Functional expansion of sensorimotor representation and structural reorganization of callosal connections in lower limb amputees.

Previous studies have indicated that amputation or deafferentation of a limb induces functional changes in sensory (S1) and motor (M1) cortices, related to phantom limb pain. However, the extent of cortical reorganization after lower limb amputation in patients with nonpainful phantom phenomena remains uncertain. In this study, we combined functional magnetic resonance (fMRI) and diffusion tensor imaging (DTI) to investigate the existence and extent of cortical and callosal plasticity in these subjects. Nine "painless" patients with lower limb amputation and nine control subjects (sex- and age-matched) underwent a 3-T MRI protocol, including fMRI with somatosensory stimulation. In amputees, we observed an expansion of activation maps of the stump in S1 and M1 of the deafferented hemisphere, spreading to neighboring regions that represent the trunk and upper limbs. We also observed that tactile stimulation of the intact foot in amputees induced a greater activation of ipsilateral S1, when compared with controls. These results demonstrate a functional remapping of S1 in lower limb amputees. However, in contrast to previous studies, these neuroplastic changes do not appear to be dependent on phantom pain but do also occur in those who reported only the presence of phantom sensation without pain. In addition, our findings indicate that amputation of a limb also induces changes in the cortical representation of the intact limb. Finally, DTI analysis showed structural changes in the corpus callosum of amputees, compatible with the hypothesis that phantom sensations may depend on inhibitory release in the sensorimotor cortex.

Biosensor for luteolin based on silver or gold nanoparticles in ionic liquid and laccase immobilized in chitosan modified with cyanuric chloride.

Novel and effective biosensors based on Ag or Au nanoparticles dispersed in ionic liquid (IL) 1-butyl-3-methylimidazolium hexafluorophosphate (BMI.PF(6)) and laccase (Lac) from Aspergillus oryzae immobilized in chitosan (Chi) chemically cross-linked with cyanuric chloride (CC) were constructed. This enzyme catalyzes the oxidation of luteolin to the corresponding o-quinone, which is electrochemically reduced back to luteolin at 0.35 V vs. Ag/AgCl. Square-wave voltammetry was used for the electrochemical determination of luteolin at the Lac-nanoparticles-BMI.PF(6) biosensors. The best performance was obtained with 50:20:15:15% (w/w/w/w) as the graphite powder:Chi-CC:Nujol:Ag-BMI.PF(6) or Au-BMI.PF(6) composition (Lac 0.29 units mL(-1)) in 0.1 M acetate buffer solution (pH 4.0) with frequency, pulse amplitude and scan increment at 50 Hz, 100 mV, and 5.0 mV, respectively. Under optimized conditions, the cathodic currents increased linearly for the luteolin concentration range of 0.099-5.825 microM with detection limits of 0.054 +/- 0.004 microM (Ag-BMI.PF(6)) and 0.028 +/- 0.002 microM (Au-BMI.PF(6)). These biosensors demonstrated high sensitivity, good repeatability and reproducibility, and long-term stability (13% decrease in response over 70 days). The recovery study for luteolin in chamomile tea samples gave values of 91.8-104.8%. The influence of Lac immobilized in Chi-CC and nanoparticles-BMI.PF(6) contributes to the excellent performance of the biosensors.

Rutin determination in pharmaceutical formulations using a carbon paste electrode modified with poly(vinylpyrrolidone).

A carbon paste electrode modified with poly(vinylpyrrolidone) (PVP) was developed for the determination of rutin. PVP enhances the adsorption of rutin on the electrode surface due to the presence of hydrogen bonding between the imide group in PVP and the hydroxyl group in rutin. The current responses in cyclic and linear sweep voltammetric experiments were investigated and an oxidation peak was observed at +0.87 V vs. Ag/AgCl. Several parameters were investigated to evaluate the performance of the modified electrode. The best analytical response was obtained employing (75:15:10%, w/w/w) graphite powder:Nujol:PVP, with an accumulation time of 10 min, scan rate of 100 mV s(-1) and 0.1M phosphate buffer solution (pH 6.0) as supporting electrolyte. The analytical curve was linear for rutin concentrations of 3.9 x 10(-7) to 1.3 x 10(-5)M (r=0.9991) and the detection limit was 1.5 x 10(-7)M. The recovery of rutin from pharmaceutical samples ranged from 98.3 to 101.7% and the relative standard deviation was 3.3% for a solution containing 7.7 x 10(-6)M rutin (n=5). This electrode was successfully applied to the determination of rutin in pharmaceutical formulations. The results obtained using the proposed modified carbon paste electrode and those obtained by the standard method are in agreement at the 95% confidence level.

Consenso Abem para o ensino de comunicação nas escolas médicas brasileiras / ABEM consensus for the brazilian medical schools' communication curriculum

Resumo: Introdução: A comunicação é uma competência essencial para o(a) médico(a) e outras categorias profissionais, e deve ser desenvolvida durante sua formação profissional. A elaboração de um projeto de comunicação, incluindo um consenso brasileiro, visou subsidiar as escolas médicas a preparar os estudantes de Medicina para se comunicarem efetivamente com os(as) cidadãos/cidadãs brasileiros(as), de características plurais intra e inter-regionais, pautando-se no profissionalismo e nos princípios do Sistema Único de Saúde (SUS). Objetivo: Este manuscrito apresenta o consenso para o ensino de comunicação nas escolas médicas brasileiras. Método: O consenso foi construído colaborativamente com 276 participantes, experts em comunicação, docentes, profissionais de saúde e discentes, de 126 escolas médicas e cinco instituições de saúde, ao longo de nove encontros presenciais em congressos e de encontros virtuais quinzenais ou mensais. Nos encontros, compartilharam-se as experiências dos participantes e o material bibliográfico, incluindo os consensos internacionais, e apresentou-se o consenso em construção, com discussão em grupos para elencar novos componentes para o consenso brasileiro, seguida por debate com todos para pactuá-los. A versão final foi aprovada em reunião virtual, com convite a todos(as) os(as) participantes em julho de 2021. Após submissão, diversas alterações foram requeridas, o que demandou novos encontros para revisão da versão final do consenso. Resultado: O consenso tem como pressupostos que a comunicação deve ser centrada nas relações, pautada nos princípios do SUS, na participação social e no profissionalismo, e embasada nas Diretrizes Curriculares Nacionais do curso de graduação em Medicina, em referenciais teóricos e nas evidências científicas. São descritos objetivos específicos para desenvolver a competência em comunicação nos estudantes, abrangendo: fundamentos teóricos; busca e avaliação crítica da literatura; elaboração e redação de documentos; comunicação intrapessoal e interpessoal no ambiente acadêmico-científico, na atenção à saúde em diversos contextos clínicos e na gestão em saúde. Recomenda-se a inserção curricular da comunicação do início ao final do curso, integrada a outros conteúdos e áreas de saber. Conclusão: Espera-se que esse consenso contribua para a revisão ou implementação da comunicação nos currículos das escolas médicas brasileiras.

Abstract: Introduction: Communication is an essential competence for the physician and other professional categories, and must be developed their professional training. The creation of a communication project including a Brazilian consensus aimed to subsidize medical schools in preparing medical students to communicate effectively with Brazilian citizens, with plural intra and inter-regional characteristics, based on the professionalism and the Brazilian Unified System (SUS) principles. Objective: The objective of this manuscript is to present the consensus for the teaching of communication in Brazilian medical schools. Method: The consensus was built collaboratively with 276 participants, experts in communication, faculty, health professionals and students from 126 medical schools and five health institutions in face-to-face conference meetings and biweekly or monthly virtual meetings. In the meetings, the participants' experiences and bibliographic material were shared, including international consensuses, and the consensus under construction was presented, with group discussion to list new components for the Brazilian consensus, followed by debate with everyone, to agree on them. The final version was approved in a virtual meeting with invitation to all participants in July 2021. After the submission, several changes were required, which demanded new meetings to review the consensus final version. Result: The consensus is based on assumptions that communication should be relationship-centered, embedded on professionalism, grounded on the SUS principles and social participation, and based on the National Guidelines for the undergraduate medical course, theoretical references and scientific evidence. Specific objectives to develop communication competence in the students are described, covering: theoretical foundations; literature search and its critical evaluation; documents drafting and editing; intrapersonal and interpersonal communication in the academicscientific environment, in health care and in health management; and, communication in diverse clinical contexts. The inclusion of communication in the curriculum is recommended from the beginning to the end of the course, integrated with other contents and areas of knowledge. Conclusion: It is expected that this consensus contributes the review or implementation of communication in Brazilian medical schools' curricula.

Profile of disabilities and their associated factors in patients with type 2 diabetes evaluated by the Canadian occupational performance measure: the Rio De Janeiro type 2 diabetes cohort study.

PURPOSE: To investigate the profile of disability in patients with type 2 diabetes and to evaluate its associated variables. METHOD: The Canadian Occupational Performance Measure (COPM) assessed disabilities in 475 type 2 diabetic individuals. The activities were categorised by the International Classification of Functioning, Disability and Health. The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) was used to evaluate pain, emotional and physical functioning domains of life-quality. Multivariable logistic regression assessed the independent correlates of better/worse performance. RESULTS: Median COPM score was 4.5 (interquartile range 3-6). Problems in mobility (53.6%), self-care (21.1%) and daily-life (13.0%) were most frequently self-reported. Presence of restriction/pain in the upper limbs (odds ratio [OR]: 1.66; 95% CI: 1.11-2.47; p=0.013) and of peripheral neuropathy (OR: 1.64; 95% CI: 1.06-2.53; p=0.026) were associated with greater chance of worse performance. Higher values of SF-36 in pain and emotional domains (each 10 point increase; OR: 0.92 95% CI: 0.85-0.98; p=0.011; OR: 0.96; 95% CI: 0.92-1.00; p=0.063, respectively) and physical activity (OR: 0.63; 95% CI: 0.41-0.98; p=0.042) were associated with better performance. CONCLUSIONS: Type 2 diabetic patients frequently reported disabilities in mobility, self-care and daily-life domains; and its associated factors were the presence of depression, upper limb pain and diabetic peripheral neuropathy. Implications for Rehabilitation The Canadian Occupational Performance Measure (COPM) instrument can be applied to patients with diabetes, as it identifies several disabilities, mostly in mobility, self-care and domestic life areas. Rehabilitation directed to upper limb pain/limitation and to lower limb peripheral neuropathy shall be implemented and may improve diabetic patients' performance and quality of life. A patient-centered rehabilitation strategy, guided by the COPM, may enable greater independence and autonomy, but this should be confirmed in future intervention studies.

Validation of the Brazilian version of the Spinal Cord Independence Measure III.

INTRODUCTION: The Spinal Cord Independence Measure (SCIM III) specifically assesses individuals with spinal cord injuries. OBJECTIVE: To translate and validate the Brazilian version of SCIM III. METHOD: SCIM III was translated, back-translated and adapted to the Portuguese language. Two interviewers assessed 83 subjects with spinal cord injuries in each one of seven collaborating rehabilitation centers. Functional Independence Measure (FIM™) and ASIA motor and sensory indices were also used. After six months, subjects were re-evaluated with the same instruments. RESULTS: Examiners clearly understood the Brazilian version of SCIM III. Inter-rater intraclass correlation coefficient (ICC) was 0.918, and test-retest ICC was 0.991. After six months, the variation of gains in the FIM™ positively correlated with gains in SCIM III. CONCLUSION: The Brazilian version of the SCIM III is easy to understand, has good psychometric properties, and is valid.

Development of biosensor for phenolic compounds containing PPO in ß-cyclodextrin modified support and iridium nanoparticles.

A biosensor based on the iridium nanoparticles dispersed in ionic liquid (IL) 1-butyl-3-methylimidazolium hexafluorophosphate (Ir-BMI·PF6) and a celery (Apium graveolens) extract as a source of polyphenol oxidase (PPO) was constructed. A modified support based on ß-cyclodextrin (ß-CDEP) was used for enzyme immobilization. The behavior of phenolic compounds was investigated by square-wave voltammetry and rutin was selected by presenting the greatest signal. The best performance was obtained with a composition of 70:10:10:10% (w/w/w/w) of the graphite powder:ß-CDEP:Nujol:Ir-BMI·PF6 composition, a PPO concentration of 500unitsmL(-1), in 0.1M phosphate buffer solution (pH 6.0) with frequency, pulse amplitude and scan increment at 100Hz, 60mV, and 3.0mV, respectively. Under optimized conditions, the cathodic currents increased linearly for the rutin concentration range of 1.3×10(-7)-2.0×10(-6)M with a detection limit of 7.9×10(-8)M. This sensor demonstrated acceptable repeatability and reproducibility and the results for the rutin recovery ranged from 92.8 to 103.4%. A relative error of 0.7% was obtained in the rutin determination in simulated samples.

A novel support for laccase immobilization: cellulose acetate modified with ionic liquid and application in biosensor for methyldopa detection.

A material based on cellulose acetate (CA) and the room temperature ionic liquid 1-butyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide (BMI·N(Tf)(2)) was developed and characterized by scanning electron microscopy, electron dispersive spectroscopy and infrared analysis. Laccase (Lac) from Aspergillus oryzae was immobilized in this material to investigate the behavior of methyldopa by square-wave voltammetry. Under optimized conditions, the Lac biosensor based on CA/BMI·N(Tf)(2) exhibited an excellent electrocatalytic performance: the analytical curve showed good linear range for methyldopa concentrations from 34.8 to 370.3 µM with a detection limit of 5.5 µM. This sensor demonstrated acceptable stability (ca. 60 days; at least 350 determinations), good repeatability and reproducibility (relative standard deviations of 1.5 and 4.3%, respectively). The recovery study of methyldopa in pharmaceutical formulations ranged from 94.1 to 105.9%. The determination of this substance using the biosensor compared favorably with that using a spectrophotometry procedure at the 95% confidence level, and indicated potential application to methyldopa determination in pharmaceutical samples.

Validação do Questionário Life Space Assessment - LSA em um grupo de pacientes hemiplégicos / Validation of the Life Space Assessment - LSA Questionnaire in a group of hemiplegic patients

A mobilidade do paciente hemiplégico é uma interação entre a sua habilidade funcional e fatoresexternos. O questionário ?Life Space Assessment? (LSA) é uma ferramenta que avalia essa mobilidadeem 5 níveis. Objetivo: Validar o LSA em uma população de hemiplégicos em tratamentofisioterapêutico em um centro de reabilitação, correlacionando-o com medidas de performancefísica. Método: Instrumentos utilizados na validação concorrente: Teste Timed Up and Go (TUG),Postural Assessment Scale (PASS), Índice de Mobilidade de Rivermead. Estatística: descritiva, Índicede Spearman e Índice de Correlação Intra Classe (ICC). Resultados: Foram avaliados 30 hemiplégicospor sequela de AVE (73% do sexo masculino, idade média 58,6 anos, tempo médiode lesão 1,9 anos). O LSA apresentou correlação significativa (p < 0,01) com a idade, o TUG, oPASS e o Rivermead. Concordância entre examinadores: ICC 0,941 e Intra examinadores 0,981.Conclusão: O LSA se mostrou uma medida válida numa população de hemiplégicos crônicos, comexcelente correlação intra e entre examinadores, tendo se correlacionado significativamente commedidas de função e estrutura corporal e atividades (TUG, PASS e Rivermead).

The mobility of a hemiplegic patient is an interaction between their functional ability and externalfactors. The ?Life Space Assessment? (LSA) questionnaire is a tool that assesses their mobility on5 levels. Objective: To validate the LSA in a population of stroke survivors in physical therapy at arehabilitation center, correlating it with measures of physical performance. Method: Instrumentsused in concurrent validation: Timed Up and Go Test (TUG), Postural Assessment Scale (PASS),Rivermead Mobility Index. Statistics: Descriptive, Spearman Index and Intra Class Correlation(ICC). Results: Thirty hemiplegic patients were assessed (73% male, mean age 58.6 years, meantime since injury 1.9 years). The LSA correlated significantly (p < 0.01) with age, TUG, PASS, andRivermead. Inter-rater agreement: ICC 0.941 Intra-rater agreement 0.981. Conclusion: The LSAwas valid in a population of chronic stroke survivors, with excellent intra and inter-rater correlationmeasures, correlating significantly with measurements of body structure, function, and motoractivities (TUG, PASS, and Rivermead).

Development of biosensors containing laccase and imidazolium bis(trifluoromethylsulfonyl)imide ionic liquid for the determination of rutin.

Biosensors based on hydrophobic ionic liquids (ILs) derived from the bis(trifluoromethylsulfonyl)imide [(CF(3)SO(2))(2)N(-) = Tf(2)N(-)] anion associated with three different imidazolium cations: 1-butyl-3-methylimidazolium (BMI x Tf(2)N), 1-decyl-3-methylimidazolium (DMI x Tf(2)N) and 1-tetradecyl-3-methylimidazolium (TDMI x Tf(2)N), along with laccase from Aspergillus oryzae, were constructed and optimized for determination of rutin. The laccase catalyzes the oxidation of rutin to the corresponding o-quinone, which is electrochemically reduced back to rutin. The best performance was obtained with 50:20:15:15% (w/w/w/w) as the graphite powder:laccase:Nujol:ILs composition in 0.1 mol L(-1) acetate buffer solution (pH 5.0). The parameters for the square-wave voltammetry experiments and scanning electron microscopy images of the biosensors were studied. Under the selected conditions, the cathodic peak current increased linearly in the rutin concentration ranges of 4.77x10(-6) to 4.62x10(-5) mol L(-1), 5.84x10(-6) to 5.36x10(-5) mol L(-1) and 5.84x10(-6) to 5.36x10(-5) mol L(-1) using the (I) BMI x Tf(2)N-laccase, (II) DMI x Tf(2)N-laccase and (III) TDMI x Tf(2)N-laccase, respectively. The rutin contents of commercial samples of pharmaceuticals were successfully determined by the biosensors and the results compared well with those obtained using the official method. The studies on rutin recovery from these samples gave values of 96.9-104.6%.

Biomimetic sensor based on MnIIIMnII complex as manganese peroxidase mimetic for determination of rutin.

A novel biomimetic sensor for rutin determination based on a dinuclear complex [Mn(III)Mn(II)(Ldtb)(mu-OAc)(2)]BPh(4) containing an unsymmetrical dinucleating ligand, 2-[N,N-bis(2-pyridylmethyl)-aminomethyl]-6-[N-(3,5-di-tert-butyl-2-oxidoben-zyl)-N-(2-pyridylamino)aminomethyl]-4-methylphenol (H(2)Ldtb), as a manganese peroxidase mimetic was developed. Several parameters were investigated to evaluate the performance of the biomimetic sensor obtained after the incorporation of the dinuclear complex in a carbon paste. The best performance was obtained in 75:15:10% (w/w/w) of the graphite powder:Nujol:Mn(III)Mn(II) complex, 0.1 mol L(-1) phosphate buffer solution (pH 6.0) and 4.0x10(-5) mol L(-1) hydrogen peroxide. The response of the sensor towards rutin concentration was linear using square wave voltammetry in the range of 9.99x10(-7) to 6.54x10(-5) mol L(-1) (r=0.9998) with a detection limit of 1.75x10(-7) mol L(-1). The recovery study performed with pharmaceuticals ranged from 96.6% to 103.2% and the relative standard deviation was 1.85% for a solution containing 1.0x10(-3) mol L(-1) rutin (n=6). The lifetime of this biomimetic sensor was 200 days (at least 750 determinations). The results obtained for rutin in pharmaceuticals using the biomimetic sensor and those obtained with the official method are in agreement at the 95% confidence level.

Biosensor based on laccase and an ionic liquid for determination of rosmarinic acid in plant extracts.

Novel biosensors based on laccase from Aspergillus oryzae and the ionic liquids (ILs) 1-n-butyl-3-methylimidazolium hexafluorophosphate (BMIPF(6)) and 1-n-butyl-3-methylimidazolium tetrafluoroborate (BMIBF(4)) were constructed for determination of rosmarinic acid by square-wave voltammetry. The laccase catalyzes the oxidation of rosmarinic acid to the corresponding o-quinone, which is electrochemically reduced back to rosmarinic acid at +0.2V vs. Ag/AgCl. The biosensor based on BMIPF(6) showed a better performance than that based on BMIBF(4). The best performance was obtained with 50:20:15:15% (w/w/w/w) of the graphite powder:laccase:Nujol:BMIPF(6) composition in 0.1mol L(-1) acetate buffer solution (pH 5.0). The rosmarinic acid concentration was linear in the range of 9.99 x 10(-7) to 6.54 x 10(-5)mol L(-1) (r=0.9996) with a detection limit of 1.88 x 10(-7)mol L(-1). The recovery study for rosmarinic acid in plant extract samples gave values from 96.1 to 105.0% and the concentrations determined were in agreement with those obtained using capillary electrophoresis at the 95% confidence level. The BMIPF(6)-biosensor demonstrated long-term stability (300 days; 920 determinations) and reproducibility, with a relative standard deviation of 0.56%.

Validation of the Brazilian version of the Spinal Cord Independence Measure III / Validação da versão brasileira da Medida de Independência da Medula Espinhal III

Introduction : The Spinal Cord Independence Measure (SCIM III) specifically assesses individuals with spinal cord injuries. Objective : To translate and validate the Brazilian version of SCIM III. Method : SCIM III was translated, back-translated and adapted to the Portuguese language. Two interviewers assessed 83 subjects with spinal cord injuries in each one of seven collaborating rehabilitation centers. Functional Independence Measure (FIM™) and ASIA motor and sensory indices were also used. After six months, subjects were re-evaluated with the same instruments. Results : Examiners clearly understood the Brazilian version of SCIM III. Inter-rater intraclass correlation coefficient (ICC) was 0.918, and test-retest ICC was 0.991. After six months, the variation of gains in the FIM™ positively correlated with gains in SCIM III. Conclusion : The Brazilian version of the SCIM III is easy to understand, has good psychometric properties, and is valid. .

Introdução : A Medida de Independência da Medula Espinhal III (SCIM III) avalia especificamente a funcionalidade de indivíduos com lesões da medula espinhal. Objetivo : Traduzir e validar a versão brasileira da SCIM III. Método : A SCIM III foi traduzida, contra-traduzida e adaptada para o idioma português brasileiro. Dois entrevistadores avaliaram 83 indivíduos com lesões da medular espinhal em sete centros de reabilitação colaboradores. A Medida de Independência Funcional (FIM™) e índices motor e sensitivo da ASIA também foram usados. Após seis meses, os sujeitos foram reavaliados com os mesmo instrumentos. Resultados : Os avaliadores entenderam claramente a versão brasileira da SCIM III. O coeficiente de correlação intraclasse (ICC) inter-examinadores foi 0,918, e de teste-reteste foi 0,991. Após seis meses, a variação de ganhos na FIM™ correlacionou-se positivamente com os ganhos da SCIM III. Conclusão : A versão brasileira da SCIM III é de fácil entendimento, apresenta boas propriedades psicométricas e é válida. .

Tradução, adaptação cultural e validação de uma escala para aferir limitação da atividade de subir e descer escadas / Translation, cultural adaptation and validation of a scale measuring activity limitations in climbing stairs

INTRODUÇÃO: Subir e descer escadas são tarefas importantes do cotidiano. A limitação dessa atividade é especialmente prevalente na população idosa, com implicações em sua independência funcional. O objetivo deste estudo foi realizar a tradução, adaptação cultural para a língua portuguesa e validação da escala Activity Limitations in Climbing Stairs, que afere se há limitação da atividade de subir e descer escadas. MÉTODOS: Tradução, tradução reversa e adaptação cultural. Instrumentos utilizados: teste de performance de membros inferiores de Guralnik; tempo de subida e descida de uma escada de sete degraus com corrimão, observando-se a utilização de corrimão e o uso de passos alternados durante a tarefa. Após 15 dias, a escala foi reaplicada na mesma população. Estatística descritiva e testes de correlação, sendo a diferença entre grupos α<0,05. RESULTADOS: Participaram do estudo 22 pacientes (72,2% mulheres), idade média de 76 anos. Na fase de adaptação cultural, uma questão foi revista. O escore da escala se correlacionou significativamente com o tempo de subir e descer a escada, e diferenciou o grupo que utilizava pés alternados e corrimão. O teste de Guralnik se correlacionou significativamente com o tempo de subir e descer a escada. A consistência interna foi de 0,8477. A escala se manteve estável após a segunda aplicação. CONCLUSÃO: Foram realizadas tradução e adaptação cultural da Escala Activity Limitations in Climbing Stairs. Sua validade foi estabelecida em um grupo de idosos, pela correlação significativa com o tempo cronometrado de subir e descer uma escada e com a forma de realizar a atividade; apresentando alta consistência interna e estabilidade.

INTRODUCTION: Stair climbing is an essential daily task. Climbing limitations are especially prevalent in elderly populations and affect functional independence. This paper aims to translate and make the cultural adaption to Brazilian Portuguese of the "Activity Limitations in Climbing Stairs" scale and its validation. METHODS: Translation, back-translation and cultural adaptation. Instruments: Guralnik short physical performance battery; timing to ascend and descend a seven-step staircase with handrail. Use of handrail and alternate steps were observed. The scale was reapplied to the same population, after 15 days. Descriptive statistics, with correlation and comparing group tests α<0.05. RESULTS: The study observed 22 patients (72.2% female); average age 76 years. Only one question was revised due to cultural adaptation. The scale score was significantly correlated to stair ascending and descending time and differentiated the group using alternate feet and handrail. The Guralnik test was significantly correlated with stair climbing. The internal consistency was 0.8477. The scale remained stable. CONCLUSION: The "Activity Limitations in Climbing Stairs" scale translation and cultural adaptation was completed. Its validity was established in a group of elderly subjects by the significant scale correlation to the actual task. High internal consistency and stability were determined.

Etapas da elaboração do Instrumento de Classificação do Grau de Funcionalidade de Pessoas com Deficiência para Cidadãos Brasileiros: Índice de Funcionalidade Brasileiro - IF-Br / Development of a grading instrument of functioning for Brazilian citizens: Brazilian Functioning Index - IF-Br

Os sistemas usados no Brasil para definir a incapacidade variam de acordo com o setor. A partir de uma recomendação da Presidência da República, uma força-tarefa interministerial foi organizada em janeiro de 2011 para desenvolver um modelo único de avaliação e classificação da incapacidade a ser usado em todo o país. O grupo de trabalho partiu de uma avaliação ampla de informações biodemográficas das pessoas com deficiência no Brasil obtidas a partir de fontes como o censo populacional, censo escolar, relação anual de informações sociais e pesquisa de informações básicas municipais, bem como grupos focais realizados com representantes de vários estados da federação, diferentes deficiências e faixas etárias. Por meio de reuniões mensais num período de 8 meses, foi escolhido o modelo conceitual da Classificação Internacional de Deficiências, Incapacidades e Saúde como base teórica e partir do qual foram selecionadas as 41 atividades e fatores ambientais que deveriam ser contemplados no em cada uma delas. A pontuação de cada atividade foi definida numa escala de 25 a 100, de acordo com o nível de independência. Ajustes para crianças foram realizados comparando o instrumento ao desenvolvimento esperado para cada faixa etária de acordo com a descrição presente em outros instrumentos. Além da avaliação quantitativa do grau de incapacidade, foi desenvolvida uma avaliação qualitativa seguindo a lógica fuzzy, específica para as deficiências visual, motora, auditiva e intelectual. A definição de notas de corte não foi efetuada e exige estudos futuros.

The systems used for disability certification in Brazil vary according to the sectors. By recommendation from the Presidency of the Republic, an interministerial task force was organized in January 2011 to develop a single model evaluation and classification of disability to be used throughout the country. The working group began with a comprehensive review of biodemographic information of people with disabilities in Brazil, obtained from sources such as the national census, school census, annual list of social information and research of municipal basic information, as well as focus groups with representatives various states of the federation, as well as data collected from focus groups performed with different disabilities and age groups. Through monthly meetings over a period of eight months, the conceptual model of the International Classification of Impairments, Disability and Health was have chosen as a theoretical basis and from which the 41 activities were selected and the environmental factors should be assessed in each of them. The score was defined for each activity in a ratio from 25 to 100, depending on the level of independence. Adjustments were made for children comparing the expected development for each age group according to the description found in other instruments. In addition to the quantitative assessment of the degree of disability, another questionnaire was developed following a qualitative fuzzy logic, which were specific for visual, motor, auditory and intellectual impairments. The definition of cutoff scores was not performed and requires further study.

Perfil funcional de locomoção em um grupo de pacientes com lesão medular atendidos em um centro de reabilitação / Perfil funcional de locomoción en un grupo de pacientes con lesión medular atendidos en un centro de rehabilitación / Functional ambulation profile in a group of spinal cord injured patients attended at a rehabilitation center

OBJETIVO: descrever o perfil de locomoção de um grupo de pacientes com lesão medular (LM), correlacionando-o com as características da amostra. MÉTODOS: setenta pacientes (50 com LM traumática e 20 com LM não-traumática). Instrumentos: Classificação Funcional da Marcha Modificada (CFMM), WISCI-II, Escala de Ashworth Modificada (EAM), Classificação AIS, Lower Extremities Muscle Score (AIS-LEMS). Estatística: descritiva, comparação entre grupos, testes de correlação considerando p<0,05. RESULTADOS: a média da idade dos pacientes foi de 36 anos; 72,9 por cento dos pacientes eram homens; tempo médio de lesão: 4,7 anos; AIS: 38,6 por cento A, 10 por cento B, 22,8 por cento C, 28,6 por cento D; Nível de lesão: 32,8 por cento cervical, 52,9 por cento torácico, 14,3 por cento lombossacro. Causas mais frequentes: PAF 30 por cento; acidente automobilístico 18,6 por cento; CFMM: CR 34,3 por cento; marcha terapêutica 20 por cento; domiciliar 12,8 por cento; comunitária 32,9 por cento. WISCI-II: 7,5. AIS-LEMS: 13,4. Houve diferença entre os grupos LM traumática e não-traumática quanto à idade, sexo, AIS, AIS-LEMS, CFMM e WISCI-II. Correlações significativas: AIS correlacionou-se positivamente com CFMM, WISCI-II, AIS-LEMS. Nível de lesão correlacionado negativamente com EAM. AIS-LEMS positivamente com a AIS, CFMM, WISCI-II e negativamente com apoio e órteses na deambulação. O tempo de lesão e a presença de dor incapacitante não se correlacionaram com as variáveis estudadas. CONCLUSÕES: o grupo de LM traumática era composto por pacientes mais jovens e com maior prevalência de lesão completa. A idade se correlacionou com o uso de aparelhos de auxílio à marcha e órteses. O desempenho funcional da marcha esteve ligado à AIS e ao AIS-LEMS, sendo que a marcha comunitária necessitou de um AIS-LEMS de pelo menos 32 pontos.

OBJECTIVE: to describe the locomotion profile of a group of spinal cord injured (SCI) patients and its correlation with the sample features. METHODS: seventy patients (50 with traumatic SCI and 20 non-traumatic) were assessed. Instruments: Modified Functional Ambulation Classification (MFAC), Walking Index for Spinal Cord Injury II (WISCI-II), Modified Ashworth Scale (MAS), American Spinal Injury Association Impairment Scale (AIS) and AIS Lower Extremities Muscle Score (AIS-LEMS). Statistics: descriptive, comparison between groups, correlation tests (considering p<0,05). RESULTS: average values were: age: 36 years, 72.9 percent males, average time of lesion 4.7 years. AIS A, 38.6 percent; AIS B, 10 percent; AIS C, 22.8 percent; AIS D, 28.6 percent. Level of lesion: 32.8 percent cervical, 52.9 percent thoracic, 14.3 percent lumbar. More prevalent etiologies: gunshot wounds 30 percent and car accidents 18 percent. MFAC: Non-ambulation, 34.3 percent; Therapeutic ambulation 20 percent, Household ambulation 12.8 percent, community ambulation (32.9 percent); WISCI-II: 7.5, AIS-LEMS: 13.4. There were differences between traumatic and non-traumatic groups concerning age, sex, AIS, AIS-LEMS, MFAC and WISCI-II. Significant correlations: AIS positively correlated to MFAC, WISCI-II and AIS-LEMS. Level of lesion negatively correlated to MAS. AIS-LEMS positively correlated to AIS, MFAC, WISCI-II and negatively correlated to support and orthosis during ambulation. Time of lesion and presence of disabling pain were not correlated to the studied variables. CONCLUSIONS: traumatic SCI group was composed by younger patients with higher prevalence of complete lesion. Age was correlated to the use of orthosis and walking devices. Functional performance of gait was correlated with AIS and AIS-LEMS, and a AIS-LEMS of at least 32 points was needed to achieve community gait.

OBJETIVO: describir el perfil de locomoción de un grupo de pacientes con lesión medular (LM), correlacionándolo con las características de la muestra. MÉTODOS: setenta pacientes (50 con LM traumática y 20 con LM no traumática). Instrumentos: Clasificación Funcional de la Marcha Modificada (CFMM), WISCI-II, Escala de Ashworth Modificada (EAM), Clasificación AIS, AIS Lower Extremities Muscle Score (AIS-LEMS). Estadística: descriptiva, comparación entre grupos, testes de correlación considerando un p<0,05. RESULTADOS: el promedio de la edad de los pacientes fue de 36 años, 72,9 por ciento hombres, tiempo promedio de lesión de 4,7 años; 38,6 por ciento A, 10 por ciento B, 22,8 por ciento C, 28,6 por ciento D; nivel de lesión de 32,8 por ciento cervical, 52,9 por ciento torácico y 14,3 por ciento lumbo sacro. La causa más frecuente fue PAF 30 por ciento, accidente automovilístico con 18,6 por ciento. CFMM: CR 34,3 por ciento marcha terapéutica 20 por ciento, domiciliar 12.8 por ciento, comunitaria 32,9 por ciento WISCI-II: 7,5. AIS-LEMS: 13,4. Hubo diferencia entre los grupos LM traumático y no traumático según la edad, sexo, AIS, AIS-LEMS, CFMM y WISCI-II. Correlaciones significativas: AIS positivamente con CFMM, WISCI-II, AIS-LEMS. Nivel de lesión negativamente con apoyo y ortesis en la ambulación. El tiempo de lesión y la presencia de dolor discapacitante no se correlacionaron con las variables estudiadas. CONCLUSIONES: el grupo de LM traumático era compuesto por pacientes más jóvenes y con mayor prevalencia de lesión completa. La edad se correlacionó con el uso de aparatos de auxilio para la marcha y ortesis. El desempeño funcional de la marcha se correlacionó con AIS y el AISLEMS, siendo que la marcha comunitaria necesitó de un AISLEMS de por lo menos 32 puntos.

Correlação do perfil de deambulação e velocidade da marcha em um grupo de pacientes hemiplégicos atendidos em um centro de reabilitação / Correlation between the ambulation profile and gait velocity in a group of hemiplegic patients treated at a rehabilitation center

A marcha de pacientes com hemiplegia é caracterizada por diminuição da velocidade e assimetria, trazendo limitações às atividades e restrições da participação social deste indivíduo. O objetivo deste estudo foi descrever o perfil funcional da deambulação deste grupo de pacientes, correlacionando-o à velocidade da marcha. Métodos: Foram avaliados 87 pacientes utilizando a Classificação Funcional da Marcha Modificada (CFMM), velocidade da marcha em 10 metros sendo identificada a necessidade de auxílio de terceiros e o uso de transporte público. Análise estatística: descritiva, comparação entre grupos e testes de correlações (p?0,05). Resultados: 49 homens, idade média 54 anos, tempo médio de lesão 33 meses. Três pacientes realizavam marcha terapêutica, 10 marcha domiciliar, 29 comunitária restrita, 43 comunitária e 2 marcha normal. Em relação a assistência à marcha: 38 pacientes necessitavam de auxílio de terceiros ou supervisão, 45 utilizavam transporte público, 59 não utilizavam apoio. A velocidade de marcha foi diferente entre osgrupos divididos pelos tipos funcionais de marcha, necessidade de auxílio de terceiros e uso de transporte público, se correlacionandocom idade, CFMM, assistência de terceiros e uso de transporte público.Conclusão: 85% da amostra realizavam marcha comunitária, massomente 55% o faziam de maneira independente. Houve correlação entre a velocidade e as categorias funcionais de marcha estudadas,sendo estabelecidos limiares de velocidades de marcha para os diferentes grupos.

The gait of hemiplegic patients is characterized by decreased velocity and asymmetry, which brings limitations to the activities of daily living and restrictions in the individual?s social integration. The aim of this study was to describe the functional ambulation profile in this group of patients and correlate it with gait velocity. Methods: 87 patients were evaluated using the Modified Functional Gait Classification (MFGC), gait velocity at 10 meters, with the identification of the need for help and use of public transportation. Statistical analysis: descriptive analysis; comparison between groups and correlation tests (p?0.05). Results: 49 male individuals, with a mean age of 54 yrs, mean injury time of 33 months. Three patients performed therapeutic gait, 10 at-home gait, 29 restricted community gait, 43 community gait and 2 presented normal gait. Regarding gait assistance: 38 patients needed help or supervision from others, 45 used public transportation, 59 did not need gait support. Gait velocity was different among the groups divided by the gait functional type,need for others? help and use of public transportation, correlated with age, MFGC, help from others and use of public transportation.Conclusion: 85% of the sample performed community gait, but only 55% did it independently. There was a correlation between gaitvelocity and the functional types of gait evaluated, with gait velocity thresholds being established for the different groups.