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1.
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
2.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(4): 238-242, 2019 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-31460711

RESUMO

In order to detect freezing of gait of Parkinson's patients automatically, a system based on inertial measurement unit to detect freezing of gait for Parkinson's patients is established. The two inertial measurement units are respectively fixed on the left and right ankles of the patient to be measured, the freezing index is calculated by windowed Fourier transform, the freezing threshold is calculated based on the freezing index during normal walking, and the freezing index and the freezing threshold are compared to complete the detection of freezing of gait. The experimental results show that the number of freezing of gait occurrences in Parkinson's patients is accurately detected, and it has high sensitivity and specificity, which can assist doctors to objectively assess the patient's condition.


Assuntos
Equipamentos para Diagnóstico , Transtornos Neurológicos da Marcha , Doença de Parkinson , Equipamentos para Diagnóstico/normas , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Doença de Parkinson/complicações , Sensibilidade e Especificidade , Caminhada
3.
J Pediatr Orthop ; 39(7): 366-371, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31305380

RESUMO

BACKGROUND: Surgical lengthening of the hamstrings is often performed to correct crouch gait in children with cerebral palsy (CP). Previous studies have demonstrated the effectiveness of open hamstring lengthening (oHSL) in improving knee extension static and dynamic range of motion; however, literature regarding percutaneous hamstring lengthening (pHSL) is limited. The purpose of this study was to investigate the effect of open versus pHSL for improving crouch gait and knee function in children with CP. METHODS: This retrospective cohort study included 87 ambulatory children with CP who underwent HLS surgery with both preoperative and postoperative gait analysis (mean time, 29.4±19.9 mo after surgery) testing between 1997 and 2015. In total, 65 patients underwent oHLS surgery (mean age, 8.5±2.5 y) and 22 patients underwent pHSL surgery (mean age, 8.3±2.3 y). Lower extremity three-dimensional kinematic data were collected while subjects walked at a self-selected speed. Outcome variables for operative limbs were compared within and between groups using t tests, χ tests, and multiple regression analysis. RESULTS: Significant postoperative decreases in knee flexion at initial contact were seen for both open (Δ12.7±13.4 degrees; P<0.001) and percutaneous (Δ19.1±13.1 degrees; P<0.001) groups. Increased postoperative maximum knee extension in stance was found for both open (Δ8.2±16.8 degrees; P=0.001) and percutaneous (Δ14.4±16.5 degrees; P=0.001) groups. No significant differences between open and percutaneous groups were found when comparing postoperative changes in kinematic variables between groups after adjusting for covariates. Postoperative changes in static range of motion were similar between lengthening groups. CONCLUSIONS: pHSL is as effective as open lengthening in improving stance phase knee kinematics during gait in children with CP. This is the first study to compare the kinematic effects of open versus pHSL in the pediatric population. Percutaneous lengthening is tolerated well by patients, and as it allows for rapid rehabilitation it may be preferable to the open procedure. LEVEL OF EVIDENCE: Level III-retrospective comparative study.


Assuntos
Paralisia Cerebral/cirurgia , Transtornos Neurológicos da Marcha/cirurgia , Músculos Isquiotibiais/cirurgia , Articulação do Joelho/fisiopatologia , Tenotomia/métodos , Adolescente , Fenômenos Biomecânicos , Paralisia Cerebral/complicações , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Feminino , Marcha , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Joelho/fisiopatologia , Extremidade Inferior/fisiopatologia , Masculino , Período Pós-Operatório , Amplitude de Movimento Articular , Estudos Retrospectivos , Caminhada
4.
NeuroRehabilitation ; 44(4): 579-586, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256094

RESUMO

BACKGROUND: Gait function is known to be impaired by Parkinson's disease (PD). The effect of exercise to improve gait has been widely examined, often with special intervention. However, in clinical settings, physiotherapy rarely consists only of gait training. OBJECTIVE: To examine whether versatile physiotherapy intervention conducted in accordance with European Physiotherapy Guideline for Parkinson's Disease (EPGPD) is sufficient to increase gait speed (GS). METHODS: Participants (24) with idiopathic PD were randomly enrolled into intervention (IG) and control groups (CG) (n = 12, 7 females and 5 males in each group). Sixteen one-hour therapy sessions (twice per week) were conducted for IG. Each session focused on core areas recommended in EPGPD. Participants were assessed twice with 10 weeks between assessments. GS was calculated based on a gait test of Short Physical Performance Battery. Dominant side hip flexion and abduction range of motion (HFLEX & HABD) were measured and Freezing of Gait questionnaire (FOG) was administered. RESULTS: Versatile intervention in groups resulted in increase of GS (ES -0.9 [CI{0.1}-{0.4}] m/s) and HFLEX (ES-0.6 [CI{5.9}-{16.6°}]. FOG was reduced (ES -0.41 [CI {-2.8}{-5.5}]). Re-evaluation HABD differed between groups and indicated large ES (r = -0.5). CONCLUSIONS: Versatile physiotherapy is sufficient to improve GS, range of motion and reduce FOG.


Assuntos
Transtornos Neurológicos da Marcha/terapia , Doença de Parkinson/terapia , Modalidades de Fisioterapia , Velocidade de Caminhada/fisiologia , Idoso , Exercício/fisiologia , Terapia por Exercício/métodos , Feminino , Marcha/fisiologia , Transtornos Neurológicos da Marcha/epidemiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/epidemiologia , Doença de Parkinson/fisiopatologia , Distribuição Aleatória , Inquéritos e Questionários
5.
Z Gerontol Geriatr ; 52(4): 316-323, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31161336

RESUMO

BACKGROUND: Personal autonomy in advanced age critically depends on mobility in the environment. Geriatric patients are often not able to walk safely with sufficient velocity. In many cases, multiple factors contribute to the deficit. Diagnostic identification of single components enables a specific treatment. OBJECTIVE: This article describes the most common neurological causes of imbalance and impaired gait that are relevant for a pragmatic approach for the assessment of deficits in clinical and natural environments taking into account the physiology of balance and gait control, typical morbidities in older people and the potential of innovative assessment technologies. MATERIAL AND METHODS: Expert opinion based on a narrative review of the literature and with reference to selected research topics. RESULTS AND DISCUSSION: Common neurological causes of impaired balance and mobility are sensory deficits (reduced vision, peripheral neuropathy, vestibulopathy), neurodegeneration in disorders with an impact on movement control and motoric functions (Parkinsonian syndromes, cerebellar ataxia, vascular encephalopathy) and functional (psychogenic) disorders, particularly a fear of falling. Clinical tests and scores in laboratory environments are complemented by the assessment in the natural environment. Wearable sensors, mobile smartphone-based assessment of symptoms and functions and adopted strategies for analysis are currently emerging. Use of these data enables a personalized treatment. Furthermore, sensor-based assessment ensures that effects are measured objectively.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/terapia , Avaliação Geriátrica/métodos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Equilíbrio Postural , Idoso , Idoso de 80 Anos ou mais , Tontura/fisiopatologia , Tontura/psicologia , Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos , Doenças do Sistema Nervoso/complicações , Caminhada
6.
Dtsch Med Wochenschr ; 144(12): 799-806, 2019 06.
Artigo em Alemão | MEDLINE | ID: mdl-31212323

RESUMO

Gait disturbance and risk for falls of the elderly are a major problem for neurotologic diagnosis and treatment. Diagnostic differentiation especially in the case of acute vestibular syndrome and in cases of chronic or recurrent paroxysmal vestibular deficits is mandatory for treatment indications. Criteria for medical, surgical conservative and surgical destructive therapy as well as for vestibular rehabilitation are outlined.


Assuntos
Tontura , Transtornos Neurológicos da Marcha , Vertigem , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
7.
Rev. neurol. (Ed. impr.) ; 68(11): 468-479, 1 jun., 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-180792

RESUMO

La reunión Post-ECTRIMS se celebró por undécimo año consecutivo el pasado octubre de 2018 en Madrid, con el objetivo de analizar los avances en esclerosis múltiple destacados en el último congreso anual ECTRIMS. Fruto de esta reunión, formada por los líderes de opinión en esclerosis múltiple de ámbito nacional, se presentan dos artículos de revisión. En esta segunda parte, se incluye el creciente número de evidencias que confirman la seguridad de la exposición a los tratamientos modificadores de la enfermedad en mujeres que planifican un embarazo, y el efecto beneficioso de la lactancia, siempre y cuando la enfermedad no esté muy activa. Se abordan los datos que muestran cómo la aplicación de los criterios de McDonald de 2017 en población pediátrica ha mejorado considerablemente el diagnóstico en comparación con los criterios anteriores. En cuanto a la esclerosis múltiple progresiva, los resultados de los fármacos neuroprotectores son poco concluyentes, pero se proponen biomarcadores para mejorar la evaluación de la respuesta terapéutica. Los estudios sobre tratamientos de reparación de la mielina sugieren que la remielinización en la esclerosis múltiple es posible. De igual manera, se exponen indicios favorables sobre el trasplante de células madre hematopoyéticas, siempre que se seleccione adecuadamente a los pacientes. Por otro lado, se revisan las similitudes y diferencias de las recomendaciones de las nuevas guías de práctica clínica publicadas. Por último, los resultados positivos de la rehabilitación cognitiva y motora con el uso de las nuevas tecnologías vaticinan la incorporación sistemática de estas herramientas en el tratamiento de la enfermedad en un futuro próximo


The Post-ECTRIMS Meeting was held for the eleventh consecutive year in October 2018 in Madrid, with the aim of analysing the advances made in multiple sclerosis that were highlighted at the latest ECTRIMS annual congress. Based on the issues discussed at this meeting, attended by the nation’s foremost opinion leaders on multiple sclerosis, two review articles are presented. This second part includes the growing body of evidence confirming the safety of exposure to disease-modifying treatments in women planning a pregnancy, and the beneficial effect of breastfeeding, provided that the disease is not very active. It addresses data showing how the application of the 2017 McDonald criteria in the paediatric population has significantly improved diagnosis compared to the previous criteria. With regard to progressive multiple sclerosis, the results of neuroprotective drugs are inconclusive, but biomarkers are proposed to improve the evaluation of the therapeutic response. Studies on myelin repair treatments suggest that remyelination in multiple sclerosis is possible. Likewise, there are favourable indications for haematopoietic stem cell transplantation, provided that patients are selected appropriately. On the other hand, we also conduct a review of the similarities and differences of the recommendations in the new clinical practice guidelines. Finally, the positive results of cognitive and motor rehabilitation with the use of new technologies point to the systematic incorporation of these tools in the treatment of the disease in the near future


Assuntos
Humanos , Criança , Esclerose Múltipla/epidemiologia , Fármacos Neuroprotetores/uso terapêutico , Transplante de Células-Tronco/tendências , Resultado do Tratamento , Esclerose Múltipla/complicações , Esclerose Múltipla/reabilitação , Sociedades Médicas/normas , Farmacovigilância , Planejamento Familiar , Complicações na Gravidez , Aleitamento Materno , Transtornos Neurológicos da Marcha/reabilitação , Necessidades e Demandas de Serviços de Saúde
8.
Expert Opin Pharmacother ; 20(11): 1405-1411, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31039621

RESUMO

Background: Gait disorders are common in Parkinson's disease patients who respond poorly to dopaminergic treatment. Blockade of adenosine A2A receptors is expected to improve gait disorders. Istradefylline is a first-in-class selective adenosine A2A receptor antagonist with benefits for motor complications associated with Parkinson's disease. Research design and methods: This multicenter, open-label, single-group, prospective interventional study evaluated changes in total gait-related scores of the Part II/III Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Freezing of Gait Questionnaire (FOG-Q) in 31 Parkinson's disease patients treated with istradefylline. Gait analysis by portable gait rhythmogram was performed. Results: MDS-UPDRS Part III gait-related total scores significantly decreased at Weeks 4-12 from baseline with significant improvements in gait, freezing of gait, and postural stability. Significant decreases in MDS-UPDRS Part II total scores and individual item scores at Week 12 indicated improved daily living activities. At Week 12, there were significant improvements in FOG-Q, new FOG-Q, and overall movement per 48 h measured by portable gait rhythmogram. Adverse events occurred in 7/31 patients. Conclusions: Istradefylline improved gait disorders in Parkinson's disease patients complicated with freezing of gait, improving their quality of life. No unexpected adverse drug reactions were identified. Trial registration: UMIN-CTR (UMIN000020288).


Assuntos
Antagonistas do Receptor A2 de Adenosina/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Purinas/uso terapêutico , Antagonistas do Receptor A2 de Adenosina/efeitos adversos , Administração Oral , Idoso , Esquema de Medicação , Discinesias/etiologia , Feminino , Marcha/fisiologia , Transtornos Neurológicos da Marcha/complicações , Transtornos Neurológicos da Marcha/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Estudos Prospectivos , Purinas/efeitos adversos , Qualidade de Vida , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(20): e15706, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096519

RESUMO

RATIONALE: Anti-IgLON5 disease is a complex neurological illness which is characterized by progressive sleep and movement disorders and defined by specific autoantibodies to IgLON5. We here describe the first case of a patient with coexisting anti-IgLON5 as well as anti-γ-aminobutyric acid B (GABAB)-receptor antibodies and predominant clinical features of anti-IgLON5 disease. PATIENT CONCERNS: The patient initially presented with subacute symptoms of severe sleep disorder, gait stability, dysarthria, cognitive impairment, depressive episode and hallucinations. DIAGNOSES: The patient was diagnosed with autoimmune encephalitis, based on clinical features and positive anti-IgLON5 antibodies in serum as well as in cerebrospinal fluid and anti-GABAB-receptor antibodies in serum only. INTERVENTIONS: Initially, the patient was treated with high dosages of methylprednisolone and subsequently with plasmapheresis. Due to the lack of clinical improvement immunosuppressive treatment with intravenous cyclophosphamide was initiated. OUTCOMES: Following the first year of cyclophosphamide treatment, neurological examination revealed an improvement in gait instability, visual and acoustic hallucinations and sleep disorder. LESSONS: The case report demonstrates that anti-IgLON5 and anti-GABAB-receptor antibodies can coexist in the same patient whereas clinical leading symptoms are determined by those antibodies that were tested positive in cerebrospinal fluid.


Assuntos
Moléculas de Adesão Celular Neuronais/sangue , Moléculas de Adesão Celular Neuronais/líquido cefalorraquidiano , Encefalite/imunologia , Antagonistas de Receptores de GABA-B/sangue , Doença de Hashimoto/imunologia , Administração Intravenosa , Autoanticorpos/sangue , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etiologia , Disartria/diagnóstico , Disartria/etiologia , Encefalite/diagnóstico , Encefalite/tratamento farmacológico , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Glucocorticoides/uso terapêutico , Alucinações/diagnóstico , Alucinações/etiologia , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Plasmaferese/métodos , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/etiologia , Resultado do Tratamento
10.
Eur J Paediatr Neurol ; 23(3): 357-367, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30940509

RESUMO

BACKGROUND: Dravet Syndrome is a rare developmental and epileptic encephalopathy characterised by epileptic seizures, cognitive impairment and motor disorders. Gait is markedly impaired and could benefit from targeted intervention to improve quality of life for patient and caregivers. OBJECTIVE: To establish the state of the art regarding gait deviations in patients with Dravet Syndrome. METHODS: A systematic search was performed in Pubmed, Web of Science, Science Direct and Embase. Studies that assessed gait deviations in patients diagnosed with Dravet Syndrome using clinical observation, video gait analysis or three dimensional (3D) gait analysis and reported gait characteristics, spatiotemporal or kinematic outcomes were included. Screening, quality assessment and data extraction were performed by independent reviewers. RESULTS: Out of a total of 478 citations, nine articles were included. The total study population had an age range from 2.5 to 47 years. Three studies used clinical observation, three studies video analysis and three studies 3D gait analysis. Crouch gait was observed in about half of the population next to a variety of other gait deviations such as parkinsonian and cerebellar gait. Other findings included abnormalities in spatiotemporal parameters and kinematics, passive knee extension deficits, skeletal malalignment and neurological signs. CONCLUSIONS: A variety of gait characteristics was observed with crouch gait being the most reported gait pattern. Inconsistency in methods and findings from clinical and instrumented evaluation impede thorough understanding of the causal mechanism and evolution behind these deviations. PROSPERO REGISTRATION NUMBER: CRD42017070370.


Assuntos
Epilepsias Mioclônicas/complicações , Transtornos Neurológicos da Marcha/etiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936345

RESUMO

Leber's hereditary optic neuropathy (LHON) is a mitochondrially inherited disorder characterised by bilateral, painless visual loss which leads to severe optic atrophy. It can be associated with other conditions including multiple sclerosis (MS), movement disorders, epilepsy and cardiac arrhythmias. The association of LHON with an MS-like illness is often referred to as Harding's disease (or Harding's syndrome). We report two siblings, who both harbour the 11 778 mitochondrial DNA (mtDNA) mutation, but who manifest markedly different clinical phenotypes; a male with classical LHON and a female with an MS-like illness. LHON affects males four to five times more often than females. By contrast, Harding's disease is seen predominantly in females, in a pattern comparable to that seen in MS. The pathogenic basis behind the variation in penetrance and phenotype between genders and individual family members remains unclear.


Assuntos
Esclerose Múltipla/fisiopatologia , Atrofia Óptica Hereditária de Leber/fisiopatologia , Mutação Puntual/genética , Transtornos da Visão/etiologia , DNA Mitocondrial/genética , Família , Feminino , Transtornos Neurológicos da Marcha/genética , Transtornos Neurológicos da Marcha/fisiopatologia , Aconselhamento Genético , Humanos , Imunoterapia , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/genética , Atrofia Óptica Hereditária de Leber/diagnóstico , Atrofia Óptica Hereditária de Leber/genética , Encaminhamento e Consulta , Distúrbios da Fala/genética , Distúrbios da Fala/fisiopatologia , Resultado do Tratamento , Transtornos da Visão/genética , Transtornos da Visão/fisiopatologia
12.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(2): 306-314, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31016949

RESUMO

In this paper, the research has been conducted by the Microsoft kinect for windows v2 for obtaining the walking trajectory data from hemiplegic patients, based on which we achieved automatic identification of the hemiplegic gait and sorted the significance of identified features. First of all, the experimental group and two control groups were set up in the study. The three groups of subjects respectively completed the prescribed standard movements according to the requirements. The walking track data of the subjects were obtained straightaway by Kinect, from which the gait identification features were extracted: the moving range of pace, stride and center of mass (up and down/left and right). Then, the bayesian classification algorithm was utilized to classify the sample set of these features so as to automatically recognize the hemiplegia gait. Finally, the random forest algorithm was used to identify the significance of each feature, providing references for the diagnose of disease by ranking the importance of each feature. This thesis states that the accuracy of classification approach based on bayesian algorithm reaches 96%; the sequence of significance based on the random forest algorithm is step speed, stride, left-right moving distance of the center of mass, and up-down moving distance of the center of mass. The combination of step speed and stride, and the combination of step speed and center of mass moving distance are important reference for analyzing and diagnosing of the hemiplegia gait. The results may provide creative mind and new references for the intelligent diagnosis of hemiplegia gait.


Assuntos
Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/diagnóstico , Marcha , Hemiplegia/complicações , Algoritmos , Teorema de Bayes , Humanos , Caminhada
13.
BMJ Case Rep ; 12(4)2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30996063

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological syndrome characterised by a unique reversible pattern on imaging and total regression of clinical symptoms and signs. We describe an unusual case of PRES with isolated pontine involvement with coincidental acute ischaemic stroke in a 60-year-old man who presented with headache, unsteadiness of gait, blurred vision and elevated blood pressure. MRI scan revealed an expanded pons with diffuse T2 and Fluid attenuated Inversion Recovery (FLAIR) hyperintensities and an acute infarct in the right temporal lobe. A diagnosis of PRES was considered most likely after exclusion of other differentials and the patient was started on antihypertensive treatment as for hypertensive encephalopathy. He became asymptomatic after controlling blood pressure and the follow-up MRI scan at 3 weeks showed complete resolution of the pontine high signals which confirmed the diagnosis of PRES.


Assuntos
Anti-Hipertensivos/uso terapêutico , Transtornos Neurológicos da Marcha/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Imagem por Ressonância Magnética , Ponte/patologia , Síndrome da Leucoencefalopatia Posterior/patologia , Acidente Vascular Cerebral/patologia , Transtornos Neurológicos da Marcha/etiologia , Cefaleia/etiologia , Humanos , Hipertensão/etiologia , Isquemia , Masculino , Pessoa de Meia-Idade , Neuroimagem , Ponte/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Resultado do Tratamento
14.
Gait Posture ; 70: 389-396, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30974394

RESUMO

BACKGROUND: The mechanisms by which spasticity reductions after botulinum toxin A (BoNT) affect gait in stroke are not well understood. We systematically reviewed the effects of BoNT on spatiotemporal, kinematic, kinetic and electromyographic (EMG) measures during gait. QUESTION: What are the effects of botulinum toxin on gait mechanics in stroke patients? METHODS: Systematic search using PubMed and Web of Science. We considered all studies that reported laboratory-based and instrumented gait measures as primary or secondary outcomes to determine the effects of BoNT on walking performance in stroke populations only. Selected studies were classified and analysed based on the injection sites. RESULTS: A total of 240 articles were identified of which 22 were selected for analysis. Overall, 91% of the studies reported spatiotemporal, 64% kinematics, 23% kinetics, 32% EMG and 23% other gait measures. All but one study found significant effects of BoNT on gait measures using instrumented assessments even when clinical measures (i.e. speed) did not significantly improve. However, the majority of the studies had a high risk of bias. Overall, BoNT improved: a) dorsiflexion during stance, propulsive forces and timing and activity of more proximal musculature with injections in the plantarflexors; b) hip, knee and ankle angles and velocities, coordination and energetic cost with injections in the rectus femoris; c) segmental coordination and energetic cost when several lower limb muscles were injected; and, d) elbow and trunk angles when upper limb muscles were injected. CONCLUSION: Instrumented and laboratory measures of gait improve after BoNT injections in different muscle groups even in the absence of clinical changes.


Assuntos
Antidiscinéticos/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Transtornos Neurológicos da Marcha/tratamento farmacológico , Marcha/efeitos dos fármacos , Acidente Vascular Cerebral , Velocidade de Caminhada , Antidiscinéticos/administração & dosagem , Antidiscinéticos/farmacologia , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/farmacologia , Humanos , Injeções Intramusculares
15.
J Electromyogr Kinesiol ; 46: 63-69, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30927632

RESUMO

Ankle-foot orthosis (AFO) can improve gait in stroke patients. Addition of plantar flexion resistance (PFR) can improve the first foot rocker function. However, the effect of changing the PFR on the ankle muscle force during gait training is unclear. This study aimed to determine the effect of changing the PFR of an AFO on spatiotemporal parameters (speed, bilateral step length, and cadence), peak angle of ankle plantar flexion and knee flexion, and muscle force (tibialis anterior [TA], medial head of the gastrocnemius [MGAS], and soleus) during early stance using a musculoskeletal model. Ten healthy adult men walked under five conditions: a no-AFO condition and PFR conditions 1-4. Spatiotemporal parameters and peak joint angles during the early stance phase were measured from experimental data, with muscle force estimated from simulations of a musculoskeletal model. Increasing the PFR of the AFO decreased TA muscle force and increased MGAS muscle force but had no influence on spatiotemporal parameters and joint angles. Adjustment of the PFR modifies the muscle force around the ankle, which can maximize the effect of AFO during gait training.


Assuntos
Tornozelo/fisiopatologia , Órtoses do Pé , Marcha , Amplitude de Movimento Articular/fisiologia , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Terapia por Exercício , Pé/fisiopatologia , Transtornos Neurológicos da Marcha/fisiopatologia , Voluntários Saudáveis , Humanos , Masculino , Músculo Esquelético/fisiologia , Reabilitação do Acidente Vascular Cerebral , Caminhada/fisiologia , Adulto Jovem
16.
J Clin Neurosci ; 65: 71-76, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30902437

RESUMO

Dual-tasking studies have shown that gait automaticity in Parkinson's disease (PD) is significantly diminished. Additionally, it's well accepted that dopaminergic medication improves single-task gait. But, how dopaminergic medication influences gait automaticity in PD has not been sufficiently understood. This study was a cross-sectional design, where sixteen subjects with PD completed single- and dual-task walking for 3 min off and on medication. Gait velocity, cadence, and stride length were measured. Kinematic variables included mean, maximum, and SD angles of bilateral hip, knee, and shoulder joints. Data were analyzed with a repeated measures ANOVA and a linear mixed effects repeated measures model. Dopaminergic medication significantly increased gait velocity (p = 0.007) and stride length (p = 0.046). After controlling for gait velocity, several kinematic variables were also improved with medication. Despite medication state, dual-tasking significantly interfered with cadence (p = 0.042), stride length (p < 0.001), and some kinematic measures. Dopaminergic medication mostly increased the hip and knee joint angles, while dual-tasking primarily decreased the hip joint angles on the less PD-affected side. There was no significant interaction between medication status and task condition. The significant differences in dual-tasking between off- and on-medication states indicates that motor improvements from taking medications improved dual-tasking. However, the lack of significant interactions and secondary task effects does not support a medication-induced improvement in automaticity.


Assuntos
Transtornos Neurológicos da Marcha/etiologia , Marcha/efeitos dos fármacos , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Idoso , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Caminhada
17.
Clin Rehabil ; 33(6): 964-979, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30897960

RESUMO

OBJECTIVE: This systematic review aimed to investigate the effects of interventions intended for retraining leg somatosensory function on somatosensory impairment, and secondary outcomes of balance and gait, after stroke. DATA SOURCES: Databases searched from inception to 16 January 2019 included Cochrane Library, PubMed, MEDLINE, CINAHL, EMBASE, PEDro, PsycINFO, and Scopus. Reference lists of relevant publications were also manually searched. REVIEW METHODS: All types of quantitative studies incorporating interventions that intended to improve somatosensory function in the leg post stroke were retrieved. The Quality Assessment Tool for Quantitative Studies was used for quality appraisal. Standardised mean differences were calculated and meta-analyses were performed using preconstructed Microsoft Excel spreadsheets. RESULTS: The search yielded 16 studies, comprising 430 participants, using a diverse range of interventions. In total, 10 of the included studies were rated weak in quality, 6 were rated moderate, and none was rated strong. Study quality was predominantly affected by high risk of selection bias, lack of blinding, and the use of somatosensory measures that have not been psychometrically evaluated. A significant heterogeneous positive summary effect size (SES) was found for somatosensory outcomes (SES: 0.52; 95% confidence interval (CI): 0.04 to 1.01; I2 = 74.48%), which included joint position sense, light touch, and two-point discrimination. There was also a significant heterogeneous positive SES for Berg Balance Scale scores (SES: 0.62; 95% CI: 0.10 to 1.14; I2 = 59.05%). Gait SES, mainly of gait velocity, was not significant. CONCLUSION: This review suggests that interventions used for retraining leg somatosensory impairment after stroke significantly improved somatosensory function and balance but not gait.


Assuntos
Extremidade Inferior/fisiopatologia , Distúrbios Somatossensoriais/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Humanos , Equilíbrio Postural/fisiologia , Distúrbios Somatossensoriais/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia
18.
NeuroRehabilitation ; 44(1): 43-66, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30814368

RESUMO

BACKGROUND: During gait training in persons with central nervous system (CNS) movement disorders, virtual reality (VR) can offer added value by providing task-specific gait training in more interactive and motivating environments. OBJECTIVE: To summarize current evidence for the effectiveness of VR-enhanced gait training in persons with CNS movement disorders. METHODS: PubMed, Web of Science and CENTRAL were systematically searched for studies using VR during walking to improve gait outcomes (spatiotemporal, functional, kinematic and kinetic). Meta-analyses were performed to estimate pooled effects. RESULTS: Eighteen studies with in total 337 patients were included (12 studies with people post-stroke, 4 with multiple sclerosis, 1 with Parkinson's disease, 1 with traumatic brain injury). Spatiotemporal and functional parameters significantly improved in each population after the VR training. Compared to gait training without VR, differences in favor of VR were found for spatiotemporal and functional parameters only in people post-stroke. CONCLUSION: VR-enhanced gait training is an effective method to improve spatiotemporal and functional parameters in persons with CNS movement disorders. Current evidence supports that, in comparison to training without VR, for people post-stroke VR-enhanced gait training is more effective to improve gait function. Future research regarding other outcome measures and other CNS movement disorders is necessary.


Assuntos
Terapia por Exercício/métodos , Marcha/fisiologia , Transtornos dos Movimentos/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Terapia de Exposição à Realidade Virtual/métodos , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Humanos , Masculino , Transtornos dos Movimentos/fisiopatologia , Estudos Prospectivos
19.
Sensors (Basel) ; 19(6)2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30871253

RESUMO

Freezing of gait is one of the most debilitating symptoms of Parkinson's disease and is an important contributor to falls, leading to it being a major cause of hospitalization and nursing home admissions. When the management of freezing episodes cannot be achieved through medication or surgery, non-pharmacological methods such as cueing have received attention in recent years. Novel cueing systems were developed over the last decade and have been evaluated predominantly in laboratory settings. However, to provide benefit to people with Parkinson's and improve their quality of life, these systems must have the potential to be used at home as a self-administer intervention. This paper aims to provide a technological review of the literature related to wearable cueing systems and it focuses on current auditory, visual and somatosensory cueing systems, which may provide a suitable intervention for use in home-based environments. The paper describes the technical operation and effectiveness of the different cueing systems in overcoming freezing of gait. The "What Works Clearinghouse (WWC)" tool was used to assess the quality of each study described. The paper findings should prove instructive for further researchers looking to enhance the effectiveness of future cueing systems.


Assuntos
Marcha/fisiologia , Doença de Parkinson/fisiopatologia , Dispositivos Eletrônicos Vestíveis , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos
20.
Hum Mov Sci ; 64: 355-365, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30852469

RESUMO

This study investigated the immediate effects of auditory-motor entrainment across effector systems by examining whether Rhythmic Auditory Stimulation training of arm or finger movements would modulate gait speed. Forty-one participants with idiopathic Parkinson's Disease were randomly assigned to 3 groups. Participants in the finger-tapping group tapped in synchrony with a metronome set to 20% faster pace than the pre-training walking cadence, whereas participants in the other group were asked to swing both arms in an alternating motion in synchrony with the metronome. Participants in the control condition did not receive training. To assess gait parameters pre- and post-training, participants walked on a 14-meter flat walkway at his/her preferred walking cadence with no auditory cueing. Results indicated that there was a significant increase in gait velocity after the finger tapping training (p < .005), whereas no differences were observed in the arm swing (p = .802) and in the control conditions (p = .525). Similarly, there were significant changes in gait cadence post-training in the finger tapping group (p < .005), but not after arm swing training (p = .879) or control (p = .759). There were no significant changes in stride length post-training in none of the groups. These findings suggest that auditory-motor entrainment in one effector system may prime a second effector system. Interestingly, however, the priming effect on gait was only observed in the finger tapping condition and not with synchronized arm swing movements. These findings have significant implications for motor rehabilitation and open new avenues for further investigation of the mechanisms underlying cross-effector coupling.


Assuntos
Estimulação Acústica/métodos , Transtornos Neurológicos da Marcha/fisiopatologia , Movimento , Doença de Parkinson/fisiopatologia , Velocidade de Caminhada , Idoso , Braço , Sinais (Psicologia) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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