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Secretion management in mechanically ventilated patients is a paramount task for clinicians. A better understanding of the mechanisms of flow bias and airway dynamic compression during airway clearance therapy may enable a more effective approach for this population. Ventilator hyperinflation, expiratory rib cage compression, a PEEP-ZEEP maneuver, and mechanical insufflation-exsufflation are examples of techniques that can be optimized according to such mechanisms. In addition, novel technologies, such as electric impedance tomography, may help improve airway clearance therapy by monitoring the consequences of regional secretion displacement on lung aeration and regional lung mechanics.

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INTRODUCTION: Parkinson's disease (PD) is a neurological disorder that causes loss of functional abilities and independence. The aim of this study was to evaluate the effects of a physical therapist-supervised home-based exercise program in patients with PD using the UPDRS scale. MATERIALS AND METHODS: Thirty-three PD patients in the 1.5 to 3 Hoehn and Yahr stages participated in the trial. The patients and their relatives received a booklet with a 12-week home program, with a series of strengthening, stretching and flexibility exercises. The patients were trained by a physical therapist, and each session took 60 minutes, three times a week. RESULTS: We classified our patients in four groups: Group 1 - patients under 60 years of age and less than five years of PD; Group 2 - patients under 60 years of age and more than five years of PD; Group 3 - patients over 60 years of age and less than five years of the disease; and Group 4 - patients over 60 years of age and more than five years of PD. Significant improvement was found in group 1 in mentation, activities of daily living and motor function (p > 0.05). Group 3 presented statistically significant differences in motor function subscale (p > 0.05) and Group 4 showed no worsening in mentation subscale (p > 0.05). Group 2, however, presented no difference in all subscales (p < 0.05). CONCLUSION: Although not all patients improved their UPDRS scores, our data support the use of a home program as an alternative method of physical therapy treatment for PD patients.

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| Background: Cystic fibrosis (CF) is a hereditary condition in which lung disease affects all patients. In addition to pulmonary involvement, the multisystemic components of CF cause significant physical limitations. However, the impact of lung function on balance control in CF has not been studied. Objective: To assess body balance in adults with CF and to test its possible associations with lung function, nutritional status, and functional capacity. Method: This was a cross-sectional study in which 14 adults with CF underwent pulmonary function testing (spirometry, body plethysmography, and carbon monoxide diffusing capacity (DLco), respiratory muscle strength, 6-min walking distance (6MWD), Berg balance scale (BBS), nutritional analysis (body mass index and bioelectrical impedance), and stabilometry. Body balance was quantified using stabilometry; all participants performed the following two trials: opened base, eyes open (OBEO); closed base, eyes closed (CBEC). Results: In stabilometry, the median for the lateral range and anterior-posterior range in the CBEC trial was 0.10 (0.08-0.11) and 0.13 (0.11-0.22), respectively (p<0.05). The maximal inspiratory pressure (MIP) correlated inversely with the lateral standard deviation (ρ=-0.61; p<0.05) as the DLco correlated positively with the anterior-posterior range (ρ=0.54; p<0.05). There were significant relationships between body composition indexes and almost all stabilometric variables measured. There were no relationships of the BBS and 6MWD with the stabilometric variables. Conclusions: In adults with CF, imbalance occurs mainly in the anterior-posterior direction and is especially associated with body composition.Keywords: cystic fibrosis; rehabilitation; respiratory function tests; postural balance; psychomotor performance; nutrition assessment. HOW TO CITE THIS ARTICLEPenafortes JTS, Guimarães FS, Ribeiro Moço VJ, Almeida VP, Menezes SLS, Lopes AJ. Relationship between body balance, lung function, nutritional status and functional capacity in adults with cystic fibrosis. Braz J Phys Ther. 2013 Sept-Oct; 17(5):450-457. http://dx

BACKGROUND: Patients who require prolonged weaning from mechanical ventilation represent a major challenge in intensive care, and the timed inspiratory effort (TIE) index has been shown to be a clinically valuable tool to predict weaning success. OBJECTIVE: To evaluate whether weekly serial measurements of the TIE index can predict the success in prolonged weaning. METHODS: A prospective observational study in which the subjects who started the weaning process off mechanical ventilation underwent weekly measurements of the TIE index. The area under the receiver operating characteristic curve was used to evaluate the accuracy of the TIE index as a predictor of weaning success. A multivariate Cox regression model was developed to test the association of TIE index values of >1.0 cm H 2 O/s with a failure of weaning. RESULTS: Seventy subjects were selected. Their median (IQR) age was 72 (62-78) y, the median (IQR) duration of mechanical ventilation was 17.5 (14-28) d, and the median (IQR) APACHE II (Acute Physiology and Chronic Health Evaluation) II score was 28 (24-31). Thirty-five of the 70 subjects (50%) died, 22 of them after successful weaning. A total of 224 tests were performed over 56 d. The area under the receiver operating characteristic curve of the TIE index was 0.93. In the analysis of the probability of success during the follow-up (Kaplan-Meier method), a significant difference was obtained in favor of those with a TIE index of > 1.0 cm H 2 O/s (53% vs 32%, P ‫؍‬ .030). In the multivariate Cox regression analysis, values of the TIE index > 1.0 cm H 2 O/s revealed an inverse, strong, and independent association with failure (hazard ratio 0.36, 95% CI 0.15-0.91; P ‫؍‬ .030). The following variables were also found to have an independent but direct association with failure: age and length of time before weaning. CONCLUSIONS: When measured weekly, a TIE index of >1.0 cm H 2 O/s was a good predictor of success in subjects who required prolonged weaning in our hospital.