Rodrigo José Knabben

Tradução, adaptação e confiabilidade interexaminadores do manual de administração da escala de Fugl-Meyer

BACKGROUND Recently, the reliability of the Brazilian version of the Fugl-Meyer Assessment (FMA) was assessed through the scoring given according to observations made by a single evaluator who applied the test. When different raters apply the scale, the reliability may depend on the interpretation given to the assessment sheet. In such cases, a clear administration manual is essential for ensuring homogeneity of application. OBJECTIVES To translate and adapt the French Canadian version of the FMA administration manual into Brazilian Portuguese and to evaluate the inter-rater reliability when different evaluators apply the FMA on the basis of the information contained in the manual. METHODS Eighteen adults (59±10 years) with chronic hemiparesis (38±35 months after a stroke) took part in this study. Eight patients participated in the first part of the study and 10 in the second part. Based on analyzing the results from part 1, an adapted version was developed, in which information and photos were added to illustrate the positions of the patient and evaluator. The inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). RESULTS The reliability of the FMA based on the adapted version of the manual was excellent for the total motor scores for the upper limbs (ICC=0.98) and lower limbs (ICC=0.90), as well as for movement sense (ICC=0.98) and upper and lower-limb passive range of motion (ICC=0.84 and 0.90, respectively). The reliability was moderate for tactile sensitivity (0.75). The joint pain assessment presented low reliability. CONCLUSIONS The results showed that, except for pain assessment, application of the FMA based on the adapted version of the application manual for Brazilian Portuguese presented adequate inter-rater reliability.

Non-paretic lower limb constraint with a step decreases the asymmetry of vertical forces during sit-to-stand at two seat heights in subjects with hemiparesis.

This study investigated the effects of non-paretic leg constraint by a step, combined with two different seat heights, on weight-bearing on the paretic leg and reduction of asymmetry during STS. Thirteen adult subjects (60.4 ± 5.7 years) were selected, with chronic hemiparesis (43.7 ± 50 months) due to stroke. Two force plates were used to analyze the vertical force (Fz) in the standing position and during STS. Individuals were instructed to rise from an instrumented bench at two seat heights, 100% (normal) and 130% (elevated) of knee height with four foot positions: (1) spontaneous (SPO); (2) symmetrical (SYM); (3) asymmetrical (ASY; non-paretic limb in front of paretic); and (4) step (STP; non-paretic limb supported on a step and paretic at ground level). A reduction of asymmetry occurred during STS movement when the non-paretic leg was constrained by a step compared with positions SPO (p<0.001), SYM (p<0.001) and ASY (p=0.02) at the normal seat level. Raising seat height to 130% increased asymmetry in the SPO condition (p=0.01); however, this effect was reversed in the ASY and STP conditions. Constraint of the non-paretic leg by a step is presented as a potential therapeutic route to a less asymmetrical STS. Together with a higher seat level this can benefit the training of individuals with hemiparesis unable to keep the paretic foot backward during STS from a standard seat height.

A produção de conhecimento em fisioterapia: análise de periódicos nacionais (1996 a 2009)

INTRODUCTION: To evaluate the production of knowledge from one area may facilitate the understanding of their identity as well as pointing out which direction is traveling. OBJECTIVE: To determine which area of studies and greater occurrence of descriptors in articles published in magazines at physiotherapy in periodicals of national circulation. METHOD: This is a documental research with a qualitative approach through content analysis. We included abstracts from journals of physiotherapy Brazilians, ranked higher or equal to B2 in WebQualis and free access to the website. With these criteria was selected: Brazilian Journal of Physical Therapy and Physical Therapy in Movement, from 1996 to 2009. The items discussed were: keywords and study area. We used the program to count words TextStat. RESULTS: We analyzed 726 articles. Areas of study occurred more frequently orthopedics, neurology, pulmonology and pediatrics, which together comprise 65% of production in physical therapy, and orthopedics, alone accounts for 36% of the studies. In relation to the keyword, the prevalence was highest descriptor physiotherapy, followed by elderly and physical activity. Discussion: As for area studies, especially considering the practice of orthopedics physical therapist that has historically focused on hospitals and rehabilitation clinics under the supervision of the orthopedic doctors and seeking its independence a second time. In relation to the descriptors, the highest frequency of the word therapy should be reassessed by the researchers, because it reflects the content of studies. CONCLUSION: The scientific production in orthopedics was more frequent, reflecting the largest professional performance.

Postural control in blind subjects

OBJECTIVE To analyze postural control in acquired and congenitally blind adults. METHODS A total of 40 visually impaired adults participated in the research, divided into 2 groups, 20 with acquired blindness and 20 with congenital blindness - 21 males and 19 females, mean age 35.8 ± 10.8. The Brazilian version of Berg Balance Scale and the motor domain of functional independence measure were utilized. RESULTS On Berg Balance Scale the mean for acquired blindness was 54.0 ± 2.4 and 54.4 ± 2.5 for congenitally blind subjects; on functional independence measure the mean for acquired blind group was 87.1 ± 4.8 and 87.3 ± 2.3 for congenitally blind group. CONCLUSION Based upon the scale used the results suggest the ability to control posture can be developed by compensatory mechanisms and it is not affected by visual loss in congenitally and acquired blindness.

Análise do controle postural em deficientes visuais

Objective: To analyze postural control in acquired and congenitally blind adults. Methods: A total of 40 visually impaired adults participated in the research, divided into 2 groups, 20 with acquired blindness and 20 with congenital blindness - 21 males and 19 females, mean age 35.8 ± 10.8. The Brazilian version of Berg Balance Scale and the motor domain of functional independence measure were utilized. Results: On Berg Balance Scale the mean for acquired blindness was 54.0 ± 2.4 and 54.4 ± 2.5 for congenitally blind subjects; on functional independence measure the mean for acquired blindness group was 87.1 ± 4.8 and 87.3 ± 2.3 for congenitally blind group. Conclusion: Based upon the scale used the results suggest the ability to control posture can be developed by compensatory mechanisms and it is not affected by visual loss in congenitally and acquired blindness. Objetivo: Analisar o controle postural de individuos adultos com cegueira completa congenita e adquirida. Metodos: Fizeram parte da pesquisa 40 sujeitos, divididos em 2 grupos (20 com deficiencia visual adquirida e 20 com deficiencia visual congenita - 21 homens e 19 mulheres, media de idade 35,8 ± 10,8). Os instrumentos utilizados foram a versao brasileira da Escala de Equilibrio de Berg e o dominio motor da medida de independencia funcional. Resultados: Na Escala de Equilibrio de Berg a media do grupo com deficiencia visual adquirida foi 54,0 ± 2,4 e no grupo com deficiencia visual congenita foi 54,4 ± 2,5; na medida de independencia funcional a media do grupo com deficiencia visual adquirida foi 87,1 ± 4,8 e no grupo com deficiencia visual congenita foi 87,3 ± 2,3. Conclusao: Baseado no instrumento utilizado, os resultados sugerem que a habilidade de controlar a postura pode ser adquirida por meio de mecanismos compensatorios, nao sendo afetada pela perda visual em cegos congenitos e adquiridos.