Translation and measurement properties of the Portuguese-Brazil version of the Hammersmith Infant Neurological Examination (HINE-Br) / Tradução e propriedades de medida da versão Português-Brasil do Hammersmith Infant Neurological Examination (HINE-Br)

ABSTRACT Objective: The current study aimed to translate the Hammersmith Infant Neurological Examination (HINE) into Brazilian Portuguese and analyze the reliability of the translated version for a population of Brazilian infants. Methods: This was a methodological study, approved by the Ethics Committee, carried out between June 2020 and May 2021. HINE is a standardized clinical neurological examination used for the early detection of cerebral palsy. The quantitative section, "neurological examination", contains 26 items scored from 0 to 3 points, divided into five categories: cranial nerve function, posture, movements, muscle tone and reflexes, and reactions. The HINE translation followed four steps: translation, synthesis, back-translation, and evaluation by an expert committee. To verify the reliability of the HINE-Br (Portuguese-Brazil version) two independent examiners evaluated 43 infants, between 3 and 22 months of age. Internal consistency was verified by Cronbach's Alpha coefficient and interrater reliability by the intraclass correlation coefficient (ICC). Results: The translated version was similar to the original version and a few semantic and idiomatic adjustments were necessary. Appropriate internal consistency (Alpha=0.91) was found for the 26 items of the HINE-Br, as well as strong interrater reliability for the total score (ICC2.1=0.95), and also for the five categories (ICC2.1=0.83-0.95). Conclusions: The HINE-Br presents adequate rates of internal consistency and interrater reliability, and can be used for the evaluation of children at risk for cerebral palsy, between 3 and 24 months of age, by pediatricians and pediatric physical therapists.

RESUMO Objetivo: Traduzir o Hammersmith Infant Neurological Examination (HINE) para o português brasileiro e analisar a confiabilidade da versão traduzida em lactentes brasileiros. Métodos: Estudo metodológico, aprovado por Comitê de Ética, realizado entre junho de 2020 e maio de 2021. O HINE é um exame clínico neurológico padronizado, utilizado para detecção precoce de paralisia cerebral. A seção quantitativa, "exame neurológico", contém 26 itens pontuados de 0 a 3, divididos em 5 categorias: função dos nervos cranianos; postura; movimentos; tônus muscular e reflexos; e reações. A tradução do HINE seguiu quatro etapas: tradução; síntese; retrotradução; e avaliação por um comitê de especialistas. Dois examinadores independentes avaliaram 43 lactentes, entre 3 e 22 meses, utilizando a versão HINE-Br (versão em português brasileiro), para verificar sua confiabilidade. A consistência interna foi verificada pelo coeficiente Alpha de Cronbach e a confiabilidade interexaminadores pelo coeficiente de correlação intraclasse (CCI). Resultados: A versão traduzida foi semelhante à versão original e poucos ajustes semânticos e idiomáticos foram necessários. Encontrou-se consistência interna adequada (Apha=0,91) para os 26 itens do HINE-Br, bem como forte confiabilidade interexaminadores para o escore total (CCI2,1=0,95) e também para as cinco categorias (CCI2,1=0,83-0,95). Conclusões: O HINE-Br apresenta índices adequados de consistência interna e confiabilidade interexaminadores, podendo ser utilizada para avaliação de crianças com risco de apresentar paralisia cerebral, entre 3 e 24 meses de idade, por pediatras e fisioterapeutas infantis.

History and national survey on reflex hammers: which is the chosen one of Brazilian neurologists? / História e questionário nacional sobre martelos de reflexo: qual é o escolhido dos neurologistas brasileiros?

Abstract Background Percussion is an important part of the neurological examination and reflex hammers are necessary to obtain it properly. Objective We aimed to review the historical aspects of the main reflex hammers and to define the favorite one of Brazilian neurologists. Methods We searched original and review articles about historical aspects of the reflex hammers in Scielo and Pubmed and conducted an online survey to investigate the favorite reflex hammer of Brazilian neurologists. Results In the first part, we describe the major milestones in the creation of the reflex hammers. Following, we exhibit the results of the online survey: Babinski-Rabiner was the most voted. Conclusions The origins of the reflex hammers goes back long before their creation, from a basic clinical examination method: percussion. Since the description of deep tendon reflexes and the creation of percussion hammers, much has been improved in this technique. Among all the hammers surveyed, the Babinski-Rabiner was the chosen one by a significant portion of Brazilian neurologists.

Resumo Antecedentes A percussão é uma parte importante do exame neurológico e os martelos de reflexo são necessários para obtê-la adequadamente. Objetivo Nós visamos revisar os aspectos históricos dos principais martelos de reflexo neurológico e definir qual é o preferido dos neurologistas brasileiros. Métodos Procuramos artigos originais e artigos de revisão sobre os aspectos históricos dos martelos de reflexo na Scielo e no Pubmed, e conduzimos um questionário online para investigar qual é o preferido dos neurologistas brasileiros. Resultados Na primeira parte, descrevemos os principais marcos na criação dos martelos de reflexo. Na sequência, expomos os resultados do questionário online: Babinski-Rabiner foi o martelo mais votado. Conclusões A origem dos martelos de reflexos vem muito antes de sua criação, a partir de um método de exame clínico básico: a percussão. Desde a descrição dos reflexos tendinosos profundos e da criação de martelos de percussão, muito se aperfeiçoou sobre essa técnica. Dentre todos os martelos pesquisados, o de Babinski-Rabiner foi o escolhido por uma parcela significativa dos neurologistas brasileiros.

Validation of the Connecticut olfactory test (CCCRC) adapted to Brazil / Validação do teste de olfato de Connecticut (CCCRC) adaptado para o Brasil

Abstract Introduction Olfactory changes are quite common in the population, causing a significant impact on the quality of life. Documentation of the olfactory function is essential for the diagnosis, treatment and follow-up of patients with inflammatory diseases of the upper airways, neurodegenerative diseases or viral infections. Among the different existing smell tests, the CCCRC is an inexpensive test, easy to apply, but it has not yet been evaluated on a large scale in the Brazilian population. Objective To validate the CCCRC smell test, after adaptation for the Brazilian population, evaluating the performance of healthy volunteers and the stability of the test in retests. Methods In this study, we carried out a cultural adaptation of the CCCRC test to Brazil. To validate and determine the normality scores, we applied the test to 334 healthy volunteers, aged >18 years of age. The retest was also carried out in up to four weeks on 34 additional volunteers to assess validity of the results. Results When evaluating the participants' performance, normosmia and mild hyposmia values were obtained in more than 95% of them. Women (58.4%) showed better accuracy than men (41.6%): p < 0.02, and individuals over 60 years of age showed worse performance (median: 6; 75th percentile: 6.5; 25th percentile). The test and retest of the 34 volunteers demonstrated that there was agreement (ICC, intraclass correlation coefficient) considered good in the left nostril (ICC = 0.65) and excellent in the right nostril (ICC = 0.77) in the combined score. Conclusion The CCCRC test adapted to Brazil showed normal values, similar to the originally-described test and validations in other countries, with a high reproducibility rate. Considering the highly favorable cost-benefit ratio, the adapted CCCRC is a very useful tool for measuring olfactory function in the Brazilian population.

Resumo Introdução Alterações olfativas são bastante comuns na população, causam significativo impacto na qualidade de vida. A documentação da função olfatória é fundamental para o diagnóstico, tratamento e seguimento de pacientes que cursam com doenças inflamatórias das vias aéreas superiores, neurodegenerativas ou infecções virais. Entre os diferentes testes de olfato existentes, o teste do Connecticut Chemosensory Clinical Research Center (CCCRC) é barato, de fácil aplicação, mas que ainda não foi avaliado em grande escala para a população brasileira. Objetivo Validar o teste de olfato CCCRC com adaptação para a população brasileira, avaliar o desempenho de voluntários saudáveis e a estabilidade do teste em retestes. Método Neste estudo fizemos adaptação cultural do teste CCCRC para o Brasil. Para validação e determinação dos escores de normalidade, aplicamos o teste em 334 voluntários saudáveis, com mais de 18 anos. O reteste foi ainda feito em até quatro semanas em 34 voluntários adicionais para avaliar concordância dos resultados. Resultados Avaliando o desempenho dos participantes, valores de normosmia e hiposmia leve foram obtidos em mais de 95% deles. Mulheres (58,4%) apresentaram melhor acurácia em relação aos homens (41,6%), p< 0,02; e indivíduos acima dos 60 anos apresentaram pior desempenho (mediana: 6; percentil 75: 6,5; percentil 25: 5). O teste e reteste dos 34 voluntários demonstrou que houve concordância (coeficiente de correlação intraclasse, CCI) considerada boa em narina esquerda (CCI = 0,65) e excelente em narina direita (CCI = 0,77) no escore combinado. Conclusão O teste CCCRC adaptado para o Brasil apresentou valores de normalidade semelhantes ao teste originalmente descrito e a validações em outros países, com alta taxa de reprodutibilidade. Considerando a relação custo-benefício altamente favorável, o CCCRC adaptado é uma ferramenta muito útil para mensuração da função olfatória na população brasileira.

The Hammersmith Infant Neurological Examination for following-up the gross motor development of high-risk infants / 中华物理医学与康复杂志

Objective:To explore the ability of the Hammersmith Infant Neurological Examination (HINE) to predict the gross motor development of high-risk infants.Methods:A total of 207 high-risk infants were assessed with the HINE and the Gesell Developmental Schedule (GDS) at the ages of 3, 6, 9 and 12 months. They were then divided into a normal development group and a delayed group according to their gross motor development at 12 months old. The validity of the HINE′s discrimination was quantified retrospectively as the difference in the total HINE score at each follow-up month between the two groups. Spearman coefficients relating the total HINE score with the gross motor development quotient from the GDS were calculated at each follow-up month. The HINE′s total score threshold for predicting gross motor retardation at 12 months was determined from a receiver operating characteristics curve, and the predictive validity, sensitivity and specificity were evaluated by calculating the area under the curve.Results:At each time point the average total HINE score of the delayed group was significantly lower than the normal group′s average. The correlation between the HINE total scores and the GDS gross motor development quotients was strongest at 6 months old, and weakest at 3 months. The threshold total HINE score for predicting gross motor retardation at 12 months old was 60 at 3 months, 67 at 6 months, and then 71. The instrument′s sensitivity and specificity were very good at all four time points.Conclusion:The HINE can usefully predict gross motor retardation in the first year of life for high-risk infants. The critical value of the total score can be used as an auxiliary diagnostic reference for neuromotor development in such infants.

Qualidade de registros de enfermeiros acerca da avaliação neurológica em unidade especializada / Quality of nurses' records concerning neurological assessments in a specialized intensive care unit

O registro das ações, observações e avaliações realizadas pela equipe de enfermagem é um meio para gerenciar a assistência, avaliar a qualidade do atendimento e garantir a continuidade do cuidado. O enfermeiro ao realizar o exame neurológico em usuários no pós-operatório de cirurgias intracranianas e o adequado registro, possibilitará a identificação de possíveis alterações que coloquem em risco a vida do usuário após o procedimento. Nesse sentido, o estudo teve como objetivo analisar a qualidade dos registros dos enfermeiros de uma Unidade de Terapia Intensiva especializada quanto à avaliação neurológica de usuários em pós-operatório de cirurgia intracraniana. Trata-se de um estudo retrospectivo, quantitativo, realizado no período de junho a julho de 2019, com analise descritiva. Foram identificadas 134 admissões na unidade de terapia intensiva neurológica, totalizando 536 registros de enfermeiros. Houve predomínio dos registros quanto avaliação do nível de consciência e pupilar (92,5%), em 3,9% possuíam exclusivamente a avaliação pupilar, 2,7% somente o nível de consciência, e em 0,7% ausência de registros. Quanto a completude, 90,7% das avaliações do nível de consciência foram completas e, 84,3% da avaliação pupilar estavam completas. Identificou-se que os registros dos enfermeiros da Unidade de Terapia Intensiva em que se desenvolveu o estudo foram classificados como ótimos, a partir dos parâmetros de qualidade previamente definidos.

Recording the actions, observations, and evaluations carried out by the nursing team is a means to manage care, assess the quality of care, and ensure continuity of care. When a nurse performs a neurological examination on patients in the postoperative period of intracranial surgeries and provides proper records, it is possible to identify potential changes that put the patient's life at risk after the procedure. Therefore, this study aimed to analyze the quality of records of nurses regarding the neurological assessment of patients in the postoperative period of intracranial surgery within a specialized Intensive Care Unit. This was a retrospective, quantitative study, carried out from June to July 2019, with a descriptive analysis. A total of 134 admissions to the neurological intensive care unit were identified, totaling 536 nurse records. There was a predominance of records concerning the assessment of the level of consciousness and pupils (92.5%), in 3.9% they had only the pupillary exam, 2.7% only recorded the level of consciousness, and in 0.7% there were no records. As for comprehensiveness, 90.7% of the assessments of the level of consciousness were complete and 84.3% of the pupillary exam were complete. It was identified that the records of nurses in the Intensive Care Unit where the study was developed were classified as excellent, based on previously defined quality parameters.

A prospective study to determine etiology, clinical profile and neurodevelopmental outcome of neonatal seizures admitted in newborn unit of Chengalpattu Medical College and Hospital, Tamil Nadu, India

Background: Newborn with neonatal seizures is at risk of neurodevelopmental delay. The aim of this study was to determine the factors affecting the adverse outcome of neonatal seizures and to study the significant factors associated with poor neurodevelopmental outcome in neonatal seizures.Methods: This was a prospective study done at neonatal intensive care unit (NICU) in Chengalpattu Medical College during the period from June 2017 to September 2018. A total of 110 neonates with seizures admitted in NICU from first hour of life to 28 days of age were included in the study. Detailed history was collected in preformed proforma, and followed up to one year and neurological assessment done at 4th month, 8th month and 1 year. The Hammersmith infant neurological examination (HINE) was done at 4 and 8 month and the Bayley'III assessment was done at 1 year of age to determine the neurodevelopment outcome.Results: Out of 110 newborns with seizures, 86 cases were followed up to 1 year of age. Neurological assessment done by HINE determined abnormal neurodevelopment in 33.6% neonates. Bayley-III scale assessment found cognitive delay in 10.9%, language delay in 20%, motor delay in 5.55%, socio-emotional delay in 30%, and adoptive delay in 31.8% cases. Delayed developmental outcome is significantly associated with onset of seizures, frequency of seizure, poor 5 minute Apgar score, abnormal EEG, and hypoxic ischemic encephalopathy (HIE).Conclusions: The delayed developmental outcome high among the neonates with subtle and myoclonic seizures. Mortality and neurological impairment was after neonatal seizure is associated with Onset and frequency of seizures, low Apgar score at 5 min, findings of USG cranium, CT brain, EEG, and HIE.

Clinical application of Hammersmith infant neurological examination / 中华实用儿科临床杂志

The Hammersmith infant neurological examination (HINE) is a simple, scoreable, standardized clinical neurological examination for infants between 2 months and 24 months of age.It only requires 5 to 10 minutes to complete without the necessity of using specific professional equipment.The HINE can assist in the early detection, diagnosis and prognosis of infants at risk of developing cerebral palsy, being widely used in the early follow-up protocol of high-risk infants.

Clinical application of Hammersmith infant neurological examination / 中华实用儿科临床杂志

The Hammersmith infant neurological examination (HINE) is a simple,scoreable,standardized clinical neurological examination for infants between 2 months and 24 months of age.It only requires 5 to 10 minutes to complete without the necessity of using specific professional equipment.The HINE can assist in the early detection,diagnosis and prognosis of infants at risk of developing cerebral palsy,being widely used in the early follow-up protocol of high-risk infants.

A Rare Case Of Space Occupying Lesion Of Brainstem In An Elderly Male Patient

An elderly male patient aged 65 presented to us with history of swaying towards left side of the body since 1 month with normal higher mental functions and neurological examination suggestive of cerebellar ataxia. MRI Brain plus contrast was suggestive of an irregular, ill-defined heterogeneous enhancing lesion with few necrotic areas within and few foci of blooming on FFE (Fast Field Echo imaging technique) with significant perilesional oedema involving right thalamus and brainstem showing Choline peak on MR Spectroscopy.

Lumbar herniated disc: spontaneous regression

BACKGROUND: Low back pain is a frequent condition that results in substantial disability and causes admission of patients to neurosurgery clinics. To evaluate and present the therapeutic outcomes in lumbar disc hernia (LDH) patients treated by means of a conservative approach, consisting of bed rest and medical therapy. METHODS: This retrospective cohort was carried out in the neurosurgery departments of hospitals in Kahramanmaraş city and 23 patients diagnosed with LDH at the levels of L3−L4, L4−L5 or L5−S1 were enrolled. RESULTS: The average age was 38.4 ± 8.0 and the chief complaint was low back pain and sciatica radiating to one or both lower extremities. Conservative treatment was administered. Neurological examination findings, durations of treatment and intervals until symptomatic recovery were recorded. Laségue tests and neurosensory examination revealed that mild neurological deficits existed in 16 of our patients. Previously, 5 patients had received physiotherapy and 7 patients had been on medical treatment. The number of patients with LDH at the level of L3−L4, L4−L5, and L5−S1 were 1, 13, and 9, respectively. All patients reported that they had benefit from medical treatment and bed rest, and radiologic improvement was observed simultaneously on MRI scans. The average duration until symptomatic recovery and/or regression of LDH symptoms was 13.6 ± 5.4 months (range: 5−22). CONCLUSIONS: It should be kept in mind that lumbar disc hernias could regress with medical treatment and rest without surgery, and there should be an awareness that these patients could recover radiologically. This condition must be taken into account during decision making for surgical intervention in LDH patients devoid of indications for emergent surgery.

Gait Disturbances in Elderly Life

Gait disturbances in elderly often lead to falls and disability. And abnormal gait predicts functional decline and poor quality of life. I reviewed on the nervous systems and higher cortical function on gait. I also draw attention to the concept of senile gait disorder. Recent evidence showed that gait disturbances are not an unpreventable consequence of ageing, but suggest underlying diseases that need to specific concern. The complete neurological examination with timed up and go test is the best way to assess gait disorders. As a geriatric neurologist, we have to familiar with patterns of gait disturbances and approach with step-wise manner.

Sedación con medicamentos y homeopatía para estudio electroencefalográfico en niños / Sedation with medication and homeopathy for electroencephalographic study in children

Introducción: los trastornos neurológicos son una de las patologías más frecuentes en la edad pediátrica. Para su estudio es muy útil el registro de la actividad eléctrica cerebral a través del electroencefalograma. En los niños pequeños, se hace necesaria la sedación para obtener un registro de sueño, habitualmente realizada, a pesar de sus inconvenientes, con tratamiento medicamentoso. Objetivo: valorar el efecto sedante para la realización de electroencefalograma en niños de la passiflora homeopática a la 6CH, comparándola con el hidrato de cloral y la difenhidramina en jarabe. Material y método: se realizó una investigación experimental con los 100 niños de ambos sexos entre uno y cuatro años que acudieron al departamento de Neurofisiología del Hospital Pediátrico Provincial Docente "Pepe Portilla" de Pinar del Río durante el 2014, para someterse a electroencefalograma bajo sedación. Se realizó un muestreo sistemático aleatorizado para asignar y conformar dos grupos de tratamiento (convencional y homeopático) con 50 pacientes cada uno, que se compararon según la efectividad de la sedación y su duración. Resultados: la sedación con passiflora a la 6CH fue tan efectiva como la que se obtuvo con el tratamiento convencional con hidrato de cloral y difenhidramina jarabe, lográndose en todos los niños y manteniéndose durante todo el registro electroencefalográfico, sin la aparición de reacciones adversas. Conclusiones: la passiflora homeopática es una alternativa terapéutica efectiva e inocua para la sedación de niños pequeños, en los que se realiza electroencefalograma para diagnóstico de enfermedades del sistema nervioso central.

Introduction: neurological disorders are one of the most common diseases in pediatric ages. To study these disorders, the recording of brain electrical activity through electroencephalogram is very useful. Sedation is necessary in young children to obtain a record of sleep, usually performed, despite its drawbacks with drug treatment. Objective: to assess the sedative effect of homeopathic passionflower at 6CH to conduct EEG in children compared with chloral hydrate and diphenhydramine syrup. Material and method: an experimental study was conducted with 100 children of both sexes between one and four years old attending the Provincial Department of Neurophysiology at "Pepe Portilla" Pediatric Hospital, Pinar del Rio 2014, to undergo EEG under sedation. A randomized systematic sampling was performed to assign and form two groups of treatment (conventional and homeopathic) with 50 patients each, which was compared by the effectiveness of sedation and its duration. Results: sedation with the 6CH passionflower was as effective as than the one obtained with conventional treatment using chloral hydrate and diphenhydramine syrup, achieving and maintaining all children sedated without the occurrence of adverse reactions, throughout the electroencephalogram. Conclusions: passionflower is an effective and safe homeopathic medication to sedate young children; it is a therapeutic alternative to perform EEG to diagnose central nervous system diseases.

Conversive gait disorder: you cannot miss this diagnosis / Distúrbio conversivo da marcha: você não pode deixar de fazer esse diagnóstico

Bizarre, purposeless movements and inconsistent findings are typical of conversive gaits. The objective of the present paper is to review some phenomenological aspects of twenty-five consecutive conversive gait disorder patients. Some variants are typical – knees give way-and-recover presentation, monoparetic, tremulous, and slow motion – allowing clinical diagnosis with high precision.

Movimentos bizarros, sem finalidade e inconsistentes são típicos das marchas conversivas. O objetivo deste artigo é descrever os aspectos fenomenológicos de vinte e cinco pacientes com distúrbio conversivo da marcha, salientando que algumas variantes são tão típicas – dobrando os joelhos e recuperando, monoparética, trêmula e em câmara lenta – que praticamente não possuem diagnóstico diferencial.

El dilema del paciente con trastornos mentales y de la conciencia en la práctica clínica / The dilemma of the patient with mental upsets and of the conscience in the clinical practice

Introducción: el paciente con trastornos mentales, alteraciones de la conciencia y la conducta es frecuente en la práctica clínica y no necesariamente por enfermedad psiquiátrica. Objetivo: enfatizar en el razonamiento clínico, fundamental en la aplicación del Método Clínico o Proceso diagnóstico en la Práctica Clínica. Material y Métodos: se realizó una revisión bibliográfica sobre el tema a través de la consulta de bases de datos de publicaciones biomédicas (PubMed, Hinari, SeCimed, Scielo, EBSCO, Google, LIS Cuba), para acceder a artículos fundamentalmente de los últimos 5 años. Desarrollo: se revisaron conceptos básicos, causas, manifestaciones clínicas y mecanismos relacionados, conducta y una revisión sobre algunas drogas como problemática actual incluida en el tema. Como resultado servirá de orientación en la interpretación y la adopción de decisiones clínicas del tema abordado en la práctica clínica. Conclusiones: el enfrentamiento requiere una correcta aplicación del Método Clínico y un nivel adecuado de competencia y desempeño profesional, no solo en el internista, sino en todos los profesionales vinculados a la práctica clínica.

Introduction: the patient with mental upsets, alterations of the conscience and of the conduct is frequent in practice clinical and not necessarily for psiquiatrical illness. Objective: the objective of the present work is to emphasize in the clinical, fundamental reasoning in the application of the clinical method or prosecute in practice clinical diagnosis. Material and Methods: it carried out to him a bibliographical revision on the topic through the consultation of biomedical bases of data of publications (PubMed, Hinari, SeCimed, Scielo, EBSCO, Google, LIS Cuba), to accede to articles fundamentally of the the last ones 5 years. Development: were revised basic concepts, cause, clinical manifestations and related mechanisms, conduct and a revision on some drugs as problematic current included in the topic. As a result it will serve as orientation in the performance and takes it of clinical decisions of the topic put into port in practice clinical. Conclusions: confront to the treaty topic requires of a correct application of the clinical method and an appropriate competitive level and play professional, not single in the internist, but in all related professionals to the attention related to the clinical practice in urgency and ambulatory.

Disfagia e acidente vascular cerebral: relação entre o grau de severidade e o nível de comprometimento neurológico / Dysphagia and cerebrovascular accident: relationship between severity degree and level of neurological impairment

O objetivo deste estudo foi verificar a ocorrência de disfagia após acidente vascular cerebral (AVC) isquêmico agudo durante as primeiras 48 horas de aparecimento dos sintomas para o estabelecimento de uma possível relação entre o nível de comprometimento neurológico e o grau de severidade da disfagia. Após a admissão hospitalar de emergência, três pacientes passaram por avaliação clínica neurológica, composta por exame físico geral, exame neurológico e aplicação da NationalInstitute of Health Stroke Scale (NIHSS); e avaliação clínica da deglutição por meio do Protocolo Fonoaudiológico de Avaliação do Risco para Disfagia (PARD). Dos pacientes avaliados, um apresentou deglutição funcional, com NIHSS 11, e dois apresentaram disfagia orofaríngea leve e moderada, sendo o NIHSS 15 e 19, respectivamente. O fluxo do serviço e a procura tardia dos pacientes por auxílio médico determinaram o baixo número de amostra. Os resultados obtidos confirmam os dados da literatura em relação à gravidade do paciente neurológico e à manifestação de disfagia.

The aim of this case study was to verify the occurrence of dysphagia in acute ischemic stroke within 48 hours after the onset of the first symptoms, in order to establish a possible relationship between the level of neurologic impairment and the severity degree of dysphagia. After emergency hospital admission, three patients underwent neurological clinical evaluation (general physical examination, neurological examination, and application of the National Institute of Health Stroke Scale - NIHSS), and clinical assessment of swallowing using the Protocolo Fonoaudiológico de Avaliação do Risco para Disfagia (PARD - Speech-Language Pathology Protocol for Risk Evaluation for Dysphagia). One of the patients presented functional swallowing (NIHSS score 11), while the other two had mild and moderate oropharyngeal dysphagia (NIHSS scores 15 and 19, respectively). The service flow and the delay on the patients' search for medical care determined the small sample. The findings corroborate literature data regarding the severity of the neurological condition and the manifestation of dysphagia.

Rethinking the neurological examination I: static balance assessment / Repensando o exame neurológico I: avaliação do equilíbrio estático

The authors advocate a modernization of the neurologic exam with regard to the evaluation of static equilibrium through the application of some easily performed and interpreted bedside maneuvers like the Clinical Test of Sensory Integration and Balance - modified and the Functional Reach Test. The authors also believe that these and other assessments, such as that of the risk of falling for elderly patients, should be incorporated into the routine neurological examination.

Os autores advogam a modernização do exame neurológico no que diz respeito à pesquisa do equilíbrio estático, por meio da aplicação de algumas manobras de beira-de-leito fáceis de serem executadas e interpretadas, tais como o Teste Clínico de Integração Sensorial e Equilíbrio-modificado e o Teste do Alcance Funcional. Os autores também acreditam que estes e outros testes visando avaliação de risco de queda em pacientes idosos devem fazer parte do exame neurológico de rotina.

Rethinking the neurological examination II: dynamic balance assessment / Repensando o exame neurológico II: avaliação do equilíbrio dinâmico

The authors propose that the neurological exam needs reevaluation with respect to the dynamic balance test (walking). Validated tests such as: preferred and maximum gait speed, dynamic gait index, five-times-sit-to-stand test, timed up & go cognitive and manual, should be part of the neurological examination routine. In the neurological exam of older patients, these same bedside tests bring the plus of evaluation the risk of occasional falling.

Os autores propõem que o exame neurológico tradicional seja reavaliado no que diz respeito ao exame do equilíbrio dinâmico (marcha). Testes validados tais como: velocidade da marcha - preferencial e máxima; índice dinâmico da marcha, teste senta-levanta cinco vezes e o tempo levanta-e-anda cognitivo e manual, deveriam fazer parte do exame neurológico de rotina. Na avaliação neurológica dos pacientes idosos, esses mesmos testes à beira do leito trazem benefício adicional ao aferir o risco de queda ocasional.

The neurological examination of non-complicated preterm newborns using the Saint-Anne Dargassies Scale from birth to term / O exame neurológico de recém-nascidos prematuros não complicados do nascimento ao termo pela escala de Saint-Anne Dargassies

OBJECTIVE: To describe the maturational development of 20 (aged 32-36 weeks) premature newborns (PNBs) without clinical or neurological complications from birth until term. METHOD: The Saint-Anne Dargassies Scale was applied every two weeks until the age of 37 weeks. RESULTS: The PNBs showed normal Apgar and the growth in head circumference was adequate for postmentrual age. The Friedman ANOVA test found a significant difference only for the heel-to-ear angles from birth until term. The Saint-Anne Dargassies Scale detected changes in 11 PNBs and the most altered reflexes were: cardinal points, Moro, cross extension reflexe and automatic walking. These changes were found in the first 48 hours of life and in subsequent weeks until term. CONCLUSION: This finding alone justifies the neurological examination of PNBs, even if they show no clinical/neurological complications in the perinatal period and the importance of neuromotor assessment in preterm infants, as it enables detection and appropriate intervention.

OBJETIVO: Descrever a evolução maturacional de prematuros sem complicações clínicas ou neurológicas (RNP) do nascimento até atingir o termo. MÉTODO: A escala de Saint-Anne Dargassies foi aplicada a cada duas semanas até atingir a idade de 37 semanas, considerado termo pela autora. RESULTADOS: Os recém-nascidos prematuros apresentaram APGAR normal após a reanimação não invasiva e o crescimento do perímetro cefálico foi adequado à idade concepcional. O teste de Friedman ANOVA detectou diferenças significativas apenas para o ângulo calcanhar-orelha do nascimento ao termo. A escala de Saint-Anne Dargassies detectou 11 RNP com alterações nos reflexos: dos pontos cardinais, Moro, alargamento cruzado e o de marcha automática. Estas alterações foram encontradas nas primeiras 48 horas de vida e nas semanas subseqüentes até atingir o termo. CONCLUSÃO: Este achado por si justifica o exame neurológico de RNP mesmo que eles não apresentem complicações clínicas/neurológicas no período peri-natal, e mostra que é importante a avaliação neuromotora nos prematuros, pois isso viabiliza a detecção e intervenção adequadas.

Objective Structured Clinical Examination for Essential Neurological Examination. Validation and Association Between the Score and the Learning Behaviors / 医学教育

Objective: To investigate the role and validity of the objective structured clinical examination (OSCE) for neurological screening (Neuro-OSCE) performed by medical students and to analyze the association between Neuro-OSCE score and student behavior for acquiring skills. Method: A 31-item Neuro-OSCE was created for systematic and time-saving screening of neurological findings. At Saga Medical School, 44 final-year students took a screening neurological examination course and performed Neuro-OSCE from August through October 1998. A questionnaire asked about self-educational behaviors, such as self-evaluation, mental concentration, and self-learning (knowlege-based), and self-practicing time. The relationship between Neuro-OSCE score and self-educational behaviors were analyzed. statistically. Results: Cronbach's coefficient alpha was 0.731, which indicated fair internal validity. The mean Neuro-OSCE score was 51.2± 6.6 (SD). Neuro-OSCE score was correlated with self-practicing time and mental concentration but not with self-learning time or self-evaluation. Conclusion: Our Neuro-OSCE has construct validity in the psychomotor domain from a taxonomic viewpoint because the Neuro-OSCE score was correlated with self-practicing time rather than self-learning time. Mental concentration was better a self-assessment method than was self-evaluation. However, setting self-educational goals for neurological examination is probably too difficult at the undergraduate level. Objective assessment by Neuro-OSCE is expected to foster relevant learning behavior.