Effects of photobiomodulation on pain, lactate and muscle performance (ROM, torque, and EMG parameters) of paretic upper limb in patients with post-stroke spastic hemiparesis-a randomized controlled clinical trial.

The objective of the study was to investigate the impact of photobiomodulation (PBM) on the paretic upper limb in post-stroke patients with spastic hemiparesis and to understand the potential of PBM as a long-term non-invasive therapy for reducing the side effects caused by spasticity in the hemiparetic upper limb after a stroke. This is a double-blind randomized clinical trial constituted of 27 participants, being Control group (CG = 12 healthy individuals) and PBM group (PBMG = 15 post-stroke individuals). In the CG, the baseline blood lactate (BL) was evaluated, followed by the evaluation of the IC torque of the biceps and triceps muscles, with the isokinetic dynamometer associated with surface electromyography (EMG) and, subsequently, a new measurement of BL. The PBMG received 10 sessions of treatment with PBM (780 nm, Power: 100 mV, Power Density: 3.18 W/cm2, Energy: 4 J, Fluency: 127.4 J/cm2, Time: 40 s per point and 1.280 s total, Spot: 0.0314 cm2, 32 Points: 16 points (brachial biceps) and 16 points (brachial triceps) applied with contact at 90°, Total Energy: 64 J), which in the pre-treatment evaluation measured BL, the visual analogue scale (VAS) of pain; torque and EMG of the same muscles in the IC, subsequently, a new measurement of VAS and BL, and measurement of range of motion (ROM) during the reaching movement. At the conclusion of the ten sessions, all participants underwent a reassessment, wherein all tests originally administered during the initial evaluation were repeated. Subsequently, the data were analyzed using the Shapiro-Wilk normality test. For related data, the paired t-test was used for normal distributions and the Wilcoxon test for non-normal data. For unrelated data, the t test was used for normal distributions and the Mann-Whitney test for non-normal data. Muscle torque was higher for the CG, with a significant difference (CGxPBMG = p < 0.0001). There was no significant difference between the EMG values of the CG in relation to the Pre-PBM phase and with the Post-PBM phase of the PBMG (p > 0.05). On the other hand, there was a 38% reduction in pain reported by hemiparetic patients (p = 0.0127) and a decrease in BL in the PBMG. Post-PBM ROM increased by 46.1% in the elbow extension of the paretic limb. In conclusion, Photobiomodulation (PBM) demonstrated significant improvements in muscle performance, reducing fatigue and pain levels, and enhancing range of motion in post-stroke patients with spastic hemiparesis. These findings support the potential integration of PBM into rehabilitation protocols, but further research and clinical trials are needed to validate and expand upon these promising outcomes.

Transcranial photobiomodulation therapy associated with cardiorespiratory rehabilitation in spastic subjects.

The objective of this study was to evaluate the effects of cardiorespiratory rehabilitation (CR) and transcranial photobiomodulation (tPBM) on exercise tolerance (ET), heart rate variability (HRV), and peripheral muscle activity in individuals with spasticity. Fifteen participants with spasticity were randomly assigned to two groups: the tPBM group (tPBMG) consisted of eight volunteers who underwent tPBM (on mode) and CR, while the control group (CG) consisted of seven volunteers who underwent simulated tPBM (off mode) and CR. The CR program included 12 weeks of treatment, twice a week for one hour, involving aerobic exercises and lower limb strengthening. For tPBM, a cluster with three lasers (λ = 680 nm, 808 nm), with a power of 100 mW/laser and energy of 36 J, applied to the F7, F8, and Fpz points. The following parameters were evaluated after 8 and 12 weeks: ET, HRV, and surface electromyography (EMG) of the rectus femoris muscle during orthostasis (ORT), isometric squatting (ISOM), and isotonic squatting (ISOT). Both groups showed a 40% increase in ET for the CG and a 30% increase for the tPBMG. The CG had more pronounced parasympathetic modulation alterations during post-exercise effort and recovery compared to the tPBMG. The EMG results showed that the tPBMG exhibited progressive improvement in muscle activity during ISOM and ISOT, as well as a decrease in the interlimb difference. In conclusion, both CR and tPBMG demonstrated improvements in ET. However, tPBMG specifically showed promising effects on HRV modulation and peripheral muscle electrical activity, providing additional benefits compared to CR alone.

Effect of photobiomodulation associated with strengthening pelvic floor muscles in volunteers with urinary incontinence: a randomized, double-blinded, and placebo-controlled clinical trial.

The dysfunctions of the female pelvic floor have a great influence on the quality of life of women, in all areas, social, psychological, and sexual. Stress urinary incontinence is the clinical condition in which the woman involuntarily loses urine to efforts, such as coughing and sneezing, causing great embarrassment and affecting her quality of life. The physiotherapeutic treatments include muscle strengthening; however, muscle fatigue is present when performing the exercises. Here we investigate the effects of photobiomodulation to prevent muscle fatigue in the pelvic floor in the treatment of stress urinary incontinence, associated with a muscle strengthening exercise protocol. We used an infrared laser (808 nm, 100 mW) and 3 J/point and fluence of 107.1 J/cm2. The application was performed at 3 points on the vaginal introits and at another 3 points inside the vaginal canal cavity for the treatment of stress urinary incontinence associated with strengthening exercises with vaginal cones. Twenty-two volunteers participated in the study, divided into two groups: group 1 (laser therapy + strengthening) and group 2 (placebo laser + strengthening). In the group 1 quality of life score, the assessment (11.63 ± 4.33) was the highest score at 17 and in the reevaluation (7.81 ± 5.14) the lowest was 0 (p < 0.05). The muscular strength increased considerably (p < 0.05) for group 1, where the vast majority of patients gained more than twice the strength in the pelvic apparatus (8.36 ± 6.65 before X 13.81 ± 8.92 after). The volunteers acquired an increase in the contraction of the muscles of the pelvic apparatus (p < 0.05) (3.45 ± 1.07); after laser application, this number increased considerably (4.27 ± 0.61). Endurance had an increase of almost 50% compared to placebo, demonstrating the resistance gain in the perineal muscles (3.90 ± 2.35 X 5 ± 1.90). We concluded that photobiomodulation treatment showed significant efficacy in relation to muscle fatigue in the pelvic apparatus right after a strengthening program in women with stress urinary incontinence.

Long-term analyses of spastic muscle behavior in chronic poststroke patients after near-infrared low-level laser therapy (808 nm): a double-blinded placebo-controlled clinical trial.

Stroke results in impairment of basic motor functions, such as muscle weakness in limbs affected by spasticity, leading to peripheral fatigue and impaired functionality. The clinical use of photobiomodulation therapy (PBMT) has provided major advances in the treatment of muscular disorders and prevention of muscle fatigue. The aim of this study was to analyze the effects of two distinct therapies in biceps spasticity of chronic hemiparetic patients. We analyzed range of elbow motion, torque, electromyography, and mean spectral frequency after 10 sessions of PBMT (Laser 100 mW, 808 nm, 159.24 J/cm2/point, 5 J/point); PBMT active or placebo was associated with exoskeleton-assisted functional treatment. A double-blind placebo-controlled sequential clinical trial was conducted with 12 healthy volunteers and 15 poststroke patients who presented upper-limb spasticity. The healthy volunteers performed only the evaluation protocol, and the poststroke volunteers participated in three consecutive phases (PBMT, PBMT + exoskeleton, placebo + PBMT) with a washout period of 4 weeks between each phase. We could observe significant increases in range of elbow motion after PBMT from 57.7 ± 14 to 84.3 ± 27.6 degrees (p < 0.001). The root mean square (RMS) values also increased after PBMT + exoskeleton from 23.2 ± 15 to 34.9 ± 21 µV (p = 0.0178). Our results suggest that the application of PBMT may contribute to an increased range of elbow motion and muscle fiber recruitment, increases in muscle strength, and, hence, to increase signal conduction on spastic muscle fibers in spastic patients.

Efeitos da associação entre espiritualidade, religiosidade e atividade física na saúde/saúde mental: revisão sistemática / Efectos de la asociación entre espiritualidad, religiosidad y actividad física en la salud/salud mental: una revisión sistemática / Effects of the association between spirituality, religiosity and physical activity on health/mental health: a systematic review

RESUMO Objetivo: Identificar na literatura evidências acerca dos efeitos da associação entre espiritualidade, religiosidade e atividade física na saúde física e mental. Método: Revisão sistemática realizada em janeiro de 2019 nas bases de dados MEDLINE/PubMed, SCOPUS, Web Of Science, CINAHL, PsycINFO, LILACS e SciELO, com os descritores "spirituality", "religion", "physical activity" e "physical exercise". Incluíram-se estudos primários realizados com adultos, publicados até 2018 em português, inglês ou espanhol. Resultados: Foram selecionados nove estudos, publicados entre 2011 e 2017, todos internacionais, com desenho transversal (55%) e nível de evidência quatro (78%). Oito estudos abordaram efeitos na saúde física e um abordou efeitos na saúde mental. Conclusão: A Associação entre espiritualidade, religiosidade e atividade física promove efeitos na saúde física e mental, porém as evidências disponíveis não são suficientes para que esta associação seja aplicada na prática clínica.

RESUMEN Objetivo: Identificar la evidencia en la literatura sobre los efectos de la asociación entre la espiritualidad, la religiosidad y la actividad física en la salud física y mental. Método: Revisión sistemática realizada en enero de 2019 en las bases de datos MEDLINE/PubMed, SCOPUS, Web Of Science, CINAHL, PsycINFO, LILACS y SciELO, con los descriptores "espiritualidad", "religión", "actividad física" y "ejercicio físico". Se incluyeron estudios primarios realizados con adultos, publicados hasta 2018 en portugués, inglés o español. Resultados: Se seleccionaron nueve estudios, publicados entre 2011 y 2017, todos internacionales, con diseño transversal (55%) y nivel de evidencia cuatro (78%). Ocho estudios se ocuparon de los efectos en la salud física y uno de los efectos en la salud mental. Conclusión: La asociación entre la espiritualidad, la religiosidad y la actividad física promueve efectos en la salud física y mental, pero las pruebas disponibles no son suficientes para que esta asociación se aplique en la práctica clínica.

ABSTRACT Objective: To identify evidence in the literature about the effects of the association between spirituality, religiosity and physical activity on physical and mental health. Method: A systematic review conducted in January 2019 in the MEDLINE/PubMed, SCOPUS, Web Of Science, CINAHL, PsycINFO, LILACS and SciELO databases with the descriptors: "spirituality", "religion", "physical activity" and "physical exercise ". Primary studies carried out with adults published until 2018 in Portuguese, English or Spanish were included. Results: Nine international studies were selected which had been published between 2011 and 2017, with cross-sectional design (55%) and an evidence level of four (78%). Eight studies addressed effects on physical health and one addressed effects on mental health. Conclusion: The association between spirituality, religiosity and physical activity promotes effects on physical and mental health, however the available evidence is not sufficient for this association to be applied in clinical practice.

Analysis of the effects of low-level laser therapy on muscle fatigue of the biceps brachii muscle of healthy individuals and spastic individuals: Study protocol for a single-center, randomized, double-blind, and controlled clinical trial.

BACKGROUND: Muscular fatigue is caused by biochemical alterations that modify the mechanics of muscle contraction, resulting in negative changes in the performance of the contraction. Several resources are studied to mitigate this situation among which we can cite low-level laser therapy (LLLT). The effects of LLLT are being studied in healthy subjects with fibromyalgia and who are athletes, and currently the studies are being performed in spastic muscles with poststroke individuals. The aim will be to evaluate the effects of LLLT on the fatigue of the biceps brachii muscle of healthy individuals and individuals with spastic hemiparesis. METHODS: A cross-sectional, comparative, randomized, placebo, double-blind clinical trial will be divided into 2 phases: phase I shall consist of 30 healthy subjects and phase II of 30 poststroke individuals. The study will consist of 3 groups (control group, placebo group, and LLLT group), and all individuals will pass through all groups, following the randomization criteria. The protocol consists of the application of LLLT in the biceps brachii muscle on the dominant side in healthy individuals and in the hemiparetic side of poststroke individuals, and, subsequently, 3 maximal isometric voluntary contractions (MIVCs) will be performed for 50 seconds in the dynamometer, with an interval of 50 seconds between them. Pain intensity will be evaluated by means of the visual analog scale, and the myoelectric activity by means of surface electromyography associated with the evaluation of muscular strength by means of the dynamometer. The local temperature will be evaluated by infrared thermography and blood lactate concentration through the lactimeter, which will be measured at 4 different times, before the application of the laser (basal), and 3, 15, and 25 minutes after the MIVC.

Sensory-motor and cardiorespiratory sensory rehabilitation associated with transcranial photobiomodulation in patients with central nervous system injury: Trial protocol for a single-center, randomized, double-blind, and controlled clinical trial.

BACKGROUND: Central nervous system diseases such as stroke, spinal cord injury, traumatic brain injury, and multiple sclerosis can be fatal or cause sequelae, affecting sensorimotor and cardiorespiratory systems and quality of life. These subjects present a low response to aerobic and resistance exercise, due to decreased recruitment of muscle fibers and reduction of metabolic capacity. Aerobic exercises bring benefits in terms of fatigue retardation, gait improvement, regulation of the autonomic nervous system, neuroprotection of the brain, stimulation of the production of endogenous neutrotransmitters related to general well-being, and a favoring of neuroplasticity. Photobiomodulation (PBM Therapy) (previously known as low-level laser therapy), and especially transcranial PBM Therapy, has shown benefits in animals and humans such as cognitive improvement, memory, and behavioral improvement, including attenuation of depression and anxiety, and increased cortical oxygenation. The aims of this trial will be to evaluate the parameters related to the function of the musculoskeletal and cardiorespiratory system and the impact of PBM therapy on these parameters, as part of a rehabilitation and training program for people with reduced mobility. METHODS: This is a randomized, double-blind, placebo-controlled trial with 3 groups: Control, only cardiorespiratory rehabilitation (CCR), CCR with PBM Therapy (CR-PBM), CCR and placebo PBM Therapy (CR-PlaceboPBM). n = 90, 30 per group. PBM Therapy parameters: 810 nm laser, 0.028 cm, 100 mW, 3.5 W/cm, 30 seconds per point, 3 J per point, 107.1 J /cm to 3 electroencephalogram points F7 and F8 and AFz. The trial will be conducted at the University Clinics and the sessions will be 1 hour twice a week for 9 weeks. Baseline, intermediate (4th week), final (9th week), and 2-month follow-up will be performed. Muscular activation, heart rate variability, lung volumes and capacities, fatigability, exercise tolerance, cognition, and quality of life at baseline will be evaluated. Subsequent to baseline evaluations, the PBM Therapy groups will be offered laser therapy (active or inactive); all groups will then receive CCR. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID - NCT03751306 (approval date: November 22, 2018).

Efeitos da crioterapia associada à cinesioterapia e da estimulação elétrica em pacientes hemiparéticos espásticos / Efectos de la crioterapia asociada a la cinesioterapia y de la estimulación eléctrica en pacientes hemiparéticos espásticos / Effects of cryotherapy associated with kinesiotherapy and electrical stimulation on spastic hemiparetic patients

RESUMO A espasticidade causada pelo acidente vascular encefálico (AVE) é uma das principais causas de incapacidade funcional no membro superior. O objetivo do estudo foi verificar o efeito da crioterapia associada à cinesioterapia e da estimulação elétrica na capacidade de preensão palmar do membro espástico de pacientes com AVE na fase crônica. Participaram do estudo 40 pacientes com idade média de 60,5 (±9,45) anos e hemiparesia espástica, divididos aleatoriamente em grupo A (GA): submetidos à crioterapia nos músculos flexores de punho e cinesioterapia nos músculos flexores e extensores de punho; e grupo B (GB): submetidos à estimulação elétrica nos músculos extensores de punho. A capacidade de preensão palmar foi avaliada por meio de um dinamômetro de bulbo antes, depois de 16 atendimentos e um mês após o término do tratamento. Os resultados demonstraram que houve aumento da capacidade de preensão palmar no GA (p=0,0244) e GB (p=0,0144) após o tratamento, com manutenção um mês após seu término (p=0,6002 e 0,3066 respectivamente), sem diferença estatística entre estes. Os achados apontam que ambos os recursos terapêuticos foram eficazes para o aumento da capacidade de preensão palmar dos participantes do estudo.

RESUMEN La espasticidad causada por el accidente cerebrovascular (ACV) es una de las principales causas de incapacidad funcional en el miembro superior. El objetivo del estudio fue verificar el efecto de la crioterapia asociada a la cinesioterapia y de la estimulación eléctrica en la capacidad de prensión palmar del miembro espástico de pacientes con ACV en fase crónica. Participaron del estudio 40 pacientes con edad media de 60,5 (±9,45) años y hemiparesia espástica, divididos aleatoriamente en grupo A (GA) -sometidos a la crioterapia en los músculos flexores del puño y cinesioterapia en los músculos flexores y extensores del puño - y grupo B (GB) - sometidos a la estimulación eléctrica en los músculos extensores del puño. Se evaluó la capacidad de prensión palmar por medio de un dinamómetro neumático antes del tratamiento, después de 16 atendimientos y un mes después del término del tratamiento. Los resultados demostraron un aumento de la capacidad de prensión palmar en el GA (p=0,0244) y en el GB (p=0,0144) después del tratamiento, con mantenimiento un mes después de su término (p=0,6002 y 0,3066 respectivamente), sin diferencia estadística entre éstos. Los hallazgos apuntan que ambos recursos terapéuticos fueron eficaces para aumentar la capacidad de prensión palmar de los participantes del estudio.

ABSTRACT Spasticity caused by stroke is a cause of functional disability of the upper extremity. The aim of this study was to check the effect of cryotherapy associated with kinesiotherapy and electrical stimulation on the palmar grip strength of the spastic limb of stroke patients in the chronic phase. Forty patients whose mean age was 60.5 (±9.45) years old and who had spastic hemiparesis participated in the study, having been randomly sorted into group A (GA): submitted to cryotherapy on the wrist flexors and kinesiotherapy on the wrist flexors and wrist extensors, and Group B (GB): submitted to electrical stimulation on the wrist extensors. Palmar grip strength was evaluated by a bulb dynamometer before, after 16 sessions and one month after the end of treatment. The results showed that there was an increase in palmar grip strength in GA (p=0.0244) and GB (p=0.0144) after treatment, with maintenance one month after its completion (p=0.6002 and 0.3066, respectively), and no statistical difference was observed between them. The findings indicate that both therapeutic resources were effective in increasing the study participants' palmar grip strength.

EFEITOS DA CANOAGEM ADAPTADA SOBRE O SISTEMA CARDIOPULMONAR DE PARAPLÉGICOS / EFFECTS OF ADAPTED CANOEING ON THE CARDIOPULMONARY SYSTEM OF PARAPLEGICS / EFECTOS DEL PIRAGÜISMO ADAPTADO SOBRE EL SISTEMA CARDIOPULMONAR DE PARAPLÉJICOS

RESUMO Introdução: As doenças cardiovasculares e pulmonares estão entre as principais causas de morbidade e mortalidade de indivíduos com lesão medular (LM). O treinamento físico pode ser uma alternativa terapêutica para prevenir ou amenizar complicações cardiopulmonares nessa população. Objetivo: Avaliar os efeitos do treinamento com canoagem adaptada, constituído por exercícios combinados (aeróbicos e de força), sobre variabilidade da frequência cardíaca (VFC), função pulmonar e força muscular respiratória de pessoas paraplégicas em decorrência da LM. Métodos: Participaram do estudo seis paraplégicos, cinco homens e uma mulher, média de idade de 31,50 ± 7,68 anos e índice de massa corporal médio de 24,00 ± 1,13 kg/m², nível de lesão de T4 a T9, que realizaram treinamento com canoagem adaptada por três meses. Os indivíduos foram avaliados por VFC, espirometria e manovacuometria antes e depois do treinamento. Resultados: Após o treinamento houve aumento não significativo de RR (12,7%), SDNN (24,3%), rMSSD (50,0%), pNN50 (478,6%), LF (ms²) (53,3%), HF (ms²) (158,8%), SD1 (50,6%), SD2 (23,2%) e SampEn (20,2%). Os índices HF (u.n) e LF/HF tiveram redução não significativa de 5,7 e 7,0%, respectivamente. Os maiores ganhos respiratórios foram para VVM (9,7%), Pimáx (8,5%) e Pemáx (11,0%), porém, não foram significativos. Conclusão: O protocolo proposto de três meses de canoagem adaptada não foi capaz de promover efeitos significativos sobre os parâmetros cardiopulmonares avaliados em indivíduos paraplégicos pós-LM, porém se observa uma tendência de melhora da maioria desses parâmetros. Nesse sentido, provavelmente, o estímulo de treinamento foi insuficiente.

ABSTRACT Introduction: Cardiovascular and pulmonary diseases are among the leading causes of morbidity and mortality in individuals with spinal cord injury (SCI). Physical training can be an alternative therapy to prevent or mitigate cardiopulmonary complications in this population. Objective: To evaluate the effects of training with adapted canoeing, consisting of combined exercise (aerobic and strength) on heart rate variability (HRV), pulmonary function and respiratory muscle strength in paraplegics due to SCI. Methods: The study included six paraplegics, five men and one woman, average age of 31.50 ± 7.68 years and mean body mass index of 24.00 ± 1.13 kg/m², level of injury T4 to T9, who underwent training with adapted canoeing for three months. Subjects were evaluated by HRV, spirometry and manovacuometer before and after the training period. Results: After training there was no significant increase in RR (12.7%), SDNN (24.3%), rMSSD (50.0%), pNN50 (478.6%), LF (ms²) (53.3%), HF (ms²) (158.8%) SD1 (50.6%), SD2 (23.2%) and SampEn (20.2%). The HF indices (un) and LF/HF showed no significant decrease of 5.7 and 7.0%, respectively. The highest breathing gains were for MVV (9.7%), MIP (8.5%) and MEP (11.0%), being however not significant. Conclusion: The proposed protocol of three months of adapted canoeing failed to promote significant effects on cardiopulmonary parameters evaluated in paraplegic subjects after SCI, but we observe the trend of improvement in most of these parameters. In this sense, probably the training stimulus was insufficient.

RESUMEN Introducción: Las enfermedades cardiovasculares y pulmonares se encuentran entre las principales causas de morbilidad y mortalidad en las personas con lesión de la médula espinal (LME). El entrenamiento físico puede ser una alternativa terapéutica para prevenir o mitigar las complicaciones cardiopulmonares en esta población. Objetivo: Evaluar los efectos del entrenamiento con piragüismo adaptado, que consiste en el ejercicio combinado (aeróbico y fuerza) en la variabilidad de la frecuencia cardiaca (VFC), la función pulmonar y la fuerza de los músculos respiratorios en los parapléjicos debido a LME. Métodos: El estudio incluyó seis parapléjicos, cinco hombres y una mujer, la edad promedio fue 31.50 ± 7,68 años y el índice de masa corporal promedio fue 24,00 ± 1,13 kg/m² y nivel de la lesión de T4 a T9, que se sometieran a entrenamiento de piragüismo adaptado con duración de tres meses. Los sujetos fueron evaluados por la VFC, la espirometría y el manovacuómetro antes y después del entrenamiento. Resultados: Después del entrenamiento no hubo un aumento significativo en RR (12,7%), SDNN (24,3%), rMSSD (50,0%), pNN50 (478,6%), LF (ms²) (53,3 %), HF (ms²) (158,8%), SD1 (50,6%), SD2 (23,2%) y SampEn (20,2%). Los índices de HF (u.n) y LF/HF tuvieron una reducción no significativa de 5,7% y 7,0%, respectivamente. Las mayores ganancias respiratorias fueran de MVV (9,7%), PImáx (8,5%) y PEmáx (11,0%), sin embargo, no fueron significativas. Conclusión: El protocolo propuesto de tres meses de piragüismo adaptado no fue capaz de promover efectos significativos en los parámetros cardiopulmonares evaluados en parapléjicos post-LME, pero se observó una tendencia al mejoramiento de la mayoría de estos parámetros. En este sentido, probablemente el estímulo de entrenamiento ha sido insuficiente.

Effects of vibration therapy in the musculoskeletal system in post-surgical breast cancer women: longitudinal controlled clinical study

Abstract: Introduction The biomechanical changes that arise after breast cancer increase the need for new rehabilitation programs. The aim of this study was to evaluate medium- and long-term effects of vibration therapy on pain intensity, range of motion, myoelectric activity, and muscle strength of post-surgical breast cancer women. Methods This controlled longitudinal clinical study was composed of 14 breast cancer women, who underwent vibration therapy treatment (VTG), and 14 healthy women, who constituted the control group (CG). The VTG performed ten 15-minutes sessions of vibration therapy on their affected upper limb. The volunteers were evaluated before and after treatment protocol, and three months later. Results We observed an attenuation of pain intensity after vibration therapy (p < 0.0001) and significant increase in range of motion during extension, abduction, and adduction movements of the horizontal shoulder. We noticed a trend in the reduction of compensatory movements, which activated the muscle contraction mechanism. The scapular dynamometer values for shoulder strength were significant. The VTG had less muscle strength than the CG in all situations: before treatment (p < 0.0001), after treatment (p = 0.0024), and 3 months later (p = 0.0008). The VTG increased muscle strength after treatment (p = 0.0005) and 3 months later (p = 0.0006). Conclusion Vibration therapy attenuated pain symptoms, improved shoulder movements, activated muscle contraction mechanism, and increased shoulder strength, which may be benefits of the conducted physical therapy.

Effects of low-level laser therapy (LLLT 808 nm) on lower limb spastic muscle activity in chronic stroke patients.

A cerebrovascular accident (CVA) may affect basic motor functions, including spasticity that may be present in the upper extremity and/or the lower extremity, post-stroke. Spasticity causes pain, muscle force reduction, and decreases the time to onset of muscle fatigue. Several therapeutic resources have been employed to treat CVA to promote functional recovery. The clinical use of low-level laser therapy (LLLT) for rehabilitation of muscular disorders has provided better muscle responses. Thus, the aim of this study was to evaluate the effect of the application of LLLT in spastic muscles in patients with spasticity post-CVA. A double-blind clinical trial was conducted with 15 volunteer stroke patients who presented with post-stroke spasticity. Both males and females were treated; the average age was 51.5 ± 11.8 years old; the participants entered the study ranging from 11 to 48 months post-stroke onset. The patients participated in three consecutive phases (control, placebo, and real LLLT), in which all tests of isometric endurance of their hemiparetic lower limb were performed. LLLT (diode laser, 100 mW 808 nm, beam spot area 0.0314 cm(2), 127.39 J/cm(2)/point, 40 s) was applied before isometric endurance. After the real LLLT intervention, we observed significant reduction in the visual analogue scale for pain intensity (p = 0.0038), increased time to onset of muscle fatigue (p = 0.0063), and increased torque peak (p = 0.0076), but no significant change in the root mean square (RMS) value (electric signal in the motor unit during contraction, as obtained with surface electromyography). Our results suggest that the application of LLLT may contribute to increased recruitment of muscle fibers and, hence, to increase the onset time of the spastic muscle fatigue, reducing pain intensity in stroke patients with spasticity, as has been observed in healthy subjects and athletes.

Muscle electrical activity during exercises with and without load executed on dry land and in an aquatic environment

Introduction Muscle activity in the aquatic environment was investigated using electromyographic analyses. The physical properties of water and the resistance used may influence the response of the muscle during exercise. The objective of this study was to evaluate the electrical activity in water and on the floor during flexion and knee extension exercises with and without load and aimed at understanding the muscular response while performing resistance exercises in water. Methods The sample consisted of 14 volunteers between 18 and 35 years old who were subjected to active exercises involving knee flexion and extension with and without load on the floor and in water. Electromyography was performed during the movement. Results A significant increase was found in the electrical activity of the rectus femoris muscle during exercises on the floor. The biceps femoris muscle showed increased electromyographic activity when resistance was used. A significant increase was found in the electrical activity of the rectus femoris muscle compared with exercises with and without load and the moment of rest in immersion. The electrical activity of the rectus and biceps femoris muscles was reduced in exercises with load and without load in a therapy pool compared with on the floor. Conclusion There was a reduction of the electromyographic activity in the aquatic environment compared with that on the ground, which could be attributed to the effects from hot water. Therefore, it is believed that resistance exercises can be performed early in a therapy pool, which will facilitate the prevention and treatment of musculoskeletal disorders.

Immediate effects of low-intensity laser (808 nm) on fatigue and strength of spastic muscle.

The cerebrovascular accident (CVA), high-impact disease II, affects the basic functions of the limbs, leading to changes of sensory, language, and motor functions. The search for resources that minimize the damage caused by this disease grows every day. The clinical use of low-intensity laser therapy (LILT) has provided major breakthroughs in the treatment of muscular disorders and prevention of muscle fatigue. Thus, the objective of the present study is to analyze the answers and immediate adaptations of the rectus femoris and vastus medialis of spastic hemiparetic patients, facing the increase in peak torque and triggering muscle fatigue, after application of LILT. Double-blind clinical trials were conducted with 15 volunteers post-CVA with spasticity, of both genders, between 40 and 80 years old. To this end, the volunteers went through three consecutive stages of rating (control, placebo, and laser). All performed tests of isometric contraction on the patient's hemiparetic side. Significant differences were observed with regard to the increase in muscle performance (p = 0.0043) and the reduction in blood lactate concentration (p < 0.0001) of the post-LILT muscles. The LILT (diode laser, l100 mW 808 nm, 4.77 J/cm(2)/point, 40 s/AP) can be employed during and after spastic muscle-strengthening exercises, contributing to the improvement of motor function of the patient. After application of LILT, we found increased torque as well as decreased in lactate level in patients with spasticity.

Correlação da dor e qualidade de vida demulheres pós-tratamento cirúrgico de câncerde mama / Correlation pain-quality of life in women after being submittedto surgical treatment of breast cancer

O câncer de mama, considerado mais incidente na população feminina, provoca alterações físico-funcionais e emocionaisque dificulta as atividades de vida diária, gerando impacto na qualidade de vida das mulheres. O objetivo desteestudo foi caracterizar a influência da síndrome dolorosa pós mastectomia, correlacionando dor e qualidade de vida. Foirealizado um estudo descritivo-exploratório com abordagem quantitativa por meio do questionário de Qualidade de VidaSF-36. A amostra constou de 49 mulheres com idade média de 53,9 ± 8,8 anos, atendidas em Centros Especializados deOncologia da região. Não houve diferença significativa entre o domínio dor quando comparado aos demais domínios.Observou-se alta correlação entre o tempo pós-cirúrgico de 3 a 6 anos e o domínio dor (r = 0,90). Foi encontrado aumentosignificativo da dor entre mulheres idosas quando comparado as mais jovens (p = 0,05). Conclui-se com a realização destapesquisa que a dor relacionada ao câncer de mama é um sintoma clínico debilitante, porém não constitui o fator primáriopara o déficit da qualidade de vida, o qual é influenciado principalmente pelo aspecto emocional.

Breast cancer, which is more prevalent in the female population, causes physical, functional, and emotional changes thatmake daily activities difficult, affecting women’s quality of life. The aim of this study was to characterize the influence ofpost mastectomy pain syndrome, correlating pain and quality of life. We conducted a descriptive exploratory study with aquantitative approach using the Quality of Life Questionnaire SF-36. The sample consisted of 49 women with a mean ageof 53.9 ± 8.8 years, treated in Specialized Oncology Centers in the region. There was no significant difference between thepain domains compared to other domains. There was a high correlation between time after surgery, 3-6 years, and paindomain (r = 90). Older women had a significant increase in pain compared to younger ones (p = 05). This research foundthat the pain related to breast cancer is a debilitating clinical symptom, but not the primary factor for deficits in quality oflife, which is mainly influenced by emotional aspects.

Resistência ao movimento e atividade eletromiográfica dos músculos flexores e extensores de cotovelo em pacientes hemiparéticos espásticos submetidos à crioterapia e estimulação elétrica neuromuscular / Resistance to movement and electromyographic activity of the elbow flexor and extensor muscles in spastic hemiparetic patients following cryotherapy and electrical stimulation

A espasticidade quase sempre coexiste a um Acidente Vascular Encefálico (AVE), devido à lesão do motoneurônio superior, provocando um impacto nas atividades da vida diária e na qualidade de vida dos pacientes. Por esse motivo é de suma importância o controle do tônus muscular, que pode ser alcançado por meio de recursos fisioterapêuticos, como a crioterapia e a Estimulação Elétrica Neuromuscular (EENM). Como demonstrado em diversas pesquisas na área, esses recursos são vantajosos pelos efeitos fisiológicos que proporcionam, porém, são insuficientes os trabalhos científicos que forneçam embasamento para o tratamento da espasticidade dos membros superiores e, evidenciem o tempo de duração dos efeitos fisiológicos após aplicação desses recursos. Nesse sentido, o presente trabalho vem contribuir para o estabelecimento de protocolo de aplicação de crioterapia e EENM em indivíduos portadores de hemiparesia espástica e, informar a duração dos efeitos após submissão às terapias, por meio da análise da resistência ao movimento dos músculos flexores e extensores de cotovelo antes, depois, 10, 20 e 30 minutos após a aplicação de crioterapia e EENM. Participaram do estudo 15 pacientes com diagnóstico de AVE e diagnóstico fisioterapêutico de hemiparesia espástica, de ambos os sexos, com idade média de 56 ± 16 anos. A avaliação foi realizada antes e após a terapia, e nos instantes de 10, 20 e 30 minutos após o término de sua aplicação, e consistiu na captação da atividade eletromiográfica por meio da Eletromiografia (EMG) de superfície e da resistência ao movimento por meio do Dinamômetro Isocinético, no modo passivo nas velocidades angulares de 30 º/s e 150 º/s. Embora não estatisticamente significativos (p < 0,05) os resultados evidenciam uma redução da resistência à movimentação passiva dos flexores e extensores de cotovelo após a aplicação de crioterapia e EENM, comprovando a eficácia dos recursos fisioterapêuticos na redução da resistência à movimentação passiva de indivíduos hemiparéticos espásticos, embora, apresentem efeitos diferentes com relação ao tempo.

Spasticity often coexists with stroke due to an upper motor neuron lesion, which impacts the patient's quality of life. Therefore, the control of muscle tone through physical therapy such as cryotherapy and Neuromuscular Electrical Stimulation (NMES) is extremely important. Several studies have demonstrated their advantageous physiological effects. However, these studies have not provided sufficient scientific proof for the treatment of upper limb spasticity and the duration of the physiological effects after the therapy. Therefore, this work helps to establish an application protocol for cryotherapy and NMES in individuals with spastic hemiparesis. The resistance to movement of the elbow flexor and extensor muscles before and after application of cryotherapy and NMES was used to determine the effect of the therapies. The study included 15 stroke patients that required physical therapy for spastic hemiparesis. They included both sexes, mean age of 56 ± 16. An evaluation was performed before and after therapy, as well as 10, 20, and 30 minutes following the application, by means of surface electromyography (EMG). The resistance to movement was measured with an Isokinetic Dynamometer in the passive mode at an angular velocity of 30 and 150 º/s. Although not statistically significant (p < 0.05), the results showed a reduced resistance to passive movement of the elbow flexors and extensors after cryotherapy and NMES, allowing us to conclude that physical therapy effectively reduces the resistance to passive movement in spastic hemiparetic patients, however, they have different effects with respect to time.

Controle da postura semi-ajoelhada: a influência da visão e dominânicia sob a análise cinemática articular tridimensional / Half-Kneeling posture control: the infIuence of vision and dominance in the three-dimensional joint kinematics analysis

Introdução: O controle postural é complexo exigindo manutenção de articulações e músculos em que as informações visuais, vestibulares e proprioceptivas são usadas para detectar as variações da posição do corpo e ambiente visando o equilíbrio. Método: Avaliamos a influência da visão e dominância no controle da postura de semi-ajoelhado em sete indivíduos, permanecendo por 30 segundos nesta postura, com os olhos abertos e posteriormente fechados. As possíveis variações da cinemática foram coletadas pelo sistema Motion Analysis CQ®. Resultados: A visão influenciou nas articulações dos quadris, joelho E. e tornozelo D. entre as situações de olho aberto e fechado houve diferença significativa (p

Introduction: The postural control is complex, requiring maintenance of joints and muscles in which visual information, vestibular and proprioceptive information is used to detect the position of the body and environment to equilibrium. Method: We evaluated the influence of vision and dominance in the control of half-kneeling posture in seventeen subjects during 30 seconds in this posture, with eyes open and subsequently closed. The possible variations of the kinematics were collected by the Motion Analysis System CQ®. Results: The hip joints, Left knee, Right ankle between the two conditions with significant difference (p <0.001) were influenced by vision. In the pelvis, right knee, and left ankle have no difference between eyes open and closed to the dominant side. The difference in the trunk occurred inthe non-dominant side. Conclusion: The postural control was influenced by the vision and behaved differently when the sides with the dominant non-dominant in the maintenance of posture.

Comparison of methods of measurement of the finger flexor muscles' strength through dynamometry and modified manual sphygmomanometer / Comparação dos métodos de mensuração da força muscular dos flexores dos dedos das mãos através da dinamometria manual e esfigmomanômetro modificado

Objective: To evaluate the reproducibility of the modified sphygmomanometer compared to hand dynamometer to measure muscle strength of the flexor muscles of fingers. Methods: We assessed 40 healthy volunteers of both genders, aged between 20 and 55 years, who underwent the muscle strength test in the finger flexor muscles on both hands using two instruments for which the comparison was made between them. Results: After statistical analysis by the paired Student's t test, there was no significant difference between the values obtained in modified sphygmomanometer and hand dynamometer tests in relation to right and left sides (p > 0.05). Pearson's coefficient of correlation observed good correlations between them. Conclusions: The modified sphygmomanometer proved to be a reproducible technique for measuring muscle strength of the finger flexor muscles.

Objetivo: Avaliar a reprodutibilidade do esfigmomanômetro modificado para a mensuração da força muscular dos músculos flexores dos dedos das mãos através da comparação do mesmo com o dinamômetro manual. Métodos: Foram avaliados 40 voluntários saudáveis de ambos os sexos com idade entre 20 e 55 anos que realizaram o teste de força muscular dos músculos flexores dos dedos em ambas as mãos com os dois instrumentos para que fosse feita a comparação entre eles. Resultados: Após análise estatística feita pelo teste t de Student pareado, não foi observada diferença significativa entre os valores obtidos nos testes esfigmomanômetro modificado e dinamômetro manual em relação à lateralidade (p > 0,05), assim como, no teste do coeficiente de correlação de Pearson, foram observadas correlações quando analisados os valores obtidos no teste com esfigmomanômetro modificado versus o teste com dinamômetro manual. Conclusões: O esfigmomanômetro modificado mostrou ser uma técnica reprodutível para medir força muscular dos músculos flexores dos dedos.

Análise da eficácia da cinesioterapia na qualidade de vida de uma paciente portadora de fibromialgia e síndrome do pânico: estudo de caso / Analysis of the effectiveness of kinesiotherapy in the quality of Life of a patient with fibromyalgia syndrome and the panic-case study

Fibromialgia é uma síndrome reumática de etiologia desconhecida , caracterizada, por dores difusas, tendo outros sintomas, como a fadiga, distúrbios do sono rigidez matinal, ansiedade e depressão. O estudo objetivou avaliar a qualidade de vida de uma paciente portadora de fibromialgia e síndrome do pânico antes e depois de um tratamento de cinesioterapia. O tratamento proposto foi constituído de alongamentos, exercícios isotônicos e caminhada. Sendo que não obteve alterações significativas e na qualidade de vida desta paciente. Sugerindo que para um tratamento efetivo desta patologia é necessário associações de diferentes técnicas cinesioterapicos, juntamente com um acompanhamento psíquico emocional, visando à melhora da qualidade de vida do paciente.

Fibromyalgia is a syndrome rheumatic without cause, characterized by difuse pain and other symptoms such as fatigue, sleep disturbances of morning stiffness, anxiety and depression. The study aimed to evaluate the quality of life of patient with fibromyalgia syndrome and of panic before and after a treatment of kinesiotherapy. The proposed treatment was composed of stretching, exercises and isogonics walk. Since that did not achieve significant changes in quality of life of the patient. By suggesting that an effective treatment for this condition is necessary associations of different techniques cinecioterapicas precisely with a mental emotional for monitoring improves quality of life of the patient.

Análise cinemática do movimento das trocas posturais de quadrupedia para bipedestação / Kinematic movement analysis of change from quadrupedalism to bipedalism

Objetivo: Avaliar a cinemática angular das articulações do tronco, quadril, joelho e tornozelo no plano sagital durante as trocas posturais de quadrupedia para a bipedestação. Métodos: Doze voluntários participaram do estudo: seis do sexo feminino e seis do masculino, com idade entre 20  e 28 anos. Os participantes realizaram seis repetições, três iniciadas com o lado direito e as outras três com o esquerdo. Todos foram submetidos à análise computadorizada do movimento por meio de cinemetria bi-dimensional. Rresultados: Após a análise estatística não foi encontrada diferença estatisticamente significativa inter e intravoluntários nos dois grupos testados. Cconclusões: Após análise da cinemática angular foi possível constatar que não há um único padrão de movimento para realizar a troca postural de quadrupedia para ortostase em adultos jovens sadios. Houve estratégias de elaboração e execução de movimento que mostraram semelhança e pouca variabilidade intravoluntários. Porém, intervoluntários houve semelhança entre os grupos, o que possibilitou uma distinção das estratégias específicas para a realização da tarefa.

Changes in joint kinematics in children with cerebral palsy while walking with and without a floor reaction ankle-foot orthosis

INTRODUCTION: The floor reaction ankle-foot orthosis is commonly prescribed in the attempt to decrease knee flexion during the stance phase in the cerebral palsy (CP) gait. Reported information about this type of orthosis is insufficient. PURPOSE: The purpose of this study was to determine the effect of clinically prescribed floor reaction ankle-foot orthosis on kinematic parameters of the hip, knee and ankle in the stance phase of the gait cycle, compared to barefoot walking on children with cerebral palsy. METHODS: A retrospective chart review of 2200 patients revealed that 71 patients (142 limbs) had a diagnosis of diplegia, with no contractures in hip, knee or ankle flexion. Their average age was 12.2 ± 3.9. All of them were wearing clinically prescribed hinged floor reaction ankle-foot orthosis undergoing a three dimensional gait analysis. We divided the patients in three groups: Group I, with limited extension (maximum knee extension less than 15°); Group II, with moderate limited extension (maximum knee extension between 15° and 30°) and Group III Crouch (maximum knee extension in stance more than 30°). RESULTS: Results indicate the parameters maximum knee extension and ankle dorsiflexion were significant in Group II e III; no change was observed in Group I. The maximum hip extension was not significant in all three groups. Conclusion: when indicated to improve the extension of the knees and ankle in the stance of the CP patients floor reaction ankle-foot orthosis was effective.

INTRODUÇÃO: A órtese de reação ao solo é freqüentemente prescrita com o objetivo de reduzir a flexão do joelho durante a fase de apoio na marcha de pacientes com paralisia cerebral. Não há informações suficientes relatadas na literature sobre este tipo de órteses. OBJETIVOS: O objetivo deste estudo foi determinar o efeito que a órtese de reação ao solo tem na cinamática angular das articulações do quadril, joelho e tornozelo durante a fase de apoio da marcha de crianças com paralisia cerebral, comparando a marcha descalça e com o uso das órteses MÉTODOS: Após um estudo retrospectivo de 2200 pacientes avaliados no laboratório de marcha, 71 pacientes com diagnóstico de paralisia cerebral do tipo diparesia espástica e idade média de 12.2 ± 3.9 foram selecionados (142 membros). Nenhum deles apresentou contratura em flexão dos quadris, joelhos e tornozelos. Todos usavam órteses do tipo reação ao solo articulada durante a avaliação da marcha. Os pacientes foram divididos em três grupos: Grupo I Extensão Limitada (pico de extensão do joelho menor que 15°); Grupo II Extenão Moderadamente Limitada (pico de extensão do joelho entre 15° e 30°) e Grupo III Agachamento (pico de extensão do joelho no apoio maior que 30°). RESULTADOS: Os resultados demostraram que o pico de extensão do joelho e o pico de dorsiflexão tiveram alterações significantes nos grupos II e III enquanto que o grupo I não apresentou alteração. O pico de extensão do quadril não mostrou alteração nos três grupos CONCLUSÃO: A órtese de reação ao solo é eficaz quando indicada para aumentar a extensão do joelho e tornozelo durante a fase de apoio da marcha de crianças com paralisia cerebral.