Marise Bueno Zonta

Tratamento da espasticidade: uma atualização

We present an update about the treatment of spasticity, stressing the pharmacological treatment, physical therapy and botulinum toxin therapy.

The physical, social and emotional aspects are the most affected in the quality of life of the patients with cervical dystonia

OBJECTIVE Describe the functional, clinical and quality of life (QoL) profiles in patients with cervical dystonia (CD) with residual effect or without effect of botulinum toxin (BTX), as well as verify the existence of correlation between the level of motor impairment, pain and QoL. METHOD Seventy patients were assessed through the Craniocervical dystonia questionnaire-24 (CDQ-24) and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). RESULTS The greater the disability, pain and severity of dystonia, the worse the QoL (p<0.0001). Greater severity relates to greater disability (p<0.0001). Pain was present in 84% of the sample, being source of disability in 41%. The most frequent complaints were: difficulty in keeping up with professional and personal demands (74.3%), feeling uneasy in public (72.9%), hindered by pain (68.6%), depressed, annoyed or bitter (47.1%), lonely or isolated (32.9%). CONCLUSION The physical, social and emotional aspects are the most affected in the QoL of these patients.

Crescimento e antropometria em pacientes com paralisia cerebral hemiplégica

OBJECTIVE: To analyze the linear growth, the head circumference and the anthropometric differences between involved and non-involved sides of 24 children with hemiplegic cerebral palsy, comparing them to standard values for age. METHODS: This cross-sectional study enrolled 24 consecutive children with cerebral palsy clinically classified as spastic hemiplegia. The anthropometric measures included: weight, lenght, head circumference, total upper limb length, hand length, palm width, total lower limb length, foot length, and limb circumference of upper-arm, thigh and calf. The anthropometric differences between both sides were calculated in centimeters and a comparison of the involved and non-involved sides was made. Two different reference values were used to compare the measures of hand and foot length: growth charts and the software ABase® (a PalmOS-based software). The Spearmans correlation coefficient was estimated for the association between quantitative variables and the Wilcoxon non-parametric test was used for age comparisons between involved and noninvolved sides. RESULTS: The mean values of weight, length and head circumference were within the normal range for age and 21% of the children presented microcephaly. Discrepancy was noted between both sides in all cases, being the largest discrepancy in hand length and width. There was a positive correlation between the discrepancy observed in superior and inferior affected limbs (r=0.48), and discrepancy increases with age (r=0.44). CONCLUSION: Growth impairment in children with hemiplegic cerebral palsy was observed on the affected limbs and in smaller proportion in head circumference.

Functional assesment of patients with AIDS disease

We documented the types and degree of functional disability in 74 patients with AIDS at the Hospital de Clínicas of the Federal University of Paraná, Brazil. Few of these patients are referred for rehabilitation services and there is only a limited team approach in their care. We found that 91% of the patients had some degree of functional impairment; in 81% the complaint was weakness and in 47% it was neurological involvement. According to the Barthel Index, 79% were considered functionally independent, 14% partially dependent and 7% dependent. For most of them, independence requires effort and their quality of life is reduced. Severe disability was rather unusual, while mild or moderate disability levels were not. The functional physical disability found in 21% of the patients required management by a rehabilitation team. We conclude that it is important to focus attention on the quality of life of patients with AIDS.

Evaluation of AIDS-related disability in a general hospital in southern, Brazil

The increase in survival rates of patients affected by AIDS is associated with physical disabilities that can compromise their functional independence. We examined the degree and types of disabilities in hospitalized AIDS patients , as well the clinical and immunological parameters associated with disability. The lowered functional status was associated with increased time since AIDS had been diagnosed, with complaints of weakness, and with the involvement of more than one set of systems in the definition of AIDS. The inability to perform daily living activities was associated with higher viral loads (log) c/mL, lower CD4+/mL and CD4+/CD8+ ratios, and with involvement of the central nervous system, in the cause of hospitalization. Both the inability to perform daily living activities and low functional status were associated with muscle strength alteration and with being unemployed.

Dynamic of CSF and serum biomarkers in HIV-1 subtype C encephalitis with CNS genetic compartmentalization—case study

Despite the effective suppression of viremia with antiretroviral therapy, HIV can still replicate in the central nervous system (CNS). This was a longitudinal study of the cerebrospinal fluid (CSF) and serum dynamics of several biomarkers related to inflammation, the blood-brain barrier, neuronal injury, and IgG intrathecal synthesis in serial samples of CSF and serum from a patient infected with HIV-1 subtype C with CNS compartmentalization.The phylogenetic analyses of plasma and CSF samples in an acute phase using next-generation sequencing and F-statistics analysis of C2-V3 haplotypes revealed distinct compartmentalized CSF viruses in paired CSF and peripheral blood mononuclear cell samples. The CSF biomarker analysis in this patient showed that symptomatic CSF escape is accompanied by CNS inflammation, high levels of cell and humoral immune biomarkers, CNS barrier dysfunction, and an increase in neuronal injury biomarkers with demyelization. Independent and isolated HIV replication can occur in the CNS, even in HIV-1 subtype C, leading to compartmentalization and development of quasispecies distinct from the peripheral plasma. These immunological aspects of the HIV CNS escape have not been described previously. To our knowledge, this is the first report of CNS HIV escape and compartmentalization in HIV-1 subtype C.

Effects of early spasticity treatment on children with hemiplegic cerebral palsy: a preliminary study.

OBJECTIVE To compare motor and functional performance of two groups of children with hemiplegic cerebral palsy (HCP). Only the study group (SG) received early treatment of spasticity with botulinum neurotoxin type A (BXT-A). METHODS Gross Motor Function Measure (GMFM), functional performance (Pediatric Evaluation of Disability Inventory - PEDI), range of movement, gait pattern (Physician Rating Scale - PRS) and the speed of hand movements were considered. RESULTS The SG, composed of 11 HCP (45.64±6.3 months), was assessed in relation to the comparison group, composed of 13 HCP (45.92±6.4 months). SG showed higher scores in four of the five GMFM dimensions, which included scores that were statistically significant for dimension B, and higher scores in five of the six areas evaluated in the PEDI. Active wrist extension, the speed of hand movements and PRS score were higher in the SG. CONCLUSION Children who received early BXT-A treatment for spasticity showed higher scores in motor and functional performance.

Two-dimensional analysis of gait asymmetry in spastic hemiplegia

OBJECTIVE Simple measures of gait for routine clinical use could be useful when the complex gait analysis systems are not available. The aim of this study was to quantify asymmetry in children with spastic hemiplegia using a two-dimensional gait analysis by videography and to relate the asymmetry to motor function. METHODS Twenty-four children with spastic hemiplegia (19 males, 5 females; mean age 49 months [SD 5 months], range from 39 to 60 months) were assessed with a two-dimensional gait analysis by videography and the analyzed parameters were compared with normal values and with clinical and functional data. RESULTS There were significant differences in swing time (p = 0.002), stance time (p = 0.01) and stance/swing time ratio (p < 0.001). The comparison with the normal values described by Sutherland also demonstrated gait asymmetry. There was no direct relationship between the motor function and asymmetry but a score analysis for specific Gross Motor Function Measure items could quantify it in terms of age of gait acquisition. Children with more adequate muscle tone presented longer stance time in the involved limb than those with more spasticity (p = 0.03). CONCLUSIONS These results suggest that the best performance is associated with the smallest asymmetry in this sample. Although two-dimensional gait analysis does not provide as much data as three dimensional gait analyses, we believe it can contribute significantly to the gait assessment of children with cerebral palsy.

THE EFFECT OF ADAPTED SPORTS IN QUALITY OF LIFE AND BIOPSYCHOSOCIAL PROFILE OF CHILDREN AND ADOLESCENTS WITH CEREBRAL PALSY

ABSTRACT Objective: The participation in sports and recreational activities promotes inclusion and the quality of life (QOL) for people with some type of disability. This study aims to evaluate and describe the effect of adapted sports (AS) on the QOL and biopsychosocial profile of children/adolescents with cerebral palsy (CP). Methods: Forty-seven children/adolescents with CP were evaluated and referred to AS (soccer and swimming). The QOL was evaluated by the Pediatric Outcome Data Collection Instrument (PODCI) and the biopsychosocial profile by the Behavior Checklist for Children/Adolescents (CBCL). These instruments considered the influence of gender, age, race, social income, education and topography of spasticity. Results: Seventeen children/adolescents who practiced AS were re-evaluated after one year. There was significant improvement in the dimensions of transfers and mobility (p=0.009), upper extremity function (p=0.021) and global function (p=0.004) of IARRP. There was significant improvement considering the attention disorder syndrome (p=0.026), and the attention deficit hyperactivity disorders (p=0.008) in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented analysis (CBCL). Children/adolescents with diplegia obtained greater benefit than those with hemiplegia in relation to the comfort and pain (p=0.02) and global dimension (p=0.027) (PODCI). The boys had higher scores in total competence (p=0.048); the extremely poor group obtained higher levels in the breaking rules syndrome (p=0.008). Conclusions: The AS had a positive effect on the QOL and biopsychosocial profile of children/adolescents with CP in this sample, especially considering the global and upper extremity function, capacity for transfers and mobility, and benefits in the problems related to difficulties in attention.

Rehabilitation of Ataxia

Rehabilitation in patients with ataxia involves a thorough assessment to establish the current level of functioning and to set up treatment goals and strategies. Besides motor coordination and balance training, other goals in rehabilitation therapy in patients with ataxia include increased transfer and locomotion independence, muscle strengthening, increased physical resilience, “safe fall” strategy, learning to use mobility aids (e.g., a walker), monitoring posture while sitting and standing, preventing and minimizing deformities and pain in patients confined to a bed and/or wheelchair, and learning muscle relaxation exercises. This chapter provides a review of rehabilitation therapy in patients with ataxia.