Publications by authors named "Clarissa Barros de Oliveira"

4 Publications

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Effects of lower extremity constraint-induced movement therapy on gait and balance of chronic hemiparetic patients after stroke: description of a study protocol for a randomized controlled clinical trial.

Trials 2021 Jul 19;22(1):463. Epub 2021 Jul 19.

Neurology/Neuroscience program, Federal University of São Paulo - UNIFESP, Botucatu street, 862 - 5° floor Edifico Ciências Biomédicas, São Paulo, Brazil.

Background: Protocols involving intensive practice have shown positive outcomes. Constraint induced movement therapy (CIT) appears to be one of the best options for better outcomes in upper limb rehabilitation, but we still have little data about lower extremity constraint-induced movement therapy (LE-CIT) and its effects on gait and balance.

Objective: To evaluate the effects of an LE-CIT protocol on gait functionality and balance in chronic hemiparetic patients following a stroke.

Methods: The study adopts a randomized, controlled, single-blinded study design. Forty-two patients, who suffered a stroke, who were in the chronic phase of recovery (>6 months), with gait disability (no community gait), and who were able to walk at least 10 m with or without the advice or support of 1 person, will be randomly allocated to 2 groups: the LE-CIT group or the control group (intensive conventional therapy). People will be excluded if they have speech deficits that render them unable to understand and/or answer properly to evaluation scales and exercises selected for the protocol and/or if they have suffered any clinical event between the screening and the beginning of the protocol. Outcome will be assessed at baseline (T0), immediately after the intervention (T1), and after 6 months (T2). The outcome measures chosen for this trial are as follows: 6-min walk test (6minWT), 10-m walk test (10mWT), timed up and go (TUG), 3-D gait analysis (3DGA), Mini Balance Evaluation Systems Test (Mini-BESTest), and as a secondary measure, Lower Extremity Motor Activity Log will be evaluated (LE-MAL). The participants in both groups will receive 15 consecutive days of daily exercise. The participants in the LE-CIT group will be submitted to this protocol 2.5 h/day for 15 consecutive days. It will include (1) intensive supervised training, (2) use of shaping as strategy for motor training, and (3) application of a transfer package (plus 30 min). The control group will receive conventional physiotherapy for 2.5 h/day over 15 consecutive days (the same period as the CIT intervention). Repeated measures analyses will be made to compare differences and define clinically relevant changes between groups.

Results: Data collection is currently on-going and results are expected in 2021.

Discussion: LE-CIT seems to be a good protocol for inclusion into stroke survivors' rehabilitation as it has all the components needed for positive results, as well as intensity and transference of gains to daily life activities.

Trial Registration: www.ensaiosclinicos.gov.br RBR-467cv6 . Registered on 10 October 2017. "Effects of Lower Extremities - Constraint Induced Therapy on gait and balance function in chronic hemipretic post-stroke patients".
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http://dx.doi.org/10.1186/s13063-021-05424-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287769PMC
July 2021

The influence of sleep quality and circadian preferences on upper extremity rehabilitation in stroke patients after constraint-induced movement therapy.

Int J Rehabil Res 2020 Mar;43(1):20-27

Departamento de Psicobiologia, Universidade Federal de São Paulo.

Our aim was to explore the influence of sleep and circadian preference on upper extremity (UE) rehabilitation in stroke patients after constraint-induced movement therapy (CIMT) in a cross-sectional retrospective observational study. Forty-three patients were selected to complete questionnaires on circadian preference, sleep quality, excessive daytime sleepiness, and risk of obstructive sleep apnea. They had undergone a 10-day standard CIMT program without medical complications and with normal to minimal cognitive dysfunction. All pre- and postrehabilitation scores (patient perception of the quantity and quality of use of the affected UE and self-quantification of motor ability) were analyzed retrospectively. All patients had improved perception of the quantity and quality of use of the affected UE and self-quantified motor ability. Patients with an evening-type chronotype demonstrated less improvement than those with morning and intermediate types. In addition, patients with poor sleep quality showed less improvement in functional ability than those with good sleep quality. Circadian preferences and sleep quality impacted the improvements in motor performance of patients with stroke after CIMT rehabilitation. This is the first study to suggest that rehabilitation sessions must respect the circadian preferences of patients and that sleep quality can affect outcomes. Future studies should investigate the relationship and mechanisms between circadian preference and poor sleep quality and rehabilitation outcomes on a larger scale.
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http://dx.doi.org/10.1097/MRR.0000000000000379DOI Listing
March 2020

A Comparative Study of Conventional Physiotherapy versus Robot-Assisted Gait Training Associated to Physiotherapy in Individuals with Ataxia after Stroke.

Behav Neurol 2018 20;2018:2892065. Epub 2018 Feb 20.

Physiology Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Objectives: To assess the influence of RAGT on balance, coordination, and functional independence in activities of daily living of chronic stroke survivors with ataxia at least one year of injury.

Methods: It was a randomized controlled trial. The patients were allocated to either therapist-assisted gait training (TAGT) or robotic-assisted gait training (RAGT). Both groups received 3 weekly sessions of physiotherapy with an estimated duration of 60 minutes each and prescribed home exercises. The following outcome measures were evaluated prior to and after the completion of the 5-month protocol treatment: BBS, TUG test, FIM, and SARA. For intragroup comparisons, the Wilcoxon test was used, and the Mann-Whitney test was used for between-group comparison.

Results: Nineteen stroke survivors with ataxia sequel after one year of injury were recruited. Both groups showed statistically significant improvement ( < 0.05) in balance, functional independencein, and general ataxia symptoms. There were no statistically significant differences ( < 0.05) for between-group comparisons both at baseline and after completion of the protocol.

Conclusions: Chronic stroke patients with ataxia had significant improvements in balance and independence in activities of daily living after RAGT along with conventional therapy and home exercises. This trial was registered with trial registration number 39862414.6.0000.5505.
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http://dx.doi.org/10.1155/2018/2892065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838477PMC
September 2018

Balance control in hemiparetic stroke patients: main tools for evaluation.

J Rehabil Res Dev 2008 ;45(8):1215-26

Department of Neurology, Hospital das Clínicas, São Paulo University, São Paulo, Brazil.

Balance problems in hemiparetic patients after stroke can be caused by different impairments in the physiological systems involved in postural control, including sensory afferents, movement strategies, biomechanical constraints, cognitive processing, and perception of verticality. Balance impairments and disabilities must be appropriately addressed. This article reviews the most common balance abnormalities in hemiparetic patients with stroke and the main tools used to diagnose them.
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May 2009
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