Aline Scianni | UFMG - The Federal University of Minas Gerais (original) (raw)

Papers by Aline Scianni

Research paper thumbnail of Barriers to the Continuity of Pilot Studies to Definitive Randomized Controlled Trials in Stroke Rehabilitation: A Scoping Review

Objectives: To investigate if pilot and/or feasibility studies on interventions to improve mobili... more Objectives: To investigate if pilot and/or feasibility studies on interventions to improve mobility after stroke lead to Randomized Controlled Trials. In addition, to investigate the barriers faced by researchers for the continuity of the studies. Databases: Embase, Medline, PEDro, Lilacs and Cochrane Library from 1988 to May 2019. Methods: Inclusion criteria will be: pilot or feasibility studies, stroke survivors over 18 years old, and exercise interventions with outcomes of mobility (walking). Two trained reviewers will independently perform study selection and data extraction.

Research paper thumbnail of Cross-cultural adaptation and measurement properties of the Brazilian Portuguese version of the spinal cord injury - Falls Concern Scale

Spinal Cord

STUDY DESIGN Psychometric study. OBJECTIVES To cross-culturally adapt the spinal cord injury-fall... more STUDY DESIGN Psychometric study. OBJECTIVES To cross-culturally adapt the spinal cord injury-falls concern scale (SCI-FCS) to the Brazilian Portuguese language and to evaluate its measurement properties. SETTING SARAH Network of Rehabilitation Hospitals, Belo Horizonte, Brazil. METHODS The SCI-FCS was translated and culturally adapted to the Brazilian- Portuguese language, following recommended guidelines. The following measurement properties were verified: internal consistency (Cronbach's α), test-retest reliability (ICC and quadratic-weighted kappa coefficients), and construct validity (Rasch analysis). RESULTS One-hundred and thirty individuals participated. The median SCI-FCS-Brazil score was 27 (22-34). The Cronbach's α was 0.95; ICC was 0.92 (95% CI, 0.86-0.95) for the total test-retest scores, and the Kappa coefficients ranged from 0.04 to 0.87 (95% CI, 0.01-1) for the item-level reliability. Rasch analysis reliability index was 0.81 and 0.98 and the separation index was 2.10 and 6.25 for the persons and items, respectively. Both items and persons fitted the statistics model's expectations, ensuring its unidimensionality. CONCLUSIONS The SCI-FCS-Brazil showed adequate measurement properties. Its use in manual wheelchair users with SCI is recommended to help defining rehabilitation strategies.

Research paper thumbnail of Self-management to promote physical activity after discharge from in-patient stroke rehabilitation: a feasibility study

Topics in Stroke Rehabilitation

OBJECTIVES To investigate the feasibility of a self-management program aimed at increasing physic... more OBJECTIVES To investigate the feasibility of a self-management program aimed at increasing physical activity in community-dwelling ambulators after stroke in a middle-income country with high income inequality. METHODS A Phase 1, pre-post intervention study was conducted with 20 sub-acute stroke participants. The self-management program was delivered in six home-based sessions over 3 months. Feasibility of recruitment, intervention, and measurement was determined. Physical activity, cardiovascular risk, depression, walking speed, self-efficacy for exercise, participation, and quality of life were measured at baseline, 3, and 6 months. RESULTS 16% of eligible participants were recruited. 90% completed the program and were measured at 3 months, and 65% at 6 months. The most common reasons for withdrawal were return to work, lack of interest/motivation and surgery. 92% of the sessions were delivered for 59 (SD 23) minutes per session. Participants did not increase physical activity at 3 months (MD 364 steps/day, 95% CI -282 to 1010) or 6 months (MD 312 steps/day, 95% CI -881 to 1504). Post-hoc analysis showed that sedentary participants increased their step count at 3 months by 1,300 (95% CI 152 to 2447) and at 6 months by 1,701 (95% CI -556 to 3959) more steps than non-sedentary participants. CONCLUSIONS A Phase 2 study of the self-management program appears to be feasible in a middle-income country with high income inequality and has the potential to increase physical activity levels in sedentary individuals with mild disability after stroke. TRIAL REGISTRATION RBR-6bdmsk.

Research paper thumbnail of Depressive symptoms and functional status are associated with sleep quality after stroke

Topics in Stroke Rehabilitation

ABSTRACT Objective: To investigate the sleep state and determine whether variables, such as age, ... more ABSTRACT Objective: To investigate the sleep state and determine whether variables, such as age, functional status, walking capacity, fatigue, depressive symptoms, and quality of life were associated with sleep quality of individuals with chronic stroke. Methods: For this exploratory study, the dependent variable was sleep quality, which was measured by the Pittsburgh Sleep Quality Index (PSQI). Step-wise multiple linear regression analysis was employed to identify which of the independent variables, that is, age, functional status (Modified Rankin Scale-mRS), walking capacity (6-minute Walk Test), fatigue (Fatigue Severity Scale), depressive symptoms (Geriatric Depression Scale-GDS), and quality of life (EuroQol) were associated with sleep quality. Results: Ninety participants, 55 (61%) men, who had a mean age of 61 (SD 12) years and a mean time since the onset of the stroke of 58.2 (SD 58.7) months, were included. Sleep quality was significantly associated with depressive symptoms and functional status. Together, they explained 30% of the variance in the PSQI scores (p < .0001). The GDS scores alone explained 22% (F = 25.76; p < .0001) of the variance in sleep quality (PSQI). When mRS scores were included in the model, the explained variance increased to 30% (F = 20,38; p < .0001). Conclusion: Depressive symptoms and functional status, which are both potentially modifiable factors, were associated with the sleep quality of individuals with chronic stroke. It is important to consider the assessment of sleep quality in the context of stroke rehabilitation.

Research paper thumbnail of Adaptação transcultural da Modified Gait Efficacy Scale para indivíduos pós-acidente vascular encefálico

Revista de Terapia Ocupacional da Universidade de São Paulo

A Modified Gait Efficacy scale (mGES) avalia a percepção do indivíduo sobre o seu nível de confia... more A Modified Gait Efficacy scale (mGES) avalia a percepção do indivíduo sobre o seu nível de confiança na marcha, em circunstâncias desafiadoras. Para sua aplicação na população brasileira, é necessário que seja realizada a sua adaptação transcultural. Este estudo objetivou realizar a adaptação transcultural do mGES para uso no Brasil. O processo de adaptação seguiu diretrizes padronizadas, sendo realizado em cinco etapas: tradução, retrotradução, síntese das traduções, avaliação pelo comitê de especialistas e teste da versão pré final. A versão pré final foi aplicada em 12 indivíduos pós-Acidente Vascular Encefálico (AVE), que foram indagados sobre como interpretaram cada item. O processo de adaptação seguiu todas as recomendações propostas, sendo necessárias apenas pequenas alterações em três itens, para possibilitar melhor compreensão. Resultados satisfatórios foram obtidos no teste da versão pré final, uma vez que não houve nenhum problema quanto à redação e clareza dos itens ou a...

Research paper thumbnail of Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke

Stroke Research and Treatment

Aim. To describe exercise preferences and to investigate the contribution of exercise preferences... more Aim. To describe exercise preferences and to investigate the contribution of exercise preferences, walking ability, and current levels of physical activity in predicting exercise adherence in individuals with chronic stroke. Methods. For this exploratory study, exercise adherence was measured using the first question of the first section of the Exercise Preference Questionnaire (stroke)-Brazil (EPQ (stroke)-Brazil). Nine independent variables were included as potential predictors of exercise adherence: the seven factors of the EPQ (stroke)-Brazil, walking speed, and level of physical activity. Results. Participated 93 individuals with stroke, who had a mean age of 62 (SD 12) years and a mean time since the onset of the stroke of 58 (SD 67) months. The most preferable exercise was walking. Logistic regression analysis revealed that self-efficacy to engage in physical exercise and walking ability predicted and explained 80% of the variance in exercise adherence. Conclusion. The findin...

Research paper thumbnail of Perceived barriers to exercise reported by individuals with stroke, who are able to walk in the community

Disability and Rehabilitation

Abstract Purpose To identify the perceived barriers to exercise, which could be modified, as well... more Abstract Purpose To identify the perceived barriers to exercise, which could be modified, as well as the associated factors in people at the sub-acute post-stroke stages, who were able to walk in the community. Methods For this exploratory study, barriers to exercise were identified by the Exercise Barrier sub-scale of the Exercise Benefits/Barriers Scale. Step-wise multiple linear regression analysis was employed to identify which of the clinical and sociodemographic variables, that is, age, walking speed, levels of physical activity, socioeconomic status, and depressive symptoms, could significantly predict the Exercise Barrier sub-scale scores. Results Ninety-five individuals, who had a mean age of 63 (13) years and a mean time since the onset of the stroke of 4 (1) months participated. The main reported barriers to exercise were related to fatigue, as well as availability and distance from the exercise places. Additional reported barriers were “lack of a person to help” and “knowledge on how to practice exercise.” Perceived barriers were associated with depressive symptoms and socioeconomic status. Together, they explained 9% of the variance in the Exercise Barrier sub-scale scores (p < 0.01). Conclusions Fatigue, reduced number of places, and long distances to exercise places were the main reported barriers to exercise. Depressive symptoms and socioeconomic status were the only variables that explained the variance in the Exercise Barrier sub-scale scores. Rehabilitation interventions should include strategies to reduce fatigue during and after exercise, provide guidance regarding both structured and unstructured exercise venues, in addition to screening and managing depressive symptoms. Implications for Rehabilitation Stroke survivors, who are able to walk in the community, should be referred and instructed on how to reduce fatigue through the practice of exercise. Health professionals should guide stroke survivors about the existing places for practice of exercise and how to exercise without structured environments. It is necessary to create or reformulate environments for exercise and provide orientation to practice through qualified professionals. Health professionals should also be able to assess the presence of depressive symptoms and address proper referral and management of the potential barriers to exercise.

Research paper thumbnail of Impacto da fisioterapia na reabilitação do alcance e manipulação de indivíduos hemiparéticos, vítimas de acidente vascular encefálico: o que é evidência?

Fisioterapia Brasil

O objetivo deste artigo é determinar as evidências da intervenção fisioterapêutica, na melhora da... more O objetivo deste artigo é determinar as evidências da intervenção fisioterapêutica, na melhora da função de Alcance e Manipulação de pacientes hemiparéticos, vítimas de Acidente Vascular Encefálico. Metodologia: Uma pesquisa computadorizada foi conduzida nas bases de dados: Medline, Cochrane, PEDro e Pubmed. Estudos Clínicos Aleatorizados (ECA) assim como Estudo Clínico Controlado (ECC), foram incluídos neste estudo. Para a presente revisão, a fisioterapia foi classificada em 6 categorias de intervenção: 1) fisioterapia tradicional, 2) terapia de uso forçado, 3) treinamento de tarefa específica, 4) terapia com biofeedback, 5) terapia com estimulação elétrica funcional – FES, 6) uso de órteses. A qualidade metodológica dos Estudos Aleatorizados foi classificada com a escala PEDro. Resultados: Um total de 31 publicações foi utilizado neste estudo. A qualidade metodológica de todos os Estudos Clínicos Aleatórios (ECA) possuem uma média de 5 pontos na escala de 10 pontos PEDro (4-8 pont...

Research paper thumbnail of Deficits in motor coordination of the paretic lower limb best explained activity limitations after stroke

Physiotherapy theory and practice, Jan 21, 2018

To explore the relationships between selected measures of motor impairments and activities involv... more To explore the relationships between selected measures of motor impairments and activities involving the lower-limbs in ambulatory people with chronic stroke. Motor impairment measures included maximal isometric strength and motor coordination. Activity measures included walking speed, stair ascent/descent cadences, and the time to perform the Timed Up and Go (TUG) test. Ninety individuals were included. The correlations between all motor impairment and activity measures were significant (0.18 < r < 0.52, p < 0.05). Motor coordination and strength of the knee flexor muscles explained 30% (F = 20.3; p < 0.001) of the variance in walking speed, 32% (F = 19.1; p < 0.001) of stair ascent, and 31% (F = 16.8; p < 0.001) of stair descent cadence. Regarding the TUG, only motor coordination reached significance and explained 13% (F = 13.4; p < 0.001) of the variance. Measures of strength and motor coordination of the paretic lower limb were significantly correlated with ...

Research paper thumbnail of Caracterização da participação social de indivíduos na fase crônica pós-acidente vascular encefálico

Revista de Terapia Ocupacional da Universidade de São Paulo

O objetivo foi descrever e comparar diferenças na restrição na participação social de indivíduos ... more O objetivo foi descrever e comparar diferenças na restrição na participação social de indivíduos após acidente vascular encefálico (AVE) na fase crônica, considerando as deficiências, limitações em mobilidade e fatores pessoais. A restrição na participação social foi mensurada pelo LIFE-H 3.1-Brasil; as deficiências pela Escala de Depressão Geriátrica e Escala de Fugl-Meyer (EFM); as limitações em mobilidade pela velocidade de marcha e Timed Up & Go (TUG) e os fatores pessoais incluíram sexo, idade, situação familiar e tempo de evolução pós-AVE. Observou-se restrição significativa na área de recreação. Em geral, restrições na participação social foram observadas em participantes com escores ≤28 na EFM-membro inferior, sintomas de depressão, marcha comunitária limitada, risco de quedas e tempo de evolução ≤5 anos. Aqueles com escores ≤45 na EFM-membro superior apresentaram maior restrição em algumas áreas das atividades diárias. As mulheres apresentaram maior restrição em papéis soci...

Research paper thumbnail of Comparison between parameters of muscle performance and inflammatory biomarkers of non-sarcopenic and sarcopenic elderly women

Clinical interventions in aging, 2017

Sarcopenia is a multifactorial geriatric syndrome with complex interrelationships. Increased plas... more Sarcopenia is a multifactorial geriatric syndrome with complex interrelationships. Increased plasma levels of inflammatory mediators increase the catabolic stimuli of the musculature, thereby causing a decrease in mass and muscular function. The objective of this study was to compare the performance of the knee extensors test (by isokinetic dynamometer) and plasma levels of interleukin-6 (IL-6) and soluble receptors of tumor necrosis factor alpha (sTNFR1) between sarcopenics and non-sarcopenics community-dwelling elderly women residents of Brazil. The diagnosis of sarcopenia included measurements of body composition (by densitometry with dual energy source of X-ray), handgrip strength (by Jamar(®) dynamometer), and the usual gait velocity according to the recommendations of the European Working Group on Sarcopenia in Older People. In both sarcopenics and non-sarcopenics elderly women, we evaluated the muscle function by knee extensors test (using an isokinetic dynamometer Byodex Sys...

Research paper thumbnail of Efficacy of Task-Specific Training on Physical Activity Levels of People With Stroke: Protocol for a Randomized Controlled Trial

Physical Therapy, 2017

Background. The majority of people after stroke demonstrate mobility limitations, which may reduc... more Background. The majority of people after stroke demonstrate mobility limitations, which may reduce their physical activity levels. Task-specific training has been shown to be an effective intervention to improve mobility in individuals with stroke, however, little is known about the impact of this intervention on levels of physical activity. Objectives. The main objective is to investigate the efficacy of task-specific training, focused on both upper and lower limbs, in improving physical activity levels and mobility in individuals with stroke. The secondary objective is to investigate the effects of the training on muscle strength, exercise capacity, and quality of life. Design. This is a randomized controlled trial. Setting. The setting is public health centers. Participants. Community-dwelling people with chronic stroke. Interventions. Participants will be randomized to either an experimental or control group, who will receive group interventions 3 times per week over 12 weeks. The experimental group will undertake task-specific training, while the control group will undertake global stretching, memory exercises, and health education sessions. Measurements. Primary outcomes include measures of physical activity levels and mobility, whereas secondary outcomes are muscle strength, exercise capacity, and quality of life. The outcomes will be measured at baseline, postintervention, and at the 4-and 12-week follow-ups. Conclusions. The findings of this trial have the potential to provide important insights regarding the effects of task-specific training, focused on both upper and lower limbs, in preventing secondary poststroke complications and improving the participants' general health through changes in physical activity levels.

Research paper thumbnail of Measurement properties of self-report physical activity assessment tools in stroke: a protocol for a systematic review

BMJ Open, 2017

Introduction: Self-report physical activity assessment tools are commonly used for the evaluation... more Introduction: Self-report physical activity assessment tools are commonly used for the evaluation of physical activity levels in individuals with stroke. A great variety of these tools have been developed and widely used in recent years, which justify the need to examine their measurement properties and clinical utility. Therefore, the main objectives of this systematic review are to examine the measurement properties and clinical utility of self-report measures of physical activity and discuss the strengths and limitations of the identified tools. Methods and analysis: A systematic review of studies that investigated the measurement properties and/or clinical utility of self-report physical activity assessment tools in stroke will be conducted. Electronic searches will be performed in five databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) (PubMed), Excerpta Medica Database (EMBASE), Physiotherapy Evidence Database (PEDro), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SciELO), followed by hand searches of the reference lists of the included studies. Two independent reviewers will screen all retrieve titles, abstracts, and full texts, according to the inclusion criteria and will also extract the data. A third reviewer will be referred to solve any disagreement. A descriptive summary of the included studies will contain the design, participants, as well as the characteristics, measurement properties, and clinical utility of the self-report tools. The methodological quality of the studies will be evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist and the clinical utility of the identified tools will be assessed considering predefined criteria. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Discussion: This systematic review will provide an extensive review of the measurement properties and clinical utility of self-report physical activity assessment tools used in individuals with stroke, which would benefit clinicians and researchers.

Research paper thumbnail of Handgrip strength deficits best explain limitations in performing bimanual activities after stroke

Journal of Physical Therapy Science, 2016

To evaluate the relationships between residual strength deficits (RSD) of the upper limb muscles ... more To evaluate the relationships between residual strength deficits (RSD) of the upper limb muscles and the performance in bimanual activities and to determine which muscular group would best explain the performance in bimanual activities of chronic stroke individuals. [Subjects and Methods] Strength measures of handgrip, wrist extensor, elbow flexor/extensor, and shoulder flexor muscles of 107 subjects were obtained and expressed as RSD. The performance in bimanual activities was assessed by the ABILHAND questionnaire. [Results] The correlations between the RSD of handgrip and wrist extensor muscles with the ABILHAND scores were negative and moderate, whereas those with the elbow flexor/extensor and shoulder flexor muscles were negative and low. Regression analysis showed that the RSD of handgrip and wrist extensor muscles explained 38% of the variance in the ABILHAND scores. Handgrip RSD alone explained 33% of the variance. [Conclusion] The RSD of the upper limb muscles were negatively associated with the performance in bimanual activities and the RSD of handgrip muscles were the most relevant variable. It is possible that stroke subjects would benefit from interventions aiming at improving handgrip strength, when the goal is to increase the performance in bimanual activities.

Research paper thumbnail of Lower Extremity Motor Coordination Test: Valores Normativos e Propriedades Psicométricas

Brazilian Journal of Physical Therapy, 2010

Contextualizacao: As alteracoes morfofuncionais inerentes ao processo de envelhecimento humano qu... more Contextualizacao: As alteracoes morfofuncionais inerentes ao processo de envelhecimento humano quando associadas a doencas cronicas, podem levar a diminuicao da independencia fisica e mental do idoso. Objetivo: Investigar a funcao cognitiva e capacidade funcional em idosos hipertensos (GH) e normotensos (GN). Metodo: Estudo observacional, analitico e transversal, com 56 idosos divididos em dois grupos GH (n=42) e GN (n=14) avaliados atraves do Mini Exame do Estado Mental (MEEM), Questionario Internacional de Atividade Fisica (IPAQ) e Bateria de testes de aptidao fisica (Functional Fitness Test). Analise estatistica: Os dados foram avaliados utilizando teste t Student, teste Qui-quadrado e teste de correlacao de Pearson, atraves do SPSS 17.0, sendo atribuido nivel de significância de 5% para todos os testes. Resultados: Nao houve correlacao significativa, entre os grupos GH e GN, quanto ao deficit cognitivo (p=0,08) e a forca de MMII (p=0,08), ja para endurance aerobica – TME2 – houve correlacao negativa (r=-0,31; p=0,02). Em relacao aos testes de flexibilidade de MMSS e MMII houve correlacao negativa moderada entre os grupos (r=-0,62; p<0,001, para MMSS; r=-0,39; p=0,003, para MMII) e correlacao positiva moderada para agilidade e equilibrio – TUG (r=0,38; p=0,004). Foi encontrada diferenca significativa para o nivel de atividade fisica entre GH e GN com p<0,001. Conclusao: A hipertensao arterial afeta diretamente o idoso na medida em que limita a capacidade do individuo de realizar suas atividades basicas de forma independente, diminuindo a mobilidade funcional, principalmente, se associada a outras comorbidades e a habitos de vida nao saudaveis, porem nao influencia na funcao cognitiva.

Research paper thumbnail of Barreiras e Limitações À Implementação Da Prática Baseada Em Evidências Na Reabilitação Após Ave

Fisioterapia Saude Funcional, Jun 27, 2014

Clinicos e responsaveispela elaboracao de politicas de saude tem como objetivo a melhora da quali... more Clinicos e responsaveispela elaboracao de politicas de saude tem como objetivo a melhora da qualidadee eficiencia do cuidado a saude. Para que este objetivo seja alcancado,evidencias de pesquisa constituem a ferramenta necessaria. A demanda e ointeresse na implementacao da evidencia na pratica da fisioterapia apos AcidenteVascular Encefalico (AVE) tem crescido significativamente nas ultimas decadas.Isto tem sido demonstrado, em parte, pelo crescente numero de publicacoes derevisoes sistematicas registradas na base de dados de evidencias emfisioterapia PEDro (Physiotherapy Evidence Database). Mais de 300 revisoessistematicas relacionadas a reabilitacao apos AVE foram publicadas ate os diasde hoje. A integracao da experiencia clinica individual com amelhor evidencia clinica de pesquisa sistematica disponivel define a PraticaBaseada em Evidencias. E desejavel que o clinico considere a evidencia de umaforma natural e consistente.

Research paper thumbnail of Short- and long-term training effects on motor and functional performances of community-dwelling individuals with chronic stroke

European Journal of Physiotherapy, 2015

Abstract Objective: This study aimed to evaluate the short- and long-term effects (1 year follow-... more Abstract Objective: This study aimed to evaluate the short- and long-term effects (1 year follow-up) of a combined program of strengthening and aerobic conditioning on measures of impairment and activity in individuals with chronic stroke. Methods: A prospective, observational study embedded within a trial was conducted. Measures of impairment (strength of the trunk and lower limb muscles) and activity (gait speed, gait capacity and ability to manage stairs) of 23 individuals with chronic stroke were reassessed 1 year after the cessation of the training. Repeated measure ANOVAs, followed by planned contrasts, were used for analyses. Results: Significant training effects were found for all outcome measures (3.81 > F > 93.5, 0.0001 > p > 0.04). The gains in strength of the paretic and non-paretic lower limbs were not maintained and returned to baseline levels after 1 year follow-up. However, the gains in all activity measures remained. Conclusions: These findings support the short- and long-term benefits of a combined program of muscular strengthening and physical conditioning for individuals with chronic stroke with high functional levels, since the gains associated with the training were maintained after the 1 year follow-up for all studied variables, except for the strength of the paretic and non-paretic lower limbs.

Research paper thumbnail of Measurement properties of the lower extremity motor coordination test in individuals with stroke

Journal of rehabilitation medicine, Jan 15, 2015

To evaluate the construct validity, inter- and intra-rater reliabilities, best scoring method and... more To evaluate the construct validity, inter- and intra-rater reliabilities, best scoring method and testing methods (direct vs video observations), and to determine the smallest real difference (SRD) and standard error of the measurement (SEM) of the lower Extremity Motor Coordination Test (LEMOCOT). Methodological study. Thirty-six stroke subjects. Outcomes include measures of motor recovery, muscular tone, strength, motor coordination, foot tactile sensation, and gait speed. The LEMOCOT scores were able to discriminate between stroke individuals from those predicted for healthy subjects, between the paretic and non-paretic limbs for both the sub-acute and chronic groups and differentiated between individuals with different functional levels and degrees of motor recovery. For the intra- and inter-rater reliabilities, very high and significant coefficients were found for both the paretic and non-paretic lower limbs for both groups (intra-class correlation coefficients (ICC) > 0.97,...

Research paper thumbnail of Tai Chi improves balance and prevents falls in people with Parkinson's disease

Journal of physiotherapy, 2015

Research paper thumbnail of Cardiorespiratory Stress is not Achieved During Routine Physiotherapy in Chronic Stroke

International Journal of Physical Medicine & Rehabilitation, 2014

Background: Cardiorespiratory deconditioning is a well-established sequel of stroke and this may ... more Background: Cardiorespiratory deconditioning is a well-established sequel of stroke and this may interfere with integration into community. In the chronic phase, when motor recovery has plateaued, rehabilitation should include cardiorespiratory training. Objective: To determine whether physiotherapy rehabilitation in the chronic phase of stroke provides enough stress in terms of duration (>10 min) and intensity (>40% of heart rate reserve-HRR) to induce cardiorespiratory benefits. Methods: Two physiotherapy sessions, at least one week apart, of 20 chronic stroke patients (mean time since the onset of the stroke of 26 months, mean age of 58 years, 45% male) were observed, in terms of duration (time) and intensity (40 %HRR). The activities were categorized as upper limb tasks, standing, stepping, basic walking, and advanced walking. Average duration and intensity for each participant across the two sessions were determined. Results: Lower limb activities, such as standing and walking were undertaken for 25 (SD 5) minutes; comprising 57% of the total session. The remainder of the session was taken up with upper limb activities (27%) or inactivity (16%). None of the activities reached the target intensity, with the highest average intensity being achieved during advanced walking (mean 32% HRR, SD 2). Conclusions: Routine physiotherapy did not provide sufficient duration or intensity to induce cardiorespiratory stress in this group of chronic stroke patients. The evidence practice gap needs to be closed for cardiorespiratory fitness to be trained.

Research paper thumbnail of Barriers to the Continuity of Pilot Studies to Definitive Randomized Controlled Trials in Stroke Rehabilitation: A Scoping Review

Objectives: To investigate if pilot and/or feasibility studies on interventions to improve mobili... more Objectives: To investigate if pilot and/or feasibility studies on interventions to improve mobility after stroke lead to Randomized Controlled Trials. In addition, to investigate the barriers faced by researchers for the continuity of the studies. Databases: Embase, Medline, PEDro, Lilacs and Cochrane Library from 1988 to May 2019. Methods: Inclusion criteria will be: pilot or feasibility studies, stroke survivors over 18 years old, and exercise interventions with outcomes of mobility (walking). Two trained reviewers will independently perform study selection and data extraction.

Research paper thumbnail of Cross-cultural adaptation and measurement properties of the Brazilian Portuguese version of the spinal cord injury - Falls Concern Scale

Spinal Cord

STUDY DESIGN Psychometric study. OBJECTIVES To cross-culturally adapt the spinal cord injury-fall... more STUDY DESIGN Psychometric study. OBJECTIVES To cross-culturally adapt the spinal cord injury-falls concern scale (SCI-FCS) to the Brazilian Portuguese language and to evaluate its measurement properties. SETTING SARAH Network of Rehabilitation Hospitals, Belo Horizonte, Brazil. METHODS The SCI-FCS was translated and culturally adapted to the Brazilian- Portuguese language, following recommended guidelines. The following measurement properties were verified: internal consistency (Cronbach's α), test-retest reliability (ICC and quadratic-weighted kappa coefficients), and construct validity (Rasch analysis). RESULTS One-hundred and thirty individuals participated. The median SCI-FCS-Brazil score was 27 (22-34). The Cronbach's α was 0.95; ICC was 0.92 (95% CI, 0.86-0.95) for the total test-retest scores, and the Kappa coefficients ranged from 0.04 to 0.87 (95% CI, 0.01-1) for the item-level reliability. Rasch analysis reliability index was 0.81 and 0.98 and the separation index was 2.10 and 6.25 for the persons and items, respectively. Both items and persons fitted the statistics model's expectations, ensuring its unidimensionality. CONCLUSIONS The SCI-FCS-Brazil showed adequate measurement properties. Its use in manual wheelchair users with SCI is recommended to help defining rehabilitation strategies.

Research paper thumbnail of Self-management to promote physical activity after discharge from in-patient stroke rehabilitation: a feasibility study

Topics in Stroke Rehabilitation

OBJECTIVES To investigate the feasibility of a self-management program aimed at increasing physic... more OBJECTIVES To investigate the feasibility of a self-management program aimed at increasing physical activity in community-dwelling ambulators after stroke in a middle-income country with high income inequality. METHODS A Phase 1, pre-post intervention study was conducted with 20 sub-acute stroke participants. The self-management program was delivered in six home-based sessions over 3 months. Feasibility of recruitment, intervention, and measurement was determined. Physical activity, cardiovascular risk, depression, walking speed, self-efficacy for exercise, participation, and quality of life were measured at baseline, 3, and 6 months. RESULTS 16% of eligible participants were recruited. 90% completed the program and were measured at 3 months, and 65% at 6 months. The most common reasons for withdrawal were return to work, lack of interest/motivation and surgery. 92% of the sessions were delivered for 59 (SD 23) minutes per session. Participants did not increase physical activity at 3 months (MD 364 steps/day, 95% CI -282 to 1010) or 6 months (MD 312 steps/day, 95% CI -881 to 1504). Post-hoc analysis showed that sedentary participants increased their step count at 3 months by 1,300 (95% CI 152 to 2447) and at 6 months by 1,701 (95% CI -556 to 3959) more steps than non-sedentary participants. CONCLUSIONS A Phase 2 study of the self-management program appears to be feasible in a middle-income country with high income inequality and has the potential to increase physical activity levels in sedentary individuals with mild disability after stroke. TRIAL REGISTRATION RBR-6bdmsk.

Research paper thumbnail of Depressive symptoms and functional status are associated with sleep quality after stroke

Topics in Stroke Rehabilitation

ABSTRACT Objective: To investigate the sleep state and determine whether variables, such as age, ... more ABSTRACT Objective: To investigate the sleep state and determine whether variables, such as age, functional status, walking capacity, fatigue, depressive symptoms, and quality of life were associated with sleep quality of individuals with chronic stroke. Methods: For this exploratory study, the dependent variable was sleep quality, which was measured by the Pittsburgh Sleep Quality Index (PSQI). Step-wise multiple linear regression analysis was employed to identify which of the independent variables, that is, age, functional status (Modified Rankin Scale-mRS), walking capacity (6-minute Walk Test), fatigue (Fatigue Severity Scale), depressive symptoms (Geriatric Depression Scale-GDS), and quality of life (EuroQol) were associated with sleep quality. Results: Ninety participants, 55 (61%) men, who had a mean age of 61 (SD 12) years and a mean time since the onset of the stroke of 58.2 (SD 58.7) months, were included. Sleep quality was significantly associated with depressive symptoms and functional status. Together, they explained 30% of the variance in the PSQI scores (p < .0001). The GDS scores alone explained 22% (F = 25.76; p < .0001) of the variance in sleep quality (PSQI). When mRS scores were included in the model, the explained variance increased to 30% (F = 20,38; p < .0001). Conclusion: Depressive symptoms and functional status, which are both potentially modifiable factors, were associated with the sleep quality of individuals with chronic stroke. It is important to consider the assessment of sleep quality in the context of stroke rehabilitation.

Research paper thumbnail of Adaptação transcultural da Modified Gait Efficacy Scale para indivíduos pós-acidente vascular encefálico

Revista de Terapia Ocupacional da Universidade de São Paulo

A Modified Gait Efficacy scale (mGES) avalia a percepção do indivíduo sobre o seu nível de confia... more A Modified Gait Efficacy scale (mGES) avalia a percepção do indivíduo sobre o seu nível de confiança na marcha, em circunstâncias desafiadoras. Para sua aplicação na população brasileira, é necessário que seja realizada a sua adaptação transcultural. Este estudo objetivou realizar a adaptação transcultural do mGES para uso no Brasil. O processo de adaptação seguiu diretrizes padronizadas, sendo realizado em cinco etapas: tradução, retrotradução, síntese das traduções, avaliação pelo comitê de especialistas e teste da versão pré final. A versão pré final foi aplicada em 12 indivíduos pós-Acidente Vascular Encefálico (AVE), que foram indagados sobre como interpretaram cada item. O processo de adaptação seguiu todas as recomendações propostas, sendo necessárias apenas pequenas alterações em três itens, para possibilitar melhor compreensão. Resultados satisfatórios foram obtidos no teste da versão pré final, uma vez que não houve nenhum problema quanto à redação e clareza dos itens ou a...

Research paper thumbnail of Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke

Stroke Research and Treatment

Aim. To describe exercise preferences and to investigate the contribution of exercise preferences... more Aim. To describe exercise preferences and to investigate the contribution of exercise preferences, walking ability, and current levels of physical activity in predicting exercise adherence in individuals with chronic stroke. Methods. For this exploratory study, exercise adherence was measured using the first question of the first section of the Exercise Preference Questionnaire (stroke)-Brazil (EPQ (stroke)-Brazil). Nine independent variables were included as potential predictors of exercise adherence: the seven factors of the EPQ (stroke)-Brazil, walking speed, and level of physical activity. Results. Participated 93 individuals with stroke, who had a mean age of 62 (SD 12) years and a mean time since the onset of the stroke of 58 (SD 67) months. The most preferable exercise was walking. Logistic regression analysis revealed that self-efficacy to engage in physical exercise and walking ability predicted and explained 80% of the variance in exercise adherence. Conclusion. The findin...

Research paper thumbnail of Perceived barriers to exercise reported by individuals with stroke, who are able to walk in the community

Disability and Rehabilitation

Abstract Purpose To identify the perceived barriers to exercise, which could be modified, as well... more Abstract Purpose To identify the perceived barriers to exercise, which could be modified, as well as the associated factors in people at the sub-acute post-stroke stages, who were able to walk in the community. Methods For this exploratory study, barriers to exercise were identified by the Exercise Barrier sub-scale of the Exercise Benefits/Barriers Scale. Step-wise multiple linear regression analysis was employed to identify which of the clinical and sociodemographic variables, that is, age, walking speed, levels of physical activity, socioeconomic status, and depressive symptoms, could significantly predict the Exercise Barrier sub-scale scores. Results Ninety-five individuals, who had a mean age of 63 (13) years and a mean time since the onset of the stroke of 4 (1) months participated. The main reported barriers to exercise were related to fatigue, as well as availability and distance from the exercise places. Additional reported barriers were “lack of a person to help” and “knowledge on how to practice exercise.” Perceived barriers were associated with depressive symptoms and socioeconomic status. Together, they explained 9% of the variance in the Exercise Barrier sub-scale scores (p < 0.01). Conclusions Fatigue, reduced number of places, and long distances to exercise places were the main reported barriers to exercise. Depressive symptoms and socioeconomic status were the only variables that explained the variance in the Exercise Barrier sub-scale scores. Rehabilitation interventions should include strategies to reduce fatigue during and after exercise, provide guidance regarding both structured and unstructured exercise venues, in addition to screening and managing depressive symptoms. Implications for Rehabilitation Stroke survivors, who are able to walk in the community, should be referred and instructed on how to reduce fatigue through the practice of exercise. Health professionals should guide stroke survivors about the existing places for practice of exercise and how to exercise without structured environments. It is necessary to create or reformulate environments for exercise and provide orientation to practice through qualified professionals. Health professionals should also be able to assess the presence of depressive symptoms and address proper referral and management of the potential barriers to exercise.

Research paper thumbnail of Impacto da fisioterapia na reabilitação do alcance e manipulação de indivíduos hemiparéticos, vítimas de acidente vascular encefálico: o que é evidência?

Fisioterapia Brasil

O objetivo deste artigo é determinar as evidências da intervenção fisioterapêutica, na melhora da... more O objetivo deste artigo é determinar as evidências da intervenção fisioterapêutica, na melhora da função de Alcance e Manipulação de pacientes hemiparéticos, vítimas de Acidente Vascular Encefálico. Metodologia: Uma pesquisa computadorizada foi conduzida nas bases de dados: Medline, Cochrane, PEDro e Pubmed. Estudos Clínicos Aleatorizados (ECA) assim como Estudo Clínico Controlado (ECC), foram incluídos neste estudo. Para a presente revisão, a fisioterapia foi classificada em 6 categorias de intervenção: 1) fisioterapia tradicional, 2) terapia de uso forçado, 3) treinamento de tarefa específica, 4) terapia com biofeedback, 5) terapia com estimulação elétrica funcional – FES, 6) uso de órteses. A qualidade metodológica dos Estudos Aleatorizados foi classificada com a escala PEDro. Resultados: Um total de 31 publicações foi utilizado neste estudo. A qualidade metodológica de todos os Estudos Clínicos Aleatórios (ECA) possuem uma média de 5 pontos na escala de 10 pontos PEDro (4-8 pont...

Research paper thumbnail of Deficits in motor coordination of the paretic lower limb best explained activity limitations after stroke

Physiotherapy theory and practice, Jan 21, 2018

To explore the relationships between selected measures of motor impairments and activities involv... more To explore the relationships between selected measures of motor impairments and activities involving the lower-limbs in ambulatory people with chronic stroke. Motor impairment measures included maximal isometric strength and motor coordination. Activity measures included walking speed, stair ascent/descent cadences, and the time to perform the Timed Up and Go (TUG) test. Ninety individuals were included. The correlations between all motor impairment and activity measures were significant (0.18 < r < 0.52, p < 0.05). Motor coordination and strength of the knee flexor muscles explained 30% (F = 20.3; p < 0.001) of the variance in walking speed, 32% (F = 19.1; p < 0.001) of stair ascent, and 31% (F = 16.8; p < 0.001) of stair descent cadence. Regarding the TUG, only motor coordination reached significance and explained 13% (F = 13.4; p < 0.001) of the variance. Measures of strength and motor coordination of the paretic lower limb were significantly correlated with ...

Research paper thumbnail of Caracterização da participação social de indivíduos na fase crônica pós-acidente vascular encefálico

Revista de Terapia Ocupacional da Universidade de São Paulo

O objetivo foi descrever e comparar diferenças na restrição na participação social de indivíduos ... more O objetivo foi descrever e comparar diferenças na restrição na participação social de indivíduos após acidente vascular encefálico (AVE) na fase crônica, considerando as deficiências, limitações em mobilidade e fatores pessoais. A restrição na participação social foi mensurada pelo LIFE-H 3.1-Brasil; as deficiências pela Escala de Depressão Geriátrica e Escala de Fugl-Meyer (EFM); as limitações em mobilidade pela velocidade de marcha e Timed Up & Go (TUG) e os fatores pessoais incluíram sexo, idade, situação familiar e tempo de evolução pós-AVE. Observou-se restrição significativa na área de recreação. Em geral, restrições na participação social foram observadas em participantes com escores ≤28 na EFM-membro inferior, sintomas de depressão, marcha comunitária limitada, risco de quedas e tempo de evolução ≤5 anos. Aqueles com escores ≤45 na EFM-membro superior apresentaram maior restrição em algumas áreas das atividades diárias. As mulheres apresentaram maior restrição em papéis soci...

Research paper thumbnail of Comparison between parameters of muscle performance and inflammatory biomarkers of non-sarcopenic and sarcopenic elderly women

Clinical interventions in aging, 2017

Sarcopenia is a multifactorial geriatric syndrome with complex interrelationships. Increased plas... more Sarcopenia is a multifactorial geriatric syndrome with complex interrelationships. Increased plasma levels of inflammatory mediators increase the catabolic stimuli of the musculature, thereby causing a decrease in mass and muscular function. The objective of this study was to compare the performance of the knee extensors test (by isokinetic dynamometer) and plasma levels of interleukin-6 (IL-6) and soluble receptors of tumor necrosis factor alpha (sTNFR1) between sarcopenics and non-sarcopenics community-dwelling elderly women residents of Brazil. The diagnosis of sarcopenia included measurements of body composition (by densitometry with dual energy source of X-ray), handgrip strength (by Jamar(®) dynamometer), and the usual gait velocity according to the recommendations of the European Working Group on Sarcopenia in Older People. In both sarcopenics and non-sarcopenics elderly women, we evaluated the muscle function by knee extensors test (using an isokinetic dynamometer Byodex Sys...

Research paper thumbnail of Efficacy of Task-Specific Training on Physical Activity Levels of People With Stroke: Protocol for a Randomized Controlled Trial

Physical Therapy, 2017

Background. The majority of people after stroke demonstrate mobility limitations, which may reduc... more Background. The majority of people after stroke demonstrate mobility limitations, which may reduce their physical activity levels. Task-specific training has been shown to be an effective intervention to improve mobility in individuals with stroke, however, little is known about the impact of this intervention on levels of physical activity. Objectives. The main objective is to investigate the efficacy of task-specific training, focused on both upper and lower limbs, in improving physical activity levels and mobility in individuals with stroke. The secondary objective is to investigate the effects of the training on muscle strength, exercise capacity, and quality of life. Design. This is a randomized controlled trial. Setting. The setting is public health centers. Participants. Community-dwelling people with chronic stroke. Interventions. Participants will be randomized to either an experimental or control group, who will receive group interventions 3 times per week over 12 weeks. The experimental group will undertake task-specific training, while the control group will undertake global stretching, memory exercises, and health education sessions. Measurements. Primary outcomes include measures of physical activity levels and mobility, whereas secondary outcomes are muscle strength, exercise capacity, and quality of life. The outcomes will be measured at baseline, postintervention, and at the 4-and 12-week follow-ups. Conclusions. The findings of this trial have the potential to provide important insights regarding the effects of task-specific training, focused on both upper and lower limbs, in preventing secondary poststroke complications and improving the participants' general health through changes in physical activity levels.

Research paper thumbnail of Measurement properties of self-report physical activity assessment tools in stroke: a protocol for a systematic review

BMJ Open, 2017

Introduction: Self-report physical activity assessment tools are commonly used for the evaluation... more Introduction: Self-report physical activity assessment tools are commonly used for the evaluation of physical activity levels in individuals with stroke. A great variety of these tools have been developed and widely used in recent years, which justify the need to examine their measurement properties and clinical utility. Therefore, the main objectives of this systematic review are to examine the measurement properties and clinical utility of self-report measures of physical activity and discuss the strengths and limitations of the identified tools. Methods and analysis: A systematic review of studies that investigated the measurement properties and/or clinical utility of self-report physical activity assessment tools in stroke will be conducted. Electronic searches will be performed in five databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) (PubMed), Excerpta Medica Database (EMBASE), Physiotherapy Evidence Database (PEDro), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SciELO), followed by hand searches of the reference lists of the included studies. Two independent reviewers will screen all retrieve titles, abstracts, and full texts, according to the inclusion criteria and will also extract the data. A third reviewer will be referred to solve any disagreement. A descriptive summary of the included studies will contain the design, participants, as well as the characteristics, measurement properties, and clinical utility of the self-report tools. The methodological quality of the studies will be evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist and the clinical utility of the identified tools will be assessed considering predefined criteria. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Discussion: This systematic review will provide an extensive review of the measurement properties and clinical utility of self-report physical activity assessment tools used in individuals with stroke, which would benefit clinicians and researchers.

Research paper thumbnail of Handgrip strength deficits best explain limitations in performing bimanual activities after stroke

Journal of Physical Therapy Science, 2016

To evaluate the relationships between residual strength deficits (RSD) of the upper limb muscles ... more To evaluate the relationships between residual strength deficits (RSD) of the upper limb muscles and the performance in bimanual activities and to determine which muscular group would best explain the performance in bimanual activities of chronic stroke individuals. [Subjects and Methods] Strength measures of handgrip, wrist extensor, elbow flexor/extensor, and shoulder flexor muscles of 107 subjects were obtained and expressed as RSD. The performance in bimanual activities was assessed by the ABILHAND questionnaire. [Results] The correlations between the RSD of handgrip and wrist extensor muscles with the ABILHAND scores were negative and moderate, whereas those with the elbow flexor/extensor and shoulder flexor muscles were negative and low. Regression analysis showed that the RSD of handgrip and wrist extensor muscles explained 38% of the variance in the ABILHAND scores. Handgrip RSD alone explained 33% of the variance. [Conclusion] The RSD of the upper limb muscles were negatively associated with the performance in bimanual activities and the RSD of handgrip muscles were the most relevant variable. It is possible that stroke subjects would benefit from interventions aiming at improving handgrip strength, when the goal is to increase the performance in bimanual activities.

Research paper thumbnail of Lower Extremity Motor Coordination Test: Valores Normativos e Propriedades Psicométricas

Brazilian Journal of Physical Therapy, 2010

Contextualizacao: As alteracoes morfofuncionais inerentes ao processo de envelhecimento humano qu... more Contextualizacao: As alteracoes morfofuncionais inerentes ao processo de envelhecimento humano quando associadas a doencas cronicas, podem levar a diminuicao da independencia fisica e mental do idoso. Objetivo: Investigar a funcao cognitiva e capacidade funcional em idosos hipertensos (GH) e normotensos (GN). Metodo: Estudo observacional, analitico e transversal, com 56 idosos divididos em dois grupos GH (n=42) e GN (n=14) avaliados atraves do Mini Exame do Estado Mental (MEEM), Questionario Internacional de Atividade Fisica (IPAQ) e Bateria de testes de aptidao fisica (Functional Fitness Test). Analise estatistica: Os dados foram avaliados utilizando teste t Student, teste Qui-quadrado e teste de correlacao de Pearson, atraves do SPSS 17.0, sendo atribuido nivel de significância de 5% para todos os testes. Resultados: Nao houve correlacao significativa, entre os grupos GH e GN, quanto ao deficit cognitivo (p=0,08) e a forca de MMII (p=0,08), ja para endurance aerobica – TME2 – houve correlacao negativa (r=-0,31; p=0,02). Em relacao aos testes de flexibilidade de MMSS e MMII houve correlacao negativa moderada entre os grupos (r=-0,62; p<0,001, para MMSS; r=-0,39; p=0,003, para MMII) e correlacao positiva moderada para agilidade e equilibrio – TUG (r=0,38; p=0,004). Foi encontrada diferenca significativa para o nivel de atividade fisica entre GH e GN com p<0,001. Conclusao: A hipertensao arterial afeta diretamente o idoso na medida em que limita a capacidade do individuo de realizar suas atividades basicas de forma independente, diminuindo a mobilidade funcional, principalmente, se associada a outras comorbidades e a habitos de vida nao saudaveis, porem nao influencia na funcao cognitiva.

Research paper thumbnail of Barreiras e Limitações À Implementação Da Prática Baseada Em Evidências Na Reabilitação Após Ave

Fisioterapia Saude Funcional, Jun 27, 2014

Clinicos e responsaveispela elaboracao de politicas de saude tem como objetivo a melhora da quali... more Clinicos e responsaveispela elaboracao de politicas de saude tem como objetivo a melhora da qualidadee eficiencia do cuidado a saude. Para que este objetivo seja alcancado,evidencias de pesquisa constituem a ferramenta necessaria. A demanda e ointeresse na implementacao da evidencia na pratica da fisioterapia apos AcidenteVascular Encefalico (AVE) tem crescido significativamente nas ultimas decadas.Isto tem sido demonstrado, em parte, pelo crescente numero de publicacoes derevisoes sistematicas registradas na base de dados de evidencias emfisioterapia PEDro (Physiotherapy Evidence Database). Mais de 300 revisoessistematicas relacionadas a reabilitacao apos AVE foram publicadas ate os diasde hoje. A integracao da experiencia clinica individual com amelhor evidencia clinica de pesquisa sistematica disponivel define a PraticaBaseada em Evidencias. E desejavel que o clinico considere a evidencia de umaforma natural e consistente.

Research paper thumbnail of Short- and long-term training effects on motor and functional performances of community-dwelling individuals with chronic stroke

European Journal of Physiotherapy, 2015

Abstract Objective: This study aimed to evaluate the short- and long-term effects (1 year follow-... more Abstract Objective: This study aimed to evaluate the short- and long-term effects (1 year follow-up) of a combined program of strengthening and aerobic conditioning on measures of impairment and activity in individuals with chronic stroke. Methods: A prospective, observational study embedded within a trial was conducted. Measures of impairment (strength of the trunk and lower limb muscles) and activity (gait speed, gait capacity and ability to manage stairs) of 23 individuals with chronic stroke were reassessed 1 year after the cessation of the training. Repeated measure ANOVAs, followed by planned contrasts, were used for analyses. Results: Significant training effects were found for all outcome measures (3.81 > F > 93.5, 0.0001 > p > 0.04). The gains in strength of the paretic and non-paretic lower limbs were not maintained and returned to baseline levels after 1 year follow-up. However, the gains in all activity measures remained. Conclusions: These findings support the short- and long-term benefits of a combined program of muscular strengthening and physical conditioning for individuals with chronic stroke with high functional levels, since the gains associated with the training were maintained after the 1 year follow-up for all studied variables, except for the strength of the paretic and non-paretic lower limbs.

Research paper thumbnail of Measurement properties of the lower extremity motor coordination test in individuals with stroke

Journal of rehabilitation medicine, Jan 15, 2015

To evaluate the construct validity, inter- and intra-rater reliabilities, best scoring method and... more To evaluate the construct validity, inter- and intra-rater reliabilities, best scoring method and testing methods (direct vs video observations), and to determine the smallest real difference (SRD) and standard error of the measurement (SEM) of the lower Extremity Motor Coordination Test (LEMOCOT). Methodological study. Thirty-six stroke subjects. Outcomes include measures of motor recovery, muscular tone, strength, motor coordination, foot tactile sensation, and gait speed. The LEMOCOT scores were able to discriminate between stroke individuals from those predicted for healthy subjects, between the paretic and non-paretic limbs for both the sub-acute and chronic groups and differentiated between individuals with different functional levels and degrees of motor recovery. For the intra- and inter-rater reliabilities, very high and significant coefficients were found for both the paretic and non-paretic lower limbs for both groups (intra-class correlation coefficients (ICC) > 0.97,...

Research paper thumbnail of Tai Chi improves balance and prevents falls in people with Parkinson's disease

Journal of physiotherapy, 2015

Research paper thumbnail of Cardiorespiratory Stress is not Achieved During Routine Physiotherapy in Chronic Stroke

International Journal of Physical Medicine & Rehabilitation, 2014

Background: Cardiorespiratory deconditioning is a well-established sequel of stroke and this may ... more Background: Cardiorespiratory deconditioning is a well-established sequel of stroke and this may interfere with integration into community. In the chronic phase, when motor recovery has plateaued, rehabilitation should include cardiorespiratory training. Objective: To determine whether physiotherapy rehabilitation in the chronic phase of stroke provides enough stress in terms of duration (>10 min) and intensity (>40% of heart rate reserve-HRR) to induce cardiorespiratory benefits. Methods: Two physiotherapy sessions, at least one week apart, of 20 chronic stroke patients (mean time since the onset of the stroke of 26 months, mean age of 58 years, 45% male) were observed, in terms of duration (time) and intensity (40 %HRR). The activities were categorized as upper limb tasks, standing, stepping, basic walking, and advanced walking. Average duration and intensity for each participant across the two sessions were determined. Results: Lower limb activities, such as standing and walking were undertaken for 25 (SD 5) minutes; comprising 57% of the total session. The remainder of the session was taken up with upper limb activities (27%) or inactivity (16%). None of the activities reached the target intensity, with the highest average intensity being achieved during advanced walking (mean 32% HRR, SD 2). Conclusions: Routine physiotherapy did not provide sufficient duration or intensity to induce cardiorespiratory stress in this group of chronic stroke patients. The evidence practice gap needs to be closed for cardiorespiratory fitness to be trained.