Chennyfer Dobbins Paes da Rosa

Aplicação das escalas Fugl-Meyer Assessment (FMA) e Wolf Motor Function Test (WMFT) na recuperação funcional do membro superior em pacientes pós-acidente vascular encefálico crônico: revisão de literatura

It is estimated that 45-75% of chronic adult stroke patients have difficulty in using the hemiparetic upper limb (MS) in their daily life activities (DLAs). Functional scales are used in the practice of rehabilitation, in the search for diagnoses and prognoses, and in evaluating response to treatment. The Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment (FMA) scales are the instruments most commonly mentioned in the literature. Objective: The aim of this study was to review the use of the WMFT and FMA scales in the recovery of upper limb function in patients after chronic stroke. Method: We searched the MedLine database (PubMed) for articles published from 2000 to 2013. The PICO method was adopted as the search strategy. The descriptors used for the search were: (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR thrombosis intracranial embolism) AND (Fugl-Meyer assessment OR wolf motor function test). Therapy/narrow was used as a search filter. Results: We found 181 studies, 89 of which were excluded because they did not meet the inclusion criteria or did not have a topic relevant to the review search. After selection by title and by abstract, 92 articles were fully read. Of these articles, 47 were excluded because they did not fulfil the search objective. All in all, 45 articles were reviewed. FMA is the tool most used and it was found that 80% of the studies applied this scale to evaluate responses to the different therapies. In these studies, the intervention most used was the Constrained Induced Therapy (CIT) (25%), followed by Robotics Therapy (22.2%). Although the WMFT was initially developed to assess the effects of CIT, nowadays this scale is used, after the application of other techniques, to assess the functional recovery of patients with stroke sequelae. In our survey, 44.4% of the studies used WMFT; of these, 35% assessed the effects of CIT, 15% assessed robotic therapy for the upper limbs, and 65% for different therapies. Conclusion: For randomized controlled trials, the FMA scale was more used to assess functional recovery in the upper limbs of chronic stroke patients, even after application of robotics therapy. However, we found that it is not the most appropriate scale to assess the same outcomes after CIT use. WMFT is the scale most widely used for functional assessment after application of CIT; it is more sensitive than FMA for bilateral therapy, and is highly applicable in virtual reality therapy.Estima-se que de 45 a 75% dos adultos que sofreram um Acidente Vascular Encefalico (AVE) tem dificuldade de utilizar o membro superior (MS) hemiparetico nas atividades de vida diaria (AVD’s) na fase cronica. Escalas funcionais sao utilizadas na pratica da reabilitacao e em pesquisas para diagnosticos, prognosticos e resposta a tratamentos. As escalas Wolf Motor Function Test (WMFT) e Fugl-Meyer Assessment (FMA) sao instrumentos muito citados na literatura. Objetivo: O objetivo deste estudo foi verificar a aplicacao das escalas WMFT e FMA na recuperacao funcional do membro superior em pacientes pos AVE cronico. Metodo: Foi realizada uma revisao de literatura com busca nas bases de dados do MedLine (PubMed) de artigos publicados de 2000 a 2013. Adotou-se como estrategia de pesquisa o metodo (P.I.C.O.). Os descritores utilizados para a pesquisa foram: (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND (fugl-meyer assessment OR wolf motor function test). Foi utilizado therapy narrow como filtro de busca. Resultados: Foram encontrados 181 estudos, 89 foram eliminados por nao preencherem os criterios de inclusao ou por nao apresentarem tema relevante a pesquisa. Apos a selecao por titulo e resumo, 92 artigos foram lidos na integra. Destes, 47 foram excluidos por nao contemplarem o objetivo da presente pesquisa. No total, 45 artigos foram revisados. Houve predominio da utilizacao da ferramenta FMA e verificouse que 80% dos estudos aplicaram esta escala para avaliar respostas a diferentes tipos de terapias. Nestes estudos, a intervencao mais utilizada foi a Terapia de Contensao Induzida (TCI) (25%), seguida pela Terapia Robotica (22,2%). Apesar do WMFT ter sido inicialmente desenvolvido para avaliar os efeitos da TCI, nos dias de hoje verifica-se sua utilizacao para avaliar a recuperacao funcional de pacientes com sequelas de AVE apos aplicacao de outras tecnicas. Em nossa pesquisa, 44,4% dos estudos utilizaram o WMFT, destes, 35% avaliaram os efeitos da TCI, 15% da terapia robotica de MS e 65% usaram diferentes terapias. Conclusao: Em estudos controlados randomizados, a FMA foi a escala mais utilizada para avaliar a recuperacao funcional do MS em pacientes com AVE cronico, inclusive apos aplicacao de terapia robotica. Porem, verificamos que ela nao e a escala mais indicada para avaliar os mesmos desfechos apos utilizacao da TCI. Entretanto, a WMFT foi a escala mais utilizada para avaliacao funcional apos aplicacao da TCI e mostrou-se mais sensivel que a FMA na terapia bilateral, alem de alta aplicabilidade na terapia de realidade virtual.

Update on chronic nonspecific lower back pain: rehabilitation

1. What is the benefit of acupuncture in the treatment of chronic nonspecific lower back pain? a. The performance of acupuncture combined with other conservative therapies is not more beneficial than applying the same therapies in isolation b. Real acupuncture (deep insertion into acupoints) is superior to sham acupuncture (superficial insertion at sites away from the acupoints) c. Acupuncture is less effective than TENS d. Acupuncture is less effective than massage

Ultrasound therapy and transcutaneous electrical neuromuscular stimulation for management of post-mastectomy upper limb lymphedema

This article aims to assess the effect of transcutaneous electrical stimulation or ultrasound therapy in the treatment of post-mastectomy upper limb lymphedema. Method: A systematic literature review was performed from 1980 to 2012 from the MedLine, Cochrane Library, LILACS and SciELO databases. The terms used in the search were (breast neoplasm OR breast cancer OR lymphedema) and (hyperthermia, induced OR diathermy OR ultrasonic therapy OR ultrasound OR transcutaneous electrical nerve stimulation OR TENS). The selections of the studies concerned female patients with post-mastectomy upper limb lymphedema who underwent diathermy by ultrasound therapy and transcutaneous electric nerve stimulation. Only randomized (RCT) and quasi-randomized study designs were included (both Narrow and Broad Therapy). Only studies published in the full paper format were included. After reviewing the 2,158 abstracts resulting from the search, only two papers were selected. Two researchers analyzed the two articles, using the Van Tulder and JADAD scales for quality assessment. Results: Both papers evaluated the use of ultrasound therapy and electric stimulation for treatment of post-mastectomy lymphedema. A total of 132 subjects were included in these two studies, and little improvement was observed in pain reduction or quality of life. Only the study using ultrasound therapy identified a small reduction in lymphedema symptoms; however, evidence supporting the application of this method is lacking. Conclusion: Further studies are needed to evaluate the use of ultrasound therapy or electrotherapy for treatment of post-mastectomy lymphedema and to evaluate the potential effect of these therapies on later development of metastatic disease.

Câncer de pulmão: reabilitação

QUESTION 8: (“Paullinia” OR Paullinia Cupana OR Guarana) AND (“Neoplasms”[Mesh] OR Cancer OR Fatigue); These descriptors were used as correlations according to the proposed theme of the P.I.C.O. questions. After analyzing this material, articles relative to the questions were selected that yielded evidence on which to base the present guideline. QUALITY OF EVIDENCE AND STRENGTH OF RECOMMENDATIONS: A: Experimental or observational studies of high quality; B: Experimental or observational studies of lesser quality; C: Case studies (uncontrolled studies); D: Opinion with no critical evaluation, based on consensus, physiological studies, or animal models.

LER-DORT em membros superiores: reabilitação

Foram revisados artigos nas bases de dados do MEDLINE (PubMed)e outras fontes de pesquisa, sem limite de tempo. A estrategia de busca utilizada baseou-se em perguntas estruturadas na forma P.I.C.O. (das iniciais ?Paciente?, ?Intervencao?, ?Controle?, ?Outcome?). Estes descritores foram usados para cruzamentos de acordo com o tema proposto em cada topico das perguntas P.I.C.O. Apos analise desse material, foram selecionados os artigos relativos as perguntas que originaram as evidencias que fundamentaram a presente diretriz. 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 PICO format (from the initials: Patient, Intervention, Control and Outcome). These descriptors were used for cross-correlating in accordance with the theme proposed in each topic of the PICO questions. After analysis of this material, articles relative to the questions were selected that originated evidence on which to base the present guideline.

Neuropatias - Síndrome de Guillain-Barré: reabilitação

A estrategia de busca utilizada baseou-se em perguntas estruturadas na forma P.I.C.O. (das iniciais “Paciente”, “Intervencao”, “Controle”, “Outcome”). Foram utilizados como descritores: Exercise, Physical OR Physical Exercise OR Physical Exercises OR prevention and control OR preventive therapy OR preventive measures OR prophylaxis OR preventions OR control OR Guillain-Barre Syndrome OR Syndrome, Guillain-Barre OR Guillaine-Barre Syndrome OR Guillaine Barre Syndrome OR Syndrome, Guillain Barre OR Polyneuropathy, Acute Inflammatory OR Acute Autoimmune Neuropathy OR Acute Autoimmune Neuropathies OR Plasmaphereses OR Plasmapheresis OR Plasma Exchange OR Immunoglobulins/therapeutic use OR Immunoglobulins/administration and dosage OR Exercise Therapy OR Physical Therapy OR Physical Therapies OR Exercise therapies OR Resistant Training OR Strength Training OR rehabilitation OR Splints OR Splint OR Orthopedic Fixation Devices OR Orthotic Devices OR device orthotic OR devices orthotic OR Orthoses OR Orthosis OR Upper Extremity OR Upper Extremities OR Upper Limb OR Upper limbs OR Membrum Superius OR Extremities, Upper OR Limb, Upper OR Limbs, Upper OR hand deformities OR Hand Deformities, acquired OR Rehabilitation OR Lower Extremity OR Extremities, Lower OR Lower Extremities OR Lower Limb OR Limb, Lower OR Lower Limbs OR Membrum Inferius OR Walking OR Ambulation OR dependent ambulation OR Ambulation, Dependent OR gait OR gaits OR Functional Electrical Stimulation OR Electrical Stimulation, Functional OR Fes OR Electric Stimulation Therapy OR Stimulation Therapy, Electric OR Therapeutic Electrical Stimulation OR Electrical Stimulation, Therapeutic OR Stimulation, Therapeutic Electrical OR Therapy, Electric Stimulation OR Therapeutic Electric Stimulation OR Electric Stimulation, Therapeutic OR Stimulation, Therapeutic Electric OR Electrical Stimulation Therapy OR Stimulation Therapy, Electrical OR Therapy, Electrical Stimulation OR Self-help devices OR Self-help device OR Device, Self-Help device OR Assistive Technology OR Assistive Technologies OR Technologies, Assistive OR Technology, Assistive OR Assistive Devices OR Assistive Device OR Device, Assistive OR Devices, Assistive OR daily activities OR daily activity OR activity of daily living OR activities of daily living OR activities of self care OR activity of self care OR usual activities OR usual activity OR usual activity of daily living OR usual activities of daily living OR Patient Positioning OR Patient Positionings OR Positioning, Patient OR Positionings, Patient OR pressure ulcer OR pressure ulcer/prevention & control OR Guillain-Barre OR Guillain-Barre Syndrome/therapy* OR Guillain-Barre Syndrome/rehabilitation* OR Nursing care OR Pressure Ulcer OR Pressure Ulcers OR Pressure Sore OR Pressure Sores OR Decubitus ulcer OR Bed sore OR Bedsore OR Weaning Mechanical Ventilation OR Extubation OR Mechanical Ventilation Predictors OR Weaning Mechanical Ventilator Predictors OR Extubation Predictors.