Post-stroke motor and functional evaluations - A clinical correlation using Fugl-Meyer assessment scale, Berg balance scale and Barthel index

Stroke is one of the major causes of morbidity and mortality. Sequels deriving from this event may lead to motor disability and from mild to severe deficits. In order to better classify sensory-motor dysfunction, balance and ability to perform activities of daily living, quantitative and qualitative evaluation scales have been used. Objective: To correlate the scales Fugl-Meyer assessment scale, Berg balance scale and Barthel index. Twenty subjects with sequel after a single, unilateral stroke in chronic phase (> 6 months post ictus) were evaluated for about one hour. Results: Barthel scale was statistically related to the total motor score of Fugl-Meyer assessment (r = 0.597, p = 0.005). The lower limb section at Fugl-Meyer had positive correlation with Berg scale (r = 0.653, p = 0.002) and with the balance section of Fugl-Meyer own scale (r = 0.449, p = 0.047). Both balance scales were correlated one with other (r = 0.555, p = 0.011). Statistical divergence appeared when Barthel's index was correlated with Berg's Scale (r = 0.425, p = 0.062), and it is not statistically significant. Conclusion: The use of both quantitative and qualitative scales was shown to be a good measuring instrument for the classification of the general clinical performance of the patient, especially when positively related joint evaluations are applied.643B73173

Reliability study on the application of the Fugl-Meyer scale in Brazil

OBJECTIVE: The aim of this study was to produce a Brazilian version of the original Fugl-Meyer Assessment Scale and to verify the intrarater and interrater reliability in chronic post-stroke patients. METHOD: Fifty hemiparetic patients participated in this study. The Fugl-Meyer assessment was applied to them twice (intrarater reliability) by three physiotherapists (interrater reliability), from three rehabilitation centers. RESULTS: The results showed that the whole Fugl-Meyer scale demonstrated high interrater and intrarater reliability (intraclass correlation coefficient = 0.99 and 0.98, respectively), and high reliability for each subscale (intraclass interrater = 0.99 to 0.94; intraclass intrarater = 0.98 to 0.87). CONCLUSION: It was concluded that the Brazilian Portuguese version of the Fugl-Meyer Assessment Scale did not show any conflicts of interpretation. High intrarater and interrater reliability rates were obtained, thereby allowing this version to be used as instrument for clinical evaluation and research in Brazil.OBJETIVOS: Os objetivos do estudo foram realizar uma versão brasileira da escala original de Fugl-Meyer e verificar a confiabilidade da aplicação inter e intra-observador desta versão em pacientes crônicos pós AVC. MÉTODO: Participaram do estudo 50 pacientes portadores de hemiparesia, os quais foram submetidos a duas avaliações (confiabilidade intra-observador), realizadas por três fisioterapeutas (confiabilidade interobservador), procedentes de três centros de reabilitação. RESULTADOS: Os resultados demonstraram alta confiabilidade inter e intra-observador da EFM total (IC = 0,99 e 0,98; respectivamente), assim como para todas as subescalas (interobservador IC = 0,99 a 0,94; intra-observador IC = 0,98 a 0,87). CONCLUSÃO: Conclui-se neste artigo que não foi verificado conflitos de interpretação na versão brasileira da escala de Fugl-Meyer. Obtivemos alto índice de confiabilidade, tanto intra como interobservador, permitindo assim seu uso como instrumento de avaliação clínica e de pesquisa no Brasil.17718

Improvements in the upper limb of hemiparetic patients after reaching movements training

Reaching movements made with hemiparetic upper limbs are often followed by compensatory trunk and shoulder-girdle movements, especially in reach-to-grasp strategies. We investigated the effect of restraint therapy on movement aiming at targets placed within arm reach. Eleven subjects were selected to participate in this study and were submitted to training with the trunk fixed to a chair during the reaching movement. Quantitative and qualitative scales (Modified Ashworth Scale, Fugl-Meyer Assessment Scale - upper limb section, Berg Balance Scale and Barthel Index) were used to evaluate reaching in three periods - pre-treatment, post-treatment and follow-up 3 months after training was completed. We found that in the arm section of the Fugl-Meyer Assessment Scale, pain (x(2) = 8.22, P= 0.016), proprioception (x(2) = 6.00, P=0.049), flexor synergy (x(2) =6.07, P=0.048), wrist (x(2) =6.50, P=0.039), coordination velocity (x(2) = 7.05, P=0.029) and the total score for the upper limb (x(2) = 7.95, P=0.019) had statistical significance, especially in the pre-treatment and follow-up phases. The same happened using the Barthel Index (x(2)=8.33, P=0.016). Trunk restraint allowed patients with hemiparetic stroke to make use of active arm joint ranges that are present but not normally recruited during unrestrained arm reaching tasks. Appropriate treatments, such as trunk restraint, may be effective in uncovering latent movement patterns to maximize arm recovery in hemiparetic patients.301677

Analysis of parallel and transverse visual cues on the gait of individuals with idiopathic Parkinson's disease

Idiopathic Parkinson's disease (IPD) has been defined as a chronic progressive neurological disorder with characteristics that generate changes in gait pattern. Several studies have reported that appropriate external influences, such as visual or auditory cues may improve the gait pattern of patients with IPD. Therefore, the objective of this study was to use three-dimensional (3D) analysis to evaluate the effects of parallel (PVC) and transverse visual spatial cues (TVCs) on gait variables (spatiotemporal and kinematic) of individuals with IPD. Twelve IPD patients were recruited from the Neurology Clinic, Medical School Hospital, Unicamp. The patients were initially evaluated using a modified Hoehn and Yahr Scale and subsection III of the Unified Parkinson's Disease Rating Scale. A 3D analysis system consisting of six infrared cameras and 18 markers (with a sampling rate of 240 Hz) was used for gait evaluation at the Laboratory for Rehabilitation and Biomechanics of the Locomotor System - Unicamp. Patients were asked to walk down a walkway under the following circumstances: baseline condition (BC, without visual cues), TVCs (20 pieces of white adhesive tape, 5 cm width and 50 cm length, placed 45 cm apart) and PVCs (two adhesive white tapes, 30 cm distance between them, 5 cm width each tape, along the walkway). Compared with the patients without visual cues, gait velocity was higher with the aid of visual cues (PVCs and TVCs, P = 0.003), and the percentage of leg stance time was smaller when cues were used (this value was significant for the right leg, P = 0.008). In addition, stride length was significantly higher with the use of TVCs (P = 0.006) compared with BC and PVCs. Regarding kinematic variables, TVCs resulted in smaller ranges of motion in knee joint flexion at initial contact and higher maximal amplitudes of knee flexion during the oscillatory phase compared with BC and PVCs. In conclusion, The use of TVCs on the gait evaluation results in improved gait variables compared with BC and PVCs. Therefore, the use of TVCs in a rehabilitation plan would be ideal for a physiotherapeutic treatment with emphasis on gait alterations.34434334

Upper limb assessment in tetraplegia: clinical, functional and kinematic correlations

The aim of this study was to correlate clinical and functional evaluations with kinematic variables of upper limp reach-to-grasp movement in patients with tetraplegia. Twenty chronic patients were selected to perform reach-to-grasp kinematic assessment using a target placed at a distance equal to the arm's length. Kinematic variables (hand peak velocity, movement time, percent time-to-maximal velocity, index of curvature, number of peaks, and joint range of motion) were correlated to clinical (Standard Neurological Classification of Spinal Cord Injury-American Spinal Injury Association) and functional [Functional Independence Measure (FIM) and Spinal Cord Independence Measure II (SCIM II)) evaluation scores. Twenty control participants were also selected to obtain normal reference parameters. There was a positive correlation between total motor index and FIM (r=0.6089; P=0.0044) and SCIM II (r=0.5229; P=0.018). Both functional scores showed positive correlation with each other (r=0.8283; P<0.0001). A correlation was also observed between the right and left motor indices, the motor AM, and the SCIM II in most of the reach-to-grasp kinematic variables studied (hand peak velocity, movement time, index of curvature, and number of peaks). In contrast, for the joint range of motion (shoulder, elbow, and wrist), only the wrist in the horizontal plane showed correlation with clinical variables. This study shows that muscle strength assessed by the American Spinal Injury Association motor index influences the reach-to-grasp kinematic variables of patients with tetraplegia. However, the functional assessments did not present the same influence.341657

Estudo de confiabilidade da aplicação da escala de Fugl-Meyer no Brasil

OBJETIVOS: Os objetivos do estudo foram realizar uma versão brasileira da escala original de Fugl-Meyer e verificar a confiabilidade da aplicação inter e intra-observador desta versão em pacientes crônicos pós AVC. MÉTODO: Participaram do estudo 50 pacientes portadores de hemiparesia, os quais foram submetidos a duas avaliações (confiabilidade intra-observador), realizadas por três fisioterapeutas (confiabilidade interobservador), procedentes de três centros de reabilitação. RESULTADOS: Os resultados demonstraram alta confiabilidade inter e intra-observador da EFM total (IC = 0,99 e 0,98; respectivamente), assim como para todas as subescalas (interobservador IC = 0,99 a 0,94; intra-observador IC = 0,98 a 0,87). CONCLUSÃO: Conclui-se neste artigo que não foi verificado conflitos de interpretação na versão brasileira da escala de Fugl-Meyer. Obtivemos alto índice de confiabilidade, tanto intra como interobservador, permitindo assim seu uso como instrumento de avaliação clínica e de pesquisa no Brasil.<br>OBJECTIVE: The aim of this study was to produce a Brazilian version of the original Fugl-Meyer Assessment Scale and to verify the intrarater and interrater reliability in chronic post-stroke patients. METHOD: Fifty hemiparetic patients participated in this study. The Fugl-Meyer assessment was applied to them twice (intrarater reliability) by three physiotherapists (interrater reliability), from three rehabilitation centers. RESULTS: The results showed that the whole Fugl-Meyer scale demonstrated high interrater and intrarater reliability (intraclass correlation coefficient = 0.99 and 0.98, respectively), and high reliability for each subscale (intraclass interrater = 0.99 to 0.94; intraclass intrarater = 0.98 to 0.87). CONCLUSION: It was concluded that the Brazilian Portuguese version of the Fugl-Meyer Assessment Scale did not show any conflicts of interpretation. High intrarater and interrater reliability rates were obtained, thereby allowing this version to be used as instrument for clinical evaluation and research in Brazil

Ultrafast Charge Separation in Bilayer WS2/Graphene Heterostructure Revealed by Time- and Angle-Resolved Photoemission Spectroscopy

Efficient light harvesting devices need to combine strong absorption in the visible spectral range with efficient ultrafast charge separation. These features commonly occur in novel ultimately thin van der Waals heterostructures with type II band alignment. Recently, ultrafast charge separation was also observed in monolayer WS2/graphene heterostructures with type I band alignment. Here we use time- and angle-resolved photoemission spectroscopy to show that ultrafast charge separation also occurs at the interface between bilayer WS2 and graphene indicating that the indirect band gap of bilayer WS2 does not affect the charge transfer to the graphene layer. The microscopic insights gained in the present study will turn out to be useful for the design of novel optoelectronic devices