Standardization of the Electromyographic Signal Through the Maximum Isometric Voluntary Contraction

The objective of this study was to analyze the electromyographic (EMG) data, before and after normalization. One hundred (100) normal subjects (with no signs and symptoms of temporomandibular disorders) participated in this study. A surface EMG of the masticatory muscles was performed. Two different tests were performed: maximum voluntary clench (MVC) on cotton rolls and MVC in intercuspal position. The normalization was done using the mean value of the EMG signal of the first examination. The coefficient of variation CV showed lower values for the standardized data. The standardization was effective in reducing the differences between records from the same subject and in different subjects.

Ways of using evidence-based medicine in general practice

General practitioners wanting to practise evidence-based medicine (EBM) are constrained by time factors and the great diversity of clinical problems they deal with. They need experience in knowing what questions to ask, in locating and evaluating the evidence, and in applying it. Conventional searching for the best evidence can be achieved in daily general practice. Sometimes the search can be performed during the consultation, but more often it can be done later and the patient can return for the result. Case-based journal clubs provide a supportive environment for GPs to work together to find the best evidence at regular meetings. An evidence-based literature search service is being piloted to enhance decision-making for individual patients. A central facility provides the search and interprets the evidence in relation to individual cases. A request form and a results format make the service akin to pathology testing or imaging. Using EBM in general practice appears feasible. Major difficulties still exist before it can be practised by all GPs, but it has the potential to change the way doctors update their knowledge.

Low Intensity Laser Therapy in Temporomandibular Disorder: a Phase II Double-Blind Study

The purpose of this study was to evaluate the analgesic effect of Low Intensity Laser Therapy (LILT) and its influence on masticatory efficiency in patients with temporomandibular dysfunction (TMD). This study was performed using a random, placebo-controlled, and double-blind research design. Fourteen patients were selected and divided into two groups (active and placebo). Infrared laser (780 nm, 70 mw, 60s, 105J/cm(2)) was applied precisely and continuously into five points of the temporomandibular joint (TMJ) area: lateral point (LP), superior point (SP), anterior point (AP), posterior point (PP), and posterior-inferior point (PIP) of the condylar position. This was performed twice per week, for a total of eight sessions, To ensure a double-blind study, two identical probes supplied by the manufacturer were used: one for the active laser and one for the inactive placebo laser. They were marked with different letters (A and B) by a clinician who did not perform the applications. A Visual Analogue Scale (VAS) and a colorimetric capsule method were employed. Data were obtained three times: before treatment (Ev1), shortly after the eighth session (Ev2), and 30 days after the first application (Ev3). Statistical tests revealed significant differences at one percent (1%) likelihood, which implies that superiority of the active group offered considerable TMJ pain improvement. Both groups presented similar masticatory behavior, and no statistical differences were found. With regard to the evaluation session, Ev2 presented the lowest symptoms and highest masticatory efficiency throughout therapy. Therefore, low intensity laser application is effective in reducing TMD symptoms, and has influence over masticatory efficiency [Ev2 (0.2423) and Ev3 (0.2043), observed in the interaction Evaluations x Probes for effective dosage].

Increasing relevance of pharmacogenetics of drug metabolism in clinical practice

Much of the individual variation in drug response is due to genetic drug metabolic polymorphisms. Clinically relevant examples include acetylator status; cytochrome P450 2D6, 2C9 and 2C19 polymorphisms; and thiopurine methyltransferase deficiency. It is important to be aware of which drugs are subject to pharmacogenetic variability. In the future, population-based pharmacogenetic testing will allow more individualized drug treatment and will avoid the current empiricism.

Cognitive behaviour therapy for the management of obsessive-compulsive disorder

Current research reflects conflict regarding best practice in the treatment of obsessive-compulsive disorder (OCD). The. present study reports on the psychological treatment of a 54-year-old woman diagnosed with OCD, and follows the implementation of pharmacological treatment. The study utilises both exposure and response prevention (ERP) and cognitive therapy (CT), although there was no attempt to compare these approaches in an experimental design. Measures of avoiding and neutralising behaviours were taken on three occasions across treatment. Measures were also taken of intrusive thoughts, appraisal of responsibility, and effective challenging, both across treatment and at follow-up. The results indicate that gains were made in addition to those reported following the implementation of medication. The results also suggest that the addition of CT to exposure and response prevention facilitates the extinction of neutralising behaviours.

The acquisition of movement skills: Practice enhances the dynamic stability of bimanual coordination

During bimanual movements, two relatively stable inherent patterns of coordination (in-phase and anti-phase) are displayed (e.g., Kelso, Am. J. Physiol. 246 (1984) R1000). Recent research has shown that new patterns of coordination can be learned. For example, following practice a 90 degrees out-of-phase pattern can emerge as an additional, relatively stable, state (e.g., Zanone & Kelso, J. Exp. Psychol.: Human Performance and Perception 18 (1992) 403). On this basis, it has been concluded that practice leads to the evolution and stabilisation of the newly learned pattern and that this process of learning changes the entire attractor layout of the dynamic system. A general feature of such research has been to observe the changes of the targeted pattern's stability characteristics during training at a single movement frequency. The present study was designed to examine how practice affects the maintenance of a coordinated pattern as the movement frequency is scaled. Eleven volunteers were asked to perform a bimanual forearm pronation-supination task. Time to transition onset was used as an index of the subjects' ability to maintain two symmetrically opposite coordinated patterns (target task - 90 degrees out-of-phase - transfer task - 270 degrees out-of-phase). Their ability to maintain the target task and the transfer task were examined again after five practice sessions each consisting of 15 trials of only the 90 degrees out-of-phase pattern. Concurrent performance feedback (a Lissajous figure) was available to the participants during each practice trial. A comparison of the time to transition onset showed that the target task was more stable after practice (p = 0.025). These changes were still observed one week (p = 0.05) and two months (p = 0.075) after the practice period. Changes in the stability of the transfer task were not observed until two months after practice (p = 0.025). Notably, following practice, transitions from the 90 degrees pattern were generally to the anti-phase (180 degrees) pattern, whereas, transitions from the 270 degrees pattern were to the 90 degrees pattern. These results suggest that practice does improve the stability of a 90 degrees pattern, and that such improvements are transferable to the performance of the unpractised 270 degrees pattern. In addition, the anti-phase pattern remained more stable than the practised 90 degrees pattern throughout. (C) 2001 Elsevier Science B.V. All rights reserved.