Biofeedback interventions for short term upper limb function following stroke: A systematic review with meta-analysis.

BACKGROUND: Biofeedback has been used by rehabilitation professionals in the treatment of poststroke function impairments. PURPOSE: Investigate the efficacy of any type of biofeedback intervention for the treatment of upper limb function in individuals following stroke. STUDY DESIGN: Systematic review of literature with meta-analysis. METHODS: Literature searches were conducted using MESH terms and text words in PubMed, Lilacs, Scielo, Scopus, PEDro, and Web of Science databases. The main outcome was improvement in upper limb's motor function and motor function in activities of daily living. We calculated the Mean Difference and Standardized Mean Difference for the assessment scales reported as primary outcome. The methodological quality of included studies was assessed using PEDro scale. The overall quality of the evidence was assessed using GRADE system. RESULTS: From 1360 articles identified, 16 were included in the review (09 in the meta-analysis). Three forest plots of hemiparesis and one of hemiplegia showed that biofeedback therapy associated with conventional therapy has a greater improvement in participants upper limb motor function when compared to isolated conventional therapy. Two forest plots of hemiparesis and one of hemiplegia showed no superiority in participants improvement for biofeedback associated with conventional therapy when compared to isolated conventional therapy. CONCLUSION: Biofeedback therapy associated with conventional therapy showed a small clinical effect when associated to conventional therapy and very low quality of evidence. Although further research with higher quality evidence is needed.

Atuação da fisioterapia no trismo secundário ao câncer de glândula salivar / Physical Therapy for trismus secondary to salivary gland cancer

Introdução: O trismo, limitação da abertura da boca, é uma das morbidades que acarreta limitações funcionais. Objetivo: Descrever o efeito da fisioterapia por meio da terapia manual e exercícios com depressores de língua na abertura máxima bucal de paciente com trismo secundário ao câncer de glândula salivar. Métodos: Relato de caso de paciente com trismo cujo tratamento consistiu em 15 atendimentos de fisioterapia por meio da terapia manual (liberação miofascial e mobilização articular) e exercícios com depressores de língua, com 40 minutos de duração cada, para ganho de abertura bucal. A abertura máxima bucal foi avaliada por meio do paquímetro e números de depressores de língua. Resultados: A paciente apresentou aumento da abertura máxima bucal entre o primeiro e o último atendimento (11,5mm - 21,2mm) e aumento na quantidade de depressores de língua utilizados (12 ­ 17,5). Conclusão: A atuação fisioterapêutica foi eficaz para o tratamento do trismo. (AU)

Introduction: Trismus, a mouth opening amplitude limitation, is one of the morbidities that causes functional limitations. Objective: To describe the effect of physical therapy intervention utilizing manual therapy and wooden tongue depressors exercises in maximum mouth opening in a patient with trismus secondary to salivary gland cancer. Methods: Case report of a patient whose physical therapy intervention consisted in 15 sessions of manual therapy (myofascial liberation and articular mobilization) and wooden tongue depressors exercises, with 40 minutes duration each, to improve mouth opening. Maximum mouth opening was assessed with a paquimeter and number of wood tongue depressors. Results: The patient presented improvements in maximal mouth opening between the first and last assessment (11,5mm - 21,2mm) and increase in number of wood tongue depressors used. Conclusion: Physical therapy approach was an effective treatment for trismus. (AU)

Effectiveness of Circuit-Based Exercises on Gait Speed, Balance, and Functional Mobility in People Affected by Stroke: A Meta-Analysis.

BACKGROUND: Several interventions have been proposed to rehabilitate patients with neurologic dysfunctions due to stroke. However, the effectiveness of circuit-based exercises according to its actual definition, ie, an overall program to improve strength, stamina, balance or functioning, was not provided. OBJECTIVE: To examine the effectiveness of circuit-based exercise in the treatment of people affected by stroke. METHODS: A search through PubMed, Embase, Cochrane Library, and Physiotherapy Evidence Database databases was performed to identify controlled clinical trials without language or date restriction. The overall mean difference with 95% confidence interval was calculated for all outcomes. Two independent reviewers assessed the risk of bias. RESULTS: Eleven studies met the inclusion criteria, and 8 presented suitable data to perform a meta-analysis. Quantitative analysis showed that circuit-based exercise was more effective than conventional intervention on gait speed (mean difference of 0.11 m/s) and circuit-based exercise was not significantly more effective than conventional intervention on balance and functional mobility. CONCLUSION: Our results demonstrated that circuit-based exercise presents better effects on gait when compared with conventional intervention and that its effects on balance and functional mobility were not better than conventional interventions. LEVEL OF EVIDENCE: I.