Equilíbrio postural pelo Mini-Balance Evaluation Systems Test (Mini-Bestest): aprimoramento de cuidados em hanseníase / Postural balance by the Mini-Balance Evaluation Systems Test (Mni-BESTest: Improvement of leprosy care

Introdução: A hanseníase, doença infectocontagiosa crônica, pode provocar diminuição da sensibilidade e alterações motoras com comprometimento do equilíbrio. Um instrumento de avaliação clínica chamado Mini-BESTest é aplicável ao diagnóstico e acompanhamento do comprometimento do equilíbrio postural. Objetivo: Avaliar o equilíbrio dinâmico em pessoas com hanseníase pelo desempenho no Mini-BESTest nos subsistemas: ajuste postural antecipatório; respostas posturais reativas; orientação sensorial e estabilidade na marcha. Métodos: Aplicou-se o Mini-BESTest em 54 usuários do SUS, em seguimento para hanseníase e em Avaliação Neurológica Simplificada (ANS). O Grau de Incapacidade Física (GIF), obtido pela ANS, classificou as pessoas com presença e ausência de incapacidade. Utilizaram-se escores do Mini-BESTest relativos ao total de pontos por subsistema. Resultados: A análise univariada indicou que idades maiores apresentaram escores menores e a análise multivariada mostrou que a ANS é importante na explicação dos escores, controlando-se sexo e idade, onde escores menores, nos quatro subsistemas, ocorreram entre pessoas com incapacidade. Conclusões: O Mini-BESTest indica diminuição do equilíbrio dinâmico entre pessoas com hanseníase, com incapacidade física. Seu uso pode orientar a prática clínica do fisioterapeuta. Potencial de aplicabilidade: O Mini-BESTest, método barato, de fácil e rápida aplicação, é capaz de contribuir para o aprimoramento dos cuidados em hanseníase.

Equilíbrio postural pelo Mini-Balance Evaluation System Test (Mini-Bestest): aprimoramento de cuidados em hanseníase / Postural balance by the Mini-Balance Evaluation Systems Test (Mini-Bestest: improvement of leprosy care

Introdução: A hanseníase, doença infectocontagiosa crônica, é causada pelo Mycobacterium leprae ou bacilo de Hansen e compromete em especial nervos e pele. O tropismo neural do bacilo pode provocar ausência ou diminuição da sensibilidade e alterações motoras, levando a deformidades e deficiências físicas irreversíveis. Pesquisas mostraram que pessoas com hanseníase apresentam alterações no equilíbrio postural. No entanto, a avaliação clínica do equilíbrio não está incluída nas recomendações do Programa Nacional de Controle da Hanseníase do Ministério da Saúde. Um instrumento de avaliação clínica do equilíbrio, o Mini-BESTest mostrou ser abrangente e possível de ser utilizado em diversas doenças ou condições que possam comprometer o equilíbrio postural. Objetivo: O objetivo deste estudo foi identificar se há comprometimento do equilíbrio dinâmico em pessoas com hanseníase nos subsistemas avaliados por meio do Mini-BESTest. Métodos: Foi realizado estudo transversal com 54 pessoas em seguimento para hanseníase no SUS-Sorocaba, entre os meses de setembro a novembro de 2019. Foram coletados dados por anamnese e aplicação de dois testes avaliativos: Avaliação Neurológica Simplificada e Mini-BESTest. As variáveis de interesse foram o grau de incapacidade física (GIF 0, 1, 2) e os escores fornecidos pelo Mini-BESTest. Para análise, os casos foram agrupados em dois grupos, de pessoas sem incapacidade física (GIF 0) e com incapacidade física (GIF 1 e 2) relacionada à hanseníase. Resultados: Na comparação do desempenho no Mini-BESTest entre os grupos houve diferença estatisticamente significante (p<0,05) nos escores de todos os subsistemas e no escore final do teste. O melhor desempenho na avaliação dos subsistemas ocorreu no grupo sem incapacidade física. Conclusões: Concluiu-se que houve alterações nos subsistemas do equilíbrio postural, avaliados pelo Mini-BESTest, em pessoas com incapacidades físicas relacionadas à hanseníase, sendo esse um bom instrumento para utilização na prática clínica do fisioterapeuta. Potencial de aplicabilidade: Trata-se de um método barato, de fácil e rápida aplicação, capaz de contribuir para o aprimoramento dos cuidados em hanseníase.

Fisioterapia além da reabilitação física: reflexões sobre a humanização do cuidado no contexto da hanseníase na Amazônia / Physiotherapy beyond physical rehabilitation: reflections on the humanization of care in the context of hanseníase in the Amazon

A hanseníase é uma doença infecto contagiosa que provoca alterações neurológicas e dermatológicas que modificam de maneira significativa a vida do paciente, além disso, também geram muitas repercussões psicossociais. Com isso, o objetivo dessa pesquisa foi analisar a atuação da Fisioterapia na prevenção, tratamento e reabilitação do paciente com hanseníase. Trata-se de um estudo realizado na Unidade de Referência Especializada em Dermatologia Sanitária Dr. Marcelo Cândia, localizada na região metropolitana de Belém, tendo como público -alvo os usuários atendidos pela instituição que estavam em acompanhamento fisioterápico, assim como os fisioterapeutas que atuavam na instituição. Notou-se que a humanização em saúde, no contexto da hanseníase, demanda uma atitude ética transversal e não mais unidirecional, considerando a necessidade de interação entre os diversos atores envolvidos no processo terapêutico(AU).

Leprosy is a contagious infectious disease that causes neurological and dermatological changes that significantly modify the patient's life. In addition, they also generate many psychosocial repercussions. Thus, the objective of this research was to analyze the role of Physiotherapy in the prevention, treatment and rehabilitation of patients with leprosy. This is a study conducted at the Specialized Reference Unit in Sanitary Dermatology Dr. Marcelo Cândia, located in the metropolitan region of Belém, targeting users served by the institution who were undergoing physical therapy, as well as physiotherapists who worked at institution. It was noted that humanization in health, in the context of leprosy, demands a transversal and no longer unidirectional ethical attitude, considering the need for interaction between the various actors involved in the therapeutic process(AU).

Atuação da fisioterapia no acompanhamento de pacientes com hanseníase / Role of physical therapy in the follow-up of patients with leprosy

A hanseníase é uma doença crônica e infecciosa, causada por uma bactéria do tipo bacilo, cujo nome científico é Mycobacterium leprae, que acarreta afecções físicas, motoras, sensoriais e sociais. O presente estudo tem como objetivo descrever a atuação da Fisioterapia no acompanhamento terapêutico de pessoas com hanseníase, com base na produção científica brasileira divulgada em periódicos nacionais no período de 2003 a 2012. Tratou-se de uma revisão, com abordagem qualitativa, sendo a coleta de dados realizada no mês de dezembro/2013, nas bases de dados Scielo, Lilacs, Medline e Portal de Periódicos CAPES. Com o refinamento do material empírico, mediante aplicação de critérios de inclusão e exclusão, foram selecionados 6 artigos que constituíram o substrato de análise. Os resultados revelaram uma escassa produção científica na temática, e na região Norte não houve divulgação de pesquisas nesse tema. A maioria dos estudos são ensaios clínicos. Foi possível detectar que o fisioterapeuta desenvolve intervenções junto aos pacientes como diagnóstico, prevenção de incapacidades, tratamento e reabilitação. Para tanto, conta com um conjunto de testes e protocolos de avaliação, bem como dispõe de recursos e técnicas de tratamento e reabilitação. Contudo, reconhece-se a necessidade de investimento em pesquisa com vistas à construção de novas evidencias científicas na área.(AU)

Leprosy is a chronic infectious disease caused by a bacillus, whose scientific name is Mycobacterium leprae, which causes physical, motor, sensory and social disorders. The present study aimed to describe the role of physical therapy in monitoring a therapeutic program for patients with leprosy, based on scientific production published in national journals in the period 2003-2012. This was a literature review with a qualitative approach, with data collection conducted in December 2013, using Scielo, Lilacs, Medline and Portal CAPES journal databases. With the refinement of the empirical material, by applying inclusion and exclusion criteria, 6 studies that formed the substrate of analysis were selected. The results revealed lack of scientific studies on this theme, and no research related to leprosy was published in the North of Brazil. Most studies are clinical trials. It was possible to detect that a physiotherapist develops interventions to patients such as diagnosis, prevention of disability, treatment and rehabilitation. He can use a set of tests and evaluation protocols, and has the resources and techniques of treatment and rehabilitation. However, we recognize the need to invest in research in order to construct new scientific evidence in the area.(AU)

Efficacy of Steroid and Physiotherapy in Early Reported Lagophthalmos of Patient Affected with Leprosy. A Report from Trbal Dominated Leprosy Endemic State of India.

Lagophthalmos is one of the well-known complications of leprosy due to involvement of the facial nerve. In the present study an attempt has been made to elucidate the role of early intervention with steroids and adjunct physiotherapy in early reported lagophthalmos in patients affected with leprosy at a tertiary referral institute under the Disability Prevention and Medical rehabilitation (DPMR) programme. During April 2008 to March 2014, 62 patients affected with leprosy reported to Regional leprosy Training and Research Institute with lagophthalmos. Cases reporting within six months of difficulty in closure were categorized as early reporting group. These were either referred from a peripheral health centre (63%) or self-reported (37%). These patients were examined clinically and details were noted in a pretested Performa. The standard dosages of the steroids were given to patients as per NLEP guidelines. Lid gaps on direct gaze and with both gentle and forced closure were assessed using standard measuring technique by a physiotherapist. During the follow-up period the patients were imparted active and passive physiotherapy and any change in the lid gap was recorded. The data was analysed and appropriate test of significance was applied. Out of 62 lagophthalmos patients, 49(79.1%) were males and 13 (20.9%) were females. 56 (90.3%) cases were from MB category and 6 (9.7%) cases were from PB category. 53(85.4%) patients presented with unilateral eye involvement, while 9 (14.6%) had bilateral lagophthalmos. 53 (74.6%) of the eyes achieved complete lid closure, while the remaining 18 (25.4%) eyes had gap on gentle closure. During six month follow-up the amount of recession of lid gap among the early reported lagophthalmos was 4.15 mm with standard steroid regimen and physiotherapy. With the use of the steroid and regular physiotherapy lagophthalmos diagnosed and treated in initial stages shows significant improvement in the lid gap reduction.

Adaptive shortening of long flexor in patients with claw hand: A short report.

Adaptive shortening of long flexors is the common secondary impairment which can occur in patients with long standing claw hand, particularly in those who do not undergo any supervised physiotherapy programme.¹ The main purpose of this short report is to describe the current physiotherapeutic means which are commonly employed for the management of long flexor tightness. This report further gives an insight into the consequences of the delay in corrective surgery and ultimately describes the dire need for further research on this deformity.² Adaptive shortening of the muscles is a phenomenon which can occur for many reasons, like prolonged immobilisation of the of the body segment, postural imbalance, muscle imbalance, impaired muscle performance due to neuromuscular problems or may be due congenital and acquired deformity.Tightness of the muscles leads to limitation of joint range of motion.³ In leprosy the cause of adaptive shortening of the long flexors is muscle imbalance which occurs due to paralysis of the ulnar nerve at the elbow joint. Adaptive shortening of the muscles is a secondary impairment.4 Secondary impairments have multidimensional effects on the management of the deformity, including delay in surgery for the correction of deformity which in turn is responsible for the unemployment, social stigma and problems in social integration.5 Secondary impairment in some way or other is responsible for the above stated problems, but adaptive shortening of the long flexor (long flexor tightness) is important because sometimes months of therapy are required to attain full muscle length.

Changes in plantar load distribution and gait pattern following foot drop correction in leprosy affected patients.

This study was done to compare the changes in plantar load (weight distribution) and gait patterns before and after tibialis posterior transfer surgery in people affected by leprosy. Changes in gait patterns were observed and proportionate changes in plantar load were quantified using data captured by a baropodometer. All the eight patients who underwent tibialis posterior transfer surgery in 2013 in our hospital were included in the study. In addition to the regular pre-operative and post-operative assessments, the patients also underwent baropodometric evaluation. There was a significant change in plantar load at the heel, lateral border and forefoot. Using the foot pressure scan, it was noted that the progression of the centre of mass (displayed graphically as 'the gait line') was also affected by the altered pattern of weight distribution. This study reiterates the importance of tibialis posterior transfer because: it restores the normal gait pattern of 1, 2, 3 (where 1 is heel strike, 2 is mid foot contact and 3 is forefoot contact) and provides a more uniform distribution of planter load.

Weight bearing or non-weight bearing after surgically fixed ankle fractures, the WOW! Study: study protocol for a randomized controlled trial.

BACKGROUND: The optimal post-operative care regimen after surgically fixed Lauge Hansen supination exorotation injuries remains to be established. This study compares whether unprotected weight bearing as tolerated is superior to protected weight bearing and unprotected non-weight bearing in terms of functional outcome and safety. METHODS/DESIGN: The WOW! Study is a prospective multicenter clinical trial. Patients between 18 and 65 years of age with a Lauge Hansen supination exorotation type 2, 3 or 4 ankle fractures requiring surgical treatment are eligible for inclusion. An expert panel validates the classification and inclusion eligibility. After surgery, patients are randomized to either the 1) unprotected non-weight-bearing, 2) protected weight-bearing, or 3) unprotected weight-bearing group. The primary outcome measure is ankle-specific disability measured by the Olerud-Molander ankle score. Secondary outcomes are 1) quality of life (e.g., return to work and resumption of sport), 2) complications, 3) range of motion, 4) calf wasting, and 5) maximum pressure load after 3 months and 1 year. DISCUSSION: This trial is designed to compare the effectiveness and safety of unprotected weight bearing with two commonly used post-operative treatment regimens after internal fixation of specified, intrinsically stable but displaced ankle fractures. An expert panel has been established to evaluate every potential subject, which ensures that every patient is strictly screened according to the inclusion and exclusion criteria and that there is a clear indication for surgical fixation. TRIAL REGISTRATION: The WOW! Study is registered in the Dutch Trial Register ( NTR3727 ). Date of registration: 28-11-2012.

Measurement of Change in the Knowledge and Attitude about Leprosy in Physiotherapy Students Undergoing Intensive One Week Training in Leprosy.

Leprosy is a disease that causes not only physical problems, but also mental and social problems. In the post integration era, every health care professional needs to understand about leprosy, to be able to diagnose and treat them. Physiotherapy students, in their usual syllabus, have minimal exposure to leprosy, in spite of the fact that they have a major role in preventing impairments and disabilities caused by leprosy, as well as treating such impairments. In order to educate physiotherapy students on leprosy, a one-week intensive training course was organised. This study was done to assess if the intensive training to physiotherapy students resulted in increase in their knowledge on leprosy and change their attitude positively. A batch consisting of 42 physiotherapy students went through the one-week training programme. The improvement in knowledge and attitude were assessed through a pre-test and a post-test design. Results showed that there was significant improvement in knowledge (53.05%) and brought positive change in attitude (75.0%). Such training programmes are recommended for all physiotherapy students.

Equilíbrio postural em pacientes com sequelas de hanseníase / Postural balance in patients with leprosy sequels

O Mycobacterium leprae é a bactéria causadora da hanseníase, o qual possui como preferência as células nervosas, podendo provocar ausência ou diminuição das sensibilidades, isto pode limitar o controle do equilíbrio. O presente estudo objetivou analisar o controle postural de sujeitos com sequelas de hanseníase e comparar com sujeitos saudáveis. Materiais e métodos: a amostra foi composta por 28 voluntários, com idade entre 25 e 67 anos, sendo subdivididos em dois grupos: o Grupo Controle (GC) e o Grupo Hansen(GH). Os indivíduos foram submetidos ao teste de equilíbrio funcional pelo mini-BESTest e logo após,realizou-se o teste laboratorial de integração sensorial com estabilografia. Resultados: a análise da área do centro de pressão nas condições olhos fechados em superfície estável e em superfície instável do GC e GH possuíam diferenças significativas (p<0,001). Já os resultados da realização do mini-BESTest não mostraram variação significativa. Assim, observou-se quehá uma semelhança no padrão da área de oscilação corporal dentro dos grupos, entretanto, quando comparados GH com GC, os pacientes com sequela de Mal de Hansen foram piores na habilidade de manter a estabilidade corporal. Contudo, essas alterações não refletiram os resultados pelo mini-BESTest.

Mycobacterium leprae is the causative agent of leprosy. It has affinity for nerve cells and can cause loss or reduction of sensitivity that can limit the balance control in affected people. This study aimed to analyze the postural control in subjects with leprosy sequels and compare it with healthy subjects. Methods: The sample consisted of 28 volunteers, aged between 25 and 67 years, divided into two groups: control group(CG) and the leprosy group (LG). The subjects underwent functional balance by the mini-BESTest and soon after, laboratory test of sensorial integration with stabilography was carried out. Results: The analysis of pressure center area in closed eyes conditions on stable and unstable surfaces showed significant differences (p<0.001) in CG and HG. The mini-BESTest results were not significantly different. Conclusion: A similarity in the pattern of body sway area was found within the groups, however, when HG and CG were compared, leprosy patients with sequel showed less ability to maintain body stability. However, these mini-BESTest changes did not reflect the same results.

Caracterização dos participantes de um programa de prevenção de incapacidades para hanseníase / Characterization of the participants of a prevention programme of disability for leprosy

Objetivo: identificar as principais deformidades e incapacidades apresentadas pelas pessoas com hanseníase.Método: estudo descritivo, analítico documental, com delineamento retrospectivo e abordagem quantitativa.A amostra aleatória foi composta por 50 prontuários de pacientes com diagnóstico de hanseníase atendidos noAmbulatório de Fisioterapia do Complexo Hospitalar Clementino Fraga/JP/Brasil. A análise estatística foirealizada pelo software Epi-info, versão 3.5.1, e os resultados foram expostos em figura e tabelas. Esteestudo teve o projeto de pesquisa aprovado pelo Comitê de Ética em Pesquisa do Hospital Universitário LauroWanderley, protocolo nº 357/2010. Resultados: o paciente que realizou de um a seis Poliquimioterapias (PQT)teve a chance 4,76 vezes maior de ter menor quantidade de nervos acometidos. Conclusão: a hanseníaseainda é uma enfermidade de significativa prevalência, sendo necessária educação continua, com o objetivode orientar as pessoas sobre a doença e como realizar o controle, reduzindo o estigma e o preconceito.

Mensuração do ângulo articular do cotovelo no teste de tensão neural em indivíduos com hanseníase / Mensuration of elbow joint angle in the application of the neural tension test in individuals with leprosy

A hanseníase é uma patologia crônica e granulomatosa, que atinge a pele e o sistema nervoso periférico pela invasão no sistema imune do Mycobacterium leprae. O objetivo deste estudo foi mensurar o ângulo articular do cotovelo com a aplicação do teste de tensão neural do nervo ulnar em pacientes com hanseníase. Na aplicação do teste de tensão neural, foram utilizadas a goniometria e a fotometria para a mensuração do ângulo articular do cotovelo, sendo que para a realização da fotometria foi utilizada uma câmera Samsung de 12.1 Mega pixels, e os dados foram analisados pelo software Corel Draw X5 (Microsoft®). Foram selecionados 44 indivíduos da Fundação Pró-Hansen, com média de idade de 48,13±12,55 anos, divididos em três grupos: G1, G2 e G3. O G1 compreende voluntários com hanseníase e sensibilidade preservada; o G2, aqueles com hanseníase e com perda de sensibilidade; e o G3, o controle. Na goniometria, foi encontrada diferença significativa (p<0,05) na comparação dos grupos G1 e G2 com o controle tanto do membro direito quanto esquerdo, porém não foi encontrada diferença na comparação entre os dois grupos com hanseníase. Na fotometria, houve diferença entre G2 e o controle bilateralmente e entre o G1 e o controle no lado esquerdo. Comparando-se o lado direito e esquerdo, não foi encontrada diferença em nenhum grupo. Os pacientes com hanseníase apresentaram diminuição da ADM de flexão de cotovelo no teste de tensão neural do ulnar em ambos os lados quando comparados ao grupo controle.

Leprosy is a chronic and granulomatous disease, which affects skin and peripheral nervous system by invasion of Mycobacterium leprae in the immune system. The objective of this study was to evaluate the ulnar neural tension test in leprosy patients. In applying the test of neural tension, it was done goniometry and photometry to measure the angle of the elbow joint, and to perform the photometry we used a Samsung camera, 12.1 Mega pixels, and the data were analyzed using Corel Draw Software X5 (Microsoft®). We selected 44 individuals of Pro-Hansen Foundation, with an average age of 48.13±12.55 years, divided in three groups: G1, G2 and G3. G1 consisted of leprosy volunteers with preserved sensibility; the G2, the ones with leprosy and with no sensibility; and G3 was control group. In goniometry, it was found significant difference (p<0.05) when comparing the G1 and G2 with control of both the right and left limb, but no difference was found when comparing the two leprosy groups. In photometry, it was found difference between G2 and the control and bilaterally between the G1 and control on the left side. Comparing the right and left limbs, difference was not found in any group. Patients with leprosy showed a decrease in range of movement of elbow flexion in ulnar neural tension test in both sides when compared to the control group.

Electromyography function, disability degree, and pain in leprosy patients undergoing neural mobilization treatment.

INTRODUCTION: This study aimed to evaluate the effect of the neural mobilization technique on electromyography function, disability degree, and pain in patients with leprosy. METHODS: A sample of 56 individuals with leprosy was randomized into an experimental group, composed of 29 individuals undergoing treatment with neural mobilization, and a control group of 27 individuals who underwent conventional treatment. In both groups, the lesions in the lower limbs were treated. In the treatment with neural mobilization, the procedure used was mobilization of the lumbosacral roots and sciatic nerve biased to the peroneal nerve that innervates the anterior tibial muscle, which was evaluated in the electromyography. RESULTS: Analysis of the electromyography function showed a significant increase (p<0.05) in the experimental group in both the right (Δ%=22.1, p=0.013) and the left anterior tibial muscles (Δ%=27.7, p=0.009), compared with the control group pre- and post-test. Analysis of the strength both in the movement of horizontal extension (Δ%right=11.7, p=0.003/Δ%left=27.4, p=0.002) and in the movement of back flexion (Δ%right=31.1; p=0.000/Δ%left=34.7, p=0.000) showed a significant increase (p<0.05) in both the right and the left segments when comparing the experimental group pre- and post-test. The experimental group showed a significant reduction (p=0.000) in pain perception and disability degree when the pre- and post-test were compared and when compared with the control group in the post-test. CONCLUSIONS: Leprosy patients undergoing the technique of neural mobilization had an improvement in electromyography function and muscle strength, reducing disability degree and pain.

Electromyography function, disability degree, and pain in leprosy patients undergoing neural mobilization treatment / Função eletromiográfica, grau de incapacidade e de dor em portadores de hanseníase submetidos à mobilização neural

INTRODUCTION: This study aimed to evaluate the effect of the neural mobilization technique on electromyography function, disability degree, and pain in patients with leprosy. METHODS: A sample of 56 individuals with leprosy was randomized into an experimental group, composed of 29 individuals undergoing treatment with neural mobilization, and a control group of 27 individuals who underwent conventional treatment. In both groups, the lesions in the lower limbs were treated. In the treatment with neural mobilization, the procedure used was mobilization of the lumbosacral roots and sciatic nerve biased to the peroneal nerve that innervates the anterior tibial muscle, which was evaluated in the electromyography. RESULTS: Analysis of the electromyography function showed a significant increase (p<0.05) in the experimental group in both the right (Δ percent=22.1, p=0.013) and the left anterior tibial muscles (Δ percent=27.7, p=0.009), compared with the control group pre- and post-test. Analysis of the strength both in the movement of horizontal extension (Δ percentright=11.7, p=0.003/Δ percentleft=27.4, p=0.002) and in the movement of back flexion (Δ percentright=31.1; p=0.000/Δ percentleft=34.7, p=0.000) showed a significant increase (p<0.05) in both the right and the left segments when comparing the experimental group pre- and post-test. The experimental group showed a significant reduction (p=0.000) in pain perception and disability degree when the pre- and post-test were compared and when compared with the control group in the post-test. CONCLUSIONS: Leprosy patients undergoing the technique of neural mobilization had an improvement in electromyography function and muscle strength, reducing disability degree and pain.

INTRODUÇÃO: Este estudo tem como objetivo avaliar o efeito da técnica de mobilização neural sobre a função eletromiográfica, grau de incapacidade e dor em portadores de hanseníase. MÉTODOS: A amostra de 56 indivíduos portadores de hanseníase foi randomizada em: grupo experimental composto por 29 indivíduos submetidos ao tratamento com mobilização neural e grupo controle composto por 27 indivíduos submetidos ao tratamento convencional. Em ambos os grupos, foram tratadas as lesões nos membros inferiores. No tratamento com mobilização neural, o procedimento utilizado foi a mobilização das raízes lombossacrais e do nervo isquiático com viés para o nervo fibular, que inerva o músculo tibial anterior, o qual foi avaliado na eletromiografia. RESULTADOS: Ao analisar a função eletromiográfica, observou-se aumento significativo (p<0,05) no grupo experimental em ambos os músculos tibiais anteriores, direito (∆ por cento=22,1; p=0,01) e esquerdo (∆ por cento=27,7; p=0,009), comparado ao grupo controle no pré e pós teste. Ao analisar a força no movimento de extensão horizontal (∆ por centodir=11,7; p=0,003/∆ por cento esq=27,4; p=0,002) e no movimento de dorso flexão (∆ por cento dir=31,1; p=0,000/∆ por cento esq=34,7; p=0,000), observou-se aumento significativo (p<0,05) em ambos os segmentos direito e esquerdo ao comparar o grupo experimental no pré e pós teste. O grupo experimental apresentou redução significativa (p=0,000) na percepção de dor e no grau de incapacidade ao comparar o pré e pós teste e na comparação com o grupo controle no pós teste. CONCLUSÕES: Pacientes submetidos à técnica de mobilização neural obtiveram melhora na função eletromiográfica e nos níveis de força muscular reduzindo o grau de incapacidade e dor.

Avaliação da dor em portadores de hanseníase submetidos à mobilização neural / Pain in leprosy patients undergoing neural mobilisation treatment

Este estudo tem como objetivo avaliar o efeito da técnica de mobilização neural sobre a percepção da dor em portadores de hanseníase. A amostra de 56 indivíduos portadores de hanseníase foi randomizada em: grupo experimental (GMN) composto por 29 indivíduos submetidos ao tratamento com mobilização neural e grupo controle (GC) composto por 27 indivíduos que foram submetidos ao tratamento convencional. A percepção da dor foi avaliada através da Escala Visual Analógica, indicando-se em uma extremidade a marcação de ausência de dor e na outra, pior dor imaginável. O GMN foi submetido ao tratamento utilizando a técnica de mobilização neural, que consistiu de dezoito atendimentos (seis semanas), três vezes por semana. O GC foi submetido ao tratamento convencional com exercícios de flexibilidade, fortalecimento, com uso de exercitadores de tornozelo ou de recursos eletroterápicos. O GMN apresentou redução significativa (p=0,000) na percepção da dor ao comparar o pré e o pós-teste e na comparação com o GC no pós-teste. O GC não apresentou diferença significativa (p=0,520). Conclui-se que a utilização da técnica de mobilização neural promoveu redução nos níveis de dor em portadores de hanseníase.

This study aimed to evaluate the effect of the neural mobilisation technique on pain in patients with leprosy. A sample of 56 individuals with leprosy was randomised into an experimental group (GMN), composed of 29 individuals undergoing treatment with neural mobilisation, and the control group (CG) of 27 individuals who underwent conventional treatment. We evaluated the perception of pain by Visual Analogue Scale - EVA. The GMN underwent treatment using the neural mobilisation technique, which consisted of eighteen treatments (six weeks), at three times per week. The CG was subjected to conventional treatment. The GMN showed a significant reduction (p = 0.000) in pain perception when comparing the pre and post-test for the GMN and when comparing the GMN and CG in the post-test. The CG didn’t show any significant result (p=0.520). We concluded that the technique of neural mobilisation promote an improvement on reducing the pain in leprosy patients.

[The rehabilitation cares at the lepers]. / Prise en charge de la lèpre en Médecine physique et réadaptation.

Leprosy elimination (<1/100 000) is almost reached all around the world, although, but disabled people are still a lot, and they need rehabilitation as soon as possible. The different lesions (neurological, dermatologic and joint) must be treated in order to protect from handicap. Physical rehabilitation medicine can help with a global and polyvalent coverage. Therapeutic education and reinsertion are an important part.

Early active motion versus immobilization after tendon transfer for foot drop deformity: a randomized clinical trial.

BACKGROUND: Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout. QUESTIONS/PURPOSES: To confirm those studies we determined whether when compared with immobilization early active mobilization after a tendon transfer for foot-drop correction would (1) have a similar low rate of tendon insertion pullout, (2) reduce rehabilitation time, and (3) result in similar functional outcomes (active ankle dorsiflexion, plantar flexion, ROM, walking ability, Stanmore score, and resolution of functional problems. METHODS: We randomized 24 patients with surgically corrected foot-drop deformities to postoperative treatment with early mobilization with active motion at 5 days (n = 13) or 4 weeks of immobilization with active motion at 29 days (n = 11). In both groups, the tibialis posterior tendon was transferred to the extensor hallucis longus and extensors digitorum communis for foot-drop correction. Rehabilitation time was defined as the time from surgery until discharge from rehabilitation with independent walking. The minimum followup was 16 months (mean, 19 months; range, 16-38 months) in both groups. RESULTS: We observed no case of tendon pullout in either group. Rehabilitation time in the mobilized group was reduced by an average of 15 days. The various functional outcomes were similar in the two groups. CONCLUSION: In patients with Hansen's disease, an early active mobilization protocol for foot-drop correction has no added risk of tendon pullout and provides similar functional outcomes compared with immobilization. Early mobilization had the advantage of earlier restoration of independent walking. LEVEL OF EVIDENCE: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.