Dry needling, trigger point electroacupuncture and motor point electroacupuncture for the treatment of myofascial pain syndrome involving the trapezius: a randomised clinical trial.

OBJECTIVE: The objective of this study was to compare trigger point (TrP) dry needling, TrP electroacupuncture and motor point electroacupuncture of the trapezius muscle for the treatment of myofascial pain syndrome (MPS). METHODS: This randomised clinical trial included 90 patients divided into three groups. Group 1 was treated with dry needling of TrPs, group 2 with intramuscular electrical stimulation of TrPs, and group 3 with electroacupuncture of motor points and/or the spinal accessory nerve. Each group received seven treatment sessions. The outcomes were the pain score measured by visual analogue scale (VAS) and quality of life evaluated by the 12-item short form (SF-12) health questionnaire. We compared the pain outcome over serial time points using growth curve analysis methods. RESULTS: Participants in the three groups experienced significant improvements in pain scores over time. The average pain level of participants in group 3 across the repeated assessments was 0.98 units lower than in group 1 (mean difference (95% confidence interval (CI) = 1.74-0.23)), p = 0.012). There were no significant differences in pain scores between participants in groups 1 and 2, and there were no significant differences in quality of life across the three groups at the end of the treatment period. CONCLUSION: Our results provide evidence that electrical stimulation of motor points and/or of the spinal accessory nerve may be superior in terms of pain relief (but not quality of life) to dry needling and possibly electrical stimulation of trigger points for the management of MPS involving the trapezius. TRIAL REGISTRATION NUMBER: TRIAL-RBR-43R7RF (Brazilian Clinical Trials Registry).

Influence of pain prognosis and electrical stimulation modality on the amplitude of current elicited at sensory threshold in chronic lumbar pain sufferers / Influência do prognóstico para dor e da modalidade de estimulação elétrica na amplitude de corrente elicitada no limiar sensorial em lombálgicos crônicos

ABSTRACT BACKGROUND AND OBJECTIVES: Sensory function may be altered in chronic low back pain (CLBP), which may alter the perception of therapeutic currents. The aim of this study was to verify whether the risk of poor prognosis for CLBP pain influences the amplitude elicited at the sensory threshold (ST) in different modalities of neuromuscular electrical stimulation (NMES). METHODS: This is a quasi-experimental counterbalanced study with 40 subjects divided into four groups (n=10 each), according to the risk of poor prognosis for pain: no risk (control group - CG), low (LrG), medium (MrG), and high (HrG) risks. Four modalities of NMES were tested: two medium frequency currents (Aussie current [AC] and Russian current [RC]) and two low frequency currents (commonly known as functional electrical stimulation [FES]), with two phase durations of200 μs (FES_200) and 500 μs (FES_500), in the region of the lumbar multifidus muscles. All subjects were exposed to all current modalities with interval periods, and when the ST was reached, the amplitude of the current measured in mA was recorded. RESULTS: The currents that elicited the highest and lowest amplitude in the ST were FES_200 and AC, respectively. As for the risk of poor prognosis, the highest amplitudes were for the HrG and the lowest for the LrG. CONCLUSION: The amplitude of the current elicited in the ST tended to be higher among those with a higher risk of poor prognosis for pain and, among the currents, those of medium frequency elicited lower amplitudes.

RESUMO JUSTIFICATIVA E OBJETIVOS: A função sensorial é potencialmente alterada na presença de dor lombar crônica (DLC), o que pode alterar a percepção de passagem de correntes terapêuticas. O objetivo deste estudo foi verificar se o risco de mau prognóstico para DLC influencia a amplitude elicitada no limiar sensorial (LS) em diferentes modalidades de estimulação elétrica neuromuscular (EENM). MÉTODOS: Trata-se de um estudo quase-experimental contrabalanceado composto por 40 voluntários alocados em quatro grupos (n=10 cada), de acordo com o risco de mau prognóstico para dor: sem risco (grupo controle - GC), baixo risco (GBR), médio risco (GMR) e alto risco (GAR). Foram testadas quatro modalidades de EENM: duas correntes de média frequência (corrente Aussie [CA] e corrente Russa [CR]) e duas correntes de baixa frequência (comumente denominada estimulação elétrica funcional [FES]), com duas durações de fases 200 μs (FES_200) e 500 μs (FES_500) na região dos músculos multífidos lombares. Todos os voluntários foram submetidos a todas as modalidades de corrente, com períodos de intervalos, e ao ser atingido o LS, foi realizado o registro da amplitude da corrente medida em mA. RESULTADOS: As correntes que elicitaram a maior e a menor amplitude no LS foram, respectivamente, FES_200 e CA. Quanto ao risco de mau prognóstico, as maiores amplitudes foram do GAR e as menores do GBR. CONCLUSÃO: A amplitude da corrente elicitada no LS tendeu a ser mais alta entre aqueles com maior risco de mau prognóstico para dor e, dentre as correntes, aquelas de média frequência elicitaram amplitudes mais baixas.A amplitude da corrente elicitada no LS tendeu a ser mais alta entre aqueles com maior risco de mau prognóstico para dor e, dentre as correntes, aquelas de média frequência elicitaram amplitudes mais baixas.

[Follow-up of the patient with pacemakers: Interrogation and basic programming]. / Seguimiento del paciente con marcapasos: interrogatorio y programación básica.

Permanent pacemakers are a frequently used therapeutic modality. Its use has had a great impact on the morbidity and mortality and quality of life of patients with heart rhythm disturbances, with an exponential increase observed in recent decades. The use of this strategy presents different phases, in which follow-up throughout the useful life of the device is a fundamental and determinant pillar of the efficacy and safety of this therapeutic modality. This review seeks to provide a clear and structured update of the fundamental aspects to consider in the follow-up of all patients with pacemakers. The follow-up of the patient with a pacemaker must follow a complete, systematic and periodic protocol, evaluating aspects and parameters related to the patient and the pacemaker, in order to ensure the proper and safe operation of the device adapted to the person.

Los marcapasos permanentes son una modalidad terapéutica de uso frecuente. Su empleo ha tenido un gran impacto en la morbimortalidad y calidad de vida de los pacientes con alteraciones del ritmo cardiaco, observándose en las últimas décadas un incremento exponencial. El empleo de esta estrategia presenta diferentes fases, que inician con la indicación de la estimulación, la selección del sistema de marcapaso apropiado, el procedimiento de implantación, la programación inicial y el seguimiento posterior, en la cual el seguimiento a lo largo de la vida útil del dispositivo es un pilar fundamental y determinante de la eficacia y seguridad de esta modalidad terapéutica. La presente revisión busca proporcionar una actualización clara y estructurada de los aspectos fundamentales a considerar en el seguimiento de todo paciente portador de marcapasos. El seguimiento del paciente con marcapasos debe seguir un protocolo completo, sistemático y periódico, evaluando aspectos y parámetros relacionado con el paciente y el marcapaso, con la finalidad de garantizar un funcionamiento adecuado y seguro del dispositivo adaptado a la persona.

Functional electrical stimulation therapy controlled by a P300-based brain-computer interface, as a therapeutic alternative for upper limb motor function recovery in chronic post-stroke patients. A non-randomized pilot study.

Introduction: Up to 80% of post-stroke patients present upper-limb motor impairment (ULMI), causing functional limitations in daily activities and loss of independence. UMLI is seldom fully recovered after stroke when using conventional therapeutic approaches. Functional Electrical Stimulation Therapy (FEST) controlled by Brain-Computer Interface (BCI) is an alternative that may induce neuroplastic changes, even in chronic post-stroke patients. The purpose of this work was to evaluate the effects of a P300-based BCI-controlled FEST intervention, for ULMI recovery of chronic post-stroke patients. Methods: A non-randomized pilot study was conducted, including 14 patients divided into 2 groups: BCI-FEST, and Conventional Therapy. Assessments of Upper limb functionality with Action Research Arm Test (ARAT), performance impairment with Fugl-Meyer assessment (FMA), Functional Independence Measure (FIM) and spasticity through Modified Ashworth Scale (MAS) were performed at baseline and after carrying out 20 therapy sessions, and the obtained scores compared using Chi square and Mann-Whitney U statistical tests (𝛼 = 0.05). Results: After training, we found statistically significant differences between groups for FMA (p = 0.012), ARAT (p < 0.001), and FIM (p = 0.025) scales. Discussion: It has been shown that FEST controlled by a P300-based BCI, may be more effective than conventional therapy to improve ULMI after stroke, regardless of chronicity. Conclusion: The results of the proposed BCI-FEST intervention are promising, even for the most chronic post-stroke patients often relegated from novel interventions, whose expected recovery with conventional therapy is very low. It is necessary to carry out a randomized controlled trial in the future with a larger sample of patients.

Peripheral electrical stimulation on neuroplasticity and motor function in stroke patients: a systematic review and meta-analysis.

INTRODUCTION: The use of electrotherapy has been presented as a great resource for the professional physiotherapist in the most diverse pathologies. Stroke is a neurological condition responsible for sequelae such as hemiplegia that directly impair the quality of life of patients. OBJECTIVE: This study aimed to review the literature on the effects of electrotherapeutic resources on motor function and neuroplasticity in individuals with post-stroke sequelae. MATERIALS AND METHODS: 2427 articles were found in databases according to search criteria for each base according to the included descriptors (EndNote Web). After exclusion of duplicate articles, automatically and manually, Phase 1 was performed - reading of titles and abstracts of 1626 articles according to eligibility criteria by two blinded reviewers using the programme Rayyan QCRI (Qatar Computing Research Institute), conflicts were resolved in consensus between the two reviewers. Thus, 13 articles were selected for Phase 2-13 articles were selected for reading in full, leaving 8 articles in this review. To assess the quality of bias of the selected studies, the PEDro Scale was used. RESULTS: In the assessment of neuroplasticity, statistically significant results were found in two studies (p < 0.05). However, the effects of electrostimulation stood out significantly in the motor function of these individuals (p < 0.05). It can be considered with neuroplasticity, since improved functionality can be related to electrostimulation-induced neuroplasticity. Conclusions Electrostimulation is able to promote neuroplasticity and increase motor function, generating positive effects in the treatment of individuals with post-stroke sequelae.

EXERCISES AND NEUROMUSCULAR ELECTRIC STIMULATION FOR MEDIAL LONGITUDINAL ARCH: CLINICAL TRIAL.

Objective: The extrinsic muscles, such as the posterior tibialis and long flexor of the hallux and the intrinsic of the foot, are part of the active subsystem of the central system of the foot and play an essential role in the control of the medial longitudinal arch resulting from difficulty in contracting the muscle, neuromuscular electrostimulation (NMES) becomes a resource combined with strengthening and recommended for rehabilitation. T this work aims to evaluate the effectiveness of NMES associated with exercise in deforming the medial longitudinal arch. Methods: This is a randomized blind clinical trial. 60 asymptomatic participants were divided into three groups: NMES, exercise and control. The NMES and exercise group performed seven exercises for the intrinsic and extrinsic muscles twice a week for 6 weeks, and the NMES group used an NMES associated with five exercises. Navicular height and medial longitudinal arch angle were taken before and after the intervention period. Results: No statistically significant differences existed between groups for navicular height and medial longitudinal arch angle. Conclusion: NMES associated with exercise does not change the characteristics of the medial longitudinal arch in association with asymptomatic. Level of Evidence I; Randomized clinical trial.

Objetivo: Os músculos extrínsecos, como o tibial posterior e flexor longo do hálux e os intrínsecos do pé fazem parte do subsistema ativo do foot core system e exercem papel essencial no controle do arco longitudinal medial. Devido à dificuldade na contração desses músculos, a eletroestimulação neuromuscular (EENM) torna-se um recurso aliado ao fortalecimento e é recomendada para reabilitação. O objetivo desse trabalho é avaliar a eficácia da EENM associada ao exercício na deformação do arco longitudinal medial. Métodos: Este é um ensaio clínico randomizado cego. 60 participantes assintomáticos foram divididos em três grupos: EENM, exercício e controle. O grupo EENM e exercício realizaram sete exercícios para os músculos intrínsecos e extrínsecos duas vezes por semana por seis semanas, sendo o grupo EENM utilizou a EENM associada a cinco exercícios. A altura do navicular e o ângulo do arco longitudinal medial foram medidos antes e após o período de intervenção. Resultados: Não houve diferenças estatisticamente significativas entre os grupos para a altura do navicular e ângulo do arco longitudinal medial. Conclusão: A EENM associada ao exercício não altera as características do arco longitudinal medial em indivíduos assintomáticos. Nível de Evidência I; Estudo Clínico Randomizado.

Transcutaneous tibial nerve electrical stimulation versus vaginal electrical stimulation in women with overactive bladder syndrome: Is there a role for short-term interventions?

OBJECTIVE: To assess the efficacy of vaginal electrical stimulation (VS) versus transcutaneous tibial nerve electrical stimulation (TTNS) in women with overactive bladder syndrome (OAB). MATERIAL AND METHODS: Sixty-nine patients were randomized to receive 12 sessions of VS versus TTNS, or no treatment (control group-CG), over 6 weeks. OAB impact according to international consultation on incontinence questionnaire overactive bladder module (ICIQ-OAB), symptoms discomfort scores and voiding diaries were evaluated at baseline, 6 weeks and 1-month post-treatment. RESULTS: Both TTNS (mean difference = -4.2; 95% confidence interval [CI] = -6.5 to -1.9) and VS (-3.8; -6.0 to -1.6) were associated with significant reduction of ICIQ-OAB scores, as well as discomfort sensation (-3.9; -6.2 to -1,7; p < 0.001 for the TTNS and -2.8; -5.0 to -0.6; p = 0.01 for the VS) at 6 weeks when compared to CG (p < 0.001). ICIQ-OAB score remained low only in the TTNS group when compared to the CG (-3.6; -6.0 to -1.2/p = 0.00) 1 month after treatment. Discomfort symptoms improved in both active groups when compared to CG (TTNS [-3.2; -5.2 to -1.2; p < 0.001] and VS groups [-2.6; -4.7 to -0.6; p = 0.01]). No statistically differences were found in primary outcomes comparing TTNS and VS Secondary analysis showed significant improvement in urinary urgency incontinence episodes (UUI) in both TTNS and VS, but CG. UUI episodes were still reduced in the VS group and urgency in the TTNS group 1-month post-treatment. CONCLUSION: Short-term interventions (6 weeks) of TTNS and VS were both effective in treating women with OAB. TTNS provided residual effects at one-month postintervention on ICIQ-OAB score.

Exercises and neuromuscular electric stimulation for medial longitudinal arch: clinical trial / Exercícios e estimulação elétrica neuromuscular para arco longitudinal medial: ensaio clínico

ABSTRACT Objective The extrinsic muscles, such as the posterior tibialis and long flexor of the hallux and the intrinsic of the foot, are part of the active subsystem of the central system of the foot and play an essential role in the control of the medial longitudinal arch resulting from difficulty in contracting the muscle, neuromuscular electrostimulation (NMES) becomes a resource combined with strengthening and recommended for rehabilitation. T this work aims to evaluate the effectiveness of NMES associated with exercise in deforming the medial longitudinal arch. Methods This is a randomized blind clinical trial. 60 asymptomatic participants were divided into three groups: NMES, exercise and control. The NMES and exercise group performed seven exercises for the intrinsic and extrinsic muscles twice a week for 6 weeks, and the NMES group used an NMES associated with five exercises. Navicular height and medial longitudinal arch angle were taken before and after the intervention period. Results No statistically significant differences existed between groups for navicular height and medial longitudinal arch angle. Conclusion NMES associated with exercise does not change the characteristics of the medial longitudinal arch in association with asymptomatic. Level of Evidence I; Randomized clinical trial.

RESUMO Objetivo Os músculos extrínsecos, como o tibial posterior e flexor longo do hálux e os intrínsecos do pé fazem parte do subsistema ativo do foot core system e exercem papel essencial no controle do arco longitudinal medial. Devido à dificuldade na contração desses músculos, a eletroestimulação neuromuscular (EENM) torna-se um recurso aliado ao fortalecimento e é recomendada para reabilitação. O objetivo desse trabalho é avaliar a eficácia da EENM associada ao exercício na deformação do arco longitudinal medial. Métodos Este é um ensaio clínico randomizado cego. 60 participantes assintomáticos foram divididos em três grupos: EENM, exercício e controle. O grupo EENM e exercício realizaram sete exercícios para os músculos intrínsecos e extrínsecos duas vezes por semana por seis semanas, sendo o grupo EENM utilizou a EENM associada a cinco exercícios. A altura do navicular e o ângulo do arco longitudinal medial foram medidos antes e após o período de intervenção. Resultados Não houve diferenças estatisticamente significativas entre os grupos para a altura do navicular e ângulo do arco longitudinal medial. Conclusão A EENM associada ao exercício não altera as características do arco longitudinal medial em indivíduos assintomáticos. Nível de Evidência I; Estudo Clínico Randomizado.

Is Electrical Stimulation Effective in Preventing or Treating Delayed-onset Muscle Soreness (DOMS) in Athletes and Untrained Adults? A Systematic Review With Meta-Analysis.

The effectiveness of electrical stimulation (ES) in preventing or treating delayed-onset muscle soreness (DOMS) and its effects on muscle recovery is unclear. The systematic review investigated the benefits or harms of ES on DOMS and muscle recovery. Databases (PubMed, Medline, CENTRAL, EMBASE, CINAHL, PsycINFO, PEDro, LILACS, SPORTDiscus) were searched up to March, 31st 2021 for randomized controlled trials (RCTs) of athletes or untrained adults with DOMS treated with ES and compared to placebo/sham (simulation or without ES), or control (no intervention). Data were pooled in a meta-analysis. Risk of bias (Cochrane Collaboration tool) and quality of evidence (GRADE) were analyzed. Fourteen trials (n=435) were included in this review and 12 trials (n=389) were pooled in a meta-analysis. Evidence of very low to low quality indicates that ES does not prevent or treat DOMS as well as ES does not help to promote muscle recovery immediately, 24, 48, 72, 96 hours after the intervention. Only one study monitored adverse events. There are no recommendations that support the use of ES in DOMS and muscle recovery. PERSPECTIVES: No recommendations support the use of electrical stimulation in delayed-onset muscle soreness and muscle recovery in athletes and untrained adults. This means that electrical stimulation is not fruitful for this population according those protocols used. Therefore, unlikely that further randomized controlled trials with the same approach will yield promising results.

Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial.

BACKGROUND: Pressure injuries (PIs), especially in the sacral region are frequent, costly, and increase morbidity and mortality of patients in an intensive care unit (ICU). These injuries can occur as a result of prolonged pressure and/or shear forces. Neuromuscular electrical stimulation (NMES) can increase muscle mass and improve local circulation, potentially reducing the incidence of PI. METHODS: We performed a randomized controlled trial to assess the efficacy and safety of NMES in preventing PI in critically ill patients. We included patients with a period of less than 48 h in the ICU, aged ≥ 18 years. Participants were randomly selected (1:1 ratio) to receive NMES and usual care (NMES group) or only usual care (control group-CG) until discharge, death, or onset of a PI. To assess the effectiveness of NMES, we calculated the relative risk (RR) and number needed to treat (NNT). We assessed the muscle thickness of the gluteus maximus by ultrasonography. To assess safety, we analyzed the effects of NMES on vital signs and checked for the presence of skin burns in the stimulated areas. Clinical outcomes were assessed by time on mechanical ventilation, ICU mortality rate, and length of stay in the ICU. RESULTS: We enrolled 149 participants, 76 in the NMES group. PIs were present in 26 (35.6%) patients in the CG and 4 (5.3%) in the NMES group (p ˂ 0.001). The NMES group had an RR = 0.15 (95% CI 0.05-0.40) to develop a PI, NNT = 3.3 (95% CI 2.3-5.9). Moreover, the NMES group presented a shorter length of stay in the ICU: Δ = - 1.8 ± 1.2 days, p = 0.04. There was no significant difference in gluteus maximus thickness between groups (CG: Δ = - 0.37 ± 1.2 cm vs. NMES group: Δ = 0 ± 0.98 cm, p = 0.33). NMES did not promote deleterious changes in vital signs and we did not detect skin burns. CONCLUSIONS: NMES is an effective and safe therapy for the prevention of PI in critically ill patients and may reduce length of stay in the ICU. Trial registration RBR-8nt9m4. Registered prospectively on July 20th, 2018, https://ensaiosclinicos.gov.br/rg/RBR-8nt9m4.

Electrolipolysis associated with aerobic activity does not reduce subcutaneous adipose tissue of the abdominal region of young women: A randomized clinical trial.

OBJECTIVE: To analyze the effects of electrolysis, through a medium frequency current, associated to aerobic physical activity in the body composition of young women. METHODS: The study was composed of 34 sedentary women (24.35 ± 4.43 years, 71.30 ± 7.08 kg, 1.61 ± 0.06 m, 27.31 ± 1.67 kg/m2) which were evaluated for their anthropometric measures and body composition. The volunteers were randomly assigned to two group: Electrolyphysis plus Aerobic Exercise (gEEA): 17 volunteers were submitted to the application, for 60 min , of the Aussie current, followed by aerobic physical activity (77% of HRmax) on the trampoline for 40 min, through video-lessons of Jump; and Aerobic Exercise group (gEA): 17 volunteers performed only physical activity following the same parameters mentioned above. Each group performed its protocols twice weekly, for 5 weeks, totaling 10 sessions. For the data analysis, measures repeated ANOVA was performed to compare the means of the variables analyzed before and after the treatment protocols using the SPSS - 21.0 software, adopting a p ≤ 0.05. RESULTS: Although gEEA decreased suprailiac skinfold (p = 0.04), abdominal skinfold (p = 0.03) and circumference at umbilical scar (p = 0.02) in an intragroup analysis, these means differences in anthropometric measures were not important between-groups (p > 0.05). Furthermore, there were no effect of treatment on body composition (p > 0.05). CONCLUSION: To this studied condition, our results suggested that application of medium frequency electrolysis did not enhance the losses on anthropometric measures and body composition.

Intravaginal electrical stimulation increases voluntarily pelvic floor muscle contractions in women who are unable to voluntarily contract their pelvic floor muscles: a randomised trial.

QUESTION: In women who are unable to contract their pelvic floor muscles voluntarily, what is the effect of an intravaginal electrical stimulation regimen on their ability to contract the pelvic floor muscles and on self-reported urinary incontinence? DESIGN: Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: Sixty-four women with pelvic floor muscle function assessed by bi-digital palpation to be grade 0 or 1 on the Modified Oxford Scale. INTERVENTION: For 8 weeks, participants randomised to the experimental group received weekly 20-minute sessions of intravaginal electrical stimulation with instructions to attempt pelvic floor muscle contractions during the bursts of electrical stimulation in the final 10 minutes of each session. The control group received no intervention. OUTCOME MEASURES: The primary outcome was ability to voluntarily contract the pelvic floor muscles, evaluated through vaginal palpation using the Modified Oxford Scale. Secondary outcomes were prevalence and severity of urinary incontinence symptoms assessed by the International Consultation on Incontinence Questionnaire on Urinary Incontinence-Short Form (ICIQ-UI-SF) score from 0 to 21. RESULTS: Sixty-one participants provided outcome data. After the intervention, the ability to contract the pelvic floor muscles was acquired by 36% of the experimental group and 12% of the control group (absolute risk difference 0.24, 95% CI 0.02 to 0.43). The experimental group also improved by a mean of 2 points more than the control group on the ICIQ-UI-SF score (95% CI 0.02 to 3.97). CONCLUSION: In women who are unable to contract their pelvic floor muscles voluntarily, 8 weeks of intravaginal electrical stimulation with voluntary contraction attempts improved their ability to contract their pelvic floor muscles and reduced the overall severity and impact of urinary incontinence on quality of life. Although the main estimates of these effects indicate that the effects are large enough to be worthwhile, the precision of these estimates was low, so it is not possible to confirm whether the effects are trivial or worthwhile. TRIAL REGISTRATION: NCT03319095.

Patient with an implantable cardiac electrical stimulation device. What should the anesthesiologist know? / Paciente con dispositivo de estimulación eléctrica cardiaca implantable. ¿Qué debe saber el anestesiólogo?

Abstract Patients with implantable electric stimulation devices are challenging to the anesthesiologist since these cases demand a comprehensive knowledge about how the device operates, the indications for the implant and the implications that must be addressed during the perioperative period. This article is intended to provide the reader with clear and structured information so that the anesthesiologist will be able to safely deal with the situation of a patient with an implantable cardiac stimulation device, who has been programmed for emergent surgery. A search for the scientific evidence available was conducted in Pubmed / Medline, ScienceDirect, OVID, SciELO), for a non-systematic review. The incidence of the use of cardiac electric stimulation devices has been growing. Their operation is increasingly complex, and demands being constantly updated on the knowledge in the area.

Resumen El paciente portador de un dispositivo de estimulación eléctrica cardiaca implantable se convierte en un reto para el anestesiólogo debido a que implica un conocimiento integral que abarca su funcionamiento, las indicaciones que llevaron a su implante y las implicaciones que se deben abordar en el perioperatorio. Este artículo busca proporcionar al lector información clara y estructurada que le permita al anestesiólogo enfrentarse de forma segura al escenario de un paciente con un dispositivo de estimulación eléctrica cardiaca implantable programado para cirugía emergente. Se realizó una búsqueda de la evidencia científica disponible en bases de datos (Pubmed / Medline, ScienceDirect, OVID, SciELO), para una revisión no sistemática. La incidencia en el uso de dispositivos de estimulación eléctrica cardiaca viene en aumento. Su funcionamiento es cada vez más complejo lo cual implica una actualización permanente del conocimiento en esta área.

Immediate analgesic effect of transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) on chronic low back pain: Randomised placebo-controlled trial.

OBJECTIVE: To compare the immediate analgesic effect of transcutaneous nerve stimulation (TENS) and interferential current (IFC), with different combinations of parameters, in individuals with chronic low back pain (CLBP). METHODOLOGY: 280 individuals with CLBP were included in the study, both genders, randomized in 8 groups: GI2KHz/100Hz, GI2KHz/2Hz, GI4KHz/100Hz, GI4KHz/2Hz, placebo interferential group (GIP), GT100Hz, GT2Hz, and placebo TENS group (GTP). All individuals underwent a single application of TENS or IFC for 30min. The assessments were carried out prior to the intervention, as well as immediately after, with the following outcomes: pain intensity (Numeric Pain Rating Scale-NPRS), qualitative pain characteristics (McGill Pain Questionnaire-MPQ), and pressure pain threshold (PPT) by pressure algometry (PA) in 4 points of the low back region. RESULTS: In the intergroup comparison of NPRS, all intervention groups showed greater pain reduction compared to GTP (p < 0.05). In the total MPQ score, the groups that obtained significant results (p < 0.05) when compared to GTP were GT100Hz and GT2Hz, while the groups GT100Hz and GI4KHz/100Hz were significant when compared to GIP. In the PA, GI4KHz/100Hz showed an increase in the PPT in all points compared to GTP and GI2KHz/100Hz. CONCLUSION: Both TENS and IFC presented immediate analgesic effect in CLBP, with emphasis on the interferential current of 4 KHz modulated at 100Hz.

The molecular effects of electrical stimulation on the muscle components of the urethra of female rats after trauma by vaginal distention.

AIMS: To evaluate the expression of genes and proteins related to the urethral muscles of female rats after trauma by vaginal distention (VD) and after electrical stimulation therapy (EST). METHODS: We compared the urethras of four groups of 20 animals each: control without trauma (C), 7 (recent-trauma) and 30 days (late-trauma) post-VD, and VD-treated with EST. We evaluated the expression of myogenic regulatory factors MYOD1 and myogenin (MYOG); skeletal muscle myosin heavy chain 1, 2, and 3 (MYH1, MYH2, and MYH3); smooth muscle MYH11; and myosin light chain 9 (MYL9). We used real-time quantitative polymerase chain reaction, Western blot analysis, and immunohistochemistry. RESULTS: MYOD1 and MYOG genes were overexpressed in the recent-trauma group compared with the other groups (P < .05). MYH1 and MYH3 genes were upregulated in the recent-trauma group compared with the control and EST groups (P < .05). The MYH2 gene was overexpressed in the late-trauma group (P < .05), while the MYH2 protein was significantly increased in the EST group compared with control, recent-trauma and late-trauma groups by 5-, 3-, and 2.7-fold change, respectively (P < .05). MYL9 and MYH11 messenger RNA were overexpressed in both trauma groups compared with control and EST groups (P < .05). MYH11 protein was not different among the study groups (P > .05). CONCLUSIONS: EST enhances the recovery of the damaged urethral tissue of rats mainly by acting on the striated-muscle components. The MYH2 pathway underlies the positive effects of EST in the external urethral sphincter.

Efeito agudo da Transcutaneous Electric Nerve Stimulation (TENS) sobre a hipossalivação induzida pela radioterapia na região de cabeça e pescoço: um estudo preliminar / Transcutaneous Electrical Nerve Stimulation (TENS) on hyposalivation induced by radiotherapy in the head and neck region: a preliminary study

RESUMO Objetivo Verificar o efeito agudo da eletroestimulação sobre o fluxo salivar de pacientes com hipossalivação. Método Ensaio clínico não controlado que avaliou o efeito de uma única aplicação da Transcutaneous Electric Nerve Stimulation (TENS) sobre o fluxo salivar de 15 pacientes com hipossalivação induzida por radioterapia (RT), utilizada no tratamento de câncer de cabeça e pescoço. A média de idade dos pacientes foi de 56,8 ± 6,46 anos e o gênero masculino foi predominante (73%). A TENS foi programada com 50Hz de frequência, 250μs de largura de pulso e a intensidade foi ajustada ao longo dos 20 minutos conforme máxima tolerância. Os eletrodos foram fixados bilateralmente sobre a região das glândulas salivares. A avaliação do fluxo salivar foi realizada por meio de sialometria estimulada, antes e imediatamente após a aplicação da TENS. Resultados Em 80% dos casos, o tratamento oncológico incluiu quimioterapia. A RT foi aplicada em 80% dos casos na região e orofaringe, com intensidade média de 64,6 ± 7,27 Gy. Após a TENS, o fluxo salivar aumentou significativamente (p = 0,0051), passando de 0,05 (0,00; 0,40) mL/min para 0,10 (0,07;0,40) mL/min. A resposta à TENS foi diretamente correlacionada à intensidade da corrente elétrica tolerada (r = 0,553; p = 0,032) e à dose utilizada na RT (r = -0,514; p = 0,050). Conclusão A TENS aumentou significativamente o fluxo salivar de pacientes com hipossalivação induzida pela RT.

ABSTRACT Purpose To verify the acute effect of electrostimulation on the salivary flow of patients with hyposalivation. Methods Uncontrolled clinical trial evaluating 15 patients with hyposalivation induced by radiotherapy (RT) used for head and neck cancer treatment. Mean age of the patients was 56.8 ± 6.46 years. Males outnumbered females (73%). Transcutaneous Electrical Nerve Stimulation (TENS) was adjusted with 50Hz of frequency and 250μs of pulse width. Intensity was adjusted over a 20-minute period according to maximum tolerance. The electrodes were attached bilaterally on the region of the salivary glands. Evaluation of the salivary flow was performed through sialometry before and immediately after application of TENS. Results The most prevalent region for RT was the oropharynx (80.0% of cases). The mean dose used in RT was 64.6 ± 7.27 Gy. After TENS, salivary flow increased significantly (p = 0.0051) from 0.05 (0.00; 0.40) mL/min to 0.10 (0.07: 0.40) mL/min. The response to TENS was directly correlated with the intensity of the tolerated electric current (r = 0.553; p = 0.032) and the dose used in RT (r = -0.514; p = 0.050). Conclusion TENS was able to increase the salivary flow rate of patients with RT-induced hyposalivation.

Comparison of the effects of interferential current between male and female healthy adults / Comparação dos efeitos da corrente interferencial entre homens e mulheres saudáveis

AIMS: To assess accommodation phenomena characteristics (threshold, time and amplitude/intensity) during stimulation with interferential current, comparing male and female healthy adults. METHODS: A non randomized clinical trial with intentional sampling by gender included 30 healthy adult volunteers aged between 18 and 25 years, who were divided in two groups (15 in the Female Group and 15 in the Male Group) and received a tetrapolar interferential current for 20 minutes, close to L1 and L5 vertebrae. The subjects were instructed to refer an intense but comfortable paresthesia sensation and to report the moment it diminished (accommodation), requiring increasing of the current intensity. The first three events of accommodation (AV1, AV2 and AV3), including time and amplitude threshold, were analyzed. The differences from AV1 to AV2 (D1) and AV2 to AV3 (D2) were also considered. The number of accommodations for each subject during the 20 minutes experiment was identified. ANOVA and Student's t-test were used for analysis and the significance level was set at 5%. RESULTS: In the Male Group the mean time for accommodation was higher in AV3 compared to AV1 and AV2. In the Female Group the accommodation mean time was higher in AV3 in relation to AV2, and in AV2 in relation to AV1. No differences were found in the Male Group for D1 and D2, but in the Female Group, D2 was superior to D1. Women were accommodated more quickly than men in all three assessments, but the differences between one evaluation and another were constant considering both groups. Both groups showed similar current intensity behavior comparing the three evaluations within the same group. In the comparison between groups, women had lower mean values of intensity in the three evaluations. The Female Group had 7.5±1.5 accommodations, and the Male Group had 5.9±2.0 accommodations (p=0.0367) during the 20 minutes of the experiment. CONCLUSIONS: In this sample of healthy young adults, men required higher interferential current amplitude to obtain a comfortable paresthesia and took more time to have accommodations, while women had more accommodation episodes.

OBJETIVOS: Avaliar características dos fenômenos de acomodação (limiar, tempo e amplitude/intensidade) durante estimulação com corrente interferencial, comparando adultos saudáveis do gênero masculino e feminino. MÉTODOS: Um ensaio clínico não randomizado com amostragem intencional por gênero incluiu 30 voluntários adultos saudáveis com idade entre 18 e 25 anos, que foram divididos em dois grupos (15 no Grupo Feminino e 15 no Grupo Masculino) e receberam uma corrente interferencial tetrapolar por 20 minutos, na altura das vértebras L1 e L5. Os sujeitos foram instruídos a referir uma sensação de parestesia intensa mas confortável e relatar o momento em que ela diminuiu (acomodação), requerendo aumento da intensidade da corrente. Foram analisados os três primeiros fenômenos de acomodação (AV1, AV2 e AV3), incluindo tempo e limiar de amplitude. Foram consideradas também as diferenças entre AV1 e AV2 (D1) e entre AV2 e AV3 (D2). Foi identificado o número total de acomodações para cada sujeito nos 20 minutos do experimento. Para a análise foram usados ANOVA e teste t de Student e o nível de significância foi definido em 5%. RESULTADOS: No Grupo Masculino, o tempo médio para acomodação foi maior em AV3 comparado com AV1 e AV2. No Grupo Feminino, o tempo médio foi maior em AV3 em relação a AV2 e em AV2 em relação a AV1. Não foram encontradas diferenças no Grupo Masculino entre D1 e D2, mas no Grupo Feminino, D2 foi superior a D1. As mulheres apresentaram acomodação mais rapidamente do que os homens em todas as três avaliações, mas as diferenças entre uma avaliação e outra foram constantes considerando os dois grupos. Ambos os grupos apresentaram comportamento semelhante na intensidade da corrente, comparando as três avaliações dentro do mesmo grupo. Na comparação entre os grupos, as mulheres apresentaram valores médios de intensidade mais baixos em todas as três avaliações. O Grupo Feminino apresentou 7,5±1,5 acomodações e o Grupo Masculino 5,9±2,0 acomodações (p=0,0367) durante os 20 min do experimento. CONCLUSÕES: Nesta amostra de jovens adultos saudáveis, os homens necessitaram de corrente interferencial com maior amplitude para obter uma parestesia confortável e demoraram mais tempo para apresentar acomodação, enquanto as mulheres tiveram mais episódios de acomodação.

Combining physical training with transcranial direct current stimulation to improve gait in Parkinson's disease: a pilot randomized controlled study.

OBJECTIVE: To improve gait and balance in patients with Parkinson's disease by combining anodal transcranial direct current stimulation with physical training. DESIGN: In a double-blind design, one group (physical training; n = 8) underwent gait and balance training during transcranial direct current stimulation (tDCS; real/sham). Real stimulation consisted of 15 minutes of 2 mA transcranial direct current stimulation over primary motor and premotor cortex. For sham, the current was switched off after 30 seconds. Patients received the opposite stimulation (sham/real) with physical training one week later; the second group (No physical training; n = 8) received stimulation (real/sham) but no training, and also repeated a sequential transcranial direct current stimulation session one week later (sham/real). SETTING: Hospital Srio Libanes, Buenos Aires, Argentina. SUBJECTS: Sixteen community-dwelling patients with Parkinson's disease. INTERVENTIONS: Transcranial direct current stimulation with and without concomitant physical training. MAIN MEASURES: Gait velocity (primary gait outcome), stride length, timed 6-minute walk test, Timed Up and Go Test (secondary outcomes), and performance on the pull test (primary balance outcome). RESULTS: Transcranial direct current stimulation with physical training increased gait velocity (mean = 29.5%, SD = 13; p < 0.01) and improved balance (pull test: mean = 50.9%, SD = 37; p = 0.01) compared with transcranial direct current stimulation alone. There was no isolated benefit of transcranial direct current stimulation alone. Although physical training improved gait velocity (mean = 15.5%, SD = 12.3; p = 0.03), these effects were comparatively less than with combined tDCS + physical therapy (p < 0.025). Greater stimulation-related improvements were seen in patients with more advanced disease. CONCLUSIONS: Anodal transcranial direct current stimulation during physical training improves gait and balance in patients with Parkinson's disease. Power calculations revealed that 14 patients per treatment arm (α = 0.05; power = 0.8) are required for a definitive trial.

The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence / Influencia da intervencao fisioterapeutica ambulatorial sobre a musculatura do assoalho pelvico em mulheres com incontinencia urinaria

OBJECTIVE: To assess the effect of a weekly, short-term physical therapy intervention on the pelvic floor muscles and urinary incontinence (UI) among patients of the public health system. METHOD: Quasi-experimental before-and-after study. Clinical history and function evaluation were performed using perineal bidigital maneuvers and perineometry. The intervention consisted of transvaginal electrical stimulation and pelvic floor kinesiotherapy. Data were analyzed using the paired t test or Wilcoxon signed-rank test, Pearson product-moment correlation coefficient or Spearman's rank correlation coefficient. A value of P<0.05 was considered significant. RESULTS: Eight-two women 55.1±10.9 years-old were evaluated. Mixed urinary incontinence (MUI), stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were observed in 52.4%, 36.6% and 11%, respectively. The length of UI was 6.0 years (3.0-10). Approximately 13.64 physical therapy sessions were held on average. There was no difference in perineometry measurements following the intervention (40.6±24.1 versus 41.7±25.4, P=0.098). Muscle function significantly increased (P<0.01) in the bidigital maneuver. The patients reported being continent or satisfied with the treatment in 88.9% of cases. CONCLUSIONS: The results demonstrated an increase in muscle function and the attainment of urinary continence or treatment satisfaction in most cases. .

OBJETIVO: Verificar a influência de uma intervenção fisioterapêutica semanal e de curta duração sobre a musculatura do assoalho pélvico e sobre a incontinência urinária (IU) em usuárias da rede pública de saúde. MÉTODO: Estudo quase-experimental do tipo antes e depois. Foi realizada anamnese e avaliação da função perineal por meio da manobra bidigital e perineometria. A intervenção consistiu em eletroestimulação transvaginal e cinesioterapia pélvica. Os dados foram analisados por meio do teste t pareado ou Wilcoxon, regressão linear de Pearson ou Spearman. Um valor de P<0,05 foi considerado como significativo. RESULTADOS: Foram avaliadas 82 mulheres com idade de 55,1±10,9 anos. Incontinência urinária mista (IUM), incontinência urinária de esforço (IUE) e incontinência urinária de urgência (IUU) foram observadas em 52,4%, 36,6% e 11%, respectivamente. A duração da IU foi de 6,0 anos (3,0-10). Foram realizadas, em média, 13,64 sessões fisioterapêuticas. Não houve diferença, após a intervenção, nas medidas da perineometria (40,6±24,1 versus 41,7±25,4, P=0,098). Na manobra bidigital, a função muscular aumentou significativamente (P<0,01). Em 88,9% dos casos, as pacientes informaram estar continentes ou satisfeitas com o tratamento. CONCLUSÕES: Os resultados mostraram aumento da função muscular e obtenção da continência urinária ou satisfação com o tratamento na maioria dos casos. .