Marcelo Riberto | Universidade de Ribeirão Preto (UNAERP) (original) (raw)

Papers by Marcelo Riberto

Journal of neuromuscular diseases, 2014

LIPORACI, R.F. Cardiovascular and biomechanics responses caused by active and passive tilt test i... more LIPORACI, R.F. Cardiovascular and biomechanics responses caused by active and passive tilt test in healthy subjects. 2011. 97 f., Master´s dissertation-Ribeirão Preto

Introduction: The assessment of biomechanical changes related to the lower limbs is necessary in ... more Introduction: The assessment of biomechanical changes related to the lower limbs is necessary in clinical practice to measure the potential risks of injury and the influences on existing dysfunction. Biomechanical changes related to previous ankle injuries are known to influence the performance of the entire lower limb. Objective: The aim of this study was to correlate muscle strength tests, performance tests and ankle stability with the Single Hop Test (SHT). Methods: 82 amateur runners were evaluated with isokinetic tests of quadriceps and hamstring muscle strength, as well as Y Balance Test (YBT), Weight-bearing Lung Test (WBLT), and the SHT. Results: The results showed there was a significant correlation between the SHT and the YBT in subjects with hamstring/quadriceps ratio (I/Q ratio) <0.55, and the length of the unilateral SHT with the peak torque of ipsilateral knee extensors. Conclusion: The study was successful in correlating the functional tests in question with the results obtained in isokinetic dynamometry. Level of Evidence V; Cross-Sectional Study.

Acta Fisiátrica, Dec 9, 2007

Introduction: Pressure ulcers are frequent complications in patients with spinal cord injuries. T... more Introduction: Pressure ulcers are frequent complications in patients with spinal cord injuries. These ulcers need an early diagnosis and a strict follow-up to prevent a more severe evolution and delays in the rehabilitation process. Unfortunately, patients do not always have access to a center specialized in the treatment of wounds, and thus, telemedicine can be useful in such cases. Objective: To evaluate the effectiveness of a protocol for the assessment of pressure ulcers through digital images. Methods: 15 patients were selected, totaling Desenvolvimento de um protocolo para avaliação de pacientes com úlceras de pressão através da telemedicina e imagens digitais Development of a protocol for the assessment of patients with pressure ulcers through telemedicine and digital images

Revista Acta Fisiátrica, 2007

- tions, normal sensitive amplitude), moderate/grade 4 (altered sensitive and motor conductions, ... more - tions, normal sensitive amplitude), moderate/grade 4 (altered sensitive and motor conductions, low sensitive amplitude), severe/grade 5 (absent sensitive conduction, altered motor conduction) and extremely severe/grade 6 (absent sensitive and motor conductions). A prospective study was carried out in 400 hands with CTs. 56 hands (14%) were classified as grade 1,109 hands (27.3%) as grade 2, 129 hands (32.3%) as grade 3, 78 hands (19.5%) as grade 4, 22 hands (5.5%) as grade 5 and 6 hands (1.5%) as grade 6. There was a significant positive correlation (p < 0.01) between the neurophysiological scale of CTs and the patients' ages, the duration of CTs, the frequency of reported classical CTs history and the frequency of night pain symptoms, paresthesia and numbness. Additionally, there was a significant positive correlation between the neurophysiological scale and the frequency of Tinels sign, hypoesthesia on the 2nd digit, weakness and hypotrophy of the thenar muscles.

PubMed, Apr 1, 2014

Background: Low back pain is a leading cause of disability in Brazil. The multiple aspects of dis... more Background: Low back pain is a leading cause of disability in Brazil. The multiple aspects of disability in these patients require comprehensive tools for their assessment. The International Classification of Functioning, Disability, and Health (ICF) core set for low back pain is designed to comprehensively describe the experience of such patients with their functioning. Aim: This study aimed to describe functioning and contextual factors and to empirically validate the ICF core set for low back pain. Design: Cross sectional study. Setting: Three outpatient clinics in Manaus, Maceio and São Paulo, Brazil. Population. 135 low back pain outpatients under rehabilitation. Methods: Data concerning diagnosis, personal features, and the 78 ICF core set categories for low back pain were collected from clinical charts, physical examinations, tests, and interviews with patients from rehabilitation services in three parts of Brazil. Results: 7.7% of the categories (6 body functions and 10 activity and participation) were affected in less than 20% of the sample, and were thus considered not validated. Pain and other sensations related to the musculoskeletal system were the body most frequently impaired functions. Mobility and domestic life were the chapters of activity and limitation most often described as limited. All environmental factors were qualified as either facilitators or barriers and acted as modulators of disability. Conclusion: The comprehensive ICF core sets for low back pain can be used to describe the living experience of such individuals, although efforts to make it operational and enhance the reproducibility of the results are needed to warrant its reliable routine use. Clinical rehabilitation impact: This study highlights the importance of a complete assessment of chronic low back pain and demonstrate the need for multidisciplinary approach.

Acta Fisiátrica, Dec 27, 2017

Carpal Tunnel Syndrome is the most common compressive neuropathy in the general population, and i... more Carpal Tunnel Syndrome is the most common compressive neuropathy in the general population, and it may lead to disabling symptoms and significant functional limitation. This systematic review covered Pubmed, Medline, Embase, Cochrane, CINAHL, LILACS, and SCIELO databases, with no time or language delimitations. The PICO strategy defined the search strategy with keywords extracted from the Medical Subjects Headings, and the quality of the studies was evaluated by the Agency for Healthcare Research and Quality (AHRQ) scale. Overall, 857 studies were identified, of which only 10 fulfilled the inclusion criteria. Despite the good results shown, a noticeable heterogeneity was observed among the studies included, associated with methodological discrepancy and to limited sample size in a few of them. Four studies showed no correlation between electrophysiological findings and clinical symptoms and signs, whereas three could demonstrate such association and other three studies had equivocal results. Other studies are necessary, with better methodological standards and more homogeneous and precise evaluations, so as to improve the level of scientific evidence.

Acta Fisiátrica, Aug 9, 2000

Acta Fisiátrica, Nov 30, 2022

Acta Fisiátrica, Jun 9, 2007

A lesão encefálica adquirida (LEA) pode provocar numa gama variada de deficiências e, questiona-s... more A lesão encefálica adquirida (LEA) pode provocar numa gama variada de deficiências e, questiona-se o resultado da reabilitação ambulatorial quando efetuada num longo período após sua instalação. O objetivo deste estudo foi avaliar os ganhos obtidos pelos pacientes com LEA sob reabilitação ambulatorial. Foram revisados os relatórios de alta de 118 pacientes atendidos na Divisão de Medicina de Reabilitação entre 1999 e 2001, nos quais a funcionalidade é sistematicamente registrada segundo a Medida de Independência Funcional (MIF), no momento da avaliação inicial, retornos médicos e alta. Foram comparados os valores médios de cada um dos itens da MIF no início e final do tratamento. O tempo mediano desde a instalação da lesão foi de 9 meses. Houve aumento da proporção de indivíduos independentes em todas os itens da MIF ao final do tratamento, bem como aumento significativo dos seus valores médios. Os resultados apresentados diferem daqueles observados em outros países nos quais a reabilitação ocorre na fase mais aguda. Isso pode decorrer de abordagens efetuadas antes da chegada do paciente ao centro de reabilitação cujo foco é maior em aspectos da deficiência física, sem levar em conta a importância da independência funcional. Os dados apresentados permitem concluir que, em nosso meio, os pacientes com LEA podem obter ganhos funcionais com a reabilitação, mesmo que ela seja iniciada tardiamente.

Acta Fisiátrica, Mar 9, 2008

Resultados do core set da CIF de dor crônica generalizada em mulheres com fibromialgia no Brasil ... more Resultados do core set da CIF de dor crônica generalizada em mulheres com fibromialgia no Brasil Results of the ICF core sets for chronic widespread pain in women with fibromyalgia in Brazil

Revista Acta Fisiátrica, Apr 9, 2005

Objetivo: Validar empiricamente o core set da CIF para lombalgia e descrever a funcionalidade de ... more Objetivo: Validar empiricamente o core set da CIF para lombalgia e descrever a funcionalidade de uma amostra de pacientes com lombalgia mecânica crônica inespecífica. Métodos: Vinte e nove pacientes de um centro de reabilitação foram avaliados por meio do core set da CIF para lombalgia e pelo questionário de Roland Morris (QRM) e SF-36. Resultados: Todas as categorias de estruturas do corpo do core set se mostraram comprometidas em ao menos 80% dos pacientes, sendo consideradas validadas. Entre as 19 categorias de Funções do corpo, apenas quatro estavam comprometidas em menos que 80% dos pacientes, sendo consideradas nãovalidadas, o mesmo foi observado para cinco das 29 de Atividades e participações e cinco das 25 categorias de Fatores ambientais. Conclusões: As categorias selecionadas para o core set da CIF para lombalgia foram consideradas empiricamente validadas e em conjunto permitiram descrever a multiplicidade de repercussões dessa condição de saúde sobre a funcionalidade das pessoas. O core set da CIF serve para guiar a intervenção terapêutica interdisciplinar.

BrJP, 2023

RESUMO JUSTIFICATIVA E OBJETIVOS: A espasticidade refere-se ao aumento da resistência ao moviment... more RESUMO JUSTIFICATIVA E OBJETIVOS: A espasticidade refere-se ao aumento da resistência ao movimento passivo articular conforme a sua velocidade angular. Ela faz parte da tríade da síndrome piramidal, junto com a exacerbação de reflexos miotáticos e fraqueza muscular, e está presente em diversas lesões do sistema nervoso central, de topografia medular ou encefálica. A dor associada à espasticidade é causada pelos espasmos musculares, ativação de pontos-gatilho, deformidades articulares, interferência na posição dos segmentos corporais e dificuldade para o controle do movimento. Para uma intervenção terapêutica mais precisa, o exame físico detalhado do aparelho locomotor e da espasticidade pode ser completado pelo uso de escalas de avaliação específicas. A esclerose múltipla é a condição clínica para a qual há maior número de estudos com uso de canabinoides para o controle da espasticidade. O objetivo deste estudo foi realizar uma revisão da literatura sobre o possível papel dos fármacos canabinoides no controle da espasticidade e da dor associada a ela. CONTEÚDO: Há na literatura evidências moderadas de que o uso combinado de 9-tetrahidrocanabinol e canabidiol aumenta o número de pessoas que relatam melhora da espasticidade. CONCLUSÃO: É possível acreditar que a queixa de dor musculoesquelética associada à espasticidade acompanhe essa melhora com uso de nabiximol, mas ainda há lacunas na literatura para esse tópico específico.

Acta Fisiátrica, Aug 9, 2004

A fibromialgia é caracterizada por dor crônica, generalizada e pela presença de pontos dolorosos ... more A fibromialgia é caracterizada por dor crônica, generalizada e pela presença de pontos dolorosos à palpação de regiões específicas do corpo. Estudos concordam quanto à concentração de pacientes na quinta década de vida, associação com o sexo feminino e fatores socioeconômicos como baixos níveis educacionais, baixa renda e estar divorciado. As hipóteses de alterações anatomopatológicas para a fisiopatologia desta síndrome foram descartadas e os achados nesses sentido foram creditados ao sedentarismo. Os mecanismos mais aceitos para o entendimento fisiopatológico da fibromialgia no momento envolvem o desequilíbrio entre a percepção dolorosa e os mecanismos de modulação dessas vias aferentes. Níveis elevados de substância P em líquor e níveis reduzidos de serotonina e seus precursores em líquor, soro e plaquetas são sugestivos desses desequilíbrios, uma vez que a substância P é mediadora das vias aferentes enquanto a serotonina medeia a inibição da dor. Outra explicação para a alteração da atividade da serotonina seria o polimorfismo dos receptores de serotonina, o que pode explicar também o agrupamento familiar desses pacientes. Alterações cerebrais em porções rostrais ao tálamo poderiam ser responsáveis pela percepção elevada de estímulos ambientais, com a conseqüente perversão de informações proprioceptivas, térmicas e táteis ou pressórica em sensações dolorosas. Finalmente, os mecanismos reducionistas de explicação fisiopatológica da fibromialgia não têm encontrado respaldo na literatura e explicações multicausais são as mais aceitas, incluindo os mecanismos psicossociais, que não foram abordados neste artigo.

Journal of Musculoskeletal Pain, 2006

To compare clinical features of the fibromyalgia syndrome [FMS] patients of presumed traumatic et... more To compare clinical features of the fibromyalgia syndrome [FMS] patients of presumed traumatic etiology with those of non-traumatic origin, and correlate these findings with occupational status, using a prospective transversal study of symptom prevalences. Methods: Patients with FMS according to the American College of Rheumatology criteria were interviewed with a structured questionnaire about biodemographic characteristics, work and disability status, and the presence of 27 symptoms. They underwent pain evaluation by visual analog scale, pressure dolorimetry, and tender point count. Results: A total of 135 patients were evaluated, 48 with a history of trauma [group T] and 87 with a non-traumatic history [group NT]. Falls, automobile accidents, and aggressions were responsible for 13 of the traumatic events; work caused the other 35 events. Group T showed a longer period of formal education, but no other difference in terms of biodemographic data. A higher percentage of group T than group NT individuals was not working [retired: 14.6 percent versus 11.5 percent, on disability pension: 47.9 percent versus 12.6 percent, unemployed: 12.5 percent versus 6.9 percent, respectively, P < 0.001]. The groups were similar in terms of symptoms prevalence, but group T had higher prevalences of abdominal cramps and disturbances of concentration. Conclusions: Traumatic and non-traumatic FMS patients showed clinically similar results, although group T patients are considered more disabled for work. The authors question the reliability of the methods used for evaluation of work disability.

The Open Rheumatology Journal, Oct 18, 2011

Pain control in fibromyalgia patients is limited no matter the therapeutic regimens used. Recent ... more Pain control in fibromyalgia patients is limited no matter the therapeutic regimens used. Recent data have shown that daily sessions of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) in patients with fibromyalgia (FM) are associated with reduction of pain perception. Objective: We aimed to test whether active tDCS, as compared with sham tDCS, combined with multidisciplinary rehabilitation is associated with significant clinical gains in fibromyalgia. Design: This was a randomized, double-blinded controlled trial. Subjects: 23 patients were randomized to receive weekly sessions of multidisciplinary rehabilitation approach combined with sham or anodal tDCS of M1. Patients were evaluated for pain with VAS and for quality of life with SF-36, fibromyalgia pain questionnaire and health assessment questionnaire by a blinded rater before and after the 4 month period of rehabilitation. Results: Patients tolerated tDCS treatment well, without adverse effects. Patients who received active treatment had a significantly greater reduction of SF-36 pain domain scores (F (2,21) =6.57; p=0.006) and a tendency of higher improvement in Fibromyalgia Impact Questionnaire (FIQ) scores after (p=0.056) as compared with sham tDCS/standard treatment, but no differences were observed in the other domains. Conclusions: Although active tDCS was associated with superior results in one domain (SF-36 pain domain), the lack of significance in the other domains does not fully support this strategy (weekly tDCS) combined with a multidisciplinary approach.

American Journal of Physical Medicine & Rehabilitation, Feb 1, 2010

Compared to other specialties, the field of Physical and Rehabilitation Medicine (PRM) has not re... more Compared to other specialties, the field of Physical and Rehabilitation Medicine (PRM) has not received the deserved recognition from clinicians and researchers in the scientific community. One of the reasons is the lack of sound evidence to support the traditional PRM treatments. The best way to change this disadvantage is through well-conducted clinical research, such as the standard placebo or sham-controlled randomized clinical trials. Therefore, having placebo groups in clinical trials is essential to improve the level of evidence-based practice in PRM that ultimately translates in a better clinical care. To address the challenges for the use of placebo in PRM randomized clinical trials, and to create useful recommendations, we convened a working group during the inaugural International Symposium in Placebo (February 2009, in Sao Paulo, Brazil) in which the following topics were discussed: (1) current status of randomized clinical trials in PRM, (2) challenges for the use of placebo in PRM, (3) bioethical issues, (4) use of placebo in acupuncture trials and for the treatment of lowback pain, (5) mechanisms of placebo, and (6) insights from other specialties. The current article represents the consensus report from the working group.