derricksantacasa@hotmail.com

gladsonricardo@gmail.com

*Professor at Centro Universitário Lusíada (UNILUS) - Santos, SP

**Professor at Universidade Estadual do Oeste do Paraná (Unioeste) - Cascavel, PR

(Brazil)

 Reception: 11/18/2019 - Acceptance: 08/07/2021

1st Review: 06/02/2021 - 2nd Review: 06/10/2021

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Suggested reference: Artioli, D.O., & Bertolini, G.R.F. (2021). Correlation Scale, Functional Tests and Comorbidities with Episodes in Cerebrovascular Accident. Lecturas: Educación Física y Deportes, 26(282), 30-43. https://doi.org/10.46642/efd.v26i282.1795

 

Abstract

    Introduction: In assessing patients with a stroke sequel, tonic and postural changes are generally evaluated, but other important information, such as functional capacity, risk of falls, and gait, should also be taken into account. Objective: To correlate the impairment level determined by Brunnstrom's scale, the results of functional tests and analyze the characteristics of the sample as being affected by comorbidities, time and number of strokes occurred. Methods: Cross-sectional evaluation of 50 patients (convenience) at a center of public rehabilitation, using Brunnstrom's scale (1-6, better limb ability closer to 6), Time Up and Go (TUG) (significant mobility deficit and in risk of falls above 20 seconds), Upright Motor Control Test (UMCT) (1-3, bellow 3 are household walkers), Step Test (ST) (disparity between member refers to slower individuals), registration of comorbidity and the time since the stroke happened and the number of episodes. Results: Grade "4" rated for upper and lower limbs by Brunnstrom's Scale, achieving over 20 seconds in TUG, level 2 in UMCT, and commitment of paretic member related to non-paretic on the ST (p<0.01). There was no influence of the time or number of strokes suffered. The main associations found were hypertension, diabetes, and dyslipidemia. Conclusion: The Brunnstrom's scale appointed moderate level function impairment for upper and lower limbs. Wherein association with functional tests determines slower and vulnerable individuals, with disability in changing the load support between members, neuromuscular control and balance deficit, fall risk and compromised walking ability.

    Keywords: Stroke. Disability evaluation. Physical therapy modalities.

 

Resumo

    Introdução: Em pacientes com sequela de AVC, geralmente se avalia tônus e alterações posturais, porém deve-se ter em mente outras importantes informações como capacidade funcional, risco de quedas e marcha. Objetivo: Avaliar o nível de comprometimento, determinado pela escala de Brunnstrom, os resultados dos testes funcionais e analisar característica da amostra como sendo afetada por comorbidades, tempo e número de acidentes vasculares cerebrais ocorridos. Métodos: Avaliação transversal de 50 pacientes (conveniência) de um centro de reabilitação público, utilizando escala de Brunnstrom (1-6, melhor capacidade dos membros mais próximo ao 6), Time Up and Go (TUG) (déficit de mobilidade significativo e em risco de queda acima de 20 segundos), Upright Motor Control Test (UMCT) (1-3, abaixo de 3 conseguem marcha domiciliar), Step Test (ST) (disparidade entre membros), registro das comorbidades, bem como o tempo decorrido após o AVC e número de episódios. Resultados: Grau “4” de classificação para membros superiores e inferiores pelo score de Brunnstrom, realização acima de 20 segundos no TUG, nível 2 no UMCT e comprometimento da relação membro parético e não-parético no ST (p<0,01). Não houve influência do momento ou quantidade de AVCs sofridos. As principais comorbidades encontradas foram hipertensão arterial, diabetes e dislipidêmia. Conclusão: A escala de Brunnstrom apontou deficiência funcional moderada para membros superiores e inferiores. A associação com testes funcionais determinou indivíduos lentos e vulneráveis, com incapacidade de mudar o suporte de carga entre os membros, controle neuromuscular e déficit de equilíbrio, risco de queda e capacidade de caminhar comprometida.

    Unitermos: Acidente vascular cerebral. Avaliação da deficiência. Modalidades de fisioterapia.

 

Resumen

    Introducción: En los pacientes con secuelas de Accidente cerebrovascular (ACV), generalmente se valoran los cambios de tono y postura, pero hay que tener en cuenta otros datos relevantes como capacidad funcional, riesgo de caídas y la marcha. Objetivo: Evaluar el nivel de deterioro, determinado por la escala de Brunnstrom, los resultados de las pruebas funcionales y analizar la característica de la muestra afectada por comorbilidades, tiempo y número de ACVs. Métodos: Evaluación transversal de 50 pacientes (por conveniencia), utilizando la escala de Brunnstrom (1-6, mejor habilidad de las extremidades más cerca de 6), Time Up and Go (TUG) (déficit de movilidad significativo y en riesgo de caídas más de 20 segundos), Upright Motor Control Test (UMCT) (1-3, menos de 3 puede caminar en casa), Step Test (ST) (disparidad entre extremidades), registro de comorbilidades, así como el tiempo transcurrido después del ACV y número de episodios. Resultados: Grado “4” de clasificación para miembros superiores e inferiores por el puntaje de Brunnstrom, desempeño durante 20 segundos en el TUG, nivel 2 en el UMCT y deterioro de la relación de miembros paréticos y no paréticos en el ST (p<0.01). No hubo influencia por ACVs sufridos. Las principales comorbilidades encontradas fueron hipertensión, diabetes y dislipidemia. Conclusión: La escala de Brunnstrom indicó deterioro funcional moderado para miembros superiores e inferiores. La asociación con pruebas funcionales determinó individuos lentos y vulnerables, con incapacidad para cambiar el soporte de carga entre extremidades, control neuromuscular y déficit de equilibrio, riesgo de caídas y capacidad para caminar.

    Palabras clave: Accidente cerebrovascular. Evaluación de discapacidad. Modalidades de fisioterapia.

 

Lecturas: Educación Física y Deportes, Vol. 26, Núm. 282, Nov. (2021)

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Introduction 

 

    Responsible for 5.51 million death in 2002, cerebrovascular accident (CVA) is considered the major cause of long-term sequelae and lately have been allocated as the second cause of death in Brazil, above 70,000 in the last years, promoting emotional impact (patients and relatives), socioeconomic and increase spending on public health. In 2020, the expectation is that stroke and arterial disease are the main reasons for the decrease in years of healthy life (Gupta et al., 2016; Kuster et al., 2016; Lotufo et al., 2017; Martins et al., 2013). It is estimated that 62 million people have suffered a stroke in the world and originated motor changes that may make it impossible decubitus changes, activities of daily living, walking (80% initially), and return to work. Because of its implications, it is the most frequent patient in neurological physiotherapy sessions. (Ferri et al., 2016; Gupta et al., 2016)

 

    After a brain injury such as stroke, the physiotherapist through training of functional activities that require selective control of the movements, helps the neuronal reorganization and therefore, in motor recovery (Maguire et al., 2012; Maguire et al., 2016). Therefore, the assessment should be carried out by means of instruments that point functional impairment that can facilitate monitoring the evolution of the patient, but also, specifically to what extent has the motor frame been compromised (Bernhardt et al., 2015; Mercer et al., 2009). To date, the evaluation after a stroke, it is most frequently by the scale of muscle tone (Ashworth, which does not explain the function) and a narrative description of decubitus changes (Pennati et al., 2016). Despite of being a consistent way to record the current status of the patient and be able to use this information to follow-up, these data say little or do not quantify the functional capacity, risk of falls, speed, weakness and the possibility of walking. Other frequently used scales, such as Barthel Index, Modified Rankin Scale, and Functional Independence Measurement (FIM), analyze the patient in a global manner, pointing out their difficulties and functional capacity, but are unable to make reference to their specific motor frame. (Cohen et al., 2018; Jönsson et al., 2018; Srimath et al., 2018)

 

    In this manner, it becomes feasible the use of functional tests to measure the current difficulty level and in a more direct scale that analyzes limb ability. As the Brunnstrom’s scale, which assesses the upper and lower limbs engaged in an isolated way and according to the possible active movement, determining from sagging condition of even a fine selective movement pattern (Sütbeyaz et al., 2007). In addition, tests like Time Up and Go, Upright Motor Control Test and Step Test, are easy to implement, require few resources to application and are done in a few minutes (Andrews et al., 2008; Gschwind et al., 2013; Mercer et al., 2009; Reisman et al., 2013; Wevers et al., 2009). Therefore, the proposal is to analyze the combination of other means of evaluation, reflecting greater specificity to the patient assessed. Thus, it was convenient to correlate the impairment level determined by Brunnstrom’s scale, the results of functional tests and analyze the characteristics of the sample as being affected by comorbidities, time and number of strokes occur.

 

Methods 

 

    Individuals enrolled in this cross-sectional study were the first 50 who entered in the service of the Centro Municipal de Reabilitação de Itanhaém - SP (CMR) after a stroke. Since one patient is evaluated per week, the number of 50 was determined to approximately represent all stroke suffering analyses in one year. Information and tests were performed on the first visit, after being explained what the purpose of use of the data. All participants signed an informed consent previously approved by the Ethics Committee of the Lusíada University Center of Research - Unilus (Protocol Nr. 42675615.8.0000.5436). In anamnesis, it took knowledge of the following: age; gender; breed; member of dominance; hemibody committed; abnormal speech; if the patient was hypertensive, diabetic or had hyperlipidemia; elapsed time of stroke; number of strokes.

 

    Therefore, we used the functional impairment Brunnstrom’s scale, which determines the function level that the upper and lower limbs engaged are, giving a better clue of its current motor condition, ranging from a flaccid phase (level 1), in which the patient is unable to produce active movement, to isolated selective movements (level 6). The individual was asked to actively carry out the movements of each degree, being awarded the degree of its limitation to the level that could perform the task (Table 1). (Sütbeyaz et al., 2007)

 

Level	Upper Limb	Lower Limb
1	Flaccidity.	Flaccidity.
2	Little or no active flexion of fingers.	Synergy development (minimal voluntary movements).
3	Hold in bulk, there is no active extension of fingers.	Voluntary synergistic movement(combined hip flexion, knee flexion, and ankle dorsiflexion, both sitting and standing).
4	Semi-voluntary fingers extension in small ROM, release by thumb movement.	Some movements deviating from synergy (knee flexion exceeding 90° and ankle dorsiflexion with the heel on the floor in the sitting position).
5	Cylindrical and clumsy palmar grip, limited functional use; Voluntary mass extension of the fingers of variable amplitude.	Independence from basic synergies (isolated knee flexion with the hipextended and isolated ankle dorsiflexion with the knee extended in the standing position).
6	All kinds of hold under control; Improving skills; Voluntary extension of the fingers with complete ROM; Individual movements present, however, with less effectiveness compared to the contralateral limb.	Isolated joint movements (hip abduction in the standing position and knee rotation with inversion and eversion of the ankle in the sitting position).

ROM - range of motion. (Sütbeyaz et al., 2007)

 

    Finally, there were three functional physical tests, Time Up and Go (TUG) (Barry et al., 2014), Upright Motor Control Test (UMCT) (Ade et al., 2012) and Step Test (ST) (Vidoni et al., 2013). The TUG began with the individual sitting in a chair against the wall, going on through a distance of three pre-signed meters by the physiotherapist, return and sit. The timer was launched with a verbal command starting the test by the evaluator and stopped when the person sat again (Table 2, Figures A, B, C) (Bonnyaud et al., 2016). The second test (UMCT), demanded that the patient could stay in a one leg load position (impaired limb), even for a short time and with mild support for the upper limbs. The assessed could be classified into three levels according to the response of the hemiparetic member: 1) Unable to sustain body weight (Table 2, Figure D); 2) Able to support body weight, however, unable to extend the knee from 30° flexion (Table 2, Figure E); 3) Able to extend the knee (Table 2, Figure F). In the last test (ST), the starting position was standing upright, parallel legs from the start to the time the patient should insert and remove his foot on a step as many times for 15 seconds, each lower limbs were recorded in an isolated manner at the time (Table 2, Figure G, H, I) (Bouchalová et al., 2016). When the patient could not take the upright position even with aid, functional tests were not realized, however, the rest of your data was still considered.

 

Pictures: Left hemiparetic side (Personal archive)

 

    For all data records (people, Brunnstrom’s scale and functional test) it is estimated to last approximately 30-40 minutes. All participants remained in the rehabilitation process after the information registered in this first contact.

 

    In the statistical analysis, individuals elapsed stroke time up to three months, were considered in the acute phase and subsequent to this limit, chronic (Naki et al., 2012; Terranova et al., 2012). Furthermore, in another analysis they were divided into groups determined by the number of strokes conceded (one, two or three).

 

    Initially it was used the Shapiro-Wilk test, then a comparison of Brunnstrom’s scale and functional tests in relation to the number and elapsed time of stroke (acute Vs chronic) was made using the Wilcoxon and Mann-Whitney, depending on the group in question (p <0,05).

 

    The Spearman coefficient was used to correlate Brunnstrom upper limb (UL) and lower limber (LL) (for both male and female), elapsed time of stroke and UMCT, Brunnstrom UL, Brunnstrom LL in an isolated manner. PHI coefficient was applied to analyze men and women in order of speaker commitment, hypertension, hyperlipidemia, and diabetes mellitus. The Mann-Whitney test showed the possibility of time of stroke (before or after 12 weeks) could influence the results in functional tests and Brunnstrom’s scale. Spearman and Mann-Whitney tests were applied equally to the body side comparison with sequel member dominance and functional tests. As convenience samples were carried out a posteriori, the calculations with a minimum difference between the groups for Brunnstrom of 1.5, standard deviation of 1.0, and 3 groups, suggesting that for 80% of test power, 10 samples per group would be necessary, close to that presented for 1 or 2 episodes observed in the study.

 

Results 

 

    Anthropometric data and number of strokes are shown in Table 3. Also, it shows when analyzing the stroke numbers with respect to the physical functional performance, those who have suffered only one episode of stroke, had higher scores on the UMCT and ST test compared to twice situation. By contrast, individuals with two episodes were shown to be more agile in TUG. In contradiction to a possible assumption of a worse functional framework to be compromised by larger number of strokes, they had the best performance in the evaluation through Brunnstrom’s scale.

 

	1º CVA	2º CVA	3º CVA	Total
Nº Patients	38	9	3	50
Average age (years)	63.5 (9.7)	60.5 (15.3)	73.6 (15.6)	63.5 (11.3)
Gender	21 M / 17 F	5 M / 4 F	1 M / 2 F	27 M / 23 F
Hypertension	36	8	2	46
Diabetics	15	4	0	19
Dyslipidemia	16	4	1	21
Brunnstrom UL	4.3 (2.0)	4.0 (2.0)	5.6 (0.5)	4.3 (2.0)
Brunnstrom LL	4.1 (1.9)	3.2 (1.7)	5.3 (1.1)	4.0 (1.9)
TUG	24.4 (16.7)	17.4 (6.2)	31.6 (29.3)	24.9 (16.4)
UMCT	2.2 (0.8)	1.6 (0.8)	3.0*	2.1 (0.8)
ST H / P	9.0 (4.5)/7.1(4.0)	6.5(3.8)/3.25(2.7)	12.0*/14.0*	8.7(4.4)/6.8(4.2)

M - male; F - female; H - healthy limb/ P - paretic limb; UL - upper lmb; LL - lower limb. 

*Only one patient, insufficient to generate mean and standard deviation.

 

    Regarding the functional tests, although they obtained the best results after a large number of strokes (UMCT and ST), only one patient with three CVAs was able to perform the three tests, which made the comparison with the other groups surface. Of the 50 participants, 31 have achieved TUG and UMCT, 27 had the ST, and it was impossible to proceed with the functional tests in those that did not assume a standing position and/or could not move (flaccidity), which happened in approximately 40% of all (Table 4).

 

	Acute CVA	Chronic CVA	Total Average	Nº Patients Per Test	p<0.01
Nº Patients	20	30	50	-	-
Average time CVA (months)	1.5 (0.7)	87.8 (92.0)	53.3 (82.7)	-	-
Brunnstrom UL	4.4 (2.2)	4.3 (1.9)	4.3 (2.0)	50	0.58
Brunnstrom LL	4.1 (2.1)	4.0 (1.7)	4.0 (1.9)	50	0.36
TUG (s)	20.7 (11.8)	28.0 (18.8)	24.9 (16.4)	31	0.22
UMCT	2.3 (0.86)	2.2 (0.7)	2.1 (0.8)	31	0.61
ST (rep) - H / P	10.0(4.6)/8.2(4.4)	7.7(4.0)/5.6(3.8)	8.7(4.4)/6.8(4.2)	27	*

UL - upper limb; LL - lower limb; s - seconds; rep - repetions; H - healthy limb / P - paretic limb; * - described separately.

 

    On average, the patients had suffered the stroke 53.3 (82.7) months ago, coming mostly with minimal selective movement level and in small range of motion (ROM) (score 4), determined by Brunnstrom’s scale. Although the participants with more than three months of stroke (chronic) performed the TUG seven seconds slower than the configured in the acute phase, both took more than 20 seconds to complete the test. Note that among those who could perform the standing position, the stroke elapsed time did not affect the weight bearing capacity of the paretic limb, evaluated by UMCT and got almost identical results (Acute 2.2 vs Chronic 2.1). However, those designated as chronic had more difficulty in the execution of ST, with both healthy as the compromised member compared to the most recent stroke (Table 5). Importantly, the results of functional tests are not50 participants, because not everyone could perform orthostatism (flaccid phase), so did not perform these tests.

 

Limbs compared	State	Statistical significance (p<0.01)
H X P	Acute	0.00
H X P	Chronic	0.00
H X H	Acute X Chronic	0.17
P X P	Acute X Chronic	0.11
H X P	Total	0.00

H - healthy limb / P - paretic limb; Bold values ​​characterize p<0.01

 

    Using the ST was made necessary a larger number of samples, since it involves two measures (healthy and committed members) that could be related in whole or separated by the elapsed time of stroke (acute or chronic). Table 5 shows the correlation established and significance (p<0.01).

 

    The time of stroke (acute or chronic) did not influence the results obtained with the Brunnstrom's scale or with respect to functional tests. It is noted through table 5 that chronic patients had more difficulty (fewer repetitions) to execute the ST compared to participants in the acute phase. However, Table 5 shows that when comparing the members of the acute and chronic phases alone, both demonstrate that the test can capture differences in the performance of the healthy limb when compared to commit. What did not occur to analyze the same member at different times (Acute healthy Limb vs Chronic healthy limb; acute paretic limbs vs Chronic paretic limb).

 

Discussion 

 

    It can be a report that on average the patients arrived with an intermediate level of difficulty, wherein the upper limb motion was limited to small active ROM and in a semivoluntary manner, and that the lower member could not perform joint motion isolated and independent of the position of members. Rate this designated by 4 grades on the Brunnstrom's scale. This score (Brunnstrom), the TUG test, URMCT and ST were not directly influenced by the elapsed time of stroke, reasonably explained by the average of episode occurrence (53.3 months average) being long beyond of that proposed between 1 - 6 months window of functional recovery (Cohen et al., 2018). The amount of time demonstrated some peculiarities. After a single stroke, the results were better in UMCT and ST as compared with the affected twice. In the second episode, a TUG test was easier performed. By adding up three CVAs, “improvement” was noticed in the evaluation through Brunnstrom´s scale, but only three participants fell into place in this group. Although a greater number of strokes reflect a loss in load bearing capacity and flexibility, those that had sequels of the three episodes were still able to use the upper limb functionally in a limited fashion and have some isolated movements in standing position. From the comorbidities, hypertension was the most present, with more than one-third being diabetic and about half with hyperlipidemia. However, differently from the work of Cohen et al. (2018), it did not affect the performance of any of tests.

 

    The narrative of decubitus changes and the modified Ashworth´s scale is the most applied "tools" in a first neurological physiotherapy session (Pennati et al., 2016). Despite the relevance of descriptive information of the capacity to switch from daily body positions after stroke, in this study, we chose to use a quantitative assessment (Brunnstrom´s scale), which also reflects the ability to perform some specific movements and provides a better idea of ​​the patient's stage instead of pointing only muscle tone (Ashworth scale) (Lim et al., 2016). It is common that initially the patients are in a flaccid phase, subsequently rise to spasticity and move towards selective movement gradually. On Jang et al. (Jang et al., 2016) study, which also used Brunnstrom´s scale, at discharge, four months after the stroke event and going through rehabilitation, the best average score was approximately "3". In the collection performed, patients with only 1.5 months after a stroke, were already above "4", even if not yet having undergone physiotherapy. In contrast, the analysis by Maeda et al. (2015) had patients who were admitted on average half the time in this survey (approximately 26 versus 53.3 months), being already classified in stages "4" and "5" by the Brunnstrom´s evaluation system. This information corroborates the results, which do not indicate influence on the performance or function assessed by the Brunnstrom´s score over time. As acute and chronic cases fall within the same phase ("4"). Maeda et al. (2015) also discriminated that those with grade "4" or below, were suffering falls and, or also had risk for the same.

 

    The TUG is the functional physical test most commonly used in elderly patients with mobility and or balance affected, such as patients with vascular brain damage and reliable in stroke survivors (Cohen et al., 2018; Lima et al., 2016; Santos et al., 2011). The average time recorded, 24.9 seconds, is in line with other studies on the same population and on that, are characterized as dependent, vulnerable and at risk of falls (Bonnyaud et al., 2016; Lima et al., 2016; Santos et al., 2011). This statement is based on "cut" values, such as those provided by Karuka, Silva, & Navega (2011) describing predictive values ​​of difficulty based on TUG runtime. Thus, consider healthy individuals without risk of falls, those who complete the test in 10 seconds. In the range of 11-20 seconds are people with partial independence, low risk of falls, but being disabled or frail. Above 20 seconds, it is suggested a significant mobility deficit and risk of falls. When grouping by the number of CVAs suffered and analyzed separately, those impacted by one or three times would be characterized with risk of falling and dependents. However when had occurred twice, they were said to be partially dependent and with considerable difficulty. On the issue of elapsed time of stroke, by running average in the acute period (20.7 ± 11.8 s), one can say they were more agile than in chronic phase (28.0 ± 18.8 s) but despite the variation, all would still be discriminated as dependent, vulnerable and at risk of falling.

 

    The TUG allows establishing the idea of agility, fall risk, and dependency, however, the UMCT provides a prediction about the possibility of walking only in the home environment (grades 1 and 2) or "Community" (grade 3), which would be characterized as the ability of the patient to ambulate through your neighborhood, go to the market, bank, shopping and other social activities. This test has been applied and compared along with other scales, post stroke sequelae carriers and has been described as one of the best ways to predict walking ability. Furthermore, allows to alternatively assess activation and muscle strength rather than traditional manual strength measurement (Ade et al., 2012; Joa et al., 2015). From the data in question, the number of strokes and the period (acute or chronic) did not influence the execution of this test and all were classified as with household gear, in which the level of demand for muscle strength, coordination and balance is lighter (grade 3 was achieved only in patient that had three CVAs history) (Mercer et al., 2009). The position, muscle recruitment and discharge weight test mimics some of the daily activities in addition to the march, therefore, tells how the patient will have difficulty in a number of them, such as sit down and get up, go up and down stairs and steps. (Clarke et al., 2013)

 

    The last functional test is applied, the ST is characterized by evaluating the balance, motor control, load transfer capability between the paretic and healthy members and thus as a possible measure of commitment. It is not taken into consideration only the execution of the affected limb, but when it gets to loading the contralateral lower limb to perform the task. The sample showed that there was difference in the comparison between the paretic and non-paretic members (p<0.01) and that when considering that Bouchalóva et al. (2016) argue, these dynamic changes captured by ST are related to functional damage after CVA. It should be noted the similarity of the results obtained by these authors to those found in the analysis of this work, which held 7.4 (5.0) vs. 8.7 (4.4) respectively repetitions with the healthy limb and 6.4 (4.6) vs. 6.8 (4.2) repetitions with the affected limb. Since increases in only a repetition in both situations (health or compromised) refer to higher gait speed, this disparity between members refers to slower individuals (Bouchalová et al., 2016; Chung et al., 2014). Therefore, this information concurs and can be added to the previously described findings by other tests (TUG and UMCT), drawing a profile of patients with gait impairment, balance and risk of falls, neuromuscular control and function deficits.

 

    Some limitations should be taken into consideration and make the results more reliable and add more validity, as a control group, the homogeneity of the number of participants to be divided into groups (episodes or elapsed CVA) and the evaluation by two professionals, allowing to check the intra and inter-rater relationship. However, the study was carried out in a public rehabilitation center, which makes it difficult to fit these limiters and it is more viable to use a convenience sample.

 

    Even with the aforementioned constraints, we encourage that this initial approach should be tested in a more structured design, as researches could prove its effectiveness on supplement the typical stroke evaluation (narrative-descriptive assessment of decubitus and muscle tone) or even replace it. It is important to remind that 40% were unable to performance of the tests because of higher impairment state at the moment of appraisal, which needs to be considered for a more accurate and comprehensive evaluation. Following this idea, other tests and scales are to be combined to determine a patient functionality profile and show implications suggestive a better and more specific rehabilitation process.

 

Conclusion 

 

    The Brunnstrom´s scale appointed moderate level function impairment for upper and lower limbs ("4"). Wherein association with functional tests, TUG (over 20 seconds), UMCT (2), ST (considerable difference between lower limb repetitions, p<0.01) determines slower and vulnerable individuals, with disability in changing the load support between members, neuromuscular control and balance deficit, fall risk and compromised walking ability. In addition, approximately 40% were so committed that was unable to perform functional tests. The number of episodes, elapsed time, strokes, and comorbidities did not influence the results of those who carried out the tests. Further research is needed to prove the significance of this evaluation system.

 

References 

 

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Bouchalová, V., Houben, E., Tancsik, D., Schaekers, L., Meuws, L., & Feys, P. (2016). The influence of an ankle-foot orthosis on the spatiotemporal gait parameters and functional balance in chronic stroke patients. Journal of Physical Therapy Science, 28(5), 1621-1628. https://doi.org/10.1589/jpts.28.1621

 

Chung, M.M.L., Chan, R.W.Y., Fung, Y.K., Fong, S.S.M., Lam, S.S.L., Lai, C.W.K., & Ng, S.S.M. (2014). Reliability and validity of alternate step test times in subjects with chronic stroke. Journal of Rehabilitation Medicine, 46(10), 969-974. https://doi.org/10.2340/16501977-1877

 

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Lecturas: Educación Física y Deportes, Vol. 26, Núm. 282, Nov. (2021)