Júlia Guimarães Reis

Gait analysis comparing Parkinson's disease with healthy elderly subjects

UNLABELLED There is a lack of studies comparing the kinematics data of idiopathic Parkinsons disease (IPD) patients with healthy elder (HE) subjects, and when there is such research, it is not correlated to clinical measures. OBJECTIVE To compare the spatio-temporal and kinematic parameters of Parkinsonian gait with the HE subjects group and measure the relation between these parameters and clinical instruments. METHOD Twelve patients with IPD and fifteen HE subjects were recruited and evaluated for clinical instruments and gait analysis. RESULTS There were statistically significant differences between HE group and the IPD group, in stride velocity, in stride length (SL), and in the hip joint kinematic data: on initial contact, on maximum extension during terminal contact and on maximum flexion during mid-swing. Regarding the clinical instruments there were significant correlated with in stride velocity and SL. CONCLUSION Clinical instruments used did not present proper psychometric parameters to measure the IPD patients gait, while the 3D system characterized it better.Poucos estudos comparam os dados cinematicos de pacientes com doenca de Parkinson idiopatica (DPI) com individuos idosos saudaveis, e quando realizam nao correlacionam com medidas clinicas. OBJETIVO: Comparar os parâmetros espaco-temporais e cinematicos da marcha na DP com os de idosos saudaveis (IS) e avaliar a relacao entre estes parâmetros com os instrumentos clinicos. METODO: Doze pacientes com DPI e quinze IS foram recrutados e avaliados por instrumentos clinicos e de analise de marcha. RESULTADOS: Houve diferencas estatisticas significantes entre o grupo de IS e o de DPI na velocidade da marcha e no comprimento do passo (CP), nos dados cinematicos das articulacoes do quadril: no contato inicial, na maxima extensao no apoio e na maxima flexao na oscilacao. No que diz respeito aos instrumentos clinicos houve significativa correlacao com a velocidade da marcha e SL. CONCLUSAO: Os instrumentos clinicos utilizados nao apresentaram adequados parâmetros psicometricos para a avaliacao da marcha dos individuos com DPI, enquanto uma avaliacao em 3D caracteriza melhor a marcha destes individuos.

Postural Control and Functional Strength in Patients With Type 2 Diabetes Mellitus With and Without Peripheral Neuropathy

OBJECTIVE To assess the influence of diabetic neuropathy (DN) on balance and functional strength in patients with diabetes mellitus type 2 (DM2). DESIGN Cross-sectional study. SETTING Diabetes outpatient unit. PARTICIPANTS Adults (N=62; age range, 40-65y): 32 with DM2 (19 subjects without DN and 13 with DN) and 30 without DM2 (control group). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Upright balance, evaluated in 4 situations (fixed platform, unstable platform, with eyes open, with eyes closed), and functional strength, assessed with a five-times-sit-to-stand test, were analyzed using an electromagnetic system, with a sensor placed over C7 to allow maximum trunk displacements in the anterior-posterior and medial-lateral directions. The Berg Balance Scale and the Timed Up & Go test were also used. RESULTS Subjects with DM2 had greater anterior-posterior displacement (P<.05) in the unstable platform with eyes closed condition compared with those without DM2, whereas no difference in medial-lateral displacement was observed between these groups. A difference in time was observed in the five-times-sit-to-stand test (P<.05), with subjects in the control group performing the tasks faster than either group of subjects with DM2. Additionally, subjects in the control group showed a higher score in the Berg Balance Scale and performed the Timed Up & Go test in less time compared with subjects in other groups. CONCLUSIONS Subjects with DM2, with or without DN, showed deficits in postural control and functional strength compared with healthy individuals of the same age group.

Postural control parameters in elderly female fallers and non-fallers diagnosed or not with knee osteoarthritis.

OBJECTIVES To compare stabilometric parameters of elderly female fallers and non-fallers associated or not with knee osteoarthritis (OA). METHODS Fifty-six elderly female fallers and non-fallers diagnosed or not with unilateral or bilateral knee OA were divided into the following groups: FOA (n = 10), elderly female fallers with knee OA; FNOA (n = 11), elderly female fallers without knee OA; NFOA (n = 14), elderly female non-fallers with knee OA; and NFNOA (n = 21), elderly female non-fallers without knee OA. For analyzing semi-static balance on a force platform with the elderly females standing, the following parameters were assessed in four conditions: center of pressure (COP), anterior-posterior and mediolateral displacements (APD and MLD, respectively); and COP anterior-posterior and mediolateral displacement velocities (APV and MLV, respectively). The following conditions were assessed: 1) standing on a firm wooden surface with eyes open (WSEO); 2) standing on a firm wooden surface with eyes closed (WSEC); 3) standing on a foam surface with eyes open (FSEO); 4) standing on a foam surface with eyes closed (FSEC). RESULTS The elderly females with knee OA showed greater APD in all four conditions assessed (P < 0.05), while the elderly female fallers showed greater MLD (P < 0.05). No difference between the groups was observed for APV and MLV (P > 0.05). CONCLUSIONS Knee OA per se increases APD of the COP, while the history of falls, regardless of the presence of knee OA, hinders postural control in the ML direction.

Do muscle strengthening exercises improve performance in the 6-minute walk test in postmenopausal women?

BACKGROUND Walking speed seems to be related to aerobic capacity, lower limb strength, and functional mobility, however it is not clear whether there is a direct relationship between improvement in muscle strength and gait performance in early postmenopausal women. OBJECTIVE To evaluate the effect of muscle strengthening exercises on the performance of the 6-minute walk test in women within 5 years of menopause. METHODS The women were randomized into control group (n=31), which performed no exercise, and exercise group (n=27), which performed muscle strengthening exercises. The exercises were performed twice a week for 3 months. The exercise protocol consisted of warm-up, stretching, and strengthening of the quadriceps, hamstring, calf, tibialis anterior, gluteus maximus, and abdominal muscles, followed by relaxation. Muscular strength training started with 60% of 1MR (2 series of 10-15 repetitions), reaching 85% until the end of the 3-month period (4 series of 6 repetitions each). RESULTS The between-group comparisons pre- and post-intervention did not show any difference in distance walked, heart rate or blood pressure (p>0.05), but showed differences in muscle strength post-intervention, with the exercise group showing greater strength (p CONCLUSION The results suggest that muscle strengthening of the lower limbs did not improve performance in the 6-minute walk test in this population of postmenopausal women.

Body balance evaluation in osteoporotic elderly women.

SummaryOsteoporotic Brazilian women balance was evaluated by timed up and go test (TUG) and to the Berg balance scale (BBS). In the BBS, women with and without osteoporosis had normal range scores, even with history of fall. In the TUG test, women with osteoporosis were slower, but in the normal parameter. Results suggest that the references values of these tests are not appropriate for Brazilians.PurposesThe purposes of this study were to evaluate balance and functional mobility in women with osteoporosis and without osteoporosis and to verify if the history of falls has association to the TUG and to the BBS, both largely used in the clinical practice.Materials and methodsForty-five women were divided into three groups: group 1, young women with normal body mineral density (BMD); group 2, elderly with normal BMD; and group 3, elderly with osteoporosis. BBS and TUG were performed, and the history of falls was collected.ResultsBBS and TUG showed differences in the scores obtained for young women compared with both elderly with and without osteoporosis. In the TUG test, there were differences between elderly with and without osteoporosis. The fall’s history did not present correlations either for TUG or BBS.ConclusionsAlthough the results showed that all women were within the normal range for BBS and TUG, the results suggest that the reference values for TUG and BBS are not appropriate for Brazilian population.

Evaluation of postural control and quality of life in elderly women with knee osteoarthritis

OBJECTIVE To assess the balance in dynamic tasks and in the quality of life in elderly women with and without knee osteoarthritis. METHODS Elderly women were divided into Group 1 (n = 12), consisting of participants with bilateral knee osteoarthritis (Kellgreen-Lawrence grade 1 and 2), and Group 2 (n = 12), consisting of controls. A force plate (EMG System do Brazil) was used to assess postural sway in dynamic tasks, whereas the quality of life was assessed by using the WHOQOL-Bref questionnaire. RESULTS Students t-test showed no statistical difference during sitting down and standing up from the chair (p > 0.05). However, stair ascent revealed difference in displacement speed (p < 0.05), whereas stair descent showed differences in both displacement speed and amplitude (p < 0.05). In the questionnaire, Group 1 showed values lower than those in the control group regarding physical domain (p < 0.05). CONCLUSION Elderly women with knee osteoarthritis seemed to have more difficulty on stair descent task and had perception of worst physical domain. These findings were observed in OA group, even in the early stages of the disease, which shows the importance of even earlier interventions.

The influence of vision and support base on balance during quiet standing in patients with adolescent idiopathic scoliosis before and after posterior spinal fusion

BACKGROUND CONTEXT Scoliosis is the most common postural alteration in adolescence and is characterized by deviations of the spine in three planes. Surgical treatment based on arthrodesis has been developed, but the effects of such restructuring on the systems involved in postural control need to be better understood. PURPOSE To assess the influence of vision and the support base on balance in the quiet standing position in adolescents awaiting surgical treatment for idiopathic scoliosis. STUDY DESIGN/SETTING Longitudinal study/Ribeirão Preto Clinics Hospital (HC-FMRP-USP) and Laboratory of Assessment and Rehabilitation of Equilibrium at the FMRP-USP. PATIENT SAMPLE Adolescent idiopathic scoliosis patients and controls. OUTCOME MEASURES Center of pressure (CoP) sway area of the 95% confidence ellipse. METHODS Thirty female adolescents were divided into two groups according to their spinal alignment: control (n=15) and scoliosis groups (SGs) (n=15). The subjects with scoliosis were evaluated before and 7, 30, 60, and 90 days after surgery; the controls were evaluated once. The area of CoP oscillation was measured with the eyes open and closed and with two different support bases (feet apart or together). The force platform was purchased with funding support (US

Analysis of postural control and muscular performance in young and elderly women in different age groups

8,375.00) provided by the Research Foundation of São Paulo (FAPESP). The study sponsors had no involvement in the study. Data were collected from the force platform and then statistically assessed through a linear model analysis of mixed effects. RESULTS Data reveal that subjects in the SG oscillated more than controls, and postsurgery subjects had more oscillation than presurgery subjects. The results also indicated that both groups (control and scoliosis) showed more oscillation among those subjects with feet apart and eyes closed, but subjects with scoliosis were more affected by vision deprivation than by a reduced support base. CONCLUSIONS Our results indicate that adolescents with idiopathic scoliosis are more dependent on visual information and that surgical correction does not change this relationship.

Análise cinemática do joelho ao subir e descer escada na instabilidade patelofemoral

BACKGROUND: muscle strength and power are two factors affecting balance. The impact of muscle strength and power on postural control has not been fully explored among different age strata over sixty. OBJECTIVES: the aim of the present study was to assess the muscle strength and power of elderly women in different age groups and determine their correlation with postural control. METHOD: eighty women were divided into four groups: the young 18-30 age group (n=20); the 60-64 age group (n=20); the 65-69 age group (n=20); and the 70-74 age group (n=20). The participants underwent maximum strength (one repetition maximum or 1-RM) and muscle power tests to assess the knee extensor and flexor muscles at 40%, 70%, and 90% 1-RM intensity. The time required by participants to recover their balance after disturbing their base of support was also assessed. RESULTS: the elderly women in the 60-64, 65-69, and 70-74 age groups exhibited similar muscle strength, power, and postural control (p>0.05); however, these values were lower than those of the young group (p<0.05) as expected. There was a correlation between muscle strength and power and the postural control performance (p<0.05). CONCLUSION: despite the age difference, elderly women aged 60 to 74 years exhibited similar abilities to generate strength and power with their lower limbs, and this ability could be one factor that explains the similar postural control shown by these women.

Is there a relationship between complaints of impaired balance and postural control disorder in community-dwelling elderly women? A cross-sectional study with the use of posturography

OBJECTIVE: To analyze and to identify possible gait adaptations by individuals with objective patellofemoral instability when climbing up/down stairs. METHODS: A control group (group A) composed by nine women with mean age = 25 years (±1.87), height = 1.62 m (±0.05) and weight = 56.20 kg (±7.34), and; nine women with objective patellofemoral instability (group B) with mean age = 24 years (±6.02), height = 1.62 m (±0.06) and weight = 60.33 kg (±10.31) were analyzed. The groups underwent kinematic analysis while climbing up/down stairs, in a previously determined area. Images were obtained by six cameras (Qualysis) and data analysis utilized the Q gait software program. RESULTS: Group B presented, in the support phase, less knee flexion when climbing up (p = 0.0268), and lower speed (p = 0.0076/ p =0.0243) and pace (p = 0.0027/ p = 0.0165) when climbing up and down stairs, respectively. CONCLUSION: It is suggested that group B used functional changes such as reduced knee flexion, speed and pace when climbing up and down stairs.