Fátima Goulart

Adaptação do Perfil de Saúde de Nottingham: um instrumento simples de avaliação da qualidade de vida

O objetivo deste estudo foi avaliar as propriedades psicometricas da versao brasileira do Perfil de Saude de Nottingham (PSN), um instrumento generico de avaliacao da qualidade de vida. O PSN foi traduzido para o portugues, segundo metodologia recomendada, e aplicado em 215 individuos, sendo 170 idosos da comunidade (66,3 ± 8,5 anos), 30 hemiplegicos cronicos (56,4 ± 10,9 anos) e 15 parkinsonianos (59,6 ± 10,2 anos). Os dados foram submetidos a analise Rasch. Dos 38 itens do PSN, apenas dois itens (5%) nao se enquadraram no modelo estatistico, indicando que os itens colaboram para medir um constructo unidimensional. Alguns itens do PSN, no entanto, foram muito faceis para os idosos, hemiplegicos e parkinsonianos, caracterizando um efeito teto, o que pode limitar o uso da escala para individuos com niveis mais altos de habilidade. Apesar dos resultados indicarem que o instrumento se enquadra no modelo estatistico de Rash, ha necessidade de revisao dos itens, de forma a tornar o instrumento mais util clinicamente.

Percepção da qualidade de vida de indivíduos com doença de parkinson através do PDQ-39

Perception of quality of life in individuals with Parkinson’s disease using the PDQ-39 Parkinson’s disease (PD) is a chronic degenerative disease of the central nervous system that affects mainly individuals older than 50 years of age. Studies evaluating quality of life (QOL) in individuals with PD have revealed that this disease has a significant negative impact. The Parkinson’s Disease Questionnaire-39 (PDQ-39) has been indicated as one of the most appropriate instrument for evaluating QOL in individuals with PD. Objective: To evaluate the perception of QOL in individuals with PD at our Institution’s outpatient service for movement disorders, using the PDQ-39. Method: Individuals with a diagnosis of PD who were aged 40 years and older and classified in stages 1 to 3 of the Modified Hoehn & Yahr scale were included in this study. Results: Thirty-three individuals of mean age 64.65 ± 10.44 years and mean duration of the disease of 9.27 ± 4.40 years participated in this study. The descriptive analysis showed that the median total score in the PDQ-39 was 25%, with worst perceptions of QOL in the dimensions of “Activities of Daily Living” (ADL) (41.67%) and “Mobility” (34.32%). A high association was found between the total score and the dimension of “Mobility” (r s = 0.82) and a moderate association between the total score and the dimensions of “ADL” (r s = 0.68) and “Communication” (r s = 0.53). Conclusions: Motor limitations relating to mobility, ADL and communication were significantly related to the general perception of QOL among individuals with PD. These findings suggest that rehabilitation programs aiming to improve QOL among individuals with PD should focus on these limitations.

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.

Musculação e condicionamento aeróbio na performance funcional de hemiplégicos crônicos

The aim of the present study was to investigate the functional performance of chronic stroke patients, when submitted to a program of muscular strengthening, using exercise machines associated with aerobic conditioning. Thirty patients were recruited in the community according to the inclusion criteria and submitted to an established training program three times a week, for 10 weeks. The patients were assessed before and after training in the following functional parameters: gait speed, rate of stairclimbing, endurance (maximum gait speed e physiologic cost index), and symmetry in the sit to standing movement. Descriptive statistics and testes for normality (Shapiro-Wilk) were used for all outcome variables. Paired Student t-tests were used to investigate the impact of the training. Significant improvements (p <0,001) were observed for gait speed, rate of stair climbing, and maximum gait speed. No differences were found for the symmetry values and for the physiologic cost index. The findings demonstrated significant gains in functional performance measures after 10 weeks of a combined program of muscle strengthening and aerobic conditioning.

Relationships between muscular torque and gait speed in chronic hemiparetic subjects

Purpose. To identify which paretic and non-paretic muscular groups of the lower limbs were the best predictors of gait speed in chronic hemiparetic subjects. Method. Twelve hemiparetic subjects with ages ranging from 65 to 75 years (70.67 ± 3.31 years) were included in this cross-sectional study. All participants had time since onset of stroke of at least six months and the ability to walk independently. Main outcome measures included self-selected gait speed and maximum isometric torques of both the paretic and non-paretic lower limbs. Pearsons correlation coefficients and stepwise regression analysis were employed to investigate the level of associations between the outcome variables. Results. Mean gait speed was 0.65 ± 0.33 ms−1. There were significant differences (p < 0.01) in torques values between paretic and non-paretic lower limbs for all assessed muscular groups. Stepwise regression analysis revealed that the most important independent variable for predicting gait speed was the isometric torque of paretic knee flexors (). No significant associations were found between any torque values of the non-paretic side and gait speed. Conclusions. The paretic knee flexors were shown to play an important role in predicting gait speed after stroke, but no influences were found for the muscular groups of the non-paretic side. Therefore, findings of the present study suggest that paretic knee flexors torque should be addressed in rehabilitation programmes aiming to improve gait speed after stroke.

Electromyographic activity of sternocleidomastoid muscle in patients with Parkinson’s disease

The aim of this study was to evaluate the effect of administration of levo-dopa, which means without effect-off state and under effect-on state, on the sternocleidomastoid muscle electromyographic activity (SCM-EA) in patients with Parkinsons disease (PD) at rest and to compare it to asymptomatic subjects. Ten patients with PD, mean age 64.6+/-6.2 (SD) years and nine asymptomatic subjects, mean age 61.4+/-5.9 (SD) years were studied. The SCM-EA was evaluated during maximal inspiratory pressure and breathing at rest through surface electromyography. Statistical analysis was performed with t-test (anthropometric data and SCM-EA of patients in off state to asymptomatic), Mann-Whitney (SCM-EA of patients in on state to asymptomatic) and Wilcoxon test (SCM-EA off and on states). The effect size index (d) was calculated for statistically significant differences. There were no significant differences in SCM electromyographic activity between patients with PD comparing off to on (p=0.13) or among on state to asymptomatic subjects (p=0.06). However, when subjects with PD in off where compared to asymptomatic there was a significantly higher SCM electromyographic activity (p=0.03, d=1.09). These patients, without levo-dopa effect, when compared with asymptomatic subjects, present a significantly higher electromyographic activity of SCM, the main accessory respiratory muscle, which could be related to an increased work of breathing.

Análise do desempenho funcional em pacientes portadores de doença de Parkinson

Parkinson’s disease (PD) is a degenerative and progressive disease of central nervous system, characterized by movement disorders. Objective: to asses the functional performance and quality of life of parkinsonians in initial and middle stage. Methods: Twenty patients (60,8 ± 9,7 years) in Hoehn and Yahr stage between 1 and 3 were evaluated and compared with 20 healthy adults and elderly (63,5 ± 6,3 years). The Human Activity Profile (HAP), the gait speed, and the ability to ascend and descend stairs were used as outcome measures to evaluate the functional performance; the Nottingham Health Profile was used to evaluate the quality of life. Results: The findings demonstrated significant differences in HAP scores (p=0,000) and gait speed (p=0,05) indicating poorer physical conditioning and slowness of movements in patients in patients with PD. Conclusions: These findings demonstrated that changes of functional performance are present since early stages of PD and not only in advanced stages.

Comparisons of electromyographic activity of scapular muscles between elevation and lowering of the arms.

The aim of this study was to compare the electromyographic (EMG) activity levels of the serratus anterior, upper, middle, and lower trapezius muscles between elevation and lowering of the arms with 10 healthy subjects. The EMGs of each muscle was quantified and normalized for the complete movement, as well as for the six different phases of each movement. Repeated measure ANOVAs were used to investigate main and interaction effects between movements/sides and sides/phases (α<0.05). Significant differences were found between the elevation and the lowering of the arms for all muscles (p≤0.001). However, there were no significant differences between sides (0.24<p<0.97), nor interactions between movements and sides (0.28<p<0.81) and between sides and phases (0.22<p<0.94) for all muscles. In addition, significant differences were found between phases for all muscles during elevation (p≤0.001) and lowering of the arms (0.001<p<0.01). Despite the different patterns of activity of all muscles, there were some similarities: For both movements, dominance of the upper extremities did not appear to be an important variable to be considered; the serratus anterior was the only muscle that showed significant differences in EMGs between all phases; and the middle trapezius was the muscle that showed the longest plateau phase.