Alexandre Severo do Pinho

Facilitation handlings induce increase in electromyographic activity of muscles involved in head control of cerebral palsy children.

This study aimed to investigate the electromyographic (EMG) activation of the main cervical muscles involved in the head control during two postures widely used for the facilitation of head control in children with Cerebral Palsy (CP). A crossover trial involving 31 children with clinical diagnosis of CP and spastic quadriplegia was conducted. Electromyography was used to measure muscular activity in randomized postures. Three positions were at rest: (a) lateral decubitus, (b) ventral decubitus on the floor and (c) ventral decubitus on the wedge. Handlings for facilitating the head control were performed using the hip joint as key point of control in two postures: (a) lateral decubitus and (b) ventral decubitus on wedge. All children underwent standardized handlings, performed by the same researcher with experience in the neurodevelopmental treatment. EMG signal was recorded from muscles involved in the head control (paraspinal and sternocleidomastoid muscles) in sagittal, frontal and transverse planes, at the fourth cervical vertebra (C4), tenth thoracic vertebra (T10) and sternocleidomastoid muscle (SCM) levels. The results showed a significant increase in muscle activation when handling was performed in the lateral decubitus at C4 (P<0.001), T10 (P<0.001) and SCM (P=0.02) levels. A significant higher muscle activation was observed when handling was performed in lateral decubitus when compared to ventral decubitus at C4 level (P<0.001). Handling in ventral decubitus also induced an increase in EMG activation at T10 (P=0.018) and SCM (P=0.004) levels but not at C4 level (P=0.38). In conclusion, handlings performed in both positions may induce the facilitation of head control, as evaluated by the activity of cervical and upper trunk muscles. Handling performed in lateral decubitus may induce a slightly better facilitation of head control. These findings contribute to evidence-based physiotherapy practice for the rehabilitation of severely spastic quadriplegic CP children.

PROPRIOCEPTION, BODY BALANCE AND FUNCTIONALITY IN INDIVIDUALS WITH ACL RECONSTRUCTION

Objective : To evaluate and compare proprioception, body balance and knee functionality of individuals with or without unilateral anterior cruciate ligament (ACL) reconstruction. Methods : Forty individuals were divided in two groups: Experimental group, 20 individuals with ACL reconstruction at six months postoperative, and control group, 20 individuals with no history of lower limb pathologies. In the experimental group, we assessed lower limbs with reconstructed ACL and contralateral limb; in the control group the dominant and the non-dominant lower limbs were assessed. All subjects were submitted to joint position sense test to evaluate proprioception, postural control measure in single-limb, and step up and down (SUD) test for functional assessment. Results : There were no deficits in proprioception and postural control. In the SUD test, a 5% decrease in lift up force was found in reconstructed ACL lower limbs, however, a statistically not significant difference. The impact and step down force during the course of test were 30% greater in anatomic ACL than in control lower limbs. Conclusion : The individuals with ACL reconstruction at six months postoperative did not show changes in proprioception and postural control, but showed motor control changes, influencing knee functionality. Level of Evidence IV, Prognostic Studies.

Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy

This study aimed to investigate the electromyographic activity of cervical and trunk extensors muscles in children with cerebral palsy during two handlings according to the Bobath concept. A crossover trial involving 40 spastic diplegic children was conducted. Electromyography (EMG) was used to measure muscular activity at sitting position (SP), during shoulder internal rotation (IR) and shoulder external rotation (ER) handlings, which were performed using the elbow joint as key point of control. Muscle recordings were performed at the fourth cervical (C4) and at the tenth thoracic (T10) vertebral levels. The Gross Motor Function Classification System (GMFCS) was used to assess whether muscle activity would vary according to different levels of severity. Humeral ER handling induced an increase on EMG signal of trunk extensor muscles at the C4 (P=0.007) and T10 (P<0.001) vertebral levels. No significant effects were observed between SP and humeral IR handling at C4 level; However at T10 region, humeral IR handling induced an increase of EMG signal (P=0.019). Humeral ER resulted in an increase of EMG signal at both levels, suggesting increase of extensor muscle activation. Furthermore, the humeral ER handling caused different responses on EMG signal at T10 vertebra level, according to the GMFCS classification (P=0.017). In summary, an increase of EMG signal was observed during ER handling in both evaluated levels, suggesting an increase of muscle activation. These results indicate that humeral ER handling can be used for diplegic CP children rehabilitation to facilitate cervical and trunk extensor muscles activity in a GMFCS level-dependent manner.

Effects of Intradialytic Neuromuscular Electrical Stimulation on Strength and Muscle Architecture in Patients With Chronic Kidney Failure: Randomized Clinical Trial

This study aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) on muscle strength and architecture, functional capacity, and endothelial function in patients with chronic kidney failure (CKF) on hemodialysis (HD). Twenty-one patients with CKF on HD were randomized into a control group (CG; n = 10) and neuromuscular electrical stimulation group (NMESG; n = 11) who received NMES in the quadriceps muscle for 8 weeks, 3 times/week (20-34 min) during HD sessions. The muscle strength of the lower limbs was evaluated by dynamometry and sit-and-stand test (SST); muscle architecture through ultrasonography; functional capacity by the distance covered in a 6-min walk test and the endothelial function by flow-mediated dilatation technique of the brachial artery. There was an increase in the strength of the lower limbs in the NMESG compared to the CG (dynamometry: 43.28 ± 16.94 vs. 35.84 ± 16.89, P = 0.006; SST: 16.10 ± 6.51 vs. 12.50 ± 4.7, P = 0.029). There was a significant reduction in pennation angles of the right vastus lateralis (RVL) and left vastus lateralis (LVL) in the CG when compared to the NMESG (RVL: 11.93 [10.70-15.11] vs. 13.57 [11.81-15.96], P = 0.039; LVL: 11.62 [9.00-14.20] vs. 15.52 [12.86-20.02], P = 0.042). There was no change in functional capacity and in the endothelial function for CG and NMESG, respectively. In conclusion, NMES increases muscle strength and has a protective effect against muscle atrophy of the lower limbs of patients with chronic kidney failure on HD.

Different horse’s paces during hippotherapy on spatio-temporal parameters of gait in children with bilateral spastic cerebral palsy: A feasibility study

Hippotherapy is often carried out for the rehabilitation of children with Cerebral Palsy (CP), with the horse riding at a walking pace. This study aimed to explore the immediate effects of a hippotherapy protocol using a walk-trot pace on spatio-temporal gait parameters and muscle tone in children with Bilateral Spastic CP (BS-CP). Ten children diagnosed with BS-CP and 10 healthy aged-matched children (reference group) took part in this study. The children with BS-CP underwent two sessions of hippotherapy for one week of washout between them. Two protocols (lasting 30min) were applied on separate days: Protocol 1: the horses pace was a walking pace; and Protocol 2: the horses pace was a walk-trot pace. Children from the reference group were not subjected to treatment. A wireless inertial measurement unit measured gait spatio-temporal parameters before and after each session. The Modified Ashworth Scale was applied for muscle tone measurement of hip adductors. The participants underwent the gait assessment on a path with surface irregularities (ecological context). The comparisons between BS-CP and the reference group found differences in all spatio-temporal parameters, except for gait velocity. Within-group analysis of children with BS-CP showed that the swing phase did not change after the walk pace and after the walk-trot pace. The percentage of rolling phase and double support improved after the walk-trot. The spasticity of the hip adductors was significantly reduced as an immediate result of both protocols, but this decrease was more evident after the walk-trot. The walk-trot protocol is feasible and is able to induce an immediate effect that improves the gait spatio-temporal parameters and the hip adductors spasticity.

Height of the Medial Longitudinal Arch During Classical Ballet Steps

The purpose of this study was to evaluate the midfoot longitudinal arch height and correlate it with active hip external rotation (ER) in dancers during static postures and technical steps of classical ballet (i.e., first position, demi-plié, battement fondu à la seconde, pas jeté à la seconde, and grand jeté à la seconde). A 3D motion analysis system was used for kinematic analysis. The arch height was significantly reduced during the battement fondu à la seconde, pas jeté à la seconde, and grand jeté à la seconde when compared to standing (p = 0.000 for all comparisons), first position (p = 0.000, p = 0.000, and p = 0.001, respectively) and demi-plié (p = 0.015, p = 0.003, and p = 0.006, respectively). No significant correlation was found between arch height and active hip external rotation (p > 0.05). Hence, active hip external rotation does not seem to be related to midfoot pronation in this sample. Other factors, such as intrinsic and extrinsic foot muscle strength, may be related to the midfoot arch height. These findings contribute to a better understanding of ballet steps, but future studies are required to clarify this topic completely.

Evaluation of Knee Proprioception and Factors Related to Parkinson’s Disease

Background. Changes in proprioception may contribute to postural instability in individuals with neurological disorders. Objectives. Evaluate proprioception in the lower limbs of patients with Parkinsons disease (PD) and the association between proprioception and cognitive ability, motor symptoms, postural instability, and disease severity. Methods. This is a cross-sectional, controlled study that evaluated proprioception in PD patients and healthy age- and sex-matched individuals. Kinetic postural proprioception of the knee was evaluated using an isokinetic dynamometer (Biodex® Multi-Joint System 4 Pro). Participants were evaluated using the Montreal Cognitive Assessment (MoCA), the Hoehn and Yahr rating scale and postural instability (pull test and stabilometric analysis), and motor function (UPDRS-III) tests. Results. A total of 40 individuals were enrolled in the study: 20 PD patients and 20 healthy controls (CG). The PD patients had higher angular errors on the proprioceptive ratings than the CG participants (p = 0.002). Oscillations of the center of pressure (p = 0.002) were higher in individuals with PD than in the controls. Proprioceptive errors in the PD patients were associated with the presence of tremors as the dominant symptom and more impaired motor performance. Conclusion. These findings show that individuals with PD have proprioceptive deficits, which are related to decreased cognitive ability and impaired motor symptoms.

Un modelo distinto de rodillera en la rehabilitación de la marcha hemiparética con genu recurvatum: efectos sobre la distribución de las presiones plantares

O modelo de brace desenvolvido consiste em uma joelheira de neoprene que apresenta um balonete inflavel posicionado sobre a regiao poplitea do joelho. Ele proporciona estimulos sobre estruturas articulares, bem como um melhor alinhamento biomecânico durante a fase de apoio da marcha. O objetivo do estudo foi quantificar as alteracoes e adaptacoes induzidas pelo treinamento da marcha com a utilizacao do dispositivo ortotico em pacientes hemipareticos. Realizou-se um estudo quase-experimental do tipo antes e depois com doze pacientes adultos com hemiparesia decorrente de acidente vascular encefalico. Os picos de pressao plantares foram os marcadores utilizados para comparar os tres momentos do estudo: na linha de base, quando estivessem utilizando o brace e apos o treinamento da marcha. Depois das sessoes de reeducacao da marcha com auxilio da ortese, a redistribuicao das pressoes plantares evidenciou aumento na simetria durante a fase de apoio, principalmente pela diminuicao da pressao sobre o antepe paretico (p=0,024) e pelo aumento no retrope no lado paretico (p=0,010). Alem disso, essas alteracoes foram associadas a uma diminuicao da pressao sobre todas as regioes do pe nao afetado, especialmente no retrope no momento de pos-treinamento. Os resultados do estudo sugerem uma mudanca no padrao de marcha dos participantes depois da utilizacao do brace. Houve maior simetria dos valores dos picos de pressao plantar quando se comparou o lado afetado com o nao afetado. O treino com o brace contribui no processo de reabilitacao, uma vez que forneceu valores baropodometricos que se aproximaram ao padrao normal de distribuicao plantar.| The model of brace developed consists of a neoprene kneepad that has an inflatable cuff positioned over the popliteal region of the knee. It provides stimuli on joint structures as well as a better biomechanical alignment during the stance phase of the gait. The aim of this study was to quantify the changes and adaptations induced by gait training with the use of orthotic device in hemiparetic patients. A quasi-experimental beforeafter study was held with twelve adult patients with hemiparesis due to cerebrovascular accident. The peaks of plantar pressure were the markers used to compare the three moments of the study: the baseline, when they were using the brace, and post-gait training. After the sessions of gait retraining with the orthosis, the redistribution of plantar pressures showed increased symmetry during the stance phase, mainly by reducing the pressure on the paretic forefoot (p=0.024) and by the increase in the rearfoot in the paretic side (p=0.010). In addition, these changes were associated with a decrease in pressure on all regions of the foot not affected, especially in the rearfoot after training. The results of the study suggest a change in the gait pattern of participants after using the Cardoso et al. Brace para reeducação da marcha hemiparética 373 brace. There has been greater symmetry of the values of the plantar pressure peaks when the affected side was compared with the nonaffected side. Training with the brace helps in the rehabilitation process, since it provides baropodometric values approaching the normal pattern of plantar distribution.

A different brace model to retrain hemiparetic gait with genu recurvatum: effects on plantar pressure distribution

O modelo de brace desenvolvido consiste em uma joelheira de neoprene que apresenta um balonete inflavel posicionado sobre a regiao poplitea do joelho. Ele proporciona estimulos sobre estruturas articulares, bem como um melhor alinhamento biomecânico durante a fase de apoio da marcha. O objetivo do estudo foi quantificar as alteracoes e adaptacoes induzidas pelo treinamento da marcha com a utilizacao do dispositivo ortotico em pacientes hemipareticos. Realizou-se um estudo quase-experimental do tipo antes e depois com doze pacientes adultos com hemiparesia decorrente de acidente vascular encefalico. Os picos de pressao plantares foram os marcadores utilizados para comparar os tres momentos do estudo: na linha de base, quando estivessem utilizando o brace e apos o treinamento da marcha. Depois das sessoes de reeducacao da marcha com auxilio da ortese, a redistribuicao das pressoes plantares evidenciou aumento na simetria durante a fase de apoio, principalmente pela diminuicao da pressao sobre o antepe paretico (p=0,024) e pelo aumento no retrope no lado paretico (p=0,010). Alem disso, essas alteracoes foram associadas a uma diminuicao da pressao sobre todas as regioes do pe nao afetado, especialmente no retrope no momento de pos-treinamento. Os resultados do estudo sugerem uma mudanca no padrao de marcha dos participantes depois da utilizacao do brace. Houve maior simetria dos valores dos picos de pressao plantar quando se comparou o lado afetado com o nao afetado. O treino com o brace contribui no processo de reabilitacao, uma vez que forneceu valores baropodometricos que se aproximaram ao padrao normal de distribuicao plantar.| The model of brace developed consists of a neoprene kneepad that has an inflatable cuff positioned over the popliteal region of the knee. It provides stimuli on joint structures as well as a better biomechanical alignment during the stance phase of the gait. The aim of this study was to quantify the changes and adaptations induced by gait training with the use of orthotic device in hemiparetic patients. A quasi-experimental beforeafter study was held with twelve adult patients with hemiparesis due to cerebrovascular accident. The peaks of plantar pressure were the markers used to compare the three moments of the study: the baseline, when they were using the brace, and post-gait training. After the sessions of gait retraining with the orthosis, the redistribution of plantar pressures showed increased symmetry during the stance phase, mainly by reducing the pressure on the paretic forefoot (p=0.024) and by the increase in the rearfoot in the paretic side (p=0.010). In addition, these changes were associated with a decrease in pressure on all regions of the foot not affected, especially in the rearfoot after training. The results of the study suggest a change in the gait pattern of participants after using the Cardoso et al. Brace para reeducação da marcha hemiparética 373 brace. There has been greater symmetry of the values of the plantar pressure peaks when the affected side was compared with the nonaffected side. Training with the brace helps in the rehabilitation process, since it provides baropodometric values approaching the normal pattern of plantar distribution.

Um modelo diferente de brace para a reeducação da marcha hemiparética com genu recurvatum: efeitos sobre a distribuição das pressões plantares

O modelo de brace desenvolvido consiste em uma joelheira de neoprene que apresenta um balonete inflavel posicionado sobre a regiao poplitea do joelho. Ele proporciona estimulos sobre estruturas articulares, bem como um melhor alinhamento biomecânico durante a fase de apoio da marcha. O objetivo do estudo foi quantificar as alteracoes e adaptacoes induzidas pelo treinamento da marcha com a utilizacao do dispositivo ortotico em pacientes hemipareticos. Realizou-se um estudo quase-experimental do tipo antes e depois com doze pacientes adultos com hemiparesia decorrente de acidente vascular encefalico. Os picos de pressao plantares foram os marcadores utilizados para comparar os tres momentos do estudo: na linha de base, quando estivessem utilizando o brace e apos o treinamento da marcha. Depois das sessoes de reeducacao da marcha com auxilio da ortese, a redistribuicao das pressoes plantares evidenciou aumento na simetria durante a fase de apoio, principalmente pela diminuicao da pressao sobre o antepe paretico (p=0,024) e pelo aumento no retrope no lado paretico (p=0,010). Alem disso, essas alteracoes foram associadas a uma diminuicao da pressao sobre todas as regioes do pe nao afetado, especialmente no retrope no momento de pos-treinamento. Os resultados do estudo sugerem uma mudanca no padrao de marcha dos participantes depois da utilizacao do brace. Houve maior simetria dos valores dos picos de pressao plantar quando se comparou o lado afetado com o nao afetado. O treino com o brace contribui no processo de reabilitacao, uma vez que forneceu valores baropodometricos que se aproximaram ao padrao normal de distribuicao plantar.| The model of brace developed consists of a neoprene kneepad that has an inflatable cuff positioned over the popliteal region of the knee. It provides stimuli on joint structures as well as a better biomechanical alignment during the stance phase of the gait. The aim of this study was to quantify the changes and adaptations induced by gait training with the use of orthotic device in hemiparetic patients. A quasi-experimental beforeafter study was held with twelve adult patients with hemiparesis due to cerebrovascular accident. The peaks of plantar pressure were the markers used to compare the three moments of the study: the baseline, when they were using the brace, and post-gait training. After the sessions of gait retraining with the orthosis, the redistribution of plantar pressures showed increased symmetry during the stance phase, mainly by reducing the pressure on the paretic forefoot (p=0.024) and by the increase in the rearfoot in the paretic side (p=0.010). In addition, these changes were associated with a decrease in pressure on all regions of the foot not affected, especially in the rearfoot after training. The results of the study suggest a change in the gait pattern of participants after using the Cardoso et al. Brace para reeducação da marcha hemiparética 373 brace. There has been greater symmetry of the values of the plantar pressure peaks when the affected side was compared with the nonaffected side. Training with the brace helps in the rehabilitation process, since it provides baropodometric values approaching the normal pattern of plantar distribution.