RLS and PLM are common findings in SCI patients with a complete injury.

Spinal cord injury as a trigger to develop periodic leg movements during sleep: an evolutionary perspectiveLesão medular como gatilho para desenvolver movimentos periódicos das pernas durante o sono: uma perspectiva evolutiva Susana Cristina Lerosa Telles, Rosana S. Cardoso Alves, Gerson ChadiThe periodic limb movement (PLM) disorder is characterized by periodic episodes of repetitive and highly stereotyped limb movements, which occur during sleep, and by clinical sleep disturbance that cannot be accounted for by another primary sleep disorder 1 . They consist of the big toe extension in combination with partial flexion of the ankle and, sometimes, hip (Fig 1). Similar movements can occur in the upper limbs. This occurrence in spinal cord injury (SCI) patients 2 (Fig 2) suggests the spinal origin of those movements, which could be due to the disruption of REM-related inhibitory spinal pathways, producing the disconnection or disinhibition of a spinal generator, which is a kind of local pacemaker 3 .Restless legs syndrome (RLS) is a sensorimotor disorder frequently related to PLM and was recently reported in SCI patients 2 . It is characterized by a complaint of a strong, nearly irresistible, urge to move the legs, which is made worse by rest (lying or sitting) and is at least partially and temporarily relieved by walking or moving the legs. The relief is usually immediate. The urge to move the legs worsens in the evening and at night 1 . Scientific reviews have addressed the probable central pattern generator (CPG) in SCI patients and its outcome to rehabilitation. We based this review on an evolutionary perspective of CPG development from invertebrates to mammals, in order to point to the probable CPG action in humans during PLM. ABSTRACTThe primary trigger to periodic limb movement (PLM) during sleep is still unknown. Its association with the restless legs syndrome (RLS) is established in humans and was reported in spinal cord injury (SCI) patients classified by the American Spinal Injury Association (ASIA) as A. Its pathogenesis has not been completely unraveled, though recent advances might enhance our knowledge about those malfunctions. PLM association with central pattern generator (CPG) is one of the possible pathologic mechanisms involved. This article reviewed the advances in PLM and RLS genetics, the evolution of CPG functioning, and the neurotransmitters involved in CPG, PLM and RLS. We have proposed that SCI might be a trigger to develop PLM.Key words: nocturnal myoclonus syndrome, restless legs syndrome, spinal cord regeneration. RESUMOO gatilho principal para o desenvolvimento de movimentos periódicos dos membros (MPM) durante o sono ainda é desconhecido. A associação entre o MPM e a síndrome das pernas inquietas (SPI) em seres humanos já foi previamente estabelecida e relatada em pacientes com lesão medular (LM), classificados pela American Spinal Injury Association (ASIA) como A. A patogênese do MPM não foi completamente desvendada, apesar de avanços recentes poderem ampliar o conhecimento sobre...

Introdução. O artigo aborda a actigrafia e seu uso clínico. A actigrafia é um exame simples para detectar alterações de sono e ritmo circadiano, porém pode ser utilizado em outras áreas. Objetivo. O objetivo desta revisão foi mostrar os usos do actígrafo na prática clínica em outros países para esclarecer ao público brasileiro que subutiliza este aparelho em outras áreas da saúde. Método. Foi realizado estudo através de revisão bibliográfica embasada em artigos originais do Pubmed, com a palavra-chave actigraphy e publicados em 2009. Foram selecionados artigos com mais de 10 participantes no estudo e de livre acesso. Resultados. a actigrafia tem sido utilizada em várias áreas: cardiologia, cronobiologia, distúrbios do sono, dor crônica, saúde da mulher, neurologia, pediatria e psiquiatria. Conclusão. Concluímos que o actígrafo pode ser utilizado em outras áreas da saúde no Brasil assim como já é utilizado em outros países.

No abstract

The new coronavirus was first detected in the city of Wuhan, China, in late 2019. The virus infection causes Covid-19 and its main symptoms are fever, fatigue and dry cough, which can progress to dyspnea or, in graver cases, severe acute respiratory syndrome 1 and death. The disease spread, and on January 31, 2020, the World Health Organization declared a pandemic. Until April 25, 2020, 2,744,744 cases have been confirmed and a total of 195,707 people have died worldwide; in Brazil, the number is 58,509 cases and 4,016 deaths. So far, there is no drug treatment for Covid-19; therefore, hospital teams from the affected countries have organized themselves to deal with cases that develop the severe form of the disease. The hospital respiratory therapist in Brazil has the autonomy to define and apply the parameters of mechanical ventilation in intubated patients 2. The Brazilian Association of Cardiorespiratory Physiotherapy and Physiotherapy in Intensive Care 3 has published guidelines on Covid-19 recommending the use of ventilation mode controlled by volume or pressure and prone position when PaO2/ FiO2<150mmHg. Noninvasive ventilation (NIV) and high-flow nasal cannula, in the case of Covid-19, should not be first-line ventilation strategies. This modality has a great risk of spreading the virus due to possible failures. Moreover, the helmet-like interface is not available in Brazilian intensive care units in general. As for oxygen therapy, the use of a nasal catheter and a rebreathing mask is indicated; the use of Venturi masks and nebulization, in turn, is not recommended. These guidelines are based on evidence from countries already affected by the pandemic. As it is a new disease, scientific research in the field of physiotherapy is being conducted. In the records of clinical trials, studies are evaluating the prone position, comparing values of positive end-expiratory pressure, telerehabilitation, the use of NIV, testing if breathing exercises can prevent Covid-19 worsening and evaluating inclined postures. None of these studies will be carried out in Brazil. Physiotherapists

This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.

No abstract

No abstract