Control of center of mass during gait of stroke patients: Statistical parametric mapping analysis.

BACKGROUND: The control of the center of mass is essential for a stable and efficient gait. Post-stroke patients present several impairments, which may compromise the control of the center of mass during gait in the sagittal and frontal planes. This study aimed to identify changes in the vertical and mediolateral behavior of the center of mass during the single stance phase of post-stroke patients using the statistical parametric mapping analysis. It also aimed to identify alterations in the center of mass trajectories regarding the motor recovery stages. METHODS: Seventeen stroke patients and 11 neurologically intact individuals were analyzed. The statistical parametric mapping approach was used to identify changes in the center of mass trajectories between stroke and healthy groups. The trajectories of the center of mass of post-stroke individuals were compared according to their motor recovery status. FINDINGS: A near-flat vertical trajectory of the center of mass was indenfitifed in the stroke group compared to their healthy counterparts, especially on the paretic side. The center of mass trajectories in both directions (vertical and mediolateral) presented substantial alteration at the end of the single stance phase in the stroke group. The trajectory of the center of mass of the stroke group was symmetrical in the mediolateral direction between the sides. The trajectories of the center of mass presented similar pattern irrespective of the motor recovery status. INTERPRETATION: The statistical parametric mapping approach showed to be suitable for determining gait changes in post-stroke individuals, irrespective of their motor recovery stage.

Strategies Adopted by Stroke Patients to Maintain Balance in Dynamic Tasks in a Video Game.

Postural instability affects motor tasks after a stroke. We investigated the strategies used to maintain balance during quiet standing posture and dynamic tasks in a video game. Sixteen stroke volunteers (12 males, 56 ± 9 years, post-stroke time 35 ± 10 months) and sixteen matched healthy volunteers had their biomechanical data collected to obtain the variables: center of mass, base of support, margin of stability, and weight symmetry. Healthy individuals and stroke patients showed similar dynamic stability. However, they adopted different motor strategies to achieve this: healthy individuals increased their base of support as they progressed to more challenging tasks, and stroke volunteers maintained the same base. The margin of stability of stroke volunteers was correlated with the MiniBEST scale.

Time profile of kinematic synergies of stroke gait.

BACKGROUND: In stroke subjects, the motor skills differ between sides and among subjects with different levels of motor recovery, impacting inter-joint coordination. How these factors can affect the kinematic synergies over time during gait has not been investigated yet. This work aimed to determine the time profile of kinematic synergies of stroke patients throughout the single support phase of gait. METHODS: Kinematic data from 17 stroke and 11 healthy individuals was recorded using a Vicon System. The Uncontrolled Manifold approach was employed to determine the distribution of components of variability and the synergy index. To analyze the time profile of kinematic synergies, we applied the statistical parametric mapping method. Comparisons were made within the stroke group (paretic and non-paretic limbs) and between groups (stroke and healthy). The stroke group was also subdivided into subgroups with worse and better motor recovery. FINDINGS: There are significant differences in synergy index at the end of the single support phase between stroke and healthy subjects; paretic and non-paretic limbs; and paretic limb according to the motor recovery. Comparisons of mean values showed significantly larger values of synergy index for the paretic limb compared to the non-paretic and healthy. INTERPRETATION: Despite the sensory-motor deficits and the atypical kinematic behavior, stroke patients can produce joint covariations to control the center of mass trajectory in the forward progression plane, but the modulation of the synergy is impaired, reflecting altered adjustments, especially in the paretic limb of subjects with worse levels of motor recovery.

Effects of the radio electric asymmetric conveyer (REAC) on motor disorders: An integrative review.

Introduction: The radio electric asymmetric conveyer (REAC) is a technology that has the purpose of restoring the cellular polarity triggering the rebalancing of the endogenous bioelectric field, which considering the neurological dysfunctions, affects the neural communication mechanisms. The studies published so far show that the REAC neuromodulation technology has positive effects in treating these dysfunctions, with the principles of endogenous bioelectricity as a basis to achieve these effects. Objectives: This study aims to review the literature that explored the effects of REAC protocols on motor control and to identify which mechanisms would be involved. Materials and methods: This integrative review considered studies that used REAC as a therapeutic intervention directed at human motor control and experimental research with animals that applied REAC to obtain effects related to motor behavior. Results: Ten articles were included, eight clinical and two experimental studies. The clinical studies used the neuro postural optimization (NPO) protocol in 473 patients, of which 53 were healthy subjects, 91 were Alzheimer's disease patients, 128 were patients with atypical swallowing, 12 subjects with neurological diseases, and 189 were without the specification of disease. The experimental studies used the antalgic neuromodulation and neurodegeneration protocols in animal models. Conclusion: The information integrated in this review made it possible to consider REAC technology a promising resource for treating motor control dysfunctions. It is possible to infer that the technology promotes functional optimization of neuronal circuits that may be related to more efficient strategies to perform motor tasks.

Does thenumber of stepsneededfor UCM gait analysisdiffers between healthy and stroke?

The basis for the uncontrolled manifold (UCM) approach is the variability among repetitions of a motor task. Thus, reliable results might be influenced by the number of trials. This study estimated the number of steps needed for UCM analysis of stroke gait and if it is the same for healthy subjects. Twenty-five volunteers participated, sixteen in the stroke group (age 59.0 ± 7.5 years, ten hemiparesis at right), and nine in the healthy group (age 59.2 ± 4.9 years). We applied the UCM analysis over each lower limb's single support phase (SSP). The center of mass in the sagittal plane was the task variable, and the ankle, knee and hip joint angles, the elemental variables. The results obtained with 40 steps were used as a reference and compared with those obtained separately from 10, 20, and 30 steps. The mean values of the curves along the SSP were compared between the sets of steps. Further, for each volunteer, we calculated the Pearson correlation between the 40 steps curve and those obtained with other numbers of steps. Our results indicate that (1) the number of steps necessary to perform UCM analysis of stroke gait is larger than those necessary in healthy condition, (2) the synergy index is less sensitive to the number of steps than the UCM components (V_UCM and V_ORT), and (3) the analysis of the UCM over time requires a more significant number of steps than the mean values.

Estabilidade dinâmica de pessoas com AVE durante o movimento de cabeceio simulado em um jogo digital / Estabilidad dinámica de personas con ACV durante el movimiento de cabeceo simulado en un juego digital / Dynamical stability of post-stroke volunteers during soccer headers simulated by a digital game

RESUMO A estabilidade postural é um objetivo de tratamento na fisioterapia que pode ser alcançado por meio de exercícios de transferência de peso bilateral. Os jogos digitais surgem como alternativa para execução desses exercícios, mas sua avaliação ainda necessita de aprimoramento. Propõe-se aqui o uso de variáveis biomecânicas para verificar o comportamento da estabilidade postural dinâmica durante um movimento de cabeceio, simulado por um jogo digital com diferentes exigências de velocidades. Para isso, 16 voluntários pós-acidente vascular encefálico (AVE) - 12 homens e 4 mulheres, com idade média de 56 anos - e 16 hígidos pareados por sexo e idade participaram da coleta experimental, na qual eles foram submetidos ao jogo digital "cabeceio", que tem cinco níveis de velocidade, do mais lento ao mais rápido, com duração de 30 segundos cada. A partir dos sinais cinemáticos foi possível calcular os indicadores de interesse, a área da base de suporte e a margem de estabilidade, definida como a menor distância entre as bordas da base de suporte e a projeção vertical do centro de massa (CM) extrapolado, que considera a velocidade do CM. Os valores da base de suporte não apresentaram diferenças entre os níveis de velocidade do jogo, mas sim entre grupos. A margem de estabilidade não diferiu entre níveis e grupos. Os níveis de velocidade do jogo, possivelmente, não estimularam os voluntários a buscar estratégias diferentes para manter a estabilidade, como dar um passo, mas os fizeram adotar bases de suporte diferentes, sendo que indivíduos com AVE adotaram uma base de suporte menor do que a dos hígidos.

RESUMEN La estabilidad postural es el objetivo del tratamiento en fisioterapia que puede lograrse mediante ejercicios de traslado de peso bilateral. Los juegos digitales son una alternativa para realizar estos ejercicios, pero aún necesita mejorar su evaluación. Se propone el uso de variables biomecánicas para verificar el comportamiento de estabilidad postural dinámica durante el movimiento de cabeceo, simulado por un juego digital con diferentes requerimientos de velocidad. Para ello, 16 voluntarios pos-accidente cerebrovascular (ACV) -12 hombres y 4 mujeres, con edad media de 56 años- y 16 individuos sanos pareados por sexo y edad participaron de la recolección experimental, en la que fueron sometidos al juego digital "cabeceo", que cuenta con cinco niveles de velocidad, del más lento al más rápido, con una duración de 30 segundos cada uno. A partir de las señales cinemáticas fue posible calcular los indicadores de interés, el área de base de apoyo y el margen de estabilidad, definido como la menor distancia entre los bordes de la base de apoyo y la proyección vertical del centro de masa (CM) extrapolado, que considera la velocidad del CM. Los valores de la base de apoyo no mostraron diferencias entre niveles de velocidad de juego, pero sí entre grupos. El margen de estabilidad no difirió entre niveles y grupos. Los niveles de velocidad de juego posiblemente no animaron a los voluntarios a buscar diferentes estrategias para mantener la estabilidad, como dar un paso, pero les hicieron adoptar diferentes bases de apoyo, llevando a los individuos con ACV a emplear una base de apoyo menor que la de los individuos sanos.

ABSTRACT Postural stability is a goal of physical therapy treatment which can be achieved by bilateral weight transfer exercises. Digital games come as an alternative to performing these exercises, and their evaluation still needs improvement. We proposed using biomechanical variables to assess postural stability behavior. We aimed to investigate dynamic postural stability during soccer headers simulated by a digital game with different speed requirements. For this, 16 post-stroke volunteers (12 men and 4 women with a mean age of 56 years) and 16 healthy volunteers, paired by sex and age, participated in the experimental collection, in which they were subjected to the digital game "Cabeceio" (Soccer Heading), which has five speed levels, from slowest to the fastest, lasting 30 seconds each. From the kinematic signals, we could estimate our indicators of interest: the area of the base of support and the margin of stability, the latter defined as the smallest distance between the edges of the base of support and the vertical projection of the extrapolated CM, considering CM speed. The values of the base of support failed to differ between game speed levels, but did so between groups. The margin of stability failed to differ between levels and groups. The speed levels of the game possibly failed to encourage volunteers to pursue different strategies to maintain dynamic stability, such as taking a step. Although they maintained different support bases, post-stroke individuals adopted a smaller base of support than healthy ones.

Center of mass in analysis of dynamic stability during gait following stroke: A systematic review.

BACKGROUND: The Center of mass (CoM) analysis reveals important aspects of gait dynamic stability of stroke patients, but the variety of methods and measures represents a challenge for planning new studies. RESEARCH QUESTION: How have the CoM measures been calculated and employed to investigate gait stability after a stroke? Three issues were addressed: (i) the methodological aspects of the calculation of CoM measures; (ii) the purposes and (iii) the conclusions of the studies on gait stability that employed those measures. METHODS: PubMed and Science Direct databases have been searched to collect original articles produced until July 2017. A set of 26 studies were selected according to criteria involving their methodological quality. RESULTS: A compromise between accuracy and feasibility in CoM calculation could be reached using the segmental method with 7-9 segments. Regarding their purposes, two types of studies were identified: clinical and research oriented. From the first ones, we highlighted: the margin of stability (MoS) in the mediolateral (ML) direction, and the angular momentum in the frontal plane could be indicators of dynamical stability; the MoS in the anteroposterior (AP) direction might be able to detect the risk of falls and the symmetry of vertical CoM displacement could be used to analyze energy expenditure during gait. These and other CoM measures are potentially useful in clinical settings, but their psychometric properties are still to be determined. The research oriented studies allowed to clarify that stability is not improved by widening the step in stroke patients and that the impaired control of the non-paretic limb might be the main source of instability. SIGNIFICANCE: This review provides recommendations on the methods for estimating CoM and its measures, identifies the potential usefulness of CoM parameters and indicates issues that could be addressed in future studies.

Influence of feet position on COP measures in post-stroke patients in quiet standing.

BACKGROUND: Foot placement is an important methodological parameter in experiments for analyzing the behavior of the center of pressure (CoP) duringquiet standing. In the case of stroke patients, this is a relevant issue, as the standardized position, usually adopted is not ecological. RESEACH QUESTION: Do between-limb synchronization, weight-bearing symmetry, and amplitude of the postural sway of post-stroke individuals differ between standardized and comfortable foot positions during quiet standing? METHODS: A total of 36 volunteers (20 with stroke and 16 healthy) stood barefoot, for 60 s, on two force plates with feet in a comfortable and standardized position (14° of external rotation and heels 17 cm apart). Three trials were performed in each position, and the average values obtained were analyzed. RESULTS: The comfortable position adopted by stroke individuals was characterized by heels kept 17 cm apart and with 21° of external rotation. None of the measures of the healthy group were influenced by feet position. In the stroke group, the lag to maximal between-feet correlation in the mediolateral direction (ML ρmax lag) was higher (0.45 s) and the weight-bearing symmetry was better in the comfortable (38%) than in the standardized conditions (0.19 s and 32%, respectively). Neither the other CoP measures nor the intra-subject variability was sensitive to feet position. SIGNIFICANCE: The assumption that standardization leads to reduced variability might not be valid to the post-stroke and healthy individuals age around 55 years. Therefore, adoption of a comfortable condition might be advantageous, once it allows for a more practical and realistic evaluation of postural control.

Reliability and minimal detectable change of between-limb synchronization, weight-bearing symmetry, and amplitude of postural sway in individuals with stroke

Abstract Introduction: Recently, variables related to between-limb synchronization of the centers of pressure (COP) have been proposed as measures of postural control in post-stroke patients. Although it is crucial in verifying their potential clinical use, the reliability of these variables is unknown. The aim of this work was to determine the reliability and minimal detectable change (MDC) of the peak of synchronization (ρmax) in the anteroposterior (AP) and mediolateral (ML) directions, the time lag for the peak (ρmaxlag), synchronization at lag zero (ρ0), weight-bearing symmetry, and amplitude of postural sway, measured as the root mean square (RMS) values of the COP displacements in both directions (AP and ML COP displacement). Methods COP data of 16 participants with stroke were collected at quiet standing with two force plates at two sessions separated by 2 to 7 days. The procedure was repeated three times in each session. The within and between sessions reliability was determined by the intraclass correlation coefficient (ICC), and the MDC was obtained from the ICC between sessions. Results The variables ρmaxlag in the AP and ML directions, as well as ρ0 in the AP direction, exhibited poor within session reliability (ICC ≤ 0.4). The findings revealed excellent within and between sessions reliability (ICC ≥ 0.89) for weight-bearing symmetry and the RMS displacement in the AP direction, with MDC values of 5% and 2.07 mm, respectively. The remaining variables exhibited moderate reliability. Conclusion Weight-bearing symmetry and AP COP displacement can be considered reliable variables for use in clinical practice.

Reliability and Minimum Detectable Change of the Gait Deviation Index (GDI) in post-stroke patients.

The Gait Deviation Index (GDI) is a summary measure that provides a global picture of gait kinematic data. Since the ability to walk is critical for post-stroke patients, the aim of this study was to determine the reliability and Minimum Detectable Change (MDC) of the GDI in this patient population. Twenty post-stroke patients (11 males, 9 females; mean age, 55.2±9.9years) participated in this study. Patients presented with either right- (n=14) or left-sided (n=6) hemiparesis. Kinematic gait data were collected in two sessions (test and retest) that were 2 to 7days apart. GDI values in the first and second sessions were, respectively, 59.0±8.1 and 60.2±9.4 for the paretic limb and 53.3±8.3 and 53.4±8.3 for the non-paretic limb. The reliability in each session was determined by the intra-class correlation coefficient (ICC) of three strides and, in the test session, their values were 0.91 and 0.97 for the paretic and non-paretic limbs, respectively. Between-session reliability and MDC were determined using the average GDI of three strides from each session. For the paretic limb, between-session ICC, standard error of measurement (SEM), and MDC were 0.84, 3.4 and 9.4, respectively. Non paretic lower limb exhibited between-session ICC, standard error of measurement (SEM), and MDC of 0.89, 2.7 and 7.5, respectively. These MDC values indicate that very large changes in GDI are required to identify gait improvement. Therefore, the clinical usefulness of GDI with stroke patients is questionable.

Reliability and minimum detectable change of the gait profile score for post-stroke patients.

The objectives of this work were (i) to determine Gait Profile Score (GPS) for hemiparetic stroke patients, (ii) to evaluate its reliability within and between sessions, and (iii) to establish its minimal detectable change (MDC). Seventeen hemiparetic patients (mean age 54.9±10.5years; 9 men and 8 women; 6 hemiparetic on the left side and 11 on the right side; mean time after stroke 6.1±3.5months) participated in 2 gait assessment sessions within an interval of 2-7 days. Intra-session reliability was obtained from the intraclass correlation coefficient (ICC) between the three strides of each session. Inter-session reliability was estimated by the ICC from the averages of that three strides. GPS value of non paretic lower limb (NPLL) (13.9±2.4°) was greater than that of paretic lower limb (PLL) (12.0±2.8°) and overall GPS (GPS_O) was 13.7±2.5°. The Gait Variable Scores (GVS), GPS and GPS_O exhibited intra-session ICC values between 0.70 and 0.99, suggesting high intra-day stability. Most of GVS exhibited excellent inter-session reliability (ICC between 0.81 and 0.93). Only hip rotation, hip abduction of PLL exhibited moderate reliability with ICC/MDC values of 0.57/10.0° and 0.71/3.1°, respectively. ICC/MDC values of GPS were 0.92/2.3° and 0.93/1.9° for PLL and NPLL, respectively. GPS_O exhibited excellent test-retest reliability (ICC=0.95) and MDC of 1.7°. Given its reliability, the GPS has proven to be a suitable tool for therapeutic assessment of hemiparetic patients after stroke.

Duração dos efeitos de uma manipulação vertebral sobre a intensidade da dor e atividade eletromiográfica dos paravertebrais de indivíduos com lombalgia crônica mecânica / Duración de los efectos de manipulación vertebral sobre la intensidad de dolor y actividad electromiográfica de la columna en sujetos con dolor lumbar crónico mecánico / Duration of the effects of spinal manipulation on pain intensity and electromyographic activity of paravertebral parts of individuals with chronic mechanical low back pain

RESUMO O objetivo desta pesquisa foi avaliar os efeitos de uma intervenção manipulativa sobre a atividade eletromiográfica dos músculos paraverterbais e a intensidade da dor na coluna lombar imediatamente e 30 minutos após sua realização em indivíduos com dor lombar crônica mecânica. Foram avaliados 38 indivíduos, distribuídos aleatoriamente em dois grupos: o que recebeu a técnica de manipulação vertebral global (n=20) e o controle (n=18), que permanecia em decúbito lateral por dez segundos sobre cada lado do corpo. O sinal eletromiográfico dos paravertebrais ao nível L4-L5 direito e esquerdo foi coletado durante três ciclos do movimento de flexão-relaxamento-extensão do tronco. Nos intervalos entre os ciclos, os participantes relataram a intensidade de dor através da Escala Visual Analógica (EVA 100 mm). Foi observada redução significativa na intensidade da dor no grupo que recebeu a manipulação, ao contrário do grupo controle, em que a pontuação na EVA aumentou. O tamanho do efeito na intensidade da dor foi de 1,0 e 0,9 logo após a manipulação e 30 minutos depois. A razão de flexão/relaxamento (RFR) aumentou no grupo que foi submetido à manipulação, mas permaneceu inalterada no grupo controle. A RFR exibiu tamanhos de 0,6 e 0,5 entre os grupos nas duas avaliações. Foi possível constatar efeitos da manipulação nessas duas variáveis e sua continuidade no intervalo observado, concluindo-se que eles perduram pelo menos durante esse tempo.

RESUMEN En este estudio se evalúan los efectos de intervención manipulativa sobre la actividad electromiográfica de los músculos paravertebrales y la intensidad del dolor lumbar inmediatamente y treinta minutos después de realizada la actividad por sujetos con dolor lumbar crónica mecánica. Participaron 38 sujetos, los cuales fueron divididos al azar en dos grupos: el que había recibido la técnica de manejo vertebral global (n=20) y el grupo control (n=18), lo cual había permanecido en posición lateral por diez segundos sobre cada lado del cuerpo. Se recolectó el signo electromiográfico de los paravertebrales al nivel L4-L5 derecho e izquierdo durante tres ciclos de movimiento de flexión-relajamiento-extensión del tronco. Entre los intervalos de los ciclos, los participantes relataron la intensidad de dolor mediante la Escala Visual Analógica (EVA 100 mm). Los resultados mostraron una significativa disminución en la intensidad de dolor en el grupo que había recibido el manejo, mientras que el grupo control aumentó el puntaje de EVA. El efecto de la intensidad de dolor fue de 1,0 y 0,9 tras el manejo y treinta minutos después. La razón flexión/relajamiento (RFR) aumentó en el grupo al que se sometió al manejo, mientras que había permanecido inalterable en el grupo control. Los valores de los efectos de la RFR entre los grupos fueron de 0,6 y 0,5 en las dos evaluaciones. En estas dos variables se constataron efectos de manejo, que había seguido en el intervalo observado, lo que muestra su permanencia por lo menos durante el periodo.

ABSTRACT The objective of this research was to evaluate the effects of a manipulative intervention on the electromyographic activity of paraverterbral muscles and low back pain intensity, both immediately and 30 minutes after their application in individuals with chronic low back pain. Thirty-eight individuals were evaluated, being randomly divided into two groups: the one who received global vertebral manipulation technique (n=20), and control (n=18), which remained in lateral decubitus for 10 seconds on each side of the body. The electromyographic signal of paravertebral parts at L4-L5 level both right and left was collected during three cycles of flexion-relaxation-extension of the torso. In the intervals between cycles, participants reported the intensity of pain through the Visual Analog Scale (VAS, 100 mm). A significant reduction in pain intensity in the group that received the manipulation was observed, opposed to the control group, in which the score increased in VAS. The dimension of the effect on pain intensity was 1.0 and 0.9 right after the manipulation and 30 minutes later. The flexion/relaxation ratio (FRR) increased in the group that was subjected to manipulation, but remained unchanged in the control group. The FRR displayed effects between the groups that were 0.6 and 0.5 in both assessments. We were able to see effects of the manipulation in these two variables, and its continuation in the range observed, concluding that they linger at least during that time.

Acute effects of short and long duration dynamic stretching protocols on muscle strength / Efeitos agudos de protocolos de alongamento dinâmico de curto e de longa duração sobre a força muscular

Objective Compare the acute effects of dynamic stretching protocols on the isokinetic performance of the quadriceps and hamstring muscles at two velocities in adult males.Methodology Included the participation of 14 males (21 ± 2.6 years; 178 ± 0.4 cm; 73.2 ± 20.9 kg) were assessed using an isokinetic dynamometer before and after following a short or long-duration dynamic stretching protocol or a control protocol. The results were assessed by a two-way ANOVA and a Scheffé’s post hoc test at a 5% significance level.Results No difference was found in the variables assessed at 180°/s after LDDS. At 60°/s, LDDS reduced the power of the knee flexors. The control protocol reduced the power of the knee flexors and increased the power of the extensors. At 60°/s, the work of the knee flexors exhibited a reduction after LDDS. The control protocol resulted in a reduction in the work of the flexors. The peak torque angle exhibited a reduction in the extensors and flexors after LDDS and SDDS.Conclusion Dynamic stretching did not cause any change in the peak torque, which points to its possible use in activities involving velocity and muscle strength. The executing dynamic stretching before physical activities such as running and high-intensity sports might be beneficial by promoting increases in heart rate and in body temperature.

Objetivo Comparar os efeitos agudos de protocolos de alongamento dinâmico no desempenho isocinético do quadríceps e isquiotibiais em duas velocidades diferentes em homens adultos.Metodologia Participaram 14 sujeitos (21 ± 2,6 anos, 178 ± 0,4 cm; 73,2 ± 20,9 kg) avaliados através de um dinamômetro isocinético, antes e depois de seguir os protocolos de alongamento dinâmico de longa e curta duração e protocolo controle. Os resultados foram avaliados por uma análise de variância de duas fatores e teste post hoc de Scheffé ao nível de significância de 5%.Resultados Não houve diferença nas variáveis avaliadas em 180º/s após ADLD. A 60º/s, ADLD reduziu a força dos flexores do joelho na concêntrica e as fases excêntrica do movimento. O protocolo de controle reduziu a força dos flexores do joelho e aumentou a força dos extensores. A 60º/s, o trabalho dos flexores do joelho apresentou redução após ADLD. O protocolo controle reduziu trabalho dos flexores. O ângulo de pico de torque apresentou uma redução nos extensores e flexores após ADLD e ADCD.Conclusão O alongamento dinâmico não causou alteração no pico de torque, o que favorece uso em atividades que envolvam velocidade e força muscular . O alongamento antes de atividades físicas como corrida e esportes de alta intensidade pode ser benéfico por promover aumento da frequência cardíaca e da temperatura corporal. [K].

Treino locomotor com suporte parcial de peso corporal na reabilitação da lesão medular: revisão da literatura / Locomotor training with partial body weight support in spinal cord injury rehabilitation: literature review

INTRODUÇÃO: O treino locomotor com suporte de peso corporal (TLSP) é utilizado há aproximadamente 20 anos no campo da reabilitação em pacientes que sofrem de patologias neurológicas. O TLSP favorece melhoras osteomusculares, cardiovasculares e psicológicas, pois desenvolve ao máximo o potencial residual do organismo, proporcionando a reintegração na convivência familiar, profissional e social. OBJETIVO: Identificar as principais modalidades de TLSP e seus parâmetros de avaliação com a finalidade de contribuir com o estabelecimento de evidências confiáveis para as práticas reabilitativas de pessoas com lesão medular. MATERIAIS E MÉTODOS: Foram analisados artigos originais, publicados entre 2000 e 2011, que envolvessem treino de marcha após a lesão medular, com ou sem suporte parcial de peso corporal, e tecnologias na assistência do treino, como biofeedback e estimulação elétrica funcional, entre outras. RESULTADOS: A maioria dos participantes dos estudos era do sexo masculino; os níveis de lesão variavam de C3 a L3; ASIA teve pontuações de A a D; os tempos de lesão variaram entre 0,3 meses a 33 anos. Também se verificou que não há consenso em relação ao protocolo de TLSP. CONCLUSÃO: O treino locomotor com suporte de peso corporal mostra-se viável na reabilitação de pacientes que sofrem de uma patologia neurológica como a lesão medular. Independentemente do protocolo de treino utilizado, os benefícios referentes ao aumento da força muscular, manutenção ou aumento da densidade óssea, diminuição da frequência cardíaca e aumento do condicionamento físico estão presentes.

INTRODUCTION: The locomotor training with bodyweight support (LTBWS) has been used for approximately twenty years in the field of rehabilitation in patients who suffer from neurological pathologies. The LTBWS favors these improvements muscle, cardiovascular and osteo-psychological, because maximum residual potential develops the body, providing reintegration into the familial, social and professional. OBJECTIVE: Identify the main methods of assessment and their parameters LTBWS with the purpose of contributing to the establishment of reliable evidence for the rehabilitation practice of people with spinal cord. MATERIALS AND METHODS: Original articles were analyzed, published between 2000 and 2011, involving gait training after spinal cord, with or without partial body weight support, and training assistance technologies such as functional electrical stimulation and biofeedback among others. RESULTS: The majority of the participants of the studies was male; injury levels ranged from C3 to L3, ASIA had scores from A to D; injury times ranged from 0.3 months 33 years. Also it was noted that there is no consensus regarding LTBWS Protocol. CONCLUSION: The locomotor training with bodyweight support shows up, viable in the rehabilitation of patients who suffer from a neurological pathology such as the spinal cord, regardless of training protocol used the benefits relating to increases in muscular strength, maintaining or increasing bone density, decreased heart rate, increase in physical conditioning are present.

Sistemas implantáveis de estimulação elétrica funcional para controle artificial de movimentos funcionais: [revisão] / Implantable functional electrical stimulation systems for artificially controlling functional movements: [review]

Pessoas com lesão no sistema nervoso central (SNC), particularmente após lesão medular e acidente vascularencefálico podem apresentar limitação na capacidade de realização das atividades da vida diária incluindo alocomoção. A estimulação elétrica funcional (FES) promove a contração dos músculos paralisados/paréticos e permite realizar essas tarefas funcionais. O objetivo deste trabalho éapresentar uma revisão dos sistemas artificiais de controle motor implantáveis desenvolvidos para minimizar os efeitos das incapacidades causadas pela lesão e de outras como asdecorrentes de acidente vascular encefálico. Buscas foram feitas no serviço online Google Acadêmico, resultando na compilação de base com 259 artigos. Os estimuladores elétricossão classificados em quatro categorias, dependendo da localização dos eletrodos e da topologia do sistema: externos ou não-invasivos que utilizam eletrodos de superfície, hard-wired implantados com acoplamento transcutâneo, e totalmente implantados. O estimulador elétrico mais antigocitado é de 1961 e o mais recente é de 2008. Os estimuladores elétricos descritos foram eficazes para realizar artificialmente movimentos funcionais. Transdutores de várias naturezas foram empregados em sistemas de malha aberta e fechada. Sistemas de malha fechada tiveram maior incidência nos estimuladores elétricos mais recentes. Estimuladores elétricos totalmente implantados e com acoplamento transcutâneo apresentaram menos problemas com quebras de eletrodos e problemas de infecção do que os hard-wired. As estratégias de estimulação envolveram controle ativado tanto pelo paciente quanto automático. Depósitos de patente também são apresentados. A redução de dispositivos que permanecerão internos a dimensões injetáveis favorece os sistemas de FES com acoplamento transcutâneo. Pesquisas científicas de alta tecnologia buscam desenvolver microestimuladores injetáveis com novos materiais isolantese técnicas de implante menos invasivas...

After suffering a spinal trauma, people with spinal cord injury become unable to perform several daily life activities. The aim of this study is to present a review of artificial motor control systemsdeveloped to minimize the effects of this impairment. A 259-paper database was compiled from the results of queries submitted to Google Scholar online service. Electrical stimulators are classified in four categories according to electrodes placement and systemtopology: external or non-invasive which use surface electrodes, hard-wired, implanted with transcutaneous coupling, and totally implanted. The oldest electrical stimulator cited dates back to 1961 and the most recent is from 2008. The described electrical stimulators were efficient for performing artificial functionalmovements. Transducers of different natures were used in open and closed loop systems. Totally implanted and transcutaneously coupled electrical stimulators showed less electrode failures and infection problems than hard-wired systems. In recent electricalstimulators, closed loop systems are more incident. Patent deposits are also presented. The physical reduction of components and units to injectable dimensions favors transcutaneously coupled electrical stimulators. High technology scientific researches aim to develop injectable micro stimulators with new insulation materials and less invasive implantation techniques. For implantable systems, before performing the implant it is required to test the efficacy and to consider the control strategy practicality. This fact also leads to the need of developing new techniques for communicating more efficiently between implantable electrical stimulators and the external control units.

Immediate effects of a high-velocity spine manipulation in paraspinal muscles activity of nonspecific chronic low-back pain subjects.

High-velocity spinal manipulation is commonly adopted for treating chronic low-back pain (CLBP) and has been associated with changes in muscle activity, but the evidence is controversial. The aim of this study was to analyse the immediate effects of high-velocity spine manipulation on paraspinal activity during flexion-extension trunk movements. Forty nonspecific CLBP patients were randomised into two groups, manipulation (n = 20) and control (n = 20). While the manipulation group received high-velocity spine manipulation at the L4-L5 level, the control group remained lying in the same position. EMG-related variables, perceived pain intensity (100 mm VAS) and finger-floor distance were collected before and after spinal manipulation at the L4-L5 level. EMG surface signals from the right and left paraspinal muscles (L5-S1 level) were acquired during trunk flexion-extension cycles. EMG activity during the static relaxation phase was significantly reduced following intervention for the manipulation group but not for the control group. The extension-phase EMG activity was also reduced after manipulation, but the flexion-phase EMG levels remained unchanged. Accordingly, the percent changes in FRR and ERR were significantly larger for the manipulation group compared to the control. The results suggest that a high-velocity spinal manipulation is able to acutely reduce abnormal EMG activity during the full-flexion static phase and activation during the extension phase.

Efeitos de uma intervenção cinesioterapêutica e eletroterapêutica na cinemática da marcha de indivíduos hemiparéticos / Effects of a single intervention of kinesitherapy associated with FES on gait kinematics of hemiparetic individuals

INTRODUÇÃO: O treino da marcha é um dos objetivos mais importantes e complexos na reabilitação do Acidente Vascular Encefálico para o qual são aplicadas cinesioterapia e estimulação elétrica. Porém, na realidade clínica, a análise da marcha é realizada qualitativamente, sem recursos que forneçam parâmetros objetivos sobre os efeitos das intervenções. OBJETIVO: Avaliar os efeitos de um único atendimento cinesioterapêutico e eletroterapêutico na cinemática da marcha de indivíduos hemiparéticos. MÉTODOS: Nove voluntários com hemiparesia secundária à AVE, em fase crônica, tiveram marcadores adesivos posicionados em pontos anatômicos e foram filmados simultaneamente com duas câmeras posicionadas em cada lado do seu corpo, enquanto caminhavam a uma velocidade de sua escolha. Os parãmetros da marcha foram obtidos a partir de um modelo bidimensional de quatro segmentos. A intervenção fisioterapêutica foi composta por mobilizações e alongamentos musculares de membros inferiores e estimulação elétrica funcional, em músculo tibial anterior do hemicorpo parético. RESULTADOS: Os parâmetros da marcha que sofreram alterações, foram as amplitudes de movimento dos joelhos parético (de 60,66 + - 8,66 para 62,44 + - 8,15 graus) e não parético (de 39,54 + - 15,40 para 43,61 + - 18,13 graus), o comprimento do passo do lado não parético (de 0,28 + - 0,28 + - 0,31 + - 0,12 m) e a velocidade da marcha (de 0,40 + - 0,16 para ),44 + - 0,14 m/s). CONCLUSÃO: O método de análise de marcha aqui utilizado, apesar de suas limitações, foi capaz de fornecer valores coerentes com a literatura e de revelar alterações em alguns parâmetros funcionalmente importantes como a velocidade da marcha.

INTRODUCTION: Gait training is one of the most important and difficult aims in post stroke rehabilitation, for which kinesitherapy and electrical stimulation are usually employed. However, in clinical reality, gait analysis is usually done qualitatively, without resources that can provide the therapist with an objective assessment of the therapeutic intervention. OBJECTIVE: analise the effects of a single intervention associating kinesitherapy and functional electrical stimulation on the gait kinematics of hemiparetic individuals. METHODS: Nine volunteers with chronic hemiparesis secondary to stroke, had adhesive markers were placed at anatomical landmarks and were videotaped by two digital cameras, one at each body side, while walked at a speed chosen by themselves. The gait parameters were obtained using a two-dimensional, four segment kinematical model. The physiotherapeutic intervention was composed by mobilizations and stretching of lower limbs muscles and functional electrical stimulation on the anterior tibial muscle of the paretic side. RESULTS: The gait parameters whose values have changed after intervention were range of motion of paretic (from 60,66 ± 8,66 to 62,44 ± 8,15 degrees) and non-paretic (39,54 ± 15,40 to 43,61 ± 18,13 degrees) knees, non-paretic step length (from 0,28 ± 0,13 to 0,31 ± 0,12 ) and gait speed (from 0,40 ± 0,16 to 0,44 ± 0,14 m/s). CONCLUSION: The method adopted for gait analysis, in despite of its limitations, was able to provide gait parameters values according to the literature as well as to show the effect of the intervention in parameters such as the gait speed.

Desenvolvimento de instrumentação para aplicação e avaliação do treinamento locomotor com suporte parcial de peso / Development of instrumentation for application and assessment of locomotor training with partial body weight support

O treino locomotor com suporte parcial de peso (TLSP) é um método para reabilitação da marcha que consiste em suspender o indivíduo sobre uma esteira enquanto seus membros inferiores são movimentados passivamente. Para aplicar o TLSP de forma apropriada, é preciso que a descarga de peso sobre membros inferiores seja controlada e monitorada. O objetivo deste trabalho foi desenvolver um sistema de suporte de peso (SSP) capaz de medir descarga de peso sobre membros inferiores e superiores. Além disso, instrumentação para medição do ângulo do joelho, contato do pé e eletromiografia foi desenvolvida para avaliação do treino. O SSP foi construído com um sistema de polias, cabo de aço, guincho manual, uma célula de carga fixa ao cabo e duas outras em apoios para as mãos adaptados a uma esteira elétrica. Eletrogoniômetros e footswitches foram construídos para o sistema de medição, e uma plataforma de aquisição de sinais foi desenvolvida em ambiente LabVIEW®. As células de carga e os eletrogoniômetros foram calibrados e testados. Um ensaio piloto foi realizado com um indivíduo saudável a uma velocidade de 1,5 km/h com descarga de 60% do peso corporal sobre membros inferiores. O SSP desenvolvido apresentou erro menor que 1,5% e forneceu medidas das descargas de peso sobre membros superiores e inferiores. Ele permitiu analisar assimetria sobre membros superiores, o que pode ser importante na reabilitação neurológica. O spadrões cinemáticos e eletromiográficos fornecidos pelo sistema de medida foram semelhantes aos mostrados na literatura. A patente do sistema foi requerida junto ao INPI sob o protocolo n° 0000280904043771.

The locomotor training with partial weight support (LTPWS) is a method for gait rehabilitation which consists in suspending the individual over a treadmill while its lower limbs are passively moved mimicking the gait cycle. In order to properly apply LTPWS, the weight load over lower limbs must be controlled and monitored. The main aim of this work was to develop a partial weight support system (WSS) able to measure lower and upper limb loading. Also, instrumentation for measuring knee angle, foot contact and EMG data was developed for training assessment. The WSS was constructed with a pulley system, a steel cable, a manual winch, aload cell fixed at the cable and two other load cells fixed to handrails built on an electrical treadmill. For the measuring system, electrogoniometers and footswitches were constructed and a signal acquisition platform was developed on LabVIEW® environment. The load cells and electrogoniometers were calibrated and tested. A pilot test with a healthy individual was carried out at a speed of 1.5 km/h with a load of 60% of the body weight, over lower limbs. The developed WSS exhibited an error below 1.5% and was able to measure upper and lower limb weight load. It allows analyzing upper limbs loading and lateral unbalance, what might be important for neural rehabilitation. The measuring system was able to provide kinematic and electromyographic patterns similar to those shown in the literature under similar conditions. A patent request was submitted to the INPI under protocol nº 0000280904043771.

Influência do volume de alongamento estático dos músculos isquiotibiais nas variavéis isocinéticas / Influence of static stretching volume in isokinetic variables of harmstrings

A realização de alongamento muscular antes de treinamentos e competições está enraizada na cultura dos profissionais que trabalham com prescrição de exercício. Acredita-se no alongamento como forma de aprimoramento do desempenho e prevenção de lesões. No entanto, muitos estudos têm mostrado que o alongamento pode produzir efeitos deletérios na capacidade de produção de força muscular. Algumas questões relevantes nesse contexto relacionam-se com o volume de alongamento necessário para produzir déficits de força e com os mecanismos fisiológicos responsáveis pelos mesmos. A proposta deste estudo foi investigar as alterações no desempenho isocinético do grupo muscular dos isquiotibiais mediante dois protocolos de alongamento estático com diferentes volumes. Trinta e seis voluntários adultos do sexo masculino foram distribuídos em três grupos: E1, E2 e C. Todos os participantes realizaram um aquecimento sistêmico e depois foram submetidos a avaliações da amplitude de movimento ativa (ADM) de flexão do quadril e isocinética. Aos participantes dos grupos E1 e E2 foram aplicados protocolos de alongamento estático com volumes de 180s (4 x 45s) e 360s (8 x 45s), respectivamente, e estes foram novamente avaliados. Os participantes do grupo C foram submetidos à segunda avaliação, após permanecer em repouso pelo tempo de 270s. As variáveis avaliadas foram a ADM, o pico de torque (PT), o trabalho máximo (TM) e o trabalho total (TT). Observou-se que ambos os protocolos promoveram aumento da ADM, mas as variáveis PT e TM sofreram déficits somente no grupo E2. A variável TT, no entanto, manteve-se inalterada nos grupos E1 e E2. Os resultados sugerem, portanto, que as alterações na rigidez muscular, que causaram ganhos na ADM, não seriam as únicas responsáveis pelos déficits de força. Além disso, conclui-se que a capacidade máxima de produção de força é dependente do volume de alongamento, mas a produção de trabalho ao longo de algumas repetições não é.

Stretching exercises are commonly prescribed before training sessions and competitions aiming at performance improvement and reduction of injury risk. However, many studies have shown that muscular torque production capacity may be reduced just after stretching. Therefore, the stretching duration necessary to produce these acute force deficits, as well as the physiological mechanisms responsible for them are relevant issues. The aim of this work was to investigate the acute effects of static stretching protocols with different durations on the isokinetic hamstrings performance. Thirty-six young male volunteers took part in this study and were evenly distributed in three groups: E1, E2 and C. All of them performed a systemic warm-up for five minutes and went through active range of motion (AROM) of hip flexion and isokinetic assessment. The participants of groups E1 and E2 performed static stretching protocols of 180s (4 x 45s) and 360s (8 x 45s) respectively, and were evaluated again. The participants of group C (control) remained at rest for a period of 270s and were evaluated again. The variables considered were AROM, peak torque, maximum work and total work. Both stretching protocols were able to produce increase in AROM; however, only the longest protocol produced deficits on peak torque and maximum work. Total work was not affected by any of the stretching protocols, though. Therefore, these results suggest that changes in muscular stiffness, that caused AROM gain, would not be responsible alone for the force deficits. Moreover, one can conclude that the maximum muscular strength depends on the stretching duration, but the muscular work along some repetitions of an exercise does not.

Biocompatible glassceramic applied in drug release system / Vitrocerâmico biocompatível aplicado em sistemas de liberação de medicamentos

A anortita é um material inteligente que se degrada apenas em meio ácido. Este comportamento, juntamente com a sua biocompatibilidade, é interessante para aplicações clínicas onde a degradação do biomaterial é desejável, como em sistemas de liberação de medicamentos. O objetivo deste trabalho é avaliar a aplicabilidade das cápsulas de anortita como sistemas de liberação de medicamentos,usando L-Dopa mais benserazida como medicamento de teste. Cápsulas esféricas foram confeccionadas, pesadas, preenchidas com o medicamento, seladas e imersas em solução tampão com pH = 3,5 durante 120 horas, mantida em movimento constante para simular o ambiente corpóreo. No final do ensaio as cápsulas foram esvaziadas, lavadas, secas e pesadas novamente. A perda de massa média foi de 0,004 mais ou menos 0,001 g, demonstrando a degradação do vitrocerâmico em meio ácido. Um espectrofotômetro UV/VIS foi usado para medir a quantidade de medicamento liberada na solução, através de amostras coletadas em períodos de 24, 72 e 120 horas após o início do ensaio. O medicamento foi detectado na solução após 24 horas, com concentração crescente até 72 horas, quando a taxa de liberação do medicamento pareceu diminuir. Através das amostrasanalisadas, foi possível concluir que ocorreu uma liberação contínua do medicamento através das paredes das cápsulas devido à sua porosidade. Os resultados mostraram a possibilidade de utilização da anortita em sistemas de liberação de medicamentos mantendo a liberação contínua da droga no organismo.

The anorthite is an intelligent material which degrades only in acid medium. this behavior along with its biocompatibility is interesting for clinical applications where degradation of a biomaterial is desired, such as in a drug delivery systems. The aim os this work is the assessment of the application of anorthite capsules as drug delivery system...