Is the dopaminergic loss associated with gait and postural impairments in subjects with Parkinson's disease at different motor stages?

Gait and postural control deficiencies in Parkinson's disease (PD) involve several specific motor aspects. The aim of this study was to identify and compare the main changes in gait kinematics and postural control with dopaminergic loss in the striatum region. This is a cross-sectional study that included 42 individuals with PD at different motor stages, according to the Hoehn & Yahr scale (H&Y). Motor subsection of the Movement Disorder Society-Unified Parkinson Disease Rating Scale-part III (MDS-UPDRS III) was used to evaluate general motor aspects. Gait kinematics was assessed using a three-dimensional motion capture system. Postural control was assessed by stabilometry using force platforms. Dopamine depletion was verified through 99mTc-TRODAT-1 (SPECT-CT) examination. We included 12, 15 and 15 individuals classified as H&Y I, II and III, respectively. We identified worse values of dopamine transporter uptake, MDS-UPDRS III, gait parameters (velocity, step length and stride length) and center of pressure displacement as the disease progressed. Our results indicate that higher dopaminergic loss and gait and postural control deficits occur between the H&Y levels II and III.

Impairments in gait kinematics and postural control may not correlate with dopamine transporter depletion in individuals with mild to moderate Parkinson's disease.

Parkinson's disease (PD) is a progressive neurodegenerative disorder caused by the loss of dopamine, an important neurotransmitter involved in regulating movement. Nuclear medicine imaging methods such as single-photon emission computed tomography (SPECT) combined with radiotracers can obtain the density of this neurotransmitter. This reduced density leads to classic PD symptoms, such as bradykinesia, tremor and stiffness, consequently affecting walking and postural control. The aim of this study was to verify the correlation between disorders of gait kinematics and postural instability with dopamine depletion in individuals with mild to moderate PD. This is a descriptive, observational cross-sectional study. Subjects were assessed for spatiotemporal gait parameters by a three-dimensional motion capture system, for postural control by stabilometry on a force plate. Dopamine depletion was verified through 99mTc-TRODAT-1 (SPECT-CT) examination. The subjects were in the off-stage of levodopa in all analysis. We evaluated 71 individuals, 32 with mild to moderate PD (HY 2 and 2.5) and 39 healthy individuals matched for gender, age, and height. There was a significant difference between the groups regarding the spatiotemporal variables of gait, as well as in the stabilometric variables. However, there was no correlation between these disturbances and the uptake values of 99mTc-TRODAT-1. The results indicate that there is no correlation between gait impairments and postural instability of individuals with mild to moderate PD and the dopaminergic depletion measured through the 99mTc-TRODAT-1 (SPECT-CT).

Comparison of spatiotemporal and angular parameters during shallow water walking in different immersion depths by older adults with and without Parkinson's disease.

BACKGROUND: People with Parkinson's Disease (PwPD) have motor symptoms that directly interfere on dry land walking performance. Despite the shallow water walking is a viable and beneficial physical intervention for PwPD, it lacks information on the comparison of the biomechanical responses of the shallow water walking by PwPD and age paired healthy individuals. RESEARCH QUESTION: Are there differences in the spatiotemporal and angular responses of shallow water walking by older adults with and without Parkinson's disease? METHODS: In this cross-sectional study, ten older adults (9 men/1 women) with Parkinson disease (PwPD group) and ten older adults (3 men/7 women) without Parkinson's disease (Older group) walked in shallow water at self-selected comfortable speed on pool floor in the immersion depths of waist and xiphoid levels. The 2D kinematic data from the sagittal plane was collected to calculate the walking speed, stride length, stride frequency, duty factor, walk ratio, lower limb joints' range of motion and peak angular speed RESULTS: Both groups reduced similarly the walking speed with the immersion depth increase. The speed decrease was achieved by a reducing both the stride frequency and stride length only in the PwPD. The PwPD had lower contact phase than Older in the waist depth, probably due to the reduced risk of fall in water immersion and to attenuate drag force effects. The total range of joint motion was similar between groups, while the peak angular speed of ankle and knee reduced in the deeper depth in both groups. SIGNIFICANCE: The present findings can help professionals of aquatic rehabilitation to choose the best depth for exercise programs, according to the treatment objectives. To our knowledge, this was the first study that analyzed spatiotemporal and angular variables during shallow water walking of PwPD at different depths and compared them with older people without Parkinson's disease.

The impact of virtual reality on manual dexterity of Parkinson's disease subjects: a systematic review.

PURPOSE: To present the latest available evidence on the effects of a VR-based therapy on the manual dexterity of PD subjects. MATERIALS AND METHODS: The search was conducted in PubMed, EMBASE, and PEDro databases. Were included in the systematic review Randomized Clinical Trials, Pilot and Feasibility studies published up to December 2020. The studies should include at least one of the following assessments: Box and Blocks Test, 9-Hole Peg Test; Purdue Pegboard Test. PEDro Scale was used to assess the methodological quality of the included studies. RESULTS: Eight studies were included in the review. Most studies have shown an improvement in outcomes for manual dexterity, but most of them presented a high risk of bias with low methodological quality. A high heterogeneity was observed in the protocols used for each study. CONCLUSION: The results suggest that VR-based therapy has great potential and feasibility to be used as a manual dexterity rehabilitation protocol in PD subjects. However, these results must be interpreted carefully and studies with greater methodological rigor must be conducted.Implications For RehabilitationRehabilitation programs using virtual reality seem to have greater adherence to the user.Immersive virtual reality systems seem to do better in manual dexterity than non-immersive systems.It is plausible to use virtual reality systems in telerehabilitation for manual dexterity training in subjects with Parkinson's' Disease.The use of Virtual Reality by the therapist in a rehabilitation program allows him to modulate the exercises, enabling a wide variety of therapeutic options.

Measuring muscle activation using electromyography during neurodevelopmental treatment in individuals with severe cerebral palsy.

BACKGROUND: In the motor rehabilitation of individuals with neurological disorders, including cerebral palsy (CP), Neurodevelopmental treatment (NDT) one of the most used approaches worldwide. OBJECTIVE: To verify muscle activation in NDT handling in individuals with severe CP using electromyography. METHODS: This was a controlled, cross-sectional, quantitative clinical trial. The individuals were evaluated using electromyography to analyze the muscular activation of the spinal erector, gluteus medius, rectus abdominis and multifidus during different NDT handling. We evaluated 59 individuals: 39 with spastic quadriparesis CP (Gross Motor Function Classification System, level IV-V) and 20 typically-developing individuals (control group). These groups were homogeneous with respect to age and gender. RESULTS: There was a significant difference in muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in the six NDT handling used in this study: side-sitting for kneeling; supine for lateral decubitus, prone position for lateral decubitus, "sitting on horseback", sitting on the roll, and proprioceptive stimulation sitting on the ball. CONCLUSION: The results show that all NDT handling analyzed in this study were effective for muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in individuals with severe spastic quadriparetic CP.

Forced treadmill exercise prevents oxidative stress and memory deficits following chronic cerebral hypoperfusion in the rat.

Physical activity impacts functional recovery following stroke in humans, however its effects in experimental animals submitted to chronic cerebral hypoperfusion have not been investigated. The aim of this study was to evaluate the therapeutic potential of exercise, as assessed by cognitive activity in the Morris water maze and the brain oxidative status, through measurement of macromolecules damage, TBARS levels and total cellular thiols, as well as antioxidant enzymes in hippocampus, striatum and cerebral cortex. Adult male Wistar rats were submitted to the modified permanent bilateral occlusion of the common carotid arteries (2VO) method, with right common carotid artery being first occluded, and tested 3 months after the ischemic event. The effects of three different exercise protocols were examined: pre-ischemia, post-ischemia and pre+post-ischemia. Physical exercise consisted of sessions of 20-min, 3 times per week during 12 weeks (moderate intensity). Rats were submitted to cognitive assessment, in both reference and working spatial memory and after the last testing session were sacrificed to have oxidative stress parameters determined. Hypoperfusion caused a significant cognitive deficit in both spatial water maze tasks and this effect was reversed in rats receiving exercise protocol post and pre+post the ischemic event. Moreover, forced regular treadmill exercise regulated oxidative damage and antioxidant enzyme activity in the hippocampus. These results suggest that physical exercise protects against cognitive and biochemical impairments caused by chronic cerebral hypoperfusion.

Effects of chronic guanosine treatment on hippocampal damage and cognitive impairment of rats submitted to chronic cerebral hypoperfusion.

Chronic cerebral hypoperfusion contributes to a cognitive decline related to brain disorders. Its experimental model in rats is a permanent bilateral common carotid artery occlusion (2VO). Overstimulation of the glutamatergic system excitotoxicity due to brain energetic disturbance in 2VO animals seems to play a pivotal role as a mechanism of cerebral damage. The nucleoside guanosine (GUO) exerts extracellular effects including antagonism of glutamatergic activity. Accordingly, our group demonstrated several neuroprotective effects of GUO against glutamatergic excitotoxicity. Therefore, in this study, we evaluated a chronic GUO treatment effects in rats submitted to 2VO. We evaluated the animals performance in the Morris water maze and hippocampal damage by neurons and astrocytes immunohistochemistry. In addition, we investigated the cerebrospinal fluid (CSF) brain derived neurotrophic factor (BDNF) and serum S100B levels. Additionally, the purine CSF and plasma levels were determined. GUO treatment did not prevent the cognitive impairment promoted by 2VO. However, none of the 2VO animals treated with GUO showed differences in the hippocampal regions compared to control, while 20% of 2VO rats not treated with GUO presented loss of pyramidal neurons and increased glial labeling cells in CA1 hippocampal region. In addition, we did not observe differences in CSF BDNF nor serum S100B levels among the groups. Of note, both the 2VO surgery and GUO treatment changed the purine CSF and plasma profile. In conclusion, GUO treatment did not prevent the cognitive impairment observed in 2VO animals, but our data suggest that GUO could be neuroprotective against hippocampal damage induced by 2VO.

Effects of aerobic exercise using cycle ergometry on balance and functional capacity in post-stroke patients: a systematic review and meta-analysis of randomised clinical trials.

BACKGROUND: Previous studies have shown that aerobic exercise with cycle ergometer improves motor control. PURPOSE: The objective of this systematic review and meta-analysis are to evaluate evidence about the effects of aerobic exercise with cycle ergometer on the balance of post-stroke patients, evaluated by the Berg Balance Scale (BBS), and functional capacity, evaluated by the maximal oxygen intake and six-minute walk test (6MWT). METHODS: The research was conducted on MEDLINE, LILACS, Cochrane Library, EMBASE, Physiotherapy Evidence Database, and Google Scholar until March 2018 (CRD42015020146). Two independent reviewers performed the article selection, data extraction, and methodological quality assessment. The main outcome was balance assessed by the Berg scale and the secondary outcome was functional capacity of the maximal oxygen intake and the 6MWT. Meta-analysis was conducted using a random-effects method, and mean pre-post intervention difference with a 95% confidence interval (95%CI). RESULTS: The review included 5 papers and a total of 258 patients. It was observed that the cycle ergometer did not improve balance in this population (0.03 [-0.57 to 0.64] p = 0.91) or functional capacity in maximal oxygen intake (2.40 [-0.24 to 5.04] p = 0.07) and 6MWT (-40.49 [-131.70 to 50.72] p = 0.38). CONCLUSIONS: The cycle ergometer aerobic exercise did not seem to improve balance or functional capacity in post-stroke patients.IMPLICATIONS FOR REHABILITATIONAerobic exercise with cycle ergometer does not improve balance in patients after chronic stroke, but the results for functional capacity are more promising.Beneficial changes in functional capacity can be seen after 12-4 weeks of training, and are dependent on the initial level of physical fitness of each individual.The use of the cycle-ergometer to improve balance and functional capacity was not superior when compared to conventional physiotherapy; therefore, a combination of therapeutic modalities would be ideal for rehabilitation and post-stroke patients.

Effects of aerobic cycling training on mobility and functionality of acute stroke subjects: A randomized clinical trial.

BACKGROUND: Studies demonstrate the benefits of aerobic cycling training in subacute and chronic stroke subjects, but there is a lack in the literature about its effects on the acute phase. OBJECTIVE: Verify the effects of aerobic cycling training on lower limbs muscle strength, gait speed, balance, mobility and functionality of acute stroke subjects. METHODS: Control group (CG) performed conventional physiotherapy twice a day and the intervention group (IG) performed a conventional physiotherapy and a cycle ergometer session, for five consecutive days. Subjects were assessed for muscle strength by a digital dynamometer, gait speed by the 10-meter-walk-test, balance by the Berg Balance Scale, mobility by the ICU-Mobility-Scale and functionality by the Perme Score. RESULTS: Twenty subjects were enrolled in the study, 10 in the CG and 10 in the IG. Lower limbs muscle strength, the main endpoint, was better in the IG compared to the CG. The same was found in the secondary endpoints. The intragroup analysis was also positive for the CG in the mobility and functionality. CONCLUSIONS: Conventional physiotherapy combined with cycling exercise showed better results in the improvement of muscle strength of lower limbs, mobility and functionality of subjects who suffered from acute stroke.

Upper limbs cycle ergometer increases muscle strength, trunk control and independence of acute stroke subjects: A randomized clinical trial.

BACKGROUND: Studies demonstrate the benefits of upper limbs cycle ergometer (ULCE) in subacute and chronic stroke subjects, but the literature still needs to explore the acute phase of the disease. OBJECTIVE: Verify the effects of ULCE on muscular strength, trunk control and independence of post-stroke subjects in hospital acute phase. METHODS: In this randomized clinical trial participants were allocated into two groups. The control group (CG) performed two daily sessions of conventional physiotherapy, while the intervention group (IG) had one daily session of conventional physiotherapy and one of ULCE. The interventions were carried out for 20 minutes for five days. Both groups were assessed before and after the treatment for upper limbs strength by manual dynamometer, trunk control by Trunk Impairment Scale and level of independence by the Modified Rankin Scale. RESULTS: Twenty subjects with mean ages of 63.5±4.5 were enrolled. There was a significant intra-group difference of palmar grip, shoulder abductors, elbow flexor and wrist extensor strength, trunk control and functional independence only in IG. Inter-group difference for all variables showed superiority in IG. CONCLUSIONS: ULCE is an effective device for increasing muscle strength, trunk control and consequently improving the independence of post-stroke subjects in the acute hospital phase.

Running exercise effects on spatial and avoidance tasks in ovariectomized rats.

Since previous studies have shown that ovariectomy impairs memory and cognition, we investigated whether physical exercise would affect ovariectomy-induced memory deficits in inhibitory avoidance and Morris water maze tasks. Female adult Wistar rats were assigned to one of the following groups: sham (submitted to surgery without removal of the ovaries), exercise, ovariectomy (Ovx) and Ovx plus exercise. Thirty days after ovariectomy or sham surgery, animals were submitted to 1 month of treadmill exercise training for 20 min, three times per week. Rats were than tested in inhibitory avoidance and Morris water maze tasks in order to verify ovariectomy effects on aversive and spatial memory performance. Results show that ovariectomized rats were impaired in aversive memory and spatial navigation, both in reference and working memory protocols. Confirming the working hypothesis, ovariectomized rats submitted to exercise had those impairments prevented. These findings support that physical exercise might constitute an important strategy to minimize cognitive deficits found in post-menopausal women.

Dual-task activities impact the gait kinematics of both amputated and healthy participants similarly / As atividades de dupla tarefa impactam a cinemática da marcha de participantes amputados e saudáveis de forma semelhante

Abstract Introduction: Gait is the motor task most impacted by amputation, requiring several physical and cognitive adaptations. The interaction between cognition and movement can be validly assessed through dual-tasks analysis. Objective: To analyze the kinematics of single and dual-motor tasks of participants with transfemoral amputation and compare it with healthy participants. Methods: This is a comparative cross-sectional study in which 14 participants in the transfemoral amputee group and 14 non-amputee participants attended the Gait Laboratory of the Clinical Center of the Universidade de Caxias do Sul to perform cognitive and motor activities tests. Speed, cadence, stride width, stride length, step length and step time were analyzed. Results: Participants in the transfemoral amputee group presented impaired gait kinematic parameters when compared to non-amputates during single and dual-tasks. Both groups showed a similar percentage decrease in performance on the dual-task compared to the single task. Conclusion: There is a distinction observed in the gait patterns and parameters of both groups, as evidenced in both the simple gait assessment and the dual-task evaluation. The primary finding of our study suggests that changes in gait kinematics appear to be exacerbated by dual-tasking rather than solely by amputation.

Resumo Introdução: A marcha é a tarefa motora mais impactada pela amputação, exigindo várias adaptações físicas e cognitivas. A interação entre cognição e movimento pode ser validamente avaliada por meio da análise de duplas tarefas. Objetivo: Analisar a cinemática de tarefas motoras simples e duplas de participantes com amputação transfemoral e compará-las com participantes saudáveis. Métodos: Estudo transversal comparativo no qual 14 participantes do grupo de amputados trans-femorais e 14 participantes não amputados compareceram ao Laboratório de Marcha do Centro Clínico da Universidade de Caxias do Sul para realizar testes de atividades cognitivas e motoras. Foram analisados a velocidade, cadência, largura do passo, comprimento do passo, comprimento da passada e tempo de passo. Resultados: Os participantes do grupo de amputados transfemorais apresentaram parâmetros cine-máticos da marcha prejudicados em comparação com os não amputados durante as tarefas simples e duplas. Ambos os grupos mostraram uma diminuição percentual semelhante no desempenho na tarefa dupla em comparação com a tarefa simples. Conclusão: Uma distinção pode ser vista nos padrões e parâmetros da marcha de ambos os grupos, e não apenas na avaliação simples da marcha, mas especialmente na avaliação da dupla tarefa. A principal descoberta do nosso estudo sugere que as mudanças nos parâmetros da cinemática da marcha pa-recem ser exacerbadas não só pela amputação, mas também pela realização de duplas tarefas.

Effect of a neuroprotective exercise protocol on oxidative state and BDNF levels in the rat hippocampus.

Daily moderate intensity exercise (2 weeks of 20 min/day of treadmill training), which reduces damage to hippocampal slices from rats submitted to in vitro ischemia, did not modify oxidative stress parameters in the hippocampus nor the brain-derived neurotrophic factor (BDNF) levels in different brain regions. The aim was to investigate whether the modulation of hippocampal oxidative status and/or brain BDNF content is involved in exercise-induced neuroprotection. Wistar rats were submitted to daily exercise in the treadmill and were sacrificed approximately 16 h after the last treadmill running. Some several oxidative stress parameters were determined, specifically the free radical levels, the macromolecule damage, the total reactive antioxidant potential and reactivity levels, which represent the total antioxidant capacity, in the hippocampus. In addition, BDNF levels in different rat cerebral regions (hippocampus, cortex, striatum, and the cerebellum) were measured by ELISA. The used exercise protocol did not affect any oxidative stress parameters studied in the hippocampus, suggesting that it does not cause a significant oxidative stress nor induce adaptations of the cellular antioxidant system. Treadmill training also did not change the BDNF content in brain areas studied. Considering the fact that this exercise protocol have been shown to be neuroprotective, we might speculate that BDNF levels and oxidative status may not be directly involved with the mechanisms of exercise-induced neuroprotection after ischemia.

Kinesio Taping Associated with Acupuncture in the Treatment of the Paretic Upper Limb After Stroke.

The leading cause of disability in adults, leads to different consequences, such as hemiparesis and loss of function in the upper limb which can impair the performance of activities of daily living. Different techniques, such as like acupuncture and Kinesio Taping (KT), have been used to ameliorate this condition. However, there is no consensus on their concomitant effect on neurological patients. This study aimed to analyze the effects of acupuncture associated with KT on the upper limb of patients with chronic hemiparesis after stroke. In this clinical study, 16 subjects were divided into two intervention groups: acupuncture (ACP)-12 sessions of acupuncture-and acupuncture + Kinesio Taping (ACP-KT)-12 sessions of acupuncture plus KT. The Modified Ashworth Scale (spasticity), active goniometry [range of motion (ROM)], and the Wolf Motor Function Test (speed of movement) were used to assess the function of the affected upper limb. As a main result, both groups reduced spasticity in some studied musculature and increased ROM (p < 0.05), without intergroup difference. Moreover, there was no significant improvement concerning speed of movement in either group. Acupuncture was effective in reducing spasticity and increasing ROM of paretic upper limb after stroke, but did not contribute significantly to speed and quality of movement. KT did not show significant benefits concerning the analyzed variables.

A influência dos níveis de atividade física nos parâmetros da marcha durante atividades de dupla tarefa em idosos / The influence of physical activity on gait parameters during dual-task activities in the older people

Resumo Objetivo Analisar as possíveis diferenças nas variáveis ​​cinemáticas da marcha entre idosos fisicamente ativos e fisicamente inativos durante a realização de atividades de dupla tarefa. Metodo: Participaram idosos, com idade entre 60 e 75 anos, divididos em dois grupos: fisicamente inativo (FI) (n=20) e fisicamente ativo (FA) (n=20). Os participantes foram agrupados igualmente em dez indivíduos do sexo feminino e masculino, classificados por meio do Questionário Internacional de Atividade Física (International Physical Activity Questionnaire - IPAQ). Os participantes realizaram inicialmente tarefas simples (aritmética, fluência verbal e marcha) e depois realizaram atividades de dupla tarefa, associando a marcha com as duas atividades cognitivas (aritmética e fluência verbal). Foram analisadas as variáveis ​​velocidade, cadência, comprimento da passada, largura do passo, tempo da passada e duplo apoio. Para comparar as variáveis ​​por tarefa e grupo, foi utilizado o modelo de Equações de Estimativas Generalizadas (GEE) complementado pelo teste de Bonferroni. Resultados Na análise intragrupo, ambos os grupos apresentaram reduções significativas na velocidade, cadência, largura da passada, tempo da passada e duplo apoio, tanto na dupla tarefa aritmética quanto na dupla tarefa de fluência verbal. No entanto, nas comparações entre os grupos, não houve diferenças estatisticamente significativas em nenhum parâmetro cinemático analisado, tanto na análise da marcha simples quanto nas tarefas duplas. Conclusão As duplas tarefas influenciaram negativamente os parâmetros cinemáticos da marcha em ambos os grupos. No entanto, o nível de atividade física não pode ser considerado um fator que minimiza os efeitos da dupla tarefa na marcha de idosos.

Abstract Objective To analyze the possible differences in the kinematic variables of gait between physically active and physically inactive older people while performing dual-task activities. Method Older individuals, aged between 60 and 75 years, participated, divided into two groups: physically inactive (PI) (n=20) and physically active (PA) (n=20). Participants were equally grouped into ten female and male individuals, classified using the International Physical Activity Questionnaire (IPAQ). Participants initially performed simple tasks (arithmetic, verbal fluency, and gait) and then performed dual task activities, associating gait with the two cognitive activities (arithmetic and verbal fluency). The variables velocity, cadence, stride length, step width, stride time and double support were analyzed. To compare variables according to task and group, the Generalized Estimating Equations (GEE) model complemented by the Bonferroni test was used. Results In the intragroup analysis both groups showed significant decreases in velocity, cadence, step width, stride time and double support, both in the arithmetic dual task and in the verbal fluency dual task. However, in the comparisons between the groups, there were no statistically significant differences in any kinematic parameter analyzed, both in the single gait analysis and in the dual tasks. Conclusion The dual tasks had a negative influence on the kinematic gait parameters in both groups. However, the level of physical activity can not be considered a factor that minimizes the effects of the dual task on gait in the older people.

Alterações na cinemática angular da marcha de pacientes hemiparéticos após Acidente Vascular Encefálico / Changes in gait angular kinematics of hemiparetic patients After Cerebrovascular Accident

O objetivo deste estudo foi analisar as alterações na cinemática angular da marcha de adultos com hemiparesia após acidente vascular encefálico (AVE). A amostra foi composta por 17 pacientes pós-AVE; e, para a avaliação da marcha, foi utilizado um sistema de captura da trajetória tridimensional da marcha. Quanto aos membros sadio e afetado, as variáveis estudadas foram: velocidade, ângulos máximos de flexão e extensão do quadril e joelho. Para as comparações entre os membros, foi utilizado o teste t pareado; e, para as comparações com valores normais, o teste t para uma amostra, considerando, como critério de decisão, o nível de significância p ≤ 0,05. Os resultados demonstraram, na comparação entre os membros, diferenças significantes na flexão (0,001) e extensão de joelho (0,05). Já na comparação entre o membro afetado e o sadio, destaca-se a diferença significante das angulações de flexão de joelho (<0,000) e extensão de quadril (0,004). Os pacientes com hemiparesia pós-AVE apresentam alterações na cinemática angular da marcha quando comparado o membro afetado com o sadio e com os valores da normalidade. Observou se um padrão de marcha predominantemente flexor, com grande variabilidade entre os pacientes avaliados.

This study aimed to analyze changes in gait angular kinematics of adults with hemiparesis after cerebrovascular accident (CVA). The sample consisted of 17 post- cerebrovascular accident (CVA) patients; and, for gait evaluation, it used a three-dimensional gait trajectory capture system. As for healthy and affected limbs, the variables studied were: speed, maximum angles of flexion, and extension of the hip and knee. For the comparisons between the members, the study used the t-paired test; and, for comparisons with normal values, it used the t test for a sample, whereas, as a decision criterion, the significance level p ≤ 0.05. The results showed, in the comparison between the limbs, significant differences in flexion (0.001) and knee extension (0.05). In the comparison between the affected limb and the healthy one, there is a significant difference in knee flexion angles (<0.000) and hip extension (0.004). Patients with post-CVA hemiparesis present changes in gait angular kinematics when the affected limb is compared with the healthy limb and with normal values. The study observed a predominantly flexor gait pattern, with a considerable variability among the evaluated patients.

Comparison of muscular activity on ergometric bicycle and elliptical trainer in subjects with incomplete spinal cord injury / Comparação da atividade muscular em bicicleta ergométrica e aparelho elíptico em indivíduos com lesão medular incompleta

Abstract Introduction Spinal cord injury generates muscle weakness, impairing orthostatism and gait. The elliptical trainer (ET) and the ergometric bicycle (EB) are rehabilitation options for this subject. Understanding the pattern of muscle activation generated by these methods is important to answer questions arising from clinical practice. Objective To verify muscle activation with ET and EB with and without electromyographic biofeedback in subjects with incomplete spinal cord injury (ISCI). Methods Cross-sectional crossover study, enrolled in Clinical Trials (NCT05118971). Subjects with spinal cord injury (incomplete spinal cord injury group - ISCIG) and without spinal cord injury (reference group - RG) were randomized into four groups: elliptical group (EG), elliptical + biofeedback group (EBG), bicycle group (BG) and bicycle + biofeedback group (BBG). Subjects were assessed for functionality by the Functional Independence Measure, injury classification by the ASIA Scale, muscle tone by the modified Ashworth scale, and muscle activity by electromyography. Results There was greater activation of the tibialis anterior on cycling compared to other modalities in ISCIG. Biofeedback offered no difference in any of the groups. In RG the vastus medialis was the most activated muscle in all modalities, with more expressive activation in the ET. In this same group, the tibialis anterior was more activated on the EB. Conclusion This study showed that both ET and EB are safe and effective in recruiting the muscles investigated, encouraging its use by rehabilitation professionals when the objective is to strength muscles involved in gait.

Resumo Introducão A lesão medular gera fraqueza muscular, preju-dicando o ortostatismo e a marcha. O aparelho elíptico (EL) e a bicicleta ergométrica (BE) são opções de reabilitação para estes sujeitos. Compreender o padrão de ativação muscular gerado por esses métodos é importante para esclarecer dúvi-das advindas da prática clínica. Objetivo Verificar a ativação muscular com EL e BE com e sem biofeedback eletromiográfico em indivíduos com lesão medular incompleta (LMI). Métodos Estudo transversal do tipo crossover, inscrito no Clinical Trials (NCT05118971). Sujeitos com lesão medular (grupo lesão medular incompleta - GLMI) e sem lesão medular (grupo refe-rência - GR) foram randomizados em quatro grupos: elíptico (GE), elíptico + biofeedback (GEB), bicicleta (GB) e bicicleta + biofeedback (GBB). Os indivíduos foram avaliados quanto à funcionalidade pela Medida de Independência Funcional, classificação da lesão pela Escala ASIA, tônus muscular pela escala modificada de Ashworth e atividade muscular por eletromiografia. Resultados Houve maior ativação do tibial anterior no ciclismo em comparação com outras modalidades no GLMI. O biofeedback não ofereceu nenhuma diferença em nenhum dos grupos. No GR, o vasto medial foi o músculo mais ativado em todas as modalidades, com ativação mais expressiva no EL. Neste mesmo grupo, o tibial anterior foi mais ativado na BE. Conclusão Este estudo mostrou que tanto o EL quanto a BE são seguros e eficazes no recrutamento dos músculos investigados, incentivando seu uso por profissionais da reabilitação quando o objetivo é fortalecer os músculos envolvidos na marcha.

Effect of treadmill exercise on cell damage in rat hippocampal slices submitted to oxygen and glucose deprivation.

We have recently demonstrated that high intensity training exercise exacerbates brain damage, while a moderate intensity (2 weeks of 20 min/day of treadmill training) reduces the injury caused by in vitro ischemia, oxygen and glucose deprivation (OGD), to hippocampal slices from Wistar rats. In the present paper, the effect of different running programs on severity of ischemic OGD lesion was examined, by the evaluation of three protocols designed to simulate exercise conditions common to humans: one or three 20-min sessions per week, during 12 weeks (moderate intensity), and two 20-min daily sessions for 3 weeks. OGD caused an increase of lactate dehydrogenase (LDH) release into the incubation media, a marker of tissue necrosis, and a decline of cell viability, as assessed by the decrease of mitochondrial dehydrogenase activity (MTT method). Moderate exercise, three times a week during 12-week treadmill training, decreased LDH release after OGD, while one weekly session and 3 weeks of two daily sessions did not affect OGD-induced LDH released. No exercise protocol evaluated altered MTT reduction. Our data support the hypothesis that moderate intensity exercise reduces hippocampal susceptibility to in vitro ischemia.

Analysis of muscle activation in children and adolescents with severe cerebral palsy / Análise da ativação muscular em crianças e adolescentes com paralisia cerebral grave

Abstract Introduction: Children and adolescents with spastic quadriparesis have a worse selective motor control, and studies with this population are still very scarce. The same is true with scientific evidence of one of the methods most used as a physiotherapeutic treatment in this population, the Bobath Concept. Objective: To evaluate spine erector muscles activation, gluteus medius and gluteus maximus, through the handling of the Bobath Concept and the sustained kneeling posture in subjects with a diagnosis of severe cerebral palsy; and to compare muscle activation with a reference group, in order to increase the reliability of this study. Methods: A cross-sectional study was carried out with 38 children and adolescents with cerebral palsy, classified by GMFCS at levels IV and V, and 20 healthy participants, aged between 3 and 18 years. They were submitted to the handling of the Bobath Concept and to the sustained kneeling posture, with muscle activation obtained by electromyography. Results: We observed significant muscle activation during handling in side-sitting, with weight transfer and without the help of another therapist, and in the sustained kneeling posture, for the erector of the spine and gluteus medius. Conclusion: The evidence from this study suggests that both the handling in side-sitting and the sustained kneeling posture cause significant muscle activation in the erector of the spine and gluteus medius for severe quadriparesis subjects, GMFCS IV and V, which can contribute to the improvement of postural control and decision-making in physical therapy practice.

Resumo Introdução: Crianças e adolescentes com quadriparesia espástica apresentam pior controle motor seletivo e estudos com essa população ainda são muito escassos. O mesmo ocorre com as evidências científicas de um dos métodos mais utilizados como tratamento fisioterapêutico nessa população, o Conceito Bobath. Objetivo: Avaliar a ativação dos músculos eretores da coluna, glúteo médio e glúteo máximo por meio do manuseio do Conceito Bobath e da postura ajoelhada sustentada, em indivíduos com diagnóstico de paralisia cerebral grave; e comparar a ativação muscular com um grupo de referência, a fim de aumentar a confiabilidade deste estudo. Métodos: Realizou-se um estudo transversal com 38 crianças e adolescentes com paralisia cerebral, classificados pelo GMFCS nos níveis IV e V, e 20 participantes saudáveis com idade entre 3 e 18 anos. Eles foram submetidos ao manuseio do Conceito Bobath e à postura ajoelhada sustentada, com ativação muscular obtida por eletromiografia. Resultados: Observou-se ativação muscular significativa durante o manuseio na posição sentada de lado, com transferência de peso e sem auxílio de outro terapeuta, e na postura ajoelhada sustentada para o eretor da coluna e glúteo médio. Conclusão: As evidências deste estudo sugerem que tanto o manuseio na posição sentada de lado quanto a sustentação da postura ajoelhada causam significativa ativação muscular no eretor da coluna e glúteo médio para indivíduos com quadriparesia grave, GMFCS IV e V, o que pode contribuir para a melhora do controle postural e tomada de decisão na prática fisioterapêutica.

Realidade virtual como ferramenta de intervenção para os membros superiores na doença de Parkinson: série de casos / Realidad virtual como herramienta de intervención para los miembros superiores en la enfermedad de Parkinson: una serie de casos / Virtual reality as an intervention tool for upper limbs in Parkinson's disease: a case series

RESUMO A doença de Parkinson (DP) é uma desordem neurodegenerativa na qual ocorre a perda dopaminérgica na região dos núcleos da base. Uma das principais queixas associadas à DP são os déficits motores dos membros superiores (MMSS) frequentemente relatados em dificuldades para realizar as atividades de vida diária (AVDs), podendo interferir negativamente na qualidade de vida. Nos últimos anos novas tecnologias surgiram para auxiliar no processo de reabilitação dos MMSS na DP, sendo a realidade virtual uma delas. Portanto, este estudo teve como objetivo verificar os efeitos de uma intervenção nos MMSS com equipamento de realidade virtual semi-imersiva nas AVDs e na qualidade de vida de indivíduos com DP. Foram selecionados seis indivíduos com DP para intervenção, avaliados por meio do miniexame do estado mental, da escala de Hoehn e Yahr, da escala unificada de avaliação para a DP (UPDRS), do questionário sobre a doença de Parkinson (PDQ-39) e do test d'évaluation des membres supérieurs de personnes âgées (Tempa). Seis sujeitos foram submetidos à intervenção com duração de 27 minutos por sessão, duas vezes na semana, por cinco semanas, utilizando o Leap Motion Controller. Obteve-se melhora na força muscular, na resistência muscular, nas AVDs e na qualidade de vida, todos com significância estatística. Dessa forma, verificou-se que o protocolo baseado em realidade virtual aplicada nos MMSS foi eficaz para melhorar as AVDs e a qualidade de vida dos indivíduos com DP deste estudo.

RESUMEN La enfermedad de Parkinson (EP) es un trastorno neurodegenerativo con pérdidas dopaminenérgicas en la región de núcleos basales. Una de las principales quejas asociadas a la EP son los déficits motores de los miembros superiores (MMSS), que muchas veces resultan en dificultades de realizar las actividades de la vida diaria (AVD), lo que impacta negativamente la calidad de vida. En los últimos años surgieron nuevas tecnologías para ayudar en el proceso de rehabilitación de los MMSS en la EP, y una de ellas es la realidad virtual. Por lo tanto, este estudio tuvo como objetivo comprobar los efectos de una intervención en los MMSS utilizando un equipo de realidad virtual semiinmersivo en las AVD y en la calidad de vida de individuos con EP. Se seleccionaron a seis individuos con EP para la intervención, que fueron sometidos a evaluación por el Miniexamen del Estado Mental, la Escala de Hoehn y Yahr, la Escala Unificada de Evaluación de la Enfermedad de Parkinson (UPDRS), el Cuestionario de la Enfermedad de Parkinson (PDQ-39) y el test d'évaluation des membres supérieurs de personnes âgées (Tempa). Seis sujetos se sometieron a una intervención de 27 minutos por sesión, dos veces por semana, durante cinco semanas, utilizando el Leap Motion Controller. Hubo una mejora en la fuerza muscular, en la resistencia muscular, en las AVD y en la calidad de vida, todos con significación estadística. Así se constató que el protocolo basado en realidad virtual aplicado a los MMSS fue eficaz en la mejora de las AVD y en la calidad de vida de los individuos con EP de este estudio.

ABSTRACT Parkinson's disease (PD) is a neurodegenerative disorder in which dopaminergic loss occurs in the basal nuclei region. One major complaint associated with PD is upper extremity motor deficits (UE), frequently reported in difficulties to perform activities of daily living (ADL), which may negatively affect quality of life. In recent years new technologies have emerged to assist the UE rehabilitation process in PD, such as virtual reality. Therefore, this study sought to verify the effects of an intervention in the UE with semi-immersive virtual reality equipment on ADLs and quality of life of individuals with PD. Six individuals with PD were selected for intervention, and evaluated by the Mini Mental State Examination, the Hoehn & Yahr Scale, the Unified Parkinson's Disease Rating Scale (UPDRS), the Parkinson's Disease Questionnaire (PDQ-39) and the test d'évaluation des membres supérieurs de personnes âgées (TEMPA). The interventions lasted 27 minutes per session, twice per week, for 5 weeks, using the Leap Motion Controller. Individuals showed improvement in muscle strength, muscle endurance, ADLs, and quality of life, all statistically significant. In conclusion, the protocol based on virtual reality applied to the upper limbs effectively improved the activities of daily living and quality of life in individuals with PD.