Reliability of the Functional Reach Test and the influence of anthropometric characteristics on test results in subjects with hemiparesis.

First designed as an alternative method of assessing balance and susceptibility to falls among elderly, the Functional Reach Test (FR) has also been used among patients with hemiparesis. Then this study aimed to describe the intra- and inter-rater and the test/re-test reliability of the FR measure in subjects with and without hemiparesis while verifying anthropometric influences on the measurements. The FR was administered to a sample of subjects with hemiparesis and to a control group that was matched by gender and age. A two-way analysis of variance was used to verify the intra-rater reliability. It was calculated using the differences between the averages of the measures obtained during single, double or triple trials. The intra-class correlation coefficient (ICC) was utilized and data plotted using the Bland-Altman method. Associations were analyzed using Pearson's correlation coefficient. In general, the intra-rater analysis did not show significant differences between the measures for the single, double or triple trials. Excellent ICC values were observed, and there were no significant associations with anthropometric parameters for the hemiparesis and control subjects. FR showed good reliability for patients with and without hemiparesis and the test measurements were not significantly associated with the anthropometric characteristics of the subjects.

Is it correct to always consider weight-bearing asymmetrically distributed in individuals with hemiparesis?

Injuries may cause unilateral deterioration of brain areas related to postural control resulting in lateralized motor disability with abnormal asymmetry in weight-bearing distribution. Although overloading toward the nonaffected limb has been described as the preferred posture among individuals with hemiparesis, characterization of the weight-bearing asymmetry is poorly and indirectly described. Therefore, this study aimed to describe weight-bearing distribution during upright stance, establishing criteria to consider asymmetry in hemiparesis when analyzed within the limits defined by controls matched by age and gender. Forty subjects with (n = 20) or without hemiparesis (n = 20) were included in procedures to record weight-bearing values between hemibodies, and these values were used to calculate a symmetry ratio. Control presented 95% confidence interval (CI) of the mean for symmetry ratio ranging from 0.888 to 1.072, defining limits to symmetry. Four subjects with hemiparesis (20%) had symmetry ratios inside limits defined by controls (i.e., weight-bearing symmetrically distributed), and 11 (55%) subjects without hemiparesis showed symmetry ratios outside the limits, suggesting asymmetrical weight-bearing distribution. It was concluded that asymmetry, when present in a control group, was more frequently overloading nonpredominantly used hemibody (nondominant side), differing from a hemiparesis group commonly forced to assume the nonaffected side as the predominantly used hemibody and where the overload was observed.

A Brazilian experience to describe functioning and disability profiles provided by combined use of ICD and ICF in chronic stroke patients at home-care.

PURPOSE: To present experience of combined use of the International Classifications to determine functioning and disability profiles of chronic stroke patients at home-care. METHODS: It was a design observational study with 13 subjects sampled from 39 patients with stroke pre-selected from 115 patients attended by a public home-care service. Their socio-demographic and others independent variables were assessed and frequencies of codified events from International Classification of Diseases (ICD) and International Classification of Functioning, Disability and Health (ICF) were recorded. RESULTS: Endocrine, nutritional and metabolic diseases; diseases of the nervous and circulatory system; diseases of skin and subcutaneous tissue and diseases of the musculoskeletal system and connective tissue were recorded by ICD being complemented by ICF mainly describing impairments in neuromusculoskeletal and movement-related function and structure; limitations in activities and participation for domestic life and barriers for natural environment and human-made changes to environment. Moreover, it was observed functioning profile describing sensory function and structures related to movements preserved; good interpersonal interactions and facilities provided by services and policies. CONCLUSION: Preserved functions and structures related to movement and advantages in interpersonal interactions, public services and healthy policies could be used to guide therapy and to prevent rehospitalisation commonly observed in chronic stroke survivals.