Reliability of the Theory of Mind Task Battery (ToM TB) to assess social cognition in post-stroke patients.

Theory of mind is the ability to understand, and infer thoughts or mental states to others. This is a central domain of social cognition that can be impaired after brain injury, resulting in changes in social skills and implications for rehabilitation.The aim of this investigation was to analyze the reliability of the Theory of Mind Task Battery (ToM TB) in post-stroke patients.This is a cross-sectional prospective study with psychometric characteristics, involving 38 patients diagnosed with ischemic or hemorrhagic stroke assessed by three examiners using the ToM TB scale, translated and adapted to Brazilian Portuguese. Satisfactory levels of interexaminer agreement were found for almost all categories of the ToM TB: Kappa ranged from 0.036 to 1.00, total score (ICC) from 0.958 to 0.999 and a Cronbach's alpha of 0.658 was obtained with the complete instrument.The Brazilian version of the ToM TB in post-stroke patients is a reliable instrument that can be used to assess the theory of mind, prognosis and rehabilitation of post-stroke patients.

The Implementation of Teleconsultations in a Physiotherapy Service During Covid-19 Pandemic in Brazil: a Case Report.

INTRODUCTION: The Brazilian Council of Physiotherapy and Occupational Therapy regulated the use of teleconsultation during the COVID-19 pandemic, creating uncertainty about its use in Brazil. OBJECTIVE: To describe the experience of teleconsultations during the COVID-19 pandemic. METHODS: Four patients participated in the study with the following diagnoses: Parkinson's disease, stroke, peripheral facial paralysis, and tibial plateau fracture. Patients underwent up to 10 physiotherapy sessions via digital tools. The 5-A self-management tool (Assess, Advise, Agree, Assist, Arrange) guided the sessions. RESULTS: The teleconsultation type varied between synchronous (n = 1; 25%); asynchronous (n = 2; 50%) and synchronous/asynchronous (n = 1; 25%). There was 75% (n = 3) adherence and one withdrawal (25%). As the benefits of teleconsultations, the patients pointed out the convenience, maintenance of the exercises, and contact with the professional. The reported limitations were the lack of the use of physiotherapeutic devices. CONCLUSION: Teleconsultations contribute to the continuity of physiotherapy treatment during social isolation. Adherence to treatment was facilitated by access to the technology and by offering patients the choice of teleconsultation type.

Group-based constraint-induced movement therapy in the rehabilitation of chronic poststroke patients.

BACKGROUND: This study aimed to describe the effects of a 90-minute group-based constraint-induced movement therapy protocol (CIMT) on upper extremity (UE) rehabilitation in poststroke patients. METHOD: The study was a case series clinical study with 6 patients with chronic stroke admitted to the institutional integrated clinic. Ten 90-minute CIMT sessions were administered, based on the principles of the original therapy. On completion of the protocol, participants underwent group care once a week, for 1 hour a day. For comparison purposes, the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM) were applied on admission, shortly after completing the protocol, and 3 months after completion. In addition, the MAL and shaping tasks were applied daily. RESULTS: There was a statistically significant difference only in the MAL Amount of Use Scale applied daily between the 2nd (3.56) and 9th (3.31) and 2nd and 10th days (4.49) (P = .004), with a moderate effect size (d' = 0.46), and in the average value of shaping repetitions between the 1st (16.10) and 2nd (6.00) and 1st and 10th tasks (7.00) (P = .014), with a moderate effect size (d' = 0.35). CONCLUSION: The 90-minute CIMT protocol resulted in significant improvements in use of the more affected arm in activities of daily living during the 2-week protocol. Additional research with a larger sample and a control group is needed to confirm its effectiveness.

Effects of attentional focus on upper extremity motor performance in post stroke patients: A randomized pilot study.

INTRODUCTION: To facilitate the command to the learner, therapist can use verbal cues for guidance: internal focus (own body) and external focus (consequence of movement in the environment). OBJECTIVE: To examine the effects of different attentional focus on upper limb motor performance in post-stroke. METHODS: Randomized controlled trial with 2 groups. Study realized at Integrated Clinic of the Faculty of Health Science at Trairi (Santa Cruz, Rio Grande do Norte, Brazil). Twelve participants allocated into 2 groups. Two motor tasks were used: task 1, reach-point; task 2, reach-grasp-fit, with the paretic extremity, using verbal commands directed by a trained therapist. In the first phase, Group 1 received commands with internal focus, while Group 2 was instructed with commands with external focus. After 1 week, the command type was changed between groups. The variables collected was movement time, velocity and number of peaks velocity. RESULTS: Both attentional focus promoted significant differences in movement time and velocity, however, only Internal Focus provided significant results in both tasks of the same variables. DISCUSSION: The benefits of 1 attentional focus on the other are not fully confirmed. However, not receiving any kind of attention guidance compromises motor performance. The results support the hypothesis that the benefits of the External Focus are accentuated when preceded by the Internal Focus. CLINICAL TRIAL REGISTRATION: Research Ethics Committee of the Faculty of Helth Science at Trairi (Facisa - UFRN)- Number CAAE 2.625.609, approved on April 13, 2018; Brazilian Registry of Clinical Trials - RBR-4995cr approved on July 4, 2019 retrospectively registered (http://www.ensaiosclinicos.gov.br/rg/RBR-4995cr/).

Bem-estar e comprometimento motor facial em pacientes com paralisia facial periférica: um estudo transversal / Well-being and facial motor impairment in patients with peripheral facial paralysis: a cross-sectional study

A Paralisia Facial Periférica (PFP) é resultante da disfunção do nervo facial. A incapacidade de mover o rosto tem consequências sociais e funcionais para o paciente. OBJETIVO: Analisar a relação entre comprometimento motor facial e bem estar em pacientes com PFP. MÉTODO: Trata-se de uma pesquisa de caráter descritivo, observacional, do tipo transversal. Os critérios de elegibilidade consistiam em ter diagnóstico de paralisia facial e estar sendo atendido namclínica escola de Fisioterapia da FACISA. A amostra foi constituída porm20 pessoas com PFP. Os pacientes foram avaliados por uma ficha de avaliação sociodemográfica e pelos instrumentos: Escala de HouseBrackmann (HB) e o Índice de Incapacidade Facial (IIF).Utilizou-se o coeficiente de correlação de Spearman para analisar o grau de correlação entre HB, IF e o tempo de lesão. RESULTADOS: Os participantes foram 65% do sexo feminino, a mediana da idade foi de 50,5 anos, o tempo de lesão foi de 3 a 331 dias (mediana 17,5 dias), a etiologia predominante foi idiopática 65%, e ambas hemifaces foram acometidas em igual proporção (50%). Quanto as características clínicas da PFP, o nível de comprometimento motor facial graduado pela escala de HB obteve mediana 4, o IFF-física obteve mediana 60. IFF-função social obteve mediana 38. Nas correlações entre HB, tempo de lesão e IFF, foi observado que os valores obtidos indicaram que não houve correlações estatisticamente significantes. CONCLUSÃO: Mesmo que o nível de comprometimento motor facial esteja acentuado, não houve correlação com o bem-estar dos participantes.

Peripheral Facial Paralysis (PFP) is the result of facial nerve dysfunction. The inability to move the face has social and functional consequences for the patient. OBJECTIVE: To analyze the relationship between facial motor impairment and wellbeing in patients with Peripheral Facial Paralysis (PFP). METHOD: This is a descriptive, observational, cross-sectional study. The eligibility criteria consisted of having a diagnosis of facial paralysis and being seen at the FACISA School of Physiotherapy clinic. The sample consisted of 20 people affected by PFP. The patients were evaluated by a socio-demographic data sheet and by the instruments: House-Brackmann Scale (HB) and Facial Impairment Index (IIF). Spearman's correlation coefficient was used to analyze the degree of correlation between HB, IF and injury time. RESULTS: The participants were 65% female, the median age was 50.5 years, the injury time was 3 to 331 days (median 17.5 days), the predominant etiology was idiopathic 65%, and both hemifaces were affected in equal proportion (50%). As for the clinical characteristics of PFP, the level of facial motor impairment graded by the HB scale obtained a median of 4, the IFF-physics obtained a median of 60. IFFsocial function obtained a median of 38. In the correlations between HB, injury time and IFF, it was observed that the values obtained indicated that there were no statistically significant correlations. CONCLUSION: Even though the level of facial motor impairment is marked, there was no correlation with the participants' well-being.

Interferência da dupla tarefa no desempenho da marcha em indivíduos com doença de Parkinson / Dual task interference on gait performance in individuals with Parkinson Disease

A realização de duas tarefas de forma simultânea exige a capacidade de concentrar atenção e executar duas tarefas ao mesmo tempo. Em indivíduos com Doença de Parkinson as interferências podem ser ainda maiores, visto que esses indivíduos necessitam de um grau maior de atenção apenas para executar uma tarefa única, como no caso, a marcha. OBJETIVO: Analisar a interferência da dupla tarefa na marcha de pacientes com DP. MATERIAIS E MÉTODOS: Estudo observacional de caráter transversal, de natureza quantitativa. Cinco indivíduos com Doença de Parkinson, de ambos os sexos, participaram do grupo experimental; e cinco indivíduos saudáveis fizeram parte do grupo controle. Os participantes tiveram a marcha avaliada com e sem interferência cognitiva, utilizando: Escala de Equilíbrio de Berg; Índice Dinâmico da Marcha; teste de mobilidade funcional (Time Up and Go Test), Esteira Ergométrica e o Stroop Test adaptado para analfabetos. RESULTADOS: Quando comparados Grupo Experimental e Grupo Controle foram encontradas diferenças estatisticamente significantes nas condições de marcha com interferência de dupla tarefa (Dupla Tarefa Número e Dupla Tarefa Cor) nas variáveis de quantidade de acertos e amplitude de movimento. CONCLUSÃO: A dupla tarefa em pacientes com DP, interfere principalmente na função cognitiva, enquanto a função motora da marcha permanece parcialmente preservada.

Performing dual tasks simultaneously requires the ability to focus attention and perform two activities at the same time. In individuals with Parkinson's disease, the interferences may be greater, as these individuals require a major degree of attention just to perform a single task, as in this case, walking. OBJECTIVE: To analyze the interference of dual task in the gait of PD individuals. MATERIAL AND METHODS: Observational cross-sectional study with a prospective structure of a quantitative nature. Five individuals with Parkinson Disease, of both gender, participated in the experimental group; five healthy individuals were part of the control group. The participants had their gait assessed with and without cognitive interference, using: Berg's Balance Scale; Dynamic Gait Index; functional mobility test (Time Up and Go Test), Treadmill gait and Stroop Test adapted for illiterates. RESULTS: When comparing the Experimental Group and the Control Group, statistically significant differences were found in the gait conditions with dual task interference (Dual Task Number and Dual Task Color) in the variables of number of correct answers and range of motion. CONCLUSION: The dual task in PD patients mainly interferes with cognitive function, while the motor function of gait remains partially preserved.

Low-cost equipment for the evaluation of reach and grasp in post-stroke individuals: a pilot study.

BACKGROUND: Reach-grasp movements are motor components commonly affected after stroke and directly related to the independence of these individuals. Evaluations of these activities can be performed using clinical instruments and assessed by detailed and costly kinematic analyses. The aim of this study was to develop an analysis of reach-grasp movements in post-stroke patients using a simple, inexpensive, and manageable instrument. RESULTS: A Mann-Whitney test was used to compare paretic and non-paretic limb motor performance. A statistically significant difference was found between the variables of total time (p = 0.02) and speed to reach target 3 (p = 0.04) for task 1, while in task 2 significance was found only in the aspect of speed to reach target 2 (p = 0.04). The correlation between clinical tests and variables of tasks was then performed using Spearman's rank correlation coefficient. At task 1, when compared with the REACH instrument, the close target sub-item; there was a high positive correlation between the parameters of total time (p = 0.028), target velocity 3 (p = 0.028), and target acceleration 3 (p = 0.028). Another instrument that showed a high positive correlation with the target time 3 (p = 0.01) and target acceleration 3 (p = 0.028) variables was the Box and Block Test. When correlated, the data between the task 2 variables and clinical instruments did not present statistically significant data. CONCLUSION: Our instrument-the Temporal Data Acquisition Instrument-TDAI-fulfilled the expected objectives and can be used as an option to evaluate the movements of reach and grasp of upper limb post-stroke, using an easy and fast application, without the need for calibration. Trial registration Trial Registration: Research Ethics Committee of the Trairi School of Health Sciences-Number 2.625.609, approved on April 13, 2018; Brazilian Registry of Clinical Trials-RBR-4995cr approved on July 4, 2019 retrospectively registered (http://www.ensaiosclinicos.gov.br/rg/RBR-4995cr/).

Comprometimento motor e risco de quedas em pacientes pós-acidente vascular encefálico / Motor impairment and risk of falls in patients post-stroke

O objetivo desse estudo foi correlacionar o comprometimento motor do hemicorpo afetado com o equilíbrio postural e o risco de quedas em pacientes pós-Acidente Vascular Encefálico (AVE). Trata-se de um estudo descritivo do tipo transversal com 20 pacientes pós-AVE do município de Santa Cruz ­ Rio Grande do Norte. A partir de contato com os Agentes Comunitários de Saúde (ACS) das Unidades Básicas de Saúde (UBS) da cidade, os pesquisadores realizaram visita domiciliar aos sujeitos selecionados e em uma única sessão, com duração de aproximadamente 1 hora, foram aplicadas as escala de Desempenho Físico Fugl-Meyer (FM, MI ­ membro inferior e MS ­ membro superior), Escala de Equilíbrio de Berg (EEB), Escala de Categorias de Deambulação Funcional (FAC) e Timed Up and Go (TUG). Houve excelente correlação entre os escores da FAC total (3±2) com as variáveis da EEB (27,75±18,83; p<0.0001), Fugl-Meyer Membro Inferior (FM-MI) (18,15±8,01; p<0.0001), Fugl-Meyer Membro Superior (FM-MS) (34,15±20,54; p=0.0001) e Timed Up and Go Cadência (TUGc) (51,82±39,65; p=0.0019). Os resultados apontam que o comprometimento motor, não somente de MI, mas também do MS, possuem influência sobre as repercussões de equilíbrio postural e risco de quedas de pacientes pós-AVE...(AU)

The aim this study was to correlate the motor impairment of the affected side with the balance and risk of falls in post-stroke patients. This is a cross-sectional study with twenty post-stroke subjects of Santa Cruz ­ Rio Grande do Norte (Brazil). After previous contact with the basic health unit, the researchers did a home visit on the selected subjects and in a single session, with 1 hour of duration, applied Fugl-Meyer Assessment (FM. Lower Limb ­ LL and Upper Limb - UL), Berg Balance Scale (BBS), Functional Ambulation Cathegory (FAC) and Timed Up and Go cadence (TUGc) scales. There was excellent correlation between the scores of total FAC with BBS (27,75±18,83; p<0.0001), FM-LL (18,15±8,01; p<0.0001), FM-UL (34,15±20,54; p=0.0001) and TUGc (51,82±39,65; p=0.0019). The results showed both motor upper and lower limb impairments have influence in the balance and risk of falls in post-stroke patients...(AU)

Análise da ativação muscular durante o movimento de alcance nas condições ativo, ativo-assistido e autoassistido em pacientes pós-AVE / Análisis de la activación muscular durante el movimiento de alcance en las condiciones activo, activo-asistido y auto-asistido en pacientes post-AVE / Analysis of muscle activation during reaching movement in active, active-assisted and self-assisted conditions in post-stroke patients

RESUMO O Acidente Vascular Encefálico (AVE) é uma patologia que frequentemente causa limitações motoras nos Membros Superiores (MMSS) gerando prejuízos funcionais nos movimentos de alcance. O objetivo do estudo foi analisar o recrutamento muscular do membro superior parético durante três condições de alcance: ativo, ativo-assistido e autoassistido, através de dados eletromiográficos das fibras anteriores do Músculo Deltoide (MD), Bíceps Braquial (BB) e Tríceps Braquial (TB). Estudo do tipo transversal que utilizou como testes clínicos o miniexame do estado mental, escala de equilíbrio de Berg, medida de independência funcional, escala modificada de Ashworth e escala de Fugl-Meyer - seção MMSS. A coleta dos dados eletromiográficos de superfície foi realizada utilizando-se o eletromiógrafo e eletrodos de configuração bipolar da EMG System do Brasil com três canais posicionados nos pontos motores do MD (fibras anteriores), BB e TB de ambos os membros superiores. As variáveis clínicas apresentaram resultados de comprometimento motor, cognitivo e funcional leves. Os dados eletromiográficos mostraram que o MD e TB durante o alcance ativo-assistido contraíram mais que no alcance autoassistido (p<0.05). Os MD e TB apresentaram diferenças significativas durante os movimentos de alcance, enquanto que o músculo BB não mostrou alterações. Entre os diversos tipos de alcance, o ativo-assistido foi o que proporcionou maior ativação muscular. Sugere-se que sejam feitos ensaios clínicos para verificar a eficácia dos treinamentos.

RESUMEN El Accidente Vascular Encefálico (AVE) es una patología que frecuentemente causa limitaciones motoras en los Miembros Superiores (MMSS) generando perjuicios funcionales en los movimientos de alcance. El objetivo del estudio fue analizar el reclutamiento muscular del miembro superior parético durante tres condiciones de alcance: activo, activo-asistido y auto-asistido, a través de datos electromiográficos de las fibras anteriores del Músculo Deltóide (MD), Bíceps Braquial (BB) y Tríceps Braquial (TB). Estudio del tipo transversal que utilizó como pruebas clínicas el mini-examen del estado mental, escala de equilibrio de Berg, medida de independencia funcional, escala modificada de Ashworth y escala de Fugl-Meyer - sección MMSS. La recolección de los datos electromiográficos de superficie fue realizada utilizando el electromiografo y electrodos de configuración bipolar de la EMG System de Brasil con tres canales colocados en los puntos motores del MD (fibras anteriores), BB y TB de ambos miembros superiores. Las variables clínicas presentaron resultados de compromiso motor, cognitivo y funcional leves. Los datos electromiográficos mostraron que el MD y el TB durante el alcance activo-asistido contrajeron más que en el alcance auto-asistido (p<0.05). Los MD y TB presentaron diferencias significativas durante los movimientos de alcance, mientras que el músculo BB no mostró alteraciones. Entre los diversos tipos de alcance, el activo asistido fue el que proporcionó mayor activación muscular. Se sugiere que se realicen ensayos clínicos para verificar la eficacia de los entrenamientos.

ABSTRACT A cerebrovascular accident (CVA) is a disease that often causes upper limb motor limitations and functional losses in reaching movements. The objective of this study was to analyze the muscle recruitment of the paretic upper limb during three reaching conditions: active, active-assisted and self-assisted, through electromyographic data of anterior fibers of Deltoid Muscle (DM), Biceps Brachii (BB) and Triceps Brachii (TB). Cross-sectional study that used as clinical trials the Mini-Mental State Examination, Berg balance scale, functional independence measure, the modified Ashworth scale, and the Fugl-Meyer assessment - upper limbs section. Surface electromyographic data were collected using the electromyograph and bipolar electrode configuration of the EMG System do Brasil with three channels positioned in the motor points of DM (anterior fibers), BB and TB of both upper limbs. Clinical variables showed mild motor, cognitive, and functional impairment. Electromyographic data showed that DM and TB contracted more during active-assisted than during self-assisted exercise (p<0.05). DM and TB presented significant differences during reaching movements, while the BB muscle showed no changes. Among the different reaching exercises, the active-assisted was the one that provided greater muscle activation. Clinical trials are suggested to verify the effectiveness of the training.

Reach and palmar grasp in tetraplegics with neuromuscular electrical stimulation / Alcance e preensão palmar em tetraplégicos com estimulação elétrica neuromuscular / Alcance y prensión palmar en tetrapléjicos con estimulación eléctrica neuromuscular

OBJECTIVE: To evaluate the movement strategies of quadriplegics, assisted by neuromuscular electrical stimulation, on reach and palmar grasp using objects of different weights. METHODS: It was a prospective clinical trial. Four chronic quadriplegics (C5-C6), with injuries of traumatic origin, were recruited and all of them had their reach and palmar grasp movement captured by four infrared cameras and six retro-reflective markers attached to the trunk and right arm, assisted or not by neuromuscular electrical stimulation to the triceps, extensor carpi radialis longus, extensor digitorum communis, flexor digitorum superficialis, opponens pollicis and lumbricals. It was measured by a Neurological and Functional Classification of Spinal Cord Injuries of the American Spinal Injury Association, Functional Independence Measure and kinematic variables. RESULTS: The patients were able to reach and execute palmar grasp in all cylinders using the stimulation sequences assisted by neuromuscular electrical stimulation. The quadriplegics produced lower peak velocity, a shorter time of movement and reduction in movement segmentation, when assisted by neuromuscular electrical stimulation. CONCLUSION: This study showed that reach and palmar grasp movement assisted by neuromuscular electrical stimulation was able to produce motor patterns more similar to healthy subjects. Level of evidence IV; Case series.

OBJETIVO: Avaliar as estratégias de movimento de quadriplégicos com o auxílio de estimulação elétrica neuromuscular sobre o alcance e a preensão palmar com objetos de diferentes pesos. MÉTODOS: Estudo clínico prospectivo. Quatro quadriplégicos crônicos (C5-C6) com lesões de origem traumática foram recrutados e todos tiveram o alcance e movimento de preensão palmar capturado por quatro câmeras infravermelho e seis marcadores retrorreflexivos fixados no tronco e braço direito, assistidos ou não por estimulação neuromuscular do tríceps, extensor radial longo do carpo, extensor dos dedos, flexor superficial dos dedos, oponente do polegar e músculos lumbricais. A medida foi feita com base na Classificação Neurológica e Funcional de Lesões Medulares da American Spinal Injury Association, na Medida de Independência Funcional e em variáveis cinemáticas. RESULTADOS: Os pacientes foram capazes de alcançar e realizar preensão palmar em todos os cilindros utilizando as sequências de estimulação auxiliadas por estimulação elétrica neuromuscular. Os quadriplégicos produziram menor velocidade de pico, menor tempo de movimento e redução na segmentação do movimento, quando foram auxiliados pela estimulação elétrica neuromuscular. CONCLUSÃO: Este estudo mostrou que o alcance e o movimento de preensão palmar assistidos por estimulação elétrica neuromuscular foi capaz de produzir padrões motores mais semelhantes aos dos indivíduos saudáveis. Nível de evidência IV; Série de casos.

OBJETIVO: Evaluar las estrategias de movimiento de cuadripléjicos, con el auxilio de estimulación eléctrica neuromuscular sobre el alcance y la prensión palmar con objetos de diferentes pesos. MÉTODOS: Estudio clínico prospectivo. Fueron reclutados cuatro cuadripléjicos crónicos (C5-C6) con lesiones de origen traumático y todos ellos tuvieron su alcance y movimiento de prensión palmar capturado por cuatro cámaras infrarrojas y seis marcadores retrorreflexivos fijados al tronco y al brazo derecho, asistidos o no por estimulación neuromuscular del tríceps, extensor radial largo del carpo, extensor de los dedos, flexor superficial de los dedos, oponente del pulgar y músculos lumbricales. La medición fue hecha con base en la Clasificación Neurológica y Funcional de Lesiones Medulares de la American Spinal Injury Association, en la Medida de Independencia Funcional y en variables cinemáticas. RESULTADOS: Los pacientes fueron capaces de alcanzar y realizar prensión palmar en todos los cilindros utilizando las secuencias de estimulación auxiliadas por estimulación eléctrica neuromuscular. Los cuadripléjicos produjeron menor velocidad de pico, menor tiempo de movimiento y reducción en la segmentación del movimiento, cuando fueron auxiliados por la estimulación eléctrica neuromuscular. CONCLUSIÓN: El presente estudio mostró que el alcance y el movimiento de prensión palmar asistidos por estimulación eléctrica neuromuscular fue capaz de producir patrones motores más similares a los individuos saludables. Nivel de evidencia IV; Serie de casos.

Neuromodulation treats Chikungunya arthralgia: a randomized controlled trial.

The Chikungunya (CHIK) virus is epidemic in Brazil, with 170,000 cases in the first half of 2016. More than 60% of patients present relapsing and remitting chronic arthralgia with debilitating pain lasting years. There are no specific therapeutic agents to treat and rehabilitee infected persons with CHIK. Persistent pain can lead to incapacitation, requiring long-term pharmacological treatment. Advances in non-pharmacological treatments are necessary to promote pain relief without side effects and to restore functionality. Clinical trials indicate transcranial direct current stimulation (tDCS) can treat a broad range of chronic pain disorders, including diffuse neuromuscular pain and arthralgia. Here, we demonstrate that the tDCS across the primary motor cortex significantly reduces pain in the chronic phase of CHIK. High-resolution computational model was created to analyze the cortical electric field generated during tDCS and a diffuse and clustered brain current flow including M1 ipsilateral and contralateral, left DLPFC, nucleus accumbens, and cingulate was found. Our findings suggest tDCS could be an effective, inexpensive and deployable therapy to areas lacking resources with a significant number of patients with chronic CHIK persistent pain.

Treino de equilíbrio em pessoas com doença de Parkinson com uso de realidade virtual / Balance training in individuals with Parkinson disease with virtual reality use

Introdução: A doença de Parkinson é uma doença neurológica, crônica e progressiva causada pela degeneração de células situadas na região do mesencefálo, conhecida como substância negra. Objetivo: Analisar o desempenho no equilíbrio de indivíduos com Doença de Parkinson após uma sessão de realidade virtual. Material e métodos: Os indivíduos foram avaliados inicialmente pela Escala de Equilíbrio de Berg, Timed Up and Go, Escala Unificada de Avaliação da Doença de Parkinson (UPDRS) e Escala de Avaliação Modificada da Doença de Parkinson Hoenh Yahr. Depois, em outros três encontros, o equilíbrio dos voluntários foi avaliado pela posturografia antes e após 25 minutos de intervenção com realidade virtual, por meio de três jogos, em cada encontro foi utilizado um jogo diferente. A amostra foi considerada não normal. As análises estatísticas foram realizadas através do teste de Wilcoxon para analisar os dados antes e após a intervenção e o teste de Friedman para verificar se algum jogo foi melhor que outro. Resultados: Observou-se significância estatística na condição com olhos fechados e pés juntos na variável amplitude médio-lateral (p = 0,043). Conclusão: Ocorreu uma discreta melhora no equilíbrio em indivíduos com Doença de Parkinson após a realização da realidade virtual. (AU)

Introduction: Parkinson's disease is a neurological, chronic and progressive disease caused by the degeneration of cells located in the mesencephalon region, known as substantia negra. Objective: To analyze the balance performance of individuals with Parkinson's disease after a Virtual Reality session. Material and methods: Subjects were initially assessed by the Berg Balance Scale, Timed Up and Go, Unified Parkinson's Disease Rating Scale (UPDRS), and Parkinson's Disease Modified Rating Scale Hoenh Yahr. Then, in three other sesssions, the balance of the volunteers was evaluated by posturography before and after 25 minutes of intervention with Virtual Reality, through three games, different in each session. The sample was considered not normal. Statistical analyzes were performed using the Wilcoxon's test to analyze the data before and after the intervention and the Friedman's test to verify that some games were better than others. Results: Statistical significance was observed in the condition with closed eyes and joined feet in the variable medial-lateral amplitude (p = 0.043). Conclusion: We observed a slight improvement in the balance in individuals with Parkinson's disease after Virtual Reality. (AU)

The spasticity in the motor and functional disability in adults with post-stroke hemiparetic / A espasticidade no comprometimento motor e funcional de hemiparéticos pós acidente vascular cerebral

Abstract Introduction: Spasticity acts as a limiting factor in motor and functional recovery after Stroke, impairing the performance of daily living activities. Objective: To analyze the influence of spasticity on main muscle groups and to associate it with motor impairment and functional level of chronic hemiparetic patients after stroke. Methods: Twenty-seven chronic hemiparetic patients of both sexes were selected at the Physical Therapy and Occupational Therapy Service of the Unicamp Clinics Hospital. Assessments were carried out in two sessions, in the first one the motor impairment (Fugl-Meyer Assessment - FM) and functional impairment (Barthel Index - BI) were evaluated, and in the second, the degree of spasticity of the main muscle groups (Modified Ashworth Scale - MAS). Results: A negative correlation was detected between upper limb spasticity and motor and functional impairment. No muscle group evaluated in the lower limbs showed correlation between muscle tone and the level of impairment of the lower extremity on FM and the functional level measured by BI. Conclusion: Spasticity has been shown to be a negative influence factor in the level of motor and functional impairment of the upper limbs of chronic hemiparetic patients after stroke.

Resumo Introdução: A espasticidade atua como um fator limitante na recuperação motora e funcional após o Acidente Vascular Cerebral (AVC), prejudicando a realização das atividades de vida diária. Objetivo: Analisar a influência da espasticidade nos principais grupos musculares e associá-la ao comprometimento motor e ao nível funcional de pacientes hemiparéticos crônicos pós-AVC. Métodos: Vinte e sete pacientes hemiparéticos crônicos, de ambos os sexos, foram selecionados no Serviço de Fisioterapia e Terapia Ocupacional do Hospital de Clínicas da Unicamp. As avaliações foram realizadas em duas sessões: na primeira foi avaliado o comprometimento motor (Protocolo de Desempenho Físico de Fugl-Meyer - FM) e funcional (Índice de Barthel - IB), e na segunda, o grau de espasticidade dos principais grupos musculares (Escala Modificada de Ashworth - EMA). Resultados: Foi detectada uma correlação negativa entre a espasticidade dos membros superiores com o comprometimento motor e funcional. Nenhum grupo muscular avaliado nos membros inferiores apresentou correlação entre o tônus muscular e o nível de comprometimento da subseção da extremidade inferior FM e o nível funcional mensurado pelo IB. Conclusão: A espasticidade mostrou ser um fator de influência negativa no nível de comprometimento motor e funcional dos membros superiores de pacientes hemiparéticos crônicos pós-AVC.

Effects of application of texture insoles on the balance of subjects with Multiple Sclerosis / Efeitos da aplicação de palmilhas com textura no equilíbrio de sujeitos com Esclerose Múltipla

Objective: The aim of this study was to evaluate the effects on static and dynamic balance after the use of textured insoles. Method: Fifteen subjects with multiple sclerosis were evaluated before using the insoles, after using them for 1 month, and after 2 months without using, them using the following measuring instruments: the Berg Balance Scale, Dynamic Gait Index, and 10-meter Walk Test, a means of functional gait assessment. Results: Improvement was observed in the Berg Balance Scale and Dynamic Gait Index scores, walking time, number of steps and step length after using the insoles for 1 month. The improvement in Berg Balance Scale score remained after two months without the insoles and there were no changes in gait speed. Conclusion: The use of textured insoles was effective as an intervention to improve static and dynamic balance in patients with multiple sclerosis.(AU)

Objetivo: O objetivo deste estudo foi avaliar os efeitos sobre o equilíbrio estático e dinâmico após o uso de palmilhas texturizadas. Método: Quinze indivíduos com esclerose múltipla foram avaliados antes de usar as palmilhas, após usá-las por 1 mês e depois de 2 meses sem usá-las, utilizando os seguintes instrumentos de medição: a Escala de Equilíbrio de Berg, Dynamic Gait Index e teste de caminhada de 10 metros, meios de avaliação funcional da marcha. Resultados: Houve melhora na pontuação Escala de Equilíbrio de Berg e Dynamic Gait Index, tempo de caminhada, o número de passos e comprimento do passo depois de usar as palmilhas. A melhora permaneceu após dois meses sem as palmilhas e não houve mudanças na velocidade da marcha. Conclusão: O uso de palmilhas texturizadas foi eficaz como uma intervenção para melhorar o equilíbrio estático e dinâmico em pacientes com esclerose múltipla.(AU)

Klapp method effect on idiopathic scoliosis in adolescents: blind randomized controlled clinical trial.

[Purpose] To estimate the effect of Klapp method on idiopathic scoliosis in school students. [Subjects and Methods] A single-blind randomized clinical trial with 22 students randomly divided into intervention group (n=12) and inactive control group (n=10). Exercise protocol consisted of Klapp method, 20 sessions, three times a week for intervention group, and inactivity for control group. Dorsal muscle strength was measured by dynamometer; body asymmetries and gibbosity angles were measured by biophotogrammetry. Data were obtained by Generalized Estimated Equation, with 5% significance level. Clinical impact for dependent variables was estimated by "d" Cohen. [Results] There was no change in intragroup analysis and intergroup for all postural symmetry variables. However, it was detected intergroup difference in extensor muscle strength and intergroup difference with marginal significance of gibbosity angles. Regarding extensor muscle strength, intervention group produced average improvement of 7.0 kgf compared to control group. Gibbosity angles progressed less in intervention group, with 5.71° average delay compared to control group. [Conclusion] Klapp method was effective for gibbosity stabilization and it improves spine extensor muscle strength.

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)

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)

Upper extremity motor quality evaluation in children with Cerebral Palsy / Avaliação da qualidade motora das extremidades superiores de crianças com Paralisia Cerebral

Abstract Introduction: Cerebral Palsy (CP) is a non-progressive disorder that may compromise functional abilities of the upper limbs due to motor and sensitive loss, that are still poorly evaluated and described by reliable tools. Objective: This study aimed to evaluate motor quality and skills of the upper extremity in children with CP in regions of Trairi and Seridó from Rio Grande do Norte state (Brazil). Methods: It is a cross-sectional exploratory study, with a qualitative approach, with 17 children with CP, aged between four and eight years. The following instruments were used for upper extremity evaluation: Manual Ability Classification System (MACS), Quality of Upper Extremity Skills Test (QUEST) and Gross Motor Function Classification System (GMFCS). Results: Mean and standard deviation (sd) of QUEST total score and the domains dissociated movement, grasp, weight bearing and extensive protection were, respectively, 41.06/37.08; 53.12/34.50; 15.51/62.98; 37.76/37.52; 42.48/47.26. MACS and GMFCS median scores were, respectively, 3 (three) and 5 (five); high positive correlation was observed between MACS and GMFCS (rs=0.83) and high negative correlation between GMFCS and total QUEST (rs=-0.83), as well as between MACS and QUEST (rs=-0.84); and MACS and all QUEST domains (rs=-0.73; rs=-0.82; rs=-0.76; rs=-0.79), p<0.001. Conclusion: Children with CP showed deficit in motor quality and skills of the upper limb, allowing to infer functional limitations regarding manipulation of objects and consequent dependence during life activities.

Resumo Introdução: A Paralisia Cerebral (PC) é uma desordem não progressiva que pode comprometer as habilidades funcionais dos membros superiores, frequentemente decorrentes das perdas motoras e sensitivas, que são ainda pouco avaliadas e descritas por meio de instrumentos confiáveis. Objetivo: Este estudo teve como objetivo avaliar a qualidade de habilidades motoras e da extremidade superior em crianças com paralisia cerebral em regiões de Trairi e Seridó do estado do Rio Grande do Norte (Brasil). Métodos: Estudo exploratório, com abordagem qualitativa e estrutura transversal, com 17 crianças com PC, com idades entre quatro e oito anos. Foram utilizados os seguintes instrumentos para avaliação da extremidade superior: Sistema de Classificação da Habilidade Manual (MACS), Teste de Qualidade de Habilidades da Extremidade Superior (QUEST) e Sistema de Classificação da Função Motora Grossa (GMFCS). Resultados: A média e o desvio padrão da pontuação total QUEST e domínios dissociação de movimento, preensão, descarga de peso e resposta extensiva protetora foram, respectivamente, 41,06/37,08; 53,12/34,50; 15,51/62,98; 37,76/37,52; 42.48/47.26. As pontuações medianas do MACS e GMFCS foram, respectivamente, de 3 (três) a 5 (cinco), sendo observados alta correlação positiva entre MACS e GMFCS (rs=0,83) e alta correlação negativa entre o GMFCS e QUEST totais (rs=-0,83), bem como entre MACS e QUEST (rs=-0,84); MACS e todos os domínios QUEST (rs=-0.73; rs=-0.82; rs=-0.76; rs=-0.79), p<0,001. Conclusão: As crianças com PC apresentaram déficit de qualidade motora e habilidades do membro superior, possibilitando inferir limitações funcionais quanto à manipulação de objetos e consequente dependência durante atividades de vida.

Sobrecarga de cuidadores familiares e independência funcional de pacientes pós-acidente vascular encefálico / Relationship between overburdened family caregivers and functional independence in stroke survivors

Objetivo Correlacionar o nível de independência funcional de pacientes pós-acidente vascular encefálico com a sobrecarga de seus cuidadores. Métodos Trata-se de um estudo observacional descritivo com cuidadores de ambos os sexos e faixa etária de 16 a 74 anos, avaliados em domicílio. Os cuidadores, após aceitarem participar do estudo e assinarem o termo de consentimento livre e esclarecido, foram avaliados por um questionário, que serviu como roteiro de entrevista, pela Escala de Sobrecarga do Cuidador (Caregiver Burden Scale) e pela Escala Medida de Independência Funcional. Resultados As 27 entrevistas realizadas permitiram traçar um perfil dos cuidadores, tendo predominância de filhos (37,03%) e cônjuges (37,03%) na realização do cuidado, seguidos por outros (25,9%). Neste estudo, observou-se que os cuidadores apresentaram maior sobrecarga de cuidado nos domínios tensão geral (1.83) e isolamento (1.78), evidenciando que não só os pacientes, mas também os cuidadores precisam de atenção e apoio profissional. No entanto, neste estudo, não houve correlação significativa (r=-0,1551e p=0,4399) entre os domínios da Escola Medida de Independências Funcional e da Escala de Sobrecarga do Cuidador, podendo ser justificado com as novas estratégias adquiridas pelo cuidador com o intuito de superar as crises na condição dos cuidados. Conclusão Conclui-se que este estudo possibilitou analisar o quadro funcional do paciente com sequela de acidente vascular encefálico e, especificamente, de seu cuidador, evidenciando a necessidade de desenvolver um sistema de apoio formal e informal para os cuidadores.

Objective To determine whether stroke survivors' level of functional independence correlates with overburdened caregivers. Methods This is a descriptive, observational study of male and female caregivers aged 16 to 74 years assessed at home. Once the caregivers accepted to join the study and signed an informed consent form, they answered the Caregiver Burden Scale, the Functional Independence Measure, and a questionnaire, which also served as an interview script. Results The interviews allowed drawing a profile of the 27 caregivers, mostly children (37.03%) and spouses (37.03%), followed by others (25.94%). The domains that most burdened the caregivers were general tension (1.83) and isolation (1.78), demonstrating that not only patients, but also caregivers, need professional care and support. However, the domains of the Functional Independence Measure and the Caregiver Burden Scale were not significantly correlated (r=-0.1551 and p=0.4399) probably because of the new strategies acquired by caregivers, to overcome crises in the conditions of care. Conclusion In conclusion, this study made it possible to analyze the functional status of stroke survivors, and, specifically, of their caregivers, highlighting the need to develop a formal and informal caregiver support system.

Neonatal peripheral facial paralysis' evaluation with photogrammetry: A case report.

Facial paralysis in newborns can leave functional sequelae. Determining the evolution and amount of functional losses requires consistent evaluation methods that measure, quantitatively, the evolution of clinical functionality. This paper reports an innovative method of facial assessment for the case of a child 28 days of age with unilateral facial paralysis. The child had difficulty breast feeding, and quickly responded to the physical therapy treatment.