3. HOVEDDEL
3.5. D RØFTING AV BISTAND TIL TVANGSINNLEGGELSE
3.6.2. Nonverbal kommunikasjon
Aspectos éticos, desenho experimental e participantes
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Critérios de inclusão e exclusão
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Figura 1. Fluxograma amostral do estudo.*+JUXSRKHPLSDUpWLFR*&JUXSRFRQWUROH)$& Functional Ambulation Category'32& GRHQoDSXOPRQDUREVWUXWLYDFU{QLFD
Procedimentos e Instrumentos de Medida
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Avaliação do nível de atividade e funcionalidade dos grupos
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Ressonância Magnética Nuclear
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Coleta e preparo da amostra de sangue
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Mensuração da concentração sérica de IGF-I e IGFBP-3 por ELISA
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Avaliação isocinética
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Aquisição da atividade muscular por eletromiografia
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Análise Estatística
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RESULTADOS
Caracterização dos Sujeitos
Níveis de atividade, mobilidade, funcionalidade e qualidade de vida
&RQIRUPH D 7DEHOD R *UXSR &RQWUROH DSUHVHQWRX RV VHJXLQWHV YDORUHV UHIHUHQWHV jV GLPHQV}HV Medical Outcomes Study–36 Health Status Measurement (SF-36) FDSDFLGDGH IXQFLRQDODVSHFWRVItVLFRVGRUHVWDGRJHUDOGHVD~GH YLWDOLGDGHDVSHFWRVVRFLDLVDVSHFWRVHPRFLRQDLV HVD~GHPHQWDO(PUHODomRDR*UXSR+HPLSDUpWLFRRHVFRUHPpGLRGRËQGLFH GR 'HVHPSHQKR 0RWRU )XJO0D\HU IRL GH 2V YDORUHV GD Functional
Ambulation CategoryIRUDPQtYHOQ HQtYHOQ 2VYDORUHVGD(VFDODGH $VKZRUWK
0RGLILFDGD IRUDP TXDGULO Q Q Q MRHOKR Q Q Q Q WRUQR]HORQ Q Q Q $SRQWXDomRGD(VFDODGH(TXLOtEULRGH %HUJGR*UXSR+HPLSDUpWLFRIRLGHFRPUHGXomRVLJQLILFDWLYDGRHTXLOtEULRTXDQGR FRPSDUDGRDR*UXSR&RQWUROHTabela 1S
+RXYH XP DXPHQWR VLJQLILFDQWH QR WHPSR GR WHVWH 78* UHDOL]DGR SHOR *UXSR +HPLSDUpWLFRTXDQGRFRPSDUDGRDR*UXSR&RQWUROHTabela 1S(PUHODomRDRWHVWHGH FDPLQKDGDGHPR*UXSR+HPLSDUpWLFRDSUHVHQWRXXPDGLPLQXLomRQDYHORFLGDGHTXDQGR FRPSDUDGRDR*UXSR&RQWUROH 7DEHODS 2YDORUPpGLRGRËQGLFHGH%DUWKHOLQGLFRX XPDOWRQtYHOGHLQGHSHQGr QFLDGXUDQWHDVDWLYLGDGHVGHYLGDGLiULD2YDORUPpGLRGD (VFDODGH4XDOLGDGHGH9 LGD(VSHFtILFDSDUD,QGLYtGXRV+HPLSDUpWLFRVIRLGH LQGLFDQGRXPQtYHOPRGHUDGRGHTXDOLGDGHGHYLGD
Tabela 1 – Descrição demográfica e funcional dos grupos. Variáveis Grupo Controle (n=14) Grupo Hemiparético (n=14) 9DORU3 Idade (anos) Altura (m) Peso Corporal (Kg)
Índice de Massa Corporal
Escala de Equilíbrio de Berg
TUG Test (s) ±
Teste de caminhada 10 m (m/s)
Alcance Funcional
Volume dos músculos flexores e extensores do joelho
$Figura 2pUHSUHVHQWDWLYDGDPHQVXUDomRGRYROXPHPXVFXODUGRVP~VFXORVTXDGUtFHSV H LVTXLRWLELDLV QRV *UXSR &RQWUROH H *UXSR +HPLSDUpWLFR 1DV LPDJHQV GH 5HVVRQkQFLD 0DJQpWLFD1XFOHDUpSRVVtYHOLGHQWLILFDURDXPHQWRGRWHFLGRFRQMXQWLYRHDDWURILDQRVP~VFXORV GRPHPEURSDUpWLFR 2VJUiILFRVGHPRQVWUDPDVGLIHUHQoDVGRYROXPHPXVFXODUHQWUHRVJUXSRV +RXYH GLIHUHQoD VLJQLILFDWLYD QR YROXPH PXVFXODU WRWDO GR TXDGUtFHSV S H GRV LVTXLRVWLELDLVS VRPHQWHHQWUHPHPEURVSDUpWLFRHFRQWUROH9 DORUHVPpGLRVGRYROXPH PXVFXODUWRWDOGRTXDGUtFHSVPHPEURFRQWUROHFPPHPEURQmRSDUpWLFR FPPHPEURSDUpWLFRFPHGRVLVTXLRWLELDLVPHPEURFRQWUROH FPPHPEURQmRSDUpWLFRFPPHPEURSDUpWLFRFP 8PD GLPLQXLomR VLJQLILFDWLYD QR YROXPH GRV P~VFXORV 9 0 S GpILFLW GH 9 , S GpILFLW%)S GpILFLWH66S GpILFLWGRPHPEUR
SDUpWLFRFRPSDUDGRDRPHPEURFRQWUROHIRLLGHQWLILFDGD+RXYHDDWURILDVHOHWLYDGRVP~VFXORV 9 0 9 , %) H 66 QRV PHPEURV SDUpWLFRV 2V P~VFXORV 5) H 9 / DSUHVHQWDUDP YROXPHV VHPHOKDQWHVDRFRQWUROH5)S H9 /S UHVSHFWLYDPHQWH1mRIRUDPREVHUYDGDV GLIHUHQoDVHQWUHRVP~VFXORVGRPHPEURQmRSDUpWLFRHRPHPEURFRQWUROHHHQWUHRPHPEUR SDUpWLFRHRPHPEURQmRSDUpWLFRS!
Figura 2Volume dos músculos extensores e flexores do joelho.0&PHPEURFRQWUROH013PHPEUR QmRSDUpWLFR03PHPEURSDUpWLFR$)LJXUDUHSUHVHQWDWLYDGD510GRJUXSRFRQWUROH*&%)LJXUD UHSUHVHQWDWLYDGD510GR*UXSR+HPLSDUpWLFR*+&9 ROXPHGRVP~VFXORV4XDGUtFHSVUHWRIHPRUDO 5)YDVWRPHGLDO9 0YDVWRLQWHUPpGLR9 ,YDVWRODWHUDO9 /'9 ROXPHGRVP~VFXORVLVTXLRWLELDLV VHPLWHQGLQRVRHVHPLPHPEUDQRVR66HEtFHSVIHPRUDO%) SFRPSDUDGRDR*&1RWHDDWURILD VHOHWLYDGRVP~VFXORV9 09 ,%)H66QRVPHPEURVSDUpWLFRV%DUUDFP
Concentrações séricas de IGF-I e IGFBP-3
$VFRQFHQWUDo}HVVpULFDVGH,*),H,*)%3HVWmRGLPLQXtGDVQR*UXSR+HPLSDUpWLFR TXDQGRFRPSDUDGDVDR*UXSR&RQWUROHS HS UHVSHFWLYDPHQWHFig. 32EVHUYRXVH XPD IRUWH FRUUHODomR HQWUH DV FRQFHQWUDo}HV VpULFDV GH ,*), H GH ,*)%3 QR *UXSR +HPLSDUpWLFR5 S
Figura 3Concentrações séricas de IGF-I e IGFBP-3*&JUXSRFRQWUROH*+*UXSR+HPLSDUpWLFR S FRPSDUDGR D *& 2EVHUYH TXH R *+ DSUHVHQWRX PHQRUHV FRQFHQWUDo}HV VpULFDV GH ,*), H ,*)%3HPFRPSDUDomRDR*&
Torque e Ativação muscular
2V YDORUHV GDV YDULiYHLV LVRFLQpWLFDV VmR DSUHVHQWDGRV QD Tabela 2 +RXYH XPD GLPLQXLomRVLJQLILFDWLYDGR37WUDEDOKRHSRWr QFLDGRVP~VFXORVIOH[RUHVHH[WHQVRUHVGRMRHOKR GR PHPEUR SDUpWLFR HP UHODomR DR PHPEUR QmR SDUpWLFR H DR PHPEUR FRQWUROH QRV PRGRV FRQFr QWULFR H H[Fr QWULFR S Tabela 2 1mR KRXYH GLIHUHQoD GDV YDULiYHLV LVRFLQpWLFDV LQYHVWLJDGDVHQWUHPHPEURQmRSDUpWLFRHPHPEURFRQWUROHS!Tabela 2
(PUHODomRjDWLYDomRPXVFXODUHPFRQWUDo}HVFRQFr QWULFDVFig. 4IRLGHPRQVWUDGRTXH GXUDQWHD H[WHQVmRKiXPPDLRUSLFRGHDWLYDomRGRP~VFXOR5)QRV PHPEURQmRSDUpWLFR H PHPEURSDUpWLFRFRPSDUDGRDPHPEURFRQWUROHSFig. 42EVHUYDVHDLQGDRDXPHQWR GRPDLRUSLFRGHDWLYDomRGRP~VFXOR67QRPHPEURSDUpWLFRGXUDQWHDH[WHQVmRFRQFr QWULFDHP FRPSDUDomRDRPHPEURQmRSDUpWLFRHRPHPEURFRQWUROHSFig. 4(PUHODomRjIOH[mR FRQFr QWULFDIRLGHWHFWDGRXPDXPHQWRGRPDLRUSLFRGHDWLYDomRGRVP~VFXORV5)9 0H9 /QR PHPEURSDUpWLFRHP UHODomR DRPHPEURQmRSDUpWLFRHDRPHPEURFRQWUROHS )LJ 'XUDQWHDH[WHQVmRH[Fr QWULFDKRXYHPDLRUDWLYDomRGRP~VFXOR5)GRPHPEURQmRSDUpWLFRHP UHODomRDRPHPEURFRQWUROHHPHPEURSDUpWLFRSFig. 5$OpPGLVVRIRLREVHUYDGRXP DXPHQWRGRPDLRUSLFR GHDWLYDomRGRP~VFXOR 67GXUDQWHD H[WHQVmRH[Fr QWULFDQRPHPEUR SDUpWLFR HP UHODomR DR PHPEUR FRQWUROH S Fig. 5 1mR KRXYH GLIHUHQoD HQWUH RV PHPEURVGXUDQWHDIOH[mRH[Fr QWULFDS!Fig. 5
Tabela 2 – Desempenho Muscular Isocinético
CONCÊNTRICA