RCAAP Repository

A afasia cruzada caracteriza-se por um distúrbio adquirido da linguagem causado por uma lesão hemisférica cerebral direita em dextros, com uma prevalência de 1% - 2%.Os autores reportam o caso clínico de um homem de 69 anos de idade, dextro, com múltiplos fatores de risco cardiovascular.Assintomático até 28 de setembro de 2017, altura em que inicia quadro de alteração da linguagem e défice motor esquerdo, motivo pelo qual foi admitido no serviço de urgência onde efetuou estudo imagiológico cerebral que evidenciou lesões isquémicas hemisféricas direitas. Realizou trombólise endovenosa e trombectomia mecânica. Apresentou agravamento neurológico 24 horas após o início do quadro clínico, pelo que repetiu o estudo imagiológico que mostrou lesões isquémicas cortico-subcorticais fronto- temporo-parieto-insular direitas com envolvimento da região caudado-lenticulo-capsular.Admitido em Unidade de Acidente Vascular Cerebral e, posteriormente, no Serviço de Medicina Física e de Reabilitação. À avaliação inicial, além do défice motor esquerdo apresentava alterações da linguagem compatíveis com afasia global. Foi integrado num programa de reabilitação, com evolução lenta do quadro afásico e motor.O prognóstico da afasia cruzada relaciona-se com a localização e gravidade da lesão cerebral. Dada a gravidadeda lesão do doente será de esperar uma evolução lenta/estabilização do quadro clínico.

Objective: to determine if in a population of spinal cord injury above D11 patients the use of an abdominal binder(AB) improves or not respiratory function. Material and Methods: it was done a longitudinal retrospective study,and selected all inpatients that were in Spinal Cord Injury Department of Centro de Medicina de Reabilitação deAlcoitão – Portugal - with tetraplegia or paraplegia with neurological level above D11, between the 1st of Januaryand the 31st of March 2009, that have done functional respiratory tests with and without AB. We analyse thefollowing parameters: forced vital capacity (FVC), total lung capacity (TLC), residual volume (RV), inspiratorypressure (IP) and expiratory pressure (EP). It was used SPSS 11.5 and T-student test for statistical analysis. Results:AB use increased FVC (p=0,02) and EP (p=0,004), and decreased RV (p=0,00). Conclusions: this study foundevidence that AB use in patients with tetraplegia or paraplegia with neurological level above D11 improvespulmonary ventilatory function.Keywords: Spinal cord injuries; Abdominal binder; Abdomen; Respiration; Restraint, Physical.

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Actualmente a sobrevida tem aumentado em doentes com cardiopatias congénitas devido aos avanços da medicina. No entanto, a maioria ainda não realiza actividade física regular, não por impedimento devido à sua patologia de base, mas por receios dos próprios, familiares e professores. Além disso programas de reabilitação cardíaca com benefícios bem conhecidos nos adultos, ainda são pouco realizados em crianças e adolescentes, desconhecendo-se a sua metodologia e resultados a nível das capacidades funcionais e estado psicológico destes doentes. Os autores realizaram uma revisão da literatura sobre as evidências actuais dos programas de reabilitação cardíaca em crianças e adolescentes com cardiopatias congénitas e quais as recomendações actuais sobre a prática de exercício físico.A maioria dos estudos relata os efeitos benéficos de programas de reabilitação cardíaca multidisciplinares, incluindo orientação psicológica e nutricional, na diminuição do número de reinternamentos, melhoria das capacidades funcionais e qualidade de vida destes doentes. Concomitantemente, são inúmeros os artigos que salientam que a prática de exercício físico e participação em desportos de competição na maioria dos casos é possível e segura, desde que seguidas as recomendações necessárias para a patologia em concreto e tendo em conta o doente de forma individual, cabendo ao médico assistente dar todo o aconselhamento necessário em relação a este assunto em particular.

Musculoskeletal complaints take a place in the primary health care consultation grounds. Synthetic injectable corticosteroids (CCT) have been widely used as anti-inflammatory agents in several musculoskeletal disorders, both articular and soft tissues, allowing greater symptomatic control, greater range of motion and / or improved function. The effectiveness in its use depends not only on a correct medical diagnosis, but also on the selection of the most appropriate drug and on the technical execution of the procedure. Currently, there is little evidence to guide the selection of the most appropriate CCT. This review article offers an overview of the different CCT preparations that can be used in injectable procedures in musculoskeletal pathology, their indications and complications in order to assist the physician in choosing the best drug. The choice must be guided by the objective, the underlying musculoskeletal diagnosis and clinical experience. Complications resulting from its use are rare, but the doctor must be alert and understand its potential risks, in order to properly advise the patient.

Objectives: Non-traumatic spinal cord injury (NTSCI) presents a significant challenge for treatment and rehabilitation and a thorough knowledge of this population may help to adjust service responses to need. We perform a retrospective analysis of first-admission NTSCI patients in a specialized spinal cord injury service in Portugal. Methods: Medical records of all NTSCI patients first admitted between 01/01/2007 and discharged up to 30/11/2009 were sought. Patients who presented with a time to injury window greater than 24 months and who had prior rehabilitation in another specialized service were excluded. Epidemiological and injury etiology variables were collected, as well as neurological and functional outcome measures (ASIA Impairment Classification, FIM, bladder control, ambulation, and complications). Statistical analysis of data was performed using SPSS for Windows® version 17.0. Results: A total of 69 patients met criteria for inclusion. There was a slight male predominance (55.1%) and the average age was 58 years. The most common NTSCI etiologies were tumors (20.3%), degenerative diseases (18.8%) and iatrogenesis (18.8%). Less prevalent causes included infectious, idiopathic, vascular and autoimmune diseases. Paraplegia occurred in 79.7% of cases and most of the study population had incomplete injuries (89.9%). Urinary tract infections (62.5%) and nociceptive and neuropathic pain (48.4%) were the most prevalent complications. There was a significant functional improvement after the rehabilitation program. Conclusions: Data obtained from this sample is consistent with the literature, suggesting an similar gender incidence, a predominant incomplete neurological injury and a favorable outcome with the rehabilitation program.Keywords: Spinal cord injuries; Rehabilitation.

Objectivos: Avaliar a repercussão da preservação ou substituição da rótula em doentes com gonartrose submetidos a artroplastia total do joelho (ATJ) na duração do internamento e evolução da funcionalidade após reabilitação em internamento num Serviço de Medicina Física e de Reabilitação (MFR). Material e Métodos: Estudo retrospectivo comparativo entre dois grupos de 10 doentes cada submetidos a ATJ com preservação (grupo A) ou substituição (grupo B) da rótula, ambos com próteses do mesmo modelo e conservação do ligamento cruzado posterior. Grupos pareados para raça, género, idade e índice de massa corporal (IMC). Critérios de inclusão: gonartrose primária, ATJ primária unilateral e reabilitação em internamento em MFR. Critérios de exclusão: gonartrose secundária, artroplastia prévia dos membros inferiores, cirurgia bilateral e complicações pós-operatórias. Foram analisados a duração do internamento em MFR e os ganhos nas escalas de funcionalidade, flexibilidade do joelho, força muscular e autonomia na marcha, necessidade de ajudas técnicas, transferências e actividades de vida diária (AVD). Avaliaram-se também a duração da reabilitação no Serviço de Ortopedia, intercorrências no Serviço de MFR, comorbilidades e medicação. Resultados: Não se verificaram diferenças estatisticamente significativas entre os dois grupos no índice de massa corporal (p=0.880). Os dois grupos registaram diferenças estatisticamente significativas na idade (p=0.044). Não se encontrou evidência estatística de diferenças entre os grupos A e B na duração de internamento em MFR (p=0.569) e nos ganhos nas escalas de funcionalidade (valores de p superiores a 0.21) e na flexibilidade (valores de p>0.17), força muscular (p=1) e autonomia na marcha, ajudas técnicas e AVD (valores de p>0.34). Para todos os parâmetros, nos 20 doentes, verificou-se evidência de diferenças estatisticamente significativas nos registos obtidos nos momentos de entrada e alta do Serviço de MFR (valores de p inferiores a 0.01). Conclusões: Na amostra em estudo, a opção entre a preservação ou substituição da rótula durante a ATJ primária unilateral parece não influenciar a duração do internamento e a evolução da funcionalidade após a reabilitação num Serviço de MFR. O programa de reabilitação em regime de internamento conduz a ganhos na funcionalidade e autonomia dos doentes. Palavras-chave: Osteoartrose, Joelho; Artroplastia de Substituição do Joelho; Rótula; Reabilitação. 

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Lance-Adams syndrome, or chronic posthypoxic myoclonus, is a rare complication of successful cardiopulmonary resuscitation often associated with cerebellar ataxia. The authors report a 41-year-old patient who presented with clinical features of dysarthria, tetraplegia, severe myoclonus, dysdiadochokinesia and cerebellar ataxia after respiratory arrest in the context of chemotherapy treatment. These symptoms resulted in marked functional consequences with inability to stand or perform activities of daily living. Hypoxic encephalopathy with Lance-Adams syndrome was assumed. Implementation of pharmacological treatment coupled with an intensive interdisciplinary rehabilitation program produced marked symptomatic and functional improvements which permitted autonomous activities of daily living and supervised locomotion after 7 months. The aim of this report was to emphasize the importance of the correct diagnosis and proper management of Lance-Adams syndrome leading to the improvement of the patients’ functional outcomes.

Introduction: many available instruments for the evaluation of balance, fall risk and fear of fallingmeasure simple indoors activities and present a “ceiling effect” in community dwelling elderly. The “ActivitiesspecificBalance Confidence (ABC) Scale” was designed to evaluate balance more thoroughly in several activitiesof daily living with different levels of difficulty.Objectives: translate to Portuguese and culturally adapt to Portugal the “Activities-specific Balance Confidence(ABC) Scale” and to assess its’ reliability.Methods: translation and cultural adaptation of the instrument. Evaluation of an elderly Portuguese populationto assess the instrument’s intra and interobserver reliability and internal consistency.Results: Results showed great homogeneity in most of the compared data, either intra or interobserver. They also showhigh internal consistency. These reliability levels were preserved even when any of the 16 questions of thequestionnaire was removed, with values that were almost identical to those of the complete questionnaireConclusions: The Portuguese version showed good intra and interobserver reliability and internal consistency in the evaluation of balance self-perception for several activities of daily living in an elderly Portuguese population. Further studieswill be required to assess the usefulness of this instrument for the evaluation of fall risk and the effect oftherapeutic interventions in this population.Keywords: Activities of Daily Living; Postural Balance; Questionnaires.

Introduction: The automobile driving ability should be properly evaluated. The fitness to drive assessment is a medical competence involving medical, legislation and technology expertise. This should include a careful objective exam and performance tasks, which can be conveniently followed-up with a test in a driving simulator. In Portugal there is only a driving simulator for these effects. This study aims to characterize and promote the work done in the Mobility Centre of a Rehabilitation Medicine Centre in the context of assessing fitness to drive in individuals with disabilities.Material and Methods: There was carried out the characterization of the individuals evaluated in the current simulator (June 1, 2007 to December 31, 2013), particularly with regard to demographic characteristics, primary diagnosis, disability(ies) and evaluation result. Changes proposed after the fitness to drive assessment were studied too.Results: There were 1.145 evaluations, referring to 1.061 different individuals. The average age of the patients was 45 ± 16 years, 73% were males and 83% had a driving license. The most frequent primary diagnosis and motor disability were, respectively, spinal cord injury (32%) and hemiplegia/hemiparesis (32%). The patients were fit without adaptations (18%) or with adaptations (54%), or unfit (10%). The fitness was considered conditional in 17% of cases, suggesting further assessments. From the 749 individuals considered fit (conditional or not) for driving an adapted car, 30% and 18% needed 3 and 2 distinct adaptations, respectively. 1.947 adjustments were suggested in total, among which the most frequent was the automatic gearbox (34%).Conclusions: Any doctor can request a fitness to drive assessment by a multidisciplinary team (physiatrist and occupational therapist) with the particularity of conducting a test on a driving simulator. Driving is a complex task that requires attention and the proper use of physical, sensory and cognitive abilities. The fitness to drive assessment is essential whenever there are doubts about the individual’s competence, being the inclusion of a driving simulator test an important asset.

Objetivos: É objetivo do estudo a avaliação do impacto da Fampridina na marcha, equilíbrio, nível funcional e perceção da capacidade de marcha em doentes com Esclerose Múltipla.Material e Métodos: Estudo prospetivo, aberto, não controlado e não randomizado, em doentes com Esclerose Múltipla e EDSS entre 4,0-7,0 sob tratamento com Fampridina. Foram usados para a avaliação do impacto da Fampridina: Multiple Sclerosis Walking Scale 12 (MSWS-12), Timed 25-Foot Walk (T25FW), Timed Up and Go (TUG) e Escala de Equilíbrio de Berg (EEB). A análise estatística foi efetuada com um nível de significância estatística de p<0,05.Resultados: Um total de 15 doentes (88,24%) foram considerados respondedores. O aumento do equilíbrio, velocidade da marcha e na perceção da capacidade para a marcha foram estatisticamente significativos com melhoria média de 19,08% (± 31,11) no T25FW (p=0,022), 19,20% (±26,13) na EEB (p=0,012), 35,97% (±34,93) no TUG (p=0,022) e 12,99% (±12,90) na MSWS-12 (p=0,016). Há uma correlação forte e estatisticamente significativa entre TUG e T25FW (r= 0,668, p= 0,017).Conclusões: Os resultados preliminares mostram a potencialidade da Fampridina no aumento da velocidade da marcha, equilíbrio e perceção da capacidade da marcha em doentes com Esclerose Múltipla. São necessários estudos para caracterizar os preditores de eficácia de resposta e avaliação do potencial do fármaco noutros níveis funcionais.

Introduction: Stroke is the pathology with the highest mortality in Portugal. This study aims to analyze the functional evolution and the assess satisfaction with quality of life of stroke cases hospitalized in PRM acute hospital unit.Methods: This study is a retrospective cohort, analyzing data between 2017 and 2019, referring to inpatients in the PRM department. 106 patients whose diagnosis on admission was stroke were evaluated (divided into ischemic stroke (IS) and hemorrhagic stroke (HS) groups). Participants were characterized in terms of different variables, namely the characterization of functional status at admission (FIM). Also the quality of life using the Satisfaction with Life Scale (SWLS) was assessed. Finally, multiple linear regression models were performed in order to determine which factors had an impact on functional improvement in stroke cases.Results: Of the 106 patients, 76 were IS (72%) and 30 were HS (28%). The HS group had younger patients compared to the IS group (67.57 ± 11.41 vs 58.33 ± 11.33, p<0.001). There were no statistically significant differences between the IS and HS groups in terms of length of stay (pre-PRM length of stay: 13.66 ± 15.01 vs 11.53 ± 12.414, p=0.495; length of stay in PMR: 21 .74 ± 15.46 vs 22.10 ± 19.77, p=0.920; total length of stay: 35.39 ± 22.15 vs 33.63 ± 23.66, p=0.918), functional status at admission (68 .19 ± 17.25 vs 73.42 ± 16.50, p=0.198). However, there is a difference between the IS and HS groups regarding the functional status at clinical discharge (79.64 ± 19.67 vs 98.10 ± 20.04, p<0.001), as well as in the degree of improvement during the hospital stay (11.38 ± 7.08 vs 26.88 ± 14.40, p<0.001). A positive correlation of functional status at clinical discharge with the diagnosis of HS (β = 13.35, p=2.442) and with age (β = -0.268, p= 0.006). Finally, differences were found between the IS and HS groups in terms of satisfaction with quality of life (20.01 ± 5.33 vs 23.88 ± 6.07, p= 0.016).Conclusion: The results of this study reflect the importance of considering different variables of stroke cases in PRM units.

otal shoulder arthroplasty with reverse prosthesis based on Grammont’s initial model of 1985 has been gaining increasing popularity. Initially designed as a solution for cuff-tear arthropathy, its current indications have been broadened to include advanced gleno-umeral pathology caused by rheumatic, traumatic or osteonecrotic processes. Rehabilitation following this kind of surgery has its own particularities, such as the design of the prosthetic components, the biomechanical changes of the shoulder joint, and the different surgical techniques. Due to the demanding needs of postoperative care for this type of arthroplasty, the Department of Physical Medicine and Rehabilitation of Centro Hospitalar de Entre Douro e Vouga (Santa Maria da Feira, Portugal) has elaborated a rehabilitation protocol for the patients that are submitted to this intervention. It involves a series of pre and postoperative functional evaluations and a rehabilitation program that is based on three general guiding principles: articular protection, promotion of deltoid function, and therapeutic individualization. This protocol also serves the goal of keeping an updated physiatric prescription through serial functional evaluation and of promotion of communication between the several elements of the multidisciplinary team that are involved in the rehabilitation process.Keywords: Arthroplasty; Replacement; Shoulder Joint; Joint Prosthesis; Rehabilitation/standards; Prosthesis Design.

Introduction: Falls are one of the greatest health problems in the elderly, causing high mortality, morbidity, disability and premature institutionalization. The Activities-specific Balance Confidence (ABC) Scale evaluates balance in a broad set of activities. It was translated and adapted for several other languages and settings, including the Portugal-Portuguese “Escala CEEA”. This instrument lacks high risk of falling and normal mobility cut-off points. Objectives: To determine cut-off points for high risk of falling and normal mobility of the “Escala CEEA”. Methods: 90 evaluations of 50 individuals aged 65 years or older, referring balance impairment and/or history of falls. Evaluations comprised the “Escala CEEA” and the timed “up & go” (TUG) test. The TUG cut-off point of 13,5 seconds was used to determine the “Escala CEEA” cut-off point for high risk of falling. The TUG cut-off point of 12 seconds was used to determine the “Escala CEEA” scale cut-off point for normal mobility in women. In each case, “Escala CEEA” sensibility and specificity were analysed and the area under the curve (AUC) was determined. Results: The best “Escala CEEA” cut-off point corresponding to the TUG test cut-off point of 13,5 seconds was 695. The best “Escala CEEA” cut-off point corresponding to the TUG test cut-off point of 12 seconds was 795. Conclusions: Balance evaluation instruments cut-off points are clinically useful in the identification of community- dwelling elderly in high risk of falling or of losing their normal mobility. The best “Escala CEEA” cut-off point for high risk of falling was 700 (gross score), with a sensibility of 71,8% and a specificity of 73,7%. For elderly women between 65 and 85 years of age, the best “Escala CEEA” cut-off point for normal mobility was 800 (gross score), with a sensibility of 70,1% and a specificity of 72,2%. Keywords: Activities of Daily Living; Elderly; Postural Balance; Questionnaires. 

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Multifocal osteonecrosis, defined by the involvement of 3 or more anatomic sites, is unusual, being observed in only 3% to 11% of patients diagnosed with osteonecrosis. Guillain– Barré syndrome is an acute onset, usually monophasic immune-mediated disorder of the peripheral nervous system.The aim of this article is to report a clinical case of multifocal osteonecrosis and Guillain–Barré syndrome with review of the literature.We present a case of a 40-year-old male, with neurological symptoms who presented to the Emergency Department one week after a flu like syndrome. Myelitis was firstly suspected and corticosteroids were started. Diagnosis of Guillain–Barré syndrome was later confirmed and he underwent treatment with immunoglobulins. One year later, the patient developed bilateral hips and shoulders arthralgia. The diagnosis of multifocal osteonecrosis was established by magnetic resonance imaging. Total right hip arthroplasty was performed and a left one was planned. The patient underwent a rehabilitation program aiming pain relief and function improvement with a good outcome.In the last ten years literature review, there were no reports of the association between Guillain–Barré syndrome and multifocal osteonecrosis.