Effects of hydrotherapy and tactile-kinesthetic stimulation on weight gain of preterm infants admitted in the Neonatal Intensive Care Unit

Abstract Objective: The present study aimed to evaluate the effects of hydrotherapy and tactile-kinesthetic stimulation on the birth weight of preterm infants admitted in the Neonatal Intensive Care Unit. Method: It was a randomized controlled trial, without blinding, in which 44 preterm infants of both sexes with gestational age between 32 and 34 weeks were included into two groups: hydrotherapy group (n = = 22) and tactile-kinesthetic stimulation group (n = 22). Weight gain was the parameter assessed daily. Results: In the tactile-kinesthetic stimulation group there was a variation in weight gain, but without significant difference (p = 0,43). However, in the hydrotherapy group, it was observed that increased weight gain started from the 2nd day (p < 0,001). Conclusions: Hydrotherapy group presented significantly increased weight after the interventions, indicating that this technique can interfere with weight gain in preterm infants.

Effects of hydrotherapy and tactile-kinesthetic stimulation on weight gain of preterm infants admitted in the Neonatal Intensive Care Unit.

OBJECTIVE: The present study aimed to evaluate the effects of hydrotherapy and tactile-kinesthetic stimulation on the birth weight of preterm infants admitted in the Neonatal Intensive Care Unit. METHOD: It was a randomized controlled trial, without blinding, in which 44 preterm infants of both sexes with gestational age between 32 and 34 weeks were included into two groups: hydrotherapy group (n = = 22) and tactile-kinesthetic stimulation group (n = 22). Weight gain was the parameter assessed daily. RESULTS: In the tactile-kinesthetic stimulation group there was a variation in weight gain, but without significant difference (p = 0,43). However, in the hydrotherapy group, it was observed that increased weight gain started from the 2nd day (p < 0,001). CONCLUSIONS: Hydrotherapy group presented significantly increased weight after the interventions, indicating that this technique can interfere with weight gain in preterm infants.

Fatigue in complete spinal cord injury and implications on total delay.

The use of neuromuscular electrical stimulation (NMES) to artificially restore movement in people with complete spinal cord injury (SCI) induces an accelerated process of muscle fatigue. Fatigue increases the time between the beginning of NMES and the onset of muscle force (DelayTOT ). Understanding how much muscle fatigue affects the DelayTOT in people with SCI could help in the design of closed-loop neuroprostheses that compensate for this delay, thus making the control system more stable. The aim of this study was to evaluate the impact of the extent of fatigue on DelayTOT and peak force of the lower limbs in people with complete SCI. Fifteen men-young adults with complete SCI (paraplegia and tetraplegia) and stable health-participated in the experiment. DelayTOT was defined as the time interval between the beginning of NMES application until the onset of muscle force. The electrical intensity of NMES applied was adjusted individually and consisted of the amplitude required to obtain a full extension of the knee (0°), considering the maximum electrically stimulated extension (MESE). Subsequently, 70% of the MESE was applied during the fatigue induction protocol. Significant differences were identified between the moments before and after the fatigue protocol, both for peak force (P ≤ .026) and DelayTOT (P ≤ .001). The medians and interquartile range of the DelayTOT were higher in postfatigue (199.0 ms) when compared to the moment before fatigue (146.5 ms). The medians and interquartile range of the peak force were higher in unfatigued lower limbs (0.43 kgf) when compared to the moment postfatigue (0.27 kgf). The results support the hypothesis that muscle fatigue influences the increase in DelayTOT and decrease in force production in people with SCI. For future applications, the combined evaluation of the delay and force in SCI patients provides valuable feedback for NMES paradigms. The study will provide potentially critical muscle mechanical evidence for the investigation of the evolution of atrophy.

Anti-inflammatory effect of laser acupuncture in ST36 (Zusanli) acupoint in mouse paw edema.

Low-level laser therapy (LLLT) in acupuncture is a low-power laser applied to acupoints for providing luminous energy, capable to produce photobiological induction that results in biochemical, bioelectric, and bioenergetic effects. ST36 (Zusanli) is a point of acupuncture commonly used for treatment of several pathological alterations, such as inflammation, acute pain, and gastrointestinal disorders. In this study, we evaluated the anti-inflammatory effect of LLLT (830 nm, 4 J/cm(2)) in ST36 acupoint through the model of carrageenan-induced paw edema in mice and the possible mechanisms involved. Female Swiss mice were treated with LLLT in ST36 before the paw edema induction, which was measured by means of a digital micrometer and the temperature through a high-resolution digital thermograph. After this, the levels of reactive oxygen species (ROS), lipid hydroperoxides (LOOH), and reduced glutathione (GSH) were quantified. In another set of experiments, the paw edema was induced by bradykinin, histamine, and prostaglandin E2 (PGE2). LLLT in ST36 acupoint significantly inhibited the edema formation for 4 h after the carrageenan injection and reduced the paw temperature in 10 %. Furthermore, LLLT also reduced the levels of ROS (55 %) and LOOH (50 %) but, however, did not alter the GSH levels. LLLT in ST36 reduced the paw edema induced by bradykinin (30 min, 6 %, 60 min, 7 %), histamine (30 min, 11 %), and PGE2 (90 min, 10 %, 120 min, 16 %). In conclusion, these results prove that LLLT in ST36 acupoint produces a relevant anti-inflammatory effect, reducing edema, temperature, and free radicals levels in mice paw.

Iontophoresis: principles and applications / Iontoforese: princípios e aplicações

Introduction Iontophoresis is a noninvasive technique used to increase transdermal penetration of substances through the skin layer (epidermis, dermis and hypodermis) in a controlled manner. Technological advance in recent decades have provided reduced cost of equipment needed for implementation, which allowed for the expansion of this technique. Objective The aim of this paper is to present the state of the art on iontophoresis, ranging from the atomic characteristics of the ion formation to the current applications of the technique. Methods Were researched papers from databases: IOP publishing, ScienceDirect, Pubmed, Springer, IEEE Xplore, Google Scholar and books with keywords iontophoresis, ions, topical applications between 1967 and 2010. Results Were selected (number of papers and database) 1 IOP Publishing, 1 from ScienceDirect, Central, 1 from Springer, 2 from PubMed, 11 from IEEE Xplore, 35 from Google Scholar, and 15 books, totaling 66 references and websites with nationally marketed electrotherapy products. Conclusion Iontophoresis is suitable for applications such as acetic acid (calcific tendinitis and myositis ossificans), calcium chloride and magnesium sulfate (control of musculoskeletal spasms), dexamethasone (inflammation), lidocaine (inflammation of soft tissues), zinc oxide (rheumatoid arthritis). It is also used in cosmetic applications with devices attached to the skin and for eye treatment aimed at specific tissues of the eye, providing a treatment option for various eye diseases, reducing the complications secondary to traditional methods of treatment. The advantages are the significant increase in the release and control of therapeutic agents, including drugs with high molecular weight. The disadvantages of iontophoresis are the complexity of the drug release system and prolonged exposure of the skin to an electrical current. .

Introdução A iontoforese é uma técnica não invasiva utilizada para aumentar, de forma controlada, a penetração transdermal de substâncias através das camadas da pele (epiderme, derme e hipoderme). O avanço tecnológico nas últimas décadas proporcionou uma redução no custo dos equipamentos necessários à sua aplicação, o que possibilitou a expansão dessa técnica. Objetivo Apresentar o estado da arte sobre iontoforese, abrangendo desde as características atômicas da formação do íon até as atuais aplicações da técnica. Métodos Foram pesquisados artigos das bases de pesquisa: IOP publishing, ScienceDirect, Pubmed, Springer, IEEE Xplore, Google Scholar e livros com os unitermos: iontophoresis, ions, topical applications entre os anos de 1967 e 2010. Resultados Foram selecionados (número de artigos e base de pesquisa) 1 da IOP Publishing, 1 da ScienceDirect, 1 da Springer, 2 da PubMed, 11 da IEEE Xplore, 35 do Google Scholar e 15 livros, totalizando 66 referências, além de websites com produtos comerciais nacionais de eletroterapia. Conclusão A iontoforese é indicada para aplicações como de ácido acético (tendinite calcificante e miosite ossificante), cloreto de cálcio e sulfato de magnésio (controle de espasmos musculoesqueléticos), dexametasona (inflamação), lidocaína (inflamação de tecidos moles), óxido de zinco (artrite reumatóide). Também é utilizada em aplicações cosméticas com dispositivos aderidos à pele e em tratamento ocular visando tecidos específicos do olho, oferecendo uma forma de tratamento para diversas doenças oculares, diminuindo as complicações apresentadas em métodos clássicos de tratamento. As vantagens ...

Assessment of techniques of massage and pumping in the treatment of breast engorgement by thermography / Avaliação das técnicas de massagem e ordenha no tratamento do ingurgitamento mamário por termografia / Evaluación de las técnicas de masaje y bombeo en el tratamiento de la congestión mamaria por termografía

OBJECTIVE: to evaluate techniques of massage and pumping in the treatment of postpartum breast engorgement through thermography. METHOD: the study was conducted in the Human Milk Bank of a hospital in Curitiba, Brazil. We randomly selected 16 lactating women with engorgement with the classification lobar, ampullary and glandular, moderate and intense. We compared the differential patterns of temperature, before and after the treatment by means of massage and pumping. RESULTS: we found a negative gradient of 0.3°C of temperature between the pre- and post-treatment in the experimental group. Breasts with intense engorgement were 0.7°C warmer when compared with moderate engorgement. CONCLUSION: massage and electromechanical pumping were superior to manual methods when evaluated by thermography. REBEC: U1111-1136-9027. .

OBJETIVO: avaliar técnicas de massagem e ordenha no tratamento do ingurgitamento mamário puerperal, por meio da termografia. MÉTODO: a pesquisa foi realizada no Banco de Leite Humano de um hospital de Curitiba, Brasil. Selecionaram-se, aleatoriamente, 16 lactantes com ingurgitamento com classificação lobar, ampolar e glandular moderado e intenso. Compararam-se os padrões diferenciais de temperatura, antes e após o tratamento realizado, por meio de massagem e ordenha. RESULTADOS: constatou-se um gradiente negativo de 0,3ºC de temperatura entre o pré e o pós-tratamento no grupo experimental. Mamas com ingurgitamento intenso foram 0,7ºC mais quentes quando comparadas com ingurgitamento moderado. CONCLUSÃO: a massagem e ordenha eletromecânicas são superiores às manuais, quando avaliadas por termografia. REBEC: U1111-1136-9027. .

OBJETIVO: evaluar los métodos de masaje y bombeo en el tratamiento de la congestión mamaria posparto a través de la termografía. MÉTODO: el estudio se realizó en el Banco de Leche Humana de un hospital en Curitiba, Brasil. Se seleccionaron al azar 16 mujeres en periodo de lactancia con congestión con clasificación lobar, ampular y glandular, moderada e intensa. Se compararon los patrones diferenciales de temperatura, antes y después del tratamiento por medio de masaje y bombeo. RESULTADOS: se encontró un degradado negativo de 0,3°C de temperatura entre el pre y post-tratamiento en el grupo experimental. Las mamas con intensa congestión eran 0,7°C más caliente en comparación a aquellos con congestión moderada. CONCLUSIÓN: el masaje y el bombeo electromecánico fueron superiores a los métodos manuales cuando se evaluaron por termografía. REBEC: U1111-1136-9027. .

Assessment of techniques of massage and pumping in the treatment of breast engorgement by thermography.

OBJECTIVE: to evaluate techniques of massage and pumping in the treatment of postpartum breast engorgement through thermography. METHOD: the study was conducted in the Human Milk Bank of a hospital in Curitiba, Brazil. We randomly selected 16 lactating women with engorgement with the classification lobar, ampullary and glandular, moderate and intense. We compared the differential patterns of temperature, before and after the treatment by means of massage and pumping. RESULTS: we found a negative gradient of 0.3°C of temperature between the pre- and post-treatment in the experimental group. Breasts with intense engorgement were 0.7°C warmer when compared with moderate engorgement. CONCLUSION: massage and electromechanical pumping were superior to manual methods when evaluated by thermography. REBEC: U1111-1136-9027.

ST36 laser acupuncture reduces pain-related behavior in rats: involvement of the opioidergic and serotonergic systems.

Laser acupuncture is a modality of low-level light therapy used as an alternative to needling for the past three decades. Although it has proved effective for the treatment of various conditions, the mechanisms underlying its effects are not fully understood. To contribute to this understanding, this study was designed to (1) evaluate the antinociceptive effect of ST36 laser acupuncture (830 nm, 3 J/cm(2)) in rat models of acute nociception and (2) to investigate the opioidergic and serotonergic systems involvement in this effect. Our results demonstrate that ST36 laser acupuncture inhibited (36 ± 2 %) acetic acid-induced abdominal constrictions and both neurogenic (48 ± 7 %) and inflammatory (phase IIA 42 ± 8 % and phase IIB 83 ± 6 %) phases of formalin-induced nociceptive behavior. Moreover, the antinociceptive activity of laser irradiation in the acetic acid test was significantly reversed by preadministration of naloxone (1 mg/kg, nonselective opioid receptor antagonist), pindolol (1 mg/kg, subcutaneous; nonselective 5-HT 1A/B receptor antagonist), and ketanserin (1 mg/kg; selective 5-HT2A receptor antagonist) but not by ondansetron (1 mg/kg, selective 5-HT3 receptor antagonist). Taken together, our data demonstrate, for the first time, that (1) ST36 laser acupuncture elicited significant antinociceptive effect against acetic acid- and formalin-induced behavior in rats and that (2) this effect is mediated by activation of the opioidergic and serotonergic (5-HT1 and 5-HT2A receptors) systems.

Efeitos da estimulação diafragmática transcutânea sincronizada em pacientes com doença pulmonar obstrutiva crônica (DPOC): um estudo piloto / Effects of transcutaneous diaphragmatic synchronized pacing in patients with chronic obstructive pulmonary disease (COPD)

A pesquisa descrita neste artigo teve por objetivo avaliar quali-quantitativamente os efeitos da estimulação diafragmática transcutânea sincronizada em portadores de DPOC. Para isso, desenvolveu-se um sistema de estimulação elétrica controlado pelo sinal respiratório, a partir das variações de temperatura durante os eventos de inspiração e expiração, medidas por meio de dois termistores do tipo NTC inseridos dos lados interno e externo de uma máscara de respirador. Seis voluntários portadores de DPOC, de ambos os sexos, com idade entre 56 e 71anos, foram submetidos a 10 sessões estimulatórias de 20 minutos. O padrão do sinal estimulatório continha pulsos com duração de 90μs e repouso de 400μs, gerados em intervalos regulares e modulados em bursts com período ativo de 1470μs e inativo de 600μs, apresentando perfil trapezoidal com tempos de subida, descida e platô de 500ms cada. Todos os pacientes foram submetidos a uma avaliação inicial contendo: teste de força muscular respiratória avaliada por meio de PImáx e PEmáx, teste de função pulmonar e aplicação do questionário de qualidade de vida SGRQ. Após 10 sessões, houve um aumento na força muscular inspiratória em todos os pacientes, onde a PImáx sofreu um incremento médio de 66,67± 12,11cmH2O para 91,67 ± 25,03 cmH2O, a PEmáx de 92,50 ± 10,84 cmH2O para 116,67 ± 8,16 cmH2O. Também observou-se melhora da qualidade de vida no domínio sintoma, de 49,10± 19,40 para 28,60± 25,20; no domínio atividade, de 83,40± 12,50 para 67,57± 18,80; no domínio impacto, de 54,10± 11,34 para 38,00± 27,07; e escore total, de 65,50± 7,60 para 44,47± 22,31. A partir desses resultados, concluiu-se que a estimulação elétrica diafragmática sincronizada pode promover resultados positivos em portadores de DPOC.

The research described in this paper has the goal of evaluating the effects of transcutaneous diaphragmatic synchronized pacing in patients with COPD. In order to achieve the experimental protocol, it has been developed a system for electrical stimulation triggered by the respiratory signal obtained from the temperature variations during inspiration and expiration events, using two NTC thermistors coupled inside and outside of a respirator mask. It was studied six volunteers with COPD, of both sexes, aged between 56 to 71 years, who were submitted to 10sessions of 20minutes. The stimulatory parameters were set to: active phase of the pulse of 90μs, and inactive phase of 400μs, generated at regular intervals and modulated in bursts with active and inactive periods of 1470μs and 600μs, respectively; presenting trapezoidal envelope with rise time, fall time and plateau of 500ms. All patients underwent an initial assessment including: test of respiratory muscle strength seen through the MIP and MEP tests, lung function test and application of SGRQ quality of life questionnaire. After 10 sessions, there is an increasing inspiratory muscle strength in all patients, where MIP has an average increase of 66.67± 12.11cmH2O to 91.67 ± 25.03 cmH2O, MEP from 92.50 ± 10.84 cmH2O to 116.67 ± 8.16 cmH2O, and also observed a better quality of life in the symptom domain of 49.10± 19.40 to 28.60± 25.20, in the activity domain of 83.40± 12.50 to 67.57± 18.80, and in the impact domain of 54.10± 11.34 to 38.00± 27.07 and total score of 65.50± 7.60 to 44.47± 22.31. Therefore, we concluded that the transcutaneous diaphragmatic synchronized pacing can promote positive outcomes in patients with COPD.

Correlation between mechanomyography features and passive movements in healthy and paraplegic subjects.

Mechanomyography (MMG) measures both muscular contraction and stretching activities and can be used as feedback in the control of neuroprostheses with Functional Electrical Stimulation (FES). In this study we evaluated the correlation between MMG features and passive knee angular movement of rectus femoris and vastus lateralis muscles acquired from healthy volunteers (HV) and spinal cord injured volunteers (SCIV). Twelve HV and thirteen SCIV were submitted to passive and FES elicited knee extensions and in each extension, eleven windows of analysis with 0.5s length were inspected. Temporal (RMS and INT) and frequency (MF and µ3) features were extracted. Spearman correlation coefficients (p) were computed in order to check correlations between the features obtained from both MMG sensors. The correlation between MMG(MF) and MMG temporal analysis (RMS and INT) to HV was classified as positive, moderate (p from 0.635 to 0.681) and high (p from 0.859 to 0.870), and weak (positive e negative) to SCIV. These results differ from those obtained in voluntary contraction or artificially evoked by functional electrical stimulation and may be relevant in applications with closed loop control systems.

Mechanomyographic response during FES in healthy and paraplegic subjects.

Mechanomyography (MMG) registers lateral oscillations of contracting muscles. Functional electrical stimulation (FES) improves the rehabilitation of paraplegic subjects and can be used in neuroprosthesis control. During FES application, muscular contraction responses may vary, possibly due to fatigue or adaptation of nerve cells face to electrical stimuli. This study measured the differences in MMG RMS and median frequency (MF) features between healthy (HV) and spinal cord injury (SCI) volunteers. Ten HV and three SCI participated in the research. FES waveform consisted of a monophasic square wave, 1kHz pulse frequency, 100us active pulse period and 3ms active burst period with burst frequency of 70Hz. For each stimulation series, three analysis windows were inspected. RMS and MF variations were inversely related. The obtained results may help to create new strategies of muscular closed-loop control.

Optimal FES parameters based on mechanomyographic efficiency index.

Functional electrical stimulation (FES) can artificially elicit movements in spinal cord injured (SCI) subjects. FES control strategies involve monitoring muscle features and setting FES profiles so as to postpone the installation of muscle fatigue or nerve cell adaptation. Mechanomyography (MMG) sensors register the lateral oscillations of contracting muscles. This paper presents an MMG efficiency index (EI) that may indicate most efficient FES electrical parameters to control functional movements. Ten healthy and three SCI volunteers participated in the study. Four FES profiles with two FES sessions were applied with in-between 15min rest interval. MMG RMS and median frequency were inserted into the EI equation. EI increased along the test. FES profile set to 1kHz pulse frequency, 200εs active pulse duration and burst frequency of 50Hz was the most efficient.

A new pelvic muscle trainer for the treatment of urinary incontinence.

OBJECTIVE: To describe a new device for home treatment of urinary incontinence (UI) by comparing 3 conservative techniques and monitoring compliance and performance. METHODS: Thirty-two patients with UI were allocated to 1 of 3 intervention groups: pelvic floor muscle exercises (PFME; n=11) alone; PFME combined with biofeedback (n=10); or PFME combined with electrical stimulation (n=11). The outcomes assessed were: changes in quality of life score (QLS), urodynamic and perineometric parameters, episodes of urine loss, subjective assessment of improvement, and actual compliance and performance with treatment. RESULTS: Increased pelvic muscle contraction strength (P<0.05), improvement in QLS (P<0.02), and fewer episodes of urine leakage were observed in all 3 groups (P<0.05). Compliance was similar among the groups (P=0.201). CONCLUSION: All 3 techniques were effective for home treatment of UI, with significant control of symptoms and improved quality of life. The device effectively monitored compliance and performance of exercises.

Tratamento conservador da incontinência urinária de esforço / Conservative treatment of urinary stress incontinence

Este artigo apresenta uma revisão bibliográfica acerca das modalidades de tratamento conservador para incontinência urinária de esforço (IUE). Descreve-se a enfermidade, a epidemiologia, a classificação, a avaliação diagnóstica e as formas de tratamento conservador existentes. Objetivou-se verificar diferenças entre os resultados obtidos por protocolos que associam técnicas variadas no tratamento para IUE, daqueles que se utilizam apenas uma técnica. Entre os autores desta revisão, foi possível verificar que mesmo com o surgimento de estudos clínicos controlados, permanece a discrepância com relação à padronização do protocolo, para que seja possível definir qual o método mais eficaz de tratamento para esta patologia. Também foi possível constatar a importância de um trabalho conservador para a redução de custos.