Efeitos imediatos da eletroestimulação nervosa transcutânea e crioterapia na espasticidade e na atividade eletromiográfica de sujeitos hemiparéticos

Cerebrovascular accident (CVA) is a term used to characterize an ischemic or hemorrhagic vascular injury, which has got as main clinic manifestations, the motor and reflex function disturbance. In the first stage there is flaccidity and loss of voluntary movements that afterwards is substituted by mass patterns and spasticity. The spasticity brings with itself functional deficits and can generate negative impacts in various motor patterns. The aim of this research was to investigate the hyperreflexia and identify the immediate effects of transcutaneous nervous stimulation (TENS) and cryotherapy in the spasticity and electromyographic activity of hemiparetic subjects. The study is characterized as an almost experimental type, in which were selected, to compose the sample, 16 patients of both sex with CVA sequel. These individuals were evaluated by collecting the amplitude peak to peak and H reflex latency, Motor response (M response) in solear muscle and the electromyography (EMG) of the injured and healthy legs anterior tibial muscles. In the injured limb the evaluations occurred in different days for cryotherapy, TENS and control, in two moments, before and after the interventions. The healthy limb was evaluated one single time to serve as baseline, for comparison with the injured limb. It was used an statistic analysis, the t paired student test to identify the H reflex differences, latency and EMG of the injured and healthy limbs and to compare the results before and after the recourses application. The ANOVA for related samples was used to identify the differences among the recourses used. It was attributed for the statistic tests a significance level of 5%. The amplitude peak to peak of normalized maximum H reflex through the maximum motor response (Hmax/Mmax), showed itself significantly increased in the injured limb (p=0.0245). The H reflex latency was presented reduced in the injured limb (p=0, 0375). The electromyographic activity was showed decreased in the injured limb (p< 0.0001). After the TENS there was a Hmáx/Mmáx ratio decrease (0.60±0.16 versus 0.49.±0.18; P = 0.0006). Nonetheless, Just after the cryotherapy application there was an increase of Hmáx/Mmáx ratio (0.58 ± 0,15 to 0.77 ± 0.13, P=0,0007) and increase of signal latency (30.41 ± 1.87 versus 33.24 ± 2.19; P=0.0001). The electromyographic activity wasn t altered significantly by any resource. It was met statistic significant differences when the Hmáx/Mmáx P<0.0001) ratio and H reflex latency (P<0.0001) were compared between the post TENS, cryotherapy and control. One can conclude that the TENS can be used to spasticity immediate reduction, and that the cryotherapy can increase the hyperreflexia state in spastic patients. Nonetheless, the spasticity decrease or increase didn t provoke lectromyographic activity change in the muscle that is opponent to the spastic one

Efeito imediato da estimulação elétrica neuromuscular seletiva do músculo VMO em pacientes com síndrome da dor femoropatelar

Patellofemoral pain syndrome (PFPS) is described as anterior or retropatellar pain knee in the absence of other pathologies and is frequently associated with dysfunction of the vastus medialis oblique (VMO). However, several studies have demonstrated the inability to selectively activate this muscle through exercise. To evaluate the effect of Neuromuscular Electrical Stimulation (NMES) selective VMO in women with syndrome. We evaluated thirty-eight women: twenty in the control group (24.15 ± 2.60 years) and eighteen diagnosed with PFPS (25.56 ± 3.55 years). Both groups were evaluated before and after a protocol of electro stimulation. To measure for comparing groups before and after treatment, we assessed the extensor torque concentric and eccentric knee through an isokinetic dynamometer, the intensity (Root Mean Square - RMS) and the onset of activation (onset) of VMO compared to the vastus lateralis (VL) in two types of exercise: open and closed kinetic chain. . Statistical analysis was performed using SPSS 15.0, with a significance level of 5%. Results: Our data showed an increase in the intensity of activation (RMS) of the VMO muscle after NMES in both study groups. During concentric contraction the RMS of the VMO before the NMES was 105.69 ± 32.26 μV and after a single intervention was 122.10 ± 39.62 μV (p = 0.048) for the control group. In the group with PPS, we found a similar behavior, with RMS of the VMO before NMES of 96.25 ± 18.83 μV and 139.80 ± 65.88 μV after the intervention (p = 0.0001). However, there was no evidence in the RMS value of VL muscle. The onset was calculated by subtracting the onset of VL by the onset of VMO. For the group with PFPS, the onset before the intervention was -0.007 ± 0.14 ms, indicating a delay of the VMO relative to VL, and after NMES was 0.074 ± 0.09 ms (p = 0.016), showing an activation previous VMO to VL. The same occurred for the control group. We also observed that NMES increased knee extensor power during the concentric contraction in both groups. Before the intervention the mean power was 28.97 ± 9.01 W for the PPS group and after NMES was 34.38 ± 7.61 W (p = 0.0001). Conclusion: We observed an increase in electromyographic activity of the VMO and also an anticipatory effect of this muscle

Efeito do kinesio taping® no desempenho neuromuscular do quadríceps e no equilíbrio em sujeitos submetidos à reconstrução do ligamento cruzado anterior: ensaio clínico e randomizado

Objetivo: Investigar os efeitos imediatos do Kinesio Taping® no desempenho neuromuscular do Quadríceps Femoral (QF) de indivíduos submetidos à reconstrução do Ligamento Cruzado Anterior (LCA). Metodologia: trata-se de um ensaio clínico e randomizado composto por 45 indivíduos do sexo masculino que se encontravam entre 12ª e 17ª semanas após reconstrução do LCA. Todos foram submetidos a uma avaliação inicial composta pela análise do equilíbrio postural, através da baropodometria; determinação do Senso de Posição Articular (SPA), seguidas das avaliações isocinéticas excêntricas e concêntricas a 600/s, concomitante com a captação do sinal eletromiográfico do músculo Vasto Lateral (VL). Posteriormente foram alocados de forma aleatória em Grupo Controle (GC), Grupo Placebo (GP) e Grupo Experimental (GE). Os indivíduos do GE foram submetidos ao protocolo sugerido (aplicação do Kinesio Taping® no QF do membro acometido), enquanto os do GP utilizaram a aplicação do Kinesio Taping® sem as recomendações propostas pelo método. Já os indivíduos do GC permaneceram em repouso por dez minutos, sendo todos os indivíduos submetidos a uma reavaliação de forma idêntica à primeira. Foram analisadas as seguintes variáveis: pico de torque médio, pico de torque/peso corporal, potência muscular e erro absoluto do SPA para a dinamometria; amplitude ântero-posterior e médio-lateral para a baropodometria; e a amplitude de ativação muscular (Root Means Square - RMS) por meio da eletromiografia de superfície. Resultados: Nenhuma das variáveis analisadas apresentou diferenças intergrupo ou intragrupo. Conclusão: O Kinesio Taping® não altera o desempenho neuromuscular do quadríceps femoral de indivíduos submetidos à reconstrução do LCA para nenhuma das variáveis analisadas.

Prevalence of biomicroscopic findings in the anterior segment and ocular adnexa among schoolchildren in Natal/Brazil

Objective: To determine the prevalence of ocular findings of the external structures and anterior segment of the eye, detected by biomicroscopic examination in schoolchildren in Natal (RN) - Brazil. Methods: After previous random selection, 1,024 pupils from elementary and secondary public and private schools in the city of Natal were evaluated from March to June 2001. All were submitted to preestablished standard research norms, consisting of identification, demographic information, ophthalmologic biomicroscopic examination, with slit lamp, performed by ophthalmologists from the “Onofre Lopes” University Hospital. Results: Alterations of the conjunctival and palpebral conditions were the most prevalent (10.4% and 6.2% respectively). Follicles (4.2%) and papillae (3.0%) were the frequent conjunctival lesions, while blepharitis (3.5%) and meibomitis (1.1%) were the most detected abnormalities in the eyelids. Upon examining the cornea, iris, lens and anterior vitreous, the most encountered findings were nubecula (0.5%), papillary membrane reliquiae (0.5%), posterior capsula opacity (0.8%) and hyaloid arteria reliquiae (2.0%). Conclusion: The most prevalent findings affecting the external structures of the eye such as eyelids and conjunctiva, consisted of blepharitis followed by follicular reaction of the conjunctiva. The most prevalent abnormalities in the cornea, iris, lens and anterior vitreous were nubecula, papillary membrane reliquiae, posterior capsular opacity and hyaloid arteria reliquiae, in that order

Prevalência e fatores associados da síndrome de Osgood-Schlatter em uma amostra populacional de adolescentes brasileiros

Osgood-Schlatter (O-S) syndrome, a pathology of the musculoskeletal system, exhibits high incidence in adolescence, a phase of accelerated bone growth. Detection of physiopathological mechanisms that may cause disorders and dysfunctions in bone growth must be taken into account when planning physical activities, in order to promote normal physiological growth patterns. The aim of this epidemiological investigation was to identify and analyze the relationships between sociodemographic, anthropometric and clinical aspects and O-S. A cross-sectional design was used, with a representative sample of 956 subjects: 474 (49.6%) males and 482 (50.4%) females. Age range varied between 12 and 15 years (mean = 13.7±1.04). We used a battery of tests, previously applied in a pilot study, which met the aims of the investigation. Descriptive statistics (frequency, mean and standard deviation) were used and the odds ratio was calculated from bivariate and multivariate logistic regression (p<0.05). A prevalence of 9.8% was found (n = 94 cases): 11% males and 8.3% females. Hierarchized multivariate analysis showed a significant association between regular physical activities (OR= 1.94; CI 95%, 1.22-3.10) and shortening of the rectus femoris muscle (OR= 7.15; CI 95%, 2.86-17.86). The results may serve as a basis for therapeutic and prophylactic measures, in addition to increasing our knowledge of this syndrome in Brazilian adolescents. This investigation used a multidisciplinary approach, involving elements of anatomy, nutrition, physical education and physical therapy to elucidate the object under study related to Osgood-Schlatter syndrome

Efeitos da laserterapia de baixa potência sobre a fadiga do músculo quadríceps de indivíduos jovens

The objective of this study was to evaluate the effect of low laser power on the performance of anaerobic endurance of the quadriceps muscle in young subjects. Low-level laser therapy (LLLT) appears to decrease some indices of muscle fatigue. Most of these effects may be due to the influence of the laser on the muscles predominantly aerobic. Animal studies and clinical trials have already shown that the laser can improve the efficiency of mitochondrial metabolism for the resynthesis of adenosine triphosphate and thus slow down - or minimize, the deleterious effects of muscle fatigue. This research was characterized as an experimental study of the controlled clinical trial, randomized, blinded, attended by 93 volunteers, military, with ages between 18 and 19 years. The subjects were randomly allocated into three groups: Control (G1), Placebo (G2) and Laser (G3). All volunteers underwent an anthropometric assessment and a protocol Fatigue. This protocol was applied to an initial assessment (AV-1) for the collection of baseline data, and a final evaluation (AV-2). As the study variables, we used the blood lactate concentrations and indices of muscle power, as average power and peak velocity. The fatigue protocol consisted of a test of speed with twenty repetitions, performed on an exercise machine leg press 45º . In conclusion, it was found that, in this study, LLLT caused a significant increase in the Average of the Averages Powers, phase eccentric exercise in leg press 45º performed by young individuals

Desenvolvimento de uma desfribadeira para obtenção da fibra da folha do abacaxi

In 1998 the first decorticator was developed in the Textile Engineering Laboratory and patented for the purpose of extracting fibres from pineapple leaves, with the financial help from CNPq and BNB. The objective of the present work was to develop an automatic decorticator different from the first one with a semiautomatic system of decortication with automatic feeding of the leaves and collection of the extracted fibres. The system is started through a command system that passes information to two engines, one for starting the beater cylinder and the other for the feeding of the leaves as well as the extraction of the decorticated fibres automatically. This in turn introduces the leaves between a knife and a beater cylinder with twenty blades (the previous one had only 8 blades). These blades are supported by equidistant flanges with a central transmission axis that would help in increasing the number of beatings of the leaves. In the present system the operator has to place the leaves on the rotating endless feeding belt and collect the extracted leaves that are being carried out through another endless belt. The pulp resulted form the extraction is collected in a tray through a collector. The feeding of the leaves as well as the extraction of the fibres is controlled automatically by varying the velocity of the cylinders. The semi-automatic decorticator basically composed of a chassis made out of iron bars (profile L) with 200cm length, 91 cm of height 68 cm of width. The decorticator weighs around 300Kg. It was observed that the increase in the number of blades from 8 to twenty in the beater cylinder reduced the turbulence inside the decorticator, which helped to improve the removal of the fibres without any problems as well as the quality of the fibres. From the studies carried out, from each leaf 2,8 to 4,5% of fibres can be extracted. This gives around 4 to 5 tons of fibres per hectare, which is more than that of cotton production per hectare. This quantity with no doubt could generate jobs to the people not only on the production of the fibres but also on their application in different areas

Efeitos do alongamento e do aquecimento no desempenho isocinético e na atividade eletromiográfica do músculo bíceps femoral ensaio clínico randomizado

To evaluate the effects of warm-up and stretching, singly or combined, on isokinetic performance and electromyographic activity of the biceps femoris. Materials and methods: Sixty-four volunteers of both sexes, with mean age of 23,1 ± 3,5 years and mean body mass index of 23,5 ± 2,5 Kg/m2 were randomly assigned into 4 groups: control, warm-up (stationary bicycle for 10 minutes), stretching (4 sets of 30 seconds of hamstring muscles static stretching) and warm-up + stretching. All the volunteers were submitted to evaluation pre and post-intervention of the muscle latency time and biceps femoris RMS and the passive torque, peak torque and power of the hamstring muscles. Results: The warm-up + stretching group had reduction of muscle latency time. There was a reduction of RMS during passive torque evaluation in stretching group. The RMS during isometric evaluation was reduced in all experimental groups. The RMS during eccentric evaluation showed reduction in control and warm-up + stretching groups. The passive torque and the eccentric peak torque had no significant differences pre to post-intervention in any group. There was reduction in isometric peak torque in all groups. Conclusion: The warm-up and stretching, when applied in combination can reduce the muscle latency time; stretching protocol promoted neural changes; the protocols used did not alter the muscle viscoelastic properties

Influência da fadiga no comportamento neuromuscular do quadríceps femoral, após reconstrução do ligamento cruzado anterior

Muscle fatigue is a phenomenon that promotes physiological and biomechanical disorders and their changes in healthy subjects have been widely studied and have significant importance for care in preventing injuries, but we do not have many information about its effects in patients after ACL reconstruction. Thus, this study is to analyze the effects of fatigue on neuromuscular behavior of quadriceps after ACL reconstruction. To reach this objective, participants were forty men, twenty healthy (26,90 ± 6,29 years) and twenty after ACL reconstruction (29,75 ± 7,01 years) with a graft of semitendinosus and gracilis tendons, between four to six months after surgery. At first, there was an assessment of joint position sense (JPS) at the isokinetic dynamometer at a speed of 5°/s and target angle of 45° to analyze the absolute error of JPS. Next, we applied the a muscle fatigue protocol, running 100 repetitions of isokinetic knee flexion-extension at 90°/s. Concurrently with this protocol, there was the assessment of muscle performance, as the peak torque (PT) and fatigue index, and electromyographic activity (RMS and median frequency). Finally, we repeated the assessment of JPS. The statistical analysis showed that patients after ACL reconstruction have, even under normal conditions, the amended JPS compared with healthy subjects and that after fatigue, both have disturbances in the JPS, but this alteration is significantly exacerbated in patients after ACL reconstruction. About muscle performance, we could notice that these patients have a lower PT, although there are no differences between the dynamometric and EMG fatigue index. These findings show the necessity about the cares of pacients with ACL reconstruction in respect of the risks of articulate instability and overload in ligamentar graft

Efeitos da eletroestimulação sobre os parâmetros eletromiográficos e dinamométricos do músculo quadríceps femoral

To analyze the effects of electrical stimulation at two frequencies on the EMG parameters (EMG) and dynamometer, in muscles with different typing. MATERIALS AND METHODS: This is a controlled clinical trial, randomized and double blind. Sixty healthy volunteers (23.6 ± 4.2anos; 54.2 ± 7.7kg, 1.62 ± 0.009 cm) of both sexes were divided randomly into three groups: control group (CG), experimental group 1 (SG1) with application of the current Russian 30 HZ and experimental group 2 (EG2) at 70 Hz The volunteers performed an initial assessment (AV1) on the isokinetic dynamometer with three repetitions maximum voluntary isometric (MVC) for knee extension concomitant uptake of EMG for the VM muscle, VL and RF. Later, after application of NMES, they underwent an experimental protocol of isometric fatigue using 70% of MVIC, ending with the completion of a final assessment (AV2) in the same manner as the AV1. RESULTS: By analyzing the profile of the 60 subjects in three broad, VM showed a higher value of RMS behavior when the VL and RF (p = 0.03 and p = 0.02). With respect to Fmed the RF muscle (p = 0.001) showed a higher value for the VM. The VM muscle showed significant increases of Fmed (p = 0.05) after electrical stimulation at 70 Hz when compared the AV1 AV2 and RF showed significant decreases (p = 0.009) after stimulation at 30 Hz during the fatigue showed an increase RMS in the VM and VL, with a reduction in RF. For the variable Fmed was observed in three broad decline during fatigue. CONCLUSION: Our findings provide evidence that the muscles VM, VL and RF fiber typing are different besides indicating that the frequency of NMES tend to relate to the muscle stimulated. Finally suggests the surface EMG as a noninvasive method for characterizing muscle

Avaliação mecânica in vitro utilizando miniplacas quadradas e retangulares do sistema 2.0 mm em fraturas da região anterior de mandíbula

The aim of this study was to comparatively evaluate the mechanical strength of squared and rectangular 2.0 mm system miniplates comparing them to the standard configuration with 2 straight miniplates in stabilizing fractures in the anterior mandible. Ninety synthetic polyurethane mandible replicas were used in mechanical test. The samples were divided into six groups of three different methods for fixation. Groups 1, 2 and 3 showed complete fractures in symphysis, characterized by a linear separation between the medial incisor, and groups 4, 5 and 6 showed complete fractures in parasymphysis with oblique design. Groups 1 and 4 were represented by the standard technique with two straight miniplates parallel to each other. Groups 2 and 5 were stabilized by squared miniplates and groups 3 and 6 were fixed by rectangular design. Each group was subjected to a mechanical test at a displacement speed of 10 mm/min on a universal testing machine, receiving linear vertical load on the region of the left first molar. The values of the maximum load and when displacements reached 5 mm were obtained and statistically analyzed by calculating the confidence interval of 95%. Fixation systems using squared (G2) and rectangular (G3) miniplates obtained similar results. No statistically significant differences with respect to the maximum load and the load at 5 mm displacement were found when compared to standard method in symphyseal fractures (G1). In parasymphysis the fixation method using squared miniplates (G5) obtained results without significant differences regarding the maximum load and the load at 5 mm when compared to the standard configuration (G4). The fixation method using rectangular miniplates (G6) showed inferior results which were statistically significant when compared to the standard configuration (G4) for parasymphysis fractures. The mechanical behavior of the fixation methods was similar, except when rectangular miniplates were used. The fixation methods showed better results with statistical significance in symphyseal fractures

Dual path: a concept to improve the esthetic replacemente of missing anterior teeth with removable partial denture

The dual path of insertion concept for removable partial denture (RPD) design may be used in esthetically demanding situations. When compared to conventional RPDs, the main advantage of this design is the minimal use of clasps. This clinical report describes the treatment of a patient with an anterior maxillary edentulous area using a dual path RPD. The diagnostic cast was surveyed to ensure the adequacy of the undercuts on the mesial surfaces of the anterior abutments, where rigid minor connectors were placed. Inverted V-shaped canine cingulum rest seats were prepared to provide resistance to tooth movement during function. The dual path RPD concept allows excellent esthetic results, minimizes tooth preparation, and reduces the tendency toward plaque accumulation in a Kennedy class IV partially edentulous arch.

Prevalence of biomicroscopic findings in the anterior segment and ocular adnexa among schoolchildren in Natal/Brazil

Objective: To determine the prevalence of ocular findings of the external structures and anterior segment of the eye, detected by biomicroscopic examination in schoolchildren in Natal (RN) - Brazil. Methods: After previous random selection, 1,024 pupils from elementary and secondary public and private schools in the city of Natal were evaluated from March to June 2001. All were submitted to preestablished standard research norms, consisting of identification, demographic information, ophthalmologic biomicroscopic examination, with slit lamp, performed by ophthalmologists from the “Onofre Lopes” University Hospital. Results: Alterations of the conjunctival and palpebral conditions were the most prevalent (10.4% and 6.2% respectively). Follicles (4.2%) and papillae (3.0%) were the frequent conjunctival lesions, while blepharitis (3.5%) and meibomitis (1.1%) were the most detected abnormalities in the eyelids. Upon examining the cornea, iris, lens and anterior vitreous, the most encountered findings were nubecula (0.5%), papillary membrane reliquiae (0.5%), posterior capsula opacity (0.8%) and hyaloid arteria reliquiae (2.0%). Conclusion: The most prevalent findings affecting the external structures of the eye such as eyelids and conjunctiva, consisted of blepharitis followed by follicular reaction of the conjunctiva. The most prevalent abnormalities in the cornea, iris, lens and anterior vitreous were nubecula, papillary membrane reliquiae, posterior capsular opacity and hyaloid arteria reliquiae, in that order