RESUMO
OBJECTIVE: To evaluate in the follow-up the sensory-motor recovery and quality of life patients 2 months after completion of the Nintendo Wii console intervention and determine whether learning retention was obtained through the technique. METHODS: Five hemiplegics patients participated in the study, of whom 3 were male with an average age of 54.8 years (SD = 4.6). Everyone practiced Nintendo Wii therapy for 2 months (50 minutes/day, 2 times/week, during 16 sessions). Each session lasting 60 minutes, under a protocol in which only the games played were changed, plus 10 minutes of stretching. In the first session, tennis and hula hoop games were used; in the second session, football (soccer) and boxing were used. For the evaluation, the Fulg-Meyer and Short Form Health Survey 36 (SF-36) scales were utilized. The patients were immediately evaluated upon the conclusion of the intervention and 2 months after the second evaluation (follow-up). RESULTS: Values for the upper limb motor function sub-items and total score in the Fugl-Meyer scale evaluation and functional capacity in the SF-36 questionnaire were sustained, indicating a possible maintenance of the therapeutic effects. CONCLUSION: The results suggest that after Nintendo Wii therapy, patients had motor learning retention, achieving a sustained benefit through the technique.
Assuntos
Terapia por Exercício , Hemiplegia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Extremidade Superior/inervação , Jogos de Vídeo , Terapia de Exposição à Realidade Virtual , Feminino , Seguimentos , Nível de Saúde , Hemiplegia/diagnóstico , Hemiplegia/fisiopatologia , Hemiplegia/psicologia , Humanos , Aprendizagem , Estudos Longitudinais , Masculino , Saúde Mental , Pessoa de Meia-Idade , Atividade Motora , Neurônios Motores , Qualidade de Vida , Recuperação de Função Fisiológica , Sensação , Células Receptoras Sensoriais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Clinical observations indicate that many children with hemiplegic cerebral palsy (HCP) exhibit a lack of use or disregard of the affected upper limb. The aim of the present study was to develop, adapt, and verify the psychometric properties of a neuropsychological battery to assess body perception and representation disturbances in children with HCP. Three groups of children participated in this study, who took part in different phases of the validation process: one group of typically developing children (TD; n = 30; aged 4-6 years) and two groups of HCP children (HCP1: n = 12, aged 5-10 years; HCP2: n = 49, aged 5-13 years). Because no cognitive-neuropsychological model of body representation has been specifically developed for children, the tasks were designed based on a cognitive-neuropsychological model developed for adults. The chosen model comprises three levels of body representation: body schema, body structural description, and body image. The following steps were adopted in developing the instrument: development and choice of the tasks, selection and preparation of stimuli, adequacy and improvement of the instrument, semantic analysis of items, internal consistency, and feasibility and acceptability of application for TD and HCP children. The final set of tasks and items was chosen to balance the levels of difficulty and internal consistency. We concluded that the final battery was adequate and can be used to assess body representation disturbances in children with HCP.(AU)
Assuntos
Humanos , Pré-Escolar , Criança , Hemiplegia/psicologia , Paralisia Cerebral , Imagem Corporal/psicologia , Testes NeuropsicológicosRESUMO
Clinical observations indicate that many children with hemiplegic cerebral palsy (HCP) exhibit a lack of use or disregard of the affected upper limb. The aim of the present study was to develop, adapt, and verify the psychometric properties of a neuropsychological battery to assess body perception and representation disturbances in children with HCP. Three groups of children participated in this study, who took part in different phases of the validation process: one group of typically developing children (TD; n = 30; aged 4-6 years) and two groups of HCP children (HCP1: n = 12, aged 5-10 years; HCP2: n = 49, aged 5-13 years). Because no cognitive-neuropsychological model of body representation has been specifically developed for children, the tasks were designed based on a cognitive-neuropsychological model developed for adults. The chosen model comprises three levels of body representation: body schema, body structural description, and body image. The following steps were adopted in developing the instrument: development and choice of the tasks, selection and preparation of stimuli, adequacy and improvement of the instrument, semantic analysis of items, internal consistency, and feasibility and acceptability of application for TD and HCP children. The final set of tasks and items was chosen to balance the levels of difficulty and internal consistency. We concluded that the final battery was adequate and can be used to assess body representation disturbances in children with HCP...
Assuntos
Humanos , Pré-Escolar , Criança , Paralisia Cerebral , Hemiplegia/psicologia , Imagem Corporal/psicologia , Testes NeuropsicológicosRESUMO
Introducción: la hemiplejía como consecuencia de un ictus constituye una importante causa de discapacidad. La continuidad y calidad en el proceso rehabilitador supone mejores perspectivas en el pronóstico de los pacientes. Objetivo: evaluar el grado de discapacidad en los pacientes hemipléjicos del área de salud del Policlínico Docente Universitario del Cerro. Métodos: estudio descriptivo, transversal en los pacientes que acudieron consecutivamente al área de rehabilitación del citado policlínico, desde septiembre de 2009 hasta julio de 2011. La muestra estuvo constituida por 124 hemipléjicos por enfermedad cerebrovascular mayores de 15 años, los cuales fueron evaluados con la Escala de Discapacidad de Rosetón. Se excluyeron los enfermos con afasia sensorial o mixta y aquellos que se negaron a participar. Resultados: en 84 (67,8 porciento) pacientes se encontró independencia para la orientación y predominó la semidependencia para el desplazamiento y las necesidades físicas. Para la higiene personal, 48 (38,7 porciento) pacientes resultaron ser dependientes. La falta de motivación para ocupar el tiempo libre se encontró en 92 (74,2 porciento) pacientes, casi siempre por dificultades en la convivencia y en las relaciones familiares. Conclusiones: el grado de discapacidad de los pacientes hemipléjicos evaluados viene dado por la semidependencia en el desplazamiento y las necesidades físicas y la dependencia para el autocuidado. Las dificultades en la convivencia y las relaciones familiares interfieren en la motivación del paciente para ocupar el tiempo libre
Introduction: hemiplegia is an important cause of disability as a result of a stroke. The persistence and quality of the rehabilitative process lead to better results in the patient prognosis. Objective: to evaluate the extent of disability in hemiplegic patients from the health area under Cerro university teaching polyclinics. Methods: a cross-sectional and descriptive study was conducted in hemiplegic patients who regularly went to the rehabilitation service of Cerro polyclinics from September 2009 to July 2011. The sample consisted of one hundred and twenty four over 15 years-old hemiplegic patients due to cerebrovascular disease, who were evaluated according to the Rosseton's disability scale. Those patients with mixed or sensory aphasia and those who refused to participate were excluded. Results: of the participants, 84 (67.8 percent) patients were independent for orientation whereas semi-dependence for movement and physical needs prevailed. For personal hygiene, 48 (38.7 percent) patients were dependent. Ninety two (74.2percent) patients did not feel motivated to spend their leisure time in doing any activity, basically because of difficulties in living together with their relatives. Conclusions: the extent of disability of evaluated hemiplegic patients is caused by their partial dependence in terms of movement, and physical needs and by their dependence for self-care. Difficulties in coexistence and family relationships interfere with the motivation of the patients to spend their leisure time
Assuntos
Humanos , Masculino , Feminino , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/reabilitação , Saúde da Pessoa com Deficiência , Hemiplegia/epidemiologia , Hemiplegia/psicologia , Hemiplegia/reabilitação , Estatísticas de Sequelas e Incapacidade , Estudos Transversais , Epidemiologia DescritivaRESUMO
OBJECTIVE: To assess the perception of patients with chronic hemiplegia regarding the use of assistive walking devices (AWD). METHODS: Twenty-three individuals who met the inclusion criteria and used AWD were recruited from a database of 360 stroke survivors. Their mean age was 58.4 years, mean time since stroke was 80.8 months, and mean time using AWD was 67.6 months. To assess the participants' perception, was used a standardized questionnaire covering the impact of AWDs on five aspects: weight-bearing on the paretic limb; ability to move the paretic limb; confidence; safety; and walking style. Possible answers were "improved," "unchanged," or "decreased." RESULTS: Fourteen individuals used canes and nine used elbow crutches; 21 (91.3%) used AWDs on public roads and only two (8.7%) used AWDs at home. The perception regarding the use of AWDs were positive in the first four questions (6.87 < χ2 < 29.83; 0.0001 < P < 0.03), with reports of improvement in weight-bearing (82.6%), ability to move the paretic limb (39.1%), confidence (82.6%), and safety (86.9%). No significant differences were found in terms of walking style (χ2 = 1.09; P = 0.30). CONCLUSIONS: The perception of chronic hemiplegic subjects regarding the use of AWD were positive, suggesting that these devices can improve mobility and independence in activities of daily living.
Assuntos
Atitude Frente a Saúde , Bengala , Muletas , Hemiplegia/psicologia , Hemiplegia/reabilitação , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJETIVO: Avaliar a percepção de hemiplégicos crônicos sobre o uso de dispositivos auxiliares (DA) na marcha. MÉTODOS: A partir de um banco de dados de 360 hemiplégicos, foram recrutados 23 indivíduos que utilizavam DA e preenchiam os critérios de inclusão. A média de idade foi de 58,4 anos, tempo pós-acidente vascular encefálico de 80,8 meses e tempo de uso do DA de 67,6 meses. Para avaliar a percepção dos participantes, utilizou-se um questionário padronizado, composto por cinco questões: impacto do DA na habilidade para descarregar peso no membro parético; impacto na habilidade para movimentar o membro parético; impacto na confiança; impacto na segurança; e impacto no jeito de caminhar. As respostas possíveis eram "melhorou", "não alterou" ou "piorou". RESULTADOS: Quatorze indivíduos utilizavam bengalas e nove utilizavam muletas canadenses; 21 (91,3 por cento) utilizavam DA somente em vias públicas e dois (8,7 por cento) utilizavam DA também em ambiente domiciliar. A percepção em relação ao uso do DA foi positiva nas quatro primeiras questões (6,87 < χ2< 29,83; 0,0001 < P < 0,03), com relatos de melhora na descarga de peso (82,6 por cento), na habilidade de movimentar o membro parético (39,1 por cento), na confiança para caminhar (82,6 por cento) e na segurança (86,9 por cento). Não foram observadas diferenças significativas para o item jeito de caminhar (χ2= 1,09; P = 0,30). CONCLUSÕES: A percepção dos indivíduos hemiplégicos crônicos foi positiva em relação ao uso de DA para deambulação, sugerindo que esses dispositivos podem melhorar a mobilidade e a independência durante as atividades de vida diária.
OBJECTIVE: To assess the perception of patients with chronic hemiplegia regarding the use of assistive walking devices (AWD). METHODS: Twenty-three individuals who met the inclusion criteria and used AWD were recruited from a database of 360 stroke survivors. Their mean age was 58.4 years, mean time since stroke was 80.8 months, and mean time using AWD was 67.6 months. To assess the participants' perception, was used a standardized questionnaire covering the impact of AWDs on five aspects: weight-bearing on the paretic limb; ability to move the paretic limb; confidence; safety; and walking style. Possible answers were "improved," "unchanged," or "decreased." RESULTS: Fourteen individuals used canes and nine used elbow crutches; 21 (91.3 percent) used AWDs on public roads and only two (8.7 percent) used AWDs at home. The perception regarding the use of AWDs were positive in the first four questions (6.87 < χ2 < 29.83; 0.0001 < P < 0.03), with reports of improvement in weight-bearing (82.6 percent), ability to move the paretic limb (39.1 percent), confidence (82.6 percent), and safety (86.9 percent). No significant differences were found in terms of walking style (χ2 = 1.09; P = 0.30). CONCLUSIONS: The perception of chronic hemiplegic subjects regarding the use of AWD were positive, suggesting that these devices can improve mobility and independence in activities of daily living.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Atitude Frente a Saúde , Bengala , Muletas , Hemiplegia/psicologia , Hemiplegia/reabilitação , Doença Crônica , Estudos TransversaisRESUMO
Se presentan 3 casos de somatoparafrenia reunidos en el curso de 30 años. Se trata de adultos con lesiones vasculares extensas del hemisferio derecho, con hemiplejia, heminanestesia y heminanopsia. Todos tuvieron la convicción delirante de que su brazo paralizado pertenecía a un familiar próximo. Se señala la variabilidad de los síntomas (somatoparafrenia, personificación, misoplejia), la relación de estos con la anosodiaforia más que con la anosognosia y con lesiones del hemisferio derecho. Se concluye que, a semejanza de los problemas en el reconocimiento de rostros o del entorno, es necesario distinguir entre el nivel de la percepción y el nivel de la interpretación como propio o como familiar.
Assuntos
Masculino , Feminino , Pessoa de Meia-Idade , Humanos , Delusões , Hemiplegia/psicologia , Transtornos Psicofisiológicos , Agnosia , Imagem Corporal , Delírio , Alucinações , Transtornos SomatoformesRESUMO
Bilateral hand skill assessment with a computerised version of the Peg Moving Task, and neuropsychological testing, were performed in 30 children aged 7 to 8 years with spastic cerebral palsy (CP) and without mental retardation, diplegia (n = 10), right hemiplegia (n = 10), or left hemiplegia (n = 10), and in 30 controls. Compared to controls: (i) 30% of the hemiplegic children showed impairment of the unaffected hand and 70% of the diplegic children showed impairment in both hands; (ii) children with CP were impaired only in oral repetition and in visual-motor tasks. Results of neuropsychological testing were not significantly different between the three groups of children with CP. Right minus left asymmetry in hand skill was not related to neuropsychological testing; however, degree of impairment of the right hand was associated with phonological and metaphonological skills, and of the left hand with visuospatial and counting performance. Hand skill was related to the ability to perform many daily living manual activities. It is concluded that impairment of hand function, rather than the side of the more affected hand, is related to neuropsychological deficits in children with cerebral palsy.
Assuntos
Paralisia Cerebral/psicologia , Lateralidade Funcional , Destreza Motora , Testes Neuropsicológicos/estatística & dados numéricos , Desempenho Psicomotor , Atividades Cotidianas/classificação , Brasil , Criança , Dominância Cerebral , Feminino , Hemiplegia/psicologia , Humanos , Masculino , Psicometria , Valores de Referência , Estatística como AssuntoRESUMO
The aim of the present study was to evaluate the psychometric properties of the Brazilian version of the Nottingham Health Profile (NHP), a generic instrument for quality of life assessment. This NHP was translated to Portuguese, following recommended methodology, and applied to 215 subjects, being 170 community elderly (66.3 +/- 8.5 years), 30 chronic stroke survivors (56.4 +/- 10.9 years), and 15 parkinsonians (59.6 +/- 10.2 years). The data was analysed by Rasch analysis. Out of the 38 items of NHP, only two items (5%) did not fit the statistical model, indicating that the items collaborated to measure a unidimensional construct. However, some items of NHP were very easy for the elderly, stroke survivors and Parkinsonians, characterizing a ceiling effect, which could limit the use of the scale for individuals with higher levels of ability. The results, in spite of indicating that the instrument fits the Rasch statistical model for this sample, indicate a need for revision of the items, in order to make the questionnaire more clinically useful.
Assuntos
Indicadores Básicos de Saúde , Qualidade de Vida , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemiplegia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/psicologia , Psicometria , Qualidade de Vida/psicologia , TraduçãoRESUMO
Se analiza la falta de noción de enfermedad y las confabulaciones en pacientes neurológicos con distintos defectos: hemiplejia, defectos visuales, defectos de la memoria, del lenguaje, traumatismo encefalocraneanos y demencia. Se discute la posible importancia de transtornos emocionales, de defectos focales y del deterioro cognitivo general como factores del desconocimiento de la enfermedad. Se concluye que existe una relación psicopatológica entre tener un defecto, ser anosognósico, y confabular suponiendo un rendimiento normal. Además se plantea que existiría un sistema funcional de darse cuenta, constituido por diversas áreas cerebrales importantes para el monitoreo de diferentes funciones y por las áreas prefrontales