Gustavo Christofoletti

A controlled clinical trial on the effects of motor intervention on balance and cognition in institutionalized elderly patients with dementia

Purpose: To analyse the effects of two interventions on the cognition and balance of institutionalized elderly people with mixed dementia. Methods: Fifty-four participants were allocated into three groups. Group 1 was assisted by an interdisciplinary programme comprising physiotherapy, occupational therapy and physical education. A physiotherapist alone carried out the intervention in group 2. Group 3 was considered as control. Assessors were blinded to guarantee the absence of bias. Cognitive functions were analysed with the Mini-Mental State Examination and the Brief Cognitive Screening Battery. Balance was assessed with the Berg Balance Scale and the Timed Get-Up-and-Go Test. Multiple analysis of variance (MANOVA) was used to test possible main effects of the interventions. Results: The results showed benefits on the balance of subjects in both groups 1 (F=3.9, P<0.05) and 2 (F=3.1, P<0.05), compared with group 3. MANOVA did not indicate benefits on the cognitive functions between groups 1 and 3 (F=1.1, P>0.05) and groups 2 and 3 (F=1.6, P>0.05). However, univariate analysis indicated some benefits of the interdisciplinary intervention on two specific domains measured by the Brief Cognitive Screening Battery (F=26.5, P<0.05; F=4.4, P<0.05). Conclusion: Six months of multidisciplinary or physiotherapeutic intervention were able to improve a persons balance. Although global cognition did not improve through treatment, when the intervention was carried out on a multidisciplinary basis we observed an attenuation in the decline of global cognition on two specific cognitive domains. Exercises applied in different contexts may have positive outcomes for people with dementia.

Effects of motor intervention in elderly patients with dementia: an analysis of randomized controlled trials

The objective of this study was to analyze randomized controlled trials published in the last decades involving motor intervention as a treatment for dementia, based on Physiotherapy Evidence Database (PEDro) criteria. A database search was performed using the following keywords: randomized controlled trial, dementia, physiotherapy, physical therapy, occupational therapy, physical education, motor approach, exercise, and physical activity. Ten trials were found: 4 related to physiotherapy, 3 to occupational therapy, 1 to physical education, and 2 to interdisciplinary motor intervention. The efficacy of motor intervention was confirmed in the following variables: psychosocial function, physical health and function, affective status, and caregivers distress (P < .05). Results related to mobility were not significant (P > .05). Behavior, cognitive performance, activities of daily living, and risk of falls were not similar among the articles. From a total score of 10 points, with excellence characterized as the highest punctuation, the articles were classified between 3 and 7 by PEDro. Motor intervention was shown to be an alternative for minimizing physical and mental decline. PEDro has been confirmed as a very reliable tool to analyze studies and as an evaluation criteria, both qualitative and quantitative, allowing the establishment of motor intervention strategies for the treatment of patients with dementia.

Use of hippotherapy in gait training for hemiparetic post-stroke

OBJECTIVEnTo evaluate the hippotherapy influence on gait training in post-stroke hemiparetic individuals.nnnMETHODnThe study was constituted of 20 individuals divided into two groups. Group A performed the conventional treatment while group B the conventional treatment along with hippotherapy during 16 weeks. The patients were evaluated by using the Functional Ambulation Category Scale, Fugl-Meyer Scale, only the lower limbs and balance sub items, Berg Balance Scale, and functional assessment of gait (cadence) in the beginning and end of the treatment.nnnRESULTSnSignificant improvements were observed in the experimental group including motor impairment in lower limbs (p=0.004), balance, over time (p=0.007) but a significant trend between groups (p=0.056). The gait independence, cadence and speed were not significantly in both groups (p=0.93, 0.69 and 0.44).nnnCONCLUSIONnHippotherapy associated with conventional physical therapy demonstrates a positive influence in gait training, besides bringing the patients gait standard closer to normality than the control group.

Atividade física, qualidade de vida e medicamentos em idosos: diferenças entre idade e gênero

Studies have shown an inverse relationship between physical activity level (PAL), quality of life (QoL) and use of medications in the elderly. The objective of this study was to analyze possible relationships and differences between PAL, QoL and use of medications in the elderly. A total of 192 subjects (≥ 60 years) were selected by stratified random sampling according to census sector. The following assessment instruments were used: a) Modified Baecke Questio - nnaire for older adults, b) Medical Outcomes Study - 36-Item Short Form Health Survey, and c) Sociodemographic and Health Factors Questionnaire. Descriptive statistics and parametric and nonparametric tests were used (p<0.05). a) With respect to chronological age, significant differences between groups were only observed for PAL, with G1 (60-69 years) being more active than the other groups. b) With respect to gender irrespective of age, analysis showed a difference in QoL and in the number of medications, with men reporting better perceived QoL and using fewer medications. c) With respect to gender but considering chronological age, differences in PAL, QoL and medication use were observed between genders for specific age groups. In con - clusion, in the elderly a) PAL is low, declines even more during advanced age and is higher in men than in women during the first decade of old age, and b) men report better perceived QoL and use fewer medications than women.

The influence of schooling on cognitive screening test in the elderly

Introduction Tests for screening cognitive functions are gaining importance with the increasing incidence and prevalence of demential syndromes. For our elderly population, the challenge is to develop neuropsychological tests independent from the influence of educational level. Objective To compare the influence of education on the elderly with or without cognitive decline, on the Brief Cognitive Screening Battery (BCSB). Methods We studied 176 elderly people: 60 with cognitive decline (aged 73.6±9.3 years and with 5.7±0.7 years of education) and 116 without cognitive impairments (aged 73.4±0.6 years and with 5.6±0.5 years of education). The BCSB was applied in all subjects. The data were submitted to descriptive statistics and analyzed by Independent Student test with 95% confidence intervals. Results The data showed that the BCSB is an appropriate battery for identifying cognitive status in normal elderly individuals, as well as cognitive decline in our elderly sample. The BCSB items were not significantly influenced by schooling years, making this test favorable for different groups characterized by illiterate individuals, as well as by those with low or high levels of formal education. Conclusion The BCSB proved to be a useful cognitive screening test for old people with or without cognitive decline independent of their educational level.

Aspectos físicos e mentais na qualidade de vida de pacientes com doença de Parkinson idiopática

A doenca de Parkinson (DP) e um disturbio cronico e progressivo, caracterizado pela degeneracao de neuronios dopaminergicos da substantia nigra mesencefalica. A lesao das vias subcorticais, em especial a nigro-estriato-palidal, e particularmente comum e ocasiona uma serie de sinais e sintomas incapacitantes. O objetivo deste trabalho foi analisar a qualidade de vida (QV) relacionada a saude de sujeitos com DP e compara-la a de individuos controles saudaveis. Foram avaliados 40 sujeitos com idades entre 61 e 83 anos, de ambos os sexos, que foram divididos em dois grupos: grupo Parkinson (n=21), composto por sujeitos com DP idiopatica, e grupo controle (n=19), de individuos sem disturbios neurodegenerativos. Para a coleta de dados, foi utilizada a versao brasileira do questionario Brasil SF-36. Os resultados foram analisados estatisticamente, com nivel de significância fixado em 1%. Os sujeitos do grupo Parkinson apresentaram escores significativamente mais baixos do que os do grupo controle, tanto no dominio fisico quanto no mental, medidos pelo SF-36. Essa baixa QV provavelmente e explicada pela co-ocorrencia de fenomenos neurodegenerativos e do sofrimento psiquico gerado pela doenca e pelo estigma que ela produz. Abordagens interdisciplinares devem ser estimuladas a pacientes com DP, com o objetivo de melhorar sua qualidade de vida e postergar o declinio fisico e mental inerente as condicoes degenerativas.

Efeito de uma intervenção cognitivo-motora sobre os sintomas depressivos de pacientes com doença de Parkinson

OBJECTIVE: To verify the effectiveness of a cognitive-motor intervention on depressive symptoms in idiopathic PD patients. METHODS: This longitudinal design study assessed 26 patients, divided into experimental and control groups. The subjects were evaluated by means of the Geriatric Depression Scale, being, the experimental group, submitted to a six-month protocol of physiotherapeutic exercises on motor and cognitive functions. With respect to the data analysis, were applied the Repeated Measure Analysis of Variance, the contrast statistic and the Student-t test for independent samples, with a significant level of 5%. RESULTS: The results showed homogeneity of the groups at baseline and the experimental group achieved a trend of significance in the interaction moment of intervention versus group, as evidenced by the alpha error of 6% with a linear contrast data curve. Conclusion: The proposed protocol has been well accepted by patients diagnosed with idiopathic PD. Although we couldnt contemplate an interval of confidence of 95%, the significant trend obtained represents a potential of this protocol, but with a need of further corroborative studies.

Benefits of Exercise on the Executive Functions in People with Parkinson Disease: A Controlled Clinical Trial

Objective We have made a 3-arm trial (group vs. individual exercise vs. no treatment) to test the effects of a 6-month exercise program upon the executive functions in participants with Parkinson disease. Methods Twenty-four subjects were randomly allocated in 3 groups and undertook individualized exercises (G1, n = 8), group exercises (G2, n = 8), or monitoring (G3, n = 8). Executive functions were evaluated by means of the Wisconsin card sorting test and the Raven colored matrices, both assessed at the beginning of the program and after 6 months. The statistical analyses consisted of the application of repeated measurement tests, with a significant level of 5%. Results The findings showed similar behavior of groups in terms of the Wisconsin card sorting test (P = 0.792), reporting no benefit of the program on such instrument. Differently, Raven colored matrices evidenced a significant benefit provided by the intervention (P = 0.032). Compared with the control group, individuals from G1 had a substantial improvement on executive functions (P = 0.031) and from G2 had a trend of significance (P = 0.072). Conclusion Findings of this study show that 6 months of exercise improved some aspects of executive functions when compared with control peers. Individual therapy seems to have a more prominent improvement than group therapy.