Daniel Rubio de Souza

A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury

Abstract Past evidence has shown that motor cortical stimulation with invasive and non‐invasive brain stimulation is effective to relieve central pain. Here we aimed to study the effects of another, very safe technique of non‐invasive brain stimulation – transcranial direct current stimulation (tDCS) – on pain control in patients with central pain due to traumatic spinal cord injury. Patients were randomized to receive sham or active motor tDCS (2 mA, 20 min for 5 consecutive days). A blinded evaluator rated the pain using the visual analogue scale for pain, Clinician Global Impression and Patient Global Assessment. Safety was assessed with a neuropsychological battery and confounders with the evaluation of depression and anxiety changes. There was a significant pain improvement after active anodal stimulation of the motor cortex, but not after sham stimulation. These results were not confounded by depression or anxiety changes. Furthermore, cognitive performance was not significantly changed throughout the trial in both treatment groups. The results of our study suggest that this new approach of cortical stimulation can be effective to control pain in patients with spinal cord lesion. We discuss potential mechanisms for pain amelioration after tDCS, such as a secondary modulation of thalamic nuclei activity.

Epidemiologia da paralisia cerebral

Introduction: there is a great interest in finding a cerebral palsy determinant ethiologic factor, that way, it could be possible to realize a profilatic approach for this injury. On literature, many risk factors are accused and some authors suggest that is a multifatorial disease. It was also searched about possible protector factors, life expectancy and the most commum causes of death, focusing on finding ways to prevent complications and to improve life quality. Methods and material: sistematic literature reviow based in 40 articles found in Bireme, Lilacs and Pubmed sites, beside two recente edition books. Results: the most mencioned risk factors were perinatal hypoxia, prematurity and mathernal intrauterine infeccion. Other factors are multiple births, choriomnionitis and thrombophilia. The use of corticosteroids on antenatal period was mencioned as a protector factor. Some authors also suggest a pre-eclampsia and magnesium sulfate administration, however a controversy still remains about this. The principal cause of death pointed were respiratory diseases, like pneumonia. Other causes are intestinal obstruction (f. e. volvo), pedestrian and motor accidents and drowning. Conclusion: it doesn´t exist a determinant factor to cerebral palsy. The hypoxia/ischemia perinatal have a large contribution comparing others factors, but it depend on the intensity and the period that occurs. There aren´t enough studies about protective factors to prove a true efficacy. The mainly causes of death are the repiratory diseases. It´s possible to reduce drowing and pedestrian accidents incidence based on orientation and rehabilitation.

On the Small Effect of Boundary Layer Thicknesses on Slat Noise

In landing procedure the airframe noise is comparable to the noise generated by the engines of an aircraft, being the leading edge slat one of the most important components. Experiments on slat noise generation usually are limited to much lower Reynolds numbers than those obtained in ight conditions. The present paper describes analyses made to evaluate numerically the in uence of the boundary layer thickness on the unsteady ow and noise generation at the slat cove. Time accurate simulations were done using a LatticeBoltzmann solver. Grid independence studies of the Power Spectral Density (PSD) are presented. Slat boundary layer thicknesses were found to have little in uence on turbulence and pressure spectra at the slat cove, leading to investigations of the use of free-slip walls at the slat. Very small level di erences were obtained in the slat noise produced. This assumption allowed not only a coarser grid to be employed in certain regions but also the possibility to predict slat noise in high Reynolds number ows with no major increase in simulation cost.

Contemporary Trends in the Epidemiology of Traumatic Spinal Cord Injury: Changes in Age and Etiology

Background: Epidemiological features of spinal cord injury (SCI) have been changing over the last decades. We evaluated the contemporary trends in the epidemiology of traumatic SCI patients from a rehabilitation center. Methods: In a cross-sectional study, a consecutive series of 348 patients with traumatic SCI were evaluated. Variables were collected through an epidemiological form, which included gender, age at injury, duration and cause of SCI. We investigated SCI epidemiological trends over time including the association between gender and age at injury with SCI features such as etiology, injury severity and level. Results: The mean age at SCI has increased from 26.0 ± 11.8 in patients with SCI before 2003 to 37.9 ± 15.7 in those with SCI after 2009 (p < 0.001). Gunshot wounds were the main cause of injury in patients with SCI before 2003, dropping from 40.6 to 16.9% after 2009 and being surpassed by road traffic injuries (38.6%) and falls (31.4%) after 2009 (p < 0.001). Gender, SCI severity and level have not changed significantly over the time. Conclusions: There was a major increase in the average age of patients as well as changes in the etiology of SCI over the past fifteen years, including a significant decrease in gunshot wounds and an increase in the frequency of road traffic injuries and falls. These changes and accompanying risk factors must be taken into consideration when planning measures to prevent SCI.

Evaluation of Sexual Dysfunction in Men With Spinal Cord Injury Using the Male Sexual Quotient.

OBJECTIVE To assess different aspects of sexual function in men with spinal cord injury (SCI) using the Male Sexual Quotient (MSQ), a newly developed tool to assess sexual function and satisfaction. DESIGN Cross-sectional study. SETTING Tertiary rehabilitation center. PARTICIPANTS Patients (N=295) older than 18 years (mean age ± SD, 40.7±14.5y) with SCI for more than 1 year (median time since SCI, 3.6y; range, 1.6-7.0y) were assessed from February to August 2012. Patients completed the MSQ questionnaire and the Sexual Health Inventory for Men (SHIM). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Performance in various domains of sexual function was evaluated using the MSQ and SHIM questionnaires. RESULTS Erectile function, ejaculation, and orgasm were the most severely affected domains. The median MSQ score was 40 (range, 8-66), and the median SHIM score was 5 (range, 0-16). The diagnostic properties of the 2 instruments were similar in the discrimination of sexually active subjects. The area under the receiver operating characteristic curve was .950 (95% confidence interval [CI], .923-.979) for the MSQ and .942 (95% CI, .915-.968) for the SHIM. There was a strong correlation between the 2 instruments (r=.826; 95% CI, .802-.878). CONCLUSIONS Different domains of sexual function are severely impaired in men with SCI, although their sexual interest remains high. The MSQ and SHIM scores strongly correlate, but the MSQ provides a more comprehensive assessment of sexual dysfunction in male patients with SCI.

On Detrimental Effects of Excrescences on the Slat Noise

In airplane landing the slat noise is already a barrier to the development of quieter commercial airplanes. Investigations have been made by several research groups to understand the mechanism of noise generation in slat and develop better tools to predict it. Most of the published works related to slat noise considers clean idealized geometries, whereas real slats contain some imperfections to enable its operation. The in uence of a protrusion on the slat cavity surface on the unsteady ow around the slat and on the propagated sound was here investigated via numerical calculation. The protrusion was a sealing device to avoid metal-metal contact. Lattice-Boltzmann method was used in the computations. The e ect of the seal on the mean surface pressure distribution is limited to the region close to it. When the seal is positioned inside the recirculation zone, the region next to the cusp present less uctuation intensity and the vortices formed in the mixing layer keep two-dimesionality for a longer distance in the way to the reattachment point. The noise propagated to fareld also present more intense low frequency tonal peaks. Although discretization as ne was 0:15mm was employed, uctuations of a speci c frequency band were still mesh dependent.

Lesão medular: reabilitação

Spinal cord injured (SCI) persons open experience chronic pain. Methods of dealing with pain that the SCI client found helpful in the past may not be beneficial afrer the injury. This article describes a study of self-medication for the purpose of pain relief. Over-the-counter, prescription, or illicit drugs or alcohol are among the agents employed in self-medication. The rehabilitation nurse has a role in helping the SCI person to identify appropriate methods of managing chronic pain throughout life.

Post-discharge mortality in patients with traumatic spinal cord injury in a Brazilian hospital: a retrospective cohort

Study designRetrospective cohort.ObjectiveTo evaluate the survival outcomes in patients with traumatic spinal cord injury (TSCI).SettingA teaching hospital in Brazil.MethodsA total of 434 patients diagnosed with TSCI (2004–2014) were included. Overall survival, standardized mortality ratios (SMR), and causes of death were assessed by Student’s t-test, χ2 test, Kaplan–Meier analysis, and Cox proportional-hazards regression.ResultsThe mean follow-up was 4.8 years (±3.3 years). Individuals with tetraplegia had a median survival of 11 years, with participants in the paraplegia group not reaching median survival. The overall mortality rate was 37 per 1000 person-years. Age-adjusted SMR was 28.8 (95% CI: 22.8–36). There were 77 deaths with 56 defined causes, of which pneumonia was the most frequent (35.7%). Combined infectious etiologies caused 55.3% of deaths. Multivariate analysis revealed higher mortality among individuals with tetraplegia vs. paraplegia in the first 2 years post injury (HR = 8.28, 95% CI: 2.76–24.80), after 2 years post injury (HR = 2.35, 95% CI: 1.31–4.24), and in all years combined (HR = 3.36, 95% CI: 2.04–5.52).ConclusionMortality among patients with TSCI was 28.8 times higher than in the reference population. In more than half of the cases, the cause of death was linked to infectious diseases. Pneumonia caused two times more deaths in individuals with tetraplegia than in individuals with paraplegia, with a higher impact in the first 2 years post injury. Reported findings indicate the need for a surveillance and prevention program with emphasis on vaccination and respiratory rehabilitation.

Modelo de reabilitação hospitalar após acidente vascular cerebral em país em desenvolvimento

44 ABSTRACT Intensive rehabilitation services with standardized treatment for stroke survivors are desirable once they contribute to the patients’ functional improvement even in facilities with restricted financial resources. Objective: To verify whether the stroke program at our public inpatient Rehabilitation Center contributes to improvements in functional outcome. Method: This is a retrospective cross-sectional study of the first and last 100 neurological patients (2009-2010 and 2014-2015) admitted at the Lucy Montoro Rehabilitation Network (Morumbi Unit). For this study, the patients were analyzed at admission and at discharge by the modified Rankin Scale (mRS). After testing for normality, an unpaired t-test was on the patients’ clinical and demographic characteristics. Intragroup analysis was performed by the nonparametric Wilcoxon test. The intergroup analysis used the Mann-Whitney nonparametric test. Functional outcome scores ≤ 3 at discharge were considered favorable. Results: The modified Rankin Scores (mRS) were assessed just before the initiation of the therapies and at the patients’ discharge. Median mRS score at admission was 4 compared to 3 at discharge (p=0.0001), after 4 to 6 weeks in the stroke program. Conclusions: Short term, standardized intensive rehabilitation program with multidisciplinary therapies, in which the patient remains hospitalized, promote functional improvements of patients with stroke sequelae.

Intensive rehabilitation model in Guillain-Barre syndrome: a case report

There is little information in the medical literature on the rehabilitation of patients with GuillainBarre Syndrome (GBS). There are clinical studies that demonstrate the effectiveness of a rehabilitation program using an interdisciplinary team, but without well-defined protocols and only performed on an outpatient basis. This case report aims to describe the evolution of a patient with GBS during the intensive multidisciplinary inpatient rehabilitation program, discussing the therapeutic possibilities for rehabilitation of the disease