Kênia Kiefer Parreiras de Menezes

Strength deficits of the paretic lower extremity muscles were the impairment variables that best explained restrictions in participation after stroke.

Abstract Purpose: To evaluate which measures of physical impairments of both upper extremity (UE) and lower extremity (LE) would predict restrictions in participation with 105 community-dwelling stroke subjects. Methods: For this cross-sectional, exploratory study, participation was assessed by the daily activity and social role domains of the Assessment of Life Habits (LIFE-H). The potential predictors included measures of physical impairments (UE and LE motor recovery, sensation, motor coordination, and strength deficits). Results: Step-wise multiple linear regression analyses revealed that, for the daily activity domain, LE strength deficits and UE motor recovery explained 28% of the variance in the LIFE-H scores and LE strength deficits alone explained 22% (F = 29.5; p< .0001). For the social role domain, LE strength deficits and sensation explained 22% of the variance in the LIFE-H scores and LE strength deficits alone explained 16% (F = 20.6; p< .0001). Conclusions: Strength deficits of the LE muscles were the physical impairment variables that best predicted participation in both daily activity and social role domains of the LIFE-H. Although significant, UE motor recovery and LE sensation added little to the explained variance. Future research is needed to determine whether progressive resistance strength training program enhances participation after stroke. Implications for Rehabilitation Residual strength deficits of the LE muscles were the physical impairments that showed to be the main predictors of restrictions in participation, as determined by the daily activity and social role domains of the LIFE-H 3.1. It is possible that stroke individuals would benefit from physical interventions aiming at improving the strength of the LE muscles, when the goal is to enhance participation.

Effect of high-intensity home-based respiratory muscle training on strength of respiratory muscles following a stroke: a protocol for a randomized controlled trial

Highlights • High-intensity respiratory muscle training may improve neurological rehabilitation.• Gains in respiratory muscle strength are expected to be clinically meaningful.• If benefits are carried over to activity, community participation may be enhanced.• If benefits include reduction in hospital admissions, treatment costs may be reduced.

Grupos operativos na Atenção Primária à Saúde como prática de discussão e educação: uma revisão

Introduction: It is essential that health professionals learn about group phenomena, since its organization as a form of collective attention is increasing in health services. Thus, this study aimed to analyze, through a literature review, the results of educational activities in primary health care through the use of operative groups. Method: We conducted an electronic search in Medline, SciELO, LILACS and Web of Science, without restrictions of language and year of publication, the search was performed by two independent researches. Result: The search strategy returned 143 studies, however only ten studies were included. The health education groups in primary healthy care are efficient strategies when applied in different populations, opening a space to listening and informing. Additionally, objective measures show improvement in self-care, lifestyle, abandoning addictions, risk behavior, etc. Conclusion: The operative groups are included in primary health care as a practical and efficient process. All studies achieved positive results in the promotion, prevention and health education.

Review of the psychometric properties of lower limb motor coordination tests

Introduction Adequate motor coordination (MC) of the lower limbs is essential for most of the motor tasks. Therefore, it is important to know the psychometric properties of the tests employed to assess lower limb MC, so that professionals could have a better basis to choose the most adequate assessment tools. Objectives To investigate the psychometric properties and clinical utility of instruments used to assess lower limb MC, by means of a critical review of the literature. Materials and methods A search was conducted in six databases looking for studies which evaluated reliability, validity, sensitivity to changes, or clinical utility of the tests employed to assess lower limb MC. The articles were assessed and the data of their psychometric properties were extracted by two researchers, independently. Results The search returned 1361 studies, 1,325 were excluded after analyses. The hand search yielded four eligible articles, totaling nine included articles. The included studies evaluated the psychometric properties of eight tests, but only three were specific to assess lower limb MC and the others were sub-items of other scales, which assess other domains. None of the tests provided data for all of the basic psychometric properties. Final remarks According to the results of this review, none of the tests had their basic psychometric properties reported, which is necessary to be investigated in future studies. This review may facilitate the search and selection of lower limb MC tests by researchers and clinicians.

Cross-cultural validity of the ABILOCO questionnaire for individuals with stroke, based on Rasch analysis

Abstract Purpose: The purpose of this study was to evaluate the cross-cultural validity of the Brazilian version of the ABILOCO questionnaire for stroke subjects. Materials and methods: Cross-cultural adaptation of the original English version of the ABILOCO to the Brazilian–Portuguese language followed standardized procedures. The adapted version was administered to 136 stroke subjects and its measurement properties were assessed using Rash analysis. Cross-cultural validity was based on cultural invariance analyses. Results: Goodness-of-fit analysis revealed one misfitting item. The principal component analysis of the residuals showed that the first dimension explained 45% of the variance in locomotion ability; however, the eigenvalue was 1.92. The ABILOCO-Brazil divided the sample into two levels of ability and the items into about seven levels of difficulty. The item-person map showed some ceiling effect. Cultural invariance analyses revealed that although there were differences in the item calibrations between the ABILOCO-original and ABILOCO-Brazil, they did not impact the measures of locomotion ability. Conclusions: The ABILOCO-Brazil demonstrated satisfactory measurement properties to be used within both clinical and research contexts in Brazil, as well cross-cultural validity to be used in international/multicentric studies. However, the presence of ceiling effect suggests that it may not be appropriate for the assessment of individuals with high levels of locomotion ability. Implications for rehabilitation Self-report measures of locomotion ability are clinically important, since they describe the abilities of the individuals within real life contexts. The ABILOCO questionnaire, specific for stroke survivors, demonstrated satisfactory measurement properties, but may not be most appropriate to assess individuals with high levels of locomotion ability The results of the cross-cultural validity showed that the ABILOCO-Original and the ABILOCO-Brazil calibrations may be used interchangeable.

Lower-limb motor coordination is significantly impaired in ambulatory people with chronic stroke: A cross-sectional study

OBJECTIVES To establish the deficits of motor coordination of the lower limbs after stroke, in comparison with healthy controls, and to investigate whether the magnitude of the deficits would be influenced by the levels of motor recovery. DESIGN Cross-sectional study. SUBJECTS Chronic stroke patients and healthy subjects. METHODS Lower-limb motor coordination of both stroke and healthy volunteers was measured using the Lower Extremity Motor Coordination Test (LEMOCOT). The motor coordination deficits of the participants with stroke were analysed all together and separated, according to their levels of motor recovery, measured using the Fugl-Meyer lower-limb motor section scores. RESULTS Ninety-seven individuals with chronic stroke, 55 men, mean age 58 years, were evaluated. Motor coordination was significantly impaired on both paretic (mean: -22 touches; 95% confidence interval (95% CI) -24 to -19; deficit: 61%) and non-paretic (mean -6 touches; 95% CI -8 to -4; deficit: 17%) lower limbs. Significant differences in the LEMOCOT scores were found between the levels of motor recovery (p < 0.01), except between the participants with marked and moderate impairments. CONCLUSION Motor coordination of the lower limbs is significantly impaired after stroke, but the deficits of the non-paretic lower limb (17%) appear not to be clinically relevant. These findings suggest that interventions prescribed to improve motor coordination after stroke should focus on the paretic lower limb and/or include bilateral activities.

Prevalence of dyspnea after stroke: a telephone-based survey

OBJECTIVE Dyspnea is a relevant outcome to be taken into consideration during stroke rehabilitation. Prevalence, severity, and effects of this condition on individuals with stroke remain uncertain. This study investigated the prevalence and severity of dyspnea after a stroke, as well the associations between dyspnea, activity limitations, and participation restrictions. METHODS A telephone-based survey was conducted with 285 individuals with stroke. The survey included information regarding the onset and severity of the dyspnea, activity limitations, and participation restrictions. Prevalence of dyspnea was reported as percentage of individuals who had the symptom. Chi-square tests were used to investigate the associations between dyspnea, activity limitations, and participation restrictions. Relative risks and respective 95% confidence intervals were calculated. RESULTS Out of the 285 participants, 124 (44%) reported having dyspnea after stroke. Severe symptoms were reported by 51% of the participants with dyspnea. In addition, dyspnea limited activity and restricted social participation in 85% and 49% of the participants, respectively. Dyspnea was significantly correlated with activity limitations (r=0.87; 95% CI 0.82-0.92; p<0.01) and participation restrictions (r=0.53; 95% CI 0.46-0.62; p<0.01). The analyses indicated that individuals with dyspnea were more likely to report that it limited their activities (RR: 6.5; 95% CI 4.3-9.9) and restricted social participation (RR: 1.7; 95% CI 1.5-2.0). CONCLUSIONS Dyspnea is an important symptom after stroke and showed to be associated with activity limitations and restrictions in community participation. Earlier detection of dyspnea in people with stroke, followed by appropriate management, is strongly recommended and has the potential to improve activity and social participation.

High-intensity respiratory muscle training improves strength and dyspnea after stroke: a double-blind randomized trial

OBJECTIVE To examine whether high-intensity home-based respiratory muscle training, that is, with higher loads, delivered more frequently and for longer duration, than previously applied, would increase the strength and endurance of the respiratory muscles, reduce dyspnea and respiratory complications, and improve walking capacity post-stroke. DESIGN Randomized trial with concealed allocation, blinded participants and assessors, and intention-to-treat analysis. SETTING Community-dwelling patients. PARTICIPANTS Patients with stroke, who had respiratory muscle weakness (N=38). INTERVENTIONS The experimental group received 40-minute high-intensity home-based respiratory muscle training, 7 days per week, for 8 weeks, progressed weekly. The control group received a sham intervention of similar dose. MAIN OUTCOME MEASURES Primary outcome was inspiratory muscle strength (via maximal inspiratory pressure), whereas secondary outcomes were expiratory muscle strength (maximal expiratory pressure), inspiratory muscle endurance, dyspnea (Medical Research Council score), respiratory complications (hospitalizations), and walking capacity (6-minute walk test). Outcomes were measured at baseline, after intervention, and 1 month beyond intervention. RESULTS Compared to the control, the experimental group increased inspiratory (27cmH2O; 95% confidence interval [95% CI], 15 to 40) and expiratory (42cmH2O; 95% CI, 25 to 59) strength, inspiratory endurance (33 breaths; 95% CI, 20 to 47), and reduced dyspnea (-1.3 out of 5.0; 95% CI, -2.1 to -0.6), and the benefits were maintained at 1 month beyond training. There was no significant between-group difference for walking capacity or respiratory complications. CONCLUSION High-intensity home-based respiratory muscle training was effective in increasing strength and endurance of the respiratory muscles and reducing dyspnea for people with respiratory muscle weakness post-stroke, and the magnitude of the effect was higher, than that previously reported in studies, which applied standard protocols.

Effect of the provision of a cane on walking and social participation in individuals with stroke: protocol for a randomized trial

Highlights • The founds may result in an important advance in neurological rehabilitation.• A single-point cane may help improving walking of slow and intermediate walkers after stroke.• If walking is enhanced, the benefits may be carried over to participation.

The Impact of Overweight on Flexibility and Functional Capacity

Obesity is a health problem worldwide, with a significant impact on the mortality of individuals. However, considering the importance of preventive management, few studies have addressed the predictors of functional impairment in overweight subjects. The present study aimed to verify the differences in functional variables in overweight volunteers compared to eutrophic subjects, to determine the independent predictors of functional capacity in overweight subjects and to provide a model that can predict exercise capacity in this population. Seventy-four physically active participants (both sexes, aged 18 to 60 years) were evaluated and stratified into two groups: eutrophic (n=45, 33 ± 11 years, 76% females) and overweight (n=29, 37 ± 12 years, 41% females), according to body mass index (BMI). All volunteers were submitted to clinical, anthropometric, flexibility, muscle strength and endurance evaluation and maximal exercise testing. Differences between groups were verified by Independent T test or Mann-Whitney. Uni and multivariate linear regressions were performed to verify the independent predictors of functional capacity in the overweight group. The overweight individuals were predominantly male (58.6%), with iliopsoas (p=0.009), pectoral (p<0.001) and piriformis (p=0.003) shortening, and with lower values of peak oxygen uptake (VO2peak) (p=0.012). In the final multivariate model, BMI and body fat percentage were the only independent predictors of functional capacity in overweight volunteers and VO2peak can be predicted by the model VO2peak=85.161 – (0.747 × BMI) – (0.925 × body fat percentage). Overweight individuals already show musculoskeletal and functional changes when compared to eutrophic ones. Preventive strategies should be adopted in this population, aiming to prevent musculoskeletal and functional dysfunctions that may compromise the functional capacity of these individuals.