Aquatic Physical Therapy in the balance and gait of people with Parkinson’s Disease: a pilot study

Background. Parkinson’s disease (PD) is a neurodegenerative, chronic, progressive disease, resulting mainly from the depletion of dopaminergic neurons in the substantia nigra. It is characterized by four cardinal signs, namely: bradykinesia, stiffness, tremor, and postural instability, which contribute to body balance and gait functional deficits. Among the possibilities of intervention, the Aquatic Physical Therapy (APT) stands out in the prevention and rehabilitation of motor and functional alterations, using water physical and thermal properties. Objective. To verify the effects of APT on body balance and gait. Method. This pilot study is part of quasi-experimental research involving a group with a clinical diagnosis of PD. They participated in an APT program for 12 weeks, twice a week. They were assessed with the Mini-BESTest for body balance and the Dynamic Gait Index (DGI) for gait balance. The statistical analysis was made in the Statistical Package for the Social Sciences (SPSS). Results. A total of 11 people – mean age of 70.73±3.2 years – participated in the study. After the APT program, no difference was verified in the Mini-BESTest (p=0.41) or the DGI (p=0.105). Conclusions. The APT program proposed was unable to present significant improvement regarding the balance and gait in the group of people with PD in question.

Anti-gravity treadmill rehabilitation improves gait and muscle atrophy in patients with surgically treated ankle and tibial plateau fractures after one year: A randomised clinical trial

Objective: To compare the one-year postoperative outcomes of anti-gravity treadmill rehabilitation with those of standard rehabilitation in patients with ankle or tibial plateau fractures. Design: An open-label prospective randomised study. Setting: Three trauma centres. Subjects: Patients were randomised into the intervention (anti-gravity treadmill) or control (standard protocol) rehabilitation group. Main measures: The primary endpoint was changes in the Foot and Ankle Outcome Score for ankle fractures and Knee Injury and Osteoarthritis Outcome Score for tibial plateau fractures from baseline to 12 months after operation. Secondary endpoints were the subscores of these scores, muscle atrophy (leg circumference at 20 cm above and 10 cm below the knee joint) and the Dynamic Gait Index. Results: Initially, 73 patients (37 vs 36) underwent randomisation. After 12 months, 29 patients in the intervention group and 24 patients in the control group could be analysed. No significant difference was noted in the Foot and Ankle Outcome Score (80.8 ± 18.4 and 78.4 ± 21.1) and Knee Injury and Osteoarthritis Outcome Score (84.8 ± 15.2 and 81.7 ± 17.0). The change in the Dynamic Gait Index from 12 weeks to 12 months differed significantly between the groups ( P = 0.04). Patients with tibial plateau fractures had a 3 cm wider thigh circumference in the intervention group than those in the control group (95% confidence interval: −0.2 to 6.3 cm, P = 0.08). Conclusion: One year after surgery, patients who had undergone anti-gravity treadmill rehabilitation showed better gait than patients in the control group, and those with tibial plateau fractures had less muscle atrophy.

Intrarater and Interrater Reliability of Dynamic Gait Index in Post Stroke Patients With Eye Movement Disorders

The authors have requested that this preprint be withdrawn due to erroneous posting.

Intrarater and Interrater Reliability of Dynamic Gait Index in Post Stroke Patients With Eye Movement Disorders

Background: The Dynamic Gait Index is a useful scale that has been evaluated for its reliability in patients with vestibular disorder, elderly people and, in chronic stroke population but its reliability has not been evaluated yet in sub-acute stroke patients with eye movement disorders. So the purpose of this study was to evaluate the intra-rater and inter-rater reliability of the Dynamic gait index to measure the dynamic balance, gait and risk of fall in sub-acute stroke population with eye movement disorders.Methods: A total of 30 (18 male, 12 females) stroke patients in the sub-acute phase suffering from eye movement disorders were recruited for this reliability study. Two experienced Physical therapists assessed the intra-rater and inter-rater reliability of the Dynamic gait index in two testing sessions three days apart. In the later session, two raters assessed the patients’ performance simultaneously on the Dynamic gait index. Data analysis was done at 95% confidence interval using the intra-class correlation coefficient (ICC2, 1). A significance level was set at P-value <0.05.Results: Mean tests scores by rater 1 in the first and second assessment were 17.4±2.04 and 18.0±2.05. Mean tests score by rater 2 in the second assessment were 18.6±2.06. Intra-rater (ICC=0.86, CI=0.73-0.93) and inter-rater (ICC=0.91, CI=0.83-0.96) reliability of total DGI scores was found good to excellent while intra-rater (ICC=0.73-0.91) and inter-rater (ICC=0.73-0.93) reliability of individual items of DGI scores were ranged from moderate to good. Item 8 (steps) showed lowest reliability (ICC=0.73). The significant difference was seen in total and individual scores (P<0.001) of DGI scale in both intra-rater and inter-rater reliability.Conclusions: The Dynamic gait index is found clinically a reliable tool to objectively measure dynamic balance, gait and risk of fall in sub-acute stroke individuals with eye movement disorders. The intra-rater and inter-rater reliability of the total DGI scores was found good to excellent; whereas intra-rater and inter-rater reliability for individual items of DGI were varied from moderate to good.

Examining the test-retest reliability and construct validity of the Six-Spot Step Test in older adults with self-reported balance problems

Objective: To evaluate the test-retest reliability and construct validity of the Six-Spot Step Test in older adults. Design: Cross-sectional study. Setting: Outpatient clinics. Subjects: Sixty-six adults aged ⩾65 years with self-reported balance problems. Main measure: The Six-Spot Step Test was completed twice on day 1. Three days later, the Six-Spot Step Test, the Timed “Up and Go” test, Dynamic Gait Index, the Mini-BESTest, and standing balance test were conducted. Reliability and validity were estimated using Bland-Altman statistics, minimal detectable change, Intraclass Correlation Coefficient (ICC), and Spearman’s rank correlation coefficient (ρ). Results: Participants had a mean (SD) age of 75.5 (6.6) years, a median ( Q1– Q3) Montreal Cognitive Assessment test score of 26 (24–27), and a median ( Q1– Q3) Falls Efficacy Scale International score of 22 (20–26). The study found within-day and between-day limits of agreements of ±15.7% and ±18.1%, respectively. The minimal detectable changes at the 95% level of confidence for within-day and between-day were 17.5% and 21.6%, and the ICCs were 0.96 (CI: 0.92–0.98) and 0.94 (CI: 0.86–0.97), respectively. A learning effect was observed between the first and second Six-Spot Step Test. Moderate to strong correlations were found between the Six-Spot Step Test and Mini-BESTest (ρ = −0.62), Dynamic Gait Index (ρ = −0.55), and the Timed “Up and Go” test (ρ = 0.79). Weak correlations were identified between the Six-Spot Step Test and static standing balance test (ρ < 0.38). Conclusion: The Six-Spot Step Test shows excellent relative consistency and moderate to high construct validity in older adults. A change of 21.6% is a true change in outcome.

[ID 54534] EFEITOS AGUDOS DE EXERCÍCIOS NO EQUILÍBRIO, MOBILIDADE, CAPACIDADE FUNCIONAL E FORÇA MUSCULAR EM IDOSOS COM OSTEOARTRITE DE JOELHO DE UMA CLÍNICA ESCOLA DA CIDADE DE SÃO PAULO

Objetivo: Verificar o efeito de um protocolo de exercícios de solo no equilíbrio, mobilidade, capacidade funcional e força muscular em idosos com osteoartrite de joelho em um período de 10 semanas. Metodologia: Foram avaliados 17 idosos (73,53 ± 7,41 anos, com índice de massa corporal 28,60 ± 3,67 kg/m2). Foram incluídos indivíduos de ambos os gêneros, com idade ≥ 60 anos, com diagnóstico radiológico e clínico de osteoartrite crônica de joelho uni ou bilateral, deambulando com ou sem dispositivos de auxílio à marcha; apresentando dor em um ou ambos os joelhos e com cognitivo preservado de modo a compreender ordens simples. Foram excluídos aqueles submetidos a cirurgias prévias no joelho, com doenças inflamatórias, obesidade mórbida e amputados dos membros superiores e inferiores. O equilíbrio, a mobilidade, a capacidade funcional e a força muscular foram avaliados por meio da escala de equilíbrio de Berg, Dynamic Gait Index e dinamômetro manual Jamar®, respectivamente. O estudo foi aprovado pelo Comitê de Ética da Universidade São Judas Tadeu. Resultados: O teste t de Student não-pareado foi utilizado a fim de verificar o efeito da fisioterapia. Ao avaliar os períodos pré e pós-intervenção, constatou-se que ocorreu melhora (aumento) quanto à mobilidade, capacidade funcional e força muscular. Conclusão: O estudo demonstrou que existiram, em 10 semanas de tratamento, evidências de melhora funcional em idosos com osteoartrite de joelho associada a um efeito benéfico promovido pela fisioterapia de solo.