Rotator cuff isometric exercises in combination with scapular muscle strengthening and stretching in individuals with rotator cuff tendinopathy: A multiple-subject case report.

BACKGROUND AND PURPOSE: To assess the effects of a rehabilitation protocol of rotator cuff (RC) isometrics coupled with traditional shoulder exercises on patient-rated outcomes, muscle strength, and electromyographic activity in individuals with RC tendinopathy. METHODS: Eleven individuals (8 women and 3 men, 37.9 ± 5.6 years) with RC tendinopathy performed isometric RC exercises in combination with scapular muscle stretching and strengthening for 6 weeks. Treatment effects were assessed with patient-rated pain and shoulder function, isometric muscle strength, electromyographic activity during arm elevation and internal and external shoulder rotation, and pain during arm elevation before and at the end of the first session, and after 6 weeks of intervention. RESULTS: There were improvements in pain and shoulder function, increased isometric muscle strength for arm elevation and internal rotation, increased muscle activity of the infraspinatus and serratus anterior, and reduced pain during arm elevation after 6 weeks of intervention. DISCUSSION: This case report showed improvements on pain and function, increases on isometric strength of the shoulder and on electromyographic activity of the serratus anterior and infraspinatus muscles, as well as decreases on pain during arm elevation, after a 6-week intervention of RC isometric exercises associated with scapular muscle stretching and strengthening in patients with RC tendinopathy.

Comparing exercises with and without electromyographic biofeedback in subacromial pain syndrome: A randomized controlled trial.

BACKGROUND: Deficits in movement and muscle activation of scapulohumeral joint are related to Subacromial Pain Syndrome. Electromyography biofeedback during exercise may enhance muscle activation and coordination, and consequently improve pain and shoulder function. METHODS: This study compared the effects of an exercise protocol with and without using electromyographic biofeedback on pain, function and movement of the shoulder complex in subjects with Subacromial Pain Syndrome. A total of 24 patients with subacromial pain (mean age = 46.2 + 8.1;18 women) were randomized to either therapeutic exercise or exercise plus biofeedback to the trapezius and serratus muscles. Pain and shoulder function were evaluated as the primary outcome and range of motion, muscle strength, electromyographic activity and scapulohumeral kinematics as secondary outcomes. The subjects underwent eight weeks of intervention and comparisons were made between groups in baseline, at 4 weeks, 8 weeks, and at 4 weeks post intervention. FINDINGS: There were differences between groups for pain [mean difference = 1.5 (CI 0.3, 3.2) p = 0.01] at 8 weeks in the Exercise group and scapular upward rotation at 60° of arm elevation [mean difference = 13.9 (CI 0.9, 9.3), p = 0.006] in the Biofeedback group. There was no difference for the other variables of scapular kinematics as well as for shoulder function (DASH), muscle strength, range of motion and electromyographic variables. INTERPRETATION: The addition of Biofeedback to the exercise protocol increased upward rotation of the scapula. However, the volunteers who performed only the Exercises had a better response in reducing pain.

Absolute and Relative Reliability of Pressure Pain Threshold Assessments in the Shoulder Muscles of Participants With and Without Unilateral Subacromial Impingement Syndrome.

OBJECTIVE: The purpose of this study was to determine the relative and absolute reliability of the pressure pain threshold (PPT) in the shoulder muscles of participants with and without unilateral subacromial impingement syndrome. METHODS: Study of intraday intra- and interrater and interday intrarater reliability. Fifty-two participants symptomatic for unilateral subacromial impingement syndrome were divided into 2 groups (SG1 and SG2) of 26 participants each, and 26 participants asymptomatic for shoulder pain took part in the study. Two raters assessed the PPT in 4 shoulder muscles. Each rater assessed symptomatic (SG1) and asymptomatic participants twice on the same day, and one of the raters on 2 different days (SG2). The intraclass correlation coefficient, standard error of measurement (SEM95% and SEM%), and minimum detectable change (MDC95% and MDC%) were calculated. RESULTS: Relative reliability was good or excellent for all assessments, as well as for both groups and raters (intraclass correlation coefficient: 0.87-0.98). The SEM95% values for intra- and interday intrarater measures were between 0.43 and 1.50 kgf/cm2 and SEM% between 6.76 and 12.86%, whereas MDC95% values ranged from 0.60 to 2.12 kgf/cm2 and MDC% from 9.56 to 18.18%. In interrater measures, SEM95% was between 0.58 and 0.77 kgf/cm2 and SEM% between 10.10% and 13.71%, whereas MDC95% varied from 0.82 to 1.08 kgf/cm2 and MDC% from 14.29% to 19.39%. CONCLUSION: Relative reliability was good or excellent. This study presents absolute reliability values that could be used as a reference in the clinical use of PPT.

Dangerous mistake: an accidental caffeine overdose.

Caffeine (1,3,7-trimethylxanthine) is a natural product commonly presented in food's composition, beverages and medicinal products. Generally, it is thought to be safe under normal dosage, yet it can be fatal in case of severe intoxication. We report a case of a healthy 32-year-old woman who went to the local emergency department (ED) 30 min after ingesting, accidentally, 5000 mg of anhydrous caffeine for a preworkout supplement. At the ED, she presented an episode of presyncope followed by agitation. ECG showed polymorphic broad complex QRS tachycardia and arterial blood gas revealed metabolic acidaemia with severe hypokalemia. The dysrhythmia was successfully treated with intravenous propranolol. Acid-base and hydroelectrolytic disorders were also corrected. A persistent sinus tachycardia was observed in the first 2 days in the ward and 5 days later she was discharged asymptomatic with internal medicine follow-up.

Effects of the addition of functional electrical stimulation to ground level gait training with body weight support after chronic stroke / Efeitos da adição da estimulação elétrica funcional ao treino de marcha em piso fixo com suporte parcial de peso após acidente vascular encefálico crônico

BACKGROUND: The addition of functional electrical stimulation (FES) to treadmill gait training with partial body weight support (BWS) has been proposed as a strategy to facilitate gait training in people with hemiparesis. However, there is a lack of studies that evaluate the effectiveness of FES addition on ground level gait training with BWS, which is the most common locomotion surface. OBJECTIVE: To investigate the additional effects of commum peroneal nerve FES combined with gait training and BWS on ground level, on spatial-temporal gait parameters, segmental angles, and motor function. METHODS: Twelve people with chronic hemiparesis participated in the study. An A1-B-A2 design was applied. A1 and A2 corresponded to ground level gait training using BWS, and B corresponded to the same training with the addition of FES. The assessments were performed using the Modified Ashworth Scale (MAS), Functional Ambulation Category (FAC), Rivermead Motor Assessment (RMA), and filming. The kinematics analyzed variables were mean walking speed of locomotion; step length; stride length, speed and duration; initial and final double support duration; single-limb support duration; swing period; range of motion (ROM), maximum and minimum angles of foot, leg, thigh, and trunk segments. RESULTS: There were not changes between phases for the functional assessment of RMA, for the spatial-temporal gait variables and segmental angles, no changes were observed after the addition of FES. CONCLUSION: The use of FES on ground level gait training with BWS did not provide additional benefits for all assessed parameters.

CONTEXTUALIZAÇÃO: A adição da estimulação elétrica funcional (EEF) ao treino de marcha em esteira, com sistema de suporte parcial de peso corporal (SPPC), tem sido proposta como estratégia para melhorar a marcha em hemiparéticos. Entretanto, nenhum estudo verificou a eficácia da adição da EEF ao treino de marcha com SPPC em piso fixo, a superfície mais habitual de locomoção. OBJETIVO: Investigar os efeitos da adição da EEF do nervo fibular comum, ao treino de marcha com SSPC, em piso fixo, sobre os parâmetros espaço-temporais da marcha, ângulos segmentares e função motora. MÉTODOS: Participaram do estudo 12 hemiparéticos crônicos. O sistema adotado foi o A1-B-A2. A1 e A2 corresponderam ao treino em piso fixo com SPPC, e B, ao mesmo treino, associado à EEF. As avaliações foram realizadas por meio da Escala de Ashworth Modificada (EAM), da Categoria de Deambulação Funcional (CDF), da Avaliação Motora de Rivermead (AMR) e de filmagens. As variáveis cinemáticas analisadas foram: velocidade média de locomoção; comprimento do passo; comprimento, velocidade e duração da passada; duração dos períodos de apoio duplo inicial e final, apoio simples e balanço; ângulos máximos e mínimos e amplitude de movimento (ADM) dos segmentos pé, perna, coxa e tronco. RESULTADOS: Na AMR, não houve alterações entre as fases. Para as variáveis espaço-temporais e ângulos segmentares, não houve nenhuma alteração após a adição da EEF. CONCLUSÃO: A adição da EEF ao treino de marcha em piso fixo com SPPC não promoveu melhora adicional nos parâmetros mensurados.

Effects of the addition of functional electrical stimulation to ground level gait training with body weight support after chronic stroke.

BACKGROUND: The addition of functional electrical stimulation (FES) to treadmill gait training with partial body weight support (BWS) has been proposed as a strategy to facilitate gait training in people with hemiparesis. However, there is a lack of studies that evaluate the effectiveness of FES addition on ground level gait training with BWS, which is the most common locomotion surface. OBJECTIVE: To investigate the additional effects of commum peroneal nerve FES combined with gait training and BWS on ground level, on spatial-temporal gait parameters, segmental angles, and motor function. METHODS: Twelve people with chronic hemiparesis participated in the study. An A1-B-A2 design was applied. A1 and A2 corresponded to ground level gait training using BWS, and B corresponded to the same training with the addition of FES. The assessments were performed using the Modified Ashworth Scale (MAS), Functional Ambulation Category (FAC), Rivermead Motor Assessment (RMA), and filming. The kinematics analyzed variables were mean walking speed of locomotion; step length; stride length, speed and duration; initial and final double support duration; single-limb support duration; swing period; range of motion (ROM), maximum and minimum angles of foot, leg, thigh, and trunk segments. RESULTS: There were not changes between phases for the functional assessment of RMA, for the spatial-temporal gait variables and segmental angles, no changes were observed after the addition of FES. CONCLUSION: The use of FES on ground level gait training with BWS did not provide additional benefits for all assessed parameters.