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1.
Funct Neurol ; 34(2): 85-91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31556388

RESUMO

This systematic review aimed to investigate emerging methods used to quantify gait parameters in children with cerebral palsy (CP) in everyday environments. The StArt computational tool automatically screened the following databases: ACM, Engineering Village, IEEE, PubMed, Scopus and Web of Science from inception to June 2018. Studies reporting the use of wearable sensors to assess gait in daily settings in children with CP were included. Data regarding 1563 studies were extracted, but only three studies could be included on the basis of the inclusion/ exclusion criteria. These studies proposed wearable technologies based on the use of signals provided by triaxial accelerometers and force resistive pressure sensors. These are able to track levels of activity and detect falls, gait deviations and gait symmetry in children with CP in their daily environments. To date, only two types of sensors have been tested in this population and it remains to be clarified how wearable sensors, used to quantify activity level, might benefit children with CP.


Assuntos
Paralisia Cerebral/diagnóstico , Transtornos Neurológicos da Marcha/diagnóstico , Dispositivos Eletrônicos Vestíveis , Fenômenos Biomecânicos , Paralisia Cerebral/complicações , Criança , Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos
2.
BMJ Case Rep ; 12(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31519716

RESUMO

Tay-Sachs disease (TSD) is a type 1 gangliosidosis (GM2) and caused by hexosaminidase A deficiency resulting in abnormal sphingolipid metabolism and deposition of precursors in different organs. It is a progressive neurodegenerative disorder transmitted in an autosomal-recessive manner. There is an accumulation of GM2 in neurocytes and retinal ganglions which result in progressive loss of neurological function and formation of the cherry-red spot which is the hallmark of TSD. We report the first case of juvenile TSD from Pakistan in a child with death of an older sibling without the diagnosis.


Assuntos
Doença de Tay-Sachs/diagnóstico , Doença de Tay-Sachs/genética , Cadeia alfa da beta-Hexosaminidase/genética , Pré-Escolar , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Mutação/genética , Paquistão/epidemiologia , Cuidados Paliativos/métodos , Doença de Tay-Sachs/fisiopatologia , Sequenciamento Completo do Exoma/métodos
4.
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
5.
Gait Posture ; 74: 53-59, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31446333

RESUMO

BACKGROUND: Three-dimensional gait analysis (3DGA) has not previously been considered by consensus panels of spinal cord experts for use in studies of patients with spinal cord damage (SCD), yet it is frequently used in other neurological populations, such as stroke and cerebral palsy. RESEARCH QUESTION: How does 3DGA impairment based reporting guide individualised clinical decision-making in people with incomplete SCD? METHODS: Retrospective open cohort case series recruited 48 adults with incomplete SCD (traumatic or non-traumatic spinal cord dysfunction) referred to the Clinical Gait Analysis Service (CGAS), Melbourne, Australia. Three-dimensional gait data were used to identify gait impairments by the multidisciplinary clinical team. Gait patterns were classified using the plantarflexor-knee extension couple index and the Gait Profile Score (GPS). The reason for referral and the recommendations made post-3DGA were collated in decision trees to extrapolate the potential value of 3DGA in decision making for targeted intervention in this population. RESULTS: Participants with SCD generally walked at a reduced gait speed. When grouped by neurological level, the tetraplegia group had a significantly lower GPS, but no specific gait patterns emerged. Participants were primarily referred to the CGAS to direct clinical intervention decisions. The most frequent recommendation following 3DGA was the prescription of an ankle foot orthosis and in some cases, the recommendation was incongruent with the referrer's proposed intervention. SIGNIFICANCE: 3DGA can provide specific guidance in management plans for gait of patients with incomplete SCD and may help to avoid inappropriate or unnecessary interventions. This sample of patients referred to the CGAS demonstrates its clinical utility in guiding clinicians in their decision making to target individualised intervention.


Assuntos
Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/reabilitação , Marcha/fisiologia , Traumatismos da Medula Espinal/complicações , Adulto , Feminino , Pé/fisiopatologia , Transtornos Neurológicos da Marcha/etiologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Caminhada/fisiologia
6.
J Stroke Cerebrovasc Dis ; 28(11): 104330, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31439522

RESUMO

OBJECTIVE: Gait of people with unilateral stroke is characterized by pronounced asymmetry. The aim of the study was to investigate the effect of cognitive and motor tasks on asymmetry of gait in people with stroke. MATERIALS AND METHODS: Nine individuals with stroke walked over the GAITRite walkway while performing motor (holding a cup with water) or cognitive (reciting the alphabet) tasks or walked with no additional task. Gait velocity, cadence, and symmetry indexes for the stance phase, swing phase, and single support phase of a gait cycle were calculated. RESULTS: The motor and cognitive tasks negatively affected gait velocity (P < .05) and cadence (P < .05). Walking and performing additional tasks resulted in the increase of the asymmetry of gait. The cognitive task had a greater effect on gait asymmetry than the motor task. CONCLUSIONS: The study outcome revealed that gait of individuals with stroke could be affected by simultaneous performance of additional tasks. The outcome provides a basis for future investigation of the ways of improving symmetry of gait in people with stroke.


Assuntos
Cognição , Transtornos Neurológicos da Marcha/etiologia , Marcha , Atividade Motora , Acidente Vascular Cerebral/complicações , Feminino , Análise da Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Análise e Desempenho de Tarefas , Velocidade de Caminhada
7.
Rev. neurol. (Ed. impr.) ; 69(3): 99-108, 1 ago., 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184022

RESUMO

Introducción. La Toe Walking Tool (TWT) es una herramienta clínica de cribado que permite discriminar a los niños con desarrollo normal de los que presentan marcha de puntillas idiopática o marcha de puntillas de origen médico. Objetivo. Realizar la traducción y adaptación transcultural de la TWT para la población infantil española y evaluar su validez de contenido. Sujetos y métodos. El proceso se realizó según el método invertido de traducción-retrotraducción. Una vez obtenida la versión prefinal en castellano, se llevó a cabo su análisis mediante el método Delphi por parte de un panel de expertos para analizar su validez de contenido, así como la comprensión, viabilidad, aplicabilidad y utilidad de la herramienta. Resultados. Se constituyó un panel de expertos compuesto por 15 profesionales que determinaron la validez de contenido de la versión española de la TWT. El cuestionario traducido y adaptado transculturalmente al castellano presentó un índice de validez de contenido global excelente (0,94). A través del método Delphi se determinó que la escala era comprensible, viable, de aplicación sencilla y útil en el ámbito pediátrico. Conclusiones. La versión en castellano de la TWT presenta una excelente validez de contenido y se considera un instrumento comprensible, viable, sencillo y útil con aplicación en la población pediátrica española. En futuros estudios resulta necesario analizar sus características psicométricas en niños con marcha de puntillas


Introduction. The Toe Walking Tool (TWT) is a clinical screening instrument which helps in the differentiation of children with normal development, idiopathic toe-walking or toe-walking due to a medical cause. Aim. To carry out the translation and cross-cultural adaptation of the TWT for the Spanish pediatric population and to evaluate its content validity. Subjects and methods. This paper was carried out following an inverted method of translation and back-translation. Once the pre-final Spanish version was obtained, its analysis was conducted through the Delphi method by a panel of experts. The content validity of the tool explores its clarity, viability, applicability and usefulness. Results. An expert panel composed by 15 professionals determine the content validity of the Spanish version of the TWT. The questionnaire translated and adapted transculturally into Spanish presented an excellent global content validity index (0.94) and the expert committee considered that the scale was easily understandable, viable, simple to apply and useful in the pediatric setting. Conclusions. The Spanish version of the TWT presents an excellent content validity and is an understandable, viable, simple and useful assessment tool. It is necessary to carry out future studies to analyze its psychometric properties with a Spanish pediatric population


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Inquéritos e Questionários , Transtornos Neurológicos da Marcha/diagnóstico , Tradução , Espanha , Características Culturais
8.
Pediatr Emerg Care ; 35(8): e150-e151, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31335784

RESUMO

Acute disseminated encephalomyelitis (ADEM) is exceptionally uncommon, with approximately 3 pediatric cases reported in the United States each year. Given the uncommon nature of ADEM, most of the current data rely heavily on case reports. The overwhelming majority of cases have been reported after an acute viral infection or vaccination. Although up to 90% of cases exhibit full remission after intravenous steroids, those in which treatment is delayed can display debilitating sequelae. Here, we present a case of ADEM in a 7-year-old boy who presented with double vision and imbalance with no recent history of acute viral infections or vaccinations.


Assuntos
Diplopia/etiologia , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Transtornos Neurológicos da Marcha/etiologia , Administração Intravenosa , Blefaroptose/etiologia , Criança , Diplopia/diagnóstico , Encefalomielite Aguda Disseminada/líquido cefalorraquidiano , Encefalomielite Aguda Disseminada/tratamento farmacológico , Transtornos Neurológicos da Marcha/diagnóstico , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do Tratamento
9.
Gait Posture ; 73: 71-73, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31301561

RESUMO

BACKGROUND: Persons with Parkinson's disease exhibit gait deficits during comfortable-pace overground walking and data from pressure sensitive mats have been used to quantify gait performance. The Primary Gait Screen is a new assessment which includes gait initiation, overground walking, turning, and gait termination. Although overground assessments are useful, the Primary Gait Screen offers a more complex evaluation than traditional gait assessments. RESEARCH QUESTION: Is the overground walking portion of the Primary Gait Screen comparable to traditional gait assessments? METHODS: Persons with Parkinson's disease (N = 175; 47 F, 128 M; 67 ±â€¯9 yrs) prospectively completed 4 passes at a self-selected speed and two trials of the Primary Gait Screen on an 8 m long pressure-sensing mat. Spatiotemporal gait variables were computed and a repeated-measures MANOVA with a Bonferroni correction compared the spatiotemporal variables from the Primary Gait Screen to the self-selected trials: gait velocity, cadence, step length, step time, and stride length. RESULTS: The analyses failed to detect differences between the Primary Gait Screen and self-selected trials for gait velocity, step length, or stride length (p > .01). Post-hoc tests revealed decreased cadence and increased step time were the only differences between the Primary Gait Screen trials and the self-selected trial (p < .001). SIGNIFICANCE: Differences seen in cadence and step time during the Primary Gait Screen may be attributed to patients' strategy, but are likely not clinically meaningful. The Primary Gait Screen appears to be a comparable assessment of overground walking in persons with Parkinson's disease, and may be a useful and accurate clinical assessment of walking.


Assuntos
Transtornos Neurológicos da Marcha/diagnóstico , Marcha/fisiologia , Doença de Parkinson/fisiopatologia , Idoso , Feminino , Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Velocidade de Caminhada
10.
Sensors (Basel) ; 19(14)2019 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-31337067

RESUMO

Mobile gait analysis systems using wearable sensors have the potential to analyze and monitor pathological gait in a finer scale than ever before. A closer look at gait in Parkinson's disease (PD) reveals that turning has its own characteristics and requires its own analysis. The goal of this paper is to present a system with on-shoe wearable sensors in order to analyze the abnormalities of turning in a standardized gait test for PD. We investigated turning abnormalities in a large cohort of 108 PD patients and 42 age-matched controls. We quantified turning through several spatio-temporal parameters. Analysis of turn-derived parameters revealed differences of turn-related gait impairment in relation to different disease stages and motor impairment. Our findings confirm and extend the results from previous studies and show the applicability of our system in turning analysis. Our system can provide insight into the turning in PD and be used as a complement for physicians' gait assessment and to monitor patients in their daily environment.


Assuntos
Algoritmos , Monitorização Fisiológica/instrumentação , Doença de Parkinson/fisiopatologia , Sapatos , Dispositivos Eletrônicos Vestíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Desenho de Equipamento , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Reprodutibilidade dos Testes , Análise Espaço-Temporal
11.
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
12.
J Neurol ; 266(Suppl 1): 118-122, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31134375

RESUMO

This article outlines recent developments in the clinical and automated assessment of neurological gait disorders. With a primary focus on vestibular, cerebellar, and functional gait disorders, we discuss how instrumented gait examination may assist clinical decision making in these disorders with respect to the initial differential diagnosis and prognosis as well as the objective monitoring of disease progression and therapeutic interventions. We delineate strategies for data handling and analysis of quantitative gait examinations that can facilitate the clinical characterization and interpretation of walking impairments. These strategies include data normalization and dimensionality reduction procedures. We further emphasize the value of a comprehensive, standardized gait assessment protocol. Accordingly, the examination of walking conditions that challenge patients with respect to their biomechanical, sensory, or cognitive resources are particularly helpful to disclose and characterize the causes underlying their gait impairment. Finally, we provide a perspective on the emerging implementation of pattern recognition approaches within the framework of clinical management of gait disorders and discuss their potential to assist clinical decision making with respect to the differential diagnosis and the prognosis of fall risk in individual patients.


Assuntos
Cerebelo/fisiopatologia , Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Reconhecimento Automatizado de Padrão/métodos , Vestíbulo do Labirinto/fisiopatologia , Humanos
13.
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
15.
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
16.
Psychogeriatrics ; 19(4): 345-354, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30784148

RESUMO

BACKGROUND: We performed a questionnaire survey of medical doctors engaged in the management of dementia to identify the actual status of treatment for dementia with Lewy bodies (DLB) in Japan. METHODS: Among participating medical doctors, we selected neurologists (Group N) and psychiatrists (Group P) because these physicians are usually involved in the management of DLB patients. The two groups were compared based on their diagnosis and treatment of DLB and in particular, parkinsonism. RESULTS: Neurological examinations and biomarker tests were less frequently performed by Group P than Group N. Antipsychotics and other psychotropics excluding anti-dementia drugs were significantly more frequently administered by Group P than Group N. The proportion of physicians who selected L-dopa as a first-line therapy for parkinsonism was significantly higher in Group N than in Group P. Despite these between-group differences, the following findings were common to the two groups: there was a discrepancy between the symptom that patients expressed the greatest desire to treat, and the awareness of physicians regarding the treatment of these symptoms; the initial agent was L-dopa; and physicians exercised caution against the occurrence of hallucinations, delusions, and other adverse drug reactions. CONCLUSIONS: The results of the present survey offer valuable insight for the formulation of future DLB therapeutic strategies.


Assuntos
Antiparkinsonianos/uso terapêutico , Levodopa/uso terapêutico , Transtornos Parkinsonianos/diagnóstico , Transtornos Parkinsonianos/tratamento farmacológico , Médicos/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Adulto , Antipsicóticos/uso terapêutico , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/tratamento farmacológico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Hipocinesia/diagnóstico , Hipocinesia/tratamento farmacológico , Hipocinesia/etiologia , Doença por Corpos de Lewy/complicações , Doença por Corpos de Lewy/diagnóstico , Doença por Corpos de Lewy/tratamento farmacológico , Pessoa de Meia-Idade , Rigidez Muscular/diagnóstico , Rigidez Muscular/tratamento farmacológico , Rigidez Muscular/etiologia , Neurologistas/estatística & dados numéricos , Transtornos Parkinsonianos/complicações , Equilíbrio Postural/efeitos dos fármacos , Psiquiatria/estatística & dados numéricos , Tremor/diagnóstico , Tremor/tratamento farmacológico , Tremor/etiologia
17.
NeuroRehabilitation ; 44(1): 9-17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30714979

RESUMO

BACKGROUND: Children with hemiparetic cerebral palsy are often characterized by reduced speed progression, shorter step length, and increased support base. These kinematic alterations result in inefficient gait. OBJECTIVE: To assess the immediate effects of treadmill training with additional lower limb loading on kinematic gait parameters in children with Cerebral Palsy (CP). METHODS: This cross-sectional, observational study, involved 20 children with hemiparetic CP that underwent single treadmill session with ankle loading. Kinematic gait data were collected by the Qualisys Motion Capture System during baseline (PRE), immediately after training (POST) and 5 minutes after post session (FOLLOW UP). RESULTS: The results demonstrated increase in knee (p = 0.001) and hip (p = 0.005) range of motion, maximum knee (p <.0.001) and hip (p =.001) flexion in swing and paretic foot height during swing (p <0.001) when PRE x POST were compared. CONCLUSION: Treadmill gait training with additional lower limb loading was a disturbance capable of modifying the locomotor strategy of these population. The increase in hip flexion during swing phase allowed higher paretic foot clearance which may favor the improvement of gait function.


Assuntos
Articulação do Tornozelo/fisiologia , Paralisia Cerebral/terapia , Teste de Esforço/métodos , Marcha/fisiologia , Paresia/terapia , Suporte de Carga/fisiologia , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Estudos Transversais , Terapia por Exercício/métodos , Feminino , Seguimentos , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Masculino , Paresia/diagnóstico , Paresia/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
18.
Neurophysiol Clin ; 49(2): 165-171, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30711432

RESUMO

Gait disorders can be disabling in persons with multiple sclerosis (PMS). Different gait parameters have been used to evaluate gait disorders according to the International classification of functioning. Some authors have reported a direct relation between evaluations over short distances and long-term outcomes. This relationship is of interest for the purposes of clinical research, as it enables short-distance evaluations to be used as a primary endpoint for trials. However, these endpoints are not always particularly relevant for PMS, and furthermore, all evaluations do not present the same metrological characteristics, especially with regards to reproducibility. However, it is essential to have good reproducibility in order to be able to test the effect of a therapeutic strategy on walking parameters in PMS. Using a range of walk tests (timed 25-foot walk in different conditions, namely comfortable walking, fast walking and dual-task walking; the Timed Up and Go test; the 6minute walk test) associated with neuromotor analysis of the lower limbs, we describe the advantages and limitations of gait evaluation in MS. Based on clinical experience accumulated over 4 years, we propose a minimum set of measurements to be used in clinical practice and also for research purposes.


Assuntos
Análise da Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Esclerose Múltipla/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Esclerose Múltipla/complicações , Reprodutibilidade dos Testes
19.
Med Clin North Am ; 103(2): 203-213, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30704677

RESUMO

Gait disorders in the elderly may be based on a neurologic deficit at multiples levels, or may be secondary to nonneurologic causes. The physiology and pathophysiology of gait problems are reviewed and bedside examination and investigative tools are discussed. The reader will have an excellent working knowledge of the subject and will know how to diagnose and treat gait disorders and falls.


Assuntos
Acidentes por Quedas , Transtornos Neurológicos da Marcha/diagnóstico , Marcha/fisiologia , Idoso , Transtornos Neurológicos da Marcha/etiologia , Humanos , Exame Neurológico/métodos
20.
Mult Scler Relat Disord ; 29: 100-107, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30703704

RESUMO

BACKGROUND: People with Relapsing-Remitting Multiple Sclerosis (pwRR-MS), may be affected by subclinical gait impairment. The Expanded Disability Status Scale, the most used scale to assess MS related disability, may be insensitive to subclinical gait disability. Minor gait abnormalities may be detected by three Dimensional-Gait Analysis (3D-GA). OBJECTIVES: To investigate gait pattern in minimally disabled pwRR-MS by 3D-GA during walking (single task, SinT), and cognitive dual tasks (CogDT) and to evaluate correlations between altered gait parameters, cognitive scores, lesion load (LL) and brain atrophy measures. METHODS: Twenty-two pwRR-MS and twenty-one healthy controls (HCs), underwent neuropsychological (NP) evaluation, and brain MRI to assess brain volumes and lesion load (only in pwRR-MS) and 3D-GA. RESULTS: Both pwRR-MS and HCs were considered cognitively preserved (CP). During SinT pwRR-MS, compared to HCs, showed an impairment of velocity (increase of cycle time), stability (increase of stance time, swing time and coefficients of variability (CV) of swing time) and kinematic (increase of ankle dorsiflexion) parameters. During CogDT, the changes of velocity and stability parameters observed in SinT were confirmed. Moreover, a statistically significant increase of the double limb support was observed. Regarding the kinematic parameters, during CogDT, an increase of ankle dorsiflexion during mid and terminal stance phases of gait cycle was observed. No significant correlations were found between gait abnormalities and cognitive status or MRI structural damage in both groups. CONCLUSIONS: The subclinical abnormal gait in asymptomatic and CP pwRR-MS, may be detected by 3D-GA.


Assuntos
Disfunção Cognitiva/fisiopatologia , Função Executiva/fisiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Adulto , Fenômenos Biomecânicos/fisiologia , Disfunção Cognitiva/etiologia , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem
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