Use of Botulinum Toxin as a Treatment of Hemiplegic Shoulder Pain Syndrome: A Randomized Trial.

OBJECTIVE: The primary objective of this paper is to assess whether the use of 200 units of abobotulinum in the pectoralis major and subscapularis muscles modifies the pain complaint assessed using the visual analog scale in subjects with shoulder pain after the onset of spastic hemiplegia due to cerebrovascular disease when compared to the application of a placebo to the same muscles. DESIGN: A prospective, double-blind, randomized, and placebo-controlled clinical trial study in two different rehabilitation centers. SETTING: Two distinct outpatient neurological rehabilitation services. PARTICIPANTS: Patients older than 18 years who were included presented upper limb spasticity resulting from ischemic or hemorrhagic stroke and a diagnosis of Painful Hemiplegic Shoulder Syndrome (PHSS) that was independent of motor dominance. INTERVENTIONS: Patients were divided into two groups, one of them underwent the application of botulinum toxin (TXB-A) in the pectoralis major and subscapularis muscles, at a total dose of 400 U. MAIN OUTCOME MEASURE: Patients were assessed for a change in pain using the Visual Analog Scale (VAS) for at least 13 mm. RESULTS: An improvement in pain and spasticity levels in both groups, more intense in the toxin group, but without statistical significance. The comparison between the groups showed a reduction in pain by VAS (p = 0.52). CONCLUSIONS: The use of botulinum toxin in the subscapularis and pectoralis major muscles resulted in a reduction in shoulder pain in spastic hemiplegic patients without statistical significance.

Effectiveness of physical exercise on the recovery of limb function in stroke patients / Eficácia do exercício físico na recuperação da função dos membros em pacientes com avc / Efectividad del ejercicio físico en la recuperación de la función de las extremidades en pacientes con acv

ABSTRACT Introduction Patients with cerebrovascular accident and hemiplegia need to perform physical exercise and aerobic training, but physical dysfunction restricts the performance of these activities. Objective The article aims to develop physical strength sports for stroke patients with hemiplegia to explore the efficacy of sports to regain limb function in these patients. Methods We randomly selected 30 patients with stroke sequelae and divided them into control and exercise groups. While undergoing rehab, the exercise group performed a certain amount of aerobic exercise. During this period, we compared the relevant physiological indicators of the patients, and, at the same time, we used the Fugle-Meyer motor function scoring method to assess limb function. Results The two groups of patients are significantly different regarding the recovery of physical function and the capacity for daily life. Physiological indicators of patients are also different. Conclusion Low-intensity aerobic exercise can help stroke and hemiplegia patients regain their basic ability to live and exercise. Level of evidence II; Therapeutic studies: investigation of treatment results.

RESUMO Introdução É muito importante que pacientes com acidente vascular encefálico e hemiplegia realizem exercícios físicos e treinamento aeróbio, mas a disfunção física restringe a realização dessas atividades. Objetivo o artigo tem como objetivo desenvolver esportes de força física para pacientes com AVC com hemiplegia para explorar a eficácia dos esportes para recuperar a função dos membros nesses pacientes. Métodos Selecionamos aleatoriamente 30 pacientes com sequela de AVC e os dividimos em grupos controle e exercício. Durante a reabilitação, o grupo de exercícios realmente executou uma certa quantidade de exercícios aeróbicos. Durante esse período, comparamos os indicadores fisiológicos relevantes dos pacientes e, ao mesmo tempo, usamos o método de pontuação da função motora de Fugle-Meyer para avaliar a função dos membros. Resultados Os dois grupos de pacientes são significativamente diferentes em termos de recuperação da função física e capacidade para a vida diária. Os indicadores fisiológicos dos pacientes também são diferentes. Conclusão O exercício aeróbico de baixa intensidade pode ajudar os pacientes com derrame e hemiplegia a recuperar sua capacidade básica de viver e se exercitar. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

RESUMEN Introducción Es muy importante para los pacientes con accidente cerebrovascular y hemiplejía realizar ejercicio físico y entrenamiento aeróbico, pero la disfunción física restringe la realización estas actividades.Objeto: El artículo tiene como objetivo desarrollar deportes de fuerza física para pacientes con accidente cerebrovascular con hemiplejía para explorar la eficacia de los deportes para recuperar la función de las extremidades de estos pacientes. Métodos Seleccionamos aleatoriamente a 30 pacientes con secuelas por accidente cerebrovascular y los dividimos en grupos de control y de ejercicio. Mientras se sometía a rehabilitación, el grupo de ejercicio llegó a realizar una cierta cantidad de ejercicio aeróbico. Durante este período, comparamos los indicadores fisiológicos relevantes de los pacientes y, al mismo tiempo, utilizamos el método de puntuación de la función motora de Fugle-Meyer para evaluar la función de las extremidades. Resultados Los dos grupos de pacientes son significativamente diferentes en cuanto a la recuperación de la función física y la capacidad para la vida diaria. Los indicadores fisiológicos de los pacientes también son diferentes. Conclusión El ejercicio aeróbico de baja intensidad puede ayudar a los pacientes con accidente cerebrovascular y hemiplejía a recuperar su capacidad básica de vida y ejercicio. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Robotic therapy for the hemiplegic shoulder pain: a pilot study.

BACKGROUNDS: Exoskeletons development arises with a leading role in neurorehabilitation technologies; however, very few prototypes for upper limbs have been tested, contrasted and duly certified in terms of their effectiveness in clinical environments in order to incorporate into the health system. The purpose of this pilot study was to determine if robotic therapy of Hemiplegic Shoulder Pain (HSP) could lead to functional improvement in terms of diminishing of pain, spasticity, subluxation, the increasing of tone and muscle strength, and the satisfaction degree. METHODS: An experimental study was conducted in 16 patients with painful shoulder post- ischemic stroke in two experimental groups: conventional and robotic therapy. At different stages of its evolution, the robotic therapy effectiveness applied with anti-gravitational movements was evaluated. Clinical trial was developed at the Physical Medicine and Rehabilitation Department of the Surgical Clinical Hospital "Dr. Juan Bruno Zayas Alfonso" in Santiago de Cuba, from September 2016 - March 2018. Among other variables: the presence of humeral scapular subluxation (HSS), pain, spasticity, mobility, tone and muscle strength, and the satisfaction degree were recorded. Results with 95% reliability were compared between admission and third months of treatment. The Mann-Whitney U-Test, Chi-Square and Fisher's Exact Tests were used as comparison criteria. RESULTS: Robotic therapy positively influenced in the decrease and annulment of pain and the spasticity degree, reaching a range increase of joint movement and the improvement of muscle tone.

Effect of motor imagery combined with physical practice on upper limb rehabilitation in children with hemiplegic cerebral palsy.

INTRODUCTION: Evidence indicates that motor deficits in hemiplegic cerebral palsy (HCP) impair both motor execution and planning. However, current rehabilitation efforts focus mainly on relieving impairments in motor execution. Motor imagery (MI) is a promising method for stimulating neural networks underlying the planning and control of movements. OBJECTIVE: Evaluate the effectiveness of MI combined with physical practice in improving the function of the upper limbs in children with HCP. METHOD: Twenty-four participants, aged 7-14 years were divided into two groups: intervention group (IG) and control group (CG). The IG was subjected to MI training and physical practice twice a week for eight consecutive weeks, while the CG received conventional therapy. Participants were assessed with the Assisting Hand Assessment (AHA) at pre-intervention, post-intervention, and follow up. RESULTS: The results showed improved motor functions in both groups. Analysis using the general linear model (analysis of covariance) and Bonferroni post hoc tests showed significant improvements from pre-intervention to post-intervention in the AHA for the IG. The CG showed non-significant improvement in AHA scores. CONCLUSIONS: These findings suggest that the MI training, combined with the physical practice program used in this study, was effective in improving upper limb function in children with HCP.

Electromyogram-Related Neuromuscular Electrical Stimulation for Restoring Wrist and Hand Movement in Poststroke Hemiplegia: A Systematic Review and Meta-Analysis.

BACKGROUND: Clinical trials have demonstrated some benefits of electromyogram-triggered/controlled neuromuscular electrical stimulation (EMG-NMES) on motor recovery of upper limb (UL) function in patients with stroke. However, EMG-NMES use in clinical practice is limited due to a lack of evidence supporting its effectiveness. OBJECTIVE: To perform a systematic review and meta-analysis to determine the effects of EMG-NMES on stroke UL recovery based on each of the International Classification of Functioning, Disability, and Health (ICF) domains. METHODS: Database searches identified clinical trials comparing the effect of EMG-NMES versus no treatment or another treatment on stroke upper extremity motor recovery. A meta-analysis was done for outcomes at each ICF domain (Body Structure and Function, Activity and Participation) at posttest (short-term) and follow-up periods. Subgroup analyses were conducted based on stroke chronicity (acute/subacute, chronic phases). Sensitivity analysis was done by removing studies rated as poor or fair quality (PEDro score <6). RESULTS: Twenty-six studies (782 patients) met the inclusion criteria. Fifty percent of them were considered to be of high quality. The meta-analysis showed that EMG-NMES has a robust short-term effect on improving UL motor impairment in the Body Structure and Function domain. No evidence was found in favor of EMG-NMES for the Activity and Participation domain. EMG-NMES had a stronger effect for each ICF domain in chronic (≥3 months) compared to acute/subacute phases. CONCLUSION: EMG-NMES is effective in the short term in improving UL impairment in individuals with chronic stroke.

Addition of an educational programme for primary caregivers to rehabilitation improves self-care and mobility in children with cerebral palsy: a randomized controlled trial.

OBJECTIVE: To assess whether the addition of an education programme for primary caregivers to rehabilitation improves daily functioning in children with cerebral palsy. DESIGN: A randomized, single-blind, controlled study. SETTING: This study was conducted in a rehabilitation centre in Salvador, Brazil. PARTICIPANTS: A total of 63 boys and girls with cerebral palsy, at 1-12 years of age, with Gross Motor Function Classification Systems I-V, were randomly assigned to two groups: educational programme for primary caregivers and conventional rehabilitation ( n = 29) or conventional rehabilitation alone ( n = 31). INTERVENTION: Each group received 12 sessions of 30 minutes of conventional rehabilitation and 12 sessions of 45 minutes to intervention group. MEASUREMENTS: Gross Motor Function Classification System, Gross Motor Function Measure and daily functioning with the Pediatric Evaluation of Disability Inventory were assessed by a blinded assessor. The clinical outcomes were obtained at the completion of treatment (12 weeks). RESULTS: Of the 63 patients included, 60 (mean ± SD age: 4.6 ± 2.74 years) completed the protocol. The combined education and rehabilitation, as compared with conventional rehabilitation alone, yielded significantly greater benefit in the self-care domain of the Functional Skills Scale (mean change 1.74 versus 5; P = 0.001), self-care (mean change 5.52 versus 13.99; P = 0.017) and the mobility domain of the Caregiver Assistance Scale of Pediatric Evaluation of Disability Inventory (mean change 0.87 versus 17.88; P = 0.002). CONCLUSION: Self-care and mobility improved in children with cerebral palsy with the addition to conventional rehabilitation of an educational programme for primary caregivers.

Virtual Rehabilitation through Nintendo Wii in Poststroke Patients: Follow-Up.

OBJECTIVE: To evaluate in the follow-up the sensory-motor recovery and quality of life patients 2 months after completion of the Nintendo Wii console intervention and determine whether learning retention was obtained through the technique. METHODS: Five hemiplegics patients participated in the study, of whom 3 were male with an average age of 54.8 years (SD = 4.6). Everyone practiced Nintendo Wii therapy for 2 months (50 minutes/day, 2 times/week, during 16 sessions). Each session lasting 60 minutes, under a protocol in which only the games played were changed, plus 10 minutes of stretching. In the first session, tennis and hula hoop games were used; in the second session, football (soccer) and boxing were used. For the evaluation, the Fulg-Meyer and Short Form Health Survey 36 (SF-36) scales were utilized. The patients were immediately evaluated upon the conclusion of the intervention and 2 months after the second evaluation (follow-up). RESULTS: Values for the upper limb motor function sub-items and total score in the Fugl-Meyer scale evaluation and functional capacity in the SF-36 questionnaire were sustained, indicating a possible maintenance of the therapeutic effects. CONCLUSION: The results suggest that after Nintendo Wii therapy, patients had motor learning retention, achieving a sustained benefit through the technique.

Rehabilitación cognitiva de pacientes con alteraciones perceptivas sobrevivientes a ictus isquémico / Cognitive rehabilitation of patients with perceptive disorders surviving to ischemic ictus

Se realizó una intervención terapéutica en 30 pacientes con déficit motor (hemiplejía/ hemiparesia), sobrevivientes a ictus isquémico, irrigado por la arteria cerebral media con alteraciones perceptivas (negligencia sensorial, atencional o anosognosia), atendidos en el Departamento de Rehabilitación del Hospital General Docente Dr Juan Bruno Zayas Alfonso, de Santiago de Cuba, desde enero hasta noviembre del 2016, con vistas a evaluar la efectividad del tratamiento rehabilitador. La muestra fue dividida en 2 grupos de 15 integrantes cada uno: los del grupo control recibieron tratamiento convencional; los del grupo de estudio, tratamiento convencional y terapia ocupacional asociada a rehabilitación cognitiva. Se consideraron parámetros sociodemográficos, de valoración clínica y funcional, así como de recuperación funcional global. La heminegligencia resultó ser la alteración perceptiva más frecuente (63,4 por ciento) y al finalizar el tratamiento el grupo de estudio mostró una mejor recuperación funcional (93,3 por ciento), por lo cual quedó demostrada la eficacia de la rehabilitación convencional integrada a técnicas cognitivas y terapia ocupacional

A therapeutic intervention in 30 patients with motor deficit (hemiplegia/hemiparesis), surviving to ischemic ictus, irrigated by the mean cerebral artery with perceptive disorders (sensorial or atentional negligence or anosognosia), assisted in the Rehabilitation Department of Dr Juan Bruno Zayas Alfonso Teaching General Hospital, was carried out in Santiago de Cuba, from January to November, 2016, aimed at evaluating the effectiveness of the rehabilitative treatment. The sample was divided in 2 groups of 15 members each: those of the control group received conventional treatment; those of the study group, conventional treatment and occupational therapy associated with cognitive rehabilitation. They were considered sociodemographic parameters, of clinical and functional valuation, as well as of global functional recovery. Heminegligence was the most frequent perceptive disorder (63.4 percent) and the study group showed a better functional recovery (93.3 percent) when concluding the treatment, reason why the effectiveness of the conventional rehabilitation integrated to cognitive techniques and occupational therapy was demonstrated

Características das pessoas com acidente vascular encefálico atendidas em um centro de referência estadual / Características de las personas con accidente cerebrovascular atendidas em um centro de rehabilitación / Characteristics of encephalic vascular accident patients treated at a state reference center

Encephalic Vascular Accident is a clinical sign of brain dysfunction and it might result in permanent and irreversible lesions. Objective: defined the characteristics such as age, sex and date of the first treatment at a Santa Catarina State’s Rehabilitation Center. Methods: This is a quantitative cross-sectional descriptive study.The Ethnics in Human Research (CEPSH), the Pro Rector for Research and Extension Federal University of Santa Catarina, number 1024 reviewed this study. Results: Stroke affected 25,11% of women between 71-80 years old and 34,09% of the men aged between 61-70 years old. The most common consequence due to stroke was hemiplegia and the study observed that many patients only looked for proper treatment after several years post stroke. Conclusions: The physical therapy is important, so patients can relearn daily tasks and furthermore reintegrate their social life.

Acidente Vascular Encefálico (AVE) é uma disfunção cerebral que causa lesões permanentes e irreversíveis. Objetivo: Avaliar as idades, os sexos e a data do primeiro atendimento das pessoas com AVE atendidas no centro de reabilitação do Estado de Santa Catarina. Métodos: É um estudo quantitativo, descritivo e transversal, sendo a coleta de dados realizada com base documental nos prontuários. O presente estudo foi avaliado pelo Comitê de Ética em Pesquisa com Seres Humanos (CEPSH), Reitoria de Pesquisa e Extensão da Universidade Federal de Santa Catarina de número 1024. Resultados: O AVE afeta 25,11% de mulheres entre 71-80 anos e 34,09% de homens entre 61-70 anos. Observou-se que a sequela mais comum é a hemiplegia e que muitos somente procuravam tratamento após muitos anos de sequelas. Conclusão: Os dados encontrados mostram a importância da terapia física para que os pacientes reaprendam tarefas diárias e auxilia na reintegração social.

El Accidente Cerebrovascular (ACV) es un signo clínico de disfunción cerebral e ocasiona lesiones cerebrales permanentes e irreversibles. Objetivo: Evaluar las edades, sexos y la fecha del tratamiento inicial de los pacientes con accidente cerebrovascular tratados en el centro de rehabilitación en el estado de Santa Catarina. Métodos: El estudio cuantitativo, descriptivo y transversal. Este estudio fue revisado por el Pro Rector de Investigación y Extensión de la Universidad Federal de Santa Catarina para la Investigación Humana (CESPH). La recolección de datos se basó en registros documentales de las personas atendidas en el Centro de Rehabilitación del Estado de Santa Catarina, entre 2000-2009. Resultados: El AVC afecta 25.11% de las mujeres de 71-80 años y el 34,09% de los varones de 61-70 años. La hemiplejia es secuela más común. El estudio destaca que muchos pacientes buscan tratamiento sólo después de muchos años de secuela. Conclusión: Nuestros datos muestran la importancia de la terapia física, ya que permite que los pacientes pueden volver a aprender las tareas cotidianas.

Body representation in children with hemiplegic cerebral palsy.

Clinical observations indicate that many children with hemiplegic cerebral palsy refrain from using or disregard the affected upper limb. The aim of the present study is to investigate deficits in different body representations (body schema, body structural description, and body image) in children with hemiplegic cerebral palsy (HCP) compared to typically-developing (TD) children. Three groups of children participated in this study: 42 TD children (aged 5.17-10.91 years), 23 children with right HCP (aged 5.83-10.92 years), and 22 children with left HCP (aged 5.67-10.90 years). The results demonstrate generalized deficits in all three body representations in children with HCP, and do not offer evidence for an effect of hemiplegia laterality.

Alternativa de un programa de ejercicios simultáneos para la rehabilitación de pacientes hemipléjicos / Alternative of a program of simultaneous exercises for the rehabilitation of hemiplegic patient

Introducción: las enfermedades cerebrovasculares constituyen afecciones en las que los vasos sanguíneos cerebrales se encuentran lesionados. Dicho proceso puede ser intrínseco del vaso o consecuencia de émbolos que provienen del corazón o de la circulación extracraneal. Objetivo: evaluar la eficacia de la aplicación de un programa de ejercicios de forma alterna y coordinada en la rehabilitación de pacientes con hemiplejía causada por enfermedad cerebrovascular isquémica. Método: se realizó un estudio experimental tipo ensayo clínico terapéutico controlada fase II, a ciegas por terceros, en la sala de rehabilitación del policlínico René Vallejo Ortíz de Bayamo en el periodo comprendido entre marzo del 2014-marzo del 2015 para evaluar la eficacia de un programa de ejercicios para la rehabilitación de pacientes hemipléjicos. El universo de trabajo estuvo constituido por 23 pacientes con hemiplejia que acudieron a dicha sala de rehabilitación en el periodo de estudio y la muestra por 16 que cumplieron con los criterios de inclusión. Resultados: al analizar la respuesta terapéutica se pudo apreciar que existió una diferencia de proporciones de p=0,1573, estando estos resultados influenciados por el tamaño de la muestra y aunque desde el punto de vista estadísticos no tienen una diferencia significativa, desde el punto de vista social se alcanza el objetivo trazado. Conclusiones: se pudo concluir que con la aplicación de dicho método mejora la fuerza muscular y la marcha en un periodo corto de tiempo, por lo que resulta eficaz para lograr su rehabilitación(AU)

Introduction: cerebrovascular diseases are conditions in which the cerebral blood vessels are injured. Such a process may be intrinsic to the vessel or the consequence of emboli originating from the heart or extracranial circulation. Objective: to evaluate the effectiveness of the application of an alternating and coordinated exercise program in the rehabilitation of patients with hemiplegia caused by ischemic cerebrovascular disease. Method: an experimental study was conducted in the rehabilitation room of the René Vallejo Ortiz polyclinic from Bayamo in the period from March 2014 to March 2015 to evaluate efficacy of an exercise program for the rehabilitation of hemiplegic patients. The work universe consisted of 23 patients with hemiplegia who came to the rehabilitation room during the study period and the sample by 16 who met the inclusion criteria. Results: when analyzing the therapeutic response, it was observed that there was a difference of proportions of P = 0.1573, these results being influenced by the size of the sample and although from the statistical point of view they do not have a significant difference, from the point Social objective is achieved the goal outlined. Conclusions: it was possible to conclude that with the application of this method improves muscle strength and gait in a short period of time, making it effective to achieve rehabilitation(EU)

Efeito da Realidade Virtual no deslocamento do COP de indivíduos com hemiplegia / Effect of Virtual Reality on the COP displacement of individuals with hemiplegia

Introdução: O Traumatismo Cranioencefálico (TCE) é uma das principais causas de incapacidade funcional e alteração motora na população adulta. Objetivo: Avaliar o efeito da terapia com Wii no deslocamento do COP de hemiplégicos devido à sequela TCE. Métodos: Foram realizadas 10 sessões de treinamento com o Nintendo Wii Fit® em 10 indivíduos hemiplégicos pós TCE, do sexo masculino, com média de 31,3 ± 2,9 anos de idade. Os participantes foram avaliados antes, após e 3 meses após o protocolo de treinamento, nas quais mediu-se os dados cinéticos. Resultados: Não foram encontradas diferenças na RMS e velocidade do deslocamento do COP nos sentidos ântero-posterior e médio-lateral dos sujeitos hemiplégicos após as 10 sessões de treinamento com o console Wii. Esses valores se mantiveram após 3 meses. Conclusão: A terapia com o console Wii não alterou o deslocamento do COP nos sentidos ântero-posterior e médio-lateral de indiví-duos com hemiplegia.

Introducion: The Traumatic brain injury (TBI) is a major cause of disability and motor disorders in adults. Objective: To evaluate the effects of Wii rehabilitation therapy on COP displacement of hemiplegic individuals due to traumatic brain injury. Methods: 10 hemiplegic individuals after TBI were recruited for this study. Mean age, height and weight were 31.3 ± 2.9 years, 1.72 ± 0.03 m and 74.5 ± 5.1 kg, respectively. The individuals were evaluated before and after the training protocol and after 3 months again, in which kinetic data of the ground reaction force were measured. Results: There were no significant differences in the anterior-posterior and medio-lateral displacement of hemiplegic subjects after the 10 training sessions with the Wii console and these values remained the same after 3 months. Conclusion: The therapy with the Wii console was unable to alter the COP displacement of individuals with hemiplegia.

Relação entre o equilíbrio e a capacidade funcional em hemiparéticos / Relationship between the balance and functional capacity in hemiparetics

INTRODUÇÃO: O Acidente Vascular Encefálico (AVE) é responsável por incapacidades na vida do sujeito e pode muitas vezes provocar o seu óbito. Nos indivíduos acometidos, o equilíbrio é um dos principais componentes prejudicados, resultando em incapacidade. A Escala de Berg (EB) é um instrumento validado para avaliação do equilíbrio nessa população e a Escala de Avaliação de Fugl-Meyer (EFM) é também utilizada para avaliação do comprometimento sensório-motor e capacidade funcional nos pacientes vítimas de AVE. OBJETIVO: analisar a relação entre o equilíbrio e a capacidade funcional de pacientes hemiparéticos vítimas de AVE do Centro Universitário Jorge Amado. METODOLOGIA: Trata-se de um estudo observacional de corte transversal, realizado no ano de 2014, composto por 11 indivíduos, utilizando para coleta dos dados as EB e EFM como instrumento de avaliação. RESULTADOS: Correlacionando a EB com a EFM, encontrou-se uma correlação estatisticamente significante (r=0,680; p=0,021). Com a pontuação total da EB, foram correlacionados com os domínios "Sensibilidade" e "Função Motora do Membro Inferior - FMI" da EFM, além da idade e tempo de AVE, obtendo a maior relevância a relação tempo de AVE com EB (p=0,009), FMI (p=0,012) e sensibilidade (p=0,008). Os gêneros foram correlacionados com o equilíbrio e capacidade funcional, sendo as mulheres com menor pontuação na EB (p=0,425) e maior na EFM (p=0,767). Os indivíduos que realizam tratamento fisioterapêutico obtiveram melhor pontuação nas escalas (p=0,082 e p=0,166 para EB e EFM). CONCLUSÃO: Através dos resultados, é possível inferir que pacientes com melhor equilíbrio possuem melhor capacidade funcional.

INTRODUCTION: Stroke is responsible for disabilities in the life of the life of the subject and often cause his/her death. In affected individuals, the balance is one of the damaged components, resulting in disability. The Berg Balance Scale (BBS) is an instrument for the assessment of the balance in this population and the Fugl-Meyer Assessment (FMA) is also used to evaluate the sensory-motor impairment and functional capacity in patients suffering from stroke. OBJECTIVE: Analyze the relation between the balance and the functional capabilities in of hemiparetic patients victims of a Stroke on the Universitary Center Jorge Amado. METHODOLOGY: This study is a cross-sectional ob-servational study, carried out in 2014, compound of 11 individuals, using for data collection the BBS and FMA as evaluation instruments. RESULTS: Correlating the BBS with the FMA, was found a statistically significant correlation (r=0,680; p=0,021). The total score of BBS was correlated with "sensibility" and "the lower limb section" at FMA, moreover the age and time since Stroke, obtaining the bigger rel-evance in relation to the time since Stroke with BBS (p=0,009), FMI (p=0,012) and sensibility (p=0,008). The gender was correlated with the balance and functional capability, having the women the lower score at BBS (p=0,425) and the bigger in FMA (p=0,767). The individuals how have performed physiotherapeutic treatment had the best score in the scales (p=0,082 at BBS and p=0,166 at FMA). CONCLUSION: Through the results, it is possible infer that the patients with the best balance have best functional capability.

Materiales para la elaboración de cabestrillos para personas con hemiplejia / Materials to elaborate slings for hemiplegics

Los cabestrillos utilizados actualmente no han incorporado innovaciones significativas en lo que respecta a los materiales de confección. Indudablemente hay carencia de alternativas puestas a prueba que superen los materiales que actualmente se encuentran en uso, pero ello no quiere decir que éstos sean inmejorables. Este trabajo se sostiene en la convicción de que un grupo de trabajo interdisciplinario produce frutos innovadores. Es por ello que aquí, especialistas de distintas disciplinas se proponen el desarrollo de materiales y tecnologías que aporten soluciones eficientes para el mejoramiento de este producto de apoyo (PA) para esta patología específicamente...

Nowadays, there are no significant innovations on the materials used to make slings. Undoubtedly, there is lack of alternatives to exceed the current ones. Nevertheless, it does not mean that these ones cannot be improved. We believe that an interdisciplinary group of work can produce innovative fruits. As a consequence, specialists on different disciplines are decided to develop materials and technologies in order to provide several efficient solutions on the improvement of this supportive product (SP) for this specific pathology...

Afecciones Morfofisiológicas más frecuentes asociadas al uso prematuro del bastón en pacientes hemipléjicos / Most frequent morphophysiologic affections associated to the premature use of the cane in hemiplegic patients

Se realizó un estudio analítico-transversal en el Policlínico René Vallejo Ortíz de Bayamo con el objetivo de analizar las afecciones morfo- fisiológicas más frecuentes asociadas al uso prematuro del bastón en pacientes hemipléjicos. En los resultados obtenidos se pudo observar que en la etapa de rehabilitación de la marcha que más incidencia hubo, fue en la coordinación simple (2da etapa) con un 55 por ciento (6 pacientes) de una muestra de 11, con predominio en el sexo masculino con 4 pacientes - 36.6 por ciento, en cuanto a la postura la línea de gravedad más afectada fue desde la vista anterior con 7 para un 64 por ciento, apreciándose una desviación de esta hacia el lado sano cayendo entre este y el bastón disminuyendo la funcionabilidad del lado afectado, 5 de estos pacientes son totalmente dependientes del bastón para la marcha (45.4 por ciento), en cuanto a la biomecánica de la marcha se puede observar que todos los patrones se afectan en estrecha relación con la postura del paciente. El uso prematuro del bastón provoca alteraciones de la simetría, dependencia del bastón para la marcha así como alteraciones de la biomecánica para la misma, lo que entorpece el proceso de rehabilitación de dichos pacientes(AU)

It was performed a transversal- analytical study at René Vallejo Ortiz Polyclinic in Bayamo with the purpose to analyze the most frequent morphophysiologic affections associated to the premature use of the cane in hemiplegic patients. In the results obtained it was observed that in the rehabilitation stage there was more incidence in the simple coordination (2nd stage) with a 55 percent (6 patients) in a sample of 11, prevailing the male sex with 4 patients - 36.6 percent, regarding the position the most affected line of gravity was from the previous sight with 7 for 64 percent, appreciating a deviation to the healthy side, between this one and the cane, diminishing the functionality of the side affected, 5 of these patients were totally dependent of the cane to walk (45.4 percent), regarding the biomechanics it could be observed that all of the patterns were affected in relation with the position of the patient. The premature use of the cane causes alterations of the symmetry, dependency of the cane to walk as well as alterations of the biomechanics, what difficult the rehabilitation process of the patient(EU)

Intervenção motora com a tarefa direcionada na paralisia cerebral: relato de caso / Motor intervention with goal-directed task in cerebral palsy: a case report

Objetivo: Verificar o desempenho da motricidade fina pós-intervenção motora com tarefa direcionada em uma criança com paralisia cerebral hemiplégica. Método: Um menino, com seis anos de idade, com hemiplegia leve à esquerda, realizou tarefas direcionadas, por 45 minutos, durante cinco semanas, no total de 15 sessões fisioterapêuticas. Para sua avaliação, usou-se o Manual Abilities Classification (MACS) pré e pós-intervenção, o qual avalia do nível I (crianças que manipulam objetos facilmente e com sucesso) ao V (não manipula objetos e tem habilidade severamente limitada para desempenhar até mesmo ações simples). Foram aplicadas as seguintes tarefas direcionadas: colher laranjas, achar a surpresa, encher o cofrinho, atirar no alvo e jogar boliche. Resultados: Nas tarefas de colher a laranja e achar a surpresa, o MACs permaneceu no nível II, pré e pós-intervenção, mas melhorou na qualidade do movimento e na função. Nas tarefas de praticar tiro ao alvo, encher o cofrinho e jogar boliche, o MACs diminuiu um nível, ou seja, o voluntário melhorou a pontuação. Conclusão: A criança apresentou melhora na motricidade fina, referente a quantidade, qualidade e independência do movimento; teve diminuição no tempo de execução das tarefas e melhoria na habilidade funcional.

Objectives: To check the performance of the fine motor skills after the motor intervention with a goal-directed task in an infant with hemiplegic cerebral palsy. Method: A 6-year-old boy with mild left hemiplegia performed the goal-directed tasks for 45 minutes during five weeks, totaling 15 physiotherapy sessions, and he was evaluated according to the Manual Abilities Classification System (MACS), before and after the intervention, which evaluates from level I (including children who handle objects easily and successfully) to level V (children unable to handle objects and with severely limited ability to perform even the simplest actions). The program comprised the following goal-directed tasks: pick up oranges, find out the surprise, fill up a piggy bank, shoot a target and play bowling. Results: In picking up oranges and finding out the surprise, MACS remained in the level II in the pre and post-intervention, but the infant improved movement quality and function. When shooting a target and playing bowling, MACS decreased one level, i.e., the boy enhanced his score. Conclusion: There was a clear improvement in the infant’s fine motor skills in terms of quantity, quality and independence of movement. The infant reduced the amount of time needed to perform the tasks, with a clear progress in his functional ability.

Efectividad de la plataforma Wii Fit en la mejoría del equilibrio y coordinación en pacientes con parálisis cerebral hemiparética: ensayo clínico, controlado,randomizado y simple ciego / Wii platform effectiveness on equilibrium and motor coordination improvement in patients with hemiparetic cerebral palsy: a single blinded, controlled and randomized clinical trial

Los pacientes con parálisis cerebral (PC) de tipo hemiparética cursan con alteraciones del equilibrio y la coordinación uni-bipodal, lo que se traduce en una capacidad disminuida para trasladar el centro de gravedad durante las actividades funcionales. Objetivo: Evaluar los efectos en el equilibrio y la coordinación en unipodal y bípedo, post intervención con la plataforma Wii Fit en niños con parálisis cerebral hemiparética pertenecientes al Instituto Teletón Valparaíso, durante junio-diciembre de 2011. Pacientes y Métodos: Ensayo clínico, controlado, randomizado y simple ciego, en 32 pacientes, de 8 a 14 años, con PC tipo hemiparética, compromiso funcional leve o moderado y capacidad cognitiva para seguir instrucciones de mediana complejidad. Se distribuyen aleatoriamente en grupos control, kinésico y wii. Se aplica protocolo de ejercicios de equilibrio, coordinación y transferencias de peso en diferentes planos, de dificultad progresiva por 13 sesiones, durante 30 min, con excepción de grupo control. Se evalúa con pruebas de alcance funcional, equilibrio (Berg Balance Scale), centro de gravedad estático, en posición unipodal y bipodal (Wii Balance Board). Resultados: La intervención con plataforma Wii Fit produjo significancia estadística en la variable Escala de Berg (p < 0,001) lo que no se evidenció en las otras variables estudiadas. Conclusión: La plataforma Wii Fit resultó ser una herramienta que produjo mejoras parciales en ítems funcionales, sin efectos adversos en los pacientes sujetos a este tratamiento.

Introduction: Patients with hemiparetic cerebral palsy (CP) develop equilibrium and unipedal/bipedal alterations, which manifest themselves as a diminished capacity to shift the gravity center during functional activities. Objective: Evaluation of the effect of the use of the Wii Fit platform on equilibrium and coordination, in children with hemiplegic cerebral palsy, patients at Valparaíso’s Teletón Institute, between June and December of 2011. Patients and Methods: A controlled, randomized and simple blind clinical trial, was conducted with 32 hemiparetic CP patients, between 8 and 14 years of age, with mild to moderate functional impairment, and who could follow medium difficulty instructions. They were randomly assigned to control, kinesic and Wii groups. A progressively difficult exercise protocol that included coordination, equilibrium, and different levels of weight transference, was applied during thirteen sessions, except for the control group. Outcomes were assessed with functional Reach test, for equilibrium (Berg Balance Scale), standing gravity center for unipedal and bipedal positions (Wii Balance Board). Results: The Wii Fit Platform intervention showed a statistically significant effect for the Berg Scale (p < 0,001). No other effects were observed. Conclusion: Use of the Wii Fit platform generated partial improvements on functional activity items, without adverse effects for patiens who participated in treatment.

Restoring awareness: a review of rehabilitation in anosognosia for hemiplegia

Disturbances in body awareness offer important insights into neurocognitive processes involved in the construction of the bodily self. This review will focus ona specific disorder of awareness, namely, anosognosia for hemiplegia (AHP), or the denial of motor deficits contralateral to a brain lesion. Recently some progress has been made towards the management and rehabilitation of AHP, however to date no evidence-based treatment exists. Firstly, recent research on AHP will be reviewed, with the aim of providing an overview of the etiology, clinical presentation and assessment of the syndrome, as well as the majorneurological and neuropsychological explanations. This article will then focus on recent advances in the management and rehabilitation of AHP, using a casestudy example of intervention-based (i.e. video replay) motor awareness recovery (Fotopoulou, Rudd, Holmes & Kopelman, 2009). Finally, a dynamic theoreticalmodel of the multifaceted nature of anosognosia, using a predictive coding framework, will be proposed and future directions for research will also be discussed...

Comportamiento de los pacientes con enfermedad cerebrovascular en el Servicio de Rehabilitación del Hospital Militar de Matanzas / Behavior of the patients with cerebrovascular disease at the Rehabilitation Service of the Military Hospital of Matanzas

Las enfermedades cerebrovasculares constituyen la tercera causa de muerte en el mundo y una de las principales causas de discapacidad. Se realizó un estudio descriptivo en el Servicio de Rehabilitación del Hospital Militar de Matanzas, con el objetivo de describir el comportamiento de los pacientes con enfermedad cerebrovascular atendidos desde enero 2011 hasta junio de 2012. Se emplearon las variables: sexo, edad, tipo de accidente vascular encefálico, antecedentes patológicos personales, complicaciones en la rehabilitación, modalidades de tratamiento rehabilitador utilizado, tiempo de evolución, grado de incapacidad para realizar las actividades de la vida diaria (Índice de Barthel). La enfermedad cerebrovascular predominó en el sexo femenino, la edad media fue de 68,6 años. Se comprobó mayor incidencia de los accidentes vasculares encefálicos isquémicos. Se identificaron como complicaciones más frecuentes el hombro doloroso y la espasticidad. Las modalidades de tratamiento rehabilitador más utilizadas fueron la kinesioterapia y la ambulación. La ganancia en el Índice de Barthel fue mayor en los pacientes con menos de tres menos de evolución(AU)

The cerebrovascular disease is the third cause of death in the world and one of the main disability causes. A descriptive study was conducted in the Rehabilitation Service of the Military Hospital of Matanzas, with the objective of describing the behaviour of the patients with cerebrovascular diseases assisted there from January 2011 to June of 2012. The variables used were: sex, age, type of encephalic vascular accident, personal pathological history, complications in the rehabilitation, modalities of the rehabilitative treatment, time of evolution, grade of disability to carry out the daily life activities (Barthel Index). The cerebrovascular disease was predominant in the female sex; the average age was 68,6 years. A higher incidence of the ischemic encephalic vascular accidents was proved. The painful shoulder and spasticity were identified as the most frequent complications. The most used modalities of treatment were the kinesiotherapy and ambulation. The gain in the Barthel Index was bigger in patients with less than three months of evolution(AU)

Comportamiento de los pacientes con enfermedad cerebrovascular en el Servicio de Rehabilitación del Hospital Militar de Matanzas / Behavior of the patients with cerebrovascular disease at the Rehabilitation Service of the Military Hospital of Matanzas

Las enfermedades cerebrovasculares constituyen la tercera causa de muerte en el mundo y una de las principales causas de discapacidad. Se realizó un estudio descriptivo en el Servicio de Rehabilitación del Hospital Militar de Matanzas, con el objetivo de describir el comportamiento de los pacientes con enfermedad cerebrovascular atendidos desde enero 2011 hasta junio de 2012. Se emplearon las variables: sexo, edad, tipo de accidente vascular encefálico, antecedentes patológicos personales, complicaciones en la rehabilitación, modalidades de tratamiento rehabilitador utilizado, tiempo de evolución, grado de incapacidad para realizar las actividades de la vida diaria (Índice de Barthel). La enfermedad cerebrovascular predominó en el sexo femenino, la edad media fue de 68,6 años. Se comprobó mayor incidencia de los accidentes vasculares encefálicos isquémicos. Se identificaron como complicaciones más frecuentes el hombro doloroso y la espasticidad. Las modalidades de tratamiento rehabilitador más utilizadas fueron la kinesioterapia y la ambulación. La ganancia en el Índice de Barthel fue mayor en los pacientes con menos de tres menos de evolución.

The cerebrovascular disease is the third cause of death in the world and one of the main disability causes. A descriptive study was conducted in the Rehabilitation Service of the Military Hospital of Matanzas, with the objective of describing the behaviour of the patients with cerebrovascular diseases assisted there from January 2011 to June of 2012. The variables used were: sex, age, type of encephalic vascular accident, personal pathological history, complications in the rehabilitation, modalities of the rehabilitative treatment, time of evolution, grade of disability to carry out the daily life activities (Barthel Index). The cerebrovascular disease was predominant in the female sex; the average age was 68,6 years. A higher incidence of the ischemic encephalic vascular accidents was proved. The painful shoulder and spasticity were identified as the most frequent complications. The most used modalities of treatment were the kinesiotherapy and ambulation. The gain in the Barthel Index was bigger in patients with less than three months of evolution.