Paulo Fernandes Pires

Accuracy of the surface electromyography RMS processing for the diagnosis of myogenous temporomandibular disorder

Due to the multifactor etiology of temporomandibular disorder (TMD), the precise diagnosis remains a matter of debate and validated diagnostic tools are needed. The aim was to determine the accuracy of surface electromyography (sEMG) activity, assessed in the amplitude domain by the root mean square (RMS), in the diagnosis of TMD. One hundred twenty-three volunteers were evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders and distributed into two groups: women with myogenous TMD (n=80) and women without TMD (n=43). The volunteers were then submitted to sEMG evaluation of the anterior temporalis, masseter and suprahyoid muscles at rest and during maximum voluntary teeth clenching (MVC) on parafilm. The accuracy, sensitivity and specificity of the muscle activity were analyzed. Differences between groups were found in all muscles analyzed at rest as well as in the masseter and suprahyoid muscles during MVC on parafilm. Moderate accuracy (AUC: 0.74-0.84) of the RMS sEMG was found in all muscles regarding the diagnosis of TMD at rest and in the suprahyoid muscles during MVC on parafilm. Moreover, sensitivity ranging from 71.3% to 80% and specificity from 60.5% to 76.6%. In contrast, RMS sEMG did not exhibit acceptable degrees of accuracy in the other masticatory muscles during MVC on parafilm. It was concluded that the RMS sEMG is a complementary tool for clinical diagnosis of the myogenous TMD.

Effects of upper thoracic manipulation on pressure pain sensitivity in women with temporomandibular disorder: a randomized, double-blind, clinical trial.

Objective The aim of the present study was to evaluate the effects of upper thoracic manipulation on pain in subjects with temporomandibular disorder. Design Thirty-two women with a diagnosis of temporomandibular disorder were randomly allocated to an experimental group (n = 16), submitted to upper thoracic manipulation, and a placebo group (n = 16), submitted to a procedure in the thoracic region with no therapeutic effect. All volunteers underwent an evaluation of pain in the masticatory muscles and the temporomandibular joint using an algometer and the visual analog scale before and immediately after the procedure as well as after 48–72 hrs. Two-way repeated-measures analysis of variance was used for the intragroup and intergroup analyses, with the level of significance set to 5% (P < 0.05). Cohen d was calculated for the determination of the effect size. Results No significant group-by-time interaction was found (P > 0.05) for algometry in any analysis, and Cohen d revealed no significant effect of the treatment. Moreover, no significant group-by-time interaction was found for facial pain intensity determined using the visual analog scale (P > 0.05), and Cohen d also revealed no significant effect of the treatment regarding this variable. Conclusions On the basis of the present findings, upper thoracic spinal manipulation does not lead to a reduction in pain in women with temporomandibular disorder.

Immediate and Short-Term Effects of Upper Thoracic Manipulation on Myoelectric Activity of Sternocleidomastoid Muscles in Young Women With Chronic Neck Pain: A Randomized Blind Clinical Trial.

OBJECTIVE The aim of this study was to assess the immediate and short-term effects of upper thoracic spine manipulation on pain intensity and myoelectric activity of the sternocleidomastoid muscles in young women with chronic neck pain. METHODS A randomized clinical trial was carried out involving 32 women with chronic neck pain (mean age, 24.8 ± 5.4 years) allocated to an experimental group and a placebo group. Three evaluations were carried out: baseline, immediate postintervention, and short-term postintervention (48-72 hours after intervention). Myoelectric activity of the right and left sternocleidomastoid muscles was assessed at rest and during isometric contractions for cervical flexion and elevation of the shoulder girdle. Neck pain intensity was assessed at rest using a visual analog scale. Comparisons of the data were performed using 2-way repeated-measures analysis of variance with the Bonferroni correction. The level of significance was set at P < .05. RESULTS A moderate treatment effect on myoelectric activity of the right and left sternocleidomastoid muscles during isometric elevation of the shoulder girdle was found in the experimental group only on the short-term postintervention evaluation (d > 0.40). No statistically significant differences were found for any of the variables analyzed in the intergroup comparisons at the different evaluation times (P > .05). CONCLUSION No statistically significant differences were found in the intragroup or intergroup analyses of the experimental and placebo groups regarding myoelectric activity of the cervical muscles or the intensity of neck pain at rest in the immediate or short-term postintervention evaluations.

Effect of upper thoracic manipulation on mouth opening and electromyographic activity of masticatory muscles in women with temporomandibular disorder: a randomized clinical trial.

OBJECTIVE The purpose of this study was to assess the effect of upper thoracic manipulation on vertical mouth opening (VMO) and electromyographic activity of the masticatory muscles in women with temporomandibular disorder (TMD). METHODS A randomized, controlled, blinded study involving 32 women (mean age of 24.78 ± 5.41 years) diagnosed with TMD was performed. Subjects were randomly allocated to an experimental group (n = 16) or a sham manipulation (placebo) group (n = 16). A single session of manipulation was administered to the T1 vertebral area. Electromyography was used to determine activity of masticatory muscles with the mandible at rest and during isometric contraction. Vertical mouth opening was measured using a ruler. Measurements were made before manipulation, immediately after manipulation, and at the short-term follow-up (2 to 4 days after manipulation). RESULTS No significant differences were found in any of the comparisons of mandibular VMO or electromyographic activity of the masticatory muscles at rest or during isometric contraction of mandibular elevator muscles (P > .05). Regarding isometric contraction of the mandibular depressors, an immediate increase in muscle activity was found in the suprahyoid (P = .014) and left masseter (P = .005) muscles. CONCLUSION In the present study, no significant differences were found regarding VMO between the experimental and placebo groups or among the different evaluations times in each group. Moreover, Cohen d test revealed no clinical effect of the technique. Therefore, based upon the findings of this study, manipulation administered to the T1 vertebral area appears to have no effect on VMO and electromyographic activity of the masticatory muscles in women with TMD.

Factor and Rasch analysis of the Fonseca anamnestic index for the diagnosis of myogenous temporomandibular disorder

Highlights • The FAI had three dimensions.• The items of dimension 1 of the FAI showed adequate fit to the model.• The FAI can be used in clinical practice and research.

Analysis of the accuracy and reliability of the Short-Form Fonseca Anamnestic Index in the diagnosis of myogenous temporomandibular disorder in women

BACKGROUND The Fonseca Anamnestic Index is a questionnaire used to classify individuals with temporomandibular disorders. Previous studies have shown that the Fonseca Anamnestic Index provides a multidimensional measurement of the temporomandibular disorders construct and that the main dimension presents a good fit to the model according to the item response theory. OBJECTIVE To evaluate the between-day reliability, accuracy, and best cut-off score of the Short-Form Fonseca Anamnestic Index for the diagnosis of myogenous temporomandibular disorders. METHODS The sample consisted of 123 women (57 with myogenous temporomandibular disorders and 66 asymptomatic), evaluated by the Research Diagnostic Criteria for Temporomandibular Disorders. The participants answered the Short-Form Fonseca Anamnestic Index on two occasions with a seven-day interval between tests. For the analysis of between-day reliability, the intraclass correlation coefficient, the standard error of measurement and the minimum detectable change were used. The Receiver Operating Characteristic curve was used to determine the diagnostic accuracy and the best cut-off point. RESULTS The Short-Form Fonseca Anamnestic Index demonstrated excellent reliability (intraclass correlation coefficient≥0.95) for all items and for the total Short-Form Fonseca Anamnestic Index score (intraclass correlation coefficient=0.98; standard error of measurement=3.28; minimum detectable change=9.09). The level of accuracy of the Short-Form Fonseca Anamnestic Index for the diagnosis of myogenous temporomandibular disorders was high (area under the curve of 0.97), with a better cut-off score of 17.5 points. CONCLUSION The Fonseca Anamnestic Index should be used in its short form to classify the absence of myogenous temporomandibular disorders (scores between 0 and 15 points) or presence of myogenous temporomandibular disorders (scores between 20 and 50 points) in women.

Efeito da mobilização das raízes nervosas lombares sobre a força e flexibilidade dos músculos do membro inferior

Introduction: Neural mobilization is widely applied in clinical practice. Aim: To evaluate the effect of neural mobilization of the lumbar roots on the strength and flexibility of the knee and hip muscles. Methods: We selected 14 men (22.4 ± 2.87 years) healthy. Flexibility was evaluated during knee flexion movements (KFR and KFL), extension of the hip (HER and HEL) and for the lumbar spine (LS). Assessment of muscle strength was performed for the knee movements. The evaluations were performed before the neural mobilization (PRE), immediately after (POST1) and one week after (POST2). Results: In the POST1 and POST2 was a significant increase in muscle strength in KFL. For flexibility, the POST1 evaluation, it was observed significant increase in KFL, HER, and HEL. In the evaluation POST2, a significant increase flexibility in LS and reduction in KFL. Conclusion: The neural mobilization promoted increased strength of the flexor muscles of the left knee, increased flexibility in the KFL, HER, HEL and LS.