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Purpose: Finding valid and accurate methods to count steps is important after a stroke. To determine the criterion validity and accuracy of the Actigraph and Xiaomi Smart Band to count steps in individuals after stroke. To explore the influence of walking speed on the accuracy of these activity monitors., Method: Individuals after stroke performed the 2-min Walk Test while wearing the ActiGraph and Xiaomi Smart Band. The 2-min Walk Test was recorded, and the observed step count was compared with the estimated step count of both activity monitors., Results: Fifty individuals after stroke were included. The ActiGraph had a low correlation (rho 0.41) between observed and estimated step count and a high percentage absolute error (39%). The Xiaomi Smart Band had a high correlation (rho 0.83) and a moderate percentage absolute error (12%). At high walking speeds, the Xiaomi Smart Band had a low percentage absolute error (3%) and at slow walking speeds had 18% a moderate percentage absolute error., Conclusion: The Xiaomi Smart Band has good criterion validity and moderate-to-high accuracy counting steps after stroke. It is a low-cost activity monitor that is a viable alternative to the more expensive activity monitors used in research.IMPLICATIONS FOR REHABILITATIONThe ActiGraph has low criterion validity and accuracy at counting steps after stroke.The Xiaomi Smart Band has good criterion validity and accuracy at counting steps after a stroke.The Xiaomi Smart Band is a low-cost activity monitor that is a viable alternative to the more expensive activity monitors used in research.

Purposes: To measure the test-retest reliability and the clinical usefulness of the Work Limitation Questionnaire, and to compare the in-person with the telephone application., Methods: Cross-sectional, exploratory study. The Work Limitation Questionnaire was answered three times: twice in person, to measure test-retest reliability and clinical usefulness, and once, by telephone, to measure the validity of the telephone application., Results: Fifty-six individuals (32 men) with mild to moderate disabilities after stroke were included. Test-retest reliability was very high (ICC 0.96; 95% CI 0.94 to 0.98; p < 0.01), the clinical usefulness was high (9 out of 12 points), and the correlation between in-person and telephone applications was high (ρ = 0.7; 95% CI 0.5 to 0.9; p < 0.01). The average productivity loss was 4% (SD 5, min-max 0 to 15%)., Conclusions: The Work Limitation Questionnaire showed adequate test-retest reliability and clinical usefulness in individuals with stroke. The telephone application produced comparable results to in-person applications. The participants reported low productivity loss, which may be related to the mild impairments of the included sample., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Mobilization with movement has been recommended to improve foot mobility in people with ankle impairments and could improve walking after stroke., Objective: To examine the effects of the addition of mobilization with movement to commonly used exercises in physiotherapy for improving ankle range of motion and walking in people who have had a stroke., Design: Systematic review of randomized controlled trials., Settings: Not applicable., Participants: Ambulatory adults at any time after stroke., Intervention: The experimental intervention was exercises plus ankle mobilization with movement, in comparison with exercises alone., Main Outcome: Ankle range of motion., Measurements: Walking parameters (ie., walking speed, cadence, step length)., Results: Six trials, involving 160 participants, were included. The mean PEDro score of the trials was 6 (range 4 to 7). Mobilization with movement in addition to exercises improved range of motion by 4° (95% CI 2 to 6), walking speed by 0.08 m/s (95% CI 0.05 to 0.11), cadence by 9 steps/min (95% CI 7 to 12), and step length by 5 cm (95% CI 3 to 7) more than exercises alone. The quality of evidence was low for range of motion and moderate for walking outcomes., Conclusion: This systematic review provided evidence that the addition of mobilization with movement to commonly used exercises in neurological rehabilitation increases ankle dorsiflexion, and benefits are carried over to improving walking speed, cadence, and step length in moderately disabled individuals with chronic stroke., Review Registration: PROSPERO (CRD42023405130)., (© 2024 American Academy of Physical Medicine and Rehabilitation.)

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy that consists in the use of antiretroviral drugs by seronegative people at risk of HIV. Negative perceptions, inadequate understanding, and access barriers have been associated with decreased medication adherence. Manaus is the largest city in the Brazilian Amazon, where the incidence of HIV/AIDS is high, and the rates of adherence to the antiretroviral treatment for HIV and PrEP are low. In this qualitative study among PrEP users, mostly MSM, we explored perceptions, knowledge, and access barriers. We conducted 21 in-depth interviews with an intentionally sampled group of participants who had used PrEP at least once in their lifetime, selected through the snowball technique, between April and July 2022. A thematic analysis was conducted with a predominantly inductive approach. We highlight three relevant themes: (i) access to information about PrEP and its influences on users, (ii) access, monitoring, and barriers encountered, and (iii) facilitators for PrEP adherence and sexual behaviors. One of the negative perceptions identified in the study involves a misunderstanding of the association between PrEP users and the HIV/AIDS status. Participants revealed that some non-PrEP users suspect that individuals claiming PrEP usage are concealing an HIV-positive status to engage in unprotected sex. Lack of information by health professionals regarding HIV prevention methods poses significant barriers to PrEP access and adherence. Participants emphasized social media's crucial role in PrEP awareness. The results suggest a need to increase digital outreach regarding PrEP, decentralize PrEP services, and provide comprehensive healthcare training to improve the effectiveness of the preventive measure., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Batista et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: After hysterectomy, women could experience pelvic floor dysfunction and negative impact on quality of life, which could be improved by pelvic floor muscle training., Objective: To investigate effects of pelvic floor muscle training on urinary symptoms, vaginal prolapse, sexual function, pelvic floor muscle strength, and quality of life after hysterectomy., Methods: Systematic review with meta-analyses of randomized controlled trials. Trials with pelvic floor muscle training in women after hysterectomy were included. The outcomes measures were urinary symptoms, vaginal prolapse, sexual function, pelvic floor muscle strength, and quality of life. Quality of evidence was assessed by adopting the GRADE approach., Results: Six trials, involving 776 participants, were included. The mean PEDro score of trials was 5.5. Moderate-quality evidence suggested that pelvic floor muscle training improves sexual function by 5 points (95% CI: 4, 6) on the Female Sexual Function Index, compared with no intervention. It might affect strength (SMD 0.5; 95% CI: -0.4, 1.3), quality of life (SMD 0.5 points out of 108, 95% CI: -0.1, 0.9), urinary symptoms (RD -0.02; 95% CI: -0.06, 0.1); however, the estimates were too imprecise. In addition, it produces no or negligible effects on vaginal prolapse (RD 0; 95% CI: -0.1, 0.1). Long-term effects remain uncertain., Conclusion: This systematic review provides moderate-quality evidence that pelvic floor muscle training is effective for improving women's sexual function after hysterectomy, in comparison with no intervention. Benefits on urinary symptoms, pelvic floor muscle strength, quality of life, and vaginal prolapse remains unclear. Also, the effects beyond the intervention period remains uncertain., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2024 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Questions: In people with Parkinson's disease, what is the effect of adding external cueing (ie, visual, auditory or somatosensorial cueing) to walking training compared with walking training alone in terms of walking, mobility, balance, fear of falling and freezing? Are any benefits carried over to participation or maintained beyond the intervention period?, Design: Systematic review of randomised trials with meta-analysis., Participants: Ambulatory adults with Parkinson's disease., Intervention: Walking training with external cueing compared with walking training without external cueing., Outcome Measures: Walking (ie, speed, stride length and cadence), mobility, balance, fear of falling, freezing and participation., Results: Ten trials involving a total of 309 participants were included. The mean PEDro score of the included trials was 5 (range 4 to 8). Walking training with auditory cueing improved walking speed by 0.09 m/s (95% CI 0.02 to 0.15) more than walking training alone. Although the best estimate was that auditory cueing may also improve stride length by 5 cm, this estimate was imprecise (95% CI -2 to 11). The addition of visual cueing to walking training did not improve walking speed or stride length. Results regarding cadence, mobility, balance, fear of falling, and freezing and maintenance of benefits beyond the intervention period remain uncertain., Conclusion: This systematic review provided low-quality evidence that walking training with auditory cueing is more effective than walking training alone for improving walking speed in Parkinson's disease. Cueing is an inexpensive and easy to implement intervention, so the mean estimate might be considered clinically worthwhile, although the confidence interval spans clinically trivial and worthwhile effects., Registration: PROSPERO CRD42021255065., (Copyright © 2024 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Objective: To investigate if independent walking at 3 and 6 months poststroke can be accurately predicted within the first 72 hours, based on simple clinical bedside tests., Design: Prospective observational cohort study with 3-time measurements: immediately after stroke, and 3 and 6 months poststroke., Setting: Public hospital., Participants: Adults with first-ever stroke evaluated at 3 (N=263) and 6 (N=212) months poststroke., Intervention: Not applicable., Main Outcome Measures: The outcome of interest was independent walking at 3 and 6 months after stroke. Predictors were age, walking ability, lower limb strength, motor recovery, spatial neglect, continence, and independence in activities of daily living., Results: The equation for predicting walking 3 months poststroke was 3.040 + (0.283 × FAC baseline) + (0.021 × Modified Barthel Index), and for predicting walking 6 months poststroke was 3.644 + (-0.014 × age) + (0.014 × Modified Barthel Index). For walking ability 3 months after stroke, sensitivity was classified as high (91%; 95% CI: 81-96), specificity was moderate (57%; 95% CI: 45-69), positive predictive value was high (76%; 95% CI: 64-86), and negative predictive value was high (80%; 95% CI: 60-93). For walking ability 6 months after stroke, sensitivity was classified as moderate (54%; 95% CI: 47-61), specificity was high (81%; 95% CI: 61-92), positive predictive value was high (87%; 95% CI: 70-96), and negative predictive value was low (42%; 95% CI: 50-73)., Conclusions: This study provided 2 simple equations that predict walking ability 3 and 6 months after stroke. This represents an important step to accurately identify individuals, who are at high risk of walking dependence early after stroke., (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To provide information regarding the procedures, safety, tolerability, and measurement properties of the 6-min step test., Data Sources: MEDLINE, EMBASE, CINAHL, and SPORTDiscus (from inception until January 2024)., Review Methods: Studies that examined adults with acute or chronic diseases, and outcomes related to procedures, safety, tolerability, or measurement properties of the 6-min step test were included. Outcome data were summarized and combined in meta-analyses. The quality of included studies was assessed by the Consensus-based Standards for the selection of health Measurement Instruments checklist, and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system., Results: Fourteen studies, involving 847 participants, were included. All studies performed the 6-min step test in 6 min; however, some studies varied the step height and the use of upper limb support. The test appears to be safe and well tolerated by individuals. Moderate- to high-quality evidence demonstrated appropriate results for test-retest reliability (4 studies; Intraclass correlation coefficient 0.96; 95% CI 0.91-0.98; n  = 125), criterion validity (4 studies; r  = 0.53; 95% CI 0.30-0.71; n  = 307), and construct validity (4 studies; r  = 0.63; 95% CI 0.52-0.73; n  = 233)., Conclusion: This review provides recommendations for applying the 6-min step test in clinical and research settings. No adverse events were reported, and the test appears to be well tolerated. Adequate results were found for test-retest reliability, criterion validity, and construct validity., Review Registration: PROSPERO (CRD42022347744)., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To investigate the effects of inspiratory strength training on respiratory muscle strength, pulmonary function, and walking capacity in children with cerebral palsy, with Gross Motor Function Classification System I to III., Methods: Searches were conducted in CINAHL, LILACS, MEDLINE, and Physiotherapy Evidence Database (PEDro) databases. The outcomes of interest were respiratory muscle strength, pulmonary function, and walking capacity. The quality was assessed by PEDro Scale. The Grading of Recommendations Assessment, Development, and Evaluation system was used to summarize the quality of evidence., Results: Inspiratory strength training increased the strength of inspiratory muscles and may increase the strength of the expiratory muscles. No changes were observed in pulmonary function or walking capacity., Conclusions: This systematic review provides moderate-quality evidence that inspiratory strength training is effective for increasing inspiratory muscle strength in children with cerebral palsy. Benefits may be carried over to improving expiratory muscle strength but were not observed on pulmonary function or walking capacity., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Academy of Pediatric Physical Therapy of the American Physical Therapy Association.)

Questions: In adults with a burn injury, do non-invasive therapies improve pain and burn scar pruritus, elasticity and vascularisation? Are any effects maintained beyond the intervention period?, Design: Systematic review of randomised trials with meta-analyses., Participants: Adults with burn scars., Intervention: The experimental intervention was a non-invasive (ie, non-surgical or non-pharmacological) therapy applied to the burn scar., Outcome Measures: Pain intensity, pruritus intensity, elasticity and vascularisation., Results: Fifteen trials involving 780 participants were included. The results indicated a beneficial effect on pain intensity on a 0-to-10 scale after massage (MD -1.5, 95% CI -1.8 to -1.1), shockwave therapy (MD -0.8, 95% CI -1.2 to -0.4) and laser (MD -4.0, 95% CI -6.0 to -2.0). The results indicated a beneficial effect on pruritus intensity on a 0-to-10 scale after massage (MD -0.4, 95% CI -0.7 to -0.2), shockwave therapy (MD -1.3, 95% CI -2.3 to -0.3) and laser (MD -4.8, 95% CI -6.1 to -3.5). Massage, shockwave therapy and silicone produced negligible or unclear benefits on scar elasticity and vascularisation. The quality of evidence varied from low to moderate., Conclusion: Among all commonly used non-invasive therapies for the treatment of burn scars, low-to-moderate quality evidence indicated that massage, laser and shockwave therapy reduce pain and the intensity of scar pruritus. Low-to-moderate quality evidence suggested that massage, shockwave therapy and silicone have negligible or unclear effects for improving scar elasticity and vascularisation., Review Registration: PROSPERO (CRD42021258336)., (Copyright © 2023 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

The objective was to examine the effects of backward walking training for improving walking speed and balance in children with cerebral palsy. A systematic review of randomized trials was conducted. Trials had to include children with cerebral palsy, with a Gross Motor Function Classification System, between I and III, that delivered backward walking training as a solo intervention or in combination with forward walking training. The outcomes of interest were walking speed and balance. The methodological quality of included trials was assessed by the PEDro scale, and the quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation. Eight papers, involving 156 participants, were included. Using random-effects meta-analysis, we estimated that backward walking training improved walking speed by 0.10 m/s [95% confidence interval (CI) 0.05-0.16] and by 2 points on the Pediatric Balance Scale (0-56) (95% CI 1.5-2.2) more than forward walking training. We also estimated that the addition of backward walking training increased walking speed by 0.20 m/s (95% CI 0.07-0.34) and reduced the angular excursion of the center of gravity by 0.5 degrees (95% CI -0.7 to -0.3). The quality of the evidence was classified as low to moderate. In conclusion, overall, backward walking training appears to be as effective or slightly superior to forward walking training for improving walking speed in children with CP. The addition of backward walking training statistically significantly and clinically important enhanced benefits on walking speed., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Aims: To examine the effect of manual therapy applied to the cervical joint for reducing pain and improving mouth opening and jaw function in people with TMDs., Methods: A systematic review of randomized controlled trials was performed. Participants were adults diagnosed with TMDs. The experimental intervention was manual therapy applied to the cervical joint compared to no intervention/placebo. Outcome data relating to orofacial pain intensity, pressure pain threshold (PPT), maximum mouth opening, and jaw function were extracted and combined in meta-analyses., Results: The review included five trials involving 213 participants, of which 90% were women. Manual therapy applied to the cervical joint decreased orofacial pain (mean difference: -1.8 cm; 95% CI: -2.8 to -0.9) and improved PPT (mean difference: 0.64 kg/cm2; 95% CI: 0.02 to 1.26) and jaw function (standardized mean difference: 0.65; 95% CI: 0.3 to 1.0)., Conclusion: Manual therapy applied to the cervical joint had short-term benefits for reducing pain intensity and improving jaw function in women with TMDs. Further studies are needed to improve the quality of the evidence and to investigate the maintenance of benefits beyond the intervention period.

Identifying the determinants of walking confidence can be crucial in therapeutic terms. On these bases, interventions to improve these factors could improve, in turn, walking confidence. Objective is to explore the relationship between motor impairments and activity limitation measures and walking confidence in people with chronic stroke. Walking confidence was assessed using the modified Gait Efficacy Scale. The independent variables were: strength of the hip flexors and knee flexors/extensors (measured with a dynamometer), lower limb coordination (assessed by the Lower Extremity Motor Coordination Test), dynamic balance (assessed by the Four-Square Step Test), walking speed (from the 10-m Walk Test), aerobic capacity (from the 6-Minute Walk Test), and self-perceived locomotion ability (assessed by the ABILOCO). Pearson correlation was used to explore the relationships between the variables, and multiple linear regression to identify the independent explainers of walking confidence after stroke. Ninety chronic stroke individuals (35 men), with a mean age of 68 (SD 13) years were assessed. All independent variables were significantly correlated with walking confidence. Regarding the regression analysis, these measures explained 44% ( F = 9.21; P < 0.001) of the variance in walking confidence; however, only walking speed, strength of the hip flexor muscles, aerobic capacity, and perceived locomotion ability showed significance. All motor impairment and activity limitation measures correlated with walking confidence. However, the regression analysis highlighted that only walking speed, aerobic capacity, the strength of the hip flexor muscles, and perceived locomotion were independent explainers of walking confidence after stroke., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: This systematic review aimed to examine the effects of home-based exercises in comparison with centre-based exercises for improving the paretic upper limb after stroke., Data Sources: AMED, MEDLINE, EMBASE CINAHL, Cochrane, PsycINFO, and PEDro databases., Review Methods: Only randomized clinical trials were included. Participants in the reviewed studies were adults at any time after stroke. The experimental intervention was home-based exercises compared with centre-based exercises. Outcome data related to strength, motor recovery, dexterity, activity, and participation were extracted from the eligible trials and combined in meta-analyses. The quality of included trials was assessed by the PEDro scores. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system., Results: Eight trials, involving 488 participants, were included. Most trials (63%) delivered semi-supervised interventions (amount of supervision 3-43%), and three trials provided full supervision. Random-effects meta-analyses provided moderate- to high-quality evidence that home- and centre-based exercises provide similar effects on motor recovery (MD 1.4 points; 95% CI -0.9 to 3.8), dexterity (MD -0.01 pegs/s; 95% CI -0.04 to 0.05), upper limb activity performance (SMD -0.04; 95% CI -0.25 to 0.18), and quality of movement (0.1 points; 95% CI -0.2 to 0.4). Effects on strength were also similar but the quality of the evidence was rated as low. No trials examined effects on participation., Conclusion: Effects of home-based prescribed exercises on upper limb motor recovery, dexterity, and activity are likely to be similar to improvements obtained by centre-based exercises after stroke.

Purpose: To investigate the test-retest reliability and measurement error of the Brazilian version of the modified Gait Efficacy scale (mGES-Brazil) in individuals who have had stroke., Methods: The mGES-Brazil was applied on two occasions, five to seven days apart, in a research laboratory setting. Test-retest reliability and measurement error, which included the standard error of measurement (SEM), smallest detectable change (SDC), and analysis of the limits of agreement by the Bland-Altman plots, were examined., Results: Fifty individuals who have had stroke (18 men), with a mean age of 64 ± 11 years, were evaluated. All individual items showed good reliability (Intra-class Correlation Coefficient - ICC 2,1  > 0.90). The ICC was 0.98 (95% CI 0.97 to 0.99) and the Bland and Altman plots revealed no systematic changes in the mean test-retest scores. The SEM (SEM%) was 3 (5%), within the recommended values, while the SDC was 8 points., Conclusion: The mGES-Brazil demonstrated to be reliable to be applied within clinical and research contexts for the assessment of changes in walking confidence of individuals who have had stroke. Changes in mGES scores ≥8 points reflect real changes.

Objective: To explore the relationship between walking measurements (i.e., walking speed, walking performance and walking confidence), and participation in ambulatory people with chronic stroke., Materials and Methods: Participation was measured using the mobility domain of Brazilian version of the Stroke Impact Scale 3.0. Walking measures were walking speed, assessed by 10-m Walk Test, walking performance, assessed by ABILOCO, walking confidence, assessed by mGES. Pearson correlation coefficients were used to explore the relationships between the walking measures and social participation, and step-wise multiple linear regression analysis was used to identify which walking measures would explain participation after stroke., Results: Ninety-five chronic stroke individuals (38 men), with a mean age of 67 (SD 13) years were assessed. Significant positive correlations, of high magnitude, were found between participation and all walking measures (r ≥ .53; p < .001). Regarding the regression analysis, walking confidence alone explained 44% (F = 72.4; p < .001) of the variance in participation. When perceived locomotion ability was included in the model, the explained variance increased to 48% (F = 42.8; p < .001)., Conclusion: All walking measures were correlated with social participation after stroke, but only perceived locomotion ability and walking confidence explained the variance in participation. Clinicians should be encouraged to evaluate real-life performance and personal factors that may limit community participation after stroke., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Questions: In people who have had a stroke, how comparable are the effects of home-based exercises with those of equivalent centre-based exercises for improving walking speed, balance, mobility and participation? Is the comparability of the effects of these two types of exercise maintained beyond the intervention period?, Design: Systematic review of randomised controlled trials., Search Strategy: Searches were conducted on MEDLINE, AMED, EMBASE, Cochrane, PsycINFO and PEDro databases, without date or language restrictions., Participants: Participants in the reviewed studies were ambulatory adults at any time after stroke., Interventions: The experimental intervention consisted of home-based exercises, which was compared with equivalent doses of centre-based exercises., Outcome Measures: Walking speed, balance, mobility and participation., Data Analysis: The quality of included trials was assessed using the PEDro scores. Outcome data were extracted from the eligible trials and combined in random-effects meta-analyses. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system., Results: Nine trials involving 609 participants were included. Random-effects meta-analyses provided high-quality evidence that home-based and centre-based exercises provide similar effects on walking speed (MD -0.03 m/s, 95% CI -0.07 to 0.02) and balance (MD 0 points, 95% CI -1 to 2). Results regarding mobility (SMD -0.4, 95% CI -1.3 to 0.4) and participation (MD -5 points, 95% CI -19 to 10) were imprecise. For most outcomes, the effects of home-based exercises and centre-based exercises remained similar beyond the intervention period., Conclusion: Effects of home-based prescribed exercises on walking speed, balance, mobility and participation are likely to be similar to improvements obtained by equivalent doses of centre-based exercises after stroke., Review Registration: PROSPERO (CRD42021254642)., (Copyright © 2022 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

A systematic study is made of Early Cretaceous (late Aptian/earlyAlbian) ostracod assemblages from the Santo Antnio section. This section is characterized by sediment belonging to the post-rift sedimentary sequence of the Romualdo Formation in the southern-central region of the Araripe Basin, Brazil and represents on of the first marine ingression in the interior of the continent, during the beginning of the formation of the Atlantic Ocean. The Santo Antonio section presents ostracods in greater diversity than previously known. Nineteen samples were analyzed, yielding a total of 8,370 specimens. Fifteen taxa were identified, including six brackish ostracods: Pattersoncypris salitrensis, Pattersoncypris angulata, Pattersoncypris micropapillosa, Damonella grandiensis, Alicenula cf. leguminella and Theriosynoecum cf. quadrinodosum; and nine typically brackish-marine species, including seven new ones: Dicrorygma cf. minuta, Dicrorygma (Orthorygma?) dimorpha, Mongolianella aptianensis sp. nov., Mantelliana speculum sp. nov., Paracypris undulareventralis sp. nov., Microceratina retangularis sp. nov., Perissocytheridea oculusutilis sp. nov., Perissocytheridea poruslinearis sp. nov. and Perissocytheridea florisdorsalis sp. nov. Therefore, the detailed taxonomic study brings a new understanding of marine ostracods around the upper Aptian/lower Albian boundary of the Araripe Basin.

This study aimed at estimating the prevalence of stroke in older adults in Brazil, and at identifying the sociodemographic, health-related, health service-related, and environmental factors associated with independence in daily activities. Across-sectional, population-based study (Brazilian Longitudinal Study of Aging 2015-2016) was conducted. 536 individuals (≥ 50 years), from 9,412 participants, have had stroke and were included. Prevalence of stroke was 5.3% among individuals aged 50 years and over, increasing up to 8.0% among individuals aged 75 years and over, showing a dissimilar pattern between sex. Independence was associated with walking speed (Prevalence Ratio (PR) 2.72, 95%CI: 1.96 to 3.77), physical activity (PR 1.24; 95%CI: 1.04 to 1.47) and use of walking devices (PR 0.63; 95%CI: 0.41 to 0.96). A significant interaction was found between walking speed plus home adaptations and performance of daily living activities (PR 3.42; 95%CI: 1.04 to 11.29). The probability of independence was 40% among slow walkers (< 0.4 m/s), increasing up to 70% among fast walkers (> 0.8 m/s), and to 90% among those who also have home adaptations. Faster walking speed combined with home adaptations was the main factor associated with long-term independence after stroke.

Purpose: To examine whether using a cane would improve spatiotemporal parameters of walking, i.e., speed, stride length, cadence, and symmetry after stroke., Material and Methods: Searches were conducted in eight databases. The experimental condition was walking with a cane. Four outcomes were of interest: walking speed, stride length, cadence, and symmetry., Results: Twelve studies were included. Results from nine studies suggested that individuals with stroke walked 0.01 m/s (SD 0.06) slower with a single-point cane, compared with no cane. Two studies suggested a reduction in cadence (MD-5 steps/min, SD2) and an increase in stride length (MD 0.08 m, SD 0.01). Three studies suggested that individuals walked 0.06 m/s (SD 0.07) slower with a four-point cane, compared with no cane. Four studies suggested that individuals walked 0.06 m/s (SD 0.04) faster with a single- point cane compared with a four-point cane. Results regarding other outcomes were inconclusive., Conclusions: Results showed no worthwhile improvements in spatiotemporal parameters of walking with a single-point cane and a slight reduction with a four-point cane, compared with no cane. Individuals walked slightly faster with a single-point cane compared with a four-point cane, but the evidence is insufficient to support this superiority.IMPLICATIONS FOR REHABILITATIONA single-point cane may not improve spatiotemporal parameters of walking after stroke.Walking with a four-point cane may slightly decrease spatiotemporal parameters of walking.Canes may be prescribed without the fear of negatively impairing walking kinematics.

Objective: To examine the effects of the provision of a cane, delivered to ambulatory people with chronic stroke, for improving walking and social participation., Design: Two-arm, randomized trial., Setting: Community-based., Participants: Ambulatory individuals with chronic stroke., Interventions: The experimental intervention was the provision of a single-point cane during one month. The control group received a placebo intervention., Outcome Measures: Walking speed, step length, cadence, walking capacity, and walking confidence were measured without the cane to examine its rehabilitative effect. Walking speed was also measured with the cane for inclusiveness, and social participation was measured for examining carry over effects. Outcomes were measured at baseline, and after one and two months., Results: Fifty individuals were included. In the experimental group, mean age was 69 years (SD 14), and walking speed was 0.58 m/s (SD 0.17). In the control group, mean age was 68 years (SD 13), and walking speed was 0.63 m/s (SD 0.15). When walking without the cane, after one and after two months, there were no between-group differences in any measures. When walking with the cane, after one month, the experimental group walked 0.14 m/s (95% CI 0.05-0.23) faster than the control group and after two months, they were still walking 0.18 m/s (95% CI 0.06-0.30) faster., Conclusion: Use of a cane improved walking speed, only when participants walked with the cane. Use of cane for one month did not improve walking outcomes, when walking without the cane. People with stroke would need to continue to use the cane to maintain any benefits in walking speed.

Objective: This study aimed to investigate the completion rates of a home-based randomized trial, which examined home-based high-intensity respiratory muscle training after stroke compared with sham intervention., Materials and Methods: Completion was examined in terms of recruitment (enrolment and retention), intervention (adherence and delivery of home-visits) and measurement (collection of outcomes)., Results: Enrolment was 32% and retention was 97% at post-intervention and 84% at follow-up. Adherence to the intervention was high at 87%. Furthermore, 83% of planned home-visits were conducted and 100% of outcomes were collected from those attending measurement sessions., Conclusion: This home-based randomized trial demonstrated high rates of enrolment, retention, adherence, delivery of home-visits, and collection of outcomes. Home-based interventions may help to improve completion rates of randomized trials., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Transcranial direct current stimulation (tDCS) has the potential to modulate cortical excitability and enhance the effects of walking training in people with Parkinson's disease. This study will examine the efficacy of the addition of tDCS to a task-specific walking training to improve walking and mobility and to reduce falls in people with Parkinson's disease., Methods: This is a two-arm, prospectively registered, randomized trial with concealed allocation, blinded assessors, participants and therapists, and intention-to-treat analysis. Twenty-four individuals with Parkinson's disease, categorized as slow or intermediate walkers (walking speeds ≤ 1.0 m/s), will be recruited. The experimental group will undertake a 30-min walking training associated with tDCS, for 4 weeks. The control group will undertake the same walking training, but with sham-tDCS. The primary outcome will be comfortable walking speed. Secondary outcomes will include walking step length, walking cadence, walking confidence, mobility, freezing of gait, fear of falling, and falls. Outcomes will be collected by a researcher blinded to group allocation at baseline (week 0), after intervention (week 4), and 1 month beyond intervention (week 8)., Discussion: tDCS associated with walking training may help improve walking of slow and intermediate walkers with Parkinson's disease. If walking is enhanced, the benefits may be accompanied by better mobility and reduced fear of falling, and individuals may experience greater free-living physical activity at home and in the community., Trial Registration: Brazilian Registry of Clinical Trials (ReBEC) RBR-6bvnx6 . Registered on September 23, 2019., (© 2021. The Author(s).)

To validate the telephone-based application of the modified Gait Efficacy Scale (mGES) for the assessment of walking confidence in older people. Participants answered the mGES-Brazil on two randomized occasions, face-to-face and by telephone. The mean difference (MD) between the interviews was reported. Intraclass correlation coefficient (ICC3,1) was used to investigate the levels of agreement between the two occasions for total mGES-Brazil scores and for the individual items. A total of 78 individuals were included. There was no significant difference in the MD obtained between applications of the mGES (1 point, 95% confidence interval -6 to 7). A very high level of agreement was found between the mGES total scores during face-to-face and telephone applications (ICC = 0.98; 95% CI 0.97-0.99). All items, except one (item 3), had a very high agreement between the two applications. The mGES showed to be reliable to be applied for telephone assessments of walking confidence in older people., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Questions: Does walking training combined with transcranial direct current stimulation (tDCS) improve walking (ie, speed, cadence and step length) and reduce falls and freezing, compared with no/sham intervention, in people with Parkinson's disease? Is walking training combined with tDCS superior to walking training alone? Are any benefits carried over to social participation and/or maintained beyond the intervention period?, Design: A systematic review with meta-analyses of randomised clinical trials., Participants: Ambulatory adults with a clinical diagnosis of Parkinson's disease., Intervention: tDCS combined with walking training., Outcome Measures: Primary outcomes were walking speed, cadence and step length. Secondary outcomes were number of falls, fear of falling, freezing of gait and social participation., Results: Five trials involving 117 participants were included. The mean PEDro score of the included trials was 8 out of 10. Participants undertook training for 30 to 60 minutes, two to three times per week, on average for 4 weeks. Moderate-quality evidence indicated that the addition of tDCS to walking training produced negligible additional benefit over the effect of walking training alone on walking speed (MD -0.01 m/s, 95% CI -0.05 to 0.04), step length (MD 1.2 cm, 95% CI -1.2 to 3.5) or cadence (MD -3 steps/minute, 95% CI -6 to 1). No evidence was identified with which to estimate the effect of the addition of tDCS to walking training on freezing of gait, falls and social participation., Conclusion: The addition of tDCS to walking training provided no clinically important benefits on walking in ambulatory people with Parkinson's disease., Registration: PROSPERO CRD42020162908., (Copyright © 2021 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Questions: Does mechanically assisted walking improve walking speed, distance and participation compared with no/non-walking intervention or overground walking after stroke? Are any benefits maintained beyond the intervention period?, Design: Systematic review of randomised trials with meta-analysis., Participants: Ambulatory adults at any time after stroke., Intervention: Mechanically assisted walking (treadmill or gait trainer) without body weight support., Outcome Measures: Walking speed, walking distance and participation., Results: Sixteen trials involving 713 participants were included. The mean PEDro score of the trials was 6.3 (range 4 to 8). Treadmill walking increased walking speed by 0.13 m/s (95% CI 0.08 to 0.19) and distance by 46 m (95% CI 24 to 68) compared with no/non-walking intervention; these effects were largely maintained beyond the intervention. Treadmill walking had a similar or better effect on walking speed (MD 0.07 m/s, 95% CI 0.00 to 0.13) and distance (MD 18 m, 95% CI 1 to 36) compared with overground walking. The estimate of the relative effect of treadmill walking compared with overground walking on participation was very imprecise (SMD 0.16, 95% CI -0.15 to 0.48)., Conclusion: This systematic review provides moderate-quality evidence that the effect of treadmill walking is the same as or better than the effect of overground walking for improving walking speed and distance in ambulatory people after stroke. Long-term effects and carryover benefits to participation remain uncertain., Review Registration: PROSPERO (CRD42020162778)., (Copyright © 2021 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Background: Falls, which are common events after stroke, may lead to activity limitations and increased dependence. It is important to identify which commonly employed clinical measures could differentiate individuals, who are fallers from the non-fallers., Aim: To investigate specific cut-off values of clinical measures that could discriminate fallers and non-fallers individuals with chronic stroke., Method: This cross-sectional study involved 105 community-dwelling individuals with stroke. The primary outcome was report of falls over the last six months. The clinical predictors included measures of mobility (walking speed, stair ascent/descent cadences, time to perform the Timed Up and Go test, and ABILOCO) and the Fall Efficacy Scale - International (FES-I) scores. To identify which measures were able to detect between-group differences, independent Student's t-tests were employed. For measures which were able to discriminate fallers from the non-fallers, the Receiver Operating Characteristics (ROC) and the Area Under the ROC Curve (AUC) were calculated., Results: Out of the 105 participants (61 men), 41% reported falls over the previous 6 months. Stair ascent cadence, ABILOCO, and FES-I scores significantly differentiated the groups, but only the FES-I demonstrated acceptable discriminatory ability (AUC = 0.71). The optimal FES-I cut-off score was 28 points (sensitivity = 0.71; specificity = 0.57; positive predictive value = 51%; and negative predictive value = 74%)., Conclusions: The FES-I demonstrated good discriminatory ability to classify individuals with chronic stroke, who were fallers from the non-fallers. The use of the established cut-off value of 28 points is recommended and may help clinical reasoning and decision-making in stroke rehabilitation., Competing Interests: Declaration of competing interest The authors report no declarations of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The aim of the study was to validate the telephone-based application of the ABILOCO questionnaire for the assessment of locomotion ability after stroke. Individuals after stroke answered the ABILOCO-Brazil questionnaire on two randomized occasions, face-to-face and by telephone, 5-7 days apart. The mean difference between the interviews was reported. Intraclass correlation coefficient (ICC) was calculated to investigate the agreement between the total scores, and weighted-Kappa statistics to investigate the agreement between the individual items. A total of 92 individuals were included. There was no significant difference in the mean scores between face-to-face and telephone-based applications of the ABILOCO [mean difference 0.17 logits; 95% confidence interval (CI), -0.88 to 0.54]. A high level of agreement was found between the ABILOCO total scores obtained between both applications (ICC = 0.90; 95% CI, 0.84-0.93), and most of the individual items had, on average, moderate agreement. The ABILOCO showed to be a reliable questionnaire for telephone assessment of locomotion ability after stroke., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To determine, in Brazil, the proportion of individuals who return to a paid work after stroke, and the factors which predict this., Materials and Methods: A prospective observational cohort study was carried out for six months. Participants were recruited early after stroke from four public hospitals. The outcome of interest was return to work, and the following predictors were investigated: age, sex, education, marital status, contribution to household income, type of work, independence, and depression. Logistic regression was used to identify multivariate predictors of return to work., Results: Of the 117 included participants, 52 (44%) had returned to work by 6 months. Contribution to household income (OR 2.4; 95% CI 1.0 to 5.9), being a white-collar worker (OR 4.0; 95% CI 1.8 to 8.6) and being independent in daily activities at 3 months (OR 10.6; 95% CI 2.9 to 38.3), in combination, positively predicted return to work., Conclusions: Less than 50% of stroke survivors returned to work six months after stroke. Among predictors, only the level of dependence in daily activities is a modifiable factor. Interventions aimed at reducing disability after stroke might increase rates of return to work.Implications for rehabilitationIn Brazil, less than 50% of stroke survivors returned to work six months after stroke.Clinicians may collect information regarding household income, type of work and dependence in daily activities to estimate chances of returning to work, in developing countries.Being independent at 3 months was the strongest predictor of return to work; therefore, interventions aimed at reducing disability after stroke may increase rates of return to work.

Background: Foot-drop is a common impairment after stroke, which reduces walking ability., Objective: To examine the efficacy of interventions aimed at reducing foot-drop, i.e., ankle-foot orthoses and functional electrical stimulation, on walking speed and balance after stroke., Data Sources: MEDLINE, EMBASE, Cochrane, PsycINFO, and PEDro databases., Eligibility Criteria: The review included only parallel, randomized trials. Participants were ambulatory adults after stroke. The experimental interventions were the use of an ankle-foot orthosis or functional electrical stimulation., Data Synthesis: Outcome data related to walking speed and balance were extracted from the eligible trials and combined in random-effects meta-analyses. The quality of trials was assessed by the PEDro scores and the quality of evidence was determined according the Grading of Recommendations Assessment, Development, and Evaluation system., Results: Eleven trials involving 1135 participants were included. The mean PEDro score of the trials was 5.8 (ranging from 4 to 7). Ankle-foot orthoses (MD 0.24m/s; 95% CI 0.06 to 0.41) and functional electrical stimulation (MD 0.09m/s; 95% CI 0.03 to 0.14) significantly increased walking speed, compared with no intervention/placebo. Results regarding balance were inconclusive. Ankle-foot orthoses were not superior to functional electrical stimulation for improving walking speed (MD 0.00m/s; 95% CI -0.06 to 0.05) or balance (MD 0.27 points on the Berg Balance Scale; 95% CI -0.85 to 1.39) after stroke., Conclusions: This systematic review provided moderate-quality evidence that both ankle-foot orthoses and functional electrical stimulation improve walking speed after stroke, but the effects on balance remain unclear., Systematic Review Registration Number: PROSPERO CRD42019130988., (Copyright © 2020 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

The purpose of the present study was to examine the main characteristics of clinical trials in physiotherapy aimed at improving walking speed after stroke, as well as the correlation between trials' methodological quality and journals' Impact Factor. Searches were conducted on Physiotherapy Evidence Database for all randomized controlled trials aiming at improving walking speed after stroke. Data extracted from the studies were: continent, language, methodological quality, year of publication, number of normalized citations, open access, sample size, measurements of walking speed, interventions, comparators, and prior registration. Data extracted from the journals were: 2018 Impact Factor, open access, endorsement of CONSORT recommendations, predatory classification, PubMed indexing, and Journal Citation Reports category. The main outcomes were journals' Impact Factor, open access, CONSORT recommendations endorsement by the journal, and methodological quality. Spearman correlation coefficients were calculated to explore the relationships between trials' methodological quality and journals' Impact Factor. Two hundred twenty-seven trials were published in 62 journals. The number of trials has increased over the last years. Most of these trials had citations, moderate methodological quality, were published in English, in open access journals, which endorse the CONSORT recommendations, and had Impact Factor ≥2.0. The results indicated a positive, but weak correlation between methodological quality and journals' Impact Factor. Thus, trials in physiotherapy aimed at improving walking speed after stroke have increased over the last years. Overall, trials had moderate methodological quality and were published in journal with moderate-to-high Impact Factor. Best trials were not necessarily published in journals with high Impact Factor.

Parkinson's disease (PD) is one of the most prevalent neurodegenerative diseases in the world, with a high degree of disability. Among the various therapeutic possibilities, brain stimulation appears in a promising approach, with deep brain stimulation (DBS) being the best described and successful, yet it has the limitation of being invasive. In this context we present transcranial direct current stimulation (tDCS), a non-invasive treatment that brings a new perspective when thinking about treatment of neurological diseases. It is easy to handle, low cost, few side effects and good adherence to patients. TDCS presents good evidence for clinical practice, but when it comes to PD the results obtained are inconclusive and some protocols have not yet been tested. In this hypothesis we propose that the use of tDCS applied in the supplemental motor areas, together with a gait training, can facilitate the motor learning and modulate the neurons for better potentiation of the exercises together with patients with walking difficulties due to PD., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To explore the relationships between clinical measures and the ability to increase walking speed in ambulatory people with chronic stroke and to identify which measures would best predict walking speed reserve., Methods: An exploratory, cross-sectional study was conducted with 114 individuals with chronic stroke. The outcome of interest was walking speed reserve, defined as the difference between individuals' comfortable and maximal walking speeds. Predictors were characteristics of the participants (age, sex, time since stroke, relative lower-limb dominance) and motor impairments (tonus, strength, and motor coordination)., Results: The characteristics of the participants did not significantly correlate with walking speed reserve. All measures of motor impairments, i.e., tonus, strength, and motor coordination, were significantly correlated with walking speed reserve (p < 0.01), but only motor coordination was kept in the regression model. Motor coordination alone explained 35% (F = 61.5; p < 0.001) of the variance in walking speed reserve., Conclusions: The level of motor coordination of the paretic lower limb is associated with the walking speed reserve of individuals with stroke. Interventions aimed at improving motor coordination may have the potential to improve everyday situations that require immediate increases in walking speed., (Copyright © 2019 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Purpose: Telephone-based assessment may be a valuable and cost-effective approach to improve monitoring and follow-up assessments in patients and research participants. Telephone-based assessment may be of particular value during times when it is important to reduce in-person contract, such as during the Covid-19 pandemic. The purpose of this study was to investigate concurrent validity of the telephone-based administration of the ABILHAND for the assessment of manual ability in individuals with stroke., Methods: Using a cross-sectional study design, participants with stroke were invited to answer the ABILHAND questionnaire on 2 randomized occasions, face to face and by telephone, 5 to 7 days apart. The mean difference (MD) between the interviews was calculated (95% confidence interval [95% CI]) to investigate the concurrent validity. Intraclass correlation (ICC) and weighted κ coefficients were used to investigate the agreement between face-to-face and telephone-based administration., Results: One hundred two participants (50 men; mean age = 65 years, SD = 13 years) were included. No significant differences were observed between the mean scores obtained with face-to-face and telephone-based administration of the ABILHAND (MD = -0.06; 95% CI, -0.72 to 0.60). Very high agreement was found between face-to-face and telephone-based administration (ICC = 0.90; 95% CI, 0.85 to 0.93) on the ABILHAND total scores. Most of the individual items had moderate or substantial κ agreement., Discussion and Conclusions: Telephone-based administration of the ABILHAND is valid for the assessment of manual ability after stroke. Clinicians and researchers may use the ABILHAND for monitoring manual ability in persons with stroke and/or screening potential research participants.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A318).

Objectives: To investigate the adherence and the self-reported barriers to general and respiratory exercises reported by individuals with cystic fibrosis (CF)., Study Design: An exploratory, experimental study., Methods: Community-dwelling individuals aged 16 years and over, diagnosed with CF, who were accompanied in referral centers were included. Information regarding adherence to exercises was obtained by a questionnaire and reported as a ratio between prescribed exercises and self-reported adherence. The weekly frequency was used to verify adherence to exercise initiation, and the amount of session duration concluded was used to verify adherence to exercise duration. Values above 0.70 were considered as high adherence. Eight demographic and clinical factors were examined to explore their relationships with adherence, and the barriers to exercises were also collected by questionnaire., Results: Thirty-four participants met the inclusion criteria. Overall, adherence to exercise initiation was 0.40 (standard deviation [SD] = 0.3) for general exercises and 0.63 (SD = 0.4) for respiratory exercises. Adherence to exercise duration was 0.76 (SD = 0.4) for general exercises and 0.73 (SD = 0.4) for respiratory exercises. Forced vital capacity (r = 0.39; P = .02) was associated with adherence to the duration of general exercises, and body mass index (r = -0.33; P = .05) was associated with adherence to the duration of respiratory exercises. The main reported barriers were lack of interest, motivation and time, tiredness, noncommitment, and do not recognize the benefits of exercises., Conclusions: Individuals with CF minded completing the sessions of prescribed exercises once they have initiated it, but most of the days they did not practice general or respiratory exercises., (© 2020 Wiley Periodicals LLC.)

Background: Although the significance of respiratory muscle training has been established in the literature, there is a need to understand the participants' perceptions of the benefits of this intervention., Objective: To understand how individuals who had a stroke perceive changes in their body functions and structures, activities, and participation after a high-intensity respiratory muscle training intervention and to understand their perceptions of the benefits and limitations of a home-based intervention., Design: Qualitative study., Setting: Community-dwelling patients., Patients: Fifteen individuals who had a stroke., Methods: For this qualitative study, interviews were conducted using a semistructured questionnaire about topics related to participation in a home-based respiratory muscle training intervention. The interviews were transcribed and analyzed using thematic content analysis., Results: Fifteen participants were interviewed. Most of the participants reported positive perceptions of body functions and structures, grouped into two thematic categories (breathing and speech); activity, also grouped into two thematic categories (walking and domestic activities); and participation, grouped into one thematic category (community-leisure activities). Answers about the benefits of a home-based intervention were grouped into three thematic categories (no need to leave home, commitment to training, and comfort). All participants reported that they would recommend the intervention to other stroke patients and that they were either satisfied or very satisfied with the intervention. Most (80%) participants did not consider the intervention difficult to perform., Conclusion: Individuals who had experienced a stroke perceived the benefits of high-intensity home-based respiratory muscle training in all components of function., (© 2020 American Academy of Physical Medicine and Rehabilitation.)

Background: Although evidence-based practice has been widely used by physical therapists, data variation suggests that its implementation may be influenced by a number of factors. Population-specific information is required to help enhance the use of research in clinical practice., Objective: To identify the personal and organizational characteristics associated with the use of evidence-based practice by physical therapists providing services to people with stroke in Brazil., Methods: A cross-sectional mail survey was conducted. The Brazilian versions of the questionnaires "Practitioner and Organizational Barriers to Evidence-based Stroke Rehabilitation" and "Evidence-based practice self-efficacy scale" were mailed to physical therapists. Logistic regression analysis was used to explore associations between personal and organizational characteristics with education, attitudes, beliefs, interest, and perceived role, perceived support, and organizational resources for evidence-based practice., Results: The response rate was 36% (n=94). Ten characteristics explained 57% of the variance associated with attitudes and beliefs, and interest and perceived role for evidence-based practice. Nine characteristics explained 50% of the variance associated with perceived support and organizational resources for evidence-based practice. The most frequently cited barrier was lack of time (62%)., Conclusions: Although participants had positive attitudes regarding evidence-based practice, there is a need to develop a supportive organizational infrastructure, in addition to enhancing skills of the evidence-based practitioner, to increase research integration in physical therapy practice for assessing and treating people with stroke. Potential strategies should include use of evidence-based practice during undergraduate programs, partnership with professional practice-oriented organizations, and investments to enable research-related activities., (Copyright © 2019 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Here we define a ~200 Kb genomic duplication in 2p14 as the genetic signature that segregates with postlingual progressive sensorineural autosomal dominant hearing loss (HL) in 20 affected individuals from the DFNA58 family, first reported in 2009. The duplication includes two entire genes, PLEK and CNRIP1, and the first exon of PPP3R1 (protein coding), in addition to four uncharacterized long non-coding (lnc) RNA genes and part of a novel protein-coding gene. Quantitative analysis of mRNA expression in blood samples revealed selective overexpression of CNRIP1 and of two lncRNA genes (LOC107985892 and LOC102724389) in all affected members tested, but not in unaffected ones. Qualitative analysis of mRNA expression identified also fusion transcripts involving parts of PPP3R1, CNRIP1 and an intergenic region between PLEK and CNRIP1, in the blood of all carriers of the duplication, but were heterogeneous in nature. By in situ hybridization and immunofluorescence, we showed that Cnrip1, Plek and Ppp3r1 genes are all expressed in the adult mouse cochlea including the spiral ganglion neurons, suggesting changes in expression levels of these genes in the hearing organ could underlie the DFNA58 form of deafness. Our study highlights the value of studying rare genomic events leading to HL, such as copy number variations. Further studies will be required to determine which of these genes, either coding proteins or non-coding RNAs, is or are responsible for DFNA58 HL., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. F or Permissions, please email: journals.permissions@oup.com.)

Background: Water-based exercises have the potential to reduce impairments and walking limitations after stroke., Objective: To examine the effects of water-based exercises on walking speed, balance, and strength after stroke., Data Sources: Eletronic searches on MEDLINE, CINAHL, EMBASE, Cochrane, PsycINFO, and PEDro databases., Eligibility Criteria: The review included randomized trials. Participants in the reviewed studies were ambulatory adults, who have had a stroke. The experimental intervention was comprised of water-based exercises., Data Synthesis: Outcome data related to walking speed, balance, and strength were extracted from the eligible trials and combined in meta-analyses. The quality of the included trials was assessed by the PEDro scores and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system., Results: Thirteen trials involving 464 participants were included. Random-effects meta-analyses provided moderate-quality evidence that water-based exercises significantly increase walking speed by 0.06m/second (95% CI 0.01 to 0.10) and balance by 4.5 points on the Berg Balance scale (95% CI 2.2 to 6.8), compared with land-based exercises, without concurrent changes in strength (MD 5.2Nm/kg; 95% CI -1.4 to 11.9)., Conclusions: This systematic review provided low-quality evidence regarding the efficacy of water-based exercises, compared with no intervention. However, there is moderate quality evidence, which suggested significant benefits of water-based exercises in walking speed and balance, compared with land-based exercises. Differences appear small to be considered clinically relevant, and, therefore, water-based exercises can be prescribed as alternative interventions, based upon individuals' exercise preferences. Systematic Review Registration Number PROSPERO (CRD42018108419)., (Copyright © 2019 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

The objective of the present study was to investigate if different levels of inspiratory muscle strength would be associated with dyspnea, walking capacity, and quality of life after stroke. For this exploratory study, the dependent outcome was strength of the inspiratory muscles, measured by maximal inspiratory pressure. Individuals with maximal inspiratory pressure ≥80 cmH2O were classified as non-weak, those with maximal inspiratory pressure between 45 and 80 cmH2O were classified as weak, and those with maximal inspiratory pressure ≤45 cmH2O were classified as very weak. Related outcomes included dyspnea, measured by the modified Medical Research Council scale; walking capacity, measured by the 6-minute walk test; and quality of life, measured by the Stroke-Specific Quality of Life scale. Fifty-three participants, who had a mean age of 62 years (SD 12) and a mean time since the onset of the stroke of 20 (SD 17) months were included. Significant differences were found only between the weak/very weak and non-weak groups. The mean differences between the non-weak and weak/very weak participants were -1.8 points (95% confidence interval -2.7 to -0.9) for dyspnea and 55 points (95% confidence interval 22-88) for quality of life. Significant correlations were found between measures of inspiratory strength and dyspnea (r = -0.54; P < 0.01) and quality of life (r = 0.56; P < 0.01). There were not found any significant differences or correlations regarding walking capacity. The findings demonstrated that individuals with stroke, who had weakness of the inspiratory muscles, reported greater dyspnea and worse quality of life, compared with those, who did not have weakness. The results regarding walking capacity remain unclear.

Objective : To explore the relationships between selected measures of motor impairments and activities involving the lower-limbs in ambulatory people with chronic stroke. Design : Motor impairment measures included maximal isometric strength and motor coordination. Activity measures included walking speed, stair ascent/descent cadences, and the time to perform the Timed Up and Go (TUG) test. Results : Ninety individuals were included. The correlations between all motor impairment and activity measures were significant (0.18 <  r  < 0.52, p  < 0.05). Motor coordination and strength of the knee flexor muscles explained 30% (F = 20.3; p  < 0.001) of the variance in walking speed, 32% (F = 19.1; p  < 0.001) of stair ascent, and 31% (F = 16.8; p  < 0.001) of stair descent cadence. Regarding the TUG, only motor coordination reached significance and explained 13% (F = 13.4; p  < 0.001) of the variance. Conclusion : Measures of strength and motor coordination of the paretic lower limb were significantly correlated with all activity measures. However, despite the fact that knee flexor strength explained some variance in walking speed and stair ascent/descent cadences, motor coordination was the only measure that explained the variances in all three selected activity measures. These findings are innovative for neurological rehabilitation, since this is the first study to demonstrate that deficits in motor coordination of the paretic lower limb best explained limitations in performing different lower-limb activities.