Validation of the Frenchay activity index on stroke victims.

PURPOSE: To evaluate the inter-rater reliability and predictive validity of the Frenchay Activities Index (FAI) in patients after stroke. METHODS: One hundred sixty-one patients were selected for consecutive application of the FAI and National Institutes of Health Stroke Scale (NIHSS). Spearman's test was used for correlation between different scales. The FAI and NIHSS association was evaluated using ordinal logistic regression. Additionally, 36 patients underwent FAI rating on the same day by two independent evaluators. RESULTS: A negative correlation between the FAI and the NIHSS scores (p = 0.017 r = -0.22) was found. Adjusting all variables with possible association with the NIHSS, ordinal logistic regression showed that the FAI had a significant association with NIHSS scores (OR 0.93, 95% CI 0.87 to 0.99, p: 0.033). The inter-rater agreement was considered good, k = 0.66 (0.54 to 0.78), p < 0.001. CONCLUSIONS: The FAI is a valid and useful method to assess instrumental activities before acute stroke in a Brazilian population.

Validation of the Frenchay activity index on stroke victims / Validação do índice de atividades de Frenchay em indivíduos após AVC

ABSTRACT Purpose To evaluate the inter-rater reliability and predictive validity of the Frenchay Activities Index (FAI) in patients after stroke. Methods One hundred sixty-one patients were selected for consecutive application of the FAI and National Institutes of Health Stroke Scale (NIHSS). Spearman’s test was used for correlation between different scales. The FAI and NIHSS association was evaluated using ordinal logistic regression. Additionally, 36 patients underwent FAI rating on the same day by two independent evaluators. Results A negative correlation between the FAI and the NIHSS scores (p = 0.017 r = -0.22) was found. Adjusting all variables with possible association with the NIHSS, ordinal logistic regression showed that the FAI had a significant association with NIHSS scores (OR 0.93, 95% CI 0.87 to 0.99, p: 0.033). The inter-rater agreement was considered good, k = 0.66 (0.54 to 0.78), p < 0.001. Conclusions The FAI is a valid and useful method to assess instrumental activities before acute stroke in a Brazilian population.

RESUMO Objetivo Avaliar a confiabilidade inter-examinador e a validade preditiva do Índice de Atividades de Frenchay (FAI) em pacientes após acidente vascular cerebral. Métodos 161 pacientes foram selecionados para aplicação consecutiva da FAI e NIH Stroke Scale (NIHSS). O teste de Spearman foi utilizado para correlação entre as diferentes escalas. A associação FAI e NIHSS foi avaliada por meio de regressão logística ordinal. Adicionalmente, 36 pacientes foram submetidos à aplicação do FAI por dois avaliadores independentes, no mesmo dia. Resultados Foi encontrada uma correlação negativa entre o FAI e o NIHSS (r = -0,22; p = 0,017). Ajustando todas as variáveis com possível associação com NIHSS, a regressão logística ordinal demonstrou que o FAI tem associação significativa com o NIHSS (OR 0,93, 95% CI 0,87-0,99, p: 0,033). A concordância entre avaliadores foi considerada boa, k = 0,66 (0,54-0,78), p < 0,001. Conclusões FAI é um método válido e útil para avaliar atividades instrumentais antes de AVC agudo em uma população brasileira.

Dupla tarefa como estratégia terapêutica em fisioterapia neurofuncional: uma revisão da literatura / Dual task training as a therapeutic strategy in neurologic physical therapy: a literature review

Objetivo: Discutir as possibilidades de utilização da dupla tarefa no âmbito da reabilitação de pacientes neurológicos. Métodos: Foram realizadas buscas nas bases de dados PUBMED, MEDLINE, LILACS e PEDro, com o termo em inglês dual task associados a cada uma das palavras, em separado: treatment, physicaltherapy, rehabilitation, exercise, training, dividedattention, executivefunctions e attentionaldemands. Foram selecionados apenas ensaios clínicos que utilizaram o treinamento de dupla tarefa em população adulta com doença ou lesão neurológica. Resultados: Dos 2024 artigos encontrados, 1017 foram excluídos por se tratarem de artigos duplicados. Dentre os 1007 restantes, 998 foram excluídos após a análise dos resumos. Os nove artigos selecionados avaliaram pacientes com acidente vascular encefálico, traumatismo encefálico, doença de Alzheimer e de Parkinson. A maioria utilizou a marcha como tarefa primária, e uma tarefa cognitiva como secundária. Os programas variaram entre 9 e 48 horas totais de treinamento. Conclusão: O treinamento de dupla tarefa parece ter efeitos positivos na marcha, cognição, habilidades de automatização e transferência de aprendizado, sugerindo que essa pode ser uma estratégia valiosa para a reabilitação neurológica. Entretanto, ainda se faz necessário explicar quais as tarefas que são mais eficientes, o período de intervenção adequado e a extensão do período de retenção do aprendizado

Objective: Discuss the possibilities of dual task in the ambit of neurological rehabilitation. Methods: A survey was conducted in PUBMED, MEDLINE, LILACS, and PEDro, using the keywords "dual task" associated with each of the following terms separately: treatment, physical therapy, rehabilitation, exercise, training, divided attention, executive functions, and attentional demands. We selected only clinical trials that used dual task training in adults with neurological disease. Results: From the 2,024 articles found, 1,017 were excluded because they are duplicate. Among the remaining 1,007 articles, 998 were excluded after reviewing the abstracts. Nine articles were selected that included patients with stroke, brain injuries, Alzheimer's, and Parkinson's disease. Most articles used gait as the primary task, and in six studies the second task was cognitive. The training programs ranged between a total of 9 and 48 hours of training. Conclusion: Dual task training appears to improve gait, cognition, automation skills, and transference of learning, suggesting that this may be a valuable strategy for neurological rehabilitation. Nevertheless, it is still necessary to explain which tasks are more efficient and how long the learning retention lasts

Effects of the flavonoid casticin from Brazilian Croton betulaster in cerebral cortical progenitors in vitro: direct and indirect action through astrocytes.

Neurodegenerative diseases are a major constraint on the social and economic development of many countries. Evidence has suggested that phytochemicals have an impact on brain pathology; however, both their mechanisms of action and their cell targets are incompletely known. Here, we investigated the effects of the flavonoid casticin, extracted from Croton betulaster, a common plant in the state of Bahia in Brazil, on rat cerebral cortex neurons in vitro. Treatment of neural progenitors with 10 microM casticin increased the neuronal population positive for the neuronal marker beta-tubulin III and the neuronal transcriptional factor Tbr2 by approximately 20%. This event was followed by a 50% decrease in neuronal death. Pools of astrocyte (GFAP and S100beta), neural (nestin), and oligodendrocyte (Olig2 and NG2) progenitors were not affected by casticin. Neither neuronal commitment nor proliferation of progenitors was affected by casticin, suggesting a neuroprotective effect of this compound. Culture of neural progenitors on casticin-treated astrocyte monolayers increased the neuronal population by 40%. This effect was reproduced by conditioned medium derived from casticin-treated astrocytes, suggesting the involvement of a soluble factor. ELISA assays of the conditioned medium revealed a 20% increase in interleukin-6 level in response to casticin. In contrast to the direct effect, neuronal death was unaffected, but a 52% decrease in the death of nestin-positive progenitors was observed. Together our data suggest that casticin influences the neuronal population by two mechanisms: 1) directly, by decreasing neuronal death, and 2) indirectly, via astrocytes, by modulating the pool of neuronal progenitors.