Effects of respiratory exercises in sleep bruxism and associated obstructive sleep apnea: a double-blind, placebo-controlled randomized clinical trial.

PURPOSE: The aim of this study is to assess the effects of respiratory exercises (inspiratory and expiratory) in individuals with sleep bruxism (SB) and associated obstructive sleep apnea (OSA). METHODS: This is a double-blind, placebo-controlled randomized clinical trial including individuals with SB and associated respiratory events in OSA. Respiratory physical therapy was performed using inspiratory (Threshold® IMT), expiratory (Threshold® PEP) muscle training, and compared with a placebo group. A total of 30 daily respiratory cycles (inspiration and expiration) were performed five times a week for 12 weeks. Individuals were reassessed at two times, at baseline (T1) and after 12 weeks of training (T2) by means of the Pittsburgh Sleep Quality Index and Polysomnography. RESULTS: Awakening was significantly different (p ≤ 0.05) between the inspiratory group and placebo 12 weeks after respiratory physical therapy. The number of contractions of the masseter muscle differed between the inspiratory, expiratory, and placebo groups (p ≤ 0.05). CONCLUSION: Respiratory physical therapy for OSA improved awaking levels in 80 and 67% of the number of masseter muscle contractions, when compared to placebo. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (No. RBR-9F6JKM).

Effects of respiratory training on obstructive sleep apnea: systematic review and meta-analysis.

PURPOSE: This systematic review sought to answer the following focused question: "What are the effects of respiratory training devices on obstructive sleep apnea (OSA) outcomes in adults?" METHODS : The acronym "PICOS" was used to determine eligibility criteria, which consists of (P population) = adults with mild to moderate OSA, (I intervention) = spirometry devices or breathing exercises, (C comparison) = compared to no breathing exercises in adults (> 18 years) with mild to moderate OSA, (O outcomes) = improved sleep quality (sleep quality indexes) and improved apnea-hypopnea indexes (AHI), (S study types) = randomized, pseudo-randomized, and non-randomized clinical trials. The search was performed in the following databases: PubMed/Medline, LILACS, Scopus, Web of Science, Scopus, and Cochrane Library, in addition to gray literature through Google Scholar, Proquest, and Open Grey. The risk of bias was assessed using the Cochrane Collaboration tool. The certainty of the evidence was assessed using the GRADE tool. Meta-analyses of random effects were performed for the outcomes of interest. RESULTS: A total of 1171 references were found. Applying the eligibility criteria, six studies were included in qualitative synthesis. Expiratory exercises showed a decrease in the apnea-hypopnea index (AHI) when compared to baseline (MD = - 8.4; 95% CI = - 12.4 to - 4.4; I2 = 19%). There was a decrease in values compared to baseline (MD = - 4.4; 95% CI = - 8.2 to - 0.6; I2 = 0%) for the Epworth Sleepiness Scale (ESS), when considering the inspiratory exercises. Both groups of breathing exercises showed a significant decrease in the mean index assessed by the Pittsburgh Sleep Quality Index (PSQI). CONCLUSION: Results of this meta-analysis suggests that breathing exercises lead to a measurable improvement in AHI for patients with mild to moderate OSA, as well as an improvement in sleep quality and daytime sleepiness. SYSTEMATIC REVIEW REGISTRATION: CRD42020148513 (PROSPERO).

Balance rehabilitation with a virtual reality protocol for patients with hereditary spastic paraplegia: Protocol for a clinical trial.

BACKGROUND: Neurodegenerative diseases are sporadic hereditary conditions characterized by progressive dysfunction of the nervous system. Among the symptoms, vestibulopathy is one of the causes of discomfort and a decrease in quality of life. Hereditary spastic paraplegia is a heterogeneous group of hereditary degenerative diseases involving the disorder of a single gene and is characterized by the progressive retrograde degeneration of fibers in the spinal cord. OBJECTIVE: To determine the benefits of vestibular rehabilitation involving virtual reality by comparing pre intervention and post intervention assessments in individuals with hereditary spastic paraplegia. METHODS: In this randomized controlled clinical trial from the Rebec platform RBR-3jmx67 in which allocation concealment was performed and the evaluators be blinded will be included. The participants will include 40 patients diagnosed with hereditary spastic paraplegia. The interventions will include vestibular rehabilitation with virtual reality using the Wii® console, Wii-Remote and Wii Balance Board (Nintendo), and the studies will include pre- and post intervention assessments. Group I will include twenty volunteers who performed balance games. Group II will include twenty volunteers who performed balance games and muscle strength games. The games lasted from 30 minutes to an hour, and the sessions were performed twice a week for 10 weeks (total: 20 sessions). RESULTS: This study provides a definitive assessment of the effectiveness of a virtual reality vestibular rehabilitation program in halting the progression of hereditary spastic paraplegia, and this treatment can be personalized and affordable. CONCLUSION: The study will determine whether a vestibular rehabilitation program with the Nintendo Wii® involving virtual reality can reduce the progressive effect of hereditary spastic paraplegia and serve as an alternative treatment option that is accessible and inexpensive. Rebec platform trial: RBR-3JMX67.

Influence of osteopathic cervical manipulation on blood flow velocity of the cerebral circulation in chronic neck pain: analysis of three groups / Influência da manipulação osteopática cervical na velocidade de fluxo sanguíneo da circulação cerebral em indivíduos com cervicalgia crônica: análise de três grupos

ABSTRACT BACKGROUND AND OBJECTIVES: Spinal manipulation (SM) can reduce or improve the pain and dizziness originated in the neck. However, there is some criticism against SM. The objective of this study was to check if the osteopathic manipulation (OM) with a cervical rhythmic articulatory technique (CRAT) provides oscillations of the blood flow velocity (BFV) in the internal carotid arteries (ICA), vertebral arteries (VA) and basilar artery (BA), and if this technique is a risk factor for this circulatory system. METHODS: The study was conducted with 73 individuals (men and women) with mechanical cervicalgia, with an average age of 37.7±6.4 years. Fifty-eight had mild to moderate pain, randomly divided into control group (CG) and experimental-1 (EG-1), and 15 with severe pain in the experimental-2 group (EG-2). All subjects were submitted to the artery ultrasound (ICA, VA, and BA) in a blind methodology for the tests 1 (E1) and 2 (E2). Between E1 and E2, one single OM-CRAT was performed in the EGs 1 and 2 and resting for the CG. RESULTS: In the EG-1 there was a slight reduction of the BFV in the right ICA. In the EG-2 there was a significant increase of the BFV in the right VA. All samples presented normality. In the CG there was a reduction of the BFV in the left VA. When comparing the three groups, there was significance for the CG as EG-2 of the BFV in the right ICA (in E1) and of the BFV in the left ICA (in E2). CONCLUSION: Despite the BFV oscillations, one can conclude that the OM-CRAT generates oscillation in the BFV within the normality parameters and it is not a risk factor for cerebral circulation.

RESUMO JUSTIFICATIVA E OBJETIVOS: A manipulação vertebral cervical (MVC) pode reduzir ou melhorar a dor e a tontura de origem cervical. No entanto, há críticas contra a MVC. O objetivo deste estudo foi verificar se a manipulação osteopática (MO) com técnica articulatória rítmica cervical (TARC) proporciona oscilações de velocidade de fluxo sanguíneo (VFS) nas artérias carótidas internas (ACI), vertebrais (AV) e basilar (AB), e se essa técnica é um fator de risco para esse sistema circulatório. MÉTODOS: A casuística foi constituída de 73 indivíduos (homens e mulheres) com cervicalgia mecânica, com idade média de 37,7±6,4 anos, sendo 58 com dor leve a moderada, divididos por aleatorização em grupos controle (GC) e experimental-1 (GE-1), e 15 com dor intensa no grupo experimental-2 (GE-2). Todos foram submetidos à ultrassonografia arterial (em ACI, AV e AB) em metodologia encoberta para os exames 1 (E1) e 2 (E2). Entre E1 e E2 foi realizado única MO-TARC para os GE 1 e 2, e repouso para o GC. RESULTADOS: Em GE-1 houve pequena redução de VFS da ACI direita. Em GE-2 houve aumento significativo de VFS na AV direita. Todas as amostras apresentaram normalidade. Em GC houve redução de VFS da AV esquerda. No comparativo entre os três grupos houve significância para o GC como GE-2 na VFS da ACI direita (em E1) e na VFS da ACI esquerda (em E2). CONCLUSÃO: Apesar das oscilações de VFS, concluiu-se que a MO-TARC gera oscilação de VFS dentro dos parâmetros de normalidade e não é um fator de risco para a circulação cerebral.

Central auditory processing in patients with spinocerebellar ataxia.

BACKGROUND: Autosomal dominant spinocerebellar ataxias (SCAs) are a group of rare and heterogeneous neurodegenerative diseases characterized by the presence of progressive cerebellar ataxia. Although the symptomatology of SCAs is well known, information regarding central auditory functioning in these patients is lacking. Therefore, we assessed the central auditory processing disorders (CAPD) in patients with different subtypes of SCA. METHODS: In a retrospective cross-sectional study, we subjected 43 patients with SCAs to otorhinolaryngological, audiological, Brainstem Auditory Evoked Potential (BAEP) and acoustic immittance evaluations as well as CAPD tests, namely the Standard Spondaic Word (SSW) and the Random Gap Detection Test (RGDT). RESULTS: Most patients (83.7%) reported an imbalance when walking; many reported difficulty speaking (48.8%), dizziness (41.8%), and dysphagia (39.5%). In the audiometric test, 14/43 patients (32.5%) presented alterations, including 4/12 patients with SCA3 (33.3%), 1/8 patients with SCA2 (12.5%), 1/1 patient with SCA4 (100%), 1/1 patient with SCA6 (100%), 1/1 patient with SCA7 (100%), 3/6 patients with SCA10 (50%), and 3/14 patients with an undetermined type of SCA (21.4%). In the BAEP test, 20/43 patients (46.5%) presented alterations (11.6% na orelha esquerda e 34.9% bilateralmente), including 7/12 patients with SCA3 (58.3%), 5/8 patients with SCA2 (62.5%), 1/1 patient with SCA4 (100%), 1/1 patient with SCA6 (100%), 1/1 patient with SCA7 (100%), 4/6 patients with SCA10 (66.7%), and 2/14 patients with an undetermined type of SCA (14.2%). In the SSW, 22/40 patients (55%) presented alterations (2.5% in the right ear, 15% in the left ear, and 37.5% bilaterally), including 6/10 patients (60%) with SCA3, 3/8 (37.5%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 4/5 (80%) with SCA10, and 8/14 (57.1%) with an undetermined type SCA. For the RGDT, 30/40 patients (75%) presented alterations, including 8/10 (80%) with SCA3, 6/8 (75%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 4/5 (80%) with SCA10, and 9/14 (64.3%) with an undetermined type of SCA. In immittance testing, 19/43 patients (44.1%) presented alterations, including 6/12 (50%) with SCA3, 4/8 (50%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 2/6 (33.3%) with SCA10, and 4/14 (28.6%) with an undetermined type of SCA. CONCLUSIONS: A majority of patients exhibited SSW test deficits, with a predominance of bilateralism, and three-fourths had impaired RGDT performance, pointing to difficulties with binaural integration and temporal resolution. Assessment of CAPD is important for therapeutic follow ups in patients with SCA.

Influence of osteopathic manipulation on blood flow velocity of the cerebral circulation in chronic mechanical neck pain / Influência da manipulação osteopática na velocidade de fluxo sanguíneo da circulação cerebral em indivíduos com cervicalgia mecânica crônica

BACKGROUND AND OBJECTIVES: Osteopathic manipulation is indicated for pain, myofascial tensions and/or decreased movement amplitude. This study aimed at checking whether osteopathic manipulation with cervical rhythmic articulatory technique generates abnormal blood flow velocity oscillations or risks to internal carotid, vertebral and basilar arteries circulation. METHODS: The sample was made up of 58 individuals with chronic mechanical cervical pain (40 females and 18 males), with mean age of 36 years, submitted to internal carotid, vertebral and basilar arteries ultrasound before and after a single osteopathic manipulation with cervical rhythmic articulatory technique. Individuals were evaluated by ultrasound in three moments: control evaluation, rest control evaluation and study evaluation. Separation was sequential and methods were randomly and blindly applied. RESULTS: Ultrasound has shown no significant differences in the comparison of flow velocity variables means among evaluations. However, a slight increase in vertebral, intracranial and basilar arteries blood flow was observed after osteopathic manipulation with cervical rhythmic articulatory technique in the study evaluation, without statistical significance. CONCLUSION: In this studied population, osteopathic manipulation with cervical rhythmic articulatory technique has not generated significant blood flow velocity oscillation of internal carotid, vertebral and basilar arteries and has not posed risk to brain circulation. .

JUSTIFICATIVA E OBJETIVOS: Na presença de dor, tensões miofasciais e/ou redução da amplitude de movimento, é indicada a manipulação osteopática. O objetivo deste estudo foi verificar se a manipulação osteopática com técnica articulatória rítmica cervical gera oscilações anormais de velocidade de fluxo sanguíneo ou riscos à circulação das artérias carótidas internas, vertebrais e basilar. MÉTODOS: A casuística foi constituída por 58 indivíduos com cervicalgia mecânica crônica (40 mulheres, 18 homens) com idade média de 36 anos, submetidos a ultrassonografia das artérias carótidas internas, vertebrais e basilar antes e após única manipulação osteopática com técnica articulatória rítmica cervical. Os indivíduos foram analisados pela ultrassonografia em três momentos: exame controle, exame controle de repouso e exame estudo. A separação se deu de forma sequencial e os métodos de forma randomizada e encoberta. RESULTADOS: A ultrassonografia demonstrou que não existe diferença significativa em nenhum dos casos analisados, no comparativo das médias das variáveis de velocidade de fluxo entre os exames. Porém, foi observado um discreto aumento na velocidade de fluxo sanguíneo das artérias vertebral, intracraniana e basilar, após a manipulação osteopática com técnica articulatória rítmica cervical no exame estudo sem significância estatística. CONCLUSÃO: Nessa população estudada, a manipulação osteopática com técnica articulatória rítmica cervical não gerou significativa oscilação da velocidade de fluxo sanguíneo das artérias carótidas internas, vertebrais e basilar e não ...

Influência da manipulação osteopática na amplitude de rotação da coluna cervical em indivíduos com cervicalgia mecânica crônica / Influence of manipulation at range of rotation of the cervical spine in chronic mechanical neck pain

JUSTIFICATIVA E OBJETIVOS: A amplitude de movimento do pescoço pode ser reduzida pela presença de disfunções vertebrais e miofasciais, as quais podem ser tratadas pela manipulação osteopática por meio da técnica articulatória rítmica cervical. O objetivo deste estudo foi verificar se a manipulação osteopática, através da técnica articulatória rítmica gera aumento da amplitude de rotação cervical mensurada por fleximetria. MÉTODOS: A casuística foi constituída de 58 indivíduos de ambos os gêneros, com idade média de 36±6,5 anos, com cervicalgia mecânica crônica, que foram submetidos de maneira randomizada à fleximetria controle da rotação cervical, à manipulação osteopática, por meio da técnica articulatória rítmica, ao repouso de 5 minutos e à fleximetria estudo da rotação cervical. RESULTADOS: A comparação entre as médias das fleximetrias de rotação cervical através do teste t de Student para dados pareados, ao nível de significância de 0,05 (5%), mostrou que houve aumento significativo da rotação cervical em todos os casos (p<0,05) passando de 151,4º para 162,5º no arco total de movimento (aumento de 7,3%). CONCLUSÃO: Os resultados foram dentro do esperado, confirmando que a manipulação osteopática, através da técnica articulatória rítmica gerou aumento significativo da amplitude de rotação cervical em todos os casos, podendo servir de tratamento de doenças que se relacionam à redução da mobilidade vertebral, como cervicalgia e osteoartrite cervical.

BACKGROUND AND OBJECTIVES: Neck range of motion may be decreased by vertebral and myofascial dysfunctions, which may be treated with osteopathic manipulation through the cervical rhythmic articulatory technique. This study aimed at verifying whether osteopathic manipulation with rhythmic articulatory technique improves cervical rotation range measured by fleximetry. METHODS: The group was made up of 58 individuals of both genders, mean age of 36±6.5 years, with chronic mechanical neck pain, who were randomized to cervical rotation control fleximetry, to osteopathic manipulation through the rhythmic articulatory technique, to 5-minute rest and to cervical rotation study fleximetry. RESULTS: The comparison of cervical rotation fleximetry means through Student's t test for paired data at significance level of 0.05 (5%) has shown significant cervical rotation improvement in all cases (p<0.05), going from 151.4º to 162.5º in total movement arch (7.3% improvement). CONCLUSION: Results were as expected, confirming that osteopathic manipulation using the rhythmic articulatory technique generates significant improvement of cervical rotation range in all cases and may be an alternative to treat diseases related to vertebral mobility reduction, such as neck pain and cervical osteoarthritis.

Effects of sleep deprivation on central auditory processing.

BACKGROUND: Sleep deprivation is extremely common in contemporary society, and is considered to be a frequent cause of behavioral disorders, mood, alertness, and cognitive performance. Although the impacts of sleep deprivation have been studied extensively in various experimental paradigms, very few studies have addressed the impact of sleep deprivation on central auditory processing (CAP). Therefore, we examined the impact of sleep deprivation on CAP, for which there is sparse information. In the present study, thirty healthy adult volunteers (17 females and 13 males, aged 30.75±7.14 years) were subjected to a pure tone audiometry test, a speech recognition threshold test, a speech recognition task, the Staggered Spondaic Word Test (SSWT), and the Random Gap Detection Test (RGDT). Baseline (BSL) performance was compared to performance after 24 hours of being sleep deprived (24hSD) using the Student's t test. RESULTS: Mean RGDT score was elevated in the 24hSD condition (8.0±2.9 ms) relative to the BSL condition for the whole cohort (6.4±2.8 ms; p=0.0005), for males (p=0.0066), and for females (p=0.0208). Sleep deprivation reduced SSWT scores for the whole cohort in both ears [(right: BSL, 98.4%±1.8% vs. SD, 94.2%±6.3%. p=0.0005)(left: BSL, 96.7%±3.1% vs. SD, 92.1%±6.1%, p<0.0001)]. These effects were evident within both gender subgroups [(right: males, p=0.0080; females, p=0.0143)(left: males, p=0.0076; females: p=0.0010). CONCLUSION: Sleep deprivation impairs RGDT and SSWT performance. These findings confirm that sleep deprivation has central effects that may impair performance in other areas of life.

Alterações vestibulares em processos infecciosos do sistema nervoso central / Vestibular disease in infectious process in Central Nervous System

Objetiva verificar sinais de afecção do sistema vestibular central decorrente de processos infecciosos por vectoelectronistagmografia em sete [acientes cuja faixa etária variou de dez a 71 anos de idade, sendo dois do sexo feminino e cinco do sexo masculino. O nistagmo semi-espontaneo unidirecional, bidirecional e múltiplo foi o sinal mais comumente encontrado, e os outros sinais centrais foram muito variáveis de caso para caso (AU)