Impact of the suspension of neurogenic detrusor overactivity treatment with botulinum toxin due to the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic has imposed an additional pressure on health systems worldwide. Patients with neurogenic detrusor overactivity (NDO) were especially vulnerable to inadequate care. This study aims to evaluate the impact of the suspension of NDO treatment with Botulinum Toxin (BONT-A) due to the COVID-19 pandemic. METHODS: Cross-sectional study of patients with spinal cord injury and NDO, who underwent BONT-A treatment in 2018 or 2019 and, whose administration programed for 2020 or 2021 was suspended. The study protocol was divided into two parts. Phase 1 consisted of data collection from the clinical processes and in phase 2 a standardized telephone questionnaire was applied. Information was collected at 3 time points: (1) before the last BONT-A treatment, (2) after the last BONT-A treatment and (3) at the time of the telephone call. Statistical analysis used the McNemar and the Wilcoxon test with a p-value ⩽ 0.05 as level of significance. RESULTS: 21 patients with mean age of 42.0 years and disease duration of 16.9 years were included. On average patients were undergoing treatment with BONT-A for 7.6 years and mean inter-treatment frequency was 2.3 years. Mean time since the last BONT-A administration was 2.3 years and mean reported BONT-A effect duration was 11.9 months. A significant increase in the percentage of patients with involuntary urinary loss (p = 0.004) and urgency (p = 0.031) was found. A significant decrease in mean catheterization interval from 4.5 to 3.6 h (p = 0.002) and an increase in daily oxybutynin dosage from 8.5 to 12.1 mg (p = 0.002) was also found. DISCUSSION: The COVID-19 pandemic originated clinical worsening of patients undergoing regular BONT-A treatment for NDO. These patients presented a significant increase in involuntary urinary loss, urgency and medication dosage and a decrease in catheterization interval. Thus, interruption of intravesical BONT-A treatment severely affected these patients and needs to be avoided.

Ultrasound-Guided Intrathecal Baclofen Pump Refilling Method for Management of Spasticity in a Complex Clinical Case.

Intrathecal baclofen (ITB) administration is a common method in managing spasticity. The location of the reservoir fill port (RFP) is identified manually in most cases. However, it can be difficult due to a variety of factors, such as the formation of excess subcutaneous cellular tissue and scar formation overlying the RFP and rotation or inversion of the pump. Consequently, multiple failed attempts accessing the reservoir increases pain and risk of fatal complications (e.g., infection and withdrawal syndrome from pocket filling). We describe a successful ultrasound-guided pump refilling case after multiple failed attempts by the conventional method. This groundbreaking instrument assists this minimally invasive procedure while limiting iatrogenic injury in the treatment of spasticity. The presentation of this case shows the utility of ultrasound as an important tool to guide the procedure and prevent adverse events in a spasticity management consult.

A medicina física e reabilitação no século XXI: desafio e oportunidades / Physical and rehabilitation medicine in the XXI century: challenges and opportunities

Neste trabalho efetua-se uma reflexão sobre algumas das questões que estão a influenciar a reabilitação na atualidade. As alterações demográficas e a epidemiologia das doenças, o aumento das expectativas dos doentes, o crescimento dos custos dos cuidados de reabilitação, e também a dificuldade em estabelecer os limites entre a MFR, as outras especialidades médicas e outros profissionais de saúde, são alguns dos desafios da nossa prática diária. Por outro lado, as mudanças nos conceitos, mentalidades e políticas relacionadas com a deficiência tal como a evolução tecnológica, são oportunidades para alargar o campo de intervenção da Medicina de Reabilitação, confirmando o seu papel decisivo na promoção do entendimento social sobre a deficiência. Finalmente, abordam-se algumas novas perspectivas para a reabilitação no século XXI.

This paper addresses some of the issues that are shaping rehabilitation nowadays, such as changes in demographics and epidemiology of diseases, raising patients? expectations, increasing costs of rehabilitation care and also the difficulties in establishing boundaries between PMR, other medical specialties and rehabilitation professionals. Some contextual changes which have occurred in the last years in concepts, mentalities and policies related to disability and rehabilitation will be pointed out, as well as the benefits of technological evolution as a tool for enhancing social inclusion of people with disabilities. The recently created network for continued and integrated care, which is being set up in Portugal, will be referred, as a response to the need of providing integrated services. These changes may represent opportunities to enlarge PMR of intervention and to confirm its role on promoting social understandings of disability. Finally, some new perspectives for rehabilitation on the edge of the 21st are suggested.

Spinal cord lesions - The rehabilitation perspective. / Lesões vértebro-medulares - A perspectiva da reabilitação.

The present study provides an overview of the spinal cord injury focusing mainly on aspects related to rehabilitation. Spinal cord injury affects young people in an active phase of life, determining severe handicaps. Most of the lesions are traumatic, caused by car accidents. Until fifty years ago, the survival of individuals with spinal cord injury was very reduced and the leading cause of death was renal failure. Due to developments in medical knowledge and technical advances, the survival rates have significantly improved. The causes of death have also changed being respiratory complications, particularly pneumonia, the leading causes. Immediately after a spinal cord lesion there is a phase of spinal shock which is characterized by flaccid paralysis and bladder and bowel retention. Progressively there is a return of the spinal cord automatism with the beginning of some reflex activities. Based on neurological evaluation it is pos-sible to predict motor and functional recovery and establish the rehabilitation program. We can consider three phases on the rehabilitation program: the first while the patient is still in bed, directed to prevent or treat complications due to immobility and begin sphincters reeducation; the second phase is intended to achieve wheelchair autonomy; the last phase is training in ortostatism. The rehabilitation program also comprises sports and recreational activities, psychological and social support in order to achieve an integral of the individual with a spinal cord injury.