Dubens dugno raumenų aktyvinimas yra labai specifinis: dėl minėtų raumenų lokalizacijos pacientams yra sudėtinga įsivaizduoti, suprasti bei pajausti jų susitraukimą ir atliekamą funkciją. Kitas apsunkinantis veiksnys yra tas, kad daugumai pacientų dubens dugno raumenys asocijuojasi su intymumu ir lytiniu gyvenimu, ir jie vengia bei gėdisi spręsti šią problemą. Kita vertus, specialistams, dirbantiems su asmenimis, nelaikančiais šlapimo, sudėtinga įvertinti teisingą dubens dugno raumenų susitraukimą bei atliekamų pratimų efektyvumą. Šie apribojimai ir skatino ieškoti alternatyvių šlapimo nelaikymo bei dubens dugno raumenų disfunkcijų sprendimo būdų, įrodant egzistuojančius tiriamųjų raumenų funkcinius ryšius, jų poveikį funkciniams vyrų rodikliams po radikalios prostatektomijos. Šiame darbe taikant atskirų raumenų grupių aktyvinimą ir vertinant tiriamų raumenų fizinius rodiklius buvo ieškoma funkcinių sąsajų tarp dubens dugno, diafragmos ir liemens raumenų. Tikimasi, kad šio tyrimo rezultatai, išvados ir parengtos praktinės klinikinės rekomendacijos bus naudingos visiems reabilitacijos srities specialistams įvairiuose paciento gydymo etapuose, gydytojams urologams bei ginekologams, tiesiogiai susiduriančiais su asmenimis, turinčiais dubens dugno raumenų disfunkcijas. Sudarytos namų programos padės pacientams spręsti ne tik su šlapimo nelaikymu susijusias problemas, bet ir bus profilaktinė priemonė asmenims, esantiems padidintos rizikos grupėje. / Activation of pelvic floor muscles is extremely specific: due to the localization of the mentioned muscles, it is difficult for the patients to visualize, understand and feel the contraction and performed function. Another puzzling factor is the fact that many patients associate pelvic floor muscles with intimacy and sexual life and, therefore, try to avoid and are embarrassed to solve the problem. On the other hand, specialists working with patients with urinary incontinence find it difficult to evaluate a proper contraction of pelvic floor muscles and efficiency of performed exercises. These limitations have stimulated search for alternative solutions for urinary incontinence and pelvic floor muscles dysfunctions with the aim to prove existing functional relations between the studied muscles as well as their influence on the functional characteristics in men after radical prostatectomy. This particular thesis was aimed at finding functional associations between pelvic floor, diaphragm, and trunk muscles by applying activation of separate muscle groups and evaluating physical parameters of the studied muscles. It is expected that the results, conclusions, and prepared practical clinical recommendations of this research will be of use for all rehabilitation specialists in various stages of treatment, as well as for doctors urologists and gynaecologists, who deal directly with individuals possessing pelvic floor muscle dysfunctions.

This thesis addresses the organisation of drive to human upper airway and inspiratory pump muscles. The characterisation of single motor unit activity is important as the discharge frequency or timing of discharge of each motor unit directly reflects the output of single motoneurones. Thus, the firing properties of a population of motor units is indicative of the neural drive to the motoneurone pool. The experiments presented in Chapter 2 measured the recruitment time of five inspiratory pump muscles (diaphragm, scalene, second parasternal intercostal, and third and fifth dorsal external intercostal muscles) during normal quiet breathing and quantified the timing and magnitude of drive reaching each muscle. Chapter 3 examined the EMG activity of a major upper airway muscle (the genioglossus). The single motor units of the genioglossus display activity that can be grouped into six types based on its association or lack of association with respiration. The types of activity are termed: Inspiratory Phasic, Inspiratory Tonic, Expiratory Phasic, Expiratory Tonic, Tonic, and Tonic Other. A new method is presented in Chapter 4 to illustrate large amounts of data from single motor units recorded from respiratory muscles in a concise manner. This single figure displays for each motor unit, the recruitment time and firing frequency, the peak discharge frequency and its time, and the derecruitment time and its frequency. This method, termed the time-and-frequency plot, is used to demonstrate differences in behaviour between populations of diaphragm (Chapter 2) and genioglossus (Chapter 3) motoneurones. In Chapter 5, genioglossus activity during quiet breathing is compared between a group of patients with severe OSA and healthy control subjects. The distribution of central drive is identical between the OSA and control subjects with the same proportion of the six types of motor unit activity in both groups. However, there are alterations in the onset time of Inspiratory Phasic and Inspiratory Tonic motor units in OSA subjects and their peak discharge rates are also altered. Single motor unit action potentials in OSA subjects showed an increased area. This suggests the presence of neurogenic changes and may provide a pathophysiological explanation for the increased multiunit electromyographic activity reported in OSA subjects during wakefulness.

The results from computer simulations of the gas-dynamic processes that occur during and after the rupture of diaphragms within shock tubes and expansion tubes are presented. A two-dimensional and axisymmetric finite-volume code that solves the unsteady Euler equations for inviscid compressible flow, was used to perform the simulations. The flow domains were represented as unstructured meshes of triangular cells and solution-adaptive remeshing was used to focus computational effort in regions where the flow-field gradients were high. The ability of the code to produce accurate solutions to the Euler equations was verified by examining the following test cases: supersonic vortex flow between two arcs, an ideal shock tube, and supersonic flow over a cone. The ideal shock tube problem was studied in detail, in particular the shock speed. The computed shock speed was accurate when the initial pressure ratio was low. When the initial pressure ratio was high the ow was dificult to resolve because of the large density ratio at the contact surface where significant numerical diffusion occurred. However, solution- adaptive remeshing was used to control the error and reasonable estimates for the shock speed were obtained. The code was used to perform multi-dimensional simulations of the gradual opening of a primary diaphragm within a shock tube. The development of the flow, in particular the contact surface was examined and found to be strongly dependent on the initial pressure ratio across the diaphragm. For high initial pressure ratios across the diaphragm, previous experiments have shown that the measured shock speed can exceed the shock speed predicted by one- dimensional models. The shock speeds computed via the present multi-dimensional simulation were higher than those estimated by previous one-dimensional models and were closer to the experimental measurements. This indicates that multi- dimensional ow effects were partly responsible for the relatively high shock speeds measured in the experiments. The code also has the ability to simulate two-dimensional fluid-structure interac- tions. To achieve this the Euler equations are solved for a general moving frame of reference. Mesh management during a simulation is important. This includes the ability to automatically generate a new mesh when the current mesh becomes distorted (due to the motion of the structures) and the transfer of the solution from the old mesh to the new. The shock induced rupture of thin diaphragms was examined. Previous one dimen- sional models are awed because they do not simultaneously consider the diaphragm mass and allow the upstream gas to penetrate the diaphragm mass. Two multi- dimensional models which allow the upstream gas to penetrate are described. The first model assumes the diaphragm vaporises immediately after the arrival of the incident shock. The second model assumes the diaphragm shatters into a number of pieces which can be treated as rigid bodies. The results from both models are compared with experimental data.

This dissertation presents an implant model of natural latex to be used on partial canine diaphragm replacement. The implant could be used in cases of diaphragmatic hernias, or significant loss of the diaphragm integrity disabling its reconstitution. For such, seven different membranes had been tested, six of them had been produced experimentally and one is a commercial model in use, for several applications. Firstly, the biocompatibility was evaluated in rabbits. Membranes were implanted between the cutaneous and the oblique abdominal sternum muscles by the means of a surgical procedure and the reactions of hipersensibility and rejection were evaluated. Mechanical traction tests were performed in control membranes to measure deformation and resistance. Results pointed that the membranes are incompatible, and not able to substitute muscular sheath in rabbits. New tests were made in dogs. The membranes were regrouped and three of then were tested in a similar way, in abdomen straight muscle. Two membranes were selected, for use in the canine diaphragm, and being tested in front a control group, without membrane. A rectangular defect (4 cm in length and 3 cm in width) was created in the diaphragm muscle, which was substituted, in groups 1 and 2, by the implantation of the corresponding latex membrane. The animals were evaluated radiographically, by blood count, video-surgery, and histopathology study. The results showed that the membrane made of natural latex, vulcanizants mixture and formic acid, were efficient in the correction of the diaphragm defect, promoting repair and local neovascularization, capable to keep the respiratory function and movements of the diaphragm without causing rejection during the evaluated period. / Esta dissertação apresenta um modelo de implante à base de látex natural para a substituição parcial de diafragma canino. Este poderá ser utilizado em casos de hérnias diafragmáticas, ou situações em que haja perda da integridade do diafragma, impossibilitando sua reconstituição. Para tal, foram testadas sete diferentes membranas, das quais seis foram produzidas experimentalmente e um modelo comercial em uso no mercado, para diferentes fins. Foram realizados testes de resistência para verificar a deformação e elasticidade das membranas. A biocompatibilidade foi avaliada primeiramente em coelhos, nos quais as membranas foram fixadas através de procedimento cirúrgico na bainha do músculo oblíquo externo do abdome e avaliadas quanto a reações de hipersensibilidade e rejeição. Os resultados contra-indicam o uso destas em coelhos. Novos testes foram realizados em cães. As membranas foram reagrupadas e três delas testadas de maneira semelhante, no músculo reto do abdome verificando-se biocompatibilidade com essa espécie. Foram selecionadas duas membranas para a utilização no diafragma canino, sendo testadas frente a um grupo controle, sem membrana. Foi criado um defeito retangular no músculo diafragma, com 4 cm de comprimento e 3 cm de largura, que no grupo 1 e 2 foi substituído pelo implante de membrana de látex correspondente. A avaliação foi feita através de análise do hemograma, por estudo radiográfico, por vídeocirurgia e estudo histopatológico. Pode-se inferir dos resultados que a membrana constituída de: látex natural, mistura vulcanizante e ácido fórmico, foi eficiente na correção do defeito no diafragma canino, promovendo a reparação tecidual e neovascularização local, capaz de manter a função do diafragma e movimentos respiratórios sem causar rejeição durante o período de avaliação.

Made available in DSpace on 2016-06-02T20:18:14Z (GMT). No. of bitstreams: 1 3818.pdf: 2689353 bytes, checksum: 843410f25e482425b98ea3159b6b4b1e (MD5) Previous issue date: 2011-05-16 / Universidade Federal de Sao Carlos / Obesity, considered a worldwide epidemic, causes serious damage to health, especially to the respiratory function. These changes are caused by the extra adipose tissue in the chest wall and abdominal cavity of obese patients, which impairs the movement of the diaphragm and compress the lungs. In view of the limitations of conservative treatments, surgical interventions have been recommended as treatment of choice. This procedure can be carried out by laparoscopy or laparotomy (open). Because the pulmonary function is already in a compromised state before the operation in obese individuals, the choice for the surgical procedure to be used should consider the impact on respiration, thereby reducing the risk of developing postoperative pulmonary complications. Thus, the goal of the first study was to compare the effect on lung function and on pain of bariatric surgery performed by laparoscopy and laparotomy. Participated in this study 26 obese women who underwent bariatric surgery by laparoscopy (LG, n = 13) or laparotomy (OG, n = 13). The respiratory evaluation was performed in the preoperative period and on the second postoperative day by spirometry and other tests that evaluated respiratory muscle strength and diaphragmatic mobility. Pain was assessed by visual analogue scale on the second postoperative day. The results indicate that although there was no difference in the incidence of pulmonary complications and hospital stay between the groups, bariatric surgery performed by laparoscopy caused less pain and less impairment of pulmonary function in the postoperative period. Knowing the degree of impairment of pulmonary function in the postoperative period of bariatric surgery, especially by lapartomy, some strategies have been studied in order to attenuate these changes, such as preoperative inspiratory muscle training (IMT). Therefore, the objective of the second study was to determine whether the preoperative IMT in open bariatric surgery, is able to mitigate the impact of surgical trauma on muscle strength, in lung volumes and diaphragmatic mobility. We evaluated 32 obese women who underwent open bariatric surgery and randomized into two groups: one group that underwent preoperative IMT (IMT group - n = 15) or who received only conventional treatment (control group - n = 17). Tests were conducted to evaluate the respiratory muscle strength, lung volume and diaphragmatic excursion before the training period, after the training period and the first postoperative day. According to the results, could be verified that preoperative IMT improves inspiratory muscle strength (MIP) and attenuates the negative impact of open bariatric surgery to this variable, although it seems not to influence the MEP, the lung volume and diaphragmatic excursion. Additionally, studies have suggested that weight loss can reverse many changes in lung function caused by obesity. Therefore, in the third and final study, we evaluated the lung function of some patients (n = 14) of first and second study, sedentary, 1 year after bariatric surgery by means of spirometry and respiratory muscle strength tests. From the results we found that weight loss induced by bariatric surgery provides an improvement in ventilatory mechanics, increased lung volumes and respiratory endurance (MVV). However, there was also a reduction in respiratory muscle strength, probably caused by loss of lean body mass and reducing the burden breathing after weight loss. / A obesidade, considerada uma epidemia mundial atualmente, causa sérios danos à saúde em geral e especialmente à função respiratória. Essas alterações são causadas pelo grande depósito de gordura na região do tórax e abdômen dos obesos, que prejudica a movimentação do músculo diafragma, levando à redução do espaço intratorácico ocupado pelos pulmões. Nos casos de obesidade mórbida, a cirurgia tem sido recomendada como tratamento de escolha, já que o tratamento conservador é, na maioria das vezes, falho. Tal procedimento pode ser realizado por videolaparoscopia ou por laparotomia. Por se tratar de indivíduos que já apresentam prejuízos à função pulmonar no período pré-operatório, a escolha da via de acesso cirúrgico em obesos deve também levar em consideração aquela técnica que tenha menor repercussão na função pulmonar, reduzindo assim o risco de aparecimento de complicações pulmonares no período pós-operatório. Sendo assim, o objetivo do primeiro estudo foi comparar a repercussão na função pulmonar e na dor da cirurgia bariátrica realizada por videolaparoscopia e por laparotomia. Participaram desse estudo 26 mulheres obesas, que realizaram a cirurgia bariátrica por videolaparoscopia (GV, n=13) ou laparotomia (GL, n=13). A avaliação respiratória foi realizada no período pré-operatório e no segundo dia de pós-operatório por meio da espirometria, da manovacuometria e da mobilidade diafragmática. A dor foi avaliada pela escala visual analógica no segundo dia de pós-operatório. Os resultados obtidos indicam que apesar de não ter havido diferença na incidência de complicações pulmonares e no tempo de internação hospitalar entre os grupos, a cirurgia bariátrica realizada por videolaparoscopia causou menos dor e menor prejuízo à função pulmonar no período pós-operatório. Sabendo do grau de comprometimento da função pulmonar no período pós-operatório de cirurgia bariátrica, especialmente por laparotomia, algumas estratégias têm sido estudadas com o objetivo de atenuar essas alterações, tais como o treinamento muscular inspiratório (TMI) no pré-operatório. Sendo assim, o objetivo do segundo estudo foi verificar se a fisioterapia respiratória, por meio do TMI, realizada no préoperatório de cirurgia bariátrica aberta, é capaz de atenuar o impacto do trauma cirúrgico na força muscular respiratória, nos volumes pulmonares e na mobilidade diafragmática. Foram avaliadas 32 mulheres obesas submetidas à cirurgia bariátrica aberta e randomizadas em dois grupos: um grupo que realizou TMI no pré-operatório (grupo TMI - n=15) e outro que recebeu apenas o tratamento convencional (grupo controle n=17). Foram realizados testes para avaliação da força muscular respiratória, dos volumes pulmonares e da mobilidade diafragmática antes do período de treinamento, após o período de treinamento e no primeiro dia de pós-operatório. De acordo com os resultados pôde-se verificar que o TMI pré-operatório aumenta a força muscular inspiratória (PImax) e atenua o impacto negativo da cirurgia bariátrica aberta para essa variável, apesar de parecer não influenciar a PEmax, os volumes pulmonares e a mobilidade diafragmática. Adicionalmente, estudos têm sugerido que a perda de peso pode reverter muitas alterações da função pulmonar causadas pela obesidade. Por isso, no terceiro e último estudo, foi avaliada a função pulmonar de parte das voluntárias (n=14) do primeiro e segundo estudo, sedentárias, após 1 ano da realização da cirurgia bariátrica, por meio dos testes de espirometria e manovacuometria. A partir dos resultados observamos que a perda de peso induzida pela cirurgia bariátrica promove uma melhora na mecânica ventilatória, aumento dos volumes pulmonares e da endurance respiratória (VVM). No entanto, houve também uma redução na força dos músculos respiratórios, provavelmente causada pela perda de massa magra e redução da sobrecarga respiratória após a perda de peso.

La diminution de la force et l'exacerbation de la fatigue neuromusculaire sont fortement impliquées dans l'altération des capacités fonctionnelles, de la tolérance à l'effort et du pronostic de patients porteurs de pathologies chroniques variées. Ces altérations peuvent trouver leurs origines dans des atteintes primaires de la fonction neuromusculaire et/ou des atteintes secondaires causées par exemple, par une diminution de l'activité spontanée favorisée par une pathologie chronique. Ainsi, la faiblesse et la fatigabilité musculaire sont des symptômes très fréquemment rapportés dans les maladies neuromusculaires (myopathies/neuropathies d'origine génétique ou acquise), les pathologies impliquant le système cardiovasculaire (insuffisance cardiaque) et/ou respiratoire (broncho-pneumopathie chronique obstructive (BPCO)). Ces symptômes sont aussi fréquemment associés aux syndromes idiopathiques de douleurs chroniques accompagnées d'anomalies de la nociception (syndrome fibromyalgique). Le développement d'outils d'évaluation bien tolérés et fiables de la force, de l'endurance et de la fatigue neuromusculaire est d'une importance cruciale pour approfondir la compréhension des mécanismes physiopathologiques et pour disposer de critères de jugement de qualité dans le cadre d'études observationnelles et interventionnelles. Dans ce contexte, la stimulation artificielle électrique s'est révélée être un outil performant pour évaluer in situ la fonction musculaire chez l'humain au repos et au cours de l'exercice. Plus spécifiquement, la stimulation magnétique des troncs nerveux périphériques a montré des prédispositions intéressantes pour l'évaluation de la fonction des muscles locomoteurs et respiratoires dans le cadre clinique. Au cours de ce travail, nous avons développé des outils d'évaluation de la force, de l'endurance et de la fatigue neuromusculaire en utilisant la neurostimulation magnétique et des protocoles d'exercice potentiellement applicables chez le patient. Nous avons étudié leurs capacités à détecter des différences liées au sexe, l'âge et au statut d'entrainement. Dans un second temps, nous avons appliqué nos évaluations dans le cadre de maladies neuromusculaires et de syndromes douloureux chroniques. Chez le patient BPCO, nous avons étudié les phénomènes de fatigue des muscles respiratoires et locomoteurs, leur impact sur la réponse à l'effort ainsi que leurs relations entre eux et avec les symptômes perçus. Chez ces patients, nous avons recherché les effets d'un entraiment d'une prise en charge combinant un entrainement des muscles locomoteurs et un entrainement des muscles respiratoires sur ces paramètres. / Strength loss and enhanced neuromuscular fatigue are major contributing factors of impaired functional capacities, exercise tolerance and prognosis in patients with various chronic diseases. These alterations can rely on primary deficiencies of neuromuscular function and/or secondary impairments caused by decreased spontaneous physical activity promoted by a chronic disease. Consequently, muscle weakness and enhanced fatigability are frequently reported symptoms in neuromuscular (inherited or noninherited myopathies/neuropathies), cardiovascular (chronic cardiac failure) and respiratory diseases (chronic obstructive pulmonary disease (COPD)) and idiopathic painful syndromes associated with alteration of nociception (fibromyalgia syndrome). The development of reliable and well-tolerated evaluations of muscle strength, endurance and fatigue is of major interest to better understand the physiopathology of the diseases and to provide relevant outcomes for observational or interventional studies. Artificially muscular electrical stimulation has been recognized as a valuable tool for noninvasive assessments of neuromuscular function at rest and during exercise in human. Recently, magnetic stimulation showed interesting skills to assess both peripheral and respiratory muscles in the clinical field. During this work, we developed tools to assess muscle strength, endurance and fatigue using magnetic neurostimulation and exercise protocols usable in patients. We studied its ability to detect differences related to sex, age and training status. Then we used these procedures in neuromuscular diseases and fibromyalgia syndrome. In COPD patients, we assessed respiratory and locomotor muscle fatigue and studied how these phenomena impact on exercise response and perceived symptoms. In these patients, we also assessed the combined effects of locomotor and respiratory muscle training on these parameters.

Submitted by SAMUEL ANDRE POMPEO null (samuel.pompeo@terra.com.br) on 2016-08-26T22:57:31Z No. of bitstreams: 1 disserta versão final.pdf: 1455241 bytes, checksum: e7d80b4415cf358530962f2f4f703690 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-08-30T14:25:46Z (GMT) No. of bitstreams: 1 pompeo_sa_me_ia.pdf: 1455241 bytes, checksum: e7d80b4415cf358530962f2f4f703690 (MD5) / Made available in DSpace on 2016-08-30T14:25:46Z (GMT). No. of bitstreams: 1 pompeo_sa_me_ia.pdf: 1455241 bytes, checksum: e7d80b4415cf358530962f2f4f703690 (MD5) Previous issue date: 2016-06-29 / Esta pesquisa tem o objetivo de identificar a importância e os benefícios do estudo dirigido para a sonoridade nos instrumentos de sopro. O intuito desse tipo de estudo é obter melhor desempenho performático, podendo ser aplicado tanto por saxofonistas quanto por outros instrumentistas de sopro. A investigação também apurou a origem das técnicas relacionadas à sonoridade, notadamente à respiração. Os procedimentos metodológicos concentraram-se em descrever a apostila pedagógica elaborada pelo pesquisador, voltada para o estudo da sonoridade; realizar um levantamento bibliográfico dos métodos e livros destinados aos instrumentistas de sopro, principalmente aos saxofonistas; encontrar subsídios teóricos envolvendo as questões ligadas à respiração e à emissão de ar; realizar uma pesquisa-ação com alunos da Escola Municipal de Música; e entrevistar músicos profissionais ligados ao mundo popular e erudito para checagem do conhecimento relativo aos estudos e informações sobre respiração e emissão sonora. Isso possibilitou traçar um panorama do entendimento da sonoridade que músicos e professores possuem e da abordagem dada por autores de livros e métodos ao estudo da sonoridade – cabe ressaltar que os músicos e professores participantes deste estudo são, particularmente, da cidade de São Paulo. Os resultados mostram que as técnicas de respiração usadas pelos instrumentistas de sopro possuem sua origem nas técnicas do canto. Além disso, constatou-se que a adoção da prática específica e contínua para o desenvolvimento da sonoridade apresenta benefícios para o praticante, como ganho de volume e uniformidade de timbre em todas as regiões do instrumento. A dissertação contempla, além do capítulo Introdutório e das Conclusões Finais, quatro capítulos que descrevem a metodologia pedagógica empregada pelo pesquisador para o estudo da sonoridade, a fundamentação teórica da pesquisa, a pesquisa-ação e a discussão dos resultados. / This research aims to identify the importance and benefits of a study routine focused on sonority in wind instruments. The objective of that kind of study is to obtain better performance development and could be adopted by saxophonists and other wind players as well. The investigation also found out the origins of sonority techniques, notably the ones related to the breathing process. The research method concentrates on describing the pedagogical sonority workbook developed by this researcher; reviewing workbooks and handbooks that target wind musicians, especially saxophonists; finding theoretical basis encompassing questions related to breathing process and air emission; conducting an action research with students from Escola Municipal de Música; and interviewing professional musicians, both popular and classical, to verify their knowledge regarding study practices, breathing information and sound emission. That allowed me to delineate a general perspective regarding the comprehension by musicians and instructors and the approach given by book authors to sonority studies—it is worth mentioning that musicians and instructors participants in this study are mainly from São Paulo. The results show that breathing techniques used by wind performers originate from singing techniques. Additionally, results demonstrate that the adoption of the practice dedicated to sonority development offers benefits to the practioner, as volume enhancement and timbre uniformity through all instrument regions. This dissertation includes, besides Introduction and Final Conclusions, four chapters that describe simultaneously the pedagogy applied by this researcher in studying sonority, the theoretical foundation of the research, the action research and the results discussion.

Made available in DSpace on 2016-12-12T17:32:56Z (GMT). No. of bitstreams: 1 BRUNA DA CUNHA ESTIMA LEAL.pdf: 18856650 bytes, checksum: b16dc862bd361990ba33fe1a48ff311f (MD5) Previous issue date: 2014-05-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Fluoroscopy is considered the most reliable method for evaluating diaphragmatic mobility, yet most existing methods for measuring diaphragmatic mobility using fluoroscopy are complex. Thus, this study proposes a new way to measure diaphragmatic mobility. The objective of this study was to evaluate the validity and reliability of the evaluation method of diaphragmatic motion using fluoroscopy by digital radiography; and to compare diaphragmatic mobility on the right side to the left side and diaphragmatic mobility between male and female subjects. 26 adults between 20 and 47 were evaluated, according to the parameters: anthropometry, pulmonary function test and diaphragm mobility. The evaluation of diaphragm mobility by means of the fluoroscopy by digital radiography method was conducted randomly by two raters (A and B). Concurrent validity was analyzed by Pearson coefficient correlation (r) ando the intraclass correlation coefficient (ICC[2,1]) and with confidence interval of 95% (CI) to evaluate the relationship and agreement between digital diaphragmatic mobility (MDdig) and distance (MDdist). Intra and interraters reliability of the diaphragmatic motion measurement was determined using the ICC and with CI 95%. The Bland & Altman plot for better visualization of the data was used. The high correlation was found between DMdig and DMdist for mobility of the right hemidiaphragm (RH) (r = 0.97, p = 0.00) and the left (LH) (r = 0.88, p = 0.00). There was good reliability for mobility in both hemidiaphragms (RH: ICC[2,1] = 0.98, CI95% = 0.96 to 0.99; LF: ICC[2,1] = 0.93, CI95% = 0.84 to 0.97). The first assessment of interrater reliability showed a high correlation for right hemidiaphragm mobility and moderate correlation for left hemidiaphragm mobility (ICC[2,1 = 0.89, CI95% =0.76 to 0.95 and ICC[2,1 = 0.73, CI95% = 0.48 to 0.87 respectively). The second assessment, showed a good reliability for right and left hemidiaphragm mobility for rater A (ICC[2,1 = 0.83, CI95% = 0.66 to 0.92 and ICC[2,1 = 0.86, CI95% = 0.70 to 0.93, respectively) and for the rater B (ICC[2,1 = 0.89, CI95% = 0.76 to 0.95) (ICC[2,1 = 0.83, CI95% = 0.65 to 0.92) respectively. There was no statistically significant difference in the mobility measured between the right and left hemidiaphragms, and between mobility measured in men and women. The evaluation of diaphragmatic motion using fluoroscopy for digital radiography proved to be a valid and reliable method. / A fluoroscopia é considerada o método mais confiável para avaliar a mobilidade diafragmática, contudo a maioria dos métodos existentes para mensurar a mobilidade diafragmática por meio da fluoroscopia é complexo. Diante disso, este estudo propõe uma nova forma para mensurar a mobilidade diafragmática. O objetivo do estudo foi avaliar a validade e a confiabilidade de um novo método de avaliação da mobilidade diafragmática utilizando a fluoroscopia por radiografia digital e comparar a mobilidade diafragmática do lado direito com a do lado esquerdo e a mobilidade diafragmática entre os indivíduos do sexo masculino e feminino. Foram avaliados 26 adultos, entre 20 e 47 anos, segundo os parâmetros: antropometria, prova de função pulmonar e mobilidade do diafragma. A avaliação da mobilidade diafragmática por meio do método da fluoroscopia por radiografia digital foi realizada, de forma aleatória, por dois observadores (A e B). A validade concorrente foi analisada pelo coeficiente de correlação de Perason (r) e pelo coeficiente de correlação intraclasse (CCI) e com intervalo de confiança de 95% (IC) para avaliar a relação e a concordância entre as mobilidades diafragmática digital (MDdig) e distância(MDdist). A confiabilidade inter e intra-observadores da mensuração da mobilidade diafragmática foi determinada pelo CCI e com IC 95%. Foi utilizada a disposição gráfica de Bland-Altman para melhor visualização dos dados. Foi encontrada alta correlação entre a MDdig e a MDdist (r= 0,97, p= 0.00) e boa confiabilidade na mobilidade dos hemidiafragmas dos dois métodos (Hemiafragma direito: CCI[2,1] = 0,98, IC95% = 0,96-0,99; Hemidiafragma esquerdo: CCI[2,1] = 0,93, IC95% = 0,84-0,97). Houve boa confiabilidade interobservador na mobilidade do hemidiafragma direito (CCI = 0,89, IC95% = 0,76-0,95) e moderada no esquerdo (CCI = 0,73, IC95% = 0,48-0,87) na 1ª avaliação. Na 2ª avaliação, houve boa confiabilidade nos hemidiafragmas direito (CCI = 0,84, IC95% = 0,68-0,93) e esquerdo (CCI = 0,78, IC95% = 0,56-0,89), respectivamente. Houve boa confiabilidade intraobservador na mobilidade dos hemidiafragmas direito (CCI = 0,83, IC95% = 0,66-0,92) e esquerdo (CCI = 0,86, IC95% = 0,70- 0,93) para o observador A e para o observador B (CCI = 0,89, IC95% = 0,76-0,95) e (CCI = 0,83, IC95% = 0,65-0,92), respectivamente. Não houve diferença estatisticamente significante para a mobilidade mensurada entre os hemidiafragmas direito e esquerdo, e entre a mobilidade aferida nos homens e nas mulheres. A avaliação da mobilidade diafragmática utilizando a fluoroscopia por radiografia digital demonstrou ser um método válido e confiável.

Made available in DSpace on 2016-12-12T17:32:58Z (GMT). No. of bitstreams: 1 Resumo Flavia Rocha.pdf: 127670 bytes, checksum: 67a3e0c099b86b40e0b2f9b985006264 (MD5) Previous issue date: 2015-06-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Patients with Chronic Obstructive Pulmonary Disease (COPD) have reduced diaphragmatic mobility (DM) and ventilatory reserve (VR). DM has demonstrated relationship with lung function, air trapping, lung hyperinflation, distance covered on the six-minute walk test (6MWT), mortality and dyspnea in patients with COPD. Similarly, VR is correlated with exercise capacity, disease severity and dyspnea. However, there are no studies investigating whether static hyperinflation and VR influence DM in patients with COPD. Objective: To investigate the influence of static hyperinflation and VR on DM in patients with COPD, as well as to compare the anthropometric characteristics, spirometric data, DM, dyspnea and submaximal exercise capacity among VR> 11l / minute (l / min) and VR <11l / min groups. Methods: This is a cross-sectional study that evaluated 42 patients with COPD. On the first day, patients underwent the following assessments: anthropometry, vital signs, spirometry and dyspnea. On the second day, patients performed the six-minute walk test and after one week, DM was evaluated by radiographic method considering the distance between maximal inspiration and expiration (DMdist). The sample was divided into VR > 11l / min and VR <11l / min groups for the comparison of anthropometric characteristics, spirometric data, DM, dyspnea and submaximal exercise capacity. Statistical analysis: Data normality was tested by Shapiro Wilk. According to data distribution, parametric or nonparametric test was used. Simple linear regression found the influence of lung hyperinflation and VR on DM. The Pearson s linear correlation coefficient correlated DM with static hyperinflation and VR. The t test for independent samples or the Mann Whitney U test was used to compare VR> 11l / min and VR <11l / min groups. Significance level of 5% (p <0.05). Results: Static hyperinflation influenced DM by 46%, i.e., to increase 1 liter in inspiratory capacity (IC), DM increased 1.56 cm (p 0.001, F = 34.55), while VR influenced only 25%, and for every increase of 1 l / min of VR, DM increased by 0.38 mm (p = 0.001, F =13.78). By comparing VR >11l / min and VR < 11l / min groups, it was found that in the VR <11l / min group, patients were older (69 ± 5 versus 61 ± 8 years) and showed reduction in the following variables: IC, forced expiratory volume in the first second (FEV1), DM, worse submaximal exercise capacity and increased dyspnea. Conclusions: Static hyperinflation and VR influence DM. However, hyperinflation exerts greater influence on DM compared to VR. In addition, patients with COPD who have VR <11l / min are more committed both in the lung function and DM as in submaximal exercise capacity and dyspnea when compared to patients with COPD with who have VR> 11l / min. / Pacientes com doença pulmonar obstrutiva crônica (DPOC) apresentam redução da mobilidade diafragmática (MD) e da reserva ventilatória (RV). A MD tem demonstrado relação com a função pulmonar, aprisionamento de ar, hiperinsuflação pulmonar, distância percorrida no teste da caminhada de seis minutos (TC6min), mortalidade e dispneia em pacientes com DPOC. Da mesma forma, a RV apresenta relação com a capacidade de exercício, gravidade da doença e dispneia. Contudo não há estudos que investiguem se a RV influencia a MD em pacientes com DPOC. Objetivo: Investigar a influência da RV na MD em pacientes com DPOC, bem como comparar as características antropométricas, função pulmonar, MD, dispneia e capacidade de exercício entre os grupos RV >11litros/minuto (l/min) e RV <11l/min. Métodos: Tratou-se de um estudo com delineamento transversal, no qual foram avaliados 42 pacientes com DPOC de ambos os sexos e idade média de 64±8 anos. No primeiro dia, os pacientes foram submetidos às seguintes avaliações: antropometria, sinais vitais, espirometria e dispneia. No segundo dia foram submetidos ao TC6min, e após uma semana foi avaliada a MD pelo método radiográfico da distância entre a inspiração e expiração máxima (MDdist). A amostra foi subdividida nos grupos RV >11l/min e RV <11l/min para comparação das características antropométricas, dados espirométricos, MD, dispneia e capacidade submáxima de exercício. Análise estatística: A normalidade dos dados foi testada pelo teste de Shapiro Wilk. Conforme a distribuição dos dados utilizou-se um teste paramétrico ou não paramétrico. O coeficiente de correlação linear de Pearson correlacionou a RV com a MD. O teste de regressão linear simples verificou a influência da RV na MD. O teste t de Student para amostras independentes ou o teste U de Mann Whitney foi usado para comparação dos grupos RV >11l/min e RV <11l/min. Adotou-se nível de significância de 5% (p < 0,05). Resultados: A RV influenciou em 25% a MD, sendo que para cada aumento de 1 l/min da RV, a MD aumentou em 0,38 mm (p=0,001, F=13,78). Ao comparar os grupos RV &#707; 11l/min e RV &#706; 11l/min, constatou-se que no grupo RV &#706;11l/min os pacientes eram mais idosos (69±5 versus 61±8 anos) e apresentaram menores valores das variáveis: CI, volume expiratório forçado no primeiro segundo (VEF1), MD, pior capacidade submáxima de exercício e maior dispneia. Conclusões: A RV influencia a MD. Além disso, pacientes com DPOC que apresentaram RV <11l/min são mais comprometidos tanto na função pulmonar e MD quanto na capacidade submáxima de exercício e dispneia, em comparação a pacientes com DPOC que apresentam RV >11l/min.

Made available in DSpace on 2016-12-12T17:32:59Z (GMT). No. of bitstreams: 1 MARCIA APARECIDA.pdf: 19818 bytes, checksum: fde0efd28e1ebe42f0eecea0aa7e4433 (MD5) Previous issue date: 2014-09-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In chronic obstructive pulmonary disease (COPD) there is reduction in diaphragmatic mobility, increased anteroposterior diameter of the chest, horizontalization of the ribs, increased intercostal spaces and increased thoracic kyphosis. However, it is still unclear if patients with Increase in the angle of the thoracic curvature determinant of thoracic kyphosis, have lower diaphragmatic mobility. Objective: To verify whether patients with COPD and with thoracic hyperkyphosis have lower diaphragmatic mobility when compared with patients with COPD without thoracic kyphosis. Methods: Were evaluated 34 patients with COPD who underwent the following assessments: anthropometry, pulmonary function, respiratory muscle strength, thoracic curvature angle and diaphragmatic mobility. Data distribution was analyzed by the Shapiro-Wilk test. For comparison between groups, we used the Student t test or the Mann Whitney and correlation between variables, Pearson or Spearman correlation test, with the significance level set at 5%. Results: In the COPD group with thoracic hyperkyphosis the diaphragmatic mobility was statistically lower when compared with the COPD group without thoracic hyperkyphosis (34.76 ± 14.18 e 53.37 ± 18.27 mm respectively, p= 0.002). The angle of the thoracic curvature was correlated to diaphragmatic mobility (r = -0.47; p = 0.005). When comparing men and women with COPD, there was a significant difference in relation to body mass (79.41 ± 12.52 and 66.74 ± 14.96, respectively, p = 0.011), stature (170.33 ± 5.93 and 160.81 ± 5.48, respectively, p <0.001) and the angle of curvature of the thoracic kyphosis (52.06 ± 8.91 and 60.22 ± 12.68, respectively, p = 0.036). There was no significant difference in diaphragmatic mobility between men and women (47.89 ± 18.62 and 39.77 ± 18.35, respectively, p = 0.210). Conclusion: Thoracic kyphosis is a change in the postural alignment of the patient with COPD may potentiate decreased functionality of the diaphragm. / Pacientes com doença pulmonar obstrutiva crônica (DPOC) frequentemente apresentam redução da mobilidade diafragmática, aumento no diâmetro anteroposterior da caixa torácica, horizontalização das costelas, aumento dos espaços intercostais e aumento na curvatura da cifose torácica. Contudo, ainda não está claro se pacientes com aumento no ângulo da curvatura torácica, determinante da hipercifose torácica, apresentam menor mobilidade diafragmática. Objetivo: Verificar se os pacientes com DPOC e hipercifose torácica apresentam menor mobilidade diafragmática quando comparados com os pacientes com DPOC sem hipercifose torácica. Métodos: Foram avaliados 34 pacientes com DPOC que realizaram as seguintes avaliações: antropometria, função pulmonar, força muscular respiratória, mensuração do ângulo da curvatura torácica e mobilidade diafragmática. A distribuição dos dados foi analisada pelo teste Shapiro-Wilk. Para a comparação entre os grupos, utilizou-se o teste t de Student ou Mann Whitney e para correlação entre as variáveis utilizou-se coeficiente de correlação Pearson ou Spearman, com nível de significância de 5%. Resultados: No grupo de pacientes com DPOC e hipercifose torácica a mobilidade diafragmática foi estatisticamente menor quando comparada com o grupo DPOC sem hipercifose torácica (34,76 ± 14,18 e 53,37 ± 18,27 mm respectivamente, p= 0,002). O ângulo da curvatura torácica correlacionou-se com a mobilidade diafragmática (r = -0,47; p = 0,005). Quando comparado homens e mulheres do grupo DPOC, houve diferença significante em relação à massa corporal (79,41 ± 12,52 e 66,74 ± 14,96, respectivamente, p = 0,011), na estatura (170,33 ± 5,93 e 160,81 ± 5,48, respectivamente, p < 0,001) e no ângulo da curvatura da cifose torácica (52,06 ± 8,91 e 60,22 ± 12,68, respectivamente, p = 0,036). Não houve diferença significante na mobilidade diafragmática entre homens e mulheres (47,89 ± 18,62 e 39,77 ± 18,35, respectivamente, p = 0,210). Conclusão: A hipercifose torácica é uma alteração do alinhamento postural do paciente com DPOC que pode potencializar a redução da funcionalidade do diafragma.