Milton Antonio Zaro

Plantar thermography is useful in the early diagnosis of diabetic neuropathy

OBJECTIVES: This study evaluated plantar thermography sensitivity and specificity in diagnosing diabetic polyneuropathy using cardiac tests (heart rate variability) as a reference standard because autonomic small fibers are affected first by this disease. METHODS: Seventy-nine individuals between the ages of 19 and 79 years old (28 males) were evaluated and divided into three groups: control (n = 37), pre-diabetics (n = 13) and type 2 diabetics (n = 29). The plantar images were recorded at baseline and then minutes after a provocative maneuver (Cold Stress Test) using an infrared camera that is appropriate for clinical use. Two thermographic variables were studied: the thermal recovery index and the interdigital anisothermal technique. Heart rate variability was measured in a seven-test battery that included three spectral indexes (in the frequency domain) and four Ewing tests (the Valsalva maneuver, the orthostatic test, a deep breathing test, and the orthostatic hypotension test). Other classically recommended tests were applied, including electromyography (EMG), Michigan inventory, and a clinical interview that included a neurological physical examination. RESULTS: Among the diabetic patients, the interdigital anisothermal technique alone performed better than the thermal recovery index alone, with a better sensitivity (81.3%) and specificity (46.2%). For the pre-diabetic patients, the three tests performed equally well. None of the control subjects displayed abnormal interdigital anisothermal readouts or thermal recovery indices, which precluded the sensitivity estimation in this sample of subjects. However, the specificity (70.6%) was higher in this group. CONCLUSION: In this study, plantar thermography, which predominately considers the small and autonomic fibers that are commonly associated with a sub-clinical condition, proved useful in diagnosing diabetic neuropathy early. The interdigital anisothermal test, when used alone, performed best.

Human cutaneous sensors on the sole of the foot: Altered sensitivity and recovery time after whole body vibration

The goal of this study was to investigate the effect of whole body vibration (WBV) on human tactile sensitivity, both the immediate effects and the recovery time in the case of altered sensitivity. Twenty adults (25.3±2.6 years, 10 males) participated in a 10-min WBV session, at a frequency of 42 Hz with 2 mm amplitude in a spiral mode. Sensitivity was measured before and four times after WBV exposure. Pressure sensation was determined using Von Frey monofilaments. Vibration perception thresholds for 30 and 200 Hz were measured using a custom built neurothesiometer. The sensation was measured in 5 anatomical regions of the right foot. Sensitivity of measured cutaneous perception was significantly reduced. Fast-adapting mechanoreceptors for 200 Hz and 30 Hz showed 5.2 and 3.8 times lower sensation values immediately after WBV, respectively. Pressure sensation was 2 times lower in comparison to the baseline condition. In general, tactile sensitivity recovery time was between 2 and 3 h. WBV influences the discharge of fast-adapting skin mechanoreceptors. By determining the recovery time, it might be possible to estimate how long the effects of WBV on tactile sensitivity last.

Repeatability of Infrared Plantar Thermography in Diabetes Patients: A Pilot Study

Objective: Infrared (IR) thermography has been used as a complementary diagnostic method in several pathologies, including distal diabetic neuropathy, by tests that induce thermoregulatory responses, but nothing is known about the repeatability of these tests. This study aimed to assess the repeatability of the rewarming index in subjects with type 2 diabetes mellitus (T2DM) and nondiabetic control subjects. Methods: Using an IR camera, plantar IR images were collected at baseline (pre-) and 10 min after (post-) cold stress testing on two different days with 7 days interval. Plantar absolute average temperatures pre- and post-cold stress testing, the difference between them (AT), and the rewarming index were obtained and compared between days. Repeatability of the rewarming index after the cold stress test was assessed by Bland-Altman plot limits of agreement. Results: Ten T2DM subjects and ten nondiabetic subjects had both feet analyzed. Mean age did not differ between groups (p = .080). Absolute average temperatures of plantar region pre- (p = .033) and post-cold stress test (p = .019) differed between days in nondiabetic subjects, whereas they did not differ in T2DM subjects (pretest, p = .329; post-test, p = .540). AT and rewarming index did not differ between days for both groups, and the rewarming index presented a 100% agreement of day-to-day measurements from T2DM subjects and 95% with nondiabetic subjects. Conclusions: The rewarming index after cold stress testing presented good repeatability between two days a week in both groups. Despite T2DM subjects presenting no differences on absolute temperature values between days, ΔT or rewarming index after cold stress testing remain recommended beside absolute temperature values for clinical use.

Plantar Pressure Distribution Patterns of Individuals with Prediabetes in Comparison with Healthy Individuals and Individuals with Diabetes

Background: Since elevated mechanical stress along with loss of plantar protective sensation are considered relevant factors in skin breakdown resulting in diabetic foot ulcerations, the assessment of plantar pressure is important for the prevention of diabetic foot complications. Prediabetes subjects are at risk of chronic hyperglycemia complications, among them neuropathy, but information about plantar loading in this population is not available. We aimed to compare baropodometric parameters of individuals with prediabetes versus healthy persons and persons with diabetes mellitus (DM). Methods: Baropodometric data from 73 subjects (15 with prediabetes (pre-DM), 28 with type 2 DM, 30 healthy) aged between 29 and 69 years of both genders were registered through a pressure platform with self-selected gait speed and first-step protocol. Peak plantar pressure, stance time, percentage of contact time, percentage of contact area and pressure-time integral were assessed in five plantar foot regions: Heel, midfoot, metatarsals, hallux, and toes 2 to 5. Groups were compared by one-way analysis of variance with Scheffé post hoc (α = 0.05). Results: Age, body mass index, gender, and arch height index did not differ between groups. Pre-DM and DM subjects presented increased peak pressure and pressure-time integral in metatarsals (p = .010; p > .001), as well as increased percentage of contact time in midfoot (p = .006) and metatarsals (p = .004) regions when compared with healthy subjects. Stance time was significantly higher (p = .017) in DM subjects. Conclusions: Pre-DM subjects seem to exhibit an altered plantar pressure distribution pattern similar to that often found in DM subjects.

Interferential therapy effect on mechanical pain threshold and isometric torque after delayed onset muscle soreness induction in human hamstrings

Abstract This study was undertaken to examine the acute effect of interferential current on mechanical pain threshold and isometric peak torque after delayed onset muscle soreness induction in human hamstrings. Forty-one physically active healthy male volunteers aged 18−33 years were randomly assigned to one of two experimental groups: interferential current group (n = 21) or placebo group (n = 20). Both groups performed a bout of 100 isokinetic eccentric maximal voluntary contractions (10 sets of 10 repetitions) at an angular velocity of 1.05 rad · s−1 (60° · s−1) to induce muscle soreness. On the next day, volunteers received either an interferential current or a placebo application. Treatment was applied for 30 minutes (4 kHz frequency; 125 μs pulse duration; 80−150 Hz bursts). Mechanical pain threshold and isometric peak torque were measured at four different time intervals: prior to induction of muscle soreness, immediately following muscle soreness induction, on the next day after muscle soreness induction, and immediately after the interferential current and placebo application. Both groups showed a reduction in isometric torque (P < 0.001) and pain threshold (P < 0.001) after the eccentric exercise. After treatment, only the interferential current group showed a significant increase in pain threshold (P = 0.002) with no changes in isometric torque. The results indicate that interferential current was effective in increasing hamstrings mechanical pain threshold after eccentric exercise, with no effect on isometric peak torque after treatment.

Thermographic evaluation of hind paw skin temperature and functional recovery of locomotion after sciatic nerve crush in rats

INTRODUCTION: Peripheral nerves are often damaged by direct mechanical injury, diseases, and tumors. The peripheral nerve injuries that result from these conditions can lead to a partial or complete loss of motor, sensory, and autonomic functions, which in turn are related to changes in skin temperature, in the involved segments of the body. The aim of this study was to evaluate the changes in hind paw skin temperature after sciatic nerve crush in rats in an attempt to determine whether changes in skin temperature correlate with the functional recovery of locomotion. METHODS: Wistar rats were divided into three groups: control (n = 7), sham (n = 25), and crush (n = 25). All groups were subjected to thermographic, functional, and histological assessments. RESULTS: ΔT in the crush group was different from the control and sham groups at the 1st, 3rd and 7rd postoperative days (p<0.05). The functional recovery from the crush group returned to normal values between the 3rd and 4th week post-injury, and morphological analysis of the nerve revealed incomplete regeneration at the 4th week after injury. DISCUSSION: This study is the first demonstration that sciatic nerve crush in rats induces an increase in hind paw skin temperature and that skin temperature changes do not correlate closely with functional recovery

Exergaming as an Alternative for Students Unmotivated to Participate in Regular Physical Education Classes

With the novelty of exergames, an alternative form of entertainment and exercise emerged especially for physical education PE. While video games have been historically associated to problems such as obesity, social introversion and aggressive behavior, exergames brought a new perspective in which these cultural artifacts could contribute to peoples education concerning the practice of physical activity. This article presents a study about the setting up of an exergame lab focusing on kids and preadolescents who usually show signs of dissatisfaction with PE. The research methodology followed a qualitative observation approach, involving twenty-four students of both genders for three months. Results demonstrated that students who were normally unmotivated to participate in PE classes showed a positive attitude regarding the exergame practices and demonstrated their willingness to collaborate with peers. The study also showed that exergaming provides situations in which students can increase the regularity of their practice of physical exercises.

Quantitative assessment of the use of continuous wavelet transform in the analysis of the fundamental frequency disturbance of the synthetic voice.

The aim of this work is to investigate quantitatively the capability of the Continuous Wavelet Transform (CWT) as a tool to estimate (calculate) Jitter and Shimmer, assessing the error between these indices calculated in each Wavelet decomposition and the ones for the original signal, for several dilatation levels. Two synthetic vowels /a/ were generated with the fundamental frequencies of 120 Hz for male and 220 Hz for female, by an autoregressive 22 coefficient all-pole model, and Jitter and Shimmer were introduced to the signal using five different percentage variations. The signals were decomposed by CWT in eight levels of dilatation (1, 2, 4, 8, 16, 32, 64 and 128), using the Mexican Hat, Meyer and Morlet real bases. Jitter and Shimmer were calculated for the original signals and all eight levels of decompositions and then the errors between the indices in the decompositions and the original signals were calculated. It can be concluded that CWT can be used as a tool for pre-processing the signal to measure Shimmer preferentially, and Jitter, instead of using the original signal to do that. The Mexican Hat base provided the lowest errors for Shimmer analysis, where the best dilatation level was 8 (error below 0.1%). In addition, the errors associated with Shimmer index, in general, are lower than the ones associated with Jitter index.

Whole Body Vibration at Different Exposure Frequencies: Infrared Thermography and Physiological Effects

The aim of this study was to investigate the effects of whole body vibration (WBV) on physiological parameters, cutaneous temperature, tactile sensitivity, and balance. Twenty-four healthy adults (25.3 ± 2.6 years) participated in four WBV sessions. They spent 15 minutes on a vibration platform in the vertical mode at four different frequencies (31, 35, 40, and 44 Hz) with 1 mm of amplitude. All variables were measured before and after WBV exposure. Pressure sensation in five anatomical regions and both feet was determined using Von Frey monofilaments. Postural sway was measured using a force plate. Cutaneous temperature was obtained with an infrared camera. WBV influences the discharge of the skin touch-pressure receptors, decreasing sensitivity at all measured frequencies and foot regions (P ≤ 0.05). Regarding balance, no differences were found after 20 minutes of WBV at frequencies of 31 and 35 Hz. At 40 and 44 Hz, participants showed higher anterior-posterior center of pressure (COP) velocity and length. The cutaneous temperature of the lower limbs decreased during and 10 minutes after WBV. WBV decreases touch-pressure sensitivity at all measured frequencies 10 min after exposure. This may be related to the impaired balance at higher frequencies since these variables have a role in maintaining postural stability. Vasoconstriction might explain the decreased lower limb temperature.

Sugestão de método para correlacionar força muscular e eletromiografia

O objetivo deste trabalho e apresentar um metodo de estimar qualitativamente a forca muscular, a partir do sinal eletromiografico de superficie, durante contracoes isometricas. Para alcancar tal objetivo, uma serie de processos matematicos sao efetuados sobre o sinal eletromiografico, incluindo tecnicas com filtros de janela movel ponderada, transformando o eletromiograma em uma curva simples, similar ao sinal de forca. Para testar o modelo proposto, foram feitas 216 diferentes situacoes de medida de forca de mordida e eletromiografia, sobre os musculos masseter e temporal, distribuidas em um projeto de experimento. O parâmetro escolhido para medir a eficiencia do metodo foi o coeficiente de correlacao entre duas curvas. O metodo mostrou-se mais eficiente quanto maior a forca empregada.