Mensuração da força muscular dos extensores do tronco em diferentes velocidades angulares no dinamômetro isocinético em uma pessoa após traumatismo crânio encefálico: relato de caso / Muscle strength of trunk extensors measurement in different angular velocity in an isokinetic dynamometer an individual post traumatic brain injury: case report

Objetivo: Avaliar a velocidade de movimento de extensão do tronco, em três fases angulares, dentro do intervalo de movimento de 15 graus por segundo (º/s) a 60º/s, em uma pessoa com dupla hemiparesia, após traumatismo crânio encefálico. Métodos: A amostra foi composta por um participante do sexo masculino, idade 18 anos, com dupla hemiparesia predominante à direita, limitação de amplitude de movimento de quadril e joelho direito após TCE causado por acidente automobilístico. A força muscular dos extensores do tronco foi verificada por meio da avaliação isocinética, em um dinamômetro da marca Cybex® modelo 6000. O programa de treinamento isocinético foi realizado duas vezes por semana, em sessões de 60 minutos, durante 35 semanas no Serviço de Condicionamento Físico - IMREA HCFMUSP, unidade Vila Mariana, São Paulo / SP. Resultados: Após 10 sessões, o pico do torque apresentou aumento de 193,0% e 160,0% na força muscular concêntrica dos extensores do tronco realizada em velocidade angular de 15 e 30 graus por segundo respectivamente e, após 70 sessões, a melhora apresentada foi de 102% para velocidade angular de 60 graus por segundo. Conclusão: O treinamento isocinético pode contribuir para melhora da força muscular dos extensores do tronco de um adulto jovem com sequela neurológica após traumatismo crânio-encefálico, contribuindo para melhora do equilíbrio, diminuição de dores e de riscos de futuras lesões musculoesqueléticas.

Objective: The objective of this study was to evaluate the velocity of trunk extension movement, in three angular phases, within the range of 15 degrees per second (º/s) at 60º/s, in a person with double hemiparesis after traumatic brain injury. Methods: The sample consisted of a male participant, 18 years old, with predominant right hemiparesis, limitation of range of motion of the hip and right knee after TBI caused by automobile accident. The muscle strength of the trunk extensors was verified by isokinetic evaluation in a Cybex® model 6000 dynamometer. The isokinetic training program was performed twice a week, in 60-minute sessions, for 35 weeks. Results: After 10 sessions, the peak torque increase 193.0% and 160.0% in the concentric muscle strength of the trunk extensors performed at angular velocity of 15 and 30 degree per second respectively and, after 70 sessions, the improvement presented was 102% for angular velocity of 60 degree per second. Conclusion: Isokinetic training may contribute to the improvement of the muscular strength of the trunk extensors of a young adult with a neurological sequel after traumatic brain injury, and contributes to an improvement in balance, a decrease in pain and risk of future musculoskeletal injuries.

The Brief Kinesthesia test is feasible and sensitive: a study in stroke

BACKGROUND: Clinicians lack a quantitative measure of kinesthetic sense, an important contributor to sensorimotor control of the hand and arm. OBJECTIVES: The objective here was to determine the feasibility of administering the Brief Kinesthesia Test (BKT) and begin to validate it by 1) reporting BKT scores from persons with chronic stroke and a healthy comparison group and 2) examining the relationship between the BKT scores and other valid sensory and motor measures. METHOD: Adults with stroke and mild to moderate hemiparesis (N=12) and an age-, gender-, and handedness-matched healthy comparison group (N=12) completed the BKT by reproducing three targeted reaching movements per hand with vision occluded. OTHER MEASURES: the Hand Active Sensation Test (HASTe), Touch-Test(tm) monofilament aesthesiometer, 6-item Wolf Motor Function Test (Wolf), the Motor Activity Log (MAL), and the Box and Blocks Test (BBT). A paired t-test compared BKT scores between groups. Pearson product-moment correlation coefficients assessed the relationship between BKT scores and other measures. RESULTS: Post-stroke participants performed more poorly on the BKT than comparison participants with their contralesional and ipsilesional upper extremity. The mean difference for the contralesional upper extremity was 3.7 cm (SE=1.1, t=3.34; p<0.008). The BKT score for the contralesional limb was strongly correlated with the MAL-how much (r=0.84, p=0.001), the MAL-how well (r=0.76, p=0.007), Wolf (r=0.69, p=0.02), and the BBT (r=0.77, p=0.006). CONCLUSIONS: The BKT was feasible to administer and sensitive to differences in reaching accuracy between persons with stroke and a comparison group. With further refinement, The BKT may become a valuable clinical measure of post-stroke kinesthetic impairment.

Sensory deficits in ipsilesional upper-extremity in chronic stroke patients / Déficit sensorial na extremidade superior ipsilateral em pacientes com ave crônico

Objective To investigate somatosensory deficits in the ipsilesional wrist and hand in chronic stroke patients and correlate these deficits with contralesional sensorimotor dysfunctions, functional testing, laterality and handedness.Methods Fifty subjects (twenty-two healthy volunteers and twenty-eight stroke patients) underwent evaluation with Semmes-Weinstein monofilaments, the sensory and motor Fugl-Meyer Assessment, the Nottingham Sensory Assessment in both wrists and hands and functional tests.Results Twenty-five patients had sensory changes in the wrist and hand contralateral to the stroke, and eighteen patients (64%) had sensory deficits in the ipsilesional wrist and hand. The most significant ipsilesional sensory loss was observed in the left-handed patients. We found that the patients with brain damage in the right hemisphere had better scores for ipsilesional tactile sensation.Conclusions A reduction in ipsilesional conscious proprioception, tactile or thermal sensation was found in stroke subjects. Right hemisphere damage and right-handed subjects had better scores in ipsilesional tactile sensation.

Objetivo Investigar déficits somatossensoriais no punho e mão ipsilesional em pacientes com acidente vascular encefálico (AVE) crônico e correlacionar esses déficits com disfunções sensório-motoras contralesional, testes funcionais, lateralidade e preferência manual.Métodos Cinquenta indivíduos (vinte e dois voluntários saudáveis e vinte e oito pacientes com AVE) foram submetidos à avaliação com monofilamentos de Semmes-Weinstein, Avaliação Fugl-Meyer (sensorial e motora), Avaliação Sensorial Nottingham em punhos e mãos, e testes funcionais.Resultados Vinte e cinco pacientes apresentaram alterações sensoriais no punho e mão contralateral ao AVE, e dezoito pacientes (64%) apresentaram déficits sensoriais no punho e mão ipsilesional. A perda sensorial ipsilesional mais significativa foi observada nos pacientes canhotos. Pacientes com lesão cerebral no hemisfério direito tiveram melhores pontuações para sensação tátil ipsilesional.Conclusões A redução da propriocepção consciente ipsilesional, da sensibilidade tátil e térmica foi encontrada em indivíduos com AVE. Lesão no hemisfério direito e indivíduos destros apresentaram melhores pontuações na sensação tátil ipsilesional.

Yesos seriados en niños con parálisis cerebral espástica con pie y marcha en equino previamente infiltrados con toxina botulínica tipo A: estudio de 8 casos / Serial casts in children with spastic cerebral palsy and equinus foot previously treated with botulinum toxin type A: study of 8 cases

Introducción: Los yesos seriados son una estrategia de tratamiento para prevenir, corregir o disminuir alteraciones del pie equino, sin embargo, los resultados no son concluyentes cuando se usan combinados con toxina botulínica para mejorar funcionalidad. Objetivo: Evaluar los efectos de yesos seriados en el rango de movimiento (ROM) de tobillo y en la función motora gruesa, de pacientes con parálisis cerebral (PC) espástica ingresados al programa de yesos seriados del Instituto Teletón (IT) Coquimbo, entre junio y septiembre de 2014. Método: Se evaluó el ROM de tobillo mediante test de Silfverskiold y el control motor selectivo (CMS) acorde al protocolo de yesos seriados del IT Coquimbo en 8 niños con PC espástica, Gross Motor Function Classification System (GMFCS) I, infiltrados con toxina botulínica tipo A, en dosis 3U por kg/peso. Anterior al primer yeso y una semana posterior a la última aplicación, fueron evaluados en la función motora gruesa con Gross Motor Function Measure-66 (GMFM-66) en sus dimensiones D y E. Se utilizó test de Wilcoxon para comparar las medianas de las diferencias de los puntajes de las pruebas aplicadas. Se consideró un valor p < 0,05 como estadísticamente significativo. Resultados: Los 8 niños presentaron mejoría significativa en el ROM de tobillo con rodilla en extensión (p = 0,011), con rodilla en flexión (p = 0,011), en la GMFM-66 (p = 0,034) y GMFM-66-D (p = 0,038) de la misma evaluación. La dimensión E no presentó una variación estadísticamente significativa. Conclusión: La terapia con yesos seriados en pacientes con PC espástica, GMFCS I previamente infiltrados con toxina botulínica tipo A, produce incremento en el ROM de tobillo y en GMFM-66-D.

Introduction: Serial casting is a treatment strategy to prevent, correct or reduce alterations of equinus foot; however, the results are not conclusive when used in combination with botulinum toxin to improve function. Objective: To evaluate the effects of serial casting on the range of motion (ROM) of the ankle, and the gross motor function of patients with spastic cerebral palsy (CP) admitted into the serial casting program at Coquimbo Telethon Institute between June and September 2014. Method: The ROM of the ankle was evaluated using the Silfverskiold Test and the selective motor control (CMS), according to the serial casting program at Coquimbo Telethon Institute in 8 children with spastic CP, Gross Motor Function Classification System (GMFCS) level I, and injected with botulinum toxin type A, at a dose of 3U per kg of body weight. Children were evaluated before the first cast and after the last one with the Gross Motor Function Measure, version 66 (GMFM-66), dimensions D and E. Wilcoxon test was used to compare the medians of the differences in all the tests applied. A p-value < 0.05 was considered statistically significant. Results: All children showed significant improvement in ROM of the ankle with extended knee (p = 0.011), and flexed knee (p = 0.011). Similarly, all children showed significant improvement in the GMFM-66 (p = 0.034) and GMFM-66-D (p = 0.038). The GMFM- E did not show significant changes. Conclusion: Serial casting in patients with spastic CP, GMFCS I and previously injected with botulinum toxin type A improved ROM of the ankle and the GMFM-D.

Content validation of a clinical assessment instrument for stair ascent and descent in individuals with hemiparesis / Validação de conteúdo do instrumento de avaliação clínica da subida e descida de escadas em indivíduos com hemiparesia

Background: Among the current instruments used to assess stair ambulation, none were observed that specifically evaluated the quality of movement or biomechanical strategies adopted by stroke patients. Objective: To evaluate the content validity of a clinical instrument designed to identify the qualitative and kinematic characteristics and strategies adopted by stroke patients during stair ascent and descent. Method: The first developed version, which comprised 80 items, had its content evaluated by an expert panel, which was composed of 9 well-known national and international professionals who are involved in stroke rehabilitation. The content validity index (CVI) and modified Kappa coefficients were employed for the statistical analyses. The items that demonstrated a CVI≥0.80 and Kappa≥0.75 were considered valid. Results: The content validation was performed in three stages. The final version of the instrument consisted of 38 items, which were divided into descriptive (8 items), a General Characteristics Domain (16 items) and adopted strategies (14 items) during stair ascent and descent. The total scores ranged from zero to 70 and zero to 74 for ascent and descent, respectively. Lower scores corresponded with better performance. Conclusion: Despite the satisfactory results obtained during the process of content validation, other psychometric properties of the instrument are necessary and must be evaluated. .

Contextualização: Dentre os instrumentos existentes que avaliam a subida e descida de escadas, não foi encontrado nenhum específico sobre a qualidade de movimento e as estratégias biomecânicas adotadas por indivíduos com hemiparesia devido ao Acidente Vascular Encefálico (AVE). Objetivo: Avaliar a validade de conteúdo do instrumento de avaliação das características cinemáticas qualitativas e das estratégias adotadas na subida e descida de escadas por indivíduos com hemiparesia devido ao AVE. Metódo: A primeira versão do instrumento foi desenvolvida com um total de 80 itens e foi submetida a um comitê constituído por oito especialistas nacionais e internacionais para validação de conteúdo. A análise estatística foi realizada por meio do Índice de Validade de Conteúdo (IVC) e do Coeficiente Kappa Modificado, sendo considerados válidos os itens que apresentaram IVC≥0,80 e Kappa≥0,75. Resultados: Foram realizadas três etapas de validação de conteúdo, e a versão final do instrumento apresenta 38 itens divididos em Itens Descritivos (oito itens), Domínio de Características Gerais da Subida e Descida de Escadas (16 itens) e Domínio de Estratégias Adotadas para Subida e Descida de Escadas (14 itens). O escore total para a subida de escada pode variar entre 0 e 70 pontos e, para a descida, entre 0 e 74 pontos. A pontuação mínima corresponde ao melhor desempenho, e a máxima, ao pior desempenho no teste. Conclusão: Apesar dos resultados satisfatórios obtidos no processo de validação de conteúdo, as demais propriedades psicométricas devem e serão mensuradas futuramente. .

Eficacia de la terapia restrictiva sobre funcionalidad de la extremidad superior en niños de 3 a 8 años con parálisis cerebral hemiparética: un ensayo clínico experimental / Efficacy of constraint-induced movement therapy on upper limb function in children with hemiparetic cerebral palsy from 3 to 8 years old. A pilot randomized clinical trial

Introducción: Los niños con hemiparesia presentan disminución de habilidades motrices y funcionales de la extremidad afectada, con escasa integración de ésta en actividades cotidianas; la terapia restrictiva ha sido escasamente estudiada en la realidad nacional. Objetivo: Evaluar eficacia de terapia restrictiva con yeso y terapia restrictiva más infiltración de onabotulinumtoxinA (Botox®), en funcionalidad de extremidad superior parética, en niños de 3-8 años de edad, con hemiparesia y compromiso funcional leve o moderado del Instituto Teletón Valparaíso-Chile. Método: Estudio experimental, controlado, aleatorio, simple ciego en 42 pacientes con consentimiento informado. Se distribuyen en tres grupos: sólo terapia convencional (control); con terapia convencional más restricción de extremidad indemne con yeso y terapia convencional con restricción de extremidad indemne con yeso más infiltración de onabotulinumtoxinA. Concluyen el estudio 29 niños, sometidos a tratamiento durante 6 semanas, con 3 sesiones semanales de 45 min cada una. Un terapeuta ocupacional ciego al grupo de pertenencia del paciente, evalúa calidad de movimiento (prueba Quest), actividades de la vida diaria (WeeFIM) y posicionamiento del pulgar (prueba House) al inicio, final del tratamiento y seguimiento en 3 meses. Resultados: Dentro de los grupos experimentales, las medianas de las pruebas WeeFIM y Quest, disminuyen al término del tratamiento y al seguimiento en relación al momento basal. La prueba House no cambia durante el proceso. No se registran diferencias significativas respecto del grupo control. Conclusión: No se comprueba mejoría de funcionalidad motriz de la extremidad superior parética y nivel de independencia en las AVD, con terapia restrictiva y adicionada con onabotulinumtoxina .

Introduction: Children with hemiparetic cerebral palsy show decreased motor and functional skills of their paretic extremity, along with scarce integration of it in daily activities. Constraint-induced movement therapy has been scantily studied in our country. Objective: To assess the effectiveness of plaster constraint-induced movement therapy alone and plaster constraint-induced movement therapy plus a onabotulinumtoxinA (Botox®) infiltration, on paretic upper limb function, in children from 3 to 8 years old, with hemiparetic cerebral palsy, and mild or moderate functional impairment, all patients at Valparaíso’s Teleton Institute in Chile. Method: An experimental, controlled, randomized and simple blind clinical trial was conducted with 42 patients who were distributed into three groups: only conventional therapy (control); conventional therapy with plaster constraint of undamaged upper extremity; and conventional therapy with plaster constraint of undamaged upper extremity plus a onabotulinum toxin A (Botox) infiltration.The protocol was completed by 29 children who participated during 6 weeks of treatment, with three 45 minutes sessions each week. A blind occupational therapist assessed quality of movement (QUEST), daily live activities (WEE FIM) and position of thumb at onset and end of treatment; and at 3 months follow-up. Results: WEE FIM and QUEST median scores for the experimental groups declined by the end of treatment and at follow-up, when compared to baseline measures. HOUSE test results showed no improvement either. No differences between control and experimental groups were observed. Conclusion: Motor functionality improvement of hemiparetic upper extremity and level of independence in daily activities, was not demonstrated for plaster constraint induced movement therapy alone or with infiltration of onabotulinumtoxinA (Botox).

Reliability of the Balance Evaluation Systems Test (BESTest) and BESTest sections for adults with hemiparesis

BACKGROUND: The Balance Evaluation Systems Test (BESTest) was recently created to allow the development of treatments according to the specific balance system affected in each patient. The Brazilian version of the BESTest has not been specifically tested after stroke. OBJECTIVE: To evaluate the intra- and inter-rater reliability and concurrent and convergent validity of the total score of the BESTest and BESTest sections for adults with hemiparesis after stroke. METHOD: The study included 16 subjects (61.1±7.5 years) with chronic hemiparesis (54.5±43.5 months after stroke). The BESTest was administered by two raters in the same week and one of the raters repeated the test after a one-week interval. Intraclass correlation coefficient (ICC) was calculated to assess intra- and interrater reliability. Concurrent validity with the Berg Balance Scale (BBS) and convergent validity with the Activities-specific Balance Confidence scale (ABC-Brazil) were assessed using Pearson's correlation coefficient. RESULTS: Both the BESTest total score (ICC=0.98) and the BESTest sections (ICC between 0.85 and 0.96) have excellent intrarater reliability. Interrater reliability for the total score was excellent (ICC=0.93) and, for the sections, it ranged between 0.71 and 0.94. The correlation coefficient between the BESTest and the BBS and ABC-Brazil were 0.78 and 0.59, respectively. CONCLUSIONS: The Brazilian version of the BESTest demonstrated adequate reliability when measured by sections and could identify what balance system was affected in patients after stroke. Concurrent validity was excellent with the BBS total score and good to excellent with the sections. The total scores but not the sections present adequate convergent validity with the ABC-Brazil. However, other psychometric properties should be further investigated. .

Strength deficit of knee flexors is dependent on hip position in adults with chronic hemiparesis

BACKGROUND: The extent to which muscle length affects force production in paretic lower limb muscles after stroke in comparison to controls has not been established. OBJECTIVES: To investigate knee flexor strength deficits dependent on hip joint position in adults with hemiparesis and compare with healthy controls. METHOD: a cross-sectional study with ten subjects with chronic (63±40 months) hemiparesis with mild to moderate lower limb paresis (Fugl-Meyer score 26±3) and 10 neurologically healthy controls. Isometric knee flexion strength with the hip positioned at 90° and 0° of flexion was assessed randomly on the paretic and non-paretic side of hemiparetic subjects and healthy controls. Subjects were asked to perform a maximal isometric contraction sustained for four seconds and measured by a dynamometer. The ratio of knee flexor strength between these two hip positions was calculated: Hip 0°/Hip 90°. Also, locomotor capacity was evaluated by the timed up and go test and by walking velocity over 10 meters. RESULTS: In subjects with hemiparesis, absolute knee flexion torque decreased (p<0.001) with the hip in extension (at 0°). The ratio of knee flexor torque Hip 0°/Hip 90° on the paretic side in hemiparetics was lower than in controls (p=0.02). CONCLUSIONS: Weakness dependent on joint position is more significant in the paretic lower limb of adults with hemiparesis when compared to controls. More attention should be given to lower limb muscle strengthening exercises in individuals with stroke, with emphasis on the strengthening exercises in positions in which the muscle is shortened.

Estimulação elétrica funcional na recuperação do membro superior de hemiparéticos após acidente vascular encefálico / Functional electrical stimulation in upper extremity recovery of hemiparetic patients after stroke

A reabilitação do membro superior de pacientes hemiparéticos por Acidente Vascular Encefálico (AVE) é um grande desafio. Dentre os recursos terapêuticos utilizados, a Estimulação Elétrica Funcional (EEF) tem sido um recurso bastante explorado nos programas de tratamento desses pacientes. Objetivo: Avaliar os efeitos da EEF nos extensores de punho e dedos numa tarefa especifica (TE). Método: Foi realizado um estudo pré-experimental (pré e pós-testes) com oito pacientes crônicos com idade média de 63,4±6,1 anos. Os parâmetros de avaliação foram a motricidade da mão através da Escala de Movimentos da Mão (EMM), a força de preensão pela Dinamometria (Din), a destreza do membro superior pelos testes de Caixa e Blocos (CB) e dos 9 Pinos e Buracos (9PB), a espasticidade pela Escala de Ashworth Modificada (EAM) e a independência funcional pelo Índice de Barthel (IB). A TE era realizar o movimento de alcance e preensão de garrafas plásticas de diferentes tamanhos com o membro superior afetado em diferentes combinações de posições, num total máximo de 54 repetições por sessão. A EEF era usada para auxiliar a mão para pegar e soltar o objeto durante a TE. Foram realizadas em média 20 sessões com frequência de 2 x/semana. Resultados: Demonstraram melhora em todos os parâmetros avaliados, a diferença foi estatisticamente significativa nos testes, exceto para a Din. Conclusão: No grupo estudado, a EEF na TE proposta resultou em melhora o desempenho na função do membro superior dos pacientes submetidos ao tratamento.

The rehabilitation of the upper limb of hemiparetic patients by Stroke is a major challenge. Among the various therapeutic resources used, functional electrical stimulation (FES) has been a popular avenue explored in treatment programs for these patients. Objective: To evaluate the effects of FES on wrist and finger extensors in a specific task (ST). Methods: We conducted a pre-experimental study (pre and post-tests) with eight chronic patients with a mean age of 63.4 years (±6.1). The evaluation parameters were for manual mobility by the Hand Movement Scale (EMM), grip strength by dynamometry (Din), dexterity of the upper limb by the Box and Blocks test (CB) and the 9-Pin and Holes test (9PB), spasticity by the Modified Ashworth Scale (MAS), and functional independence by the Barthel Index (BI). The ST chosen was performing the movement of reaching and grasping plastic bottles of different sizes with the affected upper limb in different combinations of positions for a total maximum of 54 repetitions per session. FES was used to assist the hand in grabbing and holding the object during the ST. There was a mean of 20 sessions with attendance twice a week. Results: The results showed improvement in all parameters, the difference was statistically significant in all the tests, except for Din. Conclusion: In this sample, FES in the proposed ST resulted in improved performance in the upper limb function of patients undergoing treatment.

Immediate effects of TENS and cryotherapy in the reflex excitability and voluntary activity in hemiparetic subjects: a randomized crossover trial / Efeitos imediatos da TENS e crioterapia na excitabilidade reflexa e atividade voluntária de sujeitos hemiparéticos: um estudo controlado aleatorizado cruzado

BACKGROUND: The disorder of reflex and motor function in patients affected by stroke causes negative impact on the performance of movement patterns and affects the functional activities. OBJECTIVES: To investigate the immediate effects of transcutaneous electrical nerve stimulation (TENS) and cryotherapy interventions on the spinal reflex excitability and in the voluntary electromyography (EMG) activity in people with chronic stroke. METHOD: Randomized crossover trial. The maximum H-reflex (Hmax), the H-reflex latency and the maximum motor response (Mmax) of the soleus muscle and also the EMG of the tibialis muscle where evaluated before and after the application of TENS, cryotherapy and control conditions. RESULTS: The Hmax/Mmax ratio was statistically significant higher (p=0.0245) and the H-reflex latency was statistically significant lower (p=0.0375) in the soleus muscle of the affected limb. The EMG amplitude of the tibialis anterior was reduced in the compromised limb (p<0.0001). After the use of the TENS, a reduction in the Hmax/Mmax ratio (p=0.0006) was observed leading to lower reflex excitability. However, after the cryotherapy intervention an increase of the Hmax/Mmax ratio was observed, which was accompanied by an increase in the H-reflex latency (p=0.0001). The EMG amplitude has not changed by any of the interventions. CONCLUSIONS: Our findings suggest that TENS may be a choice for immediate reduction of reflex excitability, whereas cryotherapy intervention may increase reflex excitability in hemiparetic subjects. However, none of the changes mediated by either intervention were able to modify the electrical activity in the antagonist muscle of the spastic muscle.

CONTEXTUALIZAÇÃO: O distúrbio da função motora e reflexa em pacientes acometidos por acidente vascular encefálico (AVE) causa impactos negativos na realização de padrões motores, comprometendo as atividades funcionais. OBJETIVOS: Investigar os efeitos imediatos da estimulação elétrica nervosa transcutânea (TENS) e da crioterapia na excitabilidade reflexa e na atividade voluntária de sujeitos vítimas de AVE. MÉTODO: Estudo Crossover. O reflexo H máximo (Hmáx), a latência do reflexo H e a resposta motora máxima (Mmáx) do músculo solear e a eletromiografia (EMG) do músculo tibial anterior foram avaliados antes e após a aplicação de TENS, crioterapia e em condições de controle. RESULTADOS: A razão Hmáx/Mmáx estava significativamente aumentada (p=0,0245) e a latência do reflexo H significativamente diminuída (p=0,0375) no músculo solear do membro afetado. A amplitude do sinal EMG do músculo estava significativamente reduzida no membro comprometido (p<0,0001). Depois da TENS, houve uma diminuição da razão Hmáx/Mmáx (p=0,0006). Porém, após a aplicação do gelo, houve um aumento da razão Hmáx/Mmáx, acompanhado por um aumento da latência do reflexo H (p=0,0001). A amplitude do sinal EMG não foi alterada por nenhuma das intervenções. CONCLUSÕES: Nossos achados indicam que a TENS pode ser uma escolha para redução imediata da excitabilidade reflexa, enquanto a crioterapia pode aumentar a excitabilidade reflexa de sujeitos hemiparéticos. No entanto, nenhuma das alterações mediadas por qualquer um dos tratamentos foi capaz de alterar a atividade elétrica do músculo antagonista ao espástico.

Three-dimensional kinematic analysis of upper and lower limb motion during gait of post-stroke patients

The aim of this study was to analyze the alterations of arm and leg movements of patients during stroke gait. Joint angles of upper and lower limbs and spatiotemporal variables were evaluated in two groups: hemiparetic group (HG, 14 hemiparetic men, 53 ± 10 years) and control group (CG, 7 able-bodied men, 50 ± 4 years). The statistical analysis was based on the following comparisons (P ≤ 0.05): 1) right versus left sides of CG; 2) affected (AF) versus unaffected (UF) sides of HG; 3) CG versus both the affected and unaffected sides of HG, and 4) an intracycle comparison of the kinematic continuous angular variables between HG and CG. This study showed that the affected upper limb motion in stroke gait was characterized by a decreased range of motion of the glenohumeral (HG: 6.3 ± 4.5, CG: 20.1 ± 8.2) and elbow joints (AF: 8.4 ± 4.4, UF: 15.6 ± 7.6) on the sagittal plane and elbow joint flexion throughout the cycle (AF: 68.2 ± 0.4, CG: 46.8 ± 2.7). The glenohumeral joint presented a higher abduction angle (AF: 14.2 ± 1.6, CG: 11.5 ± 4.0) and a lower external rotation throughout the cycle (AF: 4.6 ± 1.2, CG: 22.0 ± 3.0). The lower limbs showed typical alterations of the stroke gait patterns. Thus, the changes in upper and lower limb motion of stroke gait were identified. The description of upper limb motion in stroke gait is new and complements gait analysis.

Different instructions during the ten-meter walking test determined significant increases in maximum gait speed in individuals with chronic hemiparesis / Diferentes instruções durante teste de velocidade de marcha determinam aumento significativo na velocidade máxima de indivíduos com hemiparesia crônica

OBJECTIVE: To evaluate the effects of different instructions for the assessment of maximum walking speed during the ten-meter walking test with chronic stroke subjects. METHODS: Participants were instructed to walk under four experimental conditions: (1) comfortable speed, (2) maximum speed (simple verbal command), (3) maximum speed (modified verbal command-"catch a bus") and (4) maximum speed (verbal command + demonstration). Participants walked three times in each condition and the mean time to cover the intermediate 10 meters of a 14-meter corridor was registered to calculate the gait speed (m/s). Repeated-measures ANOVAs, followed by planned contrasts, were employed to investigate differences between the conditions (α=5%). Means, standard deviations and 95% confidence intervals (CI) were calculated. RESULTS: The mean values for the four conditions were: (1) 0.74m/s; (2) 0.85 m/s; (3) 0.93 m/s; (4) 0.92 m/s, respectively, with significant differences between the conditions (F=40.9; p<0.001). Comfortable speed was significantly slower than the maximum speed, indicating that the participants were able to increase speeds when required. Significant differences were observed between the second condition with the third (p=0.002; 95%CI=-0.13 to -0.03) and the fourth conditions (p=0.004; 95%CI=-0.12 to -0.02) with no differences between the third and fourth conditions (p=1.00; 95%CI=-0.04 to 0.05). CONCLUSIONS: The results indicated that simple verbal commands were not sufficient to capture maximum gait speed with chronic stroke subjects. Thus, for clinical assessments and research purposes, where measurements of the maximum gait speed are necessary, modified verbal commands or demonstration strategies could be employed by physical therapists to ensure acurate information.

OBJETIVO: Avaliar os efeitos de diferentes instruções para avaliação da velocidade de marcha máxima de indivíduos hemiparéticos durante o teste de caminhada de 10 metros. MÉTODOS: Os indivíduos deambularam em quatro condições experimentais: (1) velocidade habitual, (2) velocidade máxima (comando verbal simples), (3) velocidade máxima (comando verbal modificado: pegar ônibus), (4) velocidade máxima (comando verbal + demonstração). Solicitou-se a cada participante que deambulasse três vezes em cada condição, e a média do tempo necessário para percorrer os 10 metros intermediários de um corredor de 14 metros foi utilizada para cálculo da velocidade (m/s). A ANOVA de medidas repetidas, com contrastes pré-planejados, foi utilizada para comparação dos dados (α=5%), sendo apresentados valores de média, desvio-padrão e intervalos de confiança (IC) de 95%. RESULTADOS: As médias de velocidade para as quatro condições foram: (1) 0,74m/s; (2) 0,85m/s; (3) 0,93m/s; (4) 0,92m/s, respectivamente, apresentando diferenças significativas entre as condições (F=40,9; p<0,001). A velocidade de marcha habitual diferiu das demais condições, indicando que os indivíduos foram capazes de aumentar a velocidade quando solicitados. Foram observadas diferenças significativas entre a segunda condição, a terceira (p=0,002; IC95%=-0,13 a -0,03) e a quarta (p=0,004; IC95%=-0,12 a -0,02), sendo que as duas últimas condições não diferiram entre si (p=1,00; IC95%=-0,04 a 0,05). CONCLUSÕES: Os resultados indicaram que comandos verbais simples não foram suficientes para captar velocidade de marcha máxima em indivíduos com hemiparesia crônica. Assim, em situações em que seja necessária a avaliação de velocidade máxima, deve-se utilizar estratégia de comando verbal modificada ou associada à demonstração para garantir acurácia da informação.

Correlations between motor and sensory functions in upper limb chronic hemiparetics after stroke / Correlações entre função motora e sensorial do membro superior de hemiparéticos crônicos pós-acidente vascular encefálico

OBJECTIVE: Describe the somatosensory function of the affected upper limb of hemiparetic stroke patients and investigate the correlations between measurements of motor and sensory functions in tasks with and without visual deprivation. METHOD: We applied the Fugl-Meyer Assessment (FMA), Nottingham Sensory Assessment (NSA), and several motor and sensory tests: Paper manipulation (PM), Motor Sequences (MS), Reaching and grasping (RG) Tests Functional (TF), Tactile Discrimination (TD), Weight Discrimination (WD) and Tactile Recognition of Objects (RO). RESULTS: We found moderate correlations between the FMA motor subscale and the tactile sensation score of the NSA. Additionally, the FMA sensitivity was correlated with the NSA total; and performance on the WD test items correlated with the NSA. CONCLUSION: There was a correlation between the sensory and motor functions of the upper limb in chronic hemiparetic stroke patients. Additionally, there was a greater reliance on visual information to compensate for lost sensory-motor skills.

OBJETIVO: Descrever a função somatossensorial do membro superior afetado de hemiparéticos crônicos após acidente vascular encefálico (AVE) e verificar as correlações entre instrumentos de medida da função motora e sensorial em tarefas com e sem privação visual. MÉTODO: Aplicados o Protocolo de Desempenho Físico de Fugl-Meyer (FMA), Avaliação Sensorial de Nottingham (ASN), e os testes de: Manipulação de Papel (MP), Sequência Motora (SM), Alcance e Preensão (AP), Testes Funcionais (TF), Discriminação Tátil (DT), Discriminação de Peso (DP) e Reconhecimento Tátil de Objetos (RO). RESULTADOS: Foram encontradas correlações moderadas entre a FMA motora e itens da subescala sensação tátil da ASN; a FMA sensibilidade correlacionou-se a ASN total; e o teste DP se correlacionou com itens da ANS. CONCLUSÃO: Houve correlação entre a função sensorial e motora do membro superior em pacientes hemiparéticos crônicos pós- AVE; e maior dependência das informações visuais para compensar a perda sensório-motora.

Confiabilidade da versão brasileira do Wolf Motor Function Test em adultos com hemiparesia / Reliability of the brazilian version of the Wolf Motor Function Test in adults with hemiparesis

CONTEXTUALIZAÇÃO: O Wolf Motor Function Test (WMFT) avalia o membro superior (MS) de adultos com hemiparesia combinando medidas de tempo e qualidade de movimento em movimentos isolados e em tarefas funcionais. OBJETIVOS: Traduzir e adaptar para a língua portuguesa o formulário, a escala de habilidade funcional (EHF) e o manual de aplicação do WMFT e avaliar a confiabilidade intra e inter-observadores. MÉTODOS: Participaram 15 indivíduos com média de idade de 57,9±11,1 anos e 68,5±53,5 meses pós acidente vascular encefálico (AVE). O WMFT foi aplicado por um fisioterapeuta utilizando as informações do manual e cotado por dois outros fisioterapeutas independentes pela observação dos vídeos. Foram acrescentadas informações mais detalhadas na EHF sobre a movimentação compensatória em relação à escala original. A confiabilidade intra e interobservadores do desempenho no tempo e da EHF dos itens individuais e do escore total foi avaliada pelo Coeficiente de Correlação Intraclasse (CCI) e pelo método Bland e Altman. Kappa ponderado (Kp) foi utilizado para avaliar a concordância intra e interobservadores da EHF. RESULTADOS: O CCI interobservador do desempenho no tempo foi >0,75 em 13 das 15 tarefas. A EHF apresentou CCI interobservador entre 0,87 e 0,99 em todas as tarefas e Kp entre 0,63 e 0,92. O CCI intraobservador do tempo variou entre 0,99 e 1 e na EHF, entre 0,96 e 1. O Kp intraobservador na EHF nas tarefas variou entre 0,79 e 0,96, sendo 0,93 para o escore total. CONCLUSÃO: A versão brasileira do WMFT demonstrou confiabilidade adequada para avaliar o MS parético pós-AVE.

BACKGROUND: The Wolf Motor Function Test (WMFT) evaluates the upper limb (UL) performance of adults with hemiparesis by combining time and quality of movement measures in both isolated movements and functional tasks. OBJECTIVES: To translate and adapt the WMFT form, functional ability scale (FAS) and manual to Brazilian Portuguese and evaluate the intra and inter-rater reliabilities. METHODS: Fifteen individuals with a mean age of 57.9±11.1 years and a mean time since stroke onset of 68.5±53.5 months participated. The WMFT was administered by one physiotherapist based on information in the manual, and video observations were assessed by two other independent physical therapists. Information regarding compensatory movements was included in the FAS. Intra-class correlation coefficients (ICCs) and Bland-Altman plots were calculated to examine the intra- and inter-rater reliabilities for performance time and FAS, whereas weighted kappa (Kp) was used to examine the agreement strength for FAS. RESULTS: The inter-rater ICC values for performance time were above 0.75 in 13 of the 15 tasks. For the FAS, they ranged from 0.87-0.99 for all evaluated tasks, with Kp values ranging from 0.63-0.92. For intra-rater reliability, the ICC ranged from 0.99-1.0 and from 0.96-1.0 for time measurement and FAS, respectively. Kp values ranged from 0.79-0.96 for individual and 0.93 for total scores. CONCLUSION: The Brazilian version of the WMFT showed adequate intra- and inter-rater reliabilities for evaluating the paretic UL of individuals with stroke.

Correlação do equilíbrio e funcionalidade no hemiparético - influencia da propriocepção / Correlation of balance and functionality in hemiparetic - influence of the proprioception

A manutenção do corpo em equilíbrio é um fenômeno complexo e dependente de múltiplos mecanismos. Esta função se faz possível com a interação do sistema nervoso central, sistema motor, sistema somatossensorial, vestibular e visual. O componente somatossensorial também se mostra importante na realização das atividades de vida diária do indivíduo. Após um Acidente Vascular Encefálico (AVE), o hemiparético pode apresentar alteracões nas componentes do equilíbrio. Assim, Esse trabalho teve por objetivo avaliar o equilíbrio, mobilidade e funcionalidade em hemiparéticos e correlacionar as alterações da componente somatossensorial do equilíbrio e as escalas de Berg, Barthel modificado e Rivermead. A amostra foi constituída por 10 pacientes hemiparéticos com idade entre 42 e 68 anos que foram avaliados por meio da Posturografia Dinâmica e dos testes de funcionalidade. Os resultados apontam influência somatossensorial positiva no equilíbrio e na funcionalidade do indivíduo, por meio da correlação entre as avaliações de funcionalidade do teste de Berg (p=0,0001) e Rivermead (p=0,0345). Já para o teste de Barthel modificado (p=0,0523) a correlação não foi significativa. A componente somatossensorial do equilíbrio apresentou correlação positiva com os Índices de Berg, Barthel Modificado e Rivermead, demonstrando a importância dessa componente frente aos desempenhos de mobilidade e funcionalidade nos indivíduos com hemiplegia.

The preservation of the body in balance is a complex and dependent phenomenon of multiple mechanisms. This functionality happens with the interaction of central nervous system, motor system, somatosensory system, vestibular and visual. The somatosensorial component is also important in the accomplishment of the daily activities of the individual. After a cerebrovascular accident (CVA), the hemiparetic can present alterations in the components of balance. Therefore, this research aimed to evaluate the balance, mobility and functionality in hemiparetic patients and to correlate the alterations of the component somatosensorial of the balance and the Berg Balance Scale, modified Barthel and Rivermead. The sample was constituted by 10 hemiplegic patients with age among 42 and 68 years old that were appraised through Dynamic Posturografia and of the functionality tests. The results indicate positive influences somatosensory in balance and functioning of the individual, through the correlation between assessments of functionality of the Berg test (p = 0.0001) and Rivermead (p = 0.0345). To test the modified Barthel (p = 0.0523) correlation was not significant. The somatosensory component balance has a positive correlation with the indices Berg, Modified Barthel and Rivermead, demonstrating the importance of this component front the performances of mobility and functionality in subjects with hemiplegia.

Tradução, adaptação e confiabilidade interexaminadores do manual de administração da escala de Fugl-Meyer / Translation, adaptation and inter-rater reliability of the administration manual for the Fugl-Meyer assessment

CONTEXTUALIZAÇÃO: Recentemente a confiabilidade da versão brasileira da Escala de Fugl-Meyer (EFM) foi avaliada pela pontuação dada pela observação de um único examinador que aplicou a escala. Quando diferentes examinadores aplicam a escala, a confiabilidade pode depender da interpretação dada à ficha de avaliação. Nesse caso, um manual de administração claro é fundamental para garantir homogeneidade na aplicação. OBJETIVOS: Traduzir e adaptar para o português-Brasil a versão do Manual de Administração em francês-canadense da EFM e avaliar a confiabilidade interexaminadores quando diferentes examinadores aplicam a EFM com base nas informações contidas no manual. MÉTODOS: Participaram do estudo 18 adultos (59±10 anos) com hemiparesia crônica (38±35 meses pós-Acidente Vascular Encefálico). Oito sujeitos participaram da primeira parte do estudo e dez, da segunda parte. Baseada na análise dos resultados da parte 1, desenvolveu-se uma versão adaptada à qual foram adicionadas informações e fotos para ilustrar a posição do paciente e do examinador. A confiabilidade interexaminadores foi avaliada com o Coeficiente de Correlação Intraclasse (CCI). RESULTADOS: A confiabilidade da EFM baseada na versão adaptada do manual foi excelente para o escore motor total do membro superior (MS, CCI=0,98) e membro inferior (MI, CCI=0,90), sentido de movimento (CCI=0,98), amplitude de movimento (ADM) passiva do MS (CCI=0,84) e do MI (CCI=0,90) e moderada para a sensibilidade tátil (0,75). A avaliação da dor articular apresentou baixa confiabilidade. CONCLUSÃO: Os resultados mostram que, com exceção da avaliação da dor, a aplicação da EFM com base na versão adaptada do manual de aplicação em português-Brasil apresenta adequada confiabilidade interexaminadores.

BACKGROUND: Recently, the reliability of the Brazilian version of the Fugl-Meyer Assessment (FMA) was assessed through the scoring given according to observations made by a single evaluator who applied the test. When different raters apply the scale, the reliability may depend on the interpretation given to the assessment sheet. In such cases, a clear administration manual is essential for ensuring homogeneity of application. OBJECTIVES: To translate and adapt the French Canadian version of the FMA administration manual into Brazilian Portuguese and to evaluate the inter-rater reliability when different evaluators apply the FMA on the basis of the information contained in the manual. METHODS: Eighteen adults (59±10 years) with chronic hemiparesis (38±35 months after a stroke) took part in this study. Eight patients participated in the first part of the study and 10 in the second part. Based on analyzing the results from part 1, an adapted version was developed, in which information and photos were added to illustrate the positions of the patient and evaluator. The inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). RESULTS: The reliability of the FMA based on the adapted version of the manual was excellent for the total motor scores for the upper limbs (ICC=0.98) and lower limbs (ICC=0.90), as well as for movement sense (ICC=0.98) and upper and lower-limb passive range of motion (ICC=0.84 and 0.90, respectively). The reliability was moderate for tactile sensitivity (0.75). The joint pain assessment presented low reliability. CONCLUSIONS: The results showed that, except for pain assessment, application of the FMA based on the adapted version of the application manual for Brazilian Portuguese presented adequate inter-rater reliability.

Avaliação da aptidão cardiopulmonar em indivíduos com hemiparesia após acidente vascular encefálico / Evaluation of cardiopulmonary fitness in individuals with hemiparesis after cerebrovascular accident / Evaluación de la aptitud cardiopulmonar en individuos con hemiparesia tras accidente vascular encefálico

FUNDAMENTO: Devido à hemiparesia, a avaliação da aptidão cardiorrespiratória de indivíduos após acidente vascular encefálico (AVE), por meio de testes ergométricos com protocolos convencionais, tem se tornado um desafio. OBJETIVO: Realizar teste cardiopulmonar (TCP) em hemiparéticos para uma avaliação pré-participação visando uma criteriosa prescrição de exercício aeróbico. MÉTODOS: Participaram do estudo 8 indivíduos com hemiparesia crônica, que foram submetidos a TCP realizado com protocolo individualizado em rampa, desenvolvido a partir da informação da velocidade de marcha dos indivíduos previamente avaliados em teste de pista. Foi considerada a proposta de inclinação variando entre 0 e 10,0 por cento, velocidade inicial correspondente a 70,0 por cento do ritmo de caminhada confortável e velocidade máxima 40,0 por cento superior à velocidade máxima no teste de pista, na expectativa de que o TCP, com este incremento gradativo e constante da intensidade, durasse entre 6 e 8 minutos. RESULTADOS: Em 100,0 por cento dos avaliados, o motivo para a interrupção do teste foi fadiga periférica. O VO2 de pico alcançado foi de 20,6 ± 5,7 ml/kg.min. O Limiar I foi identificado em todos os exames, situando-se em 82,64 ± 4,78 por cento da FC de pico e 73,31 ± 4,97 por cento do VO2 de pico. O quociente respiratório (R) do grupo foi de 0,96 ± 0,09, e três dos 8 indivíduos (37,5 por cento) atingiram R superior a 1,00, sendo o Limiar II identificado nestes sujeitos. Foram encontradas relações positivas entre variáveis do TCP e escores de equilíbrio, desempenho no teste de caminhada de 6 minutos e velocidade de marcha no solo. CONCLUSÃO: O teste mostrou ser útil para prescrição de atividade física nesses indivíduos.

BACKGROUND: Due to the hemiparesis, the assessment of cardiorespiratory fitness on individuals after cerebrovascular accident (CVA), using exercise tests with conventional protocols, has become a challenge. OBJECTIVE: Perform cardiopulmonary test (CPT) in hemiparetic patients to a pre-participation evaluation aimed at a careful prescription of aerobic exercise. METHODS: The study included eight individuals with chronic hemiparesis who underwent CPT performed with individualized ramp protocol, developed from information on the gait speed of individuals previously evaluated in the track test. We considered the proposal of inclination ranging from 0 to 10.0 percent, initial speed corresponding to 70.0 percent of comfortable walking speed rhythm and 40.0 percent higher than the maximum speed on the track test, expecting that the CPT with this gradual and steady increase in intensity, lasted from 6 to 8 minutes. RESULTS: In 100.0 percent of the sample, the reason for discontinuation was peripheral fatigue. The peak VO2 achieved was 20.6 ± 5.7 ml/kg.min. The threshold I was identified in all tests, standing at 82.64 ± 4.78 percent of peak HR and 73.31 ± 4.97 percent of peak VO2. The respiratory quotient (R) of the group was 0.96 ± 0.09, and three out of eight individuals (37.5 percent) reached R higher than 1.00, and the Threshold II was identified in these individuals. We found positive relationships between CPT variables and balance scores, performance in the 6-minute walking test and running speed on the ground. CONCLUSION: The test proved to be useful for prescribing physical activity in these individuals.

FUNDAMENTO: Debido a la hemiparesia, la evaluación de la aptitud cardiorrespiratoria de individuos después de accidente vascular encefálico (AVE), por medio de pruebas ergométricas con protocolos convencionales, se ha vuelto en un reto. OBJETIVO: Llevar a cabo prueba cardiopulmonar (PCP) en hemiparéticos para una evaluación pre participación que busca una criteriosa prescripción de ejercicio aeróbico. MÉTODOS: Participaron en el estudio 8 individuos con hemiparesia crónica, que se sometieron a PCP realizado con protocolo individualizado en rampa, desarrollado a partir de la información de la velocidad de marcha de los individuos previamente evaluados en prueba de pista. Se consideró como la propuesta de inclinación variando entre el 0 por ciento y el 10 por ciento, velocidad inicial correspondiente a un 70 por ciento del ritmo de caminata confortable y velocidad máxima el 40 por ciento superior a la velocidad máxima en la prueba de pista, en la expectativa de que el PCP, con este incremento gradual y constante de la intensidad, durase entre 6 y 8 minutos RESULTADOS: El 100 por ciento de los evaluados, la motivación para la interrupción de la prueba fue fatiga periférica. El VO2 de pico alcanzado fue de 20,6 ± 5,7 ml/kg.min. Se identificó el Umbral I en todos los exámenes, situándose en 82,64 ± 4,78 por ciento de la FC de pico y 73,31 ± 4,97 por ciento del VO2 de pico. El cociente respiratorio (R) del grupo fue de 0,96 ± 0,09, y tres de los 8 individuos (37,5 por ciento) alcanzaron R superior a 1,00, siendo el umbral II identificado en estos sujetos. Se encontraron relaciones positivas entre variables del PCP y scores de equilibrio, desempeño en la prueba de marcha de 6 minutos y velocidad de marcha en el suelo. CONCLUSIÓN: La prueba se reveló útil para prescripción de actividad física en estos individuos.

Abnormal sensory integration affects balance control in hemiparetic patients within the first year after stroke

OBJECTIVE: Impairments in balance can be a consequence of changes in the motor, sensory, and integrative aspects of motor control. Abnormal sensory reweighting, i.e., the ability to select the most appropriate sensory information to achieve postural stability, may contribute to balance impairment. The Sensory Organization Test is a component of Computerized Dynamic Posturography that evaluates the impact of visual, vestibular, and somatosensory inputs, as well as sensory reweighting, under conditions of sensory conflict. The aim of this study is to compare balance control in hemiparetic patients during the first year post-stroke and in age-matched neurologically normal subjects using the Berg Balance Scale and Computerized Dynamic Posturography. METHODS: We compared the Berg Balance Scale and Sensory Organization Test scores in 21 patients with hemiparesis after first-ever ischemic stroke and in 21 age-matched, neurologically normal subjects. An equilibrium score was defined for each Sensory Organization Test condition. RESULTS: Berg Balance Scale scores were significantly lower in the patients than in the neurologically normal subjects. Equilibrium scores were significantly lower in the patients than in the neurologically normal subjects for those Sensory Organization Test conditions that did not provide appropriate somatosensory information and under conditions of sensory conflict. A history of falls was more frequent in patients with lower equilibrium scores. CONCLUSION: During the first year after a stroke, defective sensory reweighting significantly impacts balance control in hemiparetic patients. These results are important for the planning of effective rehabilitation interventions.

Psychometric properties of the portuguese version of the Jebsen-Taylor test for adults with mild hemiparesis / Avaliação das propriedades pscicométricas da versão em português do teste de Jebsen Taylor para adultos com hemiparesia leve

OBJECTIVES: To evaluate the psychometric properties of the Portuguese version of the Jebsen-Taylor Test (JTT) in patients with stroke. METHODS: Forty participants who suffered a stroke in the cerebral hemisphere were videotaped while performing the JTT. Scores were defined by the time taken to perform the tasks, and two physical therapists evaluated the performance of the participants. Intra- and inter-rater reliability was defined by intraclass correlation coefficients (ICC) through videotape analysis. Cronbach's alpha and Pearson's correlation coefficient (r) were used to measure the internal consistency of the scale. Confidence intervals (CI) were calculated, and the influence of handedness and educational level on the JTT scores was evaluated. RESULTS: Inter-rater (ICC = 1.0; CI, 1.0-1.0) and intra-rater reliabilities (ICC=0.997; CI, 0.995-0.998) were excellent. Regarding internal consistency, Cronbach's α was 0.924. The item "writing a sentence" was less consistent than the other items (Cronbach's alpha=0.884). Pearson's r (item score - total score) was lower for the item "small objects" (r=0.657). There was no significant influence of handedness or educational level on the JTT scores. CONCLUSIONS: Videotaping test performances can be a useful tool in multicenter studies if inter-rater reliability is appropriate. The inter- and intra-rater reliabilities of the Portuguese version of the JTT were excellent in patients with stroke. The JTT can be a valuable tool for evaluating dexterity in research protocols aiming at efficacy of rehabilitation interventions.

OBJETIVOS: Avaliar as propriedades psicométricas da versão em Português do teste de Jebsen-Taylor (TJT) em pacientes com acidente vascular encefálico (AVE). MÉTODOS: Quarenta pacientes com AVEs em hemisférios cerebrais foram filmados enquanto realizaram o TJT. A pontuação no teste é definida pelo tempo de execução de tarefas motoras. Duas fisioterapeutas avaliaram o desempenho dos pacientes. Por meio das análises dos vídeos, foram determinadas as confiabilidades intra e interexaminador, pelos coeficientes de correlação intraclasse (CCI). O alfa de Crobach e o coeficiente de correlação de Pearson (r) foram utilizados para medir a consistência interna da escala. Foram avaliados os efeitos de dominância manual e escolaridade sobre a pontuação no TJT. RESULTADOS: Houve excelentes correlações interexaminador (CCI=1,0; intervalo de confiança, 1,0-1,0) e intraexaminador (CCI=0,997; intervalo de confiança, 0,995-0,998). Na avaliação da consistência interna, o alfa de Cronbach total foi 0,924. O item "escrever uma frase" teve consistência menor que os demais itens (Cronbach's alpha=0,884). O coeficiente de correlação de Pearson (item - total da escala) foi mais baixo para o item "objetos pequenos" (r=0,657). Não houve efeitos significativos de dominância manual ou escolaridade, sobre a pontuação no TJT. CONCLUSÕES: As confiabilidades interexaminador e intraexaminador foram excelentes, assim como a consistência interna da versão em Português do TJT em pacientes com AVE, avaliada por meio de vídeos. Essas são informações importantes para o planejamento de protocolos de reabilitação voltados para a melhora da função do membro superior em pacientes com AVE.

Correlação entre simetria corporal na descarga de peso e alcance funcional em hemiparéticos crônicos / Relationships between body symmetry during weight-bearing and functional reach among chronic hemiparetic patients

CONTEXTUALIZAÇÃO: O controle postural está frequentemente prejudicado nas condições de hemiparesias. Quando na posição em pé, sujeitos hemiparéticos oscilam mais do que sujeitos sem hemicorpo afetado, adotando posturas assimétricas com maior descarga de peso na perna não afetada. OBJETIVO: Analisar o alcance funcional e a dependência por dispositivo de apoio em hemiparéticos crônicos, verificando correlações entre deslocamentos de alcance funcional e valores de simetria de descarga de peso durante a posição em pé. MÉTODOS: Quatorze hemiparéticos classificados em dependentes ou independentes de dispositivo de apoio foram incluídos nos procedimentos experimentais para registro de deslocamento de alcance funcional e valores de simetria. RESULTADOS: Nenhuma diferença significativa foi obtida entre os dependentes e os independentes de dispositivo de apoio para todas as variáveis. Porém, quando a descarga de peso ocorreu no lado não afetado, os mais altos deslocamentos foram significativamente correlacionados com os hemiparéticos mais assimétricos. CONCLUSÃO: A simetria não favorece o alcance funcional nem a independência de dispositivo de apoio em hemiparéticos.

BACKGROUND: Postural control is often impaired in hemiparetic patients. During upright stance, hemiparetic subjects sway more than subjects with an unaffected hemibody, and they assume asymmetrical postures to place less weight on the affected side. OBJECTIVE: To analyze functional reach and dependence on support devices among people with chronic hemiparesis and to investigate the relationships between displacements of functional reach and weight-bearing symmetry during upright stance. METHODS: Fourteen participants with hemiparesis, classified as dependent on support devices or independent from them, were included in experimental procedures to record functional reach displacements and symmetry values. RESULTS: No significant differences were found between the dependent and independent participants for any variable. However, when weight-bearing occurred on the unaffected side, the greatest displacements were significantly correlated with the most asymmetrical hemiparetic participants. CONCLUSION: Symmetry did not contribute to functional reach or independence from support devices among participants with hemiparesis.