Effect of unilateral bag use on plantar pressures and static balance in women / Efeito do uso da bolsa unilateral nas pressões plantares e no equilíbrio estático em mulheres

Abstract Introduction: The increasing insertion of women into the labor market has created a need to adapt handbags, with different sizes and weights, which consequently can overload the musculoskeletal system. Objective: To evaluate the effect of using a unilateral bag on plantar pressures and static balance in women. Methods: Cross-sectional study, carried out in Fortaleza in 2018. 258 women aged between 18 and 59 years who used a unilateral bag participated in this study. Two questionnaires were applied, targeting sociodemographic variables, life habits, characteristics of bag use and level of physical activity. Height, scapular symmetry, body and bag mass were also measured. A baropodometer was used to assess plantar pressure and static balance with and without the unilateral bag. Independent and paired t-tests were applied to verify the influence of the bag on the variables of interest, using the SPSS Statistics program (version 23.0). Results: On the side where the bag was carried, an increase in lateral mass distribution (LMD), foot pressure and surface area, and a decrease in the distance from barycenter (p < 0.05) were observed. On the opposite side, a decrease in LMD and an increase in barycenter were detected (p < 0.05). In static balance, no differences were observed in the anteroposterior and side-to-side oscillations with bag placement (p > 0.05). Conclusion: The unilateral bag causes alterations in plantar pressures and ipsilateral barycenter alongside the use of the bag, being a risk factor or aggravation for dysfunctions of the musculoskeletal system and for the occurrence of pain.

Resumo Introdução: A crescente inserção das mulheres no mercado de trabalho ocasionou uma necessidade de adaptação das bolsas, com tamanhos e pesos diferentes, que por consequência podem sobrecarregar o sistema musculoesquelético. Objetivo: Avaliar o efeito do uso da bolsa unilateral nas pressões plantares e no equilí-brio estático em mulheres. Métodos: Estudo transversal, realizado na cidade de Fortaleza em 2018. Participaram 258 mulheres com idade entre 18 e 59 anos e que usavam bolsa unilateral. Aplicaram-se dois questionários visando as variáveis sociodemográficas, hábitos de vida, características do uso da bolsa e nível de atividade física. Foram mensuradas estatura, simetria escapular, massa corporal e da bolsa. Utilizou-se baropodômetro para a avaliação das pressões plantares e equilíbrio estático com e sem a bolsa unilateral. Aplicaram-se testes t de amostras independentes e pareado para verificar a influência da bolsa nas variáveis de interesse, pelo programa SPSS Statistics (versão 23.0). Resultados: No lado que a bolsa era carregada foram observados aumento da distribuição de massa lateral (DML), da pressão do pé e da área de superfície e diminuição da distância do baricentro (p < 0,05). No lado oposto foram detectados diminuição da DML e aumento do baricentro (p < 0,05). No equilíbrio estático, não foram verificadas diferenças nas oscilações ântero-posterior e látero-lateral com a colocação da bolsa (p > 0,05). Conclusão: A bolsa unilateral causa alterações nas pressões plantares e no baricentro homolaterais no lado do uso da bolsa, sendo um fator de risco ou agravamento para as disfunções do sistema musculoesquelético e para a ocorrência de dor.

Anthropometric profile of leg length inequality and its impact on gait / Perfil antropométrico de la desigualdad en la longitud de las piernas y su impacto en la marcha

SUMMARY: Leg length inequality (LLI) affects gait - primarily pelvic and torso movements. LLI is present in around 40-70 % of the healthy population. Due to LLI's significant impact on the body, as well as the possible occurrence of a variety of associated health problems, the aim of this research is to determine whether there is a significant difference in pelvic movement in all three planes, depending on the degree of LLI. This study was conducted on a sample of 30 healthy subjects. The functional length of lower limbs was measured. When LLI was calculated, kinematic measures were taken of pelvic and lower limb movements during gait using 3D cameras and ©Vicon Motion Systems Ltd. UK. The obtained data on kinematic pelvic movement in all three planes during gait were compared with the reference values. The results show that there is no statistically significant difference in pelvic movement about the axes x, y, and z in cases of LLI of up to 18mm (p>0,05). There is a statistically highly significant positive correlation between the difference in functional leg length (r=0,575; p=0,008) and femur length (r=0,525; p=0,015) on one hand, and the difference in pelvic movement about the axis x on the other, compared to the reference values. In a healthy population with LLI from 0 to 18 mm, gait remains unaffected and an increase in LLI predominantly affects pelvic movement about the horizontal axis (x) - pelvic tilt, which exponentially increases with an increase in femur length discrepancy.

La diferencia en la longitud de las piernas (LLI, por sus siglas en inglés) afecta la marcha, principalmente los movimientos pélvicos y del dorso. La LLI está presente en alrededor del 40-70 % de la población sana. Debido al importante impacto de LLI en el cuerpo, así como a la posible aparición de una variedad de problemas de salud asociados, el objetivo de esta investigación fue determinar si existe una diferencia significativa en el movimiento pélvico en los tres planos, dependiendo del grado de LLI. Este estudio se realizó en una muestra de 30 sujetos sanos. Se midió la longitud funcional de los miembros inferiores. Cuando se calculó el LLI, se tomaron medidas cinemáticas de los movimientos pélvicos y de los miembros inferiores durante la marcha utilizando cámaras 3D y ©Vicon Motion Systems Ltd. UK. Los datos obtenidos sobre el movimiento pélvico cinemático en los tres planos durante la marcha se compararon con los valores de referencia. Los resultados mostraron que no existe diferencia estadísticamente significativa en el movimiento pélvico sobre los ejes x, y, y z en casos de LLI de hasta 18 mm (p>0,05). Existe una correlación positiva estadísticamente muy significativa entre la diferencia en la longitud funcional de la pierna (r=0,575; p=0,008) y la longitud del fémur (r=0,525; p=0,015), y la diferencia en el movimiento pélvico sobre el eje x por otro, en comparación con los valores de referencia. En una población sana con LLI de 0 a 18 mm, la marcha no se ve afectada y un aumento en LLI afecta predominantemente el movimiento pélvico sobre el eje horizontal (x) - inclinación pélvica, que aumenta exponencialmente con un aumento en la discrepancia de longitud del fémur.

Efeitos do uso de vestes terapêuticas em programas de reabilitação de crianças com paralisia cerebral: uma revisão integrativa da literatura / Effects of suit therapy rehabilitation programs of children with cerebral palsy: an integrative literature review

A Paralisia Cerebral (PC) engloba um grupo de desordens do movimento e da postura resultantes de uma lesão não progressiva no sistema nervoso. Diversas abordagens fisioterapêuticas vêm sendo propostas para o tratamento de indivíduos com PC, dentre elas o uso de vestes terapêuticas. Sendo assim, a presente revisão teve como objetivo avaliar os efeitos das vestes terapêuticas na reabilitação de crianças com PC, destacando seus benefícios e possíveis limitações. Tratou-se de uma revisão integrativa da literatura realizada nas bases SciELO, Lilacs, Pubmed, Science Direct e PEDro, por meio do descritor "Paralisia Cerebral" e das palavras-chave "AdeliSuit", "PediaSuit", "TheraSuit". Após o levantamento bibliográfico, foram selecionados 11 estudos envolvendo crianças com idade entre um e 15 anos, os quais descreveram o uso das vestes terapêuticas AdeliSuit, TheraSuit e PediaSuit. Todos os estudos apresentaram efeitos favoráveis ao uso das vestes para função motora das crianças avaliadas. Também houveram relatos de melhora na funcionalidade, velocidade e qualidade da marcha e equilíbrio. Apenas quatro estudos compararam programas de reabilitação envolvendo vestes terapêuticas e outras abordagens, os quais apresentaram resultados controversos. Os achados demonstraram resultados favoráveis ao uso das vestes terapêuticas em indivíduos com diagnóstico de PC, apesar de poucas evidências quanto a sua superioridade sobre outras abordagens. (AU)

Cerebral Palsy (CP) is a group of movement and posture disorders resulting from nervous system non-progressive injury. Several physiotherapy approaches have been proposed to individuals with CP treatment, including the use of therapeutic suits. Thus, the present review aimed to assess the effects of therapeutic suits on children with CP rehabilitation, highlighting their benefits and possible limitations. It was an integrative literature review carried out on SciELO, Lilacs, Pubmed, Science Direct and PEDro databases, using tdescriptor "Cerebral Palsy" and keywords "AdeliSuit", "PediaSuit", "TheraSuit". After bibliographic search, 11 studies were selected involving children aged between one and 15 years old, which described the use of therapeutic suits: AdeliSuit, TheraSuit and PediaSuit. All studies showed positive effects therapeutic suits use during rehabilitation for motor function. Improvements in functionality, speed and quality of gait and balance were also reported. Only four studies compared rehabilitation programs involving therapeutic suits and other therapeutic approaches, which showed controversial results. Those findings demonstrated favorable results for the use of therapeutic suits during rehabilitation programs in individuals with CP, despite little evidence regarding their superiority over other approaches. (AU)

Impacto da realidade virtual na funcionalidade e percepção de melhora de indivíduos com hemiparesia crônica: um estudo piloto / Impact of virtual reality-based therapy on functionality and perception of improvement in individuals with chronic hemiparesis: a pilot study

Objetivo: Avaliar os efeitos da realidade virtual sobre a funcionalidade da marcha e percepção de mudança de indivíduos com hemiparesia crônica. Métodos: Estudo clínico piloto do tipo experimental, longitudinal, prospectivo e de braço único. A amostra foi composta por indivíduos hemiparéticos submetidos ao treinamento funcional em ambiente de realidade virtual (RV). Na avaliação inicial (AV1) utilizou-se o Timed Up and Go (TUG) para análise da mobilidade e após 12 sessões de RV, na avaliação final (AV2), acrescentou-se a Escala de Mudança Percebida (EMP). Para verificar a normalidade dos dados utilizou-se o teste de Shapiro-Wilk, o teste T-Student ou de Wilcoxon para comparar os dados (p ≤ 0,05) e o Effect Size (ES) pela fórmula de Cohen (d) para o tamanho do efeito. Resultados: Dez indivíduos hemiparéticos (64,6 ± 9,53 anos) realizaram o TUG (AV1) em 14,59 ± 5,03 segundos e AV2 em 13,96 ± 4,64 segundos (p = 0,18) e o EF teve efeito insignificante (d = 0,14). O jogo Free Step apresentou diferença significativa entre a primeira e última sessão (p = 0,004) e na EMP os valores obtidos foram de 2,57 ± 0,3 de três pontos. Conclusão: A RV não promoveu melhora significante na mobilidade funcional, mas os indivíduos relataram mudanças positivas em alguns componentes da EMP. (AU)

O efeito do movimento de dança Kathak no equilíbrio e marcha na doença de Parkinson: um estudo experimental / The effect of Kathak dance movement on balance and gait in Parkinson's disease: an experimental study

INTRODUÇÃO: Dificuldades de locomoção e equilíbrio são comuns entre os indivíduos com doença de Parkinson (DP). Vários programas diferentes de exercícios foram sugeridos para tratar de problemas de equilíbrio e de marcha para melhorar a qualidade de vida e a adesão do paciente aos exercícios de DP. A dança pode ser uma ferramenta eficaz para resolver esses problemas porque inclui elementos-chave de equilíbrio dinâmico, pode melhorar a mobilidade funcional e, ao mesmo tempo, é agradável e envolvente. OBJETIVOS: O objetivo deste estudo foi avaliar o efeito do movimento de dança Kathak além da fisioterapia convencional no equilíbrio e na marcha em pacientes com doença de Parkinson. MÉTODOS E MATERIAIS: Um total de 44 pacientes diagnosticados com Parkinson foram incluídos no estudo com uma idade média de 63,20 + 8,5 anos. Os pacientes foram divididos aleatoriamente em dois grupos, o grupo controle recebeu fisioterapia convencional, e o grupo experimental recebeu o mesmo juntamente com movimentos de dança Kathak que foram Tatkar e Gatnikas. A intervenção foi dada três dias por semana durante quatro semanas. A pré e pós-avaliação para equilíbrio e marcha foi avaliada por escalas incluindo o teste TUG, Tinetti, FOG-Q e UPDRS-III. A comparação dentro do grupo foi feita usando o teste Wilcoxon Signed rank e entre o grupo usando o teste Mann Whitney U para ver o efeito da intervenção de tratamento. RESULTADOS: A idade média dos participantes de ambos os grupos foi de 64,18±8,53 e 62,23±6,21, respectivamente. A comparação mostrou uma diferença significativa em TUG, Tinetti, e FOG-Q dentro do grupo com p<0,01. A comparação entre grupos não mostrou diferença significativa entre as duas intervenções de tratamento com p=0,361 para TUG, p=0,479 para Tinetti, e p= 0,73 para FOG-Q. CONCLUSÃO: Ambos os grupos mostraram melhorias semelhantes no equilíbrio e na marcha de pacientes com DP. Assim, concluímos que o movimento da Dança Kathak pode ser usado para complementar os exercícios de fisioterapia convencional.

INTRODUCTION: Difficulties with gait and balance are common among individuals with Parkinson's disease (PD). Several different exercise programs have been suggested to address balance and gait problems to improve the quality of life and patient compliance with PD exercises. Dance may be an effective tool for addressing these problems because it includes key elements of dynamic balance, can improve functional mobility, and is, at the same time, enjoyable and engaging. OBJECTIVES: The purpose of this study was to assess the effect of Kathak dance movement in addition to conventional physiotherapy on balance and gait in Parkinson's disease patients. METHODS AND MATERIALS: A total of 44 patients diagnosed with Parkinson's disease were included in the study with a mean age of 63.20 + 8.5 years. Patients were randomly divided into two groups, the control group received conventional physiotherapy, and the experimental group received the same along with Kathak dance movements which were Tatkar and Gatnikas. The intervention was given three days a week for four weeks. Preand post-assessment for balance and gait was assessed by scales including TUG test, Tinetti, FOG-Q, and UPDRS-III. The within-group comparison was made using Wilcoxon Signed rank test and between the group using the Mann Whitney U test to see the effect of treatment intervention. RESULTS: The mean age of participants for both groups were 64.18±8.53 and 62.23±6.21, respectively. The comparison showed a significant difference in TUG, Tinetti, and FOG-Q within the group with p<0.01. The between-group comparison showed no significant difference between the two treatments interventions with p=0.361 for TUG, p=0.479 for Tinetti, and p= 0.73 for FOG-Q. CONCLUSION: Both groups showed similar improvements in balance and gait in PD patients. Thus, we conclude that the Kathak Dance movement can be used to complement conventional physical therapy exercises.

The Influence of the Shoe over the Medial Foot Arch and the Lower Limbs Kinematics in Toddlers / A influência de calçados no arco longitudinal medial do pé e na cinemática dos membros inferiores de crianças no início da fase de aquisição de marcha

Abstract Objective To evaluate the biomechanical behavior of the medial longitudinal arch (MLA) of the foot and the kinematic parameters of the lower limbs with biomimetic footwear (BF) and non-biomimetic (NB1, NB2, NB3 and NB4) footwear in children at the beginning of the gait acquisition phase. Methods Four toddlers were evaluated at the beginning of the gait acquisition phase under the following conditions: walking barefoot, ambulation with BF and NB1, NB2, NB3 and NB4 footwear in hard floor. BF is described as biomimetic because of its property of emulating natural and irregular floors through a dynamic internal insole. The MLA and kinematics of the hip, knee, and ankle during gait were evaluated by three-dimensional motion analysis system. The similarity between the kinematic curves of barefoot and footwear conditions was analyzed by root mean square error (RMSE). Results The use of BF presented the highest magnitude of MLA and the greatest difference in relation to barefoot condition (higher RMSE). The BF showed less difference in the kinematics of the knee and ankle joints during gait when compared to barefoot condition (lower RMSE). NB2 footwear presented hip kinematics more similar to barefoot condition (lower RMSE). Conclusion Biomimetics footwear and NB2 shoes (both with wider forefoot region) generated smaller differences in lower limbs compared to barefoot. In addition, the MLA was higher in the BF, probably because different design from other shoes.

Resumo Objetivo Avaliar o comportamento do arco longitudinal medial do pé (ALM) e os parâmetros cinemáticos dos membros inferiores durante a deambulação com calçados biomiméticos (CBs) e não biomiméticos (NB1, NB2, NB3 e NB4) em crianças no início da fase de aquisição da marcha. Métodos Foram avaliadas quatro crianças no início da fase de aquisição da marcha nas seguintes condições: andar descalço, andar com CBs e calçados NB1, NB2, NB3 e NB4 em solo plano. O calçado biomimético é descrito como biomimético por emular pisos naturais e irregulares por meio de uma palmilha interna dinâmica. O ALM e a cinemática do quadril, joelho e tornozelo durante a marcha foram avaliados por meio de sistema de análise do movimento tridimensional. A similaridade entre as curvas cinemáticas das condições descalça e com calçado foi analisada por meio do cálculo de root mean square error (RMSE). Resultados O CB foi o que apresentou maior magnitude do ALM e maior diferença do ALM em relação à condição descalça (maior RMSE). O CB apresentou ainda menor diferença na cinemática das articulações do joelho e tornozelo durante a marcha quando comparado à condição descalça (menor RMSE). O calçado NB2 apresentou a cinemática do quadril mais semelhante à condição descalça (menor RMSE). Conclusão Os calçados CB e NB2 que apresentam a região do antepé mais larga geraram menores diferenças na cinemática dos membros inferiores. Além disso, o ALM foi maior no CB provavelmente devido a seu design ser diferente daquele dos demais calçados.

Effect of electroacupuncture on motor function and gait in patients with post-stroke spasticity in lower limbs / 中国针灸

OBJECTIVE@#To observe the effect on motor function, spasticity degree, muscle strength and the relevant parameters of three-dimensional gait analysis in the patients with post-stroke spasticity in the lower limbs treated with the combined therapy of electroacupuncture (EA) and muscle electricity biofeedback or the simple muscle electricity biofeedback therapy on the base of rehabilitation medicine.@*METHODS@#A total of 60 patients with post-stroke spasticity in the lower limbs were randomized into an EA + biofeedback group, a biofeedback group and a rehabilitation group, 20 cases in each one. In the rehabilitation group, the basic rehabilitation training was provided, 45 min each time. In the biofeedback group, on the base of the treatment as the rehabilitation group, the biofeedback therapy was added, 30 min each time. In the EA + biofeedback group, besides the treatment as the biofeedback group, acupuncture was supplemented at Futu (ST 32), Liangqiu (ST 34), Zusanli (ST 36) and Fenglong (ST 40), etc, and EA was applid at Zusanli (ST 36) and Taichong (LR 3) with continuous wave and 5 Hz in frequency. In each group, the treatment was given once daily, 5 times a week, for 6 weeks totally. Separately, before and after treatment, the score of Fugle-Meyer assessment (FMA), the score of clinical spasticity index (CSI) in the lower limbs and the strength of the anterior tibial muscle on the affected side were assessed, and the spatial-temporal parameters (step frequency and steep speed) in the three-dimensional gait analysis and the kinematic parameters (maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side) were measured in the patients of three groups.@*RESULTS@#After treatment, FMA score was increased as compared with that before treatment in all of three groups (P<0.05). FMA score in the EA + biofeedback group and the biofeedback group was higher than the rehabilitation group respectively (P<0.05). CSI score in the EA + biofeedback group and the biofeedback group was lower than that before treatment respectively (P<0.05), and lower than the rehabilitation group (P<0.05). After treatment, the step frequency and speed were all improved and the angles of maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side were all increased as compared with those before treatment in the patients of three groups separately (P<0.05). The step frequency and speed, as well as the angles of maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side in either the EA + biofeedback group or the biofeedback group were all higher than the rehabilitation group (P<0.05), and the step speed in the EA + biofeedback group was higher than the biofeedback group (P<0.05). After treatment, the strength of the anterior tibial muscle on the affected side was increased as compared with that before treatment in the patients of each group (P<0.05); and the strength of the anterior tibial muscle in the EA + biofeedback group and the biofeedback group was larger than the rehabilitation group (P<0.05).@*CONCLUSION@#On the base of rehabilitation treatment, the combined regimen of EA and muscle electricity biofeedback therapy and the simple muscle electricity biofeedback therapy all effectively strengthen the motor functions and reduce spasticity as well as improve step frequency, step speed and the range of motion of ankle joint in the patients with post-stroke spasticity in the lower limbs. Regarding the gait improvement, the combined regimen of EA and muscle electricity biofeedback is better than the simple muscle electricity biofeedback.

Effects of whole body vibration combined with extracorporeal shock wave therapy on spasticity and balance gait parameters in hemiplegic patients with stroke / 中南大学学报(医学版)

OBJECTIVES@#Stroke patients may have various sensory-motor disorders, such as spasticity, muscle weakness or sensory damage. Spasticity affects 20% to 40% of stroke patients. Patients with spasticity may have problems such as pain, motor function damage, and the decreased range of motion, which leads to decline of activity and quality of daily life. Extracorporeal shock wave therapy (ESWT) is a technique that can improve post-stroke spasticity. Whole body vibration (WBV), as a passive neuromuscular muscle stimulation technique, can improve the posture control, muscle strength, and muscle work of different people. At present, there are still few studies using WBV combined with ESWT for the treatment of hemiplegic patients with stroke. This study aims to explore the effects of WBV combined with ESWT on spasticity of the affected lower limb and gait function in stroke patients.@*METHODS@#From March 2020 to March 2021, 50 hemiplegic patients with stroke were treated in the Department of Rehabilitation Medicine of the First Hospital of Changsha and they were assigned into a control group and a combined group, 25 cases per group. Both groups carried out conventional treatment, while the control group undertook the ESWT and fake WBV based on conventional treatment, and the combined group undertook ESWT after WBV and conventional treatment. Modified Ashworth Scale (MAS), Lower Extremity portion of the Fugl-Meyer Motor Assessment (FMA-LE), Berg Balance Scale (BBS), and parameters of three-dimensional gait analysis including kinematic parameters (peak value of hip flexion and knee flexion) and spatiotemporal parameters (velocity, cadence and stride length) were assessed before and after 4-week treatment between the 2 groups.@*RESULTS@#After 4 weeks of treatment, MAS scores in 2 groups were lower than before (both P<0.05), and the combined group was lower than the control group (P<0.001); BBS and FMA-LE scores were higher than those before treatment (both P<0.05), and the combined group was higher than the control group (both P<0.001); in the control group, the walking speed, stride frequency, and stride length were higher than those before treatment (all P<0.05), and there was no significant difference between the peak value of flexion hip and peak value of flexion knee (both P<0.05); the peak value of hip flexion, peak value of knee flexion, step speed, step frequency, and stride length in the combined group were higher than those before treatment (all P<0.05), and were higher than those in control group (P<0.05 or P<0.001).@*CONCLUSIONS@#WBV combined with ESWT can improve the spasticity and motor function of the affected lower extremity, balance, and gait in hemiplegic patients with stroke.

Effects of Interactive Dynamic Scalp Acupuncture on Motor Function and Gait of Lower Limbs after Stroke: A Multicenter, Randomized, Controlled Clinical Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the effects of interactive dynamic scalp acupuncture (IDSA), simple combination therapy (SCT), and traditional scalp acupuncture (TSA) on motor function and gait of the lower limbs in post-stroke hemiplegia patients.@*METHODS@#A total of 231 patients with post-stroke hemiplegia was randomly divided into IDSA (78 cases), SCT (78 cases), and TSA (75 cases) groups by a random number table. Scalp acupuncture (SA) and lower-limb robot training (LLRT) were both performed in the IDSA and SCT groups. The patients in the TSA group underwent SA and did not receive LLRT. The treatment was administered once daily and 6 times weekly for 8 continuous weeks, each session lasted for 30 min. The primary outcome measures included Fugl-Meyer assessment of the lower extremity (FMA-LE), berg balance scale (BBS), modified barthel index (MBI), and 6-min walking test (6MWT). The secondary outcome measures included stride frequency (SF), stride length (SL), stride width (SW), affected side foot angle (ASFA), passive range of motion (PROM) of the affected hip (PROM-H), knee (PROM-K) and ankle (PROM-A) joints. The patients were evaluated before treatment, at 1- and 2-month treatment, and 1-, and 2-month follow-up visits, respectively. Adverse events during 2-month treatment were observed.@*RESULTS@#Nineteen patients withdrew from the trial, with 8 in the IDSA and 5 in the SCT groups, 6 in the TSA group. The FMA-LE, BBS, 6MWT and MBI scores in the IDSA group were significantly increased after 8-week treatment and 2 follow-up visits compared with the SCT and TSA groups (P<0.05 or P<0.01). Compared with pre-treatment, the grade distribution of BBS and MBI scores in the 3 groups were significantly improved at 1, 2-month treatment and 2 follow-up visits (P<0.05 or P<0.01). The SF, PROM-H, PROM-K and PROM-A in the IDSA group was significantly increased compared with the SCT and TSA groups after 8-week of treatment (P<0.05 or P<0.01). Compared with the SCT group, ASFA of the IDSA group was significantly reduced after 8-week of treatment (P<0.05). SF, SL, PROM-K and PROM-A were significantly increased at the 2nd follow-up visit whereas the ASFA was significantly reduced in the IDSA group compared with the SCT groups at 1st follow-up visit (P<0.05 or P<0.01). The SF was significantly increased in the SCT group compared with the TSA group after 8-week treatment (P<0.05). Compared with the TSA group, PROM-K, PROM-A were significantly increased at the 2nd follow-up visit (P<0.05).@*CONCLUSIONS@#The effects of IDSA on lower-limb motor function and walking ability of post-stroke patients were superior to SCT and TSA. The SCT was comparable to TSA treatment, and appeared to be superior in improving the motion range of the lower extremities. (Registration No. ChiCTR1900027206).

Jiao's scalp acupuncture combined with virtual reality rehabilitation training for motor dysfunction in patients with Parkinson's disease: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between Jiao's scalp acupuncture combined with virtual reality (VR) rehabilitation training and VR rehabilitation training alone for motor dysfunction in patients with Parkinson's disease (PD).@*METHODS@#A total of 52 patients with PD were randomly divided into an observation group and a control group, 26 cases in each group. The patients in both groups were treated with routine basic treatment, and the patients in the control group were treated with VR rehabilitation training. The patients in the observation group were treated with Jiao's scalp acupuncture on the basis of the control group. The scalp points included the movement area, balance area and dance tremor control area. Both groups were treated once a day, 5 times a week for a total of 8 weeks. Before treatment and 4 and 8 weeks into treatment, the gait parameters (step distance, step width, step speed and step frequency), timed "up and go" test (TUGT) time and unified Parkinson's disease rating scale part Ⅲ (UPDRS-Ⅲ) score were compared between the two groups, and the clinical efficacy was evaluated.@*RESULTS@#Four weeks into treatment, except for the step width in the control group, the gait parameters of the two groups were improved, the TUGT time was shortened, and the UPDRS-Ⅲ scores were reduced (P<0.01, P<0.05); the step distance in the observation group was better than that in the control group, and the UPDRS-Ⅲ score in the observation group was lower than that in the control group (P<0.05). Eight weeks into treatment, the gait parameters of the two groups were improved, the TUGT time was shortened, and the UPDRS-Ⅲ scores were reduced (P<0.01); the step distance and step speed in the observation group were better than those in the control group, the TUGT time in the observation group was shorter than that in the control group, and the UPDRS-Ⅲ score in the observation group was lower than that in the control group (P<0.05, P<0.01). The total effective rate was 92.3% (24/26) in the observation group, which was higher than 69.2% (18/26) in the control group (P<0.05).@*CONCLUSION@#Jiao's scalp acupuncture combined with VR rehabilitation training could improve the gait parameters, walking ability and motor function in patients with PD. The clinical effect is better than VR rehabilitation training alone.

Gait Measurement System Using Laser Range Sensor Based on Lower-limb Rehabilitation Robot / 中国医疗器械杂志

Spatiotemporal gait parameters provide important information for the rehabilitation of patients with gait dysfunction. These parameters are often obtained by complex systems such as optical motioncapture system and pressure plates. However, these systems cannot be deployed at the lower-limb rehabilitation robot easily because of high costs, large area occupation and wearable requirements. We present a gait measurement system with a Light Detection And Ranging(LIDAR) laser sensor based on the lower-limb rehabilitation robot. Firstly, to calculate gait parameters, the data are aggregated into left and right legs by the clustering algorithm and the legs contour is fitted with two circles respectively according to the least square method. Then, the spatiotemporal gait parameters are defined based on the time and position of initial contact(IC) and toe off(TO). Finally, to verify the validity of the proposed system, we compared the results of the proposed system with a 3D motion capture system based on a lower-limb rehabilitation robot. Experimental results showed that the gait detection system can measure the parameters within a small range of error that testified the validation of the proposed system. This system proved to be a valid and reliable method for the measurement of gait parameters.

Research progress on multicomponent physical exercise for patients with neurocognitive impairment / 浙江大学学报·医学版

Neurocognitive impairment is a group of clinical syndromes characterized by impaired cognitive function and decreased motor ability. Non-pharmacological interventions such as physical exercise have advantages in the treatment of patients with neurocognitive impairment. Multicomponent exercise is a combination of various physical exercises, including strength training, endurance training, balance training and flexibility training, that can improve gait, balance and cardiopulmonary function by increasing muscle mass, strength and endurance in people with neurocognitive impairment, while also reducing the risk of falls in elders. This article reviews the benefits of multicomponent exercise for patients with neurocognitive impairment and its evaluation methods; also describes 4 intervention programs and their clinical application, to provide evidence for clinical practice and promote the application of multicomponent exercise in patients with neurocognitive impairment.

A pelvic support weight rehabilitation system tracing the human center of mass height / 生物医学工程学杂志

The body weight support rehabilitation training system has now become an important treatment method for the rehabilitation of lower limb motor dysfunction. In this paper, a pelvic brace body weight support rehabilitation system is proposed, which follows the center of mass height (CoMH) of the human body. It aims to address the problems that the existing pelvic brace body weight support rehabilitation system with constant impedance provides a fixed motion trajectory for the pelvic mechanism during the rehabilitation training and that the patients have low participation in rehabilitation training. The system collectes human lower limb motion information through inertial measurement unit and predicts CoMH through artificial neural network to realize the tracking control of pelvic brace height. The proposed CoMH model was tested through rehabilitation training of hemiplegic patients. The results showed that the range of motion of the hip and knee joints on the affected side of the patient was improved by 25.0% and 31.4%, respectively, and the ratio of swing phase to support phase on the affected side was closer to that of the gait phase on the healthy side, as opposed to the traditional body weight support rehabilitation training model with fixed motion trajectory of pelvic brace. The motion trajectory of the pelvic brace in CoMH mode depends on the current state of the trainer so as to realize the walking training guided by active movement on the healthy side of hemiplegia patients. The strategy of dynamically adjustment of body weight support is more helpful to improve the efficiency of walking rehabilitation training.

Research on gait recognition and prediction based on optimized machine learning algorithm / 生物医学工程学杂志

Aiming at the problems of individual differences in the asynchrony process of human lower limbs and random changes in stride during walking, this paper proposes a method for gait recognition and prediction using motion posture signals. The research adopts an optimized gated recurrent unit (GRU) network algorithm based on immune particle swarm optimization (IPSO) to establish a network model that takes human body posture change data as the input, and the posture change data and accuracy of the next stage as the output, to realize the prediction of human body posture changes. This paper first clearly outlines the process of IPSO's optimization of the GRU algorithm. It collects human body posture change data of multiple subjects performing flat-land walking, squatting, and sitting leg flexion and extension movements. Then, through comparative analysis of IPSO optimized recurrent neural network (RNN), long short-term memory (LSTM) network, GRU network classification and prediction, the effectiveness of the built model is verified. The test results show that the optimized algorithm can better predict the changes in human posture. Among them, the root mean square error (RMSE) of flat-land walking and squatting can reach the accuracy of 10 -3, and the RMSE of sitting leg flexion and extension can reach the accuracy of 10 -2. The R 2 value of various actions can reach above 0.966. The above research results show that the optimized algorithm can be applied to realize human gait movement evaluation and gait trend prediction in rehabilitation treatment, as well as in the design of artificial limbs and lower limb rehabilitation equipment, which provide a reference for future research to improve patients' limb function, activity level, and life independence ability.

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.

Fragilidade em idosos que vivem na comunidade: prevalência e fatores associados / Frailty in community-dwelling older people: prevalence and associated factors

Fundamentos: Idosos que vivem na comunidade são propensos a desenvolver fragilidade, considerada como um estado clinicamente identificável que aumenta a vulnerabilidade a resultados adversos e prediz incapacidade e mortalidade na população idosa. Objetivo: Identificar a prevalência e fatores associados à fragilidade em idosos que vivem em uma comunidade. Método: Trata-se de um inquérito domiciliar transversal e analítico, de abordagem quantitativa realizado com 854 idosos que vivem na comunidade. A fragilidade foi mensurada pela Edmonton Frail Scale (EFS). A associação entre fragilidade e variáveis sociodemográficas e de condições clínicas foi mensurada pela análise múltipla por regressão logística. Resultados: A prevalência de fragilidade encontrada neste estudo foi de 12,3% (IC95%: 10,1 a 14,5). O modelo de regressão logística mostrou que as variáveis estatisticamente associadas à fragilidade foram: queda recorrente, uso de dispositivo para auxílio à marcha, polifarmácia, autopercepção ruim de saúde, dependência nas atividades básicas e instrumentais de vida diária. Conclusão: A prevalência de fragilidade em idosos foi baixa em comparação a outros estudos nacionais que empregaram a EFS. Os resultados indicaram múltiplos fatores associados à fragilidade modificáveis. Assim, a investigação da síndrome da fragilidade bem como dos seus fatores relacionados passíveis de prevenção são ações a serem incluídas na prática clínica. (AU)

Foundations: Elderly people living in the community are prone to developing frailty, considered as a clinically identifiable state that increases vulnerability to adverse events and predicts disability and mortality in the elderly population. Objective: To identify the prevalence and factors associated with frailty in the elderly living in the community. Materials and method: This is a cross-sectional and analytical household survey with a quantitative approach conducted with 854 elderly people living in the community. Frailty was measured by Edmonton Frail Scale (EFS). The association between frailty and sociodemographic and clinical condition variables was measured by multiple analysis using logistic regression. Results: The prevalence of frailty found in this study was 12.3% (95% CI: 10.1 to 14.5). The logistic regression model showed that the variables statistically associated with frailty were: recurrent fall, use of walking aids, polypharmacy, poor self-rated health, dependence on basic and instrumental activities of daily living. Conclusion: The prevalence of frailty in the elderly was low compared to other national studies that employed the SAI. Results indicated potentially modifiable factors associated with frailty. Thus, the investigation of frailty syndrome and its related preventable factors are actions to be included in clinical practice. (AU)

Momento aductor de la cadera durante la marcha en adultos mayores asintomáticos / Hip adductor moment during gait in asymptomatic older adults

Resumen Introducción: El momento articular durante la marcha se ha relacionado con diferentes procesos clínicos en la población adulto mayor, en Colombia no se cuentan con reportes propios. Objetivo: Analizar el momento aductor de la cadera durante la marcha de adultos mayores asintomáticos. Materiales y métodos: Se evaluó a 110 participantes siguiendo las referencias del software VICON NEXUS 2.8.1 modelo Full Body, se utilizó 2 plataformas de fuerza y el volumen de captura estuvo delimitado por 8 cámaras opto eléctricas Bonita 10. Se incluyó variables antropométricas, sociodemográficas, espaciotemporales y cinéticas durante la fase de apoyo, resaltando los dos picos máximos del momento aductor. Resultados: Las cifras del Pico Momento Aductor 1 y 2 (PMA1 y PMA2) fueron de 0,76 y 0,70 Nm/Kg respectivamente, estos picos se relacionaron con masa, talla e índice de masa corporal. Se construyó así una referencia para el análisis de adultos mayores asintomáticos. Conclusiones: La gráfica del momento aductor de la cadera es similar a la descrita por otros investigadores, pero en menor magnitud que en la población sintomática de coxartrosis.

Abstract Introduction: Although joint moment during waking has been associated with different clinical processes in the elderly population, there is a lack of reports in Colombia. Objective: To analyze the hip adductor moment during gait in asymptomatic older adults. Materials and methods: 110 participants were assessed using the VICON NEXUS 2.8.1. Full Body model software. 2 force platforms were used and the capture volume was delimited through 8 Bonita-10 optoelectronic cameras. Anthropometric, sociodemographic, spatiotemporal, and kinetic variables were included during the support phase, highlighting the two maximum peaks of the adductor moment. Results: The figures for Adductor Moment Peaks 1 and 2 (AMP1 and AMP2) were 0.76 and 0.70 Nm/Kg, respectively, which were related to mass, height and body mass index. Thus, a reference for the analysis of asymptomatic older adults was developed. Conclusion: The hip adductor moment graph is similar to that described by other researchers, but to a lesser extent than the values seen in coxarthrosis symptomatic population.

Meninas em luta: processos comunicativos e estéticos das performances feministas no movimento secundarista / Girls in struggle: communicative and aesthetic processes of feminist performances in the secondary movement / Niñas en lucha: procesos comunicativos y estéticos de performances feministas en el movimiento secundario

Este artigo busca refletir sobre processos de emancipação postos em marcha pelos jovens envolvidos no movimento secundarista em 2015, conferindo especial atenção às meninas protagonistas desse levante, às suas corporeidades e às dimensões estético-políticas de suas reivindicações. Evidenciamos que, durante as ocupações, questões ligadas ao feminismo tornaram-se tema de debates, aparecendo também no documentário Lute como uma menina! (Flávio Colombini e Beatriz Alonso, 2016), que foi produzido durante as ocupações, tecido unicamente com depoimentos das meninas que participaram do movimento. A partir de cenas e trechos dessa produção, buscamos mostrar como a agência das meninas secundaristas produzem arranjos disposicionais e subjetivações políticas e cenas de dissenso nas quais outras formas de vida e outras performatividades são possíveis.

This article seeks to reflect on the processes of emancipation set in motion by the young people involved in the secondary movement in 2015, paying special attention to the girls protagonists of this uprising, their corporealities and the aesthetic-political dimensions of their claims. We showed that, during the occupations, issues related to feminism became the subject of debates, also appearing in the documentary Fight like a girl! (Flávio Colombini and Beatriz Alonso, 2016), which was produced during the occupations, woven only with testimonies from the girls who participated in the movement. From scenes and excerpts from this production, we seek to show how the agency of high school girls produces dispositional arrangements and political subjectivities and scenes of dissent in which other forms of life and other performativities are possible.

Este artículo busca reflexionar sobre los procesos de emancipación puestos en marcha por los jóvenes involucrados en el movimiento secundario en 2015, con especial atención a las niñas protagonistas de este levantamiento, sus corporealidades y las dimensiones estético-políticas de sus reivindicaciones. Demostramos que, durante las ocupaciones, temas relacionados con el feminismo se convirtieron en tema de debate, apareciendo también en el documental Laúd como niña! (Flávio Colombini y Beatriz Alonso, 2016), que se produjo durante las ocupaciones, tejido únicamente a partir de los testimonios de las niñas que participaron en el movimiento. Basándonos en escenas y extractos de esta producción, buscamos mostrar cómo la agencia de las niñas de secundaria produce arreglos disposicionales y subjetividades políticas y escenas de disenso en las que otras formas de vida y otras performatividades son posibles.

Equilíbrio e força de membros inferiores correlacionam-se com velocidade de marcha em pacientes com AVC: um estudo observacional / Balance and lower limb strength correlate with gait speed in stroke patients: an observational study

INTRODUÇÃO: A marcha e o equilíbrio são frequentemente comprometidos após lesões cerebrais como o Acidente Vascular Cerebral (AVC). OBJETIVO: Correlacionar a força dos membros inferiores e o equilíbrio em apoio unipodal no membro parético com a velocidade de marcha em pacientes com AVC. MÉTODOS: Estudo do tipo observacional transversal. Indivíduos de ambos os sexos com diagnóstico de AVC atendidos no Ambulatório de Neurovascular do Hospital de Clínicas de Porto Alegre, que conseguissem permanecer em ortostase por dois minutos sem auxílio e com marcha domiciliar com ou sem auxílio de dispositivos de marcha, foram avaliados quanto a força muscular de MsIs, por meio do Teste de Sentar e Levantar em 30 segundos (TSL30s); avaliação do equilíbrio pelo Teste de Apoio Unipodal (AU) e da velocidade da marcha pelo Teste de Caminhada de 10 metros (TC10m) com auxílio de um acelerômetro fixado na região de L5. RESULTADOS: Dos trinta e quatro indivíduos avaliados, 67,6% eram do sexo feminino, com média de idade de 60,5 (± 13,6) anos. A velocidade de marcha confortável média foi 1,01 ± 0,31 m/s, a média no TSL30s foi 9 ± 2,94 repetições e o tempo médio de apoio no membro inferior acometido foi de 4,11 ± 10,43 segundos. Houve correlação dos valores no TC10m com o tempo de permanência no lado acometido (r=0,563 p<0,001) e com o número de repetições no TSL30s (r=0,667 p<0,001). CONCLUSÃO: Quanto maior a força muscular dos MsIs e o equilíbrio em apoio unipodal sobre o membro inferior acometido, maior a velocidade de marcha nos pacientes com AVC.

BACKGROUND: Gait and balance are often compromised after brain injuries such as stroke. OBJECTIVE: To correlate the lower limb muscle strength walking speed, and balance in unipedal support on a paretic limb with gait speed in stroke patients. METHODS: This study employed a correlational design. Individuals of both genders with a stroke diagnosis were seen at the Neurovascular Outpatient Clinic of the Hospital de Clínicas de Porto Alegre, Brazil, who were able to remain in orthostasis for two minutes without assistance and with walking at home with or without the aid of walking devices. The Sit-to-stand test for 30 seconds (STS 30s) was used to examine muscle strength of lower limbs; the balance was measured using the Unipedal Support Test (UST) and walking speed with 10 Meter Walk Test (10MWT) and used an accelerometer around the waist of the subject. RESULTS: A total of 34 subjects were evaluated, 67.6% female and mean age 60.5 (± 13.6) years. The average comfortable walking speed was 1.01 ± 0.31 m/s, the average in the STS 30s was 9 ± 2.94 repetitions, and the average support time on the affected lower limb was 4.11 ± 10.43 seconds. In addition, there was a correlation between the values in the 10MWT and the length of stay on the affected side (r=0.563 p<0.001) and with the number of repetitions in the STS 30s (r=0.667 p<0.001). CONCLUSION: The greater the muscle strength of the lower limbs and the balance in unipedal support on the affected lower limb, the greater the gait speed in stroke patients.

Enhanced active contraction of the transversus abdominis during walking / Aumento de la contracción activa del músculo transverso del abdomen durante la caminata / Aumento da contração ativa do músculo transverso do abdome durante a caminhada

ABSTRACT Introduction: We applied three-dimensional gait analysis to assess the effects of enhanced active contraction of the transversus abdominis (EACTA) during walking. We sought to evaluate the effect of EACTA during walking in order to improve walking quality. Methods: Thirty college students were recruited and trained to perform EACTA during walking. We examined gait parameters under different conditions, including EACTA and habitual ACTA (natural walking with mild contraction of the feedforward mechanism of ACTA, HACTA) during walking using three-dimensional gait analysis. We compared differences in gait parameters under the two walking conditions using SPSS 16.0 statistical software. Results: The following gait parameters were significantly lower under EACTA conditions than under HACTA conditions (P < 0.05): stance phase, 59.151% ± 1.903% vs. 59.825% ± 1.495%; stride time, 1.104 s ± 0.080 s vs. 1.134 s ± 0.073 s:; stance time, 0.656 s ± 0.057 s vs. 0.678 s ± 0.053 s; and swing time, 0.447 s ± 0.028 s vs. 0.454 s ± 0.031 s, respectively. Gait parameters single support phase and mean velocity were significantly higher for EACTA than for HACTA conditions (both P < 0.05). Conclusions: Overall, the results revealed that EACTA during walking can improve gait. This method is simple, and EACTA training during walking to improve gait quality in daily life could provide a positive basis for people to strengthen the transverse abdominal muscle. Level of evidence III; Retrospective comparative study .

RESUMEN Introducción: Aplicamos el análisis tridimensional de la marcha para evaluar los efectos del aumento de la contracción activa del músculo transverso del abdomen (EACTA) durante la caminata. Buscamos evaluar el efecto del EACTA durante la caminata para mejorar su calidad. Métodos: Treinta estudiantes universitarios fueron reclutados y entrenados para realizar el EACTA durante la caminata. Examinamos los parámetros de la marcha en diferentes condiciones, incluyendo EACTA y ACTA habitual (caminata natural con leve contracción del mecanismo de feedforward del ACTA, HACTA) durante la caminata usando análisis tridimensional de la marcha. Comparamos las diferencias en los parámetros de la marcha en las dos condiciones de caminata en el software estadístico SPSS 16.0. Resultados: Los siguientes parámetros de marcha fueron significativamente más bajos en la condición EACTA que en condiciones HACTA (P <0,05): fase de apoyo 59,151 ± 1,903% vs 59,825 ± 1,495%, tiempo de zancada 1,104 s ± 0,080 s vs 1,134 s ± 0,073 s, tiempo de apoyo 0,656 s ± 0,057 s vs 0,678 s ± 0,053 s y tiempo de balance 0,447 s ± 0,028 s vs 0,454 s ± 0,031 s, respectivamente. Los parámetros de la marcha, fase de apoyo simple y velocidad promedio fueron significativamente mayores en el EACTA que en las condiciones HACTA (ambos P <0,05). Conclusiones: En general, los resultados revelaron que el EACTA durante la caminata puede mejorar la marcha. Este método es simple, y el entrenamiento del EACTA durante la caminata para mejorar la calidad de la marcha en la vida diaria puede ser una base positiva para el fortalecimiento del músculo transverso del abdomen. Nivel de evidencia III; Estudio retrospectivo comparativo .

RESUMO Introdução: Aplicamos a análise tridimensional da marcha para avaliar os efeitos do aumento da contração ativa do músculo transverso do abdome (EACTA) durante a caminhada. Procuramos avaliar o efeito do EACTA durante a caminhada para melhorar sua qualidade. Métodos: Trinta estudantes universitários foram recrutados e treinados para realizar o EACTA durante a caminhada. Examinamos os parâmetros da marcha em diferentes condições, incluindo EACTA e ACTA habitual (caminhada natural com leve contração do mecanismo de feedforward do ACTA, HACTA) durante a caminhada usando análise tridimensional da marcha. Comparamos as diferenças nos parâmetros da marcha nas duas condições de caminhada no software estatístico SPSS 16.0. Resultados: Os seguintes parâmetros da marcha foram significativamente mais baixos na condição EACTA do que em condições HACTA (P < 0,05): fase de apoio 59,151 ± 1,903% vs. 59,825 ± 1,495%, tempo de passada 1,104 s ± 0,080 s vs. 1,134 s ± 0,073 s, tempo de apoio 0,656 s ± 0,057 s vs. 0,678 s ± 0,053 s e tempo de balanço 0,447 s ± 0,028 s vs. 0,454 s ± 0,031 s, respectivamente. Os parâmetros da marcha fase de apoio simples e velocidade média foram significativamente maiores no EACTA do que nas condições HACTA (ambos P < 0,05). Conclusões: No geral, os resultados revelaram que o EACTA durante a caminhada pode melhorar a marcha. Esse método é simples, e o treinamento do EACTA durante a caminhada para melhorar a qualidade da marcha na vida diária pode ser uma base positiva para o fortalecimento do músculo transverso do abdome. Nível de evidência III; Estudo retrospectivo comparativo .