RCAAP Repository

Introduction: The fracture of the coracoid process associated with a fracture in another location of the scapula is rarely described in the literature.Case Report: The authors present a case report of a 22- year-old male patient that suffered a fracture of the coracoid process with concurrently neck scapular fracture, in the context of a high-energy trauma of the upper limb during a rugby match. He was submitted to a surgical procedure that consisted in open reduction and placement of osteosynthesis material. Subsequently, in the initial assessment of physical medicine and rehabilitation (PMR), he showed: muscle amyotrophy in the shoulder region; active range of movement (aROM) and passive range of movement (pROM) limitation, in all axes of movement; and pain associated with movement. The patient underwent rehabilitation treatment aimed at correcting the scapulothoracic rhythm, recovering muscle strength and functional recovery, with good results.Conclusion: The authors highlight the importance of early diagnosis and the role of rehabilitation in the athlete’s clinical and functional recovery.

Language is a superior function and it is very important for communication. When a cerebral lesion occur some changes in language mechanisms happens, what is called aphasia. Authors pretend not only to present the aphasia classification, but also to explain neuropathology, linguistic characteristics of aphasias and make an approach to children aphasia prognosis. Keywords: Child; Language; Aphasia

Central pontine myelinolysis (CPM) is an acute non-inflamatory demyelinating disease, localized to the central- pontine region, which is associated to a clinical picture of flaccid tetraparesis, pseudo-bulbar paralysis and different degrees of encephalopathy or coma. The etiology is yet to be totally cleared, but it is generally associated to electrolyte unbalances, mainly severe hyponatremia and its rapid correction. The imagiologic diagnostic confirmation can be done through brain magnetic resonance imaging (MRI). This is a report of the case of a 42 year old woman, with previous history of psychiatric disturbances and heavy alcohol consumption, admitted to hospital after a fall, and presenting with jaundice, weight loss and prostration, which had been present for nearly 3 weeks. Hyponatremia was identified and corrected, after which, the patient developed tetraparesis and generalized hypotonia. The brain MRI was compatible with the diagnosis of CPM. The patient was admitted to a Rehabilitation Center 8 weeks after. She began her intensive, multimodal rehabilitation program, and she had a positive result during the 10 week inpatient treatment period. CPM is a rare condition, without an established treatment, which can have a poor prognosis, both from a vital and a functional perspective. The early initiation of an intensive and comprehensive rehabilitation program is fundamental to the final results, regarding the integration of these people. Keywords: Myelinolysis; Central Pontine; Hyponatremia; Quadriplegia; Rehabilitation. 

Introduction: The purpose of this study is to assess the impact of fampridine on walking, balance and perception of walking capacity in multiple sclerosis patients.Material and Methods: Prospective, open-label, non-controlled and non-randomized study on multiple sclerosis patients with an Expanded Disability Status scale (EDSS) between 4 and 7, treated with fampridine. For the evaluation of the impact of fampridine were used: Multiple Sclerosis Walking scale 12 (MSWS-12), Timed 25-Foot Walk (T25FW), Timed Up and Go (TUG) and Berg scale. The results were statistically analysed with statistical significance set to p < 0.05.Results: A total of 15 patients (88.24%) were considered responders. The improvement in balance, gait velocity and perception on walking capacity were statistically significant with mean value of 19.08% (± 31.11) on T25FW (p = 0.022), 19.20% (± 26.13) on BBS (p = 0.012), 35.97% (± 34.93) on TUG (p = 0.022) and 12.99% (± 12.90) on MSWS-12 (p = 0.016). This study showed a strong and statistically significant correlation between TUG and T25FW (r = 0.668, p = 0.017).Conclusion: The preliminary results show fampridine potential for gait, balance improving and improvement on perception of walking capacity. Further research is needed to identify and characterize predictors of responsiveness and evaluate other potential functional outcomes.

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Purpose: To know the factors that influence balance and postural control, as the associations andinterconnections between the sensitive-sensorial system, Central Nervous System (CNS) and neuromuscularresponse.Material and Methods: It was done a literature review with published books and databases.Results: The postural control is essential to the maintainance of the balance. The obtainment of sensorial informationsoccurs through the visual, vestibular and somatosensory systems and they are conducted to the CNS, where theyare integrated and processed by the brain, cerebellum, basal ganglia and brainstem. Numerous descending andascending pathways depart and pass through from the brainstem which will regulate the tonus, the movementsand several reflexes.Conclusions: The human body is in a constant search of balance, whose control involves acomplex net of pathways, allowing the “central comand” (CNS) to be constantly modified and regulated by theperipheral feedback. The balance is a multiorganic function that requires a global approach.Keywords: physiology; postural balance

Carcinoma of the colon and rectum is the most frequent gastrointestinal tumor. Polymyositis is a rare idiopathic inflammatory disease and is manifested by decrease in proximal muscle strength. Rarely, it can be associated with paraneoplastic syndrome. There are several studies on the relationship between cancer and dermatomyositis or polymyositis. However, the association of adenocarcinoma of the colon and inflammatory myopathies is rare, specially in the absence of skin lesions. We report a case of a patient with adenocarcinoma of the colon, evaluated in the emergency unit due to symptoms of paraneoplastic polymyositis, and subsequent clinical follow-up, underlining the role of rehabilitation in oncologic patients, attending this clinical entity in particular.

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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.