FISIOTERAPIA NEUROFUNCIONAL: ONDE ESTAMOS E PARA ONDE VAMOS?

Há um ditado popular que diz “É necessário conhecer os extremos para que se encontre o equilíbrio”. Infelizmente, não sei atribuir o autor de tamanha sabedoria, mas acredito que ela se aplica à Fisioterapia Neurofuncional. Como especialidade passamos longas décadas focando nossa atuação no manejo das deficiências, em especial nos distúrbios de tônus, enquanto sonhávamos que as limitações na atividade seriam transformadas por consequência, num futuro distante. Desde os anos 1950 até antes dos anos 2000, focamos nossos esforços em quebrar a espasticidade (e que terminologia inadequada escolhemos), melhorar as amplitudes de movimento e evitar que movimentos atípicos (antigamente denominados equivocadamente de anormais) pudessem emergir no comportamento motor dos pacientes1. Falhamos miseravelmente. Felizmente, em 2001, a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF)2 nos colocou diante da urgente necessidade de olhar para a funcionalidade de modo amplo, sob a lente do Modelo Biopsicossocial, e nos fez compreender a importância dos fatores contextuais na funcionalidade dos pacientes neurológicos. Saímos, então, para uma corrida em direção à redução das limitações na atividade e restrições na participação por meio da realização das atividades a qualquer custo, a qualquer preço e sem mínimos critérios de qualidade. De um extremo ao outro em 50 anos. E, com a atuação pautada no Modelo Biopsicossocial, usando o prisma da CIF, descobrimos que não tratamos condições de saúde, mas sim suas consequências na funcionalidade do indivíduo

Philosophy and neuroscience: between certainties and doubts

When considering the human movement from a restricted point of view (i.e. from only one field of study), its complexity is evident at each new step in Science. Considering such complexity in the human movement, we revisit the possibility of a dialogue between Philosophy and Science, focusing on the studies on the human body and movement. We invoke the strangeness between Neuroscience and Philosophy, especially the phenomenology of Merleau-Ponty with clinical examples and reflexions. The intention is not to find a system of explanations, to force an approximation or to point out elements for hierarchization, but to extract elements that help us to think about our certanties and doubts about the human movement. Philosophy can restate questions and restore the place of doubt, when initially, it helps us to enquire assumptions and consequences of our research. On the other hand, Science opens fields, stimulates curiosity and allows questioning even without one recognizing it. The difference between the ways of thinking reality and knowledge does not need to be fought at the costs of weakening both. However, it is possible to extract interesting consequences from an approximation between Philosophy and Science.Quando tentamos pensar o movimento humano, esse corpo vivo em relação com o mundo, por meio de conceitos restritos a uma única área, constata-se a complexidade deste fenômeno, que se mostra a cada novo movimento da ciência. Considerando esta complexidade, retomamos neste ensaio a possibilidade de diálogo entre Filosofia e Ciência, aqui ocupadas com os estudos sobre corpo e movimento humano. Recorremos, então, ao estranhamento entre Neurociência e Filosofia, em especial a Fenomenologia de Merleau-Ponty, por meio de exemplos clínicos e reflexões, não no sentido de buscar um sistema de explicações, forçar uma aproximação ou apontar elementos para fins de hierarquização, mas com o intuito de extrair deste movimento os elementos que nos ajudem a pensar nossas certezas e dúvidas acerca do movimento humano. A Filosofia nos auxilia, inicialmente, a indagar sobre os pressupostos e consequências das pesquisas, recolocando questões e restaurando o lugar da dúvida. A Ciência, por sua vez, abre campos, aguça curiosidades, e mesmo sem admiti-lo, deixa-se questionar. A separação entre as diferentes formas de pensar a realidade e produzir conhecimentos não precisa necessariamente ser combatida, às custas do enfraquecimento de ambas, mas é possível extrair consequências interessantes de um movimento de aproximação entre as duas áreas

Self-talk does not affect the transfer and retention in the tennis forehand learning in beginners

The aim of this study was to investigate the effects of self-talk on motor learning in beginners. The learning task was the forehand stroke in tennis. Eighty-four students were assigned into five self-talk groups and one control group. One of the self-talk groups used four cues for directing attention to key elements of the forehand stroke. The other self-talk groups made use of only one of the four cues (ball, bounce, hit, and ready), and the control group received only general instructions. In the acquisition phase, all groups performed 180 trials over three days. Then they performed a transfer test of 10 trials involving a change in the target direction. After five days they performed a retention test in the same conditions of the acquisition phase. The performance was analysed in terms of rates of success and consistency of the forehand hit to the target located on the opponent’s court. Results showed that all groups improved their performances in the acquisition phase, and that they maintained the improvement in the retention and transfer tests. However, no differences were found between the groups. It was concluded that self-talk did not affect the learning of forehand stroke in tennis. In addition, learning with self-talk with four cues was similar to that with selftalk with only one cue

HIGHER VARIABILITY IN DYADIC INTERACTION PLAYS A POSITIVE ROLE IN THE DECISION MAKING OF FUTSAL PASSING

This study investigated the role the dyadic interaction variability plays in influencing decision making on passing in the sport of futsal. Participants were 40 male students (M = 13.6 years, SD = 0.7) from physical education classes of a Brazilian school. They were randomly divided into eight teams, which played four games of 24 minutes according to the rules of the under-14 category of the local Futsal Federation. From the games, a sample of 80 sequences of play involving passes were randomly selected, from the moment the ball carrier got possession of the ball until the moment he passed it. From the x and y coordinates of all outfield players’ displacement, variability of running correlation, cross-correlation, centroid and interpersonal distance were calculated as measures of dyadic interaction. Results showed that the interaction of passer and receiver dyads were more variable than the remaining dyads. Moreover, it was verified that passer dyad had the highest variability. The findings enabled us to conclude that, from the attackers’ point of view, variability played a positive role. In addition, it appeared that the passer sought to disrupt the interaction with his defender to perform the pass more than his teammates did to receive it. It appears that the skills of passing and receiving in the sport of futsal imply the ability to vary.</p

MOTOR LEARNING IN CHILDREN WITH CEREBRAL PALSY

Abstract Introduction: cerebral palsy (CP) has the characteristic of causing changes in posture and movement that hamper the achievement of functional activities. In the face of motor disabilities, rehabilitation becomes essential and is an option based on motor learning. However, it is important to research the motor learning process in individuals with CP to make the organization of treatment programs more effective. OBJECTIVE: Analyse the motor learning in children with CP. METHOD: For the realization of this work, an experimental group (EG) and a control group (CG) was used, comprised of four children matched in relation to gender (one female and three masculine) and age (between seven and twelve years). The task was to conduct a path into a maze in the shortest time possible. The work consisted of two phases, being initially an acquisition phase (AQ) and then transfers (immediate-IM; short-term-ST and long-term-LT). RESULT: It was found that there was no statistical significance difference between AQ and transfers evaluated with the following values: IM (z= -1.83, p=0.07), p=0.14)]. CONCLUSION: In the process of maze task learning, when analyzing the results between phases AQ and transfer, significant difference was not observed, which means that individuals with CP showed learning capacity through task adaptation equivalent to individuals without CP

Motor Learning of a cognitive-motor task after stroke

The aim of this study was investigated a maze learning in stroke individuals. Forty participants assigned&nbsp;into two groups: experimental (stroke participants; n = 20) and control (neurologically healthy&nbsp;participants; n = 20). The study involved an acquisition phase, a transfer test, and a short-and longterm retention tests. The task consisted in complete a maze, with paper and pen, in the shortest time possible. The dependent variables were execution time and error. Data were analyzed with an Anova- two&nbsp;way with Repeated Measures for these variables. Results showed learning for both groups, but with the&nbsp;experimental group having worse performance compared to control group mainly related error. It was&nbsp;also seen the impact promoted in the task has impaired both groups in the transfer test performance

Motor learning in children with cerebral palsy

INTRODUÇÃO: a Paralisia Cerebral (PC) tem como característica causar alterações na postura e movimento que dificultam a realização de atividades funcionais. Diante das dificuldades motoras, a reabilitação torna-se essencial e tem como uma opção basear-se na aprendizagem motora. Porém, é importante a investigação do processo de aprendizagem motora em indivíduos com PC para viabilizar a organização de programas de tratamento mais efetivos. OBJETIVO: analisar o processo de aprendizagem motora em crianças com PC. MÉTODO: Para a realização deste trabalho utilizou-se um grupo experimental (GE) e um grupo controle (GC) ambos formados por 4 crianças pareadas em relação ao gênero (um do gênero feminino e três do gênero masculino) e idade (entre sete e doze anos). A tarefa consistia em realizar um caminho em um labirinto, no menor tempo possível. O trabalho consistiu de duas fases, sendo inicialmente a fase de aquisição (AQ) e depois as transferências (Imediata-TI; Curto Prazo-TC e Longo Prazo-TL). RESULTADO: Verificou-se que não houve diferença estatisticamente significante entre a AQ e as transferências avaliadas com os valores a seguir: TI (z = -1,83 e p = 0,07), TC (z = -1,83 e p = 0,07) e a TL [GE (z = -1,83 e p = 0,07) e GC (z = -1,46 e p = 0,14)]. CONCLUSÃO: No processo de aprendizagem da tarefa de labirinto, analisando-se os resultados entre as fases de AQ e Transferência não se observou diferença, ou seja, os indivíduos com PC mostraram capacidade de aprendizagem preservada por meio da adaptação da tarefa, fato este que ocorreu de forma equivalente aos indivíduos sem paralisia cerebral.INTRODUCTION: cerebral palsy (CP) has the characteristic of causing changes in posture and movement that hamper the achievement of functional activities. In the face of motor disabilities, rehabilitation becomes essential and is an option based on motor learning. However, it is important to research the motor learning process in individuals with CP to make the organization of treatment programs more effective. OBJECTIVE: Analyse the motor learning in children with CP. METHOD: For the realization of this work, an experimental group (EG) and a control group (CG) was used, comprised of four children matched in relation to gender (one female and three masculine) and age (between seven and twelve years). The task was to conduct a path into a maze in the shortest time possible. The work consisted of two phases, being initially an acquisition phase (AQ) and then transfers (immediate-IM; short-term-ST and long-term-LT). RESULT: It was found that there was no statistical significance difference between AQ and transfers evaluated with the following values: IM (z= -1.83, p=0.07), ST (z= -1.83, p=0.07) and LT [EG (z= -1.83, p=0.07) and CG (z= -1.46, p=0.14)]. CONCLUSION: In the process of maze task learning, when analyzing the results between phases AQ and transfer, significant difference was not observed, which means that individuals with CP showed learning capacity through task adaptation equivalent to individuals without cerevral palsy

Comparison between the six-minute walk test and the six-minute step test in post stroke patients

Abstract\ud \ud \ud \ud Background\ud The Stroke remains one of the major chronic diseases worldwide, and is considered a major cause of disability, which results not only in persistent neurological deficits, but also in the high physical deconditioning, nevertheless there are not many forms of assessing functional capacity in this population. We aimed to investigate the feasibility of the Six Minute Walk Teste and the Six-Minute Step Test (6MST) in post-stroke patients and compare the behavior of physiological variables during the 6MST and the Six-Minute Walk Test (6MWT), by correlating the functional performance obtained in both tests.\ud \ud \ud \ud Method\ud The 6MWT was carried out according to the American Thoracic Society (ATS) and the 6MST was performed in six minutes in order to compare it to the 6MWT in a 20 cm step. Was included post-stroke individuals able to walk without aid. All of them did the 6MWT and the 6MST.\ud \ud \ud \ud Results\ud 12 patients participated in the study. There was no statistical difference in the parameters analyzed when tests were compared. There was poor correlation between the functional performance in both tests.\ud \ud \ud \ud Conclusion\ud The 6MWT and the 6MST is feasible for post-stroke patients and physiological responses are equal during the performance of both tests. However, there was no correlation with respect to functional performance, which was assessed by the distance walked in the 6MWT and by the number of steps climbed in the 6MST.This study received financial support from Núcleo de Estudos, Pesquisas e Assessoria à Saúde da Faculdade de Medicina do ABC (NEPASFMABC).This study received financial support from Núcleo de Estudos, Pesquisas e Assessoria à Saúde da Faculdade de Medicina do ABC (NEPAS-FMABC)

Functional capacity and assistance from the caregiver during daily activities in brazilian children with cerebral palsy

Background: Cerebral Palsy (CP) presents changes in posture and movement as a core characteristic, which requires multiprofessional clinical treatments during children’s habilitation or rehabilitation. Besides clinical treatment, it is fundamental that professionals use evaluation systems to quantify the difficulties presented to the individual and their families in their daily lives. We aimed to investigate the functional capacity of individuals with CP and the amount of assistance required by the caregiver in day-to-day activities. Methods: Twenty patients with CP, six-year-old on average, were evaluated. The Pediatric Evaluation Inventory of Incapacities was used (PEDI - Pediatric Evaluation Disability Inventory), a system adapted for Brazil that evaluates child's dysfunction in three 3 dimensions: self-care, mobility and social function. To compare the three areas, repeated measures analysis of variance (ANOVA) were used. Results: We found the following results regarding the functional capacity of children: self-care, 27.4%, ±17.5; mobility, 25.8%, ±33.3 and social function, 36.3%, ±27.7. The results of the demand of aid from the caregiver according to each dimension were: self-care, 9.7%, ±19.9; mobility, 14.1%, ± 20.9 and social function, 19.8%, ±26.1. Conclusion: We indicated that there was no difference between the performance of the subjects in areas of self-care, mobility and social function considering the functional skills and assistance required by the caregiver.UNES

Functional capacity and assistance from the caregiver during daily activities in Brazilian children with cerebral palsy

Abstract\ud \ud \ud \ud Background\ud \ud Cerebral Palsy (CP) presents changes in posture and movement as a core characteristic, which requires multiprofessional clinical treatments during children’s habilitation or rehabilitation. Besides clinical treatment, it is fundamental that professionals use evaluation systems to quantify the difficulties presented to the individual and their families in their daily lives. We aimed to investigate the functional capacity of individuals with CP and the amount of assistance required by the caregiver in day-to-day activities.\ud \ud \ud \ud Methods\ud \ud Twenty patients with CP, six-year-old on average, were evaluated. The Pediatric Evaluation Inventory of Incapacities was used (PEDI - Pediatric Evaluation Disability Inventory), a system adapted for Brazil that evaluates child's dysfunction in three 3 dimensions: self-care, mobility and social function. To compare the three areas, repeated measures analysis of variance (ANOVA) were used.\ud \ud \ud \ud Results\ud \ud We found the following results regarding the functional capacity of children: self-care, 27.4%, ±17.5; mobility, 25.8%, ±33.3 and social function, 36.3%, ±27.7. The results of the demand of aid from the caregiver according to each dimension were: self-care, 9.7%, ±19.9; mobility, 14.1%, ± 20.9 and social function, 19.8%, ±26.1.\ud \ud \ud \ud Conclusion\ud \ud We indicated that there was no difference between the performance of the subjects in areas of self-care, mobility and social function considering the functional skills and assistance required by the caregiver.This manuscript received financial support from UNESP. The funding body provided financial support to make all procedures and in the decision to submit the manuscript for publication