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Gama G, Conceição Matias MD, de Luiz Vânia M, de Sales Regis T, Peregrino-Filho A, de Sales Tavares J, Amorim M, Melo A. Motor and cognitive response to intensive multidisciplinary therapy: the first reported case of congenital Zika virus syndrome. Physiother Theory Pract 2024; 40:1362-1371. [PMID: 36625893 DOI: 10.1080/09593985.2023.2165887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To provide a detailed description of the development of the first case of congenital Zika syndrome (CZS) to be reported in the literature worldwide. CASE DESCRIPTION This report describes the case of a child with CZS monitored from pregnancy until four years of age, with periodic evaluations of head circumference, weight, height, motor function according to the Gross Motor Function Measure (GMFM-88), and the occurrence of comorbidities. OUTCOMES The child's birth weight and length were normal (z-score = 1.1 and -1.95, respectively), while head circumference was below the expected value (z-score = -3.15). At 48 months, head circumference reached 43 cm (z-score = -4.48). During daily home physiotherapy sessions, the child achieved developmental milestones, standing unsupported at 17 months, with a GMFM-88x score of 137. With specialist therapy, the child walked independently at 36 months and a total GMFM-66 score of 214 was achieved by 42 months. In the four years of follow-up, the child was hospitalized four times for different reasons. No convulsive seizures occurred. CONCLUSIONS Despite severe neurological impairment, the child's weight and height are adequate for age, with motor and cognitive function improving over the first four years of life.
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Affiliation(s)
- Gabriela Gama
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
- Campina Grande, UNIFACISA University Center, Paraíba, Brazil
| | | | - Mell de Luiz Vânia
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
| | | | | | | | - Melania Amorim
- Instituto de Pesquisa Professor Jpaquim Amorim Neto and Instituto de Medicina Integral Professor Fernando Figueira
| | - Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
- Campina Grande, UNIFACISA University Center, Paraíba, Brazil
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Taş SA, Çankaya T. Effects of structured training on spinal posture and selective motor control in children with unilateral spastic cerebral palsy. Gait Posture 2024; 109:22-27. [PMID: 38244393 DOI: 10.1016/j.gaitpost.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/09/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Children with Unilateral Spastic Cerebral Palsy (USCP) have an asymmetrical postural pattern. Although functional limitations are less, deteriorations in spinal posture are observed. RESEARCH QUESTION What is the effect of structured training on spinal posture and selective motor control of upper extremity? METHODS Forty five children with USCP were included in the study. Participants were children ages 3-18 with GMFCS levels 1 and 2. Spinal posture and mobility was assessed by Spinal Mouse (SM) and the Spinal Alignment and Range of Motion Measure (SAROMM), and selective motor control of upper extremity was evaluated by the Selective Control of the Upper Extremity Scale (SCUES). Children were divided into two groups: structured training group (STG) (n = 22) and conventional physiotherapy group (CPG) (n = 23). Groups received treatment sessions lasting 45 min, 2 days a week for 8 weeks. Evaluations were made baseline and after treatment. RESULTS In sagittal plane, there was a significant decrease in the degree of thoracic kyphosis after treatment in the STG (p = 0.004). A significant difference was found in total spine angulation (p = 0.015) and mobility from flexion to extension in the STG group. There was a difference in total spine angulation (p = 0.014) in the CPG group, but no difference in spinal mobility. Post-training differences were found in thoracic angulation (p = 0.006) and lateral flexion mobility to the affected side in the STG in thoracic (p = 0.020), lumbar (p = 0.035) and total spine (p = 0.008) in the frontal plane. When SCUES-shoulder, elbow, wrist, total scores changes was significant in CPG (p < 0.001), SCUES-forearm (p = 0.002) and fingers (p = 0.007) changes was significant in STG. SIGNIFICANCE This study showed that although children with USCP are more mildly affected, there are adverse effects on their selective motor control and spinal posture. This study reveals the contribution of structured training in terms of selective movement, spinal smoothness and mobility in children.
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Affiliation(s)
- Seda Ayaz Taş
- Bolu Abant Izzet Baysal University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Bolu, Turkey
| | - Tamer Çankaya
- Bolu Abant Izzet Baysal University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Bolu, Turkey
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Ahola S, Piirainen A, Vuoskoski P. Perceptions of learning and teaching human movement in physiotherapy: A systematic review and metasynthesis of qualitative studies. Int J Qual Stud Health Well-being 2023; 18:2225943. [PMID: 38016038 PMCID: PMC10294735 DOI: 10.1080/17482631.2023.2225943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/12/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE Human movement is essential for health and well-being. Understanding human movement is pivotal in physiotherapy, but also an important element of physiotherapy education. This review identified, critically appraised, and synthesized the available evidence on learning and teaching human movement in physiotherapy as perceived by students, therapists, and instructors. METHODS The databases MEDLINE, CINAHL, ERIC, PsycINFO, MEDIC and FINNA, were searched. The search was conducted in March/April 2020 and updated in March 2022. The systematic review followed the JBI methodology for systematic reviews of qualitative evidence and was conducted in accordance with an a priori protocol. RESULTS The overall quality of the 17 included studies was scored low on ConQual but dependability and credibility were rated as moderate. Four synthesized findings aggregated from 17 categories and 147 findings described the perceived significance of 1) being present in movement, 2) movement quality, 3) movement transfer, and 4) contextual factors for the learning or teaching of human movement in physiotherapy. CONCLUSION The synthesized findings indicate that the perceived significance of contextual factors, movement quality and transfer, and being present in movement should be considered in all learning and teaching of movement in physiotherapy. However, the evidence of the review findings was evaluated as low-level, which should be considered when applying these results to physiotherapy education or practice.
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Affiliation(s)
- Sirpa Ahola
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
- Physiotherapy, Metropolia University of Applied Sciences, Helsinki, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
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Paludo T, Zardo F, de Mattos BTP, Frata B, Ling CC, de Castro Barroso G, Cechetti F. Measuring muscle activation using electromyography during neurodevelopmental treatment in individuals with severe cerebral palsy. J Back Musculoskelet Rehabil 2022; 36:691-700. [PMID: 36530079 DOI: 10.3233/bmr-220113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the motor rehabilitation of individuals with neurological disorders, including cerebral palsy (CP), Neurodevelopmental treatment (NDT) one of the most used approaches worldwide. OBJECTIVE To verify muscle activation in NDT handling in individuals with severe CP using electromyography. METHODS This was a controlled, cross-sectional, quantitative clinical trial. The individuals were evaluated using electromyography to analyze the muscular activation of the spinal erector, gluteus medius, rectus abdominis and multifidus during different NDT handling. We evaluated 59 individuals: 39 with spastic quadriparesis CP (Gross Motor Function Classification System, level IV-V) and 20 typically-developing individuals (control group). These groups were homogeneous with respect to age and gender. RESULTS There was a significant difference in muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in the six NDT handling used in this study: side-sitting for kneeling; supine for lateral decubitus, prone position for lateral decubitus, "sitting on horseback", sitting on the roll, and proprioceptive stimulation sitting on the ball. CONCLUSION The results show that all NDT handling analyzed in this study were effective for muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in individuals with severe spastic quadriparetic CP.
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Affiliation(s)
- Tatiane Paludo
- Rehabilitation Sciences Post-Graduation Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Franciele Zardo
- Rehabilitation Sciences Post-Graduation Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Brenda Tubelo Pereira de Mattos
- Rehabilitation Sciences Post-Graduation Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Bruna Frata
- Rehabilitation Sciences Post-Graduation Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Fernanda Cechetti
- Rehabilitation Sciences Post-Graduation Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Effect of the Trunk and Upper Limb Passive Stabilization on Hand Movements and Grip Strength Following Various Types of Strokes—An Observational Cohort Study. Brain Sci 2022; 12:brainsci12091234. [PMID: 36138970 PMCID: PMC9497157 DOI: 10.3390/brainsci12091234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Almost half of the patients surveyed report impaired function of the upper limbx and handx after stroke. The effect of the passive trunk and shoulder stabilization on the recovery of coordinated hand movement is unclear. This study examined whether passive stabilization of the trunk and shoulder could improve the functional state of the hands after various types of strokes. It is an observational prospective cohort study conducted at the Rehabilitation Clinic in two parallel groups of patients with four different types of strokes (hemorrhagic and ischemic of the brain, similar to the cerebellum). A total of 120 patients were analyzed. Patients were examined in various positions: sitting without a backrest with the upper limb adjacent to the body, supine with the upper limb perpendicular to the body, and supine with the arm stabilized in relation to the patient’s body. Hand Tutor devices and a hand dynamometer were used for the measurements. The frequency and maximum range of motion as well as the grip strength were measured in three different positions of the trunk and upper limb. Passive stabilization of the trunk and shoulder showed more statistically significant differences in Group II. In group II, both in patients after hemorrhagic stroke (wrist Hz p = 0.019; wrist ROM p = 0.005; Hz F5 p = 0.021; Hz F4 p = 0.016; Hz F3 p = 0.019; Hz F2 p = 0.021) and ischemic stroke (p = 0.001 for wrist Hz, wrist ROM, Hz F from 5 to F2; and ROM F1; ROM F3 p = 0.009; ROM F2 p = 0.010), and hemorrhagic cerebellum, improvement of parameters was observed. Stabilization of the upper limb and passive stabilization of the trunk improved the frequency and range of movements in the radiocarpal joint and in the fingers of patients after stroke, regardless of the type of stroke.
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Assessment of the Impact of the Tipstim® Device Application and the Study Position on Motor Coordination and Grip Strength of the Affected Upper Limb Post-Ischemic Stroke—A Randomized Parallel Crossover Trial. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12062761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the acute phase of stroke, most patients have reduced efficiency of the upper limb and in the chronic phase more than half of these patients still have a deficit in the mobility of the upper limb. The aim of this study was to investigate the effect of using the tipstim® device and the tested position of the body and affected upper limb on parameters of motor coordination and grip strength in patients after an ischemic stroke. A randomized, parallel crossover study was conducted in the Rehabilitation Department. The study included 29 people aged 68 ± 9.2 years, 5–7 weeks after ischemic stroke. Patients were randomly assigned to two parallel groups (A/B = 15 people and B/A = 14 people). In each of them, the patient received both experimental (A = tipstim®) and control (B = placebo effect) treatment in a specific order. The HandTutor was used to measure the parameters of motor coordination (maximum range of motion and frequency of motion). We also used an electronic dynamometer to measure the handgrip strength. The patients were examined in two positions: sitting (unstable) and lying with the trunk and affected upper limb stabilized. Results: The analysis showed smaller differences between the measurements in the A/B group than in the B/A group, both without stabilization and with stabilization (wrist Hz = p ˂ 0.001; fingers 2–5 Hz = p ˂ 0.001; handgrip strength = p ˂ 0.049 and p ˂ 0.003). When comparing the influence of the tested position on the results of motor coordination and the handgrip strength, statistically significant differences were found in the placebo group in a stable position (Hz wrist p = 0.007, MaxROM wrist = 0.038, HzF5 = 0.039, MaxROM F4 = 0.035, HzF3 = 0.035, MaxROM F3 = 0.010, HzF2 = 0.049). Conclusions: Repeated use of the tipstim® device did not improve the tested parameters. A significant improvement in the results of coordination of movements and grip strength is possible in a stable position, lying down.
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Motor Coordination and Grip Strength of the Dominant and Non-Dominant Affected Upper Limb Depending on the Body Position—An Observational Study of Patients after Ischemic Stroke. Brain Sci 2022; 12:brainsci12020164. [PMID: 35203928 PMCID: PMC8869969 DOI: 10.3390/brainsci12020164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023] Open
Abstract
Stroke is one of the leading causes of human disability globally. Motor function deficits resulting from a stroke affect the entire body, but relatively often it is the upper limbs that remain ineffective, which is very limiting in everyday life activities. The finding in neurorehabilitation that trunk control contributes to upper limb function is relatively common but has not been confirmed in clinical trials. This observational prospective study aims to analyze the effect of the position of the trunk and the affected upper limb on the coordination and grip strength of the affected dominant and non-dominant hand and wrist in people after ischemic stroke. The research was carried out at the Department of Neurological Rehabilitation, on a group of 60 patients with acute ischemic stroke. A Hand Tutor device and a hand dynamometer were used for the main measurements of the motor coordination parameters (maximum range of motion, frequency of movement) and the grip strength of the dominant and non-dominant upper limb. The patients were examined in two positions: sitting without back support and lying on the back with stabilization of the upper limb. Higher and relevant results were observed in the non-dominant hand, in the supine position in terms of motor coordination parameters of the fingers (p = 0.019; p = 0.011) and wrist (p = 0.033), and grip strength (p = 0.017). Conclusions: The laying position and stabilization of the affected upper limb in the acute phase following ischemic stroke is more beneficial for the coordination of movements and grip strength of the non-dominant hand.
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Zardo F, Paludo T, Mattos BTPD, Frata B, Ling CC, Cechetti F. Analysis of muscle activation in children and adolescents with severe cerebral palsy. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Children and adolescents with spastic quadriparesis have a worse selective motor control, and studies with this population are still very scarce. The same is true with scientific evidence of one of the methods most used as a physiotherapeutic treatment in this population, the Bobath Concept. Objective: To evaluate spine erector muscles activation, gluteus medius and gluteus maximus, through the handling of the Bobath Concept and the sustained kneeling posture in subjects with a diagnosis of severe cerebral palsy; and to compare muscle activation with a reference group, in order to increase the reliability of this study. Methods: A cross-sectional study was carried out with 38 children and adolescents with cerebral palsy, classified by GMFCS at levels IV and V, and 20 healthy participants, aged between 3 and 18 years. They were submitted to the handling of the Bobath Concept and to the sustained kneeling posture, with muscle activation obtained by electromyography. Results: We observed significant muscle activation during handling in side-sitting, with weight transfer and without the help of another therapist, and in the sustained kneeling posture, for the erector of the spine and gluteus medius. Conclusion: The evidence from this study suggests that both the handling in side-sitting and the sustained kneeling posture cause significant muscle activation in the erector of the spine and gluteus medius for severe quadriparesis subjects, GMFCS IV and V, which can contribute to the improvement of postural control and decision-making in physical therapy practice.
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Affiliation(s)
- Franciele Zardo
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Tatiane Paludo
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | | | - Bruna Frata
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Chen Chai Ling
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Fernanda Cechetti
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
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Influence of the Passive Stabilization of the Trunk and Upper Limb on Selected Parameters of the Hand Motor Coordination, Grip Strength and Muscle Tension, in Post-Stroke Patients. J Clin Med 2021; 10:jcm10112402. [PMID: 34072303 PMCID: PMC8197819 DOI: 10.3390/jcm10112402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/15/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022] Open
Abstract
Objective: Assessment of the influence of a stable trunk and the affected upper limb (dominant or non-dominant) on the parameters of the wrist and hand motor coordination, grip strength and muscle tension in patients in the subacute post-stroke stage compared to healthy subjects. Design: An observational study. Setting: Stroke Rehabilitation Department. Subjects: Thirty-four subjects after ischemic cerebral stroke and control group-32 subjects without neurological deficits, age and body mass/ height matched were included. Main measures: The tone of the multifidus, transverse abdominal and supraspinatus muscles were assessed by Luna EMG device. A HandTutor device were used to measure motor coordination parameters (e.g., range of movement, frequency of movement), and a manual dynamometer for measuring the strength of a hand grip. Subjects were examined in two positions: sitting without back support (non-stabilized) and lying with stabilization of the trunk and the upper limb. Results: Passive stabilization of the trunk and the upper extremity caused a significant improvement in motor coordination of the fingers (p ˂ 0.001) and the wrist (p < 0.001) in patients after stroke. Improved motor coordination of the upper extremity was associated with an increased tone of the supraspinatus muscle. Conclusions: Passive stabilization of the trunk and the upper limb improved the hand and wrist coordination in patients following a stroke. Placing patients in a supine position with the stability of the affected upper limb during rehabilitation exercises may help them to access latent movement patterns lost due to neurological impairment after a stroke.
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Ahola S, Skjaerven LH, Piirainen A. Physiotherapists' conceptions of movement awareness- A phenomenographic study. Physiother Theory Pract 2021; 38:1438-1452. [PMID: 33393413 DOI: 10.1080/09593985.2020.1868028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The phenomenon of movement awareness requires more attention to make it explicit in physiotherapy. The aim of this study was to explore the variation in physiotherapists' conceptions of movement quality, focusing on movement awareness. The informants were 15 physiotherapists from a variety of physiotherapy fields. We collected data through two group interviews and used the phenomenographic method to analyze them. Four themes emerged from the data: 1) Being in contact with one's own moving body; 2) Increased awareness of movement experiences; 3) Interrelationship between physiotherapist and patient; and 4) Better understanding of movement awareness. These themes varied by four descriptive categories of the movement awareness phenomenon: (I) Hesitation regarding own movement experiences; (II) Momentary contact with own movement experiences; (III) Presence in movement awareness and (IV) Better understanding of others' movement awareness. The physiotherapists' understanding of the movement awareness phenomenon widened through three critical aspects in the descriptive categories: Recognizing one's own movement awareness, Distinguishing one's own and others' movement awareness and New insights into implementing actions related to movement awareness in physiotherapy. These results can expand the understanding of the phenomenon of movement awareness among physiotherapists, although further research is needed.
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Affiliation(s)
- Sirpa Ahola
- Department of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Liv Helvik Skjaerven
- Department of Function and Health, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Arja Piirainen
- Department of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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