Sissy Veloso Fontes

Balance and motor coordination are not fully developed in 7 years old blind children

Visually impaired children show difficulties in recognizing their own bodies, objects around then and the spatial parameters that are essential for independent movement. This study analyzes the neuro-psychomotor development of a group of congenitally visually impaired children as compared to children with normal sight. We have evaluated two groups of seven-year-olds by means of neurological evolution examination (NEE). The group studied comprised 20 blind children and the control group comprised 20 children with normal sight, and they were paired up according to age and gender. In some tests, the blind children were guided by touch. The visually impaired children performed worse in tests evaluating balance and appendage coordination compared to normal sighted children (p< 0.001), and this suggests that visual deficiency impairs childrens neuro-psychomotor development.

Predictive factors for spasticity among ischemic stroke patients

UNLABELLED Spasticity is a determining for functional loss following ischemic stroke. OBJECTIVE To detect possible predictive factors for its occurrence. METHOD Demographic, clinical and tomographic data on 146 stroke patients were analyzed. RESULTS Spasticity was noted more frequently among patients who underwent physiotherapy (p<0.0001; OR=19.4; 95% CI: 4.4-84.5), those who underwent such treatment for long periods (p=0.028; OR=4.80; 95% CI: 1.1-8.3) and those with manual work (p=0.041; OR=2.2; 95% CI: 1.02-4.6), lower income (p=0.038), pain complaints (p<0.0001; OR=107.0; 95% CI: 13.5-847.3), appearance of pain at the same time as spasticity (p<0.0001), previous vascular disease (p=0.001; OR=4.2; 95% CI: 1.7-10.3), muscle weakness (p<0.0001; OR=91.9; 95% CI: 12.0-699.4), extensive lesions as seen on tomography (p=0.01) and lesions affecting more than one cerebral lobe (p=0.018). Manual work had a relative risk of 2.9; previous stroke 3.9, and extensive lesion 3.6. CONCLUSION Spasticity affected 25% of the patients, and was associated with: manual work, previous stroke, extensive lesions, decrease in individual income, underwent physiotherapy, underwent physiotherapy for longer period, pain complaints, the pain started simultaneously with the spasticity, presented changes in strength.

CINESIOTERAPIA PREVINE OMBRO DOLOROSO EM PACIENTES HEMIPLÉGICOS/PARÉTICOS NA FASE SUB- AGUDA DO ACIDENTE VASCULAR ENCEFÁLICO

BACKGROUND: Painful shoulder is considered the most common complication of hemiplegic/parethic (H/P) stroke patients. It is a negative factor for neuromotor recovery. PURPOSE: To study the effects of kinesiotherapy treatment on shoulder pain prevention, and as a secondary endpoints, to analyze muscle strength of H/P shoulder looking at basic functional active mobility. METHOD: Twenty one inpatients (12 men, 9 women) aged 26 to 87 years, with post-stroke H/P were submitted to thirty minutes daily program kinesiotherapy, started at 48 hours post-stroke up to their hospital discharge. Patients were evaluated pre and post treatment according to the presence or absence of shoulder pain, movements and shoulder strength, and for presence or absence of basic functional movements. RESULTS: No patient complaining of shoulder pain at the hospital discharge (p<0.001). The muscle strength improved signifcantly for elevation, protusion, abduction and flexion of the shoulder (p<0.001). There was improvement also for functional mobility on moving from dorsal to lateral recumb, from lateral recumb to a seated position and in keeping the seated position (p<0.001). CONCLUSION: Kinesiotherapy in acute phase of stroke prevented shoulder pain.

Mortality rates due to amyotrophic lateral sclerosis in São Paulo City from 2002 to 2006

OBJECTIVE To describe the mortality rates of amyotrophic lateral sclerosis (ALS) in the city of São Paulo as a function of demographics, year, and region. METHOD This was a retrospective descriptive study. Information was obtained from death certificates registered at the Program for the Improvement of Mortality Information, Municipal Health Department (PRO-AIM/SMS), coded as G12.2 according to International Classification of Diseases (ICD-10), from 2002 to 2006. RESULTS Over the studied time, were found 326 deaths (51.6% women, overall mean age of 64.1 years). Highest deaths percentages happened in those from 60 to 69 and 70 to 79 years and in white individuals. ALS mortality rates ranged 0.44/100,000 in 2002 and 0.76/100,000 in 2006. No significant changes overtime in administrative districts were found. CONCLUSION ALS mortality rates in São Paulo were lower in comparison to other countries, however any risk factor in our environment, lifestyle or genetic characteristics were found.

Profissionais da saúde, que assistem pacientes com Acidente Vascular Cerebral, necessitam de informação especializada

RESUMO O Acidente Vascular Cerebral (AVC) e uma doenca que pode ocasionar incapacidade funcional e levar ao obito. Sendo assim, e necessaria a intervencao de uma equipe multidisciplinar, com formacao especializada, para o manuseio desses pacientes. O objetivo desse estudo foi realizar pesquisa de campo, com profissionais da area da saude, (enfermeiro, fisioterapeuta, assistente social, medico, fonoaudiologo, terapeuta-ocupacional, nutricionista e psicologo), sobre as dificuldades, duvidas e importância de orientacoes sobre os cuidados de pacientes com AVC. Foi aplicado questionario a 146 profissionais da saude, que possuem experiencia no atendimento desses pacientes, nas cidades de Sao Paulo, Santo Andre, Sao Bernardo do Campo e Sao Caetano do Sul. Observou-se, nesse estudo, que a maioria dos profissionais da area da saude apresentam dificuldades (85%), duvidas (58%), e consideram importante receber orientacoes (91%), em relacao aos cuidados de pacientes com AVC, atraves de materiais didaticos eletronicos ou impressos, e cursos de extensao. A analise da pesquisa de campo realizada mostrou a importância e necessidade de informacao/formacao especializada para a maioria dos profissionais da saude, da amostra estudada, que atendem pacientes com AVC. Unitermos: Acidente vascular cerebral, Educacao continuada, Profissionais da saude, Cuidados especializados. SUMMARY Stroke can generate functional disability and death. It is necessary an intervention of a multidisciplinary team with specialized formation to handle those patients. The objective of this study was to accomplish field research with professionals of health area (nursing, physiotherapy, social work, physician, speech therapy, occupational therapy, nutritionist and psychologist) on the difficulties, doubts, and importance of orientations on caring of patients with stroke. 146 questionnaires were applied to health professionals,

Relação entre degeneração do trato córtico-espinhal através de ressonância magnética e escala funcional (ALSFRS) em pacientes com esclerose lateral amiotrófica

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects the corticospinal tract. ALS functional rating scale (ALSFRS) is a questionnaire that quantifies motor deficits, while diffusion tensor imaging (DTI) evaluates the integrity of fibers through the fractional anisotropy (FA). In the present study, seven ALS patients were evaluated by ALSFRS and immediately submitted to DTI, getting FA values in the following regions: cerebral peduncle (PC), internal capsule (CI) and the white matter under the primary motor cortex (M1), secondary motor cortex (M2) and somesthetic cortex (SI). A control group was constituted by twelve healthy individuals. FA values in patients were significantly lower when compared with controls, with a tendency to higher reductions in the right hemisphere and more inferior regions. Interestingly, FA values were reduced in somesthetic area. No correlation was observed between symptoms duration and FA values. Despite the correlation observed between ALSFRS scores and degeneration in PC and CI, our results suggest that this subjective scale is not a good parameter for the evaluation of the structural damage in encephalic portions of the corticospinal tract.

Análise crítica de ensaios clínicos aleatórios sobre fisioterapia aquática para pacientes neurológicos

Objetivos: Revisão da literatura na busca de evidências da efetividade da fisioterapia aquática em pacientes com doença neurológica e análise crítica dos ensaios clínicos aleatórios (ECA). Método: Localização dos ensaios clínicos aleatórios através da busca em bases eletrônicas e análise crítica dos ECA utilizando a lista Delphi. Resultados: Dos 207 trabalhos localizados 157 foram recuperados. Destes, 22 foram utilizados, sendo apenas 6 ECA. Um trabalho apresentou o método de aleatorização, mostrando que este não é um método utilizado regularmente em estudos clínicos sobre este assunto, devendo estudos futuros utilizar-se deste método para a alocação dos pacientes. A maioria dos estudos apresentou grupos similares com relação aos indicadores prognósticos mais importantes dos pacientes e, todos os estudos apresentaram critérios de elegibilidade especificados, intenção de tratar e foram relatadas estimativas das medidas de tendência central e variabilidade nas medidas de desfecho primário propiciando, assim estudos de melhor qualidade. Conclusão: existem fracas evidências na literatura dos benefícios da fisioterapia aquática quando aplicada à pacientes com doenças neurológicas, sendo fundamental a elaboração de um ensaio clínico aleatório de grande amostra para avaliar o efeito da fisioterapia aquática em pacientes com doença neurológica específica.

Queixas urinárias em mulheres com infarto cerebral

SUMMARY Urinary incontinence is defined as an involuntary urine loss. It is clinically demonstrable and causes social and hygienic problems. Objective. To determine the prevalence and symptoms of urinary incontinence in stroke women and verify the association with the lesion topography. Method. We evaluated 91 stroke women using the Mini-mental and King’s Health Questionnaire from March 2005 to March 2006. Women with cognitive deficit and previous urinary incontinency were excluded. We divided them into two groups: continent and incontinent. Lesion topography was determined by tomography scan images. Results. Out of the 91 women, 13 were excluded with cognitive deficits or previous urinary incontinency, resulting in 41 incontinent patients and 37 continent, 6 of them got better spontaneously. Urinary symptoms occurred in 45% of stroke women. We observed 28 (68.2%) that presented urge-incontinence and 24 (58.5%) with urinary urgency. Conclusion. The main symptoms were urge-incontinence and urgency and there was not a significant association between the lesion topography and the urinary symptoms.

Qualidade do sono de pacientes com esclerose lateral amiotrófica: análise dos instrumentos de avaliação

RESUMO Introducao: A Esclerose Lateral Amiotrofica (ELA) e uma afeccao neuromuscular degenerativa de acometimento do Sistema Nervoso Central e Periferico, com acometimento do neuronio motor, na qual os musculos respiratorios sao acometidos, dependendo do local de inicio da degeneracao neuronal. Como consequencia desta alteracao podem ocorrer disturbios do sono. As avaliacoes qualitativas do sono e das manifestacoes decorrentes dos disturbios de sono podem ou nao ser influenciadas pelas alteracoes respiratorias. Deve-se levar em conta ainda que a ansiedade pode ser agente desencadeante de disturbios do sono. Objetivos: Analisar e identificar qual das tres escalas de qualidade do sono (Stanford Sleepiness Scale - SSS, Epworth Sleepiness Scale - ESS, Mini-Seep Questionnaire -MSQ) e a mais apropriada para pacientes com ELA e analisar a correlacao entre qualidade do sono e duas escalas de avaliacao psicologica (Beck Depression Inventory - BDI e State-Trait Anxiety Inventory - STAI I-II). Metodos: Foram avaliados 16 pacientes com ELA (12 homens e 4 mulheres) entre 35 e 77 anos. Todos foram submetidos a aplicacao do protocolo de avaliacao proposto. Resultados: Houve correlacao entre as escalas: SSS e ESS; SSS e MSQ; BDI e SSS e BDI e MSQ. Conclusoes: A SSS foi a escala que teve maior indice de correlacao com as outras duas escalas de sono; ha uma associacao entre depressao e disturbio do sono em pacientes com ELA. O aspecto ansiedade nao pode ser considerado como preditor de disturbio do sono. Unitermos: Esclerose lateral amiotrofica, Disturbio do sono, Escalas, Alteracoes psicologicas.

Senescence with more time and better

(concept used by the famous Swiss psychiatrist, father of analytical psychology Carl Gustav Jung). The possibility of increasing our survival with quality, maintaining our usefulness, regardless of time or place (dogma), paradigms or cultures, receiving feedback, the re -moter dream of humanity and our archetype of the hero Hercules, in Greek mythology, who after being victorious over the twelve labors acquired as Olympic award the epic (heroic hermeneu-tics par excellence) that mirrors the cosmological paradigm of human adventure, the imortality