Immediate effects of cryotherapy on neuromuscular performance of ankle joint and on gait pattern of chronic spastic hemiparetic subjects post stroke

• Grant number: 13/25805-1
• Support type: Scholarships in Brazil - Doctorate
• Effective date (Start): April 01, 2014
• Effective date (End): January 31, 2018
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal researcher: Thiago Luiz de Russo
• Grantee: Carolina Carmona de Alcântara
• Home Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil
• Associated scholarship(s): 15/19197-4 - Effects of gradual or abrupt speed changes on post-stroke locomotor learning and transfer, BE.EP.DR

Abstract

Stroke has been described as the third cause of death and the leading cause of disability in adults worldwide. Although about 60% of surviving individuals are able to walk after rehabilitation, deficits in the functions of the lower limbs often persist in the majority of cases, affecting gait and functional mobility. In this context, several interventions are applied in clinical practice to optimize functional performance. Cryotherapy is among the most used techniques in order to reduce spasticity temporarily, allowing the realization of functional training, such as walking. The aim of this project is to evaluate the effects of cryotherapy (ice pack) on neuromuscular performance and the passive resistance of the dorsiflexors and plantar flexors ankle muscles, as well as on gait performance in chronic hemiparetic and in healthy subjects. Eighteen chronic hemiparetic subjects, and eighteen healthy subjects, matched for gender and age with the hemiparetic group, will participate in the study. Cryotherapy will be applied on the back of the leg, in the form of crushed ice pack for 20 minutes. Initially, Berg Balance Scale and Fugl Meyer Scale will be applied. All other variables will be assessed before and after application of cryotherapy: the level of spasticity will be evaluated according to the classification of the Modified Ashworth Scale; spatiotemporal parameters and three-dimensional joint kinematics of the trunk, hip, knee and ankle during gait will be analyzed using a system of movement analysis (AB Qualysis, Gotheburg, Sweden); resistance to passive stretching, and peak torque, average torque, work and power in isometric and isokinetic (concentric and eccentric) contractions of the plantar flexors and dorsiflexors ankle muscles will be obtained using an isokinetic dynamometer; peak activation of soleus, gastrocnemius (medialis and lateralis), tibialis anterior and peroneus (longus and brevis), coactivation index between agonists and antagonists, time for onset of muscle activation ("onset") and order of muscle recruitment will be obtained by electromyography. For statistical analysis, tests for normality (Shapiro Wilk) and homogeneity (Levene's test) will be applied. If variables were normal and homogenous, the ANOVA two-way test will be applied. Otherwise, the non-parametric Kruskal-Wallis statistics will be applied. A significance level of 0.05 will be considered for all statistical tests. (AU)

Scientific publications

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

ALCANTARA, CAROLINA CARMONA; BLANCO, JULIA; DE OLIVEIRA, LUCILENE MARIA; SAVIO RIBEIRO, PAULA FERNANDA; HERRERA, ESPERANZA; NAKAGAWA, THERESA HELISSA; REISMAN, DARCY S.; MICHAELSEN, STELLA MARIS; GARCIA, LUCCAS CAVALCANTI; RUSSO, THIAGO LUIZ. Cryotherapy reduces muscle hypertonia, but does not affect lower limb strength or gait kinematics post-stroke: a randomized controlled crossover study. Topics in Stroke Rehabilitation, v. 26, n. 4, p. 267-280, MAY 19 2019. Web of Science Citations: 1.

GARCIA, LUCCAS CAVALCANTI; ALCANTARA, CAROLINA CARMONA; SANTOS, GABRIELA LOPES; ALMEIDA MONCAO, JOAO VICTOR; RUSSO, THIAGO LUIZ. Cryotherapy Reduces Muscle Spasticity But Does Not Affect Proprioception in Ischemic Stroke A Randomized Sham-Controlled Crossover Study. AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, v. 98, n. 1, p. 51-57, JAN 2019. Web of Science Citations: 1.

ALCANTARA, CAROLINA C.; GARCIA-SALAZAR, LUISA F.; SILVA-COUTO, MARCELA A.; SANTOS, GABRIELA L.; REISMAN, DARCY S.; RUSSO, THIAGO L. Post-stroke BDNF Concentration Changes Following Physical Exercise: A Systematic Review. FRONTIERS IN NEUROLOGY, v. 9, AUG 28 2018. Web of Science Citations: 6.