João Paulo Chieregato Matheus

Efeitos da estimulação elétrica neuromuscular durante a imobilização nas propriedades mecânicas do músculo esquelético

A estimulacao eletrica neuromuscular (EENM) e um importante recurso utilizado em medicina esportiva para acelerar processos de recuperacao. O objetivo deste estudo foi analisar os efeitos da EENM durante a imobilizacao do musculo gastrocnemio, em posicoes de alongamento (LP) e encurtamento (SP). Para tanto, 60 ratas femeas jovens Wistar foram distribuidas em seis grupos e acompanhadas durante sete dias: controle (C), eletroestimuladas (EE), imobilizadas em encurtamento (ISP), imobilizadas em alongamento (ILP), imobilizadas em encurtamento e eletroestimuladas (ISP + EE) e imobilizadas em alongamento e eletroestimuladas (ILP + EE). Para a imobilizacao, o membro posterior direito foi envolvido por uma malha tubular e ataduras de algodao juntamente a atadura gessada. A EENM foi utilizada com frequencia de 50Hz, 10 minutos por dia, totalizando 20 contracoes em cada sessao. Apos sete dias os animais foram submetidos a eutanasia e os musculos gastrocnemios retirados para a realizacao do ensaio mecânico de tracao em uma maquina universal de ensaios (EMIC®). A partir dos graficos carga versus alongamento, foram calculadas as seguintes propriedades mecânicas: alongamento no limite de proporcionalidade (ALP), carga no limite de proporcionalidade (CLP) e rigidez. As imobilizacoes SP e LP promoveram reducoes significativas (p < 0,05) nas propriedades de ALP e CLP, sendo mais acentuada no grupo ISP. Quando utilizada a EENM, houve acrescimo significativo (p < 0,05) dessas propriedades somente no grupo ISP. Ja em relacao a rigidez, foi observada reducao significativa (p < 0,05) somente do grupo C para o grupo ISP. Quando utilizada a EENM, a rigidez do grupo ILP + EE foi significativamente (p < 0,05) maior e mais proxima do grupo C que a do grupo ISP + EE. Neste modelo experimental, a imobilizacao dos musculos em alongamento atrasou o processo de atrofia, e a estimulacao eletrica, realizada durante a imobilizacao, contribuiu para a manutencao das propriedades mecânicas durante o periodo de imobilismo, principalmente no grupo ILP + EE.The neuromuscular electric stimulation (NMES) is an important tool used in sports medicine to accelerate the recovery process. The objective of this study was to analyze the effects of NMES during immobilization of the gastrocnemius muscle, in lengthened (LP) and shortened positions (SP). Sixty young female Wistar rats were distributed into six groups and followed for 7 days: control (C); electric stimulation (ES); immobilized in shortening (ISP); immobilized in lengthening (ILP); immobilized in shortening and electric stimulation (ISP + ES) and immobilized in lengthening and electric stimulation (ILP + ES). For the immobilization, a tubular mesh and cotton rolls together with the plaster were wrapped around the rats right posterior paw. NMES in a frequency of 50 Hz was used 10 minutes a day, totaling 20 contractions in each session. After 7 days the animals were sacrificed and their gastrocnemius muscles of the right paw were submitted to a mechanical test of traction in a universal test machine (EMIC®). From the load versus elongation curves the following mechanical properties were obtained: elongation in the yield limit (EPL), load in the yield limit (LPL) and stiffness. The SP and LP immobilizations promoted significant reductions (p < 0.05) in the EPL and LPL properties, being more remarkable in the ISP group. When the NMES was used, there was significant increase (p < 0.05) of these properties only in the ISP group. As for stiffness, significant reduction was observed (p < 0.05) only of the C group for the ISP group. When the NMES was used, the stiffness of the ILP + EE group was significantly (p < 0.05) higher and closer to the C group than of the ISP + EE group. We conclude that in this experimental model the immobilization of the muscles in the lengthened position delayed the atrophy process and the electric stimulation during the immobilization contributed to the maintenance of the mechanical properties during the immobilization period, mainly for the ILP + ES group.

The Effect of Kinesio Taping in Forward Bending of the Lumbar Spine

[Purpose] The aim of this study was to evaluate the influence of a lumbar fascia Kinesio Taping® technique forward bending range of motion. [Subjects and Methods] This was a longitudinal study with a randomized clinical trial composed of 39 subjects divided into three groups (control, Kinesio Without Tension-KWT, and Kinesio Fascia Correction-KFC). The subjects were assessed by Schober and fingertip-to-floor tests and left the tape in place for 48 hours before being reassessed 24 hours, 48 hours and 30 days after its removal. [Results] In all three experimental groups no significant differences were observed with the Schober test, but it was possible to observe an increase in lumbar flexion after 30 days. With the fingertip-to-floor distance assessment, the KFC and KWT groups showed significantly improved flexibility 24 hours and 48 hours after tape removal. [Conclusion] The Kinesio Taping® influenced fascia mobility, allowing for slight improvement of lumbar flexibility.

The effect of Kinesio Taping on handgrip strength

[Purpose] The purpose of this research was to evaluate the change in muscle function induced by a Kinesio Tape application with no or moderate tension, to the dominant and non-dominant arms. [Subjects and Methods] This research was a quantitative study, in which 75 women participated. The subjects, aged 18–30 years, were divided into 3 groups, Kinesio, Kinesio without Tension, and Control, and they were assessed before the taping intervention and after 30 minutes, 24 hours, and 48 hours of taping. [Results] The Kinesio group subjects demonstrated an increase in handgrip strength after 30 minutes, 24 hours, and 48 hours of tape application compared to control. A statistically significant increase in strength was observed in the Kinesio group comparison to the Control after 24 hours and 48 hours for the right hand, and after 48 hours for the left hand. Improvement in the Kinesio group compared to the Kinesio without Tension was observed only after 24 hours of taping application, and only in the right hand. [Conclusion] The Kinesio Taping method augmented the handgrip strength of healthy women, and the increase in grip strength was maintained for 48 hours after its application; the dominant hand demonstrated the greatest strength values.

Association between sarcopenia and quality of life in quilombola elderly in Brazil

Introduction Currently, there is no single consensual definition of sarcopenia in the literature. This creates a challenge for the evaluation of its prevalence and its direct or indirect impact on the quality of life of elderly populations of different races and ethnicities. Furthermore, no studies as yet have analyzed these variables in populations of elderly subjects of the “quilombola” ethnic group. Objective We aimed to verify the association between sarcopenia and quality of life in quilombola elderly using the Baumgartner and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Methods This was a cross-sectional study of 70 male and female participants (mean age: 65.58±6.67 years). Quality of life was evaluated using the multidimensional 36-item Short-Form Health Survey (SF-36) of the Medical Outcomes Study. Sarcopenia was diagnosed according to the Baumgartner cutoff for appendicular skeletal muscle mass and the criteria recommended by the EWGSOP. Muscle mass and fat mass percentages were analyzed by dual-energy X-ray absorptiometry, while handgrip strength (HGS) was evaluated using a hand-held dynamometer. Physical performance was assessed through a gait speed test. Results The prevalence of sarcopenia was 15% according to the Baumgartner cutoff and 10% according to EWGSOP criteria. Quilombola elderly classified as physically active or very active were at least six times less likely to develop sarcopenia than those classified as irregularly active or sedentary. HGS was negatively associated with a diagnosis of sarcopenia according to both sets of criteria. Subjects with sarcopenia reported lower scores than those without the condition on the physical role functioning and bodily pain domains of the SF-36. Conclusion In this sample of quilombola elderly, quality of life was negatively associated with sarcopenia, regardless of the classification criteria used. Additionally, the results showed that diagnostic criteria for sarcopenia should include reductions in lean mass in addition to measures of functioning and physical performance because some subjects showed the former symptom without any alteration of the latter two variables. The cutoff value suggested by Baumgartner criteria were less accurate than that specified by the EWGSOP criteria because they do not consider functioning and physical performance. However, Baumgartner criteria were more sensitive in detecting sarcopenia because reductions in lean mass predict alterations in strength and walking speed.

The Long-term Impact of Breast Radiotherapy on Dyspnea and Pulmonary Function

To the Editor: Radiotherapy is a key component of current breast cancer treatment. A portion of the underlying lung is included in the radiation field, and this may results in pulmonary complications. Studies have shown acute pulmonary toxicity (1,2), however, the long-term effect of breast radiotherapy is not clear. The late effects of radiotherapy on lung function are particularly important for quality of life of breast cancer survivors. Few investigators have quantified these complications by using objective methods such as pulmonary function test (PFT). PFT is reliable method for detecting parenchymal lung damage (2) and more sensitive than chest radiography to diagnose pulmonary toxicity (1). PFT measured at 18 months is probably considered a good predictor for the long-term outcome (3). We recruited 20 women treated with breast conserving surgery and local radiotherapy at least 18 months before the enrollment in the study and 20 healthy matched controls selected from primary care ambulatory. Exclusion criteria were: women older than 60 years, obesity, recurrence of breast cancer, radical breast surgery, regular physical activity, heart failure, asthma, prolonged exposure to heavy pollution, respiratory infection, smoking, or primary lung disease. None of the patients had distant metastases or received hormonal therapy. There were no women who received high-dose chemotherapy associated with lung toxicity. A radiotherapy total dose of 50 Gy in 25 fractions was given to tangential fields using Cobalt 60 gamma rays. The British Medical Research Council dyspnea scale (4) was used, and PFTs were measured using a computerized system (GS Collins Gold Plus; Collins, Braintree, MA, USA). The procedures were performed according to ATS recommendations (5), and the study was approved by the institutional ethics committee. The median age was 48 years (range, 22–60) in the radiotherapy group, and 50.5 years (range, 23–60) in the control group, body mass index was 25.5 ± 2.7 kg ⁄ m for the cases and 25.1 ± 3.5 kg ⁄ m for the controls. Compared with the healthy controls, there were significant decrease in forced vital capacity (FVC) (95.8% versus 105.8%, p < 0.05), vital capacity (VC) (94.5% versus 104.8%, p < 0.05), 1 second forced expiratory volume (FEV1) (102.1% versus 113.8%, p < 0.05) and total lung capacity (TLC) (103.4% versus 111.4%, p < 0.05) of breast cancer patients. There were no significant differences in diffusing capacity of the lung for carbon monoxide (114.5% versus 116.10%, p > 0.05) between the two groups. Dyspnea symptoms were reported by six patients (30%) in the radiotherapy group and none in the controls group. The long-term effect of breast radiotherapy on lung function is not clear. Some controversal studies have been published. Lund et al. found a decrease in the FVC and the FEV1, measured 3 months after irradiation and these changes were reversed within 12 months (6). On the other hand, Ooi et al. found that lung function indices progressively declined after radiotherapy, but was irreversible at 12 months (7). In our study FEV1, FVC, TLC, and VC were significantly reduced at 18 months in irradiated breast cancer patients when compared with healthy volunteers. The reduction of VC and FVC are the best parameters to evaluate the compromise of lung function after radiotherapy (8). These reductions may be because of reduction pulmonary compliance and fibrosis development as a late side effect of radiation. TLC reduction was also expected once this parameter depends on muscular strength, pulmonary compliance, and chest wall compliance that can be negatively affected by breast irradiation (2,7). Our data highlights the importance of long-term effects of local breast radiotherapy on lung function. Despite of the small number of patients included, we believe the results are clinically significant because of the very rigid inclusion criteria, and warrant a Address correspondence and reprint requests to: Liana Barbaresco Gomide, MSc, Avenida Bandeirantes, 3900, 8o andar, 14049-900, São Paulo, Brazil, or e-mail: lbgomide@yahoo.com.br; lianagomide@usp.br.

Terapia ocupacional na artrite reumatoide: o que o reumatologista precisa saber?

Interventions focusing on education and self-management of rheumatoid arthritis (RA) by the patient improves adherence and effectiveness of early treatment. The combination of pharmacologic and rehabilitation treatment aims to maximize the possibilities of intervention, delaying the appearance of new symptoms, reducing disability and minimizing sequelae, decreasing the impact of symptoms on patients functionality. Occupational therapy is a health profession that aims to improve the performance of daily activities by the patient, providing means for the prevention of functional limitations, adaptation to lifestyle changes and maintenance or improvement of psychosocial health. Due to the systemic nature of RA, multidisciplinary follow-up is necessary for the proper management of the impact of the disease on various aspects of life. As a member of the health team, occupational therapists objective to improve and maintaining functional capacity of the patient, preventing the progression of deformities, assisting the process of understanding and coping with the disease and providing means for carrying out the activities required for the engagement of the individual in meaningful occupations, favoring autonomy and independence in self-care activities, employment, educational, social and leisure. The objective of this review is to familiarize the rheumatologist with the tools used for assessment and intervention in occupational therapy, focusing on the application of these principles to the treatment of patients with RA.

Prolonged use of Kinesiotaping does not enhance functional performance and joint proprioception in healthy young males: Randomized controlled trial.

ABSTRACT Objectives The aim of this study was to investigate the effects of continuous (48-hour) use of Kinesiotaping (KT) on functional and proprioceptive performance in healthy, physically active men. Method Twenty-six healthy, physically active men (21.8±2.2 years old) were randomly allocated into two groups: 1) Kinesiotaping group (KG, tape applied with 40% tension for rectus femoris activation); 2) Control (CG, tape applied over rectus femoris without additional tension). Subjects attended the laboratory on five separate occasions: 1) familiarization; 2) baseline measurement without tape (BL); 3) immediately post-tape application (T0); 4) 24h (T24); and 5) 48h (T48) post-tape application. The outcomes were distance in the single (SHT) and triple hop tests (THT), vertical jump height (VJH), vertical jump power (VJP), and rate of force development (RFD). A mixed-model ANOVA was applied to verify differences between and within groups. Results No significant (p >0.05) differences were found in the SHT and THT between groups and moments. Likewise, the main effects for VJH, VJP, and RFD were not significant (p >0.05). Conclusion The present study demonstrated no significant immediate or prolonged (48h) effects of KT on functional and proprioceptive performance.

Comparison of the mechanical properties of therapeutic elastic tapes used in sports and clinical practice

STUDY DESIGN Cross-sectional laboratory study. OBJECTIVE The aim of the present study was to evaluate and compare the mechanical properties of different therapeutic elastic tapes used in sports and clinical practice. BACKGROUND Therapeutic tapes have been used since around the 1800s. They are composed of cotton, elastic filaments and adhesive glue that provides an effect of tactile and mechanical stimulation. However, as taping has evolved, manufacturers have implemented new materials and claim that the tensile properties and adhesion of tapes contribute more significantly in the rehabilitation process. METHODS Fifty samples of elastic tapes (5 different manufacturers; 10 samples from each manufacturer) were submitted to longitudinal traction until rupture as well as surface adherence assays. Information was recorded on maximum deformation, maximum load, maximum tension and relative stiffness. RESULTS In tensile testing the bandages brand Kinesio Tex Gold - FP® showed higher rates, 3 in 4 properties. During surface adherence tests on the therapeutic elastic tapes the brand Premium Kinesiology 3 NS Tex® showed higher rates, 3 in 4 properties analyzed. CONCLUSIONS Tapes from different manufacturers exhibit different characteristics regarding traction and adherence mechanics. Knowledge of these characteristics is fundamental for the optimized use of each tape based on specific therapeutic needs.

Postural biomechanical risks for nursing workers

Introduction In the hospital environment, several types of professionals must be involved in continuous working shifts, under working conditions that are often unsatisfactory. Objective The objective of the present study was to analyze the biomechanical risk factors for work-related musculoskeletal disorders (WRMD). Material and methods This was a cross-sectional, exploratory, descriptive and quantitative study and its analysis considered 15 workers, in three shifts. A questionnaire containing personal information and general data regarding the work environment was applied. The REBA protocol was used for posture assessment, once the workers were recorded while performing their activities. The results were presented descriptively. Results In light of the results obtained, the working day was found excessive, particularly considering the weekly frequency and period of time of the working shifts. The REBA protocol showed that the positions adopted presented high risk for the development of WRMD in all nine activities evaluated. Conclusion The nursing activities were characterized as stressful for the workers involved.

Postural biomechanical risks for nursing workersRiscos biomecânicos posturais em trabalhadores de enfermagem

Introduction In the hospital environment, several types of professionals must be involved in continuous working shifts, under working conditions that are often unsatisfactory. Objective The objective of the present study was to analyze the biomechanical risk factors for work-related musculoskeletal disorders (WRMD). Material and methods This was a cross-sectional, exploratory, descriptive and quantitative study and its analysis considered 15 workers, in three shifts. A questionnaire containing personal information and general data regarding the work environment was applied. The REBA protocol was used for posture assessment, once the workers were recorded while performing their activities. The results were presented descriptively. Results In light of the results obtained, the working day was found excessive, particularly considering the weekly frequency and period of time of the working shifts. The REBA protocol showed that the positions adopted presented high risk for the development of WRMD in all nine activities evaluated. Conclusion The nursing activities were characterized as stressful for the workers involved.