Núbia Maria Freire Vieira Lima

Does the pain disturb the respiratory function after open heart surgery

OBJECTIVE The post operative pain after open heart surgeries had been often reported. Meager reports about respiratory function and pain correlation had been reported. The aim of this article is to assess the pain intensity and location during hospital admittance and its effect on pulmonary function in patients underwent elective cardiac surgery. METHODS Pulmonary function (lung volumes, respiratory pressures and peak expiratory flow) was assessed at the preoperative and post-operative time (1, 3 and 5 days) by ventilometer, manovacuometer and peak flow meter measurements. The assessment of pain intensity was carried out with a visual analogue scale for pain. RESULTS The majority of pain site was on sternotomy incision (50% of patients) and the intensity was higher at the first postoperative day (8.32 by visual scale measurement). All pulmonary variables decreased on post-operative time when compared to baseline values. All respiratory variables remained lower than to pre-operative time at fifth postoperative time (P > 0.05), with exception for respiratory rate. The pain and maximal inspiratory pressure showed a negative correlation at the first postoperative day (P = 0.019). CONCLUSION Postoperative pain decreased lung function in patients precluding deep inspirations, in special, at the first post-operative day.

Correlations between motor and sensory functions in upper limb chronic hemiparetics after stroke

OBJECTIVE Describe the somatosensory function of the affected upper limb of hemiparetic stroke patients and investigate the correlations between measurements of motor and sensory functions in tasks with and without visual deprivation. METHOD We applied the Fugl-Meyer Assessment (FMA), Nottingham Sensory Assessment (NSA), and several motor and sensory tests: Paper manipulation (PM), Motor Sequences (MS), Reaching and grasping (RG) Tests Functional (TF), Tactile Discrimination (TD), Weight Discrimination (WD) and Tactile Recognition of Objects (RO). RESULTS We found moderate correlations between the FMA motor subscale and the tactile sensation score of the NSA. Additionally, the FMA sensitivity was correlated with the NSA total; and performance on the WD test items correlated with the NSA. CONCLUSION There was a correlation between the sensory and motor functions of the upper limb in chronic hemiparetic stroke patients. Additionally, there was a greater reliance on visual information to compensate for lost sensory-motor skills.

Amyotrophic lateral sclerosis: combined nutritional, respiratory and functional assessment

OBJECTIVE To establish correlations between nutritional, functional and respiratory indices of patients with amyotrophic lateral sclerosis (ALS). METHOD Twenty patients (13 appendicular-GA and 7 bulbar-GB) were included in the multidisciplinary study at the Neurological Clinic Ambulatory of the University of Campinas Hospital. RESULTS Among the GA type significant correlation was observed between maximal inspiratory (MIP) and expiratory (MEP) pressure (r=-0.76), MEP and pulse oxymetry (r=0.58), MIP and percent weight loss (%WL; r=0.59), and between MIP, total and subscale respiratory scores (ALSFRS-R) with %WL. With regard to the GB, correlation was found between MEP and body mass index (BMI) (r=0.97). In both GA and GB correlations were noticed between the BMI and the variables mass (kg), fat (%), arm and wrist circumference (cm), and tricipital, subscapular and supra-iliac skinfolds (mm), as well as the arm muscle circumference (cm) and fatty arm muscular area (mm2). CONCLUSION It is suggested that the application of simple anthropometric measurements could be useful in routine monitoring of patients with ALS.

Versão Brasileira da Avaliação Sensorial de Nottingham: validade, concordância e confiabilidade

OBJECTIVES To investigate the inter-rater and intra-rater reliability, construct validity and internal consistency of the Brazilian version of the Nottingham Sensory Assessment for Stroke Patients (NSA). METHODS The instrument was translated into Portuguese from its original in English by a bilingual translator and was then back-translated into English. Twenty-one hemiparetics were evaluated by two examiners using the NSA and the Fugl-Meyer Assessment (FMA) of physical performance. RESULTS Significant correlation were found between the FMA and the NSA (r=0.752). The NSA showed excellent internal consistency (0.86), and there were acceptable inter- and intra-rater reliability for all items of the NSA, except temperature. Significant ceiling effects were found for the NSA and the FMA. CONCLUSIONS The Brazilian version of the NSA met the criteria for agreement, internal consistency and concurrent validity. It was quick and easy to apply, and it could be used within clinical practice in neuro-rehabilitation outpatient clinics to assess sensory functions following stroke. The significant ceiling effect for the NSA did not limit its use, given that for the same patients, the FMA also showed ceiling effects.OBJETIVO: Verificar a concordância inter e intraexaminador, validade construtiva e consistencia interna da versao brasileira do instrumento Nottingham Sensory Assessment para hemipareticos apos acidente vascular encefalico (AVE). METODOS: O instrumento foi traduzido para lingua portuguesa com base na sua versao original em Ingles por um tradutor bilingue e, posteriormente, revertido para a lingua inglesa. Vinte e um hemipareticos foram avaliados por dois examinadores pela Avaliacao Sensorial de Nottingham para pacientes pos-AVE (ASN) e pelo Protocolo de Desempenho Fisico de Fugl-Meyer (FM). RESULTADOS: Foi encontrada correlacao entre os instrumentos FM e ASN (0,752); excelente consistencia interna da ASN (0,86); excelentes coeficientes de concordância interexaminador e intraexaminador para todos os itens da ASN, exceto temperatura e efeito teto significativo para ASN e FM. CONCLUSAO: A versao brasileira da Nottingham Sensory Assessment cumpriu os criterios de concordância, consistencia interna e validade concorrente, sendo um instrumento de rapida e facil aplicacao, podendo ser utilizada nos ambulatorios de neuroreabilitacao para avaliar a funcao sensorial pos-AVE. O efeito teto significativo da ASN nao limita seu uso, tendo em vista que, para os mesmos pacientes, o Protocolo de Fugl-Meyer tambem revelou efeito teto.

Versão brasileira da Escala de Comprometimento do Tronco: um estudo de validade em sujeitos pós-acidente vascular encefálico

O controle de tronco - uma habilidade motora basica indispensavel a execucao de muitas tarefas funcionais - encontra-se deficitario em pacientes que sofreram acidente vascular encefalico (AVE). Ha poucas referencias estrangeiras, e nenhuma em portugues, que focalizem a avaliacao de tronco de forma quantitativa. Este estudo teve como objetivo traduzir e verificar a confiabilidade inter e intra-examinador, validade construtiva e consistencia interna da versao brasileira da ECT - Escala de Comprometimento do Tronco (Trunk Impairment Scale). Em 18 voluntarios com hemiparesia secundaria a AVE foram aplicados os seguintes instrumentos: ECT, Protocolo de Desempenho Fisico de Fugl-Meyer, Medida de Independencia Funcional, EEB - Escala de Equilibrio de Berg e Classificacao de Deambulacao Funcional. As avaliacoes foram realizadas por tres fisioterapeutas experientes e o reteste da ECT foi realizado apos 48 horas. Foram encontradas moderada confiabilidade intra-examinador e excelente confiabilidade inter-examinador (p<0,05), porem baixa consistencia interna (0,45). A EEB foi a unica a apresentar correlacao com a ECT (r=0,491, p=0,038); a comparacao com as demais escalas nao revelou significância estatistica. A ECT mostrou-se valida e eficaz para quantificar o comprometimento do tronco, com facil aplicabilidade, e cumpriu os criterios de confiabilidade, assegurando sua replicabilidade por profissionais atuantes na reabilitacao neurologica.

Efeito imediato do ortostatismo em pacientes internados na unidade de terapia intensiva de adultos

Objetivo: Analisar o nivel de consciencia, efeitos pulmonares e hemodinâmicos em pacientes internados em UTI durante a posicao ortostatica. Metodos: Estudo realizado de abril de 2008 a julho de 2009 na unidade de terapia intensiva adulto do HCUNICAMP. Foram incluidos quinze pacientes que estiveram mecanicamente ventilados por mais de sete dias; traqueostomizados; em nebulizacao intermitente; pressao inspiratoria maxima inferior a -25cmH2O; indice de Tobin inferior a 105; drive ventilatorio preservado, ausencia de sedativos; pressao parcial de oxigenio arterial maior que 70mmHg; saturacao de oxigenio maior que 90% e estabilidade hemodinâmica. Os parâmetros avaliados, nas inclinacoes de 0°, 30° e 50°, foram o nivel de consciencia; reflexo de blinking; cirtometria toraco-abdominal; capacidade vital; volume corrente; volume minuto; forca da musculatura respiratoria e sinais vitais. Resultados: Nao houve alteracao do nivel de consciencia. A frequencia respiratoria e volume minuto reduziram-se em 30° com posterior aumento em 50°, no entanto, essas alteracoes nao foram estatisticamente significativas. A cirtometria abdominal e a pressao expiratoria maxima apresentaram aumento, novamente sem significância estatistica. Em relacao a pressao inspiratoria maxima e a capacidade vital observou-se aumento estatisticamente significante na comparacao entre as angulacoes 50o e 0°. Ja o volume corrente aumentou na comparacao entre as angulacoes 30o e 0o, e entre 50o e 0°. A pressao arterial media sofreu incremento somente na comparacao entre 50° e 0°. A frequencia cardiaca elevou-se na comparacao entre 30° e 0°, 50° e 0°, e 50° e 30°. Conclusao: O ortostatismo passivo proporcionou melhora do volume corrente, capacidade vital, pressao inspiratoria maxima, e aumento da frequencia cardiaca e pressao arterial media em pacientes criticos. Abstract

Risk factors for transient dysfunction of gas exchange after cardiac surgery

Objective A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. Methods We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011. Results Fifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild transient dysfunction of gas exchange, 402 (56.1%) had moderate transient dysfunction of gas exchange, and 39 (5.4%) had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively) and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively). Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001). Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005), hemotherapy (P=0.0001), enteral nutrition (P=0.0012), or cardiac arrhythmia (P=0.0451). Conclusion Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures.

Brazilian version of the Nottingham Sensory Assessment: validity, agreement and reliability

OBJECTIVES To investigate the inter-rater and intra-rater reliability, construct validity and internal consistency of the Brazilian version of the Nottingham Sensory Assessment for Stroke Patients (NSA). METHODS The instrument was translated into Portuguese from its original in English by a bilingual translator and was then back-translated into English. Twenty-one hemiparetics were evaluated by two examiners using the NSA and the Fugl-Meyer Assessment (FMA) of physical performance. RESULTS Significant correlation were found between the FMA and the NSA (r=0.752). The NSA showed excellent internal consistency (0.86), and there were acceptable inter- and intra-rater reliability for all items of the NSA, except temperature. Significant ceiling effects were found for the NSA and the FMA. CONCLUSIONS The Brazilian version of the NSA met the criteria for agreement, internal consistency and concurrent validity. It was quick and easy to apply, and it could be used within clinical practice in neuro-rehabilitation outpatient clinics to assess sensory functions following stroke. The significant ceiling effect for the NSA did not limit its use, given that for the same patients, the FMA also showed ceiling effects.OBJETIVO: Verificar a concordância inter e intraexaminador, validade construtiva e consistencia interna da versao brasileira do instrumento Nottingham Sensory Assessment para hemipareticos apos acidente vascular encefalico (AVE). METODOS: O instrumento foi traduzido para lingua portuguesa com base na sua versao original em Ingles por um tradutor bilingue e, posteriormente, revertido para a lingua inglesa. Vinte e um hemipareticos foram avaliados por dois examinadores pela Avaliacao Sensorial de Nottingham para pacientes pos-AVE (ASN) e pelo Protocolo de Desempenho Fisico de Fugl-Meyer (FM). RESULTADOS: Foi encontrada correlacao entre os instrumentos FM e ASN (0,752); excelente consistencia interna da ASN (0,86); excelentes coeficientes de concordância interexaminador e intraexaminador para todos os itens da ASN, exceto temperatura e efeito teto significativo para ASN e FM. CONCLUSAO: A versao brasileira da Nottingham Sensory Assessment cumpriu os criterios de concordância, consistencia interna e validade concorrente, sendo um instrumento de rapida e facil aplicacao, podendo ser utilizada nos ambulatorios de neuroreabilitacao para avaliar a funcao sensorial pos-AVE. O efeito teto significativo da ASN nao limita seu uso, tendo em vista que, para os mesmos pacientes, o Protocolo de Fugl-Meyer tambem revelou efeito teto.

Tradução e validação da versão brasileira da escala de gravidade na esclerose lateral amiotrófica (Egela)

The purpose was to translate the Amyotrophic Lateral Sclerosis Severity Scale (ALSSS) into Portuguese, to validate it and assess its reliability. The scale was submitted to bilingual translators, its abbreviation in Portuguese being Egela; three physical therapists were trained for its application. Twenty-two patients (5 women, 17 men, mean age 45.9) were evaluated by the Egela and by the functional independence measure (FIM); 11 of them were assessed for dysphagia classification. In all ALSSS domains the intraclass correlation coefficients were over 0.89; high internal consistency was found in all scale domains and for each examiner. Strong correlations were found between motor FIM and spinal ALSSS (r=0.87; p<0.0001), ALSSS swallow domain and both dysphagia classifications (r=-0.88; p=0.0015), and ALSSS speech domain and expression FIM (r=0.76; p<0.001). The Portuguese version of ALSSS showed significant inter-examiner reliability and internal consistency, as well as strong correlations with FIM scores, thus proving a valid and reliable tool for assessing patients with amyotrophic lateral sclerosis.

EFEITOS DA REABILITAÇÃO VESTIBULAR NA ATAXIA CEREBELAR. Relato de três casos

A Cardiomiopatia de Takotsubo tambem sindrome do coracao partido, ocorre principalmente em mulheres, que apos sofrerem um trauma ou estresse apresentam sintomas iguais a do infarto agudo do miocardio. Os exames de angiografia coronariana demonstram as arterias coronarianas sem obstrucoes significativas, e na ventriculografia e observado um aneurisma ventricular esquerdo, semelhante a um Takotsubo (armadilha de pegar polvo). O objetivo deste artigo e identificar as caracteristicas das imagens nos exames de angiografia, ventriculografia, ecografia, angiotomografia e na ressonância magnetica. Compilamos os artigos para a construcao das caracteristicas de imagem da referida sindrome. A caracteristica principal da sindrome e o balonamento apical causado por um aneurisma ventricular, que pode ser demonstrado em exames de imagem radiograficas contrastados, podendo ser confirmado por exames como a cintilografia. A angiotomografia permite a avalicao perfeita das coronarias, associado com exames de ressonância, que demonstram que nao ha lesoes miocardicas significativas, colaboram para a caracterizacao do diagnostico da sindrome de Takotsubo. Concluimos que as caracteristicas da imagem sao de suma importância na deteccao da sindrome de Takotsubo e os exames citados sao os exames que definem a melhor qualidade de imagem, mas os exames de imagem mais utilizados sao a coronariografia e a ventriculografia.A diabetes mellitus (DM) e a nefropatia diabetica (ND) estao entre as mais prevalentes e incapacitantes complicacoes associadas a dano microvascular. A gravidade da hiperglicemia e a presenca de hipertensao arterial sistemica (HAS) estao entre os principais fatores de risco para essas complicacoes. Sendo assim o objetivo deste trabalho e fornecer uma revisao atualizada e orientada para a pratica clinica sobre a importância do controle glicemico, da homeostase pressorica e as complicacoes cardiacas, vasculares e da retina que ocorrem na ausencia deste.A automedicacao mostra-se uma pratica bastante comum na sociedade brasileira, incluindo todas as faixas etarias e graus de escolaridade, trazendo desta forma uma preocupacao aos dos profissionais da area da saude, devido aos graves problemas que essa pratica pode vir acarretar. Com intencao de verificar a incidencia de automedicacao entre os universitarios da Universidade Federal do Tocantins, Campus de Araguaina-TO, foi realizado um estudo, utilizando como instrumento para obtencao dos dados um questionario em formato de teste de multipla escolha contendo 12 questoes. Foram entrevistados 145 estudantes sendo que 84 eram do sexo feminino e 61 eram do sexo masculino. A media de idade dos academicos e de 23 anos. Foi possivel verificar que a pratica da automedicacao e algo comum e frequente na vida dos universitarios, demonstrando a necessidade de tracar estrategias de sensibilizacao da comunidade academica acerca do tema.