Objective: Converging evidence supporting an effect of transcranial direct current stimulation (t... more Objective: Converging evidence supporting an effect of transcranial direct current stimulation (tDCS) on postural control and human verticality perception highlights this strategy as promising for post-stroke rehabilitation. We have previously demonstrated polarity-dependent effects of high-definition tDCS (HD-tDCS) on weight-bearing asymmetry. However, there is no investigation regarding the time-course of effects on postural control induced by HD-tDCS protocols. Thus, we performed a nonlinear time series analysis focusing on the entropy of the ground reaction force as a secondary investigation of our randomized, double-blind, placebo-controlled, crossover clinical trial. Materials and Methods: Twenty healthy right-handed young adults received the following conditions (random order, separate days); anode center HD-tDCS, cathode center HD-tDCS or sham HD-tDCS at 1, 2, and 3 mA over the right temporo-parietal junction (TPJ). Using summarized time series of transfer entropy, we evalua...
Walking in a daily life context requires constant adaptations to meet the environment's requi... more Walking in a daily life context requires constant adaptations to meet the environment's requirements for successful locomotion. We investigated the walking adaptations of younger and older adults when dealing with holes of different lengths in the pathway (60-cm long and 1.3 times foot length [critical point] conditions). We used the critical point condition to increase the demand for accuracy as it reduces the safety margin between the foot and the borders of the hole. Fifteen younger and fifteen older adults walked barefoot on a wooden walkway in three conditions: no-hole, 60-cm hole (length: 0.60 m | width: 0.80 m | depth: 0.095 m), and critical point hole (length: participant's foot length × 1.3 | width: 0.80 m | depth: 0.095 m). Participants stepped into the hole with only one foot. We assessed the impulses based on the ground reaction forces, trunk and lower limb joint angles, stride speed, and the margin of stability based on the concept of the extrapolated center of mass in the sagittal plane. Across walking conditions, older adults exhibited a larger margin of stability than younger adults. Before the hole, both age groups increased the braking impulse and adopted a more flexed posture of the lower limbs to help to lower the body in the subsequent step. Only older adults increased the vertical braking impulse and markedly reduced stride speed when stepping into both holes. Both age groups adopted a more vertically oriented trunk posture as a strategy to contribute to stability control when stepping into the hole. The two age groups showed a larger margin of stability and a more flexed trunk posture after the hole than the no-hole condition. Older adults were able to control body stability adequately and even better than younger adults. Younger and older adults used the same anticipatory and compensatory locomotor adjustments before and after the hole. These adjustments resulted in improved stability control. The differences between younger and older adults were confined to the moment of stepping into the hole. Older adults used a more cautious strategy that ensured task accuracy and gait progression.
Journal of Policy and Practice in Intellectual Disabilities, 2015
According to the International Classification of Functioning, Disability and Health (ICF), the mo... more According to the International Classification of Functioning, Disability and Health (ICF), the mobility of individuals with spastic cerebral palsy (SCP) is influenced by the interaction between their health and the personal and environmental contexts in which they conduct their lives. In accord with the ICF, this observational study aimed to analyze and compare the functional mobility of children and adolescents with SCP in both natural environments (places typically encountered in their daily routine) and optimized environments (flat surfaces). The observed effects of the environment suggest that the functional mobility of individuals with cerebral palsy depends on the environmental context. The characteristics of the natural and optimized environments may act as barriers and/or facilitators to covering short and long distances among individuals of different ages with cerebral palsy.
The purpose of this study was to investigate the effects of a multimodal exercise program (MEP) o... more The purpose of this study was to investigate the effects of a multimodal exercise program (MEP) on the functional capacity of patients with Parkinson's disease (PD) according to disease severity and gender. Fourteen patients with PD participated in the study and were distributed into groups according to 1) stage of disease and 2) gender. Functional capacity was evaluated before and after 6 months of intervention. The overall PD patient group improved their coordination and strength. Men and women improved in strength performance after exercise. Men also improved on coordination. For severity of disease, the unilateral group improved in strength, while the bilateral group improved in strength, balance, coordination and the UPDRS-functional score. In conclusion, a MEP is efficient in improving components of functional capacity in patients with PD, especially in strength. Gender may be considered in the exercise program. Individuals in the bilateral disease group appeared to benefi...
This mini-review focuses on intrinsic risk factors for falls, particularly the changes in motor b... more This mini-review focuses on intrinsic risk factors for falls, particularly the changes in motor behavior of faller older adults. Our purpose is to present evidence that faller older adults exhibit motor behavior changes beyond the typically investigated standing and walking tasks. We showed initially that postural control alterations with more prominent differences for fallers than non-fallers seem to depend on postural demands, availability of sensory information, and tasks performed concomitantly with the balancing task. We also provided evidence that walking speed is the most consistent aspect to differentiate fallers from non-fallers. This reduction in walking speed may be a strategy to improve gait stability to avoid a fall. More recent studies have shown that fallers presented modifications in the control of the prehension movement. These changes suggest that fallers have changes in movement categories other than balancing and walking, suggesting that fallers’ difficulties are...
Revista de Terapia Ocupacional da Universidade de São Paulo
A doença de Parkinson (DP) é caracterizada pelo início assimétrico de sintomas motores e comprome... more A doença de Parkinson (DP) é caracterizada pelo início assimétrico de sintomas motores e compromete a destreza manual. Espera-se que pacientes com o lado de início da doença preferido comprometido consigam manter bom desempenho com o lado mais afetado (LMA) no teste de destreza manual decorrente da experiência motora ao longo da vida. O objetivo do estudo foi verificar a interferência da coincidência entre o lado de início da doença e preferência manual no desempenho da destreza manual, LMA e lado menos afetado, em pacientes com DP. Os pacientes foram distribuídos conforme o lado de início: Grupo Coincidente (lado preferido acometido) e Grupo Não Coincidente (lado não preferido acometido). A destreza manual foi avaliada pelo teste Annett Pegboard adaptado. A análise estatística ANOVA de dois fatores (grupo x lado), medidas repetidas no último fator, revelou que o Grupo Não Coincidente dispendeu maior tempo para completar o teste com o LMA (p=0,001), enquanto, o Grupo Coincidente dis...
According to the International Classification of Functioning, Disability and Health (ICF), the mo... more According to the International Classification of Functioning, Disability and Health (ICF), the mobility of individuals with spastic cerebral palsy (SCP) is influenced by the interaction between their health and the personal and environmental contexts in which they conduct their lives. In accord with the ICF, this observational study aimed to analyze and compare the functional mobility of children and adolescents with SCP in both natural environments (places typically encountered in their daily routine) and optimized environments (flat surfaces). The observed effects of the environment suggest that the functional mobility of individuals with cerebral palsy depends on the environmental context. The characteristics of the natural and optimized environments may act as barriers and/or facilitators to covering short and long distances among individuals of different ages with cerebral palsy.
Resumen
Introducción: Analizar la contribución de la amplitud de movimiento articular de la rodi... more Resumen
Introducción: Analizar la contribución de la amplitud de movimiento articular de la rodilla en el proceso de marcha de niños hemipléjicos y dipléjicos, considerando el hemicuerpo. Material y métodos: Participaron 12 niños con edades entre 7 y 12 años (9,5±1,93), siendo 6 hemipléjicos y 6 dipléjicos. La espasticidad fue medida según la Escala Modificada de Ashworth y la amplitud del movimiento articular pasivo de la rodilla con un electrogoniómetro. La tarea consistió en recorrer una pasarela de 8 metros, a velocidad libre, en 6 intentos, de los cuales tres fueron en el plano sagital derecho y tres en el plano sagital izquierdo.
Resultados: La prueba U de Mann-Whitney mostró diferencias en el tipo de parálisis cerebral para la extensión/hiperextensión de la rodilla en el ángulo relativo de la rodilla en la aceptación de la carga y en la amplitud del movimiento articular de la rodilla en la marcha. La prueba T de Wilcoxon mostró diferencias de hemicuerpo para los hemipléjicos en el ángulo relativo de la rodilla en la aceptación de la carga.
Conclusión: Los niños con parálisis cerebral espástica utilizaron estrategias de compensación entre los hemicuerpos para desplazarse, que fueron diferentes según el tipo de parálisis. La articulación de la rodilla tiene una función importante en esas estrategias, en especial en la fase de aceptación de la carga y propulsión.
Study on the range of movement in the joint of the knee in the walking process in children with spastic cerebral palsy
Introduction: To analyze the contribution of knee range of motion in walking of hemiplegic and diplegic children, considering their asymmetries. Material and method: Twelve children, 6 hemiplegics and 6 diplegics, from 7 to 12 years of age (9.5±1.93) participated. Spasticity was assessed with the Ashworth’s Modified Scale and the passive knee range of motion using an electrogoniometer. The task was to walk on an 8 m long walkway, using their preferred speed. Six attempts were made, three of which were on the right and three on the left sagittal planes.
Results: The Mann-Whitney’s U test found differences in the type of cerebral palsy for knee extension/hyperextension, for the relative angle of the knee at the load acceptance phase and for the knee range of motion during stride. The Wilcoxon’s test revealed differences in hemibody for hemiplegics in the relative angle of the knee in acceptance of the load.
Conclusions: Children with spastic cerebral palsy use compensation strategies between the lower limbs during walking. These strategies differed according to the type of cerebral palsy. The knee joint has an important function in those strategies, especially in the load acceptance and propulsion phases.
Functional mobility in spastic cerebral palsy
individuals according to the type and age
Functiona... more Functional mobility in spastic cerebral palsy individuals according to the type and age Functional mobility refers to the ability to move independently in the environment. Spastic cerebral palsy individuals show mobility needs according with the type (diplegia, hemiplegia and tetraplegia). With the age advance, spastic cerebral palsy individuals show deterioration on gait kinematics’ parameters. The purpose of this study was to compare functional mobility among spastic cerebral palsy individuals according to the type and the age. Sixty eight individuals with spastic cerebral palsy, 30 with diplegia, 23 with hemiplegia and 15 with tetraplegia, participated in this study. They were also distributed in 3 age groups: children group (from 4 to 12 years old); young group (from 13 to 19 years old) and adult group (from 20 to 45 years old). The functional mobility was assessed by the Functional Mobility Scale. The spent time and the scale classification were treated by non-parametric ANOVA, by type and age group, in three distances: 5m, 50m, and 500m. The results did not reveal age group differences and they showed that spastic cerebral palsy individuals with hemiplegia had better results for all distances. The segmental involvement and motor repertoire affect the functional mobility.
Objective: Converging evidence supporting an effect of transcranial direct current stimulation (t... more Objective: Converging evidence supporting an effect of transcranial direct current stimulation (tDCS) on postural control and human verticality perception highlights this strategy as promising for post-stroke rehabilitation. We have previously demonstrated polarity-dependent effects of high-definition tDCS (HD-tDCS) on weight-bearing asymmetry. However, there is no investigation regarding the time-course of effects on postural control induced by HD-tDCS protocols. Thus, we performed a nonlinear time series analysis focusing on the entropy of the ground reaction force as a secondary investigation of our randomized, double-blind, placebo-controlled, crossover clinical trial. Materials and Methods: Twenty healthy right-handed young adults received the following conditions (random order, separate days); anode center HD-tDCS, cathode center HD-tDCS or sham HD-tDCS at 1, 2, and 3 mA over the right temporo-parietal junction (TPJ). Using summarized time series of transfer entropy, we evalua...
Walking in a daily life context requires constant adaptations to meet the environment's requi... more Walking in a daily life context requires constant adaptations to meet the environment's requirements for successful locomotion. We investigated the walking adaptations of younger and older adults when dealing with holes of different lengths in the pathway (60-cm long and 1.3 times foot length [critical point] conditions). We used the critical point condition to increase the demand for accuracy as it reduces the safety margin between the foot and the borders of the hole. Fifteen younger and fifteen older adults walked barefoot on a wooden walkway in three conditions: no-hole, 60-cm hole (length: 0.60 m | width: 0.80 m | depth: 0.095 m), and critical point hole (length: participant's foot length × 1.3 | width: 0.80 m | depth: 0.095 m). Participants stepped into the hole with only one foot. We assessed the impulses based on the ground reaction forces, trunk and lower limb joint angles, stride speed, and the margin of stability based on the concept of the extrapolated center of mass in the sagittal plane. Across walking conditions, older adults exhibited a larger margin of stability than younger adults. Before the hole, both age groups increased the braking impulse and adopted a more flexed posture of the lower limbs to help to lower the body in the subsequent step. Only older adults increased the vertical braking impulse and markedly reduced stride speed when stepping into both holes. Both age groups adopted a more vertically oriented trunk posture as a strategy to contribute to stability control when stepping into the hole. The two age groups showed a larger margin of stability and a more flexed trunk posture after the hole than the no-hole condition. Older adults were able to control body stability adequately and even better than younger adults. Younger and older adults used the same anticipatory and compensatory locomotor adjustments before and after the hole. These adjustments resulted in improved stability control. The differences between younger and older adults were confined to the moment of stepping into the hole. Older adults used a more cautious strategy that ensured task accuracy and gait progression.
Journal of Policy and Practice in Intellectual Disabilities, 2015
According to the International Classification of Functioning, Disability and Health (ICF), the mo... more According to the International Classification of Functioning, Disability and Health (ICF), the mobility of individuals with spastic cerebral palsy (SCP) is influenced by the interaction between their health and the personal and environmental contexts in which they conduct their lives. In accord with the ICF, this observational study aimed to analyze and compare the functional mobility of children and adolescents with SCP in both natural environments (places typically encountered in their daily routine) and optimized environments (flat surfaces). The observed effects of the environment suggest that the functional mobility of individuals with cerebral palsy depends on the environmental context. The characteristics of the natural and optimized environments may act as barriers and/or facilitators to covering short and long distances among individuals of different ages with cerebral palsy.
The purpose of this study was to investigate the effects of a multimodal exercise program (MEP) o... more The purpose of this study was to investigate the effects of a multimodal exercise program (MEP) on the functional capacity of patients with Parkinson's disease (PD) according to disease severity and gender. Fourteen patients with PD participated in the study and were distributed into groups according to 1) stage of disease and 2) gender. Functional capacity was evaluated before and after 6 months of intervention. The overall PD patient group improved their coordination and strength. Men and women improved in strength performance after exercise. Men also improved on coordination. For severity of disease, the unilateral group improved in strength, while the bilateral group improved in strength, balance, coordination and the UPDRS-functional score. In conclusion, a MEP is efficient in improving components of functional capacity in patients with PD, especially in strength. Gender may be considered in the exercise program. Individuals in the bilateral disease group appeared to benefi...
This mini-review focuses on intrinsic risk factors for falls, particularly the changes in motor b... more This mini-review focuses on intrinsic risk factors for falls, particularly the changes in motor behavior of faller older adults. Our purpose is to present evidence that faller older adults exhibit motor behavior changes beyond the typically investigated standing and walking tasks. We showed initially that postural control alterations with more prominent differences for fallers than non-fallers seem to depend on postural demands, availability of sensory information, and tasks performed concomitantly with the balancing task. We also provided evidence that walking speed is the most consistent aspect to differentiate fallers from non-fallers. This reduction in walking speed may be a strategy to improve gait stability to avoid a fall. More recent studies have shown that fallers presented modifications in the control of the prehension movement. These changes suggest that fallers have changes in movement categories other than balancing and walking, suggesting that fallers’ difficulties are...
Revista de Terapia Ocupacional da Universidade de São Paulo
A doença de Parkinson (DP) é caracterizada pelo início assimétrico de sintomas motores e comprome... more A doença de Parkinson (DP) é caracterizada pelo início assimétrico de sintomas motores e compromete a destreza manual. Espera-se que pacientes com o lado de início da doença preferido comprometido consigam manter bom desempenho com o lado mais afetado (LMA) no teste de destreza manual decorrente da experiência motora ao longo da vida. O objetivo do estudo foi verificar a interferência da coincidência entre o lado de início da doença e preferência manual no desempenho da destreza manual, LMA e lado menos afetado, em pacientes com DP. Os pacientes foram distribuídos conforme o lado de início: Grupo Coincidente (lado preferido acometido) e Grupo Não Coincidente (lado não preferido acometido). A destreza manual foi avaliada pelo teste Annett Pegboard adaptado. A análise estatística ANOVA de dois fatores (grupo x lado), medidas repetidas no último fator, revelou que o Grupo Não Coincidente dispendeu maior tempo para completar o teste com o LMA (p=0,001), enquanto, o Grupo Coincidente dis...
According to the International Classification of Functioning, Disability and Health (ICF), the mo... more According to the International Classification of Functioning, Disability and Health (ICF), the mobility of individuals with spastic cerebral palsy (SCP) is influenced by the interaction between their health and the personal and environmental contexts in which they conduct their lives. In accord with the ICF, this observational study aimed to analyze and compare the functional mobility of children and adolescents with SCP in both natural environments (places typically encountered in their daily routine) and optimized environments (flat surfaces). The observed effects of the environment suggest that the functional mobility of individuals with cerebral palsy depends on the environmental context. The characteristics of the natural and optimized environments may act as barriers and/or facilitators to covering short and long distances among individuals of different ages with cerebral palsy.
Resumen
Introducción: Analizar la contribución de la amplitud de movimiento articular de la rodi... more Resumen
Introducción: Analizar la contribución de la amplitud de movimiento articular de la rodilla en el proceso de marcha de niños hemipléjicos y dipléjicos, considerando el hemicuerpo. Material y métodos: Participaron 12 niños con edades entre 7 y 12 años (9,5±1,93), siendo 6 hemipléjicos y 6 dipléjicos. La espasticidad fue medida según la Escala Modificada de Ashworth y la amplitud del movimiento articular pasivo de la rodilla con un electrogoniómetro. La tarea consistió en recorrer una pasarela de 8 metros, a velocidad libre, en 6 intentos, de los cuales tres fueron en el plano sagital derecho y tres en el plano sagital izquierdo.
Resultados: La prueba U de Mann-Whitney mostró diferencias en el tipo de parálisis cerebral para la extensión/hiperextensión de la rodilla en el ángulo relativo de la rodilla en la aceptación de la carga y en la amplitud del movimiento articular de la rodilla en la marcha. La prueba T de Wilcoxon mostró diferencias de hemicuerpo para los hemipléjicos en el ángulo relativo de la rodilla en la aceptación de la carga.
Conclusión: Los niños con parálisis cerebral espástica utilizaron estrategias de compensación entre los hemicuerpos para desplazarse, que fueron diferentes según el tipo de parálisis. La articulación de la rodilla tiene una función importante en esas estrategias, en especial en la fase de aceptación de la carga y propulsión.
Study on the range of movement in the joint of the knee in the walking process in children with spastic cerebral palsy
Introduction: To analyze the contribution of knee range of motion in walking of hemiplegic and diplegic children, considering their asymmetries. Material and method: Twelve children, 6 hemiplegics and 6 diplegics, from 7 to 12 years of age (9.5±1.93) participated. Spasticity was assessed with the Ashworth’s Modified Scale and the passive knee range of motion using an electrogoniometer. The task was to walk on an 8 m long walkway, using their preferred speed. Six attempts were made, three of which were on the right and three on the left sagittal planes.
Results: The Mann-Whitney’s U test found differences in the type of cerebral palsy for knee extension/hyperextension, for the relative angle of the knee at the load acceptance phase and for the knee range of motion during stride. The Wilcoxon’s test revealed differences in hemibody for hemiplegics in the relative angle of the knee in acceptance of the load.
Conclusions: Children with spastic cerebral palsy use compensation strategies between the lower limbs during walking. These strategies differed according to the type of cerebral palsy. The knee joint has an important function in those strategies, especially in the load acceptance and propulsion phases.
Functional mobility in spastic cerebral palsy
individuals according to the type and age
Functiona... more Functional mobility in spastic cerebral palsy individuals according to the type and age Functional mobility refers to the ability to move independently in the environment. Spastic cerebral palsy individuals show mobility needs according with the type (diplegia, hemiplegia and tetraplegia). With the age advance, spastic cerebral palsy individuals show deterioration on gait kinematics’ parameters. The purpose of this study was to compare functional mobility among spastic cerebral palsy individuals according to the type and the age. Sixty eight individuals with spastic cerebral palsy, 30 with diplegia, 23 with hemiplegia and 15 with tetraplegia, participated in this study. They were also distributed in 3 age groups: children group (from 4 to 12 years old); young group (from 13 to 19 years old) and adult group (from 20 to 45 years old). The functional mobility was assessed by the Functional Mobility Scale. The spent time and the scale classification were treated by non-parametric ANOVA, by type and age group, in three distances: 5m, 50m, and 500m. The results did not reveal age group differences and they showed that spastic cerebral palsy individuals with hemiplegia had better results for all distances. The segmental involvement and motor repertoire affect the functional mobility.
Uploads
Papers
conduct their lives. In accord with the ICF, this observational study aimed to analyze and compare the functional mobility of children
and adolescents with SCP in both natural environments (places typically encountered in their daily routine) and optimized environments (flat surfaces). The observed effects of the environment suggest that the functional mobility of individuals with cerebral palsy
depends on the environmental context. The characteristics of the natural and optimized environments may act as barriers and/or
facilitators to covering short and long distances among individuals of different ages with cerebral palsy.
Introducción: Analizar la contribución de la amplitud de movimiento articular de la rodilla en el proceso de marcha de niños hemipléjicos y dipléjicos, considerando el hemicuerpo. Material y métodos: Participaron 12 niños con edades entre 7 y 12 años (9,5±1,93), siendo 6 hemipléjicos y 6 dipléjicos. La espasticidad fue medida según la Escala Modificada de Ashworth y la amplitud del movimiento articular pasivo de la rodilla con un electrogoniómetro. La tarea consistió en recorrer una pasarela de 8 metros, a velocidad libre, en 6 intentos, de los cuales tres fueron en el plano sagital derecho y tres en el plano sagital izquierdo.
Resultados: La prueba U de Mann-Whitney mostró diferencias en el tipo de parálisis cerebral para la extensión/hiperextensión de la rodilla en el ángulo relativo de la rodilla en la aceptación de la carga y en la amplitud del movimiento articular de la rodilla en la marcha. La prueba T de Wilcoxon mostró diferencias de hemicuerpo para los hemipléjicos en el ángulo relativo de la rodilla en la aceptación de la carga.
Conclusión: Los niños con parálisis cerebral espástica utilizaron estrategias de compensación entre los hemicuerpos para desplazarse, que fueron diferentes según el tipo de parálisis. La articulación de la rodilla tiene una función importante en esas estrategias, en especial en la fase de aceptación de la carga y propulsión.
Study on the range of movement in the joint of the knee in the walking process in children with spastic cerebral palsy
Introduction: To analyze the contribution of knee range of motion in walking of hemiplegic and diplegic children, considering their asymmetries. Material and method: Twelve children, 6 hemiplegics and 6 diplegics, from 7 to 12 years of age (9.5±1.93) participated. Spasticity was assessed with the Ashworth’s Modified Scale and the passive knee range of motion using an electrogoniometer. The task was to walk on an 8 m long walkway, using their preferred speed. Six attempts were made, three of which were on the right and three on the left sagittal planes.
Results: The Mann-Whitney’s U test found differences in the type of cerebral palsy for knee extension/hyperextension, for the relative angle of the knee at the load acceptance phase and for the knee range of motion during stride. The Wilcoxon’s test revealed differences in hemibody for hemiplegics in the relative angle of the knee in acceptance of the load.
Conclusions: Children with spastic cerebral palsy use compensation strategies between the lower limbs during walking. These strategies differed according to the type of cerebral palsy. The knee joint has an important function in those strategies, especially in the load acceptance and propulsion phases.
individuals according to the type and age
Functional mobility refers to the ability to move independently in the environment. Spastic cerebral palsy individuals show mobility needs according with the type (diplegia, hemiplegia and tetraplegia). With the age advance, spastic cerebral palsy individuals show deterioration on gait kinematics’ parameters. The purpose of this study was to compare functional mobility among spastic cerebral palsy individuals according to the type and the age. Sixty eight individuals with spastic cerebral palsy, 30 with diplegia, 23 with hemiplegia and 15 with tetraplegia, participated in this study. They were also distributed in 3 age groups: children group (from 4 to 12 years old); young group (from 13 to 19 years old) and adult group (from 20 to 45 years old).
The functional mobility was assessed by the Functional Mobility Scale. The spent time and the scale classification were treated by non-parametric ANOVA, by type and age group, in three distances: 5m, 50m, and 500m. The results did not reveal age group differences and they showed that spastic cerebral palsy individuals with hemiplegia had better results for all distances. The segmental involvement and motor repertoire affect the functional mobility.
conduct their lives. In accord with the ICF, this observational study aimed to analyze and compare the functional mobility of children
and adolescents with SCP in both natural environments (places typically encountered in their daily routine) and optimized environments (flat surfaces). The observed effects of the environment suggest that the functional mobility of individuals with cerebral palsy
depends on the environmental context. The characteristics of the natural and optimized environments may act as barriers and/or
facilitators to covering short and long distances among individuals of different ages with cerebral palsy.
Introducción: Analizar la contribución de la amplitud de movimiento articular de la rodilla en el proceso de marcha de niños hemipléjicos y dipléjicos, considerando el hemicuerpo. Material y métodos: Participaron 12 niños con edades entre 7 y 12 años (9,5±1,93), siendo 6 hemipléjicos y 6 dipléjicos. La espasticidad fue medida según la Escala Modificada de Ashworth y la amplitud del movimiento articular pasivo de la rodilla con un electrogoniómetro. La tarea consistió en recorrer una pasarela de 8 metros, a velocidad libre, en 6 intentos, de los cuales tres fueron en el plano sagital derecho y tres en el plano sagital izquierdo.
Resultados: La prueba U de Mann-Whitney mostró diferencias en el tipo de parálisis cerebral para la extensión/hiperextensión de la rodilla en el ángulo relativo de la rodilla en la aceptación de la carga y en la amplitud del movimiento articular de la rodilla en la marcha. La prueba T de Wilcoxon mostró diferencias de hemicuerpo para los hemipléjicos en el ángulo relativo de la rodilla en la aceptación de la carga.
Conclusión: Los niños con parálisis cerebral espástica utilizaron estrategias de compensación entre los hemicuerpos para desplazarse, que fueron diferentes según el tipo de parálisis. La articulación de la rodilla tiene una función importante en esas estrategias, en especial en la fase de aceptación de la carga y propulsión.
Study on the range of movement in the joint of the knee in the walking process in children with spastic cerebral palsy
Introduction: To analyze the contribution of knee range of motion in walking of hemiplegic and diplegic children, considering their asymmetries. Material and method: Twelve children, 6 hemiplegics and 6 diplegics, from 7 to 12 years of age (9.5±1.93) participated. Spasticity was assessed with the Ashworth’s Modified Scale and the passive knee range of motion using an electrogoniometer. The task was to walk on an 8 m long walkway, using their preferred speed. Six attempts were made, three of which were on the right and three on the left sagittal planes.
Results: The Mann-Whitney’s U test found differences in the type of cerebral palsy for knee extension/hyperextension, for the relative angle of the knee at the load acceptance phase and for the knee range of motion during stride. The Wilcoxon’s test revealed differences in hemibody for hemiplegics in the relative angle of the knee in acceptance of the load.
Conclusions: Children with spastic cerebral palsy use compensation strategies between the lower limbs during walking. These strategies differed according to the type of cerebral palsy. The knee joint has an important function in those strategies, especially in the load acceptance and propulsion phases.
individuals according to the type and age
Functional mobility refers to the ability to move independently in the environment. Spastic cerebral palsy individuals show mobility needs according with the type (diplegia, hemiplegia and tetraplegia). With the age advance, spastic cerebral palsy individuals show deterioration on gait kinematics’ parameters. The purpose of this study was to compare functional mobility among spastic cerebral palsy individuals according to the type and the age. Sixty eight individuals with spastic cerebral palsy, 30 with diplegia, 23 with hemiplegia and 15 with tetraplegia, participated in this study. They were also distributed in 3 age groups: children group (from 4 to 12 years old); young group (from 13 to 19 years old) and adult group (from 20 to 45 years old).
The functional mobility was assessed by the Functional Mobility Scale. The spent time and the scale classification were treated by non-parametric ANOVA, by type and age group, in three distances: 5m, 50m, and 500m. The results did not reveal age group differences and they showed that spastic cerebral palsy individuals with hemiplegia had better results for all distances. The segmental involvement and motor repertoire affect the functional mobility.