ENERGY EXPENDITURE DURING BACKWARD AND FORWARD WALKING AFTER STROKE
Karine Kulkamp de Souza,1 Bruno Freire,1 Tayara Gaspar da Silva,1 Daniela Parizotto,1 Lucas Rodrigues Nascimento,2,3 and Stella Maris Michaelsen1
1Laboratorio de Controle Motor, Universidade do Estado de Santa Catarina, Brazil; 2Universidade Federal do Espirito Santo, Brazil; 3NeuroGroup, Universidade Federal de Minas Gerais, Brazil
Background and Purpose: Treadmill training improves cardiorespiratory fitness after stroke. However, pronounced motor impairments might limit the achievement of optimal intensity of aerobic training. Backward walking has the potential to promote greater cardiorespiratory effort and perceived exertion, compared with forward walking in healthy subjects. The purpose of this study was to compare the cardiorespiratory parameters, related to energy expenditure, during backward and forward treadmill walking in individuals who had stroke.
Methods: Twenty-five ambulatory individuals who had stroke, with a mean age of 58 (14) years and a mean time since stroke of 4 (4) years, participated. Data were collected in 2 days, with an interval of 72 hours. On each day, one incremental treadmill test (ie, backward or forward walking) was performed. The order of the conditions was randomized. The incremental tests had 8 stages and a maximum duration of 12 minutes. The initial treadmill speed was set at 0.5 m/s and increments of 0.08 m/s were conducted every 1.5 minutes. The outcome measures were: (i)
O2, reported as mL/min, (ii)
O2/kg, reported as mL/Kg/min, and (iii) heart rate, reported as beats per minute (bpm). Data were obtained using a respiratory gas analyzer (Quark Cpet-COSMED) and values obtained during the last increment were compared. Paired t tests were conducted to analyze differences between conditions. The study was approved by the institutional ethics committee, and the participants provided a signed informed content.
Results: Cardiorespiratory stress was significantly higher during backward walking, in comparison with forward walking. During backward walking, the
O2 mean value was 1310 (306) mL/min, the
O2/kg was 18 (4) mL/kg/min, and the heart rate was 122 (20) bpm. During forward walking, the
O2 mean value was 1117 (307) mL/min, the
O2/kg was 15 (4) mL/kg/min, and the heart rate was 103 (15) bpm. Values of the cardiorespiratory outcomes were approximately 15% higher during backward walking, compared with forward walking (P < 0.01).
Discussion and Conclusions: Individuals after stroke achieved higher cardiorespiratory effort during backward walking, in comparison with forward walking at same speeds. Backward walking may be an alternative exercise for improving cardiorespiratory fitness after stroke. In particular, it may be a useful intervention for patients who cannot walk at faster speeds during treadmill training.
EFFECTS OF HYDROTHERAPY ON PREMATURE BABIES WITHOUT THE CAPACITY OF THERMAL CONTROL
Elaine Pereira Raniero,1 Walusa Assad Goncalves Ferri,1 and Francisco Eulogio Martinez1
1Ribeirao Preto Medical School, Department of Child Care and Pediatrics, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
Background and Purpose: The inclusion of hydrotherapy in neonatology as a physiotherapy resource has spread in recent years, but there are few scientific studies that broached its effects on premature newborns. Safe application protocols have not been determined yet, as well as the babies who would be selected to receive the intervention. The purpose of this study was to evaluate the effects of a hydrotherapy protocol on premature newborns of gestational age less than 32 weeks, without the capacity of thermal control, who were hospitalized in a neonatal intensive care unit, and it was done by verifying its viability and the immediate and medium-term effects.
Methods: A randomized and controlled clinical trial, which was approved by the ethics committee (CAEE 49147515.2.0000.5440), was performed in the period from 32 to 37 weeks after conception, in babies of gestational age less than 32 weeks. Sixteen babies were selected and they were randomized in 2 groups: the intervention group-immersion in a bucket for 10 minutes, with warm water, twice a week, and the vital signs (heart rate, oxygen saturation, and body temperature) and behavioral state (Brazelton Scale) were checked, 5 minutes before and after the intervention. In the control group, the same procedures were performed, except the immersion in water. At the end of the intervention period, the gain of body weight was observed. In order to compare the clinical signs, linear mixed-effects models were used, and for the behavioral state and the gain of body weight, a simple linear regression model was used.
Results: There were no differences between the groups with regard to clinical signs and behavioral state before and after the intervention. In relation to the gain of body weight during the intervention period, there were no statistically significant differences between the groups both in the simple linear regression model and multiple model adjusted to the number of interventions (immersion or control).
Discussion and Conclusions: The methodology used did not demonstrate the benefits of hydrotherapy in relation to the parameters evaluated. However, it should be emphasized that damages were not found in the application of this technique, in spite of the evaluated babies have not had the capacity of thermal control yet. Therefore, more studies are needed to prove the benefits of this intervention.
MODELING HEALTH INFORMATION FOR MEASUREMENT OF HEALTH STATE DESCRIPTIONS CODED BY ICF: REQUIREMENTS FOR SOFTWARE DEVELOPMENT
Paulo Henrique Ferreira de Araujo Barbosa,1,2 Fernanda da Rocha Medeiros,1 Marianna Brandao Rosa,1 Tatiana Isabela de Souza Oliveira,1 Thiago Vidal Pereira,1 and Emerson Fachin-Martins1,2
1Universidade de Brasilia, Campus de Ceilandia, Faculdade de Ceilandia, Brasilia, Brazil; 2Universidade de Brasilia, Campus de Ceilandia, Faculdade de Ceilandia, Programa de Pos-Graduacao em Ciencias e Tecnologias em Saude, Brasilia, Brazil
Background and Purpose: The International Classification of Functioning, Disability, and Health (ICF) proposes an organization based on coded and qualified information distinguishing functioning and disability codes. This study aimed to develop a tool able to use information converted into qualified codes proposed by the ICF to establish a measure of the health-related states for individuals and populations, and that represents reliable and valid indices for investment in health information systems.
Methods: We outlined a cross-sectional study with descriptive and exploratory aims for technological development, including quantitative and qualitative approaches to collective speech content analysis, and modeling of data in a single case report. We performed 3 stages: (1) modeling of data coming from the information reported in the case to identify codes and qualify them; (2) survey of the requirements and face validation through focus group, which was heard the demands of future users of the software, beyond to establish a list of useful requirements; and (3) development of the computer program.
Results: The sequence of events followed the simulation model, producing theoretical results, conceptual, graphics, and numeric components. The simulation revealed that the measure might be better represented by a 3-dimensional model, which considers the events over time, the ratio between functioning and disability codes, and discrete events representing health condition hallmarks.
Discussion and Conclusions: The model was validated by the focus group (face validation), resulting in a list of requirements that contributed to the development of the preliminary version of the desired product: the DataCIF.
PLANTAR PRESSURE ANALYSIS: COMPARISON BETWEEN CHARCOT-MARIE-TOOTH AND TYPICAL CHILDREN
Adriana Nascimento-Elias,1,2 Juliana Cardoso,3 Cyntia Rogean de Jesus Alves de Baptista,4 and Ana Claudia Mattiello-Sverzut4
1Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil; 2Moura Lacerda University Ribeirao Preto, Brazil; 3Rehabilitation and Functional Performance Program, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil; 4Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
Background and Purpose: Plantar pressure analysis of children and adolescents with Charcot-Marie-Tooth neuropathy (CMT) can guide physical therapy intervention strategies for minimizing the development of feet deformities. We examined whether children and adolescents with CMT have different plantar pressure, lower limb muscle strength and foot posture, when compared with their typical counterparts.
Methods: A cross-sectional study comprising of 36 (6-17 years old) assigned to: CMT group (n = 16) and control group (n = 20). We collected anthropometric data, lower limb isometric muscle strength, ankle passive range of motion (ROM), Foot Posture Index (FPI), and plantar pressure (Pedar-X, Novel). Peak pressure (PP), contact area (CA), and pressure time integral (PTI) were analyzed for the lateral-forefoot, medial-forefoot, midfoot, and rearfoot.
Statistical Analysis: We used Kolmogorov-Smirnov tests for normality, [chi]2 to analyze the FPI, and Student's t test for intergroup comparisons (P < 0.005).
Results: Supinated feet predominated in CMT (69.0%) and normal feet (63.8%) in control. CMT presented lower muscle strength and dorsiflexion ROM and CA in the lateral-forefoot and medial-forefoot [mean (standard deviation): 12.3 (6.7); 25.6 (6.3), respectively] when compared with control [14.8 (2.3); 29.6 (4.1)]. CMT showed higher PP for forefoot-lateral, forefoot-medial, and midfoot [285.6 (135.9); 279.4 (111.6); 190.8 (114.7)], when compared with control [235.6 (93.7); 237.0 (69.5); 114.6 (36.5)]. Medial-forefoot and midfoot PTI were higher in CMT [78.3 (35.7); 62.0 (36.1)] compared with control [63.1 (22.9); 37.7 (13.2)].
Discussion and Conclusions: CMT showed significant alterations in plantar pressure, feet posture, and ankle muscle strength, when compared with typical children and adolescents.