Alterações cardiorrespiratórias em indivíduos hemiparéticos crônicos pós-acidente vascular cerebral / Cardiorespiratory changes in chronic post-stroke hemiparetic patients

Objetivo: Analisar a função cardiorrespiratória em pacientes he- miparéticos crônicos pós-acidente vascular cerebral. Métodos: Estudo retrospectivo, por meio da análise de dados de prontuários de pacientes submetidos ao teste de caminhada de 6 minutos e manovacuometria em uma clínica de fisioterapia de um centro universitário. Foram analisados os dados de sete prontuários. Re- sultados: A média de metros percorridos pelos participantes no teste de caminhada de 6 minutos foi de 199,5. Os valores percentuais da manovacuometria foram de -41,34 na pressão inspiratória máxima e de 57,85 na pressão expiratória máxima. Conclusão: Os dados desta pesquisa sugerem que indivíduos hemiparéticos crônicos apresentam fadiga respiratória e muscular, diminuição da capacidade funcional durante a marcha e fraqueza dos músculos respiratórios.

Objective: To analyze the cardiorespiratory function in chronic post-stroke hemiparetic patients. Methods: This is a retrospective study, through data analysis of medical records from patients who underwent the 6-minute walk test and manovacuometry, in a physical therapy clinic of a university center. Results: The mean number of meters walked by participants in the 6-minut walk test was 199.5 meters. The percentage values of manovacuometry were -41,34 in the maximun inspiratory pressure and 57.85 in the maximun expiratory pressure. Conclusion: The data from this survey suggest that chronic hemiparetic individuals have respiratory and muscle fatigue, decreased functional capacity during gait, and respiratory muscle weakness.

Body weight support through a walking cane in inexperienced users with knee osteoarthritis.

BACKGROUND: Walking canes are a self-management strategy recommended for people with knee osteoarthritis (OA) by clinical practice guidelines. Ensuring that an adequate amount of body-weight support (%BWS) is taken through the walking cane is important as this reduces measures of knee joint loading. RESEARCH QUESTION: 1) How much body weight support do people with knee OA place through a cane? 2) Do measures of body weight support increase following a brief simple training session? METHODS: Seventeen individuals with knee pain who had not used a walking cane before were recruited. A standard-grip aluminum cane was then used for 1 week with limited manufacturer instructions. Following this, participants were evaluated using an instrumented force-measuring cane to assess body weight support (% total body weight) through the cane. Force data were recorded during a 430-metre walk undertaken twice; once before 10 min of cane training administered by a physiotherapist, and once immediately after training. Measures of BWS (peak force, average force, impulse equal to the average cane force times duration, and cane-ground contact duration) were extracted. Using bathroom scales, training aimed to take at least 10% body weight support through the cane. RESULTS: Before training, the average peak BWS was 7.2 ± 2.5% of total body weight. Following 10 min of training, there was a significant increase in average peak BWS by 28%, average BWS by 25%, and BWS impulse by 54% (p < 0.05). However, individual BWS responses to training were variable. Duration of cane placement increased by 22% after training (p = 0.02). Timing of peak BWS through the cane occurred at 51% of contact phase before training, and at 53% after training (p = 0.05). SIGNIFICANCE: A short training session can increase the transfer of body weight through a walking cane. However, more sophisticated feedback may be needed to achieve target levels of BWS.

Exploring potential prejudice toward older adult mobility device users.

Many older adults require assistive technology to maintain mobility (e.g., canes, walkers, wheelchairs, or scooters), but concerns about experiencing prejudice because of mobility devices can deter use. We explore this potential prejudice in a sample recruited through online crowdsourcing. Overall, prejudice toward older adult mobility device users was not observed. Older adult mobility device users were evaluated more positively than common prejudice target groups. However, heightened prejudice toward older adult mobility device users was observed among those higher in authoritarianism or social dominance orientation. This was explained by perceptions that older adult mobility device users are a greater threat to resources (e.g., health care spending, time, attention) among those higher in these qualities. This pattern was present at all ages assessed but was stronger for those who were younger versus older. Relationships between ideology and heightened threat from older adult mobility device users were not present for those older than 60 years of age. Our results demonstrate that concerns about this prejudice are not completely unwarranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Association of Admission Functional Status and Assistive Device Provision for Veterans Poststroke: A Retrospective Study.

OBJECTIVES: The aims of the study were (a) to provide knowledge about the provision of assistive devices in practice and (b) to describe the challenges of standardizing device provision. DESIGN: This is a retrospective study using Department of Veteran Affairs National Prosthetic Patient Database and other administrative databases. The cohort included all veterans treated by the Veterans Health Administration for stroke during fiscal years 2007-2008. Descriptive methods were used to analyze data with emphasis on inspecting relationships between device provision and motor and cognitive function using Functional Independence Measure scores. RESULTS: A total of 8374 veterans treated for stroke and receiving at least one assistive device are included. Individuals who received standard or caregiver controlled wheelchairs tended to be older, and those who received ultralight or caregiver controlled wheelchairs had a higher proportion of Hispanics than the overall cohort. Veterans who received any type of wheelchair had lower motor, cognitive, and total functioning scores than the cohort as a whole. Veterans who received canes had the highest functioning. Veteran patients who received patient lifts and beds had lower cognitive scores compared with the overall cohort. CONCLUSIONS: Functional status can provide some objectivity to the largely subjective assistive device provision decision-making process; however, many other factors must be considered simultaneously, complicating efforts to standardize provision.

Mobility device use in people with Parkinson's disease: A 3-year follow-up study.

OBJECTIVES: This study aimed to investigate how the use and perceived unmet need of mobility devices (MD) in people with Parkinson's disease (PD) evolve over a 3-year period. METHODS: The study reports baseline assessments (n = 255) and comparisons for participants with complete data at baseline and the 3-year follow-up (n = 165). Structured questions addressed the use and perceived unmet need of various MDs indoor and outdoor (eg, canes, wheeled walkers, and manual and powered wheelchairs). McNemar tests were used to investigate differences over time. RESULTS: In the total sample at baseline, 30% and 52% of the participants reported using MDs indoors and outdoors, respectively. Among those with complete data also at the 3-year follow-up, the proportion of participants using MDs increased significantly (P < .001) from 22% to 40% for indoors and from 48% to 66% for outdoors, with transition of MD toward more assistive potential (ie, wheeled walker and manual wheelchair). Wheeled walkers were the most commonly used MD indoors as well as outdoors on both occasions. Among the users of multiple MDs, the most common combination was cane and wheeled walker on both occasions. The proportion of participants who reported a perceived unmet need of MDs was 5% at baseline, whereas it was 21%, 3 years later. CONCLUSIONS: The use and perceived unmet need of MDs in people with PD increase over time. There is a need for addressing MDs at clinical follow-ups of people with PD, with continuous attention in primary health care and municipality contexts.

Factors Influencing Cane Use for the Management of Knee Osteoarthritis: A Cross-Sectional Survey.

OBJECTIVE: To investigate demographic, symptom-related, and cognitive determinants of cane use for knee osteoarthritis (OA) and prioritize the factors that could facilitate cane use in people with no previous cane use. METHODS: A survey of people ages ≥45 years with a clinical diagnosis of knee OA was conducted. The survey consisted of the following two sections: 1) demographic and cognitive determinants of cane use assessed via subscales of the Cane Cognitive Mediator Scale, and 2) 19 statements, underpinned by the Behaviour Change Wheel theoretical framework, relating to factors that could facilitate regular cane use. Logistic regression was used to examine determinants of cane use, while a priority pairwise ranking activity (1000minds software) determined the rank order of the 19 statements that could facilitate cane use. RESULTS: A total of 529 people completed Part 1 (80% females; 35% cane users) and 231 people completed Part 2. Age (odds ratio [OR] 1.06, 95% confidence interval [95% CI] 1.03- 1.09), body mass index (BMI) (OR 1.03, 95% CI 1.01-1.06), knee pain ≥3 years (OR 2.62, 95% CI 1.63-4.21) and numeric rating scale pain level while walking (OR 1.19, 95% CI 1.09-1.30) were significant independent determinants of cane use. In people who had never used a cane, statements relating to cane-use technique, fitting, knowledge of benefits, and motivation were ranked highest overall. CONCLUSION: Independent determinants of cane use include older age, higher BMI, greater pain duration, and greater severity of knee pain. Strategies targeting an individual's capability and motivation to use a cane may increase cane use among people with knee OA.

Falls Risks and Prevention Behaviors Among Community-Dwelling Homebound and Non-Homebound Older Adults.

The objectives were to examine falls risk factors to determine how the magnitude of risk may differ between homebound and non-homebound older adults, and to describe falls prevention behaviors and participation in falls prevention education. A cross-sectional survey was conducted with convenience samples of community-dwelling older adults recruited through Meals on Wheels programs (homebound, n = 80) and senior centers (non-homebound, n = 84) in North Carolina. Data were collected during home visits and included an interview and medication inventory. Multivariate negative binomial regression with robust variance estimation modeled risk factors for falls. Risk factors for falls observed in both the homebound and non-homebound populations are consistent with what is known in the literature. However, the magnitude of the risk was higher in the homebound than in the non-homebound population with respect to vision impairments, number of high-risk and over-the-counter medications, and use of walking aids .Few participants reported participating in a falls prevention program.

Walking Aids for Enabling Activity and Participation: A Systematic Review.

In this systematic literature review, we examined whether and how walking aids (i.e., canes, crutches, walkers, and rollators) enable activity and participation among adults with physical disabilities. Medline, Embase, all EBM reviews, PsychInfo, CINAHL, and Web of Science databases were used to identify studies published since 2008. Quantitative and qualitative designs were included. Data regarding participants, assistive device use, outcome measures, and domains of participation were extracted. Two reviewers independently rated the level of evidence and methodological quality of the studies. Outcomes were categorized per types of walking aids and activity and participation domains. Thirteen studies were included. Two studies involved canes, four pertained to rollators, and seven dealt with multiple types of walking aids. Mobility was the most frequently examined domain of activity and participation. Both negative and positive results were found. Negative outcomes were linked to the physical characteristics of the device, the use, environment, and personal reluctance. When incorporated in daily life, walking aids were found to enable several domains of activity and participation. Whether walking aids facilitate activity and participation may depend on the user's ability to overcome obstacles and integrate them in daily life. More high-quality research is needed to draw conclusions about their effectiveness.

Do Canes or Walkers Make Any Difference? NonUse and Fall Injuries.

Purpose of the Study: Examine patterns of cane and walker use as related to falls and fall injuries. Hypotheses: Among people who fall at home, most do not have an assistive device with them when they fall. Nonusers who fall sustain more severe injuries. Design and Methods: This was a cross-sectional study using a self-administered written survey completed by 262 people aged 60 and older who were community dwelling, cognitively intact, and current cane/walker users with a history of falls. They were recruited through clinical practice sites, churches, and senior housing in central Michigan. Outcomes of interest included patterns of device use, reasons for nonuse, device use at time of fall, and fall-related injuries. Results: Seventy-five percent of respondents who fell were not using their device at the time of fall despite stating that canes help prevent falls. Reasons for nonuse included believing it was not needed, forgetfulness, the device made them feel old, and inaccessibility. Perceived risk was not high enough to engage in self-protective behavior. However, nonuse led to a significantly higher proportion of falls resulting in surgery than among device users. Among respondents requiring surgery, 100% were nonusers. Most respondents never received a home safety evaluation (68%) and only 50% received training on proper device use. Implications: Providers must place increased emphasis on the importance of cane/walker use for injury prevention through patient education to promote personal relevance, proper fitting, and training. New strategies are needed to improve device acceptability and accessibility.

Gender Differences in Mobility Device Use Among U.S. Older Adults.

Objectives: Research has shown greater mobility limitations among women than men. We aimed to examine (a) gender differences in the use of canes for mobility and (b) what factors contribute to these differences under the frameworks of the disablement model and the Theory of Planned Behavior. Method: Using National Health and Aging Trends Study data, we estimated hierarchical logistic regression models to predict the likelihood of cane use among older adults who completed performance-based measures (n = 5,503). We tested the interactions between gender and selected variables to further understand gender difference. Results: In unadjusted analysis, 22% of women and 16% of men used canes. In models adjusted in steps for sociodemographics, health, physical impairments, capacity, psychosocial, and social environment factors, women were progressively less likely to use canes, significantly so at the last step. Suppression effect analyses showed the influence of living alone and receiving mobility help variables. Interaction analyses showed that women reporting poor health or balance were less likely to use canes; obese women were more likely. Discussion: Significant gender differences exist in cane use among older community-living adults. Findings suggest that health and function partly account for these differences. Future research is needed to understand social/cultural factors involved.

Distribution, Determinants, and Prevention of Falls Among the Elderly in the 2011-2012 California Health Interview Survey.

OBJECTIVES: Falls in the geriatric population are a major public health issue. With the anticipated aging of the population, falls are expected to increase nationally and globally. We estimated the prevalence and determinants of falls in adults aged ≥65 years and calculated the proportion of elderly who fell and made lifestyle changes as a result of professional recommendations. METHODS: We included adults aged ≥65 years from the 2011-2012 California Health Interview Survey (CHIS) and categorized them into two groups based on whether or not they had had at least two falls in the previous 12 months. We performed logistic regression analysis adjusted for the complex survey design to determine risk factors for falls and compare the odds of receiving professional recommendations among elderly with vs. without falls. RESULTS: Of an estimated 4.3 million eligible elderly participants in the CHIS (2011-2012), an estimated 527,340 (12.2%) fell multiple times in the previous 12 months. Of those, 204,890 (38.9%) were told how to avoid falls by a physician and 211,355 (40.1%) received medical treatment, although fewer than 41.0% had made related preventive changes to avoid future falls. Falls were associated with older age, less walking, and poorer physical or mental health. Non-Asians had higher odds of falling compared with Asians (adjusted odds ratio = 1.69, 95% confidence interval 1.16, 2.45). Most participants reported changing medications, home, or daily routines on their own initiative rather than after professional recommendations. CONCLUSION: Patients with a history of falls did not consistently receive professional recommendations on fall prevention-related lifestyle or living condition changes. Given the high likelihood of a serious fall, future interventions should focus on involving primary care physicians in active preventive efforts before a fall occurs.

Mobility device use in older adults and incidence of falls and worry about falling: findings from the 2011-2012 national health and aging trends study.

OBJECTIVES: To examine the prevalence of mobility device use in community-dwelling older adults in the United States and to investigate the incidence of falls and worry about falling according to type and number of mobility devices used. DESIGN: Analysis of cross-sectional and longitudinal data from the 2011-12 National Health and Aging Trends Study. SETTING: In-person interviews in the homes of study participants. PARTICIPANTS: Nationally representative sample of Medicare beneficiaries (n=7,609). MEASUREMENTS: Participants were asked about mobility device use (e.g., canes, walkers, wheelchairs and scooters) in the last month, 1-year fall history and worry about falling. RESULTS: Twenty-four percent of adults aged 65 and older reported mobility device use in 2011, and 9.3% reported using multiple devices within the last month. Mobility device use increased with advancing age and was associated with nonwhite race and ethnicity, female sex, lower education level, greater multimorbidity, and obesity (all P<.001). Adjusting for demographic and health characteristics and physical function, the incidence of falls and recurrent falls was not associated with the use of multiple devices or any particular type of mobility device. Activity-limiting worry about falling was significantly higher in cane-only users than in nonusers. CONCLUSION: The percentage of older adults reporting mobility device use is higher than results from previous national surveys, and multiple device use is common in those who use any device. Mobility device use is not associated with greater incidence of falls. Cane-only users may compensate for worry about falling by limiting activity.

Determinants of use of a walking device in persons with Parkinson's disease.

OBJECTIVE: To identify determinants for the use of a walking device in persons with Parkinson's disease (PD). DESIGN: Cross-sectional study of participants with PD. SETTING: Laboratory. PARTICIPANTS: Persons with PD (N=85; 60 men) were studied. Their mean age was 69.4±8.9 years. The average time since diagnosis was 7.9±5.3 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Age, sex, disease duration, disease severity, and motor impairment were recorded. Participants were asked whether they usually used any walking device (eg, cane or walker) and were categorized as either an "independent walker" or a "device walker." Clinical balance measures including functional reach, turn duration, 5-meter timed Up and Go (5m-TUG) test, and Activities-specific Balance Confidence (ABC) scale were investigated for their contribution to the prediction of walking with a device. RESULTS: Thirty-one participants (36.5%) reported that they usually used a walking device. Classification and regression tree analysis determined that the 5m-TUG test and the ABC scale were important factors in differentiating participants who used a walking device from those who did not. Critical thresholds included 13 seconds for the 5m-TUG test and a score of 75 for the ABC scale in determining device walking. Using only these 2 determinants, the classification and regression tree model correctly classified 81% of the patients as either independent or needing a walking device. CONCLUSION: The 5m-TUG test and the ABC scale may be useful in clinical assessments of the need for a walking device in persons with PD.

Functional impairment in patients with sporadic Inclusion Body Myositis.

INTRODUCTION: We conducted a retrospective chart review of 53 patients diagnosed with sporadic Inclusion Body Myositis (sIBM) who have been followed at the McMaster Neuromuscular Clinic since 1996. OBJECTIVES: We reviewed patient medical histories in order to compare our findings with similar cohorts, and analyzed quantitative strength data to determine functionality in guiding decisions related to gait assistive devices. METHODS: Patient information was acquired through retrospective clinic chart review. RESULTS: Our study found knee extension strength decreased significantly as patients transitioned to using more supportive gait assistive devices (P < 0.05). A decline to below 30 Nm was particularly indicative of the need for a preliminary device (i.e. cane)(P < 0.05). Falls and fear of falling poses a significant threat to patient physical well-being. The prevalence of dysphagia increased as patients required more supportive gait devices, and finally a significant negative correlation was found between time after onset and creatine kinase (CK) levels (P < 0.01). CONCLUSION: This study supports that knee extension strength may be a useful tool in advising patients concerning ambulatory assistance. Further investigations concerning gait assistive device use and patient history of falling would be beneficial in preventing future falls and improving long-term patient outcomes.

Assistive walking device use and knee osteoarthritis: results from the Health, Aging and Body Composition Study (Health ABC Study).

OBJECTIVES: To identify factors that predicted incident use of assistive walking devices (AWDs) and to explore whether AWD use was associated with changes in osteoarthritis of the knee. DESIGN: Prospective cohort study. SETTING: Community. PARTICIPANTS: Older adults (N=2639) in the Health, Aging and Body Composition (Health ABC) Study including a subset of 874 patients with prevalent knee pain. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incident use of AWDs, mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores, and the frequency of joint space narrowing on knee radiographs over a 3-year time period. RESULTS: AWD use was initiated by 9% of the entire Health ABC cohort and 12% of the knee pain subset. Factors that predicted use in both groups were age ≥73 (entire cohort: odds ratio [OR]=2.07; 95% confidence interval [CI], 1.43-3.01; knee pain subset: OR=1.87; 95% CI, 1.16-3.03), black race (entire cohort: OR=2.95; 95% CI, 2.09-4.16; knee pain subset: OR=3.21; 95% CI, 2.01-5.11), and lower balance ratios (entire cohort: OR=3.18; 95% CI, 2.21-4.59; knee pain subset: OR=3.77; 95% CI, 2.34-6.07). Mean WOMAC pain scores decreased slightly over time in both AWD and non-AWD users. Twenty percent of non-AWD users and 28% of AWD users had radiographic progression in joint space narrowing of the tibiofemoral joint in at least 1 knee. Fourteen percent of non-AWD users and 12% of AWD users had radiographic progression in joint space narrowing in the patellofemoral joint in at least 1 knee. CONCLUSIONS: AWDs are frequently used by older adults. Knee pain and balance problems are significant reasons why older adults initiate use of an AWD. In an exploratory analysis, there was no consistent relation between the use or nonuse of an AWD and WOMAC pain scores or knee joint space narrowing progression. Further studies of the relation of use of AWDs to changes in knee osteoarthritis are needed.

Gait variability and disability in multiple sclerosis.

Gait variability is clinically relevant in some populations, but there is limited documentation of gait variability in persons with multiple sclerosis (MS). This investigation examined average and variability of spatiotemporal gait parameters in persons with MS and healthy controls and subsequent associations with disability status. 88 individuals with MS (age 52.4±11.1) and 20 healthy controls (age 50.9±8.7) performed two self-paced walking trials on a 7.9-m electronic walkway to determine gait parameters. Disability was indexed by the Expanded Disability Status Scale (EDSS) and ranged between 2.5 and 6.5. Gait variability was indexed by standard deviation (SD) and coefficient of variation (CV=SD/mean) of step time, step length, and step width. Average gait parameters were significantly correlated with EDSS (ρ=0.756-0.609) and were significantly different in individuals with MS compared to controls (p≤0.002). Also, step length (p<0.001) and step time (p<0.001) variability were both significantly greater in MS compared to controls. EDSS was positively correlated with step length variability and individuals with MS who used assistive devices to walk had significantly greater step length variability than those who walked independently (p's<.05). EDSS was correlated with step time and length variability even when age was taken into account. Additionally, Fisher's z test of partial correlations revealed that average gait parameters were more closely related to disability status than gait variability in individuals with MS. This suggests that focusing on average gait parameters may be more important than variability in therapeutic interventions in MS.

Usefulness and acceptability of a standardised orientation and mobility training for partially-sighted older adults using an identification cane.

BACKGROUND: Orientation and mobility (O&M) training in using an identification (ID) cane is provided to partially-sighted older adults to facilitate independent functioning and participation in the community. Recently, a protocolised standardised O&M-training in the use of the ID cane was developed in The Netherlands. The purpose of this study is to assess the usefulness and acceptability of both the standardised training and the regular training for participants and O&M-trainers in a randomised controlled trial (NCT00946062). METHODS: The standardised O&M-training consists of two structured face-to-face sessions and one telephone follow-up, in which, in addition to the regular training, self-management and behavioural change techniques are applied. Questionnaires and interviews were used to collect data on the training's usefulness, e.g. the population reached, self-reported benefits or achievements, and acceptability, e.g. the performance of the intervention according to protocol and participants' exposure to and engagement in the training. RESULTS: Data was collected from 29 O&M-trainers and 68 participants. Regarding the self-reported benefits, outcomes were comparable for the standardised training and the regular training according the trainers and participants e.g., about 85% of the participants in both groups experienced benefits of the cane and about 70% gained confidence in their capabilities. Participants were actively involved in the standardised training. Nearly 40% of the participants in the standardised training group was not exposed to the training according to protocol regarding the number of sessions scheduled and several intervention elements, such as action planning and contracting. CONCLUSIONS: The standardised and regular O&M-training showed to be useful and mostly acceptable for the partially-sighted older adults and trainers. Yet, a concern is the deviation from the protocol of the standardised O&M-training by the O&M-trainers regarding distinguishing elements such as action planning. Overall, participants appreciated both trainings and reported benefit.

Evaluation of immediate impact of cane use on energy expenditure during gait in patients with knee osteoarthritis.

PURPOSE: The aim of the present study was to assess the immediate impact of cane use on energy expenditure during gait in patients with knee OA analyzing VO(2). METHODS: An observational, cross-sectional study was carried out on 64 symptomatic patients with a diagnosis of knee OA. The assessment of energy expenditure was performed through an analysis of expired gases using the portable K4 apparatus (Cosmed, Model K4 b2, Italy) during the six-min walk test (6MWT). Two tests were performed with a cane and two without a cane on two different days within a seven-day period. RESULTS: The patients walked farther on the test without the cane (p<0.001). Oxygen expenditure (VO(2)) and the O(2) cost of walking at the end of the 6MWT increased approximately 50% and 80% during cane-assisted gait when compared to gait without the use of a cane (p<0.001). Pain (Borg scale) decreased approximately 20% at the end of the 6MWT with cane-assisted gait in comparison to gait without a cane (p<0.001). CONCLUSION: Cane use causes an immediate increase in energy expenditure (VO(2)) during gait and O(2) cost of walking and an immediate decrease of pain during gait. It is necessary to do a more prolonged follow up in order to assess the impact of daily cane use on energy expenditure among these patients and determine whether adaptation occurs. Furthermore, it is necessary to study whether daily cane use has a positive impact on important parameters in these patients, such as pain, function and quality of life.