RESUMO
OBJECTIVES: To evaluate effects of somatosensory stimulation in the form of repetitive peripheral nerve sensory stimulation (RPSS) in combination with transcranial direct current stimulation (tDCS), tDCS alone, RPSS alone, or sham RPSS + tDCS as add-on interventions to training of wrist extension with functional electrical stimulation (FES), in chronic stroke patients with moderate to severe upper limb impairments in a crossover design. We hypothesized that the combination of RPSS and tDCS would enhance the effects of FES on active range of movement (ROM) of the paretic wrist to a greater extent than RPSS alone, tDCS alone or sham RPSS + tDCS. MATERIALS AND METHODS: The primary outcome was the active ROM of extension of the paretic wrist. Secondary outcomes were ROM of wrist flexion, grasp, and pinch strength of the paretic and nonparetic upper limbs, and ROM of wrist extension of the nonparetic wrist. Outcomes were blindly evaluated before and after each intervention. Analysis of variance with repeated measures with factors "session" and "time" was performed. RESULTS: After screening 2499 subjects, 22 were included. Data from 20 subjects were analyzed. There were significant effects of "time" for grasp force of the paretic limb and for ROM of wrist extension of the nonparetic limb, but no effects of "session" or interaction "session x time." There were no significant effects of "session," "time," or interaction "session x time" regarding other outcomes. CONCLUSIONS: Single sessions of PSS + tDCS, tDCS alone, or RPSS alone did not improve training effects in chronic stroke patients with moderate to severe impairment.
Assuntos
Encéfalo/fisiologia , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/terapia , Sistema Nervoso Periférico/fisiologia , Acidente Vascular Cerebral/complicações , Estimulação Transcraniana por Corrente Contínua , Estimulação Elétrica Nervosa Transcutânea , Adulto , Idoso , Doença Crônica , Terapia Combinada , Método Duplo-Cego , Feminino , Humanos , Masculino , Nervo Mediano/fisiologia , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Extremidade Superior/fisiopatologiaRESUMO
BACKGROUND: The Wolf Motor Function Test (WMFT) evaluates the upper limb (UL) performance of adults with hemiparesis by combining time and quality of movement measures in both isolated movements and functional tasks. OBJECTIVES: To translate and adapt the WMFT form, functional ability scale (FAS) and manual to Brazilian Portuguese and evaluate the intra and inter-rater reliabilities. METHODS: Fifteen individuals with a mean age of 57.9±11.1 years and a mean time since stroke onset of 68.5±53.5 months participated. The WMFT was administered by one physiotherapist based on information in the manual, and video observations were assessed by two other independent physical therapists. Information regarding compensatory movements was included in the FAS. Intra-class correlation coefficients (ICCs) and Bland-Altman plots were calculated to examine the intra- and inter-rater reliabilities for performance time and FAS, whereas weighted kappa (Kp) was used to examine the agreement strength for FAS. RESULTS: The inter-rater ICC values for performance time were above 0.75 in 13 of the 15 tasks. For the FAS, they ranged from 0.87-0.99 for all evaluated tasks, with Kp values ranging from 0.63-0.92. For intra-rater reliability, the ICC ranged from 0.99-1.0 and from 0.96-1.0 for time measurement and FAS, respectively. Kp values ranged from 0.79-0.96 for individual and 0.93 for total scores. CONCLUSION: The Brazilian version of the WMFT showed adequate intra- and inter-rater reliabilities for evaluating the paretic UL of individuals with stroke.
Assuntos
Paresia/fisiopatologia , Extremidade Superior/fisiopatologia , Adulto , Idoso , Brasil , Técnicas de Diagnóstico Neurológico , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Atividade Motora , Variações Dependentes do Observador , Paresia/etiologia , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicaçõesRESUMO
CONTEXTUALIZAÇÃO: O Wolf Motor Function Test (WMFT) avalia o membro superior (MS) de adultos com hemiparesia combinando medidas de tempo e qualidade de movimento em movimentos isolados e em tarefas funcionais. OBJETIVOS: Traduzir e adaptar para a língua portuguesa o formulário, a escala de habilidade funcional (EHF) e o manual de aplicação do WMFT e avaliar a confiabilidade intra e inter-observadores. MÉTODOS: Participaram 15 indivíduos com média de idade de 57,9±11,1 anos e 68,5±53,5 meses pós acidente vascular encefálico (AVE). O WMFT foi aplicado por um fisioterapeuta utilizando as informações do manual e cotado por dois outros fisioterapeutas independentes pela observação dos vídeos. Foram acrescentadas informações mais detalhadas na EHF sobre a movimentação compensatória em relação à escala original. A confiabilidade intra e interobservadores do desempenho no tempo e da EHF dos itens individuais e do escore total foi avaliada pelo Coeficiente de Correlação Intraclasse (CCI) e pelo método Bland e Altman. Kappa ponderado (Kp) foi utilizado para avaliar a concordância intra e interobservadores da EHF. RESULTADOS: O CCI interobservador do desempenho no tempo foi >0,75 em 13 das 15 tarefas. A EHF apresentou CCI interobservador entre 0,87 e 0,99 em todas as tarefas e Kp entre 0,63 e 0,92. O CCI intraobservador do tempo variou entre 0,99 e 1 e na EHF, entre 0,96 e 1. O Kp intraobservador na EHF nas tarefas variou entre 0,79 e 0,96, sendo 0,93 para o escore total. CONCLUSÃO: A versão brasileira do WMFT demonstrou confiabilidade adequada para avaliar o MS parético pós-AVE.
BACKGROUND: The Wolf Motor Function Test (WMFT) evaluates the upper limb (UL) performance of adults with hemiparesis by combining time and quality of movement measures in both isolated movements and functional tasks. OBJECTIVES: To translate and adapt the WMFT form, functional ability scale (FAS) and manual to Brazilian Portuguese and evaluate the intra and inter-rater reliabilities. METHODS: Fifteen individuals with a mean age of 57.9±11.1 years and a mean time since stroke onset of 68.5±53.5 months participated. The WMFT was administered by one physiotherapist based on information in the manual, and video observations were assessed by two other independent physical therapists. Information regarding compensatory movements was included in the FAS. Intra-class correlation coefficients (ICCs) and Bland-Altman plots were calculated to examine the intra- and inter-rater reliabilities for performance time and FAS, whereas weighted kappa (Kp) was used to examine the agreement strength for FAS. RESULTS: The inter-rater ICC values for performance time were above 0.75 in 13 of the 15 tasks. For the FAS, they ranged from 0.87-0.99 for all evaluated tasks, with Kp values ranging from 0.63-0.92. For intra-rater reliability, the ICC ranged from 0.99-1.0 and from 0.96-1.0 for time measurement and FAS, respectively. Kp values ranged from 0.79-0.96 for individual and 0.93 for total scores. CONCLUSION: The Brazilian version of the WMFT showed adequate intra- and inter-rater reliabilities for evaluating the paretic UL of individuals with stroke.