RESUMO
BACKGROUND: Scapular focused exercise interventions are frequently used to treat individuals with shoulder pain. However, evidence for changes in scapular motion after intervention is limited. OBJECTIVE: To compare the effects of scapular movement training versus standardized exercises for individuals with shoulder pain. METHODS: This will be a single-blinded randomized controlled trial. Sixty-four individuals with shoulder pain for at least 3 months, scapular dyskinesis, and a positive scapular assistance test will be randomly allocated to one of two groups: Scapular Movement Training (group 1) and Standardized Exercises (group 2). Group 1 will receive education about scapular position and movement, and be trained to modify the scapular movement pattern. Group 2 will perform stretching and strengthening exercises. Both groups will be treated twice a week for eight weeks. Three-dimensional scapular kinematics and muscle activity of the serratus anterior and upper, middle, and lower trapezius during elevation and lowering of the arm will be assessed at baseline and after 8 weeks of treatment. Pain intensity, function, fear avoidance beliefs, and kinesiophobia will be assessed at baseline and after 4 and 8 weeks of treatment, and 4 weeks after the end of treatment. CONCLUSIONS: The results of this study may contribute to a better understanding of the efficacy of scapular focused treatments for individuals with shoulder pain. CLINICAL TRIAL REGISTRATION: NCT03528499.
Assuntos
Terapia por Exercício/métodos , Escápula/fisiologia , Dor de Ombro/fisiopatologia , Músculos Superficiais do Dorso/fisiologia , Fenômenos Biomecânicos/fisiologia , Discinesias/fisiopatologia , Exercício Físico , Humanos , Movimento/fisiologiaRESUMO
BACKGROUND: Recognition of motor signs in the prodromal stage could help identify those at risk of developing Parkinson's disease (PD). OBJECTIVE: This study identified motor symptoms and signs in individuals suspected of having PD but who did not have a progressive reduction in the speed and amplitude of finger tapping or other physical signs indicative of bradykinesia. METHODS: 146 patients, who had symptoms or signs suggestive of PD, were serially evaluated by a movement disorder specialist, using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III and video recordings. If the patients 'converted' to PD during follow-up, they were categorized as cases and compared with those who did not meet PD criteria during follow-up (non-cases). RESULTS: The 82 cases were more likely to have action dystonia or postural/action/rest tremor of a limb (OR 2.8; 95% CI 1.1-7.1; pâ=â0.02), a reduced blink rate at rest (OR 2.3; 95% CI 1.2-4.6; pâ=â0.01), anxiety (OR 8.9; 95% CI 2.6-31.1; pâ<â0.001), depression (OR 7.0; 95% CI 2.9-17.2; pâ<â0.001), or a frozen shoulder (OR 3.1; 95% CI 1.6-6.2) than the 64 'non-cases'.A reduction of the fast blink rate was common in patients who met the criteria for PD (pâ<â0.001). CONCLUSIONS: This study emphasizes that motor dysfunction is a component of the clinical prodrome seen in some patients with PD.
Assuntos
Ansiedade/fisiopatologia , Depressão/fisiopatologia , Progressão da Doença , Discinesias/fisiopatologia , Doença de Parkinson/fisiopatologia , Sintomas Prodrômicos , Idoso , Ansiedade/diagnóstico , Piscadela/fisiologia , Depressão/diagnóstico , Discinesias/diagnóstico , Distonia/diagnóstico , Distonia/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Índice de Gravidade de Doença , Tremor/diagnóstico , Tremor/fisiopatologiaRESUMO
BACKGROUND: Congenital Zika syndrome causes a spectrum of neurological symptoms with varying effects on function that require different therapeutic strategies. To date, this spectrum of effects and its clinical implications have not been completely described. We describe the neurological examination findings in toddlers and preschoolers, including predominant symptom complexes and comorbidities. METHODS: This study is a case-series neurological evaluation of 75 children with congenital Zika syndrome in Campina Grande, Brazil. The study is part of a cohort of children with congenital Zika syndrome that started in 2015 and is still ongoing. Children with Zika virus infection detected during pregnancy (mothers exhibited rash and were followed and diagnosed by fetal ultrasound abnormalities or RT-PCR) or through microcephaly screening after birth, using Intergrowth 21 guidelines, were selected by laboratory and radiological criteria. Children were examined during a 10-day period in September, 2018, and underwent neurological interview, examination, and assessment of functional outcomes and comorbidities. Children were divided in groups of predominant corticospinal or neuromuscular clinical signs and the associations between these groups and clinical comorbidities were assessed. FINDINGS: All of the children recruited to the study from Nov 29, 2015 to Nov 30, 2017 had imaging correlates of congenital Zika syndrome. Children were assigned to groups depending on the signs exhibited, either corticospinal or neuromuscular, with or without dyskinetic signs. 75 children completed the evaluation, 38 (51%) girls and 37 (49%) boys. Median age was 33 months (range 26-40 months; IQR 29-34). Microcephaly was present at birth in 56 (75%) children, and 19 (25%) children were born with normal head circumference, 15 of whom later developed microcephaly. Neurological examination grouped four children as having isolated dyskinetic signs, 48 children were assigned to the corticospinal group and 23 into the neuromuscular group. Dyskinetic findings were present in 30 (40%) children, either alone (four [5%]) or combined with corticospinal (19 [40%] of 48) or neuromuscular (seven [30%] of 23) findings. Comorbidities were highly prevalent, and the neuromuscular group had worse functional outcomes, evaluated by gross motor function (p=0·026), manual abilities (p=0·0013), and communication function (p<0·0005) classification scales, than the corticospinal group, whereas pneumonia (p<0·0005) and urinary tract infections (p<0·0005) were more frequent in the corticospinal group. Cortical hyperexcitability was supported by several clinical correlates, such as early onset epilepsy, persistence of primitive reflexes, and dystonia. INTERPRETATION: We describe distinct neurological profiles in the congenital Zika syndrome spectrum, with functional outcomes tending to correlate with these groups. The clinical division of children based on the disease signs proposed here is supported by the literature on central and peripheral nervous system pathology in congenital Zika syndrome. The high prevalence of dyskinetic symptoms merits special attention. FUNDING: Brazilian National Council for Scientific and Technological Development and by the Coordination for the Improvement of Higher Education Personnel.
Assuntos
Discinesias/fisiopatologia , Doenças Neuromusculares/fisiopatologia , Infecção por Zika virus/fisiopatologia , Encéfalo/diagnóstico por imagem , Encefalopatias/diagnóstico por imagem , Encefalopatias/epidemiologia , Brasil/epidemiologia , Calcinose/diagnóstico por imagem , Calcinose/epidemiologia , Pré-Escolar , Comorbidade , Transtornos de Deglutição/epidemiologia , Discinesias/epidemiologia , Epilepsia/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Malformações do Desenvolvimento Cortical/diagnóstico por imagem , Malformações do Desenvolvimento Cortical/epidemiologia , Malformações do Desenvolvimento Cortical/fisiopatologia , Microcefalia/epidemiologia , Microcefalia/fisiopatologia , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/fisiopatologia , Exame Neurológico , Doenças Neuromusculares/epidemiologia , Pneumonia/epidemiologia , Tratos Piramidais/fisiopatologia , Transtornos do Sono-Vigília/epidemiologia , Tomografia Computadorizada por Raios X , Infecções Urinárias/epidemiologia , Infecção por Zika virus/congênito , Infecção por Zika virus/diagnóstico por imagem , Infecção por Zika virus/epidemiologiaRESUMO
BACKGROUND: Alterations in glenohumeral and scapulothoracic kinematics have been theorized to contribute to rotator cuff pathology by impacting the magnitude of the subacromial space. OBJECTIVE: The purpose of this review is to summarize what is currently known about the relationship between shoulder kinematics and subacromial proximities. CONCLUSIONS: A variety of methods have been used to quantify subacromial proximities including photographs, MR imaging, ultrasonography, and single- and bi-plane radiographs. Changes in glenohumeral and scapulothoracic kinematics are associated with changes in subacromial proximities. However, the magnitude and direction of a particular motion's impact on subacromial proximities often vary between studies, which likely reflects different methodologies and subject populations. Glenohumeral elevation angle has been consistently found to impact subacromial proximities. Plane of humeral elevation also impacts subacromial proximities but to a lesser degree than the elevation angle. The impact of decreased scapulothoracic upward rotation on subacromial proximities is not absolute, but instead depends on the angle of humerothoracic elevation. The effects of scapular dyskinesis and humeral and scapular axial rotations on subacromial proximities are less clear. Future research is needed to further investigate the relationship between kinematics and subacromial proximities using more homogenous groups, determine the extent to which compression and other factors contribute to rotator cuff pathology, and develop accurate and reliable clinical measures of shoulder motion.
Assuntos
Discinesias/fisiopatologia , Manguito Rotador/fisiopatologia , Ombro/fisiologia , Ultrassonografia/métodos , Humanos , Escápula/fisiologiaRESUMO
BACKGROUND: The possible factors related to functional impairment and limitations in patients with temporomandibular disorders (TMDs) still need to be clarified because recovery of orofacial functions is a goal of their treatment. OBJECTIVE: To investigate whether chronic TMD patients had any changes in tongue strength, besides the difficulty in chewing and orofacial functional impairment, compared to a control group. Moreover, to examine whether tongue strength, chewing difficulties, and orofacial functions were associated. METHODS: Twenty-three patients with chronic TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and volunteers without TMD (control group) were compared. Strength measures were obtained using the Iowa Oral Performance Instrument (IOPI) during tongue protrusion (TPS) and swallowing of saliva (SS) tasks. A scale was used to investigate self-reported chewing difficulties, and the orofacial muscles and functions were evaluated using the orofacial myofunctional evaluation with scores protocol (OMES). RESULTS: Compared to the control group, TMD patients showed reduced TPS and SS, higher difficulty in chewing and worse myofunctional orofacial conditions. Tongue strength was correlated with mastication and swallowing behaviors, as well as with general myofunctional status. Chewing difficulty increased with decreasing tongue strength and with worsening of orofacial muscles and functions. CONCLUSION: Patients with chronic TMD showed reduced tongue strength and worse masticatory and swallowing functions, and these aspects were interrelated. CLINICAL RELEVANCE: The present results contribute additional evidence regarding the impairment of orofacial muscles other than jaw elevator muscles in patients with chronic TMD.
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Transtornos de Deglutição/fisiopatologia , Mastigação , Força Muscular , Transtornos da Articulação Temporomandibular/fisiopatologia , Língua/fisiopatologia , Adolescente , Adulto , Força de Mordida , Doença Crônica , Deglutição , Discinesias/fisiopatologia , Feminino , Humanos , Masculino , Adulto JovemRESUMO
Using bacterial artificial chromosome-double transgenic mice expressing tdTomato in D1 receptor-medium spiny neurons (MSNs) and enhanced green fluorescent protein in D2 receptor-MSNs, we have studied changes in spine density and perisomatic GABAergic boutons density in MSNs of both the D1R and D2R pathways, in an experimental model of parkinsonism (mouse injected with 6-hydroxydopamine in the medial forebrain bundle), both in the parkinsonian and dyskinetic condition induced by L-DOPA treatment. To assess changes in perisomatic GABAergic connectivity onto MSNs, we measured the number of contacts originated from parvalbumin (PV)-containing striatal "fast-spiking" interneurons (FSIs), the major component of a feed-forward inhibition mechanism that regulates spike timing in MSNs, in both cell types as well as the number of vesicular GABA transporter (VGAT) contacts. Furthermore, we determined changes in PV-immunoreactive cell density by PV immunolabeling combined with Wisteria floribunda agglutinin (WFA) labeling to detect FSI in a PV-independent manner. We also explored the differential expression of striatal activity-regulated cytoskeleton-associated protein (Arc) and c-Fos in both types of MSNs as a measure of neuronal activation. Our results confirm previous findings of major structural changes in dendritic spine density after nigrostriatal denervation, which are further modified in the dyskinetic condition. Moreover, the finding of differential modifications in perisomatic GABAergic connectivity and neuronal activation in MSNs suggests an attempt by the system to regain homeostasis after denervation and an imbalance between excitation and inhibition leading to the development of dyskinesia after exposure to L-DOPA.
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Espinhas Dendríticas/fisiologia , Discinesias/fisiopatologia , Rede Nervosa/fisiopatologia , Animais , Corpo Estriado/metabolismo , Proteínas do Citoesqueleto/metabolismo , Feminino , Interneurônios/metabolismo , Levodopa , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Proteínas do Tecido Nervoso/metabolismo , Oxidopamina , Parvalbuminas/metabolismo , Lectinas de Plantas/metabolismo , Proteínas Proto-Oncogênicas c-fos/metabolismo , Receptores de N-Acetilglucosamina/metabolismoRESUMO
OBJECTIVES: The aim of the study was to report 4 patients with Parkinson disease (PD) and On-period blepharospasm (BS). METHODS: We analyzed patients with PD and motor fluctuations who developed BS in several different centers in Latin America. RESULTS: Four patients had BS while in the ON periods. CONCLUSIONS: Blepharospasm in the On period in patients with PD is extremely uncommon, and our series is the only one to describe such association.
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Blefarospasmo/tratamento farmacológico , Blefarospasmo/etiologia , Levodopa/administração & dosagem , Levodopa/efeitos adversos , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/fisiopatologia , Idoso , Antiparkinsonianos/administração & dosagem , Antiparkinsonianos/efeitos adversos , Blefarospasmo/induzido quimicamente , Toxinas Botulínicas Tipo A/efeitos adversos , Toxinas Botulínicas Tipo A/uso terapêutico , Carbidopa/efeitos adversos , Carbidopa/uso terapêutico , Combinação de Medicamentos , Discinesias/tratamento farmacológico , Discinesias/fisiopatologia , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-IdadeAssuntos
Ataxia/fisiopatologia , Discinesias/fisiopatologia , Hipertonia Muscular/fisiopatologia , Hipotonia Muscular/fisiopatologia , Postura/fisiologia , Infecção por Zika virus/congênito , Brasil , Feminino , Maternidades , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Infecção por Zika virus/fisiopatologiaRESUMO
Introduction: To assess the effectiveness of seating devices during the sitting position on postural stability and upper limb functionality in users with dyskinetic type cerebral palsy. Method: A systematic review that included randomized, quasi-randomized, cohort, and pre-post intervention clinical trials with evaluation before and after the intervention. This review included studies of chil-dren with a diagnosis of cerebral palsy, mainly of the dyskinetic type, with ages between 2 and 10 years old. The databases of CINAHL Plus, Cochrane (Central), EMBASE (Via Ovid), Virtual Health Library, OT Seeker, Medline (Via PubMed) and OpenGrey were used. Results: Two studies met the inclusion criteria; however, the analysis was carried out qualitatively due to the methodological quality for these, with presence of a high risk of bias. The study by Cimolin described greater trunk stability and smooth upper extremity movements with the use of a dynamically configured seat. Nwaobi described better upper extre-mity functionality in a seat inclined at 0º and 30º, not referring to trunk stability. Conclusion: From the review of the results it is concluded that there is not enough scientific evidence to determine that the use of seating devices favors the postural control and the functionality of upper extremities in children with cerebral dyskinesia type cerebral palsy.
Introducción: Evaluar la eficacia del posicionamiento sedente en la estabilidad postural y funcionalidad de extremidades superiores, en ni-ños con parálisis cerebral discinética, comparando el uso y el no uso de seating de posicionamiento. Método: Revisión siste-mática incluyendo ensayos clínicos de tipo aleatorio, cuasialeatorizado, de cohorte y casos con evaluación antes y después de la intervención. Se incluyó niños con parálisis cerebral discinético, entre 2 y 10 años de edad. Se utilizó bases de datos de CI-NAHL Plus, Cochrane (Central), EMBASE (Vía Ovid), Biblioteca Virtual de la Salud, OT Seeker, Medline (Via PubMed) y Open Grey. Resultados: Dos estudios cumplieron criterios de inclusión, aunque el análisis se realizó de forma cualitativa por la calidad metodológica de estos. Cimolin detectó mayor estabilidad de tronco y suavidad en los movimientos de extremidades superiores con el uso de un asiento de configuración dinámica. Nwaobi describió mejor funcionalidad de extremidad superior en un asiento inclinado a 0º y 30º, no haciendo referencia a la estabilidad de tronco. Conclusión: De la revisión de los resulta-dos, se concluye que no existe evidencia científica suficiente que determine que el uso de seating favorezca o no el control postural y la funcionalidad de extremidades superiores en niños y jóvenes con parálisis cerebral de tipo discinética.
Assuntos
Humanos , Pré-Escolar , Criança , Paralisia Cerebral/reabilitação , Extremidade Superior/fisiologia , Postura Sentada , Paralisia Cerebral/fisiopatologia , Discinesias/fisiopatologia , Discinesias/reabilitação , Equilíbrio PosturalRESUMO
BACKGROUND: This study measured strength of the trunk and hip, and compared Y Balance Test and Upper Quarter Y Balance Test in individuals without and with scapular dyskinesis. Strength and endurance of the scapulothoracic muscles were also assessed. METHODS: Forty-four individuals without shoulder pain were divided in 2 groups: without scapular dyskinesis (age 26.00, SD 4.10â¯years) and scapular dyskinesis (age 23.68, SD 4.20â¯years). Scapular dyskinesis was assessed by clinical observation of the scapular motion during arm elevation, and was classified as present or absent. A handheld dynamometer was used to measure the isometric strength of the trunk flexors and lateral flexors, hip extensors and abductors, lower trapezius, serratus anterior, and latissimus dorsi. Y and Upper Quarter Y Balance Tests were performed with the individual in single-limb and 3-point plank position, respectively. Endurance of the scapulothoracic muscles was assessed with the individuals in prone with the arm at 135° abduction. Independent t-test and Mann-Witney test were used for comparison between groups. A Pâ¯<â¯0.05 was considered significant. Effect sizes between groups were also calculated. FINDINGS: No differences (Pâ¯>â¯0.05) were demonstrated between groups for all variables. Moderate effect size (dâ¯~â¯0.40) was found for the trunk flexors and hip extensors, and endurance of the scapulothoracic muscles, whereas the scapular dyskinesis group showed less strength and endurance in relation to the group without dyskinesis. INTERPRETATION: Strength of the trunk flexors and hip extensors, and endurance of the scapulothoracic muscles seem to have influence in scapular dyskinesis in non-athletes without shoulder pain.