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BACKGROUND: Stroke is the leading cause of disability worldwide. Assessing stroke's impact on patients' daily activities and social participation can provide important complementary information to their rehabilitation process. However, no previous study had been conducted on the psychometric properties of the Brazilian version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) in the stroke population. OBJECTIVES: This study aimed to examine the internal consistency, test-retest and inter-rater reliability, convergent validity and floor/ceiling effect of the Brazilian version of the WHODAS 2.0 in individuals after chronic stroke. METHODS: Two examiners interviewed 53 chronic stroke individuals who responded to the Brazilian 36-item version of the WHODAS 2.0 three times to analyze test-retest and inter-rater reliabilities. Floor/ceiling effects were calculated as relative frequencies of the lowest or the highest possible WHODAS 2.0 scores. Participants also responded to the Stroke Impact Scale 3.0 (SIS 3.0) and the Functional Independence Measure (FIM) to analyze convergent validity. RESULTS: The internal consistency analyses for domains of WHODAS showed a strong correlation among the items of each domain (0.76-0.91) except for the "getting along" domain, which presented a moderate correlation (ρ = 0,62). Total scores of WHODAS 2.0 showed satisfactory internal consistency (α = 0.93), good inter-rater reliability (ICC = 0.85), excellent test-retest reliability (ICC = 0.92) and no significant floor/ceiling effect. Convergent validity indicated moderate to strong correlations (ρ=-0.51 to ρ=-0.88; p < 0.001), with the highest values associated with the correlation with the SIS scale. CONCLUSIONS: The Brazilian version of the WHODAS 2.0 instrument presented evidence of reliability and validity for chronic post-stroke individuals.

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BACKGROUND: Life-space mobility (LSM) is a mobility measure that assesses the physical and social environments through which people move during their daily lives. OBJECTIVE: To characterize LSM among individuals with Parkinson disease and explore the relationship between LSM, self-efficacy, and balance. DESIGN: A cross-sectional study. SETTINGS: Movement disorder clinic at a teaching hospital. PARTICIPANTS: Eighty-eight participants with Parkinson disease. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The dependent variable (LSM) was assessed using the Life-Space Assessment (LSA) instrument. Balance evaluation and balance self-efficacy were assessed using the Mini Balance Evaluation Systems Test (Mini-BESTest) and the Activities-Specific Balance Confidence Scale, respectively. Other variables, such as age, disease staging (Hoehn-Yahr staging system), cognition (Montreal Cognitive Assessment), and depressive symptoms (Beck Depression Inventory-II), were also measured. RESULTS: The mean LSA score was 65.2 (SD: 22.8) and mean age was 63.2 years (SD: 10.5 years). Among the 88 patients, 32 (36.4%) were classified as restricted LSM. Age (p = .03), disease severity (p = .02), cognition (p = .02), and motor subtype (p = .006) were associated with more restricted LSM among participants. A multiple linear regression model demonstrated that LSM can be predicted by balance performance (R2  = 0.377; p < .001). CONCLUSION: Age, disease severity, cognition, motor subtype, balance self-efficacy, and balance performance are associated with LSM. Understanding and improving balance and self-efficacy in people with Parkinson disease could facilitate community mobility and promote functional independence and health maintenance.

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Resumo Introdução A assistência ao indivíduo pós-acidente vascular encefálico (AVE) geralmente é prestada por cuidadores familiares, mas com grande sobrecarga e impacto negativo em sua qualidade de vida (QV). Objetivo Identificar a população que atualmente cuida de maneira informal de indivíduos com sequelas decorrentes de AVE em Araranguá/SC (Brasil) e avaliar a relação entre a QV e o nível de sobrecarga nessa população. Método Estudo transversal que avaliou 60 indivíduos: 30 cuidadores informais de 30 indivíduos pós-AVE crônicos inscritos nas Unidades Básicas de Saúde de Araranguá, SC. Os seguintes instrumentos de avaliação foram utilizados: Escala Zarit Burden Interview para avaliar a sobrecarga e Questionário World Health Organization Quality of Life (WHOQOL-BREF) para avaliar a QV do cuidador; Medida de Independência Funcional (MIF) para avaliar a independência funcional e a Escala de Rankin Modificada para avaliar o nível de incapacidade do indivíduo pós-AVE. Resultados Foi observado algum nível de sobrecarga em 71,67% dos cuidadores avaliados, sendo que a maioria (46,67%) apresentou sobrecarga leve a moderada. A QV dos cuidadores mostrou-se alterada, com menores índice de satisfação com os domínios físico e meio ambiente. Foi observada correlação significativa entre a sobrecarga e a QV (ρ=-0,60; p<0,01) dos cuidadores. Conclusão A população de cuidadores de indivíduos pós-AVE residentes em Araranguá mostrou-se sobrecarregada com a função de cuidar, com alteração na sua QV. Os achados sugerem a necessidade de intervenções de saúde dirigidas não só aos indivíduos pós-AVE, mas também a seus cuidadores familiares.

Abstract Introduction Assistance to post-stroke individuals is usually provided by family caregivers, but with a great burden and negative impact on their quality of life (QoL). Objective To identify the population that currently takes care informally for individuals with sequelae resulting from stroke in Araranguá/SC (Brazil) and to assess the relationship between QoL and the level of burden in this population. Method A cross-sectional study that evaluated 60 individuals: 30 informal caregivers of 30 chronic post-stroke individuals enrolled in Basic Health Units in Araranguá, SC. The following assessment instruments were used: Zarit Burden Interview Scale to assess burden and World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) to assess caregiver QoL; Functional Independence Measure (FIM) to assess functional independence and the Modified Rankin Scale to assess the individual's level of disability post-stroke. Results Some level of burden was observed in 71.67% of the caregivers evaluated, with the majority (46.67%) having mild to moderate burden. The caregivers' QoL was altered, with lower levels of satisfaction on the physical and environment domains. A significant correlation was observed between burden and QoL (ρ=-0.60; p<0.01) of caregivers. Conclusion The population of caregivers of post-stroke individuals residing in Araranguá proved to be overloaded with the care function, with changes in their QoL. The findings suggest the need for health interventions aimed not only at post-stroke individuals, but also at their family caregivers.

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Indivíduos acometidos por acidente vascular encefálico (AVE) podem apresentar déficits motores, como a hemiparesia, que limitam a autonomia para realização das atividades de vida diária (AVD). Objetivo: Avaliar o comprometimento motor e a independência funcional de indivíduos pós-AVE cadastrados nas Unidades Básicas de Saúde (UBS) no município de Araranguá/SC. Método: A amostra foi composta por indivíduos com sequelas motoras de AVE cadastrados nas UBS de Araranguá, que foram avaliados através da Escala de Rankin Modificada, Mini Exame do Estado Mental, Medida de Independência Funcional (MIF), Escala de Fugl Meyer (EFM) e questionário sociodemográfico. Resultados: Foram avaliados 56 indivíduos, com média de idade de 67,3±11 anos. Na MIF, 67,9% apresentaram dependência modificada, necessitando de até 25% de auxílio para realizar suas AVD. Na pontuação total da EFM, 58,9% dos indivíduos apresentaram comprometimento marcado, 32,1% apresentaram comprometimento grave para membro inferior e 46,4% apresentaram comprometimento moderado para membro superior. Foi observada correlação significativa entre o resultado da EFM total com o resultado da MIF total (ρ=0.6; ρ<0,01) e entre o resultado da EFM total com todos os itens da escala MIF (ρ<0,01). Conclusão: Os indivíduos avaliados apresentaram comprometimento motor marcado e algum grau de dependência funcional. A correlação significativa entre as variáveis demonstrou que indivíduos pós-AVE crônico no município de Araranguá apresentam comprometimento motor que gera dependência funcional para realização das AVD. Espera-se que os resultados encontrados possam auxiliar profissionais de saúde da região a criarem abordagens para manter estes indivíduos mais independentes.

Individuals affected by stroke may have motor deficits, such as hemiparesis, which can limit autonomy to perform activities of daily living (ADLs). Objective: To evaluate the motor impairment and the functional independence of post-stroke individuals registered in Basic Health Units (BHU) in the city of Araranguá/SC. Method: The sample consisted of individuals with sequelae of stroke registered in the Basic Health Units (BHU) of Araranguá, selected in an intentional non-probabilistic manner. Individuals were assessed using the Modified Rankin Scale, Mini Mental State Examination, Functional Independence Measure, Fugl Meyer Scale and socioeconomic questionnaire. Results: 56 individuals were evaluated, mean age of 67.3 ± 11. According to FIM scores, 67.9% had a modified dependence, requiring up to 25% assistance to perform their ADLs. In the total FMS score, 58.9% of the individuals had marked impairment. 32.1% had severe impairment for the lower limb and 46.4% had moderate impairment for the upper limb. A significant correlation was observed between the result of the total FMS with the result of the total FIM (ρ=0.6; ρ<0.01) and between the result of the total FMS with all the items of the FIM scale (ρ <0.01). Conclusion: The evaluated individuals presented marked motor impairment and some level of functional dependence. The significant correlation between the variables demonstrated that individuals after chronic stroke in Araranguá have motor impairment that generates functional dependence for performing ADLs. It is hoped that the results found will help health professionals in the region to create approaches to keep these individuals more independent.

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BACKGROUND: The Timed up and go test (TUG), the Five times sit-to-stand test (FTSTS) and the Bed Mobility test (BMT) are widely used in clinical practice for Parkinson Disease (PD). However, no reported studies have evaluated the responsiveness to group physical therapy intervention (GPTI). OBJECTIVE: To verify if TUG, FTSTS and BMT were responsive to GPTI. METHODS: Thirty individuals with PD were assessed prior to and after an 8-week evidence-based GPTI. Paired t test was used to determine statistically significant change pre-and post-intervention. Internal responsiveness (IR) was classified with the standardized response mean (SRM). A 5-point Likert scale assessed self-perceived performance by the subjects after the intervention. Analysis of the receiver operating characteristic (ROC) curve was used to determine the accuracy and cut-off scores for identifying participants who had shown improvement. RESULTS: GPTI was efficient in improving real (p≤0.001) and self-perceived mobility performance in all measures. All tests were responsive to changes: the IR varied from medium to high (SRM = 0.7-1.5); the cut-off point for TUG test was >2.2 s, for FTSTS test was >2.5 s and for BM test >1.4 s. CONCLUSIONS: The TUG, FTSTS and BMT were responsive to the GPTI and accurately detected meaningful clinical changes. Our results provide an important information about the clinical application of these tests in PD individuals.

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PURPOSE: The PROFILE PD scale was developed specifically to evaluate patients with Parkinson's disease (PD) within the context of the International Classification of Functioning, Disability and Health, directly applied to physical therapy practice. The study aimed to translate and cross-culturally adapt the PROFILE PD scale to Portuguese-Brazil, and to analyze its psychometric domains. METHODS: Fifty participants with PD participated in the study. We assessed the clarity of the Brazilian version of the scale by physiotherapists, presence of floor and ceiling effects, interrater and test-retest reliabilities, in addition to discriminant, concurrent (UPDRS) and construct validity, internal consistence, minimal detectable change (MDC), and responsiveness. RESULTS: The scale was considered highly clear for physical therapists. The interrater ICC was 0.74 and Wk was 0.89 for the total score. For test-retest reliability, the total ICC score was 0.99. The analysis of concurrent validity showed the Spearman correlation between Brazilian version of PROFILE PD and UPDRS (ρ = 0.77; p < 0.001). Factor analyses demonstrated that the test comprises a single scale. Brazilian version of PROFILE PD was able to discriminate the subject with PD in mild and moderate stages, and in mild and severe stages. A high internal consistency was found (α = 0.99). MDC was 2.41 points and there were no floor and ceiling effects. Also, the scale was responsive to physical therapy intervention, with improvement in 8 points after two months (effect size = 0.85). CONCLUSION: The Brazilian version of PROFILE PD is an instrument reliable, valid, and responsive to physical therapy intervention, that can be used to quantify impairments and limitations in patients with PD and can provide an overall summary of the impact of disease, useful for physiotherapy practice. Implications for Rehabilitation PROFILE PD is a reliable and valid instrument to be applied in Brazilian Parkinson disease patients. This scale is design specially to be used in physical therapy practice within the contexts surrounding the International Classification of Functioning, Disability and Health. PROFILE PD was able to discriminate between patients in mild and moderate stages of disease which is difficult in clinical practice mainly because the scale used for this relies on balance and gait rather than a global profile.

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Diversos instrumentos desenvolvidos em países estrangeiros têm sido propostos para avaliar diferentes aspectos de indivíduos pós-acidente vascular encefálico (AVE). A identificação dos instrumentos de medida utilizados nesta população nos conceitos da CIF permite uma abordagem sistêmica do indivíduo. Este estudo objetivou realizar uma revisão sistemática de instrumentos para avaliação pós-AVE que passaram pelo processo de tradução e adaptação para a língua portuguesa, caracterizá-los nos conceitos da CIF e identificar suas propriedades de medida. Dois autores realizaram, de forma sistemática, as etapas de seleção dos estudos elegíveis. A busca se fez pela exploração dos bancos de dados Medline via Ovid, Cinahl via EBSCO, Scielo e Lilacs. A busca resultou em 562 títulos, reduzidos a 22 artigos elegíveis, entre os quais foram identificados 19 instrumentos de avaliação, seis destes classificados como funções e estruturas corporais (FEC), um classificado dentro de FEC e atividade, oito como atividade e quatro como participação. Apenas em 4 estudos foram observadas todas as etapas do processo de tradução. A confiabilidade foi testada em todos os instrumentos, enquanto apenas 4 avaliaram alguma forma de validade e 4 avaliaram efeito piso/teto. Sugere-se a realização de futuros estudos com o objetivo de submeter estes instrumentos à avaliação das propriedades que ainda não foram avaliadas. (AU)

Many instruments developed in foreign countries have been proposed to evaluate different aspects of patients post-stroke. The identification measuring instruments already used in the population with cerebrovascular accident (CVA) in the concepts of the ICF provides a systemic approach of patients. The purpose of the study was to perform a systematic review of instruments for post-stroke evaluation that went through the process of translation and adaptation into Portuguese, featuring instruments in accordance with the concepts of the ICF and identify its psychometric properties. Two authors performed, systematically, the steps for selection of eligible studies. The databases searched were: Medline via Ovid, Cinahl via EBSCO, Scielo and Lilacs. We selected 562 titles and reduced to 22 eligible studies, in which 19 instruments were identified, six classified as structure and body function (SBF), one as SBF and activity, and eight as activity and four as participation. Only in four studies all the steps of the translation process were identified. Reliability was the psychometric property tested in all instruments, while only 4 have evaluated some type of validity and other four the floor/ceiling effects. Further studies are suggested in order to submit these instruments to evaluation of properties that have not yet been evaluated. (AU)

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Abstract Introduction : The Graded Wolf Motor Function Test (GWMFT) was developed as a modification of the Wolf Motor Function Test (WMFT), designed to address moderate-to-severe upper-extremity motor impairment, consequent to a stroke or brain injury, by combining time and quality of movement measures in both isolated movements and functional tasks. Objectives : To translate and adapt the GWMFT form and instructions manual to Brazilian Portuguese and evaluate the inter-rater reliability. Materials and methods : Ten individuals, mean age 53.2 ± 11.39 (range: 28-72) years and a mean time since stroke onset of 82.5 ± 85.83 (16-288) months participated in the study. After translation and cultural adaptation, two independent evaluators, based on the instructions manual information, administered GWMFT. Video observations were used to rate the time and the compensatory movements in the Functional Ability Scale (FAS). Intra-class Correlation Coefficients (ICCs) and Bland-Altman plots were calculated to examine the inter-rater reliability for performance time and FAS. Results : The translated and adapted version obtained a total ICC inter-rater time 0.99 (0.95-1.00), showing less reliability in the task of lifting a pen, with ICC = 0.71 (- 0.15-0.93). The ICC of the total FAS was 0.98 (0.92-0.99) and the task of elbow extension has shown the lowest ICC rate = 0.83 (0.31-0.96). Conclusion : The GWMFT scale reliability proved to be appropriate to evaluate the paretic upper limb in individuals with chronic hemiparesis post severe stroke.

Resumo Introdução : O Graded Wolf Motor Function Test (GWMFT) foi desenvolvido por meio de uma modificação do Wolf Motor Function Test (WMFT) para avaliar o membro superior de adultos com hemiparesia grave combinando medidas de tempo e qualidade de movimento em movimentos isolados e tarefas funcionais. Objetivos : Traduzir e adaptar para a língua portuguesa o formulário e o manual de aplicação do GWMFT e avaliar a confiabilidade interavaliadores. Materiais e Métodos : Participaram do estudo 10 indivíduos com média de idade 53,2 ± 11,39 (28-72) anos que apresentavam hemiparesia grave (Fugl-Meyer ≤ 30) com cronicidade de 82,5 ± 85,83 (16-288) meses, função cognitiva preservada e ausência de dupla hemiparesia. Após a tradução e adaptação cultural da escala, o GWMFT foi aplicado por dois avaliadores utilizando as informações do manual de aplicação e a filmagem das tarefas foi utilizada para cotar o tempo e qualidade de movimento pela Escala de Habilidade Funcional adaptada (EHF). A confiabilidade interavaliador do tempo e EHF do movimento foram avaliadas pelo Coeficiente de Correlação Intraclasse (CCI) e pelo método Bland-Altman. Resultados : Com a aplicação da versão traduzida e adaptada obteve-se CCI interavaliador total do tempo de 0,99 (0,95-1,00), apresentando menor confiabilidade na tarefa de levantar caneta, com CCI de 0,71 (- 0,15-0,93). O CCI da EHF total foi de 0,98 (0,92-0,99) sendo a tarefa extensão do cotovelo com menor índice de CCI = 0,83 (0,31-0,96). Conclusão : A confiabilidade da escala GWMFT demonstrou-se adequada para avaliar o membro superior parético com acometimento grave em indivíduos com hemiparesia crônica pós AVC.

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RATIONALE: Residual walking deficits are common in people after stroke. Treadmill training can increase walking speed and walking distance. A new way to increase the challenge of walking is to walk backwards. Backward treadmill walking may provide advantages by promoting improvement in balance, walking spatiotemporal parameters and quality that may reflect in improving walking distance. AIM: This study will test the hypothesis that backward treadmill walking is superior to forward treadmill walking in improving walking capacity, walking parameters, quality and balance in people with stroke. DESIGN: A prospective, single-blinded, randomized trial will randomly allocate 88 community-dwelling people after stroke into either an experimental or control group. The experimental group will undertake 30-min sessions of backward treadmill walking, three-days/week for six-weeks, while the control group will undertake the same dose of forward treadmill walking. Training will begin at the baseline overground walking speed and will increase each week by 10% of baseline speed. STUDY OUTCOMES: The primary outcome will be distance walked in the 6-min Walk Test. Secondary outcomes will be walking speed, step length, cadence, and one-leg stance time. Outcomes will be collected by a researcher blinded to group allocation at baseline (Week 0), at the end of training period (Week 6), and three-months after the cessation of intervention (Week 18). DISCUSSION: If backward treadmill walking can improve walking capacity more than forward treadmill training in stroke, it may have broader implications because walking capacity has been shown to predict physical activity level and community participation.

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INTRODUÇÃO E OBJETIVO: Estudos sobre o andar para trás (AT) em indivíduos saudáveis demonstraram que esse exercício demanda maior consumo de oxigênio e esforço cardiopulmonar comparado ao andar para frente (AF). Em indivíduos após acidente vascular encefálico (AVE), o AT demonstrou ser uma forma de terapia benéfica para melhorar parâmetros de marcha. Este estudo teve como objetivo comparar as variáveis frequência cardíaca (FC) e percepção subjetiva de esforço (PSE) entre o AF e AT em esteira rolante em duas velocidades distintas em indivíduos com hemiparesia, algo que poderá contribuir para a definição da melhor estratégia para colocar os indivíduos na zona-alvo de um exercício visando ao aprimoramento das condições cardiorrespiratórias. MÉTODOS: Participaram 13 indivíduos adultos de ambos os sexos (53,7 ± 13,5 anos) com sequela de AVE crônica (38,5 ± 31,2 meses de acometimento). Os indivíduos realizaram a tarefa de AT na esteira em velocidade confortável e máxima, repetindo os procedimentos em velocidades idênticas durante o AF. Foi utilizada uma ANOVA fatorial para testar o efeito do sentido (AF e AT) e da velocidade (confortável e máxima) sobre a FC e PSE. RESULTADOS: A FC foi maior durante o AT nas duas velocidades, sendo essa incrementada com o aumento da velocidade (p < 0,01 para todas comparações). Da mesma forma, a PSE foi maior durante o AT nas duas velocidades, sendo incrementada com o aumento da velocidade (p < 0,01 para todas as comparações). CONCLUSÃO: Andar para trás é uma atividade física mais intensa que andar para frente em uma mesma velocidade para indivíduos com hemiparesia. Os achados sugerem que esta atividade poderia ser uma alternativa na realização de programas com ênfase no condicionamento cardiopulmonar e como complemento de outros procedimentos na reeducação do andar após AVE.

BACKGROUND AND PURPOSE: Backward walking (BW) studies in healthy subjects have demonstrated that this exercise requires more oxygen consumption and cardiopulmonary effort compared to forward walking (FW). In patients after stroke, BW has proven to be a beneficial form of therapy to improve gait parameters. The purpose of this study was to determine whether there are differences in heart rate (HR) and perceived exertion (PE) between FW and BW on a treadmill at two different speeds in individuals with hemiparesis. This may help to define the best strategy to put individuals in the target zone of an exercise aimed at improving cardiorespiratory conditions. METHODS: Participated in the study 13 male and female adults (53.7±13.5 years) with chronic sequelae of stroke (38.5±31.2 months of onset). The subjects performed BW task on the treadmill at comfortable speed and maximum speed and repeated the procedures during the FW at identical speeds. A two-way ANOVA was used to test the effect of directional orientation (BW and FW) and speed (comfortable and maximum) on HR and PE. RESULTS: The HR was greater for the BW in both speeds, and has increased with increasing speed (p < 0.01 for all comparisons). Similarly, the PE was higher in BW compared to FW in both speeds, and has increased with increasing speed (p < 0.01 for all comparisons). CONCLUSION: Walking backwards is a physical activity more intense than walking forward at the same speed for individuals with hemiparesis. This finding suggests that this activity could be used as an alternative method with emphasis on cardiopulmonary fitness and as a complement to other procedures in the rehabilitation of gait after stroke.

INTRODUCCIÓN Y OBJETIVO: Los estudios sobre el andar para atrás (AT), en individuos sanos, demostraron que ese ejercicio demanda más consumo de oxígeno y esfuerzo cardiopulmonar en comparación con el andar hacia adelante (AD). En personas, después de accidente vascular encefálico (AVE), el AT demostró ser una forma de terapia benéfica para mejorar parámetros de marcha. Este estudio tuvo como objetivo comparar las variables frecuencia cardíaca (FC) y percepción subjetiva de esfuerzo (PSE) entre el AD y el AT, en estera rodante, en dos velocidades diferentes en individuos con hemiparesia, algo que podrá contribuir para la determinación de la mejor estrategia a fin de colocar a los individuos en la zona-meta de un ejercicio dirigido a perfeccionar las condiciones cardiorrespiratorias. MÉTODOS: Participaron 13 individuos adultos de ambos sexos (53,7 ± 13,5 años) con secuela de AVE crónica (38,5 ± 31,2 meses de acometimiento). Estas personas hicieron la tarea de AT en la estera, en velocidades confortable y máxima, repitiendo los procedimientos en velocidades idénticas durante el AD. Se utilizó una ANOVA factorial para comprobar el efecto del sentido (AD y AT) y de la velocidad (confortable y máxima) sobre la FC y la PSE. RESULTADOS: La FC fue mayor durante el AT en las dos velocidades, siendo esta incrementada con el aumento de la velocidad (p < 0,01 para todas las comparaciones). De la misma forma, la PSE fue más alta durante el AT en las dos velocidades, siendo incrementada con el aumento de la velocidad (p < 0,01 para todas las comparaciones). CONCLUSIÓN: Andar para atrás es una actividad física más intensa que andar para adelante en una misma velocidad para individuos con hemiparesia. Los hallazgos sugieren que esta actividad podría ser una alternativa en la realización de programas con énfasis en el condicionamiento cardiopulmonar y como complemento de otros procedimientos en la reeducación del andar después de AVE.

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INTRODUÇÃO: A Terapia por Contensão Induzida (TCI) é um protocolo terapêutico que visa diminuir a assimetria de uso dos membros superiores. OBJETIVO: Verificar o efeito da TCI em dois adolescentes, com paralisia cerebral hemiparética (PCH). MATERIAIS E MÉTODOS: Dois adolescentes com PCH, de 12 e 14 anos de idade, receberam aplicação de TCI por três horas diárias durante três semanas. Este estudo apresentou desenho ABA experimental, com um mês de seguimento. Os adolescentes foram avaliados com a Teenager Motor Activity Log (TMAL) e o Wolf Motor Function Test (WMFT); o avaliador esteve independente da intervenção e cegado quanto à ordem das avaliações. RESULTADOS: Houve melhora na quantidade, qualidade e espontaneidade de uso após a aplicação da TCI segundo a escala da TMAL. Os dois pacientes apresentaram diminuição no tempo de execução das tarefas do WMFT e foi observada também melhora na habilidade funcional. CONCLUSÃO: Este estudo mostra efeitos positivos da TCI em adolescentes com PCH. Ressalta-se, no entanto, que se fazem necessários ensaios clínicos para confirmar a eficácia da intervenção nessa população.

INTRODUCTION: The Constraint Induced Movement Therapy (CIMT) is a therapeutic protocol proposed as an attempt to overcome the learned nonuse. OBJECTIVE: To assess constraint induced movement therapy protocol effects on two adolescents with hemiparetic cerebral palsy (HCP). MATERIALS AND METHODS: Two adolescents with HCP aged 12 and 14 years old were included and submitted to a CIMT protocol of three hours/day for three weeks. This study presented an ABA experimental design with a month follow-up. Teenager Motor Activity Log (TMAL) and Wolf Motor Function Test (WMFT) were used for adolescents' data assessment and the evaluator did not participate on the intervention and was blinded considering evaluation order. RESULTS: There have been improvements in quality, amount and spontaneity of use of the affected upper extremity following CIMT with basis on TMAL. Both patients presented a decrease in time spent to perform WMFT tasks and functional skill improvement was observed. CONCLUSION: This study has shown positive effects CIMT on adolescents with HCP. However, further studies are necessary to confirm the intervention's efficacy in this clinical population.

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UNLABELLED: The Motor Activity Log (MAL) assesses the spontaneous use of the most affected upper limb with the amount of use (AOU) and quality of movement (QOM) scales during daily activities in real environments in individuals with chronic stroke. OBJECTIVES: This study translated the testing manual into Portuguese and assessed the inter-rater and test-retest reliabilities of the MAL, based upon the Brazilian manual version. METHODS: The inter-rater reliability was evaluated by comparing the results of two examiners, and the test-retest reliability was tested by comparing the results of two evaluations, repeated one-week apart with 30 individuals with chronic hemiparesis (55.8±15.1 years). RESULTS: The intra-class correlation coefficients (ICCs) for the total scores were adequate for both the inter-rater (0.98 for the AOU and 0.91 for QOM) and test-retest reliabilities (0.99 for both scales). CONCLUSIONS: The results suggested that the MAL was reliable to evaluate the spontaneous use of the most affected upper limb after stroke.

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The Motor Activity Log (MAL) assesses the spontaneous use of the most affected upper limb with the amount of use (AOU) and quality of movement (QOM) scales during daily activities in real environments in individuals with chronic stroke. Objectives: This study translated the testing manual into Portuguese and assessed the inter-rater and test-retest reliabilities of the MAL, based upon the Brazilian manual version. Methods: The inter-rater reliability was evaluated by comparing the results of two examiners, and the test-retest reliability was tested by comparing the results of two evaluations, repeated one-week apart with 30 individuals with chronic hemiparesis (55.8±15.1 years). Results: The intra-class correlation coefficients (ICCs) for the total scores were adequate for both the inter-rater (0.98 for the AOU and 0.91 for QOM) and test-retest reliabilities (0.99 for both scales). Conclusions: The results suggested that the MAL was reliable to evaluate the spontaneous use of the most affected upper limb after stroke.

O Motor Activity Log (MAL) avalia o uso espontâneo do membro superior mais afetado por meio da escala de quantidade (EQT) e qualidade (EQL) de uso nas atividades cotidianas em ambiente real em pacientes com acidente vascular cerebral crônico. Objetivo: Este estudo traduziu para o português o manual de aplicação e testou a confiabilidade interavaliadores e teste-reteste do MAL com base na versão brasileira do manual. Métodos: Participaram 30 indivíduos (55,8±15,1 anos) com hemiparesia crônica. A confiabilidade interavaliadores foi testada comparando o resultado de dois avaliadores, e a confiabilidade teste-reteste, pela comparação dos resultados de duas avaliações de um mesmo avaliador, todas com intervalo de uma semana. Resultados: As confiabilidades interavaliadores (coeficiente de correlação intraclasse - CCI=0,98 para a EQT e 0,91 para a EQL) e teste-reteste (CCI=0,99 para ambas as escalas) para os escores totais foram adequadas. Conclusões: A versão brasileira do MAL demonstrou confiabilidade adequada para avaliar o uso espontâneo do membro superior parético depois de um acidente cerebral vascular.

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O objetivo do presente estudo foi comparar as variáveis espaço-temporais entre o andar para frente (AF) e para trás (AT) em indivíduos com hemiparesia. Dez participantes com hemiparesia crônica (30,6±25,1 meses), comprometimento motor leve (20-31 pontos no Fugl-Meyer-membro inferior), bom equilíbrio (escore=50±7 na escala de Berg) e marcha independente (capaz de caminhar 10 metros sem auxilio) foram filmados caminhando em velocidade confortável, com marcadores reflexivos nos maléolos laterais. As variáveis comprimento, duração e velocidade da passada, bem como duração do apoio foram analisadas pela ANOVA com 2 fatores: tarefa e membro inferior. O comprimento da passada foi menor (~44cm) no AT do que no AF (F(1,18)=130,94; p≤0,001), assim como a velocidade da passada (F(1,18)=163,78;p≤0,001) e da marcha (t19=10,99;p≤0,001). A duração da passada e do apoio foram respectivamente maiores, ~0,18s e ~8%, no AT do que no AF, (F(1,18)=11,98; p=0,003; F(1,18)=32,00; p≤0,001, respectivamente). Embora o comprimento da passada do AT seja reduzido, o maior tempo do MI parético suportando o peso do corpo no AT pode ser um indicador relevante na reabilitação motora.

The present study aimed to compare spatial temporal variables between forward (FW) and backward walking (BW) in individuals with hemiparesis. Ten adults with chronic hemiparesis (30.6±25.1 months), mild motor impairment (20-31 points on Fugl-Meyer lower limb test), good balance (score=50±7 in the Berg scale) and independent walking (able to walk 10 meters without aid) were videotaped walking at comfortable speed with reflexive markers placed on lateral malleolus. The variables stride length, duration and speed and stance phase duration were analyzed with a two-way ANOVA: task and lower limb (LL). Stride length was lower (~44cm) in BW than in FW (F(1,18)=130,94; p≤0,001), as well as for stride (F(1,18)=163,78;p≤0,001) and walking speed (t19=10,99;p≤0,001). Stride and stance duration were ~0,18s e ~8%, respectively larger in BW than in FW (F(1,18)=11,98; p=0,003; F(1,18)=32,00; p≤0,001, respectively). Although the stride length in BW was reduced, the fact that the affected LL remained longer in stance in BW compared to FW indicates that the BW might be a relevant parameter in motor rehabilitation.

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O objetivo deste estudo foi verificar se existe efeito da preensão manual máxima (o ato de realizar ou não a preensão) sobre o controle do equilíbrio de judocas em postura restrita, além de verificar se existe correlação entre a força de preensão manual (FPM) e o controle do equilíbrio. Foram avaliados sete judocas com um dinamômetro e uma plataforma estabilométrica sendo mensuradas, concomitantemente, a FPM e o centro de pressão (CP). Foi verificado que até 80% da variabilidade do CP pode ser atrelada a preensão manual indicando que a mesma gera perturbações no controle do equilíbrio. Entretanto, foram encontradas correlações (r = 0,348 até 0,816) entre a FPM e o deslocamento do CP. Com isso pode-se concluir que, apesar da preensão manual gerar perturbações no equilíbrio, seu comportamento parece estar relacionado com os movimentos do corpo realizados para manter o equilíbrio, indicando uma possível correlação entre esses fenômenos.

The purpose of this study was to verify if there is an effect of maximum hand grip (the act of performing or not the hand grip) on the balance control of judokas in a restrict posture, and also to verify if there is a correlation between the hand grip strength (HGS) and the balance control. Seven judokas were evaluated with a dynamometer and a stabilometric force platform, being measured, at the same time, the HGS and the center of pressure (COP). It was found that up to 80% of the COP variability was related to the hand grip demonstrating that it generates perturbations to the balance control. However, It was found correlations (r = 0,348 to 0,816) between de HGS and de COP displacement. With that, it can be concluded that, despite the hand grip generating perturbation on the balance, its behavior appears to be related to the body movements performed to sustain balance, indicating a possible correlation between this phenomenons.

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BACKGROUND: Due to the hemiparesis, the assessment of cardiorespiratory fitness on individuals after cerebrovascular accident (CVA), using exercise tests with conventional protocols, has become a challenge. OBJECTIVE: Perform cardiopulmonary test (CPT) in hemiparetic patients to a pre-participation evaluation aimed at a careful prescription of aerobic exercise. METHODS: The study included eight individuals with chronic hemiparesis who underwent CPT performed with individualized ramp protocol, developed from information on the gait speed of individuals previously evaluated in the track test. We considered the proposal of inclination ranging from 0 to 10.0%, initial speed corresponding to 70.0% of comfortable walking speed rhythm and 40.0% higher than the maximum speed on the track test, expecting that the CPT with this gradual and steady increase in intensity, lasted from 6 to 8 minutes. RESULTS: In 100.0% of the sample, the reason for discontinuation was peripheral fatigue. The peak VO2 achieved was 20.6 ± 5.7 ml/kg.min. The threshold I was identified in all tests, standing at 82.64 ± 4.78% of peak HR and 73.31 ± 4.97% of peak VO2. The respiratory quotient (R) of the group was 0.96 ± 0.09, and three out of eight individuals (37.5%) reached R higher than 1.00, and the Threshold II was identified in these individuals. We found positive relationships between CPT variables and balance scores, performance in the 6-minute walking test and running speed on the ground. CONCLUSION: The test proved to be useful for prescribing physical activity in these individuals.

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FUNDAMENTO: Devido à hemiparesia, a avaliação da aptidão cardiorrespiratória de indivíduos após acidente vascular encefálico (AVE), por meio de testes ergométricos com protocolos convencionais, tem se tornado um desafio. OBJETIVO: Realizar teste cardiopulmonar (TCP) em hemiparéticos para uma avaliação pré-participação visando uma criteriosa prescrição de exercício aeróbico. MÉTODOS: Participaram do estudo 8 indivíduos com hemiparesia crônica, que foram submetidos a TCP realizado com protocolo individualizado em rampa, desenvolvido a partir da informação da velocidade de marcha dos indivíduos previamente avaliados em teste de pista. Foi considerada a proposta de inclinação variando entre 0 e 10,0 por cento, velocidade inicial correspondente a 70,0 por cento do ritmo de caminhada confortável e velocidade máxima 40,0 por cento superior à velocidade máxima no teste de pista, na expectativa de que o TCP, com este incremento gradativo e constante da intensidade, durasse entre 6 e 8 minutos. RESULTADOS: Em 100,0 por cento dos avaliados, o motivo para a interrupção do teste foi fadiga periférica. O VO2 de pico alcançado foi de 20,6 ± 5,7 ml/kg.min. O Limiar I foi identificado em todos os exames, situando-se em 82,64 ± 4,78 por cento da FC de pico e 73,31 ± 4,97 por cento do VO2 de pico. O quociente respiratório (R) do grupo foi de 0,96 ± 0,09, e três dos 8 indivíduos (37,5 por cento) atingiram R superior a 1,00, sendo o Limiar II identificado nestes sujeitos. Foram encontradas relações positivas entre variáveis do TCP e escores de equilíbrio, desempenho no teste de caminhada de 6 minutos e velocidade de marcha no solo. CONCLUSÃO: O teste mostrou ser útil para prescrição de atividade física nesses indivíduos.

BACKGROUND: Due to the hemiparesis, the assessment of cardiorespiratory fitness on individuals after cerebrovascular accident (CVA), using exercise tests with conventional protocols, has become a challenge. OBJECTIVE: Perform cardiopulmonary test (CPT) in hemiparetic patients to a pre-participation evaluation aimed at a careful prescription of aerobic exercise. METHODS: The study included eight individuals with chronic hemiparesis who underwent CPT performed with individualized ramp protocol, developed from information on the gait speed of individuals previously evaluated in the track test. We considered the proposal of inclination ranging from 0 to 10.0 percent, initial speed corresponding to 70.0 percent of comfortable walking speed rhythm and 40.0 percent higher than the maximum speed on the track test, expecting that the CPT with this gradual and steady increase in intensity, lasted from 6 to 8 minutes. RESULTS: In 100.0 percent of the sample, the reason for discontinuation was peripheral fatigue. The peak VO2 achieved was 20.6 ± 5.7 ml/kg.min. The threshold I was identified in all tests, standing at 82.64 ± 4.78 percent of peak HR and 73.31 ± 4.97 percent of peak VO2. The respiratory quotient (R) of the group was 0.96 ± 0.09, and three out of eight individuals (37.5 percent) reached R higher than 1.00, and the Threshold II was identified in these individuals. We found positive relationships between CPT variables and balance scores, performance in the 6-minute walking test and running speed on the ground. CONCLUSION: The test proved to be useful for prescribing physical activity in these individuals.

FUNDAMENTO: Debido a la hemiparesia, la evaluación de la aptitud cardiorrespiratoria de individuos después de accidente vascular encefálico (AVE), por medio de pruebas ergométricas con protocolos convencionales, se ha vuelto en un reto. OBJETIVO: Llevar a cabo prueba cardiopulmonar (PCP) en hemiparéticos para una evaluación pre participación que busca una criteriosa prescripción de ejercicio aeróbico. MÉTODOS: Participaron en el estudio 8 individuos con hemiparesia crónica, que se sometieron a PCP realizado con protocolo individualizado en rampa, desarrollado a partir de la información de la velocidad de marcha de los individuos previamente evaluados en prueba de pista. Se consideró como la propuesta de inclinación variando entre el 0 por ciento y el 10 por ciento, velocidad inicial correspondiente a un 70 por ciento del ritmo de caminata confortable y velocidad máxima el 40 por ciento superior a la velocidad máxima en la prueba de pista, en la expectativa de que el PCP, con este incremento gradual y constante de la intensidad, durase entre 6 y 8 minutos RESULTADOS: El 100 por ciento de los evaluados, la motivación para la interrupción de la prueba fue fatiga periférica. El VO2 de pico alcanzado fue de 20,6 ± 5,7 ml/kg.min. Se identificó el Umbral I en todos los exámenes, situándose en 82,64 ± 4,78 por ciento de la FC de pico y 73,31 ± 4,97 por ciento del VO2 de pico. El cociente respiratorio (R) del grupo fue de 0,96 ± 0,09, y tres de los 8 individuos (37,5 por ciento) alcanzaron R superior a 1,00, siendo el umbral II identificado en estos sujetos. Se encontraron relaciones positivas entre variables del PCP y scores de equilibrio, desempeño en la prueba de marcha de 6 minutos y velocidad de marcha en el suelo. CONCLUSIÓN: La prueba se reveló útil para prescripción de actividad física en estos individuos.

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A avaliação da força de preensão manual (FPM) do tipo palmar é frequentemente utilizada, especialmente, no âmbito fisioterápico e desportivo. A busca por valores normativos tem sido foco de alguns estudos, mas os diferentes instrumentos e protocolos dificultam a generalização dos resultados. Além disso, existem diversos fatores que podem influenciar a FPM como o sexo, a idade, a dominância, o horário de avaliação, o posicionamento corporal, a sinceridade do esforço, as características antropométricas e o tamanho da empunhadura. Este trabalho teve como objetivo realizar uma revisão crítico-narrativa do estado da arte relacionado a medidas da FPM e alguns aspectos referentes à sua interpretação. De acordo com o universo bibliográfico revisado, em avaliações de FPM parece ser fundamental a utilização de um dinamômetro que permita a mensuração de curvas força vs tempo e que possibilite o ajuste contínuo da empunhadura de acordo com as dimensões da mão. Recomenda-se ainda: padronizar o horário de avaliação, avaliar ambas as mãos, realizar no mínimo três avaliações em cada mão, adotar um posicionamento corporal padrão, utilizar incentivo verbal e/ou visual e corrigir a força pela massa corporal. A padronização dos métodos de avaliação e interpretação dos resultados pode permitir a construção de valores de referência confiáveis e universalmente aceitos.

The evaluation of hand grip strength (HGS) is commonly used, especially in physiotherapy and sports. The establishment of reference values has been the focus of some studies, but the different instruments and protocols used impair generalization of the results. Moreover, several factors influence HGS, such as gender, age, dominance, time of assessment, body position, sincerity of effort, anthropometric characteristics, and grip span. The objective of this study was to review the current state of the art regarding HGS measures and some aspects related to their interpretation. According to the literature, the use of a dynamometer that allows the construction of force vs. time curves and the continuous adjustment of grip span according to hand dimensions seems to be essential for the evaluation of HGS. Additional recommendationsare the standardization of the time of evaluation, assessment of both hands, a minimum number of three trials for each hand, adoption of a standard body position, use of verbal and/or visual encouragement, and the correction of muscle strength according to body weight. The standardization of evaluation methods and interpretation of the results permits the establishment of reliable and universally accepted reference values of HGS.

RESUMO

Um número crescente de programas de treinamento com resultados positivos tem sido proposto para a reabilitação de pacientes com sequelas motoras após acidente vascular encefálico (AVE).No entanto, observa-se que muitos não oferecem recomendações no que diz respeito a indicações para técnicas e procedimentos específicos. Objetivo: Revisar a literatura pertinente sobre programas de treinamento envolvendo marcha, condicionamento cardiorrespiratório e fortalecimento muscular de membros inferiores em pacientes portadores de hemiparesia por sequela de AVE, e descrever a eficácia,limitações e efeitos desses programas na recuperação cardiovascular, funcional e motora dessa população.Método: Foi realizada uma busca por ensaios clínicos, trabalhos pré-experimentais, meta-análises e revisões de literatura que abordassem os temas treinamento físico, fortalecimento muscular, treinamento de marcha e programas de exercícios para membros inferiores após AVE. Resultados: Foram encontrados27 artigos relatando diversos protocolos de treinamento (marcha, treinamento cardiovascular, fortalecimento muscular, entre outros) e seus efeitos no sistema cardiovascular, músculo-esquelético e sobre o status funcional em indivíduos portadores de hemiparesia após AVE. Conclusão: Praticamente todas as intervenções relatam resultados positivos em termos de ganhos funcionais, além de efeitos específicos de acordo com o tipo de treinamento. No entanto, as diferenças metodológicas, a carência de grupo controle em alguns estudos, a variabilidade da população estudada e os critérios de análise nem sempre permitem a recomendação segura de procedimentos específicos na prática clínica.

An increasing number of training programs with positive results has been proposed for rehabilitation of stroke survivors with motor impairments. However, few studies offer recommendations regarding indications for specific techniques and procedures. Objective: To review data from the literature about training and exercise programs in patients with hemiparesis following stroke regarding walking training, lower limb strengthening and cardiorespiratory fitness, and to describe the efficacy, limitations and effect of such programs on cardiovascular, motor recovery and functional status. Method: It was made a search in relevant medical journals for articles of clinical trials, meta-analyses, and literature reviews pertaining to physical training, muscular strengthening, gait training and exercise programs for lower limbs after stroke. Results: It was found 27 articles reporting on various training and exercise techniques (gait training, cardiovascular training, muscle strengthening, and others) and their results on the cardiovascular, musculoskeletal, and neurological systems, as well as functional status in stroke patients. Conclusion: Training and exercise programs have value in stroke rehabilitation, and published results are, in general, promising. The differences in the populations tested, methods, and criteria for analysis do not always allow the recommendation of specific procedures in clinical practice.

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O objetivo deste estudo foi verificar o efeito da temperatura da água nas respostas cardiovasculares: frequência cardíaca (FC), pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD), durante a caminhada aquática em três temperaturas (29ºC, 33ºC e 37ºC). Participaram do estudo 10 homens, com média de idade de 23,2 ± 2,25 anos, massa corporal de 78,4 ± 4,01kg e estatura de 1,774 ± 0,017m. Os participantes realizaram caminhadas aquáticas durante 30 min, a uma cadência controlada de 55 passos/minuto, na altura do processo xifoide, em dias diferentes para cada temperatura, sendo as respostas cardiovasculares monitoradas nos minutos 5, 10, 20 e 30. Apesar do efeito principal de 75,4 por cento (p < 0,001) da temperatura da água sobre a variação da FC, também foi identificado um efeito do tempo de exercício de 91,8 por cento (p = 0,001). A FC aumentou gradativamente no decorrer da caminhada, especialmente na temperatura de 37ºC (71,3 ± 8,4 para 114,6 ± 4,4); ao final da caminhada foi maior que os 29ºC (p < 0,01) e 33ºC (p < 0,05); estas últimas não apresentaram diferença entre si. A temperatura parece ter tido pouco efeito sobre a PAS, visto que apenas nos minutos 20 e 30 foi maior aos 33ºC comparada com a de 29ºC (p < 0,05). A PAD sofreu efeito da temperatura, diminuindo gradativamente no decorrer da caminhada, especialmente na temperatura de 37ºC (70,0 ± 5,0 para 40,0 ± 2,5); apresentou diferença significativa em relação às temperaturas de 29ºC e 33ºC (p < 0,05), as quais não mostraram diferença entre si. Considerando o efeito da temperatura da água sobre a FC e a PAD durante a caminhada aquática, sugere-se que, quando piscinas terapêuticas forem utilizadas para realização de caminhada na água, a escolha da temperatura da água seja considerada, recomendando-se valores entre 29ºC e 33ºC para menor estresse cardiovascular.

The purpose of this study was to investigate the effect of water temperature in cardiovascular responses: heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), while walking in water at different temperatures (29ºC, 33ºC e 37ºC). Ten men, mean age 23.2 ± 2.25 years, mean weight 78.4 ± 4.01 kg, mean stature 1.774 ± 0.017 m, participated in the study. Each individual underwent water walking in different days for each temperature during 30 min, with a controlled cadence of 55 steps per minute, at a depth in the xiphoid process. During aquatic walking, the HR and blood pressure (BP) were measured at the 5th, 10th, 20th, and 30th minute of walking. Despite the 75.4 percent (p<0.001) main effect of water temperature on the HR, we also identified a significant effect of 91.8 percent (p=0.001) of exercise time. HR increased most during exercise in water at 37ºC (71.3 ± 8.4 to 114.6 ± 4.4), showing significant difference compared to 29ºC (p<0.01) and 33ºC (p<0.05) temperatures, which were not different from each other. Water temperature seemed to have little effect on the SBP, we have only identified differences between 29ºC and 33ºC temperatures in the 20' e 30' minutes (p<0.05). DBP has decreased at all temperatures studied, and it was more expressive in 37ºC (70.0 ± 5.0 to 40.0 ± 2.5) showing significant difference compared to 29ºC and 33ºC (p<0.05) temperatures, which were not different from each other. Considering the effect of water temperature on HR and DBP during water walking, it is suggested that water temperature should be considered when walking in water, and temperatures between 29 and 33C are recommended for less cardiovascular strain during water walking.

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