INTRODUÇÃO: Incontinência urinária (IU) é uma complicação comum após prostatectomia radical. Apesar da recuperação da continência ser adquirida pela maioria dos pacientes, esta pode demorar de um a dois anos. Neste trabalho, estudou-se o efeito da reabilitação do assoalho pélvico com biofeedback (RAPB) precoce sobre a gravidade e duração da IU até 12 meses após a prostatectomia radical retropúbica (PRR). MÉTODOS: Realizou-se um estudo prospectivo, controlado e randomizado comparando a RAPB precoce, aos cuidados usuais. A amostra incluiu 73 homens entre 47 e 76 anos, que elegeram a PRR para o tratamento de câncer de próstata localizado e que poderiam cumprir a agenda do programa ambulatorial. Os pacientes foram randomizados em grupo de tratamento (n=36) e grupo controle (n=37). Após a retirada do catéter, os pacientes do grupo de tratamento receberam RAPB uma vez por semana enquanto estavam incontinentes por no máximo 12 semanas e praticaram exercícios domiciliares. Pacientes do grupo controle receberam instruções usuais para contraírem os músculos do assoalho pélvico. Ambos os grupos foram avaliados antes da cirurgia e um, três, seis e 12 meses após a PRR. A força muscular do assoalho pélvico (FMAP) foi avaliada pela escala de Oxford. Os sintomas de incontinência foram medidos pelo domínio de incontinência do Questionário da Sociedade Internacional de Continência para homens (ICSmaleSF). O impacto da IU sobre a qualidade de vida foi medido pelo Questionário de Impacto da Incontinência (IIQ-7). Continência urinária foi definida como o uso de uma proteção ou menos por dia. A incontinência foi graduada pelo teste de fraldas de 24h em leve (perdas menores que 20g), moderada (perdas entre 21 e 74g) e grave (perdas maiores que 75g). RESULTADOS: A avaliação pré-operatória não mostrou diferenças de idade, diabetes, índice de massa corpórea, peso da próstata, FMAP ou sintomas miccionais entre os grupos. Após 12 meses de cirurgia, 25 (96.2%) dos pacientes do grupo de tratamento e 20 (75.0%) pacientes do grupo controle estavam continentes (p=0.028). A redução do risco absoluto foi 21.2% (95% CI: 3.4538.81%) e o risco relativo de recuperação da continência foi 1.28 (95% CI: 1.021.69). O número necessário para tratar foi 5 (95% CI: 2.628.6). O percentual de incontinência grave foi maior no grupo controle em um mês (p=0.015), três meses (p=0.038), seis meses (p=0.012) e 12 meses (p=0.021). Os sintomas de incontinência diminuíram significativamente no grupo de tratamento em um mês (p=0.011), três meses (p=0.002) e 12 meses (p=0.04), mas não em seis meses (p=0.063). A FMAP foi maior após o tratamento em um mês (p=0.043), três meses (p<0.001), seis meses (p=0.021) e 12 meses (p=0.035). O impacto da IU sobre a qualidade de vida foi significativamente melhor no grupo de tratamento no primeiro mês (p=0.025). CONCLUSÕES: A reabilitação do assoalho pélvico com biofeedback precoce diminuiu a gravidade e duração da incontinência urinária após prostatectomia radical retropúbica / INTRODUCTION: Urinary incontinence (UI) is a common complication after radical prostatectomy. Although recovery of continence is achieved by most patients, it can take one to two years. This study tested the effectiveness of pelvic floor biofeedback training (PFBT) on the severity and duration of UI up to 12 months following radical retropubic prostatectomy (RRP). METHODS: This study was a prospective, controlled, randomized trial comparing early postoperative PFBT to usual care. The sample included 73 men between 47 and 76 years old who elected RRP for treatment of clinically localized prostate cancer and could comply with the ambulatory treatment schedule. Patients were randomized into a treatment group (n=36) and a control group (n=37). After catheter removal, patients in the treatment group received PFBT once a week for as long as they were incontinent for a maximum of 12 weeks and practiced exercises at home. Patients in the control group received the usual instructions to contract the pelvic floor muscles. Both groups were evaluated before surgery and one, three, six and 12 months after RRP. Pelvic floor muscle strength (PFMS) was evaluated by the Oxford Scale. Incontinence symptoms were measured by the incontinence part of the International Continence Society Male Short Form Questionnaire (ICSmaleSF). The impact of incontinence on quality of life was measured by the Incontinence Impact Questionnaire (IIQ-7). Urinary continence was defined as the use of one or less pad per day. Incontinence was graduated by the 24h pad test in mild (less than 20g), moderate (between 21 and 74g) and severe (more than 75g). RESULTS: The preoperative assessment did not show differences in age, diabetes, body mass index, prostate weight, PFMS or voiding symptoms between the groups. At 12 months postoperatively, 25 (96.2%) patients in the treatment group and 20 (75.0%) in the control group were continent (p=0.028). The absolute risk reduction was 21.2% (95% CI: 3.4538.81%) and the relative risk of recovering continence was 1.28 (95% CI: 1.021.69). The number needed to treat was 5 (95% CI: 2.628.6). The percentage of severe incontinence was stronger for the control group at one month (p=0.015), three months (p=0.038), six months (p=0.012) and 12 months (p=0.021). Incontinence symptoms significantly decreased in the treatment group at one month (p=0.011), three months (p=0.002) and 12 months (p=0.04), but not at six months (p=0.063). PFMS was stronger after PFBT at one month (p=0.043), three months (p<0.001), six months (p=0.021) and 12 months (p=0.035). The impact of UI on quality of life was significantly improved for the treated group in the first month (p=0.025). CONCLUSIONS: Early pelvic floor biofeedback training decreased the severity and duration of urinary incontinence after radical retropubic prostatectomy

O futebol é um esporte coletivo, em que desempenhos individuais podem definir o resultado de um jogo ou de um campeonato. Especialmente em cobranças de pênalti, o destino da partida encontra-se nos pés do cobrador. A ansiedade no momento das cobranças de pênalti em jogos de futebol de campo é um dos motivos que podem fazer com que um jogador de futebol não converta a cobrança em gol. Neste estudo experimental controlado foi testado um protocolo de biofeedback e psicologia cognitivo-comportamental com o objetivo de reduzir o estado de ansiedade em atletas de futebol amadores de futebol de campo de 15 e 16 anos de idade. Os participantes do grupo experimental foram avaliados antes de duas competições de pênaltis, que aconteceram antes e depois de quatro encontros de intervenção com o protocolo de biofeedback e psicologia cognitivo-comportamental para a redução de ansiedade dos jogadores de futebol que participaram do grupo ativo, em relação ao grupo controle / Soccer is a collective sport in which individual performances can define the outcome of a game or a championship. Especially at penalties shootouts, the destination of the match is at the feet of the penalty taker. Anxiety at the time of penalty kicks at soccer matches is one of the reasons why a soccer player may not score the goal. In this controlled experimental study, a protocol of biofeedback and cognitive-behavioral psychology was tested with the objective of reducing the state anxiety in 15 and 16 year old amateur soccer athletes. Participants in the experimental group were assessed before two penalty shoot-outs, which took place before and after four intervention sessions with a biofeedback and cognitive-behavioral psychology protocol. The results showed that the protocol was efficient as a method and effective in reducing the anxiety state of soccer players who participated in the experimental group, in comparison to the control group

O neurofeedback é um processo psicofisiológico de aprendizagem por meio do qual o indivíduo obtém controle sobre a freqüência de suas ondas cerebrais. Este estudo objetivou avaliar o efeito do treinamento do ritmo beta inferior (12-15Hz) sobre o córtex sensoriomotor e a concomitante inibição do ritmo teta (4-8Hz) na mesma área, sobre o desempenho atencional, mnemônico e cognitivo de adultos normais de nível universitário. Formou-se um grupo experimental e um grupo controle com 11 sujeitos cada, com idade média de 25,7 anos, estudantes de uma instituição de ensino superior particular em São Paulo. Todos os sujeitos foram submetidos a pré e pós-testes de inteligência não-verbal (Matrizes Progressivas de Raven Escala Avançada), verbal (V-47), atenção (D2) e memória (Fator M Bateria Cepa). O experimento, que durou dois meses, submeteu os sujeitos experimentais a 36 sessões (em média) de treinamento em neurofeedback, com a duração de 15 minutos cada e freqüência de três vezes por semana. Os resultados indicaram uma melhora significante nos processos atencionais, mnemônicos (icônicos) e edutivos (inteligência não-verbal). Não foram obtidas melhoras significantes nos processos mnemônicos (ecóicos) e reprodutivos (inteligência verbal). A comparação do grupo experimental com o grupo controle indicou a não relevância do efeito aprendizagem (teste-reteste) nas tarefas utilizadas para a avaliação dos sujeitos / Neurofeedback is a psychophysiological process where visual stimuli and sounds are employed to reinforce voluntary control over EEG patterns. This study evaluated the effect of low beta (12-15Hz) increase and theta (4-8Hz) inhibit training over sensorimotor cortex on attention, memory and cognitive performance of young adults college students. Experimental and control groups were formed by 11 volunteers subjects each, aging 25,7 years on average. All subjects were submitted to pre and post evaluations of non-verbal (Ravens Advanced Progressive Matrices) and verbal intelligence (V-47 test), attention (D2 test) and memory (Fator M Bateria Cepa). The experiment was conducted along two months, subjects having an average of 36 sessions (15 minutes each), three times a week. Results provide strong evidences of significant improvement on attention, visual memory and non-verbal intelligence (eduction). However, it could not be found evidence of significant improvement on auditory memory or verbal intelligence (reproduction). The experimental and control comparision did not indicate test-retest effects on the experiment

Seit vier Jahrzehnten werden verschiedene Neurofeedbackmethoden bei der Behandlung unterschiedlicher Störungen, unter anderem bei AD/HS-Kindern, eingesetzt. Die Grundlage der Anwendung von Neurofeedback bei dieser Störung besteht darin, dass die Kinder Auffälligkeiten in ihrem EEG zeigen. Dort treten im Vergleich zu unauffälligen Kindern vermehrt Theta-Gehirnwellen und weniger Beta-Gehirnwellen auf. Mittels Neurofeedback wird versucht, die Gehirnfunktionen zu korrigieren. Zahlreiche Einzellfallstudien bestätigen die Wirksamkeit dieser Therapiemethode bei der AD/HS-Behandlung. Bisher wurde jedoch keine Studie veröffentlicht, in der die Wirksamkeit von Neurofeedback mit einer Placebogruppe verglichen wurde. Ziel der vorliegenden Studie war es, die Wirksamkeit eines Theta/Beta-Neurofeedbacks (NF) bei der Behandlung von AD/HS-Kindern zu überprüfen und mit einem EMG-Biofeedback (BF) als Placebobedingung zu vergleichen. Es wurden 35 ADHS-Kinder (6 -14 Jahre; 26 Jungen und 9 Mädchen) untersucht. Nach Standarddiagnostik und Vergabe der AD/HS-Diagnose durch einen unabhängigen Psychotherapeuten wurden die Kinder per Zufall zwei Gruppen (NF: n = 18 bzw. BF: n = 17) zugeteilt. Alle Kinder beider Gruppen erhielten ein 30 Sitzungen umfassendes Training mittels Theta/Beta-Neurofeedback bzw. EMG-Biofeedback. Unmittelbar vor und nach dem Training wurden Intelligenz- bzw. Aufmerksamkeitsleistungen untersucht und Einschätzungen des Verhaltens von Eltern und Lehrern erhoben. Im Anschluss an das Training erfolgte eine erneute diagnostische Einschätzung durch einen unabhängigen Psychotherapeuten. Die EEG-Daten in der NF-Gruppe zeigen eine Reduktion der Theta/Beta-Quotienten im Laufe der NF-Sitzungen. Die EMG-Daten zeigen für die EMG-Biofeedback-Bedingung gleichfalls eine Reduktion der EMG-Amplitude. Die Ergebnisse der zweifaktoriellen Varianzanalysen mit Messwiederholung auf einem Faktor zeigen für die angewendeten diagnostischen Verfahren die erwarteten signifikanten Interaktionen zwischen Messzeitpunkt und Gruppe. Die Ergebnisse des t-Tests zeigen signifikante Verbesserungen in der Aufmerksamkeitsleistung, dem Intelligenzniveau und im Verhalten der Kinder aus der NF-Gruppe im Vergleich zu den Resultaten des Prä-Tests. Die EMG-Biofeedbackgruppe zeigt mit Ausnahme einer Erhöhung des Arbeitstempos in den Paper-Pencil-Aufmerksamkeitstests (die im CPT nicht repliziert werden konnte) keine signifikanten Verbesserungen relativ zum Prä-Test. Nach dem Training erhielten 55,6 % (n = 10) der AD/HS-Kinder aus der Neurofeedbackgruppe und 23,5 % (n = 4) der Kinder aus der EMG-Biofeedbackgruppe keine AD/HS-Diagnose nach den Kriterien der ICD-10. Der Chi-Quadrat-Test zeigt jedoch lediglich einen tendenziell bedeutsamen Unterschied (p = .086). Insgesamt bestätigen die Ergebnisse die Wirksamkeit des Neurofeedbacks bei der Behandlung von ADHS-Kindern im Vergleich mit einer Placebogruppe. Weitere Studien in diesem Bereich sind notwendig, um die Wirksamkeit des Neurofeedbacktrainings im Vergleich zu einer Placebomethode bei der ADHS-Behandlung zu untersuchen. / Neurofeedback (NF) has been introduced four decades ago as an alternative treatment for different disorders, one of these being Attention Deficit/Hyperactivity Disorder (AD/HD). As compared to a control group (non ADHD children), children diagnosed with ADHD show an increased frequency of Theta waves and a decreased frequency of Beta waves in their EEGs. A treatment consisting of NF-training attempts to correct these anomalies. There are numerous single case studies in this area but only a few controlled studies. Furthermore, there are no studies comparing the effect of NF in the treatment of ADHD with a placebo group. This study sets out to evaluate the effects of 30 (Theta/Beta) NF training sessions on ADHD symptoms and compare those with the effects of the placebo EMG-biofeedback (BF) training group. The subjects, consisting of 35 children both male (n = 26) and female (n = 9) between the ages of 6 and 14 diagnosed with ADHD by independent psychotherapists, were randomly assigned to either the treatment group (NF; n = 18) or the placebo group (BF; n = 17). In addition to the Theta/Beta quotient (in NF group) and EMG-Amplitude (in BF group) as seen during the sessions, pre and post measures of the subjects´ intelligence (Raven Test), paper-pencil attention test scores (bp/d2), Continuous Performance Task (CPT) as well as symptom ratings (MEF and FBB-HKS) from both teachers and parents were obtained. Finally, subjects were re-evaluated after treatment by independent psychotherapists. The results showed a significant decrease in the Theta/Beta quotient after the NF training and a significant decrease in the EMG-Amplitude after the BF-training. The results of an ANOVA with repeated measures showed significant differences between the treatment group (NF training) and the placebo (BF training) group in attention tests and symptom rating scores after treatment. Compared to the pre-test scores, subjects in the NF group showed significant improvements in attention scores, intelligence scores, and behaviour after the NF training sessions. The BF placebo group showed no significant improvements in any of the outcome variables except on the speed scale of the paper-pencil attention tests (this was incompatible with the results of CPT). Finally, 55.6% (n = 10) of the children in the NF training group were not diagnosed with ADHD (using ICD-10 criteria) at the time of the second evaluation. In the BF group, 23.5% (n = 4) were not diagnosed with ADHD by independent psychotherapists at the end of the BF training. The results indicate that NF training in comparing with a placebo method is an effective treatment method in the treatment of ADHD children. Further studies are necessary in comparing the effectiveness of NF training with more neutral placebo interventions in the treatment of children with ADHD.

Chez la personne atteinte d'hémiplégie, la restauration des capacités posturales est considérée comme un des objectifs majeurs du processus de réhabilitation. Aujourd'hui, les grandes caractéristiques de la posture érigée chez le patient hémiplégique sont bien connues. Cependant, un certain nombre d'interrogations, relatives à la nature des mécanismes déficitaires et au type de rééducation à développer, subsiste. Au cours de ce travail doctoral, nous avons utilisé les concepts et les outils de l'approche dynamique des systèmes sensori-moteurs pour étudier les déficits posturaux de cette population. Dans ce cadre, ces déficits sont assimilés aux anomalies spatio-temporelles observables dans les coordinations hanche/cheville. Dans un premier temps, nous avons cherché à quantifier la nature des modifications de la dynamique posturale consécutives à une lésion cérébrale. Nous avons étudié, d'une part, la dynamique spontanée lors d'une tâche de poursuite de cible, et d'autre part, la dynamique intentionnelle en présence d'une information comportementale spécifiant la coordination à produire. A travers ces deux expérimentations, une disparition de l'attracteur en phase et une diminution de la stabilité de l'attracteur en anti-phase ont pu être mises en évidence. Dans un second temps, sur la base de ces résultats, nous avons proposé un (ré)apprentissage des deux modes de coordination préférentiels à l'aide d'un dispositif de biofeedback. L'objectif était de déterminer si la restauration d'une dynamique posturale dite "normale" était possible en dépit de la pathologie. Les résultats montrent un (ré)apprentissage du patron en phase suite au protocole; (ré)apprentissage qui s'accompagne d'une amélioration du niveau d'indépendance fonctionnelle des patients. Dans leur ensemble, ces résultats contribuent à une plus grande compréhension des déficits posturaux du patient hémiplégique et proposent des pistes de réflexion intéressantes pour la mise en place de futurs protocoles de rééducation. / The improvement of postural capacities is regarded as one of the major goals of rehabilitation of hemiplegic patients. Today, the main characteristics of the upright posture are well-known. However, many questions concerning the nature of affected mechanics and possible physical therapies remain open. In this work, we studied postural deficits in a hemiplegic population following the concepts and tools of the dynamical approach of sensori-motor systems. Deficits were considered as spatio-temporal anomalies of the organization of the postural system and analyzed through ankle/hip coordination patterns. First, we investigated modifications of postural dynamics following stroke in two different experiments. We observed both spontaneous dynamics during a tracking task and intentional dynamics using behavioral information specifing the to be produced coordination pattern. Results of both studies showed disappearance of the in-phase pattern and less stable performance in the anti-phase pattern. Second, based on gained knowledge, we proposed a (re)learning task of the two preferred postural patterns using a biofeedback design. The aim was to assess the success of this protocol for the recovery of "normal" dynamics and to explore the effect of this (re)learning on postural and functional abilities. Results suggested that the recovery of the in-phase pattern is possible and seemed to improve independence of patients. Summarized, this work proposes a new way to investigate postural deficits in post-stroke population and provided a base for the development of new therapies.

Traditional treatment for insomnia has been chemotherapy-- despite short-term value and side effects. Need for an alternative has led to research on behavioral treatment methods for insomnia. Relaxation training has consistently produced effective results, but the limited research on biofeedback and stimulus control suggests that they too may be viable alternate treatment methods. The present research investigated electromyogram (EMG) biofeedback, pseudo-EMG biofeedback, relaxation, training, and stimulus control as methods of treating sleep-onset insomnia. Volunteers consisting of 12 males and 24 females were recruited through newspaper advertisements. Subjects had no known physical cause for insomnia and were either free of sleeping medication or kept their dosage constant during the study. Subjects were matched for age and sex, randomly assigned to one of the four treatment groups, then randomly assigned to one of three therapists. Results indicated that pretreatment EMG scores for the four groups were high but not significantly different-- while post treatment EMG scores were not significantly reduced. Pretreatment sleep-latency measures were high, but not significantly different from each other. Post treatment latency measures were significantly reduced, but not significantly different from each other. Correlation between EMG-change scores and sleep-latency-change measures was non-significant. Pretreatment nightly awakenings for the four groups were not significantly different. Post treatment awakenings for the four groups were significantly reduced, but not significantly different from each other. There were not significant interactions for therapist or treatment with any of the dependent variables.

This study was designed to compare the clinical effectiveness of EMG biofeedback and progressive relaxation training in the treatment of muscle tension headache. These procedures also were compared with a treatment-element control group. Results from this study indicated that EMG biofeedback, progressive relaxation, and the control procedures all led to significant improvements across sessions on EMG and most self-report measures. There was little evidence that either treatment technique was superior to the other or to the control procedures. Although in most cases there were rather large numerical differences between groups, these differences generally were not statistically significant. Analysis of correlations between EMG and self-report data revealed a pattern of variable but generally nonsignificant relationships. However, for the biofeedback and progressive relaxation groups, there were a number of highly significant correlations. The pattern of correlations suggested that the relationship between EMG tension and subjective headache pain may be better predicted by something other than a strict linear model.

Submitted by Jean Medeiros (jeanletras@uepb.edu.br) on 2016-12-13T13:27:08Z No. of bitstreams: 1 PDF - Rossini Lucena de Medeiros.pdf: 1121632 bytes, checksum: e8c808505becdcfceefb2f7f603a94b4 (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2017-02-02T18:19:47Z (GMT) No. of bitstreams: 1 PDF - Rossini Lucena de Medeiros.pdf: 1121632 bytes, checksum: e8c808505becdcfceefb2f7f603a94b4 (MD5) / Made available in DSpace on 2017-02-02T18:19:47Z (GMT). No. of bitstreams: 1 PDF - Rossini Lucena de Medeiros.pdf: 1121632 bytes, checksum: e8c808505becdcfceefb2f7f603a94b4 (MD5) Previous issue date: 2015-12-11 / Technological innovations are considered as fundamental means of provided advances in current therapy. Electromyography surface-EMG's is defined as a technique that promotes the detection and analysis of electromyographic signals picked up by the noticeable contraction of skeletal muscles or not. The SENIAM protocol for placement of electrodes in electromyography has been corroborated by studies that evaluated the electromyographic activity of the knee extensors mainly indicate that must be followed to obtain the best muscle responses. The EMG-BFB-EMG biofeedback is a learning technique defined as a physiological event monitoring process. They pick up the electrical signal of the working muscles in microvolts (uV), and transfers it to a display that is displayed by the patient in the form of signs called electromyographic amplitude. Functional electrical stimulation (Functional Electrical Stimulation - FES), can be defined as a transcutaneous electrical stimulation technique of motor neurons, with characteristics similar to the physiological and in order to produce muscle contraction, they are used in clinical practice for muscle strengthening, as well as the recovery and functional preservation of weakened muscles. If justifying the need to pursue technological innovations that contribute to improving the efficiency and reducing health procedures costs, this research aimed to unite in an intervention method the BFB-EMG technologies with the assistance of FES current and, then conceived in one box, the synergy between them. The test proposed by this research assessed the BFB-EMG in a group of 10 volunteers, control group and also evaluated the BFB-EMG with current assistance FES other 10 volunteers, the intervention group, the research followed all ethical criteria and approves the committee ethics in research with human beings of UEPB, data collection was held at SESI-PB and equipment developed in the laboratory of researchers. All statistical tests projections showed relevance and alternative hypotheses different from zero, with differences between the most favorable medium for the intervention group made use of EMG-BFB with the current FES assistance for muscle recruitment. The team devised a device that united the EMG BFB-technologies with the current FES, which is in the final testing phase, with good response and functionality. More elaborate research needs to be encouraged to build this methodological and technological innovation for physiotherapy as to combine the two technologies the new method needs to be thoroughly tested and proven by the scientific community. / As inovações tecnológicas são consideradas como meios fundamentais de proporcionar avanços na fisioterapia atual. A eletromiografia de superfície-EMG’s é definida como uma técnica que promove a detecção e análise do sinal eletromiográfico captado pela contração perceptível ou não dos músculos esqueléticos. O protocolo SENIAM para posicionamento dos eletrodos em eletromiografia já foi corroborado por estudos que avaliaram a atividade eletromiográfica principalmente dos extensores do joelho, indicam que deve ser seguido para melhor obtenção das respostas musculares. O biofeedback eletromiográfico-BFB-EMG é uma técnica de aprendizado definida como um processo de monitoração de eventos fisiológicos. Eles captam o sinal elétrico dos músculos em atividade, em microvolts (µV), e o transfere para um display que é visualizado pelo paciente na forma de sinais denominados de amplitude eletromiográfica. A estimulação elétrica funcional (Functional Electrical Stimulation - FES), pode ser definida como uma técnica de estimulação elétrica transcutânea dos neurônios motores, com características semelhantes à fisiológica e com a finalidade de produzir contração muscular, são usados na prática clínica para o fortalecimento muscular, assim como para a recuperação e preservação funcional dos músculos enfraquecidos. Justificando-se na necessidade de se buscar inovações tecnológicas que contribuam para a melhoria da eficácia e da redução dos custos com procedimentos de saúde, esta pesquisa objetivou unir em um método de intervenção as tecnologias de BFB-EMG com a assistência da corrente FES e, em seguida, idealizou, em um só equipamento, a sinergia entre as mesmas. O teste proposto por esta pesquisa avaliou o BFB-EMG num grupo de 10 voluntários, grupo controle, e também avaliou o BFB-EMG com assistência da corrente FES noutros 10 voluntários, grupo intervenção, as pesquisas seguiram todos os critérios éticos e aprova no comitê de ética em pesquisa com seres humanos da UEPB, a coleta de dados foi realizada no SESI- PB e o equipamento desenvolvido em laboratório dos pesquisadores. Todas as projeções de testes estatísticos apresentaram relevância e hipóteses alternativas diferente de zero, com diferenças entre as médias mais favoráveis para o grupo intervenção que fez uso do BFB-EMG com assistência da corrente FES para o recrutamento muscular. A equipe de pesquisadores idealizou um equipamento que uniu as tecnologias de BFB-EMG com a corrente FES, que se encontra em fase final de testes, com boa resposta e funcionalidade. Pesquisas mais elaboradas precisam ser incentivadas para concretização desta inovação metodológica e tecnológica para a fisioterapia, pois ao unir as duas tecnologias o novo método precisa ser exaustivamente testado e comprovado pela comunidade científica.

INTRODUÇÃO: Incontinência urinária (IU) é uma complicação comum após prostatectomia radical. Apesar da recuperação da continência ser adquirida pela maioria dos pacientes, esta pode demorar de um a dois anos. Neste trabalho, estudou-se o efeito da reabilitação do assoalho pélvico com biofeedback (RAPB) precoce sobre a gravidade e duração da IU até 12 meses após a prostatectomia radical retropúbica (PRR). MÉTODOS: Realizou-se um estudo prospectivo, controlado e randomizado comparando a RAPB precoce, aos cuidados usuais. A amostra incluiu 73 homens entre 47 e 76 anos, que elegeram a PRR para o tratamento de câncer de próstata localizado e que poderiam cumprir a agenda do programa ambulatorial. Os pacientes foram randomizados em grupo de tratamento (n=36) e grupo controle (n=37). Após a retirada do catéter, os pacientes do grupo de tratamento receberam RAPB uma vez por semana enquanto estavam incontinentes por no máximo 12 semanas e praticaram exercícios domiciliares. Pacientes do grupo controle receberam instruções usuais para contraírem os músculos do assoalho pélvico. Ambos os grupos foram avaliados antes da cirurgia e um, três, seis e 12 meses após a PRR. A força muscular do assoalho pélvico (FMAP) foi avaliada pela escala de Oxford. Os sintomas de incontinência foram medidos pelo domínio de incontinência do Questionário da Sociedade Internacional de Continência para homens (ICSmaleSF). O impacto da IU sobre a qualidade de vida foi medido pelo Questionário de Impacto da Incontinência (IIQ-7). Continência urinária foi definida como o uso de uma proteção ou menos por dia. A incontinência foi graduada pelo teste de fraldas de 24h em leve (perdas menores que 20g), moderada (perdas entre 21 e 74g) e grave (perdas maiores que 75g). RESULTADOS: A avaliação pré-operatória não mostrou diferenças de idade, diabetes, índice de massa corpórea, peso da próstata, FMAP ou sintomas miccionais entre os grupos. Após 12 meses de cirurgia, 25 (96.2%) dos pacientes do grupo de tratamento e 20 (75.0%) pacientes do grupo controle estavam continentes (p=0.028). A redução do risco absoluto foi 21.2% (95% CI: 3.4538.81%) e o risco relativo de recuperação da continência foi 1.28 (95% CI: 1.021.69). O número necessário para tratar foi 5 (95% CI: 2.628.6). O percentual de incontinência grave foi maior no grupo controle em um mês (p=0.015), três meses (p=0.038), seis meses (p=0.012) e 12 meses (p=0.021). Os sintomas de incontinência diminuíram significativamente no grupo de tratamento em um mês (p=0.011), três meses (p=0.002) e 12 meses (p=0.04), mas não em seis meses (p=0.063). A FMAP foi maior após o tratamento em um mês (p=0.043), três meses (p<0.001), seis meses (p=0.021) e 12 meses (p=0.035). O impacto da IU sobre a qualidade de vida foi significativamente melhor no grupo de tratamento no primeiro mês (p=0.025). CONCLUSÕES: A reabilitação do assoalho pélvico com biofeedback precoce diminuiu a gravidade e duração da incontinência urinária após prostatectomia radical retropúbica / INTRODUCTION: Urinary incontinence (UI) is a common complication after radical prostatectomy. Although recovery of continence is achieved by most patients, it can take one to two years. This study tested the effectiveness of pelvic floor biofeedback training (PFBT) on the severity and duration of UI up to 12 months following radical retropubic prostatectomy (RRP). METHODS: This study was a prospective, controlled, randomized trial comparing early postoperative PFBT to usual care. The sample included 73 men between 47 and 76 years old who elected RRP for treatment of clinically localized prostate cancer and could comply with the ambulatory treatment schedule. Patients were randomized into a treatment group (n=36) and a control group (n=37). After catheter removal, patients in the treatment group received PFBT once a week for as long as they were incontinent for a maximum of 12 weeks and practiced exercises at home. Patients in the control group received the usual instructions to contract the pelvic floor muscles. Both groups were evaluated before surgery and one, three, six and 12 months after RRP. Pelvic floor muscle strength (PFMS) was evaluated by the Oxford Scale. Incontinence symptoms were measured by the incontinence part of the International Continence Society Male Short Form Questionnaire (ICSmaleSF). The impact of incontinence on quality of life was measured by the Incontinence Impact Questionnaire (IIQ-7). Urinary continence was defined as the use of one or less pad per day. Incontinence was graduated by the 24h pad test in mild (less than 20g), moderate (between 21 and 74g) and severe (more than 75g). RESULTS: The preoperative assessment did not show differences in age, diabetes, body mass index, prostate weight, PFMS or voiding symptoms between the groups. At 12 months postoperatively, 25 (96.2%) patients in the treatment group and 20 (75.0%) in the control group were continent (p=0.028). The absolute risk reduction was 21.2% (95% CI: 3.4538.81%) and the relative risk of recovering continence was 1.28 (95% CI: 1.021.69). The number needed to treat was 5 (95% CI: 2.628.6). The percentage of severe incontinence was stronger for the control group at one month (p=0.015), three months (p=0.038), six months (p=0.012) and 12 months (p=0.021). Incontinence symptoms significantly decreased in the treatment group at one month (p=0.011), three months (p=0.002) and 12 months (p=0.04), but not at six months (p=0.063). PFMS was stronger after PFBT at one month (p=0.043), three months (p<0.001), six months (p=0.021) and 12 months (p=0.035). The impact of UI on quality of life was significantly improved for the treated group in the first month (p=0.025). CONCLUSIONS: Early pelvic floor biofeedback training decreased the severity and duration of urinary incontinence after radical retropubic prostatectomy

INTRODUÇÃO: Disfunção erétil (DE) e incontinência urinária são complicações comuns em pacientes submetidos à prostatectomia radical (PR). Sabe-se que a reabilitação do assoalho pélvico com biofeedback pode antecipar o retorno da continência urinária; porém, os efeitos sobre a função erétil não são conhecidos. Neste trabalho estudou-se o efeito da reabilitação precoce do assoalho pélvico com biofeedback sobre a função erétil, após 12 meses da PR. MÉTODOS: Realizou-se um estudo prospectivo, controlado e randomizado. Foram convidados a participar do estudo 56 pacientes sem disfunção erétil que escolheram a PR para tratamento do câncer de próstata localizado, e que poderiam cumprir a agenda de seguimento ambulatorial. A função erétil foi avaliada pelo índice internacional de função erétil (IIEF5). Foram considerados potentes os pacientes com escore IIEF 5 >= 20. Os pacientes foram randomizados para um grupo de tratamento (n=26), recebendo reabilitação do assoalho pélvico com biofeedback uma vez por semana e orientação para exercícios domiciliares ou para um grupo controle (n=26), no qual os pacientes receberam as instruções habituais do urologista. Durante o estudo, nenhum paciente recebeu tratamento com medicamentos para DE. Foram considerados continentes os pacientes que usavam no máximo um absorvente por dia. A associação entre recuperação da continência e recuperação da potência foi avaliada. RESULTADOS: Nove pacientes do grupo de tratamento e dez do grupo controle foram precocemente excluídos do estudo, antes da avaliação inicial do primeiro mês. As causas de exclusão foram: por abandono do programa (8 pacientes), complicações pós-operatórias (9), necessidade de radioterapia adjuvante (2). Não houve diferença entre os grupos em relação à idade, índice de massa corpórea, presença de diabetes, bem como quanto à função erétil pré-operatória. Nos dois grupos observou-se significativa redução da função erétil. Após 12 meses da cirurgia 8 (47,1%) pacientes do grupo de tratamento recuperaram ereção, contra 2 (12,5%) pacientes no grupo controle (p=0,032). A redução do risco absoluto foi de 34,6% (3.8-64%)IC95%. O número necessário para tratar foi de 3 (1.5-17.2; IC95%). Foi observada forte associação entre recuperação da potência e da continência, de tal forma que a probabilidade de estar potente nos pacientes continentes foi 2,6 vezes maior do que nos pacientes incontinentes (p=0,017; [1,45-4,69] IC 95%). CONCLUSÃO: A reabilitação precoce do assoalho pélvico com biofeedback parece ajudar na recuperação da função erétil após a PR. A continência urinária foi um bom indicador da recuperação da função erétil, conferindo uma chance maior de sua recuperação. / INTRODUCTION: Erectile dysfunction (ED) and urinary incontinence are common complications in the early postoperative follow-up of patients undergoing radical prostatectomy (RP). Previous studies indicate that the preservation of potency is not associated with the recovery of urinary continence after RP. Although pelvic-floor biofeedback training (PFBT) may improve urinary continence following RP, its effects on the recovery of potency are unknown. METHODS: Fifty-two patients who elected PR for treatment of clinically localized prostate cancer and who could comply with the ambulatory treatment schedule were invited to participate in this prospective study. Patients were randomized for a treatment group (n=26) receiving PFBT once a week for 3 months and home exercises or a control group (n=26), in which patients received the usual instructions to contract the pelvic floor. Patients were not allowed to receive drug treatment for ED throughout the study duration. Erectile function was evaluated with the International Index of Erectile Function-5 (IIEF-5) before surgery and one, three, six and 12 months postoperatively. Patients were considered potent when they had a total IIEF-5 score of >= 20. Additionally, the continence status was assessed and patients were considered continent when the use of pads was <= 1/day. The association of continence and recovery of potency was evaluated. RESULTS: Nine patients in the treatment group and 10 in the control group were excluded due to failure to return for the evaluation (8 pts), postoperative complications (9 pts), need for adjuvant radiotherapy (2 pts). Preoperative assessment did not show differences in age, body mass index, and diabetes between the groups. There was a significant reduction in IIEF 5 scores after surgery in both groups. In the treatment group 8 (47.1%) patients recovered potency 12 months postoperatively, as opposed to 2 (12.5%) in the control group (p=0.032). The absolute risk reduction was 34.6% (95% CI: 3.8-64%). The number needed to treat was 3 (95% CI: 1.5-17.2). A strong association between recovery of potency and urinary continence was observed, with continent patients having a 2.6 higher chance of being potent than incontinent patients (p=0.017; 95% CI: 1.45-4.69). CONCLUSIONS: Early PFBT appears to have a significant impact on the recovery of erectile function after PR. Urinary continence status was a good indicator of erectile function recovery, with continent patients having higher chance of being potent than incontinent patients.