Eficacia de la rehabilitación cognitiva en un paciente con esclerosis múltiple progresiva primaria / Efficacy of cognitive rehabilitation in a patient with primary progressive multiple sclerosis

La esclerosis múltiple (EM) es una enfermedad inflamatoria crónica que cursa con la desmielinización y la neurodegeneración a nivel del sistema nervioso central. Existen tres tipos de EM en función de la progresión de la enfermedad, pero la mayor parte de los pacientes tienden a presentar déficits cognitivos. Por lo tanto, resulta imprescindible el desarrollo de programas de entrenamiento cognitivos dirigidos a la mejora de estos déficits y, en definitiva, a la mejora de la calidad de vida de estos pacientes. En este sentido, el objetivo principal de este estudio fue la puesta en marcha de un programa de entrenamiento cognitivo dirigido a un paciente con esclerosis múltiple progresiva primaria (EMPP) a lo largo de un año. Los resultados pusieron de manifiesto que algunos de los déficits cognitivos que presentó inicialmente el paciente mejoraron tras varios meses de intervención. En este sentido, el paciente presentó notables mejoras en el control inhibitorio y la flexibilidad cognitiva. No obstante, los déficits en la velocidad de procesamiento se mantuvieron constantes a lo largo de toda la intervención. Asimismo, aparecieron otros déficits a lo largo de la intervención que remitieron tras la adecuación de los objetivos de intervención. Por todo ello, nuestro estudio reforzó la importancia de la puesta en marcha de los programas de rehabilitación cognitiva dirigidos a pacientes con enfermedades desmielinizantes para paliar las secuelas cognitivas derivadas de las mismas. Además, es importante que estos programas de entrenamiento cognitivo sean revisados periódicamente para adecuar los objetivos del tratamiento.

Multiple sclerosis (MS) is a chronic inflammatory disease that involves demyelination and neurodegeneration at the level of the central nervous system. Despite the different characteristics of each of the three types of MS, most patients with this disease present significant cognitive deficits. Therefore, it is essential to develop cognitive training programs to improve these deficits and, ultimately, increase the quality of life of these patients. Thus, the main objective of this study was to implement a one-year cognitive training program with a patient with progressive primary multiple sclerosis (PPMS). The results showed that some of the cognitive deficits the patient initially presented improved after several months of intervention. In this regard, the patient presented noteworthy improvements in inhibitory control and cognitive flexibility. However, deficits in processing speed remained constant throughout the intervention. Likewise, other deficits appeared during the intervention that remitted after adapting the intervention objectives to the patient's needs. Therefore, our study reinforces the importance of implementing cognitive rehabilitation programs for patients with demyelinating diseases to alleviate the cognitive sequelae they produce. In addition, it is important to evaluate these cognitive training programs periodically in order to adapt the objectives and improve the patient's functionality.

Physical and functional aspects of persons with multiple sclerosis practicing Tai-Geiko: randomized trial

OBJECTIVES: This study aimed to verify the influence of Tai-Geiko on the physical and functional aspects of people with multiple sclerosis (MS). METHODS: This was a parallel-group, randomized trial with two arms. People with MS were allocated to an experimental group (EG) (n=10) and control group (CG) (n=09). The participants received multidisciplinary care supervised by a physiotherapist in the Tai-Geiko exercise. Participants underwent the assessments after the intervention. The Expanded Disability Status Scale (EDSS-maximum score of 6.0), strength test (kgf) using a dynamometer, Timed Up and Go mobility test (TUG), and stabilometric balance test (Platform EMG system®) were evaluated. Demographic data were recorded, including age, sex, comorbidities, lifestyle and classification of MS. Clinical Trials (ReBeC): RBR-4sty47. RESULTS: The EG group improved in 12 variables, and the CG improved in 3 variables. The following values were obtained for pre/postintervention, respectively: EG: lumbar force (38/52 kgf), TUG (11/9 s), locomotion velocity (519/393 ms); double task two (53/39 s); platform stabilometric trajectory: traversed get up (39/26 s) and sit (45/29 s); anteroposterior (AP) amplitude rise (11/8 cm) and sit (12.40/9.94 cm) and anteroposterior frequency rise (1.00/1.56 Hz) and sit (0.8/1.25 Hz) (p<0.05); CG: right-hand grip force (26/29 kgf); TUG (9.8 /8.7 s) and AP (11.84 /9.53 cm) stabilometric amplitude at the sitting moment (p<0.05), (3.2/5.99 Hz, p=0.01) and sit (3.47/5.01 Hz, p=0.04). CONCLUSION: Tai-Geiko practice can be suggested as complementary exercise in the rehabilitation of persons with MS.

Coping strategies and mood profiles in patients with multiple sclerosis / Estratégias de enfrentamento e perfis de humor em pacientes com esclerose múltipla

Objective: The aim of the present study was to investigate the coping strategies, mood characteristics and the association between these aspects in patients diagnosed with multiple sclerosis and healthy subjects. Method: Fifty consecutive patients who were diagnosed with multiple sclerosis according to McDonald criteria and thirty-one healthy subjects were included in the study. In addition to the sociodemographic form, Expanded Disability Status Scale (EDSS), Coping Orientation for Problem Experiences Scale (COPE), and Profile of Mood States (POMS) tests were applied to the participants. Results: Non-functional coping strategies were significantly higher in the secondary-progressive type (p≤0.05). Depression-dejection, fatigue-inertia and total POMS scores were significantly higher in the secondary-progressive type (p≤0.05). Conclusion: The results of our study demonstrate the importance of rehabilitation programs that encourage exercise among patients with multiple sclerosis to increase vigor-activity levels. .

Objetivo: Investigar as estratégias de enfrentamento, as características de humor e a associação entre estes aspectos em pacientes com diagnóstico de esclerose múltipla em comparação a indivíduos saudáveis. Método: Foram incluídos no estudo 50 pacientes com diagnóstico de esclerose múltipla de acordo com os critérios de McDonald e 31 pessoas saudáveis. Além da caracterização sócio-econômica, foram aplicados a todos os pacientes testes para avaliar o Expanded Disability Status Scale (EDSS), o Coping Orientation for Problem Experiences Scale (COPE) e o Profile of Mood States (POMS). Resultados: Escores referentes a estratégias de enfrentamento não funcionais foram significativamente maiores na forma secundariamente progressiva (p≤0.05). Escores relativos a depressão-abatimento, fadiga-inércia e escores totais POMS foram significativamente maiores na forma secundariamente progressiva (p≤0.05). Conclusão: Os resultados deste estudo mostram a importância de programas de reabilitação que encorajem os pacientes com esclerose múltipla a praticar exercícios com maiores níveis de vigor e atividade. .

Caracterização e queixas relacionadas ao desempenho ocupacional: considerações de indivíduos com esclerose múltipla / Characterization and complains related to occupational performance: considerations of people with multiple sclerosis

Indivíduos com esclerose múltipla (EM) exibem sequelas características, como fadiga, paresia e déficit de marchae equilíbrio que são prejudicais ao desempenho de atividades. Os objetivos do estudo foram identificar atividades relativas ao desempenho ocupacional consideradas importantes para indivíduos com EM, analisar suas limitações ao realizá-las e averiguar suasatisfação como as executam. Trata-se de estudo exploratório e descritivo com 21 indivíduos com EM que frequentavam um hospital universitário. O grau de desempenho nas atividades e satisfação foi mensurado através da Medida Canadense de Desempenho Ocupacional (COPM) sendo os resultados analisadosatravés de estatística descritiva. A maioria das 104 atividades identificadas foi categorizada em “autocuidado” (ex., andar na rua, subir/descer escada), “lazer” (ex., praticar esportes, visitar amigos e familiares) e “produtividade” (ex., limpar/arrumar casa, trabalhar fora de casa). O estudo possibilitou identificar as limitações que indivíduos com EM apresentam ao realizar atividades variadas e o grau de satisfação como as executam.

Subjects with multiple sclerosis (MS) exhibit characteristic sequelae, such as fatigue, weakness, and impairedbalance which might be harmful to the performance of activities. The study aimed to identify activities considered important to people with MS related to their occupational performance, analyzetheir limitations to accomplish them, and check their satisfaction on how to execute them. This is an exploratory and descriptive study conducted with 21 people with MS that attended a university hospital. The degree of performance and satisfaction with it was measured by the Canadian Occupational Performance Measure(COPM) and the results were analyzed by descriptive statistics. The majority of the 104 identified activities was classified as “selfcare” (e.g., walking on street, going up/go stairs), “leisure” (e.g., playing sports, visiting friends and relatives) and “productivity” (e.g., cleaning and working outside house). The study identified the constraints individuals with MS have to perform activities and the degree of satisfaction to do them.

Early respiratory evaluation should be carried out systematically in patients with multiple sclerosis / Avaliação respiratória precoce deveria ser feita sistematicamente em pacientes com esclerose múltipla

The present study aimed at evaluating respiratory parameters in multiple sclerosis (MS). The sample comprised 30 patients with MS diagnosis and 30 healthy subjects, matched by gender and age. Neurological assessment, expanded disability status scale (EDSS), manovacuometry, and peak flow (PEF) were performed. Patients with MS had lower values of maximum inspiratory (MIP) and expiratory (MEP) pressures and PEF compared to healthy controls. It was shown that respiratory impairment may be present in MS patients with low functional disability by EDSS. The data suggest that manovacuometry and PEF determination should be carried out systematically in patients with MS, and may be a reliable tool for the early detection of respiratory impairment allowing early respiratory rehabilitation.

O presente estudo teve como objetivo avaliar a função respiratória em pacientes com esclerose múltipla (EM). A amostra foi composta por 30 pacientes com diagnóstico de EM e 30 sujeitos saudáveis, pareados de acordo com o gênero e a idade. Foram realizados avaliação neurológica, determinação da escala expandida do estado de incapacidade (EDSS), manovacuometria e “peak flow”. Pacientes com EM apresentaram pressões inspiratória (PI) e expiratória (PE) máximas inferiores e menor PFE quando comparados aos controles saudáveis. Identificou-se que o comprometimento respiratório pode ocorrer em pacientes com EM, mesmo com baixo grau de comprometimento funcional estimado pelo EDSS. Os dados do presente estudo sugerem que a avaliação respiratória com manovacuometria e PFE deve ser realizada sistematicamente em pacientes com EM, e pode ser uma ferramenta útil para detectar precocemente comprometimento respiratório, podendo sugerir a necessidade de reabilitação pulmonar precoce em pacientes com EM.

Efeito da equoterapia na estabilidade postural de portadores de esclerose múltipla: estudo preliminar / Effect of hippotherapy on the postural stability of patients with multiple sclerosis: a preliminary study / Efecto de la hipoterapia en la estabilidad postural de portadores de esclerosis múltiple: estudio preliminar

OBJETIVO: Este estudo se propôs a verificar se a estimulação por meio da equoterapia é capaz de desencadear alterações no controle postural de portadores de esclerose múltipla (EM). MÉTODO: Fizeram parte deste estudo 11 portadores de EM divididos em Grupo Intervenção (GI) e Grupo Controle (GC). O GI foi inserido num programa de hipoterapia durante 4 meses, sendo conduzidas 2 sessões semanais com duração de 50 minutos cada. A estabilidade postural foi avaliada utilizando uma plataforma de força (para calcular o deslocamento do centro de pressão (COP), durante 30 segundos, em postura ereta quasi-estática, com olhos abertos e fechados, antes e após o treinamento com equoterapia. O tratamento estatístico foi feito através do ANOVA e Post hoc de Tukey com p<0,05. RESULTADOS: A amplitude de oscilação anteroposterior reduziu significativamente no GI após a estimulação, enquanto o GC manteve um comportamento inalterado entre as avaliações. Em ambos os grupos, a estabilidade postural foi reduzida com a supressão da informação visual. CONCLUSÕES: A adaptação funcional proporcionada pela equoterapia foi capaz de melhorar a estabilidade postural dos portadores de EM. Os resultados corroboram a literatura que suporta o uso da equoterapia como uma intervenção em potencial nas desordens de controle postural em portadores de EM.

OBJECTIVE: This study intended to identify the effects of hippotherapy on the postural control of multiple sclerosis (MS) patients. METHODS: Eleven MS patients were separated into two groups: Intervention Group (IG) and Control Group (CG). Hippotherapy consisted of two 50-minute sessions each week for four months. Postural stability was evaluated before and after hippotherapy using a force plate to calculate the center of pressure (COP), when subjects stood still for 30 seconds, with eyes open and closed. Statistical analysis was performed by ANOVA and post hoc Tukey tests, p<0.05. RESULTS: Hippotherapy significantly reduced the amplitude of oscillation in the anteroposterior direction in IG while CG remained unaltered. In both groups postural stability was reduced after the suppression of visual information. CONCLUSIONS: Hippotherapy induced functional adaptations that resulted in better postural stability of subjects with MS. This study corroborates literature supporting the use of hippotherapy as a possible intervention for balance disorders in patients with MS.

OBJETIVO: El objetivo de éste estudio fue identificar los efectos de la hipoterapia sobre el control postural en pacientes con esclerosis múltiple (EM). MÉTODO: Hicieron parte de este estudio 11 portadores de EM divididos en Grupo Intervención (GI) y Grupo Control (GC). El GI fue insertado en un programa de hipoterapia durante cuatro meses, siendo realizadas dos sesiones semanales con duración de 50 minutos cada una. La estabilidad postural fue evaluada utilizando una plataforma de fuerza (para calcular el desplazamiento del centro de presión (COP), durante 30 segundos en postura erecta casi-estática, con ojos abiertos y cerrados, antes y después del entrenamiento con hipoterapia. El tratamiento estadístico fue realizado a través de ANOVA y Post hoc de Tukey con p<0,05. RESULTADOS: la amplitud de oscilación antero-posterior se redujo significativamente en el GI después de la estimulación, mientras que el GC mantuvo un comportamiento sin cambios entre las evaluaciones. En ambos grupos la estabilidad postural fue reducida con la supresión de la información visual. CONCLUSIONES: la adaptación funcional proporcionada por la hipoterapia fue capaz de mejorar la estabilidad postural de los portadores de EM. Los resultados corroboran la literatura que soporta el uso de la hipoterapia como una potencial intervención en los desordenes del control postural en portadores de EM.

Reabilitação vestibular: utilidade clínica em pacientes com esclerose múltipla / Vestibular rehabilitation: clinical benefits to patients with multiple sclerosis

O objetivo desse estudo foi analisar a eficácia do exercício de reabilitação vestibular em dois casos de esclerose múltipla remitente-recorrente. Ambos os casos foram encaminhados do Hospital de Clínicas para o Laboratório de Otoneurologia de uma instituição de ensino e foram submetidos aos seguintes procedimentos: anamnese, inspeção otológica, avaliação vestibular e aplicação do Dizziness Handicap Inventory pré e pós reabilitação vestibular utilizando-se o protocolo de Cawthorne e Cooksey. No primeiro caso, gênero feminino, 35 anos, tempo de doença de seis anos, referiu tontura há três anos, de intensidade moderada de ocorrência frequente, cefaléia, quedas, desvio de marcha à direita e sensação de desmaio (sic). Apresentou no exame labiríntico, síndrome vestibular periférica deficitária bilateral. No segundo caso, gênero feminino, 49 anos, tempo de doença de dois anos, referiu desvio de marcha à direita, dificuldade e/ou dor ao movimento do pescoço, formigamento de extremidade e alteração vocal. Apresentou no exame labiríntico, síndrome vestibular periférica deficitária à direita. Houve melhora significativa em ambos os casos dos aspectos físico, funcional e emocional do Dizziness Handicap Inventory após a realização da reabilitação vestibular. O protocolo utilizado promoveu melhora na qualidade de vida e auxiliou no processo de compensação vestibular.

The aim of the present study was to analyze the effectiveness of vestibular rehabilitation exercises in two cases of remittent-recurrent multiple sclerosis. Both cases were referred from the Clinics Hospital to the Laboratory of Otoneurology of the same institution and were submitted to the following procedures: anamnesis, otological inspection, vestibular evaluation, and application of the Dizziness Handicap Inventory before and after vestibular rehabilitation using the Cawthorne and Cooksey protocol. The first case was a 35-year-old female, diagnosed for six years, who referred frequent dizziness of moderate intensity for three years, headaches, falls, deviation of gait to the right and fainting sensations (sic). In the vestibular exam, she presented bilateral peripheral vestibular deficiency syndrome. The second case was a 49-year-old female, diagnosed for two years, who referred deviation of gait to the right, difficulty and/or pain with neck movement, paraesthesia of the extremities and vocal alteration. In the vestibular exam, she presented peripheral vestibular deficiency syndrome to the right. Both cases had significant improvements regarding physical, functional and emotional aspects of the Dizziness Handicap Inventory after vestibular rehabilitation. The protocol used benefitted the subjects' quality of life and favored the process of vestibular compensation.

Effects of aquatic exercises in a rat model of brainstem demyelination with ethidium bromide on the beam walking test / Efeitos de exercícios aquáticos no desempenho motor de ratos submetidos a um modelo de desmielização com brometo de etídio

Multiple sclerosis is a demyelinating disease of the central nervous system associated with varied levels of disability. The impact of early physiotherapeutic interventions in the disease progression is unknown. We used an experimental model of demyelination with the gliotoxic agent ethidium bromide and early aquatic exercises to evaluate the motor performance of the animals. We quantified the number of footsteps and errors during the beam walking test. The demyelinated animals walked fewer steps with a greater number of errors than the control group. The demyelinated animals that performed aquatic exercises presented a better motor performance than those that did not exercise. Therefore aquatic exercising was beneficial to the motor performance of rats in this experimental model of demyelination.

A esclerose múltipla é uma doença desmielinizante do sistema nervoso central que se associa a graus variados de incapacidade. Não se sabe se a realização de intervenções fisioterapêuticas precoces têm impacto na evolução dessa doença. Utilizamos um modelo experimental de desmielinização com o gliotóxico brometo de etídio e a aplicação de exercícios aquáticos precoces para avaliar o desempenho motor dos animais. Foram quantificados o número de passos e os erros executados durante a travessia da barra elevada. Os animais desmielinizados apresentaram menor número de passos e maior quantidade de erros em comparação aos grupos-controle. Os animais desmielinizados que realizaram exercícios aquáticos apresentaram melhor desempenho motor que os animais desmielinizados que não foram submetidos à intervenção. Portanto, a realização de exercícios aquáticos mostrou-se benéfica no desempenho motor dos animais submetidos ao modelo experimental do brometo de etídio.

Effects of visual feedback balance training by using computerised dynamic posturography in patients with multiple sclerosis

To study the effects of the visual feedback balance training on the Berg Balance Scale [BBS] under static and dynamic conditions, the somatosensory, visual and vestibular systems by dynamic posturography before and after training program in patients with multiple sclerosis [MS]. Retrospective case training study. Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait. A total of 23 patients with MS were recruited. All patients were evaluated using both the BBS and the sensory organization test [SOT] using computerized dynamic posturography [CDP] before and three months after the training program. The SOT consists of six conditions and composite equilibrium score [CES]. CES [%] and SOT were calculated. Before training, all patients had a reduction of BBSS and parameters of the SOT. After training, a significantincrease of BBS [p < 0.05], all parameters of the SOT [p < 0.05] and CES [p < 0.001] were observed. Improvement in all parameters of the SOT after training program could be explained by change in the somatosensory system of the posture control system. Also, there is impairment of the somatosensory system, rather than a specific lesion of vestibular and/or visual systems

Fisioterapia no enfrentamento de perdas em pacientes com doenças neurológicas / Physiotherapy in the process of coping with the losses in patients with neurological diseases

As doenças neurológicas são comuns em nosso meio e, muitas vezes, trazem limitações ao indivíduo, quando não, são progressivas e submetem o indivíduo ao enfrentamento diário de perdas. que culminam na finitude da vida dele. A abordagem de temas como perdas e luto antecipatório ainda é pouco difundida entre os profissionais fisioterapeutas. O presente trabalho procurou compreender o processo de reestruturação frente à crise do adoecer e a participação no tratamento, a experi~encia em relação às viv~encias de perdas e ao trabalho do profissional fisioterapeuta. Este é um estudo qualitativo que, por meio da realização de uma entrevista semi-estruturada com seis pacientes neurológicos, pretendeu compreender a vivência de pacientes neurológicos frente às suas perdas, e consequentemente, o enfrentamento delas. As respostas obtidas foram agrupadas em seis categorias de análise: não ter ciência sobre o porblema, difícil aceitação do diagnóstico, as atividades básicas são as maiores dificuldades, a adaptação às perdas é um processo, esperança de melhora, a fisioterapia auxilia no enfrentamento das perdas. Apesar de os entrevistados apresentarem quadros clínicos diversos (Doença de Parkinson, Esclerose Múltipla, Atrofia muscular Espinal e Lesão Medular Traumática), o reconhecimento dos benefícios que a fisioterapia proporciona foi unânime. Os relatos desta pesquisa nos permitem considerar que a fisioterapia ajuda os pacientes neurológicos no enfrentamento de suas perdas, especialmente as perdas físicas. A fisioterapia paliativa deve ser mais discutida, para que seja desenvolvida de forma adequada

The neurological diseases are frequent and many times cause limitations which being progressive force the person to face the daily losses which can lead to death. Approaching themes such as losses and antecipatory mourning is a rare practise among physiotherapists. The present study aimed at understanding the process of restructure when facing the crisis of the disease, the participation in the treatment, the experiences gained when dealing with losses and the work of the physiotherapist. It is a qualitative study which, through carrying out a semi-structured interview with six patients, intended to understand the life experience of neurological patients when dealing with their losses and later facing them. The answers were groupedinto six analysis categories: not knowing the problem, difficult acceptance of the diagnosis, the basic daily activities are the biggest difficulties, adaptation to the damages is a process, hope to get better, physiotherapy helps to cope with the loss. Although the interviewee presented different clinic, the regognition of the benefits given by Physiotherapy was unanimous. The accounts in this research allow us to conclude that Physiotherapy helps the neurological patients to face their losses, specially the physical ones. The palliative physiotherapy must be more discussed and studied to get better results.

Enfermería y bioética en pacientes con esclerosis múltiple, ingresados en el Hospital de Rehabilitación: 2004-2006 / Nursing and Bioethics in patients presenting with sclerosis multiple. Admitted in Rehabilitation Hospital. 2004-2006

Generalmente los pacientes con Esclerosis Múltiple sufren de discapacidad por lo que son sobreprotegidos por aquellas personas que lo rodean y se pueden ver privados de su autonomía, de recibir trato con justicia y beneficencia, sin valorar que en ocasiones le producen más daño que beneficio, por lo que nos propusimos evaluar si se respetan los principios que sustentan la bioética en el manejo de estos pacientes por el personal de enfermería en el Hospital de Rehabilitación Dr. Faustino Pérez Hernández de Sancti-Spíritus, para lo cual se realizó un trabajo descriptivo de corte transversal de un universo de 108 pacientes que han ingresado para recibir tratamiento rehabilitador en el período de abril de 2004 a febrero de 2006, a través de un proyecto de trabajo en convenio con el Instituto de Neurología y Neurocirugía de Ciudad de la Habana; se conformó una muestra de 83 pacientes a través de un muestreo aleatorio simple. Como principales resultados encontramos que un 62,7 por ciento correspondían al sexo femenino, el 59 por ciento se encuentra trabajando a pesar de sus limitaciones, el grado de discapacidad que predominó fue moderada con un 45,9 por ciento, se pudo constatar que el personal de enfermería a cargo de su cuidado respeta los principios de la Bioética.

In general, patients presenting with sclerosis multiple have disability and are overprotected by those persons in its sorrounding, and may be deprived of its autonomyd, of a treatment with justice and charity, without assess that occasionally make more damage than benefit, thus we proposed to evaluate if all principles supporting Bioethics in management by Nursing staff in “Dr. Faustino Péerez Hernández” of Sancti Spiritus Province are respected, that is why we made a transversal and descriptive work of a sample consisted of 108 patients admitted to receive rehabilitation treatment from April 2004 to February 2006, through a work project in agreement with Institute of Neurology and Neurosurgery of Havana City; we grouped 83 patients through a single randomized sampling. As main results we founded that 62,7 per cent corresponding to female sex, 59 per cent is working despite its limitations, disbility level predominance was moderate with a 45,9 per cent, it was possible to confirm that Nursing staff charged of care fulfil principles of Bioethics.

Reabilitação cognitiva em pacientes com esclerose múltipla - estudo preliminar / Neuropsychological rehabilitation in patients with multiple sclerosis - preliminary study

O objetivo desse estudo é desenvolver um programa de reabilitação das dificuldades cognitivas em esclerose múltipla (EM). Foram avaliados cinco pacientes com EM remintente-recorrente com queixas cognitivas, pela Escala de Incapacidade Funcional Expandida (EDSS), escala do ansiedade e depressão (HAD) e pela avaliação neuropsicológica. O programa abrangeu estratégias restau-radora e ecológica. Os cincos pacientes avaliados não apresentaram diferença no desempenho cognitivo em termos neuropsicológicos. Porém observamos melhora nas seis dimensões da escala Visual Análoga. Esses achados foram importantes para o implemento de um trabalho de reabilitação cognitiva para portadores de EM, levando a um desempenho adequado nas atividades profissional, social e familiar

[Assess the using and efficacy of fatigue reducing strategies in patients referred to multiple sclerosis association of Iran]

Multiple sclerosis [MS] is characterized by a broad spectrum of physical and psychological impairments. Fatigue is a common and disabling symptom for individuals with MS 75%-90% of individuals with MS reported problems with fatigue. They describe fatigue as a frustrating and overwhelming symptom that can be disabling. Assessing the usage and efficiencies of fatigue reducing strategies in patients referred to multiple sclerosis association of Iran. This is a cross-sectional survey study of 100 patients who were selected randomly. The method of collecting data was by asking and answering and the research tool was a questionnaire. The questionnaire was prepared in four parts. Part one included the disease and demographic questions. Part two included Fatigue Severity Scale [FSS]. Part tree included Fatigue Reducing Strategies and part four included Fatigue Relief Scale. The data were collected in one stage, and analyzed with SPSS software. To analyze the data, descriptive and inferential statistical methods [fisher exact test, chi square test, correlation coefficient, meant, standard deviation] have been used. The Findings of this study represented that the majority of subjects [63%] were suffering of severe fatigue symptom. The most frequently used strategies to relive fatigue were lie down [51%], watching TV [30%], frequent rest [28%] and sitting without doing any thing [28%]. But the most effective strategies were sleeping [8.17], daily nap [8.4], take a shower with lukewarm water [7.25], avoiding heat [7.16], exercising [7.14], praying [7.0] and socialization [7.0]. Results also showed that fatigue have been affected by some variables such as education level, having child, number of children, job status, daily working hours, dwelling place and time of bed-ridden. Findings also suggested that all strategies will be useful when the highest level of fatigue has been experienced [p=0.532, r=-0.063]. The most common strategies were not necessarily the most effective ones. Most frequently used strategies were included sleeping, napping, warm water bathing, heat avoidance, and exercising. However more physically active strategies such as exercise and socializing were more effective strategies. The patients should be suggested that to try variety of strategies such as walking and exercising besides sleeping and resting to relieve the fatigue. Patients should be instructed to monitor the intensity of their fatigue and also be encouraged to maintain that level of activity which is in balance with efficient rest period

Comportamiento de la fuerza muscular y de la marcha en un grupo de pacientes con esclerosis múltiple, sometidos a un programa de neurorrehabilitación / Behavior of the muscular strength and walking in a group of patientes with multiple sclerosis, submited to a neurorrehabilitation program

La esclerosis múltiple causa debilidad muscular y alteraciones de la marcha. El arsenal evaluativo para caracterizar la enfermedad es importante en la neurorrestauración. Estudio mostra como el test de fuerza muscular, dinamometría, test dinámico de la marcha e índice ambulatorio de Hausser aplicados en laboratorio permiten cuantificar los cambios en el estado de los pacientes que padecem la enfermedad

Influencia de un programa rehabilitatorio intensivo en pacientes con esclerosis múltiple / The influence of the intensive rehabilitating program in the patients with degenerating development of multiple sclerosis

The degenerating development of multiple sclerosis causes an unfavorable increase in the patient's motor inactivity. That is why, the continuous physical exercises benefits the efected functions.The objective of the present study is to analyze and appraise how the application of a physical education program influences the muscle strengt, the dynamics of equilibrium and gait.During the development of the investigation, nine hospitalized patients at out our instituion were submitted to an intensive rehabilitation program of six frequencies a week, seven hours a day, and divided into two working sessions during their stay at or center, wich fluctuated from to ten weeks.In order to know the patient's physical conditition under the effects of the exercise program, we applied three sets of tests and two internationally recognized functional sealis;before and after applying the program;a set intendid for measuring the strength of different zmuscle groups, a set used for equilibrium in sitting an standing position, and one for gait.A comparative analysis was carried out between the two measurements to know each patient's evolution stage.Its results are the following:in the set for strength, we obtained an increase in the muscle strengthening of the four limbs;in the equilibrium set test, we observed an improvement in all the tested aspects and results obtained in gait tests showed an increase in the patient's independent walking capacity or by the use of other means