Avaliação do conhecimento dos juízes do tribunal de São Paulo sobre a fisioterapia na perícia: um estudo transversal / Evaluation of the knowledge of the judges of the São Paulo court on physiotherapy in expertise: a cross-sectional study

Introdução: Com a revolução industrial, ocorreram diversas mudanças nos processos de produção, alterando totalmente a forma de trabalho, gerando acidentes de trabalho mais frequentes e maiores doenças devido às condições de trabalho precárias. A fisioterapia na saúde do trabalhador surge inicialmente para prevenir agravos à saúde do trabalhador. Objetivos: Analisar o conhecimento dos juízes no que se refere a atuação do fisioterapeuta perito. Métodos: Este estudo é caracterizado como transversal, com abordagem quantitativa. A coleta de dados foi realizada através de um questionário online, criado pelo Google Forms. Fizeram parte da pesquisa 10 juízes em exercício, cadastrados no Tribunal de Justiça de São Paulo e que concordaram em participar do estudo. Foram excluídos juízes que não estivessem atuando na área e que não tivessem disponível um meio de contato. Resultados: Diante da análise do questionário foi possível identificar que os juízes possuem dificuldades em diferenciar a perícia médica da perícia fisioterapêutica. Além disso, demonstraram pouco conhecimento acerca das atribuições do fisioterapeuta perito. Conclusão: A prática da fisioterapia forense ainda é um campo em expansão e que necessita de maiores estudos, pois a literatura sobre o tema é escassa.

Avaliação manual da mobilidade e tonicidade diafragmática em cantores líricos profissionais e não-cantores / Manual evaluation of mobility and diaphragmatic tonicity in professional lyrical singers and non-singers

Introdução: Durante sua carreira o cantor lírico sofre grande demanda e consequente alteração da coordenação dos músculos respiratórios, porém não se sabe se estas exigências podem alterar a mobilidade e tonicidade no principal músculo da respiração, o diafragma. Objetivos: Avaliar e comparar a tonicidade e a mobilidade do diafragma de cantores líricos profissionais e de não-cantores. Participaram do estudo 15 cantores líricos profissionais em plena carreira e 24 adultos não-cantores com idades e IMCs equivalentes. Métodos: Duas avaliações foram empregadas: para avaliar a mobilidade costal foi utilizada a parte referente a avaliação desse parâmetro da Manual Evaluation of the Diaphragm Scale (MED Scale); para avaliar a tonicidade diafragmática a avaliação descrita por Rial e Pinsach em 2015. Resultados: Os resultados mostraram que a distribuição da avaliação manual do diafragma no grupo dos cantores apresentou distribuição significativamente diferente, tendo p < 0,05, com relação à tonicidade bilateral do diafragma, apresentando maior hipertonicidade em relação ao grupo controle, e que não houve diferenças significativas em relação à mobilidade. Conclusão: Os gestos artísticos usados pelos cantores líricos profissionais afetam a tonicidade do diafragma. (AU)

Introduction: The professional lyrical singers during their careers suffer great demand and consequent alteration of the coordination of the respiratory muscles, however it is not known if these requirements can alter the mobility and tonicity in the main muscle of the breath, the diaphragm. Objectives: To evaluate and compare diaphragm tonicity and mobility of professional lyric singers and non-singers. The study included 15 professional lyric singers in their full careers and 24 non-singing adults of equivalent ages and BMIs. Methods: Two forms of manual evaluation of the diaphragm were used: to assess costal mobility, the part of the manual evaluation to evaluate this parameter was used the Manual Evaluation of the Diaphragm Scale (MED Scale); and to evaluate the diaphragmatic tonicity the evaluation described by Rial and Pinsach in 2015. Results: The results showed that the distribution of the manual evaluation of the diaphragm in the group of singers presented a significantly different distribution, with p < 0,05, in relation to the bilateral diaphragm tonicity, presenting them with greater hypertonicity in relation to the control group, and that there were no significant differences regarding mobility. Conclusion: The artistic gestures used by professional lyric singers affect the tone of the diaphragm. (AU)

Assessment of postural balance among individuals with Parkinson disease with and without effects from dopaminergic medications.

OBJECTIVE: The objectives of the present study were to assess the effects of dopaminergic drugs on the postural balance of Parkinson disease (PD) patients and to ascertain whether their sway is greater along the mediolateral or the anteroposterior axis. DESIGN: Twenty-two patients awaiting operations for implantation of a deep brain stimulator at the neurology service of Hospital das Clínicas, University of São Paulo School of Medicine (HC-FMUSP), were assessed. All of them were assessed on the AccuSway portable force platform, through evaluation of the center of pressure. The patients stayed standing upright on both feet with the eyes open and closed for 60-sec periods. Center-of-pressure displacements along the mediolateral and anteroposterior axes and the displacement velocity and the elliptical area covered by 95% of the displacement were measured. Two assessments were made: without medication (at least 12 hrs after the last administration) and with the effects from levodopa. RESULTS: The elliptical displacement area was greater when the patients were under the effects of the medication (P < 0.05). The center-of-pressure displacements were greater along the anteroposterior axis than along the mediolateral axis. CONCLUSIONS: Levodopa increases the sway area of the Parkinson disease patients evaluated by static posturography.

Long-term effect of early postoperative pelvic floor biofeedback on continence in men undergoing radical prostatectomy: a prospective, randomized, controlled trial.

PURPOSE: The impact of pelvic floor muscle training on the recovery of urinary continence after radical prostatectomy is still controversial. We tested the effectiveness of biofeedback-pelvic floor muscle training in improving urinary incontinence in the 12 months following radical prostatectomy. MATERIALS AND METHODS: A total of 73 patients who underwent radical prostatectomy were randomized to a treatment group (36) receiving biofeedback-pelvic floor muscle training once a week for 3 months as well as home exercises or a control group (37). Patients were evaluated 1, 3, 6 and 12 months postoperatively. Continence was defined as the use of 1 pad or less daily and incontinence severity was measured by the 24-hour pad test. Incontinence symptoms and quality of life were assessed with the International Continence Society male Short Form questionnaire and the Incontinence Impact Questionnaire. Pelvic floor muscle strength was evaluated with the Oxford score. RESULTS: A total of 54 patients (26 pelvic floor muscle training and 28 controls) completed the trial. Duration of incontinence was shorter in the treatment group. At postoperative month 12, 25 (96.15%) patients in the treatment group and 21 (75.0%) in the control group were continent (p = 0.028). The absolute risk reduction was 21.2% (95% CI 3.45-38.81) and the relative risk of recovering continence was 1.28 (95% CI 1.02-1.69). The number needed to treat was 5 (95% CI 2.6-28.6). Overall there were significant changes in both groups in terms of incontinence symptoms, lower urinary tract symptoms, quality of life and pelvic floor muscle strength (p <0.0001). CONCLUSIONS: Early biofeedback-pelvic floor muscle training not only hastens the recovery of urinary continence after radical prostatectomy but allows for significant improvements in the severity of incontinence, voiding symptoms and pelvic floor muscle strength 12 months postoperatively.