Physiotherapeutic approach in women undergoing hysterectomy

Hysterectomy is the second most frequently performed surgery on the female genital tract. The patients submitted to this procedure are susceptible to complications that can be avoided by preventive measures, among them, the accomplishment of physiotherapy. This study aims to verify in the scientific literature the physiotherapeutic approaches in women submitted to hysterectomy. Systematic Researches of indexed articles were carried out in databases: Pubmed, LILACS, MEDLINE, PEDro e SciELO, between the years 2009 and 2019. 9 articles fit the inclusion and exclusion criteria determined to compose this systematic review. The main topics of physiotherapeutic activity found in the articles were: techniques for strengthening the pelvic floor musculature, breathing exercises, aerobic exercises and strengthening of the core, upper and lower extremities, transcutaneous electrical stimulation, evaluation of physical performance, fatigue, pain and quality of life, besides applying alternative techniques such as: acupuncture, electroacupuncture, auricular electrical stimulation, transcutaneous electrical stimulation, electric acustimulation and acupressure. There is a great diversity of studies showing beneficial effects in the different interventions developed, serving as a basis to direct the physiotherapeutic conducts in hysterectomy approaches, aiming at complementary resources for the best care of the patient undergoing this procedure. Keywords: Hysterectomy. Physical Therapy Modalities. Physical Therapy Specialty.

Auricular Electrical Stimulation Alleviates Headache through CGRP/COX-2/TRPV1/TRPA1 Signaling Pathways in a Nitroglycerin-Induced Migraine Rat Model

The study aimed to investigate effect of auricular electrical stimulation (ES) on migraine. Migraine was induced in rats by intraperitoneal administration of nitroglycerin (NTG, 10 mg/kg) three times. Auricular ES pretreatment was performed for five consecutive days. Migraine behaviors were observed by a video recording. Auricular ES pretreatment could reverse the decrease of the total time spent on exploratory (2619.0 ± 113.0 s vs 1581.7 ± 217.6 s, p=0.0029) and locomotor behaviors (271.3 ± 21.4 s vs 114.3 ± 19.7 s, p=0.0135) and also could reverse the increase of the total time spent on resting (19.0 ± 10.6 s vs 154.3 ± 46.5 s, p=0.0398) and grooming (369.9 ± 66.8 s vs 1302.0 ± 244.5 s, p=0.0324) behaviors. Auricular ES pretreatment could increase the frequency of rearing behaviors (38.0 ± 1.8 vs 7.7 ± 3.5, p<0.0001) and total distance traveled (1372.0 ± 157.9 cm vs 285.3 ± 85.6 cm, p<0.0001) and also could increase the percentage of inner zone time (6.0 ± 1.6% vs 0.4 ± 0.2%, p=0.0472). The CGRP, COX-2, TRPV1, and TRPA1 immunoreactive cells in the trigeminal ganglion increased in the NTG group compared with the control group (all p<0.0001); this increase could, however, be reduced by auricular ES pretreatment (27.8 ± 2.6 vs 63.0 ± 4.2, p<0.0001; 21.7 ± 1.2 vs 61.8 ± 4.0, p<0.0001; 24.3 ± 1.0 vs 36.5 ± 1.7, p=0.0003; and 20.7 ± 1.9 vs 90.8 ± 6.5, p<0.0001, respectively). Therefore, we suggest that auricular ES pretreatment is beneficial for the treatment of migraine and this effect is partly related to CGRP/COX-2/TRPV1/TRPA1 signaling pathways.

Effects of auricular electrical stimulation on vagal activity in healthy men: evidence from a three-armed randomized trial

The activity of the VN (vagus nerve) is negatively associated with risk factors such as stress and smoking, morbidity and mortality. In contrast, it is also a target of therapeutic intervention. VN stimulation is used in depression and epilepsy. Because of its high invasivity and exclusive application to therapy-resistant patients, there is interest in less invasive methods affecting the VN. Several studies examining acupuncture report beneficial effects on vagal activity. However, findings are inconsistent, and applied methods are heterogeneous resulting in difficulties in interpretation. The purpose of the present study was evaluation of the effects of acupuncture on vagal activity in a three-armed randomized trial while controlling several disturbing factors. Fourteen healthy men participated in random order in four examinations: a control condition without intervention, a condition with placebo, manual acupuncture and electroacupuncture. Acupuncture was conducted on the concha of the ear, as there is neuroanatomical evidence for vagal afferents. Each examination took place once, with a week's time between examinations. RSATR (respiratory sinus arrhythmia adjusted for tidal volume) indicating vagal activity was measured continuously. The study was conducted partially blind in accordance with recommendations. After controlling for respiration, condition-specific pain sensation, individual differences in belief of acupuncture effectiveness and time effects not attributable to the interventions, electroacupuncture but not manual acupuncture was found to have a positive effect on RSATR. The results underline the potential role of auricular electrical stimulation to induce an increase in vagal activity, and it therefore might be used as preventive or adjuvant therapeutic intervention promoting health.