Fábio Marcon Alfieri

Efficacy of Transcranial Direct Current Stimulation Coupled with a Multidisciplinary Rehabilitation Program for the Treatment of Fibromyalgia

Pain control in fibromyalgia patients is limited no matter the therapeutic regimens used. Recent data have shown that daily sessions of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) in patients with fibromyalgia (FM) are associated with reduction of pain perception. Objective: We aimed to test whether active tDCS, as compared with sham tDCS, combined with multidisciplinary rehabilitation is associated with significant clinical gains in fibromyalgia. Design: This was a randomized, double-blinded controlled trial. Subjects: 23 patients were randomized to receive weekly sessions of multidisciplinary rehabilitation approach combined with sham or anodal tDCS of M1. Patients were evaluated for pain with VAS and for quality of life with SF-36, fibromyalgia pain questionnaire and health assessment questionnaire by a blinded rater before and after the 4 month period of rehabilitation. Results: Patients tolerated tDCS treatment well, without adverse effects. Patients who received active treatment had a significantly greater reduction of SF-36 pain domain scores (F(2,21)=6.57; p=0.006) and a tendency of higher improvement in Fibromyalgia Impact Questionnaire (FIQ) scores after (p=0.056) as compared with sham tDCS/standard treatment, but no differences were observed in the other domains. Conclusions: Although active tDCS was associated with superior results in one domain (SF-36 pain domain), the lack of significance in the other domains does not fully support this strategy (weekly tDCS) combined with a multidisciplinary approach.

Functional mobility and balance in community-dwelling elderly submitted to multisensory versus strength exercises

It is well documented that aging impairs balance and functional mobility. The objective of this study was to compare the efficacy of multisensory versus strength exercises on these parameters. We performed a simple blinded randomized controlled trial with 46 community-dwelling elderly allocated to strength ([GST], N = 23, 70.2-years-old ± 4.8 years) or multisensory ([GMS], N = 23, 68.8-years-old ± 5.9 years) exercises twice a week for 12 weeks. Subjects were evaluated by blinded raters using the timed ‘up and go’ test (TUG), the Guralnik test battery, and a force platform. By the end of the treatment, the GMS group showed a significant improvement in TUG (9.1 ± 1.9 seconds (s) to 8.0 ± 1.0 s, P = 0.002); Guralnik test battery (10.6 ± 1.2 to 11.3 ± 0.8 P = 0.009); lateromedial (6.1 ± 11.7 cm to 3.1 ± 1.6 cm, P = 0.02) and anteroposterior displacement (4.7 ± 4.2 cm to 3.4 ± 1.0 cm, P = 0.03), which were not observed in the GST group. These results reproduce previous findings in the literature and mean that the stimulus to sensibility results in better achievements for the control of balance and dynamic activities. Multisensory exercises were shown to be more efficacious than strength exercises to improve functional mobility.

Comparison of multisensory and strength training for postural control in the elderly

Objective The objective of this study was to analyze the efficacy of multisensory versus muscle strengthening to improve postural control in healthy community-dwelling elderly. Participants We performed a single-blinded study with 46 community-dwelling elderly allocated to strength (GS, n = 23; 70.18 ± 4.8 years 22 women and 1 man) and multisensory exercises groups (GM, n = 23; 68.8 ± 5.9 years; 22 women and 1 man) for 12 weeks. Methods We performed isokinetic evaluations of muscle groups in the ankle and foot including dorsiflexors, plantar flexors, inversion, and eversion. The oscillation of the center of pressure was assessed with a force platform. Results The GM group presented a reduction in the oscillation (66.8 ± 273.4 cm2 to 11.1 ± 11.6 cm2; P = 0.02), which was not observed in the GS group. The GM group showed better results for the peak torque and work than the GS group, but without statistical significance. Conclusion Although the GM group presented better results, it is not possible to state that one exercise regimen proved more efficacious than the other in improving balance control.

Concentration of cytokines in patients with osteoarthritis of the knee and fibromyalgia

Introduction Fibromyalgia and osteoarthritis may present a relationship with the concentration of cytokines. The aim of this study was to compare the serum concentrations of IL-12p70, tumor necrosis factor, IL-10, IL-6, IL-1β, and IL-8 in patients with knee osteoarthritis and fibromyalgia. Materials and methods The study included 53 women (71.2±7.6 years old) diagnosed with knee osteoarthritis with moderate-to-severe pain (visual analog scale >4) for at least 3 months. Sixty women (54.1±8.1 years old) diagnosed with fibromyalgia according to the American College of Rheumatology criteria and with moderate-to-severe pain (visual analog scale >4) also participated in this study. For the dosage of cytokines, blood was collected in the morning: 5 mL from the cubital vein. The material was centrifuged at 4°C, separated into 100 μL aliquots and stored at −80°C until processing. Serum concentrations of the studied cytokines were assessed using the BD Cytometric Bead Array method. Data were analyzed with Student’s t-test and the Mann–Whitney U test. Results We found higher levels of IL-6, IL-10, and IL-1β in fibromyalgia patients. After adjustment of age as a covariate, there was no statistically significant difference in the concentration of any cytokine between fibromyalgia and knee osteoarthritis patients. Conclusion Patients with knee osteoarthritis and fibromyalgia with the same duration and intensity of pain demonstrate similar concentrations of cytokines. Aging may play a role in cytokine profile, a finding not so extensively addressed in the literature and one that should be further investigated.

Effectiveness of an exercise program on postural control in frail older adults.

Background Exercise programs have proved to be helpful for frail older adults. This study aimed to investigate the effects of an exercise program with a focus on postural control exercises in frail older adults. Method Twenty-six older adults (76.7 ± 4.9 years) deemed clinically stable, chosen from the Falls Unit, University Hospital Mútua Terrassa, Barcelona, Spain, participated in this single-group study. Volunteers’ postural control was evaluated using the Timed Up and Go test (TUG) and the Guralnik test battery, and their static and dynamic posturography were evaluated using the Synapsys Posturography System®. These evaluations were performed before and after the intervention program, which included an educational session and two weekly 1-hour sessions over an 8-week period of stretching exercises, proprioception, balance, and motor coordination. Data were analyzed using the Student’s t-test or the Wilcoxon test, with a significance level of 5%. Results The TUG and Guralnik tests did not show significant differences. Concerning static posturography, there was improvement in the base of support (P = 0.006), anteroposterior displacement with eyes open (P = 0.02) and closed (P = 0.03), and the total amplitude of the center of pressure with eyes closed (P = 0.02). Regarding dynamic posturography, a decrease of the oscillation speed in the anteroposterior direction (P = 0.01) was observed in individuals with their eyes open. Conclusion The program used in this study was safe and was able to promote some improvement in postural control, especially in the anteroposterior direction and in the base of support. However, it is noteworthy that further improvements could be obtained from a program of longer duration and greater frequency.

Pressure pain thresholds in patients with chronic nonspecific low back pain

BACKGROUND The lumbar back and hip muscles are important for a normal functioning of the human spine and they are considered to be of etiological significance in chronic nonspecific low back pain (nCLBP). Inactivity and a lower level of physical activity in patients with nCLBP may change muscle characteristics and may be associated with pain and disability. Pressure algometry has been found to be non-invasive, efficient and reliable in the exploration of physio-pathological mechanisms involved in muscle pain syndromes. The subjective characteristic of the pressure pain thresholds (PPTs) cannot be avoided once it is the very objective of the measurement, i.e. the minimum pain perceptible by the person, is a subjective factor. Most studies have revealed gender differences between PPTs, with females showing lower thresholds. OBJECTIVE to determine whether demographic variables and PPTs, are related pain intensity and a disability in patients with nCLBP. METHODS One hundred and twenty-four patients with nCLBP were included in the study. The Visual Analogue Scale (VAS) and the Roland-Morris Questionnaire for Low Back Pain (RM) were used to evaluate the intensity of pain and degree of disability. The PPT was performed from L1 up to S2 dermatomes, at the muscles over the Gluteus medius, minimus and maximus, including a point located at the level of the piriformis, at the Quadratus lumborum, at the Iliopsoas and points of reference located at the level of the L1 up to L5 ligaments. The pain intensity was assessed by visual analogue scale (VAS) and the lumbar function by Roland Morris questionnaire (RM). Multiple linear regression models were used for both the VAS and the RM. RESULTS No significant differences were found between the PPTs measured at either left or right limb. The mean VAS value was 7.3 (± 1.5) and the RM score was 14.2 (± 5.3). The PPT-values showed significant negative correlations to the VAS and the RM. The highest correlation between the mean VAS and PPT-values were found at the level of the Gluteus medius (r= -0.34, p< 0.001), which was the only measurement correlated to the intensity of pain (r2 = 0.11, p< 0.001). The RM was correlated to the BMI, the level of education and the PPT values at the level of the Iliopsoas muscle and the L4-L5 supraspinous ligament. CONCLUSIONS This study showed that most PPT values are correlated to the VAS and the RM. Nevertheless, the variability explained by PPT values and demographic characteristics was low for pain intensity and function.

Relationships of Balance, Gait Performance, and Functional Outcome in Chronic Stroke Patients: A Comparison of Left and Right Lesions

Introduction. This study compared the balance by center of pressure (COP) and its relationship with gait parameters and functional independence in left (LH) and right (RH) chronic stroke patients. Methods. In this cross-sectional study, twenty-one hemiparetic stroke patients were assessed for Functional Independence Measure (FIM), balance with a force platform, and gait in the Motion Analysis Laboratory. Results. The amplitudes of the COP in the anteroposterior and mediolateral directions were similar in both groups. The anteroposterior direction was greater than the mediolateral direction. Only the temporal parameters showed any statistically significant differences. The LH showed a significant correlation between stride length, step length, and gait velocity with COP velocity sway for the healthy and paretic lower limbs. In both groups, the area of COP was significantly correlated with stride length. Motor FIM was significantly correlated with the COP in the LH group. Conclusion. There was no difference in the performance of balance, gait, and functional independence between groups. The correlation of the COP sway area with stride length in both groups can serve as a guideline in the rehabilitation of these patients where training the static balance may reflect the improvement of the stride length.

Postural Control of Healthy Elderly Individuals Compared to Elderly Individuals with Stroke Sequelae.

A stroke and aging process can modify the postural control. We aimed to compare the postural control of health elderly individuals to that of individuals with stroke sequelae. This cross-sectional transversal study was made with individuals capable of walking without any assistance and that were considered clinically stable. The study had 18 individuals in the group with stroke sequelae (SG) and 34 in the healthy elderly control group (CG). The participants were evaluated for the timed up and go test (TUG) and force platform. The SG showed the worst results in relation to the time of execution of the TUG and the force platform evaluation. The displacement of center of pressure was worse for both groups in the eyes-closed situation, especially in the anteroposterior direction for the CG. The GS showed worse results in the static and dynamic postural control. The healthy elderly showed more dependence on sight to maintain their static balance and there was no difference in the balance tests in relation to the side affected by the stroke.

Uso de um ambiente de realidade virtual para reabilitação de acidente vascular encefálico

O acidente vascular encefalico (AVE) e uma condicao clinica isquemica ou hemorragica que compromete o sistema nervoso central e pode desencadear deficits motores e cognitivos. Muitas pesquisas sao feitas para buscar formas de amenizar os sintomas e recuperar o maximo de funcoes dos individuos. Atualmente, as ultimas tendencias da reabilitacao sao explorar o avanco tecnologico e aparelhos de realidade virtual, como o Nintendo Wii®. Objetivo: Identificar os resultados funcionais obtidos na reabilitacao de individuos com AVE utilizando a interface de jogos do Nintendo Wii®. Metodo: Para esta revisao da literatura foram selecionados artigos dos bancos de dados MEDLINE, PubMed e biblioteca Cochrane pela estrategia PICO. Os descritores usados foram: User-Computer Interface AND Stroke AND Rehabilitation. Resultados: De 229 artigos encontrados, apenas tres foram utilizados nessa revisao, pois apresentavam relacao direta ente Wii e AVE. Todos os trabalhos apresentaram beneficios motores, como melhora da coordenacao e da agilidade de membros superiores com o uso do Wii associado a terapias convencionais, como a fisioterapia e terapia ocupacional. Conclusao: Novos estudos devem ser realizados com o Wii e as novas tecnologias de realidade virtual que surgem a cada dia a fim de melhorar o nivel de evidencia cientifica quanto ao uso destes recursos na reabilitacao de individuos portadores de sequela de AVE.

Efeitos da geoterapia e fitoterapia associadas à cinesioterapia na osteoartrite de joelho: estudo randomizado duplo cego

ABSTRACT Geotherapy is the therapeutic use of clay materials which are defined as natural earths that have different minerals in their composition. Objective: This work aimed to compare the pain, mobility, weight-bearing, and functional impairment in individuals with Knee Osteoarthritis who had un-dergone two types of physiotherapy treatments: the first group associated Geotherapy with Kine-siotherapy (GGK) and second group associated Geotherapy and Phytotherapy with Kinesiotherapy (GGFK). Method: This study was a randomized double-blind clinical trial, which was attended by 25 individuals of both sexes aged over 43 years; they underwent 10 sessions lasting 45 minutes each. The individuals performed the assessments to check for pain by using a visual analogue scale (VAS); to assess functional mobility, the test Timed Up and Go (TUG) test; to assess disability and symptoms, the Lequesne Algo functional questionnaire; and finally the Nintendo Wii Fit®, to measure weight-bearing between members. Results: The results showed that only the GGFK had improved functional mobility. Both groups improved the intensity of pain and symptoms after the intervention and that improvement in GGFK was superior for symptoms in relation to GGK. Both groups showed a reduction in the intensity of pain and symptoms after the intervention, and the GGFK improvement was greater than the GGK for symptoms of Osteoarthritis (OA). Neither group showed any improvement in weight-bearing. Conclusion: It was concluded that geotherapy and phytotherapy associated with kinesiotherapy can be beneficial in reducing the pain and functional impairment associated with knee OA.Keywords: clay, exercise therapy, osteoarthritis, knee, phytotherapy