Evaluation of functioning and associated factors in children and adolescents with osteogenesis imperfecta / Avaliação da funcionalidade e fatores associados de crianças e adolescentes com osteogênese imperfeita

ABSTRACT Objective: The aim of this study was to evaluate the functioning and associated factors in children and adolescents with osteogenesis imperfecta (OI). Methods: This is a cross-sectional study conducted on 30 children and adolescents with OI. Medical records, use of bisphosphonates, socioeconomic status, handgrip strength, balance, joint hypermobility, ambulatory level, and the Pediatric Evaluation of Disability Inventory—Computer Adaptative Test (PEDI-CAT) scores were assessed. Data is presented as mean and standard deviation and Student's t-test or Mann-Whitney U test. Categorical data is presented as frequency and analyzed using Fisher's exact test. Within-group analyses were conducted using ANCOVA or Wilcoxon signed-rank test. Correlations used Kendall's Tau-b test. Results: The participants involved in this study were 6-18 years old. The sample was separated into two groups according to disease severity. The moderate/severe OI group (n=10) presented a lower height and muscular strength than the mild group (n=20). Muscle weakness was observed in all participants with OI when compared with the normal population. No differences were observed between the groups in the PEDI-CAT scores except for the mobility domain. There were correlations between the PEDI-CAT mobility domain and the number of fractures, OI type, weight, and balance; there was also a correlation between the PEDI-CAT daily activities, mobility, responsibility, and social/cognitive domains. Conclusions: The findings suggest that children with moderate/severe forms of OI can achieve the same function levels as children with mild OI. Fractures can have a major influence on the functional level, and treatment should focus on the prevention and rehabilitation of these events when they occur.

RESUMO Objetivo: Avaliar a funcionalidade e fatores associados em crianças e adolescentes com osteogênese imperfeita (OI). Métodos: Estudo transversal com 30 crianças e adolescentes com OI. Foram avaliados prontuários médicos, uso de bisfosfonatos, características socioeconômicas, dinamometria de preensão palmar, equilíbrio, hipermobilidade articular, nível de deambulação e escores do Pediatric Evaluation of Disability Inventory - Computer Adaptative Test (PEDI-CAT). Os dados foram apresentados em média e desvio padrão e comparados por teste t por Mann-Whitney, enquanto os categóricos foram apresentados em frequência e comparados pelo teste exato de Fisher. Análises intragrupos foram realizadas por análise de covariância (ANCOVA) ou Teste de Wilcoxon para postos sinalizados. O teste Tau-b de Kendall foi usado para correlações. Resultados: A idade variou de 6 a 18 anos. A amostra foi dividida em dois grupos de acordo com a gravidade da doença. Casos moderados/graves (n=10) apresentaram menor estatura e força muscular comparadas às dos leves (n=20). Fraqueza muscular foi observada em todos os casos de OI quando comparados à população normal. Não houve diferença nos domínios do PEDI-CAT com exceção do domínio mobilidade. Houve correlação entre o número de fraturas, tipo de OI, peso e equilíbrio e o domínio mobilidade; e entre os domínios Atividades Diárias e Mobilidade e Responsabilidade e Social/cognitivo do PEDI-CAT. Conclusões: Nossos achados sugerem que crianças com OI moderada/severa podem atingir o mesmo nível de funcionalidade que crianças com a forma leve. Fraturas podem ter grande influência no nível de funcionalidade e o tratamento deve enfocar a prevenção e a reabilitação desses eventos.

Rehabilitación respiratoria en pacientes post COVID-19 con tres tratamientos; experiencia en un hospital militar peruano / Respiratory rehabilitation in post-COVID-19 patients with three treatments; experience in a Peruvian military hospital / Reabilitação respiratória em pacientes pós-COVID-19 com três tratamentos; experiência em um hospital militar peruano

La pandemia de COVID-19 ha destacado la importancia de la rehabilitación en pacientes con COVID prolongado. Objetivo: describir los efectos de tres tratamientos en un programa de rehabilitación respiratoria en pacientes post COVID-19 en un hospital militar peruano. Materiales y métodos: se llevó a cabo un estudio descriptivo y observacional. La muestra se dividió en tres grupos con diferentes tratamientos: RR+VNI+O2, Oxigenoterapia convencional y RR+CNAF+O2. Se evaluaron 348, 151 y 113 pacientes respectivamente en cada grupo. Se utilizó la Escala de Borg, mMRC, el cuestionario específico de Saint George y el genérico SF-12 para medir la percepción de falta de aire, fatiga y calidad de vida post pandemia. Resultados: tras los tratamientos, se observó un aumento significativo en la saturación de oxígeno, disminución en la frecuencia cardíaca, disnea y fatiga percibida. Conclusión: esto indica una mejora notable en la intensidad del cansancio y una significativa recuperación en la calidad de vida de los pacientes evaluados.

The COVID-19 pandemic has highlighted the importance of rehabilitation in patients with long COVID. objective: Describe the effects of three treatments in a respiratory rehabilitation program in post-COVID-19 patients in a Peruvian military hospital. Materials and methods: a descriptive and observational study was carried out. The sample was divided into three groups with different treatments: RR+NIV+O2, conventional oxygen therapy and RR+CNAF+O2. 348, 151 and 113 patients were evaluated respectively in each group. The Borg Scale, mMRC, the specific Saint George questionnaire and the generic SF-12 were used to measure the perception of shortness of breath, fatigue and post-pandemic quality of life. Results: after the treatments, a significant increase in oxygen saturation, decrease in heart rate, dyspnea and perceived fatigue was observed. Conclusion: this indicates a notable improvement in the intensity of fatigue and a significant recovery in the quality of life of the patients evaluated.

A pandemia de COVID-19 destacou a importância da reabilitação em pacientes com COVID longa. Objetivo: descrever os efeitos de três tratamentos em um programa de reabilitação respiratória em pacientes pós-COVID-19 em um hospital militar peruano. Materiais e métodos: foi realizado um estudo descritivo e observacional. A amostra foi dividida em três grupos com diferentes tratamentos: FR+VNI+O2, oxigenoterapia convencional e FR+CNAF+O2. Foram avaliados 348, 151 e 113 pacientes respectivamente em cada grupo. A Escala de Borg, mMRC, o questionário específico de Saint George e o SF-12 genérico foram utilizados para mensurar a percepção de falta de ar, fadiga e qualidade de vida pós-pandemia. Resultados: após os tratamentos foi observado aumento significativo da saturação de oxigênio, diminuição da frequência cardíaca, dispneia e fadiga percebida. Conclusão: isto indica uma melhora notável na intensidade da fadiga e uma recuperação significativa na qualidade de vida dos pacientes avaliados.

Visual rehabilitation with scleral contact lenses in patients with irregular astigmatism

Introduction: Scleral contact lenses (SCLs) are gas-permeable and are placed entirely on the sclera without contacting structures such as the cornea or limbus. These ECLs are designed to rehabilitate reduced vision of eyes with irregular corneas. Irregular astigmatism caused by corneal pathologies such as keratoconus, post-transplant, post-refractive surgery, or corneal degeneration produces poor visual acuity that cannot be corrected with air lenses, and the appearance of scleral contact lenses could be a therapeutic option in the treatment and optical correction of corneal pathologies. To determine the degree of improvement in visual acuity with adaptation of scleral lenses. Methodology: This was an observational, descriptive, retrospective, cross-sectional, retrospective study. Results: Forty cases of irregular astigmatism with different initial visual acuity effects were observed prior to the fitting of Scleral Lenses. The mean visual acuity (VA) prior to correction with scleral lenses observed in the 40 cases was 20/200 with correction on the Snellen scale with a minimum (worst VA) equal to "finger-count vision" (represented as cases with 20/ 400 vision for quantification purposes) and a maximum (best VA) of 20/70. Nineteen cases (47.5%) restored their VA to normal values (20/20), and 30 cases (75%) improved their VA by at least 10-fold from the baseline. Discussion: In this study, a remarkable and constant improvement in visual acuity was observed in all the patients. Some patients experienced an increase of up to 20 times their initial visual acuity, achieving, in many cases, a visual acuity of 20/20 on the Snellen scale. These results indicate a promising treatment strategy with fewer adverse effects.

Introducción: Las lentes de contacto esclerales (LCE) son permeables al gas y se colocan totalmente en la esclera sin hacer contacto con estructuras como la córnea o el limbo. Estas LCE son diseñadas para rehabilitar la visión reducida de los ojos con córneas irregulares. Los astigmatismos irregulares producidos por patologías corneales como el queratocono, post trasplante, post cirugía refractiva o degeneraciones corneales producen una mala agudeza visual que no puede ser corregida con lentes aéreas, actualmente con la aparición de las lentes de contacto esclerales podrían ser una de las opciones terapéuticas en el tratamiento y corrección óptica de las patologías corneales. Determinar el grado de mejoría de la agudeza visual con la adaptación de lentes esclerales. Metodología: Observacional descriptivo de corte transversal, retrospectivo. Resultados: 40 casos de astigmatismo irregular con distintas afectaciones iniciales en la agudeza visual previo a la colocación de las LCE. La media de agudeza visual (AV) previo a la corrección con las lentes esclerales observada en los 40 casos fue de 20/200 con corrección (CC) en la escala de Snellen con un mínimo (peor AV) igual a "visión cuenta dedos" (representado como casos con visión 20/400 con fines de cuantificación) y un máximo (mejor AV) de 20/70. 19 casos (47,5%) restauraron su AV a valores normales (20/20); 30 casos (el 75%) mejoraron su AV al menos 10 veces respecto al valor inicial. Discusión: En este estudio, se observó una notable y constante mejora en la agudeza visual de todos los pacientes estudiados. Algunos pacientes experimentaron aumentos de hasta 20 veces su agudeza visual inicial, logrando en muchos casos una agudeza visual de 20/20 en la escala de Snellen. Estos resultados indican un tratamiento prometedor con pocos efectos adversos evidentes.

¿Hipotonía o Flacidez en Rehabilitación? Una Recomendación desde el Origen Etimológico / Hypotonia or Flaccidity in Rehabilitation? A Recommendation from the Etymological Origin

El músculo estriado es un tejido organizado que utiliza la energía química para realizar trabajo físico, el cual se genera a partir de la contracción muscular. Un tono muscular adecuado es necesario para el movimiento eficiente y la realización de actividad básica del cuerpo humano. Las alteraciones del tono muscular en la práctica clínica se clasifican como hipertonía, que es el aumento del tono en los músculos esqueléticos y/o lisos, e hipotonía o flacidez, que es la disminución del tono del músculo esquelético. Los términos hipotonía y flacidez son ampliamente utilizados por los clínicos en la rehabilitación y ambos hacen referencia a una disminución del tono muscular. Este estudio analizó y evaluó el origen etimológico de los términos Hipotonía y Flacidez y la implicancia de sus definiciones. Para determinar el origen etimológico se realizó una búsqueda de los términos en el Diccionario médico-biológico, histórico y etimológico y Diccionario Latino-Español Español-Latino. Para determinar la definición en español se utilizó el Diccionario de Términos Médicos de La Real Academia de Medicina de España; el Diccionario de la Lengua española; el Diccionario Panhispánico de Términos Médicos; la Biblioteca Nacional Médica y la Biblioteca Virtual de Salud de Centro Latinoamericano y del Caribe. Para determinar el uso de estos términos en el ámbito clínico, se realizó una búsqueda en artículos científicos del ámbito neurológico según el criterio de los autores. Por consiguiente, el término más adecuado para referirse a una disminución de tono muscular en rehabilitación sería Hipotonía, de esta manera y según el origen de la lesión, se pueden utilizar los términos Hipotonía central e Hipotonía periférica, si es que están afectadas estructuras asociadas al sistema nervioso central o periférico, respectivamente. Se sugiere que estos términos sean considerados tanto en la práctica clínica como en la docencia cuando existan alteraciones en el sistema nervioso central o periférico que tengan como consecuencia un bajo tono muscular.

SUMMARY: Striated muscle is an organized tissue that utilizes chemical energy to perform physical work, generated through muscle contraction. Proper muscle tone is essential for efficient movement and basic bodily functions. Clinical practice categorizes muscle tone alterations as hypertonia, an increase in tone in skeletal and/or smooth muscles, and hypotonia or flaccidity, a decrease in skeletal muscle tone. These terms are widely used in rehabilitation to denote decreased muscle tone. This study examined the etymological origins of the terms Hypotonia and Flaccidity and their respective definitions. Etymological research utilized the Diccionario Médico- biológico, histórico y etimológico and Diccionario Latino-Español Español-Latino. Spanish definitions were sourced in Diccionario de Términos Médicos de La Real Academia de Medicina de España; Diccionario de la Lengua española; Diccionario Panhispánico de Términos Médicos; Biblioteca Nacional Médica and Biblioteca Virtual de Salud de Centro Latinoamericano y del Caribe. The clinical use of these terms was assessed through neurology articles per authors' criteria. Consequently, Hypotonia is deemed the more suitable term for describing decreased muscle tone in rehabilitation contexts. Depending on the lesion's origin, terms like Central Hypotonia and Peripheral Hypotonia may be used when structures associated with the central or peripheral nervous systems are affected, respectively. It is suggested that these terms be adopted in clinical practice and teaching when addressing alterations in central or peripheral nervous systems resulting in reduced muscle tone.

Reabilitação fisioterapêutica em pacientes com síndrome da pessoa rígida: revisão integrativa / Physiotherapy rehabilitation in patients with stiff person syndrome: integrative review

Introdução: A Síndrome da Pessoa Rígida é uma doença neuroimunológica rara do sistema nervoso central caracterizada por espasmos dolorosos e rigidez progressiva que envolvem os músculos proximais dos membros e axiais do tronco. A forma clássica tem início insidioso com piora gradual ao longo do tempo e muitas vezes leva à incapacidade permanente. Objetivo: Analisar os estudos publicados na literatura científica que utilizaram a reabilitação fisioterapêutica como proposta de tratamento dos sintomas motores na Síndrome da Pessoa Rígida. Método: Trata-se de uma revisão integrativa da literatura realizada no período de julho a dezembro de 2022 nas bases de dados PubMed, SciELO, LILACS e BVS. Resultados: Foram encontrados 12 artigos publicados entre o período de 2002 a 2021, que discorriam sobre o tratamento fisioterapêutico nesta população. O número escasso de estudos se dá pela raridade da patologia que dificulta a realização de ensaios clínicos robustos. Os artigos selecionados eram relatos de casos de um ou mais indivíduos, com enfoque nas intervenções realizadas de acordo com cada queixa funcional apresentada, sendo estas a dor, fraqueza muscular, hipomobilidade articular, rigidez, instabilidade postural, alterações na marcha e limitações nas atividades de vida diária. Conclusão: A reabilitação fisioterapêutica faz parte do tratamento sintomatológico e tem como finalidade, auxiliar na manutenção da funcionalidade e qualidade de vida, minimizando as repercussões motoras que são desencadeadas pela síndrome.

Introduction: Stiff Person Syndrome is a rare neuroimmunological disease of the central nervous system characterized by painful spasms and progressive rigidity involving the proximal muscles of the limbs and axial muscles of the trunk. The classic form has an insidious onset with gradual worsening over time and often leads to permanent disability. Objective: To analyze the studies published in the scientific literature that used hysiotherapeutic rehabilitation as a proposal for treating motor symptoms in Stiff Person Syndrome. Method: This is an integrative review of the literature carried out from July to December 2022 in the PubMed, SciELO, LILACS and VHL databases. Results: 12 articles published between 2002 and 2021 were found, which discussed physiotherapeutic treatment in this population. The scarce number of studies is due to the rarity of the pathology, which makes it difficult to carry out robust clinical trials. The selected articles were case reports of one or more individuals, focusing on interventions carried out according to each functional complaint presented, these being pain, muscle weakness, joint hypomobility, stiffness, postural instability, changes in gait and limitations in walking activities. daily life. Conclusion: Physiotherapy rehabilitation is part of symptomatological treatment and aims to help maintain functionality and quality of life, minimizing the motor repercussions that are triggered by the syndrome.

Cirugía preprotésica de torus mandibular bilateral con impedimento del movimiento lingual / Preprosthetic surgery of a bilateral mandibular torus with tongue movement dysfunction

El torus mandibular es un crecimiento exofítico óseo benigno en la parte interna de la mandíbula, generalmente presente en ambos lados. Su etiología se relaciona a diversos factores como la herencia, grado de estrés, factores ambientales, nutricionales y trauma oclusal. Puede causar problemas funcionales y estéticos, como dificultad en la pronunciación, mal aliento, molestias al comer con prótesis mal adaptadas y ulceraciones. En la mayoría de los casos no es necesario el tratamiento, excepto cuando se requiere para mejorar la función protésica o solucionar problemas funcionales. En este artículo presentamos la situación clínica que describe la escisión exitosa del torus mandibular bilateral en un paciente de 57 años para la posterior rehabilitación protésica. La escisión del torus mandibular bilateral es un procedimiento seguro y predecible que ayuda a prevenir complicaciones protésicas y biológicas, mejorando la estabilidad y la función del sistema estomatognático (AU)

The mandibular torus is a benign bony exophytic growth in the inner part of the mandible, usually present on both sides. Its etiology is related to various factors such as heredity, degree of stress, environmental and nutritional factors, and occlusal trauma. It can cause functional and aesthetic problems, such as difficulty in pronunciation, bad breath, discomfort when eating with ill-fitting prostheses, and ulcerations. In most cases, treatment is not necessary, except when it is required to improve prosthetic function or solve functional problems. In this article we present the clinical situation that describes the successful excision of the bilateral mandibular torus in a 57-year-old patient for subsequent prosthetic rehabilitation. Bilateral mandibular torus excision is a safe and predictable procedure that helps prevent prosthetic and biological complications, improving the stability and function of the stomatognathic system (AU)

Papillon-lefèvre syndrome: clinical case of oral rehabilitation with osseointegrated implants

Papillon-Lefèvre syndrome (PLS) is a rare benign, autosomal recessive condition caused by a mutation in the cathepsin C gene. This alteration results in palmar-plantar hyperkeratosis, or thickening of the soles of the feet and palms of the hands, as well as aggressive periodontal disease resulting in the premature loss of deciduous and permanent teeth. The etiology is multifactorial, and is influenced by immunological, genetic or microbial factors. This case report presents a successful prosthetics oral rehabilitation with osseointegrated implants in a 48-year-old female patient with PLS. Although few reports of dental implants in patients with PLS have been published, it seems to be a possible approach in selected patients. (AU)

Effects of home-based remote rehabilitation on children and adolescents with cystic fibrosis and non-cystic fibrosis bronchiectasis: a systematic review protocol

Background: Home-based remote rehabilitation combining the use of new technological tools is an alternative way of rehabilitation when traditional center-based programs are limited or are not feasible. This systematic review aims to investigate the level of evidence for the effects of home-based remote rehabilitation on children and adolescents with cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis (NCFB). Methods: This systematic review will follow the preferred reporting items for systematic reviews and meta-analysis (PRISMA). Five databases will be searched from the period of the inception until March 2024: PubMed, Web of Science, Medline (via EBSCOhost), ACM Digital Library, and Scopus. Methodological quality will be assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB 2) and the risk of bias in non-randomized studies – of interventions (ROBINS-1) tool. The overall quality of the evidence will be assessed using the grading of recommendations assessment, development, and evaluation (GRADE) approach. Conclusions: Evaluation of the level of evidence for the effects of home-based remote rehabilitation in children and adolescents with CF and NCFB is an important step in the context of telehealth, providing an alternative way of approaching pediatric patients, during the process of rehabilitation. Trial registration: PROSPERO registration number is CRD42024498403.

Unexpected clinical and functional recovery in patients with chronic traumatic chronic spinal cord injury: a case series

Motor recovery in traumatic spinal cord injury (tSCI) is reported to reach its plateau by 1 year and maximum recovery period is reported to be 2 years. Acute rehabilitation is very well documented in literature with patients reporting for functional rehabilitation immediately after shock period is over. However, the scenario being a bit different in rural areas with comparatively less awareness about role of physiotherapy, patients with tSCI reports at later stages. Reported here is a series of chronic tSCI cases who showed remarkable clinical and functional recovery in short time. Aim of this study is to report recovery in patients with chronic tSCI and to compare the patient outcomes with expected outcomes. Conventional physiotherapy was given 5 days a week with minimum 45 mins treatment. Baseline assessment at admission and at discharge was recoded. Improvement was recorded with spinal cord independence at different time points. Nine patients below 40 years of age, average duration of injury 6.2 years were treated for average of 8 months. NLI did not change in 3 patients whereas in 6 patients NLI moved 2 segments down. Mean change in SCIM score was 10 between admission and discharge. Functional status was compared with expected parameters and was found to be improved by 70%, suggesting had they come at early stage, expected recovery could have been achieved. Clinical and functional recovery in patients with tSCI may occur even after 2 years post injury.

Digital therapeutics for cardiovascular diseases in India- a low-middle income country’s perspective: a systematic review

Cardiovascular disease acts as a predominant cause for death in India. Digital technology has shown great potential in delivering cardiac rehabilitation remotely to patients with minimal cost implications. The main aim of this study was to analyze the comprehensiveness and effectiveness of digital cardiac rehabilitation intervention for cardiovascular patients on the Indian Cardiology Continuum. A comprehensive literature search was performed in Pubmed, Springer-link, Elsevier, Embase and Google Scholar. The selected tenure for this review was 10 years (16 January 2014 to 16 January 2024). Authors separately conducted the assessment of the selected studies by using the quality assessment of diagnostic accuracy studies. Microsoft excel 2020 was used for statistical analysis and graphical designs. A total of 3 articles were included in the review. The median sample size of the included studies is 153 (30-304), mean study timeline is 7.67 months (3-17), and median follow-up period is 6 months (3-12). Digital therapeutics showed significant reduction in Systolic Blood Pressure (34.67 mmHg) and Diastolic Blood Pressure (21.97 mmHg) in stage III hypertensive patients. Medication adherence of patients using digital therapeutics was 90%, while 10% patients remained non-adherent/dropped out of the trial. Digital therapeutics builds a lucrative bridge to help cardiovascular patients cross over into improved QoL, in place of traditional face-to-face CR regimes. Further research is required to improve comprehensiveness and clinical effectiveness of the digital cardiac rehab programs on a long-term basis in India.

Optimising Functional Recovery in a Paediatric Stroke patient secondary to Sickle Cell Disease: A Case Report

Out of many causes of Paediatric Stroke, Sickle Cell Disease is one of the crucial conditions with the risk of Stroke highest during the first decade that is between the ages of 2 & 5 years. Reported here, however, is a case of a 10-year-old male child with sudden onset left side hemiplegia with facial muscle weakness, who was a known case of Sickle Cell disease since 6 months of age. With the inability to use the upper extremities & walk independently, the patient was functionally dependent with a Fugl Meyer score of 55/126 & Berg balance scale score of 18/56. After 4 months of Physiotherapy Treatment patient was able to use the Upper extremities for functional activities and was able to walk independently with a Berg balance scale score of 46/56.With very few cases of pediatric Stroke receiving Physiotherapy care being reported in the literature, this case report establishes the role of Physiotherapy in preventing long-term neuro developmental disability.

Telerehabilitación respiratoria en fibrosis quística: experiencia de pacientes, padres y profesionales durante la pandemia de COVID-19. Estudio cualitativo

Introducción: la rehabilitación respiratoria (RR) se recomienda en pacientes con fibrosis quística (FQ). Durante la pandemia de COVID-19 los programas de RR debieron cerrarse o migrar a modalidades de telerehabilitación, imponiendo nuevos desafíos a pacientes y equipos de salud. El objetivo de este estudio fue explorar las percepciones de pacientes, padres y profesionales sobre la transición a la telerehabilitación respiratoria durante la pandemia de COVID-19. Método: estudio cualitativo. Se consideraron pacientes con FQ mayores de 8 años. También a padres y equipos de salud. El tamaño muestral se determinó mediante saturación teórica. Se realizaron entrevistas semiestructuradas y grupos focales vía Zoom. El análisis de datos se realizó mediante los métodos de codificación abierta y axial. El análisis se realizó utilizando el software Atlas. Ti 7.5.7. Resultados: se incluyó a 4 pacientes adultos, 1 pediátrico y 2 padres, además de 4 profesionales de equipos de salud. Existió una percepción general positiva respecto a la RR y la telerehabilitación. Entre las barreras destacó la falta de equipamiento para la telerehabilitación en domicilio y la organización diaria de los pacientes. Entre los facilitadores destacó la disponibilidad de equipos y redes que permitieran la conectividad y el apoyo familiar. Existió una valoración positiva hacia la continuidad de la telerehabilitación en la etapa post pandémica. Conclusiones: la telerehabilitación fue percibida como una alternativa viable y efectiva, sin embargo, aspectos de la conectividad, disponibilidad de equipamiento y la rutina diaria de los pacientes debe ser considerada a la hora de implementar modalidades telemáticas de atención.

Introduction: Pulmonary rehabilitation (PR) is recommended in patients with Cystic Fibrosis (CF). During the COVID-19 pandemic, PR programs had to migrate to telerehabilitation modalities, imposing new challenges for patients and health teams. The objective of this study was to explore the perceptions of patients, parents, and professionals regarding the transition to respiratory telerehabilitation experienced during the COVID-19 pandemic. Method: Qualitative study. Parents and health teams were included in the case of patients with CF over eight years old. Theoretical saturation determined the sample size. Semi-structured interviews and focus groups were conducted using the Zoom platform. Data analysis was carried out using open and axial coding methods. The analysis was performed using Atlas Ti software 7.5.7. Results: Four adult patients, one pediatric patient, two parents, and four health team professionals entered the study. There was a positive perception regarding PR and telerehabilitation. Among the barriers, the lack of equipment for telerehabilitation at home and the daily organization of patients stood out. Among the facilitators, the availability of equipment and networks that allowed connectivity and family support stood out. Patients rated the continuity of telerehabilitation in the post-pandemic stage positively. Conclusions: Telerehabilitation was perceived as a viable and effective alternative; however, aspects related to connectivity, availability of equipment, and the daily routine of patients must be considered when implementing telematics care modalities.

Efectividad de un programa de rehabilitación cardiopulmonar en trabajadores de la salud con infección por COVID-19 / Changes in functional and cardiopulmonary outcomes in patients with COVID-19 infection after a cardiopulmonary rehabilitation program

Resumen Objetivo: evaluar, en una población trabajadora de la salud con COVID-19, la gravedad de la enfermedad y el impacto de un programa de rehabilitación cardiopulmonar ambulatorio fase II basado en ejercicio, en la capacidad funcional, la función medida con la Escala de Estado Funcional posCOVID y el reintegro laboral. Materiales y método: se realizó un estudio cuasiexperimental en 48 trabajadores de la salud con infección por COVID-19. Al inicio y al final se les evaluó gravedad de la infección, función cardiopulmonar y escala de estado funcional post-COVID-19 (PCFS). Se hizo un programa de rehabilitación cardiopulmonar con tres sesiones semanales de ejercicio continuo e interválico individualizado, con una duración de 20 a 60 minutos y una intensidad del 60 al 80% de la frecuencia cardíaca máxima durante un mes. Resultados: hubo 19 casos moderados y 29 graves. La edad promedio fue 54 (DE: 15.5) años, 41.7% eran empleados, 47.9% obesos y 39.6% hipertensos. El 68.8% tuvo neumonía típica, el 29.2% estrés postraumático, el 43.8% síndrome depresivo y el 50% trastornos de ansiedad. La capacidad cardiopulmonar pasó de NYHA II (5.7 DE: 1.2) a NYHA I (8.2: DE: 2.0). Mejoró la independencia en actividades de la vida diaria (ADV) (escala PCFS) y 36 pacientes regresaron a su trabajo. No hubo complicaciones graves. Conclusión: este estudio demostró el impacto positivo de un programa de rehabilitación cardiopulmonar en la función cardiopulmonar y la independencia en actividades diarias e instrumentales en trabajadores de la salud con COVID-19, pues un 75% de estos regresó a sus labores habituales.

Abstract Objective: to evaluate, in a health worker population with COVID-19, the severity of the disease and the impact of an outpatient phase II PRCP based on exercise, on functional capacity, function measured with the post-COVID Functional Status Scale and job reinstatement. Materials and method: a quasi-experimental study was conducted involving 48 healthcare workers with COVID-19. Severity of infection, cardiopulmonary function, and PCFS were assessed at the beginning and end. The CPRP included a program of three weekly sessions of individualized continuous and interval exercises lasting 20 to 60 minutes, with an intensity of 60 to 80% of maximum heart rate over one month. Results: there were 19 moderate cases and 29 severe cases. The average age was 54 (SD: 15.5) years, with 41.7% being employees, 47.9% obese, and 39.6% hypertensive, 68.8% had typical pneumonia, 29.2% experienced post-traumatic stress, 43.8% had depressive syndrome, and 50% had anxiety disorders. Cardiopulmonary capacity improved from NYHA II (5.7 SD: 1.2) to NYHA I (8.2 SD: 2.0). Independence in activities of daily living (PCFS scale) improved and 36 patients returned to work. There were no severe complications. Conclusion: This study demonstrated a positive impact of the CPRP on cardiopulmonary function and independence in daily and instrumental activities among healthcare workers with COVID-19, with 75% returning to their regular duties.

Telerrehabilitación de sujetos con trastornos del neurodesarrollo durante el confinamiento por COVID-19 / Telerehabilitation of Subjects with Neurodevelopmental Disorders During Confinement due to COVID-19

RESUMEN Introducción: Las medidas de distanciamiento social debidas a la pandemia por COVID-19 impidieron que muchos chicos con trastornos del neurodesarrollo pudieran acceder a tratamientos presenciales. La telerrehabilitación creció en este tiempo como una herramienta terapéutica alternativa. El objetivo es analizar la telerrehXbilitación cognitiva en trastornos del neurodesarrollo. Métodos: En este estudio prospectivo, cuasi-experimental (antes-después), se incluyó a 22 pacientes (media de edad, 9,41 arios) con trastornos del neurodesarrollo que realizaron telerrehabilitación con el programa Rehametrics por más de 6 meses. Resultados: Luego de 6 meses de telerrahabilitación, se constató una mejoría estadísticamente significativa con un gran tamaño del efecto en áreas de: atención (sostenida, selectiva y dividida), funciones ejecutivas (memoria de trabajo verbal y visual, categorización, velocidad de procesamiento), habilidades visuoespaciales (orientación espacial, integración perceptiva, percepción, simultagnosia) y lenguaje (comprensivo y expresivo). En la Escala de Impedimento Funcional de Weiss mejoraron con significancia estadística todas las áreas (familia, aprendizaje y escuela, autoconcepto, actividades de la vida diaria, actividades de riesgo). Se constata una correlación positiva entre la cantidad de sesiones y la mejoría observada en funciones ejecutivas (memoria de trabajo visual, velocidad de procesamiento), atencionales (atención sostenida, atención dividida) y habilidades visuoespaciales (orientación espacial, integración perceptiva, percepción, simultagnosia). No encontramos significancia estadística entre la estructura familiar y la cantidad de sesiones realizadas. Se observó un alto grado de percepción de mejora y satisfacción en los padres. Conclusiones: La telerrehabilitación puede ser una herramienta alternativa segura que, sin reemplazar la presencialidad, puede lograr mejoras cognitivas y funcionales significativas en niños con trastornos del neurodesarrollo.

ABSTRACT Introduction: Social distancing measures due to the COVID-19 pandemic prevented many children with neurodevelopmental disorders from accessing face-to-face treatments. Tele-rehabilitation grew at this time as an alternative therapeutic tool. In this study we analyzed remote cognitive rehabilitation in neurodevelopmental disorders. Methods: This was a prospective, quasi-experimental (before-after) study that included 22 patients (mean age 9.41 years) with neurodevelopmental disorders who had telerehabilitation for over six months. Results: After six months of telerehabilitation, a statistically significant improvement was found with a large effect size in these areas: attention (sustained, selective and divided), executive functions (verbal and visual working memory, categorization, processing speed), visuospatial skills (spatial orientation, perceptual integration, perception, simultanagnosia) and language (comprehensive and expressive). On the Weiss Functional Impairment Scale, all areas (family, learning and school, self-concept, activities of daily living, risk activities) improved with statistical significance. We found a positive correlation between the number of sessions and the improvement observed in executive functions (visual working memory, processing speed), attention (sustained attention, divided attention) and visuospatial skills (spatial orientation, perceptual integration, perception, simultanagnosia). We did not find statistical significance between the family structure and the number of sessions carried out. A high degree of perception of improvement and satisfaction was observed in the parents. Conclusions: Telerehabilitation is a safe alternative tool which, although it does not replace face-to-face therapy, can achieve significant cognitive and functional improvements in children with neurodevelopmental disorders.

Strategy for the Conservative Treatment of Type-III Camptodactyly in Children with Beals-Hecht Syndrome / Estratégia para o tratamento conservador da camptodactilia de tipo III em criança com síndrome de Beals-Hecht

Abstract The authors present a successful case in the conservative treatment of type-III camptodactyly in a patient with Beals-Hecht syndrome. Camptodactyly is a flexion deformity of the proximal interphalangeal (PIP) joint, in the anteroposterior direction, painless and bilateral in 2/3 of the cases. Type-III is the most severe and disabling form, as it usually affects several fingers and is associated with syndromes and other malformations. The case herein reported had the correction achieved with the systematic use of static orthoses started at 7 months of age and completed after 23 and a half months of the intervention.

Resumo Os autores apresentam um caso bem-sucedido no tratamento conservador da camptodactilia de tipo III em paciente com síndrome de Beals-Hecht. A camptodactilia é uma deformidade em flexão da articulação interfalangeana proximal (IFP), no sentido anteroposterior, indolor, e bilateral em 2/3 dos casos. A de tipo III é a forma mais grave e incapacitante, pois geralmente acomete vários dedos e está associada a síndromes e outras malformações. O caso apresentado teve a correção alcançada com o uso sistemático de órteses estáticas iniciado aos 7 meses de idade e concluído após 23 meses e meio de intervenção.

Adaptación y validación del Voice Handicap Index y su versión abreviada al español rioplatense de Argentina

Objetivo: Este estudio tuvo como objetivo principal validar el Voice Handicap Index (VHI) y su versión abreviada (VHI-10) adaptados al español rioplatense de Argentina, con objetivos específicos centrados en evaluar su fiabilidad y validez. Metodología: La adaptación cultural incluyó técnicas de traducción directa, síntesis y retrotraducción, evaluación de la equivalencia semántica y aplicación a un grupo piloto. Para la validación se evaluó la fiabilidad de ambos índices adaptados mediante la consistencia interna (coeficiente alfa de Cronbach) y la estabilidad test-retest (prueba de Bland-Altman, CCI y r de Spearman). Además, se examinó la validez de criterio y de constructo. 213 sujetos participaron en la validación del índice adaptado de 30 ítems (123 disfónicos; 90 de control); 113, en la del índice abreviado (63 disfónicos; 50 de control). Resultados: Se constituyó el Índice de Desventaja Vocal (IDV) como la versión adaptada del VHI al español rioplatense de Argentina. Ambos índices demostraron excelente consistencia interna (IDV-30 α = 0,96; IDV-10 α = 0,92) y estabilidad y concordancia (IDV-30 CCI = 0,95; IDV-10 CCI = 0,96). Se halló alta correlación entre los puntajes de ambos índices y la autoevaluación de la severidad de la disfonía de los participantes (r = 0,85). Ambos índices demostraron capacidad de diferenciar entre individuos con disfonía y sujetos sanos (p< 0,001). El análisis factorial reveló tres factores para el IDV-30 y un factor para el IDV-10. Conclusiones: El IDV-30 e IDV-10 presentan grados adecuados de fiabilidad y validez. Ambos pueden ser incluidos en protocolos de valoración de la función vocal por profesionales de Argentina.

Aim: This study aimed to validate the Voice Handicap Index (VHI) and its abbreviated version (VHI-10) adapted into Rioplatense Spanish from Argentina, with specific goals centered on assessing their reliability and validity. Methods: Cultural adaptation involved direct translation, synthesis and back-translation techniques, followed by an assessment of semantic equivalence and application to a pilot group. For the validation process, the reliability of both adapted indices was assessed through measures of internal consistency (Cronbach's alpha coefficient) and test-retest stability (Bland-Altman test, ICC and Spearman's correlation coefficient). Additionally, we conducted analyses to asses criterion and construct validity. 213 subjects participated in the validation of the adapted 30-items index, (123 with dysphonia; 90 from control group); 113, in the abbreviated version (63 with dysphonia; 50 from control group). Results: The "Índice de Desventaja Vocal" (IDV) was established as the adapted version of the VHI into Rioplatense Spanish from Argentina. Both indeces exhibited excellent internal consistency (IDV-30 α = 0,96; IDV-10 α = 0,92) and satisfactory stability and agreement (IDV-30 CCI = 0,95; IDV-10 CCI = 0,96). Regarding validity, a strong correlation was observed between the scores of both indeces and the participant's self-assessment of dysphonia degree (r = 0,85). Both indices effectively differentiated between individuals with dysphonia and healthy subjects (p< 0,001). Factor analysis revealed three factors for the IDV-30 and one factor for the IDV-10. Conclusion: The IDV-30 and IDV-10 demonstrate satisfactory levels of reliability and validity. Both indices can be incorporated into the assessment protocols for evaluating the vocal function by professionals in Argentina.

Relación entre trastorno obsesivo-compulsivo y alteración en funciones ejecutivas / Relationship between obsessive-compulsive disorder and executive function alteration

Resumen Introducción: El trastorno obsesivo-compulsivo (TOC) se caracteriza por obsesiones y compulsiones. Las obsesiones corresponden a ideas o imágenes intrusivas y la compulsión es el acto motor o cognitivo para aplacar la obsesión. Su prevalência mundial es del 3 % y existen diferentes factores que influyen en su aparición, que pueden ser biológicos, psicológicos o ambientales. Por otra parte, las funciones ejecutivas son un conjunto de habilidades que regulan la cognición y el comportamiento, donde este estudio busca describir la relación y afectación de las funciones ejecutivas en personas que padecen TOC. Materiales y métodos: Artículo de revisión narrativa a partir del estado del arte sobre el TOC y las funciones ejecutivas. Resultados: Diversos estudios han reportado la relación clínico-anatómica entre signos y síntomas característicos del TOC y la alteración evidenciada en funciones ejecutivas. Las funciones ejecutivas impactan el funcionamiento en la vida diaria y se encuentran fuertemente relacionadas al TOC, generando limitaciones funcionales en estos pacientes. Para esta afección hay tratamientos como las terapias farmacológica, psicológica y quirúrgica. Discusión: Se encuentra la necesidad de implementar, dentro de su tratamiento, la rehabilitación neuropsicológica para rehabilitar y fortalecer las funciones ejecutivas, buscando que se desarrolle de manera integral y que le permita a la persona desenvolverse de manera óptima en su día a día. Conclusión: Las funciones ejecutivas son un componente fundamental para nuestro funcionamiento y autonomía, es por esto que al estar el TOC directamente relacionado con fallas en estas funciones, se considera un punto importante para tener en cuenta al acompañar y tratar a personas que presentan este trastorno.

Abstract Introduction: Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions. Obsessions correspond to intrusive ideas or images and compulsion is the motor or cognitive act to appease the obsession. Its worldwide prevalence is 3%. There are different factors that influence its appearance, which can be biological, psychological and environmental. Executive functions are a set of skills that regulate cognition and behavior. The objective is to describe the relationship and impact of executive functions in people who suffer from OCD. Materials and methods: Narrative review article based on the state of the art on obsessive-compulsive disorder and executive functions. Results: Various studies report a clinical-anatomical relationship between characteristic signs and symptoms of OCD and alterations evident in executive functions. Executive functions impact functioning in daily life. These functions are strongly related to OCD, generating functional limitations in these patients. For this condition there are treatments such as pharmacological, psychological and surgical therapy. Discussion: There is a need to implement neuropsychological rehabilitation within its treatment to rehabilitate and strengthen such processes, seeking to develop it comprehensively and allow the person to function optimally in their daily lives. Conclusion: Executive functions are a fundamental component for our functioning and autonomy, which is why, since OCD is directly related to failures in these functions, they are considered an important point to take into account when accompanying and treating people who present this condition. disorder.

Conservative management of traumatic brachial plexus injury: a case report

Brachial plexus injury (BPI) is one of the devastating conditions for patients, which has a negative impact on patients' quality of life. It renders patients with an inability to achieve functional independence. With advancements in surgeries and rehabilitation, improvement in these domains is possible. This case report describes the rehabilitation of a 28-year-old male patient. Being a driver by occupation and the only earning member in the family, upper limb function was essential for functional independence and resume work. After examination, problems were identified, goals were set, and intervention was planned. The patient took 2 months of inpatient rehabilitation six days a week. After completion of treatment, the patient was independent in basic and instrumental activities of daily living. The study concludes that structured, evidence-based physiotherapy treatment is effective in achieving functional independence and reducing disability in patients with traumatic BPI.

Habilidades nas transferências para desempenho das atividades cotidianas de pessoas com lesão da medula espinal / Skills in transfers to perform the daily activities of people with spinal cord injury / Habilidades en transferencias para realizar las actividades diarias de personas con lesión médula espinal

Objetivo: refletir sobre a importância do trabalho das equipes de reabilitação, orientando e habilitando os cadeirantes para o desempenho seguro das transferências diárias, fundamentais na realização das atividades cotidianas e inclusão social. Métodos: trata-se de estudo teórico-reflexivo fundamentado na teoria do déficit de autocuidado, com a utilização integrada dos diagnósticos de enfermagem, da classificação internacional das práticas de enfermagem e do instrumento de avaliação das transferências, adequados às necessidades de pessoas com lesão medular, atendidas nos ambientes institucionais de cuidados, visando o preparo para o desempenho das atividades cotidianas. Resultados: cabe aos enfermeiros assumir liderança nas equipes de reabilitação física, norteando suas intervenções no treinamento dessas pessoas e seus cuidadores para o desempenho e ajuda segura nas transferências para cuidar de si. Conclusão: considerando a lesão medular entre os maiores problemas da saúde coletiva que afeta a humanidade contemporânea, tanto pelos comprometimentos na qualidade de vida das pessoas, quanto no aumento das despesas hospitalares e reabilitação requeridos, a adoção de estratégias de cuidados preventivos de complicações musculoesqueléticas é sempre bem-vinda. Essas pessoas, quando não orientadas, executam movimentos repetitivos para se deslocar em transferências de uma superfície para outra, correndo elevados riscos de contrair lesões nas articulações, pele e mucosas. (AU)

Objective: to reflect on the importance of the work of rehabilitation teams, guiding and enabling wheelchair users to safely perform daily transfers, essential for carrying out daily activities and social inclusion. Methods: this is a theoretical-reflective study based on the theory of self-care deficit, with the integrated use of nursing diagnoses, the international classification of nursing practices and the transfer assessment instrument, adapted to the needs of people with spinal cord injury, attended in institutional care environments, aiming to prepare for the performance of daily activities. Results: it is up to nurses to assume leadership in physical rehabilitation teams, guiding their interventions in the training of these people and their caregivers for performance and safe help in transfers to take care of themselves. Conclusion: considering spinal cord injury among the biggest collective health problems that affect contemporary humanity, both because of the compromises in people's quality of life, as well as the increase in hospital and rehabilitation expenses required, the adoption of preventive care strategies for musculoskeletal complications is always welcome. These people, when not guided, perform repetitive movements to move in transfers from one surface to another, running high risks of contracting injuries to the joints, skin and mucous membranes. (AU)

Objetivo: reflexionar sobre la importancia del trabajo de los equipos de rehabilitación, orientando y capacitando a los usuarios de silla de ruedas para realizar con seguridad las tranferencias cotidianas, indispensables para el desarrollo de las actividades cotidianas y la inclusión social. Métodos: se trata de un estudio teórico-reflexivo basado en la teoría del déficit de autocuidado, con el uso integrado de los diagnósticos de enfermería, la clasificación internacional de prácticas de enfermería y el instrumento de evaluación de la transferencia, adaptado a las necesidades de las personas con lesión medular. asistidos en ambientes de atención institucional, con el objetivo de preparar para el desempeño de las actividades diárias. Resultados: corresponde a los enfermeros asumir el liderazgo en los equipos de rehabilitación física, orientando sus intervenciones en la formación de esas personas y sus cuidadores para el desempeño y ayuda segura en las transferencias para cuidarse. Conclusion: considerando la lesión medular entre los mayores problemas de salud colectiva que afectan a la humanidad contemporánea, tanto por los compromisos en la calidad de vida de las personas, como por el aumento de los gastos hospitalarios y de rehabilitación requeridos, la adopción de estrategias de atención preventiva de las complicaciones musculoesqueléticas siempre es bienvenido Estas personas, cuando no están guiadas, realizan movimientos repetitivos para moverse en transferencias de una superficie a otra, corriendo un alto riesgo de contraer lesiones en las articulaciones, piel y mucosas. (AU)

Movilización activa temprana versus cuidado habitual activo en sujetos críticos: revisión sistemática y metaanálisis / Early active mobilization versus active usual care in critically ill subjects: a systematic review and meta-analysis

RESUMEN Objetivo: Evaluar el efecto de la movilización activa temprana (MAT) en comparación con el cuidado habitual activo (CHA) en sujetos adultos críticamente enfermos respecto de la fuerza muscular y del estado funcional. Materiales y métodos: Se realizó una revisión sistemática con metaanálisis. Se incluyeron ensayos clínicos aleatorizados que compararon la MAT con el CHA en sujetos >18 años, de ambos sexos, en estado crítico durante o después del período de ventilación mecánica en la unidad de cuidados intensivos (UCI). La búsqueda se realizó en las bases de datos Cochrane, Medline/Pubmed, Embase (Elsevier), SciELO, LILACS/BVS, www.controlled-trials.com/, clinicaltrials.gov/ y www.who.int/ictrp/en/. Se analizó el riesgo de sesgo mediante la herramienta RoB 1. Se generó una síntesis cualitativa y cuantitativa (metaanálisis) de los resultados. Registro: OSF: https://bit.ly/430fF72. Resultados: Se incluyeron siete estudios, con un total de 1905 sujetos. La mayoría de los sujetos eran del sexo masculino (57 %) y tenían entre 54 y 66 años. Los desenlaces reportados mostraron baja certeza de evidencia, según la Clasificación de la valoración, desarrollo y evaluación de las recomendaciones (GRADE, por sus siglas en inglés). En el metaanálisis del estado funcional al alta hospitalaria, se observó un efecto a favor del grupo MAT, con una diferencia de medias estandarizada de 0,26 (IC 95 % 0,11 - 0,41) y baja heterogeneidad (I2 = 0 %). Conclusión: Con una baja certeza de evidencia, el efecto de la MAT en sujetos adultos críticamente enfermos en la UCI podría mejorar el estado funcional al alta hospitalaria en comparación con el CHA.

ABSTRACT Objective: To evaluate the effect of early active mobilization (EAM) compared to active usual care (AUC) in critically ill adult subjects regarding muscle strength and functional status. Materials and methods: A systematic review with meta-analysis were conducted. Randomized clinical trials comparing EAM with AUC in subjects >18 years of age, of both sexes, in critical condition during or after the period of mechanical ventilation in the intensive care unit (ICU) were included. The search was performed in the Cochrane, Medline/Pubmed, Embase (Elsevier), SciELO, LILACS/BVS, www.controlled-trials.com/, clinicaltrials.gov/, and www.who.int/ictrp/en/ databases. Bias risk was assessed using the RoB 1 tool. A qualitative and quantitative synthesis (meta-analysis) of the results was generated. Registration: OSF: https://bit.ly/430fF72. Results: Seven studies were included in this review, comprising a total of 1905 subjects. The majority of subjects were male (57 %) and aged between 54 and 66 years. The reported outcomes showed low certainty of evidence, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. In the meta-analysis of functional status at hospital discharge, a favorable effect was observed in the EAM group, with a standardized mean difference of 0.26 (95 % CI 0.11 - 0.41) and low heterogeneity (I2 = 0 %). Conclusion: With low certainty of evidence, the effect of EAM on critically ill adult subjects in the ICU may improve functional status at hospital discharge compared to AUC.