Introduction: The theoretical part of the thesis summarizes findings from foreign literature on virtual reality and its use in rehabilitation, as well as the possibility of the benefits of active video games as part of balance training, specifically gaming console Nintendo Wii. The practical part is a pilot study to evaluate the effect of balance training in patients with cerebral palsy using this gaming console. Methods: The study included five patients with cerebral palsy, three in the form of spastic hemiparesis, two in the form of spastic triparesis. Patients were aged 8-18 years. Therapy took place on the Nintendo Wii, selecting five games from cd/dvd Wii Fit Plus. Patients underwent a total of 8 treatments with a frequency of once a week. One therapy lasted 20-30 minutes, according to success in individual games. The effect of therapy was evaluated using the Balance Master, specifically through tests Weight / Bearing squat (weight distribution of the lower limbs), mCTSIB (modified test balance sensory interaction) Limits of Stability (CoG sway to the borders of support base), Rhytmic Weight Shift (fast active transfer of CoG), Walk Across, Tandem walk and Step/Quick Turn (walking with a turn). For statistical evaluation and comparison of the results before and after treatment was used...

[Truncated abstract] Anterior cruciate ligament injuries are a major problem in sport. The purpose of this thesis was to investigate the causative factors of ACL injuries and to study the effect of various types of lower-limb training on underlying neuromuscular mechanisms involved in stabilisation and risk of ACL injury. Investigation of the mechanisms was conducted on controlled balance and strength tests as well as in sporting manoeuvres. It was aimed to assess if the neuromuscular changes map over into the performance of sporting manoeuvres and if potential for loading on the ACL and risk of injury was reduced or exacerbated . . . ACL strain can be decreased through reduction in the applied loads and greater knee flexion. Further to this, muscle activation has the ability to reduce loading on the ACL through co-contraction and selective activation patterns. This thesis demonstrated differing neuromuscular adaptations from various training types that map over into the performance of sporting manoeuvres. The research indicated that the Balance-Training was the most favourable in reducing potential for injury risk on the ACL. Alternatively strength training elicited neuromuscular changes that were likely to increase the risk of force on the ACL. The Machine+Balance training resulted in some negative and positive outcomes with the balance training tending to counteract the negative affects of machine weights training resulting in small improvements in muscular support and load reduction. This study provides us with better understanding of the underlying mechanisms from various training types and their potential affect on risk of ACL injury.

Made available in DSpace on 2016-12-12T17:32:57Z (GMT). No. of bitstreams: 1 Resumo Josilene.pdf: 200186 bytes, checksum: 2f7be00775cd12b3c58b24e75d73a884 (MD5) Previous issue date: 2014-06-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study aimed to investigate the effect of balance perturbation training on the strategies of postural control in subjects with chronic ankle instability (CAI). Forty-four subjects with CAI were randomly assigned in the training group (TG, n=22) and control group (CG, n=22). The TG performed a single session of balance training (25 minutes) involving a task of kicking a ball in single-leg stance. CG received no intervention. The primary outcomes were tested during the kicking a ball (dynamic) and quietly standing on single-leg (static) tasks. The primary outcome was the sum of the integral electromyographic (Σ∫EMG) of the supporting leg lower limb muscles. The Σ∫EMG were calculated during the intervals typical for anticipatory and compensatory adjustments. Secondary outcomes were: the integral electromiographic of the lower limb muscles individually and the displacement of center of pressure (COP) during similar intervals. The primary outcome measures were not significantly different between groups. The magnitude of Σ∫EMG, however, was lower in the post-training compared to pre-training only for the TG during the compensatory adjustment, i.e., the time interval that followed the leg movement. Consequently there was a significant increase in the COP displacement area after training during the dynamic task. In contrast, the COP excursion decreased after training of during the static task. A single session of balance perturbation training may promote changes in postural control strategies in subjects with CAI. Particularly, reducing the compensatory activity of the specific muscle groups and increasing postural sway during dynamic task. Although differences between groups were not observed, these results should stimulate new and more comprehensive studies to investigate the effect of balance perturbation trainings in individuals with CAI. / O presente estudo objetivou investigar os efeitos do treino de equilíbrio mediante perturbações sobre as estratégias de controle postural em indivíduos com instabilidade crônica do tornozelo (ICT). Quarenta e quatro indivíduos com ICT foram aleatorizados no grupo treino (GT; n = 22) e grupo controle (GC; n = 22). O GT realizou uma única sessão de treino de equilíbrio (25 minutos) que envolveu a tarefa de chutar uma bola em apoio unipodal. O GC não recebeu a intervenção. As medidas de desfecho primário e secundário foram testadas durante a tarefa de chutar uma bola em apoio unipodal (dinâmica) e na postura unipodal quieta (estática). O desfecho primário foi à soma da integral eletromiográfica (Σ∫EMG) dos músculos do membro inferior de apoio durante a tarefa dinâmica. As Σ∫EMG foram calculadas nos intervalos de tempo típicos para os ajustes antecipatórios e compensatórios. Os desfechos secundários foram: as integrais eletromiográficas dos músculos analisados individualmente e a área do deslocamento do centro de pressão corporal (COP) durante intervalos de tempo similares. A medida de desfecho primário não foi significante entre os grupos. Entretanto, a magnitude da Σ∫EMG dos músculos posteriores do membro inferior foi menor no pós-treino quando comparado ao pré-treino somente para o GT durante os ajustes compensatórios, i.e., o intervalo de tempo que sucedeu o início do movimento da perna. Consequentemente, houve um aumento significante da área do deslocamento do COP após o treino durante a tarefa dinâmica. Em contraste, a excursão do COP diminuiu após o treino durante a tarefa estática. Uma única sessão de treino de equilíbrio pode promover modificações nas estratégias de controle postural em indivíduos com ICT. Particularmente, diminuindo a atividade compensatória de grupos musculares específicos e aumentando a oscilação postural durante a tarefa dinâmica. Embora não observadas diferenças entre grupos, esses resultados devem impulsionar novos estudos a fim de investigar os efeitos dos treinos que usam perturbações posturais em indivíduos com ICT.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-07T12:38:31Z No. of bitstreams: 1 Julianne Quinellato Louro.pdf: 3594581 bytes, checksum: 773d90a7f78e9d690e9646c39b81213c (MD5) / Made available in DSpace on 2015-12-07T12:38:31Z (GMT). No. of bitstreams: 1 Julianne Quinellato Louro.pdf: 3594581 bytes, checksum: 773d90a7f78e9d690e9646c39b81213c (MD5) Previous issue date: 2014 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Introdução: O equilíbrio, assim como os demais componentes da capacidade física é treinável com a pratica de exercícios físicos, no entanto, há uma falta de padronização do treinamento de equilíbrio. Objetivo: Avaliar a influência de um protocolo específico de exercícios voltados a melhora do equilíbrio em um programa global de atividade física para idosos sobre as variáveis: equilíbrio corporal e força de membros inferiores. Metodologia: Pesquisa do tipo experimental, com a duração de 3 meses. Fizeram parte deste estudo 39 mulheres idosas, sendo 21 no G-Equi e 18 no G-Cont. Para a avaliação foram utilizados questionários para a identificação de possíveis fatores de risco a saúde, variáveis socioeconômicas, nível de atividade física, histórico de quedas, como também, o questionário Mini mental, como exames físicos e testes motores; foram realizadas reavaliações ao final dos 3 meses. Resultados: Após os 3 meses pode-se perceber que o G-Equi apresentou uma diferença significativa entre os resultados dos testes TAFA, o TAFLD, o TAFLE, o TLA e o TC, no entanto, não apresentou para o TU apesar de uma tendência a um melhor desempenho. O G-CONT apresentou diferença significativa para o TLA, tendo as medianas muito próximas para os testes de alcance e TU. Em relação ao resultado da interação entre os grupos pode-se observar que o grupo que realizou a intervenção obteve melhores resultados, tendo diferenças significativas para os testes TAFA, o TAFLD, o TAFLE, e o TC, não apresentando para o TLA e o TU apesar de apresentar melhores resultados nos testes. Para os dados estabilométricos houve uma redução significativa do deslocamento total e da velocidade bidirecional, para o G-Equi com olhos abertos e fechados, e um aumento do deslocamento total e uma redução da velocidade bidirecional para o G-Cont com olhos abertos. Discussão: Os achados revelaram que o treinamento de equilíbrio auxilia na melhora do desempenho do controle postural em idosas, corroborando com a literatura. Conclusão: Os efeitos do treinamento de equilíbrio adicionado em um programa global de exercícios físicos para idosas apresentaram efeitos positivos no equilíbrio corporal e força de membros inferiores, além de evidenciar novas inquietações a respeito da afirmação que uma menor área e oscilação é o que representa maior estabilidade. / Introduction: The balance, as well as other components of physical ability is trainable with the practice of physical activity, however, there is a lack of standardization of balance training. Objective: To evaluate the influence of a specific protocol of exercises aimed at improving balance in a comprehensive physical activity program for seniors on variables: body balance and lower limb strength. Methodology: Survey of experimental type, with a duration of 3 months. This study included 39 elderly women, with 21 in G- Equi and the G- 18 Cont. For the evaluation questionnaires to identify possible risk factors to health, socioeconomic variables, physical activity level, history of falls, as were also used, the Mini Mental questionnaire such as physical exams and testing engines; revaluations were carried out at the end of 3 months. Results: After 3 months it can be seen that the G-Equi showed a significant difference between the results of the tests TAFA the TAFLD the TAFLE, TLA and TC, however, not presented to the TU despite a tendency to better performance. The G- Cont significant difference to TLA, and very close to the testing range and TU medians. Regarding the result of the interaction between the groups can be seen that the group that performed the intervention achieved better results, with significant differences for TAFA tests, TAFLD the TAFLE, and TC, for not presenting the TLA and the TU despite provide better test results. For stabilometric data there was a significant reduction in the total displacement and bidirectional speed for the G- Equi with eyes open and closed, and an increase in total displacement and reduction of bidirectional speed for the G-Cont with open eyes. Discussion: The findings showed that the Balance training helps in improving the performance of postural control in elderly, corroborating with literature. Conclusion: The effects of balance added an overall exercise program for older training had positive effects on body balance and lower limb strength, besides highlighting new concerns regarding the assumption that a shorter swing and is what is most stability.

Stürze sind weltweit die zweithäufigste Ursache für Verletzungen und Todesfälle, und stellen eine massive Belastung für jedes Gesundheitssystem dar. Die meisten Stürze resultieren aus einer fehlgeschlagenen Reaktion auf unerwartete Störungen der Fortbewegung, wie z. B. Stolpern oder Ausrutschen. Unter den vielen bestehenden Interventionsmodellen, die auf das Risiko von Stürzen abzielen, sind bewegungsbasierte Interventionen die kosteneffektivsten. Da bei den meisten Trainingsansätzen die verbesserte Gleichgewichtsfähigkeit nur begrenzt auf untrainierte Situationen übertragen werden kann, müssen Faktoren, wie die Retention und die Dosis-Wirkungs-Beziehung noch ermittelt werden. Des Weiteren sind die Mechanismen, welche den wirksamen Trainingsmaßnahmen zugrunde liegen, noch nicht vollständig erforscht. Training der grundlegenden Mechanismen zur Wiederherstellung des Gleichgewichts (d. h. die Gegenrotation von Körpersegmenten und die Modulation der Unterstützungsfläche) unter instabilen Bedingungen, sowohl unter den trainierten Bedingungen als auch unter unbekannten Bedingungen, verbessert. Darüber hinaus erhöhte dieses Training die kraftgenerierende Kapazität der Muskeln der unteren Extremitäten, was die Ausführung von Gleichgewichtswiederherstellungsreaktionen weiter fördert. Auf der Grundlage dieser vielversprechenden Ergebnisse versucht diese Arbeit, Kenntnisse über die zugrundeliegenden neuromechanischen Anpassungen dieses vorteilhaften Trainingsansatzes, zu liefern. Robustheit kann als Folge verschiedener Modulationen von Muskelsynergien entstehen. Die Wahl der Strategie von Faktoren wie der Ausprägung der Störung, sowie der Ausprägung und Beschränkungen der Bewegungsaufgabe, und der wahrgenommenen Herausforderung für das Gleichgewicht bestimmt wird. Außerdem erhöht das Training auf instabilen Oberflächen nicht per se die mechanischen Anforderungen an die Beinmuskulatur. Die Zunahme der Muskelkraft scheint daher eine Folge neuronaler Anpassungen zu sein. / Falls are the second leading cause of unintentional injury and death worldwide. Among manifold causes, most fall result from a failed response to unexpected perturbations such as a trip or slip. Fall-related injuries can significantly impair quality of life, and their consequences represent a massive burden for any healthcare system. Amid fall prevention paradigms, exercise-based interventions are the most cost-effective. However, most training approaches have a limited transfer to untrained situations and the underlying mechanisms of effective training interventions are still not fully understood. Training the execution of the fundamental balance recovery mechanism (i.e., counterrotating body segments and increasing the base of support) in the presence of perturbations has been reported as an alternative capable of improving balance recovery performance in both trained and non-trained situations and of increasing the force capacity of the lower limb, further promoting the execution of balance recovery reactions. Based on these promising results, this thesis endeavours to provide insight into the fundamental elements promoting the neuromechanical adaptations underpinning the reported advantages of this training paradigm. The analysis of the neuromuscular responses to unstable surfaces during a training session revealed different strategies to cope with perturbations and increase robustness. These different modulations of muscle synergies depend on several factors such as the characteristics of the task and the individual capacities. Moreover, training on unstable surfaces did not increase the mechanical demands upon the leg muscles per-se. Thus the gains in muscle force observed after training the fundamental mechanism of balance recovery onto unstable surfaces are likely a consequence of neural adaptations.

Goal The goal of our pilot study was to evaluate the effect of short-term home based sensomotoric Training program (six weeks) in healthy adults on dynamic postural stability. We used the SOT at baseline and post the training program to evaluate the effect. Methodology The number of participants in this experiment was 10 healthy students, the number of males was 8 and 2 females, they were all between the age of 23 and 40 (mean 29.5 and ± S.D = 5.1 years). The sensory organization test was conducted at baseline and post the home based sensomotoric training program by using the dynamic posturography SMART Balance Master System (NeuroCom). The somatosensory (SOM), visual (VIS), vestibular (VEST), preference (PREF) and composite equilibrium outcome measures of the sensory organization test were evaluated. Results The VIS sensory system has significantly improved also the VEST sensory system with p-value < 0.05. The SOM sensory system had no significant improvement also the PREF sensory system with p-value > 0.05, while the overall composite equilibrium had a significant improvement with p-value > 0.05. Conclusion According to our findings the short-term home based sensomotoric training program has a positive effect in terms of improving the overall dynamic balance in healthy adults. Keywords Dynamic...