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1.
Microsurgery ; 39(8): 679-687, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31566816

RESUMO

BACKGROUND: Lymph node flap transfer has gradually gained popularity for the treatment of upper and lower limb lymphedema. The aim of this study is to present the outcomes of an integrated treatment protocol based on double gastroepiploic lymph node flap (DG-VLN) and active physiotherapy in patients affected by Stage II and III lower extremity lymphedema. METHODS: All Stage II and III lower limb lymphedema patients operated between September 2015 and December 2017 were retrospectively identified and only those treated with an integrated approach of DG-VLN flap and active physiotherapy were included. Outcomes were assessed clinically with limb circumference measurement and radiologically with lymphoscintigraphy. Flap viability was evaluated through indocyanine green lymphography. Lymphedema related quality of life was evaluated preop and at 1 year follow up through LYMQOL questionnaire. RESULTS: Sixteen patients met inclusion criteria. Mean follow up was 26.2 months. Significant reduction in lower limb volume was observed for all patients from pre to post intervention. At 3 months of follow up, the mean CRR was 42.4% at below knee (BK) level and 25.4% at above knee (AK) level. At 12 months of follow up, the mean CRR was 58.3% at BK level (p = .001*) and 43.4% at AK level (p < .04*). LYMQOL metrics showed significantly better scores in all domains. CONCLUSIONS: Patients with lower limb lymphedema can benefit from combined DG-VLN flap and active physiotherapy, as this approach seem to fasten the onset of improvement and to have a positive impact on patients' quality of life.


Assuntos
Laparoscopia , Extremidade Inferior , Linfonodos/transplante , Linfedema/terapia , Modalidades de Fisioterapia , Retalhos Cirúrgicos , Coleta de Tecidos e Órgãos/métodos , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Omento , Estudos Retrospectivos , Estômago , Fatores de Tempo , Resultado do Tratamento
2.
NeuroRehabilitation ; 37(3): 393-403, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26518532

RESUMO

BACKGROUND: Post-coma persons in a minimally conscious state (MCS) and with extensive motor impairment and lack of speech tend to be passive and isolated. OBJECTIVE: This study aimed to (a) further assess a technology-aided approach for fostering MCS participants' responding and stimulation control and (b) carry out a social validation check about the approach. METHODS: Eight MCS participants were exposed to the aforementioned approach according to an ABAB design. The technology included optic, pressure or touch microswitches to monitor eyelid, hand or finger responses and a computer system that allowed those responses to produce brief periods of positive stimulation during the B (intervention) phases of the study. Eighty-four university psychology students and 42 care and health professionals were involved in the social validation check. RESULTS: The MCS participants showed clear increases in their response frequencies, thus producing increases in their levels of environmental stimulation input, during the B phases of the study. The students and care and health professionals involved in the social validation check rated the technology-aided approach more positively than a control condition in which stimulation was automatically presented to the participants. CONCLUSIONS: A technology-aided approach to foster responding and stimulation control in MCS persons may be effective and socially desirable.


Assuntos
Estado Vegetativo Persistente/psicologia , Estado Vegetativo Persistente/reabilitação , Desempenho Psicomotor , Tecnologia Assistiva , Comportamento Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Coma/etiologia , Coma/psicologia , Auxiliares de Comunicação para Pessoas com Deficiência , Meio Ambiente , Pálpebras , Feminino , Dedos , Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fala , Distúrbios da Fala/etiologia , Distúrbios da Fala/reabilitação , Resultado do Tratamento , Adulto Jovem
4.
J Rehabil Med ; 40(4): 315-6, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18382829

RESUMO

OBJECTIVE: Use of botulinum toxin is expanding as clinical studies demonstrate new potential therapeutic applications. In rehabilitation, botulinum toxin is predominantly used as adjunct therapy for the treatment of spasticity, but it may prove useful for other atypical clinical situations. CASE HISTORY: A 73-year-old man had a severe sub-arachnoid haemorrhage following the rupture of a giant aneurism of the middle left cerebral artery. Clinically, the patient presented a vegetative state and an oro-mandibular dyskinesia that produced a chronic ulcer on the lower lip. As treatment for this dyskinesia, a total of 320 U botulinum toxin type A were injected into the upper and lower orbicularis oris and masseter muscles. RESULTS AND DISCUSSION: This treatment allowed for application of topical medication and subsequently, ulcer healing. Botulinum toxin type A may be an important therapeutic aid for clinicians faced with treating persistent pathological conditions caused by dyskinesia.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Doenças Labiais/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Úlceras Orais/tratamento farmacológico , Idoso , Toxinas Botulínicas Tipo A/administração & dosagem , Doença Crônica , Discinesias/complicações , Discinesias/fisiopatologia , Humanos , Doenças Labiais/etiologia , Doenças Labiais/fisiopatologia , Masculino , Músculos da Mastigação/efeitos dos fármacos , Músculos da Mastigação/fisiopatologia , Fármacos Neuromusculares/administração & dosagem , Úlceras Orais/etiologia , Úlceras Orais/fisiopatologia , Estado Vegetativo Persistente/complicações , Estado Vegetativo Persistente/fisiopatologia
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