Effects of photobiomodulation on pain, lactate and muscle performance (ROM, torque, and EMG parameters) of paretic upper limb in patients with post-stroke spastic hemiparesis-a randomized controlled clinical trial

The objective of the study was to investigate the impact of photobiomodulation (PBM) on the paretic upper limb in post-stroke patients with spastic hemiparesis and to understand the potential of PBM as a long-term non-invasive therapy for reducing the side effects caused by spasticity in the hemiparetic upper limb after a stroke. This is a double-blind randomized clinical trial constituted of 27 participants, being Control group (CG = 12 healthy individuals) and PBM group (PBMG = 15 post-stroke individuals). In the CG, the baseline blood lactate (BL) was evaluated, followed by the evaluation of the IC torque of the biceps and triceps muscles, with the isokinetic dynamometer associated with surface electromyography (EMG) and, subsequently, a new measurement of BL. The PBMG received 10 sessions of treatment with PBM (780 nm, Power: 100 mV, Power Density: 3.18 W/cm2, Energy: 4 J, Fluency: 127.4 J/cm2, Time: 40 s per point and 1.280 s total, Spot: 0.0314 cm2, 32 Points: 16 points (brachial biceps) and 16 points (brachial triceps) applied with contact at 90°, Total Energy: 64 J), which in the pre-treatment evaluation measured BL, the visual analogue scale (VAS) of pain; torque and EMG of the same muscles in the IC, subsequently, a new measurement of VAS and BL, and measurement of range of motion (ROM) during the reaching movement. At the conclusion of the ten sessions, all participants underwent a reassessment, wherein all tests originally administered during the initial evaluation were repeated. Subsequently, the data were analyzed using the Shapiro-Wilk normality test. For related data, the paired t-test was used for normal distributions and the Wilcoxon test for non-normal data. For unrelated data, the t test was used for normal distributions and the Mann-Whitney test for non-normal data. Muscle torque was higher for the CG, with a significant difference (CGxPBMG = p < 0.0001). There was no significant difference between the EMG values of the CG in relation to the Pre-PBM phase and with the Post-PBM phase of the PBMG (p > 0.05). On the other hand, there was a 38% reduction in pain reported by hemiparetic patients (p = 0.0127) and a decrease in BL in the PBMG. Post-PBM ROM increased by 46.1% in the elbow extension of the paretic limb. In conclusion, Photobiomodulation (PBM) demonstrated significant improvements in muscle performance, reducing fatigue and pain levels, and enhancing range of motion in post-stroke patients with spastic hemiparesis. These findings support the potential integration of PBM into rehabilitation protocols, but further research and clinical trials are needed to validate and expand upon these promising outcomes.

Transcranial photobiomodulation therapy associated with cardiorespiratory rehabilitation in spastic subjects

The objective of this study was to evaluate the effects of cardiorespiratory rehabilitation (CR) and transcranial photobiomodulation (tPBM) on exercise tolerance (ET), heart rate variability (HRV), and peripheral muscle activity in individuals with spasticity. Fifteen participants with spasticity were randomly assigned to two groups: the tPBM group (tPBMG) consisted of eight volunteers who underwent tPBM (on mode) and CR, while the control group (CG) consisted of seven volunteers who underwent simulated tPBM (off mode) and CR. The CR program included 12 weeks of treatment, twice a week for one hour, involving aerobic exercises and lower limb strengthening. For tPBM, a cluster with three lasers (λ = 680 nm, 808 nm), with a power of 100 mW/laser and energy of 36 J, applied to the F7, F8, and Fpz points. The following parameters were evaluated after 8 and 12 weeks: ET, HRV, and surface electromyography (EMG) of the rectus femoris muscle during orthostasis (ORT), isometric squatting (ISOM), and isotonic squatting (ISOT). Both groups showed a 40% increase in ET for the CG and a 30% increase for the tPBMG. The CG had more pronounced parasympathetic modulation alterations during post-exercise effort and recovery compared to the tPBMG. The EMG results showed that the tPBMG exhibited progressive improvement in muscle activity during ISOM and ISOT, as well as a decrease in the interlimb difference. In conclusion, both CR and tPBMG demonstrated improvements in ET. However, tPBMG specifically showed promising effects on HRV modulation and peripheral muscle electrical activity, providing additional benefits compared to CR alone.

EFEITOS DA TERAPIA VIRTUAL NA FUNÇÃO MOTORA DO MEMBRO SUPERIOR PARÉTICO DE PACIENTES PÓS ACIDENTE VASCULAR ENCEFÁLICO

Este artigo teve como objetivo avaliar os efeitos da Terapia Virtual (TV) no membro superior parético de indivíduos pós AVE. Participaram do estudo seis voluntários, que realizaram a terapia virtual utilizando o vídeo game XBOX 360, por meio do jogo vazamentos. Foram realizados 10 atendimentos de tratamento ininterruptos, por 30 minutos, durante duas semanas. A avaliação consistiu na quantificação da força e atividade mioelétrica no primeiro, no sexto e após o décimo atendimento. Os resultados mostraram aumento significativo da força, com consequente aumento da atividade elétrica do músculo bíceps braquial e diminuição da atividade mioelétrica para o músculo tríceps braquial (p<0,05). Desse modo, acredita-se que esta forma de terapia possa ser associada aos recursos terapêuticos convencionais para acelerar o processo de reabilitação de indivíduos hemiparéticos espásticos.

Analysis of the effects of low-level laser therapy on muscle fatigue of the biceps brachii muscle of healthy individuals and spastic individuals: Study protocol for a single-center, randomized, double-blind, and controlled clinical trial

BACKGROUND

Muscular fatigue is caused by biochemical alterations that modify the mechanics of muscle contraction, resulting in negative changes in the performance of the contraction. Several resources are studied to mitigate this situation among which we can cite low-level laser therapy (LLLT). The effects of LLLT are being studied in healthy subjects with fibromyalgia and who are athletes, and currently the studies are being performed in spastic muscles with poststroke individuals. The aim will be to evaluate the effects of LLLT on the fatigue of the biceps brachii muscle of healthy individuals and individuals with spastic hemiparesis.

METHODS

A cross-sectional, comparative, randomized, placebo, double-blind clinical trial will be divided into 2 phases: phase I shall consist of 30 healthy subjects and phase II of 30 poststroke individuals. The study will consist of 3 groups (control group, placebo group, and LLLT group), and all individuals will pass through all groups, following the randomization criteria. The protocol consists of the application of LLLT in the biceps brachii muscle on the dominant side in healthy individuals and in the hemiparetic side of poststroke individuals, and, subsequently, 3 maximal isometric voluntary contractions (MIVCs) will be performed for 50 seconds in the dynamometer, with an interval of 50 seconds between them. Pain intensity will be evaluated by means of the visual analog scale, and the myoelectric activity by means of surface electromyography associated with the evaluation of muscular strength by means of the dynamometer. The local temperature will be evaluated by infrared thermography and blood lactate concentration through the lactimeter, which will be measured at 4 different times, before the application of the laser (basal), and 3, 15, and 25 minutes after the MIVC.

EFEITOS DA ESTIMULAÇÃO ELÉTRICA NEUROMUSCULAR NO MÚSCULO TRÍCEPS SURAL DE INDIVÍDUOS HEMIPARÉTICOS CRÔNICOS

A estimulação Elétrica Neuromuscular (EENM) tem sido utilizada como recurso terapêutico para ganho de força muscular e diminuição da hipertonia espástica. O objetivo do estudo foi verificar os efeitos da EENM aplicado no músculo gastrocnêmio medial dos indivíduos com hemiparesia espástica após AVE e verificar se a EENM promove inibição recíproca. Foi realizado um estudo experimental em seis indivíduos hemiparéticos espásticos após AVE, em que foi aplicado a EENM no músculo gastrocnêmio medial do lado parético. Utilizou a eletromiografia de superfície para obtenção da atividade elétrica do músculo tibial anterior e gastrocnêmio medial durante o movimento de dorsiflexão e flexão plantar do tornozelo. Para a verificação de existência de diferenças estatísticas entre as médias dos dados, utilizou-se a análise de variância – Anova. Os resultados indicam que a EENM aplicado no músculo gastrocnêmio medial pode promover inibição recíproca no movimento de flexão plantar (p=0,005); no entanto, durante o movimento de dorsiflexão, a maioria dos pacientes não apresentou inibição recíproca significativa (p>0,005). Em relação à atividade mioelétrica, o músculo gastrocnêmio medial e tibial anterior foi menor para a maioria dos pacientes. Conclui-se que a EENM quando aplicado no músculo gastrocnêmio medial associado ao alongamento passivo por meio de inibição autógena, pode estimular a inibição recíproca da articulação do tornozelo do membro comprometido, assim como promover a diminuição da atividade mioelétrica do músculo gastrocnêmio medial.

Sensory-motor and cardiorespiratory sensory rehabilitation associated with transcranial photobiomodulation in patients with central nervous system injury: Trial protocol for a single-center, randomized, double-blind, and controlled clinical trial

BACKGROUND

Central nervous system diseases such as stroke, spinal cord injury, traumatic brain injury, and multiple sclerosis can be fatal or cause sequelae, affecting sensorimotor and cardiorespiratory systems and quality of life. These subjects present a low response to aerobic and resistance exercise, due to decreased recruitment of muscle fibers and reduction of metabolic capacity. Aerobic exercises bring benefits in terms of fatigue retardation, gait improvement, regulation of the autonomic nervous system, neuroprotection of the brain, stimulation of the production of endogenous neutrotransmitters related to general well-being, and a favoring of neuroplasticity. Photobiomodulation (PBM Therapy) (previously known as low-level laser therapy), and especially transcranial PBM Therapy, has shown benefits in animals and humans such as cognitive improvement, memory, and behavioral improvement, including attenuation of depression and anxiety, and increased cortical oxygenation. The aims of this trial will be to evaluate the parameters related to the function of the musculoskeletal and cardiorespiratory system and the impact of PBM therapy on these parameters, as part of a rehabilitation and training program for people with reduced mobility.

METHODS

This is a randomized, double-blind, placebo-controlled trial with 3 groups: Control, only cardiorespiratory rehabilitation (CCR), CCR with PBM Therapy (CR-PBM), CCR and placebo PBM Therapy (CR-PlaceboPBM). n = 90, 30 per group. PBM Therapy parameters: 810 nm laser, 0.028 cm, 100 mW, 3.5 W/cm, 30 seconds per point, 3 J per point, 107.1 J /cm to 3 electroencephalogram points F7 and F8 and AFz. The trial will be conducted at the University Clinics and the sessions will be 1 hour twice a week for 9 weeks. Baseline, intermediate (4th week), final (9th week), and 2-month follow-up will be performed. Muscular activation, heart rate variability, lung volumes and capacities, fatigability, exercise tolerance, cognition, and quality of life at baseline will be evaluated. Subsequent to baseline evaluations, the PBM Therapy groups will be offered laser therapy (active or inactive); all groups will then receive CCR.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov ID - NCT03751306 (approval date: November 22, 2018).

Effects of low-level laser therapy (LLLT 808 nm) on lower limb spastic muscle activity in chronic stroke patients

A cerebrovascular accident (CVA) may affect basic motor functions, including spasticity that may be present in the upper extremity and/or the lower extremity, post-stroke. Spasticity causes pain, muscle force reduction, and decreases the time to onset of muscle fatigue. Several therapeutic resources have been employed to treat CVA to promote functional recovery. The clinical use of low-level laser therapy (LLLT) for rehabilitation of muscular disorders has provided better muscle responses. Thus, the aim of this study was to evaluate the effect of the application of LLLT in spastic muscles in patients with spasticity post-CVA. A double-blind clinical trial was conducted with 15 volunteer stroke patients who presented with post-stroke spasticity. Both males and females were treated; the average age was 51.5 ± 11.8 years old; the participants entered the study ranging from 11 to 48 months post-stroke onset. The patients participated in three consecutive phases (control, placebo, and real LLLT), in which all tests of isometric endurance of their hemiparetic lower limb were performed. LLLT (diode laser, 100 mW 808 nm, beam spot area 0.0314 cm(2), 127.39 J/cm(2)/point, 40 s) was applied before isometric endurance. After the real LLLT intervention, we observed significant reduction in the visual analogue scale for pain intensity (p = 0.0038), increased time to onset of muscle fatigue (p = 0.0063), and increased torque peak (p = 0.0076), but no significant change in the root mean square (RMS) value (electric signal in the motor unit during contraction, as obtained with surface electromyography). Our results suggest that the application of LLLT may contribute to increased recruitment of muscle fibers and, hence, to increase the onset time of the spastic muscle fatigue, reducing pain intensity in stroke patients with spasticity, as has been observed in healthy subjects and athletes.