Chronic refractory gastrointestinal (GI) motility disorders are a significant burden on the healthcare system, acting as a large public health issue with significant impact on the quality of life in both the pediatric and adult population. Control systems of gastrointestinal motility are complex and involve coordination of smooth muscle contraction and relaxation, which the autonomic nervous system is largely responsible for. Gaps in the diagnosis process, such as overlooking autonomic function, has left patients with diminished quality of life and limited treatment options. Many patients in the clinic have experienced injury within the spinal cord and we hypothesized that GI symptoms might be related to spinal injury causing disruption of sensory and/or motor nerves of the autonomic nervous system. Our objective became to better understand the specific location and nature of spinal injuries and GI symptoms, as completed through the development of a self-report questionnaire. Main findings suggest symptoms indicative of T3-T9 and T10-L2 spinal pathology. COVID-19 did not allow for in-clinic neuromodulation with autonomic assessments, resulting in experiments remotely assessing at-home neuromodulation treatment for GI symptoms with suspected spinal autonomic dysfunction. At-home neuromodulation was not suitable for many patients, but those who were able to manage it showed highly promising results. After years of suffering, transcutaneous electrical nerve stimulation alleviated symptoms, particularly postprandial abdominal pain, constipation, vomiting and nausea. I discuss what we learned to set us up for successful at-home treatment, and we will use all information to design randomized controlled trials to prove the benefit of TENS. The present work offers significant information on the relationship of thoracolumbar spinal pathology and complex GI symptoms, which is now used in the clinic in the diagnosis process of GI dysmotility. In addition, we have learned how to conduct at-home treatment using TENS, which allows us to execute future studies. / Thesis / Master of Science (MSc) / There are gaps in the diagnosis process of complex gastrointestinal (GI) dysmotility disorders, including lack of testing of autonomic function, leaving patients suffering with diminished quality of life with unsuccessful treatment attempts. As many patients also experience injury or conditions of the spine, I have hypothesized that GI symptoms may be related to spinal injury-induced dysfunction of the autonomic nervous system. Experimental models aim to understand the location and nature of spinal pathology with GI symptoms for future diagnoses, as well as potential treatment options such as neuromodulation. Findings of this thesis suggest symptoms indicative of particular thoracolumbar spinal pathology and promising results of transcutaneous electrical nerve stimulation (TENS) to alleviate GI symptoms, including T3-T9 and T10-L2 spinal pathology-related postprandial abdominal pain, constipation, nausea, and vomiting. This work offers information for the diagnostic process of GI dysmotility and the future design of clinical trials of neuromodulation therapies.

La stimulation électrique neurale, appliquée au système nerveux périphérique pour la restauration des fonctions motrices ou la neuromodulation, est une technologie en plein essor, en particulier la stimulation implantée avec des électrodes Cuff positionnées autour d’un nerf périphérique. Le principal frein au développement des systèmes de stimulation est la difficulté à obtenir la stimulation ou l’inhibition des fonctions cibles de manière précise et indépendante, c’est-à-dire, obtenir une sélectivité des fonctions. Les paramètres impliqués dans la sélectivité au sens large ne sont pas toujours intuitifs, et le nombre de degrés de libertés (choix de l’électrode, nombre de contacts, forme du pulse etc.) est important. Tester toutes ces hypothèses en expérimentation n’est pas faisable et inenvisageable dans le réglage des neuroprothèses en contexte clinique. La modélisation a priori nous permet d’établir des critères de choix, de déterminer les stratégies les plus efficaces et de les optimiser. Par ailleurs, un grand nombre d’études ont pu prévoir des stratégies de sélectivité inédites grâce à la modélisation, et validées a posteriori par l’expérimentation. Le schéma de calcul scientifique est composé de deux parties. On modélise, d’une part, la propagation du champ de potentiels électriques générés par les électrodes à l’intérieur d’un volume conducteur représentant le nerf (étude biophysique), et d’autre part l’interaction entre ce champ de potentiels et les neurones (réponse électrophysiologique). Notre première contribution propose une méthode originale de modélisation et d’optimisation de la sélectivité spatiale avec une électrode Cuff, sans connaissance a priori de la topographie de nerf. Partant de ce constat, nous déterminons de nouveaux critères, l’efficacité et la robustesse, complémentaires à la sélectivité, nous permettant de faire un choix entre des configurations multipolaires concurrentes. Ainsi, en fonction de la pondération de ces critères, nous avons développé un algorithme d’optimisation pour déterminer la configuration optimale en fonction de la zone choisie, du diamètre des fibres visées ainsi que de la durée de stimulation, pour un pulse type rectangulaire de référence. Des expérimentations sur modèle animal nous ont permis d’évaluer l’efficacité de la méthode et sa généricité. Ce travail est partie intégrante d’un projet plus vaste de stimulation du nerf vague (projet INTENSE), où l’une des applications concerne le traitement des troubles cardiaques. L’objectif est d’activer sélectivement une population spécifique de fibres nerveuses pour obtenir des effets plus ciblés conduisant à une thérapie améliorée, tout en diminuant les effets secondaires. La deuxième contribution consiste à combiner la sélectivité spatiale et la sélectivité au diamètre de fibre avec un modèle générique de nerf et une électrode Cuff à 12 contacts. L’utilisation d’une forme d’onde particulière (prépulse) combinée avec des configurations multipolaires permet d’activer des fibres d’un diamètre défini dans un espace ciblé. Les perspectives cliniques sont nombreuses, notamment sur la réduction de la fatigue liée à l’utilisation prolongée de la stimulation ou la diminution des effets secondaires. Dans le cadre du projet INTENSE, la seconde application liée à la stimulation du nerf vague vise le problème de l’obésité morbide. L’activation des axones cibles liés aux fonctions gastriques nécessite une quantité de charges conséquente. Plusieurs études suggèrent que les formes de pulse non rectangulaires peuvent activer les axones du système nerveux périphérique avec une quantité de charges réduite comparée à la forme de pulse rectangulaire de référence. Notre dernière contribution concerne l’étude expérimentale et de modélisation de ces formes d’ondes complexes. L’approche par modélisation, si elle est bien maîtrisée, apporte une analyse pertinente voire même indispensable au réglage clinique des neuroprothèses. / Neural electrical stimulation, applied to the peripheral nervous system for motor functions restoration or neuromodulation, is a thriving technology, especially implanted stimulation using Cuff electrodes positioned around a peripheral nerve. The main obstacle to the development of stimulation systems is the difficulty in obtaining the independent stimulation or inhibition of specific target functions (i.e. functional selectivity). The parameters involved in selectivity are not always intuitive and the number of degrees of freedom (choice of electrode, number of contacts, pulse shape etc.) is substantial. Thus, testing all these hypotheses in a clinical context is not conceivable. This choice of parameters can be guided using prior numerical simulations predicting the effect of electrical stimulation on the neural tissue. Numerous studies developed new strategies to achieve selectivity based on modeling results that have been validated a posteriori by experimental works. The computation scheme is composed of two parts : the modeling of the potential field generated by the electrodes inside a conductive medium representing the nerve on the one hand; and the determination of the interaction between this field of potentials and neurons on the other. Our first contribution is an original method of modeling and optimization of the spatial selectivity with a Cuff electrode, without prior knowledge of the nerve topography. Based on this observation, we determined new criteria, efficiency and robustness, complementary to selectivity, allowing us to choose between multipolar configurations. Thus, according to the weighting applied to these criteria, we developed an optimization algorithm to determine the optimal configuration as a function of the target zone, fiber diameter and the stimulation duration for a typical rectangular pulse. Experiments on animal model allowed us to evaluate the effectiveness and genericness of the method. This work was performed as part of a larger project on vagus nerve stimulation (INTENSE project) in which one of the applications focused on the treatment of cardiac disorders. The main objective was to selectively activate a specific population of nerve fibers to improve therapy and decrease side effects. In a second contribution, numerical simulations were used to investigate the combination of multipolar configurations and the prepulses technique, in order to obtain fiber recruitment in a spatially reverse order. The main objective was to achieve both spatial and fiber diameter selectivity. Expected clinical perspectives of this work are the reduction of fatigue related to a prolonged use of stimulation and the reduction of side effects. Within the framework of the INTENSE project, the second application investigated vagus nerve stimulation as a therapy for morbid obesity. Activation of target axons related to gastric functions requires a significant amount of charge injection. Several studies suggest that non-rectangular waveforms can activate axons of the peripheral nervous system with a reduced amount of charge compared to the reference rectangular pulse shape. Our last contribution focuses on the experimental study and the modeling of these complex waveforms. The modeling approach, if performed properly and while bearing in mind its limits, provides a relevant and even indispensable analysis tool for the clinical adjustment of neuroprostheses.

The problem of this study concerns the reduction of spasticity in physically handicapped persons with CP. The hypotheses tested were: that there would be no significant difference between the mechanical efficiency (ME) of persons with spastic CP following application of the TENS Unit and following application of the placebo unit; that there would be no significant difference between the ME of males with spastic CP, following application of the TENS Unit or the placebo unit, and the ME of females with spastic CP, following application of the TENS Unit or the placebo unit; and that there would be no significant interaction between the treatment factor and the gender category.

Thesis title: Stimulation of the zones used during reflex lokomotion by the TENS Name: Markéta Vodňanská The aim of the thesis: The aim of this thesis is to determine, whether is activated the appropriate locomotor pattern during Vojta reflex locomotion - reflexive crawling, when TENS is used for a stimulation of trigger zones, as it is during manual stimulation of trigger zones for reflexive crawling. Method: The essence of this study is the stimulation of trigger zones used in the reflex locomotion manually and by transcutaneous electrical nerve stimulation (TENS) at a frequency of 30 Hz and 182 Hz. Six probands participated in this experiment. During the manual and TENS stimulation was scanned electrical activity in selected muscles by surface electromyography. First, it was evaluated the order of activation of selected muscles, using "standard timing" analysis by MyoResearch XP Master program. Second, it was evaluated the crawling reflex locomotion pattern visually. Results: It was confirmed, that the crawling reflex locomotion pattern, which is provoked by manual stimulation of trigger zones, is provoked by TENS stimulation as well, using the same trigger zones. It follows that the vector of direction and pressure during manual stimulation of trigger zones is not necessary for recall of the...

La prise en charge thérapeutique de la fatigue musculaire par le biais d’exercices physiques vise à améliorer la qualité de vie et implique habituellement des exercices unilatéraux ou l’électrostimulation neuromusculaire pour compenser une fonction musculaire altérée aussi bien chez les personnes saines ou dites vulnérables (e.g. atteintes d’une pathologie ou d’un traumatisme). La fatigue musculaire est une réduction de la capacité de production maximale de force, induite par l’exercice, que la tâche puisse être maintenue ou non (Bigland-Ritchie et al. 1983; Gandevia 2001; Enoka and Duchateau 2008). L’objectif général de cette thèse était d’étudier les stratégies d’activation neuromusculaire lors de la fatigue musculaire, de l’endurance musculaire et sur la performance musculaire au cours et/ou après des contractions volontaires et évoquées électriquement chez des personnes saines ou vulnérables tels que des enfants atteints d’infirmité motrice cérébrale (IMC) et des patients atteints de dystrophie musculaire facio-scapulo-humérale (DMFSH). / The clinical care of muscle fatigue with exercise therapies aim at quality of life improvement and usually involve unilateral exercises or neuromuscular electrical stimulation to compensate impaired muscle function in both healthy and health-compromised people. Muscle fatigue is a decline in maximal force production, induced with exercising, whether or not the task can be maintained (Bigland-Ritchie et al. 1983a; Gandevia 2001a; Enoka and Duchateau 2008). The overall objective of this thesis was to study the effect of neuromuscular activation strategies during muscle fatigue, endurance and muscle performance after voluntary and electrically evoked contractions in healthy and health-compromised populations such as children with cerebral palsy (CP) and patients with facioscapulohumeral muscular dystrophy (FSHD).

Introdução. O uso da Estimulação Elétrica Nervosa Transcutânea (TENS) para o tratamento da dor pós-operatória tem sido objeto de estudo há alguns anos. Todavia, em quase a totalidade dos trabalhos, a TENS foi aplicada somente após os procedimentos cirúrgicos, à exceção de uma única pesquisa em que foi empregada no período pré-operatório. Em ambas as situações, esse recurso foi eficiente para o tratamento da dor, seja por meio da redução da sua intensidade ou do consumo de analgésicos. Porém, ainda hoje, não se sabe qual o papel que o seu momento de aplicação (somente antes da cirurgia; apenas após a operação; ou antes e após) pode vir a exercer no grau de analgesia obtido. Objetivo. Analisar a influência do momento de aplicação da TENS, na modalidade de alta freqüência, como recurso analgésico em pacientes do sexo masculino submetidos a herniorrafias inguinais pela técnica de Bassini. Casuística e método. A pesquisa clínica, controlada, aleatória e duplamente encoberta foi realizada no Hospital São José, entre abril de 2007 e junho de 2008, com amostra de 125 pacientes, distribuídos em 5 grupos: TENS depois (n = 25), TENS antes (n = 25), TENS antes e depois (n = 25), Placebo (n = 25) e Controle (n = 25). Todas as anestesias foram realizadas via raquidiana, com cloridrato de bupivacaína (0,5%); e a medicação analgésica utilizada no pós-operatório foi: dipirona, como medicação de resgate; e cetoprofeno, em horário programado. A mensuração da dor foi feita com a escala numérica (0-10 cm) e com a versão brasileira do Questionário de Dor McGill (Br-MPQ). Foram considerados estatisticamente significantes os valores de p 0,05. Resultados. Os grupos que foram tratados com a TENS apresentaram redução significante da dor, sendo os resultados mais expressivos naqueles pacientes em que a TENS foi aplicada tanto no período pré, quanto pós-operatório (TENS antes e depois). Houve também redução significante da administração de dipirona no período pós-operatório. Conclusão. O uso pré e pós-operatório da modalidade de alta freqüência da TENS, em pacientes submetidos a herniorrafias inguinais com técnica de Bassini, proporcionou analgesia mais satisfatória do que aquela obtida somente com a aplicação em um desses momentos. / Introduction. The use of Transcutaneous Electrical Nerve Stimulation (TENS) to treat postoperative pain has been searched lately. However, in the most of studies, TENS has been applied only after surgeries, excepting one where TENS was utilized before. In the two situations, this resource has presented good benefits for pain treatment, observed not only by a reduction in its intensity but also in consumption of analgesics. Nevertheless, there is a doubt about the role that TENS applications moment can exert in analgesias level obtained in the postoperative period. Objective. To analyze the influence of applications moment of high frequency TENS as an analgesic resource in male patients submitted to inguinal herniorraphy (Bassini technique). Cases and method. It was a placebo-controlled, randomized and double-blinded trial, carried out at the Hospital São José (Aracaju, SE, Brazil), between April 2007 and June 2008, and had a sample of 125 patients, distributed in 5 groups: pre TENS (n = 25), post TENS (n = 25), pre- and post TENS (n = 25), Sham (n = 25) and Control (n = 25). There was the standardization of the bupivacaine (0,5 %) as an anesthetic drug, as well as postoperative analgesic prescription: dipyrone, only if the patient complained about pain; and ketoprofen, prescribed for every 8 h. Pain intensity was measured by the Numerical Rating Scale (NRS), in 8 moments (2½, 3, 3½, 4, 5, 6 and 7 h after inducing the anesthesia besides one last verification at the hospital discharge). Brazilian version of the McGill Pain Questionnaire (Br-MPQ) was used 4 h following the inducing of the anesthesia. P values .05 were considered significant. Results. Patients treated with TENS showed less pain intensity, and the most expressive results occurred in pre- and post TENS, moreover there was also significant reduction in dipyrone consumption. Conclusion. The pre- and postoperative use of high frequency TENS in inguinal herniorraphy provided major analgesia than the one obtained by TENS application only in the pre- or postoperative period.

O trauma perineal em mulheres submetidas ao parto normal, seja espontâneo ou cirúrgico, pode causar considerável desconforto à mulher no período pós-parto. A dor perineal no puerpério tem sido reportada como sendo uma das causas mais comuns de morbidade materna. Investigar medidas não farmacológicas capazes de amenizar a dor perineal é um assunto ainda abordado na literatura de modo escasso. A TENS é um recurso fisioterapêutico que tem como principal finalidade o alívio da dor. O objetivo deste estudo foi avaliar a eficácia da TENS como recurso de alívio de dor aplicada as puérperas que apresentem episiotomia e caracterizar a queixa dolorosa. Realizou-se um ensaio clínico, randomizado e controlado. Participaram voluntariamente do estudo 40 puérperas primíparas que foram submetidas ao parto normal com episiotomia. Todas preenchiam aos critérios de inclusão e receberam assistência em uma maternidade conveniada ao Sistema Único de Saúde na cidade de Ribeirão Preto - SP. Os grupos foram formados pelo método de blocos, onde 20 puérperas fizeram parte do grupo experimental que receberam a TENS no pós-parto e os procedimentos de rotina da maternidade e 20 do grupo controle que foram submetidas somente aos procedimentos de rotina da instituição. A pesquisa foi realizada em três etapas. Na primeira, para ambos os grupos, foi aplicado o formulário de dados sobre o perfil sócio demográfico e obstétrico das puérperas e sobre o neonato, questões a respeito da dor na episiotomia e escala de categoria numérica (NRS), para o repouso, e para as atividades; os descritores de dor e o item PPI (Present pain intensity) da versão brasileira do questionário McGill (Br-MPQ). Finalizando esta etapa, foi aplicada no grupo experimental durante 60 minutos a TENS fixada no modo convencional, com freqüência de 100Hz e duração de pulso 75µs. Quatro eletrodos de silicone-carbono foram posicionados próximos a episiotomia, na região da coxa e glúteo da puérpera. A segunda etapa foi iniciada após se passarem 60 minutos da primeira etapa e utilizaramse os mesmos instrumentos de avaliação da fase anterior. No grupo experimental aplicou-se o instrumento de verificação da opinião da puérpera em relação ao uso da TENS. A terceira etapa ocorreu após se passarem 60 minutos da segunda etapa. Nesta, foram utilizados como instrumentos em ambos os grupos a NRS e o item PPI do Br-MPQ. Verificou-se pelo teste de Mann-Witney que houve alívio de dor nas puérperas do grupo experimental quando comparadas com o grupo controle, havendo uma diferença estatística significativa (p<0,001) que persistiu durante todo o período do estudo. Em relação à caracterização da dor, ao comparar-se a primeira e a segunda avaliação, identificou-se que no grupo experimental houve em todas as categorias, variação no percentual de descritores, porém, não foi verificado este padrão para o grupo controle, onde se percebeu pequenas alterações na freqüência de alguns descritores sem, contudo mudar o perfil dos descritores selecionados a cada uma das avaliações. Pode-se afirmar com este estudo, que a TENS foi eficaz no alívio da dor das puérperas submetidas à episiotomia, e que foram encontradas diferenças na caracterização da queixa dolorosa. / The perineal trauma in women submitted to a natural delivery, either spontaneous or surgical, can cause considerable discomfort to woman on the postpartum period. Perineal pain in the puerperium has been reported as being one of the most common causes of maternal morbidity. Investigate non-pharmacological measures capable to brighten up perineal pain still is a boarded subject in the literature in scarce way. The TENS it is a physical therapy resource that has as main purpose the pain relief. The objective of this study was to evaluate the effectiveness of TENS as a pain relief resource applied in puerperal women that present episiotomy, and to characterize the painful complaint. It was conducted a randomized controlled trial where it was included 40 primiparous volunteered women that had been submitted to a spontaneous vaginal delivery with episiotomy. All of them fullfilled the inclusion criteria and received assistance in a maternity conver by Unified National Health System in the city of Ribeirão Preto - SP/ Brazil. The groups had been formed by the method of blocks, where 20 puerperal women had been part of the experimental group that they had received TENS in the postpartum and the routine procedures of maternity and 20 of the control group that had been submitted only to the routine procedures of the institution. The research was made in three stages. In the first one, for both groups, were applied the data form\'s about the puerperal women\'s sociodemographic and obstetric profile and about neonate, questions regarding pain in the episiotomy and numeric rating scale (NRS), for the rest, and the activities; the describers of pain and the PPI (Present pain intensity) item of the Brazilian version of the McGill pain questionnaire (Br-MPQ). Finishing this stage, it was applied in the experimental group during 60 minutes the TENS fixed it in the conventional way, with frequency of 100Hz and duration of pulse 75µs. Four silica-carbon electrodes had been located next to the episiotomy, in the thigh and gluteus region of puerperal women. The second stage was initiated after to pass 60 minutes of the first stage and had used the same instruments of evaluation of the previous phases. In the experimental group it was applied the instrument of verification of the opinion of puerperal women in relation of the use of TENS. The third stage occurred after to pass 60 minutes of the second stage. In this, both groups had been used the instruments NRS and PPI item of the Br-MPQ. It was verified for the Mann- Witney test that women of the experimental group had relief of pain when compared with the controlled group, having a significant statistics difference (p<0,001) that persisted during all the study period. In relation to the characterization of pain, when comparing the first and the second evaluation, it was identified that the experimental group had variation in the percentage of the words of all the categories, however, it was not verified this standard for the controlled group, where it was perceived small alterations in the frequency of some words without, however to change the profile of the selected describers to each one of the evaluations. It can be affirmed with this study, that TENS was efficient in the relief of the pain of puerperal women submitted to episiotomy, and that differences in the characterization of the painful complaint had been found.

Em vista ao alto índice de cesárea no Brasil e ao projeto de humanização do ciclo gravídico-puerperal, observa-se a importância de pesquisar e utilizar recursos nãofarmacológicos que auxiliem na recuperação de mulheres no puerpério imediato da cesárea. A dor e o desconforto estão presentes em razão da cirurgia e dos movimentos necessários para o autocuidado e os cuidados com o recém-nascido. A Eletroestimulação Nervosa Transcutânea (Transcutaneous Electrical Nerve Stimulation - TENS) é uma modalidade terapêutica comumente utilizada para alívio de dor, inclusive dor aguda pós-operatória. O objetivo deste trabalho é analisar a efetividade da TENS no alívio de dor após cesárea. Para isto, foi realizado estudo clínico controlado, randomizado e simples-cego. Participaram do estudo 20 puérperas no grupo experimental que receberam a TENS e 20 no grupo controle, em que apenas a dor era avaliada. As puérperas foram avaliadas quanto às limitações de atividades decorrentes da dor pós-operatória. Para avaliar a dor foi usada a Escala de Categoria Numérica (Numeric Rating Scale - NRS) e o Questionário de Dor McGill. Foi feita uma primeira avaliação seguida da aplicação da TENS para o grupo experimental, por 45 minutos, e o acompanhamento do grupo controle pelo mesmo tempo. Após este período foi realizada uma segunda avaliação e, uma hora após, uma terceira avaliação. As puérperas apresentaram limitação nos movimentos de sentar e levantar e caminhar. A dor caracterizava-se, principalmente como ritmada e localizada. Os descritores mais comumente citados para descrevê-la foram \"dolorido\", \"que prende\", \"cólica\" e \"que repuxa\". Os maiores escores de dor foram relacionados aos movimentos de sentar e levantar e caminhar. Por meio de teste não paramétrico de Mann-Whitney, foi possível observar que o grupo experimental apresentou redução da dor estatisticamente significante maior que o grupo controle na segunda e na terceira avaliação pela NRS (p<0,001) e pelo McGill (p<0,001). Conclui-se que a TENS foi eficaz no alívio da dor, que permaneceu por, pelo menos, uma hora após a aplicação. Há a necessidade de mais pesquisas, possibilitando a utilização da TENS na prática clínica e como recurso não-farmacológico de humanização no puerpério de cesárea. / On the strengh of the large number of cesareans in Brazil and concerning the humanizing project of the pregnancy-puerperal cycle, it can be observed the importance of researching and prescribing non-pharmacological resources that can help by the recovery of puerperal women from the cesarean section. The pain and the discomfort by reason of the surgery and of those necessary movements for the self-help and to take care of the baby. The Transcutanous Electrical Nerve Stimulation (TENS) is a therapeutic technique commonly used for easing the pain, including the post-operating acute pain. The objective of this research is to analyze the effectiveness of the TENS in the pain relief after cesarean. Hence a simple-blind and a random clinical-controlled study was done. Twenty puerperal women composed the experimental group in which TENS technique was applied and 20 others puerperal women composed the control group in which the pain was only evaluated. The puerperal was evaluated the pain the Numeric Rating Scale (NRS) and the McGill Pain Questionnaire were chosen a first assessment was followed by a 45 minutes session of TENS technique with the experimental group, while the control group was only followed at the same time. After this period happened a second assessment and, an hour later, a third assessment. The puerperal presented limitations in sitting down, stand up and walking movements. The pain was characterized chiefly as rhythmic and located. The words more commonly used to describe pain were \"painful\", \"that holds\", \"colic\" and \"that pulls\". The highest scores of pain were related to the movements of sitting down, stand up and walking. By this Mann-Whitney non-parametric test, it was possible to observe that the experimental group presented a pain reduction more statistically significant than that of the control group in the second and third NRS (p<0,001) and McGill (p<0,001) assessment. The conclusion is that TENS is an efficient technique to promote pain reduction and resulting relief remains at least an hour after its use. More researches should be developed in order to make possible the use of TENS technique in the clinical practice and as a non-pharmacological humanizing resource in the puerperal condition of cesarean section.

Introdução: Atualmente, a primeira linha de tratamento para bexiga hiperativa (BH), incontinência urinária de urgência (IUU) e incontinência urinária mista (IUM), envolve medicação, treinamento da musculatura do assoalho pélvico (TMAP) e terapia comportamental. Outra abordagem que vem apresentando resultados positivos no tratamento dessas disfunções é a eletroestimulação do nervo tibial (ENT). Objetivo: Comparar a efetividade das técnicas de ENT e TMAP no tratamento da BH, IUU e IUM, e validar um equipamento portátil para aplicação domiciliar de ENT. Métodos: O estudo apresenta delineamento de Ensaio Clínico Randomizado tipo cross-over. A amostra foi composta por 40 mulheres acima de 18 anos com diagnóstico de BH, IUU e IUM. As participantes foram randomizadas em dois grupos: grupo ENT, iniciou a pesquisa realizando eletroestimulação, e o grupo TMAP, iniciou a pesquisa realizando exercícios pélvicos padronizados, ambos de forma domiciliar. Após 8 semanas, as participantes trocaram suas abordagens terapêuticas, totalizando 16 semanas. Todas foram submetidas a uma anamnese e avaliadas em três momentos por meio dos questionários Índice da Severidade da Incontinência (ISI), King´s Health Questionnarie (KHQ) e dados do diário miccional (DM). Resultados: Para todas as variáveis, o grupo ENT apresentou resultados estatisticamente significativos após a intervenção quando comparado ao grupo TMAP (p<0,05). Conclusão: Os dados apresentados indicam maior efetividade da ENT quando comparados ao TMAP após intervenção domiciliar. Com isto, acredita-se que o aparelho desenvolvido pelo Serviço de Engenharia Biomédica do Hospital de Clínicas de Porto Alegre (SEB/HCPA) possa ser uma alternativa de tratamento da BH, IUU e IUM, validando o equipamento para uso clínico. / Introduction: The first-line therapy in overactive bladder (OAB), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI) presently involves drug treatment, pelvic floor muscle training (PFMT) and behavioral intervention (BI). An approach that has shown positive results in the treatment of these dysfunctions is the electrical stimulation of the tibial nerve (TNES). Objective: To compare the effectiveness of TNES and PFMT for treatment of OAB, UUI and MUI, and validate a portable TNES unit designed for home use. Methods: Randomized, crossover clinical trial. The sample consisted of 40 women older than 18 with OAB, UUI and MUI. Participants were randomly assigned to two groups: TNES group, which started the experiment undergoing electrical stimulation, and PFMT group, which started the experiment doing standardized pelvic exercises, both at home. After 8 weeks, the groups exchanged their initial therapeutic approach for the other, thus totalizing 16 weeks of treatment. All the subjects underwent anamnesis and assessment in three different moments with the use of Incontinence Severity Index (ISI), King´s Health Questionnaire (KHQ) and data from a voiding diary (VD). Results: For all the variables, TNES group presented statistically significant results after intervention in comparison to PFMT group (p<0.05). Conclusion: Data have evidenced greater effectiveness of TNES as compared with PFMT after intervention. The device designed by the Department of Biomedical Engineering of Hospital de Clinicas de Porto Alegre (SEB/HCPA) may be an alternative for the treatment of OAB, UUI and MUI, and could have its validation established for clinical practice.

Dor é sintoma comum a diversos quadros clínicos. É provavelmente a razão mais freqüente de auxílio médico. Estima-se que 10 a 20% da população adulta apresentam dor crônica, sendo que, destes, cerca de 5% apresentam pouca resposta a tratamento. A abordagem terapêutica da dor crônica de origem muscular deve ser multidisciplinar, com interrupção do ciclo de dor. Para tal, são utilizadas várias técnicas, entre elas, alongamento muscular e estimulação elétrica nervosa transcutânea (TENS). O presente trabalho de pesquisa teve como objetivo avaliar a resposta analgésica de cinco sessões de fisioterapia com alongamento e/ou TENS, em dores crônicas com origem na musculatura da coluna vertebral. Foi realizado ensaio clínico randomizado, duplo-cego, em paralelo, controlado por alongamento muscular, no Centro Corpo em Porto Alegre, RS, Brasil. Foram estudados pacientes portadores de dor crônica de origem muscular, com localização na coluna vertebral. Tratava-se de pacientes adultos, com diagnóstico de dor há mais de 6 meses, feito por médico ortopedista, e que estavam iniciando tratamento fisioterapêutico entre janeiro e dezembro de 2005. Os pacientes foram alocados randomicamente em três grupos: um considerado controle e dois grupos de intervenção. O primeiro (ALONG; n=33) realizou 20 min de alongamentos musculares e 20 min de TENS-sham. O grupo intervenção 1 (TENS; n=31) realizou 20 min de falsos alongamentos musculares e 20 min de TENS acupuntural. O grupo intervenção 2 (ALONG/TENS; n=31) realizou 20 min de alongamentos musculares e 20 min de TENS acupuntural. Dos 95 pacientes estudados, 57,9% eram mulheres e 42,1%, homens, com similar distribuição nos 03 grupos (Teste qui-quadrado, P=0,622). Quanto à localização, 32,6% apresentavam dor na região cervical, 2,1% na região torácica, 49,5% em região lombar e 15,8% na região cérvico-lombar (Teste qui-quadrado, P=0,120, para comparação dos 3 grupos). A idade variou dos 19 aos 76 anos, sem diferença entre os grupos (ANOVA, P=0,456). Observou-se que, ao longo das 05 sessões, houve redução significativa dos escores de dor. Porém não foi detectada diferenças entre os regimes terapêuticos estudados. Na avaliação inicial em escala analógica visual, os grupos ALONG, TENS e ALONG/TENS apresentaram, respectivamente, escores (média + desvio padrão) de 53,85+24,18, 57,39+23,47 e 47,74+24,95 (ANOVA, P=0,288). Após 05 sessões, os valores foram, respectivamente, de 25,88+22,62, 27,48+21,47 e 20,39+20,98 (ANOVA, P<0,000 diferença significativa entre os tempos e P= 0,535 diferença não significativa entre os grupos). Na avaliação inicial em escala verbal, os grupos ALONG, TENS e ALONG/TENS apresentaram, respectivamente, escores (mediana, percentis 25% e 75%) de 4(3/4), 4(4/5) e 4(3/4) (Teste de Kruskal-Wallis, P=0,217). Após 05 sessões, os valores foram, respectivamente, de 3(1/3), 3(2/3) e 3(0/3) (Teste de Friedman P=0,000 diferença significativa ao longo do tempo). Concluiu-se que as técnicas de alongamento e TENS são capazes de reduzir significativamente dores musculares com origem na coluna vertebral. Seus efeitos são similares, sugerindo igual eficácia analgésica. / Pain is a common symptom in several situations. It is probably the most frequent reason for the search of medical care. It is estimated that ten to twenty percent of the adult population suffer from chronic pain and that five percent show little response to treatment. The clinical approach to chronic muscular pain must be multidisciplinary, trying to interrupt the pain cycle. With that in mind, many techniques are used, such as muscular stretching, and transcutaneous electrical nerve stimulation (TENS). This research project aimed to evaluate analgesic response to stretching and/or TENS in five physiotherapy sessions for chronic pain in muscles of the spinal cord. A randomized, double-blind, parallel-group, stretching-controlled clinical trial was conducted at Centro Corpo in Porto Alegre, RS, Brazil. Patients with muscular pain in the spinal cord were studied. All of them were adults, with diagnosis of pain lasting for more than six months. The diagnosis was made by an orthopedist and the patients were beginning physiotherapeutic treatment between January and December, 2005. The patients were randomly divided in three groups: one of them was the control group and the other two were the intervention groups. The first group (STRETCH, n=33) did twenty minutes of muscular stretching and twenty minutes of sham TENS. Intervention group one (TENS, n=31) did twenty minutes of ineffective stretching exercises and twenty minutes of Acupuncture TENS. Intervention group two (STRETCH/TENS, n=31) did twenty minutes of effective stretching exercises and twenty minutes of Acupuncture TENS. From the 95 patients analyzed, 57.9% were women and 42.1% were men. They were similarly distributed along the three groups (Chi-square test, P=0.622). As to the region the pain was located, 32.6% presented cervical pain, 2.1% presented thoracic pain, 49.5% had lumbar pain, and 15.8% had cervical/lumbar pain (Chi-square test, P=0.120, to compare the three groups). Age ranged from 19 to 76, with no difference among the groups (ANOVA, P=0.456). It was observed that, throughout the five sessions, there was significant reduction of pain scores. No difference was detected, though, among the therapeutic methods which were studied. In the first evaluation using the Visual Analogical Scale, the groups showed the following scores (mean ± standard deviation): STRETCH: 53.85±24.18, TENS: 57.39±23.47, and STRETCH/TENS: 47.74 ±24.95 (ANOVA, P=0.288). After five sessions, the scores were: STRETCH: 25.88±22.62, TENS: 27.48±21.47, and STRETCH/TENS: 20.39±20.98 (ANOVA, P<0.000; significant difference among the times and P=0.535; no significant difference among the groups). In the first evaluation using the Verbal Scale the groups showed the following scores (median, 25 and 75 percentiles): STRETCH: 4 (3/4), TENS: 4 (4/5), and STRETCH/TENS: 4 (3/4) (Kruskal-Wallis test, P=0.217). After five sessions, the scores were: STRETCH: 3 (1/3), TENS: 3 (2/3), and STRETCH/TENS: 3 (0/3) (Friedman test, P=0.000 significant difference over time). It is concluded that the stretching and the TENS techniques can significantly reduce muscular pain originated in the spinal cord. Their effects are similar, which suggests equal analgesic efficacy.