Work-related stress among physiotherapists from the musculoskeletal area: An observational study.

BACKGROUND: Stress is a consequence of or a general reaction to an action or situation that leads to physical, psychological or both demands on a person, which can cause major disabilities in different aspects of life. This study verified the presence and stress phase of physiotherapists in the musculoskeletal area, identifying the factors associated with stress. METHOD: Presence and phase of stress were assessed using the Lipp's Stress Symptoms Inventory for Adults, and sociodemographic, work, and subjective data through a structured questionnaire designed by the authors. RESULTS: 91 physiotherapists from 219 presented stress (41.55%). The presence of stress was associated to the workplace (p = 0.006, x2 = 20.01), number of patients per week (p = 0.023, x2 = 7.55), weekly working hours (p = 0.023, x2 = 7.56), and the perception of the work influenced their personal life (p < 0.001, x2 = 14.81). 56.04% of the physiotherapists were in the resistance phase. CONCLUSIONS: Approximately half of the physiotherapists showed signs of stress. Moreover, workplace, number of working hours, number of patients per week and the perception of the influence of work on personal life were important aspects to stress.

Age-related changes in upper limb motion during typical development.

BACKGROUND AND AIM: Understanding the maturation of upper limb (UL) movement characteristics in typically developing (TD) children is key to explore UL deficits in those with neurodevelopmental disorders. Three-dimensional motion analysis (3DMA) offers a reliable tool to comprehensively evaluate UL motion. However, studies thus far mainly focused on specific pre-defined parameters extracted from kinematic waveforms. Here, we investigated age-related differences in UL movement characteristics over the entire movement cycle in TD children. PARTICIPANTS AND METHODS: We assessed the non-dominant UL of 60 TD children (mean age 10y3m±3y1m) using 3DMA during eight tasks: reaching (forwards (RF), upwards (RU), sideways (RS)), reach-to-grasp (sphere (RGS), vertical cylinder (RGV)) and activities-of-daily-living mimicking tasks (hand-to-head (HTH), hand-to-mouth (HTM), hand-to-shoulder (HTS)). We investigated differences between four age-groups (5-7y, 8-10y, 11-12y, 13-15y) in: (1) spatiotemporal parameters (movement duration, peak velocity, time-to-peak velocity and trajectory straightness), and (2) 12 UL joint angles, using Statistical Parametric Mapping (SPM). RESULTS: We found that the 5-7y children moved with lower peak velocity and less straight trajectories compared to the 11-12y group (peak velocity: RS, HTS, p<0.01; trajectory: RU, RS, RGV, HTS, p<0.01) and the 13-15y group (peak velocity: RF, RS, RGS, RGV, HTH, HTS, p<0.01; trajectory, all tasks, p<0.01). The 5-7y children showed increased scapular protraction compared to older children (8-10y and 11-12y, HTS), as well as increased scapular medial rotation compared to the 13-15y group (RGS). During RU, the 5-7y children moved more towards the frontal plane (shoulder), unlike the 13-15y group. Lastly, the 5-7y group used less elbow flexion than older children (11-12y and 13-15y) during HTH and HTS. DISCUSSION AND CONCLUSION: In conclusion, our results point toward a maturation in UL movement characteristics up to age 11-12y, when UL motion seemed to reach a plateau. The reference values provided in this study will help to further optimize the interpretation of UL deficits in children with neurodevelopmental disorders.

Effects of inspiratory muscle training on cardiovascular autonomic control: A systematic review.

PURPOSE: To carry out a systematic review to determine if inspiratory muscle training (IMT) promotes changes in cardiovascular autonomic responses in humans. METHODS: The methodology followed the PRISMA statement for reporting systematic review analysis. MEDLINE, PEDro, SCOPUS and PubMed electronic databases were searched from the inception to March 2017. The quality assessment was performed using a PEDro scale. The articles were included if: (1) primary objective was related to the effects of IMT on the cardiovascular autonomic nervous system, and (2) randomized clinical trials and quasi-experimental studies. Exclusion criteria were reviews, short communications, letters, case studies, guidelines, theses, dissertations, qualitative studies, scientific conference abstracts, studies on animals, non-English language articles and articles addressing other breathing techniques. Outcomes evaluated were measures of cardiovascular autonomic control, represented by heart rate variability (HRV) and blood pressure variability (BPV) indexes. RESULTS: The search identified 729 citations and a total of 6 studies were included. The results demonstrated that IMT performed at low intensities can chronically promote an increase in the parasympathetic modulation and/or reduction of sympathetic cardiac modulation in patients with diabetes, hypertension, chronic heart failure and gastroesophageal reflux, when assessed by HRV spectral analysis. However, there was no study which evaluated the effects of IMT on cardiovascular autonomic control assessed by BPV. CONCLUSIONS: IMT can promote benefits for cardiac autonomic control, however the heterogeneity of populations associated with different protocols, few studies reported in the literature and the lack of randomized controlled trials make the effects of IMT on cardiovascular autonomic control inconclusive.

Joint position sense is bilaterally reduced for shoulder abduction and flexion in chronic hemiparetic individuals.

BACKGROUND: The stroke is the leading cause of adult disability in the world. One of the main complaints of individuals post-stroke refers to the loss of function of the upper limb, as evidenced during the performance of activities of daily living. This difficulty may be related to an important component of sensorimotor control, joint position sense, a submodality of proprioception. OBJECTIVES: To investigate whether the proprioception of both shoulders of chronic hemiparetic patients is altered during abduction and flexion. METHODS: Thirteen subjects with chronic hemiparesis due to ischemic stroke and 13 healthy subjects matched for gender and age was included. The joint sense position was assessed using a dynamometer. Absolute error for shoulder abduction and flexion at the 30 and 60° was calculated. RESULTS: No difference was found between the paretic and non-paretic limbs in movements at both 30 and 60°. Higher values of absolute error for both paretic and non-paretic limbs compared to the control were observed during abduction at 30 and at 60°. CONCLUSIONS: Chronic ischemic post-stroke patients have bilateral proprioceptive deficits in the shoulder during abduction and flexion. But these deficits are dependent on the movement performed and the angle tested. The results demonstrate the need to include bilateral exercises and/or visual feedback in the rehabilitation program.

Intrinsic properties and functional changes in spastic muscle after application of BTX-A in children with cerebral palsy: systematic review.

OBJECTIVE: This article aimed to review the literature to verify the effect of botulinum toxin type A (BTX-A) on the intrinsic properties of spastic muscles and functionality in children with cerebral palsy (CP). METHODS: A literature search was conducted in the following databases: CINAHL, SCOPUS, Web of Science and PubMed. Database searches were limited to the period from January 1993 to March 2014. RESULTS: A total of 2182 papers were identified, and 17 met the inclusion criteria. Only one study analyzed the effect of the toxin on muscle intrinsic properties and others analyzed the effect on functionality. CONCLUSION: BTX-A application demonstrated no changes in the passive stiffness of spastic muscle. In relation to functional level, the evidence of BTX-A effect was controversial. These studies showed methodological quality limitations that restrict the interpretation of the results for the entire CP population, which justifies the need for further randomized controlled trials.