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1.
Am J Occup Ther ; 75(1): 7501205020p1-7501205020p11, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33399050

RESUMO

IMPORTANCE: The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown. OBJECTIVE: To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke. DESIGN: Randomized, crossover-controlled, assessor-blinded study. SETTING: Rehabilitation clinic. PARTICIPANTS: Patients (N = 24) with moderate motor and sensory deficits. INTERVENTION: Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period. OUTCOMES AND MEASURES: Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes-Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability. RESULTS: RT resulted in significantly improved FMA-UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants' EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050). CONCLUSIONS AND RELEVANCE: RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke. WHAT THIS ARTICLE ADDS: The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.


Assuntos
Robótica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Mãos , Humanos , Recuperação de Função Fisiológica , Extremidade Superior
2.
Sports Health ; 13(1): 37-44, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32903164

RESUMO

CONTEXT: Plyometric training has been shown to be beneficial in adolescent overhead athletes. However, existing research on the effects of plyometrics on sport performance has been limited. OBJECTIVE: To systematically review the current literature to investigate whether plyometric training intervention improves upper- and lower-body sport performance. DATA SOURCES: Two electronic databases (MEDLINE and Web of Science) were searched using specific Medical Subject Headings (MeSH) terms up to February 2019, and hand-searching was performed by looking to relevant studies that were cited in other studies. STUDY SELECTION: A total of 932 items were identified and were further assessed for the eligibility in the systematic review. For a study to be eligible, each of the following inclusion criteria had to be met: (1) participants were aged 13 to 18 years and selected from a sports or athletic population and the study (2) involved the evaluation of a plyometric training intervention with an aim to improve sports performance; (3) must have included a control intervention and/or control group; (4) included a quantitative objective measure of sport performance variables concerning throwing, jumping, running, and sprinting; and (5) was published in English. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: A first screening was conducted based on title and abstract of the articles. In the second screening, the full text of the remaining articles was evaluated for the fulfillment of the inclusion criteria. RESULTS: A total of 14 studies were included in this review. The methodological quality of the included studies ranged from low to moderate. There is moderate evidence that plyometric training intervention improves throwing and jumping performances. There is also preliminary evidence that plyometric training intervention improves sprint performance. CONCLUSION: The current evidence suggests that sport performance consisting of throwing capacity, jumping ability, and sprint performance significantly improved due to plyometric training interventions in adolescent overhead athletes.


Assuntos
Desempenho Atlético/fisiologia , Exercício Pliométrico , Esportes Juvenis/fisiologia , Adolescente , Humanos , Extremidade Inferior/fisiologia , Corrida/fisiologia , Extremidade Superior/fisiologia
3.
Sports Health ; 13(1): 57-64, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32649842

RESUMO

CONTEXT: Evidence concerning a systematic, comprehensive injury risk assessment in the elite swimming population is scarce. OBJECTIVE: To evaluate the quality of current literature regarding clinical assessment techniques used to evaluate the presence and/or development of pain/injury in elite swimmers and to categorize objective clinical assessment tools into relevant predictors (constructs) that should consistently be evaluated in injury risk screens of elite swimmers. DATA SOURCES: PubMed, Embase, Scopus, CINAHL, SPORTDiscus, PEDro, and the Cochrane Library Reviews were searched through September 2018. STUDY SELECTION: Studies were included for review if they assessed a correlation between clinic-based objective measures and the presence and/or development of acute or chronic pain/injury in elite swimmers. All body regions were included. Elite swimmers were defined as National Collegiate Athletic Association, collegiate, and junior-, senior-, or national-level swimmers. Only cohort and cross-sectional studies were included (both prospective and retrospective); randomized controlled trials, expert opinion, and case reports were excluded, along with studies that focused on interventions, performance, or specific swim-stroke equipment or technology. STUDY DESIGN: Systematic review and qualitative analysis. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were utilized at each phase of review by 2 reviewers; a third reviewer was utilized for tie breaking purposes. Qualitative analysis was performed using the Methodological Items for Non-Randomized Studies (MINORS) assessment tool. RESULTS: A total of 21 studies assessed the presence and/or development of injury/pain in 3 different body regions: upper extremity, lower extremity, and spine. Calculated average MINORS scores for comparative (n = 17) and noncomparative (n = 4) studies were 18.1 of 24 and 10.5 of 16, respectively. Modifiable, objectively measurable injury risk factors in elite swimmers were categorized into 4 constructs: (1) strength/endurance, (2) mobility, (3) static/dynamic posture, and (4) patient-report regardless of body region. CONCLUSION: Limited evidence exists to draw specific correlations between identified clinical objective measures and the development of pain and/or injury in elite swimmers.


Assuntos
Medição de Risco/métodos , Natação/lesões , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/fisiopatologia , Força Muscular , Exame Físico , Postura , Fatores de Risco , Autorrelato , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/fisiopatologia , Extremidade Superior/lesões , Extremidade Superior/fisiopatologia
4.
Artigo em Russo | MEDLINE | ID: mdl-33340294

RESUMO

OBJECTIVE: To analyze the effectiveness of the developed technique of «3D audio-visualization¼ in restoring the motor function of the upper limb in the acute period of stroke. MATERIAL AND METHODS: The study included 20 patients in the acute period of stroke. All patients had impaired motor function of the upper limb in the form of paresis of the proximal muscle groups. The control group was enrolled according to standard methods. The treatment was well tolerated, there were no adverse effects. RESULTS: In the study group, a more complete restoration of the motor function of the upper limb is observed compared with the control group. There is also a positive effect of the proposed technique on patients in the acute period of stroke. CONCLUSION: The prospective and cost effective technique is suggested. It can be also used by the patient in the outpatient rehabilitation phase.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Paresia/etiologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Resultado do Tratamento , Extremidade Superior
7.
Cochrane Database Syst Rev ; 11: CD009645, 2020 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-33175411

RESUMO

BACKGROUND: Stroke is one of the leading causes of disability worldwide. Functional impairment, resulting in poor performance in activities of daily living (ADL) among stroke survivors is common. Current rehabilitation approaches have limited effectiveness in improving ADL performance, function, muscle strength, and cognitive abilities (including spatial neglect) after stroke, with improving cognition being the number one research priority in this field. A possible adjunct to stroke rehabilitation might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability, and hence to improve these outcomes in people after stroke. OBJECTIVES: To assess the effects of tDCS on ADL, arm and leg function, muscle strength and cognitive abilities (including spatial neglect), dropouts and adverse events in people after stroke. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase and seven other databases in January 2019. In an effort to identify further published, unpublished, and ongoing trials, we also searched trials registers and reference lists, handsearched conference proceedings, and contacted authors and equipment manufacturers. SELECTION CRITERIA: This is the update of an existing review. In the previous version of this review, we focused on the effects of tDCS on ADL and function. In this update, we broadened our inclusion criteria to compare any kind of active tDCS for improving ADL, function, muscle strength and cognitive abilities (including spatial neglect) versus any kind of placebo or control intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and risk of bias, extracted data, and applied GRADE criteria. If necessary, we contacted study authors to ask for additional information. We collected information on dropouts and adverse events from the trial reports. MAIN RESULTS: We included 67 studies involving a total of 1729 patients after stroke. We also identified 116 ongoing studies. The risk of bias did not differ substantially for different comparisons and outcomes. The majority of participants had ischaemic stroke, with mean age between 43 and 75 years, in the acute, postacute, and chronic phase after stroke, and level of impairment ranged from severe to less severe. Included studies differed in terms of type, location and duration of stimulation, amount of current delivered, electrode size and positioning, as well as type and location of stroke. We found 23 studies with 781 participants examining the effects of tDCS versus sham tDCS (or any other passive intervention) on our primary outcome measure, ADL after stroke. Nineteen studies with 686 participants reported absolute values and showed evidence of effect regarding ADL performance at the end of the intervention period (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.13 to 0.44; random-effects model; moderate-quality evidence). Four studies with 95 participants reported change scores, and showed an effect (SMD 0.48, 95% CI 0.02 to 0.95; moderate-quality evidence). Six studies with 269 participants assessed the effects of tDCS on ADL at the end of follow-up and provided absolute values, and found improved ADL (SMD 0.31, 95% CI 0.01 to 0.62; moderate-quality evidence). One study with 16 participants provided change scores and found no effect (SMD -0.64, 95% CI -1.66 to 0.37; low-quality evidence). However, the results did not persist in a sensitivity analysis that included only trials with proper allocation concealment. Thirty-four trials with a total of 985 participants measured upper extremity function at the end of the intervention period. Twenty-four studies with 792 participants that presented absolute values found no effect in favour of tDCS (SMD 0.17, 95% CI -0.05 to 0.38; moderate-quality evidence). Ten studies with 193 participants that presented change values also found no effect (SMD 0.33, 95% CI -0.12 to 0.79; low-quality evidence). Regarding the effects of tDCS on upper extremity function at the end of follow-up, we identified five studies with a total of 211 participants (absolute values) without an effect (SMD -0.00, 95% CI -0.39 to 0.39; moderate-quality evidence). Three studies with 72 participants presenting change scores found an effect (SMD 1.07; 95% CI 0.04 to 2.11; low-quality evidence). Twelve studies with 258 participants reported outcome data for lower extremity function and 18 studies with 553 participants reported outcome data on muscle strength at the end of the intervention period, but there was no effect (high-quality evidence). Three studies with 156 participants reported outcome data on muscle strength at follow-up, but there was no evidence of an effect (moderate-quality evidence). Two studies with 56 participants found no evidence of effect of tDCS on cognitive abilities (low-quality evidence), but one study with 30 participants found evidence of effect of tDCS for improving spatial neglect (very low-quality evidence). In 47 studies with 1330 participants, the proportions of dropouts and adverse events were comparable between groups (risk ratio (RR) 1.25, 95% CI 0.74 to 2.13; random-effects model; moderate-quality evidence).  AUTHORS' CONCLUSIONS: There is evidence of very low to moderate quality on the effectiveness of tDCS versus control (sham intervention or any other intervention) for improving ADL outcomes after stroke. However, the results did not persist in a sensitivity analyses including only trials with proper allocation concealment. Evidence of low to high quality suggests that there is no effect of tDCS on arm function and leg function, muscle strength, and cognitive abilities in people after stroke. Evidence of very low quality suggests that there is an effect on hemispatial neglect. There was moderate-quality evidence that adverse events and numbers of people discontinuing the treatment are not increased. Future studies should particularly engage with patients who may benefit the most from tDCS after stroke, but also should investigate the effects in routine application. Therefore, further large-scale randomised controlled trials with a parallel-group design and sample size estimation for tDCS are needed.


Assuntos
Atividades Cotidianas , Reabilitação do Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua , Adulto , Idoso , Viés , Transtornos Cognitivos/reabilitação , Intervalos de Confiança , Feminino , Humanos , Extremidade Inferior/fisiologia , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Força Muscular , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Transtornos da Percepção/reabilitação , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Extremidade Superior/fisiologia
8.
BMC Cancer ; 20(1): 1074, 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33167921

RESUMO

BACKGROUND: Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema. METHODS: Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II). RESULTS: Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat. DISCUSSION: It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations. LIMITATIONS: The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation. TRIAL REGISTRATION: This trial was registered in ClinicalTrials.gov ( NCT03762044 ). Date of registration: 23 November 2018. Prospectively Registered.


Assuntos
Linfedema Relacionado a Câncer de Mama/reabilitação , Modalidades de Fisioterapia , Linfedema Relacionado a Câncer de Mama/terapia , Bandagens Compressivas , Edema/reabilitação , Terapia por Exercício , Feminino , Humanos , Drenagem Linfática Manual , Massagem , Método Simples-Cego , Resultado do Tratamento , Extremidade Superior
11.
J Vasc Interv Radiol ; 31(12): 2066-2072, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33127247

RESUMO

PURPOSE: To retrospectively evaluate the technical and clinical outcomes of superior vena cava (SVC) stent placement through upper-limb venous access in malignant SVC syndrome (SVCS) and compare the efficacy of different nitinol stent types. MATERIALS AND METHODS: Between 2006 and 2018, 156 patients (132 male; mean age, 62 y; age range, 33-81 y) underwent SVC stent placement for malignant obstructions through upper-limb venous access with 1 of 3 types of nitinol stent: 1 venous-dedicated (Sinus-XL stent) and 2 non-venous-dedicated (E-Luminexx Vascular Stent and Protégé GPS). Cases of common femoral vein access or non-nitinol stents were excluded from further analysis. The mean duration of follow-up was 8 mo. RESULTS: Technical success was achieved in 99.3% of cases. One patient died during the procedure as a result of cardiac tamponade. Balloon predilation was performed in 10 patients and postdilation in 126. Mean procedural time was 34.4 min (range, 18-80 min). Overall survival rates were 92.3%, 57.3%, and 26.8%, and overall primary patency rates were 94.5%, 84.8% and 79.6%, at 1, 6, and 12 mo, respectively. There were no statistically significant differences in primary patency rates between venous- and non-venous-dedicated stents or among different Stanford SVCS grading groups (P > .05). CONCLUSIONS: SVC stent placement through an upper-limb approach is a safe, fast, and effective technique. There is no evident benefit of venous-dedicated vs non-venous-dedicated stents in the treatment of malignant SVCS.


Assuntos
Angioplastia com Balão/instrumentação , Cateterismo Periférico , Neoplasias/complicações , Stents , Síndrome da Veia Cava Superior/terapia , Extremidade Superior/irrigação sanguínea , Veia Cava Superior , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligas , Angioplastia com Balão/efeitos adversos , Cateterismo Periférico/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Desenho de Prótese , Sistema de Registros , Estudos Retrospectivos , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/fisiopatologia
12.
BMC Neurol ; 20(1): 365, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023487

RESUMO

BACKGROUND: Transcranial magnetic stimulation (TMS) treatments have shown promise in improving arm recovery in stroke patients. Currently, little is known about patients' experiences with repetitive TMS treatment, and this lack of knowledge may affect optimal implementation in clinical practice. The aim of this explorative study was to gain insight in the perceived effects and experiences of the design and delivery of a rTMS treatment for upper limb recovery from the perspectives of stroke patients. METHODS: This qualitative study was conducted as part of a randomized controlled trial (RCT) in a specialized rehabilitation center. Data were collected through face-to-face semi-structured interviews with 13 stroke patients who completed a 10-day rTMS intervention for upper limb recovery. The interviews were recorded, transcribed verbatim and analyzed using thematic analysis. RESULTS: The major themes that emerged from the patients' feedback were the following: positive experiences of the treatment (experienced physical effects, comfort, therapeutic relationship, receiving information, learning about the brain, no burden of added rTMS treatment session, no unpleasant aspects), concerns (effects of stimulation of the brain, equipment, logistics), general experience of recovery, experienced psychological effects (grateful, sense of purpose, recovery as extra motivation to exercise, disappointment and hope of group allocation), and motivation to participate (personal benefit and cognitions, altruism). Important components related to the positive experience of the design and delivery of the treatment included comfort (i.e. moment of relaxation) and the sensation of a painless treatment without side-effects. Key concerns included uncertainty and anxiety about possible negative consequences and group allocation. CONCLUSIONS: This study demonstrates that rTMS is well accepted by stroke patients with an upper limb paresis. Besides the expectation of a therapeutic benefit, the patients reported various psychological effects. Positive experiences, such as the provision of a short moment of relaxation each day, could have practical implications for clinical stroke rehabilitation settings aimed at improving patient satisfaction. Explanation about and feedback from routine motor recovery progression monitoring at fixed times post-stroke is also valued by patients. Negative emotions may be limited or avoided by transparent and recurrent information delivery in future trials.


Assuntos
Satisfação do Paciente , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Magnética Transcraniana/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/reabilitação , Acidente Vascular Cerebral/complicações , Extremidade Superior
13.
Angiol Sosud Khir ; 26(3): 185-190, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063767

RESUMO

The article deals with the relevant literature data concerning diagnosis and treatment of subclavian artery aneurysms. This nosological entity is relatively uncommon, however its importance for modern medicine should not be underestimated. Despite a low incidence of the pathology, it should be understood that the disease's course for the patient is associated with the development of severe complications which may lead to disability or even death. The development of complications is extremely difficult to predict and stratification of risks for such patients is too complicated. It is also known that the diagnosis of a subclavian artery aneurysm is frequently an accidental finding, since the pathology may for a long time proceed symptom-free. At the same time, the subclavian artery occupies the first place by the frequency of localization of upper-limb aneurysms, thus making this problem currently important. Besides, separate attention should be paid to modern methods of correction of this disease, since implementation of high-tech interventions into vascular surgery have significantly expanded the arsenal of the operating surgeon.


Assuntos
Aneurisma , Cirurgiões , Aneurisma/diagnóstico , Aneurisma/etiologia , Aneurisma/cirurgia , Humanos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Extremidade Superior
14.
J Stroke Cerebrovasc Dis ; 29(11): 105189, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066944

RESUMO

BACKGROUND: Acute cerebrovascular accident poses a threat to the health of the nation. Dynamic electric neurostimulation decreases the excitability of the receptor apparatus, optimize microcirculatory processes, analgesic and antispasmodic effects. METHODS: This article discusses the rehabilitation of 96 men and women with post-stroke spasticity, mean age of 60.51 ± 4.9 years, in the early recovery period after ischemic stroke, randomized into 4 equal groups: Group 1 received botulinum toxin therapy in combination with dynamic electric neurostimulation and basic therapy, including massage and therapeutic exercises; Group 2 -botulinum toxin therapy and basic therapy; Group 3 - dynamic electric neurostimulation and basic therapy; Group 4 - basic therapy only. Study methods included the use of the Modified Asworth Scale to assess spasticity, the Rivemead Motor Assessment test, and goniometry to assess the range of joint movements. RESULTS: During a three-week observation, it was found that the inclusion of botulinum toxin therapy and dynamic electrical neurostimulation in the standard therapy of post-stroke spasticity in patients after ischemic stroke in the early recovery period contributed to patients' recovery. CONCLUSIONS: Botulinum toxin therapy and dynamic electrical neurostimulation contributed to a more significant decrease in spasticity in the proximal and distal parts of the paretic upper extremity. It is also increased the amplitude of voluntary movements in the affected shoulder, elbow, and wrist joints, compared to the separate use of botulinum toxin therapy and dynamic electric neurostimulation as part of basic rehabilitation.


Assuntos
Inibidores da Liberação da Acetilcolina/administração & dosagem , Toxinas Botulínicas/administração & dosagem , Terapia por Estimulação Elétrica , Espasticidade Muscular/reabilitação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Extremidade Superior/inervação , Inibidores da Liberação da Acetilcolina/efeitos adversos , Idoso , Toxinas Botulínicas/efeitos adversos , Terapia Combinada , Terapia por Estimulação Elétrica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/fisiopatologia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Federação Russa , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
15.
Am J Physiol Regul Integr Comp Physiol ; 319(6): R666-R672, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33074709

RESUMO

Endoplasmic reticulum stress contributes to ischemia-reperfusion (I/R) injury in rodent and cell models. However, the contribution of endoplasmic reticulum stress in the pathogenesis of endothelial I/R injury in humans is unknown. We tested the hypothesis that compared with placebo, inhibition of endoplasmic reticulum stress via ingestion of tauroursodeoxycholic acid would prevent the attenuation of endothelium-dependent vasodilation following I/R injury. Twelve young adults (6 women) were studied following ingestion of a placebo or 1,500 mg tauroursodeoxycholic acid (TUDCA). Endothelium-dependent vasodilation was assessed via brachial artery flow-mediated dilation (duplex ultrasonography) before and after I/R injury, which was induced by 20 min of arm ischemia followed by 20 min of reperfusion. Endothelium-independent vasodilation (glyceryl trinitrate-mediated vasodilation) was also assessed after I/R injury. Compared with placebo, TUDCA ingestion increased circulating plasma concentrations by 145 ± 90 ng/ml and increased concentrations of the taurine unconjugated form, ursodeoxycholic acid, by 560 ± 156 ng/ml (both P < 0.01). Ischemia-reperfusion injury attenuated endothelium-dependent vasodilation, an effect that did not differ between placebo (pre-I/R, 5.0 ± 2.1% vs. post-I/R, 3.5 ± 2.2%) and TUDCA (pre-I/R, 5.6 ± 2.1% vs. post-I/R, 3.9 ± 2.1%; P = 0.8) conditions. Similarly, endothelium-independent vasodilation did not differ between conditions (placebo, 19.6 ± 4.8% vs. TUDCA, 19.7 ± 6.1%; P = 0.9). Taken together, endoplasmic reticulum stress does not appear to contribute to endothelial I/R injury in healthy young adults.


Assuntos
Artéria Braquial/fisiopatologia , Estresse do Retículo Endoplasmático , Endotélio Vascular/fisiopatologia , Traumatismo por Reperfusão/fisiopatologia , Extremidade Superior/irrigação sanguínea , Vasodilatação , Adulto , Artéria Braquial/efeitos dos fármacos , Artéria Braquial/metabolismo , Estresse do Retículo Endoplasmático/efeitos dos fármacos , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Feminino , Humanos , Masculino , Distribuição Aleatória , Traumatismo por Reperfusão/sangue , Método Simples-Cego , Ácido Tauroquenodesoxicólico/administração & dosagem , Ácido Tauroquenodesoxicólico/sangue , Vasodilatação/efeitos dos fármacos , Adulto Jovem
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2881-2884, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018608

RESUMO

Lack of sensory feedback is one of the main issues contributing to lack of control and embodiment for upper-limb prostheses. Noninvasive nerve stimulation may help amputees overcome such limitations by providing a degree of somatotopic feedback, however its neural correlates have been only partly characterized so far. While the effects of median nerve stimulation have been studied, little attention has been given to ulnar nerve and bipolar stimulation, which might provide a finer modulation of the somatotopic sensation. Here, monopolar and bipolar transcutaneous electrical nerve stimulation (TENS) is repeatedly applied to the ulnar and median nerves and elicited Somatosensory Evoked Potentials (SEPs) are characterized by means of electroencephalography (EEG). Clear P50, P150 and P270 SEPs were outlined, with significantly different amplitudes between configurations. In each case scalp topographies showed a strong contralateral activation in the early phase after the stimulus onset (40-100 ms), compatible with generators in the somatosensory cortex and in accordance to previous literature on actual tactile stimuli, which gives way to a frontal-central distribution at long latencies (130-190 ms). These findings, although needing further validation with a larger pool of subjects, show that bipolar TENS could have potential applications in improving prosthesis control with tactile feedback.


Assuntos
Potenciais Somatossensoriais Evocados , Córtex Somatossensorial , Estimulação Elétrica , Humanos , Nervo Mediano , Extremidade Superior
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2981-2985, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018632

RESUMO

Decoding upper-limb movements in invasive recordings has become a reality, but neural tuning in non-invasive low-frequency recordings is still under discussion. Recent studies managed to decode movement positions and velocities using linear decoders, even developing an online system. The decoded signals, however, exhibited smaller amplitudes than actual movements, affecting feedback and user experience. Recently, we showed that a non-linear offline decoder can combine directional (e.g., velocity) and non-directional (e.g., speed) information. In this study, it is assessed if the non-linear decoder can be used online to provide real-time feedback. Five healthy subjects were asked to track a moving target by controlling a robotic arm. Initially, the robot was controlled by their right hand; then, the control was gradually switched until it was entirely controlled by the electroencephalogram (EEG). Correlations between actual and decoded movements were generally above chance level. Results suggest that information about speed was also encoded in the EEG, demonstrating that the proposed non-linear decoder is suitable for decoding real-time arm movements.


Assuntos
Eletroencefalografia , Movimento , Mãos , Humanos , Sistemas On-Line , Extremidade Superior
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3027-3030, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018643

RESUMO

The identification of specific components in EEG signals is often key when designing EEG-based brain-computer interfaces (BCIs), and a good understanding of the factors that elicit such components can be helpful when it comes to precise, energy-efficient and time-accurate actuation of exoskeletons. CNVs (Contingent Negative Variations), ERDs or ERSs (Event-Related Desynchronizations/Synchronizations) as well as ErrPs (Error-Related Potentials) are particularly important components can be identified during motor tasks and related to specific events in a Coincident Timing (CT) task. This work investigates offline EEG signals acquired during an upper limb CT task and analyzes the task protocol with the purpose of correlating the aforementioned EEG features to movement onset. CNVs and ERD/ERS were successfully identified after averaging multiple trials, and it was further concluded that complementary information about muscle activity (via EMG) as well as video tracking of arm movement play a critical role in the synchronization of EEG components with movement onset. The framework for EEG analysis presented in this paper allows for future development of a BCI on top of this CT task capable of assessing motor learning and actuating an exoskeleton to enable faster motor rehabilitation.


Assuntos
Interfaces Cérebro-Computador , Eletroencefalografia , Humanos , Movimento , Reabilitação , Extremidade Superior
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3166-3169, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018677

RESUMO

Haptic virtual environments have been used to assess cognitive and fine motor function. For tasks performed in physical environments, upper extremity movement is usually separated into reaching and object manipulation phases using fixed velocity thresholds. However, these thresholds can result in premature segmentation due to additional trajectory adjustments common in virtual environments. In this work, we address the issues of premature segmentation and the lack of a measure to characterize the spatial distribution of a trajectory while targeting an object. We propose a combined relative distance and velocity segmentation procedure and use principal component analysis (PCA) to capture the spatial distribution of the participant's targeting phase. Synthetic data and 3D motion data from twenty healthy adults were used to evaluate the methods with positive results. We found that these methods quantify motor skill improvement of healthy participants performing repeated trials of a haptic virtual environment task.


Assuntos
Movimento , Extremidade Superior , Adulto , Humanos , Destreza Motora
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3228-3231, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018692

RESUMO

Stroke survivors often experience unilateral sensorimotor impairment. The restoration of upper limb function is an important determinant of quality of life after stroke. Wearable technologies that can measure hand function at home are needed to assess the impact of new interventions. Egocentric cameras combined with computer vision algorithms have been proposed as a means to capture hand use in unconstrained environments, and have shown promising results in this application for individuals with cervical spinal cord injury (cSCI). The objective of this study was to examine the generalizability of this approach to individuals who have experienced a stroke. An egocentric camera was used to capture the hand use (hand-object interactions) of 6 stroke survivors performing daily tasks in a home simulation laboratory. The interaction detection classifier previously trained on 9 individuals with cSCI was applied to detect hand use in the stroke survivors. The processing pipeline consisted of hand detection, hand segmentation, feature extraction, and interaction detection. The resulting average F1 scores for affected and unaffected hands were 0.66 ± 0.25 and 0.80 ± 0.15, respectively, indicating that the approach is feasible and has the potential to generalize to stroke survivors. Using stroke-specific training data may further increase the accuracy obtained for the affected hand.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Dispositivos Eletrônicos Vestíveis , Mãos , Humanos , Qualidade de Vida , Extremidade Superior
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