Gabriela Lopes dos Santos

Intrinsic properties and functional changes in spastic muscle after application of BTX-A in children with cerebral palsy: Systematic review

Abstract Objective: This article aimed to review the literature to verify the effect of botulinum toxin type A (BTX-A) on the intrinsic properties of spastic muscles and functionality in children with cerebral palsy (CP). Methods: A literature search was conducted in the following databases: CINAHL, SCOPUS, Web of Science and PubMed. Database searches were limited to the period from January 1993 to March 2014. Results: A total of 2182 papers were identified, and 17 met the inclusion criteria. Only one study analyzed the effect of the toxin on muscle intrinsic properties and others analyzed the effect on functionality. Conclusion: BTX-A application demonstrated no changes in the passive stiffness of spastic muscle. In relation to functional level, the evidence of BTX-A effect was controversial. These studies showed methodological quality limitations that restrict the interpretation of the results for the entire CP population, which justifies the need for further randomized controlled trials.

Decreased Brain-Derived Neurotrophic Factor Serum Concentrations in Chronic Post-Stroke Subjects

BACKGROUND Brain-derived neurotrophic factor (BDNF) plays a critical role in sensorimotor recovery after a stroke. However, few studies have assessed the circulating BDNF levels in post-stroke humans to understand its changes. This study was conducted to measure BDNF serum concentrations in subjects with chronic hemiparesis, as well as to correlate serum concentrations with age, post-stroke time, total score of Stroke Specific Quality of Life Scale (SS-QOL), mobility subscale score, and motor function of SS-QOL. METHODS Seventeen chronic post-stroke subjects matched by age and gender with healthy controls took part in the study. Personal data (age, hemiparesis side, and post-stroke time) were collected, and a physical examination (weight, height, body mass index) and SS-QOL assessment were carried out. On the same day, after the initial evaluation, venous blood samples were collected from the chronic post-stroke subjects and the healthy subjects. The BDNF serum concentrations were measured blindly by enzyme-linked immunosorbent assay. RESULTS Subjects with chronic hemiparesis presented a decrease in BDNF serum compared with healthy subjects (P < .01). There was no correlation between BDNF serum levels with post-stroke time, age or quality of life, mobility, and the upper extremity motor function (P > .05). BDNF concentrations are related to structural and functional recovery after stroke; thus, this reduction is important to understand the rehabilitation process more clearly. However, more studies are needed considering the genetic variations and other tools to assess motor impairment and functional independence. CONCLUSION Chronic post-stroke subjects presented a decrease in BDNF serum concentrations, without a correlation with post-stroke time, age, and quality of life.

Elastic tape improved shoulder joint position sense in chronic hemiparetic subjects: a randomized sham-controlled crossover study

Background Elastic tape has been widely used in clinical practice in order to improve upper limb (UL) sensibility. However, there is little evidence that supports this type of intervention in stroke patients. Objective To verify the effect of elastic tape, applied to the paretic shoulder, on joint position sense (JPS) during abduction and flexion in subjects with chronic hemiparesis compared to sham tape (non-elastic tape). Furthermore, to verify if this potential effect is correlated to shoulder subluxation measurements and sensorimotor impairment. Methods A crossover and sham-controlled study was conducted with post-stroke patients who were randomly allocated into two groups: 1) those who received Sham Tape (ST) first and after one month they received Elastic Tape (ET); 2) those who received Elastic Tape (ET) first and after one month they received Sham Tape (ST). The JPS was evaluated using a dynamometer. The absolute error for shoulder abduction and flexion at 30° and 60° was calculated. Sensorimotor impairment was determined by Fugl-Meyer, and shoulder subluxation was measured using a caliper. Results Thirteen hemiparetic subjects (average time since stroke 75.23 months) participated in the study. At baseline (before interventions), the groups were not different for abduction at 30° (p = 0.805; p = 0.951), and 60° (p = 0.509; p = 0.799), or flexion at 30° (p = 0.872; p = 0.897) and 60° (p = 0.853; p = 0.970). For the ET group, differences between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° p<0.010) and 60° (p<0.010) were observed. For the ST group, differences were also observed between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° (p<0.010,) and 60° (p<0.010). Potential effects were only correlated with shoulder subluxation during abduction at 30° (p = 0.001, r = -0.92) and 60° (p = 0.020, r = -0.75). Conclusion Elastic tape improved shoulder JPS of subjects with chronic hemiparesis regardless of the level of UL sensorimotor impairment. However, this improvement was influenced by the subluxation degree at abduction.

Influence of Different Sitting Positions on Healthy Infants' Reaching Movements

ABSTRACT The authors analyze the influence of different sitting positions (ring and flexion) on the reaching performance (spatiotemporal variables) of full-term infants 6 and 7 months old. In addition, they correlated level of trunk control, measured by the Segmental Assessment of Trunk Control, with performance during reaching. The different sitting positions only influenced the reaching movements of 6-month-old infants, who showed the best performance in the ring position. However, this influence was observed only for the trunk displacement, deceleration time, movement units, straightness index and mean velocity. In contrast, there was no influence of positions on 7-month-old infants’ reaching performance. Regarding the correlations, it was observed that infants with more level of trunk control showed a better performance when reaching, regardless of position and the age assessed.

Joint position sense is bilaterally reduced for shoulder abduction and flexion in chronic hemiparetic individuals

Abstract Background: The stroke is the leading cause of adult disability in the world. One of the main complaints of individuals post-stroke refers to the loss of function of the upper limb, as evidenced during the performance of activities of daily living. This difficulty may be related to an important component of sensorimotor control, joint position sense, a submodality of proprioception. Objectives: To investigate whether the proprioception of both shoulders of chronic hemiparetic patients is altered during abduction and flexion. Methods: Thirteen subjects with chronic hemiparesis due to ischemic stroke and 13 healthy subjects matched for gender and age was included. The joint sense position was assessed using a dynamometer. Absolute error for shoulder abduction and flexion at the 30 and 60° was calculated. Results: No difference was found between the paretic and non-paretic limbs in movements at both 30 and 60°. Higher values of absolute error for both paretic and non-paretic limbs compared to the control were observed during abduction at 30 and at 60°. Conclusions: Chronic ischemic post-stroke patients have bilateral proprioceptive deficits in the shoulder during abduction and flexion. But these deficits are dependent on the movement performed and the angle tested. The results demonstrate the need to include bilateral exercises and/or visual feedback in the rehabilitation program.

Post-stroke BDNF Concentration Changes Following Physical Exercise: A Systematic Review

Background: Research over the last two decades has highlighted the critical role of Brain-derived neurotrophic factor (BDNF) in brain neuroplasticity. Studies suggest that physical exercise may have a positive impact on the release of BDNF and therefore, brain plasticity. These results in animal and human studies have potential implications for the recovery from damage to the brain and for interventions that aim to facilitate neuroplasticity and, therefore, the rehabilitation process. Purpose: The aim of this study was to carry out a systematic review of the literature investigating how aerobic exercises and functional task training influence BDNF concentrations post-stroke in humans and animal models. Data Sources: Searches were conducted in PubMed (via National Library of Medicine), SCOPUS (Elsevier), CINAHL with Full Text (EBSCO), MEDLINE 1946—present with daily updates (Ovid) and Cochrane. Study Selection: All of the database searches were limited to the period from January, 2004 to May, 2017. Data Extraction: Two reviewers extracted study details and data. The methodological quality of the studies that used animal models was assessed using the ARRIVE Guidelines, and the study that evaluated human BDNF was assessed using the PEDro Scale. Data Synthesis: Twenty-one articles were included in this review. BDNF measurements were performed systemically (serum/plasma) or locally (central nervous system). Only one study evaluated human BDNF concentrations following physical exercise, while 20 studies were experimental studies using a stroke model in animals. A wide variation was observed in the training protocol between studies, although treadmill walking was the most common type of intervention among the studies. Studies were of variable quality: the studies that used animal models scored from 8/20 to 15/20 according to the ARRIVE Guidelines. The only study that evaluated human subjects scored 5/10 according to the PEDro scale and, which indicates a quality classified as “fair”. Conclusions: The results of the current systematic review suggest that aerobic exercise promotes changes in central BDNF concentrations post-stroke. On the other hand, BDNF responses following functional exercises, such as reaching training and Constraint Induced Movement Therapy (CIMT), seem to be still controversial. Given the lack of studies evaluating post-stroke BDNF concentration following physical exercise in humans, these conclusions are based on animal work.

Influence of Additional Ankle Weights on Kinematic Variables of Late Preterm Infants Aged 3–4 Months

ABSTRACT The authors analyzed and compared the effect of additional weight on the spatiotemporal parameters of the kicking movement of late preterm and full-term infants. The experiment was divided into 4 conditions: training, baseline, weight, and postweight. In the W condition, a weight of one third the lower limb mass was added to the infants ankle. During the baseline and postweight conditions, the ankle weight was removed. Late preterm infants do not differ from full-term infants in relation to spatiotemporal variables at 3 and 4 months. However, during the weight condition, the straightness index and the hip-ankle and knee-ankle correlations decreased in the preterm infants at both ages. In contrast, the straightness index increased in the postweight condition compared to the baseline values at both ages.

Effects of inspiratory muscle training on cardiovascular autonomic control: A systematic review

PURPOSE To carry out a systematic review to determine if inspiratory muscle training (IMT) promotes changes in cardiovascular autonomic responses in humans. METHODS The methodology followed the PRISMA statement for reporting systematic review analysis. MEDLINE, PEDro, SCOPUS and PubMed electronic databases were searched from the inception to March 2017. The quality assessment was performed using a PEDro scale. The articles were included if: (1) primary objective was related to the effects of IMT on the cardiovascular autonomic nervous system, and (2) randomized clinical trials and quasi-experimental studies. Exclusion criteria were reviews, short communications, letters, case studies, guidelines, theses, dissertations, qualitative studies, scientific conference abstracts, studies on animals, non-English language articles and articles addressing other breathing techniques. Outcomes evaluated were measures of cardiovascular autonomic control, represented by heart rate variability (HRV) and blood pressure variability (BPV) indexes. RESULTS The search identified 729 citations and a total of 6 studies were included. The results demonstrated that IMT performed at low intensities can chronically promote an increase in the parasympathetic modulation and/or reduction of sympathetic cardiac modulation in patients with diabetes, hypertension, chronic heart failure and gastroesophageal reflux, when assessed by HRV spectral analysis. However, there was no study which evaluated the effects of IMT on cardiovascular autonomic control assessed by BPV. CONCLUSIONS IMT can promote benefits for cardiac autonomic control, however the heterogeneity of populations associated with different protocols, few studies reported in the literature and the lack of randomized controlled trials make the effects of IMT on cardiovascular autonomic control inconclusive.

Torque steadiness and muscle activation are bilaterally impaired during shoulder abduction and flexion in chronic post-stroke subjects

OBJECTIVE To characterize sensorimotor control and muscle activation in the shoulder of chronic hemiparetic during abduction and flexion in maximal and submaximal isometric contractions. Furthermore, to correlate submaximal sensorimotor control with motor impairment and degree of shoulder subluxation. METHODS Thirteen chronic hemiparetic post-stroke age-gender matched with healthy were included. Isometric torques were assessed using a dynamometer. Electromyographic activity of the anterior and middle deltoid, upper trapezius, pectoralis major and serratus anterior muscles were collected. Variables were calculated for torque: peak, time to target, standard deviation (SD), coefficient of variation (CV), and standard error (RMSE); for muscle activity: maximum and minimum values, range and coefficient of activation. Motor impairment was determined by Fugl-Meyer and shoulder subluxation was measured with a caliper. RESULTS Paretic and non-paretic limbs reduced peak and muscle activation during maximal isometric contraction. Paretic limb generated lower force when compared with non-paretic and control. Paretic and non-paretic presented higher values of SD, CV, RMSE, and CV for prime mover muscles and minimum values for all muscles during steadiness. No correlation was found between sensorimotor control, motor impairment and shoulder subluxation. CONCLUSION Chronic hemiparetic presented bilateral deficits in sensorimotor and muscle control during maximal and submaximal shoulder abduction and flexion.

Structural muscular adaptations in upper limb after stroke: a systematic review

ABSTRACT Background: Stroke is a leading cause of disability in the adult population, impairing upper limb (UL) movements affecting activities of daily living. Muscle weakness has been associated to disabilities in this population, but much attention is given to central nervous system alterations and less to skeletal muscles. Objective: The objective of this review is to carry out a systematic literature review to identify structural muscle alterations in the UL of poststroke individuals. Method: The search was performed in December, 2017. MEDLINE, PubMed, SCOPUS, CINAHL, and Science Direct were used as electronic databases. There was no restriction regarding language and publication dates. Studies conducted on poststroke subjects and results on UL skeletal muscle alterations identified by imaging tests were included. Results: Seven studies were included. The sample size and the variables varied among the studies. All the studies compared the paretic UL with the nonparetic UL and one of the studies also compared healthy subjects. Ultrasonography was the most used measurement tool to assess muscle adaptation. Conclusions: This review demonstrated little evidence with poor to fair quality on the structural muscle adaptations in the poststroke subjects, showing muscle atrophy, a higher stiffness, and amount of fibrous and fat tissue without alterations in lean tissue of distal muscles of the paretic UL compared to the nonparetic limb. However, the nonparetic side also presented alterations, which makes it an inappropriate comparison. Thus, well-designed studies addressing this issue are required.