Mitral Valve Prolapse Syndrome (MVPS) is a benign psychosomatic cardiac condition that can severely impair one's quality of life. Symptoms targeted in this study include, atypical chest pain, palpitations, anxiety, panic, and shortness of breath.This study was undertaken to examine the effects of a diaphragmatic breathing intervention on the symptoms and underlying mechanism of dysautonomia in a small group of symptomatic females with MVPS. The intervention was based on both yoga theory and cardiorespiratory empirical studies.Seven of eight participant's completed the nine week study using a single subject multiple baseline design across subjects. Participant's began a respiratory retraining intervention, in a weekly staggered pair start, after the first week of baseline measurement. Respiratory training consisted of a four week training in diaphragmatic breathing with home practice three times a day.Autonomic, behavioral, and cognitive systems were assessed. Dependent measures included State and Trait Anxiety, Anxiety Sensitivity, a Symptom Checklist, and Respiratory Sinus Arrhythmia (RSA). RSA is a current noninvasive measure of parasympathetic tone. Data on thoracic and abdominal respiratory predominance, respiration rate, diet, exercise, and adherence were also gathered.Data were analyzed via visual inspection of trends and phase average changes. Treatment effect sizes were calculated for standardized measures to indicate the meaningfulness of change.Two of the seven participants demonstrated a decrease in total symptom frequencies over the course of intervention. One participant demonstrated a weekly progression of lowered state anxiety scores from baseline through intervention. In terms of phase averages, three participants showed a lowering of state anxiety. All seven participants demonstrated lowered trait anxiety scores from pre to post intervention. Two of the seven participants demonstrated a meaningful pre to post intervention decrease in anxiety sensitivity. Respiratory training was effective in stabilizing abdominal respiration. Results regarding vagal tone could not be determined due to unreliable ECG data.In general, results were poor with several inconsistencies. Adherence rates were low and it did not appear that a therapeutic level of change in respiration rate was achieved. Controlling respiration rate may be a critical factor in the therapeutic effectiveness of respiratory retraining interventions. / Department of Counseling Psychology and Guidance Services

Thesis (M.A.)--University of Toronto, 2005.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-08-09T12:49:12Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) BIBLIOTECA DISSERTAÇÃO VERSÃO PARA BANCA FINAL.pdf: 1603954 bytes, checksum: a9342846df18a37bc890c44c989bd9c1 (MD5) / Made available in DSpace on 2016-08-09T12:49:12Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) BIBLIOTECA DISSERTAÇÃO VERSÃO PARA BANCA FINAL.pdf: 1603954 bytes, checksum: a9342846df18a37bc890c44c989bd9c1 (MD5) Previous issue date: 2015-06-30 / FACEPE / Objetivo: Avaliar a efetividade da utilização de padrões respiratórios no controle da ansiedade materna durante o primeiro período de trabalho de parto. Métodos: Trata-se de um ensaio clínico controlado e randomizado, envolvendo 140 primíparas em trabalho de parto ativo, com idade gestacional entre 37 e 42 semanas e Idade entre 12 e 40 anos. Foram excluídas gestações múltiplas e com feto morto, parturientes em uso de analgesia, que apresentem instabilidade clínica e transtornos psiquiátricos. A ansiedade materna (desfecho primário) foi avaliada através do Inventário de Ansiedade Traço-Estado. A dor, satisfação materna e fadiga (desfechos secundários) foram avaliadas através da escala visual analógica (EVA) e da escala modificada de Borg respectivamente. No grupo intervenção foram realizados os seguintes padrões: respiração lenta e profunda, suspiro com pausa pós-expiratória e retardo expiratório a depender da fase da dilatação e intensidade da contração, enquanto que o grupo controle recebeu os cuidados de rotina do serviço. As mensurações foram feitas durante a admissão, e após 2 horas. Para a comparação das características basais dos dois grupos, foram utilizados para as variáveis categóricas os testes qui-quadrado de associação ou exato de Fisher e para as variáveis contínuas o test “t” de Student ou Mann-Whitney. Para a associação entre a variável independente e dependente foram calculadas as diferenças de média (DM) com os respectivos intervalos de confiança a 95%. Para as variáveis dependentes dicotômicas foi calculado o risco relativo (RR) com intervalos de confiança a 95%. Toda a análise desses dados foi realizada nos softwares Statistical Package for the Social Sciences (SPSS) 20.0 para Windows. Admitiu-se o nível de significância de 5%. Os resultados das associações foram tratados através de uma análise de sensibilidade pelo principio de intenção de tratar em apenas as variáveis respostas que apresentaram valores faltantes. Essa análise estatística de imputação dos dados foi realizada com o software Stata 12.1SE (StataCorp - College Station, Texas 77845 USA). Resultados: Não houve diferença entre os grupos em relação ao grau de ansiedade materna (DM: 0,3; IC95% -4.2 a 4.8 e p: 0.91), dor (DM: 0,0; IC95% -0.8 a 0.7), satisfação (DM:0.9;IC95%: -0.1 a 2.0), fadiga (DM: -0.5;IC95%: -1.4 a 2.5) e a duração do trabalho de parto (DM: 0,28;IC(95% -1,32 a 0,75). Também não houve associação entre o uso dos padrões respiratórios e a via de parto (RR: 0,90;IC95% 0,74 a 1,09) e Apgar de 5 minuto (RR: 1,05; IC95% 0,95 a 1,16). Conclusão: Os resultados mostram que o uso dos padrões respiratórios do tipo respiração lenta e profunda, suspiro pós-expiratório e o retardo expiratório durante o primeiro período do trabalho de parto não se mostraram efetivos no controle da ansiedade, dor, fadiga E SATISFAÇÃO materna. Portanto, a adoção de uma orientação respiratória durante o primeiro período de trabalho de parto deve ser realizada de maneira criteriosa e cautelosa, respeitando-se as preferências da paciente / Objective: The purpose of the study was to evaluate the effectiveness of breathing patterns in controlling maternal anxiety during the first labor period. Methods: This was a randomized controlled trial study, which included 140 primiparous women in active labor, gestational age between 37 and 42 weeks and Age between 12 and 40 years. Multiple pregnancies and dead fetuses were excluded, as well as pregnant women in use of analgesia, who also are clinically unstable and have psychiatric disorders. During admission, a questionnaire was used to identify the sociodemographic and obstetric profile in order to characterize the sample. Maternal anxiety was evaluated with the Trait Anxiety Inventory-State. Pain and maternal satisfaction were evaluated with visual analog scale (VAS) and maternal fatigue was evaluated with modified Borg scale. The groups were randomized into control and intervention (IG = 67; CG = 73). The following breathing standards were used on intervention group: slow, deep breath, sigh with post-expiratory pause and expiratory delay depending on the extension phase and intensity of contraction, while the control group received routine care service. The measurements were made during admission and after 2 hours. Statistical analysis was conducted by comparing the baseline characteristics of the two groups; for categorical variables a chi-square test was used and Fisher exact association, when necessary; for continuous variables, student “t” test was used when these variables were normally distributed, otherwise Mann-Whitney U test was used. For the association between the independent variable and the dependent or predictor variables, mean differences were calculated with their confidence intervals at 95%. For dichotomous dependent variable (mode of delivery, Apgar 5 minutes) relative risk was calculated with confidence intervals at 95%. The Data analysis was performed using Statistical Package for Social Sciences (SPSS) 20.0 software for Windows. The significance level was set of 5%. .Results of the associations were treated through a sensitivity analysis by intention to treat principle with variables that had missing values. Variables of mode of delivery and Apgar 5 minutes were considered the worst case scenario (cesarean delivery and Apgar 5 minutes <7). For the other variables: anxiety, pain, fatigue and satisfaction maternal data were imputed by the MI method (“Multiple imputation”). This statistical analysis imputation of data was performed using Stata software 12.1SE (StataCorp – College Station, Texas 77845 USA). Results: We found a mean difference (MD) between the degree of maternal anxiety of 0.3 (95% CI -4.2 to 4.8 and p: 0.91), pain (MD: 0.0 (95% CI -0.8 to 0.7 and p: 0.94) , satisfaction (MD: 0.9 (95% CI: -0.1 to 2.0 p: 12:07), fatigue (MD: -0.5 (95% CI: -1.4 2.5 p: 0.6) and the labour the first period duration MD: 0.28 (IC (95%) -1.32 to 0.75). With regards to mode of delivery RR:. 0.90 (95% CI 0.74 to 1.09) and the Apgar score of 5 minutes RR: 1.05 (95% CI 0.95 to 1.16). Conclusion: The results show that the use of breathing patterns type slow and deep breathing, post-expiratory breath and the expiratory delay during the first period of labor were not effective in controlling anxiety, pain, satisfaction and maternal fatigue. Therefore, the adoption of a respiratory guidance during the first period of labor should be performed judiciously and cautiously, respecting the preferences of the patient.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-09-19T14:33:47Z No. of bitstreams: 1 joicegomidenolascodeassis.pdf: 1748540 bytes, checksum: 000b00cb65a34f064c405d25a87459fd (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-09-22T15:04:05Z (GMT) No. of bitstreams: 1 joicegomidenolascodeassis.pdf: 1748540 bytes, checksum: 000b00cb65a34f064c405d25a87459fd (MD5) / Made available in DSpace on 2017-09-22T15:04:05Z (GMT). No. of bitstreams: 1 joicegomidenolascodeassis.pdf: 1748540 bytes, checksum: 000b00cb65a34f064c405d25a87459fd (MD5) Previous issue date: 2017-08-02 / Introdução: Temos presenciado um processo de envelhecimento populacional em todo o mundo. O envelhecimento traz consigo prejuízos cardiovasculares e pulmonares, tornando os idosos mais suscetíveis às doenças. Intervenções que objetivam prevenir ou tratar essas doenças têm sido realizadas na prática clínica e, dentre elas, encontra-se o treinamento muscular inspiratório. No entanto, apesar de conhecidos os efeitos benéficos do treinamento muscular inspiratório, a resposta cardiovascular frente a uma sessão de exercício muscular inspiratório (EMI) precisa ser melhor elucidada. Objetivo: Avaliar o efeito durante e após uma sessão de EMI no sistema cardiovascular em idosos. Método: Foram avaliados 16 voluntários, homens, idosos, sedentários e sem diagnóstico de doença cardiovascular ou pulmonar. De forma randomizada, os voluntários participaram de duas sessões experimentais: EMI compostos de 8 séries de dois minutos com 1 minuto de repouso entre as séries e com 40% da pressão inspiratória máxima e outra sessão Sham, realizada da mesma forma, porém sem carga. Foram avaliados pressão arterial (PA) (Finometer Pro); volume sistólico (VS), débito cardíaco (DC), resistência vascular periférica total (RVPT - Finometer Pro); fluxo sanguíneo muscular (Plestimógrafo Hokanson) e frequência cardíaca (FC - ECG). A resistência vascular do antebraço (RVA) foi calculada pela fórmula pressão arterial média dividida pelo fluxo sanguíneo do antebraço e reportada em unidades. A função barorreflexa espontânea foi avaliada pelo método sequencial (domínio do tempo) utilizando o software CardioSeries v2.4. Todas as variáveis foram mensuradas durante e após as sessões, por 60 minutos. Foi registrada PA de 24 horas após as sessões. Para as respostas durante e após sessões (recuperação de 60 minutos), bem como para o comportamento temporal de 24 horas, foi utilizado Anova de dois fatores com post hoc de Bonferroni quando necessário. Para as características hemodinâmicas dos voluntários em repouso antes das sessões experimentais (EMI ou Sham), para os valores de Borg após o exercício (EMI e Sham), assim como para as respostas de 24 horas de vigília e sono, foi realizado teste t de Student para amostras pareadas. Resultados: Durante ambas as sessões experimentais, verificamos elevação da FC, diminuição do VS, aumento pressórico não sustentado, manutenção do DC, RVA e RVPT. Nos 60 minutos de recuperação após ambas as sessões experimentais, verificamos diminuição da FC manutenção do VS, redução do FSM, aumento pressórico e de RVA e RVPT. Após a sessão EMI observamos manutenção do DC e após sessão Sham diminuição do DC. Os índices da função barorreflexa mantiveram-se com os valores inicias. Os valores médios de pressão arterial sistólica e diastólica de 24 horas após ambas as sessões experimentais foram similares. Conclusão: Conclui-se que homens idosos sem doenças cardiovasculares diagnosticadas, durante uma sessão de EMI apresentam aumento da FC, aumento não sustentado da pressão arterial, diminuição do VS e manutenção do DC e RVPT. Conclui-se ainda que idosos, nos primeiros 60 minutos de recuperação após EMI apresentam redução da FC, aumento da pressão arterial, manutenção do VS e DC, elevação da RVPT, diminuição do FSM, aumento da RVA e manutenção dos índices de função barorreflexa. Por fim, conclui-se que não há diferenças na recuperação de 24h da pressão arterial entre as sessões EMI e Sham. / Introduction: The world is experiencing an increase of older population. Aging brings detrimental effects to the heart and lungs, which makes elders more susceptible to diseases. Interventions aiming to prevent or treat those diseases have been conducted in clinical practices, and among them is the inspiratory muscle training (IMT). Despite the known beneficial effects of IMT, the acute cardiovascular response to the inspiratory muscular exercise (IME) needs to be better understood. Objective: To evaluate the effects during and after a session of IME in elderly people. Method: Sixteen volunteers were evaluated, all men, elderly, sedentary, with no previous diagnosis of cardiovascular or pulmonary disease. The volunteers were randomly disposed into two experimental sessions: IME was composed of eight series of two minutes each, with one minute of rest between series, and with 40% of the maximum inspiratory pressure, and then another Sham session which was conducted the same way, but without weights. The evaluated indicators were: blood pressure (BP) (Finometer Pro); stroke volume (SV), cardiac output (CO), total peripheral vascular resistance (TPVR - Finometer Pro); forearm blood flow (FBF - Hokanson Plestimograph) and heart rate (HR - ECG). The forearm vascular resistance (FVR) was calculated through the following formula: mean arterial pressure divided by the forearm blood flow, and reported in units. The spontaneous baroreflex function was evaluated through the sequential method (time domain) using the software CardioSeries v2.4. All variables were measured during the sessions, and during 60 minutes imediatly after the sessions. BP was recorded for 24 hours after the sessions. For the responses during and after sessions (recovery of 60 minutes) as well as for the 24-hour temporal behavior, we used Anova of two factors with post hoc of Bonferroni when necessary. A Student's t-test over the paired sample was conducted for the volunteers' resting hemodynamic characteristics, before the experimental sessions (IME and Sham), for the Borg values after the exercises (IME and Sham), as well as for the 24 hours response. We adopted as effect size, Cohen’s d. Results: During both experimental sessions, we found HR elevation, reduction of SV, a non-sustained rise in BP, and the non-modification of CO, FVR and TPVR values. In the 60 minutes of recovery, for both sessions, the reduction of the HR, non-modification of SV values, reduction of FBF, rise in BP, FVR e TPVR were noticed. In the IME session the non-modification of the CO levels were observed, but in the Sham session they were reduced. In the 60 minutes of recovery the baroreflex function’s indices remained unaltered. The mean values for the systolic and diastolic blood pressure of the 24 hours after both experimental sessions were very similar. Conclusion: Elderly men without previously diagnosed cardiovascular diseases will display raised HR, raised non-sustained BP, reduced SV, and unaltered levels of CO and TPVR during IME sessions. The study also allow us to conclude that elderly men, during the first 60 minutes after an IME session, display reduced HR, raised BP, unaltered levels of SV and CO, elevated TPVR, reduced FBF, raised FVR and unaltered indices of barorrefex function. Finally, through this study, we are able to learn that there is no difference in the 24 hour BP recovery between the sessions where IME and Sham were conducted.

Orientador: Desanka Dragosavac / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T23:09:28Z (GMT). No. of bitstreams: 1 Matheus_GabrielaBertolini_M.pdf: 1394514 bytes, checksum: 814cccdf11d81a381fe2058341b4254c (MD5) Previous issue date: 2012 / Resumo: Justificativa e Objetivo: Complicações pulmonares estão entre as maiores causas de morbidade e mortalidade do pós-operatório (PO) de cirurgia cardíaca. As causas são diversas e estão relacionadas à disfunção pulmonar causada pela circulação extracorpórea, esternotomia, uso da artéria mamária interna, drenos torácicos e à dor no período pós-operatório. Ocorre disfunção da musculatura respiratória acompanhada de perda da força muscular e redução das capacidades e volumes pulmonares. Nesse contexto, técnicas fisioterapêuticas têm por objetivo a reexpansão e melhora da capacidade pulmonar além da manutenção ou ganho de força muscular respiratória, e podem contribuir para prevenção e tratamento de tais complicações. O objetivo do presente estudo foi avaliar o efeito do treinamento muscular inspiratório em pacientes submetidos à cirurgia de revascularização do miocárdio, com o uso do Threshold® IMT no período pós-operatório. Método: Quarenta e sete pacientes submetidos à revascularização eletiva do miocárdio através de esternotomia mediana foram randomizados por sorteio prévio à avaliação pré-operatória e divididos em dois grupos: Grupo Estudo (23 pacientes, cinco mulheres e 18 homens) e Grupo Controle (24 pacientes, oito mulheres e 16 homens), com idade média de 61,83±8,61 e 66,33±10,20 respectivamente. Ambos os grupos foram submetidos ao protocolo de rotina para atendimento fisioterápico em pós-operatório de cirurgia cardíaca. Apenas o grupo estudo foi submetido a um protocolo de treinamento inspiratório com o uso do Threshold® IMT com carga de 40% da Pimáx obtida no 1º PO durante três dias. Foram mensuradas e comparadas às pressões respiratórias máximas (Pimáx e Pemáx), VC (Volume Corrente), CV (Capacidade Vital) e Pico de Fluxo Expiratório (Pico de Fluxo Expiratório) no Pré-OP, PO1 e PO3. Resultados: Observou-se redução significativa em todas as variáveis mensuradas no 1º dia de pós-operatório quando comparadas ao pré-operatório, nos dois grupos estudados. Pimáx (p<0,0001), Pemáx (p<0,0001), VC GE (p<0,0004) e GC (p<0,0001), CV GE (p<0,0001) e GC (p<0,0001) e Pico de Fluxo Expiratório (p<0,0001). No PO3, o GE apresentou, em comparação ao GC, maior valor de CV, (GE 1230,4±477,86ml vs GC 919,17±394,47ml, p=0,0222) e VC (GE 608,09±178,24ml vs GC 506,96±168,31ml, p=0,0490). Conclusão: Pacientes submetidos à cirurgia cardíaca sofrem redução da capacidade ventilatória e da força muscular respiratória após a cirurgia. O treinamento muscular realizado foi eficaz em recuperar o volume corrente e a capacidade vital no terceiro dia de pós-operatório, no grupo treinado. Não houve diferença na incidência de complicações respiratórias e o grupo treinado apresentou menor tempo de internação na unidade coronariana / Abstract: Background and Objectives: Pulmonary complications are the major causes of morbidity and mortality of postoperative period (PO) of cardiac surgery. The causes are diverse and are related to pulmonary dysfunction caused by cardiopulmonary bypass, sternotomy, internal mammary artery use, chest drains, and pain in the postoperative period. There may be dysfunction of the respiratory muscles accompanied by loss of muscle strength and reduction of capacity and lung volumes. In this context, physical therapy techniques are designed to re-expansion and improve lung capacity and maintenance or gain of respiratory muscle strength and may contribute to prevention and treatment of such complications. The aim of this study was to evaluate the effect of inspiratory muscle training in patients undergoing coronary artery bypass grafting, using the Threshold® IMT in the postoperative period. Method: Forty-seven patients undergoing elective coronary artery bypass grafting via median sternotomy were randomized by lot prior to the preoperative evaluation, and divided into two groups: Study Group (SG) (23 patients, 5 women and 18 men) and Control group (CG) (24 patients, 8 women and 16 men) and with mean age of 61.83±8.61 and 66.33±10.20 respectively. Both groups were subjected to routine protocol for the physical therapy treatment in post-cardiac surgery. However, only the study group was subjected to inspiratory training protocol using Threshold IMT® with a load of 40% of MIP obtained in first postoperative day for three days. Maximal respiratory pressures (MIP and MEP), VT (Tidal Volume), VC (Vital Capacity) and Peak Flow in the Pre-OP, PO1 and PO3 were measured and compared. Results: There was a significant reduction in all variables measured on PO1 compared to preoperative values in both groups, MIP (p<0.0001), MEP (p<0.0001), VT SG (p<0.0004) and CG (p<0.0001), VC SG (p<0.0001) and CG (p<0.0001) and Peak Flow (p<0.0001). At PO3, SG presented higher value of VT, SG 1230.4±477.86ml vs CG 919.17±394.47ml (p=0.0222) and VC SG 608.09±178.24ml vs CG 506.96±168.31ml (p=0.0490). There were differences between SG and CG for VT (p=0.0490) and VC (p=0.0222) in PO3. Conclusion: Patients undergoing cardiac surgery experience reduced ventilatory capacity and respiratory muscle strength after surgery. Muscle training was performed to retrieve the effective tidal volume and vital capacity in the third postoperative day of the trained group. There was no difference in the incidence of respiratory complications and the trained group had shorter hospitalization in the coronary unit / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Bakgrund Vården rör sig mot en mer patientcentrerad syn. Detta reflekteras i den fysioterapeutiska behandlingen där man kan se holistiska modaliteter göra ett inträde. En metod utanför skolmedicinens ramar som samlat uppmärksamhet det senaste decenniet är Wim Hof-Metoden. Den bygger på köldterapi, andningsövning och meditation. För var av dessa delar finns stöd, och lovande forskning har utförts på metoden i sig. Dock så är stödet fortfarande begränsat. Syfte Undersöka om utövandet av Wim Hof-metoden under tre veckor ger effekter på livskvalitet och självskattad hälsa. Metod Deltagare rekryterades via mail och annonser på social media. 8 individer utav 14 intresserade (57%) avlade medgivande och påbörjade intervention. Under tre veckor utförde de dagligen Wim Hof-Metoden. En mätning av livskvalitet med formuläret RAND-36 gjordes vid baseline och efter intervention. Så även med en generell hälsoskattning ur formuläret EQ-5L. Resultat Av 8 deltagare genomförde 5 (62,5%) studien. Således skedde ett bortfall på 3 individer (37,5 %). Efter intervention kunde man se parametriska tendenser till en ökad livskvalitet enligt RAND-36, där sammanlagt medelvärde för domänerna vitalitet, psykiskt välbefinnande och allmän hälsa ökade från 61,6 till 71,0 poäng. För generell hälsa enligt barometern från EQ-5L ökade medelvärdet från 75,4 till 85,6 enheter. Diskussion Resultatet indikerar tendenser till ökad livskvalitet och generell hälsa. Dock var antalet deltagare för lågt för statistisk analys, och gruppens förväntningar höga - vilket sänker datans tillförlitlighet. Forskning av större omfattning och med högre kvalitet behövs för att dra slutsatser kring metodens verkan.

The present study trained three adult male stutterers to increase speech fluency using relaxed breathing and a-x; biofeedback. A one group time-series design with 2 treatments was used. After an initial baseline phase (A) all 3 subjects received a relaxed breathing procedure (B), followed by a combined procedure featuring relaxed breathing and EMG biofeedback (BC). Results indicated that after 8 sessions stuttering was reduced by 19.1% from baseline levels across the 3 subjects. Despite these promising results , however, methodological questions in the baseline phase make conclusions regarding a clear relationship between the variables tentative.

Respiratory-swallow coordination (RSC) is critical for safe and efficient swallowing. In healthy adults, RSC is most frequently characterized by an exhale-swallow-exhale pattern initiated within the mid-lung volume range with a respiratory pause of approximately one second. This combination in RSC behaviors is thought to be most optimal for swallowing-related bolus clearance and airway protection. Deviations from these RSC behaviors are observed at disproportionately higher rates in people with Parkinson’s disease (PD) when compared to non-dysphagic, healthy adults. However, little is known about which variables influence RSC in PD, if the RSC behaviors that are most optimal for swallowing in healthy adults are also most optimal for swallowing in PD, and if respiratory-swallow training can be used to successfully rehabilitate suboptimal RSC, swallowing safety, and swallowing efficiency in PD. This dissertation document includes a series of four studies that address these important clinical research questions. Chapter 1 will begin by reviewing the current body of literature as it relates to dysphagia in PD, RSC in healthy adults and PD, respiratory-swallow training as a skill-based treatment for dysphagia rehabilitation, and motor learning considerations for respiratory-swallow skill training in PD. Chapter 2 will be used to examine the relationships among RSC with patient- and swallowing-specific factors in PD. Chapter 2 will also be used to assess the influence of RSC behaviors on measures of swallowing safety (penetration-aspiration) and swallowing efficiency (pharyngeal residue) in PD. Chapter 3 will then evaluate the effects of verbal cueing on RSC in PD as a method of determining if RSC is stimulable for rehabilitative change. Chapter 4 will explore the effects of respiratory-swallow training on swallowing safety and efficiency rehabilitation in a person with mid-stage PD and severe dysphagia within the context of a single-subject experimental design. Chapter 5 will then examine the effects of respiratory-swallow training on dysphagia and RSC rehabilitation within the context of a cohort study. Chapter 5 will also be used to compare the effects of constant versus variable practice in order to explore how principles of motor learning can be used to enhance respiratory-swallow training outcomes. This document will then conclude by synthesizing the results from Chapters 2-5 and by discussing directions for future research.

Orientador: Henrique Luiz Monteiro / Banca: Angelina Zanesco / Banca: Elisa Harumi Kozasa / Resumo: A prática de exercícios de Yoga pode proporcionar inúmeros benefícios à saúde, atuando como terapia complementar em patologias como a hipertensão arterial. O objetivo deste estudo foi descrever os efeitos de uma combinação de seqüências de práticas de yoga realizadas durante quatro meses sobre os parâmetros hemodinâmicos (frequência cardíaca e pressão arterial), bioquímicos (concentração plasmática de colesterol e suas frações, triglicerídeos e glicemia) e a percepção da qualidade de vida em pacientes portadores de hipertensão arterial. Trinta e três voluntários (64±9 anos) participaram do estudo. Três homens e 14 mulheres (68±7 anos) realizaram aulas de yoga durante quatro meses (GY), enquanto dois homens e 14 mulheres (58±8 anos) constituíram o grupo controle (GC), sem intervenção. Os alunos do GY compareceram nas aulas três vezes por semana e realizaram exercícios de yoga em uma seqüência composta por alongamentos, exercícios de respiração, posturas do yoga, relaxamento e meditação. Durante o experimento foram observadas a pressão arterial sistólica e diastólica, frequência cardíaca e respiratória, perfil bioquímico (glicemia de jejum, colesterol total, LDL-colesterol, HDL-colesterol e triglicerídeos) e qualidade de vida (SF-36). Os dados foram submetidos a análise estatística para verificar a normalidade (Shapiro Wilk), a diferença entre os grupos (Mann-Whitney) e entre momentos pré e pós intervenção (Wilcoxon); a variação ao longo dos meses (ANOVA para medidas repetidas) e correlação entre valores iniciais e diferenças finais (Sperman). Foi adotado nível de significância de p<0,05. Os resultados apontaram melhora significativa no valor médio de pressão arterial sistólica final do GY comparado com o valor inicial (113,8±7,7 versus 120,7±7,9; p<0,05), enquanto a pressão arterial diastólica não apresentou diferenças... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The practice of Yoga exercises can provide numerous health benefits, acting as a complementary therapy in diseases like hypertension. The aim of this study was to describe the effects of a combination of yoga sequences carried out during four months, on the hemodynamic parameters (heart rate and blood pressure), biochemical (plasma cholesterol concentrations and its fractions, triglycerides and glucose) and the perception of quality of life in hypertension patients. Thirty-three volunteers (64 ± 9 years) participated in the study. Three men and 14 women (68 ± 7 years) conducted yoga classes for four months (YG), while two men and 14 women (58 ± 8 years) constituted the control group (CG) without intervention. The yoga goers attended the YG classes three times a week and did yoga exercises in a sequence consisting of stretching, breathing exercises, yoga postures, relaxation and meditation. During the experiment it was measured systolic and diastolic blood pressure, heart rate and respiratory rate, biochemical profile (fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides) and quality of life (SF-36). Data were subjected to statistical analysis to ensure normality (Shapiro Wilk), the difference between the groups (Mann-Whitney test) and between pre and post intervention (Wilcoxon), the variation over the months (repeated measures ANOVA) and correlation differences between initial and final values (Spearman). The significance level was p <0.05. The results showed significant improvement in the average of final systolic blood pressure compared with the initial value (113.8 ± 7.7 versus 120.7 ± 7.9, p <0.05) in the YG, while diastolic blood pressure did not showed differences between times. In the CG the initial and final mean of systolic and diastolic blood pressure showed no difference statistically significant. Regarding the biochemical profile, we found... (Complete abstract click electronic access below / Mestre