Instituto de Medicina Física e de Reabilitação - HC/IMREA

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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

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(2023) CARVALHO, Mariana Cavazzoni Lima de; MARTINS, Fernanda; BATTISTELLA, Linamara Rizzo
article 0 Citação(ões) na Scopus
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.
article 0 Citação(ões) na Scopus
Lower Limb Exoskeleton During Gait and Posture: Objective and Subjective Assessment Procedures With Minimal Instrumentation
(2023) PARIK-AMERICANO, Pedro; PINHO, Joao Pedro; SANTOS, Fabia Camile dos; UMEMURA, Guilherme Silva; BATTISTELLA, Linamara Rizzo; FORNER-CORDERO, Arturo
In this work, we propose and implement an enhanced methodology for assessing the impact of wearing a lower limb passive exoskeleton on the gait and posture of the wearer, integrating both objective and subjective assessment techniques. Using only an inertial measurement unit (IMU) and a heart rate monitor, we examined the gait of eighteen healthy volunteers during treadmill and overground walking, both with and without the exoskeleton. Postural control tests were conducted on a force platform and with an IMU during standing and crouching. Our findings indicate that exoskeleton use resulted in higher physical effort, perceived effort, and user frustration. Moreover, wearing the exoskeleton showed an augmented periodic stability, which is related to more constant strides, gait movements showed reduced smoothness, which is related to difficulties to adapt the strides in response to gait perturbations. Nevertheless, the exoskeleton exhibited better stability during stance, notably reducing medio-lateral displacement by over 30%. Finally, we found an increase in cognitive effort linked to exoskeleton use. These outcomes offer valuable insights into the comprehensive influence of exoskeletons on gait performance and user experience.
article 2 Citação(ões) na Scopus
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.
article 0 Citação(ões) na Scopus
Factors associated with pain pressure threshold in both local and remote sites in knee osteoarthritis
(2024) IMAMURA, Marta; REBELLO-SANCHEZ, Ingrid; PARENTE, Joao; MARDUY, Anna; VASQUEZ-AVILA, Karen; PACHECO-BARRIOS, Kevin; CASTELO-BRANCO, Luis; SIMIS, Marcel; BATTISTELLA, Linamara; FREGNI, Felipe
Background: Knee osteoarthritis (KOA) is a prevalent condition, and its most frequent symptom is pain that often leads to disability. Pain sensitization is a core feature of KOA, and it can be measured through quantitative sensory testing protocols such as pain pressure threshold (PPT). However, there is a lack of understanding about the factors that may influence changes in PPTs in the KOA population.Objective: To explore the clinical and functional factors associated with PPTs in a sample of people with chronic KOA pain and to compare models of local (knees) and remote (thenar regions) sites.Design: Cross-sectional analysis of a prospective cohort.Setting: Primary care in public institution.Participants: 113 adults with KOA.Intervention: N/A.Main Outcome MeasuresMultivariable regression analyses evaluating demographic, clinical, and functional variables that could be associated with local and remote PPTs (main outcomes) were performed.Results: Both thenar region (adjusted-R-2: 0.29) and knee (adjusted-R-2: 0.45) models had the same significant negative association with being a female, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain levels (thenar: beta: -0.15, p = .002; knee: beta: -0.2, p < .001), and the 10-Meter Walking Test (thenar: beta: -0.05, p = .038; knee: beta: -0.08, p = .004). A small significant positive association with depressive symptoms was identified in both models, which acted as a confounder for WOMAC pain and was likely affected by unmeasured confounders.Conclusions: PPTs in KOA pain are associated with functional outcomes such as the 10-Meter Walking Test and activity-related pain intensity; thus more disability is associated with smaller pain thresholds. Similarity between models may suggest central sensitization.
article 0 Citação(ões) na Scopus
Could Cesarean Delivery Help Prevent Mother-to-Child Transmission of Human T-Lymphotropic Virus Type 1?
(2023) PRATES, Gabriela; PAIVA, Arthur; HAZIOT, Michel E.; FONSECA, Luiz Augusto M.; SMID, Jerusa; MARCUSSO, Rosa Maria do N.; ASSONE, Tatiane; OLIVEIRA, Augusto. C. P. de; CASSEB, Jorge
Background. Mother-to-child transmission (MTCT) of human T-lymphotropic virus type 1 (HTLV-1) is an important route of transmission that can cause lifelong infection. There is high morbidity and mortality due to adult T-cell leukemia/lymphoma, HTLV-1-associated myelopathy (HAM), and other inflammatory disorders. These conditions develop in nearly 10% of people with HTLV-1 infection, with a higher risk if infection occurs early in life. Identification of risk factors can inform targeted measures to reduce HTLV-1 MTCT. This study aimed to investigate the potential of cesarean delivery to prevent HTLV-1 MTCT. Methods. We performed a review of the cases of women and their offspring under regular follow-up at the HTLV-1 outpatient clinic at the Institute of Infectious Diseases Emilio Ribas. Results. A total of 177 HTLV-1-infected women and 369 adult offspring were investigated. Overall, 15% of the children were positive for HTLV-1 and 85% were negative. Regarding vertical transmission, we found that a breastfeeding duration of >6 months was associated with MTCT. Moreover, maternal proviral load was not associated with transmission, but high educational level and cesarean delivery were identified as protective factors. Conclusions. HTLV-1 MTCT was associated with mother's age at delivery of >25 years, low educational level, prolonged breastfeeding, and vaginal delivery.
article 0 Citação(ões) na Scopus
article 0 Citação(ões) na Scopus
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.
article 0 Citação(ões) na Scopus
Incident Coronary Calcium Score in Patients With OSA With and Without Excessive Sleepiness Brazilian Longitudinal Study of Adult Health
(2024) MIRANDA, Erique Jose Farias Peixoto de; MAZZOTTI, Diego R.; SANTOS, Ronaldo B.; SOUZA, Silvana P.; PARISE, Barbara K.; GIATTI, Soraya; AIELO, Aline N.; CUNHA, Lorenna F.; SILVA, Wagner A.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; LOTUFO, Paulo A.; BENSENOR, Isabela M.; BITTENCOURT, Marcio S.; DRAGER, Luciano F.
BACKGROUND: Uncertainty exists about the impact of OSA and its phenotypes on cardio-vascular disease. RESEARCH QUESTION: Are OSA and clinical features such as daytime sleepiness associated with incident subclinical coronary atherosclerosis? STUDY DESIGN AND METHODS: In this prospective community-based cohort study, we administered a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. Coronary artery calcium (CAC; 64-slice multidetector CT scan imaging) was measured at two different time points throughout the study (baseline, between 2010 and 2014, and follow-up, between 2016 and 2018). Incidence of subclinical atherosclerosis was defined as baseline CAC of 0 followed by CAC of > 0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed. RESULTS: We analyzed 1,956 participants with available CAC scores at baseline (mean age, 49 +/- 8 years; 57.9% female; 32.4% with OSA). In covariate-adjusted analyses (n = 1,247; mean follow-up, 5.1 +/- 0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis (OR, 1.26; 95% CI, 1.06-1.48), with stronger effects among those reporting EDS (OR, 1.66; 95% CI, 1.30-2.12; P = .028 for interaction). Interestingly, EDS per se was not associated with any CAC outcome. An exploratory analysis of the square root of CAC progression (baseline CAC > 0 followed by a numerical increase in scores at follow-up; n = 319) showed a positive association for both OSA (beta = 1.084; 95% CI, 0.032-2.136; P = .043) and OSA with EDS (beta = 1.651; 95% CI, 0.208-3.094; P = .025). INTERPRETATION: OSA, particularly with EDS, predicts the incidence and progression of CAC. These results support biological plausibility for the increased cardiovascular risk observed among patients with OSA with excessive sleepiness.
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.