Effects of constraint-induced movement therapy on activity and participation after a stroke: Systematic review and meta-analysis.

Introduction: Hemiparesis is the main sensorimotor deficit after stroke. It can result in limitations in Activities of Daily Living (ADL) and social participation. Hemiparesis can be treated with behavioral techniques of intensive use of the affected arm, such as constraint-induced movement therapy (CIMT), however, it remains unclear whether motor improvement can lead to increases in the domains of activity and participation. Objective: Identify whether CIMT is superior to usual techniques to enhance activity and participation outcomes in stroke survivors. Methods: A systematic review with meta-analysis was conducted, based on the PRISMA guidelines. Search databases were: PubMed, LILACS, Embase, SciELO, Cochrane Library, Scopus, Medline, and Web of Science, with no language restriction. Meta-analysis was performed with Review Manager (version 5.3), significance level p ≤ 0.05. Results: A total of 21 articles were included for analysis. Superior effects were observed on motor function and performance in activities of daily living of individuals treated with CIMT. The outcomes measures utilized were: Fugl-Meyer Assessment (p = 0.00001); Wolf motor function test (p = 0.01); Modified Barthel Index (p = 0.00001); Motor Activity log (MAL) Amount of use (AOU) (p = 0.01); MAL Quality of movement (QOM) (p = 0.00001); Action Research Arm Test-ARAT (p = 0.00001); and FIM (p = 0.0007). Conclusion: Our results show that CIMT results in more significant gains in the functional use of the upper limb in ADL and functional independence, demonstrating superior activity and participation results in stroke survivors when compared to conventional therapies.

Multisite transcranial direct current stimulation associated with cognitive training in episodic memory and executive functions in individuals with Alzheimer's disease: a case report.

BACKGROUND: Dementia is among the most common chronic noncommunicable neurodegenerative diseases. In the long term, it causes disability and loss of autonomy and independence. It is estimated that there are 35.6 million people with Alzheimer's disease worldwide. Several clinical aspects of this disease have been widely studied, but the main focus of study has been memory loss, which is one of the first symptoms. The present study proposes an innovative intervention that combines cognitive training and multisite transcranial direct current stimulation, which interferes with other clinical aspects of the subject. CASE PRESENTATION: In this study, we present two subjects diagnosed with mild Alzheimer's disease. Subject 1 is an 82-year-old Brazilian Latin American woman with a high school education who was diagnosed with Alzheimer's disease 8 years ago and uses an Exelon patch. Subject 2 is an 88-year-old Brazilian Latin American woman with an incomplete primary education who was diagnosed with Alzheimer's disease 1 year ago and received medical orientation to temporarily discontinue medications for Alzheimer's disease. Both participants were subjected to intermittent cognitive training sessions and concomitant transcranial stimulation in three weekly 30-minute sessions in which a brain area was stimulated every 10 minutes for a total of 24 sessions, with a 2-month follow-up. Transcranial stimulation was applied to six different regions of the cortex: the dorsolateral prefrontal cortex bilaterally, the somatosensory association cortex bilaterally and Broca's and Wernicke's areas. Comparing the results of tests performed before and after the treatment period, a 1-point improvement was observed for both subjects on the Word Recall task of the Alzheimer Disease Assessment Scale, which evaluates symptoms related to the decline of episodic memory. Improvement in the executive functions domain was also observed through the results of the Stroop test, Victoria version. CONCLUSIONS: The results from the two presented cases show that multisite transcranial stimulation associated with cognitive training is an effective adjuvant method for the treatment of patients diagnosed with mild Alzheimer's disease. Its effects can benefit patients' daily routines by reducing cognitive deficits by keeping intact areas active and/or compensating for lost functions. Trial registration NCT02772185. Registered 13 May 2016, http://www.clinicaltrials.gov/ct2/show/NCT02772185 . Retrospectively registered.

Time use, purchasing power, and job satisfaction: Correlation and comparison between working women with children and working women without children.

BACKGROUND: There are few correlational studies comparing family-work reconciliation between groups of women. OBJECTIVE: We intend to correlate and compare the use of time, purchasing power, and job satisfaction between two groups of working women, women with children and women without children. METHODS: This is a correlational and comparative study. The following instruments were used: Activities Diary; Brazilian Criteria for Economic Classification; and the short version of the Quality of Working Life Questionnaire. A total of 171 women participated in the study: one group was composed of 78 women with children and the other group was composed of 93 women without children. Data were analyzed using the Shapiro-Wilk test, Wilcoxon test, Student's t-test and the Kolmogorov Smirnov test. RESULTS: Women with children spent more hours/day on hygiene, taking care of elderly individuals, practicing their religion, and studying (p = 0.001), but they presented no statistical differences in job satisfaction from those women without children (p = 0.2362). Women with children belonged to a higher economic classification and had greater purchasing power than women without children. CONCLUSIONS: Having children is a variable that influences time use, purchasing power, and job satisfaction among women and the presence of children is a factor that may increase the purchasing power of a woman.

Burden and Quality of Life of Family Caregivers of Stroke Patients.

The purpose of this study was to identify the level of burden and quality of life of family caregivers of stroke patients and to investigate the correlation between burden, quality of life (including physical, social, psychological, and environmental domains), age of caregivers, and the care period. A descriptive correlational cross-sectional study was performed, with a convenience sample of family caregivers (n = 30) of stroke patients in São Paulo, Brazil. Data were collected using a questionnaire on participants' characteristics, the Zarit Burden Interview Scale (ZBIS), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument. A descriptive analysis was performed, and correlations between variables were analyzed using Pearson's product-moment correlation coefficient. The average burden score on the ZBIS was 29.6, representing a moderate burden, and the average overall quality of life score on the WHOQOL-BREF was 62.06%, which indicates moderate quality of life. A significant weak negative correlation was observed between burden and environmental domains (r = -0.470; p =.009), quality of life (r = -0.414; p =.023), and physical domains (r = -0.394; p =.031). No significant correlations were found between burden and quality of life, and variables in the psychological and social domains, age of caregivers, or care period. Caregivers for stroke patients presented with moderate levels of burden and reduction in quality of life. Levels of burden correlated negatively with environmental domains, quality of life levels, and physical domains; however, these correlations were weak, indicating the possible interference of other factors.

Electromyographic Activity of the Upper Limb in Three Hand Function Tests.

OBJECTIVE/BACKGROUND: Occupational therapists usually assess hand function through standardised tests, however, there is no consensus on how the scores assigned to hand dexterity can accurately measure hand function required for daily activities and few studies evaluate the movement patterns of the upper limbs during hand function tests. This study aimed to evaluate the differences in muscle activation patterns during the performance of three hand dexterity tests. METHODS: Twenty university students underwent a surface electromyographic (sEMG) assessment of eight upper limb muscles during the performance of the box and blocks test (BEST), nine-hole peg test (9HPT), and functional dexterity test (FDT). The description and comparison of each muscle activity during the test performance, gender differences, and the correlation between individual muscles' sEMG activity were analysed through appropriate statistics. RESULTS: Increased activity of proximal muscles was found during the performance of BEST (p < .001). While a higher activation of the distal muscles occurred during the FDT and 9HPT performance, no differences were found between them. Comparisons of the sEMG activity revealed a significant increase in the muscle activation among women (p = .05). Strong and positive correlations (r > .5; p < .05) were observed between proximal and distal sEMG activities, suggesting a coordinate pattern of muscle activation during hand function tests. CONCLUSION: The results suggested the existence of differences in the muscle activation pattern during the performance of hand function evaluations. Occupational therapists should be aware of unique muscle requirements and its impact on the results of dexterity tests during hand function evaluation.

Personas con discapacidad y sus roles ocupacionales: trabajo, familia, independencia y participación social / Occupational roles of people with disabilities: work, family, independence and social participation

Este estudio se propone describir las necesidades cotidianas y los roles ocupacionales de un grupo de personas adultas y ancianas con discapacidad en una ciudad de medio porto del Estado de São Paulo, Brasil. Metodológicamente, se seleccionaron dieciséis usuarios con una edad media de 61,7 años y desviación estándar de 17,2 años, con discapacidad física y/o sensorial, con excepción de personas con alteraciones en el lenguaje oral y/o alteraciones cognitivas. Los instrumentos utilizados para recolectar datos fueron el Mini Examen del Estado Mental (para seleccionar la muestra sin alteraciones cognitivas), el Listado de Roles y una guía de entrevista semiestructurada. Resultados: predominan ancianos de género femenino entre las personas con discapacidad física (n=10). Las entrevistas refieren que las relaciones de trabajo y funciones familiares son roles importantes, seguidos del deseo de independencia para realizar otras actividades como las de ocio, servicios domésticos y participación social. Conclusión: la investigación evidenció la importancia de mirar los roles ocupacionales en la vida cotidiana, entendiendo que la ampliación de protagonismo de las personas en su desempeño ocupacional puede favorecer su salud y el aumento de su vida social.

The objective of this study is to describe the everyday needs and occupational roles of adults and old adults with disabilities in a medium port city of the Sao Paulo provincy, Brazil. Method: sixteen adults and older adults age mean 61.7 an standard deviation 17.2 participated in this study. Those selected were people with physical and/ or sensory impairment, to the exclusion of people with alterations in verbal and / or cognitive impairments. The instruments used for data collection were the Mini Mental State Examination (as a criteria to exclude subjects with cognitive imnpairments), the Role Checklist and semi-structured interviews. The results revealed the predominance of elderly females among people with disabilities (n = 10). The interviews showed labor relations and family functions as important roles, followed by the desire for independence in carrying out other activities such as leisure, housework and greater social participation. Conclusion: The research highlighted the importance of looking at the occupational roles of people with disabilities in their daily lives, understanding that the expansion of the role of these people in their occupational performance can promote good health and increased participation in social life.

Associations among occupational roles, independence, assistive technology, and purchasing power of individuals with physical disabilities.

OBJECTIVE: to verify whether there are associations among occupational roles, independence to perform Activities of Daily Living, purchasing power, and assistive technology for individuals with physical disabilities. METHOD: 91 individuals with physical disabilities participated in the study. The instruments used were: Role Checklist, Brazilian Economic Classification Criterion, Barthel Index, and a Questionnaire to characterize the subjects. RESULTS: an association with a greater number of roles was found among more independent individuals using a lower number of technological devices. Higher purchasing power was associated with a lower functional status of dependence. CONCLUSION: even though technology was not directly associated with independence, the latter was associated with a greater number of occupational roles, which requires reflection upon independence issues when considering the participation in occupational roles. These findings support interdisciplinary actions designed to promote occupational roles in individuals with physical disabilities.

An electromyographic analysis of two handwriting grasp patterns.

BACKGROUND: Handwriting is a fundamental skill needed for the development of daily-life activities during lifetime and can be performed using different forms to hold the writing object. In this study, we monitored the sEMG activity of trapezius, biceps brachii, extensor carpi radialis brevis and flexor digitorum superficialis during a handwriting task with two groups of subjects using different grasp patterns. SUBJECTS AND METHODS: Twenty-four university students (thirteen males and eleven females; mean age of 22.04±2.8years) were included in this study. We randomly invited 12 subjects that used the Dynamic Tripod grasp and 12 subjects that used the Static Tripod grasp. RESULTS: The static tripod group showed statistically significant changes in the sEMG activity of trapezium and biceps brachii muscles during handwriting when compared to dynamic tripod group's subjects. No significant differences were found in extensor carpi radialis brevis and flexor digitorum superficialis activities among the two groups. CONCLUSION: The findings in this study suggest an increased activity of proximal muscles among subjects using a transitional grasp, indicating potential higher energy expenditure and muscular harm with the maintenance of this motor pattern in handwriting tasks, especially during the progression in academic life.