Orientador: Donizeti Cesar Honorato / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T00:41:21Z (GMT). No. of bitstreams: 1 Silva_AdrianaTeresa_M.pdf: 5979152 bytes, checksum: 4f4aa8d6d612af76e9680bc18aff0911 (MD5) Previous issue date: 2013 / Resumo: O Acidente Vascular Cerebral (AVC) é um problema de saúde pública relevante em virtude de sua alta frequência e de grande impacto na população. Classificam-se, como uma das quatro causas mais comuns de morte no mundo, sendo considerada uma doença incapacitante, e que limita a qualidade de vida. Objetivo deste estudo foi investigar o efeito imediato da vibração de corpo inteiro na função motora de pacientes acometidos por AVC. Trata-se de um ensaio clínico randomizado, nos quais foram alocados quarenta e três indivíduos (33 grupo intervenção - GI - e 10 grupo controle - GC) com sequela de hemiparesia decorrente de AVC. Aplicou-se no GI uma sessão de terapia vibratória (frequência - 50 Hz e amplitude - 2 mm) por 4 série de 1 minuto com descanso de 1 minuto entre as séries, em 3 posições: apoio bipodal com joelho fletido a 30º e a 90º, apoio unipodal sobre o membro parético. Os testes aplicados para análise foram: o teste de caminhada de 6 minutos (TC6M), teste de escada (TSE), teste de time get-up-and-go (TGUG) e a avaliação eletromiográfica (EMG). A EMG foi aplicada na contração isométrica voluntária simultaneamente para os músculos tibial anterior e retofemural ambos do lado acometido e não acometido (TAA e TANA; RFA e RFNA) respectivamente. Aplicou-se para análise estatística o teste t independente para comparar as características basais dos grupos, teste t pareado e o teste de ANCOVA para verificar o efeito da intervenção no grupo e no tempo. Os resultados demonstram que não há evidência de efeitos na interação grupo e tempo para as variáveis RFA, RFNA, TAA, TANA e TSE (p?0,05). Há evidências de efeito na interação grupo para as variáveis TC6M e para TGUG (p<0,05). Conclui-se que o efeito imediato da vibração de corpo inteiro não contribuiu para melhora da função motora em pacientes acometidos por Acidente Vascular Cerebral / Abstract: Stroke is a relevant public health problem, due to its high frequency and strong impact on the population. It is classified as one of the four most common causes of death worldwide and is considered to be a disabling disease, which limits the patients' quality of life. The aim of this paper was to investigate the immediate effects of whole body vibration on the motor function of patients affected by stroke. This is a randomized clinical trial, where forty-three hemiparetic subjects, due to stroke sequel, were allocated (33 for the intervention group - IG - and 10 for the control group - CG). For the IG subjects a vibratory therapy (50 Hz frequency and 2 mm amplitude) session was applied consisting of four series of stimulation of 1-minute each with a 1-minute resting interval among all series, in three different positions: bipodal landing position with knees bent at 30º then at 90º and finally, unipodal landing position on the hemiparetic limb. The tests used for the analysis were the 6 minute walking test (6MWT), stair climbing test (SCT), time get-up-and-go test (TGUGT) and electromyographic evaluation (EMG). The latter was applied simultaneously, at isometric voluntary contraction, of tibialis anterior and rectus femorais muscles', both affected and unaffected sides (TAA and TAU ; RFA and RFU) respectively. For statistical analysis, the independent t test was applied to compare the baseline characteristics of the groups and the paired t test as well as ANCOVA to determine the effect of the intervention in both the groups and time. The results show no evidence of effects in group and time interaction for the RFA, RFU, TAA, TAU and SCT variables (p?0.05). There is evidence of effect on the group interaction for the 6MWT and TGUGT variables (p<0.05). It was concluded that, the immediate effects of whole body vibration have not contributed for the improvement of stroke-patients' functional motor / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

The overall aim was to evaluate the effectiveness of forced use on arm and hand recovery after stroke by applying a restraining sling on the non-affected arm and to investigate psychometric properties of selected upper limb measures. Papers I and II reported a randomised trial with 1- and 3-month follow-ups. Thirty patients 1 to 6 months after stroke were included and received regular training for 2 weeks of intervention. The forced-use group had in addition a restraining sling on the non-paretic arm. Outcome measures were the Fugl-Meyer Assessment, the Modified Ashworth scale, the 16-hole peg test, grip force, the Action Research Arm test, and the Motor Assessment Scale (Paper I), and the Motor Activity Log (MAL) (Paper II). Results in Papers I and II showed no statistical difference in change between groups. Both groups improved over time. Paper III assessed the responsiveness of the MAL and its cross-sectional and longitudinal validity. The MAL was responsive to change, with Standardised Response Means and Responsiveness Ratios larger than 1.0. Correlations between the MAL and the other measures were mostly close to 0.50. Paper IV investigated test–retest intra-rater reliability of measuring grip force with Grippit, and assessed relationships between grip forces of both hands, and between sustained and peak grip force. The paretic hand needs to score a change of 10% or 50 N to exceed the measurement error. The mean ratio between sides was 0.66, and between sustained and peak grip force, 0.80–0.84. In conclusion, this thesis provides preliminary evidence that forced use does not generate greater improvement on upper limb motor impairment, capacity, and performance of activity than regular rehabilitation. The findings indicate that the MAL is a responsive measure of daily hand use in patients with stroke. Correlations of construct validity indicated that daily hand use might need to be measured separately from body function and activity capacity. The coefficients calculated for repeatability and reproducibility were acceptable, and the Grippit instrument can be recommended.

The physical culture, which includes physical education, recreation and sports, is a very intensely discussed topic, which is being given ever more attention at both the lay and the professional level. This issue is also addressed at the national level, as sport and movement generally bring a number of positive externalities in particular. These include, for example, a reduction in the level of bulky non-infectious diseases that allow for financial savings in healthcare. Another positive impact of the higher physical culture of the population is the social and cultural cultivation of human potential, which leads to the reduction of problems in the field of crime or drug issues. The modern world is facing a number of problems and the lack of movement is one of them. Even in younger children, the negative effects of the current lifestyle of the population are manifested as civilization diseases. Among the most common among children are allergies, respiratory diseases, cardiac and vascular diseases, but also body weaknesses that bind joint or back pain. Outer form of these problems is obesity, a relatively serious illness that affects a growing group of children. These diseases can be prevented by regular physical activity. In order for the population to devote sufficient attention to physical...

Introduction: Persons with Parkinson’s disease (PD) experience changes cortically, subcortically and behaviorally. This dissertation examines the asymmetry of motor behavior to explore the role of asymmetry in persons with PD and its connection to clinical symptoms. Purpose: Project 1: To assess the hand asymmetry difference in young adults versus older adults. Project 2: To investigate the difference in hand asymmetry in older adults and persons with PD. Project 3: To explore the correlation between function and clinical symptoms of persons with PD. Methods: 55 right-handed participants [Young Adults (YA) = 20, Female = 10; Older Adults (OA) = 20, Female = 10; Persons with PD = 15, Female = 5] were recruited and performed motor tasks: Purdue Pegboard test, grip strength test, response task, thumb opposition task, tapping task, three variations of timed-up-and-go test (TUG), single leg stance task (SLS), Weight Distribution test and Limits of Stability test. The two-way ANOVA was conducted to examine a variance between YA and OA. A separate two-way ANOVA was conducted comparing variance between OA and persons with PD. The purpose was to explore asymmetries, characterized by a significant difference between groups’ left and right sides. Pearson’s correlation was implemented to examine connection of clinical symptoms and motor behavior. Statistics: IBM SPSS 24 software was used. Two 2-way ANOVAs with the between group factor of group (Young vs. Older in Project 1; Older vs. PD in project 2), and within group factor of hand (Right vs. Left in Study 1 & Study 2) were used to examine if age (or PD) changes hand asymmetry. Pearson’s correlation coefficient was used to determine correlations between Unified Parkinson’s Disease Rating Scale (UPDRS) and motor tasks in PD patients (Study 3). Results: Project 1: Results indicate asymmetry reduces with age in fine motor tasks containing speed, dexterity and strength components. Project 2: The basal ganglia dysfunction does not overall further exacerbate the reduced asymmetry with age. Project 3: Clinical symptoms of PD measured by the UPDRS are generally not associated with fine motor tasks of this study.

In its general section, the thesis 'Rehabilitation of Pediatric Patients after Epilepsy Surgery with Postoperative Motor Deficits' discusses epilepsy, treatment of intractable epilepsy and epilepsy surgery. Furthermore, a chapter on possible complications of epilepsy surgery in relation to the locomotor apparatus is included in the general section. The special section deals with rehabilitation in neurology, selected physiotherapy concepts and the relationship between epilepsy and movement activity. The aim of this thesis is to assess the effectiveness of the chosen rehabilitation procedure in five pediatric patients with post-operative motor deficiency. The Gross Motor Function Measure - 88, the Barthel Index and the Box and Blocks Test were used for objective motor assessment.

Bakgrund: För de som överlever en stroke drabbas många av kraftiga funktionsnedsättningar. Nedsatt motorisk funktion är en av de vanligaste funktionsnedsättningarna. Spegelterapi är en relativt ny behandlingsmetod som visats ha god effekt på att återfå funktion. Det finns en kunskapslucka inom området och evidensen kring spegelterapi behöver stärkas. Där spelar litteraturöversikter en väsentlig roll för att uppdatera om det rådande evidensläget samt optimera framtida forskning.  Syfte: Att undersöka evidensläget för effekterna av spegelterapi på motorisk funktion i övre extremitet hos personer med hemipares efter stroke i ett subakut och kroniskt stadium.  Metod: Studien genomfördes med en litteraturstudie där randomiserade kontrollerade studier inkluderades. Sökningar genomfördes i databaserna PubMed och Cinahl. Artiklarnas enskilda risk för snedvridning granskades enligt PEDro-scale och resultatets sammanvägda tillförlitlighet granskades enligt “Bedömning tillförlitlighet systematisk översikt”. Resultat: Totalt inkluderades nio artiklar där alla bedömdes ha låg risk för snedvridning enligt PEDro-scale. Av de nio visade fem artiklar en signifikant skillnad till interventionsgruppens fördel. Den sammanvägda bedömningen gällande effekten av spegelterapi på motorisk funktion i övre extremitet visade på en låg (++) tillförlitlighet enligt “Bedömning tillförlitlighet systematisk översikt”. Konklusion: Fler än hälften av studierna visade att spegelterapi har effekt och är en säker rehabiliteringsmetod för personer med stroke och nedsatt motorisk funktion i övre extremitet. Ytterligare forskning av hög kvalitet behövs för att säkert kunna styrka dess effektivitet. / Background: For those who survive a stroke, many suffer from severe disabilities. Impaired motor function function is one of the most common disabilities. Mirror therapy is a relatively new treatment method that has been shown to be effective in regaining function. There is a knowledge gap in this area, and the evidence regarding mirror therapy needs to be strengthened. Literature reviews play an essential role in updating the current state of evidence and optimizing future research. Purpose: To investigate the evidence regarding the effects of mirror therapy on motor function in the upper extremities of individuals with hemiparesis following stroke in a subacute and chronic stage. Method: The study was conducted through a literature review, including randomized controlled trials. Searches were conducted in the PubMed and Cinahl databases. The individual risk of bias of the articles was assessed using the PEDro scale, and the combined reliability of the results was assessed using the “Bedömning tillförlitlighet systematisk översikt”. Results: In total, nine articles were included, all assessed to have low risk of bias according to the PEDro scale. Of these nine, five articles demonstrated a significant advantage for the intervention group. The combined assessment regarding the effect of mirror therapy on upper extremity motor function showed low (++) reliability according to the "Bedömning tillförlitlighet systematisk översikt" Conclusion: More than half of the studies showed that mirror therapy is effective and a safe rehabilitation method for individuals with stroke and impaired motor function in the upper extremity. Further high-quality research is needed to definitively confirm its effectiveness.

Os polinizadores são organismos fundamentais para o funcionamento de ecossistemas naturais e agrícolas, incrementando mais de 75% na produção das culturas agrícolas. Dentre os animais que participam do processo de polinização, as abelhas são consideradas as mais efetivas. Entretanto, um constante declínio na população desses polinizadores vem sendo reportado em diversos países, levando a preocupações ecológicas e econômicas, devido às perdas, tanto na produtividade agrícola como na biodiversidade. Dentre as diversas hipóteses para o declínio, o uso intensivo de agrotóxicos na agricultura tem causado preocupação, já que muitos destes compostos possuem um amplo espectro de ação, atingindo não somente os organismos alvo, mas também insetos benéficos, como as abelhas. Assim, objetivou- se com este estudo avaliar resíduos do inseticida neonicotinoide imidacloprido em amostras de flores de citros e a sua influência na riqueza de espécies de abelhas presentes nos pomares, bem como os possíveis efeitos dessas concentrações na atividade locomotora de abelhas Apis mellifera africanizada, Scaptotrigona postica e Tetragonisca angustula após exposição oral em condições de laboratório. Além disso, estimou-se a concentração letal média (CL50) dos neonicotinoides mais utilizados (acetamiprido, imidacloprido, tiacloprido e tiametoxam) para estas espécies de abelhas, e os níveis de comprometimento motor após exposição de abelhas a essas concentrações. Imidacloprido foi detectado em amostras de flores de todo os pomares, com maior concentração para área em Anhembi/SP (6,26 ng g-1 de imidacloprido) e menor concentração em Barretos/SP (3,24 ng g-1 de imidacloprido). Foram identificadas, no total, 17 espécies de abelhas visitando flores de citros, com predominância de A. mellifera em todos os pomares. No entanto, não houve relação entre a riqueza de espécies e de imidacloprido residual. Alterações significativas na atividade locomotora foram verificadas após exposição às concentrações de 0,006 e 6,26 ng &#181;L-1 de imidacloprido, com maior alteração nas variáveis de duração e frequência de repouso. Além disso, verificaram-se diferentes níveis de toxicidade entre os ingredientes ativos estudados, com menor toxicidade oral aguda para os compostos com radical ciano (acetamiprido e tiacloprido) e maior para os que apresentam radical nitro (imidacloprido e tiametoxam). A locomoção das três espécies de abelhas foi reduzida em relação ao controle após exposição a todos os neonicotinoides. Com menor nível de comprometimento quando expostas ao acetamiprido. Assim, os resultados obtidos neste estudo esclarecem os efeitos dos inseticidas neonicotinoides sobre as espécies de abelhas na região Neotropical, e contribuem para a formulação de estratégias para integrar o controle de pragas e conservação dos polinizadores. / Pollinators are fundamental organisms for the functioning of natural and agricultural ecosystems, increasing more than 75% the production of agricultural crops. Among the animals that participate in the pollination process, bees are considered the most effective. However, a steady decline in the population of these pollinators has been reported in several countries, leading to ecological and economic concerns, due to the losses in both agricultural productivity and biodiversity. Among the several hypotheses for the decline, the intensive use of pesticides in agriculture the fields has caused concern, as many of these compounds possess a broad spectrum of action, reaching not only the target organisms, but also beneficial insects, as bees. Thus, the objectives of this study were to detect and quantify the residual concentration of imidacloprid in samples of citrus flowers and if these concentrations influence the richness of bee species present in the orchards, as well as the possible effects of these concentrations on the locomotion activity of three bee species (Africanized Apis mellifera, Scaptotrigona postica and Tetragonisca angustula) after oral exposure under laboratory conditions. In addition, the median lethal concentration (LC50) the most used neonicotinoids (acetamiprid, imidacloprid, thiacloprid and thiamethoxam) to these bee species was estimated, and the levels of motor impairment after bee exposure to these concentrations. Imidacloprid was detected in flower samples in all orchards, with a higher concentration in Anhembi/SP (6.26 ng g-1 of imidacloprid) and lower concentration in Barretos/SP (3.24 ng g-1 of imidacloprid). A total of 17 species of bees were identified visiting citrus flowers, predominating A. mellifera in all orchards. However, there was no relationship between species richness and residual imidacloprid concentrations in the flowers of each evaluated region. Significant changes in the activity bee locomotion were observed after exposure to concentrations of 0.006 and 6.26 ng &#181;L-1 of imidacloprid, with a higher level of impairment for the variables duration and frequency of rests. In addition, different levels of toxicity were observed among the active ingredients studied, with lower acute oral toxicity for cyano compounds (acetamiprid and thiacloprid) and higher for those with nitro radical (imidacloprid and thiamethoxam). The locomotion of the three bee species was reduced in relation to the control after exposure to all neonicotinoids, with a lower level of impairment when exposed to acetamiprid. Thus, the results obtained in this study shed light on the effects of neonicotinoid insecticides on bee species the Neotropical region, and contribute the formulation of strategies to integrate pest control and pollinator conservation.

A isquemia cerebral é uma enfermidade grave, de incidência e prevalência global, considerada uma das principais causas de morte e incapacidade no mundo. Ela é decorrente da hipoperfusão ou interrupção sanguínea em uma determinada região encefálica e a falta de oxigênio e glicose leva a falha no metabolismo energético de neurônios e células gliais. A morte destas células libera grande quantidade de glutamato, o principal neurotransmissor excitatório, o que desencadeia a cascata isquêmica, formada por estresse oxidativo, excitotoxicidade e processo inflamatório. Estes insultos causam danos teciduais graves que comprometem, principalmente, o sistema sensorimotor, memória, cognição e as emoções. A guanosina, um derivado da guanina, tem mostrado papel neuroprotetor ao sistema nervoso central, agindo no sistema glutamatérgico. Esses efeitos têm sido demonstrados em ratos machos, mas não em fêmeas, por isso, o objetivo desta tese foi investigar através de testes comportamentais, imunoistoquímico e histológico, a ação da guanosina em ratos Wistar machos e fêmeas induzidos cirurgicamente a um modelo de isquemia focal permanente do córtex cerebral parietal, levando em consideração o ciclo estral das fêmeas imediatamente antes da indução isquêmica. Este trabalho foi aprovado pela Comissão de Ética no Uso de Animais da UFRGS (Nº 29396). Após a verificação do ciclo estral, fêmeas e machos foram anestesiados, posicionados em aparelho estereotáxico e a isquemia focal cortical foi induzida por termocoagulação dos vasos piais. Ao término da cirurgia, os animais foram tratados com solução salina 0,9% ou guanosina 60 mg/kg, ambos por via intraperitoneal, em 4 doses (0, 1, 3 e 6 horas após a indução isquêmica). No teste do cilindro, as fêmeas apresentaram significativamente melhor recuperação sensorimotora a longo prazo comparadas aos machos. No teste do campo aberto, memória de habituação a longo prazo e locomoção em fêmeas foram prejudicadas pela isquemia e os machos não apresentaram prejuízo. No teste do labirinto em cruz elevado não houve diferença significativa entre os grupos. No teste claro/escuro, as fêmeas isquêmicas demonstraram comportamento ansiolítico comparadas aos machos e às fêmeas naïves. A imunoistoquímica de astrócitos e a mensuração do volume de lesão não apresentaram diferença estatística entre os grupos. Com este trabalho demonstrou-se a importância da realização de pesquisas em ambos os gêneros, considerando o ciclo estral, principalmente para enfermidades complexas como a isquemia cerebral. O tratamento com a guanosina é promissor, principalmente na recuperação motora em fêmeas, entretanto, estudos futuros são necessários para melhor compreendimento dos mecanismos envolvidos. / Ischemic stroke is a serious disease of global incidence and prevalence, considered a leading cause of death and disability worldwide. It is due to hypoperfusion or blood disruption in a brain region and the lack of oxygen and glucose leads to failure in energetic metabolism of neurons and glial cells. The death of these cells releases large amount of glutamate, the main excitatory neurotransmitter, which triggers the ischemic cascade, formed by oxidative stress, excitotoxicity and inflammatory processes. These insults cause severe tissue damage that mainly compromise the sensorimotor system, memory, cognition and emotions. Guanosine, a guanine derivative, has shown a neuroprotective role in the central nervous system, acting on the glutamatergic system. These effects have been demonstrated in male rats, but not in females, so the aim of this thesis was to investigate through behavioral, immunohistochemical and histological tests, the action of guanosine in male and female Wistar rats surgically induced to a model of focal permanent cerebral ischemia in the motor cortex, considering the female estrous cycle immediately before the ischemic induction. This work was approved by the UFRGS Ethical Committee on the Use of Animals (No. 29396). After estrous cycle verification, females and males were anesthetized, positioned in a stereotaxic apparatus, and cortical focal ischemia was induced by thermocoagulation of the pial vessels. At the end of the surgery, the animals were treated with 0.9% saline or guanosine 60 mg/kg, both intraperitoneally, in 4 doses (0, 1, 3 and 6 hours after ischemic induction). In the cylinder test, females presented significant long-term sensorimotor recovery compared to males. In the open field test, long-term memory habituation and locomotion/exploratory activity in females were impaired by ischemia and males showed no impairment. In the elevated plus maze test, there was no significant difference between groups. In the light/dark test, the ischemic females showed anxiolytic-like behavior compared to naïve males and females. The immunohistochemistry of astrocytes and the measurement of lesion volume did not show any statistical difference between groups. With this work it was demonstrated the importance of conducting researches in both genders, considering the estrous cycle, mainly for complex diseases such as cerebral ischemia. The treatment with guanosine is promising, especially in motor recovery in females; however, future studies are necessary to better understand the mechanisms involved.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A doenÃa de Parkinson (DP) à caracterizada por acinesia, rigidez e tremor de repouso. FlutuaÃÃes clÃnicas sÃo comumente observadas nessa afecÃÃo e nÃo sÃo bem compreendidas. Tais flutuaÃÃes, provavelmente, guardam relaÃÃo com o estado de neurotransmissÃo dopaminÃrgica e com influÃncias de outros sistemas de neurotransmissores. Casos de jogo compulsivo foram descritos na DP e tem sido associados ao uso de agonistas dopaminÃrgicos. Sabe-se que a via dopaminÃrgica desempenha um papel fundamental no sistema de recompensa e tem sido implicada no reforÃo positivo apÃs o jogo. A prÃtica de jogos tem tambÃm sido associada à melhora da cogniÃÃo em pessoas idosas. O objetivo deste trabalho foi estudar a influÃncia aguda do jogo de dominà sobre a atividade motora e a memÃria na DP. NÃs avaliamos as caracterÃsticas sÃcio-demogrÃficas da populaÃÃo, o estado da funÃÃo motora atravÃs da Unified Parkinsonâs Disease Rating Scale parte III, a presenÃa de sintomas depressivos atravÃs do InventÃrio de DepressÃo de Beck (IDB), a memÃria de trabalho atravÃs do Teste de Stroop parte III e o desempenho motor atravÃs do teste de caminhada e de digitaÃÃo rÃpida. O experimento consistiu na realizaÃÃo de um jogo de dominÃ, entre 8 e 9 horas da manhÃ. Os testes de memÃria e desempenho motor foram realizados antes e apÃs o jogo. ApÃs a realizaÃÃo ou nÃo do jogo os pacientes foram classificados entre os grupos perdedor, vencedor e controle respectivamente. O estudo foi realizado no AmbulatÃrio de DistÃrbios do Movimento do HU da Faculdade de Medicina da UFC. Quarenta pacientes consecutivos, sendo 27 homens (67,5%) com idade entre 48 e 84 anos (63,2Â8,5), com Hoehn &Yahr entre I e III foram avaliados. Na amostra estudada, 28 casos (70%) apresentavam sintomas depressivos (IDB>10). O grupo controle consistiu de 13 indivÃduos que permaneceram sentados sem jogar. Quatorze pacientes foram vencedores e 13 foram perdedores. NÃo houve diferenÃa estatisticamente significante entre os grupos quanto à idade, duraÃÃo da doenÃa, Ãndice de massa corpÃrea, dose de levodopa, uso de Ãlcool, fumo, histÃrico familiar de DP, presenÃa de sintomas depressivos e hÃbitos de jogar jogos de azar. Uma paciente em uso de agonista dopaminÃrgico referiu compulsÃo por jogos de azar. Os pacientes vencedores apresentaram melhor desempenho no teste de memÃria de trabalho (p=0,002) e digitaÃÃo rÃpida (p= 0,01). Os perdedores apresentaram uma tendÃncia de melhora da caminhada apÃs o experimento. Em conclusÃo, nosso estudo mostra que a prÃtica de um jogo de dominà se associa a melhora da memÃria de trabalho e da atividade motora (avaliada pelo teste de digitaÃÃo rÃpida) em indivÃduos com DP. Tais achados podem ser explicados pela liberaÃÃo de dopamina que ocorre apÃs o jogo atravÃs do sistema de recompensa. / Parkinsonâs disease (PD) is a chronic illness characterized by the presence of akinesia, rigidity and resting tremor. Clinical fluctuation is a common finding and is probably related to the oscillation of dopaminergic neurotransmission and also to the influence of other neurotransmitters. Obsessive gambling has been described over the years and it has been associated in many cases with the use of dopaminergic agonists. The explanation for these findings might be that dopamine is involved in a reward system at the central nervous system. Games has also been associated with improvement of cognition in the elderly. The aim of this study was to evaluate the acute effect of playing dominoe on working memory, as evaluated by the Stroop test, and motor activity as evaluated by the 14-meter walk and the finger-tap test, on a population with PD. Besides socio-demographic data, patients were evaluated with the Unified Parkinson Disease Rating Scale Part III and with the Beck Depression Inventory (BDI). Experiment consisted on performing a game of dominoe, between 8 and 9 hours A.M. Patients were tested before and after experiment. Control group remained kept without specific activity for the same amount of time as the others. Patients were classified in winners, non-winners and control respectively, after experiment. The study was performed at the University Hospital of Federal University of CearÃ. All cases were out patients from a movement disorders clinic. Forty consecutive patients, 27 male (67,5%), age from 48 to 84 years (63,2Â8,5), Hoehn &Yahr between I e III were included. Twenty-eight cases (70%) presented depressive symptoms (BDI>10). Control group was made of 13 cases, 14 were winners and 13 were non-winners. Comparison among groups did not show any differences statistics regarding age, disease duration, age at presentation of symptoms, body mass index, alcohol use, smoking habit, family history, depressive symptoms, levodopa dose, and practice of games. One female patient on use of dopaminergic agonist referred compulsion for gambling. In this study, winners presented significantly better results on working memory as evaluated by the Stroop test (p=0,002) and of motor activity as evaluated by the finger-tap test (p= 0,01). Non-winners showed a trend of better performance in the 14-meter walk test. In conclusion, our study shows that in PD, performing a simple dominoe game is associated with improvement of working memory as evaluated by the Stroop Test and of motor activity as evaluated by the finger-tap test. These findings may be explained by a liberation of dopamine that occurs with gaming through the reward system.

Objetivo: Determinar la frecuencia y características de luxación de cadera en personas con parálisis cerebral institucionalizadas en una casa hogar de Lima, Perú. Método: Estudio transversal en niños, jóvenes y adultos con parálisis cerebral institucionalizados en una casa albergue en la ciudad de Lima – Perú, durante el año 2018. Se incluyó a toda la población (22 personas), por lo cual no se requirió realizar un muestreo. Se utilizó una ficha de recolección de datos en la cual se consideró únicamente a los usuarios con diagnóstico médico de parálisis cerebral (PC), la información del tiempo de institucionalización y antecedentes clínicos de cada participante. Las placas radiográficas fueron analizadas por un médico traumatólogo de acuerdo a los siguientes parámetros de medición: Porcentaje de migración de Reimers y el Índice acetabular. Resultados: Se evaluaron las historias clínicas de 22 personas con PC, 16 de ellos fueron varones. La edad promedio de los participantes fue 14 ± 8 años. La PC espástica fue la más frecuente de acuerdo a la topografía mientras que de acuerdo a su tipo, 10 presentaron PC del tipo diplejía y 9 del tipo cuadriplejia. La luxación completa y la subluxación bilateral fueron las más frecuentes al analizar las placas radiográficas. Según el Sistema de Clasificación de la Función Motora Gruesa (GMFCS) los participantes se encontraban entre los niveles III, IV y V. El grado de dependencia según el GMFCS era mayor para los usuarios que presentaban cuadriplejia teniendo tendencia a desarrollar una luxación total y subluxación de cadera. Solo 10 de los usuarios recibían tratamiento fisioterapéutico. Además, 6 de ellos solo contaban con un tipo de ayuda técnica como son las ortesis. Conclusiones: En conclusión, la luxación completa y la subluxación bilateral fueron las más frecuentes, así como los niveles III, IV y V según el Sistema de Clasificación de la Función Motora Gruesa (GMFCS). Además, se encontró un grado de dependencia mayor en los pacientes con parálisis cerebral tipo cuadriplejía. Este estudio muestra que esta población vulnerable, debe recibir mayor atención de terapia física, para garantizar una mejor calidad de vida. En este sentido el abordaje debe incluir el higiene postural (cambios de posiciones), descargas de peso en actividades de AVD (actividades de vida diaria), tratamiento para la espasticidad o el entrenamiento con aditamentos ortopédicos para corregir las alteraciones posturales y así evitar futuras complicaciones generadas por su condición. / Objective: Determine the frequency and characteristics of hip dislocation in people with institutionalized cerebral palsy in a home in Lima, Perú. Method: Cross-sectional study in children, young people and adults with institutionalized cerebral palsy in a shelter in the city of Lima - Perú, during the year 2018. The entire population (22 people) was included, so it was not required to perform a sampling. A data collection sheet was used in which only users with a cerebral palsy (CP) medical diagnosis, institutionalization time information and clinical history of each participant were considered. The radiographic plates were analyzed by a traumatologist under the measurement parameters of Reimers Migration Percentage and the Acetabular Index. Results: The medical records of 22 people with CP were evaluated, 16 of them were male. The average age of the participants was 14 ± 8 years. Spastic CP was the most frequent according to the topography while according to its type, 10 presented CP of the diplegia type and 9 of the quadriplegia type. Complete dislocation and bilateral subluxation were the most frequent when analyzing radiographic plates. According to the Gross Motor Function Classification System (GMFCS), participants were between levels III, IV and V. The degree of dependence according to GMFCS was higher for users who presented quadriplegia , having a tendency to develop total dislocation and subluxation of the hip. Only 10 of the users received physiotherapeutic treatment. In addition, 6 of them only had one type of technical assistance such as orthotics. Conclusions: In conclusion, complete dislocation and bilateral subluxation were the most frequent, as well as levels III, IV and V according to the Gross Motor Function Classification System (GMFCS). In addition, a higher degree of dependence was found in patients with quadriplegia type of cerebral palsy. This study shows that this vulnerable population should receive more physical therapy treatment care to ensure a better quality of life. In this sense, the approach must include postural hygiene (changes in positions), weight discharges in daily living activities, treatment for spasticity or training with orthopedic attachments to correct postural alterations and thus avoid future complications. generated by their condition. / Tesis