Resumo Introdução: A espasticidade atua como um fator limitante na recuperação motora e funcional após o Acidente Vascular Cerebral (AVC), prejudicando a realização das atividades de vida diária. Objetivo: Analisar a influência da espasticidade nos principais grupos musculares e associá-la ao comprometimento motor e ao nível funcional de pacientes hemiparéticos crônicos pós-AVC. Métodos: Vinte e sete pacientes hemiparéticos crônicos, de ambos os sexos, foram selecionados no Serviço de Fisioterapia e Terapia Ocupacional do Hospital de Clínicas da Unicamp. As avaliações foram realizadas em duas sessões: na primeira foi avaliado o comprometimento motor (Protocolo de Desempenho Físico de Fugl-Meyer - FM) e funcional (Índice de Barthel - IB), e na segunda, o grau de espasticidade dos principais grupos musculares (Escala Modificada de Ashworth - EMA). Resultados: Foi detectada uma correlação negativa entre a espasticidade dos membros superiores com o comprometimento motor e funcional. Nenhum grupo muscular avaliado nos membros inferiores apresentou correlação entre o tônus muscular e o nível de comprometimento da subseção da extremidade inferior FM e o nível funcional mensurado pelo IB. Conclusão: A espasticidade mostrou ser um fator de influência negativa no nível de comprometimento motor e funcional dos membros superiores de pacientes hemiparéticos crônicos pós-AVC.

Abstract Introduction: Spasticity acts as a limiting factor in motor and functional recovery after Stroke, impairing the performance of daily living activities. Objective: To analyze the influence of spasticity on main muscle groups and to associate it with motor impairment and functional level of chronic hemiparetic patients after stroke. Methods: Twenty-seven chronic hemiparetic patients of both sexes were selected at the Physical Therapy and Occupational Therapy Service of the Unicamp Clinics Hospital. Assessments were carried out in two sessions, in the first one the motor impairment (Fugl-Meyer Assessment - FM) and functional impairment (Barthel Index - BI) were evaluated, and in the second, the degree of spasticity of the main muscle groups (Modified Ashworth Scale - MAS). Results: A negative correlation was detected between upper limb spasticity and motor and functional impairment. No muscle group evaluated in the lower limbs showed correlation between muscle tone and the level of impairment of the lower extremity on FM and the functional level measured by BI. Conclusion: Spasticity has been shown to be a negative influence factor in the level of motor and functional impairment of the upper limbs of chronic hemiparetic patients after stroke.

Resumo Introdução: A Paralisia Cerebral (PC) é uma desordem não progressiva que pode comprometer as habilidades funcionais dos membros superiores, frequentemente decorrentes das perdas motoras e sensitivas, que são ainda pouco avaliadas e descritas por meio de instrumentos confiáveis. Objetivo: Este estudo teve como objetivo avaliar a qualidade de habilidades motoras e da extremidade superior em crianças com paralisia cerebral em regiões de Trairi e Seridó do estado do Rio Grande do Norte (Brasil). Métodos: Estudo exploratório, com abordagem qualitativa e estrutura transversal, com 17 crianças com PC, com idades entre quatro e oito anos. Foram utilizados os seguintes instrumentos para avaliação da extremidade superior: Sistema de Classificação da Habilidade Manual (MACS), Teste de Qualidade de Habilidades da Extremidade Superior (QUEST) e Sistema de Classificação da Função Motora Grossa (GMFCS). Resultados: A média e o desvio padrão da pontuação total QUEST e domínios dissociação de movimento, preensão, descarga de peso e resposta extensiva protetora foram, respectivamente, 41,06/37,08; 53,12/34,50; 15,51/62,98; 37,76/37,52; 42.48/47.26. As pontuações medianas do MACS e GMFCS foram, respectivamente, de 3 (três) a 5 (cinco), sendo observados alta correlação positiva entre MACS e GMFCS (rs=0,83) e alta correlação negativa entre o GMFCS e QUEST totais (rs=-0,83), bem como entre MACS e QUEST (rs=-0,84); MACS e todos os domínios QUEST (rs=-0.73; rs=-0.82; rs=-0.76; rs=-0.79), p<0,001. Conclusão: As crianças com PC apresentaram déficit de qualidade motora e habilidades do membro superior, possibilitando inferir limitações funcionais quanto à manipulação de objetos e consequente dependência durante atividades de vida.

Abstract Introduction: Cerebral Palsy (CP) is a non-progressive disorder that may compromise functional abilities of the upper limbs due to motor and sensitive loss, that are still poorly evaluated and described by reliable tools. Objective: This study aimed to evaluate motor quality and skills of the upper extremity in children with CP in regions of Trairi and Seridó from Rio Grande do Norte state (Brazil). Methods: It is a cross-sectional exploratory study, with a qualitative approach, with 17 children with CP, aged between four and eight years. The following instruments were used for upper extremity evaluation: Manual Ability Classification System (MACS), Quality of Upper Extremity Skills Test (QUEST) and Gross Motor Function Classification System (GMFCS). Results: Mean and standard deviation (sd) of QUEST total score and the domains dissociated movement, grasp, weight bearing and extensive protection were, respectively, 41.06/37.08; 53.12/34.50; 15.51/62.98; 37.76/37.52; 42.48/47.26. MACS and GMFCS median scores were, respectively, 3 (three) and 5 (five); high positive correlation was observed between MACS and GMFCS (rs=0.83) and high negative correlation between GMFCS and total QUEST (rs=-0.83), as well as between MACS and QUEST (rs=-0.84); and MACS and all QUEST domains (rs=-0.73; rs=-0.82; rs=-0.76; rs=-0.79), p<0.001. Conclusion: Children with CP showed deficit in motor quality and skills of the upper limb, allowing to infer functional limitations regarding manipulation of objects and consequent dependence during life activities.

Background: Over at least the past ten years, measures aimed at health promotion and prevention among young adults and teenagers have been being implemented from different public institutions and, in a certain sense, on a sectorial basis. The overall objective is to assess how the different measures carried out by different Public Institutions with regard to Health Promotion and Prevention have an impact on the actual conduct and practices of teenagers and young adults within the 14-25 age range in the Autonomous Community of Madrid. Methods: A study based on a structural or qualitative methodology was conducted using the discussion group method, eight groups having been formed and their comments analyzed. Results: The young adults do not feel any health-related prevention "system" as such exists on not considering themselves to be the object thereof. In the opinion of the young adults, disease, confined to the physical body, is conceived as being a short-lived, temporary and readily remedied based on the technological advances current medicine has to offer. On the contrary, the diseases related to the psychological perspective (mental disease dissociated with the area of the medical and connected to the individual/personal area) arouse interest insomuch as young people are highly vulnerable to these diseases. Conclusions: Any measure aimed at generating identification and, therefore, the active response of young people must entail creating a connection between young people and health, which, not based exclusively in providing information, is capable of putting a space of control of the youths with regard to their harmful practices into play whilst at the same time highlighting their taking responsibility for their own actions. Considering we believe it best to "redefine" the term "prevention" in terms nearer to those of maintaining, improving or regaining (in short-lived cases) health, to thus connote the idea of physical and mental well-being.

Fundamento: A lo largo de los últimos diez años mínimo, se vienen implementando desde diversas instituciones públicas acciones encaminadas a la prevención y promoción de la salud de los jóvenes y adolescentes. El objetivo de este trabajo es evaluar la manera en que las diferentes intervenciones llevadas a cabo por distintas Instituciones Públicas en materia de Prevención y Promoción de la Salud inciden sobre la conducta y prácticas reales de los jóvenes y adolescentes, entre 14 y 25 años, de la Comunidad de Madrid. Métodos: Se realizó un estudio con metodología estructural o cualitativa utilizando la técnica del grupo de discusión, habiéndose realizado ocho grupos, cuyo discurso se analizó. Resultados: Los jóvenes, no perciben la existencia de un "sistema" de prevención para la salud al no considerarse objetivo del mismo. Para ellos, la enfermedad, circunscribiéndose al cuerpo-físico, se concibe como momento puntual, transitorio y de fácil resolución a partir de los avances tecnológicos que comporta la medicina actual. Por el contrario, las enfermedades asociadas a la perspectiva psicológica (enfermedad metal disociada del área de lo médico y vinculada al área de lo individual/personal) suscitan interés en tanto que el joven se muestra muy vulnerable frente a ellas. Conclusiones: Cualquier acción encaminada a generar identificación y, por tanto, la respuesta activa del joven, debe considerar el establecimiento de un vínculo entre el joven y la salud que, no basándose exclusivamente en aportar información, sea capaz de poner en juego un espacio de control del joven respecto de sus prácticas perjudiciales, a la par que señale la autoresponsabilidad de las mismas. Basándonos en ello creemos más adecuado "re-significar" el término prevención con términos cercanos a los de mantener, mejorar o recuperar (en los casos puntuales) la salud, para así connotar la idea de bienestar físico y psíquico.

Background: Over at least the past ten years, measures aimed at health promotion and prevention among young adults and teenagers have been being implemented from different public institutions and, in a certain sense, on a sectorial basis. The overall objective is to assess how the different measures carried out by different Public Institutions with regard to Health Promotion and Prevention have an impact on the actual conduct and practices of teenagers and young adults within the 14-25 age range in the Autonomous Community of Madrid. Methods: A study based on a structural or qualitative methodology was conducted using the discussion group method, eight groups having been formed and their comments analyzed. Results: The young adults do not feel any health-related prevention "system" as such exists on not considering themselves to be the object thereof. In the opinion of the young adults, disease, confined to the physical body, is conceived as being a short-lived, temporary and readily remedied based on the technological advances current medicine has to offer. On the contrary, the diseases related to the psychological perspective (mental disease dissociated with the area of the medical and connected to the individual/personal area) arouse interest insomuch as young people are highly vulnerable to these diseases. Conclusions: Any measure aimed at generating identification and, therefore, the active response of young people must entail creating a connection between young people and health, which, not based exclusively in providing information, is capable of putting a space of control of the youths with regard to their harmful practices into play whilst at the same time highlighting their taking responsibility for their own actions. Considering we believe it best to "redefine" the term "prevention" in terms nearer to those of maintaining, improving or regaining (in short-lived cases) health, to thus connote the idea of physical and mental well-being.

Fundamento: A lo largo de los últimos diez años mínimo, se vienen implementando desde diversas instituciones públicas acciones encaminadas a la prevención y promoción de la salud de los jóvenes y adolescentes. El objetivo de este trabajo es evaluar la manera en que las diferentes intervenciones llevadas a cabo por distintas Instituciones Públicas en materia de Prevención y Promoción de la Salud inciden sobre la conducta y prácticas reales de los jóvenes y adolescentes, entre 14 y 25 años, de la Comunidad de Madrid. Métodos: Se realizó un estudio con metodología estructural o cualitativa utilizando la técnica del grupo de discusión, habiéndose realizado ocho grupos, cuyo discurso se analizó. Resultados: Los jóvenes, no perciben la existencia de un "sistema" de prevención para la salud al no considerarse objetivo del mismo. Para ellos, la enfermedad, circunscribiéndose al cuerpo-físico, se concibe como momento puntual, transitorio y de fácil resolución a partir de los avances tecnológicos que comporta la medicina actual. Por el contrario, las enfermedades asociadas a la perspectiva psicológica (enfermedad metal disociada del área de lo médico y vinculada al área de lo individual/personal) suscitan interés en tanto que el joven se muestra muy vulnerable frente a ellas. Conclusiones: Cualquier acción encaminada a generar identificación y, por tanto, la respuesta activa del joven, debe considerar el establecimiento de un vínculo entre el joven y la salud que, no basándose exclusivamente en aportar información, sea capaz de poner en juego un espacio de control del joven respecto de sus prácticas perjudiciales, a la par que señale la autoresponsabilidad de las mismas. Basándonos en ello creemos más adecuado "re-significar" el término prevención con términos cercanos a los de mantener, mejorar o recuperar (en los casos puntuales) la salud, para así connotar la idea de bienestar físico y psíquico.