MARTA IMAMURA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de MedicinaLegal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina - Docente
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/40 - Laboratório de Imunohematologia e Hematologia Forense, Hospital das Clínicas, Faculdade de Medicina
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/40 - Laboratório de Imunohematologia e Hematologia Forense, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- 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, FelipeThis 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.
- 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, FelipeBackground 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.
- 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.
- 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 deIntroduction 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.
- Virtual interviews between medical students and in-patients during COVID-19 pandemic(2021) RIOS, Izabel Cristina; IMAMURA, Marta; GARCIA, Maria Lucia Bueno; BATTISTELLA, Linamara Rizzo
- 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.
- Deficit of Inhibition as a Marker of Neuroplasticity (DEFINE Study) in Rehabilitation: A Longitudinal Cohort Study Protocol(2021) SIMIS, Marcel; IMAMURA, Marta; MELO, Paulo Sampaio de; MARDUY, Anna; BATTISTELLA, Linamara; FREGNI, FelipeBackground: Brain plasticity is an intrinsic property of the nervous system, which is modified during its lifetime. This is one mechanism of recuperation after injuries with an important role in rehabilitation. Evidence suggests that injuries in the nervous system disturb the stability between inhibition and excitability essential for the recuperation process of neuroplasticity. However, the mechanisms involved in this balance are not completely understood and, besides the advancement in the field, the knowledge has had a low impact on the rehabilitation practice. Therefore, the understanding of the relationship between biomarkers and functional disability may help to optimize and individualize treatments and build consistent studies in the future. Methods: This cohort study, the deficit of inhibition as a marker of neuroplasticity study, will follow four groups (stroke, spinal cord injury, limb amputation, and osteoarthritis) to understand the neuroplasticity mechanisms involved in motor rehabilitation. We will recruit 500 subjects (including 100 age- and sex-matched controls). A battery of neurophysiological assessments, transcranial magnetic stimulation, electroencephalography, functional near-infrared spectroscopy, and magnetic resonance imaging, is going to be used to assess plasticity on the motor cortex before and after rehabilitation. One of the main hypotheses in this cohort is that the level of intracortical inhibition is related to functional deficits. We expect to develop a better understanding of the neuroplasticity mechanisms involved in the rehabilitation, and we expect to build neurophysiological ""transdiagnostic"" biomarkers, especially the markers of inhibition, which will have great relevance in the scientific and therapeutic improvement in rehabilitation. The relationship between neurophysiological and clinical outcomes will be analyzed using linear and logistic regression models. Discussion: By evaluating the reliability of electroencephalography, functional near-infrared spectroscopy, transcranial magnetic stimulation, and magnetic resonance imaging measures as possible biomarkers for neurologic rehabilitation in different neurologic disorders, this study will aid in the understanding of brain plasticity mechanisms in rehabilitation, allowing more effective approaches and screening methods to take place.
- S1 Guidelines on Bone Impairment in Spinal Cord Injury(2021) DIONYSSIOTIS, Yannis; KALKE, Yorck-Bernhard; FROTZLER, Angela; MOOSBURGER, Jurgen; TROVAS, Georgios; KASKANI, Evangelia; ERHAN, Belgin; FOTI, Calogero; PAPATHANASIOU, Jannis; FERRETTI, Jose Luis; IMAMURA, Marta; RAPIDI, Anastasia-ChristinaDuring the acute and chronic phase of spinal cord injury (SCI) bone turnover and structure are affected. Bone mineral density of lower limbs is decreased up to 28%-50% below that of age-matched peers at 12-18 mo post injury. Coexisting secondary etiologies of osteoporosis may be present, and during ageing additional loss of bone occurs. All these compose a complex canvas of bone impairment after spinal cord injury and make the therapeutical approach challenging. The risk of fragility fractures is increased after the 2nd decade post SCI affecting the functionality and quality of life of individuals with SCI. Diagnostic flaws, lack of a ranking system to categorize the degree of bone impairment similar to the one of World Health Organization, and evidence-based clinical guidelines for management in SCI requires interdisciplinary cooperation and appropriate planning of future research and interventions. Spinal Cord Section of Hellenic Society of Physical Rehabilitation Medicine convened an expert panel working group on bone and spinal cord injury at the Pan-Hellenic Congress 2018 of PRM in Athens Greece, to establish an evidence-based position statement for bone loss in individuals with SCI of traumatic or non-traumatic etiology. This was reviewed by an International Task Force and used to create S1 Guidelines. This first version S1 guideline will work towards to provide help with prophylactic basic osteoporosis therapy diagnostic and therapeutic decisions in acute and chronic phase and rehabilitation countermeasures against osteoporosis related with spinal cord injury.
- Rehabilitation of patients after COVID-19 recovery: An experience at the Physical and Rehabilitation Medicine Institute and Lucy Montoro Rehabilitation Institute(2021) IMAMURA, Marta; MIRISOLA, Aline Rossetti; RIBEIRO, Fernando de Quadros; PRETTO, Lucas Ramos De; ALFIERI, Bio Marcon; DELGADO, Vinicius Ramos; BATTISTELLA, Linamara RizzoOBJECTIVES: As patients recovering from the novel coronavirus disease 2019 (COVID-19) present with physical, respiratory, cognitive, nutritional, and swallowing-related impairments and mental health complications, their rehabilitation needs are complex. This study aimed to describe the demographic, clinical, and functional status after the discharge of COVID-19 survivors who underwent intensive multidisciplinary inpatient rehabilitation at the Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital and Lucy Montoro Rehabilitation Institute. We determined the most important factors related to the length of inpatient rehabilitation treatment and present the functional outcomes. METHODS: This was a retrospective study based on electronic medical records. In addition to the severity of COVID-19 and length of hospital stay for the management of COVID-19 and comorbidities, we collected sociodemographic data including age, sex, height, and weight. Functional assessments were performed using the Functional Independence Measure (FIM); Short Physical Performance Battery; Montreal Cognitive Assessment; Depression, Anxiety and Stress Scale; Revised Impact of Events Scale; bioelectrical impedance; Functional Oral Intake Scale; oropharyngeal dysphagia classification; and nutritional assessment. RESULTS: There was a significant improvement in FIM before and after inpatient rehabilitation treatment (p< 0.0001). Muscle strength and walking capacity were significantly improved (p <0.01). The most important factors related to the length of inpatient rehabilitation treatment were improvement in FIM scores (Spearman's r=0.71) and gain in lean mass (Spearman's r=0.79). CONCLUSIONS: Rehabilitation of patients after COVID-19 recovery improves their functional status and should be considered in the post-acute phase for selected patients with COVID-19.