Correlation between cognition and functional independence in male stroke patients

Stroke is a chronic disease that causes motor and cognitive sequelae and possible changes in functional capacity. This study aims to identify the levels of functional independence and cognition in male stroke patients and to verify the presence of correlations between them. For that, it was adopted a cross-sectional descriptive-correlational study with a convenience sample comprised by thirty (n=30) men. The Functional Independence Measure and the Mini-Mental State Examination were used for data gathering. For data analysis, the simple descriptive analysis and the Pearson correlation coefficient were adopted. The results showed the predominance of dependent subjects and high level of cognitive impairment as well as positive correlations between cognition and motor independence (r=0.827 p=0.000), cognitive independence (r=0.912 p=0.000), and total (r=0.882 p=0.000). These data demonstrate the impact of cognitive alterations in the functional independence of post-stroke subjects and suggest the need for specific interventions in occupational therapy destined to them.O acidente vascular cerebral é uma doença crônica que causa sequelas motoras e cognitivas e possíveis alterações na capacidade funcional. Este estudo objetivou identificar os níveis de independência funcional e cognição em homens com acidente vascular cerebral e verificar a presença de correlações entre essas variáveis. Para tanto, adotou-se um estudo transversal descritivo-correlacional com amostra de conveniência composta por trinta (n=30) homens adultos. Para a coleta de dados foram aplicados a Medida de Independência Funcional e o Mini Exame do Estado Mental. Para a análise dos dados adotou-se a análise descritiva simples e o coeficiente de correlação de Pearson. Os resultados demonstraram o predomínio de sujeitos dependentes e com altos índices de alterações cognitivas bem como correlações positivas fortes entre a cognição e a independência motora (r=0,827 p=0,000), cognitiva (r=0,912 p=0,000) e total (r=0,882 p=0,000). Esses dados demonstram o impacto das alterações cognitivas na independência funcional de sujeitos pós-AVC e sugerem a necessidade de intervenções específicas em terapia ocupacional destinadas a esses

The use of mobility assistive devices and the functional independence in stroke patients

Introduction: Post-stroke limitations may cause problems and lead to dependency in daily activities, which requires the use of mobility assistive devices. Objective: Identify the level of functional independence and the use of mobility assistive devices among men as well as to check the relationship between these variables. Method: It is a descriptive, correlational research using convenience sampling carried at medical centers specialized in physical rehabilitation in a medium size town of São Paulo state. Then, a Data Form of the patient with stroke and the Functional Independence Measure were used. The data were sent to a simple descriptive analysis and biserial test. Results: It showed predominance of stroke subjects dependent for the activities of daily life (63%), and those using mobility assistive devices (66.6%). The devices were wheelchairs (10), shower chairs (9), and canes (7). Moderate positive correlations between the use of mobility device and the motor functional independence (p<0.05 and r=0.617), and the total functional independence (p<0.05 and r=0.590) was also identified. Conclusion: Data demonstrate the possible impact in preventing mobility during daily activities, in particular motor activities among stroke subjects. That increases the need of occupational therapy interventions aiming at the mobility improvement among these subjects

Experience of a transdisciplinary team’s work along with servers in sick leave

Introduction: Actions towards public servers in sick leave in a transdisciplinary perspective are necessary, however, such studies are rare in a national context. Objective: This study aimed to present an overview of the work done by a transdisciplinary team, formed by an occupational therapy, a psychotherapist, and a social worker, in evaluating, monitoring and work reinsertion of public servers during sick leave from a city in São Paulo State. Method: The work consists in reporting a transdisciplinary team’s experience from a documental study of 326 servers in sick leave, attended by the team and whose absence of work occurred from March 2014 to January 2017. To this end, as experience qualifiers, the presented data was associated with the outlined profile of the attended servers and their period of absence, to the outcome of the cases after the team’s interventions. Results: The number of servers away from work was reduced, especially those cases distinguished by chronic periods, after work reinsertion interventions through adequate conditions, as well as prevention of new chronic cases, by early actions from the transdisciplinary team’s actions and intersectoral work. Conclusion: The article opens the discussion about the importance of a transdisciplinary work toward servers in sick leave, not only in a holistic evaluation of the functionality and incapability but also in the preparation to job reinsertion by fostering the work conditions compatible to servers functionalities

The efficacy of wheelchair skills training in the occupational performance and engagement of individuals with spinal cord injury

Introduction: Evidences indicate the efficacy of wheelchair skills training in participants with spinal cord injury in the use of the resource. However, its efficacy in the occupational performance and engagement of individuals with spinal cord injury is still unknown. Objectives: To assess the efficacy of wheelchair skills training in the occupational performance and engagement of individuals with spinal cord injury. Methods: We conducted a longitudinal prospective intervention study; it is a self-control clinical trial with mixed methods. We used a non-probability convenience sampling of 11 participants with spinal cord injury from a mid-sized city in the state of São Paulo. The intervention was performed in the participants’ community by an occupational therapist over an average period of 8 hours per participant. Only 7 out of the 11 of the therapists were formalized. For the initial evaluation (IE), we employed the following measures: (1) An Identification Form of the participant with spinal cord injury; (2) The Functional Independence Measure; (3) The Canadian Occupational Performance Measure; (4) The Wheelchair Skills Test - Questionnaire; (5) The Functional Mobility Assessment, and (6) The Quebec User Evaluation of Satisfaction with Assistive Technology 2.0. After the intervention, we conducted the Revaluation 1 (R1) and applied the measures (2), (3), (4), (5), and (6). After 1 month, Revaluation 2 (R2) was performed with the application of the same measures, with the addition of a semi-structured interview to assess the participants’ opinion of the training they received. The data went through simple, descriptive analysis, and also through the Friedman non-parametric test, the Conover multiple comparisons test, and content analysis. Results: We observed statistically significant differences, at a rate of 5%, between the IE and the R1 analyzes. The differences were observed in the functional independence, in the capacity, confidence and frequency of wheelchair use, and the participants’ satisfaction with the use of a wheelchair in their daily life. The results remained unaltered through the R2, except for the wheelchair skills performance. Furthermore, we observed qualitative reports of subjective experience, an active involvement in the occupation, and social and environmental interaction. Conclusion: Our results demonstrate the efficacy of the wheelchair skills training in the occupational performance and engagement of the participants with spinal cord injury. The findings point to the importance of such practices in community-oriented public services.Não recebi financiamentoIntrodução: Evidências apontam a eficácia do treinamento de habilidades com cadeiras de rodas no uso do recurso, todavia, ainda não existem evidências sobre sua eficácia no desempenho ocupacional e engajamento de sujeitos com lesão medular. Objetivo: Avaliar a eficácia do treinamento das habilidades com cadeiras de rodas no desempenho ocupacional e engajamento de sujeitos com lesão medular. Metodologia: Tratou-se de um estudo longitudinal prospectivo intervencional tipo ensaio clínico autocontrolado de abordagem mista, com amostra não-probabilística de conveniência composta por 11 sujeitos com lesão medular de uma cidade de médio porte do Estado de São Paulo. A intervenção foi realizada na comunidade, por uma terapeuta ocupacional. sendo finalizada com apenas 7 sujeitos, com mínimo de 8 horas de treinamento cada um. Na Avaliação Inicial (AI), foram aplicadas as seguintes medidas: (1) Formulário de Identificação do Sujeito com Lesão Medular; (2) Medida de Independência Funcional; (3) Medida Canadense de Desempenho Ocupacional; (4) Questionário de Teste de Habilidades com Cadeira de Rodas; (5) Avaliação da Mobilidade Funcional; e (6) Avaliação da Satisfação do Usuário com a Tecnologia Assistiva de Quebec 2.0. Após o término da intervenção, realizou-se a Reavaliação 1 (R1), na qual foram aplicadas as medidas: (2), (3), (4), (5) e (6). Após 1 mês, realizou-se a Reavaliação 2 (R2), sendo os instrumentos reaplicados acrescidos de uma entrevista semiestruturada para avaliar a opinião dos sujeitos sobre o treinamento recebido. Os dados foram analisados por meio da análise descritiva simples, teste não paramétrico de Friedman, teste de comparações múltiplas de Conover e análise de conteúdo. Resultados: Observaram-se diferenças estatisticamente significativas ao nível de 5% entre a AI e R1 na independência funcional, na capacidade, confiança e frequência das habilidades com cadeiras de rodas e satisfação com o uso da cadeira de rodas nas atividades de vida diária. Na R2 observou-se manutenção desses resultados, com exceção do desempenho nas habilidades com a cadeira de rodas. Observaram-se também relatos qualitativos de experiência subjetiva, envolvimento ativo na ocupação e interação social e ambiental. Conclusão: Os achados deste estudo demonstram a eficácia do treinamento de habilidades com cadeiras de rodas no desempenho ocupacional e engajamento de sujeitos com lesão medular, sugerindo a relevância desse tipo de prática em serviços públicos com ênfase na comunidade

Correlação entre independência funcional e cognição em homens com AVC

O acidente vascular cerebral é uma doença crônica que causa sequelas motoras e cognitivas e possíveis alterações na capacidade funcional. Este estudo objetivou identificar os níveis de independência funcional e cognição em homens com acidente vascular cerebral e verificar a presença de correlações entre essas variáveis. Para tanto, adotou-se um estudo transversal descritivo-correlacional com amostra de conveniência composta por trinta (n=30) homens adultos. Para a coleta de dados foram aplicados a Medida de Independência Funcional e o Mini Exame do Estado Mental. Para a análise dos dados adotou-se a análise descritiva simples e o coeficiente de correlação de Pearson. Os resultados demonstraram o predomínio de sujeitos dependentes e com altos índices de alterações cognitivas bem como correlações positivas fortes entre a cognição e a independência motora (r=0,827 p=0,000), cognitiva (r=0,912 p=0,000) e total (r=0,882 p=0,000). Esses dados demonstram o impacto das alterações cognitivas na independência funcional de sujeitos pós-AVC e sugerem a necessidade de intervenções específicas em terapia ocupacional destinadas a esses.Stroke is a chronic disease that causes motor and cognitive sequelae and possible changes in functional capacity. This study aims to identify the levels of functional independence and cognition in male stroke patients and to verify the presence of correlations between them. For that, it was adopted a cross-sectional descriptive-correlational study with a convenience sample comprised by thirty (n=30) men. The Functional Independence Measure and the Mini-Mental State Examination were used for data gathering. For data analysis, the simple descriptive analysis and the Pearson correlation coefficient were adopted. The results showed the predominance of dependent subjects and high level of cognitive impairment as well as positive correlations between cognition and motor independence (r=0.827 p=0.000), cognitive independence (r=0.912 p=0.000), and total (r=0.882 p=0.000). These data demonstrate the impact of cognitive alterations in the functional independence of post-stroke subjects and suggest the need for specific interventions in occupational therapy destined to them

Correlação entre independência funcional e cognição em homens com AVC

O acidente vascular cerebral é uma doença crônica que causa sequelas motoras e cognitivas e possíveis alterações na capacidade funcional. Este estudo objetivou identificar os níveis de independência funcional e cognição em homens com acidente vascular cerebral e verificar a presença de correlações entre essas variáveis. Para tanto, adotou-se um estudo transversal descritivo-correlacional com amostra de conveniência composta por trinta (n=30) homens adultos. Para a coleta de dados foram aplicados a Medida de Independência Funcional e o Mini Exame do Estado Mental. Para a análise dos dados adotou-se a análise descritiva simples e o coeficiente de correlação de Pearson. Os resultados demonstraram o predomínio de sujeitos dependentes e com altos índices de alterações cognitivas bem como correlações positivas fortes entre a cognição e a independência motora (r=0,827 p=0,000), cognitiva (r=0,912 p=0,000) e total (r=0,882 p=0,000). Esses dados demonstram o impacto das alterações cognitivas na independência funcional de sujeitos pós-AVC e sugerem a necessidade de intervenções específicas em terapia ocupacional destinadas a esses.Stroke is a chronic disease that causes motor and cognitive sequelae and possible changes in functional capacity. This study aims to identify the levels of functional independence and cognition in male stroke patients and to verify the presence of correlations between them. For that, it was adopted a cross-sectional descriptive-correlational study with a convenience sample comprised by thirty (n=30) men. The Functional Independence Measure and the Mini-Mental State Examination were used for data gathering. For data analysis, the simple descriptive analysis and the Pearson correlation coefficient were adopted. The results showed the predominance of dependent subjects and high level of cognitive impairment as well as positive correlations between cognition and motor independence (r=0.827 p=0.000), cognitive independence (r=0.912 p=0.000), and total (r=0.882 p=0.000). These data demonstrate the impact of cognitive alterations in the functional independence of post-stroke subjects and suggest the need for specific interventions in occupational therapy destined to them

Orthotics, prosthesis and mobility aids (OPM) dispensation in the Regional Health Department of the 3RD Region of Sao Paulo State

Objective: To identify the process of dispensation of orthotics, prostheses and mobility aids (OPM) by the Unified Health System (SUS) in the Regional Health Department of the 3rd Region (DRSIII) of Sao Paulo state; perform a mapping of the existing physical rehabilitation services in that region; and subsequently correlate the data with applicable laws. Methodology: This is an exploratory cross-sectional qualitative study whose subjects were the main professionals involved in the process of OPM dispensation, or responsible for their acquisition flow in the cities of that region. Data collection was carried out through a semi-structured questionnaire, developed by the researchers themselves, composed of questions aiming to identify the physical rehabilitation centers in the towns, the staff members involved, the provision of assistive technology through SUS, delivery time and existence of waiting lists. Results and discussion: The data were statistically measured, categorized, described and correlated with the current legislation aimed to guarantee access to assistive technology. We observed that the practice around this resource in the 3rd region concentrates in a single care center, causing long waits and poor efficiency of the services provided, in addition to maintaining a paternalistic aspect. Conclusion: This study provides evidence that, although the right to access to assistive technology is legally guaranteed, there are still many difficulties and challenges around this practice

ENTRE PERDAS E GANHOS: OS PAPEIS OCUPACIONAIS DE PESSOAS PÓS- ACIDENTE VASCULAR ENCEFÁLICO / BETWEEN LOSSES AND GAINS: OCCUPATIONAL ROLES AFTER A STROKE

Introdução: os papeis ocupacionais são representações sociais de como um sujeito se vê a partir dos papeis que desempenha. Esses papeis contemplam diversas atividades e abrangem as ocupações humanas que as pessoas realizam em sua vida diária. Indivíduos com sequelas de um Acidente Vascular Encefálico (AVE) poderão encontrar dificuldades em desempenhar um ou mais papeis ocupacionais em função de estruturas e funções corporais afetadas pela lesão, por fatores pessoais e/ou ambientais, que, de uma forma ou de outra, influenciam nas atividades e participação. Objetivos: identificar os papeis ocupacionais de sujeitos pós-AVE e o grau de importância atribuído para cada papel. Metodologia: foram selecionados trinta e quatro sujeitos (n=34), de ambos os sexos, sem comprometimentos cognitivos que impedissem a coleta dos dados. O instrumento utilizado foi a Lista de Identificação de Papeis Ocupacionais, validado no Brasil. Os dados foram coletados em conjunto com os sujeitos, em forma de entrevista. Resultados: os sujeitos reportaram uma diminuição dos papeis ocupacionais pós-lesão, entretanto, com perspectivas de retorno a esses papeis no futuro. Além do desejo em resgatar os papeis perdidos, foi identificada a intenção do desempenho de novos papeis. Conclusão: esses achados poderão incrementar as práticas de reabilitação com metas de intervenção voltadas para o engajamento em ocupações significativas e importantes para essa população.   Palavras-chave: Terapia ocupacional. Atividades cotidianas. Políticas públicas. Pessoas com deficiência. Papel (figurativo).  ABSTRACT Introduction: occupational roles are social representations of the way in which individuals see themselves in society due to the roles they perform. These roles comprise several activities that represent human occupations in their daily lives. Individuals who have suffered a stroke may find it difficult to perform one or more occupational roles related with body structures and functions affected by their, personal and environmental factors, which in one way or another, influence the way in which activities and participation may be limited. Objectives: To describe the occupational roles after a stroke. Methodology: thirty four individuals (n = 34), of both genders, without cognitive problems participated in the research. The instrument used was the “Role Checklist”, validated in Brazil. Data were collected through an interview, at the individuals’ homes. Results: the participants reported a decrease in occupational roles after stroke, however, they showed an intention to return to these roles in the future. Individuals also showed a desire to perform new occupational roles, not performed in the past and present. Conclusion: these findings may improve the rehabilitation practice using intervention goals that aim to engage this population in meaningful and important occupations.  Keywords: Occupational therapy. Activities of daily living. Public policies. Disabled persons. Role