Correlação entre espasticidade do membro superior e movimentação da mão no pós-AVC / Correlación entre la espasticidad del miembro superior y el movimiento de la mano post-ACV / Correlation between upper limb spasticity and hand movement after stroke

RESUMO A hemiparesia e a espasticidade são consequências comuns em pacientes que sofreram um acidente vascular cerebral (AVC) e delas decorre a dificuldade do paciente de movimentar o hemicorpo acometido. O objetivo deste estudo foi, assim, verificar a relação da espasticidade no membro superior (MS) com a capacidade de movimentação da mão desses pacientes, a partir de um estudo transversal de delineamento ex-post facto correlacional. Foram avaliados pacientes que realizavam acompanhamento no Ambulatório Neurovascular do Hospital de Clínicas de Porto Alegre (HCPA). Foi preenchida uma ficha de avaliação com dados da amostra e realizada a avaliação da espasticidade do MS, por meio da escala de Ashworth modificada (MAS), e da movimentação ativa da mão, por meio da escala de movimentação da mão (EMM). Para a correlação das variáveis, foi usado o coeficiente de correlação tau de Kendall, adotando-se um nível de significação de 5% (p≤0,05). Foram avaliados 47 sujeitos de ambos os sexos com média de idade de 64,5 (±13) anos e média de tempo de AVC de 2,7 (±1,8) meses. A moda da EMM foi de 6 pontos e 74,4% dos pacientes não eram espásticos. O movimento da mão apresentou correlação significativa negativa com as musculaturas espásticas avaliadas. Houve uma correlação negativa moderada com as musculaturas peitoral (r=−0,383; p=0,007), os flexores de cotovelo (r=−0,339; p=0,016) e pronadores (r=−0,460; p=0,001), e correlação negativa alta com os flexores de punho (r=−0,588; p<0,001) e os flexores de dedos (r=−0,692; p<0,001). Concluiu-se que quanto maior o grau de espasticidade do membro superior, menor a capacidade de movimentação da mão dos pacientes.

RESUMEN La hemiparesia y la espasticidad en los pacientes son consecuencias frecuentes del accidente cerebrovascular (ACV), lo que resulta en la dificultad del paciente para mover el hemicuerpo afectado. El objetivo de este estudio fue verificar la relación entre la espasticidad en el miembro superior (MS) y la capacidad de mover la mano de estos pacientes a partir de un estudio transversal, con un diseño correlacional ex post facto. Se evaluaron a pacientes en seguimiento en el Ambulatorio de Neurovascular del Hospital de Clínicas de Porto Alegre (HCPA), en Brasil. El formulario de evaluación se utilizó para recoger los datos de la muestra, y para el análisis de la espasticidad del MS se aplicó la escala de Ashworth modificada (MAS), y el movimiento activo de la mano, la escala de movimiento de la mano (EMM). Para la correlación de variables se utilizó el coeficiente de correlación tau de Kendall, con un nivel de significación del 5% (p≤0,05). Se evaluaron a 47 personas de ambos sexos, con una edad media de 64,5 (±13) años y un tiempo medio del ACV de 2,7 (±1,8) meses. La moda de EMM fue de 6 puntos, y el 74,4% de los pacientes no eran espásticos. El movimiento de la mano mostró una correlación negativa significativa con las musculaturas espásticas evaluadas. Hubo una moderada correlación negativa con la musculatura pectoral (r=−0,383; p=0,007), los flexores del codo (r=−0,339; p=0,016) y pronadores (r=−0,460; p=0,001), y una alta correlación negativa con los flexores de muñeca (r=−0,588; p<0,001) y los flexores de dedos (r=−0,692; p<0,001). Se concluyó que cuanto mayor es el grado de espasticidad del miembro superior, menor será la capacidad de movimiento de las manos de los pacientes.

ABSTRACT Hemiparesis and spasticity are common consequences in stroke patients, hampering the movement in the affected side. Our study aimed to correlate upper limb spasticity and the ability to move the hand in these patients. This is a quantitative cross-sectional study with an ex post facto correlational design. We evaluated patients undergoing follow-up at the Neurovascular Outpatient Clinic at the Hospital de Clínicas de Porto Alegre. An evaluation form was filled out with sample data and the upper limb spasticity was evaluated using the Modified Ashworth Scale and the active hand movement using the Hand Movement Scale. Correlation of variables were verified using Kendall's rank correlation coefficient. A significance level of 5% (p≤0.05) was adopted. In total, we evaluated 47 subjects of all genders, with a mean age of 64.5 (±13) years and a mean stroke time of 2.7 (±1.8) months. The Hand movement Scale mode was 6 points, and 74.4% of patients were not spastic. Hand movement showed a significant negative correlation with the spastic muscles evaluated. There was a moderate negative correlation with the pectoral muscles (r=−0.383; p=0.007), elbow flexors (r=−0.339; p=0.016) and pronators (r=−0.460; p=0.001) and high negative correlation with wrist flexors (r=−0.588; p<0.001) and finger flexors (r=−0.692; p<.001). The greater the degree of spasticity of the upper limb, the smaller the hand movement capacity in stroke patients.

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.

Motor symptoms and the quality of life of relapsing-remitting multiple sclerosis patients in a specialized center in South of Brazil / Sintomas motores e qualidade de vida em pacientes com esclerose múltipla remitente recorrente em um centro especializado no Sul do Brasil

Abstract Background: Spasticity, fatigue, muscle weakness and changes in gait are some of the main motor symptoms of Multiple Sclerosis (MS). These changes can interfere with the patients' quality of life. Objective: To characterize the motor and quality of life symptoms in patients with relapsing-remitting Multiple Sclerosis at a specialized center. Methods: Fifty five patients at the Neuroimmunology Outpatient Clinic of the Hospital de Clínicas de Porto Alegre were evaluated for fatigue (Fatigue Severity Scale — FSS), walking ability (Functional Ambulation Categories — FAC), impact of MS on walking (Multiple Sclerosis Walking Scale-12 — MSWS-12), walking speed (10-Meter Walk Test — 10MWT and the Times 25-foot Walk test — T25FW), functional independence (Barthel Index — BI), functional mobility (Timed Up and Go — TUG), and quality of life (Multiple Sclerosis Impact Scale — MSIS-29). Results: The patients were mostly women (69.1%), with average age of 43.3 (±12.1) years old, with time since diagnosis of 8.2 (±5.3) years, and EDSS average of 4.3 (±1.3). On the BI, the mean was 96.6 (±5.7) points and 80% of the patients had FAC 5. At MSIS-29, patients had a higher average score on the psychological scale (19.5±26.7) than on the physical scale (10.2±23.6). Most patients (69.1%) presented fatigue. Conclusion: The patients had preserved functional independence and functional walking ability and presence of fatigue. There was minimal impact of MS on patients' quality of life.

RESUMO Antecedentes: Espasticidade, fadiga, fraqueza muscular e alterações na marcha são alguns dos principais sintomas motores da esclerose múltipla (MS). Essas alterações podem interferir na qualidade de vida dos pacientes. Objetivo: caracterizar os sintomas motores e qualidade de vida de pacientes com EM do tipo remitente-recorrente de um Centro Especializado. Métodos: Foram avaliados 55 pacientes do Ambulatório de Neuroimunologia do Hospital de Clínicas de Porto Alegre, quanto a fadiga (Escala de Severidade da Fadiga — FSS), capacidade de deambulação (Categoria de Deambulação Funcional — FAC), impacto da EM na caminhada (Multiple Sclerosis Walking Scale-12 — MSWS-12), velocidade de marcha (Teste de Caminhada de 10 Metros — 10MWT e o de Caminhada Cronometrada de 25 Pés — T25FW), independência funcional (Índice de Barthel — BI), mobilidade funcional (Timed Up and Go — TUG) e qualidade de vida (Escala de Impacto de Esclerose Múltipla — MSIS-29). Resultados: Os pacientes eram, em sua maioria, do sexo feminino (69,1%), com média de idade de 43,3 (±12,8) anos, tempo de diagnóstico de 8,2 (±5,3) anos e a média da EDSS de 4,3 (±1,3). A média no BI foi de 96,6 (±5,7) pontos e 80% dos pacientes apresentavam FAC 5. Na MSIS-29, os pacientes apresentaram maior pontuação média na escala psicológica (19,5±26,7) do que na física (10,2±23,6). A maioria dos pacientes (69.1%) apresentou fadiga. Conclusão: Os pacientes apresentaram independência funcional e capacidade de deambulação funcional preservadas e presença de fadiga. Houve pequeno impacto da EM na qualidade de vida dos pacientes.

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.

Efeito do treino locomotor com suporte parcial de peso corporal na velocidade de marcha de um paciente na fase aguda após acidente vascular cerebral: estudo de caso / Effect of partial body-weight support locomotor training on gait speed of a patient with acute stroke: a case study

O treino locomotor com suporte parcial de peso corporal (SPPC) é uma abordagem que tem sido utilizada na reabilitação do AVC. Entretanto, não há consenso na literatura sobre sua eficácia frente à reabilitação tradicional. Portanto, o objetivo desse estudo foi avaliar o efeito do treino com SPPC na velocidade de marcha após AVC na fase aguda. Um paciente, sexo masculino, 52 anos, foi avaliado através do Índice de Motricidade (IM) e Teste de Caminhada de 10 metros (TC10m). Recebeu, durante 5 dias, sessões de fisioterapia de 30 minutos, com 15 minutos de treino de marcha com SPPC. Apresentou um aumento de 28 pontos no IM e de mais de 50% nas velocidades de marcha normal e rápida. O resultado corrobora com estudos que evidenciam a eficácia do treino com SPPC na melhora da velocidade de marcha após AVC na fase aguda. (AU)

Locomotor training with partial body-weight support (PBWS) has been used for some years in stroke rehabilitation. However, there is no consensus in the literature about its effectiveness compared to conventional rehabilitation. Thus, the aim of this study was to evaluate the effect of PBWS training on gait speed after acute stroke. A 52-year-old male patient was assessed through Motricity Index (MI) and 10-meter Walk Test (10MWT). He had 30-minute physical therapy sessions, with 15-minute gait training with PBWS, for 5 days. The patient showed an increase of 28 points in MI and of over 50% in normal and fast gait speeds. The results are consistent with previous studies that showed the effectiveness of PBWS training in improving gait speed in acute stroke. (AU)

Depression, lower urinary tract symptoms and quality of life in women with multiple sclerosis: a descriptive and correlational study

Introduction: Among the most ordinary clinical manifestations of Multiple Sclerosis (MS) are depression and the presence of Lower Urinary Tract Symptoms (LUTS). Both can compromise a person's quality of life. The objective of this research was to identify the major urinary symptoms and correlate them with quality of life and with depressive symptoms in women with MS. Methods: This was an observatory, descriptive and correlational study, with nonprobabilistic sampling by convenience. This research included women over 18 years old who displayed LUT symptoms and who had been diagnosed with Relapsing-Remitting MS. Assessment consisted of an anamnesis card, the Kurtzke Expanded Disability Status Scale (EDSS), the Incontinence Impact Questionnaire-7 (IIQ-7-BR), the Urogenital Distress Inventory-6 (UDI-6-BR), the Beck Depression Inventory-2 (BDI-II) and the Multiple Sclerosis Quality of Life Questionnaire - Portuguese version (MSQOL-54). Results: 41 women participated in the study, with average age of 50.1 (± 9.45) and average of 4.11 in the EDSS. The most common urinary symptom was urinary urgency (78%). There was no correlation between the severity of the urinary symptom and quality of life. Moderate and significant negative correlation (r = -0.561 p < 0.001) was found between depression and the physical component of quality of life and strong negative correlation (r = -0.729 p < 0.001) was found between depression and the mental component. Conclusions: The most prevalent urinary symptom was urinary urgency. A strong correlation was found between symptoms of depression and quality of life and there was no correlation between urinary symptoms and quality of life.