Abstract Introduction The literature still lacks evidence about patient-reported outcome measures to fast screen the reduced physical performance of the lower body in older adults to be applied in ...any clinical setting as primary health care or without specific instruments in prevention campaigns, or even easy to be applied by phone. Objective: To develop a brief questionnaire to screen the lower body functional performance in community-dwelling older adults and to validate this new questionnaire with objective clinical tests. Methods A convenience sampling of 221 community-dwelling older adults was included in this cross-sectional study. The validity between Brief-LBFPQ and objective tests such as gait speed, Timed-Up and Go test (TUG), 5-Time Stand-to-Sit test (5TSST), and step test were assessed by multinominal logistic regression. Internal consistency was determined using Cronbach’s alpha and Test-retest reliability was determined using intraclass correlation coefficient (ICC) for numeral scale and Cohen’s Kappa for ordinal scale. Results Brief-LBFPQ was significantly associated with objective tests. All eight items from Brief-LBFPQ presented an absolute agreement with ICCs values above 0.7. Kappa values of Brief-LBFPQ items ranged from 0.6 to 0.83, showing substantial agreement and perfect agreement. Conclusion Brief-LBFPQ could be very useful in general clinic settings as it provides earlier screening of functional impairment in independent older adults, and consequently may allow an earlier intervention approach.
Resumo Introdução A literatura ainda carece de evidências acerca de instrumentos de autorrelato para o rastreio rápido do prejuízo no desempenho físico dos membros inferiores em idosos, que possam ser aplicados em qualquer ambiente clínico, como na Atenção Básica à Saúde, e que não requeiram nenhum ins-trumento específico para campanhas de prevenção, ou mesmo de fácil aplicação por contato telefônico. Objetivo Desenvolver um breve questionário para triagem do desempenho funcional dos membros inferiores em idosos da comunidade e validar este novo questionário com testes clínicos objetivos. Métodos Uma amostra de conveniência de 221 idosos da comunidade foi incluída neste estudo transversal. A validade entre o Brief-LBFPQ e os testes objetivos como velocidade da marcha, Timed-Up and Go (TUG), teste de levantar e sentar 5 vezes (TLS5x) e teste do degrau foi avaliada pela regressão logística multinominal. A consistência interna foi determinada pelo alfa de Cronbach e a confiabilidade teste-reteste foi determinada pelo coeficiente de correlação intraclasse (CCI) para a escala numérica e o Kappa de Cohen para a escala ordinal. Resultados O Brief-LBFPQ foi significativamente associado aos testes objetivos. Todos os oito itens do Brief-LBFPQ apresentaram concordância absoluta com valores de CCI acima de 0,7. Os valores de Kappa dos itens do Brief-LBFPQ variaram de 0,6 a 0,83, mostrando concordância substancial e concordância perfeita. Conclusão O Brief-LBFPQ pode ser muito útil em diferentes ambientes clínicos, pois permite uma triagem precoce do comprometimento funcional em idosos independentes e, consequentemente, pode permitir uma abordagem de intervenção mais precoce.
Abstract Objective: To evaluate the effect of vestibular manipulation on the postural sway and muscle activation of younger and older adults. Methods: The study analyzed the effects of three ...intensity levels of galvanic vestibular stimulation (GVS) (0.3; 0.6 and 1m) on the pattern of muscle activity and center of pressure (CP) displacements of 12 older adults (EG) and 12 young adults (CG) while maintaining their balance on a stable surface, with no vision. Results: The EG showed a positive correlation between CP displacement and muscle activity and GVS intensity. On the other hand, the magnitude of postural response in the EG was not modulated in accordance with GVS intensities. Additionally, during the highest GVS intensity level (1 mA) greater muscle activity was used to increase stiffness, decrease the amplitude of oscillation and ensure stability. This unusual response characterizes a pattern of co-activation and is perhaps a safety mechanism to ensure stability. Conclusion: The EG individuals were not able to select the appropriate motor strategy to efficiently compensate the effects of GVS. This unusual strategy reflects deficits in the vestibular system of older adults, a fact which negatively interferes with their ability to reevaluate sensory information.
Resumo Objetivo: Avaliar a interferência da manipulação das informações vestibulares na oscilação postural e atividade muscular de jovens e idosos. Métodos: Foi analisado o efeito de três intensidades (0,3; 0,6 e 1mA) de estimulação vestibular galvânica (GVS) no padrão de ativação muscular e deslocamento do centro de pressão (CP) de 12 idosos (GI) e 12 adultos jovens (GC), durante a manutenção do equilíbrio em uma superfície estável sem visão. Resultados: O GC mostrou correlação positiva entre o deslocamento de CP e a ativação muscular com a intensidade da GVS. Por outro lado, o GI não foi capaz de modular a magnitude da resposta postural com a intensidade da GVS. Durante o maior valor de GVS (1mA), houve um aumento da ativação muscular de agonista e antagonista caracterizando um padrão de coativação que aumentou a rigidez e diminuiu a amplitude de oscilação. Conclusão: Os indivíduos do GI selecionaram uma estratégia motora atípica para compensar os efeitos da GVS. Essa estratégia incomum refletiu deficit no sistema vestibular dos idosos e pode interferir negativamente na capacidade de reorganização das informações sensoriais.
RESUMO O medo de quedas pode fazer com que o idoso desenvolva estratégias que alteram o equilíbrio semiestático e dinâmico, predispondo-o a um risco aumentado de cair. A função muscular dos abdutores ...e adutores de quadril tem importante papel na manutenção da estabilidade postural. Entretanto, não se sabe se idosos com medo de cair apresentam maior comprometimento na função muscular do quadril. Assim, o objetivo foi comparar o pico de torque (PT) isométrico dos músculos abdutores e adutores de quadril entre idosos com e sem medo de quedas. Os participantes foram divididos em dois grupos: com (n=81) e sem (n=81) medo de quedas. O PT dos abdutores e adutores de quadril foi obtido com dinamômetro isocinético (System 4 Pro, Biodex, Nova York, EUA). A comparação do PT dos grupos foi realizada por meio de modelo linear geral univariado, ajustado pelas covariáveis idade, sexo, índice de massa corporal, nível de atividade física e histórico de quedas, utilizando o software SPSS 17.0, com nível de significância de 5%. Não houve diferença do PT abdutor e adutor do quadril entre os grupos após análise univariada com ajustamento. Observou-se que idosos com medo de quedas não apresentam prejuízos na função muscular dos estabilizadores de quadril quando comparados a idosos sem medo de quedas.
ABSTRACT The fear of falling can cause older adults to develop strategies that alter the semi-static and dynamic balance, predisposing them to increased risk of falling. The muscular function of abductors and adductors plays an important role in maintaining postural stability. However, it is unknown whether older people with fear of falling have greater impairment in hip muscular function. Thus, the objective was to compare the isometric peak torque (PT) of hip abductor and adductor muscles among older adults with and without fear of falling. Participants were divided into two groups: with (n=81) and without (n=81) fear of falling. The PT of hip abductors and adductors was obtained with isokinetic dynamometer (System 4 Pro, Biodex, New York, USA). The PT groups were compared using general linear model univariate, adjusted for covariates age, sex, body mass index, physical activity level and history of falls, using the SPSS 17.0 software, with a significance level of 5%. No difference was found between the PT of hip abductor and adductor and the groups after univariate analysis with adjustment. We observed that older people with fear of falling have no muscle function loss of the hip stabilizers when compared with subjects without fear of falling.
RESUMEN El miedo a caerse puede hacer que los ancianos desarrollen estrategias de alteración del equilibrio semiestático y dinámico, predisponiéndolos a un mayor riesgo de caídas. La función muscular de los abductores y de los aductores de cadera juega un papel importante en el mantenimiento de la estabilidad postural. Sin embargo, no se sabe si los ancianos con miedo a caerse tienen un mayor deterioro en la función muscular de la cadera. Por lo tanto, el objetivo fue comparar el torque máximo (TM) isométrico de los músculos abductores y aductores de cadera entre los ancianos con miedo y sin miedo a caerse. Los participantes se dividieron en dos grupos: con miedo a caerse (n=81) y sin (n=81) miedo a caerse. El TM de los abductores y aductores de cadera se obtuvo mediante la utilización del dinamómetro isocinético (System 4 Pro, Biodex, Nueva York, EE.UU.). La comparación del TM de los grupos se realizó mediante un modelo lineal general univariado, ajustado por covariables edad, género, índice de masa corporal, nivel de actividad física e historial de caídas, utilizando el software SPSS 17.0, con nivel de significancia del 5%. No hubo diferencias entre el TM del abductor y del aductor de cadera entre los grupos tras el análisis univariado con ajuste. Se observó que los ancianos con miedo a caerse no presentaron daños en la función muscular de los estabilizadores de la cadera en comparación con los ancianos sin miedo a caerse.
We aimed to evaluate the influence of different types of wheelchair seats on paraplegic individuals' postural control using a maximum anterior reaching test. Balance evaluations during 50, 75, and ...90% of each individual's maximum reach in the forward direction using two different cushions on seat (one foam and one gel) and a no-cushion condition were carried out on 11 individuals with a spinal cord injury (SCI) and six individuals without SCI. Trunk anterior displacement and the time spent to perform the test were assessed. No differences were found for the three types of seats in terms of trunk anterior displacement and the time spent to perform the test when intragroup comparisons were made in both groups (P>0.05). The intergroup comparison showed that body displacement was less prominent and the time spent to perform the test was more prolonged for individuals with SCI (P<0.05), which suggests a postural control deficit. The seat type did not affect the ability of the postural control system to maintain balance during the forward-reaching task.
Objective To verify the effects of gender and physical activity on postural sway. Method A cross-sectional study was conducted to analyze upright balance of young men and women between the ages of ...20-30, both active and sedentary. Study participants were 60 individuals, who were divided into: active women (n = 15), sedentary women (n = 15), active men (n = 15) and sedentary men (n = 15). The International Physical Activity Questionnaire (IPAQ) short form, was used to evaluate each participant’s level of physical activity. According to the questionnaire, active individuals are those who carry out moderate activity, with an energy expenditure between 3.5 and 6 METs (1 MET: 3.5 ml/kg/min), or vigorous activity, with an energy expenditure above 6 METs, at least three days a week for 20 minutes. To assess control of postural sway, we measured the amplitude and velocity of anteroposterior (AP) and mediolateral (ML) sway in standing position, with their eyes open and closed, with and without foam, on a force platform. Results Comparison between genders revealed that, when compared to sedentary women, sedentary men displayed poorer performance in velocity and amplitude of AP postural control sway with their eyes closed, with and without foam. There were no differences in the amplitude and velocity of ML sway, both with open and closed eyes among groups (p < 0.05). There were no differences when comparing physically active men and women either. Conclusion Sedentary men seem to rely more on vision for maintaining postural control in quiet standing situations with respect to women.
Objetivo Verificar a relação da oscilação postural entre os sexos e a prática de atividade física. Método Estudo transversal que analisou o equilíbrio semi-estático de homens e mulheres jovens entre 20 e 30 anos, ativos e sedentários. Foram incluídos 60 adultos, que foram divididos em: mulheres ativas (n = 15), mulheres sedentárias (n = 15), homens ativos (n = 15) e homens sedentários (n = 15). Para avaliar o nível de atividade física foi utilizado o Questionário Internacional de Atividade Física (IPAQ) versão curta, que considerou ativos aqueles que realizaram atividade moderada, com gasto de 3,5 a 6 METs (1 MET: 3,5 ml/kg/min), ou vigorosa, com gasto superior a 6 METs, ao menos 3 dias por semana durante 20 minutos. Para avaliação do controle postural, a amplitude e velocidade de oscilação anteroposterior (AP) e mediolateral (ML) foram obtidas por meio de plataforma de força, na posição ortostática, com os olhos abertos e fechados, com e sem a espuma. Resultados Na comparação entre os sexos, os homens sedentários apresentaram pior desempenho de velocidade e amplitude do controle postural AP com os olhos fechados, com e sem espuma, quando comparados com as mulheres sedentárias. Não houve diferenças na amplitude e velocidade de oscilação ML, tanto de olhos abertos quanto fechados entre os grupos (p < 0,05). Também não foram observadas diferenças na comparação entre sexos quando praticantes de exercícios físicos. Conclusão Conclui-se então que, em situação de sedentarismo, o sexo masculino parece mais dependente da visão para a manutenção do controle postural em situações semi-estáticas comparado ao sexo feminino.
Abstract Objective: The aim of the present study was to evaluate the influence of a balance training program on the semi-static balance of elderly persons by comparing a supervised group with ...individual home-based application. Method: A blinded randomized controlled multi-arm trial was conducted. The elderly individuals were randomized into: Supervised Group (SG; n=18); Domiciliary Group (DG; n=20) and Control Group (CG; n=18). The SG and DG participated in twice weekly training sessions for 10 weeks. A posturography evaluation was performed based on velocity, anterior-posterior (AP) and medial-lateral (ML) medial amplitude variables in firm surface with eyes open (FSEO) and closed (FSEC), tandem stance with eyes open (Tandem EO) and closed (Tandem EC), and single-leg stance (SL) situations. Two-way ANOVA and Tukey's post-hoc were used for parametric data, the Friedman and Wilcoxon post-hoc tests were used for intragroup analysis and the Kruskal-Wallis and Mann-Whitney post-hoc tests were used for intergroup analysis. Results: In intergroup analysis, the DG group showed improvement in body sway in the Tandem EC (velocity and medial amplitude AP) and single-leg stance (medial amplitude ML) situations. The SG showed a decline in the Tandem EO situation in all the variables. In intergroup analysis, the DG showed improvement in the FSEO position (medial amplitude ML), in the Tandem EC position (medial velocity ML), and the single-leg stance position (medial amplitude AP and ML). The SG showed improvement in the FSEO position (medial amplitude ML) and the single-leg stance position (medial amplitude AP), but showed a decline in the FSEO (variable medial velocity AP) and Tandem EO position (medial amplitude AP). Conclusion: The exercises were beneficial for the balance of the elderly individuals, with the DG presenting the best results. REBEC: RBR-3S9M65.
Resumo Objetivo: Avaliar o efeito de um programa de treinamento sobre o equilíbrio semiestático de idosos, comparando a forma de aplicação supervisionada em grupo e individual domiciliar. Método: Ensaio clínico cego randomizado controlado com múltiplos braços. Idosos randomizados em Grupo Supervisionado (GS; n=18); Grupo Domiciliar (GD; n=20) e Grupo Controle (GC; n=18). O GS e o GD participaram do treinamento por 10 semanas, duas vezes por semana. O equilíbrio foi avaliado pela posturografia variáveis velocidade e amplitude média antero-posterior (AP) e médio-lateral (ML) nas situações: plataforma fixa olhos abertos (PFOA), plataforma fixa olhos fechados (PFOF), tandem olhos abertos (Tandem OA), tandem olhos fechados (Tandem OF) e Unipodal. ANOVA two-way e post-hoc de Tukey foram utilizados nos dados paramétricos, teste de Friedman e post-hoc de Wilcoxon para análise intragrupos e teste de Kruskal-Wallis e post-hoc de Mann-Whitney para análise intergrupos. Resultados: Na análise intragrupo, o GD apresentou melhora na oscilação corporal pós-treinamento nas posições Tandem OF (velocidade e amplitude média AP) e Unipodal (amplitude média ML). O GS apresentou piora na posição Tandem OA em todas as variáveis. Na análise intergrupo, o GD apresentou melhora na posição PFOA (amplitude média ML), Tandem OF (velocidade média ML) e Unipodal (amplitude média AP e ML). Já o GS apresentou melhora na posição PFOA (amplitude média ML) e Unipodal (amplitude média AP), contudo apresentou piora na posição PFOA (variável velocidade média AP) e na Tandem OA (amplitude média AP). Conclusão: Os exercícios proporcionaram benefícios para o equilíbrio dos idosos investigados, embora o GD tenha apresentado os melhores resultados. REBEC: RBR-3S9M65.
Diminuiçâo da Amplitude de Movimento (ADM) de tornozelo e reduçao da força de dorsiflexores em decorrencia do processo de envelhecimento sâo alteraçöes conhecidas e que estao associadas com o aumento ...do risco de tropeços e quedas. Foi nosso objetivo avaliar a ADM de tornozelo em idosos da comunidade durante a marcha habitual e em duas condiçöes de tarefas simultáneas (funcional e cognitiva). Trinta e dois idosos da comunidade (66.8±4.7 anos), de ambos os sexos, nao caidores, que apresentavam marcha sem dispositivo de auxilio, participaram do estudo. A dorsiflexao e flexao plantar de tornozelo foram avaliadas em tres situaçöes: marcha habitual, marcha com tarefa funcional e marcha com tarefa cognitiva, utilizando 8 cámeras Qualisys Pro-reflex Oqus 300®. Análises de variáncia (ANOVA) foram aplicadas e comparaçöes foram feitas por Newman-Keuls no programa SPSS (versao 16.0) adotando nivel de significáncia de 5% (p< 0.05). Nao houve diferenças entre as diferentes tarefas (p> 0.05) para a ADM de dorsiflexao e flexao plantar dos idosos, porém, durante a marcha habitual a ADM de dorsiflexao foi menor se comparada aos valores de referencia descritos na literatura. A realizaçao de tarefas associadas a marcha nao alterou a ADM de tornozelo em idosos da comunidade nao caidores, entretanto, sao necessários mais estudos que abordem idosos que tiveram quedas prévias.
We describe the analysis of muscle hypertrophy in complete quadriplegics after 6 months of treadmill gait training with neuromuscular electrical stimulation (NMES). We aim to evaluate the effect of ...treadmill gait training using NMES, with 30-50% body weight relief, on muscle mass. Fifteen quadriplegics were divided into gait (n=8) and control (n=7) groups. The gait group (GG) performed training, associated to partial body weight support, for 6 months, twice a week, for 20 min. Control group (CG) individuals performed only conventional physiotherapy, but did not perform gait training using NMES. Magnetic resonance imaging (MRI) was performed over quadriceps, at the beginning and after 6 months. The MRI was done to determine the average of cross-sectional area of the quadriceps. Moreover, a gray scale was used to separate the muscle from the conjunctive tissue (when the value is closer to 225, there is a higher amount of muscle tissue). After 6 months there was an increase of cross-sectional area in the gait group (from 49.81+/-9.36 to 57.33+/-10.32 cm2; P=0.01), but not in the control group (from 43.60+/-7.56 to 41.65 +/- 9.44 cm2; P=0.17). The gray scale did not show significant differences after 6 months; however, the mean value of the gray scale inside the quadriceps in the gait group increased by 7.7% and in the control group decreased by 11.4%. Treadmill gait associated with NMES was efficient to promove quadriceps muscle hypertrophy in quadriplegics with chronic lesions even when a partial body weight support was provided.
Objective: To evaluate the effects of individual and combination therapies (low-level laser therapy and physical exercises) on pain, stiffness, function, and spatiotemporal gait variables in subjects ...with bilateral knee osteoarthritis (OA).
Methods: Subjects with knee OA (Grades 1-3) were evaluated and randomized into four groups: Control Group (CG), untreated; Laser Group (LG), treated with laser at 808 nm, 5.6 J; Exercise Group (EG), treated with exercise; and Laser + Exercise Group (LEG), treated with laser and exercises. The treatment was carried out twice a week for 2 months. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was applied for evaluation and reevaluation; evaluation of spatiotemporal gait variables was performed using GAITRite equipment.
Results: The EG showed significant improvement in pain (p = 0.006) and function (p = 0.01) according to WOMAC. Regarding gait variables, in intergroup analysis after 8 weeks all groups receiving intervention showed a significant increase in gait speed: LG versus CG (p = 0.03); EG versus CG (p = 0.04) and LEG versus CG (p = 0.005). Only the group treated with laser + exercise showed a significant increase (p = 0.009) in the cadence and duration of single right limb support (p = 0.04), and only the groups treated with exercise and laser + exercise showed significant decreases in the duration of right limb support (p = 0.035 and p = 0.003, respectively), compared to the CG.
Conclusions: The group treated only with exercise showed improvement in WOMAC questionnaire scores. Regarding the gait variables, all groups undergoing the interventions showed increases in the gait speed compared to the CG. The laser and exercise combination therapy provided the best results for the other gait variables (cadence and duration of right limb support and duration of single right limb support).
Implications for rehabilitation
There are differences in gait patterns in patients with knee OA, including decreased gait speed, cadence, and step length.
The results shown in the present study provide additional information about the physical therapy approaches that should be chosen during clinical practical to improve gait performance in individuals with knee osteoarthritis.
The improvement in gait performance is a relevant issue due to the fact that is associated to physical independence and better quality of life.
Typically, falls in older adults occur when 2 tasks are performed simultaneously, due to the increased motor demand required to maintain stability and attention to perform the other task. The ...authors' purpose was to investigate walking while grasping, transporting, and placing a dowel on a predetermined target while manipulating difficulty levels of the manual task. Faller and nonfaller older adults performed a walking block (manual tasks combined with gait) and a stationary block (upright stance combined with manual tasks). The manual task involved grasping, transporting, and placing the dowel over a target. The results showed that fallers underperformed when compared with nonfallers in the task of placing the dowel over the target. The main difference observed between the groups was found in the condition that required allocation of attention between tasks and greater accuracy in the final placement of the object. Fallers showed gait stability similar to the nonfallers, but fallers were less accurate than nonfallers in the object placement task, especially for the highest level of difficulty. Thus, fallers seem to use a stability-first strategy. Fallers had problems in executing the manual tasks, which suggests a more global change in motor behavior rather than specific changes to balance control.
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