At birth, preterm newborns (PTNB) often require Neonatal-ICU hospitalization, which, despite being a care setting, also causes stress such as pain, sleep disturbances and wakefulness, and alterations of physiological parameters. The aim of this study was to analyze the effects of aquatic physiotherapy on pain, sleep disturbances and wakefulness, and physiological variables of PTNB in Neonatal-ICU. Pain, sleep disturbances and wakefulness, and alterations of physiological parameters were evaluated at three moments: 5 minutes before intervention, immediately after and 10 minutes after intervention. At intervention, participants were wrapped in soft fabric and immersed at shoulder level in warm water (36 °C to 37.5 °C). Sideways, forward, backward and rotational movements were performed. Twenty-two newborns participated in the study. The results obtained in relation to pain, sleep state and wakefulness showed significant improvements in reevaluations after intervention. Physiological variables also underwent significant changes and remained within normality parameters. The results indicate that aquatic physiotherapy is effective in reducing pain, improving sleep and wakefulness and physiological variables of PTNB in Neonatal-ICU.
Objetivo. Avaliar o efeito agudo de um procedimento de Fisioterapia Aquática, no alinhamento e simetria de tronco de crianças com Encefalopatia Crônica Não Progressiva da Infância (ECNPI). Método. Aplicou-se a fotometria como instrumento de avaliação, comparando-se pré e pós intervenção aquática, observando os efeitos agudos de uma única sessão, com duração de 30 minutos, em quatro sujeitos quadriparéticos espásticos, com média de idade 12,75 anos. Realizaram-se demarcações dos pontos anatômicos: acrômios, últimas costelas e espinhas ilíacas ântero-superiores (EIAS), foto na postura sentada em cadeira de rodas. Utilizou-se o software Corel Draw para identificação de alterações na postura comparando a altura entre os pontos demarcados no plano horizontal. Para fidedignidade dessas medidas, utilizou-se o Coeficiente de Correlação Intraclasse (ICC), que verifica possíveis erros de medidas dependentes do avaliador. Resultados. O ICC resultou em 0,95. Observou-se que houve maior alinhamento e simetria corporal nos quatro sujeitos após a intervenção (p<0,05) e entre os pontos acrômios (0,02), EIAS (0,03) e não houve diferença entre últimas costelas (0,48). Conclusão. Neste estudo, concluiu-se que a Fisioterapia aquática apresentou um efeito agudo positivo na postura de crianças com ECNPI avaliadas.
Aquatic environment is widely used for recreational, sporting, and therapeutic activities. However, human motor functional behavior in immersion has not been sufficiently described. Such description is necessary to improve strategies used to perform movements in this environment and to possibly transfer them to land. Our goal is to offer a qualitative description of the aquatic motor behavior. We use action research to observe and describe motor behavior in water, which we systematized using the Aquatic Functional Assessment Scale, effects of water on the immersed body, its relationship with functional movements performed on land, and the International Classification of Functioning, Disability and Health (ICF). The results allowed the systematization of aquatic movements based on unique features of water compared to effects of activities and participation of functional movement, under a biopsychosocial view of ICF. Such systematization of aquatic behaviors enables professionals to increase their strategies and interventions in water, through that understand the complexity of this approach and improve physical and therapeutic interventions that will have an impact on health.
Cerebral palsy (CP) is the most common disability in children caused by central nervous system lesion. The aim of the present study was to verify the intensive neuromotor therapy effects in children with CP, in a reference Brazilian centre. In this study, three years of medical records from a Brazilian reference Centre of Intensive Neuromotor Therapy (INMT) which use the INMT protocol were analysed. The motor evaluation for each child was done by the Gross Motor Function Classification System (GMFCS) and GMFM-88 by an experienced professional, before and after each INMT module. A total of 53 children between the ages of 1 and 15 years (age at treatment initiation, initial evaluation), with a mean age of 5.94±3.38 years, participated in the study. Participants performed between 1 and 10 INMT modules. There was no strong correlation between age and overall performance on the GMFM scale, but it was observed a strong negative correlation between the percentage of GMFM gains and the number of modules (r=-0.709; R 2 = 0.50; p = 0.022, CI95%[0.014 -0.026]), suggesting that patients tend to present higher percentage gains in the first modules. Through an intra-module comparison, it was observed statistical difference in the total score in each of the modules.
Parkinson's Disease (PD) is a progressive disease with motor impairment, and as such requires a multidisciplinary team that includes physiotherapy. Physiotherapy can stimulate learning ability, motor recovery, neuroplasticity and neuroprotection. The aquatic physiotherapy (AP) for PD enables movements to be progressively and safely executed, reducing the risk of falls. Hence, the objective of this study is to analyze the effects of an AP program on the functional motor skills of people with PD. This is a controlled quasi-experimental clinical trial, with blind assessor. The participants were male and female, diagnosed with PD, Hoehn and Yahr stages 1 to 4 and medical certificate for AP. The exclusion criteria were: not presenting independent walking; sensorial deficit; contraindications for attending a heated pool; alterations in levodopa ingestion. The functional assessments conducted on land were: walking speed test; Five Times Sit to Stand Test; Mini BESTest, Unified Parkinson's Disease Rating Scale (UPDRS) for activities of daily living (ADL); and motor skill parts, evaluated before, after and 4 months after AP. The aquatic assessment was conducted through the Aquatic Functional Assessment Scale (AFAS). The participants were allocated in two groups: Control Group (CG), which did not take part in the pool activities, and Experimental Group (EG), which was submitted to AP, throughout 32 twice-a-week, 50-minute-long appointments. Functional exercises were proposed to respect the principles of specificity and progression regarding complexity in the aquatic activities through aquatic motor skills learning phases. Groups and times were compared statistically. At the end of the study, the EG was composed of 11 participants and the CG 7. There were no differences between the groups at the beginning of the study. A difference was observed between groups for gait speed in evaluation 2; difference between assessment 1 and 2 for GE in the ADL and motor, as well as between assessment 2 and 3 for GE in the motor assessment. CG presented a decline from assessment 1 and 3. In the aquatic assessment, the EG had a statistical difference after the intervention.
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