Association of physical therapy techniques can improve pain and urinary symptoms outcomes in women with bladder pain syndrome. A randomized controlled trial.

PURPOSE: to verify the effects of biofeedback (BF) and manual therapy (MT) associated with transcutaneous electrical nerve stimulation (TENS) or postural exercises (PE) in the treatment of bladder pain syndrome (BPS) in women regarding pain and urinary symptoms. MATERIALS AND METHODS: a parallel-randomized controlled trial was conducted in BPS patients diagnosed according to NIH clinical criteria. Two specialized physiotherapists applied demographic and validated questionnaires of perineal and suprapubic pain (VAS), urinary symptoms and problems (ICSI and ICPI) and sexual function (FSFI) and a physical assessment was made to identify myofascial trigger points. Thirty-one women, mean age 51.8 ± 10.9 were randomized in three groups of treatment consisting of ten weekly sessions of BF and MT (Conventional group); BF, MT, and TENS (TENS group); and BF, MT, and PE (Postural group). RESULTS: Postural group improved perineal and suprapubic pain after treatment (p<0.001 and p=0.001, respectively), and the suprapubic pain improvement remained persistent at 3 months of follow up (p=0.001). Postural group improved urinary symptoms and problems after treatment (p<0.001 and p=0.005, respectively) and during follow up (p<0.001 and p=0.001). CONCLUSIONS: Biofeedback and manual therapy associated with postural exercises showed a significant improvement in perineal and suprapubic pain and urinary symptoms after treatment and during follow-up. Both results suggest a possible role for the use of this physiotherapy technique to treat BPS patients. Longer follow-up and a larger number of patients are necessary to confirm these conclusions.

Noninvasive Neuromodulation Techniques in Difficult Tracheostomy Weaning of Patients With Spinal Cord Injury: Report of Two Cases.

High spinal cord injured patients (SCI) are susceptible to respiratory muscle impairments. Transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) may influence the diaphragm's central control, but until now they are not described as a therapeutic resource for difficult weaning. We present two case reports of SCI patients (P1 and P2) with long-term tracheostomy (>40 days) and hospital stay (>50 days). In association with respiratory exercise, P1 received a combined application of anodal tDCS over the supplementary motor area plus sensory PES in the thoracic-abdominal muscles, and P2 received isolated excitatory PES in the abdominal muscles, applied daily except on weekends. Maximum inspiratory/expiratory pressure, peak cough flow, diaphragm excursion, and thickening fraction were measured in the first and last days of the protocol. Both patients had improvements, with clinical impact such as cough effectiveness, decannulated after 15 applications of stimulation. Augmentation of neural respiratory drive and corticospinal excitability is suggested.

Effect of volume-oriented versus flow-oriented incentive spirometry on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly.

BACKGROUND: Aging causes physiological and functional changes that impair pulmonary function. Incentive spirometry is widely used for lung expansion, but the effects of volume-oriented incentive spirometry (VIS) versus flow-oriented incentive spirometry (FIS) on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly are poorly understood. We compared VIS and FIS in elderly subjects and healthy adult subjects. METHODS: Sixteen elderly subjects (9 women, mean ± SD age 70.6 ± 3.9 y, mean ± SD body mass index 23.8 ± 2.5 kg/m(2)) and 16 healthy adults (8 women, mean ± age 25.9 ± 4.3 y, mean ± body mass index 23.6 ± 2.4 kg/m(2)) performed quiet breathing, VIS, and FIS in randomized sequence. Chest wall kinematics (via optoelectronic plethysmography) and inspiratory muscle activity (via surface electromyography) were assessed simultaneously. Synchrony between the superior thorax and abdominal motion was calculated (phase angle). RESULTS: In the elderly subjects both types of incentive spirometry increased chest wall volumes similarly, whereas in the healthy adult subjects VIS increased the chest wall volume more than did FIS. FIS and VIS triggered similar lower thoracoabdominal synchrony in the elderly subjects, whereas in the healthy adults FIS induced lower synchrony than did VIS. FIS required more muscle activity in the elderly subjects to create an increase in chest wall volume. CONCLUSIONS: Incentive spirometry performance is influenced by age, and the differences between elderly and healthy adults response should be considered in clinical practice.

Postural control under visual and proprioceptive perturbations during double and single limb stances: insights for balance training.

Single Limb Stance under visual and proprioceptive disturbances is largely used in clinical settings in order to improve balance in a wide range of functional disabilities. However, the proper role of vision and proprioception in SLS is not completely understood. The objectives of this study were to test the hypotheses that when ankle proprioception is perturbed, the role of vision in postural control increases according to the difficulty of the standing task. And to test the effect of vision during postural adaptation after withdrawal of the somesthetic perturbation during double and single limb stance Eleven males were submitted to double (DLS) and single limb (SLS) stances under conditions of normal or reduced vision, both with normal and perturbed proprioception. Center of pressure parameters were analyzed across conditions. Vision had a main effect in SLS, whereas proprioception perturbation showed effects only during DLS. Baseline stability was promptly achieved independently of visual input after proprioception reintegration. In conclusion, the role of vision increases in SLS. After proprioception reintegration, vision does not affect postural recovery. Balance training programs must take that into account.

Misalignment of the knees: does it affect human stance stability.

INTRODUCTION: Data describing the relationships between postural alignment and stance stability are scarce and controversial. OBJECTIVE: The aim of this study was to evaluate the effects of sensory disturbances on knee alignment in upright stance and the effects of knee hyperextension on stance stability. METHOD: Kinetic and kinematic data of 23 healthy adult women were collected while quietly standing in four sensory conditions. Kinematic data: knee angle (dependent variables) variations were analyzed across sensory conditions. Kinetic data: as subjects with hyperextended knees showed a clear tendency to flex their knees as balance challenge increased, center of pressure (COP) parameters (dependent variables) were analyzed in each sensory condition among trial sub-groups: Aligned-Trials (knee angle<180°), Hyperextended-Trials (>180°) and Adjusted-Trials (>180° initially, turned <180° under challenging conditions). RESULTS: Differences were found in mean velocity of COP in two conditions showing that knee alignment can affect stance stability. CONCLUSION: Knee hyperextension is a transient condition changing under postural challenges. Knee hyperextension affected postural control as mean velocity was the highest in the hyperextended group in natural standing sensory condition and lowest with sensory disturbance.

Ensino de massoterapia: habilidades envolvidas na relação fisioterapeuta-paciente / Massotherapy teaching: abilities involved in the therapist-patient relationship

Desenvolvido no âmbito da disciplina Recursos Terapêuticos Manuais, o objetivo deste trabalho foi elaborar, aplicar e avaliar a eficácia de um programa de treinamento de habilidades profissionalizantes em sessão de massoterapia, com foco na relação fisioterapeuta-paciente, sem descuidar do autocuidado do terapeuta. Para elaboração do programa, foram identificadas 21 habilidades envolvidas nessa relação, com base na literatura e na observação de 120 sessões de massoterapia. Dez peritos validaram a definição operacional das habilidades, que foram organizadas em um programa de treinamento aplicado a alunos. O desempenho destes nas habilidades treinadas (classificado como adequado, parcialmente adequado, inadequado ou não-realizado) foi avaliado em prova prática. Também foi analisado relato escrito dos alunos sobre o programa. Participaram do estudo 25 graduandos. A análise dos resultados mostrou que todos realizaram 12 das 21 habilidades treinadas adequadamente. Quatro habilidades foram realizadas de forma parcialmente adequada por cinco alunos. Não ocorreu situação de execução inadequada...

This work was developed within the discipline Manual Therapy Resources. It consisted in designing, applying, and assessing the efficacy of a program of massotherapy training with a focus on therapist-patient relationship, also stressing therapist self care. By drawing on literature and on the observation of 120 massotherapy sessions, 21 professional abilities were defined and organised into a training program. Ten experts validated the abilities operating definition. The program was then applied to a class of 25 undergraduates, whose performance at the end of the program was assessed, in a practical test, as adequate, partially adequate, inadequate or not undertaken. Written final reports by students were also analysed. Twelve out of the 21 trained abilities were found to be adequately performed by all students; four abilities were partially adequately carried out by five students. There was no case of inadequate performance. The analysis of the written reports showed that 19 out of the 25 students approved of the training program, found relevant and necessary. The self-care training was pointed out as relevant for professional development and appropriate to the teaching context by 10 students. The program proved thus efficient in enabling students to perform with adequate therapist-patient relationship, being also well accepted by students...

Elaboração e validação de manual de massagem para bebês / Elaboration and validation of a manual of massage for babies

Masssoterapia é um recurso terapêutico que produz efeitos fisiológicos e comportamentais benéficos para a saúde do bebê e do cuidador. Objetivo: Elaborar e validar um manual teórico-prático de massagem para bebês visando população leiga. Método: Elaboração e validação de 24 peritos que avaliaram 9 critérios e de 40 mães submetidas à avaliação teórico-prática, divididas em grupos de acordo com grau de instrução. Resultados: O conteúdo teórico foi organizado em efeitos fisiológicos, psicomotores e comportamentais e aplicação prática. Após avaliação dos peritos foram necessários modificações no texto e nas figuras. A validação com mães ocorreu em dois grupos: Grupo A (formação de ensino médio e curso técnico) e Grupo B (formação de ensino fundamental). De modo geral, as mães do Grupo B apresentaram maior dificuldade quanto aos conteúdos teórico e prático em relação às do Grupo A. Conclusão: A participação de peritos e mães foi decisiva na qualidade do manual original que se mostrou instrumento eficaz para ensino de massagem em bebês para mães com formação de ensino médio e curso técnico.

Effects of an aquatic versus non-aquatic respiratory exercise program on the quality of life in healthy aged persons / Efeitos de programas de exercícios respiratórios aquáticos versus não-aquáticos sobre a qualidade de vida de pessoas idosas saudáveis

Background: Aging process is growing in the world. Exercise improves well-being and auto-esteem of aged people by many factors, leading to QOL (quality of life) improve. This study intended to assess the effects of a respiratory exercise program developed in two ways - aquatic and non-aquatic - in the QOL of aged persons. Methods: fifty-nine volunteers between 60 and 65 years were randomized into 3 groups. G1 underwent a program of aquatic respiratory exercises. G2 participated in the same program, but out of the water. G3 did not undergo an exercise program, acting as the control. All volunteers answered SF-36 generic questionnaire to measure QOL. At the end of the program, subjects were assessed once again, with the same questionnaire. Individual results were compared to each subject before and after the program. Average group results were compared between the groups. Results: There were no significant differences among experimental groups. However, physical and emotional aspect responses showed p-values close to the critical point (p= .059 and .054, respectively). Conclusions: Aquatic respiratory exercises seem to improve functional and emotional aspect of aged subjects. However, it does not seen to affect the other SF-36 aspects. Studies with higher intervention time are recommended to get definitive conclusions about it.

Exercícios aquáticos na dor de individuos com fibromialgia / Aquatic exercises for the pain of individuals with fibromyalgia

Objetivos: Este trabalho objetiva determinar de dois programas de exercícios aquáticos - gerais ou relaxamanto passivo - na dor de indivíduos com fribromialgia. Material e Métodos: Concluíram o estudo 16 indivíduos com fibromialgia, divididos randomicamente em três grupos. O GA foi submetido a um programa de exercícios aquáticos gerais e o GB a um programa de relaxamento aquático passivo. O GC atuou como controle. Os atendimentos foram realizados durante oito semanas consecutivas, duas vezes por semana, durante uma hora cada sessão. A escala análogo-numérica foi utilizada antes e depois das oito semanas e imediatamente pré e pós cada sessão. Os dados foram comparados entre os grupos e com os do próprio indivíduo. Resultados: Quando analisados os resultados pré e pós cada terapia, ambos grupos apresentaram redução significativa na dor (p = 0,001 para ambos). Comparando os dois grupos, observou diferença entre eles (p= 0,001), com melhor desempenho do GB. Conclusão: Os dois programas de tratamento mostraram-se eficazes na redução da dor dos indivíduos com fribromialgia, quando comparados a um grupo controle. Quando avaliado a influência do programa completo no quadro álgico, o grupo que realizou exercícios aquáticos gerais apresentou melhora mais acentuada. Entretanto, quando a dor era avaliada pré e pós cada terapia, não foram encontradas diferenças relevantes.

Objective: This study aims at verifying the effects of two aquatic exercise programs - general exercises or passive relaxation - on the pain of individuals with fibromyalgia. Material e Methods: Sixteen individuals with fribromyalgia concluded the study, and were divided randomly in three groups. The GA (group A) was submitted to a program of general aquatic exercises and the GB (group B) to a program of aquatic passive relaxation. The GC (group C) acted as a control. The assessments were don during eight weeks in a row, twice a week, in one-hour sessions. The Analogous-numeric scale was used before and after the eight weeks and immediately before and after each session. The data were compared among the groups and each volunter. Results: When results before and after each therapy were analyzed, both groups had a significant reduction in the pain (p= 0.001 for both). Comparing both groups, there was a difference between them (p= 0.001), once GB (group B) had the best results. Conclusion: Both treatment programs proved to be efficient in the reduction of pain in individuals with fibromyalgia, when compared to a control group. When the influence of the complete program no pain was evaluated, the group that performed general aquatic exercises had a higher improvement. However, when the pain was evaluated before and after each therapy, no significant differences were found.

Respostas posturais à perturbação externa inesperada em judocas de diferentes níveis de habilidade / Postural responses to unexpected external perturbance in judoists of different ability levels

O judô é uma modalidade esportiva na qual é requerido o controle eficiente do equilíbrio pelo atleta, por estar constantemente sujeito a movimentos inesperados impostos por seus adversários. Este estudo teve o objetivo de analisar as respostas posturais a uma perturbação externa inesperada de judocas (n = 20) em dois níveis de habilidade (faixas marrom e verde) e de um grupo de participantes não-atletas (n = 10). Uma perturbação externa posterior (PEP) foi aplicada através de uma tração horizontal ao dorso do participante, utilizando-se de um sistema de polia fixa. A PEP foi removida inesperada e rapidamente, provocando a resposta postural de interesse. Os deslocamentos do centro de pressão (CP) foram obtidos através de uma plataforma de força. As respostas posturais foram analisadas em oito intervalos de 1s (t1 a t8), iniciando-se no momento da liberação da PEP. As médias das velocidades e das posições do CP, na direção ântero-posterior, foram os principais parâmetros utilizados para analisar as respostas posturais na recuperação do equilíbrio. Análise de variância (ANOVA) com medidas repetidas para dois fatores (grupo x intervalo), seguida pelo pós-teste de Student Newman-Keuls (p < 0,05), foi aplicada para velocidade e posição de CP; ANOVA simples para o fator intervalo em cada grupo foi aplicada à posição do CP, para se verificar o padrão de reposicionamento do CP. O grupo de maior habilidade apresentou menor velocidade do CP em comparação com o grupo controle e um padrão de reposicionamento gradual e contínuo do CP durante a recuperação do equilíbrio. Nossos achados mostram que os atletas mais habilidosos apresentam melhor controle do equilíbrio e indicam que o treinamento esportivo proposto e o nível de habilidade do atleta podem influenciar o desempenho desse controle.

Judo is a sport in which the athlete must have an efficient balance control, as he or she is constantly vulnerable to unexpected movements imposed by the opponents. The aim of this study is to analyze judoist postural responses to an unexpected external perturbation (n = 20) in two levels of ability (brown and green belts) and in those of a non-athlete group (n = 10). An external posterior perturbation (EPP) was applied by means of a horizontal traction to the subject's dorsum, using a fixed pulley system. The EPP was unexpectedly and quickly removed, producing the desired postural response. Displacements of centre of pressure (COP) were obtained by means of a force platform. Postural responses were analyzed in eight intervals of 1 s (t1 to t8), beginning at the moment of EPP removal. The speed and position averages of COP, in anteroposterior plane, were the main parameters used to analyze the postural responses in the balance recovery. A two-factor (group x intervals) repeated measures analysis of variance (ANOVA) followed by Student Newman-Keuls post-hoc (p < 0.05) was applied for speed and COP. ANOVA for intervals factor in each group was applied to COP position, in order to verify COP displacement patterns. The group of greater ability presented lower COP speed compared with the control group, and a gradual and continuous COP displacement pattern during balance recovery. Our findings confirmed the hypothesis that the most skilled athletes present better balance control, and show that the proposed sport training and the athlete's level of ability may influence on this control performance.

El judo es una modalidad deportiva en la que se requiere el control eficiente del equilibrio por parte del atleta, por estar constantemente sujeto a movimientos inesperados impuestos por sus adversarios. Este estudio ha tenido el objetivo de analizar las respuestas de postura frente a la perturbación externa inesperada de los practicantes de judo (n = 20) en dos niveles de destreza (cinturón marrón y verde) y el de un grupo de participantes no atletas (n = 10). Una perturbación externa posterior (PEP) fue aplicada a través de una tracción horizontal al dorso del participante, usándose un sistema de polea fija. La PEP fue removida inesperada y rápidamente provocando la respuesta de postura de interés. Los desplazamientos del centro de presión (CP) fueron obtenidos mediante una plataforma de fuerza. Las respuestas posturales fueron analizadas en ocho intervalos de 1s (t1 a t8), iniciándose en el momento de la liberación de la PEP. Los promedios de velocidad y las posiciones de CP, en la dirección antero posterior, fueron los principales parámetros utilizados para analizar las respuestas de postura en la recuperación del equilibrio. El análisis de varianza (ANOVA) con medidas repetidas para los dos factores (grupo x intervalo), seguido por el pos test de Student Newman-Keuls (p < 0,05), fue aplicado a la velocidad y posición de CP; ANOVA simple para el factor intervalo en cada grupo fue aplicada a la posición de CP, para verificar el padrón de reposicionamiento de CP. El grupo de mayor destreza presentó menor velocidad de CP en comparación al grupo control y un padrón de reposicionamiento gradual y continuo de CP durante la recuperación de equilibrio. Nuestros hallazgos muestran que los atletas con más destreza presentan mejor control de equilibrio e indican que el entrenamiento deportivo propuesto y el nivel de destreza del atleta pueden influenciar el desempeño de este control.