Pruebas funcionales en esclerosis múltiple y su comparabilidad con los valores de administración autónoma: estudio piloto / Multiple sclerosis functional tests and their comparability with self-administered values: A pilot study

Introducción. El deterioro neurológico en la esclerosis múltiple es variable para cada paciente y su cuantificación se dificulta con el tiempo. El Multiple Sclerosis Outcome Assessment Consortium estableció medidas clínicas sensibles, costo-efectivas y reproducibles para medir los resultados de los estudios clínicos. Sin embargo, sus valores de referencia se desconocen y, en la atención habitual, su uso no está extendido por limitaciones de tiempo y entrenamiento. Objetivo. Establecer la factibilidad de la administración autónoma de las pruebas de marcha de 25 pies, símbolos y dígitos, y clavijas y nueve hoyos en individuos sanos. Materiales y métodos. Se realizó un estudio piloto descriptivo. Se incluyeron individuos sanos entre los 18 y los 80 años. Las pruebas de Timed 25-Foot Walking Test (T25-FWT) [caminata cronometrada de 25 pies], Symbol Digit Modality Test (SDMT) [símbolos y dígitos] y Nine-Hole Peg Test (9-HPT) [clavijas y nueve agujeros] fueron administradas por un médico capacitado, quien también instruyó a los sujetos sobre la administración autónoma de las pruebas. La correlación y la concordancia entre la prueba guiada y la autónoma se evaluaron con los coeficientes de Pearson y Spearman, y el análisis gráfico de Bland-Altman. Resultados. Se incluyeron 38 voluntarios sanos. La mediana de edad fue de 36 (rango: 23-55 años) y el 55,26 % eran mujeres. El coeficiente de correlación entre la prueba de administración guiada y la autónoma fue de 0,37 para la T25-FWT (p=0,01), de 0,54 para la SDMT (p<0,001) y de 0,64 y 0,65 para la 9-HPT, en las manos dominante y no dominante, respectivamente (p<0,001). Ambas formas de administración fueron concordantes para las pruebas T25-FWT (IC95%: -1,49 a 1,43), 9-HPT con la mano dominante (IC95%: -5,23 a 4,09), 9-HPT con la mano no dominante (IC95%: -7,75 a 7,14) y SDMT (IC95%: -20,94 a 24,10). Conclusiones. Los resultados de este estudio ayudan a determinar los valores de normalidad poblacional obtenidos con las pruebas T25-FWT, 9-HPT y SDMT; además, establecen la posibilidad de practicarlas de forma autónoma.

Introduction. Neurological impairment in multiple sclerosis is highly variable among patients and over time it is difficult to quantify. The Multiple Sclerosis Outcome Assessment Consortium established sensitive, cost-effective, clinically significant, and reproducible measures of different functional systems to measure outcomes in clinical trials. However, their use in clinical care routines is not widespread due to time and training constraints. Objective. To evaluate the self-administration feasibility of the timed 25-foot walking, symbol-digit-modality, and 9-peg hole tests in healthy individuals. Materials and methods. We performed a descriptive pilot study. Healthy individuals between 18 and 80 years of age were included. The Timed 25-Foot Walking Test (T25- FWT), the Symbol Digit Modality Test (SDMT), and the Nine-Hole Peg Test (9-HPT) (using the dominant and non-dominant hand) were administered by a trained physician, who also instructed the subjects about test self-administration. The correlation and agreement, between the guided and self-administered tests were assessed with Pearson and Spearman coefficients and the Bland-Altman method. Results. Thirty-eight healthy volunteers were included. The median age was 36 (range: 23-55) years old, and 55.26% were female. The correlation coefficient between guided and selfadministered tests was 0.37 for the T25-FWT (p=0.01), 0.54 for the SDMT (p<0.001), and 0.64 and 0.65 for the 9-HPT, in the dominant and non-dominant hands, respectively (p<0,001). Both forms of administration were concordant for the T25-FWT (95%CI: -1,49 to 1,43), the 9-HPT with dominant hand (95%CI: -5,23 to 4,09), the 9-HPT with non-dominant hand (95%CI: -7,75 to 7,14) and the SDMT (95% CI: -20,94 to 24,10). Conclusions. We provide a proof of concept related to the feasibility of the selfadministration of the T25-FWT, the 9-HPT, and the SDMT, as a tool to improve monitoring in routine clinical practice.

Carga de enfermedad en el Perú. Estimación de los años de vida saludables perdidos 2019 / Burden of disease in Peru. Estimated healthy years of life lost 2019

En ese sentido, el estudio de carga de enfermedad en el Perú del 2019 nos presenta las principales enfermedades y lesiones que han aportado mayor número de años de vida saludables perdidos en el país, reconociendo no solo aquellas que producen muerte prematura, sino también discapacidad. De esta manera, podemos disponer de información valiosa para la toma de decisiones en salud pública y dirigir las acciones hacia un mayor beneficio para la población de nuestro país. Los años de vida ajustados por discapacidad -AVISA- estiman la carga de la enfermedad, de acuerdo a las distintas causas o problemas de salud consideradas. Un AVISA corresponde a un año de vida sana perdido y la medición de la carga de enfermedad por este indicador significaría la brecha existente entre la situación actual de salud de una población y la ideal en la que cada miembro de esa población podría alcanzar la vejez libre de enfermedad y discapacidad.

Validation of a Simple Instrument of Fast Application to Track Disability in Leprosy Patients / Validação de um instrumento simples e de aplicação rápida para rastrear incapacidade em pacientes com hanseníase

Abstract Objective To evaluate a simple and fast diagnostic instrument to be used by any health professional to track the disability presented by leprosy patients. Method Validation study of a diagnostic test performed in a sample of 156 leprosy patients to track functional disability through the shortened disabilities of arm, shoulder, and hand (QuickDASH) questionnaire. The simplified neurological assessment proposed by the World Health Organization was used as a reference. A receiver operating characteristic (ROC) curve was constructed to determine the cutoff point of QuickDASH that best discriminated patients with functional disability caused by leprosy. Results We identified 86 (55.5%) patients with functional disability by simplified neurological evaluation. The performance of the QuickDASH instrument showed that, at a cut-off point of 30 points, the sensitivity and specificity were 72.1% and 68.1% (accuracy of 70.3%), respectively, to identify functional disability, with a positive predictive value of 73.8%. Conclusion The QuickDASH instrument showed good accuracy to track functional disability in leprosy patients, and it may be useful in clinical practice of primary and general outpatient care, with the goal of identifying patients who need specialized reference for the prevention and treatment of this condition.

Resumo Objetivo Avaliar um instrumento diagnóstico simples e rápido a ser utilizado por qualquer profissional da saúde para rastrear a incapacidade apresentada por pacientes com hanseníase. Método Estudo de validação de teste de diagnóstico realizado em uma amostra de 156 pacientes com hanseníase para rastrear incapacidade funcional, por meio do questionário abreviado disabilities of arm, shoulder, and hand (QuickDASH). A avaliação neurológica simplificada proposta pela Organização Mundial da Saúde foi utilizada como referência. Construiu-se a curva de características operacionais do receptor (ROC) para determinação do ponto de corte do QuickDASH que melhor discriminou pacientes com incapacidade funcional provocada pela hanseníase. Resultados Foram identificados 86 (55,5%) pacientes com incapacidade funcional pela avaliação neurológica simplificada. O desempenho do QuickDASH mostrou que, em ponto de corte de 30 pontos, a sensibilidade e a especificidade foram de 72,1% e 68,1% (acurácia de 70,3%), respectivamente, para identificar incapacidade funcional, com um valor preditivo positivo de 73,8%. Conclusão O instrumento QuickDASH mostrou boa acurácia para rastrear incapacidade funcional no paciente com hanseníase, podendo ser útil na prática clínica da atenção básica e ambulatorial geral, com o objetivo de identificar pacientes que necessitam de referência especializada para sua prevenção e tratamento.

Frecuencia de migraña y discapacidad generada en estudiantes de medicina humana de una universidad privada en Lima, Perú / Frequency of migraine and disability generated in medical students at a private university in Lima Peru

Objetivo : Estimar la frecuencia de migraña, y discapacidad generada en estudiantes de medicina de una universidad privada de Lima Metropolitana. Métodos : Estudio transversal en una muestra no probabilística por conveniencia, mediante la aplicación online del autocuestionario ALCOI-95, para evaluar la presencia de migraña, seguido por el cuestionario MIDAS para medir la discapacidad en los positivos al primer cuestionario. El rendimiento académico fue evaluado mediante el promedio ponderado de sus calificaciones. Resultados : Cuarenticinco (21,6%) de 208 estudiantes experimentaron migraña (12,5% con aura y 9,1% sin aura), 14 (33,3%) de los cuales mostraron discapacidad severa y 12 (28,6%) moderada. Los portadores de migraña con aura tuvieron una media menor del promedio ponderado acumulado de sus calificaciones, comparado con aquellos con migraña sin aura. Los factores independientemente asociados a la migraña fueron tener un miembro de la familia nuclear con migraña y problemas para mantener el sueño. Conclusión : Dos de cada 10 estudiantes presentaron migraña y 1/3 de los afectados experimentó discapacidad severa.

SUMMARY Objective: To estimate the frequency of migraine, associated factors and disability generated (including its relationship with academic performance) in medical students at a private university in Metropolitan Lima. Methods: Cross-sectional study in a non-probabilistic convenience sample using the online application of the ALCOI-95 self-questionnaire, to assess the presence of migraine, followed by the MIDAS questionnaire to measure disability in those positive to the first questionnaire. . Results: Fourty-five (21.6%) of 208 students experienced migraine (12.5% with aura and 9.1% without aura), 14 (33.3%) of whom showed severe, and 12 (28.6%) moderate disability. Migraine with aura carriers had a lower mean than the cumulative weighted average of their academic scores. Independent factors associated with migraine were to have a nuclear family member with migraine, and sleep-maintenance problems. Conclusion: Two out of 10 students had migraine, and one third of them had severe disability.

Percepções de psicólogos organizacionais sobre inclusão de pessoas com deficiência em empresas / Organizational psychologists' perceptions on the inclusion of people with disabilities in organizations / Percepciones de los psicólogos organizacionales sobre la inclusión de personas con discapacidad en las empresas

As dificuldades e barreiras enfrentadas no processo de inclusão de pessoas com deficiência (PcD) nas organizações incitam o desenvolvimento de pesquisas. Este estudo compreendeu a percepção de psicólogos organizacionais sobre a inclusão de PcD em empresas. Dezoito psicólogos atuantes na área de gestão de pessoas de empresas das sete regiões do estado do Rio Grande do Sul responderam a uma entrevista individual. A média de idade dos participantes foi de 33,17 anos, atuavam em empresas de diferentes segmentos, eram predominantemente do sexo feminino e possuíam pós-graduação em áreas relacionadas. Os relatos dos psicólogos alertaram para o fato de que, em suas graduações, o conteúdo sobre deficiência humana e, especificamente, inclusão no mercado de trabalho foi escasso ou inexistente. Essa lacuna na formação, de egressos de diferentes instituições de ensino superior, é relatada desde os anos de 1990. Para esses psicólogos, barreiras atitudinais e organizacionais são frequentemente enfrentadas no processo de inclusão, tais como o despreparo das empresas, gestores e colaboradores para receber as PcD, os poucos programas voltados a uma prática efetiva de inclusão e não somente ao cumprimento da legislação, além das dificuldades dos próprios profissionais em identificar os potenciais e as limitações que a PcD apresenta e de adaptá-la de maneira correta ao trabalho. O psicólogo organizacional pode contribuir para um processo adequado de inclusão por meio de práticas, tais como treinamentos e sensibilizações, que fomentem a informação e diminuam a discriminação e as dificuldades.(AU)

Difficulties and barriers to including people with disabilities (PwDs) in organizations drives research development. This study sought to understand how organizational psychologists perceived the inclusion of PwDs in organizations. Eighteen organizational psychologists who work in people management for companies in the seven regions of the state of Rio Grande do Sul participated in an individual interview. Most interviewees were female, with average age of 33.17 years, had a postgraduate degree in the field, and worked in companies from different segments. During the interviews, the psychologists called attention to the little or nonexistent content on human disability and, specifically, inclusion in the labor market covered in the graduate course. This gap has been reported by graduates from different higher education institutions since the 1990s. According to the respondents, attitudinal and organizational barriers are often faced in the inclusion process, such as the unpreparedness of companies, managers, and employees to welcome PwD, the few programs aimed at an effective inclusion and not only to comply with the law, as well as the difficulties of the professionals themselves to identify the potentials and limitations that PwD present and to adapt them correctly to the work. Organizational psychologists can contribute to an adequate inclusion process by developing training and sensibilization activities that foster information and reduce discrimination and difficulties.(AU)

Las dificultades y barreras enfrentadas en el proceso de inclusión de personas con discapacidad (PcD) en las organizaciones fortalecen el desarrollo de la investigación. Este estudio entendió la percepción de los psicólogos organizacionales acerca de la inclusión de las PcD en las empresas. Dieciocho psicólogos que trabajan en el área de gestión de personas en empresas de las siete regiones del estado de Rio Grande do Sul (Brasil) respondieron a una entrevista individual. Los participantes tenían una edad promedio de 33,17 años, trabajaban en empresas de diferentes segmentos, eran predominantemente mujeres y tenían un posgrado en el área. Los informes de los psicólogos alertaron sobre el hecho de que el contenido sobre discapacidad humana y, específicamente, su inclusión en el mercado laboral era escaso o inexistente durante su formación académica. Esta brecha en la formación de los egresados de diferentes instituciones de educación superior se reporta desde los 1990. Para estos psicólogos, a menudo ocurren barreras organizacionales y de actitud en el proceso de inclusión de las PcD, como la falta de preparación de las empresas, gerentes y empleados para recibirlas, pocos programas destinados a una práctica efectiva de la inclusión, no solo al cumplimiento de la ley, y las dificultades de los profesionales para identificar las potencialidades y limitaciones y adecuarlas correctamente al trabajo. El psicólogo organizacional puede contribuir a un proceso de inclusión adecuado, con prácticas de capacitación y sensibilización que brindan información y reducen la discriminación y dificultades.(AU)

Translation and cross-cultural adaptation of the Model Disability Survey (MDS) for Brazil / Tradução e adaptação transcultural do Model Disability Survey (MDS) para o Brasil

ABSTRACT OBJECTIVE This study has as objective the translation and cross-cultural adaptation of the Model Disability Survey (MDS), a World Health Organization instrument that provides comprehensive information on disability/functioning, for Brazil. METHODS This is a cross-sectional methodological study, carried out through five stages - initial translation, synthesis of translations, reverse translation, review by a specialist committee, and pre-test -, considering properties such as semantic, idiomatic, experimental, and conceptual equivalence. Translators, researchers, a mediating team, health professionals, a methodologist and a language specialist were needed to pass through the stages. Statistical analysis was produced from absolute and relative frequencies, measures of central tendency and dispersion, normality tests and content validity index (CVI) > 0.80. RESULTS The MDS has 474 items, which generated 1,896 analyzes of equivalence. Of these, 160 items had a CVI < 0.80 in at least one of the four types of equivalence and required adjustments. After adaptations and approval by the judges, the pre-final version went on to the pre-test with 30 participants from four regions of the Brazilian Northeast. Regarding this sample, 83.3% are women, single, with an average age of 33.7 years (SD 18.8), self-declared as black or brown, active workers, with technical education and living with three residents. Interviews lasted 123 minutes on average, where 127 health conditions were mentioned, and the most frequent cited were anxiety and back pain. Answers were analyzed and 63 items were cited as needing some adjustment, two of which were submitted for analysis by the committee because they presented a CVI < 0.80. The instrument, guide and presentation cards were adjusted after a new pre-test. CONCLUSIONS The MDS was translated and cross-culturally adapted to Brazilian Portuguese and showed adequate content validity.

RESUMO OBJETIVO Traduzir e adaptar transculturalmente o Model Disability Survey (MDS), instrumento da Organização Mundial da Saúde que fornece informações abrangentes a respeito de deficiência/funcionalidade, para o Brasil. MÉTODOS Trata-se de um estudo metodológico de corte transversal, realizado por meio de cinco etapas - tradução inicial, síntese das traduções, retrotradução, revisão por comitê de especialistas e pré-teste -, considerando propriedades como equivalência semântica, idiomática, experimental e conceitual. Para realização das etapas foram necessários tradutores, pesquisadores, equipe mediadora, profissionais da saúde, metodologista e especialista em idiomas. A análise estatística foi produzida a partir de frequências absolutas e relativas, medidas de tendência central e dispersão, testes de normalidade e índice de validade de conteúdo (IVC) > 0,80. RESULTADOS O instrumento MDS apresenta 474 itens, o que gerou 1.896 análises de equivalências. Destes, 160 itens apresentaram IVC < 0,80 em pelo menos uma das quatro equivalências e necessitaram de ajustes. Após adequações e aprovação dos juízes, a versão pré-final seguiu para o pré-teste com 30 participantes, de quatro regiões do Nordeste brasileiro. Desta amostra, 83,3% são mulheres, solteiras, com idade média de 33,7 (DP 18,8) anos, autodeclaradas pretas ou pardas, trabalhadoras ativas, com escolaridade a partir do ensino técnico e que residiam com três moradores. O tempo médio das entrevistas foi de 123 minutos de duração. Foram mencionadas 127 condições de saúde, sendo as mais frequentes ansiedade e dores nas costas. As respostas foram analisadas e 63 itens foram citados como necessitando de algum ajuste, sendo dois destes encaminhados para análise pelo comitê por possuírem IVC < 0,80. O instrumento, manual e cartões de apresentação foram ajustados após um novo pré-teste. CONCLUSÕES O MDS foi traduzido e adaptado transculturalmente para o português brasileiro e apresentou adequada validade de conteúdo.

Functional outcomes in children related to self-care, mobility, and social function after stroke in early childhood: a cohort study / Evolução funcional de crianças em autocuidado, mobilidade e função social após acidente vascular cerebral na primeira infância: um estudo coorte

ABSTRACT Background: Stroke has been increasingly recognized as an important morbidity and mortality factor in neonates and children. Children have different and more diverse risk factors than adults, commonly related to an underlying disease. Stroke may compromise functional capacity in children. Few studies have focused on functional outcomes related to activities and participation. Objectives: To investigate post-stroke functionality of children related to self-care, mobility, and social function. Methods: We assessed the functional outcome of 14 children younger than 7.5 years who suffered a stroke in early childhood through the use of the Pediatric Evaluation of Disability Inventory (PEDI). Results: The average age of the sample at assessment was 3.6 ± 1.4 years (2 - 6 years). The average scores in the PEDI functional domains of self-care, mobility, and social function were, respectively, 37.6 ± 15.4, 36.2 ± 15.4, and 48.7 ± 11.1. Children showed age-appropriate functional outcomes in the PEDI functional domains: 71.4% of them in self-care and mobility and 92.9% in social function. Children with bilateral injuries (p = 0.05) and longer hospital stays (r = -0.79, p = 0.001) showed the worst scores in ​​PEDI's social function domains. Conclusions: Overall, our sample of preschool children showed age-appropriate functional outcomes on self-care, mobility, and social function domains after stroke. However, children with bilateral injuries and longer hospital stays showed the worst scores in social function domains. We recommend focusing on functional rehabilitation to promote activities and participation and to monitor the development of children's social skills after stroke.

RESUMO Antecedentes: O acidente vascular cerebral (AVC) tem sido reconhecido como um importante fator de morbimortalidade em neonatos e crianças. As crianças têm fatores de risco diferentes e mais variados que os adultos, comumente relacionados a uma doença subjacente. A funcionalidade das crianças pode estar comprometida após um AVC. Poucos estudos focaram em desfechos funcionais relacionados à atividade e participação. Objetivos: Investigar a funcionalidade de crianças com AVC, relacionada à autocuidado, mobilidade e função social. Métodos: Avaliamos a evolução funcional de 14 crianças com idade menor que 7,5 anos com AVC na primeira infância pela aplicação do PEDI. Resultados: A idade média de nossa amostra na avaliação foi de 3,6 ± 1,4 anos (2 - 6 anos). O escore médio nos domínios de autocuidado, mobilidade e função social do PEDI foram, respectivamente, 37,6 ± 15,4, 36,2 ± 15,4 e 48,7 ± 11,1. As crianças apresentaram evolução adequada para a idade nos domínios do PEDI: 71,4% delas em autocuidado e mobilidade e 92,9% em função social. Piores escores no domínio função social se relacionaram com lesões bilaterais (p = 0,05) e maior tempo de internação (r = -0,79; p = 0,001). Conclusões: Nossa amostra de crianças em idade pré-escolar mostrou, em geral, evolução funcional adequada para a faixa etária nos domínios de autocuidado, mobilidade e função social. Porém, lesões bilaterais e internações hospitalares mais longas se relacionaram com piores performances no domínio função social. Sugerimos focar na reabilitação funcional e acompanhar o desenvolvimento das habilidades sociais de crianças pós-AVC.

Puntajes II / Scores II

El Comité Editorial quiere brindar a sus lectores una actualización de las escalas de uso corriente. El empleo de tablas y escalas es una práctica muy extendida en la Ortopedia y Traumatología. La medición y la cuantificación de los aspectos clínicos, funcionales y radiográficos se convirtieron en una herramienta imprescindible para la toma de decisiones en diferentes aspectos de la actividad asistencial. Llevamos a cabo una revisión de las escalas más utilizadas, definiendo su uso e incluyendo bibliografía original y actualizada. Nivel de Evidencia: V

The Editorial Committee wants to provide its readers with an update on the commonly used scales. The use of tables and scales is a widespread practice in Orthopedics and Traumatology. The measurement and quantification of clinical, functional, and radiographic aspects have become essential tools for decision-making in different aspects of healthcare activity. We carried out a review of the most used scales, defining their use and including original and updated literature. Level of Evidence: V

Funcionalidade de Crianças com Leucemia em Tratamento Quimioterápico / Functionality of Children with Leukemia in Chemotherapeutic Treatment / Funcionalidad de los Niños con Leucemia en Tratamiento con Quimioterapia

Introdução: A leucemia é o tipo de neoplasia mais comumente diagnosticada em crianças no mundo, afetando-as em um período crítico do desenvolvimento neuropsicomotor. Estando diagnosticadas com uma doença ameaçadora da vida, essas crianças necessitam, concomitantemente aos cuidados curativos, de cuidados paliativos. Objetivo: Avaliar a funcionalidade de crianças com leucemia durante o tratamento quimioterápico e compará-la no início e depois de um ano de tratamento em curso. Método: Estudo de corte transversal, do tipo observacional analítico, com 37 crianças avaliadas por meio de entrevista com os pais, utilizando um formulário de pesquisa e o Inventário de Avaliação Pediátrica de Incapacidade (PEDI). A análise estatística foi realizada pelos testes t de Student e de Mann-Whitney. Resultados: Não foram encontradas diferenças estatisticamente significantes entre a funcionalidade de crianças no início e depois de um ano de tratamento, estando todas com a funcionalidade abaixo do esperado para a faixa etária. Conclusão: Como forma de evitar possíveis atrasos e/ou déficits irreversíveis no desenvolvimento dessas crianças, sugere-se a criação de um programa de reabilitação em cuidados paliativos nos serviços especializados para cuidar desse público desde o diagnóstico

Introduction: Leukemia is the most common type of neoplasm diagnosed in children in the world, affecting them in a critical period of their neuropsychomotor development. Once diagnosed with a life-threatening disease, those children need palliative care concurrently with curative care. Objective: Assess the functionality of children with leukemia during chemotherapy treatment and compare it at the beginning and after one year of ongoing treatment. Method: Cross-sectional observational analytical study with 37 children evaluated with interviews performed with their parents, utilizing an investigation form and the Pediatric Evaluation Disability Inventory (PEDI). The statistical analysis was carried out with Student's t-test and Mann-Whitney test. Results: The results indicated there were no statistically significant differences in their functionality before and after 1-year treatment and all of them presented functionality bellow the expected for the age range. Conclusion: It is suggested the creation of a palliative care rehabilitation program for this group since the diagnosis as a way to avoid delays and/or irreversible deficits in the development of these children

Introducción: La leucemia es el tipo de neoplasia que se diagnostica con mayor frecuencia en niños de todo el mundo y los afecta en un período crítico del desarrollo neuropsicomotor. Al ser diagnosticados con una enfermedad potencialmente mortal, estos niños necesitan cuidados curativos concomitantes, cuidados paliativos. Objetivo: Evaluar la funcionalidad de los niños con leucemia durante el tratamiento de quimioterapia y compararla al inicio y después de un año de tratamiento en curso. Método: Se trata de un estudio transversal, tipo analítico observacional, donde se evaluó a 37 niños a través de entrevistas con los padres, utilizando un formulario de encuesta y el Inventario de Evaluación de la Discapacidad Pediátrica (PEDI). El análisis estadístico se realizó utilizando la prueba t de Student y la prueba de Mann-Whitney. Resultados: En los resultados, no se encontraron diferencias estadísticamente significativas entre la funcionalidad de los niños al inicio y al año de tratamiento, todos con una funcionalidad por debajo de lo esperado para su grupo de edad. Conclusión: Como forma de evitar posibles retrasos y/o déficits irreversibles en el desarrollo de estos niños, se sugiere la creación de un programa de rehabilitación en cuidados paliativos en servicios especializados para atender a este público desde el diagnóstico

Clinical outcome analysis in surgical patients enrolled in a Second Opinion Program in spine surgery

ABSTRACT Objective To analyze pain, functional capacity, quality of life, anxiety and depression outcomes in patients undergoing lumbar spine surgery following use of the Second Opinion Program, and to present disagreements regarding diagnoses and therapeutic indications between the first and second opinions. Methods A prospective, observational cohort study with 100 patients enrolled in the Second Opinion Program who underwent lumbar spine surgery. Questionnaires addressing pain intensity, level of disability, quality of life, anxiety and depression were applied prior to and within 1, 3, 6 and 12 months of surgery. Descriptive and comparative statistical analyses were performed. The following clinical outcomes were analyzed: pain intensity, level of disability, quality of life, anxiety, and depression. Results In this sample, 88% and 12% out of 100 patients were submitted to lumbar decompression and arthrodesis, respectively. Patients reported improvements in function, pain intensity, and quality of life factors following surgery and were able to attain the minimal clinically important difference relative to the preoperative period. Agreement between the first and second opinions was observed in 44% of diagnoses, and in 27% of therapeutic indications. Conclusion Patients had favorable postoperative outcomes regarding pain, disability, and quality of life. These findings and the high rates of diagnostic and therapeutic indication disagreements corroborate the need of a second opinion in cases of spine disease with surgical indications.

Dolor y discapacidad cervical de los trabajadores públicos usuarios de pantallas de visualización de datos / Pain and cervical disability among public workers who use data visualization display terminals

Resumen Los trastornos del cuello-hombro relacionados con el trabajo son un importante problema de salud. El objetivo de este estudio es establecer el patrón de dolor y discapacidad cervical de trabajadores con pantallas de visualización de datos, así como determinar los factores que predominan en la aparición de un nuevo episodio de dolor de espalda. Se realizó un estudio descriptivo-correlacional, en una muestra de 88 trabajadores usuarios de ordenadores de la Consellería de Sanidade (Xunta de Galicia). Los trabajadores respondieron los cuestionarios: "Neck Disability Index", "Escala analógica visual", "12-item Short Form Health Survey" y se realizó un análisis postural. Para el análisis comparativo se realizaron las pruebas T Student y U de Mann-Whitney. Un análisis de regresión logística binaria se utilizó para la extracción de un modelo predictivo de episodio de dolor cervical. El 58% refirieron dolor cervical. No existieron diferencias significativas entre hombres y mujeres. Las variables que mejor predicen la aparición de un nuevo episodio de dolor son el nivel de discapacidad y la calidad de vida física. Los resultados indican que un trabajador con altos niveles de discapacidad cervical y bajos valores de calidad de vida física, tiene mayor probabilidad de sufrir un episodio de dolor.

Abstract Work-related neck/shoulder disorders are considered an important health issue. This study is aimed at establishing the pain and cervical disability patterns of workers with visual display terminals, as well as at determining the factors that mostly affect the onset of a new episode of back pain. A descriptive, correlational study was carried out on a sample of 88 workers who use visual display terminals, of the Ministry of Health (Xunta de Galicia). The workers completed the following questionnaires: "Neck Disability Index Scale," "Visual Analog Scale," "12-item Short Form Health Survey," and an individual postural analysis was conducted. For the comparative analysis, the Student's t-test, and the Mann-Whitney U test were performed. A binary logistic regression analysis was used to extract a predictive model of a cervical pain episode, and 58% reported cervical pain. There were no differences between men and women. The variables that best predict the onset of a new episode of pain are the level of disability, and the quality of physical life. Study results indicate that a worker who uses visual display terminals, with high levels of cervical disability and low values of physical quality of life, is more likely to suffer an episode of back pain.

Legislation for disabled people in Brazil: from human dignity to social inclusion: advancing capabilities as an ethical imperative / Legislación para los discapacitados en Brasil: de la dignidad humana a la inclusión social: el avance de las capacidades como imperativo ético / Legislação para os incapacitados no Brasil: da dignidade humana à inclusão social: o avanço das capacidades como imperativo ético

Abstract The study analyzes the ethical and legal basis of Brazilian legislation for people with disabilities and verifies whether the instruments used therein are in line with national and international law. It also investigates the coherence and cohesion of the law and its ethical norms to build an inclusive and just society. Through an exploratory and integrative review, it analyzed the legal provisions in force in Brazil published on the official websites of the Brazilian federal government and available on the Internet. It was evaluated whether the definition used for persons with disabilities follows the United Nations Convention on the Rights of Persons with Disabilities. Also, whether it is necessary to evaluate disabilities and who should perform this task professionally. Thirty-three legal norms were found, among which only three laws and two decrees are in line with the recommendations of the UN Convention. It is necessary to review the existing norms and promote the consolidation of laws, decrees, ordinances and normative instructions regarding the rights of persons with disabilities in a uniform manner, on an adequate technical-scientific basis. This review should be consistent with the provisions of the 1988 Federal Constitution, the International Convention on the Rights of Persons with Disabilities and the Brazilian Inclusion Law.

Resumen El estudio analiza el fundamento ético y jurídico de la legislación brasileña para las personas con discapacidad y comprueba si los instrumentos allí utilizados se ajustan al Derecho nacional e internacional. Además, investiga la coherencia y cohesión de la ley y sus normas éticas para construir una sociedad inclusiva y justa. Mediante revisión exploratoria e integrativa, analizó las disposiciones legales vigentes en Brasil publicadas en los sitios web oficiales del gobierno federal brasileño y disponibles en Internet. Se evaluó si la definición utilizada para las personas con discapacidad sigue la Convención de las Naciones Unidas sobre los Derechos de las Personas con Discapacidad. También, si es necesario evaluar las discapacidades y quién debe realizar esa tarea profesionalmente. Se encontraron 33 normas legales, entre las cuales solo tres leyes y dos decretos se ajustan a las recomendaciones de la Convención de las Naciones Unidas. Es necesario revisar las normas existentes y promover la consolidación de las leyes, decretos, ordenanzas e instrucciones normativas relativas a los derechos de las personas discapacitadas de manera uniforme, sobre una base técnico-científica adecuada. Esta revisión debe ser coherente con las disposiciones de la Constitución Federal de 1988, la Convención Internacional sobre los Derechos de las Personas con Discapacidad y la Ley de Inclusión brasileña.

Resumo O estudo analisa o fundamento ético e jurídico da legislação brasileira para as pessoas com incapacidade e comprova se os instrumentos ali utilizados se ajustam ao Direito nacional e internacional. Além disso, investiga a coerência e coesão da lei e suas normas éticas para construir uma sociedade inclusiva e justa. Mediante revisão exploratória e integrativa, analisou as disposições legais vigentes no Brasil publicadas nos sites web oficiais do governo federal brasileiro e disponíveis na Internet. Avaliou-se se a definição utilizada para as pessoas com incapacidade segue a Convenção das Nações Unidas sobre os Direitos das Pessoas com Incapacidade. Também, se é necessário avaliar as incapacidades e quem deve realizar essa tarefa profissionalmente. Se encontraram 33 normas legais, entre as quais somente três leis e dois decretos se ajustam às recomendações da Convenção das Nações Unidas. É necessário revisar as normas existentes e promover a consolidação das leis, decretos, regulamentos e instruções normativas relativas aos direitos das pessoas incapacitadas de maneira uniforme, sobre uma base técnico-científica adequada. Esta revisão deve ser coerente com as disposições da Constituição Federal de 1988, a Convenção Internacional sobre os Direitos das Pessoas com Incapacidade e a Lei de Inclusão brasileira.

Memoria episódica posterior a cirugía de epilepsia del lóbulo temporal / Episodic memory after temporal lobe epilepsy surgery

RESUMEN INTRODUCCIÓN: La cirugía resectiva del lóbulo temporal anterior con amigdalo-hipocampectomía es un tratamiento efectivo para la epilepsia farmacorresistente del lóbulo temporal con esclerosis hipocampal. Sin embargo, este procedimiento conlleva riesgo de deterioro de la memoria episódica verbal y no verbal postoperatoria, dependiendo de la dominancia hemisférica para la memoria y el lenguaje. OBJETIVO: Explorar el desenlace de la memoria episódica posterior a la cirugía resectiva mediante lobectomía temporal anterior con amigdalo-hipocampectomía. MÉTODOS: Se analizó retrospectivamente la memoria episódica verbal y no verbal mediante pruebas neurop-sicológicas de 51 pacientes consecutivos sometidos a lobectomía temporal anterior con amigdalo-hipocampectomía del lado izquierdo y derecho. Todos los pacientes fueron sometidos a resonancia magnética cerebral preoperatoria, video-electroencefalografía y evaluaciones neuropsicológicas. A 12 pacientes (24 %) no se les realizó el test de Wada. RESULTADOS: Hubo disminución en la memoria episódica verbal postoperatoria con diferencias respecto a la preoperatoria, en la subprueba de textos II recuerdo de la escala de memoria de Wechsler III (p = 0,035). El resultado en la memoria episódica visual se mantuvo igual, no hubo diferencias en el grupo de lobectomía temporal estándar. CONCLUSIÓN: La lobectomía temporal anterior más amigdalo-hipocampectomía izquierda afecta levemente el desempeño de la memoria episódica postoperatoria, que clínicamente no es significativo en pacientes con epilepsia del lóbulo temporal mesial farmacorresistente.

SUMMARY INTRODUCTION: Resective surgery of the anterior temporal lobe with amygdalohippocampectomy is an effective treatment for drug-resistant epilepsy of the temporal lobe with hippocampal sclerosis. However, this procedure carries a risk of post-operative episodic verbal and nonverbal memory impairment depending on the hemispheric dominance for memory and language. OBJECTIVE: To explore the outcome of episodic memory after resective surgery by means of anterior temporal lobectomy with amygdalohippocampectomy. METHODS: Verbal and non-verbal episodic memory was retrospectively analyzed by neuropsychological tests of 51 consecutive patients undergoing anterior temporal lobectomy with amygadalohyppocampectomy on the left and right sides. All patients underwent preoperative brain MRI, video electroencephalography, and neuropsychological evaluations. 12 patients (24%) did not undergo the Wada test. RESULTS: There was a decrease in postoperative verbal episodic memory with differences compared to preoperative, in the text II subtest recall of the Wechsler III memory scale (p = 0.035). The result in visual episodic memory remained the same, there were no differences in the standard temporal lobectomy group. CONCLUSION: Anterior temporal lobectomy plus left amygadalohyppocampectomy slightly affects the performance of postoperative episodic memory, which is clinically not significant in patients with drug-resistant mesial temporal lobe epilepsy.

Pronóstico en pacientes con ataque cerebrovascular isquémico de circulación posterior / Functional outcome in posterior circulation acute ischemic stroke patients

RESUMEN INTRODUCCIÓN: El ochenta por ciento de los ataques cerebrovasculares son isquémicos, y uno de cada cinco afecta la circulación posterior. Su diagnóstico es difícil y los datos disponibles sobre el pronóstico y la mortalidad son discordantes. OBJETIVO: Evaluar el desenlace funcional a 180 días de los pacientes con ataque cerebrovascular (ACV) isquémico de circulación posterior (CP). MATERIALES Y MÉTODOS: Seguimiento prospectivo a pacientes con ACV de CP que ingresaron al Instituto Neurológico de Colombia entre septiembre del 2017 y septiembre del 2018. El desenlace clínico fue determinado mediante la escala Rankin modificada (mRS) al mes, a los seis meses y al año. RESULTADOS: Fueron incluidos 68 pacientes. La edad promedio fue 61 ±17 años y 60,3 % fueron hombres. El 85% tenía un mRS previo al ACV ≤ 1 y el 63 % un NIHSS basal ≤ 4. Nueve pacientes (13,2 %) recibieron terapia de reperfusión aguda (rtPA, TEV o ambas) y siete (10,3 %) adicionales arteriografía diferida. Dieciséis pacientes (23,5 %) presentaron una mejoría del NIHSS basal ≥ 4 puntos. Cuarenta y seis pacientes (74,2 %) presentaron un desenlace excelente mRS 0-1 a los seis meses y 87,1 % fueron categorizados mRS favorable (mRS 0-2). En el análisis ajustado, el NIHSS ≥ 4 fue un predictor de desenlace desfavorable a seis meses (RR 6,4; IC95 % 2,9-14,2). Seis pacientes (9,0 %) fallecieron, cuatro relacionados con el episodio actual o su recurencia. CONCLUSIONES: La mayoría de los pacientes con ACV de CP tienen desdenlaces favorables y una baja mor%talidad. La escala de NIHSS basal es un factor pronóstico independiente.

SUMMARY BACKGROUND: Ischemic strokes account for 80 % of all strokes, and one of every five compromises the posterior circulation. The diagnosis is difficult, and the data available about the outcome and mortality are discordant in the literature. OBJECTIVE: To investigate the clinicai outcome of patients at 180 days after posterior circulation ischemic stroke METHODS: Patients with diagnosis of posterior circulation stroke admitted to Instituto Neurológico de Colombia between September 2017 to 2018 were prospective included. The functional outcome by modified Rankin scale score (mRS) was determined at 1-month, 6-month, and 12-month after disease onset. RESULTS: 68 patients were included. The median age was 61 years ± 17 and 60.3 % were male. 85 % had a baseline mRS ≤ 1, and 63 % had a baseline National Institute Stroke Scale (NIHSS) ≤ 4. Nine patients were taken to acute recanalization therapies (rtPA, endovascular therapy or both) and seven more delayed arteriography. Sixteen patients (23.5 %) demonstrated an improvement of four or more points over the baseline NIHSS. Forty-six patients (74.2 %) had an excellent outcome 0-1 at six months and 87,1 % were categorized favorable mRS (mRS 0-2). In the adjusted analysis an NIHSS > 4 was a predictor of an unfavorable outcome at 6-month (RR 6.4; IC95 % 2.9-14.2). Six patients died (9 %); four of them in relation to the current event or an ischemic stroke recurrence. CONCLUSION: Most of the patients with posterior ischemic stroke have favorable outcomes and a low mortality. The baseline NIHSS is an independent prognostic risk factor.

Retraso en el diagnóstico como factor pronóstico de discapacidad en pacientes con lepra en Paraguay: estudio de casos y controles / Delay in diagnosis as a prognostic factor for disability in patients with leprosy in Paraguay: case and control study

INTRODUCCIÓN: La lepra, una infección crónica, es una de las mayores causas de discapacidad prevenible. El inicio temprano del tratamiento previene el desarrollo de discapacidad. OBJETIVO: Identificar los factores pronóstico de discapacidad en individuos con lepra multibacilar y paucibacilar que culminaron el tratamiento farmacológico entre el 2011 y 2017 en Paraguay. PACIENTES Y MÉTODOS: Se realizó un estudio de casos y controles, con 34 pacientes, 9 casos, 25 controles. Los casos fueron pacientes con discapacidad Grado 1 que presentaban falta de sensibilidad en miembros inferiores o superiores, y los de Grado 2, lagoftalmos, rigidez, ulceraciones, garra pasiva, garra activa. Los controles no presentaron discapacidad. RESULTADOS: La edad media de los pacientes fue 53 ± 15,2 años, el 55,9% fue de sexo masculino y 58,9% tenía educación primaria o no tenía educación formal. El 58,8% de los pacientes presentó lepra multibacilar; y el 64,7% fue diagnosticado tras consultar con dos o más médicos. Retraso en el diagnóstico mayor a un año fue significativamente (p = 0,047) mayor en los casos que en los controles (77,8 vs 12%; OR: 7,44; IC95%: 1,02-67,86). CONCLUSIÓN: El retraso en el diagnóstico mayor a un año es un factor pronóstico de discapacidad.

BACKGROUND: Leprosy, a chronic infectious disease, is one of the major causes of preventable disability. Early treatment prevents neurological damage and disability. AIM: To identify prognostic factors of disability in individuals with multibacillary and paucibacillary leprosy who completed a drug treatment between 2011 and 2017 in Paraguay. METHODS: A case-control study was carried out on 34 patients, of them 9 were cases and 25 controls. Cases were those patients with Grade 1, presented lack of sensation in lower or upper limbs, and those of Grade 2 lagophthalmos, rigidity, visible deformity ulcerations, passive claw, active claw. Controls had no disabilities. RESULTS: Mean age of the patients was 53 ± 15.2 years, 55.9% were male, and 58.9% had primary education or no formal education. Multibacillary leprosy was found in 58.8% of patients; and 64.7% were diagnosed after consulting with two or more physicians. Diagnosis delay of more than one year was significantly (p = 0.047) greater in the cases than in the controls (77.8% vs 12%; OR: 7.44; 95% CI: 1.02-67.86). CONCLUSION: In this study, a diagnosis delay of more than one year is a prognostic factor for disability.

Determinants of disability development in patients with multiple sclerosis / Determinantes do desenvolvimento de deficiência em pacientes com esclerose múltipla

Abstract Background: Multiple sclerosis (MS) is one of the most common chronic neurological diseases affecting the central nervous system in young adults. Objective: To investigate demographic and clinical factors that are effective in the development of irreversible disability from the onset of MS, and to identify factors that affect the transformation from the relapse-remitting MS (RRMS) phase to the progressive MS (PMS) phase. Methods: Retrospective study on 741 patients who were diagnosed with RRMS and PMS according to the McDonald criteria, and were enrolled into the Turkish MS database of the Department of Neurology MS Polyclinic, at the Faculty of Medicine, Karadeniz Technical University, in Trabzon, Turkey. Kaplan-Meier analysis was used to evaluate the time taken to reach EDSS 4 and EDSS 6 from the onset of disease, and the time taken between EDSS 4 and EDSS 6. Results: Age of onset >40 years; having polysymptomatic-type onset, pyramidal or bladder-intestinal system-related first episode; ≥7 episodes in the first 5 years; and <2 years between the first two episodes were found to be effective for MS patients to reach EDSS 4 and EDSS 6. The demographic and clinical parameters that were effective for progression from EDSS 4 to EDSS 6 were: pyramidal or bladder-intestinal system-related first episode; 4‒6 episodes in the first 5 years; >2 years until start of first treatment; and smoking. Conclusions: Our findings reveal important characteristics of MS patients in our region. However, the associations between these parameters and MS pathophysiology remain to be elucidated.

RESUMO Introdução: A esclerose múltipla (EM), uma das doenças neurológicas crônicas mais comuns, afeta o sistema nervoso central em jovens adultos. Objetivo: Investigar fatores demográficos e clínicos que são efetivos no desenvolvimento de deficiência irreversível, desde o início da EM, e identificar fatores que afetam a transformação da fase de EM recorrente-remitente (EMRR) para a fase de EM secundária progressiva (EMSP). Métodos: Estudo retrospectivo de 741 pacientes que foram diagnosticados com EMRR e EMSP, de acordo com os critérios de McDonald, e inscritos no banco de dados turco MSBase, do Departamento de Neurologia da MS Polyclinic, da Universidade Técnica de Karadeniz, Turquia. Análise de Kaplan-Meier foi usada para avaliar o tempo para alcançar EDSS 4 e EDSS 6, desde o início da doença e o tempo entre EDSS 4 e EDSS 6. Resultados: Idade de início>40 anos, início do tipo polissintomático, primeiro ataque relacionado ao sistema piramidal ou bexiga-intestinal, ≥7 recaídas nos primeiros 5 anos e <2 anos entre os dois primeiros ataques foram considerados eficazes em pacientes com EM que atingiram EDSS 4 e EDSS 6. Parâmetros demográficos e clínicos que foram efetivos no progresso de EDSS 4 para EDSS 6: primeiro ataque relacionado ao sistema piramidal ou bexiga-intestinal, 4‒6 recaídas nos primeiros 5 anos, >2 anos até o início do primeiro tratamento e tabagismo. Conclusão: Estudo revelou características importantes dos pacientes com EM em nossa região. No entanto, as associações entre esses parâmetros e a fisiopatologia da EM ainda precisam ser elucidadas.

Real-world effectiveness of natalizumab treatment in patients with relapsing multiple sclerosis in Argentina and Chile / Efectividad en el mundo real del tratamiento con Natalizumab para pacientes con esclerosis múltiple recurrente en Argentina y Chile

ABSTRACT Background: The real-world effectiveness of natalizumab in people with relapsing multiple sclerosis (PwRMS) in Argentina and Chile has not been reported. Objective: To evaluate the effectiveness of natalizumab treatment in PwRMS in Argentina and Chile, in clinical practice. Methods: We conducted a multicenter retrospective and observational study. We reviewed the medical records of PwRMS who had been treated with natalizumab for at least one year, without any interruption in MS treatment that lasted more than 12 weeks. We analyzed changes in annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) score and magnetic resonance imaging (MRI). Results: We enrolled 117 PwRMS treated with natalizumab. Natalizumab treatment was associated with a significant reduction in ARR from baseline after one year and two years of treatment (from 1.97 to 0.06 and 0.09 respectively; p<0.01 at each time point). From baseline, EDSS scores were reduced by 0.71 and 0.73 points at one and two years, respectively (p<0.01). No worsening of disability was observed in 82.9 and 67.5% of PwRMS at one and two years, respectively. The improvement in disability was 44.4% at one year and 39.3% at two years. During natalizumab treatment, the number of relapse-related hospitalizations was significantly reduced (p<0.01). MRI lesions (new/enlarging T2 or gadolinium-enhancing) were significantly reduced, compared with baseline. No evidence of disease activity was observed in 65% at two years of natalizumab treatment. Conclusions: Natalizumab significantly reduced disease activity in PwRMS in Argentina and Chile, in clinical practice. Natalizumab also decreased the number of hospitalizations compared with pre-natalizumab treatment.

RESUMEN Antecedentes: La efectividad de Natalizumab en personas con esclerosis múltiple recurrente (PwRMS) en Argentina y Chile no se ha reportado. Objetivo: Evaluar la efectividad del tratamiento con Natalizumab en PwRMS en Argentina y Chile en la práctica clínica. Métodos: Estudio multicéntrico, retrospectivo y observacional. Revisamos los registros médicos de PwRMS que fueron tratados con Natalizumab al menos 1 año, sin interrupción de tratamiento para EM durante más de 12 semanas. Analizamos los cambios en la tasa anualizada de recaídas (ARR), escala de discapacidad expandida (EDSS) y resonancia magnética (MRI). Resultados: Se incluyeron 117 PwRMS. El tratamiento con Natalizumab se asoció con una reducción significativa de la tasa anualizada de recaídas (ARR) cada 1 y 2 años (de 1.97 a 0.06 y 0.09, respectivamente; p<0.01 en ambos casos). El EDSS se redujo 0,71 y 0,73 puntos al año 1 y 2, respectivamente (p<0,01). No se observó empeoramiento del EDSS en 82,9 y 67,5% de los PwRMS al año 1 y 2, respectivamente. La mejoría del EDSS fue 44,4 y 39,3% al año 1 y 2, respectivamente. El número de hospitalizaciones se redujo significativamente (p<0,01). Las lesiones en MRI (nuevas/agrandadas en T2 o con realce con gadolinio) se redujeron significativamente en comparación con el valor basal. No se observó evidencia de actividad de la enfermedad en el 65% de los PwRMS a 2 los años. Conclusiones: Natalizumab redujo significativamente la actividad de la enfermedad en PwRMS de Argentina y Chile en la práctica clínica. Además, disminuyó el número de hospitalizaciones comparado con el tratamiento previo.

Functional outcomes among stroke patients in Alagoas, Brazil: observational study

ABSTRACT BACKGROUND: Stroke is the principal cause of disability around the world and the ensuing functional dependence (FD) can be correlated with different factors. OBJECTIVE: To determine how demographic factors and clinical characteristics after stroke distinguish patients who achieve functional independence from those who do not. DESIGN AND SETTING: Observational study at specialized neurovascular clinic in Alagoas, Brazil. METHODS: FD was classified according to the modified Rankin scale (mRs): 0 to 2 points were classified as independent (FD-), and 3 to 5 points were classified as dependent (FD+). Logistic regression analysis included age, sedentary lifestyle, the Center for Epidemiological Studies - Depression Scale (CES-D) and the National Institutes of Health Stroke Scale (NIHSS). The Mann-Whitney test and χ2 test were used to compare groups. RESULTS: We included 190 stroke patients with a mean age of 60.02 ± 14.22 years. We found that 34.8% of the patients were classified as FD+. Lower NIHSS and CES-D scores were more associated with achieving functional independence. Most of the patients had access to physical therapy, and the mean duration of rehabilitation therapy was 65.2 minutes per week. Females had higher prevalence of depressive symptoms (P = 0.005) and rehabilitation time was shorter for hemorrhagic stroke (P = 0.02). CONCLUSION: We found a FD rate four times greater than in another Brazilian study. Lower stroke severity and fewer depressive symptoms were associated with achieving functional independence. Less than half of the patients were referred to a rehabilitation service at hospital discharge and few had access to multidisciplinary treatment.