Rafael Inácio Barbosa

Comparative effects of wavelengths of low-power laser in regeneration of sciatic nerve in rats following crushing lesion

Peripheral nerves are structures that, when damaged, can result in significant motor and sensory disabilities. Several studies have used therapeutic resources with the aim of promoting early nerve regeneration, such as the use of low-power laser. However, this laser therapy does not represent a consensus regarding the methodology, thus yielding controversial conclusions. The objective of our study was to investigate, by functional evaluation, the comparative effects of low-power laser (660xa0nm and 830xa0nm) on sciatic nerve regeneration following crushing injuries. Twenty-seven Wistar rats subjected to sciatic nerve injury were divided into three groups: group sham, consisting of rats undergoing simulated irradiation; a group consisting of rats subjected to gallium–aluminum–arsenide (GaAlAs) laser at 660xa0nm (10xa0J/cm2, 30xa0mW and 0.06xa0cm2 beam), and another one consisting of rats subjected to GaAlAs laser at 830xa0nm (10xa0J/cm2, 30xa0mW and 0.116xa0cm2). Laser was applied to the lesion for 21xa0days. A sciatic functional index (SFI) was used for functional evaluation prior to surgery and on daysxa07, 14, and 21 after surgery. Differences in SFI were found between group 660xa0nm and the other ones at the 14th day. One can observe that laser application at 660xa0nm with the parameters and methods utilised was effective in promoting early functional recovery, as indicated by the SFI, over the period evaluated.

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.

Assessment of Functional Recovery of Sciatic Nerve in Rats Submitted to Low-Level Laser Therapy with Different Fluences. An Experimental Study

Peripheral nerve lesions caused sensory and motor deficits along the distribution of the injured nerve. Numerous researches have been carried out to enhance and/or accelerate the recovery of such lesions. The objective of this study was to assess the functional recovery of sciatic nerve in rats subjected to different fluences of low-level laser therapy (LLLT). Thirty-six animals were randomly divided into four groups: one consisting of sham rats and three others irradiated with progressive fluencies of 10xa0J/cm2, 40xa0J/cm2 and 80xa0J/cm2 of laser AsGaAl (830xa0nm) for 21 consecutive days. They were evaluated by the Sciatic Functional Index (SFI) method. The crush injury was performed by using a portable device with dead weight of 5,000xa0g whose load was applied for 10xa0min. A digital camera was used to record the footprints left on the acrylic track, before surgery and after, on the 7th, 14th, and 21st days. The results also showed that on the 7th day, there was a difference between the groups irradiated with 40xa0J/cm2, when compared with the sham group (pu2009<u20090.05). On the 14th day the groups irradiated with 40xa0J/cm2 and 80xa0J/cm2 also presented better results when compared with sham, however, on the 21st day, no inter-group difference was found (pu2009>u20090.05). It was possible to observe that the LLLT at fluency of 40xa0J/cm2 and 80xa0J/cm2 had a positive influence on the acceleration of the functional nerve recovery.

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 18u2009years 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

Should we think about wrist extensor after flexor tendon repair

Objective: To evaluate the activity of wrist extensor muscle, correlating with wrist motion during gripping after flexor tendon repair. Design: Cross-sectional clinical measurement study. Setting: Laboratory for biomechanics and rehabilitation. Subjects: A total of 11 patients submitted to rehabilitation by early passive motion of the fingers with wrist flexion position were evaluated after 8 weeks of fingers flexor tendon repair and 11 healthy volunteers, all ranging from 20 to 37 years of age. Intervention: Volunteers performed an isometric standardized gripping task. Main measures: We used electrogoniometry to analyze wrist range of motion and surface electromyography, considering 100% maximum voluntary contraction to represent the amplitude of electromyographic activity of the extensor carpi radialis and flexor digitorum superficialis. Results: Patients with flexor tendon repair showed co-activation deficit between wrist extensor (extensor carpi radialis) and flexor finger muscles (flexor digitorum superficialis) during gripping in the intermediate phase of rehabilitation, despite some recovering mobility for wrist extension (p ≤ 0.05). A moderate correlation between range of motion and extensor carpi radialis was present only for injured group (r = 0.32). Total active motion score, which represents finger active excursion, was regular or poor in 65% of cases, all with nerve repair associated. Conclusion: Wrist extensors have an important synergist role at handgrip, although some imbalance can be present after flexor tendon repair. These preliminary findings suggest that emphasis could be directed to add synergistic wrist motion in rehabilitation protocols after flexor tendon repair. Future studies with early active rehabilitation are necessary.

Radial nerve injury associated with humeral shaft fracture: a retrospective study.

Objective: To determine the profile of patients with humeral diaphyseal fractures in a tertiary hospital. Methods: We conducted a survey from January 2010 to July 2012, including data from patients classified under humeral diaphyseal fracture (S42.3) according to the International Classification of Diseases (ICD-10). The variables analyzed were: age, gender, presence of radial nerve injury, causal agent and the type of treatment carried out. Results: The main causes of trauma were car accidents. The radial nerve lesion was present in some cases and was caused by the same trauma that caused the fracture or iatrogenic injury. Most of these fractures occurred in the middle third of humeral diaphysis and was treated conservatively. Conclusion: The profile of patients with fracture of humeral shaft, in this specific sample, was composed mainly of adult men involved in traffic accidents; the associated radial nerve lesion was present in most of these fractures and its cause was strongly related to the trauma mechanism. Level of Evidence II, Retrospective Study.

Auditory stimuli from a sensor glove model modulate cortical audiotactile integration

The purpose of this study was to shed light on cortical audiotactile integration and sensory substitution mechanisms, thought to serve as a basis for the use of a sensor glove in the preservation of the cortical map of the hand after peripheral nerve injuries. Fourteen subjects were selected and randomly assigned either to a training group, trained to replace touch for hearing with the use of a sensor glove, or to a control group, untrained. Training group volunteers had to identify textures just by the sound. In an fMRI experiment, all subjects received three types of stimuli: tactile only, combined audiotactile stimulation, and auditory only. Results indicate that, for trained subjects, a coupling between auditory and somatosensory cortical areas is established through associative areas. Differences in signal correlation between groups point to a pairing mechanism, which, at first, connects functionally the primary auditory and sensory areas (trained subjects). Later, this connection seems to be mediated by associative areas. The training with the sensor glove influences cortical audiotactile integration mechanisms, determining BOLD signal changes in the somatosensory area during auditory stimulation.

Avaliação funcional retrospectiva de pacientes com fratura proximal de úmero fixada com placa com parafusos de ângulo fixo para região proximal no úmero

Proximal humeral fractures are common injuries leading to severe functional restrictions and complications for patients. Today, there are several surgical alternatives aimed at achieving better injury stabilization by means of osteosynthesis techniques, depending on injury severity. One of these is the fixed-angle plate fixation of the proximal humerus. This bone fixation system is intended to preserve the biologic integrity of the humeral head associated with a safe anatomical reduction, employing several fixating screws with angle stability, thereby allowing an early mobilization of the fractured limb. Eleven patients with proximal humeral fractures treated with the method of fixed-angle plate fixation of the proximal humerus in the period of 2004 to 2005 were retrospectively studied. The patients were subjected to the Constant questionnaire and the DASH index for functional assessment. The results showed some residual dysfunction at the upper end after this type of trauma, even using a fixed-angle plate fixation of the proximal humerus, which notably provides a safe fixation, associated to physical therapy.

Inter-rater, intra-rater and inter-instrument reliability of an electrogoniometer to measure wrist range of motion

Introduction Assessment of the wrist is essential in hand rehabilitation. The flexible electrogoniometer has been used to measure joint range of motion in the wrist, although it has lack of reliability. The objectives of the study were to examine intra- and inter-examiner reliability, as well as inter-device reliability, of wrist range of motion obtained by a flexible electrogoniometer. Methods Twenty-four right-handed individuals (12 men and 12 women) took part in the study. Participants were actively and randomly subjected to radial and ulnar deviation, flexion and extension of the right wrist. The motions were measured by both the universal goniometer (CARCI®) and the electrogoniometer (MIOTEC®). Two examiners carried out three series of measurements. One of the examiners performed repeated measurement after seven days. The Intraclass Correlation Coefficient, standard error of measurement and the Bland-Altman limits of agreement were used for data analysis. Results Data showed excellent intra- and inter-examiner reliability for all movements with the electrogoniometer (Intraclass Correlation Coefficientu2009>u20090.90), except for the inter-examiner analysis of wrist flexion, with an Intraclass Correlation Coefficient of 0.89. The correlation between the devices was deemed to be satisfactory. Even though the excellent reliability and low standard error of measurement results were presented, Bland-Altman graphs showed some discrepant data. Conclusion Based on this sample, we suggest that this electrogoniometer is a reliable device regarding intra- and inter-examiner for clinical application when compared with a universal goniometry for wrist motion.

A study to compare two goniometric methods for measuring active pronation and supination range of motion

Introduction Movement of the forearm allows positioning the hand during several functional activities of daily living. Assessing range of motion of supination and pronation is essential for clinical identification of functional limitations, although many methods can be used. Confounding values can be found due to different techniques used by therapists. The purpose of this study was to compare two standard goniometric methods for measuring active range of motion of forearm pronation and supination, aiming to define its reliability and ease of use. Methods The study included 33 individuals, 13 injured and 20 non-injured volunteers. We analyzed two standard goniometric methods for measuring pronation and supination. For the first method, the volunteers had to hold a pencil as a guide for the movable arm of the goniometer and for the second method the movable arm was in contact with the distal dorsal surface of the wrist near the ulna head, and the hand was free. Two trained examiners performed the evaluations. Intraclass correlation coefficient and limits of agreement of Bland and Altman were used to analyze the data. Results Intraclass correlation coefficient values were excellent for both groups and movements at inter-rater and inter-methods comparison. Bland and Altman plots showed that, although excellent reliability, some data dispersion was present. Conclusion These data suggest that both methods could be used in clinical practice with excellent reliability. The goniometric method with the movable arm placed in contact with the distal dorsal surface of the wrist near the ulna head might be easier to perform and useful in cases where finger prehension is absent or weak, which would prevent the use of a pencil as reference.