Orientador: Fábio Mícolis de Azevedo / Coorientador: Fernando Henrique Magalhães / Banca: Rúben de Faria Negrão Filho / Banca: Fernando Amâncio Aragão / Resumo: A Síndrome da Dor Femoropatelar (SDFP) é uma disfunção musculoesquelética comum na população que apresenta como principal sintoma clínico a dor intermitente nas regiões anterior, peri ou retropatelar, que é exacerbada por atividades funcionais. Embora a SDFP seja de alta incidência, até o presente momento não existem fatores que sejam considerados ideais para caracterização da disfunção. Sabe-se apenas que a SDFP pode levar a alterações eletromiográficas nos músculos Vasto Medial (VM) e Vasto Lateral (VL). Outra informação relevante conhecida é que o processo de controle neuromuscular do músculo quadríceps pode ser analisado através da obtenção do Reflexo H. A hipótese deste estudo é que mulheres com SDFP apresentam modulação do Reflexo H diferente de mulheres assintomáticas. Diante do exposto, o objetivo deste estudo foi analisar a amplitude do Reflexo H em mulheres caracterizadas clinicamente com a SDFP e em mulheres assintomáticas, bem como testar a qualidade da medida utilizada. Foram recrutadas 30 mulheres, sendo 15 com SDFP e 15 assintomáticas, e compuseram o Grupo SDFP (GSDFP) e o Grupo Controle (GC) respectivamente. As medidas pico a pico das amplitudes do Reflexo H máximo (Hmáx), do Reflexo H a 50% da intensidade necessária para atingir o Hmáx (H50%) e da Onda M máxima (Mmáx) foram coletadas, a Mmáx foi o fator de normalização... / Abstract: The Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal disorder in the population that has as main clinical symptom intermittent pain in the anterior, peri or retropatellar regions, the pain is exacerbated by functional activities. Although PPS is a high incidence, so far there are no factors that are considered ideal for characterization of dysfunction. It is only known that PPS can lead electromyographic changes in the muscles Vastus Medialis (VMO) and Vastus Lateralis (VL). Other relevant information known is that the process of neuromuscular control of the quadriceps muscle can be analyzed by obtaining the H-reflex. The hypothesis of this study is that women with PFPS have different H-reflex modulation from asymptomatic women. The objective of this study was to analyze the amplitude of the H-reflex in women characterized clinically with the PPS and in asymptomatic women, and to test the quality of the measure used. 30 women were recruited, 15 were diagnosed with PFPS and 15 assymptomatic. They composed the PFPS Group (PFPSG) and control group (CG) respectively... / Mestre

Orientador: Fábio Mícolis de Azevedo / Banca: Fernando Henrique Magalhães / Banca: Rafael Zambelli de Almeida Pinto / Resumo: A dor femoropatelar (DFP) é considerada um "enigma ortopédico", e uma das desordens musculoesqueléticas mais desafiadoras para se gerenciar. Isso porque até o presente momento não se tem definição acerca da(s) causa(s) que podem levar a esta desordem. Há mais de duas décadas têm-se investigado a presença de alterações biomecânicas em indivíduos com DFP durante as mais diversas atividades, como corrida, subida e descida de escada, agachamento e salto. Os parâmetros eletromiográficos (EMG) relacionados ao tempo e amplitude de ativação dos músculos vasto lateral (VL) e vasto medial (VM) são frequentemente abordados em estudos com essa população, no entanto, os resultados são controversos e acredita-se que uma das possíveis causas para essa inconsistência seja a característica intermitente dos sintomas. Ou seja, em determinados momentos a dor está presente e em outros não, independente da atividade que esteja sendo desenvolvida. Sabe-se que a dor recorrente pode levar a alterações no mecanismo central de controle da dor gerando respostas exageradas frente a estímulos dolorosos (hiperalgesia). Acredita-se que mulheres com DFP apresentam hiperalgesia tanto local quanto generalizada, no entanto, não se sabe o quanto a presença da dor no momento da avaliação pode alterar esses mecanismos de hiperalgesia. Diante disso, os objetivos gerais desta dissertação foram analisar o quanto a presença da dor afeta a hiperalgesia e os parâmetros EMG em mulheres com DFP, além de determinar pontos ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: As there is no definition about etiological factors of patellofemoral pain (PFP), it is considered an "orthopaedic enigma" and one of musculoskeletal disorders most challenging to manage. More than two decades, researchers have investigated the presence of biomechanics alteration in individuals with PFP during different activities as run, stair deambulation, squatting and jump. The electromyographic (EMG) parameters related to timing and amplitude of activation of vastus lateralis (VL) and vastus medialis (VM) muscles are often addressed in studies with PFP. However, the results are controversial and a plausible explanation may be the intermitent characteristic of the symptoms. In other words, at certain times the pain is present and not in others, regardless of the activity that is being developed. It is knowing that recurrent pain may result in dysfunctional analgesic control generating exaggerated responses to painful stimuli (hyperalgesia). Women with FPF present local and widespread hyperalgesia, however, it is unknown how the presence of pain at the moment of evaluation may alter the hyperalgesia. Thus, the overall aims were to analyze how the presence of pain affects hyperalgesia and EMG parameters in women with PFP, moreover, to determine cutoff points to identify the presence of hyperalgesia in women with PFP. EMG parameters were evaluated during stair climbing. EMG parameters, pressure pain thresholds (PPTs) and visual analogue scale of pain (VAS) were collected in ... (Complete abstract click electronic access below) / Mestre

Orientador: Rômulo Araújo Fernandes / Banca: Luiz Carlos Marques Vanderlei / Banca: Jefferson Rosa Cardoso / Resumo: Não disponível / Abstract: Not available / Mestre

Orientador: Carlos Marcelo Pastre / Banca: Franciele Marques Vanderlei / Banca: Fabio do Nascimento Bastos / Resumo: Cold water immersion (CWI) appears in the current scenario as an effective recuperative technique in sports, working on different outcomes. However, the concept of post-exercise recovery deserves attention, since analysis of individual parameters seem to hurt this concept. Therefore, the construction of a drawing from a unique mechanism of stress, with the same technique application feature and involving elements of various dimensions seems pertinent. Objective: To analyze the immediately recovery after a training and to verify the isolated and combined behavior of clinical, functional, metabolic and autonomic parameters from the use of immersion in cold water as recuperative technique. Methods: A sample of 64 football players, randomized into two groups, control group (CG) and experimental group (EG). The procedures were performed in two stages. 1st: Participants underwent basic tests of muscle function. 2nd: After a week of rest, underwent a key workout (50 minutes) and immediately after the intervention performed for 15 minutes, GE received the IAF (13 ± 1 ° C) and GC stay sitting. The investigated variables were subjective perception of pain, perceived recovery, abnormal sensitivity, blood lactate concentration, cardiac autonomic modulation and functional tests, these were measured during specific recovery times up to a maximum two hours post training. Statistical analysis was performed using the statistical package SPSS Statistics 22.0. For numeric data, the functional markers, the distribution of the data was tested (Komolgorov-Smirnov) and as normal we used the t student test for independent samples. For the other markers were tested sphericity data (Mauchly test). Data were analyzed using analysis of variance for repeated measures (Bonferroni post-test)... / Abstract: a imersão em água fria (IAF) aparece no cenário atual como uma técnica recuperativa eficaz no meio esportivo, atuando sobre diferentes desfechos. Entretanto, o conceito de recuperação pós-exercício merece destaque, uma vez que análise de parâmetros isolados parece ferir esse conceito. Para tanto, a construção de um desenho a partir de um único mecanismo de estresse, com a mesma característica de aplicação de técnica e envolvendo elementos de dimensões diversas parece pertinente. Objetivo: analisar a recuperação após um treino imediato e verificar o comportamento isolados e em conjunto dos parâmetros clínicos, funcionais, metabólico e autonômico a partir do uso da IAF como técnica recuperativa. Métodos: Amostra composta por 64 jogadores de futebol do sexo masculino, randomizados em dois grupos, grupo controle (GC) e grupo experimental (GE). Os procedimentos foram realizados em duas etapas. 1ª: Participantes foram submetidos a testes basais de função muscular. 2ª: Após uma semana de descanso, foram submetidos a um treino chave (50 minutos) e imediatamente após realizaram a intervenção por 15 minutos, GE recebeu a IAF (13º±1ºC) e GC permaneceu sentado. As variáveis investigadas foram percepção subjetiva de dor, percepção de recuperação, alteração de sensibilidade, concentração de lactato sanguíneo, modulação autonômica cardíaca e os testes funcionais, estas foram mensuradas durante momentos específicos da recuperação até ao máximo 2 horas pós-treino chave. Para análise estatística utilizou-se o pacote estatístico SPSS Statistics 22.0. Para os dados numéricos, nos marcadores funcionais, a distribuição dos dados foi testada (Komolgorov-Smirnov) e como normal utilizou-se o teste t de Student para amostras independentes. Para os demais marcadores foram testados a esfericidade dos dados (teste de Mauchly)... / Mestre

Orientador: Cristina Elena Prado Teles Fregonesi / Banca: Dalva Minonroze Albuquerque Ferreira / Banca: Angélica Mércia Pascon Barbosa / Resumo: Diante do elevado índice de progressão, da dificuldade encontrada no tratamento e da falta de comprovação científica de métodos fisioterapêuticos conservadores na Escoliose Idiopática do Adolescente (EIA), o presente estudo objetivou verificar o efeito de técnicas de Osteopatia Estrutural nas variáveis da postura e flexibilidade de indivíduos com EIA. MÉTODO: A população foi composta de 30 portadores de EIA (Ângulo de Cobb ≥ 10º), com idade entre 18-25 anos, de ambos os gêneros. A amostra foi dividida em Grupo Experimental (GE) (n=15) e Grupo Placebo (GP) (n=15). Para a mensuração da gibosidade foi realizado o teste de Adams. As curvaturas vertebrais (LCCe - Lordose cervical cefálica; LLCe - Lordose lombar cefálica; LCCa - Lordose cervical caudal e LLCa - Lordose lombar caudal) foram verificadas por meio de régua adaptada com nível d'água. Foi realizada a avaliação da flexibilidade da cadeia posterior (banco de Wells) e da flexibilidade lateral (teste de inclinação lateral do tronco). Para detecção da vértebra mais rodada em NSR foi realizado o Teste Quick Scaning e de Mitchel. Foram realizados os testes do Polegar Ascendente e Gillet para avaliação do Ilíaco bloqueado... / Abstract: Given the high rate of progression of difficulty in treatment and lack of scientific proof of conservative physical therapy methods in Adolescent Idiopathic Scoliosis (AIS), the present study aimed to verify the effect of Osteopathy techniques in structural variables of posture and flexibility of subjects with AIS. METHODS: The study population consisted of 30 patients with AIS (Cobb angle ≥ 10), aged 18-25 years, of both genders. The sample was divided in Experimental Group (EG) (n = 15) or placebo (GP) (n = 15). For the measurement of spinal deformity of the Adams test was performed. The spinal curvatures (LCCe - cephalic cervical lordosis; LLCe - lumbar lordosis head; LCCa - caudal cervical lordosis and LLCa - caudal lumbar lordosis) were assessed using a slit adapted watermarked. Evaluating the flexibility of the posterior chain (Wells) and lateral flexibility test (lateral inclination of the trunk) was performed. To detect more rounded vertebra in NSR was held Scaning Quick Test and Mitchel. Tests Thumb Ascending Gillet and to evaluate the locked Iliac were performed... / Mestre

Objetivos: analisar a postura corporal em pacientes disfônicos e correlacioná-los com indivíduos sem alteração de voz, a fim de estabelecer novos recursos terapêutico para reabilitar o portador de disfonia. Método: estudo prospectivo. Foram avaliados 43 indivíduos (23 disfônicos e 20 sem alteração de voz) do sexo feminino,com idade entre 18 e 40 anos ,sem alterações neurológicas ,respiratórias e reumáticas. Todos os pacientes foram encaminhado pelo serviço de Otorrinolaringologia da Escola Paulista de Medicina ( UNIFESP- EPM),após anamnese, exame do otorrinolaringologista e laringoscopia ,tendo como diagnostico de disfonia funcional ou organofuncional. Nessa população foi avaliado: 1- Postura corporal in loco, 2 – Documentação fotográfica, 3 – Exame Eletromiografia, 4 – Questionário das algias. Resultados: não houve diferença estatisticamente significante em relação à queixa,porem foi encontrado um numero maior de tensão muscular e dor na região cervical, onde se encontra situado a laringe, nos portadores de disfonia. Na avaliação postural, os indivíduos disfônicos apresentarão assimetria de ombros, alteração no posicionamento da escapula, retificação com anteriorização da região cervical em relação ao grupo controle. Nos resultados da eletromiografia houve aumento das atividades nos músculos supra-hióideo em emissão prolongada, controlada e deglutição. Nos músculos infra-hióideo houve alteração no traçado eletromiógrafico na emissão prolongada. Conclusão: pode- se concluir que o estudo mostra a existência da correlação positiva entre indivíduos portadores de disfonia e alteração na postura, baseado nas diferenças dos achados clínicos e medidas eletromiográficas. / Objectives: This study analyzed the body posture of dysphonic patients and correlated them with individuals without voice alterations, in order to establish new therapeutic resources to rehabilitate the patients with dysphonia. Method: prospective study. A total of 43 individuals were analyzed (23 with dysphonia and 20 without voice alterations), of female gender, aged 18 to 40 years, without neurological, respiratory and rheumatic alterations. All patients were referred by the ENT Sector of Paulista Medical School (UNIFESP- EPM) after anamnesis, ENT examination and laryngoscopy, with diagnosis of functional or organofunctional dysphonia. The following parameters were investigated in this population: 1- Body posture in loco, 2- Photographic records, 3- Electromyographic examination, 4- Questionnaire on pain. Results: The results indicated no statistically significant difference with regard to the complaint, yet a larger number of individuals with dysphonia reported muscle tension and pain at the cervical region, where the larynx is located. Posture evaluation revealed that dysphonic individuals presented shoulder asymmetry, alterations in scapular positioning and rectification with forward displacement of the cervical region compared to the control group. The results of electromyographic analysis demonstrated increased activity of the suprahyoid muscle in prolonged emission, controlled emission and swallowing. The infrahyoid muscles exhibited altered electromyographic tracing during prolonged emission. Conclusion: It was concluded that there is correlation between individuals with dysphonia and posture alterations, based on the differences in clinical findings and electromyographic measurements.

Orientador: Elizabeth Maria Aparecida Barasnevicius Quagliato / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T22:15:58Z (GMT). No. of bitstreams: 1 Roiz_RobertadeMelo_D.pdf: 2327794 bytes, checksum: 13370d7e71f5db5ab3805b3ac6159cd1 (MD5) Previous issue date: 2011 / Resumo: A Doença de Parkinson idiopática (DPI) é uma afecção neurodegenerativa. Parâmetros da DPI geram mudanças do padrão da marcha. Algumas escalas de avaliação vêm sendo utilizadas para caracterizar as alterações da marcha na DPI, porém há poucas publicações que correlacionem a análise cinemática e dados têmporo-espaciais com escalas clínicas, ou que avaliem o efeito de dois tipos de pistas visuais espaciais (transversas e paralelas) em comparação a ausência de pistas na marcha. O objetivo do Artigo 1 foi comparar os dados têmporo-espaciais e cinemáticos da marcha entre pacientes com DPI e idosos saudáveis (IS) e avaliar a relação entre estas variáveis com os instrumentos clínicos. Doze pacientes com DPI e quinze IS foram recrutados e avaliados por instrumentos clínicos e pela análise de marcha. Os resultados em relação à velocidade da marcha, do comprimento do passo (CP) e das variáveis cinemáticas do quadril (contato inicial, na máxima extensão no apoio e na máxima flexão no balanço) demonstraram diferenças significativas entre os grupos em estudo. Dessa forma, podemos afirmar que os instrumentos clínicos utilizados não são adequados para uma avaliação descritiva e objetiva da marcha dos indivíduos com DPI, a qual foi possível com a avaliação em 3D. Muitos estudos têm referido que influências externas adequadas, como pistas visuais, podem melhorar o padrão da marcha dos pacientes com DPI e assim, gerar padrão de marcha mais próxima do normal. Dessa forma, o Artigo 2 teve como objetivo avaliar, em indivíduos co DPI, o efeito de dois tipos de pistas visuais espaciais: pista visual transversa (PVT) e pista visual paralela (PVP) comparando-as a ausência de pista visual durante marcha. Doze pacientes com DPI foram avaliados por instrumentos clínicos e avaliação da marcha, através do sistema de análise em 3D. Neste estudo, a velocidade da marcha foi maior com o uso das pistas visuais (paralela e transversa), do que sem uso delas (p= 0.003). Já o CP com PVT foi significativamente maior (p= 0.006) quando comparada com as outras duas situações. Em relação aos dados cinemáticos com uso da PVT, a articulação do joelho apresentou menores amplitudes em flexão no contato inicial, e maiores amplitudes máximas de flexão durante a fase de balanço. Assim, a avaliação da marcha com pistas visuais demonstrou que o uso das pistas transversas gera resultados melhores do que utilizando as pistas paralelas, e até mesmo sem o uso de ambas. Assim, a reabilitação dos indivíduos com DPI deveria ter ênfase no uso de pistas visuais para compensar as alterações da marcha / Abstract: The Idiopathic Parkinson's disease (IPD) is a neurodegenerative disease. Characteristics of IPD generate changes in gait pattern. Some clinical instruments have been used to characterize gait alterations in IPD, however, there are few publications correlating kinematic analysis and temporal-spatial data with clinical instruments, or instruments that evaluate the effect of two types of spatial visual cues (transverse and parallel) in comparison to no visual cue on mobility. The objective of Article 1 was compare the spatial temporal and kinematic variables of Parkinsonian gait with the healthy elder (HE) subjects and measure the relation between these variables and clinical instruments. Twelve patients with IPD and fifteen HE subjects were recruited and evaluated for clinical instruments and gait analysis. The results related to gait velocity, stride length (SL) and hip joint kinematic data (on initial contact, on maximum extension during terminal contact and on maximum flexion during swing) have demonstrated significant differences between groups. Regarding clinical instruments, there was significant correlated between gait velocity and SL. Thus, can assert that the used clinical instruments are not adequate for a descriptive and objective evaluation of gait in individuals with IPD, which was possible through a 3D analysis. Several studies have reported that adequate external influences, such as visual and/or auditory cues, can improve gait pattern of patients with IPD, thus generate gait pattern closer to normal. Thus, the objective of the Article 2 was to evaluate, in people with IPD, the effect of 2 types of spatial visual cues: transverse visual cues condition (TVC) and parallel visual cues (PVC), comparing no-visual cue during walking. Twelve patients with IPD were assessed for clinical instruments and gait assessment, through the analysis system in 3D. In this study the gait velocity was higher with the use of visual cues (parallel and transverse), than without them (p= 0.003). The SL with TVC was significantly longer (p= 0.006) when compared with the two other situations. Regarding the kinematic data with TVC, the knee joint presented smaller range of flexion during initial contact, and larger maximum range of flexion during swing phase. Therefore, gait assessment with visual cues have demonstrated that the use of transverse cues produces better results compared to parallel cues, and even without cues. Thus, the rehabilitation in individuals with IPD should emphasize the use of these cues to compensate gait alterations / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas

Worldwide there was a growing trend towards the recognition of Chiropractic, but little was known of this recognition in South Africa. However, with regards to the Western Region of Johannesburg, it was unclear how the medical profession viewed Chiropractic and how effective they viewed Chiropractic in the treatment of neuromusculoskeletal conditions. This study attempted to establish how medical doctors viewed Chiropractic and to determine how Chiropractors compared to physiotherapists in the opinion of the medical profession in the treatment of common neuromusculoskeletal conditions. A questionnaire was hand-delivered to the consulting rooms of each general practitioner, orthopedic surgeon and neurologist/neurosurgeon in the Western Region of Johannesburg. The researcher with the aid of a statistical consultant drew up the questionnaire. The data was analysed using the SPSS 13 (2005), SPSS Incorporated, Chicago using descriptives and frequencies. To compare Chiropractic treatment to physiotherapy, statistical significance was calculated using a Paired Samples Test (T-Test). The results of this study found that the doctors had a positive view of Chiropractic as a profession. When comparing Chiropractic to physiotherapy, statistical analysis revealed that physiotherapy was seen as more effective. Physiotherapists were also more likely to receive referrals from medical doctors than Chiropractors. The results of this study were in accordance with worldwide trends in that Chiropractic was growing in recognition and was viewed as beneficial in the health care system. However, more education of the medical profession with regards to Chiropractic and more research comparing Chiropractic effectiveness compared to physiotherapy were needed. / Dr. M. Moodley Dr. J. Mitchell

<p> Back problems continue to be a leading cause for disability in all of medicine and are the number one symptom disorder for consulting integrative medicine practitioners. Feldenkrais&reg; practitioners aim to clarify new functional interrelationships towards an improved <i>neuroplasticity-based </i> change in the cognitive construct of one&rsquo;s own background body schema. These phenomena have been found to clinically correlate to chronic pain through concurrent distortions in the reorganization of usual sensory-motor cortical representations in the brain &ndash; being further associated with altered body perception (Wand, et al. 2016). The <i>Feldenkrais Method </i>&reg; (FM) is a comprehensive approach being manifested through manual sensory contact (FI&reg;) techniques and movement experiences (ATM&reg;) and has been anecdotally purported to improve symptoms and functions in Chronic Non-specific Low Back Pain (CNSLBP). However, there is little scientific evidence to support superior treatment efficacy.</p><p> A Randomized Controlled Trial compared a novel <i>Virtual Reality Bones&trade; / Feldenkrais&reg; Movement</i> (VRB³/FM) intervention against more conventional protocols for <i>Core Stabilization Biofeedback / Motor Control Exercises</i> (CSB/MCE). The (VRB³)&trade; treatment component consisted of full-scale skeletal models, kinematic avatars, skeletal density imagery, temporal bone-vestibular system relationships, and haptic self-touch techniques being aimed to re-conceptualize participant&rsquo;s prior notions and beliefs regarding body schema and low back pain (LBP). N=30 participating patients with CNSLBP were assigned to either the experimental group (VRB³/FM @ N=15) or the control group (CSB/MCE @ N=15). Known confounding biopsychosocial variables were controlled via stratified-random assignment on the FABQ. Treatment Outcome measures included VAS-PAIN, RMDQ, PSFS, and Timed Position Endurances Tests &ndash; including Flexion / Extension Ratios at baseline, 2-weeks, 4-weeks and 8-weeks. Statistical Analysis was conducted using Wilcoxon Rank Sum and paired, two-tailed t-test. Results showed that the VRB³/FM group demonstrated greater improvement in all treatment outcome measures as compared to the matched CSB/MCE control group.</p><p> This is the first RCT study to demonstrate that a <i>Feldenkrais Method</i>&reg; based approach being combined with <i>Virtual Reality Bones</i>&trade; can be more efficacious for the treatment of CNSLBP than the current and accepted physical medicine standard of isolated Core Stabilization Biofeedback / Training and Motor Control Exercises. Future multi-site RCT studies with larger sample sizes are therefore recommended.</p>

This thesis explored the current context of aquatic rehabilitative practices in Canada. More specifically, three inter-related topics on Aquatic Therapy (AT) and Aquatic Physical Therapy (APT) in Canada were examined: 1) the development of knowledge, training and expertise on APT and AT, 2) recognition and acceptance of cultural and social authority on AT and APT (Starr, 1982), and 3) the practitioners’ perceptions of barriers to practicing and participation in aquatic therapy. Semi-structured qualitative interviews were conducted with seven (7) stakeholders including Ontario aquatic physical therapists, aquatic therapists, instructors on aquatic therapy and members of the College of Physiotherapy of Ontario (CPO) and the Canadian Physiotherapy Association (CPA). Interviews were complimented with open-ended questionnaires sent to Chairs of Physical Therapy programs in seven Canadian Universities. Our research identified the most common means of acquiring knowledge on aquatic rehabilitative practices was through University Physiotherapy program curriculum; private training courses; and in-house within facilities where aquatic therapists and aquatic physical therapists are employed. This thesis also examined facilitators/barriers to practicing and receiving aquatic therapy and aquatic physical therapy. Through critical analysis, this thesis reflected on the ways in which social and cultural authority (Starr, 1982) are constructed within the field of aquatic therapy (AT) and aquatic physical therapy (APT). Recommendations and areas for future research included specialized training courses by scope of practice, and increased in-pool practicum training within Physiotherapy programs in Canada.