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  1. Article ; Online: Validity study of a triaxial accelerometer for measuring energy expenditure in stroke inpatients of a physical medicine and rehabilitation center.

    Daniel, Christiane Riedi / Yazbek, Paulo / Santos, Artur Cesar Aquino / Battistella, Linamara Rizzo

    Topics in stroke rehabilitation

    2022  Volume 30, Issue 4, Page(s) 402–409

    Abstract: Purpose: Establish the validity of a triaxial accelerometer (Dynaport®) for evaluating the energy expenditure of patients with stroke sequelae at a rehabilitation hospital.: Methods: This is a cross-sectional study with 24 stroke inpatients of a ... ...

    Abstract Purpose: Establish the validity of a triaxial accelerometer (Dynaport®) for evaluating the energy expenditure of patients with stroke sequelae at a rehabilitation hospital.
    Methods: This is a cross-sectional study with 24 stroke inpatients of a rehabilitation hospital. The participants were assessed on energy expenditure by an ergospirometer system and the triaxial accelerometer simultaneously during a walk test. The data collected by both devices were compared by intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement.
    Results: An almost perfect agreement (ICC = 0,94) in the energy expenditure measured by the accelerometer compared to the results of the ergospirometer system was found during the exercise test. The Bland-Altman analysis has shown suitable limits of agreement. Post hoc analyses with the maximum volume of oxygen and the total energy expenditure measured by the ergospirometer system evidenced significant correlation with the energy expenditure measurements by the accelerometer.
    Conclusion: Our results evidence that the triaxial accelerometer Dynaport® and its built-in software are valid for estimating the energy expenditure of stroke sequelae during a walk exercise.
    MeSH term(s) Humans ; Stroke ; Inpatients ; Cross-Sectional Studies ; Accelerometry/methods ; Physical and Rehabilitation Medicine ; Energy Metabolism ; Reproducibility of Results
    Language English
    Publishing date 2022-04-06
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1213112-x
    ISSN 1945-5119 ; 1074-9357
    ISSN (online) 1945-5119
    ISSN 1074-9357
    DOI 10.1080/10749357.2022.2058292
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  2. Article: Neurophysiological biomarkers of motor improvement from Constraint-Induced Movement Therapy and Robot-Assisted Therapy in participants with stroke.

    Simis, Marcel / Thibaut, Aurore / Imamura, Marta / Battistella, Linamara Rizzo / Fregni, Felipe

    Frontiers in human neuroscience

    2023  Volume 17, Page(s) 1188806

    Abstract: Background: The mechanism of stroke recovery is related to the reorganization of cerebral activity that can be enhanced by rehabilitation therapy. Two well established treatments are Robot-Assisted Therapy (RT) and Constraint-Induced Movement Therapy ( ... ...

    Abstract Background: The mechanism of stroke recovery is related to the reorganization of cerebral activity that can be enhanced by rehabilitation therapy. Two well established treatments are Robot-Assisted Therapy (RT) and Constraint-Induced Movement Therapy (CIMT), however, it is unknown whether there is a difference in the neuroplastic changes induced by these therapies, and if the modifications are related to motor improvement. Therefore, this study aims to identify neurophysiological biomarkers related to motor improvement of participants with chronic stroke that received RT or CIMT, and to test whether there is a difference in neuronal changes induced by these two therapies.
    Methods: This study included participants with chronic stroke that took part in a pilot experiment to compare CIMT vs. RT. Neurophysiological evaluations were performed with electroencephalography (EEG) and transcranial magnetic stimulation (TMS), pre and post rehabilitation therapy. Motor function was measured by the Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment Upper Limb (FMA-UL).
    Results: Twenty-seven participants with chronic stroke completed the present study [mean age of 58.8 years (SD ± 13.6), mean time since stroke of 18.2 months (SD ± 9.6)]. We found that changes in motor threshold (MT) and motor evoked potential (MEP) in the lesioned hemisphere have a positive and negative correlation with WMFT improvement, respectively. The absolute change in alpha peak in the unlesioned hemisphere and the absolute change of the alpha ratio (unlesioned/lesioned hemisphere) is negatively correlated with WMFT improvement. The decrease of EEG power ratio (increase in the lesioned hemisphere and decrease in the unlesioned hemisphere) for high alpha bandwidths is correlated with better improvement in WMFT. The variable "type of treatment (RT or CIMT)" was not significant in the models.
    Conclusion: Our results suggest that distinct treatments (RT and CIMT) have similar neuroplastic mechanisms of recovery. Moreover, motor improvements in participants with chronic stroke are related to decreases of cortical excitability in the lesioned hemisphere measured with TMS. Furthermore, the balance of both EEG power and EEG alpha peak frequency in the lesioned hemisphere is related to motor improvement.
    Language English
    Publishing date 2023-09-15
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2425477-0
    ISSN 1662-5161
    ISSN 1662-5161
    DOI 10.3389/fnhum.2023.1188806
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  3. Article ; Online: Robotic-Assisted Gait Training (RAGT) in Stroke Rehabilitation: A Pilot Study.

    Neves, Mariana Vita Milazzotto / Furlan, Leonardo / Fregni, Felipe / Battistella, Linamara Rizzo / Simis, Marcel

    Archives of rehabilitation research and clinical translation

    2023  Volume 5, Issue 1, Page(s) 100255

    Abstract: Objective: To compare the effects of 2 types of robotic-assisted gait training (RAGT) devices that have been used in stroke rehabilitation.: Design: Retrospective cohort.: Setting: Rehabilitation hospital.: Participants: 24 community dwelling ... ...

    Abstract Objective: To compare the effects of 2 types of robotic-assisted gait training (RAGT) devices that have been used in stroke rehabilitation.
    Design: Retrospective cohort.
    Setting: Rehabilitation hospital.
    Participants: 24 community dwelling people with stroke (N=24).
    Interventions: RAGT with either an
    Main outcome measures: The following tests/scales were employed before and after RAGT: Functional Ambulation Categories (FACs), timed Up and Go (TUG), 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), Trunk Impairment Scale, Dynamic Gait Index (DGI), Berg Balance Scale (BBS), and ability to climb stairs (time to climb 6 steps of 15 cm each; ability to climb stairs).
    Results: There were 5 dropouts, all from the
    Conclusions: Both
    Language English
    Publishing date 2023-01-22
    Publishing country United States
    Document type Journal Article
    ISSN 2590-1095
    ISSN (online) 2590-1095
    DOI 10.1016/j.arrct.2023.100255
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  4. Article ; Online: Two innovative Brazilian programs relating to road safety prevention. A case study.

    Carneiro, Leandro Piquet / Battistella, Linamara Rizzo

    Sao Paulo medical journal = Revista paulista de medicina

    2019  Volume 137Suppl, Issue Suppl, Page(s) 2–7

    Abstract: Background: The World Health Organization (WHO) 2017 Global Conference in Montevideo, Uruguay, was dedicated to promoting successful cases and best practices in fighting and preventing noncommunicable disease (NCDs). The global effort undertaken by WHO ... ...

    Abstract Background: The World Health Organization (WHO) 2017 Global Conference in Montevideo, Uruguay, was dedicated to promoting successful cases and best practices in fighting and preventing noncommunicable disease (NCDs). The global effort undertaken by WHO aims to reduce road traffic deaths in order to meet goal number 3.4 of the sustainable development goals.
    Objectives: To describe two Brazilian road safety prevention programs, presented at the WHO 2017 Global Conference: São Paulo Traffic Safety Movement (Movimento Paulista de Segurança no Trânsito) and Safe Life Program of Brasília (Programa Brasília Vida Segura), along with their governance structures, models and results.
    Design and setting: This was a descriptive case study conducted in São Paulo and Brasilia from 2015 to 2018. These programs aimed to reduce the number of deaths caused by road accidents to 8.3 deaths per 100,000 inhabitants in São Paulo by 2020 and in Brasília by 2016; and to reduce harmful use of alcohol by 10% by 2020.
    Methods: These two initiatives were designed, managed and operated to bring together government and civil society, i.e. industry, academia, non-governmental organizations (NGOs), etc., around the common goal of saving lives. They were collaborative and guided by sharing of best practices, learning and information, thereby making it possible to attain more and better results. Their format enables reproduction in cities across all Brazilian regions.
    Results: The results attest to the efficacy of the programs implemented in these two cities. In Brasília, the initiative helped reduce the number of traffic-related deaths by 35% (2017). In the same year in the state of São Paulo, 7,600 deaths were avoided.
    Conclusion: Both programs are innovative public policies that deal with health issues caused by the external agents that ultimately account for the rapid increase in days lost to disability. Prevention of external causes of deaths and injuries, such as traffic violence, strongly correlates with changes in habits and actions, especially excessive consumption of alcohol, and with NCDs in Brazil.
    MeSH term(s) Accidents, Traffic/mortality ; Accidents, Traffic/prevention & control ; Age Distribution ; Alcohol Drinking/mortality ; Alcohol Drinking/prevention & control ; Brazil/epidemiology ; Cities/statistics & numerical data ; Efficiency, Organizational ; Health Education/methods ; Humans ; Noncommunicable Diseases/mortality ; Noncommunicable Diseases/prevention & control ; Preventive Health Services/methods ; Preventive Health Services/statistics & numerical data ; Public-Private Sector Partnerships/organization & administration
    Language English
    Publishing date 2019-09-05
    Publishing country Brazil
    Document type Case Reports ; Journal Article
    ZDB-ID 1203171-9
    ISSN 1806-9460 ; 1516-3180 ; 0035-0362
    ISSN (online) 1806-9460
    ISSN 1516-3180 ; 0035-0362
    DOI 10.1590/1516-3180.2019.137150319lpc
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  5. Article ; Online: Distinct patterns of metabolic motor cortex activity for phantom and residual limb pain in people with amputations: A functional near-infrared spectroscopy study.

    Simis, Marcel / Marques, Lucas Murrins / Barbosa, Sara Pinto / Sugawara, André Tadeu / Sato, João Ricardo / Pacheco-Barrios, Kevin / Battistella, Linamara Rizzo / Fregni, Felipe

    Neurophysiologie clinique = Clinical neurophysiology

    2024  Volume 54, Issue 1, Page(s) 102939

    Abstract: Background: Phantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood.: Objectives: The aim ... ...

    Abstract Background: Phantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood.
    Objectives: The aim of this study was to understand, in patients with amputations, the association between PLP and residual limb pain (RLP), and the brain metabolic response in cortical motor circuits, using functional near-infrared spectroscopy (fNIRS).
    Methods: Sixty participants were recruited from the rehabilitation program in São Paulo, Brazil. Included patients were aged over 18 years, with traumatic unilateral lower-limb amputation, with PLP for at least 3 months after full recovery from amputation surgery. PLP and RLP levels were measured using visual analogue scales. fNIRS was performed during motor execution and motor mirror tasks for 20 s. In order to highlight possible variables related to variation in pain measures, univariate linear regression analyses were performed for both experimental conditions, resulting in four fNIRS variables (two hemispheres x two experimental conditions). Later, in order to test the topographic specificity of the models, eight multivariate regression analyses were performed (two pain scales x two experimental conditions x two hemispheres), including the primary motor cortex (PMC) related channel as an independent variable as well as five other channels related to the premotor area, supplementary area, and somatosensory cortex. All models were controlled for age, sex, ethnicity, and education.
    Results: We found that: i) there is an asymmetric metabolic activation during motor execution and mirror task between hemispheres (with a predominance that is ipsilateral to the amputated limb), ii) increased metabolic response in the PMC ipsilateral to the amputation is associated with increased PLP (during both experimental tasks), while increased metabolic response in the contralateral PMC is associated with increased RLP (during the mirror motor task only); ii) increased metabolic activity of the ipsilateral premotor region is associated with increased PLP during the motor mirror task; iii) RLP was only associated with higher metabolic activity in the contralateral PMC and lower metabolic activity in the ipsilateral inferior frontal region during motor mirror task, but PLP was associated with higher metabolic activity during both tasks.
    Conclusion: These results suggest there is both task and region specificity for the association between the brain metabolic response and the two different types of post-amputation pain. The metabolic predominance that is ipsilateral to the amputated limb during both tasks was associated with higher levels of PLP, suggesting a cortical motor network activity imbalance due to potential interhemispheric compensatory mechanisms. The present work contributes to the understanding of the underlying topographical patterns in the motor-related circuits associated with pain after amputations.
    MeSH term(s) Humans ; Adult ; Middle Aged ; Motor Cortex ; Spectroscopy, Near-Infrared ; Brazil ; Amputation, Surgical ; Phantom Limb/rehabilitation ; Lower Extremity
    Language English
    Publishing date 2024-02-20
    Publishing country France
    Document type Journal Article
    ZDB-ID 639421-8
    ISSN 1769-7131 ; 0987-7053
    ISSN (online) 1769-7131
    ISSN 0987-7053
    DOI 10.1016/j.neucli.2023.102939
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  6. Article ; Online: Non-invasive sound wave brain stimulation with Transcranial Pulse Stimulation (TPS) improves neuropsychiatric symptoms in Alzheimer's disease.

    Shinzato, Gilson Tanaka / Assone, Tatiane / Sandler, Paulo C / Pacheco-Barrios, Kevin / Fregni, Felipe / Radanovic, Marcia / Forlenza, Orestes Vicente / Battistella, Linamara Rizzo

    Brain stimulation

    2024  Volume 17, Issue 2, Page(s) 413–415

    Abstract: Background: This study explores Transcranial Pulse Stimulation (TPS) as a potential non-invasive treatment for Alzheimer's disease (AD), focusing on its impact on cognitive functions and behavioral symptoms.: Methods: In a prospective, one-arm open- ... ...

    Abstract Background: This study explores Transcranial Pulse Stimulation (TPS) as a potential non-invasive treatment for Alzheimer's disease (AD), focusing on its impact on cognitive functions and behavioral symptoms.
    Methods: In a prospective, one-arm open-label trial, ten patients with mild to moderate dementia due to AD were assessed using the Alzheimer's Disease Assessment Scale (ADAS-Cog), Neuropsychiatric Inventory (NPI), Pfeffer Functional Activities Questionnaire, and Zarit Caregiver Burden Interview. Assessments occurred at 30- and 90-days post-treatment. The TPS protocol consisted of 10 sessions over five weeks, using the Neurolith® device to deliver 6000 focused shockwave pulses at 0.25 mJ/mm2 and a frequency of 4 Hz.
    Results: TPS significantly reduced neuropsychiatric symptoms, with NPI scores decreasing by 23.9 points (95% CI: -39.19 to -8.61, p = 0.0042) after 30 days, and by 18.9 points (95% CI: -33.49 to -2.91, p = 0.022) after 90 days. These changes had large effect sizes (Cohen's dz = 1.43 and dz = 0.94, respectively). A decreasing trend was observed in the ADAS-Cog score (-3.6, 95% CI: -7.18 to 0.00, p = 0.05) after 90 days, indicating a potential reduction in cognitive impairment, though not statistically significant.
    Conclusion: The preliminary results indicate that TPS treatment leads to significant improvement in neuropsychiatric symptoms in AD patients, showing promise as a therapeutic approach for AD. Further research is needed to fully establish its effectiveness, especially concerning cognitive functions.
    MeSH term(s) Humans ; Alzheimer Disease/therapy ; Male ; Female ; Aged ; Transcranial Direct Current Stimulation/methods ; Prospective Studies ; Aged, 80 and over ; Treatment Outcome ; Neuropsychological Tests ; Cognition/physiology
    Language English
    Publishing date 2024-03-20
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Clinical Trial ; Letter
    ZDB-ID 2394410-9
    ISSN 1876-4754 ; 1935-861X
    ISSN (online) 1876-4754
    ISSN 1935-861X
    DOI 10.1016/j.brs.2024.03.007
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  7. Article ; Online: Body temperature of healthy men evaluated by thermography: A study of reproducibility.

    Alfieri, Fábio Marcon / Battistella, Linamara Rizzo

    Technology and health care : official journal of the European Society for Engineering and Medicine

    2018  Volume 26, Issue 3, Page(s) 559–564

    Abstract: Background: Thermography is a safe, painless, and efficient method for checking the temperature of the skin.: Objective: Was to assess the pattern of skin temperature of healthy men, as well as to verify the reproducibility of the method.: Methods!# ...

    Abstract Background: Thermography is a safe, painless, and efficient method for checking the temperature of the skin.
    Objective: Was to assess the pattern of skin temperature of healthy men, as well as to verify the reproducibility of the method.
    Methods: This cross-sectional observational study was conducted with 30 men evaluated by thermography in two moments by using an infrared camera (FLIR +T650SC®). The skin temperature of 24 regions of interest (ROI) was measured.
    Results: The mean difference in temperature of 10 ROIs in the two evaluations was not statistically significant. The comparisons of the ΔTsk between the right and left sides by the two evaluations showed no differences. The intra-class correlation coefficient (ICC) between the two moments of evaluation were statistically significant, where the dorsal measurements (Left forearm and Right dorsal arm) showed poor correlations and the others ranged from moderate to strong. Greater reproducibility was confirmed for ventral and dorsal hand ROIs; however, they presented the highest coefficient of variation (9% and 8%).
    Conclusion: There is a similarity between the temperatures of the ROIs and the reproducibility in 22 of the 24 ROIs varies from moderate to strong, showing that thermography is a reproducible method in healthy men.
    MeSH term(s) Adult ; Body Temperature ; Cross-Sectional Studies ; Humans ; Male ; Reproducibility of Results ; Skin Temperature ; Thermography/methods ; Thermography/standards
    Language English
    Publishing date 2018-03-22
    Publishing country Netherlands
    Document type Journal Article ; Observational Study
    ZDB-ID 1159961-3
    ISSN 1878-7401 ; 0928-7329
    ISSN (online) 1878-7401
    ISSN 0928-7329
    DOI 10.3233/THC-171164
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  8. Article ; Online: Characterisation of Phantom Limb Pain in Traumatic Lower-Limb Amputees.

    Sugawara, André Tadeu / Simis, Marcel / Fregni, Felipe / Battistella, Linamara Rizzo

    Pain research & management

    2021  Volume 2021, Page(s) 2706731

    Abstract: Introduction: There is no diagnosis for phantom limb pain (PLP), and its investigation is based on anamnesis, which is subject to several biases. Therefore, it is important to describe and standardize the diagnostic methodology for PLP.: Objective: ... ...

    Abstract Introduction: There is no diagnosis for phantom limb pain (PLP), and its investigation is based on anamnesis, which is subject to several biases. Therefore, it is important to describe and standardize the diagnostic methodology for PLP.
    Objective: To characterise PLP and, secondarily, to determine predictors for its diagnosis.
    Results: A total of 55 eligible patients participated in the study; most were male, young, above-knee amputees in the preprosthetic phase of the rehabilitation. The median PLP VAS was 60 (50-79.3) mm characterised by 13 (6-20) different descriptors in the same patient, which coexist, alternate, and add up to a frequency of 3.94 (2.5-4.38) times per week. The most frequent descriptor was movement of the phantom limb (70.91%). Tingling, numbness, flushing, itchiness, spasm, tremor, and throbbing are statistically significant PLP descriptor numbers per patient predicted by above-knee amputation, prosthetic phase, higher education level, and greater PLP intensity by VAS (
    Conclusion: PLP is not a single symptom, but a set with different sensations and perceptions that need directed and guided anamnesis for proper diagnosis.
    MeSH term(s) Adult ; Amputation ; Amputees ; Cross-Sectional Studies ; Humans ; Lower Extremity ; Male ; Middle Aged ; Phantom Limb/diagnosis ; Phantom Limb/etiology
    Language English
    Publishing date 2021-12-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2041085-2
    ISSN 1918-1523 ; 1203-6765
    ISSN (online) 1918-1523
    ISSN 1203-6765
    DOI 10.1155/2021/2706731
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  9. Article ; Online: Virtual interviews between medical students and in-patients during COVID-19 pandemic.

    Rios, Izabel Cristina / Imamura, Marta / Garcia, Maria Lúcia Bueno / Battistella, Linamara Rizzo

    Medical education

    2021  Volume 55, Issue 5, Page(s) 663

    MeSH term(s) Brazil ; COVID-19 ; Clinical Competence ; Education, Distance ; Education, Medical, Undergraduate ; Faculty, Medical ; Humanism ; Humans ; Inpatients ; Interviews as Topic ; Students, Medical
    Language English
    Publishing date 2021-03-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 195274-2
    ISSN 1365-2923 ; 0308-0110
    ISSN (online) 1365-2923
    ISSN 0308-0110
    DOI 10.1111/medu.14503
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  10. Article ; Online: Digital Platform to Continuously Monitor Patients Using a Smartwatch: Preliminary Report.

    Bin, Kaio Jia / De Pretto, Lucas Ramos / Sanchez, Fabio Beltrame / Battistella, Linamara Rizzo

    JMIR formative research

    2022  Volume 6, Issue 9, Page(s) e40468

    Abstract: Background: Monitoring vital signs such as oximetry, blood pressure, and heart rate is important to follow the evolution of patients. Smartwatches are a revolution in medicine allowing the collection of such data in a continuous and organic way. However, ...

    Abstract Background: Monitoring vital signs such as oximetry, blood pressure, and heart rate is important to follow the evolution of patients. Smartwatches are a revolution in medicine allowing the collection of such data in a continuous and organic way. However, it is still a challenge to make this information available to health care professionals to make decisions during clinical follow-up.
    Objective: This study aims to build a digital solution that displays vital sign data from smartwatches, collected remotely, continuously, reliably, and from multiple users, with trigger warnings when abnormal results are identified.
    Methods: This is a single-center prospective study following the guidelines "Evaluating digital health products" from the UK Health Security Agency. A digital platform with 3 different applications was created to capture and display data from the mobile phones of volunteers with smartwatches. We selected 80 volunteers who were followed for 24 weeks each, and the synchronization interval between the smartwatch and digital solution was recorded for each vital sign collected.
    Results: In 14 weeks of project progress, we managed to recruit 80 volunteers, with 68 already registered in the digital solution. More than 2.8 million records have already been collected, without system downtime. Less than 5% of continuous heart rate measurements (bpm) were synchronized within 2 hours. However, approximately 70% were synchronized in less than 24 hours, and 90% were synchronized in less than 119 hours.
    Conclusions: The digital solution is working properly in its role of displaying data collected from smartwatches. Vital sign values are being monitored by the research team as part of the monitoring of volunteers. Although the digital solution proved unsuitable for monitoring urgent events, it is more than suitable for use in outpatient clinical use. This digital solution, which is based on cloud technology, can be applied in the future for telemonitoring in regions lacking health care professionals. Accuracy and reliability studies still need to be performed at the end of the 24-week follow-up.
    Language English
    Publishing date 2022-09-15
    Publishing country Canada
    Document type Journal Article
    ISSN 2561-326X
    ISSN (online) 2561-326X
    DOI 10.2196/40468
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