Avaliação funcional de pacientes com hemiplegia pós acidente vascular encefálico: Disabilities of the Arm, Shoulder And Hand - DASH

A hemiplegia pós Acidente Vascular Encefálico (AVE) resulta em limitações na movimentação do MMSS e MMII, prejudicando as capacidades funcionais do indivíduo para o desempenho de suas atividades cotidianas. Objetivo: Verificar se o questionário Disability of the Arm, Sholder and Hand (DASH) é um instrumento apropriado para avaliar pacientes com hemiplegia por AVE. Métodos: Foram entrevistados 100 pacientes com hemiplegia por AVE atendidos pelo serviço de Terapia Ocupacional IMREA HC FMUSP utilizando o instrumento DASH. Resultados: O DASH mostrou-se um questionário válido e reprodutível porque avalia as dificuldades para o desempenho de atividades básicas e instrumentais da vida diária em relação as limitações motoras dos pacientes hemiplégico. Conclusão: Oferece informações do paciente sobre sua opinião e satisfação pessoal em relação sua própria condição física e grau de independência para atividades cotidianasHemiplegia after a stroke results in movement limitations of the upper and lower limbs, hindering the functional capacity of the individual to perform daily activities. Objective: To verify whether the Disability of the Arm, Shoulder, and Hand questionnaire (DASH) is an appropriate instrument to evaluate patients with hemiplegia due to a stroke. Methods: One hundred patients with hemiplegia due to stroke in treatment at the Occupational Therapy service of IMREA HC FMUSP were interviewed using the DASH instrument. Results: The DASH showed to be a valid and reproducible questionnaire because it evaluates the difficulties in performing the basic and instrumental activities of daily living regarding the motor limitations of hemiplegic patients. Conclusion: The questionnaire provided patient information on their opinion and personal satisfaction regarding their own physical condition and degree of independence for daily activitie

Terapia Ocupacional e o uso do computador como recurso terapêutico

Atualmente a tecnologia da informática vem se ampliando para diversas áreas de atuação profissional, inclusive para o campo da Terapia Ocupacional, aonde vem sendo aplicada na prática clínica como modalidade de tratamento. Neste artigo tem-se como objetivo apresentar a atuação do terapeuta ocupacional junto a pessoas com lesão cerebral e lesão medular, utilizando o computador e suas ferramentas e aplicações como recurso terapêutico que potencializa o processo de reabilitação de modo geral. Foram selecionados pacientes em programa de reabilitação que apresentavam dificuldades motoras e percepto-cognitivas, que participaram de atendimentos de Terapia Ocupacional com duração de trinta minutos a uma hora, sendo possível avaliar e documentar a evolução dos pacientes através das atividades realizadas no computador e da utilização de softwares, hardwares e adaptações. Foi possível observar que houve aumento da motivação, melhora das habilidades motoras e percepto-cognitivas, repercutindo de forma positiva no processo de reabilitação como um todo.Nowadays the computer technology can be applied in several professional fields, including the Occupational Therapy one, where it has been applied in the clinic area as a treatment modality. The aims of this present article, is to present the Occupational Therapy work with patients with cerebral injuries and spinal cord injury, using the computer and its tools and functions as a therapeutic resource that improves the rehabilitation process in general. We have selected clients who presented motor and perceptual-cognitive impairments, attending to a rehabilitation program and occupational therapy treatment. The occupational therapy intervetion included the use of softwares, hardwares and assistive technology. The motor skill and perceptual-cognitive abilities improved significantly and this fact has important consequences in the performance of the activities of daily living, resulting in an increased motivation, increasing the quality of the rehabilitation process in general

A influência da negligência unilateral no desempenho de atividades de vida cotidiana: relato de 3 casos

A negligência unilateral é descrita como uma limitação na habilidade de direcionar, responder ou orientar-se frente a estímulos apresentados no lado oposto ao da lesão cerebral, freqüentemente se manifestando através de sistemas sensoriais variados, incluindo os sistemas visual, somatosensorial e auditivo e é diagnosticada quando esta habilidade diminuída não pode ser atribuída a déficits motores ou sensitivos. O objetivo deste estudo é analisar e discutir as implicações deste acometimento influenciando o desempenho das atividades de vida cotidiana, através da realização de três relatos de caso e análise da atividade de alimentação, resultando no desenvolvimento de uma versão inicial de um protocolo para análise de atividade específica para quadros de negligência unilateral.Unilateral neglect is described as a impaired ability to attend, respond, or orient to stimuli presented to the side opposite a brain lesion, frequently occurring across various sensory systems, including the visual, somatosensory, and auditory systems and it is diagnosed when this impaired ability cannot be attributed to sensory or motor deficits. The aim of this study is to analyze and discuss the important implications of this condition affecting the performance of activities of daily living, through three case reports and analysis of the activity of feeding, resulting in the development of an initial version of a protocol for activity analysis specific for patients with unilateral neglect

Neuropathies - Guillain-Barré syndrome: rehabilitation

Foram revisados artigos nas bases de dados do MedLine (PubMed) e outras fontes de pesquisa, sem limite de tempo. A estratégia de busca utilizada baseou-se em perguntas estruturadas na forma P.I.C.O. (das iniciais "Paciente", "Intervençao", "Controle", "Outcome"). Articles in the MedLine (PubMed) database and other research sources were reviewed, with no age limit. The search strategy used was based on structured questions in the P.I.C.O. format (from the initials: Patient, Intervention, Control and Outcome).&nbsp

Acidente vascular cerebral crônico: reabilitação

This study revised articles from the MEDLINE (PubMed) databases and other research sources, with no time limit. To do so, the search strategy adopted was based on (P.I.C.O.) structured questions (from the initials "Patient"; "Intervention"; "Control" and "Outcome". As keywords were used: (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND exercise therapy AND upper extremity; (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND restraint induced therapy; stroke AND exercise therapy AND upper extremity; (intracranial arteriosclerosis OR intracranial embolism and thrombosis OR stroke OR cerebrovascular disorders) AND electric stimulation therapy AND upper extremity; (intracranial arteriosclerosis OR intracranial embolism and thrombosis OR stroke OR cerebrovascular disorders) AND (orthotic devices OR splints) AND upper extremity;knowledge of Results OR biofeedback OR electromyography AND stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis AND rehabilitation; stroke AND upper extremity AND functional laterality; stroke AND upper extremity AND robotics AND physical therapy modalities; stroke AND body weight supports treadmill training AND floor walking; stroke AND gait disorders AND (treadmill exercises OR floor walking); stroke AND postural balance AND physical therapy modalities; stroke AND postural balance AND feedback, sensory; (stroke OR hemiplegia) AND gait disorders, neurologic AND orthotic devices; (stroke OR hemiplegia) AND gait disorders, neurologic AND (feedback, sensory OR proprioception). stroke AND (TENS OR transcutaneous electric stimulation); (stroke OR hemiplegic) AND electric stimulation therapy AND muscle spasticity; hemiplegic AND electric stimulation therapy AND spasticity; stroke AND (virtual reality OR wii game); (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism OR thrombosis) AND resistance training AND recovery function; stroke AND biofeedback, psychology AND Electromyography AND gait; (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND biofeedback, psychology AND (gait OR gait disorders, neurologic).Este estudo revisou artigos nas bases de dados do MEDLINE (Pub-Med) e demais fontes de pesquisa, sem limite de tempo. Para tanto, adotou-se a estratégia de busca baseada em perguntas estruturadas na forma (P.I.C.O.) das iniciais: "Paciente"; "Intervençao"; "Controle" e "Outcome". Como descritores utilizaram-se: (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND exercise therapy AND upper extremity; (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND restraint induced therapy; stroke AND exercise therapy AND upper extremity; (intracranial arteriosclerosis OR intracranial embolism and thrombosis OR stroke OR cerebrovascular disorders) AND electric stimulation therapy AND upper extremity; (intracranial arteriosclerosis OR intracranial embolism and thrombosis OR stroke OR cerebrovascular disorders) AND (orthotic devices OR splints) AND upper extremity;knowledge of Results OR biofeedback OR electromyography AND stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis AND rehabilitation; stroke AND upper extremity AND functional laterality; stroke AND upper extremity AND robotics AND physical therapy modalities; stroke AND body weight supports treadmill training AND floor walking; stroke AND gait disorders AND (treadmill exercises OR floor walking); stroke AND postural balance AND physical therapy modalities; stroke AND postural balance AND feedback, sensory; (stroke OR hemiplegia) AND gait disorders, neurologic AND orthotic devices; (stroke OR hemiplegia) AND gait disorders, neurologic AND (feedback, sensory OR proprioception). stroke AND (TENS OR transcutaneous electric stimulation); (stroke OR hemiplegic) AND electric stimulation therapy AND muscle spasticity; hemiplegic AND electric stimulation therapy AND spasticity; stroke AND (virtual reality OR wii game); (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism OR thrombosis) AND resistance training AND recovery function; stroke AND biofeedback, psychology AND Electromyography AND gait; (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND biofeedback, psychology AND (gait OR gait disorders, neurologic)

Reabilitação ambulatorial da COVID longa: uma chamada à ação

A COVID-19 tem consequências sensório motoras, cognitivas, psíquicas e nutricionais que necessitam de reabilitação. Objetivo: Descrever o programa de reabilitação ambulatorial desenvolvido no Instituto de Medicina Física e Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, otimizado, intensivo e de curta duração. Método: Obtivemos informações sociodemográficas e clínicas de 12 adultos com diagnóstico laboratorial de COVID-19, grave e crítica, que necessitaram de hospitalização na fase aguda. Avaliações funcionais: Escala de Medida de Independência Funcional (MIF), EQ-5D-5L, World Health Organization Disability Assessment Schedule (WHODAS 2.0), Post-COVID-19 Functional Status scale, Medical Research Council (MRC) dyspnea scale, escala visual analógica (EVA) para dor, DN-4 (Douleur Neuropathique 4), escala de sonolência de Epworth, Índice de Gravidade da Insônia, Montreal Ontario Cognitive Assessment (MoCA), escala de Depressão, ansiedade e estresse (DASS-21), avaliação nutricional, Timed Up and Go, teste de caminhada de 10 metros, teste de preensão palmar, MRC sum score, ultrassonografia musculoesquelética da coxa antes, durante e após programa de reabilitação ambulatorial. Este incluiu estimulação magnética indutiva e elétrica musculoesquelética, tratamento por ondas de choque extracorpóreas, exercícios isocinéticos, abordagem emocional, estimulação cognitiva, estimulação do desempenho ocupacional, orientação nutricional e programa educacional por aplicativo COMVC. O tratamento foi realizado duas vezes por semana até atingir os critérios de alta pré-estabelecidos. Resultados: VAS e TUG proporcionaram melhora estatisticamente significante (p <0,001). PCFS, MIF, Handgrip, 10 MWT e DASS-21 domínio ansiedade apresentam tendências de melhora. Conclusão: O programa melhora a dor, mobilidade e ansiedade em pacientes com COVID longa.COVID-19 has motor, cognitive, psychological and nutritional consequences that require rehabilitation. Objetive:  To describe the outpatient rehabilitation program developed at the Instituto de Medicina Física e Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Method: We collected sociodemographic and clinical data of 12 adults with laboratory-confirmed COVID-19, severe and critical, who needed hospitalization in the acute phase.  Functional assessments included Functional Independence Scale (FIM), EQ-5D-5L, World Health Organization Disability Assessment Schedule (WHODAS 2.0),  Post-COVID-19 Functional Status scale (PCFS), Medical Research Council (MRC)  dyspnea scale, visual analog scale (VAS) for pain, Douleur Neuropathique  4 (DN-4), Epworth sleepiness scale, Insomnia Severity Index, Montreal Ontario Cognitive Assessment  (MoCA),  Depression, anxiety and stress scale (DASS-21), nutritional assessment, Timed Up and Go test,  10-meter walking test (10 MWT), handgrip strength,  MRC sum score, musculoskeletal ultrasound of the thigh.The outpatient rehabilitation program included electrical and musculoskeletal inductive magnetic stimulation, extracorporeal shockwave treatment, isokinetic exercises, emotional approach, cognitive stimulation, occupational performance stimulation, nutritional guidance, and educational program by COMVC mobile application. Individualized program was delivered twice a week until pre-stablished discharge criteria was achieved. Results:  VAS and TUG presented statistically significant improvements (p <0.001). PCFS, FIM, handgrip strength, 10 MWT and DASS-21 anxiety presented slopes in the direction of improvement. Conclusion: The optimized, intensive, interdisciplinary and short-term outpatient rehabilitation program improves pain, mobility and anxiety in long COVID patients