The effects of transcranial laser photobiomodulation and neuromuscular electrical stimulation in the treatment of post-stroke dysfunctions.

Post-stroke sequelae includes loss functions, such as cognitive and sensory-motor which lead to emotional and social problems, reducing quality of life and well-being. The main aim of our study was to investigate the effects of transcranial laser photobiomodulation together with neuromuscular electrical stimulation (NMES) in post-stroke patients. We performed a clinical trial and an ex vivo study. For the clinical trial, hemiplegic patients were separated into two groups: Treated Group (TG): Hemiplegics treated with transcranial laser (on) associated with NMES (on) and; Placebo Group (PG): Hemiplegics treated with placebo transcranial laser (off) associated with NMES (on). The cluster prototype includes 12 diode laser beams (4 × 660 nm, 4 × 808 nm and 4 × 980 nm) with average power of 720 mW per cluster applied during one minute, leading to 43.2 J energy per cluster. Fifteen regions for all head were irradiated by cluster, leading to 648 J energy per session. The parameters of NMES of the paretic limbs to generate extension wrist and ankle dorsiflexion were symmetrical biphasic rectangular waveforms, 50 Hz frequency, 250 µs pulse duration, and adjustable intensity to maintain the maximum range of motion (amplitude between 0 and 150 mA). Our clinical trial showed improvement of cognitive function, pain relief, greater manual dexterity, enhancement of physical and social-emotional health which lead to better quality of life and well-being. There was also increased temperature in the treated regions with laser and NMES. For the ex vivo study, the distribution of infrared and red radiation after penetration through the cranium and hemihead of cadavers were showed. Therefore, transcranial laser photobiomodulation associated with NMES can be an important therapeutic resource for rehabilitation after stroke.

Effects of the infrared laser on classical ballerinas' feet: Analysis of plantar foot and static balance.

BACKGROUND AND PURPOSE: Overuse injuries and painful symptoms in athletes and dancers (especially classical ballerinas) may lead to reduced functional performance. However, laser application may reduce pain and increase physical conditioning. The aim of the current study was to evaluate the immediate and long-term effects of infrared laser on classical ballerinas' feet. METHODS: Eight female adults who perform classical ballet training and feel pain in their foot, but report no injuries in the last 6 months participated in the study. Infrared laser (808 nm) was applied on ballerina's feet twice a week during three months. The laser parameters utilized were 100 mW average optical power and spot size of 0.04 cm2 applied during 1 min, leading to 6 J and 125 J/cm2 per point. Thermography, algometry and unipodal static standing balance test were performed. RESULTS: There was a significant increase in plantar arch temperature (1.6 °C for center and 2.3 °C for border, p < 0.05) immediately after laser treatment for all ballerinas. The pressure pain thresholds (PPT) were significantly increased for 5 of 7 analyzed sites (p < 0.05). Regarding to the static standing balance, the time on one-foot showed a significant increases (from 23 ± 12 s to 34 ± 13 s, p < 0.05) only when the test was performed on the left foot (support foot). CONCLUSION: Then, there were pain relief and improvement of functional performance in ballerinas. The possible mechanism of laser action in reducing pain and thus enhancing performance, like higher blood flow of foot due to an increase of cutaneous temperature, will be discussed.

Ultrasound plus low-level laser therapy for knee osteoarthritis rehabilitation: a randomized, placebo-controlled trial.

This study evaluated the synergistic effects of ultrasound (US) and low-level laser therapy (LLLT) with or without therapeutic exercises (TE) in women with knee osteoarthritis. Forty-two Caucasian women with knee osteoarthritis were allocated into three groups: (1) the placebo group who did not perform TE, but the prototype without emitting light or ultrasonic waves was applied, (2) the US + LLLT group in which only the prototype was applied and (3) the TE + US + LLLT group that performed TE before the prototype was applied. However, 35 women completed the full clinical trial. Pressure pain thresholds (PPT) using an algometer and functional performance during the sit-to-stand test were carried out. The average PPT levels increased for US + LLLT (41 ± 9 to 54 ± 15 N, p < 0.01) and TE + US + LLLT (32 ± 8 to 45 ± 9 N, p < 0.01) groups. The number of sit-to-stands was significantly higher for all groups. However, the change between pre-treatment and post-treatment (delta value) was greater for the US + LLLT (4 ± 1) and TE + US + LLLT groups (5 ± 1) than for the placebo group (2 ± 1) with a significant intergroup difference (p < 0.05). This study showed reduced pain and increased physical functionality after 3 months of US + LLLT with and without TE.

Correlação entre sensibilidade, função manual e independência em indivíduos pós acidente vascular cerebral / Correlation among sensation, hand function and independence after stroke

Objetivos: investigar a relação entre os componentes da sensibilidade para estereognosia, função manual e aindependência nas atividades da vida diária (AVD) em sujeitos com sequelas de acidente vascular cerebral (AVC).Método: pesquisa transversal e de correlação desenvolvida em dois centros de reabilitação do Estado de São Paulo.Casuística: foram selecionados 20 sujeitos com sequelas de AVC em fase crônica. Instrumentos de coleta de dados:Índice de Barthel para avaliar a independência em AVD, o Jebsen Taylor Hand Function Test para mensurar a funçãomanual e o teste de estereognosia para a avaliação da sensibilidade. A análise dos dados foi feita pelo Coeficiente deCorrelação de Spearman, não paramétrico. Resultados: foram encontradas correlações que demonstraram a diferençade função manual quanto ao membro superior comprometido e não comprometido (p=0.04). A sensibilidade paraestereognosia apresentou correlação com a função manual (p=0.0003) e com a independência em AVD (p=0.02).Conclusão: diante destes achados são recomendadas pesquisas que analisem os efeitos das intervenções utilizandoos protocolos de reeducação sensorial na função manual e independência em pacientes pós-AVC.

Objectives: to investigate the relationship between the components of sensation to stereognosis, hand function andindependence in activities of daily living (ADL) in individuals after stroke. Method: Cross-sectional and correlationalresearch developed in two rehabilitation center of São Paulo state. Sample: 20 subjects with chronic stroke. Datacollection instruments: Barthel Index; to assess independence in ADLs, the Jebsen Taylor Hand Function Test; tomeasure the hand function and the stereognosis test; for the evaluation of sensation. Data analysis was performedusing Spearman?s correlation coefficient, nonparametric. Results: Correlations were found that showed the handfunction was different in the upper limb (p = 0:04). Sensation to stereognosis was correlated with the hand function(p = 0.0003) and with independence in ADL (p = 0.02). Conclusion: based on these findings we recommend thedevelopment of research to examine the effects of interventions using the sensory rehabilitation protocols in handfunction and independence in post-stroke patients.

Synergic effects of ultrasound and laser on the pain relief in women with hand osteoarthritis.

Patients with pain avoid movements, leading to a gradual impairment of their physical condition and functionality. In this context, the use of ultrasound (US) and low-level laser therapy (LLLT) show promising results for nonpharmacological and noninvasive treatment. The aim of this study was evaluated the synergistic effects of the US and the LLLT (new prototype) with or without therapeutic exercises (TE) on pain and grip strength in women with hand osteoarthritis. Forty-five women with hand osteoarthritis, aged 60 to 80 years, were randomly assigned to one of three groups, but 43 women successfully completed the full study. The three groups were as follows: (i) the placebo group which did not perform TE, but the prototype without emitting electromagnetic or mechanical waves was applied (n = 11); (ii) the US + LLLT group which carried out only the prototype (n = 13); and (iii) the TE + US + LLLT group which performed TE before the prototype is applied (n = 13). The parameters of US were frequency 1 MHz; 1.0 W/cm(2) intensity, pulsed mode 1:1 (duty cycle 50%). Regarding laser, the output power of the each laser was fixed at 100 mW leading to an energy value of 18 J per laser. Five points were irradiated per hand, during 3 min per point and 15 min per session. The prototype was applied after therapeutic exercises. The treatments are done once a week for 3 months. Grip strength and pressure pain thresholds (PPT) were measured. Grip strength did not differ significantly for any of the groups (p ≥ 0.05). The average PPT between baseline and 3 months shows significant decrease of the pain sensitivity for both the US + LLLT group (∆ = 30 ± 19 N, p˂0.001) and the TE + US + LLLT group (∆ = 32 ± 13 N, p < 0.001). However, there were no significant differences in average PPT for placebo group (∆ = -0.3 ± 9 N). There was no placebo effect. The new prototype that combines US and LLLT reduced pain in women with hand osteoarthritis.

Effects of excess body mass on strength and fatigability of quadriceps in postmenopausal women.

OBJECTIVE: Obesity is a major public health problem leading to, among other things, reduced functional capacity. Moreover, obesity-related declines in functional capacity may be compounded by the detrimental consequences of menopause. The aim of this study was to understand the potential effects of excess body mass on measures of functional capacity in postmenopausal women. METHODS: Forty-five postmenopausal women aged 50 to 60 years were divided into two groups according to body mass index (BMI): obese (BMI, ≥ 30 kg/m(2); n = 19) and nonobese (BMI, 18.5-29.9 kg/m(2); n = 26). To determine clinical characteristics, body composition, bone mineral density, and maximal exercise testing was performed, and a 3-day dietary record was estimated. To assess quadriceps function, isokinetic exercise testing at 60° per second (quadriceps strength) and at 300° per second (quadriceps fatigue) was performed. RESULTS: The absolute value of the peak torque was not significantly different between the groups; however, when the data were normalized by body mass and lean mass, significantly lower values were observed for obese women compared with those in the nonobese group (128% ± 25% vs 155% ± 24% and 224% ± 38% vs 257% ± 47%, P < 0.05). The fatigue index did not show any significant difference for either group; however, when the data were normalized by the body mass and lean mass, significantly lower values were observed for obese women (69% ± 16% vs 93% ± 18% and 120% ± 25% vs. 135% ± 23%, P < 0.01). CONCLUSIONS: Our results show that despite reduced muscle force, the combination of obesity and postmenopause may be associated with greater resistance to muscle fatigue.

Engenharia biomédica: a tecnologia aplicada à reabilitação / Enginnering biomedics: the use of technology in rehabilitation

Esta pesquisa tem o intuito de apresentar a aplicação da tecnologia na reabilitação de portadores de lesão neurológica, exemplificado pelo estudo de caso de um tetraplégico que engloba avaliações neurofisiológicas, cardiorrespiratória e biomecânica, além do desenvolvimento de tecnologia assistida. As avaliações mostraram aumento da funcionalidade dos sistemas cardiovascular, respiratório e muscular, em função de seis meses de reabilitação através de estimulação elétrica neuromuscular (EENM); a presença do reflexo intermembros, pela atividade mioelétrica nos membros superiores durante a EENM dos membros inferiores, o que sugere plasticidade neural; e a variabilidade e alteração na cinemática do movimento voluntário de flexão e extensão do cotovelo de acordo com a magnitude das cargas aplicadas, o que indica a necessidade do uso da órtese robótica, desenvolvida para favorecer o aumento da independência nas atividades de vida diária.

Reabilitação sensório-motora de tetraplégicos através de estimulação elétrica neuromuscular / The sensory-motor rehabilitation of tetraplegics via neuromuscular electrical stimulation

O Objetivo desta pesquisa consiste em verificar o ganho neurológico e a independência na execução de atividades funcionais em tetraplégicos durante o período de 6 meses de reabilitação com estimulação elétrica neuro-muscular...

The objective of this research was to evaluate the independence to perform activities of daily living and neurological improvements due to a period of six months of neuromuscular electrical stimulation...

Respostas cardio-respiratórias em pacientes com traumatismo raquimedular / Cardiorespiratory responses of patients with spinal cord injuries

O objetivo desta pesquisa foi investigar as variáveis cardio-respiratórias (Pa, FC, VO2, VCO2 e Ve) durante a Estimulação Elétrica Neuromuscular (EENM) do quadríceps em portadores de lesão medular. Participaram da pesquisa dez pacientes (cinco paraplégicos e cinco tetraplégicos). O protocolo do teste consistiu em 10 minutos de repouso, 20 minutos de EENM dos quadriceps e 10 minutos de recuperação. Durante a EENM foram constatados baixos valores de VO2 e VCO2. Os paraplégicos apresentaram rápida cinética dos gases e os tetraplégicos lenta cinética dos gases. Houve o aumento da Pa sistólica e da FC. Ainda, os valores das variáveis cardio-respiratórias foram inversamente relatadas para o nível de lesão, ou seja, quanto maior o nível de lesão, menor os valores. Portanto, a maioria dos pacientes apresentaram algumas limitações nas respostas cardio-respiratórias, indicando realização de exercício exaustivo, mas apresentaram capacidade de realização de exercício induzido artificialmente, possivelmente devido aos benefícios da EENM.

Avancos tecnológicos na prática ortopédica: análises de membros superiores e inferiores / Technological advances in orthopedics: upper and lower limbs analysis

A Biomecânica, atualmente, é caracterizada por novos procedimentos para análise do movimento humano e por novas técnicas de medicão, armazenamento e processamento de dados, contribuindo para os avancos na prática ortopédica. A temática proposta no presente trabalho baseia-se na aplicacão da biomecânica ortopédica em diferentes quadros clínicos, através de avaliacões quantitativas do movimento dos membros superiores e inferiores, além da criacão de novas técnicas de medicão. Três exemplos são mostrados neste artigo: (I) análise tridimensional do movimento de abducão do ombro; (II) análise da marcha de indivíduos com lesão no ligamento cruzado anterior; e (III) o desenvolvimento de instrumentacão eletrônica para dispositivos de auxílio, ou seja, bengalas e muletas instrumentalizadas para o estudo das relacões de forca entre os membros superiores e inferiores, durante a marcha de pacientes com lesão ortopédica e neurológica.

Reabilitação sensório-motora de tetraplégicos através de estimulação elétrica neuromuscular / The sensory-motor rehabilitation of tetraplegies via neuromuscular electrical stimulation

O objetivo desta pesquisa consiste em verificar o ganho neurológico e a independência na execução de atividades funcionais em tetraplégicos durante o período de 6 meses de reabilitação com Estimulação Elétrica Neuro-Muscular (EENM). Foram realizados, em oito pacientes do sexo feminino, os Protocolos ASIA e FIM no período pré e pós tratamento que consistiu na Estimulação de membros inferiores e superiores, com realização de Atividades funcionais a partir da restauração.

The objective of this research was to evaluate the independence to perform activities of daily living and neurological improvements due to a period of six months of Neuromuscular Electrical Stimulation (NMES). Eight tetraplegies participated of six months in this study. The evaluation were accomplished with the ASIA and FIM Protocols. The treatement consisted in lower and upper limbs stimulation (prehension and restauration). The results of this research was analised by case report...