Search

Resumo: Introdução: Devido à inadequada resposta aos corticóides inalatórios, os pacientes com asma de difícil controlo (ADC) são submetidos a corticóides orais ou uso de omalizumabe. Embora sejam necessários para o tratamento desses pacientes, há uma relação significativa entre o uso de esteróides e fraqueza muscular periférica e respiratória, resultando em implicações como a perda da qualidade de vida e função pulmonar comprometida. No entanto, não se sabe se estes pacientes sofrem alterações neurofisiológicas devido ao efeito da droga. Objetivo: Investigar as características neurofisiológicas e funcionais de pacientes com ADC, para melhor compreensão da doença. Método: Foi realizado um estudo transversal em 3 grupos de pacientes: ADCC (que fazem uso de corticóide por via oral); ADCO (que fazem uso do Omalizumab) e GC (controlo saudável da mesma idade). A avaliação foi composta pela prova da marcha dos 6 minutos, teste senta-levanta, equilíbrio estático com a plataforma de pressão, reflexos monossimpáticos (patelar e aquileu) e a força do quadríceps do membro inferior dominante. Resultados: Embora os resultados em relação aos aspetos neurofisiológicos mostrem não haver diferença estatisticamente significativa entre os grupos controlo e com ADC, deve ser observado que o grupo com ADC, apresentou importante redução da capacidade funcional, quando comparado ao grupo controlo (diminuição da força muscular (p

OBJETIVO: Identificar categorias do componente de participação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) que já foram sistematicamente relacionadas aos instrumentos de Qualidade de Vida Relacionada à Saúde (QVRS) comumente utilizados em indivíduos acometidos pelo acidente vascular encefálico (AVE) - Nottingham Health Profile (NHP), Short-Form Health Survey (SF-36) e Stroke Specific Quality of Life (SS-QOL) - e sugerir a utilização dos mesmos para avaliar e/ou caracterizar tal componente nessa população. MÉTODOS: Por meio de busca nas bases de dados Medline, SciELO e Lilacs, foi realizado levantamento dos estudos que associavam os conceitos mensurados pelos itens do NHP, SF-36 e SS-QOL com os componentes e categorias da CIF. RESULTADOS: Dos 24 estudos identificados, quatro atenderam aos critérios estabelecidos: dois avaliaram os três instrumentos de QVRS, um avaliou o NHP e SF-36, e outro apenas o SS-QOL. Para cada instrumento, foram encontrados três estudos que associaram seus conceitos até, no mínimo, o segundo nível de hierarquia das categorias da CIF. Considerando os resultados concordantes entre os três estudos que avaliaram o mesmo instrumento, nove categorias de participação foram associadas ao NHP, sete ao SF-36 e 15 ao SS-QOL, sendo que apenas uma foi específica para o NHP, uma para o SF-36, e sete para o SS-QOL. CONCLUSÕES: Para a avaliação da participação de indivíduos acometidos pelo AVE segundo a estrutura da CIF, o SS-QOL pareceu ser o instrumento mais adequado, pois, além de avaliar o maior número de categorias, também avalia o maior número de categorias distintas quando comparado aos outros dois instrumentos de QVRS, que acrescentam apenas uma categoria àquelas mensuradas pelo SS-QOL.OBJECTIVE: To identify the categories of the participation component of the International Classification of Functionality, Incapacity, and Health (ICF) which are currently related to Health-related Quality of Life (HRQOL) instruments commonly used in cerebrovascular accident (CVA) victims-Nottingham Health Profile (NHP), Short-Form Health Survey (SF-36), and Stroke Specific Quality of Life (SS-QOL)-and suggest the utilization of these instruments to assess and/or characterize that component in that population. METHODS: Through searches in the Medline, SciELO, and Lilacs databases, a compilation of studies which associated the concepts measured by the NHP, SF-36, and SS-QOL items with the ICF components and categories, was carried out. RESULTS: Of the 24 identified studies, four met the established criteria: two assessed the three HRQOL instruments, one assessed the NHP and SF-36, and the other just the SS-QOL. For each instrument, three studies were found which associated their concepts up to, at least, the second hierarchical level of the ICF categories. Considering the results that were in agreement between the three studies that assessed the same instrument, nine participation categories were associated with the NHP, seven with the SF-36, and 15 with the SS-QOL, although just one was specific to the NHP, one to the SF-36, and seven to the SS-QOL. CONCLUSIONS: To assess the participation of CVA victims based upon the ICF framework, the SS-QOL appeared to be the most suitable instrument in that, in addition to assessing the greatest number of categories, it also assesses the greatest number of distinct categories, when compared to the other two HRQOL instruments, which added just one category to those measured by SS-QOL.

Introdução: A dança pode melhorar a qualidade de vida (QV) de pessoas que apresentam algum comprometimento psicomotor, porém, nada foi encontrado sobre a dança sênior para pacientes neurológicos. Objetivo: Avaliar a QV em pacientes hemiparéticos pós-AVE, antes e após terapia com dança sênior. Metodologia: Selecionaram-se oito hemiparéticos e foram aplicados dois questionários de QV, SF-36 e SS-QOL. As sessões de terapia com dança sênior, realizadas na clínica de Fisioterapia da Uninove, tiveram duração de uma hora, duas vezes por semana, totalizando 24 sessões. Ao final, os questionários foram reaplicados. Utilizou-se estatística descritiva para caracterização da amostra, após os dados foram submetidos ao teste de normalidade Kolmogorov-Smirnov e teste Wilcoxon. Estabeleceu-se o nível de significância de 5%. Resultados: Observou-se diferença estatisticamente significante na QV, sendo SF-36 (p=0,05) e SS-QOL (p=0,01). Conclusão: O estudo mostrou resultados positivos, pois houve uma melhora significativa na qualidade de vida dos pacientes que participaram da dança.

Introduction: The main symptoms related to Parkinson’s disease (PD) are: tremors, freezing, bradykinesia and muscle rigidity, which lead to functional decline and difficulties in the execution of activities of daily living (ADL), compromising quality of life (QOL). Objective: To characterize the clinical profile and perception of quality of life (QOL) of patients with PD assisted at Associacao Brasil Parkinson (ABP) and correlate these with disease progression and level of disability. Methods: The clinical and functional evaluation of subjects was performed using the Unified Parkinson’s Disease Rate Scale (UPDRS), a modified version of the Hoehn and Yahr Staging Scale (HY) of disability and Parkinson’s Disease Questionnaire (PDQ-39). Results: There was no significant correlation between disease progression and QOL; however, there was moderate correlation (r=0.5) between disability and QOL, p

Objetivo. Investigar la validez y la reproducibilidad de la prueba Glittre de actividades de la vida diaria (AVD-Glittre) para personas con enfermedad de Parkinson. Sujetos y metodos. Se evaluo a 30 pacientes con enfermedad de Parkinson y 19 sujetos sanos (grupo de control). El grupo con enfermedad de Parkinson fue evaluado con la Unified Parkinsons Disease Rating Scale (UPDRS) y sometido a la prueba AVD-Glittre, la prueba de marcha de seis minutos (6MWT) y la prueba de marcha de 10 metros (10mWT). El grupo de control realizo la prueba AVD-Glittre. Para el analisis intraobservador se realizaron dos pruebas AVD-Glittre, y para el analisis interobservador, la prueba se repitio otro dia con un segundo examinador. Resultados. La prueba AVD-Glittre se correlaciono significativamente con la seccion II, la seccion III y la puntuacion total de la UPDRS. Se correlaciono inversamente con la 6MWT y positivamente con la 10mWT. El tiempo requerido para realizar la prueba AVD-Glittre fue mas corto en la nueva prueba en el analisis intraobservador y en el analisis interobservador. La diferencia de medias entre la primera y la segunda pruebas, el error estandar de medicion y el cambio minimo detectable en minutos fueron 0,40, 0,08 y 0,24, respectivamente, para el analisis intraobservador, y 0,40, 0,22 y 0,62, respectivamente, para el analisis interobservador. Conclusion. La prueba AVD-Glittre es valida y reproducible para evaluar la capacidad funcional en personas con enfermedad de Parkinson.

Introdução: São necessários treino e parâmetros específicos a fim de evitar a fadiga no treinamento com estimulação elétrica funcional. Objetivo: Verificou-se o aparecimento da fadiga muscular em pacientes, pós AVE, para melhor compreender um parâmetro de estimulação elétrica, a frequência. Métodos: Analisou-se o comportamento da fadiga muscular usando-se a frequência mediana e avaliou-se a contração voluntária máxima isométrica do músculo bíceps braquial hemiparético de 18 indivíduos, em sete momentos. Utilizou-se uma corrente quadrada e bifásica, com t”on” de 10 s., e t”off” de 30 s., e frequência variável de 50 Hz (protocolo 1) e 2.000Hz (protocolo 2). Resultados: Foi observado que não houve diferença estatisticamente significante (p0,05) entre os protocolos 1 e 2; não sendo registrada diferença no período imediatamente pós-terapia. Conclusões: Pelas ferramentas de mensuração utilizadas, eletromiografia e força muscular, não foi possível detectar o aparecimento da fadiga muscular com os dois protocolos de estimulação elétrica funcional utilizados.

Purpose: Analyze the construct validity and internal consistency of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the ICF as well as analyze the ceiling and floor effects. Methods: One hundred subjects were analyzed: 85 community-dwelling and 15 institutionalized individuals. The analysis of construct validity was performed using classic psychometrics: (1) the comparison of known groups (individuals without restriction to participation vs. those with restriction to participation) using the Mann–Whitney test and (2) convergent validity – correlation between the scores on the SS-QOL items that address participation and the subscale scores of measures used to evaluate the similar constructs and concepts [the Short-Form Health Survey (SF-36), Functional Independence Measure (FIM) and grip strength test]. Spearman’s correlation coefficients were calculated for this analysis. Cronbach’s α was used for the analysis of internal consistency and both the ceiling and floor effects were analyzed. The level of significance for all analyses was α = 0.05. Results: The a priori hypotheses regarding construct validity were partially demonstrated, as only five of the eight domains exhibited positive moderate to strong correlations (r > 0.40) with measures that address constructs similar to those addressed on the SS-QOL questionnaire. The items demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. The ceiling and floor effects were considered adequate for the total SS-QOL score, but beyond acceptable standards for some domains. Conclusions: The 26 items of the SS-QOL questionnaire measure a multidimensional construct and therefore do not only address participation. However, the items demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. Implications for rehabilitationThe 26 items of the SS-QOL questionnaire demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation.The present findings can guide healthcare professionals regarding the selection of an assessment tool for the evaluation of post-stroke participation.The findings can lead to consistent and standardization evaluations, which facilitates comparisons and discussion on functional health and social participation after stroke. The 26 items of the SS-QOL questionnaire demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. The present findings can guide healthcare professionals regarding the selection of an assessment tool for the evaluation of post-stroke participation. The findings can lead to consistent and standardization evaluations, which facilitates comparisons and discussion on functional health and social participation after stroke.

Purpose: To evaluate the reproducibility of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the International Classification of Functioning, Disability and Health (ICF) and analyse the correlation between the subscore of these 26 items and the total SS-QOL score. Methods: Seventy-five stroke survivors participated in this study. Reproducibility was evaluated using the intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimum detectable change (MDC) and the Bland–Altman plot. The correlation between the subscore of the 26 items and the total SS-QOL score was analysed using Spearman’s correlation coefficients (rho) and simple linear regression. An alpha risk ≤ 0.05 was considered for all analyses. Results: The SS-QOL items that address the participation component of the ICF demonstrated excellent reliability (intra-rater ICC2,1 = 0.96; inter-rater ICC2,1 = 0.95). The SEM and MDC were adequate. The Bland–Altman plot demonstrated satisfactory agreement. A significant and strong correlation (rho = 0.83) was found between the 26 SS-QOL items that address participation and the total SS-QOL score. Moreover, the evaluation of participation was found to explain 73% of the evaluation of health-related quality of life. Conclusion: The 26 SS-QOL items that address the participation component of the ICF demonstrated adequate reproducibility. Thus, participation, which represents the social aspects of functionality, can be adequately evaluated with these items. Implications for RehabilitationThe 26 Stroke Specific Quality of Life items that address participation proved to be reproducible for the analysis of social participation following a stroke.The findings can lead to a better understanding of the social participation of individuals with chronic hemiparesis and assist in the establishment of adequate treatment for such individuals.The rehabilitation process can be directed towards more specific goals focused on the patient expectations, thereby contributing to greater humanization and effectiveness of treatment to improve social participation following a stroke. The 26 Stroke Specific Quality of Life items that address participation proved to be reproducible for the analysis of social participation following a stroke. The findings can lead to a better understanding of the social participation of individuals with chronic hemiparesis and assist in the establishment of adequate treatment for such individuals. The rehabilitation process can be directed towards more specific goals focused on the patient expectations, thereby contributing to greater humanization and effectiveness of treatment to improve social participation following a stroke.

It has been already shown that delivering tDCS that are spaced by an interval alters its impact on motor plasticity. These effects can be explained, based on metaplasticity in which a previous modification of activity in a neuronal network can change the effects of subsequent interventions in the same network. But to date there is limited data assessing metaplasticity effects in cognitive functioning., This work was supported by the Portuguese Foundation for Science and Technology (FCT) with two individual grants (SFRH/BPD/86041/2012 and SFRH/BPD/86027/2012).

This study aimed to identify the International Classification of Functioning, Disability, and Health categories addressed by the assessment tools commonly used in post-stroke rehabilitation and characterize patients based on its evaluation model. [Subjects and Methods] An exploratory, descriptive, cross-sectional study was conducted involving 35 individuals with chronic post-stroke hemiparesis. Handgrip strength was assessed to evaluate body functions and structures. The 10-meter gait speed test and Timed Up and Go test were administered to evaluate activity. The Stroke Specific Quality of Life scale was used to evaluate participation. Moreover, a systematic review of the literature was performed to identify studies that have associated these assessment tools with the International Classification of Functioning, Disability, and Health categories. [Results] The tools employed in this study for evaluating function addressed 63 International Classification of Functioning, Disability, and Health categories: 24 related to body functions and structures; 36 related to activity and participation; and 3 related to environmental factors. [Conclusion] The assessment tools employed in this study addressed 63 International Classification of Functioning, Disability, and Health categories and allowed a more complete evaluation of stroke survivors with hemiparesis. Use of this classification can therefore be more easily incorporated into clinical practice.

A stroke may leave neurological, motor and sensory sequelae, interfering with the function of movements and culminating in gait and balance changes. Therefore, it is necessary to demonstrate the efficacy of eight-point binding, a low-cost technique that functions to provide proprioceptive information and promote the biomechanical alignment of the ankle, acting against mechanisms that lead to equinovarus foot. This study aims to determine the immediate effect of eight-point binding as a physical therapy resource for the rehabilitation of function performance after a stroke. To this end, 22 patients who were able to walk alone without an orthosis were evaluated, and performed the Timed Up and Go (TUG) functional mobility test, a gait speed assessment and the Berg Balance Scale, with and without the eight-point binding in the paretic lower limb. When comparing the results after the eight-point binding, it was possible to observe a statistically significant difference (p

To identify the categories of the participation component of the International Classification of Functionality, Incapacity, and Health (ICF) which are currently related to Health-related Quality of Life (HRQOL) instruments commonly used in cerebrovascular accident (CVA) victims-Nottingham Health Profile (NHP), Short-Form Health Survey (SF-36), and Stroke Specific Quality of Life (SS-QOL)-and suggest the utilization of these instruments to assess and/or characterize that component in that population.Through searches in the Medline, SciELO, and Lilacs databases, a compilation of studies which associated the concepts measured by the NHP, SF-36, and SS-QOL items with the ICF components and categories, was carried out.Of the 24 identified studies, four met the established criteria: two assessed the three HRQOL instruments, one assessed the NHP and SF-36, and the other just the SS-QOL. For each instrument, three studies were found which associated their concepts up to, at least, the second hierarchical level of the ICF categories. Considering the results that were in agreement between the three studies that assessed the same instrument, nine participation categories were associated with the NHP, seven with the SF-36, and 15 with the SS-QOL, although just one was specific to the NHP, one to the SF-36, and seven to the SS-QOL.To assess the participation of CVA victims based upon the ICF framework, the SS-QOL appeared to be the most suitable instrument in that, in addition to assessing the greatest number of categories, it also assesses the greatest number of distinct categories, when compared to the other two HRQOL instruments, which added just one category to those measured by SS-QOL.

Objective: To determine which mechanisms lead to activation of neurons in the motor cortex during transcranial magnetic stimulation (TMS) with different current directions and pulse waveforms. Methods: The total electric field induced in a simplified model of a cortical sulcus by a figure-eight coil was calculated using the finite element method (FEM). This electric field was then used as the input to determine the response of compartmental models of several types of neurons. Results: The modeled neurons were stimulated at different sites: fiber bends for pyramidal tract neurons, axonal terminations for cortical interneurons and axon collaterals, and a combination of both for pyramidal association fibers. All neurons were more easily stimulated by a PA-directed electric field, except association fibers. Additionally, the second phase of a biphasic pulse was found to be more efficient than the first phase of either monophasic or biphasic pulses. Conclusions: The stimulation threshold for different types of neurons depends on the pulse waveform and relative current direction. The reported results might account for the range of responses obtained in TMS of the motor cortex when using different stimulation parameters. Significance: Modeling studies combining electric field calculations and neuronal models may lead to a deeper understanding of the effect of the TMS-induced electric field on cortical tissue, and may be used to improve TMS coil and waveform design.

Objective This work aims to elucidate by what physical mechanisms and where stimulation occurs in the brain during transcranial magnetic stimulation (TMS), taking into account cortical geometry and tissue heterogeneity. Methods An idealized computer model of TMS was developed, comprising a stimulation coil, a cortical sulcus, and surrounding tissues. The distribution of the induced electric field was computed, and estimates of the relevant parameters were generated to predict the locus and type of neurons stimulated during TMS, assuming three different stimulation mechanisms. Results Tissue heterogeneity strongly affects the spatial distribution of the induced electric field and hence which stimulation mechanism is dominant and where it acts. Stimulation of neurons may occur in the gyrus, in the lip of the gyrus, and in the walls of the sulcus. The stimulated cells can be either pyramidal cells having medium to large caliber axons, or intracortical fibers of medium caliber. Conclusions The results highlight the influence of cortical folding on the action of magnetic and electric fields on cortical tissue. Significance Tissue geometry and heterogeneity in electrical conductivity both must be taken into account to predict accurately stimulation loci and mechanism in TMS.

TMS is a promising tool for the non-invasive stimulation of the cerebral cortex, with applications in neurology and the neurosciences. From cable theory, it is known that the activation function for neuronal stimulation in TMS may contain contributions from the electric field and the component of the electric field gradient along the direction of the nerve. Here we present a calculation of the spatial distribution of the induced electric field by TMS using a finite element model of the cerebral cortex and surrounding tissues. This distribution allows us to calculate the activation function for different experimental conditions, and is expected to provide new insight into the mechanisms of TMS in the cortex.

The aims of the present study were to determine the prevalence of temporomandibular disorder (TMD) in a sample of patients with Parkinson's disease (PD) and to analyze the distribution of occlusal contacts.The sample was composed of patients with PD aged 50-75 years. Temporomandibular disorder was evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The distribution of occlusal contacts was determined using the portable T-Scan IIIForty-two individuals with PD were analyzed. The prevalence of TMD was 23.8%. No statistically significant association was found between TMD and occlusal contact symmetry. Moreover, no significant difference in the distribution of occlusal contacts was found between the groups with and without TMD.The present data suggest no association between TMD and occlusal contact asymmetry in individuals with PD.The results of this study identified a prevalence of 23.8% of TMD signs in subjects with PD and a high frequency of occlusal asymmetry in this sample.

The aims of the present study were to investigate the prevalence of temporomandibular disorder (TMD) in a group of patients with Parkinson’s disease (PD), and to analyze oral health according to the severity of the disease. [Methods] Signs and symptoms of TMD were evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders, and oral health impact was measured using the Oral Health Impact Profile. The unpaired Student’s t-test was used to compare groups with and without TMD. Pearson’s correlation coefficients were calculated to determine correlations between the level of functional independence and oral health impact. Fisher’s exact test was used to test the association between TMD and the severity of symptoms of PD. [Results] Fifty-nine individuals with PD were analyzed. The prevalence of TMD was 20.33%. No statistically significant associations were found between TMD and the severity of PD. Oral health impact was considered weak, but a statistically significant difference between groups with and without TMD was found for psychological disability (p = 0.003). No significant correlation was found between the level of functional independence and oral health impact. [Conclusion] The prevalence of TMD among patients with Parkinson’s disease was 20.33%. A statistically significant difference between groups with and without TMD was found regarding the psychological disability domain.

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Após o Acidente Vascular Cerebral (AVC), o acesso aos serviços de saúde para continuidade dos cuidados é fundamental e deve ser proporcionado de forma integral e multiprofissional, de acordo com as necessidades individuais. No Brasil, há políticas públicas e recomendações de cuidados para indivíduos pós-AVC. Contudo, informações sobre acesso aos serviços de saúde desta população são escassas. Os objetivos deste estudo foram caracterizar o acesso aos serviços de saúde, comparar o “acesso real” ao “acesso esperado”, e determinar os preditores sociodemográficos e clínico-funcionais, no primeiro mês (T1) após a alta hospitalar de uma Unidade de Acidente Vascular Cerebral (U-AVC). Durante seis meses (setembro/2019-fevereiro/2020), indivíduos com idade≥20 anos, identificados em uma U-AVC de Belo Horizonte/MG, com primeiro AVC e sem incapacidades prévias, foram incluídos e avaliados na alta hospitalar (T0) quanto a características sociodemográficas (sexo, idade, escolaridade, nível socioeconômico) e clínico-funcionais (gravidade do AVC e nível de incapacidade). Em T1, por telefone, foram coletadas informações sobre o acesso aos serviços de saúde (“acesso real”). Para comparação ao “acesso esperado” (encaminhamentos dos profissionais da U-AVC), utilizou-se estatística descritiva e teste de Wilcoxon e, para identificar os preditores, regressão logística binária (α=5%). Foram identificados 260 indivíduos, sendo incluídos 116 e 78 avaliados em T1: maioria do sexo feminino (53%), com média de idade de 60±16 anos, com menos de quatro anos de estudo (50%), com incapacidade leve (53%) e nível de gravidade do AVC leve (50%) o mais comum. Todos receberam pelo menos um encaminhamento. O acesso aos serviços de saúde em T1 foi obtido pela maioria dos indivíduos (77%;60/78), de forma parcial em relação ao esperado (70%;42/60), sendo a quantidade de “acesso real” (n=122) significativamente menor ao “acesso esperado” (n=249) (p