Elaine Caldeira de Oliveira Guirro

Análise da pressão plantar e do equilíbrio postural em diferentes fases da gestação

OBJECTIVE: To analyze plantar pressure and postural balance during the three trimesters of pregnancy, and also to correlate these with anthropometric characteristics. METHOD: Sixty volunteers participated in this study, with a mean age of 23.3 ± 5.5 years. There were 15 subjects in each group: non-pregnant (C), first trimester (1T), second trimester (2T) and third trimester (3T). Evaluations were performed in bipedal stance with open eyes, using a pressure platform. The following variables were analyzed in the right and left feet: peak pressures in the whole foot (WFP), forefoot (FFP) and hindfoot (HFP); distance between the medial borders of the foot (width of support base); the distance from the center of force to the anterior (COF-A) and posterior (COF-P) limits of the foot; anteroposterior (AP) and mediolateral (ML) COF displacements; and the contact area (CA). RESULTS: There were no differences in peak contact pressures and COF-A and COF-P distances between the groups. The AP displacement was greater (p 0.05) between the groups regarding ML displacement. There was a positive correlation between weight gained during pregnancy and CA for the 2T group, and between weight gain and WFP in the right feet in the 1T group. CONCLUSION: The results demonstrate the influence of the anatomical and physiological changes inherent to pregnancy on plantar pressure. They also suggest that postural equilibrium decreases in the third trimester, associated with greater AP displacement during this phase.

Immediate and lasting improvements in weight distribution seen in baropodometry following a high-velocity, low-amplitude thrust manipulation of the sacroiliac joint

The biomechanics of the sacroiliac joint makes the pelvic segment responsible for proper weight distribution between lower extremities; however, it is known to be susceptible to altered mobility. The objective of this study was to analyze baropodometric responses following thrust manipulation on subjects with sacroiliac joint restrictions. Twenty asymptomatic subjects were submitted to computerized baropodometric analysis before, after, and seven days following sacroiliac manipulation. The variables peak pressure and contact area were obtained at each of these periods as the average of absolute values of the difference between the right and left foot based on three trials. Data revealed significant reduction only in peak pressure immediately after manipulation and at follow-up when compared to pre-manipulative values (p < 0.05). Strong correlation was found between the dominant foot and the foot with greater contact area (r = 0.978), as well as between the side of joint restriction and the foot with greater contact area (r = 0.884). Weak correlation was observed between the dominant foot and the foot with greater peak pressure (r = 0.501), as well as between the side of joint restriction and the foot with greater peak pressure (r = 0.694). The results suggest that sacroiliac joint manipulation can influence peak pressure distribution between feet, but contact area does not seem to be related to the biomechanical aspects addressed in this study.

Reliability of different methodologies of infrared image analysis of myofascial trigger points in the upper trapezius muscle

BACKGROUND: Infrared thermography is recognized as a viable method for evaluation of subjects with myofascial pain. OBJECTIVE: The aim of the present study was to assess the intra- and inter-rater reliability of infrared image analysis of myofascial trigger points in the upper trapezius muscle. METHOD: A reliability study was conducted with 24 volunteers of both genders (23 females) between 18 and 30 years of age (22.12±2.54), all having cervical pain and presence of active myofascial trigger point in the upper trapezius muscle. Two trained examiners performed analysis of point, line, and area of the infrared images at two different periods with a 1-week interval. The intra-class correlation coefficient (ICC2,1) was used to assess the intra- and inter-rater reliability. RESULTS: With regard to the intra-rater reliability, ICC values were between 0.591 and 0.993, with temperatures between 0.13 and 1.57 °C for values of standard error of measurement (SEM) and between 0.36 and 4.35 °C for the minimal detectable change (MDC). For the inter-rater reliability, ICC ranged from 0.615 to 0.918, with temperatures between 0.43 and 1.22 °C for the SEM and between 1.19 and 3.38 °C for the MDC. CONCLUSION: The methods of infrared image analyses of myofascial trigger points in the upper trapezius muscle employed in the present study are suitable for clinical and research practices.

Assessment of Pelvic Floor Muscle Pressure in Female Athletes

To evaluate the pressure of the pelvic floor muscles in female athletes and the associated signs and symptoms of stress urinary incontinence.

Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a randomized controlled trial

BACKGROUND Neuromuscular electrical stimulation (NMES) is widely treatment for stress urinary incontinence (SUI) but there is no consensus in literature regarding the most effective treatment parameters. OBJECTIVE To compare two NMESintra-vaginal protocols for the treatment of SUI in women. METHODS The study included 20 volunteers with an average age of 55.55±6.51 years and with the clinical diagnosis of SUI. Volunteers were randomly divided into two groups: group 1 (G1) received NMES with medium-frequency current and group 2 (G2) received NMES with low-frequency current. Functional assessments of pelvic floor muscles (PFM) were performed by perineometry. The severity of signs and symptoms were objectively evaluated using the 1 hour pad test and subjectively evaluated using a visual analog scale that measured the discomfort caused by the SUI. Shapiro-Wilk test was used to analyze data normality, and the Friedman test was used to analyze nonparametric data. For analysis of symptoms related to SUI the Fisher exact test and the Mann-Whitney test were used. Significance level of 5% was set for all data analysis. RESULTS No significant differences (p>0.05) were found between groups for any of the variable assessed. The within group analysis of initial and final evaluations (after NMES) demonstrated significant differences (p<0.05) in amount of urine lost, the discomfort caused by urinary incontinence and perineal pressure for both treatment groups. CONCLUSION The two NMES protocols applied were equally effective in the treatment of SUI.

Effect of Laser (670 nm) on Healing of Wounds Covered with Occlusive Dressing: A Histologic and Biomechanical Analysis

OBJECTIVES To analyze the effects of low-level laser therapy (LLLT), 670 nm, with doses of 4 and 7 J/cm(2), on the repair of surgical wounds covered by occlusive dressings. BACKGROUND DATA The effect of LLLT on the healing process of covered wounds is not well defined. MATERIALS AND METHODS For the histologic analysis with HE staining, 50 male Wistar rats were submitted to surgical incisions and divided into 10 groups (n = 5): control; stimulated with 4 and 7 J/cm(2) daily, for 7 and 14 days, with or without occlusion. Reepithelization and the number of leukocytes, fibroblasts, and fibrocytes were obtained with an image processor. For the biomechanical analysis, 25 rats were submitted to a surgical incision and divided into five groups (n = 5): treated for 14 days with and without occlusive dressing, and the sham group. Samples of the lesions were collected and submitted to the tensile test. One-way analysis of variance was performed, followed by post hoc analysis. A Tukey test was used on the biomechanical data, and the Tamhane test on the histologic data. A significance level of 5% was chosen (p ≤ 0.05). RESULTS The 4 and 7J/cm(2) laser with and without occlusive dressing did not alter significantly the reepithelization rate of the wounds. The 7 J/cm(2) laser reduced the number of leukocytes significantly. The number of fibroblasts was higher in the groups treated with laser for 7 days, and was significant in the covered 4 J/cm(2) laser group. CONCLUSIONS Greater interference of the laser-treatment procedure was noted with 7 days of stimulation, and the occlusive dressing did not alter its biostimulatory effects.

High-voltage electrical stimulation improves nerve regeneration after sciatic crush injury.

BACKGROUND Peripheral nerve injury causes prolonged functional limitation being a clinical challenge to identify resources that accelerates its recovery. OBJECTIVES To investigate the effect of high-voltage electrical stimulation (HVES) on the morphometric and functional characteristics of the regenerated nerve after crush injury in rats. METHODS Twenty Wistar rats were randomly allocated into 4 groups: Control (CON) - without injury and without HVES; Denervated (D) - sciatic nerve crush only; Denervated + HVES - sciatic nerve crush and HVES; SHAM - without injury but HVES. The HVES and SHAM groups were stimulated (100 Hz; minimum voltage of 100 V, 20 μs, 100 μs interpulse interval) for 30 min/day, 5 days/week. The sciatic functional index (SFI) was evaluated before the injury and at the 7th, 14th and 21st postoperatory (PO) days. Neural components and the area density of connective tissue, blood vessels and macrophages were analyzed. RESULTS Axonal diameter was higher on the HVES than on D group, reaching almost 80% above the control values after 21 days (p<0.05). Fiber diameter and myelin sheath thickness were higher on the HVES than on D group (p<0.05) reaching 96.5% and 100% of the control values, respectively. Functional recovery at the 14th PO day was better on group HVES. The macrophages and connective tissue area density was lower on the HVES group, while blood vessels number did not differ among groups. CONCLUSIONS The HVES accelerated the functional recovery, potentiated the nerve fibers maturation and decreased macrophages and connective tissue area density, suggesting acceleration of neural repair.

Comparison of active and passive forces of the pelvic floor muscles in women with and without stress urinary incontinence

BACKGROUND The reduction of the pelvic floor muscles (PFM) strength is a major cause of stress urinary incontinence (SUI). OBJECTIVES To compare active and passive forces, and vaginal cavity aperture in continent and stress urinary incontinent women. METHOD The study included a total of thirty-two women, sixteen continent women (group 1--G1) and sixteen women with SUI (group 2--G2). To evaluate PFM passive and active forces in anteroposterior (sagittal plane) and left-right directions (frontal plane) a stainless steel specular dynamometer was used. RESULTS The anteroposterior active strength for the continent women (mean±standard deviation) (0.3±0.2 N) was greater compared to the values found in the evaluation of incontinent women (0.1±0.1 N). The left-right active strength (G1=0.43±0.1 N; G2=0.40±0.1 N), the passive force (G1=1.1±0.2 N; G2=1.1±0.3 N) and the vaginal cavity aperture (G1=21±3 mm; G2=24±4 mm) did not differ between groups 1 and 2. CONCLUSION The function evaluation of PFM showed that women with SUI had a lower anteroposterior active strength compared to continent women.

Avaliação da sinergia da musculatura abdomino-pélvica em nulíparas com eletromiografia e biofeedback perineal

PURPOSE: to verify the behavior of the abdominal and perineal musculature in respiratory changes induced in 15 nulliparous women without previous history of perineal or respiratory failures, with age ranging from 20 to 26 years (22.9±1.83). METHODS: the electrical abdominal and perineal activities were analyzed simultaneously through surface electromyography and perineal pressure (PP) obtained through digital biofeedback. The volunteers were told to accomplish three types of respiratory maneuvers: maximum inspiration (PImax), maximum expiration (PEmax) and Valsalva (VM), at random. The electromyographic signs were collected by the AqDados® (4.4) software for binary language ASCII, being processed later using the Matlab® (6.5.1) software. The statistical analysis of the envoltory (EN) of the signal was accomplished through Spearman correlation and Kruskal-Wallis test, and the level of significance was set at 5% (p<0.05). RESULTS: it was observed that PP was larger in PImax (2.98±2,38), followed by VM (29.10±10.68), both being overcome by PEmax (38.22±9,98) (p<0.01). A positive correlation between PEmax and PP (p<0.01), as well as between EN of the perineal and abdominal musculature in PEmax and PImax (p<0.05 and p=0,03, respectively) could be shown. The results regarding VM were not significant, when PP and EN were analyzed. CONCLUSION: it was possible to identify the presence of abdomino-pelvic synergy during the execution of breathing maneuvers, especially in relation to PEmax.

Evolution of Skin Temperature after the Application of Compressive Forces on Tendon, Muscle and Myofascial Trigger Point

Some assessment and diagnosis methods require palpation or the application of certain forces on the skin, which affects the structures beneath, we highlight the importance of defining possible influences on skin temperature as a result of this physical contact. Thus, the aim of the present study is to determine the ideal time for performing thermographic examination after palpation based on the assessment of skin temperature evolution. Randomized and crossover study carried out with 15 computer-user volunteers of both genders, between 18 and 45 years of age, who were submitted to compressive forces of 0, 1, 2 and 3 kg/cm2 for 30 seconds with a washout period of 48 hours using a portable digital dynamometer. Compressive forces were applied on the following spots on the dominant upper limb: myofascial trigger point in the levator scapulae, biceps brachii muscle and palmaris longus tendon. Volunteers were examined by means of infrared thermography before and after the application of compressive forces (15, 30, 45 and 60 minutes). In most comparisons made over time, a significant decrease was observed 30, 45 and 60 minutes after the application of compressive forces (p < 0.05) on the palmaris longus tendon and biceps brachii muscle. However, no difference was observed when comparing the different compressive forces (p > 0.05). In conclusion, infrared thermography can be used after assessment or diagnosis methods focused on the application of forces on tendons and muscles, provided the procedure is performed 15 minutes after contact with the skin. Regarding to the myofascial trigger point, the thermographic examination can be performed within 60 minutes after the contact with the skin.