Alessandra Rezende Martinelli

Muscle strength and ankle mobility for the gait parameters in diabetic neuropathies

AIMS To evaluate the spatio-temporal variables of gait and the isometric muscle strength component of the ankle in patients with peripheral diabetic neuropathy. Also, verify the relationship between these variables and gait parameters. METHODS This study involved 25 diabetic peripheral neuropathy (DPN) participants (62.4±8.36 years) and 27 age-matched healthy control individuals (64.48±6.21 years). The assessment of the spatio-temporal parameters of gait was performed using an electronic baropodometry treadmill. Prior to the collection data, each participant was instructed to walk on the treadmill in her/his habitual self-selected speed. RESULTS Diabetic neuropathy group showed impairment of gait, with a smaller stride and length speed of the cycle, and increased duration of support time. Restricted dorsiflexion mobility and increased plantarflexion mobility were found, with a decrease in muscle strength of the dorsiflexors and plantiflexors. There was a significant relationship between plantiflexor muscle strength and the length and speed of the gait cycle. Also the muscle strengths of the plantiflexors and dorsiflexors, and the range of motion of dorsiflexion were predictors of gait performance. CONCLUSIONS The ankle, muscle strength and ankle mobility variables could explain changes in gait speed and range of motion in patients with DPN, allowing for the application of preventive strategies.

Aging increases flexibility of postural reactive responses based on constraints imposed by a manual task

This study compared the effect of stability constraints imposed by a manual task on the adaptation of postural responses between 16 healthy elderly (mean age = 71.56 years, SD = 7.38) and 16 healthy young (mean age = 22.94 years, SD = 4.82) individuals. Postural stability was perturbed through unexpected release of a load attached to the participant’s trunk while performing two versions of a voluntary task: holding a tray with a cylinder placed with its flat side down (low constraint) or with its rolling round side down (high constraint). Low and high constraint tasks were performed in alternate blocks of trials. Results showed that young participants adapted muscular activation and kinematics of postural responses in association with previous experience with the first block of manual task constraint, whereas the elderly modulated postural responses based on the current manual constraint. This study provides evidence for flexibility of postural strategies in the elderly to deal with constraints imposed by a manual task.

Light touch modulates balance recovery following perturbation: from fast response to stance restabilization.

Abstract Light fingertip touch of a static bar generates extra somatosensory information used by the postural control system to reduce body sway. While the effect of light touch has been studied in quiet stance, less attention has been given to its potential benefit for reactive postural responses. In the present study, we tested the effect of light fingertip touch of a stable surface on recovery of postural stability from a mechanical perturbation. Participants stood upright on a force plate touching a static rigid bar while being pulled backward by a load. Unpredictable release of the load induced fast anterior body sway, requiring a reactive response to recover balance. Effect of light touch on postural responses was assessed as a function of vision and malleability of the support surface, analyzing different epochs ranging from the pre-perturbation period to recovery of a relatively stable quiet stance. Results showed that light touch induced lower magnitude of muscular activation in all epochs. Center of pressure (CoP) displacement/sway was affected by interaction of light touch with manipulation of the other sensory information. For the periods associated with quiet stance, light touch led to decreased CoP sway in the malleable surface in the pre-perturbation epoch, and in the condition combining no vision and malleable surface in the balance restabilization and follow-up quiet stance epochs. For the fast reactive response epoch, light touch induced smaller amplitude of CoP displacement across conditions, and lower CoP maximum velocity in the condition combining no vision and rigid surface. These results showed that light touch modulates postural responses in all epochs associated with an unanticipated mechanical perturbation, with a more noticeable effect in conditions manipulating sensory information relevant for balance control.

Precueing time but not direction of postural perturbation induces early muscular activation: comparison between young and elderly individuals.

In this study, we evaluated the effect of precueing characteristics of an impending perturbation to upright stance on reactive responses of distal leg muscles. Young and older individuals were compared in a task of recovering stable upright stance following rotation of the supporting platform to induce anterior or posterior body sway. Directions of the supporting platform rotation were randomized across trials. Immediately before postural perturbation participants were cued about direction and/or time of platform rotation, or performed the task under directional and temporal uncertainty of the impending perturbation. Results showed that precueing time of perturbation led to earlier muscular activation onset, while precueing perturbation direction did not modulate either latency or magnitude of muscular activation. Those effects were similar between age groups. Our findings suggest that awareness of the perturbation time favored shorter response latencies in both the young and older individuals.

Right cerebral hemisphere specialization for quiet and perturbed body balance control: Evidence from unilateral stroke

Our aim in this investigation was to assess the relative importance of each cerebral hemisphere in quiet and perturbed balance, based on uni-hemispheric lesions by stroke. We tested the hypothesis of right cerebral hemisphere specialization for balance control. Groups of damage either to the right (RHD, n=9) or the left (LHD, n=7) cerebral hemisphere were compared across tasks requiring quiet balance or body balance recovery following a mechanical perturbation, comparing them to age-matched nondisabled individuals (controls, n=24). They were evaluated in conditions of full and occluded vision. In Experiment 1, the groups were compared in the task of quiet standing on (A) rigid and (B) malleable surfaces, having as outcome measures center of pressure (CoP) amplitude and velocity sway. In Experiment 2, we evaluated the recovery of body balance following a perturbation inducing forward body oscillation, having as outcome measures CoP displacement, peak hip and ankle rotations and muscular activation of both legs. Results from Experiment 1 showed higher values of CoP sway velocity for RHD in comparison to LHD and controls in the anteroposterior (rigid surface) and mediolateral (malleable surface) directions, while LHD had lower balance stability than the controls only in the mediolateral direction when supported on the rigid surface. In Experiment 2 results showed that RHD led to increased values in comparison to LHD and controls for anteroposterior CoP displacement and velocity, time to CoP direction reversion, hip rotation, and magnitude of muscular activation in the paretic leg, while LHD was found to differ in comparison to controls in magnitude of muscular activation of the paretic leg and amplitude of mediolateral sway only. These results suggest that damage to the right as compared to the left cerebral hemisphere by stroke leads to poorer postural responses both in quiet and perturbed balance. That effect was not altered by manipulation of sensory information. Our findings suggest that the right cerebral hemisphere plays a more prominent role in efferent processes responsible for balance control.

Young and older adults adapt automatic postural responses equivalently to repetitive perturbations but are unable to use predictive cueing to optimize recovery of balance stability

Processing of contextual cues has been proposed to modulate the generation of automatic postural responses to unanticipated balance perturbations. In this investigation, we compared young and older individuals in responses to sudden rotations of the support base inducing either planti- or dorsiflexion of the ankles. Assessment was made in conditions resulting from the combination of visual directional cueing of the forthcoming platform rotation, and block versus random sequences of platform rotation directions. Results showed that, for both rotation directions, the block sequence led to reduced magnitude of activation of distal agonist muscles and direction-specific modulation of ground reaction forces to recover body balance. Visual directional cueing, conversely, failed to modulate either muscular responses or forces applied to the support base through the feet for balance recovery. Effects were similar between ages, suggesting that aging does not increase the influence of cognition on the generation of automatic postural responses, and that adaptation to repeated postural perturbations over trials is preserved in healthy older individuals.

Light touch leads to increased stability in quiet and perturbed balance: Equivalent effects between post-stroke and healthy older individuals

Cerebral damage provoked by stroke may lead to deficits of quiet balance control and of the recovery of body equilibrium following an unanticipated postural perturbation. In this investigation we aimed to evaluate the effect of light touch (LT) of an earth-fixed surface on balance stability in individuals with post-stroke hemiparesis, taking performance of age-matched healthy participants as reference. Evaluations were made in conditions of full and no visual information. Analysis of quiet balance showed that LT induced higher balance stability, with reduced amplitude and velocity of postural sway. Evaluation of the effect of LT on automatic postural responses was made in the task of recovering body equilibrium following a mechanical perturbation of balance leading to fast forward body sway. Results showed that LT led to reduced amplitude of center of mass displacement following the perturbation, in addition to reduced amplitude and velocity of center of pressure under the feet, and lower activation of the lower legs muscles. Those effects of LT were observed in both the post-stroke and control groups, and did not interact with vision availability. Our results indicated then that individuals who suffered a cerebral stroke can stabilize perturbed and non-perturbed postural responses by lightly touching a stable surface to a similar extent of healthy older individuals.

Qualidade de vida, depressão e dor em mulheres pós cirurgia de cancer de mama.

depressao, dor e consequente declinio na qualidade de vida (QV). Objetivo: Avaliar a QV, depressao e dor em mulheressubmetidas a intervencao cirurgica de câncer de mama. Metodo: Cento e trinta e duas mulheres foram divididas em tresgrupos: G1 (n=46), submetidas a tratamento cirurgico para câncer de mama que frequentavam um servico de fisioterapia;G2 (n=43), submetidas a tratamento cirurgico para câncer de mama que nao frequentavam um servico de fisioterapiae G3 (n=43), grupo controle sem diagnostico de câncer de mama. Inicialmente, as participantes foram submetidas aavaliacao fisica, para imparidades (edema de braco, limitacao de movimento articular do ombro e dor). Foi realizada umaavaliacao para deteccao de presenca e de nivel de depressao, por meio do Inventario de Depressao de Beck (BDI) e paraavaliacao da QV com aspectos relacionados a saude, foi utilizado o questionario SF-36. Resultados: foi evidenciada diminuicaoda mobilidade em todos os movimentos do ombro em ambos os grupos com intervencao cirurgica (G1 e G2). Ador e a prevalencia de linfedema tiveram relacao com a depressao, sendo mais evidente em G1. Quanto aos aspectos relacionadosa QV, o SF-36 demonstrou que o grupo G1 apresentou maiores escores nos dominios fisicos e emocionais emrelacao ao grupo G2, e os dois grupos apresentaram baixo escore no dominio dor. Houve presenca de depressao, quandoavaliada pelo BDI, em 35% das mulheres do grupo G1, 49% do grupo G2 e 28% do grupo G3. Ainda, o G1 mostra umafraca tendencia de pessoas em niveis mais proximos a depressao em relacao ao controle (G3). Conclusao: Pode-se concluirque a participacao em um programa de fisioterapia resultou em melhora da QV e que a depressao pode estar relacionadaaos niveis de dor no pos-operatorio de câncer de mama. Palavras-chave: Fisioterapia; Mastectomia; Dor; Qualidade de vida.AbstractIntroduction:

AVALIAÇÃO DO COMPLEXO DO OMBRO EM MULHERES SUBMETIDAS À INTERVENÇÃO CIRÚRGICA PARA TRATAMENTO DE CÂNCER DE MAMA

A cirurgia de câncer de mama esta associada, em torno de 70% dos casos, a complicacoes que podem levar a limitacao e diminuicao da mobilidade do ombro. Considerando as alteracoes decorrentes das cirurgias mamarias, o objetivo deste estudo foi realizar uma avaliacao fisica do ombro homolateral e contralateral a cirurgia, comparando os resultados obtidos nos dois ombros. Este estudo foi realizado com 21 mulheres submetidas a mastectomia ou quadrandectomia unilateral, incluidas, pelo menos ha seis meses, em um programa de reabilitacao em fisioterapia. Precedendo o inicio das avaliacoes clinicas, uma ficha de avaliacao especifica para esta populacao foi desenvolvida, identificando alteracoes agudas e cronicas. A idade media das pacientes foi 52,10 anos. De acordo com o exame fisico, a aderencia cicatricial estava presente em 14% das pacientes e o linfedema em 86% destas. Durante a palpacao, 95% das pacientes apresentaram dor e pontos-gatilho nos musculos trapezio, esternocleidomastoideo, escalenos e romboides. As medianas da amplitude de movimento do ombro homolateral e contralateral a cirurgia foram: flexao, 130o/154o; extensao, 38o/40o; rotacao lateral, 60o/85o; rotacao medial, 70o/90o e abducao 115o/145o. De acordo com os resultados, houve uma diminuicao significativa em todos os movimentos do ombro homolateral, quando comparado ao contralateral a cirurgia. Diante do exposto, pode-se concluir que a avaliacao, por meio da ficha especifica, elaborada para pacientes com câncer de mama, foi eficaz para identificar complicacoes pos-cirurgicas no ombro desta populacao. Portanto, esta avaliacao foi importante para identificar disfuncoes fisicas, visando a reabilitacao e independencia nas atividades de vida diaria destas mulheres.