No / This study aimed to address whether a water exercise programme improves pain and quality of life in pregnant patients with Pelvic Girdle Pain (PGP) compared to a land-based exercise programme and the feasibility of undertaking a large-scale research programme. Twenty-three participants with diagnosed PGP, recruited at St George’s Hospital London, were randomised into two groups (water or land exercise). Each group received, four, once-weekly exercise sessions on land or water. Exercise effects on PGP were measured using the Pelvic Girdle Pain Questionnaire (PGPQ) (primary outcome), Visual Analogue Scale (VAS), Patient Specific Functional Score (PSFS) and Active Straight Leg Raise (ASLR). Quality of life was measured using the Subjective Exercise Experience Scale (SEES). Outcomes were assessed at baseline and post four weeks exercise. Results showed there was a clinically significant improvement shown in all outcome measures in the water group, compared to the land group. A statistical difference between groups was shown for ASLR (p=0.036), Positive Well-Being (p=0.000) and Fatigue levels (p=0.011). No statistical difference was shown for PGPQ (p=0.056), PSFS (p=0.530) and Psychological Distress (p=0.712) scores. Exercise in water appears to offer a clinical benefit for patients experiencing PGP compared to a land exercise, particularly with Fatigue, Positive Well-Being and ASLR scores. Statistical differences between groups are limited by small sample size and that no power calculation was used in this study. Methodology and results provide support for a larger study on this topic to provide more definitive conclusions to support the use of water-based therapy for PGP.

Achieving adequate and appropriate recovery from exercise is essential in ensuring optimal performance during repeated bouts of exercise. The use of various recovery interventions has become popular in an attempt to enhance subsequent performance and accelerate post-exercise recovery. The application of various post-exercise hydrotherapy interventions has become increasingly popular, however, the majority of current recovery practices appear to be based largely on anecdotal evidence as opposed to rigorous scientific research or evidence based findings. Physiologically, various hydrotherapy protocols have been shown to affect the body via fluid shifts (interstitial to intravascular space), changes in blood flow and cardiovascular function, and reductions in oedema. The possible psychological effects of water immersion must also be considered, with athletes commonly reporting reduced sensations of fatigue and soreness following immersion. Current literature suggests both hydrostatic pressure and water temperature to be important factors influencing the success of hydrotherapy. The overall aim of the present thesis was to enhance current knowledge and understanding with regards to the physiological and performance effects of various forms of hydrotherapy, used as a post-exercise recovery intervention. Initially, four cold water immersion interventions were compared to active recovery, performed between two bouts of high intensity cycling in hot environmental conditions. Effectiveness of recovery was determined via performance in a subsequent exercise bout; in addition, core body temperature, lactate, and heart rate were recorded. The remaining studies were designed to investigate the effects of cold water immersion, hot water immersion, contrast water therapy, and passive recovery 4 (control) following exercise-induced fatigue and exercise-induced muscle damage. Rate of recovery was assessed through changes in performance, core body temperature, thigh girths, blood markers, and perceived exertion/soreness. The results of the combined studies indicate cold water immersion to be more effective than active recovery when performed immediately post-exercise between two bouts of high intensity cycling in hot environmental conditions. Additionally, both cold water immersion and contrast water therapy were effective in aiding recovery from exercise-induced fatigue and exercise-induced muscle damage. Performance variables indicated an improved maintenance or return of performance following these recovery protocols. The present studies have provided additional information to the limited knowledge base regarding the effect of post-exercise hydrotherapy interventions, specifically, the effect of such interventions on subsequent athletic performance. In conclusion, cold water immersion and contrast water therapy appear to be superior to hot water immersion, active recovery, and passive recovery following fatiguing and muscle damaging exercise. Functional and physiological recovery was enhanced following the use of these two recovery protocols.

An innovative Partially Immersed Approach, based on mixed principles of land and aquatic therapy theories was developed to enhance sitting adaptation and functioning in an Aquatics Therapy environment, thus improving quality of life for children with Cerebral Palsy. The approach aimed to enhance motor adaptation, engendering adaptation in psychosocial domains of quality of life. It employed a specially developed therapeutic treatment chair, in an unloading toward loading strategy, to regulate and control percentage of weight-bearing by manipulation of buoyancy (Archimedes principle). Participants were bilateral spastic hypertonia, Cerebral Palsy children, aged 10-15 years. Mixed-method methodology was used to investigate effectiveness of treatment, employing a small sample in a multiple case study. In conclusion, the developed approach enables aquatic therapy to be employed to improve motor function adaptation on land and consequently enhancing adaptation in other psychosocial domains - perceived competence, empowerment and motivation - thus improving quality of life for children with cerebral palsy, sustained at a one-year post-intervention test.

Contextualização. A Fisioterapia carece de programas de intervenção previamente testados para aplicação, em meio aquático, visando indução de relaxamento muscular. Estudos prévios fornecem bases suficientes para a construção de programas. Delineamento e objetivo: Estudo quase experimental visando: 1. Desenvolver e descrever, em manual, um programa de massagem em imersão visando relaxamento denominado Programa de Relaxamento, Massagem e Mobilização em Imersão (RMI); 2. Avaliar pertinência e qualidade técnica da RMI pela submissão a pareceristas; 3. Avaliar a usabilidade e a autoaprendizagem a partir do estudo do manual da RMI; 4. Avaliar o efeito da intervenção fisioterapêutica com RMI em mulheres idosas e saudáveis. Método: 1. Desenvolvimento do Programa de Relaxamento, Massagem e Mobilização em Imersão (RMI), com base em revisão de literatura, reuniões dos pesquisadores e construção do manual. 2. Avalição da técnica por 20 pareceristas por meio de ficha de avaliação. 3. Análise de usabilidade do manual para autoaprendizagem teórico-prática por 10 graduandos em Fisioterapia. A atividade prática foi avaliada, pelo pesquisador e examinador independente, utilizando roteiro de avaliação baseado na descrição do programa. 4. Análise do efeito nos indicadores de relaxamento (frequência cardíaca, pressão arterial, flexibilidade, mobilidade, dor e qualidade de vida) em 12 mulheres idosas e saudáveis, após programa RMI de 10 sessões com duração de uma hora e meia cada. O estudo foi realizado no Laboratório de Fisioterapia e Comportamento do Curso de Fisioterapia da Faculdade de Medicina da Universidade de São Paulo e na piscina de reabilitação da Clínica Integrada Simmm. A análise constou de 1. Organização de respostas dos pareceristas por categoria e análise descritiva por questão; 2. Análise estatística descritiva das notas de desempenho dos estudantes e análise de confiabilidade interexaminadores; 3. Análise descritiva e comparativa dos dados pré e pós-intervenção das variáveis de flexibilidade, mobilidade articular, resposta cardiovascular, escores nos questionários DASH, FAOS e WHOQOL e por categorização das respostas sobre relatos para análise de efeito de programa em mulheres idosas. Resultados: Foi possível desenvolver o programa de intervenção e construir o manual descritivo e ilustrativo de massagem em imersão visando relaxamento, enriquecido com as sugestões dos pareceristas. O manual mostrou-se usável e suficiente para autoaprendizagem teórico-prática. O estudo de casos em série indicou que a prática da RMI melhora a mobilidade articular do ombro (rotação medial e lateral direita e esquerda com p=0,001) e tornozelo (extensão à esquerda p<0,001,extensão à direita p=0,0017 e flexão esquerda p=0,001). Afeta as respostas cardiovasculares indicando relaxamento com p=0,04. Houve melhora na função motora dos membros superiores, avaliada pelo questionário DASH. Na avaliação pelo questionário WHOQOL-bref, encontramos melhora no domínio psicológico, consequente à intervenção. Cada participante do programa de intervenção RMI relatou pelo menos um estado de relaxamento e satisfação. Conclusão: Foi possível desenvolver e descrever um método de massagem em imersão visando relaxamento, utilizável por graduandos em Fisioterapia, a partir de seu manual, e apropriado para induzir adequações nos sistemas musculoesquelético e cardiovascular, como indicadores de resposta fisiológica de relaxamento muscular. Estes dados são compatíveis com os relatos das participantes / Contextualization: Physiotherapy lacks intervention programs previously tested to be used in the aquatic environment aiming muscle relaxation induction. Previous studies provide sufficient basis for build programs. Design and purpose: quasi-experimental study with four objectives: 1. Develop and describe in descriptive and illustrated manual a Technique of Massage and Mobilization during Immersion for Relaxation (RMI); 2. Evaluate the relevance and technical quality of RMI through submission to referees; 3. Evaluate usability and self learning through the study of the RMI manual; 4. To evaluate the effect of physiotherapy intervention with RMI in healthy older women. Methods: In order to achieve these goals the study was executed in four phases: 1. Development of Technique of Massage and Mobilization during Immersion for Relaxation (RMI), carried out through literature review, meetings of researchers and construction of descriptive and illustrated manual. 2. Evaluation of the manual by 20 referees using a form. 3. Usability and self-learning analysis. Participated 10 Physiotherapy undergraduate. The student applied the RMI in healthy volunteers. The practical activity was assessed by the research and independent examiner using valuation script based on the program description. 4. Analysis on the effect of the RMI in relaxation indicators, applied in 12 healthy elderly women. The intervention consisted of 10 sessions lasting an hour and a half each one, once a week. The study was conducted at Laboratory of Physiotherapy and Behaviour of Physiotherapy Course, Medical School, University of São Paulo and in the SIMMM Integrated Rehabilitation Clinic\'s pool. Statistical analysis was pertinent to each phase of the study: 1. Development of physiotherapy intervention program based on literature and manual writing; 2. Organization of responses from referees by category of answers and statistical descriptive analysis of the degrees from referees; 3. Analysis of the statistical analysis of degrees and inter-rater reliability analysis of the evaluation executed by the examinators; 4. Descriptive and comparative analysis of pre and post-intervention data of flexibility, joint mobility, cardiovascular response, scores in the DASH, FAOS and WOGOOL questionnaires and categorization of answers. Results: The methodology applied allowed the development of the RMI and construction of descriptive manual, enriched with suggestions from referees. The manual proved to be usable and sufficient to convey practical knowledge, no third part intervention, targeting education. The number of case studies showed that the practice of RMI improved shoulder joint mobility (medial and lateral rotation right and left with p=0,001) and ankle joint mobility (extension - left p < 0.001, extension - right p=0,0017 and bending left p=0,001) and affected the cardiovascular response showing relaxation (p=0,04). Each participant in the RMI intervention program reported at least one state of relaxation and satisfaction. Conclusion: It was possible to develop and describe a method of massage and mobilization in immersion to induced relaxation usable by students in Physiotherapy from its manual (with adjustments by referees) appropriate for change musculoskeletal and cardiovascular systems, as response indicators of physiological muscular relaxation. There was improvement in motor function of the upper limbs, assessed by DASH questionnaire. In the evaluation by WHOQOL-bref questionnaire it was found an improvement in the psychological domain, consequent to the intervention. These data are consistent with the reports from the participants

L'étude du paysage balnéaire de Rome dans l'Antiquité (Ier siècle av. J.-C.- Ve siècle ap. J.-C.) a pour but de combler certaines lacunes concernant la recherche sur les bains dits mineurs dans la capitale de l'Empire. La thèse a suivi essentiellement cinq grands axes : nous avons au préalable défini un cadre historique et social à notre étude en insistant sur les problèmes relatifs à l'origine du bain romain et à sa diffusion en péninsule italique. Nous nous sommes ensuite penchés sur les problèmes méthodologiques rencontrés lors de l'établissement de notre corpus. Afin d'appréhender de manière concrète le paysage balnéaire romain, nous avons en effet établi une base de données dont chaque entrée correspond à un complexe balnéaire connu par les sources (archéologiques, épigraphiques et littéraires). Ce catalogue a été abordé sous forme descriptive dans notre troisième grande partie. Notre quatrième axe concerne particulièrement la législation relative à ces balnea, la définition de leur statut et l'identification de leurs propriétaires. Enfin, une étude typologique et technique des bains de Rome s'est révélée nécessaire pour terminer cette étude de façon exhaustive. / The study of the baths landscape of Rome in the Antiquity(Ist century B.C.- Vth century A.D.) aims at filling certain gaps concerning the research on the minor baths in the capital of the Empire. The thesis followed essentially five main chapters: we beforehand defined a historic and social frame in our study by insisting on the relative problems at the origin of the Roman bath and in its distribution in italic peninsula. We then bent over the methodological problems met during the establishment of our corpus. To conceive in a concrete way the Roman bath landscape, we indeed established a database every evidence of which corresponds to a bath complex known by sources(archaeological, epigraphic and literary). This catalog was approached under descriptive shape on our third chapter. Our fourth axis concerns particularly the legislation relative to these balnea, the definition of their status and the identification of their owners. Finally, a typological and technical study of the baths of Rome showed itself necessary to end this study in a exhaustive way.

Made available in DSpace on 2016-08-10T10:57:43Z (GMT). No. of bitstreams: 1 Gustavo Silva de Azevedo.pdf: 1566920 bytes, checksum: 8f879f682c9eb319532582fd98a88976 (MD5) Previous issue date: 2015-09-22 / Quality of life can vary in perceived health status, social participation and autonomy during the aging process. The functional impairment in the elderly can be minimized by promoting health through physical exercise. The hydrotherapy held in heated water can promote benefits by virtue of the physical properties of water, physiological effects of immersion and systematic progress of the exercises. The aim of this study was to evaluate the effects of Halliwick on the quality of life in active elderly. Quasiexperimental study of pre- and post-attended by 12 elderly enrolled in the waiting list, awaiting care in an Educational Association. All seniors were submitted individually to the questionnaire WHOQOL Bref and hydrotherapy Protocol, held in groups of six elderly, based on the Halliwick method in 24 sessions held twice a week on fixed days, with sessions of 40 minutes in length, made in heated pool. To evaluate the data were used the program Statistical Package for Social Sciences (SPSS) version 15.0, Excel Office 2013 and the paired Wilcoxon test. Results: In this study, we had the participation of 12 elderly aged 70.67 (± 6.49 years), 10 women, married (41.66%), with low education, retired with an extra financial activity (58, 3%), most reported monthly income of up to two minimum salaries. After the accession of hydrotherapy, some of the participants got improved quality of life in three areas, prevailing an increase in the field environment, which is related to physical security and protection; health and social care; opportunity to acquire new skills; participation and opportunity for recreation and leisure. The pattern of scores showed a reduced impact on the protocol proposed effects of hydrotherapy on quality of life. However favored the elderly a brief physical and psychological restructuring, management of their health condition and self-care, that are conducive to well-being and quality of life. / A qualidade de vida pode variar quanto à percepção do estado de saúde, a participação social e a autonomia no decorrer do processo de envelhecimento. O comprometimento funcional dos idosos pode ser minimizado pela promoção da saúde, através da prática de exercícios físicos. A hidroterapia realizada em água aquecida pode promover benefícios em virtude das propriedades físicas da água, dos efeitos fisiológicos da imersão e da progressão sistematizada dos exercícios. O objetivo desse estudo foi avaliar os efeitos do Halliwick sobre a qualidade de vida em idosos ativos. Estudo quase experimental do tipo antes e depois onde participaram 12 idosos cadastrados em lista de espera, que aguardavam atendimento em uma Associação Educativa. Todos idosos foram submetidos de forma individual ao questionário WHOQOL Bref e ao protocolo de hidroterapia, realizado em grupos de seis idosos, baseado no Método Halliwick em 24 sessões, realizado duas vezes por semana em dias fixos, com sessões de 40 minutos de duração, realizadas em piscina aquecida. Para avaliar os dados obtidos foram utilizados os programas Statistical Package for Social Science (SPSS) versão 15.0, Excel Office 2013 e o Teste de Wilcoxon pareado. Resultados: Nesse estudo, tivemos a participação de 12 idosos com idade de 70,67 (± 6,49 anos), sendo 10 mulheres, casados (41,66%), com baixa escolaridade, aposentados com uma atividade financeira extra (58,3%), a maioria informou renda mensal de até dois salários mínimos. Após a adesão da hidroterapia, uma parcela dos participantes obteve melhora na qualidade de vida em três domínios, prevalecendo um acréscimo no domínio Ambiente, o qual se relaciona com segurança física e proteção; cuidados de saúde e sociais; oportunidade de adquirir novas habilidades; participação e oportunidade de recreação e lazer. O padrão de escores apresentou uma repercussão reduzida dos efeitos do protocolo proposto de hidroterapia na qualidade de vida. Entretanto propiciou ao idoso uma sucinta reestruturação física e psicológica, gerenciamento de sua condição de saúde e o autocuidado, que são favoráveis ao bem-estar e à qualidade de vida.

A estimativa das forças musculares durante o movimento humano tem inúmeras aplicações na área da Biomecânica. Nesse trabalho descrevo a aplicação de métodos de estimativa das forças musculares a dois diferentes problemas. O primeiro consiste em se quantificar as cargas a que os músculos e as articulações do membro inferior de adultos jovens estão sujeitos durante o andar em ambiente aquático e terrestre. Já o segundo consiste na investigação do efeito do aumento da complacência do tendão de Aquiles (TAq; tendão do triceps sural) na dinâmica de produção de força dos músculos gastrocnêmio e sóleo (G e S respectivamente; ambos músculos do triceps sural), visando compreender se o aumento da complacência, observado com o envelhecimento, poderia contribuir para as alterações na biomecânica da marcha de idosos. A hipótese no primeiro estudo era de que as forças desenvolvidas pelos músculos do membro inferior durante o andar em ambiente aquático não seriam menores em relação ao ambiente terrestre. Especificamente, esperávamos observar um aumento nas forças geradas nos flexores e extensores de quadril e joelho. No segundo estudo, nossas hipóteses eram de que o aumento na complacência do TAq faria com que as fibras musculares operassem mais distantes do seu comprimento ótimo, aumentando os níveis de ativação e o consumo metabólico dos músculos G e S. Com o objetivo de verificar as hipóteses levantadas nos dois estudos propostos utilizamos o software OpenSim 3.1 e dados experimentais dos movimentos estudados, para realizar simulações do andar humano e estimar as forças nos músculos do membro inferior durante essa tarefa. Em ambos os estudos os dados experimentais foram adquiridos através de sistemas de análise do movimento humano compostos por câmeras, para filmar os movimentos corporais dos voluntários, e plataformas de força, para medir as forças de reação do solo. Os resultados obtidos no primeiro estudo confirmaram nossas hipóteses, uma vez que indicam que durante determinadas fases do ciclo da marcha as forças geradas pelos músculos flexores e extensores de joelho e quadril, tais como os músculos isquiotibiais e o gluteo máximo, podem exceder as forças geradas em ambiente terrestre. Esses resultados corroboram a idéia de que o andar em ambiente aquático pode ser efetivo no ganho de força muscular. As hipóteses para o segundo estudo também foram confirmadas. Adicionalmente, nossos resultados previram que, para o triceps sural gerar a potência necessária para manter o indivíduo andando com velocidade confortável, os tendões dos músculos G e S devem se movimentar de maneira independente. A diferença no movimento dos feixes do TAq é tanto maior quanto maior a sua complacência. Além disso, verificamos que há um mínimo no consumo metabólico do gastrocnêmio em um nível específico de complacência do TAq, enquanto para o sóleo o consumo aumenta sistematicamente com o aumento da complacência. Esses resultados indicam que um aumento na complacência do TAq pode comprometer o desempenho dos músculos do triceps sural e aumentar o seu consumo energético, contribuindo para as alterações na biomecânica da marcha de idosos. As informações fornecidas nos dois estudos aqui apresentados podem auxiliar profissionais de área da saúde no planejamento de programas de treinamento e reabilitação para adultos e idosos, tanto no ambiente terrestre quanto no ambiente aquático. / Muscle force estimation during human motion has numerous applications in Biomechanics. In this work, we describe the application of methods of muscle force estimation to solve for two different problems. The first problem is to quantify lower limb muscle and joint loads that young adults are subjected to when walking in the aquatic and terrestrial environment. The second problem is to understand the effect of increased Achilles tendon compliance (AT; the triceps surae tendon) in the gastrocnemius and soleus contractile dynamics (G and S respectively; both triceps surae muscles), aiming at understanding if increased AT compliance, that occurs with aging, could play a role in the elderly gait alterations. Our hypothesis for this first study was that the forces developed by the lower limb muscles in water are not always lower than on land. Specifically, we hypothesized that the forces developed by the hip and knee flexors and extensors would be grater in water than on land. For the second study our hypothesis was that the compliant AT would cause the fibers to operate far from its optimal length resulting in higher levels of activation in both G and S, as well as higher specific metabolic consumption. In order to verify our hypotheses for both studies we used the software OpenSim 3.1 together with experimental data of volunteers walking in aquatic and terrestrial environments to simulate human walking and to estimate the forces developed by the lower limb muscles during this task. In both studies, experimental data were acquired through human movement analysis systems composed of cameras, to record the movements of the volunteers\' body, and force plates, to measure ground contact forces. We confirmed our hypotheses to the first study since our results showed that in certain periods of the gait cycle the forces developed in the knee and hip flexors and extensors, such as the hamstrings and the gluteus maximus, inside water exceeded the forces in corresponding periods of land walking. Those results corroborate the idea that walking inside water may be effective in muscle strengthening. We also confirmed our hypotheses to the second study. Additionally, we predicted that to generate the necessary power to walk with comfortable speed the triceps surae G and S tendon must move independently. This differential behavior becomes larger the greater the AT compliance. In addition, we also observed that G metabolic energy consumption was minimized for a specific level of AT compliance while S systematically increased. Those results suggest that increased AT compliance can compromise the triceps surae performance and increase metabolic consumption, contributing to the alterations on the elderly gait biomechanics. The results of our two studies may assist health professionals to better plan training and rehabilitation programs for adults and elderly in both, terrestrial and aquatic environment.

SAMMANFATTNING Hydroterapi har under en längre tid använts som behandlingsform, men det är brist på forskning inom området. Syftet med denna studie var att undersöka upplevelsen av hydroterapi hos personer med reumatisk sjukdom. En kvalitativ ansats anlades och enskilda semistrukturerade intervjuer användes. Deltagarna rekryterades genom bekvämlighetsurval via en kontakt på en reumatologklinik. Sex personer inkluderades: fem hade reumatoid artrit och en hade pelvospondylit. Resultatet tolkades med hjälp av en kvalitativ innehållsanalys, som visade på att deltagarna i denna studie var positivt inställda till hydroterapi. Deltagarna upplevde att hydroterapin ledde till minskad smärta, ökad rörlighet samt ett ökat välmående. Utöver de upplevda positiva effekterna återfanns även upplevda negativa effekter i form av träningsvärk och en ökad stelhet under sommaruppehållen. Det sociala samspel som uppstod i samband med hydroterapin upplevdes av de flesta deltagare ha haft positiv betydelse. Deltagarnas upplevelser kunde i diskussionen kopplas till operant och respondent inlärningsteori, där tänkbara konsekvenser och stimulin identifierades. Slutsatsen som drogs var att deltagarna upplevde hydroterapin som ett sätt att få tillbaka sin friska kropp genom att symtomen minskade. Då deltagarna upplevde att uppehåll orsakade försämring behövs hydroterapi som kontinuerlig behandlingsform för dem. Vidare forskning inom området bör fokuseras på enskilda patientgrupper samt inkludera ett större antal deltagare per patientgrupp. Nyckelord: hydroterapi, intervju, kvalitativ, pelvospondylit, reumatoid artrit.

Syfte: Att kartlägga förutsättningarna för gravida kvinnor att använda dusch och bad som smärtlindring på Sveriges förlossningsavdelningar. Metod: Deskriptiv tvärsnittsstudie genomfördes med telefonintervjuer utifrån ett frågeformulär. Deltagare: Alla 48 Sveriges förlossningsavdelningar deltog i studien. Respondenter var chef för förlossningsavdelning alternativt barnmorska som arbetar på förlossningsavdelning. Resultat: Förutsättningarna för att nyttja dusch och bad som smärtlindring varierar i Sverige. Många undantag finns för vem som får bada. Dusch och bad används tämligen frekvent. Infor­mation om denna smärtlindringsmetod ges mestadels muntligt. Detta har ändå inträffat senaste året. Riktlinjer för dusch och bad som smärtlindring finns på färre än hälften av för­lossnings­avdelningarna och enbart fem av dessa riktlinjer har referenser till forskning. Ingen förlossnings­avdelning bedriver vård med vattenförlossningar men detta har ändå skett på tio för­lossnings­avdelningar senaste året. Ingen avdelning har riktlinjer för hur vattenförlossning ska handläggas. Slutsats: Möjligheterna till dusch och bad som smärtlindring är mycket olika i landet. Eftersom vården ska vara lika oavsett hemort bör detta ses över. Riktlinjer bör utarbetas för ett gemensamt arbetssätt baserad på aktuell forskning. / Objective: To chart the possibilities for hydrotherapy, i.e. bathing or showering, during labour in Swedish labour wards. Design: Descriptive, cross-sectional interview study involving short phone interviews based on an interview schedule. Participants: All 48 labour wards in Sweden participated. Head of labour ward or midwife working in labour ward was interviewed. Findings: The possibilities for hydrotherapy varied. Many women are for various reasons not allowed to bathe. Hydrotherapy is relatively commonly used in Sweden. Information about hydrotherapy is mostly given verbally. Less than half of the labour wards have guidelines for hydrotherapy, only five have references to current research. Water births are not allowed but have despite this occurred in ten labour wards during the last twelve months. None of the labour wards have guidelines for management of water birth. Key conclusions and implications for practice: The Swedish government has decided that all individuals should receive equal care. There is much to be done to nationally achieve equal possibilities for hydrotherapy during childbirth. Guidelines based on current research for handling hydrotherapy and water birth are needed.

Made available in DSpace on 2014-06-11T19:31:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-02Bitstream added on 2014-06-13T20:01:40Z : No. of bitstreams: 1 souza_sf_dr_jabo.pdf: 2488552 bytes, checksum: d73363ffa31e0435be147582710b8e53 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Avaliou-se a resposta de diferentes protocolos fisioterapêuticos em cães após a indução de atrofia muscular por meio da imobilização do joelho por 30 dias. Os grupos foram denominados grupo C ou controle, grupo M (massagem e movimentação passiva), grupo E (massagem, movimentação passiva e eletroterapia), grupo H (massagem, movimentação passiva e hidroterapia em esteira aquática) e grupo EH (massagem, movimentação passiva, eletroterapia e hidroterapia em esteira aquática). Foram mensurados, os graus de claudicação, amplitude articular, circunferência da coxa, variação sérica das enzimas creatina-quinase e lactato-desidrogenase, bem como a morfometria muscular das fibras de contração rápida e contração lenta do músculo vasto lateral marcadas pela técnica de imunoistoquímica. Os cães do grupo H apresentaram retorno mais precoce à função do membro pélvico direito, mostrando que a hidroterapia pode ser beneficamente empregada para a recuperação em cães claudicantes. A fisioterapia reduziu a contratura articular. Verificou-se maior recuperação da área transversal das fibras musculares de contração lenta e rápida nos cães submetidos à eletroterapia aos 60 dias de pós-operatório. De acordo com os resultados encontrados, foi possível concluir que as modalidades terapêuticas de massagem, movimentação passiva da articulação, estimulação elétrica neuromuscular e hidroterapia por caminhada em esteira aquática aceleram a recuperação clínica em cães com atrofia muscular induzida / The response to different physiotherapeutic protocols was evaluated in dogs with muscle atrophy induced by a 30-day-long immobilization of the stifle joint. The animals were divided in groups namely: C (control), M (massage and passive range of motion), E (massage, passive range of motion and neuromuscular electrical stimulation), H (massage, passive range of motion and hydrotherapy in underwater treadmill), and EH group (massage, passive range of motion, neuromuscular electrical stimulation and hydrotherapy in underwater treadmill). The degree of lameness, range motion, thigh circumference, range of serum creatine kinase (CK) and lactate dehydrogenase (LDH) were then evaluated, as well as the morphometry of fast- and slow-twitch muscle fibers of the vastus lateralis by immunohistochemistry. Group H dogs regained function of the right hind limb faster than the other groups. This result shows that hydrotherapy helped in the recovery process of lame dogs. Physiotherapy reduced the joint contracture. There was a higher recovery rate of cross-sectional area of slow-twitch and fast-twitch muscle fibers and thigh circumference in dogs submitted to neuromuscular electrical stimulation at 60 days post-surgery. According to these results, it was possible to conclude that therapeutics modalities such as massage, passive range of motion of the joint, neuromuscular electrical stimulation and hydrotherapy by walking on underwater treadmill accelerate clinical recovery in dogs with induced muscle atrophy