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Avaliação do equilíbrio, da força muscular e da funcionalidade de indivíduos com a doença de Charcot-Marie-Tooth / Evaluation of muscle strength, balance and functionality of individuals with the disease of Charcot-Marie-ToothCosta, Iandra Maria Pinheiro de França 29 April 2016 (has links)
The Charcot-Marie-Tooth disease (CMT) is peripheral neuropathy genetically inherited most common worldwide. The most cases of CMT can be classified into two major categories of the nature of the primary nerve injury: CMT type 1 and type 2. The main clinical symptoms are muscle weakness and decreased sensation in the legs and feet, changes in gait and balance. The objectives of this study were to conduct a systematic review of the balance and functionality of individuals with the disease of Charcot-Marie-Tooth (CMT), as well as assess the muscle strength, balance and functionality of individuals with the disease of Charcot-Marie-Tooth type 2 ( CMT2). Methods: A comprehensive literature search was performed using as a database MEDLINE, PubMed, Web of Science, Scopus (1980- 2015). Furthermore, an observational and cross-sectional study was conducted through interviews and clinical evaluation of individuals with CMT2 disease in the city Tobias Barreto. The sample consisted of a group of 15 patients with CMT2 (GCMT2) and a control group (CG), with healthy subjects matched for age and gender with CMT2 group. Individuals with CMT were classified by Neuropathic scale of Charcot-Marie-Tooth disease (Neuropathy Scale Charcot-Marie-Tooth - CMTNS) that assesses the degree of severity of the disease. The muscle strength of the lower limbs was evaluated by a hand dynamometer. The balance was measured through footwork stabilometer and Berg Balance Scale. Functional assessment was measured by the Timed Up Go test (TUG). Results: In the systematic review were selected 18 articles, most of the cross-sectional and performed in Europe. The types of study were prevailed on assessment of balance and functionality, rehabilitation treatment and natural evolution of CMT disease. The number of participants per study ranged 6-211 affected individuals. In the second article, there was a statistically significant difference between the GCMT2 and GC for muscle strength of all assessed muscles (ankle extensor: p = <0.0001, plantarflexors: p = <0.0001, inverters: p = <0.0001, eversors: p = 0.0016).For the VCoPAP and DCopAP parameters stabilometry for open and closed eyes, respectively (p = 0.0123, p = 0.0183, p = 0.0132, p = 0.0129) for the Berg balance scale (p = 0.0066) and the TUG (p = 0.0003) test. The most evident correlations were between all variables and CMTNS. In addition, individuals with CMT2 have loss of balance in the anteroposterior direction and with increasing severity of the disease these individuals need more vision for maintaining balance. Conclusion: Most studies of the systematic review evaluating balance and /or functionality also included in their assessments to measure muscle strength and sensitivity. Furthermore, studies have shown that the distal muscle weakness, especially ankle extensor plantar flexors and is associated with loss of balance and dynamic activities in the stop position, respectively. Clinical evaluations, conducted in CMT2 group and control group, showed that patients with Charcot-Marie-Tooth have less balance and loss of functional activity as compared to healthy subjects. / A doença de Charcot-Marie-Tooth (CMT) é a neuropatia periférica geneticamente herdada mais frequente em todo mundo. A maioria dos casos de CMT pode ser classificada em duas grandes categorias quanto à natureza da lesão primária do nervo: CMT tipo 1 e tipo 2. As principais manifestações clínicas são fraqueza muscular e diminuição da sensibilidade nas pernas e pés, alterações na marcha e equilíbrio. Os objetivos deste estudo foram realizar uma revisão sistemática sobre o equilíbrio e funcionalidade de indivíduos com a doença de Charcot-Marie-Tooth (CMT), assim como avaliar a força muscular, o equilíbrio e funcionalidade de indivíduos com a doença de Charcot-Marie-Tooth tipo 2 (CMT2). Métodos: Uma pesquisa abrangente na literatura foi realizada utilizando como base de dados a MEDLINE-PubMed, Web of Science, Scopus (1980- 2015). Além disso, foi realizado um estudo observacional e transversal, por meio de entrevista e avaliação clínica de indivíduos com a doença de CMT2 no município de Tobias Barreto. A amostra foi composta por um grupo com 15 pacientes com CMT2(GCMT2) e um grupo controle (GC), com indivíduos saudáveis pareados por idades e gêneros com o grupo CMT2. Os indivíduos com CMT foram classificados pela escala neuropática de Charcot-Marie-Tooth (Charcot-Marie-Totth Neuropathy Score - CMTNS) que avalia o grau de severidade da doença. A força muscular foi avaliada através de um dinamômetro manual. O equilíbrio foi mensurado através do baropodômetro footwork e da escala de equilíbrio de Berg. A avaliação funcional foi mensurada pelo teste Timed Up Go (TUG). Resultados: Na revisão sistemática foram selecionados 18 artigos. Os tipos de estudo que prevaleceram foram sobre avaliação do equilibrio e funcionalidade, tratamento de reabilitação e evolução natural da doença de CMT. A maioria dos estudos encontrou que a fraqueza muscular e alterações da sensibilidade estavam relacionadas à perda de equilíbrio e menor desempenho das atividades funcionais. No segundo artigo, houve diferença estatisticamente significativa entre o GCMT2 e GC para força muscular de todos os músculos avaliados (dorsiflexores: p= < 0.0001, flexores plantares: p= < 0.0001, inversores: p= < 0.0001, eversores: p= 0.0016), para os parâmetros VCoPAP e DCopAP da estabilometria para olhos abertos e fechados respectivamente (p= 0,0123; p= 0,0183, p= 0,0132, p=0,0129), para a escala de equilíbrio de Berg (p=0,0066) e para o teste TUG ( p = 0.0003). As correlações mais evidentes foram entre todas as variáveis analisadas e o CMTNS. Além disso, indivíduos com CMT2 apresentam perda de equilíbrio no sentido ântero-posterior e com o aumento da severidade da doença esses indivíduos necessitam mais da visão para manutenção do equilíbrio. Conclusão: A maioria dos estudos da revisão sistemática que avaliaram equilibrio e/ou funcionalidade também incluiram em suas avaliações a mensuração da força muscular e sensibilidade. Além disso, os estudos mostraram que a fraqueza muscular distal, especialmente de dorsiflexores e flexores plantares, está associada à perda de equilíbrio em atividades dinâmicas e a posição estática, respectivamente. As avaliações clínicas, realizadas no grupo CMT2 e grupo controle, revelaram que pacientes com Charcot-Marie-Tooth têm menor equilíbrio e prejuízo das atividades funcionais quando comparados aos indivíduos saudáveis.
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The perceptions of Lesotho secondary schools’ teachers about the inclusion of students with disabilitiesRalejoe, Malehlanye Constrantinus 04 July 2018 (has links)
Scholars emphasise the pivotal role that teacher perceptions play in the success of inclusive education (IE). Using Bourdieu’s (1985-1999) three conceptual tools of habitus, field and capital as a theoretical framework, this qualitative case study was designed to investigate secondary school teachers perceptions of IE – particularly with regard to the inclusion of children with disabilities in mainstream schools in the Maseru District of Lesotho. Data were collected using rural and urban focus-groups’ interviews. After analysing the data using categorical indexing, and discourse and comparative analysis methods, seven overriding themes emerged: teacher philosophical understanding of IE, teacher inclusion experiences and challenges, teacher classroom practices, teacher opinions about IE, key elements of IE, advantages of IE, and disadvantages of IE.
Both focus groups demonstrated similar, but diverse conceptualisations of IE: as an integration movement requiring students to adapt to the school environment; as a segregation movement justifying special schools for students with severe disabilities; and as an education-for-all movement requiring that schools adapt to individual learner needs. The teachers understood that IE had social benefits for learners who could not reap its academic benefits. They used their traditional nurturing approaches to teach learners with different abilities – such as by memorisation of concepts and maximising peer interactions for the purpose of peer tutoring. However, the teachers’ insistence on corporal punishment and forcing learners to speak English in schools seemed to compromise their inclusion efforts. The study also found that despite the culturally influenced, positive and nurturing instincts of teachers in relation to supporting the education of children with disabilities, they were confronted with numerous challenges. These included: lack of knowledge and skills to effectively implement IE, lack of resources, lack of collaborative support from parents and government, and lack of incentives to boost their morale.
It is recommended that teachers be equipped with theoretical knowledge of IE and with practical skills to implement it. Pre-service and in-service training was recommended in this regard. It is also recommended that all stakeholders in Lesotho secondary education bring together their resources, expertise, knowledge and enthusiasm – in an effort to make IE in Lesotho both successful and sustainable. / Inclusive Education / D. Ed. (Inclusive Education)
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