Angélica Cristiane Ovando

Confiabilidade da versão brasileira do Wolf Motor Function Test em adultos com hemiparesia

BACKGROUND: The Wolf Motor Function Test (WMFT) evaluates the upper limb (UL) performance of adults with hemiparesis by combining time and quality of movement measures in both isolated movements and functional tasks. OBJECTIVES: To translate and adapt the WMFT form, functional ability scale (FAS) and manual to Brazilian Portuguese and evaluate the intra and inter-rater reliabilities. METHODS: Fifteen individuals with a mean age of 57.9±11.1 years and a mean time since stroke onset of 68.5±53.5 months participated. The WMFT was administered by one physiotherapist based on information in the manual, and video observations were assessed by two other independent physical therapists. Information regarding compensatory movements was included in the FAS. Intra-class correlation coefficients (ICCs) and Bland-Altman plots were calculated to examine the intra- and inter-rater reliabilities for performance time and FAS, whereas weighted kappa (Kp) was used to examine the agreement strength for FAS. RESULTS: The inter-rater ICC values for performance time were above 0.75 in 13 of the 15 tasks. For the FAS, they ranged from 0.87-0.99 for all evaluated tasks, with Kp values ranging from 0.63-0.92. For intra-rater reliability, the ICC ranged from 0.99-1.0 and from 0.96-1.0 for time measurement and FAS, respectively. Kp values ranged from 0.79-0.96 for individual and 0.93 for total scores. CONCLUSION: The Brazilian version of the WMFT showed adequate intra- and inter-rater reliabilities for evaluating the paretic UL of individuals with stroke.

Motor Activity Log-Brazil: reliability and relationships with motor impairments in individuals with chronic stroke

UNLABELLED The Motor Activity Log (MAL) assesses the spontaneous use of the most affected upper limb with the amount of use (AOU) and quality of movement (QOM) scales during daily activities in real environments in individuals with chronic stroke. OBJECTIVES This study translated the testing manual into Portuguese and assessed the inter-rater and test-retest reliabilities of the MAL, based upon the Brazilian manual version. METHODS The inter-rater reliability was evaluated by comparing the results of two examiners, and the test-retest reliability was tested by comparing the results of two evaluations, repeated one-week apart with 30 individuals with chronic hemiparesis (55.8±15.1 years). RESULTS The intra-class correlation coefficients (ICCs) for the total scores were adequate for both the inter-rater (0.98 for the AOU and 0.91 for QOM) and test-retest reliabilities (0.99 for both scales). CONCLUSIONS The results suggested that the MAL was reliable to evaluate the spontaneous use of the most affected upper limb after stroke.

Avaliação da aptidão cardiopulmonar em indivíduos com hemiparesia após acidente vascular encefálico

FUNDAMENTO: Debido a la hemiparesia, la evaluacion de la aptitud cardiorrespiratoria de individuos despues de accidente vascular encefalico (AVE), por medio de pruebas ergometricas con protocolos convencionales, se ha vuelto en un reto. OBJETIVO: Llevar a cabo prueba cardiopulmonar (PCP) en hemipareticos para una evaluacion pre participacion que busca una criteriosa prescripcion de ejercicio aerobico. METODOS: Participaron en el estudio 8 individuos con hemiparesia cronica, que se sometieron a PCP realizado con protocolo individualizado en rampa, desarrollado a partir de la informacion de la velocidad de marcha de los individuos previamente evaluados en prueba de pista. Se considero como la propuesta de inclinacion variando entre el 0% y el 10%, velocidad inicial correspondiente a un 70% del ritmo de caminata confortable y velocidad maxima el 40% superior a la velocidad maxima en la prueba de pista, en la expectativa de que el PCP, con este incremento gradual y constante de la intensidad, durase entre 6 y 8 minutos RESULTADOS: El 100% de los evaluados, la motivacion para la interrupcion de la prueba fue fatiga periferica. El VO2 de pico alcanzado fue de 20,6 ± 5,7 ml/kg.min. Se identifico el Umbral I en todos los examenes, situandose en 82,64 ± 4,78% de la FC de pico y 73,31 ± 4,97% del VO2 de pico. El cociente respiratorio (R) del grupo fue de 0,96 ± 0,09, y tres de los 8 individuos (37,5%) alcanzaron R superior a 1,00, siendo el umbral II identificado en estos sujetos. Se encontraron relaciones positivas entre variables del PCP y scores de equilibrio, desempeno en la prueba de marcha de 6 minutos y velocidad de marcha en el suelo. CONCLUSION: La prueba se revelo util para prescripcion de actividad fisica en estos individuos.BACKGROUND Due to the hemiparesis, the assessment of cardiorespiratory fitness on individuals after cerebrovascular accident (CVA), using exercise tests with conventional protocols, has become a challenge. OBJECTIVE Perform cardiopulmonary test (CPT) in hemiparetic patients to a pre-participation evaluation aimed at a careful prescription of aerobic exercise. METHODS The study included eight individuals with chronic hemiparesis who underwent CPT performed with individualized ramp protocol, developed from information on the gait speed of individuals previously evaluated in the track test. We considered the proposal of inclination ranging from 0 to 10.0%, initial speed corresponding to 70.0% of comfortable walking speed rhythm and 40.0% higher than the maximum speed on the track test, expecting that the CPT with this gradual and steady increase in intensity, lasted from 6 to 8 minutes. RESULTS In 100.0% of the sample, the reason for discontinuation was peripheral fatigue. The peak VO2 achieved was 20.6 ± 5.7 ml/kg.min. The threshold I was identified in all tests, standing at 82.64 ± 4.78% of peak HR and 73.31 ± 4.97% of peak VO2. The respiratory quotient (R) of the group was 0.96 ± 0.09, and three out of eight individuals (37.5%) reached R higher than 1.00, and the Threshold II was identified in these individuals. We found positive relationships between CPT variables and balance scores, performance in the 6-minute walking test and running speed on the ground. CONCLUSION The test proved to be useful for prescribing physical activity in these individuals.

Evaluation of cardiopulmonary fitness in individuals with hemiparesis after cerebrovascular accident.

FUNDAMENTO: Debido a la hemiparesia, la evaluacion de la aptitud cardiorrespiratoria de individuos despues de accidente vascular encefalico (AVE), por medio de pruebas ergometricas con protocolos convencionales, se ha vuelto en un reto. OBJETIVO: Llevar a cabo prueba cardiopulmonar (PCP) en hemipareticos para una evaluacion pre participacion que busca una criteriosa prescripcion de ejercicio aerobico. METODOS: Participaron en el estudio 8 individuos con hemiparesia cronica, que se sometieron a PCP realizado con protocolo individualizado en rampa, desarrollado a partir de la informacion de la velocidad de marcha de los individuos previamente evaluados en prueba de pista. Se considero como la propuesta de inclinacion variando entre el 0% y el 10%, velocidad inicial correspondiente a un 70% del ritmo de caminata confortable y velocidad maxima el 40% superior a la velocidad maxima en la prueba de pista, en la expectativa de que el PCP, con este incremento gradual y constante de la intensidad, durase entre 6 y 8 minutos RESULTADOS: El 100% de los evaluados, la motivacion para la interrupcion de la prueba fue fatiga periferica. El VO2 de pico alcanzado fue de 20,6 ± 5,7 ml/kg.min. Se identifico el Umbral I en todos los examenes, situandose en 82,64 ± 4,78% de la FC de pico y 73,31 ± 4,97% del VO2 de pico. El cociente respiratorio (R) del grupo fue de 0,96 ± 0,09, y tres de los 8 individuos (37,5%) alcanzaron R superior a 1,00, siendo el umbral II identificado en estos sujetos. Se encontraron relaciones positivas entre variables del PCP y scores de equilibrio, desempeno en la prueba de marcha de 6 minutos y velocidad de marcha en el suelo. CONCLUSION: La prueba se revelo util para prescripcion de actividad fisica en estos individuos.BACKGROUND Due to the hemiparesis, the assessment of cardiorespiratory fitness on individuals after cerebrovascular accident (CVA), using exercise tests with conventional protocols, has become a challenge. OBJECTIVE Perform cardiopulmonary test (CPT) in hemiparetic patients to a pre-participation evaluation aimed at a careful prescription of aerobic exercise. METHODS The study included eight individuals with chronic hemiparesis who underwent CPT performed with individualized ramp protocol, developed from information on the gait speed of individuals previously evaluated in the track test. We considered the proposal of inclination ranging from 0 to 10.0%, initial speed corresponding to 70.0% of comfortable walking speed rhythm and 40.0% higher than the maximum speed on the track test, expecting that the CPT with this gradual and steady increase in intensity, lasted from 6 to 8 minutes. RESULTS In 100.0% of the sample, the reason for discontinuation was peripheral fatigue. The peak VO2 achieved was 20.6 ± 5.7 ml/kg.min. The threshold I was identified in all tests, standing at 82.64 ± 4.78% of peak HR and 73.31 ± 4.97% of peak VO2. The respiratory quotient (R) of the group was 0.96 ± 0.09, and three out of eight individuals (37.5%) reached R higher than 1.00, and the Threshold II was identified in these individuals. We found positive relationships between CPT variables and balance scores, performance in the 6-minute walking test and running speed on the ground. CONCLUSION The test proved to be useful for prescribing physical activity in these individuals.

Treinamento de marcha, cardiorrespiratório e muscular após acidente vascular encefálico: estratégias, dosagens e desfechos

INTRODUCTION: An increasing number of training programs with positive results has been proposed for rehabilitation of stroke survivors with motor impairments. However, few studies offer recommendations regarding indications for specific techniques and procedures. OBJECTIVE: To review data from the literature about training and exercise programs in patients with hemiparesis following stroke regarding walking training, lower limb strengthening and cardiorespiratory fitness, and to describe the efficacy, limitations and effect of such programs on cardiovascular, motor recovery and functional status. Method: It was made a search in relevant medical journals for articles of clinical trials, meta-analyses, and literature reviews pertaining to physical training, muscular strengthening, gait training and exercise programs for lower limbs after stroke. RESULTS: It was found 27 articles reporting on various training and exercise techniques (gait training, cardiovascular training, muscle strengthening, and others) and their results on the cardiovascular, musculoskeletal, and neurological systems, as well as functional status in stroke patients. CONCLUSION: Training and exercise programs have value in stroke rehabilitation, and published results are, in general, promising. The differences in the populations tested, methods, and criteria for analysis do not always allow the recommendation of specific procedures in clinical practice.

Effect of backward walking treadmill training on walking capacity after stroke: a randomized clinical trial

Rationale Residual walking deficits are common in people after stroke. Treadmill training can increase walking speed and walking distance. A new way to increase the challenge of walking is to walk backwards. Backward treadmill walking may provide advantages by promoting improvement in balance, walking spatiotemporal parameters and quality that may reflect in improving walking distance. Aim This study will test the hypothesis that backward treadmill walking is superior to forward treadmill walking in improving walking capacity, walking parameters, quality and balance in people with stroke. Design A prospective, single-blinded, randomized trial will randomly allocate 88 community-dwelling people after stroke into either an experimental or control group. The experimental group will undertake 30-min sessions of backward treadmill walking, three-days/week for six-weeks, while the control group will undertake the same dose of forward treadmill walking. Training will begin at the baseline overground walking speed and will increase each week by 10% of baseline speed. Study outcomes The primary outcome will be distance walked in the 6-min Walk Test. Secondary outcomes will be walking speed, step length, cadence, and one-leg stance time. Outcomes will be collected by a researcher blinded to group allocation at baseline (Week 0), at the end of training period (Week 6), and three-months after the cessation of intervention (Week 18). Discussion If backward treadmill walking can improve walking capacity more than forward treadmill training in stroke, it may have broader implications because walking capacity has been shown to predict physical activity level and community participation.

Strength deficit of knee flexors is dependent on hip position in adults with chronic hemiparesis

BACKGROUND The extent to which muscle length affects force production in paretic lower limb muscles after stroke in comparison to controls has not been established. OBJECTIVES To investigate knee flexor strength deficits dependent on hip joint position in adults with hemiparesis and compare with healthy controls. METHOD a cross-sectional study with ten subjects with chronic (63±40 months) hemiparesis with mild to moderate lower limb paresis (Fugl-Meyer score 26±3) and 10 neurologically healthy controls. Isometric knee flexion strength with the hip positioned at 90° and 0° of flexion was assessed randomly on the paretic and non-paretic side of hemiparetic subjects and healthy controls. Subjects were asked to perform a maximal isometric contraction sustained for four seconds and measured by a dynamometer. The ratio of knee flexor strength between these two hip positions was calculated: Hip 0°/Hip 90°. Also, locomotor capacity was evaluated by the timed up and go test and by walking velocity over 10 meters. RESULTS In subjects with hemiparesis, absolute knee flexion torque decreased (p<0.001) with the hip in extension (at 0°). The ratio of knee flexor torque Hip 0°/Hip 90° on the paretic side in hemiparetics was lower than in controls (p=0.02). CONCLUSIONS Weakness dependent on joint position is more significant in the paretic lower limb of adults with hemiparesis when compared to controls. More attention should be given to lower limb muscle strengthening exercises in individuals with stroke, with emphasis on the strengthening exercises in positions in which the muscle is shortened.

Características espaço-temporais do andar para trás em indivíduos com hemiparesia

The present study aimed to compare spatial temporal variables between forward (FW) and backward walking (BW) in individuals with hemiparesis. Ten adults with chronic hemiparesis (30.6±25.1 months), mild motor impairment (20-31 points on Fugl-Meyer lower limb test), good balance (score=50±7 in the Berg scale) and independent walking (able to walk 10 meters without aid) were videotaped walking at comfortable speed with reflexive markers placed on lateral malleolus. The variables stride length, duration and speed and stance phase duration were analyzed with a two-way ANOVA: task and lower limb (LL). Stride length was lower (~44cm) in BW than in FW (F(1,18)=130,94; p≤0,001), as well as for stride (F(1,18)=163,78;p≤0,001) and walking speed (t19=10,99;p≤0,001). Stride and stance duration were ~0,18s e ~8%, respectively larger in BW than in FW (F(1,18)=11,98; p=0,003; F(1,18)=32,00; p≤0,001, respectively). Although the stride length in BW was reduced, the fact that the affected LL remained longer in stance in BW compared to FW indicates that the BW might be a relevant parameter in motor rehabilitation.

Translation, cultural adaptation and reliability of the brazilian version of the Graded Wolf Motor Function Test in adults with severe hemiparesis

Introduction : The Graded Wolf Motor Function Test (GWMFT) was developed as a modification of the Wolf Motor Function Test (WMFT), designed to address moderate-to-severe upper-extremity motor impairment, consequent to a stroke or brain injury, by combining time and quality of movement measures in both isolated movements and functional tasks. Objectives : To translate and adapt the GWMFT form and instructions manual to Brazilian Portuguese and evaluate the inter-rater reliability. Materials and methods : Ten individuals, mean age 53.2 ± 11.39 (range: 28-72) years and a mean time since stroke onset of 82.5 ± 85.83 (16-288) months participated in the study. After translation and cultural adaptation, two independent evaluators, based on the instructions manual information, administered GWMFT. Video observations were used to rate the time and the compensatory movements in the Functional Ability Scale (FAS). Intra-class Correlation Coefficients (ICCs) and Bland-Altman plots were calculated to examine the inter-rater reliability for performance time and FAS. Results : The translated and adapted version obtained a total ICC inter-rater time 0.99 (0.95-1.00), showing less reliability in the task of lifting a pen, with ICC = 0.71 (- 0.15-0.93). The ICC of the total FAS was 0.98 (0.92-0.99) and the task of elbow extension has shown the lowest ICC rate = 0.83 (0.31-0.96). Conclusion : The GWMFT scale reliability proved to be appropriate to evaluate the paretic upper limb in individuals with chronic hemiparesis post severe stroke.

Frequência cardíaca e percepção subjetiva de esforço durante o andar para trás em velocidade confortável e máxima em adultos com hemiparesia

INTRODUCAO E OBJETIVO: Estudos sobre o andar para tras (AT) em individuos saudaveis demonstraram que esse exercicio demanda maior consumo de oxigenio e esforco cardiopulmonar comparado ao andar para frente (AF). Em individuos apos acidente vascular encefalico (AVE), o AT demonstrou ser uma forma de terapia benefica para melhorar parâmetros de marcha. Este estudo teve como objetivo comparar as variaveis frequencia cardiaca (FC) e percepcao subjetiva de esforco (PSE) entre o AF e AT em esteira rolante em duas velocidades distintas em individuos com hemiparesia, algo que podera contribuir para a definicao da melhor estrategia para colocar os individuos na zona-alvo de um exercicio visando ao aprimoramento das condicoes cardiorrespiratorias. METODOS: Participaram 13 individuos adultos de ambos os sexos (53,7 ± 13,5 anos) com sequela de AVE cronica (38,5 ± 31,2 meses de acometimento). Os individuos realizaram a tarefa de AT na esteira em velocidade confortavel e maxima, repetindo os procedimentos em velocidades identicas durante o AF. Foi utilizada uma ANOVA fatorial para testar o efeito do sentido (AF e AT) e da velocidade (confortavel e maxima) sobre a FC e PSE. RESULTADOS: A FC foi maior durante o AT nas duas velocidades, sendo essa incrementada com o aumento da velocidade (p < 0,01 para todas comparacoes). Da mesma forma, a PSE foi maior durante o AT nas duas velocidades, sendo incrementada com o aumento da velocidade (p < 0,01 para todas as comparacoes). CONCLUSAO: Andar para tras e uma atividade fisica mais intensa que andar para frente em uma mesma velocidade para individuos com hemiparesia. Os achados sugerem que esta atividade poderia ser uma alternativa na realizacao de programas com enfase no condicionamento cardiopulmonar e como complemento de outros procedimentos na reeducacao do andar apos AVE.