Electromyographic analysis of pelvic floor muscles during the execution of pelvic patterns of proprioceptive neuromuscular facilitation-concept: An observational study.

OBJECTIVE: To assess the effect of pelvic patterns of proprioceptive neuromuscular facilitation (PNF-concept) on pelvic floor muscles (PFM) recruitment, as well as the electromyographic activity of muscles synergic to the pelvic floor in healthy women. METHODS: Observational study conducted with 31 women aged between 18 and 35 years, with mean age of 23.3 ± 3.2 (22.1-24.4). PFM activity was monitored by surface electromyography during the combination of isotonics technique of four pelvic patterns of PNF-concept (i.e., anterior elevation, posterior depression, anterior depression, and posterior elevation). The electromyographic signal was analyzed using root mean square amplitude. Two-way repeated measures analysis of variance was performed to analyze differences in PFM activity between types of contraction (i.e., concentric, isometric, and eccentric) and the four pelvic patterns. RESULTS: PFM activity did not differ among the four pelvic pattens. However, PFM activity was significantly different between the combination of isotonics technique and baseline, F(1.6, 48.2) = 71.5; p < 0.000, with a large effect size (partial ƞ² = 0.705). Concentric (22.4 µV ± 1.1), isometric (17.3 µV ± 0.6), and eccentric (15 µV ± 0.5) contractions of combination of isotonics technique increased PFM activity compared with baseline (10.8 µV ± 0.4) in all pelvic patterns. By analyzing the electromyographic activity of the muscles synergistic to the pelvic floor, there is effect of the interaction of the type of contraction, the pelvic pattern of the PNF concept, and the synergistic muscles on the myoelectric activity of the external anal sphincter, F(3.2, 96.5) = 5.6; p < 0.000, with a large magnitude of effect (partial ƞ² = 0.15). In the anterior elevation pattern, the muscles synergistic to the pelvic floor present synergy in phase with the PFM, and in the posterior patterns there was a decrease in the activity level of all synergistic muscles, without changing the activity level of the PFM. CONCLUSION: PFM activity did not differ among the four pelvic patterns of PNF-concept. Nonetheless, the combination of isotonics technique showed a significant effect on PFM compared with baseline, with greater PFM activity during concentric contraction. Pelvic patterns of PNF-concept may be used to increase PFM recruitment in young healthy women.

Proprioceptive neuromuscular facilitation training reduces pain and disability in individuals with chronic low back pain: A systematic review and meta-analysis.

BACKGROUND: and purpose: Although proprioceptive neuromuscular facilitation (PNF) exercises are used in rehabilitation practice, their effects in patients with low back pain (LBP) remain unclear. This study aimed to investigate the efficacy of PNF training for pain and disability in patients with LBP. METHODS: In this systematic review, we searched five databases from the earliest date available to October 2020. Three comparisons were performed: PNF versus control, PNF versus core strengthening, and PNF versus conventional physical therapy. RESULTS: Sixteen studies met the eligibility criteria (722 patients). PNF training improved pain (standardized mean difference [SMD]: -2.6; 95% confidence interval [CI]: -4.2 to -0.9, n = 174) and disability (SMD: -3.29; 95% CI: -5.3 to -1.3, n = 144) compared to the control. PNF training also yielded a greater benefit for pain reduction (mean difference [MD]: -1.8, 95% CI: -2.2 to -0.3, n = 177) and disability improvement (MD: -6.6, 95% CI: -9.3 to -3.8, n = 113) than did core strengthening. CONCLUSION: PNF training seems to be a useful strategy for decreasing pain and improving disability in patients with LBP. However, the quality of evidence for the outcomes of both pain and disability was low to moderate.

Kinematic Changes in the Uninjured Limb After a Traumatic Brachial Plexus Injury.

Background: Traumatic brachial plexus injury (TBPI) typically causes sensory, motor and autonomic deficits of the affected upper limb. Recent studies have suggested that a unilateral TBPI can also affect the cortical representations associated to the uninjured limb. Objective: To investigate the kinematic features of the uninjured upper limb in participants with TBPI. Methods: Eleven participants with unilateral TBPI and twelve healthy controls matched in gender, age and anthropometric characteristics were recruited. Kinematic parameters collected from the index finger marker were measured while participants performed a free-endpoint whole-body reaching task and a cup-to-mouth task with the uninjured upper limb in a standing position. Results: For the whole-body reaching task, lower time to peak velocity (p = 0.01), lower peak of velocity (p = 0.003), greater movement duration (p = 0.04) and shorter trajectory length (p = 0.01) were observed in the TBPI group compared to the control group. For the cup-to-mouth task, only a lower time to peak velocity was found for the TBPI group compared to the control group (p = 0.02). Interestingly, no differences between groups were observed for the finger endpoint height parameter in either of the tasks. Taken together, these results suggest that TBPI leads to a higher cost for motor planning when it comes to movements of the uninjured limb as compared to healthy participants. This cost is even higher in a task with a greater postural balance challenge. Conclusion: This study expands the current knowledge on bilateral sensorimotor alterations after unilateral TBPI and should guide rehabilitation after a peripheral injury.

Proprioceptive neuromuscular facilitation compared to conventional physiotherapy for adults with traumatic upper brachial plexus injury: A protocol for a randomized clinical trial.

BACKGROUND: Traumatic upper plexus injury affects daily living activities performance and participation of individuals. Physical therapy treatment has a fundamental role on functional recovery, but it is still an unexplored and challenging field. AIM: To develop a protocol to evaluate the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) compared to conventional physiotherapy (CPT group) on functionality and quality of life. METHODS: A committee was formed by four physical therapists to develop the treatment protocol. A Delphi study was carried out in order to quantify the level of agreement. A protocol for a randomized controlled trial was proposed to evaluate the effectiveness of the protocol in improving functionality and quality of life, according Consolidated Standards of Reporting Trials. Participants will be randomly assigned (1:1) to PNF or CPT group and two weekly sessions will be carried out for 12 months postsurgery, with a three-month follow-up. The main outcome measurements are: upper limb functionality, quality of life, range of motion, muscle strength, tactile sensitivity, and pain, which will be assessed at baseline, on the 6th, 9th, and 12th months postsurgery. RESULT: A PNF protocol was developed for traumatic upper brachial plexus injury, consisting of 11 illustrated exercises, three for immediate postoperative and eight for postoperative. Biomechanical objectives, observations, positions of patients and therapists and PNF principles, procedures and techniques have been described. An 80% agreement on all items in the first round of the Delphi study was achieved. CONCLUSION: A protocol based on the PNF-concept was developed with the aim of improving the functionality and quality of life of individuals undergoing nerve transfer after traumatic injury to the upper plexus. The detailed description of a physical therapy treatment protocol through an appropriate method will allow its use in clinical practice and in future studies with this population.

Contract-relax technique compared to static stretching in treating migraine in women: A randomized pilot trial.

INTRODUCTION: Physical therapy is often used by patients with headache, including modalities such as muscle stretching exercises. OBJECTIVES: To evaluate the feasibility of a pilot trial aimed at determining the efficacy of the proprioceptive neuromuscular facilitation (PNF) contract-relax technique compared to static stretching for treating migraineurs. METHODS: This pilot trial allocated 30 migraineur women (23 ±â€¯4 years) into PNF (n = 15) and static stretching groups (n = 15). The interventions were performed twice a week (16 sessions, 8 weeks). The feasibility outcomes included successful random allocation of 30 patients during a 12-month period, the proportion of eligible patients randomly assigned to each group, and the proportion of those who completed the 30-day follow-up. The outcomes of headache characteristics; medication intake; severity of migraine-related disability; neck disability; cervical mobility; pressure pain threshold; adverse effects and global perception of change were evaluated at baseline, after the end of treatment and after 30-day follow-up. RESULTS: The recruitment rate was 4.66% participants/month. The proportion of eligible patients randomly assigned to each group and for those who completed the 30-day follow-up was 88.23% and 100%, respectively. Both groups improved in headache-related outcomes. The perception of change was important for 67% of the PNF group and 47% of the static stretching group. No differences were found between groups regarding the studied outcomes. CONCLUSION: This is a feasible pilot trial. The PNF contract-relax technique was no more effective than static stretching for treating migraine, but both techniques improved the headache, the severity of migraine-related disability and the satisfaction after treatment.

Addition of proprioceptive neuromuscular facilitation to cardiorespiratory training in patients poststroke: study protocol for a randomized controlled trial.

BACKGROUND: Individuals affected by stroke present with changes in cardiovascular and respiratory functions. Cardiorespiratory training (CRT) is one of the classic intervention guidelines for cardiorespiratory fitness. CRT in association with the proprioceptive neuromuscular facilitation (PNF) technique for respiratory muscles could improve the quality of life, cardiorespiratory function and gait parameters of patients after stroke. OBJECTIVE: To assess the effects of respiratory and trunk patterns of CRT associated with PNF on the quality of life, gait, oxygen consumption, respiratory muscle strength and thoracic volumes. METHODS/DESIGN: A blind, randomized clinical trial with allocation confidentiality will be performed. Forty patients will be randomized into four groups: CRT-lower limb (LL) plus PNF; CRT-LL and respiration; CRT-upper limb (UL) plus PNF; or CRT-UL and respiration. Individuals will be evaluated at three different times (pretreatment, after 20 days of treatment and 1 month after the end of treatment). The treatment protocol consists of respiratory exercises, 30 min of CRT (cycle ergometer) and then repetition of the respiratory exercises, performed three times a week over a period of 20 days. Primary outcome measures are quality of life, gait, balance, peak oxygen uptake and rib cage compartment volumes. As secondary outcomes, respiratory function and maximal inspiratory and expiratory pressures will be measured. DISCUSSION: The association of PNF with CRT may be a viable and accessible alternative to increase cardiorespiratory function in patients with stroke. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03171012. Registered on 6 June 2017.

Electromyographic Biofeedback in Motor Function Recovery After Peripheral Nerve Injury: An Integrative Review of the Literature.

Electromyographic biofeedback (EMG-BF) has been applied to treat different types of peripheral nerve injuries (PNI). However, despite the clinical practice widespread use its evidence is controversial. With the objective of summarize the available evidence on the electromyographic biofeedback effectiveness and efficacy to help motor function recovery after PNI an integrative review was performed. A secondary objective was to identify the conceptual framework and strategies of EMG-BF intervention, and the quality of technical description of EMG-BF procedures. To conduct this integrative review a systematic search of the literature was performed between October 2013 and July 2018, in PUBMED, ISI and COCHRANE databases for EMG-BF original studies in PNI patients of any etiology, in English, Portuguese, Spanish or French, published after 1990. Exclusion criteria were poor description of EMG-BF treatment, associated treatment that could impair EMG-BF effect, inclusion of non-PNI individuals and case studies design. The PEDro scale was used to evaluate study quality of randomized clinical trials (RCTs) included. This resulted in 71 potential articles enrolled to full reading, although only nine matched the inclusion criteria. PNI included facial paralysis, acute sciatic inflammation and carpal tunnel syndrome. The average quality score of the included RCTs was five, corresponding to low methodological quality. Due to the small number of included articles, low quality studies and heterogeneity of interventions, outcomes and population we concluded that there is limited evidence of EMG-BF effectiveness and efficacy for motor function recovery in PNI patients.

Validação de um instrumento de avaliação da funcionalidade para indivíduos com lesão traumática do plexo braquial ­ perspectiva dos pacientes / Validation of a functioning evaluation instrument for individuals with traumatic brachial plexus injury - patients' perspective

Introdução: Dentre as Lesões do Plexo Braquial (LPB), 80% a 90% são resultantes de traumas auto/motociclísticos. As Lesões Traumáticas do Plexo Braquial (LTPB) são uma condição altamente incapacitante, com prevalência em homens entre 21 e 40 anos, que em sua maioria, são moradores de região urbana e trabalhadores braçais. Objetivo: O estudo visa realizar uma das três etapas necessárias para a validação de um instrumento de avaliação da funcionalidade, baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), para indivíduos com LTPB. Métodos: Trata-se de um estudo qualitativo com grupo focal, composto por 5 (cinco) indivíduos adultos com LTPB. Resultados: Das cinquenta e seis categorias da CIF presentes no instrumento a ser validado, trinta e uma foram relatadas pelos indivíduos que participaram do grupo focal. Uma categoria referente ao componente de atividade e participação foi citada pelos participantes e não havia sido contemplada pelo instrumento. Em relação às categorias da CIF de fatores ambientais, apenas duas categorias citadas pelos participantes do grupo não estão presentes no instrumento de avaliação. Conclusão: A maioria das categorias da CIF presentes no instrumento de avaliação a ser validado pôde ser confirmada a partir da perspectiva de indivíduos com LTPB participantes do grupo focal. (AU)

Among brachial plexus injuries (BPI), 80% to 90% are result of automovel or motorcycle traumas. Traumatic brachial plexus injuries (TBPI) are a highly incapacitating condition. The most prevalent are in men between the ages of 21 and 40, where the majority are urban residents and manual workers. Objective: The aim of this study is the validation of a functional evaluation tool based on International Classification of Functioning, Disability and Health (ICF) for individuals with TBPI. Methodology: This is a qualitative study with a focal group, composed of 5 (five) adult individuals with TBPI. Results: Of the fifty-six ICF categories present in the instrument to be validated, thirty-one were reported by individuals who participated in focal group. Only one category referring to the activity and participation component was mentioned by the participants and had not been contemplated by the instrument. Regarding the ICF categories of environmental factors, only two categories cited by group participants are not present in the assessment. Conclusion: Most of the ICF categories present in the assessment instrument to be validated could be confirmed from the perspective of individuals with TBPI participants in the focus group. (AU)

A Neglected Cause of Iatrogenic Brachial Plexus Injuries in Psychiatric Patients.

BACKGROUND: Psychiatric patients are often kept immobilized during hospitalization to avoid self-inflicted injuries and danger to third parties. Inadequate positioning can lead to brachial plexus injuries (BPI). OBJECTIVE: To present a series of 5 psychiatric patients with BPI after being left sedated and restrained for prolonged periods of time during hospitalization. METHODS: We retrospectively reviewed the charts of 5 psychiatric patients with iatrogenic BPI referred by other institutions to our service. The restraint technique adopted by those institutions consisted of a high-thoracic restraint. All patients underwent complete clinical and neurological examination at our center. Information concerning patient demographics, BPI characteristics, treatment choice, and ultimate outcome was recorded. RESULTS: Three patients were male. The age of our patients ranged from 25 to 61 years old (mean: 41.2; median: 43). Three patients had a diagnosis of bipolar disorder while 2 had schizophrenia. Duration of immobilization ranged from 5 to 168 h (mean: 77.8; median: 72). Four patients presented with a unilateral right-sided lesion. Time to presentation ranged from 1 to 9 mo (mean: 4.2; median: 4). All patients also had intense pain and axillary lesions. Four patients received conservative treatment with partial or full functional recovery and complete pain resolution. The remaining patients underwent surgical repair and experienced good functional outcome. CONCLUSION: Psychiatric patients who need to be sedated and immobilized must be monitored closely, as BPI can occur from high-thoracic restraints. When such an injury occurs, the patient must be referred to a center specialized in peripheral nerve surgery and rehabilitation.

Efeitos da irradiação de força contralateral na extensão de punho de pacientes após acidente vascular cerebral / Efects of contralateral force irradiation in the wrist extention, in patients after stroke

FUNDAMENTO: Um dos princípios de irradiação de força da facilitação neuromuscular proprioceptiva (FNP) é estimular a musculatura fraca, a partir da resistência da musculatura forte, contribuindo para o aprendizado motor. Por esta razão, este procedimento básico tem sido utilizado em pacientes após acidente vascular cerebral (AVC), no tratamento da hemiparesia contralateral à lesão. OBJETIVO: Avaliar os efeitos da técnica de irradiação de força contralateral no controle motor para ativação dos músculos extensores de punho em pacientes após AVC. MÉTODOS: Foram incluídos 10 participantes de ambos os sexos (62±6,4 anos), divididos em grupo hemiparético (n=5) e controle saudável (n+5). Foi realizado o padrão da FNP: flexão, abdução e rotação externa no membro não afetado do grupo hemiparético e no braço direito do controle. O sinal eletromiográfico dos músculos extensores radial longo e curto do carpo foi registrado em duas etapas (FNP1 e FNP2). Foram realizadas quatro repetições do padrão, mantidas por 6 segundos. A ativação muscular foi analisada pela root mean square (RMS). RESULTADOS: Houve aumento na ativação da musculatura extensora do punho por irradiação entre as etapas FNP1 e FNP2 de 7,32% no grupo hemiparético e de 18,62% no grupo saudável, porém sem diferença estatística (p>0,05). A resposta motora foi maior na etapa FNP2, após a repetição das diagonais. CONCLUSÃO: Não houve ativação significativa dos extensores de punho em pacientes hemiparéticos com o procedimento de irradiação de força da FNP. Todavia, a repetição parece aumentar a resposta de irradiação de força em pacientes após AVC.

BACKGROUND: A principle of force irradiation of proprioceptive neu-romuscular facilitation (PNF) is to stimulate the weak muscles by applying resistance in strong muscles, contributing to motor learning. Therefore, this technique is used in patients after stroke, to treat the hemiplegia contralateral to the lesion. OBJECTIVE: To evaluate controlateral force irradiation effects in motor control for activation of the wrist extensors in patients after ischemic stroke. METHODS: The study included 10 subjects of both sexes (62±6.4 years) divided into hemiparetic group (n=5) and healthy controls (n=5). We performed the PNF pattern: flexion, abduction and external rotation in the unaffected member of the hemiparetic group and in the right arm of the control. The electromyography signal of the long and short radial extensor carpi was recorded in the first stage (FNP1) , in which the diagonal was repeated 4 times, and in the standard learning stage (FNP2), with 4 times. The contractions were maintained for 6 seconds. Muscle activation was analyzed by the root mean square (RMS). RESULTS: The-re was an increase in the extensor muscles of the wrist activation by irradiation between FNP1 and FNP2 stages, of 7.32% in hemiparetic group and 18.62% in healthy group, without statiscal difference (p>0.05). Motor response was higher in FNP2 stage, after the repetition of the diagonals. CONCLUSION: There was no significant activation of the wrist extensors in hemiparetic patients with the technique of force irradiation of PNF. However, the repetition seems to increase the force irradiation response in patients after stroke.

Perfil dos indivíduos com doença de Parkinson atendidos no setor de fisioterapia de um hospital universitário no Rio de Janeiro / Profile of individuals with Parkinson's disease cared in a physical therapy sector of an university hospital in Rio de Janeiro

Na doença de Parkinson (DP), uma desordem neurológica complexa, ocorre depleção de dopamina por degeneração dos neurônios da substância negra, ocasionando perdas motoras e cognitivas. Os quatro principais sintomas que acometem indivíduos com DP são o tremor de repouso, a rigidez, a bradicinesia e a instabilidade postural. Essas alterações podem aumentar o risco de quedas e trazer prejuízos para as atividades e participação social dos indivíduos. O objetivo deste estudo é avaliar a funcionalidade, incapacidade e qualidade de vida dos pacientes com DP em atendimento fisioterapêutico em um hospital universitário no Rio de Janeiro. Os pacientes foram avaliados por meio dos seguintes instrumentos: escala de Hoehn e Yahr, questionário sobre a qualidade de vida na doença de Parkinson - PDQ-39 -, Miniexame do Estado Mental, Escala de Equilíbrio de Berg, teste de caminhada de 10 metros, timed up and go test, Dynamic Gait Index, Escala Unificada de Avaliação para a Doença de Parkinson e Escala de Schwab e England. Embora a maior parte dos indivíduos estivesse no estágio 3 de Hoehn e Yahr, a maioria apresentou risco de queda diminuído, bom estado cognitivo e emocional, qualidade de vida moderada e pouca dificuldade para a marcha e realização de atividades de vida diária (AVD). Os dados obtidos com este estudo servirão para a orientação da implementação de medidas fisioterapêuticas voltadas para essa amostra de pacientes, orientações de gestores para uma política de saúde efetiva e orientação de profissionais em busca de atendimento mais eficaz.

In Parkinson's disease (PD), a complex neurologic disorder, occurs dopamine depletion by lesions of the neurons that produce it, causing motor and cognitive impairments. The four main symptoms that affect individuals with PD are resting tremor, rigidity, bradykinesia and postural instability. These changes may increase the risk of falls and bring impairments to their activities and social participation. The aim of this study is to evaluate the functioning, disability and quality of life of PD patients cared in a physical therapy sector of an university hospital in Rio de Janeiro. Patients were assessed through the following instruments: Hoehn & Yahr Scale, quality of life questionnaire in Parkinson's disease - PDQ-39 -, Mini-mental, Berg Balance Scale, walk test of 10 meters, timed up and go test, Dynamic Gait Index, Unified Rating Scale for Parkinson's Disease and Schwab and England Scale. Although most of the individuals were on stage Hoehn & Yahr three, most showed decreased risk of fall, good cognitive and emotional state, a moderate quality of life and little difficulty in walking and performing activities of daily living (ADL). The data obtained here will serve to guide the implementation of physiotherapy measures aimed at this group of patients, managers of guidelines for an effective health policy and for the orientation of professionals in search of a more effective service.

Decreasing fall risk in spinocerebellar ataxia.

[Purpose] Spinocerebellar ataxia consists of a group of autosomal dominant disorders that cause progressive degeneration, mainly in the cerebellum and its connections. Falls, which are a significant concern of this condition, reduce patients' mobility, deteriorate their health and have physical and social consequences. The aim of this study was to test the effectiveness of a modified protocol for improving balance and diminishing the fall risk of spinocerebellar ataxia patients exclusively. [Subjects and Methods] Exercises aiming to improve static and dynamic balance, whole body movements, measures to prevent falls and falling strategies were performed twice per week for four weeks by 11 spinocerebellar ataxia patients. Balance was evaluated using the Berg Balance Scale. [Results] The results show that there was a significant increase in Berg Balance Scale scores after the interventions (Wilcoxon p=0.0034). [Conclusion] This study demonstrated that the modified protocol is effective at reducing the fall risk of spinocerebellar ataxia patients. This protocol may be a useful option for appropriately coping with falls caused by spinocerebellar ataxia.

Validação do Questionário Life Space Assessment - LSA em um grupo de pacientes hemiplégicos / Validation of the Life Space Assessment - LSA Questionnaire in a group of hemiplegic patients

A mobilidade do paciente hemiplégico é uma interação entre a sua habilidade funcional e fatoresexternos. O questionário ?Life Space Assessment? (LSA) é uma ferramenta que avalia essa mobilidadeem 5 níveis. Objetivo: Validar o LSA em uma população de hemiplégicos em tratamentofisioterapêutico em um centro de reabilitação, correlacionando-o com medidas de performancefísica. Método: Instrumentos utilizados na validação concorrente: Teste Timed Up and Go (TUG),Postural Assessment Scale (PASS), Índice de Mobilidade de Rivermead. Estatística: descritiva, Índicede Spearman e Índice de Correlação Intra Classe (ICC). Resultados: Foram avaliados 30 hemiplégicospor sequela de AVE (73% do sexo masculino, idade média 58,6 anos, tempo médiode lesão 1,9 anos). O LSA apresentou correlação significativa (p < 0,01) com a idade, o TUG, oPASS e o Rivermead. Concordância entre examinadores: ICC 0,941 e Intra examinadores 0,981.Conclusão: O LSA se mostrou uma medida válida numa população de hemiplégicos crônicos, comexcelente correlação intra e entre examinadores, tendo se correlacionado significativamente commedidas de função e estrutura corporal e atividades (TUG, PASS e Rivermead).

The mobility of a hemiplegic patient is an interaction between their functional ability and externalfactors. The ?Life Space Assessment? (LSA) questionnaire is a tool that assesses their mobility on5 levels. Objective: To validate the LSA in a population of stroke survivors in physical therapy at arehabilitation center, correlating it with measures of physical performance. Method: Instrumentsused in concurrent validation: Timed Up and Go Test (TUG), Postural Assessment Scale (PASS),Rivermead Mobility Index. Statistics: Descriptive, Spearman Index and Intra Class Correlation(ICC). Results: Thirty hemiplegic patients were assessed (73% male, mean age 58.6 years, meantime since injury 1.9 years). The LSA correlated significantly (p < 0.01) with age, TUG, PASS, andRivermead. Inter-rater agreement: ICC 0.941 Intra-rater agreement 0.981. Conclusion: The LSAwas valid in a population of chronic stroke survivors, with excellent intra and inter-rater correlationmeasures, correlating significantly with measurements of body structure, function, and motoractivities (TUG, PASS, and Rivermead).

Comparison of strength training, aerobic training, and additional physical therapy as supplementary treatments for Parkinson's disease: pilot study.

INTRODUCTION: Physical rehabilitation is commonly used in patients with Parkinson's disease (PD) to improve their health and alleviate the symptoms. OBJECTIVE: We compared the effects of three programs, strength training (ST), aerobic training (AT), and physiotherapy, on motor symptoms, functional capacity, and electroencephalographic (EEG) activity in PD patients. METHODS: Twenty-two patients were recruited and randomized into three groups: AT (70% of maximum heart rate), ST (80% of one repetition maximum), and physiotherapy (in groups). Subjects participated in their respective interventions twice a week for 12 weeks. The assessments included measures of disease symptoms (Unified Parkinson's Disease Rating Scale [UPDRS]), functional capacity (Senior Fitness Test), and EEG before and after 12 weeks of intervention. RESULTS: The PD motor symptoms (UPDRS-III) in the group of patients who performed ST and AT improved by 27.5% (effect size [ES]=1.25, confidence interval [CI]=-0.11, 2.25) and 35% (ES=1.34, CI=-0.16, 2.58), respectively, in contrast to the physiotherapy group, which showed a 2.9% improvement (ES=0.07, CI=-0.85, 0.99). Furthermore, the functional capacity of all three groups improved after the intervention. The mean frequency of the EEG analysis mainly showed the effect of the interventions on the groups (F=11.50, P=0.0001). CONCLUSION: ST and AT in patients with PD are associated with improved outcomes in disease symptoms and functional capacity.

Muscle strength and executive function as complementary parameters for the assessment of impairment in Parkinson's disease.

OBJECTIVE: To evaluate the relationship between the quantitative results of functional and cognitive performance of patients with Parkinson's disease (PD) and disease severity; and to study the relationship between patients' functional and cognitive capacity and motor impairment (Unified Parkinson's Disease Rating Scale - UPDRS III). METHOD: Twenty-nine subjects clinically diagnosed with PD were classified into three groups according to disease severity using the modified Hoehn and Yahr Scale (H&Y). They were submitted to functional (Senior Fitness Test) and neuropsychological tests. Stepwise regression analysis showed a significant association between H&Y and upper limb strength (r² =0.30; p=0.005) and executive function (r² =0.37; p=0.004). In relation to UPDRS III, there was a significant association between lower limb strength (r² =0.27; p=0.010) and global cognitive status (r² =0.24; p=0.024). CONCLUSION: The implementation of simple tests of functional capacity associated with neuropsychological testing can help to assess disease severity and motor impairment, and can be used to monitor the response to treatment in PD.

Muscle strength and executive function as complementary parameters for the assessment of impairment in Parkinson's disease / Forca muscular e funcao executiva como parametros complementares para a avaliacao do comprometimento da doenca de Parkinson

Objective To evaluate the relationship between the quantitative results of functional and cognitive performance of patients with Parkinson's disease (PD) and disease severity; and to study the relationship between patients' functional and cognitive capacity and motor impairment (Unified Parkinson's Disease Rating Scale - UPDRS III). Method Twenty-nine subjects clinically diagnosed with PD were classified into three groups according to disease severity using the modified Hoehn and Yahr Scale (H&Y). They were submitted to functional (Senior Fitness Test) and neuropsychological tests. Stepwise regression analysis showed a significant association between H&Y and upper limb strength (r 2 =0.30; p=0.005) and executive function (r 2 =0.37; p=0.004). In relation to UPDRS III, there was a significant association between lower limb strength (r 2 =0.27; p=0.010) and global cognitive status (r 2 =0.24; p=0.024). Conclusion The implementation of simple tests of functional capacity associated with neuropsychological testing can help to assess disease severity and motor impairment, and can be used to monitor the response to treatment in PD. .

Objetivo Avaliar a relação entre resultados quantitativos do desempenho funcional e cognitivo de pacientes com doença de Parkinson (DP) e a gravidade da doença; estudar a relação entre a capacidade funcional e cognitiva dos pacientes e o comprometimento motor (Unified Parkinson's Disease Rating Scale - UPDRS III). Método Vinte e nove sujeitos diagnosticados clinicamente com DP foram classificados em três grupos de acordo com a gravidade da doença através da Escala de Hoehn & Yahr (H&Y) modificada, e submetidos a testes funcionais (Senior Fitness Test) e neuropsicológicos. As análises de regressão Stepwise mostraram associação significativa entre a gravidade da doença e a força de membros superiores (r 2 =0,30; p=0,005) e a função executiva (r 2 =0,37; p=0,004). Em relação ao comprometimento motor, houve associação significativa com a força de membros inferiores (r 2 =0,27; p=0,010) e com o estado cognitivo global (r 2 =0,24; p=0,024). Conclusão Testes simples de capacidade funcional associados a testes neuropsicológicos podem contribuir para a avaliação da gravidade e do comprometimento motor e podem ser utilizados para o acompanhamento da resposta ao tratamento da DP. .

Avaliação da aptidão cardiorrespiratória por meio de protocolo submáximo em idosos com transtorno de humor e doença de Parkinson / Assessment of cardiorespiratory fitness using submaximal protocol in older adults with mood disorder and Parkinson's disease

CONTEXTO: Evidências demonstram benefícios para a saúde mental com o treinamento aeróbico orientado em percentuais do VO2max, indicando a importância dessa variável para a prática clínica. OBJETIVO: Validar um método para estimar o VO2max por meio de um protocolo submáximo em idosos com diagnóstico clínico de transtorno depressivo maior (DM) e doença de Parkinson (DP). MÉTODOS: A amostra foi composta por 18 pacientes (64,22 ± 9,92 anos; sete pacientes com DM e 11 com DP). Foram realizadas três avaliações: I) estadiamento da doença, II) mensuração direta de VO2max e III) teste de esforço submáximo. Foi realizada regressão linear para verificar a precisão de estimativa do VO2max estabelecido na ergoespirometria pelo VO2max predito no teste submáximo. Também foi analisada a concordância de Bland-Altman entre os procedimentos. RESULTADOS: A análise de regressão mostrou que os valores de VO2max estimados pelo protocolo submáximo associam-se com o VO2max medido, tanto no valor absoluto (R2 = 0,65; EPE = 0,26 ; p < 0,001) quanto no relativo (R2 = 0,56; EPE = 3,70; p < 0,001). A análise de concordância de Bland-Altman mostrou boa associação entre as duas medidas. CONCLUSÃO: O VO2max predito por meio do protocolo submáximo demonstrou satisfatória validade de critério e simples execução comparado à ergoespirometria.

BACKGROUND: Evidence has shown benefits for mental health through aerobic training oriented in percentage of VO2max, indicating the importance of this variable for clinical practice. OBJECTIVE: To validate a method for estimating VO2max using a submaximal protocol in elderly patients with clinically diagnosis as major depressive disorder (MDD) and Parkinson's disease (PD). METHODS: The sample comprised 18 patients (64.22 ± 9.92 years) with MDD (n = 7) and with PD (n = 11). Three evaluations were performed: I) disease staging, II) direct measurement of VO2max and III) submaximal exercise test. Linear regression was performed to verify the accuracy of estimation in VO2max established in ergospirometry and the predicted VO2max from the submaximal test measurement. We also analyzed the correlation between the Bland-Altman procedures. RESULTS: The regression analysis showed that VO2max values estimated by submaximal protocol associated with the VO2max measured, both in absolute values (R2 = 0.65; SEE = 0.26; p < 0.001) and the relative (R2 = 0.56; SEE = 3.70; p < 0.001). The Bland-Altman plots for analysis of agreement of showed a good correlation between the two measures. DISCUSSION: The VO2max predicted by submaximal protocol demonstrated satisfactory criterion validity and simple execution compared to ergospirometry.

Perfil epidemiológico de pacientes com lesão traumática do plexo braquial avaliados em um Hospital Universitário no Rio de Janeiro, Brasil, 2011 / Epidemiological profile of patients with traumatic brachial plexus injury evaluated in a University Hospital in Rio de Janeiro, Brazil, 2011

INTRODUÇÃO: Os traumas queacometem o plexo braquial estão cada vez mais incidentes, ocorrendo principalmente por acidentes automobilísticos e de motocicleta. Lesões associadas ao trauma podem gerar graves disfunções sensitivas e motoras, temporárias ou permanentes, comprometendo o desempenho do indivíduo em vários aspectos. O grande índice de morbidade no indivíduo jovem masculino pode causar forte impacto econômico e social. Procuramos por meio deste estudo, descrever o perfil epidemiológico dos pacientes com lesão traumática do plexo braquial (LTPB) avaliados no Setor de Fisioterapia do Instituto de Neurologia Deolindo Couto (UFRJ/RJ). METODOLOGIA: Foram avaliados 21 pacientes com lesão do plexo braquial no período de Setembro a Novembro de 2011. Foram incluídos pacientes de ambos os sexos, com idade entre 18 a 75 anos e história de trauma do plexo braquial. Os dados foram retirados da anamnese e do questionário sócio-demográfico. Todos os pacientes assinaram o Termo de Consentimento Livre e Esclarecido. RESULTADOS: A população do estudo foi composta por 18 homens e 3 mulheres, evidenciando maior incidência da lesão no sexo masculino (85,7%, acometimento de homens na razão de 6:1). A média de idade foi de 33,2 anos. Os acidentes de trânsito foram os principais causadores de trauma (81%), sendo os acidentes de motocicleta responsáveis por 66,7% das lesões. Lesões associadas ao trauma ocorreram em 76,2% dos pacientes. Dezoito pacientes foram submetidos a cirurgias. DISCUSSÃO: Os dados encontrados estão de acordo com a literatura científica no que diz respeito à grande incidência de LTPB na população jovem do sexo masculino, sendo os acidentes de trânsito, especialmente de motocicleta, os maiores responsáveis pelas lesões. CONCLUSÃO: A crescente incidência de LTPB constitui um problema de saúde pública, sendo, portanto necessários programas de conscientização e prevenção deste tipo de acometimento,visto que as causas externas de óbito vêm se mantendo como terceira causa de morte no Brasil. Futuros estudos são necessários para extrapolação dos resultados.

INTRODUCTION: The trauma affecting the brachial plexus is increasingly incident, occurring mainly by car accidents and motorcycle. Injuriesassociated with trauma can lead to severe sensory and motor dysfunction, temporary or permanent, affecting the individual's performance in severalaspects. The high rate of morbidity in young male individual can cause severe economic and social impact. We seek, through this study, to describe the epidemiological profile of patients with traumatic brachial plexus injury (TBPI) evaluated at the Department of Physical Therapy at the Instituto de Neurologia Deolindo Couto (UFRJ / RJ). METHODOLOGY: We evaluated 21 patients with brachial plexus injury in the period of September to November in 2011. Patients of both genders and aged 18-75 years and a history of trauma on the brachial plexus were included.The data weretaken from the history and socio-demographic questionnaire. All patients signed an informed consent form. RESULTS: The population comprised 18men and 3 women, showing a higher incidence of injury in males (85.7%, involvement of men in a ratio of 6:1). The mean age was 33.2 years.Traffic accidents were the main cause of trauma (81%), and motorcycle accidents accounted for 66.7% of lesions. Injuries associated with the trauma occurred in 76.2% of patients. Eighteen patients underwent surgery. DISCUSSION: The data are consistent with the scientific literature regarding thehigh incidence of TBPI in young males, and traffic accidents, especially motorcycle, the most responsible for the injuries. CONCLUSION: The increasing incidence of LTPB constitutes a public health problem, therefore, needed awareness programs and prevention of this type of involvement, as the external causes of death have remained as the third cause of death in Brazil. Future studies are necessary to extrapolate the results.

Quality of life in patients with HTLV-I associated myelopathy/tropical spastic paraparesis / Qualidade de vida em pacientes com mielopatia associada ao HTLV-I/paraparesia espástica tropical

OBJECTIVE: To assess the quality of life (QoL) of patients with HTLV-I-associate myelopathy/tropical spastic paraparesis (HAM/TSP) and to correlate it with specific aspects of the disease. METHODS: Fifty-seven HAM/TSP patients completed the SF-36 QoL questionnaire. They were also asked about common complaints related to the disease, and we looked for associations between QoL and these complaints. RESULTS: Patients with HAM/TSP showed a strong negative association to QoL. Pain was the condition which most affected their QoL. The practice of physical activity is associated with better QoL in five out of eight domains of the scale. CONCLUSION: HAM/TSP leads to a poor QoL, mostly influenced by pain. Physical activity may have a positive association to QoL of these patients.

OBJETIVO: Avaliar a qualidade de vida (QV) em pacientes com mielopatia associada ao HTLV-I/paraparesia espástica tropical (MAH/PET) e correlacioná-la com aspectos específicos da doença. MÉTODOS: Cinquenta e sete pacientes com MAH/PET completaram o questionário de qualidade de vida SF-36. Também foram feitas perguntas sobre queixas comuns relacionadas à doença e investigadas posteriormente associações entre QV e essas queixas. RESULTADOS: Pacientes com MAH/PET apresentaram uma associação negativa com a QV. A dor foi a condição que mais afetou a QV. A prática de atividade física foi associada a uma melhor QV em cinco dos oito domínios da escala. CONCLUSÃO: MAH/PET leva a uma pior QV, principalmente influenciada pela dor. A atividade física pode estar positivamente associada à QV destes pacientes.

Quality of life in patients with HTLV-I associated myelopathy/tropical spastic paraparesis.

OBJECTIVE: To assess the quality of life (QoL) of patients with HTLV-I-associate myelopathy/tropical spastic paraparesis (HAM/TSP) and to correlate it with specific aspects of the disease. METHODS: Fifty-seven HAM/TSP patients completed the SF-36 QoL questionnaire. They were also asked about common complaints related to the disease, and we looked for associations between QoL and these complaints. RESULTS: Patients with HAM/TSP showed a strong negative association to QoL. Pain was the condition which most affected their QoL. The practice of physical activity is associated with better QoL in five out of eight domains of the scale. CONCLUSION: HAM/TSP leads to a poor QoL, mostly influenced by pain. Physical activity may have a positive association to QoL of these patients.