Catecholamine response to exercise in individuals with different levels of paraplegia.

The purpose of this study was to investigate the effect of the level of injury on the serum level of norepinephrine (Nor) and epinephrine (Epi) at rest and after maximal exercise in individuals with paraplegia. Twenty-six male spinal cord-injured subjects with complete paraplegia for at least 9 months were divided into two groups of 13 subjects each according to the level of injury, i.e., T1-T6 and T7-T12. Serum Nor and Epi concentrations were measured by HPLC-ECD, at rest (PRE) and immediately after a maximal ergospirometric test (POST). Statistical analysis was performed using parametric and non-parametric tests. Maximal heart rate, peak oxygen uptake, and PRE and POST Nor were lower in the T1-T6 than in the T7-T12 group (166 +/- 28 vs 188 +/- 10 bpm; 18.0 +/- 6.0 vs 25.8 +/- 4.1 ml kg(-1) min(-1); 0.54 +/- 0.26 vs 0.99 +/- 0.47 nM; 1.48 +/- 1. 65 vs 3.07 +/- 1.44 nM). Both groups presented a significant increase in Nor level after exercise, while only the T7-T12 group showed a significant increase in Epi after exercise (T1-T6: 0.98 +/- 0.72 vs 1.11 +/- 1.19 nM; T7-T12: 1.24 +/- 1.02 vs 1.89 +/- 1.57 nM). These data show that individuals with paraplegia above T6 have an attentuated catecholamine release at rest and response to exercise as compared to subjects with injuries below T6, which might prevent a better exercise performance in the former group.

Catecholamine response to exercise in individuals with different levels of paraplegia

The purpose of this study was to investigate the effect of the level of injury on the serum level of norepinephrine (Nor) and epinephrine (Epi) at rest and after maximal exercise in individuals with paraplegia. Twenty-six male spinal cord-injured subjects with complete paraplegia for at least 9 months were divided into two groups of 13 subjects each according to the level of injury, i.e., T1-T6 and T7-T12. Serum Nor and Epi concentrations were measured by HPLC-ECD, at rest (PRE) and immediately after a maximal ergospirometric test (POST). Statistical analysis was performed using parametric and non-parametric tests. Maximal heart rate, peak oxygen uptake, and PRE and POST Nor were lower in the T1-T6 than in the T7-T12 group (166 Ý 28 vs 188 Ý 10 bpm; 18.0 Ý 6.0 vs 25.8 Ý 4.1 ml kg-1 min-1; 0.54 Ý 0.26 vs 0.99 Ý 0.47 nM; 1.48 Ý 1.65 vs 3.07 Ý 1.44 nM). Both groups presented a significant increase in Nor level after exercise, while only the T7-T12 group showed a significant increase in Epi after exercise (T1-T6: 0.98 Ý 0.72 vs 1.11 Ý 1.19 nM; T7-T12: 1.24 Ý 1.02 vs 1.89 Ý 1.57 nM). These data show that individuals with paraplegia above T6 have an attentuated catecholamine release at rest and response to exercise as compared to subjects with injuries below T6, which might prevent a better exercise performance in the former group

Serum level of serotonin during rest and during exercise in paraplegic patients.

The purpose of this study was to evaluate the serum level of serotonin (5-HT) during rest and response to exercise in subjects with spinal cord injury (SCI) with different levels of physical activity. Twenty-five male subjects with traumatic paraplegia, the neurological levels being between T1 and T12, volunteered for the study. They were divided into two groups matched for age, weight and time since injury, according to the level of physical activity: 14 inactive and 11 subjects regularly involved in sports activity and considered active. They all performed a maximal spiroergometric test with an arm crank ergometer. Two samples of blood were collected for 5-HT determination, during rest (PRE) and immediately after exercise test (POST). Serum 5-HT concentration was measured by high performance liquid chromatography using electrochemical detection (HPLC-ED). The results showed that peak oxygen uptake (VO2peak) was higher in the active group (27.08 +/- 2.60 vs 18.89 +/- 5.58 mL.kg-1.min-1, P < 0.001). There were no significant differences between the inactive and active groups for the 5-HT PRE (respectively 176.96 and 193.73 ng.mL - 1, P > 0.05) or POST values (275.44 vs 311.05 ng.mL-1, P > 0.05). Both groups showed an increment in 5-HT after maximal exercise, but only in the active group it reached statistical significance (Wilcoxon test, P < 0.02). Our results show that chronic paraplegic individuals have normal resting serum serotonin levels and normal response to exercise. The relationship between training status, mood elevation and 5-HT in SCI could not be established in the present study, and further investigation is needed to clarify this issue.

Próteses ortopédicas de baixo custo: estudo crítico do pé de Jaipur nos amputados transtibiais / Low cost orthopedic prostheses: critical study of the Jaipur foot for below-the-knee amputers

No intuito de avaliar a funcionalidade do pé de Jaipur em próteses de baixo custo para amputados abaixo do joelho, foram observados dez amputados transtibiais unilaterais com média de 27,4 anos de idade, cinco dos quais já usavam próteses. Cada paciente foi submetido a testes pelo método baropodométrico, realizados no F-Scan versäo 1,3, em ortostatismo e em marcha, usando próteses de polietileno de alta densidade equipados com pés Sach e com pés de Jaipur. A avaliaçäo das pressöes nas superfícies plantares dos pés protéticos e, simultaneamente, dos pés näo amputados, demonstrou que o pé de Jaipur é mais instável do que o pé Sach no plano sagital, devido a ter o tornozelo mais flexível. Os parâmetros cronológicos de marcha analisados näo mostraram diferenças significativas entre os pés Sach e os de Jaipur, permitindo concluir pela indicaçäo de próteses com pés de Jaipur, mais baratas, aos amputados abaixo do joelho ativos, com membro inferior contralateral hígido.

O valor da reabilitaçäo no tratamento de pacientes portadores de doença de Legg-Calvé-Perthes submetidos à osteotomia de Salter modificada / The value of rehabilitation in treatment of patients with Legg-Calvé-Perthes disease submitted to modified Salter osteotomy

No período compreendido entre janeiro de 1987 e agosto de 1990, 28 pacientes portadores de DLCP foram tratados cirurgicamente pela osteotomia de Salter modificada e acompanhadas no Setor de Fisiatria do Departamento de Ortopedia e Traumatologia da Escola Paulista de Medicina, no sentido de se verificar a influência de um tratamento fisiátrico reabilitacional sobre os resultados clínicos finais. Os pacientes foram avaliados clinicamente de modo padronizado em relaçäo aos dados mensuráveis, que chamamos de grau de disfunçäo articular (goniometria, força muscular e discrepância de membros), e àqueles observáveis (postura e marcha), denominados por nós grau de alteraçäo de postura e marcha em três ocasiöes pré-operatório, pós-operatório e avaliaçäo final. No pré-operatório foram feitos exames radiológico e artrográfico, objetivando a determinaçäo da fase da doença e do grau de comprometimento da cabeça do fêmur. Pôde-se observar uma média de idade de 6,9 anos, variando de 3 a 10 anos, com predomínio do sexo masculino (75%). No pós-operatório, todos os pacientes foram encaminhados para tratamento de reabilitaçäo. Nessa ocasiäo, de modo espontâneo, foram estabelecidos dois grupos de pacientes: os que fizeram reabilitaçäo (grupoI) e os que näo fizeram (grupo II). Na análise dos resultados, pôde-se notar que, clinicamente, todas as crianças estavam piores do ponto de vista cinético postural na avaliaçäo pós-operatória em relaçäo à avaliaçäo inicial, e que elas melhoraram por ocasiäo da avaliaçäo final, especialmente as do grupo I, que fizeram tratamento reabilitacional. O tratamento reabilitacional foi positivo nos pacientes considerados inicialmente graves e moderados, tanto para o grau de disfunçäo articular como para o grau de alteraçäo de postura e marcha. A ausência desse tratamento influenciou negativamente mesmo os pacientes iniciais leves, especialmente quanto ao grau de alteraçäo de postura e marcha, que notamos ser a disfunçäo mais persistente. Além disso, o tratamento reabilitacional favoreceu especialmente as crianças novas, notadamente as do sexo masculino

Follow-up of paraplegic patients after comprehensive rehabilitation.

One hundred patients from a total of 239 paraplegic patients were surveyed after at least 6 months in community life in order to assess the value of the rehabilitation programme. The patients' average age was 24 years, and the highest neurological level being T1. All patients had received intensive care, the average time being 4.7 months. The results were similar to those described in the literature, but the lower socio-economic levels and the absence of comprehensive initial care in general hospitals soon after trauma were negative factors. It is concluded that (1) Brazil requires medical and paramedical staff with specific training for the acute phase in more Rehabilitation Centres; (2) that paraplegics are greatly benefited by a rehabilitation programme; (3) the Brazilian Social Security should sponsor the rehabilitation programme.