Uso de aplicativo para análise de movimento: estudo piloto / App for motion analysis: pilot study

Medidas alternativas e de baixo custo podem ser importantes para análise do movimento humano. Objetivo: Verificar a concordância de análise de movimento humano entre aplicativo de monitoramento por meio de inteligência artificial com análise tridimensional de movimento. Método: Estudo transversal observacional no qual voluntário sadio realizou movimentos de: flexão dos braços, flexão de cotovelos, flexão de tronco, inclinação de tronco e sentar e levantar. As imagens foram captadas por meio de sistema de análise tridimensional do movimento por câmeras infravermelhas e pelo aplicativo da Linkfit por meio de dois dispositivos móveis (smartphones). Foram comparados os ângulos estimados pelo aplicativo da Linkfit com os ângulos correspondentes medidos pelo sistema de análise tridimensional do movimento. Para comparar os ângulos da LinkFit com os ângulos mensurados pelo laboratório tridimensional de movimento, o teste de causalidade de Granger foi usado para cada série paralela dos dados. Resultados: A utilização de técnicas de visão computacional e deep learning para detecção de movimento utilizando câmeras de celular mostrou um grau de concordância de 84% em relação à medidas geradas por análise tridimensional de movimento realizadas em laboratório. Conclusão: A utilização de técnicas de visão computacional e deep learning é promissora para a realização de estudos que envolvem a detecção do movimento do corpo humano, quando comparadas com medidas de padrão-ouro de análise de movimento, podendo ser portanto, uma alternativa. Estudos futuros devem ser realizados utilizando maior número de voluntários e movimentos, com o intuito de consolidar os resultados obtidos nesse estudo.

Alternative and low-cost measures may be important for analyzing human movement. Objective: The objective of this study was to verify the agreement of human movement analysis of a monitoring app that uses artificial intelligence compared to three-dimensional movement analysis. Methods:Observational cross-sectional case report study in which a healthy volunteer performed arm flexion, elbow flexion, trunk flexion, lateral trunk bending, and sitting and standing. Images of the volunteer were simultaneously captured by a three-dimensional movement analysis system based on infrared cameras and the Linkfitapp of two mobile devices (smartphones). The body angles estimated by the Linkfitapp were compared with the corresponding angles measured by the three-dimensional movement analysis system. The Granger causality test was used to compare the pairs of angles for each parallel data series. Results:The use of smartphone cameras and deep learning techniques for motion detection had an 84% degree of agreement compared to measurements generated by the three-dimensional movement analysis performed in the laboratory. Conclusion:The use of smartphone cameras and deep learning techniques is promising for conducting studies for body movement detection compared to the gold standard measures of movement analysis. This technology may become an alternative for movement analysis. Future studies should consider a more significant number of volunteers and model movements to strengthen the results obtained in this study.

Effects of lower extremity constraint-induced movement therapy on gait and balance of chronic hemiparetic patients after stroke: description of a study protocol for a randomized controlled clinical trial.

BACKGROUND: Protocols involving intensive practice have shown positive outcomes. Constraint induced movement therapy (CIT) appears to be one of the best options for better outcomes in upper limb rehabilitation, but we still have little data about lower extremity constraint-induced movement therapy (LE-CIT) and its effects on gait and balance. OBJECTIVE: To evaluate the effects of an LE-CIT protocol on gait functionality and balance in chronic hemiparetic patients following a stroke. METHODS: The study adopts a randomized, controlled, single-blinded study design. Forty-two patients, who suffered a stroke, who were in the chronic phase of recovery (>6 months), with gait disability (no community gait), and who were able to walk at least 10 m with or without the advice or support of 1 person, will be randomly allocated to 2 groups: the LE-CIT group or the control group (intensive conventional therapy). People will be excluded if they have speech deficits that render them unable to understand and/or answer properly to evaluation scales and exercises selected for the protocol and/or if they have suffered any clinical event between the screening and the beginning of the protocol. Outcome will be assessed at baseline (T0), immediately after the intervention (T1), and after 6 months (T2). The outcome measures chosen for this trial are as follows: 6-min walk test (6minWT), 10-m walk test (10mWT), timed up and go (TUG), 3-D gait analysis (3DGA), Mini Balance Evaluation Systems Test (Mini-BESTest), and as a secondary measure, Lower Extremity Motor Activity Log will be evaluated (LE-MAL). The participants in both groups will receive 15 consecutive days of daily exercise. The participants in the LE-CIT group will be submitted to this protocol 2.5 h/day for 15 consecutive days. It will include (1) intensive supervised training, (2) use of shaping as strategy for motor training, and (3) application of a transfer package (plus 30 min). The control group will receive conventional physiotherapy for 2.5 h/day over 15 consecutive days (the same period as the CIT intervention). Repeated measures analyses will be made to compare differences and define clinically relevant changes between groups. RESULTS: Data collection is currently on-going and results are expected in 2021. DISCUSSION: LE-CIT seems to be a good protocol for inclusion into stroke survivors' rehabilitation as it has all the components needed for positive results, as well as intensity and transference of gains to daily life activities. TRIAL REGISTRATION: www.ensaiosclinicos.gov.br RBR-467cv6 . Registered on 10 October 2017. "Effects of Lower Extremities - Constraint Induced Therapy on gait and balance function in chronic hemipretic post-stroke patients".

Comparison between semitendinosus transfer to distal femur and medial hamstrings surgical lengthening for treatment of flexed knee gait in cerebral palsy.

PURPOSE: Hamstrings surgical lengthening (HSL) has been frequently used for the treatment of flexed knee gait in cerebral palsy; however, recurrence of knee flexion deformity (KFD) and increase of anterior pelvic tilt (APT) were reported in a long-term follow-up. RESEARCH QUESTION: The aim of this study was to compare semitendinosus transfer to distal femur (STTX) and semitendinosus surgical lengthening (STL) regarding the reduction of KFD and the increase of APT after flexed knee gait treatment. METHODS: One hundred and eleven patients were evaluated and they were divided into two groups according to surgical procedures at knees: group A (65 patients/130 knees), including patients who received medial HSL as part of multilevel approach; group B (46 patients/92 knees), represented by patients who underwent orthopedic surgery including an STTX instead of STL. RESULTS: Fixed knee flexion deformity (FKFD) decreased only in group B (from 6.79° to 2.96°, p < 0.001) after intervention. In kinematics, APT increased from 16.38° to 19.03° in group A (p = 0.003), while group B also increased from 15.26° to 20.59° (p < 0.001). The minimum knee flexion in stance phase (MKFS) reduced from 25.34° to 21.65° (p = 0.016) in group A and from 31° to 19.57° (p < 0.001) in group B. In the comparison between groups A and B, the increase of APT (p = 0.028) and reduction of FKFD (p < 0.001), popliteal angle (p = 0.001), bilateral popliteal angle (p = 0.003) and MKFS (p = 0.006) were higher after STTX than STL. CONCLUSION: In the present study, patients who received STTX exhibited more improvement of knee extension at clinical examination and during gait than those who underwent to STL; however, STTX was not effective to prevent the increase of APT after flexed knee gait treatment.

O trabalho mecânico segmentar como novo instrumento de avaliação do controle postural / The segmentary mechanical work as a new instrument to postural control evaluation

Objetivo: Calcular o trabalho mecânico (W), aplicando o trabalho mecânico total (Wtot) e o trabalho segmentar (Wseg) como um novo recurso de avaliação complementar dos mecanismos de controle postural em sujeitos submetidos a perturbação motora e visual. Método: Dez voluntários adultos saudáveis do sexo masculino foram selecionados com idade 25,6 (± 2,26) anos, cuja altura era de 1,69 (± 0,25) m e peso corporal de 68,22 (± 0,25) kg. Os dados cinemáticos da extensão do tronco com os olhos abertos e vendados foram capturados com frequência de 200 Hz. Dessa forma, foi selecionado o intervalo pós-perturbação e o Wseg (tronco, cabeça, etc) e o trabalho mecânico total (Wtot) calculados, que foram obtidos por meio de energia mecânica total integral. Resultados: A análise estatística das informações foi feita pelo teste t student para dados emparelhados. Não houve diferença significativa (p<0,08) para a Wtot durante o intervalo pós-perturbação. Por outro lado, houve uma diferença significativa (p<0,05) no intervalo pós-perturbação de Wseg. Entretanto, houve diferenças significativas no intervalo (p<0,05). Esta diferença está relacionada com Wseg de cabeça (Wcabeça) e membros inferiores (Wperna e Wcoxa ) no intervalo pós-perturbação com intervalo inicial de [0. 60] ms e [0. 100] ms após a auto-perturbação. Conclusão: Essas diferenças encontradas em Wcabeça entre as duas condições podem estar associadas a modulações do sistema vestibulo-ocular-motor. Por outro lado, as diferenças encontradas em Wperna e Wcoxa podem ser associadas a mecanismos de ajuste somato-sensorial.

Objectie: Calculate the mechanical work (W), applying the total mechanical work (Wtot) and segmental work (Wseg) as a new complementary evaluation resource of the postural control mechanisms in subjects undergoing motor and visual disturbance. Methods: Ten healthy adult male volunteers were selected with ages 25.6 (±2.26) years, whose height was 1.69 (± 0.25) m and body weight was 68.22 (± 0.25) kg. Kinematic data of trunk extension with eyes open and blindfolded were captured with a frequency of 200 Hz. This way the post perturbation interval has been selected and the Wseg (i.e. trunk, head, etc) and the total mechanical work (Wtot) calculated, which were obtained by means of total integral mechanical energy. Results: The statistical analyzing of information was done by paired-data Student's t test. There has been no significant difference (p<0,08) for the Wtot during the post perturbation interval. On the other hand, there has been a significant difference (p<0.05) in the post perturbation interval of Wseg. However, there were significant differences in interval (p<0.05). This difference is related to Wseg of head (Whead) and lower limbs (Wleg and Wthigh ) in the post-perturbation interval with early range of [0. 60] ms and [0. 100] ms after the self-perturbation. Conclusion: These differences that were found in Whead between the two conditions can be associated with modulations of the vestibulo-ocular-motor system. On the other hand, the differences that were found in Wleg and Wthigh can be associated with somato-sensory adjustment mechanisms.

The effect of the Majestro-Frost procedure on internal hip rotation during gait in patients with cerebral palsy.

BACKGROUND: Muscle imbalance is related to persistent internal hip rotation (IHR) after femoral derotation osteotomy (FDO) in cerebral palsy (CP). The aim of this study was to evaluate the effect of the Majestro-Frost soft tissue procedure (MFP), which potentially addresses muscle imbalance, on IHR in CP patients during walking. METHODS: A retrospective study of an existing database (medical records and gait laboratory data) was conducted and a search was performed using the following inclusion criteria: (1) diagnosis of spastic CP, (2) GMFCS levels I-III; (3) mean IHR during stance phase higher than 11° at baseline; (4) individuals who received single event multilevel orthopedic surgery in the lower limbs and had three-dimensional gait analyses (3DGA) before and after the intervention. Patients who underwent a FDO were excluded. Eighty-three individuals were considered for the study and they were divided into two groups: No MFP (45 patients who did not receive a MFP) and MFP (36 patients who underwent a MFP). A full clinical examination and 3DGA, with kinematics calculated according to a standard software procedure (Plugin Gait), were performed before and after the intervention, and the results were compared. RESULTS: The studied groups matched regarding demographic data and GMFCS distribution. The mean follow-up time was more than 20 months on both groups. The increase of clinical external hip rotation (EHR) on physical examination was observed only in the MFP group (from 26.4° to 33°, p = 0.002). During gait analysis, IHR decreased from 21.2° to 4.5° in the MFP group (p < 0.001) and from 16.9° to 7.9° in the No MFP group (p < 0.001). The reduction of IHR during gait was more significant in the MFP group (p = 0.001). SIGNIFICANCE: In the present study, patients who underwent a MFP showed more reduction of IHR during gait than those which did not undergo a MFP.

The increase of anterior pelvic tilt after crouch gait treatment in patients with cerebral palsy.

BACKGROUND: The increase of anterior pelvic tilt (APT) has been described after the treatment of crouch gait in cerebral palsy (CP). The ideal treatment option for flexed knee gait in CP should provide knee extension improvement in the stance phase without generating the increase of APT. RESEARCH QUESTION: The purpose of this study was to compare three different approaches used for the treatment of crouch gait in CP [distal femur extension osteotomy (DFEO), patellar tendon shortening (PTS) and the combination of DFEO +PTS] regarding the increase of APT after the interventions. METHODS: The inclusion criteria were: (1) diagnosis of spastic diplegic CP, (2) GMFCS levels I-III, (3) patients who underwent DFEO and/or PTS and (4) with complete documentation in the gait laboratory before and after the intervention. The included patients were divided into 3 groups, according to the procedures performed for crouch gait treatment: PTS (19 patients), DFEO (54 patients) and PTS + DFEO (22 patients). RESULTS: During stance phase, knee flexion decreased from 41.60 to 13.60 in the PTS group (p < 0.001), from 46.00 to 30.70 in the DFEO group (p < 0.001) and from 52.30 to 29.50 in the PTS + DFEO group (p < 0.001). APT increased 140 (p < 0.001) in the PTS group, 7.1° (p < 0.001) in the DFEO group and 6.60 (p < 0.001) in the PTS + DFEO group after surgical intervention. The PTS group presented a more significant deterioration of pelvic tilt than the DFEO (p = 0.002) and PTS + DFEO (p = 0.001) groups. The increase of APT was higher when HSL was also performed in the PTS + DFEO group (p = 0.016). SIGNIFICANCE: The increase of APT was observed in all studied groups, but it was more significant for those who underwent a PTS. The inclusion of HSL in the surgical plan was related a higher increase of APT in the PTS + DFEO group.

Correlation between physical examination and three-dimensional gait analysis in the assessment of rotational abnormalities in children with cerebral palsy.

Objective To evaluate the correlation between physical examination data concerning hip rotation and tibial torsion with transverse plane kinematics in children with cerebral palsy; and to determine which time points and events of the gait cycle present higher correlation with physical examination findings. Methods A total of 195 children with cerebral palsy seen at two gait laboratories from 2008 and 2016 were included in this study. Physical examination measurements included internal hip rotation, external hip rotation, mid-point hip rotation and the transmalleolar axis angle. Six kinematic parameters were selected for each segment to assess hip rotation and shank-based foot rotation. Correlations between physical examination and kinematic measures were analyzed by Spearman correlation coefficients, and a significance level of 5% was considered. Results Comparing physical examination measurements of hip rotation and hip kinematics, we found moderate to strong correlations for all variables (p<0.001). The highest coefficients were seen between the mid-point hip rotation on physical examination and hip rotation kinematics (rho range: 0.48-0.61). Moderate correlations were also found between the transmalleolar axis angle measurement on physical examination and foot rotation kinematics (rho range 0.44-0.56; p<0.001). Conclusion These findings may have clinical implications in the assessment and management of transverse plane gait deviations in children with cerebral palsy.

Correlation between physical examination and three-dimensional gait analysis in the assessment of rotational abnormalities in children with cerebral palsy / Correlação entre exame físico e análise tridimensional da marcha na determinação dos desvios rotacionais em crianças com paralisia cerebral

Abstract Objective To evaluate the correlation between physical examination data concerning hip rotation and tibial torsion with transverse plane kinematics in children with cerebral palsy; and to determine which time points and events of the gait cycle present higher correlation with physical examination findings. Methods A total of 195 children with cerebral palsy seen at two gait laboratories from 2008 and 2016 were included in this study. Physical examination measurements included internal hip rotation, external hip rotation, mid-point hip rotation and the transmalleolar axis angle. Six kinematic parameters were selected for each segment to assess hip rotation and shank-based foot rotation. Correlations between physical examination and kinematic measures were analyzed by Spearman correlation coefficients, and a significance level of 5% was considered. Results Comparing physical examination measurements of hip rotation and hip kinematics, we found moderate to strong correlations for all variables (p<0.001). The highest coefficients were seen between the mid-point hip rotation on physical examination and hip rotation kinematics (rho range: 0.48-0.61). Moderate correlations were also found between the transmalleolar axis angle measurement on physical examination and foot rotation kinematics (rho range 0.44-0.56; p<0.001). Conclusion These findings may have clinical implications in the assessment and management of transverse plane gait deviations in children with cerebral palsy.

Resumo Objetivo Avaliar a correlação entre dados do exame físico relativos à rotação do quadril e torção tibial com a cinemática do plano transverso em crianças com paralisia cerebral; e determinar quais pontos no tempo e eventos do ciclo de marcha apresentam maior correlação com achados do exame físico. Métodos Um total de 195 crianças com paralisia cerebral vistas em dois laboratórios de marcha, de 2008 a 2016, foi incluído neste estudo. As medidas do exame físico incluíram rotação interna do quadril, rotação externa do quadril, ponto médio da rotação do quadril e ângulo do eixo transmaleolar. Foram selecionados seis parâmetros cinemáticos para cada segmento, para avaliar a rotação do quadril e a do pé em relação à perna durante a marcha. As correlações entre exame físico e medidas cinemáticas foram analisadas por coeficientes de correlação de Spearman, e considerou-se um nível de significância de 5%. Resultados Comparando as medidas da rotação do quadril e da cinemática do quadril, encontramos correlações moderadas a fortes para todas as variáveis (p<0,001). Os coeficientes mais altos foram observados entre o ponto médio da rotação do quadril no exame físico e a rotação do quadril na cinemática (rho range: 0,48-0,61). Correlações moderadas também foram encontradas entre a medição do ângulo do eixo transmaleolar no exame físico e a rotação do pé em relação à perna na cinemática (faixa rho: 0,44-0,56; p<0,001). Conclusão Estes achados podem ter implicações clínicas na avaliação e no tratamento de desvios da marcha do plano transverso em crianças com paralisia cerebral.

Postural Control of Healthy Elderly Individuals Compared to Elderly Individuals with Stroke Sequelae.

A stroke and aging process can modify the postural control. We aimed to compare the postural control of health elderly individuals to that of individuals with stroke sequelae. This cross-sectional transversal study was made with individuals capable of walking without any assistance and that were considered clinically stable. The study had 18 individuals in the group with stroke sequelae (SG) and 34 in the healthy elderly control group (CG). The participants were evaluated for the timed up and go test (TUG) and force platform. The SG showed the worst results in relation to the time of execution of the TUG and the force platform evaluation. The displacement of center of pressure was worse for both groups in the eyes-closed situation, especially in the anteroposterior direction for the CG. The GS showed worse results in the static and dynamic postural control. The healthy elderly showed more dependence on sight to maintain their static balance and there was no difference in the balance tests in relation to the side affected by the stroke.

DOES RECTUS FEMORIS TRANSFER INCREASE KNEE FLEXION DURING STANCE PHASE IN CEREBRAL PALSY?

OBJECTIVE: To evaluate whether distal rectus femoris transfer (DRFT) is related to postoperative increase of knee flexion during the stance phase in cerebral palsy (CP). METHODS: The inclusion criteria were Gross Motor Function Classification System (GMFCS) levels I-III, kinematic criteria for stiff-knee gait at baseline, and individuals who underwent orthopaedic surgery and had gait analyses performed before and after intervention. The patients included were divided into the following two groups: NO-DRFT (133 patients), which included patients who underwent orthopaedic surgery without DRFT, and DRFT (83 patients), which included patients who underwent orthopaedic surgery that included DRFT. The primary outcome was to evaluate in each group if minimum knee flexion in stance phase (FMJFA) changed after treatment. RESULTS: The mean FMJFA increased from 13.19° to 16.74° (p=0.003) and from 10.60° to 14.80° (p=0.001) in Groups NO-DRFT and DRFT, respectively. The post-operative FMJFA was similar between groups NO-DRFT and DRFT (p=0.534). The increase of FMJFA during the second exam (from 13.01° to 22.51°) was higher among the GMFCS III patients in the DRFT group (p<0.001). CONCLUSION: In this study, DRFT did not generate additional increase of knee flexion during stance phase when compared to the control group. Level of Evidence III, Retrospective Comparative Study.

DOES RECTUS FEMORIS TRANSFER INCREASE KNEE FLEXION DURING STANCE PHASE IN CEREBRAL PALSY?

ABSTRACT Objective: To evaluate whether distal rectus femoris transfer (DRFT) is related to postoperative increase of knee flexion during the stance phase in cerebral palsy (CP). Methods: The inclusion criteria were Gross Motor Function Classification System (GMFCS) levels I-III, kinematic criteria for stiff-knee gait at baseline, and individuals who underwent orthopaedic surgery and had gait analyses performed before and after intervention. The patients included were divided into the following two groups: NO-DRFT (133 patients), which included patients who underwent orthopaedic surgery without DRFT, and DRFT (83 patients), which included patients who underwent orthopaedic surgery that included DRFT. The primary outcome was to evaluate in each group if minimum knee flexion in stance phase (FMJFA) changed after treatment. Results: The mean FMJFA increased from 13.19° to 16.74° (p=0.003) and from 10.60° to 14.80° (p=0.001) in Groups NO-DRFT and DRFT, respectively. The post-operative FMJFA was similar between groups NO-DRFT and DRFT (p=0.534). The increase of FMJFA during the second exam (from 13.01° to 22.51°) was higher among the GMFCS III patients in the DRFT group (p<0.001). Conclusion: In this study, DRFT did not generate additional increase of knee flexion during stance phase when compared to the control group. Level of Evidence III, Retrospective Comparative Study.

Relationships of Balance, Gait Performance, and Functional Outcome in Chronic Stroke Patients: A Comparison of Left and Right Lesions.

INTRODUCTION: This study compared the balance by center of pressure (COP) and its relationship with gait parameters and functional independence in left (LH) and right (RH) chronic stroke patients. METHODS: In this cross-sectional study, twenty-one hemiparetic stroke patients were assessed for Functional Independence Measure (FIM), balance with a force platform, and gait in the Motion Analysis Laboratory. RESULTS: The amplitudes of the COP in the anteroposterior and mediolateral directions were similar in both groups. The anteroposterior direction was greater than the mediolateral direction. Only the temporal parameters showed any statistically significant differences. The LH showed a significant correlation between stride length, step length, and gait velocity with COP velocity sway for the healthy and paretic lower limbs. In both groups, the area of COP was significantly correlated with stride length. Motor FIM was significantly correlated with the COP in the LH group. CONCLUSION: There was no difference in the performance of balance, gait, and functional independence between groups. The correlation of the COP sway area with stride length in both groups can serve as a guideline in the rehabilitation of these patients where training the static balance may reflect the improvement of the stride length.

Most frequent gait patterns in diplegic spastic cerebral palsy.

OBJECTIVE: To identify gait patterns in a large group of children with diplegic cerebral palsy and to characterize each group according to age, Gross Motor Function Classification System (GMFCS) level, Gait Deviation Index (GDI) and previous surgical procedures. METHODS: ONE THOUSAND EIGHT HUNDRED AND FIVE PATIENTS WERE DIVIDED IN SEVEN GROUPS REGARDING OBSERVED GAIT PATTERNS: jump knee, crouch knee, recurvatum knee, stiff knee, asymmetric, mixed and non-classified. RESULTS: The asymmetric group was the most prevalent (48.8%). The jump knee (9.6 years old) and recurvatum (9.4 years old) groups had mean age lower than the other groups. The lowest GDI (43.58) was found in the crouch group. There were more children classified within GMFCS level III in the crouch and mixed groups. Previous surgical procedures on the triceps surae were more frequent in stiff knee and mixed groups. The jump knee group received less and the stiff-knee group more surgical procedures at hamstrings than others. CONCLUSIONS: The asymmetrical cases were the most frequent within a group of diplegic patients. Individuals with crouch gait pattern were characterized by the lowest GDI and the highest prevalence of GMFCS III, while patients with stiff knee exhibited a higher percentage of previous hamstring lengthening in comparison to the other groups. Level of Evidence III, Retrospective Comparative Study.

Padrões de marcha mais frequentes na paralisia cerebral tipo diparesia espástica / Most frequent gait patterns in diplegic spastic cerebral palsy

Identificar padrões de marcha em um grande grupo de crian-ças com paralisia cerebral (PC) tipo diplegia espástica e caracterizarcada grupo de acordo com a idade, nível do Gross Motor FunctionClassification System (GMFCS) e Gait Deviation Index (GDI) e cirurgiasprévias. Métodos: Foram divididos em sete grupos 1805 pacientescom base nos padrões de marcha observados: joelho saltitante, agachamento,recurvatum, joelho rígido, assimétrico, misto, e não classificável.Resultados: O grupo assimétrico foi o mais prevalente (48,8%).Os grupos joelho saltitante (9,6 anos) e recurvatum (9,4 anos) exibiramidade média menor que os demais grupos. O GDI mais baixo (43,58)foi observado no grupo agachamento. Notaram-se mais pacientesclassificados como nível III do GMFCS nos grupos agachamento emisto. Cirurgias prévias no tríceps sural foram mais frequentes nosgrupos joelho rígido e misto. O grupo joelho saltitante recebeu menornúmero de procedimentos cirúrgicos prévios nos isquiotibais, enquantoque o grupo com joelho rígido recebeu maior número, quandocomparado aos demais. Conclusões: Os casos assimétricos forammais frequentes, mesmo em grupo de pacientes diplégicos. Pacientescom padrão em agachamento foram caracterizados pelo GDI maisbaixo e prevalência do nível III no GMFCS, enquanto que o grupojoelho rígido exibiu uma porcentagem maior de alongamento préviodos isquiotibiais em comparação com os demais grupos. Nível deEvidência III, Estudo Retrospectivo Comparativo...

To identify gait patterns in a large group of childrenwith diplegic cerebral palsy and to characterize each groupaccording to age, Gross Motor Function Classification System(GMFCS) level, Gait Deviation Index (GDI) and previous surgicalprocedures. Methods: One thousand eight hundred and fivepatients were divided in seven groups regarding observed gaitpatterns: jump knee, crouch knee, recurvatum knee, stiff knee,asymmetric, mixed and non-classified. Results: The asymmetricgroup was the most prevalent (48.8%). The jump knee (9.6 yearsold) and recurvatum (9.4 years) groups had mean age lowerthan the other groups. The lowest GDI (43.58) was found in thecrouch group. There were more children classified within GMFCSlevel III in the crouch and mixed groups. Previous surgical procedureson the triceps surae were more frequent in stiff kneeand mixed groups. The jump knee group received less and thestiff-knee group more surgical procedures at hamstrings thanothers. Conclusions: The asymmetrical cases were the most frequentwithin a group of diplegic patients. Individuals with crouchgait pattern were characterized by the lowest GDI and the highestprevalence of GMFCS III, while patients with stiff knee exhibited ahigher percentage of previous hamstring lengthening in comparisonto the other groups. Level of Evidence III, RetrospectiveComparative Study...

Quantificação do equilíbrio pelo videogame: estudo piloto / Balance quantification with videogame: pilot study

Os videogames (VG) de sétima geração propõe uma avaliação física que inclui diversos testes de equilíbrio. Porém não são reportados na literatura os parâmetros utilizados para fornecer a pontuação destes testes e se estes podem ser relacionados a prática clínica e funcionalidade dousuário. Objetivo: O objetivo do presente estudo foi de correlacionar as pontuações obtidas pelos testes da plataforma de equilíbrio do VG Wii® com as variáveis cinéticas fornecidas pela plataformade força, a qual estava integrada a plataforma de equilíbrio do VG. Método: Participaram deste estudo piloto, dois indivíduos com diagnóstico de acidente vascular encefálico (AVE) e dois de traumatismo craniano (TCE). As variáveis cinéticas analisadas foram área, velocidade dedeslocamento e valor quadrático médio da posição média (RMS) nos eixos médio-lateral (x) e antero-posterior (y) do deslocamento do centro de pressão (COP) que foram processadas pelo software Matlab 7.0 e correlacionadas com a pontuação do console pelo coeficiente de Pearson eSpearman, ambos com (p < 0,05). Resultados: Os resultados apresentaram correlação significativa apenas para o SL e RMSy, porém moderada (r = 0,5839). Quando comparada a pontuação do ST com as variáveis Área (r = 0,8164), RMSx (r = -0,6418) e RMSy (r = -0,8094) a correlação foimoderada a forte. Conclusão: Não encontrou-se correlação com nenhum dos testes do console quando comparados com a velocidade de deslocamento do centro de pressão medido na plataforma de força. Conclui-se que a pontuação do VG apresentou correlação significativa comas variáveis cinéticas, porém o método é pouco prático para ser empregado na avaliação clínica.

Seventh generation video games (VG) propose various balancing tests to asses the stability of the user. However, the parameters used to provide the score of these tests are not reported in the literature, nor is their relationship to clinical practice and user functionality. Objective: The objective of this study was to correlate the scores obtained by the balance platform of the Wiivideo game with kinetic variables provided by a force platform in simultaneous measurements. Methods: This pilot study included two subjects with stroke and two with traumatic brain injury. The kinetic variables analyzed were: area, movement speed, and root mean square of center of pressure (COP) position in the medial-lateral and anterior-posterior directions, and were processed in Matlab 7.0® and correlated with the score provided by the console (balancing tests: Single-leg test - SL - and Steadiness test - ST -) using the Pearson and Spearman correlation coefficients, both with p < 0.05. Results: A moderate correlation was found between the SL score and RMSy (r = 0.5839). When comparing the ST score to the variables: area (r = 0.8164), RMSx (r = -0.6418)and RMSy (r = -0.8094) the correlation was moderate to strong. Conclusion: No correlation was found between the console tests and the movement speed of the center of pressure measured on the force platform. It is concluded that the score of VG presented significant correlation withthe kinetic variables, but the method is not practical for being employed in a clinical evaluation.

Análise do controle postural após a aplicação da eletroestimulação funcional no acidente vascular encefálico / Analysis of postural control after the application of functional electrical stimulation in stroke patients

O Acidente Vascular Encefálico (AVE) é o principal acometimento neurológico em adultos no mundo. Pode resultar em déficits neuromotores e cognitivos. Entre os déficits neuromotores observa-se a espasticidade, esta interfere no planejamento dos movimentos e no controle da postura. O sistema de controle da postura é primordial para a independência funcional nas atividades de vida diária e, por isso, é um dos principais objetivos a se atingir em programas de reabilitação. Nestes, diversas condutas terapêuticas visam dar estímulos ao indivíduo para que consiga realizar mais eficientemente os movimentos e controlar a postura. E, entre tantas técnicas, está a estimulação elétrica neuromuscular, a qual contribui para diminuição da espasticidade, além de outros benefícios. Quando utilizada para tarefas funcionais é então denominada estimulação elétrica funcional conhecida como Functional Eletrical Stimulation (FES). Tendo em vista a importância do controle da postura nas atividades de vida diária e as contribuições advindas da FES. Objetivo: o objetivo do presente estudo foi de observar a resposta do controle postural em dois indivíduos com hemiparesia por AVE após a aplicação de FES em um curto período de tempo. Método: o protocolo experimental contou com quatro fases; A: pré FES; B: Imediatamente após a aplicação da FES; C: 45 minutos após a aplicação da FES; D: 90 minutos após aplicação da FES. Em cada fase o participante posicionava-se sobre uma plataforma de força e realizava por três tentativas a tarefa escolhida, o teste do terceiro dedo ao chão. Resultados: o software Matlab 7.0 forneceu a variável de Velocidade média do Centro de Pressão no sentido médio-lateral (Vmx) e ântero-posterior (Vmy). Dessa forma, foi possível constatar que mesmo quando os participantes apresentaram uma redução na Vmx e Vmy estas foram menores que 1%. Conclusão: isto possivelmente indique atividade regulatória postural semelhante a etapa pré FES, e, ainda uma menor atividade...

Strokes cause the main neurological impairments in adults around the world. They can result in neuromotor and cognitive deficits. Among the neuromotor deficits there is spasticity; this affects the planning of movements and posture control. The postural control system is essential for functional independence in daily life activities and is, therefore, one of the main goals to achieve in rehabilitation programs. These programs have various therapeutic elements aimed at providing stimulus to the individual, which help them control their movements and stance more efficiently. Among these techniques is neuromuscular electrical stimulation, which contributes to decreasing spasticity and other benefits. When used for functional tasks it is called Functional ElectricalStimulation (FES). Objective: The purpose of this study was to verify the response of the postural control in two individuals with hemiparesis by stroke after the application of the FES over a short period time. Method: the experimental protocol had four phases. A: pre-FES; B: Immediately after the application of FES; C: 45 minutes after the application of FES; D: 90 minutes after application of FES. In each phase, the participants were positioned on a force platform and made three attempts to do the chosen task: touching the fingertip-to-floor test. Results: The software Matlab 7.0 provided the variable center-of-pressure velocities along the mediolateral (Vmx) and anteroposterior (Vmy) axes. In this way it was possible to see that, even when the participants showed a reduction in Vmx and Vmy, it was by less than 1%. Conclusion: This may indicate postural regulatory activitysimilar to before the application of FES, and even less postural regulatory activity when the centerof-pressure velocities were greater at the start, even 90 minutes after the application of FES.

Comparison of multisensory and strength training for postural control in the elderly.

OBJECTIVE: The objective of this study was to analyze the efficacy of multisensory versus muscle strengthening to improve postural control in healthy community-dwelling elderly. PARTICIPANTS: We performed a single-blinded study with 46 community-dwelling elderly allocated to strength (GS, n = 23; 70.18 ± 4.8 years 22 women and 1 man) and multisensory exercises groups (GM, n = 23; 68.8 ± 5.9 years; 22 women and 1 man) for 12 weeks. METHODS: We performed isokinetic evaluations of muscle groups in the ankle and foot including dorsiflexors, plantar flexors, inversion, and eversion. The oscillation of the center of pressure was assessed with a force platform. RESULTS: The GM group presented a reduction in the oscillation (66.8 ± 273.4 cm(2) to 11.1 ± 11.6 cm(2); P = 0.02), which was not observed in the GS group. The GM group showed better results for the peak torque and work than the GS group, but without statistical significance. CONCLUSION: Although the GM group presented better results, it is not possible to state that one exercise regimen proved more efficacious than the other in improving balance control.

Functional mobility and balance in community-dwelling elderly submitted to multisensory versus strength exercises.

It is well documented that aging impairs balance and functional mobility. The objective of this study was to compare the efficacy of multisensory versus strength exercises on these parameters. We performed a simple blinded randomized controlled trial with 46 community-dwelling elderly allocated to strength ([GST], N = 23, 70.2-years-old +/- 4.8 years) or multisensory ([GMS], N = 23, 68.8-years-old +/- 5.9 years) exercises twice a week for 12 weeks. Subjects were evaluated by blinded raters using the timed 'up and go' test (TUG), the Guralnik test battery, and a force platform. By the end of the treatment, the GMS group showed a significant improvement in TUG (9.1 +/- 1.9 seconds (s) to 8.0 +/- 1.0 s, P = 0.002); Guralnik test battery (10.6 +/- 1.2 to 11.3 +/- 0.8 P = 0.009); lateromedial (6.1 +/- 11.7 cm to 3.1 +/- 1.6 cm, P = 0.02) and anteroposterior displacement (4.7 +/- 4.2 cm to 3.4 +/- 1.0 cm, P = 0.03), which were not observed in the GST group. These results reproduce previous findings in the literature and mean that the stimulus to sensibility results in better achievements for the control of balance and dynamic activities. Multisensory exercises were shown to be more efficacious than strength exercises to improve functional mobility.

Estabilidade postural de adultos jovens na privação momentânea da visão / Postural stability of young adults during momentary absence of vision

Esse trabalho teve como objetivo a análise da estabilidade postural de adultos jovens na privação momentânea da visão (PMV), no movimento de extensão de tronco para a postura ereta. Foi utilizado um sistema de plataformas de força (uma para cada pé), com freqüência de aquisição de 1000 Hz e um sistema de imagens, com freqüência de aquisição de 200 Hz; ambos os sistemas foram sincronizados. Foram obtidas as forças de reação ao solo (FRS) em cada pé de apoio e calculado o centro de pressão (COP: Center of Pressure). Também foi obtido o centro de gravidade (COG: Center of Gravity) por meio da reconstrução tridimensional das 8 câmeras. Os sinais cinéticos e cinemáticos brutos foram filtrados, utilizando filtro Butterworth de 6ª e 4a ordem, respectivamente, com freqüência de corte de 12 Hz. A coleta de dados foi realizada em 10 indivíduos, adultos jovens do sexo masculino, com média de idade de 25,6 ±2,3 anos, sob duas condições visuais: (1) Visão Preservada (VP) e (2) Privação Momentânea da Visão (PMV) e foram realizadas 5 tentativas para cada condição visual. A tarefa de movimento, denominada auto-perturbação, partiu da posição inicial de flexão de tronco (90º) até a postura ereta. Foi definida como variável de estudo a amplitude do módulo do vetor nos intervalos antes da perturbação, perturbação e pós-perturbação, a fim de quantificar o tempo de recuperação da estabilidade no intervalo pós-perturbação. A amplitude do módulo do vetor foi ajustada com uma curva exponencial. Os valores médios obtidos para o tempo de recuperação da estabilidade foram: 779,6 ms (±138,6) para condição VP e 404,8 ms (±170,2) para a condição PMV. Foi aplicado o teste de Kolmogorov-Smirnov para testar a normalidade das variáveis: tempo de recuperação da estabilidade e amplitude pósperturbação (p<0.05)....

Na seqüência foram aplicados os testes: t de Student para dados pareados e ANOVA bidirecional para as 5 tentativas de cada condição visual. Foram constatadas diferenças significativas (P<0,05) para as variáveis analisadas no intervalo de pós-perturbação. Concluiu-se que os indivíduos PMV utilizaram mecanismos de ajustes neuromusculares rápidos quando comparados com indivíduos VP para se estabilizar na postura ereta e não cair.

A quantificação do trabalho mecânico como recurso de avaliação do controle postural / The quantification of mechanical work as a resource for analyzing postural control

O estudo tem por objetivo propor dois métodos de cálculo para a quantificação do trabalho mecânico ( ) como recurso para análise do controle postural em indivíduos submetidos a perturbações motoras, visuais e/ou que estão em processo de reabilitação física. Neste estudo se aborda a quantificação do realizado pelo sistema muscular após a extensão do tronco para postura ereta (auto-perturbação) em indivíduos com visão preservada (VP) e privação momentânea da visão (PMV) por meio de dois métodos denominados: i) Trabalho mecânico total ( ) e ii) Trabalho mecânico do centro de massa ( ). A amostra constituiu-se de 10 voluntários saudáveis, do sexo masculino com idades de 25,6 (± 2,2) anos. Foram realizadas cinco tentativas para cada voluntário em ambas as condições. Para coleta dos dados foi utilizado um sistema de imagem para rastreamento optoeletrônico tridimensional, composto de 8 câmeras de vídeo, com freqüência de captação de 200 Hz. Observou-se pela análise de regressão linear que o e apresentam forte correlação entre as duas condições (r2 = 0,77 para a condição VP e r2 = 0,84 para a condição PMV) e pelo teste t de Student observou-se diferenças estatisticamente significativas (p<0,10) na primeira tentativa entre os voluntários com VP e PMV para o durante o intervalo pós-perturbação, bem como diferenças no nos intervalos [0,80]ms e [0,100]ms. Concluiu-se que os métodos que calculam o e o possibilita investigar o controle postural após perturbações motoras e visuais podendo ser utilizado como recurso na reabilitação física.

This study proposes two methods for calculating the amount of mechanical work ( ) as a resource for analyzing postural control in individuals subject to motor or visual disturbances, and/or are in the process of physical rehabilitation. This study addresses the quantification performed by the muscle after the extension of the trunk to the upright position (self-disturbance) in subjects with preserved vision (VP) and temporary deprivation of vision (PMV) by two methods known as: i) Total Mechanical Work ( ) and ii) Mechanical Work of the Center of Mass ( ). The study sample consisted of 10 healthy volunteers, males aged 25.6 (± 2.2) years. Five trials were performed for each volunteer under both conditions. An imaging system for three-dimensional optoelectronic tracking was used to collect data, consisting of 8 video cameras, with a capture frequency of 200 Hz. The linear regression analysis and showed a strong correlation between the two conditions (r2 = 0.77 for the VP condition and r2 = 0.84 for PMV condition), and the Student?s t-test revealed statistically significant differences (p<0.10) in the first attempt among the volunteers with VP and PMV for during the post-interval disturbance, and differences in in the intervals [0.80]ms and [0.100]ms. It was concluded that the methods to calculate and make it possible to investigate postural control after motor and visual disturbances and may be used as a resource in physical rehabilitation.