Efeitos de um protocolo de reeducação sensorial da mão: estudo de caso

Uma paciente em pós-operatório de reparo das lesões dos tendões flexores e nervo digital do 5o dedo da mão direita foi estudada com o objetivo de avaliar os efeitos da aplicação de um protocolo de reeducação sensorial da mão. A paciente foi avaliada antes e após três meses da aplicação do protocolo. Nessas avaliações foram aplicados: teste de limiar de sensibilidade com monofilamentos, teste de discriminação de dois pontos estático e dinâmico, o questionário Dash (sigla em inglês de incapacidades de ombro, braço e mão) e testes de força de preensão palmar e de pinça. Os exercícios propostos envolveram: discriminação de toque estático e dinâmico e de objetos de diferentes formas, tamanhos e texturas. A paciente também foi orientada a executar programa domiciliar. Foi realizada a análise descritiva dos dados. Ao final dos três meses, verificou-se redução do limiar sensitivo na região volar do 5º dedo, bem como desenvolvimento de discriminação estática de dois pontos nessa região. Além disso, verificou-se aumento das forças de preensão palmar e de pinça e menor pontuação no questionário Dash. Os resultados sugerem que a aplicação de programas de reeducação da sensibilidade pode contribuir para a recuperação da função sensorial da mão, trazendo benefícios reais ao paciente.A patient who had undergone nerve injury repair surgery of the right-hand 5th-finger flexor tendons and digital nerve was studied in order to assess the effects of a hand sensory reeducation program. The patient was evaluated before and after the three-month program application, as to: touch pressure threshold (by monofilaments); static and moving two-point discrimination; pinch strength; and answered the Dash - Disabilities of the arm, shoulder and hand - questionnaire. The proposed exercises involved static and moving touch discrimination, and recognition of different shapes, sizes and textures. The patient was also guided to do the exercises at home. After the three-month program, a pressure threshold reduction was noticed in the 5th-finger volar region, as well as a static two-point discrimination improvement in the same area. Also, an increase of grip and pitch strength and a minor score in the Dash questionnaire were found. Results thus suggest that the sensorial reeducation program proposed may contribute to improving hand sensory function, bringing real benefits to the patient

Interdisciplinary Therapy for patients with dementia

Patients with dementia require rehabilitation involving several health professionals, where interdisciplinary care can further enhance the routine of patients and their families.OBJECTIVE:To compare the functional performance of elderly with dementia before and after an interdisciplinary intervention program provided by a healthcare service of medium complexity.METHODS: Three cases with clinically-confirmed dementia enrolled on an interdisciplinary rehabilitation program were reported. The following instruments were applied: Mini Mental-State Exam, Clinical Dementia Rating, Geriatric Depression Scale, Lawton & Brody Index, and the Functional Independence Measure for adults (FIM). The therapeutic strategies were individualized and designed based on patient performance on the FIM, according to the criteria of the Classification of Functionality, Disability and Health, implemented at the house of therapy of the Center for Integrated Rehabilitation together with provision of guidance.RESULTS: A reduction in functional dependence was observed after intervention, evidenced by less supervision needed to carry out Activities of Daily Living. Conclusion: The three patients benefited from the interdisciplinary intervention