RCAAP Repository

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

Introduction: Chronic low back pain causes a high level of disability and is a public health problem that currently affects a large percentage of the working population in Europe. Fatigue, although subjective and complex, seems to be one of the main symptoms of patients with chronic low back pain. The prevalence and pathogenesis of fatigue are not completely understood, but it is well known that fatigue interferes decisively in the perception of wellness and quality of life. This study aims to assess the prevalence of fatigue in patients with nonspecific chronic low back pain and its impact on functionality.Material and Methods: This was a transversal, non-randomized clinical study, with 30 Portuguese adults suffering from chronic low back pain, and included the following instruments: an individual characterization questionnaire, visual analogue scale for pain, fatigue impact scale and Roland Morris questionnaire.Results: The study showed a long duration of pain (mean 10.6 years) and moderate to high value of disability in this population. We found a significant relationship between pain intensity and fatigue (p ≤ 0.05) and between fatigue and disability (p ≤ 0.001).Discussion: Fatigue is a prevalent symptom in patients with chronic low back pain and increases with the intensity of pain. In these patients more fatigue means greater functional disability. This underlines the need for comprehensive clinical management of the nociceptive environment, understood as a potential generator of limitation on activity and participation. It emphasizes also the need for a functional rehabilitation program to identify the variables of pain, fatigue and function objectively.

Objetivos: Avaliar o impacto da inclusão de um médico fisiatra na coordenação da Equipa de Gestão de Altas e da referenciação direta pela Medicina Física e de Reabilitação para a Rede Nacional de Cuidados Continuados.Materiais e métodos: Análise estatística de base de dados disponibilizados pela Equipa de Gestão de Altas de um hospital relativamente a 2017. Comparação dos resultados com 2016 e entre os processos referenciados pela Medicina Física e de Reabilitação e os por outras especialidades.Resultados: Em 2017 foram referenciados pela Equipa de Gestão de Altas 678 doentes, menos 103 doentes que em 2016, com menos 5,8% de processos cancelados e mais 4,4% de óbitos prévios à sua inclusão. Os tempos médios de espera para cada unidade foram sobreponíveis nos dois anos. A partir de abril de 2017, os fisiatras referenciaram 219 doentes, dos quais 50,2% foram para Unidade de Média Duração e Reabilitação, 41,6% para Unidade de Convalescença e 8,2% para Equipa de Cuidados Continuados Integrados. Os tempos médios de espera globais foram inferiores para os casos referenciados por fisiatra face aos das outras especialidades, no entanto analisando cada unidade em particular os mesmos foram sobreponíveis. Dos doentes referenciados pelo fisiatra apenas 14,2% foram cancelados, 7,3% faleceram e 75,8% dos doentes foram colocados, enquanto pelas outras especialidades: 29,3% foram cancelados, 27,1% faleceram e 39,3% foram colocados.Conclusões: O papel do fisiatra é essencial na avaliação clínica e determinação do potencial de reabilitação e terapêuticas de reabilitação, favorecendo a celeridade do processo e otimização dos recursos existentes.

Shoulder injury related to vaccine administration (SIRVA) are rare events that can lead to multiple diagnosis, such as bursitis, muscle rupture, adhesive capsulitis, chondral injury and infection.The authors describe the case of a 39-year-old nurse, who developed severe left omalgia shortly after receiving the second dose of COVID-19 vaccine. She attended an Occupation Health consultation, after four weeks of clinical worsening and was referred for a Physical Medicine and Rehabilitation consultation. On objective examination she presented pain during the mobilization of her left shoulder and loss of mobility, and it was made the diagnosis of adhesive capsulitis. Ultrasound guided suprascapular nerve block and hydrodistension of the joint capsule were performed with immediate symptomatic relief. She started later physiotherapy sessions that are still being performed.The correct anatomical positioning of the needle as well as the choice of its length are essential to prevent this type of injury, since deeper inoculations can contribute to the immune response to the injected material. It is also essential to alert and train health professionals responsible for administering vaccines, in order to carry out rapid diagnosis and appropriate treatment.

Background: Peripheral arterial disease (PAD) is strongly associated with increased cardiovascular risk and limitswalking ability, further contributing to physical inactivity, cardiopulmonary and peripheral muscledeconditioning, worsened cardiovascular risk factor profile further compromising prognosis of ischemiccardiomiopathy.Objective: Establish prevalence of vascular claudication in a hospital-based cardiac rehabilitation (CR) setting, andassess its influence on cardiac rehabilitation outcomes, including functional, psychosocial and quality of lifeaspects.Methods and Subjects: Longitudinal interventional study of patients who completed a two-month phase II CRprogram, recruited between October 2008 and March 2010. Data on sociodemographic, clinical, laboratorial,echocardiographic and functional capacity was collected from clinical files. Quality of life and walking limitationwere assessed by Short-Form 36 (SF-36) version 2 and the Walking Impairment Questionnaire (WIQ), respectively.The authors summarized walking ability using a mean value of the three components of the WIQ, and furthercategorized patients in two groups: claudicating (<80%) and non-claudicating (≥80%).Results: A total of 126 patients were analyzed, including 47 (40,8%) with clinical claudication. Except for gender,with higher proportion of claudication in males (p<0,05), there were no difference between groups in age, levelof education or professional status. Prevalence of hypertension, diabetes, tobacco consumption, overweight andabdominal obesity was higher in the claudicating group. Walking impairment was associated with higher levelsof anxiety, depressive symptoms, lower functional capacity and functional impairment in both physical andmental dimensions of health-related quality of life, both at program entry and completion. Both groups showedsimilar improvements in anthropometric, functional and quality of life measures.Conclusions: An individually tailored CRP allows for significant gains in functional capacity and health-relatedquality of life, even in those severely impaired by their peripheral arteriopathy. Adjustments in both intensity andvolume of exercise training sessions will allow for significant improvements and compliance withrecommendations for secondary prevention in coronary heart disease in this subset of the coronary heart diseasepatients.Keywords: Peripheral Arterial Disease; Cardiac Rehabilitation.

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Introduction: The goal of this study was to find the existing evidence about the suprascapular nerve block in chronic shoulder pain. Methods: The term “suprascapular nerve block” was searched at PubMed, in October 2015, with 156 analyzed articles. The inclusion criteria were experimental studies with non-continuous suprascapular nerve blocks in patients with chronic shoulder pain not surgery-related.Results: After the application of the inclusion/exclusion criteria, 8 studies were selected: 7 randomized controlled trials and 1 case series. Of these trials, only 2 were placebo controlled with saline injection. The most frequent pathologies were adhesive capsulitis, hemiplegic shoulder pain and glenohumeral osteoarthritis. The procedures were guided by ultrasound, electromyography or anatomy landmarks and the most frequent drugs used were a mixture of bupivacaine and metilprednisolone. All the studies reported significant improvements in pain and range of motion scores (p < 0.05), which are analyzed.Discussion: There are multiple variations among the studies, from the number of injections (1-3), the drugs used (with or without corticosteroid), the studied pathologies and the control groups. However, across all the studies there is a longitudinal improvement in patient’s pain and range of motion scores.Conclusion: Suprascapular nerve block may be an effective treatment in chronic shoulder pain. Additional quality studies are needed to find in which pathologies it may be useful and which are the most efficient injected drugs and treatment regime.

Introduction: Informal caregivers are the people who take care of other persons in a chronic, deficiency or dependent situation, partially or totally, temporarily or forever, besides their regular work. There are several functions related to informal caregivers and the act of caring is related to several positive and negative aspects that are important to identify in order to plan and discuss a correct health plan. It is essential that health care professionals know the impact of the act of caring in the caregivers.Methods: The used databases were “Medline”, “PEDro” and “Scielo and the keywords used were “Informal”, “Caregiver”, “Palliative” to conduct a narrative review that obtained 173 articles that were later reduced to 12 articles by analysis and filter utilization. The goal of this work was to make a literature review of consequences of the act of caring in the informal caregivers.Results: From the 12 articles there was not any positive aspect of the act of caring. On the contrary, there were innumerable negative aspects associated with caring. Female caregivers were more affected by the negative effects of caring.Discussion: The act of caring is associated with positives and negatives aspects that are diffused in the literature. However, only the negative aspects were focused on the analysed articles. The bigger impact of the negative aspects and the highest prevalence of female caregivers were also accord to the literature.Conclusion: The increased aging of population is related with a more dependent status and will demand an increase number of caregivers. The act of caring is associated with several positive and negative aspects that should be remembered in order to make the best decisions in health planning. Health professionals should be sensitized to these aspects so they can be able to decrease them and potentiate the support by the caregivers.

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Introduction: Patients discharged from the Intensive Care Units (ICU) with tracheostomy tubes in situ are increasing; optimal care of patients with tracheostomy is provided by inter/multidisciplinary care teams. This article makes a literature review and presents a study conducted at an Acute Patient Care Unit (APCU), cocoordinated by a Physiatrist.Material and Methods: Data were collected retrospectively, for the 40 patients with tracheostomy admitted to the APCU from May 2011 to 2013. Reference department, mean age, main diagnosis, medical/ surgical pathology, time to decannulation, hospital length of stay, percentage of decannulations and discharge destination were recorded. Statistical analysis was performed for functional improvement in all patients and by subgroups (decannulated versus non decannulated). For literature review we searched MEDLINE database. A comparative analysis was performed between APCU outcomes and literature data.Results: Forty patients with tracheostomy were admitted to the APCU. The average age was 59.6 years. 77.5% of patients were decannulated, 100% successfully. The mean time to decannulation was 35 days and the mean hospital length of stay was 60.9 days. Functional scores at admission date were statistically different from functional scores at discharge (p < 0.001), and decannulated patients have higher functional improvement than those who remained with a tracheostomy tube in situ (p = 0.023). Mean age, time to decannulation and hospital length of stay were at the upper limit of that described in the literature.Conclusion: Inter and multidisciplinary care model for patients with tracheostomy has a favourable impact. The APCU described represents a growing experience providing care for patients with tracheostomy. Decannulated APCU’s patients verified greater functional improvement than those who remained with a tracheostomy tube in situ. The mean age, time to decannulation and hospital length of stay were at the upper limit of that described in the literature, probably due to higher severity-of-disease scores, more comorbidities and provide rehabilitation regardless predetermined hospital length of stay. APCU may be demonstrative of an innovative healthcare Physical Medicine and Rehabilitation (PRM) clinical area.

Adolescent idiopathic scoliosis (AIS) is defined as three- dimensional deformation of the spine with a lateral curvature on the frontal plane greater than 10° and age of onset greater than 10 years, with no underlying etiology. The clinical assessment requires the exclusion of other etiologies. Management of AIS is determined according to the magnitude of the curve and remaining growth potential. The main goals of the conservative management are the control of curve progression, prevention of future complications, improve aesthetic appearance and quality of life. Orthotic management (bracing) of scoliosis, particularly rigid braces, has greater scientific evidence in AIS compared to other conservative strategies. There is a dose-response effect in bracing and non-adherence to the treatment is the main cause for loss of effectiveness which demands an appropriate monitoring. Electronic monitoring with compliance sensors applied on braces is an effective strategy for AIS monitoring. Scoliosis-specific exercises have some evidence in AIS, but in lesser degree compared to bracing, and can be used as an individual strategy or as a complement of bracing. The Schroth method and the Scientific Exercise Approach to Scoliosis accounts more evidence supporting better control of AIS. Management of AIS is complex and therefore it requires an individualized and integrative approach with multidisciplinary teams based on the current recommendations and scientific evidence which are highlighted throughout this work as well as some innovations in study.

Snapping Scapula Syndrome is a rare disorder that consists mainly in an audible and/or palpable crepitus of thescapula with movements on the scapulo-thoracic plane. This crepitus is often associated with shoulder or cervicodorsalpain. Patients generally seek medical help for pain relief.This syndrome can have many causes, originating from the various anatomical structures involved in the scapulothoracicmovement (bone, muscle, bursa…). The diagnosis is clinical, although imaging studies can be helpful inthe identification of the underlying cause.Most patients with Snapping Scapula Syndrome are treated conservatively, with a rehabilitation program andanalgesic medication. Surgical approach can be beneficial in patients that do not respond to the nonoperativetreatment, although its execution is still not consensual.The authors present the case of a patient with Snapping Scapula Syndrome, its diagnostic and therapeuticapproach and a revision of the literature on this pathological entity.Keywords: Scapula, Shoulder pain, Case Report.

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