Instituto de Medicina Física e de Reabilitação - HC/IMREA
URI Permanente desta comunidade
O Instituto de Medicina Física e de Reabilitação (IMREA) da Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, (FMUSP-HC) teve início em 1958, quando a USP firmou um convênio com a Organização das Nações Unidas (ONU) criando o Instituto Nacional de Reabilitação (INAR), mais tarde denominado Instituto de Reabilitação (IR), que inspirou estudos e pesquisas que resultaram na criação do Centro de Reabilitação do Hospital das Clínicas, inaugurado em 1975. Inicialmente denominado Divisão de Reabilitação Profissional de Vergueiro (DRPV), em julho de 1994 passou a se chamar Divisão de Medicina de Reabilitação (DMR). Em janeiro de 2009, tornou-se mais um Instituto do Sistema FMUSP-HC, recebendo sua atual denominação. Possui, atualmente, quatro unidades: Vila Mariana, Lapa, Umarizal e Clínicas, que, atualmente, integram a Rede de Reabilitação Lucy Montoro.
Atende aos portadores de deficiência física, transitória ou definitiva, buscando desenvolver o seu potencial físico, psicológico, social, profissional e educacional, através de serviços médicos especializados com equipe multiprofissional onde trabalham médicos, enfermeiros, assistentes sociais, terapeutas ocupacionais, fisioterapeutas, fonoaudiólogos, odontólogos e psicólogos.
Site oficial: http://www.redelucymontoro.org.br
Atende aos portadores de deficiência física, transitória ou definitiva, buscando desenvolver o seu potencial físico, psicológico, social, profissional e educacional, através de serviços médicos especializados com equipe multiprofissional onde trabalham médicos, enfermeiros, assistentes sociais, terapeutas ocupacionais, fisioterapeutas, fonoaudiólogos, odontólogos e psicólogos.
Site oficial: http://www.redelucymontoro.org.br
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- Instituto de Medicina Física e de Reabilitação - HC/IMREA
- Instituto de Medicina Física e de Reabilitação - HC/IMREA
- Instituto de Medicina Física e de Reabilitação - HC/IMREA
Submissões Recentes
Percepções de estudantes de Medicina sobre o estresse acadêmico e a mentoria no seu enfrentamento: um estudo qualitativo
(2023) RIOS, Izabel Cristina; SANTOS, Renata Silva; VITAL JUNIOR, Pedro Felix
Medical training is considered stressful due to factors such as heavy course load, complex practical activities, the large volume of content and high expectations in terms of dedication. Mentoring programs can alleviate academic stress. The aim of this qualitative cross-sectional study was to investigate medical students’ perceptions of a mentoring program designed to reduce stress and mentoring as a tool for coping. We selected 12 students and held focus group sessions. We performed a thematic analysis, which resulted in the identification of two categories of stressors and protectors: being a student and the academic environment and self-care and mentoring, respectively. Mentoring was considered a coping resource because it provided a space for reflection and helped students develop skills and behavior that enhance relational skills, in addition to providing a welcoming environment, psychological relief, a feeling of belonging and a tranquilizing effect.
Non-invasive sound wave brain stimulation with Transcranial Pulse Stimulation (TPS) improves neuropsychiatric symptoms in Alzheimer's disease
(2024) SHINZATO, Gilson Tanaka; ASSONE, Tatiane; SANDLER, Paulo C.; PACHECO-BARRIOS, Kevin; FREGNI, Felipe; RADANOVIC, Marcia; FORLENZA, Orestes Vicente; BATTISTELLA, Linamara Rizzo
Background: This study explores Transcranial Pulse Stimulation (TPS) as a potential non-invasive treatment for Alzheimer's disease (AD), focusing on its impact on cognitive functions and behavioral symptoms. Methods: In a prospective, one-arm open-label trial, ten patients with mild to moderate dementia due to AD were assessed using the Alzheimer's Disease Assessment Scale (ADAS-Cog), Neuropsychiatric Inventory (NPI), Pfeffer Functional Activities Questionnaire, and Zarit Caregiver Burden Interview. Assessments occurred at 30- and 90days post-treatment. The TPS protocol consisted of 10 sessions over five weeks, using the Neurolith (R) device to deliver 6000 focused shockwave pulses at 0.25 mJ/mm2 and a frequency of 4 Hz. Results: TPS significantly reduced neuropsychiatric symptoms, with NPI scores decreasing by 23.9 points (95% CI: -39.19 to -8.61, p = 0.0042) after 30 days, and by 18.9 points (95% CI: -33.49 to -2.91, p = 0.022) after 90 days. These changes had large effect sizes (Cohen's dz = 1.43 and dz = 0.94, respectively). A decreasing trend was observed in the ADAS-Cog score (-3.6, 95% CI: -7.18 to 0.00, p = 0.05) after 90 days, indicating a potential reduction in cognitive impairment, though not statistically significant. Conclusion: The preliminary results indicate that TPS treatment leads to significant improvement in neuropsychiatric symptoms in AD patients, showing promise as a therapeutic approach for AD. Further research is needed to fully establish its effectiveness, especially concerning cognitive functions.
The state of the art in therapeutic administration of botulinum toxin in children with cerebral palsy: an review
(2024) DORF, Sandro Rachevsky; FONSECA, Adriana Rodrigues; SZTAJNBOK, Flavio Roberto; OLIVEIRA, Thiffany Rodrigues Delfino de; BASTTISTELLA, Linamara Rizzo
Objective: To describe the current state of the art in the therapeutic administration of botulinum toxin with indications, efFicacy, and safety profile for children and adolescents with cerebral palsy. Data source: An integrative review was conducted. The MEDLINE/ PubMed database was searched twice within the last decade using distinct terms, and only studies written in the English language were included. The study population was limited to those aged 0-18 years. Articles that were duplicates or lacked sufFicient methodology information were excluded. Data synthesis: We found 256 articles, of which 105 were included. Among the included studies, most were conducted in developed countries. Botulinum toxin demonstrated good safety and efFicacy in reducing spasticity, particularly when administered by a multidisciplinary rehabilitation team. It is primarily utilized to improve gait and upper limb function, facilitate hygiene care, reduce pain, prevent musculoskeletal deformities, and even decrease sialorrhea in patients without a functional prognosis for walking. Conclusions: The administration of botulinum toxin is safe and efFicacious, especially when combined with a multi-professional rehabilitation team approach, which increases the probability of functional improvement. It can also be beneficial for patients with significant functional impairments to help with daily care tasks, such as hygiene, dressing, and reducing sialorrhea. Pediatricians must be familiar with this treatment and its indications to attend to and refer patients promptly when necessary, and to exploit their neuroplasticity. Further research on this topic is required in developing countries.
Post-COVID-19 condition: systemic inflammation and low functional exercise capacity
(2024) CASTRO, Gabriela Salim de; GAMA, Leonardo R.; RAMOS, Alexandre Ferreira; SILVA, Guilherme Gatti da; TEIXEIRA, Alexandre Abilio de Souza; CUNHA-NETO, Edecio; SOUZA, Heraldo Possolo de; MARIE, Suely K.; TALIB, Leda L.; COELHO, Veronica; KALIL, Jorge; ARAUJO, Adriana Ladeira de; RITTO, Ana Paula; BELON, Alessandro Rodrigo; SANTOS, Amanda Soares; BARRERE, Ana Paula Noronha; SAWAMURA, Marcio V. Y.; LAMAS, Celina Almeida; BALDI, Bruno Guedes; CARVALHO, Carlos R. R.; KULIKOWSKI, Leslie Domenici; DAMIANO, Rodolfo Furlan; IMAMURA, Marta; ROSA NETO, Jose Cesar; LIRA, Fabio S.; OTOCH, Jose Pinhata; MIGUEL, Euripedes Constantino; BATTISTELLA, Linamara; FORLENZA, Orestes V.; BUSATTO, Geraldo; SEELAENDER, Marilia
Introduction Post-COVID-19 condition (PCC) is characterised by a plethora of symptoms, with fatigue appearing as the most frequently reported. The alterations that drive both the persistent and post-acute disease newly acquired symptoms are not yet fully described. Given the lack of robust knowledge regarding the mechanisms of PCC we have examined the impact of inflammation in PCC, by evaluating serum cytokine profile and its potential involvement in inducing the different symptoms reported.Methods In this cross-sectional study, we recruited 227 participants who were hospitalised with acute COVID-19 in 2020 and came back for a follow-up assessment 6-12 months after hospital discharge. The participants were enrolled in two symptomatic groups: Self-Reported Symptoms group (SR, n = 96), who did not present major organ lesions, yet reported several debilitating symptoms such as fatigue, muscle weakness, and persistent loss of sense of smell and taste; and the Self-Reported Symptoms and decreased Pulmonary Function group (SRPF, n = 54), composed by individuals with the same symptoms described by SR, plus diagnosed pulmonary lesions. A Control group (n = 77), with participants with minor complaints following acute COVID-19, was also included in the study. Serum cytokine levels, symptom questionnaires, physical performance tests and general clinical data were obtained in the follow-up assessment.Results SRPF presented lower IL-4 concentration compared with Control (q = 0.0018) and with SR (q = 0.030), and lower IFN-alpha 2 serum content compared with Control (q = 0.007). In addition, SRPF presented higher MIP-1 beta serum concentration compared with SR (q = 0.029). SR presented lower CCL11 (q = 0.012 and q = 0.001, respectively) and MCP-1 levels (q = 0.052 for both) compared with Control and SRPF. SRPF presented lower G-CSF compared to Control (q = 0.014). Female participants in SR showed lower handgrip strength in relation to SRPF (q = 0.0082). Male participants in SR and SRPF needed more time to complete the timed up-and-go test, as compared with men in the Control group (q = 0.0302 and q = 0.0078, respectively). Our results indicate that different PCC symptom profiles are accompanied by distinct inflammatory markers in the circulation. Of particular concern are the lower muscle function findings, with likely long-lasting consequences for health and quality of life, found for both PCC phenotypes.
Surgical complications in the first and second semesters of the general surgery medical residence. A study of 14063 cases
(2024) ALVARENGA, Bruno Henrique; RIOS, Izabel Cristina; SILVA, Francisco de Salles Collet e; UTIYAMA, Edivaldo Massazo
Objective: To evaluate whether the rate of surgical complications is higher during the first semester of the General Surgery residency in the largest hospital complex in Latin America. During this period, students are expected to have less experience in carrying out procedures. Methods: During a period of two years, all General Surgery resident doctors at the Hospital das Cl & iacute;nicas of the Faculty of Medicine of the University of Sao Paulo, made a notification of all the procedures they performed (n = 14.063), containing information such as name of the procedure, date, who participated, complications, among others. These data were analyzed with the purpose of evaluating the variation in the rate of complications throughout the year. Results: There was a 52 % increase in the rate of complications in the first academic semester when compared to the second semester. This phenomenon was observed in resident doctors in the first and second years of residency. Furthermore, it was observed that second-year residents remain with high rates of complications, in some procedures, for a longer time than first-year residents. Furthermore, the first three months (March, April and May) seem to have the highest complication rates of the entire year. Conclusion: The impact of these complications can affect several health services and the increase in surgical complications in the first half of the year must be monitored by institutions, in order to control this phenomenon.
Transcranial Magnetic Stimulation
(2018) LEITE, J.; SIMIS, M.; CARVALHO, S.; FREGNI, F.
More than 30 years have already passed since the seminal article of Baker et al., in which a transcranial magnetic stimulation (TMS) pulse over the motor cortex (MC) was successfully used to painlessly elicit a recordable electromyography response. Since then, multiple studies have been conducted exploring the underlying physiology of TMS effects, its potential uses in clinical settings, as well as safety. In this chapter, we provide an overview regarding the basic mechanisms of TMS, how it can be used as a tool to investigate human brain cortex physiology, how it can be used to alter cortical excitability, its safety concerns, and its use in clinical settings. © 2018 Elsevier Ltd. All rights reserved.
The contribution of concentric electrode-evoked potentials and nociceptive withdrawal reflex to the routine neurophysiological assessment of neuropathic pain: cross-sectional study
(2023) NUNES, Lucas Martins de Exel; KUBOTA, Gabriel Taricani; FERNANDES, Ana Mércia; CHUNG, Tae Mo; ANDRADE, Daniel Ciampi de
ABSTRACT BACKGROUND AND OBJECTIVES: Conventional electrodiagnostic studies (EDX) are frequently used to support the diagnosis of peripheral neuropathic pain. However, routine EDX has poor diagnostic yield for identifying small fiber neuropathy, which may be cause of neuropathic pain in some patients. This study aimed to assess the gain in diagnostic yield brought by adding pain-related evoked potentials with concentric electrode (CN-PREP) and nociceptive withdrawal reflex (NWR) assessments to EDX. METHODS: Transversal observational accuracy study which included patients referred to routine EDX in a tertiary-care hospital who reported chronic neuropathic pain in their lower limbs. Besides routine EDX, subjects underwent CN-PREP and NWR assessments. Diagnostic yield and tolerability were examined and compared between test studies. RESULTS: The study enrolled 100 patients (54% female), with 57 ± 12 years. EDX was altered in 47% of all patients. The addition of CN-PREP alone, and NWR combined with CN-PREP increased diagnostic yield to 69% and 72%, respectively. CN-PREP proved to be well tolerable, while NWR was associated with higher test-related pain intensity and discontinuation rate (9% vs. 0%). Considering EDX as the reference test, CN-PREP sensitivity was 85.1% and specificity 58.5%. CONCLUSION: Combining CN-PREP with the routine EDX for patients with neuropathic pain is feasible and results in increased diagnostic yield. Conversely, the addition of NWR to the aforementioned tests provides little improvement to this yield and is less tolerable to the patient. Further studies are needed to determine the actual sensitivity and specificity of CN-PREP when compared to the gold-standard for small fiber neuropathy diagnosis, i.e. intraepidermal nerve fiber density assessment.
Telerreabilitação
(2023) CARVALHO, Mariana Cavazzoni Lima de; MARTINS, Fernanda; BATTISTELLA, Linamara Rizzo
Distinct patterns of metabolic motor cortex activity for phantom and residual limb pain in people with amputations: A functional near-infrared spectroscopy study
(2024) SIMIS, Marcel; MARQUES, Lucas Murrins; BARBOSA, Sara Pinto; SUGAWARA, Andre Tadeu; SATO, Joao Ricardo; PACHECO-BARRIOS, Kevin; BATTISTELLA, Linamara Rizzo; FREGNI, Felipe
Background: Phantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood. Objectives: The aim of this study was to understand, in patients with amputations, the association between PLP and residual limb pain (RLP), and the brain metabolic response in cortical motor circuits, using functional near-infrared spectroscopy (fNIRS). Methods: Sixty participants were recruited from the rehabilitation program in Sao Paulo, Brazil. Included patients were aged over 18 years, with traumatic unilateral lower-limb amputation, with PLP for at least 3 months after full recovery from amputation surgery. PLP and RLP levels were measured using visual analogue scales. fNIRS was performed during motor execution and motor mirror tasks for 20 s. In order to highlight possible variables related to variation in pain measures, univariate linear regression analyses were performed for both experimental conditions, resulting in four fNIRS variables (two hemispheres x two experimental conditions). Later, in order to test the topographic specificity of the models, eight multivariate regression analyses were performed (two pain scales x two experimental conditions x two hemispheres), including the primary motor cortex (PMC) related channel as an independent variable as well as five other channels related to the premotor area, supplementary area, and somatosensory cortex. All models were controlled for age, sex, ethnicity, and education. Results: We found that: i) there is an asymmetric metabolic activation during motor execution and mirror task between hemispheres (with a predominance that is ipsilateral to the amputated limb), ii) increased metabolic response in the PMC ipsilateral to the amputation is associated with increased PLP (during both experimental tasks), while increased metabolic response in the contralateral PMC is associated with increased RLP (during the mirror motor task only); ii) increased metabolic activity of the ipsilateral premotor region is associated with increased PLP during the motor mirror task; iii) RLP was only associated with higher metabolic activity in the contralateral PMC and lower metabolic activity in the ipsilateral inferior frontal region during motor mirror task, but PLP was associated with higher metabolic activity during both tasks. Conclusion: These results suggest there is both task and region specificity for the association between the brain metabolic response and the two different types of post-amputation pain. The metabolic predominance that is ipsilateral to the amputated limb during both tasks was associated with higher levels of PLP, suggesting a cortical motor network activity imbalance due to potential interhemispheric compensatory mechanisms. The present work contributes to the understanding of the underlying topographical patterns in the motor-related circuits associated with pain after amputations.
The cerebellum is causally involved in episodic memory under aging
(2023) ALMEIDA, Jorge; MARTINS, Ana R.; AMARAL, Lenia; VALERIO, Daniela; BUKHARI, Qasim; SCHU, Guilherme; NOGUEIRA, Joana; SPINOLA, Monica; SOLEIMANI, Ghazaleh; FERNANDES, Filipe; SILVA, Ana R.; FREGNI, Felipe; SIMIS, Marcel; SIMOES, Mario; PERES, Andre
Episodic memory decline is a major signature of both normal and pathological aging. Many neural regions have been implicated in the processes subserving both episodic memory and typical aging decline. Here, we demonstrate that the cerebellum is causally involved episodic memory under aging. We show that a 12-day neurostimulation program delivered to the right cerebellum led to improvements in episodic memory performance under healthy aging that long outlast the stimulation period - healthy elderly individuals show episodic memory improvement both immediately after the intervention program and in a 4-month follow-up. These results demonstrate the causal relevance of the cerebellum in processes associated with long-term episodic memory, potentially highlighting its role in regulating and maintaining cognitive processing. Moreover, they point to the importance of non-pharmacological interventions that prevent or diminish cognitive decline in healthy aging.