Terapia Ocupacional em doenças neurológicas e os significados do serviço ambulatorial prestado na perspectiva do usuário / Terapia ocupacional en enfermedades neurológicas y el significado del servicio ambulatorio proporcionado desde la perspectiva del usuario / Occupational therapy in neurological diseases and the meanings of ambulatory service provided from the user's perspective

O presente estudo objetivou identificar como o paciente neurológico, em atendimento no setor de Terapia Ocupacional (T.O), percebe a influência desse serviço em sua saúde global. O estudo foi desenvolvido em um Centro Especializado em Reabilitação II (CER II), de uma cidade de médio porte do interior de São Paulo, que dispõe do serviço de Terapia Ocupacional em Neurologia Ambulatorial Adulto e Idoso. O instrumento utilizado para a coleta de dados foi um roteiro de perguntas semiestruturado, aplicado na forma de entrevista. Foram abordados tópicos para a caracterização dos participantes e para o registro de suas percepções. Os temas destacados abrangeram: como o usuário se sente com o tratamento; quais sentimentos se destacam nesse processo; mudanças percebidas no decorrer das intervenções; e grau de satisfação com o serviço. A análise de dados foi realizada de forma qualitativa por meio dos dados provindos das entrevistas. Houve a prevalência do sexo masculino (n=10), na faixa etária acima de 18 anos e menor de 60 (n=8), com maior incidência de Acidente Vascular Encefálico (n=6). Nas questões abertas foi possível identificar a prevalência de sentimentos positivos, a percepção do usuário sobre a contribuição positiva da T.O em relação ao ganho de independência, qualidade de vida e que todos os participantes recomendariam o serviço ofertado pela T.O. O estudo possibilitou um feedback sobre a intervenção prestada e demonstrou que o significado da intervenção contempla a complexidade da base holística do tratamento.

El objetivo de la presente investigación es evaluar como el paciente neuropata, en cuidados por la Terapia Ocupacional (T.O), percibe la importancia del servicio en su salud general. La investigación fue desarrollada en el Centro Especialista en Rehabilitación II (CER II), ubicado en una ciudad del departamento de São Paulo, el centro cuenta con un ambulatorio de terapia ocupacional neurológica para adultos y ancianos. Para recolectar los informes fue puesta en práctica una encuesta con un cuestionario semiestructurado, fueron abordados temas con el fin de caracterizar y registrar sus visiones con las siguientes cuestiones principales: ¿Cómo se siente el paciente con el tratamiento recebido?, ¿Cuáles son los sentimientos destacados en este proceso?, los cambios percibidos por el paciente hacia las citas y el grado de satisfacción con el servicio. El análisis de datos fue hecho cualitativamente con los datos recibidos de la encuesta. Hubo un predominio del sexo masculino (n = 10), en el grupo de edad mayor de 18 años y menor de 60 (n = 8), con mayor incidencia de accidente vascular encefálico (n = 6). En las preguntas abiertas fue posible identificar el predominio de sentimientos positivos, la percepción del paciente sobre la contribución positiva de la T.O en relación con la ganancia de independencia, calidad de vida y que todos los participantes recomendarían el servicio ofrecido por la T.O. La investigación proporcionó un feedback positivo sobre la intervención y demostró que el significado de la intervención, aborda la complejidad de la base holística del tratamiento.

The following study aimed to identify how the neurological patient, who is receiving care in the occupational herapy (O.T.) sector, realizes on this service's influence in their global health. The study was developed in a Specialized Center for Rehabilitation II (CER II), located in a medium-sized town in the interior of São Paulo, which has an Occupational Therapy in Adult and Elderly Outpatient Neurology Service. The instrument used for data collection was a semi-structured questionnaire, applied as an interview. Topics for characterizing the participants and recording their perceptions were addressed. The highlighted topics covered: how the user feels about the treatment; what feelings stand out in this process; changes perceived in the course of activities; and degree of satisfaction with the service. Data analysis was performed qualitatively based on the information from the interviews. There was a prevalence of males (n = 10) aged over 18 and under 60 (n = 8), with a higher incidence of stroke (n = 6). In the open questions it was possible to identify positive feelings prevalence, the user's perception of the positive contribution of O.T. regarding gaining independence and quality of life and that all participants would recommend the service offered by O.T. The study provided feedback on the intervention given and showed that the intervention meaning fulfills the complexity of holistic basis of treatment.

Integrated care of chronic degenerative non-communicable diseases and rehabilitation: the odd couple?

Chronic degenerative non-communicable diseases affecting different organs and systems are considered by the World Health Organization (WHO) as the emergent epidemic in the third millennium...

Diseño de una escala de medida del grado de convivencia en pacientes con un proceso crónico / Design of a measuring scale to evaluate the degree of living wth a chronic illnes, such as Parkinson´disease

INTRODUCCIÓN. Conocer cómo los pacientes conviven con un proceso crónico es necesario para proporcionar un cuidado individualizado e integral. En la actualidad, no existe ninguna escala validada que evalúe la convivencia con un proceso crónico, como es la enfermedad de Parkinson. OBJETIVOS. Los objetivos fueron: 1) definir el concepto Convivencia con un proceso crónico; 2) diseñar una escala de medición del grado de convivencia en pacientes con un proceso crónico, y en concreto, con la enfermedad de Parkinson. METODOLOGÍA. Se llevaron a cabo dos pasos metodológicos. Respecto al primero, se realizó un análisis del concepto Convivencia con un proceso crónico, a través del método evolutivo de Rodgers. El segundo paso metodológico fue el diseño de la escala, a través de la guía propuesta por DeVellis. RESULTADOS. A través del análisis de concepto se identificó que la Convivencia con un proceso crónico es un proceso complejo, dinámico, cíclico y multidimensional compuesto por los atributos de Aceptación, Afrontamiento, Automanejo, Integración y Adaptación. En cuanto a los resultados del diseño de la escala, se desarrolló una medida autocumplimentada, con cinco opciones de respuesta, tipo Likert y 27 ítems. CONCLUSIONES. La escala diseñada, es una medida innovadora y de interés potencial clínico que permite identificar qué factor o factores hacen que la persona conviva mejor o peor con la enfermedad y, consecuentemente, intervenir de manera integral, acorde con las necesidades individuales de cada persona (AU)

INTRODUCTION. Understanding how a person lives with a chronic illness is necessary to provide care according to the individual’s needs. Nowadays, there is no validated scale to measure how the person is living with a chronic condition, such as Parkinson’s disease. OBJECTIVES. The objectives were to: 1) define the concept of Living with a chronic illness; 2) design a measuring scale of the degree of Living with a chronic illness, in particular with Parkinson’s disease. METHODOLOGY. Two methodological steps were carried out. Regarding the first methodological step, a concept analysis of Living with a chronic illness was done using Rodgers’ evolutionary method. The second methodological step was the design of the scale, following DeVellis guideline. RESULTS. Through the concept analysis it was identified that Living with a chronic illness is a complex, dynamic, cyclic and multidimensional process, involving the attributes of Acceptance, Coping, Self-management, Integration and Adjustment. In relation to the design of the scale, it was developed a self-reported measure, with five Likert response options and 27 items. CONCLUSIONS. The designed scale, is an innovative measure with a high potential interest in clinical community to identify with are the factor(s) that make the person have a positive or negative living with the disease. Consequently, nurses could intervene in a holistic way, according to the patient individual needs (AU)

Aquatherapy for neurodegenerative disorders.

Aquatherapy is used for rehabilitation and exercise; water provides a challenging, yet safe exercise environment for many special populations. We have reviewed the use of aquatherapy programs in four neurodegenerative disorders: Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, and Huntington's disease. Results support the use of aquatherapy in Parkinson's disease and multiple sclerosis, however further evidence is required to make specific recommendations in all of the aforementioned disorders.

Balance rehabilitation therapy by tongue electrotactile biofeedback in patients with degenerative cerebellar disease.

Few clinical studies have evaluated physiotherapeutic interventions in patients with degenerative cerebellar ataxia. Investigations on the effectiveness of biofeedback-based interventions for training postural control in these patients have not been conducted yet. The aim of the present study was to assess the effectiveness of a 2-week intensive tongue-placed electrotactile biofeedback program for patients with progressive cerebellar ataxia. Subjects were seven adult patients suffering from cerebellar degeneration. Postural control was assessed with static posturography in two sensory conditions eyes open/closed on firm surface. For quantification of postural behavior, we used area, sway path and mean velocity of the centre of foot pressure (CoP). Effects of treatment were determined by comparing Pre, Post and one month follow-up (Retention) experimental sessions. Analysis of measured CoP parameters for tests on firm surface showed a significant main effect of visual condition and no difference across test sessions under open eyes condition. Under eyes closed condition, there were significant differences between Pre versus Post and Pre versus Retention, while the difference Post versus Retention was not significant. Our results suggest that a balance rehabilitation program with postural exercise performed with a head position-based tongue-placed biofeedback system could significantly improve bipedal postural control in patients suffering from degenerative cerebellar ataxia.

[Effects of multisensory stimulation interventions in brain-damaged patients]. / Effekte multisensorischer Stimulationsverfahren bei hirngeschädigten Patienten.

Classical multisensory stimulation (MSS) programmes comprises modules for visual, acoustical, olfactorial and vestibularic stimulation. Therapeutic goal is a near-optimally structured and supporting environment adapted to the reduced abilities in perception and cognition of patients in a coma, with dementia, or with a learning disability. A critical review (based on the EMBASE and PubMed databases) shows that there is a shortage of studies as well as poor evidence of the effectiveness of multisensory stimulation approaches in general. A few studies show positive short-term effects concerning behavioural changes in patients in a coma, with dementia or with a learning disability but no evident long-term effects. Verifiable short-term effects, however, legitimate multisensory interventions in brain-damaged patients.