Daniella Araújo de Oliveira

Crioterapia e cinesioterapia no membro superior espástico no acidente vascular cerebral

INTRODUCTION: The spasticity in patients with sequel of stroke causes limitations in activities of daily life and becomes an important risk fator for the development of static deformities if not treated. OBJECTIVE: This study aimed to evaluate the effect of cryotherapy combined with kinesiotherapy to the standard postural flexor and the degree of spasticity of the upper limb of patients with stroke. METHODOLOGY: Seven volunteers participated in this research. The routine of care included the application of ice on the extensor muscles of the wrist and fingers (cryostimulation) for 1 minute and 40 seconds and kinesiotherapy in upper limb spasticity, totaling 10 minutes of action, two times a week during ten sessions. The default posture adopted by the upper limb flexor spastic was evaluated from the goniometry of the wrist joints, metacarpofalangeas and proximal interphalangeal. The first measure bearing was obtained after the arrival of the patient to the session. The second measure occurred after application of cryotherapy and the third after 10 minutes of intervention. The assessment of the spasticitys degree occurred through the Modified Ashworth Scale and implemented before the end of the intervention. RESULTS: The therapy through cryostimulation and kinesiotherapy was efficient in reducing the flexor posture of the upper limb and the degree of spasticity in the three joints, and this effect is observed at each session and at the end of ten sessions. CONCLUSION: However further studies are needed using a larger sample for further clarification of these findings.

Headache precipitated by Valsalva maneuvers in patients with congenital Chiari I malformation

The objective of this study was to characterize the headache precipitated by Valsalva maneuvers associated with Chiari type I malformation (CM-1). Nineteen patients were evaluated, with ages ranging from 30 to 75 years. Ten of them presented headache. Pain was more prevalent in the occipital (80%) and frontal region (60%). The headaches were of significantly shorter duration in the women compared with the men. The frequency of headache crises was relatively high. All patients with Valsalva-related headache suffered from at least one episode per month. The most prevalent precipitating factors were coughing, which is well described in the literature, and sexual activity, which only now is recognized as an event associated with CM-1.

The characteristics of head pain in response to an experimental cold stimulus to the palate: An observational study of 414 volunteers

Objective: The objective of this article is to study the characteristics of headaches following an experimental cold stimulus and evaluate whether the ICHD-II criteria for headache attributed to ingestion or inhalation of a cold stimulus (HICS) are adequate for the diagnosis of the headache induced by ice on the palate area (ice-induced headache (IH)). Results: One hundred and fifty-three out of 414 (37.0%) individuals tested had IH, but only 77/153 (50.3%) satisfied the ICHD-II criteria. The frontal (60.8%) and temporal (48.4%) areas were the most affected ones, with bilateral (77.1%) predominance, often of the pulsatile type (41.2%). One hundred and forty-seven out of 379 (38.8%) individuals who presented with a previous history of primary headache presented with IH, while only six out of 35 (17.1%) who had no history of previous headache reported pain in the test (OR 3.063, 95% CI 1.241–7.557). The ice-induced headache test was positive in 115/240 (47.9%) of the migraine sufferers and in 32/139 (23%) of the tension-type headache sufferers (OR 3.076, 95% CI 1.924–4.918). Conclusion: IH is predominantly frontotemporal, bilateral and throbbing, most commonly affecting migraine sufferers, and the ICHD-II criteria are insufficient for classifying all individuals. We should, however, recommend caution regarding such a generalization from our findings with experimentally provoked cold stimulus headache to cold stimulus headache in general (i.e. HICS, ICHD-II).

Alice in Wonderland Syndrome, Burning Mouth Syndrome, Cold Stimulus Headache, and HaNDL: Narrative Review

Unusual headache syndromes are not as infrequent in clinical practice as was generally believed. About three fourths of the classified headache disorders found in the ICHD‐II can be considered rare.

The Frequent Unusual Headache Syndromes: A Proposed Classification Based on Lifetime Prevalence.

There is no agreement on a single cutoff point or prevalence for regarding a given disease as rare. The concept of what is a rare headache disorder is even less clear and the spectrum from a very frequent, frequent, occasional to rare headache syndrome is yet to be established.

Life quality, depression and anxiety symptoms in chronic post-traumatic headache after mild brain injury

Post-traumatic headache (PTH) is the most common symptom found in the post-traumatic syndrome, whose onset occurs within seven days of the trauma. The condition is characterized as acute when it persists for up to 3 months. PTH beyond this period is considered chronic. Objectives The objective of this study was to determine the clinical features of chronic post-traumatic headache (cPTH) and its association with depression, anxiety and quality of life. Methods A total of 73 female subjects were evaluated. Patients were divided into three groups: (a) group without headache, CONTROL, n=25; (b) cPTH group, n=19; and (c) MIGRAINE, n=29, with all subjects in the 11-84 year age group. Symptoms of anxiety and depression were evaluated by the Beck inventories of anxiety and depression, and quality of life assessed by the Lipp and Rocha quality of life inventory. Qualitative variables were analyzed using the Chi-square or Fishers exact tests and expressed as percentages whereas quantitative variables were analyzed by ANOVA, Mann-Whitney or Kruskal-Wallis tests with data expressed as mean±standard deviation, p<0.05. Results Subjects with cPTH presented with headache manifesting similar features to those found in migraine. The cPTH group was associated with similar levels of anxiety and depression to the migraine group and higher than the CONTROL (p<0.001). Quality of life of individuals with cPTH was similar to that of subjects with migraine and lower than CONTROL subjects (p<0.05). Conclusions cPTH presents similar clinical characteristics to migraine. Subjects with cPTH had high levels of anxiety and depression symptoms and reduced quality of life.

Efficacy of proprioceptive neuromuscular facilitation compared to other stretching modalities in range of motion gain in young healthy adults: A systematic review

ABSTRACT The objective of this study was to evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) on range of motion (ROM) gain in young healthy adults. We performed a systematic review of randomized controlled trials and quasi-randomized trials, including young healthy adults. The interventions were: PNF compared with different PNF techniques, control, other muscle stretching exercises and musculoskeletal manipulations. The outcome measures were: articular ROM and adverse effects. The final number of included studies was 46, involving 1,864 adults. There was difference on ROM comparing assisted hold-relax (HR) on diagonal plane to control, based on very low-quality evidence. There was also difference on ROM comparing assisted HR to self-HR; self-contract-relax (CR) to control; assisted CR contract to control; and assisted HR contract to control, based on low-quality evidence. Moderate-quality evidence shows that results differ between self HR and control (SMD: 0.95; 95%CI 0.03, 1.86; I249%; P = 0.16) in terms of ROM gain. When performing the other comparisons, the results were based on low or very low-quality evidence and do not allow to state if PNF is more or less effective than other stretches for improving ROM in healthy young adults. No adverse effects were mentioned.

Diagnostic accuracy of magnetic resonance imaging in post-traumatic brachial plexus injuries: A systematic review

Computed Tomographic Myelography (CTM) is a gold-standard imaging test for evaluating the brachial plexus and has been used for a long time. Another imaging test more recently used is Magnetic Resonance imaging (MRI), which is also part of the plexus evaluation. The purpose of this study was to determine the accuracy of MRI in diagnosing post-traumatic injuries of the brachial plexus. We conducted a Systematic Review with cross-sectional studies of diagnostic accuracy. Studies with populations presenting post-traumatic brachial plexus injury, over 16 years old, both genders, and examined by CT Myelography and MRI were evaluated. The trial resulted in three studies that covered the inclusion criteria. The sample consisted of 46 participants. The tool Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the studies, and the software RevMan was used to identify the homogeneity of the studies that entered the analysis. The study was registered in PROSPERO under the number CRD42016041720. Studies showed moderate to high risk of bias, with low or very low quality of evidence due to the limitations of studies and differences in comparing the assessment groups. The heterogeneity of the studies made it impossible to create meta-analyzes. MRI has been an excellent test for assessing traumatic brachial plexus injuries in clinical practice; however, the quantitative analysis of studies identified a lack in methodological rigor. Future studies should focus on methodological rigor, providing more accurate assessments of modalities and their benefits.

Effect of low frequency transcutaneous electrical nerve stimulation of TE5 (waiguan) and PC6 (neiguan) acupoints on cold-induced pain

[Purpose] This study assesse the effect of low frequency transcutaneous electrical nerve stimulation (TENS) of theTE5 (waiguan) and PC6 (neiguan) acupoints on cold-induced pain. [Subjects and Methods] Forty-eight subjects were divided by convenience into three groups: TENS with electrodes of 1 cm2 area, TENS with electrodes of area 15 cm2 and a placebo group. The study consisted of three phases: cold-induced pain without electroanalgesia, cold-induced pain with electroanalgesia or placebo, and cold-induced pain post-electroanalgesia or placebo. [Results] Acupuncture like TENS increased the pain threshold latency during treatment (45.7 ± 11.7s) compared to pre-treatment (30.9 ± 8.9s) in the TENS group with 1 cm2 electrodes. In the TENS group with 15 cm2 electrodes, the pain threshold latency increased at post-treatment (36.2 ± 12.9s) compared to pre-treatment (25.5 ± 7.4s). The placebo group showed no significant changes. The group with 1 cm2 electrodes showed a significantly higher pain threshold latency (45.7 ± 11.7s) than the other two groups. At post-treatment, the pain threshold latencies of both the 1 cm2 (39.4 ± 11.5s) and 15 cm2 (36.2 ± 12.9s) TENS group were higher than that of the placebo group (22.4 ± 7.4s). [Conclusion] Acupuncture like TENS applied to PC6 and TE5 acupoints increased the pain threshold latency. The pain intensity was reduced by TENS with an electrode area of 1 cm2.

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.