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- Avaliação funcional, equilíbrio e risco de queda em idosos independentes residentes na comunidade no concelho de LouresPublication . Fernandes, Beatriz; Tomás, Maria Teresa; Quirino, DiogoIntrodução - Em virtude do seu crescente índice de envelhecimento a população portuguesa apresenta um potencial aumento do risco elevado de quedas. Este risco está relacionado com níveis mais baixos e força dos membros inferiores e equilíbrio, factores que estão relacionados com o declínio funcional. A fisioterapia tem reconhecidamente um papel fundamental não só na intervenção nesta área, mas também na identificação dos factores relacionados com o risco de queda. Objetivo do estudo - Caracterizar o risco de queda e factores relacionados em idosos residentes na comunidade.
- Handgrip strengthPublication . Tomás, Maria Teresa; Fernandes, BeatrizThe basic function of the human hand is the manipulation and grasping of various objects in all daily activities, including work activities. This is greatly influenced by strength and manual dexterity. However age, gender and other contexts such as work or leisure activities could influence strength. Handgrip strength, a measure of maximum voluntary force of the hand, has proved to be reliable and valid as an objective parameter to evaluate the functional integrity of the hand as part of the musculoskeletal system. It correlates highly with strength in other muscular groups and is therefore considered as a good indicator of overall muscular strength and functional stress and could be used as a predictor of physical disability. Handgrip strength assessment is simple and reliable and used commonly by several investigators and health professionals, in different contexts (medical, nutritional, rehabilitation, professional settings, engineering, etc.) and with different purposes (research, diagnostic, assessment, etc.). In clinical and rehabilitation settings is of vital importance in the determination of effectiveness of several interventions and for monitoring evolution of diseases. Various ways (methods, techniques and equipments) of collecting information on grip strength have been reported. This chapter will review basic concepts on handgrip function, methodologies of assessment, contexts of application and correlates, such as physical activity, health or nutritional status. Several populations and reference values as also the relationships between handgrip and clinical status, aging, risk of disability and diseases, will be discussed.
- Study and comparison of physiological response with Harmony® suspension system and suspension with pinPublication . Santos, Ana Rita; Fernandes, Diana; Granadas, Joana; Aguiar, Mara; Marçal, Margarida; Matos, José Pedro; Tomás, Maria TeresaThe purpose of this study is a cross-qualitative and quantitative gait analysis in 3 traumatic unilateral amputees using prosthesis with pin suspension compared to the use of prosthesis with a high vacuum suspension, the Harmony® system. In Portugal, there aren’t many studies made in the field of orthotic and prosthetic and knowledge about the number of amputees in the country. The only know is that the major cause of lower limb amputation is diabetes mellitus, being the most affected population the older age groups. The combination of technological developments with daily needs of the amputees is becoming more and more important for they better quality of life. This work was done during the curricular unit “Investigation in Prosthetics and Orthotics” class, in the 4th year of Health Technology School of Lisbon, in Portugal. This study analyzes if the change of suspension in transtibial prosthesis will influence some physiological response in amputees.
- Lower limbs strength, balance, mobility and risk of falling in community-dwelling older adultsPublication . Fernandes, Beatriz; Tomás, Maria Teresa; Quirino, DiogoIntroduction - During the last decades, there has been a rapid aging of the Portuguese population. The aging process involves several changes namely a decreasing in lower limbs strength, mobility and balance which contributes to increasing the risk of falling and the likelihood to suffer fractures or traumatic brain injuries among other injuries. Physiotherapy can develop an important intervention in identifying the factors that potentiate the risk of falling and can provide strategies to prevent or reverse this risk. The purpose of this study was to characterize the risk of falling and related factors in a sample of Portuguese community-dwelling older adults. Methods - A cross-sectional study. 74 subjects participated in the study (50 women, 24 men), aged 65-97 years, apparently healthy, independent and living in the community. The following tests were used: to assess lower limbs strength the 30s chair stand test; 8-foot up and go test to assess mobility and the Berg Balance Scale (BBS) to assess balance. The risk of falling was determined based on BBS. Results - The results of our study showed that for 30s chair stand test the mean value was 11 repetitions and for 8-foot up and go test was 8.63 seconds. For BBS the median was 53 points. 36.5% of the participants reported at least one fall during the previous year. Negative correlations have been found between 8-foot up and go test and 30s chair stand test (R=0.664; p=0.00) and between 8-foot up and go test and BBS (R=0.653; p=0.00). A weak positive correlation was also found between 30s chair stand test and BBS (R=0.475; p=0.00). Discussion - The results of the 8-foot up and go test (>8,5 seconds) indicate that this population was at risk of falling. In addition, BBS scores showed that the risk of falling was 11%. Lower limbs strength was decreased compared with reference values for Portuguese population. Assessment of these factors seems to be recommended in order to develop and implement strategies directed to increase lower limbs strength, balance, and mobility and decrease the risk of falling.
- Frailty as the future core business of public health: report of the activities of the A3 Action Group of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)Publication . Liotta, Giuseppe; Ussai, Silvia; Illario, Maddalena; O’Caoimh, Rónán; Cano, Antonio; Holland, Carol; Roller-Winsberger, Regina; Capanna, Alessandra; Grecuccio, Chiara; Ferraro, Mariacarmela; Paradiso, Francesca; Ambrosone, Cristina; Morucci, Luca; Scarcella, Paola; De Luca, Vincenzo; Palombi, Leonardo; Tomás, Maria TeresaBackground: The prevalence of frailty at population-level is expected to increase in Europe, changing the focus of Public Health. Here, we report on the activities of the A3 Action Group, focusing on managing frailty and supporting healthy ageing at community level. Methods: A three-phased search strategy was used to select papers published between January 2016 and May 2018. In the third phase, the first manuscript draft was sent to all A3-Action Group members who were invited to suggest additional contributions to be included in the narrative review process. Results: A total of 56 papers were included in this report. The A3 Action Group developed three multidimensional tools predicting short⁻medium term adverse outcomes. Multiple factors were highlighted by the group as useful for healthcare planning: malnutrition, polypharmacy, impairment of physical function and social isolation were targeted to mitigate frailty and its consequences. Studies focused on the management of frailty highlighted that tailored interventions can improve physical performance and reduce adverse outcomes. Conclusions: This review shows the importance of taking a multifaceted approach when addressing frailty at community level. From a Public Health perspective, it is vital to identify factors that contribute to successful health and social care interventions and to the health systems sustainability.
- A reliable M-mode ultrasound protocol for the assessment of diaphragm motionPublication . Parreira, Filipe; Machado, Rui; Tomás, Maria Teresa; Ribeiro, RicardoDiaphragm is the principal inspiratory muscle. Different techniques have been used to assess diaphragm motion. Among them, M-mode ultrasound has gain particular interest since it is non-invasive and accessible. However it is operator-dependent and no objective acquisition protocol has been established. Purpose: to establish a reliable method for the assessment of the diaphragmatic motion via the M-mode ultrasound.
- Malnutrition and body composition in elderly populationPublication . Cebola, Marisa; Mendes, Diana; Costa-Veiga, Ana; Tomás, Maria Teresa; Coelho, André; Mendes, Lino; Rico, Miguel Toscano; Guerreiro, António SousaIntroduction: Ageing leads to an increase in chronic disease’s prevalence, change in body composition: increased fat mass and decreased lean mass that can lead to malnutrition. Objectives: The aim was relating malnutrition with depletion of lean mass and alteration of fat mass. Materials and methods: Cross-sectional study, developed in the district of Lisbon, in the period from January 1, 2019, to June 30, 2019. Elderly people (≥ 65 years) admitted to the Internal Medicine Unit of a central hospital (up to 72 hours) were eligible for the study. The elderly participants had to present the capacity to make their informed consent, without the intervention of any element of coercion, with enough knowledge and understanding of the objectives of the study that allowed free and informed decision making. The nutritional assessment was performed through the MNA-LF® and the analysis of the body composition through the measurement of the calf circumference and triceps skinfold. Results: n=38 patients, with a mean age of 78.8 + 5.8 years (70-91), 50% (n=19) males and 73.6%. At hospital admission 7.9% (n=3) were malnourished, 39.5% (n=15) presented nutritional risk, 34.2% (n=13) presented depletion of lean mass and 31.6% (n=12) depletion of fat mass. When we reported the presence of malnutrition with the calf circumference and tricipital skin fold, there was a statistically significant correlation (4=0,04; r=0,05). Malnourished patients presented the depletion of lean mass and fat mass. Discussion/Conclusion: The nutritional assessment using the body composition analysis presents extreme importance in the hospital admission, which allows better performance of the nutritional support adapted to each elderly and better nutritional goals. Signaling the patients who need intervention alert all the clinical team to the importance of nutritional intervention also in the community.
- Prevenir para não cair: guia de exercíciosPublication . Fernandes, Beatriz; Cebola, Marisa; Ferreira, Miguel Marques; Tomás, Maria TeresaA atividade física e o exercício regular são importantes para a saúde física e mental de qualquer cidadão desde os mais jovens aos mais idosos e desde os mais saudáveis aos menos saudáveis. A atividade física regular e o exercício regular podem reduzir o risco de desenvolver algumas doenças ou podem mesmo ser um tratamento eficaz para muitas doenças crónicas. Muitos estudos demonstraram já que pessoas com diabetes, doenças cardíacas ou respiratórias, artrites, hipertensão arterial ou problemas de equilíbrio, entre outros, beneficiam dos efeitos positivos da atividade física e do exercício regular na gestão das suas doenças. Por isso mantenha-se ativo. Faça uma atividade que lhe dê prazer, preferivelmente todos os dias pelo menos durante 30 minutos. Caminhe idealmente 10.000 passos por dia. Passeie o seu cão, suba as escadas em vez de ir de elevador, ou faça outra atividade. Reduza o tempo que passa sentado. Adicionalmente a isto, ou em alternativa, oferecemos-lhe neste guia um conjunto de exercícios que o vão ajudar a manter-se mais ativo e a manter a sua força muscular, a sua flexibilidade e no geral a sua capacidade funcional.
- Walking for functional lifePublication . Tomás, Maria Teresa; Carnero, Elvis; Galán-Mercant, Alejandro; Fernandes, BeatrizNas próximas décadas os indivíduos com mais de 60 anos duplicarão e os indivíduos com mais de 80 anos quadruplicarão. A perda de independência ocorre devido a vários fatores (restrições à mobilidade, fragilidade, etc.). Conclusões: Quando se prescreve exercicio ou programas de promoção da saúde tendo como alvo populações idênticas às deste estudo, deve existir uma atenção especial para as atividades de marcha e atividades que utilizam as mãos (motricidade fina), uma vez que estes componentes específicos parecem ter um maior impacto na aptidão física functional. Programas adequados e políticas adequadas mostraram contribuir para manter adultos mais velhos saudáveis e independentes ao longo do tempo com um impacto social, financial e suporte de saúde pública positivo. Os resultados apontam para a importância da prescrição de exercício conciso tendo como alvo adultos mais velhos. Deve ser dada mais atenção especificamente à marcha e a atividades manuais como componentes de um programa de exercício comunitário, como objetivo de aumentar o envelhecimento ativo e saudável.Também uma maior atenção deve ser dada às estruturas ambientais (parques, jardins públicos, etc.), de modo a aumentar as atividades de marcha para todos, especialmente para os mais velhos.
- Consumo energético e eficiência da marcha com dois modelos de joelhos protésicos: estudo de casoPublication . Sá, Catarina; Cruz, Joana; Nascimento, Rafael; Silva, José Maurício; Tomás, Maria TeresaIntrodução – Os componentes protésicos têm um papel fundamental na eficiência energética da marcha dos indivíduos amputados. Esta é uma área de conhecimento ainda em desenvolvimento, onde a investigação desempenha um papel central. Objectivos – Comparar e analisar o efeito de dois joelhos protésicos, 3R34, monocêntrico modular, de fricção constante, com auxiliar de extensão incorporado (A) e 3R92, monocêntrico modular, com travão de fricção e controlo pneumático da fase de balanço (B) no consumo energético e eficiência da marcha. Metodologia – Um indivíduo do sexo masculino de 27 anos, com amputação transfemural longa, foi sujeito a um protocolo submáximo de avaliação da resposta ao exercício em passadeira rolante (H/P/Cosmos(R) Mercury), através de um sistema de análise de gases breath‑by‑breath (Cosmed Quark PFT Ergo). Foi efetuado o mesmo protocolo com intervalo de dois dias, primeiro utilizando o joelho A e depois o B. As variáveis analisadas foram o consumo de O2 (VO2), o equivalente metabólico (MET) e a eficiência energética da marcha (Quociente de VO2 esperado de um individuo saudável e o VO2 do individuo em estudo). O esforço percecionado foi medido com a escala RPE de Borg. Resultados – O consumo energético com o joelho A (24,2 ml O2/kg/min; 6,9 MET) foi inferior ao obtido com o joelho B (28,68 ml O2/kg/min; 8,2 MET). A eficiência energética da marcha foi mais elevada para o joelho A (43%) do que para o joelho B (39%). Conclusão – A utilização do joelho A na prótese do indivíduo em estudo resulta numa marcha de menor consumo energético e maior eficiência. No entanto, este valor poderá estar influenciado pelo curto período de adaptação ao joelho B, sendo necessários mais estudos para confirmar os resultados do estudo e a influência deste fator. ABSTRACT - Background – Prosthetic components have a crucial role in the energy efficiency of amputee’s gait. This is an area of knowledge still in development, where research plays a central role. Objective – The purpose of this case study is to compare the impact in energy consumption of two prosthetic knees, titanium single‑axis constant friction knee joint with internal extension assist, 3R34 (A) and a single‑axis pneumatic swing phase control, 3R92 (B). Methodology – The participant was a transtibial amputee, male, with 27 years old, with no other clinical or functional impairments. To measure the energy expenditure a submaximal treadmill (H/P/Cosmos(R) Mercury) exercise stress test combined with a breath‑by‑breath analysis system (Cosmed Quark PFT Ergo) was used. The same test was applied to both knees, separated by two days. The analyzed variables were O2 consumption (VO2), metabolic equivalent (MET) and gait efficiency (VO2 ratio expected from a healthy individual and the studied individual). A rate of perceived exertion (Borg’s Scale) was used. Results – The results were favorable to knee A (24.2 ml O2/kg/min; 6.9 MET, 43% efficiency) compared with knee B (28.68 ml O2/kg/min; 8.2 MET, 39% efficiency). Conclusion – In this case, a less energy consumption gait corresponds to the prosthesis with knee A. These values may be influenced by the short adaptation period with knee B, so it’s necessary to perform more studies to confirm the previous results and to understand the truly impact of correct adaptation factor to the best prosthetics components for different patients.