Mariana Callil Voos

Estudo comparativo entre a relação do hemisfério acometido no acidente vascular encefálico e a evolução funcional em indivíduos destros

OBJECTIVE: The left hemisphere is supposed to be dominant for motor control and the right hemisphere dominant for spatial orientation. This study aimed to test the hypothesis that left-side lesions cause greater impairment of voluntary movement, while right-side lesions cause loss of spatial attention loss and postural control. Individuals with left-side lesions were compared with individuals with right-side lesions, in relation to initial impairment and recovery three months after their stroke. METHODS: Twenty-two right-handed individuals with an ischemic lesion in the area of the middle cerebral artery (11 on the left side and 11 on the right side) were assessed monthly, for the first three months after their stroke, in terms of sensitivity, tonus, posture, gait, functional independence and spatial attention. RESULTS: In relation to the initial impairment, there was no difference in sensitivity, tonus, strength, posture and spatial attention between the groups. The left-side lesion group presented worse initial performance in gait and functional independence tests. In relation to the recovery rate, there were no differences in sensitivity, tonus, strength, posture, spatial attention or functional independence between the two groups. However, the gait recovery rate in the left-side lesion group was slower than in the other group. CONCLUSIONS: The hypothesis that left-side lesions cause greater impairment of voluntary movement (represented by gait and functional independence) than do right-side lesions was supported. However, no evidence that right-side lesions cause greater impairment of spatial attention and posture maintenance than do left-side lesions was found.

Relationship of executive function and educational status with functional balance in older adults.

Background:The Berg Balance Scale (BBS) is frequently used to assess functional balance in older adults. The relationship of executive function and level of education with the BBS performance has not been described. The aim of this study was to determine whether (1) the performance on a task requiring executive function (part B of the Trail Making Test, TMT-B) influences results of motor and cognitive tests and (2) the number of years of formal education could be related to performance on BBS in older adults. We also explored whether there would be differences, based on performance on TMT-B (high vs low) in motor function (BBS, the timed up and go [TUG]) or cognitive function (TMT-A and TMTDELTA), the Mini Mental State Examination (MMSE), as well as years of education. Methods:Participants included 101 older adults (age range, 60-80 years) residing in São Paulo, Brazil. Functional balance was assessed using BBS and TUG. Executive function was assessed using the TMT and MMSE. Educational status was determined by self-report of participants total number of years of formal education. Results:The BBS scores were inversely related to TMT-A time (r = −0.63, r2 = 0.40, P < .001) and TMT-B time (r = −0.56, r2 = 0.31, P < .001). There was a similar relationship with TMTDELTA (r = −0.47, r2 = 0.22, P < .001). The BBS scores were positively correlated to years of formal education (r = 0.48, r2 = 0.23, P < .001). There was a ceiling effect on the TMT-B, with many individuals reaching maximum score of 300 seconds. Participants with high levels of executive function had higher BBS and MMSE scores, more education, and lower TMT-A, TMTDELTA and TUG scores (P < .001) than the lower functioning group. Conclusions:Individuals with higher capacity on tasks requiring visuospatial abilities, psychomotor speed, and executive function, such as the TMT, had better performance on BBS. Individuals with a high executive function, measured by TMT-B, also performed better on other motor and cognitive tests.

Influence of Educational Status on Executive Function and Functional Balance in Individuals with Parkinson Disease

Objective:This study investigated whether educational status influenced how people with Parkinson disease (PD) performed on Parts A, B, and DELTA of the Trail Making Test (TMT) and on the Berg Balance Scale (BBS). Background:Recent studies have shown that educational status may influence cognitive and motor test performance. Methods:We gave the TMT and the BBS to assess executive function and functional balance in 28 people with PD (Hoehn and Yahr score between 2 and 3) and 30 healthy elderly people. Participants reported their number of years of formal education. We divided each group of participants by educational status: low (4 to 10 years of education) or high (≥11 years). Results:In both the PD (P=0.018) and control (P=0.003) groups, participants with low educational status performed worse on the TMT Part B than did those with high educational status. Within the PD group, the less-educated participants scored worse on the BBS than did the more educated (P<0.001); this difference was not significant between the more- and less-educated controls (P=0.976). Conclusions:Whether or not they had PD, less-educated people performed worse than more-educated people on the TMT Part B. Educational status affected executive function, but PD status did not. Among individuals with PD, educational status influenced functional balance.

Compensatory movements during functional activities in ambulatory children with Duchenne muscular dystrophy

OBJECTIVE During the transitional phase (ambulatory to non-ambulatory), synergies characterize the evolution of Duchenne muscular dystrophy (DMD). This study was performed to describe and quantify compensatory movements while sitting down on/rising from the floor and climbing up/down steps. METHOD Eighty videos (5 children × 4 assessments × 4 tasks) were recorded quarterly in the year prior to gait loss. Compensatory movements from the videos were registered based on the Functional Evaluation Scale for DMD. RESULTS The most frequently observed compensatory movements were upper limb support on lower limbs/floor/handrail during all the tasks and lumbar hyperlordosis, trunk support on handrail, equinus foot, increased base of support, non-alternated descent, and pauses while climbing up/down steps. CONCLUSION Climbing up/down steps showed a higher number of compensatory movements than sitting down on/rising from the floor, which seemed to be lost before climbing up/down steps in ambulatory children with DMD.

Relação entre cognição (função executiva e percepção espacial) e equilíbrio de idosos de baixa escolaridade

The aim of this study was to investigate whether spatial perception and executive function deficits might have a relationship with functional balance in low-educational status elderly. Thirty-eight volunteers (mean aged 69.1±6.8 years), having one to six years of formal education, were assessed by the following tests: part A of the trail making test (TMT-A), for visual scanning ability, and cognitive processing sequencing and speed); part B of the TMT (TMT-B), that assesses mental flexibility and working memory); delta TMT (TMT-D), that assesses executive function; the star cancellation test (SCT), that evaluates spatial perception; Berg balance scale (BBS) and the Falls Efficacy Scale - International (FES-I), both used in the assessment of balance and falls. Correlations were sought for by means of the Spearman test and the significance level was set at 0.05. Significant, strong correlations were found between the balance scales (BBS and FES-I) and TMT-B (r=-0.61 and r=0.65, respectively); and moderate correlations between BBS and TMT-A (r=-0.51), and between FES-I and TMT-D (r=0.55). Significant correlations between the balance scales (BBS and FES-I) and the SCT were also found (r=0.45 and r=-0.45, respectively). Executive function and spatial perception showed relationship with balance and fear of falling in elderly with a low educational level. The better the executive function and spatial perception, the better balance tends to be and the lower the trend to fear of falling.

The competition with a concurrent cognitive task affects posturographic measures in patients with Parkinson disease

OBJECTIVES To estimate the impact of a sensory-motor- cognitive task on postural balance, in Parkinson disease patients (Hoehn and Yahr 2-3) and to investigate possible relationships between posturography and functional balance clinical scales. METHOD Parkinson disease patients (n = 40) and healthy controls (n = 27) were evaluated with fluency tests, Berg Balance scale, Mini Best test and static posturography on the conditions eyes open, eyes closed and dual-task (simultaneous balance and fluency tasks). RESULTS Posturographic data showed that Parkinson disease patients performed worse than controls in all evaluations. In general, balance on dual-task was significantly poorer than balance with eyes closed. Posturographic data were weakly correlated to clinical balance scales. CONCLUSION In clinical practice, Parkinson disease patients are commonly assessed with eyes closed, to sensitize balance. Our study showed that adding a cognitive task is even more effective. Static posturographic data should be carefully overgeneralized to infer functional balance impairments.

Development and Reliability of the Functional Evaluation Scale for Duchenne Muscular Dystrophy, Gait Domain: A Pilot Study

BACKGROUND AND PURPOSE The progression of Duchenne muscular dystrophy (DMD) results in the emergence of multiple and varied synergies to compensate muscle weakness and to deal with the demands of the functional tasks (e.g. gait). No functional evaluation instrument for individuals with DMD allows the detailed description (subjective qualitative evaluation) and compensatory movement scoring (objective quantitative evaluation) exclusively of gait. For this reason, clinicians and therapists face difficulties in assessment and decision-making of this functional activity. This study aimed to elaborate the gait domain of the Functional Evaluation Scale for DMD (FES-DMD-GD) and test its intra-rater and inter-rater reliabilities and its relationship with age and timed motor performance. METHOD We listed all the compensatory movements observed in 102 10-m gait videos of 51 children with DMD. Based on this report, the FES-DMD-GD was created and submitted to the review of 10 experts. After incorporating the experts suggestions, three examiners scored the videos using the FES-DMD-GD. The intra-rater and inter-rater reliabilities was calculated. Spearman correlation tests investigated the relationships between FES-DMD-GD and age and timed motor performance (p < 0.05). RESULTS The FES-DMD-GD was composed of three phases and had 14 items to quantify compensatory movements on gait. Intra-class correlation coefficients ranged from acceptable (0.74) to excellent (0.99). FES-DMD-GD correlated to age and timed motor performance. CONCLUSION This pilot version of FES-DMD-GD showed reliability and correlated to age and timed motor performance.

Interferência mútua entre atividade visual e atividade motora em jovens e idosos

Como o envelhecimento provoca dificuldade na capacidade de dividir a atencao, este estudo visou verificar, em jovens e idosos: (1) a eventual interferencia entre uma tarefa visual e uma motora; (2) se essa interferencia (caso exista) ocorre de forma diferente no desempenho de jovens e idosos; (3) se as tarefas propostas tem correlacao com testes validados, de sequencia alfanumerica (TMT) e de levantar e caminhar cronometrado (TLCC). A tarefa visual consistiu na verbalizacao do reconhecimento de duas figuras iguais ou diferentes apresentadas rapidamente. A tarefa motora consistiu na alternância de passos do chao a uma plataforma fixa de 10 cm de altura. As tarefas foram avaliadas isoladas (tarefa-simples) e associadas (tarefa-dupla) em dois grupos: 10 jovens (23±2,8 anos) e 10 idosos (68,8±8,6 anos). Na tarefa visual, os jovens fizeram menos erros que os idosos (p<0,001); nos dois grupos nao houve maior numero de erros na tarefa-simples quando comparada a tarefa-dupla. Na tarefa motora, os idosos tiveram pior desempenho na tarefa-dupla em relacao a tarefa-simples (p=0,009). Houve correlacao positiva entre o TMT e o numero de alternâncias de passos (p<0,05) e correlacao negativa entre o numero de alternâncias de passos e o TLCC (p<0,05). A tarefa motora nao interferiu na tarefa visual em jovens nem em idosos, mas a tarefa visual diminuiu a velocidade da tarefa motora dos idosos. A proposicao das tarefas sem atribuir primariedade a uma ou outra permitiu detectar essas interferencias.

The clinical relevance of timed motor performance in children with Duchenne muscular dystrophy

Abstract Background: The measurement of time and compensatory movements for functional tasks is not frequently used to evaluate children with Duchenne muscular dystrophy (DMD). As muscle weakness progresses, new synergies (compensatory movements) are selected to perform the tasks, demanding higher times. Objectives: The present study aimed to describe the timed motor performance of rising from the floor to standing, sitting down on the floor from standing, climbing up four steps and climbing down four steps 18 and 6 months prior to gait loss and to investigate possible relationships between these timed performances, the compensatory movements and the Vignos Scale (VS) scores. Method: Fourteen children with DMD (mean age: 9.6) were videotaped performing the tasks. Spearman correlation tests investigated the relationships between the times, compensatory movements (scored by FES-DMD) and VS. Results: The timed performance and the compensatory movements for rising from the floor, climbing up and climbing down steps varied broadly and were correlated to each other among patients with DMD at 18 and 6 months prior to gait loss. The relationship was not found for sitting on the floor. The timed performance and compensatory movements for climbing up and down steps also correlated to the VS. Conclusion: Rising from the floor, climbing up, and climbing down steps have some components in common, such as the demand for muscle strength and the recruitment of compensatory muscle synergies, as DMD progresses. To sit down on the floor, some children let themselves fall, resulting in a faster performance, but more compensatory movements.

Case Report: Physical therapy management of axial dystonia

Abstract Few studies have described physical therapy approaches to provide functional independence and reduce pain in individuals with dystonia. This report describes the physical therapy treatment of a 46-year-old woman diagnosed with idiopathic segmental axial dystonia. For two years, the patient was treated with kinesiotherapy (active and resisted movements and stretching of neck and trunk muscles), abdominal taping (kinesiotaping techniques), functional training, and sensory tricks. She was assessed with parts I, II and III of Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-I, TWSTRS-II and TWSTRS-III), Berg Balance Scale (BBS), Six-Minute Walk Test (6-MWT), and the motor domain of Functional Independence Measure (FIM-motor) before and after the two-year treatment and after the one year follow-up. Postural control and symmetry improved (TWSTRS-I: from 30 to 18), functional independence increased (TWSTRS-II: from 27 to 15; BBS: from 36 to 46; 6-MWT: from 0 to 480 meters (m); FIM-motor: from 59 to 81), and the pain diminished (TWSTRS-III: from 12 to 5). The functional improvement was retained after one year (TWSTRS-I: 14/35; TWRTRS-II: 12/30; TWRTRS-III: 5/20; BBS: 48/56; 6-MWT: 450 m; FIM-motor: 81/91). This program showed efficacy on providing a better control of the dystonic muscles and thus the doses of botulinum toxin needed to treat them could be reduced. Outcomes support the therapeutic strategies used to deal with this type of dystonia.