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BACKGROUND: The control of the center of mass is essential for a stable and efficient gait. Post-stroke patients present several impairments, which may compromise the control of the center of mass during gait in the sagittal and frontal planes. This study aimed to identify changes in the vertical and mediolateral behavior of the center of mass during the single stance phase of post-stroke patients using the statistical parametric mapping analysis. It also aimed to identify alterations in the center of mass trajectories regarding the motor recovery stages. METHODS: Seventeen stroke patients and 11 neurologically intact individuals were analyzed. The statistical parametric mapping approach was used to identify changes in the center of mass trajectories between stroke and healthy groups. The trajectories of the center of mass of post-stroke individuals were compared according to their motor recovery status. FINDINGS: A near-flat vertical trajectory of the center of mass was indenfitifed in the stroke group compared to their healthy counterparts, especially on the paretic side. The center of mass trajectories in both directions (vertical and mediolateral) presented substantial alteration at the end of the single stance phase in the stroke group. The trajectory of the center of mass of the stroke group was symmetrical in the mediolateral direction between the sides. The trajectories of the center of mass presented similar pattern irrespective of the motor recovery status. INTERPRETATION: The statistical parametric mapping approach showed to be suitable for determining gait changes in post-stroke individuals, irrespective of their motor recovery stage.

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Background: After a Stroke, there is an autonomic nervous system (ANS) changes. Transcranial Direct Current Stimulation (tDCS) can promote the reorganization of the affected circuits. Objective: To evaluate the effects of tDCS applied before a session of physical activity on the treadmill, in the modulation of the autonomic nervous system of post-stroke patients. Methodology: Cross-over study, were randomized 12 adult hemiparetic subjects in 2 groups, Group 1 (active tDCS before exercise on the treadmill) and Group 2 (sham tDCS before exercise on the treadmill). Stimulation times were 20 min; treadmill time was 20 min. The heart rate variability (HRV) and Variability of Systolic Blood Pressure (VSBP) were evaluated for 15 min, in 3 periods (pre and post tDCS and during exercise recovery on the treadmill). Results: There was no difference in the VSBP and the HRV between the groups, compared with the baseline data; however, in the intragroup analysis, the parasympathetic modulation after active tDCS increased by 18% over baseline by the RMSSD with IC 95% (-7.85 to -0.34). In group 1, the post-tDCS active and post-exercise periods presented a value of variance above baseline, indicating a better prognosis. In group 2, there was a significant reduction of 38% of Variance values (p = 0.003) after tDCS sham. Conclusion: tDCS does not generate immediate effects on HRV and VSBP, except for intragroup comparison, which has greater participation in parasympathetic modulation in the group receiving active tDCS.

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BACKGROUND: The Gait Deviation Index, initially conceived to evaluate the gait of children with cerebral palsy, has been used as a quantitative parameter of gait pattern changes of individuals with other conditions. However, there are no studies evaluating changes in the gait pattern of chronic hemiparetic post-stroke subjects based on this index. AIMS: To characterize the changes in gait pattern according to the Gait Deviation Index and gait spatiotemporal parameters of chronic hemiparetic subjects compared to healthy subjects. METHODS: Retrospective study. Data were obtained from the database of the Gait Laboratory of Hospital Israelita Albert Einstein. Thirty subjects were included in this study, with previous unilateral, ischemic or hemorrhagic chronic stroke (time post-lesion > 6 months) and ability of walking classified as 2, 3, 4 or 5 according to Functional Ambulation Category. Data from 87 healthy subjects were included in control group, obtained from a normality database. Statistical analysis was applied through the Kruskall Wallis test, followed by Mann-Whitney post-hoc test, considering a critical p value <0.05. RESULTS: The Gait Deviation Index scores were decreased for both paretic (64.69 ± 16.29) and non-paretic limbs (64.88 ± 15.00) compared to control (101.01 ± 10.12; p < 0.001). No differences were observed in Gait Deviation Index scores between paretic and non-paretic limbs (p > 0.99). CONCLUSION: The findings of the current study demonstrate that the Gait Deviation Index may be a sensitive parameter to identify changes in the gait pattern of chronic hemiparetic post-stroke subjects.

BASES: O Índice de Desvio da Marcha, inicialmente utilizado para avaliar a marcha de crianças com paralisia cerebral, tem sido utilizado como parâmetro quantitativo de alterações de marcha de indivíduos com outras condições. No entanto, não existem estudos que avaliem alterações no padrão de marcha de indivíduos hemiparéticos crônicos pós-AVC com base nesse índice. OBJETIVOS: Caracterizar as alterações no padrão de marcha de acordo com o Índice de Desvio da Marcha e parâmetros espácio-temporais da marcha de sujeitos hemiparéticos crônicos em relação a indivíduos saudáveis. MÉTODOS: Estudo retrospetivos. Os dados foram obtidos a partir da base de dados do Laboratório de Marcha do Hospital Israelita Albert Einstein. Trinta indivíduos foram incluídos neste estudo, com AVC unilateral, isquêmico ou hemorrágico, crônico (tempo pós-lesão> 6 meses) e habilidade de caminhada classificada como 2, 3, 4 ou 5 segundo a Categoria de Ambulação Funcional. Os dados de 87 indivíduos saudáveis foram incluídos no grupo controle, obtido a partir da base de dados de normalidade. A análise estatística foi aplicada através do teste de Kruskall Wallis, seguido do teste pós-hoc de Mann-Whitney, considerando um valor p crítico <0,05. RESULTADOS: Os valores observados para o Índice de Desvio da Marcha foram menores para os membros paréticos (64,69 ± 16,29) e não-paréticos (64,88 ± 15) em relação ao controle (101,01 ± 10,12; p <0,001). Não foram observadas diferenças nos escores do Índice de Desvio da Marcha entre os membros paréticos e não paréticos (p> 0,99). CONCLUSÃO: Os achados do presente estudo demonstram que o Índice de Desvio da Marcha pode ser um parâmetro sensível para identificar alterações no padrão de marcha de indivíduos hemiparéticos crônicos pós-AVC.

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[Purpose] The study analyzed the electroencephalographic (EEG) data of the central cortical areas, during execution of the motor gestures of feeding, activation of the system of mirror neurons, and imagery between a right hemiparetic volunteer (RHV) and a healthy volunteer (HV). [Subjects and Methods] The volunteers' EEG data were recorded with their eyes open for 4 minutes while they performed five experimental tasks. [Results] The alpha band, absolute power value of HV was lower than that of RHV. In the beta band, during the practice condition, there was an increase in the magnitude of the absolute power value of HV at T3, possibly because T3 is representative of secondary motor areas that work with cortical neurons related to planning and organizing sequence of movements performed by the hands. The gamma band is related to the state of preparation for movement and memory. The results of this study indicate that there was increased activation of the gamma frequency band of HV. [Conclusion] The findings of this study have revealed the changes in pattern characteristics of each band which may be associated with the brain injury of the hemiparetic patient.

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A estabilidade dinâmica (ED) é um indicador de qualidade de vida, pois está relacionada com o equilíbrio durante a caminhada e sua diminuição apresenta maior risco de quedas. O objetivo deste estudo é comparar a ED, em diferentes velocidades de caminhada em esteira, entre sujeitos saudáveis e hemiparéticos. Participaram da pesquisa sete adultos hemiparéticos e dez saudáveis. Foram utilizadas quatro câmeras (50 Hz) para identificar os momentos de contato e despregue para posterior cálculo da ED. Uma ANOVA com medidas repetidas foi aplicada para comparar as variáveis dependentes entre as velocidades e entre os grupos. Maiores velocidades de caminhada proporcionaram aumento da estabilidade para ambos os grupos (p<0,05), indicando influência da velocidade na ED. Portanto, torna-se importante, durante o processo de reabilitação de indivíduos hemiparéticos, o estímulo ao aumento da velocidade de caminhada de forma crônica, com o objetivo de torná-la mais estável e com menor risco de quedas.

The dynamic stability (DE) is an important indicator of the quality of life, because it indicates lower balance during walking and is related to the fall risk. The walk stability is a critical issue for stroke individuals. The aim of this study was to compare the DE of walking at different speeds in healthy and stroke patients. The study included seven stroke and ten healthy individuals. 4 cameras (50Hz) were used to identify the heel-strike and push-off moments and, subsequently calculate the DE. To compare the DE among speeds and groups, an Anova two-way with repeated measures was used. The results suggest that at higher walking speeds, there was an increase in stability for both groups, indicating that the walking speeds have influence on stability. Therefore, it becomes important in stroke individuals during the rehabilitation process, the stimulus to increase walking speed, in order to make it more stable and with less risk of falls.

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OBJECTIVE: This study evaluated the effects of neuromuscular electrical stimulation (NMES) on muscle strength, range of motion (ROM) and gross motor function, among spastic hemiparetic children while standing, walking, running and jumping. METHODS: Ten children were divided into two groups of five. The children who were normally receiving physical therapy sessions twice a week had two 30-minute NMES sessions per week (group 1), while those who were having one physical therapy session per week had one 30-minute NMES session per week (group 2), for seven weeks in both groups. The children were evaluated three times: before beginning the NMES protocol (initial), right after the end of the protocol (final) and eight weeks after the final evaluation (follow-up). The evaluations included manual goniometry on ankle dorsiflexion, manual muscle strength of the tibialis anterior and gross motor function (measurements while standing, walking, running and jumping). The statistical analysis was performed using the Wilcoxon and Mann-Whitney tests, considering a p level of 0.05. RESULTS: There were significant increases in muscle strength, gross motor function and passive ROM of ankle dorsiflexion, in both groups, and in active dorsiflexion in the first group. No significant differences were found between the groups. CONCLUSIONS: The improvements in ROM, muscle strength and gross motor function demonstrated that the use of NMES was effective in both groups, since no significant differences were found between the groups. This study suggests that NMES may be a useful therapeutic tool, even when applied once a week. Further studies are needed to confirm these findings.

OBJETIVO: Este estudo avaliou os efeitos da estimulação elétrica neuromuscular (EENM) na força, amplitude de movimento (ADM) e função motora grossa (FMG) em pé, andando, correndo e pulando de crianças hemiparéticas espásticas. MÉTODOS: Dez crianças foram divididas em dois grupos de cinco. As que realizavam sessões de fisioterapia duas vezes por semana tiveram duas sessões semanais de EENM de 30 minutos cada (grupo 1), enquanto as que compareciam à uma sessão tiveram uma sessão semanal (grupo 2), ambas por sete semanas. As crianças foram avaliadas três vezes: antes do início do protocolo de EENM (inicial), ao final do protocolo (final) e oito semanas após a avaliação final (tardia). As avaliações englobaram goniometria manual da dorsiflexão de tornozelo, força muscular manual do tibial anterior e função motora grossa, (Gross Motor Function Measure em pé, andando correndo e pulando). A análise estatística foi feita pelos testes de Wilcoxon e Mann-Whitney, com p adotado de 0,05. RESULTADOS: Houve aumentos significativos na força muscular, na FMG e na ADM passiva da dorsiflexão de tornozelo em ambos os grupos, assim como na dorsiflexão ativa no primeiro grupo. Nenhuma diferença significativa foi encontrada entre os grupos. CONCLUSÕES: As melhoras obtidas na ADM, força muscular e FMG demonstram que o uso da EENM foi eficaz nos dois grupos, não tendo sido encontradas diferenças significativas entre os mesmos. Este estudo sugere que a EENM pode ser útil no auxílio à terapia, mesmo em baixas freqüências, como uma vez por semana. Estudos adicionais são necessários para confirmar estes achados.