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Browsing Physical Therapy by Author "Swarowsky, Alessandra"
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Item Anticipatory and Compensatory Postural Adjustments in Response to External Lateral Shoulder Perturbations in Subjects with Parkinson’s Disease(2016) Swarowsky, AlessandraThe purpose of this study was to investigate the anticipatory (APA) and compensatory (CPA) postural adjustments in individuals with Parkinson’s disease (PD) during lateral instability of posture. Twenty-six subjects (13 individuals with PD and 13 healthy matched controls) were exposed to predictable lateral postural perturbations. The electromyographic (EMG) activity of the lateral muscles and the displacement of the center of pressure (COP) were recorded during four time intervals that are typical for postural adjustments, i.e., immediately before (APA1, APA2) and after (CPA1 and CPA2) the postural disturbances. The magnitude of the activity of the lateral muscles in the group with PD was lower only during the CPA time intervals and not during the anticipatory adjustments (APAs). Despite this finding, subjects with PD exhibit smaller COP excursions before and after the disturbance, probably due to lack of flexibility and proprioceptive impairments. The results of this study suggest that postural instability in subjects with PD can be partially explained by decreased postural sway, before and after perturbations, and reduced muscular activity after body disturbances. Our findings can motivate new studies to investigate therapeutic interventions that optimize the use of postural adjustment strategies in subjects with PD.Item Are Functional Mobility Tests Responsive to Group Physical Therapy Intervention in Individuals with Parkinson’s Disease?(2018) Swarowsky, AlessandraBACKGROUND: The Timed up and go test (TUG), the Five times sit-to-stand test (FTSTS) and the Bed Mobility test (BMT) are widely used in clinical practice for Parkinson Disease (PD). However, no reported studies have evaluated the responsiveness to group physical therapy intervention (GPTI). OBJECTIVE: To verify if TUG, FTSTS and BMT were responsive to GPTI. METHODS: Thirty individuals with PD were assessed prior to and after an 8-week evidence-based GPTI. Paired t test was used to determine statistically significant change pre-and post-intervention. Internal responsiveness (IR) was classified with the standardized response mean (SRM). A 5-point Likert scale assessed self-perceived performance by the subjects after the intervention. Analysis of the receiver operating characteristic (ROC) curve was used to determine the accuracy and cut-off scores for identifying participants who had shown improvement. RESULTS: GPTI was efficient in improving real (p ≤0.001) and self-perceived mobility performance in all measures. All tests were responsive to changes: the IR varied from medium to high (SRM = 0.7–1.5); the cut-off point for TUG test was >2.2 s, for FTSTS test was >2.5 s and for BM test >1.4 s. CONCLUSIONS: The TUG, FTSTS and BMT were responsive to the GPTI and accurately detected meaningful clinical changes. Our results provide an important information about the clinical application of these tests in PD individuals.Item Assessing Timed Up and Go in Parkinson's Disease: Reliability and Validity of Timed Up and Go Assessment of Biomechanical Strategies(2017) Swarowsky, AlessandraObjective: To investigate the measurement properties of the Timed Up and Go Assessment of Biomechanical Strategies (TUG-ABS) to determine its adequacy for use with individuals with Parkinson's disease. Subjects: Fifty individuals with Parkinson's disease. Design: Diagnostic accuracy. Methods: The study investigated the following properties: reliability (inter-examiner, intra-examiner, test-retest, internal consistency and minimal detectable change), construct validity, and floor and ceiling effect. Results: Considering the total score, the inter-examiner, test-retest and intra-examiner reliabilities were classified as excellent (0.95 ≤ intra-class correlation coefficient (ICC)≤0.99). The TUG-ABS presented excellent internal consistency (α = 0.98). The minimal detectable change was 3.82 points. The construct validity between the TUG-ABS and the Unified Parkinson's Disease Rating Scale (UPDRS) - part III was classified as moderate (ρ = -0.62). Significant, elevated and positive correlations were obtained between TUG-ABS and the Balance Evaluation System Test (BESTest)-VI (ρ = 0.72) and negative correlations between TUG-ABS and TUG (ρ = -0.78). The discriminant function obtained with the total score of TUG-ABS classified 60% of the individuals correctly with respect to the group (determined by the performance in TUG) to which they belonged. One-way analysis of variance (ANOVA) showed that TUG-ABS discriminated the individuals with Parkinson's disease in all stages according to Hoehn & Yahr. There was a ceiling effect of 22%. Conclusion: TUG-ABS presented adequate measurement properties in individuals with Parkinson's disease.Item Binary Dance Rhythm or Quaternary Dance Rhythm Which Has the Greatest Effect on Non-motor Symptoms of Individuals With Parkinson's Disease?(2021) Swarowsky, AlessandraThis study aimed to compare the effect of a binary and quaternary rhythm protocol on cognition, mental activity, daily life, and quality of life among individuals with Parkinson's Disease. A two-arm randomized clinical trial with 31 individuals diagnosed with Parkinson's disease, who were allocated to the binary group or quaternary group. Both groups underwent a 12-week intervention. The following variables were analyzed: personal and clinical information; MoCA; UPDRSI and II; PDQ-39. Both intervention groups improved cognition, mental activity, activities of daily living, and quality of life. In addition, there were intergroup differences in total UPDRSII, writing, and hygiene where the quaternary group was superior to the binary group. It concludes that the binary and quaternary rhythm positively influenced and presented similar effects on the complementary treatment of individuals with Parkinson's disease on the studied variables. Thus, it is believed that both interventions are possible and feasible for the health professionals involved in the area.Item Body Surface Posture Evaluation: Construction, Validation and Protocol of the SPGAP System (Posture Evaluation Rotating Platform System)(2016) Swarowsky, AlessandraBackground Several posture evaluation devices have been used to detect deviations of the vertebral column. However it has been observed that the instruments present measurement errors related to the equipment, environment or measurement protocol. This study aimed to build, validate, analyze the reliability and describe a measurement protocol for the use of the Posture Evaluation Rotating Platform System (SPGAP, Brazilian abbreviation). Methods The posture evaluation system comprises a Posture Evaluation Rotating Platform, video camera, calibration support and measurement software. Two pilot studies were carried out with 102 elderly individuals (average age 69 years old, SD = ±7.3) to establish a protocol for SPGAP, controlling the measurement errors related to the environment, equipment and the person under evaluation. Content validation was completed with input from judges with expertise in posture measurement. The variation coefficient method was used to validate the measurement by the instrument of an object with known dimensions. Finally, reliability was established using repeated measurements of the known object. Results Expert content judges gave the system excellent ratings for content validity (mean 9.4 out of 10; SD 1.13). The measurement of an object with known dimensions indicated excellent validity (all measurement errors <1 %) and test-retest reliability. A total of 26 images were needed to stabilize the system. Participants in the pilot studies indicated that they felt comfortable throughout the assessment. The use of only one image can offer measurements that underestimate or overestimate the reality. To verify the images of objects with known dimensions the values for the width and height were, respectively, CV 0.88 (width) and 2.33 (height), SD 0.22 (width) and 0.35 (height), minimum and maximum values 24.83–25.2 (width) and 14.56 – 15.75 (height). In the analysis of different images (similar) of an individual, greater discrepancies were observed in the values found. The cervical index, for example, presented minimum and maximum values of 15.38 and 37.5, a coefficient of variation of 0.29 and a standard deviation of 6.78. Conclusions The SPGAP was shown to be a valid and reliable instrument for the quantitative analysis of body posture with applicability and clinical use, since it managed to reduce several measurement errors, amongst which parallax distortion.Item Brazilian Samba Protocol for Individuals with Parkinson’s Disease: A Clinical Non-randomized Study(2017) Swarowsky, AlessandraBackground: In the 10 most populated countries in the world, Parkinson's disease (PD) affects more than 5 million individuals. Despite optimal treatment options already developed for the disease, concomitant involvement of other areas of health care plays an important role in complementing the treatment. From this perspective, dancing can be viewed as a non-drug alternative that can reduce falls by improving some motor skills, such as mobility, balance, gait, and posture, and can also improve the overall quality of life. Brazilian samba promotes improvement in motor and non-motor symptoms in individuals with PD, providing a new treatment option for this population. Objective: The main objective of this quasi-experimental study is to provide a 12-week samba protocol (2x/week) for individuals with PD and to compare its effects with the group without intervention. The hypothesis is that the Brazilian samba protocol will promote improvement in primary (motor) and secondary (non-motor) outcomes in individuals with PD. Methods: The sample will be selected at random from individuals diagnosed with PD in the city of Florianopolis (SC, Brazil). Sample size calculation was performed with the G*Power 3.1.9.2 software, with 0.447 effect size, at 5% significance level, power of 0.9, and test and sample loss of 20%. This yielded 60 individuals divided between the intervention and control groups. The questionnaires will be filled out before and after the dance intervention. The data collection for the control group will be held simultaneously to the intervention group. The classes will last for 1 hour, twice a week in the evening for 12 weeks, and all classes will be divided into warm-up, main part, and relaxation. Two-way analysis of variance with repeated measures and Sidak post-hoc comparison test will be used for a comparative analysis of the final results of the control group with the experimental group and of the within-group changes between pre- and postintervention period. Results: We expect to complete follow-up in September 2017. Conclusions: The major inspiration for this study was to encourage the creation of new rehabilitation programs that do not emphasize doctor involvement. This is a unique protocol for PD and we believe it can be an important tool to alleviate the motor and non-motor symptoms of individuals with PD. Dance is a simple activity depending on little equipment and few financial resources, facilitating its implementation and improving the cost-benefit relationship. In addition, activities that have a cultural aspect for the population in question, and which are pleasant, enable the participants to commit long term. This can enhance patient’s compliance with the therapy, which is often a problem for many rehabilitation programs.Item Comparison between Two Functional Mobility Scales for Parkinson's Disease Directly Applied to Physical Therapy Practice: Cross-cultural Adaptation and Measurement Properties(2017) Swarowsky, AlessandraThe Modified Parkinson Activity Scale (PASm) and Lindop Parkinson's Disease Mobility Assessment (LPA) scales were developed to assess the functional mobility in patients with Parkinson's disease (PD) being directly applied to physical therapy practice. To translate and perform the cross-cultural adaptation of PASm and LPA scales to Portuguese-Brazil, and to analyze some psychometric properties. Cross-cultural validation study. Clinical environment. Thirty-two Brazilian subjects with Parkinson's disease. The study consisted of two stages: 1) cross-cultural adaptation process; 2) evaluation of psychometric properties. Considering the total score, the interrater and test-retest reliabilities showed a coefficient of intra-class correlation that ranged between 0.97 and 0.98. Both scales showed excellent internal consistency (α=0.83 and 0.94). Positive correlations were obtained between the Brazilian versions of the LPA and PASm and PAS (ρ=0.63 and 0.92). The concurrent validity between scales and part III of UPDRS, established a moderate negative correlation, (ρ=-0.54 and -0.65). The one way ANOVA showed that LPA-Brazil discriminates the individual with PD between all stages according HY, and the PASm- Brazil between mild and severe stages, and moderate and severe. The MDC of scales ranging from 1 to 2 points. There was Ceiling effect only for the LPA-Brazil. Brazilian versions of PASm and LPA are valid and reliable instruments to assess the functional mobility in patients with PD, being directly applied to physical therapy clinical practice. The major goal of physical therapy in PD is to maintain functional mobility and independence of the patient. The results of study are relevant and could improve the physical therapy practice in Brazil, since it provides the Brazilian version of two mobility scales (one of them recommended by the European Guidelines for Physical Therapy Practice in patients with Parkinson disease).Item Cross Cultural Adaptations and Sychometric Domains of Brazilian Version of PROFILE PD for Parkinson’s Disease(2017) Swarowsky, AlessandraPurpose: The PROFILE PD scale was developed specifically to evaluate patients with Parkinson’s disease (PD) within the context of the International Classification of Functioning, Disability and Health, directly applied to physical therapy practice. The study aimed to translate and cross-culturally adapt the PROFILE PD scale to Portuguese-Brazil, and to analyze its psychometric domains. Methods: Fifty participants with PD participated in the study. We assessed the clarity of the Brazilian version of the scale by physiotherapists, presence of floor and ceiling effects, interrater and test–retest reliabilities, in addition to discriminant, concurrent (UPDRS) and construct validity, internal consistence, minimal detectable change (MDC), and responsiveness. Results: The scale was considered highly clear for physical therapists. The interrater ICC was 0.74 and Wk was 0.89 for the total score. For test–retest reliability, the total ICC score was 0.99. The analysis of concurrent validity showed the Spearman correlation between Brazilian version of PROFILE PD and UPDRS (ρ = 0.77; p < 0.001). Factor analyses demonstrated that the test comprises a single scale. Brazilian version of PROFILE PD was able to discriminate the subject with PD in mild and moderate stages, and in mild and severe stages. A high internal consistency was found (α = 0.99). MDC was 2.41 points and there were no floor and ceiling effects. Also, the scale was responsive to physical therapy intervention, with improvement in 8 points after two months (effect size = 0.85). Conclusion: The Brazilian version of PROFILE PD is an instrument reliable, valid, and responsive to physical therapy intervention, that can be used to quantify impairments and limitations in patients with PD and can provide an overall summary of the impact of disease, useful for physiotherapy practice. Implications for Rehabilitation • PROFILE PD is a reliable and valid instrument to be applied in Brazilian Parkinson disease patients. • This scale is design specially to be used in physical therapy practice within the contexts surrounding the International Classification of Functioning, Disability and Health. • PROFILE PD was able to discriminate between patients in mild and moderate stages of disease which is difficult in clinical practice mainly because the scale used for this relies on balance and gait rather than a global profile.Item Dance Rhythms Improve Motor Symptoms in Individuals With Parkinson's Disease: A Randomized Clinical Trial(2022) Swarowsky, AlessandraBackground: Evidence-based practices involving dance modalities found in binary (two-beat rhythm) or quaternary (four-beat rhythm) show that dance positively influences the motor aspects of disease. Aim: This randomized clinical trial aimed to analyze the effect of two dance rhythm (binary and quaternary) on the balance, gait, and mobility in individuals with Parkinson's disease (PD). Methods: Thirty-one individuals with PD were randomized into the binary group (n = 18) and the quaternary group (n = 13). Both groups participated in different dance rhythms lasting 12 weeks, twice a week, for 45 minutes. Results: The binary group showed a significant difference in balance (p = 0.003), freezing of gait (p = 0.007), as well as in the motor aspects of MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), with emphasis on the total values with a score change of 3.23. In the quaternary group, significant differences were found in balance (p = 0.021) with a score change of -2.54 and in the motor aspects of the MDS-UPDRS Part III where the total values stood out with a change of 3.54. Discussion: When comparing the possible effects of binary and quaternary rhythms on the motor symptoms of individuals with PD, it was demonstrated that binary rhythm improved balance, freezing gait, and UPDRSIII. As for the quaternary rhythm, the benefits were in balance and the UPDRSIII. Conclusion: The binary and the quaternary rhythm dance protocols positively influenced the motor symptoms of individuals with PD after 12 weeks of intervention.Item Dual-task Demands in Various Motor Skills Through Parkinson’s Disease Progression(2019) Swarowsky, AlessandraAim: The aim of this study was to investigate the effects of adding a cognitive task on the performance of three different motor tasks with different demands, discrete skills, serial skills and continuous skills, by individuals with mild, moderate, and severe idiopathic Parkinson’ disease (PD). We also investigate the effect of the cognitive task in the secondary task and the cost of the dual-task. Method: This is a cross-sectional study. Individuals with idiopathic PD were divided in three groups with respect to motor severity (mild, moderate and severe groups). Participants’ performances were assessed in single and DT conditions including Sit-to-Stand test (SST), Timed Up and Go (TUG), and 10-meter Walk test (T10W). Cognitive task used was verbal fluency Results: The results show that dual task impact the performance of all primary tasks. DT negatively affects the performance of the motor tasks. And there is a different impact according the severity of the disease, severe ones are more affected than mild and moderate. Conclusion: In conclusion, adding a concurrent cognitive task negatively affected the performance of discrete, serial and continuous motor tasks, and this effect is more noticeable in severe than in mild patients. Under dual-task conditions, patients improved their cognitive task performance for gait and TUG, suggesting a prioritization of the secondary task for these tasks. There was no difference between the costs of the three tasks.Item EMPOWER-PD - A Physical Therapy Intervention to Empower the Individuals with Parkinson’s Disease: A Study Protocol for a Feasibility Randomized Controlled Trial(2019) Swarowsky, AlessandraOne of the greatest barriers found by physical therapy treating individuals with Parkinson’s disease (PD) is the adherence to treatment, associated with the lack of motivation to remain active. Therefore, there is a need to change the look given to physical therapy and for the individual, seeking the centralization of the therapy in their preferences. This study aims to present the EMPOWER-PD, a protocol based on individual preferences and its design for feasibility.Item Feasibility of a Brazilian Samba Protocol for Patients with Parkinson's Disease: A Clinical Non-randomized Study(2020) Swarowsky, AlessandraObjective: To investigate the feasibility of a Brazilian samba protocol in individuals with Parkinson's disease. Methods: Twenty participants, mean age of 66.4±10.7 years, diagnosed with idiopathic Parkinson 's disease, divided into: experimental group that received the intervention of Brazilian samba dance classes (10 individuals); and control group that maintained their routine activities (10 individuals). For data collection, a divided questionnaire was used: General Information; Disability stages scale; Balance and Quality of Life. Results: During class implementation, there were no falls, as all dance activities adhered to the details of the protocol steps without any changes. On average, patients completed 82.7% of activities. After 12 weeks, the experimental group had improvements in the UPDRS global score, in daily activities, and on motor examination. There was also improvement in balance scores and in the mobility domain of the quality of life in the experimental group. Conclusion: The samba protocol seems to be feasible and safe for patients with PD. Moreover, it has pleasant characteristics and offers sufficient physical benefits for combination with drug treatment. There were also benefits in social relationships and as a possible rehabilitation tool in individuals with Parkinson's disease.Item Functional Recovery Occurs Even After Partial Remyelination of Axon-meshed Median and Ulnar Nerves in Mice(2019) Swarowsky, AlessandraUpper limb nerve injuries are common, and their treatment poses a challenge for physicians and surgeons. Experimental models help in minimum exploration of the functional characteristics of peripheral nerve injuries of forelimbs. This study was conducted to characterize the functional recovery (1, 3, 7, 10, 14, and 21 days) after median and ulnar nerve crush in mice and analyze the histological and biochemical markers of nerve regeneration (after 21 days). Sensory–functional impairments appeared after 1 day. The peripheral nerve morphology, the nerve structure, and the density of myelin proteins [myelin protein zero (P0) and peripheral myelin protein 22 (PMP22)] were analyzed after 21 days. Cold allodynia and fine motor coordination recovery occurred on the 10th day, and grip strength recovery was observed on the 14th day after injury. After 21 days, there was partial myelin sheath recovery. PMP22 recovery was complete, whereas P0 recovery was not. Results suggest that there is complete functional recovery even with partial remyelination of median and ulnar nerves in mice.
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