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
Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic
(2024) RITTO, Ana Paula; ARAUJO, Adriana Ladeira de; CARVALHO, Carlos Roberto Ribeiro de; SOUZA, Heraldo Possolo De; FAVARETTO, Patricia Manga e Silva; SABOYA, Vivian Renata Boldrim; GARCIA, Michelle Louvaes; KULIKOWSKI, Leslie Domenici; KALLAS, Esper Georges; PEREIRA, Antonio Jose Rodrigues; COBELLO JUNIOR, Vilson; SILVA, Katia Regina; ABDALLA, Eidi Raquel Franco; SEGURADO, Aluisio Augusto Cotrim; SABINO, Ester Cerdeira; RIBEIRO JUNIOR, Ulysses; FRANCISCO, Rossana Pulcineli Vieira; MIETHKE-MORAIS, Anna; LEVIN, Anna Sara Shafferman; SAWAMURA, Marcio Valente Yamada; FERREIRA, Juliana Carvalho; SILVA, Clovis Artur; MAUAD, Thais; GOUVEIA, Nelson da Cruz; LETAIF, Leila Suemi Harima; BEGO, Marco Antonio; BATTISTELLA, Linamara Rizzo; DUARTE, Alberto Jose da Silva; SEELAENDER, Marilia Cerqueira Leite; MARCHINI, Julio; FORLENZA, Orestes Vicente; ROCHA, Vanderson Geraldo; MENDES-CORREA, Maria Cassia; COSTA, Silvia Figueiredo; CERRI, Giovanni Guido; BONFA, Eloisa Silva Dutra de Oliveira; CHAMMAS, Roger; BARROS FILHO, Tarcisio Eloy Pessoa de; BUSATTO FILHO, Geraldo
Introduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency.Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output.Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19.Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
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.
Mental health among children and adolescents after SARS-CoV-2 infection: A prospective study in a tertiary university hospital
(2023) MATSUO, Olivia Mari; LINDOSO, Livia; MARQUES, Heloisa Helena de Sousa; V, Guilherme Polanczyk; FARHAT, Sylvia Costa Lima; BAIN, Vera; FINK, Thais T.; MARTINS, Fernanda; ASTLEY, Camilla; SUGUITA, Priscila; TRINDADE, Vitor; CORREA-SILVA, Simone; PALMEIRA, Patricia; SANSON, Camila; PAULA, Yoshino de; LITVINOV, Nadia; FERREIRA, Juliana Caires O. A.; SAKITA, Neusa Keico; GUALANO, Bruno; SILVA, Clovis Artur A.; PEREIRA, Maria Fernanda Badue
Impaired cardiorespiratory fitness and endothelial function after SARS-CoV-2 infection in a sample of mainly immunocompromised youth
(2023) ASTLEY, Camilla; PRADO, Danilo Marcelo Leite do; SIECZKOWSKA, Sofia Mendes; ESTEVES, Gabriel P.; SUGUITA, Priscila; FINK, Thais; LINDOSO, Livia; MATSUO, Olivia; MARTINS, Fernanda; BAIN, Vera; PEREIRA, Maria Fernanda Badue; MARQUES, Heloisa Helena; MALLUF, Adriana; LEAL, Gabriela Nunes; SILVA, Clovis Artur; ROSCHEL, Hamilton; GUALANO, Bruno
This study aimed to compare cardiopulmonary fitness and endothelial function 6 months after hospital diagnosis in a sample mainly comprising immunocompromised patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection versus noninfected controls. Youth (n = 30; age: 14 yr; 60% females) with confirmed SARS-CoV-2 seen in a tertiary hospital of Sao Paulo, Brazil, were matched by propensity score based on BMI, age, sex, and pre-existing diseases with a control group who had not been tested positive for SARS-CoV-2 infection (n = 30; age: 15 yr; 50% females). Cardiopulmonary fitness (by means of a cardiopulmonary exercise test: CPET) and brachial flow-mediated dilation (%b-FMD) were assessed 3-6 mo after diagnosis. Patients were matched by propensity score based on BMI, age, sex and pre-existing diseases, if any, with a control group who had not been tested positive for SARS-CoV-2. Compared with controls, patients with COVID-19 showed reduced ventilatory anaerobic threshold (VAT) and peak exercise time and minute ventilation/maximum voluntary ventilation (V_E/MVV) (all P < 0.01). Brachial endothelial function variables were all adjusted for body surface area (BSA). Patients with COVID-19 had decreased %b-FMD (3.6 vs. 5.4; P = 0.03) mean and positive flow (P = 0.02 and P = 0.03, respectively) versus controls. Adjusted linear regression models exploring associations between CPET variables, %b-FMD and the potential predictors post-COVID-19 syndrome, number of symptoms, hospitalization, and COVID severity did not detect significant associations, except for total shear rate in hospitalization (coefficient: -65.07 [95%CI -119.5;-10.5], P = 0.02). Immunocompromised and previously healthy children and adolescents with COVID-19 presented with impaired exercise capacity and endothelial dysfunction when compared with their noninfected counterparts, but the mechanisms remain unknown.
OPRM1 and BDNF polymorphisms associated with a compensatory neurophysiologic signature in knee osteoarthritis patients
(2023) GONCALVES, Fernanda de Toledo; MARQUES, Lucas Murrins; PESSOTTO, Anne Victorio; BARBOSA, Sara Pinto; IMAMURA, Marta; SIMIS, Marcel; FREGNI, Felipe; BATTISTELLA, Linamara
Objective: The present study investigated the relationship between three genetic polymor-phisms of OPRM1 (rs1799971 -A118G and rs1799972 -C17T) and BDNF (rs6265 -C196T) and EEG-measured brain oscillations in Knee Osteoarthritis (KOA) patients.Materials and Methods: We performed a cross-sectional analysis of a cohort study (DEFINE cohort), KOA arm, with 66 patients, considering demographic (age, sex, and education), clinical (pain intensity and duration), OPRM1 (rs1799971 -A118G and rs1799972 -C17T) and BDNF (rs6265 -C196T) genotypes, and electrophysiological measures. Brain oscillations relative power from Delta, Theta, Alpha, Low Alpha, High Alpha, Beta, Low Beta and High Beta oscillations were measured during resting state EEG. Multivariate regression models were used to explore the main brain oscillation predictors of the three genetic polymorphisms.Results: Our findings demonstrate that Theta and Low Beta oscillations are associated with the variant allele of OPRM1-rs1799971 (A118G) on left frontal and left central regions, respectively, while Alpha brain oscillation is associated with variant genotypes (CT/TT) of BDNF-rs6265 on frontal (decrease of oscillation power) and left central (increase of oscillation power) regions. No significant model was found for OPRM1-rs1799972 (C17T) in addition to the inclusion of pain intensity as a significant predictor of this last model.Conclusion: One potential interpretation for these findings is that polymorphisms of OPRM1 that is involved with endogenous pain control lead to increased compensatory oscillatory mechanisms, characterized by increased theta oscillations. Along the same line, polymorphisms of the BDNF lead to decreased alpha oscillations in the frontal area, likely also reflecting the disruption of resting states to also compensate for the increased injury associated with knee OA. It is possible that these polymorphisms require additional brain adaption to the knee OA related injury.(c) 2023 Published by Elsevier Masson SAS.
Robotic-Assisted Gait Training (RAGT) in Stroke Rehabilitation: A Pilot Study
(2023) NEVES, Mariana Vita Milazzotto; FURLAN, Leonardo; FREGNI, Felipe; BATTISTELLA, Linamara Rizzo; SIMIS, Marcel
Objective: To compare the effects of 2 types of robotic-assisted gait training (RAGT) devices that have been used in stroke rehabilitation. Design: Retrospective cohort.Setting: Rehabilitation hospital.Participants: 24 community dwelling people with stroke (N=24).Interventions: RAGT with either an exoskeleton (Lokomat) (mean age=53.8 years; 30% men; mean duration of stroke =17.8 months) or an end-effector (G-EO) (mean age=50.5 years; 77.8% men; mean duration of stroke =13.11) delivered 3 times per week (36 sessions total).Main Outcome Measures: The following tests/scales were employed before and after RAGT: Functional Ambulation Categories (FACs), timed Up and Go (TUG), 10-Meter Walk Test (10MWT), 6 -Minute Walk Test (6MWT), Trunk Impairment Scale, Dynamic Gait Index (DGI), Berg Balance Scale (BBS), and ability to climb stairs (time to climb 6 steps of 15 cm each; ability to climb stairs).Results: There were 5 dropouts, all from the G-EO group. At the end, 10 participants in the Lokomat and 9 in the G-EO group completed the intervention. From pre-to post-RAGT, G-EO patients improved on all functional tests/scales, whereas Lokomat patients improved only on the TUG, DGI, and BBS. Most patients showed improvements above the relative smallest real difference in the TUG, 10MWT, and 6MWT.Conclusions: Both end-effectors and exoskeletons may improve clinically relevant aspects of walking function. However, this study had a small sample, was retrospective, non-randomized, and had a significant number of drop-outs, therefore its findings should be interpreted carefully. Future studies are needed for investigating potential differences in clinical results, side effects, contraindications, and cost effectiveness between these 2 different types of RAGT.(c) 2023 The Authors.
Hemoperitoneum after a Bothrops snakebite: Case report
(2024) RIBEIRO, Adriana Baqueiro Abad; SANTORO, Marcelo Larami; DUARTE, Marcelo Ribeiro; VIRGULINO, Cristiana Cruz; OLIVEIRA, Gerson Sobrinho Salvador de; FRANCA, Francisco Oscar de Siqueira
Snakebites are frequent in tropical countries. Brazil has an average of 27,000 cases per year, with a fatality rate of 0.5%, and the Bothrops genus is the most common causative agent, accounting for about 70-90% of the accidents. This report describes a case of human envenomation by a juvenile Bothrops jararaca snake in Sa similar to o Paulo, Brazil, in a 71 years-old man, previously healthy. He presented a life-threatening envenomation, which developed to severe hypotension, acute kidney injury and extensive peritoneal hemorrhage. The hemoperitoneum was diagnosed due to persistent hypotension associated with anemia, pain and gastrointestinal complaints. Abdominal Computed Tomography scans showed a moderate to large amount of presumable hematic material inside the abdominal cavity, predominantly in the perihepatic and perisplenic spaces. The intra-abdominal hemorrhage was not surgically addressed, and the patient was discharged 5 days after hospitalization, with the progressive absorption of the hemoperitoneum. Systemic bleeding is one of the complications and main causes of death in Bothrops envenomations. Acute peritoneal hemorrhage is one of these serious complications that must be carefully addressed since its management must take into account the risk of bleeding caused by toxins that affect hemostasis. The case described highlights the importance of early diagnosis and adequate management of this potentially fatal complication in snakebites.
A model for personalized diagnostics for non-specific low back pain: the role of the myofascial unit
(2023) SIKDAR, Siddhartha; SRBELY, John; SHAH, Jay; ASSEFA, Yonathan; STECCO, Antonio; DESTEFANO, Secili; IMAMURA, Marta; GERBER, Lynn H.
Low back pain (LBP) is the leading cause of disability worldwide. Most LBP is non-specific or idiopathic, which is defined as symptoms of unknown origin without a clear specific cause or pathology. Current guidelines for clinical evaluation are based on ruling out underlying serious medical conditions, but not on addressing underlying potential contributors to pain. Although efforts have been made to identify subgroups within this population based on response to treatment, a comprehensive framework to guide assessment is still lacking. In this paper, we propose a model for a personalized mechanism-based assessment based on the available evidence that seeks to identify the underlying pathologies that may initiate and perpetuate central sensitization associated with chronic non-specific low back pain (nsLBP). We propose that central sensitization can have downstream effects on the ""myofascial unit"", defined as an integrated anatomical and functional structure that includes muscle fibers, fascia (including endomysium, perimysium and epimysium) and its associated innervations (free nerve endings, muscle spindles), lymphatics, and blood vessels. The tissue-level abnormalities can be perpetuated through a vicious cycle of neurogenic inflammation, impaired fascial gliding, and interstitial inflammatory stasis that manifest as the clinical findings for nsLBP. We postulate that our proposed model offers biological plausibility for the complex spectrum of clinical findings, including tissue-level abnormalities, biomechanical dysfunction and postural asymmetry, ecological and psychosocial factors, associated with nsLBP. The model suggests a multi-domain evaluation that is personalized, feasible and helps rule out specific causes for back pain guiding clinically relevant management. It may also provide a roadmap for future research to elucidate mechanisms underlying this ubiquitous and complex problem.
Digital Platform for Continuous Monitoring of Patients Using a Smartwatch: Longitudinal Prospective Cohort Study
(2023) BIN, Kaio Jia; PRETTO, Lucas Ramos De; SANCHEZ, Fabio Beltrame; CASTRO, Fabio Pacheco Muniz De Souza e; RAMOS, Vinicius Delgado; BATTISTELLA, Linamara Rizzo
Background: Since the COVID-19 pandemic, there has been a boost in the digital transformation of the human society, where wearable devices such as a smartwatch can already measure vital signs in a continuous and naturalistic way; however, the security and privacy of personal data is a challenge to expanding the use of these data by health professionals in clinical follow-up for decision-making. Similar to the European General Data Protection Regulation, in Brazil, the Lei Geral de Protecao de Dados established rules and guidelines for the processing of personal data, including those used for patient care, such as those captured by smartwatches. Thus, in any telemonitoring scenario, there is a need to comply with rules and regulations, making this issue a challenge to overcome.Objective: This study aimed to build a digital solution model for capturing data from wearable devices and making them available in a safe and agile manner for clinical and research use, following current laws.Methods: A functional model was built following the Brazilian Lei Geral de Protecao de Dados (2018), where data captured by smartwatches can be transmitted anonymously over the Internet of Things and be identified later within the hospital. A total of 80 volunteers were selected for a 24-week follow-up clinical trial divided into 2 groups, one group with a previous diagnosis of COVID-19 and a control group without a previous diagnosis of COVID-19, to measure the synchronization rate of the platform with the devices and the accuracy and precision of the smartwatch in out-of-hospital conditions to simulate remote monitoring at home.Results: In a 35-week clinical trial, >11.2 million records were collected with no system downtime; 66% of continuous beats per minute were synchronized within 24 hours (79% within 2 days and 91% within a week). In the limit of agreement analysis, the mean differences in oxygen saturation, diastolic blood pressure, systolic blood pressure, and heart rate were -1.280% (SD 5.679%), -1.399 (SD 19.112) mm Hg, -1.536 (SD 24.244) mm Hg, and 0.566 (SD 3.114) beats per minute, respectively. Furthermore, there was no difference in the 2 study groups in terms of data analysis (neither using the smartwatch nor the gold-standard devices), but it is worth mentioning that all volunteers in the COVID-19 group were already cured of the infection and were highly functional in their daily work life.Conclusions: On the basis of the results obtained, considering the validation conditions of accuracy and precision and simulating an extrahospital use environment, the functional model built in this study is capable of capturing data from the smartwatch and anonymously providing it to health care services, where they can be treated according to the legislation and be used to support clinical decisions during remote monitoring.
The Cardiovascular Impact of Obstructive Sleep Apnea in Women Current Knowledge and Future Perspectives
(2023) PARISE, Barbara K.; FERREIRA, Naira Lapi; DRAGER, Luciano F.