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1.
J Clin Neurosci ; 75: 228-231, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32201027

RESUMO

Charcot Marie Tooth (CMT) due to myelin protein zero (MPZ) mutations, may cause a wide variation of phenotypes, depending on the localization of the mutation within the gene. Among the most common phenotypes are: an infantile onset disease with extremely slow nerve conduction velocities (CMT1B) and an adult onset phenotype with nerve velocities in the axonal range (CMT2I). We reported a patient with CMT1B (MPZ p.Ser63del mutation) which developed an overlapping immune mediated polyradiculoneuropathy with recurrent episodes of quadriparesis and cranial nerve involvement. We observed reversible conduction block on serial neurophysiologic studies, non-uniform demyelination and good clinical response to prednisone and cyclophosphamide, as evidenced by objective functional recovery. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)-like characteristics have not yet been described associated with a MPZ p.Ser63del mutation. This description adds evidence indicating that a defective structural myelin protein may predispose peripheral nerves to immune attacks.

2.
J Occup Environ Hyg ; 16(10): 694-706, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31461396

RESUMO

The inhalation and the deposition of welding-generated ultrafine particles in welders' respiratory tracts have been linked to severe pulmonary impairments. In the present study, a mobile aerosol lung deposition apparatus (MALDA) was developed and applied to study the respiratory deposition of ultrafine welding fume particles. The MALDA was constructed with a set of physiologically representative human tracheobronchial airway replicas made with high-resolution 3D printers. Ultrafine welding fume particles were generated in a welding fume chamber and delivered to the MALDA. A series of respiratory deposition experiments were carried out using the MALDA to investigate the deposition of ultrafine welding fume particles in different airway generations of the tracheobronchial airways. The results showed that the fractional deposition of ultrafine welding fume particle in the human tracheobronchial airways down to the 9th airway generation could be readily and systematically measured by the MALDA. The estimated cumulative respiratory deposition ranged from approximately 9-31% for ultrafine welding fume particles between 10 and 100 nm in diameter. The results acquired demonstrated that the MALDA developed has the potential to become a useful apparatus in the future to estimate the respiratory deposition of ultrafine particles in real workplaces.

3.
Neurophysiol Clin ; 49(4): 329-334, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331650

RESUMO

Our aim was to study motor unit number index (MUNIX) in myopathic disorders. We studied 11 patients with myopathy, and healthy controls. We obtained MUNIX, compound muscle action potential (CMAP), motor unit size index (MUSIX) and alpha (α, power exponent from MUNIX equation) measurements from three different muscles. MUNIX and CMAP were significantly lower in one muscle. This MUNIX decrease may not be related to motor neuron loss, but rather to muscle fiber atrophy. MUSIX and α did not change and may be useful in determining whether the MUNIX decrease is indeed due to motor unit loss.


Assuntos
Neurônios Motores/fisiologia , Músculo Esquelético/fisiopatologia , Doenças Musculares/diagnóstico , Doenças Musculares/fisiopatologia , Adulto , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
Neurol Sci ; 40(8): 1725-1727, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30997592

RESUMO

BACKGROUND: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neuropathy which affects mainly large myelinated axons and has a typically mild autonomic dysfunction mainly from postganglionic nerve fiber involvement. CASE REPORT: We report here an acute onset CIDP initially diagnosed as Guillain-Barré syndrome (GBS), unresponsive to treatment with intravenous immunoglobulin (IVIg), which later responded to plasmapheresis and corticoids. The patient had a markedly distal demyelination, prominent cranial nerve involvement and, interestingly, bilateral fixed dilated pupils. Despite complete clinical recovery, this neurological sign remained. CONCLUSIONS: Tonic pupils have previously been described in different neurologic conditions, including GBS, but not yet in acute onset CIDP or in variants with predominantly distal demyelination. It differs from the classical Adie's pupil because it lacks the light-near dissociation. This case report expands the range of possible autonomic signs in acute onset CIDP, which could help physicians establish optimal treatment strategies earlier on.


Assuntos
Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/complicações , Pupila Tônica/etiologia , Erros de Diagnóstico , Feminino , Síndrome de Guillain-Barré/diagnóstico , Humanos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Adulto Jovem
5.
Muscle Nerve ; 59(2): 249-253, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30370536

RESUMO

INTRODUCTION: In this study we aimed to determine the contribution of the E2 (reference electrode) to the compound muscle action potential (CMAP) amplitude during fibular motor recording to the tibialis anterior (TA) when E2 is placed over routine referential vs. alternative sites. METHODS: The CMAP was obtained from 10 healthy subjects, using the active electrode (E1) over sites routinely used as E2 for the TA, whereas the E2 was over the contralateral knee. The same procedure was performed with the E1 over alternative E2 sites. RESULTS: Significant electrical signal was captured over routine E2 placement sites. Among the tested alternative E2 sites, the ipsilateral patella (especially its medial aspect) was the most electrically silent. DISCUSSION: Using alternative E2 sites with near isoelectric recordings can optimize near-field potential measurement in the fibular motor recording to the TA and represents a more accurate way of measuring nerve and muscle function. Muscle Nerve 59:249-253, 2019.


Assuntos
Potenciais de Ação/fisiologia , Músculo Esquelético/fisiologia , Condução Nervosa/fisiologia , Nervo Fibular/fisiologia , Adulto , Idoso , Estimulação Elétrica , Eletrodos , Eletromiografia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade
6.
Front Psychiatry ; 9: 435, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30337887

RESUMO

Background: Obstructive sleep apnea (OSA) is characterized by apnea-hypopnea during sleep. Overnight polysomnography (PSG) is usually used to detect the frequency of apneic and hypopneic events. Attention and executive deficits are commonly reported in OSA patients. Previous investigations suggested that cognitive impairments were dependent on attention deficits. However, attention is not a unitary domain and consists of different subdomains such as alertness, sustained attention, focused attention, and executive attention (impulsivity/hyperactivity). Little is known about the attention subdomains affected in OSA. Attention is commonly assessed using continuous performance tests, such as the continuous visual attention test (CVAT). Distinct variables can be derived from the CVAT. Each CVAT variable is associated with a specific attention subdomain. Objective: This study aimed to examine the variables of the CVAT that are affected by OSA and to identify the most reliable CVAT variable that distinguishes OSA from controls via discriminant analysis. Method: Patients scheduled to perform a PSG were invited to participate in this study. Immediately before the PSG, they performed the CVAT. Based on the PSG results, 27 treatment-naïve OSA patients were sampled. The same number of healthy controls were selected to match the two groups by age and gender. Five CVAT variables were examined: commission errors, omission errors, reaction time (RT), variability of reaction time (VRT), and coefficient of variability (VRT/RT). Results: ANCOVAs indicated that RT and VRT were affected by OSA. No difference in accuracy (omission and commission errors) was observed between healthy controls and OSA patients. When the VRT measurements were corrected for their respective RT values (VRT/RT), the mean difference on this coefficient did not reach significance. The discriminant analysis indicated that the two groups could be best differentiated by the RT variable. Conclusions: Attention problems, commonly observed in OSA patients, may reflect a primary problem on the alertness subdomain. The CVAT was able to detect the primary (alertness-RT parameter) and the secondary deficits (sustained attention-VRT parameter) associated with OSA. As there is no learning effect in the condition of retests, the CVAT can be used to assess the cognitive recovery in OSA patients during treatment.

7.
JMIR Rehabil Assist Technol ; 5(1): e1, 2018 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-29475827

RESUMO

BACKGROUND: Patient-reported outcomes (PROs) translate subjective outcomes into objective data that can be quantified and analyzed. Nevertheless, the use of PROs in their traditional paper format is not practical for clinical practice due to limitations associated with the analysis and management of the data. To address the need for a viable way to group and utilize the main functioning assessment tools in the field of musculoskeletal disorders, the Physiotherapy Questionnaires app was developed. OBJECTIVE: This study aims to explain the development of the app, to validate it using two questionnaires, and to analyze whether participants prefer to use the app or the paper version of the questionnaires. METHODS: In the first stage, the app for an Android operational system was developed. In the second stage, the aim was to select questionnaires that were most often used in musculoskeletal clinical practice and research. The Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire were selected to validate the app. In total, 50 participants completed the paper and app versions of the AOFAS and 50 completed the FAOS. The study's outcomes were the correlation of the data between the paper and app versions as well as the preference of the participants between the two versions. RESULTS: The app was approved by experts after the adaptations of the layout for mobile phones and a total of 18 questionnaires were included in the app. Moreover, the app allows the generation of PDF and Excel files with the patients' data. In regards to validity, the mean of the total scores of the FAOS were 91.54% (SD 8.86%) for the paper version and 91.74% (SD 9.20%) for the app. There was no statistically significant differences in the means of the total scores or the subscales (P=.11-.94). The mean total scores for the AOFAS were 93.94 (SD 8.47) for the paper version and 93.96 (SD 8.48) for the app. No statistically significant differences were found for the total scores for the AOFAS or the subscales (P>.99). The app showed excellent agreement with the paper version of the FAOS, with an ICC value of 0.98 for the total score (95% CI 0.98-0.99), which was also found for the AOFAS with the ICC for the total score of 0.99 (95% CI 0.98-0.99). For compliance, 72% (36/50) of the participants in the FAOS group and 94% (47/50) in the AOFAS group preferred the app version. CONCLUSIONS: The Physiotherapy Questionnaires app showed validity and high levels of compliance for the FAOS and AOFAS, which indicates it is not inferior to the paper version of these two questionnaires and confirms its viability and feasibility for use in clinical practice.

8.
Muscle Nerve ; 58(2): 204-212, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29381812

RESUMO

INTRODUCTION: Our objective was to determine the utility of motor unit number index (MUNIX) and neurophysiological index (NI) as surrogate biomarkers of disease progression in limbs without clinical signs of lower motor neuron (LMN) involvement from patients with slowly progressive amyotrophic lateral sclerosis (ALS). METHODS: Patients with slowly progressive ALS and at least 1 clinically unaffected limb were prospectively enrolled. Clinical signs of LMN loss and results from hand-held dynamometer (HHD), revised ALS Functional Rating Scale (ALSFRS-R), mean-MUNIX (from 3 different muscles), and NI were longitudinally recorded. RESULTS: Eighteen patients with 43 presymptomatic muscles were evaluated. Twenty-seven muscles remained clinically unaffected during study, with stable ALSFRS-R subscores and HHD measures. However, a significant decline in mean-MUNIX and NI was detected. DISCUSSION: Mean-MUNIX and NI were more sensitive than clinical measures at detecting LMN loss in presymptomatic limbs from patients with slowly progressive ALS. Therefore, these electrophysiological biomarkers should be included in early study phases as meaningful outcome measures. Muscle Nerve 58: 204-212, 2018.


Assuntos
Esclerose Amiotrófica Lateral/patologia , Neurônios Motores/patologia , Fibras Musculares Esqueléticas/patologia , Potenciais de Ação , Idoso , Biomarcadores , Contagem de Células , Progressão da Doença , Eletrodiagnóstico , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Estudos Prospectivos , Resultado do Tratamento
9.
Phys Ther Sport ; 29: 61-69, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28974358

RESUMO

OBJECTIVE: The objective of this systematic review was to evaluate the association between ankle dorsiflexion (ADF) and dynamic knee valgus (DKV). METHODS: Electronic searches were conducted in MEDLINE, EMBASE, CINAHL and SPORTDiscus. A modified Downs and Black checklist was used for quality assessment and meta-analysis was performed to compare standardised mean differences (SMD) of ADF. RESULTS: Seventeen studies met the inclusion criteria. Meta-analysis showed that reduced ADF is associated with participants presenting with DKV compared to controls (SMD -0.65, 95% CI -0.88 to -0.41). Subgroup analysis showed consistent results regarding different forms of ADF measurement; restriction in ADF measured in weight-bearing position (SMD -1.25, 95% CI -2.24 to -0.25), non-weight-bearing with knee flexed (SMD -0.56, 95% CI -0.97 to -0.16) or non-weight-bearing with knee extended (SMD -0.54, 95% CI -0.80 to -0.28) was significantly associated with DKV. CONCLUSION: The meta-analysis results provide evidence that reduced ADF is correlated with DKV. The assessment of ADF in the clinical setting is important, as it may be related to harmful movement patterns of the lower limbs.


Assuntos
Articulação do Tornozelo/fisiologia , Articulação do Joelho/fisiologia , Amplitude de Movimento Articular , Humanos , Suporte de Carga
10.
Fisioter. Pesqui. (Online) ; 24(4): 399-405, Oct.-Dec. 2017. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-892154

RESUMO

ABSTRACT Background: resistance training is widely applied in non-diabetic physical protocol showing effectiveness in improving the tendon tissue. To address this gap, we assessed the effects of resistance training on aquatic environment, on the biomechanical properties of the calcaneal tendon of diabetic Wistar rats. Methods: 59 male Wistar rats were evaluated for 60 days, they were randomly divided into the following groups: Sedentary Control Group (SCG, n=15), Sedentary Diabetic Group (SDG, n=15), Trained Control Group (TCG, n=14) and Trained Diabetic Group (TDG, n=15). After randomization the animals from the SDG and the TDG were induced to Diabetes Mellitus by intraperitoneal injection of Streptozotocin (60 mg/kg). The animals on the trained groups performed resistance exercise that consisted of jumping in an aquatic environment. After nine weeks the calcaneal tendons were collected and tractioned on a conventional mechanical testing machine. Results: the analysis of biomechanical parameters showed lower values in elastic modulus (p=0.000), maximum strength tension (p=0.000) and energy/area (p=0.008) in TDG compared to SDG in addition to an increase on the cross-sectional area (p=0.002). There was no difference for the specific deformation variable. Conclusion: the training protocol used restored some biomechanical parameters of the calcaneal tendon in rats induced to diabetes, thus, resulting in an improvement of its mechanical efficiency.


RESUMO Antecedentes: o treinamento de resistência é amplamente aplicado no protocolo físico não diabético mostrando eficiência na melhoria do tecido do tendão. Para abordar esta lacuna, avaliamos os efeitos do treinamento de resistência no ambiente aquático, nas propriedades biomecânicas do tendão calcâneo de ratos Wistar diabéticos. Métodos: 59 ratos Wistar machos foram avaliados por 60 dias, os quais foram divididos aleatoriamente nos seguintes grupos: Grupo de Controle Sedentário (GCS, n=15), Grupo Diabético Sedentário (GDS, n=15), Grupo de Controle Treinado (GCT, n=14) e Grupo Diabético Treinado (GDT, n=15). Após a randomização, os animais do GDS e do CDT foram induzidos a diabetes mellitus por injeção intraperitoneal de Streptozotocin (60mg/kg). Os animais dos grupos treinados realizaram exercícios de resistência que consistiam em saltar em um ambiente aquático. Após nove semanas, os tendões calcaneares foram coletados e tracionados em uma máquina convencional de teste mecânico. Resultados: A análise dos parâmetros biomecânicos mostrou valores mais baixos em módulo elástico (p=0,000), tensão máxima de força (p=0,000) e energia/área (p=0,008) em GDT em comparação com GDS, além de um aumento na área transversal (p=0,002). Não houve diferença para a variável de deformação específica. Conclusão: o protocolo de treinamento usado restaurou alguns parâmetros biomecânicos do tendão calcâneo em ratos induzidos a diabetes, resultando, assim, na melhoria da eficiência mecânica.


RESUMEN Antecedentes: el entrenamiento de resistencia se aplica ampliamente en el protocolo físico no diabético mostrándose la efectividad en la mejora del tejido del tendón. Para abordar esta brecha, evaluamos los efectos del entrenamiento de resistencia en el ambiente acuático, en las propiedades biomecánicas del tendón calcáneo de las ratas Wistar diabéticas. Métodos: se evaluaron 59 ratas Wistar machos durante 60 días, éstes se dividieron aleatoriamente en los siguientes grupos: Grupo de Control Sedentario (GCS, n=15), Grupo Diabético Sedentario (GDS, n=15), Grupo de Control Entrenado (GCE, n=14) y Grupo Diabético Entrenado (GDE, n=15). Después de la aleatorización, los animales del GDS y del GDE se indujeron a diabetes mellitus por inyección intraperitoneal de Streptozotocin (60mg/kg). Los animales de los grupos entrenados realizaron ejercicios de resistencia que consistían en saltar en un ambiente acuático. Después de nueve semanas, se recogieron y traccionaron los tendones calcaneales en una máquina convencional de prueba mecánica. Resultados: El análisis de los parámetros biomecánicos mostró valores más bajos en módulo elástico (p=0.000), tensión de fuerza máxima (p=0.000) y energía/área (p = 0.008) en GDE en comparación con GDS, además de un aumento en la área transversal (p=0.002). No hubo diferencia para la variable de deformación específica. Conclusión: el protocolo de entrenamiento utilizado restauró algunos parámetros biomecánicos del tendón calcáneo en ratas inducidas a la diabetes, lo que resultó en una mejora de su eficiencia mecánica.

11.
Clin Neurophysiol ; 128(12): 2392-2396, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29096211

RESUMO

OBJECTIVE: To assess the impact of averaging multiple MUNIX trials on the follow-up of patients with amyotrophic lateral sclerosis (ALS). METHODS: We determined the percent relative change (%RC) of MUNIX, in healthy subjects and patients with ALS, by subtracting the MUNIX value in the second visit from the first. Both the mean of a set of three MUNIX (mean-MUNIX) and the first MUNIX sample (single-MUNIX) were evaluated. Then, we studied the sensitivity to detect relative changes over time and the statistical dispersion of the %RC from these two parameters. RESULTS: We found that the mean-MUNIX %RC has lower mean coefficient of variation than the single-MUNIX %RC in all muscles. The mean-MUNIX also resulted in more ALS patients with significant %RC, i.e., outside reference limits. CONCLUSION: The mean-MUNIX resulted in less dispersed values of %RC in patients with ALS and thus, increased the precision of the technique. The mean-MUNIX resulted also in an increase in the sensitivity to track changes over time in these patients. SIGNIFICANCE: The mean-MUNIX should be considered in any ALS follow-up study as a more reliable approach and as a way of potentially reducing the sample size needed for the study.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico , Esclerose Amiotrófica Lateral/fisiopatologia , Neurônios Motores/fisiologia , Recrutamento Neurofisiológico/fisiologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
12.
Int J Sports Phys Ther ; 12(4): 625-633, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28900569

RESUMO

BACKGROUND: Running has been one of the main choices of physical activity in people seeking an active lifestyle. The Functional Movement Screen (FMS™) is a screening tool that aims to discern movement competency. PURPOSE: The purposes of this study were to compare biomechanical characteristics between two groups rated using the composite FMS™ score, and to analyze the influence of specific individual tests. The hypothesis was that the group that scored above 14 would demonstrate better performance on biomechanical tests than the group that scored below 14. STUDY DESIGN: Cross-Sectional Study. METHODS: Runners were screened using the FMS™ and were dichotomized into groups based on final score: Functional, where the subjects scored a 14 or greater (G≥14, n = 16) and dysfunctional, when the subjects scored less than 14 (G < 14, n = 16). All runners were evaluated using measures for flexibility, postural balance, muscle strength, knee dynamic valgus during forward step down test and time for the electromyographic response of the transversus abdominis and fibularis longus muscles. All data were analyzed with SPSS (p ≤ 0.05) and the index of asymmetry (IS) was calculated with the mean score of nondominant limb divided by the mean score of the dominant limb, multiplied by 100. RESULTS: There were no statistically significant differences in flexibility, muscle strength, knee dynamic valgus, or myoelectric response time of the transversus abdominis and long fibular muscles. Index of asymmetry (IS) of global stability was 3.26 ± 26.79% in G≥14 and 31.72 ± 52.69% in G<14 (p = 0.02). In-line lunge and active straight-leg raise tests showed no significant difference between the groups (p > 0.05). CONCLUSIONS: Overall, there were no biomechanical differences between the groups of runners as classified by the FMS™. In addition, in-line lunge and active strength-leg raise tests did not influence on the FMS™ final score. LEVEL OF EVIDENCE: 2b.

13.
Braz J Phys Ther ; 21(6): 400-415, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28728958

RESUMO

BACKGROUND: Physical exercise has been used to mitigate the metabolic effects of diabetes mellitus. OBJECTIVE: To evaluate the effect of resistance exercise when compared to aerobic exercise without insulin therapy on metabolic and clinical outcomes in patients with type 2 diabetes mellitus. METHODS: Papers were searched on the databases MEDLINE/PubMed, CINAHL, SPORTDiscus, LILACS, and SCIELO, without language or date of publication limits. Clinical trials that compared resistance exercise to aerobic exercise in adults with type 2 diabetes mellitus who did not use insulin therapy were included. The quality of evidence and risk of bias were assessed using the GRADE system and the Cochrane Risk of Bias tool, respectively. Meta-analysis was also used, whenever possible. Two reviewers extracted the data independently. Eight eligible articles were included in this study, with a total of 336 individuals, with a mean age of 48-58 years. The protocols of aerobic and resistance exercise varied in duration from eight to 22 weeks, 30-60min/day, three to five times/week. RESULTS: Overall the available evidence came from a very low quality of evidence and there was an increase in Maximal oxygen consumption (mean difference: -2.86; 95% CI: -3.90 to -1.81; random effect) for the resistance exercise and no difference was found in Glycated hemoglobin, Body mass index, High-density lipoprotein cholesterol, Low-density lipoprotein cholesterol, triglycerides, and total cholesterol. CONCLUSIONS: Resistance exercise appears to be more effective in promoting an increase in Maximal oxygen consumption in protocols longer than 12 weeks and there is no difference in the control of glycemic and lipid levels between the two types of exercise.


Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Terapia por Exercício/métodos , Exercício Físico , Consumo de Oxigênio/fisiologia , Treinamento de Resistência , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Exercício Físico/fisiologia , Humanos , Insulina , Treinamento de Resistência/métodos
14.
Int J Sports Phys Ther ; 12(1): 67-74, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28217417

RESUMO

BACKGROUND: Brazilian Jiu-Jitsu (BJJ) athletes can be divided into two combat styles: pass fighters (PFs) and guard fighters (GFs). Flexibility of the posterior chain muscles is highly necessary in these athletes, especially in GFs. On the other hand, isometric strength of the trunk extensors is required in PFs. Handgrip strength is important in holding the kimono of the opponent, and symmetrical lower-limb strength is important for the prevention of injuries due to the overload caused by training. PURPOSE: The aim of this study was to compare the biomechanical profiles of BJJ athletes with different combat styles using the following outcome measures: flexibility, trunk extensor isometric endurance, postural balance, handgrip isometric endurance and lower-limb muscle strength. METHODS: A cross-sectional study was conducted using 19 GFs and 19 PFs. The sit-and-reach test was used to evaluate the flexibility of the posterior chain muscles. The Biodex Balance System® was used to evaluate balance. A handgrip dynamometer and a dorsal dynamometer were used to evaluate handgrip and trunk extensor endurance, respectively. Quadriceps and hamstring strength were evaluated with an isokinetic dynamometer at 60 °/s. RESULTS: No differences were observed between groups in terms of flexibility, balance, handgrip isometric endurance or quadriceps and hamstring strength; however, PFs (81.33) showed more isometric trunk extension endurance than GFs (68.85) (p = 0.02). Both groups had low values for hamstring/quadriceps ratio. CONCLUSION: No significant biomechanical differences were observed between PFs and GFs. LEVEL OF EVIDENCE: 2b.

15.
Muscle Nerve ; 55(5): 635-638, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27438087

RESUMO

INTRODUCTION: Reproducibility is an important aspect of any method intended to be a marker of disease progression. In this study we investigated approaches for improving motor unit number index (MUNIX) reproducibility. METHODS: We used the intraclass correlation coefficient (ICC) and the coefficient of variation (CV) to study reproducibility in healthy subjects. We tested reproducibility between test and retest of a single MUNIX from 3 different muscles (S-MUNIX) and also of the mean of a set of 3 measurements from these same muscles (M-MUNIX). RESULTS: M-MUNIX was more reproducible than S-MUNIX. The CV showed a greater improvement than the ICC in all 3 muscles. CONCLUSIONS: M-MUNIX may be a valuable approach for following motor unit loss, because it is more replicable than MUNIX. This may be especially relevant in amyotrophic lateral sclerosis patients, in whom MUNIX variability is higher than in healthy individuals. Muscle Nerve, 2016 Muscle Nerve 55: 635-638, 2017.


Assuntos
Potenciais de Ação/fisiologia , Neurônios Motores/fisiologia , Músculo Esquelético/fisiologia , Adulto , Idoso , Esclerose Amiotrófica Lateral/fisiopatologia , Progressão da Doença , Eletromiografia/métodos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Recrutamento Neurofisiológico/fisiologia , Reprodutibilidade dos Testes
16.
Cerebellum ; 16(1): 34-39, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-26825292

RESUMO

Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant degenerative disease. Pathological studies have demonstrated not only cerebellar and brainstem atrophy, but substantia nigra, motoneurons, basal ganglia, thalamus, and peripheral nerves involvement. These findings may explain non-motor and extra-cerebellar features in SCA2. We accessed the non-motor symptoms and extra-cerebellar signs in SCA2 patients in order to provide a better understanding on pathophysiological mechanisms and natural history of brain degeneration in the disease. Thirty-three SCA2 patients were evaluated and compared with 26 healthy subjects. We investigated the following variables: sleep disorders, cognitive deficit, olfactory impairment, urinary dysfunction, psychiatric symptoms, cramps, pain, movement disorders, and weight loss. SCA2 had a high frequency of REM sleep behavior disorder (48.48 %, N = 16) as well as excessive daytime sleepiness (42.42 %, N = 14). Chorea was present in 15.15 % (N = 5), dystonia in 27.27 % (N = 9), and parkinsonism in 27.27 % (N = 9). Slow saccadic pursuit was present in 87.87 % (N = 29) and ophtalmoparesis in 78.78 % (N = 26) of patients. Regarding sleep disorders, 18.18 % (N = 6) of patients had restless leg syndrome. Dysphagia was present in 39.39 % (N = 13), weight loss 24.24 % (N = 8), and urinary dysfunction 27.27 % (N = 9). Cramps was present in only 6 % of patients (N = 2). This study highlighted the high frequency of non-motor symptoms and extra-cerebellar signs in SCA2. Our findings demonstrate the widespread of nervous system involvement in SCA2 patients and contribute to better understand the natural history of brain degeneration in this genetic condition.


Assuntos
Ataxias Espinocerebelares/fisiopatologia , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Entrevista Psiquiátrica Padronizada , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Ataxias Espinocerebelares/complicações , Ataxias Espinocerebelares/psicologia
17.
Front Neurol ; 8: 734, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29387036

RESUMO

In contrast to virtually all organ systems of the body, the central nervous system was until recently believed to be devoid of a lymphatic system. The demonstration of a complex system of paravascular channels formed by the endfeet of astroglial cells ultimately draining into the venous sinuses has radically changed this idea. The system is subsidized by the recirculation of cerebrospinal fluid (CSF) through the brain parenchyma along paravascular spaces (PVSs) and by exchanges with the interstitial fluid (IF). Aquaporin-4 channels are the chief transporters of water through these compartments. This article hypothesizes that glymphatic dysfunction is a major pathogenetic mechanism underpinning idiopathic intracranial hypertension (IIH). The rationale for the hypothesis springs from MRI studies, which have shown many signs related to IIH without evidence of overproduction of CSF. We propose that diffuse retention of IF is a direct consequence of an imbalance of glymphatic flow. This imbalance, in turn, may result from an augmented flow from the arterial PVS into the IF, by impaired outflow of the IF into the paravenous spaces, or both. Our hypothesis is supported by the facts that (i) visual loss, one of the main complications of IIH, is secondary to the impaired drainage of the optic nerve, a nerve richly surrounded by water channels and with a long extracranial course in its meningeal sheath; (ii) there is a high association between IIH and obesity, a condition related to paravascular inflammation and lymphatic disturbance, and (iii) glymphatic dysfunction has been related to the deposition of ß-amyloid in Alzheimer's disease. We conclude that the concept of glymphatic dysfunction provides a new perspective for understanding the pathophysiology of IIH; it may likewise entice the development of novel therapeutic approaches aiming at enhancing the flow between the CSF, the glymphatic system, and the dural sinuses.

18.
Muscles Ligaments Tendons J ; 7(3): 498-503, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29387644

RESUMO

Background: Capoeira is a cultural practice with Brazilian roots that combines several elements including dance, fighting and body rhythm. Because of the diverse elements involved in its practice, capoeira is excellent at developing the physical and social abilities of its players. The aim of this study was to compare the biomechanical profile of muscle strength, plantar pressure distribution, and postural balance between players and non-players of capoeira. Methods: We evaluated 51 subjects who were allocated into two groups: capoeira group and control group. Subjects were evaluated using a baropodometer (Diasu®) and an isokinetic dynamometer (Biodex®). Results: When comparing plantar pressure distribution between groups and limbs, there were significant differences in mean load of forefoot (p=0.008) and total load (p=0.001). There were no significant differences between groups and limbs in balance and muscle strength; however, a significant difference was found in quadriceps torque peak (p=0.001) and agonist/antagonist ratio (p=0.001) when comparing these variables between the groups. Conclusion: Capoeira players displayed a tendency to have an asymmetric profile in plantar pressure distribution. No difference was found in balance between groups. Despite the fact that capoeira players showed increased strength of the quadriceps muscle, their agonist/antagonist ratio was more asymmetrical than the control group. Level of evidence: IV.

19.
Clin Neurophysiol ; 127(9): 2979-2984, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27458836

RESUMO

OBJECTIVE: To study the reproducibility, diagnostic yield to detect denervation, and clinical correlations of the Motor Unit Number Index (MUNIX) in subjects with Amyotrophic Lateral Sclerosis (ALS). METHODS: MUNIX evaluation was performed in three muscles twice on the same day to assess reproducibility. Cut-off values for the MUNIX were based on data from 51 healthy subjects (controls) to evaluate the sensitivity of the technique to detect denervation in 30 subjects with ALS. RESULTS: The method had good reproducibility. The variability was greater in the ALS group. In 23 ALS subjects (77%), low MUNIX values were detected. Most of the muscles with low MUNIX had also low compound muscle action potential (CMAP) and strength, but these parameters were normal in 9% of muscles. According to ROC curve analysis, MUNIX was generally accurate (AUC=0.9504) for discriminating between healthy individuals and subjects with at least one denervated muscle. CONCLUSIONS: MUNIX variability was higher in the ALS group. The method showed good diagnostic performance for the detection of denervation in a sample of patients with ALS. SIGNIFICANCE: This study demonstrated that in addition to being a quantitative tool MUNIX can detect denervation in subjects with ALS.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico , Esclerose Amiotrófica Lateral/fisiopatologia , Músculo Esquelético/fisiopatologia , Recrutamento Neurofisiológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Eletromiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recrutamento Neurofisiológico/fisiologia , Reprodutibilidade dos Testes
20.
Muscles Ligaments Tendons J ; 6(1): 97-103, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27331036

RESUMO

BACKGROUND: the complications caused by diabetes increase fragility in the muscle-tendon system, resulting in degeneration and easier rupture. To avoid this issue, therapies that increase the metabolism of glucose by the body, with physical activity, have been used after the confirmation of diabetes. We evaluate the biomechanical behavior of the calcaneal tendon and the metabolic parameters in rats induced to experimental diabetes and submitted to pre- and post-induction exercise. METHODS: 54-male-Wistar rats were randomly divided into four groups: Control Group (CG), Swimming Group (SG), Diabetic Group (DG), and Diabetic Swimming Group (DSG). The trained groups were submitted to swimming exercise, while unexercised groups remained restricted to the cages. Metabolic and biomechanical parameters were assessed. RESULTS: the clinical parameters of DSG showed no change due to exercise protocol. The tendon analysis of the DSG showed increased values for the elastic modulus (p<0.01) and maximum tension (p<0.001) and lowest value for transverse area (p<0.001) when compared to the SG, however it showed no difference when compared to DG. CONCLUSION: the homogeneous values presented by the tendons of the DG and DSG show that physical exercise applied in the pre- and post-induction wasn't enough to promote a protective effect against the tendinopathy process, but prevent the progress of degeneration.

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