INTRODUÇÃO: O tratamento do câncer de mama está associado à morbidade do membro superior, com complicações que têm um impacto significante na qualidade de vida das pacientes. O OBJETIVO deste trabalho foi traçar um protocolo de tratamento fisioterapêutico para prevenir as morbidades após cirurgia de câncer de mama. CASUÍSTICA E MÉTODOS: Este estudo avaliou 132 mulheres com a intervenção da fisioterapia em dois momentos: no primeiro pós-operatório (PO) e entre o 10º - 15º dia do PO. Reavaliações foram feitas nos meses 1, 2, 3, 4, 5, 6 e após um ano do PO. RESULTADOS: O grupo de intervenção precoce mostrou uma recuperação mais rápida da amplitude de movimentos e apresentou menor morbidade em relação ao grupo tardio. CONCLUSÃO: O protocolo fisioterapêutico preconizado, tanto precoce quanto tardio, é eficaz. A recuperação da função do membro superior e o menor índice de morbidades mostram que a fisioterapia deve sempre ser instituída nas pacientes que se submetem à cirurgia de câncer de mama. / INTRODUCTION: The breast cancer treatment is always linked with the morbidity of the upper limb with complications that will have an enormous impact in the quality of life of the patients submitted to breast cancer treatment. Objective : the objective of this study was to develop a physiotherapy protocol in order to prevent morbidities after breast cancer treatment METHODS: This study evaluated 132 patients submitted to physiotherapy sessions in two different moments: 1 st day post surgery and at the 10-15 th day . Follow-ups were made on months 1, 2, 3, 4, 5, 6 and after a year. RESULTS: The earlier group showed a faster recovery of arm range of motion and had less arm morbidity. CONCLUSÃO: O RESULTS: G1 showed a faster flexion and abduction ROM recovery and had less morbidity as compared to the other group. The arm circumferences in the early intervention group had lower values as compared to the late intervention group. CONCLUSION: The physiotherapy protocol used in the study showed its efficacy. The upper arm ROM was recovered and both groups had less arm morbidity.

O objetivo deste trabalho foi estudar a expressão protéica de mdm2 e avaliar a sua relação com alguns aspectos anatomopatológicos, visando também identificar fatores prognósticos no que diz respeito à sobrevida livre de recidiva local (SLRL), sobrevida livre de metástase (SLM) e sobrevida global (SG), em pacientes portadores de lipossarcoma primário de extremidades. Vinte e cinco entre 50 pacientes admitidos no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – IOT/HC/FMUSP, entre 1968 e 2004, foram eleitos para o estudo. As probabilidades de sobrevida acumuladas foram feitas pela técnica de Kaplan-Meier e as curvas de sobrevida comparadas pelo teste de Log Rank. A validade estatística foi estabelecida para valores de p<0,05. As associações entre os índices positivo ou negativo para o mdm2 com outras variáveis foram feitas utilizando-se o teste exato de Fischer. A expressão imunoistoquímica da proteína mdm2 não foi considerada de valor prognóstico em nenhuma das sobrevidas estudadas (SLRL, SLM ou SG). Os fatores adversos que influenciaram o risco de recidiva local na análise univariada foram: o gênero masculino (p = 0,023), subtipo histológico pleomórfico (p = 0,027) e alto grau histológico (p=0,007). Em relação a SLM a idade inferior a 50 anos (p = 0,040), o gênero masculino (p = 0,040), o subtipo pleomórfico (p < 0,001), o alto grau histológico (p = 0,003) tiveram um pior prognóstico. Os fatores adversos para SG foram: idade inferior a 50 anos (p = 0,040); o gênero masculino (p = 0,040); o subtipo pleomórfico (p < 0,001) e o alto grau histológico (p = 0,003). / The purpose of this was to study the expression by imunohistochemistry of mdm2 and your correlation with anatomopathological selected variables, aiming at identifying prognostic factors concerning to local recurrence free survival (LRFS), metastases free survival (MFS) and overall survival (OS) in patients with liposarcomas primary extremities. This study included 25 patients registred in the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Brazil, from 1968 to 2004. The accumulated survival probabilities were calculated by Kaplan-Meier method and survival curves were compared using the logrank test. Statistical significance was defined as a p value less than 0,05. Associations between expression of mdm2 and other variables were analyzed using Fischer’s exact test. The expression by imunohistochemistry of mdm2 was not significant factor for LRFS, MFS or OS. The adverse factors for LRFS in univariate analysis were male gender (p = 0,023), pleomorfic histologic subtypes (p = 0,027) and high grade tumor (p = 0,007). For MFS age < 50 years (p = 0,040), male gender (p = 0,040), pleomorfic histologic subtypes (p < 0,001) and high grade tumor (p = 0,003) had worse prognostic. Negative prognostic factors for OS were age < 50 years (p = 0,040), male gender (p = 0,040), pleomorfic histologic subtypes (p < 0,001) and high grade tumor (p = 0,003).

Work conditions within the public health care sector are physically and psychosocially demanding. This means that balancing work with recovery is essential for employees in order to avoid ill health and stay healthy. This thesis is based on four studies. Study I investigated the prevalence of upper extremity disorders (UED) in female dental personnel. Results showed that 81% reported UED. Consequently, interventions aimed at reducing these risks were called for. Study II investigated the health-related effects of two work-place interventions, physical exercise (PE) and reduced working hours (RWH). Health-improvements were more consistent in the PE group, suggesting that PE may be an appropriate intervention to reduce health-risks. However, there were no effects on recovery from work or fatigue, which may result from other factors, such as overcommitment (OC), that prolong or sustain stress-related activity. Study III showed that high OC was associated with poorer next-day recovery and increased fatigue. Also, OC was a more important predictor of lack of recovery and fatigue than were psychosocial work characteristics. This highlights the importance of considering perseverative cognitions in relation to recovery from work and fatigue, and has implications for interventions targeting work-related ill health. Study IV related lack of recovery and fatigue to cumulative biological risk, allostatic load (AL), and to individual biomarkers. Women with a profile characterized by fatigue, sleep difficulties and lack of short-term recovery had a 2.9 increased risk of AL. This was not shown in analyses of individual biomarkers. In sum, this thesis shows that recovery from work is an important factor in relation to women’s work-related health. Fatigue and recovery should be considered interrelated but distinct concepts and recovery should be assessed as an early risk factor for stress-related disease with early risk being investigated using AL rather than individual biomarkers.

Darbo objektas: Fugl – Meyer skalės viršutinės galūnės motorinės funkcijos vertinimo dalis ir jos pritaikomumas lietuvių kalba. Darbo problema: pasaulyje galvos smegenų insultas yra viena iš didžiausių visuomenės sveikatos problemų. Dažniausia šios ligos pasekmė – galūnių judesių valdymo sutrikimai. Po pusės metų nuo įvykusio galvos smegenų insulto net 65 proc. jį patyrusiųjų išlieka rankos parezė arba plegija. Siekiant sumažinti insulto spasekmes, svarbu tinkamai įvertinti reabilitacijos efektyvumą, apimant visas ligos paveiktas sritis. Lietuvoje patyrusiųjų galvos smegenų insultą reabilitacijos efektyvumo įvertinimui oficialiai naudojami instrumentai, kuriais vertinama kasdienė veikla ir pažintinės funkcijos, tačiau nėra oficialiai naudojamo instrumento, tinkamo motorinės funkcijos pažeidimams įvertinti. Fugl – Meyer skalės viršutinės galūnės motorinės funkcijos vertinimo dalis dėl gerų rezultatų įvertinimo kriterijų yra plačiai naudojama pasaulyje, tačiau Lietuvoje ji nėra pritaikyta. Darbo tikslas: pateikti lietuviškai parengtą Fugl – Meyer judesių atsigavimo po insulto skalės viršutinės galūnės motorinės funkcijos vertinimo dalį ir įvertinti jos tinkamumą pritaikomumui lietuvių kalba. Darbo uždaviniai: 1.Išsiaiškinti Lietuvoje pritaikytus instrumentus, skirtus patyrusiųjų galvos smegenų insultą viršutinės galūnės motorinės funkcijos vertinimui ir palyginti su kitų šalių praktika. 2.Išsiaiškinti ir įgyvendinti vertinimo instrumento vertimo į gimtąją kalbą... [toliau žr. visą tekstą] / Object: the Fugl-Meyer assessment scale the part of the upper extremity motor performance and it validation in lithuanian language. Subject: A stroke is a major public health problem. The most frequent result leading stroke is the disorder of the limb motion control. After a half years after the stroke about 65 percent of the patients still have arm paresis or plegija. According The World Health Organization rehabilitation effectiveness assessment must include all areas affected by the disease. It is important to note that the results of stroke rehabilitation outcome measures should be systematically described and classified in an appropriate way. There are two types of instruments for rehabilitation effectiveness assessment for the patients with stroke in Lithuania. One of them assess daily living activities and the other assess cognitive functions. However there are no instrument officially applied for evaluation of the motor disfunctions. According to scientific literature articles, one of the most reliable and valid scale of affected upper extremity true recovery, is Fugl – Meyer assessment scale the part of the upper extremity motor performance. Aim: to present the Fugl – Meyer assessment scale the part of the upper extremity motor performance and assess it validation in lithuanian language. Goals: 1.To investigate the instruments using for assessment of the upper extremity motor function in patients with stroke in Lithuania and to compare with other... [to full text]

Made available in DSpace on 2016-12-12T17:32:55Z (GMT). No. of bitstreams: 1 RESUMO e ABSTRACT Karoliny dos Santos.pdf: 159269 bytes, checksum: 639ce3b27162f2db0c83966f15bedab0 (MD5) Previous issue date: 2014-07-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The airflow limitation is the factor that most influences the interruption of activities of daily living (ADLs) in patients with severe chronic obstructive pulmonary disease (COPD). It is common observed the absence of ventilatory reserve, the reduction in inspiratory reserve volume and dynamic hyperinflation. Objective: to investigate ventilatory response and dynamic hyperinflation (DH) induced by three ADL protocols: Glittre-ADL test (TGlittre); an activity test to move objects on a shelf (TEST); and a modified shelf protocol, which isolates upper limbs activities (TEST-M) in patients with COPD (COPDG) and in healthy subjects (CG). This cross-sectional study included 23 patients with COPD (65 ± 6 years old, FEV1 37.2 ± 15.4% pred); and 14 healthy subjects (64 ± 4 years) matched for sex,age and body mass index. Groups performed TGlittre, TEST and TEST-M; the ventilatory response and inspiratory capacity was measured during each test. Ventilatory baseline values were similar between groups (p>0.05). The ventilatory demand (VE/MVV) increased and the inspiratory capacity reduced significantly during the tests in COPDG. VE/MVV and HD were higher (p<0.05) in TEST compared to TEST-M in patients with COPD (p<0.05). In the control group no difference was found in the variation of inspiratory capacity between the tests (p>0.05) and the ventilatory demand increased during the tests (p< 0.05) in smaller magnitude than in the COPDG. In conclusion, TEST and TGlittre induced similar responses in patients with COPD with higher VE/MVV and HD than in healthy subjects. However, the ventilatory response was lower in the TEST-M, suggesting that squatting down and bending the trunk can trigger significant ventilatory overload in TGlittre. / A limitação ventilatória é o fator que mais influencia na interrupção das atividades de vida diária (AVD) em pacientes com doença pulmonar obstrutiva crônica (DPOC) grave, sendo comuns a ausência de reserva ventilatória, a redução do volume de reserva inspiratório e a hiperinsuflação dinâmica. O objetivo deste estudo foi investigar a resposta ventilatória e hiperinsuflação dinâmica induzidas por três protocolos de AVD: teste AVD-Glittre (TGlittre); teste de atividades movimentando objetos em uma estante (TEST); e um protocolo modificado da estante, enfatizando atividade com os membros superiores (TEST-M) em pacientes com DPOC e indivíduos saudáveis. Tratou-se de um estudo transversal no qual foram avaliados 23 pacientes com DPOC (65 ± 6 anos; VEF1 37,2 ± 15,4%prev) e 14 indivíduos saudáveis (64 ± 4 anos), pareados por sexo, idade e IMC. Os grupos realizaram TGlittre, TEST e TEST-M e a resposta ventilatória e capacidade inspiratória foram avaliadas durante cada teste. As variáveis ventilatórias basais foram similares nos grupos (p>0,05). A demanda ventilatória aumentou e a capacidade inspiratória reduziu significantemente durante os testes no grupo de pacientes com DPOC. A demanda ventilatória e a hiperinsuflação dinâmica foram maiores (p<0,05) no TEST comparados ao TEST-M nos pacientes com DPOC (p<0,05). No grupo controle não houve diferença na variação da capacidade inspiratória entre os testes (p>0,05) e a demanda ventilatória aumentou durante os testes (p<0,05) em menor magnitude que no grupo DPOC. Conclui-se que o TGlittre e o TEST induzem respostas similares em pacientes DPOC, com maior demanda ventilatória e hiperinsuflação dinâmica do que em saudáveis. Entretanto no TEST-M a resposta ventilatória foi atenuada, sugerindo que atividades de agachamento e inclinação do tronco podem desencadear sobrecarga ventilatória relevante no TGlittre.

Cerebral palsy (CP) is one of the most frequent neurodevelopmental deseases. The brain lesion may disturb upper extremity functioning in children with cerebral palsy (CP). This thesis aims to create a therapeutic program focused on movability of upper limbs in school-aged children with CP and and verify the efficiency of this therapeutic program. Another goal is to consider the applicability of the Jebsen Taylor Test of Hand Function for assessment of hand function in children with CP. The theoretical part deals elaborately with cerebral palsy, therapeutic interventions in children with CP and its efficiency according to the evidence based medicine. This part also deals with standardized assassment tools and pays close attention to the Jebsen Taylor Test of Hand Function (JTTHF) and the Manual Ability Classification System (MACS). The practical part presents six case studies of children with cerebral palsy who attended the occupational therapy three times a week over three weeks. The created therapeutic program includes three areas focused on the bimanual training, grips and grafomotorics. This program was appropriate for four of six children patients. The program was too hard for children with quadruparesis classified as MACS IV. The other children were classified as MACS II. The efficiency of...

Introdução: alguns pacientes com zumbido podem apresentar pontosgatilho miofasciais, principalmente na musculatura mastigatória e cervical. No entanto, este tema é pouco abordado na literatura. Os objetivos deste estudo foram investigar a associação entre (1) zumbido e pontos-gatilho, (2) a orelha com pior zumbido e o lado do corpo com maior número de pontosgatilho, além de (3) verificar a capacidade de o ponto-gatilho modular o zumbido. Métodos: neste estudo caso-controle foram avaliados 94 pacientes com zumbido e 94 assintomáticos, pareados por sexo e idade, sem queixa de dor generalizada ou mioclonia. Todos foram submetidos, pelo mesmo investigador, a um protocolo de avaliação e à pressão digital para pesquisa de pontos-gatilho em 9 músculos bilateralmente: infra-espinal, levantador da escápula, trapézio, esplênio da cabeça, escaleno, esternocleidomastóideo, digástrico, masseter e temporal. A intensidade do zumbido foi avaliada por uma escala numérica de 0 a 10, considerando-se como modulação o aumento ou diminuição imediata de pelo menos um ponto na escala e/ou mudança no tipo de som. Os exames foram executados em local silencioso para facilitar a percepção da modulação do zumbido. Resultados: os pontos-gatilho estavam presentes em 72,3% dos pacientes com zumbido (OR= 4,87; p< 0,001) e 55,9% deles relataram modulação do sintoma durante a pressão digital nos pontos-gatilho ativos e latentes, em pelo menos um músculo, principalmente no masseter, esplênio da cabeça, esternocleidomastóideo e temporal. A modulação do zumbido pelo ponto-gatilho examinado foi predominantemente ipsilateral em 6 dos 9 músculos avaliados. Houve correlação de lateralidade entre a orelha com pior zumbido e o lado do corpo com maior número de pontos-gatilho em 56,5% dos casos (Kappa= 0,29; p< 0,001). Houve diferença significante quanto à presença de queixa prévia de dor na comparação dos pacientes com zumbido que modularam com aqueles que não modularam (p< 0,008). Conclusões: a presença significante dos pontos-gatilho em pacientes com zumbido associada à freqüente modulação do sintoma durante sua palpação, além da sua presença em maior número no lado da orelha com pior zumbido, sugere que os pontos-gatilho sejam um fator etiológico ou coadjuvante do zumbido. / Introduction: some patients suffering from tinnitus may present myofascial trigger points, mainly in head and neck muscles. However, this issue is poorly explored in the literature. The objectives of this study were to investigate an association between (1) tinnitus and trigger points, (2) the ear with the worst tinnitus and the side of the body with more trigger points, (3) presence of trigger points and their capacity of modulating tinnitus. Methods: in this case control study 94 subjects with tinnitus, and 94 without such symptom were analyzed, matched by age and gender, excluding those with widespread musculoskeletal pain or myoclonus. All of them underwent an evaluation protocol and digital pressure in order to search for trigger points in 9 bilateral muscles: infraspinatus, levator scapulae, trapezius, splenius capitis, scalenus, sternocleidomastoid, digastric, masseter and temporalis. The intensity of tinnitus was evaluated with a scale ranging from 0 to 10, and modulation was considered present in cases of immediate increase or decrease of at least one point in the scale and/or changes in the type of sound. The exams took place in a silent environment, so as to make it easier for tinnitus\' modulation to be perceived. Results: the presence of trigger points was observed in 72.3% of tinnitus patients (OR= 4.87; p< 0,001). Among them, 55.9% reported tinnitus modulation during digital pressure in both active and latent trigger points, in at least one muscle, mainly in masseter, splenius capitis, sternocleidomastoid and temporalis muscles. The rate of tinnitus modulation was significantly higher at the same side of the trigger point subject to examination in 6 out of 9 muscles. There was an association of laterality between the ear with worst tinnitus and the side of the body with more trigger points in 56.5% of the cases (Kappa value = 0.29; p< 0.001). There was a significant difference related to the presence of previous pain complaint when patients with tinnitus that modulated were compared to patients with tinnitus that did not modulate (p< 0.008). Conclusions: significant presence of trigger points in tinnitus patients, associated to frequent modulation of this symptom during palpation, besides the presence of more trigger points in the side of the ear with the worst tinnitus, suggests that trigger points are an etiologic factor or adjuvant in tinnitus onset.

INTRODUÇÃO: O tratamento do câncer de mama está associado à morbidade do membro superior, com complicações que têm um impacto significante na qualidade de vida das pacientes. O OBJETIVO deste trabalho foi traçar um protocolo de tratamento fisioterapêutico para prevenir as morbidades após cirurgia de câncer de mama. CASUÍSTICA E MÉTODOS: Este estudo avaliou 132 mulheres com a intervenção da fisioterapia em dois momentos: no primeiro pós-operatório (PO) e entre o 10º - 15º dia do PO. Reavaliações foram feitas nos meses 1, 2, 3, 4, 5, 6 e após um ano do PO. RESULTADOS: O grupo de intervenção precoce mostrou uma recuperação mais rápida da amplitude de movimentos e apresentou menor morbidade em relação ao grupo tardio. CONCLUSÃO: O protocolo fisioterapêutico preconizado, tanto precoce quanto tardio, é eficaz. A recuperação da função do membro superior e o menor índice de morbidades mostram que a fisioterapia deve sempre ser instituída nas pacientes que se submetem à cirurgia de câncer de mama. / INTRODUCTION: The breast cancer treatment is always linked with the morbidity of the upper limb with complications that will have an enormous impact in the quality of life of the patients submitted to breast cancer treatment. Objective : the objective of this study was to develop a physiotherapy protocol in order to prevent morbidities after breast cancer treatment METHODS: This study evaluated 132 patients submitted to physiotherapy sessions in two different moments: 1 st day post surgery and at the 10-15 th day . Follow-ups were made on months 1, 2, 3, 4, 5, 6 and after a year. RESULTS: The earlier group showed a faster recovery of arm range of motion and had less arm morbidity. CONCLUSÃO: O RESULTS: G1 showed a faster flexion and abduction ROM recovery and had less morbidity as compared to the other group. The arm circumferences in the early intervention group had lower values as compared to the late intervention group. CONCLUSION: The physiotherapy protocol used in the study showed its efficacy. The upper arm ROM was recovered and both groups had less arm morbidity.

O objetivo deste trabalho foi estudar a expressão protéica de mdm2 e avaliar a sua relação com alguns aspectos anatomopatológicos, visando também identificar fatores prognósticos no que diz respeito à sobrevida livre de recidiva local (SLRL), sobrevida livre de metástase (SLM) e sobrevida global (SG), em pacientes portadores de lipossarcoma primário de extremidades. Vinte e cinco entre 50 pacientes admitidos no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – IOT/HC/FMUSP, entre 1968 e 2004, foram eleitos para o estudo. As probabilidades de sobrevida acumuladas foram feitas pela técnica de Kaplan-Meier e as curvas de sobrevida comparadas pelo teste de Log Rank. A validade estatística foi estabelecida para valores de p<0,05. As associações entre os índices positivo ou negativo para o mdm2 com outras variáveis foram feitas utilizando-se o teste exato de Fischer. A expressão imunoistoquímica da proteína mdm2 não foi considerada de valor prognóstico em nenhuma das sobrevidas estudadas (SLRL, SLM ou SG). Os fatores adversos que influenciaram o risco de recidiva local na análise univariada foram: o gênero masculino (p = 0,023), subtipo histológico pleomórfico (p = 0,027) e alto grau histológico (p=0,007). Em relação a SLM a idade inferior a 50 anos (p = 0,040), o gênero masculino (p = 0,040), o subtipo pleomórfico (p < 0,001), o alto grau histológico (p = 0,003) tiveram um pior prognóstico. Os fatores adversos para SG foram: idade inferior a 50 anos (p = 0,040); o gênero masculino (p = 0,040); o subtipo pleomórfico (p < 0,001) e o alto grau histológico (p = 0,003). / The purpose of this was to study the expression by imunohistochemistry of mdm2 and your correlation with anatomopathological selected variables, aiming at identifying prognostic factors concerning to local recurrence free survival (LRFS), metastases free survival (MFS) and overall survival (OS) in patients with liposarcomas primary extremities. This study included 25 patients registred in the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Brazil, from 1968 to 2004. The accumulated survival probabilities were calculated by Kaplan-Meier method and survival curves were compared using the logrank test. Statistical significance was defined as a p value less than 0,05. Associations between expression of mdm2 and other variables were analyzed using Fischer’s exact test. The expression by imunohistochemistry of mdm2 was not significant factor for LRFS, MFS or OS. The adverse factors for LRFS in univariate analysis were male gender (p = 0,023), pleomorfic histologic subtypes (p = 0,027) and high grade tumor (p = 0,007). For MFS age < 50 years (p = 0,040), male gender (p = 0,040), pleomorfic histologic subtypes (p < 0,001) and high grade tumor (p = 0,003) had worse prognostic. Negative prognostic factors for OS were age < 50 years (p = 0,040), male gender (p = 0,040), pleomorfic histologic subtypes (p < 0,001) and high grade tumor (p = 0,003).

This study aims to evaluate the effects of functional electrical stimulation on motor and functional abilities of paretic upper limb in patients after stroke. Specifically detects the immediate effect of functional electrostimulation on the increase of the active range of motion, reduction of the hand spasticity degree and the improvement of functional performance. The research covered a total of 6 patients after first stroke in the basin aretria middle cerebral artery. The research sample had a homogeneous distribution of the paresis heaviness from light, moderate, to severe. The research was conducted in total of three weeks, every working day, 60 minutes a day, with 30 minutes of indicated electrostimulation and 30 minutes of testing of monitored parameters. Patients were evaluated using the Modified Frenchay scale, Modified Tardieu scale and the range of motion goniometer. Research showed in 60 observations that the functional electrical stimulation has immediate and significant effect on increasing the active range of dorsal flexion motion of the wrist (p-value 0.043). The average improvement on 95% interval estimation is 0.08. During the monitoring of the improvement of the active range of wrist dorsal flexion motion between input and output examination there was no statistically significant...