The neurological state and cognition of patients after a stoke

The objective of this study was to have a multidisciplinary team investigate the neurological state and cognitive performance of patients after a stroke, through a cross-sectional study with 45 patients in rehabilitation after having an acute stroke. The data collection instruments used were an assessment sheet, the Mini Mental-MEEM, and the National International Health Stroke Scale-NIHSS. The sample consisted mostly of women (55.6%), Ischemic Stroke (86.7%), right hemisphere of the brain (60%) and Educated (68.8%). The mean MEEM for educated and illiterate patients was 19.3 ± 5.0 and 15.92 ± 3.7, respectively. The overall mean of the neurological state was 13.0±4.8. A significant difference was found between the cognitive means of patients in terms of education (p value=0.017), and there was a significant relationship between the neurological state and cognitive performance (r=-0.44 p value=0.002). It appears to be a direct relationship between the neurological state and cognition performance of patients after an acute stroke, which evinces the need for greater attention to the cognitive issue involved early in rehabilitation.Se objetivó investigar mediante equipo multidisciplinario el estado neurológico y el desempeño cognitivo de pacientes post-ACV. Estudio transversal con 45 pacientes post-ACV agudo en proceso de rehabilitación. Se utilizaron para recolección de datos una ficha de evaluación; el Mini Mental-MEEM y el National International Health Stroke Scale-NIHSS. Muestra predominantemente femenina (55,6%), ACV Isquémico (86,7%), Hemisferio cerebral derecho (60%) y Escolarizados (68,8%). La media de MEEM para escolarizados y analfabetos fue 19,3±5,0 y 15,92±3,7 respectivamente. La media general del estado neurológico encontrado fue 13,0±4,8. Existió diferencia significativa entre las medias cognitivas de pacientes respecto de escolaridad (pvalor=0,017), y relación significativa entre el estado neurológico y el desempeño cognitivo (r=0,44 pvalor=0,002). El estado neurológico y el nivel cognitivo de pacientes post-ACV agudo parecen estar directamente relacionados, lo que evidencia la necesidad de mayor atención a la cuestión cognitiva involucrada en el inicio del proceso de rehabilitación.Objetivou-se investigar por meio de uma equipe multidisciplinar o estado neurológico e o desempenho cognitivo de pacientes pós-AVC mediante um estudo transversal com 45 pacientes em processo de reabilitação após um AVC agudo. Utilizaram-se como instrumentos de coleta de dados uma ficha de avaliação, o Mini Mental-MEEM e o National International Health Stroke Scale-NIHSS. Amostra mostrou-se predominantemente feminina (55,6%), AVC Isquêmico (86,7%), hemisfério cerebral direito (60%) e Escolarizados (68,8%). A média do MEEM para escolarizados e analfabetos foi de 19,3 ± 5,0 e 15,92 ± 3,7, respectivamente. A média geral do estado neurológico encontrado foi 13,0±4,8. Houve diferença significativa entre as médias cognitivas dos pacientes quanto à escolaridade (p valor=0,017) e relação significativa entre o estado neurológico e o desempenho cognitivo (r=-0,44 p valor=0,002). O estado neurológico e o nível cognitivo de pacientes pós-AVC agudo parecem estar diretamente relacionados, o que evidencia a necessidade de maior atenção à questão cognitiva envolvida no início do processo de reabilitação

Grau de conhecimento dos pacientes com acidente vascular cerebral sobre a patologia

Introdução: o Acidente Vascular Cerebral (AVC) representa a terceira causa de morte em vários países e a principal causa de incapacidade física. Objetivo: avaliar o grau de conhecimento dos pacientes com AVC sobre a patologia. Metodologia: o estudo foi do tipo transversal e a amostra foi de conveniência, sendo composta de 53 pacientes crônicos de AVC. Os pacientes foram avaliados através de questionários, observando-se os aspectos sócio-demográficos e clínicos. Quanto ao conhecimento da patologia foi questionado sobre o significado da sigla, os principais sinais e sintomas, os tipos de AVC e as complicações. Os dados foram analisados através do teste Qui-quadrado. Resultados: dos pacientes avaliados 58,5% eram homens, 66% tinham idade superior a 60 anos, 92,5% eram alfabetizados, 88,7% tinham um tempo de lesão maior ou igual a 12 meses, 52,8% tiveram o lado direito afetado e 88,6% apresentaram comprometimento neurológico leve. Além disso, 52,8% dos pacientes não sabia o significado da sigla AVC, 54,8% não conheciam os tipos de AVC, 83% falaram incorretamente um sintoma e 62,2% não sabiam que feridas podem ser complicações da doença. Conclusão: a partir dos resultados encontrados, concluiu-se que os pacientes não tinham conhecimento satisfatório sobre o AVC. Dessa forma, verificou-se a necessidade de implementar políticas públicas que levem à população informações sobre essa patologia.

Functional profile of ALS patients over 14 months of physical therapy

Introduction: Amyotrophic Lateral Sclerosis (ALS) is a degenerative and fatal disease that changes the individuals’ functionality. Physical therapy plays an important role in ALS by using assessment tools to evaluate functional performance. Objective: To investigate functional changes caused by ALS through 14 months in individuals with and without physical therapy. Method: A cohort study conducted between 2010 and 2013 in the city of Natal-RN. The study included patients in various stages of ALS, with no associated pathologies and those who were being monitored by the Reference Center since 2010. Functional characteristics were categorized by applying the motor items of Functional Independence Measure (FIM), Fatigue Severity Scale (FSS) and ALS-Functional Rating Scale (ALSFRS). Participants were divided into two groups, those who performed physical therapy (FA) and those who didn’t (CG). They were longwise evaluated in 3 different moments (1st day of assessment, four months after the first assessment and 10 months after the second evaluation). Nonparametric Friedman test was performed, considering p <0.05. Results: It was observed a significant functional decline in the control group (p <0.05) measured by the ALSFRS. The CG also presented functional decline greater than the AF group from FIM scores, however without statistical significance. There was no difference in the scores of FSS. Conclusion: Physical therapy can be a great adjunct in functional decline retardation in patients with ALS. It also emphasizes the importance of specific scales for ALS, considering the disease progressive and heterogeneous nature

Effects of exergames training on postural balance in patients who had a chronic stroke: study protocol for a randomised controlled trial

Introduction Exergames training, as an additional therapy to standard care, has been widely used for motor recovery after patients who had a stroke, and it is a valuable and positive tool in the rehabilitation of this population. This study describes a single-blind randomised clinical trial that will aim to investigate the effects of exergames training on postural balance in patients with chronic stroke.Methods and analysis Forty-two individuals with chronic stroke (&gt;6 months), aged 20–75 years, will be randomised into two groups: the experimental group, which will be subjected to an exergames protocol, and control group, which will undergo a kinesiotherapy protocol. Both protocols are based on postural balance. The intervention will consist of 40-minute sessions two times per week for 10 consecutive weeks. The volunteers will be evaluated before the treatment, at the end of the interventions and 8 weeks thereafter. The primary outcome will be postural balance (Berg Balance Scale, Functional Reach Test, Timed Up and Go test and Centre of Pressure variables) and secondary outcomes will include gait (6 m timed walk and Kinovea Software), cortical activation patterns (electroencephalography Emotiv EPOC), functional independence (Functional Independence Measure), quality of life (Stroke-Specific Quality of Life Scale) and motivation (Intrinsic Motivation Inventory).Ethics and dissemination This protocol was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (number 3.434.350). The results of the study will be disseminated to participants through social networks and will be submitted to a peer-reviewed journal and scientific meetings.Trial registration number Brazilian Registry of Clinical Trials (RBR-78v9hx)

Severidade clínica e funcionalidade de pacientes hemiplégicos pós-AVC agudo atendidos nos serviços públicos de fisioterapia de Natal (RN) Clinical severity and functionality of acute stroke patients attended at the physiotherapy public services of Natal, Rio Grande do Norte State, Brazil

O acidente vascular cerebral (AVC) representa a terceira causa de morte em vários países do mundo e principal causa de incapacidade física. O objetivo deste estudo foi investigar por meio de uma equipe multidisciplinar a severidade clínica e a independência funcional de pacientes hemiplégicos pós-AVC. Trata-se de estudo descritivo composto por quarenta hemiplégicos atendidos nos quatro maiores serviços públicos de fisioterapia da cidade de Natal (RN). Foram utilizados uma ficha de avaliação, a medida de independência funcional e o NIHSS. A amostra é predominantemente feminina(55%), AVC isquêmico(90%), hemisfério cerebral direito(52,5%) e fator de risco hipertensão(90%). A média da severidade clínica é 13,32±4,7 e da independência funcional, 54,6±17,15. Não houve diferença significativa entre as médias funcionais dos pacientes quanto ao lado do AVC (pvalor=0,66). Existiu relação significativa entre severidade clínica e independência funcional (r=-0,45 pvalor=0,003). A severidade clínica e a dependência funcional de pacientes com AVC, ao darem entrada na fisioterapia, são significativas e evidenciam a necessidade de, além do tratamento clássico, serem incentivadas condutas educacionais que visem à conscientização da população.<br>This article investigates the severity and functional independence of hemiplegics patients' post-acute stroke by means of a multidisciplinary clinical staff. It is a descriptive study composed by 40 hemiplegics attended at the four largest physiotherapy public services in Natal, Rio Grande do Norte State. The methods used were an evaluation form, Functional Independence Measure and NIHSS. The results showed a sample predominantly female (55%), stroke ischemic (90%), right brain hemisphere (52.5%) and Hypertension Risk Factor (90%). The mean of clinical severity and functional independence was 13.32±4.7 and 54.6±17.15 respectively. There was no significant difference between the mean of functionality about stroke side (pvalue = 0.66). There is a significant relation between clinical severity and functional independence (r = -0.45 pvalue=0.003). It can be concluded that the level of clinical severity and functional dependence of stroke patients that make use of public physiotherapy services is significant and show the necessity, beyond the classic treatment, to be encouraged preventive educational actions to improve knowledge of this population

Dor e funcionalidade na atenção básica à saúde Pain and functionality in primary health care

A dor osteoarticular e a funcionalidade são elementos ligados à saúde dos indivíduos e, portanto, influenciam o modo de interação entre si e entre eles e o meio ambiente que os cerca. Contudo, não são muitos os estudos que levantam essas questões de saúde na população em geral, sobretudo quando aproximamos o olhar da atenção básica sobre elas. Este artigo tem o objetivo de fornecer dados iniciais sobre dor e funcionalidade nos indivíduos com queixa osteoarticular em uma população adscrita a uma unidade básica de saúde (UBS) e suscitar o debate sobre integralidade da atenção nesse serviço. O trabalho descritivo foi realizado na UBS (n1=64) e nos domicílios (n2=48), entre indivíduos a partir dos 20 anos de idade. Foi aplicado um instrumento de avaliação de funcionalidade e a Escala Visual Analógica de dor, e foram exploradas questões sociodemográficas. Com esses instrumentos, buscou-se avaliar o perfil dos indivíduos em relação ao seu grau de dor musculoesquelética, o grau de funcionalidade nas atividades da vida diária, idade e ocupação. Nos resultados, encontramos uma predominância do sexo feminino nos dois grupos, 84,37% e 81,25%, respectivamente. Quase metade das pessoas com dor musculoesquelética eram donas de casa, e a média de idade entre os grupos estava acima dos 55 anos.<br>Musculoskeletal pain and functionality are linked to the individual health and, thus, influence the mode of interaction between individuals and between them and the environment that surrounds them. However, there are not many studies that question such health issues concerning the population in general, especially when we look at these issues from the basic care point of view. The aim of this article is to present initial data on the subject of pain and functionality in individuals with musculoskeletal complaints enrolled in a primary care unit and prompt a discussion on how complete the services provided by these units are. This study was carried out in a primary care unit and various households, among subjects aging 20 years or older. A functionality assessment tool and a Visual Analogue Scale were applied, and social and demographic issues were also considered. By using these tools, it was made an attempt to evaluate the profile of individuals in association with their degree of musculoskeletal pain and the degree of functionality in the activities of their daily lives, ages and occupations. We found a predominance of women in both groups: 84.37% and 81.25%, respectively. Nearly half of all people with musculoskeletal pain were housewives, and the average age between groups was over 55