OBJECTIVES:Acute post-stroke patients present cardiovascular autonomic dysfunction, which manifests as lower heart rate variability and impaired baroreflex sensitivity. However, few studies performed to date have evaluated cardiovascular autonomic function in chronic post-stroke patients. The aim of this study was to evaluate cardiovascular autonomic modulation in chronic post-ischemic stroke patients.METHODS:The seventeen enrolled subjects were divided into a stroke group (SG, n=10, 5±1 years after stroke) and a control group (CG, n=7). Non-invasive curves for blood pressure were continuously recorded (Finometer®) for 15 minutes while the subject was in a supine position. Heart rate variability and blood pressure variability were analyzed in the time and frequency domains.RESULTS:No differences were observed in systolic and diastolic pressure and heart rate between post-stroke patients and healthy individuals. The SG group had lower indexes for heart rate variability in the time domain (standard deviation of normal to normal R-R intervals, SDNN; variance of normal to normal R-R intervals, VarNN; and root mean square differences of successive R-R intervals, RMSSD) and a lower high-frequency band for heart rate variability than was observed in the CG. Systolic blood pressure variability and the low-frequency band for systolic pressure were higher in post-stroke patients, while the alpha index was lower in the SG than in the CG.CONCLUSION:After ischemic stroke, affected patients present chronically reduced heart rate variability, impaired cardiac vagal modulation, increased systolic blood pressure variability and higher sympathetic vascular modulation along with impaired baroreflex sensitivity, which can increase the risk of cardiovascular events, despite adequate blood pressure control.

Aims: (Stroke patients often present sensory-motor alterations and less aerobic capacity. Joint position sense, which is crucial for balance and gait control, is also affected in stroke patients). To compare the effect of two exercise training protocols (walking in deep water and on a treadmill) on the knee position sense of stroke patients. Methods: This study was designed as a randomized controlled clinical trial. Twelve adults, who suffered a stroke at least one year prior to the start of the study, were randomly assigned to one of two groups: 1) pool group submitted to aerobic deep water walking training; and 2) the treadmill group which was submitted to aerobic walk on a treadmill. Measurements: The position sense, absolute error and variable error, of the knee joint was evaluated prior to and after nine weeks of aerobic training. Results: The pool group presented smaller absolute (13.9 o versus 6.1 o ; p < 0.05) and variable (9.2 o versus 3.9 o ; p < 0.05) errors after nine-weeks gait training than the treadmill group. Conclusions: Nineweek aerobic exercise intervention in aquatic environment improved precision in the position sense of the knee joint of stroke patients, suggesting a possible application in a rehabilitation program.

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We compared the effect of gait training on treadmill versus deep water on balance and gait in 12 ischemic stroke chronic survivors randomly sorted to the Pool or Treadmill Groups. Berg Scale (BBS) and timed up and go test (TUG) were applied before and after the interventions. Just one person applied all tests and she was blinded for the aims of the study. Surface EMG of the paretic and non-paretic (NP) side muscles were recorded during walking on a treadmill. Three 100-ms epochs were extracted from the EMG related to gait phases: weight acceptance; propulsion; and pre-strike. For each epoch, we calculated the RMS of the EMG signal. Participants did gait training for 9 weeks (3 times/week, 40 minutes/session). The Pool group did the deep-water walking with a swimming belt. The Treadmill group walked on the treadmill at the maximum speed they could stand. The Manova group compared the effect of training, group, side, muscles, and gait phase into the EMG. Anova was used to test the effect of training, group side, and gait phase into BBS, TUG and EMG variables. Pool and Treadmill had increased balance and agility. The highest EMG RMS occurred at the paretic side, for the Treadmill and after training. The mm. tibialis anterior, gastrocnemius lateralis, vastus lateralis, and biceps femoris presented the highest RMS for the NP side; while for mm. rectus femoris and semitendinosus, the paretic side presented the highest RMS. Thus, the both types of exercise lead to similar functional adaptations with different muscular activations during walking.

Introduction Throwing is considered the most important technical skill in Handball. However, it requires the athlete to perform this movement with maximum speed and accuracy, as it can define the final score of the game. Objective The aim of this study was to evaluate the effect of Proprioceptive Neuromuscular Facilitation, known as the Kabat method, on the throwing performance of handball athletes. Methods An experimental study of 18 male handball athletes with a mean age of 14 ± 1.13 years. The athletes were divided into two groups: control group (CG) and Kabat method group (KG). The athletes performed 16 training sessions, with analyses at the beginning and end of each session. Range of motion (ROM) of internal and external shoulder rotation, strength, muscle imbalance, throwing speed and accuracy were measured. The results were compared by the Student t-test of repeated measures. Results KG significantly increased external shoulder rotation and muscle strength in all the analyzed shoulder complex muscles. CG also increased strength, but not in all muscles. KG significantly increased the speed and accuracy of the pitch. Conclusion The Kabat method, through proprioceptive neuromuscular facilitation, significantly increased throwing performance, speed and accuracy in handball athletes when compared to the control group. Level of evidence III; Randomized Experimental Study.