A Multidisciplinary Approach to Swallowing Rehabilitation in Patients with Forward Head Posture.

(1) Background and Objectives: The forward head posture (FHP) is characterized by increased extensions of upper cervical vertebrae and flexion of the lower cervical vertebrae and upper thoracic regions, associated with muscle shortening. The compressive loading on the tissues in the cervical spine negatively impacts suprahyoid and infrahyoid muscles and generates increased tension of the masticatory muscles. The tongue has relations with the suprahyoid and the infrahyoid muscles. The pattern of swallowing evolves gradually from birth to the age of four. If this developmental transition does not occur, the result is persistent infantile or atypical swallowing-an orofacial myofunctional disorder with the tongue in improper position during swallowing, causing strain and stress on the jaw, face, head and neck. In FHP, muscles crucial to swallowing are biomechanically misaligned. The lengthening of the suprahyoid muscles necessitates stronger contractions to achieve proper hyolaryngeal movement during swallowing. This study assesses the added benefits of physiotherapy to the traditional myofunctional swallowing rehabilitation for patients with FHP. The underlying hypothesis is that without addressing FHP, swallowing rehabilitation remains challenged and potentially incomplete. (2) Materials and Methods: A total of 61 participants (12-26 years) meeting the inclusion criteria (FHP and atypical swallowing) were divided into two similar groups. Group A attended one orofacial myofunctional therapy (OMT) and one physiotherapy session per week, group B only one OMT session per week, for 20 weeks. Exclusion criteria were as follows: ankyloglossia, neurological impairment affecting tongue and swallowing, cervical osteoarticular pathology, other previous or ongoing treatments for FHP and atypical swallowing. (3) Results: There is a significant improvement in terms of movement and use of the orofacial structures (tongue, lips, cheeks), as well as in breathing and swallowing in both groups. Group A achieved better outcomes as the CVA angle was directly addressed by manual therapy and GPR techniques. (4) Conclusions: The combined therapy proved to be more effective than single OMT therapy.

Effects of global postural reeducation on postural control, dynamic balance, and ankle range of motion in patients with hallux abducto valgus. A randomized controlled trial.

Hallux abducto valgus (HAV) is a common musculoskeletal disorder that has been addressed surgically. Nevertheless, the manual therapy approach may play an important role in the management of this condition. The present study aimed to determine the effectiveness of global postural reeducation (GPR) in subjects with symptomatic mild to moderate HAV in static postural control, dynamic stability, and ankle dorsiflexion range of motion (DFROM). A total of 80 patients with mild to moderate symptomatic HAV were allocated to the intervention group (GPR) or control group (CG) (no treatment) for 8 weeks. Outcome measures were assessed at baseline at 4 and 8 weeks including static postural control (Romberg test), dynamic balance (Star Excursion Balance Test [SEBT]), and ankle DFROM (Weight-Bearing Lunge Test [WBLT]). No improvements were observed at 4 weeks, but there were improvements at 8 weeks in: static postural control mediolateral displacement (X) of center of pressure (CoP) in both eyes open (EO) and eyes closed (EC): XEO (t(36) = 2.892, p = .006, d = 0.67); XEC (t(68) = 2.280, p = .026, d = 054); and velocity (V) of CoP displacement: VEO (t(68) = 2.380, p = .020, d = 0.57); VEC (t(36) = 2.057, p = .047, d = 0.37). It were also improvements in: WBLT (t(36) = -2.869, p = .007, d = 0.54) and SEBT at three directions (anterior, ANT; posteromedial, PM; and posterolateral, PL): SEBT.ANT (t(36) = -2.292, p = .028, d = 0.23); SEBT.PM (t(36) = -4.075, p < .001, d = 0.43); SEBT.PL (t(62) = -3.506, p = .001, d = 0.34). The present study showed that GPR compared to the CG might be effective in enhancing ankle function including postural control, dynamic balance, and DFROM.

Effect of the App-Based Video Guidance on Prenatal Pelvic Floor Muscle Training Combined with Global Postural Re-education for Stress Urinary Incontinence Prevention: A Protocol for a Multicenter, Randomized Controlled Trial.

BACKGROUND: As the effectiveness on stress urinary incontinence (SUI) prevention of pelvic floor muscle training (PFMT) for pregnant women has been inconclusive, we are planning to conduct a trial to evaluate a video program designed for prevention of SUI developed through combining PFMT with global postural reeducation (GPR). METHODS: As a randomized controlled trial, eligible participants will be randomized (1:1) into an exercise group and a control group to perform PFMT regularly following video guidance or with no intervention, respectively. The experimental stage will be from the 16th gestation week (GW) to the 12th month postpartum, with eight appointments at the 16th, 28th, 37th GW, delivery, the 6th week and the 3rd, 6th, and 12th month postpartum. Data will be collected regarding urinary leakage symptoms, the stress test, the modified Oxford Scale, pelvic floor ultrasound, perineal laceration classification at delivery, neonatal Apgar score, and questionnaires (PISQ-12, ICIQ-UI SF, I-QOL, OABSS). The primary outcome is the occurrence of the symptomatic SUI and positive stress test at the 6th week postpartum. DISCUSSION: This protocol is anticipated to evaluate the efficacy of the intervention via video app for the design of a future randomized control trial (RCT). TRIAL REGISTRATION: The trial has been registered at Chinese Clinical Trial Registry (registration number: ChiCTR2000029618).

Effectiveness of Global Postural Re-Education in Chronic Non-Specific Low Back Pain: Systematic Review and Meta-Analysis.

BACKGROUND: The aim of this systematic review and meta-analysis was to evaluate the global postural re-education (GPR) program's effectiveness compared to other exercise programs in subjects with persistent chronic low back pain. METHODS: A systematic review and meta-analysis were carried out using PRISMA2020. An electronic search of scientific databases was performed from their inception to January 2021. Randomized controlled trials that analyzed pain and patient-reported outcomes were included in this review. Four meta-analyses were performed. The outcomes analyzed were disability due to back pain and pain. The risk of bias and quality of evidence were evaluated. The final search was conducted in March. RESULTS: Seven trials were included, totaling 334 patients. The results showed improvement in pain measured by Visual Analogue Scale (VAS) (Standardised Mean Difference (SMD) = -0.69; 95% Confidence Interval (CI), -1.01 to -0.37; p < 0.0001), Numerical Pain Scale (NRS) (SMD = -0.40; 95% CI, -0.87 to 0.06); p = 0.022), VAS + NRS (SMD = -1.32; 95% CI, -1.87 to -0.77; p < 0.0001) and function (Roland Morris Disability Questionnaire (RMDQ)) (SMD = -0.55; 95% CI, -0.83 to -0.27; p < 0.0001) after GPR treatment. CONCLUSION: This meta-analysis provides reliable evidence that GPR may be an effective method for treating LBP by decreasing pain and improving function, with strong evidence.

Effects of Global Postural Reeducation versus Specific Therapeutic Neck Exercises on Pain, Disability, Postural Control, and Neuromuscular Efficiency in Women with Chronic Nonspecific Neck Pain: Study Protocol for a Randomized, Parallel, Clinical Trial.

BACKGROUND: Chronic nonspecific neck pain is the most frequent form of neck pain. It is more prevalent in women, and a costly public health issue. It is commonly associated with biomechanical, functional, proprioceptive, and postural impairments. The aim of this trial is to compare the effects of global postural exercises versus specific therapeutic exercises on neck pain, disability, mobility, pressure pain threshold, kinesiophobia, pain catastrophizing, postural control, and neuromuscular efficiency in women with chronic nonspecific neck pain. Methods and analysis: This study is a randomized, parallel-group and single blinded clinical trial. Sixty-two women with nonspecific chronic neck pain were recruited from the community of Guarda, Portugal, and randomly assigned to one of two intervention groups: (1) global postural reeducation (GPR group), (2) specific therapeutic exercises (STE group). The intervention was carried out over 4 weeks, with two sessions per week (eight sessions), and applied by a physiotherapist and paired with a daily individual at-home-exercise program. Primary outcomes are neck pain intensity and disability (Numerical Pain Rating Scale, Neck Disability Index). Secondary outcomes are cervical mobility and pressure pain threshold (CROM, algometry), attitude to pain (kinesiophobia, pain catastrophizing), standing postural control (Center of Pressure (COP) displacements), and neuromuscular efficiency (electromyography). There are four points of evaluation where the outcomes were assessed twice before the intervention, 1 week apart, and the two post-intervention assessments will be carried out after four and eight sessions. The objective was to increase scientific knowledge of different exercise modalities, such as global postural reeducation, in musculoskeletal disorders. TRIAL REGISTRATION: ClínicalTrials.gov (NCT04402463), prospectively registered (data 22 May 2020).

Effectiveness of Global Postural Reeducation in Ankylosing Spondylitis: A Systematic Review and Meta-Analysis.

The aim of this study was to determine the role of global postural reeducation for people with ankylosing spondylitis. We compared the effects of treatments on pain, dysfunction (using the Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index), range of motion, and chest expansion in a specific population aged over 18 years old with ankylosing spondylitis. We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. The search was conducted using the PubMed, Physiotherapy Database (PEDro), Scientific Electronic Library Online (SciELO), and Web of Science (WoS) databases. Clinical trials and systematic reviews/meta-analysis were reviewed. Results: 154 studies were found. Finally, four were included. Conclusions: global postural reeducation is beneficial for ankylosing spondylitis, but no more so than other conventional treatments, except for spinal mobility, where Global Postural Reeducation demonstrated an advantage.

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.

Effects of global postural reeducation exercise and anti-TNF treatments on disease activity, function, fatigue, mobility, sleep quality and depression in patients with active Ankylosing spondylitis: A prospective follow-up study.

OBJECTIVE: The purpose of this study was to investigate the effects of combination therapy with global postural reeducation exercise (GPR) and anti-TNF treatments on clinical parameters in patients with active Ankylosing spondylitis (AS). MATERIALS AND METHOD: Sixty patients with active AS were distributed into three groups. Group 1 was given anti-TNF therapy plus GPR program. Group 2 was given anti-TNF and conventional exercise therapy. Group 3 was accepted as the control group. Patients were assessed according to pain, disease activity (Bath Ankylosing Spondylitis Disease Activity Index), functionality (Bath Ankylosing Spondylitis Functional Index and walking performance), mobility (lumbar Schöber, chest expansion, hand-finger to floor distance), fatigue (Multidimensional Assessment Questionnaire), sleep quality (Pittsburgh sleep quality index), and depression. RESULTS: The parameters were significantly improved in both groups receiving exercise and anti-TNF therapy compared to the control group after treatment. The anti-TNF plus GPR exercise therapy resulted in greater improvements than the anti-TNF plus conventional exercise therapy in pain, walking performance, and mobility. CONCLUSIONS: Anti-TNF therapy and exercise were efficient in both groups on improving all clinic parameters. However, the improvements in pain, function, and mobility were greater in the active AS patients with GPR exercise method. Therefore, motivated patients should be encouraged to perform this method.

Eficácia da reeducação postural global na dor de indivíduos com disfunção temporomandibular: uma revisão sistemática / Efficacy of global postural reeducation in pain of individuals with temporomandibular dysfunction: a systematic review

INTRODUÇÃO: Disfunção temporomandibular (DTM) é caracterizada por um conjunto de alterações funcionais, que envolvem fatores predisponentes, iniciantes e perpetuantes. Considerando que os desvios posturais desorganizam a harmonia corporal entre a postura da mandíbula e todo o sistema esquelético, várias modalidades fisioterapêuticas foram propostas no tratamento da DTM, incluindo a Reeducação Postura Global (RPG). OBJETIVO: Avaliar sistematicamente as evidências sobre a eficácia da RPG no tratamento da dor em indivíduos com DTM. MÉTODOS: Revisão sistemática realizada pesquisa nas bases de dados, maio a setembro 2017, Pubmed, Biblioteca Virtual em Saúde (Lilacs, Scielo e Medline), PEDro e Cochrane Library. Os critérios de inclusão: Ensaios clínicos randomizados (ECR) e Ensaios clínicos controlados (ECC); artigos publicados em língua inglesa, portuguesa e espanhola; que abordavam sobre o tratamento com RPG; com indivíduos adultos > 18 e ≤60 anos; diagnosticados com DTM; que continham avaliação da dor. Excluídos: estudos duplicados; que utilizaram exercícios para pacientes pós-cirúrgico e que apresentassem doenças sistêmicas ou qualquer afecção que afetasse o sistema osteomioarticular; que avaliaram pacientes com histórico de trauma facial ou cervical e em uso de medicamentos. RESULTADOS: Um total de 349 artigos foram encontrados, que após a eliminação de duplicatas, filtragem de títulos, resumos e leitura de texto completo foram incluídos na pesquisa três estudos, o que evidenciou a eficácia da RPG na redução da dor. CONCLUSÃO: Considerando os resultados obtidos neste estudo, foi possível concluir que a RPG demonstra ser eficaz na redução da dor presente na DTM. Porém, faz-se necessários mais ensaios clínicos randomizados com maior rigor metodológico, protocolos mais bem definidos, que possam auxiliar na tomada de decisão clínica e que contemplem também a comparação do tratamento entre homens e mulheres. [AU]

INTRODUCTION: Temporomandibular dysfunction (TMD) is characterized by a set of functional alterations, which involves predisposing, initiative and perpetuating factors. Considering that postural deviations disorganize the body arrangement between the jaw posture and the entire skeletal system, several physical therapy modalities have been proposed in the treatment of TMD, including Global Postural Reeducation (GPR). OBJECTIVES: To evaluate systematically the evidence of the efficacy of GPR in the treatment of pain in individuals with TMD. METHODS: Systematic review conducted in the databases, May to September 2017, Pubmed, Virtual Health Library (Lilacs, Scielo and Medline), PEDro and Cochrane Library. Inclusion criteria: Randomized controlled trials (RCTs) and controlled clinical trials (RCTs); articles published in English, Portuguese and Spanish; which dealt with RPG treatment; with adult individuals> 18 and ≤60 years; diagnosed with TMD; which contained pain assessment. Excluded: duplicate studies; who used exercises for post-surgical patients and who presented with systemic diseases or any affection that affected the osteomioarticular system; who evaluated patients with a history of facial or cervical trauma and using medications. RESULTS: 349 articles were found. After the elimination of duplicates, title filtering, abstracts and full text reading we included three studies, which evidenced the efficacy of GPR in reducing pain. CONCLUSION: Considering the results obtained in this study, it was possible to conclude that the GPR demonstrates to be efficacy in the pain reduction present in TMD. However, more randomized clinical trials with more methodological rigor, better defined protocols, that can aid in clinical decision-making and that also contemplate the comparison of treatment between men and women. [AU]

Global postural re-education in pediatric idiopathic scoliosis: a biomechanical modeling and analysis of curve reduction during active and assisted self-correction.

BACKGROUND: Global postural re-education (GPR) is a physiotherapy treatment approach for pediatric idiopathic scoliosis (IS), where the physiotherapist qualitatively assesses scoliotic curvature reduction potential (with a manual correction) and patient's ability to self-correct (self-correction). To the author's knowledge, there are no studies regarding GPR applied to IS, hence there is a need to better understand the biomechanics of GPR curve reduction postures. The objective was to biomechanically and quantitatively evaluate those two re-education corrections using a computer model combined with experimental testing. METHODS: Finite elements models of 16 patients with IS (10.5-15.4 years old, average Cobb angle of 33°) where built from surface scans and 3D radiographic reconstructions taken in normal standing and self-corrected postures. The forces applied with the therapist's hands over the trunk during manual correction were recorded and used in the FEM to simulate this posture. Self-correction was simulated by moving the thoracic and lumbar apical vertebrae from their presenting position to their self-corrected position as seen on radiographs. A stiffness index was defined for each posture as the global force required to stay in the posture divided by the thoracic curve reduction (force/Cobb angle reduction). RESULTS: The average force applied by the therapist during manual correction was 31 N and resulted in a simulated average reduction of 26% (p < 0.05), while kyphosis slightly increased and lordosis remained unchanged. The actual self-correction reduced the thoracic curve by an average of 33% (p < 0.05), while the lumbar curve remained unchanged. The thoracic kyphosis and lumbar lordosis were reduced on average by 6° and 5° (p < 0.05). Self-correction simulations correlated with actual self-correction (r = 0.9). CONCLUSIONS: This study allowed quantification of thoracic curve reducibility obtained by external forces applications as well as patient's capacity to self-correct their posture, two corrections commonly used in the GPR approach.

The effect of Global Postural Reeducation on body weight distribution in sitting posture and on musculoskeletal pain. A pilot study.

OBJECTIVE: To quantify body weight distribution (BWD) in seated posture with an office chair instrumented with load cells and to evaluate the effects of ergonomic advice and Global Postural Reeducation (GPR) on seated BWD and on musculoskeletal pain. METHODS: Nineteen healthy females were randomly assigned: nine to the experimental group and 10 to the control group. Control group (CG) received only ergonomic verbal advice (EVA) regarding BWD in a seated position. Experimental group (EG) also received EVA and furthermore attended eight GPR sessions. Difference in the effects of the different therapeutic approaches was investigated using the non-parametric Wilcoxon-Mann-Whitney test. RESULTS: After treatments, there was no significant difference between the two groups as regards seated BWD. EG improved musculoskeletal pain significantly more than CG (p<0.005). Instead, musculoskeletal pain frequency decreased (p<0.005) only in EG (after EVA and GPR sessions), in neck, cervical, thoracic, lumbar, shoulders and wrists areas. CONCLUSIONS: Despite both interventions did not induce any significant improvement on seated BWD, adding GPR to EVA was related to a better reduction on musculoskeletal pain in young health females.

Effects of Global Postural Reeducation on gait kinematics in parkinsonian patients: a pilot randomized three-dimensional motion analysis study.

The Global Postural Reeducation (GPR) method is a physical therapy based on the stretching of antigravity muscle chains with the parallel enhancement of the basal tone of antagonistic muscles addressed to improve static and dynamic stability. Through a three-dimensional motion analysis (3DMA) system, our study aims to investigate whether in Parkinson's disease (PD) patients a GPR program results in a more physiological gait pattern. The kinematic parameters of gait of twenty subjects with clinically diagnosed PD were calculated. The patients were randomly assigned to a study (10 or control (10) group. All subjects underwent neurological and 3DMA assessments at entry time (t 0), at 4 weeks (t 1, end of GPR program), and at 8 and 12 weeks (t 2 and t 3, follow-up evaluation). The study group underwent a four-week GPR program, three times a week, for 40 min individual sessions. Kinematic gait parameters of thigh (T), knee (K) and ankle (A) and UPDRS-III scores were evaluated. At the end of the GPR program, we observed an improvement of the kinematic gait pattern, documented by the increase in KΔc and TΔc values that respectively express the flexion amplitude of knee and thigh. The amelioration was persistent at follow-up assessments, with a parallel enhancement in clinical parameters. GPR intervention shows a long-term efficacy on gait pattern in PD patients. Furthermore, we validated 3DMA as a valuable tool to study the kinematics of gait thus refining the understanding of the effects of specific rehabilitation programs.

Effect of a muscle stretching program using the global postural reeducation method for patients with chronic low back pain: A randomized controlled trial.

OBJECTIVES: To assess the effect of a muscle stretching program using the global postural reeducation (GPR) method for patients with chronic low back pain. METHODS: A randomized, controlled, clinical trial with a single blinded examiner and intention-to-treat analysis was conducted. Sixty-one patients with chronic low back pain were randomly allocated to either the GPR group or a control group. Patients in the GPR group underwent one weekly 60-minute session of GPR for a period of 12 weeks. The control group remained on the waiting list under drug treatment, with no physical intervention. The following parameters were evaluated: pain (VAS), function capacity (Roland-Morris Questionnaire [RMQ]), quality of life (SF-36) and depressive symptoms (Beck Inventory). The evaluations were performed by a single blinded examiner at baseline, three and six months after the initial evaluation. RESULTS: The GPR group demonstrated statistical improvements (P<0.05) in the VAS and RMQ as well as the pain, emotional aspects, limitation in physical functioning, vitality and mental health subscales of the SF-36 immediately after the intervention (three months), which were maintained through to the six-month evaluation. DISCUSSIONS: Based on the findings, a stretching program using the GPR method showed effective at improving pain, function, some quality of life aspects (emotional, limitations in physical functioning, vitality and mental health) and had no effect on depressive symptoms in patients with chronic low back pain.

Reeducação Postural Global: uma revisão da literatura / Global Postural Re-education: a literature review

CONTEXTUALIZAÇÃO: O método de Reeducação Postural Global (RPG) tem sido utilizado na clínica com relatos de benefícios para a prevenção e recuperação de disfunções musculoesqueléticas. Após duas décadas de aplicação, estudos têm verificado sua eficácia no tratamento de diferentes condições clínicas e ele tem sido comparado com outros recursos fisioterapêuticos. Entretanto, são poucos os estudos voltados à comprovação dos princípios defendidos pelo autor do método, o que torna frágeis as argumentações em favor dele. OBJETIVO: Realizar, com base na literatura científica, uma análise crítica dos efeitos da intervenção fisioterapêutica utilizando o método RPG. MÉTODOS: Pesquisaram-se as bases de dados Medline, SciELO, LILACS e PeDRO, de 2000 a 2010, considerando os unitermos: RPG, alongamento global e alongamento ativo. RESULTADOS: Foram encontrados 25 estudos, sendo 13 relacionados ao método RPG e oito aos alongamentos global e ativo, além de três livros e uma tese. Após análise, 20 referências foram utilizadas. CONCLUSÕES: Parte dos estudos aponta que o método RPG é mais efetivo, enquanto outros mostram resultados similares a outros métodos de intervenção fisioterapêutica. Estudos indicam benefícios do método na melhora da força muscular respiratória, expansibilidade torácica, mobilidade toracoabdominal e da pressão respiratória máxima, além de reduzir a dor, a perda de urina em mulheres incontinentes, melhorar a flexibilidade, a atividade eletromiográfica nas disfunções temporomandibulares e a estabilidade postural em alterações ortopédicas de membros inferiores. Limitações metodológicas observadas sugerem a necessidade de maior rigor em futuras pesquisas.

BACKGROUND: The Global Postural Re-education (GPR) method has been widely used in clinical practice, with reported benefits for prevention and rehabilitation of musculoskeletal dysfunctions. In parallel with almost two decades of clinical implementation, research studies have tested and verified the effectiveness of GPR in treating different clinical conditions and have also compared this method with other physical therapy resources. However, few studies focused on the verification of the principles of mechanisms of action defended by the author of the method making the arguments in favor of the method weak. OBJECTIVE: To perform a critical systematic review of the effects of physical therapy intervention that use the GPR method. METHODS: We searched Medline, SciELO, LILACS and PeDRO, from 2000 to 2010, considering the key words: Global Postural Re-education, global and active stretching. RESULTS: We found 25 studies, 13 about GPR and 8 about global and active stretching in addition to three books and a thesis. After analysis, 20 references were included. CONCLUSIONS: Some of the studies indicated that the GPR method was more effective than other physical therapy interventions, while others demonstrated similar results of GPR when compared to other physical therapy interventions. Studies showed benefits of the GPR in improving the respiratory muscle strength, chest expansion, maximal respiratory pressure and in reducing pain, loss of urine in incontinent women, increasing flexibility, the electromyographic activity in temporomandibular disorders and postural stability in lower limb orthopedic alterations. Methodological limitations observed suggest the need for greater rigor in future research.

O tratamento de pacientes com fibrose epidural pela reeducação postural global - RPG / Treatment of patients with epidural fibrosis withglobal postural reeducation - GPR

Muitos pacientes têm convivido com a fibrose epidural no pós-operatório de hérnia de disco lombar, doença que pode contribuir para o afastamento destes pacientes de suas atividades da vida profissional, além de interferir em outros aspectos de suas vidas, impossibilitando-as de desenvolver suas atividades habituais, em decorrência do desconforto produzido pela dor. Este trabalho teve como objetivo esclarecer a importância da fisioterapia no tratamento desta doença e mostrar a eficácia da Reeducação Postural Global (RPG), para amenizar a dor, propiciando uma melhor qualidade de vida para estes pacientes. Este trabalho foi realizado no Instituto de Neurologia Deolindo Couto da UFRJ, no ambulatório de fisioterapia. Fizeram parte deste estudo 18 pacientes de ambos os sexos, com fibrose epidural comprovada por ressonância magnética (RM). Todos os pacientes responderam ao Questionário de Dor e Incapacidade Lombar de Roland-Morris, e foram avaliados por uma Escala Visual Analógica (EVA). Essas medidas de avaliação de dor foram utilizadas sempre no momento inicial do tratamento, durante as sessões de RPG. Foram realizadas 15 sessões de RPG. Todos os pacientes envolvidos no trabalho concordaram em participar do programa proposto mediante préinformação e livre consentimento. Após o término do tratamento os pacientes foram reavaliados em um período de três e seis meses.

Many patients have been living with epidural fibrosis during the postoperative of lumbar disc hernia, a kind of disorder that take the patients away from their professional activities, and also away from other aspects of their lives. It impairs their daily activities due to the discomfort produced by the pain. This work has an objective of clarifying the importance of the Physiotherapy for the treatment of this disorder, and to show the efficacy of the Global Postural Reeducation (GPR) to diminish the pain, giving to these patients a better quality of life. This work was performed in Deolindo Couto Neurology Institute û UFRJ, at the Physiotherapy Clinic. Eighteen patients, of both sexes, were included in this study, with epidural fibrosis seen by Magnetic Resonance. All patients answered to the Questionnaire of Pain and Lumbar Incapacity of Roland-Morris, and were also evaluated by a Visual Analog Scale (VAS). These methods of pain evaluation were always used on the time of initial treatment, during GPR sessions. All patients involved in the work agreed in participating of the program, by preinformation and free assent. After the treatment, the patients were reevaluated after a three and six month's period.

Respostas cardiovasculares durante a postura sentada da Reeducação Postural Global (RPG) / Cardiovascular responses in the seated posture of the Global Postural Reeducation (GPR) method

OBJETIVO: Avaliar as respostas da freqüência cardíaca (FC), pressão arterial sistólica (PAS), diastólica (PAD), média (PAM) e duplo produto (DPr), durante a postura sentada do método de Reeducação Postural Global (RPG). MATERIAIS E MÉTODOS: Nove voluntárias saudáveis (23±2,1 anos, 56,4±7,8kg, 1,61±0,05m, 21,6±2,4kg.m2-1), inexperientes na prática do método RPG, foram submetidas a uma sessão de RPG na postura sentada, realizada em três fases: repouso pré-postura, execução da postura e recuperação pós-postura. No repouso e na recuperação, as voluntárias permaneceram sentadas por 20 minutos, sendo PA e FC verificadas a cada cinco minutos. A fase de execução da postura foi realizada em três séries e mantida por três minutos cada, com intervalo de um minuto entre elas. A verificação da PA e da FC foi realizada a cada um minuto e 30 segundos de execução da postura. RESULTADOS: Os valores de PAS, PAD, PAM e DPr foram significativamente maiores (p<0,05) do terceiro ao nono minuto da execução da postura (154±14, 107±11, 122±9mmHg e 16.478±2.802mmHg.min-1) quando comparados aos valores de repouso pré-postura (109±10, 74±7, 85±8mmHg e 9.374±1.687mmHg.min-1) e aos valores de recuperação pós-postura. Porém, estes valores retornaram aos valores de repouso nos primeiros cinco minutos de recuperação pós-postura. Durante a execução da postura, a FC não foi estatisticamente diferente da FC de repouso pré-postura. CONCLUSÕES: Elevações significativas da PAS, PAD, PAM e DPr foram observadas durante a execução da postura sentada da RPG empregada nesse estudo, mas retornaram aos valores de repouso nos primeiros cinco minutos de recuperação pós-postura.

OBJECTIVE: To evaluate heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and double product (DP) responses in the seated posture of the Global Postural Reeducation (GPR) method. METHODS: Nine healthy female volunteers (23±2.1 years; 56.4±7.8kg; 1.61±0.05m, 21.6±2.4kg/m²), without experience of the GPR, method underwent a treatment session in the seated posture. It was a three-step experiment: pre-posture resting, posture maintenance and post-posture recovery. In both the resting and the recovery step, the volunteers remained seated for 20 minutes and arterial pressure and HR were measured every five minutes. The posture maintenance step lasted for three minutes and was implemented three times with one-minute intervals between implementations. Arterial pressure and HR were measured every 1.5 minutes, while the posture was being maintained. RESULTS: The SAP, DAP, MAP and DP values were significantly greater (p<0.05) from the third to the ninth minute of maintaining the posture (154±14, 107±11, 122±9mmHg and 16,478±2,802mmHg/min) in comparison with the pre-posture resting values (109±10, 74±7, 85±8mmHg and 9,374±1,687mmHg/min) and the post-posture recovery values. However, these values returned to the resting values within the first five minutes of post-posture recovery. The HR while maintaining the posture was not statistically different from the pre-posture resting HR. CONCLUSIONS: Significant increases in SAP, DAP, MAP and DP were observed while maintaining the seated posture of the GPR method that was used in this study, but these values returned to the resting values within the first five minutes of post-posture recovery.

Impacto da reeducação postural global no tratamento da incontinência urinária de esforço feminina / Impact of global postural reeducation for treatment of female stress urinary incontinence

OBJETIVO: Avaliar os efeitos da reeducação postural global (RPG) nos sintomas de incontinência urinária de esforço (IUE) e a qualidade de vida em um grupo de mulheres incontinentes. MÉTODOS: Ensaio clínico aberto, tipo antes e depois, prospectivo, não randomizado. Foram selecionadas 26 mulheres com queixa clínica e estudo urodinâmico compatível com IUE, do Ambulatório de Uroginecologia do Hospital das Clínicas da UNICAMP. A idade média foi de 50,76 anos (23 a 72 anos). Todas as mulheres foram avaliadas por anamnese, exames clínicos e uroginecológico, avaliação postural. Todas foram submetidas a tratamento com RPG, em sessões individuais de 50 minutos semanais por três meses e quinzenais por mais três meses. As pacientes foram submetidas a posturas de alongamento propostas pela técnica, em que se coloca em tensão as cadeias musculares responsáveis pela postura estática e estrutura do corpo. O trabalho ativo da paciente nas correções, aliado à atuação do fisioterapeuta, levam ao reequilíbrio das tensões musculares e reestruturação do corpo, o que pode favorecer as funções, especificamente as relacionadas ao assoalho pélvico. Ao término do tratamento, e após seis meses, as pacientes foram reavaliadas através do questionário de impressão geral de melhora, dos domínios relacionados à IUE do King's Health Questinnaire: impacto da incontinência, em que se avaliam os prejuízos na qualidade de vida; percepção geral da saúde, qual a classificação que a paciente dá para sua saúde no momento e a presença do sintoma de perda por esforço; avaliação funcional do assoalho pélvico (AFA) e número de trocas de protetores diários. RESULTADOS: No término do tratamento, quatro pacientes (16 por cento) estavam curadas, dezoito (72 por cento) melhoraram significativamente e três (12 por cento) falharam. Após seis meses, seis pacientes (24 por cento) estavam curadas, 16 (64 por cento) melhoraram e três (12 por cento) falharam (p <0,001). Ao avaliarmos a qualidade de vida das pacientes, observamos melhora significativa (p <0,05) em todos os domínios questionados, destacando-se percepção geral da saúde, impacto da incontinência e número de episódios de perda. A avaliação do funcional do assoalho pélvico (AFA) e do teste do absorvente (número de troca/dia) também mostrou melhora significativa (p<0,001) nos diferentes tempos de coleta. CONCLUSÃO: Os resultados mostram que a RPG pode ser uma alternativa para o tratamento da IUE.

OBJECTIVE: To evaluate the effect of global postural reeducation (GPR) on stress urinary incontinence (SUI) and quality of life in SUI female patients METHODS: The study design was a prospective non-randomized clinical trial. Twenty-six patients with symptoms of SUI were selected from the Urogynecology Outpatient Clinics of the State University of Campinas (Unicamp), state of São Paulo, Brazil. Age ranged from 23 to 72 years old (mean 50.8). All women were submitted to anamnesis, physical exam, postural evaluation and urodynamic testing. Patients were treated by the GPR in individual 50 minute sessions weekly for three months and twice a month for the next three months. All patients were re-evaluated at the end of treatment and six months later by means of General Impression of Improvement, Incontinence Impact, General Perception of Health, Functional Evaluation of the Pelvic Floor, Number of Leaking Episodes and Pad Use. RESULTS: At the end of treatment 4 (16 percent) of the patients were cured, 18 (72 percent) had improved significantly and 3 (12 percent) failed. At 6 months, 6 (24 percent) were cured, 16 (64 percent) improved and 3 (12 percent) failed (p<0.001). Quality of Life questionnaires presented significant improvement (p<0.05) in all domains, with emphasis on General Perception of Health, Incontinence Impact and number of leaking episodes. The Functional Evaluation of the Pelvic Floor and Pad Use also presented significant (p<0.001) improvement. CONCLUSION: These results may demonstrate that GPR is an efficient alternative for treatment of stress urinary incontinence.