Análise do Comportamento Eletromiográfico dos Músculos Estabilizadores Primários e a Relação com a Capacidade Física Funcional de Indivíduos Assintomáticos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Início de ativação muscular de estabilizadores primários e a capacidade física para avaliar estabilização lombo-pélvica

Introduction: Due to the high incidence of low back pain without apparent cause, different approaches to evaluate the lumbar instability has been proposed, such as surface electromyography to determine pre-activation and the ability of lumbar stabilization through functional physical assessment. In this context, the objective of this study was to evaluate the early activation of the primary stabilizing muscles in subjects without low back pain, with different physical abilities function (CFF). Method: Study participants were 20 subjects with 19.8 ± 1.4 years, 55.7 ± 8.8 kilos, 1.66 ± 0.08 m, of both sexes. The subjects underwent six Tests Physical Function (TFF) and the Test of Fast Moving Flexion Arm (TMRFB) to capture the electromyographic activity of the lumbar multifidus muscles (LM) and internal oblique - lower fibers (HI). Were assigned weights for each functional test and the result of the physical capacity of the final functional subject ranged from 0 to 100%. In the analysis of TMRB was considered the onset time of activation between the ML and HI. Results: Regarding TFF 2 (10%) subjects were considered to have normal physical capacity, 6 (30%) with good physical ability and 12 (60%) with regular physical capacity or poor. As for TMRFB average values of initiation of muscle activation in 75% of subjects were within the limits to characterize the condition of pre-muscle activation. Conclusion:The results obtained in the TFF were low compared with the CFF of asymptomatic subjects evaluated. This fact does not mean that the condition of stabilization of the subject is appropriate. However, the results obtained in the electromyographic examination to suggest that 25% of asymptomatic subjects tested did not have a proper condition of lumbar stabilization.

Stabilization of lumbo-pelvic region and electromyography of the abdominal muscles

It is usual to find athletes that can perform de curl up test easily, but are unable to maintain the stabilization of the low back during the double straight leg lowering (DSLL). In spite of having strong abdominal muscles, its stabilization role seems not to be effective. Thus, the purpose of this study was to verify the relation among individuals with strong abdominal muscles and the ability in perform posterior pelvic tilt (PPT); the ability to stabilize the low back during the DSLL and the eletromyographic activity of the abdominal muscles. Eighteen male subjects (aged 19.27 ± 3.5), without history of muscle skeletal dysfunction, performed both the PPT and DSLL tests. During these tests electromyographic signals of the rectus abdominis (RA), obliquus internus abdominis (01) and obliquus externus abdominis (OE) were recorded, the angle of the hip and the pressure under the low back were measured The results of analyses of variance (ANOVA) show that most volunteers accomplished the PPT test, actively flattening the low back with regular or good quality. However, none of them was able to stabilize the low back during the DSLL test. During the PPT test all abdominal muscle portions analysed were activated without significant differences. In an attempt of maintaining the lumbo-pelvic region stabilized during the DSLL, it was observed a tendency of higher bilateral activation of OE when compared to RA and 01 muscle portions between 70 and 20 degrees of hip flexion.

Electromyographic analysis of the rectus abdominis muscle in pelvic retroversion and the decrease of the lower limbs

We often face Patients searching for rehabilitation for lower back disorders during the physiotherapeutic routine, and it is known that the abdominal muscle, specially the rectus abdominis muscle, aid the stabilization of the pelvis. Therefore, this paper analyzes the electrical activity of the rectus abdominis muscle in the pelvic retroversion in dorsal decubitus and in orthostatic position and in the lowering of the lower limbs. 30 healthy students, male and female, 17-40 yr, divided into two groups - Group 1: 15 volunteers (pelvic balance); Group 2 (pelvic unbalance) took part in this study. The electrical activity of the right and left supra-umbilical and infra-umbilical portions of the rectus abdominis muscle was detected. The mean RMS values from three attempts ftom the electromyographic traces were usedfor the analysis of the electrical activity. The RMS value was submitted to the normalization process. The data were submitted to statistic treatment by the Friedman test, and the analyses of the means and standard deviation towards a level of significance of 95%. The results demonstrated that the portions of the rectus abdominis muscle presented low electrical activity for the groups studiedfor pelvic retroversion either in dorsal decubitus or and orthostatic position. However, the decreasing movement of the lower limbs towards the portions of the rectus abdominis muscle presented more significant electrical activity whereas the lower portions presented higher activity than the higher ones for Group 2.

Use of glass transition temperature for stabilization of board's cracks of Eucalyptus grandis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Delays in stabilization or in reforms? The debt crisis

Empirical analyses attributing the 1980s' debt crisis to inconsistent stabilization policies rest on an inappropriate long-run approach. Revising this long-run approach yields opposite results: terms of trade shocks and foreign indebtedness explain this crisis, regardless of domestic stabilization policies. This prompts us to consider a new hypothesis, of delays in trade-policy reforms, with a model in which terms-of-trade variation (under shocks) is endogenous to export structure and efficiency of resource allocation. Evidence from the structural equations model shows that allocation distortions negatively affect changes in terms of trade, which then explain this crisis. A political economy extension demonstrates that income inequality and regional trade policy determine the distortions, which in turn leads to this crisis.

Enhanced stabilization of aerosol-OT surfactant monolayer upon interaction with small amounts of bovine serum albumin at the air-water interface

An investigation is made of the influence from small amounts of the protein bovine serum albumin (BSA) on the lateral organization of low molecular weight surfactant sodium bis-2-ethylhexyl sulfosuccinate (AOT) at the air-water interface. Surface pressure (pi - A), surface potential (DeltaV - A) and Brewster angle microscopy (BAM) experiments were carried out, with particular emphasis on the monolayer stability under successive compression-expansion cycles. AOT monolayer is not stable at the air-water interface, which means that the majority of AOT molecules go into the aqueous subphase as monomers and/or normal micelles. When a waiting time elapses between spreading and compression, the surfactant monolayer tends to reorganize partially at the air-water interface, with a monolayer expansion being observed for waiting times as large as 12 h. The incorporation of very small amount of BSA (10(-9) M) at the interface, also inferred from BAM, increases the monolayer stability as revealed by pi - A and DeltaV - A results. For a waiting time of circa 3 h, the mixed monolayer reaches its maximum stability. This must be related to protein (and/or protein-surfactant complexes) adsorbed onto the AOT monolayer, thus altering the BSA conformation to accommodate its hydrophobic/hydrophilic residues. Furthermore, the effects from such small amounts of BSA in the monolayer formation and stabilization mean that the AOT monolayer responds cooperatively to BSA. (C) 2004 Elsevier B.V. All rights reserved.

Clampe de Ganz no tratamento de urgência em lesões do anel pélvico

OBJETIVO: Avaliar a eficiência do clampe de Ganz na estabilização e redução dos deslocamentos da pelve, quando utilizado no tratamento de urgência, além de aquilatar eventuais dificuldades e facilidades do método. MÉTODOS: O clampe de Ganz foi utilizado no tratamento de urgência em 31 pacientes com graves lesões do anel pélvico (Tile C) associadas a importante instabilidade hemodinâmica. RESULTADO: Entre os pacientes, 27 (87,1%) apresentaram evolução favorável, com estabilização, redução dos deslocamentos e compressão da região posterior do anel, além de estabilização hemodinâmica, e quatro (12,9%) evoluíram para óbito. CONCLUSÃO: O clampe de Ganz mostrou-se eficiente ferramenta no tratamento de urgência das lesões do anel pélvico, por ser de concepção simples, de rápida colocação, não impedir ou dificultar procedimentos no abdome e, principalmente, por permitir a estabilização da pelve, redução dos deslocamentos e compressão na região posterior do anel, local onde ocorrem os maiores sangramentos, reduzindo-os ou eliminando-os.

Malformação arteriovenosa uterina após doença trofoblástica gestacional

OBJETIVO: investigar a presença e resultados de malformações vasculares uterinas (MAVU) após doença trofoblástica gestacional (DTG). MÉTODOS: estudo retrospectivo com inclusão de casos diagnosticados entre 1987 e 2004; 2764 pacientes após DTG foram acompanhadas anualmente com ultra-sonografia transvaginal e Doppler colorido no Centro de Neoplasia Trofoblástica Gestacional da Santa Casa da Misericórdia (Rio de Janeiro, RJ, Brasil). Sete pacientes tiveram diagnóstico final de MAVU baseado em análise ultra-sonográfica - índice de pulsatilidade (IP), índice de resistência (IR) e velocidade sistólica máxima (VSM) - e achados de imagens de ressonância nuclear magnética (RNM). Dosagens negativas de beta-hCG foram decisivas para estabelecer o diagnóstico diferencial com DTG recidivante. RESULTADOS: a incidência de MAVU após DTG foi 0,2% (7/2764). Achados ultra-sonográficos de MAVU: IP médio de 0,44±0,058 (extremos: 0,38-0,52); IR médio de 0,36±0,072 (extremos: 0,29-0,50); VSM média de 64,6±23,99 cm/s (extremos: 37-96). A imagem de RNM revelou útero aumentado, miométrio heterogêneo, espaços vasculares tortuosos e vasos parametriais com ectasia. A apresentação clínica mais comum foi hemorragia transvaginal, presente em 52,7% (4/7) dos casos. Tratamento farmacológico com 150 mg de acetato de medroxiprogesterona foi empregado para controlar a hemorragia, após a estabilização hemodinâmica. Permanecem as pacientes em seguimento, assintomáticas até hoje. Duas pacientes engravidaram com MAVU, com gestações e partos exitosos. CONCLUSÃO: presente sangramento transvaginal em pacientes com beta-hCG negativo e história de DTG, deve-se considerar a possibilidade de MAVU e solicitar avaliação ultra-sonográfica com dopplervelocimetria. O tratamento conservador é a melhor opção na maioria dos casos de MAVU pós-DTG.

Effect of intravaginal electrical stimulation on pelvic floor muscle strength

The aim of this study was to evaluate the effect of intravaginal electrical stimulation (IES) on pelvic floor muscle (PFM) strength in patients with mixed urinary incontinence (MUI). Between January 2001 and February 2002, 40 MUI women (mean age: 48 years) were studied. Urge incontinence was the predominant symptom; 92.5% also presented mild stress urinary incontinence (SUI). Selection criteria were clinical history and urodynamics. Pre-treatment urodynamic study showed no statistical differences between the groups. Ten percent of the women in each group had involuntary detrusor contractions. Patients were randomly distributed, in a double-blind study, into two groups. Group G 1 (n=20), effective IES, and group G2 (n=20), sham IES, with follow-up at 1 month. The following parameters were studied: (1) clinical questionnaire, (2) examiner's evaluation of perineal muscle strength, (3) objective evaluation of perineal muscle by perineometry, (4) vaginal weight test, and (5) urodynamic study. The IES protocol consisted of three 20-min sessions per week over a 7-week period using a Dualpex Uro 996 at 4 Hz. There was no statistically significant difference in the demographic data of both groups. The number of micturitions per 24 h after treatment was reduced significantly in both groups. Urge incontinence, present in all patients before treatment, was reduced to 15% in G1 and 31.5% in G2 post-treatment. The subjective evaluation of PFM strength demonstrated a significant improvement in G1. Objective evaluation of PFM force by perineometer showed a significant improvement in maximum peak contraction post-treatment in both groups. In the vaginal weight test, there was a significant increase in average number of cone retentions post-treatment in both groups. With regard to satisfaction level, after treatment, 80% of the patients in G1 and 65% of the patients in G2 were satisfied. There was no statistically significant difference between the groups. There was a significant improvement in PFM strength from both effective and sham electrostimulation, questioning the effectiveness of electrostimulation as a monotherapy in treating MUI.

Pelvic floor muscle evaluation in incontinent patients

The aim of this study was to assess pelvic floor muscle (PFM) strength and perception and its correlation with stress urinary incontinence (SUI). One hundred and one women were divided into two groups according to the presence (G1=51 patients) or absence (G2=50 patients) of SUI. Subjective [urine stream interruption test (UST), visual survey of perineal contraction and transvaginal digital palpation to assess pelvic muscle contraction] and objective evaluations of pelvic floor muscles in all patients were performed (vaginal manometry). During the UST, 25.5% of G1 patients and 80% of G2 patients were able to interrupt the urine stream (p<0.05). Digital evaluation of pelvic muscular contraction showed higher strength in G2 than in G1 patients (p<0.0001). Perineometer evaluation of PFM strength was significantly higher in the continent group (p<0.001). Pelvic floor muscle weakness in incontinent patients demonstrates the importance of functional and objective evaluation of this group of muscles.

A comparative analisys of pelvic floor muscle strength in women with stress and urge urinary incontinence

Aims: To assess pelvic floor muscle (PFM) strength in women with stress urinary incontinence (SUI) and urge urinary incontinence (UUI).Materials and Methods: 51 women were prospectively divided into two groups, according to the symptoms as SUI (G1 = 22) or UUI (G2 = 29). Demographic data, such as number of pads/ 24 hours, number of micturations/ 24 hours and nocturia, delay time of urgent void (i.e., the time period for which an urgent void could be voluntarily postponed), number of parity and vaginal deliveries were obtained using a clinical questionnaire. Objective urine loss was evaluated by 60-min. Pad Test, subjective urine stream interruption test (UST) and visual survey of perineal contraction. Objective evaluations of PFM were performed in all patients (vaginal manometry).Results: Median of age, mean number of pads/ 24 hours, nocturia and warning time were significantly higher in UUI comparing to SUI group. During UST, 45.45% in G1 and 3.44%, in G2, were able to interrupt the urine stream (p < 0.001). The 60-min. Pad Test was significantly higher in G2 compared to G1 women (2.7 +/- 2.4 vs 1.5 +/- 1.9 respectively, p = 0.049). Objective evaluation of PFM strength was significantly higher in the SUI than in the UUI patients. No statistical difference was observed regarding other studied parameters.Conclusion: Pelvic floor muscle weakness was significantly higher in women with UUI when compared to SUI.

Comparison of pelvic floor muscle strength evaluations in nulliparous and primiparous women: a prospective study

OBJECTIVE: This study aimed to compare the pelvic floor muscle strength of nulliparous and primiparous women.METHODS: A total of 100 women were prospectively distributed into two groups: Group 1 (G1) (n = 50) included healthy nulliparous women, and Group 2 (G2) (n = 50) included healthy primiparous women. Pelvic floor muscle strength was subjectively evaluated using transvaginal digital palpation. Pelvic floor muscle strength was objectively assessed using a portable perineometer. All of the parameters were evaluated simultaneously in G1 and were evaluated in G2 during the 20(th) and 36(th) weeks of pregnancy and 45 days after delivery.RESULTS: In G2, 14 women were excluded because they left the study before the follow-up evaluation. The median age was 23 years in G1 and 22 years in G2; there was no significant difference between the groups. The average body mass index was 21.7 kg/m(2) in G1 and 25.0 kg/m(2) in G2; there was a significant difference between the groups (p = 0.0004). In G2, transvaginal digital palpation evaluation showed significant impairments of pelvic floor muscle strength at the 36(th) week of pregnancy (p = 0.0006) and 45 days after vaginal delivery (p = 0.0001) compared to G1. Objective evaluations of pelvic floor muscle strength in G2 revealed a significant decrease 45 days after vaginal delivery compared to nulliparous patients.CONCLUSION: Pregnancy and vaginal delivery may cause weakness of the pelvic floor muscles.

Vaginal weight cone versus assisted pelvic floor muscle training in the treatment of female urinary incontinence. A prospective, single-blind, randomized trial

Vaginal weight cone (VWC) versus assisted pelvic floor muscle training (APFMT) in the treatment of urinary incontinence (UI) in women.One hundred three incontinent women were randomly distributed into two groups: group G1 (n = 51) treated with VWC and G2 (n = 52), APFMT. The following parameters were performed initially and after treatment: (1) clinical questionnaire, (2) visual analogue scale (VAS), (3) 60-min pad test, and (4) subjective and objective assessment of pelvic floor muscle (PFM).There was a significant decrease in nocturia and urine loss after treatment in both groups (p < 0.05). In VAS, there was a significant improvement of all parameters in both groups (p < 0.05). The pad test showed significant decrease in both groups (p < 0.05). There was a significant increase of PFM strength in both groups (p < 0.05).There was no difference between groups treated with VWC and APFMT.