Alberto Galvão de Moura Filho

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.

Reproducibility of the pressure biofeedback unit in measuring transversus abdominis muscle activity in patients with chronic nonspecific low back pain

The Pressure Biofeedback Unit (PBU) is often used by clinicians and researchers to indirectly evaluate transversus abdominis (TrA) muscle activity. The purpose of this study was to evaluate the inter and intra-examiner reproducibility of the PBU in measuring TrA muscle activity in fifty patients with chronic nonspecific low back pain. This study was performed using a test-retest design with a seven day interval. An Intraclass Correlation Coefficient (ICC(2,1)) of 0.74 (95% CI 0.54 to 0.85) and 0.76 (95% CI 0.58 to 0.86) was observed for the intra and inter-examiner reproducibility, respectively. The intra-examiner agreement (Limits of Agreement - LOA = 2.1 to -1.8 mmHg) and the inter-examiner agreement (LOA = 2.0 to -1.9 mmHg) were within the limits of agreement on 95% of occasions. The reproducibility of PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain ranged from satisfactory to excellent.

Programa de saúde da família: proposta para identificação de fatores de risco para o desenvolvimento neuropsicomotor

OBJECTIVES: To investigate the occurrence of delayed neuropsychological and motor development in a community assisted through the Family Health Program and to evaluate its association with possible biological, environmental and socioeconomic risk factors. METHODS: The sample consisted of 31 five-year-old children who were evaluated using the Neurological Development Test, following guidelines proposed by Coelho (1999)*. The study was carried out at the Family Health Program (FHP) center in the Brasilit area of Recife, PE, Brazil. Data were collected using a questionnaire that sought information on the child, its mother/guardian, the familys socioeconomic status and residence. Fishers exact test was used for the statistical analysis of the results, with a significance level of 5%. RESULTS: Appendicular coordination was the parameter with the highest frequency of deficits (90%) and static balance was the item least compromised (12.9%). The frequency of static balance deficits was higher among children who did not attend day care centers (p=0.0163) and among those who spent less time with their mother (p=0.0278). Motor persistence deficits were statistically associated with age of entry into day care (p=0.0415) and father-child time (p=0.0436). CONCLUSIONS: The FHP was not only a valuable setting for developing studies of this nature but also an appropriate setting for child development follow-up.

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

ABSTRACT 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.

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 &agr; = .79; after excluding 1 item at a time, Cronbach &agr; = .73‐.84), good testretest 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.

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

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).

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], Tukeys 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.