RCAAP Repository

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Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. TBI can result from a closed head injury or a penetrating head injury and is one of two subsets of acquired brain injury (ABI). TBI is a major public health problem, especially among males ages 15 to 24, and among elderly people of both sexes 75 years and older. Children aged 5 and younger are also at high risk for TBI.Males account for two thirds of childhood and adolescent head trauma patients. Half of all TBIs are due to transportation accidents involving automobiles, motorcycles, bicycles, and pedestrians. Approximately 20% of TBIs are due to violence, such as firearm assaults and child abuse, and about 3% are due to sports injuries. Material and methods: The authors describe a case of a young boy of 17 years old that by the age of 8 was hit by a football beacon that caused a severe brain injury. He is regularly followed in consultations in the Pediatric and Development Rehabilitation Service – Centro de Medicina de Reablitação Alcoitão. The authors will describe the effects of TBI in this particular case, either cognitive problems, sensory, emotional as physical problems. Conclusions: Rehabilitation is an important and critical part of the recovery process for a TBI patient. The overall goal of rehabilitation after a TBI is to improve the patient’s ability to function at home and in society in the face of the residual effects of the injury, which may be complex and multifaceted. Patients will often have problems in the areas of general cognition, social cognition/awareness, behavior and emotional regulation that present significant challenges, in terms of being able to resume expected social roles. This case is an example of how the neuro-phsychological sequelae were disabling in the child’s life, specially in cognition areas. Póster Científico apresentado no VII World Congress on Brain Injury – Lisboa, 9 a 12 de Maio 2008

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Introduction: Handshake is a form of interaction with those around us and it may be limited by palmar hyperhidrosis, a disease that has substantial impact upon affective, workplace and social relationships. This study aims to review the existing evidences about the effectiveness of botulinum toxin in the off-label treatment of palmar hyperhidrosis and consequent impact on quality of life, and also the role of iontophoresis as a drug delivery method.Material and Methods: The expression “”botulinum toxin” AND “palmar hyperhidrosis” AND (“quality of life” OR “iontophoresis”)” was searched on PubMed, Cochrane and PEDro databases.Results: Botulinum toxin type A, despite its cost and the transient therapeutic effect, is a valid treatment option in patients with severe sweating who have not responded to topical treatments. The benefits of using botulinum toxin type A to reduce palmar hyperhidrosis were documented in several studies and it was reported a significant improvement on quality of life after treatment. Palmar injection of botulinum toxin is however very painful. Previous studies demonstrated that botulinum toxin type A can be effectively delivered to the palms by iontophoresis with a favorable impact on quality of life.Conclusions: Palmar hyperhidrosis can lead to embarrassing social and occupational situations as well as have a psychological impact on the patients affected. Botulinum toxin type A injection grants the reduction of sweat production on hands, but this procedure has limitations. Botulinum toxin type A iontophoresis combines a noninvasive and inexpensive delivery method with a safe and effective treatment option for palmar hyperhidrosis.Botulinum toxin type A, even when delivered by iontophoresis, is an effective treatment option for palmar hyperhidrosis and that fact reflects positively on patients’ quality of life. Considering the established evidences, it is important to revise this unlabeled use.

Os autores apresentam um caso de síndrome do desfiladeiro torácico neurogénica associada a síndrome postural, numa jovem que apresentava queixas de dor no ombro direito e cãibras nos dedos da mão ipsilateral, associadas a limitação funcional progressiva de movimentos de abdução do ombro superior a 90º e pinças manuais. No exame objetivo eram evidentes alterações da estática do ráquis e atrofias tenar e hipotenar relevantes. Foi efetuado diagnóstico diferencial com radiculopatia cervical, plexite braquial, síndrome do túnel cárpico/ síndrome de Guyon, distonia do escrivão, doença de Hirayama. Apenas a eletromiografia e o estudo de condução nervosa foram sugestivos do diagnóstico, dado o radiograma simples de tórax/ cervical, ressonância magnética nuclear cervical e de plexo braquial não terem revelado alterações de relevo. Foi realizado tratamento conservador por Medicina Física e de Reabilitação, com melhoria da sintomatologia álgica e ganhos funcionais significativos. É feita uma breve e contextualizada revisão da literatura., enquadrando a síndrome no âmbito da Saúde Ocupacional.

A 21 years old female patient was referred due to pain and slight functional limitation of the left shoulder. There was fibrous band swelling of the left sternocleidomastoid muscle’s clavicular head. The imaging study revealed enlargement of the inner half of the left clavicle and diffuse thickening of the clavicular head of the left sternocleidomastoid muscle, suggesting fibrosis. After surgery, another rehabilitation program was initiated and the patient had a good recovery.

ISPRM and SPMFR - a commitment for a closer relation

Introduction: Functional capacity is a major determinant of morbidity, mortality and quality of life in most cardiovascular diseases. Understanding and identifying functional capacity predictors will allow fine-tuning of strategies and components of cardiac rehabilitation programs (CRP) in order to minimize disability and enhance patients social and vocational status. We aim to identify predictors of functional capacity at the end of phase II CRP in coronary heart disease patients, irrespective of initial functional status. The purpose of this study was to determine the functional capacity predictors in acute coronary syndrome (ACS) patients undergoing a phase II cardiac rehabilitation program (CRP). Methods: Prospective study enrolling consecutive patients admitted to an outpatient CRP after an acute coronary event between September 2008 and November 2011. Only patients who completed a formal phase II CRP were considered in this analysis. Sociodemographic, clinical, antropometric, laboratorial, echocardiographic and functional data were abstracted from medical records. Psychosocial profile and quality of life were assessed using Hospital Anxiety and Depression Scale (clinical depression/anxiety if subscores≥ 8) and short-form 36v2 (SF-36), respectively. A multivariable linear regression analyses was performed using end of PRC exercise testing duration in minutes as the dependent variable, adjusting for the duration of the baseline exercise stress test, and building a model by hierarchical inclusion of predictors identified in the univariate analysis. Results: From a total of 276 patients that completed CRP, 97(35,1%) were excluded due to incomplete data. Of the 179(54,2%) patients evaluated, 160(89,4%) were male, mean age of [mean(SD):53,5(9,8)] years and level of education of [P50(P25-75):6(4-12)] years. Among these, 30(16,8%) were diabetic; 32(17,9%) had previous history of coronary artery disease; 45(30%) were depressed, and the mean reported physical capacity perception, using the summary physical component of SF-36, was 46,6(7,7). Multivariate analysis identified male gender (p=0,008; β=0,12), level of education (p=0,007; β=0,144) and physical capacity perception (p=0,024; β=0,127) as positive predictor of functional capacity; whereas diabetes (p=0,005; β= -0,147), previous history of coronary artery disease (p= 0,019; β= -0,123) and depression (p=0,05; β= -0,102) had an inverse effect on functional status. Conclusion: Functional capacity in coronary heart disease patients is multifactorial and relies on a combination of clinical, psychosocial and socio-demographic characteristics. Specific strategies are needed to ensure adequate multidimensional/multiprofessional interventions in CRP instead of simple exercise based programs. Keywords: Coronary Disease/rehabilitation; Exercise Test; Exercise Tolerance. 

In clinical practice, it is usual for clinicians to recommend rest for several days up to weeks following a sports injury. The athlete is frequently advised to remain inactive beyond the acute inflammatory period, often starting rehabilitation several weeks after the injury. Prolonged inactivity is not usually the adequate treatment for muscle, tendon, ligament and cartilage injuries, whether chronic or acute. An extended period of total suspension of the normal mechanical load decreases the structural tissue resistance and may induce acute or chronic lesions when resuming normal sports activity.In musculoskeletal system pathological conditions, it is important to introduce at an early stage the exact benefic load since excessive or scarce loads may be injurious. In acute lesions, mechanical stress should take place soon after bleeding control and the initial inflammatory stage. The mechanical stimulus’ role on the regulation of cellular and matrix components proliferation and maintenance is important not solely in the bone (as described more than a century ago in Wolff’s law), but in all living tissue, including skin, neural tissue, hematopoietic and musculoskeletal systems. The anabolic and catabolic cellular activity is also regulated by mechanical stress on the cell surface. The conversion process of a mechanical signal in a chemical or biological response is called mechanotransduction.In this narrative review, the authors address several typical sports injuries affecting different tissues in the musculoskeletal system, for which prolonged rest, although often recommended, has been shown not to be the most appropriate treatment. Finally, they put forward treatment proposals in which the initial rest is replaced by the exact beneficial load, in light of mechanotransduction’s principles.

Introduction: Our objective was to characterize patients under 18 years old with cerebral palsy (CP), followed in our center, regarding their clinical and functional characterization and the presence of hip deformities, as well as surgical orientations.Material and Methods: Retrospective cross-sectional study based on the files of patients with CP, clinical registers, and serial radiological evaluation of hips according to the Australian Hip Surveillance Program (HSP). Analysis of the group with functional classifications IV and V and characterization of hip deformities: radiological evaluation of the femoral migration index (MI). Subanalysis of patients submitted to orthopedic surgery and patients not submitted to any surgery. The presentation of the results was divided into age groups (1-5 years; 6 – 11 years; 12-18years), according to the coverage of the HSP implemented, in 2012, at our center.Results: Of the total of 285 children with PC, the group with functional levels IV and V had 88 patients. From these group, more than half had subluxation of the hip. Were excluded 30 children. The total non-operated children was 35, the mean MI was 31.6%. The age group of 1-5 years had 3 patients, with a MI of 33.5% and the mean of the last hip radiograph was 7.1 months. The group of 6-11 years had 13 patients, with MI of 32.2%, and the mean of the last radiograph was 11.6 months. The 12-18 years group had 19 patients with a MI of 30.9% and the mean of the last radiograph was 24.5 months. The total operated patients was 23. From these group, 4 were operated before the implementation of the hip surveillance program. After 2012, 19 patients were operated. From these group, 6 were operated with preventive tenotomies and mean of 5 years.Conclusion: About half of the patients with IV and V functional levels had subluxation of the hip. About 38% of these patients have already submitted to surgery. From these group, 1/3 were tenotomies with early ages. Patients who are not surgically treated are under hip surveillance. In this population there is a high prevalence of this hip deformity. However, articulation with orthopedics has allowed early surgical interventions.

Osteoporosis is a systemic disease characterized by a decrease in bone mass and microarchitecture derangementof bone structure, which enhances the risk of fracture. Although studies focuses in the loss of bone mass in theelderly ages, it is now clear that the bone formed during normal growing period (90% of bone mineralizationoccurs during the first two decades of life) is a determinant factor for the quality of the future mature bone.Appropriate physical activity that implies load, food intake, body mass index and hormonal balance, are allimportant factor in osteoporosis and fracture prevention.In childhood, osteoporosis is secondary to chronic diseases and iatrogenic factors. The most used quantificationand assessment method is the dual energy x-ray absorptiometry (DEXA). Treatment is based in bone remodelinginhibitor drugs associated with load implied physical activities.The aim of early diagnosis and treatment is to prevent disease complications and improve life quality in thisspecific pediatric population.Keywords: Osteoporosis; Child; Densitometry; Applied Kinesiology; Drug Therapy.

Neuropathic pain results from an injury or dysfunction of the somatosensory nervous system. Neuropathic pain exists in children but its incidence is often underestimated. Many of the conditions causing neuropathic pain in adults are rare in children but some forms affect children and adolescents as complex regional pain syndrome or phantom limb pain. The diagnosis of neuropathic pain is clinical and can be difficult, especially in young children or children with developmental disabilities. Treatment strategies that have demonstrated to be efficacious in adults have been extrapolated to be use in pediatric age.

OBJECTIVE: Evaluate the intra- and interrater reliability in the thigh circumference measurement using different anatomical references.MATERIAL AND METHODS: Twenty five volunteers without history of pathology or surgery in the dominant leg entered in the study. The measurements were performed by two independent evaluators, on two occasions with an interval of one week. The  measurements and participants order were randomized. The results of the interim measures were concealed, being analyzed by a third investigator. The assessment protocol was previously defined. The intra- and inter-rater correlation was measured through the intraclass correlation coefficient (ICC). The limits of agreement were established in accordance with the method of Bland and Altman.RESULTS: The intraclass agreement in intrarater reproducibility was high (SPPICC 0,96, KJLICC 0,95, ASISICC 0,96). In the interrater results the limits of agreement were: SPPICC 0,91 (IC 95%: 0,79–0,96), KJLICC 0,94 (IC 95%: 0,86–0,97), ASISICC 0,90  (IC 95%: 0,77–0,95).CONCLUSIONS: All methods presented high intra- and interrater reliability, which by the simplicity of the measurement method may favor the choice for SPP in the absence of pathology in anatomical segment evaluated.  

Spinal cord injury (SCI) is a cause of secondary osteoporosis. The loss of bone mass after a SCI happens throughout the skeleton with greater affection of inferior extremities. This loss of bone is quicker in the first 4 months following a SCI. It continues, however to a lesser degree, over the years. A 56-year-old male patient suffered an automobile accident in 1986 with a concomitant fracture-luxation of C5-C6 vertebrae from which resulted a SCI – classified as a Tetraplegia B in the! American Spinal Cord Injury Association!(ASIA) Scale, with C4 as the neurological level. The patient was admitted to an inpatient Rehabilitation Centre on May 11, 2020, for a comprehensive and multiprofessional rehabilitation. On June 22, 2020, the patient presented with a left thigh crepitation after had been heard a “pop” during passive mobilization of the hip. The Rehabilitation Specialist asked for a radiography. The patient was transferred to an Emergency Department, being diagnosed a spiral diaphyseal fracture of the left femur – a fragility fracture due to sublesional osteoporosis. On June 29, the patient was submitted to an open reduction and internal fixation with an antegrade long nail. The patient returned to the Rehabilitation Centre on July 7 where 70 mg of oral alendronate weekly was introduced. On August 5, control radiographs showed no signs of bone consolidation. Until today, there are no guidelines to treat osteoporosis after a SCI. There are studies in the acute phase of the SCI but there is a lack of evidence when it evolves to chronicity. Bisphosphonates are a class of anti-osteoclast-mediated bone loss osteoporosis who have presented good results!on the BMD, especially oral alendronate, but none demonstrated a diminishing of the fracture risk.

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Lymphedema is the result of lymphatic fluid accumulation in the subcutaneous tissue, usually a chronic and progressive condition associated with a significant morbidity and a decrease on the quality of life of the patients. It can be classified as Primary or Secondary according to the etiopathogeny. Primary lymphedema (PL) results from abnormalities in the lymphatic system development during lymphangiogenesis. Secondary Lymphedema (SL) is the most prevalent and results from an obstruction or dysfunction of the lymphatic system usually as a consequence of infectious disease, neoplastic obstruction or cancer related treatment (lymph node dissection, radiotherapy), surgical interventions, traumatic injuries and some inflammatory diseases. In recent years there has been a increasing scientific interest in this area, especially concerning the physiopathology of the lymphedema, which can give rise to the development of more effective diagnostic and therapeutic approach. The aim of this study is to highlight a clinical case of Primary Lymphedema and to summarize some etiologic, diagnostic and therapeutic findings of Lymphedema. Keywords: Lymphedema Physical Therapy Modalities. 

Introduction: Our objective was to ascertain the incidence of autonomic dysreflexia in spinal cord injury inpatients during the hospitalization; to identify the main triggering factors; to determine which variables influence the incidence of autonomic dysreflexia.Methods: A retrospective review of patients with spinal cord injury was conducted. This study scoped all patients with an injury level above T6 admitted to a physical medicine and rehabilitation department from January 2011 to December 2013. The following data were collected from the medical records: autonomic dysreflexia episodes, demographic information, patient’s characteristics, triggering factors and need of pharmacological treatment. The Statistical Package for the Social Sciences (SPSS) was used to analyze the data.Results: A percentage of 12.7% of the included patients developed autonomic dysreflexia; 71.4% autonomic dysreflexia episodes occurred in patients with complete spinal cord injuries (AIS A). All autonomic dysreflexia episodes occurred in patients with traumatic spinal cord injury and with cervical spinal cord injury levels. The main triggers of autonomic dysreflexia were genitourinary (48%) and gastrointestinal (44.2%). Oral antihypertensive medication was administered in 26.5% of events.Conclusion: Autonomic dysreflexia is an uncommon complication in spinal cord injury patients. It is important to be aware of this condition, since the effective treatment requires early diagnosis, reversal of trigger factors and, if needed, the prompt administration of pharmacological treatment.

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