Functional Status in Peripheral Arterial Disease: Rehabilitated Versus Nonrehabilitated.

BACKGROUND: To analyze patient perception of functional status related to activity and participation of rehabilitated and nonrehabilitated individuals with peripheral arterial disease. METHODS: Cross-sectional study assessing the activity and participation domain using the Human Activity Profile (HAP) questionnaire and the Participation Scale, respectively. Groups were compared using Chi-squared test and unpaired t-test. RESULTS: A total of 87 individuals (36 rehabilitated) with 65.28 ± 8.29 years (66.7% male) were included. HAP classified 58.6% of individuals with weak or inactive physical activity level, and approximately half of the sample did not have participation restriction. HAP scores and Participation Scale (locomotion inside and outside home) were lower in nonrehabilitated than in rehabilitated individuals. CONCLUSIONS: Individuals with peripheral arterial disease presented little participation restriction and a great activity limitation, the last one being more evident among nonrehabilitated.

Variation in sociodemographic, clinical and functional characteristics of patients with chronic venous insufficiency in a single public health center.

OBJECTIVES: Describe and analyze the sociodemographic, clinical and functional characteristics of individuals with chronic venous insufficiency (CVI) and compare the clinical severity with levels of mobility. METHODS: Exploratory cross-sectional study in a single public health center. The study cohort comprised 99 individuals. INTERVENTIONS: Clinical, sociodemographic and physical activity level questionnaires were applied; we also evaluated ankle amplitude and sural triceps function. Descriptive statistics, independent t test and one-way ANOVA with post hoc Least Significant Difference (LSD) were performed. RESULTS: Ninety-nine participants (87.9% woman) with an average age with an average age of 60.6 ± 14 years who where recruited to the study. The cohort was composed of individuals were moderately active, 80% exhibited symptoms of the disease and approximately 40% reported reduced mobility. Individuals who had reduced mobility and less physical activity showed reduced ankle amplitude and muscle function (p <0.05). CONCLUSION: CVI impacts on functional capacity, even in individuals with less severe disease.

Association between heel-rise test performance and clinical severity of chronic venous insufficiency.

BACKGROUND: Peripheral pump dysfunction is important in identifying manifestations of chronic venous insufficiency. The association with disease severity may define better treatment strategies. OBJECTIVE: To evaluate the association between peripheral muscular pump performance by heel-rise test, age, physical activity, use of compression stockings, and chronic venous insufficiency clinical severity. METHODS: Subjects with chronic venous insufficiency were enrolled in the study (n = 172) and evaluated by clinical-etiology-anatomy-pathophysiology severity and heel-rise test. RESULTS: In model 1 of logistic regression, number of heel-rise test repetitions, age, and physical activity explained 47% of clinical-etiology-anatomy-pathophysiology severity (p = 0.0001), physical activity contributed the most. In model 2, heel-rise test repetition rate, age, and physical activity explained 46.4% of clinical-etiology-anatomy-pathophysiology severity (p = 0.0001), repetition rate contributed the most. Conclusion: There was an inverse association between muscular pump performance and physical activity with clinical-etiology-anatomy-pathophysiology severity, muscular pump repetition rate contributed to a less severe outcome.

Brazilian versions of the Measure of Processes of Care-20 and Measure of Processes of Care-Service Providers: translation, cross-cultural adaptation and reliability.

BACKGROUND: The Measure of Processes of Care (MPOC) questionnaires evaluate Family-Centered Practice (FCP) in services for children with developmental disorders. The MPOC-20 and MPOC-SP are completed by parents and by rehabilitation professionals, respectively, and are widely used in several countries. OBJECTIVES: To translate and cross-culturally adapt the MPOC-20 and MPOC-SP to Brazilian Portuguese and evaluate their reliability and internal consistency. METHODS: this study included translation, back-translation, cognitive interviews, testing of the pre-final versions, analysis of reliability and of internal consistency of the final versions. Respondents included parents and rehabilitation professionals from rehabilitation centers in four capital cities in Brazil. RESULTS: Translation and cultural-adaptation procedures ensured the Brazilian versions were understandable and semantically equivalent to the original MPOC-20 and MPOC-SP. Pre-final and final versions were analyzed and vetted by the original authors. The MPOC-20 internal consistency Cronbach's alpha varied between 0.61 and 0.91 (n=107), the test-retest reliability ICC varied between 0.44 and 0.83 and the standard error of measurement varied between 0.66 and 0.85 (n=50). The MPOC-SP internal consistency Cronbach's alpha varied between 0.52 and 0.83 (n=92), the test-retest reliability ICC between 0.83 and 0.90, and the standard error of measure between 0.34 and 0.46 (n=62). CONCLUSION: The Brazilian versions of the MPOC-20 and the MPOC-SP are in general stable and sufficiently reliable. They are relevant to the evaluation of FCP and provide information that can improve health services and ensure better care.

Reduced version of the Activity Measure for Post-Acute Care (AM-PAC) for inpatients, "6-clicks": Brazilian-Portuguese cross-cultural adaptation and measurement properties.

BACKGROUND: The "6-clicks" is the reduced version of the Activity Measure for Post-Acute Care for inpatients that assesses limitations in basic mobility, daily activity, and applied cognitive, simply and quickly. OBJECTIVE: Cross-culturally adapt the "6-clicks" into Brazilian-Portuguese and verify its measurement properties. METHODS: Cross-cultural adaptation followed recommendations from international guidelines. Reliability indices, standard error of measurement and minimum detectable difference were calculated. Participants included 13 professionals, 13 patients and 13 companions. Test of measurement properties involved 101 patients' of both sexes, hospitalized in the infirmary, under physical therapy care, able to understand and respond to commands and with no discharge expectation. Their 30 companions were also included. RESULTS: Minor changes implemented to the original version. The three domains showed adequate internal consistency (α>0.65). Inter-rater reliability (n=50) and test-retest reliability, when administer to patients (n=51) and to companions (n=30), showed good for basic mobility domain (ICC2.1=0.81, 0.83 and 0.82, respectively), good to moderate for daily activity (ICC2.1=0.78 and ICC3.1=0.71 and 0.82, respectively) and moderate to poor for applied cognitive (ICC2.1=0.64, 0.36 and ICC3.1=0.63), respectively. The highest agreements among patients/companions were also in basic mobility. Standard error of measurement ranged from 2.03 to 2.64 while the minimum detectable difference ranged from 5.63 to 7.32. CONCLUSION: Translated and adapted Brazilian version of the "6-clicks" showed acceptable measurement properties. The functional data provided by the instrument could be used to enhance care and help treatment follow-up.

Gait parameters, functional mobility and fall risk in individuals with early to moderate primary open angle glaucoma: a cross-sectional study.

OBJECTIVE: This study investigated the influence of early to moderate primary open angle glaucoma on gait, functional mobility and fall risk. METHODS: Thirty-three participants in the early and moderate stages of primary open angle glaucoma and 34 asymptomatic controls participated in the study. Spatiotemporal gait data were obtained with the GAITRite system and included: velocity, cadence, step length, base of support, swing, stance and double support times. Functional measures included the Timed Up and Go test, the Five-Repetition Sit-To-Stand test and the Dynamic Gait Index. Fall risk was measured using the Physiological Profile Assessment. RESULTS: The variables contrast sensitivity, proprioception and the Timed Up and Go and Dynamic Gait Index tests were significantly different between groups. In addition, the glaucoma group presented significantly higher risk of falling compared to the control group. Individuals in the early and moderate stages of primary open glaucoma presented mobility and sensory deficits that increase the risk of falling. CONCLUSIONS: The results of this study suggest that adding the Timed Up and Go and Dynamic Gait Index tests to routine physical therapy assessment of individuals with early glaucoma could be useful. Rehabilitation programs should focus on maintaining and/or improving mobility and balance, and prevention of falls in this population.

The Relationship Between Diabetes Mellitus, Geriatric Syndromes, Physical Function, and Gait: A Review of the Literature.

Diabetes mellitus is a common and growing problem worldwide, especially in the elderly population imposing a huge economic burden for individuals and healthcare services. The purpose of this narrative review was to summarize the current state of knowledge about the relationship between diabetes and important geriatric syndromes, physical function measures, and gait variables. Studies pertaining to the topics were identified through on-line search of databases. Seniors with diabetes are more likely to experience falls, depression, and frailty. Furthermore, in older patients, diabetes has been associated with disability, including basic and instrumental activities of daily living, and with poorer performance on objective measures of physical function, such as sit-to-stand test, handgrip strength, Timed Up and Go (TUG) test, and Short Physical Performance Battery (SPPB). Diabetic seniors also have an altered gait pattern characterized by lower velocity and stride length, and higher step width, stance time, double support time, and stride length variability compared to non-diabetic seniors. Little is known about fear of falling in older adults with diabetes. The relationship between these outcomes and diabetes in older people is still outstanding and merits further investigation.

Fortalecimento muscular em adolescentes com paralisia cerebral: avaliação de dois protocolos em desenho experimental de caso único / Muscle strengthening in adolescents with cerebral palsy: an evaluation of two singlecase experimental design protocols

Descrever mudanças na função motora de dois adolescentes com diplegia espástica, sendo um deles participante de um protocolo de fortalecimento muscular isolado (FMI) e o outro de protocolo de fortalecimento com tarefas funcionais (FTF). Métodos: desenho experimental de caso único, metodologia que revela a temporalidade do perfil de mudanças ao longo e após a terapia. Este desenho incluiu fases de baseline, de intervenção e de followup com quatro, seis e três semanas, respectivamente. Participantes foram duas adolescentes com displegia espástica submetidas, cada uma, a um protocolo de intervenção: fortalecimento muscular isolado (FMI) ou fortalecimento com tarefas funcionais (FTF). Os protocolos de intervenção incluíram exercícios de fortalecimento muscular isolado de extensores de quadril, extensores de joelho e flexores plantares (para a participante do FMI), ou de exercícios funcionais para as mesmas musculaturas (para a participante do FTF). Mensurações três vezes por semana avaliaram força muscular, velocidade de marcha, tempo para subir e descer escadas, tempo para se levantar do chão e tempo no teste Timed Get Up and Go. Os dados foram analisados com Celeration Line, Amplitude de Dois Desvios Padrão e Análise Visual. Resultados: ganhos de força muscular de membros inferiores foram observados nas adolescentes submetidas a ambos os protocolos. Mudanças nas atividades motoras foram observadas em 2 das 4 tarefas testadas em somente uma das adolescentes (p<0,05). Conclusões: a especificidade funcional do protocolo de fortalecimento FTF produziu modestos efeitos no desempenho de atividades motoras de uma das adolescentes com PC, em acréscimo aos ganhos de força muscular produzidos por ambos os protocolos...

To describe changes in the motor function of two adolescents with spastic diplegia, one of them participating in a muscle strengthening in isolation (MSI) protocol, the other in a functional tasks strengthening (FTS) protocol. Methods: a single case experimental design is a method that reveals the pattern of changes over time during and after therapy. The design included baseline, intervention and four- six- and three-week follow-up phases. The participants were two adolescents with spastic diplegia, each undergoing an intervention protocol: muscle strengthening in isolation (MSI) or functional tasks strengthening (FTS). The intervention protocols included isolated muscle strengthening of the hip and knee extensors and plantar flexors (for the MSI participant), or functional exercises for the same musculatures (for the FTS participant). Weekly measurements were taken of muscle strength, walking speed, time taken to walk up and down stairs, time taken to get up off the floor and time on the Timed Get Up and Go test. The data were analyzed using Celeration Line, Two Standard Deviation Amplitude and Visual Analysis. Results: gains in muscle strength in the lower limbs were observed in both adolescents. Changes in motor activity were observed in two of the four tasks tested in only one of the adolescents (p<0.05). Conclusions: The functional specificity of the FTS protocol produced modest effects on performance of motor activities in one of the adolescents with CP, in addition to the gains in muscle strength produced by both protocols...

Programa domiciliar de fortalecimento muscular em adolescentes com diplegia espástica: um relato de três casos / Home-based muscle strenghtening program for adolescents with cerebral palsy: aq report of three cases

Introdução: Evidências demonstram que o fortalecimento muscular pode promover ganhos funcionais para indivíduos com paralisia cerebral (PC). No entanto, ainda não se observa com frequência a utilização clínica dessa intervenção. Esse distanciamento entre as evidências científicas e a prática clínica pode ser prejudicial ao desenvolvimento profissional. Objetivo: descrever a implementação de um programa domiciliar de treinamento resistido progressivo e seus efeitos na força muscular, desempenho na marcha e subida e descida de escadas, função motora grossa e participação em atividades escolares de três adolescentes com diplegia espástica. Metodologia: Foram realizados exercícios resistidos domiciliares de levantamento na ponta dos pés, miniagachamentos, subida/descida no step e sentar-se e levantar-se de uma cadeira, por oito semanas, três vezes por semana, como progressão de carga a cada duas semanaas. A primeira semana consistiu de treinamento em ambiente clínico. Foram avaliadas a força muscular, parâmetros de marcha, a função motora grossa e a participação escolar antes e depois da intervenção, e foram realizados cálculos de porcentagem de mudança de desempenho para cada adolescente. Resultados: foram observadas boa adesão e boa progressão de carga, com ganhos em medidas de força muscular, velocidade de marcha confortável e rápida, tempo de subida e descida de escada. Aumentos em escores do Gross Motor Function Measure e School Function Assessment também foram observados. Conclusão: este relato de casos documenta efeitos positivos de um programa de fortalecimento domiciliar em três adolescentes com displegia espástica. A inserção de exercícios de fortalecimento na rotina diária de adolescentes com PC pode ser uma alternativa viável para a promoção funcional.

Adesão de indivíduos portadores de hemiplegia a um programa domiciliar de exercícios / Adherence of individuals with stroke to a home-based exercice program

Estudos ressaltam a importância e eficácia de programa de fortalecimento e condicionamento físico em pacientes pós-AVC e defendem a continuidade do tratamento para manutenção dos ganhos obtidos. Entretanto, a adesão de indivíduos a programas de atividade física sem supervisão e de longa duração é baixa. Apesar dessas evidências, o fisioterapeuta recomenda rotineiramente a realização de exercícios domiciliares, sem incorporar estratégias de adesão. Os objetivos deste trabalho foram avaliar a adesão de indivíduos com hemiplegia a um programa de exercícios domiciliares combinado a estratégia de adesão e identificar os fatores relacionados à adesão. Foram utilizados os instrumentos: questionário sociodemográfico e clínico, questionário de atividade física, COVS, PAH, TC6min e SF-36. As estratégias de adesão foram palestras, termo de compromisso, cartilhas, calendários de exercícios e brindes. A adesão foi interpretada de acordo com a realização total ou parcial dos exercícios propostos. Foi feita análise descritiva das variáveis e, para compração entre os grupos adesão e não adesão, foram usados o teste qui-quadrado, t-Student e poder estatístico (alfa=0,05). A média de idade dos 14 participantes foi de 57 anos (DP=6) e apresentaram boa mobilidade e condicionamento físico previamnete ao programa. Dos 11 indivíduos que aderiram, 10 apresentaram alta adesão após 0s 6 meses. Apenas os domínios aspectos emocionais e saúde mental do SF-36 apresentaram diferença significativa entre grupos: o domínio capacidade funcional apresentou poder estatístico>80 por cento. Os resultados sugerem que fatores psicológicos, combinados a estratégias de adesão parecem contribuir para a prática regular de atividade física domiciliar em indivíduos com hemiplegia crônica

Estudo do desenvolvimento da função motora aos 8 e 12 meses de idade em crianças pré-termo e a termo / Study of motor function at 8 and 12 months of age in preterm and at term children

OBJETIVO: Comparar o desenvolvimento da função motora de crianças nascidas pré-termo com crianças nascidas a termo, aos 8 e 12 meses de idade. Investigar a relação entre a qualidade motora aos 8 meses e a habilidade motora aos 12 meses. MÉTODO: Trinta e duas crianças participaram deste estudo: 16 nascidas pré-termo (grupo de risco) e 16 nascidas a termo (grupo controle). A movimentação espontânea das crianças foi avaliada aos 8 meses e as habilidades e independência em mobilidade foram avaliadas aos 12 meses de idade (idades corrigidas para grupo pré-termo), utilizando-se testes infantis padronizados (AIMS e PEDI, respectivamente). Os dados foram analisados através dos textes t de Student para grupos independentes (comparação entre grupos) e de correlação de Pearson (comparação intra grupo). RESULTADOS: Não foi evidenciada diferença significativa na comparação de crianças nascidas a termo com as pré-termo nem aos 8 nem aos 12 meses de idade. No grupo controle, foi observada relação significativa (r=0,67; p=0,004) entre movimentação aos 8 meses e habilidade de mobilidade aos 12 meses. No grupo de risco, houve relação significativa entre habilidade e independência em mobilidade aos 12 meses de idade corrigida (r=0,80; p=0,0001). CONCLUSÃO: Na ausência de outros distúrbios e com correção da idade em pré-termos, o desenvolvimento motor pode ser semelhante ao de crianças nascidas a termo. A forma pela qual as crianças nascidas pré-termo adquirem suas habilidades funcionais parece ocorrer de modo diferente da observada em crianças a termo

[Study of motor function development at 8 and 12 months of age in preterm and at term children]. / Estudo do desenvolvimento da função motora aos 8 e 12 meses de idade em crianças nascidas pré-termo e a termo.

OBJECTIVE: To compare the development of motor function in children born preterm with those born at term, at 8 and 12 months of age. To investigate the relation of motor function quality at the age of 8 months with motor ability at 12 months. METHOD: Thirty-two children participated in this study: 16 were born preterm (risk group) and 16 were born at term (control group). The spontaneous movements of the children were assessed at 8 months and their mobility skills and independence were assessed at 12 months (corrected ages for the preterm group), using standardized developmental tests (AIMS and PEDI, respectively). Data were analysed using independent t-tests (between-group comparison) and Pearson correlation coefficients (within-group comparison). RESULTS: There was no significant difference in motor function, between those born preterm with those born at term, either at 8 or at 12 months of age. In the control group, there was significant association (r=0.67; p=0.004) between movement at 8 months and mobility skills at 12 months. In the risk group, there was significant relationship between skills and independence in mobility, at 12 months corrected age (r=0.80; p=0.0001). CONCLUSION: Preterm born children, without other disorders and with age correction, might show a similar motor development as those born at term. The path for the acquisition of motor abilities in preterm born children appears to differ among those infants.