Talita Dias da Silva

Functional capacity and assistance from the caregiver during daily activities in Brazilian children with cerebral palsy.

Background Cerebral Palsy (CP) presents changes in posture and movement as a core characteristic, which requires multiprofessional clinical treatments during children’s habilitation or rehabilitation. Besides clinical treatment, it is fundamental that professionals use evaluation systems to quantify the difficulties presented to the individual and their families in their daily lives. We aimed to investigate the functional capacity of individuals with CP and the amount of assistance required by the caregiver in day-to-day activities. Methods Twenty patients with CP, six-year-old on average, were evaluated. The Pediatric Evaluation Inventory of Incapacities was used (PEDI - Pediatric Evaluation Disability Inventory), a system adapted for Brazil that evaluates childs dysfunction in three 3 dimensions: self-care, mobility and social function. To compare the three areas, repeated measures analysis of variance (ANOVA) were used. Results We found the following results regarding the functional capacity of children: self-care, 27.4%, ±17.5; mobility, 25.8%, ±33.3 and social function, 36.3%, ±27.7. The results of the demand of aid from the caregiver according to each dimension were: self-care, 9.7%, ±19.9; mobility, 14.1%, ± 20.9 and social function, 19.8%, ±26.1. Conclusion We indicated that there was no difference between the performance of the subjects in areas of self-care, mobility and social function considering the functional skills and assistance required by the caregiver.

Chronic obstructive pulmonary disease and heart rate variability: a literature update

Background The literature indicates that chronic obstructive pulmonary disease (COPD) affects cardiac autonomic control. In this study, we conducted a literature review in order to investigate the heart rate variability (HRV) in COPD subjects. Methods A search was performed in Medline database, using the link between the keywords: “autonomic nervous system”, “cardiovascular system”, “COPD” and “heart rate variability”. Results The search resulted in a total of 40 references. Amongst these references, the first exclusion resulted in the barring of 29 titles and abstracts, which were not clearly related to the purpose of review. This resulted in a total of 11 articles that were then read and utilized in the review. The selected studies indicated that there is significant reduction of HRV in patients with COPD, characterized by reduction of indices that assess parasympathetic activity in addition to dealing with the global autonomic modulation. We also established that supervised exercise can reduce these harmful effects in COPD patients. Also, it was reported that the use of non-invasive ventilation in these patients may contribute to the improvement of respiratory symptoms, with no impairing, and may even induce positive responses in cardiac autonomic regulation. Conclusion The studies indicate a need for further investigations to guide future therapies to improve the treatment of cardiovascular system in the respiratory diseases.

Comparison between the six-minute walk test and the six-minute step test in post stroke patients

Background The Stroke remains one of the major chronic diseases worldwide, and is considered a major cause of disability, which results not only in persistent neurological deficits, but also in the high physical deconditioning, nevertheless there are not many forms of assessing functional capacity in this population. We aimed to investigate the feasibility of the Six Minute Walk Teste and the Six-Minute Step Test (6MST) in post-stroke patients and compare the behavior of physiological variables during the 6MST and the Six-Minute Walk Test (6MWT), by correlating the functional performance obtained in both tests. Method The 6MWT was carried out according to the American Thoracic Society (ATS) and the 6MST was performed in six minutes in order to compare it to the 6MWT in a 20 cm step. Was included post-stroke individuals able to walk without aid. All of them did the 6MWT and the 6MST. Results 12 patients participated in the study. There was no statistical difference in the parameters analyzed when tests were compared. There was poor correlation between the functional performance in both tests. Conclusion The 6MWT and the 6MST is feasible for post-stroke patients and physiological responses are equal during the performance of both tests. However, there was no correlation with respect to functional performance, which was assessed by the distance walked in the 6MWT and by the number of steps climbed in the 6MST.

Application and outcomes of therapy combining transcranial direct current stimulation and virtual reality: a systematic review.

Abstract Purpose: To evaluate the methods and major outcomes of transcranial direct current stimulation (tDCS) combined with virtual reality (VR) therapy in randomized controlled trials. Method: A systematic review was performed following PRISMA guidelines using PubMed, PubMed Central, Web of Science and CAPES periodic databases, with no time restriction. The studies were screened for the following inclusion criteria: human subjects, combination of VR and tDCS methods, and randomized controlled study design. All potentially relevant articles were independently reviewed by two researchers, who reached a consensus on which articles met the inclusion criteria. The PEDro scale was used to evaluate the studies. Results: Eleven studies were included, all of which utilized a variety of tDCS and VR application methods. The main outcomes were found to be beneficial in intervention groups of different populations, including improvements in body sway, gait, stroke recovery, pain management and vegetative reactions. Conclusions: The use of tDCS combined with VR showed positive results in both healthy and impaired patients. Future studies with larger sample sizes and homogeneous participants are required to confirm the benefits of tDCS and VR. Implications for Rehabilitation tDCS with VR intervention can be an alternative to traditional rehabilitation programs. tDCS with VR is a promising type of intervention with a variety of positive effects. Application of tDCS with VR is appropriated to both healthy and impaired patients. There is no consensus of tDCS with VR application.

Computer task performance by subjects with Duchenne muscular dystrophy

Aims Two specific objectives were established to quantify computer task performance among people with Duchenne muscular dystrophy (DMD). First, we compared simple computational task performance between subjects with DMD and age-matched typically developing (TD) subjects. Second, we examined correlations between the ability of subjects with DMD to learn the computational task and their motor functionality, age, and initial task performance. Method The study included 84 individuals (42 with DMD, mean age of 18±5.5 years, and 42 age-matched controls). They executed a computer maze task; all participants performed the acquisition (20 attempts) and retention (five attempts) phases, repeating the same maze. A different maze was used to verify transfer performance (five attempts). The Motor Function Measure Scale was applied, and the results were compared with maze task performance. Results In the acquisition phase, a significant decrease was found in movement time (MT) between the first and last acquisition block, but only for the DMD group. For the DMD group, MT during transfer was shorter than during the first acquisition block, indicating improvement from the first acquisition block to transfer. In addition, the TD group showed shorter MT than the DMD group across the study. Conclusion DMD participants improved their performance after practicing a computational task; however, the difference in MT was present in all attempts among DMD and control subjects. Computational task improvement was positively influenced by the initial performance of individuals with DMD. In turn, the initial performance was influenced by their distal functionality but not their age or overall functionality.

Motor learning paradigm and contextual interference in manual computer tasks in individuals with cerebral palsy

BACKGROUND Cerebral palsy (CP) is a group of disorders of movement and posture that cause activity limitations. Due to the different motor problems these individuals encounter there is a need to offer rehabilitation programs that promote motor learning. Additionally, the understanding of the learning patterns of these individuals can help us attend to their learning needs to maximize their learning efficiency. AIMS The present study aimed to add to the knowledge base in regards to motor learning and the contextual interference (CI) effect. METHODS AND PROCEDURES The study included 40 individuals with CP and 40 typically developing (TD) participants matched for age and gender with the CP group. Both groups were divided into 2 subgroups regarding the practice schedule (random or constant practice) of a manual maze test on the computer. The participants who performed in the constant practice schedule performed the same standard maze 30 times, while participants in the random practice schedule performed a total of 30 trials on 5 mazes with a different spatial layout including the standard maze. After 5min of rest, retention was studied with a task in which all participants performed the standard maze. To examine the transfer effect, all participants also performed a maze with a new layout. Time of completion was registered in seconds for each trial. OUTCOMES AND RESULTS The results showed that the performance was lower in individuals with CP compared to typically developing individuals. In addition, only the participants with CP showed a contextual interference effect, with performance after the random practice schedule being superior compared to participants who practiced with a constant practice schedule. CONCLUSIONS AND IMPLICATIONS Overall performance was lower in individuals with CP compared to individuals with TD. Additionally, both TD individuals and individuals with CP showed the contextual interference effect in the transfer phase, with the execution of random practice leading to better performance than constant practice. These findings provide important information to assist clinicians in developing rehabilitation programs for children with CP.

MoVEROffice: Virtual Reality for Upper Limbs Rehabilitation

Considering the complexity involved in the motor rehabilitation process, this paper presents the development of a serious game with virtual reality and natural interaction to act as a support tool for physical therapy professionals. The objective of the developed application is to enable that patients acquire skill in performing tasks in the virtual environment to transfer them later to the real environment. An experiment was conducted to compare the performance of people with and without mobility limitations in the use of the virtual environment. The results showed that the time spent for performing tasks tend to be reduced when the users familiarize them selves with natural interaction, and size and position of objects have influence in the interaction. The study allowed inferring in this sample evaluated that the motor limitations of the patients did not have influence in the performance of the volunteers.

Heart Rate Variability and Cardiopulmonary Dysfunction in Patients with Duchenne Muscular Dystrophy: A Systematic Review

Duchenne muscular dystrophy (DMD) is a genetic recessive disorder with progressive muscle weakness. Despite the general muscle wasting, degeneration and necrosis of cardiomyocytes have been the main causes of morbidity and death in individuals with DMD. Cardiac failure is generally preceded by disturbances in heart rate variability (HRV), and non-invasive measurement of the autonomic nervous system has been an important tool to predict adverse cardiovascular events. Hence, the application of HRV to study autonomic modulation in DMD individuals, and the establishment of correlations between HRV and heart/lung diseases, age, and mortality will have the potential to improve quality of life and life expectancy of individuals with DMD. In order to evaluate the state of the art in this field, we conducted a systematic search in Medline/PubMed and BVS (virtual library in health) databases. We selected 8 studies using pre-defined criteria and meta-analysis revealed decreased parasympathetic activity and increased sympathetic predominance in individuals with DMD as major observations. Moreover, there is a strong association between diminished HRV and myocardial fibrosis with DMD. These patterns are evident in patients at early-stage DMD and become more prominent as disease severity and age increase. Thus, data minning clearly indicates that HRV assessment can be used as a predictor for sudden death in individuals with DMD. The use of the HRV, which is inexpensive, ubiquitously available in clinics and hospitals, and a non-invasive analysis tool, can save lives and decrease the morbity in DMD by alerting care givers to consider autonomic nervous system intervention.

Influência da gravidade do traumatismo cranioencefálico na admissão hospitalar na evolução clínica

O traumatismo cranioencefalico (TCE) e um problema de saude publica com muitos casos de mortalidade e repercussoes socioeconomicas. Este estudo visa investigar a influencia da gravidade do TCE no tempo de ventilacao mecânica (VM) e hospitalizacao, e na prevalencia de casos de traqueostomia, pneumonia, neurocirurgia e morte. E um estudo retrospectivo e observacional, que avaliou prontuarios de 67 pacientes com TCE na Irmandade Santa Casa de Misericordia de Sao Paulo. A gravidade foi avaliada pela escala de Glasgow (ECG): leve (13-15 pontos; 36 pacientes; 53.7%); moderado (9-12 pontos; 14 pacientes; 20.9%); ou grave (3-8 pontos; 17 pacientes; 25.4%). Pacientes com TCE grave apresentaram maior prevalencia de traqueostomia, pneumonia e neurocirurgia. Nao houve diferenca significativa entre gravidade do TCE, obito e tempo em VM, apesar de a gravidade do TCE ter influenciado o tempo de hospitalizacao. A gravidade do TCE na admissao, avaliada pela ECG, influenciou a prevalencia de traqueostomia, pneumonia, neurocirurgia e de maiores tempos de internacao.Study developed at the Department of Physical Therapy of the Irmandade da Santa Casa de Misericórdia de São Paulo – São Paulo (SP), Brazil. 1Graduate Program in Rehabilitation Sciences, Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP), Brazil. 2Graduate Program in Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo – São Paulo (SP), Brazil. 3Department of Morphology and Physiology, Faculdade de Medicina do ABC – Santo André, SP, Brazil. 4Irmandade da Santa Casa de Misericórdia de São Paulo – São Paulo (SP), Brazil. 3 Influence of severity of traumatic brain injury at hospital admission on clinical outcomes Influência da gravidade do traumatismo cranioencefálico na admissão hospitalar na evolução clínica Influencia de la gravedad del traumatismo craneoencefálico en la admisión hospitalaria en la evolución clínica Thiago Henrique da Silva1, Thais Massetti1, Talita Dias da Silva2, Laercio da Silva Paiva3, Denise Cardoso Ribeiro Papa1, Carlos Bandeira de Mello Monteiro1, Fatima Aparecida Caromano1, Mariana Callil Voos1, Lucas Del Sarto Silva4

Influence of severity of traumatic brain injury at hospital admission on clinical outcomes

O traumatismo cranioencefalico (TCE) e um problema de saude publica com muitos casos de mortalidade e repercussoes socioeconomicas. Este estudo visa investigar a influencia da gravidade do TCE no tempo de ventilacao mecânica (VM) e hospitalizacao, e na prevalencia de casos de traqueostomia, pneumonia, neurocirurgia e morte. E um estudo retrospectivo e observacional, que avaliou prontuarios de 67 pacientes com TCE na Irmandade Santa Casa de Misericordia de Sao Paulo. A gravidade foi avaliada pela escala de Glasgow (ECG): leve (13-15 pontos; 36 pacientes; 53.7%); moderado (9-12 pontos; 14 pacientes; 20.9%); ou grave (3-8 pontos; 17 pacientes; 25.4%). Pacientes com TCE grave apresentaram maior prevalencia de traqueostomia, pneumonia e neurocirurgia. Nao houve diferenca significativa entre gravidade do TCE, obito e tempo em VM, apesar de a gravidade do TCE ter influenciado o tempo de hospitalizacao. A gravidade do TCE na admissao, avaliada pela ECG, influenciou a prevalencia de traqueostomia, pneumonia, neurocirurgia e de maiores tempos de internacao.Study developed at the Department of Physical Therapy of the Irmandade da Santa Casa de Misericórdia de São Paulo – São Paulo (SP), Brazil. 1Graduate Program in Rehabilitation Sciences, Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP), Brazil. 2Graduate Program in Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo – São Paulo (SP), Brazil. 3Department of Morphology and Physiology, Faculdade de Medicina do ABC – Santo André, SP, Brazil. 4Irmandade da Santa Casa de Misericórdia de São Paulo – São Paulo (SP), Brazil. 3 Influence of severity of traumatic brain injury at hospital admission on clinical outcomes Influência da gravidade do traumatismo cranioencefálico na admissão hospitalar na evolução clínica Influencia de la gravedad del traumatismo craneoencefálico en la admisión hospitalaria en la evolución clínica Thiago Henrique da Silva1, Thais Massetti1, Talita Dias da Silva2, Laercio da Silva Paiva3, Denise Cardoso Ribeiro Papa1, Carlos Bandeira de Mello Monteiro1, Fatima Aparecida Caromano1, Mariana Callil Voos1, Lucas Del Sarto Silva4