Relationship between lymphedema after breast cancer treatment and biophysical characteristics of the affected tissue.

The treatment of breast cancer is often complicated by lymphedema of the upper limbs. Standard lymphedema evaluation methodologies are not able to measure tissue fibrosis. The ultrasound aspects related to tissue microstructures of lymphedema are neglected in clinical evaluations. The objective of this study was to identify and measure the degree of impairment, topography, and biophysical alterations of subcutaneous lymphedema tissue secondary to the treatment of breast cancer by ultrasonography. Forty-two women at a mean age of 58 (±9.7) years, with unilateral lymphedema due to breast cancer treatment, were evaluated. The upper limbs were divided into affected (affected by lymphedema) and control (contralateral limb). Each limb was subdivided into seven areas, defined by perimetry, evaluated in pairs. The biophysical characteristics thickness, entropy, and echogenicity were evaluated by ultrasonography. The results showed a significant difference in the echogenicity and thickness variables between the affected and unaffected upper limb, in all the extent of the upper limb, while entropy showed no significant difference. The findings indicate that the data presented were consistent both in identifying and measuring the degree of impairment and biophysical changes in the subcutaneous tissue of lymphedema secondary to the treatment of breast cancer.

Correlation between the range of motion of the tibiotarsal joint and blood circulation in the lower limbs in diabetic individuals

SUMMARY OBJECTIVE: The aim of this study was to evaluate the relationship between the range of motion and lower-limb hemodynamic indices in the tibiotarsal joint of individuals with diabetic neuropathy. METHODS: Twenty volunteers of both sexes, with a mean age of 61.45±7.05 years, were diagnosed with type 2 diabetes mellitus and diabetic peripheral neuropathy. Arterial blood flow was assessed using Doppler ultrasound, and the variables such as average velocity, pulsatility index, and resistivity index were also evaluated. A range of dorsiflexion and plantar flexion joint movements were assessed using digital goniometry before and after exercise. Data distribution was assessed using the Shapiro-Wilk test, followed by Pearson's correlation for normal data and Spearman's correlation for non-normal data, in order to verify the association between variables. RESULTS: A moderate correlation was found between dorsiflexion and pulse rate on two occasions before (rs=0.497) and after initial evaluation (rs=0.511). A low correlation was found between plantar flexion and mean velocity (rs=-0.357), pulsatility index (rs=0.439), and resistivity index (rs=0.328); dorsiflexion and mean velocity (rs=0.374), pulse rate (rs=0.332), and resistance index (rs=0.327) before evaluation, and peak (rs=0.346) was observed after the evaluation of blood circulation. CONCLUSION: There is a correlation between the range of motion of the tibiotarsal joint and the blood circulation of diabetics, ranging from moderate to poor for the different variables evaluated.

Intra- and inter-examiner reliability of digital images of skin donor areas in burns

SUMMARY OBJECTIVE: The main objective of this study was to evaluate intra- and inter-rater reliability in the analysis of digital images of donor areas for skin in burn patients using the CaPAS plugin in the ImageJ®. METHODS: Donor sites were reviewed by two independent reviewers in duplicate. The capture of images was standardized on the same device and distance (with a millimeter ruler), without a flash. The evaluators were trained to capture the images and use the plugin. RESULTS: We selected 70 images from donor areas, from men and women between 18 and 60 years old. In the analysis of intra-examiner reliability, eight of the nine variables exhibited excellent reliability (0.985-0.998) and one (entropy) exhibited good reliability (0.525). The same was true for the inter-examiner analysis: excellent reliability for eight variables (0.824-0.993) and good reliability for entropy (0.501). CONCLUSIONS: The CaPAS plugin has proven to be a reliable tool for use in research in skin donor areas in burns, as demonstrated by its excellent intra- and inter-examiner reliability values. This is a pioneering study in the quantitative assessment of skin donor areas in burn patients using the CaPAS plugin.

Reliability of quantitative sensory testing on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain

SUMMARY OBJECTIVE: The objective of this study was to measure the intra- and inter-rater reliability of the quantitative sensory testing for measuring the thermal pain threshold on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain. METHODS: Thirty female participants were included, aged between 18 and 45 years and with bilateral myofascial trigger points, active and centrally located in the upper trapezius muscle. Two measurements with quantitative sensory testing were performed by each examiner at an interval of 1 week between them. RESULTS: We observed substantial reliability for the intra-rater analysis (intraclass correlation coefficient ranging between 0.876 and 0.896) and excellent reliability for the inter-rater analysis (intraclass correlation coefficient ranging between 0.917 and 0.954). CONCLUSION: The measurement of the thermal pain threshold on myofascial trigger points in individuals with chronic neck pain has acceptable reliability values, supporting the use of the quantitative sensory testing in the research setting and the clinical environment.

Effects of Complex Physical Therapy and Multimodal Approaches on Lymphedema Secondary to Breast Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: What are the immediate, short-term, and long-term effects of complex physical therapy and multimodal approaches on lymphedema secondary to breast cancer? DATA SOURCES: Four electronic databases (MEDLINE, Embase, Cochrane Library, Physiotherapy Evidence Database) were searched from inception up to August 2020. STUDY SELECTION: Randomized controlled trials comparing complex physical therapy and multimodal approaches to the conservative treatment of lymphedema secondary to breast cancer. DATA EXTRACTION: Two independent researchers performed data extraction and assessed the risk of bias, respectively, using the predefined form and Cochrane Collaboration of Risk of Bias. The determination of evidence quality was carried out using the Grading of Recommendations Assessment, Development, and Evaluation tools. DATA SYNTHESIS: Fourteen studies were identified for the systematic review and 11 studies for the meta-analysis with standardized mean difference (SMD), 95% CI, and random-effect model. The common outcomes involved total volume, pain, and physical function of the upper limb. Complex physical therapy has shown a favorable tendency to control outcomes in the short- and long-term. The meta-analysis indicated a small effect for volume reduction (SMD, -0.18; 95% confidence interval [CI], -0.35 to 0.00) and a moderate effect for short-term pain reduction (SMD, -0.61; 95% CI, -1.19 to -0.02). CONCLUSIONS: High-quality evidence suggests a more significant effect of complex physical therapy on multimodal approaches to the control of the upper limb total volume, substantiating the absence of changes in the current clinical practice in the management of lymphedema secondary to breast cancer. Future research should aim to identify concrete effect of therapeutic modalities in the immediate-, short-, and long-term.

Effects of therapeutic ultrasound and paraffin with or without vacuum massage on biomechanical properties of grafted skin after burn: a randomized controlled trial

SUMMARY OBJECTIVE: This study aimed to compare the effects of therapeutic ultrasound and paraffin with or without vacuum massage on the biomechanical properties of grafted skin after a burn. METHODS: A total of 44 patients with deep second- and third-degree burns, with a mean age of 35.89 (±11.53) years, who visited the Hospital Burn Unity, were included in the study. The therapeutic interventions were randomly defined by drawing lots, with a crossover design (crossover), and a minimum interval of 7 days (washout) between interventions. Skin biomechanical parameters such as distensibility (R0) and viscoelasticity (R6) were noninvasively evaluated by Cutometer before and after 0, 10, 20, and 30 min of intervention with therapeutic ultrasound and paraffin alone, as well as associated with negative pressure therapy of the skin (vacuum therapy). In this study, all groups showed increased distensibility (R0) in the period immediately after the application of the resources and a progressive reduction in the effects in the consecutive tests. Participants with skin grafts showed a decrease in viscoelasticity (R6) in all groups, except therapeutic paraffin and therapeutic ultrasound and vacuum massage. CONCLUSION: The biomechanical properties of grafted skin after a burn are altered after therapeutic intervention with ultrasound alone or associated with vacuum massage, such as intervention with paraffin associated with vacuum massage, for both parameters evaluated, skin distensibility (R0) and skin viscoelasticity (R6). However, the same did not occur for the intervention with isolated paraffin. There was no significant difference between the interventions therapeutic ultrasound and therapeutic paraffin.

Analysis of low-level laser transmission at wavelengths 660, 830 and 904 nm in biological tissue samples.

BACKGROUND: In recent decades, low-level laser therapy (LLLT) has occupied a prominent position and has been studied in various fields of knowledge, and your effects have been widely observed in studies about numerous tissues, such as tendons, peripheral nerves, cutaneous tissue, bone, and muscle, in different fields of knowledge. PURPOSE: To analyze the power transmitted by low-level laser therapy (LLLT) to different tissue samples by using distinct wavelengths. METHODS: Skin samples of rat (n = 7, 1.17-1.63 mm) and pig (n = 10; 1.20-2.30 mm); pig fat (n = 10; 2.71-14.01 mm) and pig muscle (n = 10; 1.91-8.91 mm) were analyzed and interposed between the emitter and the power analyzer sensor. All the samples were irradiated sequentially three times, at five equidistant points and average power levels of 35.34(±1.03), 32.40(±0.70), and 42.32(±0.82) mW, for the wavelengths 660, 830, and 904 nm, respectively. Transmitted radiation was measured with a power analyzer connected to a laser emitter. Statistical analysis was performed with a Shapiro-Wilk test followed by ANOVA with Tukey's post hoc test, with a significance level of 5%. RESULTS: The transmitted power of LLLT on skin, fat, and muscle of tissues decreases with the increase of thicknesses, presenting minor attenuation on rat skin, pig fat, and pig muscle for 904 nm. The pig skin has the slight attenuation for 830 nm. CONCLUSION: The LLLT should be applied after considering the transmission loss taking place in different anatomical structures, following the Beer-Lambert law and attenuation coefficient presented for more practical application in many fields.

Intra- and Inter-Rater Reliability of Bioimpedance in the Evaluation of Lymphedema Secondary to Treatment of Breast Cancer.

The objective of the study was to evaluate the intra- and inter-rater reliability of bioimpedance in determining upper limb volume in women with lymphedema resulting from breast cancer treatment, as well as its correlation with the upper limb volume calculated by circumferential measurement. A blind cross-sectional study was performed in which 27 women (62.59 ± 10.50 years) were evaluated with upper limb lymphedema secondary to breast cancer treatment. Two examiners performed assessments in the same volunteers independently and twice, with an interval of 1 week between assessments. The collections were performed by the direct tetrapolar multifrequency segmental bioimpedance and by the circumference of the upper limb homolateral to the breast cancer. The results of the circumference showed that the homolateral limb had lymphedema. The intra- and inter-rater analysis showed excellent reliability with intraclass correlation coefficient (ICC) values ranging from 0.954 to 0.999 for the amount of liquid and excellent reliability with ICC values ranging from 0.852 to 0.999 for the electrical impedance of the upper limb with lymphedema. The correlation was strong and negative (p < 0.05) between intracellular, extracellular, and total water when associated with electrical impedance and moderate and positive (p < 0.05) when associated with upper limb volume for all frequencies. The correlations between upper limb volume and water quantities were moderate and positive (p < 0.05). The results indicate that bioimpedance is a reliable method for the evaluation of lymphedema, and the volume of the homolateral upper limb is associated with the amount of water in women with lymphedema secondary to the treatment of breast cancer.

Manual Lymphatic Drainage in Blood Circulation of Upper Limb With Lymphedema After Breast Cancer Surgery.

OBJECTIVE: The purpose of this study was to assess blood flow after manual lymphatic drainage (MLD) in women who had received surgery for breast cancer and had post-axillary lymphadenectomy lymphedema. METHODS: Sixteen volunteers (mean age 64 ± 11.44 years) were divided into 2 groups. Those in group 1 received MLD without upper limb elevation, and those in group 2 received MLD with elevation of 30° of the upper limb. Blood flow velocity of the brachial vein and artery were measured using Doppler ultrasound before, immediately after, and 30 minutes after MLD, with and without 30° of upper limb elevation as defined by a random crossover design and an interval (washout) of 7 days. Comparison of data before and after MLD was evaluated by the Friedman test. RESULTS: There was a significant increase of blood flow velocity in the brachial vein after the therapeutic procedure with upper limb elevation. However, after 30 minutes the data returned to the pretreatment value. CONCLUSION: This preliminary study indicated that MLD promoted increased brachial vein velocity flow in the short term.

Photobiomodulation laser and pulsed electrical field increase the viability of the musculocutaneous flap in diabetic rats.

The purpose of this study is to investigate the effect of pulsed electrical field (PEF) and photobiomodulation laser (PBM) on the viability of the TRAM flap in diabetic rats. Fifty Wistar rats were divided into five homogeneous groups: Group 1-control; Group 2-diabetics; Group 3-diabetics + PEF; Group 4-diabetic + laser 660 nm, 10 J/cm2, 0.27 J; Group 5-diabetic + laser 660 nm, 140 J/cm2, 3.9 J. The percentage of necrotic area was evaluated using software Image J®. The peripheral circulation of the flap was evaluated by infrared thermography FLIR T450sc (FLIR® Systems-Oregon USA). The thickness of the epidermis (haematoxylin-eosin), mast cell (toluidine blue), leukocytes, vascular endothelial growth factor, fibroblast and newly formed blood vessels were evaluated. For the statistical analysis, the Kruskal-Wallis test was applied followed by Dunn and ANOVA test followed by Tukey with critical level of 5% (p < 0.05). The PEF reduced the area of necrosis, decreased the leukocytes, increased the mast cells, increased the thickness of epidermis and increased newly formed blood vessels when it was compared to the untreated diabetic group of animals. Laser 660 nm, fluence 140 J/cm2 (3.9 J) showed better results than the 10 J/cm2 (0.27 J) related to reduction of the area of necrosis and the number of leukocytes, increased mast cells, increased thickness of the epidermis, increased vascular endothelial growth factor, increased fibroblast growth factor and increase of newly formed blood vessels in diabetic animals. The laser and pulsed electrical field increase the viability of the musculocutaneous flap in diabetic rats.

Efeitos da terapia manual laríngea e da estimulação elétrica nervosa transcutânea (TENS) na diadococinesia laríngea em mulheres disfônicas: estudo clínico randomizado / Effects of laryngeal manual therapy (LMT) and transcutaneous electrical nerve stimulation (TENS) in vocal folds diadochokinesis of dysphonic women: a randomized clinical trial

RESUMO Objetivo Verificar e comparar os efeitos da terapia manual laríngea (TML) e da estimulação elétrica nervosa transcutânea (TENS) na diadococinesia laríngea de mulheres disfônicas. Método Participaram 20 mulheres com nódulos vocais, divididas igualmente por sorteio em: Grupo TML–aplicação de TML; Grupo TENS–aplicação de TENS; ambos receberam 12 sessões de tratamento, duas vezes por semana, 20 minutos cada, pelo mesmo terapeuta. As mulheres foram avaliadas quanto à diadococinesia (DDC) laríngea em três momentos, diagnóstico, pré-tratamento e pós-tratamento, o que produziu três grupos de medidas. A gravação da DDC foi realizada por meio da repetição entrecortada das vogais: /a/ e /i/. A análise da DDC foi realizada pelo programa Motor Speech Profile Advanced (MSP)-KayPentax. Os parâmetros da DDC das três avaliações foram comparados entre si pelo teste t pareado (p≤0,05). Resultados Parâmetros DDC se apresentaram semelhantes na fase sem tratamento, indicando que não houve variabilidade individual ao longo do tempo. Não houve modificação em relação à velocidade da DDC após intervenções, mas após TML, a DDC da vogal /i/ se apresentou mais estável em relação à duração do período e à intensidade das emissões. Estes resultados indicam que TML melhorou a coordenação de movimentos das pregas vocais à fonação. Não houve modificações dos parâmetros da DDC em relação à estabilidade das emissões após TENS. Conclusão TML promove maior regularidade de movimentos diadococinéticos das pregas vocais em mulheres disfônicas, o que amplia o conhecimento sobre o efeito do reequilíbrio da musculatura laríngea na função fonatória, já TENS não proporciona efeitos na diadococinesia laríngea.

ABSTRACT Purpose To verify and compare the effect of transcutaneous electrical nerve stimulation (TENS) and laryngeal manual therapy (LMT) on laryngeal diadochokinesis (DDK) of dysphonic women. Methods Twenty women with bilateral vocal nodules participated and were equally divided into: LMT Group – LMT application; TENS Group – TENS application; both groups received 12 sessions of treatment, twice a week, with a duration of 20 minutes each, applied by the same therapist. The women were evaluated as to laryngeal DDK at three moments: diagnostic, pre-treatment, and post-treatment, which produced three groups of measurements. The DDK recording was performed with intersected repetition of vowels /a/ and / i/. The analysis of vowels was performed by the program Motor Speech Profile Advanced (MSP)-KayPentax. The DDK parameters of the three evaluations were compared by means of the paired t-test (p≤0.05). Results The measurements of laryngeal DDK parameters were similar in the phase without treatment, indicating no individual variability over time. There was no change with respect to the speed of DDK after intervention, but after LMT, DDK of the vowel /i/ was more stable in terms of the duration of the emissions and intensity of emissions repeated. These results show improved coordination of vocal folds movement during phonation. There were no changes in the DDK parameters following TENS. Conclusion LMT provides greater regularity of movement during laryngeal diadochokinesis in dysphonic women, which extends knowledge on the effect of rebalancing the larynx muscles during phonation, although TENS does not impact laryngeal diadochokinesis.

Disuse induced by the spine rectification vest: experimental study / Desuso generado por el corsé de rectificación de la columna: estudio experimenta / Desuso gerado por colete de retificação de coluna: estudo experimental

The spine is the main support and movement axis of the locomotor system, and numberless clinical conditions may require that this structure be submitted to functional restriction. Among the non-invasive treatments used in spinal or appendicular skeleton injuries, the immobilization of the spine is used as a rehabilitation strategy. Because of the functional restrictions generated by restraining devices used on the spine, the proposal of this study was to adapt a spinal orthosis on rats, thus mimicking the immobilization of corrective vests and assessing the energetic conditions of thoracic muscles after 12 weeks of application. Wistar rats that were 42 days old were used in this study (post-weaning period), followed-up for 12 weeks in 2 groups called control (C) and rectification vests (R), which were made of PVC to immobilize the spine. The following concentrations were evaluated: glycogen (GLY) of the paravertebral muscle and the thorax; total proteins and DNA (TP/DNA) and interleukin-6 (IL-6). The normality Kolmogorov-Smirnov test was used for statistical analysis, followed by the Tukey test. A 5% level was established for all of the calculations. It was observed that group R presented 12% less body mass and GLY stores 21% lower; the ratio between TP/DNA was in average 6.6% lower; IL-6 concentrations were in average 25% higher. The study shows that the movement restriction in the spine leads to energetic crisis and compromised muscular development. More studies should be conducted with this model to generate physical therapy strategies that could reduce muscle compromise after spine immobilization...

La columna se presenta como el principal eje de sustentación y movimiento del sistema locomotor, siendo que innúmeras condiciones clínicas pueden requerir que esa estructura sea sometida a restricción funcional. Entre los tratamientos no invasivos usados ​​en lesiones de la columna o esqueleto apendicular, se inmoviliza a la columna como una estrategia de rehabilitación. Frente a restricciones funcionales generadas por los dispositivos de contención aplicados en la columna vertebral, el propósito de este estudio fue adaptar un aparato ortopédico en la columna de ratones, imitando la inmovilización de los corsés ortopédicos y evaluar las condiciones energéticas de los músculos de la caja torácica después de 12 semanas de aplicación. Fueron utilizados ratones Wistar con 42 días de edad (período pos destete), seguidos por 12 semanas en 2 grupos llamados "control (C)" y "usuario de corsé de rectificación (R)" hechos de PVC para inmovilizar la columna vertebral. Fueron evaluadas las concentraciones de: glucógeno (GLY) de músculos paravertebrales y de la caja torácica; proteínas totales y ADN (PT/ADN) y interleucina 6 (IL-6). En el análisis estadístico se utilizó el test de normalidad de Kolmogorov-Smirnov seguido del test de Tukey. En todos los cálculos se estableció un nivel crítico de 5%. Se verificó que el grupo R tuvo 12% menos masa corporal y un promedio de 21% de reservas GLY más escasas; la relación PT/ADN se mostró, en promedio, 6,6 % más pequeña, mientras que las concentraciones de IL-6 en promedio, se mostraron 25 % más grande. El estudio muestra que la restricción de movimiento de la columna promueve crisis energética y compromiso en el desarrollo muscular. Se sugiere que se lleven a cabo otros estudios, con este modelo, para generar estrategias de acción fisioterápica que puedan reducir la afectación de los músculos durante la inmovilización de la columna...

A coluna vertebral configura-se como o principal eixo de sustentação e movimentação do aparelho locomotor, sendo que inúmeras condições clínicas podem requerer que essa estrutura seja submetida à restrição funcional. Dentre os tratamentos não invasivos usados em lesões da coluna ou esqueleto apendicular, tem-se a imobilização da coluna enquanto estratégia de reabilitação. Frente às restrições funcionais geradas por dispositivos de contenção aplicados na coluna vertebral, a proposta desse estudo foi adaptar uma órtese na coluna de ratos, mimetizando a imobilização dos coletes corretivos e avaliar as condições energéticas dos músculos da caixa torácica após 12 semanas de aplicação. Foram utilizados ratos Wistar com 42 dias de vida (período pós-desmame), acompanhados por 12 semanas em 2 grupos denominados controle (C) e usuário de colete de retificação (R) confeccionado de PVC para imobilizar a coluna vertebral. Foram avaliadas as seguintes concentrações: glicogênio (GLI) da musculatura paravertebral e da caixa torácica; proteínas totais e DNA (PT/DNA) e interleucina 6 (IL-6). Na análise estatística foi utilizado o teste de normalidade Kolmogorov-Smirnov seguido do teste de Tukey. Em todos os cálculos foi fixado um nível crítico de 5%. Foi verificado que o grupo R apresentou 12% menos massa corporal e reservas de GLI em média 21% menores; a relação PT/DNA apresentou-se em média 6,6% menor; já as concentrações de IL-6 mostraram-se em média 25% maiores. O estudo mostra que a restrição de movimento da coluna vertebral promove crise energética e comprometimento no desenvolvimento muscular. Sugere-se que sejam realizados outros estudos, com este modelo, para gerar estratégias de ação fisioterapêutica que possam reduzir o comprometimento muscular quando da imobilização da coluna...

Efeito da crioterapia na resposta eletromiográfica dos músculos tibial anterior, fibular longo e gastrocnemio lateral de atletas após o movimento de inversão do tornozelo / Effect of cryotherapy on the electromyographic response of the tibialis anterior, peroneus longus and gastrocnemius lateralis muscles in athletes after ankle inversion movement / Efecto de la crioterapia en la respuesta electromiográfica de los músculos tibial anterior, fibular largo y gastrocnemio lateral de atletas después del movimiento de inversión del tobillo

A crioterapia é utilizada para tratamento de traumas no tornozelo/pé em atletas; entretanto, sua ação sobre o controle motor apresenta controvérsias. Este estudo objetivou verificar o efeito da crioterapia na resposta eletromiográfica dos músculos do tornozelo de atletas após inversão. A amostra foi composta por 20 voluntários: 10 universitários atletas de basquetebol e 10 universitários não atletas. Todos foram submetidos à inversão do tornozelo em plataforma para a análise do sinal eletromiográfico dos músculos Gastrocnêmio Lateral (GL), Tibial Anterior (TA) e Fibular Longo (FL), pré e pós-crioterapia por imersão do tornozelo, a 4±2ºC, por 20 minutos. A análise estatística utilizou o teste de Shapiro Wilk, Wilcoxon e Mann-Whitney, com nível de significância em 5%. Considerou-se o pico de RMS, o RMS após 0,2 segundos e após 1,0 segundo da abertura da plataforma de inversão. Todos os dados foram normalizados pelo pico do RMS no momento pré-crioterapia. Evidenciou-se diminuição do pico do RMS e do RMS até 0,2 s para o TA nos atletas e nos músculos GL e FL dos não atletas. Após um segundo da abertura da plataforma houve menor recrutamento dos músculos GL, TA e FL para os não atletas. A comparação entre atletas e não atletas apontou, no RMS até 1 segundo, menor recrutamento para o GL dos atletas pré-crioterapia e TA pré e após o resfriamento. Conclui-se que a crioterapia diminuiu a resposta eletromiográfica do músculo TA de atletas e GL, TA e FL de não atletas...

Cryotherapy is often indicated in the treatment of ankle/foot injuries in athletes; however, there is some controversies regarding its action on motor control. The main objective was to evaluate the effects of cryotherapy on electromyographic response of the ankle muscles in athletes after inversion. The sample consisted of 20 volunteers: 10 university basketball athletes and 10 non-athletes. All athletes were submitted to ankle inversion for the analysis of the EMG signals of Lateral Gastrocnemius (LG), Tibilis Anterior (TA) and Fibular Longus (FL) muscles, before and immediately after ankle immersion in cold water at 4±2ºC, for 20 minutes. The peak Root Mean Square (RMS) values were analyzed between 0 to 0.2 seconds and between 0 to 1 second after a sudden inversion on a tilting platform. Data were normalized by the peak RMS measured before cold water immersion. The statistical analysis was performed using Shapiro Wilk, Wilcoxon and Mann-Whitney tests. The level of significance was set at 5%. The results showed that the RMS values were lower in TA muscle of athletes, and up to 0.2 seconds in LG and FL muscles of non-athletes; up to 1 second, there was lower LG, TA and FL muscle recruitment in non-athletes. The comparison between athletes and non-athletes showed, in RMS up to 1 second, lower GL muscle recruitment in athletes submitted to pre cold water immersion and TA muscle pre and after cooling. Cryotherapy decreased the electromyographic response of TA muscle in athletes and of LG, TA and FL muscles in non-athletes...

La crioterapia es utilizada para tratamiento de traumas en el tobillo/pie en atletas; entre tanto, su acción sobre el control motor presenta controversias. Este estudio intentó verificar el efecto de la crioterapia en la respuesta electromiográfica de los músculos del tobillo de atletas después de inversión. La muestra fue compuesta por 20 voluntarios: 10 universitarios atletas de básquetbol y 10 universitarios no atletas. Todos fueron sometidos a inversión del tobillo en plataforma para el análisis de la señal electromiográfica de los músculos Gastrocnemio Lateral (GL), Tibial Anterior (TA) y Fibular Largo (FL), pre y post-crioterapia por inmersión del tobillo, a 4±2ºC, durante 20 minutos. El análisis estadístico utilizó el test de Shapiro Wilk, Wilcoxon y Mann-Whitney, con nivel de significación de 5%. Se consideró el pico de RMS, el RMS después de 0,2 segundos y después de 1,0 segundo de la apertura de la plataforma de inversión. Todos los datos fueron normalizados por el pico del RMS en el momento pre-crioterapia. Se evidenció disminución del pico del RMS y del RMS hasta 0,2 s para el TA en los atletas y en los músculos GL y FL de los no atletas. Después de un segundo de la apertura de la plataforma hubo menor reclutamiento de los músculos GL, TA y FL para los no atletas. La comparación entre atletas y no atletas señaló, en el RMS hasta 1 segundo, menor reclutamiento para el GL de los atletas pre-crioterapia y TA pre y después del enfriamiento. Se concluye que la crioterapia disminuyó la respuesta electromiográfica del músculo TA de atletas y GL, TA y FL de no atletas...

Estimulação elétrica de alta voltagem incrementa a cicatrização de lesões cutâneas crônicas: análise de seis casos / High voltage pulsed stimulation increases cicatrization of chronic cutaneous ulcers: analysis of six cases / Estimulación eléctrica de alto voltaje incrementa la cicatrización de úlceras cutáneas crónicas: análisis de seis casos

O tratamento de úlceras cutâneas por estimulação elétrica tem crescido na prática clínica, no entanto, faltam estudos que investiguem a efetividade desse recurso em acompanhamento prolongado ou até que ocorra a cicatrização completa das lesões. Assim, a estimulação elétrica de alta voltagem (EEAV) foi aplicada em úlceras cutâneas crônicas com o objetivo de reduzir a área da lesão. Para tanto, participaram do estudo quatro homens que apresentavam seis úlceras cutâneas que receberam a EEAV (fase=15ms; F=100 Hz; T: 100 a 150 V; fases gêmeas), 2 vezes por semana, durante 30 minutos. O eletrodo com polaridade negativa foi colocado sobre a lesão e o positivo no trajeto vascular. As úlceras foram avaliadas pré e pós-intervenção por meio da fotogrametria, sendo calculada a área da lesão. Como resultado, observamos o fechamento completo da lesão nos sujeitos I e II (área de 4,66 cm² para 0 após 21 sessões e de 1,74 cm² para 0 após 16 sessões, respectivamente). O sujeito III obteve redução de 93% na área da lesão direita (de 2,02 para 0,14 cm²) e na esquerda de 80,40% (de 2,50 para 0,49 cm²), após 100 sessões. No sujeito IV ocorreu o fechamento completo da lesão sacral (de 10,74 cm² para 0) e a redução da lesão isquiática de 11,01 para 2,43 cm², após 75 sessões. Desse modo, concluímos que a EEAV facilitou o processo de cicatrização das úlceras estimuladas, pois as áreas de todas as úlceras apresentaram diminuição superior a 78%, havendo cicatrização completa em três delas...

The treatment of cutaneous ulcers by electrical stimulation in clinical practice has grown, however there are few studies investigating the effectiveness of these individual resources in monitoring and complete healing of the lesions. Thus, High Voltage Pulsed Stimulation (HVPS) was used in chronic skin ulcers with the aim of reduce the area of the lesion. Four male subjects with chronic cutaneous ulcers participated in the study. The treatment of the injury consisted on HVPS application (15 microseconds, 100/150 V, 100 Hz) for 30 minutes, 2 times weekly. The electrode with negative polarity was placed on the lesion and positive on vascular path. The ulcers were assessed pre and post-intervention by photogrammetry, and it was calculated the area of the lesion. As a result, we observed the complete healing in the subjects I and II (respectively, area of 4.66 cm² to 0 after 21 sessions and 1.74 cm² to 0 after 16 sessions). The area of subject III right ulcer obtained reduction of 93% after 100° session (2.02 to 0.14 cm²) and left ulcer obtained reduction of 80.40% (2.50 to 0.49 cm²). In subject IV there was a complete healing of the sacral lesion after 75 sessions (10.74 cm² to 0) and decrease sciatic lesion of 11.01 to 2.43 cm². Thus we conclude that HVPS facilitated the healing process of stimulated ulcers because the areas of all ulcers had decreased more than 78%, and in three of them there was complete healing...

El tratamiento de úlceras cutáneas con el uso de estimulación eléctrica tiene crecido en la práctica clínica, pero no hay muchos estudios que investigaron la efectividad de eso recurso en el acompañamiento prolongado o hasta la ocurrencia de la cicatrización completa de las lesiones. Así, la estimulación eléctrica de alto voltaje (EEAV) fue aplicada en úlceras cutáneas crónicas con el objetivo de reducir la área de la lesión. Para eso, cuatro hombres con seis úlceras cutáneas crónicas participaron del estudio, los cuales habían recibido la EEAV (fase=15ms; F=100 Hz; T: el 100 al 150 V; fases), dos veces por semana, por 30 minutos. Lo electrodo con polaridad negativa fue posicionado sobre la lesión y lo positivo en el trayecto vascular. Las úlceras fueron evaluadas antes y después de la intervención por medio de la fotogrametría, y la área de la lesión fue calculada. Se observó, como resultado, el cierre completo de la lesión en los sujetos I y II (área de 4,66 cm² para 0 después de 21 sesiones y de 1,74 cm² para 0 después de 16 sesiones, respectivamente). El sujeto III obtuvo reducción del 93% en el local de la lesión derecha (de 2,02 para 0,14 cm²) y en la izquierda del 80,40% (del 2,50 para 0,49 cm²) después de 100 sesiones. El cierre completo de la lesión del sacro (del 10,74 cm² para 0) y la reducción de la isquiática del 11,01 para 2,43 cm² ocurrieron en el sujeto IV después de 75 sesiones. Por lo tanto, se concluyo que la EEAV ha facilitado el proceso de cicatrización de las úlceras estimuladas, pues las áreas de todas las úlceras presentaron disminución superior al 78% con cicatrización completa en tres de ellas....

In vitro analysis of bacterial morphology by atomic force microscopy of low level laser therapy 660, 830 and 904 nm.

OBJECTIVE: The objective of this study was to analyze the bacterial morphology by atomic force microscopy (AFM) after the application of low-level laser therapy (LLLT) in in vitro culture of Staphylococcus aureus ATCC 29213. BACKGROUND DATA: Infections caused by S. aureus are among the highest occurring in hospitals and can often colonize pressure ulcers. LLLT is among the methods used to accelerate the healing of ulcers. However, there is no consensus on its effect on bacteria. MATERIALS AND METHODS: After being cultivated and seeded, the cultures were irradiated using wavelengths of 660, 830, and 904 nm at fluences of 0, 1, 2, 3, 4, 5, and 16 J/cm(2). Viable cells of S. aureus strain were counted after 24 h incubation. To analyze the occurrence of morphological changes, the topographical measurement of bacterial cells was analyzed using the AFM. RESULTS: The overall assessment revealed that the laser irradiation reduced the S. aureus growth using 830 and 904 nm wavelengths; the latter with the greatest inhibition of the colony-forming units (CFU/mL) (331.1±38.19 and 137.38±21.72). Specifically with 660 nm, the statistical difference occurred only at a fluence of 3 J/cm(2). Topographical analysis showed small changes in morphological conformity of the samples tested. CONCLUSIONS: LLLT reduced the growth of S. aureus with 830 and 904 nm wavelengths, particularly with 904 nm at a fluence of 3 J/cm(2), where the greatest topographical changes of the cell structure occurred.

Ultrassom estático e terapia manual para tratamento da enxaqueca refratária. Relato de caso / Static ultrasound and manual therapy in refractory migraine. Case report

JUSTIFICATIVA E OBJETIVOS: Limiares reduzidos de dor a pressão (LDP) e presença de pontos de gatilho musculares costumam ser observadas em pacientes com enxaqueca. A fisioterapia costuma ser útil para esses pacientes. O objetivo deste estudo foi demonstrar os benefícios do ultrassom estático no tratamento de pacientes com enxaqueca. RELATO DE CASO: Paciente do sexo feminino, 25 anos, com enxaqueca desde os 15 anos de idade. Foi enviada por especialista em cefaleia devido à refratariedade ao tratamento farmacológico. Tinha aproximadamente 8 crises incapacitantes por mês que duravam 2 a 3 dias. Foram examinados os músculos craniocervicais, medido o LDP e a amplitude de movimento cervical. Participou de 20 sessões, duas vezes por semana com duração de 40 a 50 minutos, de alongamento global e tração cervical, além de liberação miofascial e desativação dos pontos de gatilho musculares. Após a 6ª sessão introduziu-se o ultrassom estático ao protocolo. CONCLUSÃO: Houve redução significativa na frequência e duração dos ataques de enxaqueca, além de aumento do LDP. A fisioterapia com ultrassom estático pode ser útil para pacientes com enxaqueca refratária.

BACKGROUND AND OBJECTIVES: Reduced pressure pain thresholds (PPT) and presence of muscular trigger points are often observed in patients with migraine. Physical therapy is frequently helpful in these patients. The objective of this study was to demonstrate the benefits of static ultrasound in the treatment of patients with migraine. CASE REPORT: Female patient, 25 years-old with migraine since the age of 15 years. She was referred by a headache specialist due to refractoriness to pharmacological treatment. She had around 8 disabling attacks per months, lasting from 2 to 3 days. We examined the craniocervical muscles, measured the PPT and cervical range of motion. She participated in 20 sessions twice a week, lasting from 40 to 50 minutes, of global stretching, stretching and cervical traction, as well as myofascial vibration and deactivation of muscular trigger points. From the 6th section after, static ultrasound was added to the protocol. CONCLUSION: There has been significant reduction in the frequency and duration of migraine attacks, as well as increased PPT. Physical therapy using Static Ultrasound may be of value for patients with refractory migraine.