Da glória retórica ao caso Delgado : Brasil-Portugal nos anos de Álvaro Lins (1956-1959)

Dissertação (mestrado) — Universidade de Brasília, Instituto de Relações Internacionais, Programa de Pós-Graduação em Relações Internacionais, 2016.Disserta-se aqui sobre a embaixada de Álvaro Lins em Portugal (1956-1959), partindo da perplexidade gerada pelo paradoxo das “excelentes” relações Brasil-Portugal na década de 1950. Um país, que se esforçava pela modernização e pelo aprofundamento de sua democracia, abraçava-se com um Portugal salazarista, orgulhoso da tradição e da conservação da ordem autoritária de passado fascista. Focalizando sobre as contradições, as condicionantes e o arcabouço político-intelectual do período, pretendeu-se aqui a introdução de um novo perfil de análise tanto do ponto de vista onto-epistemológico quanto metodológico. Agregando novas unidades de análise e um trabalho com a perspectiva micro-histórica, esta dissertação se esforça para reinterpretar fatos já discutidos pela bibliografia e para introduzir novas fontes. Acredita-se que, analisando desta maneira o período de Álvaro Lins (uma seleção cuidadosa de “caso”, portanto), pode-se revelar outras lógicas e dinâmicas que animaram as relações Brasil-Portugal no esplendor de sua fase retórica.This work focalizes on the diplomatic relations between Brazil and Portugal at the 1950’s through the Brazilian embassy of Álvaro Lins (1956-1959). The modernization of the Brazilian state and his democracy side by side the reactionary Portuguese political regime, the salazarism, was attached in a friendly relation of very deep commitments contradictories to its own basements. So, focalizing this relation through an analysis politic-intellectual and using the new analysis units of the micro-history may allow us to reveal dynamics forgotten by the main bibliography about this issue. In general, we tried to find here a new way of comprehension about this bilateral relation

Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation

Arm-hand rehabilitation programs applied in stroke rehabilitation frequently target specific populations and thus are less applicable in heterogeneous patient populations. Besides, changes in arm-hand function (AHF) and arm-hand skill performance (AHSP) during and after a specific and well-described rehabilitation treatment are often not well evaluated.This single-armed prospective cohort study featured three subgroups of stroke patients with either a severely, moderately or mildly impaired AHF. Rehabilitation treatment consisted of a Concise_Arm_and_hand_ Rehabilitation_Approach_in_Stroke (CARAS). Measurements at function and activity level were performed at admission, clinical discharge, 3, 6, 9 and 12 months after clinical discharge.Eighty-nine stroke patients (M/F:63/23; mean age:57.6yr (+/-10.6); post-stroke time:29.8 days (+/-20.1)) participated. All patients improved on AHF and arm-hand capacity during and after rehabilitation, except on grip strength in the severely affected subgroup. Largest gains occurred in patients with a moderately affected AHF. As to self-perceived AHSP, on average, all subgroups improved over time. A small percentage of patients declined regarding self-perceived AHSP post-rehabilitation.A majority of stroke patients across the whole arm-hand impairment severity spectrum significantly improved on AHF, arm-hand capacity and self-perceived AHSP. These were maintained up to one year post-rehabilitation. Results may serve as a control condition in future studies

Changes in actual arm-hand use in stroke patients during and after clinical rehabilitation involving a well-defined arm-hand rehabilitation program: A prospective cohort study.

INTRODUCTION:Improvement of arm-hand function and arm-hand skill performance in stroke patients is reported by many authors. However, therapy content often is poorly described, data on actual arm-hand use are scarce, and, as follow-up time often is very short, little information on patients' mid- and long-term progression is available. Also, outcome data mainly stem from either a general patient group, unstratified for the severity of arm-hand impairment, or a very specific patient group. OBJECTIVES:To investigate to what extent the rate of improvement or deterioration of actual arm-hand use differs between stroke patients with either a severely, moderately or mildly affected arm-hand, during and after rehabilitation involving a well-defined rehabilitation program. METHODS:Design: single-armed prospective cohort study. Outcome measure: affected arm-hand use during daily tasks (accelerometry), expressed as 'Intensity-of arm-hand-use' and 'Duration-of-arm-hand-use' during waking hours. Measurement dates: at admission, clinical discharge and 3, 6, 9, and 12 months post-discharge. Statistics: Two-way repeated measures ANOVAs. RESULTS:Seventy-six patients (63 males); mean age: 57.6 years (sd:10.6); post-stroke time: 29.8 days (sd:20.1) participated. Between baseline and 1-year follow-up, Intensity-of-arm-hand-use on the affected side increased by 51%, 114% and 14% (p < .000) in the mildly, moderately and severely affected patients, respectively. Similarly, Duration-of-arm-hand-use increased by 26%, 220% and 161% (p < .000). Regarding bimanual arm-hand use: Intensity-of-arm-hand-use increased by 44%, 74% and 30% (p < .000), whereas Duration-of-arm-hand-use increased by 10%, 22% and 16% (p < .000). CONCLUSION:Stroke survivors with a severely, moderately or mildly affected arm-hand showed different, though (clinically) important, improvements in actual arm-hand use during the rehabilitation phase. Intensity-of-arm-hand-use and Duration-of-arm-hand-use significantly improved in both unimanual and bimanual tasks/skills. These improvements were maintained until at least 1 year post-discharge

Evaluation of a functional hand orthosis combined with electrical stimulation adjunct to arm-hand rehabilitation in subacute stroke patients with a severely to moderately affected hand function

<p><b>Purpose:</b> To investigate the usability and effectiveness of a functional hand orthosis, combined with electrical stimulation adjunct to therapy-as-usual, on functional use of the moderately/severely impaired hand in sub-acute stroke patients.</p> <p><b>Materials and Methods:</b> Single case experiment (A-B-A′-design) involving eight sub-acute stroke patients. The functional hand orthosis and electrical stimulation were used for six weeks, four days/week, 45′/day. Outcome measures: Action_Research_Arm_Test, Intrinsic_Motivation_Inventory.</p> <p><b>Results:</b> At group level, patients improved 19.2 points (median value) (interquartile range: [8.8, 29.5] points) on the Action_Research_Arm_Test (<i>p</i> = 0.001). After correcting for spontaneous recovery and/or therapy-as-usual effects Action_Research_Arm_Test scores still improved significantly (median: 17.2 points; interquartile range: [5.1, 29.2] points) (<i>p</i> = 0.002). At individual level, six patients had improved as to arm-hand skill performance at follow-up (<i>p</i> < = 0.010). In one patient, arm-hand skill performance improvement did not attain statistical significance. In another patient, no arm-hand skill performance improvement was observed. Average Intrinsic_Motivation_Inventory sub-scores were between 4.6 and 6.3 (maximum: 7), except for ‘perceived pressure/tension’ (3.3).</p> <p><b>Conclusion:</b> Sub-acute stroke patients who display only little/modest improvement on their capacity to perform daily activities, seem to benefit from training with a dynamic arm orthosis in combination with electrical stimulation. Patients’ perceived intrinsic motivation and sense of self-regulation was high. Implications for rehabilitation</p><p>Arm-hand training featuring the dynamic hand orthosis in combination with electrical stimulation shows a shift from no dexterity to dexterity.</p><p>As to the users’ experience regarding the dynamic hand orthosis, patients perceive a high-intrinsic motivation and sense of self-regulation.</p><p>Combining the orthosis with electrical stimulation creates opportunities for a nonfunctional hand towards task-oriented training.</p><p></p> <p>Arm-hand training featuring the dynamic hand orthosis in combination with electrical stimulation shows a shift from no dexterity to dexterity.</p> <p>As to the users’ experience regarding the dynamic hand orthosis, patients perceive a high-intrinsic motivation and sense of self-regulation.</p> <p>Combining the orthosis with electrical stimulation creates opportunities for a nonfunctional hand towards task-oriented training.</p

Number (and %) of patients per subgroup whose arm-hand capacity and/or performance either deteriorated (more than 5% relative to clinical discharge performance), or remained equal or improved during the <i>post-rehabilitation</i> phase.

<p>Number (and %) of patients per subgroup whose arm-hand capacity and/or performance either deteriorated (more than 5% relative to clinical discharge performance), or remained equal or improved during the <i>post-rehabilitation</i> phase.</p

Number of patients whose outcome scores exceeded the MCID thresholds, expressed as the percentage of the total number of persons within a subgroup, for FM, grip strength, ARAT and ABILHAND.

<p>Number of patients whose outcome scores exceeded the MCID thresholds, expressed as the percentage of the total number of persons within a subgroup, for FM, grip strength, ARAT and ABILHAND.</p

Added-value of spasticity reduction to improve arm-hand skill performance in sub-acute stroke patients with a moderately to severely affected arm-hand

BACKGROUND AND OBJECTIVE: Stroke patients with a moderately to severely affected hand may be impeded in exploiting their full arm-hand training potential during rehabilitation due to spasticity. Reducing early signs of spasticity in sub-acute stroke patients may lead to improvements in arm-hand-function and arm-hand-skill-performance. METHODS: Single-case-experimental-design and meta-analysis. Ten sub-acute stroke patients (Modified-Ashworth-Scale:1 + to 3) participated. Training: 2x6 weeks, using a well-described arm-hand regime (therapy-as-usual). Botulinum-toxin was administered once within 5 weeks after onset of therapy-as-usual. Measures: Action-Research-Arm-Test, ABILHAND, Fugl-Meyer-Assessment, grip-strength, Motricity-Index. RESULTS: At group level, after baseline trend correction, adjusting for spontaneous recovery and therapy-as-usual effects, the added-value of botulinum-toxin-A on arm-hand-function and arm-hand-skill-performance was not confirmed. However, non-detrended data revealed significant improvements over time on arm-hand-function and arm-hand-skill-performance level (p≤0.037). Conversely, at individual level, after baseline trend correction, 7/10 patients improved on arm-hand-function: Fugl-Meyer-Assessment (N = 4; p≤0.019), grip-strength (N = 3; p≤0.014), Motricity-Index (N = 4; p≤0.002), whereas 6/10 patients improved on arm-hand-skill-performance: Action-Research-Arm-Test (N = 3; p≤0.042), ABILHAND (N = 5; p≤0.034). CONCLUSION: Application of botulinum-toxin-A may have an added-value in a substantial part of sub-acute stroke patients suffering from spasticity early post-stroke and who, at the point of therapy admission, display no dexterity. It may improve their arm-hand performance when combined with a well– defined therapy-as-usual

Boxplots of the ARAT data per measurement moment for each of the three groups.

<p>ARAT = Action Research Arm Test; T_BL = Baseline; T_CD = Clinical Discharge; T_3m = (= T_CD + 3 months); T_6m (= T_CD + 6 months); T_9m (= T_CD + 9 months);T_12m (= T_CD + 12 months). Circles = outlier value; Asterisk = far out value.</p

Patient characteristics upon inclusion in the study.

<p>Patient characteristics upon inclusion in the study.</p