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- ItemSomente MetadadadosAvaliação da demanda cardiovascular, ventilatória e metabólica em pacientes com dpoc durante a realização do teste de atividades da vida diária de glittre(Universidade Federal de São Paulo (UNIFESP), 2013-11-27) Souza, Ferson Fonseca de [UNIFESP]; Nascimento, Oliver Augusto Nascimento [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by a progressive worsening of lung function and symptoms, leading to difficulty in performing activities of daily living (ADLs). It was recently proposed a new test designed to evaluate the functional performance for patients with COPD, called as the Glittre activities of daily living test (Glittre ADL – test). Up to date we neither know what are the COPD patients in term of cardiovascular, ventilatory and metabolic demand to perform the Glittre ADL – test, nor how these demands correspond to the maximum values obtained to the maximal incremental test. Objective: To evaluate metabolic, ventilatory and cardiovascular responses obtained during the Glittre activities of daily living test (Glittre ADL – Test) in mild, moderate and severe COPD patients, according to the GOLD classification. Methods: Cross-sectional observational study performed in sixty-two patients who present stable COPD. Assessment: spirometry, BMI, MRC, SGRQ and LCADL questionnaires, Glittre – ADL test, six-minute walking test (6MWT) and maximal incremental test on the treadmill (IT). We analyzed the mean scores of the questionnaires, and the variables obtained before and after exercises tests: VO2 peak, VO2/VO2 peak ratio, VCO2, f, VE, VE/MVV ratio, HR, BP, VO2/FC, SpO2 and Borg dyspnea. Results: The data obtained for the three groups of COPD patients have not showed significant differences related to parameters such as age, BMI and gender. On the other hand we found statistically significant differences in mean FEV1, MRC, and VVM among groups. Patients with severe COPD showed worst quality of life and the highest dyspnea according to LCADL questionnaires. The VE/MVV ratio measured in Glittre ADL – test present distinct results of 0.46 ± 0.11, 0.68 ± 0.18, 0.92 ± 0.20 for groups of mild, moderate and severe patients, respectively. The mean VO2/VO2 peak ratio were 0.81 ± 0.1, 0.88 ± 0.2 and 0.96 ± 0.2 for same sequence of groups, with the severe COPD patients showing significantly higher ratios than the mild group (p = 0.03). The mean SpO2 values were significantly lower and dyspnea significantly higher in severe COPD patients than in the other groups. There were no statistically significant differences in other variables obtained in the Glittre ADL – test, walking distance and maximal aerobic capacity among groups. Conclusions: Patients in different stages of COPD performed the Glittre ADL – test with similar time, metabolic, ventilatory and cardiovascular demand. However, the group of most severe patients presented lower metabolic, ventilatory reserve and lower SpO2, which result in increased dyspnea to run the test.
- ItemSomente MetadadadosEfeitos da reabilitação vestibular na capacidade funcional de idosos vestibulopatas crônicos: ensaio clínico randomizado(Universidade Federal de São Paulo (UNIFESP), 2014-11-28) Aratani, Mayra Cristina [UNIFESP]; Gananca, Fernando Freitas Gananca [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To compare the effectiveness of two vestibular rehabilitation protocols (Conventional versus Multimodal) on the functional capacity of older people with chronic vestibulopathy. Methods: A randomized, single blind, controlled clinical trial, with a tree month follow-up was performed. The sample was composed of older individuals with a clinical diagnosis of chronic dizziness resulting from vestibular disorders. The individuals were subjected to questionnaires that assessed the impact of dizziness on quality of life, ability and confidence to perform activities of daily living and mood at baseline, post-treatment, and at follow-up. The primary outcome measure was the Dizziness Handicap Inventory. Secondary outcomes included the Vestibular Disorders Activities of Daily Living, Activities-specific Balance Confidence Scale and Geriatric Depression Scale. The older individuals were randomized to either the Conventional or Multimodal Cawthorne & Cooksey protocols. The protocols were performed during individual 50-minute sessions, twice a week, for two months. The outcomes of both protocols were compared according to the intention-to-treat analysis. Results: 82 older individuals were randomized into either Conventional (n=40) or Multimodal (n=42) protocols. There were significant increases in the primary and second outcomes at post-treatment that was maintained on follow-up period, with no significant difference between groups, nor any interaction concerning the treatment protocol. Conclusions: The vestibular rehabilitation, regardless of the treatment protocol, resulted in improvement on elderlies? functional capacity, which was maintained during a short-term period.
- ItemAcesso aberto (Open Access)Factors associated with functional balance and mobility among elderly diabetic outpatients(Sociedade Brasileira de Endocrinologia e Metabologia, 2009-10-01) Cordeiro, Renata Cereda [UNIFESP]; Jardim, José Roberto [UNIFESP]; Perracini, Monica Rodrigues; Ramos, Luiz Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Cidade de São PauloOBJECTIVES: To characterize balance and mobility among diabetic elderly outpatients and to estimate the extent to which functional balance and mobility abnormalities can be influenced by sociodemographic, clinical and other functional factors in a cross-sectional study. METHODS: Ninety-one elderly (65+ years) outpatients were assessed. Mobility was evaluated by the Timed Up and Go Test (TUGT) and the balance, by the Berg Balance Scale (BS). RESULTS: TUGT mean score was 15.65 ± 5.9 seconds and BS mean score was 49.31 ± 7.3 points. Using linear regression analysis (α < 0.05), significant and independent positive relationships were obtained between TUGT and age, daily activities (ADL/IADL), step strategy, and proprioceptive sensitivity. Factors negatively associated with BS were: ADL/IADL, step strategy, proprioceptive sensitivity, orthostatic hypotension (OH) and conflictive sensory conditions. CONCLUSION: Elderly diabetic outpatients show abnormal balance and mobility related mainly to advanced age, disability, absence of step strategy, absence of proprioceptive sensitivity and presence of OH.
- ItemAcesso aberto (Open Access)Neuropsychological performance in patients with subcortical stroke(Academia Brasileira de Neurologia - ABNEURO, 2012-05-01) Andrade, Silviane Pinheiro Campos de [UNIFESP]; Brucki, Sônia Maria Dozzi; Bueno, Orlando Francisco Amodeo [UNIFESP]; Siqueira Neto, José Ibiapina; Universidade Federal de São Paulo (UNIFESP)Vascular cognitive impairment (VCI) is characterized by cognitive compromise predominantly of executive dysfunction. OBJECTIVES: To assess cognitive functions in VCI, focusing on executive functions, to observe functional losses in relation to activities of daily living (ADLs) and to detect early symptoms prior to the onset of dementia. METHODS: We evaluated healthy subjects matched for gender, education and age to patients with diagnosis of subcortical vascular disease who had a stroke classified into three groups: 1) vascular lesions and no impairment; 2) vascular cognitive impairment with no dementia (VCIND); 3) vascular dementia (VaD). RESULTS AND DISCUSSION: The performance on neuropsychological tests differed among groups, worsening with increased impairment level. The probable VaD group demonstrated impaired performance in memory, processing speed and verbal production, while the VCIND group showed attention deficits. CONCLUSION: Impairment in executive functions and difficulties in ADLs allow us to differentiate levels of impairment in groups of subcortical vascular disease.
- ItemAcesso aberto (Open Access)Qualidade de vida em pacientes com vertigem posicional paroxística benigna e/ou doença de Ménière(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-12-01) Handa, Patrícia Rumi [UNIFESP]; Kuhn, Ana Maria Baccari [UNIFESP]; Cunha, Fabiana [UNIFESP]; Schaffleln, Ricardo [UNIFESP]; Ganança, Fernando Freitas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Patients with benign paroxysmal positional vertigo and/or Ménière's disease relate damages in quality of life. AIM: To compare the impact of dizziness on quality of life, in patients with benign paroxysmal positional vertigo and/or Ménière's disease, in crisis and out of crisis, and to evaluate the influence of gender, age and impaired semicircular canal. STUDY DESIGN: clinical with transversal cohort. MATERIAL AND METHOD: The prospective study was realized in 2003/04 at Federal University of São Paulo. The Dizziness Handicap Inventory was applied in seventy patients with positional vertigo, seventy with Ménière's disease and fifteen with both. Two-proportion equality test and the Analysis of variance were employed in this study. RESULTS: When comparing the groups, Dizziness Handicap Inventory results evidenced higher averages in crisis and out of crisis for Ménière's disease group than for positional vertigo group. The same occurred only during the crisis period in the group when comparing with both disorders (p<0,05). No significant statistical differences were observed, when comparing the results considering age, gender and, in the group with positional vertigo, affection of posterior semicircular canal as variables. CONCLUSIONS: Ménière's disease patients presented worse quality of life when compared to BPPV patients, in and out of crisis, and during the crisis when regarding the patients with association of both disorders. The damage on quality of life was independent of gender, age and in the BPPV cases it was independent of posterior canal affection.
- ItemAcesso aberto (Open Access)Revisão sistemática das escalas utilizadas para avaliação funcional na doença de Pompe(Sociedade de Pediatria de São Paulo, 2012-06-01) Savegnago, Alana Karla [UNIFESP]; Silva, Rosangela Maria da [UNIFESP]; Jonhston, Cíntia [UNIFESP]; Martins, Ana Maria [UNIFESP]; Melo, Ana Paula L. de [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)OBJECTIVE: To identify functional assessment scales used in Pompe disease (PD) and to describe their levels of evidence and grades of recommendation. DATA SOURCE: Systematic review of the functional assessment scales used in PD. Review conducted in the databases Medline, Lilacs, Cochrane Central Register of Controlled Trials (CCTR), and SciELO including articles (except review articles) published between 2000 and 2010. The key-words used in Portuguese and English were: glycogen storage disease type II, activities of daily living, assessment. The articles were classified according to their level of evidence and grade of recommendations. DATA SYNTHESIS: 14 studies assessing patients ranging from newborns to adults were included in the present review (total sample=449). The scales found in the literature were: Pediatric Evaluation of Disability Inventory (PEDI) and its adapted version for PD (Pompe-PEDI), Alberta Infant Motor Scale (AIMS), Rotterdam Handicap Scale (RHS), Functional Independence Measure (FIM), Gross Motor Function Measure (GMFM), and Peabody Developmental Motor Scales (PDMS-II). Most studies had level of evidence III because they were non-randomized studies. The grades of recommendation of the scales were C for AIMS and Pompe-PEDI, D for GMFM and PDMS-II; and E for RHS and FIM. CONCLUSIONS: Most functional assessment scales used in PD show low level of evidence and grade of recommendation. The scales showing the highest grade of recommendation (C) were the AIMS and Pompe-PEDI used in Pediatrics.