Effects of square stepping exercise in patients with sequel of cerebrovascular accident / Efeitos do square stepping exercise em pacientes com sequelas de acidente vascular encefálico

Introduction Cerebral stroke is the interruption of blood flow to the brain and can be classified into hemorrhagic and ischemic. It may result in serious body balance and cognition complications. Kinesiotherapy is a privileged means of rehabilitation.Objective Verify the effects of Square Stepping Exercise (SSE) on cognitive functions, depressive symptoms and the body balance of cerebral stroke sequel patients.Methods Thirteen brain stroke sequel patients were divided into two groups: SSE (SSEG n = 8) and conventional physiotherapy group (PG, n = 5). The SSEG participated only of the SSE training protocol, while the PG participated of its physical therapy routine group, both for 4 months. They were evaluated using the Mini Mental State Examination (MMSE), the Brief Cognitive Screening Battery (BBRC), the Geriatric Depression Scale (GDS),Berg Balance Scale(BBS) and Timed Up and Go(TUG).Results The U Mann Whitney test showed no significant differences between groups. In intragroup analysis, the Wilcoxon test showed significant improvement in global cognitive status for PG (p < 0.042), and for SSEG there were positive results for verbal fluency (p < 0.04) and in TUG for number of steps (p < 0.04) and the time (p < 0.02).Conclusion The SSE seems to benefit dynamic balance, influencing gait agility, cognition related to verbal fluency and may have contributed to maintain other cognitive functions.

Introdução O Acidente vascular encefálico (AVE) é a interrupção do fluxo de sangue para o cérebro e pode ser classificado em hemorrágico e isquêmico, podendo resultar em graves complicações do equilíbrio corporal e cognição. A cinesioterapia constitui-se em meio privilegiado de reabilitação.Objetivo Verificar os efeitos do Square Stepping Exercise (SSE) nas funções cognitivas, nos sintomas depressivos e no equilíbrio de pacientes com sequelas de AVE.Métodos Treze pacientes com sequelas de AVE foram alocados em dois grupos: grupo SSE (GSSE n = 8) e grupo fisioterapia convencional (GF n = 5). O GSSE participou apenas do protocolo de treinamento do SSE, o GF participou apenas de sua rotina de fisioterapia realizada em grupo, ambos pelo período de 4 meses e avaliados por meio do Mini Exame do Estado Mental (MEEM), da Bateria Breve de Rastreio Cognitivo (BBRC), da Escala de Depressão Geriátrica (GDS), da Escala de Equilíbrio Funcional de Berg (EEFB) e do Timed Up and Go (TUG).Resultados O teste U Mann Whitney não apontou diferenças significantes intergrupos. Na análise intragrupo, o teste de Wilcoxon mostrou melhora significativa no GF (p < 0,042) no estado cognitivo global, e no GSSE quanto à fluência verbal (p < 0,04) e no TUG tanto para número de passos (p < 0,04) quanto para tempo o (p < 0,02).Conclusão O SSE parece beneficiar o equilíbrio dinâmico, fazendo com que os pacientes com sequela de AVE apresentem marcha mais ágil, a cognição no tocante à fluência verbal, bem como pode ter contribuído para a manutenção de outras funções cognitivas.

Functional dependence and caregiver burden in Alzheimer's disease: a controlled trial on the benefits of motor intervention.

BACKGROUND: Cognitive decline has a negative impact on functional activities in Alzheimer's disease. Investigating the effects of motor intervention with the intent to reduce the decline in functionality is an expected target for patients and caregivers. The aim of this study was to verify if a 6-month motor intervention programme promoted functionality in Alzheimer's patients and attenuated caregivers' burden. METHODS: The sample comprised 32 community patients with Alzheimer's disease and their 32 respective caregivers. Patients were divided into two groups: 16 participated in the motor intervention programme and 16 controls. Subjects performed 60 minutes of exercises, three times per week during the 6-month period, to improve flexibility, strength, agility and balance. Caregivers followed the procedures with their patients during this period. Functionality was evaluated by the Berg Functional Balance Scale and the Functional Independence Measure. Caregivers completed the Neuropsychiatric Inventory Caregiver Distress Scale and the Zarit Carer Burden Scale. Two-way ANOVA was used to verify the interaction between time (pre- and post-intervention) and the motor intervention program. RESULTS: While patients in the motor programme preserved their functionality, as assessed by the Functional Independence Measure, the controls suffered a relative decline (motor intervention group: from 109.6 to 108.4 vs controls: from 99.5 to 71.6; P= 0.01). Patients from motor intervention also had better scores than the controls on functional balance assessed by Berg scale (F: 22.2; P= 0.001). As assessed by the Neuropsychiatric Inventory and Zarit scale, burden was reduced among caregivers whose patients participated in the motor intervention programme compared with caregivers whose patients did not participate in this programme (Neuropsychiatric Inventory, caregiver's part: F: 9.37; P= 0.01; Zarit: F: 11.28; P= 0.01). CONCLUSION: Patients from the motor intervention group showed reduced functional decline compared to the controls, and there was an associated decrease in caregivers' burden.

Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial.

OBJECTIVE: To analyze the effects of motor intervention on the neuropsychiatric symptoms of Alzheimer's disease and on the caregivers' burden. DESIGN: This is a controlled trial evaluating the effects of a motor intervention program on the neuropsychiatric symptoms. SETTING: The intervention was performed on community patients from two university centers specializing in physical exercise for the elderly. SUBJECTS: Patients with Alzheimer's disease were divided into two groups: sixteen received the motor intervention and sixteen controls (five controls were excluded because of clinical intercurrences). INTERVENTIONS: Aerobic exercises (flexibility, strength, and agility) and functional balance exercises were conducted over six months for 60 minutes three times per week. MAIN MEASURES: Psychopathological features of patients were evaluated with the Neuropsychiatric Inventory and Cornell Scale for Depression in Dementia. Caregivers were evaluated using the Neuropsychiatric Inventory-Distress and Burden Interview. A two-way analysis of variance (ANOVA) was applied to observe interactions (pre- vs. post-intervention; participants vs. controls). RESULTS: Patients from the intervention presented a significant reduction in neuropsychiatric conditions when compared to controls (Neuropsychiatric Inventory: F: 11.12; p = 0.01; Cornell Depression scale: F: 11.97; p = 0.01). The burden and stress of caregivers responsible for patients who participated in the intervention significantly decreased when compared to caregivers responsible for controls (Neuropsychiatric Inventory-Distress: F: 9.37; p = 0.01; Burden Interview: F: 11.28; p = 0.01). CONCLUSIONS: Aerobic exercise was associated with a reduction in the neuropsychiatric symptoms and contributed to attenuate the caregivers' burden. However, the researchers were not blinded to the patient's intervention status, which constitutes an important limitation of this study.

Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial

OBJECTIVE: To analyze the effects of motor intervention on the neuropsychiatric symptoms of Alzheimer's disease and on the caregivers' burden. DESIGN: This is a controlled trial evaluating the effects of a motor intervention program on the neuropsychiatric symptoms. SETTING: The intervention was performed on community patients from two university centers specializing in physical exercise for the elderly. SUBJECTS: Patients with Alzheimer's disease were divided into two groups: sixteen received the motor intervention and sixteen controls (five controls were excluded because of clinical intercurrences). INTERVENTIONS: Aerobic exercises (flexibility, strength, and agility) and functional balance exercises were conducted over six months for 60 minutes three times per week. MAIN MEASURES: Psychopathological features of patients were evaluated with the Neuropsychiatric Inventory and Cornell Scale for Depression in Dementia. Caregivers were evaluated using the Neuropsychiatric Inventory-Distress and Burden Interview. A two-way analysis of variance (ANOVA) was applied to observe interactions (pre- vs. post-intervention; participants vs. controls). RESULTS: Patients from the intervention presented a significant reduction in neuropsychiatric conditions when compared to controls (Neuropsychiatric Inventory: F: 11.12; p = 0.01; Cornell Depression scale: F: 11.97; p = 0.01). The burden and stress of caregivers responsible for patients who participated in the intervention significantly decreased when compared to caregivers responsible for controls (Neuropsychiatric Inventory-Distress: F: 9.37; p = 0.01; Burden Interview: F: 11.28; p = 0.01). CONCLUSIONS: Aerobic exercise was associated with a reduction in the neuropsychiatric symptoms and contributed to attenuate the caregivers' burden. However, the researchers were not blinded to the patient's intervention status, which constitutes an important limitation of this study.