Effectiveness of physical exercise on the recovery of limb function in stroke patients / Eficácia do exercício físico na recuperação da função dos membros em pacientes com avc / Efectividad del ejercicio físico en la recuperación de la función de las extremidades en pacientes con acv

ABSTRACT Introduction Patients with cerebrovascular accident and hemiplegia need to perform physical exercise and aerobic training, but physical dysfunction restricts the performance of these activities. Objective The article aims to develop physical strength sports for stroke patients with hemiplegia to explore the efficacy of sports to regain limb function in these patients. Methods We randomly selected 30 patients with stroke sequelae and divided them into control and exercise groups. While undergoing rehab, the exercise group performed a certain amount of aerobic exercise. During this period, we compared the relevant physiological indicators of the patients, and, at the same time, we used the Fugle-Meyer motor function scoring method to assess limb function. Results The two groups of patients are significantly different regarding the recovery of physical function and the capacity for daily life. Physiological indicators of patients are also different. Conclusion Low-intensity aerobic exercise can help stroke and hemiplegia patients regain their basic ability to live and exercise. Level of evidence II; Therapeutic studies: investigation of treatment results.

RESUMO Introdução É muito importante que pacientes com acidente vascular encefálico e hemiplegia realizem exercícios físicos e treinamento aeróbio, mas a disfunção física restringe a realização dessas atividades. Objetivo o artigo tem como objetivo desenvolver esportes de força física para pacientes com AVC com hemiplegia para explorar a eficácia dos esportes para recuperar a função dos membros nesses pacientes. Métodos Selecionamos aleatoriamente 30 pacientes com sequela de AVC e os dividimos em grupos controle e exercício. Durante a reabilitação, o grupo de exercícios realmente executou uma certa quantidade de exercícios aeróbicos. Durante esse período, comparamos os indicadores fisiológicos relevantes dos pacientes e, ao mesmo tempo, usamos o método de pontuação da função motora de Fugle-Meyer para avaliar a função dos membros. Resultados Os dois grupos de pacientes são significativamente diferentes em termos de recuperação da função física e capacidade para a vida diária. Os indicadores fisiológicos dos pacientes também são diferentes. Conclusão O exercício aeróbico de baixa intensidade pode ajudar os pacientes com derrame e hemiplegia a recuperar sua capacidade básica de viver e se exercitar. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

RESUMEN Introducción Es muy importante para los pacientes con accidente cerebrovascular y hemiplejía realizar ejercicio físico y entrenamiento aeróbico, pero la disfunción física restringe la realización estas actividades.Objeto: El artículo tiene como objetivo desarrollar deportes de fuerza física para pacientes con accidente cerebrovascular con hemiplejía para explorar la eficacia de los deportes para recuperar la función de las extremidades de estos pacientes. Métodos Seleccionamos aleatoriamente a 30 pacientes con secuelas por accidente cerebrovascular y los dividimos en grupos de control y de ejercicio. Mientras se sometía a rehabilitación, el grupo de ejercicio llegó a realizar una cierta cantidad de ejercicio aeróbico. Durante este período, comparamos los indicadores fisiológicos relevantes de los pacientes y, al mismo tiempo, utilizamos el método de puntuación de la función motora de Fugle-Meyer para evaluar la función de las extremidades. Resultados Los dos grupos de pacientes son significativamente diferentes en cuanto a la recuperación de la función física y la capacidad para la vida diaria. Los indicadores fisiológicos de los pacientes también son diferentes. Conclusión El ejercicio aeróbico de baja intensidad puede ayudar a los pacientes con accidente cerebrovascular y hemiplejía a recuperar su capacidad básica de vida y ejercicio. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Rehabilitación cognitiva de pacientes con alteraciones perceptivas sobrevivientes a ictus isquémico / Cognitive rehabilitation of patients with perceptive disorders surviving to ischemic ictus

Se realizó una intervención terapéutica en 30 pacientes con déficit motor (hemiplejía/ hemiparesia), sobrevivientes a ictus isquémico, irrigado por la arteria cerebral media con alteraciones perceptivas (negligencia sensorial, atencional o anosognosia), atendidos en el Departamento de Rehabilitación del Hospital General Docente Dr Juan Bruno Zayas Alfonso, de Santiago de Cuba, desde enero hasta noviembre del 2016, con vistas a evaluar la efectividad del tratamiento rehabilitador. La muestra fue dividida en 2 grupos de 15 integrantes cada uno: los del grupo control recibieron tratamiento convencional; los del grupo de estudio, tratamiento convencional y terapia ocupacional asociada a rehabilitación cognitiva. Se consideraron parámetros sociodemográficos, de valoración clínica y funcional, así como de recuperación funcional global. La heminegligencia resultó ser la alteración perceptiva más frecuente (63,4 por ciento) y al finalizar el tratamiento el grupo de estudio mostró una mejor recuperación funcional (93,3 por ciento), por lo cual quedó demostrada la eficacia de la rehabilitación convencional integrada a técnicas cognitivas y terapia ocupacional

A therapeutic intervention in 30 patients with motor deficit (hemiplegia/hemiparesis), surviving to ischemic ictus, irrigated by the mean cerebral artery with perceptive disorders (sensorial or atentional negligence or anosognosia), assisted in the Rehabilitation Department of Dr Juan Bruno Zayas Alfonso Teaching General Hospital, was carried out in Santiago de Cuba, from January to November, 2016, aimed at evaluating the effectiveness of the rehabilitative treatment. The sample was divided in 2 groups of 15 members each: those of the control group received conventional treatment; those of the study group, conventional treatment and occupational therapy associated with cognitive rehabilitation. They were considered sociodemographic parameters, of clinical and functional valuation, as well as of global functional recovery. Heminegligence was the most frequent perceptive disorder (63.4 percent) and the study group showed a better functional recovery (93.3 percent) when concluding the treatment, reason why the effectiveness of the conventional rehabilitation integrated to cognitive techniques and occupational therapy was demonstrated

Características das pessoas com acidente vascular encefálico atendidas em um centro de referência estadual / Características de las personas con accidente cerebrovascular atendidas em um centro de rehabilitación / Characteristics of encephalic vascular accident patients treated at a state reference center

Encephalic Vascular Accident is a clinical sign of brain dysfunction and it might result in permanent and irreversible lesions. Objective: defined the characteristics such as age, sex and date of the first treatment at a Santa Catarina State’s Rehabilitation Center. Methods: This is a quantitative cross-sectional descriptive study.The Ethnics in Human Research (CEPSH), the Pro Rector for Research and Extension Federal University of Santa Catarina, number 1024 reviewed this study. Results: Stroke affected 25,11% of women between 71-80 years old and 34,09% of the men aged between 61-70 years old. The most common consequence due to stroke was hemiplegia and the study observed that many patients only looked for proper treatment after several years post stroke. Conclusions: The physical therapy is important, so patients can relearn daily tasks and furthermore reintegrate their social life.

Acidente Vascular Encefálico (AVE) é uma disfunção cerebral que causa lesões permanentes e irreversíveis. Objetivo: Avaliar as idades, os sexos e a data do primeiro atendimento das pessoas com AVE atendidas no centro de reabilitação do Estado de Santa Catarina. Métodos: É um estudo quantitativo, descritivo e transversal, sendo a coleta de dados realizada com base documental nos prontuários. O presente estudo foi avaliado pelo Comitê de Ética em Pesquisa com Seres Humanos (CEPSH), Reitoria de Pesquisa e Extensão da Universidade Federal de Santa Catarina de número 1024. Resultados: O AVE afeta 25,11% de mulheres entre 71-80 anos e 34,09% de homens entre 61-70 anos. Observou-se que a sequela mais comum é a hemiplegia e que muitos somente procuravam tratamento após muitos anos de sequelas. Conclusão: Os dados encontrados mostram a importância da terapia física para que os pacientes reaprendam tarefas diárias e auxilia na reintegração social.

El Accidente Cerebrovascular (ACV) es un signo clínico de disfunción cerebral e ocasiona lesiones cerebrales permanentes e irreversibles. Objetivo: Evaluar las edades, sexos y la fecha del tratamiento inicial de los pacientes con accidente cerebrovascular tratados en el centro de rehabilitación en el estado de Santa Catarina. Métodos: El estudio cuantitativo, descriptivo y transversal. Este estudio fue revisado por el Pro Rector de Investigación y Extensión de la Universidad Federal de Santa Catarina para la Investigación Humana (CESPH). La recolección de datos se basó en registros documentales de las personas atendidas en el Centro de Rehabilitación del Estado de Santa Catarina, entre 2000-2009. Resultados: El AVC afecta 25.11% de las mujeres de 71-80 años y el 34,09% de los varones de 61-70 años. La hemiplejia es secuela más común. El estudio destaca que muchos pacientes buscan tratamiento sólo después de muchos años de secuela. Conclusión: Nuestros datos muestran la importancia de la terapia física, ya que permite que los pacientes pueden volver a aprender las tareas cotidianas.

Efeito da Realidade Virtual no deslocamento do COP de indivíduos com hemiplegia / Effect of Virtual Reality on the COP displacement of individuals with hemiplegia

Introdução: O Traumatismo Cranioencefálico (TCE) é uma das principais causas de incapacidade funcional e alteração motora na população adulta. Objetivo: Avaliar o efeito da terapia com Wii no deslocamento do COP de hemiplégicos devido à sequela TCE. Métodos: Foram realizadas 10 sessões de treinamento com o Nintendo Wii Fit® em 10 indivíduos hemiplégicos pós TCE, do sexo masculino, com média de 31,3 ± 2,9 anos de idade. Os participantes foram avaliados antes, após e 3 meses após o protocolo de treinamento, nas quais mediu-se os dados cinéticos. Resultados: Não foram encontradas diferenças na RMS e velocidade do deslocamento do COP nos sentidos ântero-posterior e médio-lateral dos sujeitos hemiplégicos após as 10 sessões de treinamento com o console Wii. Esses valores se mantiveram após 3 meses. Conclusão: A terapia com o console Wii não alterou o deslocamento do COP nos sentidos ântero-posterior e médio-lateral de indiví-duos com hemiplegia.

Introducion: The Traumatic brain injury (TBI) is a major cause of disability and motor disorders in adults. Objective: To evaluate the effects of Wii rehabilitation therapy on COP displacement of hemiplegic individuals due to traumatic brain injury. Methods: 10 hemiplegic individuals after TBI were recruited for this study. Mean age, height and weight were 31.3 ± 2.9 years, 1.72 ± 0.03 m and 74.5 ± 5.1 kg, respectively. The individuals were evaluated before and after the training protocol and after 3 months again, in which kinetic data of the ground reaction force were measured. Results: There were no significant differences in the anterior-posterior and medio-lateral displacement of hemiplegic subjects after the 10 training sessions with the Wii console and these values remained the same after 3 months. Conclusion: The therapy with the Wii console was unable to alter the COP displacement of individuals with hemiplegia.

Relação entre o equilíbrio e a capacidade funcional em hemiparéticos / Relationship between the balance and functional capacity in hemiparetics

INTRODUÇÃO: O Acidente Vascular Encefálico (AVE) é responsável por incapacidades na vida do sujeito e pode muitas vezes provocar o seu óbito. Nos indivíduos acometidos, o equilíbrio é um dos principais componentes prejudicados, resultando em incapacidade. A Escala de Berg (EB) é um instrumento validado para avaliação do equilíbrio nessa população e a Escala de Avaliação de Fugl-Meyer (EFM) é também utilizada para avaliação do comprometimento sensório-motor e capacidade funcional nos pacientes vítimas de AVE. OBJETIVO: analisar a relação entre o equilíbrio e a capacidade funcional de pacientes hemiparéticos vítimas de AVE do Centro Universitário Jorge Amado. METODOLOGIA: Trata-se de um estudo observacional de corte transversal, realizado no ano de 2014, composto por 11 indivíduos, utilizando para coleta dos dados as EB e EFM como instrumento de avaliação. RESULTADOS: Correlacionando a EB com a EFM, encontrou-se uma correlação estatisticamente significante (r=0,680; p=0,021). Com a pontuação total da EB, foram correlacionados com os domínios "Sensibilidade" e "Função Motora do Membro Inferior - FMI" da EFM, além da idade e tempo de AVE, obtendo a maior relevância a relação tempo de AVE com EB (p=0,009), FMI (p=0,012) e sensibilidade (p=0,008). Os gêneros foram correlacionados com o equilíbrio e capacidade funcional, sendo as mulheres com menor pontuação na EB (p=0,425) e maior na EFM (p=0,767). Os indivíduos que realizam tratamento fisioterapêutico obtiveram melhor pontuação nas escalas (p=0,082 e p=0,166 para EB e EFM). CONCLUSÃO: Através dos resultados, é possível inferir que pacientes com melhor equilíbrio possuem melhor capacidade funcional.

INTRODUCTION: Stroke is responsible for disabilities in the life of the life of the subject and often cause his/her death. In affected individuals, the balance is one of the damaged components, resulting in disability. The Berg Balance Scale (BBS) is an instrument for the assessment of the balance in this population and the Fugl-Meyer Assessment (FMA) is also used to evaluate the sensory-motor impairment and functional capacity in patients suffering from stroke. OBJECTIVE: Analyze the relation between the balance and the functional capabilities in of hemiparetic patients victims of a Stroke on the Universitary Center Jorge Amado. METHODOLOGY: This study is a cross-sectional ob-servational study, carried out in 2014, compound of 11 individuals, using for data collection the BBS and FMA as evaluation instruments. RESULTS: Correlating the BBS with the FMA, was found a statistically significant correlation (r=0,680; p=0,021). The total score of BBS was correlated with "sensibility" and "the lower limb section" at FMA, moreover the age and time since Stroke, obtaining the bigger rel-evance in relation to the time since Stroke with BBS (p=0,009), FMI (p=0,012) and sensibility (p=0,008). The gender was correlated with the balance and functional capability, having the women the lower score at BBS (p=0,425) and the bigger in FMA (p=0,767). The individuals how have performed physiotherapeutic treatment had the best score in the scales (p=0,082 at BBS and p=0,166 at FMA). CONCLUSION: Through the results, it is possible infer that the patients with the best balance have best functional capability.

Materiales para la elaboración de cabestrillos para personas con hemiplejia / Materials to elaborate slings for hemiplegics

Los cabestrillos utilizados actualmente no han incorporado innovaciones significativas en lo que respecta a los materiales de confección. Indudablemente hay carencia de alternativas puestas a prueba que superen los materiales que actualmente se encuentran en uso, pero ello no quiere decir que éstos sean inmejorables. Este trabajo se sostiene en la convicción de que un grupo de trabajo interdisciplinario produce frutos innovadores. Es por ello que aquí, especialistas de distintas disciplinas se proponen el desarrollo de materiales y tecnologías que aporten soluciones eficientes para el mejoramiento de este producto de apoyo (PA) para esta patología específicamente...

Nowadays, there are no significant innovations on the materials used to make slings. Undoubtedly, there is lack of alternatives to exceed the current ones. Nevertheless, it does not mean that these ones cannot be improved. We believe that an interdisciplinary group of work can produce innovative fruits. As a consequence, specialists on different disciplines are decided to develop materials and technologies in order to provide several efficient solutions on the improvement of this supportive product (SP) for this specific pathology...

Intervenção motora com a tarefa direcionada na paralisia cerebral: relato de caso / Motor intervention with goal-directed task in cerebral palsy: a case report

Objetivo: Verificar o desempenho da motricidade fina pós-intervenção motora com tarefa direcionada em uma criança com paralisia cerebral hemiplégica. Método: Um menino, com seis anos de idade, com hemiplegia leve à esquerda, realizou tarefas direcionadas, por 45 minutos, durante cinco semanas, no total de 15 sessões fisioterapêuticas. Para sua avaliação, usou-se o Manual Abilities Classification (MACS) pré e pós-intervenção, o qual avalia do nível I (crianças que manipulam objetos facilmente e com sucesso) ao V (não manipula objetos e tem habilidade severamente limitada para desempenhar até mesmo ações simples). Foram aplicadas as seguintes tarefas direcionadas: colher laranjas, achar a surpresa, encher o cofrinho, atirar no alvo e jogar boliche. Resultados: Nas tarefas de colher a laranja e achar a surpresa, o MACs permaneceu no nível II, pré e pós-intervenção, mas melhorou na qualidade do movimento e na função. Nas tarefas de praticar tiro ao alvo, encher o cofrinho e jogar boliche, o MACs diminuiu um nível, ou seja, o voluntário melhorou a pontuação. Conclusão: A criança apresentou melhora na motricidade fina, referente a quantidade, qualidade e independência do movimento; teve diminuição no tempo de execução das tarefas e melhoria na habilidade funcional.

Objectives: To check the performance of the fine motor skills after the motor intervention with a goal-directed task in an infant with hemiplegic cerebral palsy. Method: A 6-year-old boy with mild left hemiplegia performed the goal-directed tasks for 45 minutes during five weeks, totaling 15 physiotherapy sessions, and he was evaluated according to the Manual Abilities Classification System (MACS), before and after the intervention, which evaluates from level I (including children who handle objects easily and successfully) to level V (children unable to handle objects and with severely limited ability to perform even the simplest actions). The program comprised the following goal-directed tasks: pick up oranges, find out the surprise, fill up a piggy bank, shoot a target and play bowling. Results: In picking up oranges and finding out the surprise, MACS remained in the level II in the pre and post-intervention, but the infant improved movement quality and function. When shooting a target and playing bowling, MACS decreased one level, i.e., the boy enhanced his score. Conclusion: There was a clear improvement in the infant’s fine motor skills in terms of quantity, quality and independence of movement. The infant reduced the amount of time needed to perform the tasks, with a clear progress in his functional ability.

Efectividad de la plataforma Wii Fit en la mejoría del equilibrio y coordinación en pacientes con parálisis cerebral hemiparética: ensayo clínico, controlado,randomizado y simple ciego / Wii platform effectiveness on equilibrium and motor coordination improvement in patients with hemiparetic cerebral palsy: a single blinded, controlled and randomized clinical trial

Los pacientes con parálisis cerebral (PC) de tipo hemiparética cursan con alteraciones del equilibrio y la coordinación uni-bipodal, lo que se traduce en una capacidad disminuida para trasladar el centro de gravedad durante las actividades funcionales. Objetivo: Evaluar los efectos en el equilibrio y la coordinación en unipodal y bípedo, post intervención con la plataforma Wii Fit en niños con parálisis cerebral hemiparética pertenecientes al Instituto Teletón Valparaíso, durante junio-diciembre de 2011. Pacientes y Métodos: Ensayo clínico, controlado, randomizado y simple ciego, en 32 pacientes, de 8 a 14 años, con PC tipo hemiparética, compromiso funcional leve o moderado y capacidad cognitiva para seguir instrucciones de mediana complejidad. Se distribuyen aleatoriamente en grupos control, kinésico y wii. Se aplica protocolo de ejercicios de equilibrio, coordinación y transferencias de peso en diferentes planos, de dificultad progresiva por 13 sesiones, durante 30 min, con excepción de grupo control. Se evalúa con pruebas de alcance funcional, equilibrio (Berg Balance Scale), centro de gravedad estático, en posición unipodal y bipodal (Wii Balance Board). Resultados: La intervención con plataforma Wii Fit produjo significancia estadística en la variable Escala de Berg (p < 0,001) lo que no se evidenció en las otras variables estudiadas. Conclusión: La plataforma Wii Fit resultó ser una herramienta que produjo mejoras parciales en ítems funcionales, sin efectos adversos en los pacientes sujetos a este tratamiento.

Introduction: Patients with hemiparetic cerebral palsy (CP) develop equilibrium and unipedal/bipedal alterations, which manifest themselves as a diminished capacity to shift the gravity center during functional activities. Objective: Evaluation of the effect of the use of the Wii Fit platform on equilibrium and coordination, in children with hemiplegic cerebral palsy, patients at Valparaíso’s Teletón Institute, between June and December of 2011. Patients and Methods: A controlled, randomized and simple blind clinical trial, was conducted with 32 hemiparetic CP patients, between 8 and 14 years of age, with mild to moderate functional impairment, and who could follow medium difficulty instructions. They were randomly assigned to control, kinesic and Wii groups. A progressively difficult exercise protocol that included coordination, equilibrium, and different levels of weight transference, was applied during thirteen sessions, except for the control group. Outcomes were assessed with functional Reach test, for equilibrium (Berg Balance Scale), standing gravity center for unipedal and bipedal positions (Wii Balance Board). Results: The Wii Fit Platform intervention showed a statistically significant effect for the Berg Scale (p < 0,001). No other effects were observed. Conclusion: Use of the Wii Fit platform generated partial improvements on functional activity items, without adverse effects for patiens who participated in treatment.

Restoring awareness: a review of rehabilitation in anosognosia for hemiplegia

Disturbances in body awareness offer important insights into neurocognitive processes involved in the construction of the bodily self. This review will focus ona specific disorder of awareness, namely, anosognosia for hemiplegia (AHP), or the denial of motor deficits contralateral to a brain lesion. Recently some progress has been made towards the management and rehabilitation of AHP, however to date no evidence-based treatment exists. Firstly, recent research on AHP will be reviewed, with the aim of providing an overview of the etiology, clinical presentation and assessment of the syndrome, as well as the majorneurological and neuropsychological explanations. This article will then focus on recent advances in the management and rehabilitation of AHP, using a casestudy example of intervention-based (i.e. video replay) motor awareness recovery (Fotopoulou, Rudd, Holmes & Kopelman, 2009). Finally, a dynamic theoreticalmodel of the multifaceted nature of anosognosia, using a predictive coding framework, will be proposed and future directions for research will also be discussed...

Comportamiento de los pacientes con enfermedad cerebrovascular en el Servicio de Rehabilitación del Hospital Militar de Matanzas / Behavior of the patients with cerebrovascular disease at the Rehabilitation Service of the Military Hospital of Matanzas

Las enfermedades cerebrovasculares constituyen la tercera causa de muerte en el mundo y una de las principales causas de discapacidad. Se realizó un estudio descriptivo en el Servicio de Rehabilitación del Hospital Militar de Matanzas, con el objetivo de describir el comportamiento de los pacientes con enfermedad cerebrovascular atendidos desde enero 2011 hasta junio de 2012. Se emplearon las variables: sexo, edad, tipo de accidente vascular encefálico, antecedentes patológicos personales, complicaciones en la rehabilitación, modalidades de tratamiento rehabilitador utilizado, tiempo de evolución, grado de incapacidad para realizar las actividades de la vida diaria (Índice de Barthel). La enfermedad cerebrovascular predominó en el sexo femenino, la edad media fue de 68,6 años. Se comprobó mayor incidencia de los accidentes vasculares encefálicos isquémicos. Se identificaron como complicaciones más frecuentes el hombro doloroso y la espasticidad. Las modalidades de tratamiento rehabilitador más utilizadas fueron la kinesioterapia y la ambulación. La ganancia en el Índice de Barthel fue mayor en los pacientes con menos de tres menos de evolución.

The cerebrovascular disease is the third cause of death in the world and one of the main disability causes. A descriptive study was conducted in the Rehabilitation Service of the Military Hospital of Matanzas, with the objective of describing the behaviour of the patients with cerebrovascular diseases assisted there from January 2011 to June of 2012. The variables used were: sex, age, type of encephalic vascular accident, personal pathological history, complications in the rehabilitation, modalities of the rehabilitative treatment, time of evolution, grade of disability to carry out the daily life activities (Barthel Index). The cerebrovascular disease was predominant in the female sex; the average age was 68,6 years. A higher incidence of the ischemic encephalic vascular accidents was proved. The painful shoulder and spasticity were identified as the most frequent complications. The most used modalities of treatment were the kinesiotherapy and ambulation. The gain in the Barthel Index was bigger in patients with less than three months of evolution.

Grado de discapacidad en pacientes hemipléjicos del Policlínico Docente Universitario del Cerro / Evaluation of disability in hemiplegic patients from Cerro university teaching polyclinic

Introducción: la hemiplejía como consecuencia de un ictus constituye una importante causa de discapacidad. La continuidad y calidad en el proceso rehabilitador supone mejores perspectivas en el pronóstico de los pacientes. Objetivo: evaluar el grado de discapacidad en los pacientes hemipléjicos del área de salud del Policlínico Docente Universitario del Cerro. Métodos: estudio descriptivo, transversal en los pacientes que acudieron consecutivamente al área de rehabilitación del citado policlínico, desde septiembre de 2009 hasta julio de 2011. La muestra estuvo constituida por 124 hemipléjicos por enfermedad cerebrovascular mayores de 15 años, los cuales fueron evaluados con la Escala de Discapacidad de Rosetón. Se excluyeron los enfermos con afasia sensorial o mixta y aquellos que se negaron a participar. Resultados: en 84 (67,8 porciento) pacientes se encontró independencia para la orientación y predominó la semidependencia para el desplazamiento y las necesidades físicas. Para la higiene personal, 48 (38,7 porciento) pacientes resultaron ser dependientes. La falta de motivación para ocupar el tiempo libre se encontró en 92 (74,2 porciento) pacientes, casi siempre por dificultades en la convivencia y en las relaciones familiares. Conclusiones: el grado de discapacidad de los pacientes hemipléjicos evaluados viene dado por la semidependencia en el desplazamiento y las necesidades físicas y la dependencia para el autocuidado. Las dificultades en la convivencia y las relaciones familiares interfieren en la motivación del paciente para ocupar el tiempo libre

Introduction: hemiplegia is an important cause of disability as a result of a stroke. The persistence and quality of the rehabilitative process lead to better results in the patient prognosis. Objective: to evaluate the extent of disability in hemiplegic patients from the health area under Cerro university teaching polyclinics. Methods: a cross-sectional and descriptive study was conducted in hemiplegic patients who regularly went to the rehabilitation service of Cerro polyclinics from September 2009 to July 2011. The sample consisted of one hundred and twenty four over 15 years-old hemiplegic patients due to cerebrovascular disease, who were evaluated according to the Rosseton's disability scale. Those patients with mixed or sensory aphasia and those who refused to participate were excluded. Results: of the participants, 84 (67.8 percent) patients were independent for orientation whereas semi-dependence for movement and physical needs prevailed. For personal hygiene, 48 (38.7 percent) patients were dependent. Ninety two (74.2percent) patients did not feel motivated to spend their leisure time in doing any activity, basically because of difficulties in living together with their relatives. Conclusions: the extent of disability of evaluated hemiplegic patients is caused by their partial dependence in terms of movement, and physical needs and by their dependence for self-care. Difficulties in coexistence and family relationships interfere with the motivation of the patients to spend their leisure time

Percepção de hemiplégicos crônicos sobre o uso de dispositivos auxiliares na marcha / Perception of patients with chronic hemiplegia regarding the use of assistive walking devices

OBJETIVO: Avaliar a percepção de hemiplégicos crônicos sobre o uso de dispositivos auxiliares (DA) na marcha. MÉTODOS: A partir de um banco de dados de 360 hemiplégicos, foram recrutados 23 indivíduos que utilizavam DA e preenchiam os critérios de inclusão. A média de idade foi de 58,4 anos, tempo pós-acidente vascular encefálico de 80,8 meses e tempo de uso do DA de 67,6 meses. Para avaliar a percepção dos participantes, utilizou-se um questionário padronizado, composto por cinco questões: impacto do DA na habilidade para descarregar peso no membro parético; impacto na habilidade para movimentar o membro parético; impacto na confiança; impacto na segurança; e impacto no jeito de caminhar. As respostas possíveis eram "melhorou", "não alterou" ou "piorou". RESULTADOS: Quatorze indivíduos utilizavam bengalas e nove utilizavam muletas canadenses; 21 (91,3 por cento) utilizavam DA somente em vias públicas e dois (8,7 por cento) utilizavam DA também em ambiente domiciliar. A percepção em relação ao uso do DA foi positiva nas quatro primeiras questões (6,87 < χ2< 29,83; 0,0001 < P < 0,03), com relatos de melhora na descarga de peso (82,6 por cento), na habilidade de movimentar o membro parético (39,1 por cento), na confiança para caminhar (82,6 por cento) e na segurança (86,9 por cento). Não foram observadas diferenças significativas para o item jeito de caminhar (χ2= 1,09; P = 0,30). CONCLUSÕES: A percepção dos indivíduos hemiplégicos crônicos foi positiva em relação ao uso de DA para deambulação, sugerindo que esses dispositivos podem melhorar a mobilidade e a independência durante as atividades de vida diária.

OBJECTIVE: To assess the perception of patients with chronic hemiplegia regarding the use of assistive walking devices (AWD). METHODS: Twenty-three individuals who met the inclusion criteria and used AWD were recruited from a database of 360 stroke survivors. Their mean age was 58.4 years, mean time since stroke was 80.8 months, and mean time using AWD was 67.6 months. To assess the participants' perception, was used a standardized questionnaire covering the impact of AWDs on five aspects: weight-bearing on the paretic limb; ability to move the paretic limb; confidence; safety; and walking style. Possible answers were "improved," "unchanged," or "decreased." RESULTS: Fourteen individuals used canes and nine used elbow crutches; 21 (91.3 percent) used AWDs on public roads and only two (8.7 percent) used AWDs at home. The perception regarding the use of AWDs were positive in the first four questions (6.87 < χ2 < 29.83; 0.0001 < P < 0.03), with reports of improvement in weight-bearing (82.6 percent), ability to move the paretic limb (39.1 percent), confidence (82.6 percent), and safety (86.9 percent). No significant differences were found in terms of walking style (χ2 = 1.09; P = 0.30). CONCLUSIONS: The perception of chronic hemiplegic subjects regarding the use of AWD were positive, suggesting that these devices can improve mobility and independence in activities of daily living.

Satisfacción de pacientes hemipléjicos luego de un programa individualizado de ejercicios físicos / Satisfaction of hemiplegia patients after individualized program of physical exercises

Introducción: la rehabilitación del paciente hemipléjico constituye un verdadero reto para el enfermo, sus familiares y el equipo de salud, todos los esfuerzos orientados a ello tendrán un impacto positivo en su calidad de vida. Objetivo: evaluar el estado de satisfacción de los pacientes con síndrome hemipléjico secundario a una enfermedad cerebrovascular, luego de la aplicación de un programa individualizado de ejercicios físicos terapéuticos en la atención primaria de salud. Métodos: se realizó un estudio descriptivo, longitudinal, retrospectivo en pacientes que acudieron al área de rehabilitación integral del Policlínico Docente Universitario del Cerro, desde septiembre de 2008 hasta febrero de 2010. Se efectuaron 115 encuestas que recogían, entre otros aspectos, la opinión de los pacientes sobre su evolución en las actividades de la vida diaria, el estado de satisfacción durante la aplicación del programa de ejercicios y la valoración sobre su recuperación. Resultados: el 96,7 por ciento calificación el programa de ejercicios de muy bueno y el 3,3 por ciento de bueno. En relación con las actividades de la vida diaria de recuperación más precoz, el 95 por ciento manifestó la marcha, y el 5 por ciento restante declaró otras actividades como la higiene personal y la alimentación. Conclusiones: el programa de ejercicios individualizado genera un buen estado de satisfacción en los pacientes rehabilitados

Introduction: rehabilitation of hemiplegia patient is a real challenge for patient, relatives and the health team, all efforts aimed to it will have a positive impact on quality of life. Objective: to assess the satisfaction of patients with the hemiplegia syndrome secondary to a cerebrovascular disease after implementation of a individualized of therapeutic physical exercises in primary health care. Methods: a retrospective, longitudinal and descriptive study was conducted in patients came to integral rehabilitation area of the Cerro University polyclinic from September to February, 2010. A total of 115 surveys were made including among other aspects the opinion of patients on its evolution in the daily life activities, the satisfaction level during the implementation of the exercises program and the valuation on its recovery. Results: the 96,7 percent qualified the exercises program like very good and the 3,3 percent like good. In relation to daily life earlier recovery activities, the 95 percent mentioned the gait; the remainder 5 percent mentioned other activities like the personal hygiene and the feeding. Conclusions: The individualized exercises program generates a good state of satisfaction in rehabilitated patients

Programas terapéuticos específicos en niños y jóvenes con parálisis cerebral y lesiones raquimedulares en Teletón Chile 2007-2008: evaluación mediante WeeFIM / Specific therapeutic programs in children and teens with cerebral palsy and spine lesions in Teleton Chile 2007-2008: evaluation through WeeFIM

Introduction: It is important to evaluate the effectiveness of the therapeutic endeavour, in order to improve rehabilitation programs in the motor area in patients with neuromusculoskeletal disabilities. Objective: To evaluate changes in the functional independence between admission and discharge from specific treatments in patients with cerebral palsy and spinal cord lesion, and explore whether gender, age or diagnosis, can predict the progress of children in these types of treatments. Patients and Methods: A single cohort study, consisting of 624 subjects of three years or more with cerebral palsy and 155 with spinal cord injury, attending to specific rehabilitation programs in Teletón Chile Institute from 2007-2008. In the analysis, was used the difference between the admission and discharge WeeFIM score and decision trees with p < 0.05. Results: In 264/624 of the cerebral palsy children (42.3 percent)increase discharge score; 321/624 (51.4 percent) remain the same and 39/624 (6.3 percent) decrease; in spinal cord injury 93/155 patients (60 percent) improve, 58/155 (37.4 percent) do not change and 4/155 (2.6 percent) decrease; the improvement occurs mainly in self-care activities; the decision trees show that specific treatments have best result for diplegia and hemiplegia in children under 6 years; in spinal cord injury, for thoracic bifid spine with hydrocephalus and acquired tetraplegia. Conclusion: Specific treatments have a better outcome for children with cerebral palsy hemiplegia and spine lesions, it is associated with the initial diagnosis; the age acquires predictive characteristics for children with hemiplegia and diplegias under 6 years; WeeFIM is poorly sensitive to detect changes in extreme scores and in short duration rehabilitation programs.

Introducción: Es importante evaluar la efectividad del quehacer terapéutico, con el fin de mejorar los programas de rehabilitación en el área motora de los pacientes con discapacidades neuromusculoesqueléticas. Objetivo: Evaluar cambios en la independencia funcional entre ingreso y alta de tratamientos específicos en pacientes con parálisis cerebral y lesión medular, y explorar si el género, edad y diagnóstico, permiten pronosticar el progreso de los niños en este tipo de tratamientos. Pacientes y Método: Estudio de cohorte única, constituida por 624 sujetos de 3 años o más con parálisis cerebral y 155 con lesión medular, asistentes a programas específicos de rehabilitación de Instituto Teletón Chile en 2007-2008. En el análisis, se usó diferencia de puntaje de WeeFIM entre ingreso y alta, y árboles de decisión con p < 0,05. Resultados: En parálisis cerebral 264/624 (42,3 por ciento) de los niños, aumenta puntaje de alta; 321/624 (51,4 por ciento) permanece igual y 39/624 (6,3 por ciento) desmejora; en lesión medular 93/155 pacientes (60 por ciento) mejora, 58/155 (37,4 por ciento) no cambia y 4/155 (2,6 por ciento) desmejora; la mejoría se produce principalmente en actividades de autocuidado; los árboles de decisión indican que los tratamientos específicos tendrían mejor resultado para diplejías y hemiplejias en menores de 6 años; en lesión medular, para espina bífida torácica con hidrocefalia y tetraplejia. Conclusiones: Los tratamientos específicos tienen mejor resultado para niños con hemiplejia por parálisis cerebral y alteraciones raquimedulares altas; el aumento del puntaje, está asociado al diagnóstico inicial; la edad adquiere carácter predictivo para niños con hemiplejias y diplejías menores de 6 años; WeeFIM es poco sensible para detectar cambios en puntajes extremos y en programas de rehabilitación de corta duración.

Uso de três princípios de intervenção aumenta a efetividade da terapia por contensão induzida: estudo de caso / Use of three principles of intervention increases the effectiveness of constraint induced therapy: case report

Terapia por Contensão Induzida (TCI) é formada por três componentes: treino repetitivo de tarefa orientada, restrição da extremidade do membro superior menos acometido e da aplicação de um conjunto de métodos comportamentais de reforço de adesão para transferir os ganhos obtidos na clinica para o ambiente real do paciente. Porém apenas dois desses princípios são aplicados com freqüência. O objetivo deste estudo foi de caracterizar o protocolo de intervenção através de um relato longitudinal de caso de um paciente com seqüela de hemiparesia crônica após AVE. O paciente foi avaliado pela Motor Activity Log (MAL) e pelo Wolf Motor Function Test (WMFT) e os resultados sugerem que os aspectos comportamentais pertencentes a técnica têm grande influência nos bons resultados e a TCI pode ter maior ação nas atividades de vida diária de pacientes com hemiplegia quando aplicados todos os três tipos de intervenção em que consiste.

CIT has three components: repetitive task oriented training, restraining the less impaired extremity and applying a package of adherence enhancing behavioral methods designed to transfer gains made in the clinical setting to the patient´s real world environment. But only two of these components are used with frequency. The aim of the present study was characterizing the intervention protocol through a longitudinal case report of a patient after stroke. The patient was evaluated by Motor Activity Log (MAL) and Wolf Motor Function Test (WMFT) and results suggest that behavioral aspects pertaining to technique have great influence on the success and TCI may have more action in the daily activities of patients with hemiplegia when applied to all three types of intervention that is.

Motor evoked potentials as a predictor for upper limb function following acute stroke

To record the MEPs in the affected upper limb of hemiplegic patients in order to study its role in the prediction of functional and motor recovery of the upper limb in cases of acute stroke. This study included 30 patients suffering from acute stroke, all of them were subjected to history taking, clinical and neurological examination and clinical assessment scales [initially and after three months of conventional physiotherapy] including Medical Research Council [MRC] scale, Nine Hole Peg test [NHPT] and action research arm test [ARAT]. Also, all patients and controls were subjected to MEPs recording in order to evaluate resting motor threshold, MEP amplitude and central motor conduction Time [CMCT]. The mean of initial MRC scale, NHPT and ARAT was 1.73 +/- 1.17, 4.23 +/- 2.34 and 21.53 +/- 14.42 respectively. As regards MEPs, the mean of resting motor threshold [mamp], MEP amplitude [microv] and CMCT [msec] were 109.57, 0.56 and 11.28 respectively showing a highly significant difference from the control group whose mean values were 73.4, 2.98 and 7 respectively. Patients were divided according to initial CMCT into three groups: group I and II [patients with normal and delayed CMCT respectively] and Group III [patients with absent MEP]. On comparing the initial and follow up motor and functional recovery according to the clinical scales [MRC, NHPT and ARAT] in the three patient groups, group I and II exhibited highly significant [P<0.01] higher scores than group III. Correlation study showed a significant negative correlation between CMCT and MRC scale and ARAT, also there was a significant positive correlation between CMCT and NHPT while no significant correlation was found between resting motor threshold or amplitude of MEPs and the follow up clinical scales. Predictive value of CMCT for improvement of different scores [MRC, NHPT and ARAT] was 22, 38 and 36.6% respectively. CMCT of MEPs was the parameter with the highest predictive value to functional improvement of affected upper limb in stroke patients. These data can be helpful for clinicians to plan the program of rehabilitation according to the expected recovery of motor function

Terapia de movimento induzido pela restrição na hemiplegia: um estudo de caso único / Constraint-induced movement therapy in hemiplegia: a single-subject study

A terapia de movido induzido por restrição (TMIR) tem mostrado resultados positivos em indivíduos hemiparéticos após acidente vascular cerebral; consiste na contenção do membro superior não afetado e treinamento intensivo do membro afetado...

Constraint-induced movement therapy (CIMT) consists of restraining movement of the non-affected arm while providing intensive training of the affected upper extremity. Positive results have been reported after CIMT in individuals with...

Projeto Hemiplegia: um modelo de fisioterapia em grupo para hemiplégicos crônicos / Project Hemiplegia: a model of group physical therapy of chronic hemiplegic patients

Objetivo: Este trabalho teve por objetivo caracterizar os pacientes e as atividades realizadas no Projeto Hemiplegia, que consiste em encontros de portadores de hemiplegia para realização de fisioterapia em grupo. Método: A caracterização dos pacientes foi feita por meio da análise de seus prontuários e da aplicação da Escala de Equilíbrio de Berg (EEB), e a descrição do projeto pela análise da filmagem de 18 sessões do projeto. Resultados: Dos pacientes analisados 15 pertenciam ao sexo masculino e 4 ao feminino, com idade média de59,63 ± 11,1 anos. O tempo médio de seqüela pós-AVC foi de 5,17 ± 3,92 anos. As médias alcançadas nas avaliações da EEB foram 43,00 ± 10,48 pontos na 1ª avaliação e 44,95 ± 9,69 pontos na 2ª avaliação. A análise comparativa entre as duas avaliações determinou que houve diferença estatística significativa entre elas(p<0,05). A conduta fisioterapêutica caracteriza-se pela utilização de exercícios ativos, alongamentos, exercícios de equilíbrio e coordenação e atividades lúdicas. Conclusão: O Projeto Hemiplegia demonstra que a terapia em grupo pode ser uma boa opção terapêutica capaz de impedir complicações que possam determinar uma maior deterioração da capacidade funcional e da dependência, também garante a manutenção ou melhora do equilíbrio, melhorando assim a qualidade de vida desses pacientes.

Objective: The aim of this study was to characterize the patients and the physical activities performed in theHemiplegia Project. This project consisted of a group of hemiplegic patients that get together to performgroup physical therapy. Method: The profile of the patients was made through the analysis of their medicalrecords and the use of Berg balance scale. The outline of the project was made by analyzing the recordingimages of 18 sessions of the program. Results: Of the 19 patients enrolled, 15 were male and 4 female. Meanage was 59.63 ± 11.1 years. The median known duration of sequela after a stroke (CVA) was 5.17 ± 3.92 years.The average scores reached in the BBS evaluations were 43.00 ± 10.48 points in 1st evaluation and 44.95 ± 9.69points in 2nd evaluation. A comparative analysis was performed to test differences between the two evaluations.There were no significant statistical differences between the two evaluations (p £ 0.05). The average time ofsequel after AVC was 5.17 ± 3.92 years. The physical therapy session is characterized for the use of activeexercises, stretching, equilibrium and motor coordination exercises, and playful activities. Conclusion: TheHemiplegia Project demonstrates that the group therapy can be a good therapeutical option to preventcomplications that may determine a much large deterioration of the functional capacity and the dependence.Also the group therapy assures the maintenance of the equilibrium or improves it, thus improving the qualityof life of these patients.

O teste de destreza manual Minnesota adaptado utilizado como avaliação do potencial de uso de membros superiores de pacientes hemiplégicos / The adapted Minnesota manual dexterity test as an assessment tool for the hemiplegic patients' upper extremity function

O estudo mostra a adaptação do teste de destreza manual Minnesota, no seu subteste ?de colocação?, como um modo de avaliação da função do membro superior hemiplégico, desde os que apresentam movimentos totais com déficit na destreza, até os que apresentam movimento parcial ativo ou nenhuma capacidade de preensão. O quanto, de fato o membro superior hemiplégico pode ser utilizado pelo paciente durante a realização de atividades, é muitas vezes, difícil de se mensurar. Acreditamos que o uso deste teste seja uma forma de se medir essa possibilidade e também de se medir a modificação dessa condição durante o decorrer do tempo, permitindo que façamos comparações de medições e evoluções de função do membro superior. Estas medições são úteis como estímulo de constatação da melhora da função do membro superior pelo próprio paciente e também poderão ser úteis em abordagens científicas quando queremos quantificar a performance de um paciente durante um tratamento.

The study shows the adaptation of the ?Minnesota Manual Dexterity Test? in its Placing subtest, as an assessment tool for the evaluation of the hemiplegic upper extremity function, from individuals who present total movements with dexterity deficit to those who present active partial movement or no pressing capacity. To what extent the hemiplegic upper extremity can be, in fact, used by the individual during the accomplishment of activities, is normally difficult to measure. We believe this test can be used as a tool for the assessment of this capacity and also to measure the changes in this condition with time. It also allows us to compare measurements and the evolution of the upper extremity function. These measurements are useful, as they stimulate patients by making them aware of the upper extremity function improvement as well as regarding its scientific approaches to quantify a patient?s performance during treatment.