Luci Fuscaldi Teixeira-Salmela

Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors

OBJECTIVE To evaluate the impact of a program of muscle strengthening and physical conditioning on impairment and disability in chronic stroke subjects. DESIGN A randomized pretest and posttest control group, followed by a single-group pretest and posttest design. SUBJECTS Thirteen community-dwelling stroke survivors of at least 9 months. INTERVENTION A 10-week (3 days/week) program consisting of a warm-up, aerobic exercises, lower extremity muscle strengthening, and a cool-down. MAIN OUTCOME MEASURES Peak isokinetic torque of the major muscle groups of the affected lower limb, quadriceps and ankle plantarflexor spasticity, gait speed, rate of stair climbing, the Human Activity Profile (HAP), and the Nottingham Health Profile (NHP) were recorded twice for the treatment group and three times for the control group. RESULTS Significant improvements were found for all the selected outcome measures (HAP, NHP, and gait speed) for the treatment group (p < .001). In terms of overall training effects, the 13 subjects demonstrated increases in strength of the affected major muscle groups, in HAP and NHP profiles, and in gait speed and rate of stair climbing without concomitant increases in either quadriceps or ankle plantarflexor spasticity. CONCLUSIONS The 10-week combined program of muscle strengthening and physical conditioning resulted in gains in all measures of impairment and disability. These gains were not associated with measurable changes of spasticity in either quadriceps or ankle plantarflexors.

Effects of muscle strengthening and physical conditioning training on temporal, kinematic and kinetic variables during gait in chronic stroke survivors.

The purpose of this study was to evaluate the impact of a combined program of muscle strengthening and physical conditioning on gait performance in subjects with chronic stroke, using a single group pre- and post-test design. Thirteen subjects were recruited for the 10-week program (3 days/week), which consisted of warm-up, aerobic exercises, lower extremity muscle strengthening and cool-down. Data from cinematographic film and a force plate obtained during multiple walking trials were used in a four-segment kinetic model to yield spatiotemporal, kinematic and kinetic variables. Gait analysis revealed that the 10 week training resulted in significant increases in gait speed associated with improvements in walking patterns as determined by increases in selected kinematic and kinetic measures. After training, subjects were able to generate higher levels of powers and demonstrated increases in positive work performed by the ankle plantar flexor and hip flexor/extensor muscles.

Muscle strengthening is not effective in children and adolescents with cerebral palsy: a systematic review

QUESTION Do strengthening interventions increase strength without increasing spasticity and improve activity, and is there any carryover after cessation in children and adolescents with cerebral palsy? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS Children with spastic cerebral palsy between school age and 20 years. INTERVENTION Strengthening interventions that involved repetitive, strong, or effortful muscle contractions and progressed as ability changed, such as biofeedback, electrical stimulation, and progressive resistance exercise. OUTCOME MEASURES Strength was measured as continuous measures of maximum voluntary force or torque production. Spasticity was measured as velocity-dependent resistance to passive stretch. Activity was measured as continuous measures, eg, 10-m Walk Test, or using scales eg, the Gross Motor Function Measure. RESULTS Six studies were identified and five had data that could be included in a metaanalysis. Strengthening interventions had no effect on strength (SMD 0.20, 95% CI -0.17 to 0.56), no effect on walking speed (MD 0.02 m/s, 95% CI -0.13 to 0.16), and had a small statistically-significant but not clinically-worthwhile effect on Gross Motor Function Measure (MD 2%, 95% CI 0 to 4). Only one study measured spasticity but did not report the between-group analysis. CONCLUSION In children and adolescents with cerebral palsy who are walking, the current evidence suggests that strengthening interventions are neither effective nor worthwhile.

Adaptação transcultural e análise das propriedades psicométricas da versão brasileira do Perfil de Atividade Humana

The aim of the present study was to evaluate the psychometric properties in the Brazilian version of the Human Activity Profile (HAP), an instrument for the assessment of daily functions and level of physical activity. The HAP was translated into Portuguese following the recommended methodology and applied to 230 community-dwelling elderly (66.32 +/- 8.5 years) from the city of Belo Horizonte, Minas Gerais State, Brazil. The data were submitted to Rasch analysis, which detected very easy and difficult items, making it possible to employ the instrument with both frail and highly functional individuals. The separation index of 3.1 indicated that the items divided the individuals into three levels of functional ability. Of the 94 HAP items, six (6.38%) did not fit the statistical model, which jeopardized its construct validity, since the items did not fit into a continuum. Therefore, caution should be taken when employing the HAP to individuals having similar characteristics. If HAP is applied to different samples and the proportion of erratic items is still more than 5%, modification, substitution, or exclusion of those items is suggested to guarantee that HAP measures a unidimensional construct.

Impact of an Exercise Program on Physical, Emotional, and Social Aspects of Quality of Life of Individuals With Parkinson's Disease

We evaluated changes in different domains of quality of life (QL) for persons with Parkinsons disease after a program of physical activity. Twenty subjects with a diagnosis of Parkinsons disease classified as Stages 1 to 3 on the Hoehn and Yahr scale and with a mean age of 61.5 ± 9.8 years participated in 36 group sessions of a combined group program of aerobic conditioning and muscular strengthening. QL was investigated by the Nottingham Health Profile, a generic questionnaire composed of six domains. Students paired t tests indicated significant gains associated with the program (P < 0.05) on the total score and those related to emotional reactions (ER), social interactions (SI), and physical ability (PA). SI was the domain that showed the greatest program gains (41.4%). The program of physical activity performed with persons with Parkinsons disease at light to moderate stages resulted in improvements in their perception of QL, mainly in the domains of ER, SI, and PA.

Upper Extremity Function in Stroke Subjects: Relationships between the International Classification of Functioning, Disability, and Health Domains

UNLABELLED Upper limb (UL) impairments are the most common disabling deficits after stroke and have complex relationships with activity and participation domains. However, relatively few studies have applied the ICF model to identify the contributions of specific UL impairments, such as muscular weakness, pain, and sensory loss, as predictors of activity and participation. The purposes of this predictive study were to evaluate the relationships between UL variables related to body functions/structures, activity, and participation domains and to determine which would best explain activity and participation with 55 subjects with chronic stroke. Body functions/structures were assessed by measures of grip, pinch, and UL strength, finger tactile sensations, shoulder pain, and cognition (MMSE); activity domain by measures of observed performance (BBT, NHPT, and TEMPA); and participation by measures of quality of life (SSQOL). Upper-limb and grip strength were related to all activity measures (0.52 <r < 0.82, p < .0001). Shoulder pain (r = -.39,p < .001) was the variable which was mostly related to participation. Grip strength alone accounted for 62%, 54%, and 36% of the variance in the activity measures (respectively TEMPA, BBT and NHPT). Shoulder pain accounted for 30% of the participation measure. Strength deficits and shoulder pain of the paretic UL demonstrated to be important targets for clinical interventions to improve activity and participation with chronic stroke subjects. LEVEL OF EVIDENCE 2c.

Adaptação do Perfil de Saúde de Nottingham: um instrumento simples de avaliação da qualidade de vida

O objetivo deste estudo foi avaliar as propriedades psicometricas da versao brasileira do Perfil de Saude de Nottingham (PSN), um instrumento generico de avaliacao da qualidade de vida. O PSN foi traduzido para o portugues, segundo metodologia recomendada, e aplicado em 215 individuos, sendo 170 idosos da comunidade (66,3 ± 8,5 anos), 30 hemiplegicos cronicos (56,4 ± 10,9 anos) e 15 parkinsonianos (59,6 ± 10,2 anos). Os dados foram submetidos a analise Rasch. Dos 38 itens do PSN, apenas dois itens (5%) nao se enquadraram no modelo estatistico, indicando que os itens colaboram para medir um constructo unidimensional. Alguns itens do PSN, no entanto, foram muito faceis para os idosos, hemiplegicos e parkinsonianos, caracterizando um efeito teto, o que pode limitar o uso da escala para individuos com niveis mais altos de habilidade. Apesar dos resultados indicarem que o instrumento se enquadra no modelo estatistico de Rash, ha necessidade de revisao dos itens, de forma a tornar o instrumento mais util clinicamente.

Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome

The aim of this study was to compare the recruitment patterns and latencies of the scapular muscles, as well as the isokinetic performance of the shoulder rotators in 10 subjects with unilateral impingement syndrome who comprised the impingement group (IG) with a control group (CG) of 10 asymptomatic subjects. The recruitment patterns and latencies were evaluated by electromyographic activity during arm elevation in the scapular plane. Isokinetic work ratios of the shoulder rotator muscles were used to analyze muscular performance. A 2 x 2 ANOVA detected that muscular performance and recruitment patterns were similar for both groups and sides. However, the ANOVA revealed a significant side and group interaction, indicating that the scapular muscle latencies of the affected shoulder was greater than that of the nonaffected side only for the IG (p < .001). These findings indicated that subjects with light to moderate impingement syndrome showed late recruitment of the scapular muscles during arm elevation. However, muscular performance of the shoulder rotator muscles was not affected.

Prevention of Low Back Pain: A Systematic Review and Meta-analysis

IMPORTANCE Existing guidelines and systematic reviews lack clear recommendations for prevention of low back pain (LBP). OBJECTIVE To investigate the effectiveness of interventions for prevention of LBP. DATA SOURCES MEDLINE, EMBASE, Physiotherapy Evidence Database Scale, and Cochrane Central Register of Controlled Trials from inception to November 22, 2014. STUDY SELECTION Randomized clinical trials of prevention strategies for nonspecific LBP. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed the risk of bias. The Physiotherapy Evidence Database Scale was used to evaluate the risk-of-bias. The Grading of Recommendations Assessment, Development, and Evaluation system was used to describe the quality of evidence. MAIN OUTCOMES AND MEASURES The primary outcome measure was an episode of LBP, and the secondary outcome measure was an episode of sick leave associated with LBP. We calculated relative risks (RRs) and 95% CIs using random-effects models. RESULTS The literature search identified 6133 potentially eligible studies; of these, 23 published reports (on 21 different randomized clinical trials including 30,850 unique participants) met the inclusion criteria. With results presented as RRs (95% CIs), there was moderate-quality evidence that exercise combined with education reduces the risk of an episode of LBP (0.55 [0.41-0.74]) and low-quality evidence of no effect on sick leave (0.74 [0.44-1.26]). Low- to very low-quality evidence suggested that exercise alone may reduce the risk of both an LBP episode (0.65 [0.50-0.86]) and use of sick leave (0.22 [0.06-0.76]). For education alone, there was moderate- to very low-quality evidence of no effect on LBP (1.03 [0.83-1.27]) or sick leave (0.87 [0.47-1.60]). There was low- to very low-quality evidence that back belts do not reduce the risk of LBP episodes (1.01 [0.71-1.44]) or sick leave (0.87 [0.47-1.60]). There was low-quality evidence of no protective effect of shoe insoles on LBP (1.01 [0.74-1.40]). CONCLUSION AND RELEVANCE The current evidence suggests that exercise alone or in combination with education is effective for preventing LBP. Other interventions, including education alone, back belts, and shoe insoles, do not appear to prevent LBP. Whether education, training, or ergonomic adjustments prevent sick leave is uncertain because the quality of evidence is low.

Inspiratory Muscular Training in Chronic Stroke Survivors: A Randomized Controlled Trial

OBJECTIVE To assess the effectiveness of inspiratory muscular training (IMT) on measures of strength, resistance, functional performance, and quality of life (QOL) for chronic stroke survivors. DESIGN Double-blinded randomized controlled trial. SETTING Research laboratory. PARTICIPANTS Subjects (N=21) with stroke (11 men, 10 women; maximal inspiratory pressure [MIP] <90% of predicted values) were randomly assigned to the experimental (n=11) and control groups (n=10); 18 participants completed all testing and training. INTERVENTIONS Interventions were based on home-based training, with resistance adjusted biweekly to 30% of MIP for the experimental group. The control group underwent the same protocol without the threshold resistance valve. Both groups received home training 30 minutes a day 5 times a week for 8 weeks. MAIN OUTCOME MEASURES MIP, inspiratory muscular endurance (IME), functional performance, and QOL. RESULTS There were significant between-group differences for the MIP and IME measures. Significant changes were observed for only the experimental group for MIP (67.8±14.6 at baseline to 102.2±26.0cmH(2)O at posttraining) and IME (31.8±19.3 to 49.2±21.1cmH(2)O). No statistically significant differences were observed for measures of functional performance and QOL. CONCLUSIONS Significant short-term effects of the IMT program for inspiratory strength and endurance were observed in chronic stroke survivors. These findings gave some indications that IMT may benefit people with stroke, and it is feasible to be included in rehabilitation interventions with this population.