LINAMARA RIZZO BATTISTELLA
Projetos de Pesquisa
Unidades Organizacionais
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
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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- Evaluation of body temperature in individuals with stroke(2017) ALFIERI, Fabio Marcon; MASSARO, Ayrton Roberto; FILIPPO, Thais Raquel; PORTES, Leslie Andrews; BATTISTELLA, Linamara RizzoBACKGROUND: A stroke can cause alterations in thermal sensitivity. OBJECTIVE: to verify the conditions of body temperature in hemiplegic patients after stroke as compared to healthy individuals, as well as establish relations between thermal sensitivity and gender, age, Body Mass Index ( BMI), plegic side, time after stroke, reports of thermal alterations and the motricity of patients with stroke sequelae. METHODS: This cross-sectional study included 100 patients ( 55.6 +/- 13 years) with ischemic or hemorrhagic stroke sequelae with unilateral hemiparesis and thirty healthy subjects ( 55 +/- 12.9 years). Individuals with nervous peripheral lesions, diabetes, peripheral vascular diseases or tumors were not included in this study. The volunteers underwent axillary temperature evaluations with the use of a cutaneous thermometer and evaluations of cutaneous temperature of hands and feet as measured by infrared thermography captured by an infrared sensor (ThermaCAM(TM) SC 500-FLIR Systems). The mean temperature (degrees C) was analyzed with the SigmaStat 3.5 statistical package. RESULTS: The results have shown that healthy individuals have similar temperatures on either side of the body. The hemiplegic subjects presented a lower temperature on the plegic side and compared to the healthy subjects, both feet of the hemiparetic individuals were colder. The results have also shown that age, body mass index, and the time after stroke have no influence on the alterations in temperature. Regarding the paretic side, individuals with hemiplegia on the right side ( right foot) had a lower temperature than those affected on the left side. Motricity was not related to any difference in temperature between the limbs and the reports of temperature differences had no relation with the actual differences found in the study. CONCLUSIONS: Healthy individuals have temperature symmetry between between sides of the body, while individuals with stroke sequelae present lower temperature in the paretic side, especially on their feet.
bookPart Modelo assistencial do serviço de reabilitação(2014) BRITO, Christina May Moran de; BATTISTELLA, Linamara Rizzo; BAIA, Wania Regina Mollo- 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.
- 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, FelipePhantom 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.
bookPart A telerreabilitação em tempos de covid-19(2022) BATTISTELLA, Linamara- 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.
bookPart Reabilitação de Pacientes Oncológicos(2016) BRITO, Christina May Moran de; CECATTO, Rebeca Boltes; BATTISTELLA, Linamara Rizzo- ADVANCING ACADEMIC CAPACITY IN PHYSICAL AND REHABILITATION MEDICINE TO STRENGTHEN REHABILITATION IN HEALTH SYSTEMS WORLDWIDE: A JOINT EFFORT BY THE EUROPEAN ACADEMY OF REHABILITATION MEDICINE, THE ASSOCIATION OF ACADEMIC PHYSIATRISTS, AND THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE(2022) FRONTERA, Walter R.; STUCKI, Gerold; ENGKASAN, Julia P.; FRANCISCO, Gerard E.; GUTENBRUNNER, Christoph; HASNAN, Nazirah; LAINS, Jorge; YUSOF, Yusniza Mohd; NEGRINI, Stefano; OMAR, Zaliha; BATTISTELLA, Linamara R.; SOWA, Gwen; STAM, Henk; BICKENBACH, Jerome
article 5 Citação(ões) na Scopus A transversal multicenter study assessing functioning, disability and environmental factors with the comprehensive ICF core set for low back pain in Brazil(2014) RIBERTO, M.; CHIAPPETTA, L. M.; LOPES, K. A. T.; BATTISTELLA, L. R.Background. Low back pain is a leading cause of disability in Brazil. The multiple aspects of disability in these patients require comprehensive tools for their assessment. The International Classification of Functioning, Disability, and Health (ICF) core set for low back pain is designed to comprehensively describe the experience of such patients with their functioning. Aim. This study aimed to describe functioning and contextual factors and to empirically validate the ICF core set for low back pain. Design. Cross sectional study. Setting. Three outpatient clinics in Manaus, Maceio and Sao Paulo, Brazil. Population. 135 low back pain outpatients under rehabilitation. Methods. Data concerning diagnosis, personal features, and the 78 ICF core set categories for low back pain were collected from clinical charts, physical examinations, tests, and interviews with patients from rehabilitation services in three parts of Brazil. Results. 7.7% of the categories (6 body functions and 10 activity and participation) were affected in less than 20% of the sample, and were thus considered not validated. Pain and other sensations related to the musculoskeletal system were the body most frequently impaired functions. Mobility and domestic life were the chapters of activity and limitation most often described as limited. All environmental factors were qualified as either facilitators or barriers and acted as modulators of disability. Conclusion. The comprehensive ICF core sets for low back pain can be used to describe the living experience of such individuals, although efforts to make it operational and enhance the reproducibility of the results are needed to warrant its reliable routine use. Clinical Rehabilitation Impact. This study highlights the importance of a complete assessment of chronic low back pain and demonstrate the need for multidisciplinary approach.- Paraspinous Lidocaine Injection for Chronic Nonspecific Low Back Pain: A Randomized Controlled Clinical Trial(2016) IMAMURA, Marta; IMAMURA, Satiko Tomikawa; TARGINO, Rosa Alves; MORALES-QUEZADA, Leon; TOMIKAWA, Luis C. Onoda; TOMIKAWA, Luis G. Onoda; ALFIERI, Fabio M.; FILIPPO, Thais R.; ROCHA, Ivan D. da; NETO, Raul Bolliger; FREGNI, Felipe; BATTISTELLA, Linamara RizzoIn this large, sham-controlled, randomized trial, we examined the efficacy of the combination of standard treatment and paraspinous lidocaine injection compared with standard therapy alone in subjects with chronic low back pain. There is little research-based evidence for the routine clinical use of paraspinous lidocaine injection for low back pain. A total of 378 subjects with nonspecific chronic low back pain were randomized to 3 groups: paraspinous lidocaine injection, analgesics, and exercises (group 1, LID-INJ); sham paraspinous lidocaine injection, analgesics, and exercises (group 2, SH-INJ); and analgesics and exercises (group 3, STD-TTR). A blinded rater assessed the study outcomes at 3 time points: baseline, after treatment, and after 3 months of follow-up. There were increased frequency of pain responses and better low back functional scores in the LID-INJ group compared with the SH-INJ and STD-TTR groups. These effects remained at the 3-month follow-up but differed between all 3 groups. There were significant changes in pain threshold immediately after treatment, supporting the effects of this intervention in reducing central sensitization. Paraspinous lidocaine injection therapy is not associated with a higher risk of adverse effects compared with conventional treatment and sham injection. Its effects on hyperalgesia might correlate with changes in central sensitization. (C) 2016 Published by Elsevier Inc. on behalf of the American Pain Society