ABSTRACT
Introduction: Introduction: Participation is the dynamic and complex interaction between the individual's health condition, bodily functions, activities that can be carried out and environmental factors. Measuring it helps to understand the impact of disability. Objectives: Describe the activities and participation in subjects with neurological pathologies, discharged from hospitalization for rehabilitation. Secondly, to compare the clinical-demographic characteristics and the participation among wheelchair users with respect to non-users. Material and method: Observational, prospective, cross-sectional, multicenter study. Based on a survey of people over 18 years of age with pathologies of neurological origin discharged from rehabilitation from 6 centers in Argentina. Results: 282 people responded, 69% men with an average age of 50 years and discharged 22 months ago. The most common diagnosis was cerebrovascular accident. The self-perception of participation was 49 out of 90, and those who do not use a wheelchair report a higher level of participation. The greatest satisfaction was in areas of interpersonal relationships. 50% require assistance to use transportation in the community. 61% neither work nor study, nor do they engage in sports activities (65%). 61% of wheelchair users cannot go to places in the community because they are inaccessible. Conclusion: Less participation in community activities was observed, mainly due to architectural barriers and difficulties in using transport in wheelchair users. The family occupies a central place so that they can integrate into the community.
Introducción: La participación es la interacción dinámica y compleja entre la condición de salud del individuo, las funciones corporales, las actividades que puede realizar y los factores ambientales. Medirla ayuda a comprender el impacto de la discapacidad. Objetivos: Describir las actividades y participación en sujetos con patologías neurológicas, dados de alta de internación para rehabilitación. Secundariamente comparar las características clínico-demográficas y la participación entre usuarios de silla de ruedas respecto a personas no usuarias. Material y método: Estudio observacional, prospectivo, transversal, multicéntrico. Basado en una encuesta a mayores de 18 años con patologías de origen neurológico dados de alta de rehabilitacion de 6 centros de Argentina. Resultados: Respondieron 282 personas, 69% hombres con una media de edad de 50 años y dados de alta hace 22 meses. El diagnóstico más frecuente fue el accidente cerebrovascular. La autopercepción de la participación fue de 49 sobre 90, y los que no utilizan silla de ruedas refieren mayor nivel de participación. La mayor satisfacción fue en áreas de relaciones interpersonales. El 50% requiere de asistencia para utilizar los transportes en la comunidad. El 61% no trabaja ni estudia, así como tampoco realizan actividades deportivas (65%). Al 61% de los usuarios de silla de ruedas no pueden ir a lugares de la comunidad por ser inaccesibles. Conclusión: Se observó menor participación en actividades comunitarias, principalmente por barreras arquitectónicas y por dificultades para usar el transporte en usuarios de silla de ruedas. La familia ocupa un lugar central para que puedan integrarse en la comunidad.
Subject(s)
Disabled Persons , Wheelchairs , Adolescent , Adult , Argentina , Cross-Sectional Studies , Disabled Persons/rehabilitation , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
BACKGROUND: Tracheostomy is a frequent surgical procedure in subjects with chronic disorders of consciousness (DOC). There is no consensus about safety of tracheostomy decannulation in this population.The aim of our study was to estimate if DOC improvement is a predictor for tracheostomy decannulation. Secondary outcomes include mortality rate and discharge destination. METHODS: We conducted an observational, retrospective, case-control study at a weaning and rehabilitation center (WRC). We included tracheostomized subjects with DOC admitted between August 2015 and December 2017. We matched groups based on the consciousness level at admission assessed withthe coma recovery scale revised (CRS-R). Subjects who were later decannulated formed the cases, while those that remained tracheostomized at the end of follow-up formed the controls. Improvement of DOC was defined as a progress in the categories of the CRS-R. RESULTS: 22 subjects were included in each group. No significant differences were found in clinical and demographic variables, except that controls had longer neurologic injury evolution (65.5 vs 51 days, P = .047), more tracheostomy days at admission to ourinstitution (53 vs 33.5, P = .02), and higher prevalence of neurological comorbidities (12 vs 4, P = .03). Subjects who improved their DOC had more chances of being decannulated (OR 11.28, 95% CI 1.96-123.08). Tracheostomy decannulation could not be achieved in most subjects who did not improve from vegetative state (VS) (OR 0.13, 95% CI 0.02-0.60). 8 subjects, however, could be decannulated in VS, with only one decannulation failure and no deaths. Mortality was higher in controls (0 vs 6, P = .02), especially among VS (0 vs 5, P = .049). No significant differences were found in discharge destination between groups. CONCLUSIONS: Subjects who improve their DOC are more likely to achieve tracheostomy decannulation. Some subjects in VS were decannulated, with lower mortality than those who remained tracheostomized.
Subject(s)
Consciousness , Tracheostomy , Case-Control Studies , Device Removal , Humans , Retrospective StudiesABSTRACT
Luego del estudio de 43 pacientes con síndromes extrapiramidales (Parkinsonismos, Temblor esencial, Parálisis Supranuclear) mediante evaluaciones clínicas, por Resonancia Magnética y ecografía transcraneana se perfeccionó la metodología de evaluación incluyendo el estudio sistematizado de la región mesencefálica (SN;T) Unidades de Intensidad ROI; Grado 2: 85-105 y Grado 1: 105-115, detección de depósitos férricos mediante técnica de GRE y correlacionarlo con la evaluación del área de sección transversal por eco transcraneano y la determinación de grados de visualización ecográfica del mesencéfalo...Lo anterior nos ha permitido incluir en nuestras evaluaciones rutinarias cuestionarios para evaluar olfato y conducta alimentaria, relacionados con las alteraciones del núcleo accumbens como marcadores tempranos de Enfermedad de Parkinson. Asimismo nos ha permitido diferenciar entre los distintos cuadros con afectación del circuito extrapiramidal.
