Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-20T20:26:04Z No. of bitstreams: 1 Marcia Helena Machado Nascimento.pdf: 4734214 bytes, checksum: d3e07e20873861d014bba8270609ff30 (MD5) / Made available in DSpace on 2018-07-20T20:26:04Z (GMT). No. of bitstreams: 1 Marcia Helena Machado Nascimento.pdf: 4734214 bytes, checksum: d3e07e20873861d014bba8270609ff30 (MD5) Previous issue date: 2018-03-05 / Introduction: The Modified Shuttle Test (MST) is useful to assess the functional capacity of children with Congenital Heart Disease (CHD) due to its incremental characteristic and for being externally cadenced. Objective: To assess functional capacity and quality of life in children with CHD pre and post surgery. Methods: A transversal (Study I) and longitudinal study (Study II), that took place in a public hospital (heart disease group – GCard) and in a high school (control group – GC). In Study I the participants were children with CHD (n=32, 6-12 years old) vs control group (healthy children, n=32). In Study II, children with acyanotic congenital heart, age 6-12 years old, were assessed before hemodynamic or surgery procedures (pre-procedure, n=32), up to 15 days after hospital discharge (post-procedure 15, n=21), and up to 30 days after hospital discharge (post-procedure 30, n=27). Both studies assessed lung function, used the pediatric quality of life inventory (PedsQL4.0) and the Modified Shuttle Test (MST). Heart rate (HR), blood pressure (BP) and oxygen saturation were assessed during rest, during the test, at peak exercise, and in the recovering time. We considered HR x BPsystolic as the Double Product. Results: In Study I, the distance achieved was higher in the GC group when compared to the GCard group (644,6 ± 160,7m, p <0,001). At peak exercise we observed statically significant differences in the variables heart rate (bpm and %prev), SpO2, desaturation at peak exercise, and distance achieved, where these variables were lower in the heart disease group in comparison to the control group, p<0,05. PedsQL4.0 was worse in the GCard, and there was significant correlation between distance achieved and the dominance over the physical activity (r = 0,95,p <0,001). Study II showed that functional capacity was reduced in the pre-procedure (69,1 ± 17,5%prev), with significant worsening in the post-procedure 15 (55,7 ± 18,0%prev), and recovery in the post-procedure 30 (78,9 ± 12,8), p<0,05. The double product was not statistically different during the assessed periods of time, although, when correcting this variable with the distance achieved, we found that the children in the post-procedure 15 (23 – 39, median=31) had significant higher values when compared to the post-procedure (19 – 29, median=25), p<0,05. There was significant correlation between distance achieved and the psychosocial domain of the children age 8 to 12 years old (PedsQL 8-12) in the post-procedure 15 (r=0,70, p=0,002). The distance achieved was correlated to the item physical activity (5 -7 years old) in the post-procedure 15 (r=0,90, p=0,03). Conclusion: Children with congenital heart disease has reduced functional capacity and quality of life. Additionally, the surgery to correct the disease increses the functional capacity and quality of life after 30 days of the procedure. / Introdução: O shuttle teste modificado (STM) é útil para avaliar a capacidade funcional de crianças com cardiopatia congênita (CC) por ter característica incremental e ser cadenciado externamente. Objetivo: Avaliar a capacidade funcional e a qualidade de vida de crianças com CC no pré-operatório e após procedimento cirúrgico. Método: estudo transversal (Estudo I) e longitudinal (Estudo II), realizado no hospital público (grupo cardiopatia -GCard) e na escola de ensino médio (grupo controle- GC). Participaram do Estudo I crianças CC (n = 32, 6-12 anos) vs grupo controle (crianças saudáveis, n = 32). Estudo II, crianças com doença cardíaca congênita acianótica de 6 a 12 anos no pré-procedimento hemodinâmico ou cirúrgico (pré, n=32), até 15 dias de alta hospitalar (pós 15, n=21), e 30 dias de alta hospitalar (pós 30, n=27). Em ambos estudos foram avaliadas a função pulmonar, qualidade de vida (PedsQL4.0) e shuttle teste modificado. A frequência cardíaca (FC), a pressão arterial (PA) e a saturação de oxigênio foram avaliadas em repouso, no decorrer do teste, no pico do exercício e na recuperação do teste. Resultados: No estudo I, a distância percorrida foi maior no GC (829,6 ± 129,0 m) comparado ao GCard (644,6 ± 160,7m), p <0,001. No pico do exercício no STM foram observadas diferenças estatisticamente significativas nas variáveis frequência cardíaca, SpO2, dessaturação no pico, distância percorrida, sendo essas menores no grupo cardiopata em relação ao controle, p<0,05. O PedsQL 4.0 foi pior no GCard, e houve correlação significante entre a distância percorrida e o domínio da atividade física (r = 0,95, p<0,001). No estudo II, a capacidade funcional estava reduzida (69,1± 17,5%prev) no pré; com piora significante no pós 15 (55,7 ± 18,0%prev) e melhora da após 30 dias de alta (78,9 ± 12,8), p<0,05. O duplo produto (PAS x FC) não foi estatisticamente diferente no pré, pós 15 e pós 30, entretanto, ao corrigir essa variável pela distância percorrida, notam-se que os pacientes no pós 15 tiveram valores 31 (23 – 39mmHg/bpm) significantemente maiores comparado ao pré-operatório 25 (19 – 29mmHg/bpm), p<0,05. Correlação significante entre a distância percorrida e o domínio psicossopcial das crianças entre 8-12 anos (PedsQL 8-12) na fase pós 15 (r=0,70, p=0,002). A distância percorrida correlacionou-se com o domínio atividade criança (5 -7 anos) na fase pós 15 (r=0,90, p=0,03). Conclusão: Crianças com cardiopatia congênita apresentam redução na capacidade funcional e da qualidade de vida. A correção do defeito anatômico no coração resulta em melhora da capacidade funcional e na qualidade de vida desses pacientes após 30 dias de cirurgia.

The human immunodeficiency virus (HIV) together with acquired immunodeficiency syndrome (AIDS) is a world wide pandemic. Sub Sahara Africa, of which South Africa forms a part, is host to the highest HIV population in the world. In the light of this, it is significant to conduct a study of the effect that aerobic exercise might have on the management of disease symptoms. HIV and AIDS seriously affect the quality of life of the infected person. Decreased quality of life leads to decreases in productivity and increase in absenteeism. This has a negative effect on the economy. Several symptoms of HIV and AIDS cause quality of life to decrease. In this study the following parameters of health related quality of life were investigated: body composition, functional capacity, pain, anxiety and depression and fatigue. Absenteeism was monitored. The study further investigates how and why each of these parameters affects health related quality of life, and also the effect of aerobic exercise on the above mentioned parameters. The body composition of HIV positive persons is affected in one of three ways: wasting of muscle mass due to the virus, obesity because of too high energy intake and too little activity in an attempt to stop wasting, or lipodystrophy due to anti retroviral therapy. HIV patients have a decreased functional capacity. This may lead to fatigue, another common symptom in HIV patients. The prevalence of anxiety and depression is high in the HIV population, and even more so in South Africa. It is clear from the literature that aerobic exercise for HIV patients is safe. It is also clear that aerobic exercise has a positive effect on the mentioned parameters – not only on the HIV population, but also on other diseases and the healthy population. Thus the assumption was made that aerobic exercise can be used as a tool to increase health related quality of life in HIV positive persons. Initially, a quantitative pre-post test experimental design was proposed. In an attempt to recruit enough participants, the discovery was made that HIV is still a highly stigmatised disease in both Mpumalanga and Gauteng. After eighteen months of negotiations with AIDS clinics, mine groups and a newspaper advertisement, only three participants were enrolled. It must be kept in mind, however, that an important factor which influenced recruitment of participants was availability of funds. The indication was that HIV patients are willing to participate if there is proper compensation. In order to continue with the study, the design changed to a case study. It combined two approaches: qualitative and quantitative. This seems to work well in HIV research. The qualitative and quantitative data supported each other and provided the bigger picture. The results of this study support the expectation that aerobic exercise enhances the quality of life in HIV infected persons. Body composition and functional capacity improved. Feelings of anxiety and depression decreased and there were indications that pain and fatigue decreased as well. Absenteeism from work decreased in one person. The conclusion was made that aerobic exercise definitely contributes to the enhancement of quality of life in HIV positive employees. Biokineticists, as exercise specialists, are ideally positioned to provide exercise tests and program prescriptions to this population and should play a bigger role in the management of HIV and AIDS symptoms. Copyright / Dissertation (MA)--University of Pretoria, 2008. / Biokinetics, Sport and Leisure Sciences / unrestricted

Bakgrund Attention Deficit Hyperactivity Disorder (ADHD) hos vuxna är en neuropsykiatrisk diagnos som ofta bemöts med misstro trots att tre till fyra procent av den vuxna befolkningen i Sverige beräknas leva med diagnosen. ADHD påverkar många aspekter av det dagliga livet och kan problematisera sociala relationer, utbildning, arbetsliv, ekonomi och hälsa. Förståelse för individens funktionella förmåga är ett nödvändigt verktyg för sjuksköterskan i omvårdnadsarbetet. Med medvetenhet om hur ADHD påverkar patientens funktionella förmåga ökar förutsättningarna för att kunna bedriva vård i enighet med den svenska Hälso- och sjukvårdslagen. Syfte Syftet var att beskriva faktorer som kan påverka funktionell förmåga i det dagliga livet för vuxna med ADHD-diagnos. Metod Litteraturstudie valdes som metod. Databassökning genomfördes i Cinahl, PsycInfo och PubMed. Efter kvalitetsgranskning och sammanställning i en matris sammanställdes resultatet utifrån 15 inkluderade artiklar. Resultat Ett flertal faktorer framkom som påverkade funktionell förmåga i det dagliga livet för individer med ADHD-diagnos. De identifierade teman som påverkade individens möjligheter att fungera i olika miljöer och situationer var symtombild, samsjuklighet, stödjande relationer samt copingstrategier. Slutsats Symtombild och typ av undergrupp har stor inverkan på hur en ADHD-diagnostiserad individ anpassar sig till situationer och hanterade information i det dagliga livet. Kvinnor med konstaterad ADHD upplever i större utsträckning än män bristande funktionell förmåga i det dagliga livet. Då diagnostisering beskrivs vara ett startskott för utveckling av positiva copingstrategier framkom värdet av tidig diagnostisering av ADHD.

The purpose of this study was to discern the effectiveness of Cardiac Rehabilitation/ Secondary Prevention Programs (CR/ SPP’s) by evaluating increased functional capacity in the form of MET (metabolic equivalent) scores post-myocardial infarction (MI) or heart attack. The Duke Activity Status Index (DASI) survey is administered as part of the Standard Operating Procedure (SOP) for participation in the Secondary Prevention Program. Criterion for the research included patients 65 and older, with a history of one myocardial infarction, and had completed all 36 sessions of CR. The scores from 11 SPP surveys were analyzed and compared in three time increments from sessions 1-18 (initial, or “pre”), sessions 19-36 (“pan”), and sessions 1-36 (“post”). A total of 11 (n=11) surveys were collected and analyzed at The Computing and Statistical Technology Laboratory in Education (CASTLE) in the Teaching Academy on UCF Main Campus. Results from the data showed mean MET scores of 6.21 at session 1, 7.59 at session 18, and 8.15 at session 36. The mean changes over time represented in METs were 1.38 (1), .56 (18), and 1.93 (36). Percent changes over time were 27% (1), 8% (18), and 36% (36). This study showed increased functional capacity over time and will improve program design in terms of frequency and duration.

[ES] Constituye el objeto de esta tesis establecer un proceso de reflexión sobre determinados conceptos naturalizados históricamente por la ciencia urbanística y ambiental, de tal manera que pueda llevarse a cabo una revisión de los mismos -y, consecuentemente, de la legislación que los adopta filosóficamente- en el sentido de, frente a la situación de cambio climático y depredación territorial, permitirnos proceder a cuestionar un sistema que establece el desarrollo como un elemento de progreso económico en términos de crecimiento ilimitado, y proponer la posibilidad real de establecer un desarrollo en equilibrio con el medio. Para ello, se define el contexto evolutivo de la formación del concepto Ordenación Territorial, llegándose a la conclusión de que el significante tradicionalmente aceptado resulta más propio de un modelo basado en la generación de plusvalías, que en la determinación de su propia ordenación, derivada ésta de sus determinaciones intrínsecas, para poder, posteriormente, generar la planificación de los usos y actividades que sobre éste deben o pueden llevarse a cabo. Se trata de reflexionar en cómo considerar el territorio como un recurso ya ordenado en sí mismo, constituido por lo que denominamos sus invariantes, el cual va a ser utilizado por la sociedad -desordenándolo necesariamente-, para poder extraer respetuosamente de él los beneficios que precisa para el propio desarrollo social, todo ello alternativamente al modelo de explotación económica -corregida en base a criterios de «sostenibilidad»- tratado como un mero tablero de actuación, sobre el que planificar usos y actividades. Esta mencionada «sostenibilidad» viene instrumentalizada por el denominado Desarrollo Sostenible, término al que calificamos de oxímoron, por cuanto «desarrollo» -obviamente, en nuestro contexto, desarrollo económico- es un término que se contrapone a «límite», indicador que se debe considerar inherente al concepto de sostenibilidad. Entenderemos, por tanto, que la Ordenación Territorial vinculada a criterios de Desarrollo Sostenible implica la incapacidad, en la evolución territorial, de considerar el equilibrio necesario para poder recuperar y mantener aquellos elementos territoriales, sus recursos, para considerar unos niveles de bienestar aceptables. Consecuentemente, cualquier evolución hacia el límite, que no implique recuperación de lo agostado, con mayor o menor celeridad -desarrollo en «sostenibilidad» -, implicará, indefectiblemente, aproximación a la depleción definitiva. Revisar un sistema basado en el crecer por crecer, implementando un sistema de Estabilidad Continuada, que, en la situación de exaltación de políticas expansivas, sólo será alcanzable mediante un proceso de decrecimiento, senda de reversión hacia posiciones intralímite. Es así, por tanto, como se proponen nuevas figuras territoriales previas a la planificación urbanística basadas en lo que denominamos Capacidades Funcionales de Acogida, figura que vinculamos a la naturaleza intrínseca del territorio y su capacidad para mantenerse en un cierto equilibrio. Capacidades que vienen vinculadas para su activación a la real y verificable Necesidad Social, sin la cual carece de sentido la transformación del patrimonio común. Ello implica, por otro lado, instrumentos básicos limitativos a implementar en la legislación, de manera que el criterio vire hacia posiciones no expansionistas: desterrar la clase de suelo urbanizable; considerar el suelo rural, con sus diferentes aptitudes desarrollables, como alternativa; desclasificación, descalificación e, incluso, desurbanización, ante el expansionismo; determinaciones como ciudad cuidadora, ciudad mediterránea, compacta, mixta, cohesionada, localizabilidad de los recursos; el derecho al aprovechamiento, con recuperación social de plusvalías reales; renaturalización, revegetación y desmovilidad -movilidad no motorizada, proximidad- como ítem proyectual, serían incorporados como proceso cultural de decrecimiento. / [CA] Constitueix l'objecte d'aquesta tesi establir un procés de reflexió al voltant de determinats conceptes naturalitzats històricament per la ciència urbanística i ambiental, de tal manera que puga dur-se a terme una revisió dels mateixos -i, conseqüentment, de la legislació que els adopta filosòficament- en el sentit de, enfront de la situació de canvi climàtic i depredació territorial, permetre'ns procedir a qüestionar un sistema que estableix el desenvolupament com un element de progrés econòmic en termes de creixement il·limitat, i proposar la possibilitat real d'establir un desenvolupament en equilibri amb el medi. Per a això, es defineix el context evolutiu de la formació del concepte Ordenació Territorial, arribant-se a la conclusió que el significant tradicionalment acceptat resulta més propi d'un model basat en la generació de plusvàlues, que en la determinació de la seua pròpia ordenació, derivada esta de les seues determinacions intrínseques, per a poder, posteriorment, generar la planificació dels usos i activitats que sobre aquell deuen o poden dur-se a terme. Es tracta de reflexionar en com considerar el territori com un recurs ja ordenat en si mateix, constituït pel que denominem les seues invariants, el qual serà utilitzat per la societat -desordenant-ho necessàriament-, per a poder extreure respectuosament d'ell els beneficis que precisa per al propi desenvolupament social, tot això alternativament al model d'explotació econòmica -corregida sobre la base de criteris de «sostenibilitat»- tractat com un simple tauler d'actuació, sobre el qual planificar usos i activitats. Esta esmentada «sostenibilitat» ve instrumentalitzada pel denominat Desenvolupament Sostenible, terme al qual qualifiquem d'oxímoron, doncs que «desenvolupament» -òbviament, en el nostre context, desenvolupament econòmic- és un terme que es contraposa a «límit», indicador que s'ha de considerar inherent al concepte de sostenibilitat. Entendrem, per tant, que l'Ordenació Territorial vinculada a criteris de Desenvolupament Sostenible implica la incapacitat, en l'evolució territorial, de considerar l'equilibri necessari per a poder recuperar i mantenir aquells elements territorials, els seus recursos, per a considerar uns nivells de benestar acceptables. Conseqüentment, qualsevol evolució cap al límit, que no implique recuperació d'allò ja agostat, amb major o menor celeritat -desenvolupament en «sostenibilitat» -, implicarà, indefectiblement, aproximació a la depleció definitiva. Revisar un sistema basat en el créixer pel créixer, implementant un sistema d'Estabilitat Continuada, que, en la situació d'exaltació de polítiques expansives, només serà assolible mitjançant un procés de decreixement, senda de reversió cap a posicions intralímit. És així, per tant, com es proposen noves figures territorials prèvies a la planificació urbanística basades en allò que denominem Capacitats Funcionals d'Acolliment, figura que vinculem a la naturalesa intrínseca del territori i la seua capacitat per a mantenir-se en un cert equilibri. Capacitats que venen vinculades per a la seua activació a la real i verificable Necessitat Social, sense la qual manca de sentit la transformació del patrimoni comú. Això implica, d'altra banda, instruments bàsics limitatius a implementar en la legislació, de manera que el criteri vire cap a posicions no expansionistes: bandejar la classe de sòl urbanitzable; considerar el sòl rural, amb les seues diferents aptituds desenvolupables, com a alternativa; desclassificació, desqualificació i, fins i tot, desurbanización, davant l'expansionisme; determinacions com a ciutat cuidadora, ciutat mediterrània, compacta, mixta, cohesionada, localizabilitat dels recursos; el dret a l'aprofitament, amb recuperació social de plusvàlues reals; renaturalització, revegetació i desmovilidad -mobilitat no motoritzada, proximitat- com a ítem projectual, serien incorporats com a procés cultural de decreixement. / [EN] The object of this thesis is to establish a process of reflection on certain concepts historically naturalized by urban and environmental science, in such a way that a review of them can be carried out -and, consequently, of the legislation that adopts them philosophically- in the sense of, in the face of the situation of climate change and territorial predation, allowing us to proceed to question a system that establishes development as an element of economic progress in terms of unlimited growth, and to propose the real possibility of establishing development in balance with the territorial environment. To get this, the evolutionary context of the formation of the Territorial Planning concept is defined, reaching the conclusion that the traditionally accepted signifier is more typical of a model based on the generation of capital gains, than on the determination of its own planning, derived from this of its intrinsic determinations, in order to subsequently generate the planning of the uses and activities that must or can be carried out on it. It is about reflecting on how to consider the territory as a resource already ordered in itself, made up of what we call its invariants, which will be used by society -necessarily disordering it-, in order to respectfully extract from it the benefits it needs. for social development itself, all of this alternatively to the economic exploitation model -corrected based on "sustainability" criteria- treated as a mere action board, on which to plan uses and activities. This aforementioned "sustainability" is instrumentalized by the so-called Sustainable Development, a term that we describe as oxymoron, since "development" -obviously, in our context, economic development- is a term that is opposed to "limit", an indicator that must be considered inherent to the concept of sustainability. We will understand, therefore, that Territorial Planning linked to Sustainable Development criteria implies the inability, in territorial evolution, to consider the necessary balance to be able to recover and maintain those territorial elements, their resources, to consider acceptable levels of well-being. Consequently, any evolution towards the limit, which does not imply recovery of what has been exhausted, with greater or lesser speed -development in "sustainability"- will inevitably imply an approach to definitive depletion. Review a system based on growth by growth, implementing a system of Permanent Stability, which, in the situation of exaltation of expansive policies, will only be achievable through a process of decrease, a path of reversion towards intra-limit positions. This is, therefore, how new territorial figures are proposed prior to urban planning based on what we call Functional Acceptance Capabilities, a figure that we link to the intrinsic nature of the territory and its capacity to maintain a certain balance. Capacities that are linked for their activation to the real and verifiable Social Need, without which the transformation of the common heritage is meaningless. This implies, on the other hand, basic limiting instruments to be implemented in the legislation, so that the criterion turns towards non-expansionist positions: banishing the type of developable land; consider rural land, with its different developable abilities, as an alternative; disclassification, disqualification and even disurbanization, in front of expansionism; determinations such as caring city, mediterranean city, compact, mixed, cohesive, localizability of resources; the right to get urban benefits, with social recovery of real capital gains; renaturalization, revegetation and demobility -non-motorized mobility, proximity- as a project item would be incorporated as a cultural process of degrowth. / Pérez Lores, LD. (2024). Ordenación del territorio y sostenibilidad. Análisis del concepto en el ámbito cultural occidental interpelación legislativa para un nuevo modelo en el caso valenciano [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/203401

INTRODUÇÃO: As distrofias musculares de cinturas (DMC) representam um grupo heterogêneo de desordens hereditárias e degenerativas da musculatura esquelética, com evolução progressiva, caracterizadas pelo acometimento predominante das cinturas escapular e/ou pélvica. São classificadas de acordo com o padrão de herança e o gene envolvido, podendo ser autossômicas dominantes ou autossômicas recessivas. No presente estudo, foi feita a análise de pacientes com diagnóstico de distrofia muscular de cinturas 2B (DMC2B). Trata-se de condição autossômica recessiva, cujo gene envolvido na sua fisiopatologia é o DYSF; sua mutação pode associar-se a alterações na proteína disferlina. OBJETIVOS: Avaliar a distribuição da fraqueza muscular na distrofia muscular de cinturas 2B com ênfase no acometimento dos membros superiores; realizar avaliação objetiva da força muscular para preensão palmar e pinças; correlacionar a força muscular dos diferentes movimentos com a idade de início dos sintomas, idade na ocasião da avaliação, tempo de evolução da doença e capacidade funcional. METODOLOGIA: Estudo prospectivo, observacional, corte transversal, caso-controle. Foi feita avaliação clínica da força muscular de membros superiores e superiores dos pacientes, através de instrumentos clínicos específicos e dinamômetro de pinça e de preensão palmar; adicionalmente, foram aplicadas escalas de capacidade funcional (Escala de Vignos e Escala de Brooke). RESULTADOS: Foram avaliados 12 pacientes com diagnóstico molecular confirmado de DMC2B e recrutados 41 pacientes para o grupo controle. Os grupos não diferiram por gênero nem nas médias etárias. A média da idade de início dos sintomas dos pacientes foi de 26,9 anos (DP 10,05); a idade média na ocasião da avaliação foi de 43,6 anos (DP 9,34). A avaliação clínica da força muscular evidenciou maior acometimento de membros inferiores em relação aos membros superiores. A dinamometria de pinça (bidigital e trigidital) e de preensão palmar evidenciou diferença significativa entre os pacientes e o grupo controle para todos os movimentos citados. Os valores de CK apresentaram média de 2769 U/L (cerca de quinze vezes o limite superior de normalidade). As escalas de avaliação de capacidade funcional evidenciaram uma correlação significativa entre a idade do paciente na ocasião da avaliação e o escore na escala de Brooke. CONCLUSÃO: A análise do padrão de fraqueza dos pacientes com DMC2B evidenciou acometimento de membros inferiores e também de membros superiores. A análise objetiva com dinamometria demonstrou acometimento em todos os movimentos avaliados, evidenciando o envolvimento distal de membros superiores. A análise da capacidade funcional de membros superiores apresentou correlação com idade na avaliação (quanto maior a idade do paciente, maior o grau de incapacidade para membros superiores). Os valores de CK e de força muscular correlacionaram-se com a idade do início dos sintomas e idade na avaliação, ou seja, o início mais precoce da doença correlacionou-se com quadros mais graves (maiores valores de CK e maior envolvimento de força muscular - principalmente distal de membros superiores) / INTRODUCTION: Limb-girdle muscular dystrophies (LGMD) are a heterogeneous group of hereditary and degenerative disorders of the skeletal muscle, with progressive evolution, characterized by the predominant involvement of the scapular and / or pelvic girdles. They are classified according to the inheritance pattern and the involved gene, being autosomal dominant or autosomal recessive. In the present study, we evaluated patients with a diagnosis of 2D (LGMD2B). The LGMD2B is an autosomal recessive condition whose gene involved in its pathophysiology is DYSF; its mutation may be associated with changes in protein dysferlin. OBJECTIVES: To assess the distribution of muscle weakness in 2D womb muscular dystrophy with emphasis on upper limb involvement; perform objective evaluation of muscle strength for palmar grip and forceps; to correlate the muscular strength of the different movements with the age of onset of symptoms, age at the time of evaluation, duration of disease and functional capacity. METHODS: Prospective, observational, cross-sectional, case-control study. Clinical evaluation of the muscular strength of the upper and upper limbs of the patients was made through specific clinical instruments and pinch dynamometer and palmar grip; In addition, functional capacity scales were applied (Vignos Scale and Brooke Scale). RESULTS: Twelve patients with confirmed molecular diagnosis of DMC2B were evaluated and 41 patients were recruited for the control group. The groups did not differ by gender nor in the age groups. The mean age of onset of the patients\' symptoms was 26.9 years (SD 10.05); the mean age at the time of the evaluation was 43.6 years (SD 9.34). The clinical evaluation of muscle strength showed a greater involvement of the lower limbs in relation to the upper limbs. Pinch dynamometry (bidigital and trigidital) and handgrip dynamometry showed a significant difference between the patients and the control group for all the mentioned movements. CK values presented a mean of 2769 U / L (about eight times the upper limit of normality); there was a significant negative correlation (p <0.01) between the age of the patient at the time of the evaluation and the maximum value of CK. The functional capacity evaluation scales showed a significant correlation between the age of the patient at the time of the evaluation and the score on the Brooke scale. The correlation values between the muscular strength between the different movements evaluated and the age of onset of symptoms, age at the time of evaluation and time of evaluation of the disease presented values of significance close to 0.05 for the upper limb distal muscles and age of onset and age at the time of evaluation. CONCLUSION: The analysis of the weakness pattern of patients with LGMD2B showed involvement of lower limbs as well as upper limbs. Objective analysis with dynamometry showed involvement in all the movements evaluated, showing the distal involvement in the upper limbs. The analysis of functional capacity of upper limbs showed correlation with age in the evaluation (the higher the patient\'s age, the greater the degree of incapacity for upper limbs). The values of CK and muscle strength correlated with the age of onset of symptoms and age at the assessment, ie the earlier onset of the disease was correlated with more severe conditions (higher CK values and greater involvement of muscle strength - mainly distal upper limbs)

Thesis (Ph.D. (Physiotherapy))--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Stroke impacts on a survivor’s ability to participate in community activities such as return to work (RTW) and affects people who are still within the working age. Return to work contributes to life satisfaction and social identity at least partly through independence gained from income-generation. The impact of RTW programmes for stroke survivors is limited and not generalisable to South Africa. This study aimed to bridge this gap in South Africa, and was conducted within the Gauteng province as it comprises the largest share of the South African population. Objectives and Methodology: The aim of the study was to determine the current practice in RTW intervention programmes for stroke survivors in the Gauteng Province of South Africa and to establish the effect of a workplace intervention programme on the rate of RTW of previously employed stroke survivors. This study had two stages: Stage one: A cross sectional survey was performed using a self administered questionnaire to establish current practice in RTW intervention programmes and the therapists’ perceived barriers and enablers of RTW after stroke. Stage two study included: a) a randomised controlled trial (RCT) to evaluate a six week RTW intervention, with follow-up at three and six months. The workplace intervention programme was tailored according to the functional ability and workplace challenges of each stroke survivor and was as follows: Week one: Assessment for work skill. The assessment included work modules which identified potential problems such as: visual discrimination; eye hand coordination; form and spatial perception; manual dexterity; colour discrimination; cognitive problems, and job specific physical demand factors. Week two: The therapist interviewed the stroke survivor and employer separately to establish perceived barriers and enablers of RTW. This was followed by a meeting between the therapist, stroke survivor and employer/supervisor to discuss and develop a plan to overcome identified barriers and to strengthen identified enablers based on consensus between stroke survivor and employer. Week three: A work visit for the stroke survivor to demonstrate what they did at work and identify what they could still do safely and what they could not do. This included vocational counselling and coaching; emotional support; adaptation of the working environment; advice on coping strategies to compensate for mobility and upper limb functional limitations; and fatigue management. Weeks four, five and six: continuation of the work visits, while monitoring progress, and making necessary adjustments as per stroke survivor and employer’s needs. This was done at the workplace while the participants continued with their usual therapy at the hospital. The control group received usual care. The primary outcome was RTW rate. The secondary outcomes included activities of daily living (measured with the Barthel Index); mobility (measured with the Modified Rivermead Mobility Index); basic cognitive function (measured with the Montreal Cognitive Assessment) and perceived quality of life (measured with the Stroke Specific Quality of life Scale). Another aim of stage two study was to: b) establish the stroke survivors’ and employers’ perceived barriers and enablers of RTW (this was done with the experimental group only); and to: c) identify predictors of RTW. Stage one study results: Thirty six (68%) of the 53 questionnaires sent to stroke rehabilitation facilities were returned. Seventeen (47%) of the 36 clinical settings referred stroke survivors to facilities offering RTW services; 12 (33%) facilities did not refer stroke survivors for RTW and did not offer RTW services; and seven (20%) facilities offered RTW services. Of the seven facilities that rendered RTW services for stroke survivors, five (71%) communicated with the employer to discuss reasonable accommodation and four (57%) did assessments for potential to RTW. The most common reason given by the 29 facilities for not offering RTW services was that they referred stroke survivors to other therapists who offered these services. The second most common reason was the unemployment status of the stroke survivor at the time of having stroke. The therapists’ most commonly perceived barriers of RTW were the severity of the stroke survivors’ physical impairments (n = 3) (36%) and their employment status (n = 11) (31%) at the time of having stroke. The most commonly perceived enablers were willingness of the employer to reasonably accommodate the stroke survivor at work (n = 12) (33%), family support (n = 8) (22%) and increased length of hospital stay to allow for intensive rehabilitation (n = 7) (19%). Stigma in the workplace was the only variable which had a statistically significant relationship with the type of clinical facility therapists worked at (p = 0.02). Stage two study results: The average age for the study group was 45 (SD: 8.7) years and the average stroke duration was 4.6 (SD: 1.8) weeks. There were 41 (51%) male stroke survivors and 39 (49%) female stroke survivors. Majority (55%) of the stroke survivors were breadwinners (63%), had a grade 11 to 12 educational level (64%), an income above R5000 (46%) and had a helper (74%) whom they did not have to pay (81%). Stroke survivors who returned to work had better quality of life at six months after stroke than those who did not RTW (p = 0.05). Results from the qualitative study indicated that the perceived enablers of RTW included: ability of the employer to provide reasonable accommodation and good interpersonal working relationships between stroke survivor, employer and co-workers. The perceived barriers of RTW included: unaffordable reasonable accommodation costs; inaccessible transport; having cognitive (memory and attention) and speech impairments and high unemployment rates. The overall RTW rate was 20% at three months follow-up and 40% at six months follow-up. Twenty seven percent of the stroke survivors in the intervention group returned to work at three months compared to 12% in the control group (p = 0.13). At six months, the majority of stroke survivors (60%) in the intervention group returned to work compared to 20% in the control group (p <0.001). The following factors were predictive of RTW: male gender (p = 0.03); fewer speech problems (p = 0.02); increased time off work post stroke (p = 0.001); ability to perform activities of daily living (p = 0.02); good mobility (p = 0.01) and good cognitive ability (p = 0.02). The stroke survivors in the intervention group were 5.2 times more likely to RTW than those in the control group at six months following stroke, and for every unit increase in the activities of the Barthel Index and Montreal Cognitive assessment score, the likelihood of RTW increased by 1.7 and 1.3 respectively. Conclusion: A RTW intervention consisting of workability assessments and workplace visits was effective in facilitating RTW for stroke survivors in Gauteng province, South Africa. Key predictors of RTW included male gender; increased time off work post stroke; ability to perform activities of daily living; good mobility and good cognitive ability and were identified as facilitating RTW; speech problems were identified as barriers to RTW. Overall, these results suggest the need to direct resources towards increasing work place intervention strategies after stroke.

Introdução: A Esclerose Lateral Amiotrófica (ELA) é uma doença degenerativa e progressiva que afeta neurônios motores da medula espinhal, tronco cerebral e/ ou córtex motor. Sua manifestação clínica é bastante variada, sua etiologia desconhecida e a progressão, fatal. Não existe ainda um tratamento curativo para a ELA, porém alguns medicamentos e a realização de fisioterapia podem auxiliar, fornecendo ao paciente uma melhor qualidade de vida. Objetivos: Testar a hipótese de que técnicas quantitativas de Ressonância Magnética (RM) são eficazes para detectar a lesão neuronal no encéfalo de pacientes com ELA no estágio inicial da doença e, verificar se existe correlação entre a lesão encefálica e a perda funcional do paciente. Dessa forma, pretende-se estabelecer um protocolo capaz de contribuir para o diagnóstico precoce da ELA. Metodologia: Quinze pacientes com diagnóstico de ELA definida ou provável (12 homens e três mulheres), com idade entre 37 e 79 anos e seus respectivos controles foram submetidos a um protocolo de avaliação por RM, que incluiu um estudo estrutural volumétrico e quantitativo do dano neuronal e mielínico por razão de sequências ponderadas em T1 e FLAIR, da Transferência de Magnetização (MT), Relaxometria, Anisotropia Fracionada (FA) e Difusão (DTI), além da Espectroscopia de prótons. Alguns dos sujeitos foram submetidos também à uma avaliação física de força muscular, de funcionalidade através da Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R), de qualidade de vida através da Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40) e de quantificação da fadiga pela Fadigue Severity Scale (FSS). Os dados da RM dos dois grupos foram comparados através da análise de variância multi e univariada e submetidos à correção de múltiplas comparações de Bonferroni. Nas variáveis com diferença significante entre os grupos, foi estudada a validade preditiva da medida, calculando-se a área sob a curva ROC e estabelecidos os valores de sensibilidade, especificidade e acurácia. Os dados das escalas foram comparados pelo teste de Mann-Whitney e correlacionados entre si e com as estruturas através da correlação de Spearman. Resultados: As várias técnicas da RM, com exceção da MT, identificaram pelo menos uma estrutura com diferença significante entre os dois grupos, totalizando 11 estruturas mais a razão dos metabólitos NAA/Cre. Os valores de sensibilidade, especificidade e acurácia foram satisfatórios variando entre 0,60 e 1,00 , com destaque para o Volume do Giro Superior Frontal Direito e Giro Superior Frontal Esquerdo que apresentaram valores 1,00 , 0,93 e 0,97 , respectivamente. As escalas ALSFRS-R e ALSAQ-40 apresentaram diferença significativa entre os dois grupos, mas a FSS não apresentou. As escalas apresentaram correlação significativa entre si em quase todos os escores totais e domínios. Já a correlação das escalas com as estruturas foi significativa apenas para o Volume. Conclusões: Técnicas como DTI, FA, Relaxometria e Volume se mostraram mais eficazes no diagnóstico precoce de pacientes com ELA do que as outras. A redução de volume de substância cinzenta se correlacionou positivamente com a ALSFRS-R. Por fim, propomos um protocolo para avaliação de pacientes com ELA, que inclua imagem volumétrica de alta resolução para cálculo da Volumetria e DTI. / Introduction: Amyotrophic Lateral Sclerosis (ALS) is a progressive and degenerative disease that affects motor neurons in the spinal cord, brain stem and/ or motor cortex. Their clinical presentation is varied, its unknown etiology and fatal progression. There isnt still a curative treatment for ALS, but some medications and physical therapy can help by providing the patient a better quality of life. Objectives: To test the hypothesis that quantitative techniques of magnetic resonance imaging (MRI) are effective to detect neuronal damage in the brain of patients with ALS at the inicial stage of the disease and see if there is a correlation between brain injury and functional loss of the patient. Thus, we intend to establish a protocol can to contribute to early diagnosis of ALS. Methods: Fifteen patients with definite or probable ALS (12 men and three women) aged between 37 and 79 and their respective controls underwent an MRI evaluation protocol, including a volumetric and quantitative structural study of damage neuronal and myelin by reason of T1-weighted sequences and FLAIR , Magnetization Transfer (MT), Relaxometry, Fractional Anisotropy (FA), Diffusion (DTI) and Proton magnetic resonance spectroscopy. Some of the subjects also underwent a physical assessment of muscle strength, functionality by Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R), quality of life through the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40) and quantification of fatigue by Fadigue Severity Scale (FSS). The MRI data of the two groups were compared using analysis of variance multivariate and univariate and submitted to correction for multiple comparisons of Bonferroni. In the variables with significant differences between groups, we studied the predictive validity of the measure, by calculating the area under the ROC curve and set the sensitivity, specificity and accuracy. The data of the scales were compared using Mann-Whitney test and correlated with each other and with the structures by Spearman correlation. Results: The various MRI techniques, with the exception of MT, identified at least one structure with a significant difference between the two groups, a total of 11 structures over the reason for the metabolites NAA/Cre. The sensitivity, specificity and accuracy were satisfactory ranging from 0.60 to 1.00 , with emphasis on Volume of Gyros Superior Frontal Right and Gyros Superior Frontal Left that averaged 1.00 , 0.93 and 0,97 , respectively. The ALSFRS-R and ALSAQ-40 scales showed significant differences between the two groups, but the FSS did not. The scales were significantly correlated with each other in almost all domains and total scores. The correlation with the structures of the scales was significant only for the Volume. Conclusions: Techniques such as DTI, FA, Relaxometry and Volume are more effective in early diagnosis of ALS patients than others. The decrease in gray matter volume was positively correlated with the ALSFRS-R. Finally, we propose a protocol for evaluation patients with ALS, including high-resolution volumetric image to calculate the Volume and DTI.

Introdução: o processo fisiológico de envelhecimento traduz-se em diversas alterações estruturais do sistema musculoesquelético. Estas, por sua vez, acarretam em modificações funcionais que se repercutem na dependência do senescente, determinando a diminuição da sua qualidade de vida. Das estratégias existentes para atenuar os efeitos da senescência o treinamento de potência tem sido apontado como preferido. Existem, contudo, indícios de que um treinamento baseado na potencialização da ação do ciclo alongamento-encurtamento seja uma melhor escolha. Hipóteses do estudo: pelos resultados obtidos em intervenções similares, hipotetiza-se que as participantes do protocolo de intervenção proposto apresentarão um aumento da densidade mineral óssea, do volume muscular, da capacidade funcional e melhora de alguns parâmetros biomecânicos da marcha, bem como da sua qualidade de vida. Objetivos: o objetivo geral do presente trabalho é, portanto, propor um modelo de treinamento fundamentado na potencialização da ação do ciclo alongamento-encurtamento e averiguar os seus efeitos em parâmetros selecionados da morfologia osteomuscular, capacidade funcional e qualidade de vida de idosas. Materiais e Métodos: 21 idosas sedentárias (66,9±4,2 anos) executaram o protocolo proposto durante 20 semanas, tendo os efeitos na densidade mineral óssea de fêmur, coluna, tíbia e rádio; efeitos na composição corporal, na força, no equilíbrio, na marcha, na flexibilidade e na qualidade de vida comparados aos efeitos obtidos pelo grupo controle (N=17, 65,0±3,4 anos), que não alterou o seu nível de atividade física. O protocolo de intervenção, composto por onze exercícios de força realizados com o intuito de potencializar a ação do ciclo alongamento-encurtamento, que apresentava duas modalidades de salto (salto vertical com contramovimento e drop jump), exigia a realização da fase concêntrica na maior velocidade possível. Resultados: quando comparado com o grupo controle, o grupo experimental apresentou alterações significantes (p<0,05) na densidade mineral óssea de coluna (g=1,06) e sua microarquitetura (g=0,80), na microarquitetura da tíbia (g=0,82), na força máxima (g=2,39) e potência (g=1,38) de extensores de joelho, na velocidade máxima de marcha (g=0,96), na flexibilidade de membros inferiores (g=1,05) e superiores (g=0,86) e no domínio Atividades passadas, presentes e futuras da qualidade de vida (g=1,08). Conclusão: os resultados apontam para a eficácia da proposta de intervenção, apresentando-se como uma nova estratégia para atenuar e até mesmo reverter algumas perdas estruturais e funcionais impostas pelo processo de envelhecimento / Introduction: the physiological aging process induces several structural changes in the musculoskeletal system. These, in turn, result in functional changes that are reflected in the senescent dependency, determining the reduction in their quality of life. Power training has been identified as ideal to mitigate the effects of aging. However, there are indications that an intervention based on the potentiation of the stretch-shortening cycle action is a better choice. Study hypotheses: the participants of the proposed intervention will increase their bone mineral density, muscle volume, functional capacity and will show some improvement in their gait, as well as in their quality of life. Purposes: the main objective of this study was to propose a training model based in the potentiation of the stretch-shortening cycle action and assess its effects on selected parameters of musculoskeletal morphology, functional capacity and quality of life of elderly women. Methods: 21 sendentary elderly women (66.9 ± 4.2 years) performed the proposed intervention protocol for 20 weeks and the effects on bone mineral density of the femur, spine, tibia and radio; effects on body composition, strength, balance, gait, flexibility and quality of life were compared to the effects obtained by the control group (N = 17, 65.0 ± 3.4 years) that did not change their level of physical activity. The program was composed by eleven strength exercises performed in order to enhance stretch-shortening cycle action, had two jump exercises (vertical jump with countermovement and drop jump) and had the concentric phase of the movements performed as fast as possible. Results: when compared to the control group the experimental group showed significant changes (p <0.05) in bone mineral density of the spine (g = 1.06) and its microarchitecture (g = 0.80), the microarchitecture of the tibia (g = 0.82), the knee extensors maximum force (g = 2.39) and power (g = 1.38), the maximum walking speed (g = 0.96), the lower (g = 1.05) and upper (g = 0.86) limbs flexibility and in the domain past, present and future activities of the quality of life (g = 1.08). Conclusion: the results point to the effectiveness of the proposed intervention, suggesting it as a new strategy to slow down and even reverse some structural and functional losses imposed by the aging process

Introdução: O treinamento físico melhora a capacidade funcional e a qualidade de vida em pacientes com insuficiência cardíaca (IC) crônica. Entretanto, a aderência ao treinamento físico supervisionado é baixa por diversas razões. Como alternativa, o treinamento domiciliar tem sido proposto. Objetivo: Comparar os efeitos de um programa de treinamento domiciliar (domiciliar) com um programa de treinamento supervisionado (supervisionado) sobre a capacidade funcional, comportamento sedentário e qualidade de vida em pacientes com IC crônica ao longo de 12 semanas. Métodos: Este estudo incluiu 23 pacientes com IC (classe funcional da New York Heart Association II e III, fração de ejeção do ventrículo esquerdo 31±6%) randomizados em grupos de treinamento domiciliar (n=11) ou supervisionado (n=12). Durantes 12 semanas os pacientes exercícios aeróbicos (60-70% da frequência cardíaca de reserva): caminhadas para o grupo domiciliar e exercício em cicloergômetro para o supervisionado, combinados ao exercício resistido (50% de uma repetição máxima). No momento basal e após 12 semanas mensuramos variáveis do teste cardiopulmonar, teste da caminhada de seis minutos (TC6M), pressões respiratórias máximas, força muscular do quadríceps e de preensão palmar, atividade física e comportamento sedentário por meio de acelerometria, qualidade de vida e aderência. Resultados: Os grupos domiciliar e supervisionado tiveram altas taxas de adesão, com aumentos (p=0,037) similares no consumo de oxigênio pico (0,8 e 3,7 ml/kg/min, respectivamente, p=0,085), ventilação máxima (11,5 e 15,6 l/min, respectivamente, p=0,775), distância percorrida no TC6M (9% e 5%, respectivamente, p=0,805), força muscular do quadríceps (21% e 11%, respectivamente, p=0,155) e qualidade de vida avaliada por meio do questionário Minnesota Living with Heart Failure (1 e 13, respectivamente, p=0,092). O comportamento sedentário reduziu (p=0,05) nos dois grupos (p=0,472). Entretanto, o treinamento supervisionado foi mais efetivo em melhorar a força muscular inspiratória (p=0,042), o número de passos/dia (p=0,001) e o componente de saúde mental do questionário SF-36 (p=0,001). Conclusões: O programa de treinamento domiciliar pode ser uma alternativa ao treinamento supervisionado para reduzir o comportamento sedentário e melhorar a capacidade funcional e qualidade de vida em pacientes com IC crônica. Entretanto, o treinamento supervisionado, além dos benefícios acima citados para o grupo domiciliar, é superior em aumentar a força muscular inspiratória, número de passos/dia e melhora de aspectos de saúde mental em pacientes com IC crônica, quando comparado ao treinamento supervisionado / Background: Exercise training improves functional capacity and quality of life in chronic heart failure (HF) patients. However, centre-based adherence is lower for several reasons. As an alternative, home-based training has been proposed. Objective: To compare the effects of home-based program (home-based) and centre-based (centre-based) training programs on functional capacity, sedentary behavior and quality of life in HF patients along 12 weeks. Methods: This study included 23 chronic HF patients (New York Heart Association functional class II and III, left ventricular ejection fraction 31±6%) randomized to home-based (n=11) or centre-based (n=12) training programs. Patients underwent a 12-week period of aerobic training (60-70% reserve heart rate): walking outdoor for home-based and supervised cycling for centre-based, both combined with resistance training (50% of one maximum repetition). At baseline and after 12 weeks of training, we assessed cardiopulmonary test measures, six minute walk (6MW) test distance, maximal respiratory pressures, quadriceps muscle strength, handgrip strength, physical activity and sedentary behavior (accelerometer), quality of life and adherence. Results: Home-based and centre-based had high adherence rate and similar improvements (p=0.037) in peak oxygen consumption (0.8 and 3.7 ml/kg/min, respectively, p=0.085), maximal ventilation (11.5 and 15.6 L/min, respectively, p=0.775), 6MW test distance (9% and 5%, respectively, p=0.805), quadriceps muscle strength (21% and 11%, respectively, p=0.155) and quality of life assessed by Minnesota Living with Heart Failure questionnaire (1 and 13, respectively, p=0.092). Sedentary behavior reduced (p=0.05) in both groups (p=0.472). However, centre-based program was markedly effective in improving inspiratory muscle strength (p=0.042), number of steps/day (p=0.001) and mental health component of SF-36 questionnaire (p=0.001). Conclusion: Home-based program can be an alternative to centre-based program to reduce sedentary behavior and to improve functional capacity and quality of life in patients with chronic HF. However, the centre-based training, in addition to the benefits mentioned above to home-based training, is superior in increasing the inspiratory muscle strength, number of steps/day and mental health in chronic heart faiure patients compared to home-based training