Effectiveness of the open and closed kinetic chain exercises in the treatment of the patellofemoral pain syndrome

The aim of this study was to analyze the therapeutic effects of the open kinetic chain (OKC) and closed kinetic chain (CKC) exercises to treat the patellofemoral syndrome (PFSD). For this, 24 volunteers, bearers of the PFSD were randomly divided in two groups: group I (n = 12) performed the OKC exercises; group II (n = 12) performed the CKC exercises. Both groups were submitted to eight consecutive weeks of treatment consisting of three weekly sessions performed in alternate days. To analyze the activation pattern of the vastus medialis oblique (VMO) and the vastus lateralis (VL) muscles, the electromyographic signals (EMG) were collected using bipolar surface electrodes quantified by the root mean square (RMS) normalized by the maximal voluntary isometric contraction of the quadriceps. The pain intensity and the functionality of the volunteers were assessed using scales. The analysis of the amounts of the VMO/VL ratio in both groups I and II showed no significant differences as to the pre- and post-treatment times in the concentric (p > 0.05) and eccentric (p > 0.05) phases of the OKC and CKC exercises. Despite of this, the VMO muscle presented a lower activation rate compared to the VL in the eccentric phase of the CKC exercise. It was found significant increases in the functionality (p 0,05) e excêntrica (p > 0,05) dos exercícios em CCA e CCF. Apesar disso, o músculo VMO apresentou menor taxa de ativação em relação ao VL na fase excêntrica do exercício em CCF. Foram encontrados aumentos significativos na funcionalidade (p 0,05) y excéntricas (el p > 0,05) de los ejercicios en CCA y CCC. A pesar de eso, el músculo VMO presentó un punto de activación más pequeño respecto a VL en la fase excéntrica del ejercicio en CCF. En ellos se encontraron aumentos significantes en la funcionalidad (p < 0,05) y en la reducción de la intensidad del dolor (p < 0,05) entre veces de tiempo y post-tratamiento en ambos grupos, sin embargo, el de grupo II se mostraron superiores al grupo I en estas dos variables. Los resultados de este estudio sugieren que, de acuerdo con las condiciones experimentales usadas, los ejercicios en CCA y CCC no provocaron los cambios en los modelos de activación EMG de los músculos VMO y VL, sin embargo, ellos promovieron mejora de la funcionalidad y reducción de la intensidad del dolor después de ocho semanas de intervención, y los ejercicios en CCC eran superiores al de en CCA.667

Fractures of the neck of the talus: evaluation of reproducibility of Hawkins´s classification

OBJECTIVE: To evaluate the intraobserver and interobserver reproducibility of Hawkins' classification for fractures of the neck of the talus. METHODS: 20 random cases of fracture of the talus were selected, to be defined according to the classification of types by eight orthopedic surgeons, 13 orthopedic residents and 15 radiology residents. RESULTS: Using the statistical test of Landis and Koch, measurements of 0.627 and 0.668 were obtained in the first and second evaluations, respectively. These values define a satisfactory agreement for Hawkins' classification. CONCLUSION: We conclude that this classification is reproducible between observers, with better values for the more experienced observers. Level of Evidence I, Study Diagnostic - Investigating a diagnostic test.OBJETIVO: Avaliar a reprodutibilidade intra-observador e inter-observador da classificação de Hawkins para fraturas do colo do talus. MÉTODOS: Selecionou-se 20 casos aleatórios de fratura de tálus para serem definidos entre os tipos da classificação por oito cirurgiões ortopédicos, 13 residentes de ortopedia e 15 de radiologia. RESULTADOS: Utilizando o teste estatístico de Landis e Kock foram obtidas médias de 0.627 e 0.668, na primeira e segunda avaliação, respectivamente. Tais valores definem uma concordância satisfatória para a classificação de Hawkins. CONCLUSÃO: Conclui-se que tal classificação é reprodutível entre observadores, possuindo melhores valores conforme maior experiência. Nível de Evidência I, Estudos diagnósticos - Investigação de um exame para diagnóstico.17017

Clinical assessment of spasticity in individuals with spinal cord injury

OBJECTIVE: To evaluate the effect of neuromuscular electrical stimulation on spasticity in patients with spinal cord injury. METHODS: The study included eleven subjects with spinal cord injuries (C4 to T5). The modified Ashworth scale and pendulum test, which is accomplished through the Pendular Test Device - PTD (equipment which has a quartz crystal transducer accelerometer and optic fiber flexible electrogoniometer measuring the tensions and angular displacements). Patients underwent neuromuscular electrical stimulation (NMES) to the quadriceps muscle from fibular nerve, and the tests were administered before and after therapy. RESULTS: The data show a decrease in spasticity after NMES, with features such as increasead variation between maximum and minimum peaks, i.e. increased amplitude of the curves. Furthermore, data from the subjective scale, and modified Ashworth scale after neuromuscular electrical stimulation also showed a reduction in the values of spasticity. CONCLUSION: The data suggest that NMES is effective in reducing spasticity immediately after completion. Level of Evidence II, Therapeutic Studies-Investigating the Results of Treatment.OBJETIVO: Avaliar o efeito da estimulação elétrica neuromuscular na espasticidade nos pacientes com lesão medular. MÉTODOS: Participaram do estudo onze sujeitos lesados medulares (C4 a T5). Foram utilizados para esta avaliação a escala modificada de Ashworth e o teste pendular, que foi realizado através do Dispositivo de Teste Pendular - DTP (o equipamento possui um acelerômetro de transdutores de cristais de quartzo e eletrogoniômetro de fibra óptica flexível que mede as tensões e os deslocamentos angulares). Os pacientes realizaram estimulação elétrica neuromuscular (EENM) nos músculos quadríceps e nervo fibular, sendo que os testes foram aplicados antes e após o procedimento. RESULTADOS: Os dados mostram uma diminuição da espasticidade após a EENM, com características tais como um aumento na variação entre o pico máximo e o mínimo, ou seja, aumento da amplitude das curvas. Além disso, os dados da escala subjetiva, e escala modificada de Ashworth, após a estimulação elétrica neuromuscular também apresentaram uma redução nos valores da espasticidade. CONCLUSÃO: Os dados sugerem que a EENM é eficaz para reduzir a espasticidade imediatamente após a sua realização. Nível de Evidência II, Estudos Terapêuticos -Investigação dos Resultados do Tratamento.31031

Pilot randomized controlled trial to evaluate the effect of aquatic and land physical therapy on musculoskeletal dysfunction of sickle cell disease patients

Objective: To compare the effect of aquatic and land-based physiotherapy in reducing musculoskeletal hip and lower back pain and increasing overall physical capabilities of sickle cell disease patients. Methods: Informed written consent was obtained from all volunteers who were submitted to evaluations using different functional scales: Lequesne's Algofunctional Questionnaire and Oswestry Disability Index, trunk and hip range of motion, goniometry, trunk and hip muscle strength assessment using load cell, and surface electromyography of the iliocostalis, long dorsal (longissimus), gluteus maximus, gluteus medius and tensor fasciae latae muscles. Ten patients were randomized into two groups: aquatic physiotherapy with a mean age of 42 years (range: 25-67) and conventional physiotherapy with a mean age of 49 years (range: 43-59). Both groups were submitted to a twelve-week program of two sessions weekly. Results: After the intervention, significant improvements were observed regarding the Lequesne index (p-value = 0.0217), Oswestry Disability Index (p-value = 0.0112), range of motion of trunk extension (p-value = 0.0320), trunk flexion muscle strength (p-value = 0.0459), hip extension and abduction muscle strength (p-value = 0.0062 and p-value = 0.0257, respec- tively). Range of motion of trunk and hip flexion, extension, adduction and abduction, trunk extensor muscle strength and all surface electromyography variables showed no significant statistical difference. Conclusion: Physical therapy is efficient to treat musculoskeletal dysfunctions in sickle cell disease patients, irrespective of the technique; however, aquatic therapy showed a trend toward improvement in muscle strength. Further studies with a larger patient sample and longer periods of therapy are necessary to confirm these results

POSTURAL CONTROL ASSESSMENT IN PHYSICALLY ACTIVE AND SEDENTARY INDIVIDUALS WITH PARAPLEGIA

<div><p>ABSTRACT Objective: The aim of this study was to evaluate functional independence and trunk control during maximum-range tasks in individuals with spinal cord injuries, who were divided into sedentary (SSI, n=10) and physically active (PASI, n=10) groups . Methods: Anamnesis was conducted and level and type of injury were identified (according to the American Spinal Injury Association protocol, ASIA) and the Functional Independence Measure (FIM) questionnaire was applied. For the forward and lateral reach task, the subjects were instructed to reach as far as possible. Mean data were compared using the unpaired t test and Mann-Whitney test and differences were considered significant when p<0.05 . Results: The PASI group performed better in self-care activities (PASI: 40.8±0.42 points, SSI: 38.0±3.58 points, p=0.01), sphincter control (PASI: 10.5±1.84 points, SSI: 8.2±3.04 points, p=0.02), transfers (PASI: 20.7±0.48 points, SSI: 16.9±4.27 points, p=0.04), and total FIM score (PASI: 104.0±2.30 points, SSI 105.1±8.56 points, p=0.01). On the maximum reach task, the PASI group had a greater average range in all directions evaluated (p<0.05) . Conclusion: The continuous practice of exercise increased motor function independence and trunk control in individuals with complete spinal cord injury. Level of Evidence II, Prospective Comparative Study.</p></div

Development of a skin temperature map for dermatomes in individuals with spinal cord injury: a cross-sectional study

The aim of this study was to map the skin temperature (Tsk) of individuals with SCI and compare able-bodied individuals, and among the groups to demonstrate the effects of differences in the levels of injury (paraplegia and tetraplegia with high and low injuries). Outpatient clinic, Brazil. Individuals with tetraplegia (n = 20), paraplegia (n = 21), and able-bodied (n = 11) individuals were recruited. A noncontact infrared thermometer (IRT) was used to measure three times the Tsk at the forehead, and at the C2 to S2 dermatomes. Core body temperature was measured at the axilla using the IRT and three other clinical thermometers. Autonomic regulation is impaired by the injury. A Tsk map was constructed for the three groups. Significant differences in the Tsk of dermatomes were observed when comparing individuals with SCI and the able-bodied at the following dermatomes: C3, C7, T2, T3, T8, T9, L1, L2, L4, and S2. When comparing individuals with tetraplegia and able-bodied individuals, the dermatomes that showed significant differences were C5, C6, C8, T1, T10, L3, and S1. Dermatomes C5–C7, and T5 showed significant differences between individuals with tetraplegia and those with paraplegia. For L5 and S1 in paraplegia significant differences were found when comparing high with low injury. A Tsk map on dermatomes in individuals with SCI was implemented, and showed a significant difference between able-bodied. As temperature is a parameter for analyzing autonomic function, the study could benefit rehabilitation by providing baseline values when constructing clinical protocols5810901095CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP140215/2014–02016/50253-

HETEROTOPIC OSSIFICATION AFTER SPINAL CORD INJURY: PREVENTION AND TREATMENT - A SISTEMATIC REVIEW

ABSTRACT Trauma configures the main cause of spinal cord injuries. Patients with traumatic spinal cord injury often develop severe and debilitating outcomes that require multidisciplinary care to adapt patients to their new reality. Heterotopic ossification (HO) is one of the frequent comorbidities in these patients but it still lacks well-established treatments or a gold standard one. Thus, this systematic review aimed to search the current literature for HO treatment and prevention. This study was conducted following PRISMA recommendations (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) and searches were conducted in three databases (PubMed, Embase, and Web of Science). A total of 193 articles were found in an initial search. After screening following the established criteria, eight articles were included in this review; of these, two reported prevention and the others, treatments. Based on data analysis, the use of non-steroidal anti-inflammatory drugs in the acute post-traumatic period proved to be the best method of prevention. In cases of mature HO or accompanied by ankylosis, surgical resection proved to be the most effective treatment despite the high rate of postoperative infections. Level of Evidence III, Systematic Review

Trunk restraint therapy: the continuous use of the harness could promote feedback dependence in poststroke patients a randomized trial

The objective of this study was to evaluate the long-term effects of the task-specific training with trunk restraint compared with the free one in poststroke reaching movements. The design was randomized trial. The setting was University of Campinas (Unicamp). Twenty hemiparetic chronic stroke patients were selected and randomizedinto2traininggroups: trunkrestraintgroup(TRG) (reachingtraining with trunk restraint) and trunk free group (TFG) (unrestraint reaching). Twenty sessions with 45minutes of training were accomplished. The patientswere evaluated in pretreatment (PRE), posttreatment (POST) and 3 months after the completed training (RET) (follow-up). Main outcome measures were modified Ashworth scale, Barthel index, Fugl-Meyer scale, and kinematic analysis (movement trajectory, velocity, angles). A significant improvement, which maintained in the RET test, was found in the motor (P< 0.001) and functional (P = 0.001) clinical assessments for both groups. For trunk displacement, only TFG obtained a reduction statistical significance fromPRE to the POST test (P = 0.002), supporting this result in the RET test. Despite both groups presenting a significant increase in the shoulder horizontal adduction (P = 0.003), only TRGshowed a significant improvement in the shoulder (P = 0.001 -PRE to POST and RET) and elbow (P = 0.038 -PRE to RET) flexion extension, and in the velocity rate (P = 0.03 -PRE to RET). The trunk restraint therapy showed to be a long-term effective treatment in the enhancement of shoulder and elbow active joint range and velocity rate but not in the maintenance of trunk retention9412CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP302189/2004-106/61199-