Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

Transtorno do movimento estereotipado associado ao atraso da linguagem: dados de estudos de caso que contribuem para o diagnóstico diferencial / Stereotyped movement disorder associated with language delay -: data from case report that contribute to differential diagnosis / Trastorno del movimiento estereotipado asociado con el retraso del lenguaje: datos de estudios de casos que contribuyen al diagnóstico diferencial

Introdução: Movimentos repetitivos associados a alterações de linguagem representam dois importantes sinais de alerta para os TEA (Transtornos do Espectro do Autismo). Ainda que, segundo pesquisas atuais, o atraso na aquisição da linguagem não faça parte do conjunto de características comumente observadas em crianças na primeira infância com Transtorno do Movimento Estereotipado (TME), a sua coocorrência pode ser mais comum do que se imagina, o que pode levar a diagnósticos falso positivo para os TEA. Objetivo: Caracterizar o processo desviante de aquisição da linguagem associado ao TME, buscando diferenciar das características específicas aos TEA. Método: A presente pesquisa apresenta o relato de caso de duas crianças, na faixa etária dos 30 aos 36 meses, com importante atraso na aquisição da fala associado à presença de movimentos estereotipados, com perfis considerados de risco para o autismo. Resultados: Na primeira avaliação as duas crianças apresentavam escore médio referente ao número de sinais de alerta para os TEA. Após intervenção de 6 meses, para diagnóstico diferencial, houve queda no número de sinais de risco, como remissão de alguns comportamentos característicos dos TEA, melhora na intensidade dos movimentos repetitivos e aumento do repertório de fala. Conclusão: Ainda que a presença de movimentos repetitivos ou estereotipadas seja um dos sinais clássicos dos TEA, mesmo que coocorra com outras alterações igualmente sugestivas a este diagnóstico, como o atraso na fala, para que o diagnóstico seja conclusivo, é necessária a observação da presença de outros sintomas que se manifestam de forma persistente ao longo do desenvolvimento.

Introduction: The repetitive movements associated with language disorders represent two important warning signs for ASD (Autism Spectrum Disorders). Even if, according to current research, the delay in language acquisition may not be part of the set of characteristics commonly observed in toddlers with Stereotyped Movement Disorder (SMD), this co-occurrence of language impairment and Stereotyped Movement Disorder may be more common than can be imagined, which leads to mistaken ASD diagnoses. Objective: To characterize the deviant language acquisition process associated with SMD, seeking to differentiate the specific characteristics of ASD. Method: This research presents a case report of two toddlers, aged 30 to 36 months, with an important delay in the acquisition and development of speech associated with the presence of stereotyped movements, with profiles considered at risk for autism. Results: The first assessment showed important results indicating ASD for both children. After a 6-month intervention, there was a decrease in the number of risk signs, such as remission of some behavior characteristic of ASD, improvement in the intensity of repetitive movements and increase of the speech repertoire. Conclusion: Although the presence of repetitive or stereotyped movements is one of the classic signs of ASD, even if it co-occurs with other disorders equally suggestive to this diagnosis, such as delayed speech, for a conclusive diagnosis it is necessary the observation of other symptoms that manifest themselves persistently throughout development.

Introducción: Los movimientos repetitivos asociados con los cambios de lenguaje representa importantes señales de advertencia para los TEA (Trastornos del Espectro Autista). Aunque, según la investigación actual, el retraso en la adquisición del lenguaje no es parte del conjunto de características comúnmente observadas en niños en la primera infancia con trastorno de movimientos estereotipados, su coocurrencia puede ser más común de lo imaginado, lo que conduce a diagnósticos falsos positivos de TEA. Objetivo: Caracterizar el proceso de adquisición del lenguaje desviado asociado al Trastorno de Movimientos Estereotipados (TME), buscando diferenciar las características específicas de los TEA. Método: Esta investigación presenta el caso clínico de dos niños, de 30 a 36 meses, con un importante retraso en la adquisición y desarrollo del habla asociado a la presencia de movimientos estereotipados, con perfiles considerados en riesgo de autismo. Resultados: En la primera evaluación, los dos niños obtuvieron una puntuación media con respecto al número de señales de advertencia de TEA. Después de una intervención de 6 meses, diagnóstico diferencial, hubo una disminución en el número de signos de riesgo, como la remisión de algunos comportamientos característicos de los TEA, una mejora en la intensidad de los movimientos repetitivos y un aumento en el repertorio del habla. Conclusión: Si bien la presencia de movimientos repetitivos o estereotipados es uno de los signos clásicos de los TEA, aunque concurra con otros cambios igualmente sugestivos para este diagnóstico, como el retraso en el habla, para que el diagnóstico sea concluyente es necesaria la observación de la observación. otros síntomas que se manifiestan de forma persistente a lo largo del desarrollo.

Methylphenidate Induced Lip and Tongue Biting

Attention deficit hyperactivity disorder (ADHD) is a life-long neurodevelopmental disorder and treatment depends on pharmacotherapy because of its biological origin. Stimulant drugs are the most commonly used treatment for ADHD and they have various side effects. Herein, we report a case who bit off the tip of her tongue with Osmotic Release Oral System methylphenidate (OROS MPH) 36 mg/day, bit the tip of her lower lip with immediate release (IR) MPH 10 mg/day and lateral part of her tongue with IR MPH 20 mg/day. A diagnosis of epilepsy was unlikely because of the normal neurological examination and electroencephalography findings. This case was considered as an atypical side effect of MPH such as perseverative/compulsive behaviours and movement disorders. Clinicians should be aware of that stimulant medications may cause lip and tongue biting behavior and this may effect treatment compliance tremendously.

Targets for treatment of dystonia caused by several etiologies. Meta analysis

Introducción: Para utilizar un meta-análisis de todos los casos reportados de la estimulación cerebral profunda (DBS) para ladistonía para determinar cuáles son los factores significativos resultados influencia relacionada con el destino. La escala demovimiento Burke-Fahn-Marsden (BFM), la medida más informado, fue elegida como la principal medida de resultado paraeste análisis. Material y Métodos: Una búsqueda en MEDLINE identificaron 137 pacientes que se sometieron a DBS para ladistonía en 24 estudios que tenían puntuaciones individuales BFM. Datos de los pacientes individuales, incluyendo la edad deinicio de la distonía, la edad de la cirugía, el género, la distribución de la distonía, la etiología de la distonía, la presencia decaracterísticas asociadas, anormalidad de las imágenes preoperatorias, cirugías estereotáxica anteriores, el núcleo estimulado,el tipo de anestesia que se utiliza, el tiempo de respuesta a la estimulación, y el momento de la evaluación de resultadosse introdujeron en una base de datos de SPSS para el análisis estadístico. Resultados: La media BFM cambio porcentual(mejora en la puntuación postoperatoria de la línea de base) fue 51,8% (rango - 34% a 100%). Significativamente se lograronmejores resultados con la estimulación del globo pálido interno (GPI) que con la estimulación de la parte posterior del núcleolateral ventral (VLP) del tálamo (p = 0,0001)...

Introduction: To use a meta-analysis on all reported cases of deep brain stimulation (DBS) for dystonia to reevaluate the good effect using the GPi as a target, which factors significant influence outcome related to the target. The Burke-Fahn-Marsden (BFM) movement scale, the most reported measure, was chosen as the primary outcome measure for this analysis. Material and Methods: Computerized MEDLINE searches on English literature search identified 137 patients who underwent BBS for dystonia in 24 studies that had individual BFM scores. The study was done with statistical analysis by intention to treat. Statistical analysis was made with a significant p- value of 0.05. For the comparison of pre- and postoperative scores, a test Wilcoxon signed was used. Results: The mean BFM percentage change (improvement in postoperative score from baseline) was 46.3 percent(range - 34 percent to 100 percent)...

Epilepsia del lóbulo frontal como imitadora de trastornos psiquiátricos. Reporte de un caso, Bogotá, 2016 / Frontal lobe epilepsy imitating psychiatric disorders: A case report, Bogota, 2016

La epilepsia del lóbulo frontal se confundió durante años con enfermedades del orden psiquiátrico y, de hecho, en la actualidad sigue constituyéndose un reto clínico dado el amplio espectro de manifestaciones clínicas que limitan la conducta esquizoide. Los desórdenes ictales del lóbulo frontal podrían ser confundidos con una gran variedad de enfermedades, desde trastornos del sueño de predominio nocturno hasta afecciones del movimiento, tales como distonía paroxística nocturna o el síndrome autosómico recesivo de epilepsia nocturna, que se caracteriza por paroxismos hipermotores de corta duración de predominio nocturno. Los artefactos hacen que el electroencefalograma no sea una herramienta suficiente y es por esto que planteamos el reporte de este caso como un verdadero reto diagnóstico.

The frontal lobe epilepsy was confused with psychiatric disorders for years, and in fact it is still a clinical challenge considering the broad spectrum of clinical manifestations that define schizoid conduct. Ictal disorders of the frontal lobe could be confused with a variety of diseases, from predominantly nocturnal sleep disorders to movement disorders, such as nocturnal paroxysmal dystonia or autosomal recessive nocturnal epilepsy syndrome, characterised by hypermotor paroxysms of short duration and nocturnal predominance. These artefacts mean that the electroencephalogram may not be a sufficient tool, and it is for this reason that this case report is presented as a true diagnostic challenge.

Tic & Tourette Syndrome and Motor Disorders / 한양의대학술지

Motor disorders in childhood include tic disorder, developmental coordination disorder, and stereotypic movement disorder. A tic is a sudden, rapid, repetitive and nonrhythmic movement (motor tics) or phonic production (phonic or vocal tics) that can occur at any part of the body. Developmental coordination disorder (DCD) is characterized by marked impairment in the acquisition and performance of motor skills. Stereotypic movement disorder is a common childhood disorder which repetitive, hard to control, aimless motor activity interrupts everyday life or causes self-infliction of a child. Despite increased attention and the growing scientific knowledge about motor disorders, there are limitations in our understanding and knowledge about the pathogenesis and the management of the disorders. Motor disorders can itself be the primary diagnosis, or can be secondarily diagnosed caused by other disorders, and accompany many neuropsychiatric disorders such as autism and attention deficit hyperactivity disorder (ADHD), which in turn impairs proper learning and socializing of the children with motor disorders. Therefore comprehensive medical history taking, continuous observation of the changes in symptoms, and systematic assessment considering the child's developmental stage and current adaptive capacity are needed. Behavioral therapy and pharmacological therapy are the two most often mentioned treatments of motor disorders.

Bases moleculares del síndrome de Rett, una mirada actual / Molecular basis of Rett syndrome: A current look

El síndrome de Rett (SR) es un trastorno del neurodesarrollo que afecta casi exclusivamente a niñas y cursa secundariamente con autismo. Es poco frecuente y consta de 5 formas clínicas, una clásica y el resto atípicas que comprometen de manera general la habilidad manual, el lenguaje y la motricidad amplia unida a la aparición de estereotipias y epilepsia precoz. Con el objetivo de actualizar la información sobre SR, se aplicaron los descriptores de búsqueda Síndrome de Rett, genes y «Síndrome de Rett¼, «Rett Syndrome gene¼, «Rett Syndrome¼, «Rett Syndrome gene therapy¼ y «Rett Syndrome review¼. Se investigó en los archivos digitales PubMed, Hinari, SCIELO y Medline, y se consultaron los sitios web OMIM, ORPHANET, GeneMap, Genetests, Proteins y Gene, entre otros. Entre 1.348 artículos se seleccionaron 42, los cuales reportan 3 genes causantes del síndrome: MECP2, CDKL5 y FOXG. El gen MECP2 está mutado en el 80% de los pacientes con SR clásico así como en el 40% de los afectados con alguna de sus formas atípicas. El SR con epilepsia precoz y la variante congénita se deben fundamentalmente a variaciones en los genes CDKL5 y FOXG1 respectivamente. Conclusiones: El diagnóstico del SR se basa en criterios clínicos, sin embargo, los avances en la biología molecular y en la genética en particular han abierto el abanico de posibilidades diagnósticas a las diferentes formas clínicas que antes quedaban sin clasificar, a la vez que el análisis molecular permite confirmar el criterio clínico y aportar información en cuanto al pronóstico del paciente.

Rett syndrome (RS) is a neurodevelopmental disorder that exclusively affects girls, and occurs along with autism. It is very uncommon, and has five distinct forms, one classic and the others atypical, which generally compromise manual skills, language, and mobility, and widely associated with the appearance of stereotypy and early epilepsy. With the aim of updating the information about RS, a search was performed in the computer data bases of PubMed, Hinari, SCIELO and Medline, as well as consulting other web sites including OMIM, ORPHANET, GeneMap, Genetests, Proteins and Gene, using the descriptors "Síndrome de Rett", "genes y Síndrome de Rett", "Rett Syndrome gene", "Rett Syndrome", "Rett Syndrome gene therapy", and "Rett Syndrome review". Of the 1,348 articles found, 42 articles were selected, which reported 3 genes causing the syndrome: MECP2, CDKL5 and FOXG. The MECP2 gene is mutated in 80% of patients with classic RS, as well as in 40% of those affected by any of its atypical forms. RS with early epilepsy and the congenital variant are mainly due to variations in the CDKL5 and FOXG1 genes, respectively. Conclusions: The diagnosis of RS is based on clinical criteria. However, the advances in molecular biology and genetics have opened a wide range of possibilities for diagnosing the different clinical forms that could not be classified before. Molecular analysis can help confirm the clinical criteria and provided information as regards the prognosis of the patient.

Análise estabilométrica após exercícios proprioceptivos: estudo clínico controlado randomizado / Analysis after stabilometric proprioceptive exercises: a randomized controlled clinical study

OBJETIVO: identificar as alterações estabilométricas antes e após um programa de treinamento proprioceptivoMÉTODO: um estudo clinico controlado randomizado foi realizado com 18 indivíduos, com idade média de 20,6 ± 2,1 anos de idade, de ambos os sexos, com índice de massa corporal médio de 23,3 ± 5,4 Kg/m2, que foram avaliados na plataforma estabilométrica antes e após um programa de treinamento proprioceptivo, utilizando os aparelhos balancim e disco proprioceptivo,e divididos em grupo propriocepção (n = 10) e grupo controle (n = 8). O treinamento proprioceptivo foi composto de 10 intervenções com apoio unipodal, em semiflexão de joelho, durante 30 segundos,duas vezes por semana, durante cinco semanas, utilizando os aparelhos balancim e disco proprioceptivoRESULTADOS: foram realizados testes de D'Agostino, para testar a normalidade, ao qual observou-se que a amostra estudada obteve comportamento normal para ambos os grupo: propriocepção e controle, de tal forma que utilizou-se o teste T-Studentpara observação da significância do valor de p (<0,05). Ao término das intervenções os indivíduos foram reavaliados na plataforma estabilométrica na qual observou-se que no grupo propriocepção houve uma redução significativa da oscilação corporalem relação ao grupo controle (p = 0,002CONCLUSÃO: a curto prazo o treinamento proprioceptivo unipodal demonstrou-se eficaz para a melhora do equilíbrio com a redução das oscilações corporais.

OBJECTIVE: identify stabilometric changes before and after a program of proprioceptive training METHODS: a randomized controlled clinical trial was conducted with 18 subjects, mean age 20.6 ± 2.1 years of age, of both sexes, with a mean body mass index 23.3 ± 5.4 kg/m² that were evaluated in stabilometric platform before and after a program of proprioceptive training using the equipment and proprioceptive hard rocker, and divided into proprioception (n = 10) and control group (n = 8) group. The proprioceptive training consisted of 10 measures with one foot, knee in semiflexion for 30 seconds twice a week for five weeks using the rocker apparatus and proprioceptive disc RESULTS: D'Agostinotests were performed to test the normality, to which it was noted that the study sample was obtained normal behavior for both groups: proprioception and control, was used the Student t-test for observation the significance of p value (<0.05). At the end of the intervention subjects were reassessed at stabilometric platform on which it was observed that the proprioception group there was a significant reduction in body sway in relation to the control group (p = 0.002) CONCLUSION: the short time, with one leg proprioceptive training has been shown to be effective for improving balance by reducing body sway.

Body-focused repetitive behavior disorders in ICD-11

This article addresses the question of how body-focused repetitive behavior disorders (e.g., trichotillomania and skin-picking disorder) should be characterized in ICD-11. The article reviews the historical nosology of the two disorders and the current approaches in DSM-5 and ICD-10. Although data are limited and mixed regarding the optimal relationship between body-focused repetitive behavior disorders and nosological categories, these conditions should be included within the obsessive-compulsive and related disorders category, as this is how most clinicians see these behaviors, and as this may optimize clinical utility. The descriptions of these disorders should largely mirror those in DSM-5, given the evidence from recent field surveys. The recommendations regarding ICD-11 and body-focused repetitive behavior disorders should promote the global identification and treatment of these conditions in primary care settings.

Prevalencia de estereotipias en pacientes sin enfermedades crónicas / Prevalence of stereotypies in patients without chronic diseases

Introducción: Las estereotipias han sido descritas en niños con trastornos del desarrollo pero su prevalencia y características en niños con desarrollo madurativo normal no es conocida. Objetivo: Estimar la prevalencia de estereotipias en niños sin enfermedades crónicas y describir sus características clínicas y epidemiológicas Pacientes y Métodos: Estudio de corte transversal. Se aplicó una encuesta a madres de niños recién nacidos hasta niños de 12 años que concurrieron a los consultorios externos con muestreo consecutivo y no aleatori-zado. La encuesta fue analizada previamente en un subgrupo de madres. Resultados: Se completaron 406 encuestas, en el 57 por ciento se refirieron estereotipias y las más frecuentes fueron chuparse los dedos (21,8 por ciento) y comerse las uñas (20 por ciento). El análisis multivariado identificó mayor probabilidad de presentar estereotipias en niños con antecedentes de esterotipia en los padres, situaciones de estrés y madres mayores de 35 años. Conclusión: Las estereotipias tienen una elevada prevalencia en los niños y son más frecuentes en niños con antecedentes familiares de estereotipias, situaciones de estrés y en niños con madres de mayor edad.

Background: Stereotypies have been described in children with developmental disorders but their prevalence and characteristics in developmentally normal children is unknown. Objective: To estimate the prevalence of stereotypies in children without chronic diseases and describe their clinical and epidemiological characteristics. Patients and Methods: A Cross-sectional study was performed. Mothers of children aged from birth to 12 years, who attended the outpatient clinic, answered survey questions. Results: 406 surveys were completed; stereotypies were observed in 57 percent of patients, among the most frequent, finger sucking (21.8 percent) and nail biting (20 percent). A multivariate analysis identified that stereotypies are more likely in children with a history of stereotypy in parents, under stressful environments, and with mothers over 35 years old. Conclusion: Stereo-typies showed a high prevalence in this study, most frequently in those children under stressful environments, mothers older than 35 years, and affected parents.

Utilização da informação visual no controle postural de crianças com paralisia cerebral / Use of visual information on the postural control of children with cerebral palsy

INTRODUÇÃO: As limitações impostas pela paralisia cerebral (PC) levam à persistência de distúrbios dos movimentos e da postura. Sendo assim, o controle postural tem um papel importante, pois a capacidade de manter a orientação postural é fundamental para realização das atividades de vida diária. OBJETIVOS: Investigar a utilização da informação visual no controle postural de crianças com PC e de crianças neurologicamente normais (NN). MATERIAIS E MÉTODOS: Foram avaliadas nove crianças com PC diplégica e nove crianças NN de ambos os sexos, entre 6 e 12 anos de idade. Todas as crianças permaneceram em pé e paradas dentro de uma sala móvel nas seguintes condições experimentais: sem movimento da sala com olhos abertos e com olhos fechados e com movimento da sala nas frequências de 0,2 e 0,5 Hz. O registro dos movimentos da sala e das crianças foi realizado por marcadores ativos afixados entre as escápulas das crianças e na parede da sala, respectivamente, e do sistema OPTOTRAK. RESULTADOS: As crianças com PC oscilaram mais em relação às crianças NN, e o movimento da sala influenciou a oscilação corporal de todas as crianças de maneira similar, sendo que todas elas foram influenciadas pela frequência em que a sala foi movimentada. CONCLUSÃO: Crianças com PC e NN são influenciadas pela manipulação da informação visual durante a manutenção da postura ereta e quieta e pela frequência em que o estímulo visual é apresentado.

INTRODUCTION: The limitations imposed by cerebral palsy lead to persistence of disorders of movement and posture, therefore postural control plays an important role, since the ability to maintain postural orientation is fundamental to perform activities of daily living. OBJECTIVES: To investigate the use of visual information in postural control of children with cerebral palsy (CP) and neurologically normal children (NN). MATERIALS AND METHODS: We evaluated eight children with diplegic CP and eight NN children of both genders, aged 6 to 12 years old, as they remained standing still inside of a moving room in the following experimental conditions: no movement of the room with eyes open and eyes closed during movement of the 30s and 60s in the room for frequencies 0.2 and 0.5 Hz. Registration of movements of the room and children was performed by active markers fixed on the front wall of the room, and on the trunk between the scapulae of children, through the OPTOTRAK system. RESULTS: Children with CP swayed more than NN children in the two movement conditions of the room, and all children swayed more with no vision than with vision on the condition that the room was moved. Moreover, the movement of the moving room influenced children with PC and NN and similarly all children were influenced by the frequency at which the room has been moved. CONCLUSION: Children with CP and NN are influenced by the manipulation of visual information during maintenance of upright stance and by the frequency at which the visual stimulus is presented.

Tecnologia baropodométrica utilizada para analisar tipos de suporte de peso durante postura ortostática hemiparética / Baropodometric technology used to analyze types of weight-bearing during hemiparetic upright position

INTRODUCTION: Although baropodometric analysis has been published since the 1990s, only now it is found a considerable number of studies showing different uses in the rehabilitation. OBJECTIVE: To amplify the use of this technology, this research aimed to analyze baropodometric records during upright position of subjects with hemiparesis, describing a way to define weight-bearing profiles in this population. METHOD: 20 healthy subjects were matched by gender and age with 12 subjects with chronic spastic hemiparesis. This control group was formed to establish the limits of symmetry during weight-bearing distribution in the hemiparesis group. Next, hemiparesis group was submitted to procedures to measure baropodometric records used to provide variables related to the weight-bearing distribution, the arch index and the displacements in the center of pressure (CoP). Data were used to compare differences among kinds of weight-bearing distribution (symmetric, asymmetric toward non-paretic or paretic foot) and coordination system for CoP displacements. RESULTS: Hemiparesis group was compounded by eight symmetrics, eight asymmetrics toward non-paretic foot and four asymmetric toward paretic foot. Significant differences in the weight-bearing distributions between non-predominantly and predominantly used foot did not promote differences in the other baropodometric records (peak and mean of pressure, and support area). Mainly in the asymmetry toward non-paretic foot it was observed significant modifications of the baropodometric records. CONCLUSION: Baropodometric technology can be used to analyze weight-bearing distribution during upright position of subjects with hemiparesis, detecting different kinds of weight-bearing profiles useful to therapeutic programs and researches involving subjects with this disability.

INTRODUÇÃO: Embora análises baropodométricas sejam encontradas desde a década de 1990, somente agora é observado número considerável de estudos mostrando usos na reabilitação. OBJETIVOS: Para ampliar o uso dessa tecnologia, objetivou-se analisar registros baropodométricos durante a posição ortostática de sujeitos com hemiparesia, descrevendo o suporte de peso nessa população. MÉTODOS: 20 sujeitos saudáveis foram pareados por gênero e idade com 12 sujeitos com hemiparesia espástica crônica. Controles foram formados para estabelecer limites de simetria na distribuição do suporte de peso no grupo hemiparesia. Em seguida, o grupo hemiparesia foi submetido a procedimentos usados para fornecer variáveis como: distribuição no suporte de peso, índice de arqueamento e deslocamentos no centro de pressão (CoP). Os dados diferenciaram tipos de distribuição do suporte de peso (simétrico, assimétrico em direção ao pé não parético ou parético) e estabeleceram sistemas de coordenadas para deslocamentos do CoP. RESULTADOS: O grupo hemiparesia apresentou oito simétricos, oito assimétricos em direção ao pé não parético e quatro em direção ao pé parético. Distribuição assimétrica do suporte entre os pés não predominantemente ou predominantemente usados não promoveram diferenças em registros baropodométricos (pico e média de pressão e área de suporte). Principalmente para a assimetria em direção ao pé não parético, observou-se modificações significativas nos registros baropodométricos. CONCLUSÃO: Tecnologia baropodométrica pode ser usada para analisar a distribuição no suporte de peso durante a posição ortostática de sujeitos com hemiparesia, detectando diferentes tipos de suporte de peso, úteis para serem usados em programas terapêuticos e em pesquisas envolvendo sujeitos com essa incapacidade.

Viabilidade da terapia virtual na reabilitação de pacientes com doença de Parkinson: estudo-piloto / Feasibility of virtual therapy in rehabilitation of Parkinson's disease patients: pilot study

INTRODUCTION: Among Parkinson's disease (PD) motor disabilities, postural and balance alterations are important parameters to physical therapists who need to choose specific, targeted therapies for their patients. Among many therapy options, virtual therapy is studied as to whether it can be a viable rehabilitation method. OBJECTIVE: To verify the applicability of virtual rehabilitation in PD patients for the improvement of their balance and quality of life. MATERIAL AND METHODS: Six volunteers, diagnosed to be in Stages II and III of PD (Hoehn and Yahr Scale), were recruited for this study. Patients (65 ± 13 years old) participated in activities involving Wii Fit, for a total of twelve interventions, twice per week. Clinical and qualitative methods were used for the data collection for the initial and final evaluations: Borg's Scale, Berg Functional Balance Scale, Time Up and Go, anterior and lateral functional reach and Nottingham's Scale were performed during the study. Penguin Slide, Ski Slalom, Soccer Heading and Table Tilt were the Wii games selected as a form of virtual therapy. RESULTS: The collected data were analyzed using the Wilcoxon test. Motor skill, functional capacities and quality of life were analyzed as variables of the patients' balance. Statistically significant differences were found in the following tests: Borg's Scale (p = 0.0464), Berg Functional Balance Scale (p = 0.0277), lateral functional reach to the right (p = 0.0431*) and lateral functional reach to the left (p = 0.0277). CONCLUSION: It is believed that exercises with virtual reality therapy can be a useful tool to improve the balance in PD patients.

INTRODUÇÃO: Dentre as incapacidades motoras da Doença de Parkinson (DP), as alterações posturais e de equilíbrio são parâmetros importantes para fisioterapeutas que necessitam escolher terapias específicas e direcionadas a seus pacientes. Dentre muitas opções de terapia para essa condição, a terapia virtual é estudada como um método viável para reabilitação. OBJETIVO: Verificar a aplicabilidade da reabilitação virtual em pacientes com DP para a melhora de seu equilíbrio e da qualidade de vida. MATERIAL E MÉTODOS: Seis voluntários, diagnosticados como portadores da DP nas fases II e III (escala de Hoehn e Yahr), foram recrutados para este estudo. Os pacientes (de 65 ± 13 anos) participaram de atividades envolvendo o Wii Fit, em um total de doze intervenções, duas vezes por semana. Métodos clínicos e qualitativos foram utilizados na coleta de dados para as avaliações iniciais e finais: escala de Borg, escala de equilíbrio funcional de Berg, time Up and Go, reação funcional anterior e lateral e escala de Nottingham foram aplicadas durante o estudo. Penguin Slide, Slalom Ski, Futebol e Inclinação da Mesa foram os jogos de Wii selecionados como forma de terapia virtual. RESULTADOS: Os dados coletados foram analisados utilizando o teste de Wilcoxon. Habilidade motora, capacidade funcional e qualidade de vida foram analisadas como variáveis de equilíbrio dos pacientes. Foram encontradas diferenças estatisticamente significativas nos seguintes testes: escala de Borg (p = 0.0464), escala de equilíbrio funcional de Berg (p = 0.0277), alcance lateral funcional à direita (p = 0.0431) e alcance lateral funcional à esquerda (p = 0.0277). CONCLUSÃO: Estima-se que os exercícios com terapia de realidade virtual podem ser uma ferramenta útil para melhorar o equilíbrio em pacientes com DP.

Restrição visual e oscilações corporais ântero-posteriores na doença de Parkinson / Visual restriction and anterior-posterior body oscillations in Parkinson's disease

Sem visão poucos ajustes antecipatórios e/ou compensatórios ocorrem na doença de Parkinson e as evidências destes ajustes são menores quando a evolução da doença e as oscilações corporais são consideradas. Objetivo: O objetivo deste estudo foi evidenciar os efeitos da restrição visual sobre os ângulos das oscilações corporais ântero-posteriores na postura ereta de parkinsonianos considerando os estágios inicias de evolução da doença. Método: Dez idosos com Doença de Parkinson até o estágio 2 de Hoehn & Yahr (HY) ficaram de pé parados por 30 segundos para medir os ângulos das oscilações corporais com e sem visão. Resultados: ANOVA two-way com medidas repetidas revelou efeito principal de visão (F(1,7)=8,931;p<0,02). Conclusão: Os ângulos das oscilações corporais ântero-posteriores sem visão foram maiores do que com visão, estes não diferiram entre si quanto aos estágios de HY e as condições de visão interferiram no controle da postura independente do estágio de evolução da Doença de Parkinson.

With their vision restricted, sufferers of Parkinson?s disease (PD) make few anticipatory and/or compensatory adjustments in their posture and the evidence of these adjustments is even less when the disease progresses and body oscillations are considered. Objective: The aim of this study was to demonstrate the effects of visual restriction on the anterior-posterior body oscillation angles in parkinsonian stance considering the early stages of this disease. Method: Ten elderly PD patients with Hoehn & Yahr (HY) stage 2 remained standing still for 30 seconds to measure the body oscillation angles with and without restricted vision. Results: Two-way ANOVA analyses with repeated measurements revealed the main effect of vision (F(1,7) = 8.931, p<0.02). Conclusion: The angles of the anterior-posterior body oscillations without visibility were greater than with visibility. They did not differ in correlation with the HY stages and visibility conditions interfered with the postural control regardless of the PD evolution stage.

Avaliação da mobilidade funcional do paciente com sequela de AVC após tratamento na piscina terapêutica, utilizando o teste Timed Up and Go / Evaluation of functional mobility of patients with stroke sequela after treatment in hydrotherapy pool using the Timed Up and Go Test

Objective: To evaluate the functional mobility of patients with stroke over 12 sessions of hydrotherapy. Methods: Ten stroke patients aged between 5 and 85 years were evaluated by means of the Timed Up and Go test, which contains some items, such as balance, walking speed, changing directions, and standing up from a seated position. The study patients performed the test before and after each hydrotherapy session (total of 12 sessions). Each individual was compared to him/herself both short-term (pre- and post-therapy) and long-term (after 12 therapy sessions). Result: Comparing baseline and after 12 sessions, it was noted that the 10 patients improved their performance, with a decrease in time to execute the Timed Up and Go test. Conclusion: An exercise program in a hydrotherapy pool was beneficial for functional mobility performance improvement in stroke patients.

Objetivo: Avaliar a mobilidade funcional de pacientes com acidente vascular cerebral no decorrer de 12 sessões de hidroterapia. Métodos: Foram avaliados 10 pacientes com acidente vascular cerebral com idades entre 5 e 85 anos por meio do teste Timed Up and Go, que contém itens como equilíbrio, velocidade da marcha, mudança de direção e transferência de sentado para em pé. Os pacientes do estudo realizaram o teste antes e depois de cada sessão de hidroterapia (total de 12 terapias). Cada indivíduo foi comparado com ele mesmo, a curto prazo (pré e pós-terapia) e a longo prazo (após 12 terapias). Resultado: Comparados no início e ao final das 12 sessões, verificou-se que os 10 pacientes melhoraram sua performance, apresentando diminuição do tempo na execução do teste Timed Up and Go. Conclusão: O programa de exercícios em piscina terapêutica foi benéfico para melhora da performance da mobilidade funcional de pacientes portadores de acidente vascular cerebral.

Encephalitis Lethargica With Catatonia

Encephalitis lethargica (EL) is an acute or subacute central nervous system (CNS) infectious disorder presenting with pharyngitis followed by sleep disorder, basal ganglia signs (particularly parkinsonism), and neuropsychiatric sequelae. We report a 67-year-old man who had hypersomnolence, oculogyric crisis, akinetic mutism, parkinsonism, and malignant catatonia, which represented the stereotypic movement disorder with additional features of hyperthermia. His symptoms dramatically improved after steroid pulse therapy, indicating that EL syndrome could be a postinfectious neurological autoimmune CNS disorder.

Clinical approach to motor stereotypies in autistic children

This is an overview of stereotypic behavior in autistic spectrum disorder [ASD]. This repetitive, nonfunctional, fixed pattern of behavior is associated with autism severity but it is not specific for ASD. There are a wide range of behaviors mentioned as Stereotypies. It usually starts in 1 early childhood and its severity is associated with outcomes and severity of autism in j adolescence and adulthood. It is usually co-morbid with other psychiatric problems and its pathophysiology is not exactly known. Management is most likely behavioral. There are some | reports regarding efficacy of antipsychotics for its management Further studies should be J conducted to improve our knowledge about it and our ability to differentiate it from tics

Manejo del paciente autista en el consultorio odontológico / Management of the autistic patient during a dental care visit

La cavidad oral es la puerta de entrada tanto de nutrientes como de enfermedades e infecciones, en pacientes que tienen algún tipo de discapacidad es aun mßs importante mantener una buena salud oral que determine una mejor salud general. El Autismo es un Síndrome no una enfermedad, en la gran mayoría de los casos congénito, que afecta las relaciones sociales y afectivas así como la capacidad de comunicación de los individuos. Los profesionales que trabajemos alrededor de el tendremos la importante misión de darle una mejor calidad de vida. Para lograr esto es indispensable que el profesional se informe sobre el síndrome, sus características, sus antecedentes, etc. para así poder tratar a cada individuo como único, ya que en este tipo de pacientes descubriremos que no existe un caso igual a otro y deberemos adecuarnos a cada uno en particular, utilizando todos los recursos de los que podamos valernos para lograr resultados positivos. El manejo Psicológico debe realizarse desde la primera sesión y no dejar de hacerse hasta la última, debemos tener en consideración los datos consignados en la historia clinica, mantener contacto permanente con el o los médicos que tratan al paciente así como conel terapeuta físico, del lenguaje u ocupacional dependiendo de cada caso. El paciente autista debe familiarizarse con el profesional, el staff del consultorio, los colores, olores y ruidos propios del ambiente odontológico, debemos recordar que este tipo de pacientes son muy susceptibles a cambios de cualquier tipo a pesar de que en muchos casos pueden parecer abstraídos en su propio mundo 3. Es por esto que nuestro abordaje debe ser realizado de afuera hacia adentro, nunca acercarnos directamente a la cavidad oral e ir avanzando de acuerdo a como el paciente reaccione ante cada uno de nuestros movimientos.

The oral cavity is the main entrance for nutrients as well as for illness and infections, in patients who have any type of disability it is extremely important to maintain a good oral health which will determine a good general health. Autism is a syndrome, not an illness, most of the times congenital and which interferes with social and affective relations as well as the person communication. As Dental Care providers we all have the responsibility to improve their life condition into a better one. It is very important for Dental Care Providers to be appropriate informed about this syndrome, it will be the only way to treat each patient as a unique person because we will learn and notice that every case is different and each patient will need to be treated with all the medical resources as possible to obtain a positive result. The patient psychological management needs to be treated since the first visit, all the patient medical history and information is essential and will be considered for the treatment. Keep in touch with the patient's general care provider as well as the physical or the speech therapist depending on each case. It will help for a better understanding of the patient needs. The autistic patient needs to be involved and comfortable with the medical provider and office staff, the space, colours and noises to be found the dental office. Remember that, this type of patient is extremely sensitive to any changes surrounding, although they may look totally inside of their own world. This is why we will need to approach to the patient from the outside to the inside, never go directly to their oral cavity; all movements and actions will need to be done depending on the patient's reaction.