Cross-cultural adaptation, reliability and construct validity of the Tampa scale for kinesiophobia for temporomandibular disorders (TSK/TMD-Br) into Brazilian Portuguese.

Fear of movement (kinesiophobia) seems to play an important role in the development of chronic pain. However, for temporomandibular disorders (TMD), there is a scarcity of studies about this topic. The Tampa Scale for Kinesiophobia for TMD (TSK/TMD) is the most widely used instrument to measure fear of movement and it is not available in Brazilian Portuguese. The purpose of this study was to culturally adapt the TSK/TMD to Brazilian Portuguese and to assess its psychometric properties regarding internal consistency, reliability, and construct and structural validity. A total of 100 female patients with chronic TMD participated in the validation process of the TSK/TMD-Br. The intraclass correlation coefficient (ICC) was used for statistical analysis of reliability (test-retest), Cronbach's alpha for internal consistency, Spearman's rank correlation for construct validity and confirmatory factor analysis (CFA) for structural validity. CFA endorsed the pre-specified model with two domains and 12-items (Activity Avoidance - AA/Somatic Focus - SF) and all items obtained a loading factor greater than 0·4. Acceptable levels of reliability were found (ICC > 0·75) for all questions and domains of the TSK/TMD-Br. For internal consistency, Cronbach's α of 0·78 for both domains were found. Moderate correlations (0·40 < r < 0.60) were observed for 84% of the analyses conducted between TSK/TMD-Br scores versus catastrophising, depression and jaw functional limitation. TSK/TMD-Br 12 items and two-factor demonstrated sound psychometric properties (transcultural validity, reliability, internal consistency and structural validity). In such a way, the instrument can be used in clinical settings and for research purposes.

Associations among temporomandibular disorders, chronic neck pain and neck pain disability in computer office workers: a pilot study.

Neck pain is the most common musculoskeletal complaint among computer office workers. There are several reports about the coexistence of neck pain and temporomandibular disorders (TMD). However, there are no studies investigating this association in the context of work involving computers. The purpose of this study was to verify the association between TMD and neck pain in computer office workers. Fifty-two female computer workers who were divided into two groups: (i) those with self-reported chronic neck pain and disability (WNP) (n = 26) and (ii) those without self-reported neck pain (WONP) (n = 26), and a control group (CG) consisting of 26 women who did not work with computers participated in this study. Clinical assessments were performed to establish a diagnosis of TMD, and craniocervical mechanical pain was assessed using manual palpation and pressure pain threshold (PPT). The results of this study showed that the WNP group had a higher percentage of participants with TMD than the WONP group (42·30% vs. 23·07%, χ(2) = 5·70, P = 0·02). PPTs in all cervical sites were significantly lower in the groups WNP and WONP compared to the CG. Regression analysis revealed TMD, neck pain and work-related factors to be good predictors of disability (R(2) = 0·93, P < 0·001). These results highlighted the importance of considering the work conditions of patients with TMD, as neck disability in computer workers is explained by the association among neck pain, TMD and unfavourable workplace conditions. Consequently, this study attempted to emphasise the importance of considering work activity for minimising neck pain-related disability.

Reduced thermal threshold in patients with Temporomandibular Disorders.

BACKGROUND: Many studies have demonstrated the presence of somatosensory modulation changes at different sites in patients with temporomandibular disorders (TMDs) using different modalities. However, the neck area, a well-know condition related to TMD, remains unexplored. OBJECTIVE: To assess the thermal pain threshold in patients with TMD and controls at cephalic and extra-cephalic areas, including the neck. METHODS: Twenty female patients with TMDs diagnosed by the Research Diagnostic Criteria for TMD (RDC/TMD) and twenty age-matched controls underwent a first interview about neck pain and disability (NDI questionnaire). A blinded evaluator assessed the thermal pain threshold for cold (CPT) and heat (HPT) stimuli in accordance with an ascending method of limits of the Quantitative Sensory Testing at the following sites: periorbital, masseter, cervical posterior and ventral forearm. The groups were compared using a t-test with α = 5%. RESULTS: Patients with TMDs reported pain at higher temperature for cold stimuli in all sites (P < 0·05) and at lower temperature for heat stimuli in the right periorbital site (P < 0·05) than controls. Pain and disability due tothis symptom were reported more often in the TMD group (P < 0·05). CONCLUSION: Patients with TMD have pain modulation changes in the neck area as well, especially for cold stimuli, associated with higher disability and a higher report of neck pain than controls. These findings reinforce the evidence regarding the relationship between TMDs and neck pain.

Cervical muscle parameters and allodynia in migraine and cervical pain-A controlled study.

BACKGROUND: Neck pain is common among individuals with migraine, but there is a lack of information of how this comorbidity can be associated with cervical muscle function. This controlled cross-sectional study aimed to compare cervical muscle function, activity, and sensitization in women with migraine, neck pain, both, and neither. METHODS: This study included women, between 18 and 55 years old, with either episodic migraine with or without aura, without any concomitant headache diagnosis; chronic neck pain, with at least moderate intensity and mild disability; or neither headache nor neck pain. Pain pressure threshold, allodynia, muscle strength, and endurance and cervical muscles activity were evaluated. RESULTS: One hundred subjects, with mean age of 30.4 years old, were stratified by diagnosis (n = 25 per group) and by self-reported pain during tests. Lower endurance during flexion was observed for migraine and neck pain (34s) relative to neck pain alone (45s), migraine (40s), and controls (58s) (p = 0.04). For extensor endurance, means were 142s, 166s, 215s, and 270s, respectively (p < 0.001). Endurance times were impacted by the presence of test-induced pain decreasing about 40%-53% of the performance. Diagnostic groups did not differ significantly in strength (p > 0.05), but all pain groups presented significantly higher proportion of test-induced pain, lower muscle activity during the maximal isometric voluntary contractions, and lower pressure pain thresholds. CONCLUSION: Patients with migraine, chronic neck pain, and the association of both present altered cervical muscle function and activity. Also, test-induced pain impacts significantly on neck muscles endurance. SIGNIFICANCE: The diagnosis of migraine and chronic neck pain is associated with altered function and activity of the cervical muscles. However, the test-induced pain had an important contribution to worse cervical muscle endurance. This suggests that the therapeutic approach should focus on de-sensitization of the trigeminal-cervical complex when dealing with the comorbidity of migraine and cervical pain.

Temporomandibular disorders and cutaneous allodynia are associated in individuals with migraine.

The objective of this study was to estimate and contrast the occurrence of ictal and interictal cutaneous allodynia (CA) in individuals with migraine with and without temporomandibular disorders (TMD). Both TMD and CA are common in migraine and may be associated with migraine transformation from episodic into a chronic form. Herein we hypothesize that TMD contributes to the development of CA and to more severe headaches. In a clinic-based sample of individuals with episodic migraine, the presence of TMD was assessed using the research diagnostic criteria for myofascial or mixed (myofascial and arthralgic) TMD. Ictal CA was quantified using the validated Allodynia Symptom Checklist (ASC-12). The ASC-12 measures CA over the preceding month by asking 12 questions about the frequency of allodynia symptoms during headaches. Interictal CA was assessed in the domains of heat, cold and mechanical static allodynia using quantitative sensory testing. Our sample consists of 55 individuals; 40 (73%) had TMD (23 with myofascial TMD and 17 with the mixed type). CA of any severity (as assessed by ASC-12) occurred in 40% of those without TMD (reference group), 86.9% of those with myofascial TMD (P = 0.041, RR = 3.2, 95% CI = 1.5-7.0) and in 82.3% of those with mixed TMD (P = 0.02, RR = 2.5, 95% CI = 1.2-5.3). Individuals with TMD were more likely to have moderate or severe CA associated with their headaches. Interictally (quantitative sensory testing), thresholds for heat and mechanical nociception were significantly lower in individuals with TMD. Cold nociceptive thresholds were not significantly different in migraine patients with and without TMD. TMDs were also associated with change in extra-cephalic pain thresholds. In logistical regression, TMD remained associated with CA after adjusting for aura, gender and age. TMD and CA are associated in individuals with migraine.

Do patients with migraine experience an increased prevalence of falls and fear of falling? A cross-sectional study.

OBJECTIVE: To assess the prevalence of falls and fear of falling in patients with migraine compared with controls. DESIGN: Cross-sectional. SETTING: Tertiary headache clinic. PARTICIPANTS: This study consisted of 105 controls and 105 consecutive patients diagnosed with migraine with aura (MA, n=35), migraine without aura (MO, n=35) and chronic migraine (CM, n=35). MAIN OUTCOME MEASURES: Patients were interviewed using a questionnaire containing questions about the history of falls and impairment in balance, and completed the International Falls Efficacy Scale (FES-I). Groups were contrasted using Student's t-test and analysis of variance, and prevalence ratios were estimated. RESULTS: Falls and self-reported impairment in balance are more prevalent in patients with migraine (54% and 69%, respectively) than in controls (2% and 2%, respectively). In particular, patients with CM and MA reported a greater mean number of falls during the previous year {CM 1.4 [standard deviation (SD) 2.2]; MA 2.2 (SD 2.3)} compared with patients with MO [0.5 (SD 1.0); P <0.04] and controls [0.05 (SD 0.2); P <0.002]. The prevalence ratio of falls was greater in patients with MA (7.2; P <0.002) and CM (4.5; P <0.002) compared with controls. Patients with migraine experienced a high level of concern about falls during their daily activities compared with controls (29.8 vs 20.1 points in the FES-I questionnaire; P<0.0001). CONCLUSIONS: The balance impairment of patients with migraine may have a functional impact. Migraine is associated with risk of falling, and patients exhibit a higher prevalence of impairment in balance, falls and fear of falling.

Assessment of the maximum voluntary arm muscle contraction in sign language for the deaf.

OBJECTIVE: The purpose of this study was to investigate the levels of upper member muscles' activation of deaf individuals, who use the Brazilian sign language - LIBRAS, comparing these findings to volunteers with no postural deviations and normal hearing METHODS: Forty eight volunteers divided into two groups comprising healthy and deaf subjects (24 volunteers for each group). The signs of rest were obtained with the volunteer maintaining the upper member in an anatomical position, but with the forearm flexed and sustained by the lower member. Maximum voluntary isometric contractions (MVIC) of the biceps, triceps, deltoid, and trapezius muscles were performed in the position of muscular function testing. Statistical analysis was performed using the SPSS-10.0. Continuous data with normal distribution were analyzed by ANOVA with the significance level of p < 0.01. RESULTS: The normalized electromyographic muscle data obtained in muscular rest do not show statistically significant differences among the studies muscles, in both groups. In the comparison of normalized RMS values obtained in MVIC, the mean values for the trapezius muscle of deaf group were statistically lower than control group. CONCLUSIONS: This study's results indicate there are no differences between the levels of muscular activation for arm biceps, arm triceps, and the anterior portion of the deltoid muscle between the mean normalized RMS values of deaf and healthy individuals.

Electromyographic amplitude variability of chewing cycles in deaf individuals.

This study had the goal of determining if the amplitude of the surface electromyograph signals changes in terms of time of analysis and subjects, deaf or normal listeners, when estimated in a 250 ms of length window, visually determined, considering the most stable signal period from the center of the chewing cycle. In order to do this, groups with control subjects, listeners and deaf individuals, who made use of the Brazilian sign language (LIBRAS), were studied. All participants performed continuous 5 s of chewing for the electromyographic recording of the temporalis and masseter muscles. The normalized RMS values of three chewing cycles were compared between and among groups. The results from the Kruskall-Wallis test did not show any statistically significant differences (p > 0.05) between the normalized RMS values obtained in the three individual chewing cycles, for each of the two completed and evaluated cycles, in both groups studied. The Mann-Whitney test showed that the mean normalized RMS values obtained in the first chewing cycle were higher for the control group when compared to the mean amplitude values of the first chewing cycle of the group of deaf volunteers. It can be concluded that, in these experimental conditions, the RMS values obtained from the select windows of 250 ms length duration, in relatively stable periods of the electromyographic signal of chewing cycles did not suffer any changes in terms of EMG register duration, in both studied groups, but does give evidence of the differences among the groups.

Análise comparativa entre avaliação postural visual e por fotogrametria computadorizada / Comparative analysis between visual and computerized photogrammetry postural assessment

OBJETIVOS: Comparar a concordância interobservador da avaliação postural visual e por fotogrametria e verificar se os resultados quantitativos da fotogrametria correspondem à detecção de simetrias e assimetrias pela avaliação postural visual qualitativa. MÉTODOS: Vinte e um voluntários (24±1,9 anos) foram inicialmente avaliados visualmente por três fisioterapeutas experientes que preencheram um protocolo de avaliação postural. Em seguida tiveram fotografados a face e o corpo todo nos planos frontal anterior, posterior e sagital. As fotos foram utilizadas para traçar ângulos a partir de marcadores fixados à pele, em vários pontos anatômicos, que são referências frequentes na avaliação postural tradicional. Essas fotografias foram analisadas por três examinadores diferentes da avaliação postural visual. A concordância de cada método de avaliação postural foi avaliada pelos Coeficientes de Cramer V ou de PHI, considerando-se um nível de significância de 5 por cento. RESULTADOS: Foi encontrada uma concordância entre os examinadores que utilizaram a fotogrametria para todos os segmentos avaliados. Não apresentaram concordância os segmentos comissura labial (p=0,00), acrômio clavicular (p=0,01), esternoclavicular (p=0,00), espinhas ilíacas anterior e posterior (p=0,00 e p=0,01) e ângulo inferior da escápula (p=0,00), que foram analizados por meio da avaliação postural visual. A comparação entre a fotogrametria e a avaliação postural visual demonstrou que o grau de concordância entre os dois métodos de avaliação foi pouco significativo para alguns segmentos do membro inferior e pelve. CONCLUSÕES: Nessas condições experimentais, os dados da fotogrametria não podem ser correlacionados com os dados da avaliação postural visual. A avaliação postural visual apresentou dados menos concordantes do que a fotogrametria, devendo ser questionada sua utilização como gold-standart.

OBJECTIVES: To compare the interobserver agreement between visual and photogrammetry postural assessment and to determine whether the quantitative photogrammetry results correspond to the symmetries and asymmetries detected through qualitative visual postural assessment. METHODS: Twenty-one volunteers (mean age 24±1.9 years) were visually evaluated by three experienced physical therapists, who completed a postural assessment form. The participants' face and whole body were then photographed in the anterior and posterior frontal and sagittal planes. The photographs were used to draw angles from markers fixed to the skin at various anatomical points that are frequent references in traditional postural assessment. These photographs were analyzed by three examiners (other than the ones who performed the visual assessment). The agreement in each postural assessment method was determined using Cramer's V or the Phi coefficient, with the significance level set at 5 percent. RESULTS: There was agreement between the examiners who used photogrammetry, for all segments analyzed. No agreement was found for the labial commissure (p=0.00), acromioclavicular joint (p=0.01), sternoclavicular joint (p=0.00), anterior and posterior iliac spines (p=0.00 and p=0.01) or inferior angle of the scapula (p=0.00) when assessed visually. The comparison between photogrammetry and visual postural assessment showed that the agreement level between the two assessment methods was poor for some segments of the lower limb and pelvis. CONCLUSIONS: Under these experimental conditions, the photogrammetry data were not correlated with the results from the visual postural assessment. The visual postural assessment produced data that were in less agreement than the photogrammetry data, and its use as a gold standard must be questioned.

Craniocervical posture analysis in patients with temporomandibular disorder / Análise da postura cranio-cervical em pacientes com disfunção temporomandibular

OBJECTIVE: To compare head positioning and cervical spine alignment between individuals with and without temporomandibular disorders (TMDs), by means of positional evaluation using photographs, radiographs and visual observation, and to investigate whether the type of TMD influences head posture and cervical spine positioning. METHODS: Ninety randomly chosen women were diagnosed using the research diagnostic criteria for TMDs (RDC/TMD) by a trained examiner and were divided into three groups: Group 1, with a diagnosis of myofascial dysfunction (group I of RDC axis I); Group 2, with mixed TMD (groups I, II and III of RDC axis I); and Control, without TMD. Following this, the participants were photographed in frontal and lateral views by a single examiner. To produce these photos, the following anatomical points were marked out on the skin: occipital protuberance, C4, C7, acromioclavicular joint and sternoclavicular joint. From these points, different angles were analyzed by means of the ALCimagem-2000 application. These same photos were then evaluated qualitatively (visual evaluation). Next, lateral teleradiography and radiography of the cervical spine was requested. The examiner was blind when analyzing the images. To compare the results, the chi-squared test and analysis of variance were used, with significance levels of 5 percent. RESULTS: Regardless of the method used, the results revealed that head and cervical spine posture did not differ between the groups with and without TMD, independent of the diagnostic group. CONCLUSION: The posture of individuals with myogenic or arthrogenous TMD does not differ from the posture of individuals without TMD. The presence of TMD does not influence the head and cervical spine posture.

OBJETIVO: Comparar o posicionamento da cabeça e o alinhamento da coluna cervical em indivíduos com e sem DTM, por meio da avaliação postural por fotografias, radiografias e por observação visual e verificar se o tipo de DTM influencia na postura da cabeça e no posicionamento da coluna cervical. MÉTODOS: Noventa mulheres escolhidas aleatoriamente foram diagnosticadas por meio dos Critérios para Diagnóstico em Pesquisa para Disfunções Temporomandibulares (RDC/TMD) por um examinador treinado e divididas em três grupos: grupo 1, diagnóstico de disfunção miofascial (grupo I do eixo I do RDC); grupo 2, com DTM mista (grupo I, II e III do eixo I do RDC) e controle, sem DTM . Em seguida, foram fotografadas em vista anterior e em perfil por um único examinador. Para a realização dessas fotografias, foram demarcados sobre a pele os seguintes pontos anatômicos: protuberância occiptal, C4, C7, articulação acromioclavicular e esternoclavicular. A partir desses pontos, foram analisados diferentes ângulos por meio do aplicativo ALCimagem-2000. Essas mesmas fotos foram posteriormente avaliadas qualitativamente (avaliação visual). Em seguida, foi solicitada uma radiografia e uma telerradiografia em perfil. O examinador foi cego ao analisar as imagens. Para comparação dos resultados, foi utilizado o teste qui-quadrado e a análise de variância com nível de significância de 5 por cento. RESULTADOS: Independentemente do método utilizado, os resultados revelaram que a postura da cabeça e da coluna cervical não diferem entre o grupo com DTM e sem DTM, independentemente do grupo diagnosticado. CONCLUSÃO: A postura do indivíduo com DTM miogênica ou artrogênica não é diferente do indivíduo sem DTM. A presença da DTM não influencia na postura da cabeça e da coluna cervical.

Análise do tempo de resposta reflexa dos músculos estabilizadores patelares em indivíduos com síndrome da dor patelofemural / Analysis of the reflex response time of the patellar stabilizer muscles in individuals with patellofemoral pain syndrome

OBJETIVO: Avaliar o tempo de resposta reflexa (TRR) dos músculos vasto medial oblíquo (VMO), vasto lateral oblíquo (VLO) e vasto lateral longo (VLL) em indivíduos clinicamente saudáveis e portadores de síndrome da dor patelofemural (SDPF). MÉTODOS: Foram avaliadas 12 mulheres clinicamente saudáveis e 12 mulheres com SDPF. Os registros eletromiográficos foram obtidos por eletrodos ativos simples conectados a um eletromiógrafo, acionados por um sensor externo fixado sobre a porção média do ligamento da patela a partir de sua percussão. A análise do TRR foi realizada por meio da medida do tempo zero ao pico da resposta elétrica dos músculos VMO, VLO e VLL, em segundos, para ambos os grupos. A análise estatística empregada foi o teste de análise de variância (ANOVA, p< 0,05) e teste Tukey post hoc (p< 0,05) para comparação entre os músculos, e o teste t de Student (p< 0,05) para a comparação entre os grupos. RESULTADOS: Ambos os grupos apresentaram um TRR menor para o músculo VMO, quando comparado aos músculos VLO e VLL; entretanto, não se observou diferença significativa entre os músculos VLO e VLL. Na comparação do TRR entre os grupos, não se observou diferença significativa. CONCLUSÕES: De acordo com esses resultados, pode-se sugerir que o TRR das porções do músculo quadríceps não diferencia indivíduos com SDFP dos indivíduos clinicamente saudáveis, sendo que o VMO apresenta um TRR menor em relação ao VLO e VLL para ambos os grupos.

OBJECTIVE: To investigate the reflex response time (RRT) of the vastus medialis obliquus (VMO), vastus lateralis obliquus (VLO) and vastus lateralis longus (VLL) muscles in clinically healthy individuals and subjects with patellofemoral pain syndrome (PPS). METHODS: Twelve clinically health women and twelve women with PPS were evaluated. Electromyography (EMG) records were obtained using active electrodes connected to an electromyograph that was activated by an external sensor attached to the medial portion of the patella ligament, by means of percussion. The RRT was analyzed by measuring the time, in seconds, between zero and peak electrical response of the VMO, VLO and VLL muscles, for both groups. The statistical analysis consisted of analysis of variance (ANOVA, p< 0.05) and the Tukey post-hoc test (p< 0.05) to compare the response between muscles, and Student's t test (p< 0.05) to compare the response between groups. RESULTS: Both groups presented lower RRT for the VMO muscle than for the VLO and VLL muscles. However, no significant difference was seen between the VLO and VLL muscles. There was no significant difference in RRT between the groups. CONCLUSIONS: According to these results, it can be suggested that the RRTs in the different portions of the quadriceps muscle do not distinguish between subjects with PPS and clinically healthy individuals. The RRT for the VMO muscle was lower than the RRT for the VLO and VLL muscles, for both groups.

Confiabilidade da fleximetria e goniometria na avaliação da amplitude de movimento cervical em crianças / Reliability of fleximetry and goniometry for assessing cervical range of motion among children

OBJETIVO: Determinar a confiabilidade intra e interexaminadores e correlacionar os valores de amplitudes de movimentos (ADM) cervical obtidas por fleximetria e goniometria em crianças. MÉTODOS: Participaram deste estudo 106 crianças saudáveis, 49 meninos (8,91±2,09 anos) e 57 meninas (9,14±1,46 anos), com idades entre seis e 14 anos, assintomáticas para disfunção cervical. Dois examinadores previamente treinados e dois auxiliares avaliaram a ADM cervical. Os examinadores coletaram as medidas por fleximetria e goniometria (confiabilidade interexaminadores) e repetiram as avaliações, após uma semana (confiabilidade intra-examinador). Todas as medidas foram registradas três vezes por cada examinador e o valor médio foi considerado para análise estatística. O coeficiente de correlação intraclasse (ICC 2,1 e 2,2) foi utilizado para verificação das confiabilidades e o coeficiente de correlação de Pearson (p<0,05) foi utilizado para verificação da correlação entre as medidas obtidas por ambas as técnicas. RESULTADOS: Foram observadas confiabilidades intra-examinador moderado e excelente para a fleximetria e moderada para a goniometria. As confiabilidades interexaminadores foram moderada e excelente para a fleximetria e pobre e moderada para a goniometria. Foi verificada correlação significativa e pobre entre todas as medidas de ADM cervical obtida pelas técnicas estudadas, exceto para o movimento de rotação à esquerda. CONCLUSÕES: A correlação pobre entre as mensurações de ADM cervical obtidas por fleximetria e goniometria demonstram que as técnicas não apresentam medidas intercambiáveis e, como a fleximetria apresentou maiores níveis de confiabilidade para avaliação da ADM cervical em crianças, seu uso é recomendado em relação à goniometria.

OBJECTIVE: To determine the intra and interrater reliability of fleximetry and goniometry in children and correlate the cervical spine range of motion (ROM) values obtained from these methods. METHODS: One hundred six children participated in this study: 49 males (8.91±2.09 years) and 57 females (9.14±1.46 years). Their ages ranged from six to 14 years and symptom-free to cervical dysfunction. Two previously trained raters and two assistants assessed neck ROM. The measurements were made using fleximetry and goniometry (interrater reliability) and repeated them one week later (intrarater reliability). All measurements were made three times by each rater and the mean value was used for statistical analysis. Intraclass correlation coefficients (ICC 2.1 and 2.2) were used to investigate reliability and Pearson's correlation coefficient (p<0.05) was used to investigate the correlation between measurements obtained from the two techniques. RESULTS: Moderate and excellent levels for intrarater reliability were observed for fleximetry and moderate reliability for goniometry. The interrater reliability was moderate and excellent for fleximetry and poor and moderate for goniometry. Significantly poor correlation was found among all neck ROM measurements obtained using both techniques, except for rotation to the left. CONCLUSIONS: The poor correlation between neck ROM measurements obtained from fleximetry and goniometry demonstrated that these techniques do not present interchangeable measurements. Since fleximetry presented higher reliability levels for assessments of neck ROM among children, the use of fleximetry rather than goniometry is recommended.

Efeitos na medida do ângulo Q com a contração isométrica voluntária máxima do músculo quadricipital / Effects in the Q angle measurement with maximal voluntary isometric contraction of the quadriceps muscle

A proposta deste estudo foi verificar a diferença entre o ângulo quadricipital em indivíduos sintomáticos e assintomáticos, em duas diferentes situações de exame, com o quadríceps relaxado e em contração isométrica voluntária máxima (CIVM) através da mensuração radiográfica para contribuir na avaliação e tratamento de pacientes com disfunção femoropatelar (DFP). Foram avaliadas 20 mulheres (40 joelhos), com idade média de 21 anos, através de método radiológico padronizado. Os indivíduos foram posicionados em decúbito dorsal com um estabilizador podálico em "U", com os membros inferiores relaxados, com a utilização de película de chumbo sobre a tuberosidade anterior da tíbia. Para a análise estatística foram utilizadas as médias dos grupos assintomático e sintomático, em estado de relaxamento e em CIVM, e o teste t de Student, com nível de significância de p < 0,05. Os valores médios do ângulo Q para os assintomáticos foram de 17,15º em relaxamento e de 14,5º em CIVM, enquanto os sintomáticos apresentaram 21,45º e 15,8º, respectivamente. Nos resultados para a análise da igualdade entre os grupos sintomáticos e assintomáticos no estado de relaxamento obteve-se p = 0,004, e para o estado de contração isométrica voluntária máxima, p = 0,29. Considerando os dados obtidos no presente estudo, pode-se verificar que em estado de relaxamento há diferença entre o valor do ângulo Q entre indivíduos sintomáticos e assintomáticos, sendo este maior nos portadores da DFP, enquanto que em estado de contração isométrica máxima do músculo quadricipital não houve diferença estatística, ocorrendo redução do ângulo em ambos os grupos.

The purpose of this study was to analyze the difference between the angle of the quadriceps in symptomatic and asymptomatic individuals in two different examination situations, having the quadriceps relaxed and in a maximal voluntary isometric contraction (MVIC) through radiographic measurement, aiming to contribute to the assessment and treatment of patients with patelofemoral disorder (PFD). Through the standard radiological method twenty 21 years old mean women (40 knees) were assessed. All individuals were positioned supine using a U-podalic stabilizer, having their lower limbs relaxed, using a plumb film on the anterior tuberosity of the tibia. For the statistical analysis, the averages for the asymptomatic and symptomatic groups in a relaxed and MVIC status, as well as the Student's t-test with p < 0.05 significance level were used. The mean values to the Q angle compared to the asymptomatic group were 17.15º on relaxation, and 14.5º on MVIC, while the asymptomatic group presented 21.45º, and 15.8º, respectively. The results in the equality analysis between the symptomatic and asymptomatic groups on the relaxed status attained a p = 0.004, and to the maximal voluntary isometric contraction, p = 0.29. Considering the data attained in the present study, it can be verified that in a relaxing status, there is a difference between the value of the Q angle among symptomatic and asymptomatic individuals, being found a higher value in the FPD bearers, while in a maximal isometric contraction of the quadriceps muscle no statistical difference was found in the present study, with a reduction in the angle in both groups.

La propuesta de este estudio era verificar la diferencia entre el ángulo cuadricipital en los individuos sintomáticos y asintomáticos, en dos situaciones diferentes del examen físico; con el cuadriceps relajado y en el máximo de la reducción isométrico voluntario (CIVM) a través de la medida radiográfica para contribuir en la evaluación y el tratamiento de pacientes con trastorno fémoro-patelar (DFP). Se estimaron 20 mujeres (40 rodillas), con la edad media de 21 años, a través de método radiológico estandardizado. Los individuos se pusieron en decúbito con un estabilizador podálico en "U", con los miembros inferiores relajados, con el uso de película de plomo en la tuberosidad anterior de la espinilla. Para el análisis estadístico se usaron las medias del grupo asintomático y sintomático, en estado de relajación y en CIVM, y la prueba del test t, con un nivel de significancia de p < 0,05. Los valores medios del ángulo Q para los asintomáticos fueron de 17,15º en la relajación y de 14,5º en CIVM, mientras los sintomáticos presentaron 21,45º y 15,8º, respectivamente. En los resultados para el análisis de la igualdad entre los grupos sintomático y asintomático en el estado de relajación se obtuvo p = 0,004, y para el estado de reducción isométrica voluntaria máximo, p = 0,29. Considerando los datos obtenidos en el estudio presente, puede verificarse que en el estado de relajación hay diferencia entre el valor del ángulo Q entre los individuos sintomáticos y asintomáticos, siendo este más grande en los portadores de DFP, mientras en el estado de contracción isométrica máxima del músculo cuadriceps no presentó diferencia estadística, habiendo reducción del ángulo en ambos los grupos.

Efeito da rotação do quadril na sindrome da dor femoropatelar / Effect of hip rotation on patellofemoral pain syndrome

A proposta deste trabalho foi investigar o efeito da rotacao do quadril na atividade eletrica dos musculos Vasto Medial Obliquo (VMO). Vasto Lateral Obliquo (VLO) e Vasto Lateral Longo (VLL) no agachamento a 45o. de flexao do joelho associado a posicao neutra, rotacao laterala 45o. e rotacao medial a 15 e 30o. de quaril. Materiais e metodos: foram avaliadas 27 mulheres, sendo 15 mulheres normais do grupo controle (21,1+-2,1 anos) e 12 portadoras de sindrome da Dor Femoropatelar (SDFP) (21,0+-2,3 anos). A atividade eletrica do musculo quadriceps foi captada opr eletrodos ativos diferenciais simples de superficie, eletromiografo de 8 canais e programa Aqdados 7.2.6. Os dados foram normalizados pela porcentagem da media do agachamento a 75o. com o quadril em posicao neutra - RMS (uV). A analise estatistica utilizada foi ANOVA two way com medidas repetidas e Turkey pos hoc (p<-0,05). Resultados: os resultados evidenciaram interacao entre grupos e musculos (p=0,00), independente da posicao do quadril (p=0,39) e nao houve interacao entre grupos e posicoes do quadril (p=0,96). Os musculos VMO e VLL do grupo SDFP apresentaram atividade eletrica significativamente maior que o VMO (p=0,00) e VLL (p=0,04) do grupo controle. Por outro lado, a atividade eletrica do musculo VLO nao apresentou diferenca significativa entre os grupos (p=0,99). Conclusao: os resultados dessa pesquisa, nas condicoes experimentais utilizadas, sugerem que a rotacao do quadril nao influenciou a atividade eletrica das porcoes do quadriceps nos dois grupos no agachamento a 45o. de flexao do joelho

Atividade eletromiografica dos musculos masseter e temporal anterior de criancas com mordida cruzada posterior unilateral (MCPu) / EMG activity os Masseter and Anterior Temporalis muscles in children with unilateral posterior crossbite

A Mordida Cruzada Posterior unilateral (MCPu) pode estar relacionada ao desenvolvimento de alteracoes neuromusculares do sistema estomatognatico. No entanto, um padrao de atividade eletrica da musculatura mastigatoria de criancas com MCPu ainda nao foi determinada na literatura. Objetivo: comparar a atividade eletrica de musculos mastigatorios em criancas com MCPu comparadas a criancas com normoclusao. Metodo: participaram deste estudo seis criancas com MCPu a direita (MCPD: 7,5+-1,87 anos), seis com MCPu a esquerda (MCPE: 7,5+- 1,87 anos) e oito normoclusao (8,14+-2,91 anos). A atividade eletrica dos musculos temporal porcao anterior e masseter bilaterais foi avaliada por meio de eletromiografia de superficie durante a mastigacao habitual e bilateral com frequencia controlada de 0,9 HZ. para analise estatistica foi utilizado o teste de ANOVA (P<-0,05). Resultados: os resultados obtidos demonstraram nao haver diferencas significativas entre os gupos MCPD, MCPE e normoclusao na atividade eletrica dos musculos mastigatorios avaliados nas duas situacoes de mastigacao avaliadas, entretanto, foi observada tendencia de maior atividade dos musculos elevadores homolaterais a mordida cruzada de criancas com MCPu, bem como maior atividade dos musculos masseteres e temporais anteriores direitos, em comparacao aos musculos contralaterais, apenas em cria ncas com MCPD. Conclusao: Esses resultados demonstram nao haver diferencas na atividade eletrica dos musculos mastigatorios de criancas com MCPU. No entanto, a grande variabilidade observada nas criancas com MCPu, principalmente nas criancas com MCPD, pode ser mascarado as diferencas entre os grupos avaliados

Confiabilidadeintra e interexaminadores e repetibilidade da avaliacao postural pela fotogrametria / Intra and inter-examiner reliability and method repeatability of postural evaluation via photogrammetry

Propor avaliacao quantitativa das assimetrias posturais e verificar a confiabilidade intra e interexaminadores e a repetibilidade do metodo. Metodos: participaram 21 voluntarios (24+-1,9 anos) que tiveram fotografados a face e o corpo todo nos planos frontal anterior, posterior e sagital. Os angulos estudados form tracados nas fotos digitais, a partir de marcadores fixos a pele em varios pontos anatomicos, que sao referencias frequentes na avaliacao postural tradicional. A analise da confiabilidade foi efetuada a partir das medidas angulares de uma mesma foto, obtidas por um unico examinador em duas ocasioes (intra-examinadores) intervaladas por um mes e de uma so medida realizada por um terceiro examinador (interexaminadores). Arepetibilidade do metodo foi analisada pelas medidas angulares tomadas por um examinador em 2 fotos diferentes do mesmo sujeito, realizadas com intervalos de uma semana. O coeficiente de correlacao intraclasse (ICC) foi aplicado com nivel de significancia de 5 por cento. Resultados: O metodo proposto apresenta significativa confiabilidade intra e interexaminadores para a maioria dos angulos estudados. No entanto, a cifose toracica apresentou niveis nao aceitaveis de confiabilidade para a analise inter (ICC=0,603) e intra-examinador (ICC=0,031). Na repetibilidade do metodo, a maioria dos angulos estudados apresentou baixo nivel de confiabildade, exceto pelos angulos de inclinacao do pe direito (ICC=0,863) e triangulos de Talles (esquerdo ICC=0,922 e direito = 0,867). Conclusao: nessas condicoes experimentais a maioria dos valores angulares obtidos pelo metodo proposto apresentou confiabilidade intra e interexaminadores. No entanto, sua repetibilidade e baixa, sugerindo que o metodo e pouco indicado para o acompanhamento de mudancas posturais