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Previous issue date: 2016-11-11 / Background: Traumatic spinal cord injury (TSCI) is a severe, incapacitating,
neurological syndrome that leads to changes in sensitivity, motor function, and the
autonomic system of body segments located below the level of injury. Although it is
one of the most devastating injuries and poses multiple challenges for the patients,
family, and clinicians involved, physical therapy can lead to neurological
improvements in patients with TSCI. The purpose of this study was to evaluate the
effects of corporal suspension and pendulum exercises (CHORDATA? method) on
torque, muscle activation, muscle thickness, and functionality in patients with TSCI.
Methods: This study was a randomized, controlled clinical trial including 26 male
TSCI patients (in whom injury occurred up to 3 years earlier at the thoracic level; age,
18?65 years). The subjects were categorized into two groups: an intervention group
(IG; n = 14) and a control group (CG; n = 12). Before and after a rehabilitation
program, which comprised 16 sessions of suspension and pendulum exercises
(twice/week, 50 minutes/session), we evaluated the following parameters in each
subject: maximal voluntary isometric trunk flexion and extension torques;
electromyographic activity of the external oblique, rectus abdominis, and longissimus
muscles; muscle thickness of the external oblique, internal oblique, transversus
abdominis, rectus abdominis, and multifidus muscles; and functionality (adapted
reach test). Mean ? standard deviation values were used to summarise continuous
data, which were then compared at the baseline using t-tests. Categorical variables
were expressed as counts and percentages. Between-group baseline differences
were assessed using chi-square or Fisher?s exact tests, as required. Analysis of
covariance, with adjustments for baseline measurements, was conducted to evaluate
between-group differences after the 16 exercise sessions. The results were
presented as mean ? standard deviation with the estimated adjusted difference
between groups, followed by 95% confidence intervals. The study significance level
was set at ? = 0?05. Data were analysed using SPSS version 22.0 (SPSS, Inc.,
Chicago, USA).This trial is registered with Clinical Trials.gov, #NCT02316067.
Findings: The CG and IG patients had similar ages (p = 0?93), injury time (p = 0?41),
injury level (p = 0?27), injury mechanism (p = 0?22), American Spinal Injury
Association (ASIA) scale (p = 0?11), injury type (p = 0?22), and functional reach (p =
0?11). Post-intervention, the IG trunk flexion (58%, p = 0?004) and extension (76%, p
= 0?005) torques were higher in the IG than in the CG. Similar between-group
differences were observed post-intervention for RA-L absolute RMS values (p =
0?028), RA-R RMS values normalized to the resting state (p = 0?047), and functional
reach (p = 0?015). Muscle thickness for all muscles was higher in the IG patients as
compared to the CG patients post-intervention (p < 0?002), except for the MULT-R
muscle (p = 0?057).
Interpretation: Sixteen sessions of suspension and pendulum exercises improved
rectus abdominis muscle activation, trunk muscle structure and strength, and
reaching capacity in TSCI patients. Thus, this novel, effective rehabilitation method
may improve functionality in TSCI patients. / Introdu??o: A les?o medular (LM), especialmente quando instalada de maneira
s?bita, ? uma das les?es mais devastadoras, do ponto de vista f?sico e psicol?gico,
confrontando paciente, fam?lia e equipe de profissionais com m?ltiplos desafios.
N?o obstante, sabe-se que a LM tem potencial de recupera??o, havendo relatos de
diversos estudos que demonstram a melhoria do estado neurol?gico. O objetivo
deste estudo foi avaliar os efeitos dos exerc?cios com suspens?o e pendula??o
corporal (M?todo Chordata?) sobre o torque, a ativa??o muscular, a espessura
muscular e a funcionalidade de indiv?duos com les?o medular tor?cica.
M?todo: Ensaio cl?nico randomizado e controlado onde foram estudados 26
indiv?duos do sexo masculino com les?o medular tor?cica e idades entre 18 e 65
anos, divididos em grupo interven??o (GI; n=14) e grupo controle (GC; n=12) com
no m?ximo tr?s anos de les?o at? a sua inclus?o no estudo. Foram estudados o
torque flexor e extensor do tronco durante contra??es volunt?rias m?ximas, a
atividade eletromiogr?fica do reto abdominal, obl?quo externo e longu?ssimo do
dorso bilateral e a espessura muscular dos m?sculos reto abdominal, obl?quo
externo e interno, transverso do abdomen e multifidos bilateral e a funcionalidade
por meio do teste do Alcance Funcional adaptado. Os indiv?duos foram avaliados
nos per?odos pr? e p?s a um programa composto por 16 sess?es de exerc?cios
com M?todo Chordata? com frequ?ncia de duas vezes por semana durante 50
minutos. A m?dia ? desvio padr?o foram usados para avaliar os dados cont?nuos, os
quais foram comparados aos dados basais utilizando o teste t de Student. Vari?veis
categ?ricas foram expressas por porcentagens e diferen?as entre os grupos no
baseline foram avaliadas usando o Qui-quadrado ou teste exato de Fisher. An?lise
de covari?ncia com ajustes das medidas no baseline foram utilizadas para avaliar as
diferen?as entre os grupos. Os resultados foram apresentados pela m?dia ? desvio
com as diferen?as estimadas ajustadas entre os grupos, seguindo intervalo de
confian?a de 95%. Os resultados foram considerados estatisticamente significativos
quanto P<0,05. O programa SPSS 22.0 (SPSS, Inc., Chicago, USA) foi utilizado para
a an?lise dos dados. Este estudo foi registrado no Clinical Trials.gov,
#NCT02316067.
Resultados: No per?odo pr?-interven??o n?o houve diferen?as significativas
entre os grupos em rela??o ?s idades (p = 0?93), tempo de les?o (p = 0?41), n?vel
da les?o (p = 0?27), mecanismo da les?o (p = 0?22), escala ASIA (p = 0?11), tipo de
les?o (p = 0?22), e Alcance Funcional adaptado (p = 0?11). No per?odo p?sinterven??o,
o GI apresentou melhora do torque flexor (58%, p = 0?004) e extensor
(76%, p = 0?005) em rela??o ao GC. Diferen?as similares entre os grupos foram
observadas no per?odo p?s-interven??o para o reto abdominal esquerdo em seu
valor absoluto RMS (p = 0?028), e reto abdominal direito em seu valor RMS
normalizado pelo repouso (p = 0?047), e no teste do Alcance Funcional (p = 0?015).
A espessura muscular foi maior no GI no periodo p?s-interven??o para todos os
grupos estudados quando comparados ao GC (p < 0?002), com exce??o dos
mult?fidos direito (p = 0?057).
Conclus?o: Dezesseis sess?es de exerc?cios com M?todo Chordata?
mostraram melhora na ativa??o do m?sculo reto do abdomen, na estrutura
muscular, na for?a e na capacidade de deslocar o tronco ? frente de indiv?duos
com les?o medular tor?cica. Esses resultados apontam para evid?ncias em
uma nova e efetiva reabilita??o por meio de um M?todo que melhora a
funcionalidade desses indiv?duos.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/7388 |
| Date | 11 November 2016 |
| Creators | Frison, Ver?nica Baptista |
| Contributors | Franco, Alexandre Rosa, Vaz, Marco Aur?lio |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, Brasil, Escola de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 600, 600, 600, -224747486637135387, -969369452308786627 |
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