Factores asociados a la disminución de funcionalidad del miembro superior en estudiantes universitarios chilenos en pandemia por COVID-19 / Risk factors associated with a lower upper limb functionality among university students

Background: Upper limb (UL) function is compromised in university students due to prolonged academic activities and excessive use of electronic devices. However, it is unknown whether this relationship was affected by the COVID-19 pandemic situation. Aim: To determine the risk factors associated with reduced UL functionality in university students in a pandemic situation due to COVID-19. Material and Methods: Cross-sectional study that included 621 university students from the northern, central and southern areas of Chile. Physical variables, musculoskeletal, anthropometric and sociodemographic history were evaluated through self-reported questionnaires. Results: The factors with the higher association with a lower UL functionality were pain (Odds ratio (OR) = 17.6; 95% confidence intervals (CI) = 5.2-60; p < 0.01) and injury (OR = 10.4; 95% CI = 3.9-28.3; p < .001). Also, a low weight (OR = 10.5; 95% CI = 2.2-49.6; p < 0.01) and a quarantine lasting for five or more weeks (OR = 9.1; 95% CI = 1,1-77.2; p = 0.043) were considered risk factors. The lower probability was observed in male participants (OR = 0.2; 95% CI = 0.1-0.51; p < 0.01) and in those with a moderate/high muscular condition (OR = 0.3; 95% CI = 0.1-0.9; p = 0.031. Conclusions: The identification of these modifiable risk factors can help to implement preventive or rehabilitative actions at home or universities.

Intervention bimanual stimulates the abilities in infants with asymmetry / A intervenção bimanual estimula as habilidades em bebês com assimetria

Abstract Introduction: The cerebral palsy and brachial plexus injury may cause asymmetry in the use of the upper limbs (UL). This condition requires early treatment to reduce the impact of the child's life; therefore, several proposed interventions aim to increase their functional independence. The Constraint-Induced Movement Therapy (CIMT) and Hand-Arm Bimanual Intensive Therapy (HABIT) have been widely considered effective interventions to improve hand function. Objective: Investigate the effects of an intervention protocol based on the CIMT and HABIT theoretical foundations in the stimulation of manual function in infants with the UL asymmetry. Methods: Five infants (6-24 months) participated in the study. To evaluate the motor function of infants we used Pediatric Motor Activity Log (PMAL-R) and Manual Function Evaluation (AMIGO), and to assess the caregiver's perception of the participation of the infant in daily tasks, we used the Pediatric Disability Assessment Inventory (PEDI). All evaluations occurred before, immediately after the intervention, and after four months for follow-up recording, and were analyzed descriptively by Jacobson- Truax method. Results: The results between evaluation and reevaluation demonstrated evolution in all aspects studied. In the PEDI self-care session, an average of 38.6 (±8.4) - 44.2 (±7.4); PEDI Mobility: 28.8 (±20.3) - 36.28 (±21.7); PEDI Social Function: 40.1 (±10.2) - 42.3 (±8.9). The PMAL-R quantity and quality results evidence a highly positive clinical significance in all infants. Conclusion: The application of the modified restriction intervention protocol resulted in reliable and clinically significant changes in all cases.

Resumo Introdução: A paralisia cerebral e a lesão do plexo braquial podem causar assimetria no uso dos membros superiores (MS). Esta condição requer tratamento precoce para reduzir o impacto na vida do indivíduo, portanto várias intervenções têm sido propostas com o objetivo final de aumentar sua independência funcional. A terapia de movimento induzido por restrição (CIMT) e a terapia intensiva bimanual de mão-braço (HABIT) têm sido amplamente eficazes para aumentar a função da mão. Objetivo: Investigar os efeitos de um protocolo de intervenção beseado nos fundamentos teóricos da CIMT e do HABIT, na estimulação da função manual em bebês com assimetria de MS. Métodos: Cinco crianças (6-24 meses) participaram do estudo. Para avaliar a função motora dos lactentes foram utilizados o Pediatric Motor Activity Log (PMAL) e a Avaliação de Função Manual (AMIGO); o Pediatric Disability Assessment Inventory (PEDI) foi aplicado aos cuidadores, a fim de avaliar sua percepção da participação funcional do lactente nas tarefas diárias. Todas as avaliações ocorreram antes, imediatamente após a intervenção e após quatro meses para registro de acompanhamento. Os dados foram analisados descritivamente pelo método de Jacobson-Truax. Resultados: Os resultados entre avaliação e reavaliação demonstraram evolução em todos os aspectos estudados. Na sessão de autocuidado do PEDI, a média de 38,6 (±8,4) foi para 44,2 (±7,4); PEDI - Mobilidade: de 28,8 (±20,3) a 36,28 (±21,7); PEDI - Função Social: de 40,1 (±10,2) a 42,3 (±8,9). Os resultados de quantidade e qualidade do PMAL-R evidenciam um significado clínico altamente positivo em todos os bebês. Conclusão: A aplicação do protocolo de intervenção de restrição modificado resultou em alterações confiáveis e clinicamente significativas em todos os casos.

Colgajos de pedículo perforante en hélice para reconstrucción dearticulaciones mayores en secuelas de quemaduras / Perforator pedicled propeller flaps for big joins reconstruction in burns sequelaeperspective

Introducción: Las secuelas de quemadura juegan un papel fundamental en la recuperación del paciente quemado, ya que tiene una repercusión funcional y estética; para decidir el tratamiento de las contracturas cicatriciales, se necesita una evaluación cuidadosa y una clasificación de las contracturas por sitio, se debe explorar las articulaciones afectadas y notar los rangos de movilidad y las deformidades resaltando cualquier contractura cicatrizal y una vez que se establezca adecua-damente el tipo de secuela se tomara decisiones para orientar a un óptimo tratamiento. Los avances en el conocimiento de la anatomía vascular, en conjunto con el método de disección de colgajos "estilo libre", han permitido el desarrollo de los colgajos en hélice (propeller flap). Presentación de casos: Durante el período de un año (2018-2019) se presentaron seis casos de secuelas de quemaduras que comprometieron articulaciones mayores y que fueron tratadas con colgajo de pedículo perforante en hélice. La edad de los pacientes se ubicó entre 5 a 60 años con una mediana de 29 años con secuelas de quemaduras. Un caso con infección de sitio quirúrgico y seis sin complicaciones. El tiempo quirúrgico entre 120 a 170 min, la estancia hospitalaria tuvo una me-diana de 19 días (rango 6 a 55días). El diámetro del colgajo fue entre 24cm2 y 84cm2, con diferentes diseños lobulado (un caso), bilobulado (tres casos), tetralobulado (dos casos); permitiendo que el defecto secundario se cierre de forma directa en cinco de ellos y en un caso se colocara injerto de piel. Discusión: La literatura científica provee evidencia de las ventajas al utilizar colgajos en hélice por la capacidad de recons-trucción del tejido en un procedimiento de una sola etapa, logrando obtener resultados similares que ofrecen los colgajos libres microvascularizados.Conclusiones: El colgajo en hélice mejora las retracciones en las articulaciones mayores devolviendo el rango de movili-dad, preserva el músculo subyacente, proporciona una menor morbilidad del sitio donante.

Introduction: The sequelae of burns play a fundamental role in the recovery of the burned patient, since they have a func-tional and aesthetic impact; To decide on the treatment of scar contractures, a careful evaluation and classification of the contractures by site is needed, the affected joints should be explored and ranges of motion and deformities noted highli-ghting any scar contractures and once the type of sequel, decisions will be made to guide a better treatment. Advances in the knowledge of vascular anatomy, together with the "freestyle" flap dissection method, have allowed the development of propeller flaps. Case presentation: During a one-year period (2018-2019), there were six cases of burn sequelae that compromised major joints and that were treated with a pedicled propeller flaps. The age of the patients ranged from 5 to 60 years with a median of 29 years with burn sequelae. One case with surgical site infection and six without complications. The surgery time between 120 and 170 min, the hospital stay had a median of 19 days (range 6 to 55 days). The diameter of the flap was between 24cm2and 84cm2, with different designs: lobed (one case), bilobed (three cases), tetralobed (two cases); considering that the secon-dary defect is closed directly in five of them and in one case a skin graft is placed. Discussion: The scientific literature provides evidence of the advantages of using pedicled propeller flaps due to the ability to reconstruct the tissue in a single-stage procedure, achieving similar results as those offered by microvascularized free flaps.Conclusions: The pedicled propeller flaps improves retractions in major joints, restoring the range of motion, preserving the underlying muscle, and providing less donor site morbidity.