Publications by authors named "Alexandre Marcio Marcolino"

20 Publications

  • Page 1 of 1

Viability of transverse rectus abdominis musculocutaneous flap treated with photobiomodulation and therapeutic ultrasound: an experimental model.

Lasers Med Sci 2021 Mar 16. Epub 2021 Mar 16.

Laboratory of Assessment and Rehabilitation of the Locomotor Apparatus, Department of Health Sciences, Center Araranguá, Federal University of Santa Catarina, Campus Jardim das Avenidas, Rod. Gov. Jorge Lacerda, 3201, Ararangua, SC, 88906-072, Brazil.

Report the effects of photobiomodulation (PBM) and therapeutic ultrasound (TUS) on the viability of TRAM in mice.

Materials And Methods: Fifty-five mice Swiss were subjected to treatment for 5 days. Group 1, treatment was performed with the agents switched off. Groups 2 to 5 were treated with different wavelengths 660 and 830 nanometers (nm) and groups 6 to 11 with TUS of 1 and 3 MHz frequency. Macrometric analyses were performed using a specific camera and analyzed by the ImageJ® software. Thermographic analyses were performed with the Flir C2 and analyzed using the FLIR Tools software.

Results: Group 9 obtained 95% of viable area on the 3rd day and 85% on the 5th day, showing the effectiveness of the TUS in the flap viability. Regarding skin temperature, there was a difference only in the immediate postoperative period in group 1, which had a lower temperature than the other groups.

Conclusions: TUS demonstrated greater efficiency in maintaining the viability of TRAM. PBM 830 nm also demonstrated good results in the viability of TRAM.
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http://dx.doi.org/10.1007/s10103-021-03283-4DOI Listing
March 2021

Comparison of photobiomodulation in the treatment of skin injury with an open wound in mice.

Lasers Med Sci 2021 Jan 25. Epub 2021 Jan 25.

Laboratory of Assessment and Rehabilitation of the Locomotor Apparatus, Department of Health Sciences, Universidade Federal de Santa Catarina, Campus Araranguá - Campus Mato Alto, Rua Pedro João Pereira, 150, Araranguá, Santa Catarina, 88905-120, Brazil.

This study aimed to investigate the effects of photobiomodulation at a wavelength of 660 and 830 nm at different numbers of application points in the healing of open wounds in mice. In total, 120 mice were divided into 10 groups. The animals were submitted to cutaneous lesion of the open wound type (1.5 × 1.5 cm). Photobiomodulation at a wavelength of 660 and 830 nm and total energy of 3.6 J were used, applied at 1, 4, 5, and 9 points, for 14 days. The animals were subjected to analysis of the lesion area, skin temperature, and histological analysis. Macroscopic analysis results showed a difference (p < 0.05) between the irradiated groups and the sham group at 14 days PO. There was no statistical difference in skin temperature. Histological analysis findings showed better results for the epidermis thickness. Regarding the number of blood vessels, a difference was found between the 1- and 5-point 830-nm photobiomodulation groups and between the 4-point 660-nm group and the naive group. A significant difference in the number of fibroblasts was observed between the 830- and 660-nm photobiomodulation groups and the naive and sham groups. When comparing photobiomodulation wavelength, the 830-nm groups were more effective, and we emphasize the groups irradiated at 5 points, which showed an improvement in macroscopic analysis and epidermis thickness, an increase in the number of vessels, and a lower number of fibroblasts on the 14th day after skin injury.
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http://dx.doi.org/10.1007/s10103-020-03216-7DOI Listing
January 2021

Dry Needling and Photobiomodulation Decreases Myofascial Pain in Trapezius of Women: Randomized Blind Clinical Trial.

J Manipulative Physiol Ther 2021 Jan 26;44(1):61-71. Epub 2020 Nov 26.

Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil. Electronic address:

Objective: The purpose of this study was to assess whether dry needling (DN) added to photobiomodulation (PBM) has effects on the treatment of active myofascial trigger points in the upper trapezius.

Methods: This study was a randomized clinical trial, with 43 participants divided into 3 groups: DN and PBM (DNP), DN, and DN outside of the trigger point (DNout). Each group received 1 session of DN followed by PBM therapy with the machine turned on or off. Pain, disability, pain pressure threshold, and muscle activity were assessed before the intervention and afterward at intervals of 10 minutes, 30 minutes, 1 week, and 1 month.

Results: Pain decreased after intervention in the DNP and DNout groups, with mean differences, respectively, of 1.33 cm (95% confidence interval [CI], 0.019-2.647) and 2.78 cm (95% CI, 1.170-2.973). Scores for the disability questionnaire decreased in all groups after intervention (F = 36.53, P < .0001) after the intervention, with mean differences of 3.8 points in the DNP group (95% CI, 1.082-5.518), 3.57 in the DN group (95% CI, 0.994-6.149), and 5.43 in the DNout group (95% CI, 3.101-7.756). There were no significant differences between or within groups in pain pressure threshold (F = 2.14, P = .139), with mean differences after 30 minutes of 0.139 kgf for the DNP group (95% CI, -0.343 to 0.622), 0.273 for the DN group (95% CI, -0.661 to 1.209), and -0.07 for the DNout group (95% CI, -0.465 to 0.324). Muscle activation for the DN group increased 8.49% after the intervention, where for the DNP group it decreased 11.5%, with a significant difference between groups.

Conclusion: DN added to PBM presented similar results compared to DNout and DN. In this sample, the effects of the application of DN outside of the trigger point had better effects on pain and disability scores than DN applied directly on the trigger point.
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http://dx.doi.org/10.1016/j.jmpt.2020.07.002DOI Listing
January 2021

Photobiomodulation promotes neural regeneration when compared to simvastatin treatment in a sciatic nerve crush model.

Lasers Med Sci 2020 Nov 18. Epub 2020 Nov 18.

Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina/UFSC, Araranguá, Brazil.

To determine whether the effects of photobiomodulation (PBM) were associated with the use of Simvastatin in the functional recovery from sciatic nerve in mice submitted to crush injury. Fifty Swiss mice (approximately 3 months old; average weight 40 g) were randomly divided into six groups: naive, sham, control, PBM (660 nm, 10 J/cm; 30 mW; 0.6 J per day for 28 days; 0.06 cm; 16.8 J total and 20 s), Simvastatin (20 mg/kg), and PBM/Simv (association of the two protocols). The sciatic functional index (SFI), thermal heat hyperalgesia, mechanical hyperalgesia, and thermographic evaluation were used as analyses. The evaluations were performed preoperatively and 7, 14, 21, and 28 days after the initial injury analyzed by two-way analysis of variance (ANOVA) for mixed models followed by the Bonferroni post-test. All groups except sham and naive presented an SFI compatible with severe peripheral nerve injury on the 7th day of evaluation. The PBM group presented better results in the SFI analysis (p < 0.001) on the 21st postoperative day compared to the control group. This benefit was maintained when compared to the Simvastatin (p < 0.001) and PBM/Simv groups (p < 0.01). The results of the thermal and mechanical hyperalgesia and thermography analyses were not significant (p > 0.05). The obtained results showed that PBM alone was more effective compared to Simvastatin alone or PBM combined with Simvastatin for sciatic nerve injury in mice.
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http://dx.doi.org/10.1007/s10103-020-03176-yDOI Listing
November 2020

Photobiomodulation in Sciatic Nerve Crush Injuries in Rodents: A Systematic Review of the Literature and Perspectives for Clinical Treatment.

J Lasers Med Sci 2020 21;11(3):332-344. Epub 2020 Jun 21.

Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina / UFSC - Araranguá, Brazil.

The aim of the study was to perform a literature review to analyze the effect of photobiomodulation in experimental studies on peripheral nerve regeneration after sciatic nerve crush injury in rodents. A bibliographic search was performed in the electronic databases, including MEDLINE (PubMed), SCOPUS, and SciELO, from 2008 to 2018. A total of 1912 articles were identified in the search, and only 19 fulfilled all the inclusion criteria. Along with the parameters most found in the manuscripts, the most used wavelengths were 660 nm and 830 nm, power of 30 and 40 mW, and energy density of 4 and 10 J/cm . For total energy throughout the intervention period, the lowest energy found with positive effects was 0.70 J, and the highest 1.141 J. Seventeen studies reported positive effects on nerve regeneration. The variables selected to analyze the effect were: Sciatic Functional Index (SFI), Static Sciatic Index (SSI), morphometric, morphological, histological, zymographic, electrophysiological, resistance mechanics and range of motion (ROM). The variety of parameters used in the studies demonstrated that there is yet no pre-determined protocol for treating peripheral nerve regeneration. Only two studies by different authors used the same power, energy density, beam area, and power density. It was concluded that the therapeutic window of the photobiomodulation presents a high variability of parameters with the wavelength (632.8 to 940 nm), power (5 to 170 mW) and energy density (3 to 280 J /cm ), promoting nerve regeneration through the expression of cytokines and growth factors that aid in modulating the inflammatory process, improving morphological aspects, restoring the functionality to the animals in a brief period.
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http://dx.doi.org/10.34172/jlms.2020.54DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369549PMC
June 2020

Effects of Photobiomodulation Therapy and Restriction of Wrist Extensor Blood Flow on Grip: Randomized Clinical Trial.

Photobiomodul Photomed Laser Surg 2020 Dec 28;38(12):743-749. Epub 2020 Jul 28.

Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina (UFSC), Araranguá, Brazil.

To evaluate the influence of two different photobiomodulation therapy (PBMT) protocols (red 660 nm vs. infrared 830 nm) combined with a blood flow restriction (BFR) training protocol in wrist extensor muscles on handgrip, wrist extension force, and electromyographic behavior [root mean square (RMS)]. PBMT has been widely used to increase muscle performance and recovery in recent clinical trials. However, there is no evidence whether PBMT (red and/or infrared) can promote better results when combined with BFR, a known method to induce better strength gains. This study was a randomized controlled trial including 58 volunteers allocated into four groups: (1) control (conventional strengthening), (2) BFR (strengthening with BFR), (3) 660 nm (BFR strengthening with 660 nm PBMT-35 mW; 0.05 cm; 2.10 J, total energy 18.9 J), and (4) 830 nm (BFR strengthening with 830 nm PBMT-32 mW; 0.101 cm; 1.92 J, total energy 17.2 J). Data were analyzed by using a mixed-effects model, with a 5% significance index. A statistically significant increase was obtained for handgrip strength for the 660 nm group [27.36 ± 2.61 kilogram force (kgF)] compared with the 830 nm group (23.04 ± 3.06 kgF) ( = 0.010) and for wrist extensor strength in the 660 nm (7.77 ± 0.58 kgF) and BFR (7.54 ± 0.92 kgF) groups compared with the control group (5.33 ± 0.61 kgF) ( = 0.001 and  = 0.004, respectively). The RMS value for the 660 nm group was significantly higher than control ( < 0.0001), BFR ( < 0.0001), and the 830 nm group ( = 0.0009). The association of PBMT (660 nm) and BFR was effective for increasing handgrip strength of the wrist extensors, associated with an increase in RMS.
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http://dx.doi.org/10.1089/photob.2019.4800DOI Listing
December 2020

Effects of a Pilates protocol in individuals with non-specific low back pain compared with healthy individuals: Clinical and electromyographic analysis.

Clin Biomech (Bristol, Avon) 2020 02 19;72:172-178. Epub 2019 Dec 19.

Programa de Pós Graduação em Ciências da Reabilitação da Universidade Federal de Santa Catarina (PPGCR-UFSC), Araranguá, SC, Brazil; Laboratório de Avaliação e Reabilitação do Aparelho Locomotor da Universidade Federal de Santa Catarina (LARAL-UFSC), Araranguá, SC, Brazil. Electronic address:

Background: Electromyography may be useful for assessing and understanding trunk muscle activation, and Pilates is commonly used as a treatment for low back pain. The objective of this study was to verify electromyography of trunk muscles after a Pilates protocol in individuals with non-specific low back pain and in healthy individuals.

Methods: Volunteers were divided into two groups: non-specific low back pain (n = 19) and clinically healthy (n = 16) groups. Clinical assessments, classification of patients into subgroups, electromyography evaluations of the right lumbar extensor and right transverse abdominal/internal oblique muscle of the abdomen were performed before and after an 8-week Pilates protocol.

Findings: Comparisons were made before and after the protocol and with the control group. There was significant improvement in pain, flexibility, resistance and strength of trunk muscles. In addition, after the Pilates, there was a decrease in the time elapsed between the onset and peak of lumbar muscle activation during the evaluation of trunk extension in the low back pain group, coming closer to the time of the abdominal muscle, as it also occurred in the control group.

Interpretation: Pilates caused clinical improvement and balanced trunk muscle activation in the low back group, becoming similar to that of the control group. Furthermore, the effects of the proposed protocol were the same between the groups. Thus, Pilates may be indicated for management of non-specific low back pain.
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http://dx.doi.org/10.1016/j.clinbiomech.2019.12.009DOI Listing
February 2020

Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: systematic review of psychometric properties.

Syst Rev 2018 10 27;7(1):175. Epub 2018 Oct 27.

Clinical Research, Hand and Upper Limb Centre, St Joseph's Health Centre, Western University, London, ON, Canada.

Background: Outcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair.

Methods: This systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence.

Results: Sixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity.

Conclusions: Few studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective.
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http://dx.doi.org/10.1186/s13643-018-0836-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204279PMC
October 2018

Comparative effect of photobiomodulation associated with dexamethasone after sciatic nerve injury model.

Lasers Med Sci 2018 Aug 2;33(6):1341-1349. Epub 2018 Apr 2.

Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina/UFSC, Araranguá, Brazil.

To analyze the effect of photobiomodulation and dexamethasone on nerve regeneration after a sciatic nerve crushing model. Twenty-six Swiss mice were divided into the following groups: naive; sham; injured, low-level laser therapy (LLLT) (660 nm, 10 J/cm, 0.6 J, 16.8 J total energy emitted during the 28 days of radiation, 20 s, for 28 days); dexamethasone (Dex) (local injection of 2 mg/kg for 10 consecutive days); and LLLT group associated with Dex (LLLT/Dex), with the same parameters of the other groups. For nerve injury, a portable adjustable pinch was used. The animals were evaluated using the Sciatic Functional Index (SFI) and Sciatic Static Index (SSI). The results obtained were evaluated with Image J™ and Kinovea™. Data and images were obtained at baseline and after 7, 14, 21, and 28 days after surgery. The evaluation of hyperalgesia, using Hargreaves, and behavior through the open field was also performed. In functional and static analysis, all groups presented significant differences when compared to the injured group. In the analysis of the SSI results, the group treated with both LLLT and dexamethasone was more effective in improving the values of this parameter, and in the SFI, the laser-treated group obtained better results. In the evaluation through the open field and the Hargreaves, there was no difference. The application of LLLT and dexamethasone was effective in nerve regeneration according to the results and was more effective when LLLT was associated with dexamethasone than in LLLT alone for the SSI.
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http://dx.doi.org/10.1007/s10103-018-2494-9DOI Listing
August 2018

Laser photobiomodulation (830 and 660 nm) in mast cells, VEGF, FGF, and CD34 of the musculocutaneous flap in rats submitted to nicotine.

Lasers Med Sci 2017 Feb 2;32(2):335-341. Epub 2016 Dec 2.

Post-Graduate Program in Rehabilitation and Functional Performance of Ribeirão Preto Medical School of the University of São Paulo (FMRP/USP), Av. dos Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.

The aim of this study was to investigate the effect of laser photobiomodulation (PBM) on the viability of the transverse rectus abdominis musculocutaneous (TRAM) flap in rats subjected to the action of nicotine. We evaluated 60 albino Wistar rats, divided into six groups of ten animals. Group 1 (saline) underwent the surgical technique to obtain a TRAM flap; group 2 (laser 830 nm) underwent the surgical technique and was irradiated with a laser 830 nm; group 3 (laser 660 nm) underwent the surgical technique and was irradiated with a laser 660 nm; group 4 was treated with nicotine subcutaneously (2 mg/kg/2×/day/4 weeks) and underwent surgery; group 5 (nicotine + laser 830 nm) was exposed to nicotine, underwent the surgical technique, and was irradiated with a laser 830 nm; group 6 (nicotine + laser 660 nm) was exposed to nicotine, underwent the surgical technique, and was irradiated with a laser 660 nm. The application of PBM occurred immediately after surgery and on the two following days. The percentage of necrosis was assessed using the AxioVision® software. The number of mast cells (toluidine blue staining) was evaluated, and immunohistochemistry was performed to detect vascular endothelial growth factor expression (anti-VEGF-A), fibroblasts (anti-basic FGF), and neoformed vessels (anti-CD34). PBM with a wavelength of 830 nm increased the viability of the TRAM flap, with a smaller area of necrosis, increased number of mast cells, and higher expression of VEGF and CD34. PBM increases the viability of musculocutaneous flaps treated with to nicotine.
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http://dx.doi.org/10.1007/s10103-016-2118-1DOI Listing
February 2017

Multimodal approach to rehabilitation of the patients with lateral epicondylosis: a case series.

Springerplus 2016 5;5(1):1718. Epub 2016 Oct 5.

Rehabilitation and Functional Performance, University of São Paulo, São Paulo, SP Brazil.

Purpose: The objective of this study was to evaluate the effectiveness of mobilization with movement and kinesiotherapy in the treatment of patients with lateral epicondylosis.

Methods: This cases series included eight volunteers who had chronic lateral epicondylosis. The patients were treated with stretching, massage deep transverse at the lateral epicondyle and mobilization with movement associated with eccentric exercise. The mobilization with movement that consisted of a force of lateral glide of the proximal forearm. We performed twelve sessions, twice a week for 45 min/session. All patients underwent an evaluation with a visual analog scale and functional assessment through questionnaires patient-rated tennis elbow evaluation (PRTEE) and disabilities of the arm, shoulder and hand (DASH), before and after the treatment. Data were analyzed by student's test (p < 0.05).

Results: The results showed statistical differences in pain symptoms before and after treatment, in the analysis and functional assessment through both questionnaires comparing the pre and post treatment.

Conclusion: The data obtained in this study demonstrates improvement of the function and pain status of the sample investigated.
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http://dx.doi.org/10.1186/s40064-016-3375-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052242PMC
October 2016

The influence of different non-articular proximal forearm orthoses (brace) widths in the wrist extensors muscle activity, range of motion and grip strength in healthy volunteers.

J Back Musculoskelet Rehabil 2016 Jun 30. Epub 2016 Jun 30.

Rehabilitation and Functional Performance Post-Graduate Program, Ribeirão Preto of the Medical School, University of São Paulo, Ribeirão Preto, Brazil.

Purpose: The purpose this study was perform a biomechanical evaluation to compare the influence of commercial models of different non-articular proximal forearm orthoses widths (2.5 cm, 5.5 cm, 7.5 cm and 12.0 cm) in the extensor muscle activation, range of motion and grip strength in healthy subjects.

Methods: Was analyzed data from extensor carpi radialis, extensor carpi ulnares and extensor digitorum comunis using surface electromyography, simultaneous with a wrist electrogoniometer MiotecTM and a hydraulic dynamometer JamarTM. The sequence of tests with all the commercial orthoses models was randomized. Statistics analyses were performed by linear model with mixed effects.

Results: According to our findings the non-articular proximal forearm orthoses (2.5 cm - narrowest) positioned close to lateral epicondyle provided lesser muscle activation on extensor carpi radialis brevis/longus and extensor digitorum comunis, decreased wrist extension and grip strength during submaximal grip task (p< 0.01).

Conclusions: A narrow non-articular proximal forearm orthosis positioned close to the lateral epicondyle might decrease the extensor muscle activation and therefore could reduce mechanical stress on its insertion, based on this sample. Clinical studies must be conducted to confirm these findings.
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http://dx.doi.org/10.3233/BMR-160727DOI Listing
June 2016

Efficacy of low-level laser therapy associated to orthoses for patients with carpal tunnel syndrome: A randomized single-blinded controlled trial.

J Back Musculoskelet Rehabil 2016 Aug;29(3):459-66

School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.

Objective: Compare the efficacy of orthoses and patient education with and without the addition to Low-Level Laser Therapy (LLLT - 660 nm, 30 mW, a continuous regime and bean area of 0.06 cm2). The laser irradiation was delivered with the fluency of 10J/cm2 in patients with mild and moderate Carpal Tunnel Syndrome (CTS).

Methods: 48 patients were randomized and 30 finished the protocol (a sample loss of 37.5%), 90% female and 10% males. Randomization was applied to allocate the patients in each one of the groups, with association or not to LLLT (group orthoses or LLLT and orthoses). All of them were submitted to ergonomic home orientations. The short-term symptoms and function outcome were assessed through: Boston Carpal Tunnel Questionnaire (BCTQ) - Severity of Symptoms (SS) Functional Score (FS). Pain (VAS), Semmes-Weinstein monofilaments, 2PD and pinch strength was used for characterization of the sample. Most of the participants were women, over 4th decade enrolled on heavy hand duties occupations, right-handed, 66.7% affected on dominant hand, without alterations in sensory median nerve thresholds or pinch strength.

Results: Both groups showed a reduction of total BCTQ score and its subdomains after six weeks, with significant difference (p< 0.05), comparing to baseline. No significant difference was found between groups. A Minimal clinical change was observed after the intervention in 92.3% of participants for BCTQ subdomain severity of symptoms at individual comparison for LLLT and orthoses group and 76.5% for the orthoses group, demonstrating clinical relevance. Effect size Cohen's index was moderate for the severity of symptoms.

Conclusion: LLLT in association to orthoses and ergonomic orientation seems to be effective in short-term symptoms relieve for patients with mild and moderate CTS.
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http://dx.doi.org/10.3233/BMR-150640DOI Listing
August 2016

Effects of High-Voltage Electrical Stimulation in Improving the Viability of Musculocutaneous Flaps in Rats.

Ann Plast Surg 2016 Oct;77(4):e50-4

From the *Program in Rehabilitation and Functional Performance, Sao Paulo University, Ribeirao Preto, Sao Paulo; and †Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil.

Background: The musculocutaneous flap of the transverse rectus abdominis muscle is a technique used for breast reconstruction, and one of the complications of this procedure is tissue necrosis. The objective of the study is to determine the effect of high-voltage electrical stimulation (HVES) in the transverse rectus abdominis muscle flap in rats.

Methods: Fourteen rats underwent surgery for obtaining the flap. The rats were distributed into 2 homogeneous groups: group 1 underwent both surgery and the use of HVES, whereas group 2 underwent just the surgery (control). Electrical stimulation was applied immediately after surgery and for 2 consecutive days. The percentage of necrotic area was analyzed using the Image J software, and blood flow was assessed by infrared thermography in different regions of the flap, divided into 4 zones according to the proximity of the pedicle of the inferior epigastric artery.

Results: The results were analyzed using a Student t test, where group 1 experienced a necrotic area of 26.2%, and group 2 had an area of 54.5%. Regarding the temperature, the 2 groups showed increase in the minimum and maximum temperature on the fourth postoperative day.

Conclusion: The HVES appeared to have a positive influence on the viability of the flap.
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http://dx.doi.org/10.1097/SAP.0000000000000621DOI Listing
October 2016

Ascorbic acid iontophoresis for chondral gain in rats with arthritis.

Acta Ortop Bras 2014 ;22(4):202-5

Universidade de São Paulo, Faculdade de Medicina, Ribeirão Preto, SP, Brazil, Faculdade de Medicina, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil ; Universidade Paulista, Ribeirão Preto, SP, Brazil, Universidade Paulista (UNIP), Campus Ribeirão Preto, Ribeirão Preto, SP, Brazil.

Objectives: To examine the cellularity and thickness of the articular cartilage of the femur in rats with arthritis after treatment with iontophoresis.

Methods: To evaluate these objectives, a histological analysis was performed on hematoxylin and eosin, where cellularity and cartilage thickness were observed and evaluated qualitatively and quantitatively by manual counting by 700.09µm² area.

Results: The group treated with IAA had normal cellularity (40.1 cells/μm(2)) and maintenance of non-calcified cartilage (75.5μm), suggesting normal thickness. The non-treated group C+, on the other hand, had a lower mean number of chondrocytes (13.0μm(2)) (P <0.05) and, when the cartilage thickness was compared, it showed higher average thickness of calcified cartilage (104.8 mm) and lower mean of non-calcified cartilage (53.3μm).

Conclusion: The use of iontophoresis with L-ascorbic acid by continuous electric current contributed to a quantitative gain of chondrocytes and improved the thickness distribution of calcified and non-calcified cartilage. Level of Evidence III, Case Control Study.
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http://dx.doi.org/10.1590/1413-78522014220400769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167044PMC
September 2014

Evaluation of shoulder overload during acrobatic flight: Analysis of pilot’s self-report and surface electromyography (SEMG).

J Back Musculoskelet Rehabil 2015 ;28(1):159-66

Background And Objectives: The physical injuries caused by +Gz include skeletal-muscle overloads. This study has aimed at demonstrating ergonomic conditions of the pilots from the Brazilian Air Force’s Aerial Demonstration Squadron (BAFADS) during flight.

Methods: All the 13 pilots from the BAFADS were evaluated through an interview. Surface electromyography (SEMG) was employed during the flight manoeuvre simulation (under normal and overload conditions).

Results: The report analyses showed perception of discomfort in the right shoulder related to +Gz. The SEMG showed moderate levels of shoulder muscles activation for normal contractions (± 25%). During vigorous contraction, levels of recruitment were high: upper trapezius fibres (± 105%), middle trapezius fibres (± 90%) and posterior deltoid fibres (± 95%). The great demand from the deltoid muscles (posterior fibres) infers a very high level of recruitment from the rotator cuff muscle, which may explain the discomfort in the pilots’ shoulder during the flight manoeuvre.

Conclusion: The mutual analysis of both methods not only does it demonstrate a correlation between symptoms and muscle recruitment, but also provides data to implement intervention measures for pilots’ physical training in order to minimise the discomfort symptoms during flights.
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http://dx.doi.org/10.3233/BMR-140504DOI Listing
August 2016

Assessment of functional recovery of sciatic nerve in rats submitted to low-level laser therapy with different fluences. An experimental study: laser in functional recovery in rats.

J Hand Microsurg 2013 Dec 25;5(2):49-53. Epub 2013 Apr 25.

Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil.

Peripheral nerve lesions caused sensory and motor deficits along the distribution of the injured nerve. Numerous researches have been carried out to enhance and/or accelerate the recovery of such lesions. The objective of this study was to assess the functional recovery of sciatic nerve in rats subjected to different fluences of low-level laser therapy (LLLT). Thirty-six animals were randomly divided into four groups: one consisting of sham rats and three others irradiated with progressive fluencies of 10 J/cm(2), 40 J/cm(2) and 80 J/cm(2) of laser AsGaAl (830 nm) for 21 consecutive days. They were evaluated by the Sciatic Functional Index (SFI) method. The crush injury was performed by using a portable device with dead weight of 5,000 g whose load was applied for 10 min. A digital camera was used to record the footprints left on the acrylic track, before surgery and after, on the 7th, 14th, and 21st days. The results also showed that on the 7th day, there was a difference between the groups irradiated with 40 J/cm(2), when compared with the sham group (p < 0.05). On the 14th day the groups irradiated with 40 J/cm(2) and 80 J/cm(2) also presented better results when compared with sham, however, on the 21st day, no inter-group difference was found (p > 0.05). It was possible to observe that the LLLT at fluency of 40 J/cm(2) and 80 J/cm(2) had a positive influence on the acceleration of the functional nerve recovery.
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http://dx.doi.org/10.1007/s12593-013-0096-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827659PMC
December 2013

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial.

BMC Musculoskelet Disord 2012 Dec 13;13:248. Epub 2012 Dec 13.

Rehabilitation and Functional Performance Program, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900 Ribeirão Preto, SP CEP 14049-900, Brasil.

Background: Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome.

Methods/design: Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test.

Discussion: This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome.

Trial Registration: Brazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184.
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http://dx.doi.org/10.1186/1471-2474-13-248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3552983PMC
December 2012

Low-level laser therapy on the viability of skin flap in rats subjected to deleterious effect of nicotine.

Photomed Laser Surg 2011 Aug 1;29(8):581-7. Epub 2011 Apr 1.

Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, University of São Paulo-FMRP/USP, Ribeirão Preto, Brazil.

Objective: The purpose of this study was to evaluate the effect of 830-nm laser in blocking the action of nicotine on the viability of skin flap.

Background Data: The authors have analyzed the deleterious effect of cigarette smoke or nicotine on the skin flap alone with evidence of increased skin necrosis in the flap.

Materials And Methods: Twenty-four Wistar-albino rats were divided into three groups of eight animals each: Group 1 (control), subjected to a surgical technique to obtain a flap for cranial base, laser irradiation simulation, and a subcutaneous injection of saline; Group 2, similar to Group 1, with subcutaneous injection of nicotine (2  mg/kg/day) for a period of 1 week before and 1 week after surgery; and Group 3, similar to Group 2, with skin flaps subjected to a λ 830-nm laser irradiation. The laser parameters used were: power 30 mW, beam area 0.07 cm(2), irradiance 429 mW/cm(2), irradiation time 84  sec, total energy 2.52  J, and energy density 36 J/cm(2). The laser was used immediately after surgery and for 4 consecutive days, in one point at 2.5  cm of the flap cranial base. The areas of necrosis were examined by two macroscopic analyses: paper template and Mini-Mop(®). The pervious blood vessels were also counted.

Results: The results were statistically analyzed by ANOVA and post-test contrast orthogonal method (multiple comparisons), showing that the laser decreased the area of necrosis in flaps subjected to nicotine, and consequently, increased the number of blood vessels (p < 0.05).

Conclusions: The laser proved to be an effective way to decrease the area of necrosis in rats subjected to nicotine, making them similar to the control group.
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http://dx.doi.org/10.1089/pho.2010.2883DOI Listing
August 2011

Comparative effects of wavelengths of low-power laser in regeneration of sciatic nerve in rats following crushing lesion.

Lasers Med Sci 2010 May 6;25(3):423-30. Epub 2010 Feb 6.

Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto 14049-900, SP, Brazil.

Peripheral nerves are structures that, when damaged, can result in significant motor and sensory disabilities. Several studies have used therapeutic resources with the aim of promoting early nerve regeneration, such as the use of low-power laser. However, this laser therapy does not represent a consensus regarding the methodology, thus yielding controversial conclusions. The objective of our study was to investigate, by functional evaluation, the comparative effects of low-power laser (660 nm and 830 nm) on sciatic nerve regeneration following crushing injuries. Twenty-seven Wistar rats subjected to sciatic nerve injury were divided into three groups: group sham, consisting of rats undergoing simulated irradiation; a group consisting of rats subjected to gallium-aluminum-arsenide (GaAlAs) laser at 660 nm (10 J/cm(2), 30 mW and 0.06 cm(2) beam), and another one consisting of rats subjected to GaAlAs laser at 830 nm (10 J/cm(2), 30 mW and 0.116 cm(2)). Laser was applied to the lesion for 21 days. A sciatic functional index (SFI) was used for functional evaluation prior to surgery and on days 7, 14, and 21 after surgery. Differences in SFI were found between group 660 nm and the other ones at the 14th day. One can observe that laser application at 660 nm with the parameters and methods utilised was effective in promoting early functional recovery, as indicated by the SFI, over the period evaluated.
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http://dx.doi.org/10.1007/s10103-009-0750-8DOI Listing
May 2010