Development of a first-contact protocol to guide assessment of adult patients in rehabilitation services networks

Objective: This paper describes the development of the Protocol for Identification of Problems for Rehabilitation (PLPR), a tool to standardize collection of functional information based on the International Classification of Functioning, Disability and Health (ICF). Development of the protocol: The PLPR was developed for use during the initial contact with adult patients within a public network of rehabilitation services. Steps to develop the protocol included: survey of the ICF codes most used by clinical professionals; compilation of data from functional instruments; development and pilot testing of a preliminary version in the service settings; discussion with professionals and development of the final version. The final version includes: user identification; social and health information; brief functional description (BFD); summary of the BFD; and PLPR results. Further testing of the final version will be conducted. Conclusions: The protocol standardizes the first contact between the user and the rehabilitation service. Systematic use of the protocol could also help to create a functional database that would allow comparisons between rehabilitation services and countries over time.

Longitudinal assessment of grip strength using bulb dynamometer in Duchenne Muscular Dystrophy

BACKGROUND: Grip strength is used to infer functional status in several pathological conditions, and the hand dynamometer has been used to estimate performance in other areas. However, this relationship is controversial in neuromuscular diseases and studies with the bulb dynamometer comparing healthy children and children with Duchenne Muscular Dystrophy (DMD) are limited. OBJECTIVE: The evolution of grip strength and the magnitude of weakness were examined in boys with DMD compared to healthy boys. The functional data of the DMD boys were correlated with grip strength. METHOD: Grip strength was recorded in 18 ambulant boys with DMD (Duchenne Group, DG) aged 4 to 13 years (mean 7.4±2.1) and 150 healthy volunteers (Control Group, CG) age-matched using a bulb dynamometer (North Coast- NC70154). The follow-up of the DG was 6 to 33 months (3-12 sessions), and functional performance was verified using the Vignos scale. RESULTS: There was no difference between grip strength obtained by the dominant and non-dominant side for both groups. Grip strength increased in the CG with chronological age while the DG remained stable or decreased. The comparison between groups showed significant difference in grip strength, with CG values higher than DG values (confidence interval of 95%). In summary, there was an increment in the differences between the groups with increasing age. Participants with 24 months or more of follow-up showed a progression of weakness as well as maintained Vignos scores. CONCLUSIONS: The amplitude of weakness increased with age in the DG. The bulb dynamometer detected the progression of muscular weakness. Functional performance remained virtually unchanged in spite of the increase in weakness. .

Cinética da resposta imune humoral de cães jovens imunizados contra Leptospira interrogans / Kinetics of the humoral immune response of dogs young immunized with Leptospira interrogans

Objetivou-se analisar a resposta imune humoral contra Leptospira interrogans mediante a utilização da prova de soroaglutinação microscópica (SAM) em 26 cães jovens, sendo 17 de raça definida (Grupo A) e nove sem raça (Grupo B), de ambos os sexos, pertencentes a canis e ambientes domiciliares em Uberlândia, Minas Gerais. Os cães foram vacinados com bacterina inativada comercial polivalente com os sorovares Canicola, Grippotyphosa, Icterohaemorrhagiae e Pomona. O esquema vacinal baseou-se em três imunizações. A primovacinação foi realizada aos quarenta e cinco dias de idade, considerado dia zero, e após dois reforços com intervalos de trinta dias cada. Sete colheitas sanguíneas de cada cão foram efetuadas do dia zero até aos 180 dias pós-vacinais, com intervalos de trinta dias cada. Não foram detectados títulos pré-vacinais para os sorovares Canicola, Icterohaemorrhagiae e Grippotyphosa no dia zero. Apenas um cão do grupo A foi reagente com título 1:100 contra o sorovar Pomona na primeira colheita. Não houve diferença estatística entre os títulos de anticorpos aglutinantes entre os Grupos A e B (p>0,05), induzidos pela bacterina comercial utilizada, exceto na colheita II (p<0,05), na qual o grupo B apresentou títulos para o sorovar Autumnalis em todos os cães avaliados, enquanto que, no grupo A, 64,7 por cento dos cães não foram reagentes a nenhum sorovar testado. No dia 30, títulos para o sorovar Autumnalis que persistiram até os 180 dias pós-vacinais, em ambos os grupos, variando apenas a intensidade da resposta imunológica sem diferença estatística significativa. Para avaliação da eficiência vacinal da bacterina anti-Leptospira, a presente pesquisa alerta para os ricos à infecção que os cães vacinados anualmente estão submetidos.

The objective was to analyze the humoral immune response against Leptospira interrogans using the microscopic agglutination test (MAT) in 26 young dogs, and 17 mixed breed (Group A) and nine mixed breed (Group B) of both sexes, pertaining to kennels and home environments in Uberlandia, Minas Gerais. Dogs were vaccinated with commercial inactivated polyvalent bacterin with Canicola, Grippotyphosa, Icterohaemorrhagiae and Pomona serovars. The immunization schedule was based on three immunizations. The first vaccination was performed at forty-five days of age, considered day zero, and after two boosters at intervals of thirty days each. Seven blood samples from each dog were made from time zero up to 180 days post-vaccination, at intervals of thirty days each. Titles have not been detected pre-vaccination against serovars Canicola, and Icterohaemorrhagiae Grippotyphosa on day zero. Only one dog in group A was reactive with a titer of 1:100 against Pomona in the first harvest. There was no statistical difference between the agglutinating titers between Groups A and B (p>0.05) induced by commercial vaccine used, except at harvest II (p<0.05), in which the group B presented evidence to serovar Autumnalis in all dogs evaluated, whereas in group A, 64.7 percent of dogs were not reactive to any serovar tested. There were on the 30th title to serovar Autumnalis that persisted until 180 days post-vaccination in both groups, varying only the intensity of immune response without significant statistical difference. To assess the efficiency of vaccine culture anti-Leptospira this research to warn the risks infection that dogs are vaccinated annually submitted.