Composição corporal e expansão torácica em indivíduos que vivem e convivem com atrofia muscular espinhal tipo II e III / Body composition and chest expansion of type II and III Spinal muscular atrophy patients

Introdução: pacientes com atrofia muscular espinhal apresentam fraqueza muscular, problemas ortopédicos, complicações alimentares e declínio da função respiratória. Alterações na massa magra e na massa gorda também são esperadas. Objetivo: verificar a composição corporal e a expansão torácica de pacientes com atrofia muscular espinhal tipo II e III. Método: foram avaliados 14 indivíduos, sete no Grupo I (pacientes) com 9 (7 - 12)anos, 29,7 (23,5 - 60,0) kg; e sete no Grupo II (sem a doença) com 9 (9-12) anos, 31,0 (27,8 - 54,1) kg. A análise da composição corporal foi obtida pela bioimpedância elétrica monofrequencial. Os perímetros de tórax, quadril e abdômen foram medidos com uma fita métrica. As análises estatísticas foram realizadas no programa SPSS (p < 0,05). Resultados: os pacientes apresentaram maior impedância: 1416,9 (850,5 - 1559,1) vs788,0 (68 3, 6 - 853,8), P < 0,05; e percentual de gordura: 31,2 (23,9 - 46,6) vs 19,1 (14,9 - 27,0) por cento, P<0,05. A diferença entre a perimetria de tórax em inspiração forçada e em expiração forçada foi menor para os pacientes em comparação com o Grupo II: 3,0 (0,8 - 4,4) vs. 5,0 (3,9 - 6,5) cm, P < 0,05. Conclusão: pacientes com amiotrofia muscular espinhal apresentaram maior adiposidade e menor expansão torácica.

INTRODUCTION: spinal muscular atrophy patients present muscle weakness, orthopedic problems, nutritional complications and respiratory impairment. Lean mass and fat mass modifications are also expected in this population. OBJECTIVE: to verify the body composition and chest expansion of type II and III spinal muscular atrophy patients. METHODS: fourteen individuals were evaluated: seven patients in Group I of 9 (7-12) years of age, weighing 29.7 (23.5-60.0) kg; and seven children without the disease in Group II of 9 (9-12) years, weighing 31.0 (27.8-54.1) kg. Patients' monofrequency bioelectrical impedance was used for analyze body composition. Chest, hip and abdominal girths were measured by a flexible steel tape. The SPSS program was used to statistical analysis (p < 0.05). RESULTS: patients presented higher impedance: 1416.9 (850.5-1559.1) vs 788.0 (683.6-853.8), P < 0.05; and fat percentage: 31.2 (23.9-46.6) vs 19.1 (14.9-27.0)%, P < 0.05. The difference between forced inspiration and forced expiration thorax girth was smaller for patients when comparing to Group II: 3.0 (0.8-4.4) vs. 5.0 (3.9-6.5) cm, P<0.05. CONCLUSIONS: patients with spinal muscular atrophy presented higher adiposity and lower chest expansion.

Três protocolos fisioterapêuticos: efeitos sobre os volumes pulmonares após cirurgia cardíaca / Three physiotherapy protocols: effects on pulmonary volumes after cardiac surgery

OBJETIVO: Avaliar o volume inspiratório e os efeitos da espirometria de incentivo (EI) e da técnica breath stacking (BS) sobre a CVF em pacientes submetidos a cirurgia cardíaca. MÉTODOS: Estudo prospectivo controlado e randomizado com 35 pacientes submetidos a cirurgia cardíaca no Hospital de Força Aérea do Galeão, Rio de Janeiro (RJ). Todos os pacientes realizaram procedimentos de mobilização e tosse e foram randomicamente alocados em três grupos: grupo exercício controle (EC), que realizou somente esses procedimentos; grupo EI, que realizou inspirações profundas utilizando um espirômetro de incentivo; e grupo BS, que realizou esforços inspiratórios sucessivos utilizando uma máscara facial acoplada a uma válvula unidirecional. A espirometria forçada foi realizada no período pré-operatório e do primeiro ao quinto dia de pós-operatório. O volume inspiratório foi medido durante as manobras nos grupos EI e BS. RESULTADOS: No primeiro dia de pós-operatório, a CVF diminuiu significativamente em todos os grupos (EC: 87,1 vs. 32,0 por cento; EI: 75,3 vs. 29,5 por cento; e BS: 81,9 vs. 33,2 por cento; p < 0.001 para todos) assim como o volume inspiratório nos grupos EI e BS (EI: 2,29 vs. 0,82 L; e BS: 2,56 vs. 1,34 L, p < 0.001 para ambos). Do primeiro ao quinto dia de pós-operatório, a CVF apresentou recuperação parcial independentemente do protocolo (EC: 32,0 vs. 51,3 por cento; EI: 29,5 vs. 46,7 por cento; e BS: 33,3 vs. 54,3 por cento; p < 0.001 para todos). Durante o período pós-operatório avaliado, o volume inspiratório foi significativamente maior no grupo BS do que no EI. CONCLUSÕES: Os protocolos foram equivalentes no que se refere à recuperação da CVF nos primeiros cinco dias de pós-operatório. Quando comparada à EI, a técnica BS promoveu maiores volumes inspiratórios nesta amostra de pacientes submetidos à cirurgia cardíaca.

OBJECTIVE: To evaluate inspiratory volume in patients undergoing cardiac surgery and to determine the effects that incentive spirometry (IS) and the breath stacking (BS) technique have on the recovery of FVC in such patients. METHODS: A prospective, controlled, randomized clinical trial involving 35 patients undergoing cardiac surgery at the Hospital de Força Aérea do Galeão (HFAG, Galeão Air Force Hospital), in the city of Rio de Janeiro, Brazil. The patients, all of whom performed mobilization and cough procedures, were randomly divided into three groups: exercise control (EC), performing only the abovementioned procedures; IS, performing the abovementioned procedures and instructed to take long breaths using an incentive spirometer; and BS, performing the abovementioned procedures, together with successive inspiratory efforts using a facial mask coupled to a unidirectional valve. Forced spirometry was carried out in the preoperative period and on postoperative days 1 to 5. During the maneuvers, inspiratory volume was measured in the IS and BS groups. RESULTS: On postoperative day 1, FVC significantly decreased in all groups (EC: 87.1 vs. 32.0 percent; IS: 75.3 vs. 29.5 percent; and BS: 81.9 vs. 33.2 percent; p < 0.001 for all), as did inspiratory volume in the IS and BS groups (2.29 vs. 0.82 L; and 2.56 vs. 1.34 L, respectively; p < 0.001 for both). Between postoperative days 1 and 5, FVC partially normalized in all groups (EC: 32.0 vs. 51.3 percent; IS: 29.5 vs. 46.7 percent; and BS: 33.3 vs. 54.3 percent; p < 0.001 for all). During the postoperative period, inspiratory volume was significantly higher in the BS group than in the IS group. CONCLUSIONS: The three protocols were equivalent concerning the recovery of FVC on the first five postoperative days. When compared with IS, the BS technique promoted higher inspiratory volumes in this sample of postoperative cardiac patients.

Adiposity and postural balance control: correlations between bioelectrical impedance and stabilometric signals in elderly Brazilian women

OBJECTIVE: The purpose of this study was to investigate the correlation between body adiposity and postural control in elderly women. INTRODUCTION: Aging and obesity account for a significant portion of healthcare spending. Life expectancy is increasing worldwide, and Rio de Janeiro has the largest proportion of elderly residents of all Brazilian states. METHODS: A total of 45 women underwent bioelectrical impedance analysis, waist circumference measurements, weight and height measurements, and stabilometric tests in eight different stance conditions (opened and closed bases with both eyes opened and closed and right and left tandem and unilateral stances with eyes opened). During unilateral stances, the number of hand or foot contacts was counted. RESULTS: Weight, body mass index, waist circumference, fat percentage, and fat mass showed statistically significant (p,0.05) and positive correlations with the number of contacts made during unilateral stances. The subjects with greater fat mass showed significantly higher anterior-posterior standard deviation and range when their eyes were closed. The sway area was also greater for this group in opened base when their eyes were closed. DISCUSSION: The results relating body adiposity and postural control can be explained by the difficulty of maintaining a greater quantity of body fat mass within the limits of the individual support base, especially while assuming a unilateral stance. CONCLUSION: The subjects with a greater fat mass exhibited poor balance control, indicating that body adiposity level was associated with postural control in the elderly women examined in the present study.

Efeito da pressão positiva contínua nas vias aéreas sobre os volumes pulmonares em portadores de doença pulmonar obstrutiva crônica / Effect of the continuous positive airway pressure over pulmonary volumes in chronic obstructive pulmonary disease

Introdução: Em pacientes com doença pulmonar obstrutiva crônica (DPOC), a ventilação não-invasiva com pressão positiva reduz o trabalho respiratório e melhora a ventilação alveolar. O objetivo do presente estudo foi avaliar os efeitos imediatos da pressão positiva contínua nas vias aéreas (CPAP) sobre os parâmetros funcionais em portadores de DPOC. Metodologia: Em um ensaio clínico não randomizado e aberto, foram avaliados 11 portadores de DPOC moderada ou grave, estáveis clinicamente. Todos os pacientes foram avaliados antes e depois da aplicação de dois diferentes níveis de CPAP (7 e 11 cmH2O). Resultados: Dos 11 pacientes estudados, 6 eram homens e 5 eram mulheres, com média de idade de 70,72 anos. A capacidade vital forçada (CVF) aumentou após a aplicação dos dois níveis de CPAP, mais acentuadamente após a CPAP de 11 cmH2O (p<0,05). Capacidade pulmonar total (CPT), capacidade residual funcional (CRF) e volume residual (VR) mostraram tendência à redução, porém sem atingir relevância estatística (p>0,05). Conclusão: A aplicação da CPAP aumenta rapidamente a CVF em pacientes portadores de DPOC.

Introduction: In patients with chronic obstructive pulmonary disease (COPD), noninvasive positive pressure ventilation reduces the work of breathing and improves alveolar ventilation. The aim of the present study was to evaluate the immediate effects of the continuous positive airway pressure (CPAP) over pulmonary volumes in chronic obstructive pulmonary disease. Methodology: This was an open, non-randomized clinical trial involving 11 clinically stable patients with COPD moderate or severe. All were evaluated before and after of the utilisation of two different level of CPAP (7 and 11 cmH2O). Results: Of the 11 patients studied, 6 were male, and 5 were female, with a mean age of 70.72 years. Forced vital capacity (FVC) increasedafter of the utilisation of two different level of CPAP, specially after CPAP of 11 cmH2O (p<0,05). Total lung capacity (TLC), functional residual capacity (FRC) and residual volume (RV) decreased, however without significant change (p>0,05). Conclusion: The utilisation of the CPAP increase quickly FVC in patients with COPD.