[Show abstract][Hide abstract] ABSTRACT: Amyotrophic lateral sclerosis (ALS), Charcot's disease or Lou Gehrig's disease, is a term used to cover the spetrum of syndromes caracterized by progressive degeneration of motor neurons, a paralytic disorder caused by motor neuron degeneration. Currently, there are approximately 25,000 patients with ALS in the USA, with an average age of onset of 55 years. The incidence and prevalence of ALS are 1-2 and 4-6 per 100,000 each year, respectively, with a lifetime ALS risk of 1/600 to 1/1000. It causes progressive and cumulative physical disabilities, and leads to eventual death due to respiratory muscle failure. ALS is diverse in its presentation, course, and progression. We do not yet fully understand the causes of the disease , nor the mechanisms for its progression; thus, we lack effective means for treating this disease. In this chapter, we will discuss the diagnosis, treatment, and how to cope with impaired function and end of life based on of our experience, guidelines, and clinical trials. Nowadays ALS seems to be a more complex disease than it did two decades – or even one decade – ago, but new insights have been plentiful. Clinical trials should be seen more as experiments on pathogenic mechanisms. A medication or combination of medications that targets more than one pathogenic pathway may slow disease progression in an additive or synergistic fashion.
Neurology International 09/2015; 7(2). DOI:10.4081/ni.2015.5885
[Show abstract][Hide abstract] ABSTRACT: Amyotrophic lateral sclerosis is a progressive neuromuscular disease, resulting in respiratory muscle weakness, reduced pulmonary volumes, ineffective cough, secretion retention, and respiratory failure. Measures as vital capacity, maximal inspiratory and expiratory pressures, sniff nasal inspiratory pressure, cough peak flow and pulse oximetry are recommended to monitor the respiratory function. The patients should be followed up by a multidisciplinary team, focused in improving the quality of life and deal with the respiratory symptoms. The respiratory care approach includes airway clearance techniques, mechanically assisted cough and noninvasive mechanical ventilation. Vaccination and respiratory pharmacological support are also recommended. To date, there is no enough evidence supporting the inspiratory muscle training and diaphragmatic pacing.
Arquivos de neuro-psiquiatria 09/2015; DOI:10.1590/0004-282X20150132 · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The vestibular system is a reference in balance control because it acts as a gravity sensor controlling the dynamic posture. Vestibular dysfunctions may be peripheral and/or central, presents different manifestations (visual or somatosensory conflict), reduced stability and functional capacity, gait deviations
and falls. The use of virtual reality has use in treatment of phobias, Parkinson’s disease, after stroke, children with cerebral palsy as well as vestibular disorders. Vestibular rehabilitation is based on mechanisms related to neuronal plasticity of the central nervous system and virtual games activities have been used. The
virtual reality therapy in the treatment of vestibular dysfunction presents few studies run on journals; however, the few studies have evidenced good results, which, nevertheless, need to be further explored, applying stricter protocols. The therapy has contributed to improvement of postural balance, motor coordination, flexibility, physical function, also increased stability limit, reduce dizziness
levels and rates of falls, providing functional independence and quality of life. Considering that, this feature may be relevant in the treatment of vestibular dysfunctions it is essential to investigate how virtual reality is being aggregated in the vestibular rehabilitation process.
[Show abstract][Hide abstract] ABSTRACT: [Purpose] Stretching using proprioceptive neuromuscular facilitation involve physiological reflex mechanisms through submaximal contraction of agonists which activate Golgi organ, promoting the relaxation reflex. The aim of this study was to evaluate the effects of proprioceptive neuromuscular facilitation alone and with prior application of cryotherapy and thermotherapy on hamstring stretching. [Subjects and Methods] The sample comprised of 32 young subjects with hamstring retraction of the right limb. The subjects were randomly allocated to four groups: the control, flexibility PNF, flexibility PNF associated with cryotherapy, flexibility PNF in association with ultrasound therapy. [Results] After 12 stretching sessions, experimental groups showed significant improvements compared to the control group. Moreover, we did not find any significant differences among the experimental groups indicating PNF stretching alone elicits similar results to PNF stretching with prior administration of cryotherapy or thermotherapy. [Conclusion] PNF without other therapy may be a more practical and less expensive choice for clinical care.
[Show abstract][Hide abstract] ABSTRACT: [Purpose] Physical therapists, osteopathic practitioners, and chiropractors often perform manual tests to evaluate sacroiliac joint (SIJ) mobility. However, the available evidence demonstrates an absence of reliability in these tests and in investigations with kinematic analysis. The aim of this study was to verify the three-dimensional kinematic reliability in SIJ movement measurements. [Subjects] This cross-sectional study analyzed 24 healthy males, aged between 18 and 35 years. [Methods] Three-dimensional kinematic analysis was performed for measurements of posterior superior iliac displacement and greater trochanter (femur) displacement during hip flexion movement in an orthostatic position. The distance variations were measured from a reference point in 3 blocks. The intra-observer reliability was compared with the mean of three 3 blocks using the interclass correlation coefficient (ICC) and a 99% significance level. [Results] The measurements indicated a strong correlation among blocks: ICC = 0.94 for right side SIJ and ICC = 0.91 for left side SIJ. The mean displacement between the reference points was 7.7 mm on the right side and 8.5 mm on the left side. [Conclusion] Our results indicate that three-dimensional kinematic analysis can be used for SIJ mobility analyses. New studies should be performed for subjects with SIJ dysfunction to verify the effectiveness of this method.
[Show abstract][Hide abstract] ABSTRACT: Modified constraint-induced movement therapy (CIMT) protocols show motor function and real-world arm use improvement. Meanwhile it usually requires constant supervision by physiotherapists and is therefore more expensive than customary care. This study compared the preliminary efficacy of two modified CIMT protocols. A two-group randomized controlled trial with pre and post treatment measures and six months follow-up was conducted. Nineteen patients with chronic stroke received 10 treatment sessions distributed three to four times a week over 22 days. CIMT3h_direct group received 3 hours of CIMT supervised by a therapist (n=10) while CIMT1.5h_direct group had 1.5 hours of supervised CIMT+1.5 hours home exercises supervised by a caregiver (n=9). Outcome measures were the Fugl-Meyer Assessment, the Motor Activity Log, and the Stroke Specific Quality of Life Scale. The modified CIMT protocols were feasible and well tolerated. Improvements in motor function, real-world arm use and quality of life did not differ significantly between treated groups receiving either 3 or 1.5 hours mCIMT supervised by a therapist.
Neurology International 03/2015; 7(1):5430. DOI:10.4081/ni.2015.5430
[Show abstract][Hide abstract] ABSTRACT: Previous acute poliomyelitis (PAP) can be defined as an endemic human disease caused by an enterovirus of worldwide distribution, which compromises the anterior horn cells of the spinal cord. Poliovirus has infected and victimized thousands of people all over the world. Only after the development of the inactivated virus vaccine by Jonas Salk, in 1955, and then with the attenuated virus vaccine, by Albert Bruce Sabin, in 1961, we saw a reduction in the number of poliomyelitis cases in the world.
[Show abstract][Hide abstract] ABSTRACT: Previous acute poliomyelitis (PAP) can be defined as an endemic human disease caused by an enterovirus of worldwide distribution, which compromises the anterior horn cells of the spinal cord. Poliovirus has infected and victimized thousands of people all over the world. Only after the development of the inactivated virus vaccine by Jonas Salk, in 1955, and then with the attenuated virus vaccine, by Albert Bruce Sabin, in 1961, we saw a reduction in the number of poliomyelitis cases in the world
Neurology International 03/2015; 7:5452. DOI:10.4081/ni.2015.5452
[Show abstract][Hide abstract] ABSTRACT: The motor imagery (MI) has two strategies (kinesthetic and visual) and can be defined as an act to codify the mental rehearsal of an intended action, without executing it. Studying the execution of the movement, several researchers believe that the deep muscles of the trunk are activated before the agonist of the limbs, showing a motor neurophysiologic recruitment order. This behavior can be also seen during MI tasks as the postural control, because the postural control is inserted in the movement context. The aim was to investigate, by a systematic review, evidences of MI and the postural control on healthy subjects. The selected articles were searched on different databases, dated from 1985 to 2014. Twelve studies were selected regarding the MI and the postural control on healthy subjects. All articles using balance scale or those which were about clinical conditions were excluded. Data show that kinesthetic MI with high levels of vividness promotes major changes in the body oscillations when comparing with the visual MI. To date, the number of articles about this theme is limited and the results should be interpreted cautiously.
International Archives of Medicine 03/2015; 8:43. DOI:10.3823/1642 · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper reviews the current and most neurological (central nervous system, CNS) uses of the botulinum neurotoxin type A. The effect of these toxins at neuromuscular junction lends themselves to neurological diseases of muscle overactivity, particularly abnormalities of muscle control. There are seven serotypes of the toxin, each with a specific activity at the molecular level. Currently, serotypes A (in two preparations) and B are available for clinical purpose, and they have proved to be safe and effective for the treatment of dystonia, spasticity, headache, and other CNS disorders in which muscle hyperac-tivity gives rise to symptoms. Although initially thought to inhibit acetylcholine release only at the neuromuscular junction, botulinum toxins are now recognized to inhibit acetylcholine release at autonomic cholinergic nerve terminals , as well as peripheral release of neuro-transmitters involved in pain regulation. Its effects are transient and nondestructive, and largely limited to the area in which it is administered. These effects are also graded according to the dose, allowing individualized treatment of patients and disorders. It may also prove to be useful in the control of autonomic dysfunction and sialorrhea. In over 20 years of use in humans, botulinum toxin has accumulated a considerable safety record, and in many cases represents relief for thousands of patients unaided by other therapy.
[Show abstract][Hide abstract] ABSTRACT: The objective of the present study was to compare resting metabolic rate (RMR) of chronic hemiparetic patients to sedentary health individuals. The sample was composed of 16 individuals, that were divided into two groups. The first group had eight hemiparetic patients and the second group was formed by eight sedentary individuals. To access and ana-lyze the gases information a VO2000 analyzer was used. The following variables were meas-ured: VO 2 , VCO 2 , VE, QR, grams of fat (GrFAT), grams of carbohydrate. RMR was calculated based on Weir's equation. There was a signifi-cant shift on ventilation variables: VE (P<0.0003), VO 2 (P<0.0004) and VCO 2 (P<0.0001) on hemiparetic individuals group when compared to control group. When the energetic substrate used behavior is observed, it shows that fat consumption (represented by GrFAT) is higher on the hemiparetic group when compared to controls (P<0.0001) signif-icant differences were observed for RMR between groups (P<0.0001). RMR showed a correlation to VO 2 on the hemiparetic group (r=0.9277, P=0.0022). To sum up, it was observed through the results that individuals with hemiparesis as a sequel of stroke showed a RMR larger than normal individuals.
Neurology International 11/2014; 6(4). DOI:10.4081/ni.2014.5442
[Show abstract][Hide abstract] ABSTRACT: A paresia distal crural, muito marcante nos pacientes com doença de Charcot-Marie-Tooth (CMT), provoca inúmeras alterações nos padrões da marcha. Vários recursos de reabilitação têm sido propostos
para gerenciar os problemas de deambulação, entre eles a utilização de órteses tornozelo-pé (OTP). O objetivo deste trabalho foi analisar efeitos imediatos do uso de OTP na cinemática da marcha e nos parâmetros estabilométricos em paciente com CMT. Buscou-se avaliar: o equilíbrio e a marcha, por meio da Escala de Avaliação da Mobilidade Orientada pelo Desempenho (POMA); a cinemática da marcha, com o sistema Qualisys Track Manager (QTM); e a estabilometria, utilizando a plataforma de força. As avaliações foram realizadas antes e durante o uso de OTP. Observou-se declínio na escala POMA durante o uso da OTP de 11%. Na cinemática da marcha, verificou-se decréscimo na velocidade e comprimento da passada, assim como aumento na duração dela. Na estabilometria, observou-se aumento na velocidade médio-lateral e na velocidade média na condição sem restrição visual, e aumento em todos os parâmetros de velocidade e deslocamento na condição com restrição visual durante o uso da OTP. O paciente avaliado não apresentou melhoras imediatas com aplicação de OTP, fato justificado pela presença de contraturas e tempo de evolução da doença. A prescrição de órteses na CMT deve respeitar as particularidades do paciente e a forma de apresentação da patologia.
[Show abstract][Hide abstract] ABSTRACT: Fasciculations are visible, fine and fast, sometimes vermicular contractions of fine muscle fibers that occur spontaneously and intermittently. The aim of this article is to discuss the main causes for fasciculations and their pathophysiology in different sites of the central/peripheral injury and in particular to disprove that the presence of this finding in the neurological examination is indicative of amyotrophic lateral sclerosis. Undoubtedly, most fasciculations have a distal origin in the motor nerve both in normal subjects and in patients with motor neuron disease. Most of them spread to other dendritic spines often producing an antidromic impulse in the main axon. The clinical and neurophysiological diagnosis must be thorough. It may often take long to record fasciculations with electroneuromyography. In other cases, temporal monitoring is necessary before the diagnosis. The treatment, which may be adequate in some cases, is not always necessary.
Neurology International 08/2014; 6(3):5208. DOI:10.4081/ni.2014.5208
[Show abstract][Hide abstract] ABSTRACT: [Purpose] The study analyzed the electroencephalographic (EEG) data of the central cortical areas, during execution of the motor gestures of feeding, activation of the system of mirror neurons, and imagery between a right hemiparetic volunteer (RHV) and a healthy volunteer (HV). [Subjects and Methods] The volunteers' EEG data were recorded with their eyes open for 4 minutes while they performed five experimental tasks. [Results] The alpha band, absolute power value of HV was lower than that of RHV. In the beta band, during the practice condition, there was an increase in the magnitude of the absolute power value of HV at T3, possibly because T3 is representative of secondary motor areas that work with cortical neurons related to planning and organizing sequence of movements performed by the hands. The gamma band is related to the state of preparation for movement and memory. The results of this study indicate that there was increased activation of the gamma frequency band of HV. [Conclusion] The findings of this study have revealed the changes in pattern characteristics of each band which may be associated with the brain injury of the hemiparetic patient.
[Show abstract][Hide abstract] ABSTRACT: Low level laser therapy (LLLT) has been suggested as an effective therapeutics in inflammatory processes modulation and tissue repairing. However, there is a lack of studies that analyze the antiinflamma tory effects of the infrared lasers in muscular skeletal injury. The aim of this study was to investigate the effects of lowlevel laser therapy 904 nm in the repair process of skeletal muscle tissue. Swiss mice were submitted to cryoinjury and divided in test (LLLTtreated) and control groups. Histological sections were stained with hematoxylineosin to assess general morphology and inflammatory influx, and Picrossirus to quantify col lagen fibers deposition. Our results showed significant reduction in inflammatory infiltrated in irradiated mice after 4 days of treatment compared to control (p = 0.01). After 8 days, the irradiated group showed high levels at regenerating myofibers with significant statistically differences in relation at control group (p < 0.01). Collagen deposition was significantly increased in the final stages of regeneration at test group, when com pared with control group (p = 0.05). Our data suggests that LLLT reduces the inflammatory response in the initial stages of injury and accelerates the process of muscular tissue repair.
[Show abstract][Hide abstract] ABSTRACT: [Purpose] Among the physical therapeutic procedures to decrease pain, there is transcutaneous electrical neural stimulation (TENS). There is no consensus about its efficacy for oncological patients, especially for post-mastectomy pain and eletrocortical changes in somatosensory areas. The aim of this study was to analyze acute electrocortical changes after TENS treatment of patients with intercostobrachial post mastectomy pain. [Subjects] Eighteen patients were divided into acupuncture (A) and burst (B) group. [Methods] In this pre and post-intervention study each group was measured for EEG analysis in absulte power in alpha band (8-14 Hz). Outcomes variables were the alpha waveband in the sensorymotor cortex and pain pre-and-post TENS intervention. Data were analyzed using ANOVA to compare times (rest, 10 and 15 min), group and electrodes. Pain was analyzed using percentual pain evaluation (PPE) in both groups. [Results] Outcomes indicate main effects of time and electrodes because of slow (8-10 Hz) and fast alpha (10-12 Hz) wavebands decreased. PPE reduced 88.4% in A and 66.3% in G. [Conclusion] TENS promoted electrical modification in the parietal region and a decrease in pain. Future studies should investigate other wave must be proposed for other bands and use different methods of EEG analysis to elucidate the actual mechanisms behind the efficacy of TENS treatment.
[Show abstract][Hide abstract] ABSTRACT: The use of the Nintendo Wii has been considered a good alternative in the motor rehabilitation of individuals with Parkinson's disease (PD), requiring simultaneous interaction to develop strategies for physical, visual, auditory, cognitive, psychological and social activities in the performing of virtual activities, resulting in improvement in functional performance and gait. The aim of this study was to analyze the effect of virtual sensorimotor activity on gait disorders in people with PD. Fifteen subjects with a clinical diagnosis of PD were submitted to the Unified Parkinson's Disease Rating Scale (UPDRS III), Schwab and England Activities of Daily Living Scale (SE), Functional Independence Measure (FIM), and biomechanical gait analysis using digital images taken with a video camera before and after the treatment program. The activities with the Nintendo Wii virtual platform were standardized into three categories: aerobics, balance and Wii plus exercises. Participants carried out separate virtual exercises for 40 min, twice a week, for a total of 14 sessions. The program improved sensorimotor performance in PD gait, with an increase in stride length and gait speed, in addition to a reduction in motor impairment, especially in items of rigidity and flexibility of the lower limbs evaluated by UPDRS III, and greater functional independence, as evidenced in the SE and FIM scales. Improvements in items related to locomotion and stair climbing were also observed. The training was effective in motor recovery in chronic neurodegenerative diseases, showing improvement in motor performance and functional independence in individuals with PD.
Neurology International 01/2014; 6(1):5048. DOI:10.4081/ni.2014.5048