Techniques for Registration of Myoelectric Activity of Women's Pelvic Floor Muscles: A Scoping Review

INTRODUCTION AND HYPOTHESIS

Surface electromyography is commonly applied to measure the electrophysiological activity of the neuromuscular system. However, there is no consensus regarding the best protocol to assess pelvic floor muscles.

METHODS

A scoping literature review was carried out in six databases, using MeSH descriptors. It included studies with electromyographic assessment in adult women presenting or not with pelvic floor dysfunction. The results were presented in categories to contribute to the development of a protocol considering the most used parameters for non-invasive assessment of myoelectric activity of pelvic floor muscles.

RESULTS

A total of 1,074 articles were identified, and 146 studies were selected for analysis. The intravaginal probe was used in 80.8% of the studies, the bipolar sensor with metallic plates placed on both sides of the vagina was the most frequent (71.3%), with a reference electrode positioned on the anterior superior iliac spine (33.5%). The supine position with hip and knee flexed (45.2%) was the most frequent position used. Of the studies, 44.5% normalized the data by maximum voluntary contraction (MVC) whereas 44.5% performed an average of 3 MVCs.

CONCLUSIONS

The most frequently used protocol for the pelvic floor is the bipolar intracavitary probe with metal plates positioned at 3-9 o'clock and introduced distally to the vaginal introitus with the volunteer in the supine position and the hip and knee flexed with the reference placed on the anterior-superior iliac spine.

Oral health quality of life is associated to jaw function and depression in patients with myogenous temporomandibular dysfunction

OBJECTIVE

To determine which factors influence and better differentiate between good and poor oral health-related quality of life (OHRQoL) in patients with myogenous TMD and which cut-off could predict a good/poor OHRQoL.

METHODS

Fifty-eight women with myogenous TMD were included. Factors of interest were collected (i.e., demographic variables, depression symptoms (Symptom Checklist-90 R (RDC/TMD)), pain intensity (Visual Analog Scale), jaw function (Mandibular Functional Limitation Questionnaire), and OHRQoL (Oral Health Impact Profile-14). A multivariable regression model, logistic regression, and receiver operating curve (ROC) analyses were conducted.

RESULTS

Depression symptoms (β = 0.139) and jaw function (β = 0.478) were significantly associated with OHRQoL in the multivariable model. The best model to discriminate between good/poor OHRQoL included only jaw function (AUC = 0.90), with the best cut-off of 17 points (sensitivity: 0.93; specificity: 0.79).

CONCLUSION

Depression symptoms and jaw function were significantly associated with OHRQoL. The best model and cut-off to discriminate good/poor OHRQoL included only jaw function.

What are the best parameters of low-level laser therapy to reduce pain intensity and improve mandibular function in orofacial pain? A systematic review and meta-analysis

PURPOSE

To determine the effectiveness of laser therapy for managing patients with orofacial pain (OFP). In addition, to determine which parameters provide the best treatment effects to reduce pain, improve function, and quality of life in adults with OFP.

METHODS

Systematic review. Searches were conducted in six databases; no date or language restrictions were applied. Studies involving adults with OFP treated with laser therapy were included. The risk of bias (RoB) was performed with the Revised Cochrane RoB-2. A meta-analysis was structured around the OFP type, and outcomes. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessed the overall certainty of the evidence.

RESULTS

Eighty-nine studies were included. Most studies (n = 72, 80.9%) were considered to have a high RoB. The results showed that laser therapy was better than placebo in improving pain, maximal mouth open (MMO), protrusion, and tenderness at the final assessment, but with a low or moderate level of evidence. The best lasers and parameters to reduce pain are diode or gallium-aluminum-arsenide (GaAlAs) lasers, a wavelength of 400-800 or 800-1500 nm, and dosage of <25 J/cm2.

CONCLUSIONS

Laser therapy was better than placebo to improve pain, MMO, protrusion, and tenderness. Also, it was better than occlusal splint to improve pain, but not better than TENS and medication.Implications for rehabilitationLaser therapy was found to be good in improving pain, maximal mouth opening, jaw protrusion, and tenderness at the end of the treatment.For patients with all types of temporomandibular disorders (TMDs) (myogenous, arthrogenous, and mixed), the following lasers and parameters are recommended: diode or gallium-aluminum-arsenide (GaAlAs) laser, wavelength of 400-800 or 800-1500 nm, and a dosage <25 J/cm2.For patients with arthrogenous TMDs, the following lasers and parameters are recommended: Diode laser and a wavelength between 400 and 800 nm.For patients with myogenous TMDs, the following lasers and parameters are recommended: diode laser, wavelength between 800 and 1500 nm, and dosage of <25 J/cm2.For patients with mixed TMDs, the following lasers and parameters are recommended: diode, GaAlAs, or infrared laser, a wavelength of 800-1500 nm, a dosage >100 J/cm2, and an application time between 15 and 30 s or >60 seconds.

Linking assessment instruments for brachial plexus injury to the international classification of functioning, disability and health

BACKGROUND

Brachial plexus injuries (BPI) affect not only body structure and function, but also several aspects of individual's well-being. Considering the crescent need for assessing such patients through a biopsychosocial perspective, linking meaningful concepts of BPI instruments to the International Classification of Functioning, Disability and Health (ICF) provides a useful overview of how the ICF components are contemplated on the current measurements available.

PURPOSE

To identify patient-reported outcome measures (PROMs) specifically designed for BPI assessment and link the content with the ICF.

STUDY DESIGN

Content Analysis through ICF linking.

METHODS

The study was conducted in two steps: the first one encompassed a literature review to identify questionnaires specifically designed for assessing patients with BPI, where two PROMs were eligible: the Brachial Assessment Tool (BrAT) and the Impact of Brachial Plexus Injury Questionnaire (IBPIQ); in the second phase, the items of such instruments were linked to the ICF by two independent reviewers, in accordance to the methodology proposed by Cieza et al.

RESULTS

54 different significant concepts were identified from the 74 questionnaire items and linked to 49 distinct ICF categories. The categories were mostly related to the activities and participation component (56.9%, n = 29), followed by body functions (27.45%, n = 14), body structures (9.8%, n = 5) and environmental factors component (1.96%, n = 1).

CONCLUSION

The questionnaires developed for adults with BPI were BrAT and IBPIQ. Although both instruments presented with a diverse coverage of ICF components, their content had a major focus on activities and participation domain and poorly or did not addressed environmental factors. Thus, other instruments could be considered in a complementary way for clinical assessment.

The accuracy of computerized biophotogrammetry in diagnosing changes in the cervical spine and its reliability for the cervical lordosis angle

BACKGROUND

Accuracy studies of biophotogrammetry protocols require standardization similar to radiography.

OBJECTIVE

To estimate the diagnostic accuracy of a biophotogrammetric assessment protocol for cervical hyperlordosis, compared to radiography, and its intra- and inter-examiner reliability for measuring the cervical lordosis angle.

METHODS

A study of diagnostic accuracy in women complaining of cervical pain. Two photos were taken using the CorelDraw biophotogrammetric protocol and one radiograph using the Cobb C1-C7 method. The Intra- and Inter-examiner reliability was calculated using the Kappa index and the intraclass correlation coefficient (ICC). The Bland-Altman plot and the ROC curve were presented.

RESULTS

The sample consisted of 19 women. The accuracy of biophotogrammetry was 94.73% and the reliability between biophotogrammetry and radiography presented an ICC of 0.84 and a Kappa of 0.87. The excellent intra (ICC = 0.94) and inter-examiner (ICC = 0.86) reliability of the biophotogrammetry was confirmed. The area under the ROC curve was 93.5%. The Bland-Altman plot indicated differences between the two instruments close to the mean (1.5∘).

CONCLUSION

The biophotogrammetric protocol proved to be accurate in diagnosing cervical hyperlordosis, with excellent reliability between the biophotogrammetric and radiographic assessments. It also demonstrated excellent intra- and inter-examiner reliability in measuring the cervical lordosis angle.

Release of CGRP in vivo from rat dura mater: Influence of capsaicin and topiramate

Introduction Migraine is a disease that stands out for its high prevalence with changes in the nervous system, abnormal levels of neurotransmitters, neuromodulators, and neuropeptides. The main mechanisms of action of capsaicin are chemical induction through the activation of TRPV1 channels, allowing calcium influx into neurons in the trigeminal ganglion of the dura mater, activating mast cell degranulation, releasing pro-inflammatory (e.g., histamine, oxide nitric) and vasoactive (e.g., CGRP and substance P) substances. For treatment, classes of drugs are used to act on blood vessels and to prevent vasodilation, as well as depolarization of sensory fibers of the dura mater. Objectives To better understand sterile inflammation after exposing the dura mater bilaterally, we created an experimental model to study mechanisms of action of topiramate and capsaicin in mast cell degranulation and release of CGRP in a rat skull preparation in vivo using anesthetized animals. Methods Thirty-five Wistar rats were used, divided into two groups of chronic topiramate (GTC) treated with 20mg/kg/day, gavage/10 days, and acute topiramate (GTA) in situ in the dura mater (10-3M). The animals were anesthetized and cranial windows between the coronal and lambda sutures in the hemicraniums were performed with a drill to expose the dura mater bilaterally. 10-3M capsaicin was placed on the right side and synthetic interstitial fluid on the left side and exposed to contact for 10 minutes to a small cotton ball soaked with the respective solutions so that there is no leakage of the treatment, and posteriorly kept in the freezer (-20°C) for later quantification of CGRP. The percentage of degranulated mast cells was quantified after removal of the dura mater by staining it with toluidine blue. A commercial enzyme immunoassay quantified the release of CGRP from the cranial dura mater... (Too see the complet abstract, please, check out the PDF.)

Ventilation asymmetry, diaphragmatic mobility and exercise capacity in men with traumatic brachial plexus injury

OBJECTIVE

To investigate the repercussions of traumatic brachial plexus injury (TBPI) on diaphragmatic mobility and exercise capacity, compartmental volume changes, as well as volume contribution of each hemithorax and ventilation asymmetry during different respiratory maneuvers, and compare with healthy individuals. The velocity of shortening of the diaphragm, inspiratory, and expiratory muscles were also assessed.

PARTICIPANTS

The cross-sectional study was conducted with 40 male individuals (20 with TBPI who have not undergone nerve transfer surgery [mean age 30.1 ± 5.3] and 20 healthy paired by age and body mass index). Only patients with C8-T1 root avulsion were studied.

MAIN OUTCOME

Compartmental and hemithoracic volumes, as well as asymmetry between the affected and unaffected sides were assessed using optoelectronic plethysmography. The 6 minute walking test was performed to evaluate exercise capacity, while diaphragm mobility was assessed during quiet breathing (QB) using an ultrasound device.

RESULTS

TBPI patients with mean lesion time of 174 ± 45.24 days showed a decreased pulmonary function, respiratory muscle strength, exercise capacity, and diaphragm mobility (all p < .001) compared with healthy. The pulmonary ribcage compartment of the affected side was the main contributor to the reduction in volume during inspiratory capacity, vital capacity, and inspiratory load imposition (all p < .05). This compartment also exhibited a higher ventilation asymmetry with reduced shortening velocity of the inspiratory ribcage muscles.

CONCLUSION

Compared with healthy, TBPI patients who have not undergone nerve transfer surgery present low exercise capacity and diaphragmatic mobility, as well as reduced volume of the upper ribcage compartment on the affected side that leads to reduced shortening velocity and ventilation asymmetry.

Assessment of balance and functional capacity in fibromyalgia patients with and without migraine

ObjectiveTo evaluate the balance and functional capacity of fibromyalgia patients’ with and without migraine.MethodsObservational study with 60 women, between 20 and 60 years old (47±9 years), who were allocated into the following groups: 1. fibromyalgia and migraine (n=49); 2. only fibromyalgia (n=11). The following were used: Migraine Disability Assessment Test (MIDAS) to analyze the impact of migraine on quality of life; Revised Fibromyalgia Impact Questionnaire (FIQ-R) to assess the impact of fibromyalgia; six-minute walk test (6MWT)to assess functional capacity and Berg Balance Scale (BBE) for balance analysis.ResultsThere was no difference between groups 1 and 2 regarding functional capacity (TC6M: 308.7 m ±107.33 vs. 298.8 m ±153.54; p=0.55) and balance (BBE: 48± 14 vs. 47±16; p=0.68) as well as the impact on quality of life (FIQ: 78.8±14.77 vs. 74.4±13.99; p=0.28 and MIDAS: 31 ±24).ConclusionsOur study showed that there was no difference in functional capacity, balance and quality of life in fibromyalgia patients compared to patients with fibromyalgia associated with migraine.

The presence of migraine symptoms was associated with a higher likelihood to present eating disorders symptoms among teenage students

OBJECTIVE

To investigate the association between migraine and signs and symptoms of eating disorders among teenagers. And as secondary objectives: to investigate the prevalence of eating disorders signs and symptoms and to identify the prevalence of migraine among teenagers.

METHODS

Cross-sectional study was carried out in public schools which included adolescents aged 11-18 years, of both sexes. For eating disorders evaluation two self-reported questionnaires were used: Eating Attitudes Test-26 (EAT-26) and The Bulimic Investigatory Test of Edinburg (BITE). The presence and characterization of headache were verified following the International Classification of Headache Disorders (ICHD-II).

RESULTS

607 adolescents (388 females) with mean age of 13.9 years (95% CI: 13.7; 14) were included. The eating disorders symptoms based on EAT-26 (p = 0.041) and the bulimia nervosa symptoms (p = 0.014) evaluation were more prevalent among teenagers with migraine compared with non-migraine. Also, in multivariate analysis, the adjusted odds ratio (OR) to present bulimia nervosa symptoms is 1.85 times higher among females than males. And, the adjusted OR to present bulimia nervosa symptoms among teenagers with migraine is 1.51 times (OR) higher than among non-migraine.

CONCLUSIONS

The presence of migraine symptoms were associated with a higher likelihood to present eating disorders symptoms among teenagers, especially in females, that was associated with a 1.85-fold increase in the risk to present bulimia nervosa symptoms.

LEVEL OF EVIDENCE

III, Evidence obtained from cross-sectional study.

Proprioceptive neuromuscular facilitation training reduces pain and disability in individuals with chronic low back pain: A systematic review and meta-analysis

BACKGROUND

and purpose: Although proprioceptive neuromuscular facilitation (PNF) exercises are used in rehabilitation practice, their effects in patients with low back pain (LBP) remain unclear. This study aimed to investigate the efficacy of PNF training for pain and disability in patients with LBP.

METHODS

In this systematic review, we searched five databases from the earliest date available to October 2020. Three comparisons were performed: PNF versus control, PNF versus core strengthening, and PNF versus conventional physical therapy.

RESULTS

Sixteen studies met the eligibility criteria (722 patients). PNF training improved pain (standardized mean difference [SMD]: -2.6; 95% confidence interval [CI]: -4.2 to -0.9, n = 174) and disability (SMD: -3.29; 95% CI: -5.3 to -1.3, n = 144) compared to the control. PNF training also yielded a greater benefit for pain reduction (mean difference [MD]: -1.8, 95% CI: -2.2 to -0.3, n = 177) and disability improvement (MD: -6.6, 95% CI: -9.3 to -3.8, n = 113) than did core strengthening.

CONCLUSION

PNF training seems to be a useful strategy for decreasing pain and improving disability in patients with LBP. However, the quality of evidence for the outcomes of both pain and disability was low to moderate.

Neck and back muscle chains hypomobility in women with migraine

OBJECTIVE

To compare the mobility of neck and back flexor and extensor muscle chains in women with migraine, chronic migraine and headache-free.

METHODS

This is a cross-sectional study. The muscle chain test was performed based on the theoretical assumptions of the Busquet method, in women with migraine (MG, n = 24), chronic migraine (CMG, n = 36) and headache-free (CG, n = 27). The evaluation of neck and back mobility was performed by an examiner expert in the Busquet method with the aid of cervical range of motion (CROM®) device (neck muscles) and the Tiltmeter® application (back muscles).

RESULTS

Compared to woman headache-free, women with migraine (MD = -12° [CI95% = -19°, -5°] and chronic migraine (MD = -15° [CI95% = -21°, -8°] present reduced mobility in the neck extensor muscle chain. Also, in the back extensor muscle chain, migraine vs headache-free (MD = -9° [CI95% = -15°, -2°]) and chronic migraine vs headache-free (MD = -10° [CI95% = -16°, -4°]) and in the back flexor muscle chain, migraine vs headache-free (MD = -6° [CI95% = -10°, -0.1°]) and chronic migraine vs headache-free (MD = -7 [CI95% = -11°, -2°]), with an effect sizes varying between 1.19 e 2.38. No difference was found between groups for neck flexor muscle chain.

CONCLUSION

Women with migraine and chronic migraine have hypomobility of the neck and back extensor muscle chains, and of the back flexor chain.

Headache catastrophization and its relationship with disability, depression, anxiety, stress and sleep quality

IntroductionCross-sectional studies on headache have not yet explored the influence of pain catastrophizing and associations with other psychosomatic comorbidities. The migraine-affected group of individuals was frequently associated with other clinical conditions such as depression, anxiety, stress, and poor sleep quality. These conditions exert a significant influence on carrier’s coping with daily pain and helplessness, since disability hampers work and daily living activities and overly burden individual, their family, society and the health system. Identifying the elements that contribute to disability is crucial in assisting interventions that minimize these conditions.ObjectiveThe aim of this cross-sectional study was to evaluate how the combination of migraine and catastrophizing, associated with functional disability, depression, anxiety, stress, and sleep quality in college students, can influence the perception of pain.MethodsThe 340 participants were selected by drawing lots, in which individuals with primary headaches were assigned. Therefore, the final analysis sample consisted of 288 individuals. The sample was divided into Group with migraine and Group with other primary headaches, with the application of scales: HIT-6 and the scale of pain catastrophizing.ResultsOf the 360 participants, 20 losses were recorded due to inadequate completion of scales, leaving out 340 participants. Of these, 52/340 (15.25%) did not suffer from headaches. 288/340 (84.7%) participants that reported headaches were included in this study, of which 133/288 (46.2%) had migraine, and 155/288 (53.8%) had non-migraine headache. Women who had migraine attacks were those with the most intense anxious symptoms, worse sleep quality, and catastrophization. The odds ratio of catastrophizing was higher for the Migraine Group. Linear and multivariate logistic regression revealed that the greater the presence of catastrophizing, the greater the occurrence of migraine. Catastrophizing had a greater power of contribution related to the disability generated by the crises in the group of migrainous (β = 0.564). The migraine group has a greater perception of pain.ConclusionHigher catastrophization was also associated with a greater intensity of depressive and anxiety symptoms, higher perceived stress, and worse quality of sleep in headache-affected individuals in our study.

Is it possible to sort the disability of individuals with migraine based on the International Classification of Functioning, Disability and Health? — A Scoping Review

PurposeTo identify the most frequent outcomes related to disability assessed in individuals with migraine and to correlate these findings with the categories of International Classification of Functioning, Disability and Health.Material and methodThis scoping review was developed based on studies with adult population (18-55 years) of both sexes and assessing the disability generated by migraine. We included studies in which patients had a diagnosis of migraine based on International Classification of Headache Disorders.Results52 articles were found with 42 outcomes related to 17 categories of International Classification of Functioning, Disability and Health, including the four main components of the classification, with seven categories in "Body Functions", one in "Body Structures", four in “Activities and Participation” and five in "Environmental Factors".ConclusionThe findings show that disabilities, activity limitation, or participation restriction generated by migraine can be classified by International Classification of Functioning, Disability and Health. The components "body functions", "environmental factors" and "activities and participation" were the most identified in the present study. Thus, this classification is important to classify the disability caused by migraine and to guide a rehabilitation more focused onthe patient's real demands, as well as directing the research involving this population.

Immediate effect of a motor control exercise target to the neck muscles on upper cervical range of motion and motor control in patients with temporomandibular disorder

ObjectiveTo evaluate whether a single specific motor control training session for the neck flexor and deep extensor muscles improves upper cervical range of motion and neck motor control in patients with temporomandibular disorder (TMD) and compare them to a group without TMD. MethodsThis is a before and after, controlled study. The TMD group included women aged between 18-45 years old, complaining of pain in the orofacial region in the last 6 months and diagnosed with masticatory myofascial pain according to Research Diagnostic Criteria (RDC/MD). The control group included match-controls without TMD. The participants were evaluated to global and upper (Flexion Rotation Test - FRT) neck range of motion (ROM) and to neck motor control (Cranio-Cervical Flexion Test - CCFT). They were treated with a protocol of specific motor control exercises targeted to flexor and extensor neck muscles for 30 minutes. One day after the protocol the patients were reevaluated. ResultsA total of 23 volunteers were evaluated. The TMD group showed immediate improvement in left cervical rotation (p=0.043) and right FRT (p=0.036), while the control group did not show any improvement. There was no difference between the groups before and after treatment in relation to cervical movements. Regarding cervical motor control in both groups, the highest prevalence was of results between 24 and 26 mmHg after treatment, different from before the intervention (20 and 22 mmHg) in both groups.ConclusionA single session of specific neck motor control training only improved the left cervical rotation and upper right rotation in the TMD group, but not in the control group. There is no difference at the end of treatment between the groups. Volunteers with TMD showed improvement in the pattern of motor control of the neck when compared to volunteers without TMD.

Persistent idiopathic facial pain associated with borderline personality disorder: a case report

IntroductionBorderline personality disorder may be associated with persistent facial pain since its relationship with different pain syndromes has been reported. Persistent idiopathic facial pain is commonly unilateral, pulsating, burning, or profound and challenging for clinicians. Therefore, excluding underlying organic causes by appropriate clinical investigation and complementary tests is essential to diagnose this disease.Objective This case report aimed to provide evidence of the relationship between idiopathic persistent facial pain and borderline personality disorder.Case report A 24-year-old woman reported severe pain in the left hemiface for ten months, three to six hours per day, five days per week. No abnormalities were found in dental and neurological assessments. A psychiatric evaluation was performed, and the patient met the criteria for borderline personality disorder. Pharmacological treatment consisted of daily lithium carbonate (900 mg) and venlafaxine (150 mg). Weekly sessions of cognitive-behavioral therapy with emotional regulation and tolerance to stress were performed. The patient was evaluated every 30 days and showed improved pain intensity and frequency over six months. Conclusion Proper management of borderline personality disorder can modify the evolution of persistent idiopathic facial pain when both pathologies are comorbidities.

Physical therapeutic treatment for traumatic brachial plexus injury in adults: A scoping review

Traumatic brachial plexus injury (BPI) is one of the most disabling injuries of the upper extremity, often requiring specialized treatment and a prolonged rehabilitation period. This scoping review was carried out to identify and describe the physical therapy modalities applied in the rehabilitation of adult individuals with BPI. Electronic databases, gray literature, and reference lists were searched, and studies meeting the following eligibility criteria were included: (a) interventions including any physical therapy modality; (b) individuals age ≥18 years old; and (c) a clinical diagnosis of BPI. The literature search yielded 681 articles of which 49 met the inclusion criteria and had their outcomes, treatment parameters, and the differences between conservative and pre- and postoperative treatment phases analyzed. The most commonly used physical therapy interventions were in the subfields of kinesiotherapy (ie, involving range of motion exercises, muscle stretching, and strengthening), electrothermal and phototherapy, manual therapy, and sensory re-education strategies. Although several physical therapy modalities were identified for the treatment of BPI in this scoping review, the combination of low levels of evidence and the identified gaps regarding the treatment parameters challenge the reproducibility of such treatments in clinical practice. Therefore, future controlled clinical trials with clearer treatment protocols for individuals with BPI are needed.

Ponytail headache (external-traction headache): prevalence, characteristics and relationship with migraine

IntroductionDespite its frequent occurrence, external-traction headache (previously named as “ponytail headache”) is scarcely documented in the literature.ObjectiveIn the present study we set out to estimate the prevalence of ponytail headache and its relationship with migraine.MethodsOne hundred and thirty women (27.7±11.1 years of age), 108 of them reported a previous history of primary headache [81/130 (62.3%) migraine or probable migraine and 27/130 (20.8%) non-migraine headache; 22/130 (16.9%) did not report any previous episode of headache], were requested to wear a ponytail for 60 minutes, removing it only in case of pain. When pain occurred, it was recorded for the latency between the placement of the ponytail and the onset of the pain, its duration and characteristics. The women also filled out a questionnaire on previous headache episodes.ResultsDuring the 60 minute-period, 52/130 (40%) women had ponytail headache elicited by the experiment. There was a higher prevalence of ponytail headache in those who reported previous episodes of primary headache [48/108 (44.4%)], compared to those who did not [4/22 (18.2%)] (p=0.022). The migraineurs had more ponytail headache than non-migraneurs [39/81 (48.2%) versus 9/27 (33.3%), p=0.180] with a positive history of primary headache and they also had more than those without [4/22 (18.2%)] (p=0.012). The group of women with migraine also presented more ponytail-induced headache than non-migraineurs combined with the groupof individuals without a previous history of headache [13/49 (26.5%), OR 2.57, 95%CI 1.19-5.55; p=0.015]. Migraine-like episodes were trigged in 3/52 (5.8%) by the experiment, all three migraineurs. The latency time for the beginning of ponytail headache during the experiment was 21.5 ± 15.4 min and the duration was 76.0±159.3 min.ConclusionThe prevalence of ponytail headache in our study was 40% and was statistically higher in migraineurs.

Techniques for registration of myoelectric activity of women's pelvic floor muscles: a scoping review protocol

OBJECTIVE

The objective of this review is to identify the most frequently used protocols for analyzing the myoelectric activity of the pelvic floor muscles during surface electromyography in women aged 18 years or older.

INTRODUCTION

Surface electromyography is normally used in assessment and treatment for research purposes when it is intended to quantitatively measure the electrophysiological behavior of the neuromuscular system. However, although there are internationally standardized, non-invasive assessment protocols for most muscle groups, there is no consensus for pelvic floor muscles, which makes it difficult to standardize in scientific research and clinical applicability.

INCLUSION CRITERIA

Studies that explore registration protocols and filtering parameters of surface electromyographic signals in women aged over 18 years old with or without pelvic floor dysfunction will be considered. Studies encompassing either electromyographic biofeedback as a treatment resource only or electroneuromyography (needle electrode) will be excluded.

METHODS

Primary studies published in the previous 10 years in MEDLINE, Embase, Scopus, Web of Science, CINAHL, and Cochrane Central databases will be included. The search will encompass descriptors registered in MeSH. The identified articles will be assessed for eligibility by two independent reviewers in three stages: evaluation by title, abstract, and full text. If there is any disagreement, a third reviewer will be consulted. Data will be extracted and organized in standardized spreadsheets. The results will be assigned to categories in order to facilitate the organization of a protocol with the most commonly used parameters for non-invasive assessment of myoelectric activity of pelvic floor muscles.

MRI in migraineurs: are there abnormalities in the area where the myofascial trigger points are palpable and in volume measurements?

INTRODUCTION

Patients with migraine may present a higher quantity of myofascial trigger points (MTrP) and alterations in the cervical muscles when compared to non-migraineurs. The magnetic resonance imaging (MRI) is a robust method for the study of human soft tissues and could be useful to investigate these points.

OBJECTIVES

To identify the presence of MTrP in the descending fibers of the trapezius muscle in women with migraine and to quantify the muscle volume by MRI, correlating it with the headache characteristics.

METHODS

A cross-sectional analytic study was conducted among 14 women, eight in migraine group, and six in without migraine group. The presence of MTrP was evaluated using Simons' criteria, and linolenic acid capsules subsequently marked the areas. MRI was performed with 1.5T, T1-weighted sequence, and T2 in the axial, sagittal, and coronal planes. The T1-weighted sequences were performed with and without gadolinium contrast.

RESULTS

The T1-weighted image analysis with and without gadolinium did not show any signal alteration in the MTrP areas in both groups. The migraine group presented more MTrP in the trapezius muscle (MD [95%CI] = 1[1; 3]; MD [95%CI] = 1[0; 2] right and left side, respectively), and a smaller muscle volume (MD [95%CI] = -198.1[-338.7;-25.6], MD [95%CI] = -149.9[-325.05;-0.13] right and left side, respectively) than non-migraineurs. The migraine frequency presented a negative strong correlation with the trapezius volumes (r = -0.812; p = 0.014).

CONCLUSION

Migraineurs present more MTrP and a smaller muscle volume than non-migraineurs. The trapezius volume is negatively correlated with migraine frequency. MRI is not a suitable outcome measure for assessing MTrP.

Proprioceptive neuromuscular facilitation compared to conventional physiotherapy for adults with traumatic upper brachial plexus injury: A protocol for a randomized clinical trial

BACKGROUND

Traumatic upper plexus injury affects daily living activities performance and participation of individuals. Physical therapy treatment has a fundamental role on functional recovery, but it is still an unexplored and challenging field.

AIM

To develop a protocol to evaluate the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) compared to conventional physiotherapy (CPT group) on functionality and quality of life.

METHODS

A committee was formed by four physical therapists to develop the treatment protocol. A Delphi study was carried out in order to quantify the level of agreement. A protocol for a randomized controlled trial was proposed to evaluate the effectiveness of the protocol in improving functionality and quality of life, according Consolidated Standards of Reporting Trials. Participants will be randomly assigned (1:1) to PNF or CPT group and two weekly sessions will be carried out for 12 months postsurgery, with a three-month follow-up. The main outcome measurements are: upper limb functionality, quality of life, range of motion, muscle strength, tactile sensitivity, and pain, which will be assessed at baseline, on the 6th, 9th, and 12th months postsurgery.

RESULT

A PNF protocol was developed for traumatic upper brachial plexus injury, consisting of 11 illustrated exercises, three for immediate postoperative and eight for postoperative. Biomechanical objectives, observations, positions of patients and therapists and PNF principles, procedures and techniques have been described. An 80% agreement on all items in the first round of the Delphi study was achieved.

CONCLUSION

A protocol based on the PNF-concept was developed with the aim of improving the functionality and quality of life of individuals undergoing nerve transfer after traumatic injury to the upper plexus. The detailed description of a physical therapy treatment protocol through an appropriate method will allow its use in clinical practice and in future studies with this population.

Main symptoms associated to the catastrophizing in women with fibromyalgia and migraine

ObjectiveTo evaluate the main symptoms associated catastrophizing in women with fibromyalgia and migraine.MethodologyWe conducted an observational study with 26 women diagnosed with both fibromyalgia and migraine, aged between 30 and 60 years (46±8 years). The Pain Catastrophizing Scale was applied as a cut-of point =30, dividing the volunteers in groups with (n=18) and without catastrophizing (n=8). We assessed the quality of sleep (Pittsburgh sleep quality index), the presence of depression and anxiety (Becks depression and anxiety inventories), the quality of life perception (Fibromyalgia impact questionnaire-revised), the disability due to migraine (Migraine disability assessment) and the level of physical activity (International physical activity questionnaire).ResultsThe time of fibromyalgia did not difer (p=0.80) between the group with (8.54±4.88) and without catastrophizing (10.04±3.47). The Fibromyalgia impact questionnaire-revised scores were significantly higher (p=0.01) among women with catastrophizing (78±12.6) than those without (56.6±22.3). There was no diference between the groups (p>0.05) in relation to the other outcomes evaluated.ConclusionThe presence of catastrophizing in women with fibromyalgia and migraine are associated with a worse perception of quality of life. a worse perception of quality of life.

Associação entre sintomas depressivos e disfunção sexual em homens com lesão medular traumática

Introdução: A lesão medular acarreta em perda da independência funcional, autonomia e status social. Essa enorme mudança contribui para o aparecimento dos sintomas depressivos nessa população. Objetivo: Avaliar os sintomas depressivos e disfunção sexual em homens com lesão medular traumática, analisando a associação entre eles. Métodos: Estudo observacional, realizado com 44 homens com lesão medular traumática, idade entre 18 e 60 anos, tempo de lesão superior a um ano e vida sexual ativa. O grau de comprometimento neurológico foi avaliado através da versão revisada em 2011 da ASIA Impairment Scale, os sintomas depressivos através do Inventário de Depressão de Beck e a função sexual através do Índice Internacional de Função Erétil. Foram aplicadas técnicas de estatística descritiva e análise bivariada para verificar associação, utilizando um nível de significância de 0,05. Resultados: Os voluntários possuíam média de idade de 34,1 anos, e tempo médio de lesão de 7,7 anos. Todos os indivíduos da amostra tinham nível de lesão acima do segmento medular L2, sendo as incompletas as mais frequentes (68,2%). O tempo médio da última relação sexual foi de 56,5 dias e a frequência semanal de relação sexual foi a mais relatada (65,9%). Da amostra, apenas 17,6% tinham sintomas depressivos, sendo 6,8% com disforia e 6,8% apresentando sintomas leves a moderados. Não foi encontrada associação entre sintomas depressivos e disfunção sexual, exceto para o domínio da disfunção de satisfação geral (p=0,02). Conclusão: Não existe associação entre sintomas depressivos e disfunção sexual em homens com lesão medular crônica.

ICF categories compromised in Migraine

Objective: To identify which categories of the International Classification of Functioning, Disability, and Health (ICF) are compromised in patients with migraine from the perspective of health professionals. Methods: This is a cross-sectional study conducted at the headache outpatient clinic of the Clinical Hospital of Pernambuco, Oswaldo Cruz University Hospital and at the Motor Learning and Control Laboratory of the Federal University of Pernambuco. A five-section printed and online questionnaire based on ICF checkList 2.1 was used. Health professionals from different specialities who had experience in treating patients with migraine were invited. Professionals were instructed to complete the questionnaire and to choose, based on their clinical experience, which categories had the highest degree of impairment or the highest relationship with the clinical condition of migraine patients. A cut-off point of 70% for approval of categories was considered. Results: Sixteen professionals were enrolled in the survey. The questionnaire was compost by 106 categories, of which 32 reached the cutoff point of 70% to be considered approved. Among these categories, seven (21.8%) are part of the body functions component, five (15.6%) body structures, thirteen (40.6%) activities, and participation and seven (21.8%). of environmental factors. Conclusion: In the perception of health professionals, individuals with migraine present impairment in all domains of the ICF and the activity and participation domains presented the highest number of compromised categories.

Functionality changes of migraine women

Objective: Identification of changes in functionality of women with migraine according to the International Classification of Functioning, Disability, and Health (ICF). Method: This is a qualitative study conducted in the format of focus group interviews, which included women between 18 and 55 years old diagnosed with migraine based on the criteria of the International Headache Society. The women were divided into groups with averages of two to four people and, guided by a moderator, they were encouraged to talk about the influence of migraine on performing the tasks to which they are exposed daily, taking into account the environment in which they are inserted. The categories that reached the 30% agreement cutoff point in the groups were approved. Results: There were 10 rounds of interviews, each with a focus group with an average of two to four people, totaling 29 women with a mean age of 35 years old (95% CI: 18 - 51). Eighteen categories were approved, four in the Body Function domain, four in the Body Structure domain, six categories in the Activity and Participation domain and four categories in the Environmental Factors domain. Conclusion: Women with migraine perceive lteration in functionality in all ICF domains, with the Activities and Participation domain presenting the most mentioned categories.

Estratégias terapêuticas na função sexual de homens com lesão medular traumática

Introdução: Repercussões estruturais e fisiológicas são causadas após a lesão medular e, dependendo da extensão e localização da lesão, a resposta sexual será alterada. Movidos pelo conhecimento sociocultural e dificuldade de satisfação na relação sexual, muitos indivíduos recorrem a estratégias alternativas para tratamento das disfunções. Objetivos: Conhecer as principais estratégias terapêuticas utilizadas por homens com lesão medular traumática nas disfunções sexuais. Métodos: Trata-se de um estudo observacional descritivo, realizado com 24 homens com média de idade de 32,62 (IC 28,65 – 36,60), com lesão medular traumática, recrutados em serviços de referência em lesão medular na cidade do Recife (PE). Os indivíduos passaram por avaliação neurológica de acordo com as diretrizes da International Standards for Neurological Examination and Functional Classification of Spinal Cord Injury (ISNCSCI), a American Spinal Injury Association (ASIA), avaliação da função sexual através do Índice Internacional de Função Erétil (IIFE) e responderam a um formulário semiestruturado para identificar as estratégias terapêuticas utilizadas na função sexual. Para a coleta de informações acerca das plantas medicinais, foi feita uma pesquisa nos entornos dos mercados públicos localizados na Região Metropolitana do Recife (PE). Resultados: As estratégias terapêuticas utilizadas foram: uso de plantas medicinais (25%) e uso drogas inibidoras da fosfodiesterase tipo 5 (33,3%). Das plantas medicinais, as mais utilizadas foram Catuaba - Trichilia catigua (33,3%), Guaraná- Paullinia cupana (33,3%), Maca Peruana Lepidium meyenii (33,3%) e Tríbulus Terrestris (33,3%). Considerações finais: As principais estratégias terapêuticas utilizadas pelos participantes foram plantas medicinais e uso drogas inibidoras da fosfodiesterase tipo 5.Palavras-chave: Traumatismo da Medula Espinhal. Sexualidade. Terapias Complementares. Plantas medicinais.ClinicalTrials.gov  ID: NCT02908867

Efficacy of proprioceptive neuromuscular facilitation compared to other stretching modalities in range of motion gain in young healthy adults: A systematic review

The objective of this study was to evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) on range of motion (ROM) gain in young healthy adults. We performed a systematic review of randomized controlled trials and quasi-randomized trials, including young healthy adults. The interventions were: PNF compared with different PNF techniques, control, other muscle stretching exercises and musculoskeletal manipulations. The outcome measures were: articular ROM and adverse effects. The final number of included studies was 46, involving 1,864 adults. There was difference on ROM comparing assisted hold-relax (HR) on diagonal plane to control, based on very low-quality evidence. There was also difference on ROM comparing assisted HR to self-HR; self-contract-relax (CR) to control; assisted CR contract to control; and assisted HR contract to control, based on low-quality evidence. Moderate-quality evidence shows that results differ between self HR and control (SMD: 0.95; 95%CI 0.03, 1.86; I²49%; P = 0.16) in terms of ROM gain. When performing the other comparisons, the results were based on low or very low-quality evidence and do not allow to state if PNF is more or less effective than other stretches for improving ROM in healthy young adults. No adverse effects were mentioned.

Catastrofização e migrânea: uma reflexão sobre o enfrentamento da dor

Os fatores psicológicos assumem função importante no equilíbrio e controle de situações que geram sofrimento para os indivíduos, especificamente aquelas ligadas à dor, e são reconhecidos por contribuir para o seu agravamento. Neste contexto, a catastrofização é um conjunto de pensamentos negativos em resposta à dor. Em pacientes que sofrem com a migrânea, a catastrofização pode gerar reflexos negativos para o controle e enfrentamento da dor, potencializando as crises. Objetivo: identificar o estado da arte das publicações científicas sobre a relação entre a catastrofização e migrânea.Métodos: trata-se de uma revisão integrativa da literatura, a partir da busca de artigos nas bases de dados. Na base do LILACS foram utilizados os descritores do DeCS: "cefaleia", "transtornos de enxaqueca" e "catastrofização". Nas bases Pubmed, SCOPUS e Web of Science foram utilizados os descritores do MeSH: "headache", "headache disorders primary", "Migraine disorders" e "Catastrophization". No Cinahl foram utilizados os DeCS "Headache", "headache migraine" e "headache disorder". Como critérios de elegibilidade foram selecionados todas as categorias de artigo original, revisão de literatura, reflexão, atualização, relato de experiência, estudos com indivíduos na faixa etária de 18 a 50 anos, com diagnóstico de migrânea e com sintomas de catastrofização da dor. Resultados: em um universo de 106 artigos, foram selecionados quatro que atenderam aos critérios de inclusão. Os resultados dos estudos mostram que a catastrofização da dor associada a crises de migrânea, potencializa a percepção da gravidade da mesma, colaborando para sentimentos deincapacidade para sair da crise, assim como aumento da sensação de desamparo e desespero que dificultamo controleda dor. Conclusão: indivíduos migranosos que apresentam catastrofização da dor percebem as crises de maneira mais intensa e incapacitante, o que gera impacto negativo e exerce implicações nocivas para a sua qualidade de vida.

The role of physiotherapy in headache treatment: literature review

The intolerance to movements, neck disability and changes in pericranial muscles are aspects that can affect during migraine attacks. The presence of these findings allowed the physiotherapy to be an alternative therapeutic modality for the headache. Thus, the structural and behavioral disorders can promote muscle changes in the biomechanics of the head and neck, as well as limitations in the cervical mobility of patients with headache, which can be treated by different physiotherapy modalities. The aim of this study was to review the relevant publications on the role of physiotherapy in the treatment of headache, in order to support and direct the non-pharmacological treatment of these patients. A literature survey, between September/2015 and May/2016, was done on the basis of MEDLINE/PubMed, LILACS and Cochrane Central Register of Controlled Trials - CENTRAL, looking for randomized and quasi-randomized controlled trials on the subject. The MeSH/DeCS descriptors were: 'headache', 'physical therapy modalities,' and their equivalents in English. We identified 589 articles, of which 19 were included, according to the eligibility criteria. According to the evaluated studies results, physiotherapy promotes improvement of headache, associated symptoms and musculoskeletal disorders related. The modalities used are postural correction, spinal mobilization, muscle stretching, relaxation techniques, massage, active or passive exercises and others. Due to the low methodological quality of most of these studies, it is important to conduct new randomized controlled trials, based on the ICHD diagnostic criteria, using protocols described in more detail and reproducible way, including the assessment of adverse effects.

Relationship between functionality and level of physical activity of women with fibromyalgia and migraine

Objective: Evaluate the relationship between functionality and level of physical activity in women with fibromyalgia and migraine. Methods: An observational study was conducted with 22 women diagnosed with fibromyalgia and migraine. To evaluate the functionality, we used the function domain of the fibromyalgia impact questionnaire - revised version (FIQR). For the classification of the level of physical activity were used the short version of the International Physical Activity Questionnaire (IPAQ) and the classification of the Brazilian Society of Cardiology (SBC) based on oxygen consumption (VO2 max), by ergospirometry. Migraine Disability Assessment Test - MIDAS was used to assess the degree of disability of headache. Results: Participants were women with a mean age of 46 ± 7 years, whose first episode of headache occurred since childhood age to the young-adult stage. Women classified as active (n = 4), physically active (n = 14) and sedentary (n = 4) by IPAQ, all were considered sedentary by SBC (n = 22). No difference between the level of function and level of physical activity among patients in this study, which can be explained by the small sample size was observed. Conclusion: This study was not able to see the difference between physical activity level and functionality.entillness or worsening of the individual's health status.

Effect of low frequency transcutaneous electrical nerve stimulation of TE5 (waiguan) and PC6 (neiguan) acupoints on cold-induced pain

[Purpose] This study assesse the effect of low frequency transcutaneous electrical nerve stimulation (TENS) of theTE5 (waiguan) and PC6 (neiguan) acupoints on cold-induced pain. [Subjects and Methods] Forty-eight subjects were divided by convenience into three groups: TENS with electrodes of 1 cm(2) area, TENS with electrodes of area 15 cm(2) and a placebo group. The study consisted of three phases: cold-induced pain without electroanalgesia, cold-induced pain with electroanalgesia or placebo, and cold-induced pain post-electroanalgesia or placebo. [Results] Acupuncture like TENS increased the pain threshold latency during treatment (45.7 ± 11.7s) compared to pre-treatment (30.9 ± 8.9s) in the TENS group with 1 cm(2) electrodes. In the TENS group with 15 cm(2) electrodes, the pain threshold latency increased at post-treatment (36.2 ± 12.9s) compared to pre-treatment (25.5 ± 7.4s). The placebo group showed no significant changes. The group with 1 cm(2) electrodes showed a significantly higher pain threshold latency (45.7 ± 11.7s) than the other two groups. At post-treatment, the pain threshold latencies of both the 1 cm(2) (39.4 ± 11.5s) and 15 cm(2) (36.2 ± 12.9s) TENS group were higher than that of the placebo group (22.4 ± 7.4s). [Conclusion] Acupuncture like TENS applied to PC6 and TE5 acupoints increased the pain threshold latency. The pain intensity was reduced by TENS with an electrode area of 1 cm(2).

Caricature and headache

The authors comment on the use of caricature to represent a migraine sufferer and show a caricature of a woman with migraine drawn by an artist from Goiânia, Goias State, Brazil.

Relation between primary headache and restriction of cervical range of motion: a pilot study

Introduction: Headache is the most common neurological symptom across the world. The presence of this alteration promotes different effects on the biomechanics of cervical muscles, which may limit cervical mobility and also bring damage to patients suffering with headache. Objective: Evaluate the relation between the presence of primary headache and cervical range of motion restriction. Methods: Pilot study conducted by using a sample of 33 subjects aged between 20 and 38 years (26 ± 5 years). To evaluate active cervical mobility, universal goniometer was used. The degree of cervical dysfunction was assessed by Neck Disability Index questionnaire. To sort the primary headache were used criteria established by the International Classification of Headache Disorders (ICHD-III beta version, 2013). Results: There was no statistical difference between the groups in relation to gender and last headache crisis. The cervical mobility differs between groups with headache and healthy, but this was not statistically significant. There were also differences between the headache and the healthy group regarding to the Neck Disability Index (NDI). Conclusion: The study does not demonstrate a difference between the cervical mobility in patients with primary headache compared to healthy subjects.

Impact of primary headache on quality of life in military policemen and its relation to common mental disorder

Objective: To determine the impact caused by primary headache on quality of life in military policemen of Recife and its relation to the presence of common mental disorders. Methods: This is a transversal study with 211 active policemen, aged between 20 and 50 years (33.0 ± 7.7 years). The presence of headache was evaluated by using a questionnaire based on ICHD-II, in the last three months. To evaluate the impact of the headache it was used the Headache Impact Test-6. The indicative of probable case of common mental disorder was done by the Self Reporting Questionnaire-20. Pain intensity was measured using a numeric pain rating scale. Results: 142/211 officers (67.3%) had headache in the last three months. 57/142 (40.1%) were placed in the most severe category in HIT-6. Common mental disorders were observed in 82/142 (57.7%). There was a significant correlation between the intensity of pain reported by the subjects and the score obtained in HIT-6 (r2=0.2466; p<0.0001), as well as between the intensity of pain and the score found in the SRQ-20 (r2=0.0887; p<0.0003). The ten officers who reported to have never had an episode of headache in their lifetime had neither symptoms of mental distress nor were dissatisfied with their work activity. Conclusion: The presence of headache in the military policemen of Recife, in the last three months, caused a negative impact on their quality of life, as well as, a higher indicative of non-psychotic psychiatric morbidity in these individuals.

Cross-cultural adaptation of the Brazilian Portuguese version of Quality of Life Headache-Youth (QLH-Y) Questionnaire

Objectives: To translate into Portuguese, culturally adaptand validate the Quality of Life Headache - Youth (QLH-Y),assessing its reliability through internal consistency of its itemsin a sample of adolescents of both sexes, attending publicschools in the city of Recife. Methods: The originalinstrument was translated from English into Portuguese,generating a synthetic consensus. The Portuguese version ofthe instrument was back translated, and then developed apre-final version for a field test. After the suitability of theinstrument into Portuguese was conducted a pilot study with100 students. Results: The findings of the internal consistencyof the Brazilian version were very good, with the alpha valueof 0.906 (greater than 0.7) indicating a degree high internalconsistency. Conclusion: The Portuguese version of QLH -Y has an excellent internal consistency and a goodunderstanding of its items for cross-cultural adaptation inthe city of Recife

Are cervical muscles involved in migraine and tension-type headache pathogenesis? A review

Migraine and tension-type headache (TTH) physiopathology is still unclear and controversial. According to researches, there is an association between these primary headaches and musculoskeletal dysfunctions of deep and superficial cervical flexor muscles. Therefore, it is possible to suspect that these structural and behavioral muscles dysfunction are associated with migraine and CTT pathogenesis, causing some changes in head and neck biomechanics, as well as limitations in cervical mobility. Thus, the need for more information required a review of more relevant studies to clarify the role of neck muscles in migraine and CTT pathogenesis, in order to support and direct the nonpharmacological treatment of patients with headache and muscular disorders. The Pubmed, Cochrane and Bireme databases were searched, between January/2012 and June/ 2013, using the keywords: 'migraine disorders', 'tension-type headache', 'neck muscles', 'ultrasound', 'electromyography'. The selection identified 73 articles, of which 8 were excluded according to the eligibility criteria. Evidences suggest the existence of a cause and effect relationship between cervical structures and migrainous and TTH pain, indicating that both peripheral and central mechanisms of sensitization are involved. However, most of these studies are based on experimental animal models, which have different painprocessing systems from humans. Furthermore, the methodological aspects decrease the strength of evidence found in their results.

Sintomatologia depressiva em adolescentes com cefaleia primária

Objetivo: Investigar a relação entre os sintomas depressivos e a cefaleia primária em adolescentes. Métodos: Foram avaliados 117 estudantes (68 meninas) de escolas da rede pública estadual na cidade de Recife, com idade variando entre 11 e 17 anos (14 ± 2 anos). Para classificar a cefaleia primária foram utilizados os critérios diagnósticos estabelecidos pela Sociedade Internacional de Cefaleia (ICHD-II) e para o rastreamento de sintomatologia depressiva foi utilizado o Inventário de Depressão Infantil. Resultados: Não houve associação estatística entre presença de sintomatologia depressiva e cefaleia no último mês em adolescentes com cefaleia [66/80 (82,5%)] quando comparados aos sem cefaleia [30/37 (81,1%)], p>0,05; χ2]. 68,4% da amostra referiu cefaleia no último mês, sendo 53/68 (77,9%) meninas e 27/49 (55,1%) meninos. A sintomatologia depressiva foi observada em 96/117 (82,1%) dos alunos [62/68 (91,2%) meninas e 34/49 (69,4%) meninos, p=0,003; χ2]. As meninas apresentaram maiores médias nos domínios problemas interpessoais p=0021; humor deprimido p=0,013; inefetividade p=0,024 e autoestima negativa p<0,001. Conclusão: Cefaleia primária e sintomas depressivos são frequentes entre os adolescentes estudados, porém não houve associação entre essas duas condições.

Cefaleia e arte: ex-voto como arte da devoção e gratidão

Neste artigo, os autores revisam o uso do ex-voto como uma forma de arte para expressar devoção e gratidão. Ex-voto pode ser manifestado como objetos ou pinturas, como uma forma de ação de graças por uma oração respondida ou benção recebida. Muitos santos são invocados quando se está lidando com dores de cabeça incapacitantes, como São Denis, Santo Acacius, Santa Gemma e Santa Teresa de Ávila, além do uso de objetos de arte, incluindo esculturas e pinturas, que são produzidos comercialmente como base dessas práticas religiosas.

Alodinia é mais frequente nos indivíduos com crises mais intensas de cefaleia e nas mulheres

Objetivo: Identificar a presença de alodinia em alunos com cefaleia primária de uma Instituição de Ensino Superior. Método: Foram avaliados 378 alunos (273 mulheres) com idade entre 18 e 45 anos (22 ± 5 anos). Foi utilizado um questionário sobre as características clínicas da cefaleia, baseado nos critérios da ICHD-II (2004), e um questionário para identificação e diferenciação da alodinia cefálica e extracefálica. Resultados: Na amostra estudada, 374/378 (98,9%) dos alunos apresentaram cefaleia ao longo da vida [271/273 (99,3%) mulheres e 103/105 (98,1%) homens, p = 0,309; χ2] e 334/378 (88,4%) queixaram-se de cefaleia nos últimos três meses [248/273 (90,8%) mulheres e 86/105 (81,9%) homens, p = 0,020; χ2]. Dos alunos com cefaleia nos últimos três meses 331/378 (87,6%) apresentaram alodinia [250/273 (91,6%) mulheres e 81/105 (77,1%) homens, p<0,001; χ2]. Houve associação entre a intensidade da cefaleia nos últimos três meses e a presença de alodinia [5/12 (41,7%) dos indivíduos com dor leve, 211/236 (89,4%) dor moderada e 83/86 (96,5%) dor intensa; p<0,001; χ2]. A alodinia cefálica foi mais frequente nas seguintes condições: pentear o cabelo (43,5%), rabo de cavalo (57,3%) nas mulheres; uso de óculos (33,7%), nos homens; uso de chapéu ou boné (53,6% mulheres e 59,3% homens), exposição ao frio (45,6% mulheres e 41,9% homens) e ao calor (56,9% mulheres e 50% homens). A alodinia extracefálica foi mais frequentemente desencadeada na exposição ao calor (60,9% mulheres e 59,3% homens) e ao frio (42,7 mulheres e 38,4% homens). Conclusão: Alodinia é mais frequente nas mulheres e em indivíduos durante crises mais intensas de cefaleia.

Avaliação da tendência da anteriorização da cabeça em adolescentes com cefaleia primária

Objetivo: Avaliar a relação entre a anteriorização de cabeça e cefaleias primárias em adolescentes. Métodos: O estudo foi realizado com 69 estudantes entre 10 e 19 anos (12,5 ± 1,7 anos). Os participantes foram divididos em três grupos: cefaleia tipo tensional (CTT), migrânea e sem cefaleia. Foi utilizado um questionário sobre as características clínicas da cefaleia, baseado nos critérios da ICHD II- 2004. Para avaliar a anteriorização de cabeça foram utilizados os ângulos crâniovertebral e o manúbrio-esternal. Resultados: Não houve diferença estatística entre os grupos em relação ao gênero p=0,68 (χ2) e a idade p=0,574 (teste de Mann-Whitney). Adolescentes com CTT apresentaram anteriorização da cabeça em relação aos controles sem cefaleia, em ambos os ângulos estudados [ângulo crânio-vertebral: CTT (50,7° ± 1,3°) vs. controle (50,9° ± 1,1°); p=0,915, Mann-Whitney] e ângulo manúbrio-esternal: [CTT (97,6° ± 1,7°) vs. controle (96,6° ± 1,9°); p=0,533, teste de Mann-Whitney]. O ângulo manúbrioesternal foi maior nos migranosos [sem cefaleia (96,6°±1,9°) vs. migranosos (100,3°±5,8°); p=0,724, Mann-Whitney]. Conclusão: nesse estudo não ficou evidente a correlação entre a anteriorização de cabeça com as cefaleias primárias em adolescentes.

Life quality, depression and anxiety symptoms in chronic post-traumatic headache after mild brain injury

Post-traumatic headache (PTH) is the most common symptom found in the post-traumatic syndrome, whose onset occurs within seven days of the trauma. The condition is characterized as acute when it persists for up to 3 months. PTH beyond this period is considered chronic.

Headache attributed to ingestion or inhalation of a cold stimulus (Abstract)

Thesis

Headache precipitated by Valsalva maneuvers in patients with congenital Chiari I malformation

The objective of this study was to characterize the headache precipitated by Valsalva maneuvers associated with Chiari type I malformation (CM-1). Nineteen patients were evaluated, with ages ranging from 30 to 75 years. Ten of them presented headache. Pain was more prevalent in the occipital (80%) and frontal region (60%). The headaches were of significantly shorter duration in the women compared with the men. The frequency of headache crises was relatively high. All patients with Valsalva-related headache suffered from at least one episode per month. The most prevalent precipitating factors were coughing, which is well described in the literature, and sexual activity, which only now is recognized as an event associated with CM-1.

Avaliação postural da coluna vertebral em escolares surdos de 7-21 anos

INTRODUÇÃO: A infância e a adolescência são períodos em que a prevenção e o tratamento de alterações posturais decorrentes do mau hábito postural e da sobrecarga biomecânica são mais eficazes, graças à maturação osteomuscular que ocorre nessas fases. OBJETIVOS: Detectar possíveis alterações posturais da coluna vertebral em escolares surdos de 7-21 anos no Centro de Reabilitação e Educação Especial Rotary Club Caruaru. METODOLOGIA: Trinta de dois escolares surdos participaram de uma entrevista sobre dados referentes ao período de instalação e tipo de surdez, dados biológicos, antropométricos e de hábitos posturais, e foram submetidos a uma avaliação postural de acordo com critérios propostos pela literatura. Os dados foram analisados de modo descritivo e a associação entre as variáveis utilizou o teste Qui-Quadrado ou suas variações, por meio do programa SPSS® versão 11.5. RESULTADOS: Os resultados mostraram que a prevalência de alterações posturais nos escolares surdos foi de 90,62% dos casos. A alteração postural mais frequente foi a hipercifose torácica, que esteve associada à dor nos escolares. Considerando a distribuição por sexo, a alteração postural do tipo escoliose mostrou-se associada ao sexo feminino. CONCLUSÃO: A elevada prevalência de alterações posturais nos escolares surdos no nosso estudo sugere que a surdez pode representar um fator importante no desenvolvimento de alterações posturais. Entretanto, existe a necessidade de novos estudos que investiguem uma possível relação entre a surdez e fatores biológicos e ambientais em populações maiores de escolares.

Qualidade de vida das mães de crianças e adolescentes com paralisia cerebral

INTRODUÇÃO: A dependência funcional da criança com paralisia cerebral (PC) parece ocasionar uma sobrecarga física e emocional em seus familiares. OBJETIVO: O objetivo deste estudo foi avaliar a qualidade de vida das mães de crianças e adolescentes com PC atendidas nas clínicas de fisioterapia da rede privada de Caruaru, PE, e identificar possíveis variações de acordo com o grau de comprometimento motor e com a idade das crianças e adolescentes. METODOLOGIA: Participaram desse estudo 31 mães de crianças e adolescentes com PC, que responderam ao questionário WHOQOL-Bref. Em seguida, os pesquisadores avaliaram o nível de função motora grossa das crianças por meio do teste Gross Motor Function Classification System (GMFCS). RESULTADOS: Na análise descritiva dos dados, verificou-se que a maior parte da amostra apresentou comprometimento motor grave e idade entre 2-5 anos. Ao relacionar o grau de comprometimento motor com os domínios do questionário, observou-se que 60% das mães de crianças com comprometimento leve apresentavam uma percepção negativa do domínio físico. Quando o prejuízo motor foi moderado, a percepção da qualidade de vida materna no domínio meio ambiente foi negativa em 55,5% da amostra. E nas mães de crianças com comprometimento motor grave, observamos uma percepção positiva nos domínios físico (58,8%) e psicológico (76,3%), e negativa nos domínios de relações sociais e de meio ambiente (52,6%). CONCLUSÃO: A percepção da qualidade de vida de mães de crianças e adolescentes com PC na cidade de Caruaru encontra-se prejudicada, principalmente quando relacionada aos aspectos que compõem o domínio meio ambiente e das relações sociais.