Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management.

BACKGROUND: The biomedical understanding of chronic musculoskeletal pain endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. Although the biopsychosocial approach is an important advancement, it has a limited theoretical foundation. As such, it tends to be misinterpreted in manners that lead to artificial boundaries between the biological, psychological, and social, with fragmented and polarized clinical applications. OBJECTIVE: We present an ecological-enactive approach to complement the biopsychosocial model. In this approach, the disabling aspect of chronic pain is characterized as an embodied, embedded, and enactive process of experiencing a closed-off field of affordances (i.e., shutting down of action possibilities). Pain is considered as a multi-dimensional, multicausal, and dynamic process, not locatable in any of the biopsychosocial component domains. Based on a person-centered reasoning approach and a dispositional view of causation, we present tools to reason about complex clinical problems in face of uncertainty and the absence of 'root causes' for pain. Interventions to open up the field of affordances include building ability and confidence, encouraging movement variability, carefully controlling contextual factors, and changing perceptions through action according to each patient's self-identified goals. A clinical case illustrates how reasoning based on an ecological-enactive approach leads to an expanded, multi-pronged, affordance-based intervention. CONCLUSIONS: The ecological-enactive perspective can provide an overarching conceptual and practical framework for clinical practice, guiding and constraining clinicians to choose, combine, and integrate tools that are consistent with each other and with a true biopsychosocial approach.

Measuring subjective aspects of participation in adults with disabilities: A systematic review of the coverage, content validity and internal structure of standardised instruments.

OBJECTIVE: To systematically review evidence on the coverage, content validity and internal structure of self-report measures capturing subjective aspects of participation for adults with disabilities. DATA SOURCES: EMBASE, MEDLINE and reference lists were searched until July 10th, 2022 for articles on measurement properties of instruments measuring participation as defined in the International Classification of Functioning, Disability and Health, from a subjective perspective. METHOD: Each instrument was assessed for its coverage of subjective aspects of participation. The Consensus-based Standards for the Selection of Health Measurement Instruments were used to assess the quality of each study. Content validity and internal structure (structural validity, internal consistency and cross-cultural validity) were rated against published standards and qualified by the adapted Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Thirty-eight studies regarding 10 instruments were analysed. Most instruments mix activity and participation items. Only the Measure of Experiential Aspects of Participation (with high-quality evidence of sufficient structural validity and generally sufficient internal consistency), the Participation Enfranchisement and the Community Integration Measure showed adequate coverage. For all instruments, evidence of content validity is of low- to very low quality. There is high-quality evidence that the Participation Scale is not unidimensional. CONCLUSION: In general, the coverage and the evidence for content validity and internal structure of measures capturing experiential aspects of participation are limited. The Measure of Experiential Aspects of Participation has the best level of evidence in support of its use. The score of the Participation Scale cannot be considered an adequate reflection of participation.

Family-Centered practice in a Brazilian rehabilitation network service.

BACKGROUND: Family-centered practice (FCP) is widely accepted as a best practice in pediatric rehabilitation. However, its implementation in Brazil is incipient, and systematic documentation of the extent to which it has been achieved is not available. OBJECTIVES: To determine parents' and service providers' perceptions of family-centeredness and specific areas in need of improvement in four rehabilitation hospitals. METHODS: A total of 107 caregivers and 89 service providers responded to the Measure of Processes of Care-20 (MPOC-20) and the Measure of Processes of Care for Service providers (MPOC-SP), respectively. The MPOC questionnaires evaluate FCP from the point of view of parents and rehabilitation professionals. Domain scores within each questionnaire were compared with Kruskal-Wallis and Mann-Whitney tests. MPOC items with low scores (from 1-4 out of 7 by 33% or more of respondents) were considered to indicate weaknesses in service delivery. RESULTS: Median MPOC-20 scores varied from 5.2 (4.7, 5.8) (Providing General Information) to 7.0 (6.0, 7.0) (Enabling and Partnership). The Providing General Information scores were significantly lower than those of other domains (p <  0.003). The MPOC-SP scores varied from 4.8 (4.0, 5.8) (Providing General Information) to 6.1 (5.8, 6.6) (Treating People Respectfully). Scores for Treating People Respectfully were significantly higher (p <  0.0001) and Providing General Information scores significantly lower (p <  0.0001) than those of the other domains. Most items with high percentages of low scores were from the domain Providing General Information. CONCLUSION: Except for Providing General Information, the results indicated that services implement FCP "to a fairly great extent," comparing favorably to international data. Provision of information can be improved.

Stress, anxiety, self-efficacy, and the meanings that physical therapy students attribute to their experience with an objective structured clinical examination.

BACKGROUND: Excessive stress and anxiety can impair learning. The objective structured clinical examination (OSCE) is a valuable tool to assess and promote the acquisition of clinical skills. However, significant OSCE-related stress and anxiety are frequently reported. The aim of this study was to investigate the relationships between physiological stress, self-reported levels of anxiety due to an OSCE, self-efficacy, and the meanings that physical therapy students attribute to their experience with the exam. DESIGN: Concurrent mixed methods study. METHODS: A total of 32 students took part in this study. All were enrolled in the third semester of a 10-semester Physical Therapy Bachelor Program. Salivary cortisol levels, self-reported anxiety (State-Trait Anxiety Inventory, STAI) were measured before the OSCE. Exam scores and self-efficacy ratings were also recorded. Correlations between variables were tested with the Pearson correlation, with ɑ at 0.05. Semi-structured interviews were used to explore the personal perspectives of students. Thematic analysis was used to investigate emergent themes. RESULTS: Trait anxiety scores were significantly higher than normative values (p < 0.001). A high proportion of students showed high (STAI> 49) state anxiety (37.5%) and trait anxiety (65.6%). Salivary cortisol was not associated anxiety (p > 0.05). Neither stress nor anxiety correlated with OSCE scores. A moderate and significant direct correlation was found for self-efficacy scores and OSCE scores (r = 0.475, p = 0.007). Students reported that confidence had a calming effect and led to better self-perceived performance. They also reported that the OSCE can provide meaningful learning experiences despite being stressful. CONCLUSIONS: A high proportion of our students reported a stable/lingering negative affect. However, neither stress nor anxiety related to OSCE scores. Students' confidence in their capabilities was correlated with their performance. Their subjective reports suggest that self-confidence may have protected them from the negative effects of stress and anxiety on academic performance.

Brazilian versions of the Measure of Processes of Care-20 and Measure of Processes of Care-Service Providers: translation, cross-cultural adaptation and reliability.

BACKGROUND: The Measure of Processes of Care (MPOC) questionnaires evaluate Family-Centered Practice (FCP) in services for children with developmental disorders. The MPOC-20 and MPOC-SP are completed by parents and by rehabilitation professionals, respectively, and are widely used in several countries. OBJECTIVES: To translate and cross-culturally adapt the MPOC-20 and MPOC-SP to Brazilian Portuguese and evaluate their reliability and internal consistency. METHODS: this study included translation, back-translation, cognitive interviews, testing of the pre-final versions, analysis of reliability and of internal consistency of the final versions. Respondents included parents and rehabilitation professionals from rehabilitation centers in four capital cities in Brazil. RESULTS: Translation and cultural-adaptation procedures ensured the Brazilian versions were understandable and semantically equivalent to the original MPOC-20 and MPOC-SP. Pre-final and final versions were analyzed and vetted by the original authors. The MPOC-20 internal consistency Cronbach's alpha varied between 0.61 and 0.91 (n=107), the test-retest reliability ICC varied between 0.44 and 0.83 and the standard error of measurement varied between 0.66 and 0.85 (n=50). The MPOC-SP internal consistency Cronbach's alpha varied between 0.52 and 0.83 (n=92), the test-retest reliability ICC between 0.83 and 0.90, and the standard error of measure between 0.34 and 0.46 (n=62). CONCLUSION: The Brazilian versions of the MPOC-20 and the MPOC-SP are in general stable and sufficiently reliable. They are relevant to the evaluation of FCP and provide information that can improve health services and ensure better care.

Mechanisms contributing to gait speed and metabolic cost in children with unilateral cerebral palsy.

BACKGROUND: Gait speed and metabolic cost are indicators of functional capacity in children with cerebral palsy. Uncovering their mechanisms helps guide therapeutic actions. OBJECTIVES: To investigate the contributions of energy-generating and energy-conserving mechanisms to gait speed and metabolic cost of children with unilateral cerebral palsy. METHODS: Data on eccentric and concentric muscle work, co-contraction, elastic torque and vertical stiffness of the affected-limb, forcing torque of the non-affected limb, gait speed and metabolic cost were collected from 14 children with unilateral cerebral palsy, aged 6-12 years. Analyses included two groups of multiple regression models. The first group of models tested the association between each dependent variable (i.e., speed and metabolic cost) and the independent variables that met the input criteria. The second group verified the contribution of the non-selected biomechanical variables on the predictors of the first model. RESULTS: Gait speed (R2=0.80) was predicted by elastic torque (ß=0.62; 95%CI: 0.60, 0.63), vertical stiffness (ß=-0.477; 95%CI: -0.479, -0.474) and knee co-contraction (ß=0.27; 95%CI: -1.96, 2.49). The production of eccentric work by the affected limb proved relevant in adjusting the vertical stiffness (R2=0.42; ß=-0.64; 95%CI: 0.86, -0.42); elastic torque of the affected-leg was associated with impulsive torque of the non-affected leg (R2=0.31; ß=0.55; 95%CI: 0.46, 0.64). Metabolic cost of gait (R2=0.48) was partially predicted by knee co-contraction (ß=0.69; 95%CI: 0.685, 0.694). CONCLUSIONS: The chain of associations revealed by the two steps models helped uncover the mechanisms involved in the locomotion of children with unilateral cerebral palsy. Intervention that changes specific energy conserving and generating mechanisms may improve gait of these children.

Motor synergies research in physical therapy: advantages of the uncontrolled manifold approach / Pesquisa de sinergias motoras em fisioterapia: vantagens da abordagem da variedade não controlada / Estudio de sinergias motoras en fisioterapia: ventajas del enfoque múltiple no controlado

ABSTRACT Movement is central to physical therapy identity and practice. Advances in the science of movement control, motor learning and development are thus inextricably tied to professional development and clinical activity. This paper aims to describe a prominent approach to motor control with potential to greatly advance the understanding of movement dysfunction: the uncontrolled manifold (UCM). An argument is formulated for incorporating this method of data analysis in rehabilitation research. It is a narrative review of the relevant literature. Research in physical therapy could greatly benefit from investigating synergies with the theory and methods of UCM. Research should seek connections between functioning in daily life tasks and the assembling of synergies to stabilize different performance variables, the UCM variability measures, the synergy strength indexes, and the anticipatory synergy adjustments. Changes in these synergy variables should also be quantified after rehabilitation interventions. UCM can offer one solid science-based approach to inform clinical decisions on whether synergies have to be broken, rebalanced, created, or reinforced in patients with movement dysfunction.

RESUMO O movimento humano é fundamental para a identidade e prática profissional da Fisioterapia. Avanços nas ciências do controle, aprendizagem e desenvolvimento motor são portanto inseparáveis do desenvolvimento da profissão e da atividade clínica. Este trabalho descreve uma abordagem importante de controle motor com grande potencial de contribuição para a investigação de disfunções de movimento: a abordagem da variedade não controlada (UCM). Argumentos para a incorporação dos métodos de investigação da UCM na pesquisa em reabilitação é apresentado. Trata-se de uma revisão narrativa da literatura relacionada. A pesquisa na Fisioterapia pode se beneficiar bastante da investigação de sinergias com a teoria e os métodos de análise de dados da UCM. A pesquisa deve investigar conexões entre atividades de vida diária e a formação de sinergias motoras para estabilizar diferentes variáveis de desempenho, assim como a distribuição de variabilidade das sinergias, sua força e seus ajustes antecipatórios. Mudanças nesses quantificadores de sinergias também devem ser investigadas após intervenções de reabilitação. A UCM é uma abordagem científica sólida para informar decisões clínicas sobre a necessidade de desfazer, reequilibrar, criar ou reforçar sinergias motoras dos pacientes com disfunção de movimento.

RESUMEN El movimiento del ser humano es esencial a la identidad y práctica profesional en Fisioterapia. Los avances en las ciencias de control, del aprendizaje y del desarrollo motor son inseparables del desarrollo profesional y práctica clínica. En este estudio se intenta describir un importante abordaje de control motor que puede contribuir a los estudios sobre los trastornos del movimiento: el enfoque múltiple no controlado (UCM). Se presentan argumentos para incorporar a los métodos de estudios de la UCM en rehabilitación. Se trata de una revisión sistemática de literatura. Las investigaciones en Fisioterapia se pueden favorecer del estudio de sinergias con la teoría y los métodos de análisis de datos del UCM. Se estudian las conexiones entre las actividades de la vida diaria y la formación de sinergias motoras para estabilizar los distintos niveles de rendimiento, así como la distribución de la variabilidad de las sinergias, su fuerza y sus ajustes de anticipación. Tras las intervenciones en la rehabilitación también se deben estudiar cambios en los valores de las sinergias. El UCM es un sólido abordaje científico para informar sobre decisiones clínicas a cerca de la necesidad de deshacer, reequilibrarse, crear o fortalecer las sinergias motoras de los pacientes con trastornos de movimiento.

Towards an ecologically grounded functional practice in rehabilitation.

According to the International Classification of Functioning, Disability and Health, effective rehabilitation requires interventions that go beyond minimizing pathological conditions and associated symptoms. The scope of practice must include promoting an individual's activity within relevant contexts. We argue that best practice requires decisions that are not only evidence-based but also theory-based. Perception and action theories are essential for interpreting evidence and clinical phenomena as well as for developing new interventions. It is our contention that rehabilitation goals can best be achieved if inspired by the ecological approach to perception and action, an approach that focuses on the dynamics of interacting constraints of performer, task and environment. This contrasts with organism-limited motor control theories that have important influence in clinical practice. Parallels between such theories and the medical model of care highlight their fundamental inconsistency with the current understanding of functioning. We contend that incorporating ecological principles into rehabilitation research and practice can help advance our understanding of the complexity of action and provide better grounding for the development of effective functional practice. Implications and initial suggestions for an ecologically grounded functional practice are outlined.

Effects of kinesiology taping in children with cerebral palsy: a systematic review / Os efeitos do Kinesiotaping em crianças com Paralisia Cerebral: Uma revisão sistemática

Abstract Introduction: Cerebral Palsy is a group of non-progressive movement and posture disorders. There are many rehabilitation methods for children and adolescents with these disorders. Kinesiology Taping(KT) is becoming a popular as an option of rehabilitation method for these children. Objective: The aim of this systematic review is to summarize evidence regarding the methods of Kinesiology Taping use in children and adolescents with Cerebral Palsy and its effects. Materials: A search of scientific papers in the databases Medline, Scielo and PEDro was conducted with no data or language restriction. For this search the keywords "Kinesio taping", "Kinesiology Taping", "Taping", and "Bandages" combined with "Cerebral Palsy" were used. The search was conducted between May of 2015 and November of 2016. Results: Eleven studies were included in the review, six were randomized controlled clinical trials, four were quasi-experimental studies, and one was a case study. In general, the studies followed the guidelines proposed by the Kinesiology Taping creator; they used corrective techniques and muscle contraction facilitation/inhibition techniques. Results varied according to techniques used and outcomes chosen. Conclusion: There is strong to insufficient evidence of KT effects in motor function related outcomes. Stronger quality level studies are necessary to support use of KT in clinical practice.

Resumo Introdução: A Paralisia Cerebral é definida como um grupo de distúrbios não progressivos de movimento e de postura. Existem diferentes métodos de reabilitação para crianças e adolescentes com Paralisia Cerebral. Dentre eles, o uso do Kinesio Taping vem se tornando comum. Objetivo: O objetivo da presente revisão sistemática é sumarizar evidências relativas a métodos de aplicação do Kinesio Taping e seus efeitos em crianças e adolescentes com Paralisia Cerebral. Métodos: Foi realizada uma busca da literatura científica nas bases de dados Medline, Scielo e PEDro sem restrição de idioma. Para esta pesquisa foram utilizadas as palavras-chave "Kinesio taping", "Kinesiology Taping", "Taping" e "Bandages" combinadas à "Cerebral Palsy". A busca aconteceu entre Maio de 2015 a Novembro de 2016. Resultados: Foram selecionados onze estudos, sendo seis ensaios clínicos controlados e aleatorizados, quatro ensaios clínicos não controlados e um estudo de caso. Os estudos no geral seguem os modelos de aplicação do taping propostos pelo criador da técnica, utilizando técnicas corretivas e técnicas de facilitação/inibição da contração muscular. Há pobre evidência de efeitos e estes variam com os métodos de aplicação utilizados e os desfechos escolhidos. Conclusão: Há evidência forte a insuficiente quanto aos efeitos do KT desfechos relacionados às funções motoras. São necessários estudos com maior qualidade metodológica para justificar o uso do KT na prática clínica.

Fortalecimento muscular em adolescentes com paralisia cerebral: avaliação de dois protocolos em desenho experimental de caso único / Muscle strengthening in adolescents with cerebral palsy: an evaluation of two singlecase experimental design protocols

Descrever mudanças na função motora de dois adolescentes com diplegia espástica, sendo um deles participante de um protocolo de fortalecimento muscular isolado (FMI) e o outro de protocolo de fortalecimento com tarefas funcionais (FTF). Métodos: desenho experimental de caso único, metodologia que revela a temporalidade do perfil de mudanças ao longo e após a terapia. Este desenho incluiu fases de baseline, de intervenção e de followup com quatro, seis e três semanas, respectivamente. Participantes foram duas adolescentes com displegia espástica submetidas, cada uma, a um protocolo de intervenção: fortalecimento muscular isolado (FMI) ou fortalecimento com tarefas funcionais (FTF). Os protocolos de intervenção incluíram exercícios de fortalecimento muscular isolado de extensores de quadril, extensores de joelho e flexores plantares (para a participante do FMI), ou de exercícios funcionais para as mesmas musculaturas (para a participante do FTF). Mensurações três vezes por semana avaliaram força muscular, velocidade de marcha, tempo para subir e descer escadas, tempo para se levantar do chão e tempo no teste Timed Get Up and Go. Os dados foram analisados com Celeration Line, Amplitude de Dois Desvios Padrão e Análise Visual. Resultados: ganhos de força muscular de membros inferiores foram observados nas adolescentes submetidas a ambos os protocolos. Mudanças nas atividades motoras foram observadas em 2 das 4 tarefas testadas em somente uma das adolescentes (p<0,05). Conclusões: a especificidade funcional do protocolo de fortalecimento FTF produziu modestos efeitos no desempenho de atividades motoras de uma das adolescentes com PC, em acréscimo aos ganhos de força muscular produzidos por ambos os protocolos...

To describe changes in the motor function of two adolescents with spastic diplegia, one of them participating in a muscle strengthening in isolation (MSI) protocol, the other in a functional tasks strengthening (FTS) protocol. Methods: a single case experimental design is a method that reveals the pattern of changes over time during and after therapy. The design included baseline, intervention and four- six- and three-week follow-up phases. The participants were two adolescents with spastic diplegia, each undergoing an intervention protocol: muscle strengthening in isolation (MSI) or functional tasks strengthening (FTS). The intervention protocols included isolated muscle strengthening of the hip and knee extensors and plantar flexors (for the MSI participant), or functional exercises for the same musculatures (for the FTS participant). Weekly measurements were taken of muscle strength, walking speed, time taken to walk up and down stairs, time taken to get up off the floor and time on the Timed Get Up and Go test. The data were analyzed using Celeration Line, Two Standard Deviation Amplitude and Visual Analysis. Results: gains in muscle strength in the lower limbs were observed in both adolescents. Changes in motor activity were observed in two of the four tasks tested in only one of the adolescents (p<0.05). Conclusions: The functional specificity of the FTS protocol produced modest effects on performance of motor activities in one of the adolescents with CP, in addition to the gains in muscle strength produced by both protocols...

Clinical changes during an intervention based on constraint-induced movement therapy principles on use of the affected arm of a child with obstetric brachial plexus injury: a case report.

The objective of this study was to test the feasibility of a treatment programme based on the elements of constraint-induced movement therapy (CIMT) to encourage use of the affected arm of a child with obstetric brachial plexus injury (OBP), as well as to document clinical changes observed with this intervention. A 2-year-old female child with Erb's palsy had 14 weeks of daily home-based treatment with 30-minute sessions planned according to the principles of CIMT. The child was assessed every 2 weeks with the Toddler Arm Use Test. Test scores throughout the intervention period demonstrated improvements in quality of movement, amount of use and willingness to use the affected extremity. The child's mother reported improved ability to perform bimanual activities at home. The results suggest that treatment based on CIMT principles has potential to promote functional gains for children with OBP. Experimental studies should test the effects of this kind of intervention for children with OBP.

Adapted version of constraint-induced movement therapy promotes functioning in children with cerebral palsy: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of constraint-induced movement therapy on the use of the affected arm and on daily functioning in children with hemiplegic cerebral palsy. DESIGN: A single-blinded randomized clinical trial. SUBJECTS: Sixteen children with cerebral palsy randomized to intervention (n = 8, 4 males, 4 females, mean age 5 years and 6 months) and control groups (n = 8, 4 males, 4 females, mean age 6 years and 7 months). INTERVENTIONS: Non-affected arm of intervention group was restricted for 10 hours/ day and the affected arm intensively trained for 3 hours/day for two weeks. The intervention protocol included one week of bimanual functional training following constraint therapy. The control group maintained usual rehabilitation throughout the intervention period. MAIN MEASURES: Pediatric Evaluation of Disability Inventory (self-care domain) and an adapted version of the Jebsen-Taylor test were administered before and after intervention, and at one month follow-up. General linear models tested differences in gain scores and the number needed to treat estimated relative effectiveness of intervention protocol for functional skills and independence in self-care. RESULTS: Results are reported for 15 children who completed assessments and intervention. Higher gains were observed in the intervention group for functional skills and independence post intervention (d(functional skills) = 1.61, P =0.0134; d(independence)=1.37; P =0.0001) and follow-up (d(functional skills) = 2.08, P =0.004; d(independence) = 0.85; P =0.0016). No group difference in manual dexterity gains was observed. Low indices of number needed to treat (1.75 and 2.33) illustrate clinical relevance of intervention. CONCLUSIONS: The protocol associating constraint-induced movement therapy and bimanual functional training was effective in promoting daily living functioning among children with cerebral palsy.

Programa domiciliar de fortalecimento muscular em adolescentes com diplegia espástica: um relato de três casos / Home-based muscle strenghtening program for adolescents with cerebral palsy: aq report of three cases

Introdução: Evidências demonstram que o fortalecimento muscular pode promover ganhos funcionais para indivíduos com paralisia cerebral (PC). No entanto, ainda não se observa com frequência a utilização clínica dessa intervenção. Esse distanciamento entre as evidências científicas e a prática clínica pode ser prejudicial ao desenvolvimento profissional. Objetivo: descrever a implementação de um programa domiciliar de treinamento resistido progressivo e seus efeitos na força muscular, desempenho na marcha e subida e descida de escadas, função motora grossa e participação em atividades escolares de três adolescentes com diplegia espástica. Metodologia: Foram realizados exercícios resistidos domiciliares de levantamento na ponta dos pés, miniagachamentos, subida/descida no step e sentar-se e levantar-se de uma cadeira, por oito semanas, três vezes por semana, como progressão de carga a cada duas semanaas. A primeira semana consistiu de treinamento em ambiente clínico. Foram avaliadas a força muscular, parâmetros de marcha, a função motora grossa e a participação escolar antes e depois da intervenção, e foram realizados cálculos de porcentagem de mudança de desempenho para cada adolescente. Resultados: foram observadas boa adesão e boa progressão de carga, com ganhos em medidas de força muscular, velocidade de marcha confortável e rápida, tempo de subida e descida de escada. Aumentos em escores do Gross Motor Function Measure e School Function Assessment também foram observados. Conclusão: este relato de casos documenta efeitos positivos de um programa de fortalecimento domiciliar em três adolescentes com displegia espástica. A inserção de exercícios de fortalecimento na rotina diária de adolescentes com PC pode ser uma alternativa viável para a promoção funcional.

Effects of strength training aided by electrical stimulation on wrist muscle characteristics and hand function of children with hemiplegic cerebral palsy.

Nine children with spastic hemiplegic cerebral palsy underwent 24 sessions of wrist muscles strengthening in the extended wrist range aided by electrostimulation. Isometric strength of flexors and extensors was registered in three wrist positions (30 degrees of flexion, neutral, and 30 degrees of extension) to infer on angle-torque curves. Passive stiffness of wrist flexors and wrist flexion angle during manual tasks and hand function were also documented. Significant strength gains were observed at 30 degrees of wrist extension for flexors (p= 0.029) and extensors (p= 0.024). No gains were observed at 30 degrees of flexion. The difference in extensor strength between the three test positions changed after intervention (p< 0.034), suggesting a shift in the angle-torque curve. No changes were observed in passive stiffness (p= 0.506), wrist angle (p< 0.586), or hand function (p= 0.525). Strength training in specific joint ranges may alter angle-torque relationships. For functional gains to be observed, however, a more aggressive intervention and contextualized task training would probably be needed.

Terapia de movimento induzido pela restrição na hemiplegia: um estudo de caso único / Constraint-induced movement therapy in hemiplegia: a single-subject study

A terapia de movido induzido por restrição (TMIR) tem mostrado resultados positivos em indivíduos hemiparéticos após acidente vascular cerebral; consiste na contenção do membro superior não afetado e treinamento intensivo do membro afetado...

Constraint-induced movement therapy (CIMT) consists of restraining movement of the non-affected arm while providing intensive training of the affected upper extremity. Positive results have been reported after CIMT in individuals with...

Treadmill training for ataxic patients: a single-subject experimental design.

OBJECTIVE: To investigate changes in gait quality, balance and mobility associated with treadmill training for ataxic individuals. DESIGN: Single-subject ABA design. Baseline phases (A) lasted three weeks and intervention (B) lasted four weeks. SETTING: University rehabilitation clinic. SUBJECTS: A woman (25 years) and a man (53 years) with chronic ataxia due to head trauma. INTERVENTION: Three 20-minute treadmill training sessions each week with progression in velocity and step length. MAIN MEASURES: Rivermead Visual Gait Assessment, Timed Up and Go, time to complete a balance task, walking speed, cadence, and stride length assessments three times a week during the 10 weeks. Data were analysed with the celeration line technique and two standard deviation band. RESULTS: Both individuals demonstrated gains in all parameters over initial baseline and subsequent phases, with performance increases ranging from 26% to 233% when first and last assessments were compared. Significantly superior effects of treadmill training over baseline conditions on cadence were detected (P<0.05). Gains in walking speed were not significantly better during intervention, but intervention withdrawal produced deceleration of performance gains. Gains in Timed Up and Go, step length and balance were not consistent and were possibly caused by a learning effect of the association between repeated testing and treadmill training. Rivermead Visual Gait Assessment gains reached significance only for subject 2 (P<0.05), probably because of increased variability of performance of subject 1. Results suggest that the association between repeated testing and treadmill training might have been responsible for the observed gains in the two ataxic patients.

Therapeutic effects of electrical stimulation on manual function of children with cerebral palsy: evaluation of two cases.

PURPOSE: To investigate changes in hand function associated with electrical stimulation for children with hemiplegic cerebral palsy. METHOD: An ABCA single-subject design, replicated in two children, was used in this study. Each baseline (phase A) lasted 4 weeks. Intervention consisted of electrical stimulation of wrist extensors (phase B) and of wrist extensors and flexors (phase C) for 15 minutes three times a week. Intervention phases also lasted 4 weeks. Active wrist extension range of movement and three timed manual tasks were tested two times a week every week. Data analysis included the Celeration Line and Two Standard Deviation Band methods in addition to visual analysis. RESULTS: Significant performance gains were observed for both children, especially in phase C, when both extensors and flexors were stimulated. After intervention withdrawal, significant performance decreases were observed on most analysed variables. CONCLUSIONS: The observed performance changes seem to be associated with the presence of intervention and suggest that electrical stimulation can be a useful adjunct to improve hand function of children with cerebral palsy.

Muscle stiffness and strength and their relation to hand function in children with hemiplegic cerebral palsy.

This study compared the passive stiffness of wrist flexors and the strength of wrist flexors and extensors in three different wrist positions (30 degrees of flexion, neutral, and 30 degrees of extension) between children with cerebral palsy (CP) and typically developing (TD) comparison children. It also examined associations between these characteristics and manual function in children with CP. Eleven children with spastic hemiplegic CP (six females, five males; mean age 8y 5mo [SD 1y 8mo], range 6-11y) and 11 TD children, matched for age and sex, took part in this study. Passive stiffness of muscles was measured as the torque/angle relation during passive motion. Isometric strength tests were performed and the time needed to complete three tasks based on the Jebsen-Taylor Hand Function Test was recorded. Flexor stiffness was higher in the group with CP. Strength of flexors and extensors in the group with CP was lower with the wrist extended. No difference among test positions was found in the TD group. Moderate correlations were observed between manual function and variables related to strength and stiffness of wrist muscles in the group with CP. Children with CP showed muscle alterations coherent with the use of the wrist in flexion. Intervention on these characteristics could have a positive impact on manual function.

Work-related hand injuries: case analyses in a Brazilian rehabilitation service.

PURPOSE: Professionals who work with rehabilitation of the hand usually assess performance components as their main outcome measures. Intervention is aimed at normalization of deficits of these components, with the expectation that the integrity of the structures and functions of the body will revert to improvements in the client's functional performance. The objectives of this study were to describe changes in patients who received rehabilitation in a Brazilian public hospital after having suffered hand injuries due to workplace accidents, and to examine the relations between performance components and levels of functioning. METHODS: Observational cross-sectional study was used. A convenience sample was selected, including 42 patients assessed at service admission and at discharge. Assessed characteristics included grip strength, wrist and finger range of movement (ROM), sensitivity, and self-perceptions of functional performance (COPM). Statistical procedures included correlations between performance components and COPM scores and differences on selected variables at admission and discharge. RESULTS: Significant improvements in all assessed functional components. COPM values increased more than 100% after intervention (effect size d = 1.996 for performance and d = 1.553 for satisfaction) demonstrating improvements in both domains. Low correlations between grip strength and COPM scores were found only at admission (r = 0.314; p = 0.045). When the relationship between gains in strength and COPM scores at discharge were examined, significant correlations were found with the performance (r = 0.324; p = 0.039) and satisfaction (r = 0.0326; p = 0.038) subscales. CONCLUSIONS: Results of this study provide evidence for functional gains in clients treated in a rehabilitation service and supply information about the relation between specific components and functional performance.

Análise dos efeitos da utilização da tala seriada em crianças portadoras de paralisia cerebral: uma revisão sistemática da literatura / Analysis of the effects of the use of serial casting in children with cerebral palsy: a systematic review of the literature

OBJETIVOS: realizar uma revisão sistemática da literatura através da seleção e análise criteriosa de artigos científicos que investigaram os efeitos da tala seriada em crianças com diagnóstico clínico de paralisia cerebral espástica. MÉTODOS: busca sistemática na literatura foi realizada no período de março a agosto de 2004, nas bases de dados eletrônicas Medline, Lilacs e PEDro publicados nas línguas inglês e português, no período de 1980 a 2004. O nível de evidência dos artigos estudados foi qualificado utilizando-se a escala Magee. RESULTADOS: os quatro artigos incluídos nessa revisão preencheram todos os critérios de inclusão e foram classificados como fracos de acordo com a escala Magee (índice de concordância Kappa K=1,0) devido às limitações metodológicas apresentadas. CONCLUSÕES: as evidências utilizadas nessa revisão sistemática não apresentam nível que possa suportar a utilização clínica da tala seriada em crianças com paralisia cerebral. Futuras pesquisas devem ser realizadas em observância à necessidade de maior rigor metodológico dos estudos para a fundamentação da prática baseada em evidência.