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Cerebral electrostimulation (CES) as a treatment for migraine headache was investigated. Eighteen participants recorded data on headaches for two baseline weeks. Six were assigned to each of three groups--an active treatment group receiving CES, a placebo group receiving a simulated version of CES, and a no-treatment control group placed on a waiting list during the study. The CES group evidenced a significant reduction in headache duration and intensity relative to the placebo group. The waiting list control group did as well as the CES group. A number of hypotheses were put forth in an attempt to account for the unexpected finding.

Η ανάπτυξη πρωτεϊνικών κρυστάλλων, κατάλληλων για κρυσταλλογραφία ακτίνων-Χ, είναι γνωστό ότι είναι το βασικό στοιχείο του προσδιορισμού της πρωτεϊνικής δομής. Οι κρυσταλλογράφοι αντιμετωπίζουν σε καθημερινή βάση προβλήματα όπως η ποσότητα της πρωτεΐνης, η διαθεσιμότητα της υψηλής ποιότητας κρυστάλλων πρωτεΐνης και ο έλεγχος του μεγέθους του κρυστάλλου. Πολλές προσπάθειες έχουν γίνει για να βελτιωθεί η διαδικασία κρυστάλλωσης με τη χρήση των μαγνητικών πεδίων, της ηλεκτρό-εστίασης, και των εσωτερικών ή εξωτερικών ηλεκτρικών πεδίων. Τα ηλεκτρικά πεδία αποτελούν μια σημαντική μεθοδολογική πρόοδο και έχουν χρησιμοποιηθεί προκειμένου να ενισχυθεί η δημιουργία και ανάπτυξη πυρήνων κρυστάλλωσης. Σε αυτή την εργασία διερευνήθηκε η επίδραση της ασύρματης μεταγωγής ρεύματος κατά την κρυστάλλωση της λυσοζύμης, της ριβονουκλεάσης Α και της ινσουλίνης χρησιμοποιώντας μια πρωτότυπη συσκευή παραγωγής ιόντων. Η μέθοδος διάχυσης ατμών χρησιμοποιήθηκε σε όλες τις πειραματικές διατάξεις. Η ποιότητα των κρυστάλλων και η τρισδιάστατη δομή των πρωτεϊνών που καλλιεργήθηκαν με και χωρίς την επίδραση του ηλεκτρικού πεδίου αναλύθηκαν μέσω της περίθλασης ακτίνων-Χ. Οι κρύσταλλοι εμφανίστηκαν νωρίτερα στα δείγματα που εκτέθηκαν στο ηλεκτρικό πεδίο σε σχέση με τα μη εκτεθειμένα δείγματα κάτω από ταυτόσημες συνθήκες. Επιπλέον, οι κρύσταλλοι πρωτεΐνης που ελήφθησαν σε μικρότερους χρόνους ήταν μεγαλύτεροι σε μέγεθος. Αρκετά ενδιαφέρον ήταν ότι η ποιότητα των κρυστάλλων που αναπτύχθηκαν στις εκτεθειμένες σταγόνες ήταν η ίδια, αν όχι καλύτερη από, εκείνη των κρυστάλλων που αναπτύχθηκαν στις μη εκτεθειμένες σταγόνες σε κάποιο ηλεκτρικό πεδίο. Η διαδικασία πυρήνωσης φαίνεται να διαφέρει μετά από την έκθεση σε κάποιο ηλεκτρικό πεδίο από ότι η μη έκθεση σε αυτό υπό ταυτόσημες συνθήκες. Η χρήση της πρωτότυπης συσκευής ασύρματης μεταγωγής ρεύματος φαίνεται να επάγει τον προσανατολισμό των πολικών μορίων της πρωτεΐνης, ευνοώντας έτσι την κρυστάλλωση. Η χρήση της συσκευής προσφέρει το πλεονέκτημα ότι παρέχει φορτισμένα σωματίδια πάνω σε ολόκληρη την εκτεθειμένη επιφάνεια του διαλύματος κρυστάλλωσης, ενώ ταυτόχρονα ελαχιστοποιεί τον κίνδυνο μόλυνσης. Επίσης, η συσκευή αυτή είναι πολύ απλούστερη και ευκολότερη στη χρήση από ό,τι άλλες συσκευές με κλασικά ηλεκτρόδια. / The growth of protein crystals, suitable for X-ray crystallography is known to be the basic element of the protein structure determination. Crystallographers face problems such as the amount of the protein, the availability of high-quality protein crystals and the control of the crystal size in a daily basis. Many efforts have been made to improve crystallization process with the use of magnetic fields, electro–focusing, and internal or external electric fields. The electric fields consist a significant methodological advancement and have been used in order to enhance nucleation and crystal growth. In this work, the influence of a non-contact current transfer upon the crystallization of Lysozyme, Rnase A and Insulin was investigated using a prototype ion-generator device. The vapor diffusion method was used in both hanging and sitting drop setups. The crystal quality and the three-dimensional structure of lysozyme grown with and without the EF influence were analyzed by means of X-ray diffraction. Crystals appeared earlier in samples exposed to NCCT than in non-exposed samples under identical conditions. Furthermore, protein crystals that were obtained after shorter times were larger in size when grown after exposure to NCCT device. More interestingly, the quality of the crystals grown in NCCT-exposed drops was the same as, if not better than, that of the crystals grown in the control drops. The nucleation process after exposure to NCCT differs from that after exposure to an ion-free gas stream under identical conditions. The use of the NCCT prototype device appears to induce the orientation of the polar protein molecules, thereby favoring crystallization. The use of NCCT offers the advantage of delivering charged particles onto the entire exposed surface of the crystallization solution, while at the same time minimizes the risk of contamination. Also, the use of this device is much simpler and easier to use than other devices with classic electrodes.

Orientador: Juvenal Ricardo Navarro Goes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-04T01:14:01Z (GMT). No. of bitstreams: 1 Mergulhao_MelissaEichenbergerAlves_M.pdf: 6053409 bytes, checksum: f6f4ceb9229c4e46eb9fa5a3d2b24f1d (MD5) Previous issue date: 2004 / Resumo: defecação é função privada e sua ocorrência, num momento ou local Índesejável, pode ser constrangedora, ocasionando uma condição de alienação social. A ÍncontÍnência fecal apresenta baixa morbidade; pode estar associada à depressão, ao pessimismo e à dimÍnuição da auto-estima, levando à limitação das atividades da vida diária. Dentre as várias causas da ÍncontÍnência fecaI, a multiparidade e o parto vaginal são considerados fatores de risco significativos. Como opções de tratamento conservador para a ÍncontÍnência fecal tem-se a cÍnesioterapia clássica, o biofeedback e a eletroestimulação, dos quais espera-se aumento do tônus da musculatura esfincteriana e conscientização sensório-motora, permitÍndo ao paciente maior controle sobre sua defecação. o objetivo deste estudo foi comprovar a eficácia da eletroestimulação neuromuscular em pacientes multíparas com ÍncontÍnência fecaI, em estudo comparativo com o tratamento pelo biofeedback isolado ou deste associado à eletroestimulação. Foram estudadas 25 doentes multíparas portadoras de ÍncontÍnência fecaI, e estas foram divididas, mediante sorteio, em três grupos: oito doentes foram submetidas à eletroestimulação; oito, foram tratadas com o emprego da eletroestimulação com biofeedback e nove foram submetidas ao biofeedback. As doentes foram avaliadas pelos seguÍntes parâmetros: manometria anorretal, escore do índice funcionaI clínico de ÍncontÍnência fecaI e questionário de qualidade de vida e tempo de urgência de evacuação, perda de fezes durante o repouso, durante atividades da vida diária, perda de fezes andando, durante esforço leve, moderado, Íntenso e perda de fezes sem perceber, pré e póstratamento. Foi considerada também a estimativa de melhora e o grau de satisfação com o tratamento. O estUdofoi prospectivo e randomizado. A análise dos dados demonstrou diferença estatisticamente significativa entre o pré e pós-tratamento, Índependentemente do grupo estudado, nas variáveis referentes à área sob o traçado da contração voluntária, escore do índice funcional da ÍncontÍnência fecaI, ao escore da qualidade de vida, tempo de urgência de evacuação, perda de fezes durante repouso,duranteatividadesda vidadiária,perdade fezesandando,perdade fezesduranteo esforço moderado e perda de fezes sem perceber. Houve correlação estatisticamente significativa entre o pré e pós-tratamento no grupo de biofeedback, quando se comparou o valor da pressão anal média da contração voluntária máxima. Já a pressão anal média de repouso, a capacidade de sustentação e a perda de fezes durante esforço intenso não apresentaram nenhuma diferença com significância estatística. Os resultados obtidos neste estudo permitem concluir que a eletroestimulação é eficaz no tratamento da incontinência fecal em doentes multíparas, quando aplicada isoladamente ou em associação com tratamento pelo biofeedback. Estatisticamente não foi constatada superioridade entre os métodos / Abstract: Defecation is a private function and its occurrence at an undesirable moment or place can be embarrassing and lead to a condition of social alienation. Although fecal incontinence does not present a high mortality rate, it causes social and moral perturbations which are difficult to solve. It is an embarrassing condition with important socioeconomic repercussions. It can be associated with depression, pessimism and a drop in the patient self-esteem, leading to restrictions in day-to-day activities. Among the several causes of fecal incontinence, multiparity and vaginal delivery has been implicated as a significant causal factor. Options for the conservative treatment of fecaI incontinence include classical cinesiotherapy, biofeedback and electrostimulation ITomwhich the increase ofthe sphincter muscle tonus as well as of sensorial awareness are expected, resulting in a better defecation control. The aims ofthis study were to prove the efficiency ofneuromuscular electrostimulation in patients with fecal incontinence in comparison with patients treated by biofeedback and patients treated with electrostimulation plus biofeedback. In order to get a homogeneous group, twenty-five females and muhiparas patients sufIering ITom fecal incontinence were allocated to three groups to be submitted to treatment; 8 patients underwent electrostimulation, 8 patients underwent electrostimulation plus biofeedback and 9 patients were submitted to biofeedback alone. The patients were evaluated by anorectal manometry, by a clinical functional index of fecal incontinence, by a questionnaire about their quality of life, time of evacuation urge, loss of feces during rest hours, daily activities , walking, during light, moderate or intense efIort as well as loss of feces without noticing pre- and post-treatment. The patient's evaluation of their improvement and satisfaction degree has also been analyzed. This study was prospective and randomized. The Analysis of the data demonstrated statistically significant difIerences independent of the group assessed between the pre- and post-treatment scores of functional index of fecal incontinence, the quality of life assessments, the area under graphic traces of voluntary squeeze and the times of urgency of evacuation, loss of feces during rest hours, daily actives, waIking, during light or moderate or effort as well as 10ss of feces with out noticing. There was a statistically significant correlation between the pre- and post-treatment in the biofeedback group when comparing the mean anal pressure of maximum voluntary squeeze. However, the mean resting anal pressure and the capacity of sustentation and the 10ss of feces during intense effort did not present any significant difference. The results obtained in the present study enabled us to conclude that electrostimulation is as . etlicacious as biofeedback in the treatment of fecal incontinence, without giving a statistically significant difference between the two methods / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

This work deals with the electrophysiology of cardiac cells, their electro-stimulation and design of stimulation device to extend their life. The first part is focused on the action potential in general, in muscle cells, followed by an analysis of the process and characteristics of the action potential in cardiomyocytes. The next section provides a procedure for isolating and process of changes that lead to cell death and of a method that the process would be eliminated. Part of this work is a program for processing and evaluation of pictures obtained during electro-stimulation process.

Nous ne sommes plus autorisés à parler de la BPCO comme d'une simple maladie respiratoire mais plutôt comme une maladie générale. Parmi les atteintes systémiques, la dysfonction musculaire apparaît comme un facteur clé dans la physiopathologie de la BPCO car elle domine l'évolution de la maladie. Par ailleurs, le mystère autour de l'origine exacte de cette dysfonction reste encore entier. Il est maintenant bien établi qu'au cours des épisodes d'exacerbations, la dysfonction musculaire atteint son paroxysme, de plus en absence d'accompagnement musculaire spécifique la récupération est quasi nulle. Ainsi, les objectifs de ce travail de thèse ont étés la compréhension des mécanismes impliqués, d'une part, dans la dysfonction musculaire périphérique des patients BPCO stables et instables (après épisode d'exacerbation) et, d'autre part, dans l'amélioration de la fonction musculaire après différents programmes de réentraînements à l'effort. Dans le cadre de notre première étude, nous avons rapporté que l'oxydation des protéines, plus particulièrement les protéines mitochondriales était plus élevée dans le quadriceps des patients avec une BPCO stable. De plus, nous avons montré que les épisodes d'exacerbations sont associés à une augmentation de l'oxydation des protéines, au niveau mitochondriales et contractiles, corrélée à une dysfonction musculaire. Dans un second temps, nous avons envisagé un réentrainement par électrostimulation chez les patients en cours d'exacerbation et un réentrainement individualisé au seuil ventilatoire (intensité modérée) pour les patients cliniquement stables. Nos résultats indiquent que les deux programmes d'entraînement proposés préviennent le stress oxydant musculaire et améliorent la fonction musculaire périphérique chez les patients BPCO. Cependant, les adaptations mitochondriales restent limitées chez les patients BPCO stables comparativement aux sujets contrôles. En conclusion, nos résultats montrent que les protéines contractiles et mitochondriales sont la cible d'une augmentation du stress oxydant musculaire particulièrement au cours d'une exacerbation. Par ailleurs, des programmes de réentraînement adaptés à la sévérité de la fonction musculaire préviennent les dommages liés au stress oxydant musculaire et contribuent à l'amélioration de la fonction musculaire périphérique. Ainsi, nous pensons que nos résultats pourront probablement favoriser l'amélioration de la prescription du réentraînement à l'effort chez les patients BPCO. / We are no longer allowed to consider COPD as a simple respiratory disease but rather as a systemic disease. Among the systemic effects, muscle dysfunction appears to be a key factor in the pathogenesis of COPD because it strongly influences how the disease will progress. However, the exact origin of muscle dysfunction is still unknown. It is acknowledged that during COPD exacerbations muscle dysfunction is worsened and that, in the absence of post-exacerbation muscle training, recovery is slow and partial. Thus, the objectives of this thesis were first to try to understand the cellular mechanisms involved in the peripheral muscle dysfunction in patients with stable and unstable (after exacerbations) COPD and, then, to assess different programs of physical training to improve muscle function in such patients.Concerning the identification of the mechanisms underlying peripheral muscle dysfunction, we found that protein oxidation, particularly mitochondrial protein oxidation, is higher in the quadriceps of patients with stable COPD than in control subjects. In addition, we have shown that COPD exacerbations are associated with increased muscle oxidative damage of mitochondrial and contractile proteins that is correlated with the level of muscle dysfunction. We then assessed a training protocol using neuromuscular electrostimulation for patients during COPD exacerbation and a training program of moderate intensity (ventilatory threshold) for clinically stable patients. Our results indicate that the two training programs prevent oxidative stress and improve muscle function in COPD patients. However, mitochondrial adaptation is limited in patients with stable COPD compared with controls. In conclusion, our results show that contractile and mitochondrial proteins are the target of increased oxidative stress particularly during COPD exacerbation. However, training programs tailored to the severity of muscle dysfunction can prevent further oxidative damage and contribute to improving muscle function. Our findings might help improving the choice of training programs for patients with COPD.

La perméabilité de la peau ne permet pas la diffusion passive de grandes molécules, comme l'insuline ou encore les plasmides d'ADN, au travers de l'épiderme dans le but d'atteindre les vaisseaux sanguins. Cela est uniquement possible pour des molécules de plus petite taille comme la nicotine par exemple. Il existe différentes voies alternatives (électrique, mécanique, thermique) de délivrance transdermique permettant d'éviter l'utilisation de la seringue d'injection, qui pourraient améliorer la qualité de vie des patients atteints de maladies comme le diabète. Ces méthodes incluent par exemple les micro-aiguilles, l'électro-perméabilisation, et l'iontophorèse. L'électroperméabilisation permet, via l'application d'un champ électrique, d'augmenter momentanément la perméabilité de la peau et par conséquent de permettre le passage transdermique de molécules de haut poids moléculaire. L'objectif de ces travaux de thèse était de concevoir et de réaliser un patch nanocomposite à base de nanotubes de carbone permettant de stocker, mais également de relarguer un médicament lorsque qu'il est soumis à une électrostimulation. Pour ce faire, différents polymères ainsi que différentes techniques de mise en forme ont été explorées et développées pour permettre de démontrer la faisabilité de notre approche. Les études ont permis de proposer et de développer un hydrogel nanocomposite biocompatible comportant une matrice polymère agarose et contenant de nanotubes de carbone biparois dans le but d'améliorer les propriétés à la fois électriques et mécanique du matériau. Nous en avons étudié les différentes caractéristiques telles que la microstructure, la capacité de stockage et de relargage, ainsi que les propriétés électriques. Dans le contexte général de précaution en relation avec la mise en œuvre de nanoparticules, et sur la base de travaux antérieurs démontrant l'innocuité des nanotubes utilisés lorsqu'ils ne sont pas en contact direct avec des cellules. Nous avons aussi démontré qu'il n'y a pas de relargage des nanotubes dans des conditions extrêmes (sans électrostimulation) de température en milieu sueur artificielle. L'avancée de ces travaux a permis d'effectuer les premiers tests de délivrance transdermique ex-vivo sur peau de souris et a démontré ainsi la faisabilité et l'intérêt d'utiliser les nanotubes de carbones biparois dans une matrice en polymère pour la délivrance transdermique électrostimulée de molécules de masse molaire de l'ordre de celle de l'insuline. Cette thèse en co-direction alliant la Science des Matériaux (CIRIMAT) et la Science du Vivant (IPBS) a réuni différentes compétences lui donnant un véritable contexte interdisciplinaire. Elle s'est intégrée dans un projet de plus grande ampleur associant la Sociologie et le Droit (Défi Nano CNRS), centré sur le cas du diabète. Ceci a permis de démontrer l'intérêt de développer un tel dispositif (du point de vue des médecins et des patients), mais aussi en nous orientant vers un dispositif médical afin d'éviter de futurs écueils juridiques en termes d'application. / The permeability of skin does not allow the passive diffusion across epidermis to reach blood vessels for large molecular weight molecules such as insulin or DNA plasmids. This is possible only for small molecules such as nicotine, for example. Alternative routes of transdermal delivery exist (thermal, electrical, mechanical) that avoid injections and improve the quality of life of patients suffering of diseases like diabetes. These methods known as "Transdermal Drug Delivery" (TDD) technologies, include for example electroporation, iontophoresis and micro needles. In particular, electropermeabilisation is known to temporarily increase the permeability of the skin, consequently allowing transdermal passage of molecules of high molecular weight. The aim of this work was to conceive and elaborate an innovative needle-free device for transdermal drug delivery, made of a nanocomposite material containing carbon nanotubes to improve both electrical and mechanical properties of the biocompatible polymer matrix. This nanocomposite device aims at permeabilising the skin and delivering drug molecules simultaneously when electrically stimulated. To reach this goal, we investigated different biocompatible polymers and shaping processes, finally demonstrating the feasibility of the fabrication of such a device. We have developed a bio-sourced and biocompatible nanocomposite hydrogel with an agarose matrix and containing double-walled carbon nanotubes, and characterized it in terms of microstructure, storage and release capacity, as well as electrical properties. In the general context of precaution in relation to the implementation of nanoparticles, and on the basis of previous work demonstrating the safety of nanotubes used when they are not in direct contact with cells, we have also demonstrated that there is no release of the nanotubes under extreme conditions of temperature (without electrostimulation) in an artificial sweat medium. Finally, we have demonstrated the feasibility of its first use as a TDD system using an ex vivo mouse skin model. These results provide good evidence that the use of double-walled carbon nanotubes makes possible the transdermal delivery of large molecules with a molecular weight similar to insulin with such a nanomaterial. This thesis was in co-direction, combining Materials Science (CIRIMAT) and Life Science (IPBS) in order to gather different skills, giving it a real interdisciplinary context. Moreover, this work was integrated into a larger project (CNRS, "Nano challenge"), also including Sociology and Law, focusing on diabetes. This has demonstrated the actual demand for such a device from both the medical doctors and the patients, but also directed our work towards a medical device thanks from the juridical point of view.

Pacientes com diabetes mellitus apresentam perda de massa e força muscular esquelética. O treinamento de força é prescrito aos pacientes diabéticos como parte do tratamento, pois melhora o controle glicêmico além de promover aumento da massa muscular. Foram investigados os mecanismos envolvidos na hipertrofia muscular induzida por sobrecarga mecânica durante o estabelecimento do estado diabético do tipo I induzido por estreptozotocina em ratos. Os experimentos foram realizados nos músculos com predominância de fibras oxidativas (sóleo) ou glicolíticas (extensor digital longo - EDL). Avaliou-se a modulação da via de síntese de proteínas PI3K-AKT-mTOR sete dias após indução de hipertrofia dos músculos sóleo por tenotomia do músculo gastrocnêmio e do EDL pela ablação do músculo tibial. Determinou-se também a expressão de mRNA de outras vias de sinalização que controlam a hipertrofia muscular: mecanotransdução (FAK), Wnt/β-catenina e miostatina e folistatina. Os músculos sóleo e EDL quando submetidos à sobrecarga funcional sofreram hipertrofia semelhante em animais controles e diabéticos. O aumento das forças tetânica e isotônica, absolutas e específicas, ocorreu na mesma magnitude que a hipertrofia muscular. A hipertrofia do músculo EDL nos animais diabéticos envolveu principalmente a via PI3K-AKT-mTOR além da redução no conteúdo de AMPK e diminuição da expressão de miostatina. No músculo sóleo, a hipertrofia foi mais pronunciada nos animais diabéticos por ativação mais intensa da via pelas proteínas rpS6 e aumento na expressão de mRNA de IGF-1, MGF e folistatina além de diminuição nos conteúdos de miostatina, MuRF-1 e atrogina-1. As modificações relacionadas à sinalização permitiram ao músculo sóleo alcançar valores de força e massa muscular similares ao grupo controle. / Patients with diabetes mellitus have reduction in skeletal muscle mass and strength. Strength training is prescribed to diabetic patients as part of the treatment since it improves glycemic control and promotes an increase of skeletal muscle mass. The mechanisms involved in the overload-induced muscle hypertrophy during the establishment of the type I diabetic state, induced by streptozotocin, were investigated in rats. The experiments were performed in muscles with predominance of oxidative (soleus) or glycolytic (EDL) fibers. PI3K/AKT/mTOR protein synthesis pathway was evaluated seven days after the overload-induced hypertrophy of the soleus muscle by tenotomy of the gastrocnemius muscle and of the EDL muscle by tibialis anterior muscle ablation. The mRNA expression of genes associated with different signaling pathways that control muscle hypertrophy was also evaluated: mechanotransduction (FAK) signaling, Wnt/β-catenin, myostatin and follistatin. The soleus and EDL muscles when submitted to overload had similar hypertrophic responses in control and diabetic animals. The increase of twitch and tetanic, absolute and specific, forces had the same magnitude as the muscle hypertrophic response. Hypertrophy of the EDL muscle from diabetic animals mostly involved mechanical loading-stimulated PI3K/AKT/mTOR pathway in addition to the reduced activation of AMPK and decrease of myostatin expression. Hypertrophy was more pronounced in the soleus muscle of diabetic animals due to a more potent activation of rpS6 and increased mRNA expression of IGF-1, MGF and follistatin, and decrease of the myostatin, MuRF-1 and atrogin-1 contents. The activated signaling pathways enabled the soleus muscle mass and force of the diabetic rats to reach the values of the control group.

Introdução: O treinamento dos músculos do assoalho pélvico (MAP) é a primeira linha de tratamento conservador da incontinência urinária (IU), contudo, muitas mulheres não conseguem contrair essa musculatura voluntariamente. A eletroestimulação intravaginal (EEIV) é bem documentada nestes casos e o estímulo vibratório intravaginal (EVIV) também tem sido utilizado, mas poucos estudos abordam o método. Objetivo: Comparar a EEIV com o EVIV na funcionalidade dos MAP de mulheres com IU que não conseguem contrair voluntariamente os MAP. Materiais e métodos: Ensaio clínico randomizado realizado no Hospital de Clínicas de Porto Alegre de junho de 2016 a setembro de 2017. Critérios de inclusão: mulheres maiores de 18 anos, com IU e incapazes de contrair voluntariamente os MAP. Critérios de exclusão: alergia ao látex e treinamento dos MAP nos últimos seis meses Após avaliação, as pacientes que correspondiam aos critérios de inclusão foram randomizadas em grupo EEIV e EVIV. Foram realizadas seis sessões individuais de 20 minutos, uma vez por semana. Resultados: Foram randomizadas 21 mulheres para cada grupo e 18 completaram o protocolo de EVIV e 17 o de EEIV. Ao final, o grupo EVIV apresentou aumento significativo na força dos MAP em relação ao grupo EEIV (p=0,026) e houve interação significativa do tempo e tipo de intervenção para a mesma variável (p=0,008) no GEVIV. Conclusão: O EVIV foi significativamente melhor que a EEIV na melhora da força dos MAP, mas são necessários mais estudos para consolidar seu uso na melhora da funcionalidade dos MAP e no tratamento da IU. / Introduction: Pelvic floor muscle (PFM) training is the first line of conservative treatment for urinary incontinence (UI); however, many women are unable to contract these muscles voluntarily. Intravaginal electrostimulation (IVES) is well documented in these cases and intravaginal vibratory stimulation (IVVS) is also used, but few studies address this method. Objective: To compare the use of IVES and IVVS on the function of the PFM in women with UI who cannot voluntarily contract the PFM. Materials and methods: Randomized clinical trial performed at the Hospital de Clínicas de Porto Alegre from June 2016 to September 2017. Inclusion criteria: women over 18 years of age with UI and unable to voluntarily contract their PFM. Exclusion criteria: latex allergy and PFM training over the last six months. After the assessment, the patients that met the inclusion criteria were randomized into IVES and IVVS groups. Six individual 20-minute sessions were held once a week Results: Twenty-one women were randomly assigned to each group and 18 completed the IVVS and 17 the IVES protocols. In the end, the IVVS group presented a significant increase in strength of the PFM in relation to the IVES group (p = 0.026) and there was a significant interaction between time and type of intervention for the same variable (p = 0.008) in the IVVS group. Conclusion: IVVS was significantly better than IVES in improving PFM strength, but more studies are needed to consolidate its use regarding PFM function and the treatment of UI.

Introdução: Variados recursos são utilizados na reabilitação pós Acidente Vascular Encefálico (AVE). Todavia os dados apresentados não evidenciam que alguma intervenção fisioterápica em especifico seja melhor que outra. Objetivo: Avaliar os efeitos da Eletroestimulação Funcional na amplitude de movimento (ADM), força muscular, pressão plantar e independência funcional comparado a estimulação sham em indivíduos hemiparéticos crônicos. Método: Trata-se de um estudo prospectivo, randomizado e controlado, composto por 10 indivíduos hemiparéticos pós AVE Isquêmico, com idade entre 30 e 80 anos de ambos os sexos. O grupo intervenção recebeu a aplicação do FES no músculo tibial anterior, 3 vezes por semana, por 4 semanas, durante 30 minutos. O grupo controle recebeu a aplicação de uma corrente elétrica sham no mesmo período. Todos os sujeitos receberam, adicionalmente, tratamento fisioterapêutico convencional. O grupo controle recebeu a aplicação de uma corrente elétrica sham no mesmo período. Todos os sujeitos receberam, adicionalmente, tratamento fisioterapêutico convencional. Os efeitos do tratamento foram avaliados por um observador cegado para os seguintes desfechos: (1) grau de espasticidade, (2) tônus muscular, (3), força muscular de dorsiflexores e plantiflexores através do dinamômetro isocinético Biodex System Pro, (4) pressão plantar através do Sistema de baropodometria computadorizada- F-Scan[TM] versão 4.22 Windows 95 Tekscan e (5) independência funcional através da Medida de Independência Funcional (MIF). Resultados: O grupo intervenção apresentou maiores valores de ADM de tornozelo em relação ao grupo controle, além de maior pressão plantar a região do antepé e maior escore na MIF. Comparando-se pré e pós tratamento no grupo intervenção, a ADM de dorsiflexão e plantiflexão (p=0.0001), força muscular de dorsiflexores (p=0.023) e escore da MIF (p=0.001) apresentaram maiores no período pós intervenção. No grupo controle, somente o escore da MIF apresentou diferença estatisticamente significativa entre pré e pós intervenção (p=0.034). Conclusão: A EENM demonstrou aspectos eficazes em relação à estimulação sham, todavia, estudos adicionais com amostras maiores devem ser realizados para melhor investigar os efeitos destas correntes. / Background: Considerable resources are devoted to poststroke rehabilitation. However, to date there is no evidence that one physiotherapy approach is any better than any other approach. Objective: To evaluate the effects of the functional electrostimulation – FES on the range of movement, muscle strength, plantar pressure and functional independency, compared to a sham stimulation, in stroke patients. Methods: A prospective, randomized, controlled clinical trial was carried out at a Physiotherapy Unit of University hospital with consecutive hemiparetic ischemic stroke patients. The study sample was randomized into the functional electrostimulation (FES) or sham stimulation groups. Interventions were carried out 3 times/week during 4 weeks, for 30 minutes. Ten hemiparetic ischemic stroke patients with age between 30 and 80 years of both sexes were included in the study. All subjects received routine interdisciplinary stroke rehabilitation, as the kinesiotherapic treatment program. The effects of the treatments were assessed by a blinded observer for: (1) degree of spasticity, (2) muscle tone, (3) muscle strength of the maximal voluntary torque of the dorsal and plantar flexion of the feet, (4) plantar pressure, (5) functional independence. Results: The FES group presented higher values than the sham group in the range of movement of the ankle, in the plantar pressure of the anterior region of the foot, and in the functional independence measure at the post-intervention period. Comparing the pre- and post-intervention periods of the FES group, dorsiflexion and plantar flexion of the foot (p = 0.0001), muscle strength responsible for the dorsiflexion of the foot (p = 0.023), and functional independence (p = 0.001) presented higher values at the post-intervention period. In the Sham group, the FIM scale was the only measure significantly different between the two moments (preand post-intervention) (p = 0.034). Conclusions: This functional electrostimulation showed aspects of efficacy in relation to the sham stimulation, however, further investigation with higher sample should be carried out.