Valéria Meirelles Carril Elui

Aspects of Manual Wheelchair Configuration Affecting Mobility: A Review

Many aspects relating to equipment configuration affect users’ actions in a manual wheelchair, determining the overall mobility performance. Since the equipment components and configuration determine both stability and mobility efficiency, configuring the wheelchair with the most appropriate set-up for individual users’ needs is a difficult task. Several studies have shown the importance of seat/backrest assembly and the relative position of the rear wheels to the user in terms of the kinetics and kinematics of manual propulsion. More recently, new studies have brought to light evidence on the inertial properties of different wheelchair configurations. Further new studies have highlighted the handrim as a key component of wheelchair assembly, since it is the interface through which the user drives the chair. In light of the new evidence on wheelchair mechanics and propulsion kinetics and kinematics, this article presents a review of the most important aspects of wheelchair configuration that affect the users’ actions and mobility.

Força de preensão palmar e pinças em indivíduos sadios entre 6 e 19 anos

OBJECTIVE: This study aimed to determine and compare the values of maximum isometric palmar grip and pinch forces in healthy children between 6 and 19 years old using dynamometry, considering gender, dominance and age. METHODS: 199 subjects were evaluated using Jamar® dynamometer to measure palmar grip strength and Preston Pinch Gauge® dynamometer to evaluate pulp to pulp, lateral and three points pinch strength in a standardization testing protocol. The mean of three consecutive grip tests was recorded. Linear regression with mixed effects was used to statistically analyze the differences between data. RESULTS: Mean values found for palmar grip, pulp to pulp, three points and lateral pinch were 24,51kgf, 3,64kgf, 5,37kgf and 6,78kgf, respectively, regardless of the variables. There was statistical difference in all measures by gender and dominance, and the dominant hand and the males had higher grip forces. It was verified that mean values varied with age, with significant difference in most of comparisons between the age groups. CONCLUSION: We concluded that pinch and palmar grip strength demonstrated significant differences in gender, dominance and in most of age subgroups studied, being important to consider them on dynamometry. This study was relevant as reference of normality of hand strength in children and adolescents.

Early sensory re-education of the hand after peripheral nerve repair based on mirror therapy: a randomized controlled trial.

BACKGROUND: Mirror therapy has been used as an alternative stimulus to feed the somatosensory cortex in an attempt to preserve hand cortical representation with better functional results. OBJECTIVE: To analyze the short-term functional outcome of an early re-education program using mirror therapy compared to a late classic sensory program for hand nerve repair. METHOD: This is a randomized controlled trial. We assessed 20 patients with median and ulnar nerve and flexor tendon repair using the Rosen Score combined with the DASH questionnaire. The early phase group using mirror therapy began on the first postoperative week and lasted 5 months. The control group received classic sensory re-education when the protective sensation threshold was restored. All participants received a patient education booklet and were submitted to the modified Duran protocol for flexor tendon repair. The assessments were performed by the same investigator blinded to the allocated treatment. Mann-Whitney Test and Effect Size using Cohens d score were used for inter-group comparisons at 3 and 6 months after intervention. RESULTS: The primary outcome (Rosen score) values for the Mirror Therapy group and classic therapy control group after 3 and 6 months were 1.68 (SD=0.5); 1.96 (SD=0.56) and 1.65 (SD=0.52); 1.51 (SD=0.62), respectively. No between-group differences were observed. CONCLUSION: Although some clinical improvement was observed, mirror therapy was not shown to be more effective than late sensory re-education in an intermediate phase of nerve repair in the hand. Replication is needed to confirm these findings.

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

BackgroundCarpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome.Methods/DesignPatients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test.DiscussionThis paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome.Trial registrationBrazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184

Resultados funcionais da artrodese do punho

Sao analisados os resultados funcionais 51 artrodeses do punho em 49 pacientes, portadores de variadas patologias dessa regiao. Em todos os casos, a artrodese foi realizada com fixacao interna rigida, usando placa e parafusos e o seguimento pos-operatorio variou de 6 a 201 meses (media: 73 meses). Para a avaliacao funcional foi empregado um metodo de subjetivo, baseado nas impressoes dos proprios pacientes, e outro objetivo, atraves da analise das radiografias e de testes funcionais que simulam todo tipo de funcao do membro superior. A posicao de fixacao da artrodese foi de 14o de extensao e 8o de desvio ulnar, em media. Consolidacao primaria foi obtida em 50 (98%) punhos, num periodo medio de oito semanas, sendo que, no punho restante ocorreu pseudartrose, consolidada apos re-operacao com enxertia ossea. Houve melhora da intensidade e mudanca do padrao da dor pre-operatoria e todos os pacientes com atividade leve retornaram ao trabalho.. Houve perda relativa da forca de preensao manual (61% do contralateral) e das pincas (cerca de 70% do lado contralateral), porem os testes funcionais apresentaram resultados considerados satisfatorios e concordantes com a literatura. Conclui-se que a artrodese do punho e um metodo aplicavel a diversas patologias que impliquem em dor e instabilidade da articulacao, que produz resultados consistentemente repetitiveis, sem afetar significativamente a funcao global do membro superior, apesar da relativa perda da forca, a qual se deveu mais a fatores pre-existentes do que a artrodese em si.

A new design for an old concept of wheelchair pushrim

Purpose: Report on the development of an ergonomic manual wheelchair pushrim and evaluate the user’s perception of the quality of the device. Method: Based on anthropometric features and ergonomic concepts, a new wheelchair pushrim was designed, and a prototype was manufactured in polyurethane, using the rapid prototyping technique and serial production of parts by molding. The prototype was tested by a sample of wheelchair users, who rated the perceived quality of the device after testing both the new and conventional pushrims in a wheelchair propulsion experimental protocol. Results: The new ergonomic pushrim was found to be, in general, better than the conventional round tube pushrim. Specifically, experienced wheelchair users found the new wheelchair pushrim better in terms of easy and comfortable propulsion, braking and maneuvering of the wheelchair, and appearance. Conclusions: The new wheelchair pushrim provides a proper fit for the hands due to its ergonomic design and its polyurethane composition, making wheelchair propulsion easier and more comfortable than the conventional wheelchair pushrim. Assistive technology devices should be design based on ergonomic concepts that involve less effort and offer greater comfort for the user. Implications for Rehabilitation Manual wheelchair propulsion has been related with upper limb injuries that may potentially limit functionality. The conventional pushrim does not meet the need for a firm and stable grip, requiring further effort to hold the pushrim during manual propulsion that may cause discomfort, pain and contribute for developing upper limb injuries. In a relatively small sample of wheelchair users, this study shows that an ergonomically designed pushrim makes manual propulsion easier and more comfortable compared to the conventional pushrim.

Prevenção de incapacidade na hanseníase com apoio em um manual de autocuidado para pacientes

Leprosy is an infectious disease of slow evolution, manifested by dermatoneurological signs and symptoms, with skin and peripheral nerve injuries. The aim of this study was to assess physical and functional status of eyes, hands and feet of patients with leprosy, as well as to assess evolution of sensory-motor disabilities, degree of disability and quality of life, having specially produced and handed the patients an illustrated self-care manual for preventing disability. Twenty- six patients with leprosy were assessed initially and after 12 months of using the manual as to: skin inspection, peripheral nerves palpation, corneal sensitivity, skin sensitivity, limb muscle function, hand muscle strength (finger grip and pinch strength); the disability degree w as determined and patients answered the SF-36 questionnaire. Most affected nerves were the ulnar and posterior tibial ones. Results showed that, though the degree of disability and deformities persisted, there were significant improvements in SF-36 social aspects and pain domains, as well as improvements in skin dryness and hands and feet muscle function. Since the latter are directly related to self-care, this suggests that the self-care manual may have an important supporting role in relieving symptoms of patients with leprosy.

Radial nerve injury associated with humeral shaft fracture: a retrospective study.

Objective: To determine the profile of patients with humeral diaphyseal fractures in a tertiary hospital. Methods: We conducted a survey from January 2010 to July 2012, including data from patients classified under humeral diaphyseal fracture (S42.3) according to the International Classification of Diseases (ICD-10). The variables analyzed were: age, gender, presence of radial nerve injury, causal agent and the type of treatment carried out. Results: The main causes of trauma were car accidents. The radial nerve lesion was present in some cases and was caused by the same trauma that caused the fracture or iatrogenic injury. Most of these fractures occurred in the middle third of humeral diaphysis and was treated conservatively. Conclusion: The profile of patients with fracture of humeral shaft, in this specific sample, was composed mainly of adult men involved in traffic accidents; the associated radial nerve lesion was present in most of these fractures and its cause was strongly related to the trauma mechanism. Level of Evidence II, Retrospective Study.

Social determinants of health, inequality and social inclusion among people with disabilities

OBJETIVO: analizar la inclusion social familiar y comunitaria, y la participacion social de personas con deficiencia, asi como su insercion en ocupaciones en la vida cotidiana. METODO: estudio cualitativo, con recoleccion de datos por medio de entrevistas abiertas sobre historia de vida y por observacion sistematica. La muestra estuvo compuesta por diez personas con deficiencia, adquirida o congenita, habitantes de una region adscrita a un Nucleo de Salud de la Familia. El referencial teorico fue la concepcion social de la deficiencia. Los datos fueron analizados segun abordaje interpretativo reconstructivo, fundamentado en el referencial de la Teoria de la Accion Comunicativa de Habermas. RESULTADOS: los resultados evidenciaron que la inclusion social familiar y comunitaria de los sujetos del estudio se condiciona a determinantes sociales de la salud, presentando indices de iniquidades sociales, expresados por la dificultad de acceso a servicios de Atencion Primaria de la Salud y de rehabilitacion, trabajo y renta, educacion, cultura, transporte y participacion social. CONCLUSION: se concluye que existe la necesidad de elaborar programas de atencion centrados en la comunidad, dirigidos al enfrentamiento de la pobreza y a la inclusion social, en articulacion con servicios de Atencion Primaria a la Salud.

Reflections about learning and teaching assistive technology in Brazil

It is assumed that an inclusive society has to ensure accessibility, which goes beyond just adapting the physical environment, as it corresponds to the equality of access and opportunity for all. Objective: This article addresses the competencies and abilities of Brazilian practitioners in using assistive technology based on their professional background. Specifically, it was sought to discuss the teaching and learning settings in Brazil regarding different areas of knowledge that assistive technology requires. Materials & Methods: This is a theoretical study based on specific literature related to assistive technology and accessibility. Conclusion: It is necessary to invest in both formation and qualification of personnel throughout Brazil for this specific issue.