Revista Brasileira de Fisioterapia

Online ISSN: 1413-3555
Domain descriptions for the SRS-22 questionnaire. 
Intraclass correlation coefficient for test/retest reliability. 
The SRS-22r questionnaire is a well-accepted instrument used to measure health-related quality of life in patients with idiopathic scoliosis. No validated tool exists in Brazil for idiopathic scoliosis, and the use of the SRS-22r in non-English Laguage contries requires its transcultural adaptation. The objective of this study was to culturally adapt the translated Brazilian version of the SRS-22r questionnaire and to determine its reliability using statistical tests for internal consistency and test-retest reliability. The transcultural adaptation process was carried out according to the recommendations of the American Academy of Orthopedic Surgeons. The pre-final version was administered to 44 patients with idiopathic scoliosis. The mean age of the participants was 18.93 years and the mean curve magnitude was 54.6°. A subgroup of 30 volunteers completed the questionnaire a second time one week later to determine the scale's reproducibility. Internal consistency was determined using Cronbach's alpha coefficient, and the test-retest reliability was determined using the Intraclass Correlation Coefficient (ICC). No floor effects were observed using the Brazilian version of the SRS-22r. Ceiling effects were observed in the Pain and Satisfaction with Management domains. The internal consistency values were very good for 3 domains and good for 2 domains. The ICC values were excellent for all domains. The high values of internal consistency and ICC reproducibility suggest that this version of the questionnaire can be used in Brazilian patients with idiopathic scoliosis.
An important parameter in cross-cultural adaptations, and concurrent validity are the relationships between the performance of an instrument of interest and the performance of a similar instrument with known validity. To determine the concurrent validity of the Brazilian version of the revised questionnaire of the Scoliosis Research Society (Br-SRS-22r) and the Brazilian version of the Short-Form-36 questionnaire (SF-36). Fifty-four patients with idiopathic scoliosis were selected. The mean age was 19.9 yrs. (+/-7.7) and the mean Cobb angle of curvature was 31.6 degrees (+/-20.5 degrees ), ranging from 10 masculine to 92 masculine. The results from each questionnaire were converted into scores and, in the statistical analyses, the relationships between the concurrent domains were analyzed using Spearman's correlation coefficient. The best correlations were found between the function and pain domains: function in the Br-SRS-22r and physical function in the Br-SF-36 (r=0.83); pain in the Br-SRS-22r and pain in the Br-SF-36 (r=0.86). However, the domains of self-image and satisfaction with treatment with the Br-SRS-22r showed moderate and poor correlations with their corresponding domains in the Br-SF-36. There were moderate correlations between the questionnaires, with the best correlations showing greater similarity in the evaluated parameters between the respective instruments. Unlike the function and pain domains, the mental health domains did not have a good correlations, possibly because of difficulties in interpreting of the questions in the Br-SF-36. For the self-image and satisfaction domains, the correlations were moderate and poor because these topics were not specifically covered by the SF-36. The Brazilian version of the SRS-22r demonstrated moderate concurrent validity results in relation to the Br-SF-36, and this version adapted for the Brazilian culture was deemed valid.
Flow diagram of the study.  
Appropriate instruments for the assessment of health-related quality of life (HRQOL) domains are useful for planning therapeutic interventions for individuals with stroke. The generic quality of life (QOL) instruments, Short Form Health Survey-36 (SF-36) and Nottingham Health Profile (NHP), have been frequently employed in the Brazilian literature. However, the literature is still scarce regarding their psychometric properties when applied to stroke individuals. To compare the Brazilian versions of the SF-36 and the NHP to verify which had better psychometric properties for the assessment of HRQOL in 120 individuals with chronic stroke. Spearman correlation coefficients were calculated to examine the comparable domains and total scores of the SF-36 and the NPH; Cronbach's alpha coefficients, to evaluate internal consistency; intra-class correlation coefficients, to assess reliability; and Bland-Altman plots, to assess the levels of agreement, with a significance level of 5%. Significant positive associations were observed between the common domains and the total scores of the SF-36 and the NPH. Ceiling effects were more frequent for the NPH. The total scores of both instruments achieved adequate reliability levels, and the agreement levels were within the normal limits in 95% of the cases. The SF-36 and the NPH were shown to measure similar constructs and proved to be useful measures for the assessment of QOL of chronic stroke subjects. However, the SF-36 yielded better results and appeared to be more appropriate.
Fibromyalgia is a painful syndrome characterized by widespread chronic pain and associated symptoms with a negative impact on quality of life. Considering the subjectivity of quality of life measurements, the aim of this study was to verify the discriminating power of two quality of life questionnaires in patients with fibromyalgia: the generic Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the specific Fibromyalgia Impact Questionnaire (FIQ). A cross-sectional study was conducted on 150 participants divided into Fibromyalgia Group (FG) and Control Group (CG) (n=75 in each group). The participants were evaluated using the SF-36 and the FIQ. The data were analyzed by the Student t-test (α=0.05) and inferential analysis using the Receiver Operating Characteristics (ROC) Curve--sensitivity, specificity and area under the curve (AUC). The significance level was 0.05. The sample was similar for age (CG: 47.8 ± 8.1; FG: 47.0 ± 7.7 years). A significant difference was observed in quality of life assessment in all aspects of both questionnaires (p<0.05). Higher sensibility, specificity and AUC were obtained by the FIQ (96%, 96%, 0.985, respectively), followed by the SF-36 (88%, 89% and 0.948 AUC). The FIQ presented the highest sensibility, specificity and AUC showing the most discriminating power. However the SF-36 is also a good instrument to assess quality of life in fibromyalgia patients, and we suggest that both should be used in parallel because they evaluate relevant and complementary aspects of quality of life.
Mean values of the total scores and the common domains of the NHP and SF-36 (n=40).  
The aging population and associated high disability rates make the assessment of health-related quality of life (HRQOL) a high priority for elderly people. To compare the Brazilian versions of the Nottingham Health Profile (NHP) and the Short Form Health Survey-36 (SF-36) regarding their measurement properties, such as, ceiling and floor effects, inter-rater/test-retest reliabilities, internal consistency, and the associations between the total scores and those of similar domains. The NHP and the SF-36 were randomly administered through interviews to 40 community-dwelling elderly (mean age 70.57; SD=7.42 years). The scores of the five similar domains of the NHP and the SF-36, in percentages, were compared: Energy level/Vitality (EL/V), pain, emotional reactions/mental health (EM/MH), social isolation/social functioning (SI/SF), and physical mobility/physical functioning (PA/PF). Descriptive statistics, Spearman Correlation Coefficient, a-Cronbach, and Intraclass Correlation Coefficients (ICCs) were used for analyses (a=0.05). Both instruments demonstrated ceiling and floor effects for all similar domains, however the NHP showed, on average, higher scores for individual domains and total scores, as well as, floor effects for the SI domain. The internal consistency (NHP=0.86; SF-36=0.80), the inter-rater reliability (NHP=0.99; SF-36=0.96) and the test-retest reliability (NHP=0.94; SF-36=0.83) were considered adequate. Positive and statistically significant correlations were found between all similar domains (p≤0.01; 0.41≤r(s)≤0.70), except for those related to EL and vitality (r(s)=0.21;p=0.19). The SF-36 demonstrated to be more adequate regarding the ceiling and floor effects, whereas the NHP presented a higher internal consistency and reliability levels. These findings should be considered for selecting instruments for the assessment of HRQOL of community-dwelling elderly.
Anthropometric characteristics and pulmonary function test of the study population. 
Comparison of HRV before and after the six-minute walk test in children with Cystic Fibrosis and the Control Group. Values represent mean ± standard deviation. LF: Low Frequency; HF: High Frequency. Paired t-test used for intragroup comparison and unpaired t-test used for intergroup comparison.  
Variables values obtained from the six-minute walk test (6MWT). 
Comparison of low and high frequency ratio (LF/ HF) before and after six-minute walk test in both groups. Values represent mean ± standard deviation. LF: Low Frequency; HF: High Frequency. Unpaired t-test was used for intergroup comparison.  
Cystic fibrosis (CF) is a multisystem disease that affects the cardiorespiratory system and the cardiac autonomic control may be altered at rest and after a submaximal exercise. To assess the cardiac autonomic control by heart rate variability (HRV) analysis before and after a 6-minute walk test (6MWT). Thirteen children diagnosed with Cystic Fibrosis (CFG) aged 12±2.7 years (FEV1/FVC: 0.83±0.11, FEV1: 71.4±21 %pred) and 12 healthy children (control group-CG) aged 11.4±2.4 years (FEV1/FVC: 0.91±0.12, FEV1: 91.6±17.4 %pred) were included in the study. HRV was evaluated prior to and immediately after the 6MWT and the heart rate recovery assessed on the first and second minute after test. Prior to exercise, CF patients presented higher values for the variables LF(nu) (53.2±15.0 vs. 32.8±7.9, p=0.0003) and LF/HF (1.25±0.72 vs. 0.49±0.18, p<0.006) as well as lower values of HF(%) (25.4±18.4 vs. 53±9.6, p=0.002) and HF(nu) (47.3±14.7 vs. 68.3±8.7, p0.001) when compared to CG. After the 6MWT, both groups demonstrated HRV recovery to baseline levels; however, the differences between CFG and CG were maintained for the variables LF(ms 2) (846.7±754.8 vs. 345.6±197.2, p=0.02); LF(%) (35.4±8.1 vs. 25.9±6.2, p=0.002); LF(nu) (60.0±16.3 vs. 34.9±8.7, p<0.0001); HF(%) (27.4±13.7 vs. 48.1±6.3, p=0.0003); HF(nu) (40.4±15.8 vs. 65.6±8.2, p=0.0003) and LF/HF (1.9±1.7 vs. 0.5±0.2, p=0.0001). Children with cystic fibrosis exhibited predominance of sympathetic activity at rest that persisted after the 6-minute walking test when compared to the control group.
To evaluate respiratory muscle strength (RMS) in a sample composed exclusively of healthy sedentary individuals and to compare with predicted values, to investigate the relationship between maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) and age, weight and height, and propose predictive equations of MIP and MEP for this population. Subjects were 140 healthy and sedentary individuals: 70 males (55+/-20 years) and 70 females (54+/-21 years), separated into groups according to age. The RMS was obtained with an aneroid vacuum manometer (+/-300 cmH2O). There was a significant reduction in RMS with increasing age (ANOVA one-way, p<0.05). Moreover, the RMS values decreased significantly from age 40 compared to the predicted values (Student t test, p<0.05). There were also significant correlations of RMS with age, weight and height (Pearson correlation, p<0.05). The predictive equations using linear regression for maximal respiratory pressures according to sex showed that age in males and females and weight in females influenced the prediction of the MIP and MEP values. Our results showed that age and anthropometric characteristics influence RMS values. In addition, the RMS values were lower compared to the predicted values from age 40 because the sample was composed exclusively of sedentary individuals. In this context, we propose equations to predict the MIP and MEP values exclusively for healthy, sedentary individuals from 20 to 89 years of age.
Original and six modified items in the cross-cultural adaptation of the ABC scale. 
The Activities-specific Balance Confidence (ABC) scale was developed to quantify the self-perceived level of confidence in performing specific activities without losing balance or becoming unsteady. The ABC scale has been adopted in clinical practice and in research, although cross-cultural differences may impose difficulties in its use. To translate, cross-culturally adapt and verify the intra- and inter-rater reliability of the Brazilian-Portuguese version of the ABC scale and describe the self-perceived balance confidence of elderly Brazilian people. The ABC scale was translated and culturally adapted. To verify the intra- and inter-rater reliability, 40 elderly individuals with ages ranging from 60 to 88 years were interviewed. The scale was administered by two raters on the same day and readministered after seven days by rater 1. To test the reliability, we used the intraclass correlation coefficient (ICC). Six items from the ABC scale were considered culturally, semantically or regionally inappropriate and were modified. The intra-rater reproducibility was excellent (ICC=0.94), and the inter-rater reproducibility was very good (ICC=0.80). The self-perception of balance in specific activities of the elderly was considered very good, with an average of 81.7 and scores ranging from 61.2 to 96.7. The ABC scale was translated and culturally adapted for the Brazilian population and presents good intra- and inter-rater reliability. The self-perceived balance confidence in elderly Brazilian people evaluated with the ABC scale is moderate.
Diagram of the device used to position the participant during ultrasound image collection. Source: Ferreira et al. 12 (used with permission). 
Sociodemographic and clinical characteristics of the studied cohort (n=54). 
Associations between the TrA, IO, and EO recruitment levels and LBP and UI. 
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. 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. 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. 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; β=-0.0343) was observed only between UI and IO recruitment. 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.
Flow chart of the search process. 
Methodological classification of studies. 
Background: There is currently no consensus on the indication and benefits of breathing exercises for the prevention of postoperative pulmonary complications PPCs and for the recovery of pulmonary mechanics. Objective: To undertake a systematic review of randomized and quasi-randomized studies that assessed the effects of breathing exercises on the recovery of pulmonary function and prevention of PCCs after upper abdominal surgery UAS. Method: Search strategy: We searched the Physiotherapy Evidence Database PEDro, Scientific Electronic Library Online SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials. Selection criteria: We included randomized controlled trials and quasi-randomized controlled trials on pre- and postoperative UAS patients, in which the primary intervention was breathing exercises without the use of incentive inspirometers. Data collection and analysis: The methodological quality of the studies was rated according to the PEDro scale. Data on maximal respiratory pressures MIP and MEP, spirometry, diaphragm mobility, and postoperative complications were extracted and analyzed. Data were pooled in fixed-effect meta-analysis whenever possible. Results: Six studies were used for analysis. Two meta-analyses including 66 participants each showed that, on the first day post-operative, the breathing exercises were likely to have induced MEP and MIP improvement treatment effects of 11.44 mmH2O (95%CI 0.88 to 22) and 11.78 mmH2O (95%CI 2.47 to 21.09), respectively. Conclusion: Breathing exercises are likely to have a beneficial effect on respiratory muscle strength in patients submitted to UAS, however the lack of good quality studies hinders a clear conclusion on the subject.
Correlation between the rectus abdomini electromyographic activity (RMS) and umbilical diastasis.  
During the second stage of labor, the progression of the fetal expulsion depends on many factors related to maternal and fetal parameters, including the voluntary abdominal pushing. This study aimed to correlate the maternal and fetal parameters that may influence the voluntary maternal pushes during the second stage of labor by using surface electromyography. The electromyographic activity of the rectus abdominis and external oblique muscles were measured during the second stage of labor in 24 Brazilian pregnant women. The diastasis of the rectus abdominis, the body mass index and the uterine fundal height were analyzed as maternal parameters and the fetal weight, cephalic circumference, APGAR scores and arterial pH and CO2 were analyzed as fetal parameters. The oxytocin usage and the expulsive phase duration were considered. A negative correlation between the rectus abdominis diastasis and the rectus abdomini muscle electromyographic parameters was found (r=-0.407 p=0.04). No statistically significant correlations were found among the rectus abdominis and external oblique muscles electromyography and the other maternal or fetal parameters, as well as among expulsive phase duration and the oxytocin usage. This study suggests that the rectus abdominis diastasis may be an influential parameter in generating voluntary pushes during the second stage of labor, however it cannot be considered the only necessary parameter for a successful labor.
Description of the pressure measures and electromyographic measures during the TrA muscle activity. 
Background: The Pressure biofeedback unit (PBU) is an assessment tool used in clinical practice and research aimed to indirectly analyze the transversus abdominis (TrA) muscle activity. The concurrent validity of the PBU in a clinically relevant sample is still unclear. Objective: The purpose of this study was to evaluate the concurrent validity and diagnostic accuracy of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain. Method: This study was performed using a validation, cross-sectional design. Fifty patients with chronic nonspecific low back pain were recruited for this study. To test the concurrent validity both PBU measures (index test) and superficial electromyographic measures (reference-standard test) were compared and collected by a physical therapist in a series of voluntary contraction maneuvers of TrA muscle. Results: Participants were on average 22 years old, weighed 63.7 kilos, 1.70 meters height and mean low back pain duration was 1.9 years. It was observed a weak and non-significant Phi coefficient (r=0.2, p<0.20). With regards to diagnostic accuracy tests, our results suggest a low sensitivity (60%) and specificity (60%) of the PBU. The positive predictive value was high (0.8) and negative predictive value was low (0.2). Conclusions: Concurrent validity of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain is poor given the low correlation and diagnostic accuracy with superficial EMG.
Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60º/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60º/s and 180º/s using an isokinetic dynamometer. DASH scores, peak torque, total work and acceleration time improved (p<0.05) after the period of intervention. This study suggests that isokinetic eccentric training for shoulder abductors improves physical function of the upper limbs in subjects with SIS.
shows the involvement of physical therapists in performing activities within the previously cited sports 
To analyze the profile of Brazilian physical therapists working with soccer and volleyball professional teams, by verifying their level of education (graduate or undergraduate), as well as their role and insertion within the interdisciplinary team. Structured questionnaires were administered to forty-nine physical therapists working at soccer, volleyball clubs and Brazilian national teams. These questionnaires provided data on social demographic, characteristics of the work environment and organization of clinical practice and its domains. From the 49 participants in this study only five were female. Mean age of all participants was 32.2 years. The majority of the sports physical therapists had specialization degrees in different areas (78.2%), were hired through referral (78.2%), worked more than 8 hours a day or were exclusively dedicated to their clubs (80.0%) and earned seven to ten Brazilian minimal wages (58.2%). They reported to have participation in the domains of emergency care (87.3%), prevention (92.7%), functional rehabilitation (98.2%) and return to competition (100%). They had interdisciplinary relationships with physical educators during functional rehabilitation programs (70.9%) and with physicians in the decision process of return to activity after rehabilitation (74.5%) and on the veto of an athlete to take part in practices or matches (63.6%). Therapists also complained of threats to their professional autonomy, specially directed by the team's physician. There is still a need to invest in continuing education of sports physical therapists with the objective to improve their educational level and to strengthen their professional autonomy.
Tuberculosis (TB) remains as an important public health problem worldwide. The most common type is pulmonary TB, and the most prevalent form of extra-pulmonary disease among HIV-negative patients is pleural disease. The objective of the present study was to determine the effect of continuous positive airway pressure (CPAP) on fluid absorption among patients with pleural effusion due to TB. Twenty patients were randomized into two groups. The interventional group (n=10) received CPAP three times a week during the initial four weeks of anti-TB treatment, and the control group (n=10) received anti-TB drugs only. The primary endpoint was the volume of pleural fluid after four weeks of treatment. Both groups were submitted to thoracic computed tomography using three-dimensional image reconstruction. The Mann-Whitney test for independent samples and the Wilcoxon paired samples test were used for statistical analysis. The normal distribution samples were analyzed using the unpaired t test. The reduction of pleural effusion volume was significantly greater in the intervention group (83.5%+/-SD 3.6) than in the control group (36.9%+/-SD 2.9; p<0.001), and the final dyspnea index was lower in the Intervention group than in the control group (p=0.002). Our findings indicate that CPAP during the first month of TB treatment accelerates the absorption of pleural effusion, however, additional studies are needed to confirm these findings and evaluate the impact of CPAP on pleural sequelae after the end of anti-TB treatment. Article registered in the Clinical Trials under the number NCT00560521.
To identify whether flight training activities cause postural changes in cadets and pilots of the Brazilian Air Force Academy (AFA). Eighty subjects were assessed through photographic images in anterior and right side views. Four groups of cadets (n=20 per group) divided according to the year since enlistment and a fifth group of fifteen pilots from the Air Demonstration Squadron (ADS) were included. Pictures were analyzed using the Postural Analysis Program (SAPO) and angles related to head vertical alignment (HVA), head horizontal alignment (HHA), acromion horizontal alignment (AHA) and anterior-superior iliac spine horizontal alignment (HAS) were plotted. We did not find statistical significant differences in the angles: HVA, HHA and AHA. However, a significant difference was found for the HAS angle with pilots having lower values than cadets, suggesting greater postural stability for this variable in pilots. The horizontal alignment of the anterior-superior iliac spine was the only measure that showed significant difference in the comparison between pilots and cadets. The remaining alignments were not different, possibility because of the strict criteria used for admission of cadets at the AFA and the efficiency of the physical training that is performed periodically.
Study design. AS: ankle sprain; AFx: ankle fracture; UTAL: University of Talca (Universidad de Talca, in Spanish).  
Baseline characteristics of the sample population.
Procedure. The location of motor points in the NMCs and the installation of the accelerometer. S-NMC, superior neuromuscular compartment; AI-NMC, anteroinferior neuromuscular compartment; PI-NMC, posteroinferior neuromuscular compartment.  
Comparison of motor threshold between neuromuscular compartments.
Muscles are innervated exclusively by a nerve branch and possess definite actions. However, mammalian skeletal muscles, such as the trapezius, the medial gastrocnemius, and the peroneus longus, are compartmentalized. In the peroneus longus muscle, multiple motor points, which innervate individual neuromuscular compartments (NMC), the superior (S-NMC), anteroinferior (AI-NMC), and posteroinferior (PI-NMC), have been described. The contribution of each neuromuscular compartment to the final action of the muscle is fundamental for the rehabilitation of patients afflicted by neurological and muscle dysfunctions. Interventions are often based on electrical principles that take advantage of the physiological characteristics of muscles and nerves to generate therapeutic effects. To compare the effects of stimulating the different neuromuscular compartments (NMCs) of the peroneus longus muscle on the motor threshold (MT) and acceleration of the foot. This is a cross-sectional study comprising 37 subjects. The three NMCs of the peroneus longus muscle were stimulated, and the acceleration of the foot and the motor threshold of each NMC were evaluated. A repeated measures analysis of variance with Bonferroni corrections of two intra-subjects factors was performed. The stimulation of the different NMCs did not result in any differences in MT (F=2.635, P=0.079). There were significant differences between the axes of acceleration caused by the stimulation of the different NMCs (F=56,233; P=0.000). The stimulation of the posteroinferior compartment resulted in the greatest acceleration in the X-axis (mean 0.614; standard deviation 0.253). The posteroinferior compartment primarily contributes to the eversion movement of the foot. NMCs have specific functional roles that contribute to the actions of the muscles to which they belong.
Characteristics of dynamometers: (a) Takei ® , model 5101 TKK, digital, non-static handle, rectified, with a mechanism for continued selection of positions (C); (b) Jamar ® , model 2A, hydraulic, analog, anatomical grip, 5 position options; (c) force transducer (EMG System, Brazil) digital, computerized, modified anatomical grip, with six position options (3 options in options A and 3 B). The grips are identified by anterior (1) and posterior (2) aspects that support the fingers and the thenar and hypothenar eminences.
Dynamometers calibration system with the handle fixed on a wooden support to receive the load. The mass of the system that supported the load washers weighted 2.83 kgf. Illustrative image without scaling.
Limits of agreement of Bland-Altman plots between the force values measured by the dynamometers.  
Given the variety of available hand-held dynamometers and their different handle shapes, reliability studies are needed. Objectives: To compare the accuracy and reliability between three different hand-held dynamometers and analyze the influence of their handles on grip strength. Methods: The tests were performed with the Jamar® dynamometer, the Takei® dynamometer and the EMG System Manual Transducer with modified handle. Eighteen healthy volunteers aged 20.0±1.3 years without history of musculoskeletal disorders or trauma in the evaluated limbs were included. Data normality was tested using the Shapiro-Wilk test. To verify possible differences between the dynamometers, repeated measures ANOVA was administered, followed by Tukey post-hoc tests. Reliability between measurements was evaluated using intraclass correlation coefficient (ICC) and agreement was tested using Bland and Altman plots. The dynamometers calibration process was evaluated using linear regressions. We observed statistically significant differences on the female group between the Jamar® and the Takei® dynamometers (females p<0.001 and males p=0.022) and the EMG System Manual Transducer (female p<0.001 and males p=0.007). However, the Takei® dymamometer and the EMG System Manual Transducer were similar for both female (p=0.161) and male groups (p=0.850). Although acceptable values of intraclass correlation coefficients between measurements were identified, low agreement between the Jamar® dynamometer and all other instruments was found. The results demonstrated that there is an influence of the dynamometer's handle shapes on the measurements of grip strength. Furthermore, the results demonstrated the need for previous calibration of this type of instrument.
Objective: To determine the accuracy of the Timed Up and Go Test (TUGT) for screening the risk of falls among community-dwelling elderly individuals. Method: This is a prospective cohort study with a randomly by lots without reposition sample stratified by proportional partition in relation to gender involving 63 community-dwelling elderly individuals. Elderly individuals who reported having Parkinson's disease, a history of transitory ischemic attack, stroke and with a Mini Mental State Exam lower than the expected for the education level, were on a wheelchair and that reported a single fall in the previous six months were excluded. The TUGT, a mobility test, was the measure of interested and the occurrence of falls was the outcome. The performance of basic activities of daily living (ADL) and instrumental activities of daily living (IADL) was determined through the Older American Resources and Services, and the socio-demographic and clinical data were determined through the use of additional questionnaires. Receiver Operating Characteristic Curves were used to analyze the sensitivity and specificity of the TUGT. Results: Elderly individuals who fell had greater difficulties in ADL and IADL (p<0.01) and a slower performance on the TUGT (p=0.02). No differences were found in socio-demographic and clinical characteristics between fallers and non-fallers. Considering the different sensitivity and specificity, the best predictive value for discriminating elderly individuals who fell was 12.47 seconds [(RR=3.2) 95%CI: 1.3-7.7]. Conclusions: The TUGT proved to be an accurate measure for screening the risk of falls among elderly individuals. Although different from that reported in the international literature, the 12.47 second cutoff point seems to be a better predictive value for Brazilian elderly individuals.
Isometric and eccentric (30 and 120º/s) knee extensor peak torque of the involved limb, pre-training (AV1), after six (AV2) and twelve weeks (AV3).
Representative axial T2-weighted MRI of the involved limb, before (A and C) and after training (B and D) of the same subject. The images were obtained between 6 cm (A and B) and 20 cm (C and D) from the proximal border of the patella. VM=vastus medialis; VL=vastus lateralis; VI=vastus intermedius; RF=rectus femoris.
Electromyographic activity (RMS) of the VMO, VL and RF during isometric contractions of the involved limbs, pre-training (AV1), after six (AV2) e twelve weeks (AV3).  
The purpose of this study was to investigate the contributions of functional and morphological factors in the recovery of the quadriceps muscle after anterior cruciate ligament (ACL) reconstruction. Nine subjects (31.3±5.8 years) underwent eccentric exercise sessions twice a week for 12 weeks. Quadriceps muscle function was evaluated using an isokinetic dynamometer (isometric and eccentric peak torque) and electromyography (RMS). Morphological changes were measured using magnetic resonance imaging. The initial evaluation showed a significant deficit in knee extensor torque in the involved limb and significant muscle atrophy along the length of the quadriceps. EMG activity was lower in all tested situations. Eccentric training significantly increased isokinetic torque (from 199±51 to 240±63, p<0.05, respectively) and quadriceps area, with the greatest hypertrophy in the proximal thigh region (from 169±27 to 189±25.8 cm², p<0.01). The EMG activity of vastus medialis increased after the first six weeks of eccentric training. The increased extensor torque was correlated with quadriceps cross-sectional area (r=0.81, p<0.01) and EMG activity (r=0.69, p<0.05). After twelve weeks of training, there was a correlation only between torque and cross-sectional area (r=0.78, p<0.01). 1) eccentric training proved to be a potent resource for the quadriceps recovery, both morphologically and functionally, 2) the contributions of functional and morphological factors varied according to the length of training.
Characteristics of the CAP and control groups. 
Study flow diagram. CAP: community-acquired pneumonia; PMS: peripheral muscle strength; 6MWT: six minute walk test; GT: Glittre test. 
Results of 6MWT and GT. 
Correlations between the length of hospital stay and GT/6MWT (A) and between MRC scale and GT/6MWT (B). A) Glittre test: black circles, solid line (r=0.35, P=0.02), 6MWT: white circles, dashed line (r=-0.2, P=0.19). B) Glittre test: black circles, solid line (r=0.36, P=0.02), 6MWT: white circles, dashed line (r=-0.16, P=0.28). 
Comparison between the CAP and control groups for dyspnea and HRQoL. 
Symptoms of fatigue and dyspnea, treatment with oral corticosteroids, high circulating levels of cytokines, and oxidant/antioxidant imbalance in patients hospitalized with community-acquired pneumonia (CAP) could affect the patients' exercise tolerance and peripheral muscle strength (PMS). To evaluate the functional capacity (FC) of patients hospitalized for CAP and to correlate the FC with length of hospital stay. We prospectively evaluated 45 patients (49±16 years; CAP group) and 20 healthy subjects (53±17 years; control group). They were randomized to perform, on separate days, a 6-minute walk test (6MWT), a test of PMS, and the Glittre test (GT). Additionally, the SF-36 questionnaire and the MRC scale were completed and evaluated. There were significant differences between the groups (CAP and controls) for the 6MWT (381.3±108 vs. 587.1±86.8 m) and GT (272.8±104.3 vs. 174±39 sec). The CAP group also presented worse health-related quality of life (HRQoL) scores, reduced strength (quadriceps and biceps), and higher scores of dyspnea. The time required to perform the GT correlated with the length of hospital stay (r=0.35, P=0.02) and dyspnea (r=0.36, P=0.02). Significant correlations were observed between GT and 6MWT (r=-0.66, P=0.0001) and between GT with the physical functioning domain of SF-36 (r=-0.51, P=0.0001). Patients hospitalized for CAP presented with reduced FC, PMS, and HRQoL during hospitalization. In addition, GT performance was related to the length of hospital stay.
this study aimed to characterize the pattern and rate of motor skill acquisition among preterm infants from newborn to four months corrected age, in comparison with a group of full-term infants. twelve healthy preterm infants (mean gestational age=33.6 weeks ± 1.25) and 10 healthy full-term infants (mean gestational age=39.1 weeks ± 0.73) participated in the study. These infants were assessed monthly (0-4 months of age) using the Test of Infant Motor Performance (TIMP). the motor performance pattern increased over the months in both groups, with variability in the total scores at all ages. The preterm group presented a higher mean score than shown by the full-term group between one and four months of age. In the full-term group, the motor acquisition rate was higher from age newborn to one month than from age three to four months. It was also found that the caregivers of the preterm infants began toy stimulation earlier than did the caregivers of the full-term infants. Both groups presented mean scores below the TIMP values. the preterm infants presented a pattern of motor development similar to the typical pattern regarding the sequence of abilities achieved. The preterm infants also presented a faster rate during the neonate period at one month of age. This suggests that correction for prematurity is unnecessary for preterm infants with these characteristics and that follow-up programs should instruct parents and caregivers to begin stimulation with toys at one month of age, thereby providing early exploration of various motor skills.
Graph comparing the variation (Δ) of the number of inflammatory cells after seven days of treatment. 
, Photo A, stained with H&E shows that for animals treated for seven days with US and sterile lotion there was the presence of maturing granulation tissue, swelling, and newly formed vessels, but in less quantity than in the newly formed granulation tissue, with more organized vessels and proliferation of fibroblasts with deposition of extracellular matrix (EM). At 14 days of treatment, as shown on Photo B, stained with H&E, there was organizing fibrosis, proliferation of fibroblasts and more organized vessels and in less quantity than in the granulation tissue, but in even greater numbers than in the mature fibrous tissue. In animals treated for seven days with US and sterile lotion, Photo C stained with TM demonstrated that there was the deposit of EM in a disorganized way, with thinner fibers than in normal conjunctive tissue. In Photo D stained with TM, for the same patient population after 14 days of treatment there were areas of fibrosis with blue areas (deposited EM) in greater quantities than in the red area (proliferated fibroblasts). The fibrosis was in process of organization. Analyzing Figure 4, of animals treated for seven days with US and Ovis aries, Photo A stained with H&E shows maturing granulation tissue, swelling and neovascularization, but in less quantity than in the newly formed granulation tissue. The vessels were also more organized than in the newly formed granulation tissue. There was proliferation of fibroblasts and deposition of EM. After 14 days of treatment Photo B stained with H&E showed organizing fibrosis, fibroblast proliferation, with more organized vessels and in less quantity than in the 
Microscopy of the rat Achilles tendon. Group (3) treated with pulsed US+ sterile Lotion (Oil free). Photo (A) intratendineous 7 days, stained with H&E and a 40X objective Photo (B) intratendineous 14 days, stained with H&E and a 40X objective, showing large cellularity at the expense of inflammatory cells (1), fibroblasts (2) and edema (3), demonstrating that it was a newly formed granulated tissue, showing a decrease in cellularity due to the decrease of inflammatory cells. The fibroblasts now are predominant and are more ordered (4). Photo (C) intratendineous 7 days, stained with Trichrome to Massom using a 40X objective. Photo (D) intratendineous 14 days, stained with Trichrome to Massom using a 40X objective. The last two photos show the maturation of granulation tissue with increased deposition of extracellular matrix, as seen on photo D compared with C. 
Microscopy of the Achilles tendon of rats, group (4) treated with US + gel Ovis aries. Photo (A) intratendineous 7 days, stained with H&E and a 40X objective, viewing capillaries (5). Photo (B) intratendineous 14 days, stained with H & E and a 40X objective. Photo (C) intratendineous 7 days, stained with Trichrome to Massom using a 40X objective, viewing the extracellular matrix-elastic tissue (6). Photo (D) intratendineous 14 days, stained with Trichrome to Massom using a 40X objective. 
Studies have demonstrated the beneficial effects of topical application of fatty acids as healing agents. The lipid fraction of Ovis aries have an anti-inflammatory action that accelerates the healing process. Ultrasound increases blood flow and the extensibility of collagen structures and tendons. To assess the anti-inflammatory action of the Ovis aries lipid fraction associated to pulsed therapeutic ultrasound and friction in an induced tendinitis model. Fifty Wistar rats were divided into four groups: control that consisted of Ovis aries gel for topical use; pulsed ultrasound plus oil free sterile lotion; pulsed ultrasound plus Ovis aries gel; and oil free sterile lotion for topical use alone. To induce tendinitis a 10 µL intratendinous injection of collagenase was injected into the right Achilles tendon of rats. Treatment consisted of daily applications of ultrasound using the following parameters: 10% pulsed mode, 10% pulsed frequency of 1 MHz and intensity of 0.5 W/cm² for seven or fourteen days. After 7 days of treatment, only the Ovis aries plus ultrasound group showed statistically significant difference when compared to the control group.The variation in the number of inflammatory cells on animals treated for fourteen days for the control, ultrasound plus oil free, ultrasound plus Ovis aries, Ovis aries plus massage and massage plus oil free groups were statistically significant different, p<0.01. It was observed in animals treated for seven days that the ultrasound plus Ovis aries group was statistically significant better than the control group, p<0.05. It can be concluded that treatment using ultrasound plus Ovis aries is more effective than other treatments as it produces significantly better reduction on the number of inflammatory cells at 7 and 14 days.
Demographic characteristics of the participants. Data are shown as the mean ± standard deviation. 
Experimental design.  
Previous studies have shown that preloading an antagonist muscle may increase the acute agonist neuromuscular performance. In addition, studies have suggested that very short-term resistance exercise (RE) programs may also be useful to increase strength and muscular performance. To evaluate the effects of three days of RE using a reciprocal action method on the muscular performance of healthy men and to compare these effects with those of a traditional RE group. Thirty-three men (21.1 ± 2.3 years) were randomly assigned to one of three groups: 1) reciprocal (REC; knee flexion immediately followed by a knee extension exercise); 2) traditional (TRA; non-preload; a concentric knee extension exercise); and 3) control (CON; no exercise). The REC and TRA subjects performed four sets of 10 repetitions at 60º/s with one minute of rest. The pre- and post-RE tests included two sets of four maximal concentric repetitions at 60º/s and 180º/s. A 3x2 ANOVA with Tukey post-hoc was used to analyze the differences in peak torque (PT), rating of acceleration development (RAD) and time to peak torque (TIMEtorque). A significant PT increase was found for REC and TRA (p<0.05) at 60º/s and for REC at 180º/s (p<0.05). There was a decrease in the RAD for REC and TRA (p<0.05), and TIMEtorque showed a significant decrease for REC. The inter-group analysis revealed that REC is more effective than TRA for PT gains at both velocities (p<0.05). It is recommended that REC offers benefits for the clinical practice of professionals involved in neuromuscular rehabilitation.
Esquema ilustrativo das etapas, técnicas e principais resultados encontrados nas empresas de micro e pequeno porte do ramo ALI-BEBI. Bahia, 2006-2007.  
To describe working conditions in small companies in the food and beverage sector and to assess the health and the work ability of the selected workers. Social security data and records from periodic medical examinations were analyzed. For the observations of the work conditions, we used a data sheet created specifically for this study to apply the Short Ergonomic Assessment. For the survey, the Work Ability Index (WAI) and the Nottingham Health Profile (NHP) were used. The following risk factors and distress-generating situations were observed: manual transport of loads; work performed while standing and in production lines; improvised workbenches; hazardous facilities; and poorly maintained machines. Most of the workers were male with a mean age of 32 years. The mean WAI score was 43 (SD=4.25), suggesting good work ability. Musculoskeletal diseases were the conditions most frequently diagnosed and the most frequently self-reported symptoms. According to the NHP, the workers' general health status could be considered good. Despite the relevance of small companies in the national economy, many of them are family-based and lack the capital needed to invest in infrastructure and productive processes. Furthermore, the lack of knowledge about occupational health and safety puts employees at risk. Positive results were discerned following the present study that included investigation, training and intervention to support small companies, which are generally excluded from broader social actions. The results could be documented through the longitudinal monitoring of the companies.
Pre-activation of antagonistic muscles is used in different modalities of exercise and neuromuscular rehabilitation protocols, but its effectiveness is still controversial. To verify the impact of two different methods of pre-activation of knee antagonist muscles in the neuromuscular performance and electromyographic activity of knee extensors. Fifteen healthy men (23.9±4.2 years of age, 1.78±0.08 meters and 81.4±10.7 kg) performed, on different days, two protocols of isokinetic muscle contraction with 4 sets of 10 repetitions at 60°.s-1 and 1 minute between sets: (1) Reciprocal Contraction (RC): reciprocal concentric exercise of agonist/antagonist muscles (knee flexion [KF] immediately followed by knee extension [KE]) and (2) Superset (SS): alternated concentric exercise of agonist/antagonist muscles (KF set followed by a set of KE). A repeated measures ANOVA with least-significant difference post-hoc test was used to detect differences between protocols. There were no significant differences between protocols (p>0.05) for peak torque (PT) and total work (Tw). On the SS protocol there was a significant decrease in Tw on the last two sets (p<0.05) while for RC the decrease occurred only in the last set. There were no significant differences of root mean square (RMS) between protocols, but the activation pattern was more uniform during the RC protocol. The results indicated that the peak torque was not influenced by the different pre-activation methods. However, the RC protocol appears to better maintain the total work training volume.
To investigate whether performing a low-intensity, single-joint exercises for knee extensors was an efficient strategy for increasing the number of motor units recruited in the vastus lateralis muscle during a subsequent multi-joint exercises. Nine healthy male participants (23.33+/-3.46 yrs) underwent bouts of exercise in which knee extension and 45 degrees , and leg press exercises were performed in sequence. In the low-intensity bout (R30), 15 unilateral knee extensions were performed, followed by 15 repetitions of the leg presses at 30% and 60% of one maximum repetition load (1-MR), respectively. In the high-intensity bout (R60), the same sequence was performed, but the applied load was 60% of 1-MR for both exercises. A single set of 15 repetitions of the leg press at 60% of 1-MR was performed as a control exercise (CR). The surface electromyographic signals of the vastus lateralis muscle were recorded by means of a linear electrode array. The root mean square (RMS) values were determined for each repetition of the leg press, and linear regressions were calculated from these results. The slopes of the straight lines obtained were then normalized using the linear coefficients of the regression equations and compared using one-way ANOVAs for repeated measures. The slopes observed in the CR were significantly lower than those in the R30 and R60 (p<0.05). The results indicated that the recruitment of motor units was more effective when a single-joint exercise preceded the multi-joint exercise. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number ACTRN12609000413224.
Community activity grouped into four types. 
Characteristics of participants. 
Correlation between walking performance and amount and type of community activity using Pearson's correlation coefficient. 
To examine the relationship between clinical walking performance and amount and type of community activity in people after stroke. A cross-sectional observational study of 14 people with stroke living in Sydney and able to walk was carried out. Demographics (such as age, gender, side of stroke, time since stroke, presence of spouse) and aspects of walking performance (such as speed, capacity, automaticity, and stairs ability) were measured. People with stroke were observed for at least five hours while they carried out activities in the community. These activities were then categorized into four types: domestic intrinsic, domestic extrinsic, leisure without contact, and leisure with contact activity. No relationship was found between walking performance and the amount of community activity. There was no relationship between walking performance and total time spent on domestic intrinsic activity. Walking speed and stairs ability were significantly correlated with leisure with contact activity (r=0.56, p=0.04, and r=0.57, p=0.03 respectively) and inversely correlated with leisure without contact (r=-0.72, p<0.01, and r=-0.66, p=0.01 respectively). Walking capacity was also inversely correlated with leisure without contact (r=-0.77, p<0.01). Only stairs ability was significantly correlated with domestic extrinsic activity (r=0.77, p<0.01). Findings suggest that if walking performance is poor after stroke, activities at home and in the community will be limited, so that people may become housebound and isolated from society.
Characteristics of patients. 
Scores of LCADL among the quartiles of the BODE index. 
Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that reduces functional capacity, deteriorating the ability to perform activities of daily living (ADL). A close relationship between morbidity and mortality with functional limitation is observed in patients with COPD. To determine if there is a relationship between ADL limitation and the BODE index, which is a predictor of mortality, in patients with moderate to severe COPD. Thirty-nine patients with COPD GOLD 2 to 4 recruited by convenience, were submitted to the following tests: spirometry, body mass index (BMI), the London Chest Activity of Daily Living (LCADL) scale, six-minute walking test (6MWT), the Medical Research Council (MRC) scale and the BODE index was calculated. The total score and the percentage of the total score LCADL (LCADL%total) were compared between patients of the four quartiles of the BODE using the Analysis of Variance test. The Spearman correlation coefficient was used to investigate the association between scores of LCADL and BODE index. Patients had an average of FEV1%pred=37±12% and were on average 66±8 years-old. The LCADL%total correlated with the BODE index (r=0.65, p<0.05) as well as with the variables FEV1, dyspnea and walked distance in the 6MWT (r=-0.42, r=0.76 and r=-0.67, p<0.05, respectively). The comparison of the average scores of the LCADL%total between BODE quartiles 1, 2, 3 and 4, demonstrated that only the 4th quartile differed significantly from the others (p<0.05). ADL limitation has a strong association with the BODE index in patients with moderate to severe COPD and with three of the four variables that composes it.
Correlations between the scores on FES-DMD–climbing up the stairs (A) and the scores on FES-DMD–going down the stairs (B) with age (years). 
Correlations between the scores on FES-DMD–climbing up the stairs (A) and FES-DMD–going down the stairs (B) with the scores on the Vignos Scale. 
Correlations between the scores on FES-DMD–climbing up the stairs (A) and FES-DMD–going down the stairs (B) with timed performance (seconds). 
Background: Knowing the potential for and limitations of information generated using different evaluation instruments favors the development of more accurate functional diagnoses and therapeutic decision-making. Objective: To investigate the relationship between the number of compensatory movements when climbing up and going down stairs, age, functional classification and time taken to perform a tested activity (TA) of going up and down stairs in boys with Duchenne muscular dystrophy (DMD). Method: A bank of movies featuring 30 boys with DMD performing functional activities was evaluated. Compensatory movements were assessed using the climbing up and going down stairs domain of the Functional Evaluation Scale for Duchenne Muscular Dystrophy (FES-DMD); age in years; functional classification using the Vignos Scale (VS), and TA using a timer. Statistical analyses were performed using the Spearman correlation test. Results: There is a moderate relationship between the climbing up stairs domain of the FES-DMD and age (r=0.53, p=0.004) and strong relationships with VS (r=0.72, p=0.001) and TA for this task (r=0.83, p<0.001). There were weak relationships between the going down stairs domain of the FES-DMD-going down stairs with age (r=0.40, p=0.032), VS (r=0.65, p=0.002) and TA for this task (r=0.40, p=0.034). Conclusion: These findings indicate that the evaluation of compensatory movements used when climbing up stairs can provide more relevant information about the evolution of the disease, although the activity of going down stairs should be investigated, with the aim of enriching guidance and strengthening accident prevention. Data from the FES-DMD, age, VS and TA can be used in a complementary way to formulate functional diagnoses. Longitudinal studies and with broader age groups may supplement this information.
Relationship between neuropsychiatric disorders and cognitive functions.
Scores for performance of instrumental activities of daily living expressed by the Pfeffer Functional Activities Questionnaire for control and intervention groups.  
To analyze the influence of a six-month exercise program on neuropsychiatric disorders and on the performance of instrumental activities in elderly patients with Alzheimer's disease (AD). The study included 20 patients with AD in the mild to moderate stages of the Clinical Dementia Rating (CDR) divided into two groups: the experimental group, composed of 10 women who participated in the six-month exercise program, and the control group, composed of the 10 remaining AD patients who did not take part in an exercise program during the same period. All participants were evaluated using the Mini-Mental State Exam for global cognitive function, the Neuropsychiatric Inventory Questionnaire for neuropsychiatric disorders, and the Pfeffer Functional Activities Questionnaire for the degree of functional impairment. The control group showed functional and neuropsychiatric deterioration in the comparisons between pre- and post-intervention times and between groups. The experimental group showed a propensity for less deterioration in neuropsychiatric disorders and performance of instrumental activities compared to the sedentary group.
Discriminant analysis for the Vestibular Activities of Daily Living Scale total score and subscales. 
Total score in the Vestibular Disorders Activities of Daily Living Scale-Brazil and scores in the Functional subscale, Ambulation subscale, and Instrumental subscale.  
ROC curve analysis of VADL-Brazil total score to discriminate patient's severity in the DHI versus non-severity (n=105).  
Exploratory factor analysis of the Vestibular Activities of Daily Living Scale-Brazilian version (n=140). 
Responsiveness analysis of the Vestibular Disorders Activities of Daily Living Scale total score and subscales (n=20). 
Background: The Vestibular Disorders Activities of Daily Living Scale (VADL) is considered an important subjective assessment to evaluate patients suffering from dizziness and imbalance. Although frequently used, its metric characteristics still require further investigation. Objective: This paper aims to analyze the psychometric properties of the Brazilian version of the VADL in an elderly population. Method: The sample comprises patients (≥65 years old) with chronic dizziness resulting from vestibular disorders. For discriminant analysis, patients were compared to healthy subjects. All subjects answered the VADL-Brazil by interview. To examine the VADL validity, patients filled out the Dizziness Handicap Inventory (DHI) and the ABC scale and were tested on the Dynamic Gait Index (DGI). To evaluate the VADL responsiveness, 20 patients were submitted to rehabilitation. Results: Patients (n=140) had a VADL total score of 4.1±1.6 points. Healthy subjects scored significantly less than patients in all the subscales and in the VADL total score. The VADL-Brazil was weakly correlated with the DHI and moderately to the ABC scale and the DGI. Instead of the original 3 subscales, factor analysis resulted in 6 factors. The VADL was capable of detecting changes after rehabilitation, which means that the instrument has responsiveness. Conclusions: This study provided more data about the psychometric properties and usefulness of the VADL-Brazil. The use of such a reliable and valid instrument increases the knowledge about disability in patients with vestibular disorders.
Study design and procedures.
shows the data related to the evaluation of dyspnea after the completion of both interventional protocols. It was observed that the performance of the interventional procedures promoted a significant increase in dyspnea after the completion of both protocols, with no difference between them.
Patients with chronic obstructive pulmonary disease (COPD) complain of dyspnea on activities of daily living (ADLs) with the upper limbs. Dynamic hyperinflation (DH) is one of the ventilatory mechanisms that may contribute towards dyspnea. To minimize the DH it is indicated the use of noninvasive ventilation (NIV). To verify whether there is DH and dyspnea during the performance of ADL with the upper limbs with and without the use of NIV. 32 patients with moderate-to-severe COPD, aged 54 to 87 years (mean 69.4, SD 7.4) were evaluated. The subjects lift up containers weighing between 0.5 and 5.0 kg over a five-minute period, starting from the waist level and putting them onto a shelf located above head height, with and without the use of NIV (BiPAP®; IPAP 10cmH₂O; EPAP 4 cmH₂O). The inspiratory capacity (IC) and dyspnea (Borg scale) were evaluated on all the patients. The IC was measured before and after simulation of the ADL. In order to analyze the data, Student's t test for dependent samples and the Wilcoxon test were used. There were statistically significant reductions in IC after the ADL with and without NIV (p=0.01). The dyspnea increased after the ADL with and without the NIV, however between both interventional procedures protocols no between-group difference was observed. The simulation of an ADL with the upper limbs resulted in an increase in DH and dyspnea. The NIV supplied with pre-established pressure was not enough to prevent the DH and dyspnea.
Intra-and intergroup comparisons of range of motion pre-treatment and post-treatment (eight sessions; means±standard deviations). 
Enrollment of participants and study design. Al = Allocated intervention; *refers to menstrual cycle period. 
Means and standard deviations for general pain (A), pain at the right upper trapezius (B) and at the left upper trapezius (C) in pre-and post-treatment and including the follow-up evaluation (D, E, F). Uppercase letters above the standard deviation bars refer to intragroup comparisons: A≠B (P<0.05); lowercase letters refer to intergroup comparisons: c: AC=EAC and AC=SHAM; d: SHAM=AC and AC≠EAC; a≠b*(P<0.05). 
Acupuncture stimulates points on the body, influencing the perception of myofascial pain or altering physiologic functions. The aim was to evaluate the effect of electroacupuncture (EAC) and acupuncture (AC) for myofascial pain of the upper trapezius and cervical range of motion, using SHAM acupuncture as control. Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were randomized into EAC, AC, and SHAM groups. Eight sessions were scheduled and a follow-up was conducted after 28 days. The Visual Analog Scale assessed the intensity of local and general pain. A fleximeter assessed cervical movements. Data were analyzed using paired t or Wilcoxon's tests, ANOVA or Friedman or Kruskal-Wallis tests and Pearson's correlation (α=0.05). There was reduction in general pain in the EAC and AC groups after eight sessions (P<0.001). A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups. Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group (P<0.05), which showed an increase in left rotation (P=0.049). The AC group showed increases in inclination (P=0.005) sustained until follow-up and rotation to the right (P=0.032). EAC and AC were effective in reducing the pain intensity compared with SHAM. EAC was better than AC for local pain relief. These treatments can assist in increasing cervical range of motion, albeit subtly.
Attendance at intervention sessions. 
Number (%) of training sessions not attended for each reason. 
There is a high demand for stroke rehabilitation in the Brazilian public health system which should make undertaking clinical trials straightforward. The aims of this study were to 1) determine the rate of recruitment of community-dwelling stroke survivors into a randomized trial of the effects of strength training in addition to task-specific gait training, 2) compare the effectiveness of various recruitment strategies on accrual rates, and 3) determine the attendance at training sessions and adherence to the intervention protocol. Participants within six months of a stroke were screened for eligibility and invited to participate. Recruitment strategies were classified as advertisement or referral. The number of people who were screened, eligible and recruited for each strategy was recorded. Attendance at training sessions and adherence to the intervention protocol were recorded. Over the first 14 months, 150 stroke survivors were screened, 10 were recruited, and 35 (23%) were eligible. Twenty-five of these patients (71%) were unable to participate with lack of transport given as the most common reason. The most successful strategy was referral via hospital-based physical therapists (50%). Overall attendance was 72% with lack of transport being the most common reason for non-attendance. Overall adherence to the protocol was 97% with feeling unwell being the most common reason for non-adherence. Recruitment of stroke survivors was inefficient. Lack of transport was the most common barrier to participate in and attend training sessions. Funding for transport is essential to make carrying out trials in Brazil feasible. Trial Registration ACTRN12609000803291.
HRV indices in (A) rMSSD, (B) LF – low frequency and (C) HF -high frequency compared with spontaneous breathing (SB) and different maximal inspiratory load percentages. *p<0.05 compared with SB; # p<0.05 compared with 60 and 80%.  
Demographic, anthropometric and clinical data.
Poincaré-plot in different inspiratory exercise loads: (A) 30%, (B) 60% and (C) 80%. SD1: standard deviation of the instantaneous beat-to-beat R-R interval variability. SD2: standard deviation of the long term R-R interval variability.  
Heart rate variability at different inspiratory load levels during controlled respiratory breathing.
The cardiovascular system is noticeably affected by respiration. However, whether different inspiratory resistive loading intensities can influence autonomic heart rate (HR) modulation remains unclear. The objective was to investigate HR modulation at three different inspiratory resistive loading intensities in healthy elderly men. This was a prospective, randomized, double-blind study that evaluated 25 healthy elderly men. Cardiac autonomic modulation was assessed using heart rate variability (HRV) indices. All of the volunteers underwent maximal inspiratory pressure (MIP) measurements according to standardized pulmonary function measurements. Three randomly-applied inspiratory resistive loading (30, 60 and 80% of MIP) intensities were then applied using an inspiratory resistance device (POWERbreathe, Southam, UK), during which the volunteers were asked to inhale for 2 seconds and exhale for 3 seconds and complete 12 breaths per minute. Each effort level was performed for 4 minutes, and HR and the distance between 2 subsequent R waves of electrocardiogram (R-R intervals) were collected at rest and at each intensity for further HRV analysis. The parasympathetic HRV (rMSSD, SD1 and HF) indices demonstrated lower values at 80% (rMSSD: 19±2 ms, SD1: 13±2 ms and HF: 228±61 ms2) than at 30% MIP (rMSSD: 25±3 ms, SD1: 18±2 ms and HF: 447±95 ms2; p<0.05). Lower inspiratory resistive loading intensities promoted a marked and positive improvement of parasympathetic sinus node modulation.
The effects of physical therapy on heart rate variability (HRV), especially in children, are still inconclusive. We investigated the effects of conventional physical therapy (CPT) for airway clearance and nasotracheal suction on the HRV of pediatric patients with acute bronchiolitis. 24 children were divided into two groups: control group (CG, n=12) without respiratory diseases and acute bronchiolitis group (BG, n=12). The heart rate was recorded in the BG at four different moments: basal recording (30 minutes), 5 minutes after the CPT (10 minutes), 5 minutes after nasotracheal suction (10 minutes), and 40 minutes after nasotracheal suction (30 minutes). The CG was subjected to the same protocol, except for nasotracheal suction. To assess the HRV, we used spectrum analysis, which decomposes the heart rate oscillations into frequency bands: low frequency (LF=0.04-0.15Hz), which corresponds mainly to sympathetic modulation; and high frequency (HF=0.15-1.2Hz), corresponding to vagal modulation. Under baseline conditions, the BG showed higher values in LF oscillations, lower values in HF oscillations, and increased LF/HF ratio when compared to the CG. After CPT, the values for HRV in the BG were similar to those observed in the CG during basal recording. Five minutes after nasotracheal suction, the BG showed a decrease in LF and HF oscillations; however, after 40 minutes, the values were similar to those observed after application of CPT. The CPT and nasotracheal suction, both used for airway clearance, promote improvement in autonomic modulation of HRV in children with acute bronchiolitis.
Initial and last evaluation by study group. 
The effectiveness of high-voltage pulsed current (HVPC) treatments in humans as a means of controlling edema and post-traumatic pain has not yet been established. Objective: To analyze the effects of HVPC plus conventional treatment on lateral ankle sprains. This was a randomized, controlled, double-blind clinical trial with three intervention groups: CG (control group with conventional treatment); HVPC(-) group (conventional treatment plus negative polarity HVPC); HVPC+ group (conventional treatment plus positive polarity HVPC). Twenty-eight participants with lateral ankle sprain (2 to 96 h post-trauma) were evaluated. Conventional treatment consisted of cryotherapy (20 min) plus therapeutic exercises. Additionally, the HVPC(-) and HVPC+ groups received 30 min of electrical stimulation (submotor level; 120 pps). Pain, edema, range of motion (ROM) and gait were assessed before the first treatment session and after the last treatment session. At the final evaluation, there were no significant differences between groups. Nevertheless, the HVPC(-) group had greater values in all assessed parameters. The data analysis showed that the HVPC(-) group had greater reductions in volume and girth, and greater recovery of ROM and gait velocity. This group also reached the end of the treatment (1.7 weeks; range 1.2-2.2) faster than the HVPC+ group and the CG (2.2 weeks; range 1.8-2.6). There were no differences between the study groups, but the results suggest that HVPC(-) can accelerate the initial phase of recovery from ankle sprain. Article registered in the Clinical under the number NCT 00732017.
Mouth opening variation according to the radiation field. 
Mouth opening variation according to the field of feeding. 
To evaluate radiotherapy effects (RT) on mandibular movements of patients with head and neck cancer (H&NC) and associate them to the variables: functional capacity, radiation field, disease staging, type of feeding, concomitant chemotherapy and total dose of RT. Twenty-six patients with H&NC were followed up at the RT service. Physical examination was performed in 3 follow up time points: before the beginning of RT (T0), between 14th and 17th session of RT (T1) and after the last session of RT (T2). The physical examination consisted of the assessment of the following variables: mouth opening without pain (MO), maximum mouth opening (MMO), right lateral excursion (RLE), left lateral excursion (LLE) and protrusion (PR) of the jaw. The feeding type and the Karnofsky Performance Status Scale (KPS) were evaluated in each follow up time point. Data with regards to the tumor lesion and the RT were collected from the patient's clinical notes. There was a statistical significant reduction in the values of MO (p=0.006), MMO (p=0.001), LLE (p=0.006) and KPS (p=0.001). There was significant a statistical association among the reduction in KPS and decreased measure of MO (r=0.390, p=0.048) and MMO (r=0.435, p=0.026). The mouth and oropharynx radiation fields when combined showed a significant reduction for both the measure of MO (p=0.005) and for MMO (p=0.004). Patients who used nasoenteric tube feeding (NTF) had greater reduction in the measurement of MMO (p=0.031). The remaining variables showed no statistically significant difference. Patients with H&NC present reduction of the measures of MO and MMO during the RT, especially if they present reduced functional capacity, have radiation in the mouth and oropharynx fields and used NTF.
Experimental protocol. 
Transcutaneous electrical diaphragmatic stimulation (TEDS) has been used to improve respiratory muscle strength in patients with respiratory muscle weakness. However, this physical therapy resource has not been studied in chronic obstructive pulmonary disease (COPD). To evaluate the respiratory pattern during one session of TEDS in COPD patients. Fifteen COPD patients participated in one TEDS session for plethysmographic analysis and assessment of peripheral oxygen saturation (SpO2) and heart rate (HR). After the session, patients were divided into two groups: Responder (R; n=9) and Non-Responder (NR; n=6) to TEDS. Statistic analysis was performed using the Shapiro-Wilk normality test and two-way ANOVA. For the parameters that showed interaction, the Student t test was used (P<0.05). R group consisted mainly of men, with lower SpO2 and higher HR than NR group. When time (before and during) and groups (R and NR) were compared (interaction), there were differences in the parameters minute ventilation (Vent), inspiratory tidal volume (ViVol), expiratory tidal volume (VeVol), and respiratory rate (Br/M). In the intergroup comparison, differences were observed in the parameters Vent, ViVol, and VeVol. A significant effect was also observed for time in change in end-expiratory lung volume level (qDEEL), phase relation during inspiration (PhRIB); phase relation during expiration (PhREB); phase relation of entire breath (PhRTB), and phase angle (PhAng). During TEDS, there was an increase in SpO2 and a reduction in HR in both groups. The most hypoxemic group with greater HR responded to TEDS and there was interaction between group and time of analysis for the pulmonary volumes. The time factor had an influence on the two groups with an increase in thoracoabdominal asynchrony.
Top-cited authors
Rosana Sampaio
  • Federal University of Minas Gerais
Marisa Cotta Mancini
  • Federal University of Minas Gerais
Débora Bevilaqua-Grossi
  • University of São Paulo
Isabel C N Sacco
  • University of São Paulo