Ana Raquel Rodrigues Lindquist

Gait Training Combining Partial Body-Weight Support, a Treadmill, and Functional Electrical Stimulation: Effects on Poststroke Gait

Background and Purpose: Treadmill training with harness support is a promising, task-oriented approach to restoring locomotor function in people with poststroke hemiparesis. Although the combined use of functional electrical stimulation (FES) and treadmill training with body-weight support (BWS) has been studied before, this combined intervention was compared with the Bobath approach as opposed to BWS alone. The purpose of this study was to evaluate the effects of the combined use of FES and treadmill training with BWS on walking functions and voluntary limb control in people with chronic hemiparesis. Subjects: Eight people who were ambulatory after chronic stroke were evaluated. Methods: An A1-B-A2 single-case study design was applied. Phases A1 and A2 included 3 weeks of gait training on a treadmill with BWS, and phase B included 3 weeks of treadmill training plus FES applied to the peroneal nerve. The Stroke Rehabilitation Assessment of Movement was used to assess motor recovery, and a videography analysis was used to assess gait parameters. Results: An improvement (from 54.9% to 71.0%) in motor function was found during phase B. The spatial and temporal variables cycle duration, stance duration, and cadence as well as cycle length symmetry showed improvements when phase B was compared with phases A1 and A2. Discussion and Conclusions: The combined use of FES and treadmill training with BWS led to an improvement in motor recovery and seemed to improve the gait pattern of subjects with hemiparesis, indicating the utility of this combination method during gait rehabilitation. In addition, this single-case series showed that this alternative method of gait training—treadmill training with BWS and FES—may decrease the number of people required to carry out the training.

Muscle Atrophy and Functional Deficits of Knee Extensors and Flexors in People With Chronic Stroke

Background Further clarification is needed with regard to the degree of atrophy in individual muscle groups and its possible relationship to joint torque deficit poststroke. Objective The purpose of this study was to investigate quadriceps and hamstring muscle volume and strength deficits of the knee extensors and flexors in people with chronic hemiparesis compared with a control group. Design This was a cross-sectional study. Methods Thirteen individuals with hemiparesis due to chronic stroke (hemiparetic group) and 13 individuals who were healthy (control group) participated in this study. Motor function, quadriceps and hamstring muscle volume, and maximal concentric and eccentric contractions of the knee extensors and flexors were assessed. Results Only the quadriceps muscle of the paretic limb showed reduced muscle volume (24%) compared with the contralateral (nonparetic) limb. There were no differences in muscle volume between the hemiparetic and control groups. The peak torque of the paretic-limb knee extensors and flexors was reduced in both contraction modes and velocities compared with the nonparetic limb (36%–67%) and with the control group (49%–75%). The nonparetic limb also showed decreased extensor and flexor peak torque compared with the control group (17%–23%). Power showed similar deficits in strength (12%–78%). There were significant correlations between motor function and strength deficits (.54–.67). Limitations Magnetic resonance imaging coil length did not allow measurement of the proximal region of the thigh. Conclusions There were different responses between quadriceps and hamstring muscle volumes in the paretic limb that had quadriceps muscle atrophy only. However, both paretic and nonparetic limbs showed knee extensor and flexor torque and power reduction.

Avaliação do desempenho funcional de crianças com paralisia cerebral de acordo com níveis de comprometimento motor

CONTEXTUALIZACAO: Diversos estudos tem avaliado a funcao motora de criancas com Paralisia Cerebral (PC), entretanto pouco se sabe sobre as inter-relacoes entre comprometimentos da mobilidade, autocuidado e funcao social relacionadas as habilidades funcionais da crianca e a assistencia do cuidador. OBJETIVOS: Identificar diferencas funcionais de criancas com PC em diferentes niveis de disfuncao motora e correlaciona-las com os dominios mobilidade, autocuidado e funcao social na habilidade funcional e na assistencia do cuidador. METODOS: Realizou-se uma pesquisa analitica de corte transversal com 70 criancas/familias, com idades de 4 a 7,5 anos, atendidas no Centro de Reabilitacao Infantil, por meio do Pediatric Evaluation Disability Inventory (PEDI) e do Gross Motor Function Classification System (GMFCS). A analise dos dados foi realizada por meio da ANOVA e teste de correlacao de Pearson. RESULTADOS: Os resultados indicaram importante variabilidade funcional das criancas com PC em diferentes niveis de severidade da disfuncao motora. Essa variacao foi observada nos dominios mobilidade, autocuidado e funcao social. Os resultados apresentaram, tambem, forte correlacao entre os dominios mobilidade e autocuidado e mobilidade e funcao social. CONCLUSOES: Diante da variabilidade apresentada pelas criancas, percebe-se a necessidade de aplicacao do PEDI e GMFCS, o que parece aumentar o entendimento sobre a relacao entre funcoes motoras grossas e atividades da vida diaria. Essa correlacao demonstra o quanto a mobilidade e determinante para avaliar o desempenho funcional e orientar a pratica terapeutica no sentido de desenvolver as potencialidades das criancas, bem como orientar o cuidador na estimulacao.

Infants with Down syndrome: Percentage and age for acquisition of gross motor skills

The literature is bereft of information about the age at which infants with Down syndrome (DS) acquire motor skills and the percentage of infants that do so by the age of 12 months. Therefore, it is necessary to identify the difference in age, in relation to typical infants, at which motor skills were acquired and the percentage of infants with DS that acquire them in the first year of life. Infants with DS (N=20) and typical infants (N=25), both aged between 3 and 12 months, were evaluated monthly using the AIMS. In the prone position, a difference of up to 3 months was found for the acquisition of the 3rd to 16th skill. There was a difference in the percentage of infants with DS who acquired the 10th to 21st skill (from 71% to 7%). In the supine position, a difference of up to one month was found from the 3rd to 7th skill; however, 100% were able to perform these skills. In the sitting position, a difference of 1-4 months was found from the 1st to 12th skill, ranging from 69% to 29% from the 9th to 12th. In the upright position, the difference was 2-3 months from the 3rd to 8th skill. Only 13% acquired the 8th skill and no other skill was acquired up to the age of 12 months. The more complex the skills the greater the difference in age between typical infants and those with DS and the lower the percentage of DS individuals who performed the skills in the prone, sitting and upright positions. None of the DS infants were able to stand without support.

Effects of treadmill inclination on the gait of children with Down syndrome

The goal of this study was to analyze the effects of upward treadmill inclination on the gait of children with Down syndrome (DS). Sixteen children with a mean age 8.43 ± 2.25 years, classified at level I of the Gross Motor Function Classification System (GMFCS) and able to walk without personal assistance and/or assistive devices/orthosis were evaluated. Spatial-temporal variables were observed as well as the angular variation of hip, knee and ankle in the sagittal plane, while children walked on the treadmill carried out on 0% and 10% upward inclination. The results showed that children with DS presented changes in spatio-temporal variables (reduced cadence and increased cycle time and swing time) and in angular variables (increased hip, knee and ankle angles at initial contact; increased maximum hip flexion and maximum stance dorsiflexion; and reduced plantarflexion at pre-swing). Treadmill inclination seemed to act positively on the angular and spatio-temporal characteristics of gait in children with DS, demonstrating a possible benefit from the use of this type of surface in the gait rehabilitation of this population.

Effects of Treadmill Inclination on the Gait of Individuals With Chronic Hemiparesis

OBJECTIVE To analyze the effects of electric treadmill inclination on the gait of individuals with chronic hemiparesis. DESIGN Descriptive, observational study. SETTING Laboratory for human movement analyses of UFRN. PARTICIPANTS Individuals (N=18) with a mean age of 55.3 ± 9.3 years and a lesion time of 36 ± 22.8 months. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Subjects were assessed for functional independence (FIM) and balance (Berg Balance Scale). Spatial-temporal variables were observed as well as the angular variation of the hip, knee, and ankle in the sagittal plane, while the individuals walked on the treadmill at 3 different inclinations (0%, 5%, and 10%). RESULTS There was an increase in stance time between 0% and 5% (0.83 ± 0.21 vs 0.87 ± 0.20; P=.011) and 0% and 10% (0.83 ± 0.21 vs 0.88 ± 0.23; P=.021). The other spatial-temporal variables did not change. During initial contact there was an increase in the hip, knee, and ankle flexion angle. An increase in hip amplitude was also observed between 0% and 10% (37.83 ± 5.23 vs 41.12 ± 5.63; P<.001) and 5% and 10% (38.80 ± 5.96 vs 41.12 ± 5.63; P=.002) and in knee amplitude between 0% and 10% (47.51 ± 15.07 vs 50.30 ± 12.82; P=.040), as well as decreased hip extension and increased dorsiflexion. CONCLUSIONS Treadmill inclination promoted angular alterations such as an increase in hip, knee, and ankle angle during initial contact and the swing phase and an increase in the amplitude of movement of the hip and knee, as well as an increase in stance time of the paretic lower limb.

Immediate effects of TENS and cryotherapy in the reflex excitability and voluntary activity in hemiparetic subjects: a randomized crossover trial

BACKGROUND The disorder of reflex and motor function in patients affected by stroke causes negative impact on the performance of movement patterns and affects the functional activities. OBJECTIVES To investigate the immediate effects of transcutaneous electrical nerve stimulation (TENS) and cryotherapy interventions on the spinal reflex excitability and in the voluntary electromyography (EMG) activity in people with chronic stroke. METHOD Randomized crossover trial. The maximum H-reflex (Hmax), the H-reflex latency and the maximum motor response (Mmax) of the soleus muscle and also the EMG of the tibialis muscle where evaluated before and after the application of TENS, cryotherapy and control conditions. RESULTS The Hmax/Mmax ratio was statistically significant higher (p=0.0245) and the H-reflex latency was statistically significant lower (p=0.0375) in the soleus muscle of the affected limb. The EMG amplitude of the tibialis anterior was reduced in the compromised limb (p<0.0001). After the use of the TENS, a reduction in the Hmax/Mmax ratio (p=0.0006) was observed leading to lower reflex excitability. However, after the cryotherapy intervention an increase of the Hmax/Mmax ratio was observed, which was accompanied by an increase in the H-reflex latency (p=0.0001). The EMG amplitude has not changed by any of the interventions. CONCLUSIONS Our findings suggest that TENS may be a choice for immediate reduction of reflex excitability, whereas cryotherapy intervention may increase reflex excitability in hemiparetic subjects. However, none of the changes mediated by either intervention were able to modify the electrical activity in the antagonist muscle of the spastic muscle.

Effects of treadmill inclination on hemiparetic gait: controlled and randomized clinical trial.

ObjectiveThe aim of this study was to analyze the effects of inclined treadmill training on the kinematic characteristics of gait in subjects with hemiparesis. DesignA blind, randomized, controlled study was conducted with 28 subjects divided into two groups: the control group, submitted to partial body weight–support treadmill gait training with no inclination, and the experimental group, which underwent partial body weight–support treadmill training at 10% of inclination. All volunteers were assessed for functional independence, motor function, balance, and gait before and after the 12 training sessions. ResultsBoth groups showed posttraining alterations in balance (P < 0.001), motor function (P < 0.001), and functional independence (P = 0.002). Intergroup differences in spatiotemporal differences were observed, where only the experimental group showed posttraining alterations in velocity (P = 0.02) and paretic step length (P = 0.03). Angular variables showed no significant differences in either group. ConclusionsIn subjects with hemiparesis, the addition of inclination is a stimulus capable of enhancing the effects of partial body weight–support treadmill gait training.

Effects of a training program based on the Proprioceptive Neuromuscular Facilitation method on post-stroke motor recovery: A preliminary study

This preliminary study sought to analyze the effects of a training program based on the Proprioceptive Neuromuscular Facilitation (PNF) method on motor recovery of individuals with chronic post-stroke hemiparesis. Eleven individuals with chronic hemiparesis (mean lesion time of 19.64 months) after unilateral and non-recurrent stroke underwent training based on PNF method for twelve sessions, being evaluated for motor function - using the Stroke Rehabilitation Assessment of Movement (STREAM) instrument; functionality, by the Functional Independence Measure (FIM); and gait kinematic (using the Qualisys Motion Capture System), at baseline and post-training. Significant changes in FIM (from median 67 to median 68; P = .043) and STREAM scores (from median 47 to median 55; P = .003) were observed. Data showed significant changes in motor function and functionality after training, suggesting that this program can be useful for rehabilitation of chronic stroke survivors.

Effects of Treadmill Training with Load on Gait in Parkinson Disease: A Randomized Controlled Clinical Trial.

ObjectiveThe aim of this study was to assess the effects of 3% of body weight loads (0%, 5%, and 10%) on treadmill gait training in subjects with Parkinson disease. DesignThis study used a randomized controlled single-blind trial. ResultsSpatiotemporal variables demonstrated significant intragroup alterations in all three groups at pretraining and posttraining, with an increase in speed (m/sec; F = 4.73, P = 0.04), stride length (m; F = 12.00, P = 0.002), and step length (m; F = 16.16, P = 0.001) and a decrease in the double-stance phase (%; F = 6.59, P = 0.02) and stance phase (%; F = 4.77, P = 0.04). Intergroup pretraining and posttraining did not exhibit significant differences (F < 2.18, P > 0.14). Angular variables showed significant intragroup alterations, with an increase in knee range of motion (F = 5.18, P = 0.03), and intergroup comparison revealed no significant changes (F = 1.87, P = 0.17). ConclusionsPosttraining improvements in speed, stride length, step length, double-stance, stance phase, and knee range of motion were observed in all groups, where no load (0%, 5%, or 10%) had any significant effect, suggesting that the influence of load did not make one experimental condition better than another. All participants benefitted from treadmill gait training, irrespective of the use of load.