Development of a Virtual Game with Android Operating System for the Rehabilitation of Chewing and Swallowing in the Elderly

Introduction With the aging, the orofacial structures may suffer changes related to disorganization of the stomatognathic system, with a reduction in the strength and resistance of the tongue reflecting delays in the handling of the boluses in the mouth and the elevation of the hyolaryngeal complex; it may result in changes in swallowing (presbifagia or dysphagia). Changes in swallowing may be adjuvants for the illness of the elderly with great socioeconomic impact due to the high costs that bring to the public health with prolonged hospitalizations.

Objectives Before it an app was created with a board game for android operating system with the possibility of training in the functions of chewing and swallowing in elderly using biofeedback.

Methodology A hardware was built capable of capturing, conditioning and transmitting the electrical signal of the masseter and supra-hyoid muscles, with surface electrodes, using an interface system scan with four channels for a mobile device with Android operating system via Bluetooth. The electrical signal is received by software through a biogame, which originally held the calibration of the data, being the value range of the strength of the bite ranging from zero to 255 µV. The participant will receive the information to chew and swallow through the simulation of a “virtual farm” with the displacement of a tractor irrigating the earth which will create a plantation. The chewing cycle was standardized in 10 insect chewing’s, five for each side, ending with the swallowing.

Results At the end of the game a report stating: date of the examination, consistency of the food chosen, testing time, masticatory cycles completed and incomplete, maximum and average power of bite and muscle activity of the swallowing of each side.

Conclusion The application with game developed is a promising resource for training of the masticatory muscles and the swallowing of the elderly.

Effects of mental practice strategies associated to physiotherapy on gait and risk of falls in Parkinson’s disease: a pilot study of a randomized clinical trial

Introduction Parkinson’s Disease (PD) is a degenerative disorder that interferes with the voluntary movements due to dysfunction of the basal ganglia and presenting with motor signals, such as the reduction of gait speed. This contributes to an increased risk of falls. In rehabilitation, mental practice (MP) has been shown to promote plastic modulation of neural circuits and improve motor learning, but the results of research with MP in PD are still ambiguous due to the diversity of intervention strategies.

Objectives To compare the effects of MP strategies associated to physiotherapy in gait and risk of falls in PD patients.

Methodology We performed a pilot study of a clinical randomized, single blind, trial, conducted in accordance with the consort checklist. Patients with idiopathic PD were included and allocated to four groups: Control group (CG); Group with mental practice guided by images (MPI); Group with mental practice guided by audio (MPA); group with mental practice without a guide (MPWG). The subjects of the experimental groups were submitted to 15 sessions of physiotherapy and mental practice, while the CG received only physiotherapy. The sessions were held 2 times per week, 40 minutes for physiotherapy and approximately 5-10 minutes for the corresponding mental practice protocol. Spatial-temporal parameters of gait were assessed with the 10 meters Walking Test (TC10m), and the risk of falls was evaluated with the Timed Up and Go (TUG) test.

Results The MPI group showed significant results for the parameters time (p = 0.027) and speed (p = 0.025) when compared with the results of the CG. No main effects for the group were observed concerning cadence and risk of falls had. Groups MPWG and MPA showed no significant results for the TC10m and TUG when compared with the CG.

Conclusion The results of this pilot study suggest that MP guided by images associated to physical therapy was more effective to increase the gait speed than the alternative strategies.

Association among fatigue, sleep disorders and other clinical parameters in Parkinson’s disease

Introduction Fatigue and sleep disorders are common in Parkinson disease (PD) patients. Fatigue is not always clinically recognized because of its subjective character manifested by feelings of extreme tiredness. These non-motor symptoms can occur from the early stages of the disease and tend to persist.

Objectives To evaluate fatigue in patients with PD and the possible association with sleep disorders and other clinical parameters of the PD; and to evaluate the impact of fatigue on quality of life

Methodology A cross-sectional study with 123 patients with PD was implemented. The following instruments were used: Mini Mental State Examination, the Hoehn-Yarh Scale, Beck Depression Inventory, Parkinson’s Disease Quality of Life Questionnaire, Parkinson’s Disease Sleep Scale, Epworth Sleepiness Scale, and Parkinson’s Disease Fatigue Scale.

Results Fatigue was found in 48% of patients. Patients with fatigue presented longer duration of illness, depressive symptoms, cognitive impairment, severity of motor symptoms, excessive daytime sleepiness and nocturnal sleep disorder. Fatigue combined with sleep disorder occurred in 21% of the total sample, being more frequent in females (32% vs 15%) and in patients at more advanced stages of the disease (52% in HY3). The multiple logistic regression analysis indicated that the significant independent variables for the presence of fatigue were: cognition (OR = 1.19 P = 0.02), nocturnal sleep disorder (OR = 1.03 P = 0.0001); among PDSS domains, nocturnal motor symptoms (OR = 1.09 P = 0.0005) and sleep refreshment (OR = 1.11 P = 0.02); among PDQ-39 domains, mobility (OR = 0.9323 P < 0.0001) and body discomfort (OR = 0.9767 P = 0.0428).

Conclusion Fatigue is common in PD, especially in the more advanced stages, and it seems to be associated with the female gender, nocturnal sleep disorder and cognition, having thus a negative impact on the quality of life.

Repercussions of a very active life style in body composition and cardiometabolic parameters of the elderly in a sample of the population of the mid region of the city of recife/Brazil

Introduction Aging is accompanied by changes in body composition and cardio metabolic parameters, which indicate the onset of chronic degenerative diseases such as cardiovascular, coronary and metabolic diseases. The prevention of these diseases in the elderly may depend on changes in risk factors related to life style, with physical activities as one of the most important components for a healthy life style.

Objectives To assess the impact of a very active life style in body composition and cardio metabolic parameters in a sample of the elderly population in the city of Recife.

Methodology A cross-sectional study conducted with the elderly (age ≥ 60 years) that were allocated into two groups of sedentary life style, and very active, according to the variable "physical exercise" of the table of coronary risk (CR) of the Michigan Heart Association, which considers the recreational and occupational effort played by the individual. The variables related to body composition were body weight, body fat percentage (%F), lean body mass, fat mass and body mass index (BMI). The cardio metabolic parameters were obtained from the CR, blood pressure and casual blood glucose. The independent T test and Fishers exact test were used, considering P < 0.05.

Results The sample consisted of 363 elderly people (156 men and 207 women), 61 being very active and 302 sedentary. A significant part of the very active elderly (p = 0.001) was between 60 and 69 years (n = 41 - 69%), and none of the elderly aged ≥ 80 years (n = 21) was categorized as very active. The very active elderly presented body mass (p = 0.01), %F (p = 0.005), fat mass (p = 0.0007), BMI (p = 0.005), casual blood glucose levels (p = 0.003) and CR (p < 0.0001) significantly lower than the sedentary elderly.

Conclusion The elderly with very active life style have body composition and cardio metabolic parameters better than the sedentary elderly of the sample.