GUILHERME CARLOS BRECH
Projetos de Pesquisa
Unidades Organizacionais
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
45 resultados
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- Crash Risk Predictors in Older Drivers: A Cross-Sectional Study Based on a Driving Simulator and Machine Learning Algorithms(2023) SILVA, V. C.; DIAS, A. S.; GREVE, J. M. D.; DAVIS, C. L.; SOARES, A. L. D. S.; BRECH, G. C.; AYAMA, S.; JACOB-FILHO, W.; BUSSE, A. L.; BIASE, M. E. M. de; CANONICA, A. C.; ALONSO, A. C.The ability to drive depends on the motor, visual, and cognitive functions, which are necessary to integrate information and respond appropriately to different situations that occur in traffic. The study aimed to evaluate older drivers in a driving simulator and identify motor, cognitive and visual variables that interfere with safe driving through a cluster analysis, and identify the main predictors of traffic crashes. We analyzed the data of older drivers (n = 100, mean age of 72.5 ± 5.7 years) recruited in a hospital in São Paulo, Brazil. The assessments were divided into three domains: motor, visual, and cognitive. The K-Means algorithm was used to identify clusters of individuals with similar characteristics that may be associated with the risk of a traffic crash. The Random Forest algorithm was used to predict road crash in older drivers and identify the predictors (main risk factors) related to the outcome (number of crashes). The analysis identified two clusters, one with 59 participants and another with 41 drivers. There were no differences in the mean of crashes (1.7 vs. 1.8) and infractions (2.6 vs. 2.0) by cluster. However, the drivers allocated in Cluster 1, when compared to Cluster 2, had higher age, driving time, and braking time (p < 0.05). The random forest performed well (r = 0.98, R2 = 0.81) in predicting road crash. Advanced age and the functional reach test were the factors representing the highest risk of road crash. There were no differences in the number of crashes and infractions per cluster. However, the Random Forest model performed well in predicting the number of crashes.
- Postural control during single leg stance in individuals with clinical indication for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: a cross-sectional study(2022) NOVAES, Marilia; CARVALHO, Adriana; SAUER, Juliana F.; BRECH, Guilherme C.; HELITO, Camilo P.; JOAO, Silvia M. A.Background Several studies have shown persistent postural control deficits and rotatory instability in patients after isolated Anterior Cruciate Ligament (ACL) reconstruction. There is evidence to support that the Anterolateral Ligament (ALL) plays an important role in the remaining anterolateral rotatory laxity of the knee. There are no further evidences in order to understand how patients with a combined ACL + ALL reconstruction surgery indication behave regarding postural control. The aim of this cross-sectional study was to assess if patients with a clinical indication for the combined ACL + ALL surgery showed a deficient postural control in single leg stance compared to subjects with a regular ACL reconstruction indication and to a control group. Methods An assessment of static postural control on single leg stance was performed on a force plate, with eyes open and closed, and the center of pressure (COP) displacement variables were analyzed: maximum and mean amplitude in anteroposterior (AP) and in mediolateral (ML) direction; mean velocity of displacement and area of displacement. Eighty-nine male individuals participated and were divided into 3 groups: ACL Group, ACL + ALL Group and Control Group. Results The ACL+ ALL Group showed significantly greater COP displacement in most variables in the injured leg for the eyes closed test, compared to the ACL Group, as detailed: Total ML displacement (9.8 +/- 6.77 vs. 13.98 +/- 6.64, p < 0.001); Mean ML displacement (2.58 +/- 2.02 vs. 3.72 +/- 1.99, p < 0.001); Total AP displacement (9.5 +/- 3.97 vs. 11.7 +/- 3.66, p = 0.001); Mean AP displacement (1.77 +/- 0.87 vs. 2.27 +/- 0.86, p = 0.001); Area of displacement (111.44 +/- 127.3 vs. 183.69 +/- 131.48, p < 0.001). Conclusion Subjects with a clinical indication for ACL + ALL combined reconstruction surgery showed increased COP displacement compared to patients with indication for an ACL isolated reconstruction surgery.
- Response to fatigue observed through magnetic resonance imaging on the quadriceps muscle in postmenopausal women(2020) BRECH, Guilherme Carlos; PAULA, Thalita Sousa de; FEDELE, Thiago Antonio; DIAS, Aluane Silva; SOARES, Jose Maria; BORDALO-RODRIGUES, Marcelo; BARACAT, Edmund Chada; ALONSO, Angelica Castilho; GREVE, Julia Maria D'AndreaOBJECTIVES: Menopause marks the end of women's reproductive period and can lead to sarcopenia and osteoporosis (OP), increasing the risk of falls and fractures. The aim of this study is to evaluate the influence of normal and low bone mineral density (BMD) on muscular activity, observed through inflammatory edema when mapping using magnetic resonance imaging (MRI) on the quadriceps muscle of postmenopausal women. METHODS: This was a cross-sectional study involving 16 older women, who were divided into two groups: osteoporosis group (OG), older women with OP, and control group (CG), older women without OP. The groups were evaluated in terms of nuclear MRI exam before and after carrying out fatigue protocol exercises using an isokinetic dynamometer and squatting exercises. RESULTS: The results of the present study showed that in intragroup comparisons, for both groups, there was a significant increase (p<0.05) in the T2 signal of the nuclear MRI in the quadriceps muscle after carrying out exercises using both thighs. In the intergroup comparison, no statistically significant difference was observed between the OG and CG, pre- (p=0.343) and postexercise (p=0.874). CONCLUSION: The acute muscular activation of the quadriceps evaluated by T2 mapping on nuclear MRI equipment is equal in women with and without OP in the postmenopausal phase. BMD did not interfere with muscle response to exercise when muscle fatigue was reached.
- RELATIONSHIP OF FORCE PLATFORM WITH THE CLINICAL BALANCE EVALUATION SYSTEMS TEST IN OLDER ADULTS(2020) ERNANDES, Rita De Cassia; BRECH, Guilherme Carlos; LUNA, Natalia Mariana Silva; NUNES, Michele Figueira; GREVE, Julia Maria D'Andrea; LEME, Luiz Eugenio Garcez; ALONSO, Angelica CastilhoThe 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.
- Association between handgrip strength, balance, and knee flexion/extension strength in older adults(2018) ALONSO, Angelica Castilho; RIBEIRO, Samia Maria; LUNA, Natalia Mariana Silva; PETERSON, Mark D.; BOCALINI, Danilo Sales; SERRA, Marcos Mauricio; BRECH, Guilherme Carlos; GREVE, Julia Maria D. Andrea; GARCEZ-LEME, Luiz EugenioThe objective of the study was to examine the association between handgrip strength (HGS), knee flexion and extension strength, and static and dynamic balance in older women. One hundred and ten women with a mean age of 67.4 +/- 5.9 years were assessed for dynamic postural balance using the Time Up & Go Test (TUG) with and without cognitive tasks. Semi-static balance was assessed by means of a force platform; knee flexor and extensor muscle strength was calculated using an isokinetic dynamometer; and HGS using a hand held dynamometer. Weaker HGS was significantly correlated with worse performance in dynamic postural balance, as well as performance with TUG with and without cognitive tasks; however, there was no correlation between HGS and static balance. There was a moderate positive correlation between knee flexion/extension strength and HGS. This suggests that HGS could be used as a proxy indicator of overall strength capacity for clinical screening among older women.
- Brake response time between male drivers with and without paraplegia: Association between sociodemographic, motor and neurological characteristics(2021) SANTOS, Sileno; BRECH, Guilherme Carlos; ALONSO, Angelica Castilho; GREVE, Julia Maria D'AndreaObjective: The objective of this study was to compare the brake response time of drivers with paraplegia (who use hand control) with drivers without paraplegia (who use their feet) in a virtual driving simulator brake test. Additionally, we aimed to predict and evaluate the association of virtual brake response time with sociodemographic, motor and cognitive variables. Methods: 40 male adult drivers, with paraplegia (n = 20, mean age 38.1 +/- 3.6 years) and without paraplegia (n = 20, mean age 38.0 +/- 5.8 years), with valid driver licenses, had their brake response time evaluated in an automatic transmission car simulator. Non-disabled drivers were tested with conventional foot controls, while paraplegic drivers used hand controls. Drivers with paraplegia performed simple, choice and go/no-go reaction time tests as neuropsychological evaluations. Student's t-test was used to examine the differences of driving simulator brake response time between groups. Pearson coefficient verified the correlation of driving simulator brake response time with years of driving, length of disability, handgrip strength and neuropsychological tests of the paraplegic drivers. A regression model was developed to describe the mean of driving simulator brake response time using the backward elimination method for model adjustment selecting the explanatory variables. Results: Differences of simulator brake response time between groups were not statistically significant (non-paraplegic drivers = 0.90 seconds; paraplegic drivers = 0.92 seconds, p > 0.05). Years of driving significantly correlates with brake response time of paraplegic driver (r= -58, p = 0.009). Linear regression analyses indicated that years of schooling and years of driving (explanatory variables) explained 60.2% of driving simulator brake response time for the drivers with paraplegia. Driving simulator brake response time showed no difference between drivers with and without paraplegia. Years of driving and schooling were the main predictors of braking performance in drivers with paraplegia measured in a driving simulator.
- Quality of life and socio-demographic factors associated with nutritional risk in Brazilian community-dwelling individuals aged 80 and over: cluster analysis and ensemble methods(2024) BRECH, Guilherme Carlos; SILVA, Vanderlei Carneiro da; ALONSO, Angelica Castilho; MACHADO-LIMA, Adriana; SILVA, Daiane Fuga da; MICILLO, Glaucia Pegorari; BASTOS, Marta Ferreira; AQUINO, Rita de Cassia deIntroductionThe aim of the present study was to use cluster analysis and ensemble methods to evaluate the association between quality of life, socio-demographic factors to predict nutritional risk in community-dwelling Brazilians aged 80 and over.MethodsThis cross-sectional study included 104 individuals, both sexes, from different community locations. Firstly, the participants answered the sociodemographic questionnaire, and were sampled for anthropometric data. Subsequently, the Mini-Mental State Examination (MMSE) was applied, and Mini Nutritional Assessment Questionnaire (MAN) was used to evaluate their nutritional status. Finally, quality of life (QoL) was assessed by a brief version of World Health Organizations' Quality of Life (WHOQOL-BREF) questionnaire and its older adults' version (WHOQOL-OLD).ResultsThe K-means algorithm was used to identify clusters of individuals regarding quality-of-life characteristics. In addition, Random Forest (RF) and eXtreme Gradient Boosting (XGBoost) algorithms were used to predict nutritional risk. Four major clusters were derived. Although there was a higher proportion of individuals aged 80 and over with nutritional risk in cluster 2 and a lower proportion in cluster 3, there was no statistically significant association. Cluster 1 showed the highest scores for psychological, social, and environmental domains, while cluster 4 exhibited the worst scores for the social and environmental domains of WHOQOL-BREF and for autonomy, past, present, and future activities, and intimacy of WHOQOL-OLD.ConclusionHandgrip, household income, and MMSE were the most important predictors of nutritional. On the other hand, sex, self-reported health, and number of teeth showed the lowest levels of influence in the construction of models to evaluate nutritional risk. Taken together, there was no association between clusters based on quality-of-life domains and nutritional risk, however, predictive models can be used as a complementary tool to evaluate nutritional risk in individuals aged 80 and over.
- DYNAMIC POSTURAL BALANCE IS MEDIATED BY ANTHROPOMETRY AND BODY COMPOSITION IN OLDER WOMEN(2021) BRECH, Guilherme Carlos; FREITAS, Jessica Sillas de; GOUVEA, Marcia; MACHADO-LIMA, Adriana; BASTOS, Marta Ferreira; TAKAYAMA, Liliam; PEREIRA, Rosa Maria Rodrigues; GREVE, Julia Maria D'Andrea; ALONSO, Angelica CastilhoObjective: 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/m(2)). The assessment of dynamic postural balance was performed by the mini Balance Master Evaluation System clinical test and the computerized Balance Master (R) 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.
- Men and women do not have the same relation between body composition and bone mineral density in Brazilian people(2017) ALONSO, A. C.; RIBEIRO, T. C.; FERREIRA, R. B.; DUARTE, R.; BRECH, G. C.; SILVA, L. X.; BOCALINI, D. S.; PETERSON, M.; MAIFRINO, L. B. M.; GREVE, J. M. D. A.Objectives: The main objective this study was to examine if lean mass and the adiposity related with BMD in a eutrophic population of Brazilian adults, in different sites and gender. Methods: A crossectional observational study, without intervention. One hundred non-obese men and women, aged 20-40 years, who did not practice regular physical activity were evaluated. Body composition analysis was conducted by dual energy X-ray absorptiometry (DXA), and multiple regression was used to examine the sex-specific association between adiposity and lean mass profiles. Results: Even after adjusting for age, sex, and BMI, total fat mass was inversely associated with total BMD (β=-4.52 g/cm2, p<0.01). Lean mass was positively associated with BMD and female groups. In our study the lean mass has a postive effect in BMD for eutrophic Brazilian adults, opposite of adiposity. Although when stratified by gender, in adults women lean mass and adiposity have positive effects on BMD, which did not happen with men. © 2017, Brazilian Society of Anatomy. All rights reserved.
- Biomechanical evaluation in runners with Achilles tendinopathy(2021) ANDERE, Nathalie Ferrari Bechara; GODOY, Alexandre Leme; MOCHIZUKI, Luis; RODRIGUES, Marcelo Bordalo; FERNANDES, Tulio Diniz; SOARES-JUNIOR, Jose Maria; ALONSO, Angelica Castilho; LUNA, Natalia Mariana Silva; BRECH, Guilherme Carlos; GREVE, Julia Maria D'AndreaOBJECTIVES: 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 degrees/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.