Search

Data from theend-stage renal disease patients undergoing hemodialysis.

BACKGROUND: Several therapies are being used for the rehabilitation of stroke patients, such as Virtual Reality (VR) which has emerged as an interactive intervention to motivate and rehabilitate post-stroke patients. However, data comparison between the virtual and real environments is inconclusive. Thus, this study aimed to compare the kinematics and performance of the affected lower limb of post-stroke patients and healthy individuals during stationary walking activity between the real and virtual non-immersive environments. METHODS: A cross-sectional study was conducted with 10 stroke patients and 10 healthy individuals, matched for gender and age. The participants performed stationary walking in a real and non-immersive virtual environment (Wii Fit Plus® –Running mode) for 3 minutes in random order. The performance was measured in both environments using the number of steps, while the kinematics was assessed by calculating the mean maximum flexion and extension of each joint (hip, knee, and ankle) of the affected lower limb. RESULTS: Post-stroke patients performed a higher total number of steps (p = 0.042), mainly in the third minute (p = 0.011), less knee flexion (p = 0.001) and total knee range of motion (p = 0.001) in the virtual compared with the real environment. CONCLUSIONS: Post-stroke patients performed more steps, with a faster cadence and smaller knee range of motion on the affected side in non-immersive virtual environment compared with the real environment.

Aims To describe a pelvic floor muscle training (PFMT) isolated and associated with game therapy (PFMT + GT) for women facing mixed urinary incontinence (MUI) during climacteric period. Methods To standardize a randomized controlled clinical trial intervention, a protocol was created, in an attempt to decrease women's symptomatology generated by MUI, through pelvic floor and abdomino-loin-pelvic muscles strength, and endurance. This study protocol will be composed of 32 volunteers, divided into two groups of 16. They will perform PFMT isolated or PFMT + GT, twice a week during 8 weeks. Interventions will last 40 minutes and will be divided into warming (5 minutes), training (30 minutes), and 5 minutes will be composed of resting time between exercises (1 minute each). Isolated PFMT sessions will be performed through four modalities of exercises: diaphragmatic, bridge, abdominal (plank), and pelvic mobility. PFMT + GT training will be carried out by using Wii Fit Plus games, such as Lotus Focus, Penguin Slide, Basic Step, and Hula Hoop from Wii equipment. Assessments will occur before, after, and 1 month after interventions. Vaginal manometry, 1-hour Pad Test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Intervention (PGI) will be used to evaluate the sample. Conclusions It is expected greater increase on pelvic floor muscle (PFM) strength, endurance, vaginal pressure for PFMT + GG. Moreover, it is supposed that PFMT + GT volunteers present better treatment adherence due to games motivational inclusion.

PURPOSE: Diabetes Mellitus (DM) is a chronic disease which presents a big prevalence in the world and several patients with this condition fail to respond to the available treatments. There is a huge unmet clinical need for the development of new therapeutic approaches for this condition. This study aims to evaluate the effects of anodal tDCS on Quality of Life and physical fitness in patients with diabetic polyneuropathy. METHODS: A pilot, parallel, sham, randomized, double-blind trial was conducted with twenty patients. Five consecutive sessions of C3/Fp2 tDCS montage were performed. To assess the primary outcome Short Form 36 Health Survey (SF-36) was used. Physical fitness level, according to lower and upper body strength, flexibility, Time Up and Go Test (TUG) and Six-Minute Walking Test (6MWT) were measured as secondary outcomes. The measures were performed at 3 different times (baseline, 1st and 2nd weeks). RESULTS: SF-36 increased throughout the protocol, but no difference between groups were found. However, there was a significant difference between groups at 1st and 2nd weeks, which shows a permanent growth in the active-tDCS group. Physical health and functioning, functional capacity and bodily pain showed significant improvements in active-tDCS group in 1st and 2nd weeks during inter-group analysis. Emotional scores showed significant interaction group-time with interaction effects only for active-group in 1st and 2nd weeks. TUG and 6MWT showed significant improvements only in active-tDCS group. CONCLUSIONS: It is suggested that five sessions of anodal M1 tDCS improves QoL and functionality of patients with diabetic polyneuropathy.

Chronic data after 12 sessions.

SUMMARY The novel coronavirus disease (COVID-19) has infected millions of people worldwide and generated many sequels in the survivors, such as muscular pain and fatigue. These symptoms have been treated through pharmacological approaches; however, infected people keep presenting physical limitations. Besides, the COVID-19 damage to the central nervous system has also been related to the presence of some physical impairment, so strategies that focus on diverse brain areas should be encouraged. Transcranial Direct Current Stimulation (tDCS) is a non-pharmacological tool that could be associated with pharmacological treatments to improve the central nervous system function and decrease the exacerbation of the immune system response. tDCS targeting pain and fatigue-related areas could provide an increase in neuroplasticity and enhancements in physical functions. Moreover, it can be used in infirmaries and clinical centers to treat COVID-19 patients.

Objective The aim of this trial was to investigate the effects of five consecutive sessions of anodal transcranial direct current stimulation (tDCS) over the motor cortex (M1) on pain, mood, and physical performance in patients with primary dysmenorrhea (PDM). Design This is a double-blind randomized controlled trial. Subjects Twenty-two participants with PDM according to the No. 345-PDM Consensus Guideline were included. Methods Eleven active treatment and 11 sham stimulation patients received five applications over a one-week period. The primary outcome measures were pain evaluated by numeric rating scale (NRS) and McGill Questionnaire score. Secondary outcomes measures were responses to the Positive and Negative Affect Schedule (PANAS), Hamilton Anxiety Scale (HAM-A), grip strength, and six-minute walk test (6MWT). Baseline data were performed during the first menstrual cycle, and during the second menstrual cycle, participants were conducted to tDCS treatment, and postintervention data were collected. Results The intervention provided significant improvements on NRS in active tDCS, shown as an interaction between group intervention vs pre/postintervention vs days of menstrual cycle (Wald x2 = 10.54, P = 0.005), main effect of days of menstrual cycle (Wald x2 = 25.42, P < 0.001), and pre/postintervention (Wald x2 = 6.97, P = 0.008). McGill showed an interaction effect between pre/postintervention and group of stimulation (Wald x2 = 18.45, P = 0.001), with a large reduction in active tDCS (P < 0.001, d = 0.75). Psychological and functional outcomes did not differ between groups or pre/postintervention. Conclusions tDCS could provide pain relief in subjects with PDM. These results provide some preliminary evidence for the potential role of tDCS as a contributor to the management of symptoms of PDM.

Background Interstitial cystitis or painful bladder syndrome is a chronic disorder that presents an unknown etiology, with no generally accepted treatment. Although there is no gold standard treatment, transcranial direct current stimulation (tDCS) has shown efficacy in several chronic pain syndromes with decrease in pain, and improved functionality and mood. tDCS could be a safe, ease to use, and low-cost complementary intervention for patients with interstitial cystitis. Aim This study will investigate the effects of a tDCS protocol on pain, functionality, and mood in patients with interstitial cystitis. Methods A randomized controlled clinical trial with two arms. Women will be randomized into two groups: active or sham. Anodal tDCS over the primary motor cortex will be performed for 5 consecutive days with an intensity of 2 mA for 20 min. Participants will be evaluated five times: 1 week before intervention; on the 5th day of tDCS; and 1, 6, and 12 months after the last day of tDCS. The outcomes will be assessed using the numeric rating scale, McGill pain questionnaire, positive and negative affect scale, international consultation on incontinence questionnaire for female lower urinary tract symptoms, Hamilton anxiety scale, six-minute walk test, patient global impression of change, and voiding diary. Discussion Only the active group will be expected to show decreased pain. The results of this trial will be the first step in the use of neuromodulation in interstitial cystitis and will provide additional data to support new studies with tDCS.

SUMMARY The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic shows a rapid increase in cases and deaths. The World Health Organization (WHO) has shown that more than 200.000 confirmed cases have been identified in more than 166 countries/territories. Public health authorities in Brasil have reported 532 confirmed cases by March 19. Approximately 5% of the patients will require intensive care unit treatment with oxygen therapy and mechanical ventilation. Limited data are available about rehabilitation protocols for severe illness and intensive care treatment of COVID-19 increase. Thus, we aim to show current information about COVID-19, describing symptoms and the respiratory management for critical patients and preventive care. Physical therapists and all health care professionals need to recognize the challenges they will face in the coming months.

Infrared thermography (IRT) is an easy-to-use, noninvasive and pain-free tool that can be used to evaluate function of the pelvic floor (PF) muscles.To analyze vaginal manometry, temperature, and percentage of colors achieved through IRT of the PF muscles at rest and during maximum voluntary contraction. The relationship between PF muscles strength and IRT temperature was also assessed.Two-hundred and thirty-one women (mean ± SD age: 58.4±5.9 years) participated in this study. IRT recorded the minimum, average, and maximum temperatures, and the colors of the PF area at rest and during maximum voluntary contraction. The pressure applied during the three maximum voluntary PF contractions was evaluated through vaginal manometry.The women had a PF average temperature of 36.4 ± 0.8°C. There were no differences in the IRT temperatures between rest and during PF muscles contraction. The percentages of white, red, orange, yellow, green, cyan, and blue colors were different at rest and during contraction. Warm colors became more visible in the center of the image during the PF muscles maximum voluntary contraction. There was a positive correlation between the PF average temperature and PF manometry (r=0.7; p=0.001).The IRT was not able to detect differences in the temperature of the PF area between at rest and during contraction. However, a strong correlation between PF temperature and vaginal manometry was found.

To analyze whether pelvic floor muscle training (PFMT) associated with weight loss (WL) is better than isolated PFMT to provide additional beneficial effects to urinary symptoms in women with MUI. A randomized, simple-blind parallel controlled trial was performed and included women with MUI aged between 40 and 65 years and body mass index between 25 and 40 kg/m2. The sample was randomized into two groups: 11 PFMT + WL and 11 PFMT. Data collection was performed in baseline and after interventions. The primary outcome was to investigate the loss of urine. Secondary aim includes PFM pressure and quality of life. PFMT was performed with two sets of eight repetitions in the first 4 weeks, and with three sets of eight repetitions in the final 4 weeks. The weight loss program was based on the calculation of total energy value needs. Data analysis was performed by SPSS 20.0 software and one-way ANCOVA. 22 volunteers participated in the study. There was no intergroup significant difference in post-intervention ICIQ-SF F(1, 19) = 7.115, p = 0.87, partial η2 = 0.001; manometry F(1, 19) = 0.608, p = 0.44, partial η2 = 0.003; pad test 1 h F(1, 19) = 0.185, p = 0.67, partial η2 = 0.01; QoL F(1, 19) = 1.018, p = 0.32, partial η2 = 0.05; and weight F(1, 19) = 0.251, p = 0.62, partial η2 = 0.01. Weight loss did not provide additional beneficial effects to PFMT in women with overweight or obesity grade I with MUI symptoms.

Introduction: Total Hip Replacement (THR) is a surgical procedure used to minimize symptoms generated by orthopedic pathologies, such as osteoarthritis. It is emphasized that there is no agreement if gait parameters are restored after surgery. Objective: To compare gait space-time and functionality between individuals submitted to unilateral or bilateral THR in relation to healthy controls. Method: A cross-sectional study was conducted with 23 subjects, eight submitted to Bilateral THR (BG), eight submitted to Unilateral THR (UG) and seven healthy individuals (CG). For the gait analysis, the 10-meter walk test was used, with the subjects walking in their Habitual (HS) and Maximal (MS) gait Speeds. Variables of interest included average speed, number of steps, test duration, cadence and Inter-Stride Time Variability (ISTV). Functionality was assessed by the Harris Hip Score and the WOMAC questionnaire. Comparisons were made between the three groups. Results: At the HS condition, the average gait speed was significantly lower in the BG compared to the CG. Similarly, during the MS condition, the BG showed a lower gait speed compared to the CG. During MS gait, the BG performed significantly worse regarding ISTV compared to both the UG, and the CG. The functionality results showed that both the BG and UG scored significantly worse than the CG. Conclusion: Hip functionality and gait mechanics are impaired even after several years of surgery in subjects submitted to THR. Resumo Introdução: A Artroplastia Total de Quadril (ATQ) é um procedimento cirúrgico utilizado para minimizar sintomas gerados por patologias ortopédicas, como a osteoartrite. Ressalta-se que não há concordância se os parâmetros da marcha são restaurados após a cirurgia. Objetivo: Comparar os parâmetros espaço-temporais e funcionalidade da marcha entre indivíduos submetidos a ATQ unilateral ou bilateral, em relação aos controles saudáveis. Método: Estudo transversal com 23 sujeitos, oito submetidos à ATQ bilateral (BG), oito submetidos a ATQ unilateral (UG) e sete indivíduos saudáveis(GC). Para a análise da marcha, foi utilizado o teste de velocidade de marcha de 10 metros, com os sujeitos caminhando em suas velocidades de Marcha Habitual (HS) e Máxima (MS). As variáveis de interesse incluíram velocidade média, número de passos, duração do teste, cadência e Variabilidade Temporal Entre os Passos (ISTV). A funcionalidade foi avaliada pelo Harris Hip Score e o questionário WOMAC. Foram realizadas comparações entre os três grupos. Resultados: Na condição do HS, a velocidade média da marcha foi significativamente menor no grupo BG quando comparado ao GC. Da mesma forma, durante a condição de MS, o GB apresentou menor velocidade de marcha em relação ao GC. Durante a marcha MS, o BG teve um desempenho significativamente pior em relação ao ISTV em comparação tanto com o UG quanto com o GC. Os resultados de funcionalidade mostraram que tanto o BG como o UG tiveram pontuação significativamente pior que o GC. Conclusão: A funcionalidade do quadril e a mecânica da marcha estão prejudicadas mesmo após vários anos de cirurgia em indivíduos submetidos à ATQ. Resumen Introducción: La Artroplastia Total de Cadera (ATC) es un procedimiento quirúrgico utilizado para minimizar los síntomas generados por patologías ortopédicas, como la osteoartritis. Se resalta que no hay concordancia si los parámetros de la marcha se restauran después de la cirugía. Objetivo: Comparar los parámetros espacio-temporales y la funcionalidad de la marcha entre individuos sometidos a ATC unilateral o bilateral, en relación a los controles sanos. Método: Estudio transversal con 23 sujetos, ocho sometidos a ATC bilateral (BG), ocho sometidos a ATC unilateral (UG) y siete individuos sanos (IS). Para el análisis de la marcha, se utilizó la prueba de velocidad de marcha de 10 metros, con los sujetos caminando en sus velocidades de Marcha Habitual (MH) y Máxima (MM). Las variables de interés incluyeron velocidad media, número de pasos, duración de la prueba, cadencia y Variabilidad Temporal Entre los Pasos (VTEP). La funcionalidad fue evaluada por Harris Hip Score y el cuestionario WOMAC. Se realizaron comparaciones entre los tres grupos. Resultados: En la condición de la MH, la velocidad media de la marcha fue significativamente menor en el grupo BG cuando comparado al IS. De la misma forma, durante la condición de MM, el BG presentó menor velocidad de marcha en relación al IS. Durante la marcha MM, el BG tuvo un desempeño significativamente peor con respecto al VTEP en comparación con el UG y el IS. Los resultados de funcionalidad mostraron que tanto el BG como el UG tuvieron una puntuación significativamente peor que el IS. Conclusión: La funcionalidad de la cadera y la mecánica de la marcha están perjudicadas incluso después de varios años de cirugía en individuos sometidos a ATC.

The Chikungunya (CHIK) virus is epidemic in Brazil, with 170,000 cases in the first half of 2016. More than 60% of patients present relapsing and remitting chronic arthralgia with debilitating pain lasting years. There are no specific therapeutic agents to treat and rehabilitee infected persons with CHIK. Persistent pain can lead to incapacitation, requiring long-term pharmacological treatment. Advances in non-pharmacological treatments are necessary to promote pain relief without side effects and to restore functionality. Clinical trials indicate transcranial direct current stimulation (tDCS) can treat a broad range of chronic pain disorders, including diffuse neuromuscular pain and arthralgia. Here, we demonstrate that the tDCS across the primary motor cortex significantly reduces pain in the chronic phase of CHIK. High-resolution computational model was created to analyze the cortical electric field generated during tDCS and a diffuse and clustered brain current flow including M1 ipsilateral and contralateral, left DLPFC, nucleus accumbens, and cingulate was found. Our findings suggest tDCS could be an effective, inexpensive and deployable therapy to areas lacking resources with a significant number of patients with chronic CHIK persistent pain.

This study evaluated the performance, body water balance, ingestive behavior and blood metabolites in goats fed with cactus pear silage subjected to an intermittent water supply. Thirty-six goats were distributed in a randomized block design arranged as a 3 &times, 3 factorial with cactus pear silage in the goats&rsquo, diet (on a 0%, 21% and 42% dry matter-DM basis) and water offer frequency (ad libitum, and 24 and 48 h water restrictions). There was an interaction only between the cactus pear silage level and water offerings for drinking water. Goats fed 42% cactus pear silage had greater intake of non-fibrous carbohydrates, energy, Ca, Mg and Na minerals, water intake, urinary water excretion, body water retention and nutrient digestibility. Cactus pear silage inclusion up to a 42% rate reduced eating and ruminating time and increased the time spent idling as well as the eating and the ruminating efficiency rate. Water restriction at 48 h reduced drinking water intake. Performance and blood metabolites were not affected by cactus silage inclusion or water offering. Cactus pear silage inclusion at up to 42% for goats is recommended during periods of water shortage in semiarid and arid regions because it improves eating, the ruminating efficiency rate, and body water retention, cactus pear silage inclusion at this rate reduces water consumption and it does not affect the performance or health of the animals.