JANINI CHEN

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Lattes
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P IOT, Hospital das Clínicas, Faculdade de Medicina
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina

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  • article 23 Citação(ões) na Scopus
    Gait, posture and cognition in Parkinson's disease
    (2016) BARBOSA, Alessandra Ferreira; CHEN, Janini; FREITAG, Fernanda; VALENTE, Debora; SOUZA, Carolina de Oliveira; VOOS, Mariana Callil; CHIEN, Hsin Fen
    ABSTRACT Gait disorders and postural instability are the leading causes of falls and disability in Parkinson's disease (PD). Cognition plays an important role in postural control and may interfere with gait and posture assessment and treatment. It is important to recognize gait, posture and balance dysfunctions by choosing proper assessment tools for PD. Patients at higher risk of falling must be referred for rehabilitation as early as possible, because antiparkinsonian drugs and surgery do not improve gait and posture in PD.
  • article 2 Citação(ões) na Scopus
    Rehabilitation in patients with cerebellar ataxias
    (2022) CHIEN, Hsin Fen; ZONTA, Marise Bueno; CHEN, Janini; DIAFERIA, Giovana; VIANA, Celiana Figueiredo; TEIVE, Helio Afonso Ghizoni; PEDROSO, Jose Luiz; BARSOTTINI, Orlando Graziani Povoas
    Cerebellar ataxias comprise a heterogeneous group of diseases characterized by motor and non-motor symptoms, which can be acquired, degenerative, or have a genetic cause, such as spinocerebellar ataxias (SCA). Usually, the genetic and neurodegenerative forms of cerebellar ataxias present a progressive and inevitable worsening of the clinical picture so that rehabilitation treatment is fundamental. Rehabilitation treatment includes physical therapy, respiratory therapy, speech, voice and swallowing therapy, occupational therapy, and new technologies, such as the use of exergames. The current treatment of patients with cerebellar ataxias, especially neurodegenerative forms, genetic or not, should include these different forms of rehabilitation, with the main objective of improving the quality of life of patients.
  • article 22 Citação(ões) na Scopus
    Cognitive or Cognitive-Motor Executive Function Tasks? Evaluating Verbal Fluency Measures in People with Parkinson's Disease
    (2017) BARBOSA, Alessandra Ferreira; VOOS, Mariana Callil; CHEN, Janini; FRANCATO, Debora Cristina Valente; SOUZA, Carolina de Oliveira; BARBOSA, Egberto Reis; CHIEN, Hsin Fen; MANSUR, Leticia Lessa
    Introduction. Executive function deficits are observed in people with Parkinson's disease (PD) from early stages and have great impact on daily living activities. Verbal fluency and oral diadochokinesia involve phonarticulatory coordination, response inhibition, and phonological processing and may also be affected in people with PD. This study aimed to describe the performance of PD patients and an age-and education-matched control group on executive function, verbal fluency, and oral diadochokinesia tests and to investigate possible relationships between them. Methods. Forty people with PD and forty controls were evaluated with Trail Making Test (TMT, executive function) and phonemic/semantic verbal fluency and oral diadochokinesia (/pataka/) tests. Groups were compared by ANOVA and relationships were investigated by Pearson tests. Results. People with PD showed longer times in parts A and B of TMT. They also said fewer words in phonemic/semantic verbal fluency tests and less syllables in the diadochokinesia test. Oral diadochokinesia strongly correlated to parts A and B of TMT and to phonemic verbal fluency. Conclusion. Oral diadochokinesia was correlated to executive function and verbal fluency. The cognitive-motor interaction in verbal fluency and oral diadochokinesia must be considered not to overestimate the cognitive or motor impairments in people with PD.
  • article 16 Citação(ões) na Scopus
    Relationship Between Posturography, Clinical Balance and Executive Function in Parkinson ' s Disease
    (2019) SOUZA, Carolina de Oliveira; VOOS, Mariana Callil; BARBOSA, Alessandra Ferreira; CHEN, Janini; FRANCATO, Debora Cristina Valente; MILOSEVIC, Matija; POPOVIC, Milos; FONOFF, Erich Talamoni; CHIEN, Hsin Fen; BARBOSA, Egberto Reis
    This study aimed to evaluate the relationship between posturography, clinical balance, and executive function tests in Parkinson ' s disease (PD). Seventy-one people participated in the study. Static posturography evaluated the center of pressure fluctuations in quiet standing and dynamic posturography assessed sit-to-stand, tandem walk, and step over an obstacle. Functional balance was evaluated by Berg Balance Scale, MiniBESTest, and Timed Up and Go test. Executive function was assessed by Trail Making Test (TMT) and semantic verbal fluency test. Step over obstacle measures (percentage of body weight transfer and movement time) were moderately correlated to Timed Up and Go, part B of TMT and semantic verbal fluency (r > 0.40; p < 0.05 in all relationships). Stepping over an obstacle assesses the responses to internal perturbations. Participants with shorter movement times and higher percentage of body weight transfer (higher lift up index) on this task were also faster in Timed Up and Go, part B of TMT, and semantic verbal fluency. All these tasks require executive function (problem solving, sequencing, shifting attention), which is affected by PD and contribute to postural assessment.
  • article 5 Citação(ões) na Scopus
    Effects of resistance training on postural control in Parkinson's disease: a randomized controlled trial
    (2021) CHEN, Janini; CHIEN, Hsin Fen; FRANCATO, Debora Cristina Valente; BARBOSA, Alessandra Ferreira; SOUZA, Carolina de Oliveira; VOOS, Mariana Callil; GREVE, Julia Maria D'Andrea; BARBOSA, Egberto Reis
    Background: Postural instability affects Parkinson's disease (PD) patients' postural control right from the early stages of the disease. The benefits of resistance training (RT) for balance and functional capacity have been described in the literature, but few studies have been conducted showing its effects on PD patients' postural control. Objective: To investigate the effects of a three-month RT intervention on static posturography (SP) measurements and clinical functional balance assessment among PD patients. Methods: Seventy-four patients were randomly assigned to a three-month RT intervention consisting of using weightlifting machines at a gym (gym group) or RT consisting of using free weights and elastic bands (freew group), or to a control group. The participants were evaluated at baseline, three months and six months. We evaluated changes of SP measurements under eyes-open, eyes-closed and dual-task conditions (primary endpoint), along with motor performance and balance effects by means of clinical scales, dynamic posturography and perceptions of quality of life (secondary endpoints). Results: There were no significant interactions in SP measurements among the groups. Unified Parkinson Disease Rating Scale (UPDRS-III) motor scores decreased in both RT groups (p<0.05). Better perceived quality of life for the mobility domain was reported in the gym group while functional balance scores improved in the freew group, which were maintained at the six-month follow-up (p<0.05). Conclusions: This study was not able to detect changes in SP measurements following a three-month RT intervention. Both RT groups of PD patients showed improved motor performance, with positive balance effects in the freew group and better perceived quality of life in the gym group.
  • article 44 Citação(ões) na Scopus
    Anti-Nerve Growth Factor in the Treatment of Low Back Pain and Radiculopathy: A Systematic Review and a Meta-Analysis
    (2014) LEITE, Victor F.; BUEHLER, Anna M.; ABD, Omar El; BENYAMIN, Ramsin M.; PIMENTEL, Daniel C.; CHEN, Janini; HSING, Wu Tu; MAZLOOMDOOST, Danesh; AMADERA, Joao E. D.
    Background: Low back pain with or without radiculopathy is an important cause of disability and economic expenditure. However, many patients are not meeting optimal pain control through existing treatments. Recent studies have linked nerve growth factor (NGF) and the pathophysiology of persistent pain. Anti-NGF could be an alternative drug treatment for low back pain. Objective: Systematically review the efficacy and safety of anti-NGF in the treatment of low back pain. Methods: A systematic review of the literature with no language, date or publication status restriction, using Medline, EMBASE, Cochrane Library, and the clinicaltrials. gov database. Additional literature was retrieved by conferring with experts in the field or reviewing bibliographies and annals of meetings and congresses. Search terms included ""monoclonal antibodies,"" "" nerve growth factor,"" ""anti-ngf,"" ""fulranumab,"" ""tanezumab,"" "" sciatica,"" "" back pain,"" and ""spine."" Study Design: Inclusion criteria were observational studies with safety as an outcome and randomized or nonrandomized controlled trials studying the efficacy and/or the safety of anti-NGF drugs on low back pain. Exclusion criteria included patients with autoimmune conditions or osteoporosis. Studies were assessed independently by 2 authors regarding inclusion/exclusion criteria, risk of bias, clinical relevance, and quality of evidence (GRADE approach). Results: 1,168 studies were retrieved. After excluding duplicates and applying the inclusion/exclusion criteria, 4 RCTs remained (n = 2,109): 2 for tanezumab, one for REGN475, and one for fulranumab. Only the tanezumab studies showed any significant difference over placebo (n = 1,563) for both pain relief and functional improvement. Conclusions: There is very low evidence that systemically administered anti-NGF therapy has a small positive effect compared to placebo for both pain relief (standarized mean difference [SMD] = -0.29, 95% confidence interval [CI] -0.58 to 0.00) and functional improvement (SMD = -0.21, 95% CI -0.37 to -0.05) of low back pain. There was low evidence of adverse effects (AEs) compared to placebo and low evidence of neurological AEs than placebo (relative risk = 1.93, 95% CI 1.41 to 2.64). Tanezumab, as a specific anti-NGF treatment, showed low evidence of a small to moderate effect for pain relief of low back pain (SMD = -0.44, 95% CI -0.81 to -0.07); and low evidence of a small effect for functional improvement (SMD = -0.26, 95% CI -0.40 to -0.12) with systemic administration, although not clinically significant. Tanezumab and anti-NGFs overall had, respectively, moderate and low evidence of overall AEs and serious AEs and a higher risk of developing neurological AEs when compared with placebo. Although anti-NGF, specifically tanezumab, showed a low-to-moderate effect on pain relief and functional improvement, it cannot be recommended for low back pain treatment. Without more research on the pathophysiology of anti-NGFs and adverse effects, its use is not safe in the overall population. However, as corroborated by the US Food and Drug Administration, this meta-analysis underscores a role for greater insight into anti-NGF therapy for painful conditions that are refractory to current drugs, such as oncologic pain, chronic pancreatitis, and phantom-limb pain. Given the pathophysiology of axial pain involving inflammatory mediators and the adverse effects of systemic anti-NGF use, consideration of local therapies may warrant further exploration.
  • article 76 Citação(ões) na Scopus
    Changes in Pressure Pain Threshold in Patients With Chronic Nonspecific Low Back Pain
    (2013) IMAMURA, Marta; CHEN, Janini; MATSUBAYASHI, Suely Reiko; TARGINO, Rosa A.; ALFIERI, Fabio Marcon; BUENO, Daniel Kamura; HSING, Wu Tu
    Study Design. Cross-sectional study. Objective. The purpose of this study is to compare pressure pain threshold (PPT) values between patients with chronic nonspecific low back pain (CLBP) and healthy individuals and correlate PPT values of the structures investigated with demographic and clinical data from patients with CLBP. Summary of Background Data. Chronic pain may decrease pain tolerance of almost the entire spinal cord segment; however, previous studies on PPT in patients with low back pain have limited their focus to evaluating only patient complaints. Methods. Forty subjects participated in the study: 20 with a clinical diagnosis of CLBP and 20 healthy individuals. Outcome measures were PPT values of myotomes, sclerotomes, and dermatomes corresponding to segments L1 to S3; demographic, clinic, and social data; visual analogue scale, and Roland and Morris Questionnaire. Results. Most analyzed structures had lower PPT values in patients with CLBP than in healthy individuals on both sides (bilaterally). PPT correlated positively with height and pain duration (P < 0.05) and negatively with body mass index in the suprainterspinous ligament between L2 and L3 and dermatomes L5 to S2 (P < 0.05). Conclusion. Our results showed that individuals with CLBP have lower PPT values than healthy individuals in almost all assessed structures. We propose a simple approach that can differentiate patients with CLBP whose hyperalgesia in the painful area may be the result of several mechanisms that should be further investigated, such as sensitization of the central nervous system.
  • conferenceObject
    Executive function and verbal fluency in patients with Parkinson's disease
    (2016) BARBOSA, A. F.; VOOS, M. C.; SOUZA, C. O.; CHEN, J.; CHIEN, H. F.; FRANCATO, D. V.; BARBOSA, E. R.; MANSUR, L. L.
  • article 30 Citação(ões) na Scopus
    Anti-Tumor Necrosis Factor Antagonists in the Treatment of Low Back Pain and Radiculopathy: A Systematic Review and Meta-analysis
    (2014) PIMENTEL, Daniel C.; ABD, Omar El; BENYAMIN, Ramsin M.; BUEHLER, Anna M.; LEITE, Victor F.; MAZLOOMDOOST, Danesh; CHEN, Janini; HSING, Wu Tu; AMADERA, Joao E. D.
    Background: Low back pain, with or without radiculopathy, is an important cause of disability and economic expenditure. However, many patients are not achieving optimal pain control with existing medications. Tumor necrosis factor antagonists (anti-TNF alpha) could be an alternative drug treatment. Objectives: Systematic review the efficacy and safety of anti-TNF alpha in the treatment of low back pain with or without radiculopathy. Study Design: Inclusion criteria were observational studies with safety as an outcome, and randomized or nonrandomized controlled trial (RCT) studies on efficacy and/or safety of anti-TNF alpha drugs on low back pain. Exclusion criteria included patients with auto-immune conditions or osteoporosis. Results: Studies were assessed independently by 2 authors regarding inclusion/exclusion criteria, risk of bias, clinical relevance, quality, and strength of evidence (GRADE approach). Of the 1,179 studies retreived, all duplicates were excluded and then the inclusion/exclusion criteria was applied. One observational study (n = 143) and 11 RCTs remained (n = 539): 8 for etanercept (n = 304), one for adalimumab (n = 61), one for adalimumab and etanercept (n = 60), one for infliximab (n = 40) and one for REN-1654 (n = 74). Only 3 etanercept and 2 adalimumab studies showed statistically significant pain relief when compared to placebo. There was no difference in the overall incidence of adverse effects when comparing anti-TNF-alpha and placebo. Limitations: Despite the statistically significant effect, this meta-analysis has important limitations, such as high heterogeneity and high use of outcome imputation. Conclusions: There is low evidence that epidural etanercept has a low-to-moderate effect size when compared to placebo for pain due to discogenic lumbar radiculopathy (5 studies, n=185), with a standardized mean difference = -0.43 (95% confidence interval [CI] -0.84 to -0.02). There is moderate evidence that epidural etanercept does not have a higher adverse effects incidence rate when compared to placebo for discogenic lumbar radiculopathy (5 studies, n = 185) with a relative risk (RR) = 0.84 (95% CI 0.53 to 1.34). There is moderate evidence that anti-TNF alpha does not have a higher adverse effects incidence rate when compared to placebo for low back pain (10 studies, n= 343) with an RR = 0.93 (95% CI 0.56 to 1.55). We strongly suggest that anti-TNF alpha continue to be studied in experimental settings for the treatment of low back pain. We cannot currently recommend this therapy in clinical practice. New research could shed some light on the efficacy of anti-TNF alpha and change this recommendation in the future.
  • article 21 Citação(ões) na Scopus
    The competition with a concurrent cognitive task affects posturographic measures in patients with Parkinson disease
    (2015) BARBOSA, Alessandra Ferreira; SOUZA, Carolina de Oliveira; CHEN, Janini; FRANCATO, Debora Valente; CAROMANO, Fatima Aparecida; CHIEN, Hsin Fen; BARBOSA, Egberto Reis; GREVE, Julia Maria D'Andrea; VOOS, Mariana Callil
    Objectives: To estimate the impact of a sensory-motor-cognitive task on postural balance, in Parkinson disease patients (Hoehn and Yahr 2-3) and to investigate possible relationships between posturography and functional balance clinical scales. Method: Parkinson disease patients (n = 40) and healthy controls (n = 27) were evaluated with fluency tests, Berg Balance scale, Mini Best test and static posturography on the conditions eyes open, eyes closed and dual-task (simultaneous balance and fluency tasks). Results: Posturographic data showed that Parkinson disease patients performed worse than controls in all evaluations. In general, balance on dual-task was significantly poorer than balance with eyes closed. Posturographic data were weakly correlated to clinical balance scales. Conclusion: In clinical practice, Parkinson disease patients are commonly assessed with eyes closed, to sensitize balance. Our study showed that adding a cognitive task is even more effective. Static posturographic data should be carefully overgeneralized to infer functional balance impairments.