Effects of the infrared laser on classical ballerinas' feet: Analysis of plantar foot and static balance.

BACKGROUND AND PURPOSE: Overuse injuries and painful symptoms in athletes and dancers (especially classical ballerinas) may lead to reduced functional performance. However, laser application may reduce pain and increase physical conditioning. The aim of the current study was to evaluate the immediate and long-term effects of infrared laser on classical ballerinas' feet. METHODS: Eight female adults who perform classical ballet training and feel pain in their foot, but report no injuries in the last 6 months participated in the study. Infrared laser (808 nm) was applied on ballerina's feet twice a week during three months. The laser parameters utilized were 100 mW average optical power and spot size of 0.04 cm2 applied during 1 min, leading to 6 J and 125 J/cm2 per point. Thermography, algometry and unipodal static standing balance test were performed. RESULTS: There was a significant increase in plantar arch temperature (1.6 °C for center and 2.3 °C for border, p < 0.05) immediately after laser treatment for all ballerinas. The pressure pain thresholds (PPT) were significantly increased for 5 of 7 analyzed sites (p < 0.05). Regarding to the static standing balance, the time on one-foot showed a significant increases (from 23 ± 12 s to 34 ± 13 s, p < 0.05) only when the test was performed on the left foot (support foot). CONCLUSION: Then, there were pain relief and improvement of functional performance in ballerinas. The possible mechanism of laser action in reducing pain and thus enhancing performance, like higher blood flow of foot due to an increase of cutaneous temperature, will be discussed.

Diretrizes para a assistência da terapia ocupacional na pandemia da COVID-19 e perspectivas pós-pandemia / Guidelines for occupational therapy assistance in COVID-19 pandemic and post-pandemic perspectives

RESUMO: INTRODUÇÃO: A COVID-19 é uma doença altamente contagiosa, de apresentação recente, causada pelo novo coronavírus, denominado SARS-CoV-2 por ser da família SARS (Síndrome Respiratória Aguda Grave). São necessárias diretrizes cientificamente fundamentadas sobre as intervenções dos terapeutas ocupacionais no cuidado de pessoas com a COVID-19 e sobre as perspectivas de atenção pós-pandemia. OBJETIVO: Apresentar diretrizes e recomendações aos terapeutas ocupacionais sobre o manejo clínico de pacientes com COVID-19 em diferentes níveis de atenção à saúde, para favorecer a assistência segura e com qualidade técnico-científica. MÉTODO: Dez terapeutas ocupacionais de diferentes estados brasileiros, experts em suas áreas de atuação, reuniram-se, por meio de web conferências, para desenvolver diretrizes para a atuação do terapeuta ocupacional na pandemia da COVID-19. O público-alvo destas diretrizes é composto porterapeutas ocupacionais, gestores e outros profissionais interessados no conhecimento e nas ações da terapia ocupacional com pacientes com COVID-19 e seus familiares. Como ainda não existem estudos e revisões sistemáticas de evidências científicas relativas à terapia ocupacional na COVID-19, foram analisadas as melhores diretrizes e evidências disponíveis na literatura. Foi realizada uma ampla revisão de documentos nacionais e internacionais publicados sobre o tema, como artigos científicos e resoluções da Organização Mundial da Saúde e do Ministério da Saúde do Brasil. Foram também revisadas publicações disponibilizadas por sociedades ou organizações profissionais internacionais de terapia ocupacional, como a Federação Mundial de Terapeutas Ocupacionais, a Associação Americana dos Terapeutas Ocupacional, o Royal College of Occupational Therapists, do Reino Unido, e o Colegio Profesional de Terapeutas Ocupacionales de la Comunidad de Madrid, Espanha. RESULTADOS: As diretrizes reunidas nesta publicação não substituem as políticas institucionais e nacionais. Estão baseadas nos princípios da Ciência Ocupacional e nas melhores evidências disponíveis na literatura, balizadas pela experiência de todos os profissionais envolvidos na produção deste documento. Foram abordados temas como a privação ocupacional decorrente da pandemia e da estratégia de distanciamento social e os recursos técnicos recomendados para a promoção do desempenho ocupacional e manejo de dor e de sintomas em diferentes contextos, com destaque para a atuação do terapeuta ocupacional na atenção básica, na atenção hospitalar e nos cuidados paliativos. CONSIDERAÇÕES FINAIS: Dada a recente apresentação da COVID-19, há necessidade de constante atualização das informações e novas evidências científicas poderão ser publicadas. O raciocínio clínico é imprescindível para o planejamento e implementação da assistência aos pacientes e seus familiares ou cuidadores e será necessário o acompanhamento dos pacientes positivos para o SARS-CoV-2 para a verificação das consequências da COVID-19, das necessidades e demandas de reabilitação das pessoas acometidas, pós-hospitalização e pós-pandemia. (AU)

ABSTRACT: INTRODUCTION: COVID-19 is a highly contagious disease of a recent presentation, caused by the new coronavirus called SARS-CoV-2 because it belongs to the SARS family (Severe Acute Respiratory Syndrome). Scientifically grounded guidelines are needed on occupational therapists' interventions in caring for people with COVID-19 and on prospects for post-pandemic care. OBJECTIVE: To present guidelines and recommendations to occupational therapists on the clinical management of patients with COVID-19 at different levels of health care, to favor safe care with technical and scientific quality. METHOD: Ten occupational therapists from different Brazilian states, experts in their areas of expertise, met, through web conferences, to develop guidelines for the work of the occupational therapist in the pandemic of COVID-19. The target audience of these guidelines is composed of occupational therapists, managers, and other professionals interested in the knowledge and actions of Occupational Therapy with patients with COVID-19 and their families. As there are still no studies and systematic reviews of scientific evidence related to occupational therapy in COVID-19, the best guidelines and evidence available in the literature were analyzed. A wide review of national and international documents published on the subject, such as scientific articles and resolutions of the World Health Organization and the Ministry of Health of Brazil, was carried out. Publications made available by international occupational therapy societies or professional organizations, such as the World Federation of Occupational Therapists, the American Association of Occupational Therapists, the Royal College of Occupational Therapists from United Kingdom, and the Colegio Profesional de Terapeutas Ocupacionales de la Comunidad from Madrid, Spain. RESULTS: The guidelines in this publication do not replace institutional and national policies. They are based on the principles of Occupational Science and the best evidence available in the literature and the experience of all professionals involved in the production of this document. Topics such as occupational deprivation resulting from the pandemic and the strategy of social detachment and the technical resources recommended for the promotion of occupational performance and management of pain and symptoms in different contexts were addressed, with emphasis on the role of the occupational therapist in primary care, hospital care and palliative care. FINAL CONSIDERATIONS: Given the recent presentation of COVID-19, there is a need for constant updating of information, and new scientific evidence may be published. Clinical reasoning is essential for planning and implementing assistance to patients and their families or caregivers. It will be necessary to monitor patients who tested positive for SARS-CoV-2 to verify the consequences of COVID-19, their needs and demands of rehabilitation, post-hospitalization, and post-pandemic. (AU)

Pressure distribution analysis in three wheelchairs cushions of subjects with spinal cord injury.

Purpose: Pressure injuries are a complication due to spinal cord injury. The objective of the study is to compare the pressure distribution in the wheelchair seat of subjects with spinal cord injury using 3 pads (Roho®, Varilite® and Jay®). Methods: Pressure analysis was performed on 10 participants in two situations: (a) the participant sitting in static posture and (b) with the wheelchair being used for locomotion. Results: In the static position: Jay® showed the best rates for average pressure and also the contact area, the Roho® had the lowest average for the peak pressure. During the wheelchair moving, Jay® showed the best average pressure, Roho® had a lower average for peak pressure and Varilite® provided a highest means for the contact area of the buttocks and thighs. Conclusions: The use of appropriate cushion is an effective measure in people with spinal cord injury. Implications for Rehabilitation Pressure injuries are a complication due to spinal cord injury. Study to compare the pressure distribution in the wheelchair seat of subjects with spinal cord injury is important to minimize the injuries resulting from pressure injuries. The comfort resulting from the use of the cushion suited to the demands of the subjects with spinal cord injury is fundamental for the process of rehabilitation and social participation of the people affected. Understanding and minimizing pressure points can contribute to the appropriate rehabilitation process.

Revisão sistemática sobre os posicionamentos de tilt e recline para usuários de cadeira de rodas / Systematic review of the tilt and recline positions for wheelchair users

Introdução: O uso prolongado de cadeira de rodas pode acarretar em lesões por pressão, dores e perda de independência funcional. O método de inclinação e/ou de reclinar (tilt/recline) é prescrito para neutralizar e minimizar esses efeitos nocivos. Porém, não há um consenso de qual ângulo destes recursos é o ideal, bem como a eficiência destes para os usuários. Objetivos: a) conhecer e verificar quais angulações dos sistemas de posicionamento de tilt e recline são mais utilizadas e favoráveis para os usuários de cadeira de rodas e; b) classificar pesquisas encontradas pelo seu nível de evidência. Métodos: Trata-se de uma revisão sistemática sem meta-análise. Foram recuperados artigos publicados até setembro de 2017, na Biblioteca Virtual em Saúde-BVS, Pubmed, Scopus, Web of Science e OTseeker, utilizando as palavras-chave: "wheelchair", "tilt-in-space", "tilt-recline", "recline", "pressure relief" e "repositioning systems". Resultados: A maioria dos artigos selecionados correspondeu ao nível IV de evidência, que se caracteriza como estudos não experimentais. Os principais resultados apontam que a combinação de tilt e recline favorece o alívio de pressão na região das nádegas dos usuários de cadeira de rodas e promove conforto postural, mas para existir eficácia, há a necessidade de maiores angulações. Identificou-se que os menores ângulos são os mais realizados pelos usuários de cadeira de rodas, com a finalidade de gerar conforto e alívio de pressão. Conclusão: A prescrição e utilização dos sistemas de posicionamentos variáveis favorecem o usuário de cadeira de rodas, sendo os efeitos proporcionalmente relacionados ao grau de angulação adotado. (AU)

Introduction: Prolonged use of a wheelchair may result in pressure peak, pain, pressure ulcers and loss of functional independence. The method of tilting and/or reclining (tilt/recline) is prescribed in order to relieve and minimize these adverse effects. However, there is no consensus on which angle of these features is the ideal, and also the efficiency of these resources to users. Objective: To identify and analyze the practices on the use of tilt and recline systems described in the national and international research through a systematic review. Methods: The articles recovered were published until September 2017, on Virtual Health Library-BVS, PubMed, Scopus, Web of Science and OTSeeker using the keywords "wheelchair", "tilt-in- space", "tilt-recline", "recline", "pressure relief" and "repositioning systems". Results: We found 17 publications. The main results show that the combination of tilt and recline favors the pressure relief in the buttocks region of wheelchair users and promotes postural comfort, but to be effective there is a need for higher angles of tilt and recline, despite the difficulty to specify the optimal degree or accurate time to use this feature and most of the articles corresponds to the level IV of evidence, which is characterized as non-experimental studies. Conclusion: Regardless of the angles made the prescription and use of variable positioning systems favor the wheelchair user, and the effects proportionally related to the degree of angulation adopted. (AU)

Electromyographic Activity of the Upper Limb in Three Hand Function Tests.

OBJECTIVE/BACKGROUND: Occupational therapists usually assess hand function through standardised tests, however, there is no consensus on how the scores assigned to hand dexterity can accurately measure hand function required for daily activities and few studies evaluate the movement patterns of the upper limbs during hand function tests. This study aimed to evaluate the differences in muscle activation patterns during the performance of three hand dexterity tests. METHODS: Twenty university students underwent a surface electromyographic (sEMG) assessment of eight upper limb muscles during the performance of the box and blocks test (BEST), nine-hole peg test (9HPT), and functional dexterity test (FDT). The description and comparison of each muscle activity during the test performance, gender differences, and the correlation between individual muscles' sEMG activity were analysed through appropriate statistics. RESULTS: Increased activity of proximal muscles was found during the performance of BEST (p < .001). While a higher activation of the distal muscles occurred during the FDT and 9HPT performance, no differences were found between them. Comparisons of the sEMG activity revealed a significant increase in the muscle activation among women (p = .05). Strong and positive correlations (r > .5; p < .05) were observed between proximal and distal sEMG activities, suggesting a coordinate pattern of muscle activation during hand function tests. CONCLUSION: The results suggested the existence of differences in the muscle activation pattern during the performance of hand function evaluations. Occupational therapists should be aware of unique muscle requirements and its impact on the results of dexterity tests during hand function evaluation.

Independence and cognition post-stroke and its relationship to burden and quality of life of family caregivers.

BACKGROUND: Stroke is a chronic disease responsible for changes in the functional capacity of the patients. Patient care is usually provided by family caregivers, but with great burden and negative impact on their quality of life. OBJECTIVES: (1) To investigate whether a correlation existed between the levels of independence and cognition in stroke patients and the burden and quality of life of their caregivers; (2) to assess whether periods of injury, rehabilitation and care, and age of the stroke patients interfered with these correlations. METHODS: This was a cross-sectional and correlational study that included 60 participants, of which 30 were post-stroke patients and 30 were their caregivers. The data collection instruments were the Mini Mental State Examination and the Functional Independence Measure for the post-stroke participants, and the Zarit Burden Interview Scale and the World Health Organization Quality of Life-BREF, for the caregivers. The Pearson's product-moment correlation was used for the data analysis. RESULTS: Independence and cognition showed no correlation with the burden and quality of life of the caregivers. We identified a strong positive correlation between independence and cognition (r = 0.882), and a moderate negative correlation between independence and rehabilitation period (r = -0.398) and between burden and quality of life of the caregivers (r = -0.414). CONCLUSIONS: Our data suggest the need for health interventions aimed not only at stroke patients, but also at their family caregivers, given the association between the burden and the low levels of quality of life of the caregivers.