Estimulação elétrica neuromuscular pós transplante de pulmão

Introdução: Após o transplante ( pulmonar, algumas complicações como redução da massa muscula r, fraqueza muscular e incapacidade funcional podem ser observadas. A reabilitação com estimulação elétrica neuromuscular ( é importante para a recuperação do indivíduo, nos aspectos funcionais, e na minimização no tempo d e internação hospitalar O objetivo principal foi comparar o efeito da EENM com a fisioterapia convencional sobre a morfologia do músculo quadríceps femoral e, secundariamente sobre a força muscular e capacidade funcional em pacientes pós transplante de pu lmão ( Foram randomizados 15 pacientes: seis no grupo intervenção ( que receberam EENM e fisioterapia e nove no grupo controle ( que receberam apenas a fisioterapia. A avaliação de força (através do teste senta e levanta TSL e MRC Medical Re search Council e morfologia muscular (por ultrassonografia) foi realizada em três momentos: na UTI ( antes de iniciar o acompanhamento; alta da UTI e nas unidades de internação pré alta hospitalar ( e a capacidade funcional (através do teste de c aminhada de seis minutos TC6) foi avaliada pré TXP e após alta hospitalar. Não houve diferença entre os grupos em relação a força muscular e a capacidade funcional. Contudo, nas avaliações de morfologia muscular, o GI apresentou melhora na espessura do v asto lateral direito ( em relação ao GC (p< e o GC apresentou redução na espessura de reto femoral e aumento na área da secção transversa intra grupo. O tamanho de efeito intra grupos foi considerado para o TSL fraco ( e alto para o TC6 ( para o GC e para o GI médio ( e fraco ( e, entre grupos o TSL apresentou tamanho de efeito alto e no TC6 tamanho de efeito médio ( para GC. Concluímos que o GI apresentou melhora na espessura muscular do VLD comparado a o GC e o GC apresentou redução na espessura de reto femoral. Porém, a EENM não foi capaz de fornecer benefícios nos demais desfechos e demais musculaturas. Portanto, são necessários mais estudos com maior tamanho amostral.Introduction: After lung transplantation (TX), some complications such as reduced muscle mass, muscle weakness and functional disability can be observed. Rehabilitation with neuromuscular electrical stimulation (NMES) is important for the recovery of the individual, in the positive aspects and in minimizing the length of hospital stay. The main objective was to compare the effect of NMES with conventional physiotherapy on the morphology of the quadriceps femoris muscle and, secondarily, on muscle strength and functional capacity in patients after lung transplantation (LTx). Fifteen patients were randomized: six in the intervention group (IG) who received NMES and physical therapy and nine in the control group (CG) who received only physical therapy. The evaluation of strength (through the sit-and-stand test - SST10 and MRC - Medical Research Council) and muscle morphology (by ultrasound) was carried out in three moments: in the ICU (pre) before starting the follow-up; discharge from the ICU and in the pre-hospital discharge units (post); and functional capacity (through the six-minute walk test - 6MWT) was assessed before LTx and after hospital discharge. There was no difference between the groups regarding muscle strength and functional capacity. However, in muscle morphology assessments, the GI showed an improvement in the thickness of the vastus lateralis right (VLD) in relation to the CG (p <0.01) and the CG showed a reduction in the thickness of the femoral rectum and an increase in the area of the intra transversal section. group. The intra-group effect size was considered for the weak SST10 (0.23) and high for the 6MWT (1.00) for the CG and for the medium (0.53) and weak (0.30) IG, and, between groups, the SST10 had a high effect size and, in the 6MWT, a medium effect size (0.539), for CG. We concluded that the IG showed an improvement in the muscular thickness of the VLD compared to the CG and the CG showed a reduction in the thickness of the rectus femoris. However, NMES was not able to provide benefits in other outcomes and other muscles. Therefore, more studies with a larger sample size are needed

Inspiratory muscle training in patients with heart failure: what is new? Systematic review and meta-analysis.

Objective. The benefits of inspiratory muscle training (IMT) have already been demonstrated in patients with heart failure (HF), but the best mode of training and which patients benefit from this intervention are not clear. The purpose of this study was to review the effects of IMT on respiratory muscle strength, functional capacity, pulmonary function, quality of life, and dyspnea in patients with HF; IMT isolated or combined with another intervention (combined IMT), the presence of inspiratory muscle weakness, training load, and intervention time were considered. Methods. The search included the databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and LILACS database through September 2019. The review included randomized studies that assessed IMT in isolation or combined with another intervention—in comparison with a control group, a placebo, or another intervention—in patients with HF. Fourteen studies were included, 13 for meta-analysis (10 for isolated IMT and 3 for combined IMT). Results. Isolated IMT demonstrated an increase in maximal inspiratory pressure (MIP) (25.12 cm H2O; 95% CI = 15.29 – 34.95), 6-Minute Walk Test (81.18 m; 95% CI = 9.73 – 152.63), maximum oxygen consumption (12 weeks: 3.75 mL/kg/min; 95% CI = 2.98 to 4.51), and quality of life (−20.68; 95% CI = −29.03 to −12.32). The presence of inspiratory muscle weakness, higher loads, and longer intervention times resulted in greater increases in MIP. IMT combined with another intervention demonstrated an increase only in MIP. Conclusions. Isolated IMT resulted in an increase in inspiratory muscle strength, functional capacity, and quality of life. IMT combined with another intervention resulted only in a small increase in inspiratory strength. Isolated IMT with higher loads can be considered an adjuvant intervention, especially for those who do not adhere to conventional rehabilitation and who have respiratory muscle weakness. Impact. A systematic review was necessary to review the effects of IMT on respiratory muscle strength, lung function, functional capacity, quality of life, and dyspnea in patients with HF. Various clinical issues important for a better training prescription were considered; these included whether the performance of the training IMT as a form of isolated training benefits patients with HF, whether the combination of IMT with another intervention has additional effects, whether any patient with HF can benefit from IMT (alone or combined with another intervention), and whether only patients who already have respiratory muscle weakness benefit. Also important was establishing which training load provides the best result and the best intervention time, so that health care can be provided more efficiently. Lay Summary. For people with heart failure, IMT by itself, without being combined with other exercise, can improve ease of breathing, increase the amount of distance that they can walk, and improve quality of life. Inspiratory training with higher loads might be helpful for those with respiratory muscle weakness who are unable to do conventional exercise

Comparación entre pico de torque y flexibilidad de los miembros inferiores de individuos con y sin diabetes mellitus tipo 2

O objetivo deste trabalho foi comparar o pico de torque e flexibilidade dos membros inferiores de indivíduos com e sem diabetes mellitus tipo 2 (DM2). O método foi o estudo com grupos expostos e não expostos ao DM2. Foram incluídos indivíduos com diagnóstico médico de DM2, encaminhados para eletroneuromiografia, e não expostos ao DM2. Foram excluídos da pesquisa indivíduos com idade superior a 70 anos ou que, por algum motivo, não conseguiram realizar um ou dois dos testes. A amostra foi não probabilística, composta por 64 indivíduos: 34 (53,1%) expostos ao DM2 e 30 não expostos; 50 (78,1%) eram do sexo feminino, a idade média era de 60,7±7,1 anos, e o membro inferior dominante era o direito em 57 (89,1%) dos indivíduos. Comparando indivíduos com e sem diagnóstico de DM2, observou-se redução do torque de flexão à esquerda, em velocidade angular de 120° (25,94±2,26 vs. 33,79±2,4nm, p=0,027, respectivamente). Relatou-se menor valor do torque de dorsiflexão à direita, em velocidade angular de 60°, dos diabéticos em relação aos não diabéticos (10,95±0,89 vs. 13,95±0,96nm, p=0,033, respectivamente). Ao comparar indivíduos com DM2, com e sem diagnóstico de neuropatia diabética periférica (NDP), notou-se maior déficit de flexão entre os indivíduos neuropatas em comparação com não neuropatas (46,57±9,47 vs. 11,63±13,85nm, p=0,049, respectivamente). Não foram encontradas diferenças estatisticamente significativas ao comparar os grupos de expostos e não expostos ao DM2 e diabéticos neuropatas e não neuropatas.El objetivo de este trabajo fue comparar el pico de torque y la flexibilidad de los miembros inferiores de individuos con y sin diabetes mellitus tipo 2 (DM2). El método fue el estudio con grupos expuestos y no expuestos al DM2. Se incluyeron individuos con diagnóstico médico de DM2, encaminados para electroneuromiografía, y no expuestos al DM2. Se excluyeron de la investigación a individuos mayores de 70 años o que, por algún motivo, no pudieron realizar una o dos de las pruebas. La muestra fue no probabilística, compuesta por 64 individuos: 34 (53,1%) expuestos al DM2 y 30 no expuestos; 50 (78,1%) eran de sexo femenino, la edad media era de 60,7±7,1 años, y el miembro inferior dominante era el derecho en 57 (89,1%) de los individuos. En comparación con individuos con y sin diagnóstico de DM2, se observó reducción del torque de flexión a la izquierda, en velocidad angular de 120° (25,94±2,26 frente a 33,79±2,4nm, p=0,027, respectivamente). Se ha reportado un menor valor del torque de dorsiflexión a la derecha, en velocidad angular de 60°, de los diabéticos con relación a los no diabéticos (10,95±0,89 frente a 13,95±0,96nm, p=0,033, respectivamente). Al comparar individuos con DM2, con y sin diagnóstico de neuropatía diabética periférica (NDP), se notó mayor déficit de flexión entre los individuos neuropáticos en comparación con no neuropáticos (46,57±9,47 vs. 11,63±13,85nm, p=0,049, respectivamente). No se encontraron diferencias estadísticamente significativas al comparar los grupos de expuestos y no expuestos al DM2 y los diabéticos neuropáticos y no neuropáticos.To compare the muscle strength and flexibility of the lower limbs of individuals with and without T2DM. The method was a study of the types exposed and unexposed to T2DM. Individuals diagnosed with T2DM, individuals referred to electromyography, and those unexposed to T2DM were included. The exclusion criteria were: individuals over 70 years old; those who for some reason failed to complete one or both tests. The study population consisted of 64 individuals; 34 (53.1%) exposed to DM and 30 unexposed, 50 (78.1%) were female, the mean age was 60.7±7.1 and the dominant lower limb was right in 57 (89.1%) individuals. Comparing individuals with and without a diagnosis of DM, one observed a reduction in the flexion torque on the left at a 120 ° angular velocity in diabetics individuals compared with nondiabetic patients, 25.94±2.26 vs 33.79±2, 4nm, p=0.027, respectively. The reduction in dorsiflexion torque on the right, at a 60 ° angular velocity was observed in diabetics compared with nondiabetic patients, 10.95±0.89 vs. 13.95±0.96nm, p=0.033, respectively. When comparing diabetic individuals with and without a diagnosis of PDN, one observed a greater flexion deficit among neuropathic individuals when compared with non-neuropathic individuals, 46.57±9.47 vs 11.63±13.85nm, p=0.049, respectively. No statistically significant differences were found when comparing groups exposed and unexposed to T2DM, and neuropathic and non-neuropathic diabetics

Physical exercise in patients with diabetic neuropathy: systematic review and meta-analysis of randomized clinical trials

Este estudio tiene por objeto revisar sistemáticamente los efectos en el tratamiento con la práctica de ejercicios físicos aerobios, resistivos o combinados (resistido/aerobio/equilibrio) en el equilibrio, en la fuerza muscular y el índice de la glucemia de sujetos con neuropatía diabética. Se llevó a cabo una búsqueda de estudios clínicos controlados en los que fueron empleados ejercicio aerobio, ejercicio resistido o ejercicio combinado en sujetos con neuropatía diabética comparados con un grupo control en las siguientes bases de datos: MEDLINE (vía PubMed), Cochrane CENTRAL, LILACS (vía Bireme) y PEDro. Se consideraron los términos: equilibrio, evaluación desde la escala AB, índice de la glucemia a través del valor de la glucemia en ayuno y después de la comida, y la fuerza muscular, evaluada según la dinamometría y el test Five-times-sit-to-stand. De los 389 estudios encontrados, se incluyeron cinco, con un total de 292 sujetos. Se observó que el ejercicio combinado (resistido/equilibrio) comparado con el del control presentó una significativa mejora en el equilibrio (8; IC 95%: 1,12 a 14,88; I2=0%). De estos cinco estudios incluidos, dos evaluaron la fuerza muscular de MMII (n=116), ambos estudios con ejercicios combinados (resistido/equilibrio) versus control, sin embargo no se realizó el metaanálisis, debido a que se evaluó la fuerza muscular de distintas formas. Solamente un estudio evaluó el índice de la glucemia después de la comida y en ayuno (n=87), por lo que impidió el metaanálisis. En dicho estudio, el índice de la glucemia después de la comida y en ayuno, cuando comparados en los dos grupos, no presentaron diferencias significativas. Los datos evaluados en esta revisión mostraron que el equilibrio en pacientes con neuropatía diabética presentó una mejora durante la práctica de ejercicios combinados.The aim of this study was to systematically review the effects of treatment with aerobic, resistance or combined (resistance/aerobic/balance) exercises in the balance, muscular strength and glycemic index of patients with diabetic neuropathy. Searches were conducted in the electronic databases: MEDLINE (via PubMed), COCHRANE CENTRAL, LILACS (via Bireme) and PEDro of randomized clinical trials, which conducted aerobic, resistance or combined (resistance/aerobic/balance) exercises compared with the control group in individuals with diabetic neuropathy. The outcomes considered were: balance evaluated from ABC scale and glycemic index at fasting and at postprandial. Out of 389 studies, five were included, with a total of 292 individuals. We observed that the combined exercise (resistance/balance) compared with the control demonstrated significant improvement of balance (8; 95%CI). 1.12, 14.88; I2 = 0%). Two out of the five included studies evaluated the muscular strength of LL (Lower Limbs) (n=116), both studies with combined exercises (resistance/balance) versus control, but we could not conduct the meta-analysis of these studies as muscle strength was evaluated in different ways. Only one article evaluated the postprandial and fasting glycemic index (n = 87), which precluded meta-analysis. In this study, the postprandial and fasting glycemic index showed no significant difference when compared the two groups. The data analyzed in this review demonstrated that the balance in individuals with diabetic neuropathy improved with combined exercise.O objetivo deste estudo foi revisar sistematicamente os efeitos do tratamento com exercícios aeróbio, resistido ou combinado (resistido/aeróbio/equilíbrio) no equilíbrio, força muscular e índice glicêmico de portadores de neuropatia diabética. A busca de ensaios clínicos randomizados que realizaram exercício aeróbio, exercício resistido ou exercício combinado em indivíduos com neuropatia diabética comparados com grupo controle foi realizada nas bases de dados eletrônicas MEDLINE (via PubMed), Cochrane CENTRAL, LILACS (via Bireme) e PEDro. Os desfechos considerados foram: equilíbrio, avaliado a partir da escala ABC, índice glicêmico, através da glicemia de jejum e pós-prandial, e a força muscular, avaliada pela dinamometria e pelo teste Five-times-sit-to-stand. Dos 389 estudos identificados, cinco foram incluídos, com um total de 292 indivíduos. Foi observado que o exercício combinado (resistido/equilíbrio) comparado com o controle demonstrou melhora significativa do equilíbrio (8; IC 95%: 1,12 a 14,88; I2=0%). Dois dos cinco estudos incluídos avaliaram a força muscular de MMII (n=116), ambos os estudos com exercícios combinados (resistido/equilíbrio) vs. controle, porém não foi possível realizar a metanálise desses estudos, pois a força muscular foi avaliada de formas diferentes. Apenas um artigo avaliou o índice glicêmico pós-prandial e índice glicêmico de jejum (n=87), o que impossibilitou a metanálise. Nesse estudo, o índice glicêmico pós-prandial e o de jejum, quando comparados os dois grupos, não apresentaram diferença significativa. Os dados analisados nesta revisão demonstraram que o equilíbrio em indivíduos com neuropatia diabética melhorou com o exercício combinado

Reliability of knee extensor neuromuscular structure and function and functional tests’ performance

Introduction The aim of this study was to evaluate the intra and inter-rater and inter-analyzer reliability of neuromuscular variables and functional tests. Methods Cross-sectional crossover design. Two independent raters and analyzers evaluated twenty-two healthy subjects. Knee-extensor strength was assessed from three maximal voluntary isometric contractions. Muscle activation was obtained from the vastus lateralis (VL), rectus femoris (RF), and vastus medialis (VM) muscles. VL and RF muscles’ architecture [fascicle length (FL), pennation angle (PA), muscle thickness (MT)] was obtained at rest by ultrasound. The time from five sit-to-stand (STS) trials, and the distance from the 6-min walk test (6MWT) were obtained. Intraclass correlation coefficient was determined and classified as strong (r = 0.75–1.00), moderate (r = 0.40–0.74), and weak (r < 0.40). Strong intra-rater reliability values were observed for strength (r = 0.97), muscle activation [VL (r = 0.91); RF (r = 0.92); VM (r = 0.80)], VL [FL (r = 0.90); PA (r = 0.94); MT (r = 0.99)] and RF [MT (r = 0.85)] muscle architecture, STS (r = 0.95), and 6MWT (r = 0.98). Inter-rater reliability also presented strong values for strength (r = 0.97), muscle activation [VL (r = 0.94); RF (r = 0.79); VM (r = 0.78)], muscle architecture VL [PA (r = 0.81) and MT (r = 0.88)] and RF [MT (r = 0.80)], STS (r = 0.93), and 6MWT (r = 0.98). A moderate correlation VL muscle architecture [FL (r = 0.69)]. Inter-analyzer muscle architecture reliability presented strong VL [FL (r = 0.77); PA (r = 0.76); MT (r = 0.91)] and RF [MT (r = 0.99)]. Conclusion The high intra and inter-rater and inter-analyzer reliability values for most variables is evidence that they can be used for clinical evaluation. Muscle architecture might need a longer training period by different raters and analyzers to increase reliability