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Capato T.1,2, Gonçalves R.1, Maciel L.1, Kayo I.2, Ferreira A.2, Tornai J.2, Barbosa E.R.1, Piemonte M.E.1
1University of São Paulo, Physicaltherapy, São Paulo, Brazil, 2PHYSICAL, Physicaltherapy, Sāo Paulo, Brazil
Background: Parkinson's Disease (PD) is a neurodegenerative disease, and current clinical bradykinesia assessment tools do not aim to help clinicians identify the underlying movement control systems responsible for poor functional activity in people with Parkinson's disease (pwp). By identifying the disordered systems underlying functional movements control, physical therapists can assist in clinical diagnosis, and target the program specific types of intervention for different types of functional activities and dexterity problems.
Purpose: The goal of this study was to develop a clinical functional activities assessment of upper limb function skills tool that aims to target different movements control systems so that specific rehabilitation approaches can be targeted for different functional tasks. In a secondarily analysis we determine the correlation between upper limb function skills with falls and balance.
Methods: In 1 interrater trials, cohort 80 subjects with idiopathic PD H&Y 1 to 4, ranging in age from 55 to 88 years old. They were recruited from the Movement Disorders Ambulatory Clinic of the University of São Paulo Faculty of Medicine Clinics Hospital, and rated concurrently on the Brief Battery Functional Assessment (BBFA) by 04 therapists, 04 students, and Parkinsons Disease researchers. Balance was assessed by MiniBest and Falls Efficacy Scale-International. The number of falls will be registered by the physiotherapist at the hospital and by the patient at home. Concurrent validity was measured by correlation between the BBFA and balance confidence, as assessed with the M-PAS. The BBFA consists of 12 items, grouped into 06 systems: Biomechanical impairments (strength, flexibility, tone, range of motion), Bradykinesia, Coordination, Anticipatory and Compensatory Postural Adjustments, Sensory Orientation, and Dexterity.
Results: Consistent with our theoretical framework, pwp scored poorly on different sections of the BBFA. In comparison with normal subjects these results of this subjects were worse. There were a strong intraclass correlation (P 0,01) and variability (P 0,01). There was a strong correlation with balance, falls and the decrease in range of motion, dexterity and bradykinesia.
Conclusion(s): BBFA allows clinicians to identify the type of motor control problems to direct specific treatments for patients. It is a good clinical tool to evaluate motor control of upper limbs in all stages of H&Y. Useful to correlate balance and poor upper limb function skills.
Implications: The BBFA is easy to learnt and to be managed, with excellent reliability and very good validity. Further testing is needed to determine whether:
(1) the sections of the BBFA actually detect upper limb motor deficits,
(2) other systems important for motor control should be added, and
(3) a shorter version of the test is possible by insensitive items.
Funding acknowledgements: FMUSP
Topic: Neurology: Parkinson's disease
Ethics approval: Ethics Committee of the University of São Paulo Faculty of Medicine - 1.102.464
All authors, affiliations and abstracts have been published as submitted.
