Effects of the Anchor System on Postural Balance of Women Undergoing Breast Cancer Treatment: A Clinical, Randomized, Controlled, and Crossover Trial.

OBJECTIVE: Investigate the effects of multisensory training with and without the anchor system on breast cancer survivors' postural balance and self-efficacy of falls. DESIGN: Clinical randomized, controlled, and crossover trial. SETTING: Teaching, Research, and Assistance Center in Mastectomized Rehabilitation. PARTICIPANTS: Eighty breast cancer survivors homogeneously distributed in the groups of adults and elderly affected, or not, by lymphedema. INTERVENTIONS: Participants were randomized to multisensory training with and without the anchor system involving 3 sessions per week for 12 weeks. After the 4-week washout period, the remaining therapeutic intervention was applied. MAIN OUTCOME MEASURES: The primary outcome was semi-static and dynamic balance as evaluated by baropodometry and Mini Balance Evaluation Systems Test, and the secondary outcome was self-efficacy of the fall episode as assessed by Falls Efficacy Scale - International in the pre-, post-immediate, and 4-week follow-up period. RESULTS: Both therapeutic interventions caused positive and significant effects on postural balance and self-efficacy of falls in the immediate period. The multisensory training with the anchor system induced significant functional retention in the short term, related to the clinical effect of small to moderate variation. CONCLUSIONS: Multisensory training with the anchor system is convenient for postural balance and self-efficacy for falls, regardless of age and upper limb volume, for breast cancer survivors.

In vivo attenuation profile of 660 nm and 830 nm wavelengths on human elbow skin and calcaneus tendon of different phototypes.

Physical factors and tissue characteristics determine the transmission of light through tissues. One of the significant clinical limitations of photobiomodulation is the quantification of fluence delivered at application sites and optical penetration depth in vivo. There is also the difficulty of determining the distances of the application points to cover a uniformly irradiated area. Thus, the aim was to evaluate in vivo the influence of melanin on light transmission of the 660 nm and 830 nm laser wavelengths on skin and tendon. Thirty young individuals of both sexes were recruited, divided into two groups based on melanin index, and submitted to photobiomodulation protocols in the posterior region of the elbow (skin-skin) and the calcaneus tendon (skin-tendon-skin). The irradiation area was evaluated using a homemade linear array of five sensors. We found significant transmission power values for different melanin indexes and wavelengths (p<0.0001). Also, different equipment can generate significant differences in the transmitted power at an 830-nm wavelength. Average scattering values are 14 mm and 21 mm for 660 nm, in higher and lower melanin index, respectively. For 830 nm, values of 20 mm and 26 mm are indicated. Laser light transmission in vivo tissues is related to wavelength, beam diameter, tissue thickness, and composition, as well as melanin index. The 830-nm laser presents higher light transmission on the skin than 660 nm. The distances between the application points can be different, with higher values for 830 nm than 660 nm.

Interaction predictors of self-perception menstrual symptoms and influence of the menstrual cycle on physical performance of physically active women.

OBJECTIVE: To analyze the physical performance, self-perception menstrual symptoms, of physically active eumenorrheic women with endogenous ovarian cycle in two phases of the menstrual cycle. METHODS: Twenty-six women participated in the study (age 25.8 ± 3.9 years; height 1.64 ± 0.58 m; mass 64 ± 12.32 kg; menarche 11.69 ± 1.28 years). Assessments were performed in two phases of the menstrual cycle (MC), Early-Follicular Phase (FP) and Mid-Luteal Phase (LP), performance was assessed through total time to exhaustion (TTE), complete stages (CE), and final speed (FE), through a graded exercise test (GXT). Information on the participants' menstrual symptoms and their perceptions of the influence of MC on their performance were also collected. Data normality was assessed using the Shapiro-Wilk test. Paired analyses were conducted (t test or Wilcoxon) to examine the responses between the menstrual phases. The interaction analysis of symptom predictors was performed by multiple linear regression, with a significance level of p ≤ 0.05. RESULTS: There was no significant difference in physical performance between the phases during the GXT in TTE (mean difference 8.50; 95% CI - 11.99 to 42; p = 0.36). During FP, women with heavy flow had shorter performance in the GXT (t = - 2.5; p = 0.01), demonstrating an r2 = 0.32. In LP, for the women who reported not having the perception of the influence of the menstrual cycle on exercise, the total test time was longer (t = 2.55; p = 0.01), with an r2 = 0.45. CONCLUSION: There was no difference in physical performance between FP and LP. However, menstrual flow intensity and perception of cycle interference demonstrated a decrease in TTE.

Segmental bioelectrical impedance analysis can detect differences between the affected and non-affected limbs in individuals with hip osteoarthritis.

OBJECTIVE: To analyze the bioelectrical impedance parameters of the lower limbs of individuals with hip osteoarthritis and healthy individuals. DESIGN: Cross-sectional study. SETTING: The study was carried out at the Hip Surgery Outpatient Clinic. PARTICIPANTS: The volunteers had to be between 45 and 70 years of age, of both sexes, with a clinical and radiological diagnosis of hip osteoarthritis for at least three years, unilateral involvement, or a significant complaint in one hip. METHODS: This was a cross-sectional study. Fifty-four individuals were recruited for the study, 31 individuals with hip osteoarthritis (OA group) and 29 healthy individuals for the control group (C group). Demographic and anthropometric data were collected and then the Numerical Pain Rating Scale, WOMAC, Harris Hip Score, and bioimpedance assessment were applied. MAIN OUTCOME MEASURE(S): Electrical bioimpedance parameters. Phase angle (PhA), impedance, reactance, and muscle mass. RESULTS: There was a significant difference in phase angle (PhA), impedance, and muscle mass at 50 kHz frequency on the side affected by OA when compared to the contralateral side. In the OA group, there was a significant decrease in phase angle (PhA) -0.54 (-0.85 to -0.23) and muscle mass - 0.29 (-0.40 to -0,19), as well as an increase in impedance at the 50 kHz frequency on the side affected by OA when compared to contralateral side 21.71 (13.69 to 29.74). In the C group, there was no difference between the dominant and non-dominant sides (P > 0.05). CONCLUSION: The segmental electrical bioimpedance equipment can detect differences between limbs affected and unaffected by hip osteoarthritis.

Intrareliability and Interreliability of Low-Cost Devices to Measure Skin Tone, Moisture, and Oiliness.

OBJECTIVE: To evaluate the intraexaminer and interexaminer reliability of low-cost commercial devices to measure skin tone, moisture, and oiliness; determine associations with the Fitzpatrick Scale; and compare results with those of widely used commercial equipment. METHODS: Researchers bilaterally collected a total of 36 samples from 18 participants. For data acquisition, two experienced raters were considered for skin index assessment. Evaluations were conducted independently, with measurements taken at two different times with an interval between them, thus enabling intrarater and interrater reliability measures. The measurements were made with two low-cost devices and compared with those acquired using standard equipment for such analyses. RESULTS: For the intraexaminer reliability results, the authors observed intraclass correlation coefficient ranging from moderate to high reliability between these tools (0.747-0.971). Regarding interexaminer reliability, intraclass correlation coefficient ranging from moderate to high (0.541-0.939) were observed. For the results of the correlations, a moderate to a large association was observed for skin tone. However, a small association for moisture was observed among the tools. CONCLUSIONS: Evaluations of skin tonality, oiliness, and moisture showed moderate to excellent intrareliability and interreliability. These methods can be applied in different environments, especially clinics, because of their low cost and ease of use.

Inhibition of bacterial growth through LED (light-emitting diode) 465 and 630 nm: in vitro.

Photobiomodulation has been used to inactivate bacterial growth, in different laser or LED protocols. Thus, the aim of this study was to verify the inhibition of Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, in ATCC strains and bacteria collected from patients with skin burns, after irradiation with LED; 300 µl of saline solution with bacterial suspension was irradiated at a concentration of 0.5-0.63, by the McFarland scale, after five serial dilutions, with evaluation of pre- and post-irradiation pH and temperature control. The cultures were placed in a bacteriological incubator at 37 °C for 24 h for later counting of colony-forming units (CFU). Data were analyzed by Shapiro-Wilk tests and single-factor ANOVA, with Tukey post hoc (p < 0.05). Both wavelengths and energy densities tested showed inhibition of bacterial growth. The comparison of the irradiated groups (ATCC) with the control group showed the following: S. aureus and P. aeruginosa 465 nm (40 J/cm2) and 630 nm (50 J/cm2) and E. coli 465 nm (40 J/cm2) and 630 nm (30 J/cm2). Among the ATCC S. aureus groups, there was a difference for 630 nm (30 J/cm2) and 465 nm (30, 40, 50 J/cm2). The bacteria from the burned patients were S. aureus (30 and 50 J/cm2) and P. aeruginosa (50 J/cm2). We conclude that different bacterial strains were reduced into colony-forming units after LED irradiation.

Acute application of photobiomodulation does not bring important gains for the muscular performance and functionality of diabetic individuals.

Photobiomodulation therapy (PBMT) has been used to improve the physical performance of individuals with advanced age; however, there are no studies in the literature that support the application of light-emitting diode (LED) therapy for the muscular performance of individuals with diabetes mellitus who show a decline in functionality. The aim of the study was to analyze the acute effects of PBMT on strength and functional performance in type 2 diabetic individuals. Sixty-three volunteers were recruited and randomized into five groups: control (C), sham (S), red LED (R), infrared LED (IR), and red LED + infrared LED (R + IR). On the first day, the volunteers were evaluated using the time up and go (TUG), the 6-min walk test (6MWT), and isokinetic dynamometer of the ankle. In the following 3 days, groups R, IR, R + IR, and S returned for application of PBMT bilaterally, with 180 J of energy on each leg. On the fifth day, a reassessment was performed. There was no statistical difference between groups for the variables of the isokinetic dynamometer, TUG, and 6MWT. Analysis of the size of the clinical effect for the isokinetic variables showed that there was no pattern among the effects observed. There is a moderate effect in favor of R, IR, and R + IR in relation to C for the TUG and a moderate effect of R + IR in relation to C for the 6MWT. The PBMT applied for a short period does not bring important gains for the muscular performance and functionality of diabetic individuals.

Photobiomodulation by light emitting diode applied sequentially does not alter performance in cycling athletes.

Analyze the effects of sequential application of photobiomodulation therapy (PBMT) at different wavelengths on the performance of cycling athletes. Cyclists (48 male, mean age 33.77 years) underwent a performance evaluation through an incremental test, VO2max, blood lactate analysis, perception of effort, infrared thermography, and isokinetic evaluations. Photobiomodulation (180 J) with infrared (IR 940 ± 10 nm), red (RED 620 ± 10 nm), mixed Red, and IR (RED/IR 620 + 940 nm) or Sham (disabled device) intervention occurred on three consecutive days and was applied to the quadriceps femoris bilaterally. Reevaluations were performed 24 h after the last application, with 1 week of follow-up. A significance level of 5% was adopted, and the effect size (ES) was calculated by Cohen's d. Results: There were no significant differences in the analyzed variables under any experimental condition (p > 0.005), but a moderate effect size was observed for torque peak at 60°/s on left lower limb (LLL) (ES = 0.67), average power at 60°/s of the right lower limb (RLL) (0.73), and LLL (ES = 0.65) and a considerable effect size in torque peak at 60°/s of the RLL (ES = 0.98) in the IR/RED group compared with sham 24 h after the last application. Moreover, a large effect size was observed for total time to exhaustion (ES = 1.98) and for VO2max (ES = 6.96), and a moderate effect size was seen for anaerobic threshold (ES = 0.62) in the IR/RED group compared with sham. Photobiomodulation, when not associated with training, was not able to produce a cumulative effect on the performance of cycling athletes. However, the association of two wavelengths seems to be better for increased performance. ClinicalTrials.gov Identifier: NCT03225976.

Thermographic Characterization of Cutaneous Ulcers of Different Etiologies.

The characterization of the temperature of skin ulcers may provide preliminary diagnostic evidence. The aim of this study was to characterize cutaneous ulcers of different etiologies by infrared thermography. 122 cutaneous ulcers of 87 patients (age 60.1 ± 15.7 years) were evaluated, allocated into five groups: venous ulcers (VU) n = 26, arterial ulcers (AU) n = 20, mixed ulcers (MU) n = 25, pressure ulcers (PU) n = 29, and neuropathic ulcers (NU) n = 22. The cutaneous temperature was recorded by infrared thermography (FLIR-450™); we also evaluated the ulcer area, the ankle brachial index (ABI), the range of motion (ROM) of the ankle, and pain. For the different variables, the statistical analysis was performed using the Kruskal Wallis test, ANOVA, the chi-squared test, and the Spearman test (SPSS™ software version 20, p < 0.05). A significant difference was found between the temperatures of PU and NU. The ABI was significantly lower in the MU and AU groups, and pain was also higher in these groups. The ROM was decreased in all groups, and the MU and VU groups had the lowest ROM. There was no correlation between temperature and the clinical findings (ABI, ROM, and pain). There was a moderate correlation in the analysis between the temperature and the area of the ulcer in the PU group, as larger ulcers had lower temperatures. It is possible to characterize cutaneous ulcers by infrared thermography, and there are temperature differences among ulcers with different etiologies.

Measurement of Physical Parameters and Development of a Light Emitting Diodes Device for Therapeutic Use.

INTRODUCTION: Effectiveness of light-emitting diode (LED) in biological tissue is due to the correct application of physical parameters. However, most studies found do not provide complete information on the physical characteristics of the diodes. It is necessary to carefully evaluate the diode parameters so that the results of research with this feature can be reproduced. The objective of this study was to develop a light-emitting device using LED, with proper measurements for application in clinical research. It was used 267 LEDs, powered with 12-V voltage and fixed on a plate of ethylene-vinyl acetate (25 × 42 cm), equidistant at 1.0 cm. For the calculation of red and infrared irradiation, a spectrometer was used, and the data were processed in routines implemented in the OriginPro 8.5.0 SR1 Software. The irradiance was determined by the integration of the spectral irradiation in the LED emission region. The red LED has a wavelength of 620 ± 10 nm, a power density of 52.86 mW/cm2, power of 6.6 mW, and total power of 1.76 W on the device. The infrared LED has a wavelength of 940 ± 10 nm, power density 33.7 mW/cm2, power of 6 mW, and total power of 1.6 W on the device. The LED characterization enables the generation and application of energy with greater precision and reproducibility. Besides, it is a light source, a device capable of framing large areas, reducing the time and cost of the application in different clinical conditions related to neuromuscular performance or rehabilitation.

Correlation Between Skin Temperature Over Myofascial Trigger Points in the Upper Trapezius Muscle and Range of Motion, Electromyographic Activity, and Pain in Chronic Neck Pain Patients.

OBJECTIVE: The purpose of this study was to assess the correlation between skin temperature over a myofascial trigger point in the upper trapezius muscle and range of motion of the cervical spine, electromyographic activity, and pain in patients with chronic neck pain. METHODS: This is a single-blind cross-sectional study. Forty participants of both sexes, aged 18 to 45 years, with chronic neck pain and myofascial trigger points in the upper trapezius muscle were included in the study. The participants were assessed using the Numeric Rating Scale, the Neck Disability Index, infrared thermography, algometry, fleximetry, and electromyographic activity. RESULTS: A positive association was observed between skin temperature to the right with the range of motion of cervical flexion (r = 0.322, P = .043), the median frequency of isometrics to the right (r = 0.341, P = .032), and the median frequency of rest to the left (rs = 0.427, P = .006); as were a negative association between skin temperature to the right and the root mean square of rest to the right (rs = -0.447, P = .004), and a positive association of skin temperature to the left with the median frequency of isometrics to the right (r = 0.365, P = .020), and the median frequency of rest to the left (rs = 0.573, P < .001). CONCLUSION: Patients with chronic neck pain who had reduction of skin temperature over myofascial trigger points in the upper trapezius muscle had reduced cervical range of motion for flexion, reduced median frequency at rest and during isometric contraction, and increased root mean square at rest.

Location of Reference Electrode Does Not Interfere on Electromyographic Parameters in the Domains of Time and Frequency.

There is currently little information on the positioning of reference electrode (RE). It is generally accepted that it must be positioned on electrically neutral tissues, such as tendons or bony prominences. The objective of this study is to analyze the characteristics of the electromyographic signal (EMG) for different positions of RE as well as at different levels of muscle contraction. Signals from the brachial biceps and triceps were recorded from 18 healthy women (BMI: 21.20 kg/m2 ± 1.72; mean age: 21.94 ± 1.98 years old) during 100 and 50% maximum flexion voluntary isometric contractions, as well as at rest. For each situation, the RE was randomly positioned in 4 different locations: a) homolateral acromion; b) homolateral brachial biceps; c) styloid process of the contralateral ulna; and d) lateral malleolus of the contralateral ankle. For statistical analysis, Shapiro-Wilk and Kruskal-Wallis tests were used, followed by Dunn's post-hoc test, at a significance level of 5% (p < 0.05). RMS, normalized RMS, PSD, median frequency and levels of energy at 60 Hz, 120 Hz and 180 Hz were assessed for the different sites of RE. The results show that the positioning of the RE on the four experimental locations did not change important features of the electromyographic signals in the time and frequency domains, for the three levels of isometric contractions studied. Such findings compel us to re-think the current trend regarding the RE position followed by the great majority of the researches in areas such as physical therapy.

LLLT actives MMP-2 and increases muscle mechanical resistance after nerve sciatic rat regeneration.

The purpose of this study was to analyze the low-level laser therapy (LLLT) on metalloproteinase expression and the mechanical strength of skeletal muscle regeneration after peripheral nerve injury. Rats were subjected to crush injury of the right sciatic nerve, followed by LLLT (830 nm, 35, 70, 140, and 280 J/cm2) for 21 consecutive days. Functional gait analysis was performed at weekly intervals and the animals were sacrificed after the last evaluation at day 21 for collection of the gastrocnemius muscles, which were submitted to analysis of resistance, and the tibialis anterior, for evaluation of metalloproteinase-2 (MMP-2). The results were statistically analyzed at a significance level of 5%. The irradiated groups showed a significant decrease in the sciatic functional index and a significant increase in the mechanical strength when compared to the injured group with no treatment (p < 0.05), with no significant difference among the energy densities used. While no difference among groups was observed for the activity of MMP-2 in pro-active band, at the intermediate band, the activity was significantly higher (p < 0.05) for the groups irradiated with 35, 70, and 140 J/cm2, and at the active band, the activity was significantly more intense in the group irradiated with 280 J/cm2. The present study demonstrated that injury of the sciatic nerve, with consequent muscle denervation, are benefited by the laser therapy, which restores neuromuscular function, active MMP-2 and increases the maximum breaking strength.

Accuracy and Reliability of Infrared Thermography in Assessment of the Breasts of Women Affected by Cancer.

Evaluate reliability and accuracy of infrared thermography in the assessment of women wth breasts cancer. Thirty-five participants had unilateral breast cancer and 17 control subjects were assessed using infrared thermography. To evaluate reliability, two professionals, who were experienced, measured the temperature of the infrared images in two different moments, with a one-week interval. Biopsy was used as a gold standard exam with regard identify breast cancer. The analysis illustrated excellent reliability in terms of the affected, contralateral and control breasts with the intra-class correlation coefficient values ranging from 0.948 to 0.999. Standard measurement error ranged from 0.04 to 0.28 °C, and minimum detectable change deviated from 0.11 to 0.78 °C. Moreover, low to moderate accuracy were observed in terms of the establishment of the breast cancer diagnosis with values of the area under the receiver operating characteristic (ROC) curve ranging from 0.571 and 0.749. Breasts affected by cancer present higher skin temperature compared to contralateral and control. Furthermore, excellent reliability of the analysis of the infrared images and low-moderate accuracy in terms diagnosis were observed. Considering the results, infrared thermography can be applied as an instrument complement the assessment of breast cancer patients, but not for diagnostic purposes.

Red and infrared laser therapy inhibits in vitro growth of major bacterial species that commonly colonize skin ulcers.

Low-level laser therapy (LLLT) is used in chronic wounds due to its healing effects. However, bacterial species may colonize these wounds and the optimal parameters for effective bacterial inhibition are not clear. The aim of this study was to analyze the effect of LLLT on bacterial growth in vitro. Bacterial strains including Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa were suspended in saline solution at a concentration of 10(3) cells/ml and exposed to laser irradiation at wavelengths of 660, 830, and 904 nm at fluences of 0 (control), 3, 6, 12, 18, and 24 J/cm(2). An aliquot of the irradiated suspension was spread on the surface of petri plates and incubated at 37 °C for quantification of colony-forming unit after 24, 48, and 72 h. Laser irradiation inhibited the growth of S. aureus at all wavelengths and fluences higher than 12 J/cm(2), showing a strong correlation between increase in fluence and bacterial inhibition. However, for P. aeruginosa, LLLT inhibited growth at all wavelengths only at a fluence of 24 J/cm(2). E. coli had similar growth inhibition at a wavelength of 830 nm at fluences of 3, 6, 12, and 24 J/cm(2). At wavelengths of 660 and 904 nm, growth inhibition was only observed at fluences of 12 and 18 J/cm(2), respectively. LLLT inhibited bacterial growth at all wavelengths, for a maximum of 72 h after irradiation, indicating a correlation between bacterial species, fluence, and wavelength.

Influence of Different Photobiomodulation Parameters on Multi-Potent Adipose Tissue Mesenchymal Cells In Vitro.

Objective: Investigating the effect of different parameters of photobiomodulation (PBM) with low-power laser on multi-potent mesenchymal stem cells (MSCs) derived from adipose tissue in terms of proliferation and cell death. Methods: MSCs were submitted to PBM applications with combinations of the following physical parameters: control group (no intervention), wavelengths of 660 and 830 nm; energy of 0.5, 2, and 4 J; and power of 40 and 100 mW. MSC analysis was performed using MetaXpress® software at 24, 48, and 72 h. Results: Irradiation promoted a significant increase in cell proliferation (p < 0.05), with 830 nm laser, 100 mW, with energy of 0.5, 2, and 4 J in relation to the control group at all times. PBM with 660 nm, power of 40 mW, and energy of 0.5, 2, and 4 J produced greater cell death at 24 h compared with the control group. At the time of 72 h, there was no significant difference concerning cell death. Conclusions: According to the results found, we can conclude that both wavelengths were effective; however, the 830 nm laser was more effective in terms of cell proliferation compared with the 660 nm laser. The 660 nm wavelength showed a significant increase in cell death when compared with the 830 nm laser.

Optical Properties of Human Skin Phototypes and Their Correlation with Individual Angle Typology.

Objective: This study aims to correlate human skin phototypes with complete optical characterization (absorption, scattering, effective attenuation, optical penetration, and albedo coefficients) based on individual typology angle (ITA) values and colorimetric parameters. Methods: A colorimeter was used to group 12, fresh, ex vivo human skin samples according to their phototype; the CIELAB color scale and ITA values were employed. An integrating sphere system and the inverse adding-doubling algorithm were applied during optical characterization, conducted from 500 to 1300 nm. Results: On the basis of ITA values and their classification, the skin samples were separated into six groups: two intermediates, two tan, and two brown. In the visible range, for lower ITA values (darker skins), the absorption and effective attenuation coefficient parameters increased, whereas the albedo and depth penetration parameters decreased. In the infrared region, all the phototypes had similar parameters. The scattering coefficient was similar for all the samples and did not change with ITA values. Conclusions: ITA analysis, a quantitative method, showed that the human skin tissue's optical properties and pigmentation colors were highly correlated.

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial.

BACKGROUND: Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome. METHODS/DESIGN: Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test. DISCUSSION: This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184.

Does sensorimotor training influence neuromuscular responses, balance, and quality of life in diabetics without a history of diabetic distal polyneuropathy?

OBJECTIVE: To evaluate the effect of supervised and home sensorimotor training on static postural balance (SPB), quality of life (QL), and neuromuscular responses of Type 2 Diabetics (DM-2). DESIGN: Randomized controlled blind study with DM-2 patients, between 45 and 64 years old, of both sexes, divided into 3 groups: Control Group - CG (n = 27), Home Training Group - HTG (n = 27), and Supervised Training Group - STG (n = 26). The subjects were evaluated before and at the end of 3 months of treatment, with a four-week follow-up. The intervention was held twice a week, for 45 min, divided into three phases: warm-up, sensorimotor training, and cool-down. The primary outcome was SPB, using the force platform. Secondary outcome: questionnaires and clinical measures related to diabetic foot and knee flexor-extensors using isokinetic dynamometry. RESULTS: In the baseline, the characteristics were similar between groups and between times. Tactile and vibratory sensitivity demonstrated the absence of symptoms of peripheral neuropathy in diabetic patients. In the intra-group comparison, there was a significant increase in the classification without symptoms of diabetic distal polyneuropathy in the HTG and STG groups (p < 0.05) and there were no significant effects on other clinical outcomes and QL and SPB, muscle strength, and sense of knee joint position. CONCLUSION: The intervention showed no improvement in SPB, QL, and other clinical outcomes of DM-2 patients. Thus, no differences were found between the groups, considering that the patients did not present clinical characteristics of diabetic distal polyneuropathy.

Comparative effects of wavelengths of low-power laser in regeneration of sciatic nerve in rats following crushing lesion.

Peripheral nerves are structures that, when damaged, can result in significant motor and sensory disabilities. Several studies have used therapeutic resources with the aim of promoting early nerve regeneration, such as the use of low-power laser. However, this laser therapy does not represent a consensus regarding the methodology, thus yielding controversial conclusions. The objective of our study was to investigate, by functional evaluation, the comparative effects of low-power laser (660 nm and 830 nm) on sciatic nerve regeneration following crushing injuries. Twenty-seven Wistar rats subjected to sciatic nerve injury were divided into three groups: group sham, consisting of rats undergoing simulated irradiation; a group consisting of rats subjected to gallium-aluminum-arsenide (GaAlAs) laser at 660 nm (10 J/cm(2), 30 mW and 0.06 cm(2) beam), and another one consisting of rats subjected to GaAlAs laser at 830 nm (10 J/cm(2), 30 mW and 0.116 cm(2)). Laser was applied to the lesion for 21 days. A sciatic functional index (SFI) was used for functional evaluation prior to surgery and on days 7, 14, and 21 after surgery. Differences in SFI were found between group 660 nm and the other ones at the 14th day. One can observe that laser application at 660 nm with the parameters and methods utilised was effective in promoting early functional recovery, as indicated by the SFI, over the period evaluated.