The reliability of qualitative analyses of video fluoroscopic images / 中华物理医学与康复杂志

Objective To analyze temporal and kinematic parameters of video fluoroscopic images of swallowing using a digital acquisition and analysis system and to verify the reliability of this method.Methods Eighteen patients with dysphagia were requested to completed six swallows (3 ml and 5 ml of thin liquid, thick liquid, and paste mixed with 600 kg/m3 barium sulfate suspension) in the natural sitting position.Video fluoroscopy was used to measure the oral transit times, soft palate elevation times, hyoid movement times, laryngeal closure times, cricopharyngeal muscle opening times, hyoid anterior movement (HAM) , hyoid superior movement (HSM) , cricopharyngeal muscle opening diameter and pharyngeal constriction rate.Each was extracted from the videos four times by two raters working separately with an interval of 4 weeks between the sets of evaluations.Results Reliability varied among the different observations.HAM and HSM showed inter-rater reliability between 0.41 and 0.60 and intra-rater reliability between 0.61 and 0.80.The other observations all demonstrated acceptable reliability.Conclusion The self-designed digital acquisition and analysis system tested showed acceptable reliability and could be applied to analyze swallowing function clinically.

Influence of body weight unloading and support surface during walking of children with cerebral palsy / Influência do alívio de peso corporal e da superfície de suporte durante o andar de crianças com paralisia cerebral espástica

Introduction Partial body weight support (BWS) systems have been employed for gait training of children with cerebral palsy (CP). Therefore, it would be important to analyze if the type of walking surface and the amount of body weight unloading over lower limbs change the way these children walk. Objectives Investigate the influence of walking surface and amount of body weight unloading on the spatial temporal characteristics during walking of children with CP. Materials and methods Seven children with spastic CP between four and eight years old and GMFCS (Gross Motor Function Classification System) between I and IV, were videotaped walking with 0%, 15% and 30% of BWS on both dynamic (treadmill) and static (ground level) surfaces. Walking spatial temporal variables were calculated. Results Children walked with similar velocity in all experimental conditions. While stance duration decreased as the percentage of BWS increased, no differences were found for stance and swing periods and cadence. Children walked with longer steps and strides and with faster strides on static surface compared to dynamic surface. Conclusion Children with CP presenting different levels of motor impairment presented some alterations in the spatial temporal walking parameters as they walked with body unloading. However, such alterations might be due mainly to the type of walking surface than the percentage of body weight unloading on lower limbs.

Introdução Sistemas de suporte parcial de peso corporal (SPPC) têm sido utilizados para treinamento do andar de crianças com paralisia cerebral (PC). Sendo assim, seria importante analisar se o tipo de superfície e a quantidade de alívio de peso corporal sobre os membros inferiores interferem na forma como essas crianças andam. Objetivo Investigar a influência do tipo de superfície e da porcentagem de alívio de peso corporal sobre as características espaço-temporais durante o andar de crianças com PC. Materiais e métodos Sete crianças com PC espástica, entre quatro e oito anos de idade, e GMFCS (Gross Motor Function Classification System) entre I e IV, foram filmadas andando com 0%, 15% e 30% de SPPC em superfícies móvel (esteira motorizada) e fixa (chão). Variáveis espaço-temporais do andar foram calculadas. Resultados As crianças andaram com velocidade semelhante em todas as condições experimentais. Enquanto que a duração do período de apoio diminuiu conforme a porcentagem de SPPC aumentou, nenhuma diferença para as fases de apoio e balanço e cadência foi encontrada. As crianças andaram com passos e passadas mais longos e passadas mais rápidas na superfície fixa do que na superfície móvel. Conclusão Crianças com PC com diferentes níveis de acometimento motor apresentaram algumas alterações nos parâmetros espaço-temporais durante o andar com alívio de peso corporal em superfícies móvel e fixa. Entretanto, tais alterações podem ser atribuídas principalmente ao tipo de superfície em que as crianças andam do que às porcentagens de alívio de peso corporal proporcionadas aos membros inferiores.

Análise do uso de suporte parcial de peso corporal em esteira e em piso fixo durante o andar de crianças com paralisia cerebral / Analysis of partial body weight support during treadmill and overground walking of children with cerebral palsy

OBJETIVO: Analisar características espaço-temporais e ângulos articulares de crianças com paralisia cerebral andando sem o uso de suporte parcial de peso corporal (SPPC) em piso fixo e com 0 por cento e 30 por cento de SPPC em piso fixo e em esteira. MÉTODOS: Seis crianças com paralisia cerebral hemiplégica espástica (7,70±1,04 anos) foram filmadas andando com velocidade confortável sem o uso de SPPC, com 0 por cento e 30 por cento de SPPC em piso fixo e com 0 por cento e 30 por cento de SPPC em esteira. Marcadores refletivos foram afixados nos principais pontos anatômicos dos dois hemicorpos para registro das coordenadas "x", "y", "z". RESULTADOS: As crianças andaram mais rapidamente e com passadas mais longas e mais rápidas, com duração dos períodos de apoio simples e balanço maiores e apoio duplo menor no piso fixo do que na esteira, independentemente do uso do SPPC. O quadril foi a única articulação que apresentou diferenças entre os hemicorpos e entre as condições, sendo que o hemicorpo plégico apresentou menor amplitude de movimento (ADM) que o hemicorpo não plégico, e a ADM foi maior na condição sem o uso de SPPC do que com 30 por cento de SPPC em piso fixo. CONCLUSÃO: Crianças com paralisia cerebral hemiplégica espástica são capazes de andar em piso fixo e esteira com diferentes porcentagens de SPPC, sendo que seus desempenhos foram melhores no piso fixo, independentemente do uso de SPPC, do que na esteira.

OBJECTIVE: To analyze the spatial-temporal characteristics and joint angles during overground walking without body weight support (BWS) and with 0 percent and 30 percent BWS, and during treadmill walking with the same BWS in children with cerebral palsy. METHODS: Six children with hemiplegic and spastic cerebral palsy (7.70 ± 1.04 years old) were videotaped during overground walking at a comfortable speed with no BWS, with 0 percent and 30 percent BWS, and during treadmill walking with 0 percent and 30 percent BWS. Reflective markers were placed over main bony landmarks in both body sides to register the coordinates "x", "y", "z". RESULTS: During overground walking, children walked faster and presented longer and faster strides, longer duration of single-stance and swing periods, and shorter duration of double-stance period, than treadmill walking, regardless of BWS use. The hip was the only joint that presented a difference between body sides and experimental conditions; i.e. range of motion (ROM) was reduced in the plegic side when compared to the nonplegic side, and during overground walking without BWS when compared to 30 percent BWS. CONCLUSION: Children with hemiplegic and spastic cerebral palsy were able to walk overground and on a treadmill with different percentages of BWS, and their performance was superior during overground walking, regardless of BWS use.

Influence of Body Weight Unloading on Hemiplegic Gait

OBJECTIVE: To investigate the biomechanic influence of body weight unloading on the hemiplegic gait and to provide database for producing optimal strategies of gait training through body weight unloading (BWU) in hemiplegic patients. METHOD: We evaluated dynamic electromyographic data, temporal parameters of gait, and energy consumption in 20 hemiplegic patients walking on a treadmill with 0%, 10%, 20%, 30% and 40% of their BWU at their comfortable walking speed. RESULTS: 1) Stance phase and double limb support phase significantly decreased, and swing phase and single limb support phase increased according to BWU. 2) Asymmetricity of temporal parameters of gait improved according to BWU. 3) O2 rate, O2 cost, O2 pulse and heart rate significantly decreased with increasing BWU. 4) Muscular activities of rectus femoris, vastus medialis and biceps femoris decreased at initial contact and first half of stance phase and activities of medial gastrocnemius significantly decreased during entire stance phase with increasing BWU. CONCLUSION: BWU during treadmill locomotion would be advantageous as a therapeutic approach to retrain gait in hemiplegic patients.