Is motor learning of stroke patients in non-immersive virtual environment influenced by laterality of injury? A preliminary study.

BACKGROUND: Stroke is the leading cause of long-term disability in adults, causing residual sensorimotor deficits in many survivors. Patients may have different impairments according to laterality of injury, as well as different responses to some therapies. OBJECTIVE: This preliminary study sought to investigate motor learning in rehabilitation of stroke patients with non-immersive virtual environment by process (electroencephalography) and product (performance) measures in stroke patients with left and right cerebral hemispheres damage. METHODS: The study included 10 chronic stroke patients; 5 with left brain injury (LI), mean age 48.8 years (±4.76), and 5 with right brain injury (RI), mean age 52 years (±10.93). Patients were evaluated for electroencephalographic activity (alpha and beta frequencies) and performance (absolute error) in a darts game on XBOX Kinect (Microsoft®). Then they underwent a virtual darts game training task, 12 sessions for 4 weeks (acquisition stage). After training, they were revaluated (long-term retention). RESULTS: RI group increased alpha power and decreased beta in ipsilesional areas, increased activation on left hemisphere and decreased the absolute error of performance; LI group increased right hemisphere activation and did not decrease the absolute error. CONCLUSIONS: Patients with right brain injury reduce neural effort and errors after virtual darts training, which did not happen to patients with left brain injury. Therefore, the laterality of lesion should be considered in studies that use virtual reality for stroke rehabilitation.

Predictive factors of functional independence in basic activities of daily living during hospitalization and after discharge of stroke patients.

Objective: The aim of this study was to identify the predictive factors of functional independence in the basic activities of daily living during hospitalization, on the 10th and 28th day after stroke.Methods: A total of 433 patients (204 men and 229 women) took part. Functional independence data were collected using the Step 1 from an instrument called Stepwise. Analysis was conducted by logistic regression.Results: Due to the OR values below 1.0 we can verify that the age of 59 years or less and the presence of physiotherapy in the hospital were protective factors of functional independence. Other predictive factors were the number of stroke risk factors (bathing: OR = 0.4; p = .005, transfer: OR = 0.487; p = .025), the amount of medication used before stroke (bathing: OR = 1.7; p = .013), sex (grooming: OR = 1.6; p = .026); type of stroke (continence: OR = 2.2; p = .003-10th day; OR = 1.9; p = .013-28th day), previous strokes (eating: OR = 0.5; p = .036).Conclusions: According to the results, the risk of impaired functional independence decreased in bathing and eating and increased for dressing, grooming and transfer during clinical recovery suggesting the need for greater therapeutic intervention in different basic activities of daily living.

Seguimento de pessoas acometidas por doenças cerebrovasculares em um hospital regional amazônico: uma metodologia WHO STEP Stroke / Follow-up of people affected by cerebrovascular disease in a regional amazonic hospital: a WHO STEPS Stroke methodology

O WHO STEP Stroke foi desenvolvida para monitorar casos de doenças cerebrovasculares e possibilitar comparações de incidências. Objetivo: Descrever o perfil sociodemográfico e funcionalidade de pacientes acometidos por AVC admitidos no Hospital Regional de Coari durante um ano, e acompanha-los ao longo de um mês após admissão. Método: Estudo descritivo observacional, prospectivo e de seguimento dos casos entre outubro de 2010 e outubro de 2011. Utilizou-se a primeira etapa (Step 1) do WHO STEP Stroke para avaliar as hospitalizações por AVC em Coari-AM. Foram acompanhados 23 pacientes através de questionário padrão em até dois dias na internação, 10 e 28 dias após a internação. Resultados: A população estudada tinha média de idade de 72,8 (DP= 12,4) anos, em sua maioria homens (65,7%), pardos (65,2%) e hipertensos (95,7%), com incidência hospitalar de 30 casos em 100.000 habitantes e taxa de letalidade em 10 dias de 30,4% e 28 dias de 34,8%. O comprometimento neurológico na internação teve mediana de 28 (IIQ= 15-38) pontos, sendo 73,9% classificados como grave. Houve comprometimento funcional entre os sobreviventes. Conclusão: Estudo revelou uma predominância de homens, com idade elevada, pardos, sem estudo formal, baixa renda e com histórico de hipertensão arterial e diabetes, como perfil de internação hospitalar por doenças cerebrovasculares no município. A incidência de casos hospitalares de AVC foi em 30 (por 100.000) em Coari-AM, com graves comprometimentos neurológicos na admissão, e altas taxas de letalidade e prejuízo funcional após 28 dias do evento, quando comparadas a outras localidades no Brasil e no mundo

The WHO STEP Stroke is a tool developed to monitor cases of cerebrovascular and allow comparison of its incidence throughout the world. Objective: To describe the sociodemographic profile and functionality of stroke inpatients admitted in Coari´s Regional Hospital and followed up one month after admittance. Method: This is a prospective, descriptive observational and follow-up study of cases between October 2010 and October 2011. In this study, we used the first step (Step 1) of the WHO STEP Stroke to assess stroke hospitalization in Coari-AM Twenty-three patients were monitored with a standard questionnaire up to two days after hospitalization, 10 days, and 28 after hospitalization. Results: The studied population had average age of 72.8 (SD= 12.4) years, mostly men (65.7%), brown (65.2%), and hypertensive (95.7%), with a hospital incidence of 30 cases for 100.000 people, and mortality in 10 days of 30.4% and 28 days of 34.8%. The neurological impairment at hospitalization had a median of 28 (IIQ= 15-38) points, with 73.9% classified as severe. There was an impairment in functionality among the survivors. Conclusion: This study showed the profile of hospital admittance for cerebrovascular disease in this city to be mainly composed by older men, brown, with no formal study, low income, and history of systemic arterial hypertension and diabetes. The hospital incidence for stroke was 30 (per 100.000) in Coari-AM, with severe neurological impairment at admission, with high mortality rates, and functional deficits 28 days after the event when compared to other regions in Brazil and in the world

Effects of exergames training on postural balance in patients who had a chronic stroke: study protocol for a randomised controlled trial.

INTRODUCTION: Exergames training, as an additional therapy to standard care, has been widely used for motor recovery after patients who had a stroke, and it is a valuable and positive tool in the rehabilitation of this population. This study describes a single-blind randomised clinical trial that will aim to investigate the effects of exergames training on postural balance in patients with chronic stroke. METHODS AND ANALYSIS: Forty-two individuals with chronic stroke (>6 months), aged 20-75 years, will be randomised into two groups: the experimental group, which will be subjected to an exergames protocol, and control group, which will undergo a kinesiotherapy protocol. Both protocols are based on postural balance. The intervention will consist of 40-minute sessions two times per week for 10 consecutive weeks. The volunteers will be evaluated before the treatment, at the end of the interventions and 8 weeks thereafter. The primary outcome will be postural balance (Berg Balance Scale, Functional Reach Test, Timed Up and Go test and Centre of Pressure variables) and secondary outcomes will include gait (6 m timed walk and Kinovea Software), cortical activation patterns (electroencephalography Emotiv EPOC), functional independence (Functional Independence Measure), quality of life (Stroke-Specific Quality of Life Scale) and motivation (Intrinsic Motivation Inventory). ETHICS AND DISSEMINATION: This protocol was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (number 3.434.350). The results of the study will be disseminated to participants through social networks and will be submitted to a peer-reviewed journal and scientific meetings. TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (RBR-78v9hx).

Functional activities habits in chronic stroke patients: A perspective based on ICF framework.

BACKGROUND: Functional autonomy and social inclusion are of key importance for stroke patient's rehabilitation. OBJECTIVE: To evaluate activity and participation of chronic stroke patients by means of basic (BADL), instrumental (IADL) and social (SADL) activities of daily living. METHODS: Forty individuals, 24 patients and 16 healthy individuals fill in a functional activities habits questionnaire. RESULTS: Regarding BADL, 25% of the patients did not get out of bed and 70.8% did not use toilet by themselves. Considering IADL, 29.2% of the patients did not dial the telephone, 70.8% did not wash dishes and clothes, 58.3% did not cook, 100% did not sew, 87.5% did not carry out repairs, 41.7% did not go to the bank, 54.2% did not shop and 45.8% did not write (all p < 0.05). Regarding SADL, 87.5% of the patients were not working professionally, 41.7% did not visit friends or relatives, 75% did not travel and go to the beach and 95.8% did not dance (all p < 0.05). CONCLUSIONS: Chronic stroke patients have limitations in activity and restrictions to participation, even after few years of stroke onset, particularly regarding applying knowledge, use of communication devices, domestic life, major life areas and community, social and civic life.

Circadian activity rhythm and fragmentation are associated with sleep-wake patterns and sleep quality in patients with stroke.

BACKGROUND: Activity levels and disturbances of the sleep-wake pattern affect health and quality of life and need to be further explored in patients with stroke. OBJECTIVE: To evaluate activity levels and their association with sleep-wake patterns in patients with stroke. METHODS: Ten adults with (51±6 years) and 10 without stroke (52±7 years) participated in the study; they were matched on age, sex and educational level. Neurological status, motor function, sleep quality, and activity levels were measured. The groups were compared using Student t-tests and the association between the measures was assessed using Pearson's correlation. RESULTS: Compared to people without stroke, those with stroke had worse sleep quality (p = 0.044), twice lower 24h-activity levels (p < 0.0001), higher interdaily stability and intradaily variability, lower activity during the most active 10 h and during the least active 5 h. Sleep quality was associated with activity level (r= -0.72) and with within-day activity variability (r= 0.53). CONCLUSIONS: Activity level and fragmentation are associated with sleep-wake patterns and sleep quality in patients with stroke.

Electroencephalographic changes using virtual reality program: technical note.

The aim of the study was to describe the technique of an electroencephalographic (EEG) assessment using the Emotiv EPOC® during the performance of a virtual reality motor task and compare theta, alpha, beta and gamma power frequencies between left and right hemispheres. This is technical note in which 9 healthy young subjects were submitted to an evaluation with Emotiv EPOC® during the Nintendo® Wii 'Basic Step' virtual game using the Wii Balance Board (WBB) on a support 13 centimeters high. The Wilcoxon statistical test was applied and pairing between the cerebral hemispheres was performed. Participants had a mean age of 22.55 ± 2.78 years, 77.8% were right-handed, and 22.8% had no experience with the selected virtual game. According to dominancy (right handed n = 7; and left handed n = 2), it was observed that the right-handed individuals showed significantly greater difference in the right hemisphere in the EEG in front region (gamma power in channels AF4, p = 0.028 and F4, p = 0.043) and parietal region (theta and beta power in P8 channel, p = 0.043), while alpha power showed a greater activity in the left hemisphere (P7 channel, p = 0.043). Considering the inter-hemispheric analysis, it was observed that the right hemisphere presented a higher activation potential in the frontal lobe for gamma waves (p = 0.038 for AF3-AF4 channels), and in the temporal lobe for beta and alpha waves (p = 0.021). This study showed that the virtual environment can provide distinct cortical activation patterns considering an inter-hemispheric analysis, highlighting greater activation potential in the right hemisphere.

Brain activity during a lower limb functional task in a real and virtual environment: A comparative study.

BACKGROUND: Virtual Reality (VR) has been contributing to Neurological Rehabilitation because of its interactive and multisensory nature, providing the potential of brain reorganization. Given the use of mobile EEG devices, there is the possibility of investigating how the virtual therapeutic environment can influence brain activity. OBJECTIVE: To compare theta, alpha, beta and gamma power in healthy young adults during a lower limb motor task in a virtual and real environment. METHODS: Ten healthy adults were submitted to an EEG assessment while performing a one-minute task consisted of going up and down a step in a virtual environment - Nintendo Wii virtual game "Basic step" - and in a real environment. RESULTS: Real environment caused an increase in theta and alpha power, with small to large size effects mainly in the frontal region. VR caused a greater increase in beta and gamma power, however, with small or negligible effects on a variety of regions regarding beta frequency, and medium to very large effects on the frontal and the occipital regions considering gamma frequency. CONCLUSIONS: Theta, alpha, beta and gamma activity during the execution of a motor task differs according to the environment that the individual is exposed - real or virtual - and may have varying size effects if brain area activation and frequency spectrum in each environment are taken into consideration.

Predicted normal values for maximal respiratory pressures in children / Valores preditos para as pressões respiratórias máximas em crianças

Introduction: Reference equations are used to predict normal values for maximal respiratory pressures. Objectives: To develop predictive equations for maximal respiratory pressure in children. Methods: A total of 144 healthy children, aged between 7 and 11 years, were assessed. Maximal inspiratory and expiratory pressures were assessed with a digital manovacuometer on top of residual volume and total lung capacity, respectively. Results: The variables sex, age and weight showed association with maximal inspiratory pressure, while maximal expiratory pressure, in addition to the aforementioned variables, also showed association with height. After regression analysis, only sex and age had an influence on the variability of inspiratory and expiratory pressures. Conclusions: The present study provides reference values and proposes two equation models that predict maximal respiratory pressure values among children aged between 7 and 11 years.

Introdução: Equações de referência são utilizadas para predizer valores de normalidade de pressões respiratórias máximas. Objetivo: Elaborar equações preditivas para as pressões respiratórias máximas de crianças. Métodos: Um total de144 crianças saudáveis, com idade entre 7 e 11 anos, foram avaliadas. As pressões inspiratória e expiratória máximas foram avaliadas utilizando um manovacuômetro digital a partir do volume residual e da capacidade pulmonar total, respectivamente. Resultados: As variáveis sexo, idade e peso apresentaram associação com a pressão inspiratória máxima, enquanto que a pressão expiratória máxima, além das variáveis anteriormente citadas, também mostrou associação com a altura. Após a análise de regressão, apenas o sexo e a idade permaneceram exercendo influência sobre a variabilidade das pressões inspiratória e expiratória máximas. Conclusões: Este estudo disponibiliza valores de referência e propõe dois modelos de equação que predizem o valor das pressões respiratórias máximas de crianças entre 7 e 11 anos.

Maximal respiratory pressures of healthy children: comparison between obtained and predicted values.

PURPOSE: To compare maximal inspiratory and expiratory pressures (PImax and PEmax, respectively) obtained in Brazilian children who are healthy with reference and predicted values from previous studies. METHODS: Respiratory muscle strength of 144 children (63 boys), aged 7 to 11 years, was assessed. A digital manovacuometer was used to measure PImax and PEmax from residual volume and total lung capacity, respectively. Children were assessed in the sitting position while wearing a nose clip. RESULTS: Mean values of PImax for boys and girls were 81.6 ± 20.2 and 66.1 ± 19.5 cmH2O, respectively. Mean values of PEmax in boys and girls were 95.6 ± 21.1 and 78.9 ± 19.7 cmH2O, respectively. CONCLUSIONS: Published reference values demonstrated a wide diversity across age groups studied, and published equations were not successful in predicting maximal respiratory pressures; thus, the assessment of respiratory muscle strength of children should consider the minimization of ethnic and methodological differences.

[Pulmonary function of children with acute leukemia in maintenance phase of chemotherapy]. / Função pulmonar de crianças com leucemia aguda na fase de manutenção da quimioterapia.

OBJECTIVE: The aim of this study was to assess the pulmonary function of children with acute leukemia. METHODS: Cross-sectional observational analytical study that enrolled 34 children divided into groups A (17 with acute leukemia in the maintenance phase of chemotherapy) and B (17 healthy children). The groups were matched for sex, age and height. Spirometry was measured using a spirometer Microloop Viasys(®) in accordance with American Thoracic Society and European Respiratory Society guidelines. Maximal respiratory pressures were measured with an MVD300 digital manometer (Globalmed(®)). Maximal inspiratory pressures and maximal expiratory pressures were measured from residual volume and total lung capacity, respectively. RESULTS: Group A showed a significant decrease in maximal inspiratory pressures when compared to group B. No significant difference was found between the spirometric values of the two groups, nor was there any difference between maximal inspiratory pressure and maximal expiratory pressure values in group A compared to the lower limit values proposed as reference. CONCLUSION: Children with acute leukemia, myeloid or lymphoid, during the maintenance phase of chemotherapy exhibited unchanged spirometric variables and maximal expiratory pressure; However, there was a decrease in inspiratory muscle strength.

Pulmonary function of children with acute leukemia in maintenance phase of chemotherapy / Função pulmonar de crianças com leucemia aguda na fase de manutenção da quimioterapia

OBJECTIVE: The aim of this study was to assess the pulmonary function of children with acute leukemia. METHODS: Cross-sectional observational analytical study that enrolled 34 children divided into groups A (17 with acute leukemia in the maintenance phase of chemotherapy) and B (17 healthy children). The groups were matched for sex, age and height. Spirometry was measured using a spirometer Microloop Viasys(r) in accordance with American Thoracic Society and European Respiratory Society guidelines. Maximal respiratory pressures were measured with an MVD300 digital manometer (Globalmed(r)). Maximal inspiratory pressures and maximal expiratory pressures were measured from residual volume and total lung capacity, respectively. RESULTS: Group A showed a significant decrease in maximal inspiratory pressures when compared to group B. No significant difference was found between the spirometric values of the two groups, nor was there any difference between maximal inspiratory pressure and maximal expiratory pressure values in group A compared to the lower limit values proposed as reference. CONCLUSION: Children with acute leukemia, myeloid or lymphoid, during the maintenance phase of chemotherapy exhibited unchanged spirometric variables and maximal expiratory pressure; However, there was a decrease in inspiratory muscle strength...

OBJETIVO: O objetivo desse estudo foi avaliar a função pulmonar de crianças com leucemia aguda. MÉTODOS: Trata-se de um estudo observacional do tipo analítico transversal com 34 crianças, divididas nos grupos A (17 crianças com leucemia aguda na fase de manutenção do tratamento quimioterápico) e B (17 crianças saudáveis). Os grupos foram pareados em relação ao sexo, idade e altura. A espirometria foi mensurada utilizando um espirômetro Microloop Viasys(r), de acordo com as recomendações da American Thoracic Society e European Respiratory Society. As pressões respiratórias máximas foram mensuradas utilizando um manovacuômetro digital MVD300 (Globalmed(r)). As pressões inspiratória máxima e expiratória máxima foram mensuradas a partir do volume residual e da capacidade pulmonar total, respectivamente. RESULTADOS: O grupo A apresentou diminuição significativa da pressão inspiratória máxima quando comparado ao grupo B. Não foram observadas diferenças entre os dados espirométricos dos dois grupos avaliados, bem como entre os valores de pressão inspiratória máxima e pressão expiratória máxima do grupo A com os limites inferiores propostos como referência. CONCLUSÃO: As crianças com leucemia aguda, linfoide ou mieloide não apresentam mudança das variáveis espirométricas e da pressão expiratória máxima durante o período de manutenção do tratamento quimioterápico; no entanto, há uma diminuição da pressão inspiratória máxima...

Effects of motor tasks through photos and videos in patients after stroke / Efeitos da demonstração de tarefas motoras por fotos e vídeos em pacientes pós-acidente vascular encefálico

The aim of the present study was to examine the effects of motor tasks through photos and videos in post-stroke patients. Participants were 12 patients and 10 control people. Five functional tasks were presented in four different sequences and participants had to indicate the ones which reached the goal correctly. By ANOVA it was found that the response time of the patients was greater than of the control group (photos = patients: 4833 ± 310 ms, control: 1112 ± 76 ms, p = .0001 and videos = patients: 3655 ± 242 ms, control: 2451 ± 270 ms, p = .0001). Patients performed better with videos (p = .001). These results may influence therapeutic strategies and enable a discussion about a possible impairment of the mirror neuron system. (AU)

O objetivo deste estudo foi analisar os efeitos da demonstração de tarefas motoras através de fotos e vídeos em pacientes pós-AVE (acidente vascular encefálico). Participaram 12 pacientes e 10 controles. Cinco tarefas funcionais foram apresentadas em quatro sequências diferentes e os participantes indicavam aquela que alcançava o objetivo corretamente. Pela ANOVA verificou-se que o tempo de resposta dos pacientes foi maior (fotos = pacientes: 4833 ± 310 ms, controle: 1112 ± 76 ms, p = 0,0001 e vídeos = pacientes: 3655 ± 242 ms; controle: 2451 ± 270 ms, p= 0,0001). Os pacientes apresentaram melhor desempenho com os vídeos (p= 0,001). Estes resultados podem influenciar as estratégias terapêuticas e permitir uma discussão a respeito de um possível impedimento do sistema de neurônios-espelho. (AU)

Comparison of the immediate effect of the training with a virtual reality game in stroke patients according side brain injury.

BACKGROUND: Stroke is a major cause of motor disability in adults and needs interventions that contribute to motor recovery. OBJECTIVE: This study aimed to compare the immediate effect of the training with virtual reality game in stroke patients according side brain injury. METHODS: The participants included 20 patients (10 right brain injury), mean age of 50.6 ± 9.2 years, and 20 healthy subjects of 50.9 ± 8.8 years. All participants made a kinematic evaluation of drinking a cup of water before and after training with the table tennis game of the XBOX 360 Kinect®, in two series of 10 tries of 45 s, with 15 minutes rest between them, a total of 30 minutes. Data were analyzed by ANOVA. RESULTS: There was a significant difference in the number of hits between patients and healthy subjects groups, in which patients had a lower performance in all the trials (p = 0.008). After the training, only patients with right brain injury improved their shoulder and elbow angles, approaching the left upper limb movement pattern of healthy subjects (p < 0.05). CONCLUSION: Patients with right brain injury responded better to the virtual reality game, suggesting introduction of new treatment techniques that promote neurorehabilitation.

Rastreio cognitivo em pacientes com acidente vascular cerebral: um estudo transversal / Cognitive screening in patients with stroke: a cross-sectional study

Objetivo O estudo objetivou-se a fazer um rastreio cognitivo nos pacientes com acidente vascular cerebral (AVC), a fim de determinar pontos de corte de acordo com a idade, escolaridade e grau de comprometimento neurológico. Métodos Foi realizado um estudo transversal no qual participaram 109 pacientes ambulatoriais, sendo 61 homens, com média da idade de 59 anos (± 11), média do tempo de escolaridade de 5 anos (± 4) e do tempo de sequela de 16 meses (± 14). Os pacientes foram avaliados por meio do Miniexame do Estado Mental (MEEM) e pela National Institute of Health Stroke Scale. Os dados foram analisados pela regressão linear múltipla (stepwise forward). Resultados Verificou-se que as variáveis grau de comprometimento neurológico, idade e escolaridade contribuíram significativamente para o valor global do MEEM e explicaram a variância do estado cognitivo (R2 ajustado = 0,24). Cada aumento do comprometimento neurológico representou diminuição de 0,456 no escore do MEEM. Quanto maior a idade, ocorreu uma diminuição de 0,202 no MEEM, e à medida que diminui o tempo de escolaridade, houve uma diminuição de 0,190 no MEEM. Os pontos de corte variaram de 14 a 22 de acordo com o grau de comprometimento neurológico, idade e escolaridade. Conclusão Os resultados apontaram que, por meio do rastreio positivo de déficit cognitivo, foram encontrados pontos de corte associados ao comprometimento neurológico, necessitando também serem ajustados pela idade e escolaridade, sugerindo que essas associações sejam preferencialmente levadas em consideração na planificação da reabilitação neuropsicológica dos pacientes com AVC. .

Objective The aim of this study was to make a cognitive screening in patients with stroke in order to determine cutoff points according to age, education and degree of neurological impairment. Methods A cross-sectional study was conducted. The study included 109 outpatients (61 men), mean age 59 years (± 11), 5 years of schooling (± 4) and 16 months sequel time (± 14). Patients were assessed by the Mini-Mental State Examination (MMSE) and the National Institute of Health Stroke Scale. Data were analyzed by multiple linear regression (stepwise forward). Results It was found that the variable degree of neurological impairment, age and education contributed significantly to the overall value of the MMSE and explained variance in cognitive status (adjusted R2 = 0.24). Each increase of neurological impairment represented a decrease of 0.456 in MMSE score. The greater the age, there was a decrease of 0.202. As the years of education decreased there was a decrease in MMSE score of 0.190. The cutoffs ranged 14-22 according to the degree of neurological impairment, age and education. Conclusion The results showed that through positive screening for cognitive impairment cutoffs associated with neurological impairment were found, need to be adjusted for age and education, suggesting that these associations are preferably taken into consideration in planning the neuropsychological rehabilitation of stroke patients. .

Respiratory muscle strength of Brazilian adolescents: obtained and predicted values

OBJECTIVES: To compare the obtained values for maximal respiratory pressures of a sample of Brazilian adolescents with the values predicted by Wilson et al. and Domènech-Clar et al. METHODS: 156 adolescents (84 boys) aged between 12 and 17 years were assessed. Maximal respiratory pressures were assessed by a digital manometer with the adolescents in the seated position and wearing a nose clip. Maximal inspiratory and expiratory pressures were performed from residual volume and total lung capacity, respectively. Comparison of the values of maximal respiratory pressures obtained in this study with those predicted by the equations proposed by Wilson et al. and Domenèch-Clar et al., was performed by the paired Student's t test. To verify the association between these values, the Pearson's correlation test was used. RESULTS: Mean maximal inspiratory pressure was 74,66 ± 22,95 cm H2O and 103,52 ± 25,67 cm H2O for girls and boys, respectively. Mean maximal expiratory pressure was 86,23 ± 25,92 cm H2O and 120,08 ± 27,37 cm H2O for girls and boys, respectively. The values obtained by this study did not differ and also did not significantly correlate with those predicted by the equations proposed by Wilson et al., e Domènech-Claret al. CONCLUSIONS: The equations proposed by Wilson et al. and Domènech-Clar et al. were not successful in predicting the values for maximal respiratory pressures in the population studied, indicating the necessity of using in clinical practice reference values from a healthy population of the same ethnicity...(AU)

OBJETIVOS: Comparar os valores encontrados para as pressões respiratórias máximas de uma amostra de adolescentes brasileiros com os valores preditos por Wilson et al e Domènech-Clar et al. MÉTODO: Foram avaliados 156 adolescentes (84 meninos) entre 12 e 17 anos. As pressões respiratórias máximas foram avaliadas por meio de um manovacuômetro digital com os adolescentes sentados e utilizando um clipe nasal. As avaliações das pressões inspiratória e expiratória máximas foram realizadas a partir do volume residual e da capacidade pulmonar total, respectivamente. A comparação dos valores das pressões respiratórias máximas obtidos no atual estudo com os preditos pelas equações propostas por Wilson et al e Domènech-Clar et al, foi realizada pelo teste t de Student pareado. Para verificar a associação entre estes valores, foi utilizado o teste de correlação de Pearson. RESULTADOS: A média da pressão inspiratória máxima foi de 74,66 ± 22,95 cm H2O e de 103,52 ± 25,67 cm H2O para meninas e meninos, respectivamente. A média da pressão expiratória máxima foi de 86,23 ± 25,92 cm H2O e de 120,08 ± 27,37 cm H2O para meninas e meninos, respectivamente. Os valores obtidos não diferiram e também não se correlacionaram significativamente com os preditos através das equações propostas por Wilson et al., e Domènech-Clar et al. CONCLUSÕES: As equações propostas por Wilson et al. e Domènech-Clar et al., não foram capazes de predizer os valores das pressões respiratórias máximas na população estudada, indicando a necessidade de se usar na prática clínica valores de referência advindos de uma população saudável de mesma etnia...(AU)

Respiratory muscle strength of Brazilian adolescents: obtained and predicted values

OBJECTIVES: To compare the obtained values for maximal respiratory pressures of a sample of Brazilian adolescents with the values predicted by Wilson et al. and Domènech-Clar et al. METHODS: 156 adolescents (84 boys) aged between 12 and 17 years were assessed. Maximal respiratory pressures were assessed by a digital manometer with the adolescents in the seated position and wearing a nose clip. Maximal inspiratory and expiratory pressures were performed from residual volume and total lung capacity, respectively. Comparison of the values of maximal respiratory pressures obtained in this study with those predicted by the equations proposed by Wilson et al. and Domenèch-Clar et al., was performed by the paired Student's t test. To verify the association between these values, the Pearson's correlation test was used. RESULTS: Mean maximal inspiratory pressure was 74,66 ± 22,95 cm H2O and 103,52 ± 25,67 cm H2O for girls and boys, respectively. Mean maximal expiratory pressure was 86,23 ± 25,92 cm H2O and 120,08 ± 27,37 cm H2O for girls and boys, respectively. The values obtained by this study did not differ and also did not significantly correlate with those predicted by the equations proposed by Wilson et al., e Domènech-Claret al. CONCLUSIONS: The equations proposed by Wilson et al. and Domènech-Clar et al. were not successful in predicting the values for maximal respiratory pressures in the population studied, indicating the necessity of using in clinical practice reference values from a healthy population of the same ethnicity...

OBJETIVOS: Comparar os valores encontrados para as pressões respiratórias máximas de uma amostra de adolescentes brasileiros com os valores preditos por Wilson et al e Domènech-Clar et al. MÉTODO: Foram avaliados 156 adolescentes (84 meninos) entre 12 e 17 anos. As pressões respiratórias máximas foram avaliadas por meio de um manovacuômetro digital com os adolescentes sentados e utilizando um clipe nasal. As avaliações das pressões inspiratória e expiratória máximas foram realizadas a partir do volume residual e da capacidade pulmonar total, respectivamente. A comparação dos valores das pressões respiratórias máximas obtidos no atual estudo com os preditos pelas equações propostas por Wilson et al e Domènech-Clar et al, foi realizada pelo teste t de Student pareado. Para verificar a associação entre estes valores, foi utilizado o teste de correlação de Pearson. RESULTADOS: A média da pressão inspiratória máxima foi de 74,66 ± 22,95 cm H2O e de 103,52 ± 25,67 cm H2O para meninas e meninos, respectivamente. A média da pressão expiratória máxima foi de 86,23 ± 25,92 cm H2O e de 120,08 ± 27,37 cm H2O para meninas e meninos, respectivamente. Os valores obtidos não diferiram e também não se correlacionaram significativamente com os preditos através das equações propostas por Wilson et al., e Domènech-Clar et al. CONCLUSÕES: As equações propostas por Wilson et al. e Domènech-Clar et al., não foram capazes de predizer os valores das pressões respiratórias máximas na população estudada, indicando a necessidade de se usar na prática clínica valores de referência advindos de uma população saudável de mesma etnia...

Circadian and homeostatic changes of sleep-wake and quality of life in stroke: implications for neurorehabilitation.

The present study aimed to assess changes in the circadian and homeostatic control of the sleep-wake pattern in stroke patients and correlations with quality of life. Participants were 22 patients (55 ± 12 years) and 24 healthy subjects (57 ± 11 years). Instruments used were: the Pittsburgh Sleep Quality Index, SF-36 Questionnaire and Actigraphy. Data were analyzed by Mann-Whitney test and Spearman's correlation. Results identified a significant difference in sleep quality and quality of life between patients and healthy subjects, with patients on average exhibiting poor sleep quality (patients: 8.4 ± 3.4; healthy subjects: 6.2 ± 2.5; p = 0.0001) and low quality of life scores (p < 0.001). Correlation analysis detected an association between circadian variables (total activity, start and finish times of activity) and quality of life (p < 0.001). Associations between homeostatic variables (sleep duration, latency and efficiency) and quality of life were also significant (p < 0.001). In conclusion, results in this study showed compromised sleep quality and quality of life in the patients evaluated, associated with circadian and homeostatic alterations. This suggests that complaints regarding poor sleep quality be taken into consideration when planning the rehabilitation of stroke patients.