ABSTRACT
BACKGROUND: Foot placement is an important methodological parameter in experiments for analyzing the behavior of the center of pressure (CoP) duringquiet standing. In the case of stroke patients, this is a relevant issue, as the standardized position, usually adopted is not ecological. RESEACH QUESTION: Do between-limb synchronization, weight-bearing symmetry, and amplitude of the postural sway of post-stroke individuals differ between standardized and comfortable foot positions during quiet standing? METHODS: A total of 36 volunteers (20 with stroke and 16 healthy) stood barefoot, for 60 s, on two force plates with feet in a comfortable and standardized position (14° of external rotation and heels 17 cm apart). Three trials were performed in each position, and the average values obtained were analyzed. RESULTS: The comfortable position adopted by stroke individuals was characterized by heels kept 17 cm apart and with 21° of external rotation. None of the measures of the healthy group were influenced by feet position. In the stroke group, the lag to maximal between-feet correlation in the mediolateral direction (ML ρmax lag) was higher (0.45 s) and the weight-bearing symmetry was better in the comfortable (38%) than in the standardized conditions (0.19 s and 32%, respectively). Neither the other CoP measures nor the intra-subject variability was sensitive to feet position. SIGNIFICANCE: The assumption that standardization leads to reduced variability might not be valid to the post-stroke and healthy individuals age around 55 years. Therefore, adoption of a comfortable condition might be advantageous, once it allows for a more practical and realistic evaluation of postural control.
Subject(s)
Foot/physiopathology , Postural Balance/physiology , Stroke/physiopathology , Adult , Aged , Female , Humans , Male , Middle Aged , Posture/physiology , Pressure , Standing Position , Stroke Rehabilitation , Weight-Bearing/physiologyABSTRACT
Tendo em vista o crescente número de pacientes complexos atendidos em domicílio, o objetivo deste estudo foi avaliar a eficácia do uso de tecnologia em saúde, em pacientes de 0-17 anos,11 meses e 29 dias, atendidos pelo serviço público de atenção domiciliar, Programa Melhor em Casa, da cidade de Curitiba - Paraná. Os seguintes dados foram coletados de planilhas e prontuários: uso e identificação de recurso tecnológico, tempo de permanência no programa, re-hospitalizações e dados clínicos e funcionais. A análise dos dados resultou em 40 participantes, predomínio do sexo masculino, idade média de 7 (± 6) anos, e diagnósticos clínicos variados. A incidência de alteração de mecânica ventilatória foi de 50% e o tempo de permanência no programa foi 82,5% superior em pacientes com uso de tecnologia respiratória. A baixa incidência de re-hospitalizações pode indicar a efetividade do atendimento domiciliar possibilitando o uso consciente e seguro de tecnologia em domicílio. (AU)
Considering the growing number of complex patients treated at home, the objective of this study was to evaluate the efficacy of health technology in patients aged 0-17 years, 11 months and 29 days, attended by a public home care service, 'Programa Melhor em Casa' of the city of Curitiba state of Paraná. The following data were collected from worksheets and medical reports: use and identification of technological resources, length of stay in the program, hospital readmissions, and clinical and functional data. Data analysis resulted in 40 participants, male predominance, mean age of 7 (± 6) years, and varied clinical diagnoses. The incidence of altered ventilatory mechanics was 50% and the time spent in the program was 82.5% higher in patients with respiratory technology use. The low incidence of hospital readmissions may indicate the effectiveness of home care, allowing the conscious and safe use of home-based technology. (AU)
Subject(s)
Humans , Male , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Child Health , Biomedical Technology , Home Care ServicesABSTRACT
Abstract Introduction: Recently, variables related to between-limb synchronization of the centers of pressure (COP) have been proposed as measures of postural control in post-stroke patients. Although it is crucial in verifying their potential clinical use, the reliability of these variables is unknown. The aim of this work was to determine the reliability and minimal detectable change (MDC) of the peak of synchronization (ρmax) in the anteroposterior (AP) and mediolateral (ML) directions, the time lag for the peak (ρmaxlag), synchronization at lag zero (ρ0), weight-bearing symmetry, and amplitude of postural sway, measured as the root mean square (RMS) values of the COP displacements in both directions (AP and ML COP displacement). Methods COP data of 16 participants with stroke were collected at quiet standing with two force plates at two sessions separated by 2 to 7 days. The procedure was repeated three times in each session. The within and between sessions reliability was determined by the intraclass correlation coefficient (ICC), and the MDC was obtained from the ICC between sessions. Results The variables ρmaxlag in the AP and ML directions, as well as ρ0 in the AP direction, exhibited poor within session reliability (ICC ≤ 0.4). The findings revealed excellent within and between sessions reliability (ICC ≥ 0.89) for weight-bearing symmetry and the RMS displacement in the AP direction, with MDC values of 5% and 2.07 mm, respectively. The remaining variables exhibited moderate reliability. Conclusion Weight-bearing symmetry and AP COP displacement can be considered reliable variables for use in clinical practice.
ABSTRACT
The Gait Deviation Index (GDI) is a summary measure that provides a global picture of gait kinematic data. Since the ability to walk is critical for post-stroke patients, the aim of this study was to determine the reliability and Minimum Detectable Change (MDC) of the GDI in this patient population. Twenty post-stroke patients (11 males, 9 females; mean age, 55.2±9.9years) participated in this study. Patients presented with either right- (n=14) or left-sided (n=6) hemiparesis. Kinematic gait data were collected in two sessions (test and retest) that were 2 to 7days apart. GDI values in the first and second sessions were, respectively, 59.0±8.1 and 60.2±9.4 for the paretic limb and 53.3±8.3 and 53.4±8.3 for the non-paretic limb. The reliability in each session was determined by the intra-class correlation coefficient (ICC) of three strides and, in the test session, their values were 0.91 and 0.97 for the paretic and non-paretic limbs, respectively. Between-session reliability and MDC were determined using the average GDI of three strides from each session. For the paretic limb, between-session ICC, standard error of measurement (SEM), and MDC were 0.84, 3.4 and 9.4, respectively. Non paretic lower limb exhibited between-session ICC, standard error of measurement (SEM), and MDC of 0.89, 2.7 and 7.5, respectively. These MDC values indicate that very large changes in GDI are required to identify gait improvement. Therefore, the clinical usefulness of GDI with stroke patients is questionable.
Subject(s)
Gait Disorders, Neurologic/physiopathology , Gait , Lower Extremity/physiology , Minimal Clinically Important Difference , Stroke/physiopathology , Walking , Adult , Aged , Biomechanical Phenomena , Disability Evaluation , Female , Humans , Male , Middle Aged , Reproducibility of Results , Severity of Illness IndexABSTRACT
Introdução: a obesidade é considerada uma doença crônica que vem despertando o interesse cada vez maior por tratamentos alternativos, como a Acupuntura, auriculoterapia e a stiper terapia que, por se tratar de uma técnica relativamente recente, ainda há poucos estudos científicos sobre seus efeitos. Objetivo: avaliar os efeitos da acupuntura sistêmica isolada e associada à stiper no emagrecimento de indivíduos hígidos sedentários com sobrepeso ou obesidade. Método: os participantes foram randomizados em dois grupos: Grupo Controle (GC) e Grupo Experimental (GE). Ambos os grupos receberam a aplicação da acupuntura durante cinco semanas (uma aplicação por semana) e o GE recebeu adicionalmente a aplicação da stiper terapia na mesma proporção. Foram avaliadas a massa corporal total (MCT) e a perimetria da circunferência abdominal (CA) semanalmente. Resultados: A MCT apresentou redução de -0,36 kg no GC e de - 0,81 kg no GE, e a CA diminuiu -2,46 cm no GC e -3,38 cm no GE, ambas com ausência de significância estatística na comparação entre os grupos. Na comparação dentro de cada grupo separadamente, o GE apresentou maiores regressões, com significância estatística em ambas as variáveis. Discussão: os estudos comparados que associaram a acupuntura sistêmica à alguma outra técnica também não encontraram diferenças significantes estatisticamente entre as modalidades. Conclusão: Ambos os grupos apresentaram redução nos valores de MCT e CA, porém, nenhuma intervenção evidenciou superioridade em relação à outra.
Subject(s)
Humans , Male , Female , Weight Loss , Acupuncture , Sedentary BehaviorABSTRACT
The objectives of this work were (i) to determine Gait Profile Score (GPS) for hemiparetic stroke patients, (ii) to evaluate its reliability within and between sessions, and (iii) to establish its minimal detectable change (MDC). Seventeen hemiparetic patients (mean age 54.9±10.5years; 9 men and 8 women; 6 hemiparetic on the left side and 11 on the right side; mean time after stroke 6.1±3.5months) participated in 2 gait assessment sessions within an interval of 2-7 days. Intra-session reliability was obtained from the intraclass correlation coefficient (ICC) between the three strides of each session. Inter-session reliability was estimated by the ICC from the averages of that three strides. GPS value of non paretic lower limb (NPLL) (13.9±2.4°) was greater than that of paretic lower limb (PLL) (12.0±2.8°) and overall GPS (GPS_O) was 13.7±2.5°. The Gait Variable Scores (GVS), GPS and GPS_O exhibited intra-session ICC values between 0.70 and 0.99, suggesting high intra-day stability. Most of GVS exhibited excellent inter-session reliability (ICC between 0.81 and 0.93). Only hip rotation, hip abduction of PLL exhibited moderate reliability with ICC/MDC values of 0.57/10.0° and 0.71/3.1°, respectively. ICC/MDC values of GPS were 0.92/2.3° and 0.93/1.9° for PLL and NPLL, respectively. GPS_O exhibited excellent test-retest reliability (ICC=0.95) and MDC of 1.7°. Given its reliability, the GPS has proven to be a suitable tool for therapeutic assessment of hemiparetic patients after stroke.
