Soraia Micaela Silva

Evaluation of post-stroke functionality based on the International Classification of Functioning, Disability, and Health: a proposal for use of assessment tools

This study aimed to identify the International Classification of Functioning, Disability, and Health categories addressed by the assessment tools commonly used in post-stroke rehabilitation and characterize patients based on its evaluation model. [Subjects and Methods] An exploratory, descriptive, cross-sectional study was conducted involving 35 individuals with chronic post-stroke hemiparesis. Handgrip strength was assessed to evaluate body functions and structures. The 10-meter gait speed test and Timed Up and Go test were administered to evaluate activity. The Stroke Specific Quality of Life scale was used to evaluate participation. Moreover, a systematic review of the literature was performed to identify studies that have associated these assessment tools with the International Classification of Functioning, Disability, and Health categories. [Results] The tools employed in this study for evaluating function addressed 63 International Classification of Functioning, Disability, and Health categories: 24 related to body functions and structures; 36 related to activity and participation; and 3 related to environmental factors. [Conclusion] The assessment tools employed in this study addressed 63 International Classification of Functioning, Disability, and Health categories and allowed a more complete evaluation of stroke survivors with hemiparesis. Use of this classification can therefore be more easily incorporated into clinical practice.

Impact of depression following a stroke on the participation component of the International Classification of Functioning, Disability and Health

AbstractPurpose: To assess the impact of post-stroke depression on the participation component of the International Classification of Functioning, Disability and Health (ICF).Method: Thirty-five stroke survivors with chronic hemiparesis were divided into two groups: those with and without depression. The Geriatric Depression Scale (GDS) was used for the analysis of depressive symptoms. Participation was analysed using the Stroke Specific Quality of Life scale. The Mann–Whitney test was used to compare the participation scores between the two groups. Spearman’s correlation coefficients were calculated to determine the strength of the association between the assessment tools. Simple linear regression was used to determine the impact of depression on participation. An alpha risk of 0.05 was considered indicative of statistical significance.Results: The group with depression had low participation scores (p = 0.04). A statistically significant negative correlation of moderate magnitude was found between depres...Abstract Purpose: To assess the impact of post-stroke depression on the participation component of the International Classification of Functioning, Disability and Health (ICF). Method: Thirty-five stroke survivors with chronic hemiparesis were divided into two groups: those with and without depression. The Geriatric Depression Scale (GDS) was used for the analysis of depressive symptoms. Participation was analysed using the Stroke Specific Quality of Life scale. The Mann–Whitney test was used to compare the participation scores between the two groups. Spearman’s correlation coefficients were calculated to determine the strength of the association between the assessment tools. Simple linear regression was used to determine the impact of depression on participation. An alpha risk of 0.05 was considered indicative of statistical significance. Results: The group with depression had low participation scores (p = 0.04). A statistically significant negative correlation of moderate magnitude was found between depression and participation (r =  −0.6; p  = 0.04). The linear regression model demonstrated that depression is a moderate predictor of participation (r2 = 0.51; p = 0.001). Conclusions: Depression is a moderate predictor of participation among stroke survivors, explaining 51% of the decline of this aspect. Thus, depression should be diagnosed, monitored and treated to ensure a better prognosis regarding social participation following a stroke. Implications for Rehabilitation Individuals with post-stroke depression experience a lower degree of social participation. Depression explains 51% of the decline in participation following a stroke. The present findings can serve as a basis to assist healthcare professionals involved in the rehabilitation of stroke survivors and can assist in the establishment of adequate treatment plans in stroke rehabilitation.

Impact in oral health and the prevalence of temporomandibular disorder in individuals with Parkinson's disease

The aims of the present study were to investigate the prevalence of temporomandibular disorder (TMD) in a group of patients with Parkinson’s disease (PD), and to analyze oral health according to the severity of the disease. [Methods] Signs and symptoms of TMD were evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders, and oral health impact was measured using the Oral Health Impact Profile. The unpaired Student’s t-test was used to compare groups with and without TMD. Pearson’s correlation coefficients were calculated to determine correlations between the level of functional independence and oral health impact. Fisher’s exact test was used to test the association between TMD and the severity of symptoms of PD. [Results] Fifty-nine individuals with PD were analyzed. The prevalence of TMD was 20.33%. No statistically significant associations were found between TMD and the severity of PD. Oral health impact was considered weak, but a statistically significant difference between groups with and without TMD was found for psychological disability (p = 0.003). No significant correlation was found between the level of functional independence and oral health impact. [Conclusion] The prevalence of TMD among patients with Parkinson’s disease was 20.33%. A statistically significant difference between groups with and without TMD was found regarding the psychological disability domain.

Reproducibility of the items on the Stroke Specific Quality of Life questionnaire that evaluate the participation component of the International Classification of Functioning, Disability and Health.

Abstract Purpose: To evaluate the reproducibility of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the International Classification of Functioning, Disability and Health (ICF) and analyse the correlation between the subscore of these 26 items and the total SS-QOL score. Methods: Seventy-five stroke survivors participated in this study. Reproducibility was evaluated using the intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimum detectable change (MDC) and the Bland–Altman plot. The correlation between the subscore of the 26 items and the total SS-QOL score was analysed using Spearman’s correlation coefficients (rho) and simple linear regression. An alpha risk ≤ 0.05 was considered for all analyses. Results: The SS-QOL items that address the participation component of the ICF demonstrated excellent reliability (intra-rater ICC2,1 = 0.96; inter-rater ICC2,1 = 0.95). The SEM and MDC were adequate. The Bland–Altman plot demonstrated satisfactory agreement. A significant and strong correlation (rho = 0.83) was found between the 26 SS-QOL items that address participation and the total SS-QOL score. Moreover, the evaluation of participation was found to explain 73% of the evaluation of health-related quality of life. Conclusion: The 26 SS-QOL items that address the participation component of the ICF demonstrated adequate reproducibility. Thus, participation, which represents the social aspects of functionality, can be adequately evaluated with these items. Implications for Rehabilitation The 26 Stroke Specific Quality of Life items that address participation proved to be reproducible for the analysis of social participation following a stroke. The findings can lead to a better understanding of the social participation of individuals with chronic hemiparesis and assist in the establishment of adequate treatment for such individuals. The rehabilitation process can be directed towards more specific goals focused on the patient expectations, thereby contributing to greater humanization and effectiveness of treatment to improve social participation following a stroke.

Computerized analysis of the distribution of occlusal contacts in individuals with Parkinson's disease and temporomandibular disorder

Objectives: The aims of the present study were to determine the prevalence of temporomandibular disorder (TMD) in a sample of patients with Parkinsons disease (PD) and to analyze the distribution of occlusal contacts. Method: The sample was composed of patients with PD aged 50–75 years. Temporomandibular disorder was evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The distribution of occlusal contacts was determined using the portable T-Scan III® occlusal analysis system during maximum voluntary clenching. Fishers exact test was used to test the association between TMD and occlusal contact symmetry. Results: Forty-two individuals with PD were analyzed. The prevalence of TMD was 23.8%. No statistically significant association was found between TMD and occlusal contact symmetry. Moreover, no significant difference in the distribution of occlusal contacts was found between the groups with and without TMD. Discussion: The present data suggest no association between TMD and occlusal contact asymmetry in individuals with PD. Conclusion: The results of this study identified a prevalence of 23.8% of TMD signs in subjects with PD and a high frequency of occlusal asymmetry in this sample.

Social participation following a stroke: an assessment in accordance with the international classification of functioning, disability and health

Abstract Objective: Evaluate, code and qualify the participation of Brazilian stroke survivors based on the international classification of functioning, disability and health (ICF) and identify predictors of post-stroke participation. Methods: An exploratory, observational, cross-sectional study was conducted involving 78 individuals with hemiparesis stemming from a stroke. The stroke specific quality of life (SS-QOL) was used to evaluate the participation component of the ICF. The geriatric depression scale was used to screen depressive symptoms; the functional independence measure (FIM) was used to measure the degree of dependence; grip strength was determined using a dynamometer; and cognitive status was evaluated using the mini mental state examination. The one-way analysis of variance followed by the Bonferroni test was used for the comparison the participation scores of different groups (age and marital status). The independent t-test was used for the comparisons of the other groups (sex, time since the occurrence of stroke (<12 months or >12 months) and degree of functional independence). Multiple linear regression was employed to identify measures capable of predicting participation. Results: Based on the classification and qualifiers of the ICF, the individuals analyzed exhibited a moderate level of participation. Participation was significantly associated with time since the occurrence of stroke (F = 2.46; 95% confidence interval (CI) = −23.67–0.34; p = 0.05), degree of functional independence (F = 2.40; 95% CI = −33.0 to −18.93; p < 0.001) and marital status (married or widowed) (F = 2.6; p = 0.05). No statistically significant associations were found with regard to age, sex or affected side of the body. Functional independence was the main predictor of participation (F = 99.2; r2 = 0.57; p <0.001) and the occurrence of depressive symptoms was a moderate predictor (F =12.78; r2 = 0.40; p = 0.001). Conclusions: Twenty-four ICF categories were coded and qualified with the use of the SS-QOL, enabling the participation component of the ICF biopsychosocial model to be easily evaluated in clinical practice. Overall, the sample in the present study demonstrated a moderate decline in participation following a stroke and only the “social roles” domain was severely affected. The FIM was the main predictor of participation and the depression was a moderate predictor. Therefore, health professionals involved in the rehabilitation of these patients should focus on the promotion of functional independence and improvements in emotional health to optimize social participation following a stroke. Implications for Rehabilitation The Brazilian stroke individuals analyzed exhibited a moderate level of participation. Functional independence was the main predictor of participation and the occurrence of depressive symptoms was a moderate predictor. Age, sex and affected side of the body were not predictors of participation. Our findings support that twenty-four International classification of functioning, disability and health categories were coded and qualified with the use of the stroke specific quality of life. Rehabilitation of social functioning post stroke patients should be focused on the promotion of functional independence and improvement in emotional health. This study offers a participation assessment model that can facilitate the incorporation of the ICF in the clinical practice.

Comparação da força muscular respiratória entre idosos após acidente vascular cerebral

A diminuicao do recolhimento elastico dos pulmoes e da complacencia da caixa toracica sao uma das principais mudancas no sistema respiratorio com o avancar da idade, quando essas alteracoes estao associadas as manifestacoes clinicas subjacentes ao Acidente Vascular Cerebral (AVC), a forca muscular respiratoria dos idosos pode ser gravemente afetada, portanto, faz-se necessario investigar as condicoes da forca muscular respiratoria de hemipareticos idosos tanto em fase aguda como cronica. Objetivo: Comparar a forca muscular respiratoria de idosos hemipareticos em fase aguda e cronica apos AVC, avaliadas por meio dos valores das pressoes respiratorias maximas, para que assim, a reabilitacao desses individuos seja mais orientada. Metodo: Foram avaliados 29 individuos hemipareticos, 17 em fase aguda e 12 em fase cronica, os valores da pressao inspiratoria maxima (PImax) e pressao expiratoria maxima (PEmax) coletados por meio de um manovacuometro. Resultados: Nao houve diferenca entre a fase aguda e cronica, no entanto, as medidas de PImax e PEmax apresentaram diminuicao estatisticamente significante quando comparadas ao valores preditos. Conclusao: Nao houve diferenca da forca muscular respiratoria entre as fases aguda e cronica, no entanto, a PImax e PEmax apresentou-se diminuida em todos os individuos avaliados, isto sugere fraqueza semelhante da musculatura respiratoria em ambas as fases apos AVC, e este quadro pode ser agravado pelo processo de senescencia. Sugere-se que seja abordado um programa de treinamento da musculatura respiratoria desses individuos para melhor reabilitacao apos AVC.

Immediate effect of transcranial direct current stimulation combined with functional electrical stimulation on activity of the tibialis anterior muscle and balance of individuals with hemiparesis stemming from a stroke

[Purpose] The aim of the present study was to evaluate the immediate effects of transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) on activity of the tibialis anterior muscle (TA) and static balance of individuals with hemiparesis stemming from stroke. [Subjects and Methods] A randomized, double-blind, crossover, clinical trial conducted with 30 individuals with chronic post-stroke hemiparesis. Median frequency of electrical activity of the TA were determined using electromyography in five contractions concentrics and Static balance (body sway velocity and frequency), both before and immediately after the intervention. The participants were submitted to four 20-minute intervention protocols with 48-hour interval: anodal tDCS + sham FES; sham tDCS + active FES; anodal tDCS + active FES and sham tDCS + sham FES. Anodal tDCS was administered over C3 or C4, the cathode was positioned in the supraorbital region on the contralateral side and FES was administered to the affected TA. [Results] No significant differences among the protocols were found regarding electrical activity of the TA and static balance. [Conclusion] The results demonstrate that tDCS alone or in combination with FES had no immediate effect on electrical activity of the TA and static balance of the 30 individuals analyzed.