Paulo Henrique Ferreira de Araujo Barbosa

Tecnologia baropodométrica utilizada para analisar tipos de suporte de peso durante postura ortostática hemiparética

INTRODUCTION: Although baropodometric analysis has been published since the 1990s, only now it is found a considerable number of studies showing different uses in the rehabilitation. OBJECTIVE: To amplify the use of this technology, this research aimed to analyze baropodometric records during upright position of subjects with hemiparesis, describing a way to define weight-bearing profiles in this population. METHOD: 20 healthy subjects were matched by gender and age with 12 subjects with chronic spastic hemiparesis. This control group was formed to establish the limits of symmetry during weight-bearing distribution in the hemiparesis group. Next, hemiparesis group was submitted to procedures to measure baropodometric records used to provide variables related to the weight-bearing distribution, the arch index and the displacements in the center of pressure (CoP). Data were used to compare differences among kinds of weight-bearing distribution (symmetric, asymmetric toward non-paretic or paretic foot) and coordination system for CoP displacements. RESULTS: Hemiparesis group was compounded by eight symmetrics, eight asymmetrics toward non-paretic foot and four asymmetric toward paretic foot. Significant differences in the weight-bearing distributions between non-predominantly and predominantly used foot did not promote differences in the other baropodometric records (peak and mean of pressure, and support area). Mainly in the asymmetry toward non-paretic foot it was observed significant modifications of the baropodometric records. CONCLUSION: Baropodometric technology can be used to analyze weight-bearing distribution during upright position of subjects with hemiparesis, detecting different kinds of weight-bearing profiles useful to therapeutic programs and researches involving subjects with this disability.

Is it correct to always consider weight-bearing asymmetrically distributed in individuals with hemiparesis?

Injuries may cause unilateral deterioration of brain areas related to postural control resulting in lateralized motor disability with abnormal asymmetry in weight-bearing distribution. Although overloading toward the nonaffected limb has been described as the preferred posture among individuals with hemiparesis, characterization of the weight-bearing asymmetry is poorly and indirectly described. Therefore, this study aimed to describe weight-bearing distribution during upright stance, establishing criteria to consider asymmetry in hemiparesis when analyzed within the limits defined by controls matched by age and gender. Forty subjects with (n = 20) or without hemiparesis (n = 20) were included in procedures to record weight-bearing values between hemibodies, and these values were used to calculate a symmetry ratio. Control presented 95% confidence interval (CI) of the mean for symmetry ratio ranging from 0.888 to 1.072, defining limits to symmetry. Four subjects with hemiparesis (20%) had symmetry ratios inside limits defined by controls (i.e., weight-bearing symmetrically distributed), and 11 (55%) subjects without hemiparesis showed symmetry ratios outside the limits, suggesting asymmetrical weight-bearing distribution. It was concluded that asymmetry, when present in a control group, was more frequently overloading nonpredominantly used hemibody (nondominant side), differing from a hemiparesis group commonly forced to assume the nonaffected side as the predominantly used hemibody and where the overload was observed.

Reliability of the Functional Reach Test and the influence of anthropometric characteristics on test results in subjects with hemiparesis

First designed as an alternative method of assessing balance and susceptibility to falls among elderly, the Functional Reach Test (FR) has also been used among patients with hemiparesis. Then this study aimed to describe the intra- and inter-rater and the test/re-test reliability of the FR measure in subjects with and without hemiparesis while verifying anthropometric influences on the measurements. The FR was administered to a sample of subjects with hemiparesis and to a control group that was matched by gender and age. A two-way analysis of variance was used to verify the intra-rater reliability. It was calculated using the differences between the averages of the measures obtained during single, double or triple trials. The intra-class correlation coefficient (ICC) was utilized and data plotted using the Bland-Altman method. Associations were analyzed using Pearsons correlation coefficient. In general, the intra-rater analysis did not show significant differences between the measures for the single, double or triple trials. Excellent ICC values were observed, and there were no significant associations with anthropometric parameters for the hemiparesis and control subjects. FR showed good reliability for patients with and without hemiparesis and the test measurements were not significantly associated with the anthropometric characteristics of the subjects.

Comparação entre medidas de descarga, simetria e transferência de peso em indivíduos com e sem hemiparesia

Avaliacao da Simetria e Transferencia de Peso (ASTP) foi indicada para se fazer associacao entre simetria e atividades funcionais nas hemiparesias, apontando simetricos como mais capacitados. Contudo, tais relacoes nao sao claras e divergem com evidencias que sugerem assimetrias como estrategias funcionais. Assim, objetivou-se verificar se as medidas subjetivamente determinadas pela ASTP concordam com medidas calculas pela descarga de peso entre os pes. Realizou-se estudo observacional do tipo transversal para amostra de sujeitos com hemiparesia (n=20) pareados por idade e genero a controles (n=20). Os participantes submeteram-se a procedimentos para obtencao de escore determinado pela ASTP e para calculo da razao de simetria (RS) na descarga de peso entre os pes obtido por meio de duas balancas digitais. Os resultados obtidos pela ASTP identificaram apenas um sujeito com hemiparesia apresentando simetria, dentre os quatro sujeitos identificados pela RS como simetricos. Ainda, a ASTP nao diferenciou assimetrias com sobrecarga para o lado afetado e apresentou correlacao significativa somente quando os escores foram analisados com os valores de RS<1(sobrecarga para o lado nao afetado). Conclui-se que a ASTP nao foi concordante em identificar sujeitos hemipareticos com descarga de peso compativel com simetria. Ainda, nao identificou sobrecargas para o lado afetado que poderia conduzir a analises equivocadas da associacao entre simetria e desempenho funcional.