Metabolic output in a transtibial amputee using crutches and prosthesis

Compared to the normal gait cycle, transtibial amputees have a 20% greater oxygen consumption. Fisher et al. in a study with non amputees using crutches found that their oxygen consumption reached 40% of the maximum and that their heart beat, 62% of maximum calculated for their age. Thus the authors concluded that the use of crutches in patients with heart pathologies should be considered with restraint. The metabolic output of ambulation with crutches is aproximately twice as much when compered to normal gait. The objective of this study is to compare the metabolic output of lower limb amputees when using crutches and prosthesis. This was done using the Shuttle Test and the K4b² â this is a fully portable pulmonary gas exchange system that allows us direct assess to the cardio-pulmonary limitations. Our study has shown that the metabolic output of ambulation with the prosthesis is less than that with crutches.Pacientes com amputação transtibial têm um maior gasto energético durante a marcha com a prótese, necessitando consumir 20% a mais de oxigênio quando comparados a indivíduos normais na mesma velocidade relativa. Fisher et al. estudaram o gasto energético em pacientes não amputados em uso de muletas em terreno plano e escadas; concluíram que o volume de oxigênio (VO2) destes indivíduos atingia 40% do máximo esperado para os mesmos e que a freqüência cardíaca chegava à 62% da máxima prevista e portanto, que o uso de muletas em pacientes cardiopatas deveria ser feito com restrições. O gasto energético durante a marcha com muletas axilares é aproximadamente duas vezes maior quando comparada à marcha normal. O objetivo deste trabalho é comparar o gasto energético em pacientes amputados de membro inferior com uso de prótese e muletas. O paciente foi avaliado em relação ao gasto energético com prótese e com muletas axilares através do teste de Shuttle. O instrumento para avaliação foi o K4b2Ò, espiromêtro portátil da Cosmed. Nossos dados mostram que o paciente possui menor gasto energético com a prótese e portanto, percorre uma distância maior do que com as muletas

A manual method to obtain platelet rich plasma

OBJECTIVE:This study is to report a manual method to obtain platelet rich plasma (PRP).METHODS:For this study 61 ml of peripheral blood was obtained and submitted to centrifugation at 541g for 5 min. The centrifugation separates the blood into three components: red blood cells, buffy coat and platelet rich plasma. Blood and platelet rich plasma samples were sent to the Hospital's Laboratory and platelets and leukocytes were measured.RESULTS:A sample of 637 blood donors was evaluated. The platelet yield efficiency was 86.77% and the increase in platelet concentration factor was 2.89 times. The increase in leukocyte concentration factor was 1.97 times.CONCLUSION:The method described here produces leukocyte-rich and platelet-rich plasma with a high platelet and leukocyte increased factor.Level of Evidence IV, Controlled Laboratory Study.Hospital do Coração Knee InstituteUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Orthopedics and TraumatologyUNIFESP, EPM, Department of Orthopedics and TraumatologySciEL

Art rehabilitation in amputee women with Pandora’s myth as a self-esteem and quality of life facilitator resource

A amputação é um evento traumático que repercute intensamente na vida da pessoa acometida. A dificuldade em lidar com a nova realidade pode contribuir negativamente para a autoestima e reabilitação do indivíduo, afetando a sua qualidade de vida. A Arteterapia por meio dos recursos expressivos pode ser um canal facilitador e promotor de aspectos resilientes para a superação do trauma. Objetivo: Averiguar a influência da Arteterapia na autoestima e qualidade de vida em mulheres amputadas. Grupo formado por 8 mulheres amputadas, entre 35 a 65 anos. Método: Divididos em 2 grupos (4 indivíduos no grupo de intervenção e 4 indivíduos no grupo controle). Instrumentos de avaliação: WHOQOL- Bref (World Health Organization Quality of Life), Escala de Autoestima Rosemberg (EAR), o Desenho da Figura Humana e Relatos das Participantes. As atividades foram desenvolvidas com base no mito de Pandora, em 11 oficinas arteterapêuticas com 1 hora de duração, uma vez por semana no setor de Arte-Reabilitação, AACD – Ibirapuera, São Paulo. Resultados: Estatisticamente não foram observadas diferenças significantes entre os momentos inicial e final para os domínios de Whoqol Bref e EAR, em ambos os grupos; porém, o grupo intervenção apresenta um movimento de melhora na autoestima, especialmente no quesito autodepreciação. Qualitativamente foram observadas através do discurso das participantes melhorias de autoestima e possibilidade de melhoria na qualidade de vida das participantes. Conclusão: A arteterapia, junto com a equipe interdisciplinar, pode contribuir positivamente para o processo de reabilitação em mulheres amputadas ajudando a promover a autoestima e qualidade de vida.Amputation is a traumatic event that has serious repercussions on the amputee’s life. The difficulty in dealing with the new reality can contribute negatively to self-esteem and rehabilitation, affecting the patient’s quality of life. The Art therapy, through its expressive resources, can be a facilitator and provide resilience to overcoming the trauma. Objective: The objective of this study is to investigate the influence of art therapy in self-esteem and quality of life in amputee women. Methods: A group of 8 amputees, aged 35-65 years were divided into 2 groups (4 in the experimental group and 4 in the control group). They were evaluated with the WHOQoL-Bref (World Health Organization Quality of Life), Rosenberg Self-Esteem Scale (RSE), Human Figure Drawing test and the participants’ own Reports. The activities, based on the Pandora myth, were developed in 11 art therapy workshops sessions of one hour that were carried out once a week in the Art-Rehabilitation sector off AACD – Ibirapuera, São Paulo. Results: There was no statistically significant differences observed between the initial and final assessments of quality of life (WHOQoL-Bref) and RSE domains of both groups, however, the experimental group evidenced a tendency towards the improvement of self-esteem, especiallyin regards of self-depreciation. Qualitatively, improvements of self-esteem and the possibility of improving the participants’ quality of life were also observed. Conclusion: Art Therapy, combined with interdisciplinary care, can contribute positively to the rehabilitation process of amputee women, by helping to promote better self-esteem and quality of life

Fisioterapia aquática no paciente sobrevivente da Poliomielite traqueostomizado com suporte ventilatório: relato de caso

Muitos pacientes sobreviventes da poliomielite apresentam importante comprometimento da função respiratória. A fisioterapia aquática é indicada para esta população, porém, a presença da traqueostomia leva a uma maior dificuldade de tratamento no meio líquido pela dificuldade da manipulação. O objetivo deste trabalho é verificar os benefícios que uma paciente traqueostomizada, com suporte ventilatório não invasivo, pode ter com a abordagem da fisioterapia aquática. A paciente sofreu intervenção de vinte sessões de fisioterapia aquática. Para avaliação foram usadas as Escalas de Fadiga, Dor e Qualidade de vida e analisados os parâmetros: Saturação de Oxigênio (SatO2), Freqüência Cardíaca (FC)e Freqüência Respiratória (FR). Foi constatada melhora na pontuação de todas as escalas de fadiga utilizadas: inicial 55 e final 28, demonstrando ao final do estudo ausência de fadiga Fator esse também verificado na qualidade de vida principalmente na dimensão de vitalidade inicial 29,16 e final 50. A FC, a (excluir) FR e a SatO2 não sofreram alterações significativas, observando dessa maneira a segurança durante o atendimento. No término do tratamento, o quadro álgico cessou nos principais grupos articulares. Os resultados demonstraram que o meio líquido foi favorável para o tratamento dessa paciente, garantindo a segurança, diminuindo a fadiga e a dor, melhorando assim a qualidade de vida.Survivors of polio exhibit significant impairment of respiratory function. Aquatic physical therapy is recommended for this population, however, the presence of tracheostomy produces greater difficulty in treatment when using water because of the difficulty involved in moving the patient. The aim of this study is to assess the benefits that a tracheostomized patient with noninvasive ventilatory support, may have with an aquatic therapy approach. The patient underwent an intervention/treatment of twenty sessions of aquatic therapy. The fatigue, pain and quality of life scales were used for evaluation and the parameters were analyzed: Oxygen Saturation (SaO2), heart rate (HR), Respiratory Rate (RR). It was a striking improvement in the scores of all scales used for fatigue: initial 55 and final 28, demonstrating an absence of fatigue at the end of the study. This factor was also observed in the quality of life mainly in the initial (29.16) and final (50) periods of vitality. The HR, RR and SaO2 did not change significantly, demonstrating the safety during the treatment. The pain ceased in the major joints at the end of treatment. The results showed that the use of water was favorable for the treatment of the patient, ensuring safety, reducing fatigue and pain, thereby improving the quality of life

Dupla deficiência motora em um centro de reabilitação: hemiparesia após acidente vascular cerebral e amputação de membro inferior - Quem são eles?

Objectives: To estimate the prevalence of dual motor disability and to identify social, demographic, clinical and rehabilitation-related characteristics. Methods: Retrospective descriptive study in an outpatient rehabilitation center with individuals with dual motor disability from major lower limb amputation associated to post-stroke hemiparesis. Social demographic, clinical and rehabilitation characteristics data were collected from medical record. Results: The prevalence of dual motor disability was 5.4%. Seventy-six subjects were evaluated, 69.7% were male, with a mean age of 65.6 ± 9.3 years. Hypertension was present in 96.1% of subjects, and 25% were smokers. Over 73% of patients had had the stroke prior to amputation. Time elapsed between lesions had a median of 23 months, and sequelae were ipsilateral in 51.3% of patients. Of these, 54 patients (71%) were referred to physical therapy. The time interval between dual disability and the beginning of therapy was 28 months, with total rehabilitation time of 14.3 months. At rehabilitation completion, 36% achieved their goals but 30% were discharges consequent to lack of compliance. Conclusion: The prevalence of dual motor disability due to hemiparesis secondary to stroke and lower limb amputation in a rehabilitation center was 5.4%. Our population showed singular characteristics related to the rehabilitation process, such as a long time between the occurrence of dual disability and the beginning of rehabilitation, and long rehabilitation period.Objetivo: Estimar a prevalência da dupla deficiência motora e identificar as características social, demográficas, clinicas e relacionadas á reabilitação desses indivíduos. Métodos: Estudo descritivo retrospectivo realizado em um centro de reabilitação com indivíduos com dupla deficiência motora decorrente de amputação de membro inferior associada à hemiparesia após acidente vascular cerebral (AVC). Características sociodemografica, clinica e relacionada a reabilitação foram coletadas através de consulta a prontuários. Resultados: A prevalência da dupla deficiência motora foi de 5,4%. Dos 76 indivíduos avaliados, 69,7% eram do sexo masculino, com média de idade de 65,6 (±9,3). A hipertensão arterial sistema estava presente em 96,1% dos indivíduos e 25% eram tabagistas. Mais que  73% dos pacientes tiveram o AVC prévio à amputação. O tempo entre as lesões foi, em mediana, de 23 meses, as sequelas foram ipsilaterais em 51,3% dos pacientes. Desses, 54 pacientes (71%) foram encaminhados para as terapias físicas. O tempo entre a dupla deficiência e o início da terapia foi de 28 meses, com tempo de reabilitação total de 14,3 meses. Ao fim do processo de reabilitação 36% alcançaram suas metas, mas 30% teve alta devido a falta de adesão ao tratamento. Conclusão: A prevalência da dupla deficiência motora devido a hemiparesia após AVC e amputação de membro inferior foi 5,4%, e a população estudada apresentou características singulares relacionada ao processo de reabilitação, como um longo tempo entre a ocorrência da dupla deficiência e o inicio da reabilitação, e um longe tempo na reabilitação

Epidemiological study of patients with spinal cord injury treated at the Lar Escola São Francisco

A lesão medular apresenta-se como um grande problema de saúde pública, uma vez que a maior parte dos pacientes lesados medulares são jovens e, portanto, encontram-se no auge de sua produtividade, tanto profissional, quanto pessoal. Neste trabalho procurou-se estudar o perfil epidemiológico dos pacientes atendidos no Lar Escola São Francisco, Escola Paulista de Medicina - Universidade Federal de São Paulo. Foram revisados 171 prontuários de pacientes atendidos no período de 1999 a 2001 e foi encontrado um predomínio de pacientes jovens (média 35,4 anos) e do sexo masculino (62,6%). A principal causa de lesão medular encontrada foi o ferimento por arma de fogo (30,1%) e a principal lesão foi a incompleta (59,6%) e espástica (57,3%). O nível neurológico mais frequente foi o torácico, em 59% dos pacientes.Spinal cord injury is a National Health issue as the majority of patients are young and consequently in the highlights of life, professional and personal. In this study, we analyzed patients treated at the Lar Escola São Francisco – Escola Paulista de Medicina – Federal University of São Paulo. 171 patients were studied in the period of 1999 to 2001 and a higher prevalence of young (mean: 35.4 years) males (62.6%) was found. The most frequent cause of injury was gun shot injury (30.1%) and the most frequent lesion was an incomplete one (59.6%). Spasticity was found in 57.3% of the patients. The most frequent level of injury was the thoracic one

Radiological study of reconstruction of the anterior cruciate ligament by transtibial approach

Introduction: the rupture of the anterior cruciate ligament (ACL) is often due to sports activities and its reconstruction methods have undergone constant changes due to improvements in the surgical techniques. Objective: To evaluate the radiological placement of the tibial and femoral tunnels using the transtibial technique assisted by the femoral pre-drilling. Method: Radiological analysis (AP and lateral), at 4 weeks postoperatively in 98 patients, totaling 100 cases of ACL reconstruction. Three examiners evaluated the placement of the tibial and femoral tunnels. Methods for assessing the positioning of the tunnels were: Scanlan, Staubli and Rauschning and Bernard. Results: the a angle (AP) was 64.13 degrees (+/- 4.29 degrees) and the beta angle (lateral) was 57.28 degrees (+/- 4.41 degrees). the mean tibial positioning was 41.99% (+/- 5.14%). the ACL graft was inserted into the lateral condyle of the femur and the average percentage of radiographic positioning in the green quadrant was 62%, the yellow quadrant, 37% and 1% in the red quadrant. Conclusions: the transtibial technique for ACL reconstruction, assisted by the femoral pre-drilling provides the anatomical position of the graft in the majority of the cases, as radiological evidence.Hosp Coracao HCor, Inst Joelho, São Paulo, SP, BrazilInst Assistencia Med Servidor Publ Estadual IAMSP, São Paulo, SP, BrazilUniversidade Federal de São Paulo Unifesp, São Paulo, SP, BrazilUniversidade Federal de São Paulo Unifesp, São Paulo, SP, BrazilWeb of Scienc

Shock wave therapy associated with eccentric strengthening versus isolated eccentric strengthening for Achilles insertional tendinopathy treatment: a double-blinded randomised clinical trial protocol

Background There is no consensus regarding the treatment of Achilles insertional tendinopathies. Eccentric training remains the main choice in the conservative treatment of this illnesshowever, the good results in the management of non-insertional Achilles tendinopathy were not replicated in the insertional condition. Low energy shock wave therapy has been described as an alternative to these patients, but has yet to be empirically tested. Hypothesis Shock wave therapy, adjunctive to the eccentric strengthening protocol, will improve measures of pain and function. Design Double blind, placebo-controlled, parallel groups, randomised clinical trial. Materials and methods 93 patients with a diagnosis of chronic insertional tendinopathy, referred from primary or secondary healthcare services, will be assessed and enrolled in this study. They will be divided into two groups (randomised by sequentially numbered identical envelopes, which will be administered serially to participants), one containing the combination of low energy shock wave and eccentric exercises, as treatment and the other comprehending the exercises and the placebo treatment (an apparatus placed in the therapeutic head). The assessments will occur in 2, 4, 6, 12 and 24weeks. Patients will be evaluated primarily by the Victorian Institute of Sport Assessment-Achilles questionnaire and secondarily by the visual analogue scale, Algometry, the American Orthopedic Foot and Ankle Society scale, the Foot and Ankle Outcome Score and the 12-item Short Form Health Survey. We will use comparison of two proportions via relative frequency analysis, the Pearson Correlation the (2) test and the analysis of variance for statistical analyses. Discussion This study intends to demonstrate if the association of the eccentric exercise programme with the shock wave therapy can produce good results regarding the treatment of the Achilles insertional tendinopathy. In an attempt to prevent the high costs and complications associated with the surgical intervention, we will try to prove this combination as a viable therapeutic option in the conservative management of this prevalent condition. The strengths of the study are the design and the novelty of the combination of methods. The main limitation is the short follow-up course. Ethics and dissemination The study is registered in the Clinical Trials database (protocol number: 8094833648737701) and was approved by the University Ethics Committee (number: 1373481). Trial registration number 8094833648737701 (NCT02757664)Pre-results.Univ Fed Sao Paulo, Dept Orthopaed, Sao Paulo, SP, BrazilFed Univ Sao Paulo UNIFESP EPM, Orthoped & Traumatol Div Hand Surg & Upper Limb, Sao Paulo, SP, BrazilDepartment of Orthopaedics, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, BrazilOrthopedics and Traumatology—Division of Hand Surgery and Upper Limb, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, BrazilWeb of Scienc