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Objective: After deep brain stimulation (DBS), patients with Parkinson's disease (PD) typically still present significant gait and postural stability problems, and thus additional interventions are needed. In this way, our purpose was evaluate the comparative effectiveness of treadmill training, with and without body weight support, on balance outcomes among patients with PD after DBS. Methods: Eleven patients with PD that were using bilateral subthalamic nucleus DBS were evaluated using Time Up and Go test (TUG); Berg Balance Scale (BBS) and Static Posturography. In phase 1, all subjects participated in 8-weeks of treadmill training in conjunction with conventional physiotherapy. After six weeks (wash-out), each patient then participated in a subsequent 8-weeks of treadmill training with partial body weight support. Results: After the phase 1, there were improvements on the cognitive TUG performance (Before: 15.7 ± 1,8 sec; After: 13.7 ± 3.1 sec; p < 0.01) and an increase of anteroposterior and medio-lateral body oscillation with eyes closed. After the phase 2, there were improvements in conventional (Before: 12.3 ± 2.0 sec; After: 10.7 ± 1.7 sec; p < 0.01) and cognitive (Before: 14.6 ± 3.5 sec; After: 12.5 ± 1.6 sec; p < 0.05) TUG performances. There were no significant changes in the Berg Balance Scale following either training protocol. Conclusion: Both trainings improved static and dynamic balance and had similar results; however, supported treadmill training seemed to be a potentially superior option, as patients tended to feel safer. Level of Evidence II, therapeutic studies - investigation of treatment outcomes.

Objetivo: Mesmo após a estimulação cerebral profunda (ECP), os pacientes com doença de Parkinson (DP) muitas vezes ainda apresentam problemas significativos de marcha e estabilidade postural, e, portanto, intervenções adicionais são necessárias. Avaliar a eficácia comparativa do treinamento em esteira, com e sem suporte de peso corporal, nos resultados de equilíbrio de pacientes com DP após ECP. Métodos: Onze pacientes com DP em uso de ECP bilateral do núcleo subtalâmico foram avaliados pelos testes Time Up and Go (TUG), escala de equilíbrio de Berg (EEB) e posturografia estática. Na fase 1, todos participaram de oito semanas de treinamento em esteira em conjunto com fisioterapia convencional. Após seis semanas (wash-out), cada paciente participou de oito semanas subsequentes de treinamento em esteira com suporte parcial de peso corporal. Resultados: Depois da fase 1, houve melhora no desempenho cognitivo do TUG (antes: 15,7 ± 1,8 s; depois: 13,7 ± 3,1 s; p < 0,01) e aumento da oscilação anteroposterior e médio-lateral do corpo com os olhos fechados. Após a fase 2, os resultados do TUG convencional (antes: 12,3 ± 2,0 seg; depois: 10,7 ± 1,7 seg; p < 0,01) e cognitivo (antes: 14,6 ± 3,5 s; depois: 12,5 ± 1,6 s; p < 0,05) demonstraram melhora. Os protocolos de treinamento não causaram mudanças significativas na EEB.. Conclusão: Ambos os treinos melhoraram o equilíbrio estático e dinâmico e tiveram resultados semelhantes; no entanto, o treinamento em esteira com suporte é uma opção potencialmente superior, uma vez que os pacientes tendiam a se sentir mais seguros. Nível de Evidência II, estudos terapêuticos - investigação de resultados de tratamento.

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Introdução: A Síndrome da Pessoa Rígida é uma doença neuroimunológica rara do sistema nervoso central caracterizada por espasmos dolorosos e rigidez progressiva que envolvem os músculos proximais dos membros e axiais do tronco. A forma clássica tem início insidioso com piora gradual ao longo do tempo e muitas vezes leva à incapacidade permanente. Objetivo: Analisar os estudos publicados na literatura científica que utilizaram a reabilitação fisioterapêutica como proposta de tratamento dos sintomas motores na Síndrome da Pessoa Rígida. Método: Trata-se de uma revisão integrativa da literatura realizada no período de julho a dezembro de 2022 nas bases de dados PubMed, SciELO, LILACS e BVS. Resultados: Foram encontrados 12 artigos publicados entre o período de 2002 a 2021, que discorriam sobre o tratamento fisioterapêutico nesta população. O número escasso de estudos se dá pela raridade da patologia que dificulta a realização de ensaios clínicos robustos. Os artigos selecionados eram relatos de casos de um ou mais indivíduos, com enfoque nas intervenções realizadas de acordo com cada queixa funcional apresentada, sendo estas a dor, fraqueza muscular, hipomobilidade articular, rigidez, instabilidade postural, alterações na marcha e limitações nas atividades de vida diária. Conclusão: A reabilitação fisioterapêutica faz parte do tratamento sintomatológico e tem como finalidade, auxiliar na manutenção da funcionalidade e qualidade de vida, minimizando as repercussões motoras que são desencadeadas pela síndrome.

Introduction: Stiff Person Syndrome is a rare neuroimmunological disease of the central nervous system characterized by painful spasms and progressive rigidity involving the proximal muscles of the limbs and axial muscles of the trunk. The classic form has an insidious onset with gradual worsening over time and often leads to permanent disability. Objective: To analyze the studies published in the scientific literature that used hysiotherapeutic rehabilitation as a proposal for treating motor symptoms in Stiff Person Syndrome. Method: This is an integrative review of the literature carried out from July to December 2022 in the PubMed, SciELO, LILACS and VHL databases. Results: 12 articles published between 2002 and 2021 were found, which discussed physiotherapeutic treatment in this population. The scarce number of studies is due to the rarity of the pathology, which makes it difficult to carry out robust clinical trials. The selected articles were case reports of one or more individuals, focusing on interventions carried out according to each functional complaint presented, these being pain, muscle weakness, joint hypomobility, stiffness, postural instability, changes in gait and limitations in walking activities. daily life. Conclusion: Physiotherapy rehabilitation is part of symptomatological treatment and aims to help maintain functionality and quality of life, minimizing the motor repercussions that are triggered by the syndrome.

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BACKGROUND: Guillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries. OBJECTIVE: To evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia. METHODS: Telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study between 2016 and 2020. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status. RESULTS: Forty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9-34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5-100), improvement in disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0-3] vs. 4.5 [IQR = 4-5], p < 0.001), and most were able to walk without assistance (median GDS = 2, IQR = 0-2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age. CONCLUSIONS: This study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.

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OBJECTIVE: To estimate rates and time to reach emergence of consciousness from vegetative state/unresponsive wakefulness syndrome (VS/UWS), and explore factors associated with improved recovery in children and adolescents with disorders of consciousness (DoC) following severe traumatic and non-traumatic brain injury. METHODS: Analytical, retrospective, cohort study. Clinical records of consecutively referred patients admitted in VS/UWS to a neurological rehabilitation institute in Argentina, between 2005 and 2021 were reviewed. Seventy children and adolescents were included in the analysis. A specialized 12-week rehabilitation program was administered, and emergence was defined by scores ≥44 points on the Western Neuro Sensory Stimulation Profile (WNSSP), sustained for at least 3 weeks on consecutive weekly evaluations. RESULTS: Emergence from VS/UWS to consciousness occurred within 5.4 (SD 2.6) weeks in almost one-third of patients. Multivariate Cox regression analysis showed emergence was significantly lower in patients with hypoxic ischemic encephalopathy compared to patients with other non-traumatic etiologies [HRadj 0.23 (95% CI 0.06-0.89); p = 0.03)]. CONCLUSIONS: Our findings reinforce growing evidence on the impact of etiology on DoC recovery in pediatric populations, ultimately influencing treatment and family-related decisions in child neurorehabilitation.

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OBJECTIVE: The aim of this study is to identify the main processes and outcomes related to family-centred care (FCC) in neuromotor and functional rehabilitation of preschool children with cerebral palsy (CP). BACKGROUND: FCC is considered a reference for best practices in child rehabilitation. CP is the most common cause of physical disability in childhood with repercussions on functionality. There is a gap in knowledge of the practical principles of FCC, and it is necessary to develop a reference model for the practice of child rehabilitation professionals. METHODS: In this scoping review, the main databases selected were as follows: LILACS; Pubmed; Embase; The Cochrane Library; CINAHL (EBSCO); Scopus; Web of Science; PEDro (Physiotherapy Evidence Database); Open Gray and other banks of thesis. The terms combined in the search strategy were as follows: 'Family-centered', 'Family-centred' and 'CP'. Inclusion criteria are as follows: studies on preschool-aged children with CP, undergoing family-centred functional therapeutic interventions (FCFTI) with outcomes on bodily structures and functions and/or activities and/or participation. RESULTS: The main participatory care methods identified were home intervention, environmental enrichment, collaborative realistic goal setting, planning of home-based activities and routine, child assessment feedback, family education/training, family coaching, encouraging discussion, observation of therapist and supervised practice. The main relational care qualities identified were as follows: respect, active listening, treat parents as equals, clear language, respect parents' ability to collaborate, demonstrate genuine care for the family, appreciate parents' knowledge and skills, demonstrate competence, experience and commitment. The main outcomes identified in children were improvement in motor and cognitive function and the child's functional ability. The main parentaloutcomes identified were empowerment, feeling of competence, self-confidence, motivation and engagement. CONCLUSION: The main differences in FCFTI programs refer to the parental education/guidance component and the amount of intervention carried out by parents. It is possible that the elements chosen by the therapist in a FCFTI depend on characteristics of the child and caregivers.

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People with Parkinson's disease (PD) face disruptions in arm swing (AS) motion during walking, including a reduction in amplitude and an increase in asymmetry. Both conditions are detrimental to gait performance. Nordic walking (NW) is a walking modality that uses poles and can positively affect the parameters of AS. This study aims to compare an NW with a free walking (FW) protocol and investigate its effects on AS asymmetry, AS amplitude and gait parameters in people with PD. Twenty-eight people with PD, stages 1-3 on the Hoehn and Yahr Scale, will be randomly assigned to the NW training group (n=14) or the FW training group (n=14). The primary outcomes are amplitude asymmetry of AS (%) and AS amplitude (deg). We will also analyse temporospatial measurements during walking, functional mobility and quality of life. Blinded researchers will conduct evaluations at baseline (T0), postintervention (T1) and at 1 month follow-up (T2). Participants will complete 24 supervised NW or FW training sessions for 12 weeks. This is the first study to address the effects of NW on the asymmetry of AS, AS amplitude and its influence on gait parameters. We hypothesise that an NW programme in PD will reduce the asymmetry and increase the AS amplitude during gait to a greater extent than FW. The results of this study may provide new evidence to understand the effects of NW on gait in people with PD. The study was registered in ClinicalTrial.gov (NCT06342271).

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La enfermedad de Parkinson (EP) es una condición neurodegenerativa caracterizada por alteraciones motoras que afectan principalmente el desarrollo de la marcha, produciéndose generalmente el fenómeno del congelamiento de la marcha con la posibilidad del riesgo de caída. Objetivo: Analizar los beneficios del entrenamiento de la marcha con la cinta rodante antigravitatoria en pacientes con EP. Materiales y métodos: Es un estudio pre-experimental con un solo grupo de intervención. Se llevó a cabo el entrenamiento de la marcha a través de una cinta rodante antigravitatoria (AlterG) durante un mes dividido en 2 sesiones por semana. Los parámetros de la marcha arrojados por el equipo AlterG fueron la descarga de peso, cadencia, tiempo de apoyo y longitud del paso; además se valoró el congelamiento de la marcha con el cuestionario (FOGQ) y el riesgo de caída con el test Timed Up and Go (TUG). Resultados: En los parámetros de la marcha y en el FOGQ se encontró diferencias significativas (p<0,05) entre los valores de pre y post intervención, exceptuando a la variable cadencia. El riesgo de caída disminuyó 4,6 y 4,3 segundos promedio en el test TUG en hombres y mujeres respectivamente. Conclusión: El entrenamiento de la marcha en la cinta rodante antigravitatoria mejora las condiciones de la marcha y reduce el riesgo de caídas en pacientes con EP.

Parkinson's disease (PD) is a neurodegenerative condition characterized by motor alterations that mainly affect the development of gait, generally producing the phenomenon of freezing of gait with the possibility of risk of falling. Objective: To analyze the benefits of gait training with the antigravity treadmill in patients with PD. Materials and methods: It is a pre-experimental study with a single intervention group. Gait training was carried out using an antigravity treadmill (AlterG) for one month divided into 2 sessions per week. The gait parameters returned by the AlterG team were weight unloading, cadence, support time and step length; Furthermore, freezing of gait was assessed with the questionnaire (FOGQ) and the risk of falling with the Timed Up and Go test (TUG). Results: In the gait parameters and in the FOGQ, significant differences (p<0.05) were found between the pre- and post-intervention values, except for the cadence variable. The risk of falling decreased by 4.6 and 4.3 seconds on average in the TUG test in men and women respectively. Conclusion: Antigravity treadmill gait training improves walking conditions and reduces the risk of falls in PD patients.

A doença de Parkinson (DP) é uma condição neurodegenerativa caracterizada por alterações motoras que afetam principalmente o desenvolvimento da marcha, geralmente produzindo o fenômeno de congelamento da marcha com possibilidade de risco de queda. Objetivo: Analisar os benefícios do treino de marcha com esteira antigravitacional em pacientes com DP. Materiais e métodos: Trata-se de um estudo pré-experimental com um único grupo de intervenção. O treinamento de marcha foi realizado em esteira antigravitacional (AlterG) durante um mês dividido em 2 sessões semanais. Os parâmetros de marcha retornados pela equipe AlterG foram descarga de peso, cadência, tempo de apoio e comprimento do passo; Além disso, o congelamento da marcha foi avaliado com o questionário (FOGQ) e o risco de queda com o teste Timed Up and Go (TUG). Resultados: Nos parâmetros da marcha e no FOGQ foram encontradas diferenças significativas (p<0,05) entre os valores pré e pós-intervenção, exceto na variável cadência. O risco de queda diminuiu em média 4,6 e 4,3 segundos no teste TUG em homens e mulheres respectivamente. Conclusão: O treino de marcha em esteira antigravitacional melhora as condições de marcha e reduz o risco de quedas em pacientes com DP.

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OBJECTIVE: To identify the main biopsychosocial factors associated with disability level after stroke using the International Classification of Functioning, Disability and Health (ICF) model. METHODS: A cross-sectional study was conducted with chronic stroke survivors. Disability was assessed using the World Health Disability Assessment Schedule 2.0. The independent variables were: Body functions: emotional functioning and whether the dominant upper limb was affected. For the Activities & Participation component, satisfaction regarding the execution of activities and participation were assessed using the SATIS-Stroke, as well as the locomotion ability for adults (ABILOCO), manual ability (ABILHAND) and the return to work. For environmental factors, income and facilitators and obstacles were assessed using the Measure of the Quality of the Environment (MQE). Personal factors: age and sex. Multiple Linear Regression was employed. RESULTS: Limited locomotor ability (ß = -0.281; t = -3.231 p = 0.002), dissatisfaction regarding activities and participation (ß = -0.273; t = -3.070 p = 0.003), and the non-return to work (ß = 0.162; t = 2.085 p = 0.04) were associated with disability. CONCLUSION: The reduction in locomotor ability, dissatisfaction regarding activities and participation and the non-return to work were associated with disability in the chronic phase following a stroke.

The reduction in locomotion ability, dissatisfaction regarding activities and participation, and the non-return to work were associated with disability in the chronic phase following a stroke.Clinicians will be able to develop rehabilitation strategies focused on diminishing locomotor limitations, increasing satisfaction with activities and participation, and improving vocational planning for the return to work after a strokeThese findings underscore the importance of assessments and intervention strategies based on the individual rather than the disease as well as focusing on social and personal issues to guide clinical decision making.

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ABSTRACT Objective: After deep brain stimulation (DBS), patients with Parkinson's disease (PD) typically still present significant gait and postural stability problems, and thus additional interventions are needed. In this way, our purpose was evaluate the comparative effectiveness of treadmill training, with and without body weight support, on balance outcomes among patients with PD after DBS. Methods: Eleven patients with PD that were using bilateral subthalamic nucleus DBS were evaluated using Time Up and Go test (TUG); Berg Balance Scale (BBS) and Static Posturography. In phase 1, all subjects participated in 8-weeks of treadmill training in conjunction with conventional physiotherapy. After six weeks (wash-out), each patient then participated in a subsequent 8-weeks of treadmill training with partial body weight support. Results: After the phase 1, there were improvements on the cognitive TUG performance (Before: 15.7 ± 1,8 sec; After: 13.7 ± 3.1 sec; p < 0.01) and an increase of anteroposterior and medio-lateral body oscillation with eyes closed. After the phase 2, there were improvements in conventional (Before: 12.3 ± 2.0 sec; After: 10.7 ± 1.7 sec; p < 0.01) and cognitive (Before: 14.6 ± 3.5 sec; After: 12.5 ± 1.6 sec; p < 0.05) TUG performances. There were no significant changes in the Berg Balance Scale following either training protocol. Conclusion: Both trainings improved static and dynamic balance and had similar results; however, supported treadmill training seemed to be a potentially superior option, as patients tended to feel safer. Level of Evidence II, therapeutic studies - investigation of treatment outcomes.

RESUMO Objetivo: Mesmo após a estimulação cerebral profunda (ECP), os pacientes com doença de Parkinson (DP) muitas vezes ainda apresentam problemas significativos de marcha e estabilidade postural, e, portanto, intervenções adicionais são necessárias. Avaliar a eficácia comparativa do treinamento em esteira, com e sem suporte de peso corporal, nos resultados de equilíbrio de pacientes com DP após ECP. Métodos: Onze pacientes com DP em uso de ECP bilateral do núcleo subtalâmico foram avaliados pelos testes Time Up and Go (TUG), escala de equilíbrio de Berg (EEB) e posturografia estática. Na fase 1, todos participaram de oito semanas de treinamento em esteira em conjunto com fisioterapia convencional. Após seis semanas (wash-out), cada paciente participou de oito semanas subsequentes de treinamento em esteira com suporte parcial de peso corporal. Resultados: Depois da fase 1, houve melhora no desempenho cognitivo do TUG (antes: 15,7 ± 1,8 s; depois: 13,7 ± 3,1 s; p < 0,01) e aumento da oscilação anteroposterior e médio-lateral do corpo com os olhos fechados. Após a fase 2, os resultados do TUG convencional (antes: 12,3 ± 2,0 seg; depois: 10,7 ± 1,7 seg; p < 0,01) e cognitivo (antes: 14,6 ± 3,5 s; depois: 12,5 ± 1,6 s; p < 0,05) demonstraram melhora. Os protocolos de treinamento não causaram mudanças significativas na EEB.. Conclusão: Ambos os treinos melhoraram o equilíbrio estático e dinâmico e tiveram resultados semelhantes; no entanto, o treinamento em esteira com suporte é uma opção potencialmente superior, uma vez que os pacientes tendiam a se sentir mais seguros. Nível de Evidência II, estudos terapêuticos - investigação de resultados de tratamento.

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Abstract Background Gait disturbances are prevalent and debilitating symptoms, diminishing mobility and quality of life for Parkinson's disease (PD) individuals. While traditional treatments offer partial relief, there is a growing interest in alternative interventions to address this challenge. Recently, a remarkable surge in assisted technology (AT) development was witnessed to aid individuals with PD. Objective To explore the burgeoning landscape of AT interventions tailored to alleviate PD-related gait impairments and describe current research related to such aim. Methods In this review, we searched on PubMed for papers published in English (2018-2023). Additionally, the abstract of each study was read to ensure inclusion. Four researchers searched independently, including studies according to our inclusion and exclusion criteria. Results We included studies that met all inclusion criteria. We identified key trends in assistive technology of gait parameters analysis in PD. These encompass wearable sensors, gait analysis, real-time feedback and cueing techniques, virtual reality, and robotics. Conclusion This review provides a resource for guiding future research, informing clinical decisions, and fostering collaboration among researchers, clinicians, and policymakers. By delineating this rapidly evolving field's contours, it aims to inspire further innovation, ultimately improving the lives of PD patients through more effective and personalized interventions.

Resumo Antecedentes Os distúrbios da marcha são sintomas prevalentes e debilitantes, diminuindo muito a mobilidade e a qualidade de vida dos indivíduos com doença de Parkinson (DP). Embora os tratamentos tradicionais ofereçam alívio parcial, há um interesse crescente em intervenções alternativas para enfrentar esse desafio. Recentemente, um aumento notável no desenvolvimento de tecnologia assistida (TA) foi testemunhado para ajudar indivíduos com DP. Objetivo Explorar o cenário crescente de intervenções de TA adaptadas para aliviar deficiências de marcha relacionadas à DP e descrever as pesquisas atuais para esse fim. Métodos Nessa revisão, pesquisamos artigos em inglês publicados no PubMed de 2018 a 2023. Além disso, os resumos de cada trabalho foram lidos para assegurar a sua inclusão. Quatro pesquisadores buscaram independentemente os artigos de acordo com os critérios de inclusão e exclusão. Resultados Incluímos trabalhos que preencheram os critérios de inclusão. Identificamos as tendências em tecnologia assistiva na análise dos parâmetros da marcha em DP. Esses compreendem os sensores portáteis, análise da marcha, retroalimentação em tempo real e técnicas de pista, realidade virtual e robótica. Conclusão Essa revisão é um recurso para orientar pesquisas futuras, informar decisões clínicas e promover a colaboração entre pesquisadores, médicos e formuladores de políticas. Ao delinear os contornos deste campo em rápida evolução, pretende inspirar mais inovação, melhorando em última análise a vida dos pacientes com DP através de intervenções mais eficazes e personalizadas.