Danielli Souza Speciali

Validation of GDI, GPS and GVS for use in parkinson's disease through evaluation of effects of subthalamic deep brain stimulation and levodopa

The Gait Deviation Index (GDI), Gait Profile Score (GPS) and Gait Variable Scores (GVSs) have been proposed as measures of gait quality and validated for use with children with cerebral palsy. The aim of this study was to extend this validation to people with Parkinsons disease by evaluating the effects of subthalamic deep brain stimulation and levodopa on gait. 16 participants had their gait evaluated with stimulation, medication or a combination of both. The Unified Parkinsons Disease Rating Scale (UPDRS) showed statistically significant differences in agreement with previous studies. The GPS and GDI showed similar treatment effects as did GVS for hip and knee flexion/extension, as assessed with Cohens d where medium or large. Overall the results suggest that these gait indices are sensitive to treatment in this group of patients and that their use in groups other than children with cerebral palsy is valid.

Use of the Gait Deviation Index and spatiotemporal variables for the assessment of dual task interference paradigm

Three-dimensional gait analysis (3DGA) is an important element in the quantitative evaluation of gait in subjects with Parkinsons disease (PD). Indexes, such as the Gait Deviation Index (GDI), have recently been proposed as a summary measure of gait. The aim of the present study was to investigate the effectiveness of the GDI and spatiotemporal variables in the quantification of changes in gait during a dual-task (DT) exercise. Fourteen patients with idiopathic PD and nine healthy subjects (CG) participated in the study. All subjects walked under two conditions: free walking and DT walking. The GDI was computed from the 3DGA data. The results show gait impairment during DT, a significant difference between groups regarding GDI and an interaction effect involving the group, side and task factors. The CG and PDG were different independent of interference and side, but interference was only different for the PDG group. The results also demonstrate that the GDI should be an appropriate outcome measure for the evaluation of the effects of DT on patients with Parkinsons disease.

Gait profile score and movement analysis profile in patients with Parkinson's disease during concurrent cognitive load

Background: Gait disorders are common in individuals with Parkinsons Disease (PD) and the concurrent performance of motor and cognitive tasks can have marked effects on gait. The Gait Profile Score (GPS) and the Movement Analysis Profile (MAP) were developed in order to summarize the data of kinematics and facilitate understanding of the results of gait analysis. Objective: To investigate the effectiveness of the GPS and MAP in the quantification of changes in gait during a concurrent cognitive load while walking in adults with and without PD. Method: Fourteen patients with idiopathic PD and nine healthy subjects participated in the study. All subjects performed single and dual walking tasks. The GPS/MAP was computed from three-dimensional gait analysis data. Results: Differences were found between tasks for GPS (P<0.05) and Gait Variable Score (GVS) (pelvic rotation, knee flexion-extension and ankle dorsiflexion-plantarflexion) (P<0.05) in the PD group. An interaction between task and group was observed for GPS (P<0.01) for the right side (Cohens ¯d=0.99), left side (Cohens ¯d=0.91), and overall (Cohens ¯d=0.88). No interaction was observed only for hip internal-external rotation and foot internal-external progression GVS variables in the PD group. Conclusions: The results showed gait impairment during the dual task and suggest that GPS/MAP may be used to evaluate the effects of concurrent cognitive load while walking in patients with PD.

Analysis of static and dynamic balance in healthy elderly practitioners of Tai Chi Chuan versus ballroom dancing

OBJECTIVE: To determine whether Tai Chi Chuan or ballroom dancing promotes better performance with respect to postural balance, gait, and postural transfer among elderly people. METHODS: We evaluated 76 elderly individuals who were divided into two groups: the Tai Chi Chuan Group and the Dance Group. The subjects were tested using the NeuroCom Balance Master® force platform system with the following protocols: static balance tests (the Modified Clinical Tests of Sensory Interaction on Balance and Unilateral Stance) and dynamic balance tests (the Walk Across Test and Sit-to-stand Transfer Test). RESULTS: In the Modified Clinical Test of Sensory Interaction on Balance, the Tai Chi Chuan Group presented a lower sway velocity on a firm surface with open and closed eyes, as well as on a foam surface with closed eyes. In the Modified Clinical Test of Sensory Interaction on Unilateral Stance, the Tai Chi Chuan Group presented a lower sway velocity with open eyes, whereas the Dance Group presented a lower sway velocity with closed eyes. In the Walk Across Test, the Tai Chi Chuan Group presented faster walking speeds than those of the Dance Group. In the Sit-to-stand Transfer Test, the Tai Chi Chuan Group presented shorter transfer times from the sitting to the standing position, with less sway in the final standing position. CONCLUSION: The elderly individuals who practiced Tai Chi Chuan had better bilateral balance with eyes open on both types of surfaces compared with the Dance Group. The Dance Group had better unilateral postural balance with eyes closed. The Tai Chi Chuan Group had faster walking speeds, shorter transfer times, and better postural balance in the final standing position during the Sit-to-stand Test.

Treadmill training in Parkinson's patients after deep brain stimulation: Effects on gait kinematic

OBJECTIVE The purpose of this study was to evaluate the effect of treadmill training with body weight support on gait kinematics parameters in patients with PD using DBS. DESIGN Twelve patients completed the protocols (age: 60.9±10.6 years; disease duration: 20±7 years; and time since DBS surgery: 20±4 months). The same set of patients underwent two trainings protocols and four gait analyses (before and after each training). They received eight weeks of treadmill training without body weight support (16 sessions) in conjunction with physiotherapy program followed by six weeks of wash out period, followed by eight weeks of body-weight-supported treadmill training in conjunction with a same physiotherapy program. The Gait Kinematic Analysis involved eight infrared cameras that detected 19 reflective spherical markers attached in limb lower of patients. Statistical analysis used the Wilcoxon test (p≤0.05). RESULTS Both the training no showed significant differences in linear variables. As the angular variables, only training with support showed significant increase of ranges of motion: pelvis tilt, obliquity and rotation amplitude; hip adduction-abduction and rotation amplitude; percentage of peak flexion in swing phase; foot progression amplitude. CONCLUSION The body weight supported treadmill training may promote increase of mobility of lower limbs during gait and it could be a targeted intervention for PD patients treated with DBS.

Correlation between temporal-spatial parameters and manual ability of adults with dyskinetic cerebral palsy

The aim of this study was to verify relation between kinematic variables of temporal-spatial parameters and manual ability and between own temporal-spatial variables during the movement of bring a mug to the mouth in adults with dyskinetic cerebral palsy (DCP). Sixteen adults with DCP were evaluated by MACS (Manual Ability Classification System), and by temporal-spatial variables of tridimensional kinematics of the movement to bring a bug to the mouth by means of 9 cameras infra-red Vicon(r) MX 40 (Oxford Metrics Group, Oxford, UK). The Spearman correlation coefficient (ρ) was used to correlate variables. As a result, we found weak correlation between the classification of manual ability and the adjusting phase (ρ=0.219), the velocity variables - average velocity (ρ=-0.313), peak velocity (ρ=-0.282) and time to peak velocity (ρ=-0.250). No correlation was found between the variables going and returning phase and MACS. Moderate correlation was found between going and returning phase (ρ=0.559), between the going phase and time to peak velocity (ρ=0.518) and between the adjusting phase and peak velocity (ρ=-0.562). A strong correlation was found between the mean velocity and peak velocity (ρ=0.947) and between the adjusting phase and average velocity (ρ=-0.635). In conclusion, functional impairment may be related to longer adjusting phase and decrease of movement speed in subjects with PCD. Kinematic variables were related to each other in moderate and strong way and indicated that the phases runtime influences the movement speed.El objetivo de este estudio fue verificar si hay una relacion entre las variables cinematicas espacio-temporales y la habilidad manual y entre las propias variables espacio-temporales estudiadas durante el movimiento de traer una taza a la boca en adultos con paralisis cerebral tipo discinetica (PCD). Dieciseis adultos con PCD fueron sometidos a una evaluacion de habilidad manual por medio de la escala MACS (Manual Ability Classification System) y analisis de las variables espacio-temporales de la cinematica tridimensional del movimiento para llevar una taza a la boca por medio de 9 camaras infrarrojas Vicon(r) MX 40 (Oxford Metrics Group, Oxford, UK). El coeficiente de correlacion de Spearman (r) fue aplicado para verificar la relacion entre las variables estudiadas. Como resultado, fue encontrada una debil correlacion entre la clasificacion de la habilidad manual y la fase de ajuste del movimiento (r=0,219), las variables de velocidad - velocidad media (r=-0,313), velocidad maxima (r=-0,282) y tiempo para alcanzar la velocidad maxima (r=-0,250). No se encontro correlacion entre la variable tiempo de ida y la variable de regreso del movimiento y la MACS. Correlacion moderada se encontro entre la fase de ida y la fase de regreso del movimiento (r=0,559), entre la fase de ida y el tiempo para alcanzar la velocidad maxima (r=0,518) y entre la fase de ajuste y la velocidad maxima (r=-0,562). Fuerte correlacion se encontro entre la velocidad media y la velocidad maxima (r=0,947) y entre la fase de ajuste y la velocidad media (r=-0,635). A modo de conclusion, el perjuicio funcional puede ser relacionado con mas tiempo de ejecucion de la fase de ajuste y con la reduccion de la velocidad del movimiento en sujetos con PCD. Las variables cinematicas se relacionaban de manera moderada y fuerte e

Correlação entre os parâmetros espaçotemporais e a habilidade manual de adultos com paralisia cerebral do tipo discinético

The aim of this study was to verify relation between kinematic variables of temporal-spatial parameters and manual ability and between own temporal-spatial variables during the movement of bring a mug to the mouth in adults with dyskinetic cerebral palsy (DCP). Sixteen adults with DCP were evaluated by MACS (Manual Ability Classification System), and by temporal-spatial variables of tridimensional kinematics of the movement to bring a bug to the mouth by means of 9 cameras infra-red Vicon(r) MX 40 (Oxford Metrics Group, Oxford, UK). The Spearman correlation coefficient (ρ) was used to correlate variables. As a result, we found weak correlation between the classification of manual ability and the adjusting phase (ρ=0.219), the velocity variables - average velocity (ρ=-0.313), peak velocity (ρ=-0.282) and time to peak velocity (ρ=-0.250). No correlation was found between the variables going and returning phase and MACS. Moderate correlation was found between going and returning phase (ρ=0.559), between the going phase and time to peak velocity (ρ=0.518) and between the adjusting phase and peak velocity (ρ=-0.562). A strong correlation was found between the mean velocity and peak velocity (ρ=0.947) and between the adjusting phase and average velocity (ρ=-0.635). In conclusion, functional impairment may be related to longer adjusting phase and decrease of movement speed in subjects with PCD. Kinematic variables were related to each other in moderate and strong way and indicated that the phases runtime influences the movement speed.El objetivo de este estudio fue verificar si hay una relacion entre las variables cinematicas espacio-temporales y la habilidad manual y entre las propias variables espacio-temporales estudiadas durante el movimiento de traer una taza a la boca en adultos con paralisis cerebral tipo discinetica (PCD). Dieciseis adultos con PCD fueron sometidos a una evaluacion de habilidad manual por medio de la escala MACS (Manual Ability Classification System) y analisis de las variables espacio-temporales de la cinematica tridimensional del movimiento para llevar una taza a la boca por medio de 9 camaras infrarrojas Vicon(r) MX 40 (Oxford Metrics Group, Oxford, UK). El coeficiente de correlacion de Spearman (r) fue aplicado para verificar la relacion entre las variables estudiadas. Como resultado, fue encontrada una debil correlacion entre la clasificacion de la habilidad manual y la fase de ajuste del movimiento (r=0,219), las variables de velocidad - velocidad media (r=-0,313), velocidad maxima (r=-0,282) y tiempo para alcanzar la velocidad maxima (r=-0,250). No se encontro correlacion entre la variable tiempo de ida y la variable de regreso del movimiento y la MACS. Correlacion moderada se encontro entre la fase de ida y la fase de regreso del movimiento (r=0,559), entre la fase de ida y el tiempo para alcanzar la velocidad maxima (r=0,518) y entre la fase de ajuste y la velocidad maxima (r=-0,562). Fuerte correlacion se encontro entre la velocidad media y la velocidad maxima (r=0,947) y entre la fase de ajuste y la velocidad media (r=-0,635). A modo de conclusion, el perjuicio funcional puede ser relacionado con mas tiempo de ejecucion de la fase de ajuste y con la reduccion de la velocidad del movimiento en sujetos con PCD. Las variables cinematicas se relacionaban de manera moderada y fuerte e

Correlación entre los parámetros espacio-temporales y la habilidad manual de adultos con parálisis cerebral tipo discinética

The aim of this study was to verify relation between kinematic variables of temporal-spatial parameters and manual ability and between own temporal-spatial variables during the movement of bring a mug to the mouth in adults with dyskinetic cerebral palsy (DCP). Sixteen adults with DCP were evaluated by MACS (Manual Ability Classification System), and by temporal-spatial variables of tridimensional kinematics of the movement to bring a bug to the mouth by means of 9 cameras infra-red Vicon(r) MX 40 (Oxford Metrics Group, Oxford, UK). The Spearman correlation coefficient (ρ) was used to correlate variables. As a result, we found weak correlation between the classification of manual ability and the adjusting phase (ρ=0.219), the velocity variables - average velocity (ρ=-0.313), peak velocity (ρ=-0.282) and time to peak velocity (ρ=-0.250). No correlation was found between the variables going and returning phase and MACS. Moderate correlation was found between going and returning phase (ρ=0.559), between the going phase and time to peak velocity (ρ=0.518) and between the adjusting phase and peak velocity (ρ=-0.562). A strong correlation was found between the mean velocity and peak velocity (ρ=0.947) and between the adjusting phase and average velocity (ρ=-0.635). In conclusion, functional impairment may be related to longer adjusting phase and decrease of movement speed in subjects with PCD. Kinematic variables were related to each other in moderate and strong way and indicated that the phases runtime influences the movement speed.El objetivo de este estudio fue verificar si hay una relacion entre las variables cinematicas espacio-temporales y la habilidad manual y entre las propias variables espacio-temporales estudiadas durante el movimiento de traer una taza a la boca en adultos con paralisis cerebral tipo discinetica (PCD). Dieciseis adultos con PCD fueron sometidos a una evaluacion de habilidad manual por medio de la escala MACS (Manual Ability Classification System) y analisis de las variables espacio-temporales de la cinematica tridimensional del movimiento para llevar una taza a la boca por medio de 9 camaras infrarrojas Vicon(r) MX 40 (Oxford Metrics Group, Oxford, UK). El coeficiente de correlacion de Spearman (r) fue aplicado para verificar la relacion entre las variables estudiadas. Como resultado, fue encontrada una debil correlacion entre la clasificacion de la habilidad manual y la fase de ajuste del movimiento (r=0,219), las variables de velocidad - velocidad media (r=-0,313), velocidad maxima (r=-0,282) y tiempo para alcanzar la velocidad maxima (r=-0,250). No se encontro correlacion entre la variable tiempo de ida y la variable de regreso del movimiento y la MACS. Correlacion moderada se encontro entre la fase de ida y la fase de regreso del movimiento (r=0,559), entre la fase de ida y el tiempo para alcanzar la velocidad maxima (r=0,518) y entre la fase de ajuste y la velocidad maxima (r=-0,562). Fuerte correlacion se encontro entre la velocidad media y la velocidad maxima (r=0,947) y entre la fase de ajuste y la velocidad media (r=-0,635). A modo de conclusion, el perjuicio funcional puede ser relacionado con mas tiempo de ejecucion de la fase de ajuste y con la reduccion de la velocidad del movimiento en sujetos con PCD. Las variables cinematicas se relacionaban de manera moderada y fuerte e