Pulsão de destruição ­ o disruptivo em ação ­ entre o tanático e o criativo: repercussões na pandemia e no racismo do dia a dia de nossas vidas / Destruction drive ­ the disruptive in action ­ between the tanatic and the creative: repercussions in day by day of pandemic and racismo of our lives / Pulsión de destrucción - lo disruptivo en acción - entre lo tanático y lo creativo: repercusiones en la pandemia y en el racismo diarios de nuestras vidas

O presente trabalho parte da ideia de caracterizar o disruptivo no pensamento freudiano. Como ponto de partida, toma o trabalho de 1914, À guisa de introdução ao narcisismo, por reconhecer nele um momento primeiro de ruptura na teoria pulsional vigente: libido do Eu versus libido objetal. Durante o trajeto, sinaliza marcas desse processo e direciona-se para o disruptivo que se instala em termos metapsicológicos, com maior consistência, com o advento da pulsão de morte. A pulsão de destruição, como agente do disruptivo em sua relação com Eros, desenhará caminhos que permitem vislumbrar destinos tanáticos ou criativos. Com essa concepção metapsicológica como indicador, busca-se refletir a respeito da interação entre o disruptivo da pandemia viral e o disruptivo da virulência do racismo e seus desdobramentos criativos na efetivação, pelo coletivo da humanidade, de posturas antirracistas. Tal contexto alberga uma interrogação pontual: como a pandemia, em seu efeito disruptivo, está relacionada com a percepção em toda a sua sensorialidade, em grande escala, de norte a sul, daquilo que mantinha-se parcialmente silencioso e invisível, o racismo? (AU)

The present article begins from the idea of characterize the disruptive in the freudian's thoughts. Is takes as a starter point the work of 1914, On narcissism: an introduction, for recognize it as a first moment of rupture in the current drive theory: self libido versus object libido. In this path, it signals marks of this process and orientate to the disruptive that develops in metapsychological terms, with great consistency, with the advent of the death drive. The destruction drive, as a disruptive agent, in its relation with Eros, will draw paths that allow glimpse its tanatic fate or criative fate. From this metapsychological conception, as an indicator, seeks to reflect the interaction between the disruptive in the viral pandemic and the disruptive in the racism virulence, and its criatives developments in the effectuation of anti-racist postures, by the humanity collective. Context that holds an punctual interrogation: how the pandemic, with its disruptive effect, is related with the perception in all its sensoriality, in big scale, from north to south, with what was, in part, silence and inivisible: the racism? (AU)

El objetivo inicial del presente trabajo es caracterizar lo disruptivo en el pensamiento freudiano. Se toma como punto de partida el célebre texto de 1914 Introducción del narcisismo por reconocer en él un primer momento de ruptura en la teoría pulsional vigente hasta ese momento, que distinguía la libido del Yo y la libido de objeto. En ese recorrido, se irán señalando marcas de dicho proceso orientándose hacia lo disruptivo, que se instalará con mayor consistencia, en términos metapsicológicos, con el advenimiento de la pulsión de muerte. La pulsión de destrucción, como agente de lo disruptivo, en su relación con Eros, trazará caminos que permiten vislumbrar sus destinos tanáticos o creativos. Tomando esa concepción metapsicológica como indicador, busco reflejar la interacción entre lo disruptivo de la pandemia viral y lo disruptivo de la virulencia del racismo, así como sus desdoblamientos creativos en la adopción de posturas antirracistas por parte del colectivo humano. En este contexto se plantea una interrogación puntual: ¿cómo la pandemia, con su efecto disruptivo, está relacionada con la percepción en toda su sensorialidad, en gran escala, de norte a sur, de aquello que, en parte, se mantenía silencioso e invisible, el racismo?

Negative Emotion and Joint-Stiffness Regulation Strategies After Anterior Cruciate Ligament Injury.

CONTEXT: Fear of reinjury after an anterior cruciate ligament (ACL) reconstruction (ACLR) may be associated with persistent deficits in knee function and subsequent injury. However, the effects of negative emotion on neuromuscular-control strategies after an ACL injury have remained unclear. OBJECTIVE: To identify how negative emotional stimuli affect neural processing in the brain and muscle coordination in patients after anterior cruciate ligament reconstruction compared with healthy control participants. DESIGN: Case-control study. SETTING: Neuromechanics laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty patients after unilateral anterior cruciate ligament reconstruction and 20 healthy recruits. MAIN OUTCOME MEASURE(S): Electrocortical θ (4-8 Hz) activity (event-related synchronization, % increased power relative to a nonactive baseline) at selected electrodes placed at the frontal (F3, Fz, F4) and parietal (P3, Pz, P4) cortices using electroencephalography, neurophysiological cardiac changes (beats/min), and subjective fear perceptions were measured, along with joint stiffness (Nm/°/kg) with and without an acoustic stimulus in response to 3 types of emotionally evocative images (neutral, fearful, and knee-injury pictures). RESULTS: Both groups had greater frontoparietal θ power with fearful pictures (Fz: 35.9% ± 29.4%; Pz: 81.4% ± 66.8%) than neutral pictures (Fz: 24.8% ± 29.7%, P = .002; Pz: 64.2 ± 54.7%, P = .024). The control group had greater heart-rate deceleration with fearful (-4.6 ± 1.4 beats/min) than neutral (-3.6 ± 1.3 beats/min, P < .001) pictures, whereas the ACLR group exhibited decreased heart rates with both the fearful (-4.6 ± 1.3 beats/min) and injury-related (-4.4 ± 1.5 beats/min) pictures compared with neutral pictures (-3.4 ± 1.4 beats/min, P < .001). Furthermore, during the acoustic startle condition, fearful pictures increased joint stiffness (Nm/°/kg) in the ACLR group at the midrange (0°-20°: 0.027 ± 0.02) and long range (0°-40°: 0.050 ± 0.02) compared with the neutral pictures (0°-20°: 0.017 ± 0.01, P = .024; 0°-40°: 0.043 ± 0.02, P = .014). CONCLUSIONS: Negative visual stimuli simultaneously altered neural processing in the frontoparietal cortices and joint-stiffness regulation strategies in response to a sudden perturbation. The adverse effects of fear on neuromuscular control may indicate that psychological interventions should be incorporated in neuromuscular-control exercise programs after ACL injury.

PROMIS CAT forms demonstrate responsiveness in patients following arthroscopic rotator cuff repair across numerous health domains.

BACKGROUND: Recent studies of patients with rotator cuff tears have demonstrated improved efficiency with Patient-Reported Outcomes Measurement Information System (PROMIS) when compared with traditional patient-reported outcome measures (PROM). However, these studies have been cross-sectional in nature and the responsiveness of PROMIS computer adaptive test (CAT) forms has not been evaluated. The purpose of this study was to determine the responsiveness of PROMIS CAT assessments in patients undergoing arthroscopic rotator cuff repair. METHODS: All patients undergoing arthroscopic rotator cuff repair by one of 3 fellowship-trained surgeons were included in the study. PROMIS CAT upper extremity physical function ("PROMIS-UE"), pain interference ("PROMIS-PI"), and depression ("PROMIS-D") scores from preoperative and 6-month postoperative visits were collected and analyzed. Patient-centric demographic factors, tear size, and biceps involvement were also correlated to preoperative and postoperative PROMIS scores. RESULTS: A total of 101 patients were enrolled in the study. The average age was 59.8 ± 8.9 years with 51 males (50.5%). Preoperative PROMIS-UE, PROMIS-PI, and PROMIS-D CAT scores improved significantly from 29.8 ± 6.0, 62.6 ± 5.1, and 48.4 ± 8.7, respectively, to 40.9 ± 9.8, 51.2 ± 9.3, and 42.9 ± 9.0, respectively, at 6-month follow-up (P < .001). Preoperative correlations were found between PROMIS-UE and PROMIS-PI scores (P < .001) and between PROMIS-PI and PROMIS-D scores (P = .001). No significant correlation was found between PROMIS-UE and PROMIS-D scores (P = .08), preoperatively. Preoperative PROMIS-UE, PROMIS-PI, or PROMIS-D scores were not correlated with rotator cuff tear size (P = .4). CONCLUSION: PROMIS CAT forms demonstrate responsiveness in patients undergoing arthroscopic rotator cuff repair across numerous domains.

Validity and reliability of the Norwegian translation of the Achilles tendon Total Rupture Score.

PURPOSE: Patient reported outcome measures (PROMs) are increasingly being used in clinical research. The Achilles tendon Total Rupture Score (ATRS) is a PROM designed to assess outcomes in patients with ruptures of the Achilles tendon. The aim of this study was to develop a Norwegian adaption of the ATRS and evaluate its validity and reliability. METHODS: The ATRS was translated into Norwegian in accordance with recommended guidelines. The study included 94 patients treated for Achilles tendon ruptures from January 2010 until February 2013, and the web-based questionnaires were administered twice. Reliability was assessed by Cronbach's alpha, the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). Construct validity was evaluated by calculating the Spearman's correlation coefficient with the five subclasses of the Foot and Ankle Outcome Score (FAOS), the SF-36 subclass physical function and the SF-36 physical and mental summary scores. RESULTS: Both internal consistency (Cronbach's alpha = 0.96) and test-retest reliability (ICC = 0.90) were excellent, and the MDC was 2.12 at the group level and 16.98 at the individual level. Construct validity was supported by Spearman's correlation coefficients above 0.7 with the SF-36 subclass physical function and the SF-36 physical summary score as well as the FAOS subclasses Sport/Rec and quality of life. There was no floor effect, and 6 patients (6.4%) achieved a maximum score of 100. CONCLUSIONS: The Norwegian adaption of the ATRS demonstrates acceptable validity and reliability for use in the Norwegian population to assess clinical outcomes in patients with Achilles tendon ruptures.

Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions.

BACKGROUND: An Achilles sleeve avulsion occurs when the tendon ruptures distally from its calcaneal insertion as a continuous "sleeve." This relatively rare injury pattern may not be appreciated until the time of surgery and can be challenging to treat because, unlike a midsubstance rupture, insufficient tendon remains on the calcaneus to allow for end-to-end repair, and unlike a tuberosity avulsion fracture, any bony element avulsed with the tendon is inadequate for internal fixation. This study aimed to highlight the characteristics of Achilles sleeve avulsions and present the outcomes of operative repair using suture anchor fixation. METHODS: A retrospective analysis was conducted on 11 consecutive Achilles tendon sleeve avulsions (10 males, 1 female; mean age 44 years) that underwent operative repair between 2008 and 2014. Patient demographics, injury presentation, and operative details were reviewed. Postoperative outcomes were collected at a mean follow-up of 38.4 (range, 12-83.5) months, including the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, visual analog scale (VAS) for pain, plantarflexion strength, patient satisfaction, and complications. RESULTS: Eight patients (72.7%) had preexisting symptoms of insertional Achilles disease. Ten of 11 (90.9%) injuries were sustained during recreational athletic activity. An Achilles sleeve avulsion was recognized preoperatively in 7 of 11 (64%) cases, where lateral ankle radiographs demonstrated a small radiodensity several centimeters proximal to the calcaneal insertion. Intraoperatively, 90.9% of sleeve avulsions had a concomitant Haglund deformity and macroscopic evidence of insertional tendinopathy. All patients healed after suture anchor repair. The average AOFAS score was 92.8 and VAS score was 0.9. Ten patients (90.9%) were completely satisfied. One complication occurred, consisting of delayed wound healing. CONCLUSIONS: Achilles tendon sleeve avulsions predominantly occurred in middle-aged men with preexisting insertional disease, while engaged in athletic activity. Suture anchor fixation, combined with addressing concomitant insertional pathology, was a reliable and safe technique for the operative management of Achilles tendon sleeve avulsions. The majority of patients returned to their preinjury levels of work and recreational activity. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Quality of life in anterior cruciate ligament-deficient individuals: a systematic review and meta-analysis.

BACKGROUND: Physical and psychological impairments impacting quality of life (QOL) are common following ACL reconstruction. Rehabilitation alone is an effective alternative to reconstruction for some patients, warranting the investigation of QOL in ACL-deficient individuals. PURPOSE: To report and compare QOL in ACL-deficient individuals with population norms and ACL-reconstructed groups, and investigate relationships between participant characteristics and QOL. STUDY DESIGN: Systematic review and meta-analysis. METHODS: We systematically identified and methodologically appraised all studies reporting QOL in ACL-deficient individuals ≥5 years following ACL rupture. Knee-related and health-related QOL scores in ACL-deficient cohorts were compared to ACL-reconstructed groups using a random-effects meta-analysis. Descriptive comparisons were made with population norms. RESULTS: Eleven studies reported QOL in 473 ACL-deficient individuals, a mean of 10 (range 5-23) years following ACL rupture. Eight studies reported knee-related QOL using the Knee injury and Osteoarthritis Outcome Score QOL subscale (KOOS-QOL); scores (mean±SD) ranging from 54±17 to 77±22 were impaired compared to population norms. Health-related QOL, measured with the SF-36 domain scores in five studies, was similar to population norms, but impaired compared to physically active populations. Meta-analysis revealed no significant differences in KOOS-QOL (mean difference (95% CI) 2.9 (-3.3 to 9.1)) and SF-36 scores (for all SF-36 domains except Vitality) between ACL-deficient and ACL-reconstructed groups. CONCLUSIONS: This systematic review found impaired knee-related QOL in ACL-deficient individuals ≥5 years after ACL rupture, compared to population norms. Meta-analysis revealed similar knee-related QOL in ACL-deficient and ACL-reconstructed groups, and no difference in health-related QOL scores for seven of the eight SF-36 domains.

Ability to perform a single heel-rise is significantly related to patient-reported outcome after Achilles tendon rupture.

This study evaluated the short-term recovery of function after an acute Achilles tendon rupture, measured by a single-legged heel-rise test, with main emphasis on the relation to the patient-reported outcomes and fear of physical activity and movement (kinesiophobia). Eighty-one patients treated surgically or non-surgically with early active rehabilitation after Achilles tendon rupture were included in the study. Patient's ability to perform a single-legged heel-rise, physical activity level, patient-reported symptoms, general health, and kinesiophobia was evaluated 12 weeks after the injury. The heel-rise test showed that 40 out of 81 (49%) patients were unable to perform a single heel-rise 12 weeks after the injury. We found that patients who were able to perform a heel-rise were significantly younger, more often of male gender, reported a lesser degree of symptoms, and also had a higher degree of physical activity at 12 weeks. There was also a significant negative correlation between kinesiophobia and all the patient-reported outcomes and the physical activity level. The heel-rise ability appears to be an important early achievement and reflects the general level of healing, which influences patient-reported outcome and physical activity. Future treatment protocols focusing on regaining strength early after the injury therefore seem to be of great importance. Kinesiophobia needs to be addressed early during the rehabilitation process.

A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery.

OBJECTIVE: To determine whether the psychological characteristics of athletes who have undergone an anterior cruciate ligament (ACL) reconstruction change during rehabilitation are related to returning to competitive sport. DESIGN: Prospective longitudinal study. METHOD: 87 athletes completed the Emotional Response of Athletes to Injury Questionnaire (ERAIQ) and the ACL Return to Sport after Injury scale (ACL-RSI) at 3, 6 and 12 months following ACL reconstruction surgery. Physical outcome measures were also taken at each time point. RESULTS: At 12 months 44 (51%) participants had returned to competitive sport and 43 (49%) participants had not returned. There were no differences in physical recovery or scores on the ERAIQ between the two groups. Participants who had returned to competitive sport at 12 months, however, scored significantly higher on the ACL-RSI scale (reflecting a more positive psychological response about sport participation) at both 6 and 12 months than participants who had not returned to competitive sport. CONCLUSIONS: During rehabilitation there are significant psychological differences regarding sport resumption between athletes who do, and do not, resume competitive sport 12 months following ACL reconstruction. These differences occur as early as 6 months postoperatively and highlight the importance of addressing all aspects of an athlete's recovery in order to help facilitate the athlete returning to sport.

[Functional and quality of life outcome of non-operated rotator cuff tears]. / Le devenir fonctionnel et la qualité de vie des ruptures de la coiffe des rotateurs non opérées.

UNLABELLED: Our objective was to determine the long-term functional and quality-of-life outcomes for patients with rotator cuff tears receiving conservative treatment. We also studied correlations between the Constant and SF-36 scores. MATERIAL AND METHODS: This was a prospective survey carried out on patients having consulted in our Rehabilitation Department between January 1995 and December 2004 for radiologically-confirmed rotator cuff tears and having received medical treatment combined with a rehabilitation programme. The outcome measures used in our study were as follows: degree of motion, muscle strength, degree of pain on a visual analogical scale (VAS) and scores on the Constant and SF-36 scales. RESULTS: The study population consisted of 38 women and 21 men (mean age: 61 years; range 46-75). The mean final outcome measurements were taken after an average of seven years of follow-up (range: 4-12). The VAS score for pain at rest dropped from 68.3+/-31 to 28.3+/-12 (p<10(-3)) over the follow-up period. The score for pain during effort fell from 82.5+/-36 to 40.3+/-15. In all cases, active joint mobility was better at the final assessment (p<0.001). The Constant score rose from 28.8+/-14.2 to 51.6+/-21.8. The SF36 score showed a 16% improvement. Sixty-two percent of patients were satisfied or very satisfied with this treatment. The change over time was rated as good to very good by 42 patients (71.8%). The observed improvement in quality of life was correlated with reduced pain at rest (r=0.62) and during effort (r=0.59) and with the increased Constant score. CONCLUSION: Our results underline the benefits (in terms of short- and long-term pain reduction, functional improvements and better quality of life) of an individualized rehabilitation programme (combined with medical treatment) in cases of rotator cuff tears.

Internal health status belief and lower perceived functional deficit are related among anterior cruciate ligament-deficient patients.

PURPOSE: Health locus of control has been shown to influence the recovery process after injury and surgery. This study attempted to determine relationships between patient perceptions of health locus of control and their perceived functional limitations after anterior cruciate ligament (ACL) rupture. An external health locus of control refers to the belief that one's outcome after injury or surgery is under the control of powerful others or is determined by fate, luck, or chance. An internal health locus of control refers to the belief that one's outcome is directly related to individual patient behaviors. TYPE OF STUDY: Quasi-experimental, posttest only design. METHODS: Over a 1-year time period, 70 consecutive patients with unilateral ACL deficiency (acute, <1 month after onset) agreed to participate in this study. All data were collected 1 week before ACL reconstruction. Subjects completed the Health Locus of Control Scale (HLC) and the physical function section of the Short Form 36 (SF-36) Health Survey. A Kruskal-Wallis 1-way analysis of variance was used to assess group differences (P <.05) based on SF-36 physical function score classification. RESULTS: Subjects with minimal perceived functional limitations (SF-36 physical function group 3) displayed lower (more internal) HLC scores (29.6 +/- 4.4; range, 24-36) than subjects with moderate perceived functional limitations (SF-36 physical function group 2) (33.0 +/- 6.1; range, 22-44) or subjects with maximal perceived functional limitations (SF-36 physical function group 1) (33.9 +/- 2.8; range, 30-38). CONCLUSIONS: Subjects with lower perceived functional limitations regarded their health status as being controlled more by internal factors. It is not proven whether there is a cause-and-effect relationship or which of these parameters is the antecedent. Related reports suggest that perception of control may positively influence functional outcome and disability levels. Patients who perceive preoperative pain and functional limitation to be excessive may have low tolerance for the stressors associated with surgery and postoperative rehabilitation. With these patients, a more conservative surgical and rehabilitation approach may be better. Alternatively, methods to change their perceptions, such as cognitive therapy, may have a positive role.