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Altered scapular movement in subacromial pain syndrome has been demonstrated using discrete data reduction approach. However, this approach does not consider the data collinearity and variability, and scapular translations are poorly investigated in symptomatic individuals. The purpose of this study was to investigate the scapular rotation and translation of asymptomatic individuals and those with subacromial pain syndrome during arm motions using principal component analysis. Scapulothoracic kinematics were evaluated in 47 participants with subacromial pain syndrome and 50 asymptomatic individuals. The symptomatic group had increased range of scapular anterior/posterior tilt during arm elevation (P =.01, effect size =.59) and arm lowering (P <.01, effect size =.61), and increased range of scapular forward/backward translation during arm lowering (P <.01, effect size =.60) compared with the asymptomatic group. In addition, the symptomatic group had a reduced difference in anterior tilt angular velocities between the early-arm and mid-arm lowering phases and between the mid- and late-arm lowering phases compared with the asymptomatic group (P =.03, effect size =.44). This study demonstrated that scapular anterior/posterior tilt motion and angular velocity and scapular forward/backward translation of symptomatic individuals were different from asymptomatic individuals when considering the entire arm movement. [ABSTRACT FROM AUTHOR]

Imbalance and weakness of the serratus anterior and upper trapezius force couple have been described in patients with shoulder dysfunction. There is interest in identifying exercises that selectively activate these muscles and including it in rehabilitation protocols. This study aims to verify the UT/SA electromyographic (EMG) amplitude ratio, performed in different upper limb exercises and on two bases of support. Twelve healthy men were tested (average age = 22.8 [+ or -] 3.1 years), and surface EMG was recorded from the upper trapezius and serratus anterior using single differential surface electrodes. Volunteers performed isometric contractions over a stable base of support and on a Swiss ball during the wall push-up (WP), bench press (BP), and push-up (PU) exercises. All SEMG data are reported as a percentage of root mean square or integral of linear envelope from the maximal value obtained in one of three maximal voluntary contractions for each muscle studied. A linear mixed-effect model was performed to compare UT/SA ratio values. The WP, BP, and PU exercises showed UT/SA ratio mean [+ or -] SD values of 0.69 [+ or -] 0.72, 0.14 [+ or -] 0.12, and 0.39 [+ or -] 0.37 for stable surfaces, respectively, whereas for unstable surfaces, the values were 0.73 [+ or -] 0.67, 0.43 [+ or -] 0.39, and 0.32 [+ or -] 0.30. The results demonstrate that UT/SA ratio was influenced by the exercises and by the upper limb base of support. The practical application is to show that Rp on a stable surface is the exercise preferred over WP and PU on either surfaces for serratus anterior muscle training in patients with imbalance between the UT/SA force couple or serratus anterior weakness. KEY WORDS eiectromyograhy, shoulder, closed kinetic, chain, exercises

Context: The closed kinetic chain upper-extremity stability (CKCUES) test is a functional test for the upper extremity performed in the push-up position, where individuals support their body weight on 1 hand placed on the ground and swing the opposite hand until touching the hand on the ground, then switch hands and repeat the process as fast as possible for 15 s. Objective: To study scapular kinematic and kinetic measures during the CKCUES test for 3 different distances between hands. Design: Experimental. Setting: Laboratory. Participants: 30 healthy individuals (15 male, 15 female). Main Outcome Measures: Participants performed 3 repetitions of the test at 3 distance conditions: original (36 in), interacromial, and 150% interacromial distance between hands. Participants completed a questionnaire on pain intensity and perceived exertion before and after the procedures. Scapular internal/external rotation, upward/downward rotation, and posterior/anterior tilting kinematics and kinetic data on maximum force and time to maximum force were measured bilaterally in all participants. Percentage of body weight on upper extremities was calculated. Data analyses were based on the total numbers of hand touches performed for each distance condition, and scapular kinematics and kinetic values were averaged over the 3 trials. Scapular kinematics, maximum force, and time to maximum force were compared for the 3 distance conditions within each gender. Significance level was set at α = .05. Results: Scapular internal rotation, posterior tilting, and upward rotation were significantly greater in the dominant side for both genders. Scapular upward rotation was significantly greater in original distance than interacromial distance in swing phase. Time to maximum force in women was significantly greater in the dominant side. Conclusion: CKCUES test kinematic and kinetic measures were not different among 3 conditions based on distance between hands. However, the test might not be suitable for initial or mild-level rehabilitation due to its challenging requirements. [ABSTRACT FROM AUTHOR]

Objective: We aimed to empirically derive psychosocial and pain sensitivity subgroups using cluster analysis within a sample of individuals with chronic musculoskeletal pain (CMP) and to investigate derived subgroups for differences in pain and disability outcomes. Methods: Eighty female participants with CMP answered psychosocial and disability scales and were assessed for pressure pain sensitivity. A cluster analysis was used to derive subgroups, and analysis of variance (ANOVA) was used to investigate differences between subgroups. Results: Psychosocial factors (kinesiophobia, pain catastrophizing, anxiety, and depression) and overall pressure pain threshold (PPT) were entered into the cluster analysis. Three subgroups were empirically derived: cluster 1 (high pain sensitivity and high psychosocial distress; n = 12) characterized by low overall PPT and high psychosocial scores; cluster 2 (high pain sensitivity and intermediate psychosocial distress; n = 39) characterized by low overall PPT and intermediate psychosocial scores; and cluster 3 (low pain sensitivity and low psychosocial distress; n = 29) characterized by high overall PPT and low psychosocial scores compared to the other subgroups. Cluster 1 showed higher values for mean pain intensity (F(2,77) = 10.58, p < 0.001) compared with cluster 3, and cluster 1 showed higher values for disability (F(2,77) = 3.81, p = 0.03) compared with both clusters 2 and 3. Conclusions: Only cluster 1 was distinct from cluster 3 according to both pain and disability outcomes. Pain catastrophizing, depression, and anxiety were the psychosocial variables that best differentiated the subgroups. Overall, these results call attention to the importance of considering pain sensitivity and psychosocial variables to obtain a more comprehensive characterization of CMP patients' subtypes. [ABSTRACT FROM AUTHOR]

Background: A walker is a common device prescribed for ambulatory assistance for individuals with balance difficulties or to reduce lower extremity demands following injury or surgery. The long-term use of a walker imposes significant demands on the patient's upper extremities that may lead to increased risk for development of secondary conditions such as wrist, elbow or shoulder pain. Objective: To describe the joint kinematics, forces and moments of the wrist, elbow and shoulder in a sample of twenty patients that were using a walker as a result of total joint surgery of the hips and knees. Methods: Three-dimensional upper extremity kinematics were recorded using a motion capture system synchronized with forces and torques transmitted through a walker instrumented with force transducers in the handles. Results: Compressive forces were found to be nearly 20% of the body weight at each of the upper extremity joints, both surgical and non-surgical sides, being the greatest force at the wrist and decreasing proximally. Compression forces were greater in the non-surgical side limb at the wrist and at the elbow. Conclusion: Our findings indicated that loads on upper extremity joints associated with the use of a walker for assisted ambulation are high and further studies are needed to address the cause-effect relationship between the actual joint loading and the development of secondary musculoskeletal upper extremity complaints in more frail patients. [ABSTRACT FROM AUTHOR]

Background:The scoliometer was developed to analyze the axial rotation of the trunk in patients with idiopathic scoliosis. However, there is controversy regarding the reliability of the measures obtained with this device. Objective: To test the intra-rater and inter-rater reliability of the scoliometer in patients with scoliosis. Methods: 24 volunteers of both sex with idiopathic scoliosis diagnostic (18±4 years-old) and curvatures with mean and standard deviation of 24.8±12.7° Cobb. The measurement procedure was accomplished in one day by two trained examiners. The palpation and determination of each spinal level was accomplished by just one examiner. Each examiner obtained one measure with the device for each vertebra from the thoracic and lumbar levels in each evaluation. For statistical analysis the measurements were divided by spinal levels into upper thorax, medium thorax, lower thorax and lumbar segments. The Intraclass Correlation Coefficient type 1,1 (ICC1,1) was used to determine the intra-rater reliability while the ICC3,1 was used to determine the inter-rater reliability. Results: The observed intra-rater reliability values for the medium and lower thorax and lumbar segments of the subjects ranged from very good to excellent. The inter-rater reliability of the measures of axial trunk rotations was considered good to the upper thorax and excellent for the medium and lower thorax and lumbar spine. Conclusion: The scoliometer is a device that has intra-rater reliability estimates ranging from very good to excellent. The interrater reliability for the upper and low thorax and for the lumbar spine is relatively lower than the intra-rater values for the same spinal segments, even when the errors from palpation and positioning of the instrument were eliminated. [ABSTRACT FROM AUTHOR]

Background: The SRS-22r questionnaire is a well-accepted instrument used to measure health-related quality of life in patients with idiopathic scoliosis. No validated tool exists in Brazil for idiopathic scoliosis, and the use of the SRS-22r in non-English Language countries requires its transcultural adaptation. Objective: The objective of this study was to culturally adapt the translated Brazilian version of the SRS-22r questionnaire and to determine its reliability using statistical tests for internal consistency and test-retest reliability. Method: The transcultural adaptation process was carried out according to the recommendations of the American Academy of Orthopedic Surgeons. The pre-final version was administered to 44 patients with idiopathic scoliosis. The mean age of the participants was 18.93 years and the mean curve magnitude was 54.6°. A subgroup of 30 volunteers completed the questionnaire a second time one week later to determine the scale's reproducibility. Internal consistency was determined using Cronbach's alpha coefficient, and the test-retest reliability was determined using the Intraclass Correlation Coefficient (ICC). Results: No floor effects were observed using the Brazilian version of the SRS-22r. Ceiling effects were observed in the Pain and Satisfaction with Management domains. The internal consistency values were very good for 3 domains and good for 2 domains. The ICC values were excellent for all domains. Conclusions: The high values of internal consistency and ICC reproducibility suggest that this version of the questionnaire can be used in Brazilian patients with idiopathic scoliosis. [ABSTRACT FROM AUTHOR]

Background: Hip and knee muscle weaknesses have been associated with the onset of anterior knee pain (AKP). Therefore, the understanding of how squats exercises can be performed in order to optimize the electrical activity of these muscles is relevant for physical therapy treatments. Objective: To compare the electromyographic activity of patella and pelvic stabilizers during traditional squat and squat associated with isometric hip adduction or abduction in subjects without AKP. Methods: Electromyography signals were captured using double-differential electrodes at the vastus medialis obliquus (VMO), vastus lateralis obliquus (VLO), vastus lateralis longus (VLL) and gluteus medium (GMed) in 15 healthy and sedentary women during squats exercises: traditional and associated with hip adduction and hip abduction with load of 25% of body weight. Linear mixed models with significance level of 5% were used for data analysis. Results: Squat associated with hip adduction and abduction produced electromyographic activity of GMed of 0.47 (0.2) and 0.59 (0.22) respectively, while conventional squat produced an electromyiographic activity of 0.33 (0.27). The higher VMO activity was 0.59 (0.27) during the isometric contraction in the squat associated with hip adduction. The higher VLO activity was 0.60 (0.32) during isometric contraction in the squat associated with hip abduction. Conclusion: Squat exercise associated with hip adduction increased VMO muscle activity as well as the activity of GMed activity. [ABSTRACT FROM AUTHOR]

Background: Hip and knee muscle weaknesses have been associated with the onset of anterior knee pain (AKP). Therefore, the understanding of how squats exercises can be performed in order to optimize the electrical activity of these muscles is relevant for physical therapy treatments. Objective: To compare the electromyographic activity of patella and pelvic stabilizers during traditional squat and squat associated with isometric hip adduction or abduction in subjects without AKP. Methods: Electromyography signals were captured using double-differential electrodes at the vastus medialis obliquus (VMO), vastus lateralis obliquus (VLO), vastus lateralis longus (VLL) and gluteus medium (GMed) in 15 healthy and sedentary women during squats exercises: traditional and associated with hip adduction and hip abduction with load of 25% of body weight. Linear mixed models with significance level of 5% were used for data analysis. Results: Squat associated with hip adduction and abduction produced electromyographic activity of GMed of 0.47 (0.2) and 0.59 (0.22) respectively, while conventional squat produced an electromyiographic activity of 0.33 (0.27). The higher VMO activity was 0.59 (0.27) during the isometric contraction in the squat associated with hip adduction. The higher VLO activity was 0.60 (0.32) during isometric contraction in the squat associated with hip abduction. Conclusion: Squat exercise associated with hip adduction increased VMO muscle activity as well as the activity of GMed activity. [ABSTRACT FROM AUTHOR]

Objectives: To translate and culturally adapt the Shoulder Pain and Disability Index (SPADI) into Brazilian-Portuguese and to assess its reliability. Methods: The first step was the translation, synthesis, back-translation, revision by the committee, pre-testing and evaluation of documents by the committee and the author of the SPADI. The revised version by the committee was applied to 90 subjects with shoulder dysfunction, aged over 18 years from different education and sociocultural levels. The items misunderstood by 20% or more of patients were reformulated and reapplied until they reach values lower than 20%. The second stage consisted of two applications of SPADI to 32 patients with shoulder dysfunction in a interval ranging from 2 to 7 days. The data from the translation were analyzed descriptively, the test-retest reliability by Intraclass Correlation Coefficient (ICC) and the internal consistency by Cronbach's Alpha. Results: Some expressions have been adapted to the Brazilian population and the items in the pain and disability subscales were changed for an easier reading in Portuguese Language. The pre-test revealed a need to change only one item of the pain domain and to administer the questionnaire by interview, since it was repeated three times and in the first two applications with self-reported questionnaire the patients had not been reporting their symptoms with regards to the past week and also they have not been properly used the item "Not Applicable". The test-retest reliability ranged from 0.90 to 0.94 and the internal consistency ranged from 0.87 to 0.89. Conclusion: After the translation and cultural adaptation, it was obtained a reliable version of SPADI-Brazil. [ABSTRACT FROM AUTHOR]

Background: Although photogrammetry is a widespread technique in the health field, despite of the methodological efforts distortions in the angular readings of the images are common., Objective: To measure the error of angular measurements in photo images with different digital resolutions in an object with pre-determined angles., Methods: We used a rubber ball with 52 cm in circumference. The object was previously marked with angles of 10°, 30°, 60° and 90° degrees. The photographic records were performed with the focal axis of the camera perpendicular and three meters away from the object, without the use of optical zoom and a resolution of 3, 5 and 10 Megapixels (Mp). All photographic records were stored and a previously trained experimenter using the computer program ImageJ analyzed the angular values of each photo. The measurements were performed twice within a fifteen-days interval. Subsequently, we calculated the accuracy, relative error and error in degrees values, precision and the Intraclass Correlation Coefficient (ICC)., Results: When analyzing the angle of 10°, the average accuracy of measurements was higher for those records of 3 Mp resolution compared to 5 and 10 Mp resolutions. The ICC was considered excellent for all resolutions. With regards to the analyzed angles in photographic records, it was possible to verify that the 90-degree angle photographs were more accurate, had lower relative error and error in degrees, and were more precise, regardless of image resolution., Conclusion: The photographs records that were taken with a 3 Mp resolution provided great accuracy and precision measurements and lower errors values, suggesting to be the proper resolution to generate image of angles of 10º and 30º.

Background: Maintaining continence is among the functions of the pelvic floor muscles (PFM) and their dysfunction can cause urinary incontinence (UI), which is a common occurrence during pregnancy and the puerperal period. Pelvic floor muscle training (PFMT), therefore, is important during pregnancy, although most women perform the muscle contractions unsatisfactorily., Objectives: This study is an exploratory analysis of the results of three electromyographic (EMG) activity biofeedback sessions in pregnant women., Methods: The study sample included 19 nulliparous women with low risk pregnancies. The participants performed three sessions of EMG biofeedback consisting of slow and fast contractions. The average value of the normalized amplitudes of surface electromyography was used to evaluate the results. The linear regression model with mixed effects was used for statistical analysis, with the EMG data normalized by maximum voluntary contraction (MVC)., Results: A steady increase in EMG amplitude was observed during each contraction and by the end of the biofeedback sessions, although this difference was only significant when comparing the first tonic contraction of each session (p=0.03)., Conclusions: The results indicate that three sessions of training with biofeedback improved PFM EMG activity during the second trimester in women with low-risk pregnancies. The effectiveness of this protocol should be further investigated in randomized controlled trials.

Background: Hip and knee muscle weaknesses have been associated with the onset of anterior knee pain (AKP). Therefore, the understanding of how squats exercises can be performed in order to optimize the electrical activity of these muscles is relevant for physical therapy treatments., Objective: To compare the electromyographic activity of patella and pelvic stabilizers during traditional squat and squat associated with isometric hip adduction or abduction in subjects without AKP., Methods: Electromyography signals were captured using double-differential electrodes at the vastus medialis obliquus (VMO), vastus lateralis obliquus (VLO), vastus lateralis longus (VLL) and gluteus medium (GMed) in 15 healthy and sedentary women during squats exercises: traditional and associated with hip adduction and hip abduction with load of 25% of body weight. Linear mixed models with significance level of 5% were used for data analysis., Results: Squat associated with hip adduction and abduction produced electromyographic activity of GMed of 0.47 (0.2) and 0.59 (0.22) respectively, while conventional squat produced an electromyiographic activity of 0.33 (0.27). The higher VMO activity was 0.59 (0.27) during the isometric contraction in the squat associated with hip adduction. The higher VLO activity was 0.60 (0.32) during isometric contraction in the squat associated with hip abduction., Conclusion: Squat exercise associated with hip adduction increased VMO muscle activity as well as the activity of GMed activity.

Objectives: To translate and culturally adapt the Shoulder Pain and Disability Index (SPADI) into Brazilian-Portuguese and to assess its reliability., Methods: The first step was the translation, synthesis, back-translation, revision by the committee, pre-testing and evaluation of documents by the committee and the author of the SPADI. The revised version by the committee was applied to 90 subjects with shoulder dysfunction, aged over 18 years from different education and sociocultural levels. The items misunderstood by 20% or more of patients were reformulated and reapplied until they reach values lower than 20%. The second stage consisted of two applications of SPADI to 32 patients with shoulder dysfunction in a interval ranging from 2 to 7 days. The data from the translation were analyzed descriptively, the test-retest reliability by Intraclass Correlation Coefficient (ICC) and the internal consistency by Cronbach's Alpha., Results: Some expressions have been adapted to the Brazilian population and the items in the pain and disability subscales were changed for an easier reading in Portuguese Language. The pre-test revealed a need to change only one item of the pain domain and to administer the questionnaire by interview, since it was repeated three times and in the first two applications with self-reported questionnaire the patients had not been reporting their symptoms with regards to the past week and also they have not been properly used the item "Not Applicable". The test-retest reliability ranged from 0.90 to 0.94 and the internal consistency ranged from 0.87 to 0.89., Conclusion: After the translation and cultural adaptation, it was obtained a reliable version of SPADI-Brazil.

Background: the scoliometer was developed to analyze the axial rotation of the trunk in patients with idiopathic scoliosis. However, there is controversy regarding the reliability of the measures obtained with this device., Objectives: to test the intra-rater and inter-rater reliability of the scoliometer in patients with scoliosis., Methods: 24 volunteers of both sex with idiopathic scoliosis diagnostic (18 ± 4 years-old) and curvatures with mean and standard deviation of 24.8 ± 12.7º Cobb. The measurement procedure was accomplished in one day by two trained examiners. The palpation and determination of each spinal level was accomplished by just one examiner. Each examiner obtained one measure with the device for each vertebra from the thoracic and lumbar levels in each evaluation. For statistical analysis the measurements were divided by spinal levels into upper thorax, medium thorax, lower thorax and lumbar segments. The Intraclass Correlation Coefficient type 1,1 (ICC1,1) was used to determine the intra-rater reliability while the ICC3,1 was used to determine the inter-rater reliability., Results: the observed intra-rater reliability values for the medium and lower thorax and lumbar segments of the subjects ranged from very good to excellent. The inter-rater reliability of the measures of axial trunk rotations was considered good to the upper thorax and excellent for the medium and lower thorax and lumbar spine., Conclusions: the scoliometer is a device that has intra-rater reliability estimates ranging from very good to excellent. The inter-rater reliability for the upper and low thorax and for the lumbar spine is relatively lower than the intra-rater values for the same spinal segments, even when the errors from palpation and positioning of the instrument were eliminated.

Background: An important parameter in cross-cultural adaptations, and concurrent validity are the relationships between the performance of an instrument of interest and the performance of a similar instrument with known validity., Objective: To determine the concurrent validity of the Brazilian version of the revised questionnaire of the Scoliosis Research Society (Br-SRS-22r) and the Brazilian version of the Short-Form-36 questionnaire (SF-36)., Methods: Fifty-four patients with idiopathic scoliosis were selected. The mean age was 19.9 yrs. (+/-7.7) and the mean Cobb angle of curvature was 31.6 degrees (+/-20.5 degrees ), ranging from 10 masculine to 92 masculine. The results from each questionnaire were converted into scores and, in the statistical analyses, the relationships between the concurrent domains were analyzed using Spearman's correlation coefficient., Results: The best correlations were found between the function and pain domains: function in the Br-SRS-22r and physical function in the Br-SF-36 (r=0.83); pain in the Br-SRS-22r and pain in the Br-SF-36 (r=0.86). However, the domains of self-image and satisfaction with treatment with the Br-SRS-22r showed moderate and poor correlations with their corresponding domains in the Br-SF-36. There were moderate correlations between the questionnaires, with the best correlations showing greater similarity in the evaluated parameters between the respective instruments. Unlike the function and pain domains, the mental health domains did not have a good correlations, possibly because of difficulties in interpreting of the questions in the Br-SF-36. For the self-image and satisfaction domains, the correlations were moderate and poor because these topics were not specifically covered by the SF-36., Conclusions: The Brazilian version of the SRS-22r demonstrated moderate concurrent validity results in relation to the Br-SF-36, and this version adapted for the Brazilian culture was deemed valid.

The purpose of this experiment was to look for signals of muscle fatigue in volunteers with Temporomandibular Disorders (TMD) during short period of mastication. Twenty female volunteers selected by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) participated, 10 with myogenic TMD (experimental) and 10 clinically normal (control). The Masseter and Temporalis muscles were evaluated electromyographically with active differential surface electrodes. The masticatory activity was recorded for 15 seconds and the signals were normalized by 4 seconds of teeth clenching. Three complete masticatory cycles were taken to calculating the median frequency (MF) and electromyographic amplitude (RMS). The data were submitted to statistics analysis and non-parametric tests. The results showed that RMS and median frequency did not change during the mastication period analyzed, indicating the absence of muscle fatigue, for the Masseter and Temporalis muscles in both groups (p> 0.05). These results confirm the absence of signals of muscle fatigue in masticatory muscles during short period of mastication even in individuals with TMD, possibly due to increased of blood flow, consequence of dynamic muscle contraction and the individual characteristics of muscle fiber composition and recruitment.