Enio Walker Azevedo Cacho

Gait analysis comparing Parkinson's disease with healthy elderly subjects

UNLABELLED There is a lack of studies comparing the kinematics data of idiopathic Parkinsons disease (IPD) patients with healthy elder (HE) subjects, and when there is such research, it is not correlated to clinical measures. OBJECTIVE To compare the spatio-temporal and kinematic parameters of Parkinsonian gait with the HE subjects group and measure the relation between these parameters and clinical instruments. METHOD Twelve patients with IPD and fifteen HE subjects were recruited and evaluated for clinical instruments and gait analysis. RESULTS There were statistically significant differences between HE group and the IPD group, in stride velocity, in stride length (SL), and in the hip joint kinematic data: on initial contact, on maximum extension during terminal contact and on maximum flexion during mid-swing. Regarding the clinical instruments there were significant correlated with in stride velocity and SL. CONCLUSION Clinical instruments used did not present proper psychometric parameters to measure the IPD patients gait, while the 3D system characterized it better.Poucos estudos comparam os dados cinematicos de pacientes com doenca de Parkinson idiopatica (DPI) com individuos idosos saudaveis, e quando realizam nao correlacionam com medidas clinicas. OBJETIVO: Comparar os parâmetros espaco-temporais e cinematicos da marcha na DP com os de idosos saudaveis (IS) e avaliar a relacao entre estes parâmetros com os instrumentos clinicos. METODO: Doze pacientes com DPI e quinze IS foram recrutados e avaliados por instrumentos clinicos e de analise de marcha. RESULTADOS: Houve diferencas estatisticas significantes entre o grupo de IS e o de DPI na velocidade da marcha e no comprimento do passo (CP), nos dados cinematicos das articulacoes do quadril: no contato inicial, na maxima extensao no apoio e na maxima flexao na oscilacao. No que diz respeito aos instrumentos clinicos houve significativa correlacao com a velocidade da marcha e SL. CONCLUSAO: Os instrumentos clinicos utilizados nao apresentaram adequados parâmetros psicometricos para a avaliacao da marcha dos individuos com DPI, enquanto uma avaliacao em 3D caracteriza melhor a marcha destes individuos.

Post-stroke motor and functional evaluations: a clinical correlation using Fugl-Meyer assessment scale, Berg balance scale and Barthel index

UNLABELLED Stroke is one of the major causes of morbidity and mortality. Sequels deriving from this event may lead to motor disability and from mild to severe deficits. In order to better classify sensory-motor dysfunction, balance and ability to perform activities of daily living, quantitative and qualitative evaluation scales have been used. OBJECTIVE To correlate the scales Fugl-Meyer assessment scale, Berg balance scale and Barthel index. Twenty subjects with sequel after a single, unilateral stroke in chronic phase (>6 months post ictus) were evaluated for about one hour. RESULTS Barthel scale was statistically related to the total motor score of Fugl-Meyer assessment (r=0.597, p=0.005). The lower limb section at Fugl-Meyer had positive correlation with Berg scale (r=0.653, p=0.002) and with the balance section of Fugl-Meyer own scale (r=0.449, p=0.047). Both balance scales were correlated one with other (r=0.555, p=0.011). Statistical divergence appeared when Barthels Index was correlated with Bergs Scale (r=0.425, p=0.062), and it is not statistically significant. CONCLUSION The use of both quantitative and qualitative scales was shown to be a good measuring instrument for the classification of the general clinical performance of the patient, especially when positively related joint evaluations are applied.

Effectiveness of the open and closed kinetic chain exercises in the treatment of the patellofemoral pain syndrome

El objetivo de este estudio era analizar los efectos terapeuticos de los ejercicios en la cadena cinetica abierta (CCA) y la cadena cinetica cerrada (CCC) en el tratamiento del sindrome del dolor femoropatelar (SDFP). Para esto se ofrecieron 24 portadores de SDFP que fueron divididos aleatoriamente en dos grupos: Se agruparon en: los ejercicios I en CCA (el n = 12); y los ejercicios II en CCC (el n = 12). Los grupos se sometieron a ocho semanas consecutivas de tratamiento que consistio en tres sesiones semanales logradas en los dias alternados. Para los analisis de los modelos de activacion de los musculos medio oblicuo (VMO) y vasto lateral (VL) las senales electromiograficas (EMG) adquiridas con los electrodos bipolares de superficie, cuantificaron por la raiz cuadrada del promedio (la raiz el cuadrado - RMS) y se normalizo por el maximo de la reduccion isometrico voluntario del cuadriceps. A traves de balanzas se evaluo la intensidad del dolor y la funcionalidad de los voluntarios. El analisis de los valores de la razon VMO/VL en los grupos I y II demostramos que no habia diferencias significantes entre la veces de tiempos pre y post-tratamiento en las fases concentricas (el p > 0,05) y excentricas (el p > 0,05) de los ejercicios en CCA y CCC. A pesar de eso, el musculo VMO presento un punto de activacion mas pequeno respecto a VL en la fase excentrica del ejercicio en CCF. En ellos se encontraron aumentos significantes en la funcionalidad (p < 0,05) y en la reduccion de la intensidad del dolor (p < 0,05) entre veces de tiempo y post-tratamiento en ambos grupos, sin embargo, el de grupo II se mostraron superiores al grupo I en estas dos variables. Los resultados de este estudio sugieren que, de acuerdo con las condiciones experimentales usadas, los ejercicios en CCA y CCC no provocaron los cambios en los modelos de activacion EMG de los musculos VMO y VL, sin embargo, ellos promovieron mejora de la funcionalidad y reduccion de la intensidad del dolor despues de ocho semanas de intervencion, y los ejercicios en CCC eran superiores al de en CCA.The aim of this study was to analyze the therapeutic effects of the open kinetic chain (OKC) and closed kinetic chain (CKC) exercises to treat the patellofemoral syndrome (PFSD). For this, 24 volunteers, bearers of the PFSD were randomly divided in two groups: group I (n = 12) performed the OKC exercises; group II (n = 12) performed the CKC exercises. Both groups were submitted to eight consecutive weeks of treatment consisting of three weekly sessions performed in alternate days. To analyze the activation pattern of the vastus medialis oblique (VMO) and the vastus lateralis (VL) muscles, the electromyographic signals (EMG) were collected using bipolar surface electrodes quantified by the root mean square (RMS) normalized by the maximal voluntary isometric contraction of the quadriceps. The pain intensity and the functionality of the volunteers were assessed using scales. The analysis of the amounts of the VMO/VL ratio in both groups I and II showed no significant differences as to the pre- and post-treatment times in the concentric (p > 0.05) and eccentric (p > 0.05) phases of the OKC and CKC exercises. Despite of this, the VMO muscle presented a lower activation rate compared to the VL in the eccentric phase of the CKC exercise. It was found significant increases in the functionality (p < 0.05), and a reduction in the pain intensity (p < 0.05) between the pre- and post-treatment times in both groups, but group II showed higher amounts compared to group I in both variables. The results found in this study suggest that according to the conditions of the trial, the OKC and CKC exercises provoke no changes in the patterns of the EMG activation in the VMO and VL muscles. However, they promoted an improvement in the functionality and a reduction in the pain intensity after the eight week intervention, and the CKC exercises presented better performances than OKC exercises.

Versão brasileira da Escala de Comprometimento do Tronco: um estudo de validade em sujeitos pós-acidente vascular encefálico

O controle de tronco - uma habilidade motora basica indispensavel a execucao de muitas tarefas funcionais - encontra-se deficitario em pacientes que sofreram acidente vascular encefalico (AVE). Ha poucas referencias estrangeiras, e nenhuma em portugues, que focalizem a avaliacao de tronco de forma quantitativa. Este estudo teve como objetivo traduzir e verificar a confiabilidade inter e intra-examinador, validade construtiva e consistencia interna da versao brasileira da ECT - Escala de Comprometimento do Tronco (Trunk Impairment Scale). Em 18 voluntarios com hemiparesia secundaria a AVE foram aplicados os seguintes instrumentos: ECT, Protocolo de Desempenho Fisico de Fugl-Meyer, Medida de Independencia Funcional, EEB - Escala de Equilibrio de Berg e Classificacao de Deambulacao Funcional. As avaliacoes foram realizadas por tres fisioterapeutas experientes e o reteste da ECT foi realizado apos 48 horas. Foram encontradas moderada confiabilidade intra-examinador e excelente confiabilidade inter-examinador (p<0,05), porem baixa consistencia interna (0,45). A EEB foi a unica a apresentar correlacao com a ECT (r=0,491, p=0,038); a comparacao com as demais escalas nao revelou significância estatistica. A ECT mostrou-se valida e eficaz para quantificar o comprometimento do tronco, com facil aplicabilidade, e cumpriu os criterios de confiabilidade, assegurando sua replicabilidade por profissionais atuantes na reabilitacao neurologica.

Efetividade dos exercicios em cadeia cinetica aberta e cadeia cinetica fechada no tratamento da sindrome da dor femoropatelar

El objetivo de este estudio era analizar los efectos terapeuticos de los ejercicios en la cadena cinetica abierta (CCA) y la cadena cinetica cerrada (CCC) en el tratamiento del sindrome del dolor femoropatelar (SDFP). Para esto se ofrecieron 24 portadores de SDFP que fueron divididos aleatoriamente en dos grupos: Se agruparon en: los ejercicios I en CCA (el n = 12); y los ejercicios II en CCC (el n = 12). Los grupos se sometieron a ocho semanas consecutivas de tratamiento que consistio en tres sesiones semanales logradas en los dias alternados. Para los analisis de los modelos de activacion de los musculos medio oblicuo (VMO) y vasto lateral (VL) las senales electromiograficas (EMG) adquiridas con los electrodos bipolares de superficie, cuantificaron por la raiz cuadrada del promedio (la raiz el cuadrado - RMS) y se normalizo por el maximo de la reduccion isometrico voluntario del cuadriceps. A traves de balanzas se evaluo la intensidad del dolor y la funcionalidad de los voluntarios. El analisis de los valores de la razon VMO/VL en los grupos I y II demostramos que no habia diferencias significantes entre la veces de tiempos pre y post-tratamiento en las fases concentricas (el p > 0,05) y excentricas (el p > 0,05) de los ejercicios en CCA y CCC. A pesar de eso, el musculo VMO presento un punto de activacion mas pequeno respecto a VL en la fase excentrica del ejercicio en CCF. En ellos se encontraron aumentos significantes en la funcionalidad (p < 0,05) y en la reduccion de la intensidad del dolor (p < 0,05) entre veces de tiempo y post-tratamiento en ambos grupos, sin embargo, el de grupo II se mostraron superiores al grupo I en estas dos variables. Los resultados de este estudio sugieren que, de acuerdo con las condiciones experimentales usadas, los ejercicios en CCA y CCC no provocaron los cambios en los modelos de activacion EMG de los musculos VMO y VL, sin embargo, ellos promovieron mejora de la funcionalidad y reduccion de la intensidad del dolor despues de ocho semanas de intervencion, y los ejercicios en CCC eran superiores al de en CCA.The aim of this study was to analyze the therapeutic effects of the open kinetic chain (OKC) and closed kinetic chain (CKC) exercises to treat the patellofemoral syndrome (PFSD). For this, 24 volunteers, bearers of the PFSD were randomly divided in two groups: group I (n = 12) performed the OKC exercises; group II (n = 12) performed the CKC exercises. Both groups were submitted to eight consecutive weeks of treatment consisting of three weekly sessions performed in alternate days. To analyze the activation pattern of the vastus medialis oblique (VMO) and the vastus lateralis (VL) muscles, the electromyographic signals (EMG) were collected using bipolar surface electrodes quantified by the root mean square (RMS) normalized by the maximal voluntary isometric contraction of the quadriceps. The pain intensity and the functionality of the volunteers were assessed using scales. The analysis of the amounts of the VMO/VL ratio in both groups I and II showed no significant differences as to the pre- and post-treatment times in the concentric (p > 0.05) and eccentric (p > 0.05) phases of the OKC and CKC exercises. Despite of this, the VMO muscle presented a lower activation rate compared to the VL in the eccentric phase of the CKC exercise. It was found significant increases in the functionality (p < 0.05), and a reduction in the pain intensity (p < 0.05) between the pre- and post-treatment times in both groups, but group II showed higher amounts compared to group I in both variables. The results found in this study suggest that according to the conditions of the trial, the OKC and CKC exercises provoke no changes in the patterns of the EMG activation in the VMO and VL muscles. However, they promoted an improvement in the functionality and a reduction in the pain intensity after the eight week intervention, and the CKC exercises presented better performances than OKC exercises.

Trunk restraint therapy: the continuous use of the harness could promote feedback dependence in poststroke patients: a randomized trial.

AbstractThe objective of this study was to evaluate the long-term effects of the task-specific training with trunk restraint compared with the free one in poststroke reaching movements.The design was randomized trial.The setting was University of Campinas (Unicamp).Twenty hemiparetic chronic stroke patients were selected and randomized into 2 training groups: trunk restraint group (TRG) (reaching training with trunk restraint) and trunk free group (TFG) (unrestraint reaching).Twenty sessions with 45 minutes of training were accomplished. The patients were evaluated in pretreatment (PRE), posttreatment (POST) and 3 months after the completed training (RET) (follow-up).Main outcome measures were modified Ashworth scale, Barthel index, Fugl–Meyer scale, and kinematic analysis (movement trajectory, velocity, angles).A significant improvement, which maintained in the RET test, was found in the motor (P < 0.001) and functional (P = 0.001) clinical assessments for both groups. For trunk displacement, only TFG obtained a reduction statistical significance from PRE to the POST test (P = 0.002), supporting this result in the RET test. Despite both groups presenting a significant increase in the shoulder horizontal adduction (P = 0.003), only TRG showed a significant improvement in the shoulder (P = 0.001 – PRE to POST and RET) and elbow (P = 0.038 – PRE to RET) flexion extension, and in the velocity rate (P = 0.03 – PRE to RET).The trunk restraint therapy showed to be a long-term effective treatment in the enhancement of shoulder and elbow active joint range and velocity rate but not in the maintenance of trunk retention.Trial registration: NCT02364141.

AVALIAÇÃO CINEMÁTICA DA TRANSFERÊNCIA DE PARAPLÉGICOS DA CADEIRA DE RODAS

Objective: To evaluate the transfer strategy of paraplegic subjects from their wheelchairs. Methods: Twelve thoracic spinal cord injured subjects participated in this study (T2 to T12). The subjects were able to independently transfer from a wheelchair to a one square meter (m2) platform, half a meter in height. Images of reflexive anatomic markers were captured by six ProReflex infrared cameras and processed using a QTRac Capture software. Kinematic parameters of the trunk, head, shoulders and elbows were evaluated. Results: The data analyzed compared the subjects’ preferential side for performing transfers, according to the functions performed by each body segment. Angular displacement of the head on sagittal plan (y-z), and the shoulders on the transversal plan (x-y), showed statistical differences (p<0.05). Conclusion: The data obtained on this study showed that there are differences in transfer strategies of paraplegic subjects to their preferential side, in comparison with the non-preferential side. Level of Evidence II, Development of diagnostic criteria on consecutive patients (with universally applied reference “gold” standard).

Functional electrical stimulation reduces pain and shoulder subluxation in chronic post-stroke patients?

Background: Shoulder subluxation is a common complication of cerebral vascular accident (stroke) and the use of Functional Electrical Stimulation (FES) within the rehabilitation process is extremely important. Objective: To analyze the therapeutic effects of FES in the treatment of chronic shoulder subluxation in post-stroke patients. Method: This is a case study of patients with radiologically subluxation confirmed, who were randomly divided into two groups: Control Group (CG) and Treatment Group (TG). Patients were assessed before and after treatment and at the 2-month follow-up. The assessment consisted of the modified Ashworth scale; passive goniometry; Fugl-Meyer scale; McGill pain questionnaire and evaluation of shoulder subluxation by radiography. The CG did not receive physiotherapeutic intervention; and TG underwent 20 sessions of motor kinesiotherapy and FES associated with functional exercises with a total duration of 1 hour, three times a week, for 7 weeks. The data were analyzed descriptively. Results: The mean age of CG participants was 82.5 ± 1.5 years and of the TG was 70.5 ± 13.5 years. All of them were retired, sedentary, non-smokers/alcoholics and had hemiparesis on the left side. There was an approximate increase of 10o for most joint movements of the shoulder, improvement in McGill scale scores and reduction of shoulder subluxation in TG patients. Conclusion: FES associated with functional movements was effective in reducing the degree of subluxation of the shoulder joint and decreased pain in subjectsin the chronic phase of the post-stroke.

Evolução Funcional de Pacientes com Hemorragia Subaracnóide Aneurismática não Traumática

Objective: To describe the functional outcome of patients undergoing surgical treatment of intracranial aneurysm clipping admitted to the University of Campinas (Unicamp) hospital. Material and methods: Hunt-Hess and Fisher evaluation was performed with patients at admission. The Functional Independence Measure (FIM) test was performed post-operatively and at discharge, and the Glasgow Outcome Scale (GOS) assessment was carried out at patient discharge. Data on the length of hospital stay as well as affected arteries were obtained. Physical therapy, based on conventional kinesiotherapy, was performed twice a day. Results: A total of 13 patients were studied, with a prevalence of aneurysms in the middle cerebral artery (53.85%). The average age was 51.62 (±13.04) years, and the change in FIM between admission and discharge averaged 34.85 (± 20.85) points (p <0.001). Comparison of FIM with the HuntHess, Fisher and GOS scales demonstrated no significant correlations. Conclusion: ASH is a serious event that results in cognitive and motor impairment of the patient. FIM could be an important predictive tool for monitoring in-hospital neurorehabilitation in the subacute phase of non-traumatic aneurysm.

Efetividade dos exercícios em cadeia cinética aberta e cadeia cinética fechada no tratamento da síndrome da dor femoropatelar

El objetivo de este estudio era analizar los efectos terapeuticos de los ejercicios en la cadena cinetica abierta (CCA) y la cadena cinetica cerrada (CCC) en el tratamiento del sindrome del dolor femoropatelar (SDFP). Para esto se ofrecieron 24 portadores de SDFP que fueron divididos aleatoriamente en dos grupos: Se agruparon en: los ejercicios I en CCA (el n = 12); y los ejercicios II en CCC (el n = 12). Los grupos se sometieron a ocho semanas consecutivas de tratamiento que consistio en tres sesiones semanales logradas en los dias alternados. Para los analisis de los modelos de activacion de los musculos medio oblicuo (VMO) y vasto lateral (VL) las senales electromiograficas (EMG) adquiridas con los electrodos bipolares de superficie, cuantificaron por la raiz cuadrada del promedio (la raiz el cuadrado - RMS) y se normalizo por el maximo de la reduccion isometrico voluntario del cuadriceps. A traves de balanzas se evaluo la intensidad del dolor y la funcionalidad de los voluntarios. El analisis de los valores de la razon VMO/VL en los grupos I y II demostramos que no habia diferencias significantes entre la veces de tiempos pre y post-tratamiento en las fases concentricas (el p > 0,05) y excentricas (el p > 0,05) de los ejercicios en CCA y CCC. A pesar de eso, el musculo VMO presento un punto de activacion mas pequeno respecto a VL en la fase excentrica del ejercicio en CCF. En ellos se encontraron aumentos significantes en la funcionalidad (p < 0,05) y en la reduccion de la intensidad del dolor (p < 0,05) entre veces de tiempo y post-tratamiento en ambos grupos, sin embargo, el de grupo II se mostraron superiores al grupo I en estas dos variables. Los resultados de este estudio sugieren que, de acuerdo con las condiciones experimentales usadas, los ejercicios en CCA y CCC no provocaron los cambios en los modelos de activacion EMG de los musculos VMO y VL, sin embargo, ellos promovieron mejora de la funcionalidad y reduccion de la intensidad del dolor despues de ocho semanas de intervencion, y los ejercicios en CCC eran superiores al de en CCA.The aim of this study was to analyze the therapeutic effects of the open kinetic chain (OKC) and closed kinetic chain (CKC) exercises to treat the patellofemoral syndrome (PFSD). For this, 24 volunteers, bearers of the PFSD were randomly divided in two groups: group I (n = 12) performed the OKC exercises; group II (n = 12) performed the CKC exercises. Both groups were submitted to eight consecutive weeks of treatment consisting of three weekly sessions performed in alternate days. To analyze the activation pattern of the vastus medialis oblique (VMO) and the vastus lateralis (VL) muscles, the electromyographic signals (EMG) were collected using bipolar surface electrodes quantified by the root mean square (RMS) normalized by the maximal voluntary isometric contraction of the quadriceps. The pain intensity and the functionality of the volunteers were assessed using scales. The analysis of the amounts of the VMO/VL ratio in both groups I and II showed no significant differences as to the pre- and post-treatment times in the concentric (p > 0.05) and eccentric (p > 0.05) phases of the OKC and CKC exercises. Despite of this, the VMO muscle presented a lower activation rate compared to the VL in the eccentric phase of the CKC exercise. It was found significant increases in the functionality (p < 0.05), and a reduction in the pain intensity (p < 0.05) between the pre- and post-treatment times in both groups, but group II showed higher amounts compared to group I in both variables. The results found in this study suggest that according to the conditions of the trial, the OKC and CKC exercises provoke no changes in the patterns of the EMG activation in the VMO and VL muscles. However, they promoted an improvement in the functionality and a reduction in the pain intensity after the eight week intervention, and the CKC exercises presented better performances than OKC exercises.