Christina Danielli Coelho de Morais Faria

Impact of an Exercise Program on Physical, Emotional, and Social Aspects of Quality of Life of Individuals With Parkinson's Disease

We evaluated changes in different domains of quality of life (QL) for persons with Parkinsons disease after a program of physical activity. Twenty subjects with a diagnosis of Parkinsons disease classified as Stages 1 to 3 on the Hoehn and Yahr scale and with a mean age of 61.5 ± 9.8 years participated in 36 group sessions of a combined group program of aerobic conditioning and muscular strengthening. QL was investigated by the Nottingham Health Profile, a generic questionnaire composed of six domains. Students paired t tests indicated significant gains associated with the program (P < 0.05) on the total score and those related to emotional reactions (ER), social interactions (SI), and physical ability (PA). SI was the domain that showed the greatest program gains (41.4%). The program of physical activity performed with persons with Parkinsons disease at light to moderate stages resulted in improvements in their perception of QL, mainly in the domains of ER, SI, and PA.

Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome

The aim of this study was to compare the recruitment patterns and latencies of the scapular muscles, as well as the isokinetic performance of the shoulder rotators in 10 subjects with unilateral impingement syndrome who comprised the impingement group (IG) with a control group (CG) of 10 asymptomatic subjects. The recruitment patterns and latencies were evaluated by electromyographic activity during arm elevation in the scapular plane. Isokinetic work ratios of the shoulder rotator muscles were used to analyze muscular performance. A 2 x 2 ANOVA detected that muscular performance and recruitment patterns were similar for both groups and sides. However, the ANOVA revealed a significant side and group interaction, indicating that the scapular muscle latencies of the affected shoulder was greater than that of the nonaffected side only for the IG (p < .001). These findings indicated that subjects with light to moderate impingement syndrome showed late recruitment of the scapular muscles during arm elevation. However, muscular performance of the shoulder rotator muscles was not affected.

Effects of the Direction of Turning on the Timed Up & Go Test with Stroke Subjects

Abstract Purpose: To compare the Timed Up & Go (TUG) test between subjects with and without hemiparesis, considering the direction toward which they turned, and to determine the potential clinical variables that could explain possible observed differences between the groups and/or the turning directions. Method: Twenty-two hemiparetic and 22 matched control subjects performed the TUG twice, with each one turning in both directions. Measures of the strength and tonus of the quadriceps, gait speed, balance, and fear of falling were also collected. Results: Stroke subjects were slower in the TUG than the control group, independent of the direction toward which they turned (F = 45.87; p < .001). For both groups, similar performances were observed when turning toward the paretic and nonparetic/matched sides (F = 0.50; p = .48). The absolute differences between the two TUG trials were greater for the stroke subjects (p = .001) and were significantly correlated with gait speed, balance, and fear of falling (−0.69 < r < − 0.52; p < .013), with fear of falling being the only variable retained in the regression model (R2 = 0.44; p = .001). For the control subjects, no significant correlations were found. Conclusions: The larger differences between the two TUG trials for the stroke subjects illustrated the impact of the turning direction on test performance. These differences were not related to hemiparesis, but to the fear of falling.

Avaliação das atividades de vida diária de idosos com diferentes níveis de demência

OBJECTIVE: To compare the performance of elderly people with different levels of severity of dementia using questionnaires on basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). Also, to verify whether there were any association between the IADL questionnaires applied. METHOD: Ninety elderly people, aged 75.46 ± 7.66 years with a clinical diagnosis of dementia (DSM-IV/APA) who were seen at the Minas Gerais Reference Center for the Elderly, were randomized selected and classified according to the level of severity of their dementia (Clinical Dementia Rating). Their BADLs were assessed using the Katz Index and their IADLs by the Lawton-Brody and Pfeffer indexes. The Kruskal-Wallis and Mann-Whitney tests were used in order to investigate the elderly peoples performance regarding BADLs, while the Spearman correlation was used to investigate the relationships among the IADL (a< 0.05). RESULTS: Statistically significant differences in performance were found between the elderly people with different levels of severity of dementia, as assessed by the BADL and IADL questionnaires (p< 0.001). The IADL questionnaires presented significant correlation for the total sample (p< 0.0001; r = -0.818) as well as for the groups with mild dementia (p= 0.007; r = -0.530) and severe dementia (p< 0.0001; r = -0.723). CONCLUSION: The severity of the dementia process interfered with the elderly peoples performance of the elderly in BADLs and IADLs. The IADLs were more affected in the early stages of dementia whereas the BADLs were more affected in the more advanced stages. Despite structural particularities, the IADL questionnaires utilized seemed to be measuring a common construct. The variability in the clinical condition of the individuals with moderate dementia may be an explanation for the lack of correlation between the questionnaires in this specific group.Evaluation of the activities of daily living of elderly people with different levels of dementia Objective: To compare the performance of elderly people with different levels of severity of dementia using questionnaires on basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). Also, to verify whether there were any association between the IADL questionnaires applied. Method: Ninety elderly people, aged 75.46 ± 7.66 years with a clinical diagnosis of dementia (DSM-IV/APA) who were seen at the Minas Gerais Reference Center for the Elderly, were randomized selected and classified according to the level of severity of their dementia (Clinical Dementia Rating). Their BADLs were assessed using the Katz Index and their IADLs by the Lawton-Brody and Pfeffer indexes. The Kruskal-Wallis and Mann-Whitney tests were used in order to investigate the elderly people’s performance regarding BADLs, while the Spearman correlation was used to investigate the relationships among the IADL (α< 0.05). Results: Statistically significant differences in performance were found between the elderly people with different levels of severity of dementia, as assessed by the BADL and IADL questionnaires (p< 0.001). The IADL questionnaires presented significant correlation for the total sample (p< 0.0001; r = -0.818) as well as for the groups with mild dementia (p= 0.007; r = -0.530) and severe dementia (p< 0.0001; r = -0.723). Conclusion: The severity of the dementia process interfered with the elderly people’s performance of the elderly in BADLs and IADLs. The IADLs were more affected in the early stages of dementia whereas the BADLs were more affected in the more advanced stages. Despite structural particularities, the IADL questionnaires utilized seemed to be measuring a common construct. The variability in the clinical condition of the individuals with moderate dementia may be an explanation for the lack of correlation between the questionnaires in this specific group.

Content comparisons of stroke-specific quality of life based upon the international classification of functioning, disability, and health

PurposeTo link the concepts underlying the Stroke-Specific Quality of Life (SS-QOL) scale with those of the International Classification of Functioning, Disability, and Health (ICF), which are two different perspectives to consider functioning and health. This will facilitate the understanding of the relationships between the SS-QOL and the ICF. One of the purposes of the ICF is to be used as a common terminology and a clinical problem-solving tool in clinical and research settings. The ICF concept of functioning can also serve as the basis for the operationalization of the health-related quality of life. Thus, efforts should be made to allow the concurrent use of the ICF and health measurements in both clinical and research settings.MethodsLinking of the SS-QOL concepts with the ICF categories was carried out by two independently trained health care professionals who applied the standardized eight linking rules that were specifically developed and updated for this purpose. The degree of agreement between the health care professionals was determined by kappa coefficients.ResultsOf the 49 items of the SS-QOL, 54 concepts were identified. The level of agreement between the health care professionals showed that the kappa coefficients ranged from 0.75 to 1.00. Three concepts (5.5%) could not be linked to the ICF and were coded as not covered. Fifty-one were linked to the ICF categories for the following components: 22 (41%)—body functions; 26 (48%)—activities and participation; and three (5.5%)—environmental factors. Eleven ICF chapters were identified.ConclusionsSeveral categories of the ICF were linked to the items of the SS-QOL, with acceptable levels of agreement. These categories were specific and meaningful for stroke subjects, since the majority of the identified concepts were included in the comprehensive ICF core set for stroke. The findings indicated that the ICF provided a useful framework for the conceptual understanding of the SS-QOL, which demonstrated multiple representations of the ICF categories and covered a broad range of the ICF components that were meaningful for the stroke subjects.

Scapular muscular activity with shoulder impingement syndrome during lowering of the arms.

Objective:To compare isolated electromyographic (EMG) activity of the serratus anterior, upper, middle, and lower trapezius, as well as the coactivation of the upper and middle trapezius/serratus anterior in subjects with and without shoulder impingement syndrome (IS), during lowering of the arms. Design:Cross-sectional study. Setting:University laboratory. Participants:Twenty young adults, 10 with unilateral IS degree I or II (mean age 28.6 ± 5.89 years) and 10 without any complaints or history of previous shoulder lesions (mean age 29.0 ± 5.35 years), matched by gender, age, and levels of physical activity. Main Outcome Measurements:Isolated EMG activity of the serratus anterior, upper, middle, and lower trapezius, as well as the coactivation of the upper trapezius and middle trapezius/serratus anterior. The EMG activity was quantified by root mean square calculations and normalized by maximal voluntary isometric contractions. Results:Significant differences between groups were found only for the coactivation of the middle trapezius/serratus anterior (F = 6.81; P = 0.02). No significant differences were found between sides (F = 0.05; P = 0.83) nor for interactions between sides and groups (F = 3.85; P = 0.07). Conclusions:These findings pointed out the importance of evaluating the lowering of the arms in individuals with IS and suggested that measures of coactivation, besides reflecting the real purpose of the muscular actions during functional activities, are more sensitive to detect changes between groups. The evaluation of the coactivation of the middle trapezius/serratus anterior should be included in clinical assessment of individuals with IS and investigations on the etiology and progression of IS.

Versão brasileira do Fear Avoidance Beliefs Questionnaire

The aim of the present study was to investigate the psychometric properties and validate the Portuguese version of the Fear Avoidance Beliefs Questionnaire (FABQ-Brazil). This instrument assesses how beliefs and fear of individuals with lower back pain affect two subscales related to their physical activities (FABQ-Phys) and work (FABQ-Work). The questionnaire was translated into Brazilian Portuguese, following the recommended methodology, and applied to 53 individuals with non-specific chronic lower back pain. The test-retest intra-class correlation coefficients (ICC = 0.84 and 0.91) and the internal consistency (Cronbachs = 0.80 and 0.90) for FABQ-Phys and FABQ-Work, respectively, were acceptable. The stepwise multiple regression analyses revealed statistically significant correlations between all isolated items with their respective subscales, and the set of the items explained 99% of the changes in scores for each subscale. No significant correlations were found between the subscales; however, both the FABQ-Phys and FABQ-Work subscales were positively associated with pain intensity (visual numerical scale) and degree of disability (Roland Morris Questionnaire). These findings supported the evidence that the FABQ-Brazil showed adequate psychometric properties for individuals with chronic lower back pain.

The effects of walking sticks on gait kinematics and kinetics with chronic stroke survivors

BACKGROUND There are robust clinical paradigms against the prescription of walking sticks for people with stroke. However, there is little information on the biomechanics of gait with and without these devices to guide clinical practice. Therefore, this study investigated how the use of walking sticks (canes or crutches) affected both the kinematics and kinetics of gait in people with chronic stroke after their walking had stabilized. METHODS Nineteen people with chronic stroke walked at both comfortable and fast speeds. A 3-D motion analysis system and one force platform were used to obtain kinematic and kinetic data of the paretic lower limb during four conditions: With and without walking sticks, and at comfortable and fast speeds. Outcomes included linear kinematics (walking speeds) and angular kinematics (maximum joint angles), power, and work of the paretic hip, knee and ankle joints in the saggital plane. FINDINGS The use of walking sticks resulted in increases in speed during both fast (P<0.001) and comfortable (P=0.001) walking, but did not result in changes in maximum joint angles. This also led to increases in ankle plantar flexion (P<0.01), knee extension (P<0.01), and hip flexion (P<0.001) power generation, but did not result in changes in work. There were no greater changes as a result of using walking sticks during fast versus comfortable walking for any outcome. INTERPRETATIN: The outcomes with the use of walking sticks were beneficial, which suggests that the prescription of these devices is not detrimental to walking that was stabilized in people with stroke.

Measurement of scapular kinematics with the moiré fringe projection technique

The aim of this study was to investigate the applicability of the moiré fringe projection technique (MFPT) to quantify the scapular motions relative to the thorax. This system was composed of a LCD projector, a digital photographic camera, and a microcomputer. To automatically obtain the scapular profiles, the phase shifting method was combined with the MFPT. Four fringes were projected on the scapula and four on the reference planes. By the simple subtraction of the reference values from the scapular phase maps, the map due to the moiré fringes could be digitally obtained. After the phase decoding, the tridimensional (3D) profiles were obtained without prior information about the samples and the calculations of the scapular kinematics were carried out using dedicated software. On average, the movements of lateral rotation ranged from -1.8+/-6.1 degrees to -26.5+/-3.5 degrees; the protraction from 28.4+/-4.7 degrees to 27.7+/-6.8 degrees, and the posterior tilt from -6.4+/-7.8 degrees to -21.7+/-6.1 degrees, during the arm elevation in the scapular plane performed by six healthy subjects. For the test-retest reliability, the intra-class correlation coefficients ranged from 0.92 to 0.997 and the maximum estimated error was 0.8%. The MFPT allowed the scapular 3D measurements to be obtained in a digital and non-invasive manner. The main advantages compared with other existing systems were its ease in implementation, the use of standard optical components, and its possible clinical applications.

Strength of the respiratory and lower limb muscles and functional capacity in chronic stroke survivors with different physical activity levels

BACKGROUND The assessment of strength and its relationships with functional capacity could contribute to more specific and effective disability management of stroke survivors. OBJECTIVE To compare and investigate associations between measures of strength and functional capacity of 98 chronic stroke survivors, stratified into three groups, according to their physical activity levels. METHOD The physical activity levels were classified as impaired, moderately active, and active, based on their Human Activity Profile (HAP) scores. Strength was assessed by the maximal inspiratory (MIP) and expiratory (MEP) pressures and by the residual deficits (RDs) of work of the lower limb and trunk muscles, whereas functional capacity was evaluated by the distance covered during the six-minute walking test (6MWT). RESULTS One-way analyses of variance revealed significant differences between the groups, except between the active and moderately active groups regarding the RDS of the hip and knee flexors/extensors and ankle dorsiflexors (2.91<F<8.62; 0.001<p<0.01). Differences between the groups were found for the 6MWT (F=10.75; p<0.001), but no differences were found for the MIP and MEP measures (0.92<F<2.13; 0.13<p<0.40). Significant, negative, and fair correlations were observed between the RDS of the hip and knee muscles and the 6MWT (0.30<r<-0.43; p<0.01) and the HAP (-0.28<r<-0.41; p<0.01). Moderate to good correlations were found between the 6MWT and the HAP (r=0.50; p<0.0001). There were no significant correlations between measures of respiratory strength and any of the investigated variables (-0.11<r<0.12; 0.26<p<0.56). CONCLUSIONS Lower strength deficits and higher functional capacity were associated with higher physical activity levels. However, the moderately active and active groups demonstrated similar strength deficits.