Planning and Executing Aiming Movements in Middle Childhood.

Harmonious voluntary movements require efficiency in their planning and execution. Throughout middle childhood structural changes in the central nervous and musculoskeletal systems influence these processes and resultant motor behavior. In this study, we evaluated the characteristics of the motor planning and executing of aiming movements directed at targets located in different positions in space in children aged 7, 9, and 11 years. We divided 43 right-handed children, into three age groups and instructed them to perform aiming movements directed at targets using a stylus on a digital tablet. The children performed the movement with their dominant upper limbs from a starting point towards targets positioned ipsilaterally or contralaterally to this dominant limb. We analyzed temporal and spatial variables of motor performance. Younger (7-year-old) children made more errors in the initial movement direction and more frequently corrected their movements during task execution when compared to 9- and 11-year-old children who did not differ from each other. All age groups were similar in movement accuracy and precision. Movements toward contralateral targets were slower and more accurate than movements toward ipsilateral targets for all groups. These results show that performing aiming movements develop with the onset of middle childhood.

Development of a Comprehensive Outcome Measure for Motor Coordination, Step 2: Reliability and Construct Validity in Chronic Stroke Patients.

BACKGROUND: A comprehensive scale assessing motor coordination of multiple body segments was developed using a 3-phase content validation process. The Comprehensive Coordination Scale (CCS) evaluates motor coordination defined as the ability to produce context-dependent movements of multiple effectors in both spatial and temporal domains. The scale assesses motor coordination in individuals with neurological injuries at 2 levels of movement description: the motor performance level describes end point movements (ie, hand, foot), and the movement quality level describes limb joints/trunk movements contributing to end point movement. OBJECTIVE: To determine measurement properties of the scale in people with chronic stroke. METHODS: Standardized approaches determined the internal consistency (factor loadings), intrarater and interrater reliability (interclass correlation coefficient), measurement error (SEM; minimal detectable change [MDC]), construct validity, and interpretability (ie, ceiling and floor effects) of the CCS. RESULTS: Data from 30 patients with chronic stroke were used for the analysis. The internal consistency of the scale was high (0.94), and the scale consisted of separate factors characterizing end point motor performance and movement quality. Intrarater (intraclass correlation coefficient [ICC] = 0.97-0.97) and interrater (ICC=0.76-0.98) reliability of the whole scale and subscales were good to excellent. The CCS had an SEM of 1.80 points (total score = 69 points) and an MDC95 of 4.98 points. The CCS total score was related to Fugl-Meyer Assessment total and motor scores and had no ceiling or floor effects. CONCLUSIONS: The CCS scale has strong measurement properties and may be a useful measure of spatial and temporal coordination deficits in chronic stroke survivors.

Measurement properties of the Reaching Performance Scale for Stroke.

AIM: Reaching Performance Scale for Stroke (RPSS) evaluates the upper limb reach-to-grasp movement quality and compensatory movements. The objective of the study was to test the reliability, construct validity, and interpretability of the Brazilian-Portuguese RPSS. METHODS: Fifty-one individuals (mean age 62 ± 10.8 years), with acute-to-chronic stroke (range: 1-300 months) were video recorded while performing a reach-to-grasp task of a cone placed both close and far from the individual. Their degree of motor impairment ranged from 4 to 59 points in the Fugl-Meyer scale. RESULTS: Reaching Performance Scale for Stroke showed excellent intra- (ICC2,1 = 1.00) and interrater (ICC2,1 = 0.98-0.99) reliability, and redundant internal consistency (Cronbach's α = 0.98). The construct validity between RPSS and Fugl-Meyer scale was strong (Spearman rho = 0.88-0.89; p < 0.0001). The scale was able to discriminate individuals with mild or moderate upper limb impairment from those with severe impairment. We found ceiling and floor effects. CONCLUSIONS: Reaching Performance Scale for Stroke showed excellent reliability and redundant internal consistency. The construct validity with the Fugl-Meyer scale was strong. Reaching Performance Scale for Stroke was able to discriminate individuals with different levels of upper limb impairment.IMPLICATIONS FOR REHABILITATIONPost-stroke individuals develop compensatory strategies to perform reaching movements with the paretic upper limb.The Reaching Performance Scale for Stroke provides a quantitative and qualitative evaluation of the reach-to-grasp movement.The Reaching Performance Scale for Stroke is suitable for use with Brazilian-Portuguese speakers and has adequate reliability and validity.

Development of a Comprehensive Outcome Measure for Motor Coordination; Step 1: Three-Phase Content Validity Process.

BACKGROUND: Motor coordination, the ability to produce context-dependent organized movements in spatial and temporal domains, is impaired after neurological injuries. Outcome measures assessing coordination mostly quantify endpoint performance variables (ie, temporal qualities of whole arm movement) but not movement quality (ie, trunk and arm joint displacements). OBJECTIVE: To develop an outcome measure to assess coordination of multiple body segments at both endpoint trajectory and movement quality levels, based on observational kinematics, in adults with neurological injuries. METHODS: A 3-phase study was used to develop the Comprehensive Coordination Scale (CCS): instrument development, Delphi process, and focus group meeting. The CCS was constructed from common tests used in clinical practice and research. Rating scales for different behavioral elements were developed to guide analysis. For content validation, 8 experts (ie, neurological clinicians/researchers) answered questionnaires about relevance, comprehension, and feasibility of each test and rating scale. A focus group conducted with 6 of 8 experts obtained consensus on rating scale and instruction wording, and identified gaps. Three additional experts reviewed the revised CCS content to obtain a final version. RESULTS: Experts identified a gap regarding assessment of hand/finger coordination. The CCS final version is composed of 6 complementary tests of coordination: finger-to-nose, arm-trunk, finger, lower extremity, and 2- and 4-limb interlimb coordination. Constructs include spatial and temporal variables totaling 69 points. Higher scores indicate better performance. CONCLUSIONS: The CCS may be an important, understandable and feasible outcome measure to assess spatial and temporal coordination. CCS measurement properties are presented in the companion article.

Performance of discrete, reciprocal, and cyclic movements of the ipsilesional upper limb in individuals after stroke.

Aiming movements of the upper limbs can be classified either as discrete, or reciprocal, or cyclic. The control of these movements after a stroke can be affected. The aim of this experimental, cross-sectional study was to characterize the performance of these movements after the right and left hemisphere chronic stroke. Thirty-six individuals aged between 40 and 70 years, right-handed, were allocated into three groups (control, right stroke, and left stroke). Participants were asked to perform aiming movements on a tablet. Individuals after stroke performed the tasks only with their ipsilesional limb, while the control group performed movements with both limbs. The reaction and movement times, peak velocity, and the variability and error of the endpoint were analyzed. Individuals after stroke presented a worse performance in all movement classes as expected, but differently depending on the damaged hemisphere. Participants with right hemisphere damage showed larger endpoint errors, while those with left hemisphere damage had longer reaction and movement times. Both differences were seen consistently in discrete and reciprocal, but not in cyclic movements. Cyclic movements presented shorter latencies, were faster, and showed greater endpoint errors when compared to discrete and reciprocal movements. These results suggest that stroke affects differently the performance of discrete and reciprocal movements according to the hemisphere lesion side, but not in cyclic movements. Different levels of motor control among the three classes of movements by the nervous system may justify these results.

From One to Two: Can Visual Feedback Improve the Light Touch Effects on Postural Sway?

The postural control is improved by implicit somatosensory information from lightly touching a rigid bar or explicit visual information about the postural sway. Whether these two additional sources provided at the same time further reduce the postural sway is still unknown. Participants stood on a force plate as quiet as possible lightly touching the bar while received or not visual feedback of the center of pressure position on a monitor screen. Postural sway reduced similarly with the light touch regardless of the additional visual feedback. The findings suggested that providing explicit visual feedback of the center of pressure does not increase the light touch effects on the postural sway. The importance of the implicit somatosensory information on postural control is discussed.

Gait characteristics of younger-old and older-old adults walking overground and on a compliant surface / Características da marcha de idosas jovens e muito idosas em solo estável e sobre superfície complacente

BACKGROUND: Walking across unstable surfaces disturbs normal stability and efficient strategies must be used to avoid falls. This study identified age-related changes in gait during unstable surface walking. METHOD: Eight healthy younger-old adults (YOG, mean age, 68.6 years) and eight healthy older-old adults (OOG, mean age, 82.1 years) were assessed. Both groups performed the Timed Up and Go Test (TUG) and walked on a rigid and on a compliant surface while kinematic data were obtained. RESULTS: The OOG needed more time to complete the TUG test compared to YOG (F1,14=5.18; p=0.04). The gait speed, stride length and vertical displacement of the foot were similar for both groups, but they were slower (F1,14=5.64; p=0.03) when walking on the compliant surface. The knee and hip range of motion on the sagittal plane (F1,14=191.9; p<0.001 and F1,14=36.4, p<0,001, respectively) increased on the complaint surface but no group effect was found. The displacement of upper trunk on the frontal plane was similar between groups (F1,14=2.43; p=0.14) and conditions (F1,14=1.15; p=0.3). The OOG had greater displacement of the pelvic segment on the frontal plane than the YOG (F1,14=4.9; p=0.04) mainly for the complaint surface. CONCLUSIONS: Older-old individuals have slower TUG test and greater displacement of the pelvic segment on a compliant surface. More challenging tasks and/or environment should be used for gait assessment and intervention of older adults with risk of falls.

CONTEXTUALIZAÇÃO: Caminhar em superfícies instáveis perturba a estabilidade corporal, e estratégias eficientes devem ser utilizadas para evitar quedas. Objetivo: Identificar alterações da marcha relacionadas ao envelhecimento durante a caminhada em superfície instável. MÉTODO: Oito idosos jovens sadios (GIJ, idade média, 68,6 anos) e oito idosos muito idosos sadios (GMI, idade média, 82,1 anos) foram avaliados. Ambos os grupos realizaram o Teste Timed Up and Go (TUG) e andaram sobre uma superfície rígida e uma complacente, enquanto dados cinemáticos foram registrados. RESULTADOS: O GMI levou mais tempo para completar o TUG quando comparado ao GIJ (F1,14=5,18; p=0,04). A velocidade, o comprimento do passo e o deslocamento vertical do pé foram similares entre os grupos, e ambos foram mais lentos (F1,14=5,64; p=0.03) ao andar sobre a superfície complacente. A amplitude de movimento do joelho e do quadril no plano sagital (F1,14=191,9; p<0,001 e F1,14=36,4, p<0,001, respectivamente) aumentaram na superfície complacente, mas nenhuma diferença entre os grupos foi encontrada. O deslocamento do tronco superior no plano frontal foi similar entre os grupos (F1,14=2,43; p=0,14) e condições (F1,14=1,15; p=0,3). O GMI teve maior deslocamento do segmento da pelve no plano frontal do que o GIJ (F1,14=4,9; p=0,04), principalmente na superfície complacente. CONCLUSÃO: Indivíduos muito idosos são mais lentos no TUG e apresentam maior deslocamento do segmento pélvico na superfície complacente. Tarefas e/ou ambientes mais desafiadores deveriam ser usados para avaliação da marcha e intervenção em idosos com risco de quedas.

Analysis of reporting of systematic reviews in physical therapy published in Portuguese.

BACKGROUND: Systematic reviews are considered the best design to synthesize all existing information of a given research topic. To date, there is no study that investigated the quality of reporting of systematic reviews relevant to physical therapy published in Portuguese. OBJECTIVE: To analyse the quality of reporting of systematic reviews in the field of physical therapy published in Portuguese by using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) checklist. METHOD: All systematic reviews published in Portuguese that were indexed on PEDro database up to August 2011 were included. The quality of reporting of the eligible papers was analysed by using the PRISMA checklist. Each quality assessment was performed by two independent reviewers with arbitration of a third reviewer if necessary. RESULTS: A total of 37 systematic reviews were identified. These studies were published between 2003 and 2010. Less than 30% of the PRISMA checklist items were satisfied, being most of the items related to the introduction and discussion sections. No improvements over time were observed. CONCLUSIONS: Most of the studies did not satisfy the items from the PRISMA Checklist. It seems that most of authors did not know the existence of this checklist. The implementation of reporting statements such as the PRISMA statement by Portuguese-written journals is likely to help authors to write their systematic reviews in a more transparent and clear way.

Analysis of reporting of systematic reviews in physical therapy published in Portuguese / Análise da apresentação textual de revisões sistemáticas em fisioterapia publicadas no idioma português

BACKGROUND: Systematic reviews are considered the best design to synthesize all existing information of a given research topic. To date, there is no study that investigated the quality of reporting of systematic reviews relevant to physical therapy published in Portuguese. Objective: To analyse the quality of reporting of systematic reviews in the field of physical therapy published in Portuguese by using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) checklist. METHOD: All systematic reviews published in Portuguese that were indexed on PEDro database up to August 2011 were included. The quality of reporting of the eligible papers was analysed by using the PRISMA checklist. Each quality assessment was performed by two independent reviewers with arbitration of a third reviewer if necessary. RESULTS: A total of 37 systematic reviews were identified. These studies were published between 2003 and 2010. Less than 30% of the PRISMA checklist items were satisfied, being most of the items related to the introduction and discussion sections. No improvements over time were observed. CONCLUSIONS: Most of the studies did not satisfy the items from the PRISMA Checklist. It seems that most of authors did not know the existence of this checklist. The implementation of reporting statements such as the PRISMA statement by Portuguese-written journals is likely to help authors to write their systematic reviews in a more transparent and clear way.

CONTEXTUALIZAÇÃO: As revisões sistemáticas são consideradas a melhor forma de sintetizar toda a informação existente sobre um determinado tópico, porém não se conhece, até o momento, a qualidade da apresentação textual das revisões sistemáticas em fisioterapia publicadas no idioma português. Objetivo: Analisar a apresentação textual de revisões sistemáticas em fisioterapia publicadas no idioma português utilizando as recomendações PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). MÉTODO: Foram analisadas todas as revisões sistemáticas apresentadas na base de dados PEDro até o mês de agosto de 2011. Para a análise da descrição textual foi utilizada a lista de verificação PRISMA. Cada revisão foi avaliada por pares de revisores independentes e, em caso de discordância entre os pares, um terceiro avaliador fez a arbitragem final. RESULTADOS: Foram identificadas 37 revisões sistemáticas que foram publicadas entre os anos de 2003 e 2010. Menos de 30% dos itens da lista de verificação PRISMA foram descritos pelos autores, sendo que a maioria dos itens satisfeitos se refere às seções de introdução e discussão. Observou-se que não houve um aumento na adesão aos itens recomendados para a apresentação textual com o passar do tempo. CONCLUSÕES: A adesão aos critérios preconizados pela lista de verificação da PRISMA é baixa para revisões sistemáticas publicadas no idioma português, o que pode ser reflexo do desconhecimento da existência de tais recomendações. A implementação de recomendações aos autores pelos periódicos nacionais poderá auxiliar os autores na redação de seus artigos, melhorando a clareza com que reportam seus estudos.

Gait characteristics of younger-old and older-old adults walking overground and on a compliant surface.

BACKGROUND: Walking across unstable surfaces disturbs normal stability and efficient strategies must be used to avoid falls. This study identified age-related changes in gait during unstable surface walking. METHOD: Eight healthy younger-old adults (YOG, mean age, 68.6 years) and eight healthy older-old adults (OOG, mean age, 82.1 years) were assessed. Both groups performed the Timed Up and Go Test (TUG) and walked on a rigid and on a compliant surface while kinematic data were obtained. RESULTS: The OOG needed more time to complete the TUG test compared to YOG (F1,14=5.18; p=0.04). The gait speed, stride length and vertical displacement of the foot were similar for both groups, but they were slower (F1,14=5.64; p=0.03) when walking on the compliant surface. The knee and hip range of motion on the sagittal plane (F1,14=191.9; p<0.001 and F1,14=36.4, p<0,001, respectively) increased on the complaint surface but no group effect was found. The displacement of upper trunk on the frontal plane was similar between groups (F1,14=2.43; p=0.14) and conditions (F1,14=1.15; p=0.3). The OOG had greater displacement of the pelvic segment on the frontal plane than the YOG (F1,14=4.9; p=0.04) mainly for the complaint surface. CONCLUSIONS: Older-old individuals have slower TUG test and greater displacement of the pelvic segment on a compliant surface. More challenging tasks and/or environment should be used for gait assessment and intervention of older adults with risk of falls.

Different protocols of physical exercise produce different effects on synaptic and structural proteins in motor areas of the rat brain.

The plastic brain responses generated by the training with acrobatic exercise (AE) and with treadmill exercise (TE) may be different. We evaluated the protein expression of synapsin I (SYS), synaptophysin (SYP), microtubule-associated protein 2 (MAP2) and neurofilaments (NF) by immunohistochemistry and Western blotting in the motor cortex, striatum and cerebellum of rats subjected to TE and AE. Young adult male Wistar rats were divided into 3 groups: sedentary (Sed) (n=15), TE (n=20) and AE (n=20). The rats were trained 3 days/week for 4 weeks on a treadmill at 0.6 km/h, 40 min/day (TE), or moved through a circuit of obstacles 5 times/day (AE). The rats from the TE group exhibited a significant increase of SYS and SYP in the motor cortex, of NF68, SYS and SYP in the striatum, and of MAP2, NF and SYS in the cerebellum, whereas NF was decreased in the motor cortex and the molecular layer of the cerebellar cortex. On the other hand, the rats from the AE group showed a significant increase of MAP2 and SYP in the motor cortex, of all four proteins in the striatum, and of SYS in the cerebellum. In conclusion, AE induced changes in the expression of synaptic and structural proteins mainly in the motor cortex and striatum, which may underlie part of the learning of complex motor tasks. TE, on the other hand, promoted more robust changes of structural proteins in all three regions, especially in the cerebellum, which is involved in learned and automatic tasks.