Adaptação transcultural do Chedoke Arm and Hand Activity Inventory (CAHAI) / Cross-cultural adaptation of the Chedoke Arm and Hand Activity Inventory (CAHAI)

Introdução: O Chedoke Arm and Hand Activity Inventory (CAHAI) foi desenvolvido nas línguas inglesa e francesa, com versão original nos dois idiomas, para a avaliação do nível de atividade dos membros superiores em indivíduos com hemiparesia após Acidente Vascular Encefálico (AVE). Objetivo: Realizar o processo de adaptação transcultural do manual de aplicação e da folha de pontuação do CAHAI para a língua portuguesa-Brasil. Método: Constituído de sete etapas, o processo de tradução consistiu em: i) duas traduções independentes; ii) compilação das duas traduções, formando uma única tradução; iii) revisão do layout, da tipografia e da gramática; iv) duas retrotraduções independentes; v) reunião com Comitê de Especialistas; vi) envio para a autora da versão original, e vii) pré-teste da versão CAHAI-Brasil (avaliadores: n=5; sujeitos: n=4). Resultados: A versão CAHAI-Brasil teve resultados satisfatórios nas etapas de tradução e adaptação, e índices de concordância entre os avaliadores adequados (kappa entre 0,76 e 1,00). Houve necessidade de substituir alguns termos utilizados no manual e de adaptar alguns dos materiais utilizados no teste. Conclusão: Este estudo mostra que a versão CAHAI-Brasil foi traduzida e adaptada com êxito.

Introduction: The Chedoke Arm and Hand Activity Inventory (CAHAI) was developed in English and French (original version in both languages) for evaluation of the level of the upper limb activity in subjects with hemiparesis after stroke. Objective: To translate and cross-culturally adapt the manual of application and scoring of CAHAI to Portuguese-Brazil. Method: The process included six steps: the translation process with two independent translation; merging of the two translation; layout, typography and grammar review; two independent backtranslations; meeting with the Committee of Experts, and sending to the author of the original version, and pre-testing of the version CAHAI-Brazil (raters: n=5; subjects: n=4). Results: The CAHAI-Brasil version had satisfactory results in the translation and adaptation, and appropriate index of agreement among raters (kappa between 0,76 and 1,00). Some expressions in the manual and some of the materials used for the test had to be adapted to Brazilian culture. Conclusion: This study show the CAHAI-Brazil version was successfully translated and adapted

Effect of backward walking treadmill training on walking capacity after stroke: a randomized clinical trial.

RATIONALE: Residual walking deficits are common in people after stroke. Treadmill training can increase walking speed and walking distance. A new way to increase the challenge of walking is to walk backwards. Backward treadmill walking may provide advantages by promoting improvement in balance, walking spatiotemporal parameters and quality that may reflect in improving walking distance. AIM: This study will test the hypothesis that backward treadmill walking is superior to forward treadmill walking in improving walking capacity, walking parameters, quality and balance in people with stroke. DESIGN: A prospective, single-blinded, randomized trial will randomly allocate 88 community-dwelling people after stroke into either an experimental or control group. The experimental group will undertake 30-min sessions of backward treadmill walking, three-days/week for six-weeks, while the control group will undertake the same dose of forward treadmill walking. Training will begin at the baseline overground walking speed and will increase each week by 10% of baseline speed. STUDY OUTCOMES: The primary outcome will be distance walked in the 6-min Walk Test. Secondary outcomes will be walking speed, step length, cadence, and one-leg stance time. Outcomes will be collected by a researcher blinded to group allocation at baseline (Week 0), at the end of training period (Week 6), and three-months after the cessation of intervention (Week 18). DISCUSSION: If backward treadmill walking can improve walking capacity more than forward treadmill training in stroke, it may have broader implications because walking capacity has been shown to predict physical activity level and community participation.

Bilateral impairments of shoulder abduction in chronic hemiparesis: electromyographic patterns and isokinetic muscle performance.

OBJECTIVE: To analyze electromyographic (EMG) patterns and isokinetic muscle performance of shoulder abduction movement in individuals who sustained a cerebrovascular accident (CVA). DESIGN: Twenty-two individuals who sustained a CVA and 22 healthy subjects volunteered for EMG activity and isokinetic shoulder abduction assessments. EMG onset time, root mean square (RMS) for upper trapezius and deltoid muscles, as well as the isokinetic variables of peak torque, total work, average power and acceleration time were compared between limbs and groups. RESULTS: The paretic side showed a different onset activation pattern in shoulder abduction, along with a lower RMS for both muscles (21.8±13.4% of the maximal voluntary isometric contraction (MVIC) for the deltoid and 25.9±15.3% MVIC for the upper trapezius, about 50% lower than the control group). The non-paretic side showed a delay in both muscles activation and a lower RMS for the deltoid (32.2±13.7% MVIC, about 25% lower than the control group). Both sides of the group of individuals who sustained a CVA presented a significantly lower isokinetic performance compared to the control group (paretic side ∼60% lower; non-paretic side ∼35% lower). CONCLUSIONS: Shoulder abduction muscle performance is impaired in both paretic and non-paretic limbs of individuals who sustained a CVA.

Enhancing robotic gait training via augmented feedback.

Recent work has examined the feasibility of robotic-assisted gait training in pediatric patients, including children with cerebral palsy (CP). Herein we present a case series describing clinical outcomes in four children with CP who underwent gait training using a robotic driven gait orthosis (DGO) (Pediatric Lokomat©). Children had a diagnosis of spastic diplegia due to CP. They were paired based on functional abilities and observed gait characteristics. Two children had a GMFCS of III and showed excessive ankle plantarflexion during stance. The other two children had a GMFCS of II and displayed a crouch gait pattern. Each subject participated in a 6-week intervention of robotic-assisted gait training that involved three 30-minute sessions per week. Pre-and post-training evaluations were performed including clinical tests of standing and walking function, walking speed, and walking endurance. Clinical gait analysis was also performed using a motion capture system to assess changes in gait mechanics. All subjects showed an improvement in locomotor function. For lower functioning children, this may be mediated by improved trunk control. The use of augmented feedback was associated with larger. However, these results have to be considered with caution because of the limited sample size of the study.

Chlorpheniramine impairs spatial choice learning in telencephalon-ablated fish.

This work investigated the effect of the H1 receptor blockade in the forebrain of ablated Carassius auratus in a simple stimulus-response learning task using a T-maze test with positive reinforcement. The goldfish were submitted to surgery for removal of both telencephalic lobes five days before beginning the experiment. A T-shaped glass aquarium was employed, with two feeders located at the extremities of the long arm. One of the two feeders was blocked. The experimental trials were performed in nine consecutive days. Each fish was individually placed in the short arm and confined there for thirty seconds, then it was allowed to swim through the aquarium to search for food for ten minutes (maximum period). Time to find food was analysed in seconds. Animals were injected intraperitoneally with chlorpheniramine (CPA) at 16 mg/kg of body weight or saline after every trial, ten minutes after being placed back in the home aquarium. The results show that all the training latencies of the A-SAL group were higher than the latencies of the S-SAL group. The S-SAL group had decreased latencies from the second trial on, while the S-CPA group showed decreased latencies after the fourth trial. The A-SAL group showed reduced latencies after the fifth trial, but the A-CPA group maintained the latencies throughout the experiment. This suggests that CPA impairs the consolidation of learning both on telencephalon ablated animals and in sham-operated ones through its action on mesencephalic structures of the brain and/or on the cerebellum in teleost fish.

Chlorpheniramine impairs spatial choice learning in telencephalon-ablated fish

This work investigated the effect of the Hj receptor blockade in the forebrain of ablated Carassius auratus in a simple stimulus-response learning task using a T-maze test with positive reinforcement. The goldfish were submitted to surgery for removal of both telencephalic lobes five days before beginning the experiment. A T-shaped glass aquarium was employed, with two feeders located at the extremities of the long arm. One of the two feeders was blocked. The experimental triáis were performed in nine consecutive days. Each fish was individually placed in the short arm and confined there for thirty seconds, then it was allowed to swim through the aquarium to search for food for ten minutes (máximum period). Time to find food was analysed in seconds. Animáis were injected intraperitoneally with chlorpheniramine (CPA) at 16 mg/kg of body weight or saline after every trial, ten minutes after being placed back in the home aquarium. The results show that all the training latencies of the A-SAL group were higher than the latencies of the S-SAL group. The S-SAL group had decreased latencies from the second trial on, while the S-CPA group showed decreased latencies after the fourth trial. The A-SAL group showed reduced latencies after the fifth trial, but the A-CPA group mainteined the latencies throughout the experiment. This suggests that CPA impairs the consolidation of learning both on telencephalon ablated animáis and in sham-operated ones through its action on mesencephalic structures of the brain and/or on the cerebellum in teleost fish.