Gait, balance, and functional independence level in stroke patients

Introduction: Most stroke patients present limited movement, which alters gait speed and balance. This study aimed to correlate balance and gait speed, and weight distribution and balance in post-stroke patients.Methods: In total, 36 participants were included. Data collection occurred as follows: filling out the assessment form; assessment with the Berg Balance Scale (BBS); assessment with the baropodometric platform; performing the 10 Meter Walk Test (10mWT) with accelerometer; measurements with the modified Rankin Scale (mRS); the Functional Ambulation Classification (FAC); and the Barthel Index (BI).Results: A negative correlation between FAC and mRS (r = −0.708; p < 0.05) and between BI and mRS (r = −0.716; p < 0.05) was found. The correlation between BI and FAC was positive (r = 0.591). There was a strong positive correlation between the 10mWT values and the BBS score (r = 0.708; p < 0.05). Moreover, a weak negative correlation was observed between BBS values and lower limb weight distribution (r = −0.378; p < 0.05).Conclusion: We found a correlation between the functional ambulation and the degree of independence.This study showed that the better the balance, the greater the gait speed, and the lower the difference on lower limbs weight distribution, the better the balance in post-stroke patients.

Distribución de patrones espásticos en extremidad superior posterior a un daño de motoneurona superior / Distribution of spastic patterns in upper extremity after an upper motor neuron syndrome

ANTECEDENTES: la evidencia sobre personas que presentan daño de motoneurona superior y desarrollan un patrón de espasticidad en extremidad superior (EES) es limitada. Este signo positivo de disfunción o secundario al daño de la motoneurona superior se asocia con pérdida de función y disminución de la independencia, provocando discapacidad y alterando la calidad de vida. OBJETIVO: determinar la distribución de frecuencias de los patrones de EES, muñeca, dedos y pulgar posterior a un daño de motoneurona superior. MÉTODO: diseño descriptivo de corte transversal prospectivo. Se realizó una medición a 206 sujetos pertenecientes a 17 centros de salud, quienes cumplieron con los criterios de inclusión y firmaron el consentimiento. La evaluación incluyó datos clínicos y la evaluación del patrón de EES (Clasificación de Hefter), muñeca, dedos (Zancolli adaptado) y pulgar (Clasificación de House). RESULTADOS: El análisis consideró cada una de las taxonomías de los patrones de EES evaluados (Hefter I a V). La distribución de frecuencias fue investigada mediante la prueba χ2 de bondad de ajuste, seguida de la inspección post hoc de los residuos estandarizados (z) en cada celda. Se identificaron frecuencias significativamente mayores en: el patrón III de extremidad superior, el patrón cubitalizado neutro de muñeca, el patrón del flexor profundo y mixto de Zancolli adaptado, y en los patrones 3, 4 del pulgar. Ninguna taxonomía se asoció al tiempo de evolución y tipo de ACV. CONCLUSIÓN: El estudio aporta evidencia relevante sobre la distribución frecuencia de patrones espásticos, posterior a un daño de motoneurona superior. La información proporcionada busca apoyar el proceso de decisión terapéutica potenciando la recuperación funcional de la extremidad superior.

BACKGROUND: The evidence regarding people who present superior motor neuron damage and develop a pattern of spasticity in the upper limb (SUL) is limited. This positive sign of the superior motor neuron is associated with both the loss of function and the decreased independence, causing disability and altering life quality. OBJECTIVE: to determine the frequency distribution of SUL, wrist, finger and thumb patterns after superior motor neuron damage. METHOD: prospective cross-sectional descriptive design, the sample consisted of 206 patients belonging to 17 health centers, who met the inclusion criteria and signed the informed consent, approved by the committee of ethics. The study considered a measurement, including clinical data and evaluation of the pattern of SUL (Hefter´s classification), wrist, fingers (adapted Zancolli) and thumb (House Classification). RESULTS: The analysis considered each of the taxonomies of evaluated patterns (Hefter´s I-V). Frequency distribution was investigated by χ2 goodness of fit tests, followed by post hoc inspection of standardized residues (z) in each cell. Significantly higher frequencies were identified in the upper limb pattern III, the neutral cubitalized wrist pattern, the adapted Zancolli deep flexor pattern and in the thumb patterns 3, 4. No taxonomy was associated with the evolution time and type of stroke. CONCLUSION: The study provides with relevant scientific evidence regarding the frequency distribution of spasticity patterns after superior motor neuron damage. The information provided can support the therapeutic decision process by enhancing the functional recovery of upper limb.

Presentation of cerebral and cervical arterial dissections in Botucatu, Brazil: case series / Apresentação de dissecções arteriais cerebrais e cervicais em Botucatu, Brasil: uma série de casos

Abstract Spontaneous dissection of the cervical and cerebral arteries is an important cause of stroke and disability in young patients. In this report, the authors present a case series of patients with spontaneous carotid, vertebral, or cerebral artery dissection who underwent digital angiography. A review of the published literature on this subject is also presented.

Resumo A dissecção espontânea das artérias cervicais e cerebrais é uma causa importante de acidente vascular cerebral e incapacidade em pacientes jovens. Neste relato, é apresentada uma série de casos de pacientes com dissecção espontânea da artéria carótida, vertebral ou cerebral submetidos à angiografia digital. Além disso, é fornecida uma revisão da literatura sobre esse assunto.

Influence of height on endothelial maintenance activity: a narrative review

Recent studies have revealed an inverse association between height and cardiovascular disease. However, the background mechanism of this association has not yet been clarified. Height has also been reported to be positively associated with cancer. Therefore, well-known cardiovascular risk factors, such as increased oxidative stress and chronic inflammation, are not the best explanations for this inverse association because these risk factors are also related to cancer. However, impaired blood flow is the main pathological problem in cardiovascular disease, while glowing feeding vessels (angiogenesis) are the main characteristic of cancer pathologies. Therefore, endothelial maintenance activity, especially for the productivity of hematopoietic stem cells such as CD34-positive cells, could be associated with the height of an individual because this cell contributes not only to the progression of atherosclerosis but also to the development of angiogenesis. In addition, recent studies have also revealed a close connection between bone marrow activity and endothelial maintenance; bone marrow-derived hematopoietic stem cells contribute towards endothelial maintenance. Since the absolute volume of bone marrow is positively associated with height, height could influence endothelial maintenance activity. Based on these hypotheses, we performed several studies. The aim of this review is not only to discuss the association between height and bone marrow activity, but also to describe the potential mechanism underlying endothelial maintenance. In addition, this review also aims to explain some of the reasons that implicate hypertension as a major risk factor for stroke among the Japanese population. The review also aims to clarify the anthropological reasons behind the high risk of atherosclerosis progression in Japanese individuals with acquired genetic characteristics.

Procesos cognitivos en trombosis de seno longitudinal superior: reporte de caso / Cognitive processes in superior longitudinal sinus thrombosis: case report

INTRODUCCIÓN: la trombosis de seno longitudinal superior es una enfermedad de difícil detección a causa de sus diferentes causas y debido al polimorfismo de sus manifestaciones neurológicas; además es común en el sexo femenino relacionado a los estímulos estrogénicos y otros factores hormonales, pero poco probable en menor de 40 años. PACIENTE: paciente menor de 40 años posterior a presentar dos episodios de accidentes cerebrovasculares isquémicos, se evalúa un año después de la lesión el estado cognitivo y funcional mediante la batería Neuropsi Atención y Memoria y el Inventario de Adaptabilidad Mayo-Portland; los procesos cognitivos afectados en un nivel de clasificación leve fueron la atención y concentración, el funcionamiento ejecutivo; en el estado funcional reportado por el cónyuge sugiere afectación de síntomas clínicos como irritabilidad, ira agresividad, dolores de cabeza, cansancio y reacciones a síntomas menores e interacción inadecuada, estos síntomas no fueron reportados por la paciente sugiriendo posible anosognosia en su proceso de adaptabilidad CONCLUSIÓN: Tras un proceso de lesión cerebral por afectación trombótica, las secuelas cognitivos y funcionales permanecen posterior a la recuperación espontanea, llevando a emplear procesos de rehabilitación.

INTRODUCTION: the superior longitudinal sinus thrombosis is a disease difficult to detect because of its different causes and because of the polymorphism of its neurological manifestations; It is also common in females related to estrogen stimuli and other hormonal factors, but unlikely in younger than 40 years. PATIENT: a patient younger than 40 years after having two episodes of ischemic strokes, cognitive and functional status is assessed one year after the injury using the neuropsi battery attention and memory and the mayo-portland adaptability inventory; Cognitive processes affected at a slight level of classification were attention and concentration, executive functioning; In the functional status reported by the spouse suggests involvement of clinical symptoms such as irritability, anger, aggression, headaches, fatigue and reactions to minor symptoms and inadequate interaction, these symptoms were not reported by the patient suggesting possible anosognosia in her process of adaptability CONCLUSIÓN: After a process of brain injury due to thrombotic involvement, the cognitive and functional sequelae remain after spontaneous recovery, suggesting the import of rehabilitation processes.

Rehabilitación multidisciplinaria para pacientes adultos con accidente cerebrovascular / Multidisciplinary rehabilitation for adult patients with stroke

Se estima que dos tercios de las personas que han sufrido un accidente cerebrovascular (ACV) tienen secuelas que condicionan su calidad de vida. La rehabilitación del ACV es un proceso complejo, que requiere de un equipo multidisciplinario de profesionales especializados (médicos, kinesiólogos, enfermeros, terapistas ocupacionales, fonoaudiólogos, neuropsicólogos y nutricionistas). Actualmente, las prácticas realizadas en rehabilitación son consecuencia de la combinación de evidencia y consenso, siendo la mayoría aportadas a través de guías internacionales de rehabilitación en ACV. El objetivo de esta revisión es ajustar las recomendaciones internacionales sobre rehabilitación a lo aplicado a la práctica diaria, a fin de unificar criterios en las recomendaciones y reducir la variabilidad de las prácticas empleadas. En este trabajo, se realizó una revisión de la literatura sobre las guías de rehabilitación en ACV realizadas en los últimos 10 años y cada apartado fue supervisado por distintos profesionales especializados en dichas áreas. Se analizaron los tiempos y organización necesaria para desarrollarla, las recomendaciones para la rehabilitación motora, cognitiva y visual, el tratamiento de la disfagia y nutrición, de las comorbilidades (trombosis venosa, úlceras cutáneas, dolor, trastornos psiquiátricos, osteoporosis) y las tareas necesarias para favorecer el retorno a las actividades de la vida diaria.

It is estimated that two thirds of people who have suffered a stroke have sequels that condition their quality of life. The rehabilitation of the stroke is a complex process, which requires the multidisciplinary approach of specialized professionals (doctors, kinesiologists, nurses, occupational therapists, phonoaudiologists, neuropsychologists and nutritionists). Currently, the practices carried out are a consequence of the combination of evidence and consensus, most of them through international stroke rehabilitation guides. The objective of this review is to adjust the international recommendations on stroke rehabilitation to what is applied to daily practice, in order to unify the criteria of the recommendations and to reduce the variability of the practices carried out. This work is a review of the literature on stroke rehabilitation guides developed in the last 10 years. Each section was supervised by different professionals specialized in these areas. We analyze the time and organization necessary to develop rehabilitation, recommendations for motor, cognitive and visual rehabilitation, the management of dysphagia and nutrition, the approach of comorbidities (venous thrombosis, skin ulcers, pain, psychiatric disorders and osteoporosis) and the necessary tasks to favor the return to the activities of daily life.

Cirugía de hombro en posición silla de playa: estrategias y recomendaciones para la prevención de complicaciones isquémicas / Strategies and recommendations for the prevention of ischemic complications in beach chair position for shoulder surgery

Beach chair position is require for Shoulder surgery frequently for proper resolution. The stroke associated with shoulder surgery is a rare complication and probably underreported. The objective of this article is to review the pathophysiology of the ischemic damage associated with beach chair position, learn about strategies and develop recommendations to minimize risks.

La cirugía de hombro (CH), requiere y requerirá colocar a los pacientes en la posición en silla de playa (PSP), cada vez con mayor frecuencia para su adecuada resolución. El asociado a CH, es una complicación poco frecuente y probablmente subreportada. El objetivo de esta revisión, es repasar la fisiopatología del daño isquémico asociado a PSP, conocer estrategias y elaborar recomedaciones destinadas a minimizar riesgos.

The association between CHA2DS2-VASc score and erectile dysfunction: a cross-sectional study

ABSTRACT Purpose: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. Materials and methods: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. Results: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). Conclusion: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.

Effect of Leap Motion-based 3D Immersive Virtual Reality Usage on Upper Extremity Function in Ischemic Stroke Patients / Efeito do uso imersivo da realidade virtual 3D baseada em movimento de salto na função de extremidade superior em pacientes com AVC isquêmico

ABSTRACT Immersive virtual reality (VR) is a technology that provides a more realistic environmental design and object tracking than ordinary VR. The aim of this study was to investigate the effectiveness of immersive VR on upper extremity function in patients with ischemic stroke. Sixty-five patients with ischemic stroke were included in this randomized, controlled, double-blind study. Patients were randomly divided into VR (n = 33) and control (n = 32) groups. The VR group received 60 minutes of the upper extremity immersive VR rehabilitation program and the control group received 45 minutes of conventional therapy and 15 minutes of a sham VR program. Rehabilitation consisted of 18 sessions of therapy, three days per week, for six weeks. The outcome measures were the Action Research Arm Test (ARAT), Functional Independence Measure (FIM), Fugl-Meyer Upper Extremity Scale (FMUE) and Performance Assessment of Self-Care Skills (PASS). In both the VR and control groups all parameters except the PASS improved over time. However independent t-test results showed that all of the FMUE, ARAT, FIM and PASS scores were significantly higher in the VR group compared with the control (p < 0.05). The minimal clinically important difference (MCID) scores of the FMUE and ARAT were higher than the cut-off MCID scores described in the literature in the VR group, whereas the FIM scores were below the cut-off MCID scores. All scores in the control group were below the cut-off scores. Immersive VR rehabilitation appeared to be effective in improving upper extremity function and self-care skills, but it did not improve functional independence.

RESUMO A VR imersiva é uma tecnologia que fornece design ambiental e rastreamento de objetos mais realistas do que a VR comum. O objetivo deste estudo foi investigar a eficácia da VR imersiva na função da extremidade superior em pacientes com AVC isquêmico. Sessenta e cinco pacientes com AVC isquêmico foram incluídos neste estudo randomizado, controlado e duplo-cego (clinictrials.gov. ID: NCT03135418). Os pacientes foram divididos aleatoriamente em VR (n = 33) e controle (n = 32). O grupo VR recebeu 60 minutos do programa de reabilitação imersiva da extremidade superior e o grupo controle recebeu 45 minutos de terapia convencional e 15 minutos de um programa falso de VR. A reabilitação consistiu em 18 sessões de terapia, 3 dias por semana, durante 6 semanas. As medidas de resultado foram Teste de braço de pesquisa-ação (ARAT), Medida de independência funcional (FIM), Escala de extremidades superiores de Fugl-Meyer (FMUE) e Avaliação de desempenho de habilidades de autocuidado (PASS). Nos grupos VR e controle, todos os parâmetros, exceto o PASS, melhoraram com o tempo. No entanto, os resultados dos testes t independentes mostraram que todos os escores FMUE, ARAT, FIM e PASS foram significativamente maiores no grupo VR em comparação ao controle (p <0,05). Os escores de FMUE e ARAT de diferença minimamente clinicamente importante (MCID) foram maiores que os pontos de corte de MCID descritos na literatura no grupo VR, enquanto os escores de FIM estiveram abaixo dos pontos de corte de MCID. Todas as pontuações no grupo controle estiveram abaixo das pontuações de corte. A reabilitação imersiva da VR parece ser eficaz para melhorar a função da extremidade superior e as habilidades de autocuidado, mas não melhora a independência funcional.

Clinical swallowing prognostic indicators in patients with acute ischemic stroke / Indicadores de prognóstico clínico da deglutição em pacientes com acidente vascular cerebral isquêmico

ABSTRACT A swallowing disorder is present in more than 50% of patients with acute stroke. Objective To identify clinical prognostic indicators of the swallowing function in a population with acute ischemic stroke and to determine prioritization indicators for swallowing rehabilitation. Methods Participants were adults admitted to the emergency room who were diagnosed with acute ischemic stroke. Data gathering involved a swallowing assessment to determine the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) and the verification of demographic and clinical variables. Results The study sample included 295 patients. For analysis purposes, patients were grouped as follows: ASHA NOMS levels 1 and 2 - ASHA1 (n = 51); levels 3, 4 and 5 - ASHA2 (n = 96); levels 6 and 7 - ASHA3 (n = 148). Statistical analyses indicated that patients who presented a poorer swallowing function (ASHA1) were older (age ≥ 70 years); had anterior circulation infarct; had lower scores on the Glasgow Coma Scale (GCS ≤ 14 points); took longer to initiate swallowing rehabilitation; had longer hospital stays; made more use of alternative feeding methods; needed more sessions of swallowing rehabilitation to remove alternate feeding methods; took longer to return to oral feeding and had poorer outcomes (fewer individuals discharged from swallowing rehabilitation sessions and increased mortality). Conclusion Patients with acute ischemic stroke, admitted to the emergency room, aged ≥ 70 years, score on the GCS ≤ 14, anterior circulation infarct and dementia should be prioritized for swallowing assessment and rehabilitation.

RESUMO Alterações da deglutição são observadas em mais de 50% dos pacientes com acidente vascular cerebral isquêmico (AVCI) agudo. Objetivo Identificar os indicadores de prognóstico clínico da funcionalidade da deglutição na população com AVCI em fase aguda, visando o estabelecimento de indicadores de priorização de atendimento fonoaudiológico. Métodos Participaram do estudo adultos admitidos em Pronto Socorro (PS) com AVCI. As etapas de coleta de dados envolveram avaliação fonoaudiológica para determinação do nível funcional da deglutição (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) e a coleta de variáveis demográficas e clínicas. Resultados A amostra do estudo incluiu 295 pacientes agrupados de acordo com os níveis ASHA NOMS: níveis 1 e 2 - ASHA1 (n = 51); níveis 3, 4 e 5 - ASHA2 (n = 96); níveis 6 e 7 - ASHA3 (n = 148). As análises indicaram os seguintes resultados significantes: pacientes com pior funcionalidade da deglutição (ASHA1) apresentaram média de idade superior a 70 anos, maior comprometimento da circulação cerebral anterior pós-AVCI, pior pontuação na Escala de Coma de Glasgow (ECG ≤ 14 pontos), demoraram mais tempo para iniciar o atendimento fonoaudiológico, permaneceram mais tempo internados no hospital, fizeram mais uso de via alternativa de alimentação, necessitaram de mais sessões fonoaudiológicas para retirada da via alternativa de alimentação, demoraram mais tempo para retornar para alimentação por via oral e apresentaram pior desfecho (um número menor de indivíduos recebeu alta fonoaudiológica e apresentaram mortalidade aumentada). Conclusão Pacientes com AVCI agudo, admitidos em PS, que apresentem idade ≥ 70 anos, pontuação na ECG ≤ 14, com comprometimento do sistema circulatório cerebral anterior e demência, devem ser priorizados no atendimento fonoaudiológico.

Relationship between pulmonary function, functional independence, and trunk control in patients with stroke / Relação entre função pumonar, independência functional e controle de tronco em pacientes após acidente vascular cerebral

ABSTRACT Stroke often leads to abnormalities in muscle tone, posture, and motor control that may compromise voluntary motor function, thus affecting the motor control required for maintaining the synergy of both peripheral and respiratory muscles. Objective To evaluate respiratory muscle strength, pulmonary function, trunk control, and functional independence in patients with stroke and to correlate trunk control with the other variables. Methods This was a cross-sectional study of patients diagnosed with stroke. We assessed respiratory muscle strength, trunk control as assessed by the Trunk Impairment Scale, spirometric variables, and the Functional Independence Measure. Results Forty-four patients were included. Pulmonary function and respiratory muscle strength were significantly lower than predicted for the study population, and the mean Trunk Impairment Scale score was 14.3 points. The following significant correlations were found between the variables: trunk control vs. maximal inspiratory pressure (r = 0.26, p < 0.05); trunk control vs. forced vital capacity (r = 0.28, p < 0.05); trunk control vs. forced expiratory volume in one second (r = 0.29, p < 0.05), and trunk control vs. the Functional Independence Measure (r = 0.77, p < 0.05). Conclusion The present study showed that respiratory muscle strength, pulmonary function, functional independence, and trunk control are reduced in patients diagnosed with stroke.

RESUMO Acidente vascular cerebral (AVC) frequentemente leva a anormalidades no tônus muscular, postura e controle motor que podem comprometer a função motora voluntária, afetando o controle motor necessário para manter a sinergia dos músculos periféricos e respiratórios. Objetivo Avaliar a força muscular respiratória, a função pulmonar, o controle do tronco e a independência funcional em pacientes com AVC e correlacionar o controle do tronco com as demais variáveis. Métodos Este foi um estudo transversal, incluindo pacientes diagnosticados com AVC. Avaliamos a força muscular respiratória, o controle do tronco avaliado pela escala de comprometimento de tronco, as variáveis espirométricas e a medida de independência funcional. Resultados Quarenta e quatro pacientes foram incluídos. A função pulmonar e a força muscular respiratória foram significativamente menores do que o previsto para a população estudada, e o escore médio do escala de comprometimento de tronco foi de 14,3 pontos. As seguintes correlações significativas foram encontradas entre as variáveis: controle do tronco vs. pressão inspiratória máxima (r = 0,26, p <0,05); controle do tronco vs capacidade vital forçada (r = 0,28, p <0,05); controle do tronco versus volume expiratório forçado no primeiro segundo (r = 0,29, p <0,05) e controle do tronco vs. medida de independência funcional (r = 0,77, p <0,05). Conclusão O presente estudo demonstrou que a força muscular respiratória, a função pulmonar, a independência funcional e o controle do tronco estão diminuídos em pacientes diagnosticados com AVC.

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.

Virtual reality in the rehabilitation of patients with stroke: an integrative review / Realidade virtual na reabilitação de pacientes após acidente vascular cerebral: uma revisão integrativa

ABSTRACT Objective: To describe the intervention protocols to using commercial video games as virtual reality (VR) in rehabilitation of patients with stroke. Methods: Integrative review using the descriptors "rehabilitation", "virtual reality exposure therapy" and "videogames" in the LILACS and PUBMED databases. Articles published from 2011 to 2018 were selected. Results: We found 1,396 articles, 1,383 were excluded and 13 were selected. Most of the articles were randomized clinical trials published in 2014 or later. The sample size varied from 5-47 adults, or adults and elders, with chronic stroke. The Nintendo Wii® was the most used video game system. The intervention happened two or three times a week, each session lasting from 30 to 60 minutes, over 2-12 weeks. Balance, upper limb motor functions, quality of life and daily living activities were the most common evaluated outcomes. The Fugl-Meyer Assessment, Berg Balance Scale, Timed Up and Go test, Barthel Scale and SF-36 were the most common outcome measurement tools. Conclusions: The studies indicated improvement in dynamic balance, upper limb motor function and quality of life after rehabilitation using VR. The VR was more effective than conventional treatments for the outcome of dynamic balance. Two studies did not find any changes in static balance and daily living activities. Physical aspects and quality of life were the outcomes most evaluated by the researchers; as were the population with chronic strokes and protocols of long duration and low intensity. Few studies targeted immediate VR effects, performance in daily living activities and social participation.

RESUMO Objetivo: Descrever os protocolos de intervenção utilizando sistemas de vídeo game comerciais como realidade virtual (RV) na reabilitação de pacientes após AVE. Método: Revisão integrativa usando os descritores "reabilitação", "terapia de exposição a realidade virtual" e "videogames", nas bases de dados LILACS e PUBMED, e artigos publicados entre 2011 e 2018. Resultados: Foram encontrados 1.396, excluídos 1.383 e selecionados 13 artigos. A maioria era ensaio clínico aleatorizado publicados a partir de 2014. O tamanho da amostra variou de 5 a 47 participantes adultos ou adultos e idosos com AVE crônico. O Nintendo Wii® foi o videogame mais empregado. A intervenção constava de duas ou três sessões semanais, com duração de 30 ou 60 minutos por um período de duas a 12 semanas. Equilíbrio, função motora de membro superior, qualidade de vida e atividade de vida diária foram os principais desfechos. Empregou-se principalmente Escala Fugl-Meyer, Escala de Equilíbrio de Berg, teste Timed Up and Go, Índice de Barthel e SF-36 como medidas de desfecho. Conclusões: Os estudos indicaram melhora do equilíbrio dinâmico, função motora de membro superior e qualidade de vida após reabilitação usando RV. A RV se mostrou mais eficaz que tratamentos convencionais para o desfecho equilíbrio dinâmico. Dois estudos não encontraram mudanças no equilíbrio estático e atividade de vida diária. Observou-se maior foco em desfechos relacionados a aspectos físicos e qualidade de vida, em população com AVE crônico e protocolo com maior duração e menor intensidade. Poucos estudos voltados para efeitos imediatos da RV, desempenho em atividades de vida diária e participação social.

Evaluation of vestibular and oculomotor functions in individuals with dizziness after stroke / Avaliação das funções vestibular e oculomotora em indivíduos com tontura após acidente vascular encefálico

ABSTRACT Changes in postural balance and visual complaints are frequent consequences of stroke. We aimed to investigate the symptoms and the vestibular and oculomotor functions of patients with dizziness post ischemic and hemorrhagic stroke and compare the results among them. Methods: Fifty patients with dizziness after stroke were evaluated through a clinical anamnesis and computerized vector electronystagmography: calibration of ocular movements, spontaneous nystagmus, semi-spontaneous nystagmus, pendular tracking, optokinetic nystagmus, rotary chair testing, and the caloric test. Results: All patients complained of dizziness, especially imbalance. Ischemic stroke in the carotid territory was the prevalent type. Visual complaints were reported by 56% of the sample and were related to abnormalities in oculomotor and caloric tests. Conclusion: The occurrence of visual symptoms was related to some abnormalities in the vector electronystagmography tests, being more frequent in cases of stroke in the vertebrobasilar system, and with oscillopsia and reduced visual acuity as symptoms.

RESUMO Alterações no equilíbrio postural são consequências frequentes no acidente vascular cerebral (AVC). O objetivo deste estudo foi investigar os sintomas e as funções vestibular e oculomotora de sujeitos com tontura após AVC isquêmico e hemorrágico, comparando seus resultados. Métodos: Foram avaliados 50 sujeitos com tontura após AVC, por meio de anamnese clínica e vectoeletronistagmografia computadorizada (VENG): calibração dos movimentos oculares; nistagmo espontâneo e semi-espontâneo; rastreio pendular; nistagmo optocinético; prova rotatória pendular decrescente e prova calórica com estímulo a ar. Resultados: Todos relataram tontura, principalmente do tipo desequilíbrio. O AVC isquêmico e no sistema carotídeo foi o mais frequente. Sintomas visuais pós-AVC foram referidos por 56% da amostra, os quais tiveram relação com alterações nas provas oculomotoras e calórica da VENG. Conclusão: A ocorrência de sintomas visuais relacionou-se a alterações em alguns testes. Essas alterações foram mais frequentes nos casos de AVC da circulação posterior, naqueles com oscilopsia e diminuição da acuidade visual.

Platelet function, coagulation and fibrinolysis in patients with previous coronary and cerebrovascular ischemic events

OBJECTIVES: Ischemic stroke (IS) or transient ischemic attack (TIA) history is present in 4-17% of patients with coronary artery disease (CAD). This subgroup of patients is at high risk for both ischemic and bleeding events. The aim of this study was to determine the role of platelet aggregability, coagulation and endogenous fibrinolysis in patients with CAD and previous IS or TIA. METHODS: A prospective case-control study that included 140 stable CAD patients divided into two groups: the CASE group (those with a previous IS/TIA, n=70) and the CONTROL group (those without a previous IS/TIA, n=70). Platelet aggregability (VerifyNow Aspirin® and VerifyNow P2Y12®), coagulation (fibrinogen and thromboelastography by Reorox®) and endogenous fibrinolysis (D dimer and plasminogen activator inhibitor-1) were evaluated. RESULTS: Patients in the CASE group presented significantly higher systolic blood pressure levels (135.84±16.09 vs 123.68±16.11, p<0.01), significantly more previous CABG (25.71% vs 10%, p=0.015) and significantly higher calcium channel blocker usage (42.86% vs 24.29%, p=0.02) than those in the control group. In the adjusted models, low triglyceride values, low hemoglobin values and higher systolic blood pressure were significantly associated with previous IS/TIA (CASE group). Most importantly, platelet aggregability, coagulation and fibrinolysis tests were not independently associated with previous cerebrovascular ischemic events (CASE group). CONCLUSION: Platelet aggregability, coagulation and endogenous fibrinolysis showed similar results among CAD patients with and without previous IS/TIA. Therefore, it remains necessary to identify other targets to explain the higher bleeding risk presented by these patients.

Resíduos faríngeos nas disfagias orofaríngeas neurogênicas / Pharyngeal residue in neurogenic oropharyngeal dysphagia

RESUMO Objetivo Comparar os resíduos faríngeos por consistência de alimento entre indivíduos com disfagia orofaríngea neurogênica. Método Estudo clínico transversal. Realizada análise de 30 exames de videoendoscopia de deglutição de indivíduos com diagnóstico de doenças neurológicas e disfagia orofaríngea, independentemente do tempo ou estágio das doenças. Os indivíduos foram divididos em três grupos: o grupo I composto por 10 indivíduos pós-Acidente Vascular Cerebral, 8 homens e 2 mulheres, faixa etária entre 51 e 80 anos (média 67 anos); o grupo II por 10 indivíduos com Esclerose Lateral Amiotrófica, 5 homens e 5 mulheres, faixa etária entre 39 e 78 anos (média 57 anos), e o grupo III por 10 indivíduos com Doença de Parkinson (DP), 5 homens e 5 mulheres, faixa etária entre 65 e 88 anos (média 74 anos). Para análise dos resíduos faríngeos em valéculas e seios piriformes, foi aplicada a Yale Pharyngeal Residue Severity Rating Scale, considerando a primeira deglutição de 5 mL nas consistências pastosa e líquida espessada, por dois juízes independentes e de forma cega. Resultados Não houve diferença estatística significativa nos resíduos faríngeos, em valéculas (p= 0,25/ p= 0,18) e seios piriformes (p= 1,41/ 0,49), respectivamente nas consistências pastosa e líquida espessada, nas diferentes doenças estudadas. Conclusão Os níveis de resíduos faríngeos na consistência pastosa ou líquida espessada na população estudada foram semelhantes e mais frequentes nos níveis menos grave.

ABSTRACT Purpose To compare pharyngeal residues of different consistencies among groups of individuals with neurogenic oropharyngeal dysphagia. Methods In a cross-sectional study, a fiberoptic endoscopic evaluation was performed in 30 swallowing exams of individuals diagnosed with neurological disease and oropharyngeal dysphagia, regardless of the time or stage of the disease. The individuals were divided into three groups according to etiology: group I, 10 post-stroke, 8 male and 2 female, aged 51 to 80 years (average age: 67 years); group II, 10 individuals with amyotrophic lateral sclerosis, 5 male and 5 female, aged 39 to 78 years (average age: 57 years); group III, 10 examinations of individuals with Parkinson's disease, 5 male and 5 female aged 65-88 years (average age: 74 years). The Yale Pharyngeal Residue Severity Rating Scale was applied by two independent raters in a blind manner for the analysis of pharyngeal residues in valleculae and pyriform sinuses based on the first swallowing of 5 mL of pureed and thickened liquid. Results No statistically significant difference was observed among groups in the degree of pharyngeal residues of puree food or thickened liquid in the valleculae (p = 0.25/p = 0.18) or the pyriform sinuses (p = 1.41/0.49). Conclusion The pharyngeal residue levels of pureed and thickened liquid were similar for the groups studied, with less severe levels being more frequent.