Servomotor Assistance in the Improvement of Manual Wheelchair Mobility.

This study reports the development of a servo-controlled power-assisted wheelchair, designed to reduce the loads on the upper limbs while maintaining the drivability of a manual chair. It is presented the concept and implementation of an assisted propulsion system, focusing on the assistance controlling and the torque transmission.

Órtese com impressão 3D para ombro: relato de caso / 3D print orthesis for shoulder: case report

Subluxação do ombro é a complicação musculoesquelética mais comum das afecções do Sistema Nervoso Central e Periférico, que leva a diminuição do movimento, da função e aumento de dor. Órtese é um dos recursos auxiliares utilizados no tratamento desta patologia e visa corrigir deformidade, diminuir dor e proporcionar função ao membro acometido. Objetivo: Este trabalho propõe uma nova metodologia para projetar e fabricar órteses customizadas estabilizadoras de ombro utilizando as tecnologias de aquisição 3D por escaneamento e de fabricação por Impressão 3D, e assegurar melhor adaptabilidade e maior conforto para o usuário. Método: A metodologia utilizada neste estudo foi dividida em cinco fases: estudo de caso, escaneamento, modelagem e impressão em 3D; e acabamento. O estudo de caso do usuário com lesão de plexo braquial motivou o projeto de desenho original de órtese híbrida, personalizada e manufaturada em 3D, usando estrutura rígida e faixas de tração, com objetivo de estabilizar o ombro, diminuir a dor e permitir função. Resultados: Após escaneamento em 3D utilizou-se softwares especializados para processar a imagem tridimensional STL. Realizaram-se otimizações do projeto com geração de modelos e peças prototipadas em FDM; avaliada pelo usuário. O conceito desenvolvido foi: órtese personalizada, fácil de higienizar e vestir, resistente, articulada, veste nos dois braços com faixas de tração em tecido rígido acoplado à cintura. Conclusão: O teste com usuário corroborou com o conceito projetado e mostrou um protótipo preliminar com bom acoplamento ao tronco, tração satisfatória e possibilidade de realizar um maior número de AVD´s com menos dor e/ou sensação de cansaço

Subluxation of the shoulder is the most common musculoskeletal complication of Central and Peripheral Nervous System disorders, which leads to decreased movement, function, and increased pain. Objective: Orthosis is one of the assistive devices used in the treatment of this pathology and it focuses in correcting deformity, decreasing pain and providing function to the affected member. This study proposes a new methodology for designing and manufacturing customized shoulder stabilization orthoses with 3D scan image acquisition and 3D printing technologies, for ensuring better adaptability and comfort for the user. Method: The methodology used in this study was divided into five phases: case study, scanning, modeling and 3D printing; and finishing. The case study included a user with brachial plexus injury that motivated the original design of hybrid orthosis, personalized and manufactured in 3D, with rigid structure and traction straps, for stabilizing the shoulder, reduce pain and allowing function. Results: After 3D scanning, we used specialized software to process the three-dimensional STL image. Optimization of the project with generation of models and prototyped parts in FDM based on the user evaluations was performed. The developed concept was: personalized orthosis, easy to clean and wear, resistant, articulated, for wearing in both arms with traction straps in rigid fabric coupled to the waist. Conclusion: The user test corroborated with the designed concept and showed a preliminary prototype with good trunk coupling, satisfactory traction and possibility of performing a greater number of ADLs with less pain and/or tiredness

A new concept of orthosis for correcting fingers ulnar deviation

Abstract Introduction Rheumatoid arthritis (RA) is a chronic, multisystem disease that involves synovial inflammation, leading to deformities, like finger ulnar deviation, pain and functional difficulties. The conservative treatment comprises orthoses, features added to the body that aims to correct deformity, reduce pain and improve functionality. In the market there are few kinetic/mobile orthosis models for correction of ulnar deviation in the fingers. However, users usually complain about increased palmar volume, presence of pressure points and functional loss, demonstrating the necessity to develop more effective orthoses. In this paper we introduce an innovative concept, of an original and articulate dynamic/kinetics orthosis, which aims to correct this finger deformity and encourage functionality. Methods Methodological procedures were divided into: Need Recognition; Specification Concept; Prototype and Validation. This paper deals with the last two stages of this research. Results A virtual orthosis prototype using CAD Solid Edge Insight™ was proposed. The orthosis developed consisted of 10 pieces, made of metal and resin with carbon fiber. Conclusion After virtual movement simulation, it was verified that the prototype allows for wrist and finger flexion/extension, the possibility of bilateral use, and provids ulnar deviation correction for the fingers. The final product is innovative and is easy to put on/off; volunteers claimed that the new prototype was satisfactory in terms of deformity correction.

Radial nerve injury associated with humeral shaft fracture: a retrospective study.

OBJECTIVE: To determine the profile of patients with humeral diaphyseal fractures in a tertiary hospital. METHODS: We conducted a survey from January 2010 to July 2012, including data from patients classified under humeral diaphyseal fracture (S42.3) according to the International Classification of Diseases (ICD-10). The variables analyzed were: age, gender, presence of radial nerve injury, causal agent and the type of treatment carried out. RESULTS: The main causes of trauma were car accidents. The radial nerve lesion was present in some cases and was caused by the same trauma that caused the fracture or iatrogenic injury. Most of these fractures occurred in the middle third of humeral diaphysis and was treated conservatively. CONCLUSION: The profile of patients with fracture of humeral shaft, in this specific sample, was composed mainly of adult men involved in traffic accidents; the associated radial nerve lesion was present in most of these fractures and its cause was strongly related to the trauma mechanism. Level of Evidence II, Retrospective Study.

Social determinants of health, inequality and social inclusion among people with disabilities.

OBJECTIVE: to analyze the socio-familial and community inclusion and social participation of people with disabilities, as well as their inclusion in occupations in daily life. METHOD: qualitative study with data collected through open interviews concerning the participants' life histories and systematic observation. The sample was composed of ten individuals with acquired or congenital disabilities living in the region covered by a Family Health Center. The social conception of disability was the theoretical framework used. Data were analyzed according to an interpretative reconstructive approach based on Habermas' Theory of Communicative Action. RESULTS: the results show that the socio-familial and community inclusion of the study participants is conditioned to the social determinants of health and present high levels of social inequality expressed by difficult access to PHC and rehabilitation services, work and income, education, culture, transportation and social participation. CONCLUSION: there is a need to develop community-centered care programs in cooperation with PHC services aiming to cope with poverty and improve social inclusion.

Social determinants of health, inequality and social inclusion among people with disabilities / Determinantes sociais da saúde, iniquidades e inclusão social entre pessoas com deficiência / Determinantes sociales de la salud, iniquidades e inclusión social entre personas con deficiencia

OBJECTIVE: to analyze the socio-familial and community inclusion and social participation of people with disabilities, as well as their inclusion in occupations in daily life. METHOD: qualitative study with data collected through open interviews concerning the participants' life histories and systematic observation. The sample was composed of ten individuals with acquired or congenital disabilities living in the region covered by a Family Health Center. The social conception of disability was the theoretical framework used. Data were analyzed according to an interpretative reconstructive approach based on Habermas' Theory of Communicative Action. RESULTS: the results show that the socio-familial and community inclusion of the study participants is conditioned to the social determinants of health and present high levels of social inequality expressed by difficult access to PHC and rehabilitation services, work and income, education, culture, transportation and social participation. CONCLUSION: there is a need to develop community-centered care programs in cooperation with PHC services aiming to cope with poverty and improve social inclusion. .

OBJETIVO: analisar a inclusão sociofamiliar e comunitária e a participação social de pessoas com deficiência, bem como sua inserção em ocupações na vida cotidiana. MÉTODO: estudo qualitativo, com coleta de dados por meio de entrevistas abertas sobre história de vida e observação sistemática. A amostra foi composta por dez pessoas com deficiência, adquirida ou congênita, moradoras de região adstrita a um Núcleo de Saúde da Família. O referencial teórico foi a concepção social da deficiência. Os dados foram analisados segundo abordagem interpretativa reconstrutiva, fundamentada no referencial da Teoria da Ação Comunicativa de Habermas. RESULTADOS: os resultados evidenciaram que a inclusão sociofamiliar e comunitária dos sujeitos do estudo condiciona-se a determinantes sociais da saúde, apresentando índices de iniquidades sociais, expressos pela dificuldade de acesso a serviços de Atenção Primária à Saúde e de reabilitação, trabalho e renda, educação, cultura, transporte e participação social. CONCLUSÃO: conclui-se a necessidade da elaboração de programas de atenção centrados na comunidade, voltados ao enfrentamento da pobreza e à inclusão social, em articulação com serviços de Atenção Primaria à Saúde. .

OBJETIVO: analizar la inclusión social familiar y comunitaria, y la participación social de personas con deficiencia, así como su inserción en ocupaciones en la vida cotidiana. MÉTODO: estudio cualitativo, con recolección de datos por medio de entrevistas abiertas sobre historia de vida y por observación sistemática. La muestra estuvo compuesta por diez personas con deficiencia, adquirida o congénita, habitantes de una región adscrita a un Núcleo de Salud de la Familia. El referencial teórico fue la concepción social de la deficiencia. Los datos fueron analizados según abordaje interpretativo reconstructivo, fundamentado en el referencial de la Teoría de la Acción Comunicativa de Habermas. RESULTADOS: los resultados evidenciaron que la inclusión social familiar y comunitaria de los sujetos del estudio se condiciona a determinantes sociales de la salud, presentando índices de iniquidades sociales, expresados por la dificultad de acceso a servicios de Atención Primaria de la Salud y de rehabilitación, trabajo y renta, educación, cultura, transporte y participación social. CONCLUSIÓN: se concluye que existe la necesidad de elaborar programas de atención centrados en la comunidad, dirigidos al enfrentamiento de la pobreza y a la inclusión social, en articulación con servicios de Atención Primaria a la Salud. .

Radial nerve injury associated with humeral shaft fracture: a retrospective study

Objective: To determine the profile of patients with humeral diaphyseal fractures in a tertiary hospital. Methods: We conducted a survey from January 2010 to July 2012, including data from patients classified under humeral diaphyseal fracture (S42.3) according to the International Classification of Diseases (ICD-10). The variables analyzed were: age, gender, presence of radial nerve injury, causal agent and the type of treatment carried out. Results: The main causes of trauma were car accidents. The radial nerve lesion was present in some cases and was caused by the same trauma that caused the fracture or iatrogenic injury. Most of these fractures occurred in the middle third of humeral diaphysis and was treated conservatively. Conclusion: The profile of patients with fracture of humeral shaft, in this specific sample, was composed mainly of adult men involved in traffic accidents; the associated radial nerve lesion was present in most of these fractures and its cause was strongly related to the trauma mechanism. Level of Evidence II, Retrospective Study.

Confiabilidade de um teste funcional de desempenho do membro superior: Teste Elui / Reliability of the ELUI Upper Extremity Functionality Test

A destreza manual é uma habilidade fundamental para o desempenho das atividades cotidianas. Medidas da força muscular, amplitude de movimento e sensibilidade isoladamente podem não refletir o status funcional na avaliação físico-funcional. É importante também o uso de questionários autoaplicáveis e testes funcionais específicos que avaliem o desempenho levando em consideração o membro superior e que possam testar aspectos como a destreza, coordenação e qualidade da preensão, podendo variar em termos de padronização e propriedades psicométricas. A partir desta necessidade foi desenvolvido o Teste Funcional de Membro Superior Elui que visou oferecer um instrumento nacional de mensuração e de referência a ser utilizado na prática clínica, porém suas propriedades psicométricas ainda não são definidas. Objetivo: Analisar a confiabilidade interexaminador e teste re-teste do Teste Funcional de Membro Superior Elui. Método: 50 voluntários saudáveis, de ambos os sexos, com idade média de 32,62 anos que não apresentassem disfunção ou sintomatologia nos membros superiores foram submetidos ao teste por dois examinadores e após 30 dias por um examinador. A aplicação deste teste requer materiais simples presentes no cotidiano, divididos em 10 subitens: Simular Escrita, Virar Chave, Pegar pequenos objetos, Simular alimentação, Despejar água, Abrir Potes, Cortar com a Faca, Simular Vestuário, Pegar objetos Grandes e leves e Pegar objetos grandes e pesados. Cada voluntário avaliado deveria realizar cada item do teste com ambas as mãos ou com a mão dominante, dependendo do subitem analisado, sendo adaptada a lateralidade quando necessário. Resultados: A análise estatística foi realizada visando comparar as diferenças das medidas de cada sub-item do teste em segundos e a análise da confiabilidade interexaminadores e teste reteste pelo Coeficiente de Correlação Intraclasse (ICC) com intervalo de confiança de 95% e p < 0,05. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa local e todos os voluntários assinaram o termo de consentimento livre e esclarecido. Os resultados mostraram que com exceção da tarefa pegar pequenos objetos que teve ICC considerado não aceitável (0,65), todos os outros 9 itens apresentaram excelente confiabilidade interexaminadores entre 0,95-0,99 e Alpha de Cronbach entre 0,97-0,99. Para o teste reteste as tarefas com excelente confiabilidade foram despejar água ICC 0,98 e simular escrita ICC 0,91, boa confiabilidade para as tarefas pegar objetos grandes e pesados ICC 0,85, cortar com faca ICC 0,85 e simular alimentação ICC 0,80; confiabilidade aceitável dos itens virar chave ICC 0,74 e simular vestuário ICC 0,76; com Alpha de Cronbach de todas as tarefas entre 0,79 e 0,99. Conclusão: O Teste Elui apresentou excelente repetitividade tanto entre examinadores como em medidas repetidas ao longo do tempo pelo mesmo examinador na maioria dos subitens, sendo considerado confiável para a amostra estudada, sendo utilizada a terceira medida.

Manual dexterity is a key skill for the performance of everyday activities. Measurements of muscle strength, range of motion, and sensitivity alone may not reflect the functional status in assessing physical and functional conditions. It is also important to use self-applied assessments and specific functional tests to assess overall performance and test aspects such as dexterity, coordination and grasp quality, but these may differ in terms of standardization and psychometric properties. From this need we have developed the Elui Upper Extremity Functionality Test, with the intent to provide a national measuring instrument of the upper extremity and reference to be used in clinical practice, but its psychometric properties have not been yet defined. Objective: The aim of this study was to assess the inter-examiner reliability and test retest of the Elui Upper Extremity Functionality Test. Methods: Healthy volunteers (50) of both genders, with an average age of 32.62 years and no impairment or symptoms in the upper limbs were submitted to the test by two examiners and after 30 days by one examiner. The application of this test requires simple materials present in our everyday life, divided into 10 sub-items: Simulated writing, Turning a Key, Grasping small objects, Simulated feeding, Pouring water, Opening containers, Cutting with a knife, Simulated dressing, Grasping large and light objects, and Grasping large and heavy objects. Each volunteer evaluated should perform each item test with both hands or with the dominant hand, depending on the sub-item analyzed, and if needed, they adapted the laterality. Results: A statistical analysis was carried out to compare the differences in time measurements of each sub-item of the test in seconds. The analysis of the inter-examiner reliability and test-retest used the Interclass Correlation Coefficient (ICC) with a confidence interval of 95% and p < 0.05. The local Research Ethics Committee approved this study and all volunteers signed an informed consent form. With the exception of the Grasping small objects task, which had an unacceptable ICC (0.65), the results showed that all the other nine items had excellent inter-examiner reliability: between 0.95 and 0.99 and Cronbach's alpha between 0.97 and 0.99. For the test-retest, the tasks with excellent reliability were Pouring water ICC 0.98 and simulated writing with ICC 0.91, good reliability for the tasks Grasping large and heavy objects ICC 0.85, Cutting with a knife ICC 0.85 and Simulated feeding ICC 0.80; acceptable reliability for the items Turning a key ICC 0.74 and Simulated dressing ICC 0.76; with Cronbach's alpha of all tasks between 0.79 and 0.99. Conclusion: The Elui test showed excellent repeatability between examiners as well as with repeated measurements over time by the same examiner in most sub-items, being considered reliable for the studied sample using the third measurement.

Aspects of manual wheelchair configuration affecting mobility: a review.

Many aspects relating to equipment configuration affect users' actions in a manual wheelchair, determining the overall mobility performance. Since the equipment components and configuration determine both stability and mobility efficiency, configuring the wheelchair with the most appropriate set-up for individual users' needs is a difficult task. Several studies have shown the importance of seat/backrest assembly and the relative position of the rear wheels to the user in terms of the kinetics and kinematics of manual propulsion. More recently, new studies have brought to light evidence on the inertial properties of different wheelchair configurations. Further new studies have highlighted the handrim as a key component of wheelchair assembly, since it is the interface through which the user drives the chair. In light of the new evidence on wheelchair mechanics and propulsion kinetics and kinematics, this article presents a review of the most important aspects of wheelchair configuration that affect the users' actions and mobility.

Uso de equipamentos de monitoramento da saúde por idosos no ambiente doméstico / The use of health-monitoring devices by elderly in the household

INTRODUÇÃO: O envelhecimento da população aumenta a demanda por cuidados de saúde e o progresso nesta área tem sido ampliado com as novas tecnologias de cuidado. A população brasileira tem incorporado equipamentos de monitoramento à saúde de uso doméstico e estes podem auxiliar o sujeito se este for adequadamente instrumentalizado para o uso. OBJETIVO: Identificar os aparelhos de monitoramento da saúde que são frequentemente utilizados por idosos em ambiente doméstico, descrevendo as dificuldades apresentadas na utilização destes equipamentos. MÉTODO: Trata-se de estudo exploratório, analítico e transversal. A coleta de dados incluiu um questionário socioeconômico, Escala de Lawton & Brody para avaliação da capacidade funcional e um questionário para classificação do uso de equipamentos eletrônicos por idosos. Para a análise dos dados, foi utilizado o método de estatística descritiva. RESULTADOS: Participaram do estudo 185 idosos ativos, sendo 78,4% mulheres. Do total dos participantes, 53% eram casados e 31,9% possuíam ensino superior completo. Quanto aos problemas de saúde e uso de dispositivos, 48,5% relataram ter hipertensão arterial sistêmica e 25,3%, diabetes; 38,4% relataram possuir o aferidor de pressão arterial digital, 14% o medidor de glicemia e 15,7% o porta-comprimidos. Entre as dificuldades, estavam o manuseio do aferidor de pressão e do medidor de glicemia, a falta de conhecimento na interpretação e gravação dos resultados no aparelho e, por não confiarem nos resultados, os idosos referiram preferir recorrer ao auxílio de um profissional qualificado. CONCLUSÃO: As dificuldades de uso apontadas podem estar associadas ao fato de os idosos de hoje pertencerem a uma geração que não ...

INTRODUCTION: The aging population increases the demand for health care and progress in this area has been driven by new care-related technologies. The Brazilian population has incorporated the use of health-monitoring equipment in the domestic environment and these can assist subjects if they receive adequate training. OBJECTIVE: Identify health-monitoring devices that are often used by the elderly in the home environment and describe the difficulties encountered in the use of these devices. METHOD: This is an exploratory, analytical and cross-sectional study. Data collection included a socioeconomic questionnaire, a Lawton and Brody Scale to assess functional capacity, and a questionnaire to classify the use of electronic devices by elderly. Data analysis employed the method of descriptive statistics. RESULTS: The study included 185 active seniors, of which 78.4% were women. Of the total participants, 53% were married and 31.9% have completed higher education. As for health problems and use of devices, 48.5% reported having hypertension and 25.3% diabetes; 38.4% reported owning a digital blood pressure meter; 14%, a glucose meter and 15.7%, pillboxes. Among the difficulties listed were handling the digital blood pressure meter and blood glucose meter and lack of knowledge in the interpretation and recording of results. The subjects also reported not trusting the results of the devices and preferring to seek help from a qualified professional. CONCLUSION: The difficulties of use may be associated with the fact that today's seniors belong to a generation that had no contact with these devices when younger, lack of training to use the equipment and lack of knowledge of how to manage results. .

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial.

BACKGROUND: Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome. METHODS/DESIGN: Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test. DISCUSSION: This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184.

Correlação entre os testes Pick-Up de Moberg e a estesiometria após reconstrução do nervo mediano / Correlation between Moberg Pick-Up test and sensation threshold test after median nerve reconstruction

A avaliação funcional da sensibilidade é essencial para analisar o estado, recuperação, e efetividade do programa de tratamento em pacientes que sofreram perdas decorrentes de deficiência motora e/ou sensitiva, após lesões nervosas periféricas. Estas lesões geram a interrupção das sensações ocasionando a perda da sensibilidade e uma significante perda funcional da mão. Objetivo: O objetivo deste estudo foi correlacionar o teste funcional Pick-Up de Moberg com o teste de limiar sensitivo Estesiômetro SORRI® na reconstrução do nervo mediano. Métodos: Foram analisados 14 homens com idade entre 18 e 40 anos que sofreram ferimento corto-contuso na região volar do punho e tratamento cirúrgico há pelo menos um ano de pós-operatório. Foram utilizados para a avaliação da sensibilidade cutânea o Estesiômetro SORRI® e o teste Pick-Up de Moberg modificado, no qual a avaliação foi dividida em duas fases, olhos abertos e fechados, ambas realizadas com a mão dominante e não dominante, e em duas etapas com diferentes avaliadores, sendo repetidas três vezes em cada mão. A sequência dos avaliadores foi sorteada e mantida durante toda a avaliação. Na análise dos dados foi utilizado o coeficiente de Pearson e aplicado o teste não-paramétrico de Mann-Whitney com o nível de significância ? = 0,05. Resultados: A média da idade foi de 27,14 anos (±6,43), com maior frequência entre 21 a 30 anos sendo que 64% apresentaram lesão na mão dominante. O coeficiente de Pearson (r) entre o Estesiômetro e o Pick-Up foi entre 0,5 e 0,7, com p-valor <0,05. Os intervalos de confiança e p-valores dos testes de Mann-Whitney não indicaram diferenças estatisticamente significantes. Conclusão: Apesar do teste Pick-Up de Moberg não possuir medidas padronizadas, na amostra estudada pode-se concluir que existe correlação entre o teste funcional e o teste de limiar sensitivo. Novos estudos são necessários para a validação e confiabilidade de ambos os métodos.

Functional assessment of sensitivity is essential to analyzing the status, recovery, and effectiveness of the treatment program for patients who have suffered losses due to physical and / or sensory disability after peripheral nerve injuries. Such losses of sensation lead to a significant loss of hand function. Objective: The purpose of the present study was to establish a correlation between functional and sensory threshold tests after a peripheral nerve lesion in the hand. Methods: Fourteen men aged 18 to 40 years, who had bruises and cut injuries at the volar region of the wrist resulting in median nerve lesion, were selected for study. All the subjects were at least 1-year post-surgery. An esthesiometer SORRI® and a modified Moberg pick-up test were used. The test was divided into two phases, one with eyes open and the other with eyes closed. Also, the same test was performed by two different examiners. It was a "blinded" test that was performed three times, being repeated by the examiners according to a random sequence kept during the entire evaluation. Mean age and standard deviation were obtained during analysis in which Pearson's coefficient was calculated and the non-parametric Mann-Whitney test was applied at 5% significance. Results: The mean age was 27.14 years with a standard deviation of 6.43 years, with the lesions being more frequently seen in men aged 21 to 30 years. Also, 64% of the cases involved lesion of the dominant hand. Pearson's coefficient (r) regarding the correlation between sensory threshold test and Moberg pick-up test ranged from 0.5 to 0.7, which was statistically significant. Confidence intervals and p-values obtained from the Mann-Whitney test showed no statistically significant differences. Conclusion: One can conclude, therefore, that despite lacking standardized measures, the Moberg pick-up test correlated with the functional test. However, further studies are needed to support validation and reliability of the two methods.

A new design for an old concept of wheelchair pushrim.

PURPOSE: Report on the development of an ergonomic manual wheelchair pushrim and evaluate the user's perception of the quality of the device. METHOD: Based on anthropometric features and ergonomic concepts, a new wheelchair pushrim was designed, and a prototype was manufactured in polyurethane, using the rapid prototyping technique and serial production of parts by molding. The prototype was tested by a sample of wheelchair users, who rated the perceived quality of the device after testing both the new and conventional pushrims in a wheelchair propulsion experimental protocol. RESULTS: The new ergonomic pushrim was found to be, in general, better than the conventional round tube pushrim. Specifically, experienced wheelchair users found the new wheelchair pushrim better in terms of easy and comfortable propulsion, braking and maneuvering of the wheelchair, and appearance. CONCLUSIONS: The new wheelchair pushrim provides a proper fit for the hands due to its ergonomic design and its polyurethane composition, making wheelchair propulsion easier and more comfortable than the conventional wheelchair pushrim. Assistive technology devices should be design based on ergonomic concepts that involve less effort and offer greater comfort for the user. [Box: see text].

Estudo retrospectivo do estado funcional de pacientes com fratura do rádio distal submetidos à osteossíntese com placa LCP / A retrospective study of functionality of patients with distal radius fracture after osteosynthesis with an LCP volar plate

As fraturas do rádio distal estão entre as mais comuns do esqueleto humano, correspondendo a um sexto de todas as fraturas. Para seu tratamento, existem diversas técnicas cirúrgicas e materiais de síntese que podem ser utilizados, no entanto, o uso de placa volar tem se mostrado eficiente e apresentado poucas complicações. Objetivo: Realizar uma análise retrospectiva do estado funcional de pacientes com fratura do radio distal submetidos à osteossíntese com placa volar LCP que passaram por um programa de reabilitação. Método: A amostra foi composta por 14 pacientes com fratura unilateral de rádio distal submetidos à osteossíntese com placa volar LCP 2,4 mm ou 3,5 mm. Os indivíduos foram divididos em dois grupos: grupo acometido (n = 14), composto pelos punhos fraturados; grupo controle (n = 14) composto pelos punhos contralaterais. Foram realizadas medidas de amplitude de movimento (ADM) ativa e passiva do punho, força de preensão e pinças e aplicado um questionário de disfunção do membro superior (DASH). Para a análise dos dados, foi realizada comparação entre os grupos, acometido e controle, por meio de testes de significância de duas amostras independentes para médias. Resultados: A média encontrada para o questionário DASH foi de 10,63 pontos (± 12,23). Em relação às medidas de força de preensão e pinças, e de ADM de punho, não houve diferenças significantes na comparação entre os grupos (p > 0,05). Conclusão: Na amostra analisada, pode-se concluir que, após um ano de pós-operatório, os pacientes apresentam resultados semelhantes na comparação, o que evidencia uma recuperação satisfatória do estado funcional.

Distal radius fractures are the most common fractures of the human skeleton, accounting for one sixth of all fractures. For his treatment, there are several surgical techniques and synthesizing materials that can be used, however, the use of a volar plate has been proven effective and haspresented few complications. Objective: Here was to make a retrospective study of thefunctionality of patients with distal radius fracture after internal fixation with an LCP volar plate that went through a rehabilitation program. Method: The sample consisted of 14 patients with unilateral distal radius fracture who underwent internal fixation with a 2.4 mm or 3.5 mm LCP volar plate who completed 1 year after surgery in 2010. The subjects were divided into two groups: affected group (n = 14), composed of fractured wrists; control group (n = 14) composed of the contralateral wrists. Measurements were made of active and passive range of motion (ROM) of the wrist, grip strength, pinch grip strength, and a questionnaire of disabilities of the arm, shoulder, and hand (DASH). The data was analyzed to compare the affected and controlgroups, through tests of significance of two independent samples for means. Results: The average for the DASH questionnaire was 10.63 points (± 12.23). For measures of grip strength, pinch grip strength, and ROM, there were no significant differences in comparison groups (p > 0.05). Conclusion: We concluded that after one year post-surgery, patients showed similar results when comparing the wrists, which shows a satisfactory recovery of functional status.

Força de preensão palmar e pinças em indivíduos sadios entre 6 e 19 anos / Grip and pinch strength in healthy children and adolescents

OBJETIVO: Determinar e comparar os valores das forças isométricas de preensão palmar e pinças em indivíduos sadios de 6 a 19 anos através da dinamometria, considerando as variáveis sexo, dominância e faixa etária. MÉTODOS: Foram avaliados 199 indivíduos utilizando os dinamômetro Jamar® para a mensuração da preensão palmar e Preston Pinch Gauge® para as pinças, realizando três mensurações consecutivas,, utilizando a média. A análise estatística foi realizada pela regressão linear com efeitos mistos. RESULTADOS: Os valores em kgf encontrados foram 24,51, 3,64, 5,37 e 6,78, respectivamente para preensão palmar, pinça polpa-a-polpa, trípode e lateral, independente das variáveis. Houve diferença significativa em todas as forças mensuradas analisando sexo e dominância independentemente, sendo a mão dominante e o sexo masculino os que obtiveram valores maiores. Entre as faixas etárias foi verificado que as forças variaram conforme a idade, com diferença significativa na maioria das comparações. CONCLUSÃO: Concluímos que a força de preensão palmar e das pinças apresentou diferença significativa no sexo, na dominância e na maioria dos subgrupos etários estudados, devendo ser considerados na dinamometria. Este estudo se mostrou relevante como referência de normalidade para avaliações das forças de preensão e pinças das mãos em crianças e jovens.

OBJECTIVE: This study aimed to determine and compare the values of maximum isometric palmar grip and pinch forces in healthy children between 6 and 19 years old using dynamometry, considering gender, dominance and age. METHODS: 199 subjects were evaluated using Jamar® dynamometer to measure palmar grip strength and Preston Pinch Gauge® dynamometer to evaluate pulp to pulp, lateral and three points pinch strength in a standardization testing protocol. The mean of three consecutive grip tests was recorded. Linear regression with mixed effects was used to statistically analyze the differences between data. RESULTS: Mean values found for palmar grip, pulp to pulp, three points and lateral pinch were 24,51kgf, 3,64kgf, 5,37kgf and 6,78kgf, respectively, regardless of the variables. There was statistical difference in all measures by gender and dominance, and the dominant hand and the males had higher grip forces. It was verified that mean values varied with age, with significant difference in most of comparisons between the age groups. CONCLUSION: We concluded that pinch and palmar grip strength demonstrated significant differences in gender, dominance and in most of age subgroups studied, being important to consider them on dynamometry. This study was relevant as reference of normality of hand strength in children and adolescents.

Limitações no desempenho ocupacional de indivíduos portadores de hemofilia em Centro Regional de Hemoterapia de Ribeirão Preto, Brasil / Limitations in occupational performance of individuals with hemophilia in Hemotherapy Regional Center of Ribeirão Preto, Brazil

A hemofilia é grave distúrbio hereditário da coagulação sanguínea que resulta em incapacidades que influenciam no desempenho dos acometidos. A tecnologia assistiva (TA) é equipamento ou conjunto de produtos, comprados ou modificados ou feitos sob medida, usados ampliar o desempenho funcional. Esta pesquisa teve como objetivo identificar as limitações no desempenho ocupacional dos hemofílicos e verificar a influência dos recursos de TA na funcionalidade destes. O estudo foi realizado de janeiro a julho de 2009 no Centro Regional de Hemoterapia do HCFMRP-USP. Todos os indivíduos portadores de hemofilia em seguimento foram convidados. Participaram 42 indivíduos através da aplicação de roteiros para o levantamento dos dados sócio-demográficos e clínicos; das barreiras e facilitadores da acessibilidade na residência e na comunidade; dos recursos da TA utilizados nas Atividades de Vida Diária (AVD´s), na mobilidade em sua residência e na comunidade e o instrumento de avaliação da funcionalidade HAQ (Health Assessment Questionnaire).Os resultados demonstram que a maioria dos entrevistados apresentam limitação nas AVD´s, Atividades Produtivas e de Trabalho, mobilidade; e obtiveram classificação "com alguma dificuldade" no HAQ. Os recursos de TA utilizados pela maioria dos participantes estavam relacionados à higiene e uso do vaso sanitário e dispositivos de ajuda para deambulação.

Hemophilia is a serious hereditary disorder of blood clotting that results in disabilities that influence the performance of affected infants. The assistive technology (AT) is equipment or set of products, modified or purchased or custom made, used to expand the functional performance. This research aimed to identify limitations in occupational performance of the hemophiliacs and the influence of resources on the functionality of the TA. The study was conducted from January to July 2009 at the Regional Blood Center HCFMRP-USP. All individuals with hemophilia followed up were invited. 42 individuals participated through the application of a schedule for the removal of socio-demographic and clinical data, the accessibility barriers and facilitators of the residence and in the community resources used in the TA activities of daily living (ADLs), mobility in resident and community assessment tool and functionality HAQ (Health Assessment Questionnaire). The results show that most respondents have limitations in ADLs, Productive Activities and Work, mobility, and were classified as "with difficulty" in HAQ. The TA resources used by the majority of participants were related to hygiene and use the toilet and assistive devices for ambulation.

Prevenção de incapacidade na hanseníase com apoio em um manual de autocuidado para pacientes / Disability prevention in leprosy using a self-care manual for patients

A hanseníase é uma doença infectocontagiosa, de evolução lenta, que se manifesta por sinais e sintomas dermatoneurológicos, com lesões na pele e nos nervos periféricos. O objetivo deste estudo foi avaliar o status físico e funcional de olhos, mãos e pés de pacientes com hanseníase, em relação ao aparecimento e evolução de deficiências sensitivo-motoras, grau de incapacidade e qualidade de vida, tendo os pacientes recebido e utilizado durante um ano um manual especialmente elaborado, com orientações de autocuidados para prevenção de incapacidade. Foram realizadas e comparadas avaliações fisioterapêuticas inicial e após 12 meses de uso do manual, de 26 pacientes com hanseníase: palpação de nervos periféricos, teste de sensibilidade da córnea, teste de sensibilidade cutânea, teste manual de função muscular e dinamometria isométrica de preensão e pinças dos dedos, sendo aplicado ainda o questionário de qualidade de vida SF-36 e classificado o grau de incapacidade. Os nervos mais acometidos foram o ulnar e otibial posterior. Embora o grau de incapacidade e as deformidades preexistentes tenham persistido, houve melhora significativa nos domínios dor e aspectos sociais do questionário SF-36, bem como na função muscular das mãos e dos pés e no ressecamento da pele. Como estas últimas são diretamente relacionadas ao autocuidado, sugere-se que o manual de orientações pode ter importante papel coadjuvante na melhora de sintomas dos pacientes com hanseníase.

Leprosy is an infectious disease of slow evolution, manifested by dermatoneurological signs and symptoms, with skin and peripheral nerve injuries. The aim of this study was to assess physical and functional status of eyes, hands and feet of patients with leprosy, as well as to assess evolution of sensory-motor disabilities, degree of disability and quality of life, having specially produced and handed the patients an illustrated self-care manual for preventing disability. Twenty six patients with leprosy were assessed initially and after 12 months of using the manual as to: skin inspection, peripheral nerves palpation, corneal sensitivity, skin sensitivity, limb muscle function, hand muscle strength (finger grip and pinch strength); the disability degree was determined and patients answered the SF-36 questionnaire. Most affected nerves were the ulnar and posterior tibial ones. Results showed that, though the degree of disability and deformities persisted, there were significant improvements in SF-36 social aspects and pain domains, as well as improvements in skin dryness and hands and feet muscle function. Since the latter are directly related to self-care, this suggests that the self-care manual may have an important supporting role in relieving symptoms of patients with leprosy.

Planejamento e gerenciamento de serviços como conteúdos da formação profissional em Terapia Ocupacional: reflexões com base na percepção dos estudantes / Services planning and management as contents of professional education in Occupational Therapy: reflections based on the students' perception / Planeamiento y administración de servicios como contenidos de formación profesional en Terapia Ocupacional: reflexiones a partir de la percepción de los estudiantes

This study discusses the inclusion, in the Occupational Therapy professional education curriculum, of contents referring to Health Services planning and management. It is a documental research study whose object are the monographs produced in the discipline "Planning and Management of Occupational Therapy Services", of the Occupational Therapy Course of the School of Medicine of Ribeirão Preto - USP, years 2005 and 2006. The analyzed categories were: organization, physical, material and human resources, financial aspects, relationship to the team and institution. The results show that the articulation between theory and practice is emphasized; however, the future professionals are not qualified to deal with the practical and operational demands involved in the assistance they should provide for different populations and contexts. The required health education includes qualification for the planning, execution, control and evaluation of the health services, as well as developing policies, plans and programs for the health sector.

Este estudo discute a inserção, na formação profissional em Terapia Ocupacional, de conteúdos referentes a planejamento e gerenciamento de serviços de saúde. Trata-se de uma pesquisa documental, tendo como objeto as monografias da disciplina "Planejamento e Gestão de Serviços de Terapia Ocupacional", do Curso de Terapia Ocupacional da Faculdade de Medicina de Ribeirão Preto - USP, dos anos 2005/2006. As categorias analisadas foram: organização, recursos físicos, materiais e humanos, aspectos financeiros, relação com a equipe e instituição. Os resultados mostram que é enfatizada a articulação teórico-prática, porém, os futuros profissionais não têm se capacitado para lidar com as demandas práticas e operacionais para o atendimento de diferentes populações e contextos. A requerida formação em saúde inclui a capacitação para o planejamento, execução, controle e avaliação dos serviços de saúde, assim como desenvolver políticas, planos e programas para o setor saúde.

Este estudio discute la inserción en la formación profesional en Terapia Ocupcional, de contenidos referentes a planeamiento y administración de servicios de salud. Se trata de una investigación documental que tiene por objeto las monografías de la disciplina "Planeamiento y Gestión de Servicios de Terapia Ocupacional" del Curso de Terapia Ocupacional de la Facultad de Medicina de Ribeirão Preto, Universidad del estado de São Paulo, Brasil, en los años 2005 y 2006. Las categorías analizadas fueron: organización, recursos físicos, materiales y humanos, aspectos financieros, relación con el equipo e institución. Los resultados muestran que se enfatiza la articulación teóricopráctica pero los futuros profesionales no se han capacitado para afrontar las demandas prácticas y operacionales destinadas a atender diferentes poblaciones y contextos. La formación en salud requerida incluye la capacitación para el planeamiento, ejecución, control y valoración de los servicios de salud, así como el desarrollo de políticas, planes y programas para el sector salud.

Efeitos de um protocolo de reeducação sensorial da mão: case report / Effects of a hand sensory reeducation program: case report

Uma paciente em pós-operatório de reparo das lesões dos tendões flexores e nervo digital do 5o.dedo da mão direita foi estudada com o objetivo de avaliar os efeitos da aplicação de um protocolo de reeducação sensorial da mão. A paciente foi avaliada antes e após três meses da aplicação do protocolo. Nessas avaliações foram aplicados: teste de limiar de sensibilidade...

A patient who had undergone nerve injury repair surgery of the right-hand 5th-finger flexor tendons and digital nerve was studied in order to assess the effects of a hand sensory reeducation program. The patient was evaluated before and after the three-month program application...