João Carlos Ferrari Corrêa

Atividade muscular durante a marcha após acidente vascular encefálico

OBJECTIVE: To compare muscle activity and joint moments in the lower extremities during walking between subjects with stroke and control subjects. METHOD: We compared fifteen healthy volunteers and fifteen stroke patients, with the same age gender and weight data had been compared by electromyography. The system of signals acquisition used consisted of five pairs of electrodes of surface, beyond one electrogoniometer on the axis articulate of rotation of the joint of the ankle in study. RESULTS: Onset times with respect to heel-strike for the medial gluteus, tibialis anterior, soleus, rectus femoris and medial hamstring muscles were significantly earlier during the gait cycle in subjects with stroke than in control subjects. The cessation times of soleus, tibialis anterior, rectus femoris, and medial hamstring muscles were significantly prolonged in subjects with stroke. CONCLUSION: Subjects with stroke showed more co-contractions of agonist and antagonist muscles at the ankle and knee joints during stance phase. These gait changes and co-contractions may allow subjects with stroke to adopt a safer, more stable gait pattern to compensate for diminished sensory information from the ankle.

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.

Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial

BackgroundThe project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning.Methods/designA prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test.DiscussionThis paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population.Trial registrationReBEC RBR-9B5DH7

Validation of GDI, GPS and GVS for use in parkinson's disease through evaluation of effects of subthalamic deep brain stimulation and levodopa

The Gait Deviation Index (GDI), Gait Profile Score (GPS) and Gait Variable Scores (GVSs) have been proposed as measures of gait quality and validated for use with children with cerebral palsy. The aim of this study was to extend this validation to people with Parkinsons disease by evaluating the effects of subthalamic deep brain stimulation and levodopa on gait. 16 participants had their gait evaluated with stimulation, medication or a combination of both. The Unified Parkinsons Disease Rating Scale (UPDRS) showed statistically significant differences in agreement with previous studies. The GPS and GDI showed similar treatment effects as did GVS for hip and knee flexion/extension, as assessed with Cohens d where medium or large. Overall the results suggest that these gait indices are sensitive to treatment in this group of patients and that their use in groups other than children with cerebral palsy is valid.

Neurophysiological aspects and their relationship to clinical and functional impairment in patients with chronic obstructive pulmonary disease

OBJECTIVE: The purpose was to assess functional (balance L–L and A–P displacement, sit‐to‐stand test (SST) and Tinetti scale – balance and gait) and neurophysiological aspects (patellar and Achilles reflex and strength) relating these responses to the BODE Index. INTRODUCTION: The neurophysiological alterations found in patients with chronic obstructive pulmonary disease (COPD) are associated with the severity of the disease. There is also involvement of peripheral muscle which, in combination with neurophysiological impairment, may further compromise the functional activity of these patients. METHODS: A cross‐sectional study design was used. Twenty‐two patients with moderate to very severe COPD (>60 years) and 16 age‐matched healthy volunteers served as the control group (CG). The subjects performed spirometry and several measures of static and dynamic balance, monosynaptic reflexes, peripheral muscle strength, SST and the 6‐minute walk test. RESULTS: The individuals with COPD had a reduced reflex response, 36.77±3.23 (p<0.05) and 43.54±6.60 (p<0.05), achieved a lower number repetitions on the SST 19.27±3.88 (p<0.05), exhibited lesser peripheral muscle strength on the femoral quadriceps muscle, 24.98±6.88 (p<0.05) and exhibited deficits in functional balance and gait on the Tinetti scale, 26.86±1.69 (p<0.05), compared with the CG. The BODE Index demonstrated correlations with balance assessment (determined by the Tinetti scale), r = 0.59 (p<0.05) and the sit‐to‐stand test, r = 0.78 (p<0.05). CONCLUSIONS: The individuals with COPD had functional and neurophysiological alterations in comparison with the control group. The BODE Index was correlated with the Tinetti scale and the SST. Both are functional tests, easy to administer, low cost and feasible, especially the SST. These results suggest a worse prognosis; however, more studies are needed to identify the causes of these changes and the repercussions that could result in their activities of daily living.

Use of the Gait Deviation Index and spatiotemporal variables for the assessment of dual task interference paradigm

Three-dimensional gait analysis (3DGA) is an important element in the quantitative evaluation of gait in subjects with Parkinsons disease (PD). Indexes, such as the Gait Deviation Index (GDI), have recently been proposed as a summary measure of gait. The aim of the present study was to investigate the effectiveness of the GDI and spatiotemporal variables in the quantification of changes in gait during a dual-task (DT) exercise. Fourteen patients with idiopathic PD and nine healthy subjects (CG) participated in the study. All subjects walked under two conditions: free walking and DT walking. The GDI was computed from the 3DGA data. The results show gait impairment during DT, a significant difference between groups regarding GDI and an interaction effect involving the group, side and task factors. The CG and PDG were different independent of interference and side, but interference was only different for the PDG group. The results also demonstrate that the GDI should be an appropriate outcome measure for the evaluation of the effects of DT on patients with Parkinsons disease.

Psychometric properties of the stroke specific quality of life scale for the assessment of participation in stroke survivors using the rasch model: a preliminary study

[Purpose] The aim of the present study was to analyze the psychometric properties of the Stroke Specific Quality of Life (SS-QOL) scale for the assessment of social participation following a stroke. [Methods] A preliminary analysis was performed of the SS-QOL items that address the participation category. For this, the scoring patterns of the answers of individuals and internal consistence were determined using the Rasch model. Reliability was assessed by intraclass correlation coefficients (ICC). [Results] The reliability coefficients analyzed by the Rasch model were 0.91 for the items and 0.87 for the patients. The separation index was 3.19 for the items and 2.58 for the patients. The findings indicate that the items separated the patients into three levels of participation: low, medium, and high. Among the 26 items addressing participation, three did not fit the model. All items showed adequate reliability (ICC ≥ 0.60). [Conclusion] The Rasch analysis detected three items with erratic behavior; however, the erratic patterns of these items may be explained by individual peculiarities among the patients. These items should be monitored to determine if the problems found in the present study persist. If so, the items should also be revised or possibly even eliminated.

Kinematic and Kinetic Analysis of the Single-Leg Triple Hop Test in Women With and Without Patellofemoral Pain.

STUDY DESIGN Cross-sectional study. OBJECTIVES To compare the biomechanical strategies of the trunk and lower extremity during the transition period between the first and second hop of a single-leg triple hop test in women with and without patellofemoral pain (PFP). BACKGROUND Recent literature has shown that PFP is associated with biomechanical impairments of the lower extremities. A number of studies have analyzed the position of the trunk and lower extremities for functional activities such as walking, squatting, jumping, and the step-down test. However, studies on more challenging activities, such as the single-leg triple hop test, may be more representative of sports requiring jumping movements. METHODS Women between 18 and 35 years of age (control group, n = 20; PFP group, n = 20) participated in the study. Three-dimensional kinematic and kinetic data were collected during the transition period between the first and second hops while participants performed the single-leg triple hop test. RESULTS Compared to the control group, women with PFP exhibited greater (P<.05) anterior and ipsilateral trunk lean, contralateral pelvic drop, hip internal rotation and adduction, and ankle eversion, while exhibiting less hip and knee flexion. A significant difference (P<.05) in time to peak joint angle was also found between groups for all the variables analyzed, except anterior pelvic tilt and hip flexion. In addition, women with PFP exhibited greater (P<.05) hip and knee abductor internal moments. CONCLUSION Compared to the control group, women with PFP exhibited altered trunk, pelvis, hip, knee, and ankle kinematics and kinetics.

Gait profile score and movement analysis profile in patients with Parkinson's disease during concurrent cognitive load

Background: Gait disorders are common in individuals with Parkinsons Disease (PD) and the concurrent performance of motor and cognitive tasks can have marked effects on gait. The Gait Profile Score (GPS) and the Movement Analysis Profile (MAP) were developed in order to summarize the data of kinematics and facilitate understanding of the results of gait analysis. Objective: To investigate the effectiveness of the GPS and MAP in the quantification of changes in gait during a concurrent cognitive load while walking in adults with and without PD. Method: Fourteen patients with idiopathic PD and nine healthy subjects participated in the study. All subjects performed single and dual walking tasks. The GPS/MAP was computed from three-dimensional gait analysis data. Results: Differences were found between tasks for GPS (P<0.05) and Gait Variable Score (GVS) (pelvic rotation, knee flexion-extension and ankle dorsiflexion-plantarflexion) (P<0.05) in the PD group. An interaction between task and group was observed for GPS (P<0.01) for the right side (Cohens ¯d=0.99), left side (Cohens ¯d=0.91), and overall (Cohens ¯d=0.88). No interaction was observed only for hip internal-external rotation and foot internal-external progression GVS variables in the PD group. Conclusions: The results showed gait impairment during the dual task and suggest that GPS/MAP may be used to evaluate the effects of concurrent cognitive load while walking in patients with PD.

Evaluation of post-stroke functionality based on the International Classification of Functioning, Disability, and Health: a proposal for use of assessment tools

This study aimed to identify the International Classification of Functioning, Disability, and Health categories addressed by the assessment tools commonly used in post-stroke rehabilitation and characterize patients based on its evaluation model. [Subjects and Methods] An exploratory, descriptive, cross-sectional study was conducted involving 35 individuals with chronic post-stroke hemiparesis. Handgrip strength was assessed to evaluate body functions and structures. The 10-meter gait speed test and Timed Up and Go test were administered to evaluate activity. The Stroke Specific Quality of Life scale was used to evaluate participation. Moreover, a systematic review of the literature was performed to identify studies that have associated these assessment tools with the International Classification of Functioning, Disability, and Health categories. [Results] The tools employed in this study for evaluating function addressed 63 International Classification of Functioning, Disability, and Health categories: 24 related to body functions and structures; 36 related to activity and participation; and 3 related to environmental factors. [Conclusion] The assessment tools employed in this study addressed 63 International Classification of Functioning, Disability, and Health categories and allowed a more complete evaluation of stroke survivors with hemiparesis. Use of this classification can therefore be more easily incorporated into clinical practice.