Validation of the "Six Step Spot Test" for gait among patients with multiple sclerosis in Brazil Validação do teste de marcha "Six Step Spot Test" em pacientes com esclerose múltipla no Brasil

The clinical manifestations of multiple sclerosis (MS) are variable among patients, and the course of disease is not linear. Different symptoms are presented, with gradual accumulation of disability. These variations are difficult to quantify in clinical practice, and several studies have attempted to create instruments capable of measuring these disabilities. The Six Step Spot Test (SSST) was developed for quantitative evaluation of the lower limbs (LL) over time. Performance in this test reflects the complexity of sensory-motor function, including LL strength, spasticity, coordination and balance, going beyond vision and cognition. The aim of the present study was to validate the SSST in a population of MS patients in Brazil. This prospective study included 75 patients with MS, with EDSS 0 to 6.5 in the study group. Ninety-one healthy subjects were randomly selected for the control group. The results showed that the groups were similar, and that the SSST is a reliable and reproducible test. According to the statistical analysis on the data in this study, the SSST is a valid, reliable and reproducible tool for use in the Brazilian MS patient population.As manifestações clínicas da esclerose múltipla (EM) são variáveis e o curso da doença não é linear, caracterizado por sintomas, acúmulo progressivo de incapacidades. Estas variações são difíceis de quantificar na prática clínica, motivo pelo qual surgiram diversos estudos para criação de instrumentos capazes de mensurar essas incapacidades. O Six Step Spot Test (SSST) foi desenvolvido para avaliar função dos membros inferiores (MMII) de forma quantitativa, mensurado no domínio tempo, avaliando a complexa função sensório-motora, como força em MMII, espasticidade, coordenação e equilíbrio, além da visão e cognição. Este estudo teve como objetivo validar o SSST para pacientes com EM no Brasil. Estudo prospectivo do qual participaram 75 pacientes com EM e EDSS de 0 a 6,5 no grupo de estudo e 91 indivíduos saudáveis no controle que foram selecionados aleatoriamente. Segundo os dados estatísticos deste estudo, o SSST é válido, confiável e reprodutível para pacientes com EM no Brasil

Transcranial direct-current stimulation induced in stroke patients with aphasia: a prospective experimental cohort study

CONTEXT AND OBJECTIVE: Previous animal and human studies have shown that transcranial direct current stimulation can induce significant and lasting neuroplasticity and may improve language recovery in patients with aphasia. The objective of the study was to describe a cohort of patients with aphasia after stroke who were treated with transcranial direct current stimulation. DESIGN AND SETTING: Prospective cohort study developed in a public university hospital. METHODS: Nineteen patients with chronic aphasia received 10 transcranial direct current stimulation sessions lasting 20 minutes each on consecutive days, using a current of 2 mA. The anode was positioned over the supraorbital area and the cathode over the contralateral motor cortex. The following variables were analyzed before and after the 10 neuromodulation sessions: oral language comprehension, copying, dictation, reading, writing, naming and verbal fluency. RESULTS: There were no adverse effects in the study. We found statistically significant differences from before to after stimulation in relation to simple sentence comprehension (P = 0.034), naming (P = 0.041) and verbal fluency for names of animals (P = 0.038). Improved scores for performing these three tasks were seen after stimulation. CONCLUSIONS: We observed that excitability of the primary motor cortex through transcranial direct current stimulation was associated with effects on different aspects of language. This can contribute towards future testing in randomized controlled trials

Avaliação clínica dos atletas paraolímpicos Clinical evaluation of paralympic athletes

O objetivo deste trabalho foi verificar de modo amplo o comportamento de variáveis importantes para a saúde preventiva e o desempenho dos atletas paraolímpicos. Os paratletas foram avaliados clinicamente (aplicação de questionário, história clínica, exame físico) e com exames laboratoriais, raio x simples de tórax e controle de doping. A equipe brasileira que participou dos Jogos Paraolímpicos de Sydney 2000 foi também classificada de acordo com as seguintes variáveis: sexo, idade, modalidades esportivas, meios de locomoção, tipos de deficiência, resultados dos exames laboratoriais e de tórax, avaliação odontológica e controle de doping. Os resultados obtidos serviram de parâmetro para se traçar um perfil dos atletas e orientá-los na prevenção das doenças e lesões esportivas que pudessem interferir nos treinamentos e competições.<br>The purpose of this study was to evaluate characteristics that were important for preventive health and for performance of paralympic Brazilian athletes. The athletes were evaluated clinically (questionnaires, clinical history, physical examination) and also with laboratory studies, chest roentgenogram and doping control. The Brazilian team that participated in the Sydney 2000 Paralympic Games was also classified according to some characteristics such as gender, age, sports modality, way of locomotion, types of disabilities, laboratory study results, chest X-ray results, odontological evaluation, and doping control. The results obtained were used to define a profile of such athletes and to give them information about prevention of diseases and sports-related injuries that could hinder their training and competition result

Avaliação da fatigabilidade em pacientes com esclerose múltipla através do dinamômetro manual Fatigability evaluation on multiple sclerosis patients by using a hand held dynamometer

A fadiga é um dos mais freqüentes sintomas e incapacitantes na esclerose múltipla (EM). O objetivo do presente estudo foi avaliar a fatigabilidade em pacientes com EM pela aplicação de exercícios isotônicos e isométricos com dinamômetro manual. Como resultados, a fatigabilidade, a força e o tempo máximo de isometria são semelhantes estatisticamente entre o grupo controle e o grupo de EM. Conclui-se que embora a queixa subjetiva de fadiga seja freqüente na EM, a fatigabilidade e a recuperação após o exercício demonstraram ser normais.<br>Fatigue is one of the most commom disabling symptoms in multiple sclerosis (MS). The aim of this study was to evaluate the fatigability on patients with MS by the aplication of hand grip isotonic and isometric exercises with dynamometer. As results the fatigability, the isometric strenght and time were statistically similar in the control group and in MS. We conclude that although fatigue is a frequent subjective complaint on MS, the fatigability and the recover after exercises seems to be normal

Validation of the Santa Casa evaluation of spasticity scale Validação da escala de avaliação da espasticidade Santa Casa

Spasticity is a clinical condition that has negative repercussions on function. A scale capable of quantifying the severity and impact of an injury is fundamental to the rehabilitation process. The objective of this study was to retest and validate the Santa Casa evaluation of spasticity scale, a descriptive assessment of activities of daily living, transfers and locomotion. We analyzed spasticity and functional status in 97 hemiparetic patients. With statistical significance (p<0.05), this new scale demonstrated reliability in assessing clinical-functional conditions and reproducibility as a daily assessment scale for use during rehabilitation.<br>A espasticidade é uma condição clínica que pode repercutir negativamente na condição funcional. Um instrumento de avaliação capaz de mensurar a gravidade e a conseqüência da lesão torna-se ferramenta fundamental ao processo de reabilitação. O objetivo foi reproduzir e validar a Escala de Avaliação da Espasticidade Santa Casa (EAESC), instrumento descritivo correspondente às atividades de vida diária, transferências e locomoção. Analisou-se a espasticidade e condição funcional de 97 pacientes hemiparéticos. Com significância estatística (p<0,05), a EAESC mostrou-se sensível à análise das condições clínico-funcionais, sendo hábil sua reprodutibilidade como instrumento rotineiro de avaliação à reabilitação