Un caso de síndrome de embolia grasa: tratamiento y rehabilitación neurológica y cognitiva / A case report off at embolism syndrome: Treatment and neurological and cognitive rehabilitation

Resumen Se reporta el proceso de recuperación y rehabilitación neurológica y cognitiva de una mujer joven que desarrolló un síndrome de embolia grasa con repercusiones neurológicas, después de sufrir un politraumatismo. La paciente era una mujer de 21 años de edad con fractura cerrada de húmero y fémur izquierdos, que presentó un síndrome de embolia grasa, neumotórax izquierdo e hipertensión pulmonar, en las primeras 24 horas después de un accidente. Estuvo hospitalizada un mes y quedó con varios déficits neurológicos centrales, como infartos 'lacunares' y necrosis cortical laminar occipital, así como limitaciones en la bipedestación, la marcha, la visión y las funciones cognitivas. A partir del primer mes después del alta hospitalaria, se comenzó un proceso integral de rehabilitación neurológica y cognitiva en casa, y posteriormente, en una unidad médica de rehabilitación. Durante los primeros dos años después del accidente, la paciente recibió estimulación sensorial, sensoperceptiva y motora, así como rehabilitación motora y visual intensiva. Una vez se recuperó físicamente, se inició un proceso de rehabilitación neuropsicológica. Seis años después del accidente, la paciente terminó sus estudios universitarios y hoy está laboralmente activa. El proceso de rehabilitación neurológica es complejo, individual y difícil, aunque no imposible, y no se puede estandarizar un patrón de recuperación para todos los pacientes. Si bien existe la recuperación espontánea, la cual se da en los primeros seis meses, el caso aquí reportado demuestra que, en la fase crónica, la recuperación se puede lograr, pero requiere de evaluaciones y técnicas coordinadas de rehabilitación neurológica.

Abstract We report the neurological and cognitive recovery and rehabilitation process in a young woman who developed a fat embolism syndrome with neurological repercussions secondary to multiple trauma. The patient was a 21-year-old woman with a closed fracture of the left humerus and femur. She developed fat embolism syndrome, left pneumothorax and pulmonary hypertension in the first 24 hours after the accident. After one month of hospitalization, the patient had several central neurological deficits such as lacunar infarcts and occipital laminar cortical necrosis, as well as limitations in standing, walking, vision, and cognitive functions. An integral process of neurological and cognitive rehabilitation--first at home and later in a medical rehabilitation unit-- was carried out from the first month after being released from the hospital. During the first two years after the accident, the patient received sensory and motor stimulation, motor rehabilitation, and intensive visual rehabilitation. Once recovered physically, a process of neuropsychological rehabilitation began. Six years after the accident, the patient finished her university studies and she is working actively. The neurological rehabilitation process is complex, individual and difficult, but not impossible, and a recovery pattern cannot be standardized for all patients. Although there is spontaneous recovery, which occurs in the first six months, the case here reported shows that in the chronic phase recovery can be achieved but requires evaluations and coordinated techniques of neurological rehabilitation.

La electroacupuntura y principales mecanismos asociados al control postural de enfermedades neurológicas: revisión bibliográfica / Electroacupunture and main mechanisms associated with postural control in neurological disease: literature review

El control postural es la capacidad de mantener el cuerpo en una posición sin oscilaciones o caídas, capacidad que es fundamental para el desarrollo de habilidades motoras y la funcionalidad Los enfermedades neurológicos han sido caracterizadas por limitaciones en el control postural, llevando o disfunciones del movimiento,funcionalidad y calidad de vida en la población adulto. la electroacupuntura (EA) es una terapia que podría contribuir a la mejoría del control postural, ligado a mecanismos de analgesia, que facilitarían la movilidad aumentos de circulación cerebral y liberación de factores neurotróficos en zonas asociados al control del movimiento. Sin embargo, es necesario entender con mayor profundidad estos mecanismos. Por esa razón, esta revisión busca identificar y comprender los efectos terapéuticos de la EA en el control postural en enfermedades neurológicos.

Postural control is the capacity to keep the body in a position without oscillation or falls, this ability is important for the development of mobility skilIs and functionality. Neurological diseases have been characterized by limitations in postural control, leading to dysfunction of movement, functionality and quality of ljfe. Electroacupunture (EA) is a therapy which could contribute to the improvement o postural control associated to analgesic mechanisms, that facilitate the mobility, increasing the cerebral circulation and release of neurotrophic factors in area associated with movement control However it is necessary to understand better about these mechanisms. For this reason, this review aimed to identify and comprehend the therapeutic effects of the EA on the control postural in neurological diseases.

Complicações observadas em cães e gatos com doenças neurológicas / Complications observed in dogs and cats with neurological diseases

Cães e gatos com problemas neurológicos estão sujeitos a várias sequelas e complicações, em decorrência das deficiências motoras, sensoriais e viscerais. Algumas complicações estão relacionadas a maior mortalidade, principalmente aquelas relacionadas ao trauma vertebromedular. O objetivo do presente estudo foi avaliar nessas espécies a frequência do aparecimento de complicações, a epidemiologia, localização da lesão e etiologia, avaliando ainda a evolução e o tempo de sobrevida. Foram acompanhados 100 cães e gatos com doenças neurológicas trazidos para atendimento no Serviço de Neurologia do Hospital Veterinário da Universidade Estadual de Londrina. Observou-se que 91% dos animais desenvolveram complicações, sendo que as mais frequentes foram atrofia muscular (n=32), retenção urinária (n=24), incontinência urinária (n=24), incontinência fecal (n=17) e feridas de decúbito (n=16). O principal local de lesão associado ao aparecimento das complicações foi medula espinhal (91,3%) e a principal etiologia foi o trauma vertebromedular (37,3%). O tempo mediano e médio de vida estimado foram, respectivamente, dois e sete meses sendo que as principais causas de morte ou eutanásia estavam relacionadas ao trauma vertebromedular, trauma cranioencefálico ou doença inflamatória/infecciosa. O tempo de vida estimado foi menor para animais mais velhos e mais pesados. Embora o índice de sobrevivência dos animais com complicações tenha sido alto, muitos permaneceram com sequelas, indicando que a sobrevivência não significou capacidade funcional normal. Cães e gatos com problemas neurológicos requerem alto grau de atenção do veterinário e de seus tutores, sendo fundamental a orientação a respeito da real expectativa de recuperação e das dificuldades de manejo que poderão ser encontradas no curso da doença.(AU)

Dogs and cats with neurological diseases can show several sequelae and complications as a result of motor, sensory and visceral deficiencies. Some complications are an important cause of mortality, mainly complications related to spinal cord injury. The aim of this study was to evaluate in 100 dogs and cats brought to the Neurology Service of Veterinary Hospital from Universidade Estadual de Londrina the frequency of complications, epidemiology, lesion localization and etiology, still assessing the evolution and survival time. It was observed that 91% of the animals developed complications. The most frequent were muscular atrophy (n=32), urinary retention (n=24), urinary incontinence (n=24), fecal incontinence (n=17) and pressure sores (n=16). The main site of injury associated with the onset of complications was spinal cord (91%) and the main cause was the spinal cord trauma (37.3%). The median survival time of animals with complications was two months and the mean was seven months. The main causes of death or euthanasia were related do spinal cord trauma, traumatic brain injury or inflammatory/infectious disease. The estimated lifetime was lower for older and heavier animals. Although the survival rate of animals with complications was high, most of them remained with sequelae, indicating that survival does not mean normal functional capacity. Dogs and cats with neurological problems require a high degree of attention of the veterinarian and their guardians, and guidelines regarding the real expectation of recovery and management difficulties that may be encountered in the course of the disease are essential.(AU)

Manejo familiar da criança e adolescente com doença neurológica e sua relação com a estrutura familiar e dependência física: um estudo transversal / Family management of children and adolescents with neurological disease and their relationship with family structure and physical dependence: a cross-sectional study

Trata-se de uma pesquisa observacional, transversal e analítica, cujo objetivo foi relacionar a estrutura familiar e a dependência física infantojuvenil com o manejo familiar de crianças/adolescentes com doenças neurológicas. O estudo foi realizado em um Centro de Neuropediatria de um Hospital Público, universitário do Estado do Paraná. A amostra foi por conveniência, sendo incluídas 141 famílias de crianças/adolescentes com doenças neurológicas no período de maio a setembro de 2016. A coleta de dados foi efetuada por meio de entrevistas presenciais com uso de dois instrumentos de pesquisa, o de Condição Familiar e o de Medida de Manejo Familiar. Os dados obtidos foram organizados em tabelas elaboradas no programa Microsoft® Excel 2007 e, efetuada análise descrita, com distribuição de frequência e de medidas expressas em média, desvio padrão, valores mínimos e máximos e testes estatísticos de associação de variáveis. Para o cálculo da relação entre duas variáveis contínuas, utilizou-se o Coeficiente de Spearman; entre uma variável contínua e uma dicotômica, aplicou-se o Teste de Mann Whitney; e, entre uma variável contínua e uma categórica nominal se executou o Teste de Kruskal Wallis. Os valores de p?0,05 foram considerados estatisticamente significativos. Os resultados demonstraram que 58,16% constituíam família nuclear, em 52% algum membro alterou sua condição de trabalho para cuidar da criança/adolescente, 75,9% de pais permaneciam empregados, 67,4% das mães estavam desempregadas, 49,6% das famílias recebiam Benefício da Prestação Continuada (BPC), 44% recebiam medicação do sistema público de saúde e 47,5% das mães estudaram de nove a 11 anos. Sobre a criança/adolescente, 60% estavam com idade de dois a dez anos, 67% eram do sexo masculino, 92% tinham acesso à educação, 92% estudavam em escola pública, destes, 61,54% cursavam ensino regular, 65% possuíam dependência física em uma ou mais atividades de vida diária (AVD) e 56% apresentavam comorbidades. As variáveis de estrutura familiar relacionadas de forma negativa com o manejo familiar foram: maior tempo dos sinais da doença infantojuvenil; maior tempo de atendimento à saúde e maior tempo de atendimento em serviço especializado, famílias compostas por crianças/adolescentes com idade de seis a 12 anos; famílias que recebiam BPC e ou medicação do sistema público de saúde, as que os membros mudaram a condição de trabalho para cuidar do púbico infantojuvenil; crianças/adolescentes que cursavam ensino especial, com acesso à escola pública e dependência física nas AVD. As variáveis de estrutura familiar que se relacionaram de forma positiva com o manejo familiar foram: famílias que não recebiam subsídio governamental, mães com mais anos de estudos, famílias com maior renda per capita, membros familiares que não mudaram a condição de trabalho, crianças/adolescentes que cursavam ensino regular, com acesso à escola privada e eram independentes de forma física nas AVD. As variáveis relacionadas de forma negativa com o manejo evidenciaram a cronicidade da doença infantojuvenil, exigindo-se das famílias maiores esforços. As variáveis de contexto social apontam que as necessidades deste público não estão sendo geridas pelos programas governamentais de forma eficaz, indicando a necessidade de rever a aplicabilidade das políticas públicas, para que possam contribuir no manejo familiar de crianças/adolescentes com doenças neurológicas crônicas.

It is an observational, cross-sectional and analytical research whose objective was to relate the family structure and the physical and child dependence with the family management of children / adolescents with neurological diseases. The study was carried out in a Neuropediatrics Center of a Public Hospital, university of the State of Paraná. The sample consisted of 141 families of children and adolescents with neurological diseases from May to September 2016. Data were collected through face-to-face interviews using two research instruments, Family Status and Or Family Management Measure. The obtained data were organized in tables elaborated in the program Microsoft® Excel 2007 and, with described analysis, with frequency distribution and measures expressed in average, standard deviation, minimum and maximum values and statistical tests of association of variables. For the calculation of the relation between two continuous variables, the Spearman Coefficient was used; Between a continuous and a dichotomous variable, the Mann Whitney test was applied; And, between a continuous variable and a nominal categorical one was executed the Test of Kruskal Wallis. Values of p?0.05 were considered statistically significant. The results showed that 58.16% were a nuclear family, 52% of the members changed their work condition to care for the child / adolescent, 75.9% of the parents remained employed, 67.4% of the mothers were unemployed, 49.6% % Of families received Continuous Care Benefit (BPC), 44% received medication from the public health system and 47.5% of mothers studied from nine to 11 years. About 60% of the children were between the ages of two and ten, 67% were male, 92% had access to education, 92% attended public schools, 61.54% attended regular school, 65% Had physical dependence in one or more activities of daily living (ADL) and 56% had comorbidities. Family structure variables negatively related to family management were: longer time of signs of childhood illness; Greater time of health care and longer time of service in specialized service, families composed of children / adolescents aged 6 to 12 years; Families who received PCBs and / or medication from the public health system, which members changed the condition of work to care for the child and adolescent; Children / adolescents attending special education, with access to the public school and physical dependence on ADL. The family structure variables that were positively related to family management were: families that did not receive government subsidies, mothers with more years of schooling, families with higher per capita income, family members who did not change their working conditions, children / Adolescents who attended regular school, with access to private school and were independent of physical form in ADL. Variables related negatively with management evidenced the chronicity of the infantojuvenile disease, requiring greater efforts from families. The social context variables point out that the needs of this public are not being managed by government programs effectively, indicating the need to review the applicability of public policies, so that they can contribute to the family management of children / adolescents with chronic neurological diseases.

Avaliação da sobrecarga do cuidador de pacientes neurológicos cadeirantes adultos / Assessment of the burden of adult wheelchair-bound patients with neurological disabilities on the caregiver

Resumo O objetivo foi avaliar fatores que influenciam na sobrecarga dos cuidadores informais de pacientes neurológicos cadeirantes adultos. Foram entrevistados 16 cuidadores informais de pacientes neurológicos cadeirantes adultos, utilizando para avaliar sua sobrecarga a escala Zarit Burden Interview (ZBI) e coletados os dados de cuidar e sociodemográficos dos cuidadores, os dados socioeconômicos e o grau de independência funcional dos pacientes neurológicos cadeirantes adultos. Para análise dos dados foram utilizados os testes T-students, ANOVA Unifatorial com método de Tukey e Coeficiente de Correlação de Pearson. Resultados foram associados, menor grau de escolaridade do cuidador (p-valor = 0,01) e menor nível de informação da patologia acometida (p-valor = 0,01), com maiores sobrecargas. O suporte terapêutico e social dado pelas instituições de apoio, como a Clínica/Escola de Fisioterapia da CEUNSP, demonstrou ser importante para auxiliar os cuidadores a enfrentar situações de forma mais tranquila. O conhecimento de fatores que podem influenciar a sobrecarga dos cuidadores é importante para o planejamento e a intervenção desse público específico.

Abstract The scope of this study was to evaluate factors that influence the burden of adult wheelchair-bound patients with neurological alterations on informal caregivers. Sixteen informal caregivers of adult wheelchair-bound patients with neurological alterations were evaluated, using the Zarit Burden Interview (ZBI) scale to evaluate the burden on caregivers, as well as gather data on the care and socio-demographic profile of the caregivers, on the socio-economic data and the degree of functional independence of adult wheelchair-bound patients with neurological alterations. Student’s t-test, the one-way ANOVA with Tukey method and Pearson’s product moment correlation coefficient were used for data analysis. The results associated lower education level of the caregiver (p = 0.01) and lower level of information of the affected pathology (p-value = 0.01) to a heavier burden on the caregiver. The therapeutic and social support provided by the support institutions, such as the Physiotherapy Clinic/School of CEUNSP, was revealed as being important to help caregivers to handle situations in an easier manner. Understanding the factors that influence the burden on the caregiver is important for planning and intervention for this specific population group.

Dignidad ocupacional en personas con secuelas secundarias a daño neurológico severo / Occupational dignity in people with side effects to severe neurological damage

La terapia ocupacional es una disciplina socio sanitaria difícil de definir y explicar por su amplio espectro de acción, diversos autores han hecho distintas definiciones de ésta, sin embargo aún cuesta que la sociedad general entienda y conozca el significado de esta profesión, que desde un enfoque contemporáneo está centrada en la participación ocupacional de las personas. (Crepeau, 2011)Tiene como objetivo principal dotar a los individuos, organizaciones o poblaciones que interviene, de los recursos necesarios para su bienestar ocupacional, aprovechando todas las capacidades individuales, colectivas, los recursos cotidianos y el entorno para esto. Según los planteamientos de la Asociación Americana de Terapia Ocupacional, la terapia ocupacional asegura el compromiso con la justicia ocupacional (Aviles, 2010) de las personas, lo cual quiere decir, que indistinto de las características de la situación de discapacidad que presenta una persona, éstas tienen el derecho a lograr participar de las ocupaciones humanas. Esto se vincula con un concepto mayor, propio a la característica de humanidad de nuestra especie, la cual se denomina dignidad humana, a partir de estos dos términos, la experiencia clínica y académica de las autoras en intervención de personas con secuelas secundarias a daño neurológico severo, generan el concepto Dignidad Ocupacional, que hace referencia a que toda persona tiene derecho a disfrutar dignamente de experiencias ocupacionales a pesar de no contar con las destrezas de desempeño necesarias para involucrarse en ellas de manera independiente...

Occupational Therapy is a socio-health discipline which is difficult to define and explain due to its wide range of action. Several authors have defined it, however it is still hard for society to understand and know the meaning of this profession, which from a contemporary approach, is focused on the occupational participation of people (Crepeau, 2011).Its main objective is to deal with individuals, organizations and population to provide the necessary resources for their occupational welfare, taking advantage of all individual and group capacities, as well as daily resources and environment. According to the statements of the American Occupational Therapy Association , occupational therapy ensures the commitment to occupational justice (Aviles, 2010) with people , that is ,no matter the characteristics of the disability situation of a given person, she or he has the right to participate in human occupations. This goes along with a major concept that is inherent to our species human characteristic: human dignity, notion based on considering a person able to offer options to improve the quality of life, independent of his or her condition When it comes to people suffering from severe neurological damage, it is often believed that they only need to satisfy their basic self-care needs, nevertheless, they are people subject to rights, worthy and who deserve equal treatment. Thus, the effort to satisfy the occupations they cannot do by themselves is what we call Occupational Dignity, concept that was born with the blending of human dignity and occupational justice...

Dupla tarefa como estratégia terapêutica em fisioterapia neurofuncional: uma revisão da literatura / Dual task training as a therapeutic strategy in neurologic physical therapy: a literature review

Objetivo: Discutir as possibilidades de utilização da dupla tarefa no âmbito da reabilitação de pacientes neurológicos. Métodos: Foram realizadas buscas nas bases de dados PUBMED, MEDLINE, LILACS e PEDro, com o termo em inglês dual task associados a cada uma das palavras, em separado: treatment, physicaltherapy, rehabilitation, exercise, training, dividedattention, executivefunctions e attentionaldemands. Foram selecionados apenas ensaios clínicos que utilizaram o treinamento de dupla tarefa em população adulta com doença ou lesão neurológica. Resultados: Dos 2024 artigos encontrados, 1017 foram excluídos por se tratarem de artigos duplicados. Dentre os 1007 restantes, 998 foram excluídos após a análise dos resumos. Os nove artigos selecionados avaliaram pacientes com acidente vascular encefálico, traumatismo encefálico, doença de Alzheimer e de Parkinson. A maioria utilizou a marcha como tarefa primária, e uma tarefa cognitiva como secundária. Os programas variaram entre 9 e 48 horas totais de treinamento. Conclusão: O treinamento de dupla tarefa parece ter efeitos positivos na marcha, cognição, habilidades de automatização e transferência de aprendizado, sugerindo que essa pode ser uma estratégia valiosa para a reabilitação neurológica. Entretanto, ainda se faz necessário explicar quais as tarefas que são mais eficientes, o período de intervenção adequado e a extensão do período de retenção do aprendizado

Objective: Discuss the possibilities of dual task in the ambit of neurological rehabilitation. Methods: A survey was conducted in PUBMED, MEDLINE, LILACS, and PEDro, using the keywords "dual task" associated with each of the following terms separately: treatment, physical therapy, rehabilitation, exercise, training, divided attention, executive functions, and attentional demands. We selected only clinical trials that used dual task training in adults with neurological disease. Results: From the 2,024 articles found, 1,017 were excluded because they are duplicate. Among the remaining 1,007 articles, 998 were excluded after reviewing the abstracts. Nine articles were selected that included patients with stroke, brain injuries, Alzheimer's, and Parkinson's disease. Most articles used gait as the primary task, and in six studies the second task was cognitive. The training programs ranged between a total of 9 and 48 hours of training. Conclusion: Dual task training appears to improve gait, cognition, automation skills, and transference of learning, suggesting that this may be a valuable strategy for neurological rehabilitation. Nevertheless, it is still necessary to explain which tasks are more efficient and how long the learning retention lasts

Reproducibility of the six-minute walk test and Glittre ADL-test in patients hospitalized for acute and exacerbated chronic lung disease

Background: The 6-minute walk test (6MWT) and the Glittre ADL-test (GT) are used to assess functional capacity and exercise tolerance; however, the reproducibility of these tests needs further study in patients with acute lung diseases. Objectives: The aim of this study was to investigate the reproducibility of the 6MWT and GT performed in patients hospitalized for acute and exacerbated chronic lung diseases. Method: 48 h after hospitalization, 81 patients (50 males, age: 52±18 years, FEV1: 58±20% of the predicted value) performed two 6MWTs and two GTs in random order on different days. Results: There was no difference between the first and second 6MWT (median 349 m [284-419] and 363 m [288-432], respectively) (ICC: 0.97; P<0.0001). A difference between the first and second tests was found in GT (median 286 s [220-378] and 244 s [197-323] respectively; P<0.001) (ICC: 0.91; P<0.0001). Conclusion: Although both the 6MWT and GT were reproducible, the best results occurred in the second test, demonstrating a learning effect. These results indicate that at least two tests are necessary to obtain reliable assessments. .

New technologies in assessment and neuropsychological rehabilitation / Novas tecnologias na avaliação e reabilitação neuropsicológica / Las nuevas tecnologías en la rehabilitación neuropsicológica y evaluación

There is increasing use of technological innovations in assessment and neuropsychological rehabilitation in research and clinical practice. Thus, the purpose of this narrative review is to present what and how new technologies has been historically embedded in clinical and experimental neuropsychology, with a demonstrated academic production increased in the last 10 years. The literature presents that neuropsychological assessment highlights the use of computerized versions of instruments which traditionally are used in pencil and paper; cognitive simulations, artificial intelligence, and problem solving tasks. However, computerized tests are the most established technologies in this field. Further, a considerable part of the studies are performed in adults and elderly people, but few validations in children. In rehabilitation, the use of new technologies is more diversified, such as electronic devices and cell phones, tablet computers, video games, virtual reality, robots, and videofeedback neurofeedback, transcranial direct current stimulation, among others. In neuropsychological rehabilitation, the new technologies have facilitated the development of compensatory strategies and real-world simulations. From this review we discuss the new possibilities of technological interfaces in neuropsychology, as well the need for development and validation of computerized batteries and more dynamic and versatile rehabilitation protocols.

Nas últimas décadas, observa-se um crescente uso de inovações tecnológicas na avaliação e reabilitação neuropsicológica em pesquisas e na prática clínica. Sendo assim, o objetivo da presente revisão narrativa é apresentar quais são e como as novas tecnologias vem sendo inseridas historicamente na neuropsicologia clínica e experimental, com um aumento da produção acadêmica evidenciada nos últimos 10 anos. A literatura evidencia que a avaliação neuropsicológica destaca o uso de versões computadorizadas de instrumentos, que tradicionalmente utilizavam o lápis e papel; simulações cognitivas; inteligência artificial; e tarefas de resolução de problemas. Contudo, a que se mostra mais consolidada é o uso de baterias de testes computadorizados. Além disso, uma parte considerável de estudos é feito com adultos e idosos, sendo as validações para crianças mais escassas. Na reabilitação, o uso de inovações tecnológicas se mostra mais diversificado, tais como a utilização de dispositivos eletrônicos e celulares, computadores e tablets, videogames, realidade virtual, robôs, videofeedback e neurofeedback, estimulação transcraniana por corrente contínua e direta, entre outros. Na reabilitação neuropsicológica, as novas tecnologias têm facilitado o desenvolvimento de estratégias compensatórias e simulações de situações do cotidiano. A partir desta revisão discute-se sobre as novas possibilidades das interfaces tecnológicas na neuropsicologia bem como a necessidade do desenvolvimento e validação de baterias computadorizadas e protocolos de reabilitação mais dinâmicos e versáteis.

En las últimas décadas, hay un uso creciente de las innovaciones tecnológicas en la evaluación y rehabilitación neuropsicológica en la práctica clínica y la investigación. Por lo tanto, el propósito de esta revisión narrativa es presentar qué y cómo las nuevas tecnologías se han incorporado históricamente en neuropsicología clínica y experimental, con una producción académica demostrada aumentado en los ultimos 10 años. La literatura muestra que o más consolidado es el uso de baterías de pruebas computarizadas. Además, una parte considerable de los estudios se realizan con los adultos y ancianos, y con los ninos una validacion escasa. En la rehabilitación, la utilización de innovaciones tecnológicas se muestra más diversificada. Los estudios apuntan a utilizar: los dispositivos electrónicos y teléfonos celulares, y computadoras tablet, videojuegos, realidad virtual, robots y neurofeedback videofeedback, estimulación transcraneal de corriente continua y directa, entre otros. En la rehabilitación neuropsicológica, las nuevas tecnologías han facilitado el desarrollo de estrategias de compensación, simulaciones de situaciones reales. De esta revisión se discute que otros estudios deben llevarse a cabo para el desarrollo y validación de constructo de las baterías computarizadas y protocolos de rehabilitación que utilizan las nuevas tecnologías de tratamiento de la información y la comunicación.

Presente y futuro de la estimulación magnética transcraneal / Present and future of the transcranial magnetic stimulation

La estimulación magnética transcraneal ha llamado la atención de neurocientíficos y público en general por la posibilidad de estimular y “controlar” el sistema nervioso de forma no invasiva, realizar diagnósticos más exactos, y aplicar tratamientos y programas de rehabilitación más efectivos en múltiples enfermedades que afectan el sistema nervioso. Así mismo, esta novedosa herramienta ha ayudado a develar la complejidad del comportamiento neural, sus conexiones y su modulación plástica. La estimulación magnética aplicada de manera simple o pareada, se ha convertido en una alternativa útil en el diagnóstico de enfermedades como esclerosis múltiple, enfermedad de Parkinson, epilepsia, distonía, esclerosis lateral amiotrófica, enfermedad cerebro vascular, así como el sueño y sus trastornos, entre otras alteraciones. A nivel terapéutico, se ha sugerido el uso de la estimulación magnética repetitiva con diferentes niveles de evidencia en depresión refractaria a tratamiento farmacológico convencional, tinitus, afonía psicógena, enfermedad de Alzheimer, autismo, enfermedad de Parkinson, distonías, accidente cerebro vascular, epilepsia, trastornos de ansiedad generalizada, estrés post-traumático, alucinaciones auditivas, dolor crónico, afasias, trastorno obsesivo compulsivo, disquinesias inducidas por L-Dopa, manía y síndrome de Rasmussen, entre otros trastornos. Su beneficio en neurorehabilitación es una realidad inocultable, en cuyo caso se ha podido usar con efectividad y, prácticamente, sin efectos secundarios.

Magnetic stimulation has called the attention of neuroscientists and the public due to the possibility to stimulate and “control” the nervous system in a non-invasive way. It has helped to make more accurate diagnosis, and apply more effective treatments and rehabilitation protocols in several diseases that affect the nervous system. Likewise, this novel tool has increased our knowledge about complex neural behavior, its connections as well as its plastic modulation. Magnetic stimulation applied in simple or paired-pulse protocols is a useful alternative in the diagnosis of diseases such as multiple sclerosis, Parkinson disease, epilepsy, dystonia, amyotrophic lateral sclerosis, cerebrovascular disease, and sleep disorders. From the therapeutic perspective, magnetic stimulation applied repetitively has been found useful, with different degrees of efficacy, in treating resistant depression, tinnitus, psychogenic dysphonia, Alzheimer disease, autism, Parkinson disease, dystonia, stroke, epilepsy, generalized anxiety as well as post traumatic stress disorder, auditory hallucinations, chronic pain, aphasias, obsessive-compulsive disorders, L-dopa induced dyskynesia, mania and Rasmussen syndrome, among others. The potential of magnetic stimulation in neurorehabilitation is outstanding, with excellent range of safety and, in practical terms, without side effects.

Grupo de orientações aos familiares de pacientes adultos com seqüelas neurológicas: ausência nas reuniões / Orientation group to relatives of adult patients with neurological sequelae: meeting absences

As doenças neurológicas podem afetar as pessoas causando seqüelas que, muitas vezes, necessitam de cuidados especiais no domicílio. A família é parte desse processo de cuidado e, por isso, o Grupo de Orientações aos Familiares de Pacientes Adultos com Seqüelas Neurológicas promove orientações individualizadas aos familiares, visando ao seu cuidado. Com o objetivo de conhecer quais dificuldades levam os familiares desses pacientes a não comparecerem às reuniões de orientação, desenvolveu-se estudo qualitativo no qual foram entrevistados cinco familiares de pacientes internados e atendidos pelo grupo. A análise de conteúdo de suas falas revelou duas categorias: dificuldade em deixar o paciente sozinho e pouca disponibilidade para cuidar do paciente. Os resultados evidenciam a necessidade de desenvolver as ações do grupo prioritariamente à beira do leito, levando em consideração a não participação de familiares nas reuniões e a necessidade desses receberem orientações.

Neurological conditions may cause sequelae in patients, who often need special home care. Family is part of this care process and, for that reason, the Orientation Group to Relatives of Adult Patients with Neurological Sequelae provides individual guidance to relatives. A qualitative study was developed with the aim of finding which difficulties prevent patients’ relatives to attend orientation meetings. To do so, five relatives of hospitalized patients participating in the group were interviewed. Content analysis of their statements revealed two categories: leaving the patient alone and availability to look after the patient. Results showed the need to develop group activities, mainly at the bedside, considering relatives’ nonadherence to orientation meetings and their need to receive guidance.

Experiencia e ilusión: una rehabilitación pediátrica en polonia / Experience and hope: a pediatric rehabilitation in poland

En los orfanatos Polacos encontramos niños que sufren una situación de profunda injusticia ocupacional. Dentro de un entorno privado de estímulos externos, tanto afectivos como educativos, analizamos una situación que desencadena un retraso en su desarrollo motor e intelectual, al que debemos sumar en algunos casos enfermedades congénitas. El presente artículo pretende mostrar, bajo el punto de vista de un grupo de jóvenes y basándonos en una experiencia vivencial, la rehabilitación de estos niños a través de una gran diversidad de técnicas que consideramos útiles desde el punto de vista de la Terapia Ocupacional.

In the polish orphanages we can find children in an occupational apartheid hard situation. Within an environment without external stimulus, not only affective but also educational stimulus, we try to analyse a situation that can bring us to a delay in the motor and intellectual development. Moreover, we will also have to take into account in some cases congenital illness. This article tries to show, from a group of young people point of view and from their experience, the rehabilitation of these children by using a great diversity of techniques with are useful from an occupational therapy point of view.

Avaliação dos critérios médicos para o encaminhamento de pacientes com disfunções neurológicas para atendimento fisioterapêutico / Assessment of medical criteria for referring neurological patients to physical therapy treatment

Este estudo objetivou investigar critérios utilizados por neurologistas para o encaminhamento de pacientes para o atendimento fisioterapêutico. Foram convidados os 44 neurologistas de um hospital universitário que atuam em todos os níveis do atendimento terciário à saúde...

The aim of the present study was to investigate the criteria used by neurologists to refer patients to physical therapy treatement. All (44) neurologists from a university hospital were contacted, Thirthy physicians answered a questionnaire composed by 12 multiple choice and four open ones, in view of assessing both their referral criteria...

El aprendizaje motor en la práctica clínica: nuevos paradigmas en la rehabilitación de individuos con lesiones del sistema nervioso central: I parte / The motor learning in the clinical practice: New paradigms in the rehabilitation of individuals with central nervous system disorders: part I

El aprendizaje motor como conjunto de procesos determinantes en los cambios permanentes de la conducta motora humana, solamente ha sido estudiado en profundidad en las últimas dos décadas. El presente artículo define, describe y analiza el aprendizaje motor y las condiciones de la práctica clínica. Revisa en forma crítica, las teorías más importantes sobre control y aprendizaje motor y las condiciones que favorecen la práctica de habilidades motoras. El autor concluye el artículo con un resumen de aplicaciones terapéuticas, las cuales pretenden ofrecer nuevas alternativas en el tratamiento de individuos con lesiones del sistema nervioso central.

Management of neurocommunication disorders in an acute care hospital in India - a review of our experiences in a neuro-rehab team

Neurocommunication disorders are undoubtedly common in neurological practice. Therefore, concentrated exposure to a large number of patients with neurocommunication disorder eventually gains clinician a better perspective of: a] The range and scope of problems that are presented to a speech language pathologist. b] The diversity of the treatment offered to patients with seemingly similar problems. It has been time and again emphasized that treatment of neurocommunication disorders is still as much an art as it is a science, Team approach is desirable in the management of many disorders. The need for such an approach in the area of managing individuals with neurological disorders has been responsible for initiating the concept of a neuro rehabilitation team. In such a team, the contribution of the expertise from many disciplines is ensured with a common goal to provide quality health care that includes aspects of the patients' psychosocial well being. The purpose of this paper is to provide an overview of the present status of the management of individuals with neuro-communication disorders as practiced by speech-language pathologists in a neuro-rehab team

Community neurological rehabilitation

There is now good evidence of the efficacy of multidisciplinary rehabilitation for better recovery after stroke. Many hospitals around the world now have a dedicated stroke rehabilitation unit. However, people will only spend a few weeks or months in a stroke unit before returning home. There is often much further rehabilitation potential after discharge. This article emphasises the importance of continuing rehabilitation in the community after discharge from hospital. The article discusses some theoretical models for ongoing rehabilitation in a community setting and briefly describes the evidence base for the efficacy of community rehabilitation. Overall it is important that rehabilitation is not seen as a short term event but is seen as a lifelong support process that continues to work with the disabled person and their family to maximize independence and community integration

Atención Integral de enfermería a niños con afecciones neurológicas crónicas / Comprehensive nursing care to children with chronic neurological diseases

La Clínica de Neurología Infantil del CIREN se encarga del estudio, tratamiento y rehabilitación de enfermedades neurológicas crónicas en niños. Sus objetivos son mostrar la experiencia acumulada en la atención de enfermería en niños con estas enfermedades; definir las acciones más efectivas según enfermedad y características del paciente, y para este fin se realiza un estudio retrospectivo en 140 pacientes ingresados entre enero 1996 y noviembre 1998. Se observa un predominio de la parálisis cerebral tipo displejia espástica. La labor de enfermería se encamina a evitar deformidades osteoarticulares y aumentar validismo, entre otras. Se aprecian pacientes con epilepsias y retardos mentales. En ellos, la labor se centra en educar a los padres en su manejo y enfrentar las implicaciones sociales que esta enfermedad ocasiona. La atención de enfermería reviste especial importancia, pues es el enfermo quien permanece en forma continua al lado del paciente, por lo que se convierte en la persona que mejor conoce sus características y limitaciones y por lo tanto, puede trabajar en hacer más placentera su vida(AU)

The Pediatric Neurological Clinics of CIREN is in charge of the study, treatment and rehabilitation of chronic neurological diseases in children. Its objectives are to show its experience in the nursing care to children suffering from these disease and set up most effective actions according to the disease and the characteristics of the patient. For this purpose, a retrospective study of 140 patients admitted to the clinics from January 1996 to November 1998 was made. There was a predominance of spastic-type cerebral palsy. Nursing labor is aimed at avoiding osteo-articular deformities and increase fitness, among other things. Patients with epilepsy and mental retardation were observed. The work of nurses is focused at educating the parents of these children in their management and in facing the social implications of this disease. Nursing care is particularly important since the nurse is the one who permanently stay on the patient's side so she/he is the one that better knows the characteristics and limitations of a patient and can work for making his/her life more comfortable(AU)

Pneumatic splints: fabrication and use in neurorehabilitation.

Asymmetrical tone and weakness in antagonistic muscles often result in misalignment of joint, contractures and deformities. Traditional static splints used to prevent these complications are expensive, have to be custom made and cannot be used when deformities are marked. Authors describe fabrication and use of pneumatic splints, which are economic, safe and easy to apply. These splints have wide application in the management of common medical problems in neurological rehabilitation like hypotension, edema, pain, spasticity and early deformities.