Influence of Different Dual-Task Conditions During Straight or Curved Walking on Gait Performance of Physically Active Older Women With Cognitive Decline.

Real-world walking requires shifting attention from different cognitive demands to adapt gait. This study aims to evaluate the effect of dual tasking on spatiotemporal gait parameters of older adults. Participants were asked to perform a primary complex single-walking task, consisting of a fast-paced linear and a curved gait. Primary task was performed separately and simultaneously with different motor and cognitive secondary tasks. Spatiotemporal gait parameters, walk ratio, and walk stability ratio were measured. Apart from stride length, which stood relatively unchanged, gait speed and cadence were strongly affected by cognitive dual tasking. Cadence seems to be the most impacted by dual tasking during curved gait as it combines challenges of both primary and secondary tasks. Also, during curved phase, walking ratio was significantly lower and stability ratio was greater demonstrating that participants adopted a cautious gait where maintenance of stability took preference over efficiency.

Conhecimento e expectativas de acadêmicos de fisioterapia sobre a atuação profissional na atenção primária à saúde / Conocimientos y expectativas de estudiantes de fisioterapia sobre la actuación profesional en la atención primaria de salud / Physiotherapy undergraduates' knowledge and expectations of professional practice in primary health care

RESUMO A promulgação do SUS apontou uma nova concepção de saúde não mais focada na ausência de doenças. Fez-se necessário o fortalecimento de ações no nível primário sendo elaborada a Política Nacional de Atenção Básica para promover, proteger e reabilitar a saúde dos indivíduos e coletividades. A Fisioterapia precisa se adequar para se aproximar da Atenção Primária à Saúde (APS) e aos novos modelos de atenção à saúde, o que é recomendado pelas Diretrizes Curriculares Nacionais do Curso de Fisioterapia. O objetivo do estudo é investigar o conhecimento e as expectativas de acadêmicos de Cursos de Fisioterapia de Porto Alegre e região metropolitana sobre a atuação do fisioterapeuta na Atenção Primária à Saúde. Foi realizado estudo observacional, descritivo, transversal, com questionário on-line composto por 13 questões, objetivas e dissertativas. Para verificar as associações, utilizou-se o teste qui-quadrado e adotou-se significância de 5%. 171 acadêmicos de Fisioterapia (90,53% do sexo feminino, com idades entre 18 e 55 anos) participaram do estudo. A minoria dos participantes registrou corretamente as quatro atividades e locais de atuação da Fisioterapia na APS. Para as atividades, foram utilizados termos amplos como "promoção" e "prevenção"; "Unidade de Saúde" foi o local mais frequentemente citado. Do total, 43,2% apontaram se sentirem preparados.

RESUMEN La promulgación del Sistema Único de Salud (SUS) apuntó a una nueva concepción de salud que ya no se centra en la ausencia de enfermedades. Fue necesario fortalecer las acciones en el ámbito primario con el desarrollo de la Política Nacional de Atención Primaria para promover, proteger y rehabilitar la salud de las personas y las comunidades. La fisioterapia necesita adaptarse para acercarse a la Atención Primaria de Salud (APS) y los nuevos modelos de atención sanitaria, según lo recomendado por los Lineamientos Curriculares Nacionales para la Carrera en Fisioterapia. El objetivo de este estudio fue identificar los conocimientos y expectativas de universitarios y Carreras de Fisioterapia de Porto Alegre y región metropolitana sobre el rol del fisioterapeuta en la Atención Primaria de Salud. Se trata de un estudio observacional, descriptivo, transversal, que aplicó un cuestionario on line compuesto de 13 preguntas, tanto de elección única como de ensayo. Para verificar las asociaciones se utilizó la prueba de chi-cuadrado, y se adoptó un nivel de significancia del 5%. En el estudio participaron 171 estudiantes de fisioterapia (el 90,53% mujeres con edades entre 18 y 55 años). La minoría de los participantes contestaron correctamente las cuatro actividades y locales de actuación de la fisioterapia en la APS. Para las actividades, se utilizaron términos amplios como "promoción" y "prevención"; y el local de actuación más citado fue "Unidad de Salud". Del total, el 43,2% afirmaron sentirse preparados.

ABSTRACT The consolidation of SUS led to a new concept of health no longer focused on the absence of diseases. The strengthening of actions at the primary level was necessary, therefore the National Policy of Primary Care was created to promote, protect and rehabilitate people's health. Physiotherapy had to undergo a series of adjustments in order to fit the primary care system and, according to the National Curriculum Guidelines, undergraduate courses should observe the new models of health care. The objective was to assess the knowledge and expectations of Physiotherapy undergraduate students in the Porto Alegre and surrounding cities about the physiotherapist's role in primary care. The study was descriptive, observational, and cross-sectional. An online survey was conducted with 13 objective and dissertation questions. The chi-square test was used to verify associations and significance was found when p≤0.05. A total of 171 Physiotherapy undergraduate students (90.53% females, aging between 18 and 55 years) agreed to participate. A minority of participants correctly registered four activities to be developed and four places of practice for physiotherapists in primary care. Unspecific terms like "promotion" and "prevention" were used to describe the activities, while "Healthcare Units" was the most frequently cited place. Among our sample, 43.2% stated feeling prepared to act in primary care and 53.25% considered as an option to work in primary care. In conclusion, although participants showed limited knowledge about primary care, they mostly feel satisfied with the knowledge acquired on this topic.

Effects of physical exercise on cognitive function of older adults with mild cognitive impairment: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Mild Cognitive Impairment (MCI) is associated with a greater risk of dementia for older adults. However, systematic reviews have shown that some physical exercise (PE) seems to improve MCI symptoms and signs. Those reviews and meta-analysis could not explain what possible moderator influenced their results. This meta-analysis aims to identify the effect of PE over older people's cognition with MCI and explore sources of heterogeneity. METHODS: Databases were searched from inception January 2020 for randomized clinical trials that evaluated the effects of PE over cognition of older persons with MCI. Random effect meta-analyses were performed for each cognitive outcome. Subgroup analyses and meta-regressions models explored the potential sources of heterogeneity. RESULTS: A total of 2077 participants (mean age = 71.8 years) from 27 studies were included. PE improves global cognitive function (SMD = 0.348 [95 % CI 0.166 to 0.529]; p = 0.0001), executive function (SMD = 0.213 [95 % CI 0.026 to 0.400]; p = 0.026) and delayed recall (SMD = 0.180 [95 % CI 0.002 to 0.358]; p = 0.047). A trend towards beneficial effects of PE on verbal fluency (SMD = 0.270 [95 %, CI -0.021 to 0.561]; p = 0.069) and attention (SMD = 0.170 [CI -0.016 to 0.357]; p = 0.073) were also observed. Subgroup analyses showed a relationship between modality and intensity of physical exercise and changes observed in global cognitive function, executive function, delayed recall, verbal fluency and working memory. DISCUSSION AND CONCLUSION: PE can ameliorate cognitive deficts of older adults with MCI. The most pronounced effects appear to arise from other types of exercise that included mind-body exercises and moderate intensity.

Associação entre a ocorrência de dor e sobrecarga em cuidadores principais e o nível de independência de idosos nas atividades de vida diária: estudo transversal / Association between the occurrence of pain and caregivers overload on main and the elderly independence level in daily life activities: cross sectional study

Resumo Introdução Cuidar do idoso costuma ser uma tarefa árdua, e as demandas podem extrapolar a capacidade do cuidador, causando sobrecarga e dor. Objetivo Investigar a ocorrência de sobrecarga e dor em cuidadores de idosos, bem como verificar a relação dessas variáveis com o nível de independência do idoso. Método Amostra por conveniência que, a partir de Unidades de Saúde de uma região distrital de Porto Alegre, identificou potenciais idosos e seus cuidadores principais. Estes, em visitas domiciliares, responderam questões referentes ao perfil socioeconômico, à ocorrência de dor (questionário nórdico e escala visual analógica de dor), à sobrecarga do cuidador (Inventário de Sobrecarga do Cuidador) e ao nível de independência do idoso (índice de Katz). Foi realizada correlação de Spearman. Resultados Participaram 14 idosos e 14 cuidadores com idade média de 82,1 (±6,9) e 65,9(±11,3) anos, respectivamente. Dos idosos, 28,6% foram classificados independentes, 50% dependência moderada e 21,4% muito dependentes. Houve correlação forte e inversa entre o nível de independência do idoso e a sobrecarga do cuidador (ρ=-0,619; p=0,018) e com os domínios, separadamente, sobrecarga tempo dependente (ρ=-0,866; p=0,000) e sobrecarga à vida pessoal (ρ=-0,708; p=0,005). Conclusão Quanto mais independente o idoso, menor foi a sobrecarga atribuída ao seu cuidador. Não houve associação entre dor e sobrecarga do cuidador.

Abstract Background Caring for an elderly is often an arduous task, and the care demands go beyond the caregiver's capacity may cause overload and pain. Objective The aim of this study was to investigate the association between independence level of the elderly in daily life activities and the occurrence of pain and overload your primary caregiver. Method The study included 14 elderly residents in adscript territory of health units of the North Zone-Axis Baltazar area Baltazar North axis of the city Porto Alegre and their primary caregivers, in home visits, answered questions regarding the socioeconomic profile, the occurrence of pain (Nordic questionnaire and visual analog pain scale), the caregiver burden (Inventory caregiver overload) and the level of independence of the elderly (Katz index). Results The average age of the elderly is 82.1 years (± 6.9) and caregivers, 65.9 years (± 11.3). Of the 14 elderly, 28.6% were classified as independent, 50% as having moderate dependence and 21.4% as very dependent. There was strong inverse correlation between the old level of independence and caregiver burden (ρ = -0.619; p = 0.018). When evaluating areas of the inventory separately overload time dependent (ρ = -0.866; p = 0.000) and over the personal life (ρ = -0.708; p = 0.005) correlated to the level of independence of the elderly. Conclusion The study showed that the more independent for the elderly, the lower the burden attributed to the caregiver.

Effects of Scalp Acupuncture on Functional Deficits Induced by Early Sensorimotor Restriction.

The aim of this study was to investigate the effects of scalp acupuncture and electrostimulation, combined or not, in a disuse model consisted of early sensorimotor restriction in rats. Male Wistar pups received sensorimotor restriction from the second postnatal day (P2) until P28. Animals were divided into five different groups (n = 6): control (CT), sensorimotor restricted (SR), acupuncture (AC), electrostimulation (EL), and electroacupuncture (AC+EL). Experimental animals received sham, acupuncture, or electrical stimulation, combined or not, of two scalp regions for 7 days (P29-P35). Before treatment period (P29) and after treatment (P36), animals were evaluated with the narrow suspended bar, horizontal ladder, and stride length tests. SR animals had worse performance in the narrow suspended and horizontal ladder tasks compared with SR animals at P29 (p ≤ 0.005). Significant improvements were observed in both tasks in AC, EL, and EL+AC groups comparing P29 and P36 (p < 0.001). Also, at P35, all treated animals performed significantly better motor tasks compared with SR group (p < 0.05). There was no difference between treated groups. Finally, acupuncture and electrical stimulation, combined or not, have beneficial effect on motor performance following early developmental disuse.

Effects of Exercise on Inflammatory, Oxidative, and Neurotrophic Biomarkers on Cognitively Impaired Individuals Diagnosed With Dementia or Mild Cognitive Impairment: A Systematic Review and Meta-Analysis.

Although the effects of physical exercise (PE) on cognitive function in dementia and mild cognitive impairment (MCI) have been largely studied, its biochemical effect is still poorly explored. The aim of this systematic review was to investigate the effects of PE on inflammatory, oxidative, and neurotrophic biomarkers of participants with MCI or dementia. Six electronic databases, (PubMed, Cochrane Central, Embase, PEDro, PsycINFO, and SportDiscus) were searched for randomized controlled trials assessing the effects of PE on serum and/or plasma biomarkers of elderly participants with MCI or dementia. After selection process, eight studies were included. Meta-analysis was performed by comparison of changes from baseline, using the random effects method. Meta-analysis showed a significant effect of aerobic exercise on interleukin-6 and tumor necrosis factor alpha decrease and positive effects on brain-derived neurotrophic factor expression. As only one study was included with oxidative biomarker assessment, the effects of PE on oxidative process remain unclear. Finally, even though it was possible to observe positive effects of PE on some biomarkers of MCI and dementia individuals, current evidence does not allow drawing specific practical recommendations such as type, frequency, intensity, or duration of PE in these population. Further researches aiming to estimate the PE effectiveness on biomarkers of MCI and Alzheimer's disease are needed.

Synaptophysin and caspase-3 expression on lumbar segments of spinal cord after sensorimotor restriction during early postnatal period and treadmill training.

The purpose of the current study was to investigate whether locomotor stimulation training could have beneficial effects on spinal cord plasticity consequent to sensorimotor restriction (SR). Male Wistar rats were exposed to SR from postnatal day 2 (P2) to P28. Control and experimental rats underwent locomotor stimulation training in a treadmill from P31 to P52. The intensity of the synaptophysin and caspase-3 immunoreaction was determined on ventral horn of spinal cord. The synaptophysin immunoreactivity was lower in the ventral horn of sensorimotor restricted rats compared to controls animals and was accompanied by an increased caspase-3 immunoreactivity. Those alterations were reversed at the end of the training period. Our results suggest that immobility affects the normal developmental process that spinal cord undergoes in early postnatal life influencing both pro-apoptotic and synapse markers. Also, we demonstrated that this phenomenon was reversed by 3 weeks of treadmill training.

THE FUNCTIONAL MOVEMENT SCREEN (FMS™) IN ELITE YOUNG SOCCER PLAYERS BETWEEN 14 AND 20 YEARS: COMPOSITE SCORE, INDIVIDUAL-TEST SCORES AND ASYMMETRIES.

BACKGROUND: The Functional Movement Screen (FMS™) is a widely used seven-test battery used by practitioners working in sport medicine. The FMS™ composite score (sum of seven tests) in soccer athletes from different competitive levels has been well explored in literature, but the specific movement deficits presented by young high competitive level players remains unclear. PURPOSE: The aim of the present study was to provide a detailed description of the performance of elite young soccer players (age 14-20 years) on the FMS™ testing battery. STUDY DESIGN: Cross-sectional observational study. METHODS: One-hundred and three young soccer players (14-20 years) from a premier league club were assessed by two experienced raters using the FMS™ testing battery. FMS™ composite score, individual-test scores and asymmetries were considered for analysis, and comparisons between age categories were performed. RESULTS: FMS™ composite scores ranged from 9 to 16 points (median=13 points). 82% of the athletes had a composite score ≤14 points, and 91% were classified into the "Fail" group (score 0 or 1 in at least one test). Almost half of athletes (48%) had poor performance (i.e., individual score < 2) in "deep squat" test. Most of athletes in the younger categories (under-15 and under-16) had poor performance in the "trunk stability push-up" test (70%) and in the "rotary stability" test (74%). Asymmetry in at least one of five unilateral FMS™ tests was found in 65% of athletes. CONCLUSION: High-performance young soccer players have important functional deficits, especially in tasks involving deep squat and trunk stability, as well as high prevalence of asymmetry between right and left body side. LEVEL OF EVIDENCE: 3a.

Beneficial effects of early environmental enrichment on motor development and spinal cord plasticity in a rat model of cerebral palsy.

Cerebral palsy (CP) results from nonprogressive lesions in the immature brain generating changes on the neuromuscular system. Environmental enrichment (EE) is a combination of stimuli that provides greater motivation and interest in novel movement exploration through the provision of various devices associated to enhanced social stimulation that would mimic the physiotherapy approach. The aim of this study was to verify whether EE is able to prevent the establishment of motor impairment in a CP rat model. The animals were divided in two groups: control animals (healthy) and animals submitted to a CP model. After this, the pups were exposed to two environments: enriched or standard, totaling four groups: Control group (without CP in a standard environment), CP group (CP model in a standard environment), EE group (without CP in an enriched environment) and CP-EE (CP model in an enriched environment). The experimental model was induced in pregnant Wistar rats by the association of maternal exposure to bacterial endotoxin, perinatal anoxia and sensorimotor restriction of the pups. The assessment of motor skills was held using the following tests: open field, rotarod, horizontal ladder, narrow suspended bar and stride length. The histological analysis evaluated the mean cross-sectional area (CSA) of the soleus muscle fibers, the mean CSA of motoneuronal somata and expression of synaptophysin in the ventral horn of the spinal cord. EE was able to prevent the motor deficits, however, it did not reverse the muscle atrophy observed in CP animals. Furthermore, there was an average increase in the mean area of motoneurons and an increase in the expression of synaptophysin in the ventral horn of the spinal cord of the CP-EE group in relation to CP animals reared in a standard environment. Hereupon, the stimulus increment provided by EE can prevent the onset of motor deficits and histological changes in a CP rat model.

Inflammatory response and oxidative stress in developing rat brain and its consequences on motor behavior following maternal administration of LPS and perinatal anoxia.

Cerebral palsy (CP) is a disorder of locomotion, posture and movement that can be caused by prenatal, perinatal or postnatal insults during brain development. An increased incidence of CP has been correlated to perinatal asphyxia and maternal infections during gestation. The effects of maternal exposure to low doses of bacterial endotoxin (lipopolysaccharide, LPS) associated or not with perinatal anoxia (PA) in oxidative and inflammatory parameters were examined in cerebral cortices of newborns pups. Concentrations of TNF-α, IL-1, IL-4, SOD, CAT and DCF were measured by the ELISA method. Other newborn rats were assessed for neonatal developmental milestones from day 1 to 21. Motor behavior was also tested at P29 using open-field and Rotarod. PA alone only increased IL-1 expression in cerebral cortex with no changes in oxidative measures. PA also induced a slight impact on development and motor performance. LPS alone was not able to delay motor development but resulted in changes in motor activity and coordination with increased levels of IL-1 and TNF-α expression associated with a high production of free radicals and elevated SOD activity. When LPS and PA were combined, changes on inflammatory and oxidative stress parameters were greater. In addition, greater motor development and coordination impairments were observed. Prenatal exposure of pups to LPS appeared to sensitize the developing brain to effects of a subsequent anoxia insult resulting in an increased expression of pro-inflammatory cytokines and increased free radical levels in the cerebral cortex. These outcomes suggest that oxidative and inflammatory parameters in the cerebral cortex are implicated in motor deficits following maternal infection and perinatal anoxia by acting in a synergistic manner during a critical period of development of the nervous system.

Treadmill training induces plasticity in spinal motoneurons and sciatic nerve after sensorimotor restriction during early postnatal period: new insights into the clinical approach for children with cerebral palsy.

The aim of the present study was to investigate whether locomotor stimulation training could have beneficial effects on the morphometric alterations of spinal cord and sciatic nerve consequent to sensorimotor restriction (SR). Male Wistar rats were exposed to SR from postnatal day 2 (P2) to P28. Control and experimental rats underwent locomotor stimulation training in a treadmill for three weeks (from P31 to P52). The cross-sectional area (CSA) of spinal motoneurons innervating hind limb muscles was determined. Both fiber and axonal CSA of myelinated fibers were also assessed. The growth-related increase in CSA of motoneurons in the SR group was less than controls. After SR, the mean motoneuron soma size was reduced with an increase in the proportion of motoneurons with a soma size of between 0 and 800 µm(2). The changes in soma size of motoneurons were accompanied by a reduction in the mean fiber and axon CSA of sciatic nerve. The soma size of motoneurons was reestablished at the end of the training period reaching controls level. Our results suggest that SR during early postnatal life retards the growth-related increase in the cell body size of motoneurons in spinal cord and the development of sciatic nerve. Additionally, three weeks of locomotor stimulation using a treadmill seems to have a beneficial effect on motoneurons' soma size.

Effects of fetal exposure to lipopolysaccharide, perinatal anoxia and sensorimotor restriction on motor skills and musculoskeletal tissue: implications for an animal model of cerebral palsy.

Cerebral palsy (CP) is a disorder of locomotion, posture and movement that can be caused by prenatal, perinatal or postnatal insults during brain development. An increased incidence of CP has been correlated to perinatal asphyxia and maternal infections during gestation. The effects of maternal exposure to low doses of bacterial endotoxin (lipopolysaccharide, LPS) on motor behavior and hind leg muscle morphology were examined in young adult rats. Prenatal exposure to LPS was also studied in association with perinatal anoxia (PA) and/or combined with subsequent sensorimotor restriction (SR) and all possible combinations of the three conditions. Rats exposed to LPS, PA and SR alone or combined (LPS + PA, LPS + SR, PA + SR, and LPS + PA + SR) showed deficits in balance and coordination when tested on the Rotarod. The SR groups, with or without other insults, (SR, LPS + SR, PA + SR, and LPS + PA + SR) exhibited the greatest motor deficits, characterized by the reduced ability to perform the horizontal ladder and suspended bar tests on postnatal day 29 (P29) and P45. Histological assessment revealed substantial morphological alterations in the slow ankle extensor soleus muscle of all SR rats. Soleus myofibers presented a reduction in cross-sectional area (CSA), an increase in sarcomere length and a decrease in sarcomere density. The CSA of the fast flexor tibialis anterior muscle was only decreased by the association of all treatments (LPS, PA, SR), but no differences were found in sarcomere length and density when compared to control. A slow-to-fast fiber type transition was only observed in the soleus and tibialis anterior muscles in the SR groups. These results suggest that exposure to LPS during the prenatal period, PA, SR alone or in combination has various degrees of consequences on motor behavior and muscle morphology. These data corroborate the concept that early experience-dependent movements play the most important role in shaping motor behavior and that reduced or anomalous sensorimotor experience can contribute to the development of aberrant motor behavior and muscle morphology.

Different effects of anoxia and hind-limb immobilization on sensorimotor development and cell numbers in the somatosensory cortex in rats.

Cerebral palsy (CP) is a group of movement and posture disorders attributed to insults in the developing brain. In rats, CP-like motor deficits can be induced by early hind-limb sensorimotor restriction (SR; from postnatal days P2 to P28), associated or otherwise with perinatal anoxia (PA; on P0 and P1). In this study, we address the question of whether PA, early SR or a combination of both produces alterations to sensorimotor development. Developmental milestones (surface righting, cliff aversion, stability on an inclined surface, proprioceptive placing, auditory startle, eye opening) were assessed daily from P3 to P14. Motor skills (horizontal ladder and beam walking) were evaluated weekly (from P31 to P52). In addition, on P52, the thickness of the somatosensory (S1) and cerebellar cortices, and corpus callosum were measured, and the neuronal and glial cell numbers in S1 were counted. SR (with or without PA) significantly delayed the stability on an inclined surface and hastened the appearance of the placing reflex and impaired motor skills. No significant differences were found in the thickness measurements between the groups. Quantitative histology of S1 showed that PA, either alone or associated with SR, increased the number of glial cells, while SR alone reduced neuronal cell numbers. Finally, the combination of PA and SR increased the size of neuronal somata. We conclude that SR impairs the achievement of developmental milestones and motor skills. Moreover, both SR and PA induce histological alterations in the S1 cortex, which may contribute to sensorimotor deficits.

Beneficial effects of treadmill training in a cerebral palsy-like rodent model: walking pattern and soleus quantitative histology.

The aim of the present study was to investigate whether treadmill locomotor training could have beneficial effects on deficits consequent to perinatal anoxia, sensorimotor restriction or a combination of both. Fifty-six newborn male Wistar rats were divided into four groups: control, anoxic, sensorimotor-restricted and anoxic-sensorimotor-restricted. Rats were exposed to anoxia in the first two postnatal days (P0 and P1) and/or hind-limb sensorimotor restriction from P2 to P28 for 16 h/day. Control and experimental rats underwent treadmill training for three weeks (from P31 to P52). Body weight and walking patterns (stride length and foot angle) were measured weekly during treadmill locomotor training. Soleus muscle cross-sectional mean area and fiber density were measured using planar morphometry. Anoxia per se did not cause gait or muscle deficits. Body weight, stride length and soleus fiber cross-sectional mean area, however, were increased in trained anoxic rats. Sensorimotor-restricted animals, either with or without perinatal anoxia, showed deficits in body weight gain, decreased stride length, wider foot angle and soleus fiber atrophy. In the sensorimotor-restricted group, treadmill training improved body weight gain and stride length, and decreased the percentage of the atrophic fibers. However, in the anoxic-sensorimotor-restricted group, training improved stride length only. Three weeks of treadmill training were able to improve stride length in restricted and anoxic-restricted animals, although body weight deficit and the degree of degradation in muscle histology were reduced only in the restricted group.