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1.
Medicine (Baltimore) ; 100(9): e24931, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655958

RESUMO

ABSTRACT: Although the mutual relationship between ambulation and physical activity (PA) in people with multiple sclerosis (pwMS) has been described in several studies, there is still a lack of detailed information about the way in which specific aspects of the gait cycle are associated with amount and intensity of PA. This study aimed to verify the existence of possible relationships among PA parameters and the spatio-temporal parameters of gait when both are instrumentally assessed.Thirty-one pwMS (17F, 14 M, mean age 52.5, mean Expanded Disability Status Scale (EDSS) score 3.1) were requested to wear a tri-axial accelerometer 24 hours/day for 7 consecutive days and underwent an instrumental gait analysis, performed using an inertial sensor located on the low back, immediately before the PA assessment period. Main spatio-temporal parameters of gait (i.e., gait speed, stride length, cadence and duration of stance, swing, and double support phase) were extracted by processing trunk accelerations. PA was quantified using average number of daily steps and percentage of time spent at different PA intensity, the latter calculated using cut-point sets previously validated for MS. The existence of possible relationships between PA and gait parameters was assessed using Spearman rank correlation coefficient rho.Gait speed and stride length were the parameters with the highest number of significant correlations with PA features. In particular, they were found moderately to largely correlated with number of daily steps (rho 0.62, P< .001), percentage of sedentary activity (rho = -0.44, P < .001) and percentage of moderate-to-vigorous activity (rho = 0.48, P < .001). Small to moderate significant correlations were observed between PA intensity and duration of stance, swing and double support phases.The data obtained suggest that the most relevant determinants associated with higher and more intense levels of PA in free-living conditions are gait speed and stride length. The simultaneous quantitative assessment of gait parameters and PA levels might represent a useful support for physical therapists in tailoring optimized rehabilitative and training interventions.


Assuntos
Exercício Físico/fisiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Marcha/fisiologia , Esclerose Múltipla/complicações , Modalidades de Fisioterapia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Análise da Marcha , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/reabilitação , Estudos Retrospectivos , Adulto Jovem
2.
Am J Phys Med Rehabil ; 100(3): 235-242, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33595935

RESUMO

OBJECTIVE: The aims of this study were to (1) evaluate the relationships between stationary and dynamic associated reaction (AR) tests in people with acquired brain injury using surface electromyography (sEMG) muscle activity and three-dimensional motion analysis kinematic measures and (2) assess the test-retest reliability of sEMG and seated tests of ARs. DESIGN: Forty-two adults with acquired brain injury underwent AR testing with seated contralateral maximal voluntary isometric contraction tests and walking (self-selected and fast speeds). Associated reaction measurements included biceps brachii sEMG, elbow goniometry, and three-dimensional motion analysis kinematics during walking. Pearson correlations evaluated the relationships between seated and dynamic walking AR tests and between muscle activity and kinematic measures. Chronic participants were reassessed 1 wk later for reliability. RESULTS: A strong (r = 0.65) and moderate (r = 0.53) relationship existed for biceps brachii sEMG during seated and walking tests at self-selected and fast walk, respectively. A weak to moderate relationship existed between biceps brachii sEMG and kinematics during walking and between seated and walking measures of ARs (r = 0.23-0.53). All tests had strong to very strong test-retest reliability (intraclass correlation coefficients, >0.78). CONCLUSION: Seated contralateral maximal voluntary isometric contraction tests correlate only weakly to moderately with AR walking kinematics and moderately to strongly with biceps brachii activation during walking. Moderate relationships exist between sEMG and kinematics, indicating that they may provide different information for ARs.


Assuntos
Lesões Encefálicas/fisiopatologia , Transtornos Neurológicos da Marcha/fisiopatologia , Contração Isométrica/fisiologia , Movimento/fisiologia , Músculo Esquelético/fisiopatologia , Postura Sentada , Extremidade Superior/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Adulto Jovem
3.
Medicine (Baltimore) ; 100(5): e24348, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592882

RESUMO

ABSTRACT: Gait automaticity is reduced in patients with Parkinson disease (PD) due to impaired habitual control. The aim of this study was to investigate the effect of robot-assisted gait training (RAGT) on gait automaticity as well as gait speed and balance in patients with PD.This study was a prospective, open-label, single-arm, pilot study. We planned to recruit 12 patients with idiopathic PD. Participants received 12 sessions of RAGT using exoskeleton-type robotic device. Sessions were 45-minute each, 3 days a week, for 4 consecutive weeks using an exoskeleton-type gait robot. The primary outcome was the percentage of dual-task interference measured by the 10-Meter Walk Test (10MWT) under single and dual-task (cognitive and physical) conditions. Secondary outcomes were the Berg Balance Scale and Korean version of the Falls Efficacy Scale-International. All measures were evaluated before treatment (T0), after treatment (T1), and 1-month post-treatment (T2).Twelve patients were enrolled and 1 dropped out. Finally, 11 patients with idiopathic PD were analyzed. The mean age of 11 patients (5 males) was 66.46 ±â€Š5.66 years, and disease duration was 112.91 ±â€Š50.19 months. The Hoehn and Yahr stages were 2.5 in 8 patients and 3 in 3 patients. Linear mixed-effect model analysis showed a significant change over time only in single-task gait speed of the 10MWT (P = .007), but not in dual-task gait speed, dual-task interferences, and Korean version of the Falls Efficacy Scale-International. Cognitive dual-task interference significantly increased (P = .026) at T1, but not at T2 (P = .203). No significant changes were observed for physical dual-task interference at T1 and T2. Single-task gait speed of the 10MWT was significantly increased at T1 (P = .041), but not at T2 (P = .445). There were no significant changes in the dual-task gait speed of 10MWT. A significant improvement was observed in Berg Balance Scale score at T1 and T2 (P = .004 and P = .024, respectively).In this pilot study, despite improvement in walking speed and balance, gait automaticity in patients with PD was not improved by RAGT using an exoskeleton-type robot. Additional therapeutic components may be needed to improve gait automaticity using RAGT in patients with PD.


Assuntos
Terapia por Exercício/instrumentação , Exoesqueleto Energizado , Transtornos Neurológicos da Marcha/terapia , Doença de Parkinson/terapia , Robótica/instrumentação , Idoso , Terapia por Exercício/métodos , Feminino , Marcha/fisiologia , Análise da Marcha , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Projetos Piloto , Estudos Prospectivos , República da Coreia , Robótica/métodos , Resultado do Tratamento
4.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500294

RESUMO

Prototheca wickerhamii is a common, indolent alga that seldom causes central nervous system infections in humans. We report the first UK case of cerebral protothecosis in an immunocompetent 56-year-old woman who presented with a 5-month history of intermittent fatigue followed by a 2-week history of symptoms, including right arm and leg weakness, a loss of fine motor coordination, worsening gait, right facial tingling, diplopia and a metallic oral taste. MRI scans revealed a multifocal abnormality suggestive of high-grade glioma. Given the clinical presentation, absence of immunodeficiency and characteristic MRI features, a diagnosis of high-grade glioma was deemed most likely by the multidisciplinary team. Surgical biopsy provided material for histopathological and microbiological diagnosis. She underwent a 2-year course of antimicrobials with surveillance MRI scans. The patient made a good functional recovery but still retains mild neurological sequelae.


Assuntos
Anfotericina B/uso terapêutico , Anti-Infecciosos/uso terapêutico , Neoplasias Encefálicas/diagnóstico , Infecções do Sistema Nervoso Central/diagnóstico por imagem , Glioma/diagnóstico , Prototheca , Tetraciclina/uso terapêutico , Biópsia , Infecções do Sistema Nervoso Central/tratamento farmacológico , Infecções do Sistema Nervoso Central/patologia , Infecções do Sistema Nervoso Central/fisiopatologia , Diagnóstico Diferencial , Diplopia/fisiopatologia , Face , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Imunocompetência , Infecções/diagnóstico por imagem , Infecções/tratamento farmacológico , Infecções/patologia , Infecções/fisiopatologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Parestesia/fisiopatologia , Distúrbios do Paladar/fisiopatologia
5.
Rev. neurol. (Ed. impr.) ; 71(12): 447-454, 16 dic., 2020. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-199338

RESUMO

INTRODUCCIÓN: El entrenamiento en tapiz rodante se considera una intervención eficaz para mejorar la capacidad de la marcha en pacientes con enfermedad de Parkinson (EP). Paralelamente, la realidad virtual se muestra como una intervención prometedora con diversas aplicaciones en el entorno médico hospitalario. OBJETIVO: Evaluar la viabilidad y la eficacia preliminar de la asistencia mecánica para la marcha combinada con la realidad virtual inmersiva en pacientes con EP. PACIENTES Y MÉTODOS: Este estudio piloto y de viabilidad siguió un diseño pre-post. La intervención consistió en 12 sesiones de 30 minutos, distribuidas regularmente durante cuatro semanas consecutivas. Los participantes deambularon sobre un tapiz rodante con un sistema de descarga del peso corporal establecido aproximadamente en el 20% del peso corporal y equipados con un casco de realidad virtual controlado por un joystick para cada mano. Las mediciones de viabilidad y tratamiento se recopilaron al inicio del estudio y después de cuatro semanas de intervención. RESULTADOS: De un total de 60 pacientes, se reclutó finalmente a 12 participantes. Nueve de ellos (75%) completaron el tratamiento, con una tasa de adhesión del 97%. Dos participantes abandonaron el estudio, uno debido a náuseas asociadas con la realidad virtual y otro por falta de motivación. Hubo diferencias significativas asociadas con un tamaño del efecto pequeño-mediano al comparar los valores pre y post para la distancia recorrida, velocidad de la marcha, equilibrio y calidad de vida. CONCLUSIONES: El estudio proporcionó evidencia preliminar que apoya la viabilidad de la combinación de un tapiz rodante antigravitatorio y un sistema de realidad virtual inmersivo para la rehabilitación de pacientes con EP


INTRODUCTION: Treadmill training is considered an effective intervention to improve gait ability in patients with Parkinson's disease (PD). In parallel, virtual reality shows promising intervention with several applications in the inpatient medical setting. AIM: To evaluate the feasibility and preliminary efficacy of mechanical gait assistance combined with immersive virtual reality in patients with PD. PATIENTS AND METHODS: This pilot and feasibility study followed a pre-post study design. The intervention consisted of 12 sessions of 30 minutes, distributed regularly over four consecutive weeks. Participants walked on a treadmill with a body-weight support system set at approximately 20% of body weight and equipped with a virtual reality helmet controlled by a two-handed joystick. Feasibility and intervention outcomes were collected at baseline and after four weeks of intervention. RESULTS: Twelve participants of 60 patients were finally enrolled. Nine of them (75%) completed the treatment intervention with an adherence rate of 97%. Two participants left the study, one of them due to sickness associated with virtual reality and another because of a lack of motivation. There were significant differences associated with small-medium effect sizes when comparing the pre and post values for walk distance, walk speed, balance, and quality of life. CONCLUSIONS: The present study provided preliminary evidence supporting the feasibility of the combination of antigravity treadmill and immersive virtual reality system for the rehabilitation of patients with PD


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença de Parkinson/reabilitação , Transtornos Neurológicos da Marcha/reabilitação , Terapia de Exposição à Realidade Virtual/métodos , Teste de Esforço/métodos , Projetos Piloto , Transtornos Neurológicos da Marcha/fisiopatologia , Doença de Parkinson/fisiopatologia , Gravitação , Resultado do Tratamento , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Tempo , Estudos de Viabilidade
6.
PLoS One ; 15(12): e0244676, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382785

RESUMO

BACKGROUND: Gait disturbances have emerged as some of the main therapeutic concerns in late-stage Parkinson's disease (PD) treated with dopaminergic therapy and deep brain stimulation (DBS). External cues may help to overcome freezing of gait (FOG) and improve some of the gait parameters. AIM: To evaluate the effect of 3D visual cues and STN-DBS on gait in PD group. METHODS: We enrolled 35 PD patients treated with DBS of nucleus subthalamicus (STN-DBS). Twenty-five patients (5 females; mean age 58.9 ±6.3) and 25 sex- and age-matched controls completed the gait examination. The gait in 10 patients deteriorated in OFF state. The severity of PD was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (HY). The PD group filled the Falls Efficacy Scale-International (FES) and Freezing of Gait Questionnaire (FOGQ). Gait was examined using the GaitRite Analysis System, placed in the middle of the 10m marked path. The PD group was tested without dopaminergic medication with and without visual cueing together with the DBS switched ON and OFF. The setting of DBS was double-blind and performed in random order. RESULTS: The UPDRS was 21.9 ±9.5 in DBS ON state and 41.3 ±13.7 in DBS OFF state. HY was 2.5 ±0.6, FES 12.4 ±4.1 and FOGQ 9.4 ±5.7. In the DBS OFF state, PD group walked more slowly with shorter steps, had greater step length variability and longer duration of the double support phase compared to healthy controls. The walking speed and step length increased in the DBS ON state. The double support phase was reduced with 3D visual cueing and DBS; the combination of both cueing and DBS was even more effective. CONCLUSION: Cueing with 3D visual stimuli shortens the double support phase in PD patients treated with DBS-STN. The DBS is more effective in prolonging step length and increasing gait speed. We conclude that 3D visual cueing can improve walking in patients with DBS.


Assuntos
Sinais (Psicologia) , Transtornos Neurológicos da Marcha/fisiopatologia , Marcha/fisiologia , Doença de Parkinson/fisiopatologia , Núcleo Subtalâmico/fisiopatologia , Idoso , Estimulação Encefálica Profunda , Método Duplo-Cego , Feminino , Transtornos Neurológicos da Marcha/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/terapia , Inquéritos e Questionários , Resultado do Tratamento
7.
Fortschr Neurol Psychiatr ; 88(9): 573-581, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32957142

RESUMO

The background of the freezing-of-gait (FOG) phenomenon in Parkinson's syndrome is presented in this review. The following issues are addressed: characterization of the symptom freezing and its subtypes that challenge standardized diagnostic procedures; available assessment methods generating freezing-related parameters that not only support clinical studies but can also be applied in everyday care, and current therapy options. FOG exists in different subtypes, and clinical and diagnostic definitions are limited by subjective characterization and semi-standardized tests. FOG-specific drug options are not existing, apart from the optimization of dopaminergic medication, which may also be due to the poor discriminatory power of standardized diagnostics. This is also true for deep brain stimulation. Both of these therapeutic options may be due not only to the complex neural network alterations as a motor-control correlate of FOG, but also because of challenging diagnostic assessments methodologies. Innovative, wearable, sensor-based diagnostic strategies are currently being developed, and supportive therapies using tools and technologies focusing on 'cueing' are becoming increasingly well accepted. Even though high level evidence is missing, they provide a helpful treatment option for individualized therapy. It can be assumed that these options will become particularly popular due to technological progress and likely alter the everyday treatment challenges faced by doctors and therapists.


Assuntos
Transtornos Neurológicos da Marcha/complicações , Transtornos Neurológicos da Marcha/fisiopatologia , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Marcha , Humanos
8.
J Stroke Cerebrovasc Dis ; 29(9): 105035, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807447

RESUMO

BACKGROUND AND PURPOSE: Stiff-knee gait, which is a gait abnormality observed after stroke, is characterized by decreased knee flexion angles during the swing phase, and it contributes to a decline in gait ability. This study aimed to identify the immediate effects of pedaling exercises on stiff-knee gait from a kinesiophysiological perspective. METHODS: Twenty-one patients with chronic post-stroke hemiparesis and stiff-knee gait were randomly assigned to a pedaling group and a walking group. An ergometer was set at a load of 5 Nm and rotation speed of 40 rpm, and gait was performed at a comfortable speed; both the groups performed the intervention for 10 min. Kinematic and electromyographical data while walking on flat surfaces were immediately measured before and after the intervention. RESULTS: In the pedaling group, activity of the rectus femoris significantly decreased from the pre-swing phase to the early swing phase during gait after the intervention. Flexion angles and flexion angular velocities of the knee and hip joints significantly increased during the same period. The pedaling group showed increased step length on the paralyzed side and gait velocity. CONCLUSIONS: Pedaling increases knee flexion during the swing phase in hemiparetic patients with stiff-knee gait and improves gait ability.


Assuntos
Acidentes por Quedas/prevenção & controle , Ciclismo , Terapia por Exercício , Transtornos Neurológicos da Marcha/reabilitação , Marcha , Articulação do Joelho/fisiopatologia , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Análise da Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/etiologia , Paresia/fisiopatologia , Projetos Piloto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Método Simples-Cego , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
9.
Ideggyogy Sz ; 73(7-08): 255-259, 2020 Jul 30.
Artigo em Húngaro | MEDLINE | ID: mdl-32750242

RESUMO

The evaluation of hand dexterity is an important marker for the success of DBS (deep brain stimulation) operation in patients with Parkinson's disease. In this study we applied a simple, semiquantitative optical dental plaque staining technique for the evaluation of the hand dexterity. Ten patient with Parkinson's disease were involved in the study. After dental students aided tooth brushing, bacterial dental deposits (plaque) were stained then photographed, and quantified under standard conditions before and after DBS surgery. Our results showed a significant decrease in dental plaque deposits after DBS operation. This simple technique seems to be a routinely applicable marker for the evaluation of the hand dexterity. Our future plans is repeating the previous experiement on a higher number of cases.


Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/fisiopatologia , Escovação Dentária , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Destreza Motora , Higiene Bucal , Resultado do Tratamento
10.
Arch Phys Med Rehabil ; 101(9): 1580-1589, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32540135

RESUMO

OBJECTIVE: To compare participants with Parkinson disease (PD) motor subtypes, postural instability and gait difficulty (PIGD) (n=46) and tremor dominant (TD) (n=28), in cognitive and motor-cognitive assessments with the purpose of identifying associations between subtype and visuospatial, whole-body spatial, inhibition and/or switching, and planning and/or organizational aspects of cognitive and motor-cognitive function. DESIGN: Retrospective cohort study. Fisher exact test was used for categorical variables, while 2-sample independent t tests were used to analyze continuous variables. SETTING: Assessments took place at Emory University. PARTICIPANTS: Participants (N=72) were 40 years and older, had a clinical diagnosis of PD, exhibited 3 of the 4 cardinal signs of PD, had shown benefit from antiparkinsonian medications, and were in Hoehn and Yahr stages I-IV. Participants could walk 3 m or more with or without assistance. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Balance and mobility tests included Fullerton Advanced Balance Scale and the time needed to turn 360 degrees. Cognitive assessments included Montreal Cognitive Assessment, Brooks Spatial Memory Task, Color-Word Interference Test, Tower of London, Trail Making Test, Corsi Blocks, Serial 3s Subtraction, and Body Position Spatial Task. Motor-cognitive function measures included Four Square Step Test and Timed Up and Go. RESULTS: Participants with PIGD performed lower than those with TD symptoms on mental status (P=.005), spatial memory (P=.027), executive function (P=.0001-.034), and visuospatial ability (P=.048). CONCLUSIONS: Findings suggest that PIGD subtype is linked to greater deficits in spatial cognition, attentional flexibility and organizational planning, and whole-body spatial memory domains. These findings support the need for more personalized approaches to clinically managing PD.


Assuntos
Doença de Parkinson/classificação , Doença de Parkinson/fisiopatologia , Idoso , Agnosia/fisiopatologia , Antiparkinsonianos/uso terapêutico , Transtornos Cognitivos/fisiopatologia , Função Executiva/fisiologia , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Doença de Parkinson/tratamento farmacológico , Equilíbrio Postural/fisiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Navegação Espacial/fisiologia
11.
World Neurosurg ; 138: 672-679, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32545020

RESUMO

OBJECTIVE: In this study, we considered the treatment of cognitive characteristics of Parkinson's subtypes under resting magnetic resonance imaging scans, and used magnetic resonance imaging to analyze brain activity characteristics of patients with Parkinson's subtypes at rest. METHODS: In this study, patients with neurological Parkinson's disease subtypes were selected: 27 patients in the tremor group, 33 patients in the orthostatic gastric instability group, and 3 patients with mild cognitive impairment and neuropathic Parkinson's disease. Scientific treatment was adopted. RESULTS: Nineteen patients had mild cognitive dysfunction tremor and unstable posture, and 23 of them had mild cognitive dysfunction. Fifteen healthy controls were subjected to resting state functional magnetic resonance imaging by plane echo imaging sequence scanning. Neurological diseases-Regional consistency analysis of brain regions in patients with Parkinson's disease increased, including the right lower lobe, while regional consistency analysis of brain regions decreased, including the right frontal gyrus, right middle anterior gyrus, and lateral cerebellum. CONCLUSIONS: The experimental results show that the local consistency analysis method based on resting magnetic resonance imaging scan can effectively detect the differences in early neural activity in patients with Parkinson's disease subtype cognitive impairment, and can effectively reflect the brain characteristics of Parkinson's disease.


Assuntos
Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Cognição , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/psicologia , Feminino , Neuroimagem Funcional , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Descanso , Tremor/fisiopatologia
12.
J Pediatr Orthop ; 40(6): e510-e515, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501924

RESUMO

BACKGROUND: Serial extension casting represents a novel solution for addressing residual knee flexion contractures following hamstring lengthening in children with cerebral palsy. The purpose of this study was to investigate postoperative changes in patients following hamstring lengthening with a serial casting protocol. METHODS: Measures from preoperative and postoperative gait analyses were reviewed retrospectively for 19 patients with cerebral palsy who underwent hamstring lengthening followed by serial extension casting. Postoperative changes in clinical, functional, and kinematic parameters were assessed using paired parametric methods. RESULTS: Improvements were measured in popliteal angle, knee contracture, peak stance phase knee extension, sagittal plane range of motion of the knee during walking, Gait Deviation Index, and pediatric outcomes data collection instrument Global score. Nearly 80% of the cohort (15/19 patients) demonstrated a significant or moderate response to the intervention, whereas 20% demonstrated no improvement. Of note, significantly increased anterior pelvic tilt was also observed. CONCLUSIONS: Hamstring lengthening combined with a serial casting protocol was associated with significant postoperative improvements in a range of clinical (eg, knee contracture), functional (eg, pediatric outcomes data collection instrument Global), and kinematic (eg, knee extension in stance) parameters. Improvements following this minimally invasive surgery were comparable to outcomes from procedures with higher complication rates. LEVEL OF EVIDENCE: This is a Level III Therapeutic Study (retrospective study investigating the results of a treatment).


Assuntos
Moldes Cirúrgicos , Paralisia Cerebral/complicações , Contratura/cirurgia , Marcha/fisiologia , Músculos Isquiossurais/cirurgia , Adolescente , Fenômenos Biomecânicos , Criança , Pré-Escolar , Feminino , Análise da Marcha , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Masculino , Período Pós-Operatório , Postura , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Caminhada
13.
BMC Neurol ; 20(1): 161, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349688

RESUMO

BACKGROUND: We investigated the gait characteristics of patients with Parkinson's disease (PD), under free-living conditions, using a wearable device, and assessed their relationships with global cognitive function and motor abnormalities. METHODS: The study subjects comprised patients with PD aged < 80 years, with a Mini-Mental State Examination (MMSE) score of ≥20, free of any motor complications. A wearable sensor with a built-in tri-axial accelerometer was waist-mounted on each patient, and continuous, 24-h records were obtained. The mean gait cycle duration and mean gait acceleration amplitude, under free-living conditions, were computed and analyzed to determine their relationship with disease duration, MMSE score, Unified Parkinson's Disease Rating Scale (UPDRS) Part III score, and postural instability and gait difficulty (PIGD) score. RESULTS: The study included 106 consecutive patients with PD. The mean gait cycle duration was 1.18 ± 0.12 s, which was similar to that of the normal controls. However, the mean gait acceleration amplitude of PD patients (1.83 ± 0.36 m/s2) was significantly lower than that of the control (p < 0.001). In PD patients, the mean gait acceleration amplitude correlated with the MMSE (ß = 0.197, p = 0.028), UPDRS Part III (ß = - 0.327, p < 0.001), and PIGD (ß = - 0.235, p = 0.008) scores. CONCLUSIONS: The gait rhythm of PD patients is preserved at levels similar to those of normal subjects. However, the mean gait acceleration amplitude was significantly reduced in patients with PD. The results indicate that gait acceleration amplitude correlates with the severity of motor disorders and global cognitive function.


Assuntos
Cognição/fisiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/psicologia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Equilíbrio Postural/fisiologia , Acelerometria , Idoso , Feminino , Transtornos Neurológicos da Marcha/complicações , Humanos , Estudos Longitudinais , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Dispositivos Eletrônicos Vestíveis
14.
J Clin Neurosci ; 78: 301-306, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32389546

RESUMO

Patients with stroke (PwS) demonstrate impaired gait and balance, and asymmetric gait, placing them at high risk of falls. We aimed to investigate the effects of a single training session that included mechanical external perturbation which resists forward movement of the paretic leg during its swing phase of walking on gait and balance in PwS. In a pre-post pilot study, gait asymmetry and balance function were assessed in 22 first-event chronic PwS (i.e., unilateral hemiparesis). PwS underwent tests during baseline and one week later, after participating in a single training session that resisted forward stepping during the swing phase of walking with a device secured around the patient's waist and connected diagonally to the patient's foot by a tension cord. Ground reaction forces and center of pressure were sampled during treadmill gait to assess step length asymmetry. Performance-oriented mobility assessment (POMA), a two-minute walk test (2MWT), and the voluntary step execution test were also measured. We found no significant improvement in step length asymmetry. However, POMA scores, as well as voluntary step execution tests improved with a moderate effect size. It seems that applying diagonal resistance force to the swinging leg resulted in insufficient horizontal force. However, the improvement in the preparation phase, i.e., better weight-bearing abilities during the voluntary stepping, may be due to the compression force applied to the lower limb joints thus providing proprioceptive training. This suggests that proprioceptive training may improve gait performance in stroke patients in a very short training period.


Assuntos
Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/reabilitação , Marcha/fisiologia , Paresia/reabilitação , Equilíbrio Postural/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidentes por Quedas/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Teste de Esforço/métodos , Terapia por Exercício/métodos , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/fisiopatologia , Projetos Piloto , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
15.
Int J Rehabil Res ; 43(3): 247-254, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32459669

RESUMO

This study aimed to determine the efficacy of using real-time visual feedback during overground walking training to improve walking function in patients with post-stroke hemiparesis. Twenty-four patients with post-stroke hemiparesis who were able to walk independently under less impact of synergy pattern on the affected lower limbs (Brunnstrom stage IV or V) were randomly assigned to either the experimental group or the control group. All subjects performed overground walking for 30 min, three times a week for 6 weeks, with real-time visual feedback (weight load to the affected lower limb) provided during training for subjects in the experimental group. Outcome measures comprised the timed up-and-go test and gait parameters (step length, stride length, single and double support times, step and stride length ratios, and single support time ratio). In between-group comparison, the changes between pre-test and post-test scores in all parameters were significantly greater in the experimental group than in the control group (P < 0.05), except for double support time and step length ratio. Furthermore, post-test values of all parameters were significantly more improved in the experimental group than in the control group (P < 0.05). Our findings suggest that real-time visual feedback may be an advantageous therapeutic adjunct to reinforce the effects of overground walking training in patients with post-stroke hemiparesis.


Assuntos
Transtornos Neurológicos da Marcha/fisiopatologia , Marcha , Paresia/terapia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/complicações , Retroalimentação Sensorial , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Método Simples-Cego
16.
Adv Exp Med Biol ; 1194: 173-180, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468533

RESUMO

This article is about "kinesia paradoxa," a phenomenon presented in Parkinson's disease patients who generally suffer from bradykinesia and freezing of gait (FOG) but under certain circumstances exhibit a sudden, brief period of mobility. The objective of this paper was to identify the mechanisms causing this phenomenon, record possible brain circuits involved, and try to locate interconnections between these circuits. Moreover, we are proposing various modeling schemes in order to form the appropriate conditions for experimental design.


Assuntos
Encéfalo , Transtornos Neurológicos da Marcha , Doença de Parkinson , Encéfalo/fisiopatologia , Marcha , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Cinética , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Amplitude de Movimento Articular
17.
Acta Neurol Scand ; 142(3): 229-238, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32299120

RESUMO

OBJECTIVE: Individuals with Parkinson's disease (PD) and freezing of gait (FOG) present peripheral and central sensitivity disturbances that impair motor performance. This study aimed to investigate long-term effects of plantar sensory stimulation on brain activity, brain connectivity, and gait velocity of individuals with PD and FOG. METHODS: Twenty-five participants were enrolled in this clinical trial (NCT02594540). Plantar sensory stimulation was delivered using the Automated Mechanical Peripheral Stimulation therapy (AMPS). Volunteers were randomly assigned to real or placebo AMPS groups and received eight sessions of treatment. The primary outcome was brain activity (task-based fMRI-active ankle dorsi-plantar flexion). Secondary outcomes were brain connectivity (resting state-RS fMRI) and gait velocity. fMRI was investigated on the left, right, and mid-sensory motor regions, left and right basal ganglia. RESULTS: No changes in brain activity were observed when task-based fMRI was analyzed. After real AMPS, RS functional connectivity between basal ganglia and sensory-related brain areas increased (insular and somatosensory cortices). Gait velocity also increased after real AMPS. A positive correlation was found between gait velocity and the increased connectivity between sensory, motor and supplementary motor cortices. CONCLUSION: Plantar sensory stimulation through AMPS was not able to modify brain activity. AMPS increased the RS brain connectivity mainly in areas related to sensory processing and sensorimotor integration. Plantar stimulation could be a way to improve plantar sensitivity and consequently ameliorate gait performance. However, the mechanisms behind the way AMPS influences brain pathways are still not completely known.


Assuntos
, Vias Neurais/fisiopatologia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Estimulação Física/métodos , Idoso , Idoso de 80 Anos ou mais , Gânglios da Base/fisiopatologia , Método Duplo-Cego , Feminino , Marcha , Transtornos Neurológicos da Marcha/diagnóstico por imagem , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Vias Neurais/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Resultado do Tratamento
18.
PLoS One ; 15(4): e0231984, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348346

RESUMO

Freezing of gait (FOG) is a devastating motor symptom of Parkinson's disease that leads to falls, reduced mobility, and decreased quality of life. Reliably eliciting FOG has been difficult in the clinical setting, which has limited discovery of pathophysiology and/or documentation of the efficacy of treatments, such as different frequencies of subthalamic deep brain stimulation (STN DBS). In this study we validated an instrumented gait task, the turning and barrier course (TBC), with the international standard FOG questionnaire question 3 (FOG-Q3, r = 0.74, p < 0.001). The TBC is easily assembled and mimics real-life environments that elicit FOG. People with Parkinson's disease who experience FOG (freezers) spent more time freezing during the TBC compared to during forward walking (p = 0.007). Freezers also exhibited greater arrhythmicity during non-freezing gait when performing the TBC compared to forward walking (p = 0.006); this difference in gait arrhythmicity between tasks was not detected in non-freezers or controls. Freezers' non-freezing gait was more arrhythmic than that of non-freezers or controls during all walking tasks (p < 0.05). A logistic regression model determined that a combination of gait arrhythmicity, stride time, shank angular range, and asymmetry had the greatest probability of classifying a step as FOG (area under receiver operating characteristic curve = 0.754). Freezers' percent time freezing and non-freezing gait arrhythmicity decreased, and their shank angular velocity increased in the TBC during both 60 Hz and 140 Hz STN DBS (p < 0.05) to non-freezer values. The TBC is a standardized tool for eliciting FOG and demonstrating the efficacy of 60 Hz and 140 Hz STN DBS for gait impairment and FOG. The TBC revealed gait parameters that differentiated freezers from non-freezers and best predicted FOG; these may serve as relevant control variables for closed loop neurostimulation for FOG in Parkinson's disease.


Assuntos
Estimulação Encefálica Profunda , Marcha , Doença de Parkinson/fisiopatologia , Idoso , Área Sob a Curva , Estudos de Casos e Controles , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Inquéritos e Questionários , Caminhada
19.
Gait Posture ; 77: 300-307, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32126493

RESUMO

BACKGROUND: Given the prevalence of gait dysfunction following stroke, walking recovery is a primary goal of rehabilitation. However, current gait rehabilitation approaches fail to demonstrate consistent benefits. Gait asymmetry, prevalent among stroke survivors who regain the ability to walk, is associated with an increased energy cost of walking and is a significant predictor of falls post-stroke. Furthermore, differential patterns of gait asymmetry may respond differently to gait training parameters. RESEARCH QUESTION: The purpose of this study was to determine whether differential responses to locomotor task condition occur on the basis of step length asymmetry pattern (Symmetrical, NPshort, Pshort) observed during overground walking. METHODS: Participants first walked overground at their self-selected walking speed. Overground data were compared against three task conditions all tested during treadmill walking: self-selected speed with 0% body weight support (TM); self-selected speed with 30 % body weight support (BWS); and fastest comfortable speed with 30 % body weight support and nonparetic leg guidance (GuidanceNP). Our primary metrics were: symmetry indices of step length, stride length, and single limb support duration. RESULTS: We identified differences in the response to locomotor task conditions for each step length asymmetry subgroup. GuidanceNP induced an acute spatial symmetry only in the NPshort group and temporal symmetry in the Symmetrical and Pshort groups. Importantly, we found the TM and BWS conditions were insufficient to impact either spatial or temporal gait symmetry. SIGNIFICANCE: Task conditions consistent with locomotor training do not produce uniform effects across subpatterns of gait asymmetry. We identified differential responses to locomotor task conditions between groups with distinct asymmetry patterns, suggesting these subgroups may require unique intervention strategies. Despite group differences in asymmetry characteristics, improvements in symmetry noted in each group were driven by changes in both the paretic and nonparetic limbs.


Assuntos
Transtornos Neurológicos da Marcha/fisiopatologia , Marcha/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Teste de Esforço , Terapia por Exercício/métodos , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Análise Espaço-Temporal , Reabilitação do Acidente Vascular Cerebral , Análise e Desempenho de Tarefas
20.
Eur J Paediatr Neurol ; 26: 68-74, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32147412

RESUMO

In children with cerebral palsy (CP), rigid ventral shell ankle-foot orthoses (vAFOs) are often prescribed to reduce excessive knee flexion in stance and lower the energy cost of walking (ECW). However, how vAFOs affect ECW is a complex issue, as vAFOs may have an impact on lower limb biomechanics, upper body movements, and balance. Besides, the vAFO's biomechanical effect have been shown to be dependent on its stiffness around the ankle joint. We examined whether vAFO stiffness influences trunk movements and gait stability in CP, and whether there is a relationship between these factors and ECW. Fifteen children with spastic CP were prescribed vAFOs. Stiffness was varied into a rigid, stiff and flexible configuration. At baseline (shoes-only) and for each vAFO stiffness configuration, 3D-gait analyses and ECW-tests were performed. From the gait analyses, we derived trunk tilt, lateroflexion, and rotation range of motion (RoM) and the mediolateral and anteroposterior Margins of Stability (MoS) and their variability as measures of gait stability. With the ECW-test we determined the netEC. We found that wearing vAFOs significantly increased trunk lateroflexion (Wald χ2 = 33.7, p < 0.001), rotation RoM (Wald χ2 = 20.5, p < 0.001) and mediolateral gait instability (Wald χ2 = 10.4, p = 0.016). The extent of these effects partly depended on the stiffness of the vAFO. Significant relations between trunk movements, gait stability and ECW were found r = 0.57-0.81, p < 0.05), which indicates that trunk movements and gait stability should be taken into account when prescribing vAFOs to improve gait in children with CP walking with excessive knee flexion.


Assuntos
Tornozelo/fisiopatologia , Paralisia Cerebral/reabilitação , Metabolismo Energético/fisiologia , Órtoses do Pé , Transtornos Neurológicos da Marcha/reabilitação , Fenômenos Biomecânicos , Paralisia Cerebral/fisiopatologia , Criança , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Amplitude de Movimento Articular , Teste de Caminhada , Caminhada/fisiologia
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