Abstract Context: Many studies show the importance of evaluating the adaptation time of subjects in a virtual driving environment, looking forwards to a response as closest as a possible real vehicle. Objectives: This study aimed to identify and analyze the adaptation to the driving simulator in older adults and middle-aged adults with and without a distraction, and a secondary aim was to identify predictors of safe performance for older adults’ drives. Design: Male and female middle-aged adults (n = 62, age = 30.3 ± 7.1 years) and older adults (n = 102, age = 70.4 ± 5.8 years) were evaluated for braking time performance in a driving simulator; cognition performance assessment included the Mini-Mental State Examination; motor evaluation included ankle flexor muscle strength with the isokinetic dynamometer and handgrip strength; the postural balance was evaluated with Timed Up and Go test, with and without a cognitive distraction task. Results: Older adults (men and women) and middle-aged adult women require more time to adapt to the driving simulator. The distractor increases the adaptation time for all groups. The main predictors of braking time for older women are age, muscle strength, and postural balance associated with distraction, and for older men, muscle strength. Conclusions: Age, sex, and distractor interfere in the adaptation of the virtual task of driving in a simulator. The evaluation model developed with multi-domains demonstrated the ability to predict which skills are related to braking time with and without the presence of the distractor.

Abstract Context: Transtibial Amputation (TA) predisposes to a sedentary lifestyle. Objectives: To evaluate the efficiency of a short-term (8-week) Concurrent Training (CT) program in Unilateral Transtibial Amputees (UTA) and to compare it with the physical condition of a group of Paralympic athletes in preparation for the Rio de Janeiro Paralympics. Design: This was a longitudinal, prospective and controlled trial study. Methods: Thirty-four male subjects with UTA and using prostheses for six months or more were selected for this study. They were divided into two groups: Group 1 (G1) – 17 non-athlete and untrained UTA and Group 2 (G2) – 17 paralympic athletes with active UTA in the training phase. G1 was evaluated before and after eight weeks of CT and G2 made a single evaluation for control. All were submitted to anamnesis, clinical evaluation (blood pressure, electrocardiogram, and heart rate) and cardiopulmonary exercise testing on a lower limb cycle ergometer, and isokinetic knee dynamometry. The CT of G1 included resistance exercise and aerobic interval training on a stationary bicycle and G2 followed the training of the Paralympic teams. Results: Patients were retested by the same methods after CT. The two most important central dependent variables (maximal oxygen uptake and muscular strength) increased by 22% and knee extensor and flexor strength by 106% and 97%, respectively. Conclusion: After eight weeks of CT, there was an improvement in general functional condition, muscle strength, and cardiorespiratory performance improving protection against chronic diseases and quality of life.

ABSTRACT The study aims to evaluate the perception of health, quality of life and functional capacity during six months after COVID-19-related hospitalization. This is a prospective longitudinal study carried out at Universidade São Judas Tadeu (USJT) in partnership with the Instituto Ânima Brasil. Thirteen adult participants, including young and older adults, were evaluated, had a confirmed diagnosis of COVID-19 and were hospitalized. A characterization and interdisciplinary questionnaire built by the researchers was used to assess health perception, quality of life, and functional capacity of participants. In this study, participants were followed for a 6-month period and the main results obtained were: the identification of a significant increase in walking time after three months (p=0.002) as well as an improvement in the perception of quality of life (p=0.002). In addition, the levels of tiredness and physical activity were evaluated; the mean responses were “little tired” and “irregularly active,” respectively, and remained unchanged over six months. Considering that patients who were hospitalized due to COVID-19 showed a reduction in the perception of quality of life and walking time soon after the hospital period, it was identified that over time they tend to improve these perceptions.

RESUMEN El objetivo de este estudio fue evaluar la percepción de salud, calidad de vida y capacidad funcional durante seis meses posteriores a la hospitalización por COVID-19. Se trata de un estudio prospectivo longitudinal, realizado en la Universidade São Judas Tadeu (USJT) y el Instituto Ânima Brasil. Se evaluaron a trece participantes, entre adultos jóvenes y adultos mayores, que tenían diagnóstico confirmado del COVID-19 y se encontraban hospitalizados por complicaciones de esa enfermedad. Se utilizó un cuestionario de caracterización e interdisciplinario elaborado por los investigadores para evaluar la percepción de salud, la calidad de vida y la capacidad funcional de los participantes. En este estudio se realizó seguimiento de los participantes durante un período de seis meses, y los principales resultados fueron: un significativo aumento en el tiempo de caminata después de tres meses (p=0,002), así como una mejora en la percepción de la calidad de vida (p=0,002). Además, se evaluaron los niveles de cansancio y de actividad física, y las respuestas medias fueron “poco cansado” e “irregularmente activo”, las cuales se mantuvieron sin cambios durante seis meses. Considerando que los pacientes que fueron hospitalizados por COVID-19 presentaron una reducción en la percepción de calidad de vida y en el tiempo de marcha tras el período en el hospital, se identificó que con el tiempo tienden a mejorar estas percepciones.

RESUMO O objetivo do estudo foi avaliar a percepção de saúde, a qualidade de vida e a capacidade funcional dos pacientes durante seis meses após a internação por COVID-19. Trata-se de um estudo de delineamento prospectivo longitudinal realizado na Universidade São Judas Tadeu (USJT) em parceria com o Instituto Ânima Brasil. Foram avaliados 13 participantes adultos, entre jovens e idosos, que apresentaram diagnóstico confirmado de COVID-19 e foram internados. Foi utilizado um questionário de caracterização e interdisciplinar construído especificamente para inquirir a percepção de saúde, a qualidade de vida e a capacidade funcional dos participantes. Neste estudo, eles foram acompanhados no período de seis meses, e os principais resultados obtidos foram: a identificação do aumento significativo no tempo de caminhada após três meses (p=0,002), bem como a melhora na percepção de qualidade de vida (p=0,002). Além disso, foram avaliados os níveis de cansaço e de prática de atividade física, e as respostas médias foram, respectivamente, “pouco cansaço” e “irregularmente ativo”, as quais se mantiveram inalteradas ao longo de seis meses. Tendo em vista que os pacientes que foram submetidos à internação hospitalar devido à COVID-19 apresentaram redução da percepção de qualidade de vida e do tempo de caminhada logo após o período hospitalar, foi identificado que, com o decorrer do tempo, eles demonstraram tendência de melhora dessas percepções.

ABSTRACT Objective: Fatigue of the ankle’s stabilizing muscles may influence the performance of functional activities and postural control. The purpose of this study was to evaluate the performance of healthy young adults using functional jump tests and static posturography control under pre- and post-fatigue conditions of the ankle invertor and evertor muscles. Methods: Thirty physically active healthy male and female (15 male and 15 female) volunteers (24.3 years) were enrolled in this prospective cross-sectional study. Participants performed tests on one day under a non-fatigued state of invertor and evertor muscles and on the second day in a fatigued state. Tests included static posturography on a force platform in a bipedal stance with eyes open and closed and in one-legged support with eyes open and functional jump tests (figure-of-8, side hop, 6-m crossover hop, and square hop). Fatigue of the ankle invertor and evertor muscles was induced using isokinetic dynamometry with 30 repetitions at 120°/s. Results: Participants had an average age of 24.3 years (SD ± 2.08), the height of 1.73 m (SD ± 0.08), and a weight of 68.63 kg (SD ± 10.29). The average Body Mass Index (BMI) was 22.88 (SD ± 2.46). A decrease in performance was observed in functional activities and postural control under all conditions after the induction of muscle fatigue, except for the speed at a bipedal stance with eyes open. Conclusions: Functional jump tests are low cost and useful for clinical practice and evaluation of the effects of muscle fatigue and could be used in clinical practice.

Abstract Context Aging causes a progressive worsening in postural balance, affecting functional independence and increasing the risk of falls. Objective The aim of the study was to evaluate the effect of aging on the static balance in women from 50-years to 89-years of age. Design This was a cross-sectional study, with 400 irregularly active women were evaluated and grouped by age: Group 6thdecade (age 50 to 59) ‒ 58 participants; Group 7thdecade (age 60 to 69) ‒ 214 participants; Group 8thdecade (age 70 to 79) ‒ 92 participants; Group 9thdecade (age 80 to 89) ‒ 36 participants. Postural balance was evaluated using a portable force platform in a standard standing position, with Eyes Open (EO) and Eyes Closed (EC). Results In the two measurement conditions, the elderly women in Group 9thdecade presented mediolateral displacement and range, and mean velocity greater than the women's values in Groups 6thand 7thdecade. In the EO e EC situation, the displacement was higher in the elderly Group 9thdecade compared to younger groups. Group 8thhas a mean velocity greater than Group 6thdecade in the EO situation. Conclusions Posturography showed a decline in postural balance with advancing age, suggesting that the 9thdecade of life is a borderline age to this detriment due to an increase in postural instability.

Abstract Context In the elderly, weak lower limb muscles impair functional tasks' performance. Objective To evaluate the healthy elderly's ankle dorsiflexion and plantarflexion maximum torque and its variability in two sets of 5 RM isokinetics evaluation. Method 50 women (68.0 ± 4.6 years old) and 50 men (72.7 ± 8.5 years old) did two sets of ankle plantar flexor and dorsiflexor isokinetic tests at 30°/s. Peak torque, total work, and coefficient of variation were analyzed. Results Men did the strongest plantarflexion torque (p < 0.05) and dorsiflexion torque (p < 0.05); their highest peak torque occurred at set 2 (p < 0.05), while the largest plantarflexion torque variability (p < 0.05), dorsiflexion torque variability (p < 0.05), and the largest plantarflexion torque variability occurred at set 1 (p < 0.05). Men did the highest plantarflexion and dorsiflexion total work (p < 0.05) at set 2 (p < 0.05). Conclusion Older men are stronger than older women. The torque variability, in men, was higher during the first set, suggesting an adaptation to the isokinetics evaluation. Clinicians and researchers should consider that different muscles might need different numbers of sets and trials to measure their maximal muscle strength.

Abstract Context: Anterior Cruciate Ligament (ACL) injury is disabling in several sports because it causes knee instability and functional deficit. Usually, surgical treatments produce the best functional outcomes, however, sometimes they are not always able to fully restore stability and function. Objective: The objective of this study was to evaluate postural balance, muscle strength, and functional performance of young athletes with an ACL injury before and after ACL reconstruction. Design: This was a longitudinal observational prospective study. Method: 74 athletes, 60 men, and 14 women, aged between 16 and 45, divided into two groups: the Group-Lesion of ACL with 34 athletes (24.1 years) and the Group-Control with 40 athletes without ACL lesion (27.7 years old). All volunteers performed posturography, isokinetic dynamometry, and the Hop-Test. The ACL-Group was evaluated before and 12 months after the reconstruction and the control group was evaluated once. Results: The Postoperative ACL Group presented greater limb symmetry, 0.96 (± 0.12), than the preoperative ACL Group, 0.87 (± 0.17), p < 0.01 in the Hop-Test. In the posturography, the displacement area was smaller in the postoperative ACL Group, 19.85 (± 5.74), compared to the preoperative ACL Group, 24.20 (± 8.97), p < 0.01. In isokinetic dynamometry the torque peak was greater in the postoperative ACL Group, 0.91 (± 0.14), than in the preoperative ACL Group, 0.74 (± 0.15), p < 0.01. Conclusion: The functional outcomes increased in ACL reconstruction athletes after 12 months, but not at the same level as in the Control Group. The result indicates an incomplete functional recovery, adaptive changes in postural control after injury, reconstruction, and return to sport.

RESUMO Objetivo: Investigar a relação da antropometria e composição corporal com o equilíbrio postural dinâmico em idosas com baixa Densidade Mineral Óssea (DMO). Métodos: 45 idosas (≥ 60 anos), baixa DMO e diagnóstico nutricional entre baixo peso e sobrepeso. Para a avaliação da composição corporal utilizou-se a densitometria por emissão de raios x de dupla energia e exame antropométrico para aferir: massa corporal (kg), estatura (cm) e índice de massa corporal (IMC) (k/m2). A avaliação do equilíbrio postural dinâmico foi realizada pelo teste clínico mini Balance Master Evaluation System, pelo teste computadorizado Balance Master ® System e pelos testes Sit-to-Stand e Step Up/Over. Resultados: Houve correlação negativa do miniBESTest (r = − 0,566; p ≤ 0,001) e tempo de subir e descer um degrau (r = − 0,393; p ≤ 0,007) com a massa gorda, e correlação positiva do miniBESTest (r = 0,526; p ≤ 0,001) e tempo de subir e descer um degrau com a massa muscular (r = 0,297; p ≤ 0,04). Quanto às variáveis antropométricas, apenas a estatura apresentou correlação positiva (r = 0,296; p ≤ 0,04) com a velocidade no teste de sentar-se e levantar-se. Conclusão: A massa magra reduz as oscilações posturais. Em contrapartida, a massa gorda interfere de forma negativa no equilíbrio postural dinâmico de mulheres com baixa DMO. A estatura esteve relacionada ao equilíbrio postural dinâmico: quanto mais altas as idosas pior era seu equilíbrio. Nível de Evidência II, Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.

ABSTRACT Objective: To investigate the relationship between anthropometry and body composition with dynamic postural balance in elderly women with low bone mineral density (BMD). Methods: 45 older women (≥ 60 years), low BMD and nutritional diagnosis of low weight to overweight. For the assessment of body composition, Dual energy X-ray emission densitometry and anthropometric examination were used to measure: body mass (kg), height (cm) and BMI (k/m2). The assessment of dynamic postural balance was performed by the mini Balance Master Evaluation System clinical test and the computerized Balance Master® System test by the Sit to Stand and Step Up/Over tests. Results: There was a negative correlation between miniBESTest (r = − 0.566; p ≤ 0.001) and time to ascend and descend step (r = − 0.393; p ≤ 0.007) with fat mass, and positive correlation with miniBESTest (r = 0.526; p ≤0.001) and time to go up and down a step with muscle mass (r = 0.297; p ≤ 0.04). As for anthropometric variables, only height showed a positive correlation (r = 0.296; p ≤ 0.04) with the speed in the sit and stand test. Conclusion: Lean mass reduces postural oscillations; in contrast, fat mass negatively interfered with dynamic postural balance in women with low BMD. Height was related to dynamic postural balance, the taller the elderly, the worse their balance. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

OBJECTIVES: To evaluate the clinical characteristics, ground reaction force (GRF), and function of the plantar muscles and dorsiflexors of the ankle in runners with and without Achilles tendinopathy (AT) and in non-runners. METHODS: Seventy-two participants (42 men, 30 women; mean age: 37.3±9.9 years) were enrolled in this cross-sectional study and divided into three groups: AT group (ATG, n=24), healthy runners’ group (HRG, n=24), and non-runners’ group (NRG, n=24). Both ankles were evaluated in each group. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for clinical and functional evaluation. GRF was evaluated using force plates and muscle strength was evaluated using an isokinetic dynamometer. RESULTS: The AOFAS scores were lower in the ATG. The strike impulse was higher in the ATG than in the HRG and NRG. However, GRF was similar among the groups. The ATG exhibited lower total work at 120°/s speed than the HRG. The peak torque in concentric dorsiflexion was lower in the NRG than in the ATG and HRG. The peak torque and total work in concentric plantar flexion were lower in the NRG than in the ATG. The peak torque and total work in eccentric plantar flexion were lower in the NRG than in the ATG and HRG. CONCLUSION: Runners with AT showed higher strike impulse, lower muscle strength of the plantar flexors, and higher clinical and functional damage.

OBJECTIVE: This study aimed to analyze the physical and pulmonary capacities of hospitalized patients with severe coronavirus disease and its correlation with the time of hospitalization and complications involved. METHODS: A total of 54 patients, aged ≥18 years of both sexes, were evaluated 2-4 months after hospital discharge in São Paulo, Brazil. The physical characteristics analyzed were muscle strength, balance, flexibility, and pulmonary function. The K-means cluster algorithm was used to identify patients with similar physical and pulmonary capacities, related to the time of hospitalization. RESULTS: Two clusters were derived using the K-means algorithm. Patients allocated in cluster 1 had fewer days of hospitalization, intensive care, and intubation than those in cluster 2, which reflected a better physical performance, strength, balance, and pulmonary condition, even 2-4 months after discharge. Days of hospitalization were inversely related to muscle strength, physical performance, and lung function: hand grip D (r=−0.28, p=0.04), Short Physical Performance Battery score (r=−0.28, p=0.03), and forced vital capacity (r=−0.29, p=0.03). CONCLUSION: Patients with a longer hospitalization time and complications progressed with greater loss of physical and pulmonary capacities.

RESUMO Objetivo: Analisar a influência da neuropatia diabética periférica (NDP) no equilíbrio postural, atividades funcionais e na qualidade de vida em idosos. Métodos: Estudo transversal. Avaliamos 60 homens e mulheres idosos (60-79 anos) divididos em três grupos: controle, DM sem e com NDP. Foram avaliados: antropometria; qualidade de vida; equilíbrio postural (BESTest); atividades funcionais pelo equilíbrio funcional na placa de força (NeuroCom Balance). Resultados: Grupo NDP apresentou diferenças comparado a outros grupos, pior desempenho na qualidade de vida que o DM2 sem NDP em: funcionamento sensorial (p = 0,030); passado e futuro (p = 0,036); morte e morrer (p = 0,035). Déficit de equilíbrio postural no escore total (p = 0,025) e seção de restrições biomédicas (p = 0,043) do BESTest comparado ao DM2 sem NDP (p = 0,007). No equilíbrio funcional (Neurocom), o grupo NDP apresentou pior desempenho no tempo gasto no lado esquerdo (p = 0,030) comparado ao grupo controle. Durante a etapa de teste, o grupo controle executou a tarefa mais rapidamente que o grupo NDP (p = 0,004). Conclusão: Neuropatas apresentaram pior desempenho físico e déficits no equilíbrio postural, limitações sensoriais, afetando as tarefas diárias da doença e, consequentemente, diminuição da qualidade de vida em idosos brasileiros. Nível de Evidência II, Estudo observacional transversal.

ABSTRACT Objective: To analyze the impact of the Peripheral Diabetic Neuropathy (PDN) on the postural and functional balance and quality of life of Brazilian older adults. Methods: A cross-sectional study. Sixty older men and women (60-79 years) were divided into three groups: control, DM without and with PDN. The following parameters were evaluated: anthropometry; quality of life; postural balance (BESTest); functional balance in force plate (NeuroCom Balance). Results: PDN group presented significant differences compared with the other groups, with the worst performance in quality of life than DM2 without PDN in: sensory functioning (p = 0.030); past and future (p = 0.036); death and dying (p = 0.035). Postural balance deficit in the total score (p = 0.025) and biomedical constraints section (p = 0.043) of the BESTest, compared with DM2 without PDN (p = 0.007). In the functional balance (Neurocom), PDN group presented a worse performance in the time spent on the left side (p = 0.030) than the control group. During step up over test, the control group performed the task faster than the group with PDN (p = 0.004). Conclusion: This study showed that neuropaths presented worse physical performance and postural balance deficits, sensorial limitations, affecting the daily tasks and, as a consequence, decreasing the quality of life in Brazilian older adults. Level of Evidence II, Cross-sectional observational study.

RESUMO Introdução: O limite de estabilidade caracteriza-se pelo ângulo máximo de inclinação que um indivíduo pode alcançar e pela maior variabilidade em condições extremas; trata-se de uma estratégia arrojada e/ou perigosa do controle motor. Objetivos: Avaliar se as medidas antropométricas e a composição corporal interferem nos limites de estabilidade e nas descargas de peso em diferentes velocidades em adultos. Métodos: Foram analisados 87 indivíduos de ambos os sexos, entre 20 a 40 anos de idade, por meio de avaliação antropométrica e composição corporal. Para as avaliações de equilíbrio foram usados uma plataforma de força, testes de limite de estabilidade (LE) e troca rítmica de peso (TRP). Resultados: No teste de LE, o sexo feminino correlacionou-se negativamente com o tamanho do pé e o tempo de reação e positivamente com a excursão máxima. Na TRP, o grupo feminino apresentou correlação negativa com estatura e comprimento do membro superior (CMS) com controle de direção médio-lateral. O grupo masculino apresentou correlação negativa com CMS e controle de direção látero-lateral. Conclusões: As variáveis de composição corporal não interferem nos testes de LE e TRP em indivíduos que apresentam valores de índice de massa corporal (IMC) dentro da normalidade, exceto a densitometria óssea (DMO) em mulheres. Quanto aos parâmetros antropométricos, estatura, CMS e tamanho dos pés no grupo feminino e no masculino foram os seguintes: CMS e tamanho dos pés têm pouca influência no controle do equilíbrio postural. Nível de evidência II, Estudos diagnósticos – Investigação de um exame para diagnóstico.

ABSTRACT Introduction: The limit of stability is characterized by the maximum angle of inclination that an individual can reach and greater variability in extreme conditions; it is a bold and/or dangerous motor control strategy. Objective: Assess whether anthropometric measurements and body composition interfere with limits of stability and weight-bearing at different speeds in adults. Methods: Eighty-seven subjects of both sexes aged between 20 and 40 years were analyzed using anthropometric assessment and body composition. A force platform, limits of stability (LoS) and rhythmic weight shift (RWS) tests were used for the balance assessments. Results: In the LoS test, being female was negatively correlated with foot size and reaction time, and positively correlated with maximum excursion. In the RWS test, the female group had a negative correlation with height and upper limb length (ULL), with mediolateral directional control. The male group had a negative correlation with ULL and laterolateral directional control. Conclusion: Body composition variables do not interfere in the LoS and RWS tests in subjects with normal body mass index (BMI) values, except for bone densitometry (BMD) in women. As regards anthropometric parameters, height, ULL and foot size in the female and male groups were as follows: ULL and foot size exert little influence on postural balance control. Level of evidence II, Diagnostic studies - Investigation of a diagnostic test.

RESUMEN Introducción: El límite de estabilidad se caracteriza por el ángulo de inclinación máximo que puede alcanzar un individuo y por la mayor variabilidad en condiciones extremas; se trata de una estrategia audaz y/o peligrosa de control motor. Objetivos: Evaluar si las medidas antropométricas y la composición corporal interfieren en los límites de estabilidad y en las descargas de peso en diferentes velocidades en adultos. Métodos: Fueron analizados 87 individuos de ambos sexos, entre 20 a 40 años de edad, por medio de evaluación antropométrica y composición corporal. Para las evaluaciones de equilibrio se usaron una plataforma de fuerza, tests de límite de estabilidad (LE) e intercambio rítmico de peso (IRP). Resultados: En el test de LE, el sexo femenino se correlacionó negativamente con el tamaño del pie y el tiempo de reacción y positivamente con la excursión máxima. En el IRP el grupo femenino presentó correlación negativa con estatura y longitud de miembros superiores (LMS) con control de dirección medio-lateral. El grupo masculino presentó correlación negativa con LMS y control de dirección latero-lateral. Conclusiones: Las variables de composición corporal no interfieren en los tests LE y IRP en individuos que presentan valores de índice de masa corporal (IMC) dentro de la normalidad, excepto la densitometría ósea (DMO) en mujeres. Sobre los parámetros antropométricos, estatura, LMS y tamaño de los pies en el grupo femenino y en el masculino fueron los siguientes: LMS y tamaño de los pies tienen poca influencia en el control del equilibrio postural. Nivel de evidencia II, Estudios diagnósticos - Investigación de un examen para diagnóstico.

RESUMO O novo coronavírus, que causa a doença infecciosa denominada COVID-19 pela Organização Mundial de Saúde, foi notificado em dezembro, na China. As principais manifestações clínicas dos pacientes infectados são febre, tosse e dispneia. Esses pacientes têm propensão a desenvolver alterações cardíacas, miopatia difusa, diminuição da função pulmonar, diminuição da força muscular inspiratória e deterioração da capacidade funcional. Assim sendo, é esperado que os pacientes afetados pela COVID-19 sofram sequelas musculoesqueléticas em decorrência do processo inflamatório e perda de massa muscular causada pela imobilidade, que geram incapacidades motoras ainda não quantificáveis. Existe a necessidade de entender as implicações clínicas causadas pela COVID-19 para elaborar melhores estratégias de reabilitação para esses pacientes. O objetivo deste estudo foi realizar uma análise reflexiva no que tange ao impacto da COVID-19 nos sistemas imunológico, neuromuscular e musculoesquelético e no processo de reabilitação. Trata-se de uma análise reflexiva, desenvolvida no Laboratório do Estudo do Movimento do Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil. Nesta análise, fizemos uma reflexão sobre os seguintes tópicos relacionados com a COVID-19: mecanismos imunológicos, impacto no sistemas neuromuscular e musculoesquelético e reabilitação dos pacientes. Nível de evidência V; Opinião do especialista.

ABSTRACT The new coronavirus, which causes the infectious disease named COVID-19 by the World Health Organization (WHO), was notified in 2020 in China. The main clinical manifestations in infected patients are fever, cough and dyspnoea. These patients are prone to developing cardiac changes, diffuse myopathy, decreased pulmonary function, decreased inspiratory muscle strength, and a deterioration in functional capacity. Thus, it is expected that patients affected by COVID-19 will suffer musculoskeletal consequences as a result of the inflammatory process and loss of muscle mass caused by immobility, generating motor incapacities that are not yet quantifiable. It is important to understand the clinical implications caused by COVID-19, in order to have better rehabilitation strategies for these patients. The aim of this study was to conduct a reflective analysis of the impact of COVID-19 on the immune, neuromuscular and musculoskeletal systems, and its rehabilitation process. This is a reflexive analysis, developed in the Laboratory for the Study of Movement of the Institute of Orthopaedics’ and Traumatology, at the Universidade de São Paulo School of Medicine, SP, Brazil. In this analysis, we reflect on the following topics related to COVID-19: immunological mechanisms, impact on the neuromuscular and musculoskeletal systems, and the rehabilitation of patients. Level of evidence V; Opinion of the specialist.

RESUMEN El nuevo coronavirus, que causa la enfermedad infecciosa llamada COVID-19 por la Organización Mundial de la Salud, fue notificado en diciembre en China. Las principales manifestaciones clínicas de los pacientes infectados son fiebre, tos y disnea. Esos pacientes son propensos a desarrollar cambios cardíacos, miopatía difusa, disminución de la función pulmonar, disminución de la fuerza muscular inspiratoria y deterioro de la capacidad funcional. Por lo tanto, se espera que los pacientes afectados por COVID-19 sufran secuelas musculoesqueléticas debido al proceso inflamatorio y pérdida de masa muscular causada por la inmovilidad, que generan discapacidades motoras aún no son cuantificables. Es necesario comprender las implicaciones clínicas causadas por COVID-19 para elaborar mejores estrategias de rehabilitación para estos pacientes. El objetivo de este estudio fue realizar un análisis reflexivo sobre el impacto de COVID-19, en los sistemas inmunitario, neuromuscular y musculoesquelético y en el proceso de rehabilitación. Es un análisis reflexivo, desarrollado en el Laboratorio del Estudio de Movimiento del Instituto de Ortopedia y Traumatología, Facultad de Medicina, Universidad de São Paulo, SP. En este análisis, reflexionamos sobre los siguientes temas relacionados con COVID-19: mecanismos inmunológicos, impacto en los sistemas neuromuscular y musculoesquelético y la rehabilitación de los pacientes. Nivel de evidencia V; Opinión de expertos.

RESUMO O processo de envelhecimento pode alterar a organização do controle postural causando instabilidade. Na literatura há vários equipamentos e testes, envolvendo protocolos e metodologias diversas, com a finalidade de mensurar o equilíbrio corporal. Objetivo: Avaliar o equilíbrio postural e analisar a correlação entre os dados da plataforma de equilíbrio e do teste clínico (BESTest) em idosos. Métodos: Foram avaliados 60 idosos de ambos os sexos, com idade de 60 a 79 anos. Para avaliação do equilíbrio postural foi utilizada a plataforma de força (NeuroCom Balance) e o BESTest. Resultados: Correlações negativas foram encontradas quando comparados os domínios do teste clínico (BESTest) com parâmetros estabiliométricos nas variáveis tempo, velocidade e impacto dos testes Step/Quick turn. As maiores correlações foram no score total (tempo gasto para realizar a tarefa LE − 0,41, e na velocidade do equilíbrio LE − 0,33/LD − 0,43), assim como no limite de estabilidade (tempo gasto para realizar a tarefa LE − 0,34/LD − 0,37, e a velocidade do equilíbrio LE − 0,37/LD − 0,43). Conclusão: Há poucas e fracas correlações entre o teste clínico e as variáveis do teste Step/Quick turn da plataforma de força, mostrando que cada teste mede parâmetros diferentes. Nível de Evidência II, Estudos diagnósticos - investigação de exames para diagnóstico.

ABSTRACT The aging process can alter the organization of postural control causing instability; literature shows several equipment and clinical tests whose purpose is to measure postural balance, involving different protocols and methodologies. Objective: To evaluate postural balance during the task to walk over the force platform (turn and return) and its relationship with clinic balance test (BESTest) in older adults. Methods: 60 older people of both sexes, aged 60 to 79 years, were tested in the force platform (NeuroCom Balance) and BESTest to evaluate postural balance. Results: negative correlations were found when comparing domains of the clinical test with stabilometric parameters in time and velocity variables of the tests Step/Quick turn. The highest correlations were in the total score (time spent to perform the task − 0.41, and in the velocity left side − 0.33/right side − 0.43), as well as in the stability limit (time spent to perform the task left side − 0.34/right side − 0.37, and the equilibrium velocity left side − 0.37/right side − 0.43). Conclusion: There are slim correlations between the clinical test and force platform variables, showing that each test measures different parameters. Level of evidence II, Diagnostic study - investigating a diagnostic test.

RESUMO A doença de Parkinson é o segundo distúrbio neurodegenerativo mais comum na velhice. O processo de envelhecimento de idosos com doença de Parkinson pode levar a distúrbios de marcha com mais incapacidades funcionais do que para idosos sem a doença. O treinamento em esteira como terapia pode resultar em efeitos notáveis na marcha de pacientes com Parkinson e ser um recurso para a reabilitação neurológica geriátrica. Esta revisão teve como objetivo estudar os efeitos da marcha após o treinamento em esteira na doença de Parkinson em idosos. A pesquisa foi realizada nas bases de dados PubMed®, LILACS, PEDro e EMBASE, com os seguintes descritores: “doença de Parkinson”, “idosos”, “treinamento em esteira” e “avaliação da marcha”. A qualidade dos estudos incluídos foi avaliada pela escala de PEDro. Atenderam aos critérios de inclusão e exclusão 11 estudos. Oito estudos foram randomizados, e apenas um fez follow-up . Foi possível observar que treinamento em esteira com ou sem suporte de peso (por pelo menos 20 minutos, duas a três vezes por semana, com aumento progressivo de cargas, por, no mínimo, 6 semanas) em idosos com doença de Parkinson foi efetivo para melhorar a marcha. Além disso, ambos os treinamentos foram considerados seguros (pois alguns estudos relataram o uso de cintos, mesmo no treinamento sem suporte de peso) e podem ser associados a terapias complementares à marcha, como estimulação magnética transcraniana repetitiva, estímulos visuais ou estimulação transcraniana direta anódica. O treinamento em esteira em pacientes idosos com doença de Parkinson é uma intervenção que melhora os resultados da marcha, mas requer mais estudos para melhor comprovação.

ABSTRACT Parkinson's disease is the second most common neurodegenerative disorder in old age. Aging process for elders with Parkinson's disease can induce gait disturbances with more functional disabilities than for elders without the disease. Treadmill training as a therapy has resulted in notable effects on the gait of patients with Parkinson's disease and may be a resource for geriatric neurological rehabilitation. This review aimed to study the effects on gait after treadmill training in elderly patients with Parkinson's disease. The search was performed in the databases PubMed®, LILACS, PEDro and EMBASE, with the following keywords: “Parkinson's disease”, “elderly”, “treadmill training” and “gait evaluation”. The quality of the studies included was assessed by PEDro Scale. Eleven studies met the inclusion and exclusion criteria. Eight studies were randomized, and only one did a follow-up. One can observe in this review that treadmill training with or without weight support (at least 20 minutes, two to three times a week, with progressive increase of loads, for minimum of 6 weeks) in elderly patients with the Parkinson's disease was effective to improve gait. In addition, both were considered safe (since some studies described the use of belts, even in unsupported training) and can be associated with therapies complementary to gait, such as repetitive transcranial magnetic stimulation, visual cues or anodal transcranial direct current stimulation. Treadmill training in elderly patients with Parkinson's disease is an intervention that improves gait outcomes, but further studies are required for better proofs.