Marisa de Cássia Registro Fonseca

Força de preensão palmar e pinças em indivíduos sadios entre 6 e 19 anos

OBJECTIVE: This study aimed to determine and compare the values of maximum isometric palmar grip and pinch forces in healthy children between 6 and 19 years old using dynamometry, considering gender, dominance and age. METHODS: 199 subjects were evaluated using Jamar® dynamometer to measure palmar grip strength and Preston Pinch Gauge® dynamometer to evaluate pulp to pulp, lateral and three points pinch strength in a standardization testing protocol. The mean of three consecutive grip tests was recorded. Linear regression with mixed effects was used to statistically analyze the differences between data. RESULTS: Mean values found for palmar grip, pulp to pulp, three points and lateral pinch were 24,51kgf, 3,64kgf, 5,37kgf and 6,78kgf, respectively, regardless of the variables. There was statistical difference in all measures by gender and dominance, and the dominant hand and the males had higher grip forces. It was verified that mean values varied with age, with significant difference in most of comparisons between the age groups. CONCLUSION: We concluded that pinch and palmar grip strength demonstrated significant differences in gender, dominance and in most of age subgroups studied, being important to consider them on dynamometry. This study was relevant as reference of normality of hand strength in children and adolescents.

A influência da mobilização articular nas tendinopatias dos músculos bíceps braquial e supra-espinal

As causas mais comuns de dor no ombro estao relacionadas as degeneracoes dos tendoes da musculatura do manguito rotador. OBJETIVO: Verificar a influencia da mobilizacao articular por meio dos movimentos acessorios do ombro na recuperacao inicial de 14 pacientes com tendinopatia cronica dos mm. supra-espinal e/ou biceps braquial. METODOS: Foram comparados dois protocolos de tratamento, compostos da aplicacao de ultra-som terapeutico na area do tendao afetado e de treinamento excentrico na musculatura envolvida, acompanhados ou nao de manobras de mobilizacao articular. Como metodos de avaliacao foram utilizados os questionarios de Constant e Disabilities of the Arm, Shoulder and Hand (DASH), no inicio e ao final do tratamento. RESULTADOS: Os resultados encontrados demonstraram que ambos os protocolos de tratamento foram eficazes na reabilitacao dos pacientes, pois se obtiveram melhores resultados funcionais na aplicacao dos questionarios quando comparados o final com o inicio do tratamento para os pacientes (p<0,001). Os pacientes que foram submetidos a mobilizacao articular associada ao ultra-som terapeutico e o treinamento excentrico obtiveram em media melhores escores para os questionarios, ocorrendo diferenca estatistica significante entre os escores finais nos dois grupos para os dois questionarios (p<0,05). CONCLUSOES: Assim ambos os protocolos de tratamento foram eficazes no tratamento da tendinopatia cronica do ombro, sendo que, o uso associado da mobilizacao articular parece oferecer melhores resultados funcionais.The most common causes of shoulder pain are related to degeneration of the tendons of the rotator cuff muscles. OBJECTIVE: To investigate the influence of joint mobilization by means of accessory movements of the shoulder during the early rehabilitation of 14 patients with chronic tendinopathy of the supraspinatus and/or biceps brachii muscles. METHODS: Two treatment protocols were compared: application of therapeutic ultrasound over the affected tendon area and eccentric training of the musculature involved, with or without joint mobilization maneuvers. The Constant and DASH (Disabilities of the Arm, Shoulder and Hand) questionnaires were used as the assessment method, before and after the treatment. RESULTS: The results showed that both treatment protocols were effective for patient rehabilitation, since better functional results were obtained at the end of the treatment, in comparison with the beginning (p<0.001). The patients who underwent joint mobilization in association with therapeutic ultrasound and eccentric training achieved better mean scores in the questionnaires. There was a statistically significant difference in the final scores between the two groups, for both questionnaires (p<0.05). CONCLUSIONS: Thus, both treatment protocols were effective for treating chronic tendinopathy of the shoulder, although their use in association with joint mobilization seems to provide better functional results.

Uma nova pinça regulável para a produção de lesões por esmagamento do nervo ciático do rato

Objective: A new adjustable pinch has been developed for producing a crush injury, with a previously known load of 5 kg, on a 5 mm-long segment of the nerve. Methods: Stainless steel was the material selected for building the pinch due its durability and possibility of sterilization with anti-septic substances, which are often corrosive. The crushing load of the pinch is adjustable by increasing or decreasing the tension of the spring by means of a screw used for calibration, which is performed by a load cell. Result: This pinch has been used in a few experimental investigations and was shown to be as efficient as both the universal testing machine and the dead weight machine, previously used. Conclusion: The developed pinch has the advantages of being portable and user-friendly. In addition, the pinch is cheap and allows for the standardization of the applied load.

Early sensory re-education of the hand after peripheral nerve repair based on mirror therapy: a randomized controlled trial.

BACKGROUND: Mirror therapy has been used as an alternative stimulus to feed the somatosensory cortex in an attempt to preserve hand cortical representation with better functional results. OBJECTIVE: To analyze the short-term functional outcome of an early re-education program using mirror therapy compared to a late classic sensory program for hand nerve repair. METHOD: This is a randomized controlled trial. We assessed 20 patients with median and ulnar nerve and flexor tendon repair using the Rosen Score combined with the DASH questionnaire. The early phase group using mirror therapy began on the first postoperative week and lasted 5 months. The control group received classic sensory re-education when the protective sensation threshold was restored. All participants received a patient education booklet and were submitted to the modified Duran protocol for flexor tendon repair. The assessments were performed by the same investigator blinded to the allocated treatment. Mann-Whitney Test and Effect Size using Cohens d score were used for inter-group comparisons at 3 and 6 months after intervention. RESULTS: The primary outcome (Rosen score) values for the Mirror Therapy group and classic therapy control group after 3 and 6 months were 1.68 (SD=0.5); 1.96 (SD=0.56) and 1.65 (SD=0.52); 1.51 (SD=0.62), respectively. No between-group differences were observed. CONCLUSION: Although some clinical improvement was observed, mirror therapy was not shown to be more effective than late sensory re-education in an intermediate phase of nerve repair in the hand. Replication is needed to confirm these findings.

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

BackgroundCarpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome.Methods/DesignPatients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test.DiscussionThis paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome.Trial registrationBrazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184

Esteira com velocidade controlada para captação da marcha

Histological and electrophysiological methods for evaluation of peripheral nerve regeneration do not faithfully reproduce the functional index of limbs, even in controlled experimental conditions. Some methods of functional evaluation have been proposed, but their correlation to histological and electrophysiological data is not completely established, requiring more investigations with improvement of collection, management and processing of obtained data. In this study we developed a treadmill with controlled speed for recording footprint of rats submitted to different kinds of sciatic, fibular and tibial nerve lesions. The footprints were obtained on a walking track by means of a webcam connected to the treadmill and a computer with capacity to record the gait that will be submitted to functional evaluation. The developed treadmill allows the collection and filming of gaits and it has been tested in current experimental studies in rats with sciatic nerve lesion submitted to different kinds of treatment. The treadmill also enables researchers to record gait with constant, controlled and pre-established speed, with the possibility of direct visualization through the treadmill wall. In this manner, some variables that could damage the results of the research are resolved.

Resultados funcionais da artrodese do punho

Sao analisados os resultados funcionais 51 artrodeses do punho em 49 pacientes, portadores de variadas patologias dessa regiao. Em todos os casos, a artrodese foi realizada com fixacao interna rigida, usando placa e parafusos e o seguimento pos-operatorio variou de 6 a 201 meses (media: 73 meses). Para a avaliacao funcional foi empregado um metodo de subjetivo, baseado nas impressoes dos proprios pacientes, e outro objetivo, atraves da analise das radiografias e de testes funcionais que simulam todo tipo de funcao do membro superior. A posicao de fixacao da artrodese foi de 14o de extensao e 8o de desvio ulnar, em media. Consolidacao primaria foi obtida em 50 (98%) punhos, num periodo medio de oito semanas, sendo que, no punho restante ocorreu pseudartrose, consolidada apos re-operacao com enxertia ossea. Houve melhora da intensidade e mudanca do padrao da dor pre-operatoria e todos os pacientes com atividade leve retornaram ao trabalho.. Houve perda relativa da forca de preensao manual (61% do contralateral) e das pincas (cerca de 70% do lado contralateral), porem os testes funcionais apresentaram resultados considerados satisfatorios e concordantes com a literatura. Conclui-se que a artrodese do punho e um metodo aplicavel a diversas patologias que impliquem em dor e instabilidade da articulacao, que produz resultados consistentemente repetitiveis, sem afetar significativamente a funcao global do membro superior, apesar da relativa perda da forca, a qual se deveu mais a fatores pre-existentes do que a artrodese em si.

Prevenção de incapacidade na hanseníase com apoio em um manual de autocuidado para pacientes

Leprosy is an infectious disease of slow evolution, manifested by dermatoneurological signs and symptoms, with skin and peripheral nerve injuries. The aim of this study was to assess physical and functional status of eyes, hands and feet of patients with leprosy, as well as to assess evolution of sensory-motor disabilities, degree of disability and quality of life, having specially produced and handed the patients an illustrated self-care manual for preventing disability. Twenty- six patients with leprosy were assessed initially and after 12 months of using the manual as to: skin inspection, peripheral nerves palpation, corneal sensitivity, skin sensitivity, limb muscle function, hand muscle strength (finger grip and pinch strength); the disability degree w as determined and patients answered the SF-36 questionnaire. Most affected nerves were the ulnar and posterior tibial ones. Results showed that, though the degree of disability and deformities persisted, there were significant improvements in SF-36 social aspects and pain domains, as well as improvements in skin dryness and hands and feet muscle function. Since the latter are directly related to self-care, this suggests that the self-care manual may have an important supporting role in relieving symptoms of patients with leprosy.

Upper extremity coordination strategies depending on task demand during a basic daily activity

Injury conditions affecting the upper extremity may lead to severe functional impairment and an accurate evaluation is needed in order to select the most effective treatment in a rehabilitation program. This study focused on simultaneous electromyographic and kinematic analysis to assess movement patterns of upper extremity during a basic daily activity, considering different demands existing within the task. Twenty-five healthy subjects, average age 19.8 ys SD 1.7 ys, with no upper extremity impairment, were assessed by means of electromyography (EMG) and a 3D motion capture system while performing a task that required reach, transport and release. Integrated EMG (iEMG), timing of muscle onset and active range of motion (AROM) were calculated for each subject. Data were compared within each phase and between the three phases and a repeated measure ANOVA was used for statistical analysis. We found early activation of upper trapezius associated with high activity of serratus anterior for proximal stability while anterior deltoid and triceps brachii performed shoulder flexion and elbow extension, in Reach phase. In Transport phase there was early and higher activation of upper trapezius, higher muscle activity of almost all muscles and increased AROM of all joints. No change in flexion/extension wrist posture with increased forearm muscles activity were identified as the main control strategy to keep optimal grasping. Triceps brachii was found to act as an important synergist in shoulder abduction and extension in free load conditions. Such information can lead clinicians to more specific assessment and subsequent better intervention in upper extremity rehabilitation.

A new treadmill-type motorized walking belt machine for video recording of the rat's gait and sciatic functional index measurement. A comparative study with other methods

The sciatic functional index (SFI) is a remarkable tool to assess dysfunction and functional recovery of the sciatic nerve of rats. Usually measured on hind foot imprints on paper, a new method is now being proposed, by direct analysis of video recorded foot sole images obtained with a treadmill-type walking belt machine functioning with gait speed control (G1). Results were compared with the SFI measured on imprints on paper (G2) and on video recorded foot sole images obtained with a static see-through runway (G3). The right sciatic nerve of 19 adult female Wistar rats was crushed by the application of a controlled load. Impressions/images obtained both preoperatively and at weekly intervals for eight consecutive postoperative weeks were digitized, stored and analyzed in a computer loaded with specific software, the SFI being automatically calculated after measuring the appropriate parameters. SFI differed significantly between G1 and G2 and G1 and G3 (p<0.05), but not between G2 and G3 (p>0.05) during the first and second postoperative weeks, nonsignificant differences (p>0.05) being observed for any comparison between groups during the third through eighth postoperative weeks. We conclude that the three methods yielded equivalent results from the third week onward, but both video recording methods (G2 and G3) permitted a more adequate early evaluation (first and second weeks), since the SFI parameters were more easily identifiable. Images obtained with the walking belt machine are more uniform and sharper, thus contributing to reduce the influence of biases observed with imprints on paper.