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Background Stroke is among the three leading causes of disability around the world, and it results in immediate difficulty in mobility and gait. There is a lack of instruments to evaluate what daily life is like for these individuals using their lower limbs in real-life environments (outside of the clinical environment). Objective To perform the translation and cultural adaptation to Brazilian Portuguese of the Lower-Extremity Motor Activity Log (LE-MAL) and test its measurement properties in chronic poststroke individuals. Methods The LE-MAL was translated into Brazilian Portuguese and adapted to the Brazilian culture. The comprehension and relevance of the final version were analyzed by a committee of specialists. The reliability, validity, and responsiveness of the LE-MAL/Brazil to detect changes after lower extremity constraint-induced movement therapy (LE-CIMT) and an intensive conventional therapy were tested. Results The LE-MAL/Brazil showed excellent inter- and intrarater reliability, with an intraclass correlation coefficient and Cronbach alpha > 0.70, as well as standard error of measurement and smallest detectable change < 10% of the total instrument score when applied by the same evaluators. Conclusion The responsiveness of the LE-MAL/Brazil to detect changes showed better results after LE-CIMT than after the intensive conventional therapy, with most of the correlations > 0.50. Resumo Antecedentes O acidente vascular cerebral (AVC) é a terceira causa de deficiência ao redor do mundo, e resulta em dificuldades imediatas relativas à marcha e à mobilidade. Nota-se a ausência de instrumentos que avaliem o dia a dia desses indivíduos quanto ao uso dos membros inferiores em ambientes reais (fora do ambiente clínico). Objetivo Traduzir e fazer a adaptação cultural para o português do Brasil da Lower-Extremity Motor Activity Log (LE-MAL), e testar suas propriedades psicométricas em indivíduos hemiparéticos crônicos pós-AVC. Métodos A LE-MAL foi traduzida para o português do Brasil e adaptada para a cultura brasileira. A compreensão e a confiabilidade da versão final foram testadas por um comitê de especialistas. A confiabilidade, a validade e a responsividade em detectar mudanças após a terapia de contensão induzida para membros inferiores (TCI-MMII) e uma terapia convencional também foram testadas. Resultados A LE-MAL/Brazil mostrou excelente confiabilidade intra e interavaliador, com coeficiente de correlação intraclasse e alfa de Cronbach > 0,70, bem como erro padrão da medida e mínima mudança detectável < 10% da pontuação total quando aplicada pelo mesmo avaliador. Conclusão A responsividade da LE-MAL/Brazil em detectar mudanças após a TCI-MMII apresentou resultados melhores do que após a terapia convencional, com a maioria das correlações > 0,50.

A mega-review of published systematic reviews without restriction on year of publication was implemented to summarize available assessment tools of upper limb (UL) function in children with Cerebral Palsy (CP).A multi-prong search strategy was used to identify 12 systematic literature reviews for inclusion in the mega-review. Included reviews were coded by descriptive analyses, which included methodological and reported measurement property description. Methodological quality of the selected systematic reviews was evaluated with the AMSTAR-2. We synthetized the measurement properties of the revised assessment tools and their coverage within the International Classification of Functioning, Disability and Health (ICF) domains.The 12 systematic reviews addressed 84 assessment tools. Systematic reviews' methodological quality varied between critically low to moderate. Suggested assessment tools covered ICF domains of body structure and function, and activities and participation. Measurement property data analysis was based mostly on reliability and validity.Based on the findings of the mega-review, the ABILHAND-Kids, Assisting Hand Assessment (AHA) and Melbourne Assessment of Unilateral Upper Limb Function (MUUL) are the most suitable tools to evaluate children between 6 and 12 years of age with unilateral CP.

To assess the content validity of the preliminary core set for knee dysfunction based on the opinion of experts.A panel of 180 experts in knee disorders or on the use of the International Classification of Functioning, Disability, and Health for musculoskeletal conditions was invited for this Delphi study. The experts gave their opinion on whether to include the categories of the preliminary core set for knee dysfunction in a more comprehensive core set, using a six-item Likert scale. Kappa coefficient was used to analyze the agreement between the experts, and a consensus of 75% among responses was considered acceptable.Nineteen experts participated in all rounds. Of the 24 categories from the preliminary core set for knee dysfunction, 15 remained in the comprehensive core set and one category was further detailed into three new categories. Seven new categories were included. Thus, the comprehensive core set for knee dysfunction was composed of 25 categories with an agreement of 81.5% among responses and a Kappa value of 0.63.After validation by experts, the comprehensive core set for knee dysfunction was composed of 25 categories that can be used to assess the functioning of patients with knee dysfunction.

Objective This study aimed to identify functional outcomes related to independence in walking among people affected by hereditary ataxias. Methods Sixty participants were selected by convenience in a list provided by an organization of people with ataxia. Sociodemographic and clinical data were collected using a semistructured questionnaire. The Assessment and Rating of Ataxia was used to assess and rate cerebellar ataxia. Changes in body structure and function, limitation in activities, and restriction in participation were evaluated with specific outcome measures. Participants were classified as independent in walking if they were able to walk without walking aids or human assistance and as dependent in walking if they have been using walking aids (sticks, crutches, or walkers) for more than 6 months, using a wheelchair for locomotion most of the day, or both. Multivariate logistic regression analyses were conducted hierarchically and in blocks considering upper limbs function, balance systems, sensory functions, postural control, walking, independence, cognition, and perception as independent variables. The prevalence ratio for walking independence was determined. Results The final regression model pointed out that gait capacity assessed by the 6-Minute Walk Test and dexterity assessed by the Box and Blocks test were the main markers related to walking independence in individuals with hereditary ataxias. Conclusion The distance covered in 6 minutes of walking (walking endurance) and upper extremity dexterity can be used to better assess the progression of cerebellar disease related to walking independence in individuals with hereditary ataxias. Impact This study supports early detection of individuals who are at risk of loss of walking independence and an optimized rehabilitation plan.

A prática de esportes para os deficientes físicos representa a aplicação de filosofia e de princípios de reabilitação no mais alto nível. A natação é um dos esportes mais completos e proporciona uma variedade de benefícios tanto para indivíduos em geral como para os portadores de algum tipo de deficiência física. O objetivo deste estudo é, por meio de revisão bibliográfica, apresentar os benefícios que a natação adaptada pode proporcionar aos indivíduos portadores de lesões neurológicas com seqüelas motoras.

O objetivo deste estudo foi traçar o perfil clínico e funcional dos pacientes com diagnóstico de Acidente Vascular Encefálico (AVE) atendidos na Clínica Escola de Fisioterapia da UMESP. Foi feito um estudo retrospectivo em pacientes acometidos por AVE, realizado através de uma coleta de dados em prontuários de 109 pacientes no período de fevereiro de 2001 a junho de 2003. A coleta de dados foi realizada por meio de um protocolo previamente desenvolvido, abrangendo questões sócio-demográficas, clínicas, físicas e funcionais. O AVE é uma doença comum em todo mundo, por ser a principal causa de incapacidade neurológica em adultos, podendo acometer a função dos membros, controle motor, equilíbrio, força e mobilidade. Apesar de ocorrer uma maior recuperação motora e funcional nos primeiros três meses após o AVE, há evidência de que o exercício terapêutico é efetivo mesmo em casos crônicos. O estudo demonstrou que a população atendida na Clínica Escola de Fisioterapia da UMESP é em sua maioria composta de pacientes crônicos. Este fato acarreta uma permanência maior em terapia e dificulta ganhos funcionais. Contudo pôde-se constatar melhora do quadro motor durante o tratamento, o que reforça a idéia de que mesmo pacientes em fase crônica de AVE podem ter uma boa evolução em termos funcionais.

Learning complex motor skills is an essential process in our daily lives. Moreover, it is an important aspect for the development of therapeutic strategies that refer to rehabilitation processes since motor skills previously acquired can be transferred to similar tasks (motor skill transfer) or recovered without further practice after longer delays (motor skill retention). Different acrobatic exercise training (AE) protocols induce plastic changes in areas involved in motor control and improvement in motor performance. However, the plastic mechanisms involved in the retention of a complex motor skill, essential for motor learning, are not well described. Thus, our objective was to analyze the brain plasticity mechanisms involved in motor skill retention in AE . Motor behavior tests, and the expression of synaptophysin (SYP), synapsin-I (SYS), and early growth response protein 1 (Egr-1) in brain areas involved in motor learning were evaluated. Young male Wistar rats were randomly divided into 3 groups: sedentary (SED), AE, and AE with retention period (AER). AE was performed three times a week for 8 weeks, with 5 rounds in the circuit. After a fifteen-day retention interval, the AER animals was again exposed to the acrobatic circuit. Our results revealed motor performance improvement in the AE and AER groups. In the elevated beam test, the AER group presented a lower time and greater distance, suggesting retention period is important for optimizing motor learning consolidation. Moreover, AE promoted significant plastic changes in the expression of proteins in important areas involved in control and motor learning, some of which were maintained in the AER group. In summary, these data contribute to the understanding of neural mechanisms involved in motor learning in an animal model, and can be useful to the construction of therapeutics strategies that optimize motor learning in a rehabilitative context.

Objective To develop an International Classification of Functioning, Disability and Health core set for patients with knee dysfunction. Design Cross-sectional study. Setting The study was conducted at all levels of care (general community, primary care units, rehabilitation clinics/centers, hospital). Participants Participants (N=388) with knee dysfunction with or without clinical diagnosis of knee pathology, with or without complaint of pain, with or without instability, and/or with or without knee movement restriction of any type. Interventions Not applicable. Main Outcome Measures Participants were assessed using the core sets for acute and postacute musculoskeletal conditions, the subjective form from the International Knee Documentation Committee scale, the self-report of general health and functionality, and the general health and functionality classified by the researcher. To identify the categories that best explain knee dysfunction, linear regression analyses were performed. Results Twenty-four categories were identified from the 75 core set categories for acute and postacute musculoskeletal conditions. Eleven categories belong to the component body functions, 3 represent body structures, 7 represent activities and participation, and 3 represent environmental factors. Conclusions A core set for knee dysfunction that can be used at all levels of health care was proposed, which offers a system for disability assessment related to knee dysfunction, including environmental and social factors. These factors are important for a broad assessment because they include the multiple aspects of functionality, usually not considered in other knee dysfunction assessment instruments. Further analysis of the content and construct validity of the core set is required.

Background: Successful rehabilitation is associated with physical, psychological, environmental, social, and personal factors based on the International Classification of Functioning, Disability and Health (ICF) framework. The influence of age has been suggested as crucial personal factors that may affect rehabilitation needs in post-stroke survivors. The aim of this study was to investigate the qualifiers of the ICF core set for stroke to detect differences in rehabilitation needs and goals between older (O,&gt, 65 years old) and younger (Y,&le, 65 years old,) post-stroke individuals. Materials and methods: In this observational study, the comprehensive core set for stroke was filled during the rehabilitation period. Patient information was obtained using disability scales was translated into certain ICF categories using linking rules. Frequency, similarity, and linear regression analyses were performed for ICF qualifier profiles among Y and O patients. Results: Forty-eight ICF variables were significantly different between Y (n = 35, 46.17 &plusmn, 11.27 years old) and O (n = 35, 76.43 &plusmn, 6.77 years old) patients. Frequency analysis showed that activity of daily living and basic needs were more prevalent in O patients, whereas regaining of social role and social life were more prevalent in Y patients. The average Jaccard Index result (similarity analysis) was more homogeneous in O than in Y patients. Conclusions: ICF qualifiers are useful to design patient-centered care. Y patients have more heterogeneous needs and require more personalized program than O patients.

The postural control is improved by implicit somatosensory information from lightly touching a rigid bar or explicit visual information about the postural sway. Whether these two additional sources provided at the same time further reduce the postural sway is still unknown. Participants stood on a force plate as quiet as possible lightly touching the bar while received or not visual feedback of the center of pressure position on a monitor screen. Postural sway reduced similarly with the light touch regardless of the additional visual feedback. The findings suggested that providing explicit visual feedback of the center of pressure does not increase the light touch effects on the postural sway. The importance of the implicit somatosensory information on postural control is discussed.

Background Lightly touching the tip of the index finger on an external surface reduces the postural sway during upright standing due to the additional somatosensory information provided by the touch to the postural control system. But when the individuals apply more force, it provides more mechanical support. However, because most of the studies investigated only two levels of force, whether the control mechanisms of postural sway are affected by the different force levels was unknown. Research question To examine the influence of the magnitude of force (up to 1, 2, 4, 6 or 8 N) applied to the touch bar on the mechanisms used to control the postural sway during quiet standing with eyes open or closed. Methods Ten young right-handed adults stood for 35 s on a force platform, with feet apart, while touched a rigid bar with different force levels with eyes open or closed. The amplitude and velocity of the center of pressure and its components, Rambling and Trembling trajectories, respectively, related to more supraspinal and spinal control mechanisms, were assessed. Results The touch reduced all trajectories, mainly of the Rambling component and with closed eyes. There was a floor effect of the touch force as amplitudes and velocities were minimal at 4 N of force. Significance The component of postural sway under the supraspinal neural control is more affected by different force magnitudes applied to the touch bar.

The present study aimed to investigate the influence of target height on the symmetry and amplitude of the postural adjustments assessed by the displacements of the center of pressure (COP) before and during the unilateral, arm movements in the upright position. Thirteen young, right-handed adults stood with each foot on one force platform and reached a target placed at one of three heights displayed on a monitor screen. The performance of the right arm movements (movement time and radial error), amplitude of the COP displacements of each lower limb and the percentage of body weight loading on the right lower limb before and during the reaching movements were compared across target heights conditions. Postural adjustments were symmetrical prior but asymmetrical after movement onset. Effect of target height was observed on the postural adjustments before and during the movements (i.e., amplitudes of the COP displacements increased for the higher target), mainly for the right limb. The arm performance was similar across target heights. The findings of the present study suggested that postural adjustments are dependent on the target heights to ensure success in the arm movements.

Individuals with stroke present several impairments in the ipsilesional arm reaching movements that can limit the execution of daily living activities. These impairments depend on the side of the brain lesion. The present study aimed to compare the arm reaching movements performed in sitting and standing positions and to examine whether the effects of the adopted posture configuration depend on the side of the brain lesion. Twenty right-handed individuals with stroke (half with right hemiparesis and a half with left hemiparesis) and twenty healthy adults (half used the left arm) reached toward a target displayed on a monitor screen placed in one of three heights (i.e., upper, central, or lower targets). Participants performed the reaches in sitting and standing positions under conditions where the target location was either well-known in advance (certainty condition) or unknown until the movement onset (uncertainty condition). The values of movement onset time, movement time, and constant error were compared across conditions (posture configuration and uncertainty) and groups for each target height. Individuals with stroke were slower and spent more time to start to move than healthy participants, mainly when they reached the superior target in the upright position and under the uncertainty condition. Individuals who have suffered a right stroke were more affected by the task conditions and those who suffered a left stroke showed less accurate reaches. Overall, these results were observed regardless of the adopted posture. The current findings suggested that ipsilesional arm reaching movements are not affected by the postural configuration adopted by individuals with stroke. The central nervous system modulates the reaching movements according to the target position, adopted posture, and the uncertainty in the final target position to be reached.

Background Stroke can compromise upper limb performance and influence the individual's participation in real life situations. Objective To investigate how components of body function and activity affect the individuals' self-perception of their participation after stroke. Methods In this observational study, the International Classification of Functioning, Disability and Health was used as model. Body function was assessed by palmar grip and pinch strength; Ashworth modified scale; Fugl-Meyer scale; and Motor-Free Visual Perception Test. The Purdue Pegboard Test and the aiming movement performance measured the activity. Upper limb participation was analyzed by the Hand Function domain of the Stroke Impact Scale (SIS). Thirty-four individuals after chronic stroke were divided into two groups, according to their Hand function SIS scores (severe and non-severe). Differences between groups were analyzed. Relationships between individual variables and the SIS score were verified. A regression model was proposed. Results Strength and the Fugl-Meyer scale score were greater for the non-severe group. Muscle tone was greater for the severe group only in the wrist flexors. None of the activity variables differed between groups. The upper limb Fugl-Meyer score was able to predict 79% of the individuals in SIS Hand Function groups. Conclusion Sensory-motor impairment, as measured by the upper limb Fugl-Meyer scale, can explain the influence of the upper limbs on participation in the individuals' perception.

The authors examined the effects of the degree of impairment of the contralesional upper limb and the side of the hemispheric damage on ipsilesional upper limb performance in chronic stroke individuals. Right- and left-side stroke resulting in mild-to-severe impairment and healthy participants took part in simple and choice reaction time tasks involving aiming movements. The stroke individuals performed the aiming movements with the ipsilesional upper limb using a digitizing tablet to ipsi- or contralateral targets presented in a monitor. The global performance of the group with severe right hemispheric damage was worse than that of the other groups, indicating that the side of hemispheric damage and degree of motor impairment can adversely affect aiming movement performance.

This quasi-experimental study was conducted in a poultry processing industry with the aim of assessing the benefits of ergonomics educational training for novice and experienced workers in preventing work-related musculoskeletal disorders. Sociodemographic and occupational questionnaires were used to evaluate age, marital status, education, time in job, musculoskeletal complaints and pain intensity, perceived effort, biomechanical exposure, and perception of ease or difficulty in adoption of ergonomics educational training. Musculoskeletal complaints in the neck, back, and wrists were reduced with training, but pain intensity was reduced only in the wrist region. A reduction in the occupational biomechanical exposure from the baseline to immediately post-training and 2 months after training both for novice and experienced workers was also observed. The novice workers group differed from the experienced workers by presenting a higher reduction of biomechanical exposure in the cutting room. All workers in this study benefited from the ergonomics educational training in the short and medium term. However, the success of training was highly dependent on the content and approach of the training.

Reaching Performance Scale for Stroke (RPSS) evaluates the upper limb reach-to-grasp movement quality and compensatory movements. The objective of the study was to test the reliability, construct validity, and interpretability of the Brazilian-Portuguese RPSS. Fifty-one individuals (mean age 62 ± 10.8 years), with acute-to-chronic stroke (range: 1–300 months) were video recorded while performing a reach-to-grasp task of a cone placed both close and far from the individual. Their degree of motor impairment ranged from 4 to 59 points in the Fugl-Meyer scale. Reaching Performance Scale for Stroke showed excellent intra- (ICC2,1 = 1.00) and interrater (ICC2,1 = 0.98–0.99) reliability, and redundant internal consistency (Cronbach’s α = 0.98). The construct validity between RPSS and Fugl-Meyer scale was strong (Spearman rho = 0.88–0.89; p Reaching Performance Scale for Stroke showed excellent reliability and redundant internal consistency. The construct validity with the Fugl-Meyer scale was strong. Reaching Performance Scale for Stroke was able to discriminate individuals with different levels of upper limb impairment.IMPLICATIONS FOR REHABILITATIONPost-stroke individuals develop compensatory strategies to perform reaching movements with the paretic upper limb.The Reaching Performance Scale for Stroke provides a quantitative and qualitative evaluation of the reach-to-grasp movement.The Reaching Performance Scale for Stroke is suitable for use with Brazilian-Portuguese speakers and has adequate reliability and validity. Post-stroke individuals develop compensatory strategies to perform reaching movements with the paretic upper limb. The Reaching Performance Scale for Stroke provides a quantitative and qualitative evaluation of the reach-to-grasp movement. The Reaching Performance Scale for Stroke is suitable for use with Brazilian-Portuguese speakers and has adequate reliability and validity.

Aiming movements of the upper limbs can be classified either as discrete, or reciprocal, or cyclic. The control of these movements after a stroke can be affected. The aim of this experimental, cross-sectional study was to characterize the performance of these movements after the right and left hemisphere chronic stroke. Thirty-six individuals aged between 40 and 70 years, right-handed, were allocated into three groups (control, right stroke, and left stroke). Participants were asked to perform aiming movements on a tablet. Individuals after stroke performed the tasks only with their ipsilesional limb, while the control group performed movements with both limbs. The reaction and movement times, peak velocity, and the variability and error of the endpoint were analyzed. Individuals after stroke presented a worse performance in all movement classes as expected, but differently depending on the damaged hemisphere. Participants with right hemisphere damage showed larger endpoint errors, while those with left hemisphere damage had longer reaction and movement times. Both differences were seen consistently in discrete and reciprocal, but not in cyclic movements. Cyclic movements presented shorter latencies, were faster, and showed greater endpoint errors when compared to discrete and reciprocal movements. These results suggest that stroke affects differently the performance of discrete and reciprocal movements according to the hemisphere lesion side, but not in cyclic movements. Different levels of motor control among the three classes of movements by the nervous system may justify these results.

Background Upper limb disabilities after a stroke compromise the activities of daily living. Several approaches to improve motor control and reduce disability are proposed, including specific unilateral training of the contralesional limb or bilateral training with appropriate equipment and/or robotic assistance. These approaches can be used with rhythmic or discrete movements along with usual therapy, but the most effective approach has never been determined. The objective of this study will be to verify the effect of training with rhythmic or discrete movements in conjunction with the usual therapy on motor function and participation regarding the patients’ upper limbs after chronic stroke. Methods/Design This is a 3-arm, assessor-blinded, randomized controlled trial. Seventy-five patients with chronic stroke (> 6 months) and upper limb paresis will be included. Participants will be randomly allocated into 3 groups: 1) discrete movement training and usual therapy (n = 25), 2) rhythmic movement training and usual therapy (n = 25) and 3) a control group, (n = 25) which will only receive the usual therapy. A five-week intervention period (10 sessions) with two sessions per week will be carried out. Outcome measures include participation, activity and motor function measured by the Stroke Impact Scale (SIS), Motor Activity Log (MAL) and Fugl-Meyer Scale, respectively; other measures are aiming movement performance, grip strength and spasticity, which will be obtained at follow-up assessments 5 weeks and 3 months after randomization. Discussion The results of this trial can support allied health professionals’ decision-making processes in the treatment of motor impairment and disability after chronic stroke and reduce this condition’s health-related costs.

The importance of push start times on bobsled performance was evidenced by some studies, but at this moment there is no article to the authors’ knowledge that describes the bobsled push start. Thus, the objectives of this study were to describe the two-man bobsled push start, analyze the differences between teams, and estimate the most important variable analyzed. We hypothesized that the pilot and brakeman athletes’ movement patterns during a bobsled pushing start can be described. The images used in this study were obtained during the men’s two-man XIV World Championship of Bobsled (2004). Fifteen best teams participating in the championship were recorded, and four start runs for each team were analyzed. The videos were captured by two digital video cameras. The pilot athletes were analyzed during the moment that they touched the lateral push bar of the sled, and the brakemen were analyzed during the first take-off and first landing. The teams were pooled in three groups of five teams using the final ranking of pushing time. We concluded that there was a distinct pattern movement for pilots and brakemen. The initial position of the majority of the pilots was localized slightly behind the bar. After touching the lateral bar, the pilots remained in a semi-squat position, pushing the sled forward in a pattern of marching movement. All brakemen used the board attached to the track as a support for both feet at the start. The brakeman gave the greatest contribution to break the inertia of the sled. There was no significant difference of movement between the three groups analyzed for the pilot and the brakeman.

The light touch (LT) of the fingertip on a rigid surface and the performance of a cognitive task (CT) affect the postural control. The current study examined the mechanisms involved in the control of postural sway (i.e., Rambling and Trembling components of the center of pressure) with the LT and CT performed individually or simultaneously. Thirteen adults stood on a force plate for 70 s while performed the LT, CT (visual searching of specific letters) or both tasks simultaneously. COP, Rambling, and Trembling mean amplitude and speed were computed. COP and Rambling trajectories were highly and Trembling moderately reduced with LT. The CT affected mainly the Rambling component, supporting the role of supraspinal control of postural sway. These findings suggested that while LT influences both supraspinal and peripheral control mechanisms, CT influences mostly the supraspinal mechanisms involved in postural sway. The combined effects of LT and CT improve the postural control with no negative consequences on CT performance.

Physical activity (PA) has benefits in optimising function and decreasing the impact of secondary chronic conditions due to deconditioning in older people with neurological conditions. However, PA is poorly recommended, prescribed, and delivered in this population despite the growing body of existing evidence-based research. This chapter reviews the major determinants of physical inactivity and sedentary behaviour for key neurological conditions that affect older people including stroke, Parkinson’s disease, and neuromuscular diseases and summarises the evidence on the implementation of PA programmes.

Stroke individuals frequently have balance problems and impaired arm movements that affect their daily activities. We investigated the influence of target uncertainty and the side of the brain lesion on the performance of arm movements and postural adjustments during reaching in a standing position by stroke individuals. Participants stood on force plates and reached a target displayed on the center of a monitor screen under conditions differentiated by the prior knowledge of the target location at the beginning of the movement. Individuals who had a stroke in the right side of the brain performed the tasks with the ipsilesional, right upper limb while the individuals with a left stroke performed with the ipsilesional, left upper limb. Healthy individuals performed with right and left limbs, which data were later averaged for statistical analysis. Kinematic analysis of the arm and lower limb joints and displacements of the center of pressure of each lower limb were compared between target conditions and groups. Stroke individuals showed larger center of pressure displacements of the contralesional compared to the ipsilesional limb while these displacements were symmetrical between lower limbs for the healthy individuals, regardless of the target condition. The target uncertainty affected both the characteristics of the arm movements and postural adjustments before movement onset. Right stroke individuals used more ankle joint movements under the uncertain compared to the certain condition. The uncertainty in target location affects the arm reaching in upright standing, but the effects depend on the side of the brain lesion.

The purpose of this study was to analyze the influence of the uncertainty of target location on the planning and execution of aiming movements performed towards the ipsilateral and contralateral directions by the right and left upper limbs. In addition, the association between the performance of aiming movements and the performance of functional manual tasks was investigated. Two tasks were proposed: with prior knowledge of the movement direction (simple reaction time) or not (choice reaction time). The grip strength and manual dexterity were measured. The choice option in response (i.e. uncertainty) influenced planning of the aiming movements, but not its execution, while movements performed towards the contralateral direction were worse in execution as compared to the ipsilateral direction. Manual dexterity was significantly correlated with reaction times, while the performance during movement execution was significantly correlated with handgrip/pinch strength. ResumoO objetivo desse estudo foi avaliar a influência da incerteza da localização do alvo no planejamento e execução de movimentos dirigidos ao alvo realizados para as direções ipsilateral e contralateral pelos membros superiores direito e esquerdo. Em adição, a associação entre o desempenho do movimento dirigido ao alvo e o desempenho em tarefas manuais funcionais foi investigada. Duas tarefas foram propostas: com o conhecimento prévio da direção do movimento (tempo de reação simples) ou não (tempo de reação de escolha). Foram avaliadas a força de preensão palmar e a destreza manual. A opção de escolha na resposta (ex. incerteza) influenciou o planejamento do movimento dirigido ao alvo, mas não a sua execução, enquanto os movimentos realizados para a direção contralateral apresentaram pior execução quando comparados à direção ipsilateral. Destreza manual foi significativamente correlacionada com tempos de reação, enquanto o desempenho durante a execução do movimento foi significativamente correlacionado com forças de preensão/pinça. ResumenEl propósito de este estudio fue evaluar la influencia de la incertidumbre ubicación de la diana en la planificación y ejecución de movimientos dirigidos a la diana realizado por direcciones ipsilateral y contralateral por los miembros superiores derecho e izquierdo. Además, se investigó la asociación entre el rendimiento de movimiento dirigido a la diana y el rendimiento de la mano para tareas funcionales. Se propusieron dos tareas: con el conocimiento previo de la dirección del movimiento (tiempo de reacción simple) o no (tiempo de reacción del elección). Se evaluó la fuerza de prensión y la destreza manual. La opción de elección en responder (Incertidumbre por ejemplo.) influido en la planificación del movimiento dirigido a la diana, pero no su aplicación, mientras que el movimiento de la dirección contralateral tuvo un peor rendimiento en comparación con la dirección ipsilateral. La destreza manual se correlacionó significativamente con los tiempos de reacción, mientras que el rendimiento durante la realización del movimiento se correlacionó significativamente con la fuerza de prensión / pinzas.

In simple daily activities carried out by the upper limbs, the cerebellum is responsible for the adaptations required for the accurate movement based on previous experiences and external references. This paper aims to characterize the performance of the upper limbs after a cerebellar disease. We evaluated the digital and handgrip strength, dexterity, and function of the upper limbs. The motor performance of the upper limbs was assessed through the use of a digitizing tablet by performing aiming movements with the upper limb most affected by cerebellar disease and the paired limb of the healthy group. The results showed differences between groups: the cerebellar group had higher latency to movement onset, was slower, and presented less smooth trajectories and higher initial direction errors. Moreover, the movement direction influenced the peak velocity and the smoothness for both groups (contralateral directions were slower and less smooth). We concluded that cerebellar disorder leads to movement planning impairment compromising the formulation of an internal model. Alterations on movement execution seem to be a consequence from disruptions in the anticipatory model, leading to more adaptations. These findings are compatible with the roles of the cerebellum on the control of voluntary movement.

Aiming movements are part of daily activities but the brain hemispheres’ role in targeted aiming sequential movements is not fully clear. Start and execution of discrete and sequential tasks toward targets were analyzed in 10 individuals with left-hemisphere damage, 10 right-hemisphere–damaged, and 10 healthy ones. Arm movements were performed over a digitizing tablet, following stimuli on a monitor, from initial position toward right and left-positioned targets. Poststroke individuals used their ipsilesional arm and healthy individuals, both arms. Right-hemisphere–damaged individuals showed higher reaction time and left-hemisphere–damaged individuals, lower smoothness. Due to spatial demand of tasks, the right hemisphere played a major role in movement planning, while the left, in movement execution.

To investigate whether the specificities of real jobs create distinctions in the performance of workers in different motor tests for the upper limbs, 24 participants were divided into two groups according to their specific job: fine and repetitive tasks and general tasks. Both groups reproduced tasks related to aiming movements, handling and strength of the upper limbs. There were no significant differences between groups in the dexterity and performance of aiming movements. However, the general tasks group had higher grip strength than the repetitive tasks group, demonstrating differences according to job specificity. The results suggest that a particular motor skill in a specific job cannot improve performance in other tasks with the same motor requirements. The transfer of the fine and gross motor skills from previous experience in a job-specific task is the basis for allocating training and guidance to workers.

The aim of the current study was to evaluate the performance of young healthy adults on the "Timed Up and Go" (TUG) test on the dual task paradigm. Twelve young adults performed the TUG test in four conditions: a) no secondary task;b) with a task of holding a tube with both hands without defined attentional focus; c) holding the tube with internal attentional focus; and,d) holding the tube with external attentional focus. A digital chronometer was used to record the time taken to complete the tests. The movement variability of the tube was assessed by recording the kinematics of markers placed on the lateral side of the tube. Analyses of variance were used to compare the total and relative time and tube variability across conditions. More time was necessary to complete the TUG test when specific instruction about the secondary task was given, mainly when related to the movement of the tube (external focus). However, the variability of the tube was also smallest in that condition. Therefore, the addition of a secondary task (holding a tube) affects the performance of TUG only when specific instructions on the attentional focus are given in particular about external effects of the secondary task.

Introdução: Pacientes com a doença de Parkinson (DP) apresentam alterações no controle postural e na marcha. No entanto, as adaptações na marcha desses sujeitos devido às condições do ambiente (i.e., superfícies instáveis) não são muito conhecidas. Objetivo: Analisar o padrão cinemático da marcha de pacientes com DP quando andando no solo instável. Método: Os ângulos articulares do quadril, joelho e tornozelo no plano sagital foram comparados em três condições: no solo estável, no instável e retorno ao estável, além disso, a velocidade e o comprimento da passada também foram analisados. Resultados: Os participantes aumentaram as amplitudes de tornozelo, joelho e quadril e reduziram a velocidade da marcha, quando andando no solo instável. Conclusão: Pacientes com DP reduzem a velocidade e aumentam as amplitudes de movimento dos membros inferiores durante a marcha em superfície instável. Após essa exposição, houve um aumento do comprimento da passada no solo estável.

Introdução: Os movimentos dos membros superiores são frequentemente realizados em conjunto com outras tarefas, o que pode afetar o seu desempenho. Objetivos: Avaliar o desempenho de movimentos dirigidos a alvos em jovens, quando uma tarefa cognitiva é realizada simultaneamente. Método: Vinte jovens sadios, destros, realizaram traçados entre dois alvos, o mais rápido possível, sobre uma mesa digitalizadora, com o membro direito e esquerdo, isoladamente e durante a tarefa cognitiva. Alvos de diferentes dimensões (0,5 cm, 1 cm e 1,5 cm) ou posicionados em distâncias distintas do ponto de partida (15 cm, 25 cm e 35 cm) foram utilizados. Resultados: A duração foi maior para completar o traçado quando realizando a tarefa cognitiva, principalmente para os homens. A duração e o erro de linearidade foram maiores em razão da distância do alvo. Conclusão: A execução de uma tarefa cognitiva secundária interfere negativamente no desempenho de movimentos dos membros superiores dirigidos ao alvo.

O objetivo desta revisão sistemática da literatura foi analisar os instrumentos de avaliação da função de membros superiores em indivíduos que sofreram acidente vascular encefálico (AVE), bem como suas propriedades psicométricas e adaptação cultural para o Brasil. A busca nas bases de dados eletrônicas Medline, Lilacs e Scielo levaram à seleção de 57 artigos sobre instrumentos de avaliação da função motora global, da função específica da extremidade superior, bem como os relativos à validação e avaliação das propriedades psicométricas das escalas. Foram encontrados 11 instrumentos de avaliação da função de membros superiores. Destes, a escala de Fugl-Meyer, o teste de habilidade motora do membro superior e a medida de independência funcional são traduzidos e validados para a língua portuguesa e têm sua validade, confiabilidade e reprodutibilidade determinadas e adequadas. Esses instrumentos mostram-se complementares na avaliação da função de membros superiores de pacientes que sofreram AVE, pois incluem aspectos relativos à estrutura e função corporal, à capacidade de execução de tarefas, e ao cuidado pessoal e relações interpessoais, respectivamente, sendo portanto recomendáveis para o uso clínico.The purpose of this systematic review was to analyse indexes and scales that assess poststroke patients upper extremity function, as well as their psychometric properties and cross-cultural validation for Brazil. The search through Medline, Lilacs and Scielo databases led to selecting 57 articles on instruments for assessing arms global motor and specific functions, as well as articles on their validation and psychometric properties. Eleven such instruments were found, among which the Fugl-Meyer assessment, the Arm Motor Ability Test, and the Functional Independence Measure have been translated and validated into Brazilian Portuguese, and had their validity and reliability properties established as appropriate. These instruments showed to be complementary for assessing upper extremity function in poststroke patients in as much as they respectively include structural and functional aspects, task performance, self-care and interpersonal relations, being therefore recommended for clinical use.

Introduction: A capacity to perform two tasks at the same time is a prerequisite for an individual to have a normal life. Under normal circumstances, performing motor and cognitive tasks concomitantly is common. Objective: The aim of this study was investigate the motor-cognitive dual task performance in Parkinson’s disease patients. Method: Two groups were studied. One group was composed by 10 healthy individuals and the other by 10 patients with a diagnosis of Parkinson’s disease. In both groups, the ages were between 47 and 75 years and the individuals were paired in relation to gender and age. They were asked to put on a button-up shirt as fast as possible as a single task and also while saying girls’ names in random order (dual task). Each task was repeated three times. The movement time and errors committed were analyzed. Results: The patients took more time to complete both tasks (p= 0.006) in relation to the healthy group. Both groups committed more errors in the dual task (p= 0.03). There was a reduction in the movement time with the repetition of the task (p= 0.039) for both groups. Conclusion: These results suggest that individuals with Parkinson’s disease present a loss in motor performance in relation to healthy individuals. However, the cost of performing the task is independent of motor-cognitive interference and the possibility of performance’s improvement with practice is real.

Buscamos com o presente estudo investigar o efeito da dominância manual e da visão no uso da informação somatossensorial adicional fornecida pelo toque suave no controle postural. Quinze adultos jovens e destros permaneceram em pé sobre uma plataforma de força com a) olhos abertos ou fechados e b) braços ao lado do corpo ou o dedo indicador direito ou esquerdo tocando a barra fixa. A área do centro de pressão (CP), amplitude e velocidade médias do CP nas direções anteroposterior e médio-lateral foram avaliadas. Os resultados indicaram uma redução nas medidas nas condições de toque e aumento com os olhos fechados, exceto quando o toque foi realizado com dedo indicador direito. A força máxima foi maior para a mão direita, enquanto a sensibilidade cutânea e as forças aplicadas à barra foram similares entre os hemicorpos. Esses resultados sugerem um efeito da dominância manual e visão no uso da informação somatossensorial adicional no controle postural. In this study we investigated the effect of handedness and vision on the use of additional somatosensory information provided by the light touch in postural control. Fifteen right-handed, young adults quietly stood on a force plate with a) eyes open or closed and b) arms hanging along the body or with the right or left index finger in contact with a rigid bar. We assessed the center of pressure (CP) area and CP mean sway amplitude and velocity in anterior-posterior and medial-lateral directions. The results revealed a reduction of these measures in the touch conditions and increase with the eyes closed, except when the touch was performed with right index fingertip. The grip strength was greater for the right hand, while the cutaneous sensitivity and the forces applied on the bar were similar between the two sides of the body. These results suggested an effect of the handedness and vision in the use of additional somatosensory information on the postural control.

Clinical measurement.To cross-culturally adapt the Shoulder Pain and Disability Index (SPADI) into Brazilian Portuguese and to test the measurement properties of the Brazilian Portuguese versions of the SPADI, the short form of the Disabilities of the Arm, Shoulder and Hand, the Patient-Specific Functional Scale, a numeric pain rating scale, and the Global Perceived Effect scale in patients with shoulder disorders.Most instruments for shoulder disorders were developed in English. For their use in Brazil, translation into Brazilian Portuguese, cross-cultural adaptation, and testing of measurement properties of these instruments are required.The SPADI was translated and cross-culturally adapted according to current guidelines. Measurement properties of internal consistency, reproducibility, construct validity, ceiling and floor effects, and responsiveness of all instruments were tested in 100 patients with shoulder disorders. The patients filled out the questionnaires on 3 occasions: at baseline, 24 to 48 hours after baseline, and 4 weeks after baseline.The instruments showed adequate internal consistency (Cronbach alpha between .78 and .93) and a good level of agreement, as reflected by low standard errors of measurement and minimal detectable change. The reliability (intraclass correlation coefficients) of the instruments varied from 0.82 to 0.96. Most instruments presented good levels of construct validity. All instruments showed acceptable levels of internal and external responsiveness.The Portuguese Brazilian versions of the SPADI; the short form of the Disabilities of the Arm, Shoulder and Hand; a numeric pain rating scale; the Patient-Specific Functional Scale; and the Global Perceived Effect scale are reproducible, valid, and responsive instruments for assessing patients with shoulder disorders.

BACKGROUND: Walking across unstable surfaces disturbs normal stability and efficient strategies must be used to avoid falls. This study identified age-related changes in gait during unstable surface walking. METHOD: Eight healthy younger-old adults (YOG, mean age, 68.6 years) and eight healthy older-old adults (OOG, mean age, 82.1 years) were assessed. Both groups performed the Timed Up and Go Test (TUG) and walked on a rigid and on a compliant surface while kinematic data were obtained. RESULTS: The OOG needed more time to complete the TUG test compared to YOG (F1,14=5.18; p=0.04). The gait speed, stride length and vertical displacement of the foot were similar for both groups, but they were slower (F1,14=5.64; p=0.03) when walking on the compliant surface. The knee and hip range of motion on the sagittal plane (F1,14=191.9; p

Contextualizacao: As revisoes sistematicas sao consideradas a melhor forma de sintetizar toda a informacao existente sobre um deter- minado topico, porem nao se conhece, ate o momento, a qualidade da apresentacao textual das revisoes sistematicas em fisioterapia publicadas no idioma portugues. Objetivo: Analisar a apresentacao textual de revisoes sistematicas em fisioterapia publicadas no idioma portugues utilizando as recomendacoes PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Metodo: Foram analisadas todas as revisoes sistematicas apresentadas na base de dados PEDro ate o mes de agosto de 2011. Para a analise da de- scricao textual foi utilizada a lista de verificacao PRISMA. Cada revisao foi avaliada por pares de revisores independentes e, em caso de discordância entre os pares, um terceiro avaliador fez a arbitragem final. Resultados: Foram identificadas 37 revisoes sistematicas que foram publicadas entre os anos de 2003 e 2010. Menos de 30% dos itens da lista de verificacao PRISMA foram descritos pelos autores, sendo que a maioria dos itens satisfeitos se refere as secoes de introducao e discussao. Observou-se que nao houve um aumento na adesao aos itens recomendados para a apresentacao textual com o passar do tempo. Conclusoes: A adesao aos criterios preconiza- dos pela lista de verificacao da PRISMA e baixa para revisoes sistematicas publicadas no idioma portugues, o que pode ser reflexo do desconhecimento da existencia de tais recomendacoes. A implementacao de recomendacoes aos autores pelos periodicos nacionais podera auxiliar os autores na redacao de seus artigos, melhorando a clareza com que reportam seus estudos. Palavras-chave: revisao sistematica; politicas editoriais; fisioterapia. Abstract Background: Systematic reviews are considered the best design to synthesize all existing information of a given research topic. To date, there is no study that investigated the quality of reporting of systematic reviews relevant to physical therapy published in Portuguese. Objective: To analyse the quality of reporting of systematic reviews in the field of physical therapy published in Portuguese by using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. Method: All systematic reviews published in Portuguese that were indexed on PEDro database up to August 2011 were included. The quality of reporting of the eligible papers was analysed by using the PRISMA checklist. Each quality assessment was performed by two independent reviewers with arbitration of a third reviewer if necessary. Results: A total of 37 systematic reviews were identified. These studies were published between 2003 and 2010. Less than 30% of the PRISMA checklist items were satisfied, being most of the items related to the introduction and discussion sections. No improvements over time were observed. Conclusions: Most of the studies did not satisfy the items from the PRISMA Checklist. It seems that most of authors did not know the existence of this checklist. The implementation of reporting statements such as the PRISMA state- ment by Portuguese-written journals is likely to help authors to write their systematic reviews in a more transparent and clear way.

Background Gait speed is a strong predictor of a wide range of adverse health outcomes in older adults. Mean values for gait speed in community-dwelling older adults vary substantially depending on population characteristics, suggesting that social, biological, or health factors might explain why certain groups tend to self-select their gait speed in different patterns. The vast majority of studies reported in the literature present data from North American and European populations. There are few population-based studies from other regions with a different ethnicity and/or social and health conditions. To address this, the present study identified the mean usual and fast gait speeds in a representative multiracial population of community-dwelling older adults living in a developing country, and explored their association with sociodemographic, mental and physical health characteristics. Methods This was a cross-sectional population-based study of a sample of 137 men and 248 women, aged 65 years and over. Usual gait speed and fast gait speed were measured on a 4.6 m path. Participants were classified into slow, intermediate, and faster groups by cluster analysis. Logistic regression analysis was used to estimate the independent effect of each factor on the odds of presenting with a slower usual and slower fast gait speeds. Results Participants had a mean (SD) usual gait speed of 1.11 (0.27) m/s and a mean fast gait speed of 1.39 (0.34) m/s. We did not observe an independent association between gait speed and race/ethnicity, educational level, or income. The main contributors to present a slower usual gait speed were low physical activity level, stroke, diabetes, urinary incontinence, high concern about falling, and old age. A slower fast gait speed was associated with old age, low physical activity, urinary incontinence and high concern about falling. Conclusion A multiracial population of older adults living in a developing country showed a similar mean gait speed to that observed in previously studied populations. The results suggest that low physical activity, urinary incontinence and high concern about falling should not be neglected and may help identify those who might benefit from early intervention.

This study investigated the influence of cueing on the performance of untrained and trained complex motor responses. Healthy adults responded to a visual target by performing four sequential movements (complex response) or a single movement (simple response) of their middle finger. A visual cue preceded the target by an interval of 300, 1000, or 2000 ms. In Experiment 1, the complex and simple responses were not previously trained. During the testing session, the complex response pattern varied on a trial-by-trial basis following the indication provided by the visual cue. In Experiment 2, the complex response and the simple response were extensively trained beforehand. During the testing session, the trained complex response pattern was performed in all trials. The latency of the untrained and trained complex responses decreased from the short to the medium and long cue-target intervals. The latency of the complex response was longer than that of the simple response, except in the case of the trained responses and the long cue-target interval. These results suggest that the preparation of untrained complex responses cannot be completed in advance, this being possible, however, for trained complex responses when enough time is available. The duration of the 1st submovement, 1st pause and 2nd submovement of the untrained and the trained complex responses increased from the short to the long cue-target interval, suggesting that there is an increase of online programming of the response possibly related to the degree of certainty about the moment of target appearance.

The plastic brain responses generated by the training with acrobatic exercise (AE) and with treadmill exercise (TE) may be different. We evaluated the protein expression of synapsin I (SYS), synaptophysin (SYP), microtubule-associated protein 2 (MAP2) and neurofilaments (NF) by immunohistochemistry and Western blotting in the motor cortex, striatum and cerebellum of rats subjected to TE and AE. Young adult male Wistar rats were divided into 3 groups: sedentary (Sed) (n=15), TE (n=20) and AE (n=20). The rats were trained 3days/week for 4weeks on a treadmill at 0.6km/h, 40min/day (TE), or moved through a circuit of obstacles 5 times/day (AE). The rats from the TE group exhibited a significant increase of SYS and SYP in the motor cortex, of NF68, SYS and SYP in the striatum, and of MAP2, NF and SYS in the cerebellum, whereas NF was decreased in the motor cortex and the molecular layer of the cerebellar cortex. On the other hand, the rats from the AE group showed a significant increase of MAP2 and SYP in the motor cortex, of all four proteins in the striatum, and of SYS in the cerebellum. In conclusion, AE induced changes in the expression of synaptic and structural proteins mainly in the motor cortex and striatum, which may underlie part of the learning of complex motor tasks. TE, on the other hand, promoted more robust changes of structural proteins in all three regions, especially in the cerebellum, which is involved in learned and automatic tasks.