Fisiomares Andrade. PRESIDENTE na FISIOTERAPIA/EQUOTERAPIA. Location: Santo Antônio de Pádua Area, Brazil; Industry: Philanthropy. 8 abr. Nervos motores conduzem a informação do SNC em direção aos músculos e glândulas do corpo. O que é neuroplasticidade??? Ambientes. salto monopedal e salto lateral, além da coordenação motora global. Palavras- chaves: Síndrome de Down. Fisioterapia. Equoterapia. Introduction. Today, in the .
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Hippotherapy and respiratory muscle strength in children and adolescents with Down syndrome. Individuals with Down syndrome may have decreased respiratory muscle strength due to hypotonia, a common characteristic in this population.
To fisioteeapia the effects of a hippotherapy program on respiratory muscle strength in individuals with Down syndrome.
The study included 41 subjects, 20 of which were in the hippotherapy practicing group PG and 21 of which were in the non-practicing group NPG. Study subjects were of both sexes, aged years, and all diagnosed with Down syndrome. A manovacuometer was used to measure respiratory muscle strength, following the protocol proposed by Black and Hyatt Statistical analysis was performed by means of descriptive distribution.
Individuals who practiced hippotherapy showed improvements in both inspiratory and expiratory respiratory muscle strength, although no significant difference was demonstrated.
This study demonstrates that hippotherapy benefits respiratory muscle strength in individuals with Down syndrome, and that the youngest subjects had the best results.
Every minute, about 20 babies are born equoterrapia some kind of disability, totaling approximately 9.
According to the census of the Brazilian Institute of Geography and Statistics 2 According to the non-profit organization Movimento Down [Down Movement] 3there is no specific statistic on the number of Brazilians with Down syndrome; however, based on the ratio of 1 per every births, it is estimated that about thousand people have this syndrome in Brazil. Most are poor, with little or no access to care or information, and unable to attend early stimulation treatment clinics 4.
The evolution of DS treatment is undergoing important advances. Comparing the data available from the middle of last century and today, the increase in life expectancy of this population is evident 5. The main physical characteristics common to children with DS include hypotonia, ligament laxity and reduced muscle strength. Over the years, joint wear and musculoskeletal abnormalities that affect muscle strength quality can also develop 6. Moreover, individuals with DS are predisposed to respiratory complications resulting from obstruction of the upper airway, lower airway disease, pulmonary hypertension, pulmonary hypoplasia, congenital heart disease, obstructive sleep apnea, immunodeficiency, obesity and hypotonia 7which can be aggravated by general weakness of the muscles of the torso and extremities, as well as postural deviations adopted by these individuals 8.
Due to the reasons above, individuals with DS have low respiratory pressure values. The measurement of maximal respiratory pressures can help to direct therapeutic objectives, identify early respiratory diseases and classify their severity, and evaluate responses to therapies 9.
In these patients, the sequential measurement of maximal respiratory pressures enables quantification of progression of respiratory muscle weakness Policarpo and Santos 11 claim that individuals with DS have a deficit of respiratory muscle strength, and believe that these individuals benefit from muscle training, which minimizes future respiratory complications. According to a study by Herrero et al. Assisted motor development balances the thorax and abdomen, maintaining a balance point between these two cavities, and thus adjusting lung capacity and volumes.
It is generally agreed that in hippotherapy, the movement of the horse, which, like humans, has three-dimensional motion that consists of movements on three axes vertical, right and left, and front and back 13transmits these movements to the rider. In turn, the rider must stay balanced on the animal by performing postural adjustments in the pelvis, upper limbs and head 14a process that encourages favorable changes in some kinematic variables in the gait of children with DS, and contributes to improve balance deficits, stability of the walking pattern and also in the torso musculature, which is responsible for respiratory dynamics.
Hippotherapy is a therapeutic and educational method that uses horseback riding in an interdisciplinary approach to education and health, mainly aiming for motor rehabilitation and education for the biopsychosocial development of poeple with disabilities. Hippotherapy uses horses to promote physical, psychological and educational benefits Hippotherapy has been shown to produce improvements in postural and motor control in special populations with cerebral palsy, genetic disorders, developmental delays and Down syndrome 16which reaffirms the theory that this therapy is beneficial for individuals with these conditions.
In addition to improvements of motor and postural control, social and emotional interactions may have positive effects on quality of life and self-esteem Studies show that muscular hypotonia in individuals with SD leads to increased susceptibility to reduced cardiorespiratory capacity due to disability of the transversus abdominis muscle, which fails to create synergy with the diaphragm, and decreases the action of the oblique muscles, which biomechanically stabilize the ribcage.
This effect also reduces the action of the intercostal muscles, interfering in the quality of deep, ample and adequate breathing, and reducing the physical conditioning of these individuals 18 Each and every movement of the horse requires the rider to adjust their muscle tone to the body schema, which is neurological and established by simultaneous proprioceptive and exteroceptive information, and hippotherapy multiplies these effects Hippotherapy helps patients to firm their hypotonic musculature This study aimed to analyze the effect of hippotherapy on the respiratory muscle strength of patients with Down syndrome aged between 7 and 13 years in the Federal District of Brazil.
This study was a cross-sectional, analytical, observational study. The sample was composed of children and adolescents of both sexes, selected by convenience, where a prior visit to the institutions was undertaken to present the project to the [therapy] coordinators and preselect the subjects who could participate in the study, according to the inclusion criteria described above. After this process, the institutions indicated 45 children and adolescents with SD with the desired characteristics.
Those interested in participating were given the FICF for inclusion in the study, which 41 signed. The PG was composed of 20 individuals 11 boys and 9 girlswhile the NPG was composed of 21 12 boys and 9 girls.
The activity proposed for the PG was hippotherapy lessons, while the NPG did not undertake any type of activity with objectives similar to those of hippotherapy.
For selection of NPG participants, it was decided to select from the following institutions: The protocol method of ANDE-BRASIL is based on promoting physical and psychological gains, requiring participation of the entire body, thus contributing to the development of muscle strength, relaxation, body awareness and improved motor coordination and balance.
The maneuvers were sustained for a minimum period of 2 seconds, with verbal encouragement from the evaluator. All measurements were performed with the nostrils closed with a nasal clip, in order to prevent air from escaping through the nose. Statistical analysis was by means of descriptive distribution of means, minimum, maximum and standard deviation.
The Kolmogorov-Smirnov test was performed to evaluate the normalcy of data distribution. Inferential statistics by means of the Levene test were used to check the homoscedasticity of the variables, evaluating equality or not of the variances between variables of the groups. The tests were selected and applied on 41 individuals; however, during analysis of the data, by means of the boxplot, discrepant outlier values of two individuals in the NPG were found, which could have influenced the results of the analysis.
For this reason, these values were excluded. Thus, the data analysis was performed with results from 39 individuals with Down syndrome, divided into two groups: Participants were aged between 7 and 13 years. The majority of participants in both groups were male, and aged 7 years.
In the Figure 1it is observed that the median of the MIP variable is the same for both groups, meaning that the halves of the values of the two groups were the same, even though the mean of the PG It also shows that for the two variables, the PG has widely dispersed data. Table 2 presents the major descriptive measurements that represent respiratory muscle strength MIP and MEP and the P-value of the Mann-Whitney U test, which was applied because these variables pointed to unequal variances in the homoscedasticity test, as shown above.
According to the test, there was no significant difference for the variables under analysis, even though the raw values for the two variables were better in the PG. The table above presents the results of tests to evaluate respiratory muscle strength. Considering the formula presented by Neder et al. In one study conducted in children with clinical diagnosis of DS, Schuster et al. In this study, it was observed that all subjects in both groups had muscle weakness, and the MIP and MEP values of the PG, although lower than predicted in the literature, were higher than those for the NPG.
The maximal efforts were performed from the residual volume and total lung capacity, sustained for a period of one to three seconds. In accordance with this study, a nasal clip was used for all measurements of MIP and MEP, in a seated position, and efforts from the volumes and capacities mentioned by the author. Similarly, Alexandre et al. In case there was a discrepancy between the measurements, the procedure was repeated.
This is a factor associated with deficit of torso muscle strength, which in turn results in loss of respiratory muscle strength. The same authors evaluated respiratory function and created a profile of DS children aged between 5 and 12 years, revealing low values of respiratory muscle strength. This study had a similar result, where the MIP and MEP values of individuals of both groups were far below the predicted values for age.
Regardless, the values of the PG were greater than those of the NPG, showing that hippotherapy can affect this variable. In one study evaluating respiratory muscle strength in 45 subjects, of which 15 suffered from intellectual disability, 15 had Down syndrome and 15 were classified as having no mental disability, Silva et al.
Values of maximal expiratory pressure are greater compared to those of maximal inspiratory pressure in children and adolescents of both sexes This was also observed in this study, where in both groups the mean values of these variables were greater for MEP than MIP. It is noteworthy that for Scanlan et al. In this study, fisiiterapia did not have access to the number of hippotherapy equoterwpia that each individual performed.
However, one inclusion criterion was having a minimum of 3 months of hippotherapy activity twice per week, making 24 months the mean time of this activity for equuoterapia PG. Some authors agree that it is not necessary to publish the period, since so few sessions of hippotherapy are needed for results, yet changes after twelve fisiioterapia are cited 31 As noted in the Table 3significant correlation was shown only for the variable MIP in relation to age; thus, the older the individual, the better the inspiratory respiratory muscle strength.
For other variables, moderate but not significant correlations were observed.
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For both sexes, the mean values of the tasks performed by the PG were higher in comparison to individuals in the NPG Table 4. As regards the variables MIP and MEP, which represent inspiratory and expiratory muscle strength, respectively, this study shows that the values of both groups and sexes are lower than those expected for individuals without disability.
Considering the studied population of individuals with DS, in both groups boys showed better results only on the inspiratory muscle strength test. In a study with 40 children aged between 8 and 17 years, Wagener et al. They showed that boys equuoterapia higher pressures than girls, relating to the fact that they have larger muscle area, although when compared to young adults of the same sex, they had lower MEP, also due to less muscle development.
In this study, fisioterapiw both groups, boys showed higher values only for MIP.
It is worth noting that the formulas proposed for estimating MIP and MEP, which have the primary objective to quickly establish reference values in evaluation tests of respiratory muscle strength, need to be carefully observed. The predicted values of MIP and MEP, equoterapiq by the equation proposed by these authors, for both females and males, were higher than those obtained in the results of this study.
The results of this study suggest that the practice of hippotherapy may influence respiratory muscle strength in patients with Down syndrome, equoterrapia both sexes and aged between 7 and 13 years, when compared with individuals with Down syndrome who do not practice hippotherapy.
This study aimed equoterpia analyze the respiratory muscle strength of individuals with Down syndrome and, specifically, to verify the possible effect caused in patients of hippotherapy. It was also possible to compare, within the group that practiced hippotherapy, the difference between boys and girls, and, with the results of the tests, to correlate this difference to age and time practicing hippotherapy.
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Among individuals who practice hippotherapy, the best results for respiratory muscle strength were for more advanced ages. In addition, the results of equoteraoia and expiratory muscle strength of individuals with Down syndrome who practice hippotherapy were greater than those who do not. Motor control outcomes following Nintendo Wii use by a child with Down syndrome. The respiratory system in muscular distrophy.
The utility of spirometry in diagnosing pulmonary restriction. Study of the therapeutic effects of an advanced hippotherapy simulator in children with cerebral palsy: The effect of therapeutic horseback riding on social functioning in children with autism. J Autism Dev Disord. Am Rev Respir Dis. Reference values for lung function tests.