Therezinha Rosane Chamlian

Avaliação da dor e função de pacientes com lombalgia tratados com um programa de Escola de Coluna

As dores lombares incidem em cerca de 80% da populacao em algum momento de sua vida, sendo, portanto, um grande problema de saude publica. O diagnostico diferencial das doencas da coluna vertebral e bastante amplo, mas sabe-se que boa parte das afeccoes esta relacionada a posturas e movimentos corporais inadequados. Criou-se, portanto, a Escola de Coluna como opcao de tratamento a estes pacientes. Neste trabalho avaliamos a dor e a incapacidade funcional dos pacientes, antes e apos frequentarem a Escola de Coluna, atraves do questionario de Roland-Morris e da Escala Visual Analogica de Dor. Estudamos 30 pacientes no periodo de maio a novembro de 2004, sendo 86,7% do sexo feminino, com idade media de 48,1 anos, de baixa escolaridade e com excesso de peso (70%). A maioria dos pacientes apresentou melhora da dor (56,7%) e da funcao (60%) apos o termino do programa de reabilitacao.

Effect of spastic cerebral palsy on jaw-closing muscles during clenching

The motor effort of jaw-closing muscles during maximal voluntary clenching (MVC) was compared between individuals with spastic cerebral palsy (CP) and nondisabled control subjects (CG). Bilateral electromyographic (EMG) activity of the anterior temporalis (AT) and masseter (MS) muscles was obtained during MVC in 22 subjects with CP and 29 nondisabled subjects. The oral functional status of the group with CP was evaluated using the Orofacial Motor Function Assessment Scale. The group with CP presented lower bilateral EMG activity during MVC compared to the control group for both AT and MS muscles. Comparisons of AT and MS EMG activity showed no difference in muscular effort. Subgroups with CP who were only slightly and very slightly orally impaired had a higher bilateral AT EMG activity compared to individuals with CP who were severely and moderately compromised. A statistically significant positive correlation was found between the oral motor function and EMG activity of the group with CP in all the muscles evaluated. Individuals with CP had motor weakness in the jaw-closing muscles, a condition that may compromise their masticatory function.

Efetividade da crioterapia após reconstrução do ligamento cruzado anterior

Objective The purpose of this study was to evaluate cryotherapy effectiveness in the immediate postoperative period of ACL reconstruction to improve pain and range of motion (ROM) of the knee. Methods This is a pilot study of a prospective and randomized clinical trial. Patients (n=25) were divided into two groups: Intervention (A) group (n=10): patients were submitted to an inpatient physical therapy protocol and received ice compress for 20 minutes, twice a day; Control (B) group (n=9): patients had the same protocol, twice a day. The pain intensity was evaluated with the visual analogic scale (VAS) and range of motion was measured with a goniometer. Results The Intervention (A) group had important absolute and percentual improvement when compared with the Control (B) group regarding measures of pain and knee flexion/extension ROM. Conclusion Cryotherapy in the immediate postoperative period of ACL reconstruction was effective to improve pain and range of motion of the knee. Level of Evidence I, Randomized Clinical Trial.

Dor no ombro em pacientes com lesão medular

The spinal cord injury (SCI) is one of the most severe forms of disabling syndromes. Patients with SCI usually apply an excessive overload on the upper limbs, especially the shoulders, using them more frequently and in a greater range of activities when compared to healthy subjects. Moreover, the search for the improvement of the quality of life in the last years has led an increasingly number of SCI patients to practice physical activities. Many SCI patients use wheelchairs for functional locomotion and sports practice. However, this functional demand on shoulders joint may lead to a painful picture, interfering on these patients daily activities. With the improvements on technology and healthcare life expectancy for SCI patients has been increased. Since then, issues regarding quality of life and age-related diseases are very important for this population. The purpose of this paper was to better understand shoulder pain in SCI patients by reviewing available literature.

Perfil epidemiológico dos pacientes amputados de membros inferiores atendidos no Lar Escola São Francisco entre 2006 e 2012

Objetivo: Analisar o perfil epidemiologico dos pacientes amputados de membros inferiores atendidos no Lar Escola Sao Francisco de 2006 a 2012. Metodo: A coleta de dados foi realizada de modo retrospectivo com 474 prontuarios selecionados para verificar: genero, idade, etnia, etiologia e nivel de amputacao, doencas associadas, intervalos de tempo entre a amputacao e avaliacao inicial e entre a avaliacao inicial e a alta, presenca de dor fantasma, uso de dispositivo auxiliar para marcha ou locomocao e independencia em AVD. Os dados foram analisados descritivamente (porcentagem e media) e foi utilizado o teste do qui-quadrado, com p < 0,05, como teste de diferenca de proporcao para etnia e etiologia. Resultados: Trezentos e trinta e nove pacientes (72%) eram homens com media de idade de 56,2 anos; os niveis de amputacao foram 43% transfemoral e 44% transtibial; a etiologia da amputacao foi vascular em 341 pacientes (72%) sendo 73% em caucasianos; hipertensao arterial sistemica e diabetes melitus foram as doencas associadas mais prevalentes; 267 pacientes (56%) foram protetizados, 100 pacientes (21%) abandonaram o tratamento. Conclusao: A populacao de amputados atendida no Lar Escola Sao Francisco no periodo estudado e composta, em sua maioria, por pacientes do genero masculino, na quinta decada da vida, com amputacao de origem vascular nos niveis transfemoral e transtibial. Pouco mais da metade e protetizado, o indice de abandono do tratamento e elevado e o intervalo de tempo para reabilitacao ainda e longo.

Transitory myocardial ischemia in patients with vascular lower limb amputation: relationship with long-term atherothrombotic events.

Ingham SJM, Chamlian TR, de Souza JM, Stefanini E, Azevedo R, Mussi A, Carvalho AC: Transitory myocardial ischemia in patients with vascular lower limb amputation: Relationship with long-term atherothrombotic events. Objective:To evaluate the prevalence of asymptomatic transitory myocardial ischemia during scintigraphy among amputees of vascular etiology as well as to ascertain correlation with atherothrombotic events during long-term follow-up. Design:A cohort, mean follow-up of 2.1 yrs study was performed in an outpatient rehabilitation clinic with 58 lower limb vascular amputees who were referred for rehabilitation, asymptomatic for coronary heart disease. Patients were evaluated for myocardial ischemia by dipyridamole scintigraphy, and occurrence of severe cardiovascular events (death, acute myocardial infarction, stroke, and peripheral ischemia with hospitalization) was assessed. Results:Of the 58 patients, 26 (44.8%) had positive dipyridamole myocardial scintigraphy for transitory myocardial ischemia. During follow-up, 12 subjects (20.7%), mainly diabetic patients (83%), registered a serious cardiovascular event, with 9 of 12 events having occurred in those who had tested positive for transitory ischemia on scintigraphy (P < 0.025). There were five deaths (19.2%) in those with a positive scintigraphy and a single death (3.1%) in those with a negative dipyridamole test, although the Kaplan-Meier survival curve and Cox regression were not significant (P = 0.09 and 0.1, respectively). Conclusions:We found that 44.8% of patients with vascular lower limb amputation, asymptomatic for coronary disease, tested positive on myocardial scintigraphy for transitory myocardial ischemia. In a mean follow-up of 2.1 yrs, there was 10.3% of atherothrombotic events/year, with a higher death toll in those patients with positive scintigraphy.

Efeitos da propriocepção no processo de reabilitação das fraturas de quadril

Este estudo teve como objetivo principal realizar uma revisao de literatura dos ultimos dez anos, sobre os efeitos dos tratamentos fisioterapeuticos realizados nas fraturas de quadril e a observacao da descricao e da influencia do treinamento proprioceptivo especifico nesse processo de reabilitacao. Essas fraturas sao muito comuns, principalmente entre a populacao idosa, provocando diversas consequencias ao individuo, entre elas, a alteracao das sensacoes proprioceptivas, podendo predispor o paciente a importante instabilidade articular. Sendo assim, a reabilitacao dessas lesoes e de grande importância, afim de restaurar as funcoes do quadril e prevenir contra recidivas. De acordo com o levantamento bibliografico realizado, os estudos demonstraram protocolos de tratamento fisioterapeuticos nas fraturas do quadril, porem a maioria dos autores nao apresenta um treinamento proprioceptivo especifico isoladamente; em geral, relacionam o ganho de forca muscular, equilibrio e o treino de marcha e de funcionalidade a melhora indireta da propriocepcao articular. Fica evidente a carencia teorica sobre o assunto, e espera-se que novas pesquisas possam surgir, para que se tenha maior significância clinica e estatistica em relacao ao tema abordado.

Use of prostheses in lower limb amputee patients due to peripheral arterial disease.

Objective To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease. Methods A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value <0,05 were used. Results Out of 195 patients we contacted, 151 were fitted with prosthesis and 44 not. Of those that were fitted with prosthesis, 54 still use it, 80 abandoned and 17 died. In the group without prosthesis, 27 were on wheelchair and 17 died. Mortality is statistically higher among patients who were not fitted with prosthesis and 34 death occur, on average, 3.91 years after amputation. Survival time of patients who were not fitted with prosthesis was smaller than those were fitted. Conclusion The use of prosthesis in lower limb amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients.

Translation into Brazilian Portuguese, cultural adaptation and validation of the Prosthesis Evaluation Questionnaire

BACKGROUND: Quality of life has been one of the main issues for patients with a chronic condition.OBJECTIVE: To translate, adapt and validate a Brazilian Portuguese version of the Prosthesis Evaluation Questionnaire (PEQ).METHODS: The questionnaire was translated into Portuguese, back translated into English, and cross-culturally adapted to the Brazilian Population. Sixty-five transtibial unilateral amputees were recruited. The sample comprised 45 men and 20 women with a mean age of 44 years, 47 with traumatic amputations, 14 with vascular dysfunction and 4 with other reasons for amputation, and all of them fitted with prostheses. Patients were interviewed twice, at baseline and again after 15 days. The Brazilian Portuguese version of the SF-36 (a generic Quality of Life outcome measure) and the FIM (a Functional Independence Measure) were also administered.RESULTS: The internal consistency of the nine PEQ scales was tested by computing Cronbachs Alpha coefficients (0.65 - 0.89: high values). Students t test coefficients were used for interobserver evaluation (0.35 to 084: reliable values with one exception- the Residual Limb Health scale), and Intraclass Correlation Coefficients (ICC), which ranged from 0.65 to 0.92: reliable values. Students t test coefficients and ICCs were also used for intraobserver evaluation (0.42 to 0.83, except the Residual Limb Health scale and 0.80 to 0.94, respectively: reliable values). Correlations between PEQ, SF-36 and FIM were tested using Pearsons correlation coefficients, which were not statistically significant (p > 0, 01).CONCLUSION: The Brazilian-Portuguese version of the PEQ has high internal consistency and is a reliable quality of life measure for use in amputee patients, but is not associated with the SF-36 or FIM.

Análise da reprodutibilidade da circumetria do joelho em indivíduos com osteoartrite

Knee osteoarthritis presents pain, loss of function, and joint swelling as its main symptoms. The joint swelling is defined as an accumulation of fluid in the joint due to the inflammatory process that contributes to progressive joint damage; it causes limitation in the range of knee motion, decreases proprioception, and affects the functional capacity and the quality of life of the individual. The measurement of articular cartilage volume is essential in clinical practice. The measurement of knee circumference using a measuring tape is a widely used, inexpensive, and accessible technique. However, as it is considered subjective, there is no evidence to support its use. Objective: To examine the reproducibility of this technique in patients with knee osteoarthritis. Method: Participants underwent two evaluations performed by two independent raters, at different times. The measurement of knee circumference was performed using a measuring tape 150 cm in length, taking as reference the superior pole of the patella. Results: The knee circumferences of 114 individuals were measured. According to the intraclass correlation coefficient (ICC), we observed a strong correlation (ICC = 0.98) between raters. Conclusion: The use of a measuring tape as a resource to measure knee circumference in individuals with osteoarthritis is a reliable and reproducible method.