMS, root mean square, em μV) com os valores de torque. Como essa variável não foi aplicada em pessoas com LM, recrutou-se um grupo controle de 27 indivíduos para comparação. As variáveis de força e outras preditoras de independência funcional foram inseridas na regressão multivariada stepwise para elaborar equações de regressão com três preditores, considerando os desfechos de independência funcional da SCIM-III e AMWC-Brasil. Dessa forma, foi possível detectar a influência de cada variável preditora nos desfechos de independência. Concluída essa análise, foram calculados pontos de corte com os valores de pico de torque que apresentaram maiores importância para independência funcional. Os testes de força conseguiram discriminar indivíduos com paraplegia alta, baixa e o grupo controle. Constatou-se que as forças relativas, dentre as variáveis de força, apresentaram melhor capacidade preditiva para independência funcional e habilidades em cadeira de rodas. Em seguida, foram estabelecidos pontos de corte de picos de torque relativos de forma que possam ser utilizados como referências na relação com a independência funcional e habilidade em cadeira de rodas. Os resultados ainda identificaram a importância da abdução de ombro nos desfechos estudados, sugerindo-se que o treinamento ocorra com uma compensação de musculaturas antagônicas, evitando desequilíbrios musculares e, assim, reduzindo a possibilidade de lesões nessa articulação. Por fim, a ENM apresentou baixa capacidade preditiva e não foi adequada para analisar as alterações de força e estímulo neural em diferentes níveis de LM. Sugere-se o uso da ENM em pesquisas longitudinais entre os mesmos níveis de LM ou comparando com grupos sem lesão.Functional independence is one of the main objectives of a rehabilitation process of individuals with spinal cord injury (SCI) and it is influenced by a large number of variables in different proportions. Some of these variables can be modified by health professionals, while others, such as age and level of injury, for example, present changes due to the time or trauma evolution. Among the variables that can be developed and trained, muscle strength is very important, as it interferes positively with functional independence. However, three aspects still need to be better elucidated for the proper training of this variable in a rehabilitation process. First, studies that verified the relevance of muscle strength in functional independence performed direct correlations and comparisons, and it is not possible to establish if the muscle strength influences functional independence within a set of predictor variables. Another aspect to be considered in these analyzes is the use of fully preserved muscles in the strength tests of people with paraplegia. Although the results with preserved muscles showed good associations with functional independence, partially compromised muscles present great relevance for functional independence. Trunk musculature might present compromised functionality depending on the level of injury and it is fundamental for the postural balance and stabilization of the body, necessary for the production of force in daily situations. The trunk is stabilized during strength tests performed on fully preserved muscles and, transferring the results to daily life activities may presents misinterpretation. Finally, it is essential to quantify muscular strength in order to establish rehabilitation goals to be achieved at the different SCI levels. These three aspects are intrinsically related to the main objectives of this thesis and to reach them, two previous studies were conducted. The first one consisted of a familiarization protocol elaboration for strength test in the isokinetic dynamometer in people with SCI. It was demonstrated that a session composed of 2 sets with 10 submaximal repetitions and a perception of effort classified in "2", can be used as standard protocol for familiarization in a maximum strength test in elbow and shoulder exercises. The second study aimed to adapt and validate a wheelchair skills circuit for Brazilian-Portuguese. As there is no gold standard for functional independence assessment, questionnaires such as the Spinal Cord Independence Measure (SCIM-III) and wheelchair skill circuits, are usually used. Thus, the criterion and construct validity were analyzed to elaborate the Brazilian version of the Adapted Manual Wheelchair Circuit (AMWC-Brasil). With the methodological instrumentation established, the aim of this thesis was to verify the predictive capacity of relative and absolute muscle strength in functional independence and wheelchair skills in adult men with SCI. Fifty-four individuals with SCI were evaluated in the shoulder (fully preserved musculature) and trunk (compromised muscles according to SCI level) strength maximum tests. In order to analyze the relationship between muscular strength and functional independence, in addition to the absolute and relative peak torque, neuromuscular efficiency (NME) was used to associate muscle recruitment (RMS) with torque values. As this variable was not applied in people with SCI, a control group of 27 subjects was recruited for comparison. Strength variables and other predictors of functional independence were inserted into the multivariate stepwise regression to elaborate regression equations with three predictors, considering the functional independence outcomes of SCIM-III and AMWC-Brazil. In this way, it was possible to detect the influence of each predictor variable on independence outcomes. After this analysis, cut-off points were calculated with the peak torque values that presented the greatest importance for functional independence. The strength tests were able to discriminate individuals with high and low paraplegia and the control group. The relative forces of shoulder and trunk exercises were the strength variables with the best predictive capacity for functional independence and wheelchair skills. Then, cut-off points of relative peak torque were established so that they could be used as references for functional independence and wheelchair skills. The results also identified the importance of shoulder abduction in the studied outcomes, suggesting that training occurs with an offset of antagonistic muscles, avoiding muscular imbalance, therefore, reducing the possibility of injuries in this joint. Finally, NME presented low predictive capacity and it was not adequate to analyze the changes in strength and neural stimulus at different levels of SCI. It is suggested the use of NME in longitudinal investigations between the same SCI levels or to compare to groups without injury

The effects of resistance training intervention in the rehabilitation of patients with spinal cord injury: a literature review

Objective: To review the evidence in literature on the effects of resistan-ce training intervention in the rehabilitation of patients with spinal cord injury over time. Method: Data source: a systematic literature search of five databases (MEDLINE, LILACS, SciELO, IBECS and Cochrane Library) was performed until August 2010. Results: Sixteen articles met the inclusion criteria. None reported any damage or injury for this population. Eight studies measured VO2 and found significant improvements of 10% to 30%. Strength and po-wer were analyzed in ten studies, but the magnitude varied in different ways (8% to 34% and 6% to 81%, respectively). The analysis of favora-ble resistance training response relating to functional scales (FIM, WISCI, WUSPI and Berg) or gait speed occurred in three studies. Conclusion: In all articles analyzed, responses to intervention were positive and favora-ble regarding physical improvement and increased functional capacity and, consequently, independence in daily activities. Authors suggest the inclusion of systematic resistance training in rehabilitation, according to the individual’s daily need, in favor of functional improvement, injury prevention, improved health and quality of life.Objetivo: Analisar os indícios na literatura sobre os efeitos do treinamento resistido como forma de intervenção na reabilitação de pacientes com lesão medular traumática ao longo do tempo. Método: Fontes das informações: uma busca sistematizada da literatura em cinco bancos de dados (MEDLINE, LILACS, SciELO, IBECS e Biblioteca Cochrane) foi realizada até agosto de 2010. Resultados: Foram encontrados 16 artigos que preencheram os critérios de inclusão. Nenhum encontrou qualquer tipo de prejuízo ou lesão para essa população. Oito estudos avaliaram o VO2 e detectaram melhoras significativas entre 10% e 30%. Força e potência foram verificadas em dez estudos, mas a magnitude variou de forma distinta (8% a 34% e 6% a 81%, respectivamente). A análise da resposta favorável do treinamento resistido relacionada com escalas funcionais (FIM, WISCI, WUSPI e Berg) ou com velocidade de marcha ocorreu em três investigações. Conclusões: Em todos os artigos analisados, as respostas decorrentes da intervenção foram positivas e favoráveis à melhora física e funcional aumentando, conseqüentemente, a independência nas atividades diárias. Os autores sugerem a inclusão do treinamento resistido sistematizado na reabilitação de acordo com a demanda diária do indivíduo em prol de um ganho funcional, prevenção de lesões, melhora da saúde e da qualidade de vida

The interactions between hemostasis and resistance training: a review

Physical inactivity is considered a risk factor for cardiovascular disease and is strongly associated with changes in arterial structure. Regular physical activity and exercise contributes to the prevention of coronary artery disease. Therefore, cardiovascular and resistance training improve hemostatic parameters and promote a less thrombotic blood profile. This review highlights the studies, mechanisms, and outcomes relating to the effectiveness of resistance training on the process of hemostasis. The Pubmed, Scopus, Medline, Scielo, Lilacs, Ibecs, and Cochrane databases were used to locate the original articles. Seventeen studies were found during the research process. Of these, ten articles were excluded. Those protocols using a high volume of training for young adults showed a greater fibrinolytic response, and training protocols with intensities above 80% of 1 maximum repetition showed an increased platelet activity. In subjects with coronary artery disease, just one session of resistance training resulted in improvement in the fibrinolytic system (tissue plasminogen activator) without raising potential thrombotic markers

DNA repair pathways and cisplatin resistance: an intimate relationship

The main goal of chemotherapeutic drugs is to induce massive cell death in tumors. Cisplatin is an antitumor drug widely used to treat several types of cancer. Despite its remarkable efficiency, most tumors show intrinsic or acquired drug resistance. The primary biological target of cisplatin is genomic DNA, and it causes a plethora of DNA lesions that block transcription and replication. These cisplatin-induced DNA lesions strongly induce cell death if they are not properly repaired or processed. To counteract cisplatin-induced DNA damage, cells use an intricate network of mechanisms, including DNA damage repair and translesion synthesis. In this review, we describe how cisplatin-induced DNA lesions are repaired or tolerated by cells and focus on the pivotal role of DNA repair and tolerance mechanisms in tumor resistance to cisplatin. In fact, several recent clinical findings have correlated the tumor cell status of DNA repair/translesion synthesis with patient response to cisplatin treatment. Furthermore, these mechanisms provide interesting targets for pharmacological modulation that can increase the efficiency of cisplatin chemotherapy

Control of positive end-expiratory pressure (PEEP) for small animal ventilators

<p>Abstract</p> <p>Background</p> <p>The positive end-expiratory pressure (PEEP) for the mechanical ventilation of small animals is frequently obtained with water seals or by using ventilators developed for human use. An alternative mechanism is the use of an on-off expiratory valve closing at the moment when the alveolar pressure is equal to the target PEEP. In this paper, a novel PEEP controller (PEEP-new) and the PEEP system of a commercial small-animal ventilator, both based on switching an on-off valve, are evaluated.</p> <p>Methods</p> <p>The proposed PEEP controller is a discrete integrator monitoring the error between the target PEEP and the airways opening pressure prior to the onset of an inspiratory cycle. In vitro as well as in vivo experiments with rats were carried out and the PEEP accuracy, settling time and under/overshoot were considered as a measure of performance.</p> <p>Results</p> <p>The commercial PEEP controller did not pass the tests since it ignores the airways resistive pressure drop, resulting in a PEEP 5 cmH₂O greater than the target in most conditions. The PEEP-new presented steady-state errors smaller than 0.5 cmH₂O, with settling times below 10 s and under/overshoot smaller than 2 cmH₂O.</p> <p>Conclusion</p> <p>The PEEP-new presented acceptable performance, considering accuracy and temporal response. This novel PEEP generator may prove useful in many applications for small animal ventilators.</p

Neuromuscular efficiency of the knee joint muscles in the early-phase of strength training: effects of antagonist’s muscles pre-activation

It was our objective tTo compare the neuromuscular efficiency (NME) adaptations between resistance exercise methods (with and without pre-activation of the antagonist’s muscles) after six-weeks training. This randomized controlled trial assigned forty-nine men (mean age 20.9 ± 2.2 years; height 1.80 ± 0.1 m; body mass 75.0 ± 8.2 kg) into two groups: 1) Reciprocal Training group (RT, concentric knee flexion immediately followed by concentric knee extension at 60°.s-1); and Conventional Training (CT, concentric knee extension exercise). Both training adopted three sets, 10 repetitions at 60°.s-1, 2 days/week for 6 weeks. NME of knee extension and flexion were assessed pre and post-training. The groups were similar at baseline, for all variables. We found significant effects on NME only for the rectus femoris muscle in the RT group (ES = 0.31; 95%CI [0.30-0,92]; p<0.01). There were no significant differences at NME pre- and post-training in CT and Total Work did not differ between groups. Reciprocal training provided better neuromuscular efficiency, but effects were limited to the rectus femoris muscle. The small effect sizes suggest caution in the results

Management and conservation of natural resources in the recovery of degraded areas through ethnobotany

An ethnobotanical study with an environmental perspective aims to recognize and understand the association between plants and nature for the conservation and recovery of degraded areas. Semistructured interviews were conducted with active members of the União do Vegetal religious community. The participants consider themselves key players in nature conservation and in valuing biological and cultural diversity. In addition, the interviews revealed that the cultivation of sacred plants can be carried out in agroforestry systems and contribute to conservation and recovery through plant management and use practices within a context of ecological self-sustainability, conceiving the sacred in nature itself and the means of connection with the spiritual. The results of the research show that management based on the perspectives of the União do Vegetal community can make a significant contribution to the conservation of natural resources, not only within the institution but also in society.El estudio etnobotánico con perspectiva ambiental pretende reconocer y comprender la asociación entre plantas y naturaleza para la conservación y recuperación de áreas degradadas. Se realizaron entrevistas semiestructuradas con miembros activos de la comunidad religiosa União do Vegetal. Los participantes se consideran actores claves en la conservación de la naturaleza y la valorización de la diversidad biológica y cultural. Además, las entrevistas revelaron que el cultivo de plantas sagradas puede realizarse en sistemas agroforestales y contribuir a la conservación y recuperación mediante prácticas de manejo y uso de las plantas, en un contexto de autosostenibilidad ecológica, concibiendo lo sagrado en la propia naturaleza y el medio de conexión con lo espiritual. Los resultados de la investigación muestran que la gestión basada en las perspectivas de la comunidad União do Vegetal puede contribuir significativamente a la conservación de los recursos naturales, no sólo dentro de la institución, sino también en la sociedad en su conjunto.O estudo etnobotânico com perspectiva ambiental, busca visar o reconhecimento e entendimento da associação entre planta e natureza para a conservação e recuperação de áreas degradadas. Foram conduzidas entrevistas semiestruturadas com membros ativos da comunidade religiosa União do Vegetal. Os participantes consideram-se atores-chaves para a conservação da natureza e valorização da diversidade biológica e cultural. Além disso, as entrevistas revelaram que o cultivo das plantas sagradas pode ser realizado em sistemas agroflorestais e contribuir para a conservação e recuperação por meio de práticas de manejo e uso das plantas, dentro de um contexto de autossustentabilidade ecológica, concebendo o sagrado na própria natureza e o meio de conexão com o espiritual. Os resultados da pesquisa demonstram que o manejo baseado nas perspectivas da comunidade da União do Vegetal pode contribuir significativamente para a conservação dos recursos naturais, não apenas dentro da instituição, mas também na sociedade como um todo

An analysis of Brazilian sugarcane bagasse ash behavior under thermal gasification.

Background: Ashes from sugarcane were analyzed by X-ray fluorescence, ash content, X-ray diffraction, scanning electron microscopy (SEM), and energy dispersive spectroscopy (EDS). FactSage 6.4 database software was used to estimate viscosity at high temperatures (900 - 1550°C) of them. Results: The results showed that although ashes from sugarcane bagasse contain silica, most of its SiO2 is from soil contamination. Higher and lower silica samples treated at 1350°C for 20 minutes showed that the fine portion of fraction of the ashes melted at this temperature. Conclusions: The melting phase could act as sticking flux for the coarse silica particles on the gasifier bottom wall, which could compromise the gasification process

Sit to stand test and handgrip strength in men and women with post-COVID-19 syndrome without invasive ventilator support: insights from a Brazilian observational study

Two valid tests have been used in patients with post-COVID-19 syndrome (coronavirus disease 2019) due to their fast application, feasibility, and accessible procedures, facilitating data collection in large groups: the 1-minute sit-to-stand test (STS) and handgrip strength (HGS) dynamometry. The present study aimed to: i) assess the STS and HGS in men and women with post-COVID-19 syndrome who did not require invasive ventilator support; ii) correlate STS repetitions and HGS with time since the COVID-19 diagnosis. Six hundred and twenty-two men and women with post-COVID-19 syndrome who did not require invasive ventilatory support performed the STS and HGS tests at the beginning of the rehabilitation process at a Reference Hospital Centre. Women over 55 years presented significantly lower results compared to participants under 55 years. For the HGS, the median ranged from 42 to 48 kg and 70 to 81 kg for the female and male groups, respectively. The correlations of time since COVID-19 diagnosis with STS and HGS ranged from -0.16 to 0.02 (p>0.05) for women and men, respectively.The test results could be used for the initial analysis of normality ranges and comparisons with other populations. Although STS repetitions and HGS presented low and non-significant correlations with time since the COVID-19 diagnosis, some COVID-19 sequelae were not measured, so these data should be interpreted with caution