Introduction: The participation profile of patients with chronic obstructive pulmonary disease (COPD) in pulmonary rehabilitation (PR) and the effectiveness of a video-based home exercise programme (VBHEP) were investigated using various research methods. Methods: The content analysis of the Move-On-Up exercise video against NICE guidelines and published research was performed. The video was evaluated for its suitability for use in VBHEP through focus groups involving UK population of patients with COPD and respiratory clinicians. Using the data from the content analysis and the focus groups, questionnaire items were synthesised for a national survey of both patients and clinicians. A study examined the relationship between participation in outpatient PR and patient measures of depression (Brief Assessment Depression Card), social support (Duke Social Support Index), multidimensional health locus of control (MHLC) and COPD severity (Medical Research Council dyspnea score). A randomised control trial (RCT) evaluated the effect of combining VBHEP and conventional outpatient PR on walking ability and PR benefit maintenance. The intervention arm received VBHEP concurrently with outpatient PR, while the control arm received only outpatient PR. Outcome measures included: the endurance shuttle walk test (ESWT), quality of life (QoL) (St George's Respiratory Questionnaire- SGRQ), MHLC and a modified Follick's activity diary. Measures were taken before PR, at the fourth and eighth weeks of PR and at six months post-PR. Focus groups were conducted between six and 20 months post-PR to evaluate patients' experience of and adherence to the use of VBHEP. Results: Critical review of 46 RCTs aided evaluation of the video demonstrating that the video content was consistent with both NICE recommendations and published research. The six focus groups that were part of the initial evaluation of the video involved 14 patients and 14 clinicians. The national survey generated responses from 60 patients and 62 clinicians; between 79 and 100% of respondents in each domain of the questionnaire indicated that the video is suitable for use. Fifty-one patients completed the study investigating the profile of patients participating in PR. The results indicated that depression has a moderate and negative statistically significant association with the uptake of PR (p < 0.05). Fifty-seven patients participated in the RCT [mean age 66.51 years (SD 9.96), mean FEV1% predicted 54.51% (SD 10.47)]. The results indicated that the use of VBHEP with outpatient PR has no significant additive effect in improving or maintaining the benefits of walking ability following PR (p<0.05). Seven patients participated in the follow-up focus groups where findings suggested that patients were still participating in VBHEP up to 20 months after it was first prescribed, though the frequency of its use appeared to diminish after PR ended. Conclusion: The Move-On-Up exercise video is suitable for VBHEP in patients with COPD. Patients with COPD and depression are less likely to take up a referral to PR compared to those without depression. The use of VBHEP concurrently with PR has no additive effect in improving or maintaining benefits of walking ability following PR. Adverse social circumstances and disease severity reduce the duration of participation in VBHEP.

Title: Comparison of performance of pediatric patients with diagnosis of cystic fibrosis before and after a lung transplantation. Objectives: To compare selected parameters of pediatric patients as an index of physical condition in time before and 1 year after transplantation. To compare a group of patients that undergone longtherm intensive physiotherapeutic treatment before transplantation with group of patients that did not using spirometric parameters FVC, FEV1 and BMI. To compare subjective signs of dyspnea between these groups using selected questionnaires. Methods: This theses was attended by 15 probands (7 boys and 8 girls) in age between 12 and 18 years. The data were collected by using selected dyspnea questionares and by using hospital documentation files taking place at the Motol University Hospital. The data were statistically analysed using Jamovi programme, mostly using correlations and paired T- test, and graphically analysed by using MS Excel programme. Results: We found changes of spirometric parameters in the level of significance of p < 0,001 (FEV1) and p = 0,003 (FVC) after transplantation in comparison with time before transplantation. Group that undergone longtherm intensive physiotherapeutic treatment before lung transplantation showed more physiological spirometric values...

Orientador: Vitor Engrácia Valenti / Resumo: A função cardiovascular autonômica é prejudicada durante o tratamento e a recuperação da leucemia. Nesse contexto, a variabilidade da frequência cardíaca (VFC) é uma medida não invasiva que descreve as oscilações dos intervalos entre batimentos cardíacos consecutivos (intervalos RR) influenciados pelo sistema nervoso autônomo. Revisamos a literatura mostrando as alterações da VFC em indivíduos com leucemia. Os artigos foram eleitos nas cinco bases de dados eletrônicas: Medline, Base de Dados de Evidência Fisioterapêutica – PEDro, Ensaios Clínicos Cochrane, Scientific Electronic Library Online - SciELO e Excerpta Medica dataBASE - EMBASE. Nove estudos foram incluídos. Indivíduos submetidos a tratamento para leucemia e sobreviventes reduziram a VFC, significando diminuição do controle vagal da freqüência cardíaca. A VFC é reduzida em indivíduos com leucemia que evoluem para a neuropatia secundária à quimioterapia, acompanhada de disfunção cardíaca. Nossa revisão reforça o uso da VFC para avaliar a função autonômica e colaborar para direcionar o tratamento em indivíduos com leucemia. Considerando que o controle autonômico da frequência cardíaca (FC) está alterado no câncer e que o esforço respiratório subsequente pode sobrecarregar o coração, nosso objetivo foi avaliar o efeito de uma sessão de fisioterapia respiratória na regulação autonômica da FC em crianças com leucemia, a fim de confirmar sua segurança. Foram selecionadas crianças com leucemia (n = 8) e crianças saudáveis (... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Autonomic cardiovascular function is impaired during leukemia treatment and recovery. In this context, heart rate variability (HRV) is a noninvasive measure describing the oscillations of the intervals between consecutive heart beats (RR intervals) influenced by the autonomic nervous system. We reviewed the literature showing HRV changes in individuals with leukemia. The articles were chosen from five electronic databases: Medline, Physiotherapeutic Evidence Database - PEDro, Cochrane Clinical Trials, Scientific Electronic Library Online - SciELO and Excerpta Medica dataBASE - EMBASE. Nine studies were included. Subjects undergoing treatment for leukemia and survivors reduced HRV, meaning decreased vagal control of heart rate. HRV is reduced in individuals with leukemia who progress to neuropathy secondary to chemotherapy, accompanied by cardiac dysfunction. Our review reinforces the use of HRV to assess autonomic function and collaborate to direct treatment in individuals with leukemia. Considering that autonomic control of heart rate (HR) is altered in cancer and that subsequent breathing effort can overload the heart, our objective was to evaluate the effect of a respiratory physiotherapy session on the autonomic regulation of HR in children with leukemia, in order to confirm its safety. We selected children with leukemia (n = 8) and healthy children (n = 11) who underwent a respiratory physiotherapy session. We use Infant Respiron (NCS, Brazil), Infant Voldyne (HUDSON RCI... (Complete abstract click electronic access below) / Mestre

The thesis Handling In Adults Physiotherapy summarizes the knowledge of respiratory handling in application on adult patients. Part of the thesis also covers the relationship between body position and respiratory motor control. Experimental part consists of a clinical study with 10 COPD patients. The patients were treated in 3 positions by respiratory handling therapy. The result demonstrates a significant change in blood saturation after the therapy in position on a side. It also proves appropriateness of the side position in comparison with sitting. Keywords respiratory handling, contact-stimulating physiotherapy, respiratory physiotherapy, oxymetry, NIRS

Bibliographic record ONDRÁČKOVÁ, Radka. Application of physiotherapy in treating myasthenia gravis. Prague: Charles University, 2nd Faculty of Medicine, Department of Rehabilitation and Sports Medicine, 2015, p. 90, Supervisor of the work: Doc. PaedDr. Libuše Smolíková, Ph.D. Abstract Myasthenia gravis is an autoimmune disease affecting the neuromuscular transmission. It manifests in muscular weakness and tiredness, which characteristically fluctuate and change throughout the time. The most typically affected muscles are extraocular, mimic, oropharyngeal and the muscles of lower and upper extremities. The danger of respiratory difficulties is aggravated by worsening physical condition, which comes as a consequence of muscular weakness and with the onset of the myasthenic crisis. The work is focused on the use of respiratory physiotherapy and aerobic physical activity in patients with myasthenia gravis. The aim is to verify the effect of respiratory physiotherapy and aerobic physical activity to improve lung function and condition, and the disease stabilization. Keywords Myasthenia gravis, neuromuscular disease, physiotherapy, respiratory physiotherapy, aerobic training

Bibliographic identification HAVLIŠTOVÁ, Michaela. Respiratory physiotherapy affects the quality of life of children with SMA - how, when and why? Prague: Charles University, 2nd Faculty of Medicine, Department of rehabilitation and sport medicine, 2012. 81 p. Supervisor Doc. PaedDr. Libuše Smolíková, Ph. D. Annotation This thesis deals with the influence respiratory function in children with spinal muscular atrophy (SMA). The theoretical part provides an overview of respiratory physiotherapy techniques that can be used in the care of the airways in people with SMA. The practical part deals with the question whether it is possible using the selected techniques of respiratory physiotherapy after six weeks of training to affect ventilatory parameters in children with SMA. The group of six probands with SMA I. - III. type in the range of the age from 3.5 to 12 years participated in this study. To objectively assess changes was performed spirometry efore the beginning of the therapy and after its conclusion. The main therapy was daily training with inspiratory breath simulator CliniFlo. After the finishing of therapy there was a positive change in all measured parameters except for vital capacity (VC) and maximal expiratory flow at 75% of FVC (MEF75), where the values didn't change. Statistically significant...

Made available in DSpace on 2014-06-11T19:25:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-12Bitstream added on 2014-06-13T19:32:57Z : No. of bitstreams: 1 tonon_e_me_botfm.pdf: 621514 bytes, checksum: f42de067077b49bbfe8b27db1ee8aff3 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Apesar da fisioterapia respiratória aparentemente beneficiar pacientes sob ventilação mecânica, não há evidências suficientes para sua recomendação. Usando associação das manobras compressão torácica (CT) e hiperinsuflação manual (HM), prévio estudo de nosso grupo identificou significante redução no período de ventilação mecânica (VM), no período de internação e melhora da extensão de lesão pulmonar (Murray) em pacientes sob VM. Contudo, é desconhecido o papel isolado de cada manobra nos benefícios encontrados. Portanto, o objetivo deste estudo foi comparar prospectivamente o efeito isolado e associado das manobras CT e HM no período de internação e de VM em pacientes sob VM. O estudo foi conduzido por 13 meses na UTI (Pronto-Socorro do Hospital das Clínicas, UNESP, Botucatu, SP, Brasil) de um hospital universitário terciário. Foi também avaliada a interferência das manobras nos seguintes parâmetros: índice prognóstico (APACHE-II), Murray, oxigenação (PaO2/FiO2), mecânica respiratória, repercussões hemodinâmicas e saturação periférica de oxigênio (SpO2). A análise estatística utilizou o teste de Goodman para contrastes entre e dentro de populações multinomiais, qui-quadrado, análise de variância e análise de variância para o modelo de medidas repetidas em grupos independentes. Dos 204 pacientes que preencheram os critérios de inclusão e exclusão e foram admitidos no estudo, 20 pacientes foram alocados no grupo CT, 20 no grupo HM e 20 no grupo CT+HM de acordo com o processo de sistematização. Diversas causas levaram à exclusão de alguns pacientes durante o estudo e cada grupo passou a ser constituído por 15 pacientes. O grupo CT recebeu compressão torácica, o grupo HM recebeu hiperinsuflação manual e o grupo CT+HM recebeu a associação de ambas as manobras duas vezes ao dia durante cinco... / There is no evidence to support the recommendation of chest physiotherapy on mechanically ventilated (MV) patients, although this procedure apparently improves those patients. Using association of thoracic compression (TC) and manual hyperinflation (MH), our previous study identified significant reduction in duration of weaning from ventilation, discharge from intensive care unit (ICU) and extent of lung damage index (Murray). However, it is unknown the individual role of each maneuver on those benefits. Therefore, the aim of the study was evaluate the isolated and associated effect of TC and MH on the mechanical ventilation period and length of stay in mechanically ventilated patients. Secondarily, outcomes of interest were the effect of physiotherapy on Murray, severity score and on hemodynamics, gas exchange, and respiratory mechanics. It was conducted at ICU of the Emergency Room (ER) at Hospital das Clínicas of São Paulo State University (UNESP-HC) (Botucatu, SP, Brazil) for 13 consecutive months. The significance of differences between groups was accessed by Goodman test, chi-squared analysis, ANOVA and a nonparametric repeated measures ANOVA. The present study was a three-group (TC, MH, and TC+MH), prospective and systematized clinical study lasting 5 days. Of the 204 patients who fulfilled all the inclusion criteria and were enrolled in the study, 20 patients were allocated into TC group, 20 into MH group or 20 into TC+HM group. The TC group received expiratory chest compression, the MH group received manual hyperinflation and the TC+HM received manual hyperinflation combined with expiratory chest compression twice a day for 5 days. Five patients from TC, 5 from MH and 5 from TC+HM were withdrawn during the study period due to several reasons and therefore, 15 patients remained in each group. The 3 groups... (Complete abstract click electronic access below)

En France, 460000 nourrissons âgés d’un moins à deux ans, sont affectés par la bronchiolite aiguë chaque hiver. Cette infection virale, qui a pour conséquence une inflammation des voies respiratoires, est généralement traitée par des séances de kinésithérapie respiratoire (KR). Afin d’améliorer l’apprentissage des techniques de KR pédiatriques, un simulateur, représentatif d’un nourrisson de six mois présentant un encombrement moyen, a été réalisé au laboratoire SYMME. Ce premier simulateur permet aux kinésithérapeutes novices d’apprendre les gestes de base de la KR dans un environnement didactique et protégé. Ce travail s’inscrit dans la continuité de cette étude, et devra permettre à terme d’améliorer la formation, en proposant des situations didactiques variées. Dans un premier temps, un système permettant de reproduire sur le simulateur le mouvement de respiration du nourrisson a été réalisé. Puis nous avons travaillé sur la conception d’un mécanisme permettant d’obtenir un comportement mécanique variable au niveau du thorax, afin de permettre à l’apprenant de s’entrainer sur différents cas cliniques. Pour la réalisation d’un tel dispositif, nous nous sommes orientés vers des systèmes classiquement utilisés pour dissiper de l’énergie en modifiant la raideur et/ou l’amortissement de la structure. Deux dispositifs semi-actifs basés sur l’utilisation d’un vérin hydraulique ont été principalement étudiés. Ils se différencient par la façon dont l’écoulement du fluide entre les deux chambres du vérin est modifié : le premier par un changement de section de la canalisation, le deuxième par une modification des propriétés d’écoulement d’un fluide magnétorhéologique. La première solution a été validée partiellement par un kinésithérapeute référent mais n’est pas tout à fait satisfaisante. La seconde a été testée sur un banc d’essai spécifique et semble être une voie prometteuse pour la réalisation du simulateur à propriétés variables / In France, 460000 infants between one month and two years are affected by the acute bronchiolitis each winter. This viral infection which leads to an inflammation of the respiratory tract is generally treated during a respiratory physiotherapy(RP) session. In order to improve the technical learning of the paediatric RP, a simulator which represents a six month old infant with an average type of bronchiolitis was developed in the laboratory SYMME. This first simulator allows the physiotherapist students to learn the basic gestures of the RP in a didactic and safe environment. This research work follows the frame work of this study and should allow an improvement of the training by proposing various didactic situations. As a first step, a system that allows reproducing the breathing movement of an infant on the simulator was developed. Then we worked on the design of a mechanism that allows obtaining a variable mechanical behaviour of the thorax in order to enable the student to practice on different clinical cases. For the realisation of such a device, we focused on systems which are conventionally used to dissipate energy by modifying the stiffness and/or the damping of the structure. Two semi-active devices based on the usage of a cylinder/piston system were examined. They differ in the way the pressure difference between the two chambers of the cylinder is generated : first, by changing the flow geometry and second, by a modification of the fluid flow characteristics of a magnetorheological fluid. The first solution was partially validated by a physiotherapist but was not completly satisfying. The second solution was tested on a specific test bench and seems to be a promising way to realise a simulator with variable properties.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-21T18:14:35Z No. of bitstreams: 1 Anderson Alves de Camargo .pdf: 1030153 bytes, checksum: 6ca31fab8598bd8ac6319e473c1dac59 (MD5) / Made available in DSpace on 2018-06-21T18:14:35Z (GMT). No. of bitstreams: 1 Anderson Alves de Camargo .pdf: 1030153 bytes, checksum: 6ca31fab8598bd8ac6319e473c1dac59 (MD5) Previous issue date: 2015-12-16 / Introduction: There is a shortage of studies evaluating the effects of respiratory physiotherapy isolated and linked to pulmonary rehabilitation in adults with bronchiectasis (BCT), and inflammatory level comparison of these patients with a control group. Aim: Study 1: To correlate the inflammatory and oxidative stress state with lung function and physical capacity, and with basal physical capacity after a pulmonary rehabilitation program associated with the respiratory physiotherapy; and Study 2: To compare the effects of a pulmonary rehabilitation program associated to respiratory physiotherapy with respiratory physiotherapy singly in physical capacity, peripheral muscle function and quality of life in patients with bronchiectasis. Methods: In the first study, 74 patients and 29 controls performed cardiopulmonary exercise test on cycle ergometer (CPET) and incremental shuttle walking test (ISWT), in addition to the assessment of the total number of steps/day (NSD) and the Pro and anti-inflammatory mediators and Pro and anti-oxidants in plasma. In the second study, 82 patients were randomized into two groups: respiratory physiotherapy (RP) and RP associated to pulmonary rehabilitation (RP+PR). Patients performed the ISWT and SWT endurance (ESWT), the maximum and submaximal CPET (sub), test of strength for the biceps brachii (BB), medium deltoids (MD) and quadriceps femoris (QF) and responded to the St. George's Respiratory Questionnaire (SGRQ) for assessment of health-related quality of life (HRQOL). NSD was obtained by pedometer and dyspnoea was measured by the Medical Research Council (MRC). Results: Study 1 – The level of cytokines IL1-β and IL-6 was significantly higher compared to the control group, but for Pro markers and antioxidants no differences were found. There was significant negative correlation of VO2 with IL1-β (r: -0.42), IL-6 (r: -0.31), thiobarbituric acid (T-BARS, r: 0.30), Carbonyl (r: -0.39) and nitrite (r: 0.32). The ISWT correlated with Catalase (r: 0.25) and total antioxidant capacity (TRAP, r: 0.23). Study 2 – Comparing the pre-and post-intervention intra-group effects, there was significant increase in ISWT, ESWT, CPET load, and muscle strength of DM and BB for the RP+PR group, while the endurance time in CPETsub increased both in RP+PR and RP groups; there was improvement for the RP group in all domains of SGRQ, while the RP+PR group only improved in symptoms. When comparing the effects of treatment in both groups (RP vs RP+PR), there was no statistically significant difference for any of the outcomes studied. Conclusion: Study 1 – Patients with BCT presented high systemic inflammation even in the stable phase of the disease, with equivalent Pro markers and antioxidants compared to the control group. Oxidative and inflammatory markers correlate with the aerobic and functional capacity. Study 2 – Although there was increasing exercise tolerance only at the RP+PR group, both groups showed improvement in HRQOL. Even though there wasn’t difference between interventions, it is preferable to associate RP to PR, because the latter promoted significant benefits in peripheral muscle strength and physical ability. / Introdução: Há escassez de estudos avaliando os efeitos da fisioterapia respiratória (FR) isolada e associada à reabilitação pulmonar (RP) em adultos com bronquiectasia (BCQ) e a comparação do nível inflamatório destes doentes com a de um grupo controle. Objetivos: Estudo 1: Correlacionar o estado inflamatório e estresse oxidativo com a função pulmonar e capacidade física e com a capacidade física após o programa de RP associado à FR e Estudo 2 – Comparar os efeitos de um programa de RP associado à FR com a FR isoladamente na capacidade física, função muscular periférica e qualidade de vida em pacientes com bronquiectasia. Método: No primeiro estudo, 74 pacientes e 29 controles realizaram o teste de exercício cardiopulmonar máximo em cicloergômetro (TECP) e o shuttle walking teste incremental (SWTI), além da avaliação do número total de passos/dia (NTP) e dos mediadores pró e anti-inflamatórios e pró e anti-oxidantes no plasma. No segundo estudo, 82 pacientes foram randomizados em dois grupos (Grupo 1 – FR e Grupo 2 – FR associada à RP). Os pacientes realizaram o SWTI e o SWT endurance (SWTE), o TECP máximo e submáximo (sub), teste de força para o bíceps braquial (BB), deltóide médio (DM) e quadríceps femoral (QF) e responderam ao Saint George’s Respiratory Questionnaire (SGRQ) para avaliação da qualidade de vida relacionada à saúde (QVRS). O NTP foi obtido por pedômetro e a dispneia foi mensurada pela escala Medical Research Council (MRC). Resultados: Estudo 1 - O nível de citocinas IL-1β e IL-6 foi significantemente maior em comparação ao grupo controle, mas para os marcadores pró e anti-oxidantes não foram encontradas diferenças. Houve correlação negativa significante do VO2 com IL-1β (r = -0,42), IL-6 (r = -0,31), ácido tiobarbitúrico (T-BARS, r = 0,30), Carbonila (r = -0,39) e Nitrito (r = 0,32). O SWTI correlacionou-se com a Catalase (r = 0,25) e a capacidade anti-oxidante total (TRAP, r = 0,23). Estudo 2 – Ao compararmos os efeitos pré e pós-intervenção intragrupo: houve aumento significante no SWTI, SWTE, carga no TECP, força muscular do BB e DM para o grupo FR+RP, enquanto o tempo de endurance no TECPsub aumentou tanto neste grupo quanto no grupo FR; no grupo FR houve melhora em todos os domínios do SGRQ, enquanto para o grupo FR+RP apenas no domínio sintomas. Ao comparar os efeitos do tratamento em ambos os grupos (FR vs FR+RP) não houve diferença estatisticamente significante para quaisquer dos desfechos estudados. Conclusão: Estudo 1 - Os pacientes com BCQ apresentaram elevada inflamação sistêmica, mesmo na fase estável da doença, com equivalentes marcadores pró e anti-oxidantes em relação ao grupo controle. Marcadores inflamatórios e oxidativos se correlacionam com a capacidade aeróbia e funcional. Estudo 2 – Embora ocorreu aumento da tolerância ao exercício apenas no grupo FR+RP, ambos os grupos demonstraram melhora da QVRS. Embora não tenha ocorrido diferença entre ambas as intervenções, é preferível associar à FR a RP, pois esta última promoveu benefícios significativos na capacidade física e força muscular periférica.

Diplomová práce Vliv a možnosti fyzioterapie u pacientů po onkologicko-chirurgických zákrocích hrudníku - její specifika v předoperačním, akutním pooperačním a ambulantním období Abstract Lung tumor diseases are the most frequent tumors in the world. In men it is the most common tumoral disease in incidence, in women it occupies the third place. Bronchogenic carcinoma is the most frequent one, which includes tumors of trachea, bronchus and lung parenchyma. In most cases, the treatment requires surgical removal associated with hospitalization and subsequent rehabilitation. The theoretical part addresses oncologic surgical issues of lung tumors. A major part of the theory is dedicated to the options of physiotherapy and its specifics in particular parts of rehabilitation care. The practical part observes two groups of patiens and comparatively evaluates the effect of the therapy in particular parts by objective and subjective tests.