Distribución de patrones espásticos en extremidad superior posterior a un daño de motoneurona superior / Distribution of spastic patterns in upper extremity after an upper motor neuron syndrome

ANTECEDENTES: la evidencia sobre personas que presentan daño de motoneurona superior y desarrollan un patrón de espasticidad en extremidad superior (EES) es limitada. Este signo positivo de disfunción o secundario al daño de la motoneurona superior se asocia con pérdida de función y disminución de la independencia, provocando discapacidad y alterando la calidad de vida. OBJETIVO: determinar la distribución de frecuencias de los patrones de EES, muñeca, dedos y pulgar posterior a un daño de motoneurona superior. MÉTODO: diseño descriptivo de corte transversal prospectivo. Se realizó una medición a 206 sujetos pertenecientes a 17 centros de salud, quienes cumplieron con los criterios de inclusión y firmaron el consentimiento. La evaluación incluyó datos clínicos y la evaluación del patrón de EES (Clasificación de Hefter), muñeca, dedos (Zancolli adaptado) y pulgar (Clasificación de House). RESULTADOS: El análisis consideró cada una de las taxonomías de los patrones de EES evaluados (Hefter I a V). La distribución de frecuencias fue investigada mediante la prueba χ2 de bondad de ajuste, seguida de la inspección post hoc de los residuos estandarizados (z) en cada celda. Se identificaron frecuencias significativamente mayores en: el patrón III de extremidad superior, el patrón cubitalizado neutro de muñeca, el patrón del flexor profundo y mixto de Zancolli adaptado, y en los patrones 3, 4 del pulgar. Ninguna taxonomía se asoció al tiempo de evolución y tipo de ACV. CONCLUSIÓN: El estudio aporta evidencia relevante sobre la distribución frecuencia de patrones espásticos, posterior a un daño de motoneurona superior. La información proporcionada busca apoyar el proceso de decisión terapéutica potenciando la recuperación funcional de la extremidad superior.

BACKGROUND: The evidence regarding people who present superior motor neuron damage and develop a pattern of spasticity in the upper limb (SUL) is limited. This positive sign of the superior motor neuron is associated with both the loss of function and the decreased independence, causing disability and altering life quality. OBJECTIVE: to determine the frequency distribution of SUL, wrist, finger and thumb patterns after superior motor neuron damage. METHOD: prospective cross-sectional descriptive design, the sample consisted of 206 patients belonging to 17 health centers, who met the inclusion criteria and signed the informed consent, approved by the committee of ethics. The study considered a measurement, including clinical data and evaluation of the pattern of SUL (Hefter´s classification), wrist, fingers (adapted Zancolli) and thumb (House Classification). RESULTS: The analysis considered each of the taxonomies of evaluated patterns (Hefter´s I-V). Frequency distribution was investigated by χ2 goodness of fit tests, followed by post hoc inspection of standardized residues (z) in each cell. Significantly higher frequencies were identified in the upper limb pattern III, the neutral cubitalized wrist pattern, the adapted Zancolli deep flexor pattern and in the thumb patterns 3, 4. No taxonomy was associated with the evolution time and type of stroke. CONCLUSION: The study provides with relevant scientific evidence regarding the frequency distribution of spasticity patterns after superior motor neuron damage. The information provided can support the therapeutic decision process by enhancing the functional recovery of upper limb.

Responsiveness of upper limb scales and trunk control for the evolution of patients with duchenne muscular dystrophy / Responsividade de escalas de membro superior e controle de tronco na evolução de pacientes com distrofia muscular de duchenne

ABSTRACT Objective: To verify the interval of responsiveness to the scales Segmental Assessment of Trunk Control (SATCo-BR), Performance of Upper Limbs (PUL), and Jebsen Taylor Test (JTT) in patients with Duchenne Muscular Dystrophy (DMD). Methods: We assessed patients with DMD aged 6 to 19 years old and with mini-mental (MMSE) score above 10 points. The assessments were performed individually, in a single session. The upper limb function was performed by PUL and JTT, and trunk control by SATCo-BR. Assessments were repeated six and 12 months after the initial assessment. The repeated-measures analysis of variance model and Bonferroni's multiple comparison method were employed as post hoc analysis; when the ANOVA assumptions were not met, the Friedman test was applied. Results: The sample consisted of 28 patients evaluated in three moments (initial, and six and 12 months after the beginning). There was a time effect for the Upper Limb function performance in the total JTT, and for the subtests, except for subtests 1 and 6, which did not show a difference between the different moments. There was also a time effect for the score of total PUL, proximal PUL, intermediate PUL, and distal PUL. In the SATCo-BR, this effect was observed between the initial and 6 months, and between the initial and 12 months. Conclusions: The JTT, PUL, and SATCo-BR scales can detect changes over time, and they showed responsiveness to detect the evolution of the disease in the 6-month interval.

RESUMO Objetivo: Verificar o intervalo de tempo para a responsividade das escalas Segmental Assessment of Trunk Control (SATCo-BR), Performance of Upper Limb (PUL) e o Teste de Função Manual de Jebsen Taylor (TJT) em pacientes com distrofia muscular de Duchenne (DMD). Métodos: Foram avaliados pacientes com DMD nas idades entre 6 e 19 anos, e com escore do Mini Exame do Estado Mental (MEEM) a partir de 10 pontos. As avaliações foram realizadas individualmente, em uma única sessão: a função de membro superior (MS) ocorreu pela PUL e TJT; e da do controle de tronco, pela SATCo-BR. As avaliações foram repetidas após seis e 12 meses da avaliação inicial. Foi empregado o modelo de análise de variância com medidas repetidas e o método de comparações múltiplas de Bonferroni, como análise post hoc; quando os pressupostos da ANOVA não foram atendidos, foi aplicado o teste de Friedman. Resultados: A amostra foi composta por 28 pacientes avaliados em três momentos (inicial, após seis meses e após 12 meses). Houve efeito do tempo no desempenho da função Membro Superior no TJT total e nos subtestes, exceto nos subtestes 1 e 6, que não apresentaram diferença nas avaliações entre os diferentes momentos. Houve efeito do tempo para o escore da PUL total, PUL proximal, PUL intermediário e PUL distal. No SATCo-BR, esse efeito foi entre o inicial e após seis meses, e entre o inicial e após 12 meses. Conclusões: As escalas TJT, PUL e SATCo-BR são capazes de detectar alterações ao longo do tempo, e apresentam responsividade para detectar a evolução da doença em intervalo de 6 meses.

Physical Functionality of the Upper Limb after Breast Cancer Surgery in Southern Brazilian Survivors: Cross-Sectional Study / Funcionalidade do Membro Superior após a Cirurgia do Câncer de Mama em Sobreviventes do Sul do Brasil: Estudo de Corte Transversal / Función Física de la Extremidad Superior Después de una Cirugía de Cáncer de Mama en Sobrevivientes del Sur de Brasil: Estudio Transversal

Introduction: Surgical treatment after the diagnosis of breast cancer can lead to several consequences of the survivor's upper limb. Objective: Analyze the physical function of the upper limb after breast cancer surgery in Southern Brazilian survivors. Method: 82 breast cancer survivors (55±10 years) receiving hormone therapy were included. A questionnaire for general information, pain (Visual Analogue Scale), and upper limb functionality (DASH) were applied, followed by physical tests; the shoulder range of motion (goniometer), strength (dynamometer), proprioception (kinesimeter) and arm volume (perimeter of the arm). Results: No differences were found for any variable of physical function in relation to mastectomy or breast-conserving surgery. However, better scores of strength and the shoulder range of motion were found for the non-surgery arm. Linear regression demonstrated a relation between pain, strength, range of motion, proprioception, and arm volume with the disabilities of the upper limb, and when adjusted by surgery modality, shoulder range of motion, arm volume, and proprioception maintained significantly. Conclusion: Breast cancer survivors presented physical disabilities on the upper limb after surgery, regardless of the modality of surgery. Results elucidate the need for an efficient post-treatment program to prevent poor physical function after breast cancer surgery and provide better daily activities to these women.

Introdução: O tratamento cirúrgicodo câncer de mama pode levar a consequências físicas no membro superior de sobreviventes. Objetivo: Analisar a funcionalidade do membro superior após cirurgia de câncer de mama em sobreviventes do Sul do Brasil. Método: Foram avaliadas82 sobreviventes de câncer de mama (55±10 anos) em tratamento com hormonioterapia. Foi aplicado um questionário para informações gerais, dor (Escala Visual Analógica) e funcionalidade do membro superior (DASH), seguido de testes físicos; amplitude de movimento (goniômetro), força (dinamômetro), propriocepção (cinesiômetro) e volume do braço (perímetro do braço). Resultados: Não foram encontradas diferenças para nenhuma das variáveis de funcionalidade em relação à mastectomia ou cirurgia conservadora de mama. No entanto, melhores escores de força e amplitude de movimento foram apresentados no membro contralateral à cirurgia. A regressão linear demonstrou uma relação entre dor, força, amplitude de movimento, propriocepção e volume do braço com as disfunções do membro superior e, quando ajustada pela modalidade de cirurgia, apenas a amplitude de movimento, volume do braço e propriocepção mantiveram--se significativamente. Conclusão: A cirurgia do câncer de mama pode levar à pior funcionalidade no membro superior, independentemente da modalidade da cirurgia. Os resultados elucidam a necessidade de um programa eficiente de pós-tratamento para prevenir as consequências na função física do membro superior após cirurgia de câncer de mama e proporcionar melhora nas atividades de vida diária nessa população.

Introducción: El tratamiento quirúrgico después del diagnóstico de cáncer de seno puede conducir a varias consecuencias de la extremidad superior de la sobreviviente. Objetivo: Analizar la función física de la extremidad superior después de una cirugía de cáncer de mama en sobrevivientes del sur de Brasil.Método: Se incluyeron 82 sobrevivientes de cáncer de mama (55±10 años) que recibieron terapia hormonal. Se aplicó un cuestionario para información general, dolor (escala analógica visual) y funcionalidad de la extremidad superior (DASH), seguido de pruebas físicas; el rango de movimiento (goniómetro), fuerza (dinamómetro), propiocepción (kinesímetro) y volumen del brazo (perímetro del brazo). Resultados: No se encontraron diferencias para ninguna variable de la función física con respecto a someterse a una mastectomía o cirugía conservadora de seno. Sin embargo, se encontraron mejores puntajes de fuerza y rango de movimiento para el brazo no quirúrgico. La regresión lineal demostró una relación entre el dolor, la fuerza, el rango de movimiento, la propiocepción y el volumen del brazo con las discapacidades de la extremidad superior, y cuando se ajustó por la modalidad quirúrgica, el rango de movimiento, el volumen del brazo y la propiocepción se mantuvieron significativamente. Conclusión: Las sobrevivientes de cáncer de mama presentaron discapacidades físicas en la extremidad superior después de la cirugía, independientemente de la modalidad de la cirugía. Los resultados aclaran la necesidad de un programa de postratamiento eficiente para prevenir la mala función física después de la cirugía de cáncer de mama y proporcionar mejores actividades diarias a estas mujeres.

Segmental Zoster Paresis:Report of One Case and Literature Review / 中国医学科学院学报

Segmental zoster paresis(SZP)is a rare complication in herpes zoster infection,with its symptoms often neglected due to the co-existence of pain.Here we reported a case of SZP.Also,we analyzed 42 Chinese SZP cases in literature,which revealed that the male to female ratio of SZP patients was 13∶8,and the median age of disease onset was 65 years.The most commonly affected region is upper limb.The diagnosis depends mainly on typical medical history and clinical symptoms.Although there is no definite therapy for SZP,the antiviral therapy is the most commonly used treatment,which achieved complete recovery in 78.6% of the patients and partial recovery in 14.3% of the patients.

Quality of life and upper limb function of children with neonatal brachial plexus palsy / Qualidade de vida e função do membro superior de crianças com paralisia obstétrica do plexo braquial

ABSTRACT Objective: To compare the upper limb function and quality of life between children with neonatal brachial plexus palsy and controls with unaffected brachial plexus (typical children). Methods: Twenty-four children with neonatal brachial plexus palsy and 24 typical ones were evaluated, both groups with 10±3 years of age. The upper limb function was assessed by the Modified Mallet Scale and the Active Movement Scale, whereas quality of life was analyzed by the Pediatric Outcome Data Collection Instrument and the Child Health Questionnaire. Mann-Whitney U tests investigated the differences between groups in such scales. Results: Children with neonatal brachial plexus palsy presented lower limb function compared to typical children in both scales. These children also presented lower scores for most of the Pediatric Outcome Data Collection Instrument domains, except for comfort/pain. In addition, they had lower scores in the following domains of the Child Health Questionnaire: physical functioning, pain, behavior, mental health, overall health perception, emotional impact on parents, and psychosocial summarized score. Conclusions: Neonatal brachial plexus palsy has a negative influence on upper limb function and quality of life, mainly considering overall health, basic mobility, physical and psychosocial functions, happiness, pain, behavior, mental health, upper limb function, and emotional impact on their parents.

RESUMO Objetivo: Comparar a função do membro superior e a qualidade de vida entre crianças com paralisia obstétrica do plexo braquial e aquelas sem paralisia do plexo braquial (crianças usuais). Métodos: Foram avaliadas 24 crianças com paralisia obstétrica do plexo braquial e 24 crianças usuais, ambos os grupos com 10±3 anos. A função do membro superior foi avaliada pela Escala Mallet Modificada e Active Movement Scale, já a qualidade de vida foi analisada por meio das escalas Pediatric Outcome Data Collection Instrument e Child Health Questionnaire. Foram realizados testes U de Mann-Whitney para investigar diferenças entre os grupos nas escalas. Resultados: Crianças com paralisia obstétrica do plexo braquial apresentaram menor função do membro superior quando comparadas às crianças usuais, em ambas as escalas utilizadas. Essas crianças também apresentaram menores pontuações para a maioria dos domínios do Pediatric Outcome Data Collection, exceto para conforto/dor. Além disso, apresentaram escores inferiores nos seguintes domínios do Child Health Questionnaire: função física, dor, comportamento, saúde mental, percepção da saúde em geral, impacto emocional nos pais e pontuação psicossocial resumida. Conclusões: A paralisia obstétrica do plexo braquial tem uma influência negativa na função do membro superior e na qualidade de vida, principalmente em relação à saúde geral, mobilidade básica, funções física e psicossocial, felicidade, dor, comportamento, saúde mental, funcionalidade do membro superior e impacto emocional nos pais.

The association of hand grip strength with functional measures in non-ambulatory children with Duchenne muscular dystrophy / Associação da força de preensão manual com medidas funcionais em crianças com distrofia muscular de Duchenne, que não deambulam

ABSTRACT Duchenne muscular dystrophy (DMD) is a disease characterized by progressive loss of muscle fiber, gradually from proximal to distal. Although a few studies have investigated hand grip strength in non-ambulatory DMD patients, a lack of literature was found determining its relationship with functional capacity. Objective: The aim of this study was to determine the associations between hand grip strength and functional measures in non-ambulatory children with DMD. Methods: Hand grip strength was evaluated using a dynamometer in children with DMD. The children with DMD were evaluated with the Turkish version of the Egen Klassifikation Scale Version 2 (EK2) for global functional capacity, the Performance of Upper Limb (PUL) for upper limb functional performance and the ABILHAND-Kids for hand ability. Results: The mean age of 38 DMD children was 12.02 ± 1.99 years. Dominant hand grip strength of the children with DMD was higher than the non-dominant hand (p < 0.05). The EK2 was 13.02 ± 5.50, PUL was 49.86 ± 14.34 and ABILHAND-Kids was 26.81 ± 7.59. Hand grip strength was found to be correlated with the EK2 (p < 0.05). Conclusions: It is known that measuring functional ability and strength in very weak children with DMD has been difficult and complex for therapists/clinicians in the clinical environment. Although there is a moderate correlation, hand grip strength may be used in clinical practice as a practical assessment tool to have an immediate insight into the global functional capacity in non-ambulatory DMD children.

RESUMO A distrofia muscular de Duchenne (DMD) é uma doença caracterizada por perda progressiva da fibra muscular, gradualmente de proximal a distal. Embora poucos estudos tenham investigado a força de preensão manual em pacientes com DMD não ambulatoriais, foi observada uma falta de literatura para determinar suas relações com a capacidade funcional. Objetivo: O objetivo deste estudo foi determinar as associações entre força de preensão manual e medidas funcionais em crianças não ambulatoriais com DMD. Métodos: A força de preensão manual foi avaliada com dinamômetro em crianças com DMD. As crianças com DMD foram avaliadas com a versão turca da Egen Klassifikation Scale Versão 2 (EK2) para capacidade funcional global, desempenho do membro superior (PUL) para desempenho funcional do membro superior e ABILHAND-Kids para a habilidade manual. Resultados: A idade média de trinta e oito crianças com DMD foi de 12,02 ± 1,99. A força de preensão manual dominante das crianças com DMD foi maior que a da mão não dominante (p < 0,05). A EK2 foi calculada em 13,02 ± 5,50, PUL em 49,86 ± 14,34 e ABILHAND-Kids em 26,81 ± 7,59. A força de preensão manual foi correlacionada com a EK2 (p < 0,05). Conclusões: Sabe-se que medir a capacidade funcional e força em crianças muito fracas com DMD tem sido difícil e complexo para terapeutas / clínicos em ambiente clínico. Embora exista uma correlação moderada, a força de preensão manual pode ser usada na prática clínica como uma ferramenta de avaliação prática para obter imediatamente uma percepção da capacidade funcional global em crianças com DMD não ambulatoriais.

Effect of Leap Motion-based 3D Immersive Virtual Reality Usage on Upper Extremity Function in Ischemic Stroke Patients / Efeito do uso imersivo da realidade virtual 3D baseada em movimento de salto na função de extremidade superior em pacientes com AVC isquêmico

ABSTRACT Immersive virtual reality (VR) is a technology that provides a more realistic environmental design and object tracking than ordinary VR. The aim of this study was to investigate the effectiveness of immersive VR on upper extremity function in patients with ischemic stroke. Sixty-five patients with ischemic stroke were included in this randomized, controlled, double-blind study. Patients were randomly divided into VR (n = 33) and control (n = 32) groups. The VR group received 60 minutes of the upper extremity immersive VR rehabilitation program and the control group received 45 minutes of conventional therapy and 15 minutes of a sham VR program. Rehabilitation consisted of 18 sessions of therapy, three days per week, for six weeks. The outcome measures were the Action Research Arm Test (ARAT), Functional Independence Measure (FIM), Fugl-Meyer Upper Extremity Scale (FMUE) and Performance Assessment of Self-Care Skills (PASS). In both the VR and control groups all parameters except the PASS improved over time. However independent t-test results showed that all of the FMUE, ARAT, FIM and PASS scores were significantly higher in the VR group compared with the control (p < 0.05). The minimal clinically important difference (MCID) scores of the FMUE and ARAT were higher than the cut-off MCID scores described in the literature in the VR group, whereas the FIM scores were below the cut-off MCID scores. All scores in the control group were below the cut-off scores. Immersive VR rehabilitation appeared to be effective in improving upper extremity function and self-care skills, but it did not improve functional independence.

RESUMO A VR imersiva é uma tecnologia que fornece design ambiental e rastreamento de objetos mais realistas do que a VR comum. O objetivo deste estudo foi investigar a eficácia da VR imersiva na função da extremidade superior em pacientes com AVC isquêmico. Sessenta e cinco pacientes com AVC isquêmico foram incluídos neste estudo randomizado, controlado e duplo-cego (clinictrials.gov. ID: NCT03135418). Os pacientes foram divididos aleatoriamente em VR (n = 33) e controle (n = 32). O grupo VR recebeu 60 minutos do programa de reabilitação imersiva da extremidade superior e o grupo controle recebeu 45 minutos de terapia convencional e 15 minutos de um programa falso de VR. A reabilitação consistiu em 18 sessões de terapia, 3 dias por semana, durante 6 semanas. As medidas de resultado foram Teste de braço de pesquisa-ação (ARAT), Medida de independência funcional (FIM), Escala de extremidades superiores de Fugl-Meyer (FMUE) e Avaliação de desempenho de habilidades de autocuidado (PASS). Nos grupos VR e controle, todos os parâmetros, exceto o PASS, melhoraram com o tempo. No entanto, os resultados dos testes t independentes mostraram que todos os escores FMUE, ARAT, FIM e PASS foram significativamente maiores no grupo VR em comparação ao controle (p <0,05). Os escores de FMUE e ARAT de diferença minimamente clinicamente importante (MCID) foram maiores que os pontos de corte de MCID descritos na literatura no grupo VR, enquanto os escores de FIM estiveram abaixo dos pontos de corte de MCID. Todas as pontuações no grupo controle estiveram abaixo das pontuações de corte. A reabilitação imersiva da VR parece ser eficaz para melhorar a função da extremidade superior e as habilidades de autocuidado, mas não melhora a independência funcional.

Congelamento da marcha e de membros superiores na doença de Parkinson / Freezing of gait and upper limbs in Parkinson's disease

O fenômeno do congelamento é considerado um sintoma incapacitante para indivíduos acometidos pela doença de Parkinson, gerando impactos negativos na mobilidade, funcionalidade e qualidade de vida. O congelamento pode acometer membros inferiores (congelamento da marcha) e/ou membros superiores, sendo caracterizado por súbita incapacidade de iniciar ou manter a amplitude dos movimentos. A fisiopatologia do congelamento ainda não é compreendida, porém atribui-se às alterações em diferentes estruturas neuroanatômicas, tais como: núcleo pedúnculo-pontino, locus ceruleus, circuitaria dos núcleos da base, pedúnculo cerebelar e córtices cerebrais e sistema límbico. Fatores que contribuem para o surgimento do congelamento são: tempo de duração da doença, idade avançada, subtipo acinético-rígido da doença, ansiedade ou depressão, perfil de tratamento farmacológico. Sugere-se que o congelamento da marcha e dos membros superiores compartilhem das mesmas características espaço-temporais. A avaliação clínica do congelamento da marcha é melhor estabelecida quando comparada com a avaliação do congelamento dos membros superiores. Estratégias para minimizar o fenômeno do congelamento são descritas no presente artigo.

The phenomenon of freezing is a disabling symptom for subjects with Parkinson's disease, causing impairment in mobility, functionality and quality of life. Freezing may affect lower limbs (freezing of gait) or upper limbs, and is characterized by sudden inability to initiate or maintain range of motion. The pathophysiology of freezing is not yet understood, but it is attributed to changes in different neuroanatomical structures, such as: pedunculopontine nucleus, locus ceruleus, basal ganglia circuitry, pedunculocerebellar and cerebral cortices and limbic system. Factors that contribute to the appearance of freezing are: advanced age, akinetic-rigid subtype of the disease, anxiety or depression, pharmacological treatment strategies. It is suggested that the freezing of gait and upper limbs share the same spatiotemporal characteristics. The clinical evaluation of freezing of gait is better established when compared to the freezing of upper limbs. Strategies to minimize the phenomenon of freezing are described in this article.

Órtese com impressão 3D para ombro: relato de caso / 3D print orthesis for shoulder: case report

Subluxação do ombro é a complicação musculoesquelética mais comum das afecções do Sistema Nervoso Central e Periférico, que leva a diminuição do movimento, da função e aumento de dor. Órtese é um dos recursos auxiliares utilizados no tratamento desta patologia e visa corrigir deformidade, diminuir dor e proporcionar função ao membro acometido. Objetivo: Este trabalho propõe uma nova metodologia para projetar e fabricar órteses customizadas estabilizadoras de ombro utilizando as tecnologias de aquisição 3D por escaneamento e de fabricação por Impressão 3D, e assegurar melhor adaptabilidade e maior conforto para o usuário. Método: A metodologia utilizada neste estudo foi dividida em cinco fases: estudo de caso, escaneamento, modelagem e impressão em 3D; e acabamento. O estudo de caso do usuário com lesão de plexo braquial motivou o projeto de desenho original de órtese híbrida, personalizada e manufaturada em 3D, usando estrutura rígida e faixas de tração, com objetivo de estabilizar o ombro, diminuir a dor e permitir função. Resultados: Após escaneamento em 3D utilizou-se softwares especializados para processar a imagem tridimensional STL. Realizaram-se otimizações do projeto com geração de modelos e peças prototipadas em FDM; avaliada pelo usuário. O conceito desenvolvido foi: órtese personalizada, fácil de higienizar e vestir, resistente, articulada, veste nos dois braços com faixas de tração em tecido rígido acoplado à cintura. Conclusão: O teste com usuário corroborou com o conceito projetado e mostrou um protótipo preliminar com bom acoplamento ao tronco, tração satisfatória e possibilidade de realizar um maior número de AVD´s com menos dor e/ou sensação de cansaço

Subluxation of the shoulder is the most common musculoskeletal complication of Central and Peripheral Nervous System disorders, which leads to decreased movement, function, and increased pain. Objective: Orthosis is one of the assistive devices used in the treatment of this pathology and it focuses in correcting deformity, decreasing pain and providing function to the affected member. This study proposes a new methodology for designing and manufacturing customized shoulder stabilization orthoses with 3D scan image acquisition and 3D printing technologies, for ensuring better adaptability and comfort for the user. Method: The methodology used in this study was divided into five phases: case study, scanning, modeling and 3D printing; and finishing. The case study included a user with brachial plexus injury that motivated the original design of hybrid orthosis, personalized and manufactured in 3D, with rigid structure and traction straps, for stabilizing the shoulder, reduce pain and allowing function. Results: After 3D scanning, we used specialized software to process the three-dimensional STL image. Optimization of the project with generation of models and prototyped parts in FDM based on the user evaluations was performed. The developed concept was: personalized orthosis, easy to clean and wear, resistant, articulated, for wearing in both arms with traction straps in rigid fabric coupled to the waist. Conclusion: The user test corroborated with the designed concept and showed a preliminary prototype with good trunk coupling, satisfactory traction and possibility of performing a greater number of ADLs with less pain and/or tiredness

Upper limb function and functional independence in patients with shoulder pain after stroke / Função do membro superior e independência funcional em pacientes com ombro doloroso após AVC

ABSTRACT Objective To examine the frequency of shoulder pain following stroke. Methods Stroke patient function was evaluated using the Functional Independence Measure (FIM) and Scale for Upper Limb Function in Stroke (SULFS). Function scores were examined and compared between the shoulder pain group (SPG) and the no shoulder pain group (No-SPG). Results A total of 58 patients, 22 women (37.9%), were included in this study. The mean patient age was 49.2±10.8 years and study evaluations were done 3.52±2.26 months after stroke. A total of 16 patients (27.6%) were in the SPG and 42 patients (72.4%) were in the No-SPG. The SPG scored significantly lower on the FIM (SPG: 91.06±14.65 vs. No-SPG 114.62 ± 2.27; p < 0.01) and SULFS (SPG median: 2 [range: 1-4], No-SPG median: 5 [range: 1-5]; p < 0.01) than the No-SPG. Conclusion Shoulder pain commonly occurs after stroke and is related to the affected upper limb function and functional independence in stroke patients.

RESUMO Objetivo Identificar a frequência de ombro doloroso após acidente vascular cerebral (AVC). Métodos Avaliação funcional de pacientes pós-AVC foi realizada pela Medida de Independência Funcional (MIF) e pela Escala de Função de Membro Superior pós-AVC (EFMSA). As pontuações foram comparadas entre pacientes com ombro doloroso (PcOD) e pacientes sem ombro doloroso (PsOD). Resultados 58 pacientes foram incluídos no estudo, sendo 22 (37,9%) mulheres. A idade média dos pacientes foi 49,2±10,8 anos e a avaliação foi realizada 3,52±2,26 após o AVC. Dezesseis (27,6%) pacientes foram incluídos no grupo PcOD e 42 (72,4%) no grupo PsOD. A MIF foi menor no grupo PcOD (91,06±14,65) quando comparados ao grupo PsOD (114,62 ± 2,27), p < 0.01. A EFMSA também foi menor no grupo PcOD (mediana: 2 [intervalo: 1-4] em comparação ao grupo PsOD (mediana: 5 [intervalo: 1-5], p < 0.01. Conclusão Ombro doloroso é comum após AVC e afeta de forma significativa a função do membro superior e a independência funcional.

Patients with Duchenne and Becker muscular dystrophies are not more asymmetrical than healthy controls on timed performance of upper limb tasks

This study aimed to investigate possible asymmetries and relationships between performance of dominant and non-dominant upper limbs (UL) in patients with Duchenne and Becker muscular dystrophies (DMD/BMD), to compare UL performance of patients and healthy subjects and to investigate the relationship between timed performance of UL and age, motor function and muscle strength in DMD/BMD patients. Sixteen patients with DMD and 3 with BMD were evaluated with Jebsen-Taylor Test (timed performance), Vignos scale and Dimension 3 of Motor Function Measure (motor function), and Medical Research Council scale (muscle strength) on a single session. ANOVA showed no asymmetry between dominant and non-dominant UL, except in the writing subtest, in patients and in healthy controls. There were relationships between dominant and non-dominant UL performances. Correlations between timed performance, motor function and muscle strength were found, but age was not correlated with these variables. These findings may reduce the assessment time, prevent fatigue and provide more accurate clinical reasoning involving UL in DMD/BMD treatment.

Terapia de Contensão Induzida na função do membro superior parético / Constraint-induced movement therapy in the paretic upper limb function

A reabilitação do membro superior do paciente com sequelas de acidente vascular encefálico é um dos desafios de maior complexidade para o fisioterapeuta. O objetivo deste estudo foi verificar o uso da Terapia de Contenção Induzida (técnica recente) isoladamente na melhora funcional do membro superior parético em pacientes pós-acidente vascular encefálico a partir de uma revisão sistemática sem metanálise das bases de dados PubMed,LILACS e SciELO, seguindo os critérios de inclusão: ano de publicação entre 2010 e 2015, estudos clínicos controlados e randomizados que avaliaram a funcionalidade do membro superior hemiparético, e estudos que utilizaram somente a Terapia de Contensão Induzida como técnica de tratamento no mesmo grupo estudado. Foram critérios de exclusão relativos à Terapia de Contensão Induzida: associada a outras técnicas de reabilitação no mesmo grupo estudado, modificada, realizada para fins que não para o membro superior parético, e realizada em crianças e adolescentes ou em pacientes com paralisia cerebral. Foram encontrados 352 artigos. Seis artigos se enquadraram nos critérios de inclusão e exclusão. Dos seis artigos, três apresentaram a comparação da Terapia de Contensão Induzida com outras técnicas, como Bobath, estimulação magnética transcraniana repetitiva de baixa frequência, terapia ocupacional e terapia intensiva bilateral. Dois artigos verificaram a Terapia de Contensão Induzida precoce e tardiamente; somente um avaliou o fluxo sanguíneo do hemisfério afetado durante tarefas motoras com e sem restrição. Conclui-se que a Terapia de Contensão Induzida utilizada precocemente oferece resultados satisfatórios quando comparados com técnicas mais tradicionais.

Upper limb rehabilitation in patients with stroke sequelae is one of the most complex challenges to the physiotherapist. The aim of this study was to investigate the use of constraint-Induced movement therapy (recent technique) alone in functional improvement of the paretic upper limb in post-stroke patients through a systematic review with no metanalysis of databases of PubMed, LILACS and SciELO. The inclusion criteria were: year of publication between 2010 and 2015; controlled and randomized clinical studies that evaluated the functionality of hemiparetic upper limb, and controlled and randomized clinical studies evaluating only the Constraint-induced Movement Therapy as a treatment technique in the same study group.Exclusion criteria related to the Constraint-induced Movement Therapy were: associated with other rehabilitation techniques in the same study group, modified, carried out for purposes other than for the paretic upper limb, and performed in children and teenagers or in patients with cerebral palsy. We found 352 articles. Six articles met the inclusion and exclusion criteria. Of the six articles, three had a comparison of Constraint-induced movement therapy with other techniques, such as Bobath,low-frequency repetitive transcranial magnetic stimulation,occupational therapy, and bilateral intensive therapy. Two articles observed early and late Constraint-induced Movement Therapy; only one evaluated the blood flow of the affected hemisphere during motor tasks with and without constraint. It was concluded that the Constraint-induced Movement Therapy use provides satisfactory results when compared with more traditional techniques

Translation and cross cultural adaptation of the Pediatric Motor Activity Log-Revised scale / Tradução e adaptação transcultural da escala Pediatric Motor Activity Log-Revised

ABSTRACT The standardized instrument developed to assess the use of the affected upper limb in children with cerebral palsy (CP) is the Pediatric Motor Activity Log Revised (PMAL-R). Objectives To translate PMAL-R and adapt for the Brazilian culture; analyze the reliability and the internal consistency of the Brazilian version. Method Translation of PMAL-R to the Portuguese-Brazil and back translation. The back-translated version was revised by the authors of the scale. The final version was administered to a sample of 24 patients with spastic hemiparesis CP between 2–8 years. Results The reliability intra and inter-rater were suitable (how often = 0.97 and 0.98, how well = 0.98 and 0.99 respectively) and so the internal consistency (0.98). Conclusion The Brazilian version of PMAL-R has adequate internal consistency, reliability intra and inter raters and can be used to assess the spontaneous use of the upper limb of children with CP type spastic hemiparesis, aged 2–8 years.

RESUMO A Pediatric Motor Activity Log-Revised (PMAL-R) é um instrumento padronizado desenvolvido para avaliar o uso do membro superior afetado em crianças com paralisia cerebral (PC). Objetivos Traduzir a PMAL-R e fazer sua adaptação transcultural para o Português do Brasil; analisar a confiabilidade e a consistência interna da versão brasileira. Métodos Tradução e retrotradução da PMAL-R. A versão retrotraduzida foi revista pelos autores da escala; a versão final foi administrada a uma amostra de 24 pacientes com PC do tipo hemiparesia espástica entre 2–8 anos. Resultados Adequada confiabilidade intra e inter-avaliadores (frequência = 0,97 e 0,98, qualidade = 0,98 e 0,99, respectivamente), assim como a consistência interna (0,98). Conclusão A versão brasileira da PMAL-R apresenta consistência interna e confiabilidade intra e inter examinadores adequadas, sendo válida para avaliar o uso espontâneo do membro superior de crianças com PC do tipo hemiparesia espástica, com idade entre 2–8 anos.

Assessment of grip strength with the modified sphygmomanometer test: association between upper limb global strength and motor function

ABSTRACT Background: Grip strength, commonly evaluated with the handgrip dynamometer, is a good indicator of upper limb (UL) function in stroke subjects and may reflect the global strength deficits of the whole paretic UL. The Modified Sphygmomanometer Test (MST) also provides objective and adequate measures at low-cost. Objective: To assess whether grip strength values obtained by using the MST and those obtained by using a handgrip dynamometer would present similar correlations with the global strength and motor function of the paretic UL in subjects with stroke, both in the subacute and chronic phases. Method: Measures of grip strength (MST and handgrip dynamometer), UL global strength (MST and hand-held dynamometer), and UL motor function (Fugl-Meyer motor assessment scale) were obtained with 33 subacute and 44 chronic stroke subjects. Pearson and Spearman correlation coefficients were calculated and Stepwise multiple regression analyses were performed to investigate predictor variables of grip strength (α=0.05). Results: Significant correlations of similar magnitude were found between measures of global strength of the paretic UL and grip strength assessed with both the MST (0.66≤r≤0.78) and handgrip dynamometer (0.66≤r≤0.78) and between UL motor function and grip strength assessed with both the MST (0.50≤rs≤0.51) and hand-held dynamometer (0.50≤rs≤0.63) in subacute and chronic stroke subjects. Only global strength remained as a significant predictor variable of grip strength for the MST (0.43≤R2≤0.61) and for the handgrip dynamometer (0.44≤R2≤0.61) for both stroke subgroups. Conclusion: Grip strength assessed with the MST could be used to report paretic UL global strength.

Identificación de riesgos biomecánicos de los/as trabajadores en plantas de proceso de salmón para la prevención de disfunción dolorosa de extremidad superior (DDES) / Identification of biomechanical risks / as workers salmon processing plants for the prevention of upper extremity painful dysfunction (DDES)

Investigación realizada en 3 plantas procesadoras de Salmón de la Provincia de Chiloé, Chile. Se obtuvo una muestra de 150 trabajadores sanos, de ambos sexos, los que fueron grabados en 2 planos y 2 ciclos de trabajo. Los datos que se obtuvieron fueron analizados a través de CheckList-OCRA y procesados estadísticamente mediante el Software IBM SPSS Statistics. Los resultados indican que en las tareas realizadas por los trabajadores los factores de riesgo biomecánicos más críticos y que tienen mayor importancia en el valor del índice intrínseco (CheckList OCRA) son: Postura (valores de correlación 0,89 y 0,87 para la extremidad superior derecha e izquierda, respectivamente); Fuerza (valores de correlación 0,86 y 0,87 para la extremidad superior derecha e izquierda, respectivamente); y, Frecuencia (valores de correlación 0,81 y 0,71 para la extremidad superior derecha e izquierda, respectivamente). Por otra parte, de un total de 21 puestos evaluados, un 67% (14) presentan un nivel de riesgo "alto" (valores de índice intrínseco sobre 22,5). De estos, la mayor cantidad de trabajadores se concentra en los puestos de Despinado Manual y Decorado (70% del total de la muestra). Las conclusiones de la investigación apuntan a que los mayores esfuerzos de prevención se debieran enfocar en los puestos críticos (nivel de riesgo alto-medio), principalmente hacia aquellos que involucran a una mayor masa de trabajadores (Despinado Manual y Decorado). Estas indicaciones debiesen estar dirigidas al mejoramiento de la técnica de trabajo, eliminación de acciones técnicas inútiles, perfeccionamiento de herramientas, rediseño de la línea de producción y layout, además de rotación de funciones.

Research conducted in 3 salmon processing plants in the province of Chiloé, Chile. A sample of 150 healthy workers of both sexes was obtained, which was recorded in 2 planes and 2 cycles. The data obtained were analyzed through CheckList-OCRA and processed statistically using IBM SPSS Statistics Software. The results indicate that the tasks performed by workers factors most critical biomechanical risk and that are most important intrinsic value index (CheckList OCRA) are: Posture (correlation values 0,89 and 0,87 for the tip upper right and left, respectively); Strength (correlation values 0,87 and 0,86 for the upper right and left end, respectively); and frequency (correlation values 0,81 and 0,71 for the right upper extremity and left, respectively). Moreover, a total of 21 seats tested, 67% (14) have a level of "high" (values intrinsic rate of 22,5) risk. Of these, the largest number of workers are concentrated in positions of despinado Manual and Scenery (70% of total sample). The research findings suggest that older Prevention efforts should focus on critical positions (middle-level high risk), mainly to those involving a greater mass of workers (despinado Manual and decorado). These indications are slated to be aimed at improving technical work, elimination of unnecessary technical actions, improved tools, redesigning the production line layout, plus rotation functions.

Perfil epidemiológico dos pacientes com queimadura em membros superiores atendidos em uma Unidade de Queimados terciária / Epidemiological profile of patients with burning in upper limbs treated at a tertiary Burns Unit

Objetivo: Determinar o perfil epidemiológico dos pacientes acometidos por queimaduras nos membros superiores, atendidos no setor de Fisioterapia de um hospital de referência regional do Sistema Único de Saúde (SUS) no atendimento terciário de saúde. Método: Realizada análise dos dados, durante o período de um ano, do setor de Fisioterapia da Unidade de Queimados do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Foram analisados: idade, sexo, procedência, acometimento de membros superiores, agente causal, utilização de substâncias químicas e local do acidente. Resultados: Foram avaliados 94 casos, destes, 76 apresentavam acometimento de pelo menos um dos membros superiores (80,8%). A idade média foi de 35,3 anos, sendo a faixa etária de 18 a 30 anos e o sexo masculino (68,4%) os mais acometidos. A principal causa de queimadura foi a associação de fogo com algum tipo de líquido inflamável, como álcool e gasolina. 39,5% dos pacientes eram provenientes de Ribeirão Preto/SP, sendo 67,1% dos casos acidentes domiciliares, e 5 casos de tentativa de autoextermínio, destes, três deles referentes a pacientes usuários de drogas ilícitas. Em 40,7% dos casos, os pacientes eram usuários de pelo menos uma substância química, como álcool, tabaco ou drogas. Conclusão: Na amostra analisada, o perfil dos pacientes com queimaduras em membros superiores foi composto principalmente por homens adultos jovens, envolvidos em acidentes domésticos, com líquido inflamável e em grande parte associados ao uso de substâncias químicas.

Objective: To determine the epidemiological profile of the patients affected by upper limbs burns, treated in the Physicaltherapy division of a regional referral hospital of the unified health system (SUS) in tertiary health care. Methods: A survey was conducted of data on patients affected by burns in upper limbs, during the period of one year, in Physiotherapy division of the Burn Unit of the Ribeirao Preto Medical School, University of Sao Paulo. The variables analyzed were: age, sex, origin, involvement of upper limbs, causative agent, use of chemicals and the accident site. Results: In the studied period 94 cases were evaluated in total, of these, 76 presented involvement of at least one of the upper limbs (80.8%). The average age of these patients was 35.3 years, being the most affected males (68.4%). The main cause of burns was the association of fire with some sort of flammable liquid, such as alcohol and gasoline. The age group most affected was between 18-30 years. 39.5% of the patients were from Ribeirao Preto, with 67.1% of household accidents, and 5 cases of attempted auto-extermination, being 3 of them illicit drug users patients. In 40.7% of cases, the patient was user of at least one chemical substance, such as alcohol, tobacco or drugs. Conclusion: The profile of patients with burns in upper limbs, in this specific sample, was composed mainly of young adult men, involved in domestic accidents, with flammable liquid and largely associated with the use of chemicals.

Influences of hand dominance on the maintenance of benefits after home-based modified constraint-induced movement therapy in individuals with stroke

Objective: To investigate the influence of hand dominance on the maintenance of gains after home-based modified constraint-induced movement therapy (mCIMT). Method: Aprevious randomized controlled trial was conducted to examine the addition of trunk restraint to the mCIMT. Twenty-two chronic stroke survivors with mild to moderate motor impairments received individual home-based mCIMT with or without trunk restraints, five times per week, three hours daily over two weeks. In this study, the participants were separated into dominant group, which had their paretic upper limb as dominant before the stroke (n=8), and non-dominant group (n=14) for analyses. The ability to perform unimanual tasks was measured by the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL), whereas the capacity to perform bimanual tasks was measured using the Bilateral Activity Assessment Scale (BAAS). Results: Analysis revealed significant positive effects on the MAL amount of use and quality of the movement scales, as well as on the BAAS scores after intervention, with no differences between groups. Both groups maintained the bimanual improvements during follow-ups (BAAS-seconds 0.1, 95% CI -10.0 to 10.0), however only the dominant group maintained the unilateral improvements (MAL-amount of use: 1.5, 95% CI 0.7 to 2.3; MAL-quality: 1.3, 95% CI 0.5 to 2.1). Conclusions: Upper limb dominance did not interfere with the acquisition of upper limb skills after mCIMT. However, the participants whose paretic upper limb was dominant demonstrated better abilities to maintain the unilateral gains. The bilateral improvements were maintained, regardless of upper limb dominance. .

Keratosis pilaris and prevalence of acne vulgaris: a cross-sectional study

BACKGROUND: Acne vulgaris has an important genetic predisposition, as well as keratosis pilaris. Clinical observations suggest that patients with keratosis pilaris have less frequent or less severe acne breakouts; however, we found no studies on this regard OBJECTIVE: To determine if the presence of keratosis pilaris is associated with lower prevalence and severity of acne. METHODS: A cross-sectional study was conducted with dermatology outpatients aged between 14 and 35 years. We evaluated history and clinical grade of acne, demographic variables, history of atopy, smoking, and use of hormonal contraceptives. Two groups were defined by the presence or absence of moderate to severe keratosis pilaris on the arms and were compared by bivariate analysis and by conditional multiple logistic regression. RESULTS: We included 158 patients (66% women), with a median age of 23±11 years. Twenty-six percent of them had keratosis pilaris, which was associated with a history of atopy (odds ratio [OR]=2.80 [1.36 to 5.75]; p<0.01). Acne was present in 66% of subjects, and was related to family history of acne (OR=5.75 [2.47 to 13.37]; p<0.01). In bivariate and multivariate analysis, the group with keratosis pilaris had a less frequent history of acne (OR=0.32 [0.14 to 0.70]; p<0.01). CONCLUSION: The presence of moderate to severe keratosis pilaris on the arms was associated with lower prevalence of acne vulgaris and lower severity of facial lesions in adolescents and young adults. .

Late morbidity in upper limb function and quality of life in women after breast cancer surgery / Morbidade tardia na funcao do membro superior e na qualidade de vida de mulheres pos-cirurgia do cancer de mama

BACKGROUND: Breast cancer is the most common malignancy in Brazilian women. In recent years, there has been great progress in and an increasing number of breast-conserving surgical techniques; however, immediate or late morbidity after surgery, in the form of functional impairment and pain, remains a significant clinical problem. OBJECTIVE: To investigate the relationship between late upper limb functional impairment and the quality of life in women subjected to breast cancer surgery. METHOD: A total of 81 women participated in the study, with the length of time since surgery ranging from one to five years. A survey of upper limb complaints reported by patients was conducted, and the questionnaires Disabilities of the Arm, Shoulder, and Hand (DASH) and the European Organization for Research and Treatment of Cancer (EORTC QLQC-30 and BR23) were applied. RESULTS: The correlation between the DASH score and the length of time since surgery determined that the longer the time since surgery, the greater the difficulties in functionality of the upper limb (r=0.459; p<0.0001). A statistically significant correlation was observed between the DASH score and health-related quality of life. CONCLUSION: Late functional impairment had a significant impact on upper limb function in everyday life and health-related quality of life for women who underwent breast cancer surgery. .

CONTEXTUALIZAÇÃO: O câncer de mama é a neoplasia maligna mais frequente na população feminina brasileira. Nos últimos anos, houve grande evolução das técnicas cirúrgicas e aumento do número de cirurgias conservadoras da mama, entretanto a morbidade imediata ou tardia após a cirurgia, sob a forma de comprometimento funcional e dor, ainda é um significativo problema clínico. OBJETIVO: Verificar a relação entre o comprometimento funcional tardio do membro superior e a qualidade de vida de mulheres submetidas à cirurgia do câncer de mama. MÉTODO: Participaram da pesquisa 81 mulheres com tempo decorrido de cirurgia variando entre um a cinco anos. Realizou-se levantamento das queixas referidas pelas pacientes em relação ao membro superior e foram aplicados os questionários Disabilities of the Arm, Shoulder and Hand (DASH) e European Organization for Research and Treatment of Cancer (EORTC QLQC-30 e BR23). RESULTADOS: A correlação entre o escore DASH e o tempo decorrido de cirurgia demonstrou que, quanto maior este último, maiores são as dificuldades de funcionalidade dos membros superiores das pacientes entrevistadas (r=0,459; p<0,0001). Houve correlação estatisticamente significativa entre o escore DASH e a qualidade de vida relacionada à saúde. CONCLUSÃO: O comprometimento funcional tardio apresentou impacto significativo na função do membro superior, na vida cotidiana e na qualidade de vida relacionada à saúde das mulheres que foram submetidas à cirurgia do câncer de mama. .

Comparison of combination of CIMT and BIM training with CIMT alone on fine motor skills of children with hemiplegic cerebral palsy

This study aimed to compare the combination of CIMT and BIM training with CIMT in Fine Motor Skills of Children with Hemiplegic cerebral palsy. 24 children with hemiplegic cerebral palsy aged between 60 and 120 months participated in this RCT study. They were randomly assigned into CIMT and BIM training [n=12, four males, eight females; mean age+/-standard deviation =93.58+/-14.24] and CIMT alone [n=12, six males, six females; mean age+/-standard deviation = 94.00+/-18.97] groups. The children in the CIMT and BIM group were received a combination of CIMT and bi-manual training in addition to current occupational therapy. Each session was started with restraint on non-involved upper extremity and practicing with the involved upper extremity for three hours. This was followed with bi-manual training for another three hours. The children in CIMT group received CIMT. Each session was started with restraint on non-involved upper extremity and practicing with the involved upper extremity for six hours. This process lasted for 10 out of 12 consecutive days for both groups. Fine motor skills, upper limb function and muscle tone were assessed using Bruininks-Oseretsky Test of Motor Proficiency, Jebsen-Taylor Test of Hand Function and Modified Ashworth Scale respectively. Fine motor skills and upper limb function of these children in CIMT and HABIT and CIMT alone groups had significantly improved [P<0.05]. However, these changes were not significantly different between the two groups before and after intervention [P>0.05]. Results showed that these two treatment approaches improved fine motor skills in the hemiplegic children with cerebral palsy. None of the interventions are better than the other one. Therefore, it is suggested to use a combination of CIMT and BIM training instead of CIMT alone in order to make the tasks more attractive and easier for the children