The influence of visual and tactile perception on hand control in children with Duchenne muscular dystrophy.

AIM: To investigate tactile perception and manual dexterity, with or without visual feedback, in males with Duchenne muscular dystrophy (DMD). METHOD: Forty males with DMD (mean age 9 y 8 mo, SD 2 y 3 mo; range 5-14 y), recruited from the teaching hospital of the School of Medicine of the University of São Paulo, with disease severity graded as '1' to '6' on the Vignos Scale and '1' on Brooke's Scale, and 49 healthy males (mean age 8 y 2 mo; range 5-11 y; SD 1 y 11 mo), recruited from a local education center, participated in the study. We assessed tactile perception using two-point discrimination and stereognosis tests, and manual dexterity using the Pick-Up test with the eyes either open or closed. Analysis of variance was used to compare groups; a p value of less than 0.05 was considered statistically significant. RESULTS: Males with DMD exhibited no impairment in tactile perception, as measured by the two-point discrimination test and the number of objects correctly named in the stereognosis test. Manipulation during stereognosis was statistically slower with both hands (p<0.001), and manual dexterity was much worse in males with DMD when there was no visual feedback (p<0.001). INTERPRETATION: Males with DMD exhibited disturbances in manipulation during stereognosis and dexterity tests. Hand control was highly dependent on visual information rather than on tactile perception. Motor dysfunction in males with DMD, therefore, might be related to altered neural control.

Functional reach and lateral reach tests adapted for aquatic physical therapy / Testes de alcance funcional e alcance lateral adaptados para fisioterapia aquática

Abstract Introduction: Functional reach (FR) and lateral reach (LR) tests are widely used in scientific research and clinical practice. Assessment tools are useful in assessing subjects with greater accuracy and are usually adapted according to the limitations of each condition. Objective: To adapt FR and LR tests for use in an aquatic environment and assess the performance of healthy young adults. Methods: We collected anthropometric data and information on whether the participant exercised regularly or not. The FR and LR tests were adapted for use in an aquatic environment and administered to 47 healthy subjects aged 20-30 years. Each test was repeated three times. Results: Forty-one females and six males were assessed. The mean FR test score for men was 24.06 cm, whereas the mean value for right lateral reach (RLR) was 10.94 cm and for left lateral reach (LLR) was 9.78 cm. For females, the mean FR score was 17.57 cm, while the mean values for RLR was 8.84cm and for LLR was 7.76 cm. Men performed better in the FR (p < 0.001) and RLR tests than women (p = 0.037). Individuals who exercised regularly showed no differences in performance level when compared with their counterparts. Conclusion: The FR and LR tests were adapted for use in an aquatic environment. Males performed better on the FR and RLR tests, when compared to females. There was no correlation between the FR and LR tests and weight, height, Body Mass Index (BMI), foot length or length of the dominant upper limb.

Resumo Introdução: Os testes de alcance funcional (AF) e Alcance Lateral (AL) são comumente utilizados em pesquisas científicas e na prática clínica. Os instrumentos de avaliação promovem maior segurança para avaliar cada indivíduo com maior acurasse nos resultados e são adaptados de acordo com as limitações de cada doença. Objetivo: Adaptar os testes de AF e AL para o ambiente aquático e verificar o desempenho de jovens saudáveis. Métodos: Foram coletados os dados antropométricos, e os jovens foram questionados se realizavam atividade física. Os testes de AF e AL foram adaptados para o ambiente aquático e aplicados em 47 sujeitos saudáveis com idade entre 20 e 30 anos. Repetiu-se três vezes cada teste. Resultados: 41 mulheres e seis homens foram avaliados. A média do teste de AF para os homens foi de 24,06cm, alcance lateral direito (ALD) foi 10,94cm, alcance lateral esquerdo (ALE) foi 9,78cm para os homens. No grupo das mulheres, o AF foi de 17,57cm, para ALD 8,84cm e ALE 7,76cm. Homens apresentaram melhor desempenho no AF (p < 0.001) e no ALD do que as mulheres (p = 0.037). Os indivíduos que praticavam atividade física não apresentaram diferenças de desempenho nos testes. Conclusão: Os testes de AF e AL foram adaptados para o meio aquático. Homens apresentaram um melhor desempenho no teste de AF e ALD comparado com as mulheres. Os testes de AF e AL não apresentaram correlação com peso, altura, Índice de Massa Corpórea (IMC) e comprimento do pé e do MS dominante.

Brazilian version of the Nottingham Sensory Assessment: validity, agreement and reliability.

OBJECTIVES: To investigate the inter-rater and intra-rater reliability, construct validity and internal consistency of the Brazilian version of the Nottingham Sensory Assessment for Stroke Patients (NSA). METHODS: The instrument was translated into Portuguese from its original in English by a bilingual translator and was then back-translated into English. Twenty-one hemiparetics were evaluated by two examiners using the NSA and the Fugl-Meyer Assessment (FMA) of physical performance. RESULTS: Significant correlation were found between the FMA and the NSA (r=0.752). The NSA showed excellent internal consistency (0.86), and there were acceptable inter- and intra-rater reliability for all items of the NSA, except temperature. Significant ceiling effects were found for the NSA and the FMA. CONCLUSIONS: The Brazilian version of the NSA met the criteria for agreement, internal consistency and concurrent validity. It was quick and easy to apply, and it could be used within clinical practice in neuro-rehabilitation outpatient clinics to assess sensory functions following stroke. The significant ceiling effect for the NSA did not limit its use, given that for the same patients, the FMA also showed ceiling effects.

Versão Brasileira da Avaliação Sensorial de Nottingham: validade, concordância e confiabilidade / Brazilian version of the Nottingham Sensory Assessment: validity, agreement and reliability

OBJETIVO: Verificar a concordância inter e intraexaminador, validade construtiva e consistência interna da versão brasileira do instrumento Nottingham Sensory Assessment para hemiparéticos após acidente vascular encefálico (AVE). MÉTODOS: O instrumento foi traduzido para língua portuguesa com base na sua versão original em Inglês por um tradutor bilíngue e, posteriormente, revertido para a língua inglesa. Vinte e um hemiparéticos foram avaliados por dois examinadores pela Avaliação Sensorial de Nottingham para pacientes pós-AVE (ASN) e pelo Protocolo de Desempenho Físico de Fugl-Meyer (FM). RESULTADOS: Foi encontrada correlação entre os instrumentos FM e ASN (0,752); excelente consistência interna da ASN (0,86); excelentes coeficientes de concordância interexaminador e intraexaminador para todos os itens da ASN, exceto temperatura e efeito teto significativo para ASN e FM. CONCLUSÃO: A versão brasileira da Nottingham Sensory Assessment cumpriu os critérios de concordância, consistência interna e validade concorrente, sendo um instrumento de rápida e fácil aplicação, podendo ser utilizada nos ambulatórios de neuroreabilitação para avaliar a função sensorial pós-AVE. O efeito teto significativo da ASN não limita seu uso, tendo em vista que, para os mesmos pacientes, o Protocolo de Fugl-Meyer também revelou efeito teto.

OBJECTIVES: To investigate the inter-rater and intra-rater reliability, construct validity and internal consistency of the Brazilian version of the Nottingham Sensory Assessment for Stroke Patients (NSA). METHODS: The instrument was translated into Portuguese from its original in English by a bilingual translator and was then back-translated into English. Twenty-one hemiparetics were evaluated by two examiners using the NSA and the Fugl-Meyer Assessment (FMA) of physical performance. RESULTS: Significant correlation were found between the FMA and the NSA (r=0.752). The NSA showed excellent internal consistency (0.86), and there were acceptable inter- and intra-rater reliability for all items of the NSA, except temperature. Significant ceiling effects were found for the NSA and the FMA. CONCLUSIONS: The Brazilian version of the NSA met the criteria for agreement, internal consistency and concurrent validity. It was quick and easy to apply, and it could be used within clinical practice in neuro-rehabilitation outpatient clinics to assess sensory functions following stroke. The significant ceiling effect for the NSA did not limit its use, given that for the same patients, the FMA also showed ceiling effects.

Validação da versão brasileira da Escala de Avaliação Postural para Pacientes após Acidente Vascular Encefálico / Validation of the brazilian version of the Postural Assessment Scale for Stroke Patients

Objetivo: Verificar a confiabilidade inter e intra-examinador, a validade construtiva e a consistência interna da versão brasileira da Escala de Avaliação Postural para pacientes após Acidente vascular encefálico (EAPA) Método: O instrumento foi traduzido para a Língua Portuguesa, com base na sua versão original em Inglês por um tradutor bilíngüe. Dezenove indivíduos hemiparéticos foram avaliados por três examinadores pelo Escala de Avaliação Postural para Pacientes após AVE (EAPA) e Protocolo de Desempenho Físico de Fugl-Meyer. Resultados: Não foi encontrado efeito teto. Houve correlação entre os instrumentos Fugl-Meyer e EAPA total (r=0.79 e p<0.0001); excelente consistência interna para a EAPA total (0.83) e na sua subescala Mudança de Postura [MUP] (0.84); excelente coeficiente de confiabilidade interexaminador para a EAPA total e suas subescalas Mantendo a Postura e MUP (0.93; 0.95 e 0.87, respectivamente). Conclusão: A EAPA apresentou resultados de validade construtiva, consistência interna e confiabilidade inter e intra-examinador que permitem a sua utilização na prática clínica.

Eficiência do treino de marcha em suporte parcial de peso no equilíbrio de pacientes hemiparéticos / Effect of gait training with body weight support in hemiparetic patients balance

O suporte parcial de peso (SPP) foi utilizado pela primeira vez em âmbitos clínicos nos anos 80. Acredita-se que essa terapia promova melhora da marcha em pacientes com seqüela de Acidente Vascular Encefálico (AVE). Investigamos a importância do treino de marcha na esteira elétrica com SPP nesses pacientes. Sete pacientes com diagnóstico clínico de hemiparesia ou hemiplegia foram submetidos aleatoriamente a um protocolo de treinamento em esteira elétrica em SPP (Experimental, n = 4), ou ao tratamento tradicional sem SPP (Controle, n = 3) por 20 sessões, para avaliar o equilíbrio. Observou-se melhora estatisticamente significante no equilíbrio avaliado pela escala de BERG no Grupo Experimental (p = 0,003). Mais estudos são necessários para elucidar os resultados obtidos...

The Body Weight Support (BWS) was used for the first time in clinical studies by the 80s. It is believed that this therapy promotes improvement of gait in patients with Stroke sequel. We investigated the importance of gait training in treadmill with BWS in those patients. Seven patient with clinical diagnosis of hemiparesis or hemiplegia were randomly submitted toa treadmill training protocol with BWS, (Experimental, n=4), or to traditional approach without BWS (Control, n=3) for 20 sessions to balance evaluation. The balance evaluation by BERG scale showed significant improves on experimental group (p = 0,003). Further investigations should be conducted in order to elucidate those data obtained...