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: The recovery of stroke patients is long and boring due to the repetitive nature of the exercises used and the length of treatment. Thus, we started using virtual reality as an alternative and, because of its advantages, health professionals are adapting video games for physical therapy. However, there are some limitations, such as the fact that games are designed for entertainment and not for therapeutic purposes. Objective: In order to mitigate gaps in assistive devices for physical therapy, this study describes the development and applicability of a computer support system for motor rehabilitation - Ikapp - in stroke victims. Methods: Twenty-seven stroke patients filled out a socioeconomic questionnaire, tested Ikapp during five minutes and answered a usability and satisfaction questionnaire about handling the tool. The chi-square test was used to analyze any association between sociodemographic factors and the features of the system. Results: The Ikapp system can be an excellent device to assist neurological rehabilitation of stroke patients, as participants questionnaires showed that 85.2% were satisfied in regard to motivation and inclusion of Ikapp in physiotherapy and 77.8% relative to ease of interaction with the tool. Conclusion: The Ikapp system proved to be an easy-to-use and accessible computer support system for patients with functional limitations.

BackgroundWe investigated whether transcranial magnetic stimulation (rTMS) over the primary somatosensory cortex (S1) and sensory stimulation (SS) could promote upper limb recovery in participants with subacute stroke.MethodsParticipants were randomized into four groups: rTMS/Sham SS, Sham rTMS/SS, rTMS/SS, and control group (Sham rTMS/Sham SS). Participants underwent ten sessions of sham or active rTMS over S1 (10 Hz, 1,500 pulses, 120% of resting motor threshold, 20 min), followed by sham or active SS. The SS involved active sensory training (exploring features of objects and graphesthesia, proprioception exercises), mirror therapy, and Transcutaneous electrical nerve stimulation (TENS) in the region of the median nerve in the wrist (stimulation intensity as the minimum intensity at which the participants reported paresthesia; five electrical pulses of 1 ms duration each at 10 Hz were delivered every second over 45 min). Sham stimulations occurred as follows: Sham rTMS, coil was held while disconnected from the stimulator, and rTMS noise was presented with computer loudspeakers with recorded sound from a real stimulation. The Sham SS received therapy in the unaffected upper limb, did not use the mirror and received TENS stimulation for only 60 seconds. The primary outcome was the Body Structure/Function: Fugl-Meyer Assessment (FMA) and Nottingham Sensory Assessment (NSA); the secondary outcome was the Activity/Participation domains, assessed with Box and Block Test, Motor Activity Log scale, Jebsen-Taylor Test, and Functional Independence Measure.ResultsForty participants with stroke ischemic (n = 38) and hemorrhagic (n = 2), men (n = 19) and women (n = 21), in the subacute stage (10.6 ± 6 weeks) had a mean age of 62.2 ± 9.6 years, were equally divided into four groups (10 participants in each group). Significant somatosensory improvements were found in participants receiving active rTMS and active SS, compared with those in the control group (sham rTMS with sham SS). Motor function improved only in participants who received active rTMS, with greater effects when active rTMS was combined with active SS.ConclusionThe combined use of SS with rTMS over S1 represents a more effective therapy for increasing sensory and motor recovery, as well as functional independence, in participants with subacute stroke.Clinical Trial Registration[clinicaltrials.gov], identifier [NCT03329807].

BackgroundThe ability to produce coordinated movement is dependent on dynamic interactions through transcallosal fibers between the two cerebral hemispheres of the brain. Although typically unilateral, stroke induces changes in functional and effective connectivity across hemispheres, which are related to sensorimotor impairment and stroke recovery. Previous studies have focused almost exclusively on interhemispheric interactions in the primary motor cortex (M1).ObjectiveTo identify the presence of interhemispheric asymmetry (ASY) of somatosensory cortex (S1) excitability and to investigate whether S1 repetitive transcranial magnetic stimulation (rTMS) combined with sensory stimulation (SS) changes excitability in S1 and M1, as well as S1 ASY, in individuals with subacute stroke.MethodsA randomized clinical trial. Participants with a single episode of stroke, in the subacute phase, between 35 and 75 years old, were allocated, randomly and equally balanced, to four groups: rTMS/sham SS, sham rTMS/SS, rTMS/SS, and sham rTMS/Sham SS. Participants underwent 10 sessions of S1 rTMS of the lesioned hemisphere (10 Hz, 1,500 pulses) followed by SS. SS was applied to the paretic upper limb (UL) (active SS) or non-paretic UL (sham SS). TMS-induced motor evoked potentials (MEPs) of the paretic UL and somatosensory evoked potential (SSEP) of both ULs assessed M1 and S1 cortical excitability, respectively. The S1 ASY index was measured before and after intervention. Evaluator, participants and the statistician were blinded.ResultsThirty-six participants divided equally into groups (nine participants per group). Seven patients were excluded from MEP analysis because of failure to produce consistent MEP. One participant was excluded in the SSEP analysis because no SSEP was detected. All somatosensory stimulation groups had decreased S1 ASY except for the sham rTMS/Sham SS group. When compared with baseline, M1 excitability increased only in the rTMS/SS group.ConclusionS1 rTMS and SS alone or in combination changed S1 excitability and decreased ASY, but it was only their combination that increased M1 excitability.Clinical trial registrationclinicaltrials.gov, identifier (NCT03329807).

A fisioterapia preconiza um atendimento individualizado, gradativo e, frequentemente, extenso. A repetição de exercícios aliada ao grande período de tratamento a que o paciente é submetido e os ganhos diários, geralmente ínfimos, são as principais causas da desmotivação do paciente e sua consequente evasão das clínicas de fisioterapia (MENDONÇA & GUERRA, 2004). Nesse contexto, o uso de Tecnologias Interativas (TIs) na saúde tem sido uma solução proposta para estimular maior engajamento do paciente ao processo de reabilitação por promover um ambiente de reabilitação mais rico e motivador (KESHNER, 2004;LITTMAN, 1999;SVEISTRUP, 2004 Motriz, Rio Claro, v.19 n.2, p.346-357, abr./jun. 2013 Artigo Original Desenvolvimento e aprimoramento de um sistema computacional-Ikapp-de suporte a reabilitação motora Resumo: A aplicabilidade das Tecnologias Interativas (TIs) na área de saúde, em particular na reabilitação motora, tem sido uma alternativa clínica usada com intuito de estimular maior engajamento do paciente ao seu processo de recuperação que por vezes é extenuante. O presente estudo descreve uma ferramenta tecnológica -Ikapp-de suporte a reabilitação motora. Ferramenta essa que busca ampliar as possibilidades dos dispositivos comerciais já existentes no contexto clínico. Sessenta (60) voluntários foram convidados a interagir com as interfaces do setup e do jogo do Ikapp com objetivo de examinar a funcionalidade, grau de aceitação, demandas e limitações para aprimoramentos. Os resultados do presente estudo demonstram altos índices de satisfação pelos participantes. Além disso, os resultados demonstraram que o Ikapp é uma ferramenta que agrega valores terapêuticos à ludicidade e motivação de acordo com a perspectiva dos participantes. Palavras-chave: Reabilitação. Interação usuário-computador. Tecnologia. Development and improvement of a computational system-Ikapp-to support motor rehabilitationAbstract: The applicability of Interactive Technologies (ITs) in the health area, especially in motor rehabilitation, has been a therapeutic alternative used aiming to encourage a greater patient engagement in their recovery process that is sometimes lengthy. The present study describes the technological tool (Ikapp) to support motor rehabilitation, which aims to expand the possibility of the commercial devices that is already used in clinical practice. Sixty (60) volunteers were invited to interact with the setup and game interfaces of Ikapp aiming to examine their features, the degree of acceptance, demands and limitations to the enhancement. The results of present study showed high levels of satisfaction for the participants. Furthermore, the results demonstrated that the Ikapp is a tool that adds value to therapeutic playfulness and motivation according to the participant' perspective.