Efeito agudo do método reequilíbrio toracoabdominal em lactentes com diagnóstico de bronquiolite / Acute effect of thoracic-abdominal rebalance method in infants diagnosed with bronchiolitis

Nos lactentes, o sistema imunológico ainda é imaturo, o que torna as crianças mais suscetíveis ao vírus sincicial respiratório, o principal causador da bronquiolite. O Reequilíbrio Toraco-abdominal (RTA) é um método de terapia manual que atua sobre o sistema respiratório por meio de uma leitura global em situações de doenças. Objetivos: Avaliar os efeitos do método RTA, comparado à fisioterapia tradicional (FT) em lactentes com bronquiolite. Metodologia: Pesquisa experimental e prospectiva, na qual 24 lactentes foram divididos em dois grupos, FT (n = 12) e RTA (n = 12). Parâmetros fisiológicos (frequência respiratória, frequência cardíaca, saturação de pulso de oxigênio e ausculta pulmonar), desconforto respiratório e desequilíbrio da biomecânica respiratória foram avaliados antes e após os manuseios. Resultados: A idade média foi de 13 (± 11,07) semanas no grupo FT e no grupo RTA 13,3 (± 8,41) semanas. Após os manuseios, obteve diferença estatística no grupo do RTA comparado ao da FT nos seguintes parâmetros: observamos uma diminuição significativa da frequência cardíaca (p = 0,02) e da frequência respiratória (p = 0,0002), no quesito esforço respiratório em tórax superior (p = 0,004) e tórax inferior (p = 0,017) e no escore de Wood-Downes em moderada com (p = 0,0001). Conclusão: O RTA mostrou-se mais eficaz que as técnicas da FT em relação aos benefícios ao lactente. (AU)

Estudo transversal da capacidade funcional e força muscular em setuagenários institucionalizados / Transversal study of functional capacity and muscle strength in institutionalized elderly

Introdução: As pessoas estão envelhecendo cada vez mais no Brasil e no mundo. Estudos apontam que o processo de envelhecimento populacional é acompanhado com o aumento de ocorrência de morbidade e incapacidade. Diferentes condições podem ser apresentadas pelo envelhecimento, como: diminuição da capacidade funcional, diminuição da força e da massa muscular, entre outros. Objetivo: Investigar a redução da capacidade funcional, secundária a redução de força muscular de membros inferiores em idosos institucionalizados em duas instituições de longa permanência (ILPI) no município de Nova Iguaçu (RJ/Brasil). Métodos: Trata-se de um estudo transversal, exploratório de caráter quantitativo em duas IAPI em Nova Iguaçu/RJ/ no período do mês de julho e agosto de 2017, em que foram selecionados 60 idosos de ambos os sexos (34 homens e 26 mulheres), com faixa etária ≥ 60 anos. Os voluntários foram avaliados quanto a capacidade funcional e a força muscular. Para a capacidade funcional, foi utilizado a escala de Barthel. Para o teste de força, o presente estudo usou para forma de avaliação a escala de Medical Research Council (MRC). Resultados: Os resultados mostraram que 61,7% dos idosos são classificados como independentes pelo índice de Barthel. Na escala de MRC, 95% dos idosos apresentaram fraqueza muscular. Conclusão: Concluímos que a maior proporção de idosos institucionalizados foram considerados independentes, porém, apresentaram quadro de fraqueza muscular. (AU)

Introduction: People are aging more and more in Brazil and worldwide. Studies show that the process of population aging is accompanied by increased occurrence of morbidity and disability. Different conditions can be presented by aging, such as: decreased functional capacity, decreased strength and muscle mass, among others. Objective: To investigate the reduction of functional capacity, secondary to the reduction of muscular strength of lower limbs in elderly institutionalized in two institutions in the municipality of Nova Iguaçu/RJ Brazil. Methods: This is a quantitative exploratory study in two elderly institutions at Nova Iguaçu during the period of July and August 2017, with 60 elderly men and women (34 males and 26 females), age range ≥ 60 years. The volunteers were assessed for functional capacity and muscle strength. For functional capacity, the Barthel scale was used. For strength testing, the present study used the Medical Research Council (MRC) scale for evaluation. Results: The results of the present study showed that 61.7% of the elderly are classified as independent by the Barthel index. In the MRC scale, 95% of the elderly presented muscular weakness. Conclusion: We concluded that the most proportion of institutionalized elderly was considered independent but presented a picture of muscular weakness. (AU)

Dopaminergic drugs alter beta coherence during motor imagery and motor execution in healthy adults.

BACKGROUND: Motor Imagery (MI) represents the cognitive component of the movement and recruits dopaminergic systems. OBJECTIVE: To investigate the role of dopaminergic system through the action of methylphenidate and risperidone over beta coherence during execution, action observation and motor imagery. METHODS: Electroencephalography (EEG) data were recorded before and after the substance intake. For statistical analysis, a three-way ANOVA was used to identify changes in beta coherence induced by the group, task and the moment variables. Statistical significance was set at p≤0.007. RESULTS: We found a main effect for group for C3/CZ, and a main effect for task for CZ/C4 pairs of electrodes. Furthermore, significant differences were found in the post-drug administration between groups for C3/CZ pair of electrodes, and between task for C4/CZ pair of electrodes. CONCLUSION: The administration of methylphenidate and risperidone was able to produce electrocortical changes of the cortical central regions, even when featuring antagonistic effects on the dopaminergic pathways. Moreover, the execution task allowed beta-band modulation increase.

Dopaminergic drugs alter beta coherence during motor imagery and motor execution in healthy adults / Drogas dopaminérgicas alteram a coerência beta durante a imagética motora e a execução motora em adultos saudáveis

Abstract Background: Motor Imagery (MI) represents the cognitive component of the movement and recruits dopaminergic systems. Objective: To investigate the role of dopaminergic system through the action of methylphenidate and risperidone over beta coherence during execution, action observation and motor imagery. Methods: Electroencephalography (EEG) data were recorded before and after the substance intake. For statistical analysis, a three-way ANOVA was used to identify changes in beta coherence induced by the group, task and the moment variables. Statistical significance was set at p≤0.007. Results: We found a main effect for group for C3/CZ, and a main effect for task for CZ/C4 pairs of electrodes. Furthermore, significant differences were found in the post-drug administration between groups for C3/CZ pair of electrodes, and between task for C4/CZ pair of electrodes. Conclusion: The administration of methylphenidate and risperidone was able to produce electrocortical changes of the cortical central regions, even when featuring antagonistic effects on the dopaminergic pathways. Moreover, the execution task allowed beta-band modulation increase.

Resumo Introdução: A imagética motora (IM) representa o componente cognitivo do movimento e recruta os sistemas dopaminérgicos. Objetivo: Investigar o papel do sistema dopaminérgico por meio da ação do metilfenidato e da risperidona sobre a coerência em beta durante a execução, observação de ação e imagética motora. Métodos: Os dados de eletroencefalografia (EEG) foram registrados antes e depois da ingestão das substâncias. Para a análise estatística, uma ANOVA de três vias foi utilizada para identificar mudanças na coerência beta induzidas pelas variáveis grupo, tarefa e momento. A significância estatística foi estabelecida em p≤0,007. Resultados: Encontramos um efeito principal para o grupo C3/CZ e um efeito principal para a tarefa nos pares de eletrodos CZ/C4. Além disso, diferenças significativas foram encontradas após a administração da droga entre os grupos para o par de eletrodos C3/CZ e entre tarefa para o par de eletrodos C4/CZ. Conclusão: A administração de metilfenidato e risperidona foi capaz de produzir alterações eletrocorticais das regiões somatomotoras, mesmo apresentando efeitos antagônicos nas vias dopaminérgicas. Além disso, a tarefa de execução provocou maior modulação da banda beta.

Esclerose lateral amiotrófica: novas possibilidades terapêuticas em um arcabouço fisiopatológico ainda em construção / Amyotrophic lateral sclerosis: new therapeutic possibilities in a pathophysiological framework still under construction

Introdução: A Esclerose Lateral Amiotrófica (ELA) é definida como uma doença neurológica progressiva e inexorável, com cerca de 80% dos casos de etiologia desconhecida. Novos medicamentos têm emergido no tratamento de doenças neurodegenerativas, inclusive na ELA, redesenhando o modelo fisiopatológico. Dentre eles, destacam-se o uso da: Edaravone, Vitamina K2, Serina, Metilcobalamina, Pirroloquinolina quinona (PQQ), Ubiquinol e Glutationa. Especificamente na ELA, alguns já foram validados em estudos randomizados-controlados. Metodologia: Atualização da literatura (PUBMED, Medline) sobre a utilização desses fármacos em doenças neurológicas degenerativas, com enfoque para a Doença do Neurônio Motor (DNM-ELA), nos idiomas Português, Inglês, Espanhol e Francês, compreendidos entre os anos de (2010-2017). Discussão: A associação desses medicamentos tem mostrado resultados positivos em inúmeras doenças neurológicas. Alguns, como, por exemplo, a Metilcobalamina e o Edaravone,exerceriam mecanismos de ação capazes de interferir no processo de depleção dos neurônios motores da ponta anterior e do feixe piramidal em pacientes com ELA. Conclusão: Seria precipitado concluir que o uso associado desses fármacos poderia modificar ou mesmo restaurar os danos às unidades motoras; entretanto, faz-se necessário destacar seus mecanismos de ação e potencial capacidade de intervir na evolução da doença, principalmente, a partir de estudos em modelos fisiopatológico que culminam na degeneração dos neurônios motores.(AU)

Introduction: Amyotrophic Lateral Sclerosis (ALS) is defined as a progressive and inexorable neurological disease, with about 80% of cases of unknown etiology. New drugs have emerged in the treatment of neurodegenerative diseases, including ALS, redesigning the pathophysiological model. Among them, the use of: Edaravone, Vitamin K2, Serine, Methylcobalamin, Pyrroloquinoline quinone (PQQ), Ubiquinol and Glutathione are noteworthy. Specifically in ALS, some have been validated in randomized controlled trials. Methodology: Update of the literature (PUBMED, Medline) on the use of these drugs in degenerative neurological diseases, with a focus on Motor Neuron Disease (DNM-ELA) in the Portuguese, English, Spanish and French languages, of (2010-2017). Discussion: The association of these drugs has shown positive results in neurological diseases. Some, such as Methylcobalamin and Edaravone, would exert mechanisms of action capable of interfering in the process of depletion of the motor neurons of the anterior horn and pyramidal tracts in patients with ALS. Conclusion: It would be precipitate to conclude that the associated use of these drugs could modify or even restore damage to motor units; however, it is necessary to highlight its mechanisms of action and potential ability to intervene in the evolution of the disease, mainly from studies in pathophysiological models that culminate in the degeneration of motor neurons (AU)

Fraqueza muscular adquirida na UTI (ICU-AW): efeitos sistêmicos da eletroestimulação neuromuscular / Muscular weakness acquired in ICU (ICU-AW): effects of systemic neuromuscular electrical stimulation

Com os avanços tecnológicos alcançados atualmente na terapia intensiva e maior sobrevida dos pacientes, outros desafios têm surgido para os profissionais de saúde. Dentre alguns, destaca-se a fraqueza muscular adquirida na UTI (ICU-AW), caracterizada por paresia esquelética e respiratória dos músculos promovendo aumento nas taxas de mortalidade e comprometimento da qualidade de vida. Sua incidência varia de 30% a 60% e tem na síndrome da resposta inflamatória sistêmica (SIRS) e na disfunção de múltiplos órgãos (DMO) sua principal etiologia. Outros fatores de risco como a hiperglicemia, o uso de bloqueadores neuromusculares e sedativos, a imobilidade e a própria ventilação mecânica estão entre os mais comuns. Entre as medidas de combate à ICU-AW, está o conceito de mobilização precoce, bem como despertar diário e controle estreito da glicemia. Nesse contexto, a letroestimulação muscular apresenta-se como recurso de grande valia. Sua principal vantagem está no fato de poder ser empreendida independentemente da cooperação do paciente, e por ser capaz de gerar respostas musculares eficientes, bem como resultados satisfatórios na preservação da massa muscular, condicionamento físico e funcionalidade dos que usam essa ferramenta. Desfechos interessantes têm sido observados em diversos perfis de pacientes, como os de doença pulmonar obstrutiva crônica (DPOC) e traumatismo raquimedular (TRM). No paciente crítico, seu uso tem mostrado redução nos tempos de ventilação mecânica (VM), internação na UTI e maior funcionalidade dos pacientes. A relevância dos efeitos sistêmicos e metabólicos provenientes da eletroestimulação neuromuscular (ENM) tem sido a base para os estudos nos pacientes críticos. Portanto, a ICU-AW é uma realidade no cenário da terapia intensiva e sua prevenção tem dado margem à aparição de novas propostas e ferramentas na prevenção dessas complicações.

With technological advances currently achieved in intensive care and increased patient survival, other challenges have emerged to health professionals. Among some, there is acquired weakness in the ICU (ICU-AW), characterized by skeletal and respiratory muscle paresis promoting an increase in mortality and impaired quality of life. The range of occurrence is 30% to 60% of critically ill patients, and systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction (MOD) are is the main etiology. Other risk factors such as hyperglycemia, the use of neuromuscular blockers and sedatives, immobility and mechanical ventilation are among the most common. Preventing ICU-AW is the concept of early mobilization and daily awakening and tight control of blood glucose. In this context, muscle electrostimulation appears as a great resource. This can be used undertaken regardless of the cooperation of the patient, and be able to generate efficient muscle responses showing satisfactory results in the preservation of muscle mass, physical fitness and functionality of using this tool. Interesting outcomes have been observed in several profiles of patients, such as chronic obstructive pulmonary disease (COPD) and spinal cord injury (SCI). In critically ill patients, its use has shown reduction in mechanical ventilation (MV) days, ICU length and increased functionality of patients. The relevance of the systemic and metabolic effects from the electrostimulation neuromuscular (NMES) has been the basis for studies in critically ill patients. The refore, the ICU-AW is a reality in the setting of intensive care and prevention has given rise to appearance of new proposals and tools in preventing these complications.

Comparison of the effects of hamstring stretching using proprioceptive neuromuscular facilitation with prior application of cryotherapy or ultrasound therapy.

[Purpose] Stretching using proprioceptive neuromuscular facilitation involve physiological reflex mechanisms through submaximal contraction of agonists which activate Golgi organ, promoting the relaxation reflex. The aim of this study was to evaluate the effects of proprioceptive neuromuscular facilitation alone and with prior application of cryotherapy and thermotherapy on hamstring stretching. [Subjects and Methods] The sample comprised of 32 young subjects with hamstring retraction of the right limb. The subjects were randomly allocated to four groups: the control, flexibility PNF, flexibility PNF associated with cryotherapy, flexibility PNF in association with ultrasound therapy. [Results] After 12 stretching sessions, experimental groups showed significant improvements compared to the control group. Moreover, we did not find any significant differences among the experimental groups indicating PNF stretching alone elicits similar results to PNF stretching with prior administration of cryotherapy or thermotherapy. [Conclusion] PNF without other therapy may be a more practical and less expensive choice for clinical care.

Motor Imagery and Its Effect on Complex Regional Pain Syndrome: An Integrative Review.

The motor imagery (MI) has been proposed as a treatment in the complex regional pain syndrome type 1 (CRPS-1), since it seems to promote a brain reorganization effect on sensory-motor areas of pain perception. The aim of this paper is to investigate, through an integrative critical review, the influence of MI on the CRPS-1, correlating their evidence to clinical practice. Research in PEDro, Medline, Bireme and Google Scholar databases was conducted. Nine randomized controlled trials (level 2), 1 non-controlled clinical study (level 3), 1 case study (level 4), 1 systematic review (level 1), 2 review articles and 1 comment (level 5) were found. We can conclude that MI has shown effect in reducing pain and functionality that remains after 6 months of treatment. However, the difference between the MI strategies for CRPS-1 is unknown as well as the intensity of mental stress influences the painful response or effect of MI or other peripheral neuropathies.

Electrocortical Analysis of Patients with Intercostobrachial Pain Treated with TENS after Breast Cancer Surgery.

[Purpose] Among the physical therapeutic procedures to decrease pain, there is transcutaneous electrical neural stimulation (TENS). There is no consensus about its efficacy for oncological patients, especially for post-mastectomy pain and eletrocortical changes in somatosensory areas. The aim of this study was to analyze acute electrocortical changes after TENS treatment of patients with intercostobrachial post mastectomy pain. [Subjects] Eighteen patients were divided into acupuncture (A) and burst (B) group. [Methods] In this pre and post-intervention study each group was measured for EEG analysis in absulte power in alpha band (8-14 Hz). Outcomes variables were the alpha waveband in the sensorymotor cortex and pain pre-and-post TENS intervention. Data were analyzed using ANOVA to compare times (rest, 10 and 15 min), group and electrodes. Pain was analyzed using percentual pain evaluation (PPE) in both groups. [Results] Outcomes indicate main effects of time and electrodes because of slow (8-10 Hz) and fast alpha (10-12 Hz) wavebands decreased. PPE reduced 88.4% in A and 66.3% in G. [Conclusion] TENS promoted electrical modification in the parietal region and a decrease in pain. Future studies should investigate other wave must be proposed for other bands and use different methods of EEG analysis to elucidate the actual mechanisms behind the efficacy of TENS treatment.

Mobilização do osso pisiforme no tratamento da neuropraxia do nervo ulnar no canal de Guyon: relato de caso / Pisiform bone mobilization for treating ulnar nerve neuropraxia at Guyon's canal: case report

As neuropraxias do nervo ulnar são lesões bastante freqüentes que provocam efeitos deletérios, como diminuição de força muscular e parestesias; geralmente ocorrem no nível do epicôndilo medial e do túnel ulnar (canal de Guyon). São escassos os relatos referentes a técnicas de terapia manual para compressões do nervo ulnar no canal de Guyon. Este trabalho relata o uso da técnica de mobilização do pisiforme na compressão do nervo ulnar no canal de Guyon de um homem que sofreu luxação do punho direito aos 8 anos e, aos 25, queixava-se de um deficit para adução do dedo mínimo, que atrapalhava a realização de algumas atividades de vida diária. O paciente foi submetido a uma única sessão de mobilização articular do pisiforme. Após a aplicação da técnica, o sinal positivo do teste foi eliminado, restabelecendo-se a função de adução do 5o dedo. Embora carecendo de maior fundamentação teórica, pode-se afirmar que a técnica usada, de mobilização articular do osso pisiforme, é eficaz para melhora do quadro de paresia por neuropraxia do nervo ulnar no canal de Guyon...

A common ulnar nerve neuropraxia is lesion that may result in muscle strength decrease and/or paresthesia; it usually takes place at medial epicondylelevel and the ulnar tunnel (Guyon’s canal). Studies on manual therapy techniques for ulnar nerve compression in Guyon’s canal are scarce. This paper reports the use of a technique of pisiform bone mobilization for relieving ulnar nerve compression in Guyon’s canal, in a man who had suffered a luxation of the right wrist at the age of 8 and, at 25, complained of adduction deficit of the fifth finger that interfered in his daily life activities. He was submitted to one session of pisiform mobilization; after the session, the positive test sign was eliminated, thus restoring the fifth finger function. Though lacking further grounding, it may be said that the technique used, of mobilizing the pisiform bone joint, is effective to restore normal function after ulnar nerve compression at the Guyon’s canal...

Long-term clinical results on the use of bone-replacement grafts in the treatment of intrabony periodontal defects. Comparison of the use of autogenous bone graft plus calcium sulfate to autogenous bone graft covered with a bioabsorbable membrane.

BACKGROUND: Many clinical investigations have demonstrated the benefits of different regenerative approaches in the treatment of infrabony defects. The aim of this investigation was to evaluate the results obtained with the combination of autogenous bone grafting plus calcium sulfate and to compare this outcome with the results obtained using autogenous bone grafting with a bioabsorbable membrane. METHODS: Twelve subjects participated in this split-mouth trial. Twelve 2- or 3-wall periodontal defects were treated with a combination of autogenous bone grafting plus calcium sulfate (test) and were compared to 12 defects treated with autogenous bone grafting with a bioabsorbable membrane (control). Before surgery, subjects were instructed in oral hygiene techniques, and scaling and root planing were completed. Surgery was identical for both groups except for the regenerative material. After healing, subjects followed a periodontal maintenance program. Probing depth (PD), clinical attachment level, and bleeding on probing were recorded at baseline, 6 months, and 6 years. RESULTS: There were no statistical differences between test and control defects at baseline. At 6 months, there was a PD reduction of 4.3 +/- 1.0 mm in the control group and 4.4 +/- 1.1 mm in the test group. There was a clinical attachment gain of 3.5 +/- 1.1 mm in the control group and 3.6 +/- 1.0 mm in the test group. At 6 years, there was a PD reduction of 3.3 +/- 1.0 mm in the control group and 4.2 +/- 1.2 mm in the test group. There was a clinical attachment gain of 2.6 +/- 1.2 mm in the control group and 2.4 +/- 1.1 mm in the test group. Differences between treatment groups were not statistically significant at 6 months or 6 years. CONCLUSION: Both therapies led to significant short- and long-term improvements in the outcome variables assessed.

Alongamento estático como recurso cinesioterapêutico na síndrome do piriforme encurtado / Static stretching program as a kinesiotherapeutic resource in the tightened piriformis syndrome

A dor lombar, muitas vezes, está relacionada com a irritação do nervo isquiático (NI) que, devido à sua localização, está freqüentemente envolvido com problemas do músculo piriforme (MP). A Síndrome do Piriforme Encurtado (SPE) é uma disfunção mecânica causada pela compressão do NI provocada pelo MP, proveniente de um encurtamento. Ela provoca dor na região profunda do glúteo que pode irradiar-se para coxa, perna posteriormente, e pé. As etiologias mais comuns da SPE são o trauma direto, processos inflamatórios crônicos, hipertrofia muscular por excesso de uso e variações anatômicas. Avaliação minuciosa, manobras e testes provocativos poderão ser de valia no diagnóstico da SPE, que, geralmente, é de exclusão. A maioria dos casos pode ser abordada com tratamento conservador, que consiste em programa de alongamento estático, podendo ou não, ser associado a outros recursos. O objetivo do presente trabalho é mostrar a eficácia do alongamento estático como recurso na SPE.

Low back pain is many times related to an irritation of the ischiatic nerve (IN) that, due to its location, is frequently involved with the piriformis muscle (PM) problems. The tightened piriformis syndrome (TPS) is a mechanical disorder caused by the compression of the IN by the PM, originated from a tighten muscle. It provokes a deep gluteus pain that radiates into posterior thigh, leg and foot. The most common causes of TPS are acute trauma, chronic inflammation, muscular hypertrophy because of overuse, and anatomical variations. It is necessary a thorough assessment through provoking tests and maneuvers as an assistance to the difficult diagnosis of the TPS, which is often overlooked. In most cases, the approach is the conservative treatment which consists of a static stretching program, associated or not with other resources. The main objective of the present work is to show the efficacy of the static stretching as treatment of TPS.