ANDRE TADEU SUGAWARA
Projetos de Pesquisa
Unidades Organizacionais
P IMREA, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/40 - Laboratório de Imunohematologia e Hematologia Forense, Hospital das Clínicas, Faculdade de Medicina
Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/40 - Laboratório de Imunohematologia e Hematologia Forense, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- Abandonment of assistive products: assessing abandonment levels and factors that impact on it(2018) SUGAWARA, Andre T.; RAMOS, Vinicius D.; ALFIERI, Fabio M.; BATTISTELLA, Linamara R.Purpose: To investigate the levels and factors that influence the abandonment of assistive products by users of a local reference rehabilitation center. Methods: This observational study involved users who received services and assistive products provided by our center of rehabilitation. Users were identified using the records of the center and their responses about the abandonment were collected through face-to-face interviews. Results: The abandonment level of assistive products was 19.38%. 83.5% of the users use at least one of the assistive products they have received. Rigid and folding frame wheelchairs, with and without postural support devices, as well as shower wheelchairs, presented the lowest abandonment levels, followed by canes and lower limb orthoses. Upper limb orthoses, Knee Ankle Foot Orthosis(KAFO), walkers, crutches and lower and upper limb prostheses all presented higher abandonment levels. Conclusion: The simultaneous use of mutiple assistive products, users perception on the importance of using them, and completing the rehabilitation treatment were found to impact on the short and longterm use of products. The study offers inputs to decision making and planning for assistive technology provision in developing countries with regard to expected demand and service delivery. IMPLICATIONS FOR REHABILITATION Data about the abandonment of assistive products in Sao Paulo, Brazil, could assist informing decision making on provision and servicing of these products in similar settings. The strong correlation found between abandonment levels and the simultaneous use of multiple devices should be taken into account by health professionals when prescribing assistive products and providing guidance to users. The need for follow up on the use of assistive products after discharge from rehabilitation treatment becomes strikingly clear, as data show that completing treatment is significantly relevant when evaluating abandonment levels. As assistive products users' perception about the importance of using these devices is shown to be significant in explaining abandonment, it is mandatory that health and rehabilitation professionals take it into account when providing guidance and training users.
- Developing a rigid frame wheelchair in Brazil(2021) SUGAWARA, Andre Tadeu; OSHIRO, Milton Seigui; YAMANAKA, Eduardo Inglez; RAMOS, Vinicius Delgado; BATTISTELLA, Linamara RizzoPurpose: 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.
- Characterisation of Phantom Limb Pain in Traumatic Lower-Limb Amputees(2021) SUGAWARA, Andre Tadeu; SIMIS, Marcel; FREGNI, Felipe; BATTISTELLA, Linamara RizzoIntroduction. 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.
conferenceObject Developing A Rigid Frame Wheelchair In Brazil(2021) SUGAWARA, Andre Tadeu; OSHIRO, Milton Seigui; YAMANAKA, Eduardo Inglez; RAMOS, Vini'cius Delgado; BATTISTELLA, Linamara RizzobookPart Exercício físico(2013) SUGAWARA, André Tadeu- The Institute of Physical Medicine and Rehabilitation, Hospital das Clinicas University of Sao Paulo School of Medicine comprehensive rehabilitation program for elderly people with knee osteoarthritis(2022) IMAMURA, Marta; SHINZATO, Gilson T.; SUGAWARA, Andre T.; UCHIYAMA, Sabrina Saemy Tome; MATHEUS, Denise; SIMIS, Marcel; AYRES, Denise Vianna Machado; SANTOS, Artur C. A. dos; ASSONE, Tatiane; RAMOS, Vinicius Delgado; FREGNI, Felipe; BATTISTELLA, Linamara R.BackgroundKnee osteoarthritis (OA) is a leading cause of disability in the elderly population. Chronic disabling pain is associated with maladaptive neuroplastic changes in brain networks, commonly associated with central sensitization. The main clinical features of nociplastic pain conditions include combined peripheral and central sensitization, and it is crucial to recognize this type of pain, as it responds to different therapies than nociceptive and neuropathic pain. ObjectiveTo report the effect of the Institute of Physical Medicine and Rehabilitation (IMREA) comprehensive rehabilitation program to reduce pain and to improve functioning in elderly people with knee OA, under the DEFINE cohort. MethodsThis is a retrospective observational cohort of 96 patients with knee OA, recruited from October 2018 to December 2019. All patients were evaluated by a trained multidisciplinary team using the Kellgren Lawrence classification, bilateral knee ultrasonography, the visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, rigidity and difficulty scores, the Timed Up and Go Test (TUG), 10-m and 6-min walking test (10 and 6 MWT), Berg Balance Scale, isokinetic dynamometry for knee extension and flexion strength, and pain pressure thresholds. The rehabilitation program included paraspinous lidocaine blocks, focal extracorporeal shockwaves combined with radial pressure waves and functional electrical stimulation according to individual needs. The baseline was compred with the treatment results with a paired t-test. ResultsThe study sample is composed of 96 participants, mostly females (n = 81, 84.38%), with bilateral osteoarthritis (n = 91, 94.79%), and a mean age of 68.89 (SD 9.73) years. Functional improvement was observed in TUG (p = 0.019), 6-mwt (p = 0.033), right knee flexion strength (p < 0.0001), WOMAC rigidity and difficulty domains (p < 0.0001). Pain was reduced from baseline as measured by WOMAC pain domain (p < 0.0001), VAS for both knees (p < 0.0001), and SF-36 pain domain (p < 0.0001). Pressure pain threshold was modified above the patella (p = 0.005 and p = 0.002 for right and left knees, respectively), at the patellar tendons (p = 0.015 and p = 0.010 for right and left patellar tendons, respectively), left S2 dermatome (p = 0.017), and L1-L2 (p = 0.008). ConclusionsThe IMREA comprehensive rehabilitation program improved functioning and reduced disabling pain in elderly people with knee OA. We highlight the relevance and discuss the implementation of our intervention protocol. Although this is an open cohort study, it is important to note the significant improvement with this clinical protocol.
- 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, FelipeBackground: 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.
- Long-term functioning status of COVID-19 survivors: a prospective observational evaluation of a cohort of patients surviving hospitalisation(2022) BATTISTELLA, Linamara Rizzo; IMAMURA, Marta; PRETTO, Lucas Ramos De; CAUWENBERGH, Simon K. H. A. A. Van; RAMOS, Vinicius Delgado; UCHIYAMA, Sabrina Saemy Tome; MATHEUS, Denise; KUHN, Flavia; OLIVEIRA, Ana Alice Amaral de; NAVES, Gabriella Souza; MIRISOLA, Aline Rossetti; RIBEIRO, Fernando de Quadros; SUGAWARA, Andre Tadeu; CANTARINO, Mauricio; CAVALCA, Rafael Andrade Santos Antunes; PAGANO, Vanessa; MARQUES, Melina Valentim; SILVA, Elizabeth Mendes da; GOMES, Alessandra Pereira; FREGNI, FelipeObjectives The study investigated the long-term functional status of hospitalised COVID-19 survivors to explore and document their functional situation. Design This prospective observational study assessed 801 COVID-19 survivors at 3-11 months after hospital discharge. It analyses participants' sociodemographic background, COVID-19 clinical manifestations, and clinical and functional evaluations. Setting Tertiary-level university hospital in Sao Paulo, Brazil. Participants Study participants are COVID-19 survivors admitted to hospital care for at least 24 hours to treat acute SARS-CoV-2 infection. Outcome measures Epworth Sleepiness Scale, EuroQoL-5 Dimensions-5 Levels, Functional Assessment of Chronic Illness Therapy-Fatigue, Functional Independence Measure, Functional Oral Intake Scale, Handgrip Strength, Insomnia Severity Index, Medical Research Council (MRC) Dyspnea Scale, MRC sum score, Modified Borg Dyspnea Scale, pain Visual Analogue Scale, Post-COVID-19 Functional Status, Timed Up and Go, WHO Disability Assessment Schedule 2.0, 1-Minute Sit to Stand Test. Results Many participants required invasive mechanical ventilation (41.57%, 333 of 801). Mean age was 55.35 +/- 14.58 years. With a mean of 6.56 (SD: 1.58; 95% CI: 6.45 to 6.67) months after hospital discharge, 70.86% (567 of 800) reported limited daily activities, which were severe in 5.62% (45 of 800). They also reported pain and discomfort (64.50%, 516 of 800), breathlessness (64.66%, 514 of 795), and anxiety and depression (57.27%, 457 of 798). Daytime sleepiness and insomnia evaluations showed subthreshold results. Most (92.85%, 727 of 783) participants reported unrestricted oral intake. Data indicated no generalised fatigue (mean score: 39.18, SD: 9.77; 95% CI: 38.50 to 39.86). Assessments showed poor handgrip strength (52.20%, 379 of 726) and abnormal Timed Up and Go results (mean 13.07 s, SD: 6.49). The invasive mechanical ventilation group seemed to have a better handgrip strength however. We found no clear trends of change in their functional status during months passed since hospital discharge. Conclusions Muscle weakness, pain, anxiety, depression, breathlessness, reduced mobility, insomnia and daytime sleepiness were the most prevalent long-term conditions identified among previously hospitalised COVID-19 survivors.