Terapia manual no tratamento da espondilólise e espondilolistese: revisão de literatura

A espondilólise é um defeito na pars interarticularis da vértebra com descontinuidade óssea do segmento intervertebral; a progressão do defeito resulta em deslizamento de uma vértebra sobre a outra, chamado espondilolistese, o que pode provocar dor. O tratamento não-cirúrgico é a escolha inicial na maioria dos casos de espondilolistese, mas poucos estudos verificam a eficácia dos tratamentos conservadores. O objetivo deste estudo foi realizar uma revisão da literatura sobre esses tratamentos, sobretudo no que concerne à terapia manual, a fim de ajudar os terapeutas na prescrição de intervenções eficazes. Os resultados mostram que tanto a terapia manual como a fisioterapia convencional apresentam efeitos benéficos na redução da dor lombar e na melhora funcional do paciente. As terapias manuais envolvem manipulação da coluna vertebral e articulação sacroilíaca, músculo-energia e alongamento dos músculos afetados. Exercícios de estabilização lombopélvica, fortalecimento dos músculos posturais e alongamento dos isquiotibiais e psoas também foram considerados importantes. O paciente deve ser avaliado individualmente em seu quadro clínico e radiográfico para determinação do plano de tratamento. Dentre as opções conservadoras de tratamento encontradas, nenhuma se mostrou conclusivamente superior às outras e todas podem ser incluídas no tratamento sintomático de pacientes com espondilólise/listese.

Avaliação Postural em Sujeitos com Disfunção Temporomandibular Submetidos a Tratamento de Terapia Manual

Individuals with temporomandibular disorders (TMD) often have signs and symptoms such as intra-articular pain, muscle spasm, neck pain radiating from others who interfere with this balance. Over time can lead to postural changes and correction of the cervical spine, anterior head and shoulder asymmetry. The aim was to verify the effects of manual therapy on posture in subjects with TMD. Materials and methods: 30 volunteers (mean: 21.43± SD:1.43) of both sexes who had TMD classified according to axis I of the Research Diagnostic Criteria participated in this study. These were photographed in the anterior frontal and sagittal planes for analysis of the following angles (acromion clavicular joint, sternoclavicular joint, orbicular external, corners of the mouthand and protruding head). After, the volunteers were divided into groups ATM (manual therapy in the treatment of temporomandibular joint), Cervical (manual therapy in the treatment of cervical joint) and Control. The Kolmogokov-Smirnov test, followed by ANOVA, considering a significance level of 5% was used. Results: Groups ATM, Cervical and Control were considered homogeneous with respect to the values of the angles measured. These also showed no significant difference between the 1st, 5th and 10th sessions, so the manual therapy techniques applied to the TMJ and Cervical groups were not sufficient to change postural alignment. Conclusion: The postural alignment, the TMD patients evaluated in this study did not change after attending the sessions proposals with manual therapy techniques in the cervical and TMJ.

Efeitos da terapia manual de Maitland em pacientes com lombalgia crônica

Introduction: The low back pain are a problema of health. Objective: to evaluate the effects of the Maitland´s manipulation in pain, fl exibility, functional capacity and quality of life of the patients with chronic low back pain. Method: Sxteen subjects, of both genders, with the age from 23-68 years old (48.69,± 11.61 years old) were evaluated by test sit and reach (TSA), Visual Analogue Scale (VAS) and answered the questionnaires of the quality of life Medical Outcomes Study 36- Item Short-Form Health Survey (SF-36) and the Roland-Morris Disability functional incapacity (RMDQ). The treatment was carried out twice a week, totaling 10 sessions. Each session lasted 30 minutes and consisted by Maitland´s techniques, applied as the symptoms evaluated at the beginning of each session. After 10 session, the subjects were re-evaluated. The data obtained in the assessments concerning the TSA and VAS were analyzed by Student t test, the data relating to the questionnaire were analyzed using the Wilcoxon non-parametric statistics test. For the interpretation was used signifi cance level of 5% (p≤0,05). Results: A signifi cant improvement was in the intensity of pain, disability, fl exibility and quality of life. Conclusion: The Maitland´s therapy showed effective, which suggests be an appropriate strategy for intervention for patients with chronic low back pain.

Influência da terapia de contensão induzida na funcionalidade do membro superior de indivíduos hemiparéticos

Introduction: The Constraint-induced Movement Therapy (CIMT) is a therapeutic program which main goal is the functional recuperation of paretic upper extremity of stroke patients with motor deficits by an intensive treatment, practice of functional repetition and wear of restriction in non-paretic during 90% of the daily hours. Objective: The aim of this study was evaluate the CIMT influence on upper extremity function of hemiparetic individuals. Method: The CIMT was provided for 3 daily hours for 10 consecutive days. Besides, patients were asked to wear a restraint dispositive on the unaffected hand during 90% of their activities daily living hours. Before and after the intervention period, 2 tests were administered to evaluate motor function, the Motor Activity Log (MAL) and the Wolf Motor Function Test (WMFT). Results: The results of MAL showed significant difference in quantity (p=0,011) and quality (p=0,016) of paretic upper extremity movements. Analysis of WMFT indicated a significant reduction of time that patients performed the tasks (p= 0,042) and a difference for quality of movement (p<0,0001). Conclusion: The present results showed that CIMT improves upper extremity function in hemiparetic individuals.

Caracterização da rigidez póstero-anterior da coluna lombar in vivo: uma análise biomecânica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The influence of the use of stabilizer bracelet in a child with choreoathetoid cerebral palsy

Introduction: The use of stabilizer bracelet is a frequent treatment for movement disorders to strengthen muscles and adjust coordination. Still questions remain regarding the benefi t of using loads to decrease involuntary movements and the best load and placement. Objective: To measure the infl uence of the stabilizer bracelet on the kinematics and spatiotemporal parameters in planar movements performed by the upper limb. Method: One child, who has the spastic diplegy type of cerebral palsy with choreoathetoid component, and a control child without cerebral palsy, both female and 7 years old, were subjected to analysis of movements in relation to displacement, velocity, linear acceleration, and the calculation of mean square error (MSE) with and without use of stabilizer bracelet with loads of 25, 50, and 75% of the supported maximum load. Results: After comparing data between subjects, a difference was found between patient and control in all situations and variables. An inter-individual comparison using 25% of the maximum load showed the smallest difference with the NDE. Discussion and Conclusion: This therapeutic option is low cost, easy to apply, and does not signifi cantly interfere in the aesthetic of the individual. Therefore, physiotherapists may prescribe this for activities that require greater control of the upper limb because for the case studied the upper limb movement was more effi cient with the use of the stabilizer bracelet.

O Efeito da Manipulação Miofascial sobre o Limiar Doloroso em Atletas Durante Período Competitivo

Introduction: The myofascial pain syndrome (SDM) is one of the most common causes of musculoskeletal pain. One of the possible treatments for SDM is the type of physiotherapy myofascial manipulation. Objective: This study aimed to analyze the effect of manipulative technique with myofascial pain threshold before and after applying the technique in athletes during competition period. Methods: Participated in the study 62 subjects of both genders, aged between 14 and 38 (19.64 + 4.89), who had myofascial pain syndrome, 32 oh the treatment group and 30 divided equally between control group and the placebo group. All were athletes and operated by the Department of Sport and Leisure in the city of Marilia – SP and were in competitive period. The volunteers were evaluated according to their musculoskeletal symptoms to prove the necessity of performing the technique of myofascial manipulation. Confi rmed the need to assess the pressure pain threshold (LDP) using a digital dynamometer. After the measurement, patients underwent treatment or using the technique of myofascial manipulation, or a sliding surface for the placebo or no treatment for the control group followed by the immediate reassessment of the LDP. Results: The results were normalized by Kolmogrov-Smirnov test (KS). Through the ANOVA test found no differences between the initial LDP thresholds between groups. To compare pre and post LDP of the three groups we used the paired t test. Signifi cant difference (p=0.0001) between the values of pain threshold before and after application of myofascial manipulation for the treated group and not signifi cant for the control group (p=0.45) and placebo (p=0.16). Conclusion: We conclude then that the myofascial manipulation technique is able to increase pain threshold after micro-musculoskeletal injuries in athletes in competitive period.

Desenvolvimento das habilidade de auto-cuidado em crianças com atraso neuropsicomotor

Introduction: The neuropsicomotor development could be negatively affected by several factors occurred in the pre, peri and pos natal period. The early stimulation is implemented by a set of dynamic activities which aim the child development according to the child’s phase. Objective: The purpose of this study was to analyze the functional skills acquisition in the self care area in children with development delay. Participated of this study 9 caregiver of children aged of 0 to 3 years with delay neuropsicomotor. Method: For the data collect was used the self-care area of the Pediatric Evaluation of Disability Inventory (PEDI) in the version adapted for Brazil. The data collect was performed in two different stages, with an interval of 6 months between the collects. The raw score were transformed in continuous score by the Rasch statistics, then was applied the Shapiro-Wilk and t-student test. Results: The participants obtained a signifi cant higher score in the second stage than in the fi rst (p<0,01). Conclusion: The results of the present study suggests that the early stimulation could be an important intervention in the process of self-care skills acquisition in children with neuropsicomotor delay.

Relação entre projeção do centro de gravidade e equilíbrio em idosos

During the aging process, increase the postural asymmetries that can affect the control mechanism of balance leading to falls. To evaluate the static posture of elderly; measure the balance and correlate the results of the posture with balance. The study involved 28 elderly patients, 13 males and 15 females (71.8 ± 5.7 years). The volunteers were photographed, the images transferred to a computer for evaluation of static posture and calculating the projection of the center of gravity in the frontal and sagittal planes using the Postural Assessment Software. The balance was assessed by the Berg Balance Scale (BBS). Correlations were performed by Spearman test (p ≤ 0.05). Data were presented as mean ± standart deviation (SD). BBS scores = 50.5 ± 3.3; the sagittal plane (anterior asymmetry) = 45.5 ± 11.1%; frontal plane (right or left asymmetry) = 9.8 ± 7.9. We found a correlation between BBS and asymmetry of the sagittal plane (r = -0.46, p = 0.01) and between BBS and asymmetry of the frontal plane (r = -0.41, p = 0.03). The data suggest that the higher the previous projection (asymmetry of the sagittal plane) and lateral projection (asymmetry of the frontal plane), scores of the BBs will be lower, indicating an increase of unbalance in elderly.

Relação entre incapacidade funcional, amplitude de movimento e dor em indivíduos com e sem lombalgia

Introduction: Low back pain is characterized as pain between the inferior margins of the ribs to the gluteal fold, reaching about 80% of the population throughout life. Its repercussions can affect the functionality of the subjects in their daily activities. The aim was to investigate whether a relation between symptoms of pain in the lumbar region with range of motion and functional disability. Methods: We interviewed 101 subjects with a mean age of 22.61 ± 4.06 years, these 50 participants were 51 low back pain and other complaints of back pain. OS subjects were assessed for pain by Visual Analogue Scale (VAS), mobility Lumbar Schöbber test (TS), flexibility for the Test Sit and Reach (TSA) and feature the Oswestry Disability Index (IOI). For data analysis we used GraphPad Prism 5, the significance level was set at p ≤ 0.05. Results: No significant differences were found for the comparison between the TSA of the subjects with and without pain (p = 0.25), nor to compare the performance of the TS for the subjects with and without pain (p = 0.18). Conclusion: It is concluded that in cases evaluated the range of motion has no significant link with the pain but the pain in turn directly influence the functionality of them.

Avaliação goniométrica da amplitude de movimento do ombro de crianças praticantes de beisebol

Introduction: Baseball is a Sport disputed by two teams composed at least by nine players which compete between themselves in a game of six innings in the amateur game, for children up to 10 years old. Objective: The objective is to compare the movement degrees of the shoulder joint between the dominant and the non dominant shoulder. Methods: Eleven male subjects were assessed (8,63 ± 0,67 years old) whom practiced baseball at the Nikkey Club of the city of Marília – SP. All of the subjects were assessed by the same examiner, whom measured the range of motion (ROM) of both glenohumeral joint. The Student t test was used for the comparison of the shoulders, with level of significance of 5% (p≤0,05). Results: The subjects presented significant differences on the external rotation movement (p= 0,014) between the dominant shoulder (63,63 ± 12,92°) and the non dominant shoulder (55,45 ± 16,27°), and in the internal rotation movement (p= 0,001) between the dominant shoulder (32,90 ± 5,68°) and the non dominant shoulder (40,72 ± 5,74°). Conclusion: The results obtained in this study, on the experimental conditions utilized, allow us to conclude that the practice of baseball influence the range of motion of external rotation and internal rotation of the dominant shoulder, with increased external rotation, and a decreased internal rotation, provoking instability of the shoulder joint.

Relação entre postura, queixa dolorosa e lesão em bailarinas clássicas

Introduction: Due to the high recurrence of pain complaints and the increasing incidence of musculoskeletal injuries and postural changes in dance practice, researches related to this issue gained greater importance in scientific community. Objective: This study aimed to evaluate complaints and pain threshold, postural misalignments and the incidence of injuries in dancers noting if there is a relationship between these variables. Method: Participants were 15 ballet dancers in Marília - SP. We used photogrammetry for postural analysis, the McGill Pain Questionnaire for pain location of the volunteer, algometry pressure for measuring the threshold of pain perception and Referred Morbidity to verify and characterize the incidence of injuries this population. In the data analysis we use to percentage to quantify the data from questionnaires and Pearson correlation test angles of photogrammetry correlating with the values of the threshold of pain perception. Results: 73.33% of dancers reported to have suffered some kind of injury in the last year. The area of greatest pain complaint checked at McGill, was the region of the foot (73.30%). Conclusion: There was an agreement between regions of injury and pain, however, there wasn’t a correlation between the threshold of pain tolerance and postural angles.

Influência do ambiente rural e urbano no desenvolvimento funcional de crianças de até seis anos de idade

The influence of the environment on psychomotor development of children is evidenced in many studies. Many factors can threaten children’s development and hinder the children with regard to functional activities. Objective: The objective of this research was to investigate the possible effects of urban and rural environment on the functional performance of children under six years old. Methods: The study included 30 children divided into two groups, one group consisted of 15 children of both genres with a mean age of 44.13 ± 20.97 months, residing in urban area and another for 15 children, both sexes with a mean age of 44.33 ± 20.91 months, residing in rural areas. All were tested using functional Pediatric Evaluation of Disability Inventory (PEDI), which is based on an evaluation trial, conducted through structured interviews with those responsible for the child. This test outlines the functional profi le of children in three performance areas: self-care, mobility and social function, evaluated in three parts (functional skills, caregiver assistance and modifi cations to the environment). In this study we used the parts I (funcional skills) and II (caregiver assistance) in three areas: self-care, mobility and social function. The collected data were analyzed by means of the Mann - Whitney test, with the level of signifi cance at p ≤ 0.05. Results: The results show no signifi cant difference in the areas of self-care and mobility, both in relation to functional abilities when the caregiver assistance. In the area of social function, there was a lower performance of children living in rural areas, in functional abilities (p = 0.027) and caregiver assistance (p = 0.028). Conclusion: Based on this information, we can conclude that children who live in rural areas have a worse development of the social functions of children living in urban areas.

Influência do tratamento fisioterapêutico em grupo no equilíbrio, na mobilidade funcional e na qualidade de vida de pacientes com Parkinson

Introduction: Parkinson’s disease (PD) is a chronic disease of the nervous system, characterized by degeneration of neurons in the mesencephalic substantia nigra, leading to a clinical state of rest tremor, bradykinesia, muscular rigidity and postural instability. Physical therapy seeks to act by slowing the progression of the disease and when done in a group and maintain and / or improving the motor skills of the individual, can provide psychosocial benefi ts. Objective: examine the infl uence of the physical therapy group in balance, functional mobility and quality of life of individuals with PD. Method: participated in this study 04 subjects were female, mean age 67.75 (± 9.5) years, with medical diagnosis of PD, stages 1 to 3 of the Hoehn & Yahr. Before starting treatment, subjects underwent an assessment of the balance (BBS), functional mobility (TUG) and the quality of life (PDQ-39).The treatment was performed in groups, for a period of 10 weeks, lasting 60 minutes each session twice a week, totaling 20 sessions of physiotherapy. Upon completion of the treatment period the subjects were again assessed for balance, functional mobility and quality of life. The data were analyzed using the Student t-test, with signifi cance level of 5% (p ≤ 0.05). Results: statistical analysis showed signifi cant differences in three variables: equilibrium (p = 0.010), functional mobility (p = 0.029) and quality of life (p = 0.004), after physiotherapy intervention. Conclusion: physiotherapy treatment was group provides better balance, functional mobility and quality of life of patients with PD.

Equilíbrio funcional em indivíduos com doença de Parkinson e sua relação com a qualidade de vida

Introduction: Parkinson’s Disease (PD) is characterized by a set of four motor symptoms: tremor, rigidity, bradykinesia and postural instability. These defi cits may predispose individuals to limitations resulting from falls and their secondary consequences. Objective: To evaluate the functional balance and quality of life (QoL) in individuals with PD and determine whether there is correlation between performance on tests of balance with the QoL. Method: The project was referred to the Ethics Committee in Research of Universidade Estadual Paulista “Julio de Mesquita Filho” Campus de Marília and was approved under protocol number 1806/09. Participated in this study with individuals diagnosed with PD between levels one and four in the Hoen and Yahr scale. The subjects were evaluated according to functional balance and QoL, respectively by the instruments: Functional Balance Scale Berg (EEFB), Time Up and Go test (TUG), and Parkinson’s Disease Questionnaire-39 (PDQ-39). To perform the statistical analysis used the GraphPad Prism 5. To perform the correlation analysis for the variables passed normality by the Shapiro-Wilk. Since the variables were non-parametric test was used Spearman. During the analysis the statistical signifi cance level was considered p ≤ 0, 05. Results: We studied 25 individuals aged between 54 and 85 years (71.20 ± 8.50), time of diagnosis between one and 39 years (6.54 ± 7.71) disease. Moderate correlation was found between the EEFB with QoL (r =- 0.6), and TUG with QoL (r = 0.6836). Among the aspects of QoL balance showed a higher correlation with the domains “mobility” (TUG r = 0, 6768; EEFB r = -0.6155) and “Activities of daily living” (TUG r = 0, 7357, and EEFB r = -0.6521). Conclusion: Patients with Parkinson’s disease show defi cits in balance and QoL. The balance disorders have a high correlation among themselves and show how aspects of QoL.