RCAAP Repository

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Neuralgic amyotrophy or Parsonage-Turner syndrome is an uncommon disorder, of unknown etiology, typically characterized by abrupt onset of shoulder and upper extremity pain followed by progressive neurologic deficits. An immune/autoimmune process seems to have more support in development of neuralgic amyotrophy. Neuralgic amyotrophy is a clinical diagnosis, however, further diagnostic studies can confirm clinical suspicion and help exclude other causes. The treatment consists predominantly in pain control and rehabilitation. Patients with neuralgic amyotrophy, can be evaluated by a wide range of clinical specialists in the early stage of disease before a correct diagnosis be made. This is a result of different phenotypes that this disorder exhibits, that complicate the diagnosis. It is important for clinicians to beware of the classic clinical manifestations that usually follow a characteristic clinical course of abrupt onset of shoulder girdle pain followed by progressive neurologic deficits as muscle weakness, amyotrophy and sensory abnormalities. We report the case of a 32-year-old man who had a severe bilateral and atypical shoulder involvement, that made the most probably diagnostic not so evident.

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Ankylosing spondylitis is a chronic inflammatory disease, of the group of spondyloarthropathies. Its clinicalcourse is characterized by high variability, from mild, well tolerated symptomatic presentations to extremeankylosis and major disability. To date there is no known cure. Recently new therapeutic options, such as antitumornecrosis factor, emerged which can affect the natural history of disease. Historically, rehabilitation is a partof the treatment of these patients.This paper reviews the different therapeutic modalities of rehabilitation in the treatment of Ankylosingspondylitis, but also the scientific evidence in literature supporting these different therapeutic approaches.The rehabilitation is part of the therapeutic arsenal in Ankylosing spondylitis. The empirical and historical practiceis substantiated by the data of the current revisions of Evidence Based Medicine. It is considered essential in thetreatment, with a role described as longitudinal in evolution and natural history of disease, with varying degreesof evidence perfectly demonstrated.Keywords: ankylosing spondylitis; exercise; rehabilitation

Acute disseminated encephalomyelitis is a rare disease, which consists of demyelination of the white matter of the central nervous system, usually single-phase and self-limited. The onset of acute disseminated encephalomyelitis usually occurs after a febrile prodromal illness or immunization and typically affects pre-pubertal children. Despite the favourable prognosis in most cases, the course of the disease is variable, and patients may present persistent neurological deficits, disease recurrence or death. The literature does not currently have diagnostic criteria or standard treatments. A rehabilitation program at an early stage is associated with lower morbidity, functional gains and improved quality of life. The case presented by the authors aims to highlight the importance of early diagnosis and treatment, emphasizing the importance of individualized rehabilitation program.

As miopatias inflamatórias idiopáticas (MII) são um grupo de doenças auto-imunes sistémicas, raras, caracterizadas por inflamação muscular crónica. Clinicamente partilham sintomas como diminuição progressiva da força e da resistência muscular. As formas clínicas mais comuns são a poliomiosite, a dermatomiosite e a miosite de corpos de inclusão). A intervenção da medicina física e de reabilitação visa a prevenção de complicações, a otimização da função, a promoção da autonomia e a melhoria da qualidade de vida. O exercício físico poderá ser parte integrante de um programa de reabilitação nestes doentes. Com este trabalho pretendemos demonstrar o impacto do exercício físico no tratamento dos doentes com miopatias inflamatórias idiopáticas (especificando as suas particularidades nesta população.

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Patellofemoral syndrome (PFS) is one of the most challenging knee pathologies. It is defined as localised retropatellar or peripatellar pain, typically provoked by ascending or descending stairs, squatting and sitting with flexed knees for prolonged periods of time. It is an extremely common diagnosis. However, obtaining an accurate diagnosis and outlining appropriate treatment are often challenging. Consensus is lacking in the literature regarding the etiology and treatment of the syndrome. The patellofemoral joint is complex and dependent on quadriceps function as well as on static and dynamic restraints. The etiology of patellofemoral pain is multifactorial with proposed causes including (i) bony abnormalities and/or malalignment of the lower extremity and/or the patella; (ii) muscular imbalance of the lower extremity; and (iii) overuse. Accurate diagnosis requires specific knowledge of the anatomy, biomechanics, and functional behavior of the patellofemoral joint. Most patients are successfully treated by conservative means with the rare few requiring surgical intervention. This article discusses the pathophysiology, diagnosis, and management of PFP. Keywords: Patellofemoral Pain Syndrome

Inflammatory myopathies are systemic autoimmune diseases characterized by chronic muscle inflammation of unknown etiology. Clinically, there is reduced muscle strength and endurance. Its treatment is mainly pharmacological, including corticoids and imunossupressants. The intervention of Physical and Rehabilitation Medicine intends to prevent complications, to optimize function, to promote autonomy in daily activities and to improve quality of life. This review article pretends to demonstrate the intervention of Physical and Rehabilitation Medicine in the treatment of inflammatory myopathies.Therefore, PubMed database, EMBASE WebSPIRS, Cochrane Library and Cochrane Database of Systematic Reviews were searched for relevant original articles, systematic reviews and meta-analysis using “myositis” and “rehabilitation” as MeSH terms. The intervention of Physical and Rehabilitation Medicine seems to be fundamental, significantly contributing to the improvement of functional capacity and quality of life. Though, further randomized and controlled studies with larger sample sizes are necessary to take more assertive conclusions. Keywords: Exercise Therapy; Myositis; Rehabilitation. 

The present study aimed to conduct a narrative review of the importance of physical exercise in patients with rheumatic diseases, in general and of each in particular, and consequently the quality of life of these people. We sought to understand which is the most suitable type of exercise for different rheumatic diseases, as such were grouped by different groups. A search was performed in PubMed database to identify relevant articles that addressed this association. We used the following descriptors in the English language: exercise, physical activity, rheumatic diseases, rheumatoid arthritis, systemic lupus erythematosus, spondyloarthritis, ankylosing spondylitis, osteoarthritis, osteoporosis, fibromyalgia. The exercise like any other nonpharmacological treatment of rheumatic diseases should be approached in different ways, in an integrated and individualized form for each patient. Strong evidence suggested benefits of exercise: improving aerobic fitness, muscle strength, joint mobility, functional capacity and even the humor, with no joint damage or worsening of the inflammatory process. It was not showed to exist a standard exercise protocol, and consensus regarding the best type, intensity, frequency and duration of exercise in the treatment of rheumatic diseases.

Avulsion fractures of the lesser trochanter in adolescents are rare and usually due to sports-related trauma. Forceful muscle contraction in the setting of an immature skeleton represents the most common injury mechanism. We report the case of a 14 year-old male with no previous complaints that presented with sudden anterior hip pain while sprinting and painful limp after sport. Magnetic resonance imaging revealed a lesser trochanter avulsion fracture with minimal displacement. Conservative treatment demonstrated good result with return to play 4 months after injury. Surgical approach is usually recommended for symptomatic nonunion or painful exostosis. Prognosis is usually excellent regardless approach with return to previous level of activity.

Paediatric osteoporosis (PO) can be primary or secondary to chronic diseases or medications. This second grouphas been increasing recently and capturing attention from the scientific community.PO is usually asymptomatic until fragility fractures occur. These can be very destructive to a child or adolescent,and so, every effort shall be done to avoid them. Scan or densitometry is the most used method to confirm thediagnosis of PO. However its interpretation in the growing skeleton is not easy.PO treatment is a complex and contradictory issue, as there are no controlled, randomized studies. Preventionshould be the first choice, obtaining the maximum bone mass accrual through healthy life habits (optimalnutrition, exercise and sun exposure plans) and through the control of chronic diseases and restriction ofcorticosteroids.Along with calcium and vitamin D, biphosphonates are the most used drugs. Studies demonstrate thatbiphosphonates can be safe and effective in PO, but there is no consensus about dosis, duration of therapy andmonitoring adverse effects. Their use should be reserved to specialized and experienced centers.Keywords: Osteoporosis; Child; Adolescent; Diagnosis; Therapy.

Spinal cord injury leads to functional, psychological and socio-economic important sequelae. According to the literature, vascular diseases, including cardiovascular disease are the leading cause of death in chronic cpinal cord injury. Cardiovascular disease is the leading cause of death in individuals over the age of 60 and lasting lesion greater than 30 years; these patients have a life expectancy that is approaching the general population, however, the morbidity and mortality from cardiovascular disease is superior, due to risk factors associated with physical deconditioning and premature aging, namely: physical inactivity, cardiovascular risk factors (dyslipidemia, obesity, increased insulin resistance / diabetes mellitus) and neurohumoral changes.In this work, we address the cardiovascular and metabolic consequences of spinal cord injury and discuss the benefits of an exercise training program.Exercise training might reverse some of the changes that occur after spinal cord injury thereby reducing cardiovascular risk and to contributing to promote health, independence and long-term quality of life of these patients.

Introduction: The prevalence of osteoporosis keeps rising, causing morbidity and mortality associated with osteoporotic fractures to increase; these are mostly caused by falling, with the fracture of proximal femur having the higher socioeconomic impact. Our aim was to characterize the preventive and therapeutic measures of osteoporosis and falls in inpatients with fracture of the proximal femur.Material and Methods: We carried out a one-year long retrospective cross-sectional study in 65+ year-old women with a recent fracture of the proximal femur, who were admitted to an orthopedic unit; we used a questionnaire specifically developed for this purpose and the individual clinical charts.Results: We evaluated 100 patients with fracture, mostly caused by a fall, indoor, at daytime, and on regular floor; 76% of which reported history of falling and 42% previous history of osteoporotic fracture. Of all the patients that met the criteria for treatment, only 5.3% were undergoing treatment. A statistically significant association was found between the occurrence of falls and (1) osteoporotic fractures and (2) the implementation of fall-preventive measures.Discussion and Conclusion: our results corroborate the importance of falls and osteoporotic fractures in health. We estimate the total direct costs for this sample in 1.34 M€ for the first post-fracture year. If all patients (and not only 5.3%) were to be treated, the consequent fracture risk reduction could cut these costs in, at least, 40%-45%.

Postural orthostatic tachycardia syndrome (POTS) is one of the major causes of orthostatic intolerance in young adults, highly incapacitating and with a major impact on quality of life. This article includes the presentation of a clinical case of a patient with POTS, and a literature review, intending to reiterate the importance of the clinical suspicion of this syndrome, as it is a common syndrome, although widely underdiagnosed. Patients with POTS are unable to increase the venous return when they assume an orthostatic position and therefore develop tachycardia as a compensation mechanism. The orthostatic intolerance manifests as a wide range of symptoms, triggered by orthostatic position and minimal effort; and resolve with decubitus. The treatment of POTS can include a pharmacological and non-pharmacological approach, including an exercise program, individualized and properly structured, based on the pathophysiological concepts of the disease.

Introduction: In this work, pain is conceptualized in its subjective expression, related with pleasure, human suffering and mental balance. Purpose: Consider the main expressions associated with the emotional pain of grief experience in physical rehabilitation. Methods: It is performed a comprehensive analysis of psychoanalytic content on the most relevant characteristics of mental functioning in the phenomenon of body pain. Discussion / conclusions: Feelings of guilt, historical family characteristics of feeling pain and the development of pain as a substitute for experience of loss are discuss. We will also commented efficacy of psychotherapy in patients with chronic pain. Keywords: Pain; Pleasure; Stress; Psychological; Psychoterapy.

Objective: To describe the clinical patterns and characteristics of congenital muscular torticollis.Methods: Retrospective longitudinal study of the children with congenital muscular torticollis followed in Paediatric Rehabilitation consultation of the Centro Hospitalar e Universitário de Coimbra, between January 2008 and November 2011.Results: From a total of 91 CMT infants, 67% were boys and the mean age was 20 weeks. Difficult labour history was present in 72.9% cases, 61.1% from primiparous mothers and 14 had an abnormal delivery presentation. Cervical palpation revealed a tumour in 43.8% cases and there was a limitation in range of motion of the neck in 63.8%. All children have had home program executed by caregivers and 78 were following a rehabilitation program. Most children showed a complete regression of the condition and only one needed corrective surgery.Conclusions: Congenital muscular torticollis is the most common cause of wryneck in children. An early intervention is surely the key for a good outcome. Conservative treatment may attain good results in most cases.

Introduction: Our objective is to let know the Protocol of Performance in Prematurity that has been in use a Central Hospital since September 2014.Methodology: The protocol begins before discharge from the Neonatal Intensive Care Unit (NICU) with a neuro-motor evaluation by pediatric rehabilitation physician and neurodevelopment therapist: (1) Individual therapy: < 29 weeks of gestation or ≤1500 g or neurological disorders and / or potential risks for a non-normalized psychomotor development; (2) Orientation group of preterm newborns: 29- 34 weeks of gestation and > 1500 g. The orientation group is conducted at the Hospital in 5 sessions (after discharge at 3, 6, 9 and 12 months corrected age), under the guidance of a multidisciplinary team and focusing on psychomotor development and the relationship parents/caregivers-baby.Results: From September 2014 until the end of 2016, a total of 26 groups were selected, with an average of 6 infants per group, making a total of 145 infants, 42 of whom entered into an individual intervention program at some time of follow-up in the prevention program. The losses (by refusal, change of residence or abandonment) were zero in 2014, six in 2015 and three in 2016.Discussion: The majority of the studies carried out to date use an intervention methodology in preterm newborns infants in the home environment, under the guidance of only one professional, focusing only on psycho-motor development and with a weekly and / or monthly observation frequency up to 2 years of life. The main conclusion of all the studies reflects that there are no significant differences in motor outcome in babies with and without preventive intervention. However, they do not focus their evaluation on minor motor deficits (prevalence of about 50%), nor on the capacity for functional modification / re-structuring and social participation.Conclusion: Our protocol follows the follow-up guidelines for risky newborns, but differs from the protocols of scientific studies carried out. It is intended, in the future, to evaluate in a structured way, with developmental scales, the psychomotor outcome of these babies.

Introduction: Chronic anal fissure (FAC) is a condition associated with high pain and decrease in quality of life. The hypertonia of internal anal sphincter (EAI) is the main etiologic factor implicated in FAC and the spasm-pain-spasm cycle perpetuates this mechanism. Injection of Botulinum toxin (BoNT) in EAI promotes, through transitory chemical denervation, muscle relaxation and antinoceptive effects, thereby interrupting the physiopathological cycle and consequently providing conditions for fissure resolution.Material and Methods: Retrospective study including 159 patients from January 2009 to September 2019, refereed to a Chronic Pain Unit from a Hospital Center, with diagnosis of chronic anal fissure not responding to conservative treatment. Those patients were submitted to injection of 40U of onabotulinumtoxinA in EAI. Clinical records were used to collect pain scores during and after defecation (obtained with numeric rating pain scale) in pre- and post- treatment (the latter at 1 month assessment after injection), the occurred side effects and the necessity of new injection or surgical treatment.Results: Hundred fifty nine patients in which 59.1 % were female, mean age of 51.1±14.4 years old. Pain during defecation was 7.3±2.5 and after defecation was 5.3±2.8. Pain intensity significantly reduced after injection of BoNT (p<0.001) with a magnitude of 4.4±3.1 and 3.4±2.8 during and after defecation respectively. About 31.8% of patients reported a complete resolution of pain and 14.5% maintained the same level of pain intensity. Repeated injection of BoNT was necessary in 5.0% patients in a year, 4.5 % after an year for pain control. Were submitted to surgical treatment, 19,7% due to refractoriness to treatment. Non severe side effect occurred in 16 patients. Age (p=0.267) and gender (p=0.4238) had no statistic association to treatment response.Conclusion: Treatment of pain with BoNT in FAC refractory to conservative treatment was effective and secure and therefore surgical treatment may be reserved for patients refractory to this treatment. However, refractoriness with this treatment are not negligible and predictive factors of unsuccess are still undetermined.

Congenital skeletal deficiencies are the principal cause of upper limb amputation in the first decade of life whereas between the ages of 10 to 20 years is trauma. The first prosthesis of children with upper congenital limb deficiency must be adapted between 3 and 9 months in order to contribute to psychological and motor development, allowing the use of both upper limbs to crawl and assuming the standing position. Using a prosthesis later (2 to 5 years) results in a higher rejection rate because at this age, children already developed compensatory techniques. The steps of psychological and motor development are used to guide the prosthesis and components prescription. Material and Methods: The authors made a retrospective study consulting clinical files of children followed in consultation in the Paediatric Development and Rehabilitation Service, from 1980 and 2007, with the diagnostic of upper limb amputations and congenital deficiencies. From this population, the children with prosthesis were selected and divided in two groups according to diagnostic. The final goal was to evaluate the efficacy of prosthesis utilization in this population. Results and Conclusion: The prescription at the correct time, the adequate rehabilitation program and family teaching are the key points for the child's functional independence. However, it is important to separate the concept of prosthesis function and its use. Benefits and losses should be discussed before prescription and beginning of rehabilitation treatment. Key words: cild, amputees, upper limb