Orientador: Francisco Haiter Neto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-14T23:56:05Z (GMT). No. of bitstreams: 1 Caldas_MariadePaula_D.pdf: 2507510 bytes, checksum: e7cf9f14f77a9d0d37e99a3d58f6aa74 (MD5) Previous issue date: 2009 / Resumo: O objetivo neste trabalho foi avaliar a aplicabilidade do método de análise da idade óssea vertebral, proposto por Caldas et al. (2007) nas diferentes regiões do país. Para isso, foram utilizadas radiografias cefalométricas laterais e radiografias carpais de 381 meninas e 336 meninos, com faixa etária variando entre 7 e 15.9 anos, pertencentes a arquivos digitais de seis clínicas de Radiologia Odontológica provenientes das cidades de Belém-PA, Fortaleza-CE, Recife-PE, Brasília-DF e Curitiba-PR. Nas radiografias cefalométricas laterais, os corpos das vértebras C3 e C4 foram medidos com o auxílio de uma análise computadorizada das vértebras cervicais inserida no programa de cefalometria digital Radiocef Studio 2 e as idades ósseas das vértebras cervicais foram automaticamente calculadas, utilizando as equações de regressão desenvolvidas por Caldas et al. (2007). Nas radiografias carpais, os eventos de ossificação da mão e do punho foram avaliados e as idades ósseas determinadas pelo método de Tanner e Whitehouse (TW3). Os dados foram encaminhados à análise estatística de variância e teste de Tukey (p<0,05) para comparar idade óssea vertebral, idade óssea carpal e idade cronológica. Os resultados obtidos revelaram que, em todas as regiões estudadas, a idade óssea vertebral não apresentou diferença estatística significante em relação à idade cronológica. Quando analisada a relação entre as idades ósseas, foi possível observar diferença estatística significante entre idade óssea vertebral e idade óssea carpal nos sexos masculino e feminino das regiões Norte e Nordeste, assim como no sexo masculino da região Centro-Oeste. No entanto, as diferenças não foram maiores que 0,61, 0,31 e 0,45 anos para as regiões Norte, Nordeste e Centro-Oeste, respectivamente.Com exceção do sexo masculino na região Norte e do sexo feminino na região Nordeste, não foi encontrada diferença estatística significante entre idade óssea e idade cronológica. Para as regiões Norte e Nordeste, as diferenças encontradas foram de 0,44 e 0,26 anos para o sexo masculino e feminino, respectivamente. Baseados nestes resultados, pôde-se concluir que as fórmulas desenvolvidas por Caldas et al. (2007), para avaliação objetiva da idade óssea pelas vértebras cervicais, se mostraram confiáveis e podem ser utilizadas na população estudada. / Abstract: The aim of this study was to evaluate the applicability of the formula developed by Caldas et al. (2007) in Brazilian subjects. The samples were taken from patient digital files of six Oral Radiological Clinics placed in Belém-PA, Fortaleza-CE, Recife-PE, Brasília-DF e Curitiba-PR. Lateral cephalometric and hand-wrist radiographs of 381 girls and 336 boys (aged 7.0 to 15.9 years) were selected. On the digital lateral cephalograms, the bodies C3 e C4 were measured using a cervical vertebral computerized analysis created in the software program of digital cephalometric analysis Radiocef Studio 2 and cervical vertebral bone age was calculated using the formulas developed by Caldas et al. (2007). Hand-wrist bone age was evaluated by the Tanner and Whitehouse method (TW3). An analysis of variance (ANOVA) and Tukey test were used to compare cervical vertebral bone age, hand-wrist bone age and chronological age (P <0.05). No significant difference was found between cervical vertebral bone age and chronological age in all regions studied. When analyzing bone age, it was possible to observe a statistically significant difference between cervical vertebral bone age and hand-wrist bone age for female and male subjects in the North and Northeast regions, as well as for male subjects in the Central West region, which were no more than 0,61, 0,31 e 0,45 years in the North, Northeast and Central West regions, respectively. No significant difference was observed between bone age and chronological age in all regions except for the male subjects in the North and female subjects in the Northeast, which were 0,44 and 0,26 years, respectively. We concluded that the formulas developed by Caldas et al. (2007) to objectively evaluate skeletal maturation are reliable and can be applied to Brazilian subjects. / Doutorado / Radiologia Odontologica / Doutor em Radiologia Odontológica

M. Tech. / Abstract Purpose: The purpose of this study was to assess the effects of Diversified Chiropractic adjustments versus Flexion-Distraction Technique in the management and treatment of chronic Lumbar Facet Syndrome. Method: This study consisted of two groups, Group A and Group B, each consisting of 15 participants with chronic Lumbar Facet Syndrome. The participants were between the ages of 20 and 45 years. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. Group A received Diversified Chiropractic Adjustments and Group B received Flexion-Distraction Technique to the lumbar facets. Procedure: Each participant was treated eight times over a period of four weeks. Before the commencement of treatment one, four and eight, the participants completed the Oswestry Low Back Pain and Disability Index questionnaire and the Visual Analogue Scale. A Digital Inclinometer was used to measure lumbar spine ranges of motion. Diversified Chiropractic adjustments were then administered to Group A based on the restrictions obtained during motion palpation. Flexion-Distraction Technique was administered to Group B based also on the restrictions that were obtained during motion palpation. Results: Objective statistically significant differences were noted on flexion and left lateral flexion ranges of motion before treatment, and clinically significant differences we noted on flexion and right lateral flexion after treatment, in favour of Group A. Subjective readings also showed statistically significant differences with regards to Oswestry Low Back Pain and Disability Index and Visual Analogue Scale in favour of both Group A and Group B. Conclusion: The results of the study indicate that both Diversified Chiropractic adjustments and Flexion-Distraction Technique have a positive effect on patients suffering from chronic Lumbar Facet Syndrome. However, Diversified Chiropractic adjustments proved to have a greater overall benefit compared to Flexion-Distraction Technique in the management and treatment of Lumbar Facet Syndrome.

M.Tech. (Chiropractic) / Purpose: This study aims to ascertain the extent Chiropractic manipulative therapy increases ROM beyond the joint-separation induced ROM initially experienced via the cavitation phenomenon in the absence of neck pain. Method: Sixty participants between eighteen and thirty-five years of age, thirty male and thirty female whom met the inclusion of no neck pain and perceived decreased ROM were selected for participation. There was a single group with each participant‟s pre-adjustment readings acting as a baseline. Procedure: Participants were assessed for hypomobility and joint dysfunction. Those who met the inclusion criteria underwent a detailed history, physical and cervical spine regional examination on the initial consult. A pre-adjustment objective measurement was acquired using a cervical spine range of motion (CROM) device. Once the consent form was signed participants received Chiropractic cervical spine manipulative therapy to the area/s of the cervical spine found to be restricted on motion palpation by the researcher. Post-adjustment objective measurements were taken at one, twenty, forty and sixty minutes using the CROM device. Participants were required to remain in the researcher‟s examination room for 60 minutes post-adjustment with continuation of regular day to day activity and no strenuous activity during the twenty-four hour period of the study. The participant was required to return for a single follow up visit within a time frame of twenty-four hours of the initial visit. The follow-up visit required no treatment. At twenty-four hours, the participant was objectively measured for cervical spine ROM using the CROM. The results were based on objective data in the form of cervical spine ROM measurements. Results: Clinical analysis of the percentage change in cervical spine ROM values revealed that clinically and statistically significant improvement was seen in all ranges of motion post-adjustment. General consensus showed that a peak value of improved ROM was seen post-adjustment at the one minute interval for all ranges of motion except flexion. Flexion demonstrated a peak ROM value at the twenty minute post-adjustment interval.

M.Tech. / Purpose: Acupuncture has been a controversial issue in the medical world for many years before the sceptic western medicine slowly adopted its idea. Some mechanisms for pain relief were clinically researched and proven to be valid as well as effective in treating tension-type headaches (Stux, Berman and Pomerantz, 2003) The purpose of this study was to assess and compare the effects of cervical spine manipulation and needling of acupuncture points in those patients with tension-type headache and suggest another complimentary treatment to the chiropractic manipulation, especially in those patients where manipulation is contraindicated to manipulation. If found to be effective, various mechanisms have been suggested in the formation of tension headache episodes. Those mechanisms may be alterations within the spinal cord and/or brainstem gating mechanisms as a result of facet joint dysfunction, sensitization of nociceptors in the peripheral structures of the body and psychological factors. Method: This study consisted of two groups, consisting of 16 subjects in each group. All participants were screened for tension-type headaches and accepted based on the inclusion and exclusion criteria. The subjects were between the ages of eighteen and thirty-five. Group 1 received chiropractic manipulation treatment to the most restricted levels in their cervical spine. Group 2 received treatment consisting of needling of acupuncture points to specific predetermined points. Procedure: Each successful candidate was treated six times over a 3 week period which included a total of seven sessions. Before the beginning of the treatment, the successful candidate completed the Vernon-Mior Neck Pain and Disability Index Questionnaire and the Numerical Pain Rating Scale. Readings for cervical spine ranges of motion were then taken with a CROM device. In group 1, chiropractic manipulation was then delivered to the most restricted segments in the cervical spine. In group 2, needling of six predetermined acupuncture points for relieving tension-type headache was performed bilaterally. The same treatment procedure was administered at sessions one through six, the CROM readings and questionnaires were taken in sessions one, three, five and seven. Results: The results were obtained by using the Mann-Whitney U and t-test. No statistically significant differences were identified between the groups, when comparing the 2 treatment methods at the visits. However, both groups showed a statistically significant improvement over time within each group individually for subjective measurements and for right lateral flexion in the objective measurements. Conclusion: The results were inconclusive with regards to the prolonged effects of chiropractic manipulation and needling of acupuncture points on cervical spine range of motion in patients with tension-type headache. However, it was concluded that both methods of treatment had beneficial effects on how the participants perceived their pain and disability. Due to the small group of subjects and relatively short duration of the study, accurate conclusions could not be formulated. The findings obtained were insignificant and further research needs to be performed on the effects of cervical spine manipulation and needling of acupuncture points on those suffering with tension-type headache.

M.Tech. / Purpose: Heachaches are a very common complaint among society today, and as a result there are a vast number of individuals seeking medical treatment specifically for headaches (Alix and Bates, 1999). The impact that headaches have on a patients quality of life far exceeds that of other conditions such as osteoarthritis and hypertension. Primary headaches such as Cervicogenic, Cluster and Tension-type headaches have no specific underlying cause. However, it has been shown that spinal manipulative therapy (SMT) can be used as an effective tool in the treatment of these primary headaches (Brontford, Assendelft, Evans, Haas, and Bouter, 2001; Khoury, 2000 and Vernon, 1995). A Cervicogenic Headache is defined by the North American Cervicogenic Society (NACHS) as referred pain perceived in any region of the head caused by a primary nociceptive source in the musculoskeletal tissues innervated by cervical nerves. The aim of this study was to determine the efficacy of upper cervical spine manipulation in conjunction with Interferential current and Ultrasound therapy, compared to upper cervical spine manipulations alone as a treatment protocol for Cervicogenic headaches. Method: This study consisted of two groups; both Group 1 and Group 2 consisted of 15 participants with Cervicogenic headaches. The participants were between the ages of 18 and 55 years. Potential participants were examined and accepted based on the inclusion and exclusion criteria. Group 1 received spinal manipulative therapy over restricted segments in the upper cervical spine C1-C3 levels. Group 2 received a combination treatment with Interferential current and Ultrasound therapy over active myofascial trigger points in the Posterior Cervical muscles in conjunction with spinal manipulative therapy over restricted segments in the upper cervical spine C1-C3 levels. Objective and subjective findings were based on the treatments. Procedure: The participants received six treatments in total over a three week period that is two treatments a week for three weeks followed by a seventh consultation visit where only subjective and objective measurements was taken. The participants completed a Numerical Pain Rating Scale and Headache Disability Index Questionnaire. Algometer readings were taken over the most sensitive trigger point in the Posterior Cervical muscles. Group 1 received spinal manipulative therapy over restricted segments in the upper cervical spine and Group 2 received a ten minute combination treatment with Interferential current and Ultrasound therapy over active myofascial trigger points in the Posterior Cervical muscles in conjunction with spinal manipulative therapy over restricted segments in the upper cervical spine. The same treatment procedures were administered over the study; subjective and objective readings were only taken at visits 1, 4 and 7. Results: In terms of objective measurements based on the pressure Algometer readings, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. No statistically significant difference in muscle sensitivity between the two groups over time was revealed. However, Group 1 showed a larger overall clinically significant difference in Posterior Cervical muscle sensitivity. In terms of subjective measurements based on the Headache Disability Index Questionnaire scores, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. No statistically significant difference in terms of intensity, duration and frequency of the headaches between the groups over time was revealed. However, Group 1 had a greater clinical reduction in intensity, duration and frequency of headaches when compared to Group 2. In terms of subjective measurements based on the Numerical Pain Rating Scale scores, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. A statistically significant difference in terms of intensity of the headaches between the groups over time was revealed. The overall clinical improvement was similar for both groups however Group 1 had a slightly greater clinical reduction in headache intensity when compared to Group 1. Conclusion: Both groups showed an overall improvement in the headache symptoms as well as Posterior Cervical muscle sensitivity; however Group 1 showed a greater clinical improvement when compared to Group 2.

M.Tech. (Chiropractic) / The purpose of this study was to compare the immediate effect of upper versus lower cervical manipulation on the vertebral artery blood flow in asymptomatic individuals. Thirty patients of both genders between the ages of 18-45 years of age, volunteered to participate in this study. Each participant presented with at least one upper and one lower rotary cervical facet restriction. Each participant was randomly placed into either Group 1 whom received upper cervical manipulation, or Group 2 whom received lower cervical manipulation. Any participants who presented with positive VBAI signs or symptoms were excluded from this study. The Medison SonoAce 8000 Ultrasound System was used to objectively measure the blood flow as close to C1-C2 region as possible, contralateral to the side of the adjustment contact. Three measurements were recorded in total which included neutral, pre-manipulation and post-manipulation. As this study included asymptomatic participants, no subjective data was collected. Statistical analysis was performed where the intragroup analysis was done using the Paired Sample t-test and inter-group analysis was done using the Independent Samples t-test to check for statistically significant results less than the p-value of 0.05. There were no statistically significant results found in Group 1 and Group 2 in isolation in the intragroup analysis as well as when compared in the intergroup analysis. Upper cervical manipulation resulted in a slight percentage increase in mean blood flow velocity. Lower cervical manipulation resulted in a decreased end diastolic blood flow velocity after manipulation which indicated the possibility of vertebrobasilar occlusion, however, it did not result in much change with regards to mean blood flow velocity. In addition, upper as well as lower cervical v manipulation had a minimally insignificant dilating effect on the diameter of the upper vertebral artery which may have been due to reflex vasodilation. This study demonstrated no statistically significant changes in isolation in the intragroup analysis as well as when compared in the intergroup analysis. Lower cervical manipulation did however have a moderate influence on the upper vertebral artery blood flow but overall was still less stressful in comparison to upper cervical manipulation. Additional studies are suggested to clarify these findings further.

M.Tech. (Chiropractic) / The purpose of this study is to evaluate whether action potential simulation (APS) therapy is more effective than placebo therapy in terms of pain relief and improvement in lumbar spine range of motion when treating chronic lumbar spine pain. The comparison of the two therapies was accomplished by objective and subjective assessments. The study was conducted by means of a double blind clinical trial with two experimental groups. Thirty subjects eighteen years of age and older who suffered from chronic lumbar spine pain were chosen from the general population who responded to the advertisements and from Tarentaal Home for the Aged. The researcher examined each of these subjects in order to be accepted into the study. Each subject was treated ten times over a two-week period and underwent a one-month follow-up consultation to be re-examined. Subjects in both groups received therapy for eight minutes at an amplitude of 1-2mA. Only the APS group received the electric current and the placebo group did not receive the electric current. The objective assessment was by means of measurement of the lumbar spine ranges of motion using an inclinometer. The subjective assessment was measured by means of two questionnaires, which are widely accepted in the research community namely: a) Oswestry Low Back Pain and Disability Questionnaire b) McGill Pain Questionnaire. The results, which were obtained, were statistically analyzed using the Mann-Whitney Rank Sum test (inter-group comparison) and the Wilcoxon Signed Rank test (intra-group comparison). Graphs were created using the actual values of each patient in each group and using the medians obtained. The study concluded that both the APS and the placebo group improved in terms of lumbar spine range of motion and pain relief even though not all the results were statistically significant. The graphs representing the mean values at the first, final and one-month follow-up consultations of each group showed the apparent improvement in terms of range of motion in the lumbar spine and pain relief. The APS group's mean values, at the above mentioned consultations, showed a greater improvement in range of motion and pain relief when being compared to the placebo group's mean values that are represented on the respective graphs.

M. Tech. / Although Chiropractors rely on palpation as a clinical tool, its reliability still remains to be proven (O‟Haire and Gibbons, 2000). Motion palpation is based on the assumption that Chiropractors‟ and other manual medicine practitioners‟ static palpation is performed correctly to identify bony anatomical landmarks (O‟Haire and Gibbons, 2000). The most common method taught to chiropractic students on the location of the seventh thoracic spinous process, is to place the patient‟s hand in the small of their back, forcing the inferior angle of the scapula to become more prominent. The horizontal line from the inferior angle of the scapula to the vertebral column is said to be on the seventh thoracic spinous process (T7). Therefore the scapula is a widely used anatomical landmark. One would therefore expect the literature to all be in agreement to the position of this line, but according to the literature consulted, it seems to vary. This study aimed to determine whether palpation of the inferior angle of the scapula was a reliable, accurate and/or a valid method of determining the location of the seventh thoracic spinous process. Sixty participants were marked by three examiners in the seated position, using the inferior angle of the scapula to locate the seventh thoracic spinous process. After being marked by all three examiners, measurements were then made on CT scan films as well as visual assessments by examiners to assess the location of the markers on the thoracic anatomy. The results demonstrated substantial inter-examiner reliability, and poor accuracy in locating the seventh thoracic spinous process. This is disappointing as the ability to palpate spinal levels is a basic skill and the cornerstone of Chiropractic assessment.

Alterações na coluna vertebral de cães são comumente encontradas na rotina clínica e cirúrgica veterinária. Existem poucos estudos sobre a anatomia ultrassonográfica musculoesquelética do segmento toracolombar e lombar da coluna vertebral normal de cães. O objetivo deste trabalho foi comparar a anatomia ultrassonográfica musculoesquelética normal dos segmentos vertebrais avaliados com imagens obtidas pela ressonância magnética, tomografia computadorizada e peças anatômicas visando demonstrar a sua capacidade de identificação de estruturas. A varredura ultrassonográfica permitiu a visibilização da musculatura da região, processos articulares, processos espinhosos, ligamentos interespinhosos e ligamento amarelo na janela lombossacra. A tomografia computadorizada forneceu imagens com melhor detalhamento ósseo quando comparada ao exame ultrassonográfico. A ressonância magnética de baixo campo permitiu a identificação das mesmas estruturas que o exame ultrassonográfico acrescido da identificação do líquido cefalorraquidiano, processos transversos e melhor detalhamento dos discos intervertebrais e medula espinhal. Com o conhecimento da anatomia ultrassonográfica da região, acredita-se que lesões musculares e ligamentares possam ser identificadas. Vale salientar que em regiões onde a tomografia computadorizada e a ressonância magnética não estejam acessíveis a ultrassonografia da região pode ser uma boa alternativa para identificar possíveis alterações não visibilizadas ao exame radiográfico, ou complementar o mesmo. / Changes in the spine of dogs are usually found in clinical and surgical practices. There are few studies on musculoskeletal ultrasound anatomy of thoracolumbar and lumbar segments of the normal spine of dogs. The aim of this study was to compare normal musculoskeletal ultrasound anatomy of the vertebral segments evaluated with images obtained by magnetic resonance imaging, computed tomography and anatomical parts in order to establish its ability to identify structures. The ultrasound scan allowed visualization of the muscles of the region, articular processes, spinous process, interspinous ligament and yellow ligament in the lumbosacral window. Computed tomography provide images with better bone details when compared to ultrasound examination. Low field magnetic resonance imaging allowed the identification of the same structures as the ultrasound examination plus the identification of cerebrospinal fluid, transverse processes and better detail of the intervertebral discs and spinal cord. Knowledge of ultrasound anatomy of the region may lead to detection of muscle and ligament injuries. It is emphasized that in areas where CT and MRI are not accessible, ultrasonography of the region can be a good alternative to identify possible alterations not visualized by radiographic examination or supplement it.

Within Pleistocene cave deposits, snake fossils tend to be relatively common and generally occur as isolated vertebrae. However, the specific, and sometimes generic, identification of isolated snake vertebrae is often hindered by the significant amount of intra- and interspecific variation along the precloacal vertebral column, a subject that has largely been neglected in many fossil snake identifications. Identifications are typically based on the vertebrae of disarticulated modern specimens with preference given to mid-trunk vertebrae. This study utilizes 2-D geometric morphometrics to determine the extent of intervertebral variation along the precloacal vertebral column of North American pit vipers of the genera Crotalus (rattlesnakes) and Agkistrodon (copperheads and moccasins), two closely related genera geographically sympatric in northeast Tennessee and much of the eastern United States with similar vertebral morphologies. The focus of this study is to determine the need for identifying the morphological regionalization of the precloacal vertebral column and determining the regional position of isolated vertebra prior to identification. Using one individual from each genus, every third vertebra was chosen and analyzed in anterior view using geometric morphometrics and relative warp analyses. A discriminant function analysis was then performed to distinguish between the two genera. Viperid fossils from Hickory Tree Cave in northeast Tennessee underwent the same geometric morphometric and discriminant function analyses as a means of identification. It is expected that the relative warp analyses will show some morphological regionalization of the precloacal vertebral column, but may prove to not be significant enough for use in the identification of isolated vertebrae. In that case, comparison to mid-trunk vertebrae for identification may prove accurate. This study also shows the need for more modern skeletal specimens in herpetological collections and the need for preserving the vertebral order of those specimens.