Global Postural Re-education in non-specific neck and low back pain treatment: A pilot study.

BACKGROUND: Spinal pain is an important public health issue that brings biopsychosocial problems. Global Postural Re-education (GPR) is one of its treatments. OBJECTIVE: Evaluate the effects of GPR on pain, flexibility, and posture of individuals with non-specific low back pain and/or neck pain for more than six weeks. METHODS: The study enrolled 18 individuals, which were randomized into two groups: GPR group (GPRG; n= 09), submitted to 10 sessions of GPR and control group (CG; n= 09), not submitted to any technique. The evaluations were done before and after the GPRG sessions, for pain perception (Visual Analogue Scale - VAS), flexibility (finger-floor test) and posture (SAPO). The re-evaluation was done in the GPRG after the end of 10 treatment sessions and, in the GC, after the time equivalent to 10 sessions. The level of significance was set at p< 0.05. RESULTS: This pilot study has no homogeneity between groups. GPRG presented improvement in pain and flexibility, but showed no changes in posture. In the CG, there was no difference in the variables evaluated in this study. CONCLUSION: GPR had positive effects on pain and flexibility, but did not present a significant effect on posture.

Use of Virtual Rehabilitation to Improve the Symmetry of Body Temperature, Balance, and Functionality of Patients with Stroke Sequelae.

BACKGROUND: Stroke rehabilitation that is based on the patients' needs, experiences, and priorities requires extensive knowledge and skills to capture and integrate the perspectives of the subject. PURPOSE: The objective of this study was to evaluate the acute effect of an occupational therapy protocol associated with virtual reality (VR) on the symmetry of body temperature (BTP), balance, and functionality of patients with stroke sequelae. METHODS: Ten patients (69.84 ± 7.55 years) diagnosed with stroke between 2 and 10 years earlier were evaluated during clinical care sessions integrated with VR games. Associated with games, all patients were stimulated to use both upper and lower limbs and distribute body weight symmetrically, and perceptual stimuli of body-half training, alignment, postural control, and balance were given. The variables of thermography (temperature [°C] and body asymmetry) of the upper and lower limbs, balance (Berg scale), and functionality were analyzed before and after the test. RESULTS: BTP was reduced in the 4 upper and lower limb body regions of interest: the right arm (p = 0.024, Cohen's d = 1.02), previous direct hand (p = 0.034, Cohen's d = 1.22), right back hand (p = 0.003, Cohen's d = 1.85) and Left (p = 0.013, Cohen's d = 0.92), right thigh (p = 0.035, Cohen's d = 1.32), and left thigh (p = 0.047, Cohen's d = 0.92). The mean of the bilateral asymmetry variation of the arm in the anterior position at the pre test was classified according to the level of attention monitoring (which means that the asymmetry rate is above normal), changing its state at the end of the intervention to normal. There was an increase in the functional independence score (p = 0.015, Cohen's d = 0.50) and in the static and dynamic balance function (p = 0.001, Cohen's d = 0.07). CONCLUSION: VR associated with occupational therapeutic planning can amplify and potentiate neurological recovery following stroke.

Impact of dry needling and ischemic pressure in the myofascial syndrome: controlled clinical trial / Impacto do agulhamento seco e compressão isquêmica na síndrome miofascial: ensaio clínico controlado

Introduction Musculoskeletal pain is a common clinical condition and about 10% of the population have musculoskeletal disorder. Objective The aim of this study was to evaluate whether ischemic pressure and dry needling techniques are able to reduce the pain of patients with myofascial pain syndrome. Method 22 patients aged 20-75 years were randomized into 3 groups: ischemic pressure (IPG = 8), dry needling (DNG = 7) and control (CG = 7). Patients in the IPG and DNG were assessed before and after 10 intervention sessions, which occurred 3 times per week. The CG was assessed initially and reassessed three weeks later. The assessment of pain was done through Visual Analogic Scale (VAS) and quality of life through WHOQOL-BREF (5 domains: global, physical, psychological, social and environmental). Results There was no significant difference for clinical and demographic data of all groups at baseline, except for age (p = 0.042). The results of the VAS expressed that IPG had pain relief in most sessions, the same was not observed for DNG. Comparing the 2 groups was obtained difference in the 4th and 8th sessions. The results of the WHOQOL-BREF showed that the three groups had a significant increase in the psychological domain. The same was not true for global domains, physical, environmental and social. Conclusion Ischemic pressure and dry needling were able to reduce the pain of patients and also change their quality of life, specifically the psychological aspect.

Introdução A dor musculoesquelética é uma condição clínica comum e cerca de 10% da população possui distúrbio do sistema musculoesquelético. Objetivo O objetivo deste estudo foi avaliar se a compressão isquêmica e o agulhamento seco são técnicas capazes de reduzir a dor de pacientes com síndrome miofascial. Método 22 pacientes com idade entre 20-75 anos foram randomizados em 3 grupos: compressão isquêmica (GCI = 8), agulhamento seco (GAS = 7) e controle (GC = 7). Os pacientes do GCI e GAS foram avaliados antes e após as 10 sessões terapêuticas, que ocorreram 3 vezes por semana. O GC foi avaliado inicialmente e reavaliado 3 semanas depois. Para mensuração da dor usou-se a Escala Visual Analógica (EVA) e da qualidade de vida o WHOQOL-BREF (5 domínios: global, físico, psicológico, social e meio ambiente). Resultados A análise dos dados clínicos e demográficos mostrou que não houve diferença entre os grupos, exceto para idade (p = 0,042). Os resultados da EVA expressaram que o GCI teve redução da dor na maioria das sessões, o mesmo não se observou para o GAS. Comparando os 2 grupos obteve-se diferença na 4ª e 8ª sessões. Os resultados do WHOQOL-BREF demonstraram que os 3 grupos tiveram um aumento significante no domínio psicológico. O mesmo não ocorreu para os domínios global, físico, meio ambiente e social. Conclusão A compressão isquêmica e o agulhamento seco foram capazes de reduzir a dor dos pacientes e também intervir na sua qualidade de vida, especificamente no aspecto psicológico.

Back school program for back pain: education or physical exercise? / Escola de postura para dor de coluna: educação ou exercício físico?

Introduction: Back school consists in an educational program aimed at preventing back pain and rehabilitating individuals with degenerative disorders. Objective: To evaluate the effects of back school components (education and/ or exercise therapy) in relieving pain and improving quality of life in patients with chronic back pain. Method: Forty-one patients were randomized and allocated into four groups: (i) a back school group (educational lessons and physical exercise); (ii) an educational lessons group; (iii) a physical exercise group and (iv) a waiting list control group . Patients were evaluated before and after treatment with a visual analogue scale, a short form quality-of-life questionnaire, a Roland Morris disability questionnaire and a finger-floor distance test. Results: The back school group showed significant reduction in scores in the visual analogue scale and the Roland Morris disability questionnaire and an increase in the short- form quality of life questionnaire. Conclusion: The effectiveness of back school programs in chronic back pain patients seems to be due to the physical exercise component and not on account of the educational lessons.

Introdução: A escola de postura consiste em um programa educacional visando a prevenir dores na coluna e reabilitar indivíduos com desordens degenerativas. Objetivo: Examinar os efeitos dos componentes da escola de postura (educação e/ou exercícios terapêuticos) para aliviar dor e melhorar a qualidade de vida dos pacientes com dor lombar crônica. Método : Quarenta e um pacientes foram randomizados e alocados em quatro grupos: (i) grupo escola de postura (lições educativas e exercícios terapêuticos); (ii) grupo lições educativas; (iii) grupo exercício terapêutico e (iv) grupo controle (pacientes da lista de espera). Avaliaram-se os pacientes no início e no fim do tratamento usando-se: escala visual analógica, questionário de qualidade de vida abreviado, questionário de incapacidade de Roland Morris e teste distância dedo-chão. Resultados: O grupo escola de postura apresentou redução significativa nos escores da escala visual analógica e nos do questionário de incapacidade de Roland Morris, além do aumento dos escores de saúde do questionário de qualidade de vida abreviado. Conclusão: A eficácia do programa da escola de postura no tratamento de pacientes com dor lombar crônica parece ser devido ao programa de exercício terapêutico e não as lições educativas.

Desenvolvimento e aprimoramento de um sistema computacional- Ikapp- de suporte a reabilitação motora / Development and improvement of a computational system- Ikapp- to support motor rehabilitation

A aplicabilidade das Tecnologias Interativas (TIs) na área de saúde, em particular na reabilitação motora, tem sido uma alternativa clínica usada com intuito de estimular maior engajamento do paciente ao seu processo de recuperação que por vezes é extenuante. O presente estudo descreve uma ferramenta tecnológica -Ikapp- de suporte a reabilitação motora. Ferramenta essa que busca ampliar as possibilidades dos dispositivos comerciais já existentes no contexto clínico. Sessenta (60) voluntários foram convidados a interagir com as interfaces do setup e do jogo do Ikapp com objetivo de examinar a funcionalidade, grau de aceitação, demandas e limitações para aprimoramentos. Os resultados do presente estudo demonstram altos índices de satisfação pelos participantes. Além disso, os resultados demonstraram que o Ikapp é uma ferramenta que agrega valores terapêuticos à ludicidade e motivação de acordo com a perspectiva dos participantes.

The applicability of Interactive Technologies (ITs) in the health area, especially in motor rehabilitation, has been a therapeutic alternative used aiming to encourage a greater patient engagement in their recovery process that is sometimes lengthy. The present study describes the technological tool (Ikapp) to support motor rehabilitation, which aims to expand the possibility of the commercial devices that is already used in clinical practice. Sixty (60) volunteers were invited to interact with the setup and game interfaces of Ikapp aiming to examine their features, the degree of acceptance, demands and limitations to the enhancement. The results of present study showed high levels of satisfaction for the participants. Furthermore, the results demonstrated that the Ikapp is a tool that adds value to therapeutic playfulness and motivation according to the participant' perspective.

Nutrition-dependent influence of peripheral electrical stimulation during brain development on cortical spreading depression in weaned rats.

As several other factors, nutritional deficiency and sensory input hyperactivation can influence the mammalian brain development. This work investigated the effects of repeated episodes of early peripheral electrostimulation (PE), associated or not with early malnutrition, on cortical spreading depression (CSD) propagation. From postnatal days 7-28, well-nourished and malnourished Wistar rat pups (whose mothers were fed a 23 and 8% protein diet, respectively) received daily sessions of repetitive PE (2 or 60 Hz-square-wave pulses, 1.5 ms duration, 10-40 V intensity), delivered by two electrodes attached to the left paws. At postnatal days 35-45, under anesthesia, KCl-elicited spreading depression was monitored at two cortical points of both hemispheres. In the well-nourished rats, 2 Hz, but not 60 Hz PE was associated with slower spreading depression propagation in the hemisphere contralateral to the stimulated body-side, as compared to the ipsilateral hemisphere. In the malnourished rats, this effect was found for both 2 and 60 Hz stimulation frequencies. In the sham-stimulated controls, which received similar paw-electrodes, but were not stimulated, no inter-hemispheric spreading depression differences were seen. The results indicate an impairing effect of early PE on spreading depression propagation, which is frequency-dependent and can be influenced by the animal's nutritional status. Data raise the question whether brain plasticity changes consequent to the interaction between sensory input activation and malnutrition would be involved in the here described spreading depression effects.