SALSA scale and disability grading system of the World Health Organization: evaluation of physical activity limitations and disability of individuals treated for leprosy

Verificar o grau de incapacidades da OMS (GI-OMS) e a limitação de atividades avaliada pela escala Screening of Activity Limitation and Safety Awareness (SALSA) pós-alta medicamentosa dos pacientes que tiveram hanseníase. Estudo transversal que incluiu pacientes tratados entre 2007 a 2009, em São José do Rio Preto-SP, Brasil. Utilizouse protocolo próprio para coletar dados gerais e clínicos, construído com base no Check List da Classificação Internacional Funcionalidade, Incapacidade e Saúde. A deficiência foi medida pelo GI-OMS e a limitação de atividades pelo SALSA que tem variação de 10 a 80 e ponto de corte ≥25. De 84 pessoas tratadas no período, 54(64,3%) foram entrevistadas, sendo 31(57,4%) homens, idade 53,8(dp16,3) e 33(61,2 %) possuía até 6 anos de educação formal. A forma clinica dimorfa predominou 17(32,1%), 21(38,9%) considerou sua saúde física “boa”. A analise dos escores SALSA e variáveis estudadas resultou em significância aos que relataram lesão significante (valor-p=0,04), baixa renda familiar (valor-p=0,04), baixa escolaridade (valor-p=0,00), formas clínicas multibacilares (valor-p=0,01) e deficiências avaliadas pelo GI-OMS (valor-p=0,01). As limitações de atividades são freqüentes (57,4%), assim como as deficiências medidas pelo GI-OMS (68,5%), atingem as formas multibacilares, pessoas que relataram lesão significante, de baixa renda e escolaridade.To verify the disability grading system of the World Health Organization (DG-WHO) and activity limitations evaluated by the Screening of Activity Limitation and Safety Awareness (SALSA) scale of individuals who completed treatment for leprosy. A cross-sectional study that included patients treated from 2007 to 2009 in Sao José do Rio Preto, Brazil. A questionnaire, designed using the International Classification of Functioning, Disability and Health checklist, was used to collect general and clinical data. Disability was measured by the DG-WHO and activity limitations by SALSA, using a score of 10 to 80 with a cutoff point of 25. Of 84 individuals treated, 54 (64.3%) were interviewed: 31 (57.4%) were men, mean age was 53.8 (SD 16.3) and 33 (61.2%) had up to 6 years of schooling. Borderline leprosy predominated in 17 (32.1%) participants, and 21 (38.9%) participants considered their physical health 'good'. The analysis of the SALSA scores and studied variables were significant for individuals who reported important injuries (p=0.04), low family income (p=0.04), little schooling (p=0.00), multibacillary clinical form (p=0.01) and disabilities evaluated by DG-WHO (p=0.01). Activity limitations are common (57.4%) in this population, as are disabilities identified by DG-WHO (68.5%) and are directly associated to the multibacillary clinical form, important injuries, low family income and little schooling

Contribuições da terapia da mão na paralisia cerebral: uma revisão sistemática

Este trabalho teve como objetivo identificar contribuições da área da terapia da mão para pessoas com paralisia cerebral, disponível na literatura bibliográfica nacional e internacional on-line, analisando a produção existente e verificando a existência de trabalhos estruturados. Configurou-se como sendo um estudo descritivo, retrospectivo, através critérios de revisão sistemática da literatura para coleta, seleção e análise dos dados. A busca foi realizada no período de fevereiro de 2010 a janeiro de 2011, nas bases de dados LILACS, MEDLINE, BIREME, SCOPUS e CINAHL, publicados em português e inglês, no período de 2003 a 2010. Onze artigos foram incluídos na revisão e utilizou-se um formulário elaborado pelas pesquisadoras para avaliá-los conforme a caracterização e qualidade das informações contidas. Os resultados evidenciaram que os assuntos com maior enfoque na amostra foram sobre intervenção ortótica, estimulação elétrica neuromuscular, toxina botulínica e função manual. Apesar de contribuírem com o conhecimento sobre intervenções na paralisia cerebral, os estudos não citam claramente os achados como contribuições da especialidade terapia da mão sobre o tema, e limitações metodológicas foram encontradas, inferindo-se a necessidade de maior rigor metodológico e qualidade das informações nos trabalhos científicos.This study sought to identify the contributions of the hand therapy field to people with cerebral palsy, available in the domestic and international literature online, analyzing the existing works and verifying the existence of structured studies. It was configured as a descriptive, retrospective study, through the criteria of systematic review of the literature for the collection, selection, and analysis of data. The search was done from February of 2010 to January of 2011, on the LILACS, MEDLINE, BIREME, SCOPUS, and CINAHL databases, on works published in Portuguese and English, between 2003 and 2010. Eleven articles were included in the review and a form prepared by the researchers was used to evaluate these articles according to the characterization and quality of the information contained. The results demonstrated that the most discussed subjects in the sample were orthotic intervention, neuromuscular electrical stimulation, botulinum toxin, and manual function. Despite contributing to knowledge on cerebral palsy interventions, the studies did not clearly mention the findings as contributions from the hand therapy specialty on the theme, and methodological limitations were found, implying the need for more methodological rigor and quality of information from the scientific studies

Avaliação da escrita através da fotogrametria – estudo da preensão trípode dinâmica

INTRODUCTION: Different grasp patterns can be used for handwriting and the dynamic tripod is the most prevalent among adults. Although it is considered an ideal grasp pattern, there are few studies that analyses the range of motion of hand joints during this activity. OBJECTIVE: To obtain the variations of range of motion in distal upper limb articulations during a handwriting task among healthy adults. METHODS: 50 young adults, right-handed and without impairment in the upper limb had their hands photographed during a handwriting task and analyzed with Postural Assessment Software (SAPO). RESULTS: A common pattern of forearm pronation, abduction of the fi rst interdigital space, fl exion of metecarpophalangeal and proximal interphalangeal joints of the index fi nger was observed among subjects, matching previous studies and descriptions for this grasppattern. CONCLUSION: It was possible to establish a standardpostural pattern for handwriting through photogrammetric analysis, demonstrating the applicability of this method for the upper limb.INTRODUÇÃO: Dentre as preensões utilizadas para a escrita a trípode dinâmica apresenta a maior prevalência entre a população. Apesar de considerada padrão para a escrita manual, são escassos estudos que envolvam a análise da amplitude articular das mãos durante esta atividade. OBJETIVO: Obter as variações das amplitudes de movimento das articulações distais do membro superior durante a atividade de escrita manual em adultos. METODOLOGIA: 50 adultos jovens, destros e sem comprometimento no membro superior tiveram suas mãos fotografadas durante a escrita e posteriormente analisadas através do Software de Avaliação Postural (SAPO). RESULTADOS: Foi observado um padrão comum de pronaçãode antebraço, abdução entre I e II metacarpianos e fl exão de metacarpofalangeana e interfalangeana proximal do II dedo, similar às descrições encontradas na literatura. CONCLUSÃO: Foi possível estabelecer um padrão postural por meio da análise fotogramétrica, demonstrando a aplicabilidade deste método para a análise da motora do membro superior durante a atividade de escrita manual

Eletromiography of the upper limbs during computer work : comparision of two wrist orthoses

Orientadores: Alberto Cliquet Junior, Luis Alberto MagnaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Com o advento da tecnologia de informação tem-se observado o aparecimento de problemas de saúde relacionados ao uso excessivo do computador, especialmente no que se refere às disfunções músculo-esqueléticas da região cervical e do membro superior. O objetivo deste estudo foi examinar o efeito das órteses de punho na atividade eletromiográfica dos músculos extensor ulnar do carpo, flexor superficial dos dedos e fibras superiores do trapézio durante o uso do computador. Vinte três estudantes universitários saudáveis, entre 18 e 26 anos realizaram tarefas padronizadas, randomizadas, de digitação em teclado e com o uso do mouse, quer sem órteses ou com dois tipos de órteses para o punho. Utilizou-se eletromiografia de superfície e considerou-se 100% da contração voluntária máxima como referência para representar a amplitude da atividade eletromiográfica. Observou-se um aumento na atividade miolétrica do trapézio (P<0,05) com o uso de órteses. Nenhuma diferença significativa foi observada no flexor superficial dos dedos ou no extensor ulnar do carpo durante a digitação, com ou sem órteses. No entanto, quando os participantes usaram o mouse, o músculo extensor ulnar do carpo apresentou aumento da sua atividade mioelétrica com as duas órteses e o mesmo padrão foi observado para o músculo flexor superficial dos dedos com o uso da órtese feita sob medida. Concluiu-se que as órteses de punho, nos modelos testados, afetam certas atividades musculares do membro superior em adultos saudáveis durante o uso do computador.Abstract: With the advent of information technology, health problems related to the excessive use of the computer have appeared, mainly in what it refers to musculoskeletal overuse of the cervical region and upper limbs. The objective this study was to examine the effect of wrist orthoses on the electromyographycal activities of the extensor carpi ulnaris, flexor digitorum superficialis, and fibers of the upper trapezius muscles during computer work. Twenty-three healthy university students, ranging from 18 to 26 years of age, performed standardized tasks, randomized, such as typing and using the mouse while wearing one of two types of wrist orthoses or without orthosis. Surface electromyography was used considering 100% the maximum voluntary contraction to represent the amplitude of electromyographic activity. A significant increase in the electromyographic activity of the trapezius (P<0.05) was found when either of the orthoses was used. No significant difference was observed in the activities of the flexor digitorum superficialis or extensor carpi ulnaris whether or not orthoses were used in participants who typed. However, upon mouse use, the extensor carpi ulnaris activities was increased with both orthoses, and the same pattern was observed in the flexor digitorum superficialis when the volunteers used the custom-made orthosis. It was concluded that the studied models of wrist orthoses may affect the some muscle activities in the upper limbs of healthy adults when using a computer.DoutoradoPesquisa ExperimentalDoutor em Cirurgi

Electromyography Of The Upper Limbs During Computer Work: A Comparison Of 2 Wrist Orthoses In Healthy Adults.

To examine the effect of wrist orthoses on the electromyography activities of the extensor carpi ulnaris, flexor digitorum superficialis, and fibers of the upper trapezius muscles during computer work. A randomized, 3 x 2 factorial design: orthoses (no orthosis, wearing a custom-made orthosis, wearing a commercial orthosis) and tasks (typing, using the mouse). Laboratory for biomechanics and rehabilitation. Healthy university students (N=23), ranging from 18 to 26 years of age. Study volunteers performed standardized tasks such as typing and using the mouse while wearing 1 of 2 types of wrist orthoses or no orthosis. We used surface electromyography and considered 100% maximum voluntary contraction to represent the amplitude of electromyographic activity. We observed a significant increase in the electromyographic activity of the trapezius (P.05). However, when the participants used the mouse, the extensor muscle presented an increase in activity with both orthoses, and the same pattern was observed in the flexor muscle when the volunteers used the custom-made orthosis. Wrist orthoses affected the muscle activities in the upper limbs of healthy adults who were using a computer. Electromyographic activity increased in the trapezius when the subjects used either type of orthosis, and the same pattern was observed in the extensor carpi ulnaris when the subjects used the mouse. The flexor digitorum superficialis presented an increase in activity only when the subjects worked with the mouse and used a custom-made splint.901152-

Grasps for handwriting: prevalence of different types among young adults

Para a escrita manual, as preensões maduras são consideradas as mais efi cientes e recomendadas por educadores e terapeutas, pois demandam menor gasto energético e menor tensão na região proximal do membro superior. Algumas pessoas utilizam outros padrões de preensão que são também funcionais, no entanto desconhece-se que problemas podem decorrer do uso dessas preensões. O conhecimento dos tipos de preensão de adultos jovens para escrita manual pode colaborar com estudos que relacionam a preensão utilizada em atividades funcionais com suas implicações. Este estudo, quantitativo, descritivo, de corte transversal de base populacional, identifi cou os tipos e a prevalência de preensões utilizadas por 806 estudantes universitários adultos, destros, de ambos os sexos, sem comprometimento funcional dos membros superiores. A atividade de escrita foi fi lmada e as imagens foram analisadas e identifi cadas. Os resultados revelaram que o padrão mais frequente foi a preensão trípode dinâmica, seguido pela trípode lateral, ambas maduras. As preensões de transição e as variações foram identifi cadas em 34,86% da amostra. Estudos futuros podem incluir o uso excessivo das estruturas do corpo e lesões no membro superior, ajudando a fornecer orientações adequadas para a prevenção e tratamentos de reabilitação de lesões.For handwriting, mature grasps are considered the most effi cient and recommended by educators and therapists, as they demand less energy loss and less tension in the proximal region of the upper limb. Some people use other grasps patterns that are also functional, however it is unknown what problems that may arise from use of these grasps. Knowing the types of grasp in young adults can support researches that relates the grasp used during functional activities with its implications. This study, quantitative, descriptive, cross-sectional, population- based, identifi ed the types and prevalence of pencil grasps used by 806 adults university students, all right handed, of both genders, without functional impairment of the upper limbs. The handwriting activity was fi lmed, and the images were analyzed and identifi ed. The results revealed the most frequent pattern was the dynamic tripod grasp, followed by lateral tripod, both mature grasps. The transition grasps and variations was identifi ed in 34,86% of the sample. Future researches could include excessive use of body structures and injuries in the upper limb, helping to provide suitable guidelines for the prevention and rehabilitation treatments of injuries

Preensão para escrita manual: prevalência dos diferentes tipos entre adultos jovens

For handwriting, mature grasps are considered the most effi cient and recommended by educators and therapists, as they demand less energy loss and less tension in the proximal region of the upper limb. Some people use other grasps patterns that are also functional, however it is unknown what problems that may arise from use of these grasps. Knowing the types of grasp in young adults can support researches that relates the grasp used during functional activities with its implications. This study, quantitative, descriptive, cross-sectional, population- based, identifi ed the types and prevalence of pencil grasps used by 806 adults university students, all right handed, of both genders, without functional impairment of the upper limbs. The handwriting activity was fi lmed, and the images were analyzed and identifi ed. The results revealed the most frequent pattern was the dynamic tripod grasp, followed by lateral tripod, both mature grasps. The transition grasps and variations was identifi ed in 34,86% of the sample. Future researches could include excessive use of body structures and injuries in the upper limb, helping to provide suitable guidelines for the prevention and rehabilitation treatments of injuries.Para a escrita manual, as preensões maduras são consideradas as mais efi cientes e recomendadas por educadores e terapeutas, pois demandam menor gasto energético e menor tensão na região proximal do membro superior. Algumas pessoas utilizam outros padrões de preensão que são também funcionais, no entanto desconhece-se que problemas podem decorrer do uso dessas preensões. O conhecimento dos tipos de preensão de adultos jovens para escrita manual pode colaborar com estudos que relacionam a preensão utilizada em atividades funcionais com suas implicações. Este estudo, quantitativo, descritivo, de corte transversal de base populacional, identifi cou os tipos e a prevalência de preensões utilizadas por 806 estudantes universitários adultos, destros, de ambos os sexos, sem comprometimento funcional dos membros superiores. A atividade de escrita foi fi lmada e as imagens foram analisadas e identifi cadas. Os resultados revelaram que o padrão mais frequente foi a preensão trípode dinâmica, seguido pela trípode lateral, ambas maduras. As preensões de transição e as variações foram identifi cadas em 34,86% da amostra. Estudos futuros podem incluir o uso excessivo das estruturas do corpo e lesões no membro superior, ajudando a fornecer orientações adequadas para a prevenção e tratamentos de reabilitação de lesões

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

Frequency upper limbs injuries in the emergency health service in Paranaiba, MS, Brazil

To assess the frequency of upper limb injuries in the only emergency medical service inParanaiba, State of Mato Grosso do Sul. Methods: Retrospective study with data collection from medical recordsof patients assisted with upper limb injuries in “Santa Casa de Misericordia” Hospital, the only hospital in the cityto provide emergency care, in 2008. Variables of interest such as gender and type of injury were collected basedon the International Code of Diseases (ICD 10). Results: There were 314 cases of upper limb injury in 2008and men were the most affected with 211 cases (67.2%). The wrist was the most affected segment with 64 cases(20.4%), followed by the shoulder with 55 cases (17.5%) and the hand with 50 cases (15.9%). Interventions andsurgeries involving bone portion were the most frequent - 225 (71.7%), followed by tendon - 19 (6.1%) and neural - 16 (5.1%); 35 patients (11.1%) underwent multiple operations. Osteosyntheses - 94 (29.9%), fractures- 48 (15.3%), and reduction - 46 (14.6%) were the most frequent interventions, followed by 26 dislocations(8.3%) and 14 tenorrhaphies (4.5%). Conclusion: The involvement of the upper limbs, especially bone lesions,is frequent. The segments most affected by injuries are men’s wrists and shoulders

Handwriting assessment through photogrammetry – dynamic tripod grasp evaluation

INTRODUÇÃO: Dentre as preensões utilizadas para a escrita a trípode dinâmica apresenta a maior prevalência entre a população. Apesar de considerada padrão para a escrita manual, são escassos estudos que envolvam a análise da amplitude articular das mãos durante esta atividade. OBJETIVO: Obter as variações das amplitudes de movimento das articulações distais do membro superior durante a atividade de escrita manual em adultos. METODOLOGIA: 50 adultos jovens, destros e sem comprometimento no membro superior tiveram suas mãos fotografadas durante a escrita e posteriormente analisadas através do Software de Avaliação Postural (SAPO). RESULTADOS: Foi observado um padrão comum de pronaçãode antebraço, abdução entre I e II metacarpianos e fl exão de metacarpofalangeana e interfalangeana proximal do II dedo, similar às descrições encontradas na literatura. CONCLUSÃO: Foi possível estabelecer um padrão postural por meio da análise fotogramétrica, demonstrando a aplicabilidade deste método para a análise da motora do membro superior durante a atividade de escrita manual.INTRODUCTION: Different grasp patterns can be used for handwriting and the dynamic tripod is the most prevalent among adults. Although it is considered an ideal grasp pattern, there are few studies that analyses the range of motion of hand joints during this activity. OBJECTIVE: To obtain the variations of range of motion in distal upper limb articulations during a handwriting task among healthy adults. METHODS: 50 young adults, right-handed and without impairment in the upper limb had their hands photographed during a handwriting task and analyzed with Postural Assessment Software (SAPO). RESULTS: A common pattern of forearm pronation, abduction of the fi rst interdigital space, fl exion of metecarpophalangeal and proximal interphalangeal joints of the index fi nger was observed among subjects, matching previous studies and descriptions for this grasppattern. CONCLUSION: It was possible to establish a standardpostural pattern for handwriting through photogrammetric analysis, demonstrating the applicability of this method for the upper limb