Duas estratégias e desafios comuns: a reabilitação psicossocial e a saúde da família

Este artigo tem por finalidade refletir sobre as Estratégias de Saúde da Família e de Reabilitação Psicossocial, no momento em que a atenção psiquiátrica e a atenção básica se colocam em estreita vinculação. Parte-se da experiência e da revisão de referenciais que abordam tais temas, identificando interfaces e desafios a serem superados para a transformação desses contextos sociais em espaços de trocas afetivas e materiais, de saberes e práticas mais criativas e flexíveis.

A proposta de reabilitação psicossocial de Saraceno: um modelo de auto-organização?

Discute-se a teoria da Reabilitação Psicossocial, proposta por Benedetto Saraceno, tomando como referencial a teoria de Sistemas Auto-Organizados, elaborada, entre outros, por Michel Debrun. Observa-se que a proposta de Saraceno satisfaz diversos aspectos do processo de auto-organização, porém não chega a se constituir plenamente como tal. A partir dessa reflexão, pode-se entender melhor algumas das dificuldades da prática de reabilitação na área de Saúde Mental.

A eficácia da reabilitação em disfagia orofaríngea

TEMA: eficácia da reabilitação em disfagia orofaríngea. A atuação fonoaudiológica com disfagia orofaríngea em nosso País alcançou proporções significativas e merece neste momento atenção para que esta atuação esteja baseada em evidências científicas. As técnicas terapêuticas e a eficácia da reabilitação em disfagia orofaríngea têm sido estudadas desde a década de 70, alcançando seu ápice na década de 80 e 90. Poucos estudos têm relatado a eficácia da reabilitação em disfagia orofaríngea, sendo mais freqüente aqueles que têm se preocupado em provar os efeitos da técnica terapêutica na dinâmica da deglutição. No Brasil, as pesquisas em disfagia orofaríngea têm valorizado os procedimentos de avaliação, sendo poucos os trabalhos que tratam da reabilitação. OBJETIVO: apresentar uma análise crítica sobre a eficácia da reabilitação em disfagia orofaríngea. CONCLUSÃO: este artigo de revisão aponta que estudos não randomizados têm comprometido os resultados, uma vez que a casuística das pesquisas têm utilizado amostras muito heterogêneas, que incluem disfagias orofaríngeas mecânicas e neurogênicas ocasionadas por distintas etiologias. Além disto, os programas terapêuticos empregados são pouco descritivos comprometendo a reprodução por parte de outros pesquisadores. Tais achados sugerem a necessidade de estudos mais randomizados, talvez inicialmente por meio de estudos de casos que possam excluir as variáveis do controle da eficácia terapêutica. Outra sugestão seria empregar, assim como as pesquisas atuais têm proposto, escalas que possam medir o impacto do treinamento de deglutição nas condições nutricionais e pulmonares do indivíduo disfágico. Uma importante área da pesquisa, relacionada ao controle da eficiência e eficácia terapêutica, está nos estudos que objetivam estabelecer o grau de redução de custos hospitalares e em empresas de home care, mediante a atuação do fonoaudiólogo com a disfagia orofaríngea.

Reabilitação neuropsicológica pediátrica

A neuropsicologia investiga a expressão comportamental das disfunções cerebrais, isto é, a interação entre estruturas cerebrais preservadas e prejudicadas e as funções cognitivas, tais como linguagem, memória, atenção e outras. A neuropsicologia pediátrica possui especificidades: maturação, estratégias cognitivas, ensino formal e cultura, e características intrínsecas à reorganização cerebral. O objetivo da reabilitação neuropsicológica é estabelecer estratégias para adaptação de funções cognitivas afetadas em relação às demandas do ambiente da criança. A reabilitação cognitiva pediátrica auxilia crianças com deficiência mental, epilepsia, traumatismo craniencefálico, síndromes autísticas, tumores cerebrais, paralisia cerebral, etc. Programas de reabilitação neuropsicológica podem ser voltados para dificuldades acadêmicas ou para funções cognitivas. A investigação da efetividade de programas de reabilitação depende de diversos fatores. O neuropsicólogo deve contribuir para o desenvolvimento de novas estratégias de reabilitação cognitiva, ser qualificado para o uso das mesmas e partilhar, com a equipe interdisciplinar, as técnicas e experiências efetivas.

A reabilitação psicossocial no atendimento em saúde mental: Estratégias em construção

This study aims to identify the representations about Psychosocial Rehabilitation by Mental Health professionals working in open services, and also the difficulties they have met in the process of turning the care effective for the population. The study uses a qualitative methodology, collecting data by means of semistructured interviews with 15 subjects. The professionals identify the rehabilitation process as complex, meeting several obstacles and requiring their dedication and a flexible attitude to achieve the expected results.

Morphological and histochemical analysis of the human vestibular fold

A morphological and histochemical study of the human vestibular fold was carried out using routine histological techniques. Seven μm-thick histological sections stained with hematoxylin-eosin (HE) and Calleja showed the presence of elastic collagen fibers and seromucous glands in the vestibular fold. Muscle fibers forming the ventricular muscle were also identified. Ultrastructural analyses of the epithelial layer by scanning electron microscopy (SEM) revealed ciliated cells and gland ducts opening on the epithelial surface. Histochemical analyses were performed on ventricular muscles submitted to nicotinamide-adenine-dinucleotide tetrazolium reductase (NADH-TR), succinate dehydrogenase (SDH), and myofibrillar adenosine triphosphatase (mATPase) reactions. Based on these reactions, it was observed that the muscle is formed by three types of muscle fibers: slow-twitch oxidative (SO), fast-twitch oxydative glycolytic (FOG) and fast-twitch glycolytic (FG) fibers distributed in a mosaic pattern. The fiber frequency was 22.7%, 69.9% and 7.4%, respectively. The higher frequency of SO and FOG fibers characterized the muscle as having aerobic metabolism and resistance to fatigue. The ventricular muscle was considered fast. The study of the neuromuscular junctions performed after nonspecific esterase reaction showed that they are of the en-plaque type and have multiple occurrences in the ventricular muscle.

The large vestibular aqueduct syndrome: A cause of neurosensory dysacusia

Background: The large vestibular aqueduct syndrome (LVAS) is characterized by the enlargement of the vestibular aqueduct associated with sensorioneural hearing loss. The level of hearing loss varies and may be fluctuant, progressive or sudden. Vestibular symptoms may be present. The diagnosis is reached by imaging methods. Aim: To report an LVAS case. Method: A female infant was submitted to a computerized tomography of the ears and to audiologic tests. Results: Enlargement of the vestibular aqueduct of more than 1.5mm and sensorioneural hearing loss in the right ear were observed. Conclusion: With an early hearing evaluation it is possible to diagnose hearing loss, even in children were this loss is unilateral. Although the literature indicates that the diagnosis of LVAS occurs at a later age, in this case time etiologic diagnosis was enabled by computerized tomography.

Detecção de Escherichia coli e Salmonella spp. em microbiota intestinal de Psittaciformes em fase de reabilitação para soltura

Escherichia coli is a bacteria of the Enterobacteriacea family and it is part of the enterical microflora of mammals and of many species of birds. Salmonella spp. also belongs to the family Enterobacteriacea, it is responsible for human feed toxinfection outbreaks and usually isolated from domestic and wild birds. The present study analyzed the frequency of both agents in Psittaciformes in rehabilitation process for wildlife reintroduction. In 89 birds analyzed, 19% were infected with E. coli and 1,12% with Salmonella spp. It was carried out an analysis of the profile of antibiotic resistance in which was observed the efficiency of estreptomicin, tetraciclin, trimetoprim and gentamicin over the samples. The samples of E. coli were submitted to the Congo Red Binding test and to the Hemolisis test and 70,6% of positive samples for the first test and 53% for the second one were observed.

Assistência Odontológica em Crianças com Paralisia Cerebral e Perspectivas Tecnológicas de Reabilitação

The improvement of oral health and quality of life is closely related to transdisciplinary dialogue, technological development and social responsibility. In patients with cerebral palsy, the lesion of motor areas of the brain compromises the development and function of the craniofacial complex. Considering all the ethiopathogenic conditions, the treatment of such patients involves great difficulties. The dentist and other professionals related to their rehabilitation need to deal with difficulty in chewing, respiration, phonation, besides the poor oral hygiene resulted from abnormal involuntary movements of facial and masticatory musculature, tongue, and upper limb. It is also relevant the lack of understanding about the importance of oral health care due to mental deficits of these individuals. This study aims to review some aspects of oral health in patients with cerebral palsy proposing rehabilitation associated to technology. Few studies concerned about the effectiveness of therapies for oral rehabilitation in patients with cerebral palsy. Laser therapy, electromyography, electrostimulation and LED therapy should be analyzed as options for treatment of patients with cerebral palsy. Following research projects should focus more attention on the dynamic and oral function of these patients to achieve positive repercussions in their overall health. © ArquiMed, 2010.

O papel dos sistemas visual, vestibular, somatosensorial e auditivo para o controle postural

The maintenance of a given body orientation is obtained by the complex relation between sensory information and muscle activity. Therefore, this study purpose was to review the role of visual, somatosensory, vestibular and auditory information in the maintenance and control of the posture. Method. a search by papers for the last 24 years was done in the PubMed and CAPES databases. The following keywords were used: postural control, sensory information, vestibular system, visual system, somatosensory system, auditory system and haptic system. Results. the influence of each sensory system and its integration were analyzed for the maintenance and control of the posture. Conclusion. the literature showed that there is information redundancy provided by sensory channels. Thus, the central nervous system chooses the main source for the posture control.

Influence of lateral excursion on vestibular cervical dental abfraction.

A study was performed to evaluate the influence of mandibular lateral excursion, group function and canine guidance on vestibular cervical dental abfraction (VCDA). Thirty-six individuals of both sexes, aged 20 to 45 years, with full natural dentition with at least one tooth with VCDA were selected at the San Marcos University Clinic. We evaluated number of teeth with VCDA per side (left and right), tooth type and lateral excursive movement (canine guidance or group function) affecting it. The results showed no statistical difference (p > 0.05). The tooth type most often showing VCDA was the first lower premolar, with 30.8% on the right side and 36.4% on the left. Moderate positive correlation was found between age and VCDA (R = 0.40). It is concluded that group function during lateral excursion may contribute to presence of VCDA.

Estimulação elétrica neuromuscular na reabilitação da disfagia orofaríngea neurogênica

Objective. To present an overview of the literature about the efficacy of neuromuscular electrical stimulation (NMES) in the rehabilitation of neurogenic oropharyngeal dysphagia and to compare methods of therapy in stroke. Method. An extensive bibliographic survey of several databases (Medline, Scielo Brazil, Chile and Spain and Lilacs) was performed using the following keywords: deglutition disorders, therapy, electrical stimulation, pharynx and stroke between 1990 and 2011. Results. The articles reported the use of NMES in heterogeneous population; there is no consensus thus far about the method used during the NMES and about its rehabilitation efficacy in neurogenic oropharyngeal dysphagia. Conclusions. After this study, we concluded that further investigations are necessary with homogeneous groups of patients with neurogenic dysphagia, discussing the proposition of a specific NMES protocol for the rehabilitation of neurogenic oropharyngeal dysphagia.

Entre o sofrimento e a esperança: A reabilitação da incontinência urinária como componente interveniente

This is a qualitative study seeking to understand Brazilian women's experience of urinary incontinence (UI) and design a representative theoretical model for the experience. Theoretical saturation occurred after analysis of the 18th non-directive interview in accordance with Grounded Theory. Two phenomena emerged: living with the challenges of UI and experiencing the hope and disappointment of rehabilitation from UI. Upon re-alignment of the components, the core category emerged, namely: between suffering and hope - rehabilitation from urinary incontinence as an intervening component. From the analysis in light of symbolic interactionism, pregnancy and vaginal birth were observed to be symbols of women's vulnerability to the suffering from living with the moral and physio-psychosocial challenges of UI. It is also inferred that the lack of consideration of the Unified Health System (SUS) in investing in the process of rehabilitation from UI may be having a negative effect on the incentive programs for promoting vaginal birth. Most of all, it reveals the ongoing suffering of women with UI, most of whom do not have access to rehabilitation due to the lack of programs geared to the real needs of these users of the Unified Health System.