Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 2(4)2015 - 6 Articles

REVIEW

1 - The effect of gait training and exercise programs on gait and balance in post-stroke patients

Luis Mochizuki; Aline Bigongiari; Patricia Martins Franciulli; Juliana Valente Francica; Angelica Castilho Alonso; Ulysses Fernandes Ervilha; Henry Dan Kiyomoto; Julia Maria D'Andrea Greve

MEDICALEXPRESS 2015;2(4):M150401

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The aim of this review is to evaluate studies about gait training and exercise interventions applied to patients following chronic stroke on gait and balance. The studies included in this review were random clinical trials, including only chronic post-stroke individuals that evaluated gait and balance outcomes and with a PEDro scale score > 7.0. Eight studies were selected. The results suggest gait and balance will only be affected in chronic post-stroke patients if training sessions last at least 30 minutes, are repeated three times a week, and maintained for at least five weeks. Gait training affects how chronic post-stroke individuals walk. They will probably walk faster and with a lower risk of falling; however, it is unclear whether the consequences of these procedures affect the quality of life.


Keywords: Stroke, Locomotion, Balance.

ORIGINAL RESEARCH

2 - Correlation between gender, temporomandibular joint disc position and clinical findings in patients with temporomandibular disorder

Andréa Lusvarghi Witzel; Jéssica Elen da Silva Costa; Marcelo Costa Bolzan; Marina Lara de Carli; Thaís Borguezan Nunes; Rosana Canteras Di Matteo; Carlos Eduardo Pitta de Luca; Fernando Ricardo Xavier da Silveira

MEDICALEXPRESS 2015;2(4):M150402

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OBJECTIVE: The objective of this study was to assess gender differences in temporomandibular joint disc position using magnetic resonance imaging and to check for symptoms in patients with temporomandibular disorders.
MATERIALS AND METHODS: Eighty-seven consecutive patients (70 females and 17 males) were evaluated. Bilateral magnetic resonance imaging was performed to determine the temporomandibular joint disc positions; these were divided into four diagnostic categories: no disc displacement, right disc displacement, left disc displacement and bilateral disc displacement. The clinical data assessed were pain on muscle and temporomandibular joint palpation. The data were analyzed using the Fisher's exact test, chi-square test or analysis of variance. Significance was set at p < .05.
RESULTS: The study population had more females (80.5%) than males (19.5%) and the mean age of females (31 ± 11 years) was lower than the mean age of males (41± 12 years). Bilateral disc displacement was significantly most frequent in females. Clinical examination showed more pain on muscle palpation for female than for male patients.
CONCLUSION: Women had a higher frequency of temporomandibular joint disc displacement, as well as a larger number of painful points on muscle palpation than men.


Keywords: Temporomandibular joint disorders; Temporomandibular joint; Gender; Internal derangement; Magnetic resonance imaging.

3 - Possible solutions to the shortcomings of the Yale-Brown Obsessive-Compulsive Scale

Juliana Diniz; Victor Fossaluza; Cristina Belotto-Silva; Roseli Gedanke Shavitt; Carlos Alberto Pereira

MEDICALEXPRESS 2015;2(4):M150403

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OBJECTIVE: The Yale-Brown Obsessive-Compulsive Scale is the most frequently used instrument to measure obsessive-compulsive symptom severity. We describe its shortcomings and propose new methods of evaluating current severity and treatment response.
METHOD: The Yale-Brown Obsessive-Compulsive Scale total and subscale scores were pooled from one cross-sectional study database containing information on 1,000 obsessive-compulsive disorder patients from seven specialized mental health care centers. Additional longitudinal data were pooled for 155 patients who participated in a 12-week trial that evaluated the effectiveness of fluoxetine vs. cognitive-behavior therapy as first-line treatment options. All patients were followed by a clinician who provided a clinical opinion of improvement. Neither patients nor clinicians were aware of the classifications proposed in this study. New methods for using the severity scores were compared with the clinical opinion of improvement.
RESULTS: In the Yale-Brown Obsessive-compulsive scale, the summing-up of subscale scores to compose a total score does not accurately reflect clinical severity. In addition, the reduction of scores with treatment does not usually reach score zero in either subscale. To overcome such problems, we suggest (a) use of the maximum score of any of the subscales; (b) use of a minimum score of 4 in each subscale or 5 for the maximum in any subscale as the goal after treatment. This method performed better than traditional ones regarding sensitivity and specificity against the gold standard represented by the clinical opinion of improvement.
CONCLUSION: The new proposed response criteria are coherent with the clinical opinion of improvement and perform better than the traditional methodology.


Keywords: Obsessive/compulsive disorder; Clinical trials; Obsessive/compulsive disorder evaluation; Instruments.

4 - Muscle Activation Pattern During Isometric Ab Wheel Rollout Exercise in Different Shoulder Angle-Positions

Paulo Henrique Marchetti; Brad J. Schoenfeld; Josinaldo Jarbas da Silva; Mauro Antonio Guiselini; Fabio Sisconeto de Freitas; Silvio Luiz Pecoraro; Willy Andrade Gomes; Charles Ricardo Lopes

MEDICALEXPRESS 2015;2(4):M150404

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OBJECTIVE: To investigate muscle activation of the shoulder extensors and trunk stabilizers by surface electromyography (sEMG) activity during the isometric Ab Wheel Rollout exercise in different shoulder joint positions.
METHOD: We recruited 8 young, healthy, resistance trained men (age: 25 ± 3 years, height: 178 ± 5 cm, and total body mass: 81 ± 2 kg). All subjects performed two sets of 10 sec. maximal isometric contractions of the Ab Wheel Rollout exercise keeping the knees fixed on the floor and the arms taut. To perform the exercise, all subjects were randomly assessed in the following three positions related to the angle between the arms and trunk, in random order: arms aligned vertically with the Ab Wheel Rollout exercise (neutral); 90º and 150º. A rest period of 5 minutes was provided between tests. The sEMG signals were recorded in the following muscles: Latissimus Dorsi; Pectoralis Major; Erector Spinae; Rectus Abdominis.
RESULTS: There were significant increases in Rectus Abdominis muscle activity between: neutral vs. 90º, neutral vs. 150º and 90º vs. 150º. There was a significant increase in Pectoralis Major muscle activity between neutral x 150º.
CONCLUSIONS: The present findings indicate that (a) Ab Wheel Rollout exercise emphasizes the muscle action of the Pectoralis Major and Rectus Abdominis more than the Latissimus Dorsi and Erector Spinae; (b) the level of muscle activation depends on the external force created by the body mass and lever arm from the center of mass.


Keywords: Biomechanics; Exercise performance; Functional exercise.

5 - Motor learning in mobile (cell phone) device in Down syndrome patients - pilot project

Lilian Del Ciello de Menezes; Karen da Silva Cortez Gomes; Thais Massetti; Talita Dias da Silva; Weliton Folli Possebom; Camila Miliani Capelini; Carlos Bandeira de Mello Monteiro

MEDICALEXPRESS 2015;2(4):M150405

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OBJECTIVE: The objective of this study was to verify if individuals with Down syndrome have improved performance in completing a virtual maze task using a mobile phone.
METHOD: For this task, 30 teenagers and young adults were evaluated, 15 Down syndrome patients and 15 typically developed controls. The execution of the task was to play a maze on a mobile phone. The subjects performed 30 repetitions of the maze game in the acquisition phase, five repetitions for retention and five for transfer phase. A repeated measures ANOVA was used to compare blocks (first and last - A1 - A6 acquisition blocks, retention A6 - R and transfer A6 - T) and Groups (Down syndrome and typical development).
RESULTS: The results showed that both groups had significant improvement over time in the acquisition phase, the retention and transfer tests showed that there was performance consolidation for both groups, but with longer movement time in the Down syndrome group.
CONCLUSION: Comparing the two groups, individuals with Down syndrome required more time to run the maze in all phases of the task.


Keywords: Down syndrome; Motor learning; Virtual reality.

RAPID COMMUNICATION

6 - Gluteus Maximus inhibition in proximal hamstring tendinopathy

Julio Fernandes de Jesus; Flavio Fernandes Bryk; Viviane Coimbra Moreira; Gustavo Bezerra Nakaoka; Amir Curcio dos Reis; Paulo Roberto Garcia Lucareli

MEDICALEXPRESS 2015;2(4):M150406

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OBJECTIVE: The purpose of this study was to demonstrate the inhibition of the ipsilateral Gluteus Maximus in the presence of proximal hamstring tendinopathy and to collect information about its cause.
DESIGN: We studied three subjects with clinical evidence of proximal hamstring tendinopathy previously submitted to conservative treatment with poor results and exhibiting severe hypotrophy and diminished strength in the ipsilateral Gluteus Maximus in comparison with contralateral Gluteus Maximus.
INTERVENTIONS: Patients were submitted to evaluation of the Gluteus Maximus inhibition through handheld dynamometer strength measurements before and during neuromuscular electrical stimulation.
RESULTS: The three subjects exhibited increased strength in the affected Gluteus Maximus (mean 43%; range 27%-62%) when neuromuscular electrical stimulation was added in the evaluations.
CONCLUSION: This study demonstrates that individuals with proximal hamstring tendinopathy present ipsilateral Gluteus Maximus inhibition with hypotrophy and diminished strength. Neuromuscular electrical stimulation partially restores muscular strength. Further studies are required to evaluate the effects of this type of treatment.


Keywords: Hip; Tendinopathy; Muscle Strength Dynamometer; Biomechanics.