The Effects of Pain Neuroscience Education with Conventional Physical Therapy on Chronic Plantar Fasciitis: A Case Study

Background and Purpose: Plantar Fasciitis (PF) is a condition that affects the foot and causes complaints such as pain and stiffness. The most common symptom of this condition is pain. There are many treatment options to deal with this condition, such as conservative therapy, medications, and surgical interventions in rare cases. This case study aims to investigate the potential impact of pain neuroscience education (PNE), combined with a conventional Physical Therapy (PT) program on a 37-year-old-patient with chronic plantar fasciitis. Case description: A 37-year-old male health care professional presented to an outpatient physical therapy clinic with a diagnosis of chronic PF for around two years. The participant had tried several treatment options with no improvement of his symptoms. After undergoing a physical therapy evaluation, he was given a plan of care for twelve sessions by a skilled physical therapist for a six-week period, with each session consisting of 30 minutes of conventional PT, followed by 5 to 15 minutes of PNE. Results: After completing the prescribed plan of care, the patient reported a reduction in subjective symptoms via the Visual Analog Scale (VAS). He also reported improvement with symptoms and functional independence via the Foot Function Index (FFI). The patient reported no change in the quality of sleep via Pittsburg Sleep Quality Index (PSQI). Lastly, he demonstrated no objective improvement in foot pressure with the Navicular Drop Test. Discussion: This case report indicates that PNE, combined with conventional PT for PF can have a positive impact on subjective pain and foot function. PNE should involve many topics about the physiology of pain and the nervous system and should be administered by a certified therapeutic pain specialist. Further studies are recommended to investigate the impact of this intervention in combination with traditional PT for PF in larger populations.

Effectiveness of a Group Exercise Class vs. Home Exercise Program as a Follow-up to Physical Therapy for Older Adults with High Fall Risk

This quasi-experimental study compared the results of a traditional model of physical therapy(PT)care to a PT wellness model known as GroupHab.The traditional model included discharge from PT with a home exercise program(HEP)to be self-administered with or without the addition of a community-based exercise program.The wellness model included participation in a PT-designed and supervised group exercise program(GroupHab class)in an outpatient clinical setting following discharge from PT.Independent t-tests were used to compare the number of falls,exercise frequency,and exercise duration between the two groups.A repeated measures,analysis of variance(RM-ANOVA)compared changes in balance confidence scores both within and between groups,and a multivariate analysis of variance(MANOVA)analyzed group differences across multiple quality of life ratings using the SF-20.All data were analyzed at the 0.05 alpha level using SPSS 24 statistical software.Our results showed a significantly greater reduction in recurrent falls among the GroupHab wellness group compared to the HEP group(t=2.811,p=0.009).The resulting odds ratio for subsequent falls was 2.2 among HEP participants and 0.2 among GroupHab participants.Exercise adherence was also greater for those who participated in the GroupHab class.They documented greater exercise frequency(t=-3.253,p=0.002)and more exercise minutes(t=-7.188,p<0.001)than those who participated in the HEP.When comparing changes in the participants’balance confidence,we found an average increase of 5%among GroupHab participants compared to a 6%decrease among HEP participants(F=16.877,p<0.001,power=0.981).Although our multivariate analysis of the SF-20 scores revealed no significant difference overall(F=0.768,p=0.73),the univariate analyses showed significantly greater improvements among GroupHab participants in selected areas of physical function.These results suggest that at-risk older adults who are discharged into a functionally-based group exercise class are less likely to experience recurrent falls and are more likely to have more confidence in their balance than those who are discharged with a standard HEP and/or use of community-based exercise classes.

Perceived Stress and Coping Strategies in Entry-Level Doctor of Physical Therapy Students Enrolled in a Hybrid-Learning Curriculum during the Pandemic

Physical therapy students can experience elevated levels of stress due to the pressure to be successful, changes in the environment, personal concerns, the lack of spare time, increased work, or financial burdens. The purpose of this study was to examine the perceived stress and coping strategies of Doctor of Physical Therapy (DPT) students enrolled in a hybrid-learning curriculum during the COVID-19 pademic. A total of 73 students enrolled in the DPT hybrid-learning curriculum responded to a survey which consisted of socio-demographics, the 10-item Perceived Stress Scale (PSS), and the 28-item Brief COPE. A general question regarding stress relating to COVID-19 was presented as a sliding percentage. Data analysis included a Spearman correlation, a Kruskal-Wallis test, and a linear regression to evaluate coping mechanisms against PSS scores. The mean (± SD) score on the PSS was 22.65 (± 10.21) and the Brief COPE was 59.18 (± 10.61). A non-significant negative correlation was found between the PSS and Brief COPE (r = -0.024). A third of the variation in the perceived stress score could be accounted for by students utilizing coping mechanisms regardless of other factors (R2 = 0.35). No significant differences were found when comparing PSS and Brief Cope to age, hours worked per week and term. Perceived stress was higher in females compared to males, but the results were not significant. Stress related to COVID-19 mean percentage reported by DPT students was 49.03%. During a global pandemic, DPT students enrolled in a hybrid-learning curriculum reported elevated levels of stress but reported higher adaptive versus maladaptive coping strategies. It can be beneficial that universities evaluate the stress and coping methods of students to potentially avoid the negative impacts of stress.

Comparison of Physical Therapy Follow-Up of Patients with Operated and Non-Operated Lumbar Spinal Stenosis According to the Nottingham Health Profile-Pain Scale

Background: Lumbar spinal stenosis (LSS) continues to be a major problem in societies, causing job loss and lowering quality of life. There are two types of treatment methods, physical therapy and surgery. If patients with LSS avoid treatment, they are likely to experience neurological deterioration in later years. Objective: The study aimed to evaluate the effect of physical therapy applied after decompression surgery or the effect of only applied physical therapy in patients with lumbar spinal stenosis. Materials and Methods: The results of the physical therapy follow-up of patients who had surgery and did not have surgery due to lumbar spinal stenosis between July 2014 and December 2019 were compared with each other. All patients received physical therapy for 6 months. Included were 42 patients who underwent decompression surgery due to LSS; 56 patients were not operated. Clinical outcomes were measured using the Nottingham Health Profile-Pain (NHP-Pain) scale at the initial, first, third and sixth months. The results were compared statistically. Results: The age of the operated patients was 54.69 ± 8.42 (39 - 71), while the non-operated patients were 59.16 ± 14.04 (34 - 83). There was no significant difference in the statistical comparison (p = 0.053). While the body mass index (BMI) of the operated patients was 29.43 ± 4.99 (21 - 40), the BMI of the non-operated patients was 28.84 ± 4.62 (22 - 42). There was no significant difference in the statistical comparison (p = 0.552). The scores of a 6-month physical therapy follow-up of patients were evaluated according to the NHP-pain scale. The values of patients who underwent surgery, initial - 1st month (p < 0.001), 1st month - 3rd month (p = 0.028), 3rd month - 6th month (p = 0.389) follow-up of the intervals were compared statistically. The values of non-operated patients, initial - 1st month (p = 0.008), 1st month -3rd month (p = 0.013), 3rd month - 6th month (p = 0.025) were compared statistically. Patients with and without surgery had significantly different initial pain scores (p < 0.001). Conclusions: The NHP-Pain scores of the patients undergoing physical therapy with the operation were shown to provide more significant improvement than the group receiving only the physical therapy. Patients with LSS should be treated with an operation to obtain the maximum benefit of physical therapy.

Functional Rehabilitation of Disc Herniation Treated with Combined Therapy

Current researches reveal that the number of cases diagnosed with operated lumbar disc herniation is growing rapidly, which should draw an increased attention to the treatment used. The objective of this study is to perform a comparative analysis between the application of a classical physical-kinetic program and the application of a combined kinetic program. This research will be conducted on 20 subjects with ages, between 40 - 50 years old, in INEMRCM Bucharest, for 14 days - 1 hour a day. Each subject underwent an invasive surgery for lumbar disc herniation on the L5-S1 vertebrae. During the research, the 2 patients will be given a physical-kinetic program, adapted to the pathology of the operated lumbar disc herniation. The purpose of this research is to check the efficiency of each kinetic program. Furthermore, through the muscular and articular evaluation made in the initial phase and the final phase, it will be possible to discuss the comparative evolution of the established kinetic program and the functional gain obtained. In conclusion, the research shows that mechanized therapy results in faster functional rehabilitation and physical exercise substantially improves quality of life.

The Physical and Clinical Aspects of Radiation Therapy in Skin Cancer and Subcutaneous Tissue Neoplasm

Cancers, malignant melanoma and sarcomas of the skin represent the most common group of malignancies in humans. The main treatment method of almost all skin cancers and subcutaneous tissue tumours is surgery, which consists of complete removal of a neoplastic lesion, with an adequate margin of healthy tissue. Radiotherapy plays an adjuvant role in this process, meaning complementing of the surgical procedure. This study compared four methods of irradiation treatment of cancer located in the skin or in subcutaneous tissues: contact brachytherapy, conventional orthovoltage therapy, electron beam conformal teleradiotherapy and IMRT dynamically shaped photonic beams conformal teleradiotherapy. In order to compare the methods and techniques of surface radiotherapy, following specific objectives were formulated. At the beginning in order to compare the scopes of the absorbed doses at different tissue depths, an analysis of parameters describing particular beams or radiation source has been performed—the curves for the absorbed-dose depth drop-offs. Doses distribution in tissue-like phantoms stimulating homogeneous cuboidal tissue block has been determined. A quality comparison of dose distribution in 2D and 3D treatment planning system for contact brachytherapy application has been made. The dose distribution for electron beam in the system has been determined. Conformal plannings for electron beam treatment, contact brachytherapy applicator treatment and 4 photon beams treatment optimized in IMRT technology have been performed. Dose distribution has been performed for the irradiated female patient within the well chest—the target included the recurrence area in the post-operative scar. The radiation therapy with X-rays has actually been completely eliminated from skin cancer and subcutaneous tissue radiotherapy by the electrons generated in linear accelerators, contact brachytherapy HDR and by high-energy photons used in conformal techniques, ex. IMRT. It is because the residual dose beyond the target is the highest for single X-ray beam. Although in brachytherapy HDR a rapid dose drop-off is observed, 5 cm from its normalization level for the target the residual radiation remains at the level of several percent. So, both X-rays beam radiation and brachytherapy in skin cancer treatment is connected with the administration of the dose with a high gradient in the health tissues. The dose distribution for photon conformal techniques IMRT or for electron radiation looks different. There with the dose normalization at the level of 90% or 85% we deal with the dose layer, the division does not exceed 15% of heterogeneity.

Efficacy of therapeutic ultrasound vs sham ultrasound on pain and physical function in people with knee osteoarthritis: A meta-analysis of randomized controlled trials

AIM: To determine the efficacy of therapeutic ultrasound vs sham for improving pain and physical function immediately post-intervention in people with knee osteoarthritis(OA). METHODS: We hand searched meta-analyses on the topic published in 2010 and updated the search in three electronic databases(MEDLINE, EMBASE, CINAHL) January 1, 2009 to September 5, 2013 to identify relevant studies. The inclusion criteria were human randomized controlled trials published in the English language in which active therapeutic ultrasound was compared tosham ultrasound, data for people with knee OA were reported separately, participants were blinded to treatment allocation and outcomes assessed before and after treatment included pain, self-reported physical function and performance-based physical function. Two reviewers independently screened titles and abstracts retrieved in the search to identify trials suitable for full text review. Data extraction and risk of bias assessment of the identified trials were completed independently by two reviewers. Pooled analyses were conducted using inverse-variance random effects models.RESULTS: We screened 1013 titles and abstracts. Meta-analysis of pain outcomes from 5 small trials(281 participants/OA knees) showed that, compared to sham ultrasound, therapeutic ultrasound improves pain [standardized mean difference(SMD)(95%CI) =-0.39(-0.70--0.08); P = 0.01] but not physical function [self-reported in 3 trials(130 participants/OA knees): SMD(95%CI) =-0.21(-0.55-0.14), P = 0.24; walking performance in 4 trials(130 participants/OA knees): SMD(95%CI) =-0.11(-0.59-0.37), P = 0.65). For the walking performance outcome, the dispersion of the estimated effects exceeded that expected due to sampling error(χ2 = 8.37, P = 0.04, I 2 = 64%). Subgroup analyses of three trials that administered high dose ultrasound improved the consistency(I2 = 28%) but the treatment effect remained insignificant.CONCLUSION: Meta-analyzed double-blind placebocontrolled randomized trials provide low-strength evidence that therapeutic ultrasound decreases knee OA pain and very low-strength evidence that it does not improve physical function.

Regional Interdependence: A Model That Needs to Be Integrated in the Functional Evaluation and Physiotherapy Treatment—Part 1

Background: Rehabilitation is increasing the need to use codes in order to make both a functional diagnosis and a therapeutic intervention as correct and targeted as possible. Thus, it is very important to integrate the model of Regional Interdependence (RI) in the classical rehabilitation evaluation methods, since it will be of help for understanding, solving dysfunctional problems, and improving the patient management, which is often difficult given the fact that there is no concordance on functional tests and timing of treatments. The RI should be added to the functional evaluation each time that a patient presents symptoms in a specific location, which interest also distal regions. This is due to the functional and anatomical connections of the myofascial system, vascular, autonomic nervous system (ANS), the peripheral nervous system (PNS) and the neuro-immunoendocrine system. The RI can be summarized into three groups that are correlated when it comes to applying it practically: upper, bottom and front quadrant. Adding the concept of RI to the clinical and therapeutically practice, it would have positive effects on improving the quality of life and allocate better health’s resources. The aim of this paper is to make the functional assessment in clinical practice faster and more standardized.

The Effectiveness of 6 Months Hydrotherapy Program Based on Halliwick Concept on the Respiratory System of Down Syndrome Children

The aim of the study was to investigate the effect of a hydrotherapy program on FVC, FEV, PEF, RR and SaO2 on children with Down syndrome over six months and to compare it with a conventional respiratory physiotherapy program. Eighteen children, with Down Syndrome, aged 6 - 11 years (9.53 ± 0.454), divided into two groups of nine, the intervention group (IG), that participated in the hydrotherapy program and the control group (CG) participated in the classical physiotherapy program. We calculated mean values of FVC, FEV, PEF, RR and SaO2 before and after six months intervention for both groups. There was a statistically significant improvement in all factors for both groups. However, were statistically more significant for the intervention group (IG). Based on a specific protocol of intervention in the water and at the same time with a group of children who participated in a similar program of classical respiratory physiotherapy, it was found to be statistically more important than the second group in improving respiratory function. We recommend the use of hydrotherapy as a complementary therapy that should be part of the weekly program of these children in addition to the existing treatments they attend.

Non-Drug Therapy to Combat Coronavirus

Novel coronavirus is threatening the health of people all over the world and all possible treatment strategies are in urgent. The sensitive of virus to heat proposed temperature treatment as an effective method against coronavirus. Here, we proposed several non-drug therapies including far-infrared, thermal air, thermal oxygen, ozone, hydrogen therapy and plasma physical therapy for immediate clinical trial and implementation. Compared with the drug therapy, these methods are safe without side effects, the highest benefit-to-risk ratio, user-friendly, and low implementation costs. It is urgent and significant to start these non-drug therapeutic design and implementation as early as possible, to determine the safety and effectiveness of these therapeutic methods.

Traditional medicine in cancer:what is new in 2022

Cancer is one of the leading causes of death in most countries and regions,accounting for about ten million deaths each year worldwide.Despite the endeavors and achievements made in treating cancer during the past decades,rapid resistance to the current clinically used targeted drugs or targeted chemotherapeutic agents continues to be a major problem in cancer therapies.Moreover,many cancer patients are suffering from tumor complications or cancer-related symptoms.Traditional medicine has been practiced for thousands of years and is also currently diffusely used worldwide as an alternative therapy for cancer.Areas of investigation of traditional medicine in cancer treatment,such as traditional formulas,chemical components derived from herbal medicines,and acupuncture,have received increasing attention,especially in recent years.Here,we included selected studies reported last year regarding traditional medicine for cancer treatment in an attempt to summarize the most relevant findings,providing a valuable reference for the future investigation of traditional medicine in the cancer field.

Prevalence of musculoskeletal injuries and a proposal for neuromuscular training to prevent lower limb injuries in Brazilian Army soldiers:an observational study

Background: The activities carried out by soldiers in the army involve great physical demands and require intense trainings to perform combat-specific tasks. Musculoskeletal injury is a potential threat to the health and physical integrity of the soldier. This study aimed to evaluate the prevalence of lower limb musculoskeletal injuries among soldiers and to propose a training protocol to prevent the most frequent injuries.Methods: This observational(cross-sectional) study recruited a sample of 103 soldiers who required medical attention,from a total 202 new battalion soldiers. The medical records(paper and online) had a form of running text. All data collected were recorded by the registered physicians of the battalion medical post. The records were analyzed by the following variables: medical diagnosis, injury site, mechanism, type of treatment, time loss, existence of previous injury,and recurring injury.Results: A total of 112 musculoskeletal injuries were diagnosed in 71 soldiers, and other types of diseases/injuries were diagnosed in the other soldiers. Joint pain accounted for 55.4% of the diagnoses. The knee was the most affected site, while trauma and overload were the most common mechanisms of injury. Drug treatment was used most frequently, accounting for 58% of the cases. The majority of the sample obtained a temporary leave of absence for1 to 6 days or not at all. Previous injuries and recurrence were not presented as risk factors for injury. With the data received, a protocol for the prevention of injuries to the lower limbs was proposed.Conclusions: This study indicated that the most frequent site of injury is the knee, and joint pain is the most common diagnosis. These results may support the necessity to develop a neuromuscular training protocol to prevent lower limb injuries, which we suggest to be applied in future studies.

Implementation science for the adductor canal block:A new and adaptable methodology process

BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiquated PSH elements and introduction of new practices.AIM To investigate the transition from femoral nerve blocks(FNB)to adductor canal nerve blocks(ACB)during TKA.METHODS Our 13-month study from June 2016 to 2017 was divided into four periods:a three-month baseline(103 patients),a one-month pilot(47 patients),a three-month implementation and hardwiring period(100 patients),and a six-month evaluation period(185 patients).In total,435 subjects were reviewed.Data within 30 postoperative days were extracted from electronic medical records,such as physical therapy results and administration of oral morphine equivalents(OME).RESULTS Our institution reduced FNB application(64% to 3%)and increased ACB utilization(36% to 97%)at 10 mo.Patients in the ACB group were found to have increased ambulation on the day of surgery(4.1 vs 2.0 m)and lower incidence of falls(0 vs 1%)and buckling(5% vs 27%)compared with FNB patients(P<0.05).While ACB patients(13.9)reported lower OME than FNB patients(15.9),the difference(P=0.087)did not fall below our designated statistical threshold of P value<0.05.CONCLUSION By demonstrating closure of the“knowledge to action gap”within 6 mo,our institution’s findings demonstrate evidence in the value of implementation science.Physician education,technical support,and performance monitoring were deemed key facilitators of our program’s success.Expanded patient populations and additional orthopedic procedures are recommended for future study.

Addition of hip exercises to treatment of patellofemoral pain syndrome:A meta-analysis

AIM:To determine if the addition of hip-strengthening exercises decreases pain and improves function in patients with patellofemoral pain syndrome.METHODS:The authors completed a systematic reviewsearching eight databases(i.e.,Pub Med,Cochrane,CINHAL,MEDLINE,Sports Discus,EMBASE,APTA Hooked on Evidence,and PEDro).Two independent reviewers screened and excluded studies if they did not meet the following inclusion criteria:subjects had a primary diagnosis of patellofemoral pain syndrome(PFPS),intervention group included hip-strengthening exercises,control group included a traditional physical therapy intervention,study included outcome measures of pain and/or function,study used a randomized controlled trial design,PEDro score was ≥ 7,and study was published in a peer-reviewed journal.Primary outcome measures were subjective scales of pain and function.These measures were converted to standardized mean difference [effect size(ES)],and a random-effects model was used to calculate the overall ES.RESULTS:Two hundred eighty-three studies were screened for inclusion in our meta-analysis.Nine studies were deemed suitable for data extraction and analysis.A total of 426 subjects were used in the nine studies.Overall,there was a significant positive effect of hip-strengthening exercises on measures of pain and function in subjects with PFPS(ES = 0.94,P = 0.00004).None of the individual studies had a negative ES,with study ES ranging from 0.35 to 2.59.Because of the high degree of between-study variance(I2 = 76%;Q = 34.0,P < 0.001),subgroup meta-analyses and meta-regressions were performed.None of the potential moderator variables that were investigated(e.g.,outcome type,hip region targeted,duration of treatment) could explain a significant amount of the between-study variance in ES(P ≥ 0.23).CONCLUSION:Overall,the addition of hip-strengthening exercises to traditional physical therapy produced greater improvements in measures of pain and function.

Recovery of brachial plexus injury after bronchopleural fistula closure surgery based on electrodiagnostic study:A case report and review of literature

BACKGROUND Axillary thoracotomy and muscle flap are muscle-and nerve-sparing methods among the surgical approaches to bronchopleural fistula(BPF).However,in patients who are vulnerable to a nerve compression injury,nerve injury may occur.In this report,we present a unique case in which the brachial plexus(division level),suprascapular,and long thoracic nerve injury occurred after BPF closure surgery in a patient with ankylosing spondylitis and concomitant multiple joint contractures.CASE SUMMARY A 52-year-old man with a history of ankylosing spondylitis with shoulder joint contractures presented with right arm weakness and sensory impairment immediately after axillary thoracotomy and latissimus dorsi muscle flap surgery for BPF closure.During the surgery,the patient was positioned in a lateral decubitus position with the right arm hyper-abducted for approximately 6 h.Magnetic resonance imaging and ultrasound revealed subclavius muscle injury or myositis with brachial plexus(BP)compression and related neuropathy.An electrodiagnostic study confirmed the presence of BP injury involving the wholedivision level,long thoracic,and suprascapular nerve injuries.He was treated with medication,physical therapy,and ultrasound-guided injections.Ultrasoundguided steroid injection at the BP,hydrodissection with 5%dextrose water at the BP and suprascapular nerve,and intra-articular steroid and hyaluronidase injection at the glenohumeral joint were performed.On postoperative day 194,the pain and arm weakness were resolved,and a follow-up electrodiagnostic study showed marked improvement.CONCLUSION Clinicians should consider the possibilities of multiple nerve injuries in patients with joint contracture,and treat each specific therapeutic target.

Clinical application of repetitive transcranial magnetic stimulation for post-traumatic stress disorder:A literature review

The efficacy of traditional treatment for post-traumatic stress disorder(PTSD)is still unsatisfactory.Repetitive transcranial magnetic stimulation(rTMS)has been widely used in the treatment of various types of mental disorders,including PTSD.Although rTMS has been demonstrated to be effective in many cases,there are still arguments regarding its mechanism and protocol.This review aims to summarize the origin,development,principle,and future direction of rTMS and introduce this neuro-stimulation therapy to relevant clinicians.

Effect of supervised exercise on aerobic capacity in cancer survivors: Adherence and workload predict variance in effect

AIM: To examine the efficacy of supervised aerobic exercise training on aerobic capacity in survivors of cancer.METHODS: We conducted a systematic search identifying randomized controlled trials of supervised aerobic exercise interventions among adult cancer survivors with aerobic capacity(VO2max/peak) as the primary outcome. We calculated pooled effect sizes and performed multiple regression moderator analysis. RESULTS: We identified 18 studies including 1149 survivors of cancer. Studies included mixed cancer groups(4 studies), breast cancer(10 studies), hematological cancers(2 studies), lung cancer(1 study) and liver cancer(1 study). Survivors of cancer who participated in supervised aerobic exercise training improved aerobic capacity(VO2peak) more than controls(18 comparisons, 1093 participants; standardized mean effect: 0.74; 95%CI: 0.52, 0.96; P < 0.001). However, there was significant heterogeneity among the included trials(I2: 63%; P < 0.001). Sixty-six percent of the between-study heterogeneity was explained by differences in exercise adherence and total exercise workload among studies(R2: 65.8%; P < 0.04). CONCLUSION: Supervised aerobic exercise training provides a moderate-to-large beneficial effect on aerobic capacity among survivors of cancer. Aerobic capacity was improved to a greater degree in exercise studies with better participant attendance and higher overall exercise workload.

Effect of Kinesio Taping on Hand Function in Hemiparetic Patients

Introduction: Cerebrovascular accident (CVA) is the second most frequent cause of death in the world. Nevertheless, most victims do survive and need treatment, and hand function is one that has to be dealt with in the rehabilitation process. Kinesio&reg?Taping (KT) is a bandaging method that can be applied along the muscle fibers to provide stimulation. Studies have shown its efficacy in providing afferent stimuli to weakened muscles, thus eliciting contraction with greater recruiting of motor units and inducing neuroplasticity. Benefits to the paresthesia hand have not been reported. Objective: Investigate the effects of KT on hand function in hemiparetic patients. Material and Methods: An evaluator-blinded, randomized clinical trial involving stroke victims was carried out in a physical therapy outpatient clinic. One group underwent KT intervention and the other was a control group. The Modified Ashworth Scale (MAS) and the Box and Block Test (BBT) were used as assessment tools. A data entry form was used in the Epi-info 7 software and descriptive statistics was thus calculated. The software BioStat 5.0 was employed when doing statistical tests. Associations were regarded as statistically significant when p 0.05. Results: Eight individuals were randomly assigned to two groups. All those who had received treatment with KT had spasticity improved by one point, but there was no significant improvement in BBT. Conclusion: KT was effective when it came to improving spasticity and it may be an option in rehab, but it had no effect on gross manual dexterity. Nevertheless, it can be of help as part of a functional training program.

Neuromuscular Electrical Stimulation in Intensive Care Unit Patients:Integrative Review

Intensive care units’ acquired muscle weakness is present in approximately 50% of the patients. Although active muscle training can attenuate weakness, a large proportion of critical patients cannot participate in any active mobilization. Neuromuscular electrical stimulation may be an alternative strategy to reverse muscle weakness. The objective of the study was to review the scientific publications on the use of neuromuscular electrical stimulation and its parameters and the main results in patients hospitalized in intensive care units. This is an integrative review surveying studies in online databases. The studies were selected from the following descriptors: neuromuscular electrical stimulation AND parameters AND intensive care units AND muscle weakness. The inclusion criteria included articles that addressed the topic of neuromuscular electrical stimulation and the parameters used in patients admitted to intensive care units, aged 18 years or older. Exclusion criteria were studies involving animals, case reports, letters to the editor and book chapters. The search comprised articles in the Portuguese, English and Spanish languages from January 2013 to March 2019. Of the 185 articles identified, nine met the eligibility criteria. The studies were evaluated assessing the level of evidence, and the relevant information was presented in the table and discussed. The parameters of the neuromuscular electrical stimulation employed in the studies showed positive results for the maintenance of strength and muscle mass. There was evidence of benefits in the local and systemic microcirculation, potentially mobilizing endothelial stem cells, to prevent atrophy, to reduce mechanical ventilation time and stay in intensive care unit;and when incorporated into the usual physiotherapy care, proved to be more effective than usual care. Its use is safe and viable in critically ill patients.

A remote,fully oriented personalized program of physical exercise for women in follow-up after breast cancer treatment improves body composition and physical fitness

This study aimed to evaluate the efficacy of an individualized remote exercise program on the improvement of body composition and physical fitness of a heterogeneous group of patients who completed breast cancer treatment.This prospective study included 107 women aged 18 to 60,shortly after curative treatment for localized breast cancer,at the Erasto Gaertner Cancer Hospital(HEG)in Curitiba,PR,Brazil.Body composition,maximal oxygen consumption,and muscle resistance were evaluated after nine months of intervention while considering adherence to the program,level of physical activity,presence of binge eating disorder,tumor classification,and treatment type.Seventy-eight women(72.8%)adhered to the training program.Adherent participants showed significant changes in body mass([-4.3±3.6]kg;p<0.0001),body mass index([-1.6±1.5]kg·m^(−2);p<0.0001),body fat(−3.4%±3.1%;p<0.0001),maximal oxygen consumption([7.5±2.0]ml·kg^(−1)·min^(−1));p<0.0001),and abdominal resistance([11.2±2.8]reps;p<0.0001).In contrast,these variables did not change significantly in the non-adherent group.Among the adherent participants,those subclassified in the severe binge group showed a more noticeable reduction in body mass,body mass index,and body fat(p<0.05)than those in the non-binge group.Individualized remotely-guided physical exercise programs can improve the body composition and physical fitness of women undergoing post-breast cancer surveillance,regardless of pathological history or treatment.