Introduction: Pain represents a frequent phenomenon among the general population with great socioeconomic impact. TENS is one of the most common forms of electroanalgesia. However, totally effective stimulation parameters remain uncertain. Thus, this study aims to assess the effects of 4 Hz, 10 Hz and 100 Hz TENS applied to the LU7 (Lieque) acupoint on cold-induced pain in young healthy subjects. Methods: 100 volunteers, divided into five groups (three TENS groups, one electrode group and one placebo group), completed six experimental cycles. Each cycle comprised three phases: pretreatment, treatment and posttreatment. In each cycle, pain was induced by immersion of the hand into ice water and the pain threshold latency was measured. For the analysis of results, we used the one-way ANOVA test, followed by the Student-Newman-Keuls post hoc test. The level of significance was p < 0.05. Results: The 4 Hz TENS group the pain showed elevation of the pain threshold during the treatment phase, when compared to pretreatment (p < 0.05). This elevation was maintained in the post-treatment phase. The other groups showed no changes in the pain threshold. Conclusion: 4 Hz TENS applied with 1x1 cm electrodes to LU7 acupoint increases hypothermia-induced pain threshold latency in young healthy subjects.

Objective: To correlate functional capacity test scores from chronic obstructive pulmonary disease (COPD) subjects with their functional state as assessed by health-related quality of life questionnaires (one respiratory disease-specific [SGRQ] and one generic [SF-36] questionnaire). Materials and methods: Study of a case series of 8 COPD patients. The following tests were performed: 1) Six-minute walk test (6-MWT); 2) Shuttle walking test (SWT); 3) Six-minute step test (6-MST); 4) Two-minute sit-to-stand test (STST); and 5) Pegboard and ring test (PBRT). Besides these tests, two health-related quality of life questionnaires were administered: The St George´s Respiratory Questionnaire (SGRQ) and the Short Form 36 (SF-36) health survey questionnaire. The statistical analysis was carried out by using the Shapiro-Wilk normality test, while correlations were assessed using Pearson´s (parametric data) or Spearman´s (non-parametric data) rank tests, with p < 0.05. Results: The 6-MWT showed strong correlation with the SF-36 scales of physical functioning, general health, vitality, social functioning and mental health. Conversely, the other functional capacity tests showed no correlation with this questionnaire. The SGRQ showed no correlation with any of the tests. Conclusions: The 6-MWT may be a good test to reflect the health-related quality of life of COPD subjects.

Introduction: Musculoskeletal pain is a common clinical condition and about 10% of the population have musculoskeletal disorder. Objective: The aim of this study was to evaluate whether ischemic pressure and dry needling techniques are able to reduce the pain of patients with myofascial pain syndrome. Method: 22 patients aged 20-75 years were randomized into 3 groups: ischemic pressure (IPG = 8), dry needling (DNG = 7) and control (CG = 7). Patients in the IPG and DNG were assessed before and after 10 intervention sessions, which occurred 3 times per week. The CG was assessed initially and reassessed three weeks later. The assessment of pain was done through Visual Analogic Scale (VAS) and quality of life through WHOQOL-BREF (5 domains: global, physical, psychological, social and environmental). Results: There was no significant difference for clinical and demographic data of all groups at baseline, except for age (p = 0.042). The results of the VAS expressed that IPG had pain relief in most sessions, the same was not observed for DNG. Comparing the 2 groups was obtained difference in the 4th and 8th sessions. The results of the WHOQOL-BREF showed that the three groups had a significant increase in the psychological domain. The same was not true for global domains, physical, environmental and social. Conclusion: Ischemic pressure and dry needling were able to reduce the pain of patients and also change their quality of life, specifically the psychological aspect.

Introduction: Physical exercise is recommended by health professionals for the prevention of cardiovascular events; for it is important that practitioners follow recommendations of qualified professionals. Objectives: To analyze the cardiovascular risks and the physical exercise of regulars of a municipal public park. Materials and methods: 110 regulars of a municipal public park were evaluated by questionnaire and physical examination, 60 men and 50 women with a mean age of 48.8 ± 11.76 years. Cardiovascular risk was classified according to the American Table and physical activity following the recommendations of the American College of Sports Medicine and the American Heart Association. Results: Regarding the classification of cardiovascular risk, 54% of the studied population presented potential risk and 31% moderate. As for physical exercise, 58% were considered inactive, 14% active and 28% were very active. 90% received no professional guidelines. Conclusion: The public park goers have cardiovascular risk and do exercise without individualized guidance.

Introdução: Os limiares de sensações cutâneas e proprioceptivas são mecanismos que podem degradar durante o envelhecimento, afetando a estabilidade postural. Objetivo: Verificar a estabilidade postural e a propriocepção de idosas praticantes de hidroginástica e as possíveis relações existentes entre essas variáveis. Materiais e métodos: O grupo de estudo foi constituído por 25 idosas com idade média de 70,2 (dp 6,9) anos, praticantes de hidroginástica de intensidade moderada há no mínimo três meses e com duas aulas semanais. Para testar a propriocepção, utilizou-se o goniômetro analógico fixo, assentado no membro inferior preferido do sujeito. A estabilidade postural foi analisada utilizando uma plataforma de força no nível do solo. A partir dos dados de força obtidos pela plataforma, foi calculado o centro de pressão (CP). Os sujeitos foram analisados em postura bipodal, nas condições de olhos abertos (OA) e fechados (OF). Para a análise estatística, utilizaram-se a correlação de Spermann e o teste de Mann Whitney, com nível de significância de 5%. Resultados: Não foi encontrada diferença estatisticamente significativa entre as condições visuais de OA e OF. A propriocepção apresentou correlação positiva (R = 0,551; p = 0,004) com a idade e com a estabilidade postural, na condição de OA e OF, apresentando maiores amplitudes e velocidades de deslocamento do CP (p < 0,05). Conclusão: Os resultados encontrados sugerem que as perdas funcionais ocasionadas pela idade influenciam tanto o desempenho proprioceptivo quanto a estabilidade postural.

Introduction: Adequate motor coordination (MC) of the lower limbs is essential for most of the motor tasks. Therefore, it is important to know the psychometric properties of the tests employed to assess lower limb MC, so that professionals could have a better basis to choose the most adequate assessment tools. Objectives: To investigate the psychometric properties and clinical utility of instruments used to assess lower limb MC, by means of a critical review of the literature. Materials and methods: A search was conducted in six databases looking for studies which evaluated reliability, validity, sensitivity to changes, or clinical utility of the tests employed to assess lower limb MC. The articles were assessed and the data of their psychometric properties were extracted by two researchers, independently. Results: The search returned 1361 studies, 1,325 were excluded after analyses. The hand search yielded four eligible articles, totaling nine included articles. The included studies evaluated the psychometric properties of eight tests, but only three were specific to assess lower limb MC and the others were sub-items of other scales, which assess other domains. None of the tests provided data for all of the basic psychometric properties. Final remarks: According to the results of this review, none of the tests had their basic psychometric properties reported, which is necessary to be investigated in future studies. This review may facilitate the search and selection of lower limb MC tests by researchers and clinicians.

Introduction: Stroke (CVA) is a multifactorial disease, where the combination of risk factors may be associated with and contribute to its development. Objectives: The objective of this study was to evaluate the prevalence of risk factors for stroke in the physically independent elderly in the city of Londrina, Brazil. Materials and methods: This study was composed of the elderly individuals participating in the EELO project (Age and Ageing Study, Londrina, State of Paraná, Brazil). In order to identify the risk factors for stroke, one used a structured questionnaire with information about socio-demographic and anthropometric data as well as lifestyle variables, such as physical inactivity and smoking, presence of comorbidities, and laboratory tests for diagnosis of diabetes and dyslipidemia. Results: The study included 454 elderly with mean age of 69.7 years. There was a significant relationship between the number of risk factors and gender (p = 0.01), with higher prevalence among women. In separate analysis, the elderly between 60 and 69 years had a higher incidence of obesity (p = 0.03) and dyslipidemia (p = 0.04). Regarding gender, obesity (p = 0.01), smoking (p = 0.0001), vascular disease (p = 0.0001) and heart disease in the family (p = 0.01) higher incidence was shown in females, according to Chi Square’s test. Conclusions: It is concluded that elderly people aged less than 70 years and older women were those with the highest number of risk factors for CVA. Therefore, it may be suggested the development of primary care programs in order to promote information on the prevention of these risk factors and thus reduce the occurrence of stroke.

Introduction: Knees osteoarthritis (OA) is a complex degenerative disease with intra-articular changes affecting the amplitude of the quadriceps angle (Q). To measure this variable, it is necessary to use reliable protocols aiming at methodological reproducibility. The objective was to evaluate the intra-examiner and inter-examiner reliability of clinical and radiographic measures of the Q angle and to investigate the 1 Study developed at Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM) and Santa Casa de Caridade. Diamantina, MG - Brazil. Financial Support: FAPEMIG and CNPq relationship between the degree of OA and the magnitude of this angle in the elderly. Materials and methods: 23 volunteers had the Q angle measured by two evaluators at 48-h interval. Clinical measurements were collected by using the universal goniometer in the same position adopted in the radiographic examination. Results: The intra-examiner reliability was good (0.722 to 0.763) for radiographic measurements and low (0.518 to 0.574) for clinical assessment, while inter-examiner reliability was moderate (0.634) for radiographic measurements and low (0.499) to the clinics. The correlation analysis between the radiographic values with the OA classification showed no correlation between them (p = 0.824 and r = -0.024). Conclusion: Clinically, it is suggested that the radiographic examination is preferable to evaluate the Q angle of elderly women with knee osteoarthritis. Moreover, the magnitude of this angle did not correlate with the degree of impairment of OA in this population.

Introduction: Physical exercise programs have been suggested to soften or reverse balance deficits and postural deviation. Objective: This study investigated the influence of a systematic aquatic exercise program on body balance. Method: Healthy young adult volunteers of both genders, aged 18–30 years were assessed. The experimental group (EG, n = 20) was subjected to 24 sessions of aquatic exercises of 50 minutes long, performed three times a week, and the control group (CG, n = 25) suffered no intervention. A 3-D force platform was used to calculate the center of pressure displacement (COP) in anteroposterior and mid-lateral directions with or without visual information. The individuals were assessed in pre or post-training. Results: The results demonstrated a decrease in body oscillation in both visual conditions, with post-training values lower than pre-training ones. Visual information was not expressive for EG post-training. Conclusion: It was concluded that the program was effective for body balance improvement.

Introduction: There are several stretching techniques that help increase flexibility, however, there are still questions regarding which method leads to the most effective gains. Objectives: To assess and compare the effects of two stretching techniques, namely proprioceptive neuromuscular facilitation (PNF) and static stretching on the flexibility of hamstring muscles of young women. Methods: The study sample consisted of 45 young women, mean age 20.45 (± 1.66),assigned to one of three groups: static stretching group (SSG, n = 15), proprioceptive neuromuscular facilitation group (PNFG, n = 15) and control group (CG, n = 15). Both SSG and PNFG carried out three weekly stretching sessions over a four-week period. The sit and reach and popliteal angle tests were used at the beginning and end of the intervention. Normally distributed data were analyzed using Student’s t-test, whereas data with non-normal distribution were analyzed using the Wilcoxon test, to compare initial and end measurements for each technique. Finally, we used the Mann-Whitney U test to compare both techniques with each other. A significance level of 5% (p < 0.05) adopted. Results: There was a significant increase in hamstring flexibility when analyzing the assessments and reassessments of both stretching protocols. Conclusions: Both techniques were effective in increasing hamstring flexibility and there were no significant differences to indicate which one is better in increasing the flexibility of this muscle group.

Introduction: Partial body weight support (BWS) systems have been employed for gait training of children with cerebral palsy (CP). Therefore, it would be important to analyze if the type of walking surface and the amount of body weight unloading over lower limbs change the way these children walk. Objectives: Investigate the influence of walking surface and amount of body weight unloading on the spatial temporal characteristics during walking of children with CP. Materials and methods: Seven children with spastic CP between four and eight years old and GMFCS (Gross Motor Function Classification System) between I and IV, were videotaped walking with 0%, 15% and 30% of BWS on both dynamic (treadmill) and static (ground level) surfaces. Walking spatial temporal variables were calculated. Results: Children walked with similar velocity in all experimental conditions. While stance duration decreased as the percentage of BWS development and, consequently, promotes more autonomy. Biped walking is an acquired motor action (4, 5) and, although it seems a simple motor action, it requires the control of many elements, that transform it on a complex motor action. Walking acquisition is one of the main goal of intervention programs for children with CP. Gait impairment in children with CP are due, mainly, to spasticity or abnormal muscular tonus, motor control diminished and poor balance (6), and in many cases, those children are not able to generate sufficient muscular force to maintain upright posture and ambulate around. In this way, a strategy that could promote upright posture maintenance andhelp in the balance of those children would be body weight unloading on the lower limb during the locomotion. This strategy is named body weight support or partial body weight support (BWS), and it increased, no differences were found for stance and swing periods and cadence. Children walked with longer steps and strides and with faster strides on static surface compared to dynamic surface. Conclusion: Children with CP presenting different levels of motor impairment presented some alterations in the spatial temporal walking parameters as they walked with body unloading. However, such alterations might be due mainly to the type of walking surface than the percentage of body weight unloading on lower limbs.

Introduction: It is expected that a child will acquire control of posture (CP) of the head and upper limbs in a gradual, sequential and organized way. However, there is still no consensus regarding the best position to achieve this; the evidence suggests that it is prone. Objective: To investigate whether age and inclination of the supporting surface in the prone position influence the alignment of the head and upper limbs of children with typical motor development (TMD) and atypical motor development (AMD). Methods: The study included 29 children aged between one and three months divided according to the Alberta Infant Motor Scale (AIMS) into groups with TMD (n = 18) and AMD (n = 11). The children were placed in the prone position with three angles of the support surface (0°, 25° and 45°). Kinematic analysis was conducted to evaluate the alignment angles of the head and upper limbs. Results: Children with TMD had higher head alignment. There was no difference in the upper limbs’ alignment between the group with TMD and the group with AMD. In the third month of age compared with the first, increased head alignment and decreased upper limb alignment were found in both groups. The inclination of the supporting surface did not influence the alignment of the head and upper limbs. Conclusions: Among the positions evaluated, the prone position without inclination of the supporting surface was more appropriate for weight discharge in the upper limbs, favoring the development of postural control of the child.

Introduction: This research is based on the results of the surgeries of tenorraphy, which have been improved due to the association between strong and not voluminous sutures and physiotherapic protocols, which preconize the early active motion to the postoperative period. Objective: To evaluate the healing process in vivo in different types of tenorraphies. Methods: Thirty-six rabbits that underwent early active motion after tenorraphy. The sample was constituted of 3 groups of 12, in accordance with the 3 different types of suture (Brasil, Indiana and Tsai). Results: On the 15th and 30th days after the surgery, thermographic and histological analyses revealed similar results that all groups showed similar behaviors in the same time of surgical repair, just differentiating between the periods. On the 30th day analysis were observed that collagen fibers being more exuberant thickening, thus being able to offer higher tensile strength to the tendon. Conclusion: That suggests early active motion may be increased gradually to around the 30th day taking this as clinical relevance.

Introdução: Força muscular de membros inferiores (MMII) diminuída associa-se à limitação da capacidade funcional; entretanto, existem poucas evidências sobre a repercussão direta da fraqueza muscular periférica sobre tarefas de equilíbrio, bem como com o prognóstico de mortalidade nos pacientes com doença pulmonar obstrutiva crônica (DPOC). Objetivos: Verificar se há relação da força isométrica de MMII com Índice BODE e equilíbrio funcional de pacientes com DPOC em reabilitação pulmonar (RP), além de investigar se esses pacientes apresentam fraqueza muscular, e se tal característica é capaz de influenciar nessas variáveis. Materiais e métodos: Trata-se de um estudo transversal, onde avaliou-se 24 pacientes (idade > 50 anos) de ambos os gêneros, com DPOC moderada a muito grave (VEF1 = 44 (31 - 62,8)% previsto), por meio de: modified Medical Research Council (mMRC), Teste de Caminhada de 6 minutos (TC6), Índice BODE, Teste Timed “Up and Go” (TUG), Escala de Equilíbrio de Berg (EEB), Dynamic Gait Index (DGI) e Teste de Força Isométrica de Extensores de Joelho (ExtJ) e Abdutores de Quadril (AbdQ). Resultados: Na amostra estudada, 54% dos pacientes apresentaram fraqueza muscular em ExtJ, com correlações moderadas da força de MMII com Índice BODE (AbdQ = -0,58) e mMRC (ExtJ = -0,48; AbdQ = -0,49). Foram encontradas diferenças para DPTC6 e mMRC quando a força dos ExtJ foi classificada em normal ou diminuída. Conclusão: A força de AbdQ está associada ao prognóstico de mortalidade e a força de MMII está associada à sintomatologia em pacientes com DPOC em RP. Embora a força de MMII apresente impacto negativo na capacidade funcional e na dispneia, os pacientes desse estudo mantiveram preservado o equilíbrio e mobilidade funcional.

Introdução: A redução da massa magra corpórea (MMC) é um fator independente de mortalidade em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) e a literatura mostra que exercícios físicos aumentam a MMC. Objetivo: Identificar fatores associados à melhora da composição corporal em indivíduos com DPOC após treinamento físico de alta intensidade. Métodos: 37 pacientes com DPOC (19 H; 66 ± 7 anos; IMC = 27 ± 6 kg/m²; VEF1 = 38 ± 16 %pred) foram avaliados segundo sua composição corporal, função pulmonar, força muscular respiratória e periférica, capacidade funcional de exercício (teste de caminhada dos seis minutos, TC6M), nível de atividade física diária (DynaPort®), sensação subjetiva de dispneia (escala Medical Research Council) e qualidade de vida (Saint George Respiratory Questionnaire). O treinamento conteve exercícios de endurance e força muscular (3 vezes por semana por três meses). Após três meses, os pacientes foram reavaliados. Aqueles que apresentaram incremento de MMC incorporaram à estatística. Resultados: No pré-treinamento, a MMC se correlacionou significativamente (p ≤ 0,05) com gasto energético total (r = 0,57), TC6M em %predito (r = 0,46), pressão expiratória máxima (PEmax) (r = 0,57), volume expiratório forçado no primeiro segundo em %predito (r = 0,47), força muscular de quadríceps femoral (r = 0,54), bíceps (r = 0,62) e tríceps braquial (r = 0,63). Contudo, o incremento da MMC após treinamento correlacionou-se significativamente somente com a melhora das escalas MRC (r = 0,4; p = 0,05) e PEmax (r = 0,35; p = 0,04). Conclusão: Apesar de a MMC de pacientes com DPOC estar relacionada com a capacidade funcional de exercício, força muscular respiratória e periférica, obstrução pulmonar e gasto energético no pré-tratamento, a melhora da composição corporal está relacionada somente ao incremento da força muscular expiratória e sensação de dispneia após treinamento físico de alta intensidade.

Introduction: Studies have demonstrated beneficial effects of exercise in patients with chronic kidney disease, however, based on current scientific literature, more research is needed to increase evidence level of potential effects of physical activity for this population. Objective: To evaluate effects of physical therapy based on the supervised exercise practice on functional capacity and life quality of patients with chronic kidney disease. Material and methods: This quasi-experimental study, with repeated measures design, was conducted in the ambulatory of physical therapy, in a public hospital, located in a city of the state of Pará (north region of Brazil). Functional capacity and life quality were assessed at baseline and after six weeks of aerobic and resistance training performed three times per week on alternate days with hemodialysis. Results: Eight patients (3M / 5F) with a mean age of 60.38 years (SD = 14.75) were evaluated. There was significant increase of 24% in distance walked in six minute walk test (p = 0.007), and of 47% in number of repetitions during sit-to-stand test (p = 0.002); there was also significant improvement in emotional role (p = 0.043) of life quality assessed with SF36 questionnaire. Conclusion: There was a positive impact of only six weeks of rehabilitation with physical exercise on functional capacity and emotional role of life quality of patients with chronic kidney disease.

Introduction: Approximately 80% of patients with chronic kidney disease complain about sleep disorders, which is a much higher percentage than in the general population. Excessive daytime sleepiness is the third most frequent complaint in these patients, and it is significantly associated with a higher risk of sleep apnea. The aim of this study was to assess the presence of daytime sleepiness in patients with end stage renal disease (ESRD) who were undergoing diurnal hemodialysis. Materials and methods: The Epworth Sleepiness Scale (ESS) was applied to patients with ESRD who underwent diurnal hemodialysis in the Centro de Nefrologia da Zona Norte in Sao Paulo, Brazil. Results: A total of 168 patients were included in the study. According to the ESS, 31% presented with a mild propensity to sleep, 22% with a moderate propensity, and 17% with a severe propensity. Conclusion: Our study concluded that 70% of the sample of patients with ESRD who were undergoing hemodialysis presented with a propensity to sleep in inappropriate circumstances on the ESS. When excessive daytime sleepiness is associated with sleep apnea and other comorbidities, it is essential to carefully assess patients’ complaints.

Introduction: Low-level lasers have been suggested as a complement to lymphedema treatment. However, this therapy’s mechanism of action and its effects are poorly understood up to the present. Objective: To conduct a systematic literature review to analyze the effects of low-level laser in the treatment of upper-limb lymphedema in women submitted to breast cancer surgery. Material and methods: Randomized clinical trials were included, in Portuguese, English and Spanish, from January 1990 to July 2013. The article search was carried out in the Pubmed, Lilacs and PEDro electronic databases, with the following descriptors: Terapia a Laser de Baixa Intensidade, Linfedema, Câncer de Mama, Low-level laser therapy, Lymphedema, Breast Neoplasms and also through a manual search. Results and discussion: Low-level lasers have been used for treating several acute and chronic conditions. However, its application for managing post breast cancer surgery is still recent, often based on empirical evidence. Treating upper-limb lymphedema with low-level laser presented positive results, with reduction in the circumference or volume of the affected limb. Conclusion: More studies of high methodological quality are needed in order to better understand the mechanism of action of low-level laser on the lymphatic system and its effects on lymphedema treatement.

Introduction: The International Continence Society (ICS) determines that the pelvic floor muscles training (PFMT) is the first-choice treatment of urinary symptoms in women. Objective: The aim of this study was to systematize randomized controlled clinical trials that address the effects of PFMT in the treatment of urinary symptoms in older women using objective outcome measures. Method: Systematic review search was performed eletronic the following databases: Medline, Pubmed, Lilacs, PEDro and manual research conducted in the references of the studies. Were considered eligible women aged over 60 years who performed PFMT in isolation, without the involvement of another technique. The PFMT performed in clinic or at home, with or without the supervision of a therapist and with or without the use of biofeedback as an adjunct. Considered as outcome measures urodynamic studies, voiding diary that assesses daytime urinary frequency, nocturnal urinary frequency, urinary incontinence and exchange absorbent, and, finally, the absorbent test that quantifies loss urinary grams. The assessment of methodological quality of the studies was conducted by PEDro scale. Results: Three studies were reviewed in full. Only one trial was rated high methodological quality. There was significant improvement in urinary symptoms after treatment proposed in the three selected studies. Conclusion: Considering the studies available so far are weak the evidence for the use of PFMT in the treatment of urinary symptoms in elderly women.