Tatiana Souza Ribeiro

Effects of treadmill inclination on the gait of children with Down syndrome

The goal of this study was to analyze the effects of upward treadmill inclination on the gait of children with Down syndrome (DS). Sixteen children with a mean age 8.43 ± 2.25 years, classified at level I of the Gross Motor Function Classification System (GMFCS) and able to walk without personal assistance and/or assistive devices/orthosis were evaluated. Spatial-temporal variables were observed as well as the angular variation of hip, knee and ankle in the sagittal plane, while children walked on the treadmill carried out on 0% and 10% upward inclination. The results showed that children with DS presented changes in spatio-temporal variables (reduced cadence and increased cycle time and swing time) and in angular variables (increased hip, knee and ankle angles at initial contact; increased maximum hip flexion and maximum stance dorsiflexion; and reduced plantarflexion at pre-swing). Treadmill inclination seemed to act positively on the angular and spatio-temporal characteristics of gait in children with DS, demonstrating a possible benefit from the use of this type of surface in the gait rehabilitation of this population.

Effects of a training program based on the Proprioceptive Neuromuscular Facilitation method on post-stroke motor recovery: A preliminary study

This preliminary study sought to analyze the effects of a training program based on the Proprioceptive Neuromuscular Facilitation (PNF) method on motor recovery of individuals with chronic post-stroke hemiparesis. Eleven individuals with chronic hemiparesis (mean lesion time of 19.64 months) after unilateral and non-recurrent stroke underwent training based on PNF method for twelve sessions, being evaluated for motor function - using the Stroke Rehabilitation Assessment of Movement (STREAM) instrument; functionality, by the Functional Independence Measure (FIM); and gait kinematic (using the Qualisys Motion Capture System), at baseline and post-training. Significant changes in FIM (from median 67 to median 68; P = .043) and STREAM scores (from median 47 to median 55; P = .003) were observed. Data showed significant changes in motor function and functionality after training, suggesting that this program can be useful for rehabilitation of chronic stroke survivors.

Immediate effects of adding mental practice to physical practice on the gait of individuals with Parkinson’s disease: Randomized clinical trial

BACKGROUND Mental practice has shown benefits in the rehabilitation of neurological patients, however, there is no evidence of immediate effects on gait of individuals with Parkinsons disease. OBJECTIVE Determine the effects of mental practice activity added to physical practice on the gait of individuals with Idiopathic Parkinsons Disease (IPD). METHODS 20 patients classified with stage 2 and 3, according to the Hoehn and Yahr scale were randomized into 2 groups. The experimental group (N = 10) was submitted to a single session of mental practice and physical practice gait protocol and the control group (N = 10) only to physical practice. The primary outcomes were stride length and total stance and swing time. Secondary outcomes were hip range of motion, velocity and mobility. Subjects were reassessed 10 minutes, 1 day and 7 days after the end of the session. RESULTS There was no statistically significant difference between the groups. An intragroup difference was observed in velocity, stride length, hip range of motion, and mobility, as well as total stance and swing time. These results were also observed on follow-ups. CONCLUSIONS Mental practice did not have a greater effect on the gait of individuals with IPD than physical practice, after a single session.

Does dual task walking affect gait symmetry in individuals with Parkinson’s disease?

Abstract Purpose: To investigate if dual task walking (DTW) alters spatiotemporal and angular symmetry of lower limbs of individuals with Parkinson’s disease. Material and methods: Kinematic gait data of 22 volunteers (aged 40–75 years) with moderate Parkinson’s disease (Modified Hoehn and Yahr scale 2–3) were collected. Participants were evaluated while walking at a maximum speed, without a secondary task (usual walking - UW) and performing a cognitive task often referred to as DTW. Spatiotemporal index for gait asymmetry and angular gait variables of hip, knee and ankle were assessed in both limbs. Results: Spatiotemporal index showed asymmetry in both conditions, with no difference in the degree of asymmetry between the two conditions (p = .136). Angular variables showed no significant interaction TASK x MEMBER, indicating that angular differences between right and left legs do not exist, in UW and in DTW. Conclusion: Spatiotemporal asymmetry in DTW seems to be similar to the UW and no greater angular asymmetry seems to occur during this type of dual task. These results suggest that both assessments and gait treatments could be done in DTW condition, without significantly compromising the gait symmetry of individuals with moderate Parkinson’s disease.

Effects of constraint-induced movement therapy for lower limbs on measurements of functional mobility and postural balance in subjects with stroke: a randomized controlled trial*

Abstrato Background: Constraint-induced movement therapy (CIMT) is suggested to reduce functional asymmetry between the upper limbs after stroke. However, there are few studies about CIMT for lower limbs. Objective: To examine the effects of CIMT for lower limbs on functional mobility and postural balance in subjects with stroke. Methods: A 40-day follow-up, single-blind randomized controlled trial was performed with 38 subacute stroke patients (mean of 4.5 months post-stroke). Participants were randomized into: treadmill training with load to restraint the non-paretic ankle (experimental group) or treadmill training without load (control group). Both groups performing daily training for two consecutive weeks (nine sessions) and performed home-based exercises during this period. As outcome measures, postural balance (Berg Balance Scale – BBS) and functional mobility (Timed Up and Go test – TUG and kinematic parameters of turning – Qualisys System of movement analysis) were obtained at baseline, mid-training, post-training and follow-up. Results: Repeated-measures ANOVA showed improvements after training in postural balance (BBS: F = 39.39, P < .001) and functional mobility, showed by TUG (F = 18.33, P < .001) and by kinematic turning parameters (turn speed: F = 35.13, P < .001; stride length: F = 29.71, P < .001; stride time: F = 13.42, P < .001). All these improvements were observed in both groups and maintained in follow-up. Conclusions: These results suggest that two weeks of treadmill gait training associated to home-based exercises can be effective to improve postural balance and functional mobility in subacute stroke patients. However, the load addition was not a differential factor in intervention.

Is there influence of the load addition during treadmill training on cardiovascular parameters and gait performance in patients with stroke? A randomized clinical trial

BACKGROUND Although exercises involving both lower limbs are indicated for aerobic training, stroke patients have shown expressive asymmetry between the paretic and non-paretic lower limb (NPLL). Performing activities that stimulate the paretic limb during aerobic exercise may optimize training results. OBJECTIVE To evaluate if there is influence of load addition on NPLL during treadmill training on cardiovascular parameters and gait performance of subacute stroke patients. METHODS Thirty-eight stroke subjects with gait deficits were randomized into experimental group, which underwent treadmill training with a mass attached on NPLL, and control group, which underwent only treadmill training. Interventions lasted 2 weeks (9 sessions). Main outcomes were heart rate, arterial blood pressure, gait speed and distance covered. Assessments occurred at rest, 10th and 20th minutes of the session and immediately after each session. RESULTS There was improvement in speed and walking distance in both groups. All cardiovascular parameters had showed no changes compared to 1st and 9th sessions and there were no differences between groups within each session. CONCLUSIONS Load addition on NPLL did not alter cardiovascular parameters and gait training provide better gait performance of subacute stroke patients, which indicates this therapy can be considered useful and safe for these patients.

Effects of treadmill training with load addition on non-paretic lower limb on gait parameters after stroke: A randomized controlled clinical trial

The addition of load on the non-paretic lower limb for the purpose of restraining this limb and stimulating the use of the paretic limb has been suggested to improve hemiparetic gait. However, the results are conflicting and only short-term effects have been observed. This study aims to investigate the effects of adding load on non-paretic lower limb during treadmill gait training as a multisession intervention on kinematic gait parameters after stroke. With this aim, 38 subacute stroke patients (mean time since stroke: 4.5 months) were randomly divided into two groups: treadmill training with load (equivalent to 5% of body weight) on the non-paretic ankle (experimental group) and treadmill training without load (control group). Both groups performed treadmill training during 30min per day, for two consecutive weeks (nine sessions). Spatiotemporal and angular gait parameters were assessed by a motion system analysis at baseline, post-training (at the end of 9days of interventions) and follow-up (40days after the end of interventions). Several post-training effects were demonstrated: patients walked faster and with longer paretic and non-paretic steps compared to baseline, and maintained these gains at follow-up. In addition, patients exhibited greater hip and knee joint excursion in both limbs at post-training, while maintaining most of these benefits at follow-up. All these improvements were observed in both groups. Although the proposal gait training program has provided better gait parameters for these subacute stroke patients, our data indicate that load addition used as a restraint may not provide additional benefits to gait training.