Proprioceptive neuromuscular facilitation induces muscle irradiation to the lower limbs - A cross-sectional study with healthy individuals

INTRODUCTION

This study aimed to evaluate the effectiveness of proprioceptive neuromuscular facilitation (PNF) in promoting muscle irradiation to the lower limbs and to relate these findings with muscle activation during the sit-to-stand task.

METHODS

Twenty-four healthy women were recruited via convenience sampling and submitted to four PNF patterns: upper limb pattern with flexion-abduction-external rotation (UL), lower limb pattern with flexion-adduction-external rotation with knee flexion (lower limb pattern 1 [LL1]), lower limb pattern with flexion-abduction-internal rotation with knee flexion (lower limb pattern 2 [LL2]), and lifting to the right. Electromyography was recorded from the gluteus maximus, gluteus medius, vastus medialis, vastus lateralis, and soleus during the PNF patterns and during the sit-to-stand task.

RESULTS

The most recruited muscles during the sit-to-stand task were the vastus lateralis, vastus medialis, and soleus (p < 0.05). Lifting to the right induced the greatest activation of the gluteus maximus (p < 0.001). Lifting to the right and LL2 were better than UL at recruiting the gluteus medius (p < 0.05). Lifting to the right and LL1 were better than UL at recruiting the vastus medialis and lateralis (p < 0.05; p < 0.05). and Lower limb pattern 1 and 2 were better than UL at recruiting the soleus muscle (p < 0.05).

CONCLUSION

PNF can be used to induce muscle irradiation to maintain or improve muscle activity to the muscles recruited during the sit-to-stand task. The best PNF pattern for inducing muscle irradiation to muscles recruited during the sit-to-stand task are lifting to the right, LL2, and LL1.

Plantar stimulation alters brain connectivity in idiopathic Parkinson's disease

OBJECTIVE

Individuals with Parkinson's disease (PD) and freezing of gait (FOG) present peripheral and central sensitivity disturbances that impair motor performance. This study aimed to investigate long-term effects of plantar sensory stimulation on brain activity, brain connectivity, and gait velocity of individuals with PD and FOG.

METHODS

Twenty-five participants were enrolled in this clinical trial (NCT02594540). Plantar sensory stimulation was delivered using the Automated Mechanical Peripheral Stimulation therapy (AMPS). Volunteers were randomly assigned to real or placebo AMPS groups and received eight sessions of treatment. The primary outcome was brain activity (task-based fMRI-active ankle dorsi-plantar flexion). Secondary outcomes were brain connectivity (resting state-RS fMRI) and gait velocity. fMRI was investigated on the left, right, and mid-sensory motor regions, left and right basal ganglia.

RESULTS

No changes in brain activity were observed when task-based fMRI was analyzed. After real AMPS, RS functional connectivity between basal ganglia and sensory-related brain areas increased (insular and somatosensory cortices). Gait velocity also increased after real AMPS. A positive correlation was found between gait velocity and the increased connectivity between sensory, motor and supplementary motor cortices.

CONCLUSION

Plantar sensory stimulation through AMPS was not able to modify brain activity. AMPS increased the RS brain connectivity mainly in areas related to sensory processing and sensorimotor integration. Plantar stimulation could be a way to improve plantar sensitivity and consequently ameliorate gait performance. However, the mechanisms behind the way AMPS influences brain pathways are still not completely known.

Fugl-Meyer Assessment Scores Are Related With Kinematic Measures in People with Chronic Hemiparesis after Stroke

BACKGROUND

Stroke often results in motor impairment and limited functional capacity. This study aimed to verify the relationship between widely used clinical scales and instrumented measurements to evaluate poststroke individuals with mild, moderate, and severe motor impairment.

METHODS

This cross-sectional study included 34 participants with chronic hemiparesis after stroke. Fugl-Meyer Assessment and Modified Ashworth Scale were used to quantify upper and lower limb motor impairment and the resistance to passive movement (i.e., spasticity), respectively. Upper limb Motor performance (movement time and velocities) and movement quality (range of motion, smoothness and trunk displacement) were analyzed during a reaching forward task using an optoelectronic system (instrumented measurement). Lower limb motor performance (gait and functional mobility parameters) was assessed by using an inertial measurement unit system.

FINDINGS

Fugl-Meyer Assessment correlated with motor performance (upper and lower limbs) and with movement quality (upper limb). Modified Ashworth scale correlated with movement quality (upper limb). Cutoff values of 9.0 cm in trunk anterior displacement and .57 m/s in gait velocity were estimated to differentiate participants with mild/moderate and severe compromise according to the Fugl-Meyer Assessment.

CONCLUSIONS

These results suggest that the Fugl-Meyer Assessment can be used to infer about motor performance and movement quality in chronic poststroke individuals with different levels of impairment.

Upper-limb movement smoothness after stroke and its relationship with measures of body function/structure and activity - A cross-sectional study

INTRODUCTION

After a stroke, upper limb (UL) motor impairments interfere with functional activities and quality of life. Even though a range of assessment tools has been developed to assess UL, few studies explore the interfaces between different levels of functioning after stroke.

OBJECTIVES

(a) verify the correlation between movement smoothness and other measures of body function/structure [UL - Fugl-Meyer Assessment (FMA), and handgrip strength]; (b) verify which body function/structure [UL-FMA and/or handgrip strength] could predict UL movement smoothness; and (c) verify if movement smoothness could predict levels of activity, as assessed by the Box and Block Test (BBT).

MATERIALS AND METHODS

Cross-sectional study. Thirty-four individuals with chronic hemiparesis after stroke were enrolled. Measurements of body function/structure included FMA, handgrip strength and kinematic measure of movement smoothness. Levels of activity were measured using the Box and Block Test (BBT).

RESULTS

Movement smoothness showed strong correlation with FMA (r = 0.70, p < .001) and moderate correlation with handgrip strength (r = 0.63, p < .001). FMA explained 46.4% of the variation in movement smoothness. Movement smoothness was moderately correlated with BBT (r = -0.560, p < .005) and predicted 31% of the variation in BBT.

CONCLUSION

We recommend the use of UL-FMA to predict movement smoothness in chronic post-stroke subjects. This study also showed that movement smoothness influences the level of activity. Then, movement smoothness may be emphasized during stroke rehabilitation to enhance the UL level of activity in chronic post-stroke subjects.

Noninvasive brain stimulation combined with other therapies improves gait speed after stroke: a systematic review and meta-analysis

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are noninvasive brain stimulation (NIBS) techniques able to modulate cortical excitability.

OBJECTIVE

To determine the effects of NIBS combined with other therapies on gait speed after stroke.

METHODS

Electronic databases searched were PUBMED, EMBASE, COCHRANE, SCOPUS, SCIELO and PEDro. Eligibility criteria were randomized controlled trials that reported the effects of tDCS and rTMS combined with other therapies for improving gait speed, walking cadence, functional ambulation category (FAC) and motricity index (MI-LE) after stroke. Risk of bias was assessed by Cochrane risk of bias assessment tool. Mean differences (MD) and 95% confidence intervals were calculated. Quality of evidence was assessed by Grades of Researches, Assessment, Development and Evaluation approach.

RESULTS

Ten studies (226 subjects) were included in the meta-analysis. NIBS combined with other therapies was effective for improving gait speed (MD 0.09 m/s [95% CI, 0.05 to 0.13; I² 0%, p < 0.0001]). Gait speed improved in both acute/subacute (MD 0.08 m/s [95% CI, 0.02 to 0.14]) and chronic phases (MD 0.08 m/s [95% CI, 0.03 to 0.13]). Furthermore, inhibitory (MD 0.09 m/s [95% CI, 0.04 to 0.14]) and excitatory (MD 0.07 m/s [95% CI, 0.02 to 0.12]) protocols were effective to improve gait speed. NIBS was also effective to improve walking cadence but was unable to modify other outcomes (FAC and MI-LE).

CONCLUSIONS

This systematic review with meta-analysis synthesizes moderate-quality evidence that NIBS combined with other therapies are effective to improve gait speed after stroke. Systematic Review registration number: PROSPERO registration number CDR42015024237.

Automated Mechanical Peripheral Stimulation Effects on Gait Variability in Individuals With Parkinson Disease and Freezing of Gait: A Double-Blind, Randomized Controlled Trial

OBJECTIVE

To assess the effects of automated peripheral stimulation (AMPS) in reducing gait variability of subjects with Parkinson disease (PD) and freezing of gait (FOG) treated with AMPS and to explore the effects of this treatment on gait during a single task (walking) and a dual task (walking while attending the word-color Stroop test).

DESIGN

Interventional, double-blinded, placebo-controlled, randomized trial.

SETTING

Clinical rehabilitation.

PARTICIPANTS

Thirty subjects were randomized into 2 groups: AMPS (n=15) and AMPS sham (n=15).

INTERVENTIONS

Both groups received 2 treatment sessions a week for 4 consecutive weeks (totaling 8 treatment sessions). AMPS was applied by using a medical device (Gondola™) and consisted in mechanical pressure stimulations delivered by metallic actuators on 4 areas of the feet. Treatment parameters and device configuration were modified for AMPS sham group.

MAIN OUTCOME MEASURES

Gait analyses were measured at baseline and after the first, fourth, and eighth treatment sessions.

RESULTS

Interactions among groups and sessions were found for both conditions while off anti-Parkinsonian medications. AMPS decreased gait variability in subjects with PD and FOG for both single and dual task conditions.

CONCLUSIONS

AMPS is an effective add-on therapy for treating gait variability in patients with PD and FOG.

The required coefficient of friction in Parkinson's disease: people with freezing of gait

The required coefficient of friction (RCOF) is frequently reported in the literature as an indicator of slip propensity, a consequence of the collisional aspect of legged locomotion. Little is known about the RCOF in pathological gait. Therefore, this study aimed to quantify the RCOF in subjects with Parkinson's disease (PD) and freezing of gait (FOG) during the OFF-pharma phase, and to investigate the interplay between RCOF parameters and ankle kinematic and kinetic gait variables. Fourteen subjects with PD and 14 healthy age-matched subjects were instructed to walk barefoot at self-selected speed over a force platform. The RCOF curve was obtained as the ratio between the tangential and vertical ground reaction forces. Then, the following discrete variables were identified: P1COF (the peak at the loading response phase), V1COF (the valley at midstance phase) and P2COF (the peak at push-off phase). Stepwise multiple regressions were applied to observe the influence of the gait speed and ankle kinematic and kinetic gait variables on RCOF variables. In subjects with PD and FOG the gait speed is a predictor of the RCOF in the loading response phase; plantarflexion and the plantarflexion moment are strong predictors of the RCOF in midstance; finally, push-off power is a predictor of RCOF increasing in the push-off phase. These results characterized the biomechanical strategies adopted by subjects with PD and FOG during gait in order to avoid falls.

Automated mechanical peripheral stimulation and postural control in subjects with Parkinson's disease and freezing of gait: a randomized controlled trial

Individuals with Parkinson's disease (PD) and freezing of gait (FOG) have impaired postural control. Recent studies using foot sensory stimulation delivered by means of automated mechanical peripheral stimulation (AMPS) have demonstrated improvements of gait in individuals with PD. This study aimed to investigate the effects of AMPS on postural control in individuals with PD and FOG. Thirty-three subjects participated in this randomized controlled trial. Participants were allocated to two groups: AMPS and AMPS SHAM. Subjects underwent eight sessions of real (AMPS) or placebo AMPS (AMPS SHAM) once every three/four days. Postural control was assessed by means of posturography before the first and after the eighth session of treatment. We did not find positive effects of AMPS on center of pressure parameters. Thus, it seems that AMPS has no positive effect in terms of improving static postural control in individuals with PD and FOG.

Electric Stimulation for Pain Relief in Patients with Fibromyalgia: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Fibromyalgia (FM) is a syndrome whose primary symptoms include chronic widespread muscle pain and fatigue. The treatment of patients with FM aims to provide symptomatic relief and improvement in physical capacities to perform daily tasks and quality of life. Invasive or non-invasive electric stimulation (ES) is used for pain relief in patients with FM.

OBJECTIVE

This systematic review aimed to assess the effects of treatment with ES, combined or not combined with other types of therapy, for pain relief in patients with FM.

STUDY DESIGN

Systematic review and meta-analysis.

SETTING

Electronic search was conducted on databases (from the inception to April 2016): MEDLINE (accessed by PubMed), EMBASE, Cochrane Central Register of Controlled Trials (Cochrane CENTRAL), and Physiotherapy Evidence Database (PEDro).

METHODS

Two independent reviewers assessed the eligibility of studies based on the inclusion criteria: randomized controlled trials (RCTs) examining the effects of ES combined or not with other types of treatment for pain relief in patients with FM (according to the American College of Rheumatology), regardless of the ES dosages. The primary outcome was pain, assessed by the visual analogue scale (VAS). The secondary outcomes extracted were quality of life, assessed by short form-36 health survey (SF- 36), and fatigue, assessed by VAS.

RESULTS

Nine studies were included, with 301 patients. The meta-analysis for pain showed positive effect of ES treatment versus control [-1.24 (95% CI: -2.39 to -0.08; I²: 87%, P = 0.04) n = 8 RCTs]. The sensitivity analysis for pain showed significant results for invasive ES, combined or not with other types of therapy [-0.94 (95% CI, -1.50 to -0.38; I² 0%, P = 0.001) n = 3 RCTs]. No significant improvement was found regarding quality of life [-3.48 (95% CI: -12.58 to 5.62; I²: 0%, P = 0.45), n = 2 RCTs] or fatigue [-0.57 (95% CI, -1.25 to 0.11; I² 34%, P = 0.100; n = 4 RCTs].

LIMITATIONS

This systematic review included a small number of studies and reduced number of participants in each study. Furthermore, most of the studies showed some biases and lack of methodological quality.

CONCLUSIONS

This meta-analysis indicates that there is low-quality evidence for the effectiveness of ES for pain relief in patients with FM. However, moderate-quality evidence for the effectiveness of electroacupuncture (EA), combined or not combined with other types of treatment, was found for pain relief.

CLINICAL TRIAL REGISTRATION INFORMATION

PROSPERO under the identification CRD42015025323Key words: Electric stimulation, electroacupuncture, transcutaneous electric nerve stimulation, pain, fibromyalgia, review, physical therapy, rehabilitation.