Repositório RCAAP

Os autores realizam uma revisão narrativa, abordando a especificidade da intervenção da MFR após o trauma, nomeadamente no que respeita à avaliação clínica, prevenção de sequelas de imobilidade, reabilitação da mobilidade, reabilitação da sarcopenia, reabilitação respiratória, reabilitação cognitiva, reabilitação psicológica, e reabilitação domiciliária. De forma mais superficial, abordam também algumas especificidades após reconstrução ou amputação traumática de membros, lesão vertebromedular, traumatismo cranioencefálico, lesão de nervos periféricos, e traumatismo torácico. Os objetivos de um programa de reabilitação serão discutidos com o doente, com a família e/ou com os cuidadores, e são revistos regularmente. Devem ser monitorizáveis e devem ter um significado que seja motivante para o doente, e ajustados à sua situação clínica. É também importante a uniformização da avaliação da funcionalidade e da qualidade de vida da vítima de trauma ao longo de todo o processo de reabilitação, com a utilização de escalas. Muitos doentes mantêm necessidade de internamento em Centro de Reabilitação após a alta do Centro de Trauma. O objetivo de uma Rede de Trauma não é apenas garantir a sobrevivência imediata, mas também promover a retoma da atividade e participação social das vítimas. É importante a integração efetiva da MFR nos Centros de Trauma, com vista à articulação dos cuidados de reabilitação em adequação às necessidades das vítimas de trauma.

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Introduction: Populationageingisaphenomenonassociatedwitharisingprevalenceofmorbidity,inparticular, due to chronic non-communicable diseases such as stroke. Dysphagia is one of the consequences of stroke. There are a number of scales to assess the severity of dysphagia. However, these are not validated to Portuguese. The Eating Assessment Tool (EAT-10) and the Functional Oral Intake Scale (FOIS) are easy to apply instruments and do not require a complete functional assessment of the patient. Objectives: The objective of this work is to translate and contribute to the validation of the EAT-10 and FOIS scales for the Portuguese population. Material e Methods: The methodology was divided into three phases: the first concerned the translation process; the second concerned the semantic evaluation; and the third was the evaluation of reliability and validity of the Portuguese versions of EAT-10 and FOIS in patients with deglutition disorders due to stroke. Results: The data produced by this work suggests that the Portuguese version of EAT-10 presented acceptable internal consistency (0.75), acceptable inter-rate reliability (0.86), as well as, discriminant validity. Results also suggest that the Portuguese version of FOIS presented acceptable inter-rater reliability (0.78) and criterion validity. Conclusions: The Portuguese versions of the EAT-10 and FOIS seem to be reliable and valid when used in patients with dysphagia due to stroke. Keywords: Stroke; Deglutition Disorders; Questionnaires. 

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Introdução: A dor lombar crónica (DLC) é uma entidade frequente, estando identificada como um fator importante de restrição da funcionalidade. A intervenção terapêutica na doença crónica necessita de um conhecimento aprofundado das consequências de doença e dos fatores específicos do individuo e do meio. Este estudo pretende conhecer o efeito da idade e do sexo na intensidade de dor, na limitação de atividades e ainda nas restrições na participação em doentes com DLC. Pretende também compreender as relações entre a intensidade da dor, o grau de limitação de atividades e o grau de restrições na participação.Material e Métodos: Foi efetuado um estudo transversal não randomizado. A amostra incluiu quarenta doentes consecutivos com DLC seguidos em consulta externa de Medicina Física e de Reabilitação num hospital central. Foram critérios de inclusão a dor com mais de doze meses de duração, a idade entre os dezoito e os setenta anos e a compreensão da língua portuguesa. Foram critérios de exclusão a presença de comorbilidades diversas que pudessem concorrer para a limitação de mobilidade, bem como a gravidez e o puerpério. A intensidade da dor foi avaliada pela Escala Visual Analógica, a limitação de atividade pelo Questionário de Roland Morris e a restrição de participação pelo perfil de atividade e participação relacionada com a mobilidade. Foi feita análise descritiva e correlacional com recurso ao programa Statistical Package for the Social Sciences.Resultados: A idade não influenciou significativamente os parâmetros analisados. O sexo influenciou o grau de restrição de participação. Foi identificada uma correlação significativa entre a intensidade da dor, a limitação de atividades e as restrições na participação.Conclusão: As mulheres com DLC apresentaram maiores restrições na participação. Quanto mais intensa for a dor, maior é o impacto negativo na atividade e na participação.

Incorporating Rehabilitation into the discipline of Physical Medicine has its roots in the 1960s decade, about thesame time that Physical Medicine and Rehabilitation (PM&R) is recognized officially as an independent medicalspecialty. Since that time, the evolving demographics and health care of the Western Europe population and theinternational recognition of the handicapped individual’s need for rehabilitative care has led to a new biopsycho-social approach of the patient and his illness, which is the main core of the World Health Organization’sInternational Classification of Functioning, Disability and Health (ICF). PMR’s European bodies have been workingto match today’s definition of the competences of the PM&R specialist to this new model, promoting professionalharmonization throughout the European countries. In this manuscript will be broach among others: the right toRehabilitation; Demography and Functionality; the Physiatrist and ICF; the Speciality of Physical andRehabilitation Medicine (PRM); Diagnostic and Evaluation Activity in PRM; Treatment Plan in PRM; Rehabilitationin a Team Approach; Therapeutic Interventions in PRM; Objectives and Results in PRM; European Organisms inPRM.Keywords: Disability Evaluation; Europe; History, 20th Century;History, 21st Century; Physical Medicine;Rehabilitation; Societies, Medical

Introduction: Autonomic dysreflexia is a complication after spinal cord injury and occurs in spinal injuries at or above T6. Due to its unexpected beginning and paroxistic hypertension, patients often go to the Emergency Room , where health professionals have limited experience/contact on treating this condition. This can result in a delay in diagnosis and appropriate treatment resulting in potentially serious complications, such as stroke, seizures and even death.The study goal was to determine the level of knowledge about autonomic dysreflexia of a convenience sample of physicians working at an Emergency Room in Portuguese Hospitals and to suggest measures to improve their knowledge about this syndrome.Material and Methods: We created an anonymous online multiple choice questionnaire with seven questions about autonomic dysreflexia and their treatment in the Emergency Room for physicians of Internal Medicine working in Portuguese Hospitals.Results: We obtained 41 responses. Of these, 31 of the doctors knew what autonomic dysreflexia is, however only 9 had observed a patient with this syndrome. Eleven knew the value of the normal systolic pressure in tetraplegic patients, but 8 did not know the symptoms of autonomic dysreflexia and 10 did not know how to treat a patient with this condition. When we asked about their level of knowledge about autonomic dysreflexia and its treatment, thirty of respondents assumed that this was “insufficient” and 8 said that “they didn`t know anything about this.” For the majority (33) it would be “very useful” that these patients carried an informative card about autonomic dysreflexia when they came to Emergency Room.Conclusions: It is vital to recognize this clinical syndrome that can lead to death, and with proper and timely treatment reduces possible complications. Since this is a rare situation, knowledge of medical staff of the Emergency Room of our hospitals may not be sufficient in this area. Thus, the Physical Medicine and Rehabilitation plays an important role in providing further teaching initiatives and information about autonomic dysreflexia.

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Introdução: A reabilitação cardíaca (RC) melhora o prognóstico e aumenta a qualidade de vida dos doentes com doença coronária.O score de CHA2DS2-VASc estratifica o risco cardiovascular dos doentes tendo em conta a presença de insuficiência cardíaca, hipertensão, idade, diabetes mellitus, eventos cerebrovasculares ou embólicos prévios e lesão vascular. O objetivo deste trabalho é aplicar esta escala a doentes coronários integrados num programa de RC de modo a avaliar a sua aplicabilidade como preditor de evolução da capacidade funcional e adaptação ao exercício.Material e Métodos: Foram incluídos neste estudo 69 doentes com doença coronária referenciados para um programa de RC. Os doentes foram divididos em três grupos de acordo com a classificação obtida no score de CHA2DS2-VASc: baixo risco (1-2), risco intermédio (3) e alto risco (≥4). A capacidade funcional foi avaliada através de prova de esforço realizada antes do tratamento e às 12 semanas do programa de recondicionamento ao esforço. Como valor comparativo entre doentes e entre provas, consideraram-se os equivalentes metabólicos (METs) obtidos por prova, para avaliação da capacidade ao exercício.Resultados: Quanto à evolução nas provas de esforço, os doentes de baixo risco passaram de uma média de 10,43 METs para 12,44; os doentes de risco moderado evoluíram de 9,33 para 10,85 METs e os doentes de alto risco apresentaram uma média inicial de 8,46 METs e de 10,74 METs às 12 semanas. Quando comparámos os vários grupos de doentes classificados através do score de CHA2DS2-VASc, verificámos que os doentes classificados como alto risco cardiovascular apresentam menor capacidade funcional traduzida em METs tanto na primeira prova de esforço (p=0,009) como na segunda (p=0,011). Verificou-se a existência de uma correlação negativa de - 0,451 entre o resultado obtido na primeira prova de esforço e a classificação na escala de CHA2DS2-VASc.Conclusão: O score de CHA2DS2-VASc correlaciona-se com a capacidade funcional de doentes coronários integrados em programas de RC, podendo ter um papel preditivo na evolução da capacidade funcional.

Aim: To characterize one population with persistent or recurrent pain after lumbar spinal surgery and evaluate the functional impact of this pathological condition.Methods: The sample consisted of patients with a history of back surgery that kept the pain level and whom had performed imaging examination of the lumbar spine after surgery. The authors made the demographic characterization of the population and the characterization of pain using the DN-4 survey. It was considered the findings in neurological examination and the results of imaging studies. The assessment of quality of life was objectified using the SF-36 survey.Results: The study included 28 patients, mostly female and working age. Most patients had neuropathic pain, changes in neurological examination and for 27 of the 28 patients were found in imaging compression of neurvous structures, mainly by recurrence of initial pathology and scarring. The results obtained in the survey SF- 36 clearly showed the negative impact on patients quality of life.Conclusion: In this sample, most patients presents with documented anatomical lesion that may justify pain complaints. The negative impact on quality of life makes this clinical picture a true challenge for Physical Medicine and Rehabilitation.Keywords: Pain; Lumbar spinal surgery; Quality of Life

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Introduction: The aim of the present study was to analyze the effect of an ankle-foot orthosis on walking and mobility of stroke patients with equinus and/or varus foot.Material and Methods: Nineteen subacute/chronic stroke patients with equinus and/or varus foot which were able to walk without assistance were assessed with and without an ankle-foot orthosis. Physical performance was tested with Fugl-Meyer, mobility was assessed using the timed up & go test and gait measurements were performed with a portable GAITRite system®.Results: There was a tendency of improvement on mobility and temporo-spatial parameters when using ankle-foot orthosis expressed by a timed up & go test decrease (43.00 to 39.77 s, p = 0.064), a speed improvement (32.10 to 42.00 cm/s, p = ns), a cadence increase (64.40 to 70.00 steps/ minute, p = ns), a cycle time decrease (1.86 to 1.71 s, p = ns) and a base of support decrease (14.67 to 14.55 cm, p = ns), although without significant difference. The positive difference in cadence with orthosis use had moderate correlation with a low Fugl-Meyer assessment lower extremity score (CC = -0.616). The positive difference in velocity with ankle-foot orthosis use had moderate correlation with its use before testing (CC = 0.600).Conclusion: According to the present study, there is a tendency that supports the use of an ankle-foot orthosis to improve mobility, temporo-spatial parameters and gait symmetry. However, the impact of this orthosis was inconclusive, as these differences were not statically significant. It is known that small improvements in walking cadence may represent important functional benefits. Our research shows the use of an ankle-foot orthosis, namely the more impaired patients with lowest Fugl-Meyer lower extremity score, are those that benefit more. The correlation between the previous using of ankle-foot orthosis with a speed improvement seems to demonstrate the importance of training. There is a need for further well-designed randomized, controlled clinical trials, with larger samples, to establish better scientific evidence for walking effects related to ankle-foot orthosis wearing on stroke patients with equinus and/or varus foot.

Introduction: Fragility fractures of the proximal femur (FFPF) are associated with increased mortality and functional impairment. The main aim of this work was the determination of factors associated with walking ability impairment six months post-fracture and one-year mortality.Methods: Retrospective cohort study comprising all patients admitted to a hospital center. Data were collected from electronic medical records. A comparative analysis was performed for several factors regarding walking ability impairment by six month post-fracture and one-year mortality post-fracture.Results: Five hundred twenty two patients were admitted with FFPF. Around 49% had walking ability impairment by six month post-fracture compared to pre-fracture status. Analyzing the subgroup of patients that had been integrated in rehabilitation programs on National Network of Integrated Continued Care (RNCCI), only 11% of patients recover the pre-fracture level of walking capacity during Orthopedics inpatient stay with additional recover in 28% of patients through rehabilitation intervention in RNCCI. No significative associations were found between walking ability impairment by six month and the analyzed variables. Died within oneyear post-fracture, 18% of the patients. Previous inability to walk (p=0.094), inability to walk by six month postfracture (p=0.024), femoral neck fractures (p=0.006) and surgery with arthroplasty and hemiarthroplasty (p=0.047 and p=0.033 respectively) had significant inferior survival curves. The calculated logistic regression model showed that male gender (OR 2.95; p=0.033) and walking ability impairment by six month post-fracture (OR 7.43; p=0.024) were predictors of one-year mortality.Conclusion: One-year mortality and walking ability impairment are considerable in patients with FFPF. Early comprehensive rehabilitation should be prioritized on those patients as it can impact their vital and functional prognosis.

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Introdução: A incontinência urinária (IU) é um problema frequente, particularmente nas mulheres. A abordagem de primeira linha para a IU é conservadora e inclui alterações do estilo de vida, treino vesical e reeducação muscular do pavimento pélvico (RMPP). A RMPP pode ser realizada em diferentes formatos: sessões individuais supervisionadas, aulas de grupo ou exercícios no domicílio, de acordo com um plano individualizado.A pandemia SARS-CoV-2 levou ao atraso ou cancelamento de tratamentos de reabilitação em muitos doentes, tendo a telereabilitação ganho importância. O objetivo da presente revisão é a análise da evidência relativa a diferentes métodos de telereabilitação utilizado no tratamento da IU.Métodos: Foi realizada uma pesquisa na base de dados PubMed com os termos “telerehabilitation”, “telemedicine”, “app”, “smartphone”, “mobile health” ou “videoconfe- rence”, em combinação com “pelvic floor” ou “urinary incontinence”.Resultados: Nove artigos foram analisados. Os métodos utilizados foram aplicações móveis (6 estudos), com ou sem aparelho de biofeedback; aulas de grupo por videoconferência (1 estudo); programa de RMPP via website (1 estudo); sistema de lembrete via smartphone (1 estudo). Aulas de grupo por videoconferência mostraram resultados similares aos obtidos em sessões individuais supervisionadas de RMPP. Os programas baseados em aplicações móveis mostraram superioridade relativamente à ausência de tratamento (tratamento adiado). Os programas de RMPP via website ou aplicação móvel parecem obter resultados semelhantes a instruções por escrito para exercícios no domicílio. Não parece existir benefício adicional em associar aparelho de biofeedback a um programa por aplicação móvel. Em homens após prostatectomia, um programa de RMPP baseado em aplicação móvel acelerou a melhoria da IU. A utilização de tecnologias parece fomentar a adesão e satisfação com os programas.Conclusão: A telereabilitação na IU apresenta-se como uma alternativa útil na ausência de programas presenciais supervisionados, apresentando resultados comparáveis aos de exercícios realizados no domicílio e contribuindo para a adesão e satisfação com os tratamentos. Estudos adicionais são necessários relativamente à sua aplicabilidade em populações idosas e aos resultados a longo prazo.

Background: Cerebral palsy, an umbrella designation of a group of permanent and non progressive disorders ofmovement and posture, caused by a cerebral lesion occurred until 5 years-old, is the commonest cause of disabilityin pediatric age. Its repercussions are varied, potentially causing cognitive, motor, postural, sensorial andcommunication changes, and therefore compromise the complete development of the child.Objective: Characterize the children with cerebral palsy followed in the Pediatric Rehabilitation Consultationregarding epidemiologic, demographic, social and function aspects and describe the most frequent neuroorthopaedicalcomplications in that population.Methods and Subjects: Retrospective longitudinal study of the children with cerebral palsy followed in PediatricRehabilitation Consultation of the Centro de Medicina de Reabilitação de Alcoitão (CMRA), born between 2001-2005. Data on socio-demographic and clinical aspects were collected from clinical files, and also the scores of theclassification systems used.Results: Of the 75 children followed, 40% had severe motor and bimanual manipulative ability limitations. 21children (28%) had severe or very severe oromotor changes. One third had severe or very severe changes in thecommunication ability and the majority (67%) had some degree of cognitive affection. 41% of the children hada sensorial deficit (vision and/or hearing).Lower limbs deformities were the most common orthopedic alterations, followed by upper limb deformities andcifoscoliosis. Bilateral spastic patients had the greater number of complications and therefore had more benefitof botulinum toxin administration.40% of these children inward admissions in CMRA were for rehabilitation after orthopedic surgery such asAchilles lengthening (50 %), hip varus derotation (34 %) and adductors tenotomy (16%).Conclusions: Stablishing the functional profile of children and teenagers with cerebral palsy is determinant toidentify and characterize the population followed in a Consultation, in a easy and rapid way. In order to achieveit, there are several standardized classification systems. The acknowledgement of the most frequent clinical casesallows the definition of therapeutic strategies, resource necessities in short and long-term periods, social andschool supports, besides preventing/delaying the onset of possible complications.Keywords: Cerebral Palsy; Child; Motor Skills.

The purpose of this case report is to highlight the role of acetic acid iontophoresis in the treatment of calcifying tendinitis of the shoulder. Calcifying tendinitis is a common disorder and it is most common around the shoulder joint, despite most cases being asymptomatic.The clinical use of acetic acid iontophoresis in the treatment of patients with calcium deposits was first described in 1955. It is thought that the acetic ion replaces the carbonate ion in the insoluble calcium carbonate deposit, forming a more soluble compound. Therefore, it is reasonable to expect a regression of the calcification.The use of therapeutic acid acetic iontophoresis is predominantly empirical, probably because it is relatively inexpensive and safe. Despite all doubts regarding the effectiveness of acetic acid iontophoresis on the treatment of calcifying tendinitis of the shoulder, this case report appears to be another example of therapeutic success.

Introduction: Chronic pain is a very debilitating and underestimated condition, affecting patients’ quality of life. Its prevalence is around 20% in adult European population and about 36.7% in Portugal adult population. Neuropathic pain represents about 7% - 8% of all chronic pain conditions in Europe and accounts for more depression, anxiety and sleep disorders than any other type of pain. For this reason, chronic neuropathic pain is now considered as a common public health problem with a major impact on health related costs.Objectives: To understand patients’ satisfaction regarding topical treatment with lidocaine patches in some clinical conditions of neuropathic localized chronic pain.Methods: A telephone survey of 6 questions specifically designed for this study was applied to all the patients followed in consultation for chronic neuropathic pain to whom lidocaine patches were recommended. This retrospective study took place in Hospital de Braga, at the Physical and Rehabilitation Medicine Service, between December 2015 and December 2016.Results: Fifty two patients in such conditions were identified, but only 31 were included (27 women and 4 men). Four groups were then formed, according to diagnosis or consultation purpose: Pain after surgical intervention (n=21), peripheral canal syndromes (n=3), post-herpetic neuralgia (n=1) and Morton neuroma (n=6). Twenty four patients (77%) were satisfied with the recommended treatment with lidocaine patches, with post-herpetic neuralgia attending for the biggest score for pain relief (50%), followed by pain after surgical intervention group (47% in pain relief). Eighteen out of 31 patients also tried other therapeutic options, including pharmacological or physiotherapy.Conclusion: Despite some limitations of this study, such as small simple size and heterogeneity between the groups, most of the patients felt satisfied with lidocaine patches treatment. This study enhances the potential of using lidocaine patches in different contexts of localized neuropathic pain other than Post-herpetic Neuralgia. The authors suggest, however, the need for more clinical studies to sustainably propose treatment with lidocaine patches in localized neuropathic pain.