Translation into Brazilian Portuguese, cross-cultural adaptation, reliability and validation of the Functional Ambulation Classification for the categorization of ambulation following a stroke in a clinical setting. / Traducción al portugués brasileño, adaptación transcultural, fiabilidad y validación de la Functional Ambulation Classification para la categorización de deambulación postictus en un entorno clínico.

INTRODUCTION: The Functional Ambulation Classification (FAC) is the only scale that classifies the gait of individuals with multiple sclerosis and stroke victims into ambulation categories. However, the FAC is only available in English and studies conducted in Brazil have used the FAC without an adequate translation and analysis of its measurement properties. AIM: To translate, cross-culturally adapt the FAC to Brazilian Portuguese, test its reliability and concurrent validity on stroke survivors. PATIENTS AND METHODS: The translation and cross-cultural adaptation involved six steps. Inter-observer reliability was tested with five physiotherapists who watched videos of the gait of the stroke survivors and watched a second time after at least one week for the determination of intra-observer reliability. Concurrent validity was determined by correlating the FAC with the result of the 10-meter Walk Test (10mWT). RESULTS: Intra-observer reliability ranged from kappa 0.680 to 0.952 (p = 0.001) and inter-observer reliability ranged from kappa 0.517 to 0.794 (p = 0.001). The correlation between the FAC and 10mWT was rs = 0.771 (p = 0.001). CONCLUSION: The translation, cross-cultural adaptation and measurement properties demonstrated that the FAC is a valid, reliable clinical measure for the categorization of ambulation in the Brazilian population of stroke survivors in a clinical setting.

TITLE: Traducción al portugués brasileño, adaptación transcultural, fiabilidad y validación de la Functional Ambulation Classification para la categorización de deambulación postictus en un entorno clínico.Introducción. La Functional Ambulation Classification (FAC) es la única escala que clasifica la marcha de individuos con esclerosis múltiple e ictus en categorías de deambulación. Sin embargo, la FAC sólo está disponible en la versión en inglés y los estudios realizados en Brasil la han utilizado sin una traducción y análisis adecuados de propiedades psicométricas. Objetivo. Traducir y adaptar culturalmente la FAC para el portugués brasileño y probar su fiabilidad y validez concurrente en individuos afectados por ictus. Pacientes y métodos. La traducción y la adaptación transcultural implicaron seis pasos. La fiabilidad interevaluador se probó con cinco fisioterapeutas que vieron vídeos de la marcha de las personas afectadas por ictus y, después de un intervalo mínimo de una semana, los vieron por segunda vez para determinar la fiabilidad intraevaluador. La validez concurrente se determinó correlacionando la FAC con el resultado de la prueba de marcha de 10 metros (PM10m). Resultados. La fiabilidad intraevaluador varió entre un valor kappa de 0,68-0,95 (p = 0,001), y la fiabilidad interevaluador, un valor kappa de 0,517-0,794 (p = 0,001). La correlación entre la FAC y la PM10m fue rs = 0,771 (p = 0,001). Conclusión. La traducción, la adaptación transcultural y el análisis de las propiedades psicométricas demostraron que la FAC es una medida clínica válida y fiable para clasificar la deambulación de los individuos brasileños afectados por ictus en un entorno clínico.

Validation and reproducibility of the Glittre activities of daily living test for individuals with Parkinson's disease. / Validación y reproducibilidad de la prueba Glittre de actividades de la vida diaria en personas con enfermedad de Parkinson.

AIM: To investigate the validity and reproducibility of the Glittre Activities of Daily Living (Glittre-ADL) test for individuals with Parkinson's disease. SUBJECTS AND METHODS: Thirty individuals with Parkinson's disease and 19 healthy individuals (control group) were evaluated. Parkinson's disease group was evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS) and underwent the Glittre-ADL test, six-minute walk test (6MWT) and ten-meter walk test (10mWT). Control group performed the Glittre-ADL test. For the intraobserver analysis, two Glittre-ADL tests were performed. For the interobserver analysis, the Glittre-ADL test was repeated on a different day by a second examiner. RESULTS: The Glittre-ADL test was significantly correlated with UPDRS Section II, Section III, and total score. The Glittre-ADL test was inversely correlated with the 6MWT and positively correlated with the 10mWT. The time required to perform the Glittre-ADL test was shorter on the retest in the intraobserver analysis and in the interobserver analysis. The mean difference between the first and second tests, the standard error of measurement and minimum detectable change in minutes were 0.40, 0.08 and 0.24, respectively, for intraobserver, and 0.40, 0.22 and 0.62, for interobserver. CONCLUSION: The Glittre-ADL test is valid and reproducible to evaluate functional capacity in individuals with Parkinson's disease.

TITLE: Validación y reproducibilidad de la prueba Glittre de actividades de la vida diaria en personas con enfermedad de Parkinson.Objetivo. Investigar la validez y la reproducibilidad de la prueba Glittre de actividades de la vida diaria (AVD-Glittre) para personas con enfermedad de Parkinson. Sujetos y métodos. Se evaluó a 30 pacientes con enfermedad de Parkinson y 19 sujetos sanos (grupo de control). El grupo con enfermedad de Parkinson fue evaluado con la Unified Parkinson's Disease Rating Scale (UPDRS) y sometido a la prueba AVD-Glittre, la prueba de marcha de seis minutos (6MWT) y la prueba de marcha de 10 metros (10mWT). El grupo de control realizó la prueba AVD-Glittre. Para el análisis intraobservador se realizaron dos pruebas AVD-Glittre, y para el análisis interobservador, la prueba se repitió otro día con un segundo examinador. Resultados. La prueba AVD-Glittre se correlacionó significativamente con la sección II, la sección III y la puntuación total de la UPDRS. Se correlacionó inversamente con la 6MWT y positivamente con la 10mWT. El tiempo requerido para realizar la prueba AVD-Glittre fue más corto en la nueva prueba en el análisis intraobservador y en el análisis interobservador. La diferencia de medias entre la primera y la segunda pruebas, el error estándar de medición y el cambio mínimo detectable en minutos fueron 0,40, 0,08 y 0,24, respectivamente, para el análisis intraobservador, y 0,40, 0,22 y 0,62, respectivamente, para el análisis interobservador. Conclusión. La prueba AVD-Glittre es válida y reproducible para evaluar la capacidad funcional en personas con enfermedad de Parkinson.

[Analysis of fatigue associated to periodic limb movement during sleep in former poliomyelitis patients]. / Análisis de la fatiga asociada al movimiento periódico de las extremidades durante el sueño en pacientes con antecedente de poliomielitis.

INTRODUCTION: Following poliomyelitis, patients may experience sleep disorders stemming from periodic limb movement, leading to fatigue and compromised muscle function the following day. AIM: To establish the presence or absence of muscle fatigue in these patients using electromyography and relating the data to polysomnographic findings. PATIENTS AND METHODS: An analytical cross-sectional study was carried out involving 19 individuals with motor sequelae in the lower limbs stemming from poliomyelitis. Quantitative tests for the assessment of neurophysiological aspects (knee-jerk/Achilles reflexes and peripheral muscle strength of rectus femoris) and a sleep study (standard, level I polysomnography) were administered. RESULTS: A statistically significant difference was detected (p < 0.01) in muscle strength, demonstrating muscle fatigue associated to sleep disorder. CONCLUSION: Individuals with sequelae from poliomyelitis exhibit sleep disorders that may lead to muscle fatigue. Periodic limb movement may contribute to this phenomenon.

Analysis of electromyographic muscles activity of gait in healthy subjects with and without AFO developed for patients with hemiparesis.

The aim of the present study was to analyze the electromyographic (EMG) signals of the rectus femoris (RF), vastus lateralis (VL), tibialis anterior (TA) and soleus (SO) muscles in young healthy adults with and without the use of an experimental ankle-foot-orthosis (AFO) designed for patients with hemiparesis. Twenty-eight individuals with an average age of 22 +/- 3.63 years participated in the study. An electromyograph, surface electrodes and two force plates were used. There was a non-significant increase in the TA activity with the use of the AFO (6.04 +/- 2.81) when compared to non-use (5.91 +/- 2.49) (p > 0.5); the same was true for the other muscles evaluated. There was a positive correlation (r = 0.37) between TA and SO activity (p < 0.05). The results demonstrate that the AFO did not affect the gait pattern of healthy young adults.

Neurophysiological comparison between the Sit-to-Stand test with the 6-Minute Walk test in individuals with COPD.

OBJECTIVES: The Sit-to-Stand test (SST) is accepted and utilized during functional assessments of COPD patients, along with the 6-Minute Walk test (6MWT). Since there is a lack of evidence in literature regarding the neurophysiological effectiveness of SST compared to 6MWT, the present study is justified with the purpose of assessing the neurophysiological effectiveness of SST in comparison to the 6MWT during the functional assessment of such patients, once it is known that both tests are good predictors of functional state. METHODS: Fourteen patients with moderate to severe COPD randomly performed the 6MWT and the SST with a 30-minute interval in between tests. Blood lactate was collected along with the median frequency (MDF), obtained with the electromyography of the muscles rectusfemoris (RF), vastus lateralis (VL), tibialis anterior (TA), and soleus (SO) for the comparison of the neurophysiological effectiveness. RESULTS: The results of the blood lactate concentration during rest and at the end of the functional tasks along with the results from the angular coefficient (AC) obtained from the median frequency were analyzed with the Student t test. The initial and final values obtained from SST and 6MWT were compared within each activity, along with the comparison between the initial and final values for each functional test. A significant difference (p = 0.0005) was only verified between the initial and final values of SST. CONCLUSION: We found neurophysiological correlation between both tests which enabled us to suggest that SST may determine functional status as easily as the 6MWT in regard to neurophysiological effectiveness.

Electromyographic analysis of biceps brachii muscle following neural mobilization in patients with stroke.

OBJECTIVES: The proposal of the present study is based on mobilizing the nervous system of the upper hemiplegic limb of stroke victims using the Upper Limb Neurodynamic Test (ULNT 1) and electromyographic analysis of the biceps brachii muscle. METHODS: A pre-experimental study was carried out with pretest and posttest repeated measurements on five stroke victims (4 men and 1 woman; mean age: 52.8 +/- 11 years), with Grade 1 and + 1 spasticity, according to the modified Ashworth scale. Electromyographic analysis of the biceps brachii muscle was performed with the elbow flexed at 90 degrees, following by complete extension. RESULTS: The neurodynamic test led to a decrease in electromyographic activity in the biceps brachii muscle (p < or = 0.05). CONCLUSION: Neural mobilization was efficient in reducing myoelectric activity in the biceps brachii muscle in patients with stroke and may used by physiotherapists as an efficient method for treating patients with this pathology.

Atividade muscular durante a marcha após acidente vascular encefálico / Muscle activity during gait following stroke

OBJECTIVE: To compare muscle activity and joint moments in the lower extremities during walking between subjects with stroke and control subjects. METHOD: We compared fifteen healthy volunteers and fifteen stroke patients, with the same age gender and weight data had been compared by electromyography. The system of signals acquisition used consisted of five pairs of electrodes of surface, beyond one electrogoniometer on the axis articulate of rotation of the joint of the ankle in study. RESULTS: Onset times with respect to heel-strike for the medial gluteus, tibialis anterior, soleus, rectus femoris and medial hamstring muscles were significantly earlier during the gait cycle in subjects with stroke than in control subjects. The cessation times of soleus, tibialis anterior, rectus femoris, and medial hamstring muscles were significantly prolonged in subjects with stroke. CONCLUSION: Subjects with stroke showed more co-contractions of agonist and antagonist muscles at the ankle and knee joints during stance phase. These gait changes and co-contractions may allow subjects with stroke to adopt a safer, more stable gait pattern to compensate for diminished sensory information from the ankle.

OBJETIVO: Buscar parâmetros da marcha de pacientes após ter sofrido acidente vascular encefálico (AVE) com hemiparesia. MÉTODO: Comparados 15 voluntários pós-AVE e 15 voluntários saudáveis com a mesma idade, gênero e peso. A comparação foi feita por eletromiografia utilizando cinco pares de eletrodos de superfície do lado comprometido (espástico) e um eletrogoniômetro sobre o eixo articular de rotação da articulação do tornozelo em estudo. RESULTADOS: O início da atividade eletromiográfica, a partir da fase de apoio, para os músculos glúteo medial, reto femoral, tibial anterior, sóleo, e porção medial dos isquiotibiais foi significantemente ativados anteriormente durante o ciclo da marcha nos voluntários pós-AVE. O final da atividade eletromiográfica para os músculos reto femoral, tibial anterior, sóleo, e porção medial dos isquiotibiais foi significantemente prolongado nos voluntários pós-AVE. Voluntários pós-AVE demonstraram também mais co-ativação dos músculos agonistas e antagonistas da articulação do tornozelo e joelho durante a fase de balanceio. CONCLUSÃO: Essas alterações e co-contrações musculares da marcha permitem que os voluntários pós-AVE adotem um padrão de marcha mais seguro e mais estável para compensar a diminuição da informação sensorial da articulação do tornozelo.

Effects of different protocol doses of low power gallium-aluminum-arsenate (Ga-Al-As) laser radiation (650 nm) on carrageenan induced rat paw ooedema.

The purpose of the present study was to investigate the effect of the low power laser therapy on the acute inflammatory process. Male Wistar rats were used. The rat paw oedema was induced by sub-plantar injection of carrageenan, the paw volume was measured before and 1, 2, 3 and 4 h after the injection using a hydroplethysmometer. To investigate the mechanism action of the Ga-Al-As laser on inflammatory oedema, parallel studies were performed using adrenallectomized rats or rats treated with sodium diclofenac. Different laser irradiation protocols were employed for specific energy densities (EDs), exposure times and repetition rates. The rats were irradiated with the Ga-Al-As laser during 80 s each hour. The ED that produced an anti-inflammatory effect were 1 and 2.5 J/cm(2), reducing the oedema by 27% (P<0.05) and 45.4% (P<0.01), respectively. The ED of 2.5 J/cm(2) produced anti-inflammatory effects similar to those produced by the cyclooxigenase inhibitor sodium diclofenac at a dose of 1 mg/kg. In adrenalectomized animals, the laser irradiation failed to inhibit the oedema. Our results suggest that low power laser irradiation possibly exerts its anti-inflammatory effects by stimulating the release of adrenal corticosteroid hormones.