LINAMARA RIZZO BATTISTELLA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de MedicinaLegal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina - Docente
Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas, Faculdade de Medicina
FMUSP, Hospital das Clínicas, Faculdade de Medicina
LIM/40 - Laboratório de Imunohematologia e Hematologia Forense, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas, Faculdade de Medicina
FMUSP, Hospital das Clínicas, Faculdade de Medicina
LIM/40 - Laboratório de Imunohematologia e Hematologia Forense, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Acute Effect of Robotic Therapy (G-EO System) on the Lower Limb Temperature Distribution of a Patient with Stroke Sequelae(2019) ALFIERI, Fabio Marcon; DIAS, Caren da Silva; SANTOS, Artur Cesar Aquino dos; BATTISTELLA, Linamara RizzoRobotic therapy has been gaining prominence in poststroke rehabilitation programs. An example of these devices is the G-EO System, which simulates gait as well as other more complexes standards of gait such as the steps on stairs. However, to the best of our knowledge, there are no studies that apply thermography as a tool to evaluate stroke patients who undertook rehabilitation programs with the aid of robotic devices. The patient IWPS undergoes sequelae of hemorrhagic stroke for 19 months and consequently hemiplegia, had scores of 93 points in the Fugl-Meyer scale, is undertaking a physical rehabilitation program for six months, has no complaints of discomfort due to thermic sensitivity imbalances between the plegic and the contralateral sides, and voluntarily reports that he realizes functionality improvements especially, according to his perception, due to the aid of the robotic therapy in his gait training with the G-EO System. The thermographic images were captured by an infrared sensor FLIR T650SC. By analyzing the temperature differences between both hemispheres of the body, before, immediately after, and 30 minutes after a robotic therapy for gait training, we observed that the values firstly increased immediately after the training, but after the 30-minute rest an important thermoregulation was achieved.
article 0 Citação(ões) na Scopus The concordance study of the portable camera FLIR C5 for detecting asymmetry of skin temperature in patients with stroke sequelae(2023) ALFIERI, F. M.; SANTOS, A. C. A. dos; DIAS, C. da Silva; BATTISTELLA, L. R.BACKGROUND: Low-cost portable infrared cameras are increasingly used for health assessments, especially for investigating the skin temperature of the whole body. However, some of these devices have not yet been tested for agreement with high-resolution cameras. Therefore, the objective of this study was to test the agreement of FLIR C5, a portable infrared thermographic camera, compared to the FLIR T650sc, a high-quality and high-resolution thermographic device, for detecting thermal asymmetry between both sides of the body of patients with motor sequelae after stroke. MATERIALS AND METHODS: This is an observational and cross-sectional study conducted in a physical rehabilitation facility with 14 patients with stroke sequelae. Participants had their temperature simultaneously measured by FLIR T650sc and FLIR C5 infrared thermography cameras and analyzed with the software FLIR Tools®. The temperature difference of each ROI measured by both cameras was compared with Lin's Concordance Correlation Coefficient (rho or ρc) and Bland Altman the limits of agreement (LOA). RESULTS: the temperatures measured by FLIR C5 were lower than those measured by FLIR T650sc, regardless of the region of interest or side (-0.65, SD 1.44). We observed that the general concordance was classified as adequate to excellent (ρc=0.859; 95%CI 0.817-0.901; p<0.001) and that the forearm and leg in the posterior view presented the sites with the best associations between the temperature readings of FLIR C5 and FLIR T650sc. CONCLUSIONS: The temperature asymmetry usually found among patients with stroke sequelae may be assessed by the portable infrared thermographic camera FLIR C5, given its suitable concordance with FLIR T650sc.conferenceObject TEMPERATURE AND ESTHESIA IN INDIVIDUALS WITH POST STROKE(2021) DIAS, C. D. S.; ALFIERI, F.; SANTOS, A. Dos; BATTISTELLA, L.- Robot-Assisted Therapy and Constraint-Induced Movement Therapy for Motor Recovery in Stroke: Results From a Randomized Clinical Trial(2021) TERRANOVA, Thais Tavares; SIMIS, Marcel; SANTOS, Artur Cesar Aquino; ALFIERI, Fabio Marcon; IMAMURA, Marta; FREGNI, Felipe; BATTISTELLA, Linamara RizzoBackground: Stroke is one of the leading causes of adult disability, and up to 80% of stroke survivors undergo upper extremity motor dysfunction. Constraint-Induced Movement Therapy (CIMT) and Robot-Assisted Therapy (RT) are used for upper limb stroke rehabilitation. Although CIMT and RT are different techniques, both are beneficial; however, their results must be compared. The objective is to establish the difference between RT and CIMT after a rehabilitation program for chronic stroke patients. Method: This is a randomized clinical trial, registered at ClinicalTrials.gov (ID number NCT02700061), in which patients with stroke received sessions of RT or CIMT protocol, combined with a conventional rehabilitation program for 12 weeks. The primary outcome was measured by Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment-Upper Limb (FMA-UL). Activities of daily living were also assessed. Results: Fifty one patients with mild to moderate upper limb impairment were enrolled in this trial, 25 women and 26 men, mean age of 60,02 years old (SD 14,48), with 6 to 36 months after stroke onset. Function significantly improved regardless of the treatment group. However, no statistical difference was found between both groups as p-values of the median change of function measured by WMFT and FMA were 0.293 and 0.187, respectively. Conclusion: This study showed that Robotic Therapy (RT) was not different from Constraint-Induced Movement Therapy (CIMT) regardless of the analyzed variables. There was an overall upper limb function, motor recovery, functionality, and activities of daily living improvement regardless of the interventions. At last, the combination of both techniques should be considered in future studies.
- Ultrasonographic findings in long COVID: A cross-sectional study of 312 patients(2023) IMAMURA, Marta; UCHYIAMA, Sabrina Saemy Tome; NAVES, Gabriella Souza; ABICALAF, Claudia Andreia Rabay Pimentel; MIRISOLA, Aline Rossetti; SANTOS, Artur Cesar Aquino dos; BATTISTELLA, Linamara RizzoBackgroundFatigue and muscle weakness are common complaints in COVID-19 survivors. However, little is still known about the skeletal muscle qualitative and quantitative characteristics after hospitalization due to moderate and severe COVID-19. ObjectivesTo assess rectus femoris and vastus intermedius muscle thickness (MT) and rectus femoris echo intensity (EI) and to establish its association with demographic, clinical, functional, and inflammatory parameters in long COVID patients after hospital discharge. MethodsCross-sectional study with 312 COVID-19 patients (53.53% male; age: 54.59 +/- 13.50 years), with a laboratory-confirmed diagnosis of COVID-19. Patients were assessed 3-11 months after hospital discharge. We evaluated MT of the right rectus femoris and vastus intermedius and EI of the right rectus femoris using a portable ultrasound system, 6-13 MHz, broadband linear transducer. We corrected EI using the subcutaneous fat thickness. Ultrasonographic parameters were tested in association with demographic (sex and age); functional (Handgrip strength measurement, Timed Up and Go, 1 min Sit-to-Stand test, EuroQoL-5 Dimensions-5 Levels, World Health Organization Disability Assessment Schedule (WHODAS 2.0), Post-COVID-19 Functional Status, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT), Medical Research Council (MRC) sum score, Borg Dyspnea Scale, MRC Dyspnea score, Visual Analogue Scale (VAS), Epworth Sleepiness Scale, Insomnia Severity Index, Functional Independence Measurement (FIM), and Functional Oral Intake Scale); clinical (length of hospital stay, intubation, and presence of comorbidities such as systemic hypertension, diabetes, obesity, chronic obstructive pulmonary disease, asthma), and inflammatory data assessed by the C-reactive protein and D-dimer serum concentrations. ResultsRectus femoris MT was associated with age, handgrip strength, Epworth Sleepiness Scale, and subcutaneous fat thickness (r(2) = 27.51%; p < 0.0001). Vastus intermedius MT was associated with age, pain intensity, handgrip strength, Epworth Sleepiness scale, FIM, and time since hospital discharge (r(2) = 21.12%; p < 0.0001). Rectus femoris EI was significantly associated with the male sex, TUG, Epworth Sleepiness Scale, and C-Reactive Protein levels (r(2) = 44.39%; p < 0.0001). Mean MT of rectus femoris and vastus intermedius are significantly different (p < 0.001). ConclusionAfter hospital discharge, long COVID patients present qualitative and quantitative skeletal muscle characteristics associated with a combination of demographic, clinical, and functional parameters.
article 3 Citação(ões) na Scopus Whole-body thermographic assessment of patients with stroke sequelae who report temperature differences between the sides(2022) DIAS, C. da Silva; ALFIERI, F. M.; SANTOS, A. C. A. dos; BATTISTELLA, L. R.BACKGROUND: Among the several changes caused by Cerebral Vascular Accident (CVA or stroke), alterations in skin temperature sensation, especially on the lower extremities, may be onset. Therefore, investigating skin temperature of the whole body of these patients with infra-red thermography might be meaningful. The objective of this study was to assess the whole-body temperature distribution of patients with stroke sequelae who report temperature differences between the sides of the body. MATERIALS AND METHODS: This is an observational and cross-sectional study with 43 patients with stroke sequelae conducted in a physical rehabilitation facility. Participants had their temperature measured by FLIR T650sc infrared thermography camera, and the thermographic images were analyzed with the software FLIR Tools®. Statistical analysis was conducted with Student's T-test for paired samples, and statistical significance was considered if p<0.005, after single-step correction for multiple comparisons. RESULTS: Significant temperature differences were found between both sides of the body in all Regions of Interest (ROIs), especially in the distal areas, as the average temperature difference was as significant as 0.7ºC. CONCLUSIONS: Patients with stroke sequelae who report temperature differences between the sides of the body have lower temperatures on the plegic limb than the contralateral limb. © 2022 European Association of Thermology. All rights reserved.bookPart 0 Citação(ões) na Scopus Thermography in strokes(2023) ALFIERI, F. M.; SANTOS, A. C. A. dos; BATTISTELLA, L. R.Among the consequences of stroke, sensory disorders can affect more than half of patients. One of the consequences is the change in body temperature between the hemibodies that the patients can perceive or neglect. Although this temperature difference has been reported as unpleasant, little is understood or studied. As autonomic disorders are present in patients with stroke, and as thermography can assess body temperature distribution, using this assessment in these patients is feasible. This chapter will address body temperature distribution in patients with and without stroke and the associations between sensorimotor recovery, sensitivity, perception, and body temperature in individuals with stroke sequelae. © 2023 Nova Science Publishers, Inc. All rights reserved.- Effects of an Inpatient Physical Rehabilitation Program Designed for Persons with Amputations of Traumatic or Vascular Etiologies(2022) UTIYAMA, Daniela Mitiyo Odagiri; ALFIERI, Fabio Marcon; SANTOS, Artur Cesar Aquino dos; RIBEIRO, Carla Paschoal Corsi; SALES, Viviane Caroline; BATTISTELLA, Linamara RizzoIntroduction Rehabilitation after amputation is essential, and descriptions of inpatient rehabilitation programs for individuals with amputation are scarce. Therefore, the objective of this study was to describe the effects of an inpatient physical rehabilitation program on mobility, balance, function, and gait of individuals with unilateral lower-limb amputations. Materials and Methods This was a retrospective before-after study. Data were extracted from medical records of individuals with lower-limb amputation admitted for inpatient intensive rehabilitation programs. Data on etiology, functional mobility (by timed up and go [TUG]), balance and functionality (amputee mobility predictor [AMP]), and gait (2-minute walk test [2MWT]) were collected before and after prosthetic fitting phase of an inpatient rehabilitation program. Patient information was stratified as traumatic and vascular etiologies, and after descriptive analysis, general outcomes and intragroup results were compared with t-test and followed by linear regressions analysis for a better understanding of the demographic and clinical roles on treatment evolution. Results Group comparison evidenced differences of age between traumatic and vascular groups, as traumatic amputations had greater incidence among younger individuals, regardless of the prosthesis phase. Before the prosthesis fitting and regardless of the groups, there were significant improvements on AMP, 2MWT, and TUG, and the differences between both groups were influenced by their baseline conditions. After prosthesis fitting, significant improvements were identified, regardless of the etiology. Conclusions This study provides evidence that individuals with amputation who are admitted to an intensive hospitalized physical rehabilitation program experience benefits in mobility, balance, functionality, and gait capacity irrespective of causality or if the prosthesis was provided. Gains evidenced in the preprosthetic phase were continued in the postprosthetic phase. Clinical Relevance Inpatient rehabilitation programs for individuals with amputation are beneficial for improving the functionality of these individuals. This type of multidisciplinary rehabilitation provides functional improvements to the patient from the preprosthetic to the prosthetic phases, favoring global rehabilitation in a short period, which can reduce treatment time and provide better living conditions for the patient.
- Ultrasonography findings in knee osteoarthritis: a prospective observational cross-sectional study of 100 patients(2021) ABICALAF, Claudia Andreia Rabay Pimentel; NAKADA, Leticia Naomi; SANTOS, Felipe Ricardo Aquino dos; AKIHO, Ichiro; SANTOS, Artur Cesar Aquino dos; IMAMURA, Marta; BATTISTELLA, Linamara RizzoWorldwide, knee osteoarthritis (KOA) accounts for 2.2% of total years lived with disability. There is a low correlation between joint tissue damage and pain intensity. Periarticular structures may be involved and cannot be identified in X-rays. To describe the main ultrasonography (USG) changes in symptomatic patients with primary KOA; to correlate the number of USG findings with KOA severity assessed by Kellgren and Lawrence (K&L) radiological scores, with pain intensity measured by a visual analogue scale (VAS) and with functioning scores assessed with the Timed up and go test (TUG) and Western Ontario and McMaster Universities (WOMAC) questionnaire. 100 patients with primary symptomatic KOA were assessed with X-ray and USG. Quantitative and qualitative analyses were evaluated in a systematic manner. The most frequent findings were joint effusion, pes anserinus bursitis, quadriceps tendon enthesopathy, popliteal cyst, iliotibial band tendinitis and patellar tendinitis. Pearson's correlation analysis demonstrated a significant moderate positive association between VAS scores and the number of USG findings (r = 0.36; p < 0.0001). The number of USG findings was different between K&L grades I and III (p = 0.041), I and IV (p < 0.001), and II and IV (p = 0.001, analysis of variance with Bonferroni correction). There was significant association between number of USG findings and TUG (r = 0.18; p = 0.014) and WOMAC scores for pain (r = 0.16; p < 0.029) and physical function domains (r = 0.16; p < 0.028). The most frequent USG finding was joint effusion. Periarticular structures should be explored as potential sources of pain and disability.
- Validity study of a triaxial accelerometer for measuring energy expenditure in stroke inpatients of a physical medicine and rehabilitation center(2023) DANIEL, Christiane Riedi; YAZBEK, Paulo; SANTOS, Artur Cesar Aquino; BATTISTELLA, Linamara RizzoPurpose Establish the validity of a triaxial accelerometer (Dynaport (R)) for evaluating the energy expenditure of patients with stroke sequelae at a rehabilitation hospital Methods This is a cross-sectional study with 24 stroke inpatients of a rehabilitation hospital. The participants were assessed on energy expenditure by an ergospirometer system and the triaxial accelerometer simultaneously during a walk test. The data collected by both devices were compared by intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement Results An almost perfect agreement (ICC = 0,94) in the energy expenditure measured by the accelerometer compared to the results of the ergospirometer system was found during the exercise test. The Bland-Altman analysis has shown suitable limits of agreement. Post hoc analyses with the maximum volume of oxygen and the total energy expenditure measured by the ergospirometer system evidenced significant correlation with the energy expenditure measurements by the accelerometer Conclusion Our results evidence that the triaxial accelerometer Dynaport (R) and its built-in software are valid for estimating the energy expenditure of stroke sequelae during a walk exercise.