Journal of Neurologic Physical Therapy is pleased to publish the 4 most outstanding abstracts presented at the ABRAFIN conference in Rio de Janeiro, Brazil, November 15-17, 2012
Clinical and Functional Differences Between Persons With Parkinson Disease Who Have Experienced No Falls, a Single Fall, or Recurrent Falls
Lorena R. S. Almeida, PT, MSc,1 Guilherme Valenca, MD1, Nadja Negreiros, RN1, Elen B. Pinto, PT, PhD2, Jamary Oliveira-Filho, MD, PhD2
1Movement Disorders Clinic, State of Bahia Centre for the Elderly Health Attention - CREASI/SESAB, Salvador, Bahia, Brazil; 2Stroke Clinic, Federal University of Bahia, Salvador, Bahia, Brazil.
Background/Purpose: The incidence of falls in persons with Parkinson disease is high and can lead to serious injuries. Recurrent falls are frequent and it is important to know the profile of persons who are at risk for falls. Our goal was to compare clinical and functional characteristics of persons with Parkinson disease who are nonfallers, single, and recurrent fallers.
Methods: We evaluated 150 persons with Parkinson disease. In addition to demographics and clinical data, patients were assessed with the Unified Parkinson's Disease Rating Scale, activities of daily living and motor sections, modified Hoehn and Yahr Scale, Schwab and England Scale, Falls Efficacy Scale-International, Berg Balance Scale, Dynamic Gait Index, Functional Reach, Timed Up and Go Test. Patients were followed up for 12 months to record the incidence of falls. Kruskal-Wallis test and Bonferroni correction were performed.
Results: The median age was 70 years; 46.9% were classified as nonfallers, 10.2% single fallers, and 42.9% recurrent fallers. There were no differences between nonfallers and single fallers. Compared with single fallers, recurrent fallers had longer disease duration, higher disease severity, and levodopa equivalent dose. They also had higher scores on the Unified Parkinson's Disease Rating Scale-activities of daily living and Falls Efficacy Scale-International and lower scores on the Berg Balance Scale and Dynamic Gait Index, took more time to perform the Timed Up and Go Test, and had more severity of freezing and worst scores on the pull test (P <= 0.01). Among the falls occurred at home, 83.3% were reported by recurrent fallers (P < 0.001).
Conclusions: Persons with Parkinson disease who had a history of recurrent falls showed more clinical and functional limitations, postural instability, and concern about falling than persons with Parkinson disease who had experienced a single fall or no falls. The characteristics of these groups should be considered to guide falls-prevention programs.
The Addition of Functional Task-Oriented Mental Practice to Conventional Physical Therapy Improves Motor Abilities in Daily Functions After Stroke
Clarissa Cardoso dos Santos-Couto-Paz1,2, Luci Fuscaldi Teixeira-Salmela3, Carlos Julio Tierra-Criollo2,4
1Faculdade de Ceilandia, Universidade de Brasilia, Brasilia, Distrito Federal, Brazil. 2Graduate Program in Neurosciences, Institut of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. 3Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. 4Graduate Program in Biomedical Engineering - COPPE, Universidade Federal de Rio de Janeiro, Rio de Janeiro, Brazil.
Background/Purpose: Mental practice (MP) is a method by which the internal reproduction of a given motor act is extensively repeated with the intention of improving motor performance. This study aimed to evaluate whether individualized, specific functional task-oriented MP promotes better learning of motor activities of daily living in individuals with chronic stroke, when added to conventional physical therapy (PT).
Methods: Nine individuals with stable mild and moderate upper limb impairments participated, by employing an A1-B-A2 single-case design. Phases A1 and A2 included 1 month of conventional PT and phase B the addition of MP training. The motor activity log was used to assess the amount of use and quality of movement of the paretic upper limb. The revised motor imagery questionnaire was used to assess abilities in kinesthetic and visual motor imageries. The Minnesota manual dexterity test was used to assess manual dexterity. Gait speed was used to assess mobility.
Interventions: Thirty-minute MP training sessions with one-to-one therapist interaction were provided 3 days per week during 4 weeks. The tasks to be trained were identified during the initial assessments. Conventional PT included mild stretching, strengthening, and relaxation exercises for the upper limb.
Results: After phase A1, no significant changes were observed for any of the outcome measures. However, after phase B, significant improvements were observed for all participants (P < 0.02).
Conclusions: The addition of specific functional task-oriented MP to conventional PT resulted in improvements in motor imagery abilities and was associated with increases in the amount of use during activities of daily living, in manual dexterity, and mobility.
Characteristics and Effect of Short-Term Training in Reaching in Preterm Infants
Andrea Baraldi Cunha1, Elaine Leonezi Guimaraes1,2, Daniele de Almeida Soares, Eloisa Tudella1
1Federal University of Sao Carlos (UFSCar), Department of Physiotherapy, Sao Carlos, SP, Brazil. 2Federal University of Triangulo Mineiro (UFTM), Department of Applied Physiotherapy, Uberaba, MG, Brazil.
Background and Purpose: Infants born preterm may have disadvantages in developing reaching compared with infants born full-term. However, the differences between these groups of infants and the effect of short-term training in reaching are yet to be understood. Our goal was to compare characteristics of infants born preterm and full-term and the effect of a short period of training of infants born preterm in reaching frequency.
Methods: Six infants born preterm (18.0 +/- 4.5 weeks, chronological age) and 6 infants born full-term (13.5 +/- 1.7 weeks, chronological age) were evaluated at pre- and posttraining. Reaching was evaluated while the infants were seated reclined at 45[degrees]. Between the evaluations, only infants born preterm received training in serial variable practice condition. The characteristics of the sample variables considered were motor performance according to the Alberta Infant Motor Scale, gestational age, current and birth weight, and total frequency of reaching. We used analysis of variance and the Mann-Whitney test (P < 0.05).
Results: At baseline, there were significant differences in gestational age (z = -2.918; P = 0.004) and birth weight (z = -2.722; P = 0.006) between infants born preterm (33.5 +/- 1.8 weeks) (1.9 +/- 0.5 kg) and those born full-term (38.6 +/- 1.5 weeks) (3.2 +/- 0.5 kg). There was a higher frequency of reaching at posttraining (F = 27.11; P = 0.00) in the preterm group (15.5 +/- 4.5) than in the full-term group (5.6 +/- 1.3).
Conclusion: Infants born preterm showed a disadvantage in reaching compared with their gestational-age and birth-weight peers. Considering the onset of skill and not the age of the infants, this disadvantage does not seem to influence motor development and frequency of reaching compared with that in infants born full-term. Short-term training seemed to provide sensorimotor experiences seemed to facilitate greater frequency of reaching in infants born preterm.
The Impact of Treadmill Training Using Body Weight Support on Gait Performance, Oxygen Uptake, and Risk of Falling in Persons With Spinocerebellar Ataxia
Polonini CM1, Rodrigues EC1, Horsczaruk1 CH, Lima1 DC, Vasconcellos LF2, Oliveira LAS1
Mestrado Academico em Ciencias da Reabilitacao, Centro Universitario Augusto da Motta, UNISUAM, Rio de Janeiro, Brazil. 2Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Background and Purpose: The spinocerebellar ataxia (SCA) affects cerebellum and its connections, leading to progressive gait and limb ataxia with concomitant balance disturbance. These impairments are related to mobility constraints, morbidity, enhanced risk of falling, and higher probability of injuries, with physical and social consequences.
Methods: Six patients with SCA participated in gait training with the assistance of a body weight support (BWS) device (Biodex). Patients were evaluated with the Scale for the Assessment and Rating of Ataxia, Dynamic Gait Index, Berg Scale, Timed Get Up and Go Test, and ergoespirometric test. The protocol comprised 2 parts. In the first part (8 weeks long), the gait training was performed with 30% of BWS, during 50 min, 2 times per week. The amount of BWS was progressively decreased until full weight bearing was achieved. In the second part (10 weeks long), participants walked with full weight bearing attached to the BWS structure with no weight support, throwing and catching a ball to improve balance. The patients were evaluated before and after the first and second interventions.
Results: At the end of training, we observed Vo2 peak enhancement, a 2.46-second reduction on median time to complete Timed Up and Go Test, and a 4-point increase on median score of both the Dynamic Gait Index and the Scale for the Assessment and Rating of Ataxia. Furthermore, Wilcoxon test showed significant increase in Berg scores (P = 0.02).
Conclusions: These data suggest that gait training with BWS modifies the performance and velocity of gait, influences the SCA severity, and decreases the risk of falling.