Levels Of Physical Disability Research Articles

Physical Exercise Moderates the Effects of Disability on Depression in People with Multiple Sclerosis during the COVID-19 Outbreak.

Physical disability impacts psychosocial wellbeing in people with multiple sclerosis. However, the role of physical activity in this context is still debated. By taking advantage of a previous survey, conducted online from 22 April to 7 May 2020, we performed a post-hoc analysis with the aim to assess the associations between disability, physical exercise, and mental health in multiple sclerosis. We retrieved the following data: (i) sociodemographic information, (ii) changes in lifestyle (including exercise), (iii) physical disability, as measured with the Patient-Determined Disease Steps scale, and (iv) anxiety feelings and depressive symptoms assessed via the items included in the Quality of Life in Neurological Disorders measurement system. Examination of the interaction plot showed that the effect of disability on depression, but not on anxious symptoms, was significant for all levels of physical exercise (low: b = 1.22, 95% C.I. 0.85, 1.58, p < 0.001; moderate: b = 0.95, 95% C.I. 0.66, 1.24, p < 0.001; and high: b = 0.68, 95% C.I. 0.24, 1.13, p = 0.003). Based on these data, we can conclude that disability significantly impacted depression during the COVID-19 pandemic, with physical activity playing a moderating role. Our results suggest that favoring exercise in multiple sclerosis (MS) would ameliorate psychological wellbeing regardless of the level of physical disability.

Identifying Early Neuropsychological Indicators of Cognitive Involvement in Multiple Sclerosis.

Multiple sclerosis (MS) is a debilitating disease of the central nervous system that is most commonly seen in early to middle adulthood, although it can be diagnosed during childhood or later in life. While cognitive impairment can become more prevalent and severe as the disease progresses, signs of cognitive involvement can be apparent in the early stages of the disease. In this review, we discuss the prevalence and types of cognitive impairment seen in early MS, including the specific measures used to identify them, as well as the challenges in characterizing their frequency and progression. In addition to examining the progression of early cognitive involvement over time, we explore the clinical factors associated with early cognitive involvement, including demographics, level of physical disability, disease modifying therapy use, vocational status, and psychological and physical symptoms. Given the prevalence and functional impact these impairments can have for persons with MS, considerations for clinicians are provided, such as the role of early cognitive screenings and the importance of comprehensive neuropsychological assessments.

Comparison of the Effect and Durability of Lumbar Stabilization and Global Postural Reeducation Exercises on Movement Control, Pain and Disability in Men with Lumbar Movement Control Dysfunction

Introduction: The global postural reeducation (GPR) method seems to be an effective method for the treatment of musculoskeletal disorders; therefore, the aim of this study was to compare the effect and durability of 6 weeks of GPR and lumbar stability exercises on movement control, pain and disability in men with chronic nonspecific low back pain (NSLBP) with lumbar movement control dysfunction.Methods: Based on the inclusion and exclusion criteria, 46 men with non-specific chronic low back pain (LBP) with lumbar movement control dysfunction were selected and randomly divided into three groups (two exercise groups - one control group). Training intervention groups practiced for six weeks, three sessions per week. Visual analogue scale (VAS), Roland Morris questionnaire, and movement control test were used to measure pain, level of physical disability, and lumbar movement control, respectively. Repeated measures ANOVA was utilized to compare the effect and durability of the two training protocols on the dependent variables at a significant level.Results: Results from this research showed that both types of exercises reduced pain (P = 0.001) and improved disability index (P = 0.001) and lumbar movement control (P = 0.001). Our findings suggested that a GPR intervention for 6 weeks (P = 0.040) and inactivity for 4 weeks (P = 0.001) resulted in a greater improvement in disability compared to the lumbar stabilization exercises (LSEs). Conclusion: Both types of exercises seem to be effective in improving lumbar movement control, pain, and disability in people with movement control dysfunction after both training and inactivity. The GPR method improved disability more than the LSEs.

Addressing the Needs of Persons Living With Dementia Across Care Settings (A Collaborative Symposium between the Assisted Living and Research in Quality Care Interest Groups)

Understanding the needs of persons living with dementia is critical to promoting quality of life and care. Co-sponsored by the Assisted Living (AL) and Research in Quality Care Interest Groups, this symposium includes four papers that present new ways to use claims data, qualitative data, benchmarking data, and intervention data to promote well-being for persons living with dementia. First, Degenholtz and Van Cleve use Pennsylvania Medicaid data from 2014-2016 to examine the provision of personal care to persons with and without dementia. They find that those living with dementia received more personal care per day across levels of physical disability and discuss implications for home and community based services policy. Next, Kemp et al. investigate meaningful engagement among assisted living residents with dementia using qualitative data collected over a one-year period in four diverse care communities. Findings show a range of engagement experiences and point to the influence of key resident, care partner, and care community influences. Third, Morgan et al. use data from a statewide probability sample of nursing home staff (n=438) to identify barriers and facilitators to person-centered care. Findings show key barriers to delivering person-centered care, including a lack of staff empowerment practices and low use of consistent assignment. Last, Zimmerman et al. present an evidence-based program, “Mouth Care Without a Battle” developed in nursing homes. Using data from over 2,000 assisted living stakeholders, they situate their findings within implementation science and the NIH Stage Model and make their findings transferable regardless of focus or setting.

Not All Home Care is Created Equal: The Relationship Between Sources of Care and Recipients’ Perceived Control

Perceived control is an important psychological resource for middle-aged and older adults. Aging in place may help foster feelings of control and autonomy, yet many community-dwelling older adults must rely on others for physical assistance. Little is known about psychological reactions to receiving this support. This study investigated how receiving home care from different sources was associated with two facets of perceived control (mastery and perceived constraints) among adults with varying levels of physical disability. Data was drawn from the 2012 and 2014 waves of the Health and Retirement Study. Community-dwelling adults aged 50 years and older receiving help for at least one activity of daily living (ADL) impairment (N = 884) reported their relationship to each respective caregiver (formal professional and/or informal family or friend), level of ADL impairment, and ratings of perceived control. Ordinary least squares (OLS) regression was used to examine the association between type of support and perceived control and the moderating effect of physical disability on that relationship. Receiving formal or a combination of formal and informal support was related to perceptions of greater control over one’s life, but only in terms of mastery. The level of one’s ADL impairment did not have a moderating effect on the relationship between support type and perceived control. Findings suggested that the type of instrumental support adults receive in their home has implications for specific facets of perceived control. Those receiving formal or mixed support had perceptions of greater mastery than those only receiving informal support.

Association of health-related private transfers with treatment compliance of musculoskeletal disorders in the rural elderly: evidence from an underdeveloped region of China

BackgroundThe prevalence and economic burdens of musculoskeletal disorders (MSD) are serious in rural China. In addition to formal support, health-related private transfers (HRPTs), including adult children transfers (ACTs), as well as relatives and friends transfers (RFTs), are very common in rural China. We explored the relationship between HRPTs and MSD treatment compliance and the heterogeneity of this relationship in terms of family socioeconomic status.MethodsA questionnaire survey was carried out in Enshi, Hubei, China by stratified random sampling in July 15–25,2018. A total of 2679 questionnaires on the economic burden of chronic diseases were collected. We deleted two questionnaires with missing data. The data was described using the mean and proportion. The Chi-square test and one-way ANOVA was used to compare each independent variable in the three groups, and ordered probit regression was used to analyse the relationship between each factor and treatment compliance. The heterogeneity of the effect was examined by group regression analysis of the samples with or without poverty.ResultsIn total, 853 samples with MSD were included in the analysis. The age was 70.27 ± 6.97 (mean +/− sd) years old, and the ADL was 11.64 ± 0.12, with more respondents being female (56.15%), partnered (73.51%), primary school educated (45.96%), working (57.91%), feeling poor in health (55.69%), lived alone or with a spouse (54.75%). Respondents with both ACTs and RFTs had better treatment compliance, and this was significant only in poor populations (p < 0.05). Under the same HRPTs’ condition, respondents who more compliant with MSD treatment were female (p < 0.01), had primary school education (p < 0.05), has self-reported poor (p < 0.01) and very poor (p < 0.05) health, had a high level of physical disability (p < 0.01), and were living with their children and grandchildren (p < 0.05). Respondents with more chronic diseases had poorer treatment compliance (p < 0.05).ConclusionsOnly those in poverty who both have ACTs and RFTs are likely to have better treatment compliance for MSD. Promoting a culture of filial piety and fostering harmonious interpersonal relationships, policies that focus on groups that lack social support, and general formal support are essential for sustained access to treatment for MSD.

Characterizing cognitive deficits and potential predictors in multiple sclerosis: A large nationwide study applying Brief International Cognitive Assessment for Multiple Sclerosis in standard clinical care.

With the proposal of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, the need to screen for cognitive deficits within standard clinical care of patients with multiple sclerosis (MS) has been acknowledged. Data regarding how patient characteristics might predict low cognitive performance and therefore require particularly close monitoring is, however, limited so far. We investigated a large, nationwide patient cohort from ambulatory settings, representing the typical distribution of different subtypes, levels of physical disability, and disease durations. Besides cognitive testing with BICAMS, additional sampling of multiple demographics and clinical variables allowed us to characterize general and domain-specific prevalence patterns of cognitive impairment (CI) as well as to delineate which factors are associated with cognitive performance. In a total of 1,094 patients, CI was present in 28% (using a conservative cut-off of the 5th percentile below normative values), with information-processing speed being most frequently affected. Impairment was overall higher in patients with primary progressive (PPMS) and secondary progressive MS than in patients with relapsing-remitting (RR)MS. Regression modelling revealed that disease subtype (i.e., PPMS), long disease duration, high physical disability, unemployment, low educational level, high age, male sex, and the absence of current disease-modifying treatment were important predictors forworse BICAMS' test performance. These results emphasize the importance of continuous cognitive assessment during regular neurological follow-up visits, with a particular focus on patients being identified as high-risk subjects for CI according to the reported factors.

The relationship between visuospatial neglect, spatial working memory and search behavior

ABSTRACTVisuospatial neglect (VSN) is characterized by a lateralized attentional deficit in the visual domain. In addition, patients with VSN might have an impairment in the temporary storage of spatial information in working memory (spatial working memory; SWM) that, like VSN, could impair systematic searching behavior. Several studies have demonstrated either SWM impairments or impaired searching behavior in VSN patients. Here, we related SWM performance to search behavior in patients with and without VSN. We assessed SWM using a novel task in a group of 182 stroke patients (24 with VSN, 158 without) and 65 healthy controls. We related SWM performance to available stroke-related and cognitive data. Patients with VSN exhibited lower SWM performance than patients without VSN and healthy controls. Additional control analyses indicated that differences in SWM performance are specific to visuospatial processing, instead of e.g. verbal working memory or the general level of physical disability. Last, we related SWM performance to visual search performance on cancellation tasks, one where their cancellation markings remained visible and another one where their prior cancellations markings were invisible to the patient and therefore patients had to remember which targets they had canceled. SWM performance correlated with search organization. Together, these results from a large sample of stroke patients corroborate the findings of earlier studies, while excluding several alternative explanations: SWM impairment is a part of the neglect syndrome, and SWM impairments are related to search behavior.

Play Experiences of Children With a High Level of Physical Disability

This research provides practitioners with an understanding of play from the perspective of children with a high level of physical disability. To explore the experience of play for children who have a high level of physical disability as a result of cerebral palsy. Interpretative phenomenological analysis. Children participated in three interviews each to discuss their experience of play. Visual methods, such as use of video and drawings, enabled a greater depth of discussion. Participants' homes. : Six children ages 6-11 yr with a high level of physical disability, recruited via snowball sampling and charities working with children with cerebral palsy. We found that making choices and controlling play were important for the children, that they often experienced play differently than their peers, and that they connected with others in play through humor and communication skills. Occupational therapy practitioners can respond to the findings by understanding the embodied unit, recognizing vista play, enabling expression of each child's imagined self, supporting negotiation of identity and disability, recognizing participation in play through watching, enabling opportunities for belonging, enabling development of component skills for play, and supporting strategies for connection. This article provides occupational therapy practitioners and other professionals with an understanding of play from the perspective of children who have a high level of physical disability.

Functional Status and Body Mass Index in Postmenopausal Women with Fibromyalgia: A Case-control Study.

Reduced functional capacity is a common characteristic of fibromyalgia (FMS). We aimed to investigate the relationship between functional status and body mass index (BMI) in a population with and without FMS. A pilot case–control study was performed in 34 women with FMS and 22 healthy controls which were classified according to their BMI. The main outcome measures were: Balance (MiniBestest, One Leg Stance Test), functional mobility (Timed up and Go), physical disability (Health Assessment Questionnaire Disability Index), spinal range of motion (Spinal Mouse), level of physical activity at work (Leisure Time Physical Activity Instrument), and home and leisure time (Physical Activity at Home and Work). Statistical differences were observed between overweight/obese healthy controls and women with FMS for several indicators of functional capacity. FMS patients reported worse dynamic (p = 0.001) and static balance (right: p = 0.002, left: p = 0.001), poorer functional mobility (p = 0.008), and higher levels of physical disability (p = 0.001). Functional status is altered in FMS women compared to the healthy control group, independently of nutritional status; therefore, BMI is unlikely to play a main role in functional capacity indicators in postmenopausal FMS women. Only dynamic balance seems to reduce the obesity status in this population.

Poststroke Depression

High prevalence of cerebrovascular insults (CVI) and their comorbidity with depression additionally makes difficult not just quality of life, also its serious obstacle to all measurements and attempts of patient’s rehabilitation. The scope of work is to show frequency of depression after CVI ischemic type in whole its specifics in order to age of patients, gender, localization of lesion, as well as on level of physical handicapping. International classification of disease (MKB-10), Hamilton scale of depression (HAM-D-17) and Barthel index scale of disability were used for diagnosis. Statistical analysis was performed in SPSS programme. Among 103 patients with CVI 43 of them (41.7%) were found with consequential depression what was monitored in following six months after CVI. From total number of depressions after CVI in the age of 58 years old 14 (32.6%) were found, and in the age between 59-63 years old there were 17 (39.5%) found. In the later ages that percentage was significantly lower. This result had proved significant connection between age group and depression status (p&lt;0.05): χ² (3, n = 103) = 12.24; p=0.007, Cramer’s V=0.34. Depression appearance after CVI in relation to genders has showed difference. Depression was marked at 16 (25.8%) male and 27 (65.8%) at female patients: χ² (1,n=103)=14.67; p=0.0002;Phi=0.4. Localization of lesion was significant in emergence of depression. In frontal part were found at 21 examinees, in basal ganglia at 16 and rest of localizations were found at 6 examinees: Depressions presence were more found at lesion localizations in left hemisphere, but no statistical importance. There were some correlation between level of physical disability and depression severity.

Analysis of STAT1, STAT2 and STAT3 mRNA expression levels in the blood of patients with multiple sclerosis.

Multiple sclerosis (MS) is the most common chronic, inflammatory, autoimmune disease of the central nervous system (CNS) maintained by the secretion of a large number of cytokines [1]. The signal transducer and activator of transcription (STAT) family has an essential role in transmitting many of the cytokine-mediated signals and failure in the signaling process contributes to the etiopathogenesis of MS. This study aimed to assess STAT1, STAT2 and STAT3 gene expression in the blood of 50 relapsing-remitting MS (RR-MS) patients and 50 healthy controls by TaqMan Quantitative Real-Time PCR. The results showed that STAT1 gene expression was significantly up-regulated (p= 0.023), whereas STAT2 gene expression was significantly down-regulated (p< 0.0001) in MS patients compared to controls. On the other hand, there was no significant difference between MS patients and controls for STAT3 gene expression (p= 0.837). In addition, there was no significant correlation between the expression of STAT1, STAT2, STAT3 genes and clinical findings, such as the level of physical disability in MS patients (according to the Kurtzke Expanded Disability Status Scale (EDSS) criterion) and disease duration. A significant positive correlation was demonstrated between STAT1 and STAT2 and also between STAT1 and STAT3. This study shows for the first time that a comparison of the relative quantitative expression of three different STAT genes in the blood cells of MS patients compared to controls revealed marked differences in the expression of the STAT family genes that might reflect their different roles in the pathogenesis of MS. These transcripts might be useful biomarkers for evaluating the efficacy of IFN treatment of the MS patients.

Longitudinal Health Status from Early Disease to Adulthood and Associated Prognostic Factors in Juvenile Idiopathic Arthritis.

To describe the longitudinal health status from childhood to adulthood in patients with juvenile idiopathic arthritis (JIA), compare outcomes after 19 years with those of controls, and identify early predictors of physical functioning, pain, and physical health-related quality of life (HRQOL). Between 1995-2003, 96 patients with JIA (mean 6.1 ± 4.0 yrs, 67% female) were assessed within 18 months of diagnosis and every 6 months for the next 3 years with measures of JIA disease activity, physical functioning, pain, fatigue, and well-being. They were reassessed a mean of 18.9 ± 1.5 years later (mean age 25.1 ± 4.2 yrs) with measures of physical disability [Health Assessment Questionnaire-Disability Index (HAQ-DI)], pain, fatigue, well-being (visual analog scale), and physical and mental health-related quality of life (HRQOL; Medical Outcomes Study 12-item Short Form Health Survey, version 2). During the first 3 years, physical disability improved (p < 0.001) and the proportion of patients reporting best possible well-being increased (p = 0.013), while pain and fatigue did not change. At 3- and 19-year followups, patients had similar levels of physical disability, well-being, and pain, but fatigue increased (p = 0.016) and the number of patients with HAQ-DI = 0 decreased (p = 0.001). After 19 years, patients had worse pain and physical HRQOL than controls (p < 0.001). Pain, active joints, and physical disability during the first 3 years were associated with more disability and pain and worse physical HRQOL after 19 years (p < 0.001-0.047). Patients with JIA reported similar physical functioning, well-being, and pain at 3- and 19-year followups, but more fatigue after 19 years. Patients also had worse health status than controls after 19 years. Pain, active joints, and physical disability were early predictors of unfavorable outcomes.

Is the story about sensitive women and stoical men true? Gender differences in health after adjustment for reporting behavior

Research indicates that women have higher levels of physical disability and depression and lower scores on physical performance tests compared to men, while the evidence for gender differences in self-rated health is equivocal. Scholars note that these patterns may be related to women over-reporting and men under-reporting health problems, but gender differences in reporting behaviors have not been rigorously tested. Using Wave 1 of the Survey of Health, Ageing and Retirement in Europe (SHARE), the present study investigates the extent to which adjusting for differences in reporting behavior modifies gender differences in general health. We also examine whether men and women's reporting behaviors are consistent across different levels of education. After adjusting for reporting heterogeneity, gender differences in both poor and good health widened. However, we found no clear gender-specific patterns in reporting either poor or good health. Our findings also do not provide convincing evidence that education is an important determinant of general health reporting, although the female disadvantage in poor health and the male advantage in good health were more apparent in lower than higher education groups at all ages. The results challenge prevailing stereotypes that women over-report and men under-report health problems and highlight the importance of attending to health problems reported by women and men with equal care.

Acute multiple sclerosis lesion pathology does not predict subsequent clinical course-a biopsy study.

Knowledge of the clinical outcome in tumefactive demyelination remains limited. This study aims to characterise the natural history of biopsy-proven, pathogen-free, cerebral demyelination in an adult Irish population. We identified all patients with biopsy-proven demyelination in a single neuropathology centre between 1999 and 2017. A baseline, and at least one follow-up MRI scan was available in each instance (mean of 3 scans per patient), together with both the presenting and most recent clinical details including disability level and disease-modifying drugs. In 21 patients, white matter biopsies showed the following: macrophages with myelin debris, myelin-axonal dissociation, reactive astrocytes and occasional lymphocytes. During a mean follow-up time of 8years (± 4.4), 17 patients developed MS, confirmed both clinically and on MRI, using the 2010 McDonald criteria: 11 relapsing remitting (RR) MS, four secondary progressive and two primary progressive MS. Four patients had a monophasic illness with lesion regression, without clinical or radiological evidence of any further disease activity on follow-up. The patients with progressive MS had significantly higher levels of physical disability than either the RRMS or monophasic patients. Uniform white matter subacute demyelination is associated with a diverse clinical course ranging from a monophasic illness to progressive MS, suggesting that extraneous factors distinct from the basic pathology significantly influence the clinical course in MS.

Pedagogičeskie osobennosti postroeniâ učebnyh makrociklov silovoj napravlennosti on trenažere «Soncept–2» in sportsmenov edinoborcev

In this preparation of the sportsmen of êdinoborcìv has been included in the training process of exercises on Simulator «Concept–2». This dependence is related to the fact that the athletes êdinoborcâm need to perform common power exercises on simulators to increase training volume of corresponding capacity. Sources of literature do not disclose data integrated power preparation êdinoborcìv using vesluvalnih simulators, so study the allowable amounts of load simulator «Concept–2» is the unsolved problem of the modern physical culture and Sport. Sports training is a system that is constantly being improved based on the accumulation of new data, experimental research, best practices and scientific and technical progress. For testing and training athletes êdinoborcìv, as well as to increase the level of physical disability of different population groups are widely used vesluvalnì ergometers «Concept–2», etc. An auxiliary factor for improving the general preparedness of athletes of single-fighters is the development of highly specialized manifestations of force, which determine the capabilities of the development of the necessary effort and its abilities in the process of training and competitive activities. A key element in the formation of specialized power qualities of wrestlers is the effective transfer of this motor quality in the transition from the preferential use of the PROF. In this regard, the formation of a methodical approach, based on which is the improvement of special power capabilities, as an integrated component of the system of functional training of single-team fighters, becomes actual. Analysis of special literature and practice of strength training in martial arts gave reason to speak about the possibility of solving this problem using special training devices that stimulate the development of power abilities, provided that the main groups of muscles are included and the main elements of the structure of the competitive exercise are preserved. In this case, the interest is an analysis of the method of using a specialized power simulator «Dyno-Concept». It is recommended to use a rowing simulator to assess the strength of athletes of single-team with the exercise of traction sitting for the upper limbs and foot press for the lower extremities in three modes: I (damper simulator fully open) – manifestation of power capabilities at high speed; II-th – (open half of the flaps) – the manifestation of the optimal ratio of the speed and power component at medium speed; III (damper of the simulator is completely closed) – manifestation of maximum force at low speed. In the second mode, half of the flaps were opened. To evaluate special strength endurance – maximum test 2000 m. Application of the methodology of the development of force using the specialized simulator «Сoncept–2 Dyno» allows you to get a higher rate of growth of the developing quality. In the experimental group, the strength of the hands was 5%, leg strength – 2,8%, strength endurance increased by 2,2%; in the control group, respectively, 1.4%, 1.2% and 1%.

Reviewing high-level control techniques on robot-assisted upper-limb rehabilitation

ABSTRACTThis paper presents a comprehensive review of high-level control techniques for upper-limb robotic training. It aims to compare and discuss the potentials of these different control algorithms, and specify future research direction. Included studies mainly come from selected papers in four review articles. To make selected studies complete and comprehensive, especially some recently-developed upper-limb robotic devices, a search was further conducted in IEEE Xplore, Google Scholar, Scopus and Web of Science using keywords (‘upper limb*’ or ‘upper body*’) and (‘rehabilitation*’ or ‘treatment*’) and (‘robot*’ or ‘device*’ or ‘exoskeleton*’). The search is limited to English-language articles published between January 2013 and December 2017. Valuable references in related publications were also screened. Comparative analysis shows that high-level interaction control strategies can be implemented in a range of methods, mainly including impedance/admittance based strategies, adaptive control techniques, and physiological signal control. Even though the potentials of existing interactive control strategies have been demonstrated, it is hard to identify the one leading to maximum encouragement from human users. However, it is reasonable to suggest that future studies should combine different control strategies to be application specific, and deliver appropriate robotic assistance based on physical disability levels of human users.

Evolución de la atención al ictus en un hospital de tercer nivel

Objective: to learn about the evolution of patients hospitalized and treated at the Stroke Unit of a third-level hospital following the current model of treatment, compared with those patients previously hospitalized and treated in a conventional Neurology ward. Method: an observational retrospective study, on patients managed at the Hospital Universitario Central de Asturias after suffering a stroke, conducted in two stages: before the Stroke Unit was set up (January, 1st to 31st, 2009), and after implementing the unit (January, 1st to 31st, 2014). A notebook for data collection was designed. The TOAST classification system was used, as well as the NIHSS scale (for stroke severity) and the modified Rankin scale (level of physical disability after a stroke). A review of electronic clinical records was conducted through Cerner Millenium. Analysis was conducted with the SPPS statistical package, version 22.Results: the study included 152 patients in 2009 and 132 patients in 2014; their mean age was 73.92 years, and the majority were male (62.9%). There was a reduction in hospitalization days and mortality during admission between 2009 and 2014. There was a twofold increase in the number of activations of the Stroke Code protocol. The application of recanalization treatments increased from 16.1% to 20.4%. The early initiation in physical therapy increased from 7% to 33% since the creation of the Stroke Unit; those patients who did not require physical therapy increased from 42% to 80%.Conclusions: the implementation of the Stroke Unit and the activation of the Stroke Code have contributed to improve the results in identification, classification, treatment, follow-up and results at discharge, in patients hospitalized for stroke.

Deficiências e incapacidades na hanseníase: do diagnóstico à alta por cura

Objetivou-se comparar o grau de incapacidade física, os sítios corporais afetados, as deficiências e incapacidades presentes e os nervos acometidos no diagnóstico e na alta em pacientes com hanseníase. Trata-se de um estudo desenvolvido entre 2009 e 2014 em centro de referência para hanseníase na Paraíba. Envolveu 414 prontuários, utilizando formulário estruturado. Os dados foram analisados através de técnicas de estatística descritiva (frequência absoluta e percentagem) e inferencial (Teste de Wilcoxon e Mcnemar). Nota-se decréscimo do acometimento dos sítios corporais (nariz p=0,000), das deficiências (ressecamento p=0,002 e ferida p=0,000 no nariz e úlcera p=0,004 nos pés) e da quantidade de nervos afetados (p=0,000) entre o diagnóstico e a alta por cura. Na análise dos anos 2009-2014 observa-se redução da quantidade de pacientes apresentando grau de incapacidade física 2. Conclui-se, portanto, que mesmo após a alta os pacientes estão propícios a desenvolver ou agravar incapacidades físicas, necessitando de acompanhamento periódico.

Resilience and depression/anxiety symptoms in multiple sclerosis and neuromyelitis optica spectrum disorder

BackgroundDepression and anxiety are common in multiple sclerosis (MS) and recently, studies on these symptoms in neuromyelitis optica spectrum disorder (NMOSD) are increasing. Previous studies suggest that these symptoms have negative effects on the quality of life. Resilience has garnered more interest as one of the protective factors that works to prevent psychiatric symptoms in past decades. There exist a few studies, however, regarding the effects of resilience on these psychiatric symptoms in MS/NMOSD. ObjectiveThe aim of this study was to clarify the relationships between resilience, psychiatric symptoms, and QOL in patients with MS/NMOSD. MethodSeventy-seven patients with MS/NMOSD participated in this study. They completed several questionnaires (Beck Depression Inventory-Second edition, Hospital Anxiety and Depression Scale, the Japanese version of the Resilience scale [RS], and Japanese version of Multiple Sclerosis Quality of Life-54). We also collected demographic and clinical data including age, sex, physical disability level (measured with the Expanded Disability Status Scale [EDSS]), and disease duration of the participants. ResultsThe EDSS scores showed significant negative correlations with QOL, unlike disease duration, which did not correlate with either the psychiatric symptoms or QOL. Additionally, there was no significant correlation between RS scores and EDSS scores or disease duration. We also found that resilience showed a significant negative correlation with psychiatric symptoms, and positive correlation with QOL. ConclusionThese results suggest that resilience may serve to prevent or reduce depression/anxiety symptoms and maintain the QOL regardless of the physical disability level.