Use of electromyographic signals for characterization of voluntary coughing in humans with and without spinal cord injury-A systematic review.

INTRODUCTION: Individuals with spinal cord injury (SCI) frequently have an ineffective cough ability due to dysfunctions in expiratory muscles. In such cases, several articles have reported the occurrence of residual muscular activity in muscles that are accessory to coughing. The knowledge about this activity may be useful for building cough assistance devices. The goal of this review is to investigate and to describe the electromyographic signals generated during voluntary coughing in healthy people and in patients with SCI. METHODS: Two researchers performed, blindly and independently, a systematic review of the following databases: PubMed, PEDro, LILACS, and Science Direct. We conducted the searches using descriptors in English, Portuguese, and Spanish, with no limitations regarding the publication year. The review included articles describing experiments performed in humans and with the use of electromyographic signals in the analysis of voluntary coughing. RESULTS: Among the 156 initially found articles, only nine had results that described the study of electromyographic signals associated with voluntary coughing. The results showed evidence that, during voluntary coughing, electromyographic signals are generated both in expiratory and accessory muscles in healthy subjects. In individuals with SCI below the 5th cervical level (C5), the electromyographic signal appeared only in the clavicular portion of the pectoralis major, especially in the explosive cough phase. CONCLUSION: Our evaluation of the current literature shows that, according to the analysed studies, the electromyographic signals are more pre-eminent in the expiratory phase of the pectoralis major, during voluntary cough of individuals with SCI (C5-T12).

Parâmetros e efeitos do laser não ablativo no tratamento de melasma facial / Parameters and effects of non-ablative laser in facial melasma

O uso do laser não ablativo no tratamento do melasma tem sido abordado em diversos estudos, porém, não há consenso na literatura quanto aos parâmetros e feitos de intervenções baseadas neste recurso. O objetivo deste estudo foi identificar e descrever parâmetros e efeitos do laser não ablativo no tratamento de hiperpigmentação de pele (melasma). Trata-se de uma revisão sistemática da literatura baseada no Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca eletrônica compreendeu as seguintes bases de dados: PubMed, Physiotherapy Evidence Database (PEDro), Science Direct e SciELO. Foram identificados inicialmente 641 documentos nas bases de dados eletrônicas, enquanto na busca manual 26 artigos foram encontrados, após leitura e análise 7 artigos foram selecionados. Foram analisados 7 artigos correspondentes as bases de dados PubMed e Science Direct, todos na língua inglesa e publicados a partir do ano de 2010. Apenas um estudo utilizou uma amostra maior que 30 indivíduos, os demais utilizaram em média 16 participantes, com predomínio do sexo feminino e classificação segundo Fitzpatrick entre III-V. O comprimento de onda variou entre 1064 nm a 1550 nm e a energia máxima não ultrapassou 4 J/cm². De acordo com as variáveis avaliadas, os protocolos testados demonstraram que o laser não ablativo foi ineficaz no tratamento de melasma facial, sobretudo após a interrupção da terapia. (AU)

The use of non-ablative laser in the treatment of melasma has been used in several studies, however, there is no consensus in the literature regarding the parameters and interventions based on this resource. The objective of this study was to identify and describe parameters and effects of nonablative laser in the treatment of skin hyperpigmentation (melasma). This is a systematic review of the literature based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The study included the following databases: PubMed, Physiotherapy Evidence Database (PEDro), Science Direct and SciELO. We initially identified 641 documents in the electronic databases, while in the manual search 26 articles were found, and after reading and analyzing 7 articles were selected. We analyzed these 7 articles corresponding to the PubMed and Science Direct databases, all in the English language and published after the year 2010. Only one study used a sample > 30 individuals, the others used on average 16 participants, with a predominance of female gender and Fitzpatrick classification according to III-V. The wavelength ranged from 1064 nm to 1550 nm and the maximum energy did not exceed 4 J/cm². According to the variables evaluated, the protocols tested demonstrated that the non-ablative laser was ineffective in the treatment of facial melasma, especially after the end of the therapy. (AU)

Novas perspectivas de fisioterapia respiratória em lesão medular - uma revisão sistemática / New perspectives for chest physical therapy in spinal cord injury - a systematic review

Resumo Objetivo: Descrever e analisar parâmetros e efeitos da estimulação elétrica de superfície na função muscular respiratória de pessoas com lesão medular, sobretudo durante a tosse. Métodos: Foi realizada uma revisão sistemática da literatura, com base no Preferred Reporting items for Systematic Reviews and Meta-Analyses. A busca foi realizada nas bases de dados PubMed, PEDro e LILACS, por meio dos seguintes descritores: "estimulação elétrica funcional", "eletroestimulação, estimulação elétrica", "tosse", "higiene brônquica", "quadriplegia", "lesão medular espinhal", "tetraplegia" e "sujeito com tetraplegia" - em espanhol, inglês e português, sem restrição quanto ao ano de publicação. Foram incluídos artigos com amostra de indivíduos com lesão medular assistidos por estimulação elétrica com desfecho relacionado ao sistema respiratório, e foram excluídos artigos com ensaios invasivos de estímulo a tosse. Resultados: Os 12 artigos incluídos revelam heterogeneidade nos protocolos de eletroestimulação da função expiratória, que podem incluir frequências de 30 a 50 Hz, com pulsos de 25 a 400 μs, aplicada por até oito eletrodos distribuídos pelos músculos expiratórios e acessórios. O tempo de aplicação também foi variável e a amplitude de corrente frequentemente estimada pela percepção do paciente, podendo chegar a valores superiores a 100mA. Conclusão: Apesar de não ser possível estabelecer parâmetros rigorosos de fisioterapia por meio da estimulação elétrica, pela escassez e qualidade de estudos que comparem sistematicamente parâmetros de estimulação em subgrupos, foram observadas alterações positivas nas variáveis de função muscular respiratória avaliadas, como o pico de fluxo expiratório e de tosse, em pessoas com lesão medular cervical e torácica.

Abstract Objective: To describe and analyze parameters and effects of surface electrical stimulation on the respiratory muscular function among individuals with spinal cord injuries, especially while coughing. Methods: A systematic literature review was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search was conducted in the PubMed, PEDro, and LILACS databases, using the following descriptors: "functional electrical stimulation," "electrostimulation, electrical stimulation," "coughing," "bronchial hygiene," "quadriplegia," "spinal cord injury", "tetraplegia", and "individual with tetraplegia" - in Spanish, English and Portuguese, with no restrictions on year of publication. Inclusion criteria were: articles describing studies with samples of individuals with spinal cord injuries treated with electrical stimulation and outcomes related to the respiratory system. Articles containing studies with invasive cough stimulation trials were excluded. Results: The 12 selected articles revealed the heterogeneity of electrostimulation protocols for expiratory function, which can include frequencies ranging from 30 to 50 Hz; pulse from 25 to 400 μs; applied in up to eight electrodes distributed across the expiratory and accessory muscles. Time of administration also varied, and the current amplitude was usually estimated by the patient's perception, reaching values higher than 100mA. Conclusion: Even though the review did not find rigorous parameters for physical therapy using electrical stimulation, because of the shortage and low-quality of the studies that systematically compare stimulation parameters among subgroups, positive changes were observed in the assessed respiratory muscle function variables, such as peak expiratory and cough flow in individuals with cervical and thoracic spinal cord injury.