Submitted by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-06-29T12:05:10Z No. of bitstreams: 1 TES_VERONICA_BAPTISTA_FRISON_PARCIAL.pdf: 2069499 bytes, checksum: aa6537076bca37dc159c3291dcc3c904 (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-06-29T12:05:22Z (GMT) No. of bitstreams: 1 TES_VERONICA_BAPTISTA_FRISON_PARCIAL.pdf: 2069499 bytes, checksum: aa6537076bca37dc159c3291dcc3c904 (MD5) / Made available in DSpace on 2017-06-29T12:05:34Z (GMT). No. of bitstreams: 1 TES_VERONICA_BAPTISTA_FRISON_PARCIAL.pdf: 2069499 bytes, checksum: aa6537076bca37dc159c3291dcc3c904 (MD5) Previous issue date: 2016-11-11 / Background: Traumatic spinal cord injury (TSCI) is a severe, incapacitating, neurological syndrome that leads to changes in sensitivity, motor function, and the autonomic system of body segments located below the level of injury. Although it is one of the most devastating injuries and poses multiple challenges for the patients, family, and clinicians involved, physical therapy can lead to neurological improvements in patients with TSCI. The purpose of this study was to evaluate the effects of corporal suspension and pendulum exercises (CHORDATA? method) on torque, muscle activation, muscle thickness, and functionality in patients with TSCI. Methods: This study was a randomized, controlled clinical trial including 26 male TSCI patients (in whom injury occurred up to 3 years earlier at the thoracic level; age, 18?65 years). The subjects were categorized into two groups: an intervention group (IG; n = 14) and a control group (CG; n = 12). Before and after a rehabilitation program, which comprised 16 sessions of suspension and pendulum exercises (twice/week, 50 minutes/session), we evaluated the following parameters in each subject: maximal voluntary isometric trunk flexion and extension torques; electromyographic activity of the external oblique, rectus abdominis, and longissimus muscles; muscle thickness of the external oblique, internal oblique, transversus abdominis, rectus abdominis, and multifidus muscles; and functionality (adapted reach test). Mean ? standard deviation values were used to summarise continuous data, which were then compared at the baseline using t-tests. Categorical variables were expressed as counts and percentages. Between-group baseline differences were assessed using chi-square or Fisher?s exact tests, as required. Analysis of covariance, with adjustments for baseline measurements, was conducted to evaluate between-group differences after the 16 exercise sessions. The results were presented as mean ? standard deviation with the estimated adjusted difference between groups, followed by 95% confidence intervals. The study significance level was set at ? = 0?05. Data were analysed using SPSS version 22.0 (SPSS, Inc., Chicago, USA).This trial is registered with Clinical Trials.gov, #NCT02316067. Findings: The CG and IG patients had similar ages (p = 0?93), injury time (p = 0?41), injury level (p = 0?27), injury mechanism (p = 0?22), American Spinal Injury Association (ASIA) scale (p = 0?11), injury type (p = 0?22), and functional reach (p = 0?11). Post-intervention, the IG trunk flexion (58%, p = 0?004) and extension (76%, p = 0?005) torques were higher in the IG than in the CG. Similar between-group differences were observed post-intervention for RA-L absolute RMS values (p = 0?028), RA-R RMS values normalized to the resting state (p = 0?047), and functional reach (p = 0?015). Muscle thickness for all muscles was higher in the IG patients as compared to the CG patients post-intervention (p < 0?002), except for the MULT-R muscle (p = 0?057). Interpretation: Sixteen sessions of suspension and pendulum exercises improved rectus abdominis muscle activation, trunk muscle structure and strength, and reaching capacity in TSCI patients. Thus, this novel, effective rehabilitation method may improve functionality in TSCI patients. / Introdu??o: A les?o medular (LM), especialmente quando instalada de maneira s?bita, ? uma das les?es mais devastadoras, do ponto de vista f?sico e psicol?gico, confrontando paciente, fam?lia e equipe de profissionais com m?ltiplos desafios. N?o obstante, sabe-se que a LM tem potencial de recupera??o, havendo relatos de diversos estudos que demonstram a melhoria do estado neurol?gico. O objetivo deste estudo foi avaliar os efeitos dos exerc?cios com suspens?o e pendula??o corporal (M?todo Chordata?) sobre o torque, a ativa??o muscular, a espessura muscular e a funcionalidade de indiv?duos com les?o medular tor?cica. M?todo: Ensaio cl?nico randomizado e controlado onde foram estudados 26 indiv?duos do sexo masculino com les?o medular tor?cica e idades entre 18 e 65 anos, divididos em grupo interven??o (GI; n=14) e grupo controle (GC; n=12) com no m?ximo tr?s anos de les?o at? a sua inclus?o no estudo. Foram estudados o torque flexor e extensor do tronco durante contra??es volunt?rias m?ximas, a atividade eletromiogr?fica do reto abdominal, obl?quo externo e longu?ssimo do dorso bilateral e a espessura muscular dos m?sculos reto abdominal, obl?quo externo e interno, transverso do abdomen e multifidos bilateral e a funcionalidade por meio do teste do Alcance Funcional adaptado. Os indiv?duos foram avaliados nos per?odos pr? e p?s a um programa composto por 16 sess?es de exerc?cios com M?todo Chordata? com frequ?ncia de duas vezes por semana durante 50 minutos. A m?dia ? desvio padr?o foram usados para avaliar os dados cont?nuos, os quais foram comparados aos dados basais utilizando o teste t de Student. Vari?veis categ?ricas foram expressas por porcentagens e diferen?as entre os grupos no baseline foram avaliadas usando o Qui-quadrado ou teste exato de Fisher. An?lise de covari?ncia com ajustes das medidas no baseline foram utilizadas para avaliar as diferen?as entre os grupos. Os resultados foram apresentados pela m?dia ? desvio com as diferen?as estimadas ajustadas entre os grupos, seguindo intervalo de confian?a de 95%. Os resultados foram considerados estatisticamente significativos quanto P<0,05. O programa SPSS 22.0 (SPSS, Inc., Chicago, USA) foi utilizado para a an?lise dos dados. Este estudo foi registrado no Clinical Trials.gov, #NCT02316067. Resultados: No per?odo pr?-interven??o n?o houve diferen?as significativas entre os grupos em rela??o ?s idades (p = 0?93), tempo de les?o (p = 0?41), n?vel da les?o (p = 0?27), mecanismo da les?o (p = 0?22), escala ASIA (p = 0?11), tipo de les?o (p = 0?22), e Alcance Funcional adaptado (p = 0?11). No per?odo p?sinterven??o, o GI apresentou melhora do torque flexor (58%, p = 0?004) e extensor (76%, p = 0?005) em rela??o ao GC. Diferen?as similares entre os grupos foram observadas no per?odo p?s-interven??o para o reto abdominal esquerdo em seu valor absoluto RMS (p = 0?028), e reto abdominal direito em seu valor RMS normalizado pelo repouso (p = 0?047), e no teste do Alcance Funcional (p = 0?015). A espessura muscular foi maior no GI no periodo p?s-interven??o para todos os grupos estudados quando comparados ao GC (p < 0?002), com exce??o dos mult?fidos direito (p = 0?057). Conclus?o: Dezesseis sess?es de exerc?cios com M?todo Chordata? mostraram melhora na ativa??o do m?sculo reto do abdomen, na estrutura muscular, na for?a e na capacidade de deslocar o tronco ? frente de indiv?duos com les?o medular tor?cica. Esses resultados apontam para evid?ncias em uma nova e efetiva reabilita??o por meio de um M?todo que melhora a funcionalidade desses indiv?duos.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-02-23T00:12:01Z No. of bitstreams: 1 FabianaTenorioGomesDaSilva_DISSERT.pdf: 1184676 bytes, checksum: 9d03e59733d51511aa0eec704401ade1 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-02-26T22:56:55Z (GMT) No. of bitstreams: 1 FabianaTenorioGomesDaSilva_DISSERT.pdf: 1184676 bytes, checksum: 9d03e59733d51511aa0eec704401ade1 (MD5) / Made available in DSpace on 2016-02-26T22:56:55Z (GMT). No. of bitstreams: 1 FabianaTenorioGomesDaSilva_DISSERT.pdf: 1184676 bytes, checksum: 9d03e59733d51511aa0eec704401ade1 (MD5) Previous issue date: 2014-12-08 / Introdu??o: Estimula??o transcraniana por corrente continua (ETCC) tem sido usada em estudos voltados para o tratamento da dor perif?rica cr?nica em pessoas com les?o medular (LM), mas seus efeitos sobre o sistema nervoso auton?mico (SNA) nestes indiv?duos s?o inexistentes e, portanto a necessidade de estudos ? de fundamental import?ncia, pois estes indiv?duos apresentam desbalan?o auton?mico, e sua intensidade ? dependente do grau e n?vel da les?o. Objetivo: Investigar se a ETCC sobre o c?rtex motor prim?rio ir? modular o controle do SNA em pessoas com LM e se estas altera??es s?o dependentes do grau e n?vel de les?o. M?todos: Estudo randomizado, placebo controlado, aplicou ETCC an?dica ou sham sobre o c?rtex motor prim?rio (M1), bilateralmente, com o eletrodo de refer?ncia sendo colocado na protuber?ncia occipital. Dezenove sujeitos (les?o incompleta baixa (n=7), completa baixa (n=9) e completa alta (n=3)) visitaram o laborat?rio tr?s vezes e receberam ETCC ativa ou sham por 13min. A variabilidade da frequ?ncia card?aca (VFC) foi medida antes, durante e p?s-estimula??o. A VFC foi calculada usando a analise espectral batimento a batimento dos intervalos derivados das ondas r-r. Resultados: A ETCC modulou o sistema nervoso auton?mico de forma divergente nos grupos analisados. Nos indiv?duos com LM completa alta a ETCC n?o alterou a VFC. Para os indiv?duos com LM incompleta baixa a ETCC alterou a VFC no sentido de aumentar o simp?tico e reduzir o parassimp?tico e para os indiv?duos com LM completa baixa a ETCC reduziu o simp?tico e aumentou o parassimp?tico. Conclus?o: O presente estudo observou que a ETCC an?dica aplicada sobre o c?rtex motor prim?rio de forma bilateral, conseguiu modular o balan?o do SNA em pessoas com les?o medular e este efeito ? dependente do grau e n?vel de les?o. Palavras-chave: Estimula??o Transcraniana; Sistema nervoso auton?mico; Variabilidade da frequ?ncia card?aca; Les?o medular. / Introduction: Transcranial Direct Current Stimulation (tDCS) has been used in studies for the treatment of chronic pain, but their effects on the autonomic nervous system (ANS) are non-existent. Therefore, the need for studies is of fundamental importance, as these individuals have autonomic imbalance and the intensity of this is dependent on the degree and level of injury. Objective: We investigated the effect of tDCS on the ANS in people with spinal cord injury (SCI) with different degrees and levels of injury. Methods: Randomized, placebo-controlled, double-blind, applied anodal tDCS or sham on the primary motor cortex (M1), bilaterally. The subjects (lower incomplete injury, n = 7; lower complete injury, n = 9; and high complete thoracic injury, n = 3) visited the laboratory three times and received active or sham tDCS for 13min. The heart rate variability (HRV) was measured before, during and after stimulation and analyzed the variables LF, HF and LF / HF. Results: The tDCS modulated the ANS in different ways among the groups. In individuals with SCI high complete thoracic the tDCS did not change the HRV. However, for individuals with SCI low incomplete, tDCS changed the HRV in order to increase sympathetic (LF, p = 0.046) and reduced parasympathetic (HF, p = 0.046). For individuals SCI low complete to tDCS changed the HRV reduction sympathetic (LF, p = 0.017) and increased parasympathetic (HF, p = 0.017). Conclusions: The present study suggests that anodal tDCS applied on the motor cortex bilaterally could modulate the ANS balance in people with spinal cord injury and that this effect is dependent on the degree and level of injury.

Made available in DSpace on 2014-12-17T14:13:33Z (GMT). No. of bitstreams: 1 FabioBR.pdf: 720183 bytes, checksum: 1313bd8e73f55a8bcc3e2f4c1f5d52a7 (MD5) Previous issue date: 2007-12-20 / Despite the observation of an increase in life expectancy in individuals with Spinal cord injury (SCI), it is lower than that of the general population. Studies have shown that affected individuals have a sedentary lifestyle that reflects negatively on health and quality of life. Studies have demonstrated that HDL cholesterol (HDL-C) levels, a high-density lipoprotein and important predictor of cardiovascular disease, are lower in this population exposing these people to a greater incidence of heart disease from atherosclerotic process In the general population, exercise increases HDL-C serum levels, but this phenomenon is not very clear in people with spinal cord injury (SCI). The present study examined the effect of both swimming and wheelchair basketball in the lipid profile of eleven men and seven women with SCI. The subjects included in regular exercise programs showed increases in HDL-C levels and decreases in CT/HDL-C and LDL-C/HDL-C ratios. We found better results mainly in men with lower levels of SCI and in those that sustained exercise intensities above 60% of the heart rate reserve. The duration of training sessions can be an essential factor in these results. The results suggest that both the exercise prescription and the personal characteristics of people with SCI influence changes in the lipid profile mediated through exercise. The elaboration of this work is an attempt to clarify uncertainties about health and the longevity of people with SCI generated in discussion of all members of the interdisciplinary rehabilitation team, especially the physiotherapists, nutritionists, nurses and physicians that contributed considerably in all phases of the research / Apesar do aumento da expectativa de vida das pessoas com les?o medular (LM), esta ? ainda inferior ? da popula??o em geral. Pesquisas demonstram que os indiv?duos acometidos pela LM levam um estilo de vida sedent?rio, o que repercute negativamente na sa?de e na qualidade de vida. Os n?veis do colesterol HDL (HDL-C), cada vez mais se consolidam como importantes preditores de doen?a cardiovascular. Na popula??o com LM, os n?veis destas lipoprote?nas encontram-se significativamente diminu?dos, expondo estes indiv?duos a uma maior incid?ncia de doen?as cardiovasculares ligadas ao processo ateroscler?tico. Estudos na popula??o geral assinalam que o exerc?cio f?sico regular eleva os n?veis s?ricos de HDL-C. Por?m, este fen?meno n?o ? muito claro para aqueles com LM. O presente estudo analisou o efeito da nata??o e do basquetebol em cadeira de rodas no perfillip?dico de 11 homens e sete mulheres com LM inclu?dos em um programa regular de atividade f?sica. Os participantes mostraram modifica??es entre a primeira e a segunda coleta que sugerem aumento nos n?veis de HDL-C e diminui??es nas rela??es CT/HDL-C e LDL-C/HDL-C. Verificaram-se melhores resultados nos homens com LM em n?veis mais baixos e que se submeteram a intensidade de esfor?o superior a 60% da freq??ncia card?aca de reserva. O tempo de dura??o da sess?o de treinamento pode ser uma vari?vel fundamental nestes resultados. Estes resultados sugerem que tanto a prescri??o do exerc?cio quanto caracter?sticas individuais das pessoas com LM influenciam modifica??es no perfil lip?dico mediadas pelo exerc?cio. A elabora??o deste trabalho ? uma tentativa de esclarecer questionamentos relacionados ? sa?de e a longevidade de pessoas com LM gerados atrav?s da discuss?o de todos integrantes da equipe interdisciplinar de reabilita??o, especialmente os fisioterapeutas,nutricionistas,enfermeiros e m?dicos, que contribu?ram consideravelmente em todas as fases da pesquisa