Avaliação do membro superior pós-acidente vascular encefálico: correlação das escalas Motor Activity Log, Fugl-Meyer e Medida de Independência Funcional / Assessment of upper limb pos-stroke: correlation between Motor Activity Log, FuglMeyer and Functional Independence Measure scales

Objetivo: O objetivo do estudo foi identificar a correlação existente entre as escalas de avaliação do Membro Superior (MS), Motor Activity Log (MAL), Medida de Independência Funcional (MIF) e Escala de desempenho físico de Fugl-Meyer (FM) em indivíduos pósAcidente Vascular Encefálico (AVE). Métodos: Trata-se de um estudo transversal onde 20 indivíduos com AVE crônico foram avaliados por meio de um questionário sócio-demográfico e com as escalas: Mini Exame do Estado Mental (MEEM), MAL, MIF e FM seção MS (FM-MS). O teste de Correlação de Spearman foi utilizado e adotado significância de 5%. Resultados: Os participantes tinham idade média de 63 anos e 55% eram do gênero masculino. O tempo médio de lesão foi de 5 anos, 65% tinham um evento de AVE e predomínio da lesão no hemicorpo direito. Na categorização do MS observou-se moderada qualidade e quantidade de uso, com comprometimento sensório-motor leve e maior independência funcional. Houve boa correlação da FM-MS com MAL qualitativa e quantitativa (p=0,001), MIF motora (p=0,003) e MIF total (p=0,002); assim como, MIF motora com FM punho (p=0,0001) e FM ombro-braço (p=0,004). Foi identificada forte correlação entre FM-MS coordenação-velocidade com MAL quantitativa e qualitativa (p=0,0001) e entre subcategorias da MAL, FM-MS e MIF individualmente (p=0,0001). Conclusão: As subcategorias das três escalas se complementam e estabelecem uma relação fidedigna para predizer o quadro clínico do paciente pós-AVE, sendo reprodutível a sua utilização integrada na prática clínica para desenvolver diagnóstico fisioterapêutico e cinético-funcional. (AU)

Objectives: The aim of the study was to identify the correlation between the assessment scales of the Upper Limb (UL), Motor Activity Log (MAL), Functional Independence Measure (MIF) and Fugl-Meyer Physical Performance Scale (FM) of individuals post-stroke. Methods: This is a cross-secctional study in which 20 individuals with chronic stroke were evaluated using a sociodemographic questionnaire and with the scales: Mini Mental State Examination (MMSE), MAL, MIF and UL section of FM (FM-UL). The spearman correlation test was used and adopted significance of 5%. Results: The participants had mean age of 63 years and 55% were males. The mean time of injury was 5 years, 65% had one stroke event and a predominance of the right half-body lesion. In the categorization of UL, moderate quality and quantity of use were observed, with mild sensorimotor impairment and greater functional independence. There was good correlation of FM-UL with qualitative and quantitative MAL (p=0.001), motor MIF (p = 0.003) and total MIF (p = 0.002); as well as, motor MIF with FM wrist (p = 0.0001) and FM shoulder-arm (p=0.004). It was identified a strong correlation between FM-UL coordinationvelocity with quantitative and qualitative MAL (p = 0.0001) and between sub-categories of MAL, FM-UL and MIF individually (p = 0.0001). Conclusion: The subcategories of the three scales are complementary and establish a reliable relationship to predict the clinical picture of post-stroke patients, being reproducible their utilization in the clinical practice to develop physiotherapeutic and kinetic-functional diagnosis.(AU)

Perfil Social e Funcional dos Usuários da Estratégia Saúde da Família com Acidente Vascular Encefálico / Social and Functional Profile of Userswith Stroke Assisted by the Family Health Strategy

Objetivo: Analisar o perfil social e funcional dos usuários de Unidade Básica de Saúde/Estratégia Saúde da Família com Acidente Vascular Encefálico (AVE) em Santa Cruz, município do estado do Rio Grande do Norte. Material e Métodos: Tratase de um estudo transversal constituído por 39 indivíduos com diagnóstico clínico de AVE. Foram avaliados o perfil sociodemográfico e o comprometimento cognitivo, funcional e sensório motor através das escalas: Mini Exame do Estado Mental (MEEM), Medida de Independência Funcional (MIF), Escala de Equilíbrio de Berg (EEB), Protocolo de Desempenho Físico Fugl-Meyer (FM), Timed Up and Go (TUG) e a escala de Deambulação Funcional (FAC). Resultados: A idade média dos indivíduos foi 68,94±14,01 anos onde 56,41% eram mulheres, 58,97% casados, 58,97% pardos, 46,15% analfabetos, 41,03% agricultores, 71,79% aposentados e 84,62% residentes em casa própria. O hemisfério cerebral esquerdo (56,41%) e o tipo isquêmico (61,54%) mostraram-se mais prevalentes nesta população. O tempo de lesão após o AVE foi de 6,7±6,9 anos, onde 66,67% apresentaram um único evento. 97,40% dos avaliados apresentavam fatores de risco associados. A Hipertensão Arterial Sistêmica (HAS) (74,35%) foi o de maior destaque. No MEEM observou-se 82,05% da amostra com grave comprometimento cognitivo, 48,72% com pontuação da MIF indicando maior independência funcional, grave comprometimento motorna FM (46,88%) e equilíbrio pobre com significativo risco para quedas na pontuação da EEB (43,59%) e TUG (36%). Conclusão: O elevado acometimento do AVE está relacionado com as características epidemiológicas da região,assim como os déficits funcionais, cognitivos e sensório motores encontrados evidenciando um grave problema de saúde pública. (AU)

Objective: To analyze the social and functional profile of users with stroke assisted by the Primary Care Health Unit/ Family Health Strategy in the city of Santa Cruz, Rio Grande do Norte State, Brazil. Materials and Methods: This was a cross-sectional study including 39 individuals with a clinical diagnosis of stroke. The sociodemographic, cognitive, functional and sensory motor impairment profiles of the users were evaluated using the following tools: Mini-Mental State Examination (MEEM), Functional Independence Measure (MIF), Berg Balance Scale (EEB), Fugl-Meyer Assessment Scale (FM), Timed Up and Go (TUG) and Functional Ambulation Scale (FAC). Results: The mean age of individuals was 68.94±14.01 years, where 56.41% were woman, 58.97% married, 58.97% mixed race, 46.15% illiterate, 41.03% farmers, 71.79% retirees, and 84.62% living in their own house. The leftcerebral hemisphere (56.41%) was the most affected side and ischemic stroke (61.54%) the most prevalent condition in this population. The injury time after stroke was 6.7±6.9 years, and66.67% of the individual shad a single stroke; 97.4% of them presented as sociated risk factors, particularly systemic arterial hypertension (HAS) (74.35%). The MEEM indicated that 82.05% of the sample had severe cognitive impairment; 48.72% of the sample showed MIF score indicative of functional independence; 46.88% showed severe motor impairment in FM; and poor balance with significant risk for falls was found to be 43.59%and 36% based on EEB and TUG scores, respectively. Conclusion: The high prevalence of stroke is related with the epidemiological characteristics of the region as well as with functional, cognitive and sensory motor deficits, which indicates a serious public health problem. (AU)

Upper limb assessment in tetraplegia: clinical, functional and kinematic correlations.

The aim of this study was to correlate clinical and functional evaluations with kinematic variables of upper limp reach-to-grasp movement in patients with tetraplegia. Twenty chronic patients were selected to perform reach-to-grasp kinematic assessment using a target placed at a distance equal to the arm's length. Kinematic variables (hand peak velocity, movement time, percent time-to-maximal velocity, index of curvature, number of peaks, and joint range of motion) were correlated to clinical (Standard Neurological Classification of Spinal Cord Injury-American Spinal Injury Association) and functional [Functional Independence Measure (FIM) and Spinal Cord Independence Measure II (SCIM II)] evaluation scores. Twenty control participants were also selected to obtain normal reference parameters. There was a positive correlation between total motor index and FIM (r=0.6089; P=0.0044) and SCIM II (r=0.5229; P=0.018). Both functional scores showed positive correlation with each other (r=0.8283; P<0.0001). A correlation was also observed between the right and left motor indices, the motor FIM, and the SCIM II in most of the reach-to-grasp kinematic variables studied (hand peak velocity, movement time, index of curvature, and number of peaks). In contrast, for the joint range of motion (shoulder, elbow, and wrist), only the wrist in the horizontal plane showed correlation with clinical variables. This study shows that muscle strength assessed by the American Spinal Injury Association motor index influences the reach-to-grasp kinematic variables of patients with tetraplegia. However, the functional assessments did not present the same influence.

Avaliação cinemática da transferência de paraplégicos da cadeira de rodas / Kinematic assessment of transfer of paraplegic subjects from the wheelchair

OBJETIVO: Avaliar a estratégia das transferências de paraplégicos da cadeira de rodas. MÉTODOS: Participaram do estudo doze sujeitos lesados medulares (T2 a T12), aptos a realizar independentemente a transferência da cadeira de rodas para um tablado com um metro quadrado (m²) de área por meio metro de altura. As imagens de marcadores reflexivos nos pontos anatômicos foram capturadas por seis câmeras de infravermelho ProReflex e processadas através de um software específico (QTrac). Parâmetros cinemáticos do tronco, cabeça, ombros e cotovelos foram avaliados. RESULTADOS: Os dados analisados comparam o lado preferencial do sujeito para realizar a transferência com o lado não preferencial, de acordo com as funções desempenhadas de cada segmento corporal. O deslocamento angular da cabeça no plano sagital (y-z) e ombros no plano transversal (x-y) mostraram significâncias estatísticas (p<0,05). Conclusão: Os dados obtidos neste estudo mostraram que há diferenças na estratégia da transferência dos paraplégicos do lado preferencial em comparação com o lado não preferencial. Nível de Evidência II, Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com padrão de evidência "ouro" aplicado).

OBJECTIVE: To evaluate the transfer strategy of paraplegic subjects from their wheelchairs. METHODS: Twelve thoracic spinal cord injured subjects participated in this study (T2 to T12). The subjects were able to independently transfer from a wheelchair to a one square meter (m2) table, half a meter in height. Images of reflexive anatomic markers were captured by six ProReflex infrared cameras and processed using a QTRac Capture software. Kinematic parameters of the trunk, head, shoulders and elbows were evaluated. RESULTS: The data analyzed compared the subjects' preferential side for performing transfers, according to the functions performed by each body segment. Angular displacement of the head on sagittal plan (y-z), and the shoulders on the transversal plan (x-y), showed statistical differences (p<0.05). Conclusion: the data obtained on this study showed that there are differences in transfer strategies of paraplegic subjects to their preferential side, in comparison with the non-preferential side. Level of Evidence II, Development of diagnostic criteria on consecutive patients (with universally applied reference "gold" standard).

Post-stroke motor and functional evaluations: a clinical correlation using Fugl-Meyer assessment scale, Berg balance scale and Barthel index.

UNLABELLED: Stroke is one of the major causes of morbidity and mortality. Sequels deriving from this event may lead to motor disability and from mild to severe deficits. In order to better classify sensory-motor dysfunction, balance and ability to perform activities of daily living, quantitative and qualitative evaluation scales have been used. OBJECTIVE: To correlate the scales Fugl-Meyer assessment scale, Berg balance scale and Barthel index. Twenty subjects with sequel after a single, unilateral stroke in chronic phase (>6 months post ictus) were evaluated for about one hour. RESULTS: Barthel scale was statistically related to the total motor score of Fugl-Meyer assessment (r=0.597, p=0.005). The lower limb section at Fugl-Meyer had positive correlation with Berg scale (r=0.653, p=0.002) and with the balance section of Fugl-Meyer own scale (r=0.449, p=0.047). Both balance scales were correlated one with other (r=0.555, p=0.011). Statistical divergence appeared when Barthel's Index was correlated with Berg's Scale (r=0.425, p=0.062), and it is not statistically significant. CONCLUSION: The use of both quantitative and qualitative scales was shown to be a good measuring instrument for the classification of the general clinical performance of the patient, especially when positively related joint evaluations are applied.

Post-stroke motor and functional evaluations: a clinical correlation using Fugl-Meyer assessment scale, Berg balance scale and Barthel index / Avaliações motoras e funcionais pós-AVC: correlação clínica usando a escala de desempenho físico de Fugl-Meyer, a escala de equilíbrio de Berg e o índice de Barthel

Stroke is one of the major causes of morbidity and mortality. Sequels deriving from this event may lead to motor disability and from mild to severe deficits. In order to better classify sensory-motor dysfunction, balance and ability to perform activities of daily living, quantitative and qualitative evaluation scales have been used. OBJECTIVE: To correlate the scales Fugl-Meyer assessment scale, Berg balance scale and Barthel index. Twenty subjects with sequel after a single, unilateral stroke in chronic phase (>6 months post ictus) were evaluated for about one hour. RESULTS: Barthel scale was statistically related to the total motor score of Fugl-Meyer assessment (r=0.597, p=0.005). The lower limb section at Fugl-Meyer had positive correlation with Berg scale (r=0.653, p=0.002) and with the balance section of Fugl-Meyer own scale (r=0.449, p=0.047). Both balance scales were correlated one with other (r=0.555, p=0.011). Statistical divergence appeared when Barthel's Index was correlated with Berg's Scale (r=0.425, p=0.062), and it is not statistically significant. CONCLUSION: The use of both quantitative and qualitative scales was shown to be a good measuring instrument for the classification of the general clinical performance of the patient, especially when positively related joint evaluations are applied.

O acidente vascular cerebral (AVC) é reconhecido como uma das maiores causas de morbidade e mortalidade. Seqüelas decorrentes deste evento podem levar a inabilidade motora e déficits leves a graves. Para classificar melhor a disfunção sensitivo-motora, o equilíbrio e as habilidades para as atividades de vida diária, escalas de avaliações quantitativas e qualitativas estão sendo utilizadas. OBJETIVO: Correlacionar a escala de desempenho físico de Fugl-Meyer, a escala de equilíbrio de Berg e o índice de Barthel. MÉTODO: Foram selecionados 20 sujeitos com sequela de um único e unilateral AVC em fase crônica (>6 meses pós ictal), que passaram pelas avaliações por cerca de uma hora. RESULTADOS: A escala de Barthel correlacionou-se com a pontuação motora total de Fugl-Meyer (r=0,597, p=0,005). A seção para membros inferiores de Fugl-Meyer teve correlação positiva com a de Berg (r=0,653, p=0,002) e com a seção de equilíbrio da própria escala de Fugl-Meyer (r=0,449, p=0,047). Ambas as escalas de equilíbrio tiveram correlação entre si (r=0555, p=0,011). A divergência estatística apareceu quando se correlacionou a Escala de Barthel com o índice de Berg (r=0,425, p=0,062), não sendo estatisticamente significativo. CONCLUSÃO: O uso de escalas quantitativas e qualitativas mostrou ser um bom instrumento de medida para a classificação do quadro físico geral do paciente, ainda mais quando são aplicadas avaliações em conjunto que se relacionam positivamente.