Treino de marcha no Treadmill com suspensão corporal, em utentes com sequelas de AVC – Estudo Piloto

Trabalho para atribuição do Título de Especialista em FisioterapiaA diminuição da competência da marcha é um dos principais problemas dos utentes após AVC. Torna-se importante a avaliação da eficácia de estratégias de treino de marcha, onde se inclui o uso do treadmill, com suspensão do peso do corpo, que tem sido rapidamente adoptado como parte de intervenção da fisioterapia. No entanto, a evidência é controversa. Objectivos: Perceber qual a eficácia do treino de marcha no treadmill, com suspensão do peso do corpo, associado à fisioterapia convencional e, sendo um estudo piloto, analisar e se necessário reformular a metodologia utilizada para a realização de um futuro estudo. Metodologia: Estudo quasi-experimental – Estudo Piloto. 8 utentes com sequelas de AVC (distribuídos de forma sistemática pelo grupo 1 e pelo grupo 2). O grupo 1 realizou fisioterapia convencional, o grupo 2 realizou fisioterapia convencional e treino de marcha no treadmill. Realizaram a intervenção durante 5 semanas, 5 vezes por semana. Variáveis medidas: dependência, velocidade, endurance, simetria do passo e tempo de apoio unipodal do lado hemiparético na marcha, transferência de peso em apoio bipodal e funcionalidade. Resultados: Não foram encontradas diferenças estatisticamente significativas entre a avaliação inicial e final, nem para a análise de diferenças entre grupos. Discussão: Os resultados encontrados não vão ao encontro da hipótese de que o grupo 2 teria melhores resultados. Estes podem estar relacionados com as limitações do estudo. Em quase todos os parâmetros verificou-se uma melhoria para ambos os grupos. Conclusão: O presente estudo não permite retirar conclusões para a prática clínica mas, permite-nos sugerir algumas alterações para a realização de futuros estudos.N/

The use of concept maps in teaching neurology in a physiotherapy course

A teaching and learning strategy that has recently emerged in higher education is the use of concept maps, which seems to allow the fostering of a environment of involvement of the students. The objectives of this study are to describe the use of concept maps (CM) as a teaching tool of Neurology to 2nd year Physiotherapy Students and to understand the satisfaction of these students with the elaboration of the CM and the perception of learning. Initially, an elementary CM about the pathophysiology of neurological diseases was created by the teachers, which was presented and explained to students. At the end of each week of classes, 3 clinical cases were provided to the students and they were asked to perform a group CM of these cases, based on the elementary CM and the contents covered that week. The CMs were conducted with the guidance of a 3rd grader who was trained in the structuring of the CMs. The students delivered the CM weekly and were evaluated. At the end of the course a written test was elaborated in which students had to individually elaborate a CM about 2 clinical cases. At the end of the course a questionnaire was distributed to evaluate the students' opinion about the use of CM as a teaching tool, which aimed to assess the degree of satisfaction and the perception of learning with this tool. It was feasible to organize this course based on the use of CM as a teaching tool. Of the 52 students enrolled in the course, 46 answered the questionnaire. All interviewed students (100%) agree that the use of CM is an effective strategy in teaching these themes and that this strategy allows them to better relate the contents covered throughout the course. This study showed that concept maps can be a valid teaching strategy in the training of physiotherapists.info:eu-repo/semantics/publishedVersio

Bringing neuroscience to education: using an innovative method: the “BRAIN” Method - for teaching human motor control in higher education students

The past decade has seen a tremendous interest in the potential of applying insights from neuroscience to educational settings. Some refer to this emerging field of translational research as ‘neuroeducation’, others call it: ‘mind, brain and education’ or ‘educational neuroscience’. After a review of the literature on neuroeducation we created a method based on and combined the most cited principles: Priming; Constructivism; Feedback; Motivation; Reward; Cooperative work and Self-assessment. So we created the method BRAIN, wich means – BRing what you know / Acquire new knowledge / Inquiring about what you have learned / aNalyze what you have learned. We use this method in the motor control course of the physiotherapy course of our school. The themes were distributed by modules of 2 classes (one theoretical and one practical) and each module was planned taking into account the BRAIN model. For the lectures, small preparatory activities were built to activate students' prior knowledge and prepare them for the class. During the classes the contents were presented by the teacher through a combination of expository method with interactive methods. For practical classes, activities were performed in small groups. For all modules the learning objectives were divided into 3 levels, basic, advanced and advanced +. Out of class students performed consolidation activities that gave them bonus points. During the course 2 written tests and an oral test were applied. We applied a satisfaction questionnaire and made a focus group to know the opinion of the students on the subject. After analyzing the questionnaire and the focal group we can conclude that the students were very satisfied with the implemented methodology. Regarding the grades, the performance of the class reached a very good level.info:eu-repo/semantics/publishedVersio

Oficina social: aposta na qualidade de vida das pessoas em situação de dependência

O Programa Oficina Social nasce no município de Cascais onde a Rede Social, enquanto estrutura de governança local, assume um papel centrado na responsabilidade partilhada na prossecução do desenvolvimento social do território e da coesão social. Nesse sentido, este Programa caracteriza‐se essencialmente por um trabalho em rede e em parceria com diversas instituições locais e a Escola Superior de Saúde do Alcoitão, enquanto parceiro consultor, assume o seu papel de responsabilidade social no território concelhio, através do trabalho conjunto com o município e com muitas outras organizações locais, planeando e desenvolvendo serviços à comunidade. O Programa Oficina Social tem como principal objetivo a realização de pequenas reparações e adaptações em casa de munícipes com 65 ou mais anos e/ou em situação de dependência temporária ou permanente, com rendimento igual ou inferior ao valor da Pensão Social. É verdadeiramente um exemplo de como o investimento numa melhor qualificação habitacional das pessoas idosas e das pessoas com deficiência permite, prevenir acidentes domésticos, situações de dependência e institucionalização precoce, melhorando significativamente a qualidade de vida desta população.N/

Quadro referencial teórico do raciocínio clínico em fisioterapia neurológica: NeuroQR

A Fisioterapia Neurológica (FN), intervém nos indivíduos que sofrem de doenças que afetam o sistema nervoso e que provocam distúrbios motores, que se traduzem em alterações complexas do movimento e da funcionalidade. A FN é uma área científica que evoluiu fortemente nas últimas décadas. O conhecimento adquirido ao longo dos anos exige um raciocínio clínico sólido e uma gestão bem estruturada para a sua incorporação adequada na prática clínica. Embora a literatura atual forneça muitas informações sobre o raciocínio clínico e a tomada de decisão em fisioterapia, são poucos os artigos que discutem o raciocínio clínico específico da FN. O objetivo deste artigo é apresentar um quadro referencial teórico para o raciocínio clínico do fisioterapeuta que atua junto aos utentes com disfunções motoras e funcionais decorrentes de distúrbios neurológicos. O modelo descrito está dividido em 4 níveis – conceitos, abordagens, métodos e técnicas, foi construído pelo grupo de FN do departamento da ESSAlcoitão e tem por base outros quadros referenciais previamente publicados.info:eu-repo/semantics/publishedVersio

Effectiveness of intensive physiotherapy for gait improvement in stroke: systematic review

Introduction: Stroke is one of the leading causes of functional disability worldwide. Approximately 80% of post-stroke subjects have motor changes. Improvement of gait pattern is one of the main objectives of physiotherapists intervention in these cases. The real challenge in the recovery of gait after stroke is to understand how the remaining neural networks can be modified, to be able to provide response strategies that compensate for the function of the affected structures. There is evidence that intensive training, including physiotherapy, positively influences neuroplasticity, improving mobility, pattern and gait velocity in post-stroke recovery. Objectives: Review and analyze in a systematic way the experimental studies (RCT) that evaluate the effects of Intensive Physiotherapy on gait improvement in poststroke subjects. Methodology: Were only included all RCT performed in humans, without any specific age, that had a clinical diagnosis of stroke at any stage of evolution, with sensorimotor deficits and functional gait changes. The databases used were: Pubmed, PEDro (Physiotherapy Evidence Database) and CENTRAL (Cochrane Center Register of Controlled Trials). Results: After the application of the criteria, there were 4 final studies that were included in the systematic review. 3 of the studies obtained a score of 8 on the PEDro scale and 1 obtained a score of 4. The fact that there is clinical and methodological heterogeneity in the studies evaluated, supports the realization of the current systematic narrative review, without meta-analysis. Discussion: Although the results obtained in the 4 studies are promising, it is important to note that the significant improvements that have been found, should be carefully considered since pilot studies with small samples, such as these, are not designed to test differences between groups, in terms of the effectiveness of the intervention applied. Conclusion: Intensive Physiotherapy seems to be safe and applicable in post-stroke subjects and there are indications that it is effective in improving gait, namely speed, travelled distance and spatiotemporal parameters. However, there is a need to develop more RCTs with larger samples and that evaluate the longterm resultsN/

Changes in children´s eating consumption and other food related behaviors during the lockdown of the COVID-19 pandemic,in Portugal: MUN-SI Cascais program 2019/2020

O confinamento obrigatório e o encerramento das escolas durante a pandemia da COVID-19 afetaram as rotinas e estilos de vida das crianças, com impacto na sua saúde. Este trabalho pretende identificar as mudanças no consumo e comportamentos alimentares durante o primeiro confinamento em contexto da pandemia da COVID-19 em 2020, entre crianças do 1.º Ciclo do Ensino Básico (EB). Este estudo transversal decorreu dois meses após o início do confinamento, em 11 escolas participantes no programa MUN-SI Cascais, abrangendo crianças entre os 8-10 anos. Os dados foram recolhidos através de um questionário de família online, no qual 113 encarregados de educação (EE) participaram voluntariamente. Os EE reportaram alterações na ingestão alimentar das crianças durante o confinamento como o aumento da ingestão de cereais de pequeno-almoço, pão de forma embalado e batatas fritas (25,5%, 19,4% e 18,8%, respetivamente). Metade dos EE (50,0%) reportaram ter comprado mais produtos locais, 22,4% compraram mais produtos em grandes quantidades e 19,7% usaram mais apps/lojas online para adquirir alimentos durante o confinamento. Destacam-se ainda outros comportamentos que aumentaram durante o confinamento: prestar mais atenção aos prazos de validade (52,1%), fazer mais listas de compras (51,4%), comer em horários mais regulares (43,2%), prestar mais atenção ao desperdício de alimentos (35,7%) e maior envolvimento das crianças na preparação das refeições (27,8%). Estes dados reforçam a necessidade de manter e incentivar estratégias de desenvolvimento de políticas efetivas em saúde, de base escolar e familiar, durante e após o período pós-pandemia.The mandatory lockdown and the school closures during COVID-19 pandemic brought a complete shift within children’s routines and lifestyles affecting their health. This study aims to identify the changes in school children´s eating habits and other food related behaviors, during the first 2020 lockdown of the COVID-19 pandemic. This cross-sectional study was applied two months into the national lockdown, in the scope of the MUN-SI Cascais program, in 11 elementary schools, covering children between 8 and 10 years. Data were collected through an online family questionnaire, in which 113 parents participated voluntarily. Parents perceived some changes on children’s food consumption during confinement: increased consumption of breakfast cereals, sliced white bread and chips (25.5%, 19.4% and 18.8%, respectively). Half of the parents (50.0%) reported to have purchased more local products, 22.4% purchased products in large quantities during confinement and 19,7% used more apps/online stores for buying foods. Other behaviors that increased during confinement stand out: Paying more attention to expiration dates (52.1%), making more shopping lists (51.4%), eating at more regular times (43.2%), pay more attention to food waste (35.7%) and greater involvement of children in meal preparation (27.8%). These results reinforce the need to maintain and encourage strategies to support the development of effective school and family-based public health policies during and after post-pandemic period.info:eu-repo/semantics/publishedVersio

Educational strategies to increase student knowledge and reflexion about physiotherapy intervention in the context of covid-19

Background: In the context of the COVID-19 pandemic, the Alcoitão School of Health Sciences (ESSA) interrupted on March 16, 2020, all classroom activities, including clinical activities. This situation created the need to transfer all activities and classes to an online format (synchronous and asynchronous) and to promote in students new knowledge/skills/attitudes related to the new professional reality. Purpose: To increase students literacy and reflection concerning the pandemic and to adapt, as a profession to the new needs of society, the Department of Physiotherapy decided to implement an online activity that could facilitate this process. Methods: The online activity was created with a duration of 3 weeks integrated into the clinical curricular units. It involved 218 Physiotherapy students from the 4 curricular years, the Department lecturers and guests speakers. This activity included the creation of an updated repository of information related to the pandemic COVID-19, namely national (DGS) and international (WHO) guidelines, professional guidelines (WCPT, APFISIO, Professional Interest Groups) and multimedia material (videos and podcasts). As part of the activity, students were asked to complete the Coronavirus Disease Program developed by Pysiopedia (Physioplus), according to the academic year, in whole or only some of the modules. To support the activity, several online sessions were promoted, where, with the participation of guests, the pandemic and its impact on the various contexts of Physiotherapy were discussed. To evaluate the activity, students were asked to submit certificates of completion of the Coronavirus Disease Program course and an individual reflection on the institutional e-learning platform. To assess the impact on student satisfaction, an online questionnaire with several dimensions (34 questions) was used. Results: 96% of the Students (n= 211) completed this course, submitting the certificates of completion and the individual reflection. Concerning the student satisfaction, with a response rate of 96% distributed evenly across the various academic years, 78.7% considered that the activity, in general, was clear and was well structured, having reached the general objectives of the activity (79.6%), 83.4% also considered that it was an overall positive experience and reinforcing the importance of carrying out this type of activities (76.3%). Conclusion(s): From the results we can conclude that is important to develop updated activities adapted to current needs, using online approaches and involving all the partners in the educational process. It is important that Physiotherapy educators, create and implement activities that facilitate the development of students competencies that allow them to play a proactive role in global and local efforts to reduce the impact health and social effects of this pandemic.info:eu-repo/semantics/publishedVersio

Níveis de atividade física em pessoas internadas com Acidente Vascular Cerebral: revisão sistemática

Introdução: Existem múltiplas consequências associadas ao Acidente Vascular Cerebral (AVC). Devido à diminuição da funcionalidade, as pessoas com AVC tendem a ter uma baixa frequência de atividade física (AF) moderada a vigorosa, não atingindo os níveis mínimos recomendados. A AF, além de ter outros benefícios, é fundamental como estratégia preventiva não farmacológica, sendo que fornece efeitos neuroprotetores para doenças neurológicas, levando à redução do seu impacto, retardando o seu progresso e prevenindo possíveis recidivas. Objetivo: Rever e analisar estudos que avaliem os níveis de AF, em pessoas internadas, com diagnóstico de AVC, através de uma monitorização intervalada ou contínua, com duração mínima de seis horas, ao longo do período diário mais ativo. Metodologia: Foi realizada uma pesquisa bibliográfica nas bases de dados PubMed, PEDro e CENTRAL, utilizando-se a metodologia de investigação - Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Foram incluídos quaisquer tipos de estudos que monitorizassem os níveis de AF de pessoas com AVC, com idade superior a 18 anos, em regime de internamento, e cujos resultados não estivessem relacionados com efeitos de aplicação de uma intervenção específica. Resultados: Após a aplicação dos critérios de inclusão, foram incluídos 27 estudos. Desses, 14 monitorizaram a AF através de dispositivos e 13 através de behavioral mapping. Devido à heterogeneidade metodológica dos estudos, não foi possível a realização de uma meta-análise. Conclusão: Pessoas com AVC internadas passam longos períodos em tempo inativo e sedentário, não cumprindo, possivelmente, as recomendações estabelecidas para os níveis de AF nesta doença

Estratégias educativas para facilitar o conhecimento e a reflexão dos alunos sobre a intervenção do Fisioterapeuta no contexto da COVID-19

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