Allgrove syndrome with amyotrophy.

Allgrove syndrome is an autosomal recessive disease mostly caused by mutations in the AAAS gene. It has variable clinical features but its cardinal features comprise the triad of achalasia, alacrimia and adrenal insufficiency. It typically develops during the first decade of life, but some cases have second and third decades onset. We describe a 25-year-old woman with Allgrove syndrome who had progressive amyotrophy, achalasia, dry eyes and adrenal insufficiency since childhood. Awareness of its neurological manifestations and multisystem features helps to shorten the time for diagnosis and allow appropriate symptomatic treatment.

Quality of life related to swallowing in Parkinson's disease.

Swallowing difficulties in Parkinson's disease can result in decreased quality of life. The swallowing quality of life questionnaire (SWAL-QOL) is an instrument for specifically assessing quality of life with respect to swallowing, which has been little explored in patients with Parkinson's disease (PD). The goal of this study was to evaluate the quality of life with respect to swallowing in persons with PD compared to controls and at several stages of the disease using the SWAL-QOL. The experimental group was composed of 62 persons with PD at stages 1-4. Forty-one age-matched healthy subjects constituted the control group. The SWAL-QOL scores were significantly lower for the patients with PD than for the controls in all SWAL-QOL domains. Eating duration had the largest difference in score between persons with PD and the controls and the lowest mean score, followed by communication, fatigue, fear, sleep, and food selection. The scores of most domains were lower at later stages of the disease. The scores for eating duration, symptom frequency, and sleep were significantly lower at stage 4 than stages 1 and 2. In conclusion, patients with PD have significantly lower scores in all domains of the SWAL-QOL than normal controls. This means swallowing difficulties occurring in patients with PD negatively affect their QOL. Progression of the disease worsens swallowing QOL, more specifically in the domains of eating duration, symptom frequency, and sleep. This occurs mostly at later stages of the disease.

The relationship between limit of Dysphagia and average volume per swallow in patients with Parkinson's disease.

The goal of this study was to obtain the limit of dysphagia and the average volume per swallow in patients with mild to moderate Parkinson's disease (PD) but without swallowing complaints and in normal subjects, and to investigate the relationship between them. We hypothesize there is a direct relationship between these two measurements. The study included 10 patients with idiopathic PD and 10 age-matched normal controls. Surface electromyography was recorded over the suprahyoid muscle group. The limit of dysphagia was obtained by offering increasing volumes of water until piecemeal deglutition occurred. The average volume per swallow was calculated by dividing the time taken by the number of swallows used to drink 100 ml of water. The PD group showed a significantly lower dysphagia limit and lower average volume per swallow. There was a significantly moderate direct correlation and association between the two measurements. About half of the PD patients had an abnormally low dysphagia limit and average volume per swallow, although none had spontaneously related swallowing problems. Both measurements may be used as a quick objective screening test for the early identification of swallowing alterations that may lead to dysphagia in PD patients, but the determination of the average volume per swallow is much quicker and simpler.

Portable accelerometers for the evaluation of spatio-temporal gait parameters in people with Parkinson's disease: an integrative review.

PURPOSE: The progression of Parkinson's disease causes an increase in motor dysfunctions, which makes it necessary to evaluate and monitor these changes. This integrative review aimed to gather studies - without any language restrictions - on the use, advantages and disadvantages of portable accelerometers for the evaluation of spatio-temporal gait parameters in people with Parkinson's disease published between 2014 and 2019. METHODS: Articles were selected from the PubMed, Web of Science and Science Direct databases by combining descriptors from the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) - "accelerometry", "accelerometer", "ActiGraph", "gait", "gait analysis", "gait rehabilitation", "walking inertial sensors", "Parkinson disease", "Parkinson" and "Parkinson's disease" - using OR and AND. The adapted Critical Appraisal Skill Program was used to analyze the methodological quality. RESULTS: All the studies used portable wearable and wireless triaxial accelerometers. Among all types of accelerometers discussed, commercial wearable devices not based on smartphones and prototypes of wearable devices based and not based on smartphones can be pointed out. There was no standardization for the protocols of use, but the sensors were more often attached to the lower back (L3/L4/L5 vertebrae). The advantages included lower cost, possibility of use in outdoor environments and less complexity of data reading for non-specialized users. However, they still seem to show reduced precision and accuracy. CONCLUSIONS: Due to the still insufficient number of articles published on the subject, we consider the need for further research, which should detail protocols of evaluation, advantages and disadvantages in stages of disease.

Diaphragmatic paralysis: Evaluation in infants with congenital Zika syndrome.

BACKGROUND: Paralysis of the diaphragm in newborn infants can lead to recurrent infections and life-threatening respiratory insufficiency. The clinical diagnosis of unilateral diaphragmatic paralysis has been reported in infants with laboratory evidence of congenital Zika virus infection and/or the congenital Zika syndrome (CZS) phenotype but no evaluation of phrenic nerve function has been described. All reported infants have had accompanying arthrogryposis. High infant mortality is reported. METHODS: The causal mechanism of congenital diaphragmatic paralysis was evaluated in three infants with arthrogryposis as a manifestation of CZS (two of the three infants had laboratory evidence of ZIKV infection shortly after birth; the remaining infant had negative serology for ZIKV when first tested at 7 months of age). Electromyography and phrenic nerve compound muscle action potential (CMAP) were performed in all infants with diaphragmatic paralysis demonstrated on imaging studies. RESULTS: All infants had evidence of moderate chronic involvement of peripheral motor neurons. Phrenic nerve CMAP was reduced on the side of the diaphragmatic paralysis in two infants and reduced bilaterally in the remaining infant who had primarily anterior involvement of the diaphragm. All three infants had multiple medical complications and one infant died at 18 months of age. CONCLUSION: Evaluation of three infants with CZS and diaphragmatic paralysis demonstrated phrenic nerve dysfunction. In these and other affected infants, arthrogryposis appears to be a constant co-occurring condition and health problems are significant; both conditions are likely due to involvement of the peripheral nervous system in some infants with CZS.

Respiratory muscle strength and lung function in the stages of Parkinson's disease.

OBJECTIVE: To investigate parameters of lung function and respiratory muscle strength in different stages of Parkinson's disease (PD), as well as to determine their correlation with motor function and quality of life. METHODS: This was a cross-sectional study conducted at a referral center for PD in the city of Recife, Brazil. Respiratory muscle strength and lung function, as well as their relationship with motor function and quality of life, were evaluated in patients with PD, stratified by the level of severity, and were compared with the data obtained for a control group. After confirming the normality of data distribution, we performed one-way ANOVA with a post hoc t-test. RESULTS: The sample comprised 66 individuals, in two groups: PD (n = 49) and control (n = 17). All of the parameters investigated showed inverse correlations with PD severity, and there were significant differences among the levels of severity, as well as between the PD and control groups, in terms of the MIP, MEP, FVC, FEV1, and FEF25-75%. The lung function parameters also showed moderate to weak inverse correlations with bradykinesia and rigidity. On a quality of life questionnaire, the total score and mobility domain score both presented a moderate inverse correlation with FVC, FEV1, PEF, and MEP. CONCLUSIONS: Respiratory muscle strength and some lung function parameters are impaired from the early stages of PD onward, bradykinesia and rigidity being the cardinal signs that correlate most strongly with impairment of those parameters. Such alterations negatively affect the quality of life of patients with PD.

[Repetitive stimulation test on the anconeus muscle for the diagnosis of myasthenia gravis: the mapping of its motor end-plate area]. / Teste de estimulação repetitiva no músculo ancôneo para diagnóstico da miastenia grave: mapeamento da sua área de placa motora.

PURPOSE: To map the motor end-plate area of the anconeus muscle and define the best place for positioning the recording electrodes in repetitive stimulation tests (RST) for the diagnosis of neuromuscular transmission disorders. METHOD: The compound muscle action potential of the anconeus was recorded after stimulating the motor branch of the radial nerve that innervates it. By analyzing the waveforms registered at each point of the skin we were able to define the motor end-plate area. RESULTS: The motor end-plate area of the anconeus is a line parallel to the ulna border. The best place for placing the "active" recording electrode is about 2 cm distal to the olecranon and 1 cm lateral to the border of the ulna. CONCLUSION: Performing RST in the anconeus muscle is simple and well tolerated. Stimulation of the anconeus almost doesn't move the forearm and the procedure is virtually free of movement artifacts.

[Electromyografic patterns predictive of motor evolution in neuroschistosomiasis]. / Aspectos eletromiográficos preditores da evolução motora de pacientes com neuroesquistossomose.

Neuroschistosomiasis in myeloradicular pattern is frequently observed in patients from Northeast of Brazil. Despite of this, the evolution of neurologic and electromyographic patterns is not well studied in this group of patients. The aims of this study were to describe and compare the clinic and electromyographic abnormalities of patients with neuroschistosomiasis and radicular involvement. We analyzed 21 electromyographic exams of the lower limbs carried out in the initial presentation of the disease. Electromyographic pattern of 95.2% of patients was compatible to axonal lumbosacral multirradiculopathy, with variable denervation extension, but predominantly from levels L2 to S2. There was variable degree of deficit in the lower limbs, and the follow-up of motor disturbances was better more frequently when the roots were involved in smaller number. Electromyography should permit to know the motor prognosis of patients with myeloradiculitis due schistosomiasis.

Bereitschaftspotential preceding spontaneous and voluntary eyelid blinks in normal individuals.

OBJECTIVE: To investigate the Bereitschaftspotential (BP) preceding spontaneous and voluntary eyelid blinks in normal subjects. METHODS: Eighteen healthy individuals (10 female) between 17 and 60years (mean 35) were studied. The EEG was recorded from 11 scalp positions of the 10-20 international electrode placement system referenced to linked mastoids. The vertical electrooculogram (VEOG) was recorded from two electrodes positioned above and below the right eye. The ground electrode was placed in the right clavicle. The recordings were obtained during spontaneous and voluntary eyelid blinks. Two-second EEG segments before the onset of the blink potential (visually identified at the VEOG channel) were averaged and analyzed off-line. The statistical significance of differences was evaluated by repeated-measures analysis of variance with Geisser-Greenhouse correction for violation of sphericity and the Newman-Keuls test was used for post hoc comparisons. RESULTS: A BP starting around -1700ms prior to the onset of voluntary blink was observed; it had average amplitude in the negative peak of 3.3µV. There was no BP preceding spontaneous blinking. CONCLUSION: A BP precedes voluntary blinks but not spontaneous blinks. SIGNIFICANCE: This is the first study evaluating the BP preceding spontaneous and voluntary eye blinks.

Bereitschaftspotential preceding eyelid blinks in Parkinson's disease.

METHODS: Ten PD patients in stages 1 and 2 of the Hoehn & Yahr classification were compared to 18 healthy controls. Artifact-free EEG segments of two seconds preceding the onset of the blink potential were averaged and analyzed, and the statistical significance of the measured amplitudes were evaluated by analysis of variance models. RESULTS: The presence of a BP in the PD patients was demonstrated. The mean amplitudes at 0 ms were respectively 0.6 µV and 3.3 µV for the BP patients and the normal controls, respectively. CONCLUSIONS: The BP amplitudes were significantly smaller in PD patients than normal participants. The amplitudes of the BP were not modified by levodopa.

Study of cochlear microphonic potentials in auditory neuropathy.

INTRODUCTION: Auditory Neuropathy/Dyssynchrony is a disorder characterized by the presence of Otoacoustic Emissions and Cochlear Microphonic Potentials, an absence or severe alteration of Brainstem Evoked Auditory Potential, auditory thresholds incompatible with speech thresholds and altered acoustic reflexes. The study of the Cochlear Microphonic Potential appears to be the most important tool for an accurate diagnosis of this pathology. OBJECTIVE: Determine the characteristics of the Cochlear Microphonic in Auditory Neuropathy/Dyssynchrony using an integrative review. METHODS: Bibliographic survey of Pubmed and Bireme platforms and MedLine, LILACS and SciELO data banks, with standardized searches up to July 2014, using keywords. Criteria were established for the selection and assessment of the scientific studies surveyed, considering the following aspects: author, year/place, degree of recommendation/level of scientific evidence, objective, sample, age range, mean age, tests, results and conclusion. RESULTS: Of the 1959 articles found, 1914 were excluded for the title, 20 for the abstract, 9 for the text of the article, 2 for being repeated and 14 were selected for the study. CONCLUSION: The presence of the Cochlear Microphonic is a determining finding in the differential diagnosis of Auditory Neuropathy/Dyssynchrony. The protocol for the determination of Cochlear Microphonic must include the use of insert earphones, reverse polarity and blocking the stimulus tube to eliminate electrical artifact interference. The amplitude of the Cochlear Microphonic in Auditory Neuropathy/Dyssynchrony shows no significant difference from that of normal individuals. The duration of the Cochlear Microphonic is longer in individuals with Auditory Neuropathy/Dyssynchrony.

Effects of mental practice strategies associated with physical therapy on gait and risk of falls in Parkinson disease: experimental study / Efeitos das estratégias de prática mental associadas à fisioterapia sobre a marcha e risco de quedas na doença de Parkinson: estudo experimental

Objective: To compare the effects of mental practice (MP) strategies associated with physical therapy on gait and risk of falls in people with Parkinson's disease (PD). Method: We included 35 people of both sexes with mild to moderate idiopathic PD allocated into four groups: 1- Control group (CG), 2- Image-guided mental practice group (IGMP), 3- Audio-guided mental practice group (AGMP) and 4- Unguided mental practice group (UMP). The subjects in the experimental groups underwent 15 sessions of motor physical therapy and mental practice, while the CG received only physical therapy. The sessions were held twice a week, 40 minutes for motor physical therapy and 1 minutes for the corresponding Mental Practice protocol. To evaluate the spatiotemporal parameters of the gait, the 10-meter Walking Test was used and the risk of falls using the Timed Up and Go (TUG). Results: The IGPM group presented significant results for the time (p= 0.027) and gait speed (p= 0.025) when compared to the results of the CG. Cadence and risk of falls had no major effect for the group. The UMP and AGMP groups did not present statistically significant results for TC10m and TUG when compared with CG. Conclusion: The results of this study suggest that image-guided mental practice training associated with motor physical therapy is more effective in increasing gait speed than other MP strategies.

Objetivo: Comparar os efeitos das estratégias de prática mental (PM) associadas à fisioterapia sobre a marcha e o risco de quedas em pessoas com doença de Parkinson (DP). Método: Incluímos 35 pessoas de ambos os sexos com DP idiopática leve a moderada alocadas em quatro grupos; 1- Grupo controle (GC), 2- Grupo de prática mental guiada por imagem (GPMI), 3- Grupo de prática mental guiada por áudio (GPMA) e 4- Grupo de prática mental sem guia (GPMSG). Os sujeitos dos grupos experimentais realizaram 15 sessões de fisioterapia motora e prática mental, enquanto o GC recebeu apenas fisioterapia. As sessões eram realizadas duas vezes por semana, sendo 40 minutos para fisioterapia motora e 1 minutos para o protocol de Prática Mental correspondente. Para avaliar os parâmetros espaço-temporais da marcha, foi utilizado o Teste de Caminhada de 10 metros e para avaliar o risco de quedas foi utilizado o Timed Up and Go (TUG). Resultados: O grupo GMPI apresentou resultados significativos para o tempo (p= 0,027) e velocidade da marcha (p= 0,025) quando comparados aos resultados do GC. A cadência e o risco de quedas não apresentaram resultados signifcativos. Os grupos GPMSG e GPMA não apresentaram resultados estatisticamente significantes para TC10m e TUG quando comparados ao GC. Conclusão: Os resultados deste estudo sugerem que o treinamento da prática mental orientada por imagem associado à fisioterapia motora é mais eficaz para aumentar a velocidade da marcha do que outras estratégias de PM.

Congenital Zika syndrome with arthrogryposis: retrospective case series study.

OBJECTIVE: To describe the clinical, radiological, and electromyographic features in a series of children with joint contractures (arthrogryposis) associated with congenital infection presumably caused by Zika virus. DESIGN: Retrospective case series study. SETTING: Association for Assistance of Disabled Children, Pernambuco state, Brazil. PARTICIPANTS: Seven children with arthrogryposis and a diagnosis of congenital infection presumably caused by Zika virus during the Brazilian microcephaly epidemic. MAIN OUTCOME MEASURES: Main clinical, radiological, and electromyographic findings, and likely correlation between clinical and primary neurological abnormalities. RESULTS: The brain images of all seven children were characteristic of congenital infection and arthrogryposis. Two children tested positive for IgM to Zika virus in the cerebrospinal fluid. Arthrogryposis was present in the arms and legs of six children (86%) and the legs of one child (14%). Hip radiographs showed bilateral dislocation in seven children, subluxation of the knee associated with genu valgus in three children (43%), which was bilateral in two (29%). All the children underwent high definition ultrasonography of the joints, and there was no evidence of abnormalities. Moderate signs of remodeling of the motor units and a reduced recruitment pattern were found on needle electromyography (monopolar). Five of the children underwent brain computed tomography (CT) and magnetic resonance imaging (MRI) and the remaining two CT only. All presented malformations of cortical development, calcifications predominantly in the cortex and subcortical white matter (especially in the junction between the cortex and white matter), reduction in brain volume, ventriculomegaly, and hypoplasia of the brainstem and cerebellum. MRI of the spine in four children showed apparent thinning of the cord and reduced ventral roots. CONCLUSIONS: Congenital Zika syndrome should be added to the differential diagnosis of congenital infections and arthrogryposis. The arthrogryposis was unrelated to the abnormalities of the joints themselves, but was possibly of neurogenic origin, with chronic involvement of central and peripheral motor neurones leading to deformities as a result of fixed postures in utero. Based on the neurophysiological observations, we suggest two possible mechanisms: tropism of neurones, with involvement of peripheral and central motor neurones, or a relation with vascular disorders.

Parsonage-Turner syndrome.

OBJECTIVE: To describe the clinical, electrophysiological and imaging findings from Parsonage-Turner syndrome and evaluate the results from conservative treatment. METHODS: Eight cases were studied between February 2010 and February 2012, with a minimum follow-up of one year (mean of 14 months). All the patients answered a clinical questionnaire and underwent functional evaluation using the Constant and Murley score. After clinical suspicion was raised, an electromyography examination was performed to confirm the diagnosis. RESULTS: Eight patients (mean age of 29 years) were evaluated. The right side was affected in 70% of the cases, and the dominant side in 80% of the cases. All the patients reported that their shoulder pain had started suddenly, lasting from one to five days in six cases and up to 15 days in two cases. In three cases, severe atrophy of the deltoid muscle was observed. Hypotrophy of the supraspinatus and infraspinatus muscles was observed in three cases. A winged scapula was observed in the two remaining cases. Electromyography demonstrated involvement of the long thoracic nerve in these last two cases and confirmed the involvement of the axillary and suprascapular nerves in the remaining six cases. The mean score on the Constant and Murley scale was 96 at the end of the conservative treatment with non-steroidal anti-inflammatory drugs and physiotherapy. Six of the eight patients presented good recovery of muscle strength. CONCLUSIONS: In the majority of the cases, the functional recovery was good, although muscle strength was not completely restored in some of them.

OBJETIVO: Descrever os achados clínicos, eletrofisiológicos e de imagem na síndrome de Parsonage­Turner e avaliar os resultados do tratamento conservador. MÉTODOS: Foram estudados oito casos entre fevereiro de 2010 e fevereiro de 2012, com seguimento mínimo de um ano (média de 14 meses). Todos os pacientes foram submetidos ao questionário clínico e avaliados funcionalmente com o escore de Constant e Murley. Após a suspeita clínica o exame de eletroneuromiografia foi feito para confirmação diagnóstica. RESULTADOS: Oito pacientes (média de 29 anos) foram avaliados. O lado direito foi acometido em 70% dos casos e era o dominante em 80%. Todos os pacientes relataram um início súbito de dor no ombro, com duração de um a cinco dias em seis casos e de até 15 dias em dois casos. Em três casos foi observada atrofia severa do músculo deltoide. Hipotrofia dos músculos supraespinhal e infraespinhal foi observada em três casos. Escápula alada foi observada em dois casos restantes. A eletromiografia demonstrou envolvimento do nervo torácico longo nesses dois últimos casos e confirmou o envolvimento dos nervos axilar e supraescapular nos seis casos restantes. A pontuação média na escala de Constant e Murley foi de 96 no fim do tratamento conservador com medicamentos anti-inflamatórios não esteroides e fisioterapia. Seis dos oito pacientes apresentaram boa recuperação da força muscular. CONCLUSÃO: Na maioria dos casos a recuperação funcional foi boa, embora a força muscular não tenha sido completamente restaurada em alguns deles.

Efeitos do uso de u aplicativo com estimulação auditiva rítmica com música associado a um protocolo de fisioterapia sobre a marcha e a mobilidade funcional na doença de Parkinson: uma série de casos / Effects of using an application with music-based rhythmic auditory stimulation associated with a physiotherapy protocol on gait and functional mobility in parkinsom's disease : a case series

Introdução: estudos relatam que a Estimulação Auditiva Rítmica (EAR) pode fornecer o suporte temporal necessário para sincronização e modulação da marcha na doença de Parkinson (DP). A EAR utiliza um som isócrono repetido (como o metrônomo) ou música com estrutura de batida saliente. Objetivo: descrever os efeitos do uso de um aplicativo com EAR com música (ParkinSONS) associado a um protocolo de fisioterapia sobre a marcha e a mobilidade funcional na DP. Métodos: trata-se de uma série de casos com seis pessoas no estágio moderado da DP idiopática, cadastradas em um Programa de referência de um hospital universitário do nordeste do Brasil. Foram aplicados: 1) ficha para dados gerais e clínicos; 2) teste de caminhada de 10 metros (TC10m); 3) teste Timed Up & Go (TUG). Na reavaliação foram repetidos os testes dinâmicos. Foram 10 sessões, 2 vezes por semana de um protocolo de fisioterapia associada à EAR. Para a EAR utilizou-se aplicativo com faixas musicais associadas ao metrônomo. A faixa musical foi escolhida para cada paciente baseada no incremento médio de 10% da sua cadência confortável. Resultados: uso de um aplicativo com EAR associado a um protocolo de fisioterapia promoveu ganhos nos parâmetros espaço-temporais da marcha no TC10m, além da redução do tempo no TUG. Conclusão: uso de um aplicativo com EAR com música associado a um protocolo de fisioterapia promoveu ganhos sobre a marcha e mobilidade funcional na população estudada.(AU)

Introduction: studies report that rhythmic auditory stimulation (RAS) may provide the necessary temporal support for gait's synchronization and modulation in Parkinson's disease (PD). The RAS uses repeated isochronous sound (such as the metronome) or music with protruding beat structure. Purpose: to describe the effects of using an app with music-based RAS (ParkinSONS) associated with a physical therapy protocol on gait and functional mobility in PD. Methods: this is a series of cases with six people in the moderate stage of idiopathic PD, enrolled in a referral program of a university hospital in Northeastern Brazil. As such, we applied: 1) form for general and clinical data; 2) 10 meter walk test (10MWT); 3) Timed Up & Go (TUG) test. In the revaluation, the dynamic tests were repeated. There were 10 sessions, 2 times a week of a physical therapy protocol associated with the RAS. For the RAS, we used an app with music-based associated with the metronome. The music was chosen for each patient based on the average increment of 10% of their comfortable cadence. Results: an app with music-based RAS associated with a physical therapy protocol provided gains in the spatiotemporal gait parameters in 10MWT, as well as a reduction in TUG time. Conclusion: An app with music-based RAS associated with a physical therapy protocol improved gait and functional mobility in the studied population.(AU)

Medidas eletromiográficas dos músculos supra-hióideos durante a deglutição de idosos / Electromyographic measures of suprahyoid musculature during the swallowing of older adults / Mediciones electromiográficas de los músculos suprahioideos durante la deglución de los ancianos

Introdução: A perda de massa e flacidez muscular são mudanças anatomofisiológicas esperadas como processo de envelhecimento, podendo causar mudanças no comportamento mioelétrico de músculos envolvidos na deglutição. Objetivo: Caracterizar as medidas eletromiográficas dos músculos supra-hióideos durante a deglutição de idosos. Método: Participaram 49 idosos de ambos os sexos que se alimentavam por via oral exclusiva. Os instrumentos de avaliação utilizados foram: ficha de registro de dados e a eletromiografia de superfície (EMGs) dos músculos supra-hióideos (MSH) na deglutição de 10 ml e 20 ml de água e na deglutição de 5 ml e 10 ml de iogurte pastoso, assim como no consumo contínuo de 100 ml de água. Resultados: A amplitude foi mais elevada nos volumes maiores, tanto para a água como para o iogurte (p = 0,0000 e p = 0,0048, respectivamente). A amplitude para o iogurte foi mais elevada que a amplitude para a água (p = 0,0000) independentemente da faixa etária analisada. A duração eletromiográfica foi mais prolongada para iogurte que para água (efeito principal para consistência, p = 0,0001). A deglutição dos idosos com idade ≥ 80 anos foi mais prolongada de forma significativa em ambos os volumes de água e iogurte quando comparados com demais grupos de faixas etárias: 60-69 (p = 0,0027), 70-79 (p = 0,0012). Conclusão: A consistência alimentar pastosa demonstrou influenciar a duração e a amplitude dessa atividade, independentemente da faixa etária estudada. Na amostra estudada, a duração eletromiográfica dos músculos supra-hióideos demonstrou ser o parâmetro eletrofisiológico mais influenciado pelo processo de envelhecimento, sendo mais prolongada em idosos com idade superior ou igual a 80 anos.

Introduction: Muscle flaccidity and mass loss are expected anatomo-physiological changes resulting from the aging process. They can cause alterations in the myoelectrical behavior of muscles involved in swallowing. Purpose: To characterize the electromyographic measures of the suprahyoid musculature during the swallowing of older adults. Method: A total of 49 older adults of both genders on exclusive oral feeding participated in this study. The assessment instruments used were data record sheet and surface electromyography (SEMG) of the suprahyoid musculature (SHM) when swallowing 10 ml and 20 ml of water and 5 ml and 10 ml of creamy yogurt, as well as continuous ingestion of 100 ml of water. Results:The amplitude was higher in greater volumes, both of water and yogurt (p = 0.0000 and p = 0.0048, respectively). The amplitude for yogurt was higher than that for water (p = 0.0000), regardless of the age group analyzed. The electromyographic duration was longer for yogurt than for water (main effect for consistency, p = 0.0001). The swallowing of those 80 years old or more took significantly longer in both volumes of water and yogurt when compared with the other age groups: 60-69 (p = 0.0027), 70-79 (p = 0.0012). Conclusion: The creamy consistency of food proved to influence the duration and amplitude of this activity, regardless of the age group studied. In the sample studied, the electromyographic duration of the suprahyoid musculature proved to be the electrophysiologic parameter most influenced by the aging process, as it lasted longer in adults 80 years old or more.

Introducción: La pérdida de masa muscular y flacidez son cambios anatomofisiológicos esperados como proceso de envejecimiento y pueden causar cambios en el comportamiento mioeléctrico de los músculos involucrados en la deglución. Objetivo: Caracterizar las mediciones electromiográficas de los músculos suprahyoides durante la deglución de los ancianos. Método: 49 ancianos de ambos sexos que se alimentaban exclusivamente por vía oral participaron. Los instrumentos de evaluación utilizados fueron: forma de registro de datos y electromiografía superficial (EGI) de los músculos suprahioides (MSH) en la ingestión de 10 ml y 20 ml de agua y la deglución de 5 ml y 10 ml de yogur pastoso, así como el consumo continuo de 100 ml de agua. Resultados: La amplitud fue mayor en los volúmenes más grandes, tanto para el agua como para el yogur (p-0.0000 y p-0.0048, respectivamente). La amplitud del yogur fue mayor que la del agua (p-0.0000) independientemente del grupo de edad analizado La duración electromiográfica fue más larga para el yogur que el agua. (ANOVA, efecto principal para la consistencia, p-0.0001). La ingestión de los ancianos de 80 años fue significativamente más larga en volúmenes de agua y yogur en comparación con otros grupos de edad: 60-69 (Newman-Keuls p-0.0027), 70-79 (Newman-Keuls p-0.0012). Conclusión: La consistencia de los alimentos pastosos influyó en la duración y amplitud de la actividad de la MSH independientemente del grupo de edad. La duración electromiográfica de los músculos suprahioides demostró ser el parámetro electrofisiológico más influenciado por el proceso de envejecimiento, siendo más largo en ancianos de 80 años o más.

[Sleep disorders in temporal lobe epilepsy]. / Distúrbios do sono na epilepsia do lobo temporal.

The objective of this study was to evaluate sleep macrostructure and sleep disturbance in a group of 39 patients with temporal lobe epilepsy (TLE). Patients completed questionnaires to evaluate their sleep and subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]) and undergone Polysomnography and Multiple Sleep Latency Test (MSLT). Daytime sleepiness was the most frequent complaint (85%), followed by wakefulness during sleep, history of seizures during sleep (75%) and initial insomnia (26%). Parasomnias (67%), obstructive sleep apneas (13%), restless legs syndrome (15%) and periodic limb movements (5%) were the most frequent sleep disorders. The most frequent changes of sleep patterns were: sleep architecture fragmentation (100%), decreased amount of REM sleep (92%) and increase in time awake after sleep onset (77%). There were significative correlations between the ESS and the MSLT (p<0,05). In conclusion, TLE patients have fragmented sleep with increased sleep stages shifts, increased number of awakenings and in time awake after sleep onset. REM sleep was decreased. Daytime sleepiness was the most frequent complaint in TLE patients.

Daytime sleepiness and Parkinson's disease: the contribution of the multiple sleep latency test.

Background. Sleep disorders are major nonmotor manifestations of patients with Parkinson's disease (PD), and excessive daytime sleepiness (EDS) is one of the most common symptoms. Objective. We reviewed a current literature concerning major factors that influence EDS in PD patients, using Multiple Sleep Latency Test (MSLT). Methods. A Medline search found 23 studies. Results. The presence of EDS was observed in 12.7% to 47% in patients without complaints of daytime sleepiness and 47% to 66.7% with complaints of daytime sleepiness. Despite being recognized by several authors, major factors that influence EDS, such as severity of motor symptoms, use of dopaminergic medications, and associated sleep disturbances, presented contradictory data. Conclusions. Available data suggest that the variability of the results may be related to the fact that it was conducted with a small sample size, not counting the neuropathological heterogeneity of the disease. Thus, before carrying out longitudinal studies with significant samples, careful analysis should be done by assigning a specific agent on the responsibility of EDS in PD patients.

Efeitos da prática mental associada à fisioterapia motora sobre a marcha e o risco de quedas na doença de Parkinson: estudo piloto / Efectos de la práctica mental asociada a la fisioterapia motora sobre la marcha y el riesgo de caídas en la enfermedad de Parkinson: estudio piloto / Effects of mental practice associated with motor physical therapy on gait and risk of falls in Parkinson's disease: a pilot study

RESUMO O objetivo deste estudo piloto, realizado em um hospital universitário de referência em Pernambuco, foi avaliar os efeitos da prática mental associada à fisioterapia motora sobre a marcha e o risco de queda em pessoas com doença de Parkinson. A amostra da pesquisa foi composta por 18 sujeitos, de ambos os sexos, com doença de Parkinson idiopática, divididos em grupo experimental (8 indivíduos) e controle (10 indivíduos). Ambos os grupos realizaram 15 sessões de 40 minutos de fisioterapia motora, duas vezes por semana. No grupo de intervenção, a fisioterapia foi associada a prática mental (15 minutos). Em relação às variáveis de desfecho primário, o tempo de execução do timed up and go e do teste de caminhada de 10 metros reduziu, mas a diferença não foi significativa. Em relação à velocidade, cadência e escore do dynamic gait index, houve aumento após a intervenção no grupo experimental, com diferença significativa (p=0,02). O número de passos foi mantido em ambos os grupos. Os resultados sugerem que a prática mental associada à fisioterapia motora reduz o risco de quedas em comparação com a fisioterapia motora aplicada isoladamente.

RESUMEN El objetivo de este estudio piloto, realizado en un hospital universitario de referencia en Pernambuco, fue el de evaluar los efectos de la práctica mental asociada a la fisioterapia motora sobre la marcha y el riesgo de caída en personas con enfermedad de Parkinson. La muestra de la investigación fue compuesta por 18 sujetos, de ambos sexos, con enfermedad de Parkinson idiopática, divididos en grupo experimental (8 individuos) y de control (10 individuos). Ambos grupos realizaron 15 sesiones de 40 minutos de fisioterapia motora, dos veces por semana. En el grupo de intervención, la fisioterapia se asoció a la práctica mental (15 minutos). En cuanto a las variables de desenlace primario, el tiempo de ejecución del timed up and go y de la prueba de caminata de 10 metros se redujo, pero la diferencia no fue significativa. En cuanto a la velocidad, cadencia y puntaje del dynamic gait index, hubo aumento después de la intervención en el grupo experimental, con diferencia significativa (p= 0,02). El número de pasos se ha mantenido en ambos grupos. Los resultados sugieren que la práctica mental asociada a la fisioterapia motora reduce el riesgo de caídas en comparación con la fisioterapia motora aplicada aisladamente.

ABSTRACT The objective of this pilot study, carried out in a university hospital of reference in Pernambuco, was to assess the effects of mental practice associated with motor physical therapy on gait and the risk of falls in people with Parkinson's disease. The study sample consisted of 18 subjects, of both sexes, with idiopathic Parkinson's disease, divided into experimental group (8 individuals) and control group (10 individuals). Both groups performed fifteen 40-minute sessions of motor physical therapy twice a week. In the intervention group, physical therapy was associated with mental practice (15 minutes). Regarding the primary outcome variables, the duration of the timed up and go test and of the 10-meter walking test reduced, but the difference was not significant. Speed, cadence and dynamic gait index increased after the intervention in the experimental group, with a significant difference (p=0.02). The number of steps was maintained in both groups. The results suggest that the mental practice associated with motor physical therapy reduces the risk of falls compared with applied motor physical therapy alone.

Respiratory muscle strength and lung function in the stages of Parkinson's disease / Força muscular respiratória e função pulmonar nos estágios da doença de Parkinson

ABSTRACT Objective: To investigate parameters of lung function and respiratory muscle strength in different stages of Parkinson's disease (PD), as well as to determine their correlation with motor function and quality of life. Methods: This was a cross-sectional study conducted at a referral center for PD in the city of Recife, Brazil. Respiratory muscle strength and lung function, as well as their relationship with motor function and quality of life, were evaluated in patients with PD, stratified by the level of severity, and were compared with the data obtained for a control group. After confirming the normality of data distribution, we performed one-way ANOVA with a post hoc t-test. Results: The sample comprised 66 individuals, in two groups: PD (n = 49) and control (n = 17). All of the parameters investigated showed inverse correlations with PD severity, and there were significant differences among the levels of severity, as well as between the PD and control groups, in terms of the MIP, MEP, FVC, FEV1, and FEF25-75%. The lung function parameters also showed moderate to weak inverse correlations with bradykinesia and rigidity. On a quality of life questionnaire, the total score and mobility domain score both presented a moderate inverse correlation with FVC, FEV1, PEF, and MEP. Conclusions: Respiratory muscle strength and some lung function parameters are impaired from the early stages of PD onward, bradykinesia and rigidity being the cardinal signs that correlate most strongly with impairment of those parameters. Such alterations negatively affect the quality of life of patients with PD.

RESUMO Objetivo: Investigar a repercussão de parâmetros de função pulmonar e de força muscular respiratória nos diversos estágios da doença de Parkinson (DP) e suas correlações com a funcionalidade e a qualidade de vida desses pacientes. Métodos: Estudo de corte transversal realizado em um serviço de referência para DP em Recife (PE). Foram avaliadas a força muscular respiratória e a função pulmonar, assim como suas relações com a funcionalidade e a qualidade de vida, em pacientes com DP estratificados por gravidade da DP e comparados a um grupo controle. Após a verificação da normalidade da amostra, foi realizada one-way ANOVA e teste t post hoc. Resultados: A amostra foi composta por 66 indivíduos, sendo 49 no grupo DP e 17 no grupo controle. Houve reduções nos parâmetros investigados com a progressão da doença, em comparação com o grupo controle, sendo encontradas diferenças significativas em PImáx, PEmáx, CVF, VEF1 e FEF25-75% em todos os estágios da DP. Houve correlações inversas (de fraca a moderada) de alguns parâmetros estudados com bradicinesia e rigidez. Os escores totais do questionário de qualidade de vida e de seu domínio mobilidade apresentaram moderada correlação inversa com CVF, VEF1, PFE e PEmáx. Conclusões: A força muscular respiratória e alguns parâmetros de função pulmonar encontram-se reduzidos desde os estágios iniciais da DP, sendo a bradicinesia e a rigidez os sinais cardinais mais correlacionados ao prejuízo desses parâmetros. Essas alterações repercutem negativamente na qualidade de vida desses pacientes.