Effect of Low-Level Laser Therapy and Strength Training Protocol on Hand Grip by Dynamometry

Introduction: The purpose of this study was to investigate the effect of low-level laser therapy (LLLT) – 660 nm and 904 nm - before grip strength protocol in healthy subjects.Methods: The study included 45 healthy volunteers with an average age of 22.7 (±1.4) years, subdivided into the following groups, control group: grip strength training associated with placebo LLLT; 660 nm group: LLLT (660 nm, 20 J/cm2, power of 30 mW, and beam area of 0.06 cm2, continuous, energy 1.2 J, and exposure time 40 seconds per point) before grip strength training and 904 nm group: LLLT (904 nm, 10 J/cm2, peak power of 70 W and 0.13 cm2 beam area, with pulsed beam 9.500 Hz and 30 seconds of exposure time per point and emitted energy 1.2 J) before grip strength training. The LLLT was timed to contact 10 points located in the region of the superficial and deep flexor muscles of the fingers, with a total energy of 12.0 J per session. For the strength training protocol, the volunteer exercised their fingers with the dominant hand on a small table, elbow flexed at 90°, forearm in neutral, using a light extension handle. The Oxford protocol was performed during four weeks. The grip strength was assessed using a dynamometer (Jamar™). The data were evaluated by the analysis of variance (ANOVA) statistical method.Results: In the comparison of intragroup evaluation, only the 904 nm group showed a difference compared to the baseline assessment after 4 weeks (P < 0.05), in the final intergroup evaluation, a difference was observed in the comparison between the control and 904 nm groups.Conclusion: In conclusion, LLLT (904 nm) applied before resistance training was effective in gaining grip strength when compared to LLLT (660 nm) and isolated strength training after 4 weeks

Photobiomodulation in Sciatic Nerve Crush Injuries in Rodents: A Systematic Review of the Literature and Perspectives for Clinical Treatment

Introduction: The aim of the study was to perform a literature review to analyze the effect of photobiomodulation in experimental studies on peripheral nerve regeneration after sciatic nerve crush injury in rodents.Methods: A bibliographic search was performed in the electronic databases, including MEDLINE (PubMed), SCOPUS, and SciELO, from 2008 to 2018.Results: A total of 1912 articles were identified in the search, and only 19 fulfilled all the inclusion criteria. Along with the parameters most found in the manuscripts, the most used wavelengths were 660 nm and 830 nm, power of 30 and 40 mW, and energy density of 4 and 10 J/cm2. For total energy throughout the intervention period, the lowest energy found with positive effects was 0.70 J, and the highest 1.141 J. Seventeen studies reported positive effects on nerve regeneration. The variables selected to analyze the effect were: Sciatic Functional Index (SFI), Static Sciatic Index (SSI), morphometric, morphological, histological, zymographic, electrophysiological, resistance mechanics and range of motion (ROM). The variety of parameters used in the studies demonstrated that there is yet no pre-determined protocol for treating peripheral nerve regeneration. Only two studies by different authors used the same power, energy density, beam area, and power density.Conclusion: It was concluded that the therapeutic window of the photobiomodulation presents a high variability of parameters with the wavelength (632.8 to 940 nm), power (5 to 170 mW) and energy density (3 to 280 J /cm2), promoting nerve regeneration through the expression of cytokines and growth factors that aid in modulating the inflammatory process, improving morphological aspects, restoring the functionality to the animals in a brief period.Keywords: Phototherapy; Nerve regeneration; Sciatic nerve; Experimental studies; Injury; Lasers and light sources

Fiabilidad y validez de un dispositivo de célula de carga para evaluar la fuerza de prensión palmar

A força de preensão palmar é uma medida influenciada por diversos fatores como sexo, idade, motivação, treinamento muscular, dominância, altura, peso, variáveis socioeconômicas, participação em esportes específicos ou profissões. Pode ser mensurado por meio da dinamometria ou por medidores de tensão como as células de carga (strain gauges ). Confiabilidade e validade são importantes propriedades psicométricas que avaliam a reprodutibilidade da medida de um instrumento e sua aplicabilidade. Desse modo, o objetivo deste estudo foi avaliar a confiabilidade teste-reteste e a validade de constructo de uma célula de carga para medida da força de preensão palmar isométrica, em voluntários assintomáticos e portadores de disfunções no punho e mão. Foram utilizados métodos padronizados de posicionamento do membro superior e realizada aleatorização da ordem das coletas. A análise estatística de confiabilidade foi realizada pelo ICC e a validade de constructo pelo coeficiente de correlação de Pearson (r), com pLa fuerza de prensión palmar es una medida influida por diversos factores tales como, sexo, edad, motivación, entrenamiento muscular, dominio, altura, peso, variables socioeconómicas, participación en deportes específicos o profesiones. Se la puede medir mediante la dinamometría o por medidores de tensión como las células de carga (strain gauges ). La fiabilidad y la validez son importantes propiedades psicométricas que evalúan la reproducibilidad de un instrumento de medición y su aplicabilidad. De esa manera, este estudio tuvo la pretensión de evaluar la fiabilidad test-retest y la validez del constructo de una célula de carga para medir la fuerza de prensión palmar isométrica, en participantes asintomáticos y en portadores de trastornos de la muñeca y de la mano. Se utilizaron métodos estandarizados de posicionamientos del miembro superior y se llevó a cabo la aleatorización del orden de la recolección de datos. El análisis estadístico de fiabilidad fue realizado por el ICC y la validez del constructo por el coeficiente de correlación de Pearson (r), con pThe grip strength is a complex measure influenced by factors such as gender, age, motivation, muscle training, handedness, height, weight, socioeconomic variables, and participation in specific sports or professions. It can be measured by dynamometers or by tension meters such as load cells (strain gauges). Reliability and validity are important psychometric properties, which analyze consistency and applicability of an instruments' measurement. Thus, the aim of this study was to evaluate the test-retest reliability and construct validity of a load cell device in isometric grip force measurements using a sample of asymptomatic subjects and patients with wrist and hand dysfunctions. Standardized methods of the upper limb positioning and randomization of the sample order were used. Statistical analysis of reliability was conducted by the ICC (Intraclass Correlation Coefficient) and the construct validity by Pearson correlation coefficient (r), with

Mapeamento de Áreas Agrícolas com Máquina de Vetor de Suporte no Noroeste de Minas Gerais, Brasil

A agricultura é um dos setores que mais se destaca na economia do Brasil, sendo necessário muitas vezes o emprego do sensoriamento remoto, para identificação da expansão das áreas agrícolas e estimativas da sua produção. Esse trabalho tem por objetivo mapear as áreas agrícolas do noroeste de Minas Gerais por meio de máquina de vetor de suporte e comparar os resultados obtidos com o censo estatístico do Instituto Brasileiro de Geografia e Estatística. Para identificação das áreas agrícolas foi utilizado o algoritmo Service Vector Machine e imagens dos satélites e sensores Landsat 8 / OLI e Terra / MODIS. As amostras de treinamento do algoritmo foram obtidas por meio de imagem de alta resolução espacial, disponível no programa Google Earth Pro, nas classes rios, floresta, agricultura, pastagem e silvicultura. O mapeamento utilizando imagem do sensor OLI apresentou melhor Acurácia Global (0,81) e Kappa (0,66). A classificação com imagem OLI e MODIS apresentaram maior precisão na classe agricultura quando comparada as demais classes, apresentando confusão com pastagem, em decorrência da alta fitomassa da pastagem na época de aquisição das imagens (verão). O cálculo das áreas agrícolas demonstra superestimativa do Service Vector Machine (SVM) na classificação das imagens OLI e MODIS, com forte relação dos dados MODIS com o censo do IBGE (R²=0,83). Apenas municípios com áreas agrícolas superiores a 50.000 ha apresentaram menor erro na estimativa das áreas agrícolas. A aplicação do algoritmo mostra-se potencial para mapeamento da agricultura por meio de imagens dos sensores MODIS e OLI, porém deve-se avaliar a época de aquisição das imagens orbitais e variações nos parâmetros do algoritmo para melhorar a acurácia da classificação

Validity, reliability and responsiveness of the Brazilian version of the Patient Specific Functional Scale (PSFS-Br) in upper limb lesions

Lesões podem gerar consequências funcionais e mudanças de vida para o indivíduo. Além do exame físico, a aplicação de questionários de autorrelato são fundamentais para a tomada de decisão, determinação do prognóstico e avaliação da eficácia do tratamento. O Patient Specific Functional Scale (PSFS) é um questionário individual que avalia o estado funcional do indivíduo.  Suas vantagens propostas incluem sua ampla aplicabilidade, facilidade de administração, e adequada responsividade para análise da evolução funcional. Entretanto, esta escala ainda não está disponível na versão em português-brasileiro. Objetivo: Realizar a tradução e adaptação transcultural do questionário e analisar sua validade, confiabilidade e responsividade em pacientes com lesões do membro superior. Métodos: O PSFS-Br foi desenvolvido usando diretrizes padronizadas e o processo de tradução ocorreu em 5 etapas. Após a versão definitiva, 100 pacientes com lesões do membro superior foram recrutados e responderam o PSFS-Br, Quick-DASH-Br a Escala Visual Analógica em três ocasiões. Resultados: A compreensão adequada do instrumento pela população alvo resultou em boa validade de face. O PSFS-Br, quando comparado ao QuickDASH-Br, apresentou validade de construto fraca r = -0,36, excelente confiabilidade teste-reteste (ICC = 0,91) e apresentou alta responsividade com Tamanho do Efeito(TE) = 1,85, Média da resposta Padronizada (MRP) = 2, 75, Erro padrão de medida (EPM) = 0,36 e Minima diferença dectável (MDD) = 1,5. Conclusão: Este estudo demostrou que o PSFS-Br é uma ferramenta válida, confiável e responsiva para pacientes brasileiros com lesões do membro superior.Injuries can lead to functional consequences and changes in the lives of individuals. In addition to physical examination, a self-report questionnaire application is critical for decision making, prognosis determination, and treatment evaluation. The Patient Specific Functional Scale (PSFS) is an individual questionnaire that evaluates the individuals functional status and its advantages, which can be applied, ease of administration and responsive. However, this scale is not yet available in the Portuguese-Brazilian version. Objective: To perform a translation and cross-cultural adaptation of the questionnaire and to analyze its validity,reliability and responsiveness in patients with upper limb injuries. Methods: PSFS-Br was developed using standardized guidelines and the translation process took place in 5 steps. After a definitive version, 100 patients with upper limb injuries were recruited and answered by PSFS-Br, Quick-DASH-Br and Visual Analogue Scale on three occasions. Results: Proper understanding of the instrument by the target population resulted in good face validity. PSFS-Br, when compared to QuickDASH-Br, shows poor construct validity r = -0.36, excellent retest test reliability (ICC = 0.91) and high responsiveness with Effect Size (ES) = 1.85, Standand response mean (SRM) = 2.75, Standard Error of Measure (SEM) = 0.36 and Minimal Chande Diference (MCD) = 1.5. Conclusion: PSFS-Br is a valid, reliable and responsible tool for Brazilian patients with upper limb injuries

Efeitos de um protocolo de reeducação sensorial da mão: estudo de caso

Uma paciente em pós-operatório de reparo das lesões dos tendões flexores e nervo digital do 5o dedo da mão direita foi estudada com o objetivo de avaliar os efeitos da aplicação de um protocolo de reeducação sensorial da mão. A paciente foi avaliada antes e após três meses da aplicação do protocolo. Nessas avaliações foram aplicados: teste de limiar de sensibilidade com monofilamentos, teste de discriminação de dois pontos estático e dinâmico, o questionário Dash (sigla em inglês de incapacidades de ombro, braço e mão) e testes de força de preensão palmar e de pinça. Os exercícios propostos envolveram: discriminação de toque estático e dinâmico e de objetos de diferentes formas, tamanhos e texturas. A paciente também foi orientada a executar programa domiciliar. Foi realizada a análise descritiva dos dados. Ao final dos três meses, verificou-se redução do limiar sensitivo na região volar do 5º dedo, bem como desenvolvimento de discriminação estática de dois pontos nessa região. Além disso, verificou-se aumento das forças de preensão palmar e de pinça e menor pontuação no questionário Dash. Os resultados sugerem que a aplicação de programas de reeducação da sensibilidade pode contribuir para a recuperação da função sensorial da mão, trazendo benefícios reais ao paciente.A patient who had undergone nerve injury repair surgery of the right-hand 5th-finger flexor tendons and digital nerve was studied in order to assess the effects of a hand sensory reeducation program. The patient was evaluated before and after the three-month program application, as to: touch pressure threshold (by monofilaments); static and moving two-point discrimination; pinch strength; and answered the Dash - Disabilities of the arm, shoulder and hand - questionnaire. The proposed exercises involved static and moving touch discrimination, and recognition of different shapes, sizes and textures. The patient was also guided to do the exercises at home. After the three-month program, a pressure threshold reduction was noticed in the 5th-finger volar region, as well as a static two-point discrimination improvement in the same area. Also, an increase of grip and pitch strength and a minor score in the Dash questionnaire were found. Results thus suggest that the sensorial reeducation program proposed may contribute to improving hand sensory function, bringing real benefits to the patient

Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: Systematic review of psychometric properties

© 2018 The Author(s). Background: Outcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair. Methods: This systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence. Results: Sixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity. Conclusions: Few studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective