Análisis de instrumento para evaluación del desempeño en actividades de la vida diaria instrumentales Lawton y Brody / Analysis of the Lawton and Brody instrumental activities of daily living assessment instrument

El propósito fue analizar el Índice de Lawton y Brody (ILB), determinando si los factores género, desempeño previo y nivel socioeconómico afectan las conclusiones relacionadas con la dependencia en AVDI. La metodología es analítica, exploratoria y transversal. En primera instancia se aplicó una encuesta de percepción de ILB a 22 terapeutas ocupacionales (TTOO) pertenecientes a servicios públicos de Valparaíso, Viña del Mar, Concón y Quilpué. En segunda instancia se aplicó ILB más un cuestionario complementario a 36 usuarios del Centro Comunitario de Rehabilitación de Miraflores, Instituto deNeurorehabilitación Luis Krebs y Centro de Rehabilitación Integral Siloe; paralelamente, el terapeuta ocupacional (TO) completó una encuesta con su impresión sobre la capacidad de realizar las AVDI de sus usuarios, para determinar diferencias significativas entre ambos. Resultados: Los resultados indican que los TO están en desacuerdo con las características del instrumento. En los resultados de su aplicación, el ILB permite identificar el nivel de dependencia en AVDI en los ítems que evalúa. Se condujó que el factor género no es determinante de la dependencia, pero sí es determinante el factor socioeconómico; el nivel de desempeño previo tiene una correlación positiva con el desempeño actual de las personas. Conclusiones: La percepción de los TO está en desacuerdo con ILB. Los resultados de la aplicación de ILB y la contrastación con la impresión del TO tratante permite confirmar que efectivamente el instrumento logra el objetivo para el cual fue diseñado, destacando que el género no es un factor determinante en la realización de AVDI, mientras el factor socioeconómico es considerado como relevante para su realización.

The aim was to analyze the Lawton and Brody index (LBI), to determine if factors such as gender, previous performance and socio-economic level affect the conclusions related to the IADL dependency. The methodology is analytic, exploratory and cross-sectional. An opinion survey about IADL was applied to 22 OTs belonging to public services in Valparaíso, Viña del Mar, Concón and Quilpué. The LBI plus a 36-question complementary questionnaire were applied to Rehabilitation Community Center in Miraflores, Luis Krebs Neuro-rehabilitation Institute and Comprehensive Rehabilitation Center. Besides, the OTs filled in a survey about his views on the users’ abilities to perform IADL in order to establish meaningful differences between both. Results: The results show that occupational therapists don’t agree with the instrument features. In the results application, the LBI allows to identify the dependency level in IADL in the assessed items. It was shown that the gender factor is not decisive in dependency, however, the socio-economic factor is decisive; the level of previous performance has a positive correlation with the people’s current performance. Conclusions: The OT’s perception shows disagreement with the BLI. The results of the application of LBI and the contrast with the OTs opinion allows to confirm that the instrument actually fulfills the objective for which it was designed, pointing out that gender is not a decisive factor in IADL while socio economic factor is considered relevant in its application.

Dignidad ocupacional en personas con secuelas secundarias a daño neurológico severo / Occupational dignity in people with side effects to severe neurological damage

La terapia ocupacional es una disciplina socio sanitaria difícil de definir y explicar por su amplio espectro de acción, diversos autores han hecho distintas definiciones de ésta, sin embargo aún cuesta que la sociedad general entienda y conozca el significado de esta profesión, que desde un enfoque contemporáneo está centrada en la participación ocupacional de las personas. (Crepeau, 2011)Tiene como objetivo principal dotar a los individuos, organizaciones o poblaciones que interviene, de los recursos necesarios para su bienestar ocupacional, aprovechando todas las capacidades individuales, colectivas, los recursos cotidianos y el entorno para esto. Según los planteamientos de la Asociación Americana de Terapia Ocupacional, la terapia ocupacional asegura el compromiso con la justicia ocupacional (Aviles, 2010) de las personas, lo cual quiere decir, que indistinto de las características de la situación de discapacidad que presenta una persona, éstas tienen el derecho a lograr participar de las ocupaciones humanas. Esto se vincula con un concepto mayor, propio a la característica de humanidad de nuestra especie, la cual se denomina dignidad humana, a partir de estos dos términos, la experiencia clínica y académica de las autoras en intervención de personas con secuelas secundarias a daño neurológico severo, generan el concepto Dignidad Ocupacional, que hace referencia a que toda persona tiene derecho a disfrutar dignamente de experiencias ocupacionales a pesar de no contar con las destrezas de desempeño necesarias para involucrarse en ellas de manera independiente...

Occupational Therapy is a socio-health discipline which is difficult to define and explain due to its wide range of action. Several authors have defined it, however it is still hard for society to understand and know the meaning of this profession, which from a contemporary approach, is focused on the occupational participation of people (Crepeau, 2011).Its main objective is to deal with individuals, organizations and population to provide the necessary resources for their occupational welfare, taking advantage of all individual and group capacities, as well as daily resources and environment. According to the statements of the American Occupational Therapy Association , occupational therapy ensures the commitment to occupational justice (Aviles, 2010) with people , that is ,no matter the characteristics of the disability situation of a given person, she or he has the right to participate in human occupations. This goes along with a major concept that is inherent to our species human characteristic: human dignity, notion based on considering a person able to offer options to improve the quality of life, independent of his or her condition When it comes to people suffering from severe neurological damage, it is often believed that they only need to satisfy their basic self-care needs, nevertheless, they are people subject to rights, worthy and who deserve equal treatment. Thus, the effort to satisfy the occupations they cannot do by themselves is what we call Occupational Dignity, concept that was born with the blending of human dignity and occupational justice...

Standardization of a computerized method for calculating autonomic function test responses in healthy subjects and patients with diabetes mellitus

The objectives of the present study were 1) to compare results obtained by the traditional manual method of measuring heart rate (HR) and heart rate response (HRR) to the Valsalva maneuver, standing and deep breathing, with those obtained using a computerized data analysis system attached to a standard electrocardiograph machine; 2) to standardize the responses of healthy subjects to cardiovascular tests, and 3) to evaluate the response to these tests in a group of patients with diabetes mellitus (DM). In all subjects (97 healthy and 143 with DM) we evaluated HRR to deep breathing, HRR to standing, HRR to the Valsalva maneuver, and blood pressure response (BPR) to standing up and to a sustained handgrip. Since there was a strong positive correlation between the results obtained with the computerized method and the traditional method, we conclude that the new method can replace the traditional manual method for evaluating cardiovascular responses with the advantages of speed and objectivity. HRR and BPR of men and women did not differ. A correlation between age and HRR was observed for standing (r =-0.48, P<0.001) and deep breathing (r = -0.41; P<0.002). Abnormal BPR to standing was usually observed only in diabetic patients with definite and severe degrees of autonomic neuropathy.

Relationship between the degree of cardiovascular automic dysfunction and symptoms of neuropathy and other complications of diabetes mellitus

A cross-sectional study was designed to identify a relationship between the presence of symptoms usually related to nervous system involvement as well as other chronic complications of diabetes with three objectively defined degrees of autonomic neuropathy (AN). Symtoms usually related to peripheral sensitive neuropathy and AN were assessed using a questionnaire applied to 132 diabetcs (38 IDDM and 94 NIDDM), 65 without and 67 with AN. AN was classified as follows according to 5 cardiovascular autonomic tests described by Ewing: 1) early involvement - 1 abnormal test (N = 27); 2) definite involvement - 2 or 3 abnormal tests (N = 26); 3) severe involvement - 4 or 5 abnormal tests (N = 14). A statistically significant asssociation was observed between degree of autonomic inovlvement and the presence of the following symptoms: dizziness on standing, dysphagia, vomiting, diarrhea, fecal incontinence, gustatory sweating, urinary retention, numbness and hyperesthesia of the feet or legs. Constipation and cystitis were not significantly related to cardiovascular AN. Only 3 percent of the patients without neuropathy and with early involvement had four or more than four of the symptoms. The prevalence of proliferative retnopathy and nephropathy was increased among patients with more severe degrees of AN. For IDDM patients there was a positive correlation between the degree of cardiovascular AN and the duration of diabetes. We conclude that: 1) severe cardiovascular AN is usually related to 4 or more of the evaluated symptoms and those patients usually have the other complications of diabetes; 2) severe AN could be a risk factor or an indicator of the same underlying process that determines the beginning of proliferative retinopathy and/ or nephropathy

Bloqueio do plexo braquial pela via transaxilar com altas doses de lidocaína a 1,6% / Transarterial brachial plexux block using high doses of 1,6% lidocaine

El bloqueo del plexo braquial por la via transarterial fué realizado con dosis fijas de 50 ml de lidocaina a 1,6% con epinefrina a 1:200.000 en 20 pacientes sometidos a cirugía de las extremidades superiores. Fueron avaluados el tiempo de latencia, el porcentaje de éxito del bloqueo sensitivo y del bloqueo motor y la duración de la anelgesia. El índice de éxito fué de 95-100%, en ningún paciente fué necessário complementación con anestesia general, y no fueron observados señales de toxicidad sistémica de la lidocaina. La ausencia de analgesia fué verificada en apenas un paciente, en el trajecto cutáneo de los nervios ulnar y mediano. La durarión de la analgesia fué de 3,46 ñ 0,52 h