Roberta de Oliveira Cacho

Sensory deficits in ipsilesional upper-extremity in chronic stroke patients

Objective To investigate somatosensory deficits in the ipsilesional wrist and hand in chronic stroke patients and correlate these deficits with contralesional sensorimotor dysfunctions, functional testing, laterality and handedness.Methods Fifty subjects (twenty-two healthy volunteers and twenty-eight stroke patients) underwent evaluation with Semmes-Weinstein monofilaments, the sensory and motor Fugl-Meyer Assessment, the Nottingham Sensory Assessment in both wrists and hands and functional tests.Results Twenty-five patients had sensory changes in the wrist and hand contralateral to the stroke, and eighteen patients (64%) had sensory deficits in the ipsilesional wrist and hand. The most significant ipsilesional sensory loss was observed in the left-handed patients. We found that the patients with brain damage in the right hemisphere had better scores for ipsilesional tactile sensation.Conclusions A reduction in ipsilesional conscious proprioception, tactile or thermal sensation was found in stroke subjects. Right hemisphere damage and right-handed subjects had better scores in ipsilesional tactile sensation.

Klapp method effect on idiopathic scoliosis in adolescents: blind randomized controlled clinical trial

[Purpose] To estimate the effect of Klapp method on idiopathic scoliosis in school students. [Subjects and Methods] A single-blind randomized clinical trial with 22 students randomly divided into intervention group (n=12) and inactive control group (n=10). Exercise protocol consisted of Klapp method, 20 sessions, three times a week for intervention group, and inactivity for control group. Dorsal muscle strength was measured by dynamometer; body asymmetries and gibbosity angles were measured by biophotogrammetry. Data were obtained by Generalized Estimated Equation, with 5% significance level. Clinical impact for dependent variables was estimated by “d” Cohen. [Results] There was no change in intragroup analysis and intergroup for all postural symmetry variables. However, it was detected intergroup difference in extensor muscle strength and intergroup difference with marginal significance of gibbosity angles. Regarding extensor muscle strength, intervention group produced average improvement of 7.0 kgf compared to control group. Gibbosity angles progressed less in intervention group, with 5.71° average delay compared to control group. [Conclusion] Klapp method was effective for gibbosity stabilization and it improves spine extensor muscle strength.

Trunk restraint therapy: the continuous use of the harness could promote feedback dependence in poststroke patients: a randomized trial.

AbstractThe objective of this study was to evaluate the long-term effects of the task-specific training with trunk restraint compared with the free one in poststroke reaching movements.The design was randomized trial.The setting was University of Campinas (Unicamp).Twenty hemiparetic chronic stroke patients were selected and randomized into 2 training groups: trunk restraint group (TRG) (reaching training with trunk restraint) and trunk free group (TFG) (unrestraint reaching).Twenty sessions with 45 minutes of training were accomplished. The patients were evaluated in pretreatment (PRE), posttreatment (POST) and 3 months after the completed training (RET) (follow-up).Main outcome measures were modified Ashworth scale, Barthel index, Fugl–Meyer scale, and kinematic analysis (movement trajectory, velocity, angles).A significant improvement, which maintained in the RET test, was found in the motor (P < 0.001) and functional (P = 0.001) clinical assessments for both groups. For trunk displacement, only TFG obtained a reduction statistical significance from PRE to the POST test (P = 0.002), supporting this result in the RET test. Despite both groups presenting a significant increase in the shoulder horizontal adduction (P = 0.003), only TRG showed a significant improvement in the shoulder (P = 0.001 – PRE to POST and RET) and elbow (P = 0.038 – PRE to RET) flexion extension, and in the velocity rate (P = 0.03 – PRE to RET).The trunk restraint therapy showed to be a long-term effective treatment in the enhancement of shoulder and elbow active joint range and velocity rate but not in the maintenance of trunk retention.Trial registration: NCT02364141.

Functional electrical stimulation reduces pain and shoulder subluxation in chronic post-stroke patients?

Background: Shoulder subluxation is a common complication of cerebral vascular accident (stroke) and the use of Functional Electrical Stimulation (FES) within the rehabilitation process is extremely important. Objective: To analyze the therapeutic effects of FES in the treatment of chronic shoulder subluxation in post-stroke patients. Method: This is a case study of patients with radiologically subluxation confirmed, who were randomly divided into two groups: Control Group (CG) and Treatment Group (TG). Patients were assessed before and after treatment and at the 2-month follow-up. The assessment consisted of the modified Ashworth scale; passive goniometry; Fugl-Meyer scale; McGill pain questionnaire and evaluation of shoulder subluxation by radiography. The CG did not receive physiotherapeutic intervention; and TG underwent 20 sessions of motor kinesiotherapy and FES associated with functional exercises with a total duration of 1 hour, three times a week, for 7 weeks. The data were analyzed descriptively. Results: The mean age of CG participants was 82.5 ± 1.5 years and of the TG was 70.5 ± 13.5 years. All of them were retired, sedentary, non-smokers/alcoholics and had hemiparesis on the left side. There was an approximate increase of 10o for most joint movements of the shoulder, improvement in McGill scale scores and reduction of shoulder subluxation in TG patients. Conclusion: FES associated with functional movements was effective in reducing the degree of subluxation of the shoulder joint and decreased pain in subjectsin the chronic phase of the post-stroke.

Evolução Funcional de Pacientes com Hemorragia Subaracnóide Aneurismática não Traumática

Objective: To describe the functional outcome of patients undergoing surgical treatment of intracranial aneurysm clipping admitted to the University of Campinas (Unicamp) hospital. Material and methods: Hunt-Hess and Fisher evaluation was performed with patients at admission. The Functional Independence Measure (FIM) test was performed post-operatively and at discharge, and the Glasgow Outcome Scale (GOS) assessment was carried out at patient discharge. Data on the length of hospital stay as well as affected arteries were obtained. Physical therapy, based on conventional kinesiotherapy, was performed twice a day. Results: A total of 13 patients were studied, with a prevalence of aneurysms in the middle cerebral artery (53.85%). The average age was 51.62 (±13.04) years, and the change in FIM between admission and discharge averaged 34.85 (± 20.85) points (p <0.001). Comparison of FIM with the HuntHess, Fisher and GOS scales demonstrated no significant correlations. Conclusion: ASH is a serious event that results in cognitive and motor impairment of the patient. FIM could be an important predictive tool for monitoring in-hospital neurorehabilitation in the subacute phase of non-traumatic aneurysm.

Neonatal peripheral facial paralysis’ evaluation with photogrammetry: A case report

Facial paralysis in newborns can leave functional sequelae. Determining the evolution and amount of functional losses requires consistent evaluation methods that measure, quantitatively, the evolution of clinical functionality. This paper reports an innovative method of facial assessment for the case of a child 28 days of age with unilateral facial paralysis. The child had difficulty breast feeding, and quickly responded to the physical therapy treatment.