Acute effects of photobiomodulation therapy and magnetic field on functional mobility in stroke survivors: a randomized, sham-controlled, triple-blind, crossover, clinical trial.

Identify the optimal energy delivered with a single application of the combination of photobiomodulation therapy (PBMT) combining different light sources (low-level laser therapy-LLLT and light emitting diode therapy-LEDT) and static magnetic field (sMF) in order to determine the acute effects on functional mobility of stroke survivors. Was conducted a randomized, placebo-controlled, crossover, triple-blind, clinical trial (RCT). Twelve patients were recruited, however ten concluded the study, they were randomly treated with four PBMT/sMF energies (sham-0 J, 10 J, 30 J, and 50 J per site irradiated), with 1-week interval washout between treatments. PBMT/sMF were administered after the pre-intervention (baseline) evaluation and the total energy delivered per site at each treatment was determined based on the results of the randomization procedure. PBMT/sMF were administered in direct contact with the skin and applied with slight pressure to nine sites on the knee extensors, six sites on the knee flexors, and two sites on the plantar flexors' muscles in both lower limbs (bilaterally). The primary outcome measure was the 6-min walk test (6MWT) and the secondary outcome was the Timed Up and Go (TUG) test. Significant improvements were found in the 6MWT test using a total energy of 30 J per site compared with sham (0 J) (p < 0.05) and compared with the baseline evaluation (p < 0.01). And in the TUG test significant improvements were also found using a total energy per site of 30 J per site compared to sham (0 J) and baseline (p < 0.05). PBMT with different light sources (laser and LEDs) and wavelengths in combination with sMF with a total energy per site of 30 J has positive acute effects on functional mobility in stroke survivors.

Effects of a single session of transcranial direct current stimulation on static balance in a patient with hemiparesis: a case study.

[Purpose] Cerebrovascular accident (stroke) is characterized by an abrupt onset of focal or global neurological signs and symptoms. Asymmetry of the limbs is common following a stroke due to hemiplegia or hemiparesis. [Subject and Methods] A male patient having suffered an ischemic stroke was initially evaluated using the Timed Up-and-Go Test and the Six-Minute Walk Test. Static balance was evaluated using a force plate (Kistler model 9286BA) for the stabilometry analysis of center of pressure (COP) sway. The data were interpreted using the SWAY software program (BTS Engineering) synchronized with the SMART-D 140(®) system. Anodal transcranial direct current stimulation (tDCS; 2 mA) was applied over the primary motor cortex for 20 minutes during gait training on a treadmill. [Results] Under the condition of eyes open, reductions were found in anteroposterior sway (6.18%), trace length (3.3%) and sway velocity (3.3%) immediately following tDCS. [Conclusion] A single session of anodal tDCS combined with treadmill training had a positive effect on the static balance of a subject with chronic hemiparesis stemming from a stroke.

Effect of different insoles on postural balance: a systematic review.

[Purpose] The aim of the present study was to perform a systematic review of the literature on the effect of different insoles on postural balance. [Subjects and Methods] A systematic review was conducted of four databases. The papers retrieved were evaluated based on the following inclusion criteria: 1) design: controlled clinical trial; 2) intervention: insole; 3) outcome: change in static postural balance; and 4) year of publication: 2005 to 2012. [Results] Twelve controlled trials were found comparing the effects of different insoles on postural balance. The papers had methodological quality scores of 3 or 4 on the PEDro scale. [Conclusion] Insoles have benefits that favor better postural balance and control.

Effect of Ankle-foot Orthosis on Gait Velocity and Cadence of Stroke Patients: A Systematic Review.

[Purpose] The aim of the present study was to analyze the effect of an ankle-foot orthosis on gait variables (velocity and cadence) of stroke patients. To do this, a systematic review was conducted of four databases. [Subjects and Methods] The papers identified were evaluated based on the following inclusion criteria: 1) design: controlled, clinical trial; 2) population: stroke patients; 3) intervention: analysis of spatiotemporal variables of gait with an ankle-foot orthosis; 4) control group with different intervention or no intervention; and 5) outcome: improvement in gait velocity or cadence. [Results] Thirteen controlled trials addressing the effect of an ankle-foot orthosis on gait variables of stroke patients were found. They exhibited methodological quality of 3 or more points on the PEDro scale. [Conclusion] While the findings suggest the benefits of an AFO regarding gait velocity, the impact of this type of orthosis on cadence remains inconclusive. Thus, there is a need for further well-designed randomized, controlled, clinical trials to establish better scientific evidence for the effects of AFO usage on gait variables of stroke patients.

Analysis of the electromyographic activity of the ankle muscles on unstable proprioception devices with and without the use of shoes: A cross-sectional study.

INTRODUCTION: Proprioceptive exercises are performed in physiotherapy with the use of different unstable devices to improve joint stability using the mechanical and sensory properties of the ligaments, joint capsule and muscles surrounding the joint. However, the literature does not clearly show whether the use of foot wear increases or reduces muscle activity on different types of unstable devices. OBJECTIVE: Analyze the electromyographic activity of the ankle muscles on unstable proprioception devices and a stable surface with and without the use of shoes. METHODS: Thirty active, healthy men were submitted to warmup and familiarization of the devices prior to data collection. The order of data collection was chosen randomly by lots [on stable ground or unstable platforms (BOSU in the normal and inverted positions and proprioceptive disk) with or without the use of shoes]. The individuals remained balanced on these surfaces for 15 s. Biological signals were captured using surface electromyography for the evaluation of the activity of the tibialis anterior, gastrocnemius and fibularis longus muscles. RESULTS: No differences were found in the activation of the muscle in the comparison of the use and non-use of shoes (p > 0.05). The BOSU device in the normal position led to greater muscle activation than in the inverted position (p < 0.05). CONCLUSION: The use of shoes does not alter muscle activity of the ankle on the proprioceptive devices used in the present study. Moreover, these unstable devices each generate different muscle activities.

Effect of postural insoles on gait pattern in individuals with hemiparesis: A randomized controlled clinical trial.

INTRODUCTION: Recovering the ability to walk is an important goal of physical therapy for patients who have survived cerebrovascular accident (stroke). Orthotics can provide a reduction in plantar flexion of the ankle, leading to greater stability in the stance phase of the gait cycle. Postural insoles can be used to reorganize the tone of muscle chains, which exerts an influence on postural control through correction reflexes. The aim of the present study was to perform kinematic and spatiotemporal analyses of gait in stroke survivors with hemiparesis during postural insole usage. MATERIAL AND METHODS: Twenty stroke victims were randomly divided into two groups: 12 in the experimental group, who used insoles with corrective elements specifically designed for equinovarus foot, and eight in the control group, who used placebo insoles with no corrective elements. Both groups were also submitted to conventional physical therapy. The subjects were analyzed immediately following insole placement and after three months of insole usage. The SMART-D 140® system (BTS Engineering) with eight cameras sensitive to infrared light and the 32-channel SMART-D INTEGRATED WORKSTATION® were used for the three-dimensional gait evaluation. RESULTS: Significant improvements were found in kinematic range of movement in the ankle and knee as well as gains in ankle dorsiflexion and knee flexion in the experimental group in comparison to the control group after three months of using the insoles. CONCLUSION: Postural insoles offer significant benefits to stroke survivors regarding the kinematics of gait, as evidenced by gains in ankle dorsiflexion and knee flexion after three months of usage in combination with conventional physical therapy.

Stabilometric analysis of the effect of postural insoles on static balance in patients with hemiparesis: A randomized, controlled, clinical trial.

BACKGROUND: Stroke is one of the main causes of disability among adults. OBJECTIVE: The aim of the present study was to analyze the effect of postural insoles on static balance in individuals with stroke. METHODS: Twenty-four strokes survivors with hemiparesis were recruited from the rehabilitation clinics of the university and randomly allocated to two groups: experimental and control group. The subjects were analyzed for stabilometry, immediately following insole placement and after three months of insole usage, with eyes open and eyes closed. RESULTS: A significant difference was found immediately after postural insole placement regarding anteroposterior range of movement (p < 0.05). Moreover, significant reductions were found in the inter-group analysis after three months of insole usage. CONCLUSION: Based on the present findings, postural insoles combined with conventional physical therapy offer significant benefits regarding static postural control among stroke victims after three months of use, as demonstrated by computerized stabilometry.

Effects of gastrocnemius fascia lengthening on gait pattern in children with cerebral palsy using the gait profile score.

The aim of the present study was to investigate the efficacy of the GPS regarding the quantification of changes in gait following the gastrocnemius fascia lengthening in children with CP. Nineteen children with CP were selected and evaluated in the preoperative period (PRE session) and approximately one year postoperatively (POST session; mean 13.1 ± 5.1 months) using 3D gait analysis and computing the GPS and GVSs. As the GPS represents the difference between the patient's data and the average from the reference dataset, the higher the value of GPS is, more compromised gait of the subject. A statistically significant improvement in mean GPS was found in the POST session (PRE: 13.38 ± 5°; POST: 10.26 ± 2.41°; p<0.05), with an improvement close to 23%. Moreover, the GVSs demonstrated statistically significant improvements in ankle dorsi-plantarflexion (PRE: 22.20 ± 16.36°; POST: 11.50 ± 6.57°; p<0.05) and pelvic rotation (PRE: 9.53 ± 3.87°; POST: 6.47 ± 2.98°; p<0.05). A strong correlation (r=0.75; p<0.05) was found between the preoperative GPS and the percentage of GPS improvement. The results demonstrated that the gastrocnemius fascia lengthening produced a global gait pattern improvement, as showed by the GPS value, which decreased after surgery. Besides this, the GVS permitted to better evidence the joints more compromised by the pathology and their improvement due to the surgery, in this case not only the GVS of the ankle joint but also of the pelvis were characterized by higher GVS values.

Analysis of electromyographic activity in spastic biceps brachii muscle following neural mobilization.

INTRODUCTION: Hypertonia is prevalent in anti-gravity muscles, such as the biceps brachii. Neural mobilization is one of the techniques currently used to reduce spasticity. OBJECTIVE: The aim of the present study was to assess electromyographic (EMG) activity in spastic biceps brachii muscles before and after neural mobilization of the upper limb contralateral to the hemiplegia. MATERIALS AND METHODS: Repeated pre-test and post-test EMG measurements were performed on six stroke victims with grade 1 or 2 spasticity (Modified Ashworth Scale). The Upper Limb Neurodynamic Test (ULNT1) was the mobilization technique employed. RESULTS: After neural mobilization contralateral to the lesion, electromyographic activity in the biceps brachii decreased by 17% and 11% for 90° flexion and complete extension of the elbow, respectively. However, the results were not statistically significant (p gt; 0.05). CONCLUSIONS: When performed using contralateral techniques, neural mobilization alters the electrical signal of spastic muscles.

Influence of heat on fatigue and electromyographic activity of the biceps brachii muscle.

Electromyography enables registering muscle activity during contraction and can identify muscle fatigue. In the present study, 30 volunteers between 18 and 30 years of age were submitted to an exertion 1 min of maximal voluntary isometric contraction. The electromyographic signal of the biceps brachii muscle and the strength of the flexor muscles of the elbow were determined before and after the administration of microwave diathermy in order to analyze the influence of heat over the strength of the elbow flexor muscles and fatigue of the biceps brachii. The results demonstrate that the strength of the elbow flexor muscles diminished significantly following the application of heat (p<0.05). Heat also led to a significant reduction in the electrical activity of the muscle studied. The present study demonstrates that microwave diathermy on the biceps brachii muscle reduces the flexion strength of the elbow as well as signs of muscle fatigue in the biceps.

Efetividade de exercícios de estabilização segmental sobre a dor lombar crônica mecênico-postural / Effectiveness of segmental stabilization exercises on mechanical-postural chronic low back pain

Introdução: A prevalência ao longo da vida de lombalgias mecânico-posturais é estimada em 60-70%em países industrializados. Um dos principais fatores para dor lombar é a instabilidade segmentar, e para manter a estabilidade é necessária a interação de três subsistemas: passivo, ativo e controle neural.Exercícios específicos que promovem a contração independente dos músculos profundos do tronco (transverso do abdômen e multífido) têm demonstrado ter efeitos benéficos em indivíduos que sofrem de dor lombar inespecífica, sugerindo a estimulação desses subsistemas. Objetivo: Avaliar a efetividade de exercícios de estabilização segmentar sobre a dor e a capacidade funcional em indivíduos com lombalgia crônica.Materiais e métodos: Participaram da pesquisa 12 mulheres jovens com idade média de 20,66 ± 3,74 anos.Foram realizadas 12 sessões de um programa de estabilização segmentar com frequência de duas vezes semanais, sendo avaliadas quanto à dor (questionário McGILL-Br) e capacidade funcional (questionário Rolland-Morris Brasil) antes e depois do período de intervenção. Resultados: Houve melhora significativa dos valores médios do índice de dor (p < 0,0001), melhora do índice de dor sensitiva (p = 0,0024),afetiva (p = 0,048), avaliativo (p = 0,042) e miscelânea (p = 0,017) e melhora da capacidade funcional dos indivíduos (p < 0,0001), após o período de intervenção. Discussão: Vários estudos relataram a eficácia de exercícios dos músculos profundos do tronco, apresentando efeitos benéficos em indivíduos com lombalgia, corroborando com o estudo proposto. Conclusão: Pode-se concluir que o programa de estabilização segmentar foi efetivo na redução da dor e na melhora da função nestes pacientes, demonstrando assim ser um método eficaz de tratamento de lombalgias.

Influência da diatermia por microondas na força dos músculos flexores do cotovelo e na atividade eletromiográfica do músculo bíceps braquial / Influence of the diathermy for microwaves in the force of the elbow flexors and in the activity electromyography of the muscle brachial bíceps

A eletromiografia possibilita o registro da atividade muscular durante o movimento, a qual, por meio de eletrodos de superfície, consegue captar a atividade global das unidades durante a contração muscular. Dentre as aplicações da eletromiografia de superfície destaca-se a identificação da fadiga muscular. A fadiga muscular é considerada como uma falha ao manter um npivel desejado de rendimento ou trabalho durante uma atividade repetitiva ou sustentada. No presente estudo 20 voluntários, entre homens e mulheres, com idade variando de 18 a 30 anos, foram submetidos a um protocolo exaustivo com duração de um minuto, de contração muscular isométrica máxima, em que foi obtido o sinal eletromiográfico do músculo bíceps braquial e avaliada a força dos músculos flexores do cotovelo antes e após a aplicação da diatermia por microondas, com o objetivo de analisar a influência do calor na força e na fadiga do músculo bíceps braquial. Para análise da fadiga foi utilizada a média dos valores da amplitude do sinal eletromiográfico, Root Mean Square (RMS), e a análise no domínio da frequência por meio da Transformada rápida de Fourier. Os resultados mostraram que a força dos músculos flexores do cotovelo foi reduzida de forma significativa (pmenor que 0,05) após a aplicação do calor e adversamente ocorreu um aumento da frequência mediana do músculo bíceps braquial ( p menor que 0,05). Pode-se concluir que a diatermia por microondas influenciou no aumento da frequência mediana do músculo bíceps braquial, indicando redução da fadiga após a aplicação de calor profundo.

Análise da atividade eletromiográfica dos músculos do tornozelo em solo estável e instável / Electromyography activity analysis of the ankle muscles at the stable and unstable soil

Introdução: Os exercícios proprioceptivos são realizados diariemente na reabilitação com a utilização de diversos solos instáveis e com o objetivo de melhorar a estabilidade articular através das propriedades mecânicas e sensoriais dos ligamentos, da cápsula articular e da atividade fusal dos músculos ao redor da articulação. As mudanças na característica mioelétrica dos músculos em atividade podem ser identificados através da eletromiografia de superfície (EMG), podendo oferecer informações importantes sobre o comportamento dos músculos quando submetidos aos diversos tipos de sobrecarga. Objetivos: O presente estudo tem por objetivo analisar e comparar a atividade eletromiográfica dos músculos tibial anterior, tibial posterior, fibular longo e gastrocnêmios medial e lateral em três solos instáveis e no solo estável. Metodologia: Foram selecionados 20 indivíduos, de ambos os sexos, ativos e saudáveis para o estudo, e todos foram submetidos a uma avaliação antropométrica e à aplicação de um protocolo de coleta que envolvia o aquecimento e a avaliação da atividade muscular em diferentes solos. Resultados: Houve um aumento significativo (pd"0,05) na atividade muscular na maioria dos solos instáveis, entretanto, a cama elástica não apresentou diferenças significativas (pe"0,05) na atividade eletromiográfica, mantendo seus valores próximos ao solo estável. Foi observado que os músculos tibial anterior e fibular longo apresentaram maior ativação eletromiográfica em todos os solos analisados. Em relação aos diferentes solos, houve uma maior ativação eletromiográfica no disco proprioceptivo. Conclusão: Pode-se concluir que exercícios de perturbação em solos instáveis geram aumentos significativos da atividade eletromiográfica quando comparado ao solo estável, sendo esse exercícios um recurso valioso na reabilitação sensório-motora da articulação do tornozelo.

Influência da diatermia por microondas no pico de força eletromiografico dos músculos flexores do cotovelo / Influence of diathermy for microwaves in electromyography peak of the force in elbow flexors muscle

As aplicações específicas da eletromiografia nas pesquisas em saúde são inúmeras, entre elas a avaliação da atividade muscular, análise da taxa de disparo de unidades motoras, identificação da fadiga muscular, além de possibilitar a identificação da força de tração exercida em dinamômetro, através da célula de carga. Diversos grupos musculares vem sendo alvo de estudos na área da saúde, devido ao seu potencial de exercer atividades de alto nível e manter ou vencer altos níveis de carga, dentre esses grupos musculares encontram-se os flexores de cotovelo, tornando-se portanto um importante grupo muscular a ser estudado em fisiologia do exercício. No presente estudo, induziu-se o aquecimento dos flexores do cotovelo através da diatermia por microondas, com intuito de analisar o pico e força eletromiográfico com e sem a influência do calor. Como resultado obteve-se uma diminuição do pico de força eletromiográfico do membro submetido ao aquecimento enquanto que o membro controle expressou um aumento desse pico de força. Conclui-se portanto, que o grupo muscular flexor do cotovelo, quando submetido ao aquecimento pela diatermia por microondas, obtêm uma queda do seu pico de força eletromiográfico.

The specific applications of the electromyographic in the researches in health are countless, among them the evaluation of the muscles activity, analyis of the rate of shot motor units, identification of the muscular fatigue, besides making possible the identification of the traction force exercised in your dynamometer, through the load cell. Several muscles groups are being white of studies in the area of the health, due to your potential of to exercise activities of high level and to maintain or to win high load levels, among those muscles groups are the elbow flexors, becoming therefore an important muscles group to be studied in phyiology of the exercise. In the present study, the heating of the flexors of the elbow was induced through the diathermy by microwaves, with intention of analyzing the peak of force electromyographic with and without the influence of the heat. As result was obtained a decrease of the peak of force electromyographic of the member submitted to the heating while the member control expressed an increase of that pick of force. it is ended therefore, that the group muscles flexor of the elbow, when submitted to the heating by the diathermy for microwaves, obtain a fall of your pick of the force electromyographic.

Avaliação podal de crianças do ensino fundamental de uma escola pública / Podal evaluation of the childrens in fundamental teaching of a public school

Para o processamento normal das funções como deambulação e sustentação do peso corporal, é considerado que a integridade do membro inferior é de fundamental importância. O presente trabalho tem por finalidade avaliar e quantificar os pés de crianças das primeiras e segundas séries do ensino fundamental, com idade entre 6 a 12 anos, elaborar palestras sobre a importância da patologia, orientando e conscientizando os responsáveis sobre a mesma. Foi obtido um total de 153 amostras. Verifi cou-se que houve normalidade dos pés em 57 crianças (37,25%) da amostra, 44 crianças (28,75%) apresentaram pé plano tipo dois, 31 crianças (20,26%) o pé cavo e em 15 crianças (9,8%) encontrou-se o pé plano tipo três. A normalidade foi prevalente no sexo masculino, com um total de 31 crianças contra 26 do sexo feminino, também a presença de pé plano tipo dois foi prevalente entre os sexos, com 30 indivíduos masculinos contra 14 para o sexo feminino. Embasando-se nos resultados encontrados, foram elaboradas palestras para explanar aos responsáveis sobre a importância da patologia e da realização de um tratamento. Contudo, foi possível orientar e conscientizar aos responsáveis da importância de uma visão criteriosa no desenvolvimento podálico das crianças, evitando-se, dessa forma, a instalação de possíveis patologias e deformidades decorrentes do incorreto desenvolvimento plantar.

For the normal processing of the functions as walking and sustenance of the corporal weight, is consideredthat the integrity of the inferior member is of fundamental importance. For so much, the present work has the purposeof evaluate and quantify the children’s feet from the fi rst and second series of the fundamental teaching, with ageamong 6 to 12 years totaling 153 samples. It was verifi ed that there was normality of the feet in 57 children (37,25%) of the sample, with the foot plane type two in 44 children (28,75%), in 31 children (20,26%) the concave foot and in 15 children (9,8%), he/she was the foot plane type three. The normality was prevalence in the masculine sex, with a total of 31 children against 26 of the feminine sex, the presence of foot plane type two was also prevalence among the sexes, with 30 masculine individuals against 14 for the feminine sex. Based in the found results, lectures were elaborated to explain to the children’s responsible about the importance of the pathology and of the importance of a treatment. However, it was possible to guide and to become aware to the responsible, of the importance of a discerning vision in the children’s feet development, avoiding the installation of possible pathologies and deformities, derived from the incorrect development of the feet.

Estudo eletromiográfico da relação entre estabilização dinâmica do tornozelo e o sistema visual / Electromyographic study of the relationship between dynamic stabilization of the ankle and the visual system

Exercícios proprioceptivos são realizados na reabilitação com a utilização de diversos solos instáveis e com o objetivo de melhorar a estabilidade articular através das propriedades mecânicas e sensoriais dos ligamentos, da cápsula articular e da atividade fusal dos músculos ao redor da articulação. A característica mioelétrica dos músculos em atividade pode ser identificada pela eletromiografia. O objetivo do presente estudo foi comparar a atividade eletromiográfica dos músculos do tornozelo em diferentes apoios, tanto com olhos abertos quanto fechados. De acordo com os resultados obtidos, os testes proprioceptivos com os olhos fechados apresentaram ativação eletromiográfica maior, com diferença significativa, em comparação com olhos abertos. Os resultados mostram uma diferença significativa na atividade eletromiográfica da maioria dos músculos analisados, com aumento significativamente maior com os olhos fechados comparados aos olhos abertos em todos os solos testados, com exeção do músculo gastrocnêmio medial.

The proprioceptive exercises are accomplished in rehabilitation and several unstable soils are used for that with the objective of improving the joint stability trough the mechanical and sensorial properties of the ligaments, from tehe joint capsule and of the fusal activity of the muscles around the joint. The myoletrical characteristic of the muscles in activity can be identified trouhgh the electromyography. The aim of present study was to compare electromyography activity of ankle s muscles at different supports, so much with eyes open or closed. In agreement with the obtained results, the proprioceptive tests with the closed eyes presented larger electromyographic activation, with significant difference, in comparison with open eyes. The results showed a signficant increase in the alectromyographic activity of most of the analyzed muscles, with increase significantly larger with the closed eyes compared to open eyes in all tested supports, except for medium gastrosnemis muscle.