Influência da adição de carga na marcha em esteira de crianças com paralisia cerebral hemiparética espástica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Versão breve da social rhythm metric: um instrumento para avaliar ritmo social de pacientes com acidente vascular cerebral

Stroke is a neurological disorder caused by restriction of blood flow to the brain, which generates directly a deficit of functionality that affects the quality of life of patients. The aim of this study was to establish a short version of the Social Rhythm Scale (SRM), to assess the social rhythm of stroke patients. The sample consisted of 84 patients, of both sexes, with injury time exceeding 6 months. For seven days, patients recorded the time held 17 activities of SRM. Data analysis was performed using a principal components factor analysis with varimax rotation of the full version of SRM in order to determine which activities could compose brief versions of SRM. We then carried out a comparison of hits, the ALI (Level Activity Index) and SRM, between versions, by Kruskal-Walls and the Mann-Whitney test. The Spearman correlation test was used to evaluate the correlation between the score of the full version of SRM with short versions. It was found that the activities of SRM were distributed in three versions: the first and second with 6 activities and third with 3 activities. Regarding hits, it was found that they ranged from 4.9 to 5.8 on the first version; 2.3 to 3.8 in version 2 and 2.8 to 6.2 in version 3, the first the only version that did not show low values. The analysis of ALI, in version 1, the median was 29, in version 2 was 14 and in version 3 was 18. Significant difference in the values of ALI between versions 1 and 2, between 2 and 3 and between versions 1 and 3. The highest median was found in the first version, formed by activities: out of bed, first contact, drink coffee, watch TV in the evening and go to bed. The lowest median was observed in the second version and this was not what had fewer activities, but which had social activities. The medians of the SRM version 1 was 6, version 2 was 4 and version 3 was 6. Significant difference in the values of SRM between versions 1 and 2 and between 2 and 3, but no significant difference between versions 1 and 3. Through analysis, we found a significant correlation only between the full version and the version 1 (R2 = 0.61) (p <0.05), no correlation was found with version 2 (R2 = 0.007) nor with version 3 (R2 = 0.002), this was finally a factor to consider version 1 as the short brazilian version of the Social Rhythm Metric for stroke patients

Análise do sono e da utilização de cartilhas educativas em pacientes com acidente vascular cerebral

O AVC é uma grande causa de mortalidade e uma das principais causas de incapacidade entre adultos. O presente estudo visa analisar o estado do sono e da utilização de cartilhas educativas em pacientes com AVC. No primeiro estudo foram abordados os fatores associados com os horários de dormir/acordar e no segundo estudo foi analisado o conhecimento e prática quanto às orientações sobre os hábitos de sono e estimulação cognitiva. No estudo 1 foram avaliados 50 pacientes sendo 28 homens, de faixa etária entre 25 e 90 anos que durante uma semana completaram um diário do sono e o registro de atividades através do Social Rhythm Metric (SRM) e do Indice de Nível de Atividades (ALI) e aplicação do questionário de cronotipo (MEQ). Utilizado o teste de correlação de Spearman verificou-se correlação significativa entre os horários de dormir/acordar com cronotipo e entre os horários de dormir/acordar com SRM e o ALI. No segundo estudo foram abordados 40 pacientes com idade média 56,1 ± 11,9 anos, sendo 15 homens e 25 mulheres; como instrumentos foram utilizados National Institute Health Stroke Scale (NIHSS) e em seguida os pacientes observaram cartilhas educativas sobre hábitos de sono e estimulação cognitiva respondendo se conheciam e se praticavam as orientações apresentadas. A análise estatística realizada através do teste de Fisher obteve como resultado, que das 10 orientações apresentadas sobre os hábitos de sono, 6 foram citadas como conhecidas e apenas 4 foram praticadas. Das 6 orientações cognitivas, não houve diferença significativa entre os que conheciam e não conheciam, mas em 5 delas a maior frequência foi dos pacientes que não praticaram. Os resultados dos estudos indicam a importância de avaliar o cronotipo antes do planejamento de reabilitação, e a necessidade de se estimular o ritmo social a fim de contribuir para a melhoria dos padrões de sono de pacientes. Verificou-se também que em relação ao conhecimento e prática de orientações apresentadas muitos pacientes não conheceram ou não praticaram orientações importantes a respeito de hábitos de sono e de estimulação cognitiva, mesmo na fase crônica da patologia, sugerindo que mais políticas de educação em saúde devem ser implementadas com intuito de causar mudança nos hábitos de vida dos pacientes com AVC

Realidade virtual na atividade cerebral: um estudo comparativo entre estados emocionais de adultos jovens e idosos

The association of Virtual Reality (VR) to clinical practice has become common in the recent years, showing to be an additional tool on health care, especially for elderly. Its use has been related to higher therapeutic adhesion levels and well being sensation. Such emotional based aspects are often observed by subjective tools of relative validity. This study analyzed the immediate effects of varied VR contexts balance training over emotional behavior, which was observed under peaks of maximum expression of EEG waves. Methodology: 40 individuals, divided in two groups, both gender, 20 young and 20 elderly, were submitted to a 60 minutes intervention, including balance training under VR. The first 25 minutes referred to initial evaluation, general orientation and cognitive assessment by the use of Mini Mental. The next ten minutes were designated to the avatar creation and tutorial video presentation. Through the following 20 minutes, the individuals from both groups were exposed to the exact same sequence of games under virtual contexts, while submitted to electroencephalography by Emotiv EPOC® focusing Adhesion, Frustration and Meditation states. The virtual interface was provided by the Nintendo® game, Wii Fit Plus, with the scenarios Balance Bubble (1), Penguin (2), Soccer (3), Tight Rope (4) and Table Tilt (5). Finally, a questionnaire of personal impressions was applied on the 5 minutes left. Results: data collected showed 64,7% of individuals from both groups presented higher concentration of adhesion peaks on Balance Bubble game. Both groups also presented similar behavior regarding meditation state, with marks close to 40%, each, on the same game, Table Tilt. There was divergence related to the frustration state, being the maximum concentration for the young group on the Soccer game (29,3%), whilst the elderly group referred highest marks to Tight Rope game (35,2%). Conclusion: Findings suggest virtual contexts can be favorable to adhesion and meditation emotional patterns induction, regardless age and for both sexes, whilst frustration seems to be more related to cognitive motor affordance, likely to be influenced by age. This information is relevant and contributes to the orientation for the best choice of games applied in clinical practice, as for other studies regarding this topic

Avaliação por ressonância magnética funcional e estimulação magnética transcraniana da intervenção única da terapia espelho em pacientes após acidente vascular cerebral isquêmico

Mirror therapy (MT) is being used as a rehabilitation tool in various diseases, including stroke. Although some studies have shown its effectiveness, little is known about neural mechanisms that underlie the rehabilitation process. Therefore, this study aimed at assessing cortical neuromodulation after a single MT intervention in ischemic stroke survivors, by means of by functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS). Fifteen patients participated in a single thirty minutes MT session. fMRI data was analyzed bilaterally in the following Regions of Interest (ROI): Supplementary Motor Area (SMA), Premotor cortex (PMC), Primary Motor cortex (M1), Primary Sensory cortex (S1) and Cerebellum. In each ROI, changes in the percentage of occupation and beta values were computed. Group fMRI data showed a significant decreased in the percentage of occupation in PMC and cerebellum, contralateral to the affected hand (p <0.05). Significant increase in beta values was observed in the following contralateral motor areas: SMA, Cerebellum, PMC and M1 (p<0,005). Moreover, a significant decrease was observed in the following ipsilateral motor areas: PMC and M1 (p <0,001). In S1 a bilateral significant decrease (p<0.0005) was observed.TMS consisted of the analysis of Motor Evoked Potential (MEP) of M1 hotspot. A significant increase in the amplitude of the MEP was observed after therapy in the group (p<0,0001) and individually in 4 patients (p <0.05). Altogether, our results imply that single MT intervention is already capable of promoting changes in neurobiological markers toward patterns observed in healthy subjects. Furthermore, the contralateral hemisphere motor areas changes are opposite to the ones in the ipsilateral side, suggesting an increase system homeostasis.

Efeitos da eliminação de neurônios infragranulares sobre a especificação de neurônios supragranulares do córtex cerebral

The cerebral cortex of mammals is histologically organized into different layers of excitatory neurons that have distinct patterns of connections with cortical or subcortical targets. During development, these cortical layers are established through an intricate combination of neuronal specification and migration in a radial pattern known as "insideout": deep-layer neurons are generated prior to upper-layer neurons. In the last few decades, several genes encoding transcription factors involved in the sequential specification of neurons destined to different cortical layers have been identified. However, the influence of early-generated neurons in the specification of subsequent neuronal cohorts remains unclear. To investigate this possible influence, we induced the selective death of cortical neurons from layer V and VI before the generation of layer II, III and IV neurons. Thus, we can evaluate the effects of ablation of early born neurons on the phenotype of late born neurons. Our data shows that one-day after ablation, layer VI neurons expressing the transcription factor TBR1 are newly generated while virtually no neuron expressing TBR1 was generated in the same age in control animals. This suggests that progenitors involved in the generation of neurons destined for superficial layers suffer interference from the selective death of neurons in deep layers, changing their specification. We also observed that while TBR1-positive neurons are located exclusively in deep cortical layers of control animals, many TBR1-positive neurons are misplaced in superficial layers of ablated animals, suggesting that the migration of cortical neurons could be controlled independently of neuronal phenotypes. Furthermore, we observed an increase in layer V neurons expressing CTIP2 and neurons expressing SATB2 and that these cells have changed their distributions. As a conclusion, our data indicate the existence of a mechanism of control exercised by the early-generated neurons in the cerebral cortex on the fate of the progenitors involved in the generation of the following cortical neurons. This mechanism could help to control the number of neurons in different layers and contribute to the establishment of different cortical areas

Características sociodemográficas, hábitos de sono, estado cognitivo e funcional após acidente vascular cerebral

ABSTRACT Introduction: The cerebrovascular accident (CVA) is an important cause of neurological impairment. Few data about the factors associated with morbidity of cerebrovascular accident are found in Brazil. Objectives: Evaluate sociodemographic characteristics, sleep habits, cognitive and functional status of patients with cerebrovascular accident. Methods: The patients evaluated through questionnaire Step 1 to survey the sociodemographic characteristics and Modified Rankin Scale for functional assessment. The neurological degree was evaluated by the National Institutes of Health Stroke Scale (NIHSS), the sleep Habits questionnaire for sleep and cognitive status by the Mini-Examination of the Mental State (MEMS). The data were analyzed using the chi-square test to determine differences in proportions of variables and linear regression analysis. Results: 305 patients were evaluated and the larger number of subjects was between 50 and 69 years (40%), most patients had no formal education (40.3%) and had ischemic type of cerebrovascular accident (72.5%). In the analysis of the functionality it was found that most patients had moderate impairment (55.1%). The results of the sleep habits showed that 63,6% of patients had one more person in the bedroom,12,3% complained about too much noise in the 11 room and 35% of too much light. From these patients 5,8% were smokers, 7,8% and 70,1% drank coffee drinkers, 28,6% had difficulty in initiate to sleep and woke up 37,6% in the middle of the night. Were showed complaints about nightmares (11%), feeling of suffocation (37,7%) and 35% felt very sleepy during the day. In addition, 95% were unemployed, 80,5% did not perform physical activities and 95,4% did not perform mental activities. The cognitive screening conducted a determined association of cognitive status with age and education level and neurological status. Conclusion: The study showed a high frequency of cases of cerebrovascular accident with functional dependence in a moderate degree, identified that many patients do not follow hygienic measures of sleep and found that the assessment of cognitive deficits must take into consideration the age, educational level and degree of neurological patients. We suggest the need for programs of assistance to victims of cerebrovascular accident patients, with a multidimensional approach including the rehabilitation team, the role of sleep medicine and Neuropsychology, so that patients have access to a more appropriate functional rehabilitation, develop a lifestyle that ensures a good sleep quality and are evaluated and rehabilitated with regard to cognitive impairment

Qualidade subjetiva do sono e queixa de insônia em pacientes com Acidente Vascular Cerebral

Brain injury can be associated with changes in the sleep-wake cycle. However, studies about sleep disturbances and their relationship with quality of sleep are scarce. Besides, it remains to be known how stroke affects the mechanisms of sleep. The aim of this study was to investigate quality of sleep, complaints of sleep disturbances and associated factors in stroke patients from the Physical Therapy services in Natal -RN. This was a cross-sectional descriptive study involving 70 individuals (aged 45-65 years), 40 patients (57 ± 7 years), 11 ± 9 months after injury, and 30 healthy individua ls (52 ± 6 years), evaluated with the Pittsburgh Sleep Quality Index (PSQI) and Sleep Habits Questionnaire. The data were analyzed by Chi-square test, t Student test and logistic regression. Poor quality sleep was found in 57,5% of the patients (6,3 ± 3,5) and was significantly higher than in the control population (3,9 ± 2,2) (t Student test, p=0,002). The patients showed significantly higher value of PSQI than controls: sleep latency (p=0,019), length of sleep (p=0,039) and dysfunction during the day (p=0,001). Regarding complaints of sleep disturbances (dyssomnias and parasomnias) analyzed by Chi-square test, the complaint of insomnia was the most prevalent (patients: 37,5%; healthy subjects: 6,7%; p=0,007). Regression analysis showed that sl eep latency (p=0,036) and complaint of insomnia (p=0,036) were associated with quality sleep. In addition, female gender (p=0,036) and complaint of broken sleep (p=0,003) were considered risk factors for the presence of insomnia. Our results show that stroke affects the homeostatic process of sleep. Shorter sleep latency and the absence of insomnia are considered protective factors for good sleep quality and this should be taken into consideration in the diagnostic and therapeutic strategies

Proposta de Intervenção para Auxiliar a Reabilitação Motora e Cognitiva de Pacientes com Acidente Vascular Cerebral

Stroke is the leading cause of combined motor and cognitive disability worldwide. The rehabilitation of stroke patients is mostly directed towards motor recovery through the training of the affected member under supervision of a Physical Therapist. In the present study we introduce a new approach for both cognitive and motor therapy, which relies on motor imagery of the upper limbs and working memory training. This therapy should be utilized as an adjuvant to physical therapy. Ten individuals (5 men and 5 women) were selected for the pilot study, all of them in the acute phase of the first ischemic stroke episode. The control group had 5 individuals who were submitted to physical therapy only, whilst the other 5 patients in the experimental group also performed the cognitive and motor training with a video game specially built for this study. Two patients left the experimental group before the end. Total training lasted for 9 weeks, 2 times a week, for half an hour. Patients reported they enjoyed playing the game, even though it required a lot of mental effort, according to them. Plus, they considered it had a beneficial influence in their activities of daily living. No side effects were reported. Preliminary results suggest there is a difference between groups in cognitive and upper limb motor evaluation following the intervention. It is important to notice that our conclusions are limited due the small sample number. Overall, this work is supported by other studies in literature focused in rehabilitation with motor imagery and working memory and indicate a continuity of the research, increasing total training hours