Validity study of a triaxial accelerometer for measuring energy expenditure in stroke inpatients of a physical medicine and rehabilitation center.

PURPOSE: Establish the validity of a triaxial accelerometer (Dynaport®) for evaluating the energy expenditure of patients with stroke sequelae at a rehabilitation hospital. METHODS: This is a cross-sectional study with 24 stroke inpatients of a rehabilitation hospital. The participants were assessed on energy expenditure by an ergospirometer system and the triaxial accelerometer simultaneously during a walk test. The data collected by both devices were compared by intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement. RESULTS: An almost perfect agreement (ICC = 0,94) in the energy expenditure measured by the accelerometer compared to the results of the ergospirometer system was found during the exercise test. The Bland-Altman analysis has shown suitable limits of agreement. Post hoc analyses with the maximum volume of oxygen and the total energy expenditure measured by the ergospirometer system evidenced significant correlation with the energy expenditure measurements by the accelerometer. CONCLUSION: Our results evidence that the triaxial accelerometer Dynaport® and its built-in software are valid for estimating the energy expenditure of stroke sequelae during a walk exercise.

Ultrasonographic findings in long COVID: A cross-sectional study of 312 patients.

Background: Fatigue and muscle weakness are common complaints in COVID-19 survivors. However, little is still known about the skeletal muscle qualitative and quantitative characteristics after hospitalization due to moderate and severe COVID-19. Objectives: To assess rectus femoris and vastus intermedius muscle thickness (MT) and rectus femoris echo intensity (EI) and to establish its association with demographic, clinical, functional, and inflammatory parameters in long COVID patients after hospital discharge. Methods: Cross-sectional study with 312 COVID-19 patients (53.53% male; age: 54.59 ± 13.50 years), with a laboratory-confirmed diagnosis of COVID-19. Patients were assessed 3-11 months after hospital discharge. We evaluated MT of the right rectus femoris and vastus intermedius and EI of the right rectus femoris using a portable ultrasound system, 6-13 MHz, broadband linear transducer. We corrected EI using the subcutaneous fat thickness. Ultrasonographic parameters were tested in association with demographic (sex and age); functional (Handgrip strength measurement, Timed Up and Go, 1 min Sit-to-Stand test, EuroQoL-5 Dimensions-5 Levels, World Health Organization Disability Assessment Schedule (WHODAS 2.0), Post-COVID-19 Functional Status, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT), Medical Research Council (MRC) sum score, Borg Dyspnea Scale, MRC Dyspnea score, Visual Analogue Scale (VAS), Epworth Sleepiness Scale, Insomnia Severity Index, Functional Independence Measurement (FIM), and Functional Oral Intake Scale); clinical (length of hospital stay, intubation, and presence of comorbidities such as systemic hypertension, diabetes, obesity, chronic obstructive pulmonary disease, asthma), and inflammatory data assessed by the C-reactive protein and D-dimer serum concentrations. Results: Rectus femoris MT was associated with age, handgrip strength, Epworth Sleepiness Scale, and subcutaneous fat thickness (r2 = 27.51%; p < 0.0001). Vastus intermedius MT was associated with age, pain intensity, handgrip strength, Epworth Sleepiness scale, FIM, and time since hospital discharge (r2 = 21.12%; p < 0.0001). Rectus femoris EI was significantly associated with the male sex, TUG, Epworth Sleepiness Scale, and C-Reactive Protein levels (r2 = 44.39%; p < 0.0001). Mean MT of rectus femoris and vastus intermedius are significantly different (p < 0.001). Conclusion: After hospital discharge, long COVID patients present qualitative and quantitative skeletal muscle characteristics associated with a combination of demographic, clinical, and functional parameters.

Long COVID outpatient rehabilitation: a call for action / Reabilitação ambulatorial da COVID longa: uma chamada à ação

COVID-19 has motor, cognitive, psychological and nutritional consequences that require rehabilitation. Objetive: To describe the outpatient rehabilitation program developed at the Instituto de Medicina Física e Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Method: We collected sociodemographic and clinical data of 12 adults with laboratory-confirmed COVID-19, severe and critical, who needed hospitalization in the acute phase. Functional assessments included Functional Independence Scale (FIM), EQ-5D-5L, World Health Organization Disability Assessment Schedule (WHODAS 2.0), Post-COVID-19 Functional Status scale (PCFS), Medical Research Council (MRC) dyspnea scale, visual analog scale (VAS) for pain, Douleur Neuropathique 4 (DN-4), Epworth sleepiness scale, Insomnia Severity Index, Montreal Ontario Cognitive Assessment (MoCA), Depression, anxiety and stress scale (DASS-21), nutritional assessment, Timed Up and Go test, 10-meter walking test (10 MWT), handgrip strength, MRC sum score, musculoskeletal ultrasound of the thigh.The outpatient rehabilitation program included electrical and musculoskeletal inductive magnetic stimulation, extracorporeal shockwave treatment, isokinetic exercises, emotional approach, cognitive stimulation, occupational performance stimulation, nutritional guidance, and educational program by COMVC mobile application. Individualized program was delivered twice a week until pre-stablished discharge criteria was achieved. Results: VAS and TUG presented statistically significant improvements (p <0.001). PCFS, FIM, handgrip strength, 10 MWT and DASS-21 anxiety presented slopes in the direction of improvement. Conclusion: The optimized, intensive, interdisciplinary and short-term outpatient rehabilitation program improves pain, mobility and anxiety in long COVID patients.

A COVID-19 tem consequências sensório motoras, cognitivas, psíquicas e nutricionais que necessitam de reabilitação. Objetivo: Descrever o programa de reabilitação ambulatorial desenvolvido no Instituto de Medicina Física e Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, otimizado, intensivo e de curta duração. Método: Obtivemos informações sociodemográficas e clínicas de 12 adultos com diagnóstico laboratorial de COVID-19, grave e crítica, que necessitaram de hospitalização na fase aguda. Avaliações funcionais: Escala de Medida de Independência Funcional (MIF), EQ- 5D-5L, World Health Organization Disability Assessment Schedule (WHODAS 2.0), Post- COVID-19 Functional Status scale, Medical Research Council (MRC) dyspnea scale, escala visual analógica (EVA) para dor, DN-4 (Douleur Neuropathique 4), escala de sonolência de Epworth, Índice de Gravidade da Insônia, Montreal Ontario Cognitive Assessment (MoCA), escala de Depressão, ansiedade e estresse (DASS-21), avaliação nutricional, Timed Up and Go, teste de caminhada de 10 metros, teste de preensão palmar, MRC sum score, ultrassonografia musculoesquelética da coxa antes, durante e após programa de reabilitação ambulatorial. Este incluiu estimulação magnética indutiva e elétrica musculoesquelética, tratamento por ondas de choque extracorpóreas, exercícios isocinéticos, abordagem emocional, estimulação cognitiva, estimulação do desempenho ocupacional, orientação nutricional e programa educacional por aplicativo COMVC. O tratamento foi realizado duas vezes por semana até atingir os critérios de alta pré-estabelecidos. Resultados: VAS e TUG proporcionaram melhora estatisticamente significante (p <0,001). PCFS, MIF, Handgrip, 10 MWT e DASS-21 domínio ansiedade apresentam tendências de melhora. Conclusão: O programa melhora a dor, mobilidade e ansiedade em pacientes com COVID longa.

Robot-Assisted Therapy and Constraint-Induced Movement Therapy for Motor Recovery in Stroke: Results From a Randomized Clinical Trial.

Background: Stroke is one of the leading causes of adult disability, and up to 80% of stroke survivors undergo upper extremity motor dysfunction. Constraint-Induced Movement Therapy (CIMT) and Robot-Assisted Therapy (RT) are used for upper limb stroke rehabilitation. Although CIMT and RT are different techniques, both are beneficial; however, their results must be compared. The objective is to establish the difference between RT and CIMT after a rehabilitation program for chronic stroke patients. Method: This is a randomized clinical trial, registered at ClinicalTrials.gov (ID number NCT02700061), in which patients with stroke received sessions of RT or CIMT protocol, combined with a conventional rehabilitation program for 12 weeks. The primary outcome was measured by Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment-Upper Limb (FMA-UL). Activities of daily living were also assessed. Results: Fifty one patients with mild to moderate upper limb impairment were enrolled in this trial, 25 women and 26 men, mean age of 60,02 years old (SD 14,48), with 6 to 36 months after stroke onset. Function significantly improved regardless of the treatment group. However, no statistical difference was found between both groups as p-values of the median change of function measured by WMFT and FMA were 0.293 and 0.187, respectively. Conclusion: This study showed that Robotic Therapy (RT) was not different from Constraint-Induced Movement Therapy (CIMT) regardless of the analyzed variables. There was an overall upper limb function, motor recovery, functionality, and activities of daily living improvement regardless of the interventions. At last, the combination of both techniques should be considered in future studies.

Ultrasonography findings in knee osteoarthritis: a prospective observational cross-sectional study of 100 patients.

Worldwide, knee osteoarthritis (KOA) accounts for 2.2% of total years lived with disability. There is a low correlation between joint tissue damage and pain intensity. Periarticular structures may be involved and cannot be identified in X-rays. To describe the main ultrasonography (USG) changes in symptomatic patients with primary KOA; to correlate the number of USG findings with KOA severity assessed by Kellgren and Lawrence (K&L) radiological scores, with pain intensity measured by a visual analogue scale (VAS) and with functioning scores assessed with the Timed up and go test (TUG) and Western Ontario and McMaster Universities (WOMAC) questionnaire. 100 patients with primary symptomatic KOA were assessed with X-ray and USG. Quantitative and qualitative analyses were evaluated in a systematic manner. The most frequent findings were joint effusion, pes anserinus bursitis, quadriceps tendon enthesopathy, popliteal cyst, iliotibial band tendinitis and patellar tendinitis. Pearson's correlation analysis demonstrated a significant moderate positive association between VAS scores and the number of USG findings (r = 0.36; p < 0.0001). The number of USG findings was different between K&L grades I and III (p = 0.041), I and IV (p < 0.001), and II and IV (p = 0.001, analysis of variance with Bonferroni correction). There was significant association between number of USG findings and TUG (r = 0.18; p = 0.014) and WOMAC scores for pain (r = 0.16; p < 0.029) and physical function domains (r = 0.16; p < 0.028). The most frequent USG finding was joint effusion. Periarticular structures should be explored as potential sources of pain and disability.

Body temperature and esthesia in individuals with stroke.

Patients with sequelae of stroke commonly report somatosensory losses. It is believed that body temperature may be associated with tactile sensibility and sensorimotor recovery of these patients. Demonstrate the associations among tactile sensibility, cutaneous temperature, subjective temperature perception, and sensorimotor recovery of patients with stroke sequelae. 86 patients with stroke sequelae were included. Patients had standardized regions of interest (ROIs) assessed with infrared thermography (FLIR T650SC) and monofilaments esthesiometry, and global motor recovery was evaluated with Fugl-Meyer Assessment (FMA). The presence of self-reported perception of temperature difference was used to divide the participants into two groups of 43 patients, and correlation tests were applied to establish correlations among variables. There is no clinically relevant association between tactile sensibility and cutaneous temperature of the foot, regardless of the subjective sensation of temperature changes. Sensorimotor recovery evaluated by FMA is associated with the difference of sensibility between both sides of the body (p < 0.001), as well as with the difference of tactile sensibility (p < 0.001). A clinically significant association between the difference of cutaneous temperature and tactile sensibility was not found, regardless of the presence or absence of subjective perception of such temperature difference. However, sensorimotor recovery is correlated with cutaneous temperature differences and tactile sensibility.

Cutaneous temperature and pressure pain threshold in individuals with knee osteoarthritis.

INTRODUCTION: Osteoarthritis is a common disease in which skin temperature may be included among the pathophysiological factors. Thermography allows the mapping of cutaneous temperature and may be employed in the investigation of osteoarthritis. OBJECTIVES: To evaluate cutaneous temperature of the lower limbs, as well as to verify its association with pressure pain thresholds in individuals with knee osteoarthritis. MATERIAL AND METHODS: This case series study was conducted with individuals of both genders aged 48-77 years with unilateral knee osteoarthritis. Volunteers underwent thermographic evaluation by an infrared sensor (FLIR T650SC). The anterior region of the thigh and leg and the knee area were evaluated. Pressure pain thresholds (PPT) were evaluated by algometry (Pain Diagnostics, Great Neck, USA) at the vastus medialis, vastus lateralis, rectus femoris, and patellar tendon. Data analysis was conducted with the statistical package SPSS v.24 for Windows. Comparisons between affected and unaffected sides were made by paired Student's t-test or the Mann-Whitney U test, and associations between variables were assessed by Pearson or Spearman's correlation coefficient. In all cases, the significance level was set at p ≤ 0.05. RESULTS: Eleven volunteers (63.1 ±9.5 years) participated in this study. When comparing cutaneous temperature, only the region of the knee showed a significant difference between sides (p = 0.02). There were no differences between affected and unaffected knees regarding pain tolerance (PPT) at all sites evaluated. There were also no significant associations between the study variables. CONCLUSIONS: Individuals with knee osteoarthritis presented a higher temperature of the affected knee, but this was not associated with pressure pain thresholds.

Comparison of sensitivity and plantar cutaneous temperature of patients with stroke and Diabetes Mellitus: A pilot case-control study.

BACKGROUND: Stroke combined with Diabetes Mellitus may cause sensibility and vascular alterations. OBJECTIVE: To determine whether sensitivity and plantar cutaneous temperature of clinically controlled patients with stroke and DM are different from those of patients with stroke only. METHODS: This is a cross-sectional case-control study. The volunteers were assessed for sensitivity by monofilament esthesiometry in their plantar region, and for temperature by infrared thermal imaging. The data was presented as means and standard deviations and comparisons were conducted with the Mann-Whitney statistical test, with statistical significance set at p< 0.05. RESULTS: Five cases and 11 controls were included according to the eligibility and pairing criteria. There were no discrepancies between the plegic and contralateral sides regarding temperature and sensibility of both cases and controls. However, in the control group, there was an observable tendency for different temperatures between the plegic and the contralateral sides, with p< 0.05 in most of the comparisons. CONCLUSIONS: There is no evidence that the cases and controls have different plantar sensibility nor different plantar temperature on their plegic and contralateral sides. However, significant temperature discrepancies between both plegic and contralateral sides were observed in the control group.

Acute Effect of Robotic Therapy (G-EO System™) on the Lower Limb Temperature Distribution of a Patient with Stroke Sequelae.

Robotic therapy has been gaining prominence in poststroke rehabilitation programs. An example of these devices is the G-EO System™, which simulates gait as well as other more complexes standards of gait such as the steps on stairs. However, to the best of our knowledge, there are no studies that apply thermography as a tool to evaluate stroke patients who undertook rehabilitation programs with the aid of robotic devices. The patient IWPS undergoes sequelae of hemorrhagic stroke for 19 months and consequently hemiplegia, had scores of 93 points in the Fugl-Meyer scale, is undertaking a physical rehabilitation program for six months, has no complaints of discomfort due to thermic sensitivity imbalances between the plegic and the contralateral sides, and voluntarily reports that he realizes functionality improvements especially, according to his perception, due to the aid of the robotic therapy in his gait training with the G-EO System™. The thermographic images were captured by an infrared sensor FLIR T650SC. By analyzing the temperature differences between both hemispheres of the body, before, immediately after, and 30 minutes after a robotic therapy for gait training, we observed that the values firstly increased immediately after the training, but after the 30-minute rest an important thermoregulation was achieved.

Uso da termografia como método de avaliação na medicina física e de reabilitação / The use of thermography as an assessment tool in physical medicine and rehabilitation

Por indicar a temperatura corporal, a avaliação termográfica pode servir como indicativo de alteração fisiológica em algumas condições clínicas nas quais a reabilitação se faz necessária. Objetivo: Conhecer a quantidade de publicações sobre o uso da termografia como instrumento de avaliação de desfecho de pesquisa clínica em estudos de reabilitação. Método: Foi feita uma busca na base de dados PubMed. Como descritor foi utilizado somente o MeSH term Thermography e escolhidos os artigos que reportavam pesquisa clínica. Resultados: De 6957 artigos encontrados, 316 eram Clinical trials, destes, 304 foram excluídos por não atenderem os critérios de inclusão, permanecendo assim 12 estudos. Estes foram classificados segundo a escala de JADAD. Apenas três estudos foram considerados com boa qualidade metodológica. Nos estudos incluídos, as condições clínicas avaliadas foram: dor muscular tardia, lombalgia, artrite reumatoide, síndrome da dor complexa regional, dor miofascial, osteoartrite, Fenômeno de Raynaud's, e tendinites. Diversos recursos terapêuticos foram utilizados, sendo o laser usado em 5 estudos. Apenas um estudo não conseguiu identificar mudanças após os procedimentos de reabilitação quando usada a termografia como avaliação. Conclusão: Essa revisão mostrou que poucos estudos e com baixa qualidade metodológica usaram a termografia como método de avaliação em programas de reabilitação

The infrared thermographic evaluation, given its capacity of detecting body temperature, may reveal physiological changes in clinical conditions that require physical rehabilitation. Objective: Was to identify publications that reported the use of thermography as a tool for evaluating clinical research outcomes in physical medicine and rehabilitation. Method: The MeSH term Thermography was the only descriptor in the search in PubMed database. Results: Out of 6957 articles, 316 were clinical trials, from which 304 were excluded for not fulfilling the eligibility criteria, and only 12 studies were included in the review. The articles were then classified according to the JADAD scale. Only three studies were rated as having good methodological quality. In the studies included, the clinical conditions were delayed onset muscle soreness, low back pain, rheumatoid arthritis, complex regional pain syndrome, myofascial pain syndrome, osteoarthritis, Raynaud's disease, and tendonitis. Several therapeutic interventions were used and laser therapy was reported in 5 different studies. Only one study did not manage to identify body temperature changes after the rehabilitation intervention, as measured by the thermography. Conclusion: This review has shown that a few studies, with low methodological quality, applied the thermography as a tool for evaluating physical medicine rehabilitation programs

Cutaneous temperature sensitivity alteration in subjects with chronic stroke sequelae - pharmacological perspectives.

BACKGROUND: Stroke can result in body temperature sensitivity changes. This study analyzed abnormal temperature perception of patients with stroke and the use of vasoactive drugs. METHODS: A cross-sectional retrospective study was carried out consisting of 100 patients (55.6±12.9 years old), from both genres, with either hemorrhagic or ischemic stroke, with unilateral hemiplegia or hemiparesis. Subjects had axillary temperature and different temperature sensitivities of the limbs measured using a visual analog scale (VAS). Information on the use of medical drugs was collected in clinical records. RESULTS: In total, 64 patients reported body temperature alterations, and 62 patients stated they feel cold in the affected side. They reported 6.12±2.44 cm alteration for the upper limb and 6.72±2.44 cm for the lower limb in the VAS. Some 86 different drugs were identified in the 85 medical records available. There was a prevalence of a group of drugs formed by the ß-blockers, dopamine agonists, dopamine reuptake Inhibitors, tricyclic antidepressants (TCAs) and another group formed by the selective serotonin reuptake inhibitors. CONCLUSIONS: Most of the subjects reported a sensation of cold in the affected limbs. The ß-blockers, dopamine agonists, dopamine reuptake inhibitors, and TCAs seem to be related to this sensation, however, due to the number of uncontrolled variables that may be related to these drugs and the possible role of nitric oxide, it was not possible to establish precise relations regarding the use of a specific group of drugs and the cold sensation in the affected limbs, as reported by the patients.