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BACKGROUND AND PURPOSE: With the increase in the percentage of the population in older adulthood, issues such as frailty syndrome need to be considered. The aim of the present study was to evaluate the ability of the Balance Evaluation Systems Test (BESTest) and center of pressure (COP) in their ability to discriminate between nonfrail, prefrail, and frail older adults. The proposed hypothesis is that frail older adults would show poorer performance in BESTest tasks and higher oscillation of COP on a force platform. METHODS: Sixty older adults 65 years or older were divided into 3 groups of 20: group 1, nonfrail; group 2, prefrail; and group 3, frail. The prefrail and frail identifications were made by Fried's 5 frailty phenotype criteria. Balance was assessed using the BESTest and a force platform in 6 positions: (1) fixed platform with eyes open; (2) fixed platform with eyes closed; (3) unstable platform with foam, with eyes open; (4) unstable platform, with eyes closed; (5) semitandem with eyes open; and (6) semitandem with eyes closed. RESULTS: Frail older adults had lower scores in all sections and in the total score of the BESTest, indicating worse performance in the tasks. However, on the force platform, the frail older adults did not show higher oscillations, having similar mean values when compared with the prefrail and nonfrail older adults, indicating similar behavior of COP. CONCLUSION: The BESTest seems to be more appropriate than a force plate for assessing postural control impairment and discriminating balance performance among frail, prefrail, and nonfrail older adults, providing information about different components of postural control rather than the force plate, which evaluates sensory orientation.

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BACKGROUND: The previous studies have investigated causes of and risk factors for falls and impairment of functional capability in older adults. However, the biomechanical factors involved in functional performance and postural control, and the contribution of hip muscles, are still unknown. AIMS: The aim of the present study was to verify the association between the muscle function of hip abductors and adductors and static and dynamic balance, in a narrow base of support, in community-dwelling older adults. METHODS: Eighty-one older adults, including both women and men, were evaluated. Tandem gait and single-leg stance were used to assess static and dynamic balance, and an isokinetic dynamometer was used to analyze muscle function (peak torque and rate of torque development according to body weight). Data were analyzed by a multivariate linear regression test without adjustment and with adjustment using two models: adjustment I (sex) and adjustment II (age). RESULTS: There was a statistically significant association between peak torque of abductor in single-leg stance and tandem gait speed. The PT of hip adductors contributed to static balance performance, in a narrow base of support from the unadjusted data and from the adjusted data by sex. CONCLUSION: The findings of the present study are relevant, because if deficits in balance and functionality in older adults can be linked to a decline in maximum muscle strength of hip abductors, this parameter can be treated to maintain independence in older adults for as long as possible.

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Objective: To evaluate the effects of individual and combination therapies (low-level laser therapy and physical exercises) on pain, stiffness, function, and spatiotemporal gait variables in subjects with bilateral knee osteoarthritis (OA).Methods: Subjects with knee OA (Grades 1-3) were evaluated and randomized into four groups: Control Group (CG), untreated; Laser Group (LG), treated with laser at 808 nm, 5.6 J; Exercise Group (EG), treated with exercise; and Laser + Exercise Group (LEG), treated with laser and exercises. The treatment was carried out twice a week for 2 months. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was applied for evaluation and reevaluation; evaluation of spatiotemporal gait variables was performed using GAITRite equipment.Results: The EG showed significant improvement in pain (p = 0.006) and function (p = 0.01) according to WOMAC. Regarding gait variables, in intergroup analysis after 8 weeks all groups receiving intervention showed a significant increase in gait speed: LG versus CG (p = 0.03); EG versus CG (p = 0.04) and LEG versus CG (p = 0.005). Only the group treated with laser + exercise showed a significant increase (p = 0.009) in the cadence and duration of single right limb support (p = 0.04), and only the groups treated with exercise and laser + exercise showed significant decreases in the duration of right limb support (p = 0.035 and p = 0.003, respectively), compared to the CG.Conclusions: The group treated only with exercise showed improvement in WOMAC questionnaire scores. Regarding the gait variables, all groups undergoing the interventions showed increases in the gait speed compared to the CG. The laser and exercise combination therapy provided the best results for the other gait variables (cadence and duration of right limb support and duration of single right limb support).Implications for rehabilitationThere are differences in gait patterns in patients with knee OA, including decreased gait speed, cadence, and step length.The results shown in the present study provide additional information about the physical therapy approaches that should be chosen during clinical practical to improve gait performance in individuals with knee osteoarthritis.The improvement in gait performance is a relevant issue due to the fact that is associated to physical independence and better quality of life.

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O comprometimento do desempenho funcional observado durante o processo de envelhecimento, associado às demandas socioeconômicas, são motivos que levam à institucionalização de idosos. Entretanto, a institucionalização geralmente acarreta em maior declínio funcional, mesmo em idosos com preservação da independência. Assim, entender melhor o impacto deste contexto ambiental sobre a funcionalidade é importante para auxiliar nas estratégias necessárias para a manutenção do desempenho funcional de idosos. O objetivo do estudo foi comparar o desempenho funcional de idosos independentes para a marcha entre moradores ou não de Instituição de Longa Permanência para Idosos (ILPI). Participaram do estudo 20 idosos da comunidade e 29 idosos institucionalizados, de ambos os sexos, sem declínio cognitivo. O desempenho funcional foi avaliado pela Escala de Equilíbrio Funcional de Berg - Berg Balance Scale (BBS), pelo Dynamic Gait Index (DGI), pela Performance-Oriented Mobility Assessment of Gait and Balance (POMA) e pelo Timed Up and Go Test (TUG), e a depressão foi avaliada pelo Geriatric Depression Scale (GDS). Os resultados apontaram que os idosos institucionalizados apresentaram maior comprometimento da mobilidade, equilíbrio e marcha em comparação com os idosos da comunidade, o que pode ser explicado pelo contexto social em que estão inseridos. (AU)

The impairment of functional capacity observed during the aging process, associated with socioeconomic demands, is the reason of elderly is institutionalized. However, the institutionalization commonly leads to a rise of functional decline, even in old people with preserved independence. Thus, it is important to understand the impact of this behavioral context on functionality to assist with strategies to maintain functional capacity in elderly. The main of this study was to compare the functional capacity of independent elderly to the gait between dwellers or not in long-stay institution for elderly. Twenty community-dwelling elderly and twenty-nine institutionalized elderly, males and females, without cognitive impairment were evaluated. The functional capacity was analyzed by Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Performance-Oriented Mobility Assessment of Gait and Balance (POMA) and Timed Up and Go Test (TUG), and the depression levels was assessed by Geriatric Depression Scale (GDS). The results have shown that the institutionalized elderly had more mobility, balance and gait impairment than community-dwelling elderly, which could be explained by the social context where the elderly are inserted. (AU)

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Abstract Objective: The aim of the present study was to evaluate the influence of a balance training program on the semi-static balance of elderly persons by comparing a supervised group with individual home-based application. Method: A blinded randomized controlled multi-arm trial was conducted. The elderly individuals were randomized into: Supervised Group (SG; n=18); Domiciliary Group (DG; n=20) and Control Group (CG; n=18). The SG and DG participated in twice weekly training sessions for 10 weeks. A posturography evaluation was performed based on velocity, anterior-posterior (AP) and medial-lateral (ML) medial amplitude variables in firm surface with eyes open (FSEO) and closed (FSEC), tandem stance with eyes open (Tandem EO) and closed (Tandem EC), and single-leg stance (SL) situations. Two-way ANOVA and Tukey's post-hoc were used for parametric data, the Friedman and Wilcoxon post-hoc tests were used for intragroup analysis and the Kruskal-Wallis and Mann-Whitney post-hoc tests were used for intergroup analysis. Results: In intergroup analysis, the DG group showed improvement in body sway in the Tandem EC (velocity and medial amplitude AP) and single-leg stance (medial amplitude ML) situations. The SG showed a decline in the Tandem EO situation in all the variables. In intergroup analysis, the DG showed improvement in the FSEO position (medial amplitude ML), in the Tandem EC position (medial velocity ML), and the single-leg stance position (medial amplitude AP and ML). The SG showed improvement in the FSEO position (medial amplitude ML) and the single-leg stance position (medial amplitude AP), but showed a decline in the FSEO (variable medial velocity AP) and Tandem EO position (medial amplitude AP). Conclusion: The exercises were beneficial for the balance of the elderly individuals, with the DG presenting the best results. REBEC: RBR-3S9M65.

Resumo Objetivo: Avaliar o efeito de um programa de treinamento sobre o equilíbrio semiestático de idosos, comparando a forma de aplicação supervisionada em grupo e individual domiciliar. Método: Ensaio clínico cego randomizado controlado com múltiplos braços. Idosos randomizados em Grupo Supervisionado (GS; n=18); Grupo Domiciliar (GD; n=20) e Grupo Controle (GC; n=18). O GS e o GD participaram do treinamento por 10 semanas, duas vezes por semana. O equilíbrio foi avaliado pela posturografia [variáveis velocidade e amplitude média antero-posterior (AP) e médio-lateral (ML)] nas situações: plataforma fixa olhos abertos (PFOA), plataforma fixa olhos fechados (PFOF), tandem olhos abertos (Tandem OA), tandem olhos fechados (Tandem OF) e Unipodal. ANOVA two-way e post-hoc de Tukey foram utilizados nos dados paramétricos, teste de Friedman e post-hoc de Wilcoxon para análise intragrupos e teste de Kruskal-Wallis e post-hoc de Mann-Whitney para análise intergrupos. Resultados: Na análise intragrupo, o GD apresentou melhora na oscilação corporal pós-treinamento nas posições Tandem OF (velocidade e amplitude média AP) e Unipodal (amplitude média ML). O GS apresentou piora na posição Tandem OA em todas as variáveis. Na análise intergrupo, o GD apresentou melhora na posição PFOA (amplitude média ML), Tandem OF (velocidade média ML) e Unipodal (amplitude média AP e ML). Já o GS apresentou melhora na posição PFOA (amplitude média ML) e Unipodal (amplitude média AP), contudo apresentou piora na posição PFOA (variável velocidade média AP) e na Tandem OA (amplitude média AP). Conclusão: Os exercícios proporcionaram benefícios para o equilíbrio dos idosos investigados, embora o GD tenha apresentado os melhores resultados. REBEC: RBR-3S9M65.

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OBJECTIVE: The aim of this study was to analyze the effects of low-level laser therapy (LLLT) when associated with treadmill training on the recovery of skeletal muscle, during two periods of rest after muscle injury in rats. BACKGROUND DATA: Because of photostimulation, LLLT has been presented as an alternative for accelerating the tissue healing process. MATERIALS AND METHODS: Forty rats were divided into two groups (A and B) containing four subgroups each: GC (Control Group)-cryolesion untreated; EG (Exercise Group)-cryolesion treated with physical exercise; LG (Laser Group)-cryolesion treated with laser; ELG (Exercise and Laser Group)-cryolesion treated with laser and physical exercise. The right tibialis anterior (TA) of the middle belly was injured by a cooling iron bar (cryoinjury). Group A remained at rest for 3 days, whereas Group B remained at rest for 7 days. The laser parameters utilized were 780 nm with 15 mW average optical power and spot size of 0.04 cm(2) applied during 10 sec, leading to 0.152 J and 3.8 J/cm(2). Treadmill training with and without laser application was performed during 5 days, with each session lasting for 12 min at a velocity of 17 m/min. Subsequently, the TA muscle was removed for a histological and morphometric analysis. RESULTS: The damaged area was significantly smaller for the ELG at both periods of rest, 3 and 7 days, respectively (4.4 ± 0.42% and 3.5 ± 0.14%, p < 0.05), when compared with the LG (18.6 ± 0.64% and 7.5 ± 0.13%), the EG (21 ± 0.26% and 8.7 ± 0.32%), and the CG (23.9 ± 0.37% and 21.4 ± 0.38%). In addition, the number of blood vessels were significantly higher for the ELG at both periods of rest, 3 and 7 days, respectively (71.2 ± 13.51 and 104.5 ± 11.78, p < 0.05), when compared with the LG (60.6 ± 11.25 and 93.5 ± 16.87), the EG (51.6 ± 7.3 and 93.8 ± 15.1) and the CG (34.4 ± 2.54 and 65.7 ± 14.1). CONCLUSIONS: The LLLT applied before the physical exercise on the treadmill stimulated the angiogenesis and accelerated the process of muscle recovery.

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AIM: A number of studies have explored possible relationships, behavior, and meanings of spatial and temporal gait variables in frail and pre-frail older adults, particularly the gait speed variable. However, it is necessary to know the relationship of other spatial and temporal gait variables of pre-frail older adults. Thus, the objective of the present study was to evaluate and compare gait standards between pre-frail and non-frail older people. METHODS: A total of 69 older adults aged 60 year and older, divided into two groups, non-frail (n = 42) and pre-frail (n = 27), were evaluated. Gait parameters were analyzed using the GAITRite® Platinum 26' Portable Walkway System. RESULTS: Pre-frail older people had smaller step lengths (P = 0.041), larger base of support (P = 0.040), lower speed (P = 0.019), lower single support percentage (P = 0.033) and higher double support percentage (P = 0.036), compared with non-frail older people. A history of falls was correlated to lower gait speed and step length in pre-frail older adults. CONCLUSIONS: Identifying pre-frail older people could have significant clinical consequences, as frailty is a dynamic process, and such individuals can therefore progress into a state of frailty or revert to a non-frail state. Therefore, the identification of gait variables in pre-frail older people can be an important tool to recognize gait deficits and to initiate the appropriate treatment. Geriatr Gerontol Int 2016; 16: 1102-1108.

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The main purpose of the present study was to investigate the effects of low-level laser therapy (LLLT) used in two different fluencies on injured skeletal muscle after cryolesion by means of histopathological analysis and immunohistochemistry for COX-2. A total of sixty male Wistar rats were randomly distributed into three groups: injured animals without any treatment; 808 nm laser treated group, at 10 J/cm² and 808 nm laser treated group, at 50 J/cm². Each group was divided into two different subgroups (n=10) on days 6 and 13 post-injury. The results showed that the animals irradiated with laser at 10 J/cm² or 50 J/cm² presented the areas with cell infiltrate and pointed out to minor and mild areas with destroyed zones compared with the control group. Also, a COX-2 downregulation was noticed in the groups exposed to laser at two fluences evaluated in this study. Significant statistically differences (p<0.05) were noticed to collagen deposition in the laser treated animals, with the fluence of 50 J/cm² when compared to the other groups on day 13 post-surgery. Taken together, these results suggested that laser therapy could have positive effects on muscle repair in the rats after cryolesion.

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We evaluate the effects of low-level laser therapy (LLLT) on the histological modifications and temporal osteogenic genes expression during the initial phase of bone healing in a model of bone defect in rats. Sixty-four Wistar rats were divided into control and treated groups. Noncritical size bone defects were surgically created at the upper third of the tibia. Laser irradiation (Ga-Al-As laser 830 nm, 30 mW, 0.028 cm², 1.071 W/cm², 1 min and 34 s, 2.8 Joules, 100 J/cm²) was performed for 1, 2, 3, and 5 sessions. Histopathology revealed that treated animals presented higher inflammatory cells recruitment, especially 12 and 36 h postsurgery. Also, a better tissue organization at the site of the injury, with the presence of granulation tissue and new bone formation was observed on days three and five postsurgery in the treated animals. The quantitative real time polymerase chain reaction showed that LLLT produced a significantly increase in mRNA expression of Runx-2, 12 h and three days post-surgery, a significant upregulation of alkaline phosphatase mRNA expression after 36 h and three days post-surgery and a significant increase of osteocalcin mRNA expression after three and five days. We concluded that LLLT modulated the inflammatory process and accelerated bone repair, and this advanced repair pattern in the laser-treated groups may be related to the higher mRNA expression of genes presented by these animals.

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INTRODUCTION: The effects of LLLT were studied during muscle regeneration through gene expression. METHODS: It was evaluated 10 and 50J/cm(2) doses during 7, 14 and 21days post cryoinjury, through histopathological analysis and mRNA MyoD, Myogenin, Vegf and Cox-2 expression. RESULTS: Irradiated groups presented less inflammatory process than control group after 14 and 21days. Cox-2 levels were downregulated in all irradiated groups after 7, 14 and 21days. On day 7, both treated groups had a downregulation of Vegf levels, and an upregulation after 14 and 21days, mainly with 50J/cm(2). The MyoD levels were upregulated with high dose in all periods and with low dose after 21days. Myogenin expression was downregulated in both treated groups after 7days, and was upregulated with 10J/cm(2) after 21days. CONCLUSION: These responses suggest that LLLT can improve the skeletal muscle regeneration through the gene expression stimulation.

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A incontinência urinária (IU) é um problema que afeta mulheres de todas as idades. Este trabalho objetivou verificar a eficácia dos exercícios perineais e da eletroestimulação perineal, associadas à correção postural, como modalidades fisioterapêuticas de intervenção em tres pacientes do sexo feminino , com queixa de IU. A intervenção constou de avaliações fisioterapêuticas, iniciais e finais, consistindo de dados clínicos, exame físico e postural. Foram coletados os seguintes dados: Teste do Absorvente (Pad-Test), Avaliação Funcional do Assolaho Pélvico (AFA) e Escala Visual Análoga (EVA) para sensações de umidade e desconforto. O programa de tratamento constou de 10 sessões fisioterapêuticas utiliando exercícios perineais supervisionados e eletroestimulação perineal. As tres voluntárias foram submetidas a exercícios para o realinhamento do equilíbrio estático pélvico e correção postural, prescritos conforme diagnóstico evidenciado em avaliação fisioterapêutica inicial de cada uma. Após a intervenção, houve diminuição da perda urinária, ganho de força muscular do assoalho pélvico, com melhora do mecanismo esfincterial e diminuição das sensações de unidade e desconforto. A pelve foi estaticamente equilibrada e houve ganho de flexibilidade muscular das cadeias anterior e posterior, indicando uma correção postural. A intervenção proposta neste estudo mostrou-se eficaz no tratamento da IU das tres pacientes

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