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1.
Top Stroke Rehabil ; : 1-9, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32772828

RESUMO

INTRODUCTION: Poor trunk control after stroke can impact recovery of global functional abilities. Therefore, the aim of this study was to evaluate whether clinical and functional data from stroke participants can be used to predict trunk control at 90 days. METHODS: This is a prospective study of 37 participants with stroke. The variables evaluated at hospital discharge were stroke severity (National Institute of Health Stroke Scale - NIHSS); functional capacity (modified Rankin scale - mRS); handgrip; and cognitive function. At 90 days, the variables evaluated were autonomy (Functional Independence Measure - FIM, Barthel Index); gait mobility (Tinetti mobility test -TMT); quality of life (European Quality of Life Scale - EuroQol-5D) and trunk control (trunk impairment scale - TIS). The participants were considered to have satisfactory (TIS³14) or non-satisfactory trunk control (TIS≤13), and the differences between them were assessed by chi-square test (categorical variables) and Mann-Whitney/unpaired t-test (continuous variables). A ROC curve was used to show cut-off value of clinical variables to predict trunk control. RESULTS: The unsatisfactory trunk control group presented ahigher NIHSS at discharge (p=0.01), higher mRS at discharge (p=0.00), lower Barthel Index at 90 days (p=0.03), lower FIM at 90 days (p=0.01) and lower TMT at 90 days (p=0.00) than the satisfactory trunk control group. The best cut-off points for the NIHSS and mRS scores at discharge for predicting unsatisfactory trunk control are ≥6 and ≥3, respectively. CONCLUSION: Greater NIHSS and mRS scores at hospital discharge increase the chance of unsatisfactory trunk control at 90 days after stroke.

2.
J Mot Behav ; : 1-8, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32573359

RESUMO

To assess indirectly the effects of virtual reality (VR) immersion on postural sway in thirteen healthy individuals. The ellipse sway area was recorded with an accelerometer coupled to an electrical shuttle balance under six conditions, varying Romberg and single leg stance (SLS) position with eyes open and eyes closed. The length of the ellipse traveled over 10 s was measured and Romberg and single leg stance (SLS) ratios were calculated. Ellipse sway area was reduced in all positions after VR intervention. Statistical differences were observed in the left SLS ratio 24 hr after comparison to the baseline. A single VR session could reduce ellipse sway area and decrease the visual dependency of posture control indicating increased ability to maintain stable body sway over the shuttle.

3.
Somatosens Mot Res ; 37(4): 245-251, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32597273

RESUMO

PURPOSE: Some studies have explored the relationship between music and cortical activities; however, there are just few studies investigating guitar performance associated with different sensory stimuli. Our aim was to evaluate alpha and beta activity during guitar playing. MATERIALS AND METHOD: Twenty healthy right-handed people participated in this study. Cortical activity was measured by electroencephalogram (EEG) during rest and 4 tasks (1: easy music with an auditory stimulus; 2: easy music with an audiovisual stimulus; 3: complex music with an auditory stimulus; 4: complex music with an audiovisual stimulus). The peak frequency (PF), median frequency (MF) and root mean square (RMS) of alpha and beta EEG signals were assessed. RESULTS: A higher alpha PF at the T3-P3 was observed, and this difference was higher between rest and task 3, rest and task 4, tasks 1 and 3, and tasks 1 and 4. For beta waves, a higher PF was observed at C4-P4 and a higher RMS at C3-C4 and O1-O2. At C4-P4, differences between rest and tasks 2 and 4 were observed. The RMS of beta waves at C3-C4 presented differences between rest and task 3 and at O1-O2 between rest and task 2 and 4. CONCLUSION: The action observation of audiovisual stimuli while playing guitar can increase beta wave activity in the somatosensory and motor cortexes; and increase in the alpha activity in the somatosensory and auditory cortexes and increase in the beta activity in the bilateral visual cortexes during complex music execution, regardless of the stimulus type received. Abbreviations: bpm: beats per minute; C: central; EEG: electroencephalogram; F: frontal; Hz: hertz; LABCOM: Laboratory of Motor Control and Biomechanics; MD: mean difference; MF: median frequency; O: occipital; P: parietal; PF: peak frequency; R: rest; RMS: root mean square; T: temporal; T1: task 1; T2: task 2; T3: task 3; T4: task 4; UFTM: Federal University of Triângulo Mineiro.

4.
Clinics (Sao Paulo) ; 75: e1468, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401966

RESUMO

OBJECTIVE: Unilateral spatial neglect (USN) results in a consistent and exaggerated spatial asymmetry in the processing of information about the body or space due to an acquired brain injury. There are several USN tests for clinical diagnosis, but none of them are validated in Brazil. The aim was to obtain normative values from a healthy sample in Brazil and to evaluate the effects of demographic variables on USN tests. METHODS: This was a cross-sectional study performed with 150 neurologically healthy individuals. USN was evaluated using the line cancelation (LC), star cancelation (SC), and line bisection (LB) tests in the A3 (29.7 x 42.0 cm) sheet format. RESULTS: In LC, 143 participants had 0 omissions, and the occurrence of failure was significantly associated with aging (OR=1.1[1.02-1.2]; p=0.012). In SC, 145 participants had fewer than 1 omission, and the occurrence of failure was significantly associated with aging (OR=1.07[1.03-1.11]; p<0.001). In LB, deviations were the lowest for those with the highest level of education (r=0.20; p=0.015), and the deviation was 9.5 mm. CONCLUSION: The cutoff points presented in this study may be indicative of USN, but due to performance differences based on age, we suggest using different norm scores for different age groups. These norm scores can be used in the clinic immediately for USN diagnosis.


Assuntos
Transtornos da Percepção , Adolescente , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Adulto Jovem
5.
Arq. neuropsiquiatr ; 78(3): 158-162, Mar. 2020. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1098072

RESUMO

Abstract Ischemic stroke is a common cause of death. The role of statins in the secondary prevention of the chronic ischemic stroke phase has been established. However, evidence regarding their efficacy in this phase is limited and contradictory. Objective: To evaluate the association between statin use and mortality risk during the acute phase of ischemic stroke in patients admitted to an intensive care unit. Methods: This was an observational and prospective study of ischemic stroke patients aged ≥18, admitted to an intensive care unit. Medications used during the first 7 days after the ictus, as well as medications used previously, were recorded. The primary outcome was all-cause mortality during the first 7 days. Results: We screened 212 patients and included 97 patients with ischemic stroke in the study period. The mortality rate among patients who used statins during the acute IS phase [14% (9/63)] was significantly lower than that among patients who did not use statins [41% (14/34); p=0.007]. This was confirmed in logistical regression with an 0.19 Odds Ratio - OR [p=0.018; 95% confidence interval - 95%CI 0.05-0.75]. Patients who died were older, had a higher incidence of acute myocardial infarction, higher scores on the NIHSS and lower systolic blood pressure. Statins and angiotensin converting enzyme inhibitors were used more frequently among survivors. These associations persisted even after adjustment for confounding variables. Conclusion: Statins and angiotensin converting enzyme inhibitors use during hospitalization were independently associated to a lower rate of all-cause mortality in the first 7 days of intensive care unit admission.


Resumo O acidente vascular cerebral (AVC) isquêmico é uma causa comum de morte. O papel das estatinas na prevenção secundária da fase crônica do AVC isquêmico foi estabelecido. No entanto, as evidências sobre a sua eficácia na fase aguda do AVC isquêmico são limitadas e contraditórias. Objetivo: Avaliar a associação entre o uso de estatinas e o risco de mortalidade durante a fase aguda do AVC isquêmico em pacientes internados em uma unidade de terapia intensiva. Métodos: Estudo observacional e prospectivo de pacientes com AVC isquêmico com idade ≥18 anos, internados em uma unidade de terapia intensiva. Os medicamentos utilizados durante os primeiros 7 dias após o ictus, bem como os medicamentos utilizados anteriormente, foram registrados. O desfecho primário foi mortalidade por todas as causas durante os primeiros 7 dias. Resultados: Foram selecionados 212 pacientes e incluídos 97 pacientes com AVC isquêmico no período do estudo. A taxa de mortalidade entre os pacientes que usaram estatinas durante a fase aguda do AVC [14% (9/63)] foi significativamente menor do que a dos pacientes que não usaram estatinas [41% (14/34); p=0,007]. Isso foi confirmado na regressão logística com Odds Ratio - OR 0,19 [p=0,018; intervalo de confiança de 95% - IC95% 0,05-0,75]. Os pacientes que morreram eram mais velhos, apresentavam maior incidência de infarto agudo do miocárdio, escores mais altos na National Institute of Health Stroke Scale (NIHSS) e menor pressão arterial sistólica. Estatinas e inibidores da enzima conversora de angiotensina foram utilizados com maior frequência entre os sobreviventes. Essas associações persistiram mesmo após o ajuste para variáveis de confundimento. Conclusão: O uso de estatinas e inibidores da enzima conversora de angiotensina durante a hospitalização foram associados de forma independente à uma menor taxa de mortalidade por todas as causas nos primeiros 7 dias de internação na unidade de terapia intensiva.

6.
Arq Neuropsiquiatr ; 78(3): 158-162, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32215458

RESUMO

Ischemic stroke is a common cause of death. The role of statins in the secondary prevention of the chronic ischemic stroke phase has been established. However, evidence regarding their efficacy in this phase is limited and contradictory. OBJECTIVE: To evaluate the association between statin use and mortality risk during the acute phase of ischemic stroke in patients admitted to an intensive care unit. METHODS: This was an observational and prospective study of ischemic stroke patients aged ≥18, admitted to an intensive care unit. Medications used during the first 7 days after the ictus, as well as medications used previously, were recorded. The primary outcome was all-cause mortality during the first 7 days. RESULTS: We screened 212 patients and included 97 patients with ischemic stroke in the study period. The mortality rate among patients who used statins during the acute IS phase [14% (9/63)] was significantly lower than that among patients who did not use statins [41% (14/34); p=0.007]. This was confirmed in logistical regression with an 0.19 Odds Ratio - OR [p=0.018; 95% confidence interval - 95%CI 0.05-0.75]. Patients who died were older, had a higher incidence of acute myocardial infarction, higher scores on the NIHSS and lower systolic blood pressure. Statins and angiotensin converting enzyme inhibitors were used more frequently among survivors. These associations persisted even after adjustment for confounding variables. CONCLUSION: Statins and angiotensin converting enzyme inhibitors use during hospitalization were independently associated to a lower rate of all-cause mortality in the first 7 days of intensive care unit admission.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/mortalidade , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Medicine (Baltimore) ; 98(39): e17317, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574862

RESUMO

INTRODUCTION: Stroke is the principal cause of impairment in the motor function and gait of adults. One of the resources used in rehabilitation to optimize gait is a prescription of ankle-foot orthosis (AFO), and the most prescribed AFOs are Fixed AFO and Articulated AFO; however, it is not known which of these options is more effective for these individuals. The aim of this study is to evaluate the impact of different types of ankle-foot orthosis functional mobility and dynamic balance in stroke patients. METHODS: Prospective randomized controlled clinical trial with 2 parallel groups will be conducted, and the aim is to recruit 50 patients with stroke diagnosis within 1 year, who indicated that they use both types of orthotics, who had a previous Rankin score less than or equal to 3, and who obtained AFO orthosis through the Hospital Clinics at the Botucatu Medical School (HCBMS) São Paulo, Brazil. After a specific evaluation by a physiotherapist, the patient will receive 1 of the AFO types via randomization. After 30 days, the patient will be reevaluated. The primary outcomes will be balance and mobility, which will be evaluated by the Time Up Go Test (TUG) and Tinetti's Scale of Mobility and Balance (TSMB). The secondary outcomes will be quality of life and the levels of anxiety and depression, which will be evaluated with the European (5D) Quality of Life Scale (Euroqol) and Hospital Anxiety and Depression Scale (HADS). Group allocation will be not concealed because the blinding of participants and of therapists that provide intervention is not possible, and all analyses will be based on an intention-to-treat principle. This study was approved by the Human Research Ethics Committee of the São Paulo State University UNESP, number 2.367.953. The results will be published in relevant journal. DISCUSSION: The results of this study will contribute to clinical practice by identifying the type of AFO orthosis that is more suitable for this condition, helping to standardize prescription of these orthoses by professionals, and guiding future research studies on this subject, which is still incompletely defined in the literature. TRIAL REGISTRATION: RBR-6SF2VV (March 5, 2018).


Assuntos
Tornozelo/fisiopatologia , Órtoses do Pé/normas , Transtornos Neurológicos da Marcha , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Adulto , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Desenho de Equipamento , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Masculino , Equilíbrio Postural , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/psicologia
8.
Fisioter. Pesqui. (Online) ; 26(3): 311-321, jul.-set. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1039895

RESUMO

ABSTRACT The objective of this study is to evaluate the effects of physical therapy on the cognitive and functional capacity of patients with Alzheimer's Disease (AD). This is a systematic review of randomized or quasi-randomized clinical trials, using the descriptors: AD, dementia and physical therapy. Two studies were included with a total of 207 participants. In study 1, no statistically significant difference was found on the mini-mental state examination (MMSE) (MD 0.0, 95%CI −5.76 to 5.76), neuropsychiatric inventory (MD −4.50, 95%CI −21.24 to 12.24) and Pfeffer instrumental activities questionnaire (MD 0.0 95%CI −6.48 to 6.48). In study 2, there was no statistically significant difference on the MMSE (MD −1.60, 95% CI −3.57 to 0.37), clock-drawing test (MD −0.20, 95%CI −0.61 to 0.21) and Alzheimer's Disease Assessment Scale - cognitive subscale (MD 1.0, 95%CI −2.21 to 4.21) after 12 months. There was no consistent evidence on the effectiveness of physiotherapeutic intervention in improving cognitive function and functional capacity of patients with AD. More studies should be conducted for better evidence.


RESUMO O objetivo do estudo é avaliar os efeitos da fisioterapia na capacidade cognitiva e funcional de pacientes com doença de Alzheimer (DA). Trata-se de revisão sistemática de ensaios clínicos randomizados ou quasi-randomizados utilizando os descritores: DA, demência e fisioterapia. Dois estudos foram incluídos, com um total de 207 participantes. No Estudo 1, não houve diferença estatisticamente significativa no miniexame do estado mental (MEEM) (MD 0,0, IC 95% 5,76−5,76), inventário neuropsiquiátrico (MD −4,50, IC 95% 12,24−21,24) e questionário de atividades instrumentais Pfeffer (MD 0,0 IC 95% −6,48 a 6,48). No Estudo 2, não houve diferença estatisticamente significativa no MEEM (MD −1,60, IC 95% −3,57 a 0,37), teste do desenho do relógio (MD −0,20, IC95% −0,61 a 0,21) e escala de avaliação da doença de Alzheimer - subitem cognição (MD 1,0, IC95% −2,21 a 4,21) após 12 meses. Não houve evidência consistente da eficácia da intervenção fisioterapêutica na melhora da função cognitiva e capacidade funcional na DA. Recomenda-se a produção de mais estudos para encontrar possíveis evidências.


RESUMEN El presente estudio tiene como objetivo evaluar los efectos de la fisioterapia en la capacidad cognitiva y funcional de pacientes con enfermedad de Alzheimer (EA). Se trata de una revisión sistemática de ensayos clínicos aleatorizados o casi-aleatorizados, en que se utilizó los descriptores: EA, demencia y fisioterapia. Se incluyeron dos estudios, con un total de 207 participantes. En el Estudio 1, no hubo diferencias estadísticamente significativas en el Miniexamen del estado mental (MEEM) (MD 0,0, IC 95%: 5,6 -5,76), en el inventario neuropsiquiátrico (MD -4,50, IC 95%: 12,24 -21,24) y en el cuestionario de actividades instrumentales de Pfeffer (MD: 0,0 IC 95% IC: -6,48 a 6,48). En el Estudio 2, no hubo diferencias estadísticamente significativas en el MEEM (MD −1,60, IC 95% −3,57 a 0,37), el test de diseño del reloj (MD −0,20, IC 95% −0,61 a 0,21) y la escala de evaluación de la enfermedad de Alzheimer: subítem de cognición (MD 1,0, IC 95% −2,21 a 4,21) tras 12 meses. No hubo evidencia consistente de la eficacia de la intervención fisioterapéutica en la mejora de la función cognitiva y de la capacidad funcional en la EA. Se recomienda realizar estudios adicionales para encontrar posibles evidencias.


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Modalidades de Fisioterapia , Doença de Alzheimer/psicologia , Doença de Alzheimer/terapia , Desempenho Psicomotor , Atividades Cotidianas , Resultado do Tratamento , Cognição
9.
Top Stroke Rehabil ; 26(7): 511-517, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31230583

RESUMO

Background: Upper extremity impairment is present in most of people with stroke. The use of the affected upper extremity can be impacted not only by physical impairment but also by abehavioral phenomenon called learned nonuse. Objective: The aim of this study was to evaluate which clinical factors in the acute phase are associated with the development of learned nonuse in the upper extremity after stroke. Methods: This cohort study included 38 patients with ischemic stroke. Hospital discharge data were collected for clinical aspects, scales of severity, incapacity and autonomy, as well as for neuromuscular and sensory evaluations. At 90 days after hospital discharge, the score on the Motor Activity Log scale for detecting learned nonuse was obtained, and life quality was evaluated by the EuroQol. The individuals with and without learned nonuse were compared by attest for univariate analysis, and ageneralized linear model was employed to find possible predictors, which were considered significant p <0.05. Results: In the statistical model, age (p= .006), severity at discharge (p= .036), handgrip strength (p= .000), altered sensitivity (p= .011), incapacity at discharge (p= .009) and autonomy at discharge (p= .011) were found to be associated with learned nonuse. In relation to quality of life, mobility, personal care, usual activities, anxiety, depression and perception had lower mean values in the learned nonuse group. Conclusion: Age, severity of stroke, incapacity and neuromuscular and sensory compromises are associated with upper extremity learned nonuse in stroke patients.

10.
Arq Neuropsiquiatr ; 77(5): 315-320, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31188994

RESUMO

OBJECTIVE: Embolic stroke of undetermined source (ESUS) is an important group of cryptogenic strokes that are in evidence due recent ongoing trials. We reviewed medical records at discharge from the stroke unit of all patients who met ESUS criteria and attended our institution between February 2016 and July 2017. Among 550 stroke patients, 51 had ESUS. We found that hypertension (60%), diabetes mellitus (34%), and smoking (36%) were the most prevalent risk factors. The mean National Institutes of Health Stroke Scale (NIHSS) scores were 7 at admission and 4 at discharge, while median scores on the modified Rankin scale were 0 and 2 at admission and discharge, respectively. Our sample had similar ages, risk factors prevalence and NIHSS scores at admission and discharge when compared with European and North American cohorts. Although a small cohort, our study suggests that the ESUS population is similar in countries with different health financing.


Assuntos
Hospitais Universitários/estatística & dados numéricos , Embolia Intracraniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Prevalência , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas
11.
Arq. neuropsiquiatr ; 77(5): 315-320, Jun. 2019. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1011335

RESUMO

ABSTRACT Embolic stroke of undetermined source (ESUS) is an important group of cryptogenic strokes that are in evidence due recent ongoing trials. We reviewed medical records at discharge from the stroke unit of all patients who met ESUS criteria and attended our institution between February 2016 and July 2017. Among 550 stroke patients, 51 had ESUS. We found that hypertension (60%), diabetes mellitus (34%), and smoking (36%) were the most prevalent risk factors. The mean National Institutes of Health Stroke Scale (NIHSS) scores were 7 at admission and 4 at discharge, while median scores on the modified Rankin scale were 0 and 2 at admission and discharge, respectively. Our sample had similar ages, risk factors prevalence and NIHSS scores at admission and discharge when compared with European and North American cohorts. Although a small cohort, our study suggests that the ESUS population is similar in countries with different health financing.


RESUMO Acidentes vasculares cerebrais (AVC) embólicos de fonte indeterminada (ESUS) é um grupo importante de pacientes com AVC criptogênico que estão em evidência devido a recentes ensaios clínicos. Foram revisados os prontuários médicos na alta da unidade de AVC de todos os pacientes que preencheram os critérios para ESUS atendidos em nossa instituição entre fevereiro de 2016 e julho de 2017. Entre 550 AVCs, 51 eram pacientes com ESUS. Hipertensão (60%), diabetes mellitus (34%) e tabagismo (36%) foram os fatores de risco mais prevalentes. Os escores médios do National Institutes of Health Stroke Scale (NIHSS) foram 7 na admissão e 4 na alta, enquanto os escores médios na escala de Rankin modificada (mRs) foram 0 e 2 na admissão e alta, respectivamente. Nossa amostra teve idade, prevalência de fatores de risco, escores NIHSS na admissão e alta, quando comparados com coortes europeias e norte-americanas semelhantes. Apesar de ser uma pequena coorte, nosso estudo sugere que a população ESUS é semelhante em países com diferentes níveis de financiamento em saúde.

12.
Trials ; 20(1): 298, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138281

RESUMO

BACKGROUND: Cardiovascular rehabilitation is one of the treatment options for post-stroke individuals in order to improve functional independence in activities of daily life and reduce energy expenditure. The aim of this trial is to evaluate the effect of an exercise program on the echocardiographic variables, functional capacity, inflammatory response, neurological status, nutritional status, cardiologic evaluation, and quality of life of patients after stroke. METHODS/DESIGN: This is a randomized controlled trial including patients with ischemic stroke in the chronic phase. The patients will be evaluated at the beginning of the study and after 16 weeks. This will include clinical and physical evaluation, 6-min walk test, neurological assessment, nutritional assessment, ambulatory blood pressure monitoring, transthoracic echocardiography, and assessment of the quality of life. The sample size has been determined as 40 patients, who will be divided into two groups: control group (CG; n = 20) and intervention group (IG; n = 20). The CG will undergo conventional physiotherapy for 45 min, three times a week, up to 16 weeks, while the IG will be put on a cardiovascular rehabilitation program consisting of heating, aerobic exercise, and muscle strengthening for 45 min, three times a week, for 16 weeks. The primary endpoint will be functional capacity following a 6-min walk test (delta maxVO2) and morphofunctional echocardiographic variables (indexed left ventricular mass) before and after the intervention. DISCUSSION: We expect to observe an improvement in cardiac structural and functional abnormalities in the IG, on echocardiography and biochemical examination, and that the improvement of these parameters after cardiovascular rehabilitation will have a favorable impact on the functional capacity and quality of life of patients after stroke. TRIAL REGISTRATION: REBEC, RBR-4wk4b3. Registered on 19 September 2016.


Assuntos
Remodelamento Atrial , Isquemia Encefálica/reabilitação , Reabilitação Cardíaca/métodos , Exercício Físico , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação do Acidente Vascular Cerebral/métodos , Remodelação Ventricular , Atividades Cotidianas , Monitorização Ambulatorial da Pressão Arterial , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Masculino , Estado Nutricional , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida
13.
Dement Neuropsychol ; 13(1): 82-88, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31073383

RESUMO

The Catherine Bergego Scale (CBS) is a scale to evaluates the impact of unilateral spatial neglect (USN) on everyday life of patients after stroke. Objective: The aim of this study was to evaluate the reliability and comprehension of the Portuguese version of the CBS for patients with USN after stroke. Methods: This was a cross-sectional study in patients with stroke and USN. The CBS was translated, culturally adapted and applied by two independent investigators. The patients were also evaluated by the Behavioural Inattention Test (BIT), NIHSS, mRS and Barthel scale to assess USN severity, neurological function, disability and autonomy consecutively. Consistency and coherence were analysed using Cronbach's α, inter-observer reliability by Kappa, and the correlation between the CBS, BIT, NIHSS, mRS, and Barthel was determined using Pearson correlation. Results: Twenty-two patients were evaluated and the observed Cronbach's α=0.913. For intra-observer reproducibility, the 10 items showed a reasonable and high reliability between evaluators. The CBS showed a negative correlation with the BIT. There was a low correlation between the BIT and NIHSS, mRS and Barthel index. Conclusion: The CBS is an adequate and validated scale for assessing patients with USN after stroke in a Brazilian population.

14.
Coluna/Columna ; 18(1): 74-80, Jan.-Mar. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-984317

RESUMO

ABSTRACT The aims of this article are to present cervical spondylotic myelopathy, a spinal condition caused by bony, ligament and disc alterations that results in spinal cord compression leading to progressive degeneration of the spinal cord, and to describe the possible physiotherapeutic interventions. The pathology has different forms of progression and affected areas, which contributes to the diversity of clinical presentations. This work presents two evaluations of three patients diagnosed with this disease, at different times, to compare the severity, the affected regions, and the evolution of each one. Subsequently, it describes the most appropriate physiotherapeutic treatment for this illness, demonstrating its wide variability according to the signs and symptoms presented. Level of Evidence: IV. Case series.


RESUMO O objetivo deste artigo é apresentar a Mielopatia Espondilótica Cervical, uma afecção da coluna vertebral causada por alterações ósseas, ligamentares e discais, que resultam na compressão medular, desencadeando a degeneração progressiva da medula, e descrever possíveis intervenções fisioterapêuticas. A patologia tem diferentes formas de progressão e áreas de comprometimento, o que contribui com a diversidade de quadros clínicos. Serão apresentadas duas avaliações de 3 pacientes com diagnóstico desta doença, em momentos diferentes, com o intuito de comparar a gravidade, as regiões comprometidas e a evolução de cada um. Posteriormente, é descrito o tratamento fisioterapêutico mais apropriado para esta doença, demonstrando também sua grande variabilidade de acordo com os sinais e sintomas apresentados. Nível de evidência: IV Tipo de estudo: Série de casos.


RESUMEN Los objetivo de este artículo son presentar la mielopatía espondilótica cervical, una afección de la columna vertebral causada por alteraciones óseas, ligamentos y discales, que resultan en la compresión medular, desencadenando la degeneración progresiva de la médula y describir posibles intervenciones fisioterapéuticas. La patología tiene diferentes formas de progresión y áreas de compromiso, lo que contribuye a la diversidad de cuadros clínicos. Se presentarán dos evaluaciones de tres pacientes con diagnóstico de esta enfermedad en momentos diferentes con el objetivo de comparar la gravedad, las regiones comprometidas y la evolución de cada uno. Posteriormente se describe el tratamiento fisioterapéutico más apropiado para esta enfermedad, demostrando también su gran variabilidad de acuerdo con los signos y síntomas presentados. Nivel de evidencia IV. Serie de casos.


Assuntos
Humanos , Doenças da Medula Espinal/patologia , Compressão da Medula Espinal , Fisioterapia , Espondilose
15.
Dement. neuropsychol ; 13(1): 82-88, Jan.-Mar. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-989667

RESUMO

ABSTRACT: The Catherine Bergego Scale (CBS) is a scale to evaluates the impact of unilateral spatial neglect (USN) on everyday life of patients after stroke. Objective: The aim of this study was to evaluate the reliability and comprehension of the Portuguese version of the CBS for patients with USN after stroke. Methods: This was a cross-sectional study in patients with stroke and USN. The CBS was translated, culturally adapted and applied by two independent investigators. The patients were also evaluated by the Behavioural Inattention Test (BIT), NIHSS, mRS and Barthel scale to assess USN severity, neurological function, disability and autonomy consecutively. Consistency and coherence were analysed using Cronbach's α, inter-observer reliability by Kappa, and the correlation between the CBS, BIT, NIHSS, mRS, and Barthel was determined using Pearson correlation. Results: Twenty-two patients were evaluated and the observed Cronbach's α=0.913. For intra-observer reproducibility, the 10 items showed a reasonable and high reliability between evaluators. The CBS showed a negative correlation with the BIT. There was a low correlation between the BIT and NIHSS, mRS and Barthel index. Conclusion: The CBS is an adequate and validated scale for assessing patients with USN after stroke in a Brazilian population.


RESUMO: A Escala de Catherine Bergego (CBS) é uma escala para avaliar o impacto da negligência espacial unilateral (USN) no cotidiano de pacientes após AVC. Objetivo: Não há validação da CBS para população brasileira e o objetivo deste estudo foi avaliar a confiabilidade e compreensão da versão em português da CBS para pacientes com USN após AVC. Métodos: Trata-se de um estudo transversal em pacientes com AVC e USN. A CBS foi traduzida, adaptada culturalmente e aplicada por dois investigadores independentes. Os pacientes também foram avaliados pelo Behaviour Innatention Test (BIT), NIHSS, mRS e Barthel para avaliar a gravidade da USN, função neurológica, incapacidade e autonomia consecutivamente. A consistência e a coerência foram analisadas pelo coeficiente α de Cronbach, a confiabilidade interobservador foi avaliada pelo coeficiente kappa e a correlação entre o CBS, BIT, NIHSS, mRS e Barthel foi avaliada pela correlação de Pearson. Resultados: Vinte e dois pacientes foram avaliados e observaram-se consistência e coerência pelo coeficiente α de Cronbach=0,913. Na análise da reprodutibilidade intraobservador, os 10 itens da escala apresentaram confiabilidade razoável e alta entre os avaliadores. O CBS mostrou correlação negativa com o BIT. Houve baixa correlação entre BIT e NIHSS, mRS e índice de Barthel. Conclusão: A CBS é uma escala adequada e validada para avaliar pacientes com USN após AVC em uma população brasileira e de língua portuguesa.


Assuntos
Acidente Vascular Cerebral/complicações , Transtornos da Percepção , Brasil , Reprodutibilidade dos Testes
16.
Somatosens Mot Res ; 35(3-4): 199-203, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30592433

RESUMO

BACKGROUND: Unilateral spatial neglect (USN) is the prevalent feature in patients with right-sided stroke. It is diagnosed through the behavior inattention test (BIT) and has a negative impact on patients affecting both their functional capacity and quality of life. OBJECTIVE: Here, we aimed to evaluate the impact of USN on the quality of life of patients in the chronic phase of stroke. METHODS: This is a cross-sectional study with stroke patients with USN. After confirming the presence of stroke through neuroimaging examinations and of USN through the BIT, patients' quality of life was evaluated by using the EUROQOL scale. Spearman's correlation was used to validate the correlation between patients' USN and quality of life, with a p < .05 representing significant results. RESULTS: Eighteen individuals were included. When correlating the value of each domain of the EUROQOL scale with the results of the BIT, we observed a negative correlation between mobility (r = -0.97; p = .000), self-care (r = -0.82; p = .013), usual activities (r = -0.87; p = .005); pain or discomfort (r = -0.88; p = .004), anxiety or depression (r = -0.97; p = .000), and EUROQOL total score (r = -0.97, p = .000). CONCLUSION: After a correlation between the overall EUROQOL and BIT scores, we suggest that the higher the USN degree is in stroke patients, the worse their perceived quality of life tends to be.


Assuntos
Lateralidade Funcional , Transtornos da Percepção/etnologia , Transtornos da Percepção/etiologia , Qualidade de Vida/psicologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia , Idoso , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Doença Crônica , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
17.
Arq Neuropsiquiatr ; 76(10): 654-662, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30427504

RESUMO

OBJECTIVE: Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity. The aim was to evaluate the effects of VRT associated with conventional rehabilitation for an upper limb after stroke, and the neuroimaging predictors of a better response to VRT. METHODS: Patients with stroke were selected, and clinical neurological, upper limb function, and quality of life were evaluated. Statistical analysis was performed using a linear model comparing pre- and post-VRT. Lesions were segmented in the post-stroke computed tomography. A voxel-based lesion-symptom mapping approach was used to investigate the relationship between the lesion and upper limb function. RESULTS: Eighteen patients were studied (55.5 ± 13.9 years of age). Quality of life, functional independence, and dexterity of the upper limb showed improvement after VRT (p < 0.001). Neuroimaging analysis showed negative correlations between the internal capsule lesion and functional recovery. CONCLUSION: VRT showed benefits for patients with stroke, but when there was an internal capsule lesion, a worse response was observed.


Assuntos
Neuroimagem/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Terapia de Exposição à Realidade Virtual/métodos , Atividades Cotidianas , Adulto , Idoso , Feminino , Substância Cinzenta/lesões , Humanos , Cápsula Interna/lesões , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento , Extremidade Superior , Substância Branca/lesões
18.
Arq. neuropsiquiatr ; 76(10): 654-662, Oct. 2018. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-973929

RESUMO

ABSTRACT Background: Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity. The aim was to evaluate the effects of VRT associated with conventional rehabilitation for an upper limb after stroke, and the neuroimaging predictors of a better response to VRT. Methods: Patients with stroke were selected, and clinical neurological, upper limb function, and quality of life were evaluated. Statistical analysis was performed using a linear model comparing pre- and post-VRT. Lesions were segmented in the post-stroke computed tomography. A voxel-based lesion-symptom mapping approach was used to investigate the relationship between the lesion and upper limb function. Results: Eighteen patients were studied (55.5 ± 13.9 years of age). Quality of life, functional independence, and dexterity of the upper limb showed improvement after VRT (p < 0.001). Neuroimaging analysis showed negative correlations between the internal capsule lesion and functional recovery. Conclusion: VRT showed benefits for patients with stroke, but when there was an internal capsule lesion, a worse response was observed.


RESUMO Introdução: A realidade virtual (RV) é uma intervenção interativa que induz a neuroplasticidade. O objetivo deste estudo foi avaliar os efeitos da RV associado à reabilitação convencional na função do membro superior após o AVC e as características preditores de neuroimagem de melhor resposta a esta terapia. Métodos: os pacientes com AVC foram selecionados, e as características neurológicas, a função do membro superior e a qualidade de vida foram avaliadas. A análise estatística foi realizada por meio de modelo linear geral comparando resultados pré e pós-intervenção. As lesões foram segmentadas na tomografia computadorizada após o AVC. A abordagem de mapeamento da lesão-sintoma baseada em voxel foi utilizada para avaliar a relação entre a lesão e a função do membro superior. Resultados: Foram estudados 18 pacientes (8 mulheres, 55,5 ± 13,9 anos). A qualidade de vida, independência funcional, características funcionais e destreza do membro superior apresentaram melhora após RV (p < 0,001). A análise de imagem mostrou correlações negativas principalmente entre a cápsula interna e a recuperação funcional do membro superior. Conclusão: A RV mostrou benefícios para pacientes com AVC, mas quando houve lesão da cápsula interna apresentaram pior resposta à terapia.

19.
Neural Plast ; 2018: 1638763, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30050569

RESUMO

Background: Unilateral spatial neglect (USN) is the most frequent perceptual disorder after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve perception and functional capacity. Objective: To assess the impact of NIBS on USN after stroke. Methods: An extensive search was conducted up to July 2016. Studies were selected if they were controlled and noncontrolled trials examining transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and theta burst stimulation (TBS) in USN after stroke, with outcomes measured by standardized USN and functional tests. Results: Twelve RCTs (273 participants) and 4 non-RCTs (94 participants) proved eligible. We observed a benefit in overall USN measured by the line bisection test with NIBS in comparison to sham (SMD -2.35, 95% CI -3.72, -0.98; p = 0.0001); the rTMS yielded results that were consistent with the overall meta-analysis (SMD -2.82, 95% CI -3.66, -1.98; p = 0.09). The rTMS compared with sham also suggested a benefit in overall USN measured by Motor-Free Visual Perception Test at both 1 Hz (SMD 1.46, 95% CI 0.73, 2.20; p < 0.0001) and 10 Hz (SMD 1.19, 95% CI 0.48, 1.89; p = 0.54). There was also a benefit in overall USN measured by Albert's test and the line crossing test with 1 Hz rTMS compared to sham (SMD 2.04, 95% CI 1.14, 2.95; p < 0.0001). Conclusions: The results suggest a benefit of NIBS on overall USN, and we conclude that rTMS is more efficacious compared to sham for USN after stroke.


Assuntos
Transtornos da Percepção/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Humanos , Transtornos da Percepção/diagnóstico , Transtornos da Percepção/fisiopatologia
20.
Front Neurol ; 9: 256, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29720958

RESUMO

Background: The crossed leg sign in patients with right hemisphere stroke is thought to be associated with perceptual disorders, such as unilateral spatial neglect (USN). The aim of this study was to compare the crossed leg sign with the severity of USN during the acute phase of stroke. Experimental procedures: This was an observational and prospective clinical study of individuals with a diagnosis of right parietal stroke, as confirmed by neuroimaging. The occurrence of the crossed leg sign, the time at which this occurred after the stroke, and a clinical diagnosis of USN were measured and recorded. The patients' age, sex, and lesion severity, as determined by the National Institutes of Health Stroke Scale and Glasgow coma scale, were included in the analyses as confounding variables. The outcome of interest was the degree of USN, as measured by the cancellation and bisection tests. Binary logistic regression was used to analyze the effect of crossed leg syndrome on the severity of USN. In the adjusted multiple regression model, a p-value of <0.05 was considered statistically significant. Results: Overall, 60 patients were included in this study. There were no associations between patient demographics and the presence of the crossed leg sign. There was, however, an association between the crossed leg sign and the absolute value of the deviation in the line bisection test (B = -0.234; p = 0.039). The crossed leg sign was not associated with other measures of USN. Conclusion: Based on the results of our study, we can conclude that a crossed leg sign in the acute phase of stroke is associated with USN severity, specifically the misinterpretation of the midline.

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