Telma Dagmar Oberg

Ocorrência de desvios posturais em escolares do ensino público fundamental de Jaguariúna, São Paulo

OBJECTIVE: Evaluate the posture of students from a public school in Brazil and to identify the differences between normal deviation during growth and compensatory alterations. METHODS: Students from first to fourth grade of a public school in the city of Jaguariuna, Sao Paulo, Brazil, were evaluated. The students were positioned at sagital anterior and posterior coronal planes for postural assessment. Kendall points were used as the normal reference. RESULTS: 247 students were evaluated, 131 boys and 116 girls, and the main postural deviations found were: shoulder unbalance (50.2%), protracted shoulder (39.7%), abducted scapula (40.5%), knock-knee (29.6%), pelvic unbalance (21.5%), pelvic anteversion (19%), knee hyperextension (19%), medial rotation of hip (12.9%), protracted cervical (11.7%), head tilt (15.4%), thoracic hyperkyphosis (9.7%) and lumbar hyperlordosis (26.3%). CONCLUSIONS: A high incidence of postural alterations was detected in school children. Some of the postural alterations, such as abducted scapula, unbalance and protraction of the shoulders, knock-knee and lumbar hiperlordosis, normally occur and they are naturally corrected during growth. However, some postural problems, such as protraction and inclination of the cervical spine, were also prevalent and they require early intervention.

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.

Proposta de um protocolo para reabilitação vestibular em vestibulopatias periféricas

INTRODUCTION: Vestibular rehabilitation has been recognized as a treatment of choice for patients with persistent vertigo due to peripheral vestibular dysfunction, providing significant improvements in quality of life. Among the treatments listed have been exercises Cawthorne and Cooksey, sensory integration and body-moving platforms. OBJECTIVE: The research objective was to invent the protocol of exercises in balance with the exercises of Cawthorne and Cooksey associated to the Sensory Integrative. METHOD: It was developed a pilot case, where was evaluated in the patient the balance for the Scale of Balance of Berg and Dynamic Gait Index (DGI); Five Times Sit-to-Stand (FTSTS), that evaluate the activity to sit down and to get up; Dizziness Handicap Inventory (DHI) that evaluate symptoms of vertigo; Scale of Symptoms after Physiotherapeutic Treatment (ESATF), graduates the symptoms after exercises. It was developed a protocol associating 2 techniques, which the ocular exercises, cephalic and of trunk were associated to the swinging. 10 of 20 sessions were accomplished, due to the patients little regular attendance. RESULTS: Patient obtained improvement from 19 to 22 in DGI; maintained the points of the Berg; she improved from 74 to 67 in DHI. In scale FTSTS she decreased the time from 15 to 14 seconds to accomplish activities of to sit down and to get up. In ESATF it happened oscillate in punctuation. CONCLUSION: After the treatment, the patient obtained an improvement in the appraised balance and improvement of the functional capacity, and she reduced the time spend to accomplish the activity of to sit down and to get up five times of a chair with the crossed arms. Additional studies with the proposed protocol should be accomplished, with a larger number of patients and regular attendance to have a faster adaptation.

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.

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.

Motor and sensory effects of ipsilesional upper extremity hypothermia and contralesional sensory training for chronic stroke patients

Abstract As hypothermia by immersion can reduce the sensory nerve conduction velocity, this study hypothesized that the reduction of sensory input to the ipsilesional upper extremity (UE) using cryotherapy would reduce the inhibitory activity of the contralesional hemisphere in chronic stroke subjects. Objective: In this study, hypothermia was applied by immersing the ipsilesional UE in association with sensory training of the contralesional UE of stroke patients to assess the immediate (e.g. sensorimotor function, hemodynamics, and levels of comfort) and long-term (sensory and motor performances of the UEs) effects. Methods: The sample included 27 stroke patients allocated into group 1 (n = 14), which received conventional physiotherapy for the affected UE, and group 2 (n = 13), which underwent 10 sessions of immersion hypothermia of the ipsilesional wrist and hand. Assessments were performed pre- and post-treatment and at follow-up using esthesiometry, the Fugl–Meyer Assessment (FMA), the Nottingham Sensory Assessment, functional tests, tactile and weight discrimination, motor sequence, level of comfort, and hemodynamic parameters. Results: The immediate effects of hypothermia using immersion of the ipsilesional UE in association with sensory training of the contralesional UE were hemodynamic stability during and after hypothermia, the absence of sensory abnormalities in the contralesional UE, hypoesthesia in the ipsilesional extremity (dermatomes C6 and C8) (P < 0.05), the maintenance of acceptable levels of comfort, and good patient compliance to the technique. The long-term effects included significant increases in scores on tests performed without functional vision, in scores on blindfolded functional tests, and in tactile localization and joint position sense for the contralesional hand in group 2 as well as the maintenance of these gains at long-term follow-up (5 weeks). Improvement was also found in the tactile function of the C6 and C7 dermatomes of the contralesional hand (P < 0.05). Conclusions: The use of immersion hypothermia on the ipsilesional UE in association with sensory training of the contralesional UE improved motor function and sensitivity in the contralesional UE of individuals with chronic stroke. Immersion hypothermia of the ipsilesional UE in chronic stroke patients is a safe, practical, inexpensive, and easily applied technique.