Sensory deficits in ipsilesional upper-extremity in chronic stroke patients / Déficit sensorial na extremidade superior ipsilateral em pacientes com ave crônico

Objective To investigate somatosensory deficits in the ipsilesional wrist and hand in chronic stroke patients and correlate these deficits with contralesional sensorimotor dysfunctions, functional testing, laterality and handedness.Methods Fifty subjects (twenty-two healthy volunteers and twenty-eight stroke patients) underwent evaluation with Semmes-Weinstein monofilaments, the sensory and motor Fugl-Meyer Assessment, the Nottingham Sensory Assessment in both wrists and hands and functional tests.Results Twenty-five patients had sensory changes in the wrist and hand contralateral to the stroke, and eighteen patients (64%) had sensory deficits in the ipsilesional wrist and hand. The most significant ipsilesional sensory loss was observed in the left-handed patients. We found that the patients with brain damage in the right hemisphere had better scores for ipsilesional tactile sensation.Conclusions A reduction in ipsilesional conscious proprioception, tactile or thermal sensation was found in stroke subjects. Right hemisphere damage and right-handed subjects had better scores in ipsilesional tactile sensation.

Objetivo Investigar déficits somatossensoriais no punho e mão ipsilesional em pacientes com acidente vascular encefálico (AVE) crônico e correlacionar esses déficits com disfunções sensório-motoras contralesional, testes funcionais, lateralidade e preferência manual.Métodos Cinquenta indivíduos (vinte e dois voluntários saudáveis e vinte e oito pacientes com AVE) foram submetidos à avaliação com monofilamentos de Semmes-Weinstein, Avaliação Fugl-Meyer (sensorial e motora), Avaliação Sensorial Nottingham em punhos e mãos, e testes funcionais.Resultados Vinte e cinco pacientes apresentaram alterações sensoriais no punho e mão contralateral ao AVE, e dezoito pacientes (64%) apresentaram déficits sensoriais no punho e mão ipsilesional. A perda sensorial ipsilesional mais significativa foi observada nos pacientes canhotos. Pacientes com lesão cerebral no hemisfério direito tiveram melhores pontuações para sensação tátil ipsilesional.Conclusões A redução da propriocepção consciente ipsilesional, da sensibilidade tátil e térmica foi encontrada em indivíduos com AVE. Lesão no hemisfério direito e indivíduos destros apresentaram melhores pontuações na sensação tátil ipsilesional.

Tradução e adaptação transcultural do Michigan Hand Outcomes Questionnaire / Translation and cross-cultural adaptation of the Michigan Hand Outcomes Questionnaire

INTRODUÇÃO: Atualmente há um aumento crescente no número de diagnósticos de artrite reumatoide, seja graças à evolução dos métodos diagnósticos ou a intensas pesquisas realizadas na área de reumatologia, porém há uma lacuna quanto a instrumentos de medidas para acompanhamento no campo físico e psíquico da evolução dessa doença, que pode causar limitações físicas graves com o seu avanço, além do comprometimento de diversos aspectos da qualidade de vida. OBJETIVO: Este estudo tem como objetivo desenvolver a versão em português brasileiro do Michigan Hand Outcomes Questionnaire, um instrumento de avaliação e monitoramento do estado de saúde em pacientes com transtornos e doenças que incapacitam as atividades cotidianas realizadas pelas suas mãos. MÉTODOS: Foram realizadas duas traduções e retrotraduções por avaliadores independentes e cegos quanto ao instrumento original, seguidas de composição de uma versão sintética, testada experimentalmente em um grupo de sujeitos da população geral e também pacientes com diagnóstico de artrite. RESULTADOS: São apresentadas todas as fases do processo. A participação de tradutores especialistas em saúde mental, reumatologia e ortopedia favoreceu a adequação dos termos utilizados ao construto mensurado. A aplicação experimental evidenciou a correta compreensão de todos os itens, quanto ao seu significado, por todos os respondentes. CONCLUSÃO: Elaborada a versão em português brasileiro da Michigan Hand Outcomes Questionnaire.

INTRODUCTION: Currently there are an increasing number of diagnoses of rheumatoid arthritis thanks to developments in diagnostic methods or the extensive research conducted in the area of Rheumatology, however, but there is a gap in the measurement instruments for monitoring the field of physical and mental development of this disease that cause severe physical limitations with their progress in addition to impairment of various aspects of quality of life. OBJECTIVE: This paper aims to develop the Brazilian Portuguese version of Michigan Hand Outcomes Questionnaire, an instrument of evaluation and monitoring of health status in patients with disorders and diseases that inable the daily activities carried out by their hands. METHODS: We performed two independent translations and back translations by independent examiners blinded to the original instrument, then the composition of a synthetic version, tested experimentally in a group of subjects from the general population and also patients with arthritis. RESULTS: We present all stages of the process. The participation of translators specialized in mental health, orthopedics and rheumatology favored the appropriateness of the terms used to construct measured. The experimental application showed a correct understanding of all items, as to its meaning for all respondents. CONCLUSION: Developed the Brazilian Portuguese version of the Michigan Hand Outcomes Questionnaire.

Effects of somatosensory stimulation on the excitability of the unaffected hemisphere in chronic stroke patients

INTRODUCTION: Somatosensory stimulation of the paretic upper limb enhances motor performance and excitability in the affected hemisphere, and increases activity in the unaffected hemisphere, in chronic stroke patients. We tested the hypothesis that somatosensory stimulation of the paretic hand would lead to changes in excitability of the unaffected hemisphere in these patients, and we investigated the relation between motor function of the paretic hand and excitability of the unaffected hemisphere. METHODS: Transcranial magnetic stimulation was administered to the unaffected hemisphere of nine chronic stroke patients. Patients were submitted to 2-h somatosensory stimulation in the form of median nerve stimulation and control stimulation using a cross-over design. Baseline Jebsen-Taylor test scores were evaluated. Resting motor threshold, intracortical facilitation, short-interval intracortical inhibition, and visual analog scores for attention, fatigue and drowsiness were measured across conditions. RESULTS: Better pre-stimulation baseline motor function was correlated with deeper SICI in the unaffected hemisphere. We found no overt changes in any physiological marker after somatosensory stimulation. There was increased drowsiness in the control session, which may have led to changes in intracortical facilitation. CONCLUSIONS: Our results do not support an overt effect of a single session of somatosensory stimulation of the paretic hand on motor cortical excitability of the unaffected hemisphere as measured by motor threshold, short-interval intracortical inhibition or intracortical facilitation. It remains to be determined if other markers of cortical excitability are modulated by somatosensory stimulation, and whether repeated sessions or lesion location may lead to different effects.

Carpal tunnel syndrome and manual milking: nerve conduction studies in 43 cases / Síndrome do túnel do carpo e ordenha: estudo de condução nervosa em 43 casos

From 1989 to 2004, 3125 consecutive patients had electrodiagnosis of carpal tunnel syndrome (CTS); from these 43 cases (1.38 percent) were associated to manual milking; mean age was 44.9 years and 88.4 percent were male. The mean time in the milking profession was 247 months; the mean daily milking time was 146 minutes; symptoms referred at electrodiagnostic consultation had lasted on average 34 months, 83 percent were bilateral. The median sensory nerve conduction study was abnormal in 75.6 percent to the right and 66.7 percent to the left hand. The median nerve motor distal latency (MDL) was abnormal in 92.1 percent to the right and in 80.0 percent to the left hand. There were no differences between right and left for all electrophysiological parameters. In CTS related to manual milking most cases were men, with the MDL more affected than the sensory distal latencies and the electrophysiological abnormalities were found to be symmetric. Manual milking could be a natural model for occupational CTS. In contrast to idiopathic CTS, there was a greater involvement of motor fascicles; this finding is remarkable for CTS.

No período de 1989 a 2004 foram diagnosticados por meio de eletroneuromiografia 3125 casos consecutivos de Síndrome do túnel do carpo (STC) e destes, 43 (1,38 por cento) estavam associados com ordenha; a média de idade foi 44,9 anos e 88,4 por cento eram do sexo masculino. O tempo médio de atividade profissional era 247 meses; o tempo médio de ordenha diária era 146 minutos; a sintomatologia referida na consulta eletrodiagnóstica tinha em média 34 meses de duração e 83 por cento a referiam bilateralmente. O estudo da condução senstiva do nervo mediano estava anormal em 75,6 por cento na mão direita e em 66,7 por cento da mão esquerda. A latência distal motora (LDM) do nervo mediano estava anormal em 92,1 por cento à direita e em 80 por cento à esquerda. Não havia diferença significante dos parâmetros eletrofisiológicos entre os lados direito e esquerdo. Na STC associada a ordenha, a maioria dos casos é de homens, a LDM está mais afetada que as latências distais sensitivas e as anormalidades eletrofisiológicas são simétricas. A ordenha poderia ser considerada um modelo para STC ocupacional e diferente da STC idiopática, há maior envolvimento dos fascículos motores.