Evaluación de profilaxis con factor VIII de origen plasmático en pacientes con hemofilia A severa / Evaluation of factor VIII prophylaxis of plasmatic origin in patients with severe hemophilia A / Avaliação da profilaxia do fator VIII de origem plasmática em pacientes com hemofilia A grave

Introducción: la hemofilia A severa (HAS) es una enfermedad hemorrágica hereditaria causada por un déficit de factor VIII (FVIII) menor al 1%. Se presenta principalmente con sangrados articulares, los cuales provocan una artropatía hemofílica que afecta su independencia funcional. El uso de la profilaxis terciaria con FVIII ofrece beneficios en adultos disminuyendo la tasa anual de sangrado (TAS) y mejorando la independencia funcional. Objetivo: determinar el porcentaje de pacientes que logran mantener un nivel de FVIII mayor al 1%, conocer si existe una mejora en la independencia funcional, así como una disminución en la TAS con el régimen profiláctico empleado. Métodos: estudio observacional, analítico. Se incluyó a los pacientes con HAS que se controlaron en el Hospital de Clínicas "Dr. Manuel Quintela" durante 2020 en profilaxis con FVIII durante 12 meses. Se obtuvieron tres muestras separadas en el tiempo para dosificación de FVIII y se evaluó la TAS y la independencia funcional en cada paciente. Resultados: se analizaron ocho pacientes, todos presentaron valores de FVIII superiores al 1% a la hora y 24 horas posterior a la administración de FVIII. Los episodios de sangrado se redujeron 4,76 veces con el uso de la profilaxis (p = 0,019). La independencia funcional mostró que 5/8 pacientes mejoraron al menos 1 punto del score. Conclusiones: la profilaxis terciaria en estos pacientes fue beneficioso en reducir la TAS y mejorar su capacidad funcional.

Summary: Introduction: severe hemophilia A (SAH) is an hereditary hemorrhagic disease, caused by a factor VIII (FVIII) deficiency of less than 1%. It presents with joint bleeding mainly, which causes a hemophilic arthropathy, which affects its functional independence. The use of tertiary prophylaxis with FVIII offers benefits in adults by decreasing the annual bleeding rate (ABR) and improving functional independence. Objective: to determine the percentage of patients who manage to maintain an FVIII level greater than 1%, to know if there is an improvement in functional independence, as well as a decrease in the ABR with the prophylactic regimen used. Methods: observational, analytical study. Patients with SAH who were controlled at the Hospital de Clínicas "Dr. Manuel Quintela", during the year 2020, in prophylaxis with FVIII for 12 months were included. Three samples separated in time for FVIII dosing were obtained and the ABR and functional independence were evaluated in each patient. Results: 8 patients were analyzed, all presented FVIII higher than 1% at one hour and 24 hours after the administration of FVIII. The bleeding episodes were reduced 4.76 times with the use of Prophylaxis (p = 0.019). Functional independence showed that 5/8 patients improved at least 1 point in the Score. Conclusions: tertiary prophylaxis in these patients was beneficial in reducing SAD and improving their functional capacity.

Introdução: a hemofilia A grave (HAS) é uma doença hemorrágica hereditária, causada pela deficiência do fator VIII (FVIII) inferior a 1%. Apresenta-se principalmente com sangramento articular, que causa artropatia hemofílica, que afeta sua independência funcional. O uso de profilaxia terciária com FVIII oferece benefícios em adultos, reduzindo a taxa de sangramento anual (TAS) e melhorando a independência funcional. Objetivos: determinar a porcentagem de pacientes que conseguem manter um nível de FVIII maior que 1%, identificar uma possível melhora da independência funcional, bem como uma diminuição da TAS com o esquema profilático utilizado. Métodos: estudo observacional, analítico de pacientes com HAS controlados no Hospital das Clínicas "Dr. Manuel Quintela", durante o ano de 2020, em profilaxia com FVIII durante 12 meses. Foram obtidas três amostras separadas no tempo para dosagem de FVIII e avaliação da TAS e da independência funcional de cada paciente. Resultados: foram analisados 8 pacientes, todos apresentaram FVIII maior que 1% em uma hora e 24 horas após a administração do FVIII. Os episódios de sangramento foram reduzidos 4,76 vezes com o uso da profilaxia (p = 0,019). A independência funcional mostrou que 5/8 pacientes melhoraram pelo menos 1 ponto do escore FISH. Conclusões: a profilaxia terciária nesses pacientes foi benéfica na redução da TAS e na melhora da capacidade funcional.

Family-centered task-oriented training can significantly improve the functional independence and life quality of children with spastic cerebral palsy / 中华物理医学与康复杂志

Objective:To observe the effect of a family-centered task-oriented training (TOT) program on the functional independence and life quality of children with spastic cerebral palsy.Methods:A total of 62 children with spastic cerebral palsy were randomly divided into a control group ( n=31) and a TOT group ( n=31). The children in the control group were given family rehabilitation training according to the discharge instruction manual, while the children in the TOT group received family-centered TOT. Both groups trained for 1 hour once a day, 5 days a week for 6 months. The mobility, functional independence and life quality of the two groups were evaluated with the pediatric evaluation of disability inventory (PEDI), functional independence measures for Chinese children (WeeFIM) and a pediatric quality of life inventory (PedsQL) before and after 3 and 6 months of treatment. Results:After 6 months there was significant improvement in the average mobility, WeeFIM and PedsQL scores of both groups. The average mobility, WeeFIM and PedsQL scores of the TOT group were then significantly better than those of the control group.Conclusion:Family-centered TOT training can significantly improve the functional independence and life quality of children with spastic cerebral palsy.

Effects of Exclusion Items in Outcome Assessment on the KRW Achievement Index in Convalescent Rehabilitation Wards / The Japanese Journal of Rehabilitation Medicine

Objective：To clarify the effect of exclusion items on the KRW achievement index (KRW-AI) in the outcome evaluation of a convalescent rehabilitation ward.Methods：The subjects were 812 inpatients in a convalescent rehabilitation ward. The objective variable was the KRW-AI of 40 or less, and the explanatory variables were the items excluded from the KRW-AI and their combination for a total of eight categories, such as (1) low motor FIM, (2) high motor FIM, (3) low cognitive FIM, (4) elderly, (5) (1)＋(3), (6) (1)＋(4), (7) (3)＋(4), (8) (1)＋(3)＋(4). The adjusted variables were sex, rehabilitation calculation category, and time from onset to admission to the ward. Poisson regression analysis was performed. The Incidence Rate Ratio (IRR) and 95％ confidence interval (CI) were calculated.Results：Five of the eight exclusion categories were significantly associated with low-KRW-AI scores. The highest IRR was 2.29 (95％ CI：1.41-3.69, p＜0.001) for (2).Conclusion：High motor FIM are associated with a higher relative risk of falling below the KRW-AI of 40. Conversely, being older and the presence of cognitive disorder did not interfere with low-KRW-AI scores.

Effects of Exclusion Items in Outcome Assessment on the KRW Achievement Index in Convalescent Rehabilitation Wards / The Japanese Journal of Rehabilitation Medicine

Objective：To clarify the effect of exclusion items on the KRW achievement index (KRW-AI) in the outcome evaluation of a convalescent rehabilitation ward.Methods：The subjects were 812 inpatients in a convalescent rehabilitation ward. The objective variable was the KRW-AI of 40 or less, and the explanatory variables were the items excluded from the KRW-AI and their combination for a total of eight categories, such as (1) low motor FIM, (2) high motor FIM, (3) low cognitive FIM, (4) elderly, (5) (1)＋(3), (6) (1)＋(4), (7) (3)＋(4), (8) (1)＋(3)＋(4). The adjusted variables were sex, rehabilitation calculation category, and time from onset to admission to the ward. Poisson regression analysis was performed. The Incidence Rate Ratio (IRR) and 95％ confidence interval (CI) were calculated.Results：Five of the eight exclusion categories were significantly associated with low-KRW-AI scores. The highest IRR was 2.29 (95％ CI：1.41-3.69, p＜0.001) for (2).Conclusion：High motor FIM are associated with a higher relative risk of falling below the KRW-AI of 40. Conversely, being older and the presence of cognitive disorder did not interfere with low-KRW-AI scores.

Functional independence analysis in persons with spinal cord injury / Análise da independência funcional em indivíduos com lesão da medula espinal

Abstract Introduction Spinal cord injury (SCI) radically changes a person's life because of alterations in body dynamics, leading to disabilities and reduced functionality. Objective To analyze the functional independence of individuals with spinal cord injury and compare the groups. Methods Individuals with SCI were interviewed about their functional independence using the Brazilian version of the Spinal Cord Independence Measure - Self-Reported Version (brSCIM-SR) and later their respective domains and subdomains were compared between diagnostic groups, time since injury and sex. Results The sample consisted of fifty individuals aged 40.92 ± 13.93 years, predominantly men and diagnosed with paraplegia. In most brSCIM-SR domains, all respondents achieved good independence in self-care, respiration and sphincter management, and in the total brSCIM-SR, except for mobility. In paraplegia, chronic SCIs and both sexes achieved excellent independence in most subdomains and in the total. Significantly low values were found for tetraplegia and recent SCI in the self-care subdomain. In most subdomains, tetraplegia reached significantly lower values. In the subdomains of respiration and sphincter management, the participants were independent in the breathing function, but in tetraplegia, they showed significant dependence on transfer to the toilet. In terms of mobility, there was great dependence on the items going up and down stairs and transfer from the floor to the wheelchair. Conclusion The brSCIM-SR measures the degree of functionality, allowing health professionals and the patient to quantify and locate the items that indicate their deficits or gains during the rehabilitation process. Here, individuals with SCI showed good functional independence, with worse performance in the tetraplegia and recent injury groups: however, mobility showed partial dependence in the participants.

Resumo Introdução A lesão da medula espinal (LME) muda radicalmente a vida da pessoa devido às alterações na dinâmica corporal, levando à incapacidades e redução da funcionalidade. Objetivo Analisar a independência funcional de indivíduos com LME e comparar os grupos. Métodos Indivíduos com LME foram entrevistados sobre sua independência funcional por meio da versão brasileira do Spinal Cord Independence Measure - Self-Reported Version (brSCIM-SR) e posteriormente seus respectivos domínios e subdomínios foram comparados entre os grupos diagnósticos, tempo de lesão e gênero. Resultados A amostra foi composta por 50 indivíduos com idade de 40,92 ± 13,93 anos, prevalecendo homens e diagnóstico de paraplegia. Na maioria dos domínios do brSCIM-SR todos os entrevistados atingiram boa independência no autocuidado, na respiração e controle esfincteriano e no total do brSCIM-SR, exceto na mobilidade. Na paraplegia, as LMEs crônicas e ambos os sexos alcançaram excelente independência na maioria dos subdomínios e no total do instrumento. Valores significantemente baixos foram encontrados na tetraplegia e nas LMEs recentes no subdomínio autocuidado. Na maioria dos subdomínios, a tetraplegia atingiu valores significativamente inferiores. Nos subdomínios da respiração e controle esfincteriano, os participantes eram independentes na função respiração, mas nas tetraplegias apresentaram significativa depen-dência nas transferências para o vaso sanitário. Na mobilidade houve grande dependência nos itens subir e descer escadas e transferir-se do chão para a cadeira de rodas. Conclusão Os indivíduos com LME demonstra-ram boa independência funcional, com pior desempenho na tetraplegia e lesões recentes, mas a mobilidade apresentou parcial dependência nos participantes.

Effect of Proximal Muscle Strengthening on Distal Muscle Facilitation in Guillain Barre Syndrome

In Guillain Barre Syndrome (GBS), there is symmetrical muscle weakness which ranges from mild weakness to severe palsy of all limbs. The motor symptoms start distally and move proximally. Proximal muscle weakness is primary and common factor in GBS. To overcome the weakness, one has to strengthen the muscle. Muscle activity of proximal segment is necessary for activation of distal segment. In fact, stable activity of distal parts needs controlling of the proximal parts. As distal muscle weakness is a major problem in post GBS individuals, they need to be facilitated with the help of proximal muscle strengthening. MethodsAfter obtaining the ethical committee clearance an experimental study was conducted among a total of 30 GBS subjects selected through convenience sampling. OPD subjects were given proximal muscle strengthening for 6 weeks. Each subject was examined by modified sphygmomanometer test (MST) and functional independence measure scale (FIMS) before and after the study. ResultsResult was calculated by using MST and FIMS. Exercises showed extremely significant difference on MST [p = 0.0001, t = 11.924] on handgrip strength, [p value = 0.0001) t = 12.334] on plantar flexion, [p value = 0.0001, t = 9.558] on dorsiflexion. FIMS [p value = 0.0001, t = 25.699] extremely significant difference was seen. ConclusionsProximal muscle strengthening is found to be effective for distal muscle facilitation in Guillain Barre Syndrome.

Impact of Pressure Ulcers on Therapeutic Outcomes in Inpatient Physiotherapy Services.

Pressure ulcers have been associated with an extended length of hospitalization, sepsis and mortality. Over the last few decades, little has been written about the impact of pressure ulcers on therapeutic outcomes in inpatient physiotherapy services. It is obvious that critically ill patients, who are sedated, ventilated, patients with chronic neurological, musculoskeletal and cardio-respiratory disorders who are bed ridden for prolonged period of time are particularly at risk of developing skin breakdown. This will help in identifying barriers to patient participation and develop strategies to pressure ulcer prevention. We wanted to determine the impact of pressure ulcers on therapeutic outcomes in inpatient physiotherapy services. MethodsThe study was conducted from June 2015 to January 2016. The impact of pressure ulcer on inpatient physiotherapy services was determined by detailed physical assessment, evaluation with Functional Independence Measure score (FIM) and Braden Q Scale. A total 96 subjects were assessed during this time. ResultsThere was statistically significant impact of pressure ulcers on therapeutic outcomes in inpatient physiotherapy services. The FIM takes into consideration self-care, sphincter control, transfers, locomotion, communication social cognition. A poor score denotes poor outcome at discharge. Tissue level assessment was carried out by using Braden Q Scale, a poor score of which again denotes very poor outcome in mobility, activity, sensory perception, moisture, friction – shear, nutrition, tissue perfusion and oxygenation. ConclusionsPressure ulcer is one of the preventable problems; but in majority of cases it becomes the main reason for poor therapeutic outcome.

Predictors Of Functional Outcomes In Traumatic Brain Injury At 4 Months Post Injury In South Indian Population

Background: Goals of Rehabilitation after Traumatic Brain Injury (TBI) focus on preventing complications and improving the level of functional independence. The expectation of TBI survivors and family members following rehabilitation are focused on the quality of outcomes such as reintegration into the community, return to work, and maximal functional capacity. Multiple factors may affect recovery after TBI when interacting with the primary condition and predicting the degree of recovery helps in framing realistic goals. The purpose of this study was to analyze the factors influencing the functional outcome in TBI patients at four months post-injury. Methodology: This observational study was carried out in the Neurosurgery outpatient department when TBI patients returned for review at four months post-injury. 50 TBI patients who were able to follow commands participated in this study. Factors like Admission Glasgow coma scale (GCS), Discharge GCS, Length of Hospitalization, Associated fractures of the upper and lower limb, Co-morbid conditions like Diabetes and Hypertension were obtained from the discharge summary of the patient. Caregiver literacy was obtained from the person who took care of the patient completely. Admission CT scan was graded using the Marshall CT classification. Finally, all these factors were compared to the functional status of the patient evaluated using the Barthel Index. Results: Logistic regression was used to predict the factors affecting the functional outcome. Beta value of Caregiver literacy, Discharge GCS, and Co-morbid conditions was .561, .369 and .234, respectively which influences the functional outcome of TBI patients at four months post-injury. Conclusion: The study concludes that caregiver literacy, Discharge GCS, and Co-morbid conditions influence the functional outcome of TBI patients, which emphasizes the need for awareness and education of the caregiver and along with post-discharge rehabilitation program specific exercises addressing the co-morbid conditions would enhance the recovery.

Assessment of ventilatory function in patients with spinocerebellar ataxia type 2 / Avaliação da função ventilatória em pacientes com ataxia espinocerebelar tipo 2

Abstract Subclinical ventilatory dysfunction is observed in individuals with spinocerebellar ataxias (SCA). No studies have correlated ventilatory dysfunction to clinical and functional decline in SCA2. Objective: To evaluate the relationship between the values of peak expiratory flow (PEF), maximum inspiratory pressure (MIP), and presence of respiratory complaints with age, disease duration, age at onset of symptoms, balance scores, independence in basic (ADL) and instrumental (IADL) Activities of Daily Living (ADLs), and severity of ataxia (SARA) in individuals with SCA2. Methods: Cross-sectional study evaluating age, disease duration, age at onset of symptoms, scores in the Berg Balance Scale and in the SARA, Functional Independence Measure and Lawton's scale, values of PEF and MIP, and the presence of respiratory complaints. Results: The study included 36 individuals with SCA2, with a mean age of 42.5±2.4 years, disease duration of 7.6±8.2 years, age 33.7±11.5 years at onset of symptoms, and 9.9±10.3 points in the SARA scale. The lowest PEF values correlated with the longer disease duration (p=0.021). The lowest values of PEF and MIP correlated with greater balance impairment (p=0.019 and p=0.045, respectively), increased degree of dependence in the ADL (p=0.006 and p=0.050, respectively) and IADL (p=0.003 and p=0.001, respectively) scales, and highest severity of ataxia (p=0.00 and p=0.017, respectively). Respiratory complaints were observed in 12 (33.3%) individuals and were not related to age, disease duration, age at onset of symptoms, balance, independence, ataxia severity, or PEF and MIP values. Conclusion: Ventilatory dysfunction, even when asymptomatic, is related to balance impairment, independence, and ataxia severity in individuals with SCA2.

Resumo Disfunção ventilatória subclínica tem sido observada em indivíduos com ataxias espinocerebelares (SCA). Não existem estudos relacionando disfunção ventilatória ao declínio clínico e funcional na SCA2. Objetivo: Avaliar a relação dos valores de Pico de Fluxo Expiratório (PFE), Pressão Inspiratória Máxima (PIMAX) e presença de queixas respiratórias com idade, tempo de doença, idade de início dos sintomas, escore de equilíbrio, independência para atividades básicas (AVD) e instrumentais (AIVD) de vida diária e gravidade da ataxia (SARA) em indivíduos com SCA2. Métodos: Estudo transversal, considerando: idade, tempo de doença, idade de início dos sintomas, escores nas Escalas SARA, Equilíbrio de Berg, Medida da Independência Funcional e de Lawton, valores de PFE, PIMAX e queixas respiratórias. Resultados: Foram avaliados 36 indivíduos com SCA2 com média de 42,5±2,4) anos de idade, 7,6±8,2 anos de tempo de doença, 33,7±11,5 anos de idade de início dos sintomas e 9,9±10,3 pontos na escala SARA. Os menores valores de PFE estiveram relacionados ao maior tempo de doença (p=0,021). Os menores valores de PFE e PIMAX estiveram relacionados ao maior comprometimento do equilíbrio (p=0,019; p=0,045, respectivamente), maior dependência para ADV (p=0,006; p=0,050, respectivamente) e AIVD (p=0,003; p=0,001, respectivamente) e maior gravidade da ataxia (p=0,006; p=0,017, respectivamente). Foram observadas queixas respiratórias em 12 (33,3%) indivíduos que não estiveram relacionadas à idade, idade de início dos sintomas, tempo de doença, equilíbrio, independência, gravidade da ataxia, ou valores de PFE e PIMAX. Conclusão: A disfunção ventilatória, mesmo quando assintomática, está relacionada ao comprometimento do equilíbrio, à independência e à gravidade da ataxia em indivíduos com SCA2.

A Study of Suitable Amounts of Rehabilitation Training for Patients Aged 75 Years or Above with Cerebral Infarction in Relation to Functional Improvements in Convalescent Rehabilitation Wards / The Japanese Journal of Rehabilitation Medicine

It remains unclear how much rehabilitation training is suitable for stroke patients aged ≥ 75 years. To investigate this, especially in convalescent rehabilitation wards, we studied 65 patients (28, ≦ 74 years；37 ≧ 75 years) with cerebral infarction hospitalized in the acute care ward and then in a convalescent rehabilitation ward. From their medical records, we collected data regarding the length of their hospital stay, total amount of rehabilitation training, and activities of daily living evaluated using the total scores of the functional independent measure (FIM) measured on admission to the acute care and convalescent rehabilitation wards, respectively. From these data, we calculated the absolute functional gain, relative functional gain, and average amount of rehabilitation training per day. The correlation of each item and age was analyzed. Items that significantly correlated with age were compared between ≦ 74 and ≧ 75 years age groups. As a result, the absolute functional gain and average amount of rehabilitation training per day were not significantly different between groups. The relative functional gain was significantly lower in the ≧ 75 years group than in the ≦ 74 years group. The total FIM scores at discharge showed a positive correlation with the amount of rehabilitation training in patients aged ≧ 75 years. We believe that a large amount of rehabilitation training is beneficial for patients aged ≧ 75 years with cerebral infarction.

A Study of Suitable Amounts of Rehabilitation Training for Patients Aged 75 Years or Above with Cerebral Infarction in Relation to Functional Improvements in Convalescent Rehabilitation Wards / The Japanese Journal of Rehabilitation Medicine

It remains unclear how much rehabilitation training is suitable for stroke patients aged ≥ 75 years. To investigate this, especially in convalescent rehabilitation wards, we studied 65 patients (28, ≦ 74 years；37 ≧ 75 years) with cerebral infarction hospitalized in the acute care ward and then in a convalescent rehabilitation ward. From their medical records, we collected data regarding the length of their hospital stay, total amount of rehabilitation training, and activities of daily living evaluated using the total scores of the functional independent measure (FIM) measured on admission to the acute care and convalescent rehabilitation wards, respectively. From these data, we calculated the absolute functional gain, relative functional gain, and average amount of rehabilitation training per day. The correlation of each item and age was analyzed. Items that significantly correlated with age were compared between ≦ 74 and ≧ 75 years age groups. As a result, the absolute functional gain and average amount of rehabilitation training per day were not significantly different between groups. The relative functional gain was significantly lower in the ≧ 75 years group than in the ≦ 74 years group. The total FIM scores at discharge showed a positive correlation with the amount of rehabilitation training in patients aged ≧ 75 years. We believe that a large amount of rehabilitation training is beneficial for patients aged ≧ 75 years with cerebral infarction.

Avaliação cognitiva e da independência funcional de idosos em instituição de longa permanência em Araraquara, SP, Brasil / Cognitive assessment and functional independence of the elderly in a long-term institution in Araraquara, SP, Brazil / Evaluación cognitiva e independencia funcional de los ancianos en una institución a largo plazo en Araraquara, SP, Brasil

O objetivo foi avaliar a função cognitiva e a independência funcional de indivíduos residentes em uma instituição de longa permanência (ILP) na cidade de Araraquara, estado de São Paulo, Brasil. Foi realizada a avaliação clínica composta por Mini-Exame do Estado Mental (p= 0,7413), Teste do Relógio (p= 0,7407) e Medida de Independência Funcional (p= 0,8834). Não foi encontrada diferença da função cognitiva e da independência funcional em indivíduos residentes em ILP.

The objective was to evaluate cognitive function and functional independence of individuals living in a Homes for the Aged in the city of Araraquara, state of Sao Paulo, Brazil. The clinical evaluation was performed by Mini Mental State Examination (p = 0.7413), Clock Test (p = 0.7407) and Functional Independence Measure (p = 0.8834). There was no difference in cognitive function and functional independence in individuals living in Homes for the Aged.

El objetivo fue evaluar la función cognitiva y la independencia funcional de las personas que residen en una institución a largo plazo (ILP) en la ciudad de Araraquara, estado de São Paulo, Brasil. La evaluación clínica estuvo compuesta por el Mini-Mental State Examination (p = 0.7413), Clock Test (p = 0.7407) y Functional Independence Measure (p = 0.8834). No hubo diferencias en la función cognitiva y la independencia funcional en las personas que viven en ILP.

Comparison Of Combined Effects Of Physical And Mental Practice With Physical Practice Alone On Functional Independence In Parkinson (PD) Patients

Objectives: To compare the effects of combined mental and physical practice with physical practice alone on functional independence in Parkinson disease patients. Study design: Randomized control trial. Setting: Tertiary health care center Participants: 30 subjects were recruited with idiopathic Parkinson’s disease, 60-75 years of age, who were between 1.5 -3 on the Hoehn & Yahr classification & had a score of 24 on the modified Mini Mental State Examination (MMSE). They were randomly assigned into two groups i.e. the experimental group (N=15) which received physical practice along with mental imagery & the control group (N=15) which received physical practice alone. Outcome measures: Performance time of functional movement tasks such as supine to standing position & then standing to supine position were measured. In addition to this the Timed Up& Go (TUG) test and the mental, motor & ADL subsets of the Unified Parkinson’s Disease Rating Scale (UPDRS) & Stroop test for cognitive assessment were administered. Results: There was a significant difference in the performance time of supine to standing & standing to supine position (p 0.00), TUG test (p 0.003) & Stroop test errors (p 0.004). However there was no significant difference in the UPDRS and stroop test time scores. Conclusion: This study shows that the experimental group performed better during the functional tasks and cognitive Stroop test, however there was no significant improvement in UPDRS scores.

Unilateral spatial neglect in the acute phase of ischemic stroke can predict long-term disability and functional capacity

OBJECTIVE: The aim of this study was to assess the relationship between the degree of unilateral spatial neglect during the acute phase of stroke and long-term functional independence. METHODS: This was a prospective study of right ischemic stroke patients in which the independent variable was the degree of spatial neglect and the outcome that was measured was functional independence. The potential confounding factors included sex, age, stroke severity, topography of the lesion, risk factors, glycemia and the treatment received. Unilateral spatial neglect was measured using the line cancellation test, the star cancellation test and the line bisection test within 48 hours of the onset of symptoms. Functional independence was measured using the modified Rankin and Barthel scales at 90 days after discharge. The relationship between unilateral spatial neglect and functional independence was analyzed using multiple logistic regression that was corrected for confounding factors. RESULTS: We studied 60 patients with a median age of 68 (34-89) years, 52% of whom were male and 74% of whom were Caucasian. The risk for moderate to severe disability increased with increasing star cancellation test scores (OR=1.14 [1.03-1.26], p=0.01) corrected for the stroke severity, which was a confounding factor that had a statistically positive association with disability (OR=1.63 [1.13-2.65], p=0.01). The best chance of functional independence decreased with increasing star cancellation test scores (OR=0.86 [0.78-0.96], p=0.006) corrected for the stroke severity, which was a confounding factor that had a statistically negative association with independence (OR=0.66 [0.48-0.92], p=0.017). CONCLUSION: The severity of unilateral spatial neglect in acute stroke worsens the degree of long-term disability and functional independence.

Effects of Hand-arm Bimanual Intensive Training in Group on Functional Independence and Quality of Life of Children with Hemiplegic Cerebral Palsy / 中国康复理论与实践

Objective To explore the effects of hand-arm bimanual intensive training (HABIT) in group on functional independence and quality of life of children with hemiplegic cerebral palsy. Methods From November, 2015 to September, 2016, 20 children with hemiplegic cerebral palsy were randomly divided into control group (n=10) and experimental group (n=10). Both groups received routine occupational therapy, and the experimental group received HABIT in group one hour per day additionally, for eight weeks. They were assessed with the Carroll Upper Extremities Functional Test (UEFT), Functional Independence Measure Children's Edition (WeeFIM) and Chinese Version Pe-diatric Quality of Life Inventory (PedsQLTM) 3.0 Cerebral Palsy Module respectively before and after treatment. Results After treatment, the scores of UEFT, WeeFIM and the PedsQLTM3.0 improved in both groups (t>3.970, P2.306, P<0.05). Conclusion HABIT in group could improve the fine function of upper extremity and hands coordina-tion of children with hemiplegic cerebral palsy, and enhance the functional independence and quality of life.

Hochuekkito Reduced the Incidence of Inflammatory Complications in Patients with Sequelae of Cerebrovascular Disease in Convalescent Rehabilitation Wards : A Randomized Multicenter Study / The Japanese Journal of Rehabilitation Medicine

<p>Objective：The aim of this study was to examine the efficacy and safety of hochuekkito to address reduced activities of daily living (ADL), nutritional status, and immunity in patients with severe conditions, represented by a functional independence measure (FIM) total score of ≤ 40.</p><p>Methods：Thirty-one patients who were undergoing rehabilitation for hemiplegia after cerebrovascular disease were randomized into 2 groups：those treated with hochuekkito (TJ-41 group) and those treated without hochuekkito (control group). Their conditions were observed for 24 weeks, focusing on items such as ADL and incidence of inflammatory complications.</p><p>Results：The FIM total score markedly improved after treatment in both groups, but the changes in the score between admission and discharge were similar between the two groups. The incidence of inflammatory complications was significantly lower in the TJ-41 group (P = 0.049). Among the patients with a motor FIM score of ≤ 20, those in the TJ-41 group showed a tendency of increase in total lymphocyte count after treatment. No adverse drug reactions were observed during the study period.</p><p>Conclusion：These results suggest that hochuekkito is effective in reducing the incidence of inflammatory complications in patients undergoing rehabilitation for cerebrovascular or other diseases.</p>

Factors Related to Changes in Activities of Daily Living among Elderly Patients with Slight Disability who were Discharged to Home / The Japanese Journal of Rehabilitation Medicine

<p>Purpose：To clarify factors related to changes in activities of daily living (ADL) among elderly patients who were discharged to home.</p><p>Methods：The subjects were 88 persons who received in-hospital musculoskeletal rehabilitation and discharged to home. Factors related to changes in functional independence measure (FIM) score were examined.</p><p>Results：The factors related to restoring the FIM score to its values before hospitalization were frequency of physical exercise at 1 week (odds ratio [OR] ＝1.41) and 1 month (OR＝1.27) after hospital discharge, restoring the FIM score at hospital discharge to its value before hospitalization (OR＝3.96), and feeling of self-efficacy (OR＝1.16) at 3 months after hospital discharge. A receiver-operating characteristic analysis revealed that the factors related to restoring the FIM score to its value before hospitalization were frequency of physical exercise (cutoff value＝1.5) at 1 week after discharge, frequency of physical exercise (cutoff value＝1.0) at 1 month after discharge, and feeling of self-efficacy (cutoff value＝31.5) at 3 months after discharge. In addition, ≥ 2 days of physical exercise per week after hospital discharge was more likely to lead to high FIM score than ＜ 2 days of physical exercise per week.</p><p>Conclusion：Our results implied that regular physical exercise soon after hospital discharge would lead to better prognosis</p>

Treinamento muscular inspiratório e atividades de vida diária em idosas com doença de Parkinson / Inspiratory muscle training and activities of daily living of elderly with Parkinson disease

Introdução: Parkinson é uma condição degenerativa caracterizada por sintomas como bradicinesia, tremor, rigidez, diminuição da força muscular e alterações cognitivas. Objetivo: Avaliar a força muscular inspiratória máxima, o efeito do treinamento muscular inspiratório pré e pós-treinamento muscular, a presença de dispneia, o padrão ventilatório e a independência funcional em idosas institucionalizadas com síndrome parkinsoniana. Material e métodos: Uma série de casos, com oito idosas, em que se avaliou presença de dispneia, padrão ventilatório, índice de Katz no pré-treinamento e manovacuometria antes e depois do fortalecimento da musculatura inspiratória. Utilizou-se Threshold® IMT, 3x na semana por 30 minutos em dois meses. A carga inspiratória iniciou com 30% da PImáx com incremento de 10% a cada nove dias chegando a 50 %. Os dados foram analisados com estatística descritiva e apresentados em média e desvio padrão e o Teste t para avaliar a diferença estatisticamente significativa. Resultados: Obteve-se melhora da PImáx com diferença estatisticamente significativa (p = 0,004), porém não alcançaram o predito para a idade das mesmas, no Índice de Katz 50% das idosas eram parcialmente independentes, 37,5% independentes e 12,5% totalmente dependente. Conclusão: As voluntárias apresentaram algum grau de dependência em suas atividades de vida diária, e apresentaram ganho na PImáx após o treinamento. (AU)

Introduction: Parkinson's is a degenerative condition characterized by symptoms as bradykinesia, tremor, rigidity, decrease of muscular force and cognitive alterations. Objective: To evaluate the maximum inspiratory muscle strength, the effect of inspiratory muscle training, before and after training muscle, the presence of dyspnea, the ventilatory standard and the functional independence in institutionalized elderly woman with parkinsonian syndrome. Methods: A series of cases, with eight elderly women, which the presence of dyspnea, respiratory pattern, Katz index, pre training and manovacuometry were evaluated before and after strengthening inspiratory muscles. It was used Threshold ® IMT, 3x a week for 30 minutes in two months. The inspiratory load started with 30% of PImáx with an increment of 10% every nine days reaching 50%. Data were analyzed with descriptive statistics and presented as mean and standard deviation and t test to assess the difference statistically significant. Results: We observed that Pimáx improvement was statistically significant (p = 0.004), but did not reach the predicted for the age of the same, Katz Index of 50% of the elderly women are partly independent, 37.5% independent and 12.5% totally dependent. Conclusion: The volunteers showed some degree of dependence in activities of daily living, and gain in PImáx after training.(AU)

Time influence of mechanical ventilation on functional independence in patients submitted to cardiac surgery: literature review / Influência do tempo de ventilação mecânica sobre a independência funcional em pacientes submetidos à cirurgia cardíaca: uma revisão da literatura

Abstract Introduction: Patients submitted to cardiovascular surgery present motor and respiratory complications mainly due to high surgery manipulation and the use of mechanical ventilation. Reducing the weaning start time and disconnecting patient's ventilation system prematurely can decrease the pulmonary complications and hospitalization time. Motor complications are the most relevant as they have a direct effect on functional independence provoked by immobility time. Objectives : Identify if mechanical ventilation time has an impact on functional capacity on patients submitted to cardiac surgery in order to contribute to the establishment of reliable evidence to practice through this patient's profile. Materials and methods : Original articles were analyzed, published between 2000 and 2014, which focused on the influence of mechanical ventilation time concerning the functional independence on patients submitted to cardiac surgery, contained in the following electronic database: Scielo, BIREME (LILACS), PubMed e CAPES. Results : It was observed that the length of stay in the intensive care unit in cardiac surgery was influenced directly by CPB, VM and pulmonary dysfunction. Functional independence was compromised in patients with longer duration of mechanical ventilation, postoperative pain and prolonged bed rest. It was also found that there is no consensus on the protocol for improved functional capacity. Conclusion : There is a functional decline in patients undergoing cardiac surgery, especially those at increased length of stay in mechanical ventilation, reflecting a direct and negative impact on their functional independence and quality of life.

Resumo Introdução : Os pacientes submetidos à cirurgia cardiovascular apresentam complicações motoras e respiratórias decorrentes principalmente de alta manipulação cirúrgica e do uso de ventilação mecânica. Pode-se diminuir a incidência de complicações pulmonares e o tempo de hospitalização reduzindo-se o tempo de início de desmame e desconectando o paciente precocemente do suporte ventilatório. As complicações motoras são as mais pertinentes, pois afetam diretamente a independência funcional pelo tempo de imobilismo. Objetivos : Identificar se existe impacto do tempo de ventilação mecânica sobre a capacidade funcional em pacientes submetidos à cirurgia cardíaca com a finalidade de contribuir com o estabelecimento de evidências confiáveis para as práticas nesse perfil de paciente. Materiais e métodos : Foram analisados artigos originais, publicados entre 2000 e 2014, que abordassem sobre a influência do tempo de ventilação mecânica sobre a independência funcional de pacientes submetidos à cirurgia cardíaca, contidas nas seguintes bases de dados eletrônicos: Scielo, BIREME (LILACS), PubMed e CAPES. Resultados : Observou-se que o tempo de permanência na unidade de terapia intensiva nas cirurgias cardíacas foi influenciado diretamente pelo tempo de CEC, VM e disfunção pulmonar. A independência funcional esteve comprometida em pacientes com maior tempo de VM, dor no pós-operatório e tempo prolongado de restrição ao leito. Também se verificou que não há consenso em relação ao protocolo para melhora da capacidade funcional. Conclusão : Existe uma declínio funcional nos pacientes submetidos a cirurgia cardíaca, principalmente naqueles em maior tempo de permanência na ventilação mecânica, refletindo de forma direta e negativa na sua independência funcional e qualidade de vida.

Análise dos fatores que interferem na capacidade funcional de idosos residentes em uma comunidade de Porto Alegre / Analsis of factors affecting the functional capacity of elderly residents in a community in Porto Alegre

O envelhecimento populacional brasileiro é uma realidade e provoca novas demandas na área da saúde do idoso. Nesse contexto, saúde não significa mais a ausência de doenças e, sim, a manutenção da capacidade funcional. Objetivos: verificar o grau de independência funcional de idosos residentes em uma área adscrita da vila do IAPI (Instituto de Assistência e Previdência dos Industriários) em Porto Alegre e correlacionar o grau de independência funcional com variáveis socioeconômicas e de saúde. Métodos: trata-se de um estudo transversal de base populacional, no qual os dados foram obtidos através de visitas domiciliares. A capacidade funcional foi avaliada com a Escala de Katz, o Índice de Lawton e o nível de atividade física pelo IPAQ versão 6. Os dados foram analisados pelo SPSS (Statistical Package for the Social Sciences) versão 17.0 por meio de análises bivariada e multivariada pela Regressão de Poisson hierárquica. Resultados: foram entrevistados 401 idosos e os fatores associados à independência funcional foram: ocupação (RP = 1,18), idade (RP = 0,97), ser ativo ou muito ativo fisicamente (IPAQ) (RP = 6,86) e participar de grupos de apoio (RP = 1,21). A depressão associou-se negativamente com a independência funcional (RP = 0,77). Conclusões: os resultados permitiram identificar o comportamento da capacidade funcional entre os idosos avaliados, sendo a maioria destes classificados como independentes. Faz-se importante salientar que a manutenção da capacidade funcional deve ser estimulada através de políticas públicas de promoção da saúde física e mental, redes de apoio social e participação ativa nos vários segmentos da sociedade.

The aging of the Brazilian population is a reality, and it causes new demands when the subject is elderly health. In this context, health is not anymore the absence of diseases, but the maintenance of the functional capacity. Objectives: this paper aims to verify the level of functional independence of the elderly at an enrolled area of the village of IAPI, in Porto Alegre, and correlate the level of functional independence with socioeconomic and health variables. Methods: this is a population-based cross-sectional study in which the data were obtained through home visits. The functional capacity was valued with Katz and Lawton scales, and the level of physical activity was valued through IPAQ – version 6. The data were analyzed by SPSS (Sta and multivariate analyzes by hierarchical Poison Regression. Results: 401 people were interviewed, and the factors associated to functional independence were: occupation (RP = 1,18), age (RP = 0,97), be physically active or very active (IPAQ) (RP = 6,86) and participate of support groups (RP = 1,21). Depression was associated negatively with functional independence (RP = 0,77). Conclusions: results allowed the identification of the behavior of functional capacity among elderly patients, most of these being classified as independent. It is important to note that maintenance functional capacity should be encouraged through physical and mental health public policies, social support networks, and active participation in the various segments of society.