Effect of torso training on unstable surface on lower limb motor function in patients with incomplete spinal cord injury / 浙江大学学报·医学版

OBJECTIVES@#To investigate the effect of torso training on unstable surface on lower limb motor function in patients with incomplete spinal cord injury.@*METHODS@#A total of 80 patients with incomplete spinal cord injury caused by thoracolumbar fracture admitted in Ningbo Yinzhou No.2 Hospital from April 2020 to December 2021 were randomly divided into control group and study group, with 40 cases in each group. In addition to routine training, the control group received torso training on stable surface and the study group received torso training on unstable surface. The gait, lower limb muscle strength, balance function, lower limb function, mobility and nerve function of the two groups were compared.@*RESULTS@#After treatment, the stride length, stride frequency and comfortable walking speed improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05). The muscle strength of quadriceps femoris, gluteus maximus, hamstring, anterior tibialis and gastrocnemius were improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05); the total trajectories of static eye opening and static eye closing gravity center movement in the two groups were significantly shorter (all P<0.05), and the improvements in the study group were more significant (all P<0.05). The dynamic stability limit range and the American Spinal Injury Association (ASIA) lower extremity motor score, Berg balance scale, modified Barthel index scale in the two groups were significantly higher (all P<0.05), and these scores in study group were significantly higher than those in the control group (all P<0.05). Both groups showed a significant improvement in ASIA grade (all P<0.05), and the improvement in the study group was significantly better (P<0.05).@*CONCLUSIONS@#Torso training on unstable surface can effectively improve the gait and lower limb muscle strength of patients with incomplete spinal cord injury and improve the lower limb motor function.

Effects of ankle exoskeleton assistance during human walking on lower limb muscle contractions and coordination patterns / 生物医学工程学杂志

Lower limb ankle exoskeletons have been used to improve walking efficiency and assist the elderly and patients with motor dysfunction in daily activities or rehabilitation training, while the assistance patterns may influence the wearer's lower limb muscle activities and coordination patterns. In this paper, we aim to evaluate the effects of different ankle exoskeleton assistance patterns on wearer's lower limb muscle activities and coordination patterns. A tethered ankle exoskeleton with nine assistance patterns that combined with differenet actuation timing values and torque magnitude levels was used to assist human walking. Lower limb muscle surface electromyography signals were collected from 7 participants walking on a treadmill at a speed of 1.25 m/s. Results showed that the soleus muscle activities were significantly reduced during assisted walking. In one assistance pattern with peak time in 49% of stride and peak torque at 0.7 N·m/kg, the soleus muscle activity was decreased by (38.5 ± 10.8)%. Compared with actuation timing, the assistance torque magnitude had a more significant influence on soleus muscle activity. In all assistance patterns, the eight lower limb muscle activities could be decomposed to five basic muscle synergies. The muscle synergies changed little under assistance with appropriate actuation timing and torque magnitude. Besides, co-contraction indexs of soleus and tibialis anterior, rectus femoris and semitendinosus under exoskeleton assistance were higher than normal walking. Our results are expected to help to understand how healthy wearers adjust their neuromuscular control mechanisms to adapt to different exoskeleton assistance patterns, and provide reference to select appropriate assistance to improve walking efficiency.

Association between physical functioning with cognition among community-dwelling older adults: a cross-sectional study / Associação entre função física e cognição em idosos da comunidade: estudo transversal

OBJECTIVE: Declines in physical and cognitive functioning often co-exist through aging. Gait-related parameters have been related to cognitive function, although it is unclear whether other measures of physical functioning are similarly related to cognition. Here, we analyzed the relationship between physical functioning with cognition in older adults. METHODS: In total, baseline data of 116 dementia-free older adults recruited from two separated clinical trials (RCT) were included (M age = 69 years, SD = 6; 71% women). We quantified cognitive functioning using the Montreal Cognitive Assessment (MoCA) and executive functioning tasks (Digit Span Forward minus Backward and verbal fluency ­ FAS and animal naming). Physical function measures included gait speed, Short-physical Performance Battery (SPPB), five-times Sit-to-Stand Test, the Timed Up and Go (TUG) test, the Six-minute Walk Test (6MWT), and lower extremity muscle strength. We used multiple linear regression analyses to explore the association between cognitive measures and each measure of physical functioning, adjusting for age, sex, education, and RCT. Regression coeficients (b), standard error (SE) and 95% confidence intervals (CI) were used to summarize main results. RESULTS: We observed a positive association between muscle strength and the MoCA (b = 0.84, SE = 0.40, 95%CI 0.05­1.64) after controlling for covariates. Significant associations were also found between the five-times-sit-to-stand test (b = -0.63, SE = 0.26, 95%CI -1.15­-0.12), TUG (b = -1.13, SE = 0.57, 95%CI -2.26­-0.01), 6MWT (b = 0.04, SE = 0.02, 95%CI 0.01­0.07), and lower extremity muscle strength (b = 1.92, SE = 0.93, 95%CI 0.09­3.77) with the FAS verbal fluency test, and between the TUG (b = -0.62, SE = 0.24, 95%CI -1.11­-0.14) with animal naming. CONCLUSION: In community-dwelling older adults, higher levels of muscle strength, dynamic balance and cardiorespiratory fitness were positively related with global cognition and executive control measures.

Miositis aguda benigna epidémica por influenza B en pacientes pediátricos / Epidemic mild acute myosistis due to influenza B in pediatric patients

Introducción: La miositis aguda benigna infantil es una complicación transitoria de la gripe causada por los virus influenza A o B, observada en pacientes escolares. Objetivos: Contribuir a divulgar las características de la miositis aguda benigna infantil en el personal médico. Métodos: Investigación descriptiva transversal en 18 pacientes con edad inferior a 19 años atendidos con el diagnóstico de esta afección, en el Hospital Pediátrico Docente Cerro desde el primero de octubre hasta 31 de diciembre del 2019. Se tomó muestra de sangre para estudios hematológicos y enzimáticos, determinación de anticuerpos antidengue y exudado nasofaríngeo en busca de virus respiratorios. Se empleó el programa SSPS versión 19. Los resultados se expresaron en valores absolutos, porcentajes, y los del laboratorio clínico, en promedios y desviación estándar. Resultados: Predominó la edad de 5-14 años (88 por ciento), sexo masculino (72,2 por ciento) y residencia en los municipios Cerro y 10 de 0ctubre (55,5 y 22,2 por ciento), respectivamente. El tipo de marcha anormal más frecuente fue la Frankenstein, con un conteo leucocitario promedio de 7,01 × 109 ± 2,16; linfocitosis 53,3 por ciento y promedio de creatininfosfoquinasa 591 µl × L ± 435,74. Todos los pacientes se recuperaron. El virus influenza B se identificó en 77,7 por ciento de las muestras. Conclusiones: La miositis constituyó una complicación por los virus de la gripe en mayor proporción el tipo B, en pacientes varones escolares, que mostraron trastornos en la marcha, examen neurológico normal y creatininfosfoquinasa elevada. Todos los enfermos se recuperaron en los primeros tres días de iniciada la afección(AU)

Introduction: Children mild acute myositis is a transitory complication of the flu caused by the influenza A or B viruses which presents in school patients. Objectives: To contribute to spread the characteristics of children mild acute miositis in the medical staff. Methods: Descriptive cross-sectional research in 18 patients with ages under the 19 years that were attented with a diagnosis of the disease in "Cerro" Pediatric Teaching Hospital from October 1st to December 31st, 2019. There were taken blood samples to do enzymatic and hematologic studies, antidengue antibodies determination and nasopharinx exudates looking for respiratory viruses. SSPS version 19 program was used. The results were expressed in absolute values, percentages, averages and standard deviation. Results: There was predomiance of the ages from 5 to 14 years (88 percent), male sex (72.2 percent) and living in Cerro and 10 de octubre municipalities (55,5 percent and 22,2 percent, respectively). The most frquent type of abnormal walk was the Frankenstein with an average leukocytes count of 7.01 × 109 ± 2.16; lymphocytea of 53.3 percent; and an average of creatinine fosfoquinase 591 µl × L ± 435.74. All the patients recovered. The influenza B virus was identified in 77.7 percent of the samples. Conclusions: Myositis represented a complication by influenza viruses, mainly the type B, in school male patients who showed disorders in the walk, normal neurologic examination and high creatinine phosphokinase. All the patients recovered in the first 3 days after the onset of the disease(AU)

Entrenamiento sobre cinta rodante en niños con enfermedades respiratorias crónicas: serie clínica / Treadmill training in children with chronic respiratory diseases: clinical series

INTRODUCCIÓN: Las enfermedades respiratorias crónicas (ERC) en niños han aumentado en los últimos años siendo la Rehabilitación Respiratoria uno de los tratamientos utilizados en esta población. OBJETIVO: Evaluar el impacto de un programa de entrenamiento aeróbico sobre cinta rodante en pacientes pediátricos con ERC del Hospital Josefina Martínez. METODOLOGÍA: Serie retrospectiva de casos con registro prospectivo de 9 pacientes con una edad promedio de 7,1 ± 3,9 años con ERC y entrenamiento aeróbico. Los pacientes realizaron 24 sesiones. Se analizaron los registros pre-post de los test de marcha de 6 min (TM6) y la velocidad máxima obtenida en el Test Cardiopulmonar Incremental (VTCI). RESULTADOS: Las medias de la distancia recorrida en TM6 pre y post entrenamiento fueron de 383 ± 142,4 m y 451,7 ± 142,4 m respectivamente (p < 0,0001). Las medias de las VTCI pre y post entrenamiento fueron: 4,1 ± 1,1 km/h y 5,4 ± 1,27 km/h (p = 0,001). CONCLUSIONES: La distancia recorrida en el TM6 y la capacidad máxima de trabajo mejoraron significativamente con el entrenamiento aeróbico en estos pacientes con ERC.

INTRODUCTION: Chronic respiratory diseases (CRD) in children have increased in recent years. Respiratory Rehabilitation is one of the treatments used in this population. OBJECTIVE: To evaluate the impact of a treadmill training program over pediatric patients with CRD in the Josefina Martínez Children's Hospital at Santiago de Chile. METHODS: Retrospective cases series with prospective record of 9 patients 7.1 ± 3.9 years-old with CRD and treadmill training. The patients performed 24 sessions. The Pre-post records of the 6-minute walk test (6MW) and the maximum speed obtained in the Incremental Load Test (ILT) were analyzed. RESULTS: Averages of the distance traveled pre and post-training were 383 ± 142.4 meters and 451.7 ± 142.4 meters respectively (p < 0.0001). The average maximum speed obtained in the ILT was 4.1 ± 1.1 km/h and 5.4 ± 1.27 km/h (p = 0.001). CONCLUSION: The distance walked in the 6-minute walk test and the maximum work capacity improve significantly with treadmill training in these patients with CRD.

Severe Dizziness Related to Postural Instability, Changes in Gait and Cognitive Skills in Patients with Chronic Peripheral Vestibulopathy

Abstract Introduction Peripheral vestibular disorders can lead to cognitive deficits and are more common in elderly patients. Objective To evaluate and correlate cognitive, balance and gait aspects in elderly women with chronic peripheral vestibular dizziness, and to compare them with elderly women without vestibular disorders. Methods Twenty-two women presenting peripheral vestibular dizziness episodes for at least six months participated in the study. The individuals were categorized by dizziness severity level: moderate (n = 11) or severe (n = 11). The control group (n = 11) included women showing no vestibulopathy, light-headedness or dizziness. Cognitive assessments and semi-static and dynamic balance assessments were performed with the Balance Master (Neurocom International, Inc., Clackamas, OR), while the Dizziness Handicap Inventory provided a score for the severity of the symptoms. The groups were submitted to statistics of inference and correlation between cognitive, balance and stability variables. Results The group with severe dizziness showed higher sway speed of the center of pressure in the anteroposterior direction, smaller step length, and slower gait than the control group. Regarding the cognitive variables, the group with severe dizziness symptoms presented significant correlations with stability and gait variables. Conclusion The relationship between cognitive aspects, balance and gait was stronger in women with severe dizziness than in those with no vestibulopathy.

Qual o melhor protocolo e ponto de corte no teste 4-metre gait speed para discriminar capacidade de exercício na Doença Pulmonar Obstrutiva Crônica? / Which is the best protocol and cut-off point in the 4-metre gait speed test to discriminate exercise capacity in COPD?

RESUMO Objetivo Verificar o poder discriminativo e o ponto de corte de diferentes protocolos do teste 4-metre gait speed (4MGS) para identificar capacidade de exercício preservada ou reduzida no teste de caminhada de 6 minutos (TC6min) em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC); comparar os protocolos do 4MGS; e comparar as características dos indivíduos de acordo com o melhor ponto de corte encontrado. Métodos Foram avaliados 56 pacientes com DPOC. Todos os pacientes foram submetidos à avaliação das características antropométricas, função pulmonar (espirometria) e capacidade funcional de exercício (TC6min e 4 protocolos do 4MGS). No teste 4MGS, os pacientes foram instruídos a caminhar em velocidade usual e máxima em percursos de 4 metros (4MGS 4m - usual e máximo) e 8 metros (4MGS 8m - usual e máximo). Resultados Somente o protocolo 4MGS 4m-máximo foi capaz de identificar capacidade de exercício preservada no TC6min (AUC=0,70) com correlação moderada entre os testes (r=0,52; P<0,0001). O ponto de corte encontrado no 4MGS 4m-máximo foi de 1,27 m/s. Os pacientes com capacidade de exercício preservada (4MGS 4m-máximo ≥1,27m/s) atingiram maior distância percorrida no TC6min em %predito (91±2 vs 76±3; P<0,0001). Nas outras comparações envolvendo gênero, IMC, VEF1%pred e índice GOLD não ocorreram diferenças significantes entre os grupos. Além disso, a concordância de indivíduos classificados com capacidade de exercício preservada e reduzida no TC6min e no 4MGS 4m-máximo foi significante (P=0,008). Conclusão O teste 4MGS 4m-máximo pode ser utilizado para discriminar capacidade de exercício preservada em pacientes com DPOC, e se correlaciona com o TC6min.

ABSTRACT Objective To determine the discriminative capacity and cut-off point of different 4-metre gait speed test (4MGS) protocols in identifying preserved or reduced exercise capacity using the six-minute walk test (6MWT) in patients with Chronic Obstructive Pulmonary Disease (COPD); also, to compare 4MGS protocols and characteristics of individuals according to the best cut-off point. Methods We evaluated fifty-six patients with COPD, all of which were submitted to the assessment of anthropometric characteristics, pulmonary function (spirometry) and functional exercise capacity (6MWT and four protocols of the 4MGS). In the 4MGS test, patients were instructed to walk at normal pace and at maximum speed in a 4 meters course (4MGS 4m - usual pace and at maximum) and 8 meters course (4MGS 8m - usual pace and at maximum). Results Only the 4MGS 4m-maximum protocol was able to identify preserved exercise capacity in the 6MWT (AUC=0.70) with moderate correlation between them (r=0.52; P=0<0.0001). The cut-off point found in the 4MGS 4m-maximum was 1.27 m/s. Patients with preserved exercise capacity (4MGS 4m-maximum ≥1.27m/s) walker greater distances on the 6MWT in %pred (91±2 vs 76±3; P<0.0001). In the other comparisons involving gender, BMI, FEV1% pred and GOLD index there were no significant differences between the groups. In addition, the agreement of individuals classified as preserved and reduced exercise capacity in the 6MWT and 4MGS 4m-maximum was significant (P = 0.008). Conclusion The 4MGS 4m-maximum test can be used to discriminate preserved exercise capacity in patients with COPD and correlates with the 6MWT.

Home physical exercise program: analysis of the impact on the clinical evolution of patients with normal pressure hydrocephalus / Programa de exercícios físicos domiciliares: análise do impacto na evolução clínica de pacientes com hidrocefalia de pressão normal

ABSTRACT Objective: To present a program of home physical exercises for patients with normal pressure hydrocephalus (NPH) and to evaluate adherence, acceptance and applicability; to verify possible changes in patients with NPH in the home physical exercise program, comparing patients with, and without, a ventriculoperitoneal shunt, regarding gait, quality of life, activities of daily living, static and dynamic balance and its impact on the risks of falling. Methods: This was a controlled clinical trial, with assessments in three moments (0, 10 and 18 weeks) at the home, from October 2015 to November 2017. Fifty-two patients (30 women and 22 men) participated in the study. Results: There was a statistically significant improvement with 10 weeks of home physical exercises for the groups with and without ventriculoperitoneal shunt, respectively, in the sub-items: activities of daily living p = 0.032*, p = 0.003*; static balance p < 0.001*, p < 0.001*; functional capacity p < 0.001*, p = 0.027*; and dynamic balance and gait p = 0.009*, p < 0.001*. There was no statistically significant difference for the subitems: quality of life p = 0.695, p = 1.000; and NPH grading scale p = 0.695, p = 1.000, respectively. Conclusion: The developed program of home physical exercise was easily applied and there was good acceptance by most patients with NPH included in the research. There was a statistically significant improvement with the 10 weeks of home physical exercises in the sub-items: activities of daily living, static balance and functional capacity, for both groups. In the sub-item dynamic balance and gait, there was a statistically significant improvement for both groups, but with a higher score for the group with a ventriculoperitoneal shunt. There was no statistically significant difference for the sub-items: quality of life, NPH grading scale and risk of falls, based on the Berg scale.

RESUMO Objetivo: Apresentar um programa de exercícios físicos domiciliares para pacientes com hidrocefalia de pressão normal e avaliar a adesão, aceitação e sua aplicabilidade; verificar possíveis alterações nos pacientes com HPN com o programa de exercícios físicos domiciliares, comparando os pacientes com e sem derivação ventriculoperitoneal, no que diz respeito à marcha, qualidade de vida, atividades de vida diária, equilíbrio estático e dinâmico e sua repercussão nos riscos de queda. Métodos: Trata-se de um Ensaio clínico controlado, com avaliações em três momentos (0.10 e 18 semanas) em nível domiciliar, no período de outubro/2015 a novembro/2017 Participaram do estudo 52 pacientes (30 mulheres e 22 homens). Resultados: Houve melhora estatisticamente significante com as dez semanas de exercícios físicos domiciliares para os grupos sem e com derivação ventriculoperitoneal respectivamente, nos subitens: atividades de vida diária p = 0,032* p = 0.003*, equilíbrio estático p < 0.001*, p < 0.001*; capacidade funcional p < 0.001*, p = 0,027*; equilíbrio dinâmico e marcha p = 0.009*, p < 0.001*. Não houve diferença estatística significante para os subitens: qualidade de vida p = 0,695, p = 1,000 e escala de graduação de HPN p = 0,695, p = 1,000. Conclusão: O programa de exercícios físicos domiciliares desenvolvido mostrou-se de fácil aplicabilidade e houve boa aceitação para a maioria dos pacientes com Hidrocefalia de Pressão Normal inseridos na pesquisa. Houve melhora estatisticamente significante com as dez semanas de exercícios físicos domiciliares nos subitens: atividades de vida diária, equilíbrio estático e capacidade funcional para ambos os grupos. No subitem equilíbrio dinâmico e marcha houve melhora estatisticamente significante para ambos os grupos, mas com escore maior para o grupo com derivação ventriculoperitoneal. Não houve diferença estatisticamente significante para os subitens: qualidade de vida, escala de graduação de Hidrocefalia de Pressão Normal e risco de quedas baseado na escala de Berg.

Morphological and biomechanical implications of cuboid facet of the navicular bone in the gait / Implicaciones morfológicas y biomecánicas de la faceta cuboídea del navicular en la marcha

The cuboid facet of the navicular bone is an irregular flat surface, present in non-human primates and some human ancestors. In modern humans, it is not always present and it is described as an "occasional finding". To date, there is not enough data about its incidence in ancient and contemporary populations, nor a biomechanical explanation about its presence or absence. The aim of the study was to evaluate the presence of the cuboid facet in ancient and recent populations, its relationship with the dimensions of the midtarsal bones and its role in the biomechanics of the gait. 354 pairs of naviculars and other tarsal bones from historical and contemporary populations from Catalonia, Spain, have been studied. We used nine measurements applied to the talus, navicular, and cuboid to check its relationship with facet presence. To analyze biomechanical parameters of the facet, X-ray cinematography was used in living patients. The results showed that about 50 % of individuals developed this surface without differences about sex or series. We also observed larger sagittal lengths of the talar facet (LSAGTAL) in navicular bones with cuboid facet. No significant differences were found in the bones contact during any of the phases of the gait. After revising its presence in hominins and non-human primates, and its implication in the bipedalism and modern gait, we suggest that cuboid facet might be related with the size of talar facet and the position of the talonavicular joint. However, other factors such as geographical conditions, genetics and stressful activities probably affect its presence too.

La faceta cuboídea del hueso navicular es una carilla plana e irregular, presente en primates no humanos y en algunos de nuestros ancestros. En humanos modernos, no siempre está presente y es descrita como "un hallazgo ocasional" por la bibliografía. Hasta la fecha, no hay suficientes datos acerca de su incidencia en poblaciones antiguas y contemporáneas, ni una explicación biomecánica sobre su presencia o ausencia. El objetivo de nuestro estudio fue evaluar la frecuencia de la faceta cuboídea en poblaciones recientes y antiguas, su relación con las dimensiones de los huesos tarsales y su rol en la biomecánica de la marcha. Fueron estudiados 354 pares de naviculares y otros huesos del tarso provenientes de colecciones osteológicas de Cataluña, España. Aplicamos nueve medidas aplicadas al talus, navicular y cuboides para corroborar su relación con la presencia de la faceta. Para analizar sus parámetros biomecánicos, se empleó X-ray cinematography en pacientes hospitalarios. Los resultados mostraron que alrededor de un 50 % de los individuos desarrollaron esta carilla, sin diferencias entre sexos o series. Además, observamos que la longitud sagital de la faceta talar (LSAGTAL) es mayor en aquellas muestras con faceta cuboídea. No hay diferencias significativas en el contacto de los huesos en ninguna de las fases de la marcha. Después de revisar su presencia en primates no humanos, su implicancia en el bipedismo y en la marcha moderna, sugerimos que la faceta cuboídea podría estar relacionada con el tamaño de la faceta talar y la posición de la articulación talo-navicular. Sin embargo, otros factores como las condiciones geográficas, genética y stress ocupacional también podrían afectar su presencia.

Força muscular e habilidade de locomoção em indivíduos pós-acidente vascular encefálico crônico / Fuerza muscular y habilidad de locomoción en individuos post-accidente cerebrovascular crónico / Muscle strength and locomotion ability in individuals with chronic stroke

RESUMO O objetivo do estudo foi verificar se existem diferenças na força muscular dos membros inferiores (MMII) e na habilidade de locomoção de indivíduos pós-acidente vascular encefálico (AVE) crônico, classificados como deambuladores comunitários ou não comunitários. Foi realizado um estudo transversal em 60 indivíduos pós-AVE crônico, divididos em deambuladores comunitários (n=33) e não comunitários (n=27) pela velocidade de marcha. A força muscular de sete grupos musculares bilaterais de MMII foi avaliada por meio do teste do esfigmomanômetro modificado e habilidade de locomoção pelo ABILOCO. Estatísticas descritivas foram utilizadas para caracterizar a amostra, e o teste t de Student para amostras independentes, a fim de comparar os dois grupos de indivíduos pós-AVE. Observou-se que os deambuladores comunitários apresentaram maiores valores de força muscular para a maioria dos grupos musculares de MMII (−0,973≥t≥−3,189; p≤0,04), e na habilidade de locomoção (t=−2,841; p=0,006). Os indivíduos pós-AVE crônico deambuladores comunitários possuem maior força muscular de MMII e mais habilidade de locomoção em comparação aos deambuladores não comunitários. Sugere-se que a avaliação fisioterapêutica de indivíduos pós-AVE inclua, além da mensuração da força muscular de MMII e seu tratamento, a mensuração da percepção da habilidade de locomoção, para análises da evolução do paciente e da eficácia da conduta terapêutica.

RESUMEN El objetivo del estudio fue verificar si existen diferencias en la fuerza muscular de los miembros inferiores (MMII) y en la habilidad de locomoción de individuos post-accidente cerebrovascular encefálico (ACV) crónico, clasificados como deambuladores comunitarios o no comunitarios. Se realizó un estudio transversal en 60 individuos post-ACV crónico, divididos en deambuladores comunitarios (n = 33) y no comunitarios (n = 27) por la velocidad de marcha. La fuerza muscular de siete grupos musculares bilaterales de MMII fue evaluada por medio de la prueba del esfigmomanómetro modificado, y la habilidad de locomoción por el ABILOCO. Las estadísticas descriptivas se utilizaron para caracterizar la muestra, y la prueba t de Student para muestras independientes con el fin de comparar los dos grupos de sujetos post-ACV. Se observó que los deambuladores comunitarios presentaron mayores valores de fuerza muscular para la mayoría de los grupos musculares de MMII (−0,973≥t≥−3,189; p≤0,04), y en la habilidad de locomoción (t=−2,841; p=0,006). Los individuos post-ACV crónico deambuladores comunitarios poseen mayor fuerza muscular de MMII y más habilidad de locomoción en comparación a los deambuladores no comunitarios. Se sugiere que la evaluación fisioterapéutica de individuos post-ACV incluya, además de la medición de la fuerza muscular de MMII y su tratamiento, la medición de la percepción de la habilidad de locomoción, para análisis de la evolución del paciente y de la eficacia de la conducta terapéutica.

ABSTRACT The objective of this study was to verify if there are differences in the lower-limb muscle strength (LL) and in the locomotion ability among post-stroke patients classified as community or non-community ambulators. A cross-sectional study was conducted in 60 post-chronic stroke subjects, divided into community (n=33) and non-community (n=27) ambulators by gait speed. The muscle strength of seven bilateral muscle groups of LL was evaluated through the modified sphygmomanometer test and locomotion ability through ABILOCO. Descriptive statistics were used to characterize the sample, and Student's t-test was used for independent samples to compare the two groups of post-stroke individuals. We observed that community ambulators had higher values of muscle strength for most muscle groups of LL (−0.973≥t≥3.189; p≤0.04), and in the locomotion ability (t=−2.841; p=0.006). Community ambulators showed higher LL muscle strength and better locomotion ability compared with non-community ambulators. Physiotherapeutic evaluation of post-stroke individuals should include, besides the measurement of LL muscle strength and its treatment, the measurement of the perception of locomotion ability to analyze the evolution of the patient and the efficacy of the therapeutic behavior.

Efectos de un programa de entrenamiento multicomponente en la marcha funcional en pacientes con Parkinson / Multicomponent physical training in patients with Parkinson disease

Background: Multicomponent physical training in patients with Parkinson disease may improve their functional independence, especially in terms of gait speed and coordination. Aim: To assess the effects of an eight weeks multicomponent physical training program in patients with Parkinson disease. Material and Methods: Fourteen patients with Parkinson disease participated in a physical training program that lasted eight weeks. Three sessions lasting 60 minutes per week were carried out. Patients were assessed using the six minutes walk, timed up and go and the unipodal stance test. Results: After the training period, significant improvements in the six minute walk test and timed up and go were observed. No significant changes were observed in the unipodal stance test. Conclusions: The eight weeks training program improved gait speed and functional status in these patients with Parkinson disease.

Efetividade da equoterapia na marcha de crianças com paralisia cerebral: revisão sistemática de ensaios clínicos / Effectiveness of equine assisted therapy in gait of children with cerebral palsy: systemactic review of clinical trials

A marcha das crianças com paralisia cerebral (PC) tem sido alvo de intervenções conservadoras como a Equoterapia. Entretanto, seus efeitos têm sido pouco sistematizados na literatura. Objetivo: Analisar a evidência da efetividade da Equoterapia na marcha de crianças com PC comparada às terapias conservadoras não invasivas de ensaios clínicos. Método: Trata-se de uma revisão sistemática com busca nas bases de dados Cinahl, Cochrane, Embase, Google Scholar, Lilacs, Lisa (ProQuest), PEDro, PsycINFO (APA), Pubmed e Scopus, sem fltros. Foram incluídos ensaios clínicos que compararam Equoterapia e terapias convencionais (terapias conservadoras não invasivas) versus terapias convencionais, que avaliaram parâmetros da marcha em crianças com diagnóstico de PC com idade ≤ 12 anos. Os estudos foram avaliados quanto à qualidade metodológica pela escala Physiotherapy Evidence Database Scale. Resultados: Dentre os 668 estudos identificados, seis ensaios clínicos foram selecionados. Destes, a amostra total foi de 283 crianças, sendo 151 crianças alocadas no grupo experimental (GE) (hipoterapia + terapia convencional) e 132 crianças, no grupo controle (GC) (terapia convencional). Quatro estudos apresentaram elevada qualidade metodológica e dois estudos, baixa qualidade. Em relação à melhora dos parâmetros da marcha, GE e GC melhoraram, no entanto o GE apresentou significante melhora na análise da dimensão e (andar-pular-correr) da medida da função motora grossa, redução da assimetria muscular durante a deambulação e aumento da velocidade da marcha. Conclusão: A revisão sistemática sugere que o tratamento com associação de hipoterapia e terapia convencional promove melhora da marcha de crianças com PC.

Gait in cerebral palsy (CP) has been the target of conservative interventions as hippotherapy. However, the effects of this therapy on the promotion and functional adaptation of gait have been little systematized in the literature. Objective: To analyze the evidence of the effectiveness of hippotherapy in the gait of children with CP comparing to noninvasive conservative therapies of clinical trials. Methods: A systematic review of clinical trials was performed with search indatabases Cinahl, Cochrane, Embase, Google Scholar, Lilacs, Lisa (ProQuest), PEDro, PsycINFO (APA), Pubmed and Scopus), with no flters. It was included clinical trials comparing hippotherapy plus conventional therapy (non-invasive conservative therapies) versus conventional therapy that assessed gait parameters in children with CP diagnosis and age ≤ 12 years old. The studies were examined as methodological quality by the Physiotherapy Evidence Database Scale. Results: Of the 668 studies identifed, six trials were selected. Of these, the total sample consisted of 283 children (151 children were allocated to the experimental group (hippotherapy) and 132 children, in the control group (conventional therapies). Four studies presented high methodological quality and two studies, low quality. Regarding the improvement of gait parameters, experimental group and control group improved, however, the experimental group presented signifcant improvement in the analysis of the E dimension (walk-jump-run) of the gross motor function measure instrument, reduction of muscular asymmetry during walking and increase in walking speed. Conclusion: The systematic review, suggests that the treatment with association of hippotherapy and conventional therapy promotes improvement of gait of children with CP.

Association between the results of the timed up-and-go test adjusted for disease severity and sarcopenia in patients with chronic obstructive pulmonary disease: a pilot study

OBJECTIVES: Loss of muscle mass and/or physical performance, a condition commonly known as sarcopenia, is prevalent in chronic obstructive pulmonary disease (COPD) and is associated with adverse outcomes. The aim of this study was to investigate the association between functional performance and sarcopenia in COPD patients classified by disease severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. METHODS: The study was a cross-sectional observational and the sample size consisted of 35 COPD patients (69.24±1.54 years, 20 men). Physical performance was assessed with the timed up-and-go (TUG) test. Sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People criteria. RESULTS: The frequency of sarcopenia was 20% and was more prevalent among individuals classified with greater disease severity, GOLD III, n=4 patients (23%) and GOLD IV, n=3 patients (27%), p=0.83. The mean time to complete the TUG test was 11.66±4.78 s. Binary logistic regression revealed an association between the TUG test and sarcopenia adjusted by disease severity (OR=1.55, 95% CI: 1.03-8.23, p=0.04). CONCLUSION: Our findings showed that worse performance in the TUG test leads to a substantial increase in the chance of COPD patients presenting sarcopenia.

Age-related changes and effects of regular low-intensity exercise on gait, balance, and oxidative biomarkers in the spinal cord of Wistar rats

The present study aimed to analyze age-related changes to motor coordination, balance, spinal cord oxidative biomarkers in 3-, 6-, 18-, 24-, and 30-month-old rats. The effects of low-intensity exercise on these parameters were also analyzed in 6-, 18-, and 24-month-old rats. Body weight, blood glucose, total cholesterol, and high-density lipoprotein (HDL) cholesterol were assessed for all rats. The soleus muscle weight/body weight ratio was used to estimate skeletal muscle mass loss. Body weight increased until 24 months; only 30-month-old rats exhibited decreased blood glucose and increased total cholesterol and HDL cholesterol. The soleus muscle weight/body weight ratio increased until 18 months, followed by a small decrease in old rats. Exercise did not change any of these parameters. Stride length and step length increased from adult to middle age, but decreased at old age. Stride width increased while the sciatic functional index decreased in old rats. Performance in the balance beam test declined with age. While gait did not change, balance improved after exercise. Aging increased superoxide anion generation, hydrogen peroxide levels, total antioxidant capacity, and superoxide dismutase activity while total thiol decreased and lipid hydroperoxides did not change. Exercise did not significantly change this scenario. Thus, aging increased oxidative stress in the spinal cord, which may be associated with age-induced changes in gait and balance. Regular low-intensity exercise is a good alternative for improving age-induced changes in balance, while beneficial effects on gait and spinal cord oxidative biomarkers cannot be ruled out because of the small number of rats investigated (n=5 or 6/group).

Biomecânica estática e da marcha em gestantes eutróficas e obesas / Static biomechanics and gait in eutrophic and obese pregnant women

Mais de 50% da população mundial encontra-se na faixa de sobrepeso e de obesidade, caracterizando uma epidemia global e, com isso, atingindo mulheres em idade reprodutiva.Quando da associação de obesidade e gravidez, esse risco pode estar amplificado, acentuando alterações do equilíbrio e postura, ampliando a taxa de acidentes por queda.(AU)

More than 50% of the world population is in the overweight and obesity zone, characterizing a global epidemic and with these reaching women of reproductive age. When associated with obesity and pregnancy, this risk may be amplified, accentuating alterations on balance and posture, increasing the rate of accidents by fall.(AU)

Gait in children and adolescents with idiopathic musculoskeletal pain

Abstract Introduction: Musculoskeletal pain is a constant complaint in pediatric practice. The pain may be related to a number of organic diseases and / or be part of the amplified musculoskeletal pain syndromes. Idiopathic musculoskeletal pain (IMSP) is defined as the presence of intermittent pain in three or more body regions for at least three months, excluding organic diseases that could explain the symptoms. Objective: To study the gait of children and adolescents with IMSP by dynamic baropodometry. Methodology: Thirty-two patients with IMSP and 32 healthy controls, matched by age, sex, social class, and body mass index (BMI) were enrolled. All were evaluated for pain intensity through the visual analogue scale (VAS) and gait evaluation using dynamic baropodometry. Results: The mean age of the IMSP group was 13.6 years (SD = 2.1, range 9.8-16.9) and of the control group was 13.5 years (SD = 2.0, range 9.6-16.5). The mean pain scale was 5.4 cm in the IMSP group and 0 cm in the control group (p < 0.001). In gait, the mean right foot velocity of the IMSP group was significantly lower (p = 0.034), the time of the step of the IMSP group was significantly higher (p = 0.003) and the pace of the IMSP group was significantly lower (p = 0.001). Conclusion: In our study we observed differences between the gait of children with IMSP and healthy controls according to the dynamic baropodometry. This finding indicates the need for individualized attention to the gait of children with musculoskeletal pain.

Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation / Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation

Abstract Introduction: Calcium is vital for the functioning of the inner ear hair cells as well as for the neurotransmitter release that triggers the generation of a nerve impulse. A reduction in calcium level could therefore impair the peripheric vestibular functioning. However, the outcome of balance assessment has rarely been explored in cases with osteopenia and osteoporosis, the medical conditions associated with reduction in calcium levels. Objective: The present study aimed to investigate the impact of osteopenia and osteoporosis on the outcomes of behavioural and objective vestibular assessment tests. Methods: The study included 12 individuals each in the healthy control group and osteopenia group, and 11 individuals were included in the osteoporosis group. The groups were divided based on the findings of bone mineral density. All the participants underwent behavioural tests (Fukuda stepping, tandem gait and subjective visual vertical) and objective assessment using cervical and ocular vestibular evoked myogenic potentials. Results: A significantly higher proportion of the individuals in the two clinical groups' demonstrated abnormal results on the behavioural balance assessment tests (p < 0.05) than the control group. However, there was no significant difference in latencies or amplitude of cervical vestibular evoked myogenic potential and oVEMP between the groups. The proportion of individuals with absence of ocular vestibular evoked myogenic potential was significantly higher in the osteoporosis group than the other two groups (p < 0.05). Conclusion: The findings of the present study confirm the presence of balance-related deficits in individuals with osteopenia and osteoporosis. Hence the clinical evaluations should include balance assessment as a mandatory aspect of the overall audiological assessment of individuals with osteopenia and osteoporosis.

Resumo: Introdução: O cálcio é vital para o funcionamento das células ciliadas, assim como para a liberação dos neurotransmissores que desencadeiam um impulso nervoso. Uma redução nos níveis de cálcio poderia, portanto, prejudicar o funcionamento vestibular periférico. No entanto, a avaliação do equilíbrio tem sido raramente explorada em casos de osteopenia e osteoporose, condições médicas associadas à redução dos níveis de cálcio. Objetivo: O presente estudo teve como objetivo investigar o impacto da osteopenia e da osteoporose nos resultados dos testes de avaliação comportamental e vestibular objetiva. Método: O estudo incluiu 12 indivíduos nos grupos controle e grupo de osteopenia e 11 indivíduos no grupo da osteoporose. Os grupos foram divididos com base nos achados da densidade mineral óssea. Todos os participantes foram submetidos a testes comportamentais (Prova dos Passos de Fukuda, Marcha em tandem e Vertical Visual Subjetiva) e à avaliação objetiva com o uso de potenciais evocados miogênicos vestibulares cervical e ocular (cVEMP e oVEMP). Resultados: Uma proporção significativamente maior de indivíduos nos dois grupos com condições clínicas mostrou resultados anormais nos testes de avaliação comportamental e do equilíbrio (p < 0,05) do que o grupo controle. Embora não tenha havido diferença significativa nas latências ou na amplitude de cVEMP e oVEMP entre os grupos, a proporção de indivíduos com ausência de oVEMP foi significativamente maior no grupo da osteoporose do que nos outros dois grupos (p < 0,05). Conclusão: Os resultados do presente estudo demonstram a presença de déficits de equilíbrio em indivíduos com osteopenia e osteoporose. Assim, as avaliações clínicas gerais e audiológicas de indivíduos com osteopenia e osteoporose deveriam incluir a avaliação do equilíbrio como um aspecto obrigatório.

Determinants of the use of physiotherapy services among individuals with Parkinson's disease living in Brazil / Determinantes do uso de serviço de fisioterapia entre indivíduos com doença de Parkinson que vivem no Brasil

ABSTRACT To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil. Methods: Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable "physiotherapy" with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified. Results: The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil. Conclusions: The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients' functional performance for a longer period.

RESUMO Descrever a utilização do serviço de fisioterapia e identificar os fatores que determinam o uso desse serviço entre indivíduos com doença de Parkinson (DP) que vivem no Brasil. Métodos: No total, 479 indivíduos com DP idiopática, de ambos os sexos, em qualquer estágio da escala de Hoehn & Yahr (HY) e de sete capitais do Brasil foram recrutados durante 2014 a 2016. A análise de regressão logística multivariada foi a principal ferramenta de análise estatística. Para a construção do modelo logístico foi investigada a associação da variável dependente "fisioterapia" com variáveis independentes sociodemográficas, econômicas e clínicas: idade, educação, renda familiar, tempo de DP desde o início, HY, domínio motor e atividade de vida diária da Unified Parkinson´s Disease Rating Scale, aspectos cognitivos, sintomas depressivos, medo de queda, congelamento marcha, história de quedas, nível de atividade física, velocidade de marcha, capacidade de caminhar e equilíbrio. Resultados: 479 indivíduos apresentaram média de 65,2 ± 11,0 anos, 88% tiveram HY = I-III e 43,4% faziam fisioterapia para a DP. A análise identificou duas principais variáveis determinantes do uso da fisioterapia: educação (OR = 1,24) e capacidade de caminhada (OR = 0,82). A diminuição da capacidade de caminhar e maior nível educacional aumentam o uso da fisioterapia em indivíduos com doença de Parkinson vivendo no Brasil. Conclusões: O presente estudo mostra que indivíduos com DP, residentes de diferentes regiões do Brasil, têm acesso limitado aos serviços de fisioterapia. Além disso, o Sistema Brasileiro de Saúde Pública, bem como os programas locais, precisam atingir pessoas de DP com baixo nível educacional para melhorar seu acesso aos serviços de fisioterapia. Os objetivos devem ser para o desenvolvimento de programas de exercícios físicos para melhorar o desempenho funcional dos pacientes por um período mais longo.

Botulinum toxin for hereditary spastic paraplegia: effects on motor and non-motor manifestations / Toxina botulínica nas paraplegias espásticas hereditárias: efeitos nas manifestações motoras e não-motoras

ABSTRACT Motor and non-motor manifestations are common and disabling features of hereditary spastic paraplegia (HSP). Botulinum toxin type A (Btx-A) is considered effective for spasticity and may improve gait in these patients. Little is known about the effects of Btx-A on non-motor symptoms in HSP patients. Objective To assess the efficacy of Btx-A on motor and non-motor manifestations in HSP patients. Methods Thirty-three adult patients with a clinical and molecular diagnosis of HSP were evaluated before and after Btx-A injections. Results Mean age was 41.7 ± 13.6 years and there were 18 women. Most patients had a pure phenotype and SPG4 was the most frequent genotype. The Btx-A injections resulted in a decrease in spasticity at the adductor muscles, and no other motor measure was significantly modified. In contrast, fatigue scores were significantly reduced after Btx-A injections. Conclusion Btx-A injections resulted in no significant functional motor improvement for HSP, but fatigue improved after treatment.

RESUMO Manifestações motoras e não motoras são comuns e incapacitantes nas paraparesias espásticas hereditárias (PEH). Toxina botulínica do tipo A (TB-A) é considerada eficaz no tratamento da espasticidade e pode melhorar a marcha nesses pacientes. Pouco se sabe sobre os efeitos da TB-A sobre sintomas não-motores. Objetivo avaliar a eficácia da TB-A sobre manifestações motoras e não-motoras nas PEH. Método trinta e três pacientes adultos com PEH foram avaliados antes e depois das aplicações de TB-A. Resultados A média de idade foi 41,7 ± 13,6 anos e havia 18 mulheres. A maioria dos pacientes portava a forma pura e o genótipo mais comum foi SPG4. Houve diminuição da espasticidade dos músculos adutores da coxa sem melhora da marcha. A pontuação da fadiga reduziu após as injeções. Conclusão As aplicações de TB-A não melhoraram a marcha nos pacientes mas a redução da fadiga foi significativa após o tratamento.

Correlation between physical examination and three-dimensional gait analysis in the assessment of rotational abnormalities in children with cerebral palsy / Correlação entre exame físico e análise tridimensional da marcha na determinação dos desvios rotacionais em crianças com paralisia cerebral

Abstract Objective To evaluate the correlation between physical examination data concerning hip rotation and tibial torsion with transverse plane kinematics in children with cerebral palsy; and to determine which time points and events of the gait cycle present higher correlation with physical examination findings. Methods A total of 195 children with cerebral palsy seen at two gait laboratories from 2008 and 2016 were included in this study. Physical examination measurements included internal hip rotation, external hip rotation, mid-point hip rotation and the transmalleolar axis angle. Six kinematic parameters were selected for each segment to assess hip rotation and shank-based foot rotation. Correlations between physical examination and kinematic measures were analyzed by Spearman correlation coefficients, and a significance level of 5% was considered. Results Comparing physical examination measurements of hip rotation and hip kinematics, we found moderate to strong correlations for all variables (p<0.001). The highest coefficients were seen between the mid-point hip rotation on physical examination and hip rotation kinematics (rho range: 0.48-0.61). Moderate correlations were also found between the transmalleolar axis angle measurement on physical examination and foot rotation kinematics (rho range 0.44-0.56; p<0.001). Conclusion These findings may have clinical implications in the assessment and management of transverse plane gait deviations in children with cerebral palsy.

Resumo Objetivo Avaliar a correlação entre dados do exame físico relativos à rotação do quadril e torção tibial com a cinemática do plano transverso em crianças com paralisia cerebral; e determinar quais pontos no tempo e eventos do ciclo de marcha apresentam maior correlação com achados do exame físico. Métodos Um total de 195 crianças com paralisia cerebral vistas em dois laboratórios de marcha, de 2008 a 2016, foi incluído neste estudo. As medidas do exame físico incluíram rotação interna do quadril, rotação externa do quadril, ponto médio da rotação do quadril e ângulo do eixo transmaleolar. Foram selecionados seis parâmetros cinemáticos para cada segmento, para avaliar a rotação do quadril e a do pé em relação à perna durante a marcha. As correlações entre exame físico e medidas cinemáticas foram analisadas por coeficientes de correlação de Spearman, e considerou-se um nível de significância de 5%. Resultados Comparando as medidas da rotação do quadril e da cinemática do quadril, encontramos correlações moderadas a fortes para todas as variáveis (p<0,001). Os coeficientes mais altos foram observados entre o ponto médio da rotação do quadril no exame físico e a rotação do quadril na cinemática (rho range: 0,48-0,61). Correlações moderadas também foram encontradas entre a medição do ângulo do eixo transmaleolar no exame físico e a rotação do pé em relação à perna na cinemática (faixa rho: 0,44-0,56; p<0,001). Conclusão Estes achados podem ter implicações clínicas na avaliação e no tratamento de desvios da marcha do plano transverso em crianças com paralisia cerebral.