Validation of the Brazilian version in Portuguese of the Thoracic-Lumbar Control Scale for spinal cord injury.

STUDY DESIGN: Prospective clinical study. OBJECTIVES: This study aimed to translate, adapting to Brazilian version in Portuguese, validate and measure inter and intra-examinator reliability and internal consistency of the Thoracic-Lumbar Control Scale instrument. SETTING: State University of Campinas, São Paulo, Brazil. METHODS: This instrument was translated to Brazilian Portuguese by a bilingual translator, and it was retranslated to English for conflict correction and cultural adaptation. Two physiotherapists were previously trained to standardize the scale administration. In all, 22 patients were selected and initially assessed through FIM and American Spinal Injury Association (ASIA) instruments. Furthermore, they were evaluated through the Thoracic-Lumbar Control Scale by two examiners and revaluated 1 week after by only one examinator. RESULTS: The Brazilian Portuguese version of Thoracic-Lumbar Control Scale showed excellent intra and inter-examinator reliability (0.961 and 0.986), high value of internal consistence (0.934) and significant correlation with ASIA sensory score (r=0.83, P=0.001). CONCLUSIONS: The Brazilian Portuguese version of Thoracic-Lumbar Control Scale is a valid and efficient instrument to assess trunk control of after-spinal cord injury patients, which certifies its replicability by other neurology professionals.

Altered left ventricular diastolic function in subjects with spinal cord injury.

STUDY DESIGN: This is cross-sectional study. OBJECTIVES: The aim of this study is to investigate the cardiac structure and function of subjects with spinal cord injury (SCI) and the impact of metabolic, hemodynamic and inflammatory factors on these parameters. SETTING: São Paulo, Brazil. METHODS: Sixty-five nondiabetic, nonhypertensive, sedentary, nonsmoker men (34 with SCI and 31 healthy subjects) were evaluated by medical history, anthropometry, laboratory tests, analysis of hemodynamic and inflammatory parameters and echocardiography. RESULTS: Subjects with SCI had lower systolic blood pressure and higher levels of C-reactive protein and tumor necrosis factor receptors than the healthy ones. Echocardiography data showed that the SCI group presented similar left ventricular (LV) structural and systolic parameters, but lower initial diastolic velocity (Em) (9.2 ± 0.5 vs 12.3 ± 0.5 cm s(-1); P<0.001) and higher peak early inflow velocity (E)/Em ratio (7.7 ± 0.5 vs 6.1 ± 0.3; P = 0.009) compared with the able-bodied group, even after adjustment for systolic blood pressure and C-reactive protein levels. Furthermore, injured subjects with E/Em >8 had lower peak spectral longitudinal contraction (Sm) (9.0 ± 0.7 vs 11.6 ± 0.4 cm s(-1); P<0.001) and cardiac output (4.2 ± 0.2 vs 5.0 ± 0.2 l min(-1); P = 0.029), as well as higher relative wall thickness (0.38 ± 0.01 vs 0.35 ± 0.01; P = 0.005), than individuals with SCI with E/Em<8, but similar age, body mass index, blood pressure, injury level, metabolic parameters and inflammatory marker levels. CONCLUSION: Subjects with SCI presented impaired LV diastolic function in comparison with able-bodied ones. Moreover, worse LV diastolic function was associated with a pattern of LV concentric remodeling and subclinical decreases in systolic function among injured subjects. Overall, these findings might contribute to explain the increased cardiovascular risk reported for individuals with SCI.

Subclinical atherosclerosis is related to injury level but not to inflammatory parameters in spinal cord injury subjects.

STUDY DESIGN: Cross-sectional. OBJECTIVES: Individuals with spinal cord injury (SCI) exhibit increased carotid intima-media thickness (IMT) and are reported to be exposed to higher circulating levels of inflammatory mediators. This study evaluated the relationship between inflammatory markers and carotid surrogates of cardiovascular risk in subjects with SCI. SETTING: São Paulo, Brazil. METHODS: A total of 65 nondiabetic, nonhypertensive, sedentary, nonsmoker men (34 with SCI; 31 healthy subjects) were evaluated by medical history, anthropometry, routine laboratory tests, analysis of hemodynamic, inflammatory parameters and ultrasound examination of carotid arteries. RESULTS: Subjects with SCI (18 tetraplegic and 16 paraplegic) had lower systolic blood pressure (P = 0.009), higher serum C-reactive protein (P = 0.001), tumor necrosis factor (TNF) receptor-II (P = 0.02) and TNF receptor-I (P = 0.04) levels and increased in vitro production of interleukin-6 by mononuclear cells (P = 0.04), compared to able-bodied individuals. No differences in serum interleukin-6, e-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and transforming growth factor-ß levels, or in vitro release of interleukin-10, interleukin-17 and interferon-γ by mononuclear cells, were detected between the studied groups. Common carotid IMT, but not internal carotid resistive index, was significantly higher in subjects with SCI (P<0.0001 adjusted for C-reactive protein and TNF receptor-II levels). In addition, tetraplegic subjects exhibited increased IMT (P = 0.002 adjusted for systolic blood pressure and body mass index), but similar levels of inflammatory mediators compared to paraplegic ones. CONCLUSIONS: Individuals with SCI exhibit a clustering of vascular and inflammatory surrogates of increased cardiovascular risk. Nevertheless, subclinical carotid atherosclerosis is related to injury level but not to increased inflammatory status in these subjects.

Pulmonary function testing in quadriplegic subjects.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: Pulmonary functional capacity in 23 Brazilian quadriplegic subjects (ASIA A), aged 30 (9.5) years, weight 66 (10.75) kg, height 176 (7) cm, was investigated at 42 (64) months postinjury. SETTING: University Hospital--UNICAMP, Campinas, Brazil. METHOD: Subjects performed forced vital capacity (FVC) and maximal voluntary ventilation (MVV) tests while seated in their standard wheelchairs. Forced Expired Volume after 1 s (FEV1) and FVC/FEV1 ratio were calculated from these tests. Values obtained were compared to three prediction equations from the literature that are used specifically for spinal cord subjects and include different variables in their formulae, such as age, gender, height, postinjury time and injury level. Data are expressed as median (interquartile interval). Differences between values were demonstrated by median confidence interval with significance level set at alpha=0.05. RESULTS: Obtained data were statistically different from prediction equation results, with FVC 3.11 (0.81), 4.46 (0.28), 4.16 (0.33), 4.26 (0.42); FEV1 2.77 (1.03), 3.67 (0.21), 3.66 (0.30), 3.45 (0.39) and MVV 92 (27), 154.2 (11.9), 156.6 (14), 157.3 (16.8), where the first value is obtained experimentally and the second, third and fourth values correspond to predicted values. The results obtained from spirometry test in this study differed significantly from the results obtained when prediction equations were used. CONCLUSION: The use of prediction equations developed to estimate pulmonary function in wheelchair users significantly overestimates pulmonary function of quadriplegic individuals with complete lesions (ASIA group A), in comparison to measured values.

Comparação das respostas cardiorrespiratórias entre exercício de carga constante e incremental abaixo, acima e no limiar de anaerobiose ventilatório / Comparison of cardiorespiratory responses between constant and incremental load exercises below, above and at the ventilatory anaerobic threshold

OBJETIVO: Aplicar diferentes metodologias de análise aos dados dos testes contínuo em rampa (TCR) e descontínuo em degrau (TDD) e comparar as respostas das variáveis cardiorrespiratórias. MÉTODOS: 8 homens realizaram teste ergoespirométrico em bicicleta: TCR com incremento de 20 a 25W.min-1 e TDD em degraus de 15min cada baseado no limiar de anaerobiose ventilatório (LAV) do TCR, sendo degrau 1 (70 por centoLAV), degrau 2 (100 por centoLAV) e degrau 3 (130 por centoLAV). O LAV foi determinado pela perda do paralelismo entre consumo de oxigênio (VO2) e produção de dióxido de carbono (VCO2). A freqüência cardíaca (FC bpm),VCO2, VO2, (ml.min-1), VO2, (ml.kg-1.min-1), ventilação (VE L.min-1) do TCR foram analisadas em médias móveis de 8 ciclos respiratórios, respiração-a-respiração e pela regressão linear. No TDD, a média foi aplicada do 3° ao 15°min dos degraus. Na análise estatística foram utilizados o teste de Kolmogorov-Smirnov, ANOVA, post hoc de Tukey-Kramer e regressão linear, p<0,05. RESULTADOS: No pico do exercício houve diferença estatisticamente significante entre respiração-a-respiração e demais metodologias. Na comparação de protocolos: VO2, VCO2, V E foram similares entre LAV e degrau 1 (p>0,05), porém VO2 relativo foi diferente (p<0,05) entre LAV e todos os degraus; a FC mostrou diferença (p<0,05) entre LAV e degrau 3, e na análise entre os três degraus houve diferença (p<0,05). CONCLUSÃO: Os resultados indicam que a regressão linear foi eficaz para estimar as variáveis cardiorrespiratórias. Em relação aos protocolos, verificou-se que para a obtenção no TDD de valores cardiorrespiratórios similares ao LAV do TCR foi necessário diminuir a potência em 30 por cento.