De etiologia multifatorial, a síndrome dolorosa fêmoro-patelar (SDPF) acomete de 7 a 15% da população, em sua maioria jovens, adultos e ativos. Causa dor difusa anterior ou retropatelar e é exacerbada durante atividades funcionais, como subir e descer degraus, permanecer por um período prolongado sentado, agachado ou ajoelhado (COWAN, BENNELL e HODGES, 2002). Tanto o processo de avaliação quanto a evolução do tratamento baseiam-se, fundamentalmente, no relato de dor feito pelo paciente e na incapacidade funcional. Diagnosticar corretamente o distúrbio possibilitaria um tratamento mais adequado e permitiria o acompanhamento do quadro evolutivo do paciente ao longo do tratamento proposto. Desta maneira, propôs-se a análise de alguns parâmetros biomecânicos para melhor caracterização destes indivíduos. 33 voluntárias - 11 com diagnóstico médico de dor fêmoro-patelar e 22 clinicamente normais - foram submetidas à avaliação por meio de eletromiografia de superfície das porções medial e lateral do quadríceps; análise tridimensional de movimento; e plataforma de força durante a subida de degraus. As voluntárias do grupo SDFP foram caracterizadas por um atraso no tempo de atividade máxima do músculo vasto medial em relação ao vasto lateral (4 ms), aumento da rotação externa do fêmur (3,14 graus) e menor variação global do torque (1,14 Nm), quando comparadas aos indivíduos do grupo controle. Os resultados obtidos complementam-se e ajudam a entender características de comportamento neuromotor em indivíduos com dor fêmoro-patelar. Conjuntamente, esses instrumentos apresentam grande potencial para a avaliação e classificação dos indivíduos com relação à síndrome. / From multifactorial etiology, patellofemoral pain syndrome (PFPS) affects 7 to 15% of the population, mostly young, adults and active people. It causes anterior or behind patella diffuse pain and is exacerbated during functional activities such as climbing and descending stairs or stay for a long time sitting, kneeling or crouching down (COWAN, BENNELL e HODGES, 2002). The evaluation process as much as the evolution of treatment is fundamentally based in the reporting of pain by the patient and the functional disability. Correct diagnostic of the disorder would allow a more appropriate treatment as well as to keep up with the patient evolution during the proposed treatment. Thus, it was proposed the biomechanical analysis of some parameters to better characterize these individuals. 33 female volunteers - 11 with medical diagnosis of patellofemoral pain and 22 clinically normal - were submitted to evaluation of surface electromyography of the medial and lateral portions of the quadriceps, three-dimensional motion analysis and force plate during the ascent of steps. The volunteers of the PFPS group were characterized by a delay in time of maximum activity of the vastus medialis muscle related to the vastus lateralis (4 ms), increased femoral external rotation (3.14 degrees) and less overall variation in the torque (1.14 Nm) when compared to individuals in the control group. The results complement each other and help to understand features of neuromotor behavior in individuals with patellofemoral pain. Together, these tools have great potential for assessment and classification of these individuals related to the syndrome.

Introduction: Impaired isometric muscle strength and muscle endurance in adults with Fontan circulation has previously been reported. However, the knowledge if corresponding impairment is present in children and adolescents with Fontan circulation is scarce. Aim: The aim was to examine the isometric muscle strength and muscle endurance of the lower limbs in children and adolescents with Fontan circulation in comparison to age and sex matched controls. Method: In this cross-sectional study 43 children and adolescents (6-18 years) with Fontan circulation and 43 controls were included. Isometric knee extension and plantar flexion muscle strength was assessed using dynamometry (Newton:N). Unilateral isotonic heel-lift until exhaustion was used for evaluation of lower limb muscle endurance. Analysis on group level (n=43) and for the subgroups 6-12 years (n=18) and 13-18 years (n=25) was performed. Results: On group level the children and adolescents with Fontan circulation had impaired isometric plantar flexion strength for the left leg compared to controls (393.9±181.1N vs. 492.5±241.6N, p=0.04). In addition, they had impaired isometric knee extension strength bilaterally (right 222.8±101.1N vs. 293.0±164.9N, p=0.02, left 220.7±102.7N vs. 279.5±159.1N, p=0.05). In contrast, lower limb muscle endurance did not differ. In subgroup analysis, the impaired isometric strength was only present in the group of adolescents. Conclusion: Adolescents with Fontan circulation had impaired isometric muscle strength compared to controls. However, no corresponding differences were found in children. Further, lower limb muscle endurance did not differ. This implies that the impaired isometric muscle strength may develop during adolescence whereas the impaired muscle endurance may occur later. / Del av en multicenterstudie

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Brazil, the third largest producer of biodiesel in the world, and also the third largest producer of chicken, may increase in some regions, the use of oil derived from birds, as an alternative to fossil fuels. In order to increase the range of options to reduce dependence on soybean oil for that purpose, and fostering environmental aspects, it is possible to produce biodiesel from chicken oil, the country that can provide more than 300 thousand tons of oil per year. Considering the application of alternative fuels for diesel engines, agricultural machinery, the study aimed to evaluate the performance of a tractor of 53 kW in a dynamometer bench, and the level of emissions of certain waste gases of combustion, operating with biodiesel methyl chicken oil and various binary mixtures with diesel B5. We evaluated the values of torque and power produced, fuel consumption, power consumption and thermal efficiency of the engine, as well as the levels of gases (carbon dioxide, CO2, carbon monoxide, CO, unburned hydrocarbons, HC; and oxygen, O2). We used six blends of diesel with biodiesel B5 (control), B20, B40, B60, B80 and B100. The trial was conducted with a randomized design (CRD) in a factorial design, which was held after the analysis of variance and the average adjusted for regression equations. Integrating the data, the most significant results showed advantages for the B20. Minor losses were observed in the generation of power and torque, increase in specific fuel consumption, improved engine thermal efficiency and reduced energy consumption by increasing the proportion of biodiesel in the blend. The best emission results showed a reduction in emissions of CO, in the order of 80% when operating with B100. The CO2 reduction was not significant and the level of unburned HC was higher than the control blends B60, B80 and B100. / O Brasil, terceiro maior produtor de biodiesel do mundo, e também terceiro maior produtor mundial de frango, pode incrementar em algumas regiões do país, o uso de óleo oriundo de aves, como alternativa aos combustíveis fósseis. Com vistas ao aumento do leque de opções, a redução da dependência do óleo de soja para tal fim, e fomentando aspectos ambientais, é possível produzir biodiesel de óleo de frango, que no país, pode disponibilizar mais de 300 mil toneladas de óleo por ano. Considerando a aplicação dos combustíveis alternativos para os motores diesel, em máquinas agrícolas, o trabalho teve por objetivo avaliar o desempenho de um trator agrícola de 53 kW em bancada dinamométrica, e o nível de emissões de alguns gases residuais de combustão, operando com biodiesel metílico de óleo de frango e diversas misturas binárias com óleo diesel B5. Avaliou-se os valores de potência e torque produzidos, consumo de combustível, consumo de energia e a eficiência térmica do motor, bem como os teores de gases produzidos (dióxido de carbono, CO2; monóxido de carbono, CO; hidrocarbonetos não queimados, HC; e oxigênio, O2). Utilizaram-se seis misturas de óleo diesel com biodiesel: B5 (testemunha), B20, B40, B60, B80 e B100. O ensaio foi instalado com delineamento inteiramente casualizado (DIC) em esquema fatorial, sendo que após foi realizada a análise de variância e as médias ajustadas por equações de regressão. Integrando-se os dados, os resultados mais expressivos mostraram vantagens para o B20. Foram observadas perdas pouco significativas na geração de potência e torque, aumento no consumo específico, melhoria na eficiência térmica do motor, e redução do consumo energético com o aumento da proporção de biodiesel na mistura. Os melhores resultados das emissões mostraram uma redução nas emissões de CO, na ordem de 80%, quando operando com B100. O CO2 teve redução pouco expressiva e o nível de HC não queimados foi superior ao da testemunha nas misturas B60, B80 e B100.

De etiologia multifatorial, a síndrome dolorosa fêmoro-patelar (SDPF) acomete de 7 a 15% da população, em sua maioria jovens, adultos e ativos. Causa dor difusa anterior ou retropatelar e é exacerbada durante atividades funcionais, como subir e descer degraus, permanecer por um período prolongado sentado, agachado ou ajoelhado (COWAN, BENNELL e HODGES, 2002). Tanto o processo de avaliação quanto a evolução do tratamento baseiam-se, fundamentalmente, no relato de dor feito pelo paciente e na incapacidade funcional. Diagnosticar corretamente o distúrbio possibilitaria um tratamento mais adequado e permitiria o acompanhamento do quadro evolutivo do paciente ao longo do tratamento proposto. Desta maneira, propôs-se a análise de alguns parâmetros biomecânicos para melhor caracterização destes indivíduos. 33 voluntárias - 11 com diagnóstico médico de dor fêmoro-patelar e 22 clinicamente normais - foram submetidas à avaliação por meio de eletromiografia de superfície das porções medial e lateral do quadríceps; análise tridimensional de movimento; e plataforma de força durante a subida de degraus. As voluntárias do grupo SDFP foram caracterizadas por um atraso no tempo de atividade máxima do músculo vasto medial em relação ao vasto lateral (4 ms), aumento da rotação externa do fêmur (3,14 graus) e menor variação global do torque (1,14 Nm), quando comparadas aos indivíduos do grupo controle. Os resultados obtidos complementam-se e ajudam a entender características de comportamento neuromotor em indivíduos com dor fêmoro-patelar. Conjuntamente, esses instrumentos apresentam grande potencial para a avaliação e classificação dos indivíduos com relação à síndrome. / From multifactorial etiology, patellofemoral pain syndrome (PFPS) affects 7 to 15% of the population, mostly young, adults and active people. It causes anterior or behind patella diffuse pain and is exacerbated during functional activities such as climbing and descending stairs or stay for a long time sitting, kneeling or crouching down (COWAN, BENNELL e HODGES, 2002). The evaluation process as much as the evolution of treatment is fundamentally based in the reporting of pain by the patient and the functional disability. Correct diagnostic of the disorder would allow a more appropriate treatment as well as to keep up with the patient evolution during the proposed treatment. Thus, it was proposed the biomechanical analysis of some parameters to better characterize these individuals. 33 female volunteers - 11 with medical diagnosis of patellofemoral pain and 22 clinically normal - were submitted to evaluation of surface electromyography of the medial and lateral portions of the quadriceps, three-dimensional motion analysis and force plate during the ascent of steps. The volunteers of the PFPS group were characterized by a delay in time of maximum activity of the vastus medialis muscle related to the vastus lateralis (4 ms), increased femoral external rotation (3.14 degrees) and less overall variation in the torque (1.14 Nm) when compared to individuals in the control group. The results complement each other and help to understand features of neuromotor behavior in individuals with patellofemoral pain. Together, these tools have great potential for assessment and classification of these individuals related to the syndrome.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-20T20:10:21Z No. of bitstreams: 1 Erica Feio Carneiro Nunes.pdf: 1021018 bytes, checksum: 040c57768f7aed071b8aa73bd056ade6 (MD5) / Made available in DSpace on 2018-07-20T20:10:21Z (GMT). No. of bitstreams: 1 Erica Feio Carneiro Nunes.pdf: 1021018 bytes, checksum: 040c57768f7aed071b8aa73bd056ade6 (MD5) Previous issue date: 2018-03-06 / Contextualization: Weakening of pelvic floor muscles (PMFs) has been considered a major cause of stress urinary incontinence (SUI). In this way, the physiotherapeutic treatment, classically, turned to the strengthening of these muscles. In this study it was hypothesized that, in addition to PMFs weakness, this dysfunction may also be related to a change in the pattern of reflex response of these muscles. Objective: The study objectives were to compare the contraction response time and strength of cough-induced PMFs among continents and SUI women, and to conduct a literature review on the use of biofeedback for pelvic floor muscle training in women with this dysfunction. Methods: Study II: A systematic review was conducted with a search of the databases Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL and LILACS for randomized clinical trials that had biofeedback (BF) as a therapeutic tool for SUI. Study II: This was a cross-sectional study that evaluated the cough PMFs of 20 healthy women and 20 women with SUI. The clinical evaluation consisted of the application of questionnaires that assessed the severity of urinary incontinence and quality of life. Signal capture was performed with a 4-channel acquisition system (EMG System do Brasil Ltda®) to capture the signals obtained through vaginal dynamometry, electromyography (EMG) of the right external obliquus muscle and accelerometry. Statistical analysis was performed using the Shapiro-Wilk, independent t test or Mann-Whitney test according to the data distribution and the covariance analysis (ANCOVA) with post hoc Bonferrone test. The statistical significance considered for all tests was p <0.05. Results: Study I: the training of the PMFs with BF was not better than the control group (without training and orientation, vaginal electrical stimulation). However, these contradictory results and poor quality of the studies are probably not clinically significant. Study II: the contraction response of the PMFs was significantly different between the groups for the activation time of the PMFs (F = 19.51, P <0.0001, p2= 0.61), external oblique muscle activation time (F = 11.41, P <0.002, p2= 0.23) and time of the cough pulse (F = 4.21, P <0.04, p2= 0.10). Conclusion: The systematic review provides evidence that the training of BF-PMFs does not offer superior therapeutic benefits to other types of interventions in the treatment of female SUI. The cross-sectional study showed that women with SUI have delayed cough-induced contraction of PMFs. / Contextualização: O enfraquecimento dos músculos do assoalho pélvico (MAPs) tem sido considerada uma das principais causas da incontinência urinária por esforço (IUE). Dessa maneira, o tratamento fisioterapêutico, classicamente, se voltou para o fortalecimento desses músculos. Nesse estudo foi hipotetizado que, além da fraqueza dos MAP, essa disfunção também pode estar relacionada à uma alteração no padrão de resposta reflexa desses músculos. Objetivo: Os objetivos deste estudo foram comparar o tempo de resposta da contração e a força dos MAPs induzidos pela tosse entre mulheres continentes e com IUE e, realizar uma revisão de literatura sobre o uso do biofeedback para treinamento muscular do assoalho pélvico em mulheres com essa disfunção. Métodos: Estudo I: Foi realizada uma revisão sistemática com uma busca nas bases de dados Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL e LILACS por ensaios clinicos randomizados que tivessem o biofeedback (BF) como instrumento terapeutico para a IUE. Estudo II: Esse foi um estudo transversal que avaliou os MAPs durante a tosse de 20 mulheres saudáveis e 20 mulheres com IUE. A avaliação clínica consistiu na aplicação dos questionários que avaliaram a gravidade da incontinência urinária e a qualidade de vida. A captação dos sinais foi realizada com um sistema de aquisição com 4 canais (EMG System do Brasil Ltda®) para captar os sinais obtidos por meio da dinamometria vaginal, da eletromiografia (EMG) do músculo obliquo externo direito e da acelerometria. Para análise estatística foram utilizados os testes de Shapiro-Wilk, t independente ou Mann-Whitney test de acordo com a distribuição dos dados e a análise de covariância (ANCOVA) com test post hoc de Bonferrone. A significância estatística considerada para todos os testes foi de p<0,05. Resultados: Estudo I: o treinamento dos MAPs com BF não foi melhor do que o grupo controle (sem treinamento e orientação, estimulação elétrica vaginal). No entanto, estes resultados contraditórios e a má qualidade dos estudos provavelmente não são clinicamente significativos. Estudo II: A resposta de contração dos MAPs foi significativamente diferente entre os grupos para o tempo de ativação dos MAPs (F=19.51, P <0.0001,p2=0.61), Tempo de ativação do músculo obliquo externo (F=11.41, P < 0.002, p2=0.23) e tempo do pulso da tosse (F=4.21, P < 0.04, p2=0.10). Conclusão: A revisão sistemática fornece evidências de que a treinamento dos MAPs com BF não oferece benefícios terapêuticos superiores a outros tipos de intervenções no tratamento da IUE feminina. O estudo tranversal mostrou que mulheres com IUE apresentam atraso na resposta da contração dos MAPs induzidos pela tosse.

Title: The effect of a six-week physiotherapeutic intervention in child patients with clubfoot evaluated with a change in ROM of ankle dorsiflexion and the quality of gait measured by 2D analysis. Objectives: The aim of this work was evaluation of six-week physiotherapeutic intervention focused on movement and stability improvement in child patients with clubfoot based on a change in ROM of ankle dorsiflexion and the quality of gait measured by 2D analysis. Methods: The work consists of a theoretical part, which summarizes the theoretical background to the chosen topic, and a practical part. For the purposes of the practical part, an intervention group of patients (aged from 3 to 6 years) who have already received medical treatment for clubfoot, was created. The physiotherapeutic intervention period was six weeks, during that period there were from 4 to 5 individual exercises supplemented with home exercises. At the beginning and at the end there were control measurements. The control measurements consisted of a clinical examination and a 2D analysis of gait, supplemented by a dynamometric examination of gait. Results: There were no verifiable improvements in measured parameters, especially in a combination of several factors related to both the intensity of the physiotherapeutic intervention and...

INTRODUCTION: Reaction time may be broadly defined as the time between stimulus presentation and a response. Analysis of reaction time in terms of rate of force development (RFD), peak force, and surface electromyography (EMG) may help bridge the gaps in knowledge pertaining to the neuromuscular system's role in reaction time. The purpose of the present study was to identify predictors of reaction time using digital hand grip dynamometry and EMG. It was hypothesized that RFD and rate of EMG rise (RER) at the onset of a contraction would correlate with reaction time. METHODS: For grip testing, participants were instructed to squeeze a handheld dynamometer with the right hand "…as hard and fast as possible" for 5 seconds upon hearing a "beep" from the computer. A total of 5 attempts were performed, with 1-minute rest periods. Bipolar surface EMG signals were detected from the right first dorsal interosseous (FDI) and flexor carpi radialis (FCR) muscles throughout grip testing. Bivariate correlations (Pearson r) were used to examine the statistical associations. The 95% confidence interval (CI) for each Pearson r was also computed. An alpha level of p ≤ 0.05 was used to reject the null hypothesis. RESULTS: Significant correlations were observed between reaction time and all other measures of grip force (r = -0.507 to -0.557, p= 0.016 to 0.042), except for time until peak force (r = 0.029, p = 0.915). As FDI EMG amplitude increased reaction time decreased (r = -0.664, p = .005). CONCLUSION: Many of the grip force variables were significantly associated with reaction time. Peak force and rapid force variables showed significant correlations with reaction time. While no significant correlations for any of the FDI RER or FCR variables were found, EMG amplitude from the FDI presented the strongest bivariate correlation. As FDI EMG amplitude, peak force, and rapid force variables increased reaction time decreased. These findings give some insight into the neuromuscular system's role in hand grip tasks and help broaden the current understanding of variables that may be used to assess or improve reaction time in the clinical setting.

The aim of this study is to evaluate the effect of dynamic stabilizing strategy on handgrip and pinchgrip strength. Exercise utilized in this study was based on rehabilitative approach called Dynamic Neuromuscular Stabilization (DNS) - a developmental kinesiology approach. The exercise program consisted of four primal developmental positions (3½ month supine position, oblique sitting position with support on forearm, position on all fours, and the "bear" position). A study file consisted of ten females who were instructed in basic scheme of DNS exercise. They were instructed to exercise at home five times weekly for a 6- weeks period. One exercise lesson took about thirty minutes. Both handgrip and pinchgrip strength was measured using the digital dynamometer CITEC CT 3001 recording maximum voluntary isometric contraction (MVIC). Three-pinch grip strength and fist grip strength was measured for both upper extremities. Fist grip strength was measured in three positions of forearm (pronation, supination and neutral position). Overall eight variables (for each extremity, grip form and position of the forearm) measured before and after exercise program were compared using the paired t-test. Significant increase in muscle strength (p<0,05) was identified for all eight variables after a 6 weeks exercise...

Title : Kinesio taping in treatment and prevention of thumb overload in outpatient physiotherapy Purposes : The main purpose of this thesis was to evaluate a degree of pain decrease in thumb joint after kinesio tape application. The differences in grip strength were concurrently evaluated to objectify previous results. Hand dynamometer was used to support this claim. Methods : Data for the experiment were obtained by use of hand dynamometer measurement and record of a pain degree according to chosen pain scale. Each person was measured right before defined strain and immediately after it (daily work in outpatient therapy according to therapist's working shift). Each therapist was asked to record a degree of actual pain following the instructions during strain. All the results were processed and statistically analyzed. Results : The results show that kinesio tape is successful in decreasing of thumb joint pain. This was confirmed both during and after the strain. At the same time kinesio tape prevents decreasing of the grip strength. Keywords : Thumb, thumb joint, kinesio taping of a thumb, dynamometry, pain decrease of a thumb, overloading of a thumb

Introdução. Cirrose hepática (CH) pode cursar com perda de massa muscular (MM) e sarcopenia. A avaliação de sarcopenia em pacientes com CH é limitada pela presença de ascite e edema em membros inferiores (EMI), que prejudicam o desempenho dos métodos disponíveis para estimativa de MM. A hipótese da presente investigação considerou que o diagnóstico de sarcopenia na CH possa ser realizado com uso da absorciometria radiológica de dupla energia para obtenção do índice de massa muscular esquelética apendicular (IMMA-DXA), que não inclui a região abdominal em seu cálculo. Objetivo. Avaliar se IMMA-DXA é influenciado por ascite e/ou EMI, sua capacidade em identificar baixa MM, seu valor no diagnóstico de sarcopenia e prognóstico para mortalidade, de forma isolada e/ou combinada com a medida da força muscular, em pacientes com CH. Métodos. O IMMA-DXA [calculado através da soma da massa magra dos membros estimada por DXA (kg) / altura2 (m)] e a medida da força muscular [estimada através da medida de força do aperto de mão não-dominante (FAM-ND) por dinamometria (kg)] foram obtidos em 144 homens com CH e ascite, e em 20 voluntários saudáveis. Em 20 dos indivíduos cirróticos, o IMMA-DXA também foi calculado 30 minutos após paracentese. A mortalidade foi registrada por telefonemas efetuados até 36 meses do início do estudo. A possível influência de ascite sobre IMMA-DXA foi verificada pela comparação entre valores de IMMA-DXA obtidos em 20 pacientes antes e após paracentese. A capacidade do IMMA-DXA em identificar baixa MM foi avaliada através da comparação entre valores de IMMA-DXA obtidos nesses 20 pacientes com 20 voluntários saudáveis (pareados por idade, peso e altura). A possível influência de EMI sobre IMMA-DXA foi avaliada, na amostra total, pela comparação de valores de IMMA-DXA de pacientes com e sem EMI. A capacidade de IMMA-DXA diagnosticar sarcopenia e apresentar valor prognóstico para mortalidade foi avaliada em 129 pacientes, pela análise de interação entre IMMA-DXA e FAM-ND com sobrevida; e da capacidade de IMMA-DXA, isolada e conjunta com FAM-ND, em predizer mortalidade em pacientes cirróticos. Ponto de corte para mortalidade foram obtidos pelos tercis dos valores de IMMA-DXA e FAM-ND. A probabilidade de sobrevivência de pacientes com sarcopenia, diagnosticada por este ponto de corte, foi calculada e comparada com ponto de corte proposto pelo Consenso Europeu sobre definição e diagnóstico de sarcopenia [(EWGSOP), IMMA-DXA < 7,26 kg/m2 + FAM-ND < 30 kg]. Resultados. Não houve diferença entre IMMA-DXA pré e pós-paracentese [-0,01 kg/m2, IC de 95% (-0,09; 0,07); p > 0,050] e obtiveram-se bons coeficientes de correlação de concordância de Lin (0,99 kg/m2) e limites de concordância de 95% (-0,33 a 0,31 kg/m2) entre essas medidas. Foram identificados valores menores de IMMA-DXA e FAM-ND em pacientes com cirrose, comparado aos valores obtidos no grupo controle (p < 0,001). A diferença média dos valores de IMMA-DXA não diferiu entre pacientes com EMI e sem EMI (0,30 kg/m², p = 0,068). Morte em consequência da cirrose aconteceu em 55 (38%) dos 144 pacientes avaliados, durante 32 meses de seguimento, em mediana e com intervalo interquartil de 17,52 - 33,96 meses. Encontrou-se interação significativa de IMMA-DXA com FAM-ND (p = 0,028) e bom desempenho da combinação de ambas as ferramentas para prever mortalidade [razão de risco relativo (HR) 1,03; IC 95% (1,00 - 1,05)]. Óbitos ocorreram com maior frequência em pacientes que apresentaram, em conjunto IMMA-DXA <= 7 kg/m² e FAM-ND <= 25 kg, do que em indivíduos com valores superiores a este ponto de corte. A frequência de mortalidade prevista pelo novo ponto de corte e o EWGSOP foi de 73,70% e 54,80%, respectivamente. O novo ponto de corte para diagnóstico de sarcopenia identificou pacientes com maior risco de mortalidade, em relação ao ponto de corte de EWGSOP. Conclusão. Em pacientes cirróticos, o uso de DXA para estimativa do IMMA mostrou bom desempenho na identificação de baixa MM, independente da presença de ascite e EMI, e boa aplicabilidade no diagnóstico de sarcopenia, com importante valor prognóstico na predição de mortalidade, principalmente, quando associado à medida de força muscular / Introduction. Cirrhosis can lead to muscle mass loss and sarcopenia. Ascites and lower limb edema (LLE) limit the ability to evaluate muscle mass in patients with liver cirrhosis. Our hypothesis considers that the diagnosis of sarcopenia in cirrhosis can be accomplished with the use of dual-energy x-ray absorptiometry (DXA) to calculate the appendicular skeletal muscle mass index (DXA-ASMI), which excludes the abdominal region where ascites is present. Aim. This study aimed to evaluate whether ASMI calculated by DXA (DXA-ASMI) is influenced by ascites and/or LLE, if it is able to identify low muscle mass (LMM), and if it is able, either alone or combined with muscle force, to diagnose sarcopenia in liver cirrhosis patients. Methods. DXA-ASMI (kg/m2) was calculated by summing the lean mass of limbs estimated by DXA divided by the squared height. Muscle strength (kg) was estimated by the nondominant hand grip strength (ND-HGS) measured by dynamometry. DXA-ASMI and muscle strength measurements were obtained from 144 men with cirrhosis and ascites (including 20 patients who underwent paracentesis) and 20 healthy volunteers (control group; matched by age, height, and weight). DXA-ASMI was calculated before and 30 minutes after paracentesis, when performed. Mortality was recorded by the end of the study. To analyze the influence of ascites on DXA, we compared DXA-ASMI values before and after paracentesis in the paracentesis subgroup. To analyze the ability of DXA-ASMI to identify LMM, we compared DXA-ASMI values between the paracentesis subgroup and the control group. To analyze the influence of LLE on DXA, we compared DXA-ASMI values of patients with and without LLE. We analyzed the interaction between DXA-ASMI and ND-HGS with survival, and we calculated their individual and joint capacities to predict mortality in cirrhosis patients. Cutoff points were set as thirds of the DXA-ASMI and ND-HGS values. The survival probability calculated for this cohort of sarcopenia patients was compared to the result with the cutoff point proposed by the EWGSOP (DXA-ASMI< 7.26 kg/m2 + ND-HGS < 30 kg). Results. DXA-ASMI did not differ between before and after paracentesis (-0.01 kg/m2, 95% CI: -0.09-0.07; p > 0.050), and there were good CCC (0.99 kg/m2) 95% limits of concordance (-0.33-0.31 kg/m2) between these measurements. Cirrhosis patients had lower DXA-ASMI and ND-HGS values than healthy volunteers (p < 0.001). The average difference of the DXA-ASMI values did not differ between patients with and without LLE (0.30 kg/m², p = 0.068). Patients were tracked for a mean of 32 months (interquartile interval: 17.52-33.96 months). Death due to cirrhosis occurred in 55 patients (38%). We found a significant interaction between DXA-ASMI and ND-HGS (p = 0.028). Combined, these instruments showed good ability to predict mortality (relative hazard ratio: 1.03; 95% CI: 1.00-1.05). Death occurred more frequently in patients who had a combination of DXA-ASMI <= 7 kg/m² and ND-HGS <= 25 kg than in those with values higher than the cutoff. Predicted frequencies of death with the new cutoff point and the EWGSOP cutoff were 73.70% and 54.80%, respectively. Compared to the EWGSOP cutoff, the new cutoff point for diagnosing sarcopenia identified patients with a higher risk of death. Conclusion. In cirrhotic patients, DXA-ASMI demonstrated good results, independent of the ascites or LLE presence, and successfully identified LMM. The method had good applicability to sarcopenia diagnosis with an important prognostic value in predicting mortality, especially when combined with the ND-HGS measurement