Alessandra Ferreira Barbosa

The competition with a concurrent cognitive task affects posturographic measures in patients with Parkinson disease

OBJECTIVES To estimate the impact of a sensory-motor- cognitive task on postural balance, in Parkinson disease patients (Hoehn and Yahr 2-3) and to investigate possible relationships between posturography and functional balance clinical scales. METHOD Parkinson disease patients (n = 40) and healthy controls (n = 27) were evaluated with fluency tests, Berg Balance scale, Mini Best test and static posturography on the conditions eyes open, eyes closed and dual-task (simultaneous balance and fluency tasks). RESULTS Posturographic data showed that Parkinson disease patients performed worse than controls in all evaluations. In general, balance on dual-task was significantly poorer than balance with eyes closed. Posturographic data were weakly correlated to clinical balance scales. CONCLUSION In clinical practice, Parkinson disease patients are commonly assessed with eyes closed, to sensitize balance. Our study showed that adding a cognitive task is even more effective. Static posturographic data should be carefully overgeneralized to infer functional balance impairments.

Postural control in women with breast hypertrophy

OBJECTIVES: The consequences of breast hypertrophy have been described based on the alteration of body mass distribution, leading to an impact on psychological and physical aspects. The principles of motor control suggest that breast hypertrophy can lead to sensorimotor alterations and the impairment of body balance due to postural misalignment. The aim of this study is to evaluate the postural control of women with breast hypertrophy under different sensory information conditions. METHOD: This cross-sectional study included 14 women with breast hypertrophy and 14 without breast hypertrophy, and the mean ages of the groups were 39±15 years and 39±16 years, respectively. A force platform was used to assess the sensory systems that contribute to postural control: somatosensory, visual and vestibular. Four postural conditions were sequentially tested: eyes open and fixed platform, eyes closed and fixed platform, eyes open and mobile platform, and eyes closed and mobile platform. The data were processed, and variables related to the center of pressure were analyzed for each condition. The Kruskal-Wallis test was used to compare the conditions between the groups for the area of center of pressure displacement and the velocity of center of pressure displacement in the anterior-posterior and medial-lateral directions. The alpha level error was set at 0.05. RESULTS: Women with breast hypertrophy presented an area that was significantly higher for three out of four conditions and a higher velocity of center of pressure displacement in the anterior-posterior direction under two conditions: eyes open and mobile platform and eyes closed and mobile platform. CONCLUSIONS: Women with breast hypertrophy have altered postural control, which was demonstrated by the higher area and velocity of center of pressure displacement.

Gait, posture and cognition in Parkinson's disease

Gait disorders and postural instability are the leading causes of falls and disability in Parkinsons disease (PD). Cognition plays an important role in postural control and may interfere with gait and posture assessment and treatment. It is important to recognize gait, posture and balance dysfunctions by choosing proper assessment tools for PD. Patients at higher risk of falling must be referred for rehabilitation as early as possible, because antiparkinsonian drugs and surgery do not improve gait and posture in PD.

Combined auditory and visual cueing provided by eyeglasses influence gait performance in Parkinson Disease patients submitted to deep brain stimulation: a pilot study

Background: Auditory-visual cueing using portable cueing devices has been effective for gait training in rehabilitation programs with Parkinson patients. However, it is possible that some gait problems arise due to interference from chronic high frequency stimulation with the gait and balance neural networks in patients with Parkinson Disease. Thus, it should be useful to test whether advanced Parkinson Disease patients experiencing gait problems (despite the treatment with medication and high frequency deep brain stimulation) would benefit from therapy using cueing. Methods: Eyeglasses combining auditory-visual cueing were used with 18 patients with advanced Parkinson Disease and treated with medication and deep brain stimulation. Patients were assessed using the Dynamic Gait Index, Timed Up and Go and Six-Minute Walking Test and performance was measured with and without the cueing (with and without eyeglasses on). Results: One way ANOVA on the performance measures indicated that Dynamic Gait Index and Six-Minute Walking Test significantly improved in the cued condition. Since cueing was task specific, and Timed Up and Go includes subtasks such sitting and standing, the combined auditory-visual cueing did not improve performance on such tasks. Conversely, the combined cueing may have worked as distractors during these subtasks. Conclusion: Combined auditory-visual cueing provided by this wearable technology may have practical applicability in rehabilitation therapy. It provided additional benefits on gait in patients with advanced Parkinson Disease with deep brain stimulation in the subthalamic nucleus.

Relationship Between Posturography, Clinical Balance and Executive Function in Parkinson´s Disease

ABSTRACT This study aimed to evaluate the relationship between posturography, clinical balance, and executive function tests in Parkinson´s disease (PD). Seventy-one people participated in the study. Static posturography evaluated the center of pressure fluctuations in quiet standing and dynamic posturography assessed sit-to-stand, tandem walk, and step over an obstacle. Functional balance was evaluated by Berg Balance Scale, MiniBESTest, and Timed Up and Go test. Executive function was assessed by Trail Making Test (TMT) and semantic verbal fluency test. Step over obstacle measures (percentage of body weight transfer and movement time) were moderately correlated to Timed Up and Go, part B of TMT and semantic verbal fluency (r > 0.40; p < 0.05 in all relationships). Stepping over an obstacle assesses the responses to internal perturbations. Participants with shorter movement times and higher percentage of body weight transfer (higher lift up index) on this task were also faster in Timed Up and Go, part B of TMT, and semantic verbal fluency. All these tasks require executive function (problem solving, sequencing, shifting attention), which is affected by PD and contribute to postural assessment.

Matching pairs difficulty in children with spinal muscular atrophy type I

This study aimed to investigate the performance on pair-matching tasks in children with Spinal Muscular Atrophy type I (SMA-I) and the relationship between this performance and motor function, functional independence and quality of life. SMA-I (n = 12; 6.0 ± 2.3 yrs; 9 boys, 3 girls) and control sex-, age-matched children (n = 12; 6.2 ± 2.6 yrs) performed four pair-matching figure, number and letter tasks. The eye tracker detected eye movements. SMA-I children were assessed with CHOP INTEND, Pediatric Evaluation of Disability Inventory, and Pediatric Quality of Life Inventory. Analysis of variance showed that SMA-I children had a lower percentage of correct answers and longer timed performance compared to controls (p < 0.05). Pediatric Evaluation of Disability Inventory score (social function domain) was correlated to the percentage of correct answers on the pair-matching tasks on task 1 (r = 0.81; p = 0.001) and task 2 (r = 0.66; p = 0.020). Pair-matching performance of SMA-I children was poorer than the performance of control children. There was a relationship between pair-matching performance and social function. The restricted interaction with the environment, due to severe paralysis and poor verbal communication, is associated with cognitive difficulties in SMA-I children. The eye tracker was helpful in cognitive assessment of SMA-I children, who responded to the cognitive tests with eye movements.

Avaliação interdisciplinar da diadococinesia: um estudo piloto

Diadococinesia e a capacidade de executar movimentos rapidos, repetidos e alternados. Testes de diadococinesia podem avaliar tanto a fala quanto os membros superiores. O objetivo primario foi apresentar um protocolo interdisciplinar de avaliacao da diadococinesia. Os objetivos secundarios foram comparar o desempenho com os diferentes fonemas do teste de diadococinesia oral (/papapa/, /tatata/, /kakaka/ e /pataka/), comparar o desempenho com as diferentes condicoes do teste de diadococinesia de membros superiores (realizado com ambos os membros superiores de forma espelhada, apenas com o membro superior direito, apenas com o membro superior esquerdo, com ambos os membros superiores de forma alternada) e investigar possiveis relacoes entre diadococinesia oral e de membros superiores. Participaram quinze adultos/idosos saudaveis de 40 a 70 anos. Os dados foram representados por estatistica descritiva. Os numeros de silabas nas condicoes /papapa/, /tatata/, /kakaka/ e /pataka/ e os numeros de movimentos nas condicoes espelhado, direito, esquerdo e alternado foram comparados por ANOVA e correlacionados pelo teste de Pearson. Nao houve diferenca significativa nos resultados entre os fonemas do teste de diadococinesia oral (p<0,001). Houve diferenca entre as condicoes avaliadas no teste de diadococinesia dos membros superiores (p<0,001). O numero de fonemas repetidos esteve correlacionado com o desempenho alternado de membros superiores. Concluiu-se que a correlacao entre os escores dos testes de diadococinesia oral e de membros superiores pode ser explicada pelo fato de a programacao motora e a linguagem estarem predominantemente representadas no hemisferio esquerdo. Areas cerebrais comuns/conectadas ou programas motores em comum podem nortear essas tarefas.

Cognitive or Cognitive-Motor Executive Function Tasks? Evaluating Verbal Fluency Measures in People with Parkinson’s Disease

Introduction Executive function deficits are observed in people with Parkinsons disease (PD) from early stages and have great impact on daily living activities. Verbal fluency and oral diadochokinesia involve phonarticulatory coordination, response inhibition, and phonological processing and may also be affected in people with PD. This study aimed to describe the performance of PD patients and an age- and education-matched control group on executive function, verbal fluency, and oral diadochokinesia tests and to investigate possible relationships between them. Methods Forty people with PD and forty controls were evaluated with Trail Making Test (TMT, executive function) and phonemic/semantic verbal fluency and oral diadochokinesia (/pataka/) tests. Groups were compared by ANOVA and relationships were investigated by Pearson tests. Results People with PD showed longer times in parts A and B of TMT. They also said fewer words in phonemic/semantic verbal fluency tests and less syllables in the diadochokinesia test. Oral diadochokinesia strongly correlated to parts A and B of TMT and to phonemic verbal fluency. Conclusion Oral diadochokinesia was correlated to executive function and verbal fluency. The cognitive-motor interaction in verbal fluency and oral diadochokinesia must be considered not to overestimate the cognitive or motor impairments in people with PD.

Quantificação do equilíbrio pelo videogame: estudo piloto

generation video games (VG) propose various balancing tests to asses stability of the user. However, the parameters used to provide the score of these tests are not reported in the literature, as well as their relation to clinical practice and user functionality. Objective: The objective of this study was to correlate the scores obtained by balancing tests of VG with kinetic variables provided by a force platform in simultaneous measurements. Method: This pilot study included two subjects with stroke and two with traumatic brain injury. Kinetic variables acquired were: area, velocity and root mean square of center of pressure position in the medial-lateral and anterior-posterior directions. Kinetic variables have been 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 correlation coefficient 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 with none of the tests of the console when compared with the velocity of displacement of the center of pressure measured on the force platform. It is concluded that the score of VG presented significant correlation with kinetic variables, but the method is impractical for being employed in clinical evaluation.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 Wii video 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 with the 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

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 Electrical Stimulation (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 activity similar 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.O Acidente Vascular Encefalico (AVE) e o principal acometimento neurologico em adultos no mundo. Pode resultar em deficits neuromotores e cognitivos. Entre os deficits neuromotores observase a espasticidade, esta interfere no planejamento dos movimentos e no controle da postura. O sistema de controle da postura e primordial para a independencia funcional nas atividades de vida diaria e, por isso, e um dos principais objetivos a se atingir em programas de reabilitacao. Nestes, diversas condutas terapeuticas visam dar estimulos ao individuo para que consiga realizar mais eficientemente os movimentos e controlar a postura. E, entre tantas tecnicas, esta a estimulacao eletrica neuromuscular, a qual contribui para diminuicao da espasticidade, alem de outros beneficios. Quando utilizada para tarefas funcionais e entao denominada estimulacao eletrica funcional conhecida como Functional Eletrical Stimulation (FES). Tendo em vista a importância do controle da postura nas atividades de vida diaria e as contribuicoes advindas da FES. Objetivo: O objetivo do presente estudo foi de observar a resposta do controle postural em dois individuos com hemiparesia por AVE apos a aplicacao de FES em um curto periodo de tempo. Metodo: O protocolo experimental contou com quatro fases; A: pre FES; B: Imediatamente apos a aplicacao da FES; C: 45 minutos apos a aplicacao da FES; D: 90 minutos apos aplicacao da FES. Em cada fase o participante posicionava-se sobre uma plataforma de forca e realizava por tres tentativas a tarefa escolhida, o teste do terceiro dedo ao chao. Resultados: O software Matlab 7.0 forneceu a variavel de Velocidade media do Centro de Pressao no sentido medio-lateral (Vmx) e ântero-posterior (Vmy). Dessa forma, foi possivel constatar que mesmo quando os participantes apresentaram uma reducao na Vmx e Vmy estas foram menores que 1%. Conclusao: Isto possivelmente indique atividade regulatoria postural semelhante a etapa pre FES, e, ainda uma menor atividade regulatoria postural, quando a Vmx ou Vmy foram maiores que do inicio, mesmo apos a aplicacao da FES (90 minutos).