Background: Severe obesity is a multisystemic chronic disease associated with significant neurocognitive impairments, including deficits in executive functions, memory, and attention. Traditional weight loss interventions often overlook these neurological and psychosocial barriers. Systemic Neuro-Integral Rehabilitation, combining cognitive training, functional neurorehabilitation, and Cognitive-Behavioral Therapy (CBT), emerges as a holistic approach to bridge this gap. This protocol outlines a systematic review to evaluate the efficacy of these multidisciplinary interventions in women with severe obesity. Methods: This review will follow the PRISMA guidelines and is registered in PROSPERO (CRD420261356828). A systematic search will be conducted in MEDLINE (via PubMed), Scopus, and Web of Science for Randomized Controlled Trials (RCTs) involving women with severe obesity (BMI 40 kg/m² or 35 kg/m² with comorbidities). Interventions of interest include cognitive and functional neurorehabilitation compared to conventional exercise or nutritional education. Two independent reviewers will perform study selection, data extraction, and risk of bias assessment using the Cochrane RoB 2 tool. Data will be synthesized through a narrative approach and, if feasible, a meta-analysis using random-effects models. Results: The review aims to demonstrate that integrated neurofunctional interventions lead to superior improvements in executive functions, working memory, and functional capacity compared to isolated treatments. Additionally, improvements in mental health (anxiety, depression, and body image) and autonomic regulation (heart rate variability) are anticipated. Conclusion: By synthesizing evidence on neurocentric approaches, this review seeks to provide a foundation for new clinical guidelines that prioritize cognitive health as a pillar for long-term therapeutic success and autonomy in women with severe obesity.
Background: Parkinson's disease (PD) is a progressive neurodegenerative condition that predominantly affects older individuals , with significant impacts on quality of life. It is characterized by motor symptoms, such as tremors and bradykinesia, and non-motor symptoms, such as sleep disorders. Given the complexity of PD, it is essential to deepen the analysis of the factors that interfere with quality of life, contributing to the development of integrated therapeutic strategies. Objective: To evaluate the relationship between PD progression and sleep quality and performance in activities of daily living. Methods: This is a cross-sectional observational study, conducted at the State University of Minas Gerais, involving individuals with a clinical diagnosis of PD. Participants will be recruited through a search in the Electronic Citizen Record system, in Public Health Centers of Primary Health Care in the city of Divinópolis - MG. To assess PD progression, the following tests will be conducted: the Modified Hoehn and Yahr Scale and parts I, II, and III of the Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS). Sleep quality will be assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Parkinson's Disease Sleep Scale (PDSS) and functionality will be assessed using the Five-Repetition Sit-to-Stand Test and the Coin Rotation Test. Discussion: The increased prevalence of PD and gaps in the literature on sleep quality and impact on ADLs may aggravate functional impairments and quality of life of these patients.
Background: Aging leads to a reduction in strength, changes in gait, and compromised balance, increasing the risk of falls and constituting a serious public health problem. Tai Chi Chuan (TCC) has proven effective in preventing these events in the elderly. Objective: Analyze the effectiveness of adapted forms of TCC as a method for fall prevention in the elderly. Methods: This is a systematic review of the literature. The databases PubMed, SciELO, LILACS, and Google Scholar were consulted. Randomized clinical trials (RCTs) published in English between January 1, 2015, and February 18, 2025, involving elderly individuals aged ≥60 who underwent adapted TCC interventions, compared to active or inactive controls, were included. Studies outside the topic, with insufficient methodological description, that were not RCTs, that recruited elderly individuals with prior experience in TCC, or with cognitive, neurological, or functional impairments, as well as special populations, were excluded. The studies were selected by two independent reviewers. The characteristics of the studies eligible to be included in this review were extracted and tabulated, likewise by two independent reviewers. The synthesis of the results was conducted thru narrative synthesis. The methodological characteristics and the effects of the interventions were analyzed and compared qualitatively. Results: Seven studies were included, totaling 1,017 elderly individuals. All the studies used adapted forms of TCC and demonstrated positive effects on factors related to fall risk. Only one RCT directly assessed the incidence of falls, recording a significant reduction after the TCC intervention. Conclusion: Adapted forms of TCC are effective in preventing falls in the elderly. However, overly simplified protocols or those with a frequency of more than four sessions per week reduce adherence and compromise the results. Future studies should adopt the incidence of falls as the primary outcome and rigorously monitor adherence and dropout.
Background: Total knee arthroplasty (TKA) is a widely used procedure to treat advanced osteoarthritis, providing pain relief and functional improvement. However, the long-term success of the surgery depends on the precision in the positioning of the prosthetic components and the proper alignment of the operated limb. Objective: Describe the case of a 52-year-old patient, diagnosed with advanced gonarthrosis, who underwent TKA with the aid of augmented reality (AR). The patient had a history of hypertension, grade I obesity, and complaints of chronic pain in the right knee, with functional limitation and claudication. Method: The procedure was performed using prosthetic implants from the brand MicroPort Advanced®, with a navigation system assisted by AR, aiming for greater precision in correcting the mechanical axis and better adaptation of the components. Results: The surgery proceeded without complications, with a satisfactory postoperative evolution, including rapid functional recovery and significant symptom relief. Conclusion: The use of AR can offer significant advantages in surgical precision and functional outcomes, representing a promising alternative to optimize the longevity of implants in environments with limited infrastructure.
Background: Low back pain (LBP) has emerged as a significant public health issue among adolescents, with lifetime prevalence reaching 40%. Sedentary behaviors, such as excessive screen time, are linked to increased risk, while the school environment offers a strategic setting for early intervention. This systematic review aims to identify the most effective school-based exercise interventions for reducing non-specific LBP in this population. Methods: Developed according to PRISMA-P guidelines and registered in PROSPERO (CRD420261297319), this review focuses on non-randomized studies involving adolescents aged 10–19 with non-specific LBP. Primary outcomes include pain intensity measured by validated scales like the Visual Analogue Scale. Electronic searches will be conducted in MEDLINE, PubMed, Scopus, and CENTRAL. Selection, data extraction, and risk of bias assessment (using the ROBINS-I tool) will be performed independently by two reviewers. Results: A narrative synthesis will be performed, with potential meta-analysis using a random-effects model if methodological homogeneity is met. Conclusion: By synthesizing "real-world" interventions, this review will provide evidence-based guidelines for healthcare and education professionals. Addressing LBP in adolescence serves as a crucial preventive strategy against chronic disability in adulthood.
