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To evaluate the additive effect of Transcranial Direct Current Stimulation (tDCS) associated with multi-component training (MT) on the functional capacity (FC) of older adults and to assess whether these effects remain after the end of training. The secondary objectives were to evaluate the locomotion capacity, balance, functional independence, and quality of life and correlate them with functional capacity.Twenty-eight older adults were randomized into two groups: experimental (MT associated with active tDCS - a-tDCS) and control (MT associated with sham tDCS - s-tDCS). The FC was measured by the Glittre-ADL test, locomotion capacity by the 6-minute walk test, balance by the BESTest, functional independence by the FIM, and quality of life by the WHQOL. The assessments were performed pre-, post-intervention, and 30-day follow-up.There was a significant decrease in the time to the Glittre-ADL test when comparing the a-tDCS and s-tDCS groups after the interventions (139.77 ± 21.62, 205.10 ± 43.02, p .001) and at the 30-day follow-up (142.74 ± 17.12, 219.55 ± 54.05, p .001), respectively. There was a moderate correlation between FC and locomotion capacity and balance.The addition of tDCS potentiated the results of MT to impact FC, maintaining the positive results longer. Locomotion and balance influenced the improvement of functional capacity.

To classify functional capacity of people with difficult-to-treat asthma based on the International Classification of Functioning, Disability and Health (ICF).Fifty-seven patients underwent the Incremental Shuttle Walk Test (ISWT) to assess functional capacity, in order to categorize them functionally we used the ICF qualifiers. To qualify ISWT results the individual's impairment (i.e. percentage of distance walked in relation to the percentage of predicted) was analyzed. Additionally, body mass index (BMI); physical activity level (IPAQ); and pulmonary function were evaluated. In order to analyze the difference between functional capacity levels, two groups were compared (i.e. mild/moderate vs. severe impairment); therefore, the participants were matched according to age and BMI and the unpaired Student t test was used.Among the fifty-seven included individuals, only one (1.8%) presented mild functional capacity limitation, 12 (21.1%) moderate limitation and 44 (77.2%) severe limitation. There was a significant difference between the ISWT distance between groups (F = 0.217, p .001). The other variables did not present differences between the mild/moderate and severe groups.The ICF qualifiers were able to categorize the ISWT and classified the functional capacity limitation as mild, moderate and severe. Therefore, it has proved to be a useful clinical tool for evaluation, follow-up and clinical decision-making.

Objetivo: Sintetizar as possibilidades de utilização da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) na saúde da criança. Métodos: O processo de revisão seguiu as recomendações do PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A revisão foi realizada nas bases de dados MEDLINE (Pubmed), LILACS e SciELO, compreendendo estudos em inglês, português ou espanhol, publicados até 2018. Resultados: Foram identificados 2375 estudos, destes, 1145 foram excluídos por duplicidade, restando 1230 para análise. Ao final, 29 artigos foram eleitos para a elaboração deste estudo. Foi possível observar grande diversidade de utilização da CIF, desde uso como desfechos de ensaios clínicos, uso do modelo biopsicossocial e uso de conceitos e categorias da CIF. Todos os componentes da CIF foram citados dentre os estudos, com maior ênfase para o componente de funções corporais e atividade e participação. Conclusões: A CIF é uma ferramenta importante e útil para a classificação da funcionalidade de crianças de forma holística em ensaios clínicos, estudos observacionais e na prática clínica. Além disso, é possível fazer acompanhamento evolutivo do desenvolvimento infantil a partir dos qualificadores da CIF.

BACKGROUND: SATIS-Stroke questionnaire has been translated and adapted for use in the Brazilian population, however, it is necessary to test the measurement properties in Brazilian population. OBJECTIVE: To test the reliability, agreement, concurrent validity, and diagnostic accuracy of the SATIS-Stroke. METHODS: Chronic stroke survivors were included. The calculations were made using scores in logits (Rasch Model). Reliability was tested using the intraclass correlation coefficient (ICC(2,1)), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plots. Concurrent validity was analyzed using Spearman's correlation coefficient. For such, the correlation between SATIS-Stroke and Stroke Specific Quality of Life (SS-QOL) questionnaires was determined. Diagnostic accuracy was estimated based on the area under the receiver operating characteristic (ROC) curve with a 95% confidence interval and considering the sensitivity and specificity of SATIS-Stroke in differentiating different types of activity and participation. RESULTS: Eighty stroke survivors were analyzed. Mean age was 57.98±13.85 years and 45.2% had severe impairment. Excellent reliability was found (intra-observer ICC(2,1) = 0.90; 95% CI: 0.84, 0.93; inter-observer ICC(2,1) = 0.89; 95% CI: 0.83, 0.93). The Bland-Altman plot demonstrated satisfactory agreement. In the analysis of concurrent validity, a strong, positive, significant correlation was found between SATIS-Stroke and SS-QOL (r(s) = 0.74; p

to map and synthesize the results from studies that assessed whether individuals diagnosed with cerebral palsy (CP) have abnormal masseter and temporal muscles activation during the masticatory cycle. Six databases were searched for comparative observational studies assessing masticatory muscles activation in individuals with CP through electromyography analysis. Methodological quality was evaluated using the Joanna Briggs Critical Appraisal Checklist. Outcome data were combined in meta-analysis using the Review Manager software. We included five cross-sectional studies with an overall low risk of bias. Meta-analyses showed no difference between CP and healthy individuals regarding maximum voluntary isometric contraction: right masseter (Standard mean difference [SMD] − 0.95; 95% CI −2.03 to 0.13); left masseter (SMD −0.92; 95% CI −1.93 to 0.09); right temporal (SMD −0.72; 95% CI −1.63 to 0.18); and left temporal (SMD −0.68; 95% CI −1.76 to 0.40). Electrical activity amplitude in the inactive period was superior in the CP group, and maximum bite pressure presented higher values in the control group (Mean difference [MD] − 17.38; CI 95% −26.62 to −10.15). Based on observational studies with a lower level of evidence, individuals with CP seem to present difficulties activating masticatory muscles. Future prospective cohort studies with rigorous methodology are still necessary to support these findings. PROSPERO register CRD42020208444.

To analyze WHODAS 2.0's diagnostic capacity and accuracy in stroke survivors.Cross-sectional methodological study, in which individuals with chronic stroke were evaluated. Disability was considered the outcome variable, being evaluated by WHODAS 2.0; the modified Rankin scale (mRS) was used as the parameter variable. Disability was categorized in two levels being: "No or mild disability" (mRS 0-2) and "Moderate to severe disability" (mRS 3-5). To identify the cutoff point, a Receiver-Operating Characteristic (ROC) curve was constructed with a confidence interval (CI) of 95% and considering sensitivity and specificity.The cutoff point39.62 proved acceptable for distinguishing individuals with moderate/severe disability from individuals with no or mild disability (≤39.62 points), with 66.22% sensitivity, 72.41% specificity, positive predictive value (PPV) of 45.45%, and negative predictive value (NPV) of 84.74%. The area under the curve (AUC) was 0.747 (CI 95%: 0.65-0.83;WHODAS 2.0 demonstrated acceptable diagnostic capacity and the cutoff point of 39.62 proved suitable for distinguishing individuals with moderate/severe disability from those with no or mild disability after stroke.Implications for rehabilitationWHODAS 2.0 demonstrated acceptable diagnostic capacity.The WHODAS 2.0 cut-off point of39.62 allows stratification of post-stroke disability into two different levels (no/mild disability versus moderate/severe disability).These results facilitate clinical decision-making by rehabilitation professionals.

A escolha do instrumento adequado é decisiva para o sucesso da avaliação funcional e reabilitação. Diante disto, é necessário que o profissional tenha amplo conhecimento dos instrumentos disponíveis para que possa optar pela avaliação mais eficaz, menos onerosa e mais rápida. Objetivo: Analisar se a classificação da deambulação obtida pela Functional Ambulation Classification (FAC) se associa com o desempenho obtido no Teste de Caminhada de 10 metros (TC10M). Métodos: Estudo transversal no qual foram avaliados 61 indivíduos acometidos pelo Acidente Vascular Cerebral (AVC). Utilizou-se o TC10M e a FAC. Para verificar a normalidade dos dados foi utilizado teste Kolmogorov – Smirnov. Foi utilizado o ANOVA de uma via para verificar se houve diferença dos deambuladores dependentes e independentes conforme a FAC com a velocidade da marcha por meio do TC10M. Foi realizado um teste post hoc e o método de Scheffe, considerando p≤0,05. Para analisar a associação da categorização da deambulação com a velocidade da marcha, foi o utilizado o teste do qui-quadrado de independência. Resultados: Houve diferença significante de cada nível da FAC em relação a velocidade da marcha. Houve associação entre as classificações obtidas pela FAC e pelo TC10m [x2(9) = 145,335; p=0,001]; sendo que em 48% as variáveis estão corretamente associadas. Conclusão: Os achados indicaram que os níveis da FAC apresentaram associação com a velocidade da marcha. Este achada amplia os conhecimentos sobre medidas de avaliação da marcha e auxilia a prática clínica, considerando que facilita a escolha do melhor instrumento para avaliar a marcha após AVC.

Objetivo: Abordar os efeitos da terapia com realidade virtual em crianças e adolescentes com Paralisia Cerebral de acordo com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Com intuito de reunir dados que elucidem como a aplicação da CIF pode resultar em melhor compreensão das características apresentadas em uma situação de saúde. Métodos: Os artigos foram pesquisados nas plataformas MEDLINE (Pubmed), PEDro, LILACS e SCIELO, publicados até maio de 2019. A escala de qualidade PEDro (Physioterapy Evidence Database) foi utilizada como método de avaliação de qualidade dos artigos, sendo incluídos artigos com nota ≥ 6 (seis) no PEDro. Resultados: Seis artigos foram incluídos nesta revisão. De maneira geral, observou-se resultados significantes quanto às “Funções corporais” relacionadas à melhora da função de membros superiores e inferiores, após intervenção com RV, quando comparados a terapia convencional. No domínio “Atividade” observou-se resultados na marcha, equilíbrio e habilidades motoras globais de crianças com PC após intervenção com RV. Conclusão: Os efeitos da Realidade Virtual em crianças com PC relacionados a CIF são positivos, mas foram encontrados mais resultados associados ao domínio “Funções corporais” e “Atividade”, assim, sugere-se que sejam feitos mais estudos para verificar os efeitos da RV quanto à “Participação” e “Fatores ambientais”.

Background/aims This study aimed to estimate the discriminatory power of 26 items on the Stroke Specific Quality of Life Scale questionnaire to evaluate the participation component of the International Classification of Functioning, Disability and Health. Methods A prospective study was conducted using accuracy procedures based on the Standards for Reporting Diagnostic Accuracy Studies to evaluate individuals with hemiparesis stemming from a stroke. Discriminatory power was estimated based on the area under the receiver operating characteristic curve with a 95% confidence interval. Two groups were defined for the analysis: community-dwelling and institutionalised individuals. A 5% level of significance (α=0.05) was considered for all analyses. Results The area under the receiver operating characteristic curve was 0.888 (95% confidence interval: 0.794–0.949; P=0.001). Analysis indicated a cut-off point of ≥80 with 73.9% sensitivity and 100% specificity. Conclusions The 26 items of the Stroke Specific Quality of Life questionnaire that evaluate the participation component of the International Classification of Functioning, Disability and Health demonstrate adequate discriminatory power. A cut-off point of ≥80 seems to best discriminate the perception of participation between community-dwelling and institutionalised stroke survivors.

Thirty patients with hemiparesis stemming from a stroke and 20 healthy peers were evaluated. Reproducibility was determined using the intraclass correlation coefficient (ICC), standard measurement error (SME), minimum detectable change (MDC), and Bland-Altman analysis. For construct validity, the Glittre ADL test was correlated with the Six-Minute Walk Test (6MWT), Timed Up and Go Test (TUG), and Functional Independence Measure (FIM), and analyzed based on convergent validity and the comparison of known groups (stroke survivors and healthy peers).Intra- and inter-observer reliability were excellent (ICCThe Glittre ADL test is valid for assessing functional capacity in stroke patients. It demonstrated good convergent and construct validity and excellent intra- and inter-observer reproducibility.

Background SATISPART-Stroke (SATIS-Stroke) is the most complete instrument for the assessment of activity and participation following a stroke. However, its use in a developing country has only been tested through in-person interviews. Objective To determine the validity, reproducibility and viability of the SATIS-Stroke scale administered in two tele-assessment modalities: self-assessment of an electronic form versus videoconference. Methods Methodological study with Brazilian chronic stroke survivors was conducted. Stage I comprised an in-person interview to apply the SATIS-Stroke and a self-assessment by completing an electronic form to respond to the SATIS-Stroke items. Step II occurred 6 to 8 months after Step I, during which SATIS-Stroke was administered again in-person and via videoconference. The order was randomized. Results Ninety-five stroke survivors were recruited, but only 50 answered the electronic form (adherence: 52.6%). Mean scores were higher in the self-administration of electronic form compared to the in-person interview (mean difference = −0.36 ± 0.93; P = 0.009). Adequate reliability was found in the comparison of the in-person and self-assessment of electronic form (ICC2,1 = 0.66; 95%CI: 0.40–0.81). Fifty stroke survivors participated in Step II, during which adequate reliability was found in the comparison of the in-person administration and videoconference (ICC2,1 = 0.55; 95%CI: 0.21–0.74) and a moderate correlation was found between the assessment methods ( r = 0.43; P = 0.02). Discussion Adequate validity and reliability were found in the tele-assessment. Thus, this method is appropriate and viable for use in developing countries. Although reliable, the self-assessment did not have good adherence in the Brazilian population due to internet access problems, lack of familiarity with the digital form and lack of autonomy to answer the questions alone.

BACKGROUND: The PM-Scale was developed specifically to assess participation in individuals after stroke based on the concepts contained in the International Classification of Functioning, Disability and Health. However, this measure is only available in English and French. OBJECTIVE: To translate and cross-culturally adapt the PM-Scale to Brazilian Portuguese, followed by the validation and testing of reliability of the translated version. METHODS: The translation process followed standard guidelines. Preliminary test-retest reliability was determined using the intraclass correlation coefficient (ICC(2,1)). The Rasch model was employed to analyse the validity, unidimensionality, invariance, and internal consistency of the Brazilian version of the PM-Scale. RESULTS: The final translated version of the PM-Scale presented appropriate semantic, idiomatic, cultural, and conceptual equivalence. The preliminary analysis revealed excellent intra-observer and inter-observer reliability (ICC(2,)(1) = 0.91; 95%CI: 0.83, 0.95 and ICC(2,)(1) = 0.81; 95%CI: 0.64, 0.89, respectively). The analysis of the Rasch model revealed only one erratic item. An excellent overall fit was found for items (mean ± SD = 0.01 ± 1.02) and adequate fit was found for persons (mean ± SD = 1.16 ± 0.88). Internal consistency was considered adequate (person separation index = 1.77, reliability = 0.76). No significant invariance was found with regards to the personal characteristics of the sample (p > 0.05). CONCLUSION: The Brazilian version of the PM-Scale is a valid, unidimensional, linear, reliable scale for measuring participation in stroke survivors and can be administered in less than five minutes.

Propose a way of coding and qualifying HRQoL following a stroke using the codes and qualifiers of the International Classification of Functioning, Disability and Health (ICF).An observational, cross-sectional study was conducted involving 51 individuals with hemiparesis resulting from a stroke. ICF codes related to the Stroke Specific Quality of Life (SS-QOL) scale were listed and subsequently classified using the generic ICF qualifiers, which range from .0 - no impairment to .4 - complete impairment. A simple mathematic calculation was proposed to convert the SS-QOL scores into ICF qualifiers.The use of the ICF qualifiers revealed that the individuals exhibited a moderate level (.2) of quality of life, with mild impairment (.1) regarding upper limb function, language, self-care, and vision as well as severe impairment (.3) regarding social relations.The proposal presented in this study allowed qualifying 43 ICF codes related to quality of life after a stroke in a simple, standardized manner, enabling the identification of different levels of impairment on each of the domains of the SS-QOL scale. This coding standardizes the evaluation, facilitates communication between healthcare providers, and systematizes the collection of data and information on health.Implications for rehabilitationProposal for qualifying concepts related to body functions, activityparticipation, and environmental factors in a simple, standardized manner.The proposed mathematic calculation is simple and easy to understand, which minimizes the occurrence of errors.Possibility to identify different levels of impairment in each of the domains of the Stroke Specific Quality of Life scale, facilitating the establishment of individualized, longitudinal care.The ICF codes standardize the evaluation, facilitate communication between healthcare providers, and systematize the collection of data and information on health and functioning.

Identify how environmental barriers and facilitators are associated with disability in stroke survivors.An analytical, cross-sectional study was conducted involving individuals in the chronic stage of stroke. The dependent variable was disability, which was assessed using the World Health Organization Disability Assessment Schedule (WHODAS-2.0). Environmental factors (independent variable) were evaluated using the Measure of the Quality of the Environment (MQE). Multiple linear regression analysis was performed to estimate the impact of the environment on disability following a stroke.Seventy-five individuals (mean age: 54.2 + 9.8 years) were analyzed. The most frequent environmental facilitators were related to technology, social networks, and public services. The main barriers were related to the physical environment. Environmental barrier was a predictor of both overall disability [F(1.73) = 4.24; REnvironmental barriers explained 13% of the variation in restrictions to social participation and were also a significant predictor of overall disability. The main barriers were related to the physical environment. Identifying environmental factors related to disability in stroke victims can assist in the planning of guided therapy.

O fator ambiental constitui o ambiente físico, social e atitudinal em que indivíduo vive e conduz sua vida, incluindo barreiras e/ou facilitadores. A qualidade de vida é um construto amplo que envolve vários fatores, dentre eles o ambiental. A relação entre qualidade de vida relacionada à saúde (QVRS) após Acidente Vascular Cerebral (AVC) e fatores ambientais ainda é pouco explorada. Conhecer essa relação pode facilitar o processo de avaliação e planejamento de intervenções para melhora da QVRS desses indivíduos. Objetivo: Investigar a associação entre fatores ambientais e QVRS de indivíduos com AVC, na fase crônica, usuários da atenção primária à saúde de Belo Horizonte (BH)/Brasil. Métodos: Fatores ambientais foram avaliados pelo Measure of the Quality of Environment (MQE) e a QVRS pela Escala de Qualidade de Vida Específica para Acidente Vascular Encefálico (EQVE-AVE). Correlação de Spearman foi utilizada para investigar a associação entre fatores ambientais e QVRS (escore total e dos domínios do EQVE-AVE) (α=5%). Resultados: Foram encontradas associações significantes, negativas e de fraca magnitude entre fatores ambientais considerados como obstáculos com o escore total do EQVE-AVE (p =0,001; rho = -0,33) e com os domínios de mobilidade (p =0,01 rho = -0,33) e trabalho/produtividade do EQVE-AVE (p =0,03; rho = -0,28). Conclusão: Fatores ambientais e QVRS possuem associação significante, ainda que seja de fraca magnitude. Portanto, fatores ambientais considerados como obstáculos, devem ser considerados na abordagem da QVRS de indivíduos na fase crônica após AVC, usuários da atenção primária à saúde do Brasil. Quality of life is a broad and comprehensive construct that involves several factors, including the environmental factor. However, the relationship between health-related quality of life (HRQoL) of individuals after stroke and environmental factors is still poorly understood. Knowing this relationship can facilitate the process of evaluating and planning interventions to improve HRQoL of these individuals. Objective: To investigate the association between environmental factors and HRQoL of individuals after stroke who use the primary health care in Belo Horizonte/Brazil. Methods: Environmental factors were assessed by the Measure of the Quality of Environment (MQE) and the HRQoL by the Stroke Specific Quality of Life Scale (SS-QOL). Spearman's correlation was used to investigate the association between environmental factors and HRQoL (total score and SS-QOL domains) (α = 5%). Results: Significant, negative and low associations were found between environmental factors considered as obstacles with the total SS-QOL score (p = 0.001; rho = -0.33), with the mobility (p = 0.01 rho = -0.33) and work/productivity domains of the HRQoL(p = 0.03; rho = -0.28). Conclusion: Therefore, environmental factors and HRQoL have a significant association, even if it is of low magnitude. Thus, environmental factors considered as obstacles, should be considered, along with other factors related to health and functioning when addressing the HRQoL of individuals in the chronic phase after stroke who use the Brazilian primary health care system.

Purpose: Transcranial Direct Current Stimulation (tDCS) is an intervention that seems to be an ideal tool to enhance the effects of rehabilitation therapies given it facilitates generation of plasticity in the stimulated brain area. In stroke this strategy has been highly utilized; however, the results have been mixed. In this trial we have evaluated the analgesic and functional effects of Transcranial Direct Current Stimulation (tDCS) combined with physiotherapy in stroke survivors with shoulder pain.Methods: Twenty-six stroke surviving adults with shoulder pain received 10 sessions of passive mobilization and performed upper limb exercises using a cycle ergometer, combined with active or sham tDCS. The intensity of pain in the hemiplegic shoulder was measured using the Visual Analog Scale (VAS); secondary outcomes were the level of motor impairment, handgrip strength, range of motion, motor function of the upper limbs, and quality of life (QOL) assessed before and after 10 sessions and 1 month after the end of the treatment.Results: A clinically important pain reduction (3 points) was found in both groups and was maintained at follow-up; there was no significant difference between groups (p = 0.3). Similarly, the shoulder range of motion improved, motor function and quality of life improved showed no significant differences between groups. One result that needs to be underscored is that both groups had a significant effect size toward improvement in all of these outcomes.Conclusions: We discuss in this study that tDCS is not a useful combination strategy when the physical therapy has a large effect by itself and we also review other negative trials of combined therapy under this framework of ceiling effect of the main physical therapy.Trial registry: Trial registration: Brazilian Registry of Clinical Trials, RBR-8F5MNY (http://www.ensaiosclinicos.gov.br/rg/RBR-8f5mny/). Registered on June 2, 2017.Beginning of the recruitment of the volunteers: august, 2017.

Aims: This study aims to evaluate the additional effect of anodal transcranial direct current stimulation (a-tDCS) applied on dorsolateral pré-frontal cortex on training postural balance with the use of video games in the aged. Methods: This is a blinded, randomized, controlled clinical trial protocol, with older people of both genders. Participants will be randomized into three training groups: Group 1 (videogame balance training), group 2 (videogame balance training associated with anodal tDCS), group 3 (videogame balance training associated with sham tDCS). The training will be carried out twice a week for four weeks, totaling eight sessions, and will be performed with the Nintendo Wii videogame console, using games that stimulate the postural balance associated with tDCS, with anode applied over the left dorsolateral prefrontal cortex and cathode on the contralateral supraorbital region at 2 mA for 20 minutes. The postural balance will be assessed using the Mini Test of the Balance Assessment System and posturography. Evaluations will be carried out before and after eight training sessions and 30 days after the end of treatment. Discussion: Some studies show favorable results from the use of video games in improving postural balance in older people; however, their effect does not remain long-term. TDCS associated with other therapies can potentiate and prolong the effects of these therapies owing to its ability to stimulate neurotrophins important for neurogenesis, facilitating tasks that require attention, and helping to consolidate learning and memory. The effect of the two associated techniques on balance has not yet been tested in this population. Registration: Brazilian Registry of Clinical Trials ID U1111-1213-4266; registered on 15 October 2018.

Purpose: The study aimed to analyse the association between the environment in two different Brazilian metropolises (Sao Paulo and Belo Horizonte) and disability after a stroke. Method: A cross-sectional study was conducted involving individuals with chronic hemiparesis resulting from a stroke and residing in either Sao Paulo or Belo Horizonte. The environment (city of residence) was considered an independent variable and disability (modified Rankin scale) was the dependent variable. The following clinical and demographic covariates were considered: age, number of comorbidities, socio-economic class, motor impairment (Fugl-Meyer scale), emotional functioning (Geriatric Depression Scale) and walking ability (10-metre walk test). Results: A total of 114 individuals were analysed - 51 from Sao Paulo (SP) and 63 from Belo Horizonte (BH). No association was found between the environment in which the individual resides and the degree of disability (OR = 1.436; 95%CI: 0.547 - 3.770; p = 0.46). However, the following variables were predictors of post-stroke disability: motor impairment (OR = 0.216; 95% CI: 0.090 - 0.520; p Conclusion: Living in different Brazilian cities had no impact on post-stroke disability. In contrast, motor impairment and walking ability were responsible for 77.9% of the disability found in the sample. The study findings identify possible causes of disabilities after stroke; these could facilitate the most appropriate actions to be taken during rehabilitation.

Aims: This study aims to evaluate the additional effect of transcranial direct current stimulation (tDCS) on training postural balance with the use of video games in aged. Methods: This is a blinded, randomized, controlled clinical trial protocol, with elderly people of both genders. Participants will be randomized into three training groups: Group 1 (videogame balance training), group 2 (videogame balance training associated with active tDCS), group 3 (videogame balance training associated with sham tDCS). The training will be carried out twice a week for four weeks, totaling eight sessions, and will be performed with the Nintendo Wii videogame console, using games that stimulate the postural balance associated with tDCS, with anode applied over the left dorsolateral prefrontal cortex and cathode on the contralateral supraorbital region at 2 mA for 20 minutes. The postural balance will be assessed using the Mini Test of the Balance Assessment System and posturography. Evaluations will be carried out before and after eight training sessions and 30 days after the end of treatment. Discussion: Some studies show favorable results from the use of video games in improving postural balance in the elderly; however, their effect does not remain long-term. TDCS associated with other therapies can potentiate and prolong the effects of these therapies owing to its ability to stimulate neurotrophins important for neurogenesis, facilitating tasks that require attention, and helping to consolidate learning and memory. The effect of the two associated techniques on balance have not yet been tested in this population. Registration: Brazilian Registry of Clinical Trials ID U1111-1213-4266; registered on 15 October, 2018.

Introduction When physical activity contains training of at least three components such as balance, coordination and strength, among others, it is called multicomponent training. This type of training is recommended for improving the functional capacity in elderly individuals but has no lasting effects. The association of transcranial direct current stimulation (tDCS) with other types of therapy has been shown to facilitate the enhancement and prolongation of therapy outcomes. Aim The objective of this study is to evaluate the effect of multicomponent training associated with active or sham tDCS on the performance of functional capacity in the elderly before treatment, after treatment and 30 days after the end of treatment. The secondary objective will be to correlate the performance of the primary outcome (functional capacity assessed by the Glittre Daily Life Activity Test) with walking capacity (by 6-min walk test), balance (with the mini-Balance Evaluation Systems Test), functional independence (by the Functional Independence Measure) and quality of life (with the World Health Organization Quality of Life Instrument). Methods Twenty-eight elderly people from the community will participate in the study, and will be randomized into two groups: 1) multicomponent training associated with active tDCS; and 2) multicomponent training associated with sham tDCS. The multicomponent training sessions will be held twice a week for 12 weeks, totaling 24 sessions. The tDCS will be administered over the dominant dorsolateral prefrontal cortex at the same time as multicomponent training, with an intensity of 2 mA, for 20 min. The evaluations will be made pretraining, after 24 training sessions and 30 days after the end of the training. Discussion We hypothesize that tDCS, when associated with multicomponent training, can potentiate and prolong the effects of this training on the functional capacity of the elderly. If this hypothesis is confirmed, this protocol may contribute to a longer-lasting physical rehabilitation of the elderly, encouraging them to maintain their independent daily activities for longer. Trial registration The study was registered in the Brazilian Clinical Trial Registry (RBR-2crd42) and received approval from the Human Research Ethics Committee of University Nove de Julho, São Paulo, Brazil (process number 3.077.953).

RESUMO O acidente vascular encefálico pode deixar sequelas neurológicas, motoras e sensitivas. Para avaliar e acompanhar o prognóstico do paciente, são usados diversos instrumentos funcionais de medida, como a escala de Fugl-Meyer, que apesar de amplamente utilizada para estimar a recuperação sensório-motora, é uma avaliação longa e que exige treinamento. Diante disso, o objetivo deste estudo é analisar se a força de preensão manual, o timed up and go e a medida de independência funcional podem predizer os resultados da escala Fugl-Meyer, com o intuito de otimizar o tempo de avaliação da recuperação sensório-motora, tanto para o acompanhamento da resposta ao tratamento quanto para pesquisas científicas. Para tanto, avaliou-se a força de preensão manual de 35 hemiparéticos crônicos, e em seguida foram aplicadas à escala Fugl-Meyer, que avalia a recuperação motora, a medida de independência funcional nas atividades motoras e o timed up and go, indicativo de mobilidade funcional. Para análise estatística utilizou-se a regressão linear múltipla (r2). A força de preensão manual mostrou-se preditora da recuperação motora (r2=0,46; p=0,001), enquanto a mobilidade (r2=0,255; p=0,007) e a independência funcional (r2=0,054; p=0,2) não foram capazes de predizer os resultados da escala Fugl-Meyer. Após análise, pôde-se inferir que a força de preensão manual é preditora moderada da recuperação motora pós-acidente vascular encefálico, enquanto mobilidade e a independência funcional, não. RESUMEN El accidente cerebrovascular puede ocasionar secuelas neurológicas, motores y sensoriales. Para evaluar y monitorear el pronóstico del paciente, se utilizan diversos instrumentos funcionales, como la escala de Fugl-Meyer, que aunque es ampliamente utilizada para estimar la recuperación sensoriomotor, presenta una evaluación larga y que requiere entrenamiento. Teniendo en cuenta lo anterior, este estudio pretende analizar si la fuerza de prensión manual, el timed up and go y la medición de independencia funcional pueden predecir los resultados de la escala de Fugl-Meyer para que se mejore el tiempo de evaluación de la recuperación sensorial y motora, tanto para monitorear la respuesta al tratamiento como para estudios científicos. Por tanto, se evaluó la fuerza de prensión manual de 35 hemiparéticos crónicos, y luego se aplicaron a la escala de Fugl-Meyer, que evalúa la recuperación motora, las medidas de la independencia funcional en las actividades motoras y el timed up and go, indicativo de movilidad funcional. Para el análisis estadístico se utilizó la regresión lineal múltiple (r2). La fuerza de prensión manual ha demostrado ser predictiva de la recuperación motora (r2=0,46; p=0,001), mientras que la movilidad (r2=0,255; p=0,007) y la independencia funcional (r2=0,054; p=0,2) no fueron capaces de predecir los resultados de la escala de Fugl-Meyer. Del análisis se puede inferir que la fuerza de prensión manual es una predictora moderada en la recuperación motora posaccidente cerebrovascular, mientras que no lo son la movilidad y la independencia funcional. ABSTRACT Cerebrovascular accidents can leave neurological, motor and sensory sequelae. To assess and monitor the patient’s prognosis, several functional measuring instruments are used, such as the Fugl-Meyer scale, which, although widely used to estimate the sensorimotor recovery, is a long evaluation that requires training. Therefore, the objective of this study is to analyze if the handgrip strength (HGS), the Timed up and Go test (TUG) and the Functional Independence Measure (FIM) can predict the results of the Fugl-Meyer scale, in order to optimize time during sensorimotor recovery assessment, both to monitor treatment responses and for scientific research. Thus, the HGS of 35 chronic hemiparetic patients was evaluated and then applied to Fugl-Meyer Scale, which evaluates motor recovery, the FIM, which evaluates motor activities and the TUG, which is an indicative of functional mobility. Statistical analysis was performed using multiple regression (r2). The HGS was predictive of motor recovery (r2=0.46; p=0.001), while mobility (r2=0.255; p=0.007) and functional independence (r2=0.054; p=0.2) were not capable of predicting the results of the Fugl-Meyer scale. After analysis, it was concluded that HGS is a moderate predictor of motor recovery after cerebrovascular accident, while mobility and functional independence are not.

Objective: Perform a systematic review to identify the categories of the International Classification of Functioning, Disability and Health linked to the concepts measured by functional assessment tools validated for Brazilian Portuguese: Timed Up and Go test, Functional Independence Measure, Barthel Index, and Rivermead Mobility Index and Modified Rankin Scale.Methods: The Medline, Embase and CINAHL databases were consulted using a standardized search strategy. The studies were summarized using a pre-established set of specific criteria for the adequate linkage between the concepts identified in the assessment measures and the International Classification of Functioning, Disability and Health categories. Two independent reviewers performed the selection of the studies, data extraction and evaluation of the results.Results: The search of the databanks led to the retrieval of 99 studies. However, only six articles were included in the present review. The linkage results of the studies included in the review were divergent, likely due to the taxonomic complexity of the International Classification of Functioning, Disability and Health, the difficulty in clearly relating the concepts of the assessment measures to the classifications and the fact that not all linkage rules were followed. "Activities and participation" was the most evaluated component, with mobility the most frequently covered category in the measures, followed by self-care. Among the measures analyzed, the Functional Independence Measure addresses a greater number of categories and therefore has the most concepts related to the International Classification of Functioning, Disability and Health, followed by the Barthel Index, Modified Rankin Scale, Rivermead Mobility Index and Timed Up and Go test. The Modified Rankin Scale was the assessment tool that most evaluated categories related to environmental factors.Conclusion: The Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health, since it addresses a greater number of categories. These findings can help guide health professionals in the selection of assessment tools for the evaluation of post-stroke functioning, making viable the use of the International Classification of Functioning, Disability and Health categories in clinical practice and public health services.Implications for rehabilitationThis study standardized identification of the International Classification of Functioning, Disability and Health categories in the main outcome measures used to assess post-stroke functional capacity.Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health compared to other functional assessment instruments.Findings can enable physiotherapists and researchers choose the most appropriate measure that best corresponds to their field of interest.These results facilitate the implementation of the International Classification of Functioning, Disability and Health in clinical practice.Use of International Classification of Functioning, Disability and Health categories can standardize information on functional health.

Evaluate, code and qualify the participation of Brazilian stroke survivors based on the international classification of functioning, disability and health (ICF) and identify predictors of post-stroke participation.An exploratory, observational, cross-sectional study was conducted involving 78 individuals with hemiparesis stemming from a stroke. The stroke specific quality of life (SS-QOL) was used to evaluate the participation component of the ICF. The geriatric depression scale was used to screen depressive symptoms; the functional independence measure (FIM) was used to measure the degree of dependence; grip strength was determined using a dynamometer; and cognitive status was evaluated using the mini mental state examination. The one-way analysis of variance followed by the Bonferroni test was used for the comparison the participation scores of different groups (age and marital status). The independent t-test was used for the comparisons of the other groups (sex, time since the occurrence of stroke (12 months or12 months) and degree of functional independence). Multiple linear regression was employed to identify measures capable of predicting participation.Based on the classification and qualifiers of the ICF, the individuals analyzed exhibited a moderate level of participation. Participation was significantly associated with time since the occurrence of stroke (F = 2.46; 95% confidence interval (CI) = -23.67-0.34; p = 0.05), degree of functional independence (F = 2.40; 95% CI = -33.0 to -18.93; p 0.001) and marital status (married or widowed) (F = 2.6; p = 0.05). No statistically significant associations were found with regard to age, sex or affected side of the body. Functional independence was the main predictor of participation (F = 99.2; rTwenty-four ICF categories were coded and qualified with the use of the SS-QOL, enabling the participation component of the ICF biopsychosocial model to be easily evaluated in clinical practice. Overall, the sample in the present study demonstrated a moderate decline in participation following a stroke and only the "social roles" domain was severely affected. The FIM was the main predictor of participation and the depression was a moderate predictor. Therefore, health professionals involved in the rehabilitation of these patients should focus on the promotion of functional independence and improvements in emotional health to optimize social participation following a stroke. Implications for Rehabilitation The Brazilian stroke individuals analyzed exhibited a moderate level of participation. Functional independence was the main predictor of participation and the occurrence of depressive symptoms was a moderate predictor. Age, sex and affected side of the body were not predictors of participation. Our findings support that twenty-four International classification of functioning, disability and health categories were coded and qualified with the use of the stroke specific quality of life. Rehabilitation of social functioning post stroke patients should be focused on the promotion of functional independence and improvement in emotional health. This study offers a participation assessment model that can facilitate the incorporation of the ICF in the clinical practice.

Introdução: A incontinência urinária (IU) após o Acidente Vascular Encefálico (AVE) é um forte preditor de recuperação funcional e retorno í participação social. Dentre os métodos utilizados para reabilitação da IU, destaca-se a estimulação elétrica do nervo tibial posterior (EENTP), pois é um método pouco invasivo e de maior aceitação, no entanto, não há evidências de sua eficácia em pacientes com IU decorrente do AVE. Objetivo: Avaliar o efeito da EENTP no tratamento de IU após AVE. Material e métodos: Participaram deste estudo quatro pacientes com IU, que foram submetidos a 12 sessões de EENTP, duas vezes por semana, por 30 minutos, cada sessão. A variável controle miccional e qualidade de vida foram avaliadas antes e após o tratamento, por meio do diário miccional e o questionário King"™s Health Questionnaire (KHQ), respectivamente. Para comparação antes e após a técnica, utilizou-se o teste t Student para variáveis pareadas e o Wilcoxon para variável micções/dia. Resultados: Quando comparados os resultados antes e após o tratamento, não foi evidenciada diferença estatisticamente significante em nenhuma das variáveis avaliadas. Conclusão: O tratamento mostrou-se ser uma ferramenta sem contra indicações, segura e de fácil utilização, sendo possí­vel identificar melhora do controle miccional e qualidade de vida, embora não estatisticamente significante.Palavras-chave: acidente cerebral vascular, incontinência urinária, estimulação elétrica.

Supplementary material related to this article can be found, in the online version, at doi:https://doi.org/10.1016/j.carbpol.2018.09.088., The global demand of prebiotics such as xylooligosaccharides (XOS) has been growing over the years, motivating the search for different production processes with increased efficiency. In this study, a cloned Bacillus subtilis 3610, containing the xylanase gene xyn2 of Trichoderma reesei coupled with an endogenous secretion tag, was selected for XOS production through direct fermentation of beechwood xylan. A mixture of XOS with a degree of polymerization ranging from 4-6 was obtained, presenting high stability after a static in vitro digestion (98.5±0.2%). The maximum production yield expressed as total XOS per amount of xylan (306±4mg/g) was achieved after 8h of fermentation operating under one-time impulse fed-batch. The optimal conditions found were pH 6.0 and 42.5°C, using 2.5g/L of initial concentration of xylan increased up to 5.0g/L at 3h. Xylopentaose was the major oligosaccharide produced, representing 47% of the total production yield., CA, SCS, ACP, EC and LRR acknowledge their grants (PD/BD/ 105870/2014, SFRH/BPD/88584/2012, SFRH/BPD/ 101181/2014, SFRH/BPD/70589/2010 and SFRH/BSAB/142873/2018) from Portuguese Foundation for Science and Technology (FCT). The study received financial support from FCT under the scope of the strategic funding of UID/BIO/04469/2013 unit; COMPETE 2020 (POCI-010145-FEDER-006684); QOPNA research Unit (FCT UID/QUI/00062/ 2013), through national founds and where applicable co-financed by the FEDER, within the PT2020 Partnership Agreement; the Project MultiBiorefinery (POCI-01-0145-FEDER-016403); the Project FoSynBio (POCI-01-0145-FEDER-029549) and Lignozymes (POCI-01-0145FEDER-029773). The authors also acknowledge BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020 - Programa Operacional Regional do Norte., info:eu-repo/semantics/publishedVersion

[Purpose] The aim of the present study was to evaluate the immediate effects of transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) on activity of the tibialis anterior muscle (TA) and static balance of individuals with hemiparesis stemming from stroke. [Subjects and Methods] A randomized, double-blind, crossover, clinical trial conducted with 30 individuals with chronic post-stroke hemiparesis. Median frequency of electrical activity of the TA were determined using electromyography in five contractions concentrics and Static balance (body sway velocity and frequency), both before and immediately after the intervention. The participants were submitted to four 20-minute intervention protocols with 48-hour interval: anodal tDCS + sham FES; sham tDCS + active FES; anodal tDCS + active FES and sham tDCS + sham FES. Anodal tDCS was administered over C3 or C4, the cathode was positioned in the supraorbital region on the contralateral side and FES was administered to the affected TA. [Results] No significant differences among the protocols were found regarding electrical activity of the TA and static balance. [Conclusion] The results demonstrate that tDCS alone or in combination with FES had no immediate effect on electrical activity of the TA and static balance of the 30 individuals analyzed.

Analyze the construct validity and internal consistency of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the ICF as well as analyze the ceiling and floor effects.One hundred subjects were analyzed: 85 community-dwelling and 15 institutionalized individuals. The analysis of construct validity was performed using classic psychometrics: (1) the comparison of known groups (individuals without restriction to participation vs. those with restriction to participation) using the Mann-Whitney test and (2) convergent validity - correlation between the scores on the SS-QOL items that address participation and the subscale scores of measures used to evaluate the similar constructs and concepts [the Short-Form Health Survey (SF-36), Functional Independence Measure (FIM) and grip strength test]. Spearman's correlation coefficients were calculated for this analysis. Cronbach's α was used for the analysis of internal consistency and both the ceiling and floor effects were analyzed. The level of significance for all analyses was α = 0.05.The a priori hypotheses regarding construct validity were partially demonstrated, as only five of the eight domains exhibited positive moderate to strong correlations (r 0.40) with measures that address constructs similar to those addressed on the SS-QOL questionnaire. The items demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. The ceiling and floor effects were considered adequate for the total SS-QOL score, but beyond acceptable standards for some domains.The 26 items of the SS-QOL questionnaire measure a multidimensional construct and therefore do not only address participation. However, the items demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. Implications for rehabilitation The 26 items of the SS-QOL questionnaire demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. The present findings can guide healthcare professionals regarding the selection of an assessment tool for the evaluation of post-stroke participation. The findings can lead to consistent and standardization evaluations, which facilitates comparisons and discussion on functional health and social participation after stroke.

Introducao : As disfuncoes respiratorias na Doenca de Parkinson (DP) podem ser explicadas por diversos mecanismos, como perda da flexibilidade da musculatura respiratoria, alteracoes posturais, alteracoes na ativacao e coordenacao muscular. O Reequilibrio Toracoabdominal (RTA) tem sido apontado como uma nova tecnica para tratamento respiratorio na DP, no entanto, os efeitos imediatos dessa modalidade permanecem desconhecidos em parkinsonianos. Objetivos : Investigar o efeito imediato da tecnica de RTA sobre a mecânica respiratoria de portadores da DP. Metodos : Este estudo transversal foi composto por dez pacientes parkinsonianos, que foram submetidos a uma sessao com as manobras da tecnica de RTA por 20 minutos. As variaveis de mobilidade toracica e forca muscular respiratoria foram avaliadas antes e apos a tecnica, por meio da cirtometria toracica e manovacuometria, respectivamente. Para comparacao antes e apos a tecnica, utilizou-se o teste t Student para variaveis pareadas. Resultados : Quando comparados os resultados antes e apos a tecnica de RTA, nao foi evidenciada diferenca estatisticamente significante em nenhuma das variaveis avaliadas. Conclusao : Nao foi constatada melhora imediata significante na mecânica respiratoria (forca respiratoria e mobilidade toracica), apos aplicacao da tecnica. Palavras-chave : doenca de Parkinson, pneumopatias, reabilitacao, Fisioterapia.

Introduction. SATIS-Stroke was developed to measure satisfaction regarding activities and participation among stroke survivors based on the concepts contained in the International Classification of Functioning, Disability, and Health. However, this measure is only available in English and French. Objective. Perform the translation and cross-cultural adaptation of SATIS-Stroke to Brazilian Portuguese and test the preliminary reliability of this measure. Methods. The translation process followed standardized guidelines and consisted of six phases: initial translation, back-translation, analysis of expert committee, test of final version, submission, and assessment of all written reports. To test the preliminary test-retest reliability, the measure was administered by a single observer on two occasions with an interval of 7 to 14 days for the determination of intraobserver agreement and administered again by a second observer for the determination of interobserver agreement. Reliability was analyzed using the intraclass correlation coefficient (ICC2,1) and respective 95% confidence intervals (CI). Results. All stages of the cross-cultural adaptation process were respected and the final translated version of SATIS-Stroke exhibited semantic, idiomatic, cultural, and conceptual equivalence to the original version. The preliminary analysis revealed excellent intraobserver and interobserver reliability (ICC = 0.93; 95% CI: 0.83-0.97, p = 0.001 and ICC = 0.90; 95% CI: 0.74-0.96; p = 0.001, respectively). The items demonstrated adequate internal consistency, although ceiling and floor effects were considered beyond acceptable standards for some items. In the exploratory factor analysis, three factors were extracted that aggregated more than one construct to each component, but all were related to the “Activities and Participation” component of the International Classification of Functioning, Disability, and Health. Conclusion. The final version of the SATIS-Stroke scale in Brazilian Portuguese proved to be adequate and reliable for use on the Brazilian population. Further studies are underway to give continuity to the validation process and analyze the others measurement properties of the scale in the Brazilian population.

Resumo Objetivo: caracterizar o perfil e a relação entre sobrecarga e qualidade de vida (QV) de cuidadores de pacientes hospitalizados de acordo com o modelo biopsicossocial da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Analisar a correlação entre a sobrecarga do cuidador e o nível de dependência motora e cognitiva do paciente. Métodos: estudo transversal com 68 cuidadores de pacientes hospitalizados há 12 ou mais dias. Para avaliação da QV e da sobrecarga dos cuidadores foram utilizados, respectivamente, o Short Form Health Survey (SF-36) e a escala de Zarit (Zarit Burden Interview). Utilizou-se a Medida de Independência Funcional para caracterizar a dependência motora e cognitiva dos pacientes. Os resultados foram relacionados aos conceitos da CIF. Resultados: de acordo com os qualificadores da CIF, um comprometimento progressivo na QV dos cuidadores foi observado com o aumento da sobrecarga. Houve correlação negativa, estatisticamente significante e de fraca magnitude, entre a percepção de QV e sobrecarga. Não houve correlação entre a sobrecarga do cuidador e o nível de dependência do paciente. Conclusão: o SF-36 é capaz de analisar 13 categorias da CIF, permitindo avaliar o cuidador de forma integral, de acordo com o modelo biopsicossocial, e facilitando o uso da CIF na prática clínica. Abstract Objective: to characterize the profile and the relationship between burden and quality of life (QOL) of hospitalized patients’ caregivers according to the International Classification of Functioning Disability and Health (ICF) biopsychological model. To analyze the correlation between caregiver’s burden and the level of patients’ motor and cognitive dependency. Methods: cross-sectional study, involving 68 caregivers of patients hospitalized for 12 or more days. Caregivers’ QOL and burden were assessed by the Short Form Health Survey (SF-36) and the Zarit scale (Zarit Burden Interview), respectively. Functional Independence Measure was used to characterize patients’ motor and cognitive dependency. The relationship between the results and the ICF concepts was analyzed. Results: according to ICF qualifiers, a progressive impairment in the caregivers’ QOL was observed with burden increasing. There was a statistically significant negative correlation, of low magnitude, between perception of QOL and burden. There was no correlation between caregiver’s burden and patient’s dependency level. Conclusion: SF-36 can analyze 13 ICF categories. It allows evaluating caregivers in a comprehensive way and in accordance with the biopsychosocial model. It can also help to apply ICF in clinical practice.

To assess the impact of post-stroke depression on the participation component of the International Classification of Functioning, Disability and Health (ICF).Thirty-five stroke survivors with chronic hemiparesis were divided into two groups: those with and without depression. The Geriatric Depression Scale (GDS) was used for the analysis of depressive symptoms. Participation was analysed using the Stroke Specific Quality of Life scale. The Mann-Whitney test was used to compare the participation scores between the two groups. Spearman's correlation coefficients were calculated to determine the strength of the association between the assessment tools. Simple linear regression was used to determine the impact of depression on participation. An alpha risk of 0.05 was considered indicative of statistical significance.The group with depression had low participation scores (p = 0.04). A statistically significant negative correlation of moderate magnitude was found between depression and participation (r = -0.6; p = 0.04). The linear regression model demonstrated that depression is a moderate predictor of participation (r(2) = 0.51; p = 0.001).Depression is a moderate predictor of participation among stroke survivors, explaining 51% of the decline of this aspect. Thus, depression should be diagnosed, monitored and treated to ensure a better prognosis regarding social participation following a stroke. Implications for Rehabilitation Individuals with post-stroke depression experience a lower degree of social participation. Depression explains 51% of the decline in participation following a stroke. The present findings can serve as a basis to assist healthcare professionals involved in the rehabilitation of stroke survivors and can assist in the establishment of adequate treatment plans in stroke rehabilitation.

Background: Handgrip strength is currently considered a predictor of overall muscle strength and functional capacity. Therefore, it is important to find reliable and affordable instruments for this analysis, such as the modified sphygmomanometer test (MST). Objectives: To assess the concurrent criterion validity of the MST, to compare the MST with the Jamar dynamometer, and to analyze the reproducibility (i.e. reliability and agreement) of the MST in individuals with Parkinson's disease (PD). Method: The authors recruited 50 subjects, 24 with PD (65.5±6.2 years of age) and 26 healthy elderly subjects (63.4±7.2 years of age). The handgrip strength was measured using the Jamar dynamometer and modified sphygmomanometer. The concurrent criterion validity was analyzed using Pearson's correlation coefficient and a simple linear regression test. The reproducibility of the MST was evaluated with the coefficient of intra-class correlation (ICC 2,1 ), the standard error of measurement (SEM), the minimal detectable change (MDC), and the Bland-Altman plot. For all of the analyses, α≤0.05 was considered a risk. Results: There was a significant correlation of moderate magnitude (r≥0.45) between the MST and the Jamar dynamometer. The MST had excellent reliability (ICC 2,1 ≥0.7). The SEM and the MDC were adequate; however, the Bland-Altman plot indicated an unsatisfactory interrater agreement. Conclusions: The MST exhibited adequate validity and excellent reliability and is, therefore, suitable for monitoring the handgrip strength in PD. However, if the goal is to compare the measurements between examiners, the authors recommend that the data be interpreted with caution.

Objetivo. Analisar a relação entre a força de preensão manual (FPM) e a capacidade funcional após as sequelas oriundas do Acidente Vas­cular Cerebral (AVC). Método. Avaliou-se a FPM de 35 hemiparé­ticos crônicos, e em seguida foram aplicadas a escala de Fugl-Meyer, que avalia a recuperação sensório-motora, a Medida de Independência Funcional, que avalia o grau de independência funcional nas ativida­des motoras, e o Timed Up and Go, indicativo de mobilidade fun­cional. Para análise estatística foi utilizado o coeficiente de correlação de Spearman. Resultados. Houve correlação positiva de forte magni­tude entre a FPM e a recuperação sensório-motora (r=0,7; p=0,001), e correlação negativa moderada entre a FPM e mobilidade funcional (r=-0,4; p=0,02). Contudo, não houve correlação entre a FPM e a independência (r=0,3; p=0,11). Conclusão. Após análise, encontrou­-se nesta população indícios de que a FPM tem forte relação com a recuperação sensório-motora após AVC, e é um indicativo moderado da mobilidade funcional.

Objetivo. Analisar a relacao entre a forca de preensao manual (FPM) e a capacidade funcional apos as sequelas oriundas do Acidente Vascular Cerebral (AVC). Metodo. Avaliou-se a FPM de 35 hemipareticos cronicos, e em seguida foram aplicadas a escala de Fugl-Meyer, que avalia a recuperacao sensorio-motora, a Medida de Independencia Funcional, que avalia o grau de independencia funcional nas atividades motoras, e o Timed Up and Go, indicativo de mobilidade funcional. Para analise estatistica foi utilizado o coeficiente de correlacao de Spearman. Resultados. Houve correlacao positiva de forte magnitude entre a FPM e a recuperacao sensorio-motora (r=0,7; p=0,001), e correlacao negativa moderada entre a FPM e mobilidade funcional (r=-0,4; p=0,02). Contudo, nao houve correlacao entre a FPM e a independencia (r=0,3; p=0,11). Conclusao. Apos analise, encontrou-se nesta populacao indicios de que a FPM tem forte relacao com a recuperacao sensorio-motora apos AVC, e e um indicativo moderado da mobilidade funcional.

[Purpose] The aim of the present study was to analyze the psychometric properties of the Stroke Specific Quality of Life (SS-QOL) scale for the assessment of social participation following a stroke. [Methods] A preliminary analysis was performed of the SS-QOL items that address the participation category. For this, the scoring patterns of the answers of individuals and internal consistence were determined using the Rasch model. Reliability was assessed by intraclass correlation coefficients (ICC). [Results] The reliability coefficients analyzed by the Rasch model were 0.91 for the items and 0.87 for the patients. The separation index was 3.19 for the items and 2.58 for the patients. The findings indicate that the items separated the patients into three levels of participation: low, medium, and high. Among the 26 items addressing participation, three did not fit the model. All items showed adequate reliability (ICC ≥ 0.60). [Conclusion] The Rasch analysis detected three items with erratic behavior; however, the erratic patterns of these items may be explained by individual peculiarities among the patients. These items should be monitored to determine if the problems found in the present study persist. If so, the items should also be revised or possibly even eliminated.

Introduccion. La Functional Ambulation Classification (FAC) es la unica escala que clasifica la marcha de individuos con esclerosis multiple e ictus en categorias de deambulacion. Sin embargo, la FAC solo esta disponible en la version en ingles y los estudios realizados en Brasil la han utilizado sin una traduccion y analisis adecuados de propiedades psicometricas. Objetivo. Traducir y adaptar culturalmente la FAC para el portugues brasileno y probar su fiabilidad y validez concurrente en individuos afectados por ictus. Pacientes y metodos. La traduccion y la adaptacion transcultural implicaron seis pasos. La fiabilidad interevaluador se probo con cinco fisioterapeutas que vieron videos de la marcha de las personas afectadas por ictus y, despues de un intervalo minimo de una semana, los vieron por segunda vez para determinar la fiabilidad intraevaluador. La validez concurrente se determino correlacionando la FAC con el resultado de la prueba de marcha de 10 metros (PM10m). Resultados. La fiabilidad intraevaluador vario entre un valor kappa de 0,68-0,95 (p = 0,001), y la fiabilidad interevaluador, un valor kappa de 0,517-0,794 (p = 0,001). La correlacion entre la FAC y la PM10m fue rs = 0,771 (p = 0,001). Conclusion. La traduccion, la adaptacion transcultural y el analisis de las propiedades psicometricas demostraron que la FAC es una medida clinica valida y fiable para clasificar la deambulacion de los individuos brasilenos afectados por ictus en un entorno clinico.

BACKGROUND: According to the International Classification of Functioning, Disability and Health (ICF), the participation component is considered to be the most complex component characterized in existing instruments that assess quality of life related to health (HRQoL). Questionnaires such as the Nottingham Health Profile (NHP) and the Stroke-Specific Quality of Life (SS-QOL) are currently used to evaluate the participation of individuals in life activities after stroke. However, because participation and HRQoL are different constructs, it is unclear whether these instruments are best suited to this evaluation. OBJECTIVE: To investigate whether the NHP and SS-QOL are suitable instruments for assessing the participation component of ICF. METHOD: A cross-sectional study was conducted in which a sample of 35 individuals completed the SS-QOL and NHP. The study correlated the total score on the questionnaires with the scores on items that evaluate the participation component of the ICF. Both analyses used the Spearman correlation coefficient (r). RESULTS: There was a statistically significant, positive and strong correlation between total score on the SS-QOL and NHP and the score on specific components related to participation (r=0.8, p=0.001 and r=0.9, p=0.001, respectively). CONCLUSIONS: Both the NHP and the SS-QOL show strong correlations between the total score and the score on items that assess the participation categories of the ICF. However, the SS-QOL questionnaire appeared to be the most complete for this assessment because it evaluates more distinct domains and contains the largest number of items related to participation. CONTEXTUALIZAÇÃO: O componente de participação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) foi apontado como o mais complexo de ser caracterizado a partir de instrumentos já existentes. Atualmente, indica-se o uso de questionários de qualidade de vida relacionada à saúde (QVRS) para avaliação da participação após acidente vascular encefálico (AVE), sendo indicado o Nottingham Health Profile (NHP) e o Stroke Specific Quality of Life (SS-QOL). No entanto, QVRS e participação são construtos distintos, assim, não está claro se esses instrumentos são os mais adequados para essa avaliação. OBJETIVO: Investigar se o NHP e SS-QOL são apropriados para avaliação do componente de participação da CIF. MÉTODO: Estudo transversal com amostra de 35 indivíduos nos quais foram aplicados o SS-QOL e o NHP com intuito de correlacionar o escore total dos questionários com o escore dos itens que avaliam os códigos do componente de participação da CIF utilizando o Coeficiente de Correlação Spearman (r). RESULTADOS: Houve correlação estatisticamente significante, positiva e de forte magnitude entre o escore total do SS-QOL e do NHP com os escores específicos do componente de participação, (r=0,8; p=0,001) e (r=0,9; p=0,001), respectivamente. CONCLUSÕES: Tanto o NHP quanto o SS-QOL apresentaram correlação forte entre o escore total e o escore dos itens que avaliam as categorias de participação da CIF. No entanto, o SS-QOL pareceu ser o questionário mais completo para essa avaliação por avaliar mais domínios distintos e apresentar o maior número de itens relacionados à participação.

The decrease in elastic recoil of the lungs and chest cavity compliance is a major change in the respiratory system with advancing age, when these changes are associated with clinical manifestations of under lying cerebral vascular accident (stroke), respiratory muscle strength of the elderly may be seriously affected, therefore it is necessary to investigate the conditions of respiratory muscle strength in older hemiparetic patients in both the acute and chronic phases. Objective: To compare respiratory muscle strength in elderly hemiparetic patients in both the acute and chronic phases after stroke, evaluated by the values of maximal respiratory pressures, so that the rehabilitation of these individuals will be more targeted. Method: Twenty-nine hemiparetic individuals were evaluated-seventeen in acute and twelve in chronic phases, the values of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) being measured by means of a manometer. Results: There was no difference between acute and chronic patients, however, measurements of MIP and MEP after the stroke showed statistically significant decreases when compared with predicted values. Conclusion: There was no difference in respiratory muscle strength between the acute and chronic phases, however, the fact that the MIP and MEP were also reduced in all subjects, suggests similar weakness in the respiratory musculature in both phases after stroke, and this condition can be worsened when coupled with the aging process. It is suggested that a program include muscle training for these individuals to have better rehabilitation after their strokes.

Introduction: Due to the inadequate response to inhaled corticosteroids, patients with difficult-to-control asthma (DCA) are submitted to oral corticosteroids or use of omalizumab. Although it is necessary to treat these patients, a significant relationship between steroid usage and both peripheral and respiratory weakness muscle, results in implications, such as loss of quality of life and compromised lung function. Nonetheless, it is not known whether these patients suffer neurophysiological changes due to drug effect. Objective: To investigate the neurophysiological and functional characteristics of patients with DCA in order to gain a better understanding of the condition. Method: A cross-sectional study was carried out involving three groups of patients: DCA-C (use of oral corticosteroids), DCA-O (use of omalizumab) and CG (healthy controls matched for age). The assessment involved the six-minute walk test, sit-to-stand test, static balance on a pressure platform, patellar and Achilles reflexes and quadriceps strength in the dominant leg. Results: The results revealed no statistically significant differences between the control group and DCA groups in relation to neurophysiological aspects. However, the DCA groups exhibited a significant reduction in functional capacity [decreased muscle strength (p

Resumo: Introdução: Devido à inadequada resposta aos corticóides inalatórios, os pacientes com asma de difícil controlo (ADC) são submetidos a corticóides orais ou uso de omalizumabe. Embora sejam necessários para o tratamento desses pacientes, há uma relação significativa entre o uso de esteróides e fraqueza muscular periférica e respiratória, resultando em implicações como a perda da qualidade de vida e função pulmonar comprometida. No entanto, não se sabe se estes pacientes sofrem alterações neurofisiológicas devido ao efeito da droga. Objetivo: Investigar as características neurofisiológicas e funcionais de pacientes com ADC, para melhor compreensão da doença. Método: Foi realizado um estudo transversal em 3 grupos de pacientes: ADCC (que fazem uso de corticóide por via oral); ADCO (que fazem uso do Omalizumab) e GC (controlo saudável da mesma idade). A avaliação foi composta pela prova da marcha dos 6 minutos, teste senta-levanta, equilíbrio estático com a plataforma de pressão, reflexos monossimpáticos (patelar e aquileu) e a força do quadríceps do membro inferior dominante. Resultados: Embora os resultados em relação aos aspetos neurofisiológicos mostrem não haver diferença estatisticamente significativa entre os grupos controlo e com ADC, deve ser observado que o grupo com ADC, apresentou importante redução da capacidade funcional, quando comparado ao grupo controlo (diminuição da força muscular (p

OBJETIVO: Identificar categorias do componente de participação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) que já foram sistematicamente relacionadas aos instrumentos de Qualidade de Vida Relacionada à Saúde (QVRS) comumente utilizados em indivíduos acometidos pelo acidente vascular encefálico (AVE) - Nottingham Health Profile (NHP), Short-Form Health Survey (SF-36) e Stroke Specific Quality of Life (SS-QOL) - e sugerir a utilização dos mesmos para avaliar e/ou caracterizar tal componente nessa população. MÉTODOS: Por meio de busca nas bases de dados Medline, SciELO e Lilacs, foi realizado levantamento dos estudos que associavam os conceitos mensurados pelos itens do NHP, SF-36 e SS-QOL com os componentes e categorias da CIF. RESULTADOS: Dos 24 estudos identificados, quatro atenderam aos critérios estabelecidos: dois avaliaram os três instrumentos de QVRS, um avaliou o NHP e SF-36, e outro apenas o SS-QOL. Para cada instrumento, foram encontrados três estudos que associaram seus conceitos até, no mínimo, o segundo nível de hierarquia das categorias da CIF. Considerando os resultados concordantes entre os três estudos que avaliaram o mesmo instrumento, nove categorias de participação foram associadas ao NHP, sete ao SF-36 e 15 ao SS-QOL, sendo que apenas uma foi específica para o NHP, uma para o SF-36, e sete para o SS-QOL. CONCLUSÕES: Para a avaliação da participação de indivíduos acometidos pelo AVE segundo a estrutura da CIF, o SS-QOL pareceu ser o instrumento mais adequado, pois, além de avaliar o maior número de categorias, também avalia o maior número de categorias distintas quando comparado aos outros dois instrumentos de QVRS, que acrescentam apenas uma categoria àquelas mensuradas pelo SS-QOL.OBJECTIVE: To identify the categories of the participation component of the International Classification of Functionality, Incapacity, and Health (ICF) which are currently related to Health-related Quality of Life (HRQOL) instruments commonly used in cerebrovascular accident (CVA) victims-Nottingham Health Profile (NHP), Short-Form Health Survey (SF-36), and Stroke Specific Quality of Life (SS-QOL)-and suggest the utilization of these instruments to assess and/or characterize that component in that population. METHODS: Through searches in the Medline, SciELO, and Lilacs databases, a compilation of studies which associated the concepts measured by the NHP, SF-36, and SS-QOL items with the ICF components and categories, was carried out. RESULTS: Of the 24 identified studies, four met the established criteria: two assessed the three HRQOL instruments, one assessed the NHP and SF-36, and the other just the SS-QOL. For each instrument, three studies were found which associated their concepts up to, at least, the second hierarchical level of the ICF categories. Considering the results that were in agreement between the three studies that assessed the same instrument, nine participation categories were associated with the NHP, seven with the SF-36, and 15 with the SS-QOL, although just one was specific to the NHP, one to the SF-36, and seven to the SS-QOL. CONCLUSIONS: To assess the participation of CVA victims based upon the ICF framework, the SS-QOL appeared to be the most suitable instrument in that, in addition to assessing the greatest number of categories, it also assesses the greatest number of distinct categories, when compared to the other two HRQOL instruments, which added just one category to those measured by SS-QOL.

Introdução: A dança pode melhorar a qualidade de vida (QV) de pessoas que apresentam algum comprometimento psicomotor, porém, nada foi encontrado sobre a dança sênior para pacientes neurológicos. Objetivo: Avaliar a QV em pacientes hemiparéticos pós-AVE, antes e após terapia com dança sênior. Metodologia: Selecionaram-se oito hemiparéticos e foram aplicados dois questionários de QV, SF-36 e SS-QOL. As sessões de terapia com dança sênior, realizadas na clínica de Fisioterapia da Uninove, tiveram duração de uma hora, duas vezes por semana, totalizando 24 sessões. Ao final, os questionários foram reaplicados. Utilizou-se estatística descritiva para caracterização da amostra, após os dados foram submetidos ao teste de normalidade Kolmogorov-Smirnov e teste Wilcoxon. Estabeleceu-se o nível de significância de 5%. Resultados: Observou-se diferença estatisticamente significante na QV, sendo SF-36 (p=0,05) e SS-QOL (p=0,01). Conclusão: O estudo mostrou resultados positivos, pois houve uma melhora significativa na qualidade de vida dos pacientes que participaram da dança.

Introduction: The main symptoms related to Parkinson’s disease (PD) are: tremors, freezing, bradykinesia and muscle rigidity, which lead to functional decline and difficulties in the execution of activities of daily living (ADL), compromising quality of life (QOL). Objective: To characterize the clinical profile and perception of quality of life (QOL) of patients with PD assisted at Associacao Brasil Parkinson (ABP) and correlate these with disease progression and level of disability. Methods: The clinical and functional evaluation of subjects was performed using the Unified Parkinson’s Disease Rate Scale (UPDRS), a modified version of the Hoehn and Yahr Staging Scale (HY) of disability and Parkinson’s Disease Questionnaire (PDQ-39). Results: There was no significant correlation between disease progression and QOL; however, there was moderate correlation (r=0.5) between disability and QOL, p

Objetivo. Investigar la validez y la reproducibilidad de la prueba Glittre de actividades de la vida diaria (AVD-Glittre) para personas con enfermedad de Parkinson. Sujetos y metodos. Se evaluo a 30 pacientes con enfermedad de Parkinson y 19 sujetos sanos (grupo de control). El grupo con enfermedad de Parkinson fue evaluado con la Unified Parkinsons Disease Rating Scale (UPDRS) y sometido a la prueba AVD-Glittre, la prueba de marcha de seis minutos (6MWT) y la prueba de marcha de 10 metros (10mWT). El grupo de control realizo la prueba AVD-Glittre. Para el analisis intraobservador se realizaron dos pruebas AVD-Glittre, y para el analisis interobservador, la prueba se repitio otro dia con un segundo examinador. Resultados. La prueba AVD-Glittre se correlaciono significativamente con la seccion II, la seccion III y la puntuacion total de la UPDRS. Se correlaciono inversamente con la 6MWT y positivamente con la 10mWT. El tiempo requerido para realizar la prueba AVD-Glittre fue mas corto en la nueva prueba en el analisis intraobservador y en el analisis interobservador. La diferencia de medias entre la primera y la segunda pruebas, el error estandar de medicion y el cambio minimo detectable en minutos fueron 0,40, 0,08 y 0,24, respectivamente, para el analisis intraobservador, y 0,40, 0,22 y 0,62, respectivamente, para el analisis interobservador. Conclusion. La prueba AVD-Glittre es valida y reproducible para evaluar la capacidad funcional en personas con enfermedad de Parkinson.