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

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

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

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

Physical Fitness Parameters of Elite Chinese Wheelchair Curlers / Parámetros de Aptitud Física de Curlers en Silla de Ruedas Chinos de Élite

SUMMARY: Few international studies have analyzed the characteristics of elite wheelchair curlers competing on the international stage. This study aims to investigate the physical fitness parameters of elite Chinese wheelchair curlers and explore the corresponding training enlightenment. Sixteen wheelchair curlers from the Chinese national team, including six male and two female Winter Paralympic gold medalists, were selected as research participants. The following parameters were measured: age, training age, height, weight, body fat percentage, grip strength, absolute bench press strength, and 5-km wheelchair push-timing test. Compared with ordinary curlers of the Chinese wheelchair curling team, elite curlers were older in age and training age; male curlers were shorter, whereas female curlers were taller. However, their weight and body fat percentage were lower, and their grip strength, absolute strength in the bench press, and 5-k wheelchair push-timing test were better. From an athlete development and physical training perspective, wheelchair curlers should increase training years in order to accumulate competition experience. Additionally, these athletes should manage their body weight and fat percentage, and improve their upper limb strength and aerobic capacity.

Pocos estudios internacionales han analizado las características de los curlers en silla de ruedas de élite que compiten en el escenario internacional. Este estudio tiene como objetivo investigar los parámetros de aptitud física de los bigudíes chinos en silla de ruedas de élite y explorar la iluminación del entrenamiento correspondiente. Se seleccionaron como participantes de la investigación dieciséis curlers en silla de ruedas del equipo nacional chino, incluidos seis medallistas de oro masculinos y dos femeninos de los Juegos Paralímpicos de Invierno. Se midieron los siguientes parámetros: edad, edad de entrenamiento, altura, peso, porcentaje de grasa corporal, fuerza de agarre, fuerza absoluta en press de banca y prueba de sincronización de empuje en silla de ruedas de 5 km. En comparación con los curlers ordinarios del equipo chino de curling en silla de ruedas, los curlers de élite eran mayores en edad y tiempo de entrenamiento; Los curlers masculinos eran más bajos, mientras que las mujeres eran más altas. Sin embargo, su peso y porcentaje de grasa corporal fueron menores, y su fuerza de agarre, fuerza absoluta en press de banca y prueba de sincronización de empuje en silla de ruedas de 5-k fueron mejores. Desde la perspectiva del desarrollo del atleta y del entrenamiento físico, los curlers en silla de ruedas deberían aumentar los años de entrenamiento para acumular experiencia en competencia. Además, estos deportistas deben controlar su peso corporal y porcentaje de grasa, y mejorar la fuerza de sus miembros superiores y su capacidad aeróbica.

Lista de ayudas técnicas en compra centralizada (CENABAST): 2024-2025 / List of technical aids in centralized purchasing (CENABAST): 2024-2025

Con el propósito de facilitar los procesos de prescripción y entrega, el Departamento de Rehabilitación y Discapacidad, de la División de Prevención y Control de Enfermedades disponibiliza en el presente listado, las AATT actualmente vigentes a través de la compra centralizada con CENABAST, el cual regirá hasta el año 2025.

Rotator Cuff Lesion in Wheelchair Users with Spinal Cord Injury: Does Time of Injury and Medullary Level Interfere? A Retrospective Evaluation / Lesão do manguito rotador em cadeirantes com lesão medular: O tempo de lesão e o nível medular interferem? Uma avaliação retrospectiva

Abstract Objective To describe magnetic resonance imaging (MRI) characteristics of shoulders from patients with spinal cord injury (SCI) and to correlate these findings with age, duration of SCI and neurological level. Method The study sample included patients with thoracic SCI over 18 years of age, who were active wheelchair users and had undergone an MRI of the shoulder from January 2004 to December 2015. Results We studied 41 shoulders (37 patients), including 27 men (65.9%) and 14 women (34.1%). At the time of MRI, the mean age was 41.9 years and the mean duration of SCI was 9.4 years. The analysis of the relationship between the duration of trauma and severity of the rotator cuff lesion (RCL), as well as between age and the severity of the shoulder injury showed a statistically significant difference (p< 0.001), with a positive association in both cases. No statistically significant difference (p= 0.095) was observed between the neurological level of the SCI and RCL. Conclusion In this study, a progressive increase in the severity of the shoulder lesions can be noted with advancing age and a longer duration of SCI. However, level of the SCI does not seem to interfere with RCL. Level of Evidence Level IV, case series.

Resumo Objetivo Descrever as características de ressonância magnética (RM) dos ombros de pacientes com lesão medular (LM) e correlacionar esses achados com idade, duração da LM e nível neurológico. Método A amostra do presente estudo incluiu pacientes maiores de 18 anos com LM torácica, que eram cadeirantes ativos e haviam sido submetidos a uma ressonância magnética do ombro de janeiro de 2004 a dezembro de 2015. Resultados Foram estudados 41 ombros (37 pacientes), incluindo 27 de pacientes do sexo masculino (65,9%) e 14 de pacientes do sexo feminino (34,1%). Na época da ressonância magnética, a média de idade era de 41,9 anos e a duração média da LM era de 9,4 anos. A análise da relação entre a duração do trauma e a gravidade da lesão do manguito rotador (LMR), bem como entre a idade e a gravidade da lesão do ombro mostrou diferença estatisticamente significativa (p< 0,001), com associação positiva em ambos os casos. Não foi observada diferença estatisticamente significativa (p= 0,095) entre o nível neurológico da LM e da LMR. Conclusão Neste estudo, pode-se notar um aumento progressivo da gravidade das lesões do ombro com o avanço da idade e uma maior duração da LM. No entanto, o nível da LM não parece interferir com a LMR. Nível de Evidência Nível IV, série de casos.

Frequência e eficácia dos arremessos por classe funcional e zonas de ataque na elite do basquetebol em cadeira de rodas / Throw frequency and effectiveness compared by functional classification and attack zones in elite wheelchair basketball / Frecuencia y efectividad de los lanzamientos por classe functional y zonas de ataque en la élite de baloncesto en silla de ruedas

Objetivo: O objetivo do estudo foi comparar as tentativas e eficácia dos arremessos entre as classes funcionais e zonas de ataque do basquetebol masculino em cadeira de rodas. Métodos: Os relatórios técnicos oficiais de todas as 42 partidas dos Jogos Paralímpicos Rio 2016 foram analisados e a quantidade de tentativas e eficácia por classe e quatro zonas de ataques foram anotadas. Para a comparação das distribuições de tentativas de arremessos por classes funcionais e zonas de ataque foi utilizado o teste qui-quadrado. Já o ANOVA one-way foi utilizado para verificar os efeitos principais das porcentagens do total de acertos e tentativas dos arremessos para cada zona da quadra e entre classes funcionais. Resultados e conclusão: Os principais resultados demonstraram que as classes mais elevadas (i.e., 3.0, 3.5, 4.0 e 4.5) representam 76% de todos os arremessos do jogo. Jogadores da classe 3.0 obtiveram significativamente maior frequência de arremessos nas zonas 1, 2 e 4 (áreas mais próximas da cesta). Enquanto os atletas da classe 4.0, apresentaram mais tentativas na zona 3 (área mais distante da cesta). Os jogadores das classes 3.5 e 4.0, comparados à classe 1.0, apresentaram maior eficácia na zona 1 (dentro do garrafão).

Objective: The aims of this study was to compare the frequency and effectiveness of throws by sport classes and attack zones of male wheelchair basketball. Methods: Official reports of all 42 matches from Rio 2016 Paralympics were analyzed. To compare the distributions of throws attempts by sport classes and attacking zones it was utilized the chi-square test. The ANOVA one-way was utilized to verify the main effects of the percentage of the total right throws and throwing attempts for each court zone and between sport classes. The frequency of throws and its effectiveness per class and four attack zones were noted. Results and conclusion: Our results showed that higher sport classes (i.e., 3.0, 3.5, 4.0 and 4.5) represent 76% of all throws performed during the matches. Players eligible by 3.0 sport class had significantly greater throws in zones 1, 2 and 4 (closest to the basket). Athletes of 4.0 class presented higher throw frequency in zone 3 (furthest from the basket). The players with 3.5 and 4.0 sport classes, compared to those with 1.0 class, showed greater effectiveness in zone 1 (in the painted area).

Objetivo: El objetivo del estudio fue comparar los intentos y la efectividad de los lanzamientos entre las clases funcionales y las zonas de ataque del baloncesto masculino en una silla de ruedas. Métodos: Se analizaron los informes técnicos oficiales de los 42 partidos de los Juegos Paralímpicos de Río 2016 y se anotó el número de intentos y efectividad por clase y cuatro zonas de ataque. Para comparar la distribución de los intentos de lanzamiento por clases funcionales y zonas de ataque, se utilizó la prueba de chi-cuadrado. El ANOVA de una vía se utilizó para verificar los efectos principales de los porcentajes del número total de golpes correctos e intentos de tiros para cada zona de la cancha y entre clases funcionales. Resultados y conclusión: Los resultados principales mostraron que las clases más altas (es decir, 3.0, 3.5, 4.0 y 4.5) representan 76% de todos los lanzamientos en el juego. Los jugadores de la clase 3.0 tuvieron lanzamientos significativamente más altos en las zonas 1, 2 y 4 (áreas más cercanas a la canasta). Mientras que los atletas de la clase 4.0, presentaron más intentos en la zona 3 (área más alejada de la canasta). Los jugadores de las clases 3.5 y 4.0, en comparación con la clase 1.0, mostraron una mayor efectividad en la zona 1 (dentro de la zona pintada).

Changing Concepts for the Diagnosis of Carpal Tunnel Syndrome in Powerlifting Athletes with Disabilities / Mudando os conceitos para o diagnóstico da Síndrome do Túnel do Carpo em atletas do halterofilismo do esporte adaptado

Abstract Objective To examine the prevalence of carpal tunnel syndrome in powerlifting athletes with disabilities. Methods The present study evaluated the presence and intensity of pain (numerical scale), nocturnal paresthesia (self-report), and nerve compression (Tinel and Phalen signs) in wheelchair- and non-wheelchair-bound powerlifting athletes with disabilities. The clinical diagnosis of carpal tunnel syndrome was confirmed by the presence of two or more signs/symptoms. Results In total, 29 powerlifting athletes with disabilities were evaluated. None of the athletes reported the presence of pain or nocturnal paresthesia. The Tinel sign was present in 1 (3.45%) wheelchair-bound athlete. A positive Phalen test was present in 3 (10.35%) athletes (1 wheelchair-bound and 2 non-wheelchair-bound). Concurrent positive Tinel sign and Phalen sign tests were found in 2 (6.89%) athletes (1 wheelchair-bound and 1 non-wheelchair-bound). Conclusion Carpal tunnel syndrome was clinically diagnosed in 2 (6.89%) out of 29 powerlifting athletes with disabilities.

Resumo Objetivo Examinar a prevalência da síndrome do túnel do carpo em atletas do halterofilismo do esporte adaptado. Métodos Este estudo avaliou a presença e a intensidade da dor (escala numérica), a parestesia noturna (autorrelato), e a compressão nervosa (sinais de Tinel e de Phalen) em atletas do halterofilismo do esporte adaptado em cadeira de rodas e sem cadeira de rodas. O diagnóstico clínico da síndrome do túnel do carpo foi confirmado pela presença de dois ou mais sinais/sintomas. Resultados Vinte e nove atletas de halterofilismo de esporte adaptado foram avaliados. Nenhum dos atletas relatou a presença de dor ou parestesia noturna. O sinal de Tinel estava presente em 1 (3,45%) atleta de cadeira de rodas. O teste de Phalen positivo estava presente em 3 (10,35%) atletas (1 em cadeira de rodas e 2 sem cadeira de rodas). Testes positivos de sinais de Tinel e de Phalen foram encontrados concomitantemente em 2 (6,89%) atletas (1 em cadeira de rodas e 1 sem cadeira de rodas). Conclusão A síndrome do túnel do carpo foi diagnosticada clinicamente em 2 (6,89%) dos 29 atletas com deficiência física.

Epidemiology and Outcome of Powered Mobility Device-Related Injuries in Korea

BACKGROUND: This study described and analysed the features of powered mobility device (PMD)-related injuries and compared elderly and younger adult injuries.METHODS: Data from Korea Emergency Department-based Injury In-depth Surveillance (EDIIS) database involving eight emergency departments in 2011–2016 were analysed. The inclusion criteria were injuries sustained during the use of PMDs. The variables were compared between adults aged ≥ 65 years and younger adults. Primary and secondary outcomes were severe trauma and poor clinical course accordingly. The logistic regression analysis was used to identify risk factors for study outcomes.RESULTS: A total of 231 adults were enrolled, of whom 150 were ≥ 65 years of age. The total number of PMD-related injuries and the proportion of elderly injured patients increased annually, and most injuries occurred on the roadway and did not involve crash opponents. By multivariate analysis, patients aged ≥ 65 years had a higher injury severity score (adjusted odds ratio [AOR], 2.78; 95% confidence interval [CI], 1.50–5.40) and had a higher incidence of intensive care unit admissions, surgery, and death (AOR, 2.42; 95% CI, 1.16–5.28).CONCLUSION: Given the higher number and severity of injuries sustained among elderly adults ≥ 65 years of age shown in this study, we recommend that safety educations, such as the use of protective equipment and the safe driving on the roadway, are considered for PMD users ≥ 65 years of age.

Processos psicossociais da aquisição de uma deficiência / Psychosocial processes of acquiring a disability / Procesos psicosociales de la adquisición de una discapacidad

A aquisição de uma deficiência pode ter extenso impacto na vida de uma pessoa, pois ocorre, muitas vezes, sob condições traumáticas e obriga tanto a ressignificações subjetivas quanto a adaptações práticas no cotidiano. O principal objetivo do trabalho aqui descrito consistiu em compreender aspectos psicossociais do processo de aquisição de uma deficiência, considerando diversos fatores que podem interferir nestas experiências. Para a realização da pesquisa, foram entrevistadas, de forma semiestruturada, 13 pessoas que adquiriram uma deficiência física, auditiva ou visual na idade adulta, sendo os relatos analisados pelo método de análise de conteúdo. Ao se discutir as falas dos pesquisados, são traçadas algumas semelhanças e distinções entre as experiências dos participantes, buscando também tecer considerações com base na literatura acadêmico-científica sobre o tema. Observou-se que os processos psicossociais de aquisição da deficiência foram permeados tanto por sentimentos negativos, relacionados à angústia e à depressão, bem como por reações mais harmônicas e de valorização da vida, em que se relativiza a perda do membro ou da capacidade sensorial. Representando um momento marcante na vida de quem a adquire, a deficiência pode levar à aprendizagem e ao amadurecimento, à medida que o tempo após a aquisição aumenta. Entende-se que os estudos acerca da deficiência, em especial a adquirida, devem ser ampliados e aprofundados, tendo em vista que o campo de estudos sobre esta temática ainda precisa de mais contribuições a respeito.(AU)

Becoming disabled may cause a considerable impact in someone's life, because, in most of the cases, it happens under traumatic conditions and it results in subjective resignification and practical adaptations. The main objective of this study is to understand the psychosocial aspects involved in becoming disabled, considering several factors which may interfere these experiences. For this research, 13 people who got a physical disability, a hearing or visual impairment in adulthood were interviewed in a semi-structured way and the results were evaluated using the content analysis method of Bardin (2011). When the speeches of the interviewed people are evaluated, some comparisons and distinctions among experiences of the participants are made for establishing relations with academic-scientific literature on this theme. It was noticed that the psychosocial processes involved in becoming disabled were permeated by negative feelings related to anguish and depression, as well as more harmonic reactions and valorization of life, in which the loss of a member or of a sensorial capability is relativized. As a defining moment in the lives of those who acquired it, the disability may result in learning and maturating over the years after the event. It is recommended that the studies concerning disability, especially the acquired ones, get broadened and deepened because there is a need for more contributions about this subject.(AU)

La adquisición de una discapacidad puede tener un amplio impacto en la vida de una persona, pues ocurre, muchas veces, bajo condiciones traumáticas y requiere tanto la reinterpretación subjetiva como las adaptaciones prácticas en la vida cotidiana. El principal objetivo del trabajo que se describe aquí fue entender los aspectos psicosociales del proceso de adquisición de una discapacidad, teniendo en cuenta diversos factores que pueden interferir en estas experiencias. Para la investigación, fueron entrevistadas de manera semiestructurada, 13 personas que adquirieron una discapacidad física, auditiva o visual en la edad adulta, siendo los relatos analizados por el método de análisis de contenido. En la discusión de los relatos de los entrevistados, son trazadas algunas similitudes y diferencias entre las experiencias de los participantes, buscando también tejer consideraciones con base en la literatura académica y científica sobre el tema. Se observó que los procesos psicosociales de adquisición de la discapacidad fueron permeados tanto por sentimientos negativos relacionados con la angustia y la depresión, así como por las reacciones más armónicas y de valorización de la vida, en que se relativiza la pérdida de un miembro o la capacidad sensorial. Representando un momento decisivo en la vida de quién la adquiere, la discapacidad puede llevar al aprendizaje y al crecimiento, a medida que el tiempo después de la adquisición aumenta. Se entiende que los estudios acerca de la discapacidad, en especial la adquirida, deben ser ampliados y profundizados, teniendo en cuenta que el campo de los estudios sobre este tema aún necesita más contribuciones al respecto.(AU)

Study on the Injury and Rehabilitation of Racket Athletes with Disabilities

PURPOSE: This study examined the injury and rehabilitation of athletes with disabilities in racket sports projects (i.e., badminton, table tennis, and wheelchair tennis). In addition, the characteristics of each project and the differences among those projects are discussed. METHODS: Business team athletes with disabilities in racket sport were enrolled as subjects (i.e., 19 badminton athletes, 19 table tennis athletes, and 19 wheelchair tennis athletes). The real conditions of the injury, injury severity, injury site, symptoms, and rehabilitation methods after injury were analyzed. RESULTS: No significant differences were observed among the actual condition, injury severity, symptoms and the methods of rehabilitation on racket sport for athletes (i.e., badminton, table tennis, and wheelchair tennis athletes) with disability. The differences were focused mainly on the injury sites due to the characteristics of the different projects, and specific technical actions. CONCLUSION: This study examined the real condition of the injury, injury severity, injury site, symptoms and rehabilitation methods after the injury on the rackets (i.e., badminton, table tennis, and wheelchair tennis) athletes with disabilities. The data can be used to eliminate the incidence of injury and minimize the injury severity for racket athletes with disabilities. In addition, it can also be used for the disabled, who like racket projects, as the fundamental material to prevent injury and assist in recovery.

Transition to motherhood and mothering for women in wheelchairs: a nursing perspective / Transición hacia la maternidad y el maternaje en mujeres usuarias de silla de ruedas: perspectiva de la enfermería / Transição para maternidade e maternagem em mulheres cadeirantes: perspectiva da enfermagem

ABSTRACT Objective: To discuss the process of transition to motherhood and mothering of women who are wheelchair users, from the perspective of Afaf Ibrahim Meleis. Method: Qualitative, descriptive, exploratory study conducted with six women in the state of Rio de Janeiro. The Life Narrative method was used, with thematic analysis in the light of Transitions Theory. Results: Developmental and situational transitions occurred and were influenced by personal, community and social factor. Moved mainly by ignorance and prejudice of family members and of the social network, these factors were not barriers for motherhood and mothering. Final Considerations: The reproductive rights of women with disabilities must be respected and, for this, inclusive policies focused on women with disabilities should be adopted.

RESUMEN Objetivo: Discutir el proceso de transición hacia la maternidad y el maternaje de mujeres usuarias de silla de ruedas según la perspectiva de Afaf Ibrahim Meleis. Método: Se trata de un estudio cualitativo, descriptivo, exploratorio, realizado entre 6 mujeres usuarias de silla de ruedas y residentes en el estado de Río de Janeiro. Se utilizó el método Narrativa de Vida con análisis temático a la luz de la Teoría de la Transición. Resultados: Se produjeron transiciones de desarrollo y de situación, influenciadas por factores personales, comunitarios y sociales. Movidos principalmente por el desconocimiento, el prejuicio de la familia y de la red social, estos factores no fueron un impedimento para el ejercicio de la maternidad y del maternaje. Consideraciones finales: Deben respetarse los derechos reproductivos de las mujeres con movilidad reducida y para lograr este cometido se hace necesario adoptar políticas transversales con prácticas inclusivas.

RESUMO Objetivo: Discutir o processo de transição para a maternidade e maternagem de mulheres cadeirantes na perspectiva de Afaf Ibrahim Meleis. Método: Estudo qualitativo, descritivo, exploratório, realizado com 6 mulheres cadeirantes residentes no estado do Rio de Janeiro. Utilizou-se o método Narrativa de Vida com análise temática à luz da Teoria da Transição. Resultados: Ocorreram as transições desenvolvimental e situacional, com influência de fatores pessoais, comunitários e sociais. Movidos principalmente por desconhecimento, preconceito da família e da rede social, esses fatores não foram impedimentos para o exercício da maternidade e da maternagem. Considerações finais: Os direitos reprodutivos da mulher cadeirante devem ser respeitados e, para isso, políticas transversais devem ser adotadas com práticas inclusivas às mulheres com deficiência.

Decreased respiratory performance of children and adolescents with myelomeningocele who use a wheelchair - preliminary data

Myelomeningocele (MMC) is a neural tube defect that often causes spinal cord injury at the thoracolumbar region, as well as sensory and motor paralysis in the lower limbs. This leads to continuous use of a wheelchair and, consequently, a sedentary lifestyle, predisposition to muscle weakness, cardiovascular and respiratory disorders, obesity, and structural alterations in the spine. We assessed the respiratory function and shoulder strength of MMC participants who were wheelchair-users and had no respiratory complaints and compared them to healthy children and adolescents. MMC (n=10) and healthy (n=25) participants of both genders with a mean age of 12.45 years (SD=2.1) were assessed for weight, height, respiratory performance, and isometric peak for shoulder flexors, extensors, abductors, and adductors, using an isokinetic dynamometer. Medullary lesion, functional levels, and abnormal curvatures of the spine were assessed for MMC participants. The level of spinal cord injury for the majority of the MMC participants was high lumbar and they had scoliosis. MMC showed lower values for forced vital capacity, forced expiratory volume at the first second, forced expiratory flow (25-75%), maximal voluntary ventilation, and isometric peak for shoulder flexors and adductors compared to healthy participants. This indicated a decreased vital capacity, respiratory muscle endurance, and shoulder muscle strength.

Parámetros antropométricos de atletas paralímpicos usuarios de silla de ruedas de la región del Biobío / Anthropometric parameters of paralympic athletes wheelchair users of the Biobío region

El presente estudio, tuvo como objetivo determinar el índice de masa corporal (IMC) y porcentaje de grasa corporal (%GC) de los atletas con proyección paralímpica, usuarios de sillas de ruedas, pertenecientes a la región del Biobío. El estudio fue de diseño no experimental transversal de alcance descriptivo. La evaluación antropométrica se realizó a través del protocolo ISAK. Se determinó peso y estatura utilizando una balanza con tallímetro (Seca 220), circunferencia de cintura con una cinta Lufkin y 6 pliegues con un plicómetro Harpenden (0,2 mm). El porcentaje de grasa corporal se determinó, por medio de las ecuaciones de Durnin and Womersley y Siri. Los atletas en silla de ruedas presentaron una edad promedio de 35,4 mas menos 11,2 años, obteniendo un IMC promedio de 30,0 mas menos7,1 kg/m2, y un %GC de 26,9 mas menos 7. Los atletas usuarios de silla de ruedas con proyección paralímpica, presentan un alto porcentaje de grasa corporal y clasificaciones de IMC y %GC que los categorizan en personas que presentan obesidad.

The objective of this study was to determine the body mass index (BMI) and body fat percentage of athletes with Paralympic projection, wheelchair users, belonging to the Biobío region. The study was of a non-experimental crosssectional design with a descriptive scope. The anthropometric evaluation was carried out through the ISAK protocol. Weight and height were determined using a balance with stadiometer (Seca 220), waist circumference with a Lufkin tape and 6 folds with a Harpenden pichometer (0.2mm). The percentage of body fat was determined, by means of the Durnin and Womersley equations and Siri. The athletes in wheelchairs presented an average age of 35.4 more less 11.2 years, obtaining an average BMI of 30.0 more less 7.1 kg / m2, and a GC% of 26.9 more less 7. Athletic wheelchair users with Paralympic projection, have a high body fat percentage and BMI ratings and GC% that categorize them as people who are obese

Tecnologias assistivas: aspectos que influenciam na assiduidade e no abandono dos recursos / Assistive technologies: aspects influencing assurance and abandonment of resources

As tecnologias assistivas são recursos utilizados para potencializar habilidades funcionais e proporcionar autonomia e independência. Pessoas com deficiência possuem a garantia de acesso a esses recursos, com prescrição de profissionais dos serviços de reabilitação do Sistema Único de Saúde (SUS). Objetivo: Verificar aspectos envolvidos com a adesão e abandono de órteses, próteses e cadeiras de rodas. Método: Trata-se de um estudo transversal, os dados foram coletados através de uma entrevista estruturada que questiona o processo de prescrição, benefícios e continuidade ou abandono de uso dos equipamentos. A população do estudo foi de indivíduos de 18 a 80 anos que receberam tecnologias assistivas dispensadas no período de janeiro a dezembro de 2017 através de um Centro Especializado em Reabilitação, município de Santa Maria - RS. Resultados: Em 2017 foram dispensadas 400 equipamentos, sendo entrevistadas 31 pessoas desse quantitativo, pois muitos dos beneficiados não residem no município, não consentindo em participar. As 31 pessoas receberam 38 equipamentos, sendo 6 cadeiras motorizadas, 13 manuais, 8 próteses de membro inferior, 1 de membro superior, 7 órteses de membro inferior e 3 de membro superior. Destes equipamentos, 20 continuam sendo utilizados e 18 foram abandonados. Os benefícios mais relatados foram a melhor estabilidade e a facilitação do deslocamento propiciada pelos recursos. Conclusão: A maioria dos beneficiários foram adultos e idosos, sendo que a cadeira manual e a prótese de membro inferior foram os equipamentos mais dispensados. Foi verificado que houve significativo número de abandono sugerindo que ocorreram inadequações no momento da prescrição, resultando no abandono.

Assistive Technologies are resources used to enhance functional abilities and provide autonomy and independence. Persons with disabilities are guaranteed access to these resources, with prescription from professionals in the rehabilitation services of the Unified Health System (SUS). Objective: Check aspects involved with adhesion and abandonment of orthoses, prostheses and wheelchairs. Method: This was a cross-sectional study, the data were collected through a structured interview that questions the prescription process, benefits and continuity or abandonment of use of the equipment's. The study population were individuals aged 18 to 80 years who received assistive technologies dispensed in the period from January to December of 2017 through a Specialized Center in Rehabilitation, of the municipality of Santa Maria - RS. Results: In 2017,400 equipment were dispensed, being interviewed 31 people of this amount, since many of the beneficiaries do not reside in the municipality, not consenting to participate. The 31 people received 38 equipment, 6 motorized chairs, 13 manuals, 8 lower limb prostheses, 1 upper limb, 7 lower limb orthoses and 3 upper limbs. Of these, 20 were still used and 18 were abandoned. The most reported benefits were improved stability and facilitation of resource displacement. Conclusion: The majority of the beneficiaries were adults and the elderly, and the manual chair and the lower limb prosthesis were the most dispensed equipment. It was verified that there was a significant number of abandonment suggesting that inadequacies occurred at the moment of prescription, resulting in the abandonment.

Current Situation of Assistive Devices and Appliances Provision for Persons with Cerebral Palsy in Korea / 보건행정학회지

BACKGROUND: The aim of this study was to investigate the current state of the assistive devices and appliances provision system for cerebral palsy patients registered with brain disability. METHODS: From 2003 to 2013, we analyzed the records of cerebral palsy patients who had assistive devices and appliances provisioned at least once in their lives based on National Health Information Database. Patients with cerebral palsy were divided into three groups: infants and toddlers, school age and adolescence, and adults. RESULTS: Data on short leg plastic orthoses, ankle joint orthoses, and wheelchair were mainly analyzed. The types of ankle joint orthoses divided into three categories: limited, 90° limited, and Klenzac. Limited ankle joint orthoses was most frequently supported of the three in all age groups. Powered wheelchair and scooter were most supported to adult patients. When the re-supply duration was evaluated, the duration was suitable to the duration on guideline of regulation of re-supplement according to the related laws in adult patients but not in infants/toddlers and school age/adolescence as the actual re-supplement duration was much shorter than the reference value. CONCLUSION: This study confirmed the pattern of assistive devices and appliances supply differed depending on the age of cerebral palsy patients.

The Influence of Wheelchair Use of Individuals with Spinal Cord Injury on Upper Extremity Muscular Function and Cross-Sectional Area / 대한스포츠의학회지

PURPOSE: This study was to compare the upper extremity muscular function and cross-sectional area (CSA) between wheelchair users and a pedestrian group and to observe how the changes in the muscle CSA affected upper extremity muscle function. METHODS: The study was conducted on 10 patients with spinal cord injury (SCI) who were divided into two groups based on whether they used wheelchairs (wheelchair using [WU] group and pedestrian [PS] group). The Mann-Whitney U-test was used to analyze the data and determine whether there were significant differences between the groups. RESULTS: Muscle mass in the WU group was significantly lower than in the PS groups (p < 0.01), while body fat percentage in the WU group was significantly higher than in the PS group (p < 0.05). The peak torque of shoulder external and right internal rotation was higher in the WU group than in the PS group (p < 0.05). Wrist muscle function was not significantly different for either group. In addition, the CSA of the right wrist extensor carpi radialis longus and left extensor digitorum communis was higher in the WU group than in the PS group (p < 0.05). CONCLUSION: Using a manual wheelchair may benefit upper extremity function by increasing CSA and muscle function in patients with SCI despite having a negative effect on body composition. However, there is an increased risk of injury with SCI associated with upper extremity overload; thus, an effective exercise protocol is needed to prevent muscle imbalance and injury.

Pressure Relieving Effect of Adding a Pelvic Well Pad to a Wheelchair Cushion in Individuals With Spinal Cord Injury

OBJECTIVE: To identify the pressure relieving effect of adding a pelvic well pad, a firm pad that is cut in the ischial area, to a wheelchair cushion on the ischium. METHODS: Medical records of 77 individuals with SCI, who underwent interface pressure mapping of the buttock-thigh area, were retrospectively reviewed. The pelvic well pad is a 2.5-cm thick firm pad and has a cut in the ischial area. Expecting additional pressure relief, it can be inserted under a wheelchair cushion. Subjects underwent interface pressure mapping in the subject's wheelchair utilizing the subject's pre-existing pressure relieving cushion and subsequently on a combination of a pelvic well pad and the cushion. The average pressure, peak pressure, and contact area of the buttock-thigh were evaluated. RESULTS: Adding a pelvic well pad, under the pressure relieving cushion, resulted in a decrease in the average and peak pressures and increase in the contact area of the buttock-thigh area when compared with applying only pressure relieving cushions (p < 0.05). The mean of the average pressure decreased from 46.10±10.26 to 44.09±9.92 mmHg and peak pressure decreased from 155.03±48.02 to 131.42±45.86 mmHg when adding a pelvic well pad. The mean of the contact area increased from 1,136.44±262.46 to 1,216.99±255.29 cm². CONCLUSION: When a pelvic well pad was applied, in addition to a pre-existing pressure relieving cushion, the average and peak pressures of the buttock-thigh area decreased and the contact area increased. These results suggest that adding a pelvic well pad to wheelchair cushion may be effective in preventing a pressure ulcer of the buttock area.

Mudanças no cotidiano de pessoas com lesão medular / Changes on the everyday living of people with spinal cord injury

Objetivo: apreender as mudanças ocorridas no cotidiano de pessoas com lesão medular. Métodos: estudo de natureza qualitativa, ancorado no Interacionismo Simbólico. Participaram do estudo 23 pessoas com lesão medular, selecionadas intencionalmente, a partir da Estratégia Saúde da Família e de uma Associação Paradesportiva. Dados coletados por meio de entrevistas semiestruturadas, as quais foram gravadas, transcritas na íntegra, organizadas no software IRAMUTEQ, e, posteriormente, submetidas à análise de conteúdo, modalidade temática. Resultados: emergiram duas categorias temáticas, as quais mostram a vivência de sentimentos de incapacidade, dependência e impotência; dificuldades de adaptação social, familiar e na área sexual, além do surgimento de dores, espasmos musculares, lesões por pressão e infecções do trato urinário. Conclusão: as mudanças experienciadas no âmbito emocional, fisiológico e interacional são complexas e significativas, porém, com o passar do tempo, ocorre apropriação da cadeira, adaptação social e superação. (AU)

Lesiones músculo-esqueléticas de hombro en usuarios de silla de ruedas / Musculo-skeletal injuries of shoulder in wheelchair users

Manual wheelchair is one the most used mobility device in people that is unable to walk. It enhances functional independence in non ambulant people, but it costs a great energy expenditure and is a source of painful musculoskeletal injuries. The most frequently affected joint in manual wheelchair users is the shoulder (rotator cuff tendinopathy and subacromial impingement). In this review, we aim to describe the risk factors and biomechanical issues that make wheelchair users more prone to develop shoulder pain. Further, we discuss potencial approaches for the prevention and early treatment of these injuries. (AU)

Aplicabilidade de novos parâmetros anatômicos para a avaliação postural em cadeirantes através da biofotogrametria computadorizada / Applicability of new anatomical parameters for postural assessment in wheelchair users by means of computerized biophotogrammetry

Introdução: A biofotogrametria computadorizada apresenta níveis satisfatórios de confiabilidade na avaliação postural de indivíduos na posição em pé. No entanto, há poucos estudos sobre análises posturais em cadeirantes. Objetivo: Verificar a aplicabilidade de novos parâmetros anatômicos para a avaliação postural em cadeirantes por meio da biofotogrametria computadorizada. Material e métodos: Estudo observacional descritivo, com abordagem quantitativa. A amostra do estudo foi composta por sete crianças e adolescentes cadeirantes. O registro fotográfico para a avaliação postural foi realizado no plano frontal, com o paciente sentado sobre um assento de madeira. Posteriormente, as imagens foram analisadas através do Software de Avaliação Postural. Com o auxílio de um fio de prumo, as imagens foram calibradas. Os pontos anatômicos foram demarcados com bolas de isopor em regiões corporais específicas. Os ângulos selecionados para a análise foram: o alinhamento horizontal da cabeça e vertical do tronco. Também se determinou um novo parâmetro anatômico definido pelo ângulo entre os pontos médio-axilares da última costela e da crista ilíaca. Os dados foram analisados através da análise estatística descritiva e as correlações foram determinadas pelo Coeficiente de Pearson. Resultados: Os resultados do estudo mostraram que os pacientes avaliados apresentaram desvios posturais no plano frontal com ângulos médios de 3,9°±1,9° para o alinhamento horizontal da cabeça, 2,0°±0,6º para o horizontal dos acrômios, 2,2°±1,1° para o dos trocânters e 2,8°±1,6° para o vertical do tronco. Os valores obtidos para o lado direito e esquerdo entre os pontos médio-axilares da última costela, crista ilíaca e cicatriz umbilical foram 19,0°±5,7° e 14,9°±6,0°, respectivamente. O valor médio da diferença do ângulo iliocostal entre os lados direito e esquerdo foi de 4,1±2,9. Também se observou uma forte correlação entre a diferença do ângulo iliocostal e o alinhamento vertical do tronco (r=0,75; p<0,05), assim como uma forte correlação entre os ângulos horizontais das últimas costelas e das cristas ilíacas (r=0,80; p<0,05). Conclusão: Sugere-se que a avaliação postural por meio de novos parâmetros anatômicos, tais como o ângulo iliocostal, obtido pela biofotogrametria digital, pode se configurar em recursos relevantes para o acompanhamento de alterações posturais em cadeirantes, permitindo o seu uso na prática clínica através da capacitação de profissionais da área da reabilitação. (AU)

Introduction: Photogrammetric analysis presents satisfactory levels of reliability in postural evaluation in standing position. However, there are few studies on postural analyzes in wheelchair users. Objective: To verify the applicability of new anatomical parameters for postural evaluation in wheelchair users by means of photogrammetric analysis. Methods: Descriptive observational study, with quantitative approach. The study sample consisted of seven wheelchair-bound children and adolescents. The photographic record for the postural evaluation was performed in the frontal plane, with the patient sitting on a wooden seat. Subsequently, the images were analyzed through the Postural Evaluation Software. A plumb line fixed to the ceiling, served as reference for calibration of the images obtained. The anatomical points were marked with styrofoam balls in specific body regions. The angles selected for the analysis were: horizontal alignment of the head, and vertical alignment of trunk. We also determined a new anatomical parameter defined by the angle between the mid-axillary points of the last rib and the iliac crest. Data were analyzed through descriptive statistical analysis and correlations were determined by the Pearson Coefficient. Results: The patients presented frontal deviations in frontal plan with mean angles of 3.9° ± 1.9° for horizontal head alignment, 2.0°± 0.6° for horizontal alignment of the acromion, 2.2° ± 1.1° for the alignment of the trochanters, and 2.8° ± 1.6° for vertical alignment of the trunk. The values obtained for the right and left sides between the mid-axillary points of the last rib, iliac crest and umbilical scar were 19.0° ± 5.7° and 14.9° ± 6.0°, respectively. The mean value of the iliocostal angle difference between the right and left sides was 4.1 ± 2.9. There was also a strong correlation between the iliocostal angle difference and vertical trunk alignment (r = 0.75; p <0.05), as well as a strong correlation between the horizontal angles of the last ribs and iliac crests (r = 0.80, p <0.05). Conclusion: The postural evaluation through new anatomical parameters, such as the iliocostal angle obtained by means of digital photogrammetry, can be a relevant tool for the follow-up of postural changes in wheelchair users, allowing their use in clinical practice through training of rehabilitation professionals. (AU)

Revisão sistemática sobre os posicionamentos de tilt e recline para usuários de cadeira de rodas / Systematic review of the tilt and recline positions for wheelchair users

Introdução: O uso prolongado de cadeira de rodas pode acarretar em lesões por pressão, dores e perda de independência funcional. O método de inclinação e/ou de reclinar (tilt/recline) é prescrito para neutralizar e minimizar esses efeitos nocivos. Porém, não há um consenso de qual ângulo destes recursos é o ideal, bem como a eficiência destes para os usuários. Objetivos: a) conhecer e verificar quais angulações dos sistemas de posicionamento de tilt e recline são mais utilizadas e favoráveis para os usuários de cadeira de rodas e; b) classificar pesquisas encontradas pelo seu nível de evidência. Métodos: Trata-se de uma revisão sistemática sem meta-análise. Foram recuperados artigos publicados até setembro de 2017, na Biblioteca Virtual em Saúde-BVS, Pubmed, Scopus, Web of Science e OTseeker, utilizando as palavras-chave: "wheelchair", "tilt-in-space", "tilt-recline", "recline", "pressure relief" e "repositioning systems". Resultados: A maioria dos artigos selecionados correspondeu ao nível IV de evidência, que se caracteriza como estudos não experimentais. Os principais resultados apontam que a combinação de tilt e recline favorece o alívio de pressão na região das nádegas dos usuários de cadeira de rodas e promove conforto postural, mas para existir eficácia, há a necessidade de maiores angulações. Identificou-se que os menores ângulos são os mais realizados pelos usuários de cadeira de rodas, com a finalidade de gerar conforto e alívio de pressão. Conclusão: A prescrição e utilização dos sistemas de posicionamentos variáveis favorecem o usuário de cadeira de rodas, sendo os efeitos proporcionalmente relacionados ao grau de angulação adotado. (AU)

Introduction: Prolonged use of a wheelchair may result in pressure peak, pain, pressure ulcers and loss of functional independence. The method of tilting and/or reclining (tilt/recline) is prescribed in order to relieve and minimize these adverse effects. However, there is no consensus on which angle of these features is the ideal, and also the efficiency of these resources to users. Objective: To identify and analyze the practices on the use of tilt and recline systems described in the national and international research through a systematic review. Methods: The articles recovered were published until September 2017, on Virtual Health Library-BVS, PubMed, Scopus, Web of Science and OTSeeker using the keywords "wheelchair", "tilt-in- space", "tilt-recline", "recline", "pressure relief" and "repositioning systems". Results: We found 17 publications. The main results show that the combination of tilt and recline favors the pressure relief in the buttocks region of wheelchair users and promotes postural comfort, but to be effective there is a need for higher angles of tilt and recline, despite the difficulty to specify the optimal degree or accurate time to use this feature and most of the articles corresponds to the level IV of evidence, which is characterized as non-experimental studies. Conclusion: Regardless of the angles made the prescription and use of variable positioning systems favor the wheelchair user, and the effects proportionally related to the degree of angulation adopted. (AU)