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Id: biblio-1049692
Autor: Nocciolino, Laura M; Lüscher, Sergio H; Pilot, Nicolás; Pisan, Leandro; Mackler, Leandro; Cointry, Gustavo R; Ireland, Alex; Rittweger, Jörn; Ferretti, José L; Capozza, Ricardo F.
Título: Evidencia original directa (dinamométrico-tomográfica) de la influencia sitio-específica de la musculatura sobre la estructura ósea: hacia una concepción más amplia del mecanostato / Original dynamometric and tomographic evidence of site-specific muscle effects on bone structure: towards a wider scope on the bone mechanostat concept
Fonte: Actual. osteol;14(3):178-183, sept. - dic. 2018. graf..
Idioma: es.
Resumo: Para analizar el impacto directo de la musculatura sobre la estructura ósea se determinaron el área (CtA), la densidad mineral ósea volumétrica (vDMOc) y los momentos de inercia corticales para flexión anteroposterior y lateral (MIap, MIlat) ajustados a CtA, y las relaciones entre MI y vDMOc (de Ê»distribución/calidadʼ, d/c, que describen la eficiencia de la optimización biomecánica del diseño cortical por el mecanostato) en 18 cortes seriados a lo largo de todo el peroné del lado hábil (pQCT), y la fuerza de salto y de rotación externa del pie (dinamometría computarizada) de 22 hombres sanos de 18 a 33 años entrenados en fútbol competitivo por más de 4 años, y de 9 controles etarios no entrenados. Los entrenados tuvieron valores más altos de MI en función de la fuerza de rotación del pie (no de salto), con un ajuste homogéneo para MIap pero variable (más pobre distalmente y más alto proximalmente, en la región de inserción de los peroneos) para MIlat, coincidiendo este último con pobres ajustes de las relaciones d/c (efecto arquitectónico independiente de la rigidez del tejido). Esto evidencia la influencia directa de la tracción de la musculatura peronea sobre la estructura cortical proximal subyacente del hueso y también sugiere que el mecanostato procedería, en este caso, fuera de su conocida concepción como mecanismo regulatorio de la resistencia ósea. (AU)

To analyze the direct impact of muscle contractions on the structure of bones, we determined the cortical cross-sectional area (CtA), volumetric mineral density (vBMDc) and the CtA-adjusted moments of inertia for anterior-posterior and lateral bending (MIap, MIlat), and the ʻdistribution/qualityʼ (d/c) relationships between MIs and vBMDc (which describe the efficiency of the biomechanical optimization of cortical design by bone mechanostat) in 18 serial scans taken throughout the fibula of the dominant side (pQCT), and the jump and the foot-lateral-rotation forces (computed dynamometry) of 22 healthy men aged 18-33 years, who had been trained in competitive soccer for more than 4 years, and of 9 untrained, agematched controls. Trained individuals showed higher MI values as a function of the rotative force of the foot (not the jumping force). The adjustment of these relationships was homogeneous for MIap throughout the bone, but variable (poorer distally and higher proximally, at the insertion area of peroneus muscles) for MIlat, this latter being paralleled by poor adjustments of the corresponding, d/c relationships (architectural effect independent of tissue stiffness). These findings,1. Show the direct influence of the traction force of peroneal muscles on proximal fibula structure close to the insertion area, and 2. Suggest that, in the studied conditions, the bone mechanostat would proceed beyond its known conception as a regulatory mechanism of structural bone strength. (AU)
Descritores: Fíbula/fisiopatologia
Sistema Musculoesquelético/diagnóstico por imagem
Fenômenos Fisiológicos Musculoesqueléticos
-Futebol
Fenômenos Biomecânicos/fisiologia
Osso e Ossos/fisiopatologia
Exercício
Fraturas Ósseas/prevenção & controle
Fíbula/anatomia & histologia
/diagnóstico por imagem
Músculos/fisiopatologia
Tipo de Publ: Estudo Comparativo
Responsável: AR2.1 - Biblioteca Central


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Id: biblio-1051332
Autor: Lemos, Cleidiel Aparecido Araujo.
Título: Análise biomecânica de próteses implantossuportadas variando a conexão, o sistema de retenção, material restaurador, tipo e o nível do tecido ósseo: estudo pelo método dos elementos finitos tridimensionais / Biomechanical analysis of implant-supported prostheses varying the connection, retention system, restorative material, type and level of bone tissue: study by the methods of finite three-dimensional elements.
Fonte: Araçatuba; s.n; 2019. 160 p. ilus, tab, graf.
Idioma: pt.
Tese: Apresentada a Universidade Estadual Paulista "Julio de Mesquita Filho". Faculdade de Odontologia de Araçatuba para obtenção do grau de Doutor.
Resumo: Este projeto teve como objetivo analisar as tensões geradas em próteses implantossuportadas fixa unitária variando o sistema de conexão implante/prótese, o sistema de retenção, material restaurador, tipo ósseo, e o nível de tecido ósseo ao redor do implante através do método dos elementos finitos tridimensionais, e realizar uma revisão sistemática com meta-análise sobre o tema osteoporose em relação a taxa de sobrevivência e perda óssea marginal ao redor dos implantes dentários. Em relação à metodologia experimental, foram simulados 24 modelos tridimensionais com ajuda dos programas de desenho assistido Rhinoceros 3D 4.0 (NURBS Modeling for Windows, USA) e SolidWorks 2011 (SolidWorks Corp, USA), e para confecção da porção óssea será utilizado o programa InVesalius (CTI, São Paulo, Brasil). Cada modelo representou uma secção de osso da região posterior maxilar, na forma de um bloco ósseo tipo IV (normal e osteoporótico), variando o nível de reabsorção do tecido ósseo (a nível do pescoço do implante; perda de 1,5 mm; perda de 3,0 mm; e perda de 4,5 mm) com a presença de um implante de 4,0 mm de diâmetro e 10 mm de comprimento com diferentes tipos de conexão (hexágono externo e cone morse), restaurado com coroas (metalocerâmicas e/ou metal free) com diferentes sistemas de retenção (cimentada e/ou parafusada). Os desenhos tridimensionais foram exportados ao programa de pré e pós processamento FEMAP v.11.2 (Siemens Product Lifecycle Management Software Inc. USA) para geração da malha e aplicação de uma carga de 200N axial e 100N oblíqua (45°) simulando um carregamento nas vertentes internas de cada cúspide da coroa. A análise foi realizada no programa de elementos finitos NEiNastran 11 (Noran Engineering, Inc., EUA) e os resultados serão visualizados através de mapas de tensão von Mises e deslocamento para avaliação das tensões sobre os implantes/componentes e tensão máxima principal, microdeformação e deslocamento para avaliação das tensões no tecido ósseo no tecido ósseo em cada modelo proposto no programa FEMAP v.11.2. Os resultados do capítulo 1, verificaram que a perda do tecido ósseo progressiva apresentou influência na distribuição das tensões na região do tecido ósseo, implantes e componentes. A qualidade do osso afetou apenas os valores de microdeformação, principalmente, no tecido ósseo trabeculado. Os implantes cone Morse apresentaram menores concentrações de tensões na região de tecido ósseo comparado aos implantes de hexágono externo, somente para os modelos sem perda óssea. Os implantes de hexágono externo apresentaram pior comportamento biomecânico nos implantes e parafuso de fixação, principalmente no carregamento oblíquo. Em relação ao capítulo 2 foi possível verificar que os implantes do tipo cone Morse apresentam melhor comportamento biomecânico na região de tecido ósseo cortical e parafuso de fixação em relação aos implantes de hexágono externo em relação as próteses fixas implantossuportadas parafusadas. As próteses cimentadas apresentam uma ligeira redução no tecido ósseo cortical, porém, com maior sobrecarga no parafuso de fixação dos implantes de hexágono externo. Os diferentes materiais restauradores não influenciam no comportamento biomecânico das estruturas. No capítulo 3 após a condução sistematizada das buscas, um total de cinco estudos foram incluídos para tabulação dos resultados. Após a realização da meta-análise foi observado que os implantes dentários devem ser considerados uma alternativa de tratamento viável para a reabilitação de pacientes com osteoporose, porém, cuidados clínicos são necessários aos profissionais para garantir a manutenção da estabilidade óssea periimplantar(AU)

The aim of this thesis was to perform the analysis on the stress distribution for implant-supported fixed prostheses varying the implant-abutment connection system, the fixation system, restorative material, bone type, and the level of bone tissue around the dental implant using the finite element method. Furthermore, the aim was to perform a systematic review and meta-analysis about the effect of osteoporosis in terms of implants survival rate and marginal bone loss. In relation to the experimental methodology, 24 three-dimensional models were simulated with the aid of the Rhinoceros 3D 4.0 (NURBS Modeling for Windows, USA), SolidWorks 2011, and InVesalius (CTI, São Paulo, Brazil) softwares. Each model represented a bone section of the maxillary posterior area (bone type IV) (normal and osteoporotic), varying the level of bone resorption (at the level of the implant, loss of bone tissue in 1.5 mm, loss of bone tissue in 3.0 mm and loss of bone tissue in 4.5 mm). All models containing the presence of a dental implant with 4.0 mm in diameter and 10 mm in length with two different abutment-implant connection (external hexagon and Morse taper), restored with crowns (metaloceramic and/or monolithic) with different fixation system (cemented and/or screwed). The designs were exported to FEMAP v.11.2 pre-and post-processing software (Siemens Product Lifecycle Management Software Inc. USA) for mesh generation and loading application of 200N axial and 100N oblique (45° in the long axis of implant, suppressing lingual cusps) in the slopes each cusp of the crown. The analysis was performed in the NEiNastran 11 (Noran Engineering, Inc., USA) and the results will be imported to FEMAP 11.2 through von Mises stress maps (implants and components) and maximum principal stress and microdeformation (bone tissue). The results of chapter 1 showed that the progressive loss of the bone tissue showed an influence on the stress distribution in the bone tissue, implants and components. The quality of the bone tissue (osteoporosis) affected only the microdeformation, mainly in the trabecular bone tissue. Morse taper implants showed lower stress concentrations in the bone tissue compared to external hexagon implants, only for models without bone loss. The external hexagon implants presented worse biomechanical behavior in the implants and screw fixation, especially in oblique loading. Regarding to chapter 2, it was possible to verify that Morse taper implants showed better biomechanical behavior area of cortical bone tissue and screw fixation compared to external hexagon implants for screwed prostheses. The cemented prostheses showed a slight reduction of stress in the cortical bone tissue; however, with greater stress in the fixation screw for the external hexagon implants. The type of restorative materials (metalceramic and/or monolithic) did not affect the biomechanical behavior of the structures. In chapter 3 after systematic review, a total of five studies were included for tabulation of the data. After performing the meta-analysis it was observed that dental implants should be considered as a viable treatment alternative for the rehabilitation of patients with osteoporosis; however, clinical care is necessary to guarantee the maintenance of peri-implant bone stability, due to high marginal bone loss was observed for patients with osteoporosis(AU)
Descritores: Estresse Mecânico
Prótese Dentária Fixada por Implante
-Fenômenos Biomecânicos
Implantes Dentários
Prótese Dentária
Análise de Elementos Finitos
Responsável: BR186.1 - Biblioteca Honório Monteiro
BR186.1


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Id: biblio-1018646
Autor: Mazó de López, María Gabriela.
Título: Biomecánica en ortodoncia / Biomechanics in Orthodontics.
Fonte: Asunción; s.e; 2010.Oct. 61 p. ilus.
Idioma: es.
Resumo: La biomecánica es uno de los pilares más importante de la ortodoncia, y, los principios biomecánicos fundamentales, para comprender los mecanismos de acción de los aparatos ortodónticos y del tratamiento ortodóntico en si. La importancia de conocer bien estos principios fue recalcada por Nanda (1998) con la siguiente frase: " La aplicación cognitiva de los conceptos biomecánicos en la atención ortodóntica puede ser beneficiosa para lograr un tratamiento eficiente y eficaz. Objetivo: La comprensión de la biomecánica del tratamiento ortodóntico, para una planificación y aplicación de fuerzas más precisas sobre el diente y tejidos de soporte con el mínimo efecto colateral. Propósito: La aplicación de los principios biomecánicos por parte de los profesionales en el tratamiento ortodóntico para obtener resultados equilibrados en cuanto a función y estética..
Descritores: Fenômenos Biomecânicos
Mecânica
Odontologia
Ortodontia
Limites: Seres Humanos
Tipo de Publ: Revisão
Responsável: PY8.1 - Biblioteca
PY8.1; 617.643, M33b


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Id: lil-745816
Autor: Cebolla, Elaine C; Rodacki, André L. F; Bento, Paulo C. B.
Título: Balance, gait, functionality and strength: comparison between elderly fallers and non-fallers
Fonte: Braz. j. phys. ther. (Impr.) = Rev. bras. fisioter;19(2):146-151, 27/04/2015. tab, graf.
Idioma: en.
Resumo: BACKGROUND: Accidental falls are a major health problem related to aging and affect one in every three elderly individuals over the age of sixty. OBJECTIVE: To evaluate and compare the muscle strength, gait kinematics parameters, and performance in functional tests between elderly subjects with and without a prior history of falls. In addition, the association between the history of falls and the variables that demonstrated differences between groups were tested. METHOD: 62 elderly subjects participated in the study and were allocated to the group with falls history (FG; n=20; 68.0±6.9 years old) or the group without falls history (CG; n=42; 65.5±4.1 years old). Maximal strength, gait kinematics parameters, and functional tests were tested. RESULTS: The FG showed lower muscle strength in the knee flexors (51.45±8.6 vs. 62.09±19 Kg), lower average toe clearance during the swing phase (0.04±0.006 vs. 0.043 ± 0.005 m), and lower performance in the "8-foot up-and-go" test (5.3±0.7 vs. 5.8±0.7 s) (p<0.05). There were no associations between any variables and falls, but the increased time in the "8-foot up-and-go" test may double the likelihood of a fall occurring. CONCLUSION: Fallers have reduced lower limb strength, gait alterations, the worst performance in the dynamic balance test, and an increased risk of falls. .
Descritores: Acidentes por Quedas
Equilíbrio Postural/fisiologia
Força Muscular/fisiologia
Marcha/fisiologia
-Fenômenos Biomecânicos
Estudos Retrospectivos
Limites: Seres Humanos
Masculino
Feminino
Idoso
Responsável: BR1.1 - BIREME


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Id: lil-764132
Autor: Evans, Kerrie; Tuttle, Neil.
Título: Improving performance in golf: current research and implications from a clinical perspective
Fonte: Braz. j. phys. ther. (Impr.) = Rev. bras. fisioter;19(5):381-389, Sept.-Oct. 2015. graf.
Idioma: en.
Resumo: ABSTRACTGolf, a global sport enjoyed by people of all ages and abilities, involves relatively long periods of low intensity exercise interspersed with short bursts of high intensity activity. To meet the physical demands of full swing shots and the mental and physical demands of putting and walking the course, it is frequently recommended that golfers undertake golf-specific exercise programs. Biomechanics, motor learning, and motor control research has increased the understanding of the physical requirements of the game, and using this knowledge, exercise programs aimed at improving golf performance have been developed. However, while it is generally accepted that an exercise program can improve a golfer's physical measurements and some golf performance variables, translating the findings from research into clinical practice to optimise an individual golfer's performance remains challenging. This paper discusses how biomechanical and motor control research has informed current practice and discusses how emerging sophisticated tools and research designs may better assist golfers improve their performance.
Descritores: Desempenho Atlético/fisiologia
Golfe/psicologia
-Fenômenos Biomecânicos
Amplitude de Movimento Articular
Movimento/fisiologia
Limites: Seres Humanos
Responsável: BR1.1 - BIREME


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Id: lil-764131
Autor: Hewett, Timothy E; Roewer, Benjamin; Ford, Kevin; Myer, Greg.
Título: Multicenter trial of motion analysis for injury risk prediction: lessons learned from prospective longitudinal large cohort combined biomechanical - epidemiological studies
Fonte: Braz. j. phys. ther. (Impr.) = Rev. bras. fisioter;19(5):398-409, Sept.-Oct. 2015. tab, graf.
Idioma: en.
Resumo: ABSTRACTOur biodynamics laboratory group has conducted large cohort biomechanical-epidemiological studies targeted at identifying the complex interactions among biomechanical, biological, hormonal, and psychosocial factors that lead to increased risk of anterior cruciate ligament (ACL) injuries. The findings from our studies have revealed highly sensitive and specific predictors for ACL injury. Despite the high incidence of ACL injuries among young athletes, larger cohorts are needed to reveal the underlying mechanistic causes of increased risk for ACL injury. In the current study, we have outlined key factors that contribute to the overall success of multicenter, biomechanical-epidemiological investigations designed to test a larger number of athletes who otherwise could not be recruited, screened, or tested at a single institution. Twenty-five female volleyball players were recruited from a single high school team and tested at three biodynamics laboratories. All athletes underwent three-dimensional motion capture analysis of a drop vertical jump task. Kinematic and kinetic variables were compared within and among laboratories. Reliability of peak kinematic variables was consistently rated good-to-excellent. Reliability of peak kinetic variables was consistently rated goodto-excellent within sites, but greater variability was observed between sites. Variables measured in the sagittal plane were typically more reliable than variables measured in the coronal and transverse planes. This study documents the reliability of biomechanical variables that are key to identification of ACL injury mechanisms and of athletes at high risk. These findings indicate the feasibility of executing multicenter, biomechanical investigations that can yield more robust, reliable, and generalizable findings across larger cohorts of athletes.
Descritores: Lesões do Ligamento Cruzado Anterior
Articulação do Joelho/fisiologia
-Fenômenos Biomecânicos
Estudos Epidemiológicos
Estudos Prospectivos
Reprodutibilidade dos Testes
Atletas
Limites: Seres Humanos
Responsável: BR1.1 - BIREME


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Id: lil-764124
Autor: Cools, Ann M; Johansson, Fredrik R; Borms, Dorien; Maenhout, Annelies.
Título: Prevention of shoulder injuries in overhead athletes: a science-based approach
Fonte: Braz. j. phys. ther. (Impr.) = Rev. bras. fisioter;19(5):331-339, Sept.-Oct. 2015. graf.
Idioma: en.
Resumo: The shoulder is at high risk for injury during overhead sports, in particular in throwing or hitting activities, such as baseball, tennis, handball, and volleyball. In order to create a scientific basis for the prevention of recurrent injuries in overhead athletes, four steps need to be undertaken: (1) risk factors for injury and re-injury need to be defined; (2) established risk factors may be used as return-to-play criteria, with cut-off values based on normative databases; (3) these variables need to be measured using reliable, valid assessment tools and procedures; and (4) preventative training programs need to be designed and implemented into the training program of the athlete in order to prevent re-injury. In general, three risk factors have been defined that may form the basis for recommendations for the prevention of recurrent injury and return to play after injury: glenohumeral internal-rotation deficit (GIRD); rotator cuff strength, in particular the strength of the external rotators; and scapular dyskinesis, in particular scapular position and strength.
Descritores: Traumatismos em Atletas/prevenção & controle
Articulação do Ombro/fisiologia
Manguito Rotador/fisiopatologia
Força Muscular/fisiologia
Lesões do Ombro/prevenção & controle
-Traumatismos em Atletas/fisiopatologia
Fenômenos Biomecânicos
Atletas
Lesões do Ombro/fisiopatologia
Limites: Seres Humanos
Responsável: BR1.1 - BIREME


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Id: lil-792715
Autor: Magalhães, Cristiana M; Fregonezi, Guilherme A; Vidigal-Lopes, Mauro; Vieira, Bruna S. P. P; Vieira, Danielle S. R; Parreira, Verônica F.
Título: Effects of non-invasive ventilation and posture on chest wall volumes and motion in patients with amyotrophic lateral sclerosis: a case series
Fonte: Braz. j. phys. ther. (Impr.) = Rev. bras. fisioter;20(4):336-344, July-Aug. 2016. tab, graf.
Idioma: en.
Projeto: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior; . Conselho Nacional de Desenvolvimento Científico e Tecnológico; . Fundação de Amparo à Pesquisa do Estado de Minas Gerais.
Resumo: ABSTRACT Background The effects of non-invasive ventilation (NIV) on the breathing pattern and thoracoabdominal motion of patients with amyotrophic lateral sclerosis (ALS) are unknown. Objectives 1) To analyze the influence of NIV on chest wall volumes and motion assessed by optoelectronic plethysmography in ALS patients and 2) to compare these parameters in the supine and sitting positions to those of healthy individuals (without NIV). Method Nine ALS patients were evaluated in the supine position using NIV. In addition, the ALS patients and nine healthy individuals were evaluated in both sitting and supine positions. Statistical analysis was performed using the paired Student t-test or Wilcoxon test and the Student t-test for independent samples or Mann-Whitney U test. Results Chest wall volume increased significantly with NIV, mean volume=0.43 (SD=0.16)L versus 0.57 (SD=0.19)L (p=0.04). No significant changes were observed for the pulmonary rib cage, abdominal rib cage, or abdominal contribution. The index of the shortening velocity of the diaphragmatic muscle, mean=0.15 (SD=0.05)L/s versus 0.21 (SD=0.05)L/s (p<0.01), and abdominal muscles, mean=0.09 (SD=0.02)L/s versus 0.14 (SD=0.06)L/s (p<0.01), increased during NIV. Comparisons between the supine and sitting positions showed similar changes in chest wall motion in both groups. However, the ALS patients presented a significantly lower contribution of the abdomen in the supine position compared with the controls, mean=56 (SD=13) versus 69 (SD=10) (p=0.02). Conclusions NIV improved chest wall volumes without changing the contribution of the chest wall compartment in ALS patients. In the supine position, ALS patients had a lower contribution of the abdomen, which may indicate early diaphragmatic dysfunction.
Descritores: Postura/fisiologia
Mecânica Respiratória/fisiologia
Parede Torácica/fisiologia
Ventilação não Invasiva
Esclerose Amiotrófica Lateral/fisiopatologia
-Pletismografia
Fenômenos Biomecânicos
Limites: Seres Humanos
Responsável: BR1.1 - BIREME


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Id: lil-783878
Autor: Rosa, Dayana P; Borstad, John D; Pires, Elisa D; Camargo, Paula R.
Título: Reliability of measuring pectoralis minor muscle resting length in subjects with and without signs of shoulder impingement
Fonte: Braz. j. phys. ther. (Impr.) = Rev. bras. fisioter;20(2):176-183, Mar.-Apr. 2016. tab, graf.
Idioma: en.
Projeto: Fundação de Amparo à Pesquisa do Estado de São Paulo.
Resumo: Background: Pectoralis minor adaptive shortening may change scapula resting position and scapular kinematics during arm elevation. A reliable and clinically feasible method for measuring pectoralis minor length will be useful for clinical decision making when evaluating and treating individuals with shoulder pain and dysfunction. Objectives: To evaluate intrarater, interrater, and between-day reliability of a pectoralis minor (PM) muscle length measurement in subjects with and without signs of shoulder impingement. Method: A convenience sample of 100 individuals (50 asymptomatic and 50 symptomatic) participated in this study. Intra- and interrater reliability of the measurement was estimated in 50 individuals (25 asymptomatic and 25 symptomatic), and between-day reliability of the measurement repeated over an interval of 7 days was estimated in an independent sample of 50 additional participants. Pectoralis minor length was measured using a flexible tape measure with subjects standing. Results: Intraclass correlation coefficients (ICC3,k) for intrarater and interrater reliability ranged from 0.86-0.97 and 0.95 for between-day reliability in both groups. Standard error of measurements (SEM) ranged from 0.30-0.42 cm, 0.70-0.84 cm, and 0.40-0.41 cm for intrarater, interrater, and between-day reliability, respectively, across the sample. The minimal detectable change (MDC) for between-day measurements ranged from 1.13-1.14 cm for both groups. Conclusions: In asymptomatic individuals and in those with signs of shoulder impingement, a single rater or pair of raters can measure pectoralis minor muscle length using a tape measure with very good reliability. This measurement can also be reliably used by the same rater over a seven day interval.
Descritores: Músculos Peitorais
Exame Físico/métodos
Ombro/fisiologia
Amplitude de Movimento Articular
Síndrome de Colisão do Ombro/diagnóstico
Dor de Ombro/fisiopatologia
-Fenômenos Biomecânicos
Limites: Seres Humanos
Responsável: BR1.1 - BIREME


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Id: biblio-828284
Autor: DiLiberto, Frank E; Baumhauer, Judith F; Nawoczenski, Deborah A.
Título: The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice
Fonte: Braz. j. phys. ther. (Impr.) = Rev. bras. fisioter;20(5):375-383, Sept.-Oct. 2016. graf.
Idioma: en.
Resumo: ABSTRACT Background Implementation of interprofessional clinical guidelines for the prevention of neuropathic diabetic foot ulceration has demonstrated positive effects regarding ulceration and amputation rates. Current foot care recommendations are primarily based on research regarding the prevention of ulcer recurrence and focused on reducing the magnitude of plantar stress (pressure overload). Yet, foot ulceration remains to be a prevalent and debilitating consequence of Diabetes Mellitus. There is limited evidence targeting the prevention of first-time ulceration, and there is a need to consider additional factors of plantar stress to supplement current guidelines. Objectives The first purpose of this article is to discuss the biomechanical theory underpinning diabetic foot ulcerations and illustrate how plantar tissue underloading may precede overloading and breakdown. The second purpose of this commentary is to discuss how advances in biomechanical foot modeling can inform clinical practice in the prevention of first-time ulceration. Discussion Research demonstrates that progressive weight-bearing activity programs to address the frequency of plantar stress and avoid underloading do not increase ulceration risk. Multi-segment foot modeling studies indicate that dynamic foot function of the midfoot and forefoot is compromised in people with diabetes. Emerging research demonstrates that implementation of foot-specific exercises may positively influence dynamic foot function and improve plantar stress in people with diabetes. Conclusion Continued work is needed to determine how to best design and integrate activity recommendations and foot-specific exercise programs into the current interprofessional paradigm for the prevention of first-time ulceration in people with Diabetes Mellitus.
Descritores: Úlcera do Pé/fisiopatologia
Pé Diabético/fisiopatologia
-Fenômenos Biomecânicos
Úlcera do Pé/etiologia
Pé Diabético/etiologia
Neuropatias Diabéticas/etiologia
Amputação
Limites: Seres Humanos
Responsável: BR1.1 - BIREME



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