Jean Alex Matos Ribeiro

RESUMO A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) tem sido amplamente utilizada como modelo para subsidiar e orientar o raciocínio clínico em diversas áreas da reabilitação. Contudo, apesar do aumento do conhecimento sobre a CIF ao longo dos anos, muitos profissionais ainda enfrentam dificuldades em implementá-la na prática clínica, descrevendo sua aplicação como bastante complexa. Este estudo teve como objetivo descrever a aplicação da CIF para auxiliar na tomada de decisão clínica na reabilitação de uma paciente com lesão medular: uma mulher negra, solteira, de 53 anos, com nível neurológico em T5 e sobrepeso. A coleta de informações durante a anamnese da paciente foi realizada por meio de um questionário estruturado baseado na CIF. Considerando as deficiências, limitações de atividades e restrições de participação relatadas pela paciente, diversos instrumentos de avaliação foram utilizados. As avaliações incluíram os Padrões Internacionais para Classificação Neurológica da Lesão Medular, a dinamometria de preensão manual, a versão brasileira da Spinal Cord Independence Measure - Self-Reported Version, e o teste de alcance funcional modificado. O diagnóstico de incapacidade indicou dificuldade de tomar banho de forma independente devido à fraqueza muscular dos músculos do tronco, instabilidade no controle do tronco, e medo de quedas, especialmente quando a paciente se encontrava sozinha em casa. Este estudo demonstrou que a aplicação da CIF pode ser uma ferramenta valiosa na tomada de decisão clínica para a reabilitação de pacientes com lesão medular. A abordagem sistemática da CIF permitiu avaliar as incapacidades da paciente e elaborar um plano terapêutico personalizado.

The International Classification of Functioning, Disability, and Health (ICF) has been widely used as a framework to support and guide clinical reasoning across rehabilitation settings. Despite increasing familiarity with the ICF over the years, many professionals still experience difficulties implementing it in clinical practice, often perceiving it as complex. This study aimed to describe the application of the ICF to support clinical decision-making in the rehabilitation of a patient with spinal cord injury: a 53-year-old single Black woman with a neurological level of injury at T5 and with overweight. Data were collected during the patient’s history-taking process using a structured questionnaire based on the ICF. Assessment tools were selected according to the patient’s reported impairments, activity limitations, and participation restrictions. These included the International Standards for Neurological Classification of Spinal Cord Injury, handgrip dynamometry, the Brazilian version of the Spinal Cord Independence Measure - Self-Reported version, and the Modified Functional Reach Test. The disability diagnosis identified a limitation in independently bathing due to trunk muscle weakness, impaired trunk control, and fear of falling, especially when alone at home. This study demonstrated that the ICF can be a valuable tool in clinical decision-making in spinal cord injury rehabilitation. Its systematic approach facilitated the assessment of functioning and supported the development of an individualized therapeutic plan.

Background/Objectives: Chronic pain is associated with autonomic nervous system (ANS) dysfunction, which can be indexed by heart rate variability (HRV). This cross-sectional study examined associations between ANS dysregulation and phantom limb pain (PLP) intensity in amputees and explored related clinical and psychosocial variables. Methods: Fifty-three adults with chronic PLP (mean age 57.7 ± 15.4; 60% male) were enrolled. Primary exposure was PLP intensity concurrent with HRV time- and frequency-domain metrics. Additional variables included residual limb pain, phantom limb sensations (PLS), telescoping and PLP–PLS index. Results: PLP intensity was not significantly associated with frequency-domain HRV measures. Time-domain parameters RMSSD (root mean square of successive differences) and pNN50 (percentage of successive normal RR intervals >50 ms) were lower in the positive PLP–PLS group. In multivariate models, depression (range of βs:−1.36 to −58.16), pain-medication use (range of βs: −12.3 to −953.4), and body mass index (range of βs: 0.55 to 45.8) were significantly associated with lower SDNN (standard deviation of NN intervals), RMSSD, pNN50, low-frequency (LF), and high-frequency (HF) power. Female sex and pre-amputation pain correlated with higher LF, whereas traumatic etiology correlated with lower LF. Poor sleep quality correlated with elevated HF. No predictors related to the LF/HF ratio. Conclusions: HRV alterations in PLP were associated with depression and pain-medication use rather than pain intensity. Findings support HRV dysfunction as a marker of brain compensatory failure within the autonomic circuit, and maladaptive plasticity, highlighting utility for identifying central dysfunction even when pain severity does not vary.

Background/Objectives: Chronic pain is associated with autonomic nervous system (ANS) dysfunction. Heart rate variability (HRV) indexes sympathetic–parasympathetic balance and autonomic adaptability. Phantom limb pain (PLP) is prevalent after limb loss, but evidence of ANS dysregulation in chronic PLP is limited. This cross-sectional study examined associations between ANS dysregulation and PLP intensity in amputees and explored links with clinical and psychosocial variables. Methods: Fifty-three adults with chronic PLP (mean age 57.7±15.4; 60% male) were enrolled. Primary exposure was PLP intensity concurrent with HRV time- and frequency-domain metrics. Additional variables included residual limb pain, phantom limb sensations (PLS), and telescoping. The PLP–PLS index was also evaluated. Results: PLP intensity was not significantly associated with frequency-domain HRV measures. Time-domain parameters RMSSD (root mean square of successive differences) and pNN50 (percentage of successive normal RR intervals >50 ms) were lower in the positive PLP–PLS group. In multivariate models, depression, pain-medication use, and body mass index were associated with lower SDNN (standard deviation of NN intervals), RMSSD, pNN50, low-frequency (LF), and high-frequency (HF) power. Female sex and pre-amputation pain correlated with higher LF, whereas traumatic etiology correlated with lower LF. Poor sleep quality correlated with elevated HF. No predictors related to the LF/HF ratio. Conclusions: HRV alterations in PLP were associated with depression and pain-medication use rather than pain intensity. Findings support HRV dysfunction as a marker of brain compensatory failure and central neurophysiological disruption within circuits governing autonomic regulation and maladaptive plasticity, highlighting utility for identifying central dysfunction even when pain severity does not vary.

Objetivo: Determinar quais biomarcadores têm sido relacionados à funcionalidade do membro superior na fase aguda, subaguda ou crônica de pessoas que sofreram acidente vascular cerebral (AVC) isquêmico ou hemorrágico. Métodos: Protocolo de revisão sistemática, registrado no PROSPERO (CRD42021274244), com busca de dados sem corte de tempo na PubMed, PubMed PMC, Embase, Web of Science, Scopus, Cinahl e ProQuest. Os revisores avaliarão independentemente títulos, resumos e artigos de texto completo recuperados de bases de dados para identificar estudos potencialmente elegíveis. Os artigos relevantes serão avaliados quanto ao risco de viés e qualidade por meio do uso da ferramenta Quality In Prognosis Studies (QUIPS). A revisão incluirá estudos primários (original), do tipo Ensaios Controlados ou Observacionais (transversal, caso-controle ou estudos longitudinais) com análises de biomarcadores nas diferentes fases de AVC quanto à funcionalidade ou predição de recuperação. Serão excluídos pacientes com menos de 18 anos, diagnóstico de ataque isquêmico transitório e artigos que não explicitam os critérios de forma detalhada da avaliação dos biomarcadores. A qualidade e o risco de viés dos estudos serão avaliados de forma independente por dois pesquisadores. A síntese de dados será realizada utilizando um resumo narrativo e uma análise quantitativa. Modelos de meta-análise de efeitos aleatórios poderão ser empregados com base nas variáveis de resultados encontrados.

Purpose/Aim: Cardiovascular function is controlled and regulated by a functional brain-heart axis. Although the exact mechanism is not fully understood, several studies suggest a hemispheric asymmetry in the neural control of cardiovascular function. Thus, the purpose of this study was to examine whether endothelial function and arterial compliance differ between individuals with left- and right-sided strokes.Materials and Methods: This was a cross-sectional exploratory study. Thirty individuals more than 6 months after stroke participated in the study. The endothelial function was assessed by ultrasound-measured flow-mediated dilation of the nonparetic arm brachial artery (baFMD). The arterial stiffness was assessed by measuring carotid-femoral pulse wave velocity (cfPWV) and central aortic pulse wave analysis [augmentation index (AIx), augmentation index normalized to a heart rate of 75 bpm (AIx@75) and reflection magnitude (RM)] using applanation tonometry. Results: Participants with right-sided stroke had worse endothelial function than those with left-sided stroke. This difference (baFMD = 2.51%) was significant (p = 0.037), and it represented a medium effect size (r = 0.38). Likewise, they had higher arterial stiffness than those with left-sided stroke. This difference (AIx = 10%; RM = 7%) was significant (p = 0.011; p = 0.012), and it represented a medium effect size (r = 0.48; r = 0.47).Conclusions: Our findings suggest that individuals with right-sided stroke have reduced endothelial function and arterial compliance compared to those with left-sided stroke. These data may indicate that those with right-sided strokes are more susceptible to cardiovascular events.