RESUMO
Paralisia cerebral (PC) abrange um grupo de síndromes clínicas de causa multifatorial caracterizadas por déficit motor, algumas vezes com disfunção postural. Objetivos: Caracterizar a população dos novos pacientes da clínica de PC na instituição, de Janeiro-2012 a Dezembro-2014. Métodos: Estudo retrospectivo. Avaliados 743 prontuários eletrônicos de pacientes atendidos em consultas iniciais de PC, sendo elegíveis 614 casos. Resultados: Sexo: feminino = 47,4%, masculino = 52,6%. Idade em anos: 29,5% menores de 2; 34% de 2 a 4; 15,5% de 4 a 6; 16,3% de 6 a 12; 4,6% 12 a 18; 0,2% ≥ 18 anos. Ao nascimento 50,7% eram pré-termo e 45% termo. Peso: 9,1% classificados como extremo baixo peso, 16,8% muito baixo peso, 21,8% baixo peso, 43,6% peso adequado, 2,3% macrossômicos. Tipo de parto predominante: cesáreo (56,5%). Classificação clínica e topográfica dos pacientes: 13,4% Hemiparéticos espásticos, 33,9% Diparéticos espásticos, 12,2% Tetraparéticos espásticos, 0,5% Monoparéticos espásticos, 5,9% Discinéticos/atáxicos, 5,7% PC mista, 1% hipotônicos. Em 55,5% das famílias não recebiam auxílio doença. Sobre atendimentos especializados observou-se que para 97,7% dos pacientes tratava-se da primeira consulta com um médico Fisiatra. Conclusão: Maioria das gestantes realizaram pelo menos o número mínimo adequado de consultas de pré-natal. Parto cesariano predominou. Nascimentos pré-termo foi ligeiramente superior comparado com a termo. Tipo de PC predominou o tipo Diparético espástico, com GMFCS nas faixas de 1 a 5 equivalente. Mais da metade das famílias ainda sem acesso a benefício social.
Cerebral palsy (CP) is a group of multifactorial clinical syndromes characterized by motor deficit, sometimes with postural dysfunction. Objective: To characterize a new series of clinical CP patients in the institution from January-2012 to December-2014. Method: Retrospective study of 743 electronic medical records of patients screened at CP outpatient facilities. Results: 614 cases were considered eligible. 47.4% female and 52.6% male subjects. 29.5% were under 2 years of age, 34% were from 2 to 4, 15.5% from 4 to 6, 16.3% from 6 to 12, 4.6% from 12 to 18 and 0.2% were above 18 years of age. At birth, 50.7% were preterm and 45% term. Regarding weight, 9.1% were classified as extreme low weight, 16.8% very low weight, 21.8% low weight, 43.6% adequate weight, 2.3% macrosomic. The predominant type of delivery were cesarean section (56.5%). Regarding clinical and topographic classification, 13.4% had spastic hemiplegia, 33.9% spastic diplegia, 12.2% spastic tetraplegia, 0.5% spastic monoplegia, 5.9% Dyskinetic / ataxic, 5.7% mixed CP, and 1% were hypotonic. In 55.5% of the families they did not receive any social benefits. Regarding specialized care, for 97.7% of the patients that was the first appointment with a Physiatrist. Conclusion: Most pregnant women undertook at least the minimum number of prenatal visits. Cesarean delivery was predominant. Preterm births were slightly higher. The most prevalent type of CP was the spastic diplegic, with GMFCS ranging from 1 to 5. More than half of families did not manage to have access to social benefits.
Assuntos
Quadriplegia , Perfil de Saúde , Paralisia Cerebral/fisiopatologia , Hemiplegia , Coleta de Dados/instrumentação , Estudos RetrospectivosRESUMO
AbobotulinumtoxinA (ABO) tem sido utilizada para o tratamento da espasticidade em crianças com paralisia cerebral (PC). Seu uso requer uma administração cuidadosa, quanto à dosagem, seleção de locais de aplicação, intervalo entre aplicações, eficácia e segurança. Este foi o primeiro painel de especialistas no tratamento da espasticidade que desenvolveu um guia sobre questões gerais relacionadas a terapêutica de médicos que utilizam ABO, incluindo a indicação da dosagem a ser aplicada por músculo. O tratamento deve ser iniciado o mais rápido, idealmente entre dois e seis anos de idade. Uma avaliação clínica deve identificar os músculos espásticos e determinar o objetivo: melhora funcional, analgesia, facilidade de cuidados e posicionamento, prevenção da luxação dos quadris, melhora da marcha e postura, facilitação do processo de educação, maior participação social e/ou melhora estética. Os pré-requisitos para alcançar bons resultados são a seleção muscular adequada, a dosagem de ABO e a técnica de injeção. Muitos padrões patológicos comuns podem ser tratados se vários músculos forem simultaneamente injetados em uma única sessão de tratamento; O planejamento da dose de ABO por músculo deve levar em consideração a dosagem máxima em unidades por músculo e a dose de ABO máxima total por sessão (30 U / kg de peso corporal do paciente, não superior a 1000 U). Após a aplicação, as crianças devem ser submetidas a programas de fisioterapia e terapia ocupacional, focadas em orientações domiciliares e em orientações para a família, aumentando as chances de ganho terapêutico. O tratamento com ABO é multidisciplinar e requer abordagens integradas
AbobotulinumtoxinA (ABO) has been used for the treatment of spasticity in children with cerebral palsy (CP). Its use requires careful administration, regarding dosing, selection of local of application, interval between applications and efficacy and safety monitoring. This was the first panel of experts on the treatment of spasticity, which developed a guide to provide an overview on important issues related to therapeutic strategies adopted by physicians using ABO, including its dosage to be applied per muscle.Treatment should be initiated as soon as possible, ideally between two and six years old. A clinical evaluation should identify muscles presenting spastic activity, and determine desired outcome: improvement of function, esthetics/aspect, pain treatment, easing care and positioning, preventing hips dislocation, improvement of walking and posture, and to provide conditions for education and social participation. Pre-requisites to achieve good results are adequate muscle selection, adequate ABO dosage and exact injection technique. Many common pathological patterns can be adequately treated if several muscles are simultaneously injected in a single treatment session; planning ABO dosage per muscle should take into consideration the maximum dosage in units per muscle and the total maximum ABO dosage per session (30 U/kg patient´s body weight, not exceeding 1000 U).After application children should be submitted to physical therapy and occupational therapy, focused on home therapy, and family involvement, increasing chances of therapeutic gain. Treatment with ABO is multidisciplinary and requires integrated approaches
Assuntos
Humanos , Paralisia Cerebral/fisiopatologia , Toxinas Botulínicas Tipo A/uso terapêutico , Crianças com Deficiência , Espasticidade Muscular/tratamento farmacológicoRESUMO
A espasticidade acarreta hipertonia nos músculos mastigatórios dos indivíduos com paralisia cerebral (PC), interferindo na amplitude de abertura bucal, dificultando a realização da higiene oral predispondo estes indivíduos a condições consideradas de risco para o desenvolvimento de doenças bucais. Objetivo: Avaliar o efeito da fotobiomodulação com laser de diodo, de baixa intensidade na espessura do músculo masseter em uma criança com PC do tipo espástico. Método: O relato do cuidador era que a criança apresentava grande dificuldade na realização da higiene bucal e com movimentos de fuga da cabeça quando a escova dental tocava a região de molares superiores. Com relação ao desconforto da criança, a mãe referiu como extremo. A 1ª avaliação ultrassonográfica foi realizada na avaliação inicial, e a 2ª avaliação após 6 sessões de aplicação de fobioestimulação. Foi empregado o Laser infravermelho, de Diodo, de baixa intensidade, As-Ga-Al, (? = 808 ± 3 nm, 120 mW; Twin Flex Evolution Laser MMOptics São Paulo, Brazil), usando 5,0 J/cm2 energia dose/local, com 20 segundos de exposição/local. A área do músculo masseter irradiado bilateralmente foi o ponto médio no sentido da sua extensão e largura. Foram realizadas seis sessões, com intervalo de 7 dias entre elas. Resultados: Ao final da sexta sessão da fotobioestimulação, a responsável relatou que a criança dormia melhor, apresentava redução no número de movimentos involuntários realizados pela mandíbula e a realização da higiene bucal era possível sem expressão dolorosa da criança. Durante a palpação observou-se menor hipertonia em masseter bilateral, ganho em espessura, e aumento na distância inter-incisal de 7 mm. Conclusão: A fotobioestimulação com laser de diodo parece ser efetiva na redução da espasticidade no músculo masseter de crianças com PC do tipo espástico
Spasticity causes stiffness in the masticatory muscles of individuals with cerebral palsy (CP), affecting the amplitude of mouth opening, making oral hygiene conditions difficult and predisposing these individuals to the risk of developing oral diseases. Objective: To evaluate the effect of a low-intensity photobiomodulation diode laser on the thick part of the masseter muscle in a child with spastic type CP. Method: The caregiver reported that the child had great difficulty in performing the oral hygiene, making avoidance movements of the head when the toothbrush touched the mucosa of the upper molar region in the mouth. The mother described the child's discomfort as extreme. The first ultrasound evaluation was performed at the first appointment, and the second evaluation after 6 sessions of photobiostimulation. The low-intensity Infrared Laser Diode, Ga-As-Al, was employed (? = 808 ± 3 nm, 120 mW; Twin Flex Evolution Laser MMOptics São Paulo, Brazil), using 5.0 J/cm2 dose energy/location, with 20 seconds exposure/site. The area of the masseter muscle was bilaterally irradiated towards the midpoint of its length and width. Six sessions were performed, with an interval of 7 days between them. Results: At the end of the sixth session of photobiostimulation, the mother reported that the child slept better, had reduction in involuntary movements performed by the jaw, and oral hygiene was possible now with no painful expression of the child. During palpation there was less stiffness in the bilateral masseter and an increased masseter thickness and increase in the amplitude of the mouth opening of 7 mm. Conclusion: The diode laser photobiostimulation appears to be effective in reducing spasticity in the masseter muscle of children with spastic type CP
Assuntos
Humanos , Paralisia Cerebral/fisiopatologia , Ultrassonografia/instrumentação , Lasers Semicondutores , Músculo MasseterRESUMO
OBJECTIVE: The objective of this study was to develop and validate a questionnaire on specific knowledge about low back pain entitled "The Low Back Pain Knowledge Questionnaire". INTRODUCTION: There is a need for instruments to assess patient knowledge regarding chronic illness. Such methods can contribute to the education of patients. METHODS: The Low Back Pain Knowledge Questionnaire was developed through five focus groups. The questionnaire was distributed to 50 patients to assess their comprehension of the terms. To assess the reproducibility, 20 patients were surveyed by two different interviewers on the same day and twice by a single interviewer with a one-to-two week interval. For the construct validation, the Low Back Pain Knowledge Questionnaire was given to 20 healthcare professionals with knowledge on low back pain and 20 patients to determine whether the questionnaire would discriminate between the two different populations. To assess the sensitivity of the questionnaire to changes in the knowledge level of the patients, it was given to 60 patients who were randomly assigned to the Intervention Group and the Control Group. The Intervention Group answered the questionnaire both before and after attending a chronic back pain educational program (back school), whereas the Control Group answered the questionnaire twice with an interval of one month and no educational intervention. RESULTS: The focus groups generated a questionnaire with 16 items. The Spearman's correlation coefficient and the intra-class correlation coefficients ranged from 0.61 to 0.95 in the assessments of the intra-observer and inter-observer reproducibility (p< 0.01). In the construct validation, the healthcare professionals and patients showed statistically different scores (p< 0.001). In the phase regarding the sensitivity to change, the Intervention Group exhibited a significant increase in their specific knowledge over the Control Group (p< 0.001). CONCLUSION: The Low Back Pain Knowledge Questionnaire was validated and proved to be reproducible, valid and sensitive to changes in patient knowledge.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Dor Lombar , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Doença Crônica , Avaliação Educacional/métodos , Avaliação Educacional/normas , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Adulto JovemRESUMO
OBJECTIVE: The objective of this study was to develop and validate a questionnaire on specific knowledge about low back pain entitled "The Low Back Pain Knowledge Questionnaire". INTRODUCTION: There is a need for instruments to assess patient knowledge regarding chronic illness. Such methods can contribute to the education of patients. METHODS: The Low Back Pain Knowledge Questionnaire was developed through five focus groups. The questionnaire was distributed to 50 patients to assess their comprehension of the terms. To assess the reproducibility, 20 patients were surveyed by two different interviewers on the same day and twice by a single interviewer with a one-to-two week interval. For the construct validation, the Low Back Pain Knowledge Questionnaire was given to 20 healthcare professionals with knowledge on low back pain and 20 patients to determine whether the questionnaire would discriminate between the two different populations. To assess the sensitivity of the questionnaire to changes in the knowledge level of the patients, it was given to 60 patients who were randomly assigned to the Intervention Group and the Control Group. The Intervention Group answered the questionnaire both before and after attending a chronic back pain educational program (back school), whereas the Control Group answered the questionnaire twice with an interval of one month and no educational intervention. RESULTS: The focus groups generated a questionnaire with 16 items. The Spearman's correlation coefficient and the intra-class correlation coefficients ranged from 0.61 to 0.95 in the assessments of the intra-observer and inter-observer reproducibility (p< 0.01). In the construct validation, the healthcare professionals and patients showed statistically different scores (p< 0.001). In the phase regarding the sensitivity to change, the Intervention Group exhibited a significant increase in their specific knowledge over the Control Group...