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Objective To investigate the relation between gait parameters and cognitive impairments in subjects with Parkinson’s disease (PD) and Alzheimer’s disease (AD) during the performance of dual tasks. Methods This was a cross-sectional study involving 126 subjects divided into three groups: Parkinson group (n = 43), Alzheimer group (n = 38), and control group (n = 45). The subjects were evaluated using the Timed Up and Go test administered with motor and cognitive distracters. Gait analyses consisted of cadence and speed measurements, with cognitive functions being assessed by the Brief Cognitive Screening Battery and the Clock Drawing Test. Statistical procedures included mixed-design analyses of variance to observe the gait patterns between groups and tasks and the linear regression model to investigate the influence of cognitive functions in this process. A 5% significant level was adopted. Results Regarding the subjects’ speed, the data show a significant difference between group vs task interaction (p = 0.009), with worse performance of subjects with PD in motor dual task and of subjects with AD in cognitive dual task. With respect to cadence, no statistical differences was seen between group vs task interaction (p = 0.105), showing low interference of the clinical conditions on such parameter. The linear regression model showed that up to 45.79%, of the variance in gait can be explained by the interference of cognitive processes. Conclusion Dual task activities affect gait pattern in subjects with PD and AD. Differences between groups reflect peculiarities of each disease and show a direct interference of cognitive processes on complex tasks. .

Objetivo Investigar a relação entre parâmetros da marcha e comprometimento cognitivo em sujeitos com doença de Parkinson (DP) e doença de Alzheimer (DA) durante tarefas duplas. Métodos Este estudo consistiu em uma pesquisa transversal envolvendo 126 sujeitos, divididos em três grupos: grupo Parkinson (n = 43), grupo Alzheimer (n = 38) e grupo controle (n = 45). Os sujeitos foram submetidos ao teste Timed Up and Go, administrado com distrator motor e cognitivo. Os parâmetros analisados na marcha foram cadência e velocidade, tendo as funções cognitivas avaliadas por meio da Bateria Breve de Rastreio Cognitivo e do Teste do Desenho do Relógio. Os procedimentos estatísticos incluíram a análise mista de variâncias para observar os padrões da marcha nos grupos e nas tarefas e o modelo de regressão linear para investigar a influência das funções cognitivas nesse processo. O nível de significância foi estipulado em 5%. Resultados Em relação à velocidade, os dados vislumbram diferença significativa na interação grupo vs. tarefa (p = 0,009), com pior rendimento dos sujeitos com DP na dupla tarefa motora e dos com DA na situação de dupla tarefa cognitiva. Sobre a cadência, os resultados não apontaram diferença significativa na interação grupo vs. tarefa (p = 0,105), vislumbrando pouca interferência das condições clínicas sobre esse parâmetro. O modelo de regressão linear demonstrou que até 45.79% da variação nos parâmetros da marcha podem ser explicados por processos cognitivos. Conclusão Atividades de dupla tarefa afetam a marcha de sujeitos com DA e DP. A diferença entre grupos reflete peculiaridades de cada doença e demonstra interferência direta de processos cognitivos em atividades complexas. .

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BACKGROUND: Patients with neurodegenerative diseases usually experience significant functional deficits. Older adults with Parkinson's disease (PD) and Alzheimer's disease (AD) may suffer from both motor and cognitive impairments, making them especially vulnerable to poor dual-task performance. OBJECTIVE: To analyze the dual-task cost of walking in subjects with PD and AD exposed to motor and cognitive distracters. METHODS: A cross-sectional study was conducted involving 126 older adults comprising three groups: PD (n=43), AD (n=38), and control (n=45). The subjects were evaluated using the Timed Up and Go (TUG) test administered with motor and cognitive distracters. Mixed-design analysis of variance (ANOVA) with cognition as a covariant factor was used to test the possible main effects of dual-task on motion. A 5% threshold for significance was set, with a 95% confidence interval (CI). The partial eta square (n(2)p) analysis was included to estimate the magnitude of effect. RESULTS: Examining the effects for dual-task, ANOVA revealed the main effect for group×task interactions (F=13.09; P=0.001; n(2)p =0.178), for task (F=8.186; P=0.001; n(2)p =0.063) but not for group (F=2.954; P=0.056; n(2)p =0.047). Cognition applied as a covariant factor indicated interference on dual-tasks (F=30.43; P=0.001; n(2)p =0.201). CONCLUSION: The findings of this study suggest that dual-task interference is a particularly noticeable problem in PD and AD, affecting subjects' ability to appropriately adapt to environmental challenges.

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BACKGROUND: Persons with stroke commonly have serious sequelae requiring long-term medical treatment. They often experience distress, and thus improving quality of life (QOL) has been considered a therapeutic objective in addition to prolonging the patient's life. OBJECTIVE: The aim of this study was to analyze the impact of horseback riding therapy (HBRT) on the QOL of individuals with hemiparesis after stroke. METHODS: In this single-blind, randomized, controlled trial, 24 poststroke patients were assigned to the experimental (n = 12) and control (n = 12) groups. The control group participated in a conventional physiotherapy program, whereas the experimental group participated in physiotherapy plus HBRT sessions for 16 weeks. The patients were evaluated by means of the Medical Outcomes Study 36-item Short-Form health survey (SF-36). Data analysis was applied through the use of descriptive and inferential statistics, with a 5% level of significance. RESULTS: Significant improvement was observed in the total score of the SF-36 in the experimental group when compared with the control group. The combination of conventional physiotherapy and HBRT was associated with improvements in functional capacity (P = .02), physical aspects (P = .001), and mental health (P = .04) of the stroke patients. CONCLUSIONS: Supplementation of conventional physiotherapy with HBRT, applied in different contexts, may yield positive QOL outcomes for people with stroke. We recommend that further studies be carried out to clarify the benefits of HBRT applied singly.

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OBJETIVO: Verificar a eficácia de uma intervenção cognitivo-motora sobre os sintomas depressivos de pacientes com DP idiopática. MÉTODOS: Foi realizado um estudo longitudinal, composto por 26 pacientes, divididos entre os grupos experimental e controle. Os sujeitos foram avaliados pela Escala de Depressão Geriátrica, sendo o grupo experimental submetido a uma sequência de exercícios fisioterápicos de estimulação cognitivo-motora durante seis meses. Para a análise dos dados, foram aplicados os testes de Análise de Variâncias para medidas repetidas, a estatística por contraste e o teste t de Student para amostras independentes, sob um nível de significância de 5%. RESULTADOS: Os resultados apontaram homogeneidade dos grupos no momento inicial, e o grupo submetido ao tratamento fisioterápico obteve uma tendência de significância na interação "momento de intervenção" versus "grupo", evidenciado pelo erro alfa de 6%, com contraste linear de dados. CONCLUSÃO: O protocolo proposto apresentou boa aceitação pelos pacientes com DP. Apesar de não termos alcançado um intervalo de confiança de 95%, a tendência de significância obtida vislumbra um potencial do referido protocolo, mas com a necessidade de maiores estudos comprobatórios.

OBJECTIVE: To verify the effectiveness of a cognitive-motor intervention on depressive symptoms in idiopathic PD patients. METHODS: This longitudinal design study assessed 26 patients, divided into experimental and control groups. The subjects were evaluated by means of the Geriatric Depression Scale, being, the experimental group, submitted to a six-month protocol of physiotherapeutic exercises on motor and cognitive functions. With respect to the data analysis, were applied the Repeated Measure Analysis of Variance, the contrast statistic and the Student-t test for independent samples, with a significant level of 5%. RESULTS: The results showed homogeneity of the groups at baseline and the experimental group achieved a trend of significance in the interaction "moment of intervention versus group", as evidenced by the alpha error of 6% with a linear contrast data curve. Conclusion: The proposed protocol has been well accepted by patients diagnosed with idiopathic PD. Although we couldn't contemplate an interval of confidence of 95%, the significant trend obtained represents a potential of this protocol, but with a need of further corroborative studies.

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INTRODUCTION: A significant benefit from physical activity has recently been described in some patients who suffer from neurodegenerative diseases. OBJECTIVE: To assess the effects of physical activity on neuropsychiatric disturbances in demented patients and on the mental burden of their caregivers. METHODS: Assisted by a public geriatric psychiatry clinical unit, we studied 59 patients with dementia. Patients were divided into three groups according to their diagnosis and level of physical activity. Data were assessed through a semi-structured interview. Patients were evaluated with the Neuropsychiatric Inventory, the Mini-Sleep Questionnaire and the Baecke Questionnaire. The data were statistically analyzed using the Mann-Whitney U test and linear regression, with the level of significance set at 5%. RESULTS: Patients with Alzheimer's or vascular dementia who engaged in physical activity had fewer neuropsychiatric symptoms than those who did not. When compared to the control group, the caregivers of patients with vascular dementia who engaged in physical activity had a reduced burden. CONCLUSION: The regular practice of physical activity seems to contribute to a reduction in neuropsychiatric symptoms in dementia patients and to attenuate the burden of the caregivers of those patients.

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INTRODUCTION: A significant benefit from physical activity has recently been described in some patients who suffer from neurodegenerative diseases. OBJECTIVE: To assess the effects of physical activity on neuropsychiatric disturbances in demented patients and on the mental burden of their caregivers. METHODS: Assisted by a public geriatric psychiatry clinical unit, we studied 59 patients with dementia. Patients were divided into three groups according to their diagnosis and level of physical activity. Data were assessed through a semi-structured interview. Patients were evaluated with the Neuropsychiatric Inventory, the Mini-Sleep Questionnaire and the Baecke Questionnaire. The data were statistically analyzed using the Mann-Whitney U test and linear regression, with the level of significance set at 5 percent. RESULTS: Patients with Alzheimer's or vascular dementia who engaged in physical activity had fewer neuropsychiatric symptoms than those who did not. When compared to the control group, the caregivers of patients with vascular dementia who engaged in physical activity had a reduced burden. CONCLUSION: The regular practice of physical activity seems to contribute to a reduction in neuropsychiatric symptoms in dementia patients and to attenuate the burden of the caregivers of those patients.

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OBJECTIVE: To evaluate the hippotherapy influence on gait training in post-stroke hemiparetic individuals. METHOD: The study was constituted of 20 individuals divided into two groups. Group A performed the conventional treatment while group B the conventional treatment along with hippotherapy during 16 weeks. The patients were evaluated by using the Functional Ambulation Category Scale, Fugl-Meyer Scale, only the lower limbs and balance sub items, Berg Balance Scale, and functional assessment of gait (cadence) in the beginning and end of the treatment. RESULTS: Significant improvements were observed in the experimental group including motor impairment in lower limbs (p=0.004), balance, over time (p=0.007) but a significant trend between groups (p=0.056). The gait independence, cadence and speed were not significantly in both groups (p=0.93, 0.69 and 0.44). CONCLUSION: Hippotherapy associated with conventional physical therapy demonstrates a positive influence in gait training, besides bringing the patients' gait standard closer to normality than the control group.

OBJETIVO: Avaliar a influência da hipoterapia no treino de marcha em indivíduos hemiparético pós-AVC. MÉTODO: O estudo constou de 20 indivíduos divididos em dois grupos (A e B); o grupo A realizou tratamento convencional e o grupo B, tratamento convencional e hipoterapia, durante 16 semanas. Os pacientes foram avaliados pela Escala de Fugl-Meyer, Escala de Equilíbrio de Berg, Escala de Deambulação Funcional e a Cadência, no início e no final do tratamento. RESULTADOS: Melhoras significativas foram observadas no grupo experimental incluindo comprometimento motor em membros inferiores (p-valor=0,004), o equilíbrio, em relação ao tempo (p-valor=0,007) porém uma tendência significância entre os grupos (p=0,056). A independência na marcha, cadência e a velocidade não apresentaram relevância estatística em ambos os grupos (p-valor=0,93, 0,69 e 0,44). CONCLUSÃO: A Hipoterapia associada ao tratamento convencional mostra ter influência no treino de marcha, além de tornar o padrão de marcha dos pacientes mais próximo da normalidade em relação ao grupo controle.

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OBJECTIVE: To evaluate the hippotherapy influence on gait training in post-stroke hemiparetic individuals. METHOD: The study was constituted of 20 individuals divided into two groups. Group A performed the conventional treatment while group B the conventional treatment along with hippotherapy during 16 weeks. The patients were evaluated by using the Functional Ambulation Category Scale, Fugl-Meyer Scale, only the lower limbs and balance sub items, Berg Balance Scale, and functional assessment of gait (cadence) in the beginning and end of the treatment. RESULTS: Significant improvements were observed in the experimental group including motor impairment in lower limbs (p=0.004), balance, over time (p=0.007) but a significant trend between groups (p=0.056). The gait independence, cadence and speed were not significantly in both groups (p=0.93, 0.69 and 0.44). CONCLUSION: Hippotherapy associated with conventional physical therapy demonstrates a positive influence in gait training, besides bringing the patients' gait standard closer to normality than the control group.

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Introdução: A reaquisição do controle de tronco foi identificada como importante fator para eficiência das atividades da vida diária na hemiplegia secundária ao acidente vascular encefálico, contudo, a literatura concentra-se pouco na avaliação do tronco nesta população. Não existem escalas funcionais validadas no Brasil para mensurar a seletividade muscular de tronco na hemiparesia. Objetivo: Analisar a confiabilidade interexaminador, consistência interna e validade construtiva da versão Brasileira da Trunk Impairment Scale (TIS) - Escala de Deficiências de Tronco (EDT) na hemiparesia após AVE. Materiais e Métodos: Vinte e seis hemiparéticos foram avaliados por dois examinadores no Ambulatório de Fisioterapia e Terapia Ocupacional do HC/Unicamp. Resultados: Foram observados alta confiabilidade interexaminador para a EDT total (CCI=0,96), pequena diferença entre os escores dos examinadores (-0.076) e excelente consistência interna (0.86), além de correlação com a Escala de Equilíbrio de Berg (r=0.55, p < que 0.05). Conclusão: A versão Brasileira da EDT preencheu os critérios de confiabilidade interexaminador, validade construtiva, correlação item-total e consistência interna, podendo ser usada como instrumento de avaliação funcional na prática ambulatorial e hospitalar e em pesquisas na área da reabilitação neurológica.

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A perda da habilidade locomotora em indivíduos com Acidente Vascular Encefálico (AVE) tem sido atribuída a hemiparesia, a mais comum causa de comprometimento pós AVE. Novas abordagens, como o treino de marcha utilizando o Suporte Parcial de Peso (SPP) em uma esteira ergométrica associada com a Estimulação Elétrica Funcional (FES) tem sido sugerido como um método de reabilitação da marcha em pacientes hemiparéticos. O objetivo deste trabalho foi avaliar a eficiência do treinamento de marcha com SPP em esteira ergométrica associado ao FES em pacientes hemiparéticos. Métodos: Foram selecionados aleatoriamente 14 sujeitos com hemiparesia decorrente de acidente vascular cerebral. A escala de Desempenho Físico de Fugl-Meyer, a escala de Equilíbrio de Berg, a escala de Categorias de Deambulação Funcional e uma avaliação da cadência foi utilizada como instrumento de medida. Foram realizadas quatro avaliações com os sujeitos da pesquisa, a primeira (controle) realizada antes e a segunda (pré-tratamento) depois do tratamento fisioterápico tradicional, a terceira (pós-tratamento) após o treinamento de marcha com SPP em esteira ergométrica associado ao FES (20 sessões), e há quarta (retenção), trinta dias após o término do tratamento. Resultados: O treinamento proposto apresentou melhora significativa (p-valor >0,05) na velocidade da marcha, na cadencia, no equilíbrio e no nível de comprometimento motor, mantendo os resultados após 30 dias. Conclusão: O treinamento de marcha com SSP em esteira ergométrica associado ao FES é eficaz na reabilitação da marcha em hemiparéticos.

The loss of the ambulation capacity in individuals with Cerebrovascular Accidents (CVA) has been attributed to hemiparesis, the most frequent cause of post-CVA impairment. New approaches, such as the bodyweight supported treadmill training (BWSTT) associated with functional electrical stimulation (FES), have been suggested as a gait rehabilitation method for hemiparetic patients. Objective: The aim of the present study was to evaluate the efficacy of the BWSTT associated to FES in hemiparetic patients. Methods: Fourteen individuals with hemiparesis due to CVA were randomly selected. The Fugl-Meyer Assessment of Sensorimotor Impairment (Fugl-Meyer Scale), the Berg Balance Scale, the Functional Ambulation Category Scale and the cadence assessment were used as measurement tools. The study subjects underwent four evaluations: the first (control) carried out before and the second (pre-treatment) after the conventional physical therapy, the third (post-treatment) after the BWSTT associated to FES (20 sessions) and the fourth (retention), 30 days after the end of the treatment. Results: The proposed training showed a significant improvement (p>0.05) in gait velocity, cadence, balance and motor impairment level and the results persisted 30 days after the end of the treatment. Conclusion: The BWSTT associated with FES is effective for gait rehabilitation in hemiparetic individuals.

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