Acupuncture Affects Regional Blood Flow in Various Organs

In this review, our recent studies using anesthetized animals concerning the neural mechanisms of vasodilative effect of acupuncture-like stimulation in various organs are briefly summarized. Responses of cortical cerebral blood flow and uterine blood flow are characterized as non-segmental and segmental reflexes. Among acupuncture-like stimuli delivered to five different segmental areas of the body; afferent inputs to the brain stem (face) and to the spinal cord at the cervical (forepaw), thoracic (chest or abdomen), lumbar (hindpaw) and sacral (perineum) levels, cortical cerebral blood flow was increased by stimuli to face, forepaw and hindpaw. The afferent pathway of the responses is composed of somatic groups III and IV afferent nerves and whose efferent nerve pathway includes intrinsic cholinergic vasodilators originating in the basal forebrain. Uterine blood flow was increased by cutaneous stimulation of the hindpaw and perineal area, with perineal predominance. The afferent pathway of the response is composed of somatic group II, III and IV afferent nerves and the efferent nerve pathway includes the pelvic parasympathetic cholinergic vasodilator nerves. Furthermore, we briefly summarize vasodilative regulation of skeletal muscle blood flow via a calcitonin gene-related peptide (CGRP) induced by antidromic activation of group IV somatic afferent nerves. These findings in healthy but anesthetized animals may be applicable to understanding the neural mechanisms improving blood flow in various organs following clinical acupuncture

Electromyography and asymmetry index of masticatory muscles in undergraduate students with temporomandibular disorders

Abstract Aim: To compare the electromyographic activity and the asymmetry index among degrees of severity of temporomandibular disorders (TMD). Methods: Surface electromyography (EMG) of the right and left masseter and temporalis muscles was performed in 126 undergraduate students at rest and at maximal voluntary contraction. Three measurements were performed for five seconds of maximal contraction and mandibular rest. The degree of temporomandibular dysfunction was identified according to the Fonseca anamnestic index. The analysis of the asymmetry index for two pairs of muscles during maximal voluntary contraction was based on the asymmetry index proposed by Naeije, McCarrol and Weijs (1989). Results: 48.41% of the sample had mild TMD, followed by volunteers without TMD (26.98%), moderate TMD (19.05%) and severe (5.56%). The survey results show absence of correlation between the Fonseca anamnestic index and electromyographic activity at rest and at maximal voluntary contraction in undergraduate students in both muscles (p>0.05) and the asymmetry index did not differ between the analyzed groups. Conclusions: For the population of undergraduate students, there is no evidence that the presence and severity of TMD influence the EMG activity of masseter and temporalis muscles and the muscle asymmetry index at rest and maximal voluntary contraction

Confiabilidade intra e interexaminador do questionário Perfil do Estilo de Vida Individual (PEVI) em indivíduos com dor musculoesquelética

O objetivo do estudo foi testar todas as propriedades de confiabilidade do Perfil do Estilo de Vida Individual (PEVI) em pacientes com dor musculoesquelética. Participaram desse estudo 105 pacientes com dor musculoesquelética, recrutados de um serviço público de fisioterapia de nível secundário. O PEVI foi aplicado pelo Examinador 1 na avaliação inicial e pelo Examinador 2 após uma hora. Após três a sete dias da avaliação inicial, o Examinador 1 reaplicou o PEVI. O PEVI e seus componentes apresentaram consistência interna de 0,27 a 0,61 e valores de confiabilidade intra e interexaminador de moderado a excelente (CCI=0,68 a 0,90) e de moderado a quase perfeito (K=0,59 a 0,83). A porcentagem de concordância foi de 61% a 98%, o EPM do PEVI foi de 4,1 pontos e a MMD foi de 5,7 pontos. Concluímos que o PEVI é um instrumento confiável para avaliar o estilo de vida de pacientes com dor musculoesquelética.El objetivo del estudio fue poner a prueba todas las propiedades de confiabilidad del Perfil de Estilo de Vida Individual (PEVI) en pacientes con dolor musculoesquelético. Participaron en este estudio 105 pacientes con dolor musculoesquelético, provenientes de servicios públicos de fisioterapia de nivel secundario. El evaluador 1 aplicó el PEVI en la evaluación inicial, y el evaluador 2 lo aplicó después de una hora. Después de 3 a 7 días de evaluación inicial, el evaluador 1 reaplicó el PEVI. La consistencia interna del PEVI y sus componentes fue de 0,27 a 0,61; y los valores de confiabilidad intra e interevaluador fueron de moderada a excelente (CCI=0,68 a 0,9), y de moderada a casi perfecta (K=0,59 a 0,83). El porcentaje de concordancia fue de entre un 61% y un 98%, el EPM del PEVI fue de 4,1 puntos, y el CMD fue de 5,7 puntos. Se concluye que el PEVI es un instrumento confiable para evaluar los estilos de vida de pacientes con dolor musculoesqueléticoThe aim of this study was to test all the reliability properties of the Individual Lifestyle Profile (ILP) in patients with musculoskeletal pain. A total of 105 patients with musculoskeletal pain participated in this study after being recruited from a public secondary physical therapy care. ILP was applied by Rater 1 at the initial assessment and by Rater 2 after one hour. After three to seven days of the initial assessment, Rater 1 reapplied ILP. ILP and its components showed internal consistency from 0.27 to 0.61 and intra- and inter-rater reliability values from moderate to excellent (ICC=0.68 to 0.90) and from moderate to almost perfect (K=0.59 to 0.83). Percent agreement was 61% to 98%, the SEM of ILP was 4.1 points and the MDC was 5.7 points. We conclude that ILP is a reliable instrument to assess the lifestyle of patients with musculoskeletal pain

Vascular Gap Junctions Contribute to Forepaw Stimulation-Induced Vasodilation Differentially in the Pial and Penetrating Arteries in Isoflurane-Anesthetized Rats

Somatosensory stimulation causes dilation of the pial and penetrating arteries and an increase in cerebral blood flow (CBF) in the representative region of the somatosensory cortex. As an underlying mechanism for such stimulation-induced increases in CBF, cerebral artery dilation has been thought to propagate in the vascular endothelium from the parenchyma to the brain surface. Vascular gap junctions may propagate vasodilation. However, the contribution of vascular gap junctions to cerebrovascular regulation induced by somatosensory stimulation is largely unknown. The aim of the present study was to investigate the contribution of vascular gap junctions to the regulation of the pial and penetrating arteries during neuronal activity attributed to somatosensory stimulation. Experiments were performed on male Wistar rats (age: 7–10 weeks) with artificial ventilation under isoflurane anesthesia. For somatosensory stimulation, the left forepaw was electrically stimulated (1.5 mA, 0.5 ms and 10 Hz, for 5 s). The artery in the forelimb area of the right somatosensory cortex was imaged through a cranial window using a two-photon microscope and the diameter was measured. Carbenoxolone (CBX) was intravenously (i.v.) administered, at a dose of 100 mg/kg, to block vascular gap junctions. The forepaw electrical stimulation increased the diameter of the pial and penetrating arteries by 7.0% and 5.0% of the pre-stimulus diameter, respectively, without changing the arterial pressure. After CBX administration, the change in pial artery diameter during forepaw stimulation was attenuated to 3.2%. However, changes in the penetrating artery were not significantly affected. CBF was measured using a laser speckle flowmeter, together with somatosensory-evoked potential (SEP) recorded in the somatosensory cortex. The extent of CBF increase (by 24.1% of the pre-stimulus level) and amplitude of SEP were not affected by CBX administration. The present results suggest that vascular gap junctions, possibly on the endothelium, contribute to pial artery dilation during neuronal activity induced by somatosensory stimulation

Effect of periscapular muscle strengthening with addition of scapula motor control exercises on pain and disability in patients with Shoulder Impingement syndrome: a randomized controlled trial

O objetivo do estudo foi investigar o efeito da adição de exercícios de controle motor da escápula a um programa de exercícios de fortalecimento convencional em desfechos clínicos, força muscular e amplitude de movimento em pacientes com síndrome do impacto subacromial. Métodos: Sessenta pacientes com SIS foram alocados aleatoriamente em dois grupos distintos: fortalecimento ou exercícios focalizados na escápula de controle motor. As intervenções foram realizadas três vezes por semana durante oito semanas. Função, dor, cinesiofobia, efeito percebido global, satisfação com o tratamento, força muscular, amplitude de movimento e posição da escápula foram medidos antes da intervenção (baseline), 4 semanas após o início, no final da intervenção (8 semanas após o início) e 16 semanas após a linha de base. A dor e a função do ombro foram avaliadas pela versão brasileira do Índice de Dor e Incapacidade no Ombro (SPADI-Br). Um avaliador cego para a atribuição de grupo mediu todos os resultados. Não houve diferenças entre os grupos nos desfechos primário e secundário. Em conclusão, a adição de exercícios de controle motor ao fortalecimento muscular forneceu pouco valor agregado para melhora da função e da dor em pacientes com SISThe objective of the study was investigate the effect of adding scapula motor control exercises to a program of conventional strengthening exercises in clinical outcomes, muscle strength and range of motion in patients with subacromial impingement syndrome. Methods: Sixty patients with SIS were randomly allocated in two different groups: strengthening or motor control scapula-focused exercises. The interventions were performed three times a week for eight weeks. Function, pain, kinesiophobia, global perceived effect, satisfaction with treatment, muscle strength, range of motion and scapula position were measured before intervention (baseline), 4 weeks after baseline, at the end of intervention (8 weeks after baseline) and 16 weeks after baseline. Shoulder pain and function were assessed by the Brazilian version of Shoulder Pain and Disability Index (SPADI-Br). An assessor blinded to group assignment measured all outcomes. There were no between-group differences in primary and secondary outcomes. In conclusion, the addition of motor control exercises to strengthening treatment provides little-added value regarding improving function or pain in patients with SIS

Does the training of motor control and muscle strengthening could change the scapulotoracic joint kinematic?

Indivíduos com Síndrome do Impacto apresentam alterações nos movimentos da escápula em relação ao tórax como uma diminuição da rotação superior, inclinação posterior e aumento da rotação medial, que associada a diminuição do controle e do recrutamento da musculatura estabilizadora podem causar pinçamento dos tecidos moles. O objetivo deste estudo foi determinar o efeito de um protocolo de fortalecimento com carga e complexidade progressivas e aumento da percepção cinestésica na cinemática escapular de indivíduos com síndrome do impacto, enfatizando os músculos serrátil anterior, romboides e porções superior, média e inferior do trapézio. Vinte e cinco indivíduos com diagnóstico da síndrome foram submetidos ao programa de fortalecimento muscular e aumento do controle motor que teve duração de oito semanas, realizados três vezes por semana. O sistema eletromagnético de aquisição de dados foi utilizado para avaliar a cinemática em três planos antes e após o protocolo. A dor e a função do ombro foram avaliadas pelo Shoulder Pain and Disability Index (SPADI-Brasil). O modelo linear de efeitos mistos foi utilizado para as comparações. A escápula apresentou alterações pós-intervenção com redução da rotação interna no repouso, plano sagital e frontal, diminuição da inclinação anterior nos três planos e redução da rotação superior no plano frontal e escapular . Houve diminuição da dor e melhora da função avaliada pelo SPADI-Br. O protocolo de controle motor e fortalecimento muscular altera a cinemática da articulação escapulotorácica e gera diminuição da dor e melhora da qualidade de vida.Patients with subacromial impingement syndrome have changes in the scapula relative to the thorax movements with decreased upward rotation, posterior tilt and increased medial rotation that if associated with control and recruitment of stabilizer muscles decrease, could result on soft tissues impingement. The aim of this study is to determine the effect of a strengthening and kinesthetic awareness protocol with progressive and complexity load in scapular kinematics of individuals with impingement syndrome, emphasizing the serratus anterior, rhomboids and upper, middle and lower trapezius. Twenty-five diagnosed patients with the syndrome did undergo to the muscle strengthening and increased motor control program during eight weeks, three times a week. The electromagnetic data acquisition system was used to evaluate the kinematic at three planes before and after the protocol. The shoulder pain and function were evaluated by Shoulder Pain and Disability Index (SPADI-Brazil). The linear mixed-effects model was used for comparisons pre- and post-intervention. The scapula showed post-intervention changes with reduced internal rotation at rest, sagittal and frontal plane, decreased anterior tilt in three planes and reducing the upward rotation on the frontal and the scapular planes, decreased pain and improvement in function assessed by SPADI-Br. The motor control and strengthening protocol changes the kinematics scapulothoracic joint and results in decreased pain and improved quality of life

Gentle Mechanical Skin Stimulation Inhibits Micturition Contractions via the Spinal Opioidergic System and by Decreasing Both Ascending and Descending Transmissions of the Micturition Reflex in the Spinal Cord

<div><p>Recently, we found that gentle mechanical skin stimulation inhibits the micturition reflex in anesthetized rats. However, the central mechanisms underlying this inhibition have not been determined. This study aimed to clarify the central neural mechanisms underlying this inhibitory effect. In urethane-anesthetized rats, cutaneous stimuli were applied for 1 min to the skin of the perineum using an elastic polymer roller with a smooth, soft surface. Inhibition of rhythmic micturition contractions by perineal stimulation was abolished by naloxone, an antagonist of opioidergic receptors, administered into the intrathecal space of the lumbosacral spinal cord at doses of 2–20 μg but was not affected by the same doses of naloxone administered into the subarachnoid space of the cisterna magna. Next, we examined whether perineal rolling stimulation inhibited the descending and ascending limbs of the micturition reflex. Perineal rolling stimulation inhibited bladder contractions induced by electrical stimulation of the pontine micturition center (PMC) or the descending tract of the micturition reflex pathway. It also inhibited the bladder distension-induced increase in the blood flow of the dorsal cord at L5–S1, reflecting the neural activity of this area, as well as pelvic afferent-evoked field potentials in the dorsal commissure at the lumbosacral level; these areas contain long ascending neurons to the PMC. Neuronal activities in this center were also inhibited by the rolling stimulation. These results suggest that the perineal rolling stimulation activates the spinal opioidergic system and inhibits both ascending and descending transmissions of the micturition reflex pathway in the spinal cord. These inhibitions would lead to the shutting down of positive feedback between the bladder and the PMC, resulting in inhibition of the micturition reflex. Based on the central neural mechanisms we show here, gentle perineal stimulation may be applicable to several different types of overactive bladder.</p></div