Influence of severity of traumatic brain injury at hospital admission on clinical outcomes

O traumatismo cranioencefálico (TCE) é um problema de saúde pública com muitos casos de mortalidade e repercussões socioeconômicas. Este estudo visa investigar a influência da gravidade do TCE no tempo de ventilação mecânica (VM) e hospitalização, e na prevalência de casos de traqueostomia, pneumonia, neurocirurgia e morte. É um estudo retrospectivo e observacional, que avaliou prontuários de 67 pacientes com TCE na Irmandade Santa Casa de Misericórdia de São Paulo. A gravidade foi avaliada pela escala de Glasgow (ECG): leve (13-15 pontos; 36 pacientes; 53.7%); moderado (9-12 pontos; 14 pacientes; 20.9%); ou grave (3-8 pontos; 17 pacientes; 25.4%). Pacientes com TCE grave apresentaram maior prevalência de traqueostomia, pneumonia e neurocirurgia. Não houve diferença significativa entre gravidade do TCE, óbito e tempo em VM, apesar de a gravidade do TCE ter influenciado o tempo de hospitalização. A gravidade do TCE na admissão, avaliada pela ECG, influenciou a prevalência de traqueostomia, pneumonia, neurocirurgia e de maiores tempos de internação.El traumatismo craneoencefálico (TCE) es un problema de salud pública con alta mortalidad y repercusiones socioeconómicas. Este estudio ha tenido el objetivo de investigar la influencia de la gravedad del TCE en el tiempo de ventilación mecánica (VM) y de hospitalización y en la prevalencia de traqueotomía, neumonía, neurocirugía y mortalidad. Este estudio retrospectivo, observacional ha evaluado historias clínicas de 67 pacientes con TCE admitidos en Irmandade Santa Casa de Misericórdia de São Paulo. La gravedad ha sido evaluada por la escala de Glasgow (ECG): leve (13-15 puntos; 36 pacientes; el 53,7%), moderado (9-12 puntos; 14 pacientes; el 20,9%) o grave (3-8 puntos; 17 pacientes; el 25,4%). Pacientes con TCE grave han presentado prevalencia más grande de traqueotomía, neumonía y neurocirugía. No ha habido diferencia significativa entre la gravedad del TCE, la mortalidad y el tiempo en VM; mientras tanto, la gravedad del TCE ha influenciado el tiempo de hospitalización. La gravedad del TCE en la admisión, que ha sido evaluada por la ECG, ha influenciado la prevalencia de traqueotomía, neumonía, neurocirugía y ha sido asociada la internación prolongada.Traumatic brain injury (TBI) is a public health problem with high mortality and socioeconomic repercussions. We aimed to investigate the influence of TBI severity on the length of mechanical ventilation (MV) stay and length of hospital stay and on the prevalence of tracheostomy, pneumonia, neurosurgery and death. This retrospective, observational study evaluated medical records of 67 patients with TBI admitted to Irmandade da Santa Casa de Misericórdia de São Paulo. Severity was determined according to the Glasgow Coma Scale (GCS): mild (13-15 points; 36 patients; 53.7%), moderate (9-12 points; 14 patients; 20.9%) or severe (3-8 points; 17 patients; 25.4%). Severe TBI patients had higher prevalence of tracheostomy, pneumonia and neurosurgery. No significant differences were observed between TBI severity, mortality and length of MV stay. However, TBI severity influenced the length of hospital stay. TBI severity at admission, evaluated according to the GCS, influenced the prevalence of tracheostomy, pneumonia, neurosurgery and was associated to prolonged hospital stay

Maze computer performance in Down syndrome

Introduction: These changes are the main causes of defi cits in perceptual-motor skills responsible for motor skill acquisition and performance of functional activities. AIMS: The current study aimed at verifying the quantitative performance of people with DS in undertaking a computer task to compare the performances of typical development (TD). Method: 60 subjects participated in the study, 30 with Down’s syndrome and 30 with typical development, matched by sex. Individuals were aged from 10–36. The groups were divided into three subgroups by age: Group 1 (G1) 10–18; Group 2 (G2) 18–25; Group 3 (G3) 25–36. They performed a computer maze task. During the acquisition phase all groups attempted the maze 30 times, and then after 5 minutes they performed 5 repetitions of Maze 1 for the retention phase. Finally, for the transfer phase, they performed fi ve repetitions in Maze 2. The dependent variables were submitted to a group, age group, gender and block ANOVA with repeated measures on the last factor. Results: In acquisition phase there was a significant decrease in movement time (MT) between the fi rst and last acquisition block, but only for the DS-group. In retention, there was a significant effect of Group, and an interaction between Block and Group, indicating that MTs increased from retention to transfer, but only for the DS-group. Conclusion: It was found that participants with DS improved performance during acquisition and retention, but they had diffi culty in performing the transfer of the computational task for a similar situation. The age and gender were not signifi cant in any of the stages of the study.Introduction: These changes are the main causes of defi cits in perceptual-motor skills responsible for motor skill acquisition and performance of functional activities. AIMS: The current study aimed at verifying the quantitative performance of people with DS in undertaking a computer task to compare the performances of typical development (TD). Method: 60 subjects participated in the study, 30 with Down’s syndrome and 30 with typical development, matched by sex. Individuals were aged from 10–36. The groups were divided into three subgroups by age: Group 1 (G1) 10–18; Group 2 (G2) 18–25; Group 3 (G3) 25–36. They performed a computer maze task. During the acquisition phase all groups attempted the maze 30 times, and then after 5 minutes they performed 5 repetitions of Maze 1 for the retention phase. Finally, for the transfer phase, they performed fi ve repetitions in Maze 2. The dependent variables were submitted to a group, age group, gender and block ANOVA with repeated measures on the last factor. Results: In acquisition phase there was a significant decrease in movement time (MT) between the fi rst and last acquisition block, but only for the DS-group. In retention, there was a significant effect of Group, and an interaction between Block and Group, indicating that MTs increased from retention to transfer, but only for the DS-group. Conclusion: It was found that participants with DS improved performance during acquisition and retention, but they had diffi culty in performing the transfer of the computational task for a similar situation. The age and gender were not signifi cant in any of the stages of the study

Analysis of different device interactions in a virtual reality task in individuals with Duchenne Muscular Dystrophy: A randomized controlled trial

There is a need to support individuals with Duchenne Muscular Dystrophy (DMD) to achieve optimal functionality in everyday life and with meaningful tasks and activities, throughout stages of the disease progression. Thus, technological developments have created an exciting opportunity for the use of affordable virtual reality (VR) systems with different kinds of interaction devices, providing an efficient and fun tool for enabling improvement in motor performance. Objective. To compare performance on a virtual task using interfaces with and without physical contact in order to identify functionality by using different devices in individuals with DMD. Methods. One hundred and twenty male individuals took part on this study: 60 with DMD with a mean age of 16 ± 5 (range 9–34 years old) and 60 without DMD in the control group (CG) matched by age. Participants were divided into three groups of 20 individuals each which performed a virtual task in three different interfaces: Kinect®, computer Touch Screen and Leap Motion®, in a cross over design in which all participants used all devices. Motor impairment in the DMD group was measured by using the Motor Function Measurement and Vignos scales. Results. All participants improved performance through practice, regardless of the interface used, although the DMD group had a continuous lower performance compared to the CG. In addition, the DMD group obtained a significant better performance with Leap Motion interface compared to the other interfaces, while the CG presented better performance on Touch Screen interface. Conclusion. Leap Motion provided better performance for individuals with DMD due to enablement of distal muscle function and ease of instrument adjustment using the virtual interface. Therefore, this type of interface should be encouraged for promoting functionality on general tasks using computer systems. Clinical Trial register number: NCT02891434

Analysis of Different Device Interactions in a Virtual Reality Task in Individuals With Duchenne Muscular Dystrophy—A Randomized Controlled Trial

There is a need to support individuals with Duchenne Muscular Dystrophy (DMD) to achieve optimal functionality in everyday life and with meaningful tasks and activities, throughout stages of the disease progression. Thus, technological developments have created an exciting opportunity for the use of affordable virtual reality (VR) systems with different kinds of interaction devices, providing an efficient and fun tool for enabling improvement in motor performance.Objective: To compare performance on a virtual task using interfaces with and without physical contact in order to identify functionality by using different devices in individuals with DMD.Methods: One hundred and twenty male individuals took part on this study: 60 with DMD with a mean age of 16 ± 5 (range 9–34 years old) and 60 without DMD in the control group (CG) matched by age. Participants were divided into three groups of 20 individuals each which performed a virtual task in three different interfaces: Kinect®, computer Touch Screen and Leap Motion®, in a cross over design in which all participants used all devices. Motor impairment in the DMD group was measured by using the Motor Function Measurement and Vignos scales.Results: All participants improved performance through practice, regardless of the interface used, although the DMD group had a continuous lower performance compared to the CG. In addition, the DMD group obtained a significant better performance with Leap Motion interface compared to the other interfaces, while the CG presented better performance on Touch Screen interface.Conclusion: Leap Motion provided better performance for individuals with DMD due to enablement of distal muscle function and ease of instrument adjustment using the virtual interface. Therefore, this type of interface should be encouraged for promoting functionality on general tasks using computer systems. Clinical Trial register number: NCT02891434

Development of an Evaluation Scale for Sitting and Standing From the Ground for Children With Duchenne Muscular Dystrophy

The authors developed an evaluation scale for sit-stand from the ground for children with Duchenne muscular dystrophy (DMD) and tested its reliability. The construction occurred in stages: (a) the characterization of the movement in healthy children, (b) the characterization of the movement in children with DMD, (c) the elaboration of the 1st version of the scale and the manual, (d) the evaluation by experts and readjustments, and (e) the analysis of inter- and intraexaminer reliability and correlation with the Vignos Scale, age, and time for the execution of the activity. The scale comprehended 3 phases for sitting and 5 for the standing. A very good repeatability of the measures of sitting and standing (ICC = 0.89 and 0.84, respectively) and excellent reproducibility (ICC = 0.93 and 0.92, respectively) was demonstrated. The Kappa coefficient for the 8 phases in the interexaminer analysis varied from 0.77 to 1.00 (excellent reliability), and in the intraexaminer analysis varied from 0.80 to 1.00 (excellent reliability). Good correlation was found between the variables on the Vignos Scale (age: r = 0.58; stand: r = 0.56). The scale is a reliability instrument that allows evaluation of the activity of sitting and standing in children with DMD