Tania Fernandes Campos

Avaliação do desempenho funcional de crianças com paralisia cerebral de acordo com níveis de comprometimento motor

CONTEXTUALIZACAO: Diversos estudos tem avaliado a funcao motora de criancas com Paralisia Cerebral (PC), entretanto pouco se sabe sobre as inter-relacoes entre comprometimentos da mobilidade, autocuidado e funcao social relacionadas as habilidades funcionais da crianca e a assistencia do cuidador. OBJETIVOS: Identificar diferencas funcionais de criancas com PC em diferentes niveis de disfuncao motora e correlaciona-las com os dominios mobilidade, autocuidado e funcao social na habilidade funcional e na assistencia do cuidador. METODOS: Realizou-se uma pesquisa analitica de corte transversal com 70 criancas/familias, com idades de 4 a 7,5 anos, atendidas no Centro de Reabilitacao Infantil, por meio do Pediatric Evaluation Disability Inventory (PEDI) e do Gross Motor Function Classification System (GMFCS). A analise dos dados foi realizada por meio da ANOVA e teste de correlacao de Pearson. RESULTADOS: Os resultados indicaram importante variabilidade funcional das criancas com PC em diferentes niveis de severidade da disfuncao motora. Essa variacao foi observada nos dominios mobilidade, autocuidado e funcao social. Os resultados apresentaram, tambem, forte correlacao entre os dominios mobilidade e autocuidado e mobilidade e funcao social. CONCLUSOES: Diante da variabilidade apresentada pelas criancas, percebe-se a necessidade de aplicacao do PEDI e GMFCS, o que parece aumentar o entendimento sobre a relacao entre funcoes motoras grossas e atividades da vida diaria. Essa correlacao demonstra o quanto a mobilidade e determinante para avaliar o desempenho funcional e orientar a pratica terapeutica no sentido de desenvolver as potencialidades das criancas, bem como orientar o cuidador na estimulacao.

Nonparametric methods in actigraphy: An update.

Circadian rhythmicity in humans has been well studied using actigraphy, a method of measuring gross motor movement. As actigraphic technology continues to evolve, it is important for data analysis to keep pace with new variables and features. Our objective is to study the behavior of two variables, interdaily stability and intradaily variability, to describe rest activity rhythm. Simulated data and actigraphy data of humans, rats, and marmosets were used in this study. We modified the method of calculation for IV and IS by modifying the time intervals of analysis. For each variable, we calculated the average value (IVm and ISm) results for each time interval. Simulated data showed that (1) synchronization analysis depends on sample size, and (2) fragmentation is independent of the amplitude of the generated noise. We were able to obtain a significant difference in the fragmentation patterns of stroke patients using an IVm variable, while the variable IV60 was not identified. Rhythmic synchronization of activity and rest was significantly higher in young than adults with Parkinson׳s when using the ISM variable; however, this difference was not seen using IS60. We propose an updated format to calculate rhythmic fragmentation, including two additional optional variables. These alternative methods of nonparametric analysis aim to more precisely detect sleep–wake cycle fragmentation and synchronization.

Early stroke case-fatality rates in three hospital registries in the Northeast and Southeast of Brazil

UNLABELLED Few studies have addressed early cerebrovascular lethality in Brazil. OBJECTIVE To evaluate 10 and 28-day stroke case-fatality rates in three hospitals in three Brazilian cities. METHODS We described the stroke registries in São Paulo, João Pessoa, and Natal. RESULTS Out of a total of 962 first-ever events (mean age, 68.1 years-old; 53% men), 83.6% (804 cases) were classified as ischemic and 16.4% (158) as hemorrhagic stroke. Overall, the case-fatality rates and 95% confidence intervals (95%CI) for hemorrhagic stroke events were higher than for ischemic events, both at 10 (12.3%; 95%CI 7.2-17.4 versus 7.0%; 95%CI 5.3-8.8) and at 28 days (19.8%; 95%CI 13.6-26.0 versus 11.1%; 95%CI 8.9-13.3). CONCLUSIONS We did not find any substantial differences in early case-fatality rates according to stroke subtypes, when comparing the three centers.

Treinamento muscular inspiratório em crianças com leucemia aguda: resultados preliminares

OBJECTIVE: To evaluate the effect of inspiratory muscle training in children with acute leukemia. METHODS: This is a quasi-experimental study with a control group. Fourteen patients with 5-14 years old and a diagnosis of acute leukemia were evaluated regarding their thoracic mobility and respiratory muscle strength. They were divided in two groups (A and B). Group A received domiciliary inspiratory muscle training during 15 minutes, twice a day, for ten weeks, with a Threshold® device using a load of 30% of the maximal inspiratory pressure, readjusted after weekly evaluations. Group B patients were tested regarding their maximum respiratory pressures in their first evaluation and after ten weeks. Student t-test was used to evaluate maximum inspiratory and expiratory pressures between groups Pearsons correlation test examined the association of inspiratory and expiratory pressures with the different loads, using SPSS 15.0 software. RESULTS: A significant improvement of 35% was observed in the maximum inspiratory and expiratory pressures in group A at the end of the training. There was a strong positive correlation between the used load levels and maximal inspiratory (p<0.0001) and expiratory (p=0.0001) pressures. CONCLUSIONS: Inspiratory muscle training can be effective for improving inspiratory muscle strength in children beeing treated for acute leukemia.

Regularity of Daily Activities in Stroke

Various studies have been performed using the Social Rhythm Metric (SRM), though none has been developed with stroke patients. Stroke is a pathology that provokes a strong physical and social impact caused by an abnormality in cerebral circulation. Consequently, we performed two studies to validate the SRM and translate it into Portuguese, and to evaluate the regularity of the daily activities of stroke patients. Both healthy individuals and patients with unilateral cerebral lesions were evaluated. Subjects were of both sexes and between 45 and 65 yrs of age. Participants underwent clinical evaluation and recorded the time of 17 daily activities on the SRM for two weeks. Data were analyzed by the Pearson correlation and Fisher tests. After conceptual translation into Portuguese, corrections were made to arrive at the final version. Normative SRM scores varied from 3.2 to 7.0, suggesting that the activities presented in SRM adequately represented the daily routines of the patients. A correlation was found in SRM between the weeks (r=0.84; p=0.0001), indicating instrument reliability. The mean (±SD) score of the stoke patients was 4.8 (±1.0), and the correlation between the SRM and level of neurological damage showed that patients with lower SRM values were more physically compromised (r=−0.29; p=0.04), suggesting that SRM may be a clinical predictor. Activities related to eating and the sleep‐wake cycle were rated by most patients. In all, 71% of the patients did not work, while 84% of healthy individuals did (p=0.001). Only 64% of patients left home compared to 90% of the healthy subjects (p=0.001), and 59% of patients recorded the activity of going home compared to 82% of healthy individuals (p=0.001). According to the results, there is evidence of the validity and reliability of the SRM, enabling it to be reliably used in chronobiological studies of stroke patients. Given that a less regular lifestyle may be associated with neurological compromise and a decrease in social activities, we suggest new studies with the repeated application of this instrument over the clinical evolution of the disease to better define improvement or worsening of the patients condition in terms of their social and health aspects.

Prediction equations for maximal respiratory pressures of Brazilian adolescents

BACKGROUND The literature emphasizes the need for studies to provide reference values and equations able to predict respiratory muscle strength of Brazilian subjects at different ages and from different regions of Brazil. OBJECTIVES To develop prediction equations for maximal respiratory pressures (MRP) of Brazilian adolescents. METHOD In total, 182 healthy adolescents (98 boys and 84 girls) aged between 12 and 18 years, enrolled in public and private schools in the city of Natal-RN, were evaluated using an MVD300 digital manometer (Globalmed®) according to a standardized protocol. Statistical analysis was performed using SPSS Statistics 17.0 software, with a significance level of 5%. Data normality was verified using the Kolmogorov-Smirnov test, and descriptive analysis results were expressed as the mean and standard deviation. To verify the correlation between the MRP and the independent variables (age, weight, height and sex), the Pearson correlation test was used. To obtain the prediction equations, stepwise multiple linear regression was used. RESULTS The variables height, weight and sex were correlated to MRP. However, weight and sex explained part of the variability of MRP, and the regression analysis in this study indicated that these variables contributed significantly in predicting maximal inspiratory pressure, and only sex contributed significantly to maximal expiratory pressure. CONCLUSION This study provides reference values and two models of prediction equations for maximal inspiratory and expiratory pressures and sets the necessary normal lower limits for the assessment of the respiratory muscle strength of Brazilian adolescents.

Circadian and homeostatic changes of sleep-wake and quality of life in stroke: implications for neurorehabilitation.

The present study aimed to assess changes in the circadian and homeostatic control of the sleep-wake pattern in stroke patients and correlations with quality of life. Participants were 22 patients (55 ± 12 years) and 24 healthy subjects (57 ± 11 years). Instruments used were: the Pittsburgh Sleep Quality Index, SF-36 Questionnaire and Actigraphy. Data were analyzed by Mann-Whitney test and Spearmans correlation. Results identified a significant difference in sleep quality and quality of life between patients and healthy subjects, with patients on average exhibiting poor sleep quality (patients: 8.4 ± 3.4; healthy subjects: 6.2 ± 2.5; p = 0.0001) and low quality of life scores (p < 0.001). Correlation analysis detected an association between circadian variables (total activity, start and finish times of activity) and quality of life (p < 0.001). Associations between homeostatic variables (sleep duration, latency and efficiency) and quality of life were also significant (p < 0.001). In conclusion, results in this study showed compromised sleep quality and quality of life in the patients evaluated, associated with circadian and homeostatic alterations. This suggests that complaints regarding poor sleep quality be taken into consideration when planning the rehabilitation of stroke patients.

Predictive factors of subjective sleep quality and insomnia complaint in patients with stroke: implications for clinical practice

The complaints regarding sleep problems have not been well identified after a stroke. The aim of this study was to investigate the predictive factors of sleep quality and insomnia complaints in patients with stroke. A total of 70 subjects, 40 patients (57 ± 7 years) and 30 healthy controls (52 ± 6 years) assessed by the Pittsburgh Sleep Quality Index (PSQI) and the Sleep Habits Questionnaire took part in the study. The data were analyzed using the chi-square test, the Students t-test and logistic regression analysis. On average, the patients showed poor sleep quality (patients: 6.3 ± 3.5; controls: 3.9 ± 2.2; p= 0.002) and insomnia complaint was the most prevalent (patients: 37.5%; controls: 6.7%; p= 0.007). The absence of insomnia complaint (OR= 0.120; 95%CI= 0.017-0.873; p= 0.036) and the decreased latency of sleep (OR= 0.120; 95%CI= 0.017-0.873; p= 0.036) were the protective factors of sleep quality. Female sex (OR= 11.098; 95%CI= 1.167-105.559; p= 0.036) and fragmented sleep (OR= 32.040; 95%CI= 3.236-317.261; p= 0.003) were the risk factors for insomnia complaint. We suggest that complaints of poor sleep quality and insomnia should be given priority assessment during clinical diagnosis of sleep disorders in stroke.

Figuras de atividades funcionais: concordância de nomeação e familiaridade

This study was done with the aim to examine the naming agreement and familiarity of a set of objects/animals and functional activities pictures. Twenty six children were used between 5-7 years old and 24 university students between 18-25 years old of both sexes. Participants should watch 90 pictures, being 45 of functional activities and 45 of objects/animals, nominate one by one, moreover, to refer the familiarity degree. Data were analyzed by coefficient of Kappa, Spearman correlation test and Mann-Whitney test. The original name agreement was bigger than the frequency of other nominations. The children had more difficult than adults to make the pictures nomination. The objects/animals pictures were considered more familiar, as well children as adults. This way, the study showed significant differences between the pictures and between children and adults, suggesting the use of functional activities pictures in neuropsychological studies.

Comparison of the immediate effect of the training with a virtual reality game in stroke patients according side brain injury.

BACKGROUND Stroke is a major cause of motor disability in adults and needs interventions that contribute to motor recovery. OBJECTIVE This study aimed to compare the immediate effect of the training with virtual reality game in stroke patients according side brain injury. METHODS The participants included 20 patients (10 right brain injury), mean age of 50.6 ± 9.2 years, and 20 healthy subjects of 50.9 ± 8.8 years. All participants made a kinematic evaluation of drinking a cup of water before and after training with the table tennis game of the XBOX 360 Kinect®, in two series of 10 tries of 45 s, with 15 minutes rest between them, a total of 30 minutes. Data were analyzed by ANOVA. RESULTS There was a significant difference in the number of hits between patients and healthy subjects groups, in which patients had a lower performance in all the trials (p = 0.008). After the training, only patients with right brain injury improved their shoulder and elbow angles, approaching the left upper limb movement pattern of healthy subjects (p < 0.05). CONCLUSION Patients with right brain injury responded better to the virtual reality game, suggesting introduction of new treatment techniques that promote neurorehabilitation.