The thesis deals with the issue of vestibular compensation in patiens after vestibular schwannoma surgery. The aim of this thesis was to objectively evaluate the dynamics of vestibular compensation in the early postoperative period and to determine whether the application of gentamicin impacts the dynamics of equilibrium functions. 32 patients participated in the study (20 women and 12 men) ranging from 28 to 73 years of age. Patients underwent a rehabilitation program with visual feedback using the interactive rehabilitation system, Homebalance. This rehabilitation program was carried out daily from the 5th postoperative day until hospital discharge. Patients were examined preoperatively, postoperatively and after rehabilitation. To assess the vestibular compensation, static posturography, the Synapsys Posturography System, and the Activities-Specific Balance Confidence Scale were used. The statistical analysis showed a significant increase in mean values of measured COP parameters (the length of the COP trajectory and COP confidence elipse area) postoperatively. After completing the rehabilitation program no significant reduction of measured COP parameters was found. The total score from the Activities- Specific Balance Confidence Scale showed a statistically significant decrease in postoperative...

Evidenční list Souhlasím se zapůjčením své diplomové práce ke studijním účelům. Uživatel svým podpisem stvrzuje, že tuto diplomovou práci použil ke studiu a prohlašuje, že ji uvede mezi použitými prameny. Jméno a příjmení: Fakulta / katedra: Datum vypůjčení: Podpis: ______________________________________________________________________ ABSTRAKT Název: Zhodnocení vlivu sportovního lezení na pohybový aparát se zaměřením na bederní páteř Cíle práce: Cílem práce je zhodnotit vliv sportovního lezení na pohybový aparát člověka s užším zaměřením na oblast bederní páteře pomocí předem stanovených testů a vyšetření orientujících se na bederní část axiálního systému u skupiny lezců a nelezců. Dílčím cílem je teoretické zpracování problematiky sportovního lezení, bederní páteře a shrnutí vlivu sportovního lezení na pohybový aparát. Metoda řešení: Nejprve byla provedena rešerše literatury týkající se problematiky sportovního lezení a bederní páteře. Poté byla na skupině dvaceti lezců a kontrolní skupině dvaceti nelezců provedena komparativní studie, během které bylo provedeno funkční vyšetření bederní páteře pomocí PBU ("pressure biofeedback unit") dle konceptu Spinální segmentální stabilizace a vyšetření pohybových stereotypů a zkrácených svalů dle Jandy. Výsledky byly statisticky zhodnoceny pomocí programu Microsoft...

A dissertation submitted in fulfilment of the requirements for the degree Master of Science in Engineering, in the Faculty of Engineering and the Built Environment, University of the Witwatersrand, Johannesburg. January 2017 Johannesburg / It is well known that emotional stress has a negative impact on people’s health and physical, emotional and mental performance. Previous research has investigated the effects of stress on various aspects of physiology such as respiration, heart rate, heart rate variability (HRV), skin conductance, skin temperature and electrical activity in the brain. Essentially, HRV, Electroencephalography (EEG), skin conductance and skin temperature appear to reflect a stress response or state of arousal. Whilst the relationship between respiration rate, respiration rhythm and HRV is well documented, less is known about the relationship between respiration rate, EEG, skin conductance and skin temperature, whilst HRV is maximum (when there is resonance between HRV and respiration i.e. in phase with one another). This research project aims to investigate the impact that one session of slow paced breathing has on EEG, heart rate variability (HRV), skin conductance and skin temperature. Twenty male participants were randomly assigned to either a control or intervention group. Physiological data were recorded for the intervention and control group during one breathing session, over a short initial baseline (B1), a main session of 12 minutes, and a final baseline (B2). The only difference between the control and intervention groups was that during the main session, the intervention group practiced slow paced breathing (at 6 breaths per minute), while the control group breathed spontaneously. Wavelet transformation was used to analyse EEG data while Fourier transformation was used to analyse HRV. The study shows that slow-paced breathing significantly increases the low frequency and total power of the HRV but does not change the high frequency power of HRV. Furthermore, skin temperature significantly increased for the control group from B1 to Main, and was significantly higher for the control group when compared to the intervention group during the main session. There were no significant skin temperature changes between sessions for the intervention group. Skin conductance increased significantly from Main to B2 for the control group. No significant changes were found between sessions for the intervention group and between groups. EEG theta power at Cz decreased significantly from Main to B2 for the control group only, while theta power decreased at F4 from Main to B2 for both groups. Lastly, beta power at Cz decreased from B1 to B2 for the control group only. This significant effect that slow-paced breathing has on HRV suggests the hypothesis that with frequent practice, basal HRV would increase, and with it, potential benefits such as a reduction in anxiety and improved performance in specific tasks. Slow-paced breathing biofeedback thus shows promise as a simple, cheap, measurable and effective method to reduce the impact of stress on some physiological signals, suggesting a direction for future research. / MT2017

A retroalimentação por eletromiografia é uma técnica de aprendizado para controle voluntário de respostas fisiológicas pelo condicionamento operante. Compararam-se os sinais eletromiográficos dos músculos quadríceps de duas séries de retroalimentação pelo "Método Brucker" com duração de 50 minutos semanais durante quatro semanas com um intervalo de três meses em 20 pacientes com trauma raquimedular cervical na posição sentado e na transição da posição sentado para a ortostática. Demonstrou aumento amplitude do potencial eletromiográfico na segunda série. Comprovou que na transição de sentado para a posição ortostática consegue-se arregimentar um maior número de fibras do quadríceps do que na sentado / Electromyography biofeedback is a learning technique for voluntary control of physiological responses through operant conditioning. The electromyographic signals from the quadriceps muscles of two biofeedback series were compared using the Brucker method, with a 50-minute weekly session during four weeks and a three-month interval, in 20 patients with cervical spinal cord injury, in the sitting position and during the transition from the sitting to the orthostatic position. An increase in the amplitude of the electromyographic potential was shown in the second series. It was proven that during the transition from the sitting to the orthostatic position it is possible to gather a larger number of fibers of the quadriceps as compared to the sitting position

Στον τομέα της κινητικής αποκατάστασης, η έννοια της βιοανάδρασης για τη βελτίωση του ταλάντευσης της στάσης του ανθρώπινου σώματος και του ελέγχου της ισορροπίας είναι αρκετά διαδεδομένη. Στις περισσότερες περιπτώσεις, το υποκείμενο προσπαθεί να ελέγξει τη θέση του με μια οπτική, προφορική ή αφής ανατροφοδότηση που παρέχεται από ένα ηλεκτρονικό σύστημα ή έναν νοσοκομειακό γιατρό. Πρόσφατες μελέτες αφορούν ασθενείς με κάποια νευρολογική ασθένεια που ελάμβαναν την οπτική ανατροφοδότηση στεκόμενοι σε μια δυναμοπλατφόρμα, ώστε να ελέγχουν την θέση του σημείου κεντρικής τους πίεσης (CoP). Στην έρευνά μας, καταγράφουμε τη κατανομή πίεσης κάτω από τα πόδια του υποκειμένου και παρέχουμε τις σχετικές ακουστικές πληροφορίες βιοανάδρασης (ABF) στην κατεύθυνση της βελτίωσης της ισορροπίας στάσης του. Με την παροχή αυτών των πρόσθετων ακουστικών πληροφοριών, στόχος μας είναι να διευκολύνουμε τη διαδικασία αντιστάθμησης της ελλείπουσας ή ανεπαρκούς αισθητήριας πληροφορίας από το κεντρικό νευρικό σύστημα (CNS). Έχουμε αναπτύξει και σε προκαταρκτικό στάδιο δοκιμάσει ένα σύστημα ακουστικής βιοανάδρασης βασιζόμενο σε μεσοσόλες με αισθητήρες πίεσης. Ο χρησιμοποιούμενος αλγόριθμος ABF έχει την ίδια βάση με αυτον που εφαρμόζεται σε ένα πρωτοτύπο ABF σύστημα, ήδη αναπτύγμενο και δοκιμασμένο, το οποίο ελέγχει τις μετακινήσεις επιτάχυνσης του σώματος. Οι μετρήσεις των τιμών πίεσης στα πόδια γίνονται μέσω ενός ζευγαριού εύκαμπτων μεσοσολών με 24 ειδικούς ενσωματωμένους αισθητήρες πίεζο-αντίστασης που περικλύονται σε κυτταρική δομή γεμάτη υγρό (Paromed). Η εφαρμογή ελέγχου αναπτύχθηκε σε περιβάλλον LabView και επιτρέπει τη συλλογή δεδομένων πίεσης σε 100Hz και την επεξεργασία αυτών σε πραγματικό χρόνο για τον υπολογισμό μιας εκτίμησης της τιμής του στιγμιαίου CoP. Η συμπεριφορά ταλάντευσης του CoP στα δυο επίπεδα, εμπρόσθια-οπίσθια AP και διάμεσα-πλευρικά ML, αποτυπώνεται σε ένα στερεοφωνικό ακουστικό σήμα που αλλάζει στο εύρος, τη συχνότητα και την ισορροπία L/R και μέσω των ακουστικών παρέχεται στο υποκείμενο. Το πειραματικό μας πρωτόκολλο περιέλαβε μια σειρά μετρήσεων με υγιείς εθελοντές εκτελώντας συγκεκριμένους στατικούς στόχους, με και χωρίς παρεχόμενο ABF. Κατά τη διάρκεια αυτών των στόχων προσπαθήσαμε να εξομοιώσουμε τις συνθήκες όπου η αισθητήρια πληροφορία είναι ελλείπουσα ή ανεπαρκής. Προκαταρκτικά αποτελέσματα στην ML κατεύθυνση, έδειξαν οτι με την ύπαρξη του ABF το ανθρώπινο σώμα ταλαντεύθηκε λιγότερο, γεγονός ενδεικτικό του ότι αυτό το νέο-αναπτυγμένο σύστημα βιοανάδρασης βασιζόμενο στις πίεζο-μεσοσόλες μπορεί να χρησιμοποιηθεί για να βελτιώσει την ισορροπία. Περισσότερα πειράματα και αναλυτική στατιστική ανάλυση πρέπει να ακολουθήσουν ώστε να γίνει κατανοητή η επιρροή αυτού του ABF στην ισορροπία του ανθρώπινου σώματος. / In the area of motor rehabilitation, the concept of biofeedback for improving postural sway and balance control is quite common. In most cases, the subject tries to control his position by a visual, oral or tactile feedback provided by an electronic system or a clinician. Recent studies involved patients with neurological disease that were receiving visual feedback as were standing in a force plate, for the monitoring of their centre of pressure (CoP) position. In our research, we record the pressure distribution beneath the subject's feet and provide related audio biofeedback (ABF) info in the direction of improving posture balance. By providing this extra audio information to the subject our aim is to facilitate the compensation process of the missing or inadequate sensory information by its central nervous system (CNS). We have developed and preliminary validated an insole pressure sensor-based, ABF system. The ABF concept followed is the same with the one applied in a prototype ABF system, already developed and validated, which monitors trunk acceleration movements. Foot pressure values were acquired through a pair of flexible insoles with 24 embedded discrete piezo-resistive sensors contained in a fluid-filled cell (Paromed). The control application was developed in LabView environment and permits pressure data collection in 100Hz and real-time processing for the calculation of an estimated value of the instant CoP. Swaying CoP behaviour in both AP and ML planes is mapped in a stereo audio signal changing in amplitude, frequency and L/R balance, which through the earphones is provided to the subject. Our experimental protocol involved a series of measurements with normal subjects performing specific static tasks, with and without ABF provided. During these tasks we tried to simulate conditions of missing or inadequate sensory information. Preliminary results about ML direction, shown that when ABF was provided the subject swayed less, suggesting that this new-developed biofeedback pressure-sensor insole-based system can be used to improve balance. More experiments and appropriate statistical analysis has to be done so as to understand the influence of this ABF on subject’ s balance.

Swallowing is a complex sensorimotor behaviour that includes precisely-timed bilateral activation and relaxation of muscles of the face, lips, tongue, cheeks, palate, larynx, pharynx and oesophagus. These events of activation and inhibition are controlled by many structures of the brain and are executed by cranial nerves that carry motor and sensory information to and from the swallowing muscles. Swallowing disorders are common sequelae of many neurological and structural disorders, including stroke, Parkinson’s disease, and head and neck cancer. Changes to swallowing physiology are also prevalent in older individuals, but these changes do not necessarily translate to dysphagia. Decreased muscle strength, changes to motor unit properties, and hypotrophic changes in skeletal muscles can result in age-related changes in swallowing physiology. In addition to muscular changes, neural changes might also change swallowing function in older subjects. The motor-learning literature presents a clear distinction between the differential applications and effects of skill- and strength-training approaches for rehabilitation of limb movement. In contrast to limb-movement rehabilitation, swallowing rehabilitation approaches consist mainly of strength training, although the pathophysiological basis for dysphagia is not always weakness. Therefore, this Phase I clinical-trial critically evaluated a unique swallowing skill training protocol in which the goal of intervention is to increase precision of motor control during swallowing. A Phase I clinical-trial was necessary to identify the appropriate protocol for inducing neurophysiological, biomechanical, and structural adaptations, to estimate effect sizes, and to identify adverse effects. The first and primary question addressed in this thesis was whether swallowing skill training would produce greater physiological effects in healthy subjects than a traditional swallowing strength training approach. In order to answer this question, three levels of assessment were included. Neurophysiological assessment consisted of delivering single-pulse transcranial magnetic stimulation (TMS) over the M1 area that sends efferent projections to the submental muscle group during a functional task of volitional saliva swallowing, and during a non-functional task of submental muscle group contraction. Biomechanical assessments consisted of pharyngeal and upper esophageal sphincter (UES) pressure measurements using pharyngeal manometry during effortful and non-effortful swallowing tasks, submental muscle activation measurements using surface electromyography (sEMG) during effortful and non-effortful swallowing tasks, and hyoid displacement using ultrasonography. Structural assessment consisted of measuring the cross sectional area of the submental muscle group. Finally, motor performance during training, and subjective ratings of the training protocols were assessed. Two skill training protocols were developed to assess the use of immediate versus delayed visual feedback in swallowing skill training. In addition, a pilot study aimed at examining the effects of increased dosage of training sessions was conducted. Forty healthy subjects (20 young, and 20 old; 20 females and 20 males) were allocated to skill and strength training groups in a counterbalanced manner. Strength training consisted of execution of the effortful swallowing technique targeting increased demand for strength. Skill training targeted precise timing and force execution during swallowing execution. Several motor-learning principles were considered in devising the training protocols, including the principles of task specificity and high intensity of training. Biofeedback was included to promote motor learning. Since the submental muscle group plays an important role in hyolaryngeal excursion, the current study utilized submental sEMG biofeedback using custom-made training software. The training protocols consisted of 1000 repetition of swallowing over a 2-week period. Subjects trained for an hour, five days a week, for 2 weeks (i.e., 10 training sessions). The extended dosage protocol included 10 subjects and comprised an additional eight sessions. The results indicated that there was a significant difference in submental activation following training, with strength training having an increase in sEMG peak amplitude in comparison to skill training. There were no other differences between groups at the 5% error level. Patterns of change were revealed when marginally significant results (0.05 < p ≤ 0.10) were investigated as well. Strength training resulted in a trend towards increased neural drive for volitional effortful-type tasks (i.e., effortful saliva swallowing, effortful water swallowing, and submental muscle contraction) as indicated by increased MEP magnitude (p = 0.07) which was consistent with significantly increased peak amplitude of submental activity measures (p < 0.001). This finding supports the task specificity principle of motor learning. Skill training resulted in no changes in MEP magnitude. There was a trend (p = 0.06) towards increased submental muscles activity during functional swallowing tasks (i.e., non-effortful swallowing) in young subjects,. Males in skill training had decreased duration of UES opening in 10 mL water effortful swallowing task (p = 0.02), a trend towards increased UES pressure in non-effortful saliva swallowing task (p = 0.07), and reduced hyoid displacement following training (p < 0.001). Changes in pharyngeal pressures were detected for skill training with delayed visual feedback that resulted in decreased pressure at mid-pharynx in effortful and non-effortful tasks (p < 0.05). No difference in submental CSA changes was detected in either training group. Both groups improved motor performance measured by data collected during the session (target hit-rate and muscle activity). The results of the pilot study that examined the effects of an extended dosage of training were difficult to interpret due to the small sample size. However, there were significant and marginally significant effects of skill training on mid-pharyngeal and UES pressure duration events. Dysphagia is common in patients with Parkinson’s disease, but no specific training programme exists for these patients, leading to the second question addressed through this research. Since movement planning is compromised due to dysfunction of the basal ganglia, providing external information for planning and executing swallowing was hypothesized to alleviate dysphagic symptoms. Ten subjects were recruited. Swallowing skill training with immediate feedback was administered for one hour every day, five days a week, for 2 weeks, similar to the training dosage and frequency in the healthy group. Biomechanical and structural changes were assessed. Swallowing skill training with immediate feedback led to an increase in submental activity in effortful swallowing tasks but not non-effortful tasks. In addition, it was found that individuals with dysphagia secondary to Parkinson’s disease have deceased submental muscle reserve relative to healthy subjects. Preliminary analysis of MEP data led to exploration of submental MEP measures between younger and older subjects. This ‘discovery’ research shed light on the third topic addressed in this thesis. There are contradicting results in the literature regarding age-related brain activity during swallowing. Since submental MEPs were included as an outcome measure in the main study, it was important to evaluate them at baseline in order to understand and interpret changes in this measure. Unlike other measures, such as pharyngeal pressure and hyoid displacement that have been documented in the literature to change with age, no similar study has been conducted to assess for differences in swallowing-related MEPs. Baseline data from the main study were analysed. Older subjects produced larger MEP magnitude in comparison to young in volitional saliva swallowing and volitional submental contraction. This finding raised some questions regarding the use of MEPs as an outcome measure, since it is not clear what constitutes a ‘positive’ change. This study documented, for the first time, the application of skill training in swallowing in a healthy and dysphagic population. Positive effects of treatment were found in the dysphagic group; an indication of negative effects was identified in the healthy group. In addition, this is the first study to compare skill to strength training in swallowing. The only significant difference between the two was significantly greater submental activation in effortful swallowing tasks following strength training in comparison to skill training; although there were some significant interactions between age and training type and gender and training type. This project represents the first Phase I clinical-trial of an innovative approach for addressing swallowing impairments. Achieving the ultimate aim of finding the most appropriate training protocol for treating individuals with a specific pathophysiological basis of dysphagia, requires the implementation of a long-term on-going research programme characterized by a staged process. This research programme sets an initial reference framework from which further projects can estimate the sample size required to answer specific questions, control for effects of age and gender and their interaction with training, increase precision in choosing assessment tools, and test new specific questions.

Introdução: As alterações do assoalho pélvico nas mulheres climatéricas, decorrentes das variações hormonais, de modificações físicas e do próprio envelhecimento dos tecidos, podem ser responsáveis por disfunções urinárias e sexuais. O papel da fisioterapia no tratamento da incontinência urinária tem sido documentado, porém há poucos estudos avaliando a disfunção sexual. Objetivos: Avaliar o potencial de ativação mioelétrica das musculaturas do assoalho pélvico, a função sexual através do Índice de Função Sexual Feminina (IFSF) e a qualidade de vida (Escala de Cervantes) de mulheres climatéricas com e sem dispareunia. Métodos: Estudo transversal realizado no ambulatório de Climatério do Serviço de Ginecologia do Hospital de Clínicas de Porto Alegre (HCPA) com mulheres climatéricas entre 45 e 60 anos. As participantes eram submetidas a uma anamnese e dois questionários (de qualidade de vida - Escala de Cervantes e o Índice de Função Sexual Feminina - IFSF), além da avaliação da musculatura do assoalho pélvico por meio do biofeedback eletromiográfico. Resultados: A amostra foi composta por 51 mulheres com idade média de 52,1 anos (± 4,9). Não houve diferença estatisticamente significativa em relação ao tônus muscular de repouso entre mulheres com e sem dispareunia (p=0,152). Contudo, nas mulheres com dispareunia o IFSF apresentou um pior escore (p<0,001) assim como na escala de Cervantes (p=0,009) em comparação às mulheres sem dispareunia. Houve, também, uma associação inversa significativa entre o escore de dor do FSFI e a média do tônus de base (rs= -0,300; p= 0,033). Conclusão: O presente estudo demonstrou não haver diferença entre o tônus de repouso das musculaturas do assoalho pélvico de mulheres climatéricas com e sem dispareunia. Entretanto houve diferença entre os dois grupos quanto à qualidade de vida (Escala de Cervantes) e função sexual (IFSF). Outros estudos na área da fisioterapia e disfunção sexual são necessários para aprimorar a qualidade de investigação e intervenção de mulheres climatéricas com disfunção sexual. / Introduction. Alterations in the pelvic floor during menopausal years, which are the result of hormonal and physical changes and of tissue aging itself, can lead to urinary and sexual dysfunction. The role of physical therapy in the treatment of urinary incontinence is well documented, but few studies have assessed its role in sexual dysfunction. Aim. To assess the myoelectric action potential of pelvic floor muscles, sexual function (using the Female Sexual Function Index, FSFI) and quality of life (using the Cervantes Scale) in perimenopausal and menopausal women with and without dyspareunia. Methods. Cross-sectional study carried out at the outpatient Menopause clinic of the Department of Gynecology, Hospital de Clínicas de Porto Alegre (HCPA), Brazil, in a sample of climacteric women aged 45 to 60 years. Participants were interviewed, completed two questionnaires (Cervantes Scale and FSFI), and underwent assessment of the pelvic floor muscles by the electromyographic biofeedback method. Results. The sample comprised 51 women with a mean age of 52.1±4.9 years. There were no statistically significant differences in resting muscle tone between women with and without dyspareunia (P = 0.152). However, women with dyspareunia scored worse on the FSFI (P < 0.001) and the Cervantes Scale (P = 0.009) as compared to women without dyspareunia. Furthermore, there was a significant inverse association between FSFI pain scores and mean resting tone (rs = -0.300; P = 0.033). Conclusions. Although myoelectric activation potentials were similar in women with and without dyspareunia, there were between-group differences in FSFI and Cervantes Scale scores. Further studies are required with the possibility of standardize assessment and physical therapy interventions in climacteric women with dyspareunia.

Introdução: Ensaio clínico randomizado e controlado com o propósito de comparar a eficácia da técnica de treinamento dos músculos do assoalho pélvico (TMAP) com ou sem biofeedback eletromiográfico (BFE) e a qualidade de vida (QV) em mulheres com queixas de perda urinária aos esforços. Métodos: Após seleção, as mulheres pós-menopáusicas com Incontinência Urinária de Esforço (IUE) foram randomizadas e alocadas em três grupos: grupo controle (GC), grupo treinamento assoalho pélvico (GTMAP) e grupo treinamento assoalho pélvico + biofeedback (GTMAP+BIO) Após a coleta de dados demográficos, antropométricos e gestacionais aplicou-se o questionário de qualidade de vida (QV) o International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) e a escala de OXFORD. Foi realizada a avaliação eletromiográfica do repouso inicial e final, presença de contração automática durante a tosse, contração voluntária máxima (CVM) e tempo de sustentação da contração, antes e depois da intervenção do GC, GTMAP e GTMAP+BIO. A intervenção no GTMAP e GTMAP+BIO foi de 20 minutos por dia, 2 vezes por semana, durante 4 semanas. Resultados: O estudo foi concluído com 45 mulheres. Houve aumento significativo nos grupos GTMAP e GTMAP+BIO no incremento da força muscular na OXFORD, na contração automática durante a tosse, na CVM, no tempo de sustentação e no ICIQ-SF em relação ao GC e na comparação ao tempo basal e pós-tratamento. O grupo GTMAP+BIO, quando comparado ao GTMAP, foi superior no incremento na força muscular na escala de OXFORD, na contração automática durante a tosse, na CVM e no tempo de sustentação (p<0.05). Considerações finais: O TMAP foi eficaz para a amostra estudada, porém, foi superior na adição do Biofeedback Eletromiográfico (BFE), sendo recomendado a utilização do TMAP associado ao BFE para pacientes com Incontinência Urinária de Esforço. / Introduction: This randomized controlled trial sought to compare the efficacy of pelvic floor muscle exercises (PFME) with and without electromyographic biofeedback (EMG-BF) and quality of life in women with stress urinary incontinence (SUI). Methods: Postmenopausal women with SUI were randomly allocated across three groups: control, pelvic floor muscle exercises (PFME), and PFME + biofeedback (PFME+BF). Demographic, anthropometric and gestational data were collected and the ICIQ-SF QoL questionnaire and Oxford grading scale were administered. Before and after the study intervention, women in all groups underwent EMG assessment to evaluate initial and final baseline, presence of automatic contraction while coughing (“the Knack”), maximum voluntary contraction (MVC), and duration of endurance contraction. In the PFME and PFME+BF groups, the duration of intervention was 20 min/day, twice weekly for 4 weeks. Results: The study involved 45 women. The PFME and PFME+BF groups exhibited significant increases in muscle strength (Oxford scale), automatic contraction while coughing, MVC, duration of endurance contraction, and ICIQ-SF as compared to controls and when comparing baseline vs. post-treatment. PFME+BF was associated with significantly superior improvement of muscle strength, automatic contraction while coughing, MVC, and duration of endurance contraction as compared to PFME alone (p<0.05). Conclusion: PFME was effective in this sample, but superior results were achieved when EMG-BF was added. We recommend that PFME+BF be offered to women with SUI.

Introdução: As alterações do assoalho pélvico nas mulheres climatéricas, decorrentes das variações hormonais, de modificações físicas e do próprio envelhecimento dos tecidos, podem ser responsáveis por disfunções urinárias e sexuais. O papel da fisioterapia no tratamento da incontinência urinária tem sido documentado, porém há poucos estudos avaliando a disfunção sexual. Objetivos: Avaliar o potencial de ativação mioelétrica das musculaturas do assoalho pélvico, a função sexual através do Índice de Função Sexual Feminina (IFSF) e a qualidade de vida (Escala de Cervantes) de mulheres climatéricas com e sem dispareunia. Métodos: Estudo transversal realizado no ambulatório de Climatério do Serviço de Ginecologia do Hospital de Clínicas de Porto Alegre (HCPA) com mulheres climatéricas entre 45 e 60 anos. As participantes eram submetidas a uma anamnese e dois questionários (de qualidade de vida - Escala de Cervantes e o Índice de Função Sexual Feminina - IFSF), além da avaliação da musculatura do assoalho pélvico por meio do biofeedback eletromiográfico. Resultados: A amostra foi composta por 51 mulheres com idade média de 52,1 anos (± 4,9). Não houve diferença estatisticamente significativa em relação ao tônus muscular de repouso entre mulheres com e sem dispareunia (p=0,152). Contudo, nas mulheres com dispareunia o IFSF apresentou um pior escore (p<0,001) assim como na escala de Cervantes (p=0,009) em comparação às mulheres sem dispareunia. Houve, também, uma associação inversa significativa entre o escore de dor do FSFI e a média do tônus de base (rs= -0,300; p= 0,033). Conclusão: O presente estudo demonstrou não haver diferença entre o tônus de repouso das musculaturas do assoalho pélvico de mulheres climatéricas com e sem dispareunia. Entretanto houve diferença entre os dois grupos quanto à qualidade de vida (Escala de Cervantes) e função sexual (IFSF). Outros estudos na área da fisioterapia e disfunção sexual são necessários para aprimorar a qualidade de investigação e intervenção de mulheres climatéricas com disfunção sexual. / Introduction. Alterations in the pelvic floor during menopausal years, which are the result of hormonal and physical changes and of tissue aging itself, can lead to urinary and sexual dysfunction. The role of physical therapy in the treatment of urinary incontinence is well documented, but few studies have assessed its role in sexual dysfunction. Aim. To assess the myoelectric action potential of pelvic floor muscles, sexual function (using the Female Sexual Function Index, FSFI) and quality of life (using the Cervantes Scale) in perimenopausal and menopausal women with and without dyspareunia. Methods. Cross-sectional study carried out at the outpatient Menopause clinic of the Department of Gynecology, Hospital de Clínicas de Porto Alegre (HCPA), Brazil, in a sample of climacteric women aged 45 to 60 years. Participants were interviewed, completed two questionnaires (Cervantes Scale and FSFI), and underwent assessment of the pelvic floor muscles by the electromyographic biofeedback method. Results. The sample comprised 51 women with a mean age of 52.1±4.9 years. There were no statistically significant differences in resting muscle tone between women with and without dyspareunia (P = 0.152). However, women with dyspareunia scored worse on the FSFI (P < 0.001) and the Cervantes Scale (P = 0.009) as compared to women without dyspareunia. Furthermore, there was a significant inverse association between FSFI pain scores and mean resting tone (rs = -0.300; P = 0.033). Conclusions. Although myoelectric activation potentials were similar in women with and without dyspareunia, there were between-group differences in FSFI and Cervantes Scale scores. Further studies are required with the possibility of standardize assessment and physical therapy interventions in climacteric women with dyspareunia.

Introdução: Ensaio clínico randomizado e controlado com o propósito de comparar a eficácia da técnica de treinamento dos músculos do assoalho pélvico (TMAP) com ou sem biofeedback eletromiográfico (BFE) e a qualidade de vida (QV) em mulheres com queixas de perda urinária aos esforços. Métodos: Após seleção, as mulheres pós-menopáusicas com Incontinência Urinária de Esforço (IUE) foram randomizadas e alocadas em três grupos: grupo controle (GC), grupo treinamento assoalho pélvico (GTMAP) e grupo treinamento assoalho pélvico + biofeedback (GTMAP+BIO) Após a coleta de dados demográficos, antropométricos e gestacionais aplicou-se o questionário de qualidade de vida (QV) o International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) e a escala de OXFORD. Foi realizada a avaliação eletromiográfica do repouso inicial e final, presença de contração automática durante a tosse, contração voluntária máxima (CVM) e tempo de sustentação da contração, antes e depois da intervenção do GC, GTMAP e GTMAP+BIO. A intervenção no GTMAP e GTMAP+BIO foi de 20 minutos por dia, 2 vezes por semana, durante 4 semanas. Resultados: O estudo foi concluído com 45 mulheres. Houve aumento significativo nos grupos GTMAP e GTMAP+BIO no incremento da força muscular na OXFORD, na contração automática durante a tosse, na CVM, no tempo de sustentação e no ICIQ-SF em relação ao GC e na comparação ao tempo basal e pós-tratamento. O grupo GTMAP+BIO, quando comparado ao GTMAP, foi superior no incremento na força muscular na escala de OXFORD, na contração automática durante a tosse, na CVM e no tempo de sustentação (p<0.05). Considerações finais: O TMAP foi eficaz para a amostra estudada, porém, foi superior na adição do Biofeedback Eletromiográfico (BFE), sendo recomendado a utilização do TMAP associado ao BFE para pacientes com Incontinência Urinária de Esforço. / Introduction: This randomized controlled trial sought to compare the efficacy of pelvic floor muscle exercises (PFME) with and without electromyographic biofeedback (EMG-BF) and quality of life in women with stress urinary incontinence (SUI). Methods: Postmenopausal women with SUI were randomly allocated across three groups: control, pelvic floor muscle exercises (PFME), and PFME + biofeedback (PFME+BF). Demographic, anthropometric and gestational data were collected and the ICIQ-SF QoL questionnaire and Oxford grading scale were administered. Before and after the study intervention, women in all groups underwent EMG assessment to evaluate initial and final baseline, presence of automatic contraction while coughing (“the Knack”), maximum voluntary contraction (MVC), and duration of endurance contraction. In the PFME and PFME+BF groups, the duration of intervention was 20 min/day, twice weekly for 4 weeks. Results: The study involved 45 women. The PFME and PFME+BF groups exhibited significant increases in muscle strength (Oxford scale), automatic contraction while coughing, MVC, duration of endurance contraction, and ICIQ-SF as compared to controls and when comparing baseline vs. post-treatment. PFME+BF was associated with significantly superior improvement of muscle strength, automatic contraction while coughing, MVC, and duration of endurance contraction as compared to PFME alone (p<0.05). Conclusion: PFME was effective in this sample, but superior results were achieved when EMG-BF was added. We recommend that PFME+BF be offered to women with SUI.