RESUMO
ABSTRACT Objective: To measure the intra- and inter-rater reliability of a biophotogrammetric assessment protocol for thoracoabdominal motion in preterm infants. Methods: This is an analytical cross-sectional study. Footage of 40 preterm infants was made in two views (lateral and anterior). The babies were placed in the supine position, with retroverted pelvis and semiflexed knees. Acrylic markers were positioned on surgical tape in eight predetermined anatomical points. We analyzed 4 variables in lateral view and 11 in anterior view (angular and linear) (ImageJ®), divided into two stages: 1. same frames - three blinded evaluators analyzed frames previously selected by the main researcher (inter-rater analysis 1), reviewing these same frames after 15 days (intra-rater analysis 1); 2. different frames - each evaluator selected the frames from the original video and repeated the protocol (inter-rater analysis 2), with a review after 15 days (intra-rater analysis 2). In stage 2, we tested the reliability of the entire process, from image selection to the analysis of variables. Data agreement and reproducibility were obtained by the intraclass correlation coefficient (ICC). Results: Agreement was high, particularly in angular variables (ICC 0.82 to 0.99). Linear variables ranged between very good and excellent in analysis 1 (same frames: ICC 0.64 to 0.99) and analysis 2 (different frames: ICC 0.44 to 0.89). Conclusions: The present study suggests that the proposed protocol for the thoracoabdominal motion analysis of preterm neonates has high reliability.
RESUMO Objetivo: Mensurar a confiabilidade intra e interexaminador de um protocolo de avaliação biofotogramétrica da mobilidade toracoabdominal de prematuros. Métodos: Estudo de caráter transversal e analítico. Incluíram-se filmagens de 40 prematuros em duas vistas (lateral e superior), realizadas em supino, pelve retrovertida e joelhos em semiflexão. Marcadores de acrílico foram posicionados sobre Micropores em oito pontos anatômicos predeterminados. Foram analisadas 4 variáveis na vista lateral e 11 na vista superior (angulares e lineares) (ImageJ®), divididas em duas etapas: (1-Frames iguais) análises de fotogramas previamente selecionados pela pesquisadora principal por três avaliadores cegos (análise interexaminador 1), com reanálise desses mesmos fotogramas após 15 dias (análise intraexaminador 1); (2-Frames diferentes) cada avaliador selecionou os fotogramas por meio do vídeo original e repetiu o protocolo (análise interexaminador 2), com reanálise após 15 dias (análise intraexaminador 2). Em (2), foi testada a confiabilidade de todo o processo de análise, desde a separação das imagens até a análise das variáveis. A concordância e reprodutibilidade dos dados foram obtidas pelo coeficiente de correlação intraclasse (CCI). Resultados: Houve concordância forte, com ênfase nas variáveis angulares (CCI [0,82 a 0,99]). As variáveis lineares apresentaram variação entre muito boa e excelente na análise 1 (frames iguais: CCI 0,64 a 0,99) e na análise 2 (frames diferentes: CCI entre 0,44 e 0,89). Conclusões: O presente estudo sugere forte confiabilidade do protocolo proposto para análise da movimentação toracoabdominal de neonatos prematuros.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Fotogrametria/métodos , Triagem Neonatal/instrumentação , Músculos Abdominais/fisiopatologia , Respiração , Recém-Nascido de Baixo Peso , Estudos Transversais , Reprodutibilidade dos Testes , Lactente Extremamente PrematuroRESUMO
OBJECTIVE: To measure the intra- and inter-rater reliability of a biophotogrammetric assessment protocol for thoracoabdominal motion in preterm infants. METHODS: This is an analytical cross-sectional study. Footage of 40 preterm infants was made in two views (lateral and anterior). The babies were placed in the supine position, with retroverted pelvis and semiflexed knees. Acrylic markers were positioned on surgical tape in eight predetermined anatomical points. We analyzed 4 variables in lateral view and 11 in anterior view (angular and linear) (ImageJ®), divided into two stages: 1. same frames - three blinded evaluators analyzed frames previously selected by the main researcher (inter-rater analysis 1), reviewing these same frames after 15 days (intra-rater analysis 1); 2. different frames - each evaluator selected the frames from the original video and repeated the protocol (inter-rater analysis 2), with a review after 15 days (intra-rater analysis 2). In stage 2, we tested the reliability of the entire process, from image selection to the analysis of variables. Data agreement and reproducibility were obtained by the intraclass correlation coefficient (ICC). RESULTS: Agreement was high, particularly in angular variables (ICC 0.82 to 0.99). Linear variables ranged between very good and excellent in analysis 1 (same frames: ICC 0.64 to 0.99) and analysis 2 (different frames: ICC 0.44 to 0.89). CONCLUSIONS: The present study suggests that the proposed protocol for the thoracoabdominal motion analysis of preterm neonates has high reliability.
Assuntos
Músculos Abdominais/fisiopatologia , Triagem Neonatal/instrumentação , Fotogrametria/métodos , Estudos Transversais , Feminino , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Reprodutibilidade dos Testes , RespiraçãoRESUMO
Active expiration represents an important mechanism to improve ventilation in conditions of augmented ventilatory demand, such as hypercapnia. While a rostral ventromedullary region, the parafacial respiratory group (pFRG), has been identified as a conditional expiratory oscillator, little is known about how central chemosensitive sites contribute to modulate active expiration under hypercapnia. In this study, we investigated the influence of the medullary raphe in the emergence of phasic expiratory abdominal activity during hypercapnia in unanesthetized adult male rats, in a state-dependent manner. To do so, reverse microdialysis of muscimol (GABAA receptor agonist, 1 mM) or 8-OH-DPAT (5-HT1A agonist, 1 mM) was applied in the MR during sleep and wakefulness periods, both in normocapnic (room air) and hypercapnic conditions (7% CO2). Electromyography (EMG) of diaphragm and abdominal muscles was performed to measure inspiratory and expiratory motor outputs. We found that active expiration did not occur in room air exposure during wakefulness or sleep. However, hypercapnia did recruit active expiration, and differential effects were observed with the drug dialyses in the medullary raphe. Muscimol increased the diaphragm inspiratory motor output and also increased the amplitude and frequency of abdominal expiratory rhythmic activity during hypercapnia in wakefulness periods. On the other hand, the microdialysis of 8-OH-DPAT attenuated hypercapnia-induced active expiration in a state-dependent manner. Our data suggest that the medullary raphe can either inhibit or potentiate respiratory motor activity during hypercapnia, and the balance of these inhibitory or excitatory outputs may determine the expression of active expiration.
Assuntos
Diafragma/fisiopatologia , Expiração , Hipercapnia/fisiopatologia , Núcleos da Rafe/fisiopatologia , 8-Hidroxi-2-(di-n-propilamino)tetralina/farmacologia , Músculos Abdominais/inervação , Músculos Abdominais/fisiopatologia , Animais , Diafragma/inervação , Agonistas de Receptores de GABA-A/farmacologia , Masculino , Muscimol/farmacologia , Contração Muscular , Núcleos da Rafe/efeitos dos fármacos , Ratos , Ratos Wistar , Agonistas do Receptor de Serotonina/farmacologia , Sono , VigíliaRESUMO
OBJECTIVE: The aim of this study was to estimate the prevalence of low back pain (LBP) in patients with Parkinson's disease (PD) and its impact on functional capacity and quality of life. METHODS: Patients with idiopathic PD answered a questionnaire and were submitted to a clinical and functional assessment. Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr Scale, Beck Depression Inventory (BDI), McGill Pain Questionnaire (McGill), Roland Morris Disability Questionnaire (RMDQ), 39-item Parkinson's Disease Questionnaire (PDQ-39) were used. In addition, the ability to contract transversus abdominis (TrA) was assessed. RESULTS: One hundred and fifteen patients answered the questionnaire, and 95 (82.6 %) reported painful symptoms. Of these, 67 (58.3 %) had chronic LBP, and approximately 40 % patients reported its onset before diagnosis of PD. Higher scores in pain intensity, depressive symptoms and UPDRS II and III, more advanced stages of PD, and absence of TrA contraction determined poor functional limitation induced by LBP. However, pain intensity (McGill), severity of PD symptoms (UPDRS III) and absence of TrA contraction were identified as predictive factors for functional limitation and explained 66.1 % of the variance in the RMDQ. Pain intensity and LBP-related disability caused negative impact on the quality of life. CONCLUSION: LBP is common in patients with PD and it causes disability and poor quality of life. Pain intensity, UPDRS III and absence of TrA contraction were the most significant predictive factors for disability assessed by the RMDQ.
Assuntos
Dor Lombar/fisiopatologia , Doença de Parkinson/fisiopatologia , Qualidade de Vida , Músculos Abdominais/fisiopatologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Cognição , Estudos Transversais , Depressão/psicologia , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/epidemiologia , Dor Lombar/psicologia , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Medição da Dor , Doença de Parkinson/complicações , Doença de Parkinson/psicologia , Prevalência , Inquéritos e QuestionáriosRESUMO
Background: Belly dancer syndrome (BDS) and parkinsonian features are rarely described in association as a drug-induced movement disorder. Phenomenology shown: A 62-year-old woman with paranoid schizophrenia presented with bradykinesia, rigidity, rest, and postural tremor, as well as dyskinetic abdominal movements. Educational value: Our case highlights that drug-induced parkinsonism can be associated with other rare movement disorders, such as BDS, with subsequent greater morbidity.
Assuntos
Músculos Abdominais/fisiopatologia , Antagonistas de Dopamina/efeitos adversos , Discinesia Induzida por Medicamentos/fisiopatologia , Doença de Parkinson Secundária/induzido quimicamente , Doença de Parkinson Secundária/fisiopatologia , Esquizofrenia Paranoide/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Gravação em VídeoRESUMO
SUMMARY The present quasi-experimental study aimed to assess the transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) thickness in healthy subjects with the proprioceptive Stabilizer™ training in abdominal wall muscles. A sample of 41 healthy participants (age: 31.9 ± 4.5 y; height: 1.7 ± 0.1 m; weight: 68.3 ± 13.1 kg; body mass index, BMI: 22.9 ± 2.7 kg/m2) were recruited to participate in this study. Ultrasound images of the EO, IO, TrA, rectus anterior (RA) and interrecti distance (IRD) were measured and analyzed by the ImageJ software. Measurements were made at rest and during the abdominal drawing-maneuver (ADIM) developed by the patients with the Stabilizer™ located in the low back holding 40 mmHg for 10 seconds with a visual stimulus provided by a circular pressure marker. Ultrasound measurements for the abdominal wall muscles showed statistically significant differences (Π < .05) for a thickness decrease of the EO, IO and a thickness increase of TrA. A proprioceptive Stabilizer™ training produced a thickness increase in TrA muscle and a thickness decrease in EO and IO muscles in healthy subjects. These findings suggest that a proprioceptive Stabilizer™ training could be useful in individuals with low back pain and lumbopelvic pain.
RESUMO O objetivo do presente estudo foi avaliar o transverso abdominal (TrA), o oblíquo interno (OI) e a espessura oblíqua externa (EO) em indivíduos saudáveis com o treinamento proprioceptivo Stabilizer™ nos músculos da parede abdominal. Uma amostra de 41 participantes saudáveis (idade: 31,9±4,5 y, altura: 1,7±0,1 m; peso: 68,3±13,1 kg; índice de massa corporal, IMC: 22,9±2,7 kg / m2) foram recrutados para participar deste estudo. As imagens de ultrassom do EO, IO, TrA, reto anterior (RA) e distância interrecti (IRD) foram medidas e analisadas pelo software ImageJ. As medidas foram feitas em repouso e durante a manobra de desenho abdominal (Adim) desenvolvida pelos pacientes com o StabilizerTM localizado na parte inferior das costas segurando 40 mmHg por 10 segundos com um estímulo visual fornecido por um marcador de pressão circular. As medidas de ultrassom para os músculos da parede abdominal apresentaram diferenças estatisticamente significativas (P<0,05) para uma diminuição da espessura do EO, IO e um aumento de espessura do TrA. Um treinamento proprioceptivo Stabilizer™ produziu um aumento de espessura no músculo TrA e uma diminuição da espessura nos músculos EO e IO em indivíduos saudáveis. Esses achados sugerem que um treinamento de Stabilizer™ proprioceptivo poderia ser útil em indivíduos com dor lombar e dor lombo-pélvica.
Assuntos
Humanos , Adulto , Modalidades de Fisioterapia/instrumentação , Músculos Abdominais/diagnóstico por imagem , Parede Abdominal/diagnóstico por imagem , Ultrassonografia , Músculos Abdominais/anatomia & histologia , Músculos Abdominais/fisiopatologia , Parede Abdominal/anatomia & histologia , Parede Abdominal/fisiologia , Força Muscular/fisiologia , Contração Muscular/fisiologiaRESUMO
ABSTRACT Introduction and objectives: Several studies have been investigated co-activation can enhance the effectveness of PFM training protocols allowing preventive and therapeutic goals in pelvic floor dysfunctions. The objective of the present study was to investigate if an abdominal-pelvic protocol of training (APT) using gametherapy would allow co-activation of PFM and transversus abdominis/oblique internal (TrA/OI) muscles. Patients and methods: Twenty-five nulliparous, continent, young females, with median age 24.76 (±3.76) years were evaluated using digital palpation (DP) of PFM and surface electromyography of PFM and TrA/OI simultaneously, during maximal voluntary contraction (MVC), alternating PFM and TrA/OI contraction requests. All women participated on a supervised program of APT using gametherapy, that included exercises of pelvic mobilization associated to contraction of TrA/OI muscles oriented by virtual games, for 30 minutes, three times a week, in a total of 10 sessions. Electromyographic data were processed and analyzed by ANOVA - analysis of variance. Results: When MVC of TrA/OI was solicited, it was observed simultaneous increase of electromyographic activity of PFM (p=0.001) following ATP. However, EMG activity did not change significantly during MVC of PFM. Conclusion: Training using gametherapy allowed better co-activation of pelvic floor muscles in response to contraction of TrA, in young nulliparous and continent women.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Adulto Jovem , Exercício Físico/psicologia , Músculos Abdominais/fisiopatologia , Diafragma da Pelve/fisiologia , Eletromiografia/métodos , Contração Muscular , Paridade , Protocolos Clínicos , Estudos Prospectivos , Análise de Variância , Estimulação ElétricaRESUMO
AIM: Acute intermittent hypoxia (AIH) promotes persistent increases in ventilation and sympathetic activity, referred as long-term facilitation (LTF). Augmented inspiratory activity is suggested as a major component of respiratory LTF. In this study, we hypothesized that AIH also elicits a sustained increase in expiratory motor activity. We also investigated whether the expiratory LTF contributes to the development of sympathetic LTF after AIH. METHODS: Rats were exposed to AIH (10 × 6-7% O2 for 45 s, every 5 min), and the cardiorespiratory parameters were evaluated during 60 min using in vivo and in situ approaches. RESULTS: In unanesthetized conditions (n = 9), AIH elicited a modest but sustained increase in baseline mean arterial pressure (MAP, 104 ± 2 vs. 111 ± 3 mmHg, P < 0.05) associated with enhanced sympathetic and respiratory-related variabilities. In the in situ preparations (n = 9), AIH evoked LTF in phrenic (33 ± 12%), thoracic sympathetic (75 ± 25%) and abdominal nerve activities (69 ± 14%). The sympathetic overactivity after AIH was phase-locked with the emergence of bursts in abdominal activity during the late-expiratory phase. In anesthetized vagus-intact animals, AIH increased baseline MAP (113 ± 3 vs. 122 ± 2 mmHg, P < 0.05) and abdominal muscle activity (535 ± 94%), which were eliminated after pharmacological inhibition of the retrotrapezoid nucleus/parafacial respiratory group (RTN/pFRG). CONCLUSION: These findings indicate that increased expiratory activity is also an important component of AIH-elicited respiratory LTF. Moreover, the development of sympathetic LTF after AIH is linked to the emergence of active expiratory pattern and depends on the integrity of the neurones of the RTN/pFRG.
Assuntos
Expiração , Hipóxia/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Músculos Abdominais/inervação , Músculos Abdominais/fisiopatologia , Animais , Pressão Arterial , Tronco Encefálico/fisiopatologia , Coração/fisiopatologia , Masculino , Ratos , Ratos Sprague-Dawley , Ratos Wistar , Músculos Respiratórios/inervação , Músculos Respiratórios/fisiopatologia , Fenômenos Fisiológicos RespiratóriosRESUMO
BACKGROUND: It has been demonstrated that there is an increase of intra-abdominal pressure (IAP) after correction of rectus diastasis. OBJECTIVE: To evaluate the correlation between the diastasis width and IAP variation after the plication of the anterior rectus sheath. METHODS: Seventeen patients met the inclusion criteria and were selected. The diastasis width was measured at three levels: 3 cm above the umbilicus, 2 cm above the umbilicus, and 2 cm below the umbilicus. Rectus sheath plication was performed in two layers: the first layer with separate stitches, and the second with continuous suture. The IAP was measured at two stages: before and after the correction of rectus diastasis. The distance between the iliac spines (IS) and that between the xiphoid process and pubic symphysis (XP) were measured. The abdominal surface index (ASI) was calculated using the formula: ASI = (IS × XP)/2. This index was used to determine the individual abdominal surface. The relative diastasis coefficient (RDC) was calculated using the formula: RDC = diastasis/ASI. These measurements were correlated to the IAP variation. The results of the IAP measurements obtained in each stage and the RDC values were compared, using the Pearson's linear correlation coefficient. RESULTS: There was no statistically significant correlation between the IAP variation and the RDC values at the three levels studied. CONCLUSIONS: The diastasis width does not interfere with the increase of the IAP when a plication of the anterior aponeurosis is performed. LEVEL OF EVIDENCE: 3 Diagnostic.
Assuntos
Músculos Abdominais/cirurgia , Abdominoplastia , Complicações na Gravidez/cirurgia , Músculos Abdominais/fisiopatologia , Abdominoplastia/efeitos adversos , Adolescente , Adulto , Pontos de Referência Anatômicos , Brasil , Estética , Feminino , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Pressão , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Low back pain (LBP) and urinary incontinence (UI) are highly prevalent among elderly individuals. In young adults, changes in trunk muscle recruitment, as assessed via ultrasound imaging, may be associated with lumbar spine stability. OBJECTIVE: To assess the associations between LBP, UI, and the pattern of transversus abdominis (TrA), internal (IO), and external oblique (EO) muscle recruitment in the elderly as evaluated by ultrasound imaging. METHOD: Fifty-four elderly individuals (mean age: 72±5.2 years) who complained of LBP and/or UI as assessed by the McGill Pain Questionnaire, Incontinence Questionnaire-Short Form, and ultrasound imaging were included in the study. The statistical analysis comprised a multiple linear regression model, and a p-value <0.05 was considered significant. RESULTS: The regression models for the TrA, IO, and EO muscle thickness levels explained 2.0% (R2=0.02; F=0.47; p=0.628), 10.6% (R2=0.106; F=3.03; p=0.057), and 10.1% (R2=0.101; F=2.70; p=0.077) of the variability, respectively. None of the regression models developed for the abdominal muscles exhibited statistical significance. A significant and negative association (p=0.018; ß=-0.0343) was observed only between UI and IO recruitment. CONCLUSION: These results suggest that age-related factors may have interfered with the findings of the study, thus emphasizing the need to perform ultrasound imaging-based studies to measure abdominal muscle recruitment in the elderly.