Addition of trunk restraint to home-based modified constraint-induced movement therapy does not bring additional benefits in chronic stroke individuals with mild and moderate upper limb impairments: A pilot randomized controlled trial.

BACKGROUND: People with stroke excessively move their trunk, when reaching and grasping objects. OBJECTIVE: To determine if the addition of trunk restraint to modified constraint-induced movement therapy (mCIMT) was better than mCIMT alone in improving strength, function, and quality of life after stroke. METHODS: A pilot randomized double-blinded clinical trial was conducted. Twenty-two participants with chronic stroke were randomly assigned to an experimental group that received mCIMT plus trunk restraint, or a control group (only mCIMT). Primary outcomes were the amount of use and quality of movement of the paretic upper limb (UL), determined by the Motor Activity Log (MAL) scores. Secondary outcomes included the observed performance of the paretic UL during unimanual and bimanual tasks, kinematics of reaching, strength, and quality of life. RESULTS: Both groups demonstrated significant improvements in the MAL scores and in the time to perform bimanual activities immediately after the interventions. However, no between-group differences were observed. CONCLUSIONS: The addition of trunk restraint to mCIMT resulted in no additional benefits, compared with mCIMT alone with stroke individuals with mild to moderate impairments. Unimanual and bimanual improvements were observed after mCIMT, regardless of trunk restraint, and the intervention did not adversely affect their reaching patterns.

Inspiratory muscular weakness is most evident in chronic stroke survivors with lower walking speeds.

BACKGROUND: Respiratory muscular weakness and associated changes in thoracoabdominal motion have been poorly studied in stroke subjects, since the individuals' functional levels were not previously considered in the investigations. AIM: To investigate the breathing patterns, thoracoabdominal motion, and respiratory muscular strength in chronic stroke subjects, who were stratified into two groups, according to their walking speeds. DESIGN: Cross-sectional, observational study. SETTING: University laboratory. POPULATION: Eighty-nine community-dwelling chronic stroke subjects METHODS: The subjects, according to their gait speeds, were stratified into community (gait speed ≥0.8 m/s) and non-community ambulators (gait speed <0.8 m/s). Variables related to pulmonary function, breathing patterns, and thoracoabdominal motions were assessed. Measures of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were obtained and were compared with the reference values for the Brazilian population. The MIP and MEP values were expressed as percentages of the predicted values. Mann-Whitney-U or independent Student t-tests were employed to compare the differences between the two groups for the selected variables. RESULTS: No significant between-group differences were found for the variables related to the breathing patterns and thoracoabdominal motions (0.01 < z/t < 1.51; 0.14

Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: a pilot randomized controlled trial.

BACKGROUND: Upper limb (UL) impairment is the most common disabling deficit following a stroke. Previous studies have suggested that transcranial direct current stimulation (tDCS) enhances the effect of conventional therapies. OBJECTIVE: This pilot double-blind randomized control trial aimed to determine whether or not tDCS, combined with Wii virtual reality therapy (VRT), would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals. METHODS: Twenty participants were randomly assigned either to an experimental group that received VRT and tDCS, or a control group that received VRT and sham tDCS. The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS, and one hour of virtual reality therapy. The outcomes included were determined using the Fugl-Meyer scale, the Wolf motor function test, the modified Ashworth scale (MAS), grip strength, and the stroke specific quality of life scale (SSQOL). Minimal clinically important differences (MCID) were observed when assessing outcome data. RESULTS: Both groups demonstrated gains in all evaluated areas, except for the SSQOL-UL domain. Differences between groups were only observed in wrist spasticity levels in the experimental group, where more than 50% of the participants achieved the MCID. CONCLUSIONS: These findings support that tDCS, combined with VRT therapy, should be investigated and clarified further.

Propriedades psicométricas da versão brasileira da escala de qualidade de vida específica para acidente vascular encefálico: aplicação do modelo Rasch / Psychometric properties of the Brazilian version of the Stroke Specific Quality of Life Scale: application of the Rasch model

CONTEXTUALIZAÇÃO: O acidente vascular encefálico (AVE) produz déficits importantes na qualidade de vida (QV) dos indivíduos. Medidas específicas de QV são necessárias para compreender e quantificar o impacto dessa patologia. OBJETIVO: O objetivo desse estudo foi adaptar transculturalmente o Stroke Specific Quality of Life Scale (SSQOL) para o Português (Brasil) e avaliar suas propriedades psicométricas. MATERIAIS E MÉTODOS: O SSQOL foi traduzido e adaptado seguindo instruções padronizadas e submetido a exame de confiabilidade teste-reteste (10 hemiplégicos). As propriedades psicométricas foram investigadas pela análise Rasch em 50 hemiplégicos. RESULTADOS: Foram detectados coeficientes de confiabilidade de 0,92 para itens e indivíduos. O índice de separação dos hemiplégicos foi 3,34 e dos itens, 3,36, ou seja, os itens separaram as pessoas em pelo menos três níveis de QV e em três níveis de QV - baixa, média e alta. Dos 49 itens, quatro não se enquadram no modelo, o que compromete a validade de constructo do instrumento, embora o padrão errático dos itens se justifique na amostra examinada. CONCLUSÕES: O instrumento mostrou-se clinicamente útil na população avaliada. Novos estudos em populações com outras características já estão em andamento.

BACKGROUND: Stroke results in important deficits, which reduce individuals' quality of life (QOL). Specific QOL measurements are necessary to understand and quantify the impact of this pathological condition. OBJECTIVE: The aim of this study was to make a transcultural adaptation of the Stroke Specific Quality of Life Scale (SSQOL) into Brazilian Portuguese and to assess its psychometric properties. METHODS: The SSQOL was translated and adapted in accordance with standardized procedures and was subjected to test-retest reliability analysis with 10 hemiplegic subjects. The psychometric properties were investigated using Rasch analysis on 50 hemiplegics. RESULTS: Reliability coefficients of 0.92 were found for items and subjects. The separation index for the hemiplegics was 3.34, while, for the items, it was 3.36. These results indicated that the items separated the subjects into at least three levels of QOL: Low, medium, and high. Of the 49 items, four did not fit into the model, which partially invalidated the construct validity of the instrument, although the erratic patterns of these items could also be explained in the present sample. CONCLUSIONS: The instrument was shown to be clinically useful for the assessed population and other studies in populations with other characteristics are now underway.

Percepção da qualidade de vida de indivíduos com doença de parkinson através do PDQ-39 / Perception of quality of life in individuals with Parkinson's disease using the PDQ-39

A Doença de Parkinson (DP) é uma doença crônica e degenerativa do sistema nervoso central que afeta principalmente pessoas acima de 50 anos. Estudos que avaliaram a qualidade de vida (QV) em parkinsonianos revelaram significativo impacto negativo da doença nesses indivíduos. O Parkinson Disease Questionnaire39 (PDQ-39) tem sido indicado como instrumento mais apropriado para avaliação da QV do indivíduo com DP. OBJETIVO: Avaliar a percepção da QV de indivíduos com DP do Ambulatório de Distúrbios do Movimento da Instituição, através do PDQ-39. MÉTODO: Participaram deste estudo indivíduos com diagnóstico de DP, entre os estágios 1 e 3 da escala de Hoehn & Yahr Modificada e com idade igual ou superior a 40 anos. RESULTADOS: Trinta e três indivíduos com média de idade de 64,65 (±10,44) anos e tempo médio de evolução da doença de 9,27 (±4,40) anos participaram deste estudo. A análise descritiva mostrou que a mediana do escore total no PDQ-39 foi 25 por cento, ocorrendo pior percepção da QV nas dimensões "Atividade de Vida Diária (AVD)" (41,67 por cento) e "Mobilidade" (34,32 por cento). Encontrou-se alta associação entre o escore total e a dimensão "Mobilidade" (r s= 0,82) e moderada associação das dimensões "AVD" (r s= 0,68) e "Comunicação" (r s= 0,53) com o escore total. CONCLUSÕES: As limitações motoras relacionadas à mobilidade, AVDs e comunicação possuem relação significativa com a percepção geral da QV dos indivíduos com DP. Estes achados sugerem que programas de reabilitação que tenham como objetivo a melhora da QV na DP devem enfocar tais limitações.

Parkinson's disease (PD) is a chronic degenerative disease of the central nervous system that affects mainly individuals older than 50 years of age. Studies evaluating quality of life (QOL) in individuals with PD have revealed that this disease has a significant negative impact. The Parkinson's Disease Questionnaire-39 (PDQ-39) has been indicated as one of the most appropriate instrument for evaluating QOL in individuals with PD. OBJECTIVE: To evaluate the perception of QOL in individuals with PD at our Institution's outpatient service for movement disorders, using the PDQ-39. METHOD: Individuals with a diagnosis of PD who were aged 40 years and older and classified in stages 1 to 3 of the Modified Hoehn & Yahr scale were included in this study. RESULTS: Thirty-three individuals of mean age 64.65 ± 10.44 years and mean duration of the disease of 9.27 ± 4.40 years participated in this study. The descriptive analysis showed that the median total score in the PDQ-39 was 25 percent, with worst perceptions of QOL in the dimensions of "Activities of Daily Living" (ADL) (41.67 percent) and "Mobility" (34.32 percent). A high association was found between the total score and the dimension of "Mobility" (r s= 0.82) and a moderate association between the total score and the dimensions of "ADL" (r s= 0.68) and "Communication" (r s = 0.53). CONCLUSIONS: Motor limitations relating to mobility, ADL and communication were significantly related to the general perception of QOL among individuals with PD. These findings suggest that rehabilitation programs aiming to improve QOL among individuals with PD should focus on these limitations.

Cervical spine alignment and hyoid bone positioning with temporomandibular disorders.

The relationships between temporomandibular joint (TMJ) disorders and cervical structure dysfunctions have already been demonstrated. The aim of the present study was to investigate functional and structural alterations of the head and neck of 17 individuals with TMJ disorders (TMD group), compared with a control group of 17 asymptomatic subjects in a cross-sectional design. The outcome variables included pain on palpation of the sternocleidomastoideus, superior trapezius and subocciptal muscles, as well as radiographic measures of alignment of the cervical spine and positioning of the hyoid bone. Cervical alignment, determined by measures of the cervical curvature angle, was investigated by the Cobb method. Independent Student t-tests were used to investigate differences between groups for all outcome variables (alpha < 0.05). The results demonstrated that individuals with TMJ disorders, when compared with asymptomatic subjects, presented higher levels of perception of pain in all cervical muscles (P < 0.0001). No significant differences were found between groups for the cervical alignment measures. In the TMD group, the position of the hyoid bone in relation to the cervical spine did not appear to be different from the control group.

Estudo da relação entre o comprimento da banda iliotibial e o desalinhamento pélvico / Study on the relationship between iliotibial band length and pelvic misalignment

CONTEXTUALIZAÇÃO: Desalinhamentos pélvicos, como a inclinação lateral, ocasionam diferentes disfunções e queixas de dor. Na literatura, são apontados diversos fatores associados à inclinação lateral da pelve, sendo um deles o comprimento da banda iliotibial. OBJETIVO: Verificar a existência de correlação entre o comprimento da banda iliotibial e o desalinhamento pélvico no plano frontal. MÉTODO: Trinta e dois indivíduos (22,5 ± 2,6 anos) de ambos os sexos, assintomáticos, sem diferença no comprimento dos membros inferiores e sem torção pélvica, foram incluídos no estudo. Para a medida do comprimento da banda iliotibial, utilizou-se o teste de Ober modificado, um nível pélvico e um inclinômetro e, para determinar o desalinhamento pélvico no plano frontal, foram utilizadas medidas de estruturas pélvicas obtidas por um antropômetro com o indivíduo posicionado em um instrumento de suporte de padronização. O Coeficiente de correlação de Pearson foi utilizado para investigar a associação entre as variáveis analisadas: o desalinhamento pélvico no plano frontal, determinado pela diferença da altura da espinha ilíaca ântero-superior mais elevada menos a altura da mais baixa e o comprimento da banda iliotibial, determinado pela diferença entre o comprimento da banda iliotibial correspondente à espinha ilíaca ântero-superior mais elevada menos o comprimento da mesma estrutura correspondente a espinha mais baixa. RESULTADOS: Não foi encontrada correlação estatisticamente significativa entre as variáveis analisadas (r=0,12, p=0,53). CONCLUSÃO: Os achados do presente estudo indicam que o comprimento da banda iliotibial, isoladamente, parece não influenciar o alinhamento pélvico no plano frontal. Entretanto, outros fatores podem estar envolvidos e precisam ser identificados.

BACKGROUND: Pelvic misalignments such as lateral pelvic tilt may lead to dysfunctions and pain complaints. Studies in the literature have indicated several factors associated with lateral pelvic tilt, and one of these is the length of the iliotibial band. OBJECTIVE: Investigate the presence of an association between iliotibial band length and frontal plane pelvic tilt. METHOD: Thirty-two asymptomatic individuals of both sexes (22.5 ± 2.6 years), without leg-length differences or pelvic torsion, were included in the study. The modified Ober test, performed with a pelvic level and an inclinometer, was used to assess the iliotibial band length. To determine the pelvic misalignment in the frontal plane, the individual was positioned on standard support equipment and pelvic structure measurements were obtained using an anthropometer. Pearson's correlation coefficient was utilized to determine the degree of association between pelvic misalignment in the frontal plane (established as the difference in height between higher and lower anterosuperior iliac spines) and the length of the iliotibial band (established as the difference in iliotibial band lengths corresponding to the higher and lower anterosuperior iliac spines). RESULTS: No statistically significant correlations were found between the variables analyzed (r=0.12; p=0.53). CONCLUSION: The present findings indicate that iliotibial band length alone does not appear to influence frontal plane pelvic alignment. Other factors may be involved and these still need to be identified.

Fatores associados à adesão ao uso de palmilhas biomecânicas / Factors related to compliance with biomechanical insole use

CONTEXTUALIZAÇÃO: Os benefícios das palmilhas biomecânicas no tratamento de acometimentos nos membros inferiores têm sido relatados. No entanto, observa-se na prática uma baixa adesão ao uso dessa órtese, comprometendo os benefícios que poderiam ser proporcionados. OBJETIVO: Investigar os fatores relacionados à adesão ao uso de palmilhas biomecânicas. MÉTODO: Participaram deste estudo 33 indivíduos (43,97 ± 14,73 anos) para os quais foram confeccionadas palmilhas biomecânicas. Um questionário contendo questões a respeito da palmilha e seu uso foi aplicado, em forma de entrevista, sendo as variáveis de estudo estabelecidas a partir dessas questões. Com base nos resultados obtidos, os indivíduos foram separados em 4 grupos, de acordo com o nível de adesão: adesão total, adesão parcial, adesão inconstante e não-adesão. Utilizou-se o teste "Kruskal-Wallis" para investigar se esses grupos diferiam entre si em relação às variáveis pesquisadas. Coeficientes de Correlação de Spearman foram utilizados para verificar possíveis correlações entre essas variáveis e adesão. RESULTADOS: Dos 33 participantes, 15,2 por cento tiveram adesão total, enquanto 42,4 por cento abandonaram a palmilha. Comparando-se os 4 grupos de adesão em relação às variáveis pesquisadas, observou-se diferença significativa para conforto da palmilha (p=0,003), grau de melhora atribuído à palmilha (p=0,006) e grau de conhecimento sobre o problema (p<0,002). Correlações significativas (r s=0,58; p<0,001 e r s=0,50; p<0,01) foram observadas entre adesão e conforto e grau de melhora atribuído à palmilha, respectivamente. CONCLUSÃO: Resultados do presente estudo revelaram que conforto e grau de melhora atribuído à palmilha podem influenciar na adesão ao uso dessas órteses, constituindo-se fatores importantes para o sucesso do tratamento.

BACKGROUND: The benefits of biomechanical insoles for treating lower limb impairment have been reported. However, in clinical practice, low compliance with the use of such orthoses has been observed, which detracts from the possible benefits. OBJECTIVE: To investigate the factors related to compliance with biomechanical insole use. METHOD: Thirty-three subjects (aged 44 ± 14.7 years) for whom biomechanical insoles had been molded took part in this study. A questionnaire asking about the insoles and their use was applied through interviews. The study variables were established from these questions. Based on the results obtained, the participants were divided into four groups according to their compliance level: full compliance, partial compliance, irregular compliance and non-compliance. The Kruskal-Wallis test was utilized to assess differences between these groups regarding the variables investigated. Spearman correlation coefficients were utilized to investigate possible relationships between these variables and the compliance. RESULTS: Among the 33 participants, 15.2 percent were fully compliant, while 42.4 percent abandoned the insoles. Comparing the four compliance groups in relation to the variables investigated, significant differences were observed regarding insole comfort (p=0.003), improvement attributed to the insoles (p=0.006), and degree of knowledge of the problem (p<0.002). Significant correlations (r s=0.58; p<0.001; and r s=0.50; p<0.01) were observed between compliance and the comfort and improvement attributed to the insoles, respectively. CONCLUSION: The findings from this study revealed that the comfort and degree of improvement attributed to the insoles may influence the compliance with the use of these orthoses. These factors are important for the success of the treatment.

Treinamento fisico e destreinamento em hemiplegicos cronicos: impacto na qualidade de vida / Physical training and detraining among chronic stroke surviors: impact on quality of life

A alta incidencia de Acidentes Vasculares Encefalicos (AVE), a significativa taxa de sobrevida e a permanencia de incapacidades pos-AVE justificam a importancia de avaliar a qualidade de vida desses pacientes a (QV). Objetivo: avaliar os ganhos na QV de hemiple cronicos comunitarios apos a realizacao de um programa de treinamento fisico em grupo e apontar os dominios de QV significativamente responsaveis por tais ganhos. Metodo: 30 individuos de ambos os sexos realizaram 30 sessoes de um programa de treinamento fisico envolvendo atividades aerobicas associadas a exercicios de musculacao e foram avaliados antes e imediatamente apos a intervencao. Desses, 22(57,66+=11,95 anos0 foram reavaliados apos um ano do termino das atividades (follow-up). A QV foi investigada nas tres avaliacoes mediante o Perfil de Saude de Nottingham, questionario com seis dominios de QV...

Assimetria e desempenho funcional em hemiplegicos cronicos antes e apos programa de treinamento em academia / Asymmetriy and functional performance among chronic hemiplegic individuals before and after a training program in a fitness center

E bem documentado que hemiplegicos apresentam assimetria, fraqueza muscular e baixa tolerancia ao exercicio. Tradicionalmente, programas de reabilitacao procuram focar a melhora da simetria corporal como objetivo do tratamento, entretanto, os ganhos funcionais que isso representa nao sao bem estabelecidos. Objetivo: avaliar os comportamentos da simetria e do desempenhofuncional e a relacao entre o grau de assimetria e de desempenho funcional antes e apos o treinamento de hemiplegicos utilizando a musculacao e o condicionamento aerobico. Metodos: trinta participantes com media de idade de 56,36+-10,86 anos e tempo de evolucao pos-AVC variando de 1 a 14 anos foram avaliados antes e apos o treinamento. As medidas de simetria foram obtidas em ortostatismo, durante o movimento de passar de sentado para de pe e durante a marcha pelo Balance Master, enquanto o desempenho funcional foi avaliado por meio da velocidade natural da marcha e da habilidade para subir escadas. Estatistica descritiva, testes de normalidade, testes t pareados e coeficientes de correlacao de Pearson foram utilizados para essa analise. Resultados: apos o treinamento, melhoras significativas foram observadas apenas nas medidas de desempenho funcional (p<0,001), sem alteracao significativa de nenhum dos valores de simetria. Alem diss, nao foram observadas correlacoes significativas entre as variaveis funcionais e de simetria (r=0,12-0,27). Conclusoes: os achados indicaram que medidas de simetria nao se mostraram sensiveis para demonstrar mudancas associadas ao treinamento, sugerindo que esse parametro pode ser um desfecho relevante no processo de reabilitacao para obter ganhos funcionais em hemiplegicos cronicos

Musculacao e condicionamento aerobico em hemiplegicos: impacto no desempenho motor / Strengthening and aerobic conditioning in stroke: impact on motor performance

O objetivo deste estudo foi avaliar o impacto de um programa de condicionamento aerobico e fortalecimento muscular utilizando a musculacao como recurso, no desempenho motor de individuos emiplegicos cronicos. trinta participantes (17 homens e 13 mulheres) com media de idade de 56,36+-10,86 anos, com tempo medio de evolucao pos-AVC variando de 1 a 14 anos, foram avaliados antes e apos treinamento. O programa de treinamento, de 30 sessoes (3 vezes/semana), consisitiu em sessoes supervisionadas de exercicios subdivididas em periodos de aquecimento, exercicios aerobicos, fortalecimento por meio da musculacao e rsefriamento. Medidas de toque dos principasi grupos musculares dos membros inferiores e tronco, de espaticidade do quadriceps, flexores plantares e flexores do cotovelo e punho e medidas de simetria foram utilizadas para avaliar o impacto do programa. Apos o treinamento, foram observados valores de torque significativamente maiores que os iniciais em todos os grupos musculares avaliados, sendo os ganhos observados no lado afetado (35,85 por cento) maiores que os do lado naoa fetado (27,42 por cento) sem aumento concomitante do grau de espasticidade. Alem disso, foi observada melhora significativa (p=0,019) na simetria na posicao ortostatica. A musculacao mostrou-se alternativa viavel na melhora do desempenho motor em pacientes hemiplegicos cronicos

Effects of muscle strengthening and physical conditioning training on temporal, kinematic and kinetic variables during gait in chronic stroke survivors.

The purpose of this study was to evaluate the impact of a combined program of muscle strengthening and physical conditioning on gait performance in subjects with chronic stroke, using a single group pre- and post-test design. Thirteen subjects were recruited for the 10-week program (3 days/week), which consisted of warm-up, aerobic exercises, lower extremity muscle strengthening and cool-down. Data from cinematographic film and a force plate obtained during multiple walking trials were used in a four-segment kinetic model to yield spatiotemporal, kinematic and kinetic variables. Gait analysis revealed that the 10 week training resulted in significant increases in gait speed associated with improvements in walking patterns as determined by increases in selected kinematic and kinetic measures. After training, subjects were able to generate higher levels of powers and demonstrated increases in positive work performed by the ankle plantar flexor and hip flexor/extensor muscles.

Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors.

OBJECTIVE: To evaluate the impact of a program of muscle strengthening and physical conditioning on impairment and disability in chronic stroke subjects. DESIGN: A randomized pretest and posttest control group, followed by a single-group pretest and posttest design. SUBJECTS: Thirteen community-dwelling stroke survivors of at least 9 months. INTERVENTION: A 10-week (3 days/week) program consisting of a warm-up, aerobic exercises, lower extremity muscle strengthening, and a cool-down. MAIN OUTCOME MEASURES: Peak isokinetic torque of the major muscle groups of the affected lower limb, quadriceps and ankle plantarflexor spasticity, gait speed, rate of stair climbing, the Human Activity Profile (HAP), and the Nottingham Health Profile (NHP) were recorded twice for the treatment group and three times for the control group. RESULTS: Significant improvements were found for all the selected outcome measures (HAP, NHP, and gait speed) for the treatment group (p < .001). In terms of overall training effects, the 13 subjects demonstrated increases in strength of the affected major muscle groups, in HAP and NHP profiles, and in gait speed and rate of stair climbing without concomitant increases in either quadriceps or ankle plantarflexor spasticity. CONCLUSIONS: The 10-week combined program of muscle strengthening and physical conditioning resulted in gains in all measures of impairment and disability. These gains were not associated with measurable changes of spasticity in either quadriceps or ankle plantarflexors.