O envelhecimento da população mundial é um fenômeno novo, ao qual, mesmo os países desenvolvidos, ainda estão tentando adaptar-se como envelhecer de forma saudável, priorizando esforços na manutenção da independência e autonomia do indivíduo. Os princípios deste envelhecimento com qualidade de vida descrevem o idoso como pró-ativo, definindo seus objetivos e lutando para alcançá-los, reunindo recursos que são úteis na adaptação à mudança e ativamente envolvidos na manutenção do bem-estar. Este modelo compreende desde a satisfação com a vida a modelos baseados em conceitos de independência, controle, competências sociais e cognitivas. O objetivo desta pesquisa é a caracterização do perfil dos idosos que participam do Centro de Convivência do Idoso (CCI) quanto ao sexo, idade, estado civil, etnia autodeclarada, escolaridade, ocupação, renda individual, número de filhos, naturalidade, condições de moradia, meio de locomoção que utiliza para ir ao CCI e atividade física preferida e descrever as condições de saúde e desempenho nas atividades de vida diária dos idosos participantes de CCI, segundo a Classificação Internacional de Funcionalidade, Incapacidade e Saúde(CIF). Pesquisa do tipo exploratória, descritiva, transversal, com abordagem quantitativa, realizado em CCIs do Vale Paraíba, São Paulo. Foram incluídos no estudo aqueles que atendiam aos critérios de inclusão com idade igual ou superior a 60 anos, participantes, há pelo menos três meses completos e no máximo um ano dos CCIs, que constituíram o campo de pesquisa. O estudo caracterizou-se pelo predomínio de mulheres, idade média de 72 anos, casadas, etnia autodeclarada branca, com 5-10 anos de educação escolar, aposentadas, com média de renda mensal de um salário mínimo, por meio do instrumento de coleta foi possível observar que a maior parte das categorias da CIF selecionadas era pouco comprometida com dificuldade leve ou sem dificuldade. / The aging world population is a new phenomenon, which even developed countries are still trying to adapt to aging in a healthy way, prioritizing efforts to maintain the independence and autonomy of the individual. The principles of this aging quality of life describe the elderly as proactive, setting goals and striving to achieve them, gathering resources that are useful in adapting to change and actively involved in maintaining wellness. This model comprises from life satisfaction to models based on concepts of independence, control, social and cognitive skills. The goal of this research is to characterize the profile of the elderly participating in the Elderly Community Centre (CCI) regarding gender, age, marital status, self-reported ethnicity, education, occupation, individual income, number of children, nationality, living conditions , means of transportation you use to go to the CCI and preferred physical activity and describe the health and performance in activities of daily living of the elderly participants from CCI, according to the International Classification of Functioning, Disability and Health(ICF). Research An exploratory, descriptive , Cross-sectional quantitative approach carried out in CCIs Paraíba Valley, São Paulo. The study included those who met the inclusion criteria of age or over 60 years, participating for at least three months and complete within one year of the CCIs, which were the search field. The study was characterized by the predominance of women, mean age 72 years, married, self-reported ethnicity white, with 5-10 years of education, retired, with an average monthly income of a minimum wage, through the data collection instrument was observed that most of ICF categories selected was somewhat compromised with slight difficulty or no difficulty.

A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) contextualiza a saúde do individuo sob uma perspectiva integrativa, considerando os aspectos relativos ao meio em que vivem. Seu modelo biopsicossocial se aproxima do modelo de abordagem do Conceito Bobath (CB). Este conceito é conhecido por apresentar bons resultados na clínica mas limitações no registro da evolução dos pacientes. Com a divulgação da CIF, vislumbrou-se a possibilidade de registrar os ganhos funcionais obtidos com a terapêutica Bobath. O objetivo deste estudo foi apresentado em dois artigos. O primeiro artigo se refere ao relato de experiências de uso da CIF como forma de estimular sua aplicabilidade. O segundo tem como objetivo refletir sobre a congruência entre a CIF e o CB e discutir a aplicação de ambos na reabilitação neurológica. O resultado apresenta diferentes estratégias de uso da Classificação e sugere sua aplicação em conjunto com o CB, exemplificando uma forma de uso em um centro de reabilitação. A divulgação da classificação em conjunto com uma abordagem já utilizada, seja sob um formato total ou parcial, ou sob uma estrutura nova ou préestabelecida, pode trazer benefícios para a sua disseminação, facilitando o treinamento de profissionais e permitindo registro dos ganhos funcionais obtidos em terapia. / The International Classification of Functioning, Disability and Health (ICF) contextualizes the individual\'s health in an integrative perspective, considering the aspects of the environment in which they live. Its biopsychosocial model approaches the treatment model used in the Bobath Concept (BC). This concept is known to have good clinical results but limitations in recording the outcome. With the release of ICF, the possibility of registering the functional gains obtained with Bobath therapy have been envisioned. The objective of this study was presented in two articles. The first article refers to the reporting experiences of using the ICF as a way of stimulating their applicability. The second one aims to reflect on the congruence between the ICF and the BC and discuss the application of both in neurological rehabilitation. The result shows different strategies for use of the Classification and suggests its use together with the BC, one way to use in a rehabilitation center has been exemplified. The widespread use of the classification associated with an approach already used, either in full or partial format, or under a new structure or pre-established one, can bring benefits for its dissemination, facilitate the training of professionals and allowing the record of gains obtained from functional therapy.

As lesões medulares traumáticas (LMT) são comumente geradoras de deficiências e levam a limitações na execução de atividades, como também à restrição de participação em situações concretas de vida. Conhecer os indivíduos com LMT em termos de independência funcional permite aos serviços de reabilitação estruturarem-se para atenderem às demandas dessa população de forma mais eficiente. Estudo de delineamento metodológico objetivou construir e validar instrumento baseado no Core Set resumido da CIF para indivíduos com lesão medular aguda traumática. A pesquisa, aprovada pelo Comitê de Ética, foi realizada em três etapas: etapa 1:Elaboração do instrumento a partir do Core set resumido da CIF para lesão medular aguda: \"Instrumento baseado no Core set resumido da CIF para indivíduos com Lesão Medular Aguda Traumática\"; etapa 2: Validação do instrumento e coleta de dados; etapa 3: Aplicação do pré-teste.O instrumento para validação de face e conteúdo continha13 categorias que integraram os componentes da CIF: funções do corpo (3), estrutura do copo (1), atividades e participação (9), perfazendo um total de 109 itens. Em cada seção do instrumento tinha um campo para sugestões. A validade de conteúdo do instrumento foi realizada por um comitê de dezesseis juízes.Os resultados demonstraram que a maioria dos juízes de conteúdo eram do sexo feminino, jovens, com idade entre 30 e 39 anos. Quanto à titulação acadêmica e área de atuação, a maioria tinha doutorado e eram docentes, assim como, realizavam estudos sobre a CIF e à utilizavam na sua prática clinica.Cada item do instrumento foi avaliado em mais de 70% pelos avaliadores, sendo considerado aceitável para a validação de conteúdo. Na maioria dos itens, os juízes fizeram sugestões que visavam à modificação de termos, para serem substituídos ou reformulados, a partir do conceito apreendido, para que a estrutura e a propriedade do instrumento não fossem alteradas de modo significativo. Foram sugestões pertinentes que favoreceram a adequação do instrumento, a fim de facilitar a compreensão dos itens propostos pelo publico alvo. O pré-teste foi realizado no Centro de Reabilitação do HCFMRP-USP, participaram da pesquisa 10 indivíduos com diagnóstico de LTME, com até 6 meses lesão.A maioria eram do sexo masculino, com média de idade de 43 anos, sendo a principal etiologia do trauma os acidentes automobilísticos. Quanto à escolaridade verificou-se que a maioria dos participantes tinha ensino fundamental completo ou incompleto. Nesta etapa, houve substituição de alguns termos técnicos para melhor compreensão pelo público alvo. Mediante a análise entre os pesquisadores e após consenso das modificações sugeridas pelos especialistas e público alvo, foi elaborada a versão final do instrumento. Ressalta-se que o instrumento contribuíra na prática clinica como uma ferramenta inovadora a ser utilizado pela equipe multidisciplinar, na avaliação da funcionalidade para o planejamento da assistência, com foco nas necessidades individuais e nos resultados mais efetivos das intervenções no processo de reabilitação / Traumatic spinal cord injuries (TSCI) are usually the cause of disabilities and limited performance of some activities as well as limited participation in some life moments. Knowing if TSCI patients are functional dependent helps the rehabilitation services to be organized to effectively meet the demand of that population. The goal of the methodological design study was to create and validate an instrument based on summed up ICF Core Set for patients with acute traumatic spinal cord injury. The survey was approved by the Ethics Committee and it was divided in three phases: Phase 1 - Elaboration of the instrument based on summed up ICF Core Set for acute spinal cord injury: \"Instrument based on summed up ICF Core Set for patients with Acute Traumatic Spinal Cord Injury\"; Phase 2 - Validation of the instrument and data collect; Phase 3 - Implementation of the pre-test. Face and content validation tool had 13 categories which were part of ICF components: body functions (3), body structure (1), activities and participation (9); in total 109 items. Every section of the tool had a specific place for suggestions. A sixteen-judge committee validated the content. The results showed that most of the judges were 30 to 39-year-old women, with doctorate degree and they were professors who also studied ICF and applied it in their clinics. The evaluators checked more than 70% of each item of the tool and it was considered enough for the validation of the content. The judges made some suggestions for most of the items in order to replace or redesign the terms so that the structure and the effect of the tool would not be significantly changed. Those suggestions were relevant and they helped adjusting the tool to make easier for the community to understand the items. The pre-test was performed at Rehabilitation Center of HCFMRP-USP; ten patients who have had TSCI for up to 6 months participated on the survey. Most of them were 43 -year- old men, who studied up to elementary school, with a trauma caused by a car crash. At this stage some technical terms were replaced in order to help the community understanding. After the analysis of the researchers and the modifications suggested by the experts and the community, a final version of the tool was elaborated. In clinical practice this instrument was a new tool used by the multidisciplinary team when evaluating the functioning of helping individual necessities and more effective results of the interventions on the rehabilitation process

Made available in DSpace on 2016-04-29T14:16:45Z (GMT). No. of bitstreams: 1 Viviane Duarte Correia.pdf: 2938227 bytes, checksum: 2783ac28709cfca4fd350f5a7e994220 (MD5) Previous issue date: 2015-10-05 / The Cerebral Palsy (CP) is the most common cause of severe disability in childhood. Understand the circumstances in with the children with CP live is one of the premises treated in the World Report s recommendations on Disability (2012). Therefore, this study presents an analysis of the social contribution of the International Classification of Functioning, Disability and Health (ICF) in children with Cerebral Plasy. General Purpose: Know the socioeconomic and demographic universes of the children with CP based on the ICF. Specific: Detect environmental and family factors that may affect the rehabilitation process, according to the health domain of ICF; contribute to the theoretical and methodological structure of the practice of social work in rehabilitation teams of people with disabilities. Methodology: This is quantitative, qualitative and descriptive study. The subjects are 25 children and youngs, between 0 and 18 years diagnosed with CP followed by the Physical Medicine and Reabilitation Institute, Lucy Montoro Network, in the units of the southern region of São Paulo city. A family caregiver of each child with CP, was interviewed by two instruments, prepared by the researcher: Socioeconomic and demographic profile of patients with cerebral palsy; and Social Assessment based on the International Classification of Functioning, Disability and Health. Results: The survey revealed that family arrangements could interfere with treatment in children with CP. Families of children with CP, subjects of this study, have lower incomes. The support received is given by the patient s nuclear family. Most of the patients had trouble in social interactions. The housing policy showed the worst indexes, followed by education policy. For transport and health policies, there was intensity variation, however, they were assessed as facilitating the context of life of the patient. Negative attitudes of society had the lowest scores evaluation. Conclusions: The CIF represents an appropriate assessment model to obtains subsidies, that are necessary and sensitive for the analysis of human -social reality, lived by a child with CP. Furthermore, it assists in identifying disabling barriers and allows an analysis on the provision of public services / A Paralisia Cerebral (PC) é causa mais comum de deficiência física grave na infância. Compreender as circunstâncias em que vivem as crianças com PC é umas das premissas tratadas nas recomendações do Relatório Mundial sobre a Deficiência (2012). Para tanto, este estudo apresenta uma análise social sobre a contribuição da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) em crianças com PC. Objetivos Geral: Conhecer os universos sócio econômico e demográfico de crianças com PC, com base na CIF. Específicos: Detectar fatores socioambientais e familiares que possam interferir no processo de reabilitação, de acordo com os domínios de saúde da CIF; contribuir para a estruturação teórico-metodológica da prática do Serviço Social nas equipes de reabilitação da pessoa com deficiência. Metodologia: Trata-se de estudo quantitativo, qualitativo e descritivo. Tem como sujeitos 25 crianças e jovens, de 0 a 18 anos, diagnosticados com Paralisia Cerebral (PC), em acompanhamento no Instituto de Medicina Física e Reabilitação do HCFMUSP, Rede Lucy Montoro, nas unidades da região sul, do município de São Paulo. Foram entrevistados um familiar cuidador de cada criança, utilizando-se dois instrumentos, elaborados pela própria pesquisadora: Perfil socioeconômico e demográfico dos pacientes com Paralisia Cerebral e Avaliação Social com base na Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Resultados: A pesquisa revelou que os arranjos familiares podem interferir no tratamento em reabilitação física da criança com PC. As famílias de crianças com PC, objetos deste estudo, têm menores rendas. O apoio recebido é dado, basicamente, pelo núcleo familiar do paciente. A maioria dos pacientes apresentou dificuldades de interações sociais. A política de habitação apresentou os piores índices, seguida da política de educação. Para as políticas de transporte e saúde, houve variação de intensidade, no entanto, foram avaliadas como facilitadores ao contexto de vida do paciente. Atitudes negativas da sociedade obtiveram os piores scores de avaliação. Conclusões: A CIF apresenta um modelo de avaliação apropriado à obtenção de subsídios, necessários e sensíveis à análise da realidade humano-social, vivida pela criança com PC. Outrossim, auxilia na identificação das barreiras incapacitantes e permite uma análise sobre a oferta de serviços públicos na região Sul do município de São Paulo

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Este estudo teve como objetivos principais analisar o perfil epidemiolÃgico e realizar uma avaliaÃÃo funcional dos acidentados de trÃnsito atendidos em um serviÃo de fisioterapia de Fortaleza. Para tal, foi realizado um estudo quantitativo e transversal, desenvolvido de maio a novembro de 2009, na ABCR-Centro. Participaram deste pacientes acidentados de trÃnsito realizando tratamento na instituiÃÃo, maiores de 18 anos e concordantes em participar da pesquisa. Para coleta dos dados, foram utilizados um roteiro, o instrumento MIF e a Escala de ParticipaÃÃo Social. Os dados foram analisados com o software SPSS 15.0. Foram avaliados 57 pacientes, 53 homens e quatro mulheres, com idade mÃdia de 37Â14 anos, sendo a maioria (49,1%) de casados e com o ensino fundamental completo (42,1%). Ao considerar as situaÃÃes trabalhistas antes e apÃs o acidente, encontrou-se diferenÃa significativa (p<0,01), depois do acidente, a maioria (80,7%) nÃo estava trabalhando. A motocicleta foi o veÃculo mais envolvido nos acidentes (70,2%) e o tipo mais recorrente foi colisÃo (54,4%). Ao comparar a mÃdia de idade de acordo com o tipo de veÃculo envolvido, encontrou-se diferenÃa estatisticamente significante (p=0,04) entre os acidentes com moto e aqueles com veÃculo nÃo motorizado ou sem nenhum veÃculo. As fraturas foram predominantes (73,7%) e os membros inferiores foram as regiÃes mais acometidas (60%). Ao comparar a regiÃo corporal lesionada de acordo com o veÃculo envolvido, encontrou-se que a moto acometia predominantemente os membros e os demais veÃculos a regiÃo da cabeÃa (p=0,02). A maioria dos pacientes apresentou independÃncia completa para a MIF total (54,4%), motora (42,1%) e cognitiva (86%). A locomoÃÃo foi o subdomÃnio que apresentou os maiores graus de dependÃncia. Quanto à participaÃÃo social, a maioria (28,1%) apresentou grave restriÃÃo. Ao correlacionar a MIF com a participaÃÃo social por meio do teste de correlaÃÃo de Spearman, obteve-se uma correlaÃÃo negativa moderada, estatÃsticamente significante (R=-0,54, p<0,01). Na anÃlise multivariada da participaÃÃo social, entraram no modelo explicativo a MIFmotora, o tempo de internaÃÃo e o estado civil (p=0,01; p=0,01; p=0,09, respectivamente). Concluiu-se que a maioria dos participantes era de homens, adultos jovens e solteiros; que a moto foi o veÃculo mais envolvido e a colisÃo o tipo mais recorrente; que as fraturas foram as lesÃes mais predominantes e os membros inferiores os mais acometidos; que, ao considerar o veÃculo envolvido, houve diferenÃa quanto à idade dos acidentados, bem como quanto ao perfil lesional (regiÃo acometida); que houve predominÃncia dos indivÃduos que apresentavam independÃncia funcional, entretanto ao considerar os quesitos, o mais acometido foi a locomoÃÃo; que se destacaram os indivÃduos com grave restriÃÃo da participaÃÃo social; que a MIFmotora, o tempo de internaÃÃo e o estado civil foram explicativos da participaÃÃo social. / The present study it had as objective main to analyze the profile epidemiologist and to carry through a functional evaluation of the taken care of victims of traffic in a service of physiotherapy in Fortaleza. For such, a quantitative and transversal study, developed of May the November of 2009 was carried through, in the ABCR-center. They had participated of this, patient rough of traffic carrying through treatment in the institution, greater of 18 years and concordant in participating of the research. For collection of the data, a script was used, instrument FIM and Scale de Social Participial. The data had been analyzed with software SPSS 15.0. 57 patients, 53 men and 4 women had been evaluated, with medium age of 37Â14 years, being the majority (49.1%) married and with complete basic education (42.1%). When considering the working situation before and after the accident, met significant difference between same (p<0.01), where after the accident the majority (80.7%) it wasnât working. The motorcycle was the vehicle most involved in the accidents (70.2%) e the type most recurrent was collision (54.4%). When comparing the acts average in accordance with the type of involved vehicle, met difference significant (p=0.04) it enters the accidents with motion and with vehicle not motorized or without no vehicle. The breakings had been predominant (73.7%) and the inferior members were the most injuried body region (60%). When comparing the injured body region in accordance with the involved vehicle, met that the motorcycle affect predominantly the members and the too much vehicles the region of the head (p=0.02). The majority of the patients presented complete independence for the total FIM (54.4%), motor (42.1%) e cognitive (86%).The locomotion was the subdomain that presented the biggest degrees of dependence. How much to the social participation, the majority (28.1%) it presented serious restriction of the same one. When correlating the MIF with the Social Participation through the test of correlation of Spearman, got a moderate negative correlation, statistical significant (R=-0.54, p<0.01). In the multivariate analysis of the Social Participation through multiple regression, they had entered in the clarifying model of the same a FIM motor, the time of internment and the civil state (p=0.01; p=0.01; p=0.09, respectively). Concluded that the majority of the participants were men, young adults and singles; that motorcycle was the vehicle more involved and the collision was the type more recurrent; that the factures were the most prevalent injuries and the lower limbs were the most affected; considering the vehicle involved, there was difference as the victimsâ age, as well as, the lesional profile (affected region); the people were more prevalent, who presenting functional independence, but in considering the questions of it, the most affected was the locomotion; that stood out individuals with severe restriction of social participation; that motor FIM, hospitalization time and marital status were explanatory of social participation.

As lesões medulares traumáticas (LMT) são comumente geradoras de deficiências e levam a limitações na execução de atividades, como também à restrição de participação em situações concretas de vida. Conhecer os indivíduos com LMT em termos de independência funcional permite aos serviços de reabilitação estruturarem-se para atenderem às demandas dessa população de forma mais eficiente. Estudo de delineamento metodológico objetivou construir e validar instrumento baseado no Core Set resumido da CIF para indivíduos com lesão medular aguda traumática. A pesquisa, aprovada pelo Comitê de Ética, foi realizada em três etapas: etapa 1:Elaboração do instrumento a partir do Core set resumido da CIF para lesão medular aguda: \"Instrumento baseado no Core set resumido da CIF para indivíduos com Lesão Medular Aguda Traumática\"; etapa 2: Validação do instrumento e coleta de dados; etapa 3: Aplicação do pré-teste.O instrumento para validação de face e conteúdo continha13 categorias que integraram os componentes da CIF: funções do corpo (3), estrutura do copo (1), atividades e participação (9), perfazendo um total de 109 itens. Em cada seção do instrumento tinha um campo para sugestões. A validade de conteúdo do instrumento foi realizada por um comitê de dezesseis juízes.Os resultados demonstraram que a maioria dos juízes de conteúdo eram do sexo feminino, jovens, com idade entre 30 e 39 anos. Quanto à titulação acadêmica e área de atuação, a maioria tinha doutorado e eram docentes, assim como, realizavam estudos sobre a CIF e à utilizavam na sua prática clinica.Cada item do instrumento foi avaliado em mais de 70% pelos avaliadores, sendo considerado aceitável para a validação de conteúdo. Na maioria dos itens, os juízes fizeram sugestões que visavam à modificação de termos, para serem substituídos ou reformulados, a partir do conceito apreendido, para que a estrutura e a propriedade do instrumento não fossem alteradas de modo significativo. Foram sugestões pertinentes que favoreceram a adequação do instrumento, a fim de facilitar a compreensão dos itens propostos pelo publico alvo. O pré-teste foi realizado no Centro de Reabilitação do HCFMRP-USP, participaram da pesquisa 10 indivíduos com diagnóstico de LTME, com até 6 meses lesão.A maioria eram do sexo masculino, com média de idade de 43 anos, sendo a principal etiologia do trauma os acidentes automobilísticos. Quanto à escolaridade verificou-se que a maioria dos participantes tinha ensino fundamental completo ou incompleto. Nesta etapa, houve substituição de alguns termos técnicos para melhor compreensão pelo público alvo. Mediante a análise entre os pesquisadores e após consenso das modificações sugeridas pelos especialistas e público alvo, foi elaborada a versão final do instrumento. Ressalta-se que o instrumento contribuíra na prática clinica como uma ferramenta inovadora a ser utilizado pela equipe multidisciplinar, na avaliação da funcionalidade para o planejamento da assistência, com foco nas necessidades individuais e nos resultados mais efetivos das intervenções no processo de reabilitação / Traumatic spinal cord injuries (TSCI) are usually the cause of disabilities and limited performance of some activities as well as limited participation in some life moments. Knowing if TSCI patients are functional dependent helps the rehabilitation services to be organized to effectively meet the demand of that population. The goal of the methodological design study was to create and validate an instrument based on summed up ICF Core Set for patients with acute traumatic spinal cord injury. The survey was approved by the Ethics Committee and it was divided in three phases: Phase 1 - Elaboration of the instrument based on summed up ICF Core Set for acute spinal cord injury: \"Instrument based on summed up ICF Core Set for patients with Acute Traumatic Spinal Cord Injury\"; Phase 2 - Validation of the instrument and data collect; Phase 3 - Implementation of the pre-test. Face and content validation tool had 13 categories which were part of ICF components: body functions (3), body structure (1), activities and participation (9); in total 109 items. Every section of the tool had a specific place for suggestions. A sixteen-judge committee validated the content. The results showed that most of the judges were 30 to 39-year-old women, with doctorate degree and they were professors who also studied ICF and applied it in their clinics. The evaluators checked more than 70% of each item of the tool and it was considered enough for the validation of the content. The judges made some suggestions for most of the items in order to replace or redesign the terms so that the structure and the effect of the tool would not be significantly changed. Those suggestions were relevant and they helped adjusting the tool to make easier for the community to understand the items. The pre-test was performed at Rehabilitation Center of HCFMRP-USP; ten patients who have had TSCI for up to 6 months participated on the survey. Most of them were 43 -year- old men, who studied up to elementary school, with a trauma caused by a car crash. At this stage some technical terms were replaced in order to help the community understanding. After the analysis of the researchers and the modifications suggested by the experts and the community, a final version of the tool was elaborated. In clinical practice this instrument was a new tool used by the multidisciplinary team when evaluating the functioning of helping individual necessities and more effective results of the interventions on the rehabilitation process

INTRODUÇÃO: Desde o início da doença de Alzheimer (DA), alterações de linguagem comprometem o engajamento, o exercício da vida social do indivíduo e, têm impacto em sua independência. A informação sobre essas alterações contribui para a caracterização do diagnóstico da doença. A limitação da capacidade de comunicação funcional, ou seja, a capacidade de emitir e compreender uma mensagem de maneira independente e eficiente em resposta à demanda do cotidiano, é uma das queixas mais importantes de familiares e cuidadores, daí a necessidade de se disponibilizar instrumento, em língua portuguesa, que avalie a comunicação, em contexto natural, para fins de diagnóstico e de acompanhamento de indivíduos acometidos. O objetivo deste estudo foi validar a escala de Avaliação Funcional das Habilidades de Comunicação - ASHA FACS para uso na população brasileira. A ASHA FACS é composta pelos domínios: Comunicação Social, Comunicação de Necessidades Básicas, Leitura, Escrita e Conceitos Numéricos, e Planejamento Diário. MÉTODOS: Foram realizadas a tradução e a adaptação da escala. Foram examinados 32 idosos com DA leve, 25 com DA moderada e 51 idosos sem demência. Os idosos com DA e os controles responderam ao Miniexame do Estado Mental (MEEM), à Escala Geriátrica de Depressão (GDS) e à Escala de Avaliação de Doença de Alzheimer (ADAS-cog). A ASHA FACS foi respondida pelo familiar/cuidador, tendo sido pesquisadas a consistência interna da escala, sua reprodutibilidade inter e intra-examinadores e a validade de critério, pela correlação com o MEEM e com a ADAS-cog, bem como a sensibilidade e a especificidade. Foi examinado o efeito da idade e da escolaridade no desempenho funcional da comunicação. O passo seguinte foi aplicar o instrumento em condições clínicas, com o intuito de detectar indivíduos com DA e estadiar as alterações de comunicação nas fases leve e moderada. RESULTADOS: Análises estatísticas indicaram que a ASHA FACS tem ótima consistência interna (alfa de Cronbrach = 0,955), ótima confiabilidade teste-reteste (coeficiente de correlação interclasse [ICC] = 0,995; p < 0,001) e interexaminadores (ICC = 0,998; p < 0,001), e ótima validade de critério ao ser correlacionada tanto com o MEEM como com a ADAScog. A escala ASHA FACS apresentou valores de sensibilidade (81,4%) e de especificidade (84,3%) considerados bons, já que se trata de avaliação ecológica ampla. Verificou-se que a variável escolaridade interfere no desempenho funcional da comunicação dos idosos saudáveis e com DA, mas o aumento da idade não tem a mesma influência nos dois grupos. A pontuação total da ASHA FACS diferenciou idosos saudáveis dos com DA leve e estes dos que apresentavam DA moderada. Os domínios que melhor diferenciaram os três grupos foram os de Comunicação Social e Planejamento Diário. CONCLUSÕES: A escala ASHA FACS, versão em Português, é válida e confiável para verificar alterações de comunicação em pacientes com DA, útil para fins diagnósticos e estadiamento de alterações ao longo da doença, tendo como objetivo o tratamento dos pacientes e a orientação aos familiares e cuidadores. A ASHA FACS vem preencher importante lacuna de indicadores de eficácia para intervenções fonoaudiológicas em nosso meio. / INTRODUCTION: Since the beginning of Alzheimer\'s disease (AD), language problems intervene in engagement, social life and individual\'s protection and have impact on one\'s independence. Information about such alterations, obtained from a natural context, contributes for diagnosing AD. Limitation on the ability to communicate functionally, that is, limitation on ability to utter and understand a message independently and efficiently in response to everyday demand is one of the most important complaints of relatives and caregivers. Therefore, there is a need for providing an instrument in Portuguese that assess communication in a natural context for diagnosing and following patients with AD and their relatives/caregivers. This study aimed to validate the Functional Assessment of Communication Skills - ASHA FACS for a Brazilian population. The ASHA FACS is composed of four domains: Social Communication, Communication of Basic Needs, Reading, Writing and Number Concepts and Daily Planning. METHODS: The scale was translated and adapted into Portuguese. Then, 32 mild AD patients, 25 moderate AD patients and 51 elderly without dementia were examined. The AD patients and the control group answered the Minimental State Examination (MMSE), the Geriatric Depression Scale (GDS) and Alzheimer\'s disease Assessment Scale (ADAS-cog). The ASHA FACS assessment was answered by their relative/caregiver. The scale internal consistency, its inter and intra-examiners reproducibility and scale\'s criterion validity were researched by correlation with MMSE and Adas-cog. The sensitivity and specificity were also researched. Besides, the effect of scholarship and age in functional communication performance were analyzed. The next step was to apply the ASHA FACS in clinical conditions aiming at diagnosing persons with AD and determining the communication alterations in mild and moderate AD stages. RESULTS: Statistical analyses indicated that the ASHA FACS has excellent internal consistency (Cronbach\'s Alpha=0,955), test-retest reliability (interclass correlation coefficient [ICC] = 0,995; p<0,001) and inter-examiners (ICC=0,998; p<0,001). Besides, it showed excellent criterion validity when correlated with MMSE and Adascog. The ASHA FACS scale showed good sensitivity (81.4%) and specificity (84.3%) values once it is an ecological and broad evaluation. It was verified that scholarship intervened in functional communication performance of healthy elderly people and ones with DA, but the age\'s increase did not have the same influence on functional communication performance in both groups. The ASHA FACS total score differentiated healthy elderly from mild AD patients and mild AD from moderate AD patients. Social Communication and Daily Planning were the domains that better differentiated the three groups. CONCLUSIONS: The ASHA FACS Portuguese version is a valid and reliable instrument to verify communication alterations in DA patients. It is useful for diagnosis and track alterations along the disease aiming patient\'s treatment and relative\'s and caregiver\'s orientation. Besides the use for diagnosis purpose, the ASHA FACS fills an important gap of efficiency indicators for speech language therapy in our country.

<p>The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the&nbsp / functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the&nbsp / outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered&nbsp / questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating&nbsp / to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised&nbsp / outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human&nbsp / subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package&nbsp / 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using&nbsp / chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93&nbsp / with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke&nbsp / was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All&nbsp / patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients&nbsp / (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle&nbsp / weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following&nbsp / domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p&lt / 0.0001) and stroke (p&lt / 0.0001)&nbsp / between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on&nbsp / admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple&nbsp / redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p&lt / 0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity&nbsp / limitations and participation restrictions still experienced at the time of discharge. The latter finding&nbsp / questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation&nbsp / programme and referral process . </p>

Background: The main objective of this study was to investigate older people’s physical activity, their participation in various life situations, and their perceptions of their own health. This included an exploration of potential influences of urban versus rural residency on these outcomes, an evaluation of the measurement properties of a balance confidence scale, and an examination of the proposed usefulness of the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework to facilitate analysis and understanding of selected outcomes. Methods: The study design was cross-sectional, population-based, with random selection from the national register of one urban and two rural municipalities in Northern Iceland. There were 186 participants, all community-dwelling, aged 65 to 88 years (mean = 73.8), and 48% of the group were women. The participation rate was 79%. Data was collected in 2004, in face-to-face interviews and through various standardized assessments. The main outcomes were total physical activity; leisure-time, household, and work-related physical activity; participation frequency and perceived participation restrictions; and self-rated health. Other assessments represented aspects of the ICF body functions, activities, environmental factors and personal factors. Moreover, Rasch analysis methods were applied to examine and modify the Activities-specific Balance Confidence (ABC) scale and the ICF used as a conceptual framework throughout the study. Results: The total physical activity score was the same for urban and rural people and the largest proportion of the total physical activity behavior was derived from the household domain. Rural females received the highest scores of all in household physical activity and rural males were more physically active than the others in the work-related domain. However, leisure-time physical activity was more common in urban than rural communities. A physically active lifestyle, urban living, a higher level of cognition, younger age, and fewer depressive symptoms were all associated with more frequent participation. Rural living and depressive symptoms were associated with perceived participation restrictions. Moreover, perceived participation restrictions were associated with not being employed and limitations in advanced lower extremity capacity. Both fewer depressive symptoms and advanced lower extremity capacity also increased the likelihood of better self-rated health, as did capacity in upper extremities, older age, and household physical activity. Rasch rating scale analysis indicated a need to modify the ABC to improve its psychometric properties. The modified ABC was then used to measure balance confidence which, however, was found not to play a major role in explaining participation or self-rated health. Finally, the ICF was useful as a conceptual framework for mapping various components of functioning and health and to facilitate analyses of their relationships. Conclusions: The results highlighted the commonalities and differences in factors associated with participation frequency, perceived participation restrictions, and self-rated health in old age. Some of these factors, such as advanced lower extremity capacity, depressive symptoms, and physical activity pattern should be of particular interest for geriatric physical therapy due to their potential for interventions. While the associations between depressive symptoms, participation, and self-rated health are well known, research is needed on the effects of advanced lower extremity capacity on participation and self-rated health in old age. The environment (urban versus rural) also presented itself as an important contextual variable to be aware of when working with older people’s participation and physically active life-style. Greater emphasis should be placed on using Rasch measurement methods for improving the availability of quality scientific measures to evaluate various aspects of functioning and health among older adults. Finally, a coordinated implementation of a conceptual framework such as ICF may further advance interdisciplinary and international studies on aging, functioning, and health.

<p>The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the&nbsp / functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the&nbsp / outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered&nbsp / questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating&nbsp / to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised&nbsp / outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human&nbsp / subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package&nbsp / 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using&nbsp / chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93&nbsp / with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke&nbsp / was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All&nbsp / patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients&nbsp / (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle&nbsp / weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following&nbsp / domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p&lt / 0.0001) and stroke (p&lt / 0.0001)&nbsp / between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on&nbsp / admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple&nbsp / redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p&lt / 0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity&nbsp / limitations and participation restrictions still experienced at the time of discharge. The latter finding&nbsp / questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation&nbsp / programme and referral process . </p>