Estudo quantitativo, descritivo e retrospectivo de internações hospitalares de pacientes com e sem o diagnóstico de diabetes submetidos a amputação não traumática de extremidades inferiores, no período de 2001 a 2008, em Ribeirão Preto - SP - Brasil. Este estudo teve como objetivos caracterizar as internações hospitalares de pacientes com e sem o diagnóstico de diabetes mellitus submetidos a amputação não traumática de extremidades inferiores segundo sexo, idade, período da internação hospitalar, tipo de atendimento e condições da alta; relacionar as internações hospitalares com as variáveis tipo de alta e atendimento, sexo, idade e tempo de internação, e analisar a tendência das internações hospitalares em Ribeirão Preto-SP, no período de 2001-2008. Utilizaram-se dados de fonte secundária de internações hospitalares, do Sistema de Informações do Centro de Processamento de Dados Hospitalares. Os resultados mostraram que das 2296 internações hospitalares relacionadas ao procedimento de amputação não traumática de extremidades inferiores, 954 (41,6%) tinham o diagnóstico de diabetes mellitus. A maioria (58,7%) é do sexo masculino; idade média de 63,9 anos; 54,8% residiam em Ribeirão Preto-SP e 72,6% receberam assistência hospitalar pelo Sistema Único de Saúde. O tempo de internação hospitalar variou de 0 a 128 dias, média de 9,9 dias. A taxa de reinternações foi de 12,7% e de óbito 7,9%. A tendência de internações hospitalares não obedece a um padrão regular e o modelo de regressão linear ajustado para verificar a existência de tendência não mostrou significância estatística. O teste Qui-quadrado apresentou significância estatística, p-valor < 0,001, para variável sexo e o teste de Mann-Whitney mostrou significância estatística p-valor <0,001 para o tempo de internação hospitalar. Esses resultados apontam a importância de reforçar as ações de educação aos pacientes com diabetes mellitus com vistas à prevenção de amputações como desfecho da doença / Quantitative, descriptive and retrospective study of hospital admissions of patients with and without a diagnosis of diabetes mellitus undergoing non-traumatic amputation of the lower extremities, in the period from 2001 to 2008 in Ribeirão Preto - SP - Brazil. This study aimed to characterize the hospital admissions of patients with and without a diagnosis of diabetes undergoing non-traumatic amputation of lower extremities by sex, age, hospitalization time, type of care and discharge conditions; relate the hospitalizations with the variable type of discharge and attendance, sex, age and hospitalization time and analyze the tendency of hospital admissions in Ribeirão Preto-SP, in the period from 2001 to 2008. Source of data were used secondary hospitalizations, from the National Hospital Data Processing Center Information. Of 2296 hospital admissions related to non-traumatic amputation procedure of the lower extremities, 954 (41.6%) had a diagnosis of diabetes mellitus, most (58.7%) were male, mean age 63.9 years. 54.8% live in Ribeirão Preto-SP, 72.6% received hospital care by SUS, hospital stay ranging from 0 to 128 days, an average of 9.9 days. The readmission rate was 12.7% and 7.9% died. The trend of hospitalizations did not follow a regular pattern and the linear regression model adjusted to check the trend was not statistically significant.The chi-square test was statistically significant, p <0.001, for gender variable and the Mann-Whitney test revealed statistically significant p-value <0.001 for the variable hospital stay. These results show the importance of strengthening education activities to patients with diabetes in order to prevent amputations as the outcome of the disease

O primeiro arabesque é uma pose elementar do ballet clássico e para realiza-la, a bailarina precisa dominar quesitos técnicos que incluem: a manutenção do turnout, o posicionamento do pé de apoio (em meia-ponta ou em ponta), a utlização de sapatilhas específicas e as estratégias de inicação do movimento (arabesque relevé ou arabesque piqué). Assim, o proposito deste estudo foi descrever, avaliar e comparar os padrões cinéticos e cinemáticos do membro inferior da bailarina durante a execução do primeiro arabesque realizado com os quesitos técnicos acima descritos a fim de entender as diferenças e similaridades entre os quesitos avaliados. A amostra foi composta por 26 bailarinas com 13,5±5.02 anos de ballet clássico, as quais realizaram o arabesque piqué e relevé, com sapatilhas de ponta e meiaponta de forma aleatorizada, acompanhados por uma cadência musical adequada. Foram adquiridos: a componente vertical da força reação do solo (FRS) e do centro de pressão (COP), a variação angular das articulações do joelho e tornozelo nos planos sagital, frontal e transversal, além dos momentos articulares sagitais de joelho e tornozelo calculados por dinâmica inversa. As comparações inter-condições foram realizadas por ANOVAs dois fatores [estratégia de iniciação (2) x sapatilha(2)]. A avaliação da componente vertical da FRS mostrou efeito de interação entre sapatilhas e estratégias de iniciação, além de efeitos isolados no aumento da FRS vertical para o arabesque relevé. A avaliação do comportamento do COP mostrou efeito de interação entre todas as variáveis, novamente apontando maiores oscilações em relação ao arabesque relevé. As diferentes sapatilhas não modificaram o comportamento angular e nem o momento articular resultante de joelho e tornozelo, revelando que a estratégia de iniciação é fator determinante no resultado biomecânico final do arabesque / The first arabesque is an elementary pose of classical ballet. To perform it, the dancer needs to lead with technical questions that include: the maintenance of the turnout, the positioning of the support foot (pointe or half-pointe), the iniciation movement strategies (piqué or relevé arabesque). Thus, the purpose of this study was to describe, evaluate and compare the kinetic and kinematic patterns of the lower limb of the dancer during the execution of the first arabesque performed with the technical questions described above in order to understand the differences and similarities between the evaluated items. The sample consisted of 26 dancers with 13.5 ± 5.02 years of classical ballet, who performed the piqué and relevé arabesque, with slippers or pointe shoes, in randomized trails, accompanied by a suitable musical cadence. Were evaluated: the vertical component of the ground reaction force (FRS), the center of pressure distribution (COP), the angular variation of the knee and ankle joints in the sagittal, frontal and transverse planes, and the sagittal knee and ankle joint loads (inverse dynamics). The inter-condition comparisons were performed by ANOVAs two factors [initiation strategy (2) x ballet shoes (2)]. The evaluation of the vertical component of FRS showed an interaction effect between shoes and initiation strategies, as well as isolated effects in the increase of vertical FRS for arabesque relevé. The evaluation of the behavior of the COP showed an interaction effect among all variables, again pointing to greater oscillations in relation to the arabesque relevé. The different ballet shoes (pointe shoe or slipper) did not modify the angular behavior nor the knee and ankle joint loads, revealing that the initiation strategy is a determining factor in the final arabesque biomechanical result

Este estudo avalia a qualidade de vida de sujeitos acometidos por tumores musculoesqueléticos de membros inferiores, submetidos a cirurgias de ressecção, com salvamento de membro ou amputação. A casuística foi composta por 56 sujeitos, avaliados no período de 14 meses (agosto de 2011 a setembro de 2012), que foram divididos em três grupos: 1- 12 amputados; 2- 16 em pós-operatório de salvamento do membro (colocação de endoprótese ou reconstrução biológica); 3- sujeitos saudáveis (sem diagnóstico de câncer), selecionados entre a população em geral, de forma pareada com os outros grupos, segundo sexo, idade, escolaridade e condição socioeconômica. Além do Critério de Classificação Econômica Brasil (2010), foram aplicados dois protocolos de avaliação, um de qualidade de vida (Medical Outcomes Study 36 - Item Short-Form Health Survey - SF-36) e o outro de capacidade funcional (Toronto Extremity Salvage Score - TESS), ambos adaptados culturalmente e validados no Brasil. Os dados foram estatisticamente analisados, conforme preconizado por cada protocolo. Os resultados indicaram que ambos os tipos de abordagem cirúrgica (amputação ou reconstrução) produziram prejuízos na capacidade funcional e na qualidade de vida dos sujeitos acometidos por tumores musculoesqueléticos, quando comparados à população saudável. Diferentemente do que apontaram outros trabalhos internacionais com casuística semelhante, os sujeitos submetidos a amputações apresentaram resultados melhores relacionados à sua capacidade funcional e à qualidade de vida, na maioria dos domínios do SF36 e com relevância estatística (p=0,001) no escore final do TESS, do que aqueles submetidos a técnicas de salvamento de membro. Por fim, é importante analisar a percepção dos sujeitos sobre sua funcionalidade e qualidade de vida, de modo a encontrar caminhos mais adequados no processo de reabilitação desta população. / This study appraises the quality of life of individuals with musculoskeletal tumors in lower extremities, undergoing resection surgeries with extremity salvage or amputation. The casuistry was composed by 56 subjects assessed in the course of 14 months (from August, 2001 to September, 2012), who were divided into 3 groups: 1- 12 amputated; 2- 16 in postsurgical extremity salvage (endoprosthesis implant or biological reconstruction); 3- healthy subjects (without cancer diagnosis), selected from the whole population, paired off with other groups, according to sex, age, schooling and socioeconomic status. Besides the Critério de Classificação Econômica Brasil (2010), two assessment protocols were applied, one about quality of life (Medical Outcomes Study 36 - Item Short-Form Health Survey - SF-36), and the other one about functional capacity (Toronto Extremity Salvage Score - TESS), both culturally adapted and validated in Brazil. The data were statistically analyzed according to what each protocol proclaims. The results revealed that both surgical approach types (amputation or reconstruction) caused harm to the functional capacity and to the quality of life of the subjects suffering from musculoskeletal tumors, when compared to the healthy population. Unlike what other international papers with similar casuistry have shown, the subjects undergoing amputation presented better results related to their functional capacity and quality of life, in the majority of the domains of SF36, with statistical relevance (p=0.001), than those submitted to the techniques of extremity salvage. Finally, it is important to analyze the subjects\' perception on their functionality and quality of life in order to discover the most suitable ways in the process of rehabilitating this population.

Abstract available in the Medicine and Sciences in Sports and Exercise.

PURPOSE: The purpose of the study was to examine the relationship between bat swing velocity and lower extremity strength and power in NCAA Division-I softball athletes. METHODS: Twenty-nine softball athletes (age = 19.8 ± 1.3 years, height = 167.9 ± 6.8 cm, mass = 76.4 ± 18.1 kg) participated in the study. Athletes were tested on unloaded and loaded (20kg) squat and countermovement jump peak force, peak power, and jump height performed on a force platform sampling at 1000Hz. During practice, athletes were tested on swing velocity using a timing gate system. Pearson-product moment zero-order correlations were calculated between bat swing velocity and lower extremity strength and power. Statistical significance was set at p≤0.05. RESULTS: Moderate to strong relationships were observed between swing velocity and peak force at all conditions: SJ 0kg (r= 0.51, p= 0.005), SJ 20kg (r= 0.50, p= 0.006), CMJ 0kg (r= 0.44, p= 0.016), CMJ 20kg (r= 0.43, p= 0.022). Additionally, relationships were observed between swing velocity and peak power at all conditions: SJ 0kg (r= 0.45, p= 0.015), SJ 20kg (r= 0.40, p= 0.031), CMJ 0kg (r= 0.53, p= 0.003), CMJ 20kg (r= 0.45, p= 0.015). No statistically significant relationships were observed between swing velocity and jump height. CONCLUSIONS: Swing velocity was related to lower extremity force and power variables. Considering the known effects of strength training on lower extremity strength and power production, these results provide background for inclusion of lower extremity strength training for the development of swing velocity in NCAA Division-I softball athletes.

Musculoskeletal Injuries are the most common cause of severe long-term pain and physical disability. Push-Ups and Pull-Ups are effective dynamic exercises that mimic high level function activities, such as those used in the military. The model developed allows for researchers to analyze the forces and moments associated with the shoulder, elbow and wrist, to further assess function in military personnel, athletes and the active population. The model also follows the guidelines set forth by the International Society of Biomechanics (ISB).

Computational modeling in the field of biomechanics is becoming increasingly popular and successful in practice for its ability to predict function and provide information that would otherwise be unobtainable. Through the application of these new and constantly improving methods, kinematics and joint contact characteristics in pathological conditions of femoroacetabular impingement (FAI) and total hip arthroplasty (THA) were studied using a lower extremity computational model. Patients presenting with FAI exhibit abnormal contact between the femoral neck and acetabular rim leading to surrounding tissue damage in daily use. THA is the replacement of both the proximal femur and acetabular region of the pelvis and is the most common surgical intervention for degenerative hip disorders. A combination of rigid osteoarticular anatomy and force vectors representing soft tissue structures were used in developing this model. Kinematics produced by healthy models were formally validated with experimental data from Burnfield et al. This healthy model was then modified to emulate the desired morphology of FAI and a THA procedure with a range of combined version (CV) angles. All soft tissue structures were maintained constant for each subsequent model. Data gathered from these models did not provide any significant differences between the kinematics of healthy and FAI but did show a large amount of variation in all THA kinematics including incidents of dislocation with cases of lower CV angles. With the results of these computational studies performed with this model, an increased understanding of hip morphology with regards to STS has been achieved.

No description available.

An examination of throwing was performed in a controlled environment with the aim of identifying the control and order parameters of throwing as proposed by dynamic pattern theory. A pilot study was conducted to test the possibility that the mass of a ball, the distance thrown and the size of targets were the control parameters. Based upon the results of the pilot study, only the distance was manipulated as an independent variable in the principal study.Three-dimensional motion was recorded using three video cameras in the motion analysis laboratory and later analysed using the Peak motion analysis system (software version 5.0, 1992). Sixteen right handed adult females, aged 18 - 35 years, volunteered to participate in the principal study. Subjects were seated with their trunks secured to the back support of an adjustable chair. Ten different targets (0.6 to 6.91 m) were labelled on the floor in front of the subjects. A large area for each target was defined so that the throwing skill of subjects could be ignored as a factor in the research design. Subjects were asked to throw a 0.5 kg ball to ten different distances using their own styles which allowed them to change the pattern of throwing as the distance thrown increased.All 16 subjects selected either an overarm or an underarm throw or employed both patterns. No subject used other patterns of throwing. At the shortest distance, a greater number of subjects selected an underarm throw. As the distance thrown increased, some subjects switched to the overarm throw. At the distance of 3.36 m, there were eight subjects (50%) using each style of throwing. Alteration of the throwing pattern mainly occurred from the underarm to the overarm throw. The results suggest that the distance thrown may be one of the control parameters in the throwing movement.Furthermore, the presence of both throwing patterns for all distances ++ / thrown suggests the presence of a multiple stable state in throwing motions. Trajectories of movement become more uniform as the distance thrown increased. Variability was greatest when subjects threw to the shortest distance for both patterns. These results imply that as the distance thrown increased the stability of both throwing patterns increased. Moreover, these results also imply a phase transition within each throwing pattern, in addition to the phase shift between the pattern of throwing.No result could directly illustrate the period of the transition. This may be due to the fact that phase transition in a multistable system is the result of an external force which drives the system from one state to another. Alteration of the pattern does not occur as a result of loss of the stability of the previous state. Furthermore, the presence of both throwing patterns for all distances thrown suggests the presence of a multiple stable state in throwing motions. Trajectories of movement become more uniform as the distance thrown increased. Variability was greatest when subjects threw to the shortest distance for both patterns. These results imply that as the distance thrown increased the stability of both throwing patterns increased. Moreover, these results also imply a phase transition within each throwing pattern, in addition to the phase shift between the pattern of throwing. No result could directly illustrate the period of the transition. This may be due to the fact that phase transition in a multistable system is the result of an external force which drives the system from one state to another. Alteration of the pattern does not occur as a result of loss of the stability of the previous state. However, some of the results such as the hysteresis graph presented indirect evidence, which could imply a phase shift between throwing patterns. In addition the higher ++ / degrees of joint angle recruitment in the overarm throw suggest that the stability of the system may be better maintained in the overarm throw than in the underarm throw.Alteration of the sub-styles of throwing within the same throwing pattern seemed to occur in between the shortest and the longest distances thrown. Many of the results supported this concept, for example, data related to the relative timing, the total ROM, the releasing joint angles, the trajectories of the movement, the phase plane plots, the angle-angle plots, and relative phase. However, the presence of sub-styles in the underarm throw was not as obvious as was the case for the overarm throw.In conclusion, the changes in motor behaviour during throwing as the distance thrown increased as examined in the present study can be explained by dynamic pattern theory in some aspects. However, further investigation of the stability of the patterns and energy utilisation necessary for the execution of the underarm and overarm throw are essential to determine the most suitable order parameter and to confirm the proposed control parameter (distance thrown) identified.

The work presented in this dissertation was focused on developing an affordable, automated, upper extremity exercise system suitable for individuals with stroke and spinal cord injury (SCI). The three studies presented in this thesis demonstrated the efficacy of functional electrical stimulation-assisted exercise therapy (FES-ET). Furthermore a protocol was developed to implement FES-ET in participants homes via tele-rehabilitation. The protocol included the use of an improved version of the bionic glove, an FES device that enhanced hand grasp and release in SCI individuals in combination with a custom-built workstation that enabled task-oriented rehabilitation in the home setting, supervised over the Internet. In the course of these studies, an objective hand function assessment tool was developed to complement tele-supervised FES-ET and provide the therapist with an unbiased evaluation of the participants impairment. A major section of this dissertation is concerned with the development and testing of a novel exercise workstation named the ReJoyce (Rehabilitation Joystick for Computer Exercise), that can assess hand function electronically. The ReJoyce is an instrumented workstation that provides standardized upper extremity rehabilitation based on ADLs, in the guise of computer games played by manipulating attachments on the device. The three studies presented in this thesis focus on the scientific merits and the logistics of providing tele-supervised FES-ET with this workstation. The first study demonstrated the feasibility of treating and assessing individuals on the workstation who had recently suffered a stroke. The second study explored the relationship between the quantitative assessment of hand function with the workstation and two widely-used clinical tests. The last study involved daily, tele-supervised FES-ET or conventional exercises and therapeutic electrical stimulation (TES), maintained for 6 weeks, with SCI participants spread out over a large geographical area. FES-ET performed with the workstation resulted in statistically significant and clinically important improvements in hand function that were greater than those produced by the more conventional protocol. The results demonstrated the importance of including a range of exercises aimed at improving both strength and dexterity. It is concluded that tele-supervised FES-ET on a standardized workstation is feasible, effective and affordable in the current healthcare settin