Ventilation asymmetry, diaphragmatic mobility and exercise capacity in men with traumatic brachial plexus injury.

OBJECTIVE: To investigate the repercussions of traumatic brachial plexus injury (TBPI) on diaphragmatic mobility and exercise capacity, compartmental volume changes, as well as volume contribution of each hemithorax and ventilation asymmetry during different respiratory maneuvers, and compare with healthy individuals. The velocity of shortening of the diaphragm, inspiratory, and expiratory muscles were also assessed. PARTICIPANTS: The cross-sectional study was conducted with 40 male individuals (20 with TBPI who have not undergone nerve transfer surgery [mean age 30.1 ± 5.3] and 20 healthy paired by age and body mass index). Only patients with C8-T1 root avulsion were studied. MAIN OUTCOME: Compartmental and hemithoracic volumes, as well as asymmetry between the affected and unaffected sides were assessed using optoelectronic plethysmography. The 6 minute walking test was performed to evaluate exercise capacity, while diaphragm mobility was assessed during quiet breathing (QB) using an ultrasound device. RESULTS: TBPI patients with mean lesion time of 174 ± 45.24 days showed a decreased pulmonary function, respiratory muscle strength, exercise capacity, and diaphragm mobility (all p < .001) compared with healthy. The pulmonary ribcage compartment of the affected side was the main contributor to the reduction in volume during inspiratory capacity, vital capacity, and inspiratory load imposition (all p < .05). This compartment also exhibited a higher ventilation asymmetry with reduced shortening velocity of the inspiratory ribcage muscles. CONCLUSION: Compared with healthy, TBPI patients who have not undergone nerve transfer surgery present low exercise capacity and diaphragmatic mobility, as well as reduced volume of the upper ribcage compartment on the affected side that leads to reduced shortening velocity and ventilation asymmetry.

Epidemiological Profile of Surgically-Treated Peripheral-Nerve Diseases

Objective To outline the epidemiological profile of surgical patients treated at the peripheral-nerve outpatient clinic of a public hospital in the state of Pernambuco, Brazil, from 2008 (the year this service was implemented in the hospital ) to 2016. Material and Methods A cross-sectional study with data collection from the medical records. A descriptive analysis was performed with the qualitative variables presented as relative and absolute frequencies, and the quantitative variables, as means and standard deviations. The studied variables were gender, age, diagnosis, and surgical techniques. Results In total, 506 medical records were analyzed. Of these, 269 were of male patients (53%), and 238 were of female patients (46%). The age of the sample ranged from 5 to 84 years (41 14 years). The most prevalent diagnoses were: carpal tunnel syndrome (38.9%) followed by traumatic brachial plexus injury (33.2%). The first diagnosis was more frequent among women, while the second, among men. This collaborates with the predominant findings of upper-limb lesions (91%), in which men accounted for 52,75% (244) and women, for 47,25% (217). Conclusion The present study provided relevant information regarding the reality of peripheral-nerve surgeries performed at a public hospital in the state of Pernambuco, Brazil. Public health issues increasingly require the continuity of public policies and government incentive.

Pulmonary capacity of patients with total traumatic injury of the brachial plexus submitted to neurotization with the phrenic nerve: a case series / Capacidade pulmonar de pacientes com lesão traumática total do plexo braquial submetidos à neurotização com o nervo frênico: uma série de casos

Total traumatic injury often requires surgical intervention such as neurotization using the phrenic nerve with the aim to recover the elbow function. However, its repercussions on the respiratory kinematics are unknown. Objective: To evaluate the ribcage volume in tricompartments division, kinematics of Duty Cycle, and shortening velocity of the respiratory muscles after nerve phrenic transfer. Methods: Five participants (4 male), aged 18 to 40 years old (32±2), diagnosed with total brachial plexus injury and with nerve phrenic transfer. The optoelectronic plethysmography (OEP) was the instrument to evaluate volume in quiet breathing (QB), inspiratory capacity (IC) and vital capacity (VC) of the rib cage in its tricompartments division (pulmonary rib cage, abdominal rib cage and abdomen rib cage) and in each hemithorax, as well as the shortening velocity of the respiratory muscles, and respiratory rate. Assessments occurred 30 days prior and 30 days after surgery. Results: There was a decrease in the total compartmental distribution in QB with statistical difference only in the abdominal compartment (p <0.05). Four patients showed a reduction in the shortening speed of the left diaphragm muscle. It was not possible to perform a group analysis of respiratory kinematics and volumes in CV, IC due to the variation found in each patient analyzed. Conclusion: There was a reduction in volume in the rib cage as well as a change in the speed of shortening of the respiratory muscles after the transfer of the phrenic nerve one month after surgery.

A lesão traumática total freqüentemente requer intervenção cirúrgica, como neurotização usando o nervo frênico, com o objetivo de recuperar a função do cotovelo. No entanto, suas repercussões na cinemática respiratória são desconhecidas. Objetivo: Avaliar o volume da caixa torácica na divisão dos tricompartimentos, a cinemática do Duty Cycle e a velocidade de encurtamento dos músculos respiratórios após a transferência do nervo frênico. Métodos: Cinco participantes (4 do sexo masculino), com idade entre 18 e 40 anos (32 ± 2), com diagnóstico de lesão total do plexo braquial e transferência do nervo frênico. A pletismografia optoeletrônica (OEP) foi o instrumento para avaliar o volume na respiração silenciosa (QB), a capacidade inspiratória (IC) e a capacidade vital (VC) da caixa torácica em sua divisão tricompartimental (caixa torácica pulmonar, caixa torácica abdominal e caixa torácica do abdômen ) e em cada hemitórax, bem como a velocidade de encurtamento dos músculos respiratórios e a frequência respiratória. As avaliações ocorreram 30 dias antes e 30 dias após a cirurgia. Resultados: Houve diminuição da distribuição compartimental total no QB com diferença estatística apenas no compartimento abdominal (p <0,05). Quatro pacientes apresentaram redução da velocidade de encurtamento do músculo diafragma esquerdo. Não foi possível realizar uma análise de grupo da cinemática respiratória e dos volumes em CV, IC devido à variação encontrada em cada paciente analisado. Conclusão: Houve redução do volume da caixa torácica e também alteração da velocidade de encurtamento dos músculos respiratórios após a transferência do nervo frênico um mês após a cirurgia.

Effectiveness of inspiratory muscle training associated with a cardiac rehabilitation program on sympathetic activity and functional capacity in patients with heart failure: a study protocol for a randomized controlled trial.

BACKGROUND: Individuals affected by heart failure (HF) may present fatigue, dyspnea, respiratory muscle weakness, and sympathetic activity hyperstimulation of the myocardium, among other symptoms. Conducting cardiac rehabilitation (CR) programs can be associated with inspiratory muscle training. The aim of this study was to evaluate the efficacy of inspiratory muscular training (IMT) associated with a CR program on modulating myocardial sympathetic activity and maximal functional capacity, submaximal functional capacity, thickness, and mobility of the diaphragm muscle in patients with HF. METHODS: We will conduct a clinical, controlled, randomized, double-blind trial that will include sedentary men and women who are 21-60 years old and who have diagnosed systolic HF and a left ventricular ejection fraction of less than 45%. Participants will be randomly assigned to one of two groups: experimental and control. The control group will follow the conventional CR protocol, and the experimental group will follow the conventional CR protocol associated with IMT 7 days a week. The two proposed exercise protocols will have a frequency of three times a week for a period of 12 weeks. The sympathetic innervation of the cardiac muscle, the maximum and submaximal functional capacity, diaphragm mobility and thickness, and the quality of life of the participants will be evaluated before and after the intervention protocol. DISCUSSION: This clinical trial will be the first study to investigate the additional effects of IMT on CR in sympathetic hyperstimulation in the myocardium. The results of this study will contribute to developing therapeutic strategies collaborating to elucidate whether the association of IMT with CR can induce clinical benefits for patients with HF. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02600000. Registered November 9, 2015. Retrospectively registered.

Effects of daily inspiratory muscle training on respiratory muscle strength and chest wall regional volumes in haemodialysis patients: a randomised clinical trial.

Purpose: Evaluating the effects of interdialytic daily inspiratory muscle training (IMT) on respiratory muscle strength, chest wall regional volumes, diaphragmatic mobility and thickness, pulmonary function, functional capacity, and quality of life (QoL) in haemodialysis (HD) patients.Method: A randomised, and double-blind clinical trial composed of 24 chronic kidney disease patients undergoing HD. Patients were allocated into the IMT group (n = 12) or sham group (n = 12) and performed daily IMT twice per day with a load of 50% inspiratory muscle strength for the IMT group and 5 cmH2O for the sham group during 8 weeks. Respiratory muscle strength, diaphragm thickness and mobility, chest wall regional volumes, functional capacity, and QoL were measured.Results: At the end of the study, an increase in inspiratory and expiratory muscle strength was observed for both groups, but no significant difference was found between them. Changed volume distribution was also observed in the IMT group, with significantly increased inspiratory capacity in the pulmonary compartment compared to the sham group.Conclusions: Daily interdialytic IMT promoted a change in chest wall regional volumes, with an increase in the inspiratory capacity of the pulmonary rib cage. Both groups had increased inspiratory and expiratory muscle strength with daily respiratory exercise.Trial registration: www.ClinicalTrials.gov; study number: NCT02599987; name of trial registry: IMT in Patients with End-stage Renal Disease.Implications for rehabilitationMuscular impairment in chronic kidney disease patients results from a series of common alterations, affecting respiratory muscles.Patients with chronic kidney disease have low values of diaphragmatic thickness.The daily inspiratory muscle training (IMT) or breathing exercise over a period of 8 weeks provided increased respiratory muscle strength.The daily inspiratory muscle training presented a change in tri-compartment distribution of lung volume compared to the sham group, with increased inspiratory capacity of the pulmonary rib cage.

Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: a systematic review.

QUESTION: Does inspiratory muscle training improve respiratory muscle strength, functional capacity, lung function and quality of life of patients with chronic kidney disease? Does inspiratory muscle training improve these outcomes more than breathing exercises? DESIGN: Systematic review and meta-analysis of randomised trials. PARTICIPANTS: People with chronic kidney disease undergoing dialysis treatment. OUTCOME MEASURES: The primary outcomes were: maximal inspiratory pressure, maximal expiratory pressure, and distance covered on the 6-minute walk test. The secondary outcomes were: forced vital capacity, forced expiratory volume in the first second (FEV1), and quality of life. RESULTS: The search identified four eligible studies. The sample consisted of 110 participants. The inspiratory muscle training used a Threshold® or PowerBreathe® device, with a load ranging from 30 to 60% of the maximal inspiratory pressure and lasting from 6 weeks to 6 months. The studies showed moderate to high risk of bias, and the quality of the evidence was rated low or very low, due to the studies' methodological limitations. The meta-analysis showed that inspiratory muscle training significantly improved maximal inspiratory pressure (MD 23 cmH2O, 95% CI 16 to 29) and the 6-minute walk test distance (MD 80m, 95% CI 41 to 119) when compared with controls. Significant benefits in lung function and quality of life were also identified. When compared to breathing exercises, significant benefits were identified in maximal expiratory pressure (MD 6 cmH2O, 95% CI 2 to 10) and FEV1 (MD 0.24litres 95% CI 0.14 to 0.34), but not maximal inspiratory pressure or forced vital capacity. CONCLUSION: In patients with chronic renal failure on dialysis, inspiratory muscle training with a fixed load significantly improves respiratory muscle strength, functional capacity, lung function and quality of life. The evidence for these benefits may be influenced by some sources of bias. REGISTRATION: PROSPERO (CRD 42015029986). [de Medeiros AIC, Fuzari HKB, Rattesa C, Brandão DC, de Melo Marinho PÉ (2017) Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: a systematic review. Journal of Physiotherapy 63: 76-83].

Effects of Whole Body Vibration on Muscle Strength and Quality of Life in Health Elderly: A Meta-Analysis / Efeitos da Vibração de Corpo Inteiro na Força Muscular e Qualidade de Vida em Idosos Saudáveis: Uma Meta-análise

Abstract Introduction: The literature presents different findings about the vibration training efficacy on muscle per- formance, even using protocols with similar parameters. Objective: The purpose of this systematic review was to investigate the effects of whole body vibration (WBV) on strength and quality of life in health elderly people, presenting a meta-analisys. Methods: PubMed, CINAHL, SciELO, LILACS and PEDro databases were systematically searched for studies that used WBV in healthy elderly. These searches were supplemented with material identified in references and a qualitative and quantitative analysis was performed to sum- marize the findings. The search was performed by two independent researchers with a third was selected to solve problems of search disagreement, data collection, and quality score. Results: Nine studies with strength outcome and two studies with quality of life outcome were identified, with sample ranging 21 to 220 elderly, all studies had control groups performing exercises or guidelines. Some studies have shown sig- nificant improvements in muscle strength, muscle power, vertical jump height, timed get up and go test and quality of life. Conclusion: The meta-analysis of the findings in these studies shows that WBV could benefit health elderly, increasing muscle strength and improving the quality of life mainly in functional capacity. The number of publications found in the databanks searched is small, with limitations in design of protocols with a weakness to the interpretation of the findings, suggesting the need of investigation with WBV with well-designed protocols and controlled parameters into the effects of WBV training in elderly people.

Resumo Introdução: A literatura apresenta diferentes resultados sobre a eficácia do treinamento da vibração de corpo inteiro sobre o desempenho muscular, mesmo utilizando protocolos com parâmetros semelhantes. Objetivo: O objetivo desta revisão sistemática foi investigar os efeitos da vibração de corpo inteiro (VCI) sobre a força e a qualidade de vida em idosos saudáveis, apresentando uma meta-análise. Métodos: A busca ocorreu nas bases de dados PubMed, CINAHL, SciELO, Lilacs e Pedro visando estudos sobre o uso de WBV em idosos saudáveis. Essas pesquisas foram complementadas com material identificado nas referências e foi realizada uma análise quali-quantitativa resumindo os resultados. A pesquisa foi realizada por dois pesquisadores independentes, com um terceiro sendo selecionado para resolver problemas de desacordo na busca, coleta de dados e índice de qualidade. Resultados: Foram identificados nove estudos com desfecho força e dois estudos com desfechos na qualidade de vida, com amostras entre 21-220 idosos, todos com grupo controle recebendo orientações ou realizando outro tipo de exercício. Alguns estudos mostraram melhorias significativas da força e desempenho musculares, da altura do salto vertical, do teste Timed Up and Go e da qualidade de vida. Conclusão: A meta-análise dos resultados destes estudos indicam que VCI pode beneficiar idosos saudáveis, aumentando a força muscular e melhorando a qualidade de vida, principalmente na capacidade funcional. O número de publica- ções encontradas nas bases de dados pesquisadas foi pequeno, com limitações na concepção de protocolos com uma fragilidade na interpretação dos achados, sugerindo a necessidade de investigação da VCI com protocolos melhor desenhados e com parâmetros controlados na WBV em idosos.