Introduction: Dysmenorrhea is defined as colic pain in the hypogastrium that occurs during menstruation. In the literature, as far as we know, there are no studies that evaluate the functioning or deficiencies associated with primary dysmenorrhea (PD) in any age group. In addition, studies that address dysmenorrhea are restricted to adolescents or young adult women. Objective: This dissertation involves two studies that evaluated separately, the prevalence of primary dysmenorrhea and associated factors, and the association between primary dysmenorrhea and disability in adult women. Methodology: A cross-sectional study was carried out with adult women aged between 19 and 49 years. Sociodemographic, gynecological and obstetric aspects were investigated. Primary dysmenorrhea was measured using self-report; the Numerical Pain Rating Scale measured the intensity of pain; the World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) assessed disability; the International Physical Activity Questionnaire (IPAQ), short version, evaluated the level of physical activity. The statistical analysis involved descriptive and inferential analysis. In the inferential analysis, logistic regression test, median difference tests, effect size measures were used. The level of statistical significance established was p <0.05. Results: The study that assessed the prevalence of primary dysmenorrhea and associated factors, found a prevalence of PD of 55.9% for the entire sample. Prevalence of PD was 50% among young adults, 55% adults, and 61% for middle-aged women. Cesarean delivery was associated with greater chances of PD (p = 0.026) when considering the entire sample, and women between 25 and 39 years old, insufficiently active, had higher chances of PD (p = 0.040). In the study that analyzed the association between primary dysmenorrhea and disability, PD pain lasted an average of three days or more (66%) with average pain intensity, in the crisis period of 6.10 ± 2.57, on the numerical scale of pain. Serious painful complaints were associated with greater difficulties in the domains of mobility (p = 0.003; η2 = 0.115), participation (p = 0.030; η2 = 0.063) and total WHODAS score (p = 0.012; η2 = 0.086), with size of moderate effect for all variables. Conclusion: The present study found a high prevalence of PD among adult women, where cesarean section and insufficient physical activity were factors that were associated with a higher risk of developing PD. Dysmenorrhea was also associated with impairment in functioning, in which women with severe pain intensity have greater disabilities in the domains of mobility and participation when compared to women who presented mild or moderate pain.

The American College of Rheumatology (ACR) presented in 2010 a consensus for the diagnosis of fibromyalgia (FM). However, they can use an assessment and diagnosis guide as there are many cases of underdiagnosis or false diagnosis. This causes a lack of chemical, immunological markers or tests for FM detection. This project aims to use biospectroscopy (spectroscopy without infrared) and multivariate classification techniques as new technologies for the identification of FM, using only blood plasma as the material of analysis. This is a cross-sectional analytical study with 126 members divided into the Fibromyalgia group and the control group. For all subjects, a sociodemographic questionnaire was applied, collected clinical data on the impact of FM, investigated with pain intensity, anxiety levels, quality of life; as well as a collection of 10 ml of blood from each participant. Analysis of their blood plasma using attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy in conjunction with chemometric techniques, hence, providing a low-cost, fast and accurate diagnostic approach. Different chemometric algorithms were tested to classify the spectral data; genetic algorithm with linear discriminant analysis (GA-LDA) achieved the best diagnostic results with a sensitivity of 89.5% in an external test set. The GA-LDA model identified 24 spectral wavenumbers responsible for class separation; amongst these, the Amide II (1545 cm^-1) and proteins (1425 cm^-1) were identified to be discriminant features. Clinical data showed significant difference between groups in FIQ (p = 0.0001), anxiety (p = 0.001), pain (p = 0.0001) and quality of life (p = 0.0001). These results reinforce the potential of ATR-FTIR spectroscopy with multivariate analysis as a new tool to screen and detect patients with fibromyalgia in a fast, low-cost, non-destructive and minimally invasive fashion.

Introduction: Menopause at an early age increases the time of exposure to the negative effects of hypoestrogenism on the female aging process. It is well established that early menopause is associated with osteoporosis, chronic diseases and mortality. Although it is recognized that there is a greater decline in physical function in women after menopause, the association between early menopause and measures of physical function is not well established. Objective: To assess the association between early menopause and different measures of physical function and the importance of the socioeconomic context in this association. Methods: Systematic review of observational studies in the PubMed, Cochrane Library, SciELO, LILACS and Web of Science databases. Studies that assessed the association between early menopause and measures of physical function were included, with no restriction on the period of publication or language. To assess the methodological quality of the studies, the “Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies” was used. Results: Four studies were included, all cross-sectional, totalizing 13,846 participants, and that investigated five measures of physical function (handgrip strength, gait speed, stand balance, chair stands and self-reported functional limitation). The 4 studies evaluated populations from developed countries and only one also included samples from developing countries. All studies reported an association between some measure of physical function and premature (<40 years) or early (<45 years) menopause, whether natural or surgical. The measures that were associated with the age at menopause were the handgrip strength (found in 2 of the 3 studies that evaluated this measure), being between 2.58 kg (95% CI=0.74; 4.43) and 5.21 kg (2.18; 8.25) weaker among women with menopause <40 years; gait speed (found in 2 of the 3 studies that evaluated this measure) with results between 0.03 m/s (0.01; 0.06) and 0.06 m/s (0.02; 0.09) slower between those with menopause <40 and <45 years; and self-reported functional limitation (assessed in only one study), with women with menopause after 50 years of age presenting lower chances compared to those who had menopause <40 or <45 years (OR between 0.52 [95% CI=0.29; 0.95] and 0.61 [0.40; 0.95]). Two measures of physical function, the chair stands test and stand balance, were not significantly associated with age at menopause. Due to the great heterogeneity among the studies in relation to the classification of the menopausal age groups, it was not possible to perform the meta-analysis. Conclusion: There is some evidence of an association between menopause at younger ages and worse physical function. Women who experience menopause at younger ages should be screened earlier and more frequently for functional impairment and encouraged to participate in physical rehabilitation programs. Further studies are needed to explore the association between age at menopause and different measures of physical function using standardized measures for early menopause identification and longitudinal methodologies. In addition, further studies are needed to assess the influence of different socioeconomic contexts on functionality.

INTRODUCTION: Chronic low back pain is one of the main symptoms that leads to major disability worldwide. Several therapies are studied to reduce pain and improve function of people with chronic low back pain. The dry cupping is used to treat non-specific chronic low back pain. Recent systematic reviews on cupping therapy for people with chronic non-specific low back pain conclude that the existing literature has a high risk of bias and that high-quality studies are needed. OBJECTIVE: To evaluate the effectiveness of the dry cupping on pain, physical function, quality of life and psychological symptoms in individuals with non-specific chronic low back pain compared to a sham group. METHODS: This is a randomized, controlled, double-blind study with hidden allocation and intention to treat analysis. Ninety patients were allocated to two groups, experimental group and sham group. Interventions: The experimental group (n = 45) received dry cupping therapy, parallel to the L1 - L5 vertebrae, bilaterally. The control group (n = 45) received the same procedure, but with sham dry cupping therapy. The interventions were applied once a week, for 8 weeks, with a time of 10 minutes each section. Participants were assessed before and after the first session, after 4 and 8 weeks of intervention. The primary outocome was pain, evaluated by using the numerical pain intensity scale. Secondary outcomes were physical function (ODI), functional mobility (TUG), range of motion of the trunk, perception of the global effect (GPE), quality of life (SF-36) and psychological symptoms (HADS). RESULTS: There were no significant differences between groups for pain intensity at any time. There was a significant difference in favor of the control group for the perception of the global effect in four weeks [mean difference (MD) 1.2 points, confidence interval (CI) 95% 0.4 to 2.0; p = 0.001)] and eight weeks (MD 1.5 points, 95% CI 0.6 to 2.4; p <0.001) of treatment compared to the first intervention. There were no statistically significant differences for the other secondary outcomes. CONCLUSION: Treatment with dry cupping was not superior to the sham dry cupping for reducing pain or improving physical function, quality of life and psychological symptoms in people with chronic low back pain.

Objective: To investigate whether the 90-minute modified constraint induced movement therapy (mCIMT) is better than the intervention of occupational therapy and conventional physical therapy, both using the group approach, in the rehabilitation of the upper limbs in post-stroke patients and determine whether the combination of both therapies can produce motor improvements in these participants. Methods: A quasi-experimental study, consisting of a series of cases with repetitive measures, using the A1-B-A2 design. Location: Clínica Escola de Fisioterapia of the Faculty of Health Sciences of Trairí, Federal University of Rio Grande do Norte, Santa Cruz; Rio Grande do Norte, Brazil. Subjects: A total of 5 subjects diagnosed with stroke were selected for this study, divided into three phases: phase A1, group of mCIMT, phase B, follow-up and phase A2, group of conventional rehabilitation. Intervention: In phase A1, the participants performed two consecutive weeks of mCIMT for 90 minutes a day, two consecutive weeks, using all the principles of CIMT. In phase B, the participants were accompanied in the FACISA stroke ambulatory, for 10 months. In phase A2, 90 minutes of occupational therapy and conventional physical therapy were performed for two consecutive weeks. In all phases, they were carried out in a group format. As measurement measures, the Wolf Motor Function Test (WFTM), the Motor Ativity Log (MAL) and the Canadian Occupational Performance Measure (COPM) were performed. Such measures were administered in the pre-treatment, post-treatment and follow-up of 3 to 4 months, depending on the phase. Results: When comparing the two groups, a statistically significant difference was found only in the subscale Performance of COPM (p = 0.025) and favor of phase A1, with the power of medium effect (d '= 0.51) compared to the pre- test of phase A2, and in the subscale Satisfaction of COPM also in favor of phase A1, for the period and in favor of the follow-up of the same phase (p = 0.022) with the power of medium effect (d '= 0.52) ,. In the individual analysis, according to the WFTM Tempo scale, all participants reached the phase A1 post-test MDC, four participants reached the phase A1 pre-test and follow-up and phase A2 post-test, and three reached in the pre-test of phase A2. In the analysis of the WMFT EHF, all participants reached the MDC in all periods of both phases. Regarding the MAL scales, all participants reached the MDC in both scales. In MAL EQT, only one participant (P1) presented a linear decline between the periods of the two phases, and one participant (P2) presented a constant gain between the periods of the two phases. In MAL EQL, only one participant (P2) showed a constant evolution between the two phases. At COPM, all participants achieved MDC in their subscales. Conclusion: mCIMT applied alone or combined with conventional rehabilitation, both in group format, can bring clinical benefits in occupational performance and upper limb functionality in post-stroke patients.

The prevalence of patellar tendinopathy can be quite high in athletes of different sports modalities. The consequences of this dysfunction can be devastating for an athlete's career. Several randomized controlled trials have been developed in an attempt to identify the best treatment approaches for individuals with patellar tendinopathy. However, the description of study participants is not always clear and comprehensive. This makes it difficult for clinicians to understand how relevant the results of the research in question are to their patients. Recently, an International Tendinopathy Consensus established recommendations on the characteristics of participants that should be reported in clinical trials involving tendinopathies in general, including population demographics, clinical tendinopathy descriptors, general health and comorbidities, and participant recruitment and screening. To our knowledge, however, no study has verified whether the presentation of data from participants included in clinical trials involving patellar tendinopathy is in accordance with the criteria recommended by expert consensus. The purpose of this review is to verify how comprehensive the description of participants in randomized controlled trials involving individuals with patellar tendinopathy is. A literature review was carried out in databases by two independent reviewers, seeking to identify randomized controlled trials involving individuals with patellar tendinopathy. To assess the quality of studies regarding the description of the participants, a scale was developed based on the score of the International Tendinopathy Consensus (eCONT). Pearson's correlation test was used to verify the existence of a relationship between year of publication of the trials and the quality of data presentation. Thirty-four clinical trials were included in the review. The studies involved a total of 1,262 individuals (996 men and 266 women), with an average age of 28.25 ± 4.10 years. The average score of studies in the eCONT was 9.88 ± 2.07 points, ranging from 6 to 13 points out of a total of 16 possible on the score. The inclusion criteria of the different studies were substantially heterogeneous. Most often incomplete information included medication use and the presence of comorbidities. There was no correlation between year of publication and score on the quality of data presentation scale (P=0.372). In conclusion, clinical trials involving individuals with patellar tendinopathy present heterogeneous and, in many cases, incomplete information about the included participants. The possibility that individuals with different conditions that cause anterior knee pain may have been recruited for these studies under the diagnosis of patellar tendinopathy is also of note. This could lead to confusion among the scientific community and clinicians as to which treatments are in fact effective for the rehabilitation of individuals with patellar tendinopathy.

Introduction: Osteoarthritis (OA) is a chronic, degenerative and multifactorial disease that affects the entire joint structure and is closely linked to aging, mainly aging the knee joint. The limitations corrected by the regulations with knee OA have been related to proprioceptive changes. However, research evaluates ways to improve proprioceptive acuity and the anticipatory muscle response of this population. Objective: To investigate the effect of additional sensory information to a sensory motor training program, on the functionality of women with knee OA. Methodology: This is a pilot study of a randomized clinical trial, conducted with women diagnosed with knee OA. The volunteers were assessed for strength using a portable dynamometer, balance using the BERG balance scale, function using the WOMAC scale, functional capacity using the 6MWT and TUG test and global perception of change through the PGIC. 30 women were randomized into two intervention groups: Sensory motor training group (STM, n = 15) and Sensory motor training group with additional sensory information (STM with additional sensory information, n = 15). Corrections were made before and after the 10 combined intervention protocol. The kolmogorov-Smirnov and levene tests were mandatory to verify the normality and homogeneity of the sample. Intra and inter-group differences were calculated using ANOVA for mixed models. Results: we found significant intra-group differences in the results for the 6MWT and Berg's balance test. Thus, we observed improvements in functional capacity and balance in the TSM group. In the intergroup comparisons, no relevant changes were observed between the variables. Conclusion: STM in patients with knee OA appears to promote a change in outcome in balance and improve functional capacity, regardless of the application of additional sensory information.

Introduction: With aging, there is a decline in the adaptive responses necessary to perform daily activities, thus increasing susceptibility to diseases and functional limitations. The cognitive motor interference is the accomplishment of a motor task and a cognitive accomplished simultaneously, the elderly present greater difficulty to carry out these activities. Training can promote walking, balance and cognition, however, there are no types of tasks and duration established for this training. Objective: To investigate the immediate interference of an intervention proposal with different cognitive-motor and motor-motor tasks on the balance of the elderly. Methods: Eight questionnaires / tests were used, besides the evaluation in the force platform, the subjects were divided in two groups, one group was submitted to a single intervention proposal with Double Task and the other with Simple Tasks, after the intervention were reevaluated. Results: We evaluated 30 elderly people who were randomly distributed among the groups. Regarding the sociodemographic data, motor evaluation and cognitive performance, individuals from both groups presented in a homogeneous way, the self report of difficulty to double task presented similar results. Compared to the simple test, there was an increase in the duration of the F8W motor and cognitive TUG and cognitive TUG tests. After the intervention, the Dupla Task group maintained its performance in the tests and presented improvement in the cognitive performance of the activities of semantic fluency, calculation and figures during posturography, whereas the Simple Task group required more time for the simple and motor TUG and presented oscillation in the postural control in the condition of open eyes, semantic fluency and figures, without increase in the number of hits. Conclusions: The secondary tasks caused an increase in the time to perform the functional tests, except for the motor TUG. After the intervention, the performance in the tests of the Double Task group was superior to the Simple Task group, the number of hits was similar. In the posturographic evaluation, there was an improvement in cognitive performance for the Dupla Task group, whereas the Simple Task group presented a greater oscillation for some activities, without improvement in their cognitive performance. There was no difference between the groups on the self report of the frequency of difficulty to perform double task.

INTRODUCTION: Osteoarthritis (OA) is one of the most common diseases in the elderly population and the knee is one of the most affected joints, representing a potential cause of disability and reduced quality of life. In this perspective, kinesio taping (KT) appears as a cheap and practical therapeutic alternative for the treatment of these individuals. However, the current evidence on this technique is limited and conflicting, which means that its effects on the symptomatology of the disease are still uncertain. OBJECTIVE: To analyze the effects of KT application on pain, muscle strength, edema, physical function and overall perception of change in elderly women with knee OA (KOA). MATERIALS AND METHODS: In this randomized, blinded trial, 45 elderly women were allocated to three groups: G1 (placebo group), who received the application of KT without tension on the rectus femoris and knee; G2 (control group), submitted to a class on KOA; and G3 (intervention group) in which two KT techniques were applied simultaneously with 30% and 10% tension, respectively, on the rectus femoris and the knee. The pain was evaluated by Visual Analogue Scale (EVA), quadriceps muscle strength by handheld dynamometry, physical function by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and the 6-minute Walk Test (6MWT). Furthermore, edema was measured by knee perimetry and the overall perception of change by the Patient Global Impression of Change. All volunteers were evaluated before, immediately after and 72 hours after the intervention. The Kolmogorov-Smirnov and Levene tests were applied to evaluate the normality and homogeneity of the data, respectively. Intra and intergroup comparisons were evaluated using analysis of variance ANOVA of mixed model. In the presence of a significant F, the Benferroni pot-hoc test was used to identify where the difference occurred. For all statistical analyzes a significance level of 5% (p <0.05) and 95% confidence interval (95% CI) were adopted. Statistical analysis was performed using SPSS® software (Statistical Package Social Science) version 20.0. RESULTS: The intragroup analysis showed an improvement in pain in favor of the placebo group and intervention, in addition to the increase of quadriceps strength in the placebo group. Physical function improved in all groups assessed. On the other hand, no improvement was observed in relation to edema in any of the groups. In the intergroup analysis, no significant differences were observed for any of the variables analyzed in either group. Finally, volunteers in the intervention and placebo groups reported experiencing some beneficial change with treatment. CONCLUSION: KT is not able to improve pain, quadriceps muscle strength, edema and physical function of elderly women with KOA.

Objective: To compare the administration of constraint-induced therapy (CIT) with the original protocol of 6 hours and modified protocol of 3 hours in the neurofunctional recovery of post-stroke patients in group format. Methods: Eleven patients from the Physiotherapy School Clinic of the UFRN / FACISA were selected, all of whom were diagnosed with stroke to participate in a group CIT program. Of these 11 patients, 8 participated in the first phase consisting of the application of the CIT protocol 3h daily for 10 treatment days, 5 months later 5 patients from the 8 patients who participated in the first phase and 3 new patients participated in an CIT program in group for 6h daily for 10 treatment days. In both protocols all major CIT principles (shaping, task practice and behavioral package) were used. In both phases the group of patients was supervised by a multidisciplinary team. The motor and functional recovery of the patients were evaluated through the Wolf Motor Function Test, the Motor Activity Log and the Canadian Occupational Performance Measure by an independent evaluator in six moments: immediately before the 3h program, immediately after the 3h program, 3 months after the program of 3, immediately before the program of 6h, immediately after the program 6h and 3 months after the program of 6h. Results: The CIT in group format demonstrated a motivating reinforcement for the study participants. Participants achieved statistically and clinically significant improvements in motor and functional recovery and were maintained over a 3-month follow-up period in both protocols, however the results were better in the 3-hour protocol. Conclusion: CIT in its group format produces favorable results and the application of a protocol with shorter duration (3 hours) presents more significant results, being more feasible its application.

Introduction: Anxiety is a disorder that has been affecting a great number of individuals and Brazil being the country with the highest prevalence in Americas with 9.3%. Among the anxiety disorders, there is the generalized anxiety disorder (GAD), characterized mainly by tremors, muscular hypotonia, hyperventilation, sweating, palpitations, apprehension, restlessness, distractibility, loss of concentration and insomnia. GAD cause impairment in the functional, social, affective and cognitive life of the individual, thus, there is a need for an effective treatment that can minimize these effects. One of the techniques that has been used with positive results for treatments of some psychiatric disorders is Transcranial Continuous Current Stimulation (tDCS), which is a noninvasive neuromodulation technique that, through an electric microcurrent of 0, 5 to 2 mA cause stimulation or inhibition of neuronal activity. This stimulation causes specific changes in the behavior and motor activity of individuals by modulating specific brain areas. Despite many studies of tDCS in mood disorders, such as depression, and some studies in anxiety disorders such as panic, tDCS studies with GAD are still incipient. Thus, there is a need to evaluate the effects that tDCS can have on people affected by GAD. Objectives: To analyze the effects of anodic tDCS over the left dorsolateral prefrontal cortex (CPFDL) in people affected by GAD, presenting possible improvements in the symptoms of the disease. The study was designed as a randomized double-blind clinical trial, with a sample of 30 participants aged 20 to 40 years who had a clinical diagnosis of GAD according to the criteria of the American Psychiatric Association (DSM-V). Participants were divided into two groups, sham and experimental group, and the allocation was performed in a randomized, double-blind fashion. Results: No differences were found for anxiety, depression and affectivity. However, a significant improvement was found in the active group for physical symptoms of stress. Although intragroup analyzes showed decreases in anxiety, stress, negative affectivity, and depression scores, no intergroup comparison showed significant difference. Improvement in physical aspects of stress in GAD can improve life satisfaction, cognitive function, and psychological well-being. Conclusion: It is suggested that five sessions of anodic tDCS on CPFDL did not improve anxiety and mood symptoms in patients with GAD. However, the protocol showed improvement in physical symptoms of stress.

The mortality reduction in intensive care unit (ICU) has been accompanied by comorbidities for at least five years after hospital discharge. Early mobilization is the main intervention to prevent hospitalization-related declines. The prescription of physical exercise for this population is still poorly explored regarding dose response and exercise periodization. The aim of this study was to conduct a systematic review of the scientific literature to describe protocol models and periodization strategies of early mobilization prescription in ICUs in critical patients. Methods: The Preferred Reporting Itens for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were followed. Medical Subject Headings (MeSH) was used for the search strategy: with combined concepts and boolean operators adapted to the databases: Medline, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Scopus. After searching, 6,392 resumes were found and after screening, 121 complete articles were read and 13 were included in the systematic review. No study has shown inferior quality according to the Physiotherapy Evidence Database (PEDro) scale. It was analyzed 1,380 individuals who participated of the included papers in this review. The mobilization protocols found presented a duration of 10 to 30 minutes, 2x / day for 7x / week, with weekly accumulated volume equal to or greater than 200 minutes/week, consisting of mobility and progressive exercises based on sedation level and patient tolerance. The lack of data on protocols damage the periodization strategy use, however, based on the most commonly used progress statistics, the periodization of early mobilization resembles the wavy strategy. The studies still present an incipient presentation regarding the use of these systematized strategies in Intensive Care Units, despite the large number of available studies, an exercise prescription, dose response and periodization of ICU exercise.

Introduction: Abnormal lower limb movement patterns during closed kinetic chain activities seem to contribute to the occurrence of knee injuries. The Lateral Step-Down test (LSD) is a simple test for the assessment of lower limb movement patterns. Verbal instructions may result in immediate improvements in movement patterns in certain functional activities; however, it remains unknown whether these instructions can cause these same improvements during the LSD. Objectives: the purposes of this dissertation were: 1) to conduct a narrative review regarding the assessment of quality of movement during the LSD, 2) to determine the immediate effects of a verbal instructions intervention in the quality of movement and trunk, pelvis and lower limb kinematics in healthy females during the LSD, 3) to verify possible associations between lower limb muscle strength and flexibility and the results of quality of movement and 3D kinematics during the LSD. Methods: For the first study, two independent reviewers conducted a literature review in different databases. For the experimental study, thirty-four healthy females performed the LSD and were assessed both visually and using a 3D kinematics analysis before and after receiving verbal instructions for movement correction. Participants were divided into Good Movement Group (GG) and Poor Movement Group (PG) according to their scores. Lower limb flexibility was measured using the Lunge Test and the assessment of passive hip stiffness. Muscle strength was measured using a handheld dynamometer. Verbal intervention included instructions aimed at improving the alignment of the trunk, pelvis, hip and knee during the LSD. Results: The narrative review identified a few confounding factors in the included studies that may interfere with the LSD results, such as step height and instructions given prior to the test. It was also found that the LSD is considered a simple test for clinical use, with moderate reliability (κ=0.59–0.81). Results from the experimental study showed that quality of movement during the LSD was positively correlated with kinematic measures of hip adduction, hip flexion and pelvic drop. Verbal instructions improved quality of movement of the volunteers in general, with the GG showing greater improvement in quality of movement after the instructions than the PG. In group comparisons, the PG presented greater pelvic drop, greater hip adduction and decreased hip flexion when compared to GG. Conclusions: The LSD has adequate reliability and should be standardized in order to minimize possible confounding factors. In the experimental investigation, the visual assessment of the LSD presented a significant association with pelvic drop and hip adduction during the 3D analysis in healthy females. Factors such as decreased ankle flexibility and increased hip flexibility are related to greater hip movements during the LSD. Verbal instructions caused an immediate improvement in lower limb quality of movement in healthy women during the LSD.

Abstract: Unilateral brain injuries affecting the left hemisphere bring different clinical conditions than those affecting the right hemisphere. It is postulated that the left hemisphere is more responsible for the range acceleration phase and the right hemisphere for the deceleration (grip) phase. This statement stems from kinematic studies of human movement. The aim of this study was to analyze, through clinical instruments, whether patients with right hemisphere injury differ from patients with left hemispheric injury for reach and grasp movement. Methods: This is an observational cross-sectional analytical study conducted with patients who had stroke for more than six months and had unilateral impairment. Fifteen patients (nine with right injuries and six with left injuries) were selected and evaluated in the reach and bilateral grip movements using the Box and Block test (BBT) instruments, the Action Research Arm Test (ARAT), the functional range (REACH) and dynamometry. In order to compare clinical measures (ARAT, BBT and Reach Performance Scale) and hand dynamometry) between the two groups (GR x GL) and between individuals in the same group, the Mann-Whitney U test was performed. Correlation was performed by Spearman test. Results: Fifteen subjects met the eligibility criteria for the study and, as such, the subjects were divided into two groups, lesion in the right hemisphere and lesion in the left hemisphere. However, from the results found it was not possible to verify the hemispheric differences for reach and prehension activity through the clinical instruments. Conclusion: It was not possible to obtain evidence that hemispheric specialization can be measured from clinical assessment scales.

Objective: To investigate the deterioration of gait in different conditions associated with cognitive planning in healthy elderly. METHODS: This was a cross-sectional study involving 17 elderly women aged 60-75 years (66.00 ± 4.67). Individuals were clinically described by means of the following instruments: Dynamic Gait Index, Berg Balance Scale, Mine Mental State Examination and Leganes Cognitive Test. The experimental protocol consisted of performing the three cognitive tasks of the Stroop test - Word (Pal), Color (Co) and Word-Color (Pal-Co) - in four gait conditions: treadmill running, disturbances (MS), ground running with straight disturbances (MSPR), and ground running at eight (MS8). Each task was performed three times, with duration of 20 seconds and intervals of three minutes. The ICM was evaluated by muscle contraction index (ICCm), number of steps (NP), cadence (Ca) and velocity (VL). The ICCm was collected by means of surface electrodes and an 8-channel electromyograph, along with pressure sensors on the treadmill for ME, and sensors fixed in walking soles that synchronized gait cycles (support and oscillation). The normality of the data was analyzed and the one-way ANOVA and Pearson's correlation using SPSS 2.0 software were used. Results: The cognitive tasks of the Stroop test presented a deterioration in the final score of the test, presenting a significant effect of the reduction of number of Words and number of Colors (p <0.05) in all conditions when compared to ME (Pal 33 , 78 ± 6.31, Co 23.19 ± 5.78) on MS (Pal 26.76 ± 6.59, Co 16.84 ± 5.55), MS 8 (Pal 25.72 ± 6.53; 15,17 ± 5,76) and MSPR (Pal 22,94 ± 7,22, Co 16,11 ± 6,00), whereas for Color Word there was a significant effect on the reduction in the number of items (p <0, 05) only when compared to ME (13.58 ± 3.16) with MSPR (9.88 ± 3.50) and MS8 (9.84 ± 3.50). When comparing the cost of the Stroop task in the steps and cadence of the different gait conditions, a significant change in gait variability was observed from the usual to the slower (p <0.05), however only MS x MSPR and MSPR x MS8 did not show these differences (p> 0.05), whereas the cadence was not significant in ME x Normal, MS x MSPR, MS8 x MS and MSPR (p> 0.05) situations. The correlation analysis revealed a significant and positive relationship between steps and cadence with the Stroop task, only in the MS8 situation with number of colors (r = 0.549, p = 0.022, r = 0.561, p = 0.019). Conclusion: The findings suggest that the cognitive task during gait variability was altered, suffering a negative impact as the load was increased, and that patterns of gait variability produced different measures in the steps and cadence being larger viewed only between the activities.

Introduction: Mental Practice (MP) allows the individual to perform tasks repeatedly without fatigue or any risk to safety. Studies show the efficacy of MP in stroke patients by improving motor skills and performance learning. Objective: The objective of this study was to investigate the effect of a PM program associated to physical task (PT), assessing the moment of insertion of the practice during therapy, and estimating motor and imaging functions. METHODS: This is a single-blind randomized controlled trial that evaluated the efficacy of mental practice conducted in patients diagnosed with chronic stroke. Patients were randomly assigned to the groups G1 (video + MP + PT), G2 (video + PT + MP) and G3 (video + PT). The modified Ashworth scale was the physical performance protocol of Fugl- Meyer, Functional Independence Measure (FIM), Theory of Mind Inventory (ToM), Surface Electromyography (EMGs), and the Action Research Arm test (ARAT) and Box and Block test (BBT). Results: Only 35 met the eligibility criteria, 21 accepted to participate in the study and were enrolled for the study, but only 10 completed the study. Thus, a variance test was performed between the groups, showing no statistical significance. Comparing the moments of the same group, there was a statistically significant result in G1 in Fugl Meyer's variables: hand and total upper limb, motor FIM, upper limb affected in ARAT and in BBT. Conclusion: The Mental Practice associated with physical training is an effective protocol. Our results still indicate a possible indication that mental practice has to be performed before physical training.

Background: Fibromyalgia (FM) is a syndrome characterized by chronic
widespread pain, fatigue, cognitive behavioral impairments, mood disorders
and sleep problems. Although the etiology of FM is unknown, it has been
recognized as a centralized pain state where the patient’s Central Nervous
System (CNS) is hyperactive, phenomenon known by Central Sensitization.
Transcranial Direct Current Stimulation (tDCS) is a non-invasive, safe and
cost-effective brain stimulation technique that modulates cortical excitability
and has been showing positive effects in FM patients. However, there is no
consensus on which method and exactly location of stimulation is most
effective and presents with more significant benefits in this patients
population. Objective: The aim of this study is to evaluate whether a 5
consecutive day treatment with tDCS stimulation results in better pain levels
when compared to sham, or placebo, and if there are any differential effect
between active tDCS and sham tDCS on pressure pain threshold, pressure
pain tolerance, mood disorders such as anxiety, depression and affectivity
and the disease functional impact in women with FM. Methods: This
randomized controlled trial had forty-five participants with FM, which were
randomized in one of three groups: active tDCS in the primary motor cortex
(M1; n=15) and dorsolateral prefrontal cortex (DLPFC; n=15) and sham
stimulation (SHAM; n=15). All the data were collected 7 days prior to the
begging of the intervention (baseline), on the 5 th day of treatment, with 7 and
21 days of follow-up. The pressure pain threshold and tolerance were also
revaluated at the 1 st day of treatment to analyze the immediate effect of tDCS.
A constant current of 2 mA intensity was administered during 5 consecutive
days for 20min. Results: The results showed there was no statistical
significant improvement in pain in any of the groups (p &gt; 0,05). However,
there was a reduction of 15,1% of the disease functional impact in M1 (p =
0,003) and 8,7% in DLPFC (p = 0,022) resulting in improved function of this
patient population. In addition, the results showed an improvement in anxiety
levels in DLPFC group (p &lt; 0,05) with effects maintenance of up to follow-up
periods. There was no statistical difference on the other variables.
Conclusion: The results of this study suggests that tDCS treatment of 5
consecutive days in cortical areas M1 and DLPFC of 2mA intensity for 20min
have significant results in function and anxiety in patients with FM with
sustained effects after treatment ended.

Introduction: Self-rated Health (SRH) is one of the most used outcome measures in social epidemiology, public health research and clinical practice, and has been associated with morbidity and mortality in different populations. Physical performance measures are largely determined by physiological functions that typically decrease with age. Some evidence shows that SRH is associated with objective measures of physical performance; however, studies investigating association in low- and middle-income settings are rare, especially for middle-aged populations. Objective: To verify the relationship between SRH and physical performance measures, through tests that assess upper and lower limb strength in middle-aged and elderly women in a low-income setting of Brazil. Methods: This is a cross-sectional study of 571 middle-aged women (40-59 years old) and elderly women (60-80 years old) living in the municipalities of Parnamirim and Santa Cruz, Rio Grande do Norte. Participants who reported their health status as "excellent," "very good," or "good" were allocated to the "SRH good" group, and those who reported their health as "fair" or "poor" composed the group "SRH poor". The physical performance evaluation consisted of 4 tests: handgrip strength, one-legged balance with eyes open and closed, and chair stand test. The relationship between SRH and physical performance for middle-aged and older women was assessed by multiple linear regression adjusted for covariates (age, education, family income, BMI, physical activity, comorbidities, menopausal status, and reproductive history). Results: Middle-aged women who reported good SRH had better physical performance, such as stronger handgrip strength (β = 1,927, p <0.001), greater balance time with eyes closed (β = 1.339, p = 0.041) and were faster in the chair stand test (β = -0.770, p = 0.003) when compared to those who reported their health as "poor." For the group of elderly women there is no association between physical performance measures and SRH. Conclusion: This study showed that SRH is significantly associated with objective measures of physical performance in a sample of low-income middle-aged women and is therefore a useful tool for assessing the physical health of this population.

Objective: Diabetic polyneuropathy is highly prevalent among diabetic adults and elder promoting poorer physical functioning and quality of life (QOL). This study aimed to evaluate the effects of anodal tDCS of the M1 on QOL, physical fitness and pain in patients with diabetic polyneuropathy.

Subjects and methods: It was conducted a pilot, parallel, sham, randomized, double-blind trial with twenty patients with diabetic polyneuropathy. Five consecutive sessions of C3/Fp2 tDCS montage were done. Short Form 36 Health Survey (SF-36) was used to assess the primary outcome. Secondary outcomes measures were physical fitness level according to lower and upper body strength, flexibility and submaximal level of functional capacity. All outcomes were measured in 3 different times (baseline, 1 week and 2 week).

Results: Generalized estimating equations showed significant main effects of time x group on SF-36 score (x² = 48.79; p < 0.001) with significant difference between baseline to 1 week (p = 0.001) and 2 week (p = 0.001). SF-36 score showed significant difference between group only on 2 week (p = 0.05). Mental health, physical health, emotional, general health, physical function and functional capacity showed significant interaction time x group with increase in Active-tDCS group. Bodily pain differ between groups in 2 week (p = 0.001). TUG and 6MWT have shown significant improvement only in Active-tDCS group (p = 0.0075; p = 0.0001 respectively, according to ANOVA).

Conclusions: Five sessions of anodal M1 tDCS improve QOL and functionality in patients with diabetic polyneuropathy.

The Chikungunya (CHIK) virus is epidemic in Brazil, with 170,000 cases in the first half of 2016. More than 60% of patients present relapsing and remitting chronic arthralgia with debilitating pain lasting years. There are no specific therapeutic agents to treat and rehabilitee infected persons with CHIK. Persistent pain can lead to incapacitation, requiring long-term pharmacological treatment. Advances in non-pharmacological treatments are necessary to promote pain relief without side effects and to restore functionality. Here, we demonstrate that the transcranial direct current stimulation (tDCS) across the primary motor cortex significantly reduces pain in the chronic phase of CHIK. Our findings suggest tDCS could be an effective, inexpensive and deployable therapy to areas lacking resources with a great number of patients with chronic CHIK persistent pain.