RCAAP Repository

Introduction: Plantar Fasciitis (PF) represents the most common cause of plantar heel pain. An initial conservative trial is recommended. Objectives: To characterize demographic and symptomatic factors, previous therapy, results with laser monotherapy. Material and Methods: Observational retrospective study (12 months period). The treatment consisted of infrared laser (AsGa 904nm; energy density 20J/cm2; peak potency 200mW). Descriptive and comparative statistical analysis was made (level of significance 0,05). Results: Thirty-two patients with PF were followed-up, mean age 54,28 years (24-86; SD 13,95), 66% female, mean body mass index 30,18Kg/m2 (17,91-41,13; SD 5,19), 75% unilateral, mean time of symptoms onset 6,28 months (0,2-24; SD 6,82), 21 with previous pharmacotherapy and 12 with other PRM treatment modalities. Mean initial pain level (Numeric pain scale) was 7,31 (5-10; SD 1,38). Of the 26 patients treated (6 follow-up losses), 24 (92,3%) reported improvement. The average number of sessions was 28,5 (11-60; SD 14,01). The mean end pain level was 0,75 (0-5; SD 2,37), with an average pain level reduction of 89,7% (28,6%-100%; SD 0,16). The level of pain intensity at onset was superior in patients with higher body mass index (p=0,002). There were not found other statistical significant relations.Conclusions: PF was characterized by a significant pain level (moderate to severe). Obesity was a risk factor for the initial pain intensity. Rate reduction in pain level intensity was very satisfactory. Infrared Low level laser therapy is a good therapeutic option, justifying the need for further evaluation through randomized controlled prospective studies. Keywords: Laser Therapy; Fasciitis, Plantar; Pain; Physical Therapy Modalities. 

Introduction: Acute spinal cord ischemia syndrome or spinal cord infarction is a rare condition, accounting for 1- 2% of all stroke admissions. Several mechanisms can cause impaired perfusion of the spinal cord, and in a few cases no etiology can be found. We present two case reports with acute spinal cord ischemia syndrome admitted at a Rehabilitation Department, and compare their clinical features with current literature studies.Case Report: The first case was a 55-year-old woman with a C8 incomplete tetraplegia AIS C, after medullar infarction of unknown etiology. The second case was a 58-year-old man who developed a sudden neurologic status of a C6 incomplete tetraplegia AIS C, after a heart attack. In both cases the spine magnetic resonance identified a medullar lesion of ischemic characteristics. After rehabilitation treatment they presented a good functional and neurologic development. At discharge, both patients were independent, at daily life activities, and walked with gait devices.Discussion: Acute spinal cord ischemia syndrome has a wide variety of clinical syndromes, depending on the lesion level and the vascular territory affected. The two presented cases are suggestive of an anterior spinal artery syndrome, and are in concordance with the latest literature findings. The recent studies agree that the main prognostic factor is the impairment status at admission, determined by the American Spinal Injury Association Impairment Scale. Regarding the outcome, they reveal a good functional and neurologic recovery when the patient is submitted to an individual and holistic rehabilitation program.

Introduction: Regular physical activity reduces the risk of mortality and morbidity in patients with coronary disease, regardless of other lifestyle modifications. Reassignment to effort and encouragement to practice regular physical activity are key components of cardiac rehabilitation programs (CRP). The goal of this study is to characterize the physical activity levels of patients with coronary disease after have completed the effort reconditioning program (ERP) of the CRP.Material and Methods: Demographic data and clinical history were obtained of the SClinic computing platform. To assess the level of weekly physical activity of the patients, the International Physical Activity Questionnaire (IPAQ) was applied either in person or by phone. From the calculation of the METs made in different types of exercise throughout the week, it was possible to attribute to each patient a value called “total activity score” that allows the categorization of the sample into groups, sedentary, moderately active and active.Results: Fifty-five patients (71% males, mean age 53 years) were included in the study. 62% of the patients surveyed maintained regular physical activity, with 26% being classified as active and 36% moderately active. It has been found that there is a statistically significant difference in the level of weekly physical activity practiced when comparing patients over 55 years of age and with less than 55 years of age (p<0.05), presenting these last higher levels of physical activity. Patients who have completed cardiac rehabilitation treatment longer ago (more than 1 year) appear to be more likely to be sedentary than patients who have recently completed the rehabilitation program.Conclusion: PRE is an integral part of CRP, and it is expected that patients will acquire habits of exercise and/or physical activity through this intervention. It has been found that younger patients maintain a more sustained practice of physical activity.

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Introdução: A instabilidade autonómica paroxística com distonia é uma complicação incomum de várias lesões do sistema nervoso central (SNC) ainda pouco compreendida, apesar do quadro clínico exuberante. Está associada a morbilidade e mortalidade significativas e aumento do tempo de internamento interferindo nos processos de reabilitação com resultados funcionais desfavoráveis. Por ser difícil de diferenciar de outras condições que põem a vida em risco é necessário que os médicos estejam alertados para esta síndrome. A persistente disfunção autonómica pode resultar em lesão cerebral secundária, podendo ser fatal.Caso Clínico: Cinco anos, sexo masculino, vítima de paragem cardiorrespiratória prolongada por quase afogamento, resultando numa encefalopatia anóxica grave com sequelas neuromotoras e cognitivo-perceptivas severas. Um mês depois foi internado num centro de reabilitação, em estado de mínima consciência, iniciando episódios de distonia em postura de descerebração associados a taquicardia, diaforese e choro persistente, desencadeados por diferentes estímulos. Estes episódios de difícil controlo, foram um desafio clínico interferindo grandemente no processo de reabilitação.Discussão: Esta entidade permanece pouco presente na prática clínica estando associada a morbilidade e mortalidade significativas, recurso exagerado de exames complementares de diagnóstico e terapêutica inadequada, interferindo na reabilitação destes doentes. O seu rápido reconhecimento e tratamento são cruciais para prevenir lesões cerebrais secundárias.

Purpose: Shoulder range of motion measurement is not only of diagnostic significance but is also relevant for monitoring response to therapeutic interventions. Smartphones incorporate accelerometers which enable easy multiaxial and multiangle measurements but their reliability compared to the classic goniometer remains to be established. The authors aim to ascertain the intra-rater reliability between manual and smartphone-based digital goniometry in measuring active flexion (AF) and external rotation (ER) in both standing (St) and supine (Su) positions. Methods: A convenience sample of 16 healthy volunteers was selected. Measures were taken by an independent rater at two different times, a week apart. We randomized both participant’s order and measurement sequence. The rater was trained according to a predetermined measurement protocol and blinded to intermediate measurements. We evaluated agreement between methods using the intraclass correlation coefficient (ICC), visual inspection of Bland-Altman plots and calculation of the limits of agreement. Results: The intra-rater correlation was good regarding the ER-StICC 0,87 (IC 95%: 0,66-0,95), the ER-SuICC 0,92 (IC 95%: 0,80-0,97)) and the AF-StICC 0,92 (IC 95%: 0,78-0,97). The score was lower in the AF-SuICC 0,81 (IC 95%: 0,55-0,93). Conclusions: There was a good intra-rater reliability between classic and digital goniometer in ER (regardless of positioning) and in standing AF. The smartphone based digital goniometer might be an easy tool to assist physical examination in healthy individuals, but its accuracy and applicability to clinical settings needs further evaluation.  Keywords: Arthrometry, Articular; Shoulder; Patient Positioning; Observer Variation;

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Objective: 1)To characterize a spinal cord injured (SCI) population who underwent an inpatient comprehensive rehabilitation program at the Medical Rehabilitation Centre of the Central Region of Portugal – Rovisco Pais (CMRRC-RP); 2)To quantify the functional gains of this population using the SCIM; 3) To evaluate the possible correlation between SCIM III values and the motor score (MS) of the American Spinal Injury Association Impairment Scale (AIS); 4) Contribute to validate the Portuguese version of the SCIM scale. Material and Methods: Observational study using admission and discharge data including etiology, level and completeness of SCI, MS according to the AIS, SCIM III values of all SCI patients admitted to the CMRRC-RP in the time period between January 1st and December 31st 2010. Admission and discharge total and sub-total SCIM scores were compared. Variables such as age, gender, length of stay as an inpatient, etiology, level and completeness of injury were analyzed. The correlation between MS and SCIM score (totals and subgroups) was calculated to determine the applicability of thePortuguese version of the SCIM scale. Results: 47 of the 72 admissions met the inclusion criteria. Median Self Care, median Respiratory & Sphincter Management and median Mobility SCIM Subgroups, showed a significant functional improvement from admission to discharge. The major improvement was observed in the self-care item. AIS Upper Limb MS correlated highly with the SCIM Self Care, AIS Lower Limb MS correlated highly with SCIM Mobility and AIS total MS correlated highly with SCIM total score. Conclusion: TThe Portuguese version of SCIM was found to be useful and practical in assessing functional gains in SCI individuals submitted to a comprehensive rehabilitation management program in the CMRRC-RP. Keywords: Spinal Cord Injuries; Disability Evaluation; Recovery of Function; Rehabilitation Centers.

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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.