Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Traumatismos da Medula Espinal/terapia , Traumatismos da Coluna Vertebral/terapia , Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Coluna Vertebral/classificação , Traumatismos da Coluna Vertebral/diagnósticoRESUMO
STUDY DESIGN: Global cross-sectional survey. OBJECTIVE: The aim of this study was to validate the AO Spine Subaxial Cervical Spine Injury Classification by examining the perceived injury severity by surgeon across AO geographical regions and practice experience. SUMMARY OF BACKGROUND DATA: Previous subaxial cervical spine injury classifications have been limited by subpar interobserver reliability and clinical applicability. In an attempt to create a universally validated scheme with prognostic value, AO Spine established a subaxial cervical spine injury classification involving four elements: injury morphology, facet injury involvement, neurologic status, and case-specific modifiers. METHODS: A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. Respondents graded the severity of each variable of the classification system on a scale from zero (low severity) to 100 (high severity). Primary outcome was to assess differences in perceived injury severity for each injury type over geographic regions and level of practice experience. RESULTS: A total of 189 responses were received. Overall, the classification system exhibited a hierarchical progression in subtype injury severity scores. Only three subtypes showed a significant difference in injury severity score among geographic regions: F3 (floating lateral mass fracture, P = 0.04), N3 (incomplete spinal cord injury, P = 0.03), and M2 (critical disk herniation, P = 0.04). When stratified by surgeon experience, pairwise comparison showed only two morphological subtypes, B1 (bony posterior tension band injury, P = 0.02) and F2 (unstable facet fracture, P = 0.03), and one neurologic subtype (N3, P = 0.02) exhibited a significant difference in injury severity score. CONCLUSION: The AO Spine Subaxial Cervical Spine Injury Classification System has shown to be reliable and suitable for proper patient management. The study shows this classification is substantially generalizable by geographic region and surgeon experience, and provides a consistent method of communication among physicians while covering the majority of subaxial cervical spine traumatic injuries.Level of Evidence: 4.
Assuntos
Vértebras Cervicais/lesões , Escala de Gravidade do Ferimento , Índice de Gravidade de Doença , Traumatismos da Medula Espinal/classificação , Inquéritos e Questionários/normas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Traumatismos da Medula Espinal/diagnósticoRESUMO
OBJECTIVE: To evaluate the safety and reliability of the new AO Classification, a recent classification system for Thoraco-Lumbar Spine Trauma (TLST). DESIGN: Retrospective study. METHODS: We applied the new AO system in patients with TLST treated according to the TLICS. Two researchers classified injuries independently. Eight weeks later, the classification was repeated for intra and inter-observer agreement evaluation. To evaluate safety, we correlated the treatment performed based on the TLICS with the newer AO classification obtained. RESULTS: Fifty-four patients were included in this study, with a mean follow-up of 363.8 days. Twenty-three neurologically intact patients were initially treated conservatively. Their mean TLICS was 1.78 (1-4 points). Four patients underwent late surgery. Thirty-one patients were treated surgically. Their average TLICS was 7.22 points (4-10 points). Agreements in the four independent evaluations according to AO groups and subgroups were of 64.8% (35/54) and 55.5% (30/54) respectively. Kappa index for groups A, B and C was 0.75, 0.7 and 0.85 respectively. Kappa index for subgroups ranged from 0.16 to 0.85. Regarding safety, thirty (57.6%) patients with total subgroups agreement were analyzed. All patients with fracture in groups B and C underwent surgical treatment and patients in group A received surgery according to neurological status or failure of conservative treatment. CONCLUSION: The newer AO spine classification demonstrated good reliability at the level of groups. Subgroups demonstrated worse and varying reliability. Although the safety analysis was limited due to the low level of total concordance among all evaluations, patients from group A can be treated conservatively or surgically, whereas those from groups B and C are treated surgically.
Assuntos
Exame Neurológico/normas , Traumatismos da Medula Espinal/patologia , Índices de Gravidade do Trauma , Adolescente , Adulto , Idoso , Feminino , Humanos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Exame Neurológico/métodos , Reprodutibilidade dos Testes , Traumatismos da Medula Espinal/classificação , Vértebras Torácicas/patologiaRESUMO
Studies evaluating the Quality of Life of individuals with spinal cord injury using different research tools demonstrate that the Quality of Life scores are considered low both in national and international studies. The objective of this review was to characterize the international scientific production about the most used scales to assess Quality of Life in patients with spinal cord injury. We examined articles on Quality of Life of patients with spinal cord injury published over the last 5 years and indexed in the National Library of Medicine (PUBMED). During this period, 28 articles met the inclusion criteria. Eleven studies were conducted in the United States, five articles were published in Australia, and four in Canada. Brazil, France, Holland, India, Japan, Norway, Singapore and Switzerland contributed with one study each. The scientific articles were published in 13 high impact factor journals. Seven different instruments to assess Quality of Life were used in the studies: Satisfaction with Life Scale, Short Form (36) Health Survey, The Brief Version of the WHO Quality of Life Questionnaire (WHOQOL-BREF), Comprehensive Quality of Life Scale, Life Situation Questionnaire-Revised, Quality of Well-Being Scale and the SF-12® Health Survey. The articles examined underscore the impact of spinal cord injury in the Quality of Life of patients, demonstrating how this condition impairs their lives, mainly socially, but followed by the physical aspects. Despite the studies have different goals they all acknowledge that further studies are necessary in order to determine the Quality of Life of patients with spinal cord injury. Specific instruments should be chosen or developed and validated in order to fulfill this purpose.
Assuntos
Qualidade de Vida , Traumatismos da Medula Espinal/psicologia , Inquéritos e Questionários , Humanos , Traumatismos da Medula Espinal/classificaçãoRESUMO
OBJECTIVE: To determine the most robust dimensional structure of the International Classification of Functioning, Disability and Health (ICF) categories relevant to spinal cord injury (SCI) across subgroups of lesion level, health care context, sex, age, and resources of the country. DESIGN: A multidimensional between-item response Rasch model was used. The choice of the dimensions was conceptually driven using the ICF components from the functioning chapters and splits of the activity and participation component described in the ICF. SETTING: Secondary analysis of data from an international, cross-sectional, multicentric study for the Development of ICF Core Sets for Spinal Cord Injury. PARTICIPANTS: Persons with SCI (N=1048) from the early postacute and long-term living context from 14 middle/low- and high-resource countries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Ratings of categories of the ICF relevant for SCI were analyzed. RESULTS: Five models were tested on the complete sample and 5 subgroups. The overall reliability of all models and reliability within dimensions of the unidimensional and 2-dimensional models were good to excellent. The ICF categories spread well along the disability scale. The model fit improvement from the unidimensional to the 2-dimensional and from the 2-dimensional to the 3-dimensional model was significant in all groups (P<.0001). The improvement, however, from a unidimensional to a 2-dimensional structure was markedly better than from a 2-dimensional to a 3-dimensional one. CONCLUSIONS: We propose that a 2-dimensional structure separating body functions and body structures from the activity and participation categories should serve as a basis for developing clinical measures in SCI in the future.
Assuntos
Países em Desenvolvimento , Pessoas com Deficiência/classificação , Recursos em Saúde , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Modelos Teóricos , Traumatismos da Medula Espinal/classificação , Ásia , Austrália , Brasil , Canadá , Estudos Transversais , Avaliação da Deficiência , Europa (Continente) , Feminino , Nível de Saúde , Humanos , Israel , Masculino , Nova Zelândia , Paraplegia/etiologia , Psicometria , Quadriplegia/etiologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Estados UnidosRESUMO
Studies evaluating the Quality of Life of individuals with spinal cord injury using different research tools demonstrate that the Quality of Life scores are considered low both in national and international studies. The objective of this review was to characterize the international scientific production about the most used scales to assess Quality of Life in patients with spinal cord injury. We examined articles on Quality of Life of patients with spinal cord injury published over the last 5 years and indexed in the National Library of Medicine (PUBMED). During this period, 28 articles met the inclusion criteria. Eleven studies were conducted in the United States, five articles were published in Australia, and four in Canada. Brazil, France, Holland, India, Japan, Norway, Singapore and Switzerland contributed with one study each. The scientific articles were published in 13 high impact factor journals. Seven different instruments to assess Quality of Life were used in the studies: Satisfaction with Life Scale, Short Form (36) Health Survey, The Brief Version of the WHO Quality of Life Questionnaire (WHOQOL-BREF), Comprehensive Quality of Life Scale, Life Situation Questionnaire-Revised, Quality of Well-Being Scale and the SF-12® Health Survey. The articles examined underscore the impact of spinal cord injury in the Quality of Life of patients, demonstrating how this condition impairs their lives, mainly socially, but followed by the physical aspects. Despite the studies have different goals they all acknowledge that further studies are necessary in order to determine the Quality of Life of patients with spinal cord injury. Specific instruments should be chosen or developed and validated in order to fulfill this purpose.
Estudos sobre avaliação de escalas de Qualidade de Vida em indivíduos com lesão medular, mesmo com diferentes ferramentas de pesquisa, mostram que, tanto em estudos nacionais como em outros países, os escores de avaliação são considerados baixos. O objetivo desta revisão foi caracterizar na produção científica internacional o uso das escalas para avaliação da Qualidade de Vida mais usadas em pacientes com lesão medular. Foram analisados artigos que versavam sobre estudos relacionados à Qualidade de Vida em pacientes com lesão medular, nas publicações dos últimos 5 anos, indexadas na National Library of Medicine (PUBMED). No período analisado, 28 artigos atenderam aos critérios de inclusão. Foram realizadas 11 pesquisas nos Estados Unidos, 5 artigos foram publicados na Austrália, 4 no Canadá, Brasil, França, Holanda, Índia, Japão, Noruega, Singapura e Suíça tiveram 1 trabalho cada. Foram publicados em 13 revistas de impactos. Foram usadas sete escalas diferentes de Qualidade de Vida: Satisfaction with Life Scale, Short Form (36) Health Survey, Avaliação de Qualidade de Vida da Organização Mundial da Saúde, Comprehensive Quality of Life Scale, Life Situation Questionnaire-Revised, Quality of Well-Being Scale e SF-12® Health Survey. Os artigos analisados destacaram o impacto da lesão medular na Qualidade de Vida dos pacientes, demonstrando como essa condição acarreta comprometimento, principalmente dos aspectos sociais, seguidos dos aspectos físicos. Mesmo com objetivos diferentes, reconhece-se que são necessários mais estudos para determinação da Qualidade de Vida em pacientes com lesão medular, devendo, ainda, serem escolhidos ou construídos e validados instrumentos específicos para esse fim.
Assuntos
Humanos , Qualidade de Vida , Inquéritos e Questionários , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/classificaçãoRESUMO
CONTEXT: The Thoracolumbar Injury Classification System (TLICS) has been recently described to help surgeons in the decision-making process of thoracolumbar spinal trauma. OBJECTIVE: To analyze the potential relationships between the TLICS scores with the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Spine System and patient's neurological status. METHODS: Literature analysis of the potential scored injuries in the TLICS system, based on its individual scores, its total score, and its suggested proposed treatment, correlating these with the AO system and neurological status. RESULTS: Findings are presented according to the TLICS score. Patients with a TLICS 1-3 points, receiving conservative treatment, are AO type A injuries, generally neurologically intact. TLICS 4 group also included AO type A fractures, neurologically ranging from intact to complete spinal cord injury. TLICS 5-10 points includes AO type B and C injuries, regarding their neurological status, and burst fractures (AO type A) with concomitant neurological injury and most of the patients with incomplete deficits and cauda equina syndrome. CONCLUSIONS: As a general overview, according to the TLICS, patients without neurological deficit and with AO type A injuries are conservatively treated. AO type B and C injuries are managed surgically, with regard to neurological status. Patients with cauda equina or incomplete injuries also received a higher severity score. Controversies still exist regarding the management of unstable burst fractures without neurological status. The role of the posterior ligamentous complex status and the magnetic resonance imaging in the decision-making process require more clinical evidence.
Assuntos
Índice de Gravidade de Doença , Traumatismos da Medula Espinal/classificação , Fraturas da Coluna Vertebral/classificação , Humanos , Vértebras Lombares/lesões , Traumatismos da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/lesõesRESUMO
The authors seek to clarify the nomenclature used to describe cervical spinal cord injuries, particularly the use of the terms "tetraplegia", "quadriplegia", "quadriparesis", "tetraparesis", "incomplete quadriplegia" or "incomplete tetraplegia" when applied to patients with lower cervical cord injuries. A review of the origin of the terms and nomenclature used currently to describe the neurological status of patients with SCI in the literature was performed. The terms "tetraplegia", "quadriplegia", "quadriparesis", "tetraparesis", "incomplete quadriplegia" or "incomplete tetraplegia" have been used very often to describe patients with complete lower cervical SCI despite the fact that the clinical scenario is all the same for most of these patients. Most of these patients have total loss of the motor voluntary movements of their lower trunk and inferior limbs, and partial impairment of movement of their superior limbs, preserving many motor functions of the proximal muscles of their arms (superior limbs). A potentially better descriptive term may be "paraplegia with brachial diparesis". In using the most appropriate terminology, the patients with lower cervical SCI currently referred as presenting with "tetraplegia", "quadriplegia", "quadriparesis", "tetraparesis", "incomplete quadriplegia" or "incomplete tetraplegia", might be better described as having "paraplegia with brachial diparesis".
Assuntos
Paraplegia/classificação , Quadriplegia/classificação , Traumatismos da Medula Espinal/classificação , Terminologia como Assunto , Vértebras Cervicais , Humanos , Paraplegia/etiologia , Quadriplegia/etiologia , Traumatismos da Medula Espinal/complicaçõesRESUMO
OBJECTIVE: The aim of this pilot study was to describe problems in functioning and associated rehabilitation needs in persons with spinal cord injury after the 2010 earthquake in Haiti by applying a newly developed tool based on the International Classification of Functioning, Disability and Health (ICF). DESIGN: Pilot study. SUBJECTS: Eighteen persons with spinal cord injury (11 women, 7 men) participated in the needs assessment. Eleven patients had complete lesions (American Spinal Injury Association Impairment Scale; AIS A), one patient had tetraplegia. METHODS: Data collection included information from the International Spinal Cord Injury Core Data Set and a newly developed needs assessment tool based on ICF Core Sets. This tool assesses the level of functioning, the corresponding rehabilitation need, and required health professional. Data were summarized using descriptive statistics. RESULTS: In body functions and body structures, patients showed typical problems following spinal cord injury. Nearly all patients showed limitations and restrictions in their activities and participation related to mobility, self-care and aspects of social integration. Several environmental factors presented barriers to these limitations and restrictions. However, the availability of products and social support were identified as facilitators. Rehabilitation needs were identified in nearly all aspects of functioning. To address these needs, a multidisciplinary approach would be needed. CONCLUSION: This ICF-based needs assessment provided useful information for rehabilitation planning in the context of natural disaster. Future studies are required to test and, if necessary, adapt the assessment.
Assuntos
Terremotos , Avaliação das Necessidades , Traumatismos da Medula Espinal/reabilitação , Atividades Cotidianas , Adulto , Avaliação da Deficiência , Pessoas com Deficiência/classificação , Feminino , Haiti , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/diagnósticoRESUMO
UNLABELLED: After spinal cord injury is common functionality is affected. OBJECTIVE: To evaluate the functionality of patients with spinal cord injury. METHOD: Cross-sectional study by means of the International Classification of Functionality (ICF). 109 adults with spinal cord injury in the city of Curitiba, Brazil were evaluated. RESULTS: The categories most compromised in body were intestines and bladder, sexuality, energy, sleep, emotion and weight. In the domain activities and participation, there was greater difficulty in tasks of bathing, toilet and dressing, self care and leisure. In the domain environmental factors, the categories classified as facilitators were: medications, orthoses and wheelchair, attitude of family, transport, social foresight and health services. The categories classified as barriers were: attitude of authorities, social attitudes, education and work. CONCLUSION: The application of the ICF in persons with spinal cord injury demonstrated a series of disabilities and limitations.
Assuntos
Avaliação da Deficiência , Classificação Internacional de Doenças , Traumatismos da Medula Espinal/classificação , Atividades Cotidianas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto JovemRESUMO
After spinal cord injury is common functionality is affected. OBJECTIVE: To evaluate the functionality of patients with spinal cord injury. METHOD: Cross-sectional study by means of the International Classification of Functionality (ICF). 109 adults with spinal cord injury in the city of Curitiba, Brazil were evaluated. RESULTS: The categories most compromised in body were intestines and bladder, sexuality, energy, sleep, emotion and weight. In the domain activities and participation, there was greater difficulty in tasks of bathing, toilet and dressing, self care and leisure. In the domain environmental factors, the categories classified as facilitators were: medications, orthoses and wheelchair, attitude of family, transport, social foresight and health services. The categories classified as barriers were: attitude of authorities, social attitudes, education and work. CONCLUSION: The application of the ICF in persons with spinal cord injury demonstrated a series of disabilities and limitations.
Após uma lesão medular, a funcionalidade do indivíduo é comumente afetada e fatores diversos estão envolvidos neste processo. OBJETIVO: Classificar a funcionalidade de pacientes com lesão medular. MÉTODO: Estudo transversal por meio da aplicação da Classificação Internacional de Funcionalidade (CIF). Foram avaliados 109 adultos com lesão medular na cidade de Curitiba, Brasil. RESULTADOS: As categorias mais comprometidas em relação às funções do corpo foram intestino e bexiga, sexualidade, energia, sono, emoção e peso. No domínio atividades e participação, as maiores dificuldades foram nas tarefas de tomar banho, toalete, vestuário, autocuidado e lazer. No domínio fatores ambientais, as categorias classificadas como facilitadores foram: medicamentos, órteses e cadeira de rodas, atitude da família, transporte, previdência social e serviços de saúde. As categorias classificadas como barreiras foram: atitude de autoridades, atitudes sociais, educação e trabalho. CONCLUSÃO: A aplicação da CIF em pessoas com lesão medular permitiu demonstrar uma série de limitações nesses pacientes.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Avaliação da Deficiência , Classificação Internacional de Doenças , Traumatismos da Medula Espinal/classificação , Atividades Cotidianas , Estudos Transversais , Fatores SocioeconômicosRESUMO
The aim of the study was to evaluate the performance of sniff nasal inspiratory pressure (SNIP) and MIP in individuals with spinal cord injury. We evaluated 26 patients with spinal cord injury. Mean FVC in those with tetraplegia was 52 +/- 19% of predicted, compared with 78 +/- 23% of predicted in those with paraplegia (p < 0.05). In contrast, the percentage of predicted SNIP was lower in those with tetraplegia than in those with paraplegia (p < 0.05). In all participants, SNIP correlated significantly with the level of the injury (r = 0.489; 95% CI: 0.125-0.737). The impact that the greater discriminatory power of SNIP has on the diagnosis of impaired pulmonary function in spinal cord-injured patients should be investigated further.
Assuntos
Inalação/fisiologia , Cavidade Nasal/fisiologia , Testes de Função Respiratória/métodos , Músculos Respiratórios/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Adolescente , Adulto , Humanos , Capacidade Inspiratória/fisiologia , Modelos Lineares , Masculino , Pico do Fluxo Expiratório/fisiologia , Pressão , Traumatismos da Medula Espinal/classificação , Adulto JovemRESUMO
INTRODUCTION: The neurological examination terminologies and definitions of the status of spinal cord injured (SCI) patients are of great importance to establish scales and provide standard nomenclatures. There is a disagreement between the classical neurological terminology and the definitions of complete and incomplete paraplegia that have been proposed in traumatic spinal cord injured patients. OBJECTIVE: To discuss the adequacy and the impact of the terms incomplete paraplegia and paraparesis in current literature. MATERIALS AND METHODS: A review of the origin of the terms, definitions and nomenclatures applied by the most widespread assessment scales in traumatic SCI published in peer review papers was performed, searching the scales cited on the references of the latest American Spinal Injury Association classification (2002; available in http://www.asia-spinalinjury.org/ ) up to the first classification, described by Frankel et al. [14]. RESULTS: The term "incomplete paraplegia" has been used to define clinical situations classically described as "paraparesis". CONCLUSION: The terms "complete" and "incomplete" are adequately used to characterize the completeness of spinal cord lesion but inadequately used when associated to the term "plegia" as a qualifier. Therefore, patients with any preservation of motor strength below the injury level should be described as paraparetic and not as incomplete paraplegic.
Assuntos
Neurologia/métodos , Paraparesia/induzido quimicamente , Paraplegia/classificação , Traumatismos da Medula Espinal/classificação , Terminologia como Assunto , Progressão da Doença , Humanos , Perna (Membro)/inervação , Perna (Membro)/fisiopatologia , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Paraparesia/diagnóstico , Paraparesia/fisiopatologia , Paraplegia/diagnóstico , Paraplegia/fisiopatologia , Índice de Gravidade de Doença , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/fisiopatologiaRESUMO
The aim of the study was to evaluate the performance of sniff nasal inspiratory pressure (SNIP) and MIP in individuals with spinal cord injury. We evaluated 26 patients with spinal cord injury. Mean FVC in those with tetraplegia was 52 ± 19 percent of predicted, compared with 78 ± 23 percent of predicted in those with paraplegia (p < 0.05). In contrast, the percentage of predicted SNIP was lower in those with tetraplegia than in those with paraplegia (p < 0.05). In all participants, SNIP correlated significantly with the level of the injury (r = 0.489; 95 percent CI: 0.125-0.737). The impact that the greater discriminatory power of SNIP has on the diagnosis of impaired pulmonary function in spinal cord-injured patients should be investigated further.
O objetivo deste estudo foi verificar o desempenho da pressão inspiratória nasal durante o fungar (PInas) e da PImáx em indivíduos com lesão medular traumática. Foram avaliados 26 pacientes com lesão medular traumática. Os pacientes tetraplégicos e paraplégicos exibiram diferentes médias do percentual do previsto da CVF, respectivamente, 52 ± 19 por cento e 78 ± 23 por cento (p < 0,05). Ao contrário da PImáx, o percentual do previsto médio da PInas foi inferior nos tetraplégicos (p < 0,05) e, em todos os participantes, a correlação com o nível da lesão foi significativa (r = 0,489; IC95 por cento: 0,125-0,737). O impacto do melhor discernimento da PInas no diagnóstico das alterações da função inspiratória de pacientes com lesão medular traumática merece ser aprofundado.
Assuntos
Adolescente , Adulto , Humanos , Masculino , Adulto Jovem , Inalação/fisiologia , Cavidade Nasal/fisiologia , Testes de Função Respiratória/métodos , Músculos Respiratórios/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Capacidade Inspiratória/fisiologia , Modelos Lineares , Pressão , Pico do Fluxo Expiratório/fisiologia , Traumatismos da Medula Espinal/classificação , Adulto JovemRESUMO
From 1972 to 2000 we managed 27 patients with vertebral and spinal cord trauma. The purpose of this presentation is to analyze the clinical and functional manifestations, the mechanism and treatment of this condition.
Assuntos
Traumatismos da Medula Espinal , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais , Diagnóstico Diferencial , Emergências , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/cirurgia , Síndrome , Vértebras TorácicasRESUMO
El Manual de Auto-cuidado del lesionado medular, se presenta como una alternativa de capacitación, promoción e información dirigida fundamentalmente a las personas con lesiones o afectaciones de la médula espinal, así como a los técnicos y profesionales que laboran en el Campo de la Rehabilitación: enfermería, medicina, trabajo social, psicología, fisioterapia, etc. Se pretende que este Manual sea de mucha utilidad para los técnicos y profesionales de rehabilitación integral debido a que ellos tienen la responsabilidad primaria para orientar, adiestrar y capacitar en su auto-cuidados a las personas con lesión medular, desde su llegada a los centros y establecimientos de salud para recibir los primero y más importantes conocimientos después de lesionarse. De igual manera la identificación y tratamiento temprano de las complicaciones de una lesión medular, mejorar la calidad de vida de las personas con discapacidad, por que lo que el papel de los trabajadores de rehabilitación adquiere mayor relevancia...
Assuntos
Adaptação Psicológica , Pessoas com Deficiência , Autocuidado , Sexualidade , Higiene da Pele , Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitaçãoRESUMO
STUDY DESIGN: Construction of an international walking scale by a modified Delphi technique. OBJECTIVE: The purpose of the study was to develop a more precise walking scale for use in clinical trials of subjects with spinal cord injury (SCI) and to determine its validity and reliability. SETTING: Eight SCI centers in Australia, Brazil, Canada (2), Korea, Italy, the UK and the US. METHODS: Original items were constructed by experts at two SCI centers (Italy and the US) and blindly ranked in an hierarchical order (pilot data). These items were compared to the Functional Independence Measure (FIM) for concurrent validity. Subsequent independent blind rank ordering of items was completed at all eight centers (24 individuals and eight teams). Final consensus on rank ordering was reached during an international meeting (face validation). A videotape comprised of 40 clips of patients walking was forwarded to all eight centers and inter-rater reliability data collected. RESULTS: Kendall coefficient of concordance for the pilot data was significant (W=0. 843, P<0.001) indicating agreement among the experts in rank ordering of original items. FIM comparison (Spearman's rank correlation coefficient=0.765, P<0.001) showed a theoretical relationship, however a practical difference in what is measured by each scale. Kendall coefficient of concordance for the international blind hierarchical ranking showed significance (W=0.860, P<0.001) indicating agreement in rank ordering across all eight centers. Group consensus meeting resulted in a 19 item hierarchical rank ordered 'Walking Index for Spinal Cord Injury (WISCI)'. Inter-rater reliability scoring of the 40 video clips showed 100% agreement. CONCLUSIONS: This is the first time a walking scale for SCI of this complexity has been developed and judged by an international group of experts. The WISCI showed good validity and reliability, but needs to be assessed in clinical settings for responsiveness.
Assuntos
Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/reabilitação , Índices de Gravidade do Trauma , Caminhada/normas , Austrália , Brasil , Canadá , Conferências de Consenso como Assunto , Humanos , Itália , Coreia (Geográfico) , Variações Dependentes do Observador , Aparelhos Ortopédicos/classificação , Aparelhos Ortopédicos/normas , Projetos Piloto , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Reino Unido , Estados Unidos , Gravação de VideoteipeRESUMO
Os traumatismos raquimedulares ocupam uma posiçäo importante como causa de mortes e de sequelas em indivíduos jovens. Neste trabalho säo discutidos os conceitos de anatomia da coluna vertebral, os mecanismos e a fisiopatologia do trauma, o quadro clínico e o tratamento de emergência dos pacientes com traumatismos raquimedulares
Assuntos
Humanos , Adulto , Adolescente , Traumatismos da Medula Espinal , Traumatismos da Coluna Vertebral , Traumatismos da Medula Espinal , Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/terapia , Traumatismos da Coluna Vertebral , Traumatismos da Coluna Vertebral/classificação , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/terapia , Coluna Vertebral/anatomia & histologiaRESUMO
Com o evento dos tempos modernos, imortalizado por Chaplin, observa-se a perda sistemática do controle do homem sobre a máquina por ele mesmo criada, sendo paulatinamente por ela comandado, dela sendo perigosamente dependente e quase vítima fatal, devido aos acidentes automobilísticos, às quedas acidentais na prática de esportes violentos aos mergulhos em piscinas rasas ou praias, agressoes da violência urbana por projetis de arma de fogo, estilhaços ou armas brancas. Enfim, um grande número de causas levam a dar entrada nos serviços de emergência da cidade o paciente vítima de traumatismo raquimedular. Durante vários anos tivemos a oportunidade de estudar e pensar a respeito das novas técnicas aqui descritas. Este artigo descreve esta experiência.