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.

Effects of functional taping compared with sham taping and minimal intervention on pain intensity and static postural control for patients with non-specific chronic low back pain: a randomised clinical trial protocol.

OBJECTIVES: To investigate the immediate and 1-month effects of functional taping to lumbar spine for pain intensity and postural control in patients with chronic non-specific low back pain. DESIGN: Randomised clinical trial. PARTICIPANTS: One hundred and twenty participants aged 18 to 50 years. INTERVENTIONS: Participants will be allocated at random to receive one of three interventions: functional star-shape taping for 7 days, sham functional taping for 7 days or minimal intervention, one session. MAIN OUTCOME MEASURES: The primary outcomes will be pain intensity and postural control. Four measurements of static posturography will be conducted: pre-intervention, immediately after application of the tape, 7 days post-intervention (after removal of the tape) and 1-month follow-up. The secondary outcomes will be low-back-pain-related disability, global perceived effect of treatment and fear avoidance beliefs. Primary and secondary outcomes will be assessed on three occasions: pre-intervention, 7 days post-intervention and at 1-month follow-up. All statistical analyses will be conducted following intention-to-treat principles, and the treatment effects will be calculated using linear mixed models. DISCUSSION: The results of this study will determine the effects of functional taping on pain intensity and postural control compared with sham taping and minimal intervention. CLINICAL TRIAL REGISTRATION NUMBER: NCT02546466.

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.

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.

Reproducibility of 6- and 4-category faces pain scale to the assessment of temporomandibular joint pain and muscle in school-age children.

OBJECTIVE: The aim of this study was to compare the levels of reproducibility between two Faces Pain Scales (FPS) of 6 and 4 categories to the assessment of pain intensity on children with and without Temporomandibular joint and muscle pain. MATERIAL AND METHODS: A total of 29 children were recruited: 13 symptomatic (9.79 ± 1.36 years old) and 16 asymptomatic (8.69 ± 0.87 years old). One previously-trained examiner applied manual palpation to evaluate orofacial structures, and FPS to assess pain intensity. All children were initial evaluated using 6-category FPS and after 3 days using 4-category FPS. The children were assessed after a seven day time interval from initial and second sessions. Weighted Kappa coefficient was used to verify reproducibility levels. RESULTS: Similar levels of reproducibility (moderate and fair kappa values) have been verified with the application of the 6-category FPS on symptomatic and asymptomatic children. Similar results were verified using 4-category FPS on symptomatic and asymptomatic children (poor and fair kappa values). CONCLUSION: Higher levels of reproducibility were verified with the application of the 6-category FPS in both groups and considering symptomatic and asymptomatic as single group. In this way, the 6-category FPS should be preferred over the 4-category FPS to assess pain intensity on children's orofacial structures.

Differences in pain perception in children reporting joint and orofacial muscle pain.

PURPOSE: To determine changes in orofacial pain perception in community-based children by assessing the pressure pain threshold (PPT) with an algometer and pain intensity by manual palpation (MP). METHODS: A total of 100 children from the community aged 7 to 12 years were assessed. Thirty-eight children reported pain in the orofacial region. Of these children,10 reported joint pain (GJ), 12 reported joint and muscle pain (GJMM), 5 reported muscle pain (GMM), 11 reported pain during mastication (GMAST), and 62 reported no pain. An ANOVA (p < 0.05) was used to determine the differences in pain intensity and PPT among groups. RESULTS: Significantly higher pain intensity upon MP was observed for the temporalis muscle in the GJMM, GMAST and GJ groups compared to the remaining groups. The PPT values were significantly lower in the masseter temporalis muscles, TMJ and thenar region in the GJMM group compared to the other groups. CONCLUSION: MP more accurately differentiated symptomatic subjects from symptom-free TMD subjects, and PPT values were more sensitive to the discrimination of pain in the orofacial sites assessed. In addition, the changes in perception at a larger number of sites among children reporting mixed pain may suggest the presence of a possible mechanism of central sensitization.

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.

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.

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.

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