Effectiveness of the aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in healthy community-dwelling older adults: A systematic review and meta-analysis.

BACKGROUND: Opting to use aquatic or land-based physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in community-dwelling older adults (CDOAs) is still a questionable clinical decision for physiotherapists. OBJECTIVE: Assess the quality of evidence from randomized or quasi-randomized controlled trials that used aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in CDOAs. METHODS: Articles were surveyed in the following databases: MEDLINE/PubMed, EMBASE, SCOPUS, LILACS, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, CINAHL, SciELO and Google Scholar, published in any language, up to July 31, 2023. Two independent reviewers extracted the data and assessed evidence quality. The risk of bias of the trials was evaluated by the Cochrane tool and evidence quality by GRADE approach. Review Manager software was used to conduct the meta-analyses. RESULTS: 3007 articles were identified in the searches, remaining 33 studies to be read in full, with 11 trials being eligible for this systematic review. The trials included presented low evidence quality for the balance, gait, quality of life and fear of falling. Land-based and aquatic physical therapy exercises improved the outcomes analyzed; however, aquatic physical therapy exercises were more effective in improving balance, gait, quality of life and reducing fear of falling in CDOAs. The meta-analysis showed that engaging in aquatic physical therapy exercises increases the functional reach, through of the anterior displacement of the center of pressure of CDOAs by 6.36cm, compared to land-based physical therapy exercises, assessed by the Functional Reach test: [CI:5.22 to 7.50], (p<0.00001), presenting low quality evidence. CONCLUSIONS: Aquatic physical therapy exercises are more effective than their land-based counterparts in enhancing balance, gait, quality of life and reducing the fear of falling in CDOAs. However, due to methodological limitations of the trials, this clinical decision remains inconclusive. It is suggested that new trials be conducted with greater methodological rigor, in order to provide high-quality evidence on the use of the aquatic physical therapy exercises to improve the outcomes analyzed in CDOAs.

Acute Effect of a Half-Marathon over the Muscular Function and Electromyographic Activity of the Pelvic Floor in Female Runners with or without Urinary Incontinence: A Pilot Study.

OBJECTIVE: to verify the acute effect of running a half marathon on pelvic floor muscle (PFM) function and electromyographic (EMG) activity in female runners with and without urinary incontinence. METHODS: This is a cross-sectional pilot study. The sample was divided into two groups: runners with urinary incontinence (with UI) and runners without urinary incontinence (without UI). A semi-structured form and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) were used for data collection. The EMG and PFM function were evaluated using the PERFECT method before and immediately after running a half marathon. RESULTS: A total of 14 runners were included (8 with UI; 6 without UI). Runners with and without UI did not show significant differences for EMG and PERFECT. The acute effects of the half marathon on runners without UI were reduced PFM function in terms of strength (p = 0.00), reduced endurance (p = 0.02), and reduced repetition (p = 0.03), and an increase in EMG measured by the median frequency (p = 0.02). Runners with UI showed reduced PFM function in terms of strength (p = 0.05) and repetition (p = 0.01). CONCLUSION: there was no difference in the acute effects of the half marathon on PFM function and EMG in women with and without UI.

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.

Techniques for registration of myoelectric activity of women's pelvic floor muscles: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify the most frequently used protocols for analyzing the myoelectric activity of the pelvic floor muscles during surface electromyography in women aged 18 years or older. INTRODUCTION: Surface electromyography is normally used in assessment and treatment for research purposes when it is intended to quantitatively measure the electrophysiological behavior of the neuromuscular system. However, although there are internationally standardized, non-invasive assessment protocols for most muscle groups, there is no consensus for pelvic floor muscles, which makes it difficult to standardize in scientific research and clinical applicability. INCLUSION CRITERIA: Studies that explore registration protocols and filtering parameters of surface electromyographic signals in women aged over 18 years old with or without pelvic floor dysfunction will be considered. Studies encompassing either electromyographic biofeedback as a treatment resource only or electroneuromyography (needle electrode) will be excluded. METHODS: Primary studies published in the previous 10 years in MEDLINE, Embase, Scopus, Web of Science, CINAHL, and Cochrane Central databases will be included. The search will encompass descriptors registered in MeSH. The identified articles will be assessed for eligibility by two independent reviewers in three stages: evaluation by title, abstract, and full text. If there is any disagreement, a third reviewer will be consulted. Data will be extracted and organized in standardized spreadsheets. The results will be assigned to categories in order to facilitate the organization of a protocol with the most commonly used parameters for non-invasive assessment of myoelectric activity of pelvic floor muscles.

Acupuncture and Dry Needling in the Reduction of Peripheral Acute Fatigue Induced in the Biceps Braquii: Protocol for a Single-blinded Randomized Controlled Clinical Trial.

The present study aims to propose a protocol to verify the efficacy and acute effects of traditional Chinese acupuncture, dry needling, and the rest in peripheral acute fatigue (PAF) induced by intermittent isometric contractions of the nondominant biceps brachii (BB) of nonphysically active men in a randomized, single-blind clinical trial assessed with surface electromyography, contraction time in seconds, infrared thermal imaging, and visual analog scale applied to the PAF. These instruments will evaluate the median frequency, endurance time, temperature (°C), and perceived fatigue in BB of the volunteers. The measurements will be collected in four moments (Test 0, 01, 02, and 03) divided between the beginning and the end of two sets of exercises (Exercises 01 and 02) of intermittent isometric contractions. TRIAL IDENTIFIER: NCT03448120 in www.clinicaltrials.gov.

Acute effects of whole-body vibration on spinal excitability level and ankle plantar flexion spasticity in post-stroke individuals: A randomized controlled trial.

INTRODUCTION: This study aimed to evaluate the acute effects (up to 30 min) of whole-body vibration (WBV) on spinal excitability level and ankle plantar flexion spasticity in chronic stroke subjects. METHODS: Twenty-one subjects (age 30-70 years old) with chronic stroke and ankle plantar flexion spasticity were randomly assigned to the vibration group (VG, n = 11) or the control group (CG, n = 10). Subjects in the VG underwent 10 minutes of WBV with a frequency of 35 Hz and amplitude of 2 mm. Subjects in the CG remained on the platform for 10 min without receiving vibratory stimulus. The spinal excitability level was estimated by the Hmax/Mmax ratio extracted from the H-reflex with simple stimulus examination. The value of the second/first wave ratio (H2/H1 ratio) at the peak of the first facilitation was also considered through the recovery curve with double stimulation. Spasticity was estimated by the Modified Ashworth Scale (MAS) and global perception of change. All outcomes were assessed before and at 10, 20, and 30 min after the WBV, except for MAS, which was evaluated only 10 min after WBV. RESULTS: No between-group differences were found in either the spinal excitability level or plantar flexor spasticity at the three evaluated moments after WBV. CONCLUSION: These results suggest that WBV does not reduce spinal excitability level or spasticity of the plantar flexor muscles in chronic stroke patients in the first 30 min after vibratory stimulus.

Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined to physiotherapy in stroke spastic patients.

OBJECTIVE: Repetitive Transcranial Magnetic Stimulation (rTMS) has been used to treat post-stroke upper limb spasticity (ULS) in addition to physiotherapy (PT). To determine whether rTMS associated with PT modulates cortical and spinal cord excitability as well as decreases ULS of post-stroke patients. METHODS: Twenty chronic patients were randomly assigned to either the intervention group-1 Hz rTMS on the unaffected hemisphere and PT, or control group-sham stimulation and PT, for ten sessions. Before and after sessions, ULS was measured using the modified Ashworth scale and cortical excitability using the output intensity of the magnetic stimulator (MSO). The spinal excitability was measured by the Hmax/Mmax ratio of the median nerve at baseline, at the end of treatment, and at the 4-week follow-up. RESULTS: The experimental group showed at the end of treatment an enhancement of cortical excitability, i.e., lower values of MSO, compared to control group (p = 0.044) and to baseline (p = 0.028). The experimental group showed a decreased spinal cord excitability at the 4-week follow-up compared to control group (p = 0.021). ULS decreased by the sixth session in the experimental group (p < 0.05). CONCLUSION: One-hertz rTMS associated with PT increased the unaffected hemisphere excitability, decreased spinal excitability, and reduced post-stroke ULS.

Rate of force development to evaluate the neuromuscular fatigue and recovery after an intermittent isometric handgrip task with different blood flow restriction conditions

Aim: To investigate the neuromuscular fatigue and recovery after an intermittent isometric handgrip exercise (IIHE) executed until failure with different blood flow restriction (BFR) conditions (free flow, partial and total vascular restriction). Methods: Thirteen healthy men carried out an IIHE at 45% of maximum voluntary isometric force (MVIF) until failure with total restriction (TR), partial restriction (PR) or free flow (FF). The rate of force development (RFD) was extracted from the MIVF over the time intervals of 0-30, 0-50, 0-100, and 0-200ms and normalized by MVIF [relative RFD (RFDr)]. Results: The RFDr decreased significantly (p<0.01) after the IIHE in all BFR conditions and time intervals studied, remaining lower for five minutes. The medians of the RFDr in FF condition were significantly lower (p=0.01) at 30ms (1.56 %MVIF·s-1) and 50ms (1.70 %MVIF·s-1) when compared to TR at 30ms (2.34 %MVIF·s-1) and 50ms (2.63 %MVIF·s-1) in minute 1 post failure. Conclusions: These results show that, regardless of the blood flow restriction level, there is no RFD recovery five minutes after an exhaustive IIHE. When the task was executed with FF, the reduction of the RFD was greater when compared with the TR condition.(AU)

Cross-cultural Adaptation and Measurement Properties of the Brazilian Portuguese Version of the Victorian Institute of Sport Assessment-Achilles (VISA-A) Questionnaire.

Background Achilles tendon disorders are very common among athletes. It is important to measure symptoms and functional limitations objectively related to Achilles tendinopathy using outcome measures that have been validated in the language of the target population. Objectives To perform a cross-cultural adaptation and to evaluate the measurement properties of the Brazilian version of the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire. Methods This clinical measurement study adapted the VISA-A questionnaire to Brazilian Portuguese (VISA-A-Br). The adapted questionnaire was then tested on 2 occasions within an interval of 5 to 14 days. This study evaluated the following measurement properties: internal consistency, test-retest reliability, measurement error, construct validity, and ceiling and floor effects. Results The VISA-A-Br showed good internal consistency (Cronbach α = .79; after excluding 1 item at a time, Cronbach α = .73-.84), good test-retest reliability (intraclass correlation coefficient model 2,1 = 0.84; 95% confidence interval: 0.71, 0.91), an acceptable measurement error (standard error of measurement, 3.25 points; smallest detectable change, 9.02 points), good construct validity (Spearman correlation coefficients for the Lower Extremity Functional Scale, 0.73; the Foot and Ankle Outcome Score pain subscale, 0.66; other symptoms subscale, 0.48; function in daily living subscale, 0.59; function in sport and recreation subscale, 0.67; and foot and ankle- related quality of life subscale, 0.70), and no ceiling and floor effects. Conclusion The clinical measurement properties of the VISA-A-Br are equivalent to those of the original version, and the instrument has been validated and confirmed as reliable to measure pain and function among the Brazilian population with Achilles tendinopathy. This adaptation of the questionnaire may be used in clinical and scientific settings. J Orthop Sports Phys Ther 2018;48(7):567-573. Epub 24 Apr 2018. doi:10.2519/jospt.2018.7897.

Abdominal and pelvic floor electromyographic analysis during abdominal hypopressive gymnastics.

INTRODUCTION: Abdominal hypopressive gymnastics appeared as an alternative to traditional abdominal exercises to promote abdominal muscles strength without overloading the pelvic floor muscles (PFM). To determine the activation level of abdominal muscles and PFM and the posture influence in the level of activation in these muscles during abdominal hypopressive gymnastics, we used surface electromyography in young and healthy multipara women. METHODS: This is an observational study with eutrophic nulliparous women aged between 18 and 35 years, with abdominal skinfold less than or equal to 3 cm and active or irregularly active physical activity. Surface electromyography was used for rectus abdominis, external oblique, transversus abdominal/internal oblique (TrA/IO) and PFM assessment in the supine, quadruped and orthostatic (upright standing) positions during abdominal hypopressive gymnastics using normalized electromyographic (%EMG) data. We also analyzed the difference in activation between each muscle and between muscles and positions. RESULTS: Thirty women were evaluated and the mean age was 25.77 years (SD 3.29). The group formed by the TrA/IO muscles and the PFM showed higher %EMG in all the positions assessed, followed by the external oblique and rectus abdominis muscles. A comparison of %EMG of each muscle between the different positions showed differences only in rectus abdominis between the supine and quadruped (p = 0.001) and supine and orthostatic positions (p = 0.004), and in TrA/IO between the supine and orthostatic (p = 0.023) and orthostatic and quadruped positions (p = 0.019). CONCLUSIONS: The results suggest that abdominal hypopressive gymnastics can activate the abdominal muscles and PFM and the position do not have influence on electromyographic activation level of the PFM and external oblique.

High-velocity low-amplitude manipulation (thrust) and athletic performance: a systematic review / Manipulação em alta velocidade/baixa amplitude e desempenho atlético: uma revisão sistemática

Abstract Introduction: The high demand level in sports has encouraged the search for strategies to increase the yield. In this context, manual therapy through high-velocity low-amplitude (thrust) has been employed in many sports. Despite the adhesion of manual therapists in clinical practice, there were no systematic reviews on this topic. Objective: To evaluate the effects of thrust on the performance of athletes in relation to the outcomes hand-grip strength, jump height and running speed. Methods: The databases used in the search were MEDLINE / PUBMED, LILACS, CINAHL, PEDro, WEB OF SCIENCE, CENTRAL and SCOPUS, and Randomized controlled trials were included, whose participants were professionals or recreational athletes and had thrust as intervention. The methodological quality of the studies was assessed using the PEDro scale of 10 points. Intervention effects were determined by the mean difference and confidence interval. The data analysis was done in the descriptive form due to the heterogeneity found among studies. Results: Five trials were included with a total of 95 individuals. The methodological quality of studies was low, with an average value of 5.6 on the PEDro scale. It was found two articles for each outcome, but in none of them was presented differences between the experimental and control groups considering the confidence interval. Conclusion: The current evidence is insufficient to determine the use or nonuse the MAVBA in sports in order to improve performance.

Resumo Introdução: O elevado nível de exigência no meio esportivo tem incentivado a busca por estratégias para aumentar o rendimento. Nesse contexto, a terapia manual através da Manipulação em Alta e Velocidade e Baixa Amplitude (MAVBA) tem sido empregada em vários esportes. Apesar da adesão dos terapeutas manuais na prática clínica, não foram encontradas revisões sistemáticas acerca do tema. Objetivo: Avaliar os efeitos da manipulação de alta velocidade e baixa amplitude sobre o desempenho de atletas. Métodos: As bases de dados utilizadas na busca foram MEDLINE/PUBMED, LILACS, CINAHL, PEDro, WEB OF SCIENCE, CENTRAL e SCOPUS. Foram incluídos Ensaios Randomizados e Controlados, cujos participantes eram atletas profissionais ou recreacionais, que aplicaram a MAVBA como intervenção. A qualidade metodológica dos estudos foi avaliada por meio da Escala PEDro. Os efeitos da intervenção foram determinados através da diferença de média e do respectivo intervalo de confiança (IC). A análise dos dados foi realizada de maneira descritiva, em virtude da heterogeneidade encontrada entre os estudos. Resultados: Cinco ensaios foram incluídos com um total de 95 indivíduos. A qualidade metodológica dos estudos foi baixa, com uma média de 5.6 na Escala de PEDro. Foram encontrados dois artigos para cada desfecho, e em nenhum deles foi detectada diferença entre o grupo experimental e controle quando levado em consideração o IC. Conclusão: A evidência atual é insuficiente para determinar o uso ou o não uso da MAVBA em com objetivo de melhorar o desempenho esportivo.

Electromyographic assessment of women's pelvic floor: What is the best place for a superficial sensor?

AIMS: To compare the electromyographic signal of different surface electrodes and to identify the channel that presents the highest level of electromyographic activity through the mean and peak of Root Mean Square (RMS). METHODS: Thirty healthy women participated in this study. Each woman completed three collections (on different days) of electromyographic data. Three maximal voluntary contractions of the pelvic floor muscles were requested. The electromyographic signal was recorded by intravaginal probe and surface electrodes placed on the perianal region and on the region immediately below the labia majora. To analyze the signal, an epoch of 500 ms was selected during the second contraction. The Kruskal-Wallis test followed by a post hoc Mann-Whitney test was used to compare means and to identify differences. The Bland-Altman method was used to verify the agreement between the measurements. A significance level of P ≤ 0.05 was adopted. RESULTS: There was agreement only between the measurements from perianal electrodes and intravaginal probe. Furthermore, there was no difference between the perianal electrodes and intravaginal probe in RMS mean (P = 0.225) and RMS peak (P = 0.315). However, these electrodes locations presented greater values than the electrodes in the region immediately below the labia majora (RMS mean: P < 0.001; P = 0.016. RMS peak: P < 0.001; P = 0.02). CONCLUSIONS: The intravaginal probe and the surface electrodes in perianal region are equivalent for healthy nulliparous women. The choice must be done according to the values and preferences of the patient.

Transcranial direct current stimulation associated with gait training in Parkinson's disease: A pilot randomized clinical trial.

OBJECTIVE: The aim of this study is to investigate the effects of transcranial direct current stimulation (tDCS) combined with cueing gait training (CGT) on functional mobility in patients with Parkinson´s disease (PD). METHODS: A pilot double-blind controlled, randomized clinical trial was conducted with 22 patients with PD assigned to the experimental (anodal tDCS plus CGT) and control group (sham tDCS plus CGT). The primary outcome (functional mobility) was assessed by 10-m walk test, cadence, stride length, and Timed Up and Go test. Motor impairment, bradykinesia, balance, and quality of life were analyzed as secondary outcomes. Minimal clinically important differences (MCIDs) were observed when assessing outcome data. RESULTS: Both groups demonstrated similar gains in all outcome measures, except for the stride length. The number of participants who showed MCID was similar between groups. CONCLUSION: The CGT provided many benefits to functional mobility, motor impairment, bradykinesia, balance, and quality of life. However, these effect magnitudes were not influenced by stimulation, but tDCS seems to prolong the effects of cueing therapy on functional mobility.

Upper limbs total occlusion pressure assessment: Doppler ultrasound reproducibility and determination of predictive variables.

Total occlusion pressure (TOP) is an important variable to ischaemic exercise training because the optimal pressure of flow restriction (OPR), applied during this exercise modality, is derived from it. Despite the common use of Doppler ultrasound (DU) to determine the TOP, the reproducibility of this assessment was not evaluated yet. Given this, the objective was to evaluate the reproducibility of DU for the measurement of TOP in upper limbs and determine the predictive variables. Thirteen male volunteers attended three times to the laboratory. On the 1st day, we assessed arm circumference (AC), systolic blood pressure (SBP) and diastolic (DBP), and brachial artery TOP. On 2nd and 3rd days, only TOP was assessed. We found a coefficient of variation of 5·6% and an intraclass correlation coefficient of 0·795 for the DU. In the analysis of TOP predictive variables, the Spearman coefficients (R) were 0·813 (SBP), 0·786 (DBP) and 0·388 (AC). Therefore, these results support that DU has good reproducibility for the TOP and that SBP and DBP should be considered to the determination of TOP in upper limbs.

Efeitos do kinesio taping na dinâmica articular durante a marcha de pacientes após acidente vascular encefálico / Effects of kinesio taping in joint dynamics during gait in patients after stroke

Objetivo: Analisar os efeitos do kinesio taping® na dinâmica articular durante a marcha de pacientes hemiparéticos após acidente vascular encefálico (AVE). Métodos: Foi realizado um ensaio piloto com 14 participantes pós-AVE, alocados nos grupos intervenção (n = 7) e sham (n = 7). Foram analisados os ângulos articulares do tornozelo, joelho e quadril, durante as fases de balanço inicial e médio e contato inicial da marcha, antes da aplicação do taping e 24 horas após. A satisfação do paciente também foi analisada. Resultados: Não houve diferença entre os grupos nas angulações do tornozelo [balanço inicial (DM = -0,47º, IC95% -14,37 a 13,42); balanço médio (DM = -1º, IC 95% -14 a 12); contato inicial (DM = 1,22º, IC 95% -11,5 a 13,97)]; joelho [balanço inicial (DM = 5,66º, IC 95% -12,27 a 23,58); balanço médio (DM = -1,94º, IC 95% 23,6 a -19,76)]; quadril [balanço inicial (DM = 1,97º, IC 95% -6,98 a 3,03); balanço médio (DM = 0,68º, IC 95% -7,57 a 8,9); contato inicial (DM = 0º, IC 95% - 3,7 a 3,6)]. O grupo intervenção apresentou 10,5 vezes mais chances (OR = 10,5, IC 95% 0,4 a 267,1) de observar diferença quando o taping é aplicado em comparação ao grupo sham. Conclusão: Não houve diferença nas angulações do tornozelo, joelho e quadril durante a marcha, 24 horas após a aplicação do kinesio taping® em pacientes hemiparéticos. (AU)

Objective: To analyze the effects of Kinesio taping® in the joint dynamics during gait in hemiparetic patients after stroke. Methods: We conducted a pilot study with 14 participants after stroke allocated into intervention group (n = 7) and sham group (n = 7). We measured the joint angles of ankle, knee and hip during gait analysis at initial swing, mid swing and initial contact, without the application of taping and 24 hours after application. We also evaluated the patient's experience. Results: There was no difference between groups in the ankle angles [initial swing (DM = -0.47º, 95% CI -14.37 to 13.42); mid swing (DM = -1º, 95% CI -14 to 12); initial contact (DM = -1.22º, 95% CI -11.5 to 13.97)]; knee [initial swing (DM = 5.66º, 95% CI -12.27 to 23.58); mid swing (DM = -1.94º, 95%CI -19.76 to 23.6)]; hip [initial swing (DM = 1.97º, 95%CI -6.98 to 3.03); mid swing (DM = 0.68º, 95%CI -7.57 to 8.9); initial contact (DM = 0°, 95% -3.7 to 3.6)]. The chance to observe the difference when the taping is applied was 10.5 times higher (OR = 10.5, 95%CI 0.4 a 267.1) in the intervention group. Conclusion: There was no significant difference in angles of ankle, knee and hip during gait, 24 hours after Kinesio Taping® application in hemiparetic patients. (AU)

Coativação e pico de torque dos músculos extensores e flexores do joelho em indivíduos hemiparéticos crônicos nas posições sentada e supina / Coactivación y pico de torque de los músculos extensores y flexores de rodilla en sujetos hemiparéticos crónicos en las posiciones sentada y supina / Coactivation and peak torque of extensors and flexors knee muscle in chronic hemiparetics in sitting and supine positions

RESUMO Distúrbios na coativação e diminuição de força muscular são frequentemente descritos em indivíduos hemiparéticos. Alterações do comprimento muscular decorrentes da mudança postural podem resultar em diferentes respostas de coativação e força desses indivíduos. O objetivo deste estudo foi avaliar a influência das posições sentada e supina no Índice de Coativação (ICa) e no pico de torque (PT) de indivíduos hemiparéticos crônicos pós-AVE. Participaram do estudo vinte indivíduos com média de 54±12,14 anos; Índice de Massa Corpórea médio de 26,93±3,34 kg/m²; tempo médio de AVE 55,85±49,4 meses; escore do miniexame do estado mental entre 27-30 e Fugl-Meyer do membro inferior entre 15-30. O registro eletromiográfico foi obtido enquanto os voluntários executavam cinco contrações isocinéticas (60º/s) de extensão e flexão do joelho, nas posições sentada e supina. O músculo semitendíneo do membro parético exibiu ICa menor na posição supina em comparação à sentada: 0,36±0,33; 0,44±0,33 (p=0,048). Não houve diferença no ICa do reto femoral entre as posições sentada (0,28±0,25) e supina (0,23±0,21). O PT dos músculos extensores e flexores do membro parético não variou entre as posições (PT extensor: sentado = 56,48±37,62Nm, supino = 52,29±32,37 Nm; PT flexor: sentado = 12±11,1Nm; supino = 10,95±6,4Nm). A posição supina mostrou menor ICa no músculo semitendíneo do membro parético. A mudança de posição não influenciou o ICa do músculo reto femoral nem o PT de ambos os grupos musculares do membro parético. Assim, a posição supina parece ser indicada durante mobilizações e treinamento de força desses músculos em pacientes hemiparéticos crônicos pós-AVE.

RESUMEN Los trastornos en la coactivación y disminución de la fuerza muscular están frecuentemente descriptos en sujetos hemiparéticos. Las alteraciones del tamaño muscular debido al cambio postural a los sujetos les pueden resultar diferentes respuestas de coactivación y de fuerza. En este estudio se pretende evaluar la influencia de las posiciones sentada y supina en el Índice de Coactivación (ICa) y en el pico de torque (PT) de sujetos hemiparéticos crónicos pos-ACV. Veinte personas han participado del estudio con promedio de 54±12,14 años; Índice de Masa Corporal promedio de 26,93±3,34kg/m²; promedio de tiempo del ACV de 55,85±49,4 meses; puntuación del Mini-Examen Cognoscitivo entre 27-30 y Fugl-Meyer del miembro inferior entre 15-30. Se obtuvo el registro electomiográfico mientras los participantes ejercían cinco contracciones isocinéticas (60º/s) de extensión y de flexión de la rodilla, en las posiciones sentada y supina. El músculo semitendinoso del miembro parético presentó ICa menor en la posición supina que en la sentada: 0,36±0,33; 0,44±0,33 (p=0,048). No hubo diferencias en el ICa del recto femoral entre las posiciones sentada (0,28±0,25) y supina (0,23±0,21). El PT de los músculos extensores y flexores del miembro parético no presentó variación entre las posiciones (PT extensor: sentada = 56,48±37,62Nm, supina = 52,29±32,37Nm; PT flexor: sentada = 12±11,1Nm; supina = 10,95±6,4Nm). La posición supina mostró menor ICa en el músculo semitendinoso del miembro parético. El cambio de posición no influyó el ICa del músculo recto femoral tampoco el PT de ambos grupos musculares del miembro parético. De esta manera, la posición supina parece ser la indicada durante movilizaciones y entrenamientos de fuerza de dichos músculos de sujetos hemiparéticos crónicos pos-ACV.

ABSTRACT Disorders in co-activation and decreased muscle strength are often described in hemiparetic subjects. Changes in muscle length resulting from postural change may result in different responses of co-activation and strength of these individuals. The objective of this study was to evaluate the influence of sitting and supine positions in Co-activation Index (CI) and peak torque (PT) of chronic hemiparetic subjects after stroke. The participants were twenty individuals with mean age of 54±12.14 years; mean body mass index of 26.93±3.34 kg/m²; average stroke time of 55.85±49.4 months; Mini-Mental State Examination score between 27-30; and Fugl-Meyer of lower limb between 15-30. The electromyographic record was obtained while the volunteers performed five isokinetic contractions (60º/s) of knee extension and flexion in the sitting and supine positions. The semitendinosus muscle of paretic limb exhibited lower CI in the supine position compared to sitting: 0.36±0.33; 0.44±0.33 (p=0.048). There was no difference in CI of the rectus femoris between positions: 0.28±0.25 sitting and 0.23±0.21 supine. The PT of extensor and flexor muscles of the paretic limb did not vary between positions (PT extensor: sitting = 56.48±37.62 Nm, supine = 52.29±32.37 Nm; PT flexor: sitting = 12±11.1 Nm, supine = 10.95±6.4 Nm). The supine position showed lower CI in the semitendinosus muscle of paretic limb. The change of position did not influence the CI of rectus femoris muscle neither the PT of both muscle groups of the paretic limb. Thus, the supine position appears to be indicated during movement and strength training of these muscles in chronic hemiparetic patients after stroke.

Analysis of dimensions, activation and median frequency of cervical flexor muscles in young women with migraine or tension-type headache.

BACKGROUND: Central and peripheral mechanisms may be involved in migraine and tension-type headache pathogenesis, however the role of muscle disorders in their pathophysiological mechanisms remains unclear. OBJECTIVES: To assess the association between the presence of migraine or tension-type headache and changes in longus colli muscle dimensions and sternocleidomastoid muscle activity. METHOD: An observational study with 48 women comparing the following groups: migraine (n=21), tension-type headache (n=16), and control (n=11). The cross-sectional area, lateral and anteroposterior dimensions, and shape ratio of the longus colli muscle were measured using ultrasound. The activation of the sternocleidomastoid muscle was assessed by signal amplitude and the decline in median frequency using surface electromyographic analysis. RESULTS: The dimensions of the longus colli muscle did not differ between groups (p>0.05). Post-test analysis showed lower sternocleidomastoid muscle activation on both sides, at the onset of contraction, in the group with tension-type headache when compared to the control group {right sternocleidomastoid [tension-type headache: 0.39 (0.30-0.49); control: 0.58 (0.42-0.76); p=0.026] and left sternocleidomastoid [tension-type headache: 0.39 (0.31-0.48); control: 0.60 (0.42-0.79); p=0.039], Tukey's post hoc test}. There was no difference between the three groups in sternocleidomastoid muscle activation, on both sides, at the end of contraction (p>0.05). Intergroup analysis showed no difference in the rate of decline in median frequency (p>0.05). CONCLUSION: The group with tension-type headache exhibited less activation at the onset of sternocleidomastoid muscle contraction. No association was observed between the presence of headache and alterations in longus colli muscle dimensions, median frequency, and sternocleidomastoid muscle activation at the end of contraction.

Analysis of dimensions, activation and median frequency of cervical flexor muscles in young women with migraine or tension-type headache

Background: Central and peripheral mechanisms may be involved in migraine and tension-type headache pathogenesis, however the role of muscle disorders in their pathophysiological mechanisms remains unclear. Objectives: To assess the association between the presence of migraine or tension-type headache and changes in longus colli muscle dimensions and sternocleidomastoid muscle activity. Method: An observational study with 48 women comparing the following groups: migraine (n=21), tension-type headache (n=16), and control (n=11). The cross-sectional area, lateral and anteroposterior dimensions, and shape ratio of the longus colli muscle were measured using ultrasound. The activation of the sternocleidomastoid muscle was assessed by signal amplitude and the decline in median frequency using surface electromyographic analysis. Results: The dimensions of the longus colli muscle did not differ between groups (p>0.05). Post-test analysis showed lower sternocleidomastoid muscle activation on both sides, at the onset of contraction, in the group with tension-type headache when compared to the control group {right sternocleidomastoid [tension-type headache: 0.39 (0.30-0.49); control: 0.58 (0.42-0.76); p=0.026] and left sternocleidomastoid [tension-type headache: 0.39 (0.31-0.48); control: 0.60 (0.42-0.79); p=0.039], Tukey's post hoc test}. There was no difference between the three groups in sternocleidomastoid muscle activation, on both sides, at the end of contraction (p>0.05). Intergroup analysis showed no difference in the rate of decline in median frequency (p>0.05). Conclusion: The group with tension-type headache exhibited less activation at the onset of sternocleidomastoid muscle contraction. No association was observed between the presence of headache and alterations in longus colli muscle dimensions, median frequency, and sternocleidomastoid muscle activation at the end of contraction. .

Concurrent validity of the pressure biofeedback unit and surface electromyography in measuring transversus abdominis muscle activity in patients with chronic nonspecific low back pain / Validade concorrente da unidade de biofeedback pressórico e eletromiografia de superfície na mensuração da atividade muscular do transverso abdominal em pacientes com dor lombar crônica inespecífica

BACKGROUND: The Pressure biofeedback unit (PBU) is an assessment tool used in clinical practice and research aimed to indirectly analyze the transversus abdominis (TrA) muscle activity. The concurrent validity of the PBU in a clinically relevant sample is still unclear. OBJECTIVE: The purpose of this study was to evaluate the concurrent validity and diagnostic accuracy of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain. METHOD: This study was performed using a validation, cross-sectional design. Fifty patients with chronic nonspecific low back pain were recruited for this study. To test the concurrent validity both PBU measures (index test) and superficial electromyographic measures (reference-standard test) were compared and collected by a physical therapist in a series of voluntary contraction maneuvers of TrA muscle. RESULTS: Participants were on average 22 years old, weighed 63.7 kilos, 1.70 meters height and mean low back pain duration was 1.9 years. It was observed a weak and non-significant Phi coefficient (r=0.2, p<0.20). With regards to diagnostic accuracy tests, our results suggest a low sensitivity (60%) and specificity (60%) of the PBU. The positive predictive value was high (0.8) and negative predictive value was low (0.2). Conclusions: Concurrent validity of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain is poor given the low correlation and diagnostic accuracy with superficial EMG.

CONTEXTUALIZAÇÃO: A Unidade de Biofeedback Pressórico (UBP) é uma ferramenta de avaliação usada na prática clínica e pesquisa científica para analisar indiretamente a atividade muscular do transverso abdominal (TrA). A validade concorrente da UBP em uma amostra clinicamente relevante ainda não está esclarecida. OBJETIVO: Avaliar a validade concorrente e acurácia diagnóstica da UBP em mensurar a atividade muscular do TrA em pacientes com dor lombar crônica inespecífica. MÉTODO: Este estudo foi realizado usando um delineamento de validação. Cinquenta pacientes com dor lombar crônica inespecífica foram recrutados. Para testar a validade concorrente, ambas as medidas pressóricas (teste índice) e eletromiográficas superficiais (teste padrão de referência) foram comparadas e coletadas por um fisioterapeuta a partir de uma manobra de contração voluntária do músculo TrA. RESULTADOS: Os participantes tinham em média 22 anos, 63,7 kg, 1,70 m de altura, e a duração média de dor lombar era de 1,9 ano. Observou-se um coeficiente Phi fraco e não significativo (r=0,2; p<0,20). Com relação aos testes de acurácia diagnóstica, os resultados sugerem uma baixa sensibilidade (60%) e especificidade (60%) da UBP. O valor preditivo positivo foi elevado (0,8), e o valor preditivo negativo foi baixo (0,2). Conclusões: A validade concorrente da UBP em mensurar a atividade muscular do TrA em pacientes com dor lombar crônica inespecífica é pobre, considerando a baixa correlação e acurácia diagnóstica com a EMG de superfície.

Concurrent validity of the pressure biofeedback unit and surface electromyography in measuring transversus abdominis muscle activity in patients with chronic nonspecific low back pain.

BACKGROUND: The Pressure biofeedback unit (PBU) is an assessment tool used in clinical practice and research aimed to indirectly analyze the transversus abdominis (TrA) muscle activity. The concurrent validity of the PBU in a clinically relevant sample is still unclear. OBJECTIVE: The purpose of this study was to evaluate the concurrent validity and diagnostic accuracy of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain. METHOD: This study was performed using a validation, cross-sectional design. Fifty patients with chronic nonspecific low back pain were recruited for this study. To test the concurrent validity both PBU measures (index test) and superficial electromyographic measures (reference-standard test) were compared and collected by a physical therapist in a series of voluntary contraction maneuvers of TrA muscle. RESULTS: Participants were on average 22 years old, weighed 63.7 kilos, 1.70 meters height and mean low back pain duration was 1.9 years. It was observed a weak and non-significant Phi coefficient (r=0.2, p<0.20). With regards to diagnostic accuracy tests, our results suggest a low sensitivity (60%) and specificity (60%) of the PBU. The positive predictive value was high (0.8) and negative predictive value was low (0.2). CONCLUSIONS: Concurrent validity of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain is poor given the low correlation and diagnostic accuracy with superficial EMG.