Avaliação eletromiográfica de músculos inspiratórios em hemiparéticos / Eliete Moreira Colaço

The objective was measured by surface electromyography (EMGs), the activity of inspiratory muscles during incremental test in subjects with hemiparesis and show its correlation with the Functional Independence Measure (FIM). Were included in the study 32 individuals hemiparetics and 14 healthy as control group. We performed an evaluation of lung function and anthropometric data. The EMGs were performed during the incremental test with Threshold ® (15, 30, 45 and 60% of MIP) and during maximal inspiratory pressure (MIP). The electromyographic findings were calculated by the signal amplitude (RMS). All data were initially analyzed by Kolmogorov-Smirnov, the anthropometric characteristics of both groups were tested with the Levene and then intra-subject analysis (hemiparetic hemithorax and healthy hemithorax) and inter-group analysis (experimental group and control group) by paired and non-paired Student t tests and Pearson correlation. In intra-subject comparison was observed less activation (p <0.01) of the sternocleidomastoid muscle, scalene and diaphragm paretic side in both sexes - for the Threshold ® incremental test (15, 30, 45 and 60% of the MIP) and during maximal inspiratory pressure (MIP). In inter-group comparison, there was reduced activity in the diaphragm and the scalene, in hemiparetics males and females, respectivelly, during the same test. Our results demonstrate the existence of reduced electromyographic activity of inspiratory muscles in hemiparetics, including changes between different genders and suggests the need of further studies to assess the effects of specific training of inspiratory muscles.

Efeitos do treinamento muscular inspiratório domiciliar sobre a atividade eletromiográfica dos músculos respiratórios em asmáticos: estudo piloto

Asthma treatment aims to achieve and maintain the control of the disease for prolonged periods. Inspiratory muscle training (IMT) may be an alternative in the care of patients with asthma, and it is used as a complementary therapy to the pharmacological treatment. Thus, the aim of this study was to investigate the effects of a domiciliary program of IMT on the electromyographic activity of the respiratory muscles in adults with asthma. This is a clinical trial in which ten adults with asthma and ten healthy adults were randomized into two groups (control and training). The electrical activity of inspiratory muscles (sternocleidomastoid (ECM) and diaphragm) was obtained by a surface electromyography. Furthermore, we assessed lung function (spirometry), maximal inspiratory pressure - MIP - (manometer). The functional capacity was evaluated by six minute walk test. Participants were assessed before and after the IMT protocol of 6 weeks with POWERbreathe® device. The training and the control groups underwent IMT with 50% and 15 % of MIP, respectively. The sample data were analyzed using SPSS 20.0, attributing significance of 5 %. Were used t test, ANOVA one way and Pearson correlation. It was observed an increase in MIP, after IMT, in both training groups and in healthy sham group (P < 0.05), which was accompanied by a significant increase in ECM activity during MIP in healthy training group (1488 %) and in asthma training group (ATG) (1186.4%). The ATG also showed a significant increase in diaphragm activity in basal respiration (48.5%). Functional capacity increased significantly in the asthma sham group (26.5 m) and in the asthma training group (45.2 m). These findings suggest that IMT promoted clinical improvements in all groups, especially the ATG, which makes it an important complementary treatment for patients with asthma

Normalização de eletromiografia de superfície dos músculos respiratórios em sujeitos saudáveis: contração voluntária máxima máxima isométrica versus pressões respiratórias máximas

Aim : To evaluate and to standardize surface electromyography (sEMG) normalization procedures for respiratory muscles by comparing muscle activation during Maximal Voluntary Isometric Contraction (MVIC) and Maximal Respiratory Pressures (MIP, MEP and sniff test). Methods: Healthy subjects were evalua ted regarding demographics, spirometry and sEMG during the five maneuvers: sniff test, MIP , MEP and Maximal Voluntary Isometric C ontraction (MVIC) of RA, SCM and SC A . For electrode placement, skin was prepared with abrasion, followed by shaving in the foll owing regions for acquisition of el ectromyographic signals: (1) SC M: lower third of the distance between the mastoid process and t he sternoclavicular joint; (2) SC A : 5 cm to the right from the sternoclavicular joint and at this point, up to 2 cm; and (3 ) RA: the level of umbilicus, 4 cm to the right. In electromyographic variables analysis , the data normality was assessed by Shapiro - Wilk test. Comparisons among studied maneuvers were performed by Friedman Test and Dunn’s post - hoc for multiple comparisons a mong inspiratory maneuvers, and Mann Whitney test for expiratory maneuvers. Subgroups differences between genders were performed by Student's t test or Mann - Whitney test according to data normality. Results: 35 subjects participated in the study, b ut 5 we re excluded (BMI> 25 kg/ m²). Sample consisted of 30 subjects (1 5 women), mean age 27.3±7.43 years, BMI 22.2 ± 1.69 kg/m² and spirometric indices within normal limits. Specific MVIC for SCM, SCA and RA showed the highest RMS. When we grouped sample into gender we found no difference among RMS values for the studied SCM maneuvers, while for SCA, MVIC SCM / SCA was the one with the highest RMS and for RA, MVIC RA in men. Once considering women, MVIC SCM/SCA showed the highest RMS for SCM, SCA and MVIC RA showed t he highest value for RA. Conclusion: MVIC for SCM, SCA and RA muscles showed the highest RMS values. When comparing RMS between the studied groups, there was no significant difference between men and women.

Efeito do treinamento muscular inspiratório com diferentes cargas na força e função de músculos respiratórios

Background: The inspiratory muscle training (IMT) has been considered an option in reversing or preventing decrease in respiratory muscle strength, however, little is known about the adaptations of these muscles arising from the training with charge. Objectives: To investigate the effect of IMT on the diaphragmatic muscle strength and function neural and structural adjustment of diaphragm in sedentary young people, compare the effects of low intensity IMT with moderate intensity IMT on the thickness, mobility and electrical activity of diaphragm and in inspiratory muscles strength and establish a protocol for conducting a systematic review to evaluate the effects of respiratory muscle training in children and adults with neuromuscular diseases. Materials and Methods: A randomized, double-blind, parallel-group, controlled trial, sample of 28 healthy, both sexes, and sedentary young people, divided into two groups: 14 in the low load training group (G10%) and 14 in the moderate load training group (G55%). The volunteers performed for 9 weeks a home IMT protocol with POWERbreathe®. The G55% trained with 55% of maximal inspiratory pressure (MIP) and the G10% used a charge of 10% of MIP. The training was conducted in sessions of 30 repetitions, twice a day, six days per week. Every two weeks was evaluated MIP and adjusted the load. Volunteers were submitted by ultrasound, surface electromyography, spirometry and manometer before and after IMT. Data were analyzed by SPSS 20.0. Were performed Student's t-test for paired samples to compare diaphragmatic thickness, MIP and MEP before and after IMT protocol and Wilcoxon to compare the RMS (root mean square) and median frequency (MedF) values also before and after training protocol. They were then performed the Student t test for independent samples to compare mobility and diaphragm thickness, MIP and MEP between two groups and the Mann-Whitney test to compare the RMS and MedF values also between the two groups. Parallel to experimental study, we developed a protocol with support from the Cochrane Collaboration on IMT in people with neuromuscular diseases. Results: There was, in both groups, increased inspiratory muscle strength (P <0.05) and expiratory in G10% (P = 0.009) increase in RMS and thickness of relaxed muscle in G55% (P = 0.005; P = 0.026) and there was no change in the MedF (P> 0.05). The comparison between two groups showed a difference in RMS (P = 0.04) and no difference in diaphragm thickness and diaphragm mobility and respiratory muscle strength. Conclusions: It was identified increased neural activity and diagrammatic structure with consequent increase in respiratory muscle strength after the IMT with moderate load. IMT with load of 10% of MIP cannot be considered as a placebo dose, it increases the inspiratory muscle strength and IMT with moderate intensity is able to enhance the recruitment of muscle fibers of diaphragm and promote their hypertrophy. The protocol for carrying out the systematic review published in The Cochrane Library.