Motion Analysis of the Mug Transportation Task Through Upper Limb Kinematics.

The task of transporting objects is a fundamental part of daily living activities. Previous kinematic studies focusing on tasks such as pointing, reach-to-grasp, and drinking have not fully captured the motor behaviors involved in object transportation, including placing a cup on a table or storing items in specific places. Hence, this study aimed to analyze the motor behavior associated with transporting a mug using upper limb kinematic variables. Fifteen healthy adults were instructed to transport an open-handle mug across a table. The kinematic metrics evaluated included object end-error for accuracy, frontal and lateral end-range for precision, movement time, peak velocity, time to peak velocity for control strategy, object path ratio for efficiency, and interjoint coordination. The stability of motor behavior was assessed through a test-retest analysis. The mug transporting task achieved accuracy with a radius <10 mm around the target, a peak velocity of ∼0.4 m/s, a control strategy where acceleration time constituted about 30% of the movement time, and a slightly curved trajectory. The test-retest analysis confirmed stable motor behavior across all kinematic metrics (ICCs > 0.75). Thus, the mug transporting task exhibited unique and stable kinematic characteristics, distinguishing it from non-transport activities and effectively mirroring transporting activities of daily living.

Barriers to self-administered home-based task-oriented practice post-stroke: development and content validity of a new instrument.

PURPOSE: To develop a new instrument to identify barriers to self-administered home-based task-oriented practice post-stroke and test its content validity. MATERIALS AND METHODS: The sample consisted of individuals with stroke and neurological rehabilitation professionals. The study consisted of two steps: (1) Instrument development, involving three processes; a data search in the literature, interviews with the target population and an open questionnaire (online) sent to professionals; and (2) Testing the content validity of the instrument by asking individuals with stroke and professionals about the comprehensiveness and relevance of the items and additionally asking individuals with stroke about the comprehensibility of the items. For each item in the instrument, the threshold validity scores were ≥0.80 in the Content Validity Index and ≥0.75 for the Kappa agreement. RESULTS: The preliminary version was developed with 46 items. The content validation was performed in three rounds. The last version of the instrument Barriers to self-administered home-based task-oriented practice post-stroke (BASH-TOP-Stroke) contained 34 items in five response categories, in which the higher the value presented, the greater the number of barriers. The content validity for the items was excellent. CONCLUSIONS: The study provides a new instrument to help identify barriers to self-administered home-based task-oriented practice post-stroke.

Barriers to self-administered task-oriented home-based exercises can be specific to this form of practice.Understanding barriers to self-administered task-oriented home-based exercises is essential to increase the amount of practice for optimizing motor recovery.The Barriers to self-administered home-based task-oriented practice post-stroke (BASH-TOP-Stroke) questionnaire was developed to evaluate barriers to self-administered task-oriented home-based exercises in individuals post-stroke.BASH-TOP-Stroke has excellent content validity based on patients and professionals and could help to identify strategies that may reduce barriers to self-administered home-based task-oriented practice after stroke.

Shoulder complex and trunk coordination of individuals with severe hemiparesis following a constraint-induced movement therapy protocol: A case series.

INTRODUCTION: Constraint Induced Movement Therapy (CIMT) has been shown to be an effective rehabilitation technique in individuals with mild and moderate upper limb (UL) hemiparesis. The aim was to evaluate the effect the CIMT for improving paretic UL use and interjoint coordination with individuals in severe hemiparesis. METHODS: Six individuals with severe chronic hemiparesis (mean age = 55 ± 16 years) received a UL CIMT intervention for 2 weeks. UL clinical assessments were conducted five times: two assessments at pre-intervention and then, one assessment at post-intervention and 1- and 3-month follow-up using the Graded Motor Activity Log GMAL) and the Graded Wolf Motor Function Test (GWMFT). Scapula, humerus and trunk coordination variability were assessed using the 3-D kinematics during arm elevation, combing hair, turning on the switch and grasp a washcloth. A paired t-test was used to check differences between coordination variability and a one-way ANOVA repeated measures was used to check differences between GMAL and GWMFT scores. RESULTS: There were no differences in GMAL and GWMFT between the patient screening and the baseline data collection (p > 0.05). GMAL scores increased at post-intervention and at follow-ups (p < 0.02). GWMFT performance time score decreased at post-intervention and at 1-month follow-up (p < 0.04). Improvements in kinematic variability of the paretic UL at pre and post-intervention were observed in all tasks, except in the activity of turn on the light switch. CONCLUSION: Following the CIMT protocol, improvements in GMAL and GWMFT scores may reflect improvements in paretic UL performance, in real-life environment. Improvements in kinematic variability may reflect an improving of UL interjoint coordination for individuals with chronic severe hemiparesis.

Validity, Reliability, and Measurement Error of the Remote Fugl-Meyer Assessment by Videoconferencing: Tele-FMA.

OBJECTIVE: The objective of this study was to investigate the validity, reliability, and measurement error of the Fugl-Meyer Assessment (FMA) when it was remotely administered by videoconferencing (Tele-FMA) and to describe barriers to remote administration of the FMA. METHODS: Forty-five participants who had strokes and had a smartphone or laptop computer with a camera and internet access were included. An in-person assessment was compared with a remote assessment in 11 participants, and 34 participants completed only the remote assessment. Rater 1 (R1) remotely administered, recorded, and scored the items of the FMA, after which the recording was forwarded to be scored by Rater 2. At least 7 days later, R1 rated the videorecording of the remote assessment a second time for the evaluation of intrarater reliability. In-person assessment was completed by R1 at the participant's home. Criterion validity was analyzed using the Bland-Altman limits of agreement, and convergent validity was analyzed using Spearman correlation coefficient. The intrarater and interrater reliability was analyzed using the intraclass correlation coefficient, and individual items were analyzed using the weighted kappa. The standard error of measurement and minimal detectable change were calculated to evaluate the measurement error. RESULTS: Bland-Altman plots showed adequate agreement of in-person FMA and tele-FMA. A moderate positive correlation was found between Tele-FMA lower extremity (LE) scores and step test results, and a strong positive correlation was found between Tele-FMA-upper extremity (UE) and Stroke Impact Scale hand function domain. Significant and excellent (0.96 ≤ ICC ≤ 0.99) interrater and intrarater reliabilities of the Tele-FMA, Tele-FMA-UE, and tele-FMA-LE were found. Regarding the individual items, most showed excellent reliability (weighted kappa > 0.70). The standard error of measurement for both reliabilities was small (≤3.1 points). The minimal detectable change with 95% CI for both the Tele-FMA and Tele-FMA-UE was 2.5 points, whereas it was 1.3 points for the Tele-FMA-LE. CONCLUSION: Tele-FMA has excellent intrarater and interrater reliability and should be considered as a valid measurement. IMPACT: The FMA is widely used in clinical practice. However, the measurement properties of the remote version applied by videoconferencing were unknown. This study's results demonstrate the validity and reliability of the Tele-FMA for assessing poststroke motor impairment remotely via videoconferencing. The Tele-FMA may be used to implement telerehabilitation in clinical practice.

Bilateral capacity is related to bilateral upper limb use after stroke: a study by behavioral maps, accelerometers and perceived amount of use.

PURPOSE: This study aimed to assess the following in individuals after stroke: (1) relationship between upper limb (UL) use by direct observation at home with use perceived and measured by accelerometers; (2) complementarity of these three measurements; and (3) relationship between UL bilateral capacity and bilateral use. MATERIALS AND METHODS: Thirty-one individuals with chronic hemiparesis participated in this cross-sectional study. UL use was assessed using a behavioral map (BM), the Motor Activity Log-Amount of Use (MAL-AOU), and accelerometers, while UL capacity was assessed using the Test d'Evaluation des Membres Supérieurs des Personnes Âgées (TEMPA). RESULTS: The BM was strongly correlated with perceived use (MAL-AOU, ρ = 0.76) and accelerometer (ρ = 0.70). Bilateral UL use (BM) was moderately (ρ = 0.65) correlated with bilateral MAL-AOU and bilateral use by accelerometers (ρ = 0.62). The BM aided our understanding of how the paretic UL was used. The correlation between bilateral capacity (TEMPA bilateral) and bilateral use (BM) was significant (ρ = 0.49), while that with bilateral MAL-AOU and accelerometer were ρ = 0.68 and ρ = 0.50, respectively. CONCLUSION: A BM is a valid way to quantify UL use and can complement information assessed regarding perceived use and by accelerometers.Implications for rehabilitationBehavioral maps may be valuable to complement information assessed by perceived UL use and accelerometers.Quantifying bilateral capacity will reflect in a better understanding of actual paretic UL use after stroke.Accelerometers can underestimate the amount of paretic UL use in asymmetrical bilateral tasks.

Manual Dexterity Is Associated With Use of the Paretic Upper Extremity in Community-Dwelling Individuals With Stroke.

BACKGROUND AND PURPOSE: Regarding people with stroke, simple outcome measures in clinical settings capable of representing the actual use of the upper extremity (UE) would be useful to rehabilitation professionals for the purposes of goal setting. This study seeks to describe the relative levels of paretic UE use, investigate the association between manual dexterity and task-related UE use, and to establish the manual dexterity cutoff points that correspond to relative levels of paretic UE use. METHODS: Forty-six adults with chronic hemiparesis participated in this cross-sectional study. Behavioral mapping was employed to ascertain the actual amount of UE use by the identifying the unimanual and bimanual activities performed in the participants' homes within a 4-hour period. Participants were classified into 4 levels of paretic UE integration into activities considering the data from the behavioral mapping (activity, hand function, and type of grasp). The Box and Block Test (BBT) and the Nine Hole Peg Test (NHPT) were used to evaluate dexterity. The Spearman test was used to evaluate the correlations. In analyzing the receiver operating characteristic curve, we applied the Youden index to determine the cutoff points. RESULTS: Participants with full/almost full (n = 11), partial (n = 12), and limited (n = 12) integration of the paretic UE into activities and with little/no use (n = 11) were identified. Unimanual and total paretic UE activities were found to have a high correlation with the BBT scores. The boundaries between the integration levels were between full/almost full and partial integration, BBT greater than 30 blocks or NHPT of 41 seconds and less; between partial and limited, BBT greater than 16 blocks; and between limited and little/no use, BBT greater than 3 blocks. Both tests show good accuracy (≥0.81). DISCUSSION AND CONCLUSIONS: The BBT presents a positive high correlation with paretic UE use at home and was shown to be better able to identify "limited" and "partial" integration of the paretic UE. Both tests can identify when the paretic UE is fully/almost fully integrated into activities at home.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A354).

The kinematics of paretic lower limb in aquatic gait with equipment in people with post-stroke hemiparesis.

BACKGROUND: Devices are commonly used in aquatic gait rehabilitation; therefore, investigating the effect of these devices is important. We evaluated the combined use of buoyancy cuffs and ankle weights during aquatic gait on paretic leg kinematics in people with hemiparesis. METHODS: Fifteen adults (58.6 ±â€¯4.8 years) in the chronic phase post-stroke walked on a 4.5 m walkway with underwater immersion at the height of the xiphoid process in five conditions: (1) without equipment; (2) with ankle weights or (3) buoyancy cuffs on both legs; (4) with a buoyancy leg cuff on the non-paretic leg and an ankle weight on the paretic leg; (5) with an ankle weight on the non-paretic leg and a buoyancy leg cuff on the paretic leg. Five trials were performed for each condition for a total of 25 trials and the kinematic data were recorded. Analysis of covariance was used with walking velocity as a covariate to analyze spatiotemporal and angular variables of the paretic leg. FINDINGS: The condition with buoyancy cuff on the paretic leg increased (~20°) the maximum angle of knee flexion in the mid-swing phase compared to that seen with weights on both legs or weight on the paretic leg. Buoyancy cuffs on the paretic leg increased the step length by 5.6 cm. The ankle weights on the paretic leg condition increased the total (6%) and single support (4%) duration compared to that seen with a buoyancy cuff on the paretic leg. INTERPRETATION: Aquatic gait with buoyancy cuffs on both legs or on the paretic leg can modify gait kinematics compared to that with weight on both legs or on the paretic leg. Long term effects of training with those conditions needs further research.

Cryotherapy reduces muscle hypertonia, but does not affect lower limb strength or gait kinematics post-stroke: a randomized controlled crossover study.

BACKGROUND: Based on the premise that spasticity might affect gait post-stroke, cryotherapy is among the techniques used to temporarily reduce spasticity in neurological patients. This effective technique would enhance muscle performance, and ultimately, functional training, such as walking. However, understanding whether a decrease in spasticity level, if any, would lead to improving muscle performance and gait parameters is not based on evidence and needs to be clarified. OBJECTIVES: to investigate the immediate effects of cryotherapy, applied to spastic plantarflexor muscles of subjects post-stroke, on tonus level, torque generation capacity of plantarflexors and dorsiflexors, and angular/spatiotemporal gait parameters. METHODS: Sixteen chronic hemiparetic subjects participated in this randomized controlled crossover study. Cryotherapy (ice pack) or Control (room temperature sand pack) were applied to the calf muscles of the paretic limb. The measurements taken (before and immediately after intervention) were: 1) Tonus according to the Modified Ashworth Scale; 2) Torque assessments were performed using an isokinetic dynamometer; and 3) Spatiotemporal and angular kinematics of the hip, knee, and ankle (flexion/extension), obtained using a tridimensional movement analysis system (Qualisys). RESULTS: Cryotherapy decreased plantarflexor tonus but did not change muscle torque generation capacity and did not affect spatiotemporal or angular parameters during gait compared to control application. These findings contribute to the evidence-based approach to clinical rehabilitation post-stroke. CONCLUSIONS: The findings of this study suggest that cryotherapy applied to the calf muscles of subjects with chronic hemiparesis reduces muscle hypertonia but does not improve dorsiflexors and plantarflexors performance and gait parameters.

Hand function and type of grasp used by chronic stroke individuals in actual environment.

BACKGROUND: Knowledge of paretic upper limb (UL) use in the actual environment is crucial for defining treatment strategies that are likely to enhance performance. OBJECTIVE: To quantify the hand function and type of grasp performed in the actual environment following stroke and determine if any differences in hand use are dependent on the degree of motor impairment. METHOD: This cross-sectional study enrolled 41 participants with chronic hemiparesis classified as having either mild (11), moderate (20), or severe (10) UL impairment. A behavioral map was used while observing hand use over the 4-h experimental period, during which we checked: activity- unimanual, bimanual or non-task-related; hand function- stabilization, manipulation, reach-to-grasp, gesture, support or push; and type of grasp- digital or whole-hand. RESULTS: Participants with severe impairment did not use the paretic UL spontaneously; analyzing the moderate and mild subgroup together, the predominant UL hand functions were stabilization and manipulation, the paretic UL performs the stabilization function using the whole-hand more frequently (71.2%) than digital (28.8%) grasp. In the subgroup analysis, the paretic and non-paretic UL in the moderate and the paretic UL in the mild subgroup perform the whole-hand stabilization more frequently than digital. Digital grasp is more accomplished by the non-paretic UL in reach-to-grasp hand function, particularly in the mild subgroup. CONCLUSION: The paretic UL is predominantly employed for stabilization function using a whole-hand grasp. The type of grasp in the actual environment is affected by motor impairment, and greater motor impairment leads to the performance of less complex tasks.

The activity assessment instruments of the upper limbs do contemplate the most accomplished tasks at home by people with hemiparesis? / Os instrumentos de avaliação de atividade dos membros superiores contemplam as tarefas mais realizadas em domicílio por pessoas com hemiparesia?

Abstract Introduction: There is still no consensus on the recommendation of instruments for evaluation of the upper limb (UL) after Stroke. Objective: Identify the tasks most performed at home by people after stroke, and among these, which are contemplated in the instruments of assessments of UL activity identified in the literature. Method: Direct observation during four hours at the home of 40 participants (57,2±13,0 years old) with hemiparesis, the basic activities of daily life (BADL) and instrumental (IADL) were recorded, identifying those performed by a larger number of participants. Results: From the 247 observed tasks, 70,5% were related to IADL. In the literature we identified six instruments of capacity evaluation: Arm Motor Ability Test (AMAT); Action Research Arm Test (ARAT); Chedoke Arm and Hand Activity Inventory (CAHAI); JEBSEN-TAYLOR; Test d'Evaluation des Membres Supérieurs de Personnes Agées (TEMPA) and Wolf Motor Function Test (WMFT) and four Performance: Motor Activity Log (MAL); Manual Ability Measure (MAM-16 and MAM-36) and ABILHAND. Of the 64 tasks performed by a larger number of participants, the capacity instrument that contemplated the largest number of these was CAHAI (15%) and performance was MAL (33%). The instruments with the greater proportion of tasks observed at home in relation to the total number of the instrument were the TEMPA (all eight) and the MAL (21/30) tasks. Conclusion: Performance instruments contemplate greater proportion of tasks observed directly at home, however the capacity instruments assess distinct tasks. The combination of capacity and performance tools for UL assessment in this population is recommended.

Resumo Introdução: Ainda não há consenso sobre a recomendação de instrumentos para avaliação do membro superior (MS) pós-Acidente Vascular Encefálico (AVE). Objetivo: Identificar as tarefas realizadas no domicílio por pessoas pós-AVE e, dentre estas, quais estão contempladas nos instrumentos de avaliação de atividade do MS identificados na literatura. Método: Por observação direta, durante quatro horas no domicílio de 40 participantes (57,2±13,0 anos) com hemiparesia, foram registradas as atividades básicas de vida diária (ABVD) e instrumentais (AIVD), identificando aquelas executadas por maior número de participantes. Resultados: Das 247 tarefas observadas, 70,5% foram relacionadas às AIVD. Na literatura, identificamos seis instrumentos de avaliação da capacidade: Arm Motor Ability Test (AMAT); Action Research Arm Test (ARAT); Chedoke Arm and Hand Activity Inventory (CAHAI); JEBSEN-TAYLOR; Test d'Evaluation des Membres Supérieurs de Personnes Agées (TEMPA) e Wolf Motor Function Test (WMFT), e quatro de desempenho: Motor Activity Log (MAL); Manual Ability Measure (MAM-16 e MAM-36) e ABILHAND. Dentre as 64 tarefas realizadas por um maior número de participantes, o instrumento de capacidade que contemplou maior número destas foi o CAHAI (15%) e de desempenho foi o MAL (33%). Os instrumentos com maior proporção de tarefas observadas em domicílio, em relação ao número total do instrumento, foram o TEMPA (todas as oito) e o MAL (21/30 tarefas). Conclusão: Os instrumentos de desempenho contemplam maior proporção das tarefas observadas em domicílio, entretanto os instrumentos de capacidade avaliam tarefas distintas destas. Recomenda-se a combinação de instrumentos de capacidade e desempenho para avaliação do MS nessa população.

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

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

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

"Test D'évaluation Des Membres Supérieurs Des Personnes Âgées" (TEMPA) to assess upper limb activity in Parkinson's disease.

STUDY DESIGN: Cross-sectional and observational study. PURPOSE OF THE STUDY: Assess upper limb (UL) activity limitations using the "Test d'Evaluation des Membres Supérieurs Des Personnes Agées" (TEMPA) in individuals with Parkinson's disease (PD) and verify its clinimetrics properties. METHODS: The following were evaluated: internal consistency, interrater and test-retest reliability; concurrent validity; convergent validity; know group's validity; minimal detectable change, floor and ceiling effects, and the relationship between UL activity limitations and the presence of freezing of gait. RESULTS: Excellent reliability and interrater agreement (intraclass correlation coefficient = 0.99 and κ = 0.92) and test-retest reliability (intraclass correlation coefficient = 0.97) were found, as well internal consistency (α = 0.99). A moderate negative correlation was found between TEMPA and section II of the Unified Parkinson's Disease Rating Scale (ρ = -0.58; P = .001), and moderate/low between the test and the Nine Hole Peg Test values of the right UL and moderate for left UL (ρ = 0.56 and ρ = 0.41; P = .001) (ρ = 0.52 and ρ = 0.51; P = .001 and P = .002), respectively. No significant relationship was found with freezing episodes (P = .057). DISCUSSION: TEMPA is useful for assessing UL activity limitations in PD, have adequate clinimetrics properties and is capable of detecting the influence of motor symptoms during the carrying out of daily living tasks. No differences were found between freezers and no freezers. LEVEL OF EVIDENCE: N/A.

Movement adjustments in preparation for single-leg jumps in individuals with functional ankle instability.

There is some evidence showing that people with functional ankle instability (FAI) can present changes in postural control during the landing phase of a jump. These studies also show preliminary results indicating possible changes during phases prior to landing. Therefore, the objective of this study was to investigate whether movement adjustments prior to a jump are different between people with and without FAI. Sixty participants with (n=30) and without (n=30) FAI participated in this study. The main outcome measures were the variability of range of motion in ankle inversion/eversion and dorsiflexion/plantarflexion; and variability of center of pressure for the directions anterior-posterior and medio-lateral during the pre-jump period for drop jump, vertical jump and during single-leg stance. The group with instability showed more variability of center of pressure in anterior-posterior direction (p=0.04) and variability of range of motion in ankle dorsiflexion/plantar flexion (p=0.04) compared to control in the single-leg stance test. For the within-group comparisons, the group with instability showed more variability of center of pressure in anterior-posterior direction in the drop jump higher than single-leg stance and vertical jump. The same pattern was seen for the control group. Thus, this study suggests that people with FAI have greater ankle range of motion variability and center of pressure variability in the anterior-posterior axis when compared to healthy individuals during single-leg stance. For those same two variables, preparation for a drop jump causes more postural instability when compared to the preparation for a vertical jump and to single-leg stance.

Processo de tradução, propriedades de medida e classificação de acordo a CIF dos instrumentos de avaliação pós-AVE disponíveis em Português falado no Brasil / Translation process, measurement properties and classification according to ICF of evaluation instruments post-Stroke available in Portuguese spoken in Brazil

Diversos instrumentos desenvolvidos em países estrangeiros têm sido propostos para avaliar diferentes aspectos de indivíduos pós-acidente vascular encefálico (AVE). A identificação dos instrumentos de medida utilizados nesta população nos conceitos da CIF permite uma abordagem sistêmica do indivíduo. Este estudo objetivou realizar uma revisão sistemática de instrumentos para avaliação pós-AVE que passaram pelo processo de tradução e adaptação para a língua portuguesa, caracterizá-los nos conceitos da CIF e identificar suas propriedades de medida. Dois autores realizaram, de forma sistemática, as etapas de seleção dos estudos elegíveis. A busca se fez pela exploração dos bancos de dados Medline via Ovid, Cinahl via EBSCO, Scielo e Lilacs. A busca resultou em 562 títulos, reduzidos a 22 artigos elegíveis, entre os quais foram identificados 19 instrumentos de avaliação, seis destes classificados como funções e estruturas corporais (FEC), um classificado dentro de FEC e atividade, oito como atividade e quatro como participação. Apenas em 4 estudos foram observadas todas as etapas do processo de tradução. A confiabilidade foi testada em todos os instrumentos, enquanto apenas 4 avaliaram alguma forma de validade e 4 avaliaram efeito piso/teto. Sugere-se a realização de futuros estudos com o objetivo de submeter estes instrumentos à avaliação das propriedades que ainda não foram avaliadas. (AU)

Many instruments developed in foreign countries have been proposed to evaluate different aspects of patients post-stroke. The identification measuring instruments already used in the population with cerebrovascular accident (CVA) in the concepts of the ICF provides a systemic approach of patients. The purpose of the study was to perform a systematic review of instruments for post-stroke evaluation that went through the process of translation and adaptation into Portuguese, featuring instruments in accordance with the concepts of the ICF and identify its psychometric properties. Two authors performed, systematically, the steps for selection of eligible studies. The databases searched were: Medline via Ovid, Cinahl via EBSCO, Scielo and Lilacs. We selected 562 titles and reduced to 22 eligible studies, in which 19 instruments were identified, six classified as structure and body function (SBF), one as SBF and activity, and eight as activity and four as participation. Only in four studies all the steps of the translation process were identified. Reliability was the psychometric property tested in all instruments, while only 4 have evaluated some type of validity and other four the floor/ceiling effects. Further studies are suggested in order to submit these instruments to evaluation of properties that have not yet been evaluated. (AU)

Feasibility and effectiveness of adding object-related bilateral symmetrical training to mirror therapy in chronic stroke: A randomized controlled pilot study.

PURPOSE: To evaluate the feasibility and effectiveness of adding object-related bilateral symmetrical training to mirror therapy (MT) to improve upper limb (UL) activity in chronic stroke patients. METHOD: Sixteen patients with moderate UL impairment were randomly allocated to either the experimental (EG) or control (CG) group. Both groups performed 1 hour sessions, 3 days/week for 4 weeks, involving object-related bilateral symmetrical training. EG performed the tasks observing their nonparetic UL reflected in the mirror, while CG observed the paretic UL directly. The primary outcome measure was unilateral and bilateral UL activity according to the Test d'Évaluation des Membres Supérieurs de Personnes Âgées (TEMPA). All measurements were taken at baseline, post-training, and follow-up (2 weeks). RESULTS: TEMPA total score showed the main effect of time. Significant improvement was found for bilateral but not unilateral tasks. Both groups showed gains after training, with no differences between them. CONCLUSIONS: This study showed the feasibility of adding object-related bilateral training to MT. Both types of training improved UL bilateral activity; however, a larger sample is required for a definitive study. Other studies need to be carried out to evaluate the effectiveness of combining more distal-oriented movements and object-related unilateral training to improve these effects in chronic stroke patients.

Instrumentos de avaliação sensorial pós-acidente vascular encefálico (AVE) descritos em português: uma revisão sistemática / Los instrumentos de evaluación sensorial posaccidente vascular encefalico (AVE) descriptos en portugués: una revisión sistemática / Sensory evaluation tools stroke described in Portuguese: a systematic review

RESUMO Grande parte dos sobreviventes de acidente vascular encefálico (AVE) apresenta, além de outras sequelas, algum déficit sensorial. Para avaliar o impacto desse déficit na atividade e o efeito de protocolos de reeducação sensorial é importante utilizar instrumentos objetivos. Os objetivos desta revisão sistemática foram analisar quais instrumentos de avaliação sensorial para pacientes pós-AVE estão disponíveis em português brasileiro e descrever suas características e/ou propriedades. Realizou-se uma busca nas bases de dados eletrônicas SciELO, LILACS, PubMed, CINAHL, MEDLINE via OVDI e Embase. Os estudos relevantes foram analisados quanto à acessibilidade, objetividade da pontuação e propriedades de medida, acrescentando-se artigos por meio de busca manual quando necessário. As buscas resultaram em 96 estudos, reduzidos a cinco estudos elegíveis. Um estudo foi adicionado por meio da lista de referências, e a busca manual foi utilizada para complementação. Entre os sete artigos analisados, há somente três instrumentos de avaliação sensorial disponíveis em português: Moving touch pressure (MTP), domínio sensibilidade da Escala de Fugl-Meyer (EFM) e Avaliação Sensorial de Nottingham (ASN). Além disso, embora a confiabilidade da EFM e da ASN possa ser considerada adequada, as demais propriedades de medida necessitam ser avaliadas em futuros estudos.

RESUMEN Gran parte de los supervivientes de accidente vascular encefálico (AVE) presentan, además de otras secuelas, alguno déficit sensorial. Para evaluar el impacto de ese déficit en la actividad y el efecto de protocolos de reeducación sensorial es importante utilizar instrumentos objetivos. Los objetivos de esta revisión sistemática son analizar cuales instrumentos de evaluación sensorial para pacientes pos-AVE están disponibles en portugués brasileño y describir sus características y/o propiedades. Se realizó una búsqueda en las bases de datos electrónicos SciELO, LILACS, PubMed, CINAHL, MEDLINE vía OVDI y Embase. Los estudios relevantes fueron analizados en relación a la accesibilidad, objetividad de la puntuación y propiedades de medida, añadiéndose artículos mediante búsqueda manual cuando necesario. Las búsquedas resultaron en 96 estudios, reducidos a cinco estudios elegibles. Se agregó un estudio mediante la lista de referencias, y se utilizó la búsqueda manual para la complementación. Entre los siete artículos analizados, hay solamente tres instrumentos de evaluación sensorial disponibles en portugués: Moving touch pressure (MTP), dominio sensibilidad de la Escala de Fugl-Meyer (EFM) y Evaluación Sensorial de Nottingham (ESN). Además, aunque la confiabilidad de la EFM y de la ESN es considerada adecuada, las demás propiedades de medida necesitan ser evaluadas en estudios futuros.

ABSTRACT Most survivors of stroke present, among other consequences, a sensory deficit. To assess the impact of this deficit on the activity and the effect of sensory reeducation protocols, it is important to use objective instruments. The objective of this systematic review was to analyze which sensory evaluation tools for post-stroke patients are available in Brazilian Portuguese and describe its features and/or properties. A search was conducted in the electronic databases SCIELO, LILACS, PUBMED, CINAHL, MEDLINE via OVDI, and EMBASE. The relevant studies were analyzed as to accessibility, objectivity of the score and measurement properties, adding articles through manual search when necessary. The search resulted in 96 studies, reduced to five eligible ones. A study was added through the list of references and the manual search was used for complementation. Among the seven reviewed articles, only three sensory evaluation tools are available in Portuguese: moving touch pressure (MTP), sensitivity domain of Fugl-Meyer Scale (FMS), and Nottingham Sensory Assessment (NSA). In addition, although the reliability of the FMS and of the NSA may be considered appropriate, the other properties of measurement need to be evaluated in future studies.

Pesquisas científicas com indivíduos pós acidente vascular encefálico: dificuldades no recrutamento, alocação e aderência em dois diferentes protocolos de intervenção fisioterapêutica / Las investigaciones científicas con sujetos que sufrieron accidentes cerebrovasculares: dificultades para el reclutamiento, destinación y adherencia en dos diferentes protocolos de intervención fisioterapéutica / Scientific research with individuals post stroke: difficulties in recruitment, allocation and adherence on two different protocols of physiotherapy intervention

Este estudo busca analisar as dificuldades no recrutamento, alocação e aderência de indivíduos com hemiparesia pós AVE no desenvolvimento de dois Ensaios Clínicos Randomizados (ECR). Para tanto, foram extraídas informações de dois ECR que investigaram pacientes com hemiparesia devido ao Acidente Vascular Encefálico (AVE), residentes na Grande Florianópolis, com idade superior a 40 anos. Nos ECR foram realizadas intervenções baseadas no treinamento orientado à tarefa e avaliações em três momentos distintos (pré, pós, seguimento). Os cálculos amostrais determinaram a necessidade de 54 participantes para o Estudo I e 36 para o Estudo II. Os dados quantitativos foram tratados através da estatística descritiva e as informações qualitativas através da análise de conteúdo. Verificou-se que dos 127 potenciais participantes, não foi possível contatar 18,1%, e 5,5% vieram a óbito. Na pré-seleção, 6,3% estavam internados/acamados, 7% não tinham interesse e 4,7% não tinham condições de transporte. Durante a alocação, 33% foram excluídos por não atenderem aos critérios de elegibilidade. Dentre os 32 pacientes que permaneceram nos estudos, 16% faltaram ao Estudo I e 2,5% ao Estudo II. Dados de contato equivocados, falta de recursos para transporte, critérios de elegibilidade e ausência de interesse foram os fatores que mais dificultaram o recrutamento dos indivíduos. Portanto, pode-se sugerir que a melhora entre os centros de pesquisa e as instituições, o registro adequado dos contatos, o acesso aos registros clínicos, a disponibilidade de recursos financeiros para auxílio ao recrutamento e transporte e o aumento do financiamento para ECR podem melhorar a viabilidade deste tipo de estudo no Brasil.

Esta investigación tuvo por objetivo analizar las dificultades en el reclutamiento, destinación y adherencia de sujetos con hemiparesia post accidente cerebrovascular (ACV) en el desarrollo de dos Ensayos Clínicos Aleatorizados (ECA). Para eso, se recolectó informaciones de dos ECAs los que hicieron estudios con pacientes portadores de hemiparesia debido al ACV, que vivían en la ciudad de Florianópolis, Brasil, con edad superior a 40 años. En los ECAs se han hecho intervenciones basadas en la capacitación orientada a la tarea y evaluaciones en tres ocasiones distintas (pre, post, seguimiento). Los cálculos de la muestra determinan la necesidad de 54 participantes para el Estudio I y 36 para el Estudio II. Los datos cuantitativos se han tratados a través de la estadística descriptiva y las informaciones cualitativas a través del análisis del contenido. Se han comprobado que de los 127 potenciales participantes, no ha sido posible contactarse con el 18,1%, el 5,5% fallecieron. En la preselección, el 6,3% estaban hospitalizados/encamados, el 7% no tenían interés y el 4,7% no tenían condiciones de transporte. Durante la determinación, el 33% han sido excluidos por no cumplir los criterios de elegibilidad. Entre los 32 pacientes que han permanecido en los estudios, el 16% no han comparecido al Estudio I y el 2,5% al Estudio II. Los datos de contacto equivocados, la falta de recursos para el transporte, los criterios de elegibilidad y el ausente interés en participación han sido los factores que más causaron dificultades al reclutamiento de los sujetos. Por lo tanto, se puede hacer una sugerencia a la mejora entre los centros de investigación y las instituciones, el registro adecuado de contactos, el acceso a los registros clínicos, la disponibilidad de recursos financieros para auxiliar en el reclutamiento y transporte y el aumento de los fondos para la ECA pueden ayudar a mejorar la viabilidad de este tipo de estudio en el Brasil.

This study analyze the difficulties in recruitment, allocation and adherence of individuals with hemiparesis after stroke in the development of two randomized clinical trials (RCTs). For this, data were extracted from two RCTs that investigated patients with hemiparesis due to stroke, living in Florianópolis, aged over 40 years. RCTs interventions were based to task-oriented training and were performed evaluations at three different times (pre, post, follow-up). The sample calculations determined the need of 54 participants for Study I and 36 for Study II. The quantitative data were analyzed using descriptive statistics and qualitative information through the content analysis. It was found that of 127 potential participants, it was not possible to contact 18.1%, and 5.5% came to death. In preselection 6.3% were hospitalized/bedridden, 7% had no interest and 4.7% were unable to transport. During allocation 33% were excluded for not meeting the eligibility criteria. Among 32 patients who remained in the study, 16% missed the Study I and 2.5% the Study II. Wrong contact data, lack of resources for transportation, eligibility criteria and lack of interest were the factors that hindered the recruitment of subjects. Therefore, we suggested that the relations improvement between research centers and institutions, the proper recording of contacts, access to clinical records, the availability of financial resources to support the recruitment and transportation and increased funding for RCTs can improve the viability of this type of study in Brazil.

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

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

Usando um acelerômetro para analisar o movimento de alcance e e preensão após o AVE / El uso de un acelerómetro para analizar un movimiento de alcance i e preensão después del accidente cerebrovascular / Using an accelerometer for analyzing a reach-to-grasp movement after stroke

The purpose of this study was using an accelerometer to access the kinematics of reach-to-grasp movements in subjects with hemiparesis. Eight subjects (59.4 ± 6.9 years old) with chronic hemiparesis (50.9 ± 25.8 months post-stroke) participated in this study. Kinematic assessment was performed using a triaxial accelerometer (EMG Systems, Brazil) attached to the subjects' forearm. Ten reach-to-grasp movements of grabbing a 500ml-size bottle were performed by the subjects with the paretic and the non-paretic upper limbs (ULs). The following space-temporal variables were calculated and used to compare the paretic and non-paretic ULs: movement time (MT), time to reach the peak velocity, absolute and relative (TPV and TPV%MT), relative deceleration duration (DEC%MT), time to peak acceleration (TPA) and peak hand acceleration (PA). Movements were slower in the paretic UL with increased MT, TPA and DEC. The accelerometer allowed to identify of changes in reaching-to-grasp movements of subjects with hemiparesis. When complex systems are not available, accelerometers can be an alternative to measure UL movements.

O objetivo deste estudo foi usar um acelerometro para avaliar a cinemática do movimento de alcance e preensão de indivíduos com hemiparesia. Participaram deste estudo oito indivíduos (59,4 ± 6,9 anos) com hemiparesia crônica (50,9 ± 25,8 meses pós-AVE). A avaliação cinemática foi realizada através de acelerômetro triaxial (EMG Systems do Brasil) fixado no antebraço. Os indivíduos realizaram 10 movimentos de alcançar uma garrafa de 500 ml pelo membro superior (MS) parético e não parético. As seguintes variáveis espaço-temporais foram calculadas e utilizadas para comparar o MS parético e não parético: tempo de movimento (TM), tempo para alcançar o pico de velocidade, absoluto e relativo (TPV e TPV%TM), duração relativa da desaceleração(DEC%TM), tempo para alcançar o pico de aceleração (TPA) e pico de aceleração da mão (PA). Os movimentos foram mais lentos no MS parético com maiores TM, TPA e DEC. A utilização do acelerômetro permitiu identificar alterações no movimento de alcance em indivíduos com hemiparesia. Quando sistemas mais compexos não são disponiveis, acelerometros podem ser uma alternativa para medir o movimento do MS.

El objetivo de este estudio fue analizar por acelerometría, la cinemática del movimento de alcance de los sujetos con hemiparesia. Participaron ocho individuos (59,4 ± 6,9 años) con hemiparesia crónica (50,9 ± 25,8 meses después del accidente cerebrovascular). La evaluación cinemática se realizó utilizando el acelerómetro triaxial (EMG Systems, Brasil) fijado en el antebrazo. Los sujetos realizaron10 movimientos para alcanzar una botella de 500 ml por el miembro superior (MS) parético y no parético. Las siguientes variables espacio-temporales fueron calculadas para comparar el MS parético y no parético: tiempo de movimiento (TM), tiempo para alcanzar el pico de velocidad, absoluto y relativo (TPV e TPV%TM), duración relativa de la desaceleración (DEC%TM), tiempo para alcanzar el pico de aceleración (TPA) y el pico de aceleración (PA). Los movimientos fueron más lentos en el MS parético con mayor TM, TPA y DEC. La utilización del acelerómetro permitió identificar las alteraciones en el movimiento de alcance en personas con hemiparesia. Cuando complexos sistemas no son disponibles, acelerómetros poden ser una alternativa para medir el movimiento do MS.

Frequência cardíaca e percepção subjetiva de esforço durante o andar para trás em velocidade confortável e máxima em adultos com hemiparesia / Heart rate and subjective perception of exertion during backward walking at comfortable and maximal speed in adults with hemiparesis / Frecuencia cardíaca y percepción subjetiva de esfuerzo durante el andar para atrás en velocidades confortable y máxima en adultos con hemiparesia

INTRODUÇÃO E OBJETIVO: Estudos sobre o andar para trás (AT) em indivíduos saudáveis demonstraram que esse exercício demanda maior consumo de oxigênio e esforço cardiopulmonar comparado ao andar para frente (AF). Em indivíduos após acidente vascular encefálico (AVE), o AT demonstrou ser uma forma de terapia benéfica para melhorar parâmetros de marcha. Este estudo teve como objetivo comparar as variáveis frequência cardíaca (FC) e percepção subjetiva de esforço (PSE) entre o AF e AT em esteira rolante em duas velocidades distintas em indivíduos com hemiparesia, algo que poderá contribuir para a definição da melhor estratégia para colocar os indivíduos na zona-alvo de um exercício visando ao aprimoramento das condições cardiorrespiratórias. MÉTODOS: Participaram 13 indivíduos adultos de ambos os sexos (53,7 ± 13,5 anos) com sequela de AVE crônica (38,5 ± 31,2 meses de acometimento). Os indivíduos realizaram a tarefa de AT na esteira em velocidade confortável e máxima, repetindo os procedimentos em velocidades idênticas durante o AF. Foi utilizada uma ANOVA fatorial para testar o efeito do sentido (AF e AT) e da velocidade (confortável e máxima) sobre a FC e PSE. RESULTADOS: A FC foi maior durante o AT nas duas velocidades, sendo essa incrementada com o aumento da velocidade (p < 0,01 para todas comparações). Da mesma forma, a PSE foi maior durante o AT nas duas velocidades, sendo incrementada com o aumento da velocidade (p < 0,01 para todas as comparações). CONCLUSÃO: Andar para trás é uma atividade física mais intensa que andar para frente em uma mesma velocidade para indivíduos com hemiparesia. Os achados sugerem que esta atividade poderia ser uma alternativa na realização de programas com ênfase no condicionamento cardiopulmonar e como complemento de outros procedimentos na reeducação do andar após AVE.

BACKGROUND AND PURPOSE: Backward walking (BW) studies in healthy subjects have demonstrated that this exercise requires more oxygen consumption and cardiopulmonary effort compared to forward walking (FW). In patients after stroke, BW has proven to be a beneficial form of therapy to improve gait parameters. The purpose of this study was to determine whether there are differences in heart rate (HR) and perceived exertion (PE) between FW and BW on a treadmill at two different speeds in individuals with hemiparesis. This may help to define the best strategy to put individuals in the target zone of an exercise aimed at improving cardiorespiratory conditions. METHODS: Participated in the study 13 male and female adults (53.7±13.5 years) with chronic sequelae of stroke (38.5±31.2 months of onset). The subjects performed BW task on the treadmill at comfortable speed and maximum speed and repeated the procedures during the FW at identical speeds. A two-way ANOVA was used to test the effect of directional orientation (BW and FW) and speed (comfortable and maximum) on HR and PE. RESULTS: The HR was greater for the BW in both speeds, and has increased with increasing speed (p < 0.01 for all comparisons). Similarly, the PE was higher in BW compared to FW in both speeds, and has increased with increasing speed (p < 0.01 for all comparisons). CONCLUSION: Walking backwards is a physical activity more intense than walking forward at the same speed for individuals with hemiparesis. This finding suggests that this activity could be used as an alternative method with emphasis on cardiopulmonary fitness and as a complement to other procedures in the rehabilitation of gait after stroke.

INTRODUCCIÓN Y OBJETIVO: Los estudios sobre el andar para atrás (AT), en individuos sanos, demostraron que ese ejercicio demanda más consumo de oxígeno y esfuerzo cardiopulmonar en comparación con el andar hacia adelante (AD). En personas, después de accidente vascular encefálico (AVE), el AT demostró ser una forma de terapia benéfica para mejorar parámetros de marcha. Este estudio tuvo como objetivo comparar las variables frecuencia cardíaca (FC) y percepción subjetiva de esfuerzo (PSE) entre el AD y el AT, en estera rodante, en dos velocidades diferentes en individuos con hemiparesia, algo que podrá contribuir para la determinación de la mejor estrategia a fin de colocar a los individuos en la zona-meta de un ejercicio dirigido a perfeccionar las condiciones cardiorrespiratorias. MÉTODOS: Participaron 13 individuos adultos de ambos sexos (53,7 ± 13,5 años) con secuela de AVE crónica (38,5 ± 31,2 meses de acometimiento). Estas personas hicieron la tarea de AT en la estera, en velocidades confortable y máxima, repitiendo los procedimientos en velocidades idénticas durante el AD. Se utilizó una ANOVA factorial para comprobar el efecto del sentido (AD y AT) y de la velocidad (confortable y máxima) sobre la FC y la PSE. RESULTADOS: La FC fue mayor durante el AT en las dos velocidades, siendo esta incrementada con el aumento de la velocidad (p < 0,01 para todas las comparaciones). De la misma forma, la PSE fue más alta durante el AT en las dos velocidades, siendo incrementada con el aumento de la velocidad (p < 0,01 para todas las comparaciones). CONCLUSIÓN: Andar para atrás es una actividad física más intensa que andar para adelante en una misma velocidad para individuos con hemiparesia. Los hallazgos sugieren que esta actividad podría ser una alternativa en la realización de programas con énfasis en el condicionamiento cardiopulmonar y como complemento de otros procedimientos en la reeducación del andar después de AVE.