RESUMO
Recentemente, a terapia por ondas de choque extracorpóreas (TOCE) mostraram-se ser uma promissora tecnologia não invasiva para neuromodulação e recuperação funcional devido a melhora em brotamento neuronal, neuroproteção, controle de neuroplasticidade e reorganização neuronal, além de atuar em fatores de neurogênese. Objetivo: Descrever um caso que usa TOCE como um adjuvante na reabilitação de trauma medular. Relato de caso: LPS, 25 anos, estudante de medicina, sofreu uma queda de altura indeterminada com fratura de C5 e lesão medular associada a trauma cranioencefálico. Na fase aguda, ele se recuperou adequadamente, tendo sido submetido a descompressão e fixação de coluna e hospitalizado por 5 meses devido a disautonomias e infecções urinárias. Após esse período, ele iniciou um programa de reabilitação intensiva para tetraplegia espástica com classificação inicial segundo o ASIA (American Spinal Injury Association) nível C5 motor e C6 sensório. O tratamento incluiu 10 sessões de TOCE, realizadas com Duolith SD1 (Storz Medical, Suíça) com uma densidade de energia de 0,25mJ/mm², 5 cm e 3 cm de profundidade de foco, 2000 pulsos aplicados na linha média de coluna níveis C5 a T1 e 2000 pulsos a 5 cm de profundidade aplicados em região plantar bilateral. Bloqueio com toxina botulínica e fenol foram realizados com resposta parcial apesar da dose otimizada de baclofeno.
Recently, extracorporeal shockwaves (ESWT) have shown as a promising non-invasive technology for neuromodulation and functional recovery, due to improving neuronal budding, neuroprotection, control of neuroplasticity and neuronal reorganization, in addition to acting on neurogenesis factors. Objective: To describe a case that uses ESWT as an adjuvant to the rehabilitation of spinal cord trauma. Case Report: LPS, 25 years old, medical student, suffered a fall from an undetermined height with C5 fracture and spinal cord injury, associated with a cranioencephalic trauma. In the acute phase, he was rescued properly, performed decompression and spinal cord fixation and remained hospitalized for 5 months due to dysautonomia and urinary infections. After this period, he started an intensive in-patient rehabilitation program for spastic tetraplegia with initial classification according to ASIA C5 (motor) and C6 (sensory). The treatment included 10 sessions of ESWT, made with Duolith SD1 (Storz Medical, Switzerland) with an Energy flux density 0,25 mJ/mm2, at 5cm and 3cm depth focus, 2000 pulses each over the spinal cord at the midline of levels from C5 to T1, and 2000 pulses at 5cm depth focus applied at plantar region bilaterally.
RESUMO
OBJECTIVES: As patients recovering from the novel coronavirus disease 2019 (COVID-19) present with physical, respiratory, cognitive, nutritional, and swallowing-related impairments and mental health complications, their rehabilitation needs are complex. This study aimed to describe the demographic, clinical, and functional status after the discharge of COVID-19 survivors who underwent intensive multidisciplinary inpatient rehabilitation at the Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital and Lucy Montoro Rehabilitation Institute. We determined the most important factors related to the length of inpatient rehabilitation treatment and present the functional outcomes. METHODS: This was a retrospective study based on electronic medical records. In addition to the severity of COVID-19 and length of hospital stay for the management of COVID-19 and comorbidities, we collected sociodemographic data including age, sex, height, and weight. Functional assessments were performed using the Functional Independence Measure (FIM); Short Physical Performance Battery; Montreal Cognitive Assessment; Depression, Anxiety and Stress Scale; Revised Impact of Events Scale; bioelectrical impedance; Functional Oral Intake Scale; oropharyngeal dysphagia classification; and nutritional assessment. RESULTS: There was a significant improvement in FIM before and after inpatient rehabilitation treatment (p<0.0001). Muscle strength and walking capacity were significantly improved (p<0.01). The most important factors related to the length of inpatient rehabilitation treatment were improvement in FIM scores (Spearman's r=0.71) and gain in lean mass (Spearman's r=0.79). CONCLUSIONS: Rehabilitation of patients after COVID-19 recovery improves their functional status and should be considered in the post-acute phase for selected patients with COVID-19.
Assuntos
Humanos , Medicina Física e Reabilitação , COVID-19 , Estudos Retrospectivos , Resultado do Tratamento , Recuperação de Função Fisiológica , SARS-CoV-2 , Tempo de InternaçãoRESUMO
Existem poucas informações na literatura médica sobre a reabilitação de pacientes com a Síndrome de Guillain-Barré (SGB). Há estudos clínicos que demonstram a eficácia do programa de reabilitação por meio de uma equipe interdisciplinar, porém sem protocolos bem definidos e apenas realizados em regime ambulatorial. Este relato de caso tem como objetivo descrever a evolução de um paciente com SGB, durante o programa de reabilitação multiprofissional intensivo em regime de internação, discutindo as possibilidades terapêuticas para reabilitação da doença
There is little information in the medical literature on the rehabilitation of patients with GuillainBarre Syndrome (GBS). There are clinical studies that demonstrate the effectiveness of a rehabilitation program using an interdisciplinary team, but without well-defined protocols and only performed on an outpatient basis. This case report aims to describe the evolution of a patient with GBS during the intensive multidisciplinary inpatient rehabilitation program, discussing the therapeutic possibilities for rehabilitation of the disease