Glória Elizabeth Carneiro Laurentino

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 properties of the pressure biofeedback unit in the evaluation of transversus abdominis muscle activity: a systematic review.

BACKGROUND Measurements from pressure biofeedback units (PBUs) can be used to evaluate the activity of the transversus abdominis (TrA) muscle indirectly. These measurements can classify patients or monitor the progress of treatment programmes for people with low back pain. OBJECTIVE To systematically review studies on the measurement properties of PBUs for the assessment of TrA activity. DATA SOURCES Eligible studies were identified through searches of PUBMED, CINAHL and BIREME (1990 to 2009). In addition, hand searches of journals and citation tracking were performed. STUDY SELECTION Full-text studies involving any type of clinimetric tests of PBU measurement for the assessment of TrA activity were selected. DATA EXTRACTION Two independent reviewers selected the studies, extracted the data and assessed methodological quality. DATA SYNTHESIS Due to the heterogeneity of study designs and statistical analysis, it was not possible to pool the data for a meta-analysis. RESULTS Six studies met the inclusion criteria. These studies were typically of low quality and recruited healthy subjects rather than patients with low back pain. The studies found moderate to good reproducibility (intra-class correlation coefficients from 0.47 to 0.82) and acceptable construct validity (intra-class correlation coefficients from 0.48 to 0.90). CONCLUSIONS The current evidence about the measurement properties of PBUs for the assessment of TrA activity is mainly based on studies with suboptimal designs, and the findings from these studies are likely to be overly optimistic. The most important clinical questions about the measurement properties of PBUs for the assessment of TrA activity are yet to be answered.

Identificação das categorias de participação da CIF em instrumentos de qualidade de vida utilizados em indivíduos acometidos pelo acidente vascular encefálico

OBJETIVO: Identificar categorias do componente de participacao da Classificacao Internacional de Funcionalidade, Incapacidade e Saude (CIF) que ja foram sistematicamente relacionadas aos instrumentos de Qualidade de Vida Relacionada a Saude (QVRS) comumente utilizados em individuos acometidos pelo acidente vascular encefalico (AVE) - Nottingham Health Profile (NHP), Short-Form Health Survey (SF-36) e Stroke Specific Quality of Life (SS-QOL) - e sugerir a utilizacao dos mesmos para avaliar e/ou caracterizar tal componente nessa populacao. METODOS: Por meio de busca nas bases de dados Medline, SciELO e Lilacs, foi realizado levantamento dos estudos que associavam os conceitos mensurados pelos itens do NHP, SF-36 e SS-QOL com os componentes e categorias da CIF. RESULTADOS: Dos 24 estudos identificados, quatro atenderam aos criterios estabelecidos: dois avaliaram os tres instrumentos de QVRS, um avaliou o NHP e SF-36, e outro apenas o SS-QOL. Para cada instrumento, foram encontrados tres estudos que associaram seus conceitos ate, no minimo, o segundo nivel de hierarquia das categorias da CIF. Considerando os resultados concordantes entre os tres estudos que avaliaram o mesmo instrumento, nove categorias de participacao foram associadas ao NHP, sete ao SF-36 e 15 ao SS-QOL, sendo que apenas uma foi especifica para o NHP, uma para o SF-36, e sete para o SS-QOL. CONCLUSOES: Para a avaliacao da participacao de individuos acometidos pelo AVE segundo a estrutura da CIF, o SS-QOL pareceu ser o instrumento mais adequado, pois, alem de avaliar o maior numero de categorias, tambem avalia o maior numero de categorias distintas quando comparado aos outros dois instrumentos de QVRS, que acrescentam apenas uma categoria aquelas mensuradas pelo SS-QOL.

Concurrent validity of the pressure biofeedback unit and surface electromyography in measuring transversus abdominis muscle activity in patients with chronic nonspecific low back pain

BACKGROUND The Pressure biofeedback unit (PBU) is an assessment tool used in clinical practice and research aimed to indirectly analyze the transversus abdominis (TrA) muscle activity. The concurrent validity of the PBU in a clinically relevant sample is still unclear. OBJECTIVE The purpose of this study was to evaluate the concurrent validity and diagnostic accuracy of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain. METHOD This study was performed using a validation, cross-sectional design. Fifty patients with chronic nonspecific low back pain were recruited for this study. To test the concurrent validity both PBU measures (index test) and superficial electromyographic measures (reference-standard test) were compared and collected by a physical therapist in a series of voluntary contraction maneuvers of TrA muscle. RESULTS Participants were on average 22 years old, weighed 63.7 kilos, 1.70 meters height and mean low back pain duration was 1.9 years. It was observed a weak and non-significant Phi coefficient (r=0.2, p<0.20). With regards to diagnostic accuracy tests, our results suggest a low sensitivity (60%) and specificity (60%) of the PBU. The positive predictive value was high (0.8) and negative predictive value was low (0.2). CONCLUSIONS Concurrent validity of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain is poor given the low correlation and diagnostic accuracy with superficial EMG.

Reproducibility of the pressure biofeedback unit in measuring transversus abdominis muscle activity in patients with chronic nonspecific low back pain

The Pressure Biofeedback Unit (PBU) is often used by clinicians and researchers to indirectly evaluate transversus abdominis (TrA) muscle activity. The purpose of this study was to evaluate the inter and intra-examiner reproducibility of the PBU in measuring TrA muscle activity in fifty patients with chronic nonspecific low back pain. This study was performed using a test-retest design with a seven day interval. An Intraclass Correlation Coefficient (ICC(2,1)) of 0.74 (95% CI 0.54 to 0.85) and 0.76 (95% CI 0.58 to 0.86) was observed for the intra and inter-examiner reproducibility, respectively. The intra-examiner agreement (Limits of Agreement - LOA = 2.1 to -1.8 mmHg) and the inter-examiner agreement (LOA = 2.0 to -1.9 mmHg) were within the limits of agreement on 95% of occasions. The reproducibility of PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain ranged from satisfactory to excellent.

Programa de saúde da família: proposta para identificação de fatores de risco para o desenvolvimento neuropsicomotor

OBJECTIVES: To investigate the occurrence of delayed neuropsychological and motor development in a community assisted through the Family Health Program and to evaluate its association with possible biological, environmental and socioeconomic risk factors. METHODS: The sample consisted of 31 five-year-old children who were evaluated using the Neurological Development Test, following guidelines proposed by Coelho (1999)*. The study was carried out at the Family Health Program (FHP) center in the Brasilit area of Recife, PE, Brazil. Data were collected using a questionnaire that sought information on the child, its mother/guardian, the familys socioeconomic status and residence. Fishers exact test was used for the statistical analysis of the results, with a significance level of 5%. RESULTS: Appendicular coordination was the parameter with the highest frequency of deficits (90%) and static balance was the item least compromised (12.9%). The frequency of static balance deficits was higher among children who did not attend day care centers (p=0.0163) and among those who spent less time with their mother (p=0.0278). Motor persistence deficits were statistically associated with age of entry into day care (p=0.0415) and father-child time (p=0.0436). CONCLUSIONS: The FHP was not only a valuable setting for developing studies of this nature but also an appropriate setting for child development follow-up.

Nanismo nutricional em escolares no Brasil

Literature review on stunting in Brazil. The following topics have been analyzed: problems definition, the use of schoolchildrens height as the best method to evaluate population health and nutritional status, the main causes and consequences demonstrated in the literature and, at last, the scope of this problem in Brazil. According to lierature the prevalence of stunting varies in different regions of Brazil. The poorest results are found in the North and Northeast. The main determinants of linear growth retardation are poor environmental conditions and among the consequences, results indicate lower physical and mental capacity.

Comparisons of the Nottingham Health Profile and the SF-36 health survey for the assessment of quality of life in individuals with chronic stroke

BACKGROUND Appropriate instruments for the assessment of health-related quality of life (HRQOL) domains are useful for planning therapeutic interventions for individuals with stroke. The generic quality of life (QOL) instruments, Short Form Health Survey-36 (SF-36) and Nottingham Health Profile (NHP), have been frequently employed in the Brazilian literature. However, the literature is still scarce regarding their psychometric properties when applied to stroke individuals. OBJECTIVES To compare the Brazilian versions of the SF-36 and the NHP to verify which had better psychometric properties for the assessment of HRQOL in 120 individuals with chronic stroke. METHOD Spearman correlation coefficients were calculated to examine the comparable domains and total scores of the SF-36 and the NPH; Cronbachs alpha coefficients, to evaluate internal consistency; intra-class correlation coefficients, to assess reliability; and Bland-Altman plots, to assess the levels of agreement, with a significance level of 5%. RESULTS Significant positive associations were observed between the common domains and the total scores of the SF-36 and the NPH. Ceiling effects were more frequent for the NPH. The total scores of both instruments achieved adequate reliability levels, and the agreement levels were within the normal limits in 95% of the cases. CONCLUSIONS The SF-36 and the NPH were shown to measure similar constructs and proved to be useful measures for the assessment of QOL of chronic stroke subjects. However, the SF-36 yielded better results and appeared to be more appropriate.

Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke

OBJECTIVES: To examine the strength deficits of the shoulder complex after stroke and to characterize the pattern of weakness according to type of movement and type of isokinetic parameter. METHOD: Twelve chronic stroke survivors and 12 age-matched healthy controls had their shoulder strength measured using a Biodex isokinetic dynamometer. Concentric measures of peak torque and work during shoulder movements were obtained in random order at speeds of 60°/s for both groups and sides. Type of movement was defined as scapulothoracic (protraction and retraction), glenohumeral (shoulder internal and external rotation) or combined (shoulder flexion and extension). Type of isokinetic parameter was defined as maximum (peak torque) or sustained (work). Strength deficits were calculated using the control group as reference. RESULTS: The average strength deficit for the paretic upper limb was 52% for peak torque and 56% for work. Decreases observed in the non-paretic shoulder were 21% and 22%, respectively. Strength deficit of the scapulothoracic muscles was similar to the glenohumeral muscles, with a mean difference of 6% (95% CI -5 to 17). Ability to sustain torque throughout a given range of motion was decreased as much as the peak torque, with a mean difference of 4% (95% CI -2 to 10). CONCLUSIONS: The findings suggest that people after stroke might benefit from strengthening exercises directed at the paretic scapulothoracic muscles in addition to exercises of arm elevation. Clinicians should also prescribe different exercises to improve the ability to generate force and the ability to sustain the torque during a specific range of motion.

Déficit estatural em crianças em idade escolare em menores de cinco anos: uma análise comparativa

de associacao de Pearson para testar, em cada um dos gruposestudados, a associacao entre o deficit estatural e os possiveis fatores de risco. Utilizou-se o teste de igualdadede proporcoes para verificar as diferencas das prevalencias de deficit estatural em cada grupo de idade eajustou-se um modelo multivariado explicativo do deficit estatural em menores de cinco anos.