Movilización pasiva continua en pacientes con artroplastia de rodilla / Continuous passive motion in knee arthroplasty patients

Introducción: La artroplastia total de rodilla es el recurso terapéutico para pacientes con artrosis severa y gran incapacidad física. Sin embargo, muchos evolucionan con dolor y déficit funcional. En este estudio, se utiliza un tratamiento con movilización pasiva continua a partir de los 10 días de la cirugía. Materiales y Métodos: Se incluyó a 60 pacientes que fueron asignados, en forma aleatoria, a 2 grupos (30 en cada grupo). Al grupo 1 (G1, 23 mujeres) se le aplicó un protocolo de tratamiento convencional y, al grupo 2 (G2, 17 mujeres), el mismo programa y la adicción de un equipo de movimiento pasivo continuo a los 10 días de la intervención. Se evaluaron el dolor, la movilidad articular, la fuerza muscular y la función (WOMAC y prueba TUG). Resultados: No se observaron diferencias estadísticamente significativas en los parámetros estudiados, aunque sí una tendencia a la mejoría en el G2. En este grupo, la fuerza de extensión de la rodilla fue mayor y también hubo una correlación basal entre la fuerza y la prueba TUG. Conclusiones: El uso diferido de la movilización pasiva continua mejoró la fuerza de extensión de la rodilla y el rendimiento en la prueba TUG, aunque sin diferencias significativas entre ambos grupos. No se observaron efectos adversos. Nivel de Evidencia: I

Introduction: Total knee arthroplasty (TKA) is a valid therapeutic option for patients with severe arthritis and physical disability. However, many TKA patients develop pain and functional impairment. In our study, we used a continuous passive motion (CPM) device for exercise starting 10 days after surgery. Materials and Methods: The study population consisted of 60 patients, who were randomized into 2 groups. Group I (GI: 30 patients, 23 females) underwent the standard treatment and group II (GII, 30 patients, 17 females) underwent the standard treatment plus CPM starting 10 days after surgery. We evaluated pain, range of motion (ROM), extension muscle strength, and function (WOMAC and TUG tests). Results: All compared parameters yielded no statistically significant differences. A greater trend toward improvement was observed in GII regarding some parameters: greater extension muscle strength and a baseline correlation between flexion strength and the TUG test. Conclusions: The use of CPM starting 10 days after of surgery improved the extension muscle strength and produced better TUG test results, although without any statistically significant difference with the standard procedure. No adverse effects were observed. Level of Evidence: I

Acute effect of passive cycle-ergometry and functional electrical stimulation on nitrosative stress and inflammatory cytokines in mechanically ventilated critically ill patients: a randomized controlled trial

Early mobilization is beneficial for critically ill patients because it reduces muscle weakness acquired in intensive care units. The objective of this study was to assess the effect of functional electrical stimulation (FES) and passive cycle ergometry (PCE) on the nitrous stress and inflammatory cytometry in critically ill patients. This was a controlled, randomized, open clinical trial carried out in a 16-bed intensive care unit. The patients were randomized into four groups: Control group (n=10), did not undergo any therapeutic intervention during the study; PCE group (n=9), lower-limb PCE for 30 cycles/min for 20 min; FES group (n=9), electrical stimulation of quadriceps muscle for 20 min; and FES with PCE group (n=7), patients underwent PCE and FES, with their order determined randomly. The serum levels of nitric oxide, tumor necrosis factor alpha, interferon gamma, and interleukins 6 and 10 were analyzed before and after the intervention. There were no differences in clinical or demographic characteristics between the groups. The results revealed reduced nitric oxide concentrations one hour after using PCE (P<0.001) and FES (P<0.05), thereby indicating that these therapies may reduce cellular nitrosative stress when applied separately. Tumor necrosis factor alpha levels were reduced after the PCE intervention (P=0.049). PCE and FES reduced nitric oxide levels, demonstrating beneficial effects on the reduction of nitrosative stress. PCE was the only treatment that reduced the tumor necrosis factor alpha concentration.

Oxidative stress and immune system analysis after cycle ergometer use in critical patients

OBJECTIVE: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

Efficacy of aquatic therapy on electromyography indexes and pain intensity in men with non-specific chronic low back pain

Background: Movement therapy has known as a method to reduce pain and increase muscle strength in patients with low back pain. The aim of this study was to determine the effect of aquatic therapy on maximum muscle activity and pain intensity in men with non-specific chronic low back pain

Methods: Thirty male subjects with non-specific chronic low back pain were randomly divided into two aquatic therapy group [n=15] and control group [n=15]. Before and after intervention, subjects were assessed by maximum activity of lumbar erector spine muscles and pain severity. A 24 session protocol of aquatic therapy, sixty minutes per session lasting for 6 weeks and four sessions a week were applied. Subjects in control group didn't receive any therapeutic modality during the study period

The collected data were analyzed using independent-T test and paired samples-T test. The significance level was [p<0.05]

Results: No significant difference before and after intervention in maximum muscle activity of the Right and left upper and lower lumbar-erector spine muscles were observed [p>0/05]. However, the results about the pain intensity between the two groups showed significant difference in pre and post-test [p<0/05]

Conclusion: Aquatic therapy program had no significant effect on electromyography activity of erector spine muscles and disorders of lumbar muscles in men with NCLBP. However, this method of treatment reduced pain intensity in these patients significantly, that this reduction in pain may be due to neurological and physiological factors

The Clinical Results of Conservative Treatment of Frozen Shoulder Using Continuous Passive Motion

BACKGROUND: The purpose of this study is to administer conservative treatment in 30 patients diagnosed with idiopathic frozen shoulder, following the suggested frozen shoulder rehabilitation program and to assess the clinical outcome using a prospective study. METHODS: Thirty patients diagnosed with idiopathic frozen shoulder, treated with steroid hormone injection on the articular joint with an intra-articular steroid (triamcinolone 40 mg + lidocaine 4 ml) injection and started on stepwise shoulder extension exercise were chosen. The subjects were divided into two groups of 15 people each with one group undergoing rehabilitation with continuous passive motion (CPM) and the other group without it. Follow-ups were done before rehabilitation and at 4-week intervals with the 24th being the final week. At every follow-up, passive range of motion (ROM) was measured and surveys on pain and clinical score were administered. RESULTS: In the last follow-up, both groups showed statistically significant improvements in all evaluation criteria. However, no statistical difference in all values of the ROM and Constant score evaluation criteria was observed between the groups. Only in the last follow-up, group 1 had a visual analog scale (VAS) score of 2.4 +/- 2.1 points, which was lower, with statistical significance, than the VAS score of group 2, which was 4.4 +/- 3.1 points (p<0.001). CONCLUSIONS: Study using CPM in treatment of frozen shoulder has been inadequate, meaning that there is still room for improvement and need for more study on setting a more specific protocol and guidelines for this procedure.

The Clinical Results of Conservative Treatment of Frozen Shoulder Using Continuous Passive Motion

BACKGROUND: The purpose of this study is to administer conservative treatment in 30 patients diagnosed with idiopathic frozen shoulder, following the suggested frozen shoulder rehabilitation program and to assess the clinical outcome using a prospective study. METHODS: Thirty patients diagnosed with idiopathic frozen shoulder, treated with steroid hormone injection on the articular joint with an intra-articular steroid (triamcinolone 40 mg + lidocaine 4 ml) injection and started on stepwise shoulder extension exercise were chosen. The subjects were divided into two groups of 15 people each with one group undergoing rehabilitation with continuous passive motion (CPM) and the other group without it. Follow-ups were done before rehabilitation and at 4-week intervals with the 24th being the final week. At every follow-up, passive range of motion (ROM) was measured and surveys on pain and clinical score were administered. RESULTS: In the last follow-up, both groups showed statistically significant improvements in all evaluation criteria. However, no statistical difference in all values of the ROM and Constant score evaluation criteria was observed between the groups. Only in the last follow-up, group 1 had a visual analog scale (VAS) score of 2.4 +/- 2.1 points, which was lower, with statistical significance, than the VAS score of group 2, which was 4.4 +/- 3.1 points (p<0.001). CONCLUSIONS: Study using CPM in treatment of frozen shoulder has been inadequate, meaning that there is still room for improvement and need for more study on setting a more specific protocol and guidelines for this procedure.

The development of the multifunctional automatic rotating bed with process-monitoring / 生物医学工程学杂志

We have developed a new rotating bed for the old and the paralised people. This rotating bed is composed of two bed heads at front and at end, bed boards, guardrails, an electric motor, a reducer, an induction locator and a set of electronic controls. With the preestablished program, the angle between the left/right bed board and the middle board is changed by rotating the left/right board around the rotation axis, and the gravity direction between the human body and the ground is changed by the rotation of the middle board as a whole, so that the middle bed board and the left and right ones will act respectively as supporters of weight of the person who is lying on his back or on his side. In this way, a person can turn over automatically, comfortably and naturally when he/she is asleep. This rotating bed meets the physiological needs of a sleeping person, and people with turning over problems can turn over in a comfortable and natural way by means of biotechnology. It can also improve the quality of sleep and help avoid decubitus. In addition, it can be used to promote the rehabilitation of those who are paralysed by reason of its passive exercising function.

Effect of modified constrained induced movement therapy on improving arm function in children with obstetric brachial plexus injury

Many children who sustain birth injuries to the brachial plexus suffer significant functional limitations due to various sequelae affecting the shoulder and elbow or forearm. The aim of this study was to test the feasibility of a treatment program based on the elements of the modified constraint induced movement therapy [MCIMT] to encourage use of the affected arm of a child with obstetric brachial plexus injury [OBPI]. Thirty children with OBPI from both sexes ranging in age from three to five years were assigned into two groups of equal number. The control group [group A] who received the exercise program which focused on improving the arm function as well as shoulder abduction and external rotation and the study group [group B] received MCIMT in addition to the same exercise program given to the control group. The arm function was evaluated by the Mallet score system, while active abduction and external rotation range of motion were measured by a standard universal goniometer. The results revealed no significant difference when comparing the pretreatment mean values of the two groups [study and control], while a significant improvement was observed in measuring variables of the two groups when comparing their pre and post treatment mean values. A significant difference was also observed when comparing the post treatment results of the two groups in favor of the study group [group B]. The modified constraint movement therapy is an effective method on improving the arm function in children with OBPI

Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction

In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and deviation of the mandible. In the past, closed reduction with concomitant active physical therapy conducted after intermaxillary fixation during the recovery period had been mainly used, but in recent years, open treatment of condylar fractures with rigid internal fixation has become more common. The objective of this review was to evaluate the main variables that determine the choice of an open or closed method for treatment of condylar fractures, identifying their indications, advantages, and disadvantages, and to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.

Terapia rotacional: eixo longitudinal, em unidade de terapia intensiva / Rotational therapy: longitudinal axis, in the intensive care unit

Reunir e sumarizar os benefícios e protocolos da terapia rotacional na prevenção e no tratamento das complicações pulmonares de pacientes internados em terapia intensiva. Trata-se de uma revisão sistemática da literatura, na qual foram consultadas as bases de dados Lilacs, MedLine, Cochrane, Divisão Bibliotecária da Universidade de Stanford e o Banco de Dados de Evidência em Fisioterapia. Os ensaios clínicos randomizados publucados entre 2000 e 3008 foram incluídos na análise. Sete estudos foram selecionados, sendo um multicêntrico, totalizando 573 pacientes. O objetivo da intervenção foi a prevenção e o tratamento de complicações pulmonares em três e quatro ensaios, respectivamente. A terapia rotacional foi adotada na forma de terapia cinética em dois estudos, e a terapia de rotação lateral contínua, nos demais. Dentre os principais defechos, foram observados menor incidência de pneumonia (n=3), menor ocorrência e risco de desenvolver atelectasia lobar (n=1), melhora da razão PaO2/FiO2 em pacientes com lesão pulmonar aguda (n=1) e maior volume de escarro expelido (n=1). A terapia rotacional pode ser uma terapêutica coadjuvante no tratamento e na prevenção de complicações pulmonares, uma vez que se observou melhora clínica e fisiológica nos pacientes críticos. Outros estudos são necessários, entretanto, para confirmação desses resultados

[ comparison study of available range of movement in common commercial wrist orthoses in normal subjects]

Despite the high incidence of wrist diseases and general use of commercial wrist orthoses, there is not precise information concerning the extent of immobility that these orthoses provide. Thus this study aimed to investigate and compare the range of motion [ROM] achieved from four common commercial orthoses in normal subjects. Forty students from Rehabilitation faculty of Shahid Beheshti University of Medical sciences [22 females and 18 males] aged 19-25 years, with normal range of motion, and no history of injury or pain in the right wrist participated in this study. The ROM of the right wrist was measured by electrogoniometer. Then different commercial orthoses [Teknotan, Teb o sanat, LP and OPPO] were worn in random order. Then the subjects were asked to move their wrist in flexion and extension direction as much as possible. Each movement was repeated for three times. Sixty seconds rest time was applied between each successive orthosis. Data analysis performed using repeated-measure ANOVA test. Data analysis showed that the mean range of flexion [p=0.001] and extension [p<0.001] were significantly different among four orthoses. Bonferroni test showed that OPPO orthosis [40 +/- 10] permitted significantly less flexion in comparison with Teb o sanat and Tecnotan [p=0.003 and p=0.02, respectively]. Teb o Sanat orthosis [52 +/- 10] permitted significantly less extension in comparison with LP and Tecnotan [p=0.001 and p=0.006, respectively]. The results showed that none of these commercial orthosis immobilized the wrist. Therefore, specifications of the orthosis and the fitting of the orthosis with hand should be considered by the prescribers

Aplicação da Movimentação Passiva Contínua (CPM) na reabilitação do cotovelo: uma revisão da literatura / Aplicación de Movimiento Pasivo Continuo (CPM - MPC) en la rehabilitación del codo: una revisión de la literatura / Application of Continuous Passive Motion (CPM) in elbow rehabilitation: a literature survey

A Movimentação Passiva Contínua (CPM) é utilizada na reabilitação após trauma ou cirurgia articular, e sua aplicação pode gerar resultados positivos na reabilitação dos membros. Este estudo teve como objetivo analisar e discutir a utilização de equipamentos de CPM na reabilitação do cotovelo a partir de uma revisão bibliográfica de estudos publicados nos últimos 10 anos. Esta pesquisa bibliográfica foi realizada em banco de dados informatizado da Biblioteca Virtual em Saúde, EBSCO HOST, PeDRO, Biblioteca Cochrane e Science Direct. Para localizar os estudos, foram utilizadas palavras-chave: movimento passivo contínuo, cotovelo e CPM cotovelo, em Português e Inglês. Foram selecionados artigos completos em português, inglês e espanhol. A estratégia de pesquisa estava focalizada em estudos do tratamento de patologias do cotovelo utilizando a CPM como método isolado ou associado a outras técnicas fisioterapêuticas. A amostra foi composta de 16 publicações de periódicos. Em 11 dos artigos, a aplicação da CPM associada ou não a outros métodos fisioterapêuticos gerou resultados benéficos; um não apresentou diferença quando comparada a utilização ou não da CPM; dois demonstraram resultados positivos, ressaltando cuidados específicos; e dois afirmam ser necessário mais estudos para comprovação de resultados. Portanto, foi possível evidenciar que pesquisas estão explorando a utilização da CPM na reabilitação do cotovelo, porém os parâmetros utilizados e os modos de aplicação do equipamento não estão bem especificados. Além disso, foi possível perceber que a CPM está sendo utilizada como adjuvante aos métodos de reabilitação fisioterápica e prevalecemos resultados positivos.

Continuous Passive Motion (CPM) is used in post-trauma or articulations surgery rehabilitation to articulate, and its application may produce positive results in members` rehabilitation. This study aimed to analyze and to discuss the use of CPM equipment in elbow rehabilitation through a bibliographical survey of studies published in the last 10 years. This bibliographical survey was done in a computerized databank of Virtual Library in Health, EBSCO HOST, PeDRO, Cochrane Library and Science Direct. For locating studies, we used the keywords continuous passive movement, elbow and elbow MPC/CPM in English, Portuguese and Spanish. Complete articles in Portuguese, English and Spanish were selected. The research strategy focused on studies of the treatment of elbow pathologies using CPM as an isolated method and associated to other physiotherapeutic techniques. The sample was composed by 16 newspaper articles. In 11 articles, CPM application associated or not to other physiotherapeutic methods, has produced beneficial results; 1 did not present differences in the comparison between the use of (CPM) and the use of other techniques; 2 presented positive results, emphasizing specific cares, and 2 called for more studies for result verification. Therefore, it was possible to shoe that researchs are now exploring the use of CPM in elbow rehabilitation, but parameters used and application methods are not well explained. In addition, it was possible to perceive that today CPM is used as an adjuvant method of physiotherapeutic rehabilitation, with the prevalence of positive results.

El Movimiento Pasivo Continuo (MPC) es utilizado en la rehabilitación post-trauma o cirugía articular y su aplicación puede generar resultados positivos en la rehabilitación de los miembros. Este estudio tuvo como objetivo analizar y discutir la utilización de equipamientos de MPC en la rehabilitación del codo a través de una revisión bibliográfica de estudios publicados en los últimos 10 años. Esta investigación bibliográfica fue realizada en un banco de datos informatizado de la Biblioteca Virtual en Salud, EBSCO HOST, PeDRO, Biblioteca Cochrane y Science Direct. Para localizar los estudios, fueron utilizadas las palabras-llave movimiento pasivo continuo, codo y CPM codo en Portugués y Inglés. Se seleccionaran artículos completos en portugués, inglés y español. La estrategia de investigación focalizó estudios del tratamiento de patologías del codo que utilizaban el CPM como método aislado o asociado a otras técnicas fisioterapéuticas. La muestra se compuso de 16 artículos de periódicos. En 11 de los artículos, la aplicación del CPM, asociada o no a otros métodos fisioterapéuticos, ha producido resultados benéficos; 1 no presentó diferencia en la comparación entre la utilización o no del CPM; 2 han demostrado resultados positivos, resaltando cuidados específicos, y 2 afirman se necesitar de más estudios para la comprobación de resultados. Por consiguiente, fue posible evidenciar que investigaciones exploran en la actualidad la utilización de la CPM en la rehabilitación del codo, mas los parámetros utilizados y los modos de aplicación del equipamiento non están bien especificados. Además, fue posible percibir que la CPM es hoy utilizado como adyuvante de los métodos de rehabilitación fisioterápica, prevaleciendo los resultados positivos.

Avaliação da funcionalidade da criança com paralisia cerebral espástica / Functionality evaluation of children with spastic cerebral palsy

A paralisia cerebral é resultante de uma lesão não progressiva sobre o sistema nervoso central em desenvolvimento e que pode levar a disfunções motoras, distúrbios no movimento, deficiências mentais e alterações funcionais. A espasticidade é a anormalidade motora e postural mais comumente vista na paralisia cerebral. Considerando as múltiplas repercussões da espasticidade sobre a funcionalidade do indivíduo com paralisia cerebral, torna-se claro que uma avaliação do quadro clínico deve ser precisa e direcionar-se aos aspectos específicos que exigem intervenção. Este texto tem como objetivo servir de guia aos médicos ou terapeutas na escolha de instrumentos de medição quantitativa e qualitativa.

Cerebral palsy is the result of a non-progressive lesion on the developing central nervous system and can lead to motor dysfunction, movement disorders, mental and functional changes. Spasticity is a motor and postural abnormality most commonly seen in cerebral palsy. Considering the multiple spasticity effects on the functionality of the individual with cerebral palsy, it becomes clear that a clinical evaluation must be precise and direct itself to the specific aspects that require intervention. This text is intended as a guide to the doctors or therapists in choosing the quantitative and qualitative measurements.

Clinical observation of the treatment of cervical vertebral instability with kinesitherapy / 中国骨伤

<p><b>OBJECTIVE</b>To ovserved the treatment of cervical vertebral instability with kinesitherapy combined with occipitomandibular traction.</p><p><b>METHODS</b>From April 2005 to December 2008, 400 patients with cervical vertebral instability including 220 males and 180 females with an average age of 48.4 years old ranging from 34 to 72 years, were treated by the kinesitherapy combined with occipito-mandibular traction, contradict and amend muscle training 2 min everytime, 8 time a day. All patients were followed-up for 6 months (three treatment periods), the clinical symptom improvement, changes of clinical signs scoring and imaging were observed.</p><p><b>RESULTS</b>After three treatment periods, the outcome were evaluated and the results were excellent in 210 cases, good in 126, accepted in 53, inefficacy in 11, the total effective rate was 97.3%. The total scores were (22.42 +/- 3.25) before the treatments and (9.03 +/- 1.92) after the treatments. The level replacement of intervertebral were (3.70 +/- 0.12) mm before the treatments and (2.96 +/- 0.09) mm after the treatments; The rotation angle was (12.64 +/- 0.21) degrees before the treatments and (8.90 +/- 0.17) degrees after the treatments.</p><p><b>CONCLUSION</b>The kinesitherapy was a simple method with good effect to cure patients with cervical vertebral instability.</p>

The treatment action campaign and the three dimensions of lawyering: Reflections from the rainbow nation

The spread and perpetuation of the HIV/AIDS epidemic in South Africa has hindered the country's social and economic growth after apartheid. This paper documents my experiences while working with the Projects Abroad Human Rights Office and specifically my interactions with the Treatment Action Campaign (TAC); an organization which has taken a multidimensional approach in order to educate people about HIV/AIDS and attempt to provide access to medicines for millions of South Africans afflicted with the disease. I discuss how TAC has used both traditional and non-traditional methods of advocacy to combat the epidemic and equate access to health care to a social justice issue by empowering marginalized communities. The paper's dual purpose is to applaud TAC's continuous success in combating HIV/AIDS with such a multidimensional approach and illustrate how other organizations can utilize such an approach in order to affect social change. To illustrate TAC's approach; I utilize Lucie White's three dimensions of lawyering and equate TAC to a single cause lawyer; signifying that White's characterization of multi-dimensional activism is not limited to individuals; but can rather be applied at the firm level. White's three dimensions include: (a) advocacy through litigation; (b) advocacy in stimulating progressive change; and (c) advocacy as a pedagogic process. From this analysis; I conclude that TAC's multi-dimensional approach and specifically its inherent practice of White's three dimensions has been the root of its success in educating millions about the virus and advocating for access to medicines for those who have contracted HIV. TAC's innovative advocacy has also mobilized a new generation of South African activists who have helped TAC grow into a vibrant and integral organization within the country's post-apartheid culture. Such an example can serve as a framework for future organizations who wish to tackle other challenges that face the country

Exercício físico versus programa de exercício pela eletroestimulação com aparelhos de uso doméstico / Physical exercise versus exercise program using electrical stimulation devices for home use

OBJETIVO: Avaliar os efeitos da eletroestimulação por aparelhos de uso doméstico sobre o condicionamento neuromuscular. MÉTODOS: A amostra foi composta por 20 mulheres voluntárias, sedentárias, destras, com idades entre 18 a 25 anos em Maceió, estado de Alagoas, em 2006. As mulheres foram divididas aleatoriamente em dois grupos: as do grupo A foram submetidas a eletroestimulação passiva com aparelhos comerciais e as do grupo B, a exercício físico com resistência. O programa de treinamento dos grupos totalizou 16 sessões em dois meses, com duas sessões semanais. As comparações do peso corporal, da cirtometria, fleximetria, e da força muscular antes e após os exercícios, foram utilizadas utilizando-se o teste T pareado. Nas comparações entre os grupos A e B, foi utilizado o teste t de Student. O nível de significância adotado foi de 5 por cento. RESULTADOS: A comparação da força muscular medida de forma subjetiva antes e após cada um dos procedimentos, mostrou que ocorreu aumento da força em ambos os grupos. Foram observados aumentos significantes na massa e na força muscular apenas nos indivíduos que realizaram exercício voluntário. O exercício físico resistido de flexo-extensão dos joelhos foi efetivo em aumentar massa e força muscular, ao contrário das sessões de eletroestimulação com correntes de freqüência de pulsos de 87 Hz, que não tiveram o mesmo efeito. CONCLUSÕES: Os resultados encontrados mostraram que os aparelhos de eletroestimulação para ganho passivo de condicionamento físico comercializados são menos eficientes do que a prática de exercício físico voluntário.

OBJECTIVE: To evaluate the effects of electrical muscle stimulation with devices for home use on neuromuscular conditioning. METHODS: The study sample comprised 20 sedentary, right-handed, voluntary women aged from 18 to 25 years in the city of Maceió, Northeastern Brazil, in 2006. Subjects were randomly divided into two groups: group A included women who underwent muscle stimulation using commercial electrical devices; group B included those women who performed physical activities with loads. The training program for both groups consisted of two weekly sessions for two months, in a total of 16 sessions. Comparisons of body weight, cirtometry, fleximetry, and muscle strength before and after exercise were determined using the paired t-test. For the comparisons between both groups, Student's t-test was used and a 5 percent significance level was adopted. RESULTS: Muscle strength subjectively assessed before and after each intervention was increased in both groups. Significant increases in muscle mass and strength were seen only in those subjects who performed voluntary physical activity. Resisted knee flexion and extension exercises effectively increased muscle mass and strength when compared to electrical stimulation at 87 Hz which did not produce a similar effect. CONCLUSIONS: The study results showed that electrical stimulation devices for passive physical exercising commercially available are less effective than voluntary physical exercise.

The effects of continuous passive motion on tendon-bone healing of the tendon autograft used for anterior cruciate ligament reconstruction in a rabbit model / 中华外科杂志

<p><b>OBJECTIVE</b>To study the effects of continuous passive motion on the tendon-bone healing of the semi-tendinous tendon autograft used for anterior cruciate ligament (ACL) reconstruction in rabbits.</p><p><b>METHODS</b>In 12 healthy 8-month-old male rabbits, an ACL reconstruction was performed by using double semi-tendinous tendon autograft. Postoperatively these animals were treated by either continuous passive motion (CPM) or cage activity. Specimens of the grafts were collected at 6, 12, 24 weeks postoperatively. Histological change in the tendon-bone healing was studied by haematoxylin-eosin and toluidine blue.</p><p><b>RESULTS</b>There was more new fiber tissue in the anterior half of the interface. Osteoclasts were most numerous at the tunnel aperture and in the anterior half of the interface. Cartilage in the tendon-bone interface was localized to the posterior aspect of tunnels, the area where compressive stress would be predicted. CPM group developed a denser connective tissue with less vascularity and cellularity. The bone tunnel had more areas with ingrowing denser connective tissue compared with cage activity specimens. With the growth of Sharpery's fibers and fibrocartilage into the interface, a direct ligament insertion was found. In the CPM specimens, the interface tissue was more mature and the direct insertion was broader and more structured.</p><p><b>CONCLUSIONS</b>Compressive stress promotes chondroid formation, and the tension promotes fiber formation. Tendon-bone healing may be optimized by CPM after tendon transplantation into a bone tunnel.</p>

Preliminary report of surgical treatment of post-traumatic stiff elbow / 中华外科杂志

<p><b>OBJECTIVE</b>To report the method and result of open arthrolysis of patients who suffered from severe post-traumatic elbow stiffness.</p><p><b>METHODS</b>Of the 12 patients, there were 9 male and 3 female, average age of 32 years old (16 - 47 years). Primary injury included 7 simple fractures, 1 simple dislocation, 2 fracture dislocations and 2 soft tissue injury. The averaged time of immobilization after injury was 3.3 weeks (0 - 8 weeks). The averaged time between injury and open arthrolysis was 6.4 months (1 - 14 months). Before open arthrolysis, the mean arc of total motion was 33.8 degrees (0 degrees - 80 degrees ). Three patients suffered from forearm rotation deficiency. Posterior approach was used for 4 patients, medial approach for 2 patients and both medial and lateral approach for 6 patients. tissues were resected, which hindered the motion of the elbow and perform proximal radioulnar joint arthrolysis for some patients. After arthrolysis, the arc of elbow motion could reach 0 degrees - 140 degrees , and for the patients who suffered from forearm rotation deficiency, pronation 80 degrees and supination 90 degrees were gotten. Ulnar nerve transposition was not a routine. The patients began active and active-assisted elbow and forearm movement the first day after operation. Indomethacin was taken the first day after open arthrolysis routinely.</p><p><b>RESULTS</b>Twelve patients were followed up for 14 - 18 months (averaged 15.8 months). At the latest follow-up, the mean arc of total motion was 120.8 degrees (100 degrees - 140 degrees ). Nine patients recovered the functional arc of 30 degrees - 130 degrees , and 10 patients extended to less than 10 degrees , and 4 patients could extend to 0 degrees . As for the 3 patients who suffered forearm rotation deficiency, the forearm rotation improved. The mean Mayo elbow performance score was 70.4 (50 - 90) before open arthrolysis, and 98.8 (85 - 100) after open arthrolysis. No patient was found to have signs of heterotopic ossification.</p><p><b>CONCLUSIONS</b>For the treatment of post-traumatic stiff elbow, with careful open arthrolysis and early active and active-assisted exercise we can get good results.</p>

Tratamento fisioterapêutico de um paciente com lesão obstétrica de plexo braquial / Physical therapy in patient with obstetric lesion of the brachial plexus

O objetivo deste estudo foi demonstrar o caso clínico de um paciente com paralisia de Erb em membro superior esquerdo (MSE), decorrente de lesão obstétrica do plexo braquial. Demonstra-se o caso de um paciente de 1 ano e 8 meses, acompanhado durante seis atendimentos onde se verificou o efeito das condutas aplicadas. O paciente apresentava hipotonia em MSE, diminuição da amplitude de movimento (ADM) ativa de flexão e abdução de ombro esquerdo, ausência de supinação ativa de antebraço e extensão de ombro esquerdo. As condutas foram apresentadas de forma lúdica, para que a criança participasse ativamente do tratamento. Após o término das sessões pode-se observar que houve aceitação das condutas pelo paciente, que passou a colaborar mais nas atividades solicitadas. Ocorreu, também, o incremento no uso do MSE, nas AVD, bem como, durante as sessões de fisioterapia.

The objective of the present study is to report the case of a patient with Erb paralysis in the left arm, due to an injury to the brachial plexus caused by an obstetric lesion. The patient was 1 year and 8 months old and was observed during six therapy sessions, where were observed the effects of the treatment. The patient showed symptoms like: hypotenia in the left arm; reduction in active amplitude of movements in the left shoulder in flexion and abduction; absence of active supination in the forearm and extension in the left shoulder. In order to make easier for the patient to have an active participation, the treatment was presented in a ludic form. After the end of the sessions, was observed that the procedure was accepted by the patient who collaborated with the activities. There was an increase of movements in the left arm in daily activities and during the sessions of physiotherapy.