Assessment of functional mobility and gait during a timed up and go test in adults with total blindness.

BACKGROUND: The loss of vision leads to behavioral and motor adaptations that do not necessarily translate to good functioning with regards to daily tasks. AIM: To investigate differences in functional mobility in adults with total blindness, and analyze differences in spatiotemporal gait variables with and without the use of a cane, and wearing shoes or barefoot. METHODS: We used an inertial measurement unit to assess the spatiotemporal parameters of the gait and functional mobility in seven subjects with total blindness and four sighted participants during the timed up and go test (TUG) test performed under conditions: barefoot/shod; and with/without a cane (blind subjects). RESULTS: Significant differences between groups were found in total TUG test time and in the sub-phases when the blind subjects executed the TUG barefoot and without a cane (p < .01). Other differences were found in trunk movement during sit-to-stand, and stand-to-sit where blind subjects when without cane and barefoot, they had a greater range of motion than sighted subjects (p < .01). Also, BMI has a moderate to strong influence in the execution of the TUG in blind subjects (p < .05) CONCLUSION: This study showed that, when using a gait-assistance device and wearing shoes, blind subjects have similar functional mobility and gait as sighted subjects, suggesting that an external haptic reference can compensate for the lack of vision. Knowledge of these differences can provide a better understanding of the adaptive behavior in this population, thereby assisting in minimizing the occurrence of trauma and falls.

Brain activity and upper limb movement analysis in children with Down syndrome undergoing transcranial direct current stimulation combined with virtual reality training: study protocol for a randomized controlled trial.

BACKGROUND: Children with Down syndrome have poorer functional and sensory skills compared to children with typical development. Virtual reality (VR) training could help improve these skills. Moreover, transcranial direct current stimulation (tDCS) has achieved promising results in terms of enhancing the effects of physical and sensory therapy by modulating cortical excitability. METHODS/DESIGN: Two investigations are proposed: (1) an observational study with a convenience sample consisting of children with Down syndrome (group 1-cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence) and children with typical development 6 to 12 years of age (group 2). Both groups will undergo evaluations on a single day involving a three-dimensional analysis of upper limb movements, an analysis of muscle activity of the biceps and brachial triceps muscles and an analysis of visuospatial and cognitive-motor variables. (2) Analysis of clinical intervention: a pilot study and clinical trial will be conducted involving individuals with Down syndrome (cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence). The sample will be defined after conducting a pilot study with the same methodology as that to be used in the main study. The participants will be randomly allocated to two groups: An experimental group submitted to anodal tDCS combined with a VR game and a manual motor task and a control group submitted to sham tDCS combined with a VR game and a manual motor task. The training protocol will involve 10 sessions of active or sham tDCS during memory and motor task games. Three 20-min sessions will be held per week for a total of 10 sessions. Evaluations will be performed on three different occasions: pre-intervention, post-intervention (after 10 sessions) and follow-up (1 month after the intervention). Evaluations will consist of analyses of electroencephalographic signals, electromyographic signals of the biceps and triceps brachii, and the three-dimensional reconstruction of the reaching movement. The results will be analyzed statistically with the significance level set at 5% (p ≤ 0.05). DISCUSSION: The optimization of the results obtained with virtual reality training is believed to be related to the interactive experience with a wide range of activities and scenarios involving multiple sensory channels and the creation of exercises, the intensity of which can be adjusted to the needs of children. Therefore, the proposed study aims to complement the literature with further information on tDCS and VR training considering different variables to provide the scientific community with clinical data on this combination of interventions. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (REBEC) protocol number RBR-43pk59 registered on 2019 March 27 https://ensaiosclinicos.gov.br/rg/RBR-43pk59 and Human Research Ethics Committee number 3.608.521 approved on 2019 September 30. Protocol version 2021 October 20. Any changes to the protocol will be reported to the committees and approved. Informed consent will be obtained from all participants by the clinical research coordinator and principal investigator.

tDCS and motor training in individuals with central nervous system disease: A systematic review.

BACKGROUND: Transcranial direct current stimulation (tDCS) is a promising tool for patients with neurological disorders, as it increases cortical excitability, motor learning and functionality. The studies up to date have focused on the tDCS parameters while the effects of the motor training have not yet been fully addressed. The purpose of this study is to present a systematic review of all studies related to tDCS in conjunction with motor training (MT) to improve gait performance, functionality, mobility and balance in individuals with non-progressive central nervous system diseases. METHODS: Seven databases were searched for articles from inception to October 2018. The search strategy followed Collaboration guidelines. The Physiotherapy Evidence Database (PEDro) Scale and Cochrane Collaboration's tool for assessing the risk of bias were applied to evaluate methodological quality. RESULTS: Four hundred and sixteen recorded were screened. Ten studies met the inclusion criteria. All studies were randomized controlled trials, two of them had a crossover design and other two were pilot studies. Three paper analyzed children and adolescents with cerebral palsy, seven papers analyzed adults and elderly post stroke. tDCS with MT lead to significant results. CONCLUSIONS: This review found limited evidence for the use of tDCS with MT for in children with CP and adults post stroke, due to the small number of studies as well as their methodological heterogeneity. In the absence of more robust evidence, further studies with a consistent methodological design are needed to endorse the clinical application of tDCS with motor training.

Virtual reality in the rehabilitation process for individuals with cerebral palsy and Down syndrome: A systematic review.

BACKGROUND: Childhood neurological diseases result in neuromotor impairment, which affects selective motor control, compromising the acquisition of motor skills and functional independence. The positive results achieved with virtual reality are believed to be related to training in an interactive environment that provides a broad range of activities and scenarios with multiple sensory channels, enabling the creation of exercises at an intensity based on individual need. Therefore, a review was conducted to answer the following question: What are the possible effects of virtual reality for the pediatric population, specifically children with cerebral palsy and Down syndrome? OBJECTIVE: The objective of the present study was to conduct a systematic review of the literature to determine the possible effects of virtual reality therapy in children with cerebral palsy and Down's syndrome. METHODS: The PubMed, Bireme, Scielo and PEDro electronic databases were searched in the period from January to March 2016 using the following keywords: Down syndrome and virtual reality, virtual reality and cerebral palsy, virtual reality and neuropediatrics, and Down's syndrome and virtual reality. Only randomized controlled trials published in English in the previous 10 years (2007-2016) that addressed the specific purpose of this review and achieved a score of at least 4 points on the PEDro methodological quality scale were eligible for inclusion. RESULTS: The initial research led to the retrieval of 214 articles, which were analyzed considering the inclusion criteria. Eighteen articles were submitted to an appraisal of methodological quality using the PEDro scale, only five of which received a score of four or more points and were described in the present review. Three of the studies selected analyzed children with cerebral palsy and two analyzed children with Down syndrome. Despite the different physiopathological characteristics of the two conditions, the authors employed similar therapeutic methods and evaluations. The results of the studies demonstrated that virtual reality training either alone or combined with motor training leads to improvements in sensory-motor functions and can be used as a complement to other successful rehabilitation interventions in the two populations. CONCLUSION: Based on the results of the studies included in the present systematic review, despite differences in the characteristics of each population, the objectives and methods proposed by the authors were similar and virtual reality demonstrated promising effects for individuals with cerebral palsy and Down syndrome.

Acute effects of photobiomodulation therapy and magnetic field on functional mobility in stroke survivors: a randomized, sham-controlled, triple-blind, crossover, clinical trial.

Identify the optimal energy delivered with a single application of the combination of photobiomodulation therapy (PBMT) combining different light sources (low-level laser therapy-LLLT and light emitting diode therapy-LEDT) and static magnetic field (sMF) in order to determine the acute effects on functional mobility of stroke survivors. Was conducted a randomized, placebo-controlled, crossover, triple-blind, clinical trial (RCT). Twelve patients were recruited, however ten concluded the study, they were randomly treated with four PBMT/sMF energies (sham-0 J, 10 J, 30 J, and 50 J per site irradiated), with 1-week interval washout between treatments. PBMT/sMF were administered after the pre-intervention (baseline) evaluation and the total energy delivered per site at each treatment was determined based on the results of the randomization procedure. PBMT/sMF were administered in direct contact with the skin and applied with slight pressure to nine sites on the knee extensors, six sites on the knee flexors, and two sites on the plantar flexors' muscles in both lower limbs (bilaterally). The primary outcome measure was the 6-min walk test (6MWT) and the secondary outcome was the Timed Up and Go (TUG) test. Significant improvements were found in the 6MWT test using a total energy of 30 J per site compared with sham (0 J) (p < 0.05) and compared with the baseline evaluation (p < 0.01). And in the TUG test significant improvements were also found using a total energy per site of 30 J per site compared to sham (0 J) and baseline (p < 0.05). PBMT with different light sources (laser and LEDs) and wavelengths in combination with sMF with a total energy per site of 30 J has positive acute effects on functional mobility in stroke survivors.

Effect of postural insoles on gait pattern in individuals with hemiparesis: A randomized controlled clinical trial.

INTRODUCTION: Recovering the ability to walk is an important goal of physical therapy for patients who have survived cerebrovascular accident (stroke). Orthotics can provide a reduction in plantar flexion of the ankle, leading to greater stability in the stance phase of the gait cycle. Postural insoles can be used to reorganize the tone of muscle chains, which exerts an influence on postural control through correction reflexes. The aim of the present study was to perform kinematic and spatiotemporal analyses of gait in stroke survivors with hemiparesis during postural insole usage. MATERIAL AND METHODS: Twenty stroke victims were randomly divided into two groups: 12 in the experimental group, who used insoles with corrective elements specifically designed for equinovarus foot, and eight in the control group, who used placebo insoles with no corrective elements. Both groups were also submitted to conventional physical therapy. The subjects were analyzed immediately following insole placement and after three months of insole usage. The SMART-D 140® system (BTS Engineering) with eight cameras sensitive to infrared light and the 32-channel SMART-D INTEGRATED WORKSTATION® were used for the three-dimensional gait evaluation. RESULTS: Significant improvements were found in kinematic range of movement in the ankle and knee as well as gains in ankle dorsiflexion and knee flexion in the experimental group in comparison to the control group after three months of using the insoles. CONCLUSION: Postural insoles offer significant benefits to stroke survivors regarding the kinematics of gait, as evidenced by gains in ankle dorsiflexion and knee flexion after three months of usage in combination with conventional physical therapy.

Postural insoles on gait in children with cerebral palsy: Randomized controlled double-blind clinical trial.

The aim of the present study was to assess the effect of postural insoles on gait performance in children with Cerebral Palsy (CP). Twenty four children between four and 12 years of age were randomly allocated either the control group (n = 12) or experimental group (n = 12). The control group used placebo insoles and the experimental group used postural insoles. Three-dimensional gait analysis was performed under three conditions: barefoot, in shoes and in shoes with insoles. Three evaluations were carried out: 1)immediately following placement of the insoles; 2)after three months of insole use; and 3)one month after suspending insole use. Regarding the immediate effects and after three months use of insole, significant improvements in gait velocity and cadence were found in the experimental group, along with an increase in foot dorsiflexion, a reduction in knee flexion and a reduction in internal rotation. Conversely, these changes were not maintained in the third assessment, one month after withdrawal of the insoles. The use of postural insoles led to improvements in gait performance in children with CP.

Stabilometric analysis of the effect of postural insoles on static balance in patients with hemiparesis: A randomized, controlled, clinical trial.

BACKGROUND: Stroke is one of the main causes of disability among adults. OBJECTIVE: The aim of the present study was to analyze the effect of postural insoles on static balance in individuals with stroke. METHODS: Twenty-four strokes survivors with hemiparesis were recruited from the rehabilitation clinics of the university and randomly allocated to two groups: experimental and control group. The subjects were analyzed for stabilometry, immediately following insole placement and after three months of insole usage, with eyes open and eyes closed. RESULTS: A significant difference was found immediately after postural insole placement regarding anteroposterior range of movement (p < 0.05). Moreover, significant reductions were found in the inter-group analysis after three months of insole usage. CONCLUSION: Based on the present findings, postural insoles combined with conventional physical therapy offer significant benefits regarding static postural control among stroke victims after three months of use, as demonstrated by computerized stabilometry.

Effects of Neuromuscular Electrical Stimulation on the Masticatory Muscles and Physiologic Sleep Variables in Adults with Cerebral Palsy: A Novel Therapeutic Approach.

Cerebral palsy (CP) is a term employed to define a group of non-progressive neuromotor disorders caused by damage to the immature or developing brain, with consequent limitations regarding movement and posture. CP may impair orapharygeal muscle tone, leading to a compromised chewing function and to sleep disorders (such as obstructive sleep apnea). Thirteen adults with CP underwent bilateral masseter and temporalis neuromuscular electrical stimulation (NMES) therapy. The effects on the masticatory muscles and sleep variables were evaluated using electromyography (EMG) and polysomnography (PSG), respectively, prior and after 2 months of NMES. EMG consisted of 3 tests in different positions: rest, mouth opening and maximum clenching effort (MCE). EMG values in the rest position were 100% higher than values recorded prior to therapy for all muscles analyzed (p < 0.05); mean mouth opening increased from 38.0 ± 8.0 to 44.0 ± 10.0 cm (p = 0.03). A significant difference in MCE was found only for the right masseter. PSG revealed an improved in the AHI from 7.2±7.0/h to 2.3±1.5/h (p < 0.05); total sleep time improved from 185 min to 250 min (p = 0.04) and minimun SaO2 improved from 83.6 ± 3.0 to 86.4 ± 4.0 (p = 0.04). NMES performed over a two-month period led to improvements in the electrical activity of the masticatory muscles at rest, mouth opening, isometric contraction and sleep variables, including the elimination of obstructive sleep apnea events in patients with CP. Trial registration: ReBEC RBR994XFS http://www.ensaiosclinicos.gov.br.

Clinical analysis and baropodometric evaluation in diagnosis of abnormal foot posture: A clinical trial.

Foot posture involves the integration of sensory information from the periphery of the body. This information generates precise changes through fine adjustments that compensate for the continuous, spontaneous sway of the body in the standing position. Orthopedic insoles are one of the therapeutic resources indicated for assisting in this process. Evaluation of these podal influences, by clinical examination and/or the assistance of baropodometry becomes crucial. Thus, the aim of the present study was determine the combination of the components of orthopedic insoles using two different evaluation methods. Forty healthy female volunteers between 18 and 30 years participated in the study. The volunteers were submitted to two different evaluations: clinical analysis and baropodometry. During the exams, different insole components were tested. The statistical analysis of the two evaluations revealed differences regarding the normalization of posture following the application of the insole components and in the determination of the combination of these components. The findings suggest that the clinical analysis is a fast and accurate method for determining the immediate benefits of the postural insole components and is therefore the more indicated method for the evaluation of foot posture, but does not present a concrete foundation to differentiate it with respect to baropodometric evaluation in the assessment and diagnosis of foot posture, however, a greater difficulty was encountered in achieving posture normalization when using information obtained through baropodometry.

Evaluation of the immediate effect of acupuncture on pain, cervical range of motion and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain: study protocol for a randomized controlled trial.

BACKGROUND: Nonspecific neck pain can cause considerable suffering, possible disability and reductions in quality of life and productivity. The aim of the proposed study is to evaluate the immediate effect of acupuncture on pain, cervical range of motion and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain. METHODS/DESIGN: A total of 12 patients with nonspecific neck pain and 12 healthy subjects will be enrolled in a randomized, single-blind crossover study. Each subject will receive two forms of treatment in random order: a single session of traditional acupuncture (acupoints: triple energizer 5, 'Wai-guan' and large intestine 11, 'Qu-chi') and sham acupuncture. To eliminate carry-over treatment effects, a one-week wash-out period will be respected between sessions. Surface electromyography will be used to determine motor control in the upper trapezius muscle before and after treatment. The outcome measures in the group with neck pain will be a numerical pain rating scale (range: 0 (no pain) to 10 (maximum pain)), documentation of the pain area on a body chart and cervical range of motion. Comparisons before and after acupuncture treatment will demonstrate whether acupoints affect the activity of the upper trapezius muscle, pain and cervical range of motion. DISCUSSION: The purpose of this randomized clinical trial is to evaluate the immediate effect of acupuncture on pain, cervical range of motion and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain. Data will be published after the study is completed. The study will support the practice of evidence-based physical therapy for individuals with nonspecific neck pain. TRIAL REGISTRATION: This trial was registered with Clinicaltrials.gov (identifier: NCT0984021 ) on 7 November 2013 ( https://clinicaltrials.gov/ct2/show/NCT01984021 ).

Effect of a hyperbolide mastication apparatus for the treatment of severe sleep bruxism in a child with cerebral palsy: long-term follow-up.

PURPOSE: Sleep bruxism is common among the various oromotor alterations found in individuals with cerebral palsy (CP). Few studies have investigated the use of the mastication device denominated "hyperbola" (HB) and none was found describing the use of such a device for the treatment of bruxism in children with CP. The aim of the present study was to evaluate the effect of the HB on electromyographic (EMG) activity in the jaw-closing muscles and the reduction in sleep bruxism in a child with CP using surface EMG analysis before and after nine months of treatment. METHODS: A seven-year-old boy with severe spastic CP and sleep bruxism was enrolled in this study. The HB was chosen as the treatment option for sleep bruxism in this case because the child did not accept an occlusal splint. The HB has a hyperbolic shape and is made of soft, non-toxic, odorless, tasteless silicone. There are five different sizes of HB manufactured based on the diversity of tooth sizes. This device produces proprioceptive excitation in the dentoalveolar nerve, spindles and Golgi tendon organs. HB has been employed for the treatment of temporomandibular disorder, abnormal oro-dental development, abnormal occlusion, xerostomy, halitosis and bruxism. HB therapy was performed for 5 min six times a day over a nine-week period. Surface EMG of the mandible at rest and during maximum contraction was performed on the masseter and temporalis muscles bilaterally to evaluate electromyographic activity before and after nine months of HB usage. RESULTS: HB usage led to a visible tendency toward the reorganization of mastication dynamics, achieving a marked balance in electromyographic activity of the jaw-closing muscles and improving the child's quality of life. CONCLUSION: Based on the findings of the present study, this noninvasive therapy may be useful for individuals with cerebral palsy due to its positive effects and low cost, which allows its use in the public health realm. Further clinical studies with a larger sample size are needed to validate these results and allow the development of a new treatment protocol for patients with spastic cerebral palsy.

Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial.

BACKGROUND: The project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning. METHODS/DESIGN: A prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test. DISCUSSION: This paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population. TRIAL REGISTRATION: ReBEC RBR-9B5DH7.

Use of the Gait Deviation Index and spatiotemporal variables for the assessment of dual task interference paradigm.

Three-dimensional gait analysis (3DGA) is an important element in the quantitative evaluation of gait in subjects with Parkinson's disease (PD). Indexes, such as the Gait Deviation Index (GDI), have recently been proposed as a summary measure of gait. The aim of the present study was to investigate the effectiveness of the GDI and spatiotemporal variables in the quantification of changes in gait during a dual-task (DT) exercise. Fourteen patients with idiopathic PD and nine healthy subjects (CG) participated in the study. All subjects walked under two conditions: free walking and DT walking. The GDI was computed from the 3DGA data. The results show gait impairment during DT, a significant difference between groups regarding GDI and an interaction effect involving the group, side and task factors. The CG and PDG were different independent of interference and side, but interference was only different for the PDG group. The results also demonstrate that the GDI should be an appropriate outcome measure for the evaluation of the effects of DT on patients with Parkinson's disease.

Effectiveness of global postural reeducation in the treatment of temporomandibular disorder: case report.

The aim of the present study was to evaluate the effectiveness of global postural reeducation in the treatment of temporomandibular disorder through bilateral surface electromyographic (EMG) analysis of the masseter muscle in a 23-year-old volunteer. EMG values for the masseter were collected at rest (baseline) and during a maximal occlusion. There was a change in EMG activity both at rest and during maximal occlusion following the intervention, evidencing neuromuscular rebalancing between both sides after treatment as well as an increase in EMG activity during maximal occlusion, with direct improvement in the recruitment of motor units during contractile activity and a decrease in muscle tension between sides at rest. The improvement in postural patterns of the cervical spine provided an improvement in aspects of the EMG signal of the masseter muscle in this patient. However, a multidisciplinary study is needed in order to determine the effect of different forms of treatment on this condition and compare benefits between interventions. Therefore, this study can provide a direction regarding the application of this technique in patients with temporomandibular disorder.

Effect of low-level laser therapy on pain, quality of life and sleep in patients with fibromyalgia: study protocol for a double-blinded randomized controlled trial.

BACKGROUND: Low-level laser therapy (LLLT) has been widely used as adjuvant strategy for treatment of musculoskeletal disorders. The light-tissue interaction (photobiostimulation) promotes analgesic and anti-inflammatory effects and improves tissue healing, which could justify the recommendation of this therapy for patients with fibromyalgia, leading to an improvement in pain and possibly minimizing social impact related to this disease. The present study proposes to evaluate the effect of LLLT on tender points in patients with fibromyalgia, correlating this outcome with quality of life and sleep. METHODS/DESIGN: One hundred and twenty patients with fibromyalgia will be treated at the Integrated Health Center and the Sleep Laboratory of the Post Graduate Program in Rehabilitation Sciences of the Nove de Julho University located in the city of Sao Paulo, Brazil. After fulfilling the eligibility criteria, a clinical evaluation and assessments of pain and sleep quality will be carried out and self-administered quality of life questionnaires will be applied. The 120 volunteers will be randomly allocated to an intervention group (LLLT, n = 60) or control group (CLLLT, n = 60). Patients from both groups will be treated three times per week for four weeks, totaling twelve sessions. However, only the LLLT group will receive an energy dose of 6 J per tender point. A standardized 50-minute exercise program will be performed after the laser application. The patients will be evaluated regarding the primary outcome (pain) using the following instruments: visual analog scale, McGill Pain Questionnaire and pressure algometry. The secondary outcome (quality of life and sleep) will be assessed with the following instruments: Medical Outcomes Study 36-item Short-Form Health Survey, Fibromyalgia Impact Questionnaire, Berlin Questionnaire, Epworth Sleepiness Scale and polysomnography. ANOVA test with repeated measurements for the time factor will be performed to test between-groups differences (followed by the Tukey-Kramer post hoc test), and a paired t test will be performed to test within-group differences. The level of significance for the statistical analysis will be set at 5% (P ≤ .05). TRIAL REGISTRATION: The protocol for this study is registered with the Brazilian Registry of Clinical Trials - ReBEC (RBR-42gkzt).

Analysis of electromyographic activity in spastic biceps brachii muscle following neural mobilization.

INTRODUCTION: Hypertonia is prevalent in anti-gravity muscles, such as the biceps brachii. Neural mobilization is one of the techniques currently used to reduce spasticity. OBJECTIVE: The aim of the present study was to assess electromyographic (EMG) activity in spastic biceps brachii muscles before and after neural mobilization of the upper limb contralateral to the hemiplegia. MATERIALS AND METHODS: Repeated pre-test and post-test EMG measurements were performed on six stroke victims with grade 1 or 2 spasticity (Modified Ashworth Scale). The Upper Limb Neurodynamic Test (ULNT1) was the mobilization technique employed. RESULTS: After neural mobilization contralateral to the lesion, electromyographic activity in the biceps brachii decreased by 17% and 11% for 90° flexion and complete extension of the elbow, respectively. However, the results were not statistically significant (p gt; 0.05). CONCLUSIONS: When performed using contralateral techniques, neural mobilization alters the electrical signal of spastic muscles.

Effects of neuromuscular electrical stimulation, laser therapy and LED therapy on the masticatory system and the impact on sleep variables in cerebral palsy patients: a randomized, five arms clinical trial.

BACKGROUND: Few studies demonstrate effectiveness of therapies for oral rehabilitation of patients with cerebral palsy (CP), given the difficulties in chewing, swallowing and speech, besides the intellectual, sensory and social limitations. Due to upper airway obstruction, they are also vulnerable to sleep disorders. This study aims to assess the sleep variables, through polysomnography, and masticatory dynamics, using electromiography, before and after neuromuscular electrical stimulation, associated or not with low power laser (Gallium Arsenide- Aluminun, =780 nm) and LED (= 660 nm) irradiation in CP patients. METHODS/DESIGN: 50 patients with CP, both gender, aged between 19 and 60 years will be enrolled in this study. The inclusion criteria are: voluntary participation, patient with hemiparesis, quadriparesis or diparetic CP, with ability to understand and respond to verbal commands. The exclusion criteria are: patients undergoing/underwent orthodontic, functional maxillary orthopedic or botulinum toxin treatment. Polysomnographic and surface electromyographic exams on masseter, temporalis and suprahyoid will be carry out in all sample. Questionnaire assessing oral characteristics will be applied. The sample will be divided into 5 treatment groups: Group 1: neuromuscular electrical stimulation; Group 2: laser therapy; Group 3: LED therapy; Group 4: neuromuscular electrical stimulation and laser therapy and Group 5: neuromuscular electrical stimulation and LED therapy. All patients will be treated during 8 consecutive weeks. After treatment, polysomnographic and electromiographic exams will be collected again. DISCUSSION: This paper describes a five arm clinical trial assessing the examination of sleep quality and masticatory function in patients with CP under non-invasive therapies. TRIAL REGISTRATION: The protocol for this study is registered with the Brazilian Registry of Clinical Trials - ReBEC RBR-994XFS.

Influence of heat on fatigue and electromyographic activity of the biceps brachii muscle.

Electromyography enables registering muscle activity during contraction and can identify muscle fatigue. In the present study, 30 volunteers between 18 and 30 years of age were submitted to an exertion 1 min of maximal voluntary isometric contraction. The electromyographic signal of the biceps brachii muscle and the strength of the flexor muscles of the elbow were determined before and after the administration of microwave diathermy in order to analyze the influence of heat over the strength of the elbow flexor muscles and fatigue of the biceps brachii. The results demonstrate that the strength of the elbow flexor muscles diminished significantly following the application of heat (p<0.05). Heat also led to a significant reduction in the electrical activity of the muscle studied. The present study demonstrates that microwave diathermy on the biceps brachii muscle reduces the flexion strength of the elbow as well as signs of muscle fatigue in the biceps.

Analysis of electromyographic activity of ankle muscles on stable and unstable surfaces with eyes open and closed.

INTRODUCTION: Proprioceptive exercises are performed on a daily basis in physiotherapy with the use of different unstable platforms in order to improve joint stability using the mechanical and sensory properties of ligaments, joint capsule and integrated activity of the muscles surrounding the joint. Changes in the myoelectrical characteristics of the muscles during activity can be identified using surface electromyography (EMG), which provides important information on the behavior of muscles submitted to different types of load. OBJECTIVES: The aim of the present study was to analyze the electromyographic activity of the tibialis anterior, tibialis posterior, peroneus longus, gastrocnemius lateralis and gastrocnemius medialis on stable and unstable surfaces with eyes open and closed. METHODOLOGY: Twenty-five active, healthy, male and female individuals were submitted to an anthropometric evaluation and a protocol involving warm up and the electromyographic assessment of muscle activity on different surfaces. The order of the data collection was chosen randomly by lots [on stable ground or unstable platforms (trampoline, balance platform, proprioceptive disk and proprioceptive board) with eyes open and on a trampoline, balance platform and stable ground with eyes closed]. The individuals remained balanced on these surfaces for 15 s with the knee at 30° flexion in order to provide greater instability. RESULTS: There was a significant increase (p < 0.05) in muscle activity on the unstable surfaces, with the exception of the trampoline, which did not achieve statistically significant differences in relation to the stable ground. The tibialis anterior and peroneus longus exhibited the greatest electromyographic activity on all surfaces. The proprioceptive tests performed with eyes closed exhibited significantly greater electromyographic activity than with eyes open. CONCLUSION: Proprioceptive exercises on unstable surfaces generated a significant increase in electromyographic activity, especially with eyes closed, and are therefore a valuable resource in the sensory-motor rehabilitation of the ankle.