Le bien-être spirituel des personnes nouvellement diagnostiquees d'un cancer en début de traitement : étude descriptive correlationnelle

Problématique. Le cancer touche beaucoup de personnes en Suisse et un grand nombre en décèdent encore. Recevoir une telle annonce plonge le malade dans une crise spirituelle qui bouleverse complètement sa vie. L'incertitude de son avenir, la sensibilisation à sa finitude sont exacerbées par la proximité de la mort et par les symptômes du cancer: combien de temps les malades vont-ils encore vivre ? Qu'adviendra-t-il de leur corps désormais confronté aux symptômes du cancer et à ses traitements? Les professionnels de la santé s'attacheraient davantage au bien-être spirituel des personnes en phase palliative et peu d'études se sont intéressées au bien-être spirituel des personnes en début de traitement au moment d'une telle nouvelle. But. Décrire le bien-être spirituel des personnes nouvellement diagnostiquées d'un cancer en début de traitement, explorer sa relation avec les symptômes du cancer et l'interdépendance des différentes variables. Méthode. Cette recherche descriptive corrélationnelle a été conduite auprès de 30 patients recrutés selon un échantillonnage de convenance dans un centre d'oncologie ambulatoire situé dans un hôpital universitaire suisse. Les données ont été recueillies au moyen d'un formulaire de données sociodémographiques et de santé ainsi que de deux instruments de mesure: ESAS (Edmonton Symptom Assessment System) (Bruera, Kuehn, Miller, Selmser, & Macmillan, 1991) et FACIT-Sp-12 (Functional Assessment of Chronic Ilness Therapy-Spiritual Well- Being) (Canada, Murphy, Fitchett, Peterman, & Schover, 2008). Le premier a permis de mesurer les symptômes du cancer et le second, le bien-être spirituel. Les données ont été traitées par des analyses descriptives et corrélationnelles avec le logiciel STATA Version 11. Résultats. Les répondants étaient représentés en majorité par des femmes (73%) atteintes d'un cancer du sein (60%). La plupart des participants étaient croyants (97%) de confession catholique (50%), protestante (47%) ou musulmane (3%). Sur un rang de 0 à 48, la plupart des participants ont présenté un niveau de bien-être spirituel élevé (M=36,5 ; ĒT=6,6). Les dimensions de ce dernier atteignaient également de très bon scores : sur un rang de 0 à 16, la dimension sens affichait la moyenne la plus élevée (M=14,2 ; ĒT=1,9), suivie de celle de paix (M=12,1 ; ĒT=2,7) et finalement de celle de foi (M=10,2 ; ĒT=3,2). Le bien-être spirituel était lié significativement à l'âge (p= 0,04), à la dépression (p= 0,01) et au mal-être (p= 0,02) : être jeune, présenter des symptomatologies dépressives et de mal-être influencent négativement le bien-être spirituel des malades. Conclusions. Dépister précocement la dépression et le mal-être des personnes qui surgissent souvent à la révélation du cancer est important. Il faut se soucier particulièrement du bien-être spirituel des personnes âgées et les accompagner dans leur quête de sens singulière par la prière, l'abnégation, le récit de vie, les relations avec l'entourage, l'introspection, pour adoucir l'incertitude de l'avenir et la mouvance identitaire qui composent désormais leur quotidien.

Chest magnetic resonance imaging: a protocol suggestion

Abstract In the recent years, with the development of ultrafast sequences, magnetic resonance imaging (MRI) has been established as a valuable diagnostic modality in body imaging. Because of improvements in speed and image quality, MRI is now ready for routine clinical use also in the study of pulmonary diseases. The main advantage of MRI of the lungs is its unique combination of morphological and functional assessment in a single imaging session. In this article, the authors review most technical aspects and suggest a protocol for performing chest MRI. The authors also describe the three major clinical indications for MRI of the lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.

Exercícios para membros superiores durante radioterapia para câncer de mama e qualidade de vida

OBJETIVO: avaliar a influência da fisioterapia realizada durante a radioterapia (RT) sobre a qualidade de vida (QV) de mulheres em tratamento para câncer de mama. MÉTODOS: ensaio clínico randomizado com 55 mulheres em tratamento radioterápico, sendo 28 alocadas no grupo submetido à fisioterapia (GF) e 27 no grupo controle sem fisioterapia (GC). A técnica fisioterápica utilizada para o GF foi a cinesioterapia para membros superiores, com emprego de 19 exercícios realizados ativamente, com uma série de dez repetições rítmicas ou alongamentos, englobando movimentos de flexão, extensão, abdução, adução, rotação interna e rotação externa dos ombros, isolados ou combinados. A QV foi avaliada por meio do Functional Assessment of Cancer Therapy-Breast (FACT-B) no início, no final da RT e seis meses após seu término. As sessões de fisioterapia começavam concomitantemente à RT, em média 90 dias após a cirurgia. RESULTADOS: não houve diferença entre os grupos para as subescalas: bem-estar físico (p=0,8), bem-estar social/familiar (p=0,3), bem-estar funcional (p=0,2) e subescala de mama (p=0,2) nos três momentos avaliados. A comparação da subescala emocional obtida nas três avaliações demonstrou melhor comportamento do GF em relação ao GC (p=0,01). Ambos apresentaram melhora na subescala de mama entre o início e final da RT (GF p=0,0004 e GC p=0,003). Houve melhora dos escores do FACT-B ao final da RT em ambos os grupos (GF p=0,0006 e GC p=0,003). No entanto, seis meses após a RT, esta melhora manteve-se somente no GF (p=0,005). A qualidade de vida avaliada ao longo do tempo pelo FACT B (p=0,004) e Trial Outcome Index (TOI) (soma das subescalas bem-estar físico, funcional e subescala de mama) foi melhor no GF (p=0,006). Não houve evidência de efeitos negativos associados aos exercícios. CONCLUSÕES: a realização de exercícios para membros superiores beneficiou a qualidade de vida durante e seis meses após a RT.

Quality of radiotherapy care by development of e-feedback knowledge

The aim of this three phase study was to develop quality of radiotherapy care by the e-Feedback knowledge of radiotherapy -intervention (e-Re-Know). In Phase I, the purpose was to describe the quality of radiotherapy care and its deficits experienced by cancer patients. Based on the deficits in patient education in Phase II, the purpose was to describe cancer patients’ e-knowledge expectations in radiotherapy. In Phase III, the purpose was to develop and evaluate the outcomes of the e-Re-Know among breast cancer patients. The ultimate aim was to develop radiotherapy care to support patients’ empowerment with patient e-education. In Phase I (2004-2005), the descriptive design was used, and 134 radiotherapy patients evaluated their experiences by Good Nursing Care Scale for Patients (GNCS-P) in the middle of RT period. In Phase II (2006-2008), the descriptive longitudinal design was used and 100 radiotherapy patients’ e-knowledge expectations of RT were evaluated using open-ended questionnaire developed for this study before commencing first RT, in the middle of the treatment, and concluding RT period. In Phase III, firstly (2009-2010), the e-Re-Know intervention, i.e. knowledge test and feedback, was developed in terms of empowering knowledge and implemented with e-feedback approach based on literature and expert reviews. Secondly (2011-2014), the randomized controlled study was used to evaluate the e-Re-Know. Breast cancer patients randomized to either the intervention group (n=65) receiving the e-Re-Know by e-mail before commencing first RT and standard education or the control group (n=63) receiving standard education. The data were collected before commencing first RT, concluding last RT and 3 months after last RT using RT Knowledge Test, Spielberger’s State Trait Inventory (STAI) and Functional Assessment of Cancer Therapy - Breast (FACT-B) –instruments. Data were analyzed using statistical methods and content analysis. The study showed radiotherapy patients experienced quality of care high. However, there were deficits in patient education. Furthermore, radiotherapy patients’ multidimensional e-knowledge expectations through Internet covered mainly bio-physiological and functional knowledge. Thus, the e-Re-Know was developed and evaluated. The study showed when breast cancer patients’ carried out the e-Re-Know their knowledge of side effects self-care was significantly increased and quality of life (QOL) significantly improved in line with decrease in anxiety from time before radiotherapy period to three months after. In addition, the e-Re-Know has potential to have positive effects on anxiety and QOL, regardless of patient characteristics or knowledge level. The results support the theory of empowering patient education suggesting that empowerment can be supported by confirming patients’ understanding of own knowledge level. In summary, the e-Feedback knowledge of radiotherapy (e-Re-Know) intervention can be recommended in development of quality of radiotherapy care experienced by breast cancer patients. Further research is needed to assess and develop patient-centred quality of care by patient education among cancer patients.

Élaboration et validation empirique d'un modèle de consultation individuelle auprès des enseignants afin de favoriser l'inclusion scolaire des enfants ayant un TDAH

Les interventions proactives ou comportementales en classe sont reconnues empiriquement pour leur efficacité à améliorer le comportement ou le rendement scolaire des enfants ayant un TDAH (DuPaul & Eckert, 1997; Hoza, Kaiser, & Hurt, 2008; Pelham & Fabiano, 2008; Zentall, 2005). Or, l’écart entre les interventions probantes et celles retrouvées dans le milieu général de l’éducation souligne l’importance de répliquer les résultats d’études obtenus dans un environnement contrôlé dans un format de livraison réaliste. L’objectif principal de cette thèse est d’élaborer et d’évaluer un programme de consultation individuelle (PCI) fondé sur une démarche de résolution de problème et d’évaluation fonctionnelle, pour soutenir les enseignants du primaire dans la planification et la mise en œuvre cohérente des interventions privilégiées pour aider les enfants ayant un TDAH. D’abord, une recension des principales modalités d’intervention auprès des enfants ayant un TDAH est effectuée afin d’identifier les interventions à inclure lors du développement du programme. Par la suite, des solutions favorisant le transfert des interventions probantes à la classe ordinaire sont détaillées par la proposition du PCI ayant lieu entre un intervenant psychosocial et l’enseignant. Enfin, l’évaluation du PCI auprès de trente-sept paires enfant-enseignant est présentée. Tous les enfants ont un diagnostic de TDAH et prennent une médication (M). Les parents de certains enfants ont participé à un programme d’entraînement aux habiletés parentales (PEHP). L’échantillon final est: M (n = 4), M et PEHP (n = 11), M et PCI (n = 11), M, PEHP et PCI (n = 11). Les résultats confirment l’efficacité du PCI au-delà de M et M + PEHP pour éviter une aggravation des comportements inappropriés et améliorer le rendement scolaire des enfants ayant un TDAH. Par ailleurs, une augmentation de l’utilisation des stratégies efficaces par l’enseignant est observable lorsqu’il a à la fois participé au PCI et reçu une formation continue sur le TDAH en cours d’emploi. Les implications cliniques de l’intervention pour l’enfant ayant un TDAH et son enseignant de classe ordinaire sont discutées.

Wait Times to Rheumatology and Rehabilitation Services for Persons with Arthritis in Quebec

L’arthrite est l’une des causes principales de douleur et d’incapacité auprès de la population canadienne. Les gens atteints d’arthrite rhumatoïde (AR) devraient être évalués par un rhumatologue moins de trois mois suivant l’apparition des premiers symptômes et ce afin de débuter un traitement médical approprié qui leur sera bénéfique. La physiothérapie et l’ergothérapie s’avèrent bénéfiques pour les patients atteints d’ostéoarthrite (OA) et d’AR, et aident à réduire l’incapacité. Notre étude a pour but d’évaluer les délais d’attente afin d’obtenir un rendez-vous pour une consultation en rhumatologie et en réadaptation dans le système de santé public québécois, et d’explorer les facteurs associés. Notre étude est de type observationnel et transversal et s’intéresse à la province de Québec. Un comité d’experts a élaboré trois scénarios pour les consultations en rhumatologie : AR présumée, AR possible, et OA présumée ; ainsi que deux scénarios pour les consultations en réadaptation : AR diagnostiquée, OA diagnostiquée. Les délais d’attente ont été mesurés entre le moment de la requête initiale et la date de rendez-vous fixée. L’analyse statistique consiste en une analyse descriptive de même qu’une analyse déductive, à l’aide de régression logistique et de comparaison bivariée. Parmi les 71 bureaux de rhumatologie contactés, et pour tous les scénarios combinés, 34% ont donné un rendez-vous en moins de trois mois, 32% avaient une attente de plus de trois mois et 34% ont refusé de fixer un rendez-vous. La probabilité d’obtenir une évaluation en rhumatologie en moins de trois mois est 13 fois plus grande pour les cas d’AR présumée par rapport aux cas d’OA présumée (OR=13; 95% Cl [1.70;99.38]). Cependant, 59% des cas d’AR présumés n’ont pas obtenu rendez-vous en moins de trois mois. Cent centres offrant des services publics en réadaptation ont été contactés. Pour tous les scénarios combinés, 13% des centres ont donné un rendez-vous en moins de 6 mois, 13% entre 6 et 12 mois, 24% avaient une attente de plus de 12 mois et 22% ont refusé de fixer un rendez-vous. Les autres 28% restant requéraient les détails d’une évaluation relative à l’état fonctionnel du patient avant de donner un rendez-vous. Par rapport aux services de réadaptation, il n’y avait aucune différence entre les délais d’attente pour les cas d’AR ou d’OA. L’AR est priorisée par rapport à l’OA lorsque vient le temps d’obtenir un rendez-vous chez un rhumatologue. Cependant, la majorité des gens atteints d’AR ne reçoivent pas les services de rhumatologie ou de réadaptation, soit physiothérapie ou ergothérapie, dans les délais prescrits. De meilleures méthodes de triage et davantage de ressources sont nécessaires.

Description and analysis of pulmonary rehabilitation care programs current state in four cities of Colombia

Purpose: there are many studies reporting the benefits of pulmonary rehabilitation, but few of them exhibit the behavior and activities of these services. This article presents the characteristics of services, parts management and training level of team members, in addition to the variables or instruments used to measure the effectiveness and impact in these programs. Method: it was made a cross sectional convenience sample which included seven pulmonary rehabilitation services in four Colombian cities (Bogotá, Medellín, Manizales and Cali), selected by the coverage, for having at least one year of experience and for being formally established and recognized nationwide. The interdisciplinary team of each service answered a survey that was validated through a pilot test and expert consensus. Participation was voluntary. Results: labor onset pulmonary rehabilitation services correspond to an average of a decade, with COPD and asthma pathologies of attention. The programs are characterized by an outpatient treatment with an average duration of eight to twelve weeks, with a frequency of an hour three times a week. Also, the director of the service is regularly a pulmonologist and the coordinator a physiotherapist (57.14%). The posgradual training of these professionals is notable, and they report to have procedural, administrative and communicative skills, but qualify regular there research skills. The physical and technological resources are well tested. 71.42% have done impact studies, but only 28.57% have been published. All have in common training in upper limbs, lower limbs, respiratory muscles, counseling, functional assessment and quality of life. The effectiveness and impact of programs is measured by the walking test, quality of life questionnaires and activities of daily living.

Impacto funcional con el uso de clavo telescopico tipo Fassier Duval en pacientes con osteogénesis imperfecta

Introducción: la osteogénesis es una patología de origen genético caracterizada por fragilidad ósea, en su curso natural los pacientes que la padecen se enfrentan a múltiples fracturas y múltiples intervenciones quirúrgicas, este tipo de pacientes por ser de alto riesgo necesitan técnicas quirúrgicas que aumenten el tiempo entre cada intervención y que demuestren un mayor impacto en el estado funcional. Objetivo: Determinar el impacto en el estado funcional de los pacientes con osteogénesis imperfecta llevados a tratamiento quirúrgico con clavos telescopados tipo Fassier Duval. Diseño: Estudio descriptivo prospectivo en el que se incluyeron 8 pacientes con diagnóstico de osteogénesis imperfecta, llevados a tratamiento quirúrgico con clavos telescopados tipo Fassier Duval desde el 2009 al 2013 a los cuales se les realizó seguimiento menor de 1 año del post operatorio. Resultados: La respuesta encontrada fue satisfactoria en la mayoría de los pacientes analizados 6 de 8, con cercanía a un estado funcional normal; un riesgo de caída bajo, incorporación y deambulación adecuada y una valoración funcional motora gruesa con valores cercanos al 100% identificando un buen nivel de independencia funcional. Se pudo demostrar que existieron cambios en los valores de la escala y que estos fueron estadísticamente significativos con p=0,028 indicando que el aumento dichos valores en el posoperatorio están relacionados con el procedimiento quirúrgico al utilizado en este grupo de pacientes. Conclusión: El tratamiento quirúrgico con el clavo telescopado de Fassier Duval en nuestra experiencia demostró tener una mejoría en el estado funcional de los pacientes del presente estudio, por lo tanto se sugiere la posibilidad de implementar su uso según este indicado con el fin de obtener un mejor resultado quirúrgico y funcional. Palabras clave: Osteogénesis Imperfecta, Clavo de Fassier Duval, Valoración Funcional Motora

Impacto de las cirugías múltiples, en un solo tiempo quirúrgico, sobre el patrón de marcha en niños con parálisis cerebral

Introducción: La Parálisis Cerebral (PC) es la enfermedad neurológica más incapacitante en niños, su historia natural tiende al deterioro motor y funcional. Con este estudio se busca establecer sí las cirugías múltiples de miembros inferiores, en un tiempo quirúrgico, mantienen el nivel motor y funcional. Material y Método: Estudio analítico de cohortes. Se compara un grupo de pacientes sometidos a cirugías múltiples contra un grupo de pacientes no operados, en el Instituto de Ortopedia Infantil Roosevelt. Se evaluaron los pacientes con dos Laboratorios para el Análisis del Movimiento (LAM) y se midieron los desenlaces mediante el cambio en la puntuación del perfil de marcha (GPS) y el nivel funcional motor grueso (GMFCS). Resultados: 109 pacientes cumplieron con los criterios de selección, 67 pacientes fueron sometidos a cirugía y 42 pacientes no. Los pacientes operados mejoraron el GPS promedio (diferencia -1,94; p=0,002) comparado con los pacientes no operados (diferencia 1,74; p=0,001), indicando una mejoría significativa de la cinemática de la marcha. En un modelo de regresión logística predictivo, el paciente que es operado tiene una probabilidad del 78% de mantener su patrón de marcha, mientras que sí no se opera su probabilidad disminuye al 37%. El nivel funcional motor GMFCS no mostró cambios significativos entre los grupos. Discusión: Las cirugías múltiples de miembros inferiores mantienen de manera significativa el patrón de marcha en pacientes con PC. Se destaca el seguimiento de los pacientes mediante el LAM y se sugiere el uso del GPS para valorar resultados en este tipo de pacientes.

Empirical mode decomposition: a novel technique for the study of tremor time series

Tremor is a clinical feature characterized by oscillations of a part of the body. The detection and study of tremor is an important step in investigations seeking to explain underlying control strategies of the central nervous system under natural (or physiological) and pathological conditions. It is well established that tremorous activity is composed of deterministic and stochastic components. For this reason, the use of digital signal processing techniques (DSP) which take into account the nonlinearity and nonstationarity of such signals may bring new information into the signal analysis which is often obscured by traditional linear techniques (e.g. Fourier analysis). In this context, this paper introduces the application of the empirical mode decomposition (EMD) and Hilbert spectrum (HS), which are relatively new DSP techniques for the analysis of nonlinear and nonstationary time-series, for the study of tremor. Our results, obtained from the analysis of experimental signals collected from 31 patients with different neurological conditions, showed that the EMD could automatically decompose acquired signals into basic components, called intrinsic mode functions (IMFs), representing tremorous and voluntary activity. The identification of a physical meaning for IMFs in the context of tremor analysis suggests an alternative and new way of detecting tremorous activity. These results may be relevant for those applications requiring automatic detection of tremor. Furthermore, the energy of IMFs was visualized as a function of time and frequency by means of the HS. This analysis showed that the variation of energy of tremorous and voluntary activity could be distinguished and characterized on the HS. Such results may be relevant for those applications aiming to identify neurological disorders. In general, both the HS and EMD demonstrated to be very useful to perform objective analysis of any kind of tremor and can therefore be potentially used to perform functional assessment.

EMD: A novel technique for the study of tremor time series

This paper introduces the Hilbert Analysis (HA), which is a novel digital signal processing technique, for the investigation of tremor. The HA is formed by two complementary tools, i.e. the Empirical Mode Decomposition (EMD) and the Hilbert Spectrum (HS). In this work we show that the EMD can automatically detect and isolate tremulous and voluntary movements from experimental signals collected from 31 patients with different conditions. Our results also suggest that the tremor may be described by a new class of mathematical functions defined in the HA framework. In a further study, the HS was employed for visualization of the energy activities of signals. This tool introduces the concept of instantaneous frequency in the field of tremor. In addition, it could provide, in a time-frequency-energy plot, a clear visualization of local activities of tremor energy over the time. The HA demonstrated to be very useful to perform objective measurements of any kind of tremor and can therefore be used to perform functional assessment.

Application of EMD as a novel technique for the study of tremor time series

This paper introduces the Hilbert Analysis (HA), which is a novel digital signal processing technique, for the investigation of tremor. The HA is formed by two complementary tools, i.e. the Empirical Mode Decomposition (EMD) and the Hilbert Spectrum (HS). In this work we show that the EMD can automatically detect and isolate tremulous and voluntary movements from experimental signals collected from 31 patients with different conditions. Our results also suggest that the tremor may be described by a new class of mathematical functions defined in the HA framework. In a further study, the HS was employed for visualization of the energy activities of signals. This tool introduces the concept of instantaneous frequency in the field of tremor. In addition, it could provide, in a time-frequency energy plot, a clear visualization of local activities of tremor energy over the time. The HA demonstrated to be very useful to perform objective measurements of any kind of tremor and can therefore be used to perform functional assessment.

Funcionalidade em pacientes após acidente vascular encefálico: relação com o sono e ritmo de atividade-repouso

It is known that sleep plays an important role in the process of motor learning. Recent studies have shown that the presence of sleep between training a motor task and retention test promotes a learning task so than the presence of only awake between training and testing. These findings also have been reported in stroke patients, however, there are few studies that investigate the results of this relationship on the functionality itself in this population. The objective of this study was to evaluate the relationship between functionality and sleep in patients in the chronic stage of stroke. A cross-sectional observational study was conducted. The sample was composed of 30 stroke individuals in chronic phase, between 6 and 60 months after injury and aged between 55 and 75 years. The volunteers were initially evaluated for clinical data of disease and personal history, severity of stroke, through the National Institute of Health Stroke Scale, and mental status, the Mini-Mental State Examination. Sleep assessment tools were Pittsburgh Sleep Quality Index, the Questionnaire of Horne and Ostberg, Epworth Sleepiness Scale, the Berlin questionnaire and actigraphy, which measures were: real time of sleep, waking after sleep onset, percentage of waking after sleep onset, sleep efficiency, sleep latency, sleep fragmentation index, mean activity score. Other actigraphy measures were intraday variability, stability interdiária, a 5-hour period with minimum level of activity (L5) and 10-hour period with maximum activity (M10), obtained to evaluate the activity-rest rhythm. The Functional Independence Measure (FIM) and the Berg Balance Scale (BBS) were the instruments used to evaluate the functional status of participants. The Spearman correlation coefficient and comparison tests (Student's t and Mann-Whitney) were used to analyze the relationship of sleep assessment tools and rest-activity rhythm to measures of functional assessment. The SPSS 16.0 was used for analysis, adopting a significance level of 5%. The main results observed were a negative correlation between sleepiness and balance and a negative correlation between the level of activity (M10) and sleep fragmentation. No measurement of sleep or rhythm was associated with functional independence measure. These findings suggest that there may be an association between sleepiness and xii balance in patients in the chronic stage of stroke, and that obtaining a higher level of activity may be associated with a better sleep pattern and rhythm more stable and less fragmented. Future studies should evaluate the cause-effect relationship between these parameters

Grau de conhecimento de pacientes sobre o acidente vascular cerebral e a necessidade do uso de cartilha educativa para orientação fisioterapêutica

Stroke is a neurological dysfunction of vascular origin that causes physical impairments and disabilities. Brazil leads the statistics stroke mortality among Latin American countries, demonstrating still be a neglected disease in this country. The incidence is related to risk factors and still is great misinformation in our country about stroke, treatment and prophylaxis. The aim of this study was to assess the degree of knowledge about stroke and patients need to use educational booklet for physiotherapy. The sample consisted of 53 patients, 22 females and 31 males, mean age 56.2 ± 10.9 years. Patients were evaluated by completing questionnaires, observing the socio-demographic and clinical aspects, neurological assessment, functional assessment, knowledge of pathology and presenting educational booklet. The data were analyzed using the chi-square test. According to the results, it was observed that the patients had not enough knowledge about the terminology, complications and warning signs of stroke, were not aware and did not perform the proper positioning of the limb and transfers, however, were aware and performed the stretching maneuvers. This reveals the need to implement policies that lead to information about stroke population. Following discharge from outpatient physical therapy using educational booklets with guidelines on positioning, stretching exercises and transfer is important in functional rehabilitation and encouraging independence of the individual affected by stroke

Características sociodemográficas, hábitos de sono, estado cognitivo e funcional após acidente vascular cerebral

ABSTRACT Introduction: The cerebrovascular accident (CVA) is an important cause of neurological impairment. Few data about the factors associated with morbidity of cerebrovascular accident are found in Brazil. Objectives: Evaluate sociodemographic characteristics, sleep habits, cognitive and functional status of patients with cerebrovascular accident. Methods: The patients evaluated through questionnaire Step 1 to survey the sociodemographic characteristics and Modified Rankin Scale for functional assessment. The neurological degree was evaluated by the National Institutes of Health Stroke Scale (NIHSS), the sleep Habits questionnaire for sleep and cognitive status by the Mini-Examination of the Mental State (MEMS). The data were analyzed using the chi-square test to determine differences in proportions of variables and linear regression analysis. Results: 305 patients were evaluated and the larger number of subjects was between 50 and 69 years (40%), most patients had no formal education (40.3%) and had ischemic type of cerebrovascular accident (72.5%). In the analysis of the functionality it was found that most patients had moderate impairment (55.1%). The results of the sleep habits showed that 63,6% of patients had one more person in the bedroom,12,3% complained about too much noise in the 11 room and 35% of too much light. From these patients 5,8% were smokers, 7,8% and 70,1% drank coffee drinkers, 28,6% had difficulty in initiate to sleep and woke up 37,6% in the middle of the night. Were showed complaints about nightmares (11%), feeling of suffocation (37,7%) and 35% felt very sleepy during the day. In addition, 95% were unemployed, 80,5% did not perform physical activities and 95,4% did not perform mental activities. The cognitive screening conducted a determined association of cognitive status with age and education level and neurological status. Conclusion: The study showed a high frequency of cases of cerebrovascular accident with functional dependence in a moderate degree, identified that many patients do not follow hygienic measures of sleep and found that the assessment of cognitive deficits must take into consideration the age, educational level and degree of neurological patients. We suggest the need for programs of assistance to victims of cerebrovascular accident patients, with a multidimensional approach including the rehabilitation team, the role of sleep medicine and Neuropsychology, so that patients have access to a more appropriate functional rehabilitation, develop a lifestyle that ensures a good sleep quality and are evaluated and rehabilitated with regard to cognitive impairment