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BACKGROUND: Stroke is associated with high rates of falling and severe impairment of lower limb in patients who survive. OBJECTIVE: The aim of this study was to analyze the effectiveness of different montages of transcranial direct current stimulation (tDCS) on reducing falls and on lower limb function after acute stroke. METHODS: Sixty participants with acute stroke were randomly allocated into four groups with different electrode's setups: anodal, cathodal, bilateral and sham tDCS. Each patient received 10 stimulation sessions (five consecutive days for two weeks). Four Square Step Test, Occurrence of Falling Index, Overall Stability Index, Falls Efficacy Scale - International, Berg Balance Scale, Six-minute walk test and Sit to Stand Test were measured at baseline, post-treatment, and at one- and three-month follow-up. RESULTS: At baseline, no differences between the groups in terms of clinical and demographic characteristics were found. However, after treatment and during follow up, all the groups that received active stimulation showed greater reduction in the risk of falls and improved performance of the lower limb's motor skills when compared to the sham group. No significant differences were found between the three types of active montages in relation to the risk of falling. In relation to lower limb function, bilateral stimulation provided a higher improvement when compared to anodal and cathodal tDCS. CONCLUSIONS: This is the first trial with different setups of tDCS on acute stroke patients. tDCS presents as an effective treatment strategy in reducing the risk of falls and improving lower limb function after a stroke. ClinicalTrials.gov (NCT 02422173).

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Introdução: A dor lombar promove hipotrofia, alterações do controle motor e instabilidade lombar, necessitando de adequado tratamento. Objetivo: Analisar o efeito do tratamento fisioterapêutico na força de extensão do tronco, na atividade elétrica dos músculos transverso abdominal (TrA) e multífido lombar (ML) e na dor em lombálgicos crônicos. Métodos: Foram avaliados 19 voluntários pré e póstratamento fisioterapêutico quanto a força de extensão do tronco, atividade mioelétrica (TrA e ML), e dor. Resultados: Não houve alteração na força de extensão do tronco (p=0,064); a atividade eletromiográfica apresentou diferença no ML, dos lados direito (p<0,01) e esquerdo (p<0,05) durante o repouso na comparação pré e pós, e no TrA (p<0,05) no repouso, pré tratamento; a dor apresentou diminuição significativa pós-tratamento (p<0,001). Conclusão: O tratamento fisioterapêutico aplicado não alterou a força e teve pouco efeito na atividade mioelétrica do ML e TrA, no entanto, reduziu drasticamente o quadro álgico.

Introduction: Low back pain leads to hypotrophy, changes in motor control and lumbar instability, requiring appropriate treatment. Objective: To analyze the effect of physiotherapy on the strength of upper body extension, electric activity of the TrA and ML muscles and pain in patients with chronic low back pain. Methods: Nineteen volunteers were pre and post physical therapy evaluated in the upper body extension strength, electric activity (TrA and ML) and pain.Results: There was no change in upper body extension strength (p=0.064); the was difference in ML electromyographic activity, on the right side (p<0.01) and left (p<0.05) at rest in pre and post comparison and in TrA (p<0,05) at rest pre treatment; pain post treatment showed significant reduction (p<0,001). Conclusion: The physical therapy treatment applied did not change the strength and had little effect on myoeletric activity of the ML and TrA, however, drastically reduced the painful condition.

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Objetivo: Analisar as alterações termográficas em pacientes com lombalgia crônica sob diferentes intervenções fisioterapêuticas. Método: Selecionaram-se 33 indivíduos com lombalgia crônica que foram aleatorizados em quatro grupos: terapia manual (gTM; n=10); estabilização segmentar lombar (gESL; n=7); terapia combinada ­ TM + ESL (gTC; n=7); e orientações posturais/controle (gOP; n=9). Todos realizaram dez sessões fisioterapêuticas e avaliados, pré- e pós-tratamento, quanto à temperatura cutânea (termografia infravermelha) e dor (Escala Visual Analógica ­ EVA) na região lombar. Utilizou-se Anova (4x3x2) para comparar quatro grupos, três áreas (ALE, AC e ALD) e duas avaliações (pré- e pós- tratamento), para temperatura cutânea; e Anova (4x2) entre os quatro grupos, pré- e pós-tratamento, para a EVA, considerando α≤5%. Resultados: Não houve diferença significativa na temperatura da região lombar, comparando-se pré- e pós-tratamento; contudo, a EVA mostrou redução significativa para os grupos (P≤0,01). Conclusão: Apesar dos tratamentos não terem minimizado a temperatura na região lombar, diminuíram, drasticamente, o nível de dor nos grupos.

Objective: To analyze the thermographic changes in patients with chronic low back pain under different physical therapy interventions. Method: Thirty three chronic low back pain individuals were randomized into four groups: manual therapy (MTg; n=10), lumbar stabilization (LSg; n=7); combined therapy ­ MT + LS (CTg; n=7) and postural orientation/control (PGg; n=9). All individuals underwent ten physiotherapy sessions and evaluated pre- and post-treatment as skin temperature (infrared thermography), and pain in the lower back (Visual Analogue Scale ­ VAS). Anova (4x3x2) comparing four groups, three areas (LLA, CA and RLA) and two evaluations (pre- and post-treatment) for skin temperature; and Anova (4x2) between the four groups, pre- and post-treatment, were used for VAS, considering α ≤5%. Results: There was no significant difference in lower back temperature, comparing pre- and post-treatment; however, the VAS showed a significant reduction for all groups (P≤0.01). Conclusion: Although the treatments have not minimized the temperature in the lumbar region, they were able to decrease dramatically the level of pain, in all groups.

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Objetivo: Identificar os efeitos da terapia manual notratamento de um atleta com disfunção de ilíaco. Material eMétodos: As medidas de dor, força muscular e goniométricasforam obtidas pelo mesmo avaliador, antes e após a aplicaçãodo protocolo de tratamento, que foi dividido em: fase inicial eintermediária. Foram realizadas 26 sessões de terapia manualcom duração de 50 minutos, 3 vezes por semana, durante10 semanas. Os dados dos níveis de dor, força muscular eADM foram analisados no Software SPSS (15.0), pelo testet Student (pareado) considerando-se um nível de significânciade 5%. Resultados: O atleta obteve resultados estatísticossignificativos de redução do quadro álgico no lado direito(P=0,019) e lado esquerdo (P=0,022), e aumento da forçamuscular no lado direito (P=0,021) e no lado esquerdo(P=0,023). Em relação à ADM não houve variaçõessignificativas. Conclusão: De acordo com os resultadosapresentados, o protocolo elaborado para este caso, foiefetivo no tratamento da disfunção do ilíaco por corrigirassimetrias nas estruturas pélvicas analisadas, diminuir olimiar de dor e aumentar a força muscular na região lombar epélvica.

Objective: To identify the effects of manual therapy in treatingan athlete with iliac dysfunction. Materials and methods:Measurements of pain, muscle strength and goniometricvalues were obtained by the same examiner, before andafter applying the treatment protocol, which was divided intoearly and intermediate stage. A total of 26 sessions of manualtherapy were performed lasting 50 minutes 3 times a weekfor 10 weeks. Data of levels of pain, muscle strength andROM were analyzed by Student t test (paired) on the SPSSsoftware (15.0), considering a significance level of 5%.Results: The results showed statistically significant reductionof pain on the right side (P = 0.019) and left side (P = 0.022),and increased muscle strength on the right side (P = 0.021)and left side (P = 0.023). Regarding ROM, there were nosignificant variations. Conclusion: According to the results,the protocol developed for this case was effective in iliacdysfunction treating by correcting imbalances in the analyzedpelvic structures, lowering pain threshold and increasingmuscle strength in the lower back and pelvis.

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