Dissertations / Theses on the topic 'Tono muscular'

BARROS, Adriana Rolim Campos. Efeito pró-erétil de uma fração rica em alcalóides isolada de aspidosperma ulei markgr.: estudo in vivo e in vitro. 2005. 199 f. Tese (Doutorado em Farmacologia) - Universidade Federal do Ceará. Faculdade de Medicina, Fortaleza, 2005.
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The genus Aspidosperma (Apocyanaceae) is known to be rich in yohimbine type of indol alkaloids. This study was aimed to evaluate the alkaloid rich fraction (SF3-5) obtained from Aspidiosperma ulei Markgr. root bark for its general toxicity, behavioral effects in mice and a possible proerectile activity. Acute toxicity tests were performed to determine the LD50 in mice and LC50 with Artemia sp. Behavioral effects were studied in the tests of open-field, hole-board, plus-maze, rota-rod, forded-swimming, and on barbiturate-induced sleeping time. In vitro studies with the fraction were carried out using mouse vas deferens and the rabbit and human corpus cavernous tissues. The estimated values of i.p. LD50 in mice and LC50 with Artemia sp. were in the order of 400 mg/kg, and 3.94 microg/ml, respectively. Behavioral tests in mice revealed a general stimulant activity of SF3-5 on CNS but demonstrated no motor impairment in rota-rod test. At 25 mg/kg intraperitoneal injection of SF3-5, penile erections were evidenced in 75% of the mice. This effect was completely abolished by pretreatment with clonidine (alfa2 –adrenoceptor agonist) or haloperidol (dopaminergic antagonist) and only partially inhibited by L-NAME (nitric oxide synthase inhibitor) and by methylene blue (soluble guanylate cyclase inhibitor). SF3-5 also abrogated the fluoxetine-induced depression in sexual behavior. In mouse vas deferens, contractile effects induced by electrical field stimulation or noradrenaline but not induced by ATP were inhibited by SF3-5 (1-64 microg/ml). In both human and rabbit isolated corpus cavernosum preparations pre-contracted by phenylephrine, high potassium or PGF2alfa, SF3-5 (1-300 microg/ml) caused concentration-dependent relaxation. Our results indicate that SF3-5 manifests pro-erectile activity possibly involving both central (dopaminergic, adrenergic and nitriergic systems) and peripheral (relaxant effect on corpus cavernosal smooth muscle, probably involving Ca+2 flux) mechanisms. These data also suggest that Aspidiosperma ulei Markgr. can be explored as an alternative for the treatment of erectile dysfunction. The study further warrants the identification and isolation of the active chemical compound present in SF3-5, responsible for the pharmacological activity.
O gênero Aspidosperma (Apocynaceae) é conhecido por ser rico em alcalóides indólicos do tipo ioimbina. O presente trabalho teve por objetivo avaliar a toxicidade, efeitos sobre o comportamento e um possível pró-erétil de uma fração rica em alcalóides isolada da casca da raiz de Aspidosperma ulei Markgr. (SF3-5). Os testes de toxicidade aguda foram realizados para determinar a DL50 em camundongos e a CL50 em Artemia sp. Os efeitos sobre o comportamento foram estudados nos testes do campo aberto, placa perfurada, labirinto em cruz elevado, “rota-rod”, natação forçada e tempo de sono induzido por barbitúrico. Os estudos in vitro com a fração foram realizados em canal deferente de camundongos e corpos cavernosos de coelhos e humanos. Os valores estimados para a DL50 (i.p.) em camundongos e CL50 em Artemia sp. foram na ordem de 400 mg/Kg e 3,94 microg/mL, respectivamente. Os testes comportamentais em camundongos revelaram uma atividade estimulante de SF3-5 sobre o SNC mas não demonstraram incoordenação motora no teste do “rota-rod”. A injeção intraperitoneal de 25 mg/Kg de SF3-5 induziu a ereção peniana em 75 % dos camundongos. Este efeito foi completamente abolido pelo pré-tratamento com clonidina (agonista receptores adrenérgicos alfa2) ou haloperidol (antagonista dopaminérgico) e somente parcialmente inibido pelo L-NAME (inibidor da óxido nítrico sintase) e pelo azul de metileno (inibidor da guanilato ciclase solúvel). SF3-5 também reverteu a depressão do comportamento sexual induzida por fluoxetina. No canal deferente de camundongos, as contrações induzidas pela estimulação por campo elétrico ou noradrenalina, mas não as induzidas por ATP, foram inibidas por SF3-5 (1 – 64 microg/mL). SF3-5 (1 – 300 microg/mL) promoveu relaxamento concentração-dependente nas preparações de corpos cavernoso humanos e de coelhos pré-contraídas com fenilefrina, potássio ou PGF2alfa. Nossos resultados indicam que SF3-5 manifesta atividade pró-erétil possivelmente envolvendo mecanismos centrais (sistemas dopaminérgico, adrenérgico e nitrérgico) e periférico (efeito relaxante do músculo liso cavernoso aparentemente envolvendo o fluxo de Ca+2). Estes dados também sugerem que Aspidosperma ulei Markgr. pode ser explorada como uma alternativa para o tratamento da disfunção erétil. São necessários estudos futuros para identificar e isolar o composto químico ativo presente em SF3-5 responsável pela atividade farmacológica.

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DEOCLECIANO JÚNIOR, Otacílio Benvindo. Avaliação da atividade relaxante de 17-NOR-SUBINCANADINA e, um alcalóide isolado de Aspidosperma ulei MARKGR. sobre a musculatura lisa cavernosa de coelhos. 2008. 113 f. Dissertação (Mestrado em Farmacologia) - Universidade Federal do Ceará. Faculdade de Medicina, Fortaleza, 2008.
Past studies have shown that the indole alkaloidal rich fraction (F(3-5)) from Aspidosperma ulei Markgr. root bark displays pro-erectile function in vivo and a relaxant effect on isolated rabbit corpus cavernosum in vitro. Also, a recent study demonstrated the in vivo pro-erectile like activity of 17-nor-subincanadina E (SEC), an alkaloid isolated from stem bark of this plant. This study aimed to assess further the effect of SEC on the smooth muscle tone (spontaneous or induced) in vitro, utilizing the strips of tracheal, intestinal, vascular and corpus cavernosal tissues of rabbits. An attempt was also made to study the possible mechanism of SEC on rabbit corpus cavernosum (RbCC). RbCC strips, were mounted in organ baths containing Krebs solution. After equilibration, the tissues were precontracted with phenylephrine (10 µM) or potassium (40mM). SEC (1-100 μg/ml) caused a concentration dependent relaxation in the isolated rabbit corpus cavernosum precontracted with phenylephrine and displayed comparatively greater relaxant effect on corpus cavernosum IC50 [7,174 (3,155-16,31) μg/ml], SEC produced concentration-dependent relaxations of the aortic rings in endothelium intact and denuded IC50[29,76 (90,32–115,6) μg/ml] and IC50[ 26,13 (75,83–119,9) μg/ml], respectively, trachea rings IC50[60,25 (0,330-109,8) μg/ml], and of spontaneous motility in segments of duodenum IC50[76,78 (33,09–178,2) μg/ml]. The relaxant effect of SEC (1-100 µg/ml) on phenylephrine contraction was unaffected in the presence of adrenergic blockers (phentolamine and guanethidine), muscarinic blocker (atropine), KATP channel blocker (glibenclamide), Ca2+-dependent K+ channel blockers (apamin and iberiotoxin), and in the presence of N-omega-nitro-L-arginine methyl ester (L-NAME 100 µM)). However, the SEC relaxation was significantly attenuated by ODQ (30 μ M) (79.1%±4.5%, p <0.05). Incubations of RbCC with SEC (10 and 30 µg/mL) caused significant increases of cGMP (21.5%±4.2%, p <0.05) and cAMP (331.95%±26.1%, p <0.05) levels. Preincubation with SEC (10 and 30 µM) also significantly enhanced the relaxation response to the exogenous NO-donor (GTN) and an activator of adenyl cyclase (forskolin). the relaxations evoked by electrical stimulation was significantly decreased by SEC (10 µg/mL) (65.0%±10.9%, p <0.05). The phasic component of the contraction induced by K+ 40 mM as well as the maximal contraction elicited by increasing external Ca2+ concentrations in depolarized corpora cavernosa was inhibited by SEC (15 µg/mL). Our results indicate that SEC can induce comparatively a greater relaxant effect on rabbit cavernosal tissue in vitro via a mechanism that involves an increase of cAMP and cGMP levels and a blocking effect on calcium flux. These data suggest that Aspidiosperma ulei Markgr. can be explored as an alternative for the treatment of erectile dysfunction.
Estudos anteriores demonstraram que uma fração rica (F(3-5)) em alcalóides indólicos extraída das cascas da raiz de Aspidosperma ulei Markgr. exibe função pró-eretil in vivo e relaxamento em corpos cavernosos de coelhos in vitro. Um estudo recente demonstrou que 17-nor-subincanadina E (SEC), um alcalóide extraído das cascas do caule da mesma planta, apresentou atividade pró-eretil in vivo. O presente trabalho teve por objetivo avaliar o efeito desse alcalóide sobre o tônus de diferentes tipos de musculatura lisa de coelhos e investigar o mecanismo de ação da substancia sobre o músculo liso cavernoso in vitro. Os tecidos foram montados em banhos de 5 ml contendo solução de Krebs-Henseleit (CO2 5% - O2 95%; 37ºC). A resposta relaxante máxima induzida por SEC (1 – 100 µg/ml) em segmentos de corpos cavernosos de coelhos contraídos com fenilefrina (PHE-10μM) foi de 100%, e apresentou um efeito relaxante preferencial para esse tecido, IC50[7, 174 (3,155 - 16,31) μg/ml]. SEC promoveu também relaxamento em anéis de aorta na presença e na ausência de endotélio, IC50[29,76 (90,32 – 115,6) μg/ml] e IC50[26,13 (75,83 – 119,9) μg/ml], respectivamente, anéis de traquéia IC50[60,25 (0,330 – 109,8) μg/ml] e em segmentos de duodeno IC50[76,78 (33,09 – 178,2) μg/ml]. O relaxamento induzido por SEC (1 – 100 µg/ml) não foi afetado por bloqueadores adrenérgicos (fentolamina e guanetidina), muscarínicos (atropina), ou bloqueadores dos canais de potássio dependentes de ATP (KATP)(glibenclamida) e ativados por cálcio (Kca) (apamina e iberiotoxina) e nem na presença de L-NAME; a adição de ODQ (30 µM) bloqueou o relaxamento induzido por SEC (79,1% ± 4,5%; p<0,05). Observou-se também um aumento dos níveis teciduais de AMPc (331,95% ± 26,1%; p<0,05) e GMPc (21,5% ± 4,2%; p<0,05). SEC (10 µg/ml e 30 µg/ml) potencializou o relaxamento induzido por gliceriltrinitrato (GTN) e forskolina (FK) e foi capaz de diminuir o relaxamento induzido pela estimulação por campo elétrico (ECE) (65,0% ± 10,9%; p< 0,05). SEC 15 μg/ml bloqueou a contração induzida por CaCl2 1 - 300 mM em corpos cavernosos de coelhos pré-contraídos com K+ (40 mM), 0 Ca++. Nossos resultados indicam que SEC manifesta atividade relaxante preferencial no músculo liso cavernoso a nível periférico e que esse efeito está aparentemente relacionado com um aumento dos níveis de AMPc e GMPc e um possível bloqueio do fluxo de cálcio. Estes dados sugerem que Aspidosperma ulei Markgf. pode ser explorada como uma alternativa para o tratamento da disfunção erétil.

Orientador: Jorge Rizzato Paschoal
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A Paralisia Facial (PF) tem sido progressivamente, objeto de estudo dos fonoaudiólogos que trabalham com motricidade e reabilitação orofacial. A terapia visa a reabilitação das funções orais - sucção, deglutição, mastigação, fala e expressividade facial. Na paralisia facial periférica (PFP), a diminuição dos movimentos faciais e seqüela estética resultantes podem ter repercussões emocionais importantes, além do déficit funcional. A reabilitação orofacial favorece a recuperação de movimentos e a adequação e/ou a adaptação das funções orofaciais e de expressividade, mediante atuação no tônus muscular. Entretanto, quantificar os resultados terapêuticos na tentativa de aferição do tônus muscular é tarefa difícil. O objetivo geral desta tese foi avaliar a mudança do ACL a partir de um protocolo específico aplicado em pacientes com paralisia facial periférica. Os objetivos específicos foram estudar a variação do ACL, entre o início e o final do tratamento de reabilitação e avalia a confiabilidade da variação desse ângulo como elemento quantificador da eficácia terapêutica. Foram estudados 20 pacientes com PFP (grau IV), encaminhados para reabilitação orofacial do Ambulatório de Paralisia Facial do Hospital de Clínicas da Unicamp, num ensaio longitudinal prospectivo. A constatação da evolução funcional favorável baseou-se na melhora do tônus muscular com a reabilitação. A variação do tônus foi aferida mediante modificação no ACL. O estudo foi feito nas imagens da documentação fotográfica pré (após quinze dias de instalação da paralisia facial) e pós-tratamento de um ano. Para comprovação da eficácia da reabilitação, comparou-se o ACL pré e pós-reabilitação. O grupo estudado foi comparado a um grupo controle composto de nove sujeitos com paralisia facial grau IV, não submetidos a reabilitação orofacial. Os dados foram analisados estatisticamente pelo teste emparelhado das amostras (T-Student). A confiabilidade da medida do ACL foi aferida através do teste de coeficiente de correlação de Pearson. A média da idade dos pacientes estudados foi 47,65 anos, com desvio padrão (DP) 13,50. A média do ACL pré-reabilitação foi 101,70 e, pós-reabilitação, diminuiu para 93,80 (DP = 4,3). O teste estatístico revelou diferença estatisticamente significativa (p< 0, 001). A análise de confiabilidade demonstrou que existe uma alta correlação entre as medidas de ângulos para os três juízes, sendo estatisticamente significante (p<0,001). O teste estatístico T-Student aplicado para comparação entre o grupo estudado e o grupo controle revelou que a média do ACL no grupo controle foi 100.9, não tem diferença com a média das medidas iniciais do grupo estudado (p=0,723). Em contrapartida apresentou significância estatística na comparação dos valores pós tratamento (p=0.001). Concluímos que o ACL é um marcador antropométrico que nos permite avaliar objetivamente a modificação do tônus da musculatura facial na PFP. Esse protocolo de reabilitação permitiu incremento marcante do tônus muscular, com melhora significativa da simetria do rosto no repouso facial
Abstract: Facial Paralysis has progressively been object of study by speech therapists Who work with motor skills and orofacial rehabilitation. The objective of the therapy is to rehabilitate oral functions - suction, swallowing, mastication, speech and facial expressiveness. The impairment of facial movements and aesthetical sequelae as a consequence of peripheral facial paralysis (PFP) have important emotional repercussions besides functional deficit. Orofacial rehabilitation improve recuvery of movements and adjustment and/or adaptation of the orofacial functions by acting on muscular tonus. However quantifying the therapeutic results in an attempt to valuate muscular tonus is a hard task. The general objective of this thesis was to assess the change on the LCA from a specific protocol applied to patients with peripheral facial paralysis. The specific objectives were to study the LCA variation between the beginning and end of rehabilitation treatment and to assess the reliability of this angle's variation as a quantifying element of therapeutic efficacy. Twenty patients with PFP (HB IV) were studied. They were refered for orofacial rehabilitation from the Facial Paralysis Ambulatory of the Hospital das Clínicas da UNICAMP. This is a prospective longitudinal study. The study was based on the photographically documentation images before (after fifteen days of facial paralysis onset) and one year after treatment. The value of LCA was compared before and one year after treatment. The patients were compared to a control group of nine pacients with PFP - HB IV Who were did not undergo orofacial rehabilitation. The data were analyzed statistically using a T-student test. The reliability of the measurement of the LCA was verifiedusing a Pearson correlation coefficient test. The average age of the patients was 47.65 years, with a standard deviation (SD) of 13.50. The LCA average before rehabilitation was of 101.7o and, after rehabilitation, it 93.8o (SD = 4.3). The statistical test showed a statistically significant difference (P < 0.001). The reliability analysis showed that there is a high correlation among the three angle measurements for the three judges, therefore being statistically significant (p<0.001). The statistical T-test applied to compare the group which was studied with the control groups has revealed that the average LCA in the control group was 100.9, and there is no difference with the average of the initial measurements in the group which was studied (p = 0.723). On the other hand, there is a statistical significance in the comparison of post-treatment values (p=0.001). We concluded that the LCA is an anthropometric marker which seems to allow objectively assessment the muscular tonus modification on facial muscles in patients with PFP. Our protocol of rehabilitation improved the muscular tonus, and facial functions
Doutorado
Ciencias Biomedicas
Doutor em Ciências Médicas

Orientador: Maria Aparecida Affonso Moyses
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: As alterações na musculatura e função linguais podem resultar em deglutições atípicas, distúrbios articulatórios, respiração oral, na síndrome da apnéia do sono (SAHOS) e em alterações estéticas, como as "papadas". Fez-se uso do Exercitador Lingual, desenvolvido pela autora, para fortalecer a musculatura da língua e trazer maior eficiência à reeducação. O objetivo foi propor outra forma de tratamento que consiste no fortalecimento dos músculos elevadores da língua, longitudinal superior e transverso, minimizando a ação do genioglosso. Participaram 76 crianças (6 a 18 anos), sendo 38 sem alterações - grupo controle (GC) e 38 sintomáticas, por deglutições atípicas, distúrbios articulatórios de /s/ (ceceio), /r/ (dorsalização) e respiradores orais - grupo experimental (GE). A avaliação propôs a manutenção da língua afilada e protraída por 30 segundos, classificadas em normotensas quando atingiam 30s e flácidas abaixo desse tempo, divididas em severas (0s a 8s); moderadas (9s a 15s) e leves (16s a 29s). A deglutição e a fala receberam escores de zero (inadequação máxima) a três (correta automatização da função). O GE foi avaliado em T0, início do tratamento; T1, 15 dias de uso do aparelho; T2, 45 dias e T3, 90 dias. Obteve-se, como resultados, 83,33% de correlação entre o tempo do afilamento lingual e o tempo de uso do aparelho. Em relação à deglutição, a correlação que era de 99,83% no início do tratamento, passou para -74,80% em T3. Após 90 dias de exercitação os grupos tornaram-se estatisticamente iguais. A adequação muscular propiciou uma melhora no desempenho da função, atingindo a correta automatização (86,84% de línguas normotensas; 89,47% com deglutição adequada, 69,23% eliminaram o distúrbio articulatório e 100% de respiradores nasais). Conclui-se que a intervenção proposta colaborou de forma significativa na reeducação lingual para os indivíduos pesquisados, restabelecendo a normalidade no desempenho das funções de deglutição e fala em 90 dias de exercitação
Abstract: The alterations in tongue musculature and functions have resulted in atypical deglutitions, articular disorders, oral breathing and the sleep apnea syndrome (SOHAS), as well as esthetic alterations, such as the "double chins". The Lingual Exerciser was developed by the author in order to strengthen tongue musculature, minimize the exercising time and provide higher effectiveness to reeducation. The objective of the present study was to introduce a new treatment approach for the tongue musculature, which comprises the strengthening of the elevator muscles, superior longitudinal and transverse. Seventy-six children (6 to 18 years old) were selected and divided into two groups: control group (CG), n = 38, with no alterations; and experimental group (EG), n = 38, symptomatic children, presenting atypical deglutitions, phonetic articular disorders of the /s/, frontal lisping and /r/, dorsalization or retroflection, and oral breathers. The idealized evaluation proposed to maintain the tongue tapered and protracted for 30 seconds, being classified as normotense when they reached 30 seconds, and hypotense when they were not able to keep to position for this period of time, subdivided into severe, (0s to 8s); moderate (9s to 15s); and mild (16s to 29s). Deglutition and speech were scored from 0 (maximum inadequacy) to 3 (correct function automation). The EG was evaluated in T0 for treatment baseline; T1, 15- day use of the appliance; T2, 45-day use, and T3, 90 days. The results achieved represent 83.33% of probability that the increased time of tongue tapering is related to the increased time of appliance use; after 90 days of exercising, the results were statistically significant for tongue tonicity, deglutition and speech, which made control and experimental groups statistically similar. With relation to deglutition symptomatology, the correlation which was 99.83% in the baseline, decreased to 74.80% in T3, showing that the longer the time of appliance use, the better the deglutition. There was an improvement in function performance as a consequence of the muscular fit, providing the correct automation (86.84% of the tongue became normotense; 89.47% of the individuals started to present appropriate deglutition, 69.23% eliminated articular disorder, and 100% became nasal breathers). It is possible to conclude that the approach proposed have significantly collaborated for the tongue reeducation of the individuals investigated, reestablishing normality in performing the functions of both deglutition and speech in 90 days of exercising
Doutorado
Saude da Criança e do Adolescente
Doutor em Saude da Criança e do Adolescente

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A Doença de Parkinson (DP) é uma doença neurodegenerativa progressiva, cujo diagnóstico clínico é feito pela presença de bradicinesia, tremor de repouso, rigidez muscular e instabilidade postural. O distúrbio do sono é um dos sintomas não-motores da DP, e está presente no sono noturno e na vigília diurna. A sonolência excessiva diurna acomete até 50% dos pacientes com DP, e pode constituir um marcador pré-clínico da DP. A perda da atonia muscular normal é resultado da disfunção de estruturas cerebrais que regulam a atonia muscular durante o sono REM. Sendo assim, o objetivo deste estudo foi avaliar a alteração de tônus muscular axial durante os cochilos diurnos em pacientes com doença de Parkinson e identificar e comparar as diferenças dessas alterações do tônus muscular entre pacientes com Doença de Parkinson e sujeitos normais. A hipótese é que há redução da atonia muscular durante o sono REM nos pacientes com DP. Este estudo foi realizado no Programa Pró- Parkinson e no Laboratório de Neurofisiologia Clínica do Hospital das Clínicas da Universidade Federal de Pernambuco. Foram avaliados 9 sujeitos com o diagnóstico de DP, atendidos no Programa Pró-Parkinson, bem como 10 sujeitos sem DP controles pareados por idade e sexo para avaliação durante a sonolência diurna. Para triagem foi utilizado o mini exame do estado mental e para estadiamento da doença, a escala de Hoen-Yahr original. Posteriormente os participantes foram submetidos ao teste de latência múltipla em 5 oportunidades para dormir, com duração de 20 minutos cada, com intervalos de 2 horas entre os cochilos. Os resultados mostraram que a interação condição/cochilo teve maior significância estatística. Sendo assim, durante o dia o tônus dos sujeitos com DP foi maior no primeiro e último cochilos, com diferenças estatisticamente significantes. Houveram intrusões de REM durante os cochilos diurnos nos sujeitos com DP, diferentemente dos sujeitos sem DP que não apresentaram fase REM durante o sono diurno. O comportamento do tônus durante cada estágio do sono foi semelhante nos dois grupos estudados, no entanto, no grupo com DP se manteve mais alto em todos os estágios de sono, quando comparado ao grupo controle com diferença significativa quando acordados e no estágio 1 de sono. Então, pode-se afirmar que o tônus de sujeitos com DP é maior no primeiro e último cochilos quando comparados com os demais cochilos, como também se mantém maior em todos os estágios de sono, quando comparados com sujeitos sem DP. Além disso, durante a fase de sono REM os sujeitos com DP apresentam aumento de tônus muscular diferentemente de pessoas sem DP que normalmente apresentam declínio de tônus neste estágio de sono. Estes resultados podem estar associados ao uso do medicamento para tratamento da DP que influenciam no comportamento do tônus e qualidade do sono desta população de estudo. No entanto, mais estudos precisam ser feitos isolando o efeito do medicamento, para que se possa mensurar com maior fidelidade o comportamento do tônus durante o sono na DP.
Parkinson's disease (PD) is a progressive neurodegenerative disease whose clinical diagnosis is the presence of bradykinesia, resting tremor, muscle rigidity and postural instability. The sleep disorder is one of the PD non-motor symptoms, and is present in nocturnal sleep and daytime wakefulness. Excessive daytime sleepiness occurs in 50% of patients with PD, and can be a pre-clinical marker of PD. The loss of normal muscle atonia is the result of dysfunction of brain structures that regulate muscle atonia during REM sleep. Thus, the objective of this study was to evaluate the alteration of axial muscle tone during daytime naps in patients with Parkinson's disease and to identify and compare the differences of these muscle tone changes between patients with Parkinson's disease and normal subjects. The hypothesis is that there is a reduction of muscular atonia during REM sleep. This study was conducted in the Pro-Parkinson Program and the Laboratory of Clinical Neurophysiology at the Hospital das Clinicas, Federal University of Pernambuco. Were evaluated 9 subjects with a diagnosis of PD treated at Pro-Parkinson Program, and 10 normal control subjects matched for age and sex for evaluation during daytime sleepiness. For screening, we used the mini- mental state examination, and disease staging the original Hoen-Yahr scale. Later the participants were submitted to test of multiple latency test in five opportunities to sleep, lasting 20 minutes each, at intervals of 2 hours between naps. The results showed that the condition/nap interaction had greater statistical significance. Thus, during the day the tone of subjects with PD was higher in the first and last naps, with statistically significant differences. There were intrusions of REM during daytime napping in patients with PD, unlike control group who did not present REM phase during daytime sleep. The behavior of the tonus during each stage of sleep was similar in the two groups studied, however, in the group with PD it remained higher in all the stages of sleep, when compared to the control group with significant difference when awake and in stage 1 of sleep. Therefore, it can be stated that the tone of subjects with PD is higher in the first and last naps when compared to the other naps, but it also remains higher in all stages of sleep when compared to subjects without PD. In addition, during the REM sleep phase, subjects with PD present an increase in muscle tone differently from those without PD who normally present a decline in tone at this stage of sleep. These results may be associated with the use of the drug for the treatment of PD that influence the tone behavior and sleep quality of this study population. However, more studies need to be done isolating the effect of the medication, so that the behavior can be measured more faithfully of the tonus during sleep in PD.

Orientador: Ana Maria Sedrez Gonzaga Piovesana
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A paralisia cerebral (PC) é um quadro clínico geralmente conseqüente à agressão não progressiva do cérebro em desenvolvimento, caracterizando-se por alterações do tono, força muscular e função motora. O objetivo deste estudo foi analisar a interferência do tono e força muscular nas funções motoras em crianças com paralisia cerebral tetraparética (pC-T) espástica devido a lesões hipóxico-isquêmicas (LHI). Foram avaliadas 15 crianças com diagnóstico de PC-T espástica na faixa etária de 3 a 7 anos de idade devido à LHI e nível de compreensão preservado, sendo analisados o tono muscular de acordo com a escala de Durigon e Piemonte (1993) e a versão modificada de Ashworth (1987), a força muscular baseada no exame manual de força muscular (1972) e a função motora por intermédio da escala de GMFM-66. Não houve correlação entre tono e força muscular, observando-se correlação forte entre a força muscular e a função motora e correlação fraca entre tono e função motora. Deste modo, concluiu-se que os dois fatores interferem de modo independente nas funções motoras das crianças com PC-T espástica, principalmente a fraqueza muscular
Abstract: Cerebral palsy (CP) is a clinical picture resulting from nonprogressive aggression of the developing brain, characterized by tonus, muscular strength and motor function alterations. The objective ofthis study was to ana1yzethe tonus and muscular strength interference on motor functions of children with spastic tetraparetic cerebral palsy due to hypoxic ischemic lesions (HIL). Fifteen children between 3 and 7 years of age, with adequate hypoxic ischemic encephalopathy (HIE) and preserved comprehension leveI, presenting spastic T-CP diagnosis were evaluated and the muscle tonus ana1yzedaccording to the Durigon and Piemonte scale (1993) and the modified Ashworth scale (1987). Muscular strength was evaluated based on rr..anualexamination of muscle strength (1972) and motor function by means of the GMFM-66 scale. We found strong correlation between muscle strength and motor function and little correlation between tonus and motor function, but no correlation between tonus and muscle strength being observed. In conclusion, the two factors, in particular muscular weakness, interfere in an independent way on motor functions of children with spastic T-CP
Mestrado
Mestre em Ciências Médicas

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Os distúrbios do sono são uma das principais manifestações não motoras dos pacientes com Doença de Parkinson (DP) expressando-se clinicamente de forma variada, desde a fragmentação do sono até quadros complexos como os Distúrbios Comportamentais do Sono REM. Estudos têm descrito alterações neurofisiológicas do sono noturno, em grande parte havendo desorganização em sua arquitetura, porém pouco se sabe sobre as características do sono diurno. O objetivo dessa dissertação é estudar as características do sono durante o cochilo diurno em pacientes com DP, analisando como é seu início, as características de sua estrutura e a forma em que se apresenta a sincronização da atividade motora e eletrencefalográfica (EEG), através da análise dos parâmetros do Teste das Múltiplas Latências do Sono e de possíveis fatores influenciadores. Amostra foi constituída de 22 pacientes com DP, ambos os sexos, idade acima de 40 anos. Foi utilizado um aparelho digital com quatro canais ativados de EEG para registro da atividade elétrica cerebral, além de canais para os movimentos oculares e para o tônus muscular mentual durante o sono diurno. Feita a leitura dos registros dos cochilos, estagiando a presença de vigília ou sono, latência e estágio de início do sono (NREM ou REM) e sua arquitetura (estágios). Foi realizado o estudo do tônus muscular em quinze pacientes com DP e oito controles saudáveis, sendo a atividade muscular mentoniana medida de pico a pico, a cada 30 segundos, durante a vigília e as fases de sono. Após a análise da correlação entre vários fatores como tempo de doença, sintomas motores, tratamento e distúrbios de sono com a latência do sono diurno, apenas o uso de medicamentos agonistas dopaminérgico resultou em uma redução significativa da latência do sono (12,5 ± 4,9 vs 18,9 ± 1,9 minutos, p=0,005). Aproximadamente um quarto dos pacientes apresentou uma falsa percepção do sono, sendo a acurada percepção mais significativa nos registros com menores latências do sono (6,2 ± 3,9 vs 12,6 ± 5,9 minutos, p < 0,001). Parkinsoninanos apresentaram tônus muscular maior que os controles durante todas as fases do sono (não significativo), porém com manutenção do decremento fisiológico durante as fases iniciais do sono. O efeito de medicações agonistas dopaminérgicos exerceu influência promotora sobre o sono diurno em parkinsonianos. A percepção do sono dependeu da latência do sono diurno. Os parkinsonianos preservaram a flutuação fisiológica do tônus muscular nas transições entre vigília-sono e entre fases do sono diurno no início dos sintomas motores.

El Síndrome de la banda iliotibial es la principal causa de dolor lateral de rodilla en corredores. Se asocia a debilidad en la musculatura abductora de cadera, entre otras causas que siguen siendo investigadas. El presente estudio consistió en determinar el tiempo de activación muscular del glúteo medio y tensor de la fascia lata en atletas sanos y con síndrome de la banda iliotibial, durante la carrera. La población estudio se compuso de atletas fondistas y triatletas pertenecientes a distintos clubes de corredores de la Región Metropolitana, de edades promedio de 26,31 ±7,47años. La muestra se conformó de 16 sujetos de género masculino; 9 sanos y 7 lesionados. El protocolo de estudio se llevó a cabo en el laboratorio de análisis de movimiento de la Escuela de Kinesiología de la Universidad de Chile. Cada sujeto realizó una prueba de carrera en cinta rodante, a una velocidad de 10 km/h, con 2 grados de inclinación. Se realizó un registro electromiográfico de superficie del músculo tensor de la fascia lata y del glúteo medio en ambas extremidades. Se aplicó una prueba t de student (95% intervalo de confianza) para muestras relacionadas (p<0.05). Los resultados obtenidos mostraron gran variabilidad en los tiempos de activación entre sujetos, sin embargo, se mantienen relativamente constantes para un mismo sujeto. En sujetos sanos, el tiempo de activación del glúteo medio fue -0,087±0,059 segundos y el tiempo de activación del tensor de la fascia lata fue 0,02±0,025 segundos, en donde la activación del glúteo medio precedió a la del tensor de la fascia lata, y a su vez al contacto inicial del pie, a diferencia del tensor de la fascia lata, que se activa después del contacto inicial del pie. En los individuos con síndrome de la banda iliotibial, el tiempo de activación del glúteo medio correspondió a -0,074± 0,046 segundos, y el correspondiente al tensor de la fascia lata fue de -0,005±0,038 segundos. Se concluyó que las diferencias entre los tiempos de activación de ambos grupos no fueron significativas. Tampoco lo fueron para los valores de tiempo de activación en relación al porcentaje de la fase de apoyo.
The iliotibial band syndrome is the leading cause of lateral knee pain in runners. It is associated with weakness in the hip abductor muscles, among other causes are being investigated. The present study was to determine the activation time of gluteus medius and tensor fascia lata in healthy and iliotibial band syndrome athletes during the race. The study population consisted of distance runners and triathletes from different running clubs in the metropolitan region, average age 26.31 ± 7.47 years. The sample consisted of 16 male subjects, 9 healthy and 7 injured. The study protocol was carried out in the motion analysis laboratory of the School of Kinesiology, University of Chile. Each subject performed a test of treadmill running at a speed of 10 km / h, with 2 degrees of inclination. A record was made of surface electromyography from tensor fascia lata and gluteus medius on both ends. We applied a Student's t test (95% confidence interval) for related samples (p <0.05). The results showed great variability in activation times between subjects, however, remain relatively constant for a given subject. In healthy subjects, the activation time of the gluteus medius was -0.087 ± 0.059 seconds and the activation time of the tensor fascia lata was 0.02 ± 0.025 seconds, where activation of the gluteus medius preceded the tensor fascia lata, and in turn the initial foot contact, unlike the tensor fascia lata, which is activated after initial contact of the foot. In individuals with iliotibial band syndrome, the time of activation of the gluteus medius corresponded to ± 0.046 -0.074 seconds, and for the tensor fascia lata was -0.005 ± 0.038 seconds. It was concluded that the differences between the activation times of both groups were not significant. Neither were the values for activation time relative to the percentage of the stance phase.

A la Equinoterapia se le conoce como la alternativa terapéutica que utiliza al caballo como un instrumento terapéutico que coadyuva a la rehabilitación física, social, mental y temperamental de pacientes con algunas deficiencias físicas, esta se realiza a través de la transmisión de calor corporal del caballo, del impulso rítmico y del patrón tridimensional, equivalente al patrón fisiológico del ser humano

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Cerebral palsy (CP) is a permanent condition resulting from a non-progressive injury of the immature brain, which affects posture and movement, and may be accompanied by disturbances of cognition, perception, sensation, behavior, epilepsy, among others. Children and adolescents with this condition are more likely to develop oral diseases such as tooth decays, periodontal disease, bruxism and malocclusion. In this context, the objective of the present study was to evaluate the oral health conditions of individuals with cerebral palsy, as well as the perception of their caregivers regarding the oral health of children and adolescents, and whether these conditions are associated with the motor impairment of these individuals. An observational cross-sectional study was carried out from February 2017 to August 2017 in three reference centers in the treatment of individuals with CP in the central region of the state of Rio Grande do Sul, Brazil. The sample was composed by 35 children and adolescents with CP and their caregivers. The motor function was evaluated through the application of two instruments, GMFCS and GMFM88. For the assessment of oral health, indexes such as DMFT, IPV, Malocclusion, Dental Age, pH, Buffering Capacity, and Saliva Flow were evaluated. A semi-structured questionnaire with open and closed questions was used to evaluate socio-demographic data and the caregiver's perception regarding oral health. In this study, 65.7% of the children and adolescents were quadriplegic, 88.6% with spastic tone, the mother being their main caregiver and the main responsible for the oral hygiene. It is possible to observe a significant association (p < 0,05) between GMFCS categorized according to locomotion dependence and the presence of malocclusion, but not with gross motor function (GMFM88). It has been found that patients with altered dental age have a lower GMFM88 index than those with dental age within the normal range. In the assessment of the perception of oral health, caregivers of quadriplegic patients, wheelchair users and with greater impairment of gross motor function (GMFM88) perceive more oral alterations. However, it can be concluded that malocclusion and dental age are associated with gross motor function (GMFCS and GMFM88) and dental caries has been associated with better GMFM scores88.
A paralisia cerebral (PC) é uma condição permanente, resultante de uma lesão não progressiva do encéfalo imaturo, que afeta a postura e o movimento, podendo estar acompanhada de distúrbios de cognição, percepção, sensação, comportamento, epilepsia, entre outros. Crianças e adolescentes com essa condição tem maior propensão a desenvolverem doenças bucais como cárie dentária, doença periodontal, bruxismo e má oclusão. Nesse contexto, o objetivo do presente trabalho foi avaliar as condições de saúde bucal de indivíduos com paralisia cerebral, bem como a percepção dos seus cuidadores em relação à saúde bucal das crianças e adolescentes e se estas condições estão associadas com o comprometimento motor desses indivíduos. Foi realizado um estudo transversal observacional no período de fevereiro de 2017 a agosto de 2017 em três centros de referência em tratamento de indivíduos com PC na região central do estado do Rio Grande do Sul, Brasil. A amostra foi composta por 35 crianças e adolescentes com PC e seus cuidadores. A função motora foi avaliada através da aplicação de dois instrumentos, o GMFCS e o GMFM88. Para a aferição da saúde bucal foram avaliados os índices de CPOD, IPV, Má oclusão, Idade dentária, pH, Capacidade de tampão e Fluxo da saliva. Para avaliação de dados sócio-demográficos e percepção do cuidador em relação à saúde bucal foi utilizado um questionário semi-estruturado com perguntas abertas e fechadas. No presente estudo 65,7% das crianças e adolescentes apresentaram-se quadriplégicas, 88,6% com tônus espástico, sendo a mãe seu principal cuidador e o principal responsável pela higienização bucal. Pode-se verificar uma associação significativa (p < 0,05) entre o GMFCS categorizado de acordo com a dependência para locomoção e a presença de má oclusão, mas não com a função motora grossa (GMFM88). Verificou-se que pacientes com idade dentária alterada apresentam o índice GMFM88 menor do que os que apresentam idade dentária dentro dos padrões normais. Na avaliação da percepção da saúde bucal, cuidadores de pacientes quadriplégicos, cadeirantes e com maior comprometimento da função motora grossa (GMFM88) percebem mais alterações bucais. Contudo pode-se concluir que má-oclusão e idade dentária estão associadas com a função motora grossa (GMFCS e GMFM88) e cárie dentária foi associada a melhores escores de GMFM88.

El equilibrio corporal y tono muscular de las extremidades se encuentran comprometidos en los pacientes con hemiparesia, así mismo son factores que conllevan al paciente a tener riesgo de caídas y que en consecuencia afectan el proceso de rehabilitación y actividades de vida diaria. Determina la relación que existe entre el equilibrio corporal y el tono muscular de las extremidades en pacientes hemiparéticos del departamento de medicina física y rehabilitación del Hospital Nacional Hipólito Unanue. Realiza un estudio de enfoque cuantitativo, alcance correlacional, diseño no experimental (observacional), transversal y prospectivo. Se efectuó en el departamento de medicina física y rehabilitación del Hospital Nacional Hipólito Unanue en el distrito del Agustino (Lima), en los meses de diciembre del 2017, enero y febrero del 2018, con un total de 63 pacientes hemiparéticos (23 mujeres y 40 hombres). Para la valoración del equilibrio corporal se utilizó la escala de equilibrio de Berg; y para la valoración del tono muscular de las extremidades se utilizó la escala de Ashworth Modificada. Encuentra que el mayor porcentaje de pacientes hemiparéticos con equilibrio corporal pobre se relacionó con grado 2 de tono muscular de las extremidades en un 83%, en cuanto al equilibrio corporal moderado el 63.2% se relacionó con grado 1+ de tono muscular y el mayor porcentaje de pacientes con equilibrio corporal bueno se relacionó con grado 1 de tono muscular en un 52.6%. La prueba estadística que se utilizó para comprobar la hipótesis fue la Correlación de Spearman y se trabajó a un nivel de significancia de 5% (0.05). El equilibrio corporal y el tono muscular de las extremidades mostraron moderada correlación (p=0.000). La comparación de medias entre las variables sugiere una relación de tipo negativa. Concluye que existe moderada relación entre el equilibrio corporal y el tono muscular de las extremidades en pacientes hemiparéticos del departamento de medicina física y rehabilitación del Hospital Nacional Hipólito Unanue (Rho= -0.469).
Tesis

In children, joint hypermobility (typified by structural instability of joints) manifests clinically as neuro-muscular and musculo-skeletal conditions and conditions associated with development and organization of control of posture and gait (Finkelstein, 1916; Jahss, 1919; Sobel, 1926; Larsson, Mudholkar, Baum and Srivastava, 1995; Murray and Woo, 2001; Hakim and Grahame, 2003; Adib, Davies, Grahame, Woo and Murray, 2005:). The process of control of the relative proportions of joint mobility and stability, whilst maintaining equilibrium in standing posture and gait, is dependent upon the complex interrelationship between skeletal, muscular and neurological function (Massion, 1998; Gurfinkel, Ivanenko, Levik and Babakova, 1995; Shumway-Cook and Woollacott, 1995). The efficiency of this relies upon the integrity of neuro-muscular and musculo-skeletal components (ligaments, muscles, nerves), and the Central Nervous System’s capacity to interpret, process and integrate sensory information from visual, vestibular and proprioceptive sources (Crotts, Thompson, Nahom, Ryan and Newton, 1996; Riemann, Guskiewicz and Shields, 1999; Schmitz and Arnold, 1998) and development and incorporation of this into a representational scheme (postural reference frame) of body orientation with respect to internal and external environments (Gurfinkel et al., 1995; Roll and Roll, 1988). Sensory information from the base of support (feet) makes significant contribution to the development of reference frameworks (Kavounoudias, Roll and Roll, 1998). Problems with the structure and/ or function of any one, or combination of these components or systems, may result in partial loss of equilibrium and, therefore ineffectiveness or significant reduction in the capacity to interact with the environment, which may result in disability and/ or injury (Crotts et al., 1996; Rozzi, Lephart, Sterner and Kuligowski, 1999b). Whilst literature focusing upon clinical associations between joint hypermobility and conditions requiring therapeutic intervention has been abundant (Crego and Ford, 1952; Powell and Cantab, 1983; Dockery, in Jay, 1999; Grahame, 1971; Childs, 1986; Barton, Bird, Lindsay, Newton and Wright, 1995a; Rozzi, et al., 1999b; Kerr, Macmillan, Uttley and Luqmani, 2000; Grahame, 2001), there has been a deficit in controlled studies in which the neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility have been quantified and considered within the context of organization of postural control in standing balance and gait. This was the aim of this project, undertaken as three studies. The major study (Study One) compared the fundamental neuro-muscular and musculo-skeletal characteristics of 15 children with joint hypermobility, and 15 age (8 and 9 years), gender, height and weight matched non-hypermobile controls. Significant differences were identified between previously undiagnosed hypermobile (n=15) and non-hypermobile children (n=15) in passive joint ranges of motion of the lower limbs and lumbar spine, muscle tone of the lower leg and foot, barefoot CoP displacement and in parameters of barefoot gait. Clinically relevant differences were also noted in barefoot single leg balance time. There were no differences between groups in isometric muscle strength in ankle dorsiflexion, knee flexion or extension. The second comparative study investigated foot morphology in non-weight bearing and weight bearing load conditions of the same children with and without joint hypermobility using three dimensional images (plaster casts) of their feet. The preliminary phase of this study evaluated the casting technique against direct measures of foot length, forefoot width, RCSP and forefoot to rearfoot angle. Results indicated accurate representation of elementary foot morphology within the plaster images. The comparative study examined the between and within group differences in measures of foot length and width, and in measures above the support surface (heel inclination angle, forefoot to rearfoot angle, normalized arch height, height of the widest point of the heel) in the two load conditions. Results of measures from plaster images identified that hypermobile children have different barefoot weight bearing foot morphology above the support surface than non-hypermobile children, despite no differences in measures of foot length or width. Based upon the differences in components of control of posture and gait in the hypermobile group, identified in Study One and Study Two, the final study (Study Three), using the same subjects, tested the immediate effect of specifically designed custom-made foot orthoses upon balance and gait of hypermobile children. The design of the orthoses was evaluated against the direct measures and the measures from plaster images of the feet. This ascertained the differences in morphology of the modified casts used to mould the orthoses and the original image of the foot. The orthoses were fitted into standardized running shoes. The effect of the shoe alone was tested upon the non-hypermobile children as the non-therapeutic equivalent condition. Immediate improvement in balance was noted in single leg stance and CoP displacement in the hypermobile group together with significant immediate improvement in the percentage of gait phases and in the percentage of the gait cycle at which maximum plantar flexion of the ankle occurred in gait. The neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility are different from those of non-hypermobile children. The Beighton, Solomon and Soskolne (1973) screening criteria successfully classified joint hypermobility in children. As a result of this study joint hypermobility has been identified as a variable which must be controlled in studies of foot morphology and function in children. The outcomes of this study provide a basis upon which to further explore the association between joint hypermobility and neuro-muscular and musculo-skeletal conditions, and, have relevance for the physical education of children with joint hypermobility, for footwear and orthotic design processes, and, in particular, for clinical identification and treatment of children with joint hypermobility.

Muestras de músculo esquelético y sangre fueron tomadas a 48 toros bravos (novillos) lidiados en la plaza de toros de Calasparra (Murcia). Los músculos seleccionados, cabeza larga del tríceps braquial y semitendinoso, fueron analizados desde el punto de vista histológico, con el fin de estudiar las características morfológicas e histoquímicas de los distintos tipos de miocitos y las posibles alteraciones consecuencia de la lidia. Las técnicas histoquímicas han posibilitado reconocer tres tipos de fibras musculares, denominadas I (SO), IIA (FOG) y IIX (FG). El músculo tríceps braquial presentó un porcentaje mayor de fibras oxidativas (SO + FOG) en comparación con el músculo semitendinoso donde predominaron las fibras glicolíticas (FG). El estudio histológico del músculo esquelético reveló además que tras la lidia algunas fibras musculares sufrieron lesiones agudas de tipo degenerativo. Estas lesiones se presentaron de forma aislada, afectando a las fibras de tipo II, sin que se viera comprometida la integridad funcional de los fascículos musculares. En un porcentaje reducido de animales se observaron lesiones crónicas relacionadas con la presencia de fibras anguladas atróficas y quistes de Sarcocystis spp. Las muestras de sangre fueron procesadas con objeto de valorar diversas enzimas indicativas del posible daño renal, hepático y muscular consecuencia de la lidia. Los valores de enzimas estudiados en sangre demuestran que en la mayoría de los novillos la lidia no produjo daño renal, ni hepático, ni muscular. Tan solo 5 ejemplares presentaron niveles algo más elevados de lo normal en las enzimas LDH y CK que no se correspondieron con un mayor grado de lesión muscular. Este trabajo demuestra que el músculo esquelético de los novillos estudiados se encontraba bien preparado para afrontar el esfuerzo que supone la lidia.
The samples were taken from blood and skeletal muscle in 48 fighting bulls at bullring in Calasparra (Murcia). Selected muscles, long head of the triceps brachial and semitendinosus were analyzed histologically, in order to study morphological and histochemical characteristics of different types of myocytes and their possible alterations as consequence of the fighting. Three types of muscle fibers, called I (SO), IIA (FOG) and IIX (FG) were identified from histochemical techniques. The triceps brachii muscle presented a higher percentage of oxidative fibers (SO + FOG) when comparing with semitendinosus where glycolytic fibers (FG) were highest. Histological examination of skeletal muscle also revealed that after fighting some muscle fibers suffered acute degenerative injuries. These injuries were scarce, such that these only affected to the type II fibers, without affecting the functional integrity of the muscle bundles. A small percentage of animals showed chronic injuries corresponding with atrophic angulated fibers and cysts of Sarcocystis spp. Blood samples were processed in order to assess several enzymes indicative of kidney damage, liver damage and muscle damage as result of the fight. The enzymes values in blood showed that the fight did not cause damages in kidney, liver, and muscle in the most of the bulls. Only 5 bulls showed levels of LDH and CK enzymes higher than the normal levels without observing positive correlation with the degree of muscle injury. This work shows that the skeletal muscle of the bulls was well prepared to face the effort involved in the fight.

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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (Capes)
Funda??o de Amparo ? Pesquisa do estado de Minas Gerais (FAPEMIG)
Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq)
Introdu??o: Recentemente, a vibra??o de todo o corpo (VTC) tem sido um m?todo de exerc?cio f?sico utilizado para aumentar o desempenho f?sico-funcional. No entanto, os mecanismos relacionados aos efeitos produzidos por essa modalidade de exerc?cio ainda n?o tem sido completamente investigados. Objetivos: Os objetivos desse estudo foram definir o protocolo de VTC capaz de aumentar o desempenho muscular em jovens fisicamente ativos (estudos 1 e 2) e investigar poss?veis mecanismos fisiol?gicos da VTC sobre o desempenho f?sico (estudos 3, 4 e 5). Metodologia: No estudo 1 foi avaliada a influ?ncia de diferentes ?ngulos de flex?o dos joelhos (60 e 90?) e da VTC na ativa??o muscular do vasto lateral (VL) e na transmissibilidade do est?mulo vibrat?rio para propor o melhor posicionamento corporal durante o exerc?cio. Nesse estudo, 34 jovens fisicamente ativos tiveram a atividade eletromiogr?fica (EMG) do m?sculo VL do membro dominante e a acelera??o nas articula??es dos joelhos e quadril avaliadas durante exerc?cio de agachamento (AG) a 60? e 90? de flex?o de joelhos associada ou n?o a VTC (30 Hz, 4 mm). No estudo 2 foi proposta a avalia??o da curva dose-resposta do est?mulo vibrat?rio (acelera??o) sobre o desempenho muscular dos membros inferiores e superiores. Para isto, nove homens fisicamente ativos foram submetidos a cinco condi??es experimentais: 1) AG sem VTC; 2) AG/VTC [20 Hz, 2 mm: 31,55 m.s-2]; 3) AG/VTC [45 Hz, 2 mm: 159,73 m.s-2]; 4) AG/VTC [45 Hz, 4 mm: 319,45 m.s-2]; e 5) AG/VTC [60 Hz, 4 mm: 567,91 m.s-2]. Antes e ap?s os procedimentos experimentais o desempenho muscular foi avaliado pelo teste do salto vertical (SV), for?a de preens?o palmar e desempenho anaer?bio pelo teste Wingate (TW). O objetivo do estudo 3 foi comparar os efeitos do aquecimento passivo (AP), da VTC e controle (C) sobre o desempenho de alta intensidade e curta dura??o (DAICD). Seis homens fisicamente ativos realizaram um teste de 30 segundos de sprint ap?s uma das tr?s condi??es experimentais: 1) VTC: que consistiu em 5 minutos de AG associados ? VTC (45 Hz, 2 mm), 2) AP: que consistiu de 30 minutos de AP usando uma manta t?rmica sobre as coxas e as pernas (35 W) e 3) C: que foi constitu?do por 30 minutos de repouso sem aquecimento. A excitabilidade muscular do VL, avaliada pela EMG, foi determinada em repouso e durante o DAICD. As concentra??es sangu?neas de lactato (LACT), avaliadas por espectroscopia, e a temperatura muscular (TM) da coxa, estimada indiretamente medindo a temperatura da pele, foram determinadas nos seguintes momentos: antes, imediatamente ap?s as condi??es experimentais e 3 minutos ap?s o sprint de 30 segundos. O estudo 4 foi desenhado para avaliar o efeito agudo de diferentes intensidades de VTC no desempenho muscular e relacion?-los com fatores intramusculares. Oito homens fisicamente ativos foram aleatoriamente submetidos a uma das tr?s condi??es experimentais: (1) VTC 2 mm [45 Hz e 2 mm], (2) VTC 4 mm [45 Hz e 4 mm] e (3) sem VTC. Para avaliar a PAP, o torque conc?ntrico dos flexores e extensores de joelho foi medido durante tr?s flexo-extens?es unilaterais de joelho a 60?.s-1 em um dinam?metro isocin?tico. A pot?ncia e a altura do SV tamb?m foram avaliadas. Estas medidas foram realizadas antes e ap?s as condi??es experimentais. O objetivo do estudo 5 foi determinar os efeitos da adi??o da VTC aos exerc?cios de AG na ativa??o cerebral, avaliada pelo eletroencefalografia (EEG). Sete homens fisicamente ativos foram submetidos de forma aleat?ria a uma das tr?s condi??es experimentais: a) exerc?cios de AG/VTC 45 Hz/2 mm; B) AG/VTC 45 Hz/4 mm e C) AG sem VTC. Para avaliar os efeitos da VTC na ativa??o EEG, os volunt?rios foram submetidos a um per?odo de oito minutos em estado de repouso (olhos fechados) antes e 3 minutos ap?s as condi??es experimentais. Resultados: Os principais achados do estudo 1 foram que (1) 90? de flex?o dos joelhos produziu maior atividade EMG que 60? (p <0,001), sem diferen?a na transmissibilidade acelera??o, (2) em ambos os ?ngulos de flex?o do joelho, a adi??o de VTC n?o produziu diferen?as significativas na EMG, mas com maiores valores de acelera??o em rela??o ao AG realizado sem a VTC (p <0,001). O estudo 2 demonstrou que h? uma faixa de acelera??o de VTC mais apropriada para promover melhor desempenho muscular dos membros inferiores [159,45 m.s-2 - 319,45 m.s-2]. No entanto, estes est?mulos aplicados sob os p?s n?o parecem melhorar a for?a de preens?o palmar. No estudo 3 observou-se que o pico de pot?ncia, a pot?ncia relativa, o trabalho relativo, o tempo para a pot?ncia pico e a cad?ncia no ciclismo foram significativamente mais elevados durante a VTC comparado com o C. A TM foi significativamente maior no AP comparado com a VTC e C antes do teste de desempenho. N?o foram observadas diferen?as significativas entre as condi??es experimentais para LACT imediatamente ap?s o sprint e na EMG durante o sprint. O estudo 4 demonstrou que a VTC aumentou o pico de torque para os m?sculos flexores de joelhos. Al?m disso, a pot?ncia e a altura do SV tamb?m foram aumentadas pela VTC. O estudo 5 demonstrou que houve uma diminui??o significativa da pot?ncia absoluta na banda Alfa durante a VTC com exerc?cios de AG (45 Hz/2 mm e 45 Hz/4 mm) em compara??o com a situa??o C nos seguintes eletrodos: F7 (p: 0,03, tamanho do efeito: 0,750, poder: 0,708) e F8 (p: 0,01, tamanho do efeito: 0,838, poder: 0,909). Conclus?es: Os resultados dos estudos supracitados indicam que o protocolo de VTC associado ao AG a 90? de flex?o dos joelhos, nos par?metros de VTC de 45 Hz/2-4 mm (159,45 - 319,45 m.s-2), aumentou a altura e a pot?ncia do SV, bem como o desempenho anaer?bio dos membros inferiores, sem altera??es na for?a de preens?o. Os poss?veis mecanismos relacionados com aumento no desempenho muscular dos membros inferiores seriam fatores intramusculares e envolvimento de componentes centrais (ativa??o eletroencefalogr?fica), sem modifica??es no metabolismo anaer?bio l?tico, na temperatura muscular e na atividade eletromiogr?fica.
Tese (Doutorado) ? Programa Multic?ntrico de P?s-Gradua??o em Ci?ncias Fisiol?gicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2013.
ABSTRACT Introduction: Recently, whole body vibration (WBV) has been an alternative method of exercise that is increasingly used to improve the physical performance of athletes. However, the mechanisms related to the effects produced by this training mode have not been fully elucidated in the literature. Objectives: The objectives of this study were to define the protocol of WBV able to increase muscle performance in athletes (Studies 1 and 2) and propose possible physiological mechanisms of WBV on physical performance (studies 3, 4 and 5). Methods: In study 1 was evaluated the influence of different angles of knee flexion and adittion of WBV in the vastus lateralis muscle activation and transmissibility of vibratory stimulus to propose the best body position for this exercise. In this study, 34 individuals had electromyography activity (EMG) of the vastus lateralis and the acceleration assessed while squatting with 60? and 90? of knee flexion either with or without whole-body vibration (WBV: 30 Hz, 4mm). In study 2 was proposed to evaluate the dose-response curve of vibratory stimulation on muscle performance of the lower and upper limb. Nine recreationally males were subjected to five experimental conditions: 1) Squat exercise (SE) without WBV; 2) SE/WBV [20 Hz, 2mm: 31.55 m.s-2]; 3) SE/WBV [45 Hz, 2mm: 159.73 m.s-2]; 4) SE/WBV [45 Hz, 4mm: 319.45 m.s-2] and 5) SE/WBV [567.91 m.s-2]. Before and after the experimental procedures, muscle performance was assessed by a vertical jump test, handgrip strength test and Wingate anaerobic test (WT). The purpose of the study 3 was to compare the effects of passive warm-up (PW), whole-body vibration (WBV) and control (C) on high-intensity performance during sprint cycle exercise. Six recreationally trained men performed a 30-seconds sprint cycle test after the three conditions: 1) The WBV consisted of 5 minutes of squats associated with WBV (45 Hz, 2 mm), 2) The PW consisted of 30 minutes of PW using a thermal blanket on the thighs and legs (35 W) and 3) The C consisted of 30 minutes of no warm-up with the subject lying down. Motor neuron excitability from the vastus lateralis muscle, evaluated by electromyography (EMG), was determined prior to exercise at rest and during sprint cycle exercise. Blood lactate levels (BL), evaluated by spectroscopy, and muscle temperature (MT) of the thigh, estimated indirectly by measuring skin temperature, were determined at following time points: prior to exercise at rest (before and after experimental conditions), immediately and 3 minutes after the 30-s sprint cycle test. The study 4 was designed to assess the acute effect of different intensities of WBV on post-activation potentiation (PAP). Eight recreationally trained males were randomly subjected to one of three experimental conditions: 1) WBV 2 mm [45 Hz and 2 mm], 2) WBV 4 mm [45 Hz and 4 mm] and 3) no WBV. To assess PAP, the peak concentric torque of knee flexors and extensors was measured during a set of 3 unilateral knee flexor-extensions at 600.s-1 in an isokinetic dynamometer. The power output and height during vertical jumps were also evaluated. These measurements were performed both before and after the experimental conditions and then compared. The objective of the study 5 was to determine the effects of adding whole body vibration (WBV) to squat exercises on brain activation, evaluated by electroencephalography (EEG). Seven recreationally trained males were randomly subjected to one of three experimental conditions: A) squat exercises (SE) - WBV 45 Hz/ 2 mm; B) SE - WBV 45 Hz/ 4 mm; and C) SE without WBV. The experimental sessions occurred on different days, at least 7 days after the preliminary session, with randomized intervals of 24 hours among the experimental conditions. To evaluate the effects of WBV on the EEGs, the vol?unteers were subjected to an eight-minute resting EEG (eyes closed) before and 3 minutes after the experimental conditions. Results: The main findings of the study 1 were (1) the larger the angle of knee flexion, the greater the EMG (p < 0.001), with no difference on acceleration transmissibility; (2) for both angles of knee flexion, the addition of WBV produced no significant difference in EMG and higher acceleration compared to without WBV (p < 0.001). The results of the study 2 suggest that lower limb muscular performance is dose-related to WBV acceleration. Given our results, there could be a WBV acceleration range that is suitable for improving lower limb muscular performance [159.45 m.s-2 to 319.45 m.s-2] during SE. However, these stimuli do not seem capable of improving upper limb strength. In the study 3 was noted that the peak power, relative power, relative work, time of peak power, and pedaling cadence were significantly higher in the WBV compared to C. The MT was significantly greater in PW compared to WBV and C prior to exercise and no significant differences were observed between the experimental conditions for BL immediately after sprint cycle exercise and in EMG during sprint cycle exercise. The study 4 proposes that WBV potentiated the peak torque of flexors of knee. In addition, the power output and vertical height of jump were also potentiated by WBV. However, increasing the vibratory stimulus did not further potentiate the results. The study 5 demonstrated that there was a significant decrease in the Alpha absolute power during WBV with squat exercises (45 Hz/2 mm and 45 Hz/4 mm) compared with that of the control at the following electrodes: F7 (p: 0.03, effect size: 0.750, power: 0.708) and F8 (p: 0.01, effect size: 0.838, power: 0.909). Conclusions: The results of the above-cited studies indicate that the protocol of WBV associated with squat at 90? in parameters of WBV 45Hz/2-4mm are capable of increasing the power and height in jump performance and anaerobic lower limbs, with no change in grip strength. The possible mechanism related to the increase in lower limbs anaerobic performance could be post-activation potentiation and cerebral activation, since it was not observed metabolic changes (no difference in lactate levels), MT and EMG. However, more studies should be conducted to check other physiological mechanisms related to improved physical performance caused by the WBV.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia
Introdução: A Síndrome de Down (SD) é um distúrbio genético que resulta na presença de três cromossomas 21. Os portadores de SD apresentam caraterísticas físicas específicas, assim como alguns défices, que os impede de desenvolver habilidades apropriadas a cada faixa etária. Objetivos: O objetivo desta revisão bibliográfica é estudar a intervenção da fisioterapia no equilíbrio e no tónus muscular em crianças e adolescentes com Síndrome de Down. Metodologia: Foi realizada uma pesquisa bibliográfica recorrendo às bases de dados PEDro e Pubmed, incluindo artigos randomizados controlados, artigos em português ou inglês e a amostra ter idades até aos 18 anos, inclusive. Resultados: Obtiveram-se 130 artigos dos quais foram incluídos 7 para o estudo com um total de 246 participantes com idades compreendidas entre os 2 e os 18 anos. A qualidade metodológica dos artigos utilizados foi recolhida através da Escala de PEDro, tendo-se obtido um score médio de 6. Conclusão: Verificou-se que as crianças e adolescentes com SD apresentam melhorias significativas a nível do equilíbrio e do tónus muscular, bem como, a nível do controlo motor, força muscular e agilidade, quando submetidos a programas fisioterapêuticos.
Introduction: Down Syndrome (DS) is a genetic disorder that results in the presence of three chromosomes 21. These persons have specific physical characteristics, as well as some deficits, which prevents them from developing skills appropriate to each age group. Objectives: The aim of this bibliographic review it’s to verify the intervention of physiotherapy in balance and muscle tone in children and adolescents with Down syndrome. Method: A bibliographic research was performed using the PEDro and Pubmed databases, including randomized controlled trials, where the articles are in Portuguese or in English and the sample was aged up to and including 18 years. Results: Were obtained 130 articles from which 7 of them were included in the study with a total of 246 participants, aged between 2 and 18 years. The methodological quality of the articles was collected through the PEDro Scale, yielding an average score of 6. Conclusion: It was found that children and adolescents with DS present significant improvements in balance and muscle tone, as well as in motor control, muscle strength and agility, when submitted to physiotherapeutic programs.
N/A

Objetivo: Comparar a fala, o tônus e as mobilidades dos lábios, da língua e da mandíbula de usuários de prótese total em diferentes períodos de adaptação. Método: Foram avaliados quanto aos aspectos de fala, tônus e mobilidades dos lábios, da língua e da mandíbula, quarenta usuários de prótese total (grupo experimental) e quarenta sujeitos com dentição natural (grupo controle). O grupo experimental foi dividido em três sub amostras, de acordo com o tempo de uso da prótese, a saber, um mês, seis meses e 12 meses. Resultados: Há maior dificuldade das mobilidades dos lábios, da língua e da mandíbula e maior alteração de tônus muscular orofacial em usuários de próteses há 12 meses, tanto na comparação entre os dois grupos, quanto entre as sub amostras do grupo experimental; piores resultados para a fala automática são observados em usuários de prótese há seis meses, ao contrário da nomeação, coordenação motora da fala e fala espontânea, que são aos 12 meses de uso da prótese. Estes resultados ocorreram novamente, tanto na comparação entre os grupos experimental e controle, quanto na comparação das sub amostras do grupo experimental entre si. Conclusões: Os dados obtidos neste estudo demonstraram que usuários de prótese total há 12 meses apresentam maior dificuldade para as mobilidades dos lábios, da língua e da mandíbula, para o tônus muscular orofacial e para a fala, que aqueles que têm um ou seis meses de tempo de uso.
Objective: To compare speech, tonus and mobility of lips, tongue and jaw denture wearers in different periods of adaptation. Methods: We evaluated the aspects of speech, tonus and mobility of lips, tongue and jaw, forty denture wearers (experimental group) and forty subjects with natural teeth (control group). The experimental group was divided into three sub samples, according to the time of fitting, ie one month, six months and 12 months. Results: There is increased difficulty of mobility of the lips, tongue and jaw and greatest change in muscle tone in orofacial prosthesis users for 12 months in the comparison between the two groups, and between the sub experimental samples; worse results for Automatic speech are seen in hearing aid users for six months, as opposed to the appointment, coordination of speech and spontaneous speech, which are at 12 months of fitting. These results were again, in the comparison between the experimental and control groups and in the comparison of experimental samples under each other. Conclusions: The results of this study showed that denture wearers is the most difficult 12 months for the mobility of the lips, tongue and jaw, for orofacial muscle tone and speech, that those who have one or six months time of use.

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Os pacientes com doença de Parkinson (DP) apresentam graus variados de fraqueza muscular, déficit de mobilidade, instabilidade postural e outras alterações motoras. Recentemente o treinamento com vibração tem sido usada em pacientes com DP com resultados promissores, porém ainda não conclusivos. O objetivo desse estudo foi analisar o efeito de um protocolo utilizando a vibração do corpo todo (VCT) na força muscular e na mobilidade funcional de indivíduos com DP (n=10). Antes do início do protocolo de treinamento os indivíduos realizaram uma avaliação inicial que consistiu de: avaliação da força muscular isométrica dos flexores e extensores do joelho e da mobilidade funcional (Short Physical Performance Battery-SPPB). Os mesmos procedimentos da avaliação inicial foram realizados ao final do treinamento. Os voluntários realizaram cinco semanas de treinamento na plataforma vibratória: o treinamento foi realizado com os sujeitos em pé, em duas posições: a) pés separados em uma posição estável e confortável com joelhos em extensão; b) pés separados e joelhos semiflexionados. Em cada uma das posições a vibração foi realizada em cinco séries de 1 minuto de duração, com intervalo de 1 minuto entre cada série, e de 5 minutos entre a primeira e a segunda posição. Foram realizadas duas sessões semanais com duração de 30 minutos cada. Após as cinco semanas os voluntários foram reavaliados. Os dados pré e pósintervenção foram comparados por meio do Teste ANOVA para medidas repetidas e post-hoc de Bonferroni (p<0,05). O presente estudo demonstrou que cinco semanas de terapia com VCT, 2 sesssões/semana, resultaram na melhora significativa da força muscular isométrica de flexores e extensores de joelho (F=11,558 e p=0,009) e da mobilidade funcional de (F=11,558 e p=0,009) indivíduos com DP
Patients with Parkinson's disease (PD) have varying degrees of muscle weakness, mobility impairment, postural instability and other motor abnormalities. Recently training with vibration has been used in PD patients with promising results, but not yet conclusive. The aim of this study was to analyze the effect of a protocol using the vibration of the whole body (VCT) in muscle strength and functional mobility in individuals with PD (n = 10). Before the training protocol subjects performed an initial evaluation consisting of: evaluation of isometric muscle strength of the flexor and extensor of the knee and functional mobility (Short Physical Performance Battery-SPPB). The same procedures as the initial assessment were performed at the end of training. The volunteers performed five weeks of training on the vibration platform: training was conducted with the subjects standing in two positions: a) feet apart in a stable and comfortable position with knees extended; b) feet apart and knees bended. In each position the vibration was performed in five series of 1 minute long, with 1 minute interval between each set, and 5 minutes between the first and second positions. There were two weekly sessions lasting 30 minutes each. After the five weeks the volunteers were reassessed. The pre and post-intervention data were compared using the ANOVA test for repeated measures and post hoc Bonferroni (p <0.05). This study showed that five weeks of therapy with VCT, 2 sessions per week resulted in significant improvement in isometric muscle strength of knee flexors and extensors (F = 11.558, p = 0.009) and functional mobility (F = 11.558, p = 0.009) in individuals with PD

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Background: The Pilates Method is a modality of exercise that has been growing in recent decades, but few researches has been conducted with elderly and little is known about its benefits in this population. Objective: To evaluate the effect of a program of Mat Pilates exercises in muscle performance and postural balance in elderly women. Materials and Method: This is a randomized controlled trial that evaluated the muscle performance (isokinetic dynamometer Biodex System 3 Pro?) and postural balance (Balance Master System?) of 33 women aged 65-80 years. The experimental group (EG) participated of a 12-week program of Mat Pilates exercises with two weekly sessions. Data normality was verified by the Shapiro - Wilk test and were adopted p value < 0.05 as significance level. Results: There were no differences between groups after training. However, the EG showed an increase in the values of extension and flexion average power to 60 ? / s after training (32.19 W to 37.04 W and 14.48 W to 17.56 W, respectively). Conclusion: The proposed exercise program was not effective in the total work and average power of flexor and extensor of the knee, as well as static and dynamic balance of participants
Contextualiza??o: O M?todo Pilates ? uma modalidade de exerc?cio f?sico que vem crescendo nas ?ltimas d?cadas, por?m poucas pesquisas foram conduzidas com indiv?duos idosos e pouco se sabe sobre seus benef?cios nesta popula??o. Objetivo: Avaliar o efeito de um programa de exerc?cios de Pilates em solo no desempenho muscular e no equil?brio postural de mulheres idosas. Materiais e M?todo: Trata-se de um ensaio cl?nico controlado randomizado que avaliou o desempenho muscular (dinam?metro isocin?tico Biodex System 3 Pro?) e o equil?brio postural (Balance Master System?) de 33 mulheres na faixa et?ria de 65 a 80 anos. O grupo experimental (GE) participou de um programa de 12 semanas de exerc?cios de Pilates em solo com duas sess?es semanais. A normalidade dos dados foi verificada pelo teste de Shapiro Wilk e adotou-se o p valor < 0,05 para n?vel de signific?ncia. Resultados: N?o houve diferen?as entre os grupos ap?s o treinamento. Por?m, as idosas do GE apresentaram aumento nos valores de pot?ncia m?dia extensora e flexora a 60?/s ap?s o treinamento (de 32,19W para 37,04W e de 14,48W para 17,56W, respectivamente). Conclus?o: O programa de exerc?cios proposto n?o foi efetivo no trabalho total e na pot?ncia m?dia dos m?sculos flexores e extensores de joelho, bem como no equil?brio est?tico e din?mico das participantes

Orientador: Flávia Roberta Faganello Navega
Banca: Nise Ribeiro Marques
Banca: Cristiane Rodrigues Pedroni
Resumo: Os pacientes com doença de Parkinson (DP) apresentam graus variados de fraqueza muscular, déficit de mobilidade, instabilidade postural e outras alterações motoras. Recentemente o treinamento com vibração tem sido usada em pacientes com DP com resultados promissores, porém ainda não conclusivos. O objetivo desse estudo foi analisar o efeito de um protocolo utilizando a vibração do corpo todo (VCT) na força muscular e na mobilidade funcional de indivíduos com DP (n=10). Antes do início do protocolo de treinamento os indivíduos realizaram uma avaliação inicial que consistiu de: avaliação da força muscular isométrica dos flexores e extensores do joelho e da mobilidade funcional (Short Physical Performance Battery-SPPB). Os mesmos procedimentos da avaliação inicial foram realizados ao final do treinamento. Os voluntários realizaram cinco semanas de treinamento na plataforma vibratória: o treinamento foi realizado com os sujeitos em pé, em duas posições: a) pés separados em uma posição estável e confortável com joelhos em extensão; b) pés separados e joelhos semiflexionados. Em cada uma das posições a vibração foi realizada em cinco séries de 1 minuto de duração, com intervalo de 1 minuto entre cada série, e de 5 minutos entre a primeira e a segunda posição. Foram realizadas duas sessões semanais com duração de 30 minutos cada. Após as cinco semanas os voluntários foram reavaliados. Os dados pré e pósintervenção foram comparados por meio do Teste ANOVA para medidas repetidas e post-hoc de Bonferroni (p<0,05). O presente estudo demonstrou que cinco semanas de terapia com VCT, 2 sesssões/semana, resultaram na melhora significativa da força muscular isométrica de flexores e extensores de joelho (F=11,558 e p=0,009) e da mobilidade funcional de (F=11,558 e p=0,009) indivíduos com DP
Abstract: Patients with Parkinson's disease (PD) have varying degrees of muscle weakness, mobility impairment, postural instability and other motor abnormalities. Recently training with vibration has been used in PD patients with promising results, but not yet conclusive. The aim of this study was to analyze the effect of a protocol using the vibration of the whole body (VCT) in muscle strength and functional mobility in individuals with PD (n = 10). Before the training protocol subjects performed an initial evaluation consisting of: evaluation of isometric muscle strength of the flexor and extensor of the knee and functional mobility (Short Physical Performance Battery-SPPB). The same procedures as the initial assessment were performed at the end of training. The volunteers performed five weeks of training on the vibration platform: training was conducted with the subjects standing in two positions: a) feet apart in a stable and comfortable position with knees extended; b) feet apart and knees bended. In each position the vibration was performed in five series of 1 minute long, with 1 minute interval between each set, and 5 minutes between the first and second positions. There were two weekly sessions lasting 30 minutes each. After the five weeks the volunteers were reassessed. The pre and post-intervention data were compared using the ANOVA test for repeated measures and post hoc Bonferroni (p <0.05). This study showed that five weeks of therapy with VCT, 2 sessions per week resulted in significant improvement in isometric muscle strength of knee flexors and extensors (F = 11.558, p = 0.009) and functional mobility (F = 11.558, p = 0.009) in individuals with PD
Mestre

Orientador: Flávia Roberta Faganello Navega
Banca: Rodrigo Vitorio
Banca: Karina Gramani Say
Resumo: Introdução: Vibração de Corpo Todo (VCT) é uma das ferramentas que a cada dia tem sido mais utilizada na reabilitação de diferentes populações. Alguns estudos atribuem uma melhora no desempenho muscular devido à aplicação da vibração resultando em benefícios para aspectos motores relacionados com a mobilidade funcional. Pessoas com Doença de Parkinson apresentam alguns sinais clínicos, dentre eles a rigidez muscular. Essa característica pode comprometer a marcha desses indivíduos. Objetivo: Analisar a influência do treinamento agudo com VCT durante a marcha habitual e com desvio de obstáculo em indivíduos sem acometimentos neurológicos e indivíduos com Doença de Parkinson. Métodos: Participaram do estudo pessoas com o diagnóstico médico de Doença de Parkinson e indivíduos da comunidade sem doenças neurológicas, os quais foram divididos em quatro grupos: grupo Parkinson (GP, n=9), grupo Parkinson placebo (GPP, n=9), grupo controle (GC, n=9) e grupo controle placebo (GCP, n=9). A coleta de dados foi realizada em um único dia. Os dados pessoais, medidas antropométricas, MEEM, os parâmetros espaço-temporais e co-contração muscular (tibial anterior/gastrocnêmio medial e tibial anterior/gastrocnêmio lateral) durante a marcha foram coletados antes do protocolo com a plataforma vibratória. Após os 30 minutos de treinamento com vibração (f= 30 Hz), foi realizada, novamente, a avaliação da marcha. As variáveis espaço-temporais consideradas para análise foram o comprimento, largura, dur... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Introduction: Whole Body Vibration (VCT) is one of the tools that has been increasingly used every day for the rehabilitation and treatment of different populations. Some studies attribute an improvement at muscular performance due to the application of vibrations, through the easiness of the reflection, resulting in benefits for the motors related to functional mobility. People with Parkinson's disease show some clinical signs like muscle rigidity. This feature may impair their gait. Objective: Analyze the acute effect of WBV in individuals without neurological impairments and people with Parkinson's Disease during usual gait and obstacle circumvention. Methods: People diagnosed with Parkinson's disease and individuals of community without neurological impairments participated in the study. They were divided into four groups: Parkinson's group (GP, n=9), Parkinson's placebo group (GPP, n=9), control group (GC, n=9) and control placebo group (GCP, n=9). Data collection was done in a single day. Personal data, anthropometric measures, MEEM, spatiotemporal gait parameters and muscle co-contraction (tibialis anterior/gastrocnemius medialis and tibialis anterior/gastrocnemius lateralis) analysis during gait were collected before the protocol with a vibrating platform. After the 30 minutes of vibration training (f= 30 Hz), evaluation of gait were performed again. The spatiotemporal variables considered for analysis were the length, width, duration and speed of the step and percent... (Complete abstract click electronic access below)
Mestre

Comprendre et mieux définir la pathophysiologie de l'asthme est essentiel au développement de traitements plus efficaces. L'hyperréactivité bronchique et le tonus élevé du muscle lisse entourant les voies respiratoires sont deux caractéristiques majeures de l'asthme. Si une causalité existe entre ces caractéristiques, elle demeure encore inconnue. Le travail présenté dans ce Mémoire décrit comment un tonus, induit par un spasmogène, affecte la réactivité bronchique à une bronchoprovocation in vivo chez la souris. La capacité contractile de trachées murines excisées a aussi été mesurée afin d'évaluer si la réponse obtenue in vivo implique le muscle lisse. Les résultats présentés dans ce mémoire démontrent qu'in vivo, les souris exposées à un tonus voient leur réactivité bronchique augmenter en réponse à une dose d'un spasmogène, comparées aux souris contrôles. Les résultats démontrent également que la réponse obtenue est causée, du moins en partie, par une augmentation de la capacité contractile du muscle lisse. Suite à ces résultats, les mécanismes moléculaires possiblement impliqués dans le gain de force induit par le tonus ont été investigués. L'hypothèse est que les voies de signalisation en aval de l'activation des récepteurs couplés aux protéines G sont responsables de l'augmentation de la capacité contractile du muscle lisse. L'inhibition de la polymérisation de l'actine, l'activation de la chaîne légère de myosine, l'activation de protéines G et l'inhibition des protéines kinases activées par les mitogènes ont donc été évaluées. Les résultats démontrent qu'aucune des voies de signalisation étudiées est impliquée dans le gain de force du muscle lisse provoqué par un tonus induit par la présence continue d'un spasmogène. Ces résultats démontrent la complexité que représente la recherche des mécanismes moléculaires du gain de force et que cette recherche doit être plus approfondie.
To understand and better define the pathophysiology of asthma is essential for the development of more effective treatments. Airway hyperresponsiveness and an elevated airway smooth muscle tone are two common features of asthma. Whether causality exists between these two characteristics is unknown. The work presented in this Master's thesis describes how a tone induced by a spasmogen affects airway responsiveness in vivo in mice to a spasmogenic challenge. The contractile capacity of excised murine tracheas was also measured to evaluate whether the obtained response in vivo involved airway smooth muscle. The results presented in this Master's thesis demonstrate that mice exposed to tone in vivo have an increased response to a high dose of a spasmogen, compared to control mice. The results also show that this response is caused, at least partly, by an increase in airway smooth muscle contractile capacity. Following these results, molecular mechanisms possibly involved in the gain in force induced by tone were investigated. It was hypothesized that signaling pathways downstream of G protein-coupled receptors were responsible for the increase in airway smooth muscle contractile capacity. Therefore, the inhibition of actin polymerization, the activation of myosin lightchain, the activation of G proteins, and the inhibition of mitogen-activated protein kinases were evaluated to assess whether they mediate the gain in force induced by tone. The results show that none of the pathways studied were implicated in the gain in force induced by tone elicited by the continuous presence of a spasmogen. These latter results demonstrate that the mechanisms leading to a gain in airway smooth muscle force following an induced tone are complex and will require further investigation.

Motor Function Evaluation of Hydrocephalus Children Background: Hydrocephalus constitutes a pathological condition that is manifested through signals and symptoms, including neurological and motor deficits that can result functional ability limitations. However, there are few studies that show the motor function of children with this illness. Objectives: To evaluate the kinetic and functional framework of hydrocephalus children; to identify the condition of muscle tone; to check the static and dynamic functional activities; to verify the association between tone alterations and functional activities in hydrocephalus children. Methods: A cross-sectional, descriptive, exploratory and field study, using qualitative and quantitative approach, performed at the University Hospital in Aracaju city, from August 2009 to March 2010. Results: From 50 evaluated children, 30 (60%) had hypertonia; 10 (20%) were hypotonic; and 10 (20%) showed no muscle tone alteration. The age average was considerably lower in hypertonic children and higher in hypotonic and without tone alteration children. The average of carried through surgeries was more expressive in hypertonic children. Motor sequels were present in 92% of the sample. The static functional activities, as well as dynamic ones, were lower in hypertonic children and higher in hypotonic and normal tone children. Conclusions: Muscle tone exacerbation is more present in hydrocephalus children and motor function is impaired, being the neuropsychomotor development delayed more evident in spastic children group and less pronounced in children with normal muscle tone.
Fundamento: A hidrocefalia constitui uma condição patológica que se manifesta através de sinais e sintomas, incluindo déficits neuromotores que podem resultar em limitações nas habilidades funcionais. No entanto, há poucos estudos que avaliem a função motora de crianças com esta doença. Objetivos: Avaliar o quadro cinético-funcional de crianças com hidrocefalia; identificar a condição do tônus muscular; verificar as atividades funcionais estáticas e dinâmicas; verificar a associação entre as alterações de tônus e as atividades funcionais nas crianças com hidrocefalia. Métodos: Estudo transversal, de caráter descritivo, exploratório e de campo, sob abordagem quali-quantitativa, realizado no ambulatório do Hospital Universitário, do município de Aracaju, no período de agosto de 2009 a março de 2010. Resultados: Das 50 crianças avaliadas, 30 (60%) apresentavam hipertonia; 10 (20%) eram hipotônicas; e 10 (20%) não apresentavam alteração de tônus muscular. A média de idade foi consideravelmente menor nas crianças hipertônicas em relação às crianças hipotônicas e normotônicas. O número de procedimentos cirúrgicos realizados foi mais expressivo no grupo de crianças com hipertonia muscular. As sequelas motoras estiveram presentes em 92% da amostra. As atividades funcionais estáticas, bem como as dinâmicas, encontraram-se mais comprometidas nas crianças hipertônicas do que nas hipotônicas e normotônicas. Conclusões: A hipertonia muscular foi a alteração tônica mais presente nas crianças com hidrocefalia, e a função motora é deficitária, sendo o atraso no desenvolvimento neuropsicomotor mais evidente no grupo de crianças espásticas e menos pronunciado nas crianças com tônus muscular sem alterações.

Les atteintes posturales sont des conséquences connues du vol spatial. Un des facteurs de stabilité orthostatique et postural est le tonus musculaire, qui chute en microgravité. Les études sur les effets cardiovasculaires, neuromusculaires et posturaux de la microgravité sont nombreuses ; pourtant, le rôle des troubles neuromusculaires et cardiovasculaires dans l’atteinte orthostatique et posturale reste peu connu. Notre but était d’étudier des altérations vasculaires et neuromusculaires induites par la microgravité, ainsi que les liens entre eux. Nos études chez l’homme comprenaient un vol spatial de 6 mois, un alitement antiorthostatique de 21 jours et une immersion sèche de 3 à 5 jours. Ces conditions diffèrent par le niveau de stimulation d’appui. L'état cardiovasculaire a été évalué par des tests orthostatiques, neuromusculaire - par myotonométrie et la stabilité posturale - par stabilométrie. Notre travail montre qu’un vol de longue durée induit des troubles bien plus profonds que la microgravité simulé plus courte. De plus, l'immersion sèche induit des troubles plus graves que l'alitement, malgré sa durée plus courte. Nos données suggèrent que c'est la décharge d’appui qui définit la profondeur des perturbations. Le rôle principal de la diminution du tonus des muscles posturaux est mis en avant. Cette diminution se produit par voie réflexe par diminution d’afferentation des zones d’appui. Elle pourrait être responsable de l’intolérance orthostatique via la diminution de l'efficacité de la pompe musculaire favorisant le retour veineux, et de l’instabilité posturale - via l'augmentation des seuils de recrutement des motoneurones posturaux
Postural and orthostatic impairment are both acknowledged consequences of spaceflight. One of the factors for orthostatic and postural stability is muscle tone, which decreases within the onset of microgravity. Studies of cardiovascular, neuromuscular and postural effects of microgravity are numerous ; yet the role of neuromuscular and vascular disorders in orthostatic and postural impairment remains unclear. We aimed to investigate vascular and neuromuscular alterations induced by microgravity, as well as their relationships. We studied healthy men exposed to 6-mo spaceflight, 21-day head-down bedrest and 3-to 5-day dry immersion. These conditions differ by the level of support unloading. Cardiovascular state was assessed by orthostatic tests, neuromuscular - by myotonometry, postural stability - by stabilometry. We found that long-term spaceflight induced much deeper disorders than relatively short-term modeled microgravity. Furthermore, immersion induced more severe disorders than bedrest, despite its shorter duration. Our data, along with literature, suggest that it is the support unloading that defines the depth of disturbances. The leading role in development of postural disorders under gravitational unloading belongs to decrease in postural muscle tone. This decrease occurs mainly by a reflex mechanism (decrease in support afferentation). It might be responsible for orthostatic impairment - via decrease in the efficiency of muscle pump promoting venous return, and for postural impairment - via increase in recruitment thresholds of postural motoneurons

Ce travail de thèse a pour but l’étude des douleurs de dos qui surviennent chez l’astronaute présentant davantage de hernies discales par rapport à une population contrôle. Nos recherches visent à comprendre la physiopathologie de ce phénomène et à étudier les conséquences cliniques de ce déconditionnement vertébral qui participe également aux troubles posturaux. Cet axe de recherche est recommandé par les différentes agences spatiales internationales. Pour cela nous avons eu l’opportunité d’analyser les données dans deux modèles d’études des effets de la microgravité : l’immersion sèche (n=11) et l’alitement tête déclive (n=9) et un état analogue, le confinement (n=4). Seuls les principaux résultats de l’immersion sèche, méthode d’étude nouvelle de notre paradigme, sont rapportés dans ce résumé. Celle-ci a permis grâce à l’imagerie et la spectroscopie par résonnance magnétique nucléaire de la colonne vertébrale, d’analyser en 3 dimensions le disque intervertébral et d’objectiver l’augmentation du contenu en eau (+17%) du volume de ce disque (+9,5%). Les variations du tonus des muscles paravertébraux et des membres inférieurs ont été mesurées avec la très récente et non-invasive technologie MyotonPRO. Une diminution du tonus musculaire (-7,3%) a été retrouvée, associée à une atrophie musculaire (-10,6%) ainsi qu’une perte de force démontrée sur les membres inférieurs. Ces résultats, attestant un déconditionnement musculaire, sont cohérents avec le déconditionnement postural immédiatement après immersion sèche. Nous avons également étudié les paramètres d’occlusion dentaire, qui font partie des entrées posturales et peuvent affecter la bonne stabilité du corps. Finalement deux éléments interviennent dans l’explication des dysfonctions vertébrales : l’augmentation de la taille de la colonne liée à celle du volume des disques intervertébraux. On note également une atrophie des muscles paravertébraux, qui joue un rôle majeur dans la posture. Nous avons par ailleurs montré le rôle de l’occlusion dentaire dans le déconditionnement vertébral et postural. En conclusion : le tonus musculaire, la bonne mobilité vertébrale et l’équilibre de l’occlusion dentaire sont des éléments à préserver pendant et après un séjour en impesanteur, afin d’éviter les effets délétères du déconditionnement
This work focuses on the study of back pain experienced by astronauts, who present with a greater incidence of herniated discs compared to a control population. Our research aims at understanding the physiopathology of this phenomenon and to study the clinical consequences of vertebral deconditioning which also contributes to postural disorders. This line of research has been recommended by the various international space agencies. For this reason, we had the opportunity to analyze data in two models simulating the effects of microgravity: dry immersion (n = 11) and head-down bed rest (n = 9), and a similar state, confinement (n = 4). Only the main results of dry immersion, a new method of studying our paradigm, are reported in this summary. Using magnetic resonance imaging and spectroscopy of the vertebral column, it was possible to analyze the intervertebral disc in 3 dimensions and to objectify the increase in water content (+ 17%) and the increase in intervertebral disc volume (+ 9.5%). Variations in paravertebral and lower limb muscle tone were measured with the very recent, and non-invasive, MyotonPRO technology. A decrease in muscle tone (-7.3%) was found to be associated with muscular atrophy (-10.6%) as well as a loss of strength in the lower limbs. These results, attesting to muscle deconditioning, are consistent with postural impairment immediately after dry immersion. We also studied variations in dental occlusion, which is involved with the maintenance of posture and could affect balance. In summary, two elements are involved in the explanation of vertebral dysfunction: the increase in spine height, related to increased intervertebral discs volume and paravertebral muscles atrophy, which plays a major role in posture. However, we also showed a role of dental occlusion in vertebral and postural deconditioning. In conclusion: muscle tone, good vertebral mobility, and dental occlusion are elements to be preserve during and after an exposure to weightlessness to avoid the deleterious effects of deconditioning

Title: The influence of skating frequency on muscle tone of musculus triceps surae. Objective: The aim of this master degree thesis is to determine whether and how much influence the frequency and intensity of isotonic load the muscle tone of musculus soleus during skating of a professional ice hockey player. The muscle tone of musculus soleus is the most objectively measured part of musculus triceps surae by myotonometer. Methods: The master degree thesis is divided into the theoretical part, the processed form of research that serves as a basis for investigation in the second, empirical part. Change in muscle tone of musculus soleus was investigated by using myotonometer, which followed after a full physiotherapy examination. It is quantitative research using quasi-experimental study. Measurements were performed on 10 subjects - professional ice hockey players who are fully manage the technique of skating on the ice, before load, after low frequency isotonic load and after high frequency isotonic load. Conclusion: The myotonometric measurements revealed that after low and high frequency isotonic load of skating on ice rink, the muscle tone of musculus soleus is the same or slightly lower than before load. Keywords: Muscle tone, myotonometer, musculus soleus, skating, ice hockey

Title: The influence of skating frequency on muscle tone of musculus triceps surae. Objective: The aim of this master degree thesis is to determine whether and how much influence the frequency and intensity of isotonic load the muscle tone of musculus soleus during skating of a professional ice hockey player. The muscle tone of musculus soleus is the most objectively measured part of musculus triceps surae by myotonometer. Summary: The master degree thesis is divided into the theoretical part, the processed form of research that serves as a basis for investigation in the second, empirical part. Change in muscle tone of musculus soleus will be investigated by using myotonometer, which will follow after a full physiotherapy examination. Measurements will be performed on 10 subjects - professional ice hockey players who are fully manage the technique of skating on the ice, before load, after low frequency isotonic load and after high frequency isotonic load. Conclusion: The myotonometric measurements revealed that after low and high frequency isotonic load of skating on ice rink, the muscle tone of musculus soleus is the same or slightly lower than before load. Keywords: Muscle tone, myotonometer, musculus soleus, skating, ice hockey

Les adolescents-hockeyeurs peuvent être affligés de troubles musculosquelettiques (TMS) résultant d’un excès de tension musculaire lequel peut mener à des déformations ou déséquilibres musculaires ainsi qu’à une attitude posturale inadéquate. Les conséquences de ces changements mènent souvent à une surcharge inutile du système musculosquelettique (SMS), à la perturbation des mécanismes du contrôle postural et éventuellement à l’apparition de douleurs musculaires et articulaires. Les interventions qui s’attaquent aux TMS par une rééquilibration de la tension musculaire sont peu nombreuses. Les interventions qui s’attaquent aux TMS par une normalisation de la tension musculaire sont peu nombreuses. La Reconstruction Posturale® (RP), testée cliniquement, est l’une d’entre elles. Dans un premier temps, cette thèse visait à identifier les caractéristiques du contrôle postural chez les adolescents-hockeyeurs de niveau élite lorsque le système somatosensoriel est mis à l’épreuve en position debout quasi statique pieds nus et en patins. Dans un deuxième temps, nous avons évalué l’impact d’une intervention en RP sur des variables cliniques et biomécaniques, chez ces athlètes qui souffrent de TMS. Soixante-sept adolescents-hockeyeurs de niveau élite âgés de 15 à 18 ans ont participé à l’étude. Le contrôle postural de cinquante-sept joueurs a été évalué en position debout sur deux plateformes de force les yeux ouverts et les yeux fermés, pieds nus sur une surface dure et sur une mousse. De ce groupe, trente-cinq sujets ont également été évalués en patins, les yeux ouverts et les yeux fermés. Par la suite, neuf adolescents-hockeyeurs souffrant de TMS, ont été sélectionnés pour participer au protocole d’intervention thérapeutique en RP qui consistait en l’application de six séances de thérapie prodiguées sur une période de six semaines. Le déplacement du centre de pression (CP) sous les pieds a été calculé dans les directions antéro-postérieure (AP) et médio-latérale (ML). La vélocité moyenne du CP, le déplacement moyen du CP et l’étendue du CP ont été retenus pour rendre compte de la performance du contrôle posturale. D’autre part, l’asymétrie de mise en charge, la trajectoire du CP sous les pieds gauche et droit, le CPc pour rendre compte de la stratégie de chevilles et le CPv pour rendre compte de la stratégie de hanches ont été retenues pour identifier les stratégies utilisées pour maintenir l’équilibre. L’impact de l’intervention en RP a été évalué à l’aide de trois variables cliniques soit la douleur à l’aide de l’échelle visuelle analogue (ÉVA), la capacité fonctionnelle à l’aide d’un un questionnaire autoadministré et des photographies de la posture debout pour rendre compte des variables posturales biomécaniques. Nos résultats montrent que chez les adolescents-hockeyeurs la performance du contrôle postural en position debout statique est davantage perturbée par les changements somatosensoriels en direction ML alors qu’en AP, la perte d’informations visuelles ainsi que des changements somatosensoriels affectent la performance. Dans toutes les conditions expérimentales et dans les deux directions, nous avons observé une vélocité du CP remarquablement élevée, variant entre 18 et 22 mm/s. Au niveau des stratégies et indépendamment de la condition expérimentale, nous avons observé une dominance presque complète de la stratégie de cheville en AP alors qu’en ML, la stratégie de hanche dominait avec une contribution de la stratégie de cheville de plus de 20 %. En patins, en direction ML, aucun changement significatif de la performance n’a été observé. Toutefois en AP, nous avons observé une augmentation significative de la vélocité du CP, yeux ouverts et yeux fermés ainsi qu’une augmentation significative de l’étendue, yeux ouverts seulement. Au niveau des stratégies, la stratégie de cheville domine en AP et la stratégie de hanche domine en ML avec une contribution plus modeste de la stratégie de cheville qui était inférieure à 12 %. Chez les adolescents-hockeyeurs souffrant de TMS, post-intervention, nos résultats indiquent une diminution significative de la douleur et une amélioration des capacités fonctionnelles ainsi que de l’attitude posturale. Pré intervention en direction ML, nous avons observé une contribution significativement plus élevée de la stratégie de cheville au contrôle du CPnet et un retour vers des valeurs normales post-intervention. L’impact de l’intervention thérapeutique sur la performance du contrôle postural s’est avéré non significatif en ML et en AP.
Adolescent hockey players can suffer from musculoskeletal disorders (MSD) resulting from excess muscle tension that can lead to dysmorphisms, muscle imbalances as well as inadequate standing posture. The consequences of these changes often lead to unnecessary overload of the musculoskeletal system (MSS), disturbances in postural control mechanisms and eventually the development of muscular and joint pain. Very few interventions are design to address MSD by rebalancing muscle tension. One of the clinically tested interventions is Postural Reconstruction® (PR). Our first objective was to identify the characteristics of postural control among a population of elite adolescent-hockey players when the somatosensory system is disturbed while standing in a quasi static position barefoot and on skates. Secondly, we assessed the impact of an intervention in PR on various clinical and biomechanical variables among a population of elite adolescent hockey players suffering from MSD. Sixty seven elite adolescent hockey players, 15 to 18 years of age participated in the study. The postural control of fifty seven players was assessed in standing using two force platforms, in eyes open (EO) and eyes closed (EC) conditions barefoot on hard surface and on foam. From that group, thirty five players were also assessed on skates, EO and EC. Then, nine players suffering from MSD were selected to participate in the intervention protocol in RP consisting in the application of six therapeutic sessions held once a week for six consecutive weeks. Center of pressure (COP) movements under the feet was calculated in the antero-posterior (AP) and medio-lateral (ML) directions. To account for the performance of the postural control system, mean COP velocity and displacements as well COP range were used. The variables retained to account for the strategies used to maintain balance in the upright position were weight baring asymmetry, concordance of the COP trajectory as well as COPc for the contribution of the ankle strategy and COPv for the contribution of the hip strategy. Finally, the impact of PR intervention was assessed on pain level, functional capacity and postural biomechanical variables. Our results show that among elite adolescent hockey players, the performance of the postural control in standing in a quasi static position is more disturbed by changes somatosensory information in ML direction while in AP, the absence of visual information as well as changes in somatosensory information significantly affect the performance. In all experimental conditions, and in both directions, we observed a remarkably high mean velocity, ranging between 18 to 22 mm/sec. As for the strategies, independent of the experimental condition, we observed total dominance of the ankle strategy in AP while in ML, the hip strategy dominated with a 25 % contribution for the ankle strategy. On skates, in ML direction, no significant changes were observed in the performance. However, in AP, we observed a significant increase in the mean COP velocity, EO and EC, and significant increase in COP range, EO only. As for the strategies, we observed the same dominance but the contribution on the ankle strategy in ML was more modest, that is less than 12 %. For players suffering from MSD, our results show that six sessions of PR significantly improved the level of pain, functional capacity and body alignment in standing. Pre intervention in ML, we observed a significantly higher contribution of the ankle strategy to the control of the COPnet and post-intervention, a return to normal values. The impact of the PR intervention on postural control performance was not significant in ML and AP. In conclusion, our results show that in the early stage, a PR intervention has a greater impact on postural control stratégies rather than performance.