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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.

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.

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

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: 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.

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.

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.

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.

[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.

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

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.

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.

[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.

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

Introdução: São necessários treino e parâmetros específicos a fim de evitar a fadiga no treinamento com estimulação elétrica funcional. Objetivo: Verificou-se o aparecimento da fadiga muscular em pacientes, pós AVE, para melhor compreender um parâmetro de estimulação elétrica, a frequência. Métodos: Analisou-se o comportamento da fadiga muscular usando-se a frequência mediana e avaliou-se a contração voluntária máxima isométrica do músculo bíceps braquial hemiparético de 18 indivíduos, em sete momentos. Utilizou-se uma corrente quadrada e bifásica, com t”on” de 10 s., e t”off” de 30 s., e frequência variável de 50 Hz (protocolo 1) e 2.000Hz (protocolo 2). Resultados: Foi observado que não houve diferença estatisticamente significante (p0,05) entre os protocolos 1 e 2; não sendo registrada diferença no período imediatamente pós-terapia. Conclusões: Pelas ferramentas de mensuração utilizadas, eletromiografia e força muscular, não foi possível detectar o aparecimento da fadiga muscular com os dois protocolos de estimulação elétrica funcional utilizados.

Purpose: 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. Methods: 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. Results: 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. Conclusions: 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 rehabilitationThe 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. 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.

Purpose: To evaluate the reproducibility of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the International Classification of Functioning, Disability and Health (ICF) and analyse the correlation between the subscore of these 26 items and the total SS-QOL score. Methods: Seventy-five stroke survivors participated in this study. Reproducibility was evaluated using the intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimum detectable change (MDC) and the Bland–Altman plot. The correlation between the subscore of the 26 items and the total SS-QOL score was analysed using Spearman’s correlation coefficients (rho) and simple linear regression. An alpha risk ≤ 0.05 was considered for all analyses. Results: The SS-QOL items that address the participation component of the ICF demonstrated excellent reliability (intra-rater ICC2,1 = 0.96; inter-rater ICC2,1 = 0.95). The SEM and MDC were adequate. The Bland–Altman plot demonstrated satisfactory agreement. A significant and strong correlation (rho = 0.83) was found between the 26 SS-QOL items that address participation and the total SS-QOL score. Moreover, the evaluation of participation was found to explain 73% of the evaluation of health-related quality of life. Conclusion: The 26 SS-QOL items that address the participation component of the ICF demonstrated adequate reproducibility. Thus, participation, which represents the social aspects of functionality, can be adequately evaluated with these items. Implications for RehabilitationThe 26 Stroke Specific Quality of Life items that address participation proved to be reproducible for the analysis of social participation following a stroke.The findings can lead to a better understanding of the social participation of individuals with chronic hemiparesis and assist in the establishment of adequate treatment for such individuals.The rehabilitation process can be directed towards more specific goals focused on the patient expectations, thereby contributing to greater humanization and effectiveness of treatment to improve social participation following a stroke. The 26 Stroke Specific Quality of Life items that address participation proved to be reproducible for the analysis of social participation following a stroke. The findings can lead to a better understanding of the social participation of individuals with chronic hemiparesis and assist in the establishment of adequate treatment for such individuals. The rehabilitation process can be directed towards more specific goals focused on the patient expectations, thereby contributing to greater humanization and effectiveness of treatment to improve social participation following a stroke.

It has been already shown that delivering tDCS that are spaced by an interval alters its impact on motor plasticity. These effects can be explained, based on metaplasticity in which a previous modification of activity in a neuronal network can change the effects of subsequent interventions in the same network. But to date there is limited data assessing metaplasticity effects in cognitive functioning., This work was supported by the Portuguese Foundation for Science and Technology (FCT) with two individual grants (SFRH/BPD/86041/2012 and SFRH/BPD/86027/2012).

This study aimed to identify the International Classification of Functioning, Disability, and Health categories addressed by the assessment tools commonly used in post-stroke rehabilitation and characterize patients based on its evaluation model. [Subjects and Methods] An exploratory, descriptive, cross-sectional study was conducted involving 35 individuals with chronic post-stroke hemiparesis. Handgrip strength was assessed to evaluate body functions and structures. The 10-meter gait speed test and Timed Up and Go test were administered to evaluate activity. The Stroke Specific Quality of Life scale was used to evaluate participation. Moreover, a systematic review of the literature was performed to identify studies that have associated these assessment tools with the International Classification of Functioning, Disability, and Health categories. [Results] The tools employed in this study for evaluating function addressed 63 International Classification of Functioning, Disability, and Health categories: 24 related to body functions and structures; 36 related to activity and participation; and 3 related to environmental factors. [Conclusion] The assessment tools employed in this study addressed 63 International Classification of Functioning, Disability, and Health categories and allowed a more complete evaluation of stroke survivors with hemiparesis. Use of this classification can therefore be more easily incorporated into clinical practice.

A stroke may leave neurological, motor and sensory sequelae, interfering with the function of movements and culminating in gait and balance changes. Therefore, it is necessary to demonstrate the efficacy of eight-point binding, a low-cost technique that functions to provide proprioceptive information and promote the biomechanical alignment of the ankle, acting against mechanisms that lead to equinovarus foot. This study aims to determine the immediate effect of eight-point binding as a physical therapy resource for the rehabilitation of function performance after a stroke. To this end, 22 patients who were able to walk alone without an orthosis were evaluated, and performed the Timed Up and Go (TUG) functional mobility test, a gait speed assessment and the Berg Balance Scale, with and without the eight-point binding in the paretic lower limb. When comparing the results after the eight-point binding, it was possible to observe a statistically significant difference (p

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.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.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.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.

Objective: To determine which mechanisms lead to activation of neurons in the motor cortex during transcranial magnetic stimulation (TMS) with different current directions and pulse waveforms. Methods: The total electric field induced in a simplified model of a cortical sulcus by a figure-eight coil was calculated using the finite element method (FEM). This electric field was then used as the input to determine the response of compartmental models of several types of neurons. Results: The modeled neurons were stimulated at different sites: fiber bends for pyramidal tract neurons, axonal terminations for cortical interneurons and axon collaterals, and a combination of both for pyramidal association fibers. All neurons were more easily stimulated by a PA-directed electric field, except association fibers. Additionally, the second phase of a biphasic pulse was found to be more efficient than the first phase of either monophasic or biphasic pulses. Conclusions: The stimulation threshold for different types of neurons depends on the pulse waveform and relative current direction. The reported results might account for the range of responses obtained in TMS of the motor cortex when using different stimulation parameters. Significance: Modeling studies combining electric field calculations and neuronal models may lead to a deeper understanding of the effect of the TMS-induced electric field on cortical tissue, and may be used to improve TMS coil and waveform design.

Objective This work aims to elucidate by what physical mechanisms and where stimulation occurs in the brain during transcranial magnetic stimulation (TMS), taking into account cortical geometry and tissue heterogeneity. Methods An idealized computer model of TMS was developed, comprising a stimulation coil, a cortical sulcus, and surrounding tissues. The distribution of the induced electric field was computed, and estimates of the relevant parameters were generated to predict the locus and type of neurons stimulated during TMS, assuming three different stimulation mechanisms. Results Tissue heterogeneity strongly affects the spatial distribution of the induced electric field and hence which stimulation mechanism is dominant and where it acts. Stimulation of neurons may occur in the gyrus, in the lip of the gyrus, and in the walls of the sulcus. The stimulated cells can be either pyramidal cells having medium to large caliber axons, or intracortical fibers of medium caliber. Conclusions The results highlight the influence of cortical folding on the action of magnetic and electric fields on cortical tissue. Significance Tissue geometry and heterogeneity in electrical conductivity both must be taken into account to predict accurately stimulation loci and mechanism in TMS.

The aims of the present study were to determine the prevalence of temporomandibular disorder (TMD) in a sample of patients with Parkinson's disease (PD) and to analyze the distribution of occlusal contacts.The sample was composed of patients with PD aged 50-75 years. Temporomandibular disorder was evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The distribution of occlusal contacts was determined using the portable T-Scan IIIForty-two individuals with PD were analyzed. The prevalence of TMD was 23.8%. No statistically significant association was found between TMD and occlusal contact symmetry. Moreover, no significant difference in the distribution of occlusal contacts was found between the groups with and without TMD.The present data suggest no association between TMD and occlusal contact asymmetry in individuals with PD.The results of this study identified a prevalence of 23.8% of TMD signs in subjects with PD and a high frequency of occlusal asymmetry in this sample.

The aims of the present study were to investigate the prevalence of temporomandibular disorder (TMD) in a group of patients with Parkinson’s disease (PD), and to analyze oral health according to the severity of the disease. [Methods] Signs and symptoms of TMD were evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders, and oral health impact was measured using the Oral Health Impact Profile. The unpaired Student’s t-test was used to compare groups with and without TMD. Pearson’s correlation coefficients were calculated to determine correlations between the level of functional independence and oral health impact. Fisher’s exact test was used to test the association between TMD and the severity of symptoms of PD. [Results] Fifty-nine individuals with PD were analyzed. The prevalence of TMD was 20.33%. No statistically significant associations were found between TMD and the severity of PD. Oral health impact was considered weak, but a statistically significant difference between groups with and without TMD was found for psychological disability (p = 0.003). No significant correlation was found between the level of functional independence and oral health impact. [Conclusion] The prevalence of TMD among patients with Parkinson’s disease was 20.33%. A statistically significant difference between groups with and without TMD was found regarding the psychological disability domain.

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Após o Acidente Vascular Cerebral (AVC), o acesso aos serviços de saúde para continuidade dos cuidados é fundamental e deve ser proporcionado de forma integral e multiprofissional, de acordo com as necessidades individuais. No Brasil, há políticas públicas e recomendações de cuidados para indivíduos pós-AVC. Contudo, informações sobre acesso aos serviços de saúde desta população são escassas. Os objetivos deste estudo foram caracterizar o acesso aos serviços de saúde, comparar o “acesso real” ao “acesso esperado”, e determinar os preditores sociodemográficos e clínico-funcionais, no primeiro mês (T1) após a alta hospitalar de uma Unidade de Acidente Vascular Cerebral (U-AVC). Durante seis meses (setembro/2019-fevereiro/2020), indivíduos com idade≥20 anos, identificados em uma U-AVC de Belo Horizonte/MG, com primeiro AVC e sem incapacidades prévias, foram incluídos e avaliados na alta hospitalar (T0) quanto a características sociodemográficas (sexo, idade, escolaridade, nível socioeconômico) e clínico-funcionais (gravidade do AVC e nível de incapacidade). Em T1, por telefone, foram coletadas informações sobre o acesso aos serviços de saúde (“acesso real”). Para comparação ao “acesso esperado” (encaminhamentos dos profissionais da U-AVC), utilizou-se estatística descritiva e teste de Wilcoxon e, para identificar os preditores, regressão logística binária (α=5%). Foram identificados 260 indivíduos, sendo incluídos 116 e 78 avaliados em T1: maioria do sexo feminino (53%), com média de idade de 60±16 anos, com menos de quatro anos de estudo (50%), com incapacidade leve (53%) e nível de gravidade do AVC leve (50%) o mais comum. Todos receberam pelo menos um encaminhamento. O acesso aos serviços de saúde em T1 foi obtido pela maioria dos indivíduos (77%;60/78), de forma parcial em relação ao esperado (70%;42/60), sendo a quantidade de “acesso real” (n=122) significativamente menor ao “acesso esperado” (n=249) (p