ABSTRACT
Background: We investigated the effects of brain-computer interface (BCI) combined with mental practice (MP) and occupational therapy (OT) on performance in activities of daily living (ADL) in stroke survivors. Methods: Participants were randomized into two groups: experimental (n = 23, BCI controlling a hand exoskeleton combined with MP and OT) and control (n = 21, OT). Subjects were assessed with the functional independence measure (FIM), motor activity log (MAL), amount of use (MAL-AOM), and quality of movement (MAL-QOM). The box and blocks test (BBT) and the Jebsen hand functional test (JHFT) were used for the primary outcome of performance in ADL, while the Fugl-Meyer Assessment was used for the secondary outcome. Exoskeleton activation and the degree of motor imagery (measured as event-related desynchronization) were assessed in the experimental group. For the BCI, the EEG electrodes were placed on the regions of FC3, C3, CP3, FC4, C4, and CP4, according to the international 10-20 EEG system. The exoskeleton was placed on the affected hand. MP was based on functional tasks. OT consisted of ADL training, muscle mobilization, reaching tasks, manipulation and prehension, mirror therapy, and high-frequency therapeutic vibration. The protocol lasted 1 h, five times a week, for 2 weeks. Results: There was a difference between baseline and post-intervention analysis for the experimental group in all evaluations: FIM (p = 0.001, d = 0.56), MAL-AOM (p = 0.001, d = 0.83), MAL-QOM (p = 0.006, d = 0.84), BBT (p = 0.004, d = 0.40), and JHFT (p = 0.001, d = 0.45). Within the experimental group, post-intervention improvements were detected in the degree of motor imagery (p < 0.001) and the amount of exoskeleton activations (p < 0.001). For the control group, differences were detected for MAL-AOM (p = 0.001, d = 0.72), MAL-QOM (p = 0.013, d = 0.50), and BBT (p = 0.005, d = 0.23). Notably, the effect sizes were larger for the experimental group. No differences were detected between groups at post-intervention. Conclusion: BCI combined with MP and OT is a promising tool for promoting sensorimotor recovery of the upper limb and functional independence in subacute post-stroke survivors.
ABSTRACT
Abstract: Introduction: The neuropsychomotor development (NPMD) is dynamic and complex, explained by the contextual model, which can be discussed with an expanded view of health through the International Classification of Functioning, Disability, and Health (ICF). Objective: To characterize the NPMD of children up to 3 years old participating in the "Children's Milk Program" (CMP) from the ICF model in the context of the Family Health Support Center (FHSC) and to relate to individual, family, socioeconomic aspects and stimulation of the child in different environments. Method: In this study, 19 volunteer children, 10 (52.63%) boys and 9 girls (47.37%), aged 7-35 months old (19.42 ± 9.11), duly authorized by the person responsible participated in the study, evaluated through a semi-structured interview, and ABEP socioeconomic questionnaire, Denver Developmental Screening Test and Affordances in the Home Environment for Motor Development test. The instruments were related to ICF components for Children and Young People. The study was performed at the FHCS of a metropolitan city of Curitiba/PR, Brazil. Statistical analysis was performed using the Spearman's rô (rs) for non-parametric correlation, Mann-Whitney in quantitative comparison and Fisher's Exact Test in categorical data for occurrence probability. Results: Regarding the Denver II test, 9 (47.37%) children had questionable NPDM, and the language area was the most compromised (88.88%), 7 families (36.84% were classified in C1 by ABEP and 6 children (54.5%) up to 18 months old received adequate stimulation in the home environment and all the kids (n=8) over 19 months old, presented reasonable stimulation. The model proposed in this study responded to contextual approach of the ICF. Conclusion: It is necessary to use appropriate instruments to plan actions in basic care so children at risk to NPMD can be included in programs of early intervention, to enable the FHCS as a space for monitoring and promoting the NPMD. The ICF has proved to be an adequate and valid classification instrument for this context.
Resumo Introdução: O desenvolvimento neuropsicomotor (DNPM) é dinâmico e complexo, explicado pelo modelo contextual, que pode ser discutido com visão ampliada de saúde por meio da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Objetivo: Caracterizar o DNPM de crianças com até três anos participantes do Programa Leite das Crianças (PLC) a partir da abordagem contextual por meio da CIF, no contexto do Núcleo de Apoio à Saúde da Família (NASF), e relacionar com aspectos individuais, familiares, socioeconômicos e estimulação da criança nos diferentes ambientes. Método: Participaram deste estudo 19 crianças, 10 (52,63%) meninos e 9 meninas (47,37%), com idade entre 7 e 35 meses (19,42 ± 9,11), devidamente autorizadas pelo responsável, avaliadas por meio de entrevista semiestruturada, questionário socioeconômico da ABEP, teste de triagem de Denver II e questionário de oportunidades no ambiente domiciliar para o desenvolvimento motor. Os instrumentos foram relacionados com os componentes da CIF para crianças e jovens (CIF-CJ). O estudo foi realizado no NASF de uma cidade da região metropolitana de Curitiba/PR, Brasil. Para análise estatística utilizou-se rô de Spearman (rs) para correlação não-paramétrica, Mann-Whitney na comparação quantitativa e o Exato de Fisher em dados categóricos para probabilidade de ocorrência. Resultados: Com relação à triagem, 9 (47,37%) crianças apresentaram o DNPM questionável, sendo a área da linguagem a mais comprometida (88,88%), 7 famílias (36,84%) foram classificadas em C1 pela ABEP. Para a estimulação recebida no ambiente domiciliar, 6 crianças (54,5%) com até 18 meses tiveram estimulação adequada e todas (n=8) as crianças maiores de 19 meses apresentaram estimulação razoável. O modelo proposto neste estudo respondeu à abordagem contextual da CIF. Conclusão: É necessária a utilização de instrumentos adequados para planejar ações na atenção básica, para que crianças que apresentem risco ao DNPM possam ser incluídas em programas de intervenções precoces, para viabilizar o NASF enquanto espaço de acompanhamento e promoção do DNPM. A CIF mostrou-se um instrumento de classificação adequado e válido para este contexto.
