Objectives: Investigation of the locomotion process in patients with osteogenesis imperfecta (OI), and the factors that influence it, with special attention to clinical aspects relating to motor rehabilitation. Methods: a retrospective, cross-sectional study was carried out at the physical therapy outpatient clinic of the Instituto Fernandes Figueira. All patients with a clinical diagnosis of OI were included. Patients with other diseases, and those aged under two years, old were excluded. Epi-Info version 3.4 was used to construct the database, and SPSS version 15 for the statistical analysis. Results: The odds-ratio was used to measure the association between independent walking and clinical characteristics, adopting a level of significance of 5% for the analysis. Results: 69 patients were included. Of these, 43.5% were classified as OI type I; 37.7% as type III and 18.8% as type IV. 76.8% presented long bone deformities. A negative association was observed between hypotonia, number of fractures, and independent walking. A positive association was observed between independent walking and OI type I. Conclusions: physical therapy, as a complementary approach to orthopedics, and the administration of medications of the biophosphonates class, are of fundamental importance for the rehabilitation of motor capacity of individuals with OI. Level of Evidence, cross sectional.
Introduction Individuals with osteogenesis imperfecta (OI) have bone fragility and osteopenia which cause fractures, mobility restriction and pain. Objective This article examines a physiotherapy experience with people diagnosed with OI in an OI reference center of Rio de Janeiro. Materials and methods This was an exploratory qualitative study, based on field notes related to physiotherapy care to 92 patients of both genders with clinical diagnoses of OI, aged between 30 days and 37 years old, during the period 2004–2008. The analysis comprised a reading of the field notes as a corpus, considering them as a means of understanding the subjects’ perspectives. Two different forms of codification were applied — open and focused — followed by semiotic analysis techniques. Results Early encouragement to perform active movements within a safe environment, or even after fractures, reduced articular contractures and enhanced muscular tonus; physiotherapy manipulation facilitated the integration of body perception in relation to movements and responses to tactile-kinesthetic-vestibular stimuli; promoting family involvement, by adopting practical solutions adapted to each patient’s reality, contributed to reduce fear of fractures and allowed the construction of a new functional image. Conclusion Physiotherapy assessment and treatment should be based not only on clinical and neurofunctional elements and technical strategies, but also on a dialogue that includes the multiple dimensions of the patients and their family members, in order to engage them in a learning process to stimulate potentials, abilities and competences.
Introdução: A Osteogênese Imperfeita (OI) é uma doença rara caracterizada por grande fragilidade óssea e osteopenia, que leva a ocorrência de fraturas ao longo da vida. O tratamento inclui cirurgias ortopédicas, reabilitação fisioterapêutica e o uso de bifosfonatos. Objetivos: Avaliar a prevalência de instabilidade articular e de hipotonia muscular em pacientes com OI. Material e métodos: Trata-se de estudo transversal, retrospectivo com indivíduos com diagnóstico de OI, atendidos no INSMCA/IFF/FIOCRUZ. Os desfechos foram instabilidade articular e hipotonia muscular. Os dados clínicos foram coletados dos prontuários e do instrumento de avaliação da fisioterapia. Para análise estatística utilizou-se os testes de qui-quadrado e Mann-Whitney. Resultados: Dentre 92 pacientes avaliados, quatro foram excluídos por comorbidades e um por dados insuficientes, totalizando 87 pacientes. A média de idade foi de 7,8 anos. A maioria era constituída por meninas (58,6%). Os indivíduos foram distribuídos de acordo com Sillence em OI tipo I (37,9%), OI tipo III (39,1%) e OI tipo IV (23%). A instabilidade articular e a hipotonia muscular foram observadas em 63,9% e 74,7% respectivamente, a primeira associada à idade e a segunda ao tipo de OI. Conclusão: Diante da prevalência de instabilidade articular em 63,9% dos casos de OI e da hipotonia muscular em 74,7% comprovam-se ambas como aspectos fulcrais para o exercício da clínica fisioterapêutica aplicada aos indivíduos com OI, sobretudo no seu papel de coadjuvante ao tratamento com bifosfonatos. Recomenda-se que o trabalho fisioterapêutico deve voltar-se para: a) minimização do estresse articular; b) ganho de força muscular para aumentar a resistência óssea; c) estimulação sensório-motora e d) aquisição de um alinhamento biomecânico mais neutro para evitar fraturas.Palavras-chave: Fisioterapia, osteogênese imperfeita, instabilidade articular, hipotonia muscular.
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