Investigação dos métodos avaliativos utilizados por fisioterapeutas na especificidade da neurologia funcional

A avaliação fisioterapêutica neurofuncional representa uma das ações mais importantes do profissional. Contudo, divergências nos métodos utilizados para elaboração diagnóstica fazem com que haja discrepâncias na prescrição e no prognóstico fisioterapêutico. Assim, o objetivo deste trabalho foi analisar e discutir métodos e técnicas de avaliação utilizados por fisioterapeutas vinculados à atenção à saúde da população, na especificidade da neurologia funcional. Para a concretização desta pesquisa, foi realizado um estudo quali-quantitativo de delineamento transversal. A amostra foi composta por fisioterapeutas registrados no Conselho Regional de Fisioterapia e Terapia Ocupacional da comarca de Mato Grosso do Sul (CREFITO-13), especialistas na área da reabilitação neurofuncional, e atuantes em hospitais, universidades e clínicas da cidade de Campo Grande (MS). Os dados foram analisados por meio da estatística descritiva e inferencial (teste do χ²), sob um nível de significância de 5% (p<0,05). Sobre os resultados, todos os fisioterapeutas analisados concluíram a graduação havia mais de cinco anos. As respostas referentes ao exame físico foram semelhantes entre fisioterapeutas docentes e clínicos (p=0,81), não ocorrendo o mesmo com a anamnese (p=0,02). Itens como funções cognitivas e determinantes sociais de saúde foram respondidas por menos de 15% dos entrevistados, e aproximadamente 70% dos entrevistados disseram realizar, mas não registrar, a avaliação do paciente. em conclusão, ainda não há uma padronização da avaliação fisioterapêutica neurofuncional, tornando difícil unificar a análise prescritiva e prognóstica dos casos clínicos. As respostas apontam para uma dependência da visão profissional nos aspectos da doença, com pouca valorização das questões sociais de saúde.La evaluación fisioterapéutica neuro-funcional representa una de las acciones más importantes del profesional. Sin embargo, los desacuerdos en los métodos utilizados para la elaboración diagnóstica hacen que haya discrepancias en la prescripción y pronóstico fisioterapéutico. Así, el objetivo de este trabajo fue analizar y discutir los métodos y técnicas de evaluación utilizados por fisioterapeutas vinculados a la atención de salud de la población, en la especificidad de la neurología funcional. Para la concretización de esta investigación fue realizado un estudio cuali-cuantitativo de delineamiento transversal. La muestra fue compuesta por fisioterapeutas, especialistas en el área de rehabilitación neuro-funcional, registrados en el Consejo Regional de Fisioterapia y Terapia Ocupacional del estado Mato Grosso do Sul (CREFITO-13). La investigación involucra profesionales presentes en hospitales, universidades y clínicas de la ciudad de Campo Grande/MS. Los datos fueron analizados por medio de estadística descriptiva e inferencial (test χ²), sobre un nivel de significancia de 5% (p<0,05). Sobre los resultados, todos los fisioterapeutas analizados eran formados hace más de 5 años. Las respuestas referentes al examen físico fueron semejantes entre fisioterapeutas docentes y clínicos (p=0,81), no ocurriendo lo mismo en la anamnesis (p=0,02). Ítems como funciones cognitivas y determinantes sociales de salud fueron respondidas por menos del 15% de los entrevistados, y aproximadamente 70% realiza, pero no registra la evaluación del paciente. En conclusión, todavía no hay una normalización de la evaluación fisioterapéutica neuro-funcional, tornando difícil unificar un análisis prescriptivo y pronóstico de los casos clínicos. Las respuestas apuntan para una dependencia de la visión profesional en los aspectos de la enfermedad, con poca valoración de las preguntas sociales de la salud.Neurofunctional clinical evaluation represents one of the most important activities of physical therapists. However, differences in diagnostic methods cause discrepancies between physical therapy prescription and prognosis. Thus, the aim of this study was to analyze and discuss the evaluation methods and techniques used by physical therapists bound to popular healthcare assistance, in the specificity of the neurofunctional area. To accomplish this research, a cross-sectional design study was conducted. The sample consisted of physical therapists specialized in neurofunctional rehabilitation registered in the Regional Council for Physical Therapy and Occupational Therapy of Mato Grosso do Sul (Conselho Regional de Fisioterapia e Terapia Ocupacional, CREFITO - 13), who work in hospitals, universities and clinics of the city of Campo Grande, Brazil. Data were analyzed using descriptive and inferential (χ²) statistics, under a 5% level of significance (p<0.05). Regarding the results, all physical therapists had concluded graduation five years before. Responses regarding the physical examination were similar between professors and clinical physical therapists (p=0.81), which did not happen on the anamnesis (p=0.02). Items such as cognitive functions and social determinants of health were answered by less than 15% of subjects, and about 70% of respondents said they do, but do not register, the patients' evaluation. In conclusion, there is not a standardization of the physiotherapeutic neurofunctional evaluation, making it difficult to unify the prescriptive and prognostic analysis of clinical cases. The responses indicate a dependence of professional vision in the disease aspect, with little appreciation of health social issues

Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial

BACKGROUND: Exercise interventions often do not combine physical and cognitive training. However, this combination is assumed to be more beneficial in improving walking and cognitive functioning compared to isolated cognitive or physical training. METHODS: A multicenter parallel randomized controlled trial was conducted to compare a motor to a cognitive-motor exercise program. A total of 182 eligible residents of homes-for-the-aged (n = 159) or elderly living in the vicinity of the homes (n = 23) were randomly assigned to either strength-balance (SB) or strength-balance-cognitive (SBC) training. Both groups conducted similar strength-balance training during 12 weeks. SBC additionally absolved computerized cognitive training. Outcomes were dual task costs of walking, physical performance, simple reaction time, executive functions, divided attention, fear of falling and fall rate. Participants were analysed with an intention to treat approach. RESULTS: The 182 participants (mean age ± SD: 81.5 ± 7.3 years) were allocated to either SB (n = 98) or SBC (n = 84). The attrition rate was 14.3%. Interaction effects were observed for dual task costs of step length (preferred walking speed: F(1,174) = 4.94, p = 0.028, η2 = 0.027, fast walking speed: F(1,166) = 6.14, p = 0.009, η2 = 0.040) and dual task costs of the standard deviation of step length (F(1,166) = 6.14, p = 0.014, η2 = 0.036), in favor of SBC. Significant interactions in favor of SBC revealed for in gait initiation (F(1,166) = 9.16, p = 0.003, η2 = 0.052), ‘reaction time’ (F(1,180) = 5.243, p = 0.023, η(2) = 0.028) & ‘missed answers’ (F(1,180) = 11.839, p = 0.001, η(2) = 0.062) as part of the test for divided attention. Within-group comparison revealed significant improvements in dual task costs of walking (preferred speed; velocity (p = 0.002), step time (p = 0.018), step length (p = 0.028), fast speed; velocity (p < 0.001), step time (p = 0.035), step length (p = 0.001)), simple reaction time (p < 0.001), executive functioning (Trail making test B; p < 0.001), divided attention (p < 0.001), fear of falling (p < 0.001), and fall rate (p < 0.001). CONCLUSIONS: Combining strength-balance training with specific cognitive training has a positive additional effect on dual task costs of walking, gait initiation, and divided attention. The findings further confirm previous research showing that strength-balance training improves executive functions and reduces falls. TRIAL REGISTRATION: This trial has been registered under ISRCTN75134517 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2318-14-134) contains supplementary material, which is available to authorized users