O uso da estimulação transcraniana como tratamento na reabilitação motora de criança com paralisia cerebral - projeto de estudo de caso / El uso de la estimulación transcraneal como tratamiento en la rehabilitación motora de un niño con parálisis cerebral -un proyecto de estudio de caso / The use of transcranial stimulation as a treatment in the motor rehabilitation of a child with cerebral palsy -a case study projec

RESUMO A Paralisia Cerebral (PC) também denominada como encefalopatia crônica não-progressiva da infância é consequência de lesões não progressivas que aconteceram no cérebro imaturo no período pré, peri ou pós-natal, afetando o sistema nervoso central em fase de maturação estrutural e funcional. O presente trabalho trata-se de um estudo de caso com características de Pesquisa Experimental, Intervencional, onde foi realizado um protocolo de duas sessões semanais, com tempo de atendimento de 40 minutos, num total de 20 (vinte) sessões. O protocolo terapêutico consistiu de estimulação transcraniana e teve como objetivo geral investigar os efeitos da ETCC, associada à cinesioterapia e ativação dos neurônios espelhos, na reabilitação de uma criança com paralisia cerebral, sexo masculino, 54 meses de idade cronológica, grau moderado de hipotonia muscular em membros inferiores, movimentos voluntários com debilidade de força muscular; escoliose dorso-lombar e pontuação zero na Escala de Mobilidade Funcional e Asworth Modificada. O Sistema de Classificação da Função Motora Grossa (GMFCS) apresentou-se com classificação nível V, limitação na habilidade de manter as posturas anti-gravitacionais da cabeça e tronco e de controlar os movimentos de braços e pernas. Índice de Barthel Modificado com pontuação 11- classificação de dependência severa. A escala Denver II com prejuízos significativos nos domínios: pessoal-social, motor fino adaptativo, linguagem e motor grosso.

RESUMEN La parálisis cerebral (PC) también denominada como encefalopatía crónica no progresiva de la infancia es consecuencia de lesiones no progresivas que ocurrieron en el cerebro inmaduro en el periodo pre, peri o post-natal, afectando el sistema nervioso central en la fase de maduración estructural y funcional. El presente trabajo trata de un estudio de caso con características de investigación experimental, intervencional, donde fue realizado un protocolo de dos sesiones semanales de cuarenta minutos, con un total de veinte (20) sesiones. El protocolo terapéutico consistió en una estimulación transcraniana y tuvo como objetivo general, investigar los efectos de la ETCC, asociada a la cinesioterapia y activación de las neuronas espejo, en la rehabilitación de un niño con parálisis cerebral de 54 meses de edad cronológica, grado moderado de hipertonía muscular en miembros inferiores, movimientos voluntarios con debilidad de fuerza muscular; escoliosis dorsolumbar y puntuación cero en la escala de Movilidad Fun.

ABSTRACT Cerebral Palsy (CP) also known as chronic non-progressive encephalopathy of childhood is a consequence of non-progressive lesions that occurred in the immature brain in the pre, peri or postnatal period, affecting the central nervous system in a phase of structural maturation and functional. The present work is a case study with characteristics of Experimental, Interventional Research, where a protocol of two weekly sessions was carried out, with a service time of 40 minutes, in a total of 20 (twenty) sessions. The therapeutic protocol consisted of transcranial stimulation and aimed to investigate the effects of tDCS, associated with kinesiotherapy and activation of mirror neurons, in the rehabilitation of a 54-month-old male child with cerebral palsy, moderate degree of muscular hypotonia in the lower limbs, voluntary movements with weak muscular strength; dorsolumbar scoliosis and zero score on the Functional Mobility and Modified Asworth Scale. The Gross Motor Function Classification System (GMFCS) has a level V classification, limiting the ability to maintain antigravity postures of the head and trunk and to control arm and leg movements. Modified Barthel Index with score 11- severe dependency rating. The Denver II scale with significant impairments in the following domains: personal-social, adaptive fine motor, language and gross motor.

Utilização da fisioterapia na reabilitação de bezerro com poliartrite e paresia neuromuscular: relato de caso / Use of physiotherapy in the rehabilitation of calves with polyarthritis and neuromuscular paresis: case report / Uso de la fisioterapia en la rehabilitación de un ternero con poliartritis y parisia neuromuscular: reporte de caso

A reabilitação animal na medicina veterinária é um campo recente, porém crescente a cada dia. Neste sentido, a fisioterapia veterinária atua trazendo inúmeros benefícios, como melhoria dos movimentos, redução da dor, edema e outras. Interfere ainda no tempo de recuperação, redução de custos para o proprietário, podendo ser hoje utilizada como um tratamento na recuperação pós-cirúrgica. Desta forma, objetivou-se relatar o uso da fisioterapia em uma bezerra com poliartrite e paresia neuromuscular. O animal apresentou um aumento de volume nas articulações cárpicas e társicas após histórico de onfalite, permanecendo em decúbito esternal por vários dias. O proprietário resolveu aplicar ferro dextrano na região glútea do animal, o que causou uma lesão de nervo isquiático. Foram instituídos protocolos medicamentosos e fisioterápicos, que culminaram no estímulo da marcha, propriocepção, além de hipertrofia muscular. Porém, em virtude de complicações resultantes de onfalite, o animal veio a óbito.(AU)

Animal rehabilitation in veterinary medicine is a recent field, but growing every day. In this sense, veterinary physiotherapy works bringing numerous benefits, such as improved movements, reduced pain, edema and others. Reducing the recovery time, reducing costs for the owner, and today it can be used as a treatment in post-surgical recovery. In this sense, the objective was to report the use of physiotherapy in a heifer with polyarthritis and neuromuscular paresis. The animal showed an increase in volume in the carpal and tarsal joints after a history of omphalitis, remaining in sternal decubitus for several days. The owner decided to apply iron dextran to the animal's gluteal region, which caused an injury to the sciatic nerve. Medicinal and physical therapy protocols were instituted, which culminated in the stimulation of gait, proprioception, in addition to muscle hypertrophy. However, due to complications resulting from omphalitis, the animal died.(AU)

La rehabilitación animal en medicina veterinaria es un campo reciente, pero en crecimiento cada día. En este sentido, la fisioterapia veterinaria actúa aportando numerosos beneficios, como mejora de los movimientos, reducción del dolor, edemas y otros. Disminución del tiempo de recuperación, reducción de costos para el propietario, pudiendo ser utilizado hoy en día como tratamiento en la recuperación posquirúrgica. En ese sentido, el objetivo fue reportar el uso de fisioterapia en una vaquilla con poliartritis y paresia neuromuscular. El animal presentó un aumento de volumen en las articulaciones del carpo y del tarso tras un antecedente de onfalitis, permaneciendo en decúbito esternal durante varios días. El propietario decidió aplicar hierro dextrano en la región glútea del animal, lo que provocó una lesión en el nervio ciático. Se instauraron protocolos farmacológicos y de fisioterapia, que culminaron con estimulación de la marcha, propiocepción, además de hipertrofia muscular. Sin embargo, debido a complicaciones derivadas de la onfalitis, el animal falleció.(AU)

A importância da intervenção fisioterapêutica no vaginismo: uma revisão sistemática / The importance of physiotherapeutic intervention in vaginism: a systematic review

Objetivo: Descrever a importância da intervenção fisioterapêutica para mulheres com vaginismo. Fonte de dados: Foram utilizadas as bases de dados SciELO, PubMed, Biblioteca Virtual de Saúde (BVS) e Literatura Cinza, incluindo artigos nacionais e internacionais, sem delimitação temporal. Foram propostas para as buscas as seguintes palavras-chave e operadores boleanos: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], sendo esses posteriormente adequados para as demais bases que foram utilizadas nesta revisão sistemática. Seleção dos estudos: A seleção dos estudos foi realizada por três examinadores independentes. Coleta de dados: Inicialmente foram excluídos estudos com base no título, em seguida os resumos foram analisados e, dos 353 artigos encontrados inicialmente, quatro foram elegíveis para esta revisão. Síntese dos dados: Os artigos incluídos descreveram que o tratamento fisioterapêutico é de extrema importância para as mulheres com vaginismo, pois aumenta a força e o controle sobre a musculatura do assoalho pélvico, diminuindo os sintomas do vaginismo e promovendo o incremento da satisfação sexual. Conclusão: A intervenção fisioterapêutica é imprescindível para mulheres que apresentam vaginismo, tendo em vista que suas técnicas têm efetividade na prevenção e tratamento do vaginismo, além de promover melhora importante na qualidade de vida e na satisfação sexual das mulheres.(AU)

Objective: To describe the importance of physical therapy intervention for women with vaginismus. Data source: The SciELO, PubMed, Virtual Health Library (BVS) and Gray Literature databases were used, including national and international articles, without temporal delimitation. The following keywords and Boolean operators were proposed for the searches: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], which were later suitable for the other bases that were used in this systematic review. Study selection: Study selection was performed by three independent examiners. Data collection: Initially, studies were excluded based on the title, then the abstracts were analyzed and of the 353 articles found initially, 4 were eligible for this review. Data synthesis: The articles included described that physical therapy treatment is extremely important for women with vaginismus, as it increases strength and control over the pelvic floor muscles, decreasing the symptoms of vaginismus and promoting increased sexual satisfaction. Conclusion: Physical therapy intervention is essential for women who have vaginismus, considering that its techniques are effective in preventing and treating vaginismus, in addition to promoting an important improvement in women's quality of life and sexual satisfaction.(AU)

Avaliação da adaptação da corrente interferencial nas formas bipolar e tetrapolar em mulheres com lombalgia crônica não específica: ensaio clínico cruzado / Evaluation of interferential current adaptation in bipolar and tetrapolar forms in women with chronic non-specific low back pain: cross-over clinical trial

INTRODUÇÃO: A corrente interferencial é uma modalidade bastante utilizada, porém, apresenta como fator limitante a quantidade de acomodações, o que é comum em eletroestimulação. Apesar de possuir alguns recursos que visam reduzir a adaptação fisiológica, não é totalmente eficaz; neste sentido, pode haver diferenças devido à técnica de uso. Assim, o presente estudo pretendeu analisar se há diferenças na adaptação para as formas bipolar ou tetrapolar em indivíduos com dor lombar crônica não específica. MÉTODOS: Ensaio clínico cruzado, composto por 15 voluntárias com dor lombar crônica não específica, as quais receberam terapia bipolar ou tetrapolar em semanas subsequentes. Foi explicado sobre a adaptação à corrente e o que deveria avisar quando ocorresse, e, desta forma, foi computado o número de vezes em que o fenômeno ocorreu, o tempo necessário até ocorrer a primeira adaptação, a intensidade inicial da corrente utilizada e o quanto aumentou-se após a primeira adaptação. RESULTADOS: Para nenhuma das variáveis analisadas, foi observada diferença significativa entre as duas técnicas (p>0,05). CONCLUSÃO: As técnicas analisadas não mostraram diferenças na adaptação em mulheres jovens com dor lombar não específica.

INTRODUCTION: The interferential current is a widely used modality; however, it presents as a limiting factor the amount of accommodation, which is common in electrostimulation. Despite having some resources that aim to reduce physiological adaptation, it is not fully effective in this sense, but there may be differences due to the technique of use. Thus, the present study aimed to analyze whether there are differences in the accommodation for bi- or tetrapolar forms in individuals with chronic nonspecific low back pain. METHODS: Crossover clinical study, consisting of 15 volunteers with chronic nonspecific low back pain, who received bipolar or tetrapolar therapy in subsequent weeks. They were explained about the current accommodation and that they should be told when it occurred, and in this way, the number of times that the phenomenon occurred, the time needed until the first accommodation occurred, the initial intensity of the current used, and how much it increased after the first accommodation were computed. RESULTS: None of the variables analyzed had a significant difference between the two techniques (p>0.05). CONCLUSION: The techniques analyzed showed no differences in accommodation in young women with nonspecific low back pain.

Transcutaneous tibial nerve stimulation versus parasacral stimulation in the treatment of overactive bladder in elderly people: a triple-blinded randomized controlled trial

OBJECTIVES: To evaluate the effect of transcutaneous tibial nerve stimulation (TTNS) and transcutaneous parasacral stimulation on the treatment of overactive bladder (OAB) in elderly people and to compare the final results between groups. METHODS: Fifty female volunteers, mean age 68.62 (±5.9) years, were randomly allocated into two groups: those receiving TTNS (G1, N=25) and those receiving transcutaneous parasacral stimulation (G2, N=25). The primary outcome was the International Consultation on Incontinence Questionnaire (ICIQ-OAB) score, and secondary outcomes were the International Consultation on Incontinence Questionnaire - short form (ICIQ-SF) score and 3-day bladder diary measurements. Volunteers were assessed before and after the treatment. Clinical Trials (ReBeC): RBR-9Q7J7Y. RESULTS: Both groups' symptoms improved as measured by the ICIQ-OAB (G1 = <0.001; G2 = <0.001) and ICIQ-SF (G1 = <0.001; G2 = <0.001). In the 3-day bladder diary assessments after treatment, G1 showed a reduced number of nocturia (p<0.001), urgency (p<0.001) and urge urinary incontinence episodes (p<0.001), whereas G2 showed only a reduced number of nocturia episodes (p<0.001). No difference between groups was found. CONCLUSION: Both of the proposed treatments were effective in the improvement of OAB symptoms, but TTNS showed a reduction in a greater number of symptoms as measured by the 3-day bladder diary. No differences were found between groups.

Neuromuscular Electrical Stimulation on Hemodynamic and Respiratory Response in Patients Submitted to Cardiac Surgery: Pilot Randomized Clinical Trial

Neuromuscular electrical stimulation seems to be a promising option to intensify the rehabilitation and improve the exercise capacity of patients in the immediate postoperative period of cardiac surgery. Objective: This study aimed to evaluate the hemodynamic (heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure) and respiratory (respiratory rate and oxygen saturation) responses to neuromuscular electrical stimulation in the immediate postoperative period in patients submitted to cardiac surgery and to verify its feasibility and safety. Methods: This is a pilot randomized controlled trial, wherein critical patients in the immediate postoperative period of cardiac surgery were randomly assigned to a control group, using sham neuromuscular electrical stimulation, or an experimental group, submitted to neuromuscular electrical stimulation sessions (FES), for 60 min, with a 50-Hz frequency, 200-µs pulse duration, time on: 3 s, and time off: 9 s. Data distribution was evaluated by the Shapiro-Wilk test. The analysis of variance was used and a p-value < 0.05 was considered significant. Results: Thirty patients were included in the study. The neuromuscular electrical stimulation was applied within the first 23.13 ± 5.24 h after cardiac surgery, and no changes were found regarding the hemodynamic and respiratory variables between the patients who underwent neuromuscular electrical stimulation, and those in the control group. Conclusions: In the present study, neuromuscular electrical stimulation did not promote changes in hemodynamic and respiratory responses of patients in the immediate postoperative period of cardiac surgery

Tai Chi exercise and functional electrical stimulation of lower limb muscles for rehabilitation in older adults with chronic systolic heart failure: a non-randomized clinical trial

Exercise-based training decreases hospitalizations in heart failure patients but such patients have exercise intolerance. The objectives of the study were to evaluate the effect of 12 weeks of Tai Chi exercise and lower limb muscles' functional electrical stimulation in older chronic heart failure adults. A total of 1,084 older adults with chronic systolic heart failure were included in a non-randomized clinical trial (n=271 per group). The control group did not receive any kind of intervention, one group received functional electrical stimulation of lower limb muscles (FES group), another group practiced Tai Chi exercise (TCE group), and another received functional electrical stimulation of lower limb muscles and practiced Tai Chi exercise (FES & TCE group). Quality of life and cardiorespiratory functions of all patients were evaluated. Compared to the control group, only FES group had increased Kansas City Cardiomyopathy Questionnaire (KCCQ) score (P<0.0001, q=9.06), only the TCE group had decreased heart rate (P<0.0001, q=5.72), and decreased peak oxygen consumption was reported in the TCE group (P<0.0001, q=9.15) and FES & TCE group (P<0.0001, q=10.69). FES of lower limb muscles and Tai Chi exercise can recover the quality of life and cardiorespiratory functions of older chronic heart failure adults (trial registration: Research Registry 4474, January 1, 2015).

Efeito imediato da estimulação elétrica neuromuscular na deglutição após tratamento do câncer de laringe: relato de caso / Immediate effect of neuromuscular electrical stimulation on deglutition after treatment of laryngeal cancer: a case report

RESUMO Este trabalho teve por objetivo verificar o efeito imediato da Estimulação Elétrica Neuromuscular (EENM) sensorial e motora, nas fases oral e faríngea da deglutição, em um homem de 64 anos, após tratamento de câncer de laringe. Foi realizado exame de videofluoroscopia durante a deglutição de 5 ml de mel e pudim, em três condições: sem estimulação, com EENM sensorial, com EENM motora, definidas de forma randomizada. Foi classificado o grau da disfunção da deglutição (DOSS), a presença de estase de alimentos (escala de Eisenhuber), de penetração laríngea e aspiração laringotraqueal (PAS), além da medida do tempo de trânsito oral e faríngeo, realizadas por uma avaliadora sem conhecimento sobre o estímulo aplicado. Na escala DOSS, houve melhora com a estimulação sensorial e motora. Na escala PAS, verificou-se melhora, tanto para o estímulo sensorial quanto motor na consistência mel, porém observou-se piora no estímulo motor para a consistência pudim. Houve diminuição dos resíduos em base de língua com estímulo sensorial e motor para as consistências pudim e mel; piora no estímulo motor na parede posterior da faringe para a consistência mel. Em relação ao tempo de trânsito oral e faríngeo, não foi observada diferença entre os níveis de estimulações. Os resultados demonstraram que a EENM em nível sensorial e motor melhorou o grau da disfagia em um indivíduo após o tratamento de câncer de laringe, com maiores benefícios do nível sensorial em relação ao motor no que diz respeito à presença de penetração e resíduos.

ABSTRACT The objective of this study was to verify the immediate effect of sensory and motor neuromuscular electrical stimulation (NMES), in the oral and pharyngeal phases of deglutition, in a 64 year male patient after laryngeal cancer treatment. Videofluoroscopy was performed during deglutition of 5 ml of honey and pudding, under three conditions: without stimulation, with sensory NMES, with motor NMES, randomly defined. The degree of dysfunction of deglutition (DOSS), the presence of food stasis (Eisenhuber scale), laryngeal penetration and laryngotracheal aspiration (PAS) and oral and pharyngeal transit time were evaluated. An evaluator without knowing about the applied stimulus. On the DOSS scale there was improvement with sensory and motor stimulation. In the PAS scale, there was improvement, both for the sensorial and motor stimulus in the honey consistency, but the worsening of the motor stimulus for the pudding consistency was observed. There was reduction of the residues in the base of the tongue with sensorial and motor stimulus for the consistency of pudding and honey; worsening motor stimulus in the posterior wall of the pharynx for honey consistency. There was no difference between stimulation levels regarding to oral and pharyngeal transit time. The results showed that NMES at the sensory and motor levels improved the degree of dysphagia in an individual after the treatment of laryngeal cancer, with greater benefits of the sensory level in relation to the motor regarding to the presence of penetration and residues.

De la compuerta a la neuromatriz y neuromodulación / From gate and neuromodulation to neuromatrix

The following article presents a review of the evolution of the gate and neuromatrix theories as well as their contribution in the development of neuromodulation to the present day. Nowadays the mechanism of action of neuromodulation is better to understand by dividing it according to the level where it acts (local, central or peripheral). Patient selection is crucial to optimize the effectiveness of the device; although the indications for pain that support current guidelines are failed back syndrome, complex regional pain syndrome and lower limb ischemic pain and refractory angina; neuromodulation is already being extended to multiple fields of action that affect the future, such as the improvement of human capacities.

El siguiente artículo consiste en una revisión no sistemática de la evolución de la teoría de la compuerta y la neuromatriz, así como su aporte en el desarrollo de los dispositivos de neuromodulación. Para entender mejor el mecanismo de acción de la neuromodulación se divide según el nivel en que actúe sea local, central o periférico. La selección de pacientes es crucial para optimizar la eficacia del dispositivo; aunque las indicaciones para manejo del dolor que soportan las guías actuales son síndrome de espalda fallida, síndrome doloroso regional complejo y dolor tipo isquémico en miembros inferiores y dolor por angina refractaria; actualmente la neuromodulación se está extendiendo a múltiples campos de acción entre los cuales se encuentra el mejoramiento de las capacidades humanas.

Reach and palmar grasp in tetraplegics with neuromuscular electrical stimulation / Alcance e preensão palmar em tetraplégicos com estimulação elétrica neuromuscular / Alcance y prensión palmar en tetrapléjicos con estimulación eléctrica neuromuscular

OBJECTIVE: To evaluate the movement strategies of quadriplegics, assisted by neuromuscular electrical stimulation, on reach and palmar grasp using objects of different weights. METHODS: It was a prospective clinical trial. Four chronic quadriplegics (C5-C6), with injuries of traumatic origin, were recruited and all of them had their reach and palmar grasp movement captured by four infrared cameras and six retro-reflective markers attached to the trunk and right arm, assisted or not by neuromuscular electrical stimulation to the triceps, extensor carpi radialis longus, extensor digitorum communis, flexor digitorum superficialis, opponens pollicis and lumbricals. It was measured by a Neurological and Functional Classification of Spinal Cord Injuries of the American Spinal Injury Association, Functional Independence Measure and kinematic variables. RESULTS: The patients were able to reach and execute palmar grasp in all cylinders using the stimulation sequences assisted by neuromuscular electrical stimulation. The quadriplegics produced lower peak velocity, a shorter time of movement and reduction in movement segmentation, when assisted by neuromuscular electrical stimulation. CONCLUSION: This study showed that reach and palmar grasp movement assisted by neuromuscular electrical stimulation was able to produce motor patterns more similar to healthy subjects. Level of evidence IV; Case series.

OBJETIVO: Avaliar as estratégias de movimento de quadriplégicos com o auxílio de estimulação elétrica neuromuscular sobre o alcance e a preensão palmar com objetos de diferentes pesos. MÉTODOS: Estudo clínico prospectivo. Quatro quadriplégicos crônicos (C5-C6) com lesões de origem traumática foram recrutados e todos tiveram o alcance e movimento de preensão palmar capturado por quatro câmeras infravermelho e seis marcadores retrorreflexivos fixados no tronco e braço direito, assistidos ou não por estimulação neuromuscular do tríceps, extensor radial longo do carpo, extensor dos dedos, flexor superficial dos dedos, oponente do polegar e músculos lumbricais. A medida foi feita com base na Classificação Neurológica e Funcional de Lesões Medulares da American Spinal Injury Association, na Medida de Independência Funcional e em variáveis cinemáticas. RESULTADOS: Os pacientes foram capazes de alcançar e realizar preensão palmar em todos os cilindros utilizando as sequências de estimulação auxiliadas por estimulação elétrica neuromuscular. Os quadriplégicos produziram menor velocidade de pico, menor tempo de movimento e redução na segmentação do movimento, quando foram auxiliados pela estimulação elétrica neuromuscular. CONCLUSÃO: Este estudo mostrou que o alcance e o movimento de preensão palmar assistidos por estimulação elétrica neuromuscular foi capaz de produzir padrões motores mais semelhantes aos dos indivíduos saudáveis. Nível de evidência IV; Série de casos.

OBJETIVO: Evaluar las estrategias de movimiento de cuadripléjicos, con el auxilio de estimulación eléctrica neuromuscular sobre el alcance y la prensión palmar con objetos de diferentes pesos. MÉTODOS: Estudio clínico prospectivo. Fueron reclutados cuatro cuadripléjicos crónicos (C5-C6) con lesiones de origen traumático y todos ellos tuvieron su alcance y movimiento de prensión palmar capturado por cuatro cámaras infrarrojas y seis marcadores retrorreflexivos fijados al tronco y al brazo derecho, asistidos o no por estimulación neuromuscular del tríceps, extensor radial largo del carpo, extensor de los dedos, flexor superficial de los dedos, oponente del pulgar y músculos lumbricales. La medición fue hecha con base en la Clasificación Neurológica y Funcional de Lesiones Medulares de la American Spinal Injury Association, en la Medida de Independencia Funcional y en variables cinemáticas. RESULTADOS: Los pacientes fueron capaces de alcanzar y realizar prensión palmar en todos los cilindros utilizando las secuencias de estimulación auxiliadas por estimulación eléctrica neuromuscular. Los cuadripléjicos produjeron menor velocidad de pico, menor tiempo de movimiento y reducción en la segmentación del movimiento, cuando fueron auxiliados por la estimulación eléctrica neuromuscular. CONCLUSIÓN: El presente estudio mostró que el alcance y el movimiento de prensión palmar asistidos por estimulación eléctrica neuromuscular fue capaz de producir patrones motores más similares a los individuos saludables. Nivel de evidencia IV; Serie de casos.

Arritmias ventriculares sustentadas: a tempestade chegou / Sustained ventricular arrhythmias: the storm has arrived

Um dos grandes desafios no atendimento dos pacientes nas unidades de emergência é o tratamento das arritmias ventriculares, principalmente, quando sustentadas e recorrentes, pois são de difícil tratamento e estão associadas à alta mortalidade. O principal mecanismo envolvido na sustentação das taquicardias ventriculares é o mecanismo de reentrada, devido às cicatrizes miocárdicas secundárias a diversas cardiopatias estruturais. A tempestade elétrica pode ser séria quando ocorre em portadores de desfibriladores automáticos, provocando múltiplos choques correspondentes fora do ambiente hospitalar. Nesses casos é necessária a internação hospitalar, onde medidas específicas e escalonadas de tratamento são realizadas, indo desde o manejo clínico até intervenções específicas, como programação de dispositivos eletrônicos, intervenções eletrofisiológicas ou cirúrgicas

One of the biggest challenges in the care of patients in emergency units is the treatment of ventricular arrhythmias, particularly when sustained and relapsing, as they are difficult to treat and are associated with high mortality. The main mechanism involved in the maintenance of ventricular tachycardias is the mechanism of reentry, due to myocardial scars secondary to various structural heart diseases. The electrical storm may be serious when it occurs in patients with automatic defibrillators, causing multiple corresponding shocks outside the hospital setting. In these cases, admission to hospital is necessary, where specific and stepwise treatment measures are performed, ranging from clinical management to specific interventions, such as programming of electronic devices, and electrophysiological or surgical interventions

Efeitos da eletroestimulação associada ao treino mastigatório em pessoas com síndrome de down / Effects of electrostimulation associated with masticatory training in individuals with down syndrome

RESUMO Objetivo Investigar e mensurar os efeitos da eletroestimulação na musculatura orofacial e nas funções de mastigação, respiração e deglutição dos indivíduos com síndrome de Down. Método Participaram da pesquisa 16 indivíduos com Síndrome de Down, sendo seis do gênero masculino e dez do gênero feminino com idade entre 9 e 25 anos, participantes de um projeto de extensão institucional. Foram realizadas avaliações fonoaudiológicas com uso do protocolo AMIOFE antes e após a intervenção, que consistiu em oito sessões de eletroestimulação semanais. A corrente utilizada foi a Functional Electrical Estimulation (FES), com uma frequência de 10Hz no aquecimento e 30 Hz na aplicação, em um tempo ON de 5s e OFF de 10s comuns nas duas etapas, e com a largura de pulso de 200(µs) no aquecimento e 250(µs) na aplicação. Resultados Observaram-se diferenças significativas após aplicação da eletroestimulação (FES) em relação ao aspecto das bochechas quando comparadas flacidez/arqueamento pré e pós o estímulo elétrico, diferenças na mobilidade de língua (lateralidade direita e esquerda), no comportamento da musculatura na execução das funções estomatognáticas de respiração, melhoria no comportamento dos lábios durante a deglutição e mudanças expressivas no processo de mastigação (mordida e trituração). Conclusão Foi identificado estatisticamente que houve efeito após a eletroestimulação associada ao treino mastigatório nos músculos masseteres, com ganhos funcionais na execução da mastigação, respiração e deglutição, em pessoas com Síndrome de Down.

ABSTRACT Purpose Investigate and measure the effects of electrostimulation on the orofacial musculature and on the chewing, breathing and swallowing functions of individuals with Down syndrome. Methods Study participants were 16 individuals with Down syndrome (six males and 10 females) from an institutional extension project aged nine to 25 years. Speech-language pathology assessment was performed using the protocol of Orofacial Myofunctional Evaluation with Scores (OMES) pre- and post-intervention. This protocol comprised eight weekly electrostimulation sessions. Functional Electrical Stimulation (FES) current was used at a frequency of 10Hz in warm-up and 30Hz in application, intermittent stimulation (cycling pulses) with ON-time of 5s and OFF-time of 10s common to both stages, and pulse width of 200μs in warm-up and 250μs in application. Results Significant differences were observed between pre- and post-application of FES regarding cheek appearance (flaccidity and arching), tongue mobility (right and left laterality), and musculature behavior during performance of functions of the stomatognathic system: respiration, deglutition (lip behavior), and mastication (bite and trituration). Conclusion Effects of electrostimulation associated with masticatory training of the masseter muscles were statistically identified, with functional gains in chewing, breathing and swallowing performance in individuals with Down syndrome.

New concept for treating female stress urinary incontinence with radiofrequency

ABSTRACT Purpose: To evaluate the clinical response and adverse effects of radiofrequency on the urethral meatus in the treatment of stress urinary incontinence in women. Materials and Methods: This phase one study included ten women with Stress Urinary Incontinence (SUI). The evaluation consisted of 1 hour Pad tests to quantify urine loss and to assess the degree of procedure satisfaction by using the Likert scale. To evaluate safety, we observed the number of referred side effects. Results: Average age was 53.10 years±7.08 years. In assessing the final Pad Test, 70% showed a reduction and 30% a worsening of urinary loss. Using the Pad Test one month later, there was a reduction in all patients (p=0.028). The degree of satisfaction was 90% and no side effects have been observed. One patient reported burning sensation. Conclusion: The treatment of SUI with radiofrequency on the urethral meatus has no adverse effects, being a low risk method that reduces urinary loss in women. However, to increase the validity of the study, larger clinical trials are warranted.

Efeitos da estimulação elétrica neuromuscular sobre a mobilidade diafragmática de pacientes críticos: ensaio clínico randomizado / Effects of electrical stimulation neuromuscular on mobility critical patients diaphragmatic in mechanical ventilation invasive: randomized controlled trial

Introdução: Fraqueza muscular é um dos principais problemas nos pacientes em ventilação mecânica invasiva e, para atenuar esta co-morbidade a Eletroestimulação Neuromuscular (EENM) vêm sendo estudada. Objetivos: verificar os efeitos da EENM na mobilidade diafragmática e associação entre esta e músculos acessórios da respiração em pacientes críticos. Métodos: Ensaio clínico randomizado (ECR), 24 pacientes ventilados mecanicamente, randomizados em: intervenção (G1) e placebo (G2). EENM aplicada 1 vez/dia, 30 minutos, nos músculos peitorais e reto abdominais utilizando ultrassonografia para análise de espessura. Resultados: diferença significativa (G1) na mobilidade diafragmática expiratória (p=0,015), correlação direta entre reto abdominal e peitoral (rs=0,607 e p=0,048), reto abdominal e incursão diafragmática (rs = 0,609 e p=0,047), bem como a mobilidade diafragmática (entre incursão e excursão) (rs=0,920 e p<0,001) e da excursão diafragmática e espessura diafragmática (rs=0,607 e p=0,048). Conclusão: Nesta amostra houve melhora na mobilidade diafragmática e correlação entre musculaturas estudadas, sugerindo preservação da mobilidade diafragmática no grupo eletroestimulado. Clinical Trials: NCT02298114. (AU)

Introduction: Muscle weakness is one of the problems in patients with invasive mechanical ventilation, and in order to mitigate this comorbidity Neuromuscular Electro-stimulation (NMES) has been studied. Objectives: to verify the effects of NMES on diaphragmatic mobility and its association with accessory breathing muscles in critically ill patients. Methods: Randomized clinical trial (RCT), 24 mechanically ventilated patients, randomized into: intervention (G1) and placebo (G2). NMES applied 1 time / day, 30 minutes, in the pectoral and recumbent abdominal muscles using ultrasound for analysis of thickness. Results: significant difference (G1) in expiratory diaphragmatic mobility (p = 0.015), direct correlation between abdominal and pectoral rectus (rs = 0.607 and p = 0.048), abdominal rectus and diaphragmatic incursion (rs = 0.609 and p = 0.047), as well as (rs = 0.920 and p <0.001) and diaphragmatic excursion and diaphragmatic thickness (rs = 0.607 and p = 0.048). Conclusion: In this sample there was improvement in diaphragmatic mobility and correlation between studied muscles, suggesting preservation of the diaphragmatic mobility in the electrostimulated group. (AU)

Electrical stimulation attenuates morphological alterations and prevents atrophy of the denervated cranial tibial muscle / Eletroestimulação atenua alterações morfológicas e previne atrofia do músculo tibial cranial desnervado

ABSTRACT Objective To investigate if electrical stimulation through Russian current is able to maintain morphology of the cranial tibial muscle of experimentally denervated rats. Methods Thirty-six Wistar rats were divided into four groups: the Initial Control Group, Final Control Group, Experimental Denervated and Treated Group, Experimental Denervated Group. The electrostimulation was performed with a protocol of Russian current applied three times per week, for 45 days. At the end, the animals were euthanized and histological and morphometric analyses were performed. Data were submitted to statistical analysis with a significance level of p<0.05. Results The Experimental Denervated Group and the Experimental Denervated and Treated Group had cross-sectional area of smaller fiber compared to the Final Control Group. However, there was significant difference between the Experimental Denervated Group and Experimental Denervated and Treated Group, showing that electrical stimulation minimized muscle atrophy. The Experimental Denervated and Treated Group and Initial Control Group showed similar results. Conclusion Electrical stimulation through Russian current acted favorably in maintaining morphology of the cranial tibial muscle that was experimentally denervated, minimizing muscle atrophy.

RESUMO Objetivo Investigar se a estimulação elétrica pela corrente russa é capaz de manter a morfologia do músculo tibial cranial de ratos desnervados experimentalmente. Métodos Foram utilizados 36 ratos Wistar, distribuídos em quatro grupos: Grupo Controle Inicial, Grupo Controle Final, Grupo Experimental Desnervado Tratado, Grupo Experimental Desnervado. A eletroestimulação foi realizada com um protocolo de corrente russa aplicada três vezes por semanas, durante 45 dias. Ao final, os animais foram eutanasiados e, em seguida, foram realizadas as análises histológica e morfométrica. Os dados foram submetidos à análise estatística, com nível de significância de p<0,05. Resultados Os Grupos Experimental Desnervado e o Grupo Experimental Desnervado Tratado apresentaram área de secção transversal da fibra menor quando comparados ao Grupo Controle Final. Entretanto, constatou-se diferença significativa entre o Grupo Experimental Desnervado e o Grupo Experimental Desnervado Tratado, mostrando que a estimulação elétrica minimizou atrofia muscular. Ainda, observou-se que o Grupo Experimental Desnervado Tratado apresentou resultados semelhantes ao Grupo Controle Inicial. Conclusão A estimulação elétrica por meio da corrente russa foi favorável na manutenção da morfologia do músculo tibial cranial desnervado experimentalmente, minimizando a atrofia muscular.

A critical review of trials of transcranial direct current stimulation and trigeminal nerve stimulation for depression: the issue of treatment-emergent mania / Revisão crítica da literatura de ensaios clínicos em estimulação transcraniana por corrente contínua e estimulação de nervo trigêmeo para depressão: o problema da mania tratamento-emergente

Abstract Objective: This study is a critical review analyzing occurrence of treatment-emergent mania (TEM) related to transcranial direct current stimulation (tDCS) and trigeminal nerve stimulation (TNS). Method: We present a systematic review of the literature on TEM related to tDCS and TNS treatment for major depressive disorder (MDD), conducted in accordance with the recommendations from Cochrane Group and the PRISMA guidelines. Results: Our search identified few reported episodes of TEM in the literature. In fact, we found 11 trials focused on treatment of MDD (seven controlled trials of tDCS and four trials of TNS, three open label and one controlled). We highlight the need for safety assessment in clinical research settings to establish with precision and in larger samples the risks inherent to the technique under investigation. Conclusion: Safety assessment is of fundamental importance in clinical research. TEM is a very important safety issue in MDD trials. Further and larger controlled trials will help to clarify both the safety and the clinical effects of combinations of pharmacotherapy and tDCS or TNS in daily clinical practice.

Resumo Objetivo: O presente estudo consiste em uma revisão e análise crítica da ocorrência de mania tratamento-emergente (TEM) relacionada a estimulação transcraniana por corrente contínua (ETCC) e estimulação do nervo trigêmeo (TNS). Método: Apresentamos uma revisão sistemática de literatura sobre TEM relacionada a ETCC e TNS no tratamento de transtorno depressivo maior (TDM), conduzida de acordo com as recomendações do Grupo Cochrane e protocolo PRISMA. Resultados: A pesquisa identificou poucos relatos de TEM na literatura. Na verdade, foram encontrados 11 ensaios clínicos com foco no tratamento de TDM (sete estudos controlados de ETCC e quatro de TNS, sendo três abertos e um controlado). Destacamos a necessidade de avaliações de segurança em pesquisas clínicas para se estabelecer com maior precisão e em amostras maiores os riscos inerentes à técnica sob investigação. Conclusão: Avaliação de segurança é fundamental na pesquisa clínica. A TEM é um efeito adverso importante no tratamento do TDM. Maiores ensaios clínicos controlados ajudarão a esclarecer os efeitos clínicos e a segurança da combinação de psicotrópicos e ETCC ou TNS.

High voltage pulsed current in collagen realignment, synthesis, and angiogenesis after Achilles tendon partial rupture

ABSTRACT Objective To verify the efficacy of high voltage pulsed current in collagen realignment and synthesis and in angiogenesis after the partial rupturing of the Achilles tendon in rats. Method Forty male Wistar rats were randomized into four groups of 10 animals each: sham, cathodic stimulation, anodic stimulation, and alternating stimulation. Their Achilles tendons were submitted to direct trauma by a free-falling metal bar. Then, the treatment was administered for six consecutive days after the injury. In the simulation group, the electrodes were positioned on the animal, but the device remained off for 30 minutes. The other groups used a frequency of 120 pps, sensory threshold, and the corresponding polarity. On the seventh day, the tendons were removed and sent for histological slide preparation for birefringence and Picrosirius Red analysis and for blood vessel quantification. Results No significant difference was observed among the groups regarding collagen realignment (types I or III collagen) or quantity of blood vessels. Conclusion High voltage pulsed current for six consecutive days was not effective in collagen realignment, synthesis, or angiogenesis after the partial rupturing of the Achilles tendon in rats.

Can intraurethral stimulation inhibit micturition reflex in normal female rats?

ABSTRACT Objective The study was designed to determine the effect of low frequency (2.5Hz) intraurethral electrical stimulation on bladder capacity and maximum voiding pressures. Materials and Methods The experiments were conducted in 15 virgin female Sprague-Dawley rats (220–250g). The animals were anesthetized by intraperitoneal injection of urethane (1.5g/kg). Animal care and experimental procedures were reviewed and approved by the Institutional Animal Care and Use Committee of Antwerp University (code: 2013-50). Unipolar square pulses of 0.06mA were used to stimulate urethra at frequency of 2.5Hz (0.2ms pulse width) in order to evaluate the ability of intraurethral stimulation to inhibit bladder contractions. Continuous stimulation and intermittent stimulation with 5sec ‘‘on’’ and 5sec ‘‘off’’ duty cycle were applied during repeated saline cystometrograms (CMGs). Maximum voiding pressures (MVP) and bladder capacity were investigated to determine the inhibitory effect on bladder contraction induced by intraurethral stimulation. Results The continuous stimulation and intermittent stimulation significantly (p<0.05) decreased MVP and increased bladder capacity. There was no significant difference in MVP and bladder capacity between continuous and intermittent stimulation group. Conclusions The present results suggest that 2.5Hz continuous and intermittent intraurethral stimulation can inhibit micturition reflex, decrease MVP and increase bladder capacity. There was no significant difference in MVP and bladder capacity between continuous and intermittent stimulation group.

Initial experience with sacral neuromodulation for the treatment of lower urinary tract dysfunction in Brazil

ABSTRACT Objectives: We report on the short-term outcomes of sacral neuromodulation (SNM) for treatment of idiopathic lower urinary tract dysfunction in Brazil (procedures performed before 2014). Materials and Methods: Clinical data and surgical outcomes of patients who underwent SNM staged procedures were retrospective evaluated. Urological assessment included a focused medical history and physical examination, measurement of postvoid residual volumes, urodynamics, and bladder diaries. A successful test phase has been defined by improvement of at least 50% of the symptoms, based on bladder diaries. Results: From January 2011 to December 2013, eighteen consecutive patients underwent test phase for SNM due to refractory overactive bladder (15 patients), non-obstructive chronic urinary retention (2 patients), and bladder pain syndrome/interstitial cystitis (1 patient). All patients underwent staged procedures at four outpatient surgical centers. Mean age was 48.3±21.2 (range 10-84 years). There were 16 women and 2 men. Median follow-up was 3 months. Fifteen patients (83.3%) had a successful test phase and underwent implantation of the pulse generator (IPG). Median duration of the test phase was 7 days (range 5–24 days). Mean age was 45.6±18.19 years in responders versus 61.66±34.44 years in non-responders (p=0.242). Mean operative time (test phase) was 99±33.12 min in responders versus 95±35 min for non-responders (p=0.852). No severe complications were reported. Conclusion: SNM is a minimally invasive treatment option for patients with refractory idiopathic lower urinary tract dysfunction. Our initial experience with staged technique showed that tined-lead electrodes yielded a high rate of responders and favorable clinical results in the short-term follow-up.