LINAMARA RIZZO BATTISTELLA

(Fonte: Lattes)
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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

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  • article 21 Citação(ões) na Scopus
    Effects of Combined and Alone Transcranial Motor Cortex Stimulation and Mirror Therapy in Phantom Limb Pain: A Randomized Factorial Trial
    (2021) GUNDUZ, Muhammed Enes; PACHECO-BARRIOS, Kevin; PINTO, Camila Bonin; DUARTE, Dante; VELEZ, Faddi Ghassan Saleh; GIANLORENCO, Anna Carolyna Lepesteur; TEIXEIRA, Paulo Eduardo Portes; GIANNONI-LUZA, Stefano; CRANDELL, David; BATTISTELLA, Linamara Rizzo; SIMIS, Marcel; FREGNI, Felipe
    Phantom limb pain (PLP) is a frequent complication in amputees, which is often refractory to treatments. We aim to assess in a factorial trial the effects of transcranial direct current stimulation (tDCS) and mirror therapy (MT) in patients with traumatic lower limb amputation; and whether the motor cortex plasticity changes drive these results. In this large randomized, blinded, 2-site, sham-controlled, 2 x 2 factorial trial, 112 participants with traumatic lower limb amputation were randomized into treatment groups. The interventions were active or covered MT for 4 weeks (20 sessions, 15 minutes each) combined with 2 weeks of either active or sham tDCS (10 sessions, 20 minutes each) applied to the contralateral primary motor cortex. The primary outcome was PLP changes on the visual analogue scale at the end of interventions (4 weeks). Motor cortex excitability and cortical mapping were assessed by transcranial magnetic stimulation (TMS). We found no interaction between tDCS and MT groups (F = 1.90, P = .13). In the adjusted models, there was a main effect of active tDCS compared to sham tDCS (beta coefficient = -0.99, P = .04) on phantom pain. The overall effect size was 1.19 (95% confidence interval: 0.90, 1.47). No changes in depression and anxiety were found. TDCS intervention was associated with increased intracortical inhibition (coefficient = 0.96, P = .02) and facilitation (coefficient = 2.03, P = .03) as well as a posterolateral shift of the center of gravity in the affected hemisphere. MT induced no motor cortex plasticity changes assessed by TMS. These findings indicate that transcranial motor cortex stimulation might be an affordable and beneficial PLP treatment modality.
  • article 8 Citação(ões) na Scopus
    Transcranial direct current stimulation combined with robotic training in incomplete spinal cord injury: a randomized, sham-controlled clinical trial
    (2021) SIMIS, Marcel; FREGNI, Felipe; BATTISTELLA, Linamara R.
    Study design A randomized, sham-controlled clinical trial. Objective To test the effects of tDCS, combined with robotic training, on gait disability in SCI. Our hypothesis was that participants who received active tDCS would experience greater walking gains, as indexed by the WISCI-II, than those who received sham tDCS. Setting University of Sao Paulo, Brazil. Methods This randomized, double-blind study comprised 43 participants with incomplete SCI who underwent 30 sessions of active (n = 21) or sham (n = 22) tDCS (20 min, 2 mA) before every Lokomat session of 30 min (3 times a week over 12 weeks or 5 times a week over 6 weeks). The main outcome was the improvement in WISCI-II. Participants were assessed at baseline, after 15 and 30 sessions of Lokomat, and after three months of treatment. Results There was a significant difference in the percentage of participants that improved in WISCI-II at the 30-session, compared with baseline: 33.3% in the sham group and 70.0% in the active group (p = 0.046; OR: 3.7; 95% CI: 1.0-13.5). At the follow-up, the improvement compared with baseline in the sham group was 35.0% vs. 68.4% for the active group (p = 0.046; OR: 3.7; 95% CI: 1.0-13.5). There was no significant difference at the 15-session. Conclusion Thirty sessions of active tDCS is associated with a significant improvement in walking, compared to sham. Moreover, 15 sessions had no significant effect. The improvement in WISCI-II can be related to different aspects of motor learning, including motor recovery and compensation.
  • article 12 Citação(ões) na Scopus
    Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis
    (2021) SIMIS, Marcel; IMAMURA, Marta; MELO, Paulo S. de; MARDUY, Anna; PACHECO-BARRIOS, Kevin; TEIXEIRA, Paulo E. P.; BATTISTELLA, Linamara; FREGNI, Felipe
    This study aims to investigate the associative and multivariate relationship between different sociodemographic and clinical variables with cortical excitability as indexed by transcranial magnetic stimulation (TMS) markers in subjects with chronic pain caused by knee osteoarthritis (OA). This was a cross-sectional study. Sociodemographic and clinical data were extracted from 107 knee OA subjects. To identify associated factors, we performed independent univariate and multivariate regression models per TMS markers: motor threshold (MT), motor evoked potential (MEP), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP). In our multivariate models, the two markers of intracortical inhibition, SICI and CSP, had a similar signature. SICI was associated with age (beta: 0.01), WOMAC pain (beta: 0.023), OA severity (as indexed by Kellgren-Lawrence Classification) (beta: - 0.07), and anxiety (beta: - 0.015). Similarly, CSP was associated with age (beta: - 0.929), OA severity (beta: 6.755), and cognition (as indexed by the Montreal Cognitive Assessment) (beta: - 2.106). ICF and MT showed distinct signatures from SICI and CSP. ICF was associated with pain measured through the Visual Analogue Scale (beta: - 0.094) and WOMAC (beta: 0.062), and anxiety (beta: - 0.039). Likewise, MT was associated with WOMAC (beta: 1.029) and VAS (beta: - 2.003) pain scales, anxiety (beta: - 0.813), and age (beta: - 0.306). These associations showed the fundamental role of intracortical inhibition as a marker of adaptation to chronic pain. Subjects with higher intracortical inhibition (likely subjects with more compensation) are younger, have greater cartilage degeneration (as seen by radiographic severity), and have less pain in WOMAC scale. While it does seem that ICF and MT may indicate a more acute marker of adaptation, such as that higher ICF and MT in the motor cortex is associated with lesser pain and anxiety.
  • article 0 Citação(ões) na Scopus
    Immediate effect of a single cycle ergometry session on skin temperature of women with and without varicose veins: A case report
    (2021) DIAS, C. da Silva; ALFIERI, F. M.; ANDRADE, V. C. S. de; BATTISTELLA, L. R.
    BACKGROUND: Vascular diseases such as varicose veins can affect the distribution of skin temperature, and thermography can be a useful way to capture this. The aim of this case report is to show the changes in skin temperature induced by bicycling and to evaluate the thermal symmetry before and after physical activity in two women, one with and the other without varicose veins. MATERIALS AND METHODS: Two women, one with varicose veins (subject 1) and a healthy volunteer (subject 2), were examined before and after a single session of one-hour lasting cycle ergometry. They were assessed by a FLIR T650sc infrared camera before, immediately after and 15 minutes after the session. Total body thermograms were taken with subjects 4 meters away from the camera, in anterior and posterior views, and 6 regions of interest (ROIs) were defined. RESULTS: Subject 2, who used to exercise regularly, exhibited similar temperature values in the evaluated ROIs of the right and left body sides. In the subject 2, a more pronounced thermal symmetry was observed than in the subject 1 at all examination moments. In both individuals, the degree of thermal symmetry was not affected by cycling. CONCLUSION: Varicose veins are associated with moderate thermal asymmetry, while the lower extremities of a healthy person appeared thermally symmetric. Both distribution patterns of skin temperature were not affected by single session of cycling exercise. © 2021 European Association of Thermology. All rights reserved.
  • article 4 Citação(ões) na Scopus
    Developing a rigid frame wheelchair in Brazil
    (2021) SUGAWARA, Andre Tadeu; OSHIRO, Milton Seigui; YAMANAKA, Eduardo Inglez; RAMOS, Vinicius Delgado; BATTISTELLA, Linamara Rizzo
    Purpose: Describing the development process of a rigid frame wheelchair using user-centered and open innovation approaches, as envisaged by the WHO Wheelchair Guidelines.Methods: Unstructured interviews and group discussions with conveniently sampled active wheelchair users oriented the initial brief, product design and selection. The initially approved prototype was subject to ISO 7176 tests, leading to further product adjustments. The long-term follow-up was inclusive of a new group of purposively selected active wheelchair users and measured user satisfaction and safety, as well as user mobility and wheelchair fitting. Data on user satisfaction, safety and effectiveness was produced using QUEST 2.0 and WHO Wheelchair Service Training Package's forms and checklists in Portuguese.Results: Iterative design and selection led to a prototype that was found appropriate by multiple stakeholders. ISO testing ensured its safety and durability. Follow-up trials included 40 active wheelchair users, who used the studied wheelchair for at least two months. They were 80% male, on average 36.3years old, and had received their rigid frame wheelchair approximately 4.7years after disability onset. 92.5% of them had SCI, 7.5% had bilateral transfemoral amputations. Users' assessments showed satisfaction with products (4.4) and services (4.1). Users spent an average of 4.2h/day sat in their wheelchairs. 7.5% and 20% of users reported pressure sores and falls, respectively.Conclusion: A user-centered, open innovation approach led to the development of a good quality, affordable, and acceptable rigid frame wheelchair model that increased the range of manual wheelchairs available through the Brazilian public healthcare system.Implications for rehabilitationThe feedback of rehabilitation professionals with respect to new products' features is fundamental in order to understand how these devices will be adequately serviced and delivered to users.Engaging users of assistive products and rehabilitation professionals in developing new and innovative products facilitates the iteration and selection of the best project alternatives and saves considerable time and resources.Rehabilitation professionals are in the best position to work with user of assistive products and other stakeholders, such as the industry and research and development centres, to identify the impact of new assistive products in users' functionality, acknowledging their conditions and environments and exploring their potential.Working with users and other stakeholders from different backgrounds and areas of expertise makes the moto ""Nothing about us, without us"" real. Working towards improving functionality often requires developers to challenge the usual top-down development process in order to adopt a user-centered perspective.
  • article 6 Citação(ões) na Scopus
    Electroencephalography as a Biomarker for Functional Recovery in Spinal Cord Injury Patients
    (2021) SIMIS, Marcel; CAMSARI, Deniz Doruk; IMAMURA, Marta; FILIPPO, Thais Raquel Martins; SOUZA, Daniel Rubio De; BATTISTELLA, Linamara Rizzo; FREGNI, Felipe
    Background Functional changes after spinal cord injury (SCI) are related to changes in cortical plasticity. These changes can be measured with electroencephalography (EEG) and has potential to be used as a clinical biomarker. Method In this longitudinal study participants underwent a total of 30 sessions of robotic-assisted gait training (RAGT) over a course of 6 weeks. The duration of each session was 30 min. Resting state EEG was recorded before and after 30-session rehabilitation therapy. To measure gait, we used the Walking Index for Spinal Cord Injury Scale, 10-Meter- Walking Test, Timed-Up-and-Go, and 6-Min-Walking Test. Balance was measured using Berg Balance Scale. Results Fifteen participants with incomplete SCI who had AIS C or D injuries based on American Spinal Cord Injury Association Impairment Scale classification were included in this study. Mean age was 35.7 years (range 17-51) and the mean time since injury was 17.08 (range 4-37) months. All participants showed clinical improvement with the rehabilitation program. EEG data revealed that high beta EEG activity in the central area had a negative correlation with gait (p = 0.049; beta coefficient: -0.351; and adj-R-2: 0.23) and balance (p = 0.043; beta coefficient: -0.158; and adj-R-2:0.24) measured at baseline, in a way that greater high beta EEG power was related to worse clinical function at baseline. Moreover, improvement in gait and balance had negative correlations with the change in alpha/theta ratio in the parietal area (Gait: p = 0.049; beta coefficient: -0.351; adj-R-2: 0.23; Balance: p = 0.043; beta coefficient: -0.158; and adj-R-2: 0.24). Conclusion In SCI, functional impairment and subsequent improvement following rehabilitation therapy with RAGT correlated with the change in cortical activity measured by EEG. Our results suggest that EEG alpha/theta ratio may be a potential surrogate marker of functional improvement during rehabilitation. Future studies are necessary to improve and validate these findings as a neurophysiological biomarker for SCI rehabilitation.
  • conferenceObject
    TEMPERATURE AND ESTHESIA IN INDIVIDUALS WITH POST STROKE
    (2021) DIAS, C. D. S.; ALFIERI, F.; SANTOS, A. Dos; BATTISTELLA, L.
  • article 4 Citação(ões) na Scopus
    Characterisation of Phantom Limb Pain in Traumatic Lower-Limb Amputees
    (2021) SUGAWARA, Andre Tadeu; SIMIS, Marcel; FREGNI, Felipe; BATTISTELLA, Linamara Rizzo
    Introduction. There is no diagnosis for phantom limb pain (PLP), and its investigation is based on anamnesis, which is subject to several biases. Therefore, it is important to describe and standardize the diagnostic methodology for PLP. Objective. To characterise PLP and, secondarily, to determine predictors for its diagnosis. Methodology. This is a cross-sectional study involving patients with unilateral traumatic lower-limb amputation aged over 18 years. Those with clinical decompensation or evidence of disease, trauma, or surgery in the central or peripheral nervous system were excluded. Sociodemographic and rehabilitative data were collected; PLP was characterised using the visual analogue scale (VAS), pain descriptors, and weekly frequency. Results. A total of 55 eligible patients participated in the study; most were male, young, above-knee amputees in the preprosthetic phase of the rehabilitation. The median PLP VAS was 60 (50-79.3) mm characterised by 13 (6-20) different descriptors in the same patient, which coexist, alternate, and add up to a frequency of 3.94 (2.5-4.38) times per week. The most frequent descriptor was movement of the phantom limb (70.91%). Tingling, numbness, flushing, itchiness, spasm, tremor, and throbbing are statistically significant PLP descriptor numbers per patient predicted by above-knee amputation, prosthetic phase, higher education level, and greater PLP intensity by VAS (p<0.05). Conclusion. PLP is not a single symptom, but a set with different sensations and perceptions that need directed and guided anamnesis for proper diagnosis.
  • article 12 Citação(ões) na Scopus
    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 Rizzo
    Background: 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.
  • article 24 Citação(ões) na Scopus
    Post-acute sequelae of SARS-CoV-2 infection (PASC): a protocol for a multidisciplinary prospective observational evaluation of a cohort of patients surviving hospitalisation in Sao Paulo, Brazil
    (2021) BUSATTO, Geraldo Filho; ARAUJO, Adriana Ladeira de; DUARTE, Alberto Jose da Silva; LEVIN, Anna Sara; GUEDES, Bruno Fukelmann; KALLAS, Esper Georges; PINNA, Fabio Rezende; SOUZA, Heraldo Possolo de; SILVA, Katia Regina da; SAWAMURA, Marcio Valente Yamada; SEELAENDER, Marilia; IMAMURA, Marta; GARCIA, Michelle Louvaes; FORLENZA, Orestes Vicente; NITRINI, Ricardo; DAMIANO, Rodolfo Furlan; ROCHA, Vanderson Geraldo; BATISTTELLA, Linamara Rizzo; CARVALHO, Carlos Roberto Ribeiro de
    Introduction COVID-19 may lead to persistent and potentially incapacitating clinical manifestations (post-acute sequelae of SARS-CoV-2 infection (PASC)). Using easy-to-apply questionnaires and scales (often by telephone interviewing), several studies evaluated samples of COVID-19 inpatients from 4 weeks to several months after discharge. However, studies conducting systematic multidisciplinary assessments of PASC manifestations are scarce, with thorough in-person objective evaluations restricted to modestly sized subsamples presenting greatest disease severity. Methods and analyses We will conduct a prospective observational study of surviving individuals (above 18 years of age) from a cohort of over 3000 subjects with laboratory-confirmed COVID-19 who were treated as inpatients at the largest academic health centre in Sao Paulo, Brazil (Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo). All eligible subjects will be consecutively invited to undergo a 1-2-day series of multidisciplinary assessments at 2 time-points, respectively, at 6-9 months and 12-15 months after discharge. Assessment schedules will include detailed multidomain questionnaires applied by medical research staff, self-report scales, objective evaluations of cardiopulmonary functioning, physical functionality and olfactory status, standardised neurological, psychiatric and cognitive examinations, as well as diagnostic laboratory, muscle ultrasound and chest imaging exams. Remaining material from blood tests will be incorporated by a local biobank for use in future investigations on inflammatory markers, genomics, transcriptomics, peptidomics and metabolomics. Ethics and dissemination All components of this programme have been approved by local research ethics committees. We aim to provide insights into the frequency and severity of chronic/post-COVID multiorgan symptoms, as well as their interrelationships and associations with acute disease features, sociodemographic variables and environmental exposures. Findings will be disseminated in peer-reviewed journals and at scientific meetings. Additionally, we aim to provide a data repository to allow future pathophysiological investigations relating clinical PASC features to biomarker data extracted from blood samples.