Effects of Exercise Training on Cardiovascular and Autonomic Parameters in Stroke Survivors: A Systematic Review

Negative changes in cardiovascular and autonomic variables in stroke survivors have encouraged the global scientific community to focus on investigating therapeutic strategies to mitigate stroke damage. The objective of the present study was to describe the effects of exercise training on cardiovascular and autonomic variables in stroke survivors. We used the PICO (population, intervention, control/comparison, and outcome variables) model for the search of articles in PubMed and Physiotherapy Evidence Databases from 2009 to December 2018. The following data were also recorded: type of study, author, year of publication, participants (time after stroke, sample size, and age) and benefits of exercise training. A total of 544 articles were initially selected, of which nine peer-reviewed articles met the search criteria. These nine studies enrolled 611 participants (middle-aged or elderly), and pointed to positive effects of training on maximal oxygen uptake, peak aerobic capacity, 6-minute walk test and resting heart rate. However, more well-controlled studies are needed to confirm the benefits of exercise training on cardiovascular and autonomic variables in this population

Tratamento de ferida em Coendou prehensilis (Rodentia: Erethizontidae) com laserterapia e ozonioterapia: relato de caso / Wound treatment of Coendou prehensilis (Rodentia: Erethizontidae) with laser and ozone therapy: case report

O emprego conjunto da laserterapia e da ozonioterapia em feridas apresenta alto potencial benéfico para os pacientes, uma vez que contribui para o manejo da dor, tem ação anti-inflamatória e acelera o processo de cicatrização. Este relato de caso tem como objetivo apresentar o uso de terapias alternativas na cicatrização de ferida em exemplar de Coendou prehensilis. Um ouriço-cacheiro, fêmea, adulto, com peso de 4kg foi encaminhado para atendimento médico veterinário com histórico de ter sido atacado por um cão. Inicialmente o ouriço passou pelo procedimento de higienização e desbridamento da ferida, para a retirada das bordas necróticas. Adicionalmente, foram administrados clindamicina (10mg/kg), por via intramuscular (IM), uma vez por dia (SID), tramadol (4mg/kg, IM, SID), flunixin (0,3mg/kg, SID), por via subcutânea (SC), e ferrodextrano (25mg/kg, IM, SID). Apesar da terapia instituída, observou-se reincidência de crescimento necrótico tecidual, o que levou à eleição do tratamento da ferida com as técnicas de laserterapia e ozonioterapia. O emprego das terapias alternativas como adjuvante promoveu uma cicatrização satisfatória da ferida, com ausência de sinais de sensibilidade local e de infecção, bem como ausência de crescimento de bordas necróticas. O tratamento adjuvante foi eficaz e pode ser empregado em outras situações para cicatrização de ferida em mamíferos silvestres.(AU)

The use of therapy with laser beam and ozone in wounds has a high beneficial potential for patients, since it contributes to the management of pain, has an anti-inflammatory action and accelerates the cicatricial process. Due to this casuistry importance, the case report aims to present alternative therapy use for wound healing on a Coendou prehensilis. Thus, a female of C. prehensilis weighing 4kg, was sent to veterinary care. At first there was a hygiene process and debridement for necrotic edge removal. Furthermore, injected clindamycin (10mg/kg) was administered intramuscularly (IM), once a day (SID), tramadol (4mg/kg, IM, SID), flunixin (0.3mg/kg, SID), administered subcutaneously (SC) and iron dextran (25mg/kg, IM, SID). In spite of the established therapy, tissue necrotic growth was observed, which lead the wound treatment as healing by second intention, initiating an alternative therapy with laser beam and ozone. As a result, the healing was satisfactory due to the elected techniques, without signs of pain and infection. The adjuvant treatment with physiotherapy had advantageous effect and could be applied to wound healing in wild mammal animals.(AU)

Estrategias de problematización e intervención de Kinesiología / Fisioterapia para un paciente con una afección ventilatoria crónica reagudizada / Problematizing strategies and intervention of Kinesiology / Physiotherapy for a patient with aggravated chronic ventilatory condition

La Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF), permite organizar la información mediante un lenguaje trans-disciplinario. Al respecto, es fundamental complementarlo con una epistemología propia para generar prácticas clínicas eficientes. La enfermedad pulmonar obstructiva crónica (EPOC), se ha convertido en una condicionante negativa de función, movimiento y salud en la población. Proponemos un modelo de razonamiento en kinesiología/fisioterapia para disfunciones del movimiento humano aplicado a una fase crónica ventilatoria irreversible. Paciente de 74 años con EPOC. Plantea como necesidad, la "mínima asistencia para realizar su aseo personal", lo que se estableció como contexto funcional crítico (CFC). Se entrenó progresivamente, según velocidad, por 36 sesiones, de 30 minutos. La espirometría no presentó cambios. Mejoró la capacidad de trabajo físico, calidad de vida y el CFC se hizo independiente. La intervención derivada del diagnóstico mediante estrategias de problematización permitió una mejora clínica eficiente de los indicadores evaluados.

The International Classification of Functioning, Disability and Health (CIF), make it possible to organize information through a trans-disciplinary language. In this regard, it is essential to complement it with an own epistemology to generate efficient clinical practices. Chronic obstructive pulmonary disease (COPD) has become a negative condition of function, movement and health in the population. We propose a model of reasoning in kinesiology/ physiotherapy for dysfunctions of human movement applied to an irreversible chronic ventilatory phase. Patient of 74 years old patient with COPD. As a necessity, it poses the "minimum assistance to perform personal hygiene", which was established as a critical functional context (CFC). He trained progressively, according to speed, for 36 sessions of 30 min. The spirometry did not change. The capacity for physical work, quality of life improved, and the CFC became independent. The intervention derived from the diagnosis by problematizing strategies allowed an efficient clinical improvement of the evaluated indicators.

Funcionalidade e qualidade de vida em indivíduos com linfedema unilateral em membro inferior: um estudo transversal / Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study

O linfedema de membros inferiores é uma doença crônica decorrente de dano no sistema linfático que influencia a mobilidade, a funcionalidade e a qualidade de vida dos indivíduos. Questionários e o teste físico são métodos bastante práticos, de fácil aplicação e baixo custo, que fornecem dados importantes para a avaliação desses pacientes. Objetivos Avaliar a influência do linfedema unilateral de membro inferior na funcionalidade e na qualidade de vida, correlacionando três ferramentas de avaliação. Métodos Estudo descritivo com 25 indivíduos com linfedema unilateral em membro inferior, de ambos os sexos. Foi avaliada a perimetria e foram aplicados The Medical Outcome Study Short Form-36 Health Survey (SF-36) para avaliação da qualidade de vida, Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) para estudo das habilidades físicas, mentais e sociais relacionadas ao linfedema e o Timed Up and Go (TUG) para avaliação da funcionalidade. Resultados Houve a presença de linfedema em todo o membro inferior dos participantes. Os domínios mais prejudicados pelo linfedema foram os aspectos físicos (25,0 ± 31,4) e emocionais (36,0 ± 42,9) no SF-36 e o domínio mobilidade (6,0 ± 2,6) no Lymph-ICF-LL. O TUG foi realizado em 9,88 ± 1,98 s. Houve correlação entre o TUG e os questionários e entre os dois questionários utilizados. Conclusões Indivíduos com linfedema unilateral em membro inferior apresentam um impacto negativo na qualidade de vida e na funcionalidade avaliadas através de questionários, que correlacionam entre si. Não foi encontrada alteração no TUG, mas houve correlação entre ele e os questionários utilizados

Lymphedema of the lower limbs is a chronic disease caused by damage to the lymphatic system that influences people's mobility, functionality, and quality of life. Questionnaires and physical test are very practical, easy to apply, and low cost methods that provide important data for evaluation of these patients. Objectives To evaluate the influence of unilateral lower limb lymphedema on functionality and quality of life, correlating 3 assessment tools. Methods This was a descriptive study investigating 25 patients of both sexes with unilateral lymphedema in a lower limb. Limb volume was assessed using circumferential tape measurements, the Medical Outcomes Study Short Form-36 Health Survey (SF-36) was used to assess quality of life, the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) was used to assess physical, mental, and social skills related to lymphedema, and the Timed Up and Go (TUG) test was used for functional assessment. Results Lymphedema was present throughout the affected lower limb of participants. The domains most affected by lymphedema were physical aspects (25.0 ± 31.4) and emotional aspects (36.0 ± 42.9) from the SF-36 and the mobility domain (6.0 ± 2.6) from the Lymph -ICF-LL. Patients performed the TUG in 9.88 ± 1.98 seconds. The TUG was correlated with the questionnaires and the questionnaires were correlated with each other. Conclusions People with unilateral lower limb lymphedema exhibited negative impacts on quality of life and functionality, as evaluated by questionnaires, which were correlated with each other. TUG performance was within normal limits, but results correlated with the questionnaires used

GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence.

BACKGROUND: Clinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered. The aim of this paper is to present the development, theories, and underlying evidence for 'GLA:D Back' - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain. METHODS: GLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the working version of the program was created. RESULTS: Educational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual's capacity. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures. The exercise program included 16 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions. CONCLUSION: From current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.

Conhecimentos, atitudes e práticas de pessoas com doença de parkinson sobre um programa terapêutico domiciliar com orientação em grupo / Knowledge, attitudes and practices of people with parkinson's disease about a home-based therapeutic program with group guidance

Introdução: Exercícios domiciliares são uma opção terapêutica acessível para pacientes com doença de Parkinson que apresentam dificuldade de locomoção. Serviços de fisioterapia utilizam palestras e manuais como forma de orientar a prática destes exercícios, mas carecem de avaliar o que está de fato sendo compreendido pelo paciente. Objetivo: Investigar conhecimentos, atitudes e práticas de pessoas com doença de Parkinson sobre um programa de exercícios terapêuticos domiciliares autossupervisionados com orientação em grupo. Métodos: Trata-se de um estudo transversal realizado com pessoas com doença de Parkinson idiopática leve e moderada, em um Programa de referência em um hospital universitário do nordeste do Brasil. Palestras e manual são disponibilizados pelo Programa desde 2012. Foram coletados: dados sociodemográficos, da doença, assistência e hábitos (ficha geral); conhecimentos, atitudes e práticas sobre exercícios fisioterapêuticos do manual (Inquérito Conhecimentos, Atitudes e Práticas) e barreiras associadas à prática (questionário estruturado). Utilizou-se o software BioEstat 5.0 para estatística descritiva e testes de associação, p ≤ 0,05. Resultados: Foram avaliados 28 pacientes (63 ± 7,4 anos) com tempo de diagnóstico médio de 4,5 (± 2,1) anos e maior prevalência do estágio HY 2 (71,4%). A maioria frequentava o Programa há pelo menos 1 ano (85,7%), era sedentária (60,7%) e relatava como principais entraves para a realização de sessões de fisioterapia a dificuldade financeira (92,8%) e de locomoção (53,6%). A adesão às palestras de fisioterapia foi de 60,7%. A maioria apresentou conhecimentos (60,7%) e atitudes (96,4%) adequados, entretanto, práticas inadequadas (53,6%) acerca dos exercícios terapêuticos domiciliares autossupervisionados orientados em grupo. Conclusão: Programa autossupervisionado requer maior disciplina dos pacientes e apenas orientar em grupo e distribuir manual podem não ser suficientes. Estratégias de acompanhamento semanal para motivação e suporte às dúvidas podem ser necessárias. (AU)

Introduction: Home-based exercises are an accessible therapeutic option for patients with Parkinson's disease who have locomotion difficulty. Physiotherapy services use lectures and manuals as a way of guiding the practice of these exercises, but they lack to evaluate what is in fact being understood by the patient. Purpose: To investigate knowledge, attitudes and practices of people with Parkinson's disease about a self-supervised home exercise program with a guidance group. Methods: This is a cross-sectional study carried out with people with mild and moderate idiopathic Parkinson's disease, in a reference program at a university hospital in northeastern Brazil. Lectures and manuals have been made available by the Program since 2012. Sociodemographic, disease, assistance and habits data were collected (general file); knowledge, attitudes and practices about physical therapy exercises in the manual (Knowledge, Attitudes and Practices Survey) and barriers associated with practice (structured questionnaire). BioEstat 5.0 software was used for descriptive statistics and association tests, p ≤ 0.05. Results: We evaluated 28 patients (63 ± 7.4 years) with an average diagnosis time of 4.5 (± 2.1) years and a higher prevalence of the HY 2 stage (71.4%). Most of them attended the Program for at least one year (85.7%), were sedentary (60.7%) and reported financial (92.8%) and locomotion (53.6%) difficulties as the main obstacles to physical therapy sessions. Adherence to physiotherapy lectures was 60.7%. The majority presented adequate knowledge (60.7%) and attitudes (96.4%), however, inadequate practices (53.6%) about a home therapy program with a group guidance. Conclusion: Self-supervised program requires greater discipline of the patients and only guiding in a group and distributing a manual may not be enough. Weekly follow-up strategies for motivation and support for questions may be needed. (AU)

Efectos de la hipoterapia en niños con lesión del sistema nervioso central: estudio de casos / Effects of hippotherapy in children with central nervous system injury: study of cases

Introducción la hipoterapia está constituida como coadyuvante en los procesos de intervención fisioterapéutica, definida como un procedimiento alternativo de tratamiento utilizado por los especialistas dedicados a la atención al niño en condición de discapacidad. Objetivo: Determinar los efectos de la técnica de hipoterapia en los niños con lesión del sistema nervioso central. Pacientes y Métodos: Se realizó un estudio de casos de tipo descriptivo con cuatro niños con lesión del Sistema Nervioso Central. Se valoraron antes y después de la aplicación de la hipoterapia con el fin de establecer los efectos de la técnica. Resultados y conclusiones: se encontró una influencia positiva de la hipoterapia en la movilidad articular, flexibilidad, aptitud postural y reacciones de equilibrio de los participantes.

Introduction: Hippotherapy is constituted as an adjuvant in the processes of physiotherapeutic intervention, defined as an alternative treatment procedure used by specialists dedicated to the care of children with disabilities. Objective: To determine the effects of the hippotherapy technique in children with central nervous system injury. Patients and methods: A descriptive case study was conducted with four children with Central Nervous System injury. They were assessed before and after the application of hippotherapy in order to establish the effects of the technique. Results and conclusions: a positive influence of hippotherapy on joint mobility, flexibility, postural aptitude and equilibrium reactions was found.

Aspectos clínicos, radiográficos y rehabilitadores en pacientes con síndrome doloroso regional complejo / Clinical, radiographic and rehabilitative aspects in patients with complex painful regional syndrome

Se efectuó un estudio descriptivo y transversal de 17 pacientes con síndrome doloroso regional complejo, que recibieron rehabilitación en el Departamento de Fisioterapia del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero 2016 hasta febrero 2017, con vistas a caracterizarles según aspectos clínicos y radiográficos. Entre los principales resultados predominaron el tipo 1 de la enfermedad (64,7 por ciento), la etapa precoz (25,0 por ciento), la localización en el miembro superior (82,4 por ciento) y el sexo femenino (58,8 por ciento), entre otros. La corrección postural y la cinesiterapia fueron necesarias independientemente del estadio clínico de la enfermedad. Se concluye que resulta importante efectuar un diagnóstico clínico y radiográfico oportuno, así como ejecutar medidas rehabilitadoras tempranas para evitar la discapacidad y lograr una recuperación funcional óptima

A descriptive and cross-sectional study of 17 patients with complex painful regional syndrome who received rehabilitation in the Physiotherapy Department of Dr Juan Bruno Zayas Alfonso Teaching General Hospital was carried out in Santiago de Cuba, from January, 2016 to February, 2017, aimed at characterizing them according to clinical and radiographical aspects. Among the main results there was a prevalence of the type 1 of the disease (64.7 percent), early stage (25.0 percent), localization in the upper member (82.4 percent) and the female sex (58.8 percent), among others. The postural correction and kinesiotherapy were necessary independently of the clinical stage of the disease. It was concluded that it is important to make an appropriate clinical and radiographic diagnosis, as well as to implement early rehabilitative measures to avoid disability and achieve a good functional recovery

Patient journey following lumbar spinal fusion surgery (LSFS): protocol for a multicentre qualitative analysis of the patient rehabilitation experience (FuJourn).

INTRODUCTION: There has been a 65% increase in lumbar spinal fusion surgery (LSFS) worldwide over the last 13 years, with costs of £26 million to the UK National Health Service annually. Patient dissatisfaction with outcome and persistent pain and disability incurs further costs. Three trials provide low-quality evidence for the role of physiotherapy. Our UK surveys investigating physiotherapy/surgeon practice concluded rehabilitation should be tailored to the individual patient owing to considerable clinical heterogeneity. This study will explore the perceptions of patients who undergo LSFS to inform precision rehabilitation. METHODS AND ANALYSIS: A qualitative study, using interpretive phenomenological analysis, will recruit a purposive sample (n=40) to ensure patterns of similarity and difference in their journeys can be explored. In-depth semistructured interviews will be undertaken following discharge from hospital and at 12 months postsurgery. Patients' preoperative and postoperative experiences, underlying attitudes and beliefs towards the surgical intervention, facilitators and barriers to recovery, adherence to advice and physiotherapy, experiences of rehabilitation and return to normal function/activity/work will be explored. A 12-month patient diary will provide real time access to patient data, capturing a weekly record of life as lived, including symptoms, medication, experiences of stages of recovery, rehabilitation adherence, healthcare professional appointments, attitudes, their feelings and experiences throughout their journey. Data will be analysed in a number of stages in accordance with interpretive phenomenological analysis, supported using NVivo software. Analysis of the first interviews and patient diaries will afford a rich density of data to build an overall understanding of the patients' lived experiences, informing the 12-month interview. Strategies (eg, reflexivity) will ensure trustworthiness. ETHICS AND DISSEMINATION: The study has ethical approval (IRAS 223283). Findings will ensure that patient-driven data inform precision rehabilitation by understanding the patient journey. Findings will be disseminated through peer-reviewed journals and conferences.

Evidence-Based Evaluation of Practice and Innovation in Physical Therapy Using the IDEAL-Physio Framework.

The IDEAL framework is an established method for initial and ongoing evaluations of innovation and practice for complex health care interventions. First derived for surgical sciences and embedded at a global level for evaluating surgery/surgical devices, the IDEAL framework is based on the principle that innovation and evaluation in clinical practice can, and should, evolve together in an ordered manner: from conception to development and then to validation by appropriate clinical studies and, finally, longer-term follow-up. This framework is highly suited to other complex, nonpharmacological interventions, such as physical therapist interventions. This perspective outlines the application of IDEAL to physical therapy in the new IDEAL-Physio framework. The IDEAL-Physio framework comprises 5 stages. In stage 1, the idea phase, formal data collection should begin. Stage 2a is the phase for iterative improvement and adjustment with thorough data recording. Stage 2b involves the onset of formal evaluation using systematically collected group or cohort data. Stage 3 is the phase for formal comparative assessment of treatment, usually involving randomized studies. Stage 4 involves long-term follow-up. The IDEAL-Physio framework is recommended as a method for guiding and evaluating both innovation and practice in physical therapy, with the overall goal of providing better evidence-based care.

Yoga como enfoque alternativo de terapia física / Yoga as an alternative approach to physical therapy

Yoga es una técnica terapéutica que está basada en el conocimiento profundo de la anatomía y la fisiología del cuerpo humano. Etimológicamente, la palabra yoga viene del idioma sánscrito Yug=unión, lindura, unión con el todo, bajo el mismo yugo que lo divino. Es una disciplina hindú cuyo objetivo final es la consecución del estado de yoga: Aquel en el que el hombre ha recobrado su verdadera naturaleza y vive en conformidad con ella. La finalidad de todas las diferentes variantes del Yoga es siempre el ayudar a la persona a encontrar la felicidad, tanto en el plano físico (salud, bienestar, fortaleza, longevidad), como en lo mental (inteligencia, percepción, capacidad cognitiva, memoria) y espiritual (serenidad, paz). Las asanas tonifican cada parte del cuerpo la práctica regular incrementa la capacidad de trabajo, nos brinda también flexibilidad; un cuerpo joven es mantenido y restablecido a través de un correcto estiramiento. Mientras el tono y la flexibilidad se equilibran, se establece una postura erguida y sin esfuerzo; los movimientos permiten al cuerpo adoptar posiciones muy diversas sin tener que asumirlas estáticamente. La serie se ejecuta, eso sí, con lentitud, armónicamente, evitando movimientos bruscos o precipitados y puede asociarse o no a la respiración, aunque lo más aconsejable, una vez el practicante se ha aprendido bien la serie, es asociar cada movimiento a la inhalación y la exhalación sucesivamente. Cada vez más personas son consiente de la práctica del yoga para mejorar y mantener su salud, los motivos para iniciar esta práctica es buscar la gran sensación de bienestar. Numerosas revisiones bibliográficas puntualizan acerca de los principales beneficios de este tipo de disciplinas en el manejo de determinados síntomas, principalmente el dolor. (AU)

Ventilación no invasiva en insuficiencia respiratoria aguda pediátrica: rol del terapeuta ventilatorio / Non-invasive mechanical ventilation in pediatric acute respiratory failure: the role of the respiratory therapist

Currently, Chilean pediatric intensive care units use non-invasive mechanical ventilation as ventilation support in acute respiratory conditions. However, there are differences in methodology and the number of patients treated annually. These units have a physiotherapist who has progressively incorporated skills related to non-invasive mechanical ventilation application, as well as to other forms of respiratory support and care in general. At present the role of the therapist is fundamental to the ventilatory support of patients with acute respiratory failure

En la actualidad todas las unidades de cuidados intensivos pediátricos nacionales utilizan Ventilación Mecánica no Invasiva como método de soporte ventilatorio en condiciones agudas, no obstante, estas difieren en metodología de aplicación y número de pacientes conectados anualmente. El kinesiólogo que se desempeña como terapeuta respiratorio en estas unidades, ha incorporado de manera progresiva competencias técnicas que lo relacionan con la aplicación de la ventilación no invasiva, así como con otras formas de soporte ventilatorio y cuidados respiratorios en general. Particularmente en ventilación mecánica no invasiva, existe importante dependencia de los cuidados que este profesional puede ofrecer y que son requeridos durante todo el desarrollo de la terapia

Rol del kinesiólogo respiratorio en el proceso de alta domiciliaria en niños con ventilación mecánica prolongada / Role of respiratory physiotherapists in the discharge process in children with long-term ventilation

In chronic children with long-term mechanical ventilation, early discharge improves quality of life and decreases associated health costs. In order to achieve this goal, implementation of hospital and home care programs integrating a multidisciplinary team is necessary. In North America, the Respiratory Therapist (RT) performs an important part of the respiratory care and education to caregivers before patients' discharge. In Chile, the kinesiologist (physical therapist with respiratory care knowledge) assumes part of these functions, including permeability of the airway, education about oxygen therapy systems, mechanical ventilation support adaptation, thermo-humidification, aerosol therapy and monitoring.Additionally, unlike the traditional role of RTs, kinesiologists are involved in respiratory rehabilitation activities designed to optimize cardiorespiratory function prior to discharge, integrating general and specific training strategies, use of phonation devices and implementation of individualized respiratory assessments

En niños crónicos dependientes de ventilación mecánica prolongada (VMP), el alta precoz mejora la calidad de vida y disminuye los costos sanitarios asociados. Para lograrla es necesaria la implementación de programas hospitalarios y domiciliarios que integren a distintos profesionales. En Norteamérica es el Terapista Respiratorio (TR) quien ejecuta parte importante de los cuidados respiratorios y educación a los padres previo al alta. En Chile es el Kinesiólogo quien asume parte de estas funciones, incluyendo permeabilización de la vía aérea, adecuación de sistemas de soporte ventilatorio, oxigenoterapia, termohumedificación, aerosolterapía y monitorización.Adicionalmente, a diferencia del rol clásico del TR, el kinesiólogo desarrolla actividades de rehabilitación respiratoria tendientes a optimizar el estado funcional cardiorespiratorio previo al alta, integrando actividades de acondicionamiento general y especifico, uso de dispositivos fonatorios y ejecución de evaluaciones individualizadas de la función respiratoria

Kinesiología respiratoria en pacientes asmáticos en edad escolar / Respiratory physiotherapy in asthmatic school-age patients

The role of respiratory physiotherapy in the asthmatic school-age patient is based on three pillars: evaluative, therapeutic and educational, which have gradually been incorporated and developed. Respiratory physiotherapy has advanced significantly, incorporating cardiorespiratory function tests into its diagnostic and follow-up services, allowing the execution of these tests at the primary level of healthcare. Manual and instrumental respiratory physiotherapy techniques increase the level of control of asthmatic patients. The evidence found in literature invites us to innovate the methodology we use at educational interventions in children and adolescents, with the inclusion of new technologies to motivate and generate meaningful learning in patients as well as in their parents/caregivers, thus improving adherence to treatment and achieving the desired control of the disease

El rol de la kinesiología respiratoria en el paciente asmático en etapa escolar, se basa en tres pilares: evaluativo, terapéutico y educativo, los cuales se han ido paulatinamente incorporando y desarrollando con el paso del tiempo. La kinesiología respiratoria ha avanzado significativamente, incorporando pruebas de función cardiorrespiratoria a su arsenal de prestaciones diagnósticas y de seguimiento, permitiendo la ejecución de éstas en el nivel primario de atención. Mediante la utilización de técnicas manuales e instrumentales, permite potenciar el nivel de control de los pacientes asmáticos. La literatura nos invita a innovar en la metodología a utilizar para realizar una intervención educativa efectiva en niños y adolescentes, incluyendo las nuevas tecnologías disponibles para motivar y generar un aprendizaje significativo en el paciente como en los padres/cuidadores, mejorando así la adherencia al tratamiento y por ende logrando el anhelado control de la enfermedad

Actualización en kinesiología respiratoria en pacientes con fibrosis quística / Update of chest physiotherapy in cystic fibrosis patients

Chest physiotherapy is an essential component of cystic fibrosis treatment. Its aim is to delay lung deterioration and preserve physical function, improving quality of life and long-term results. It is possible to proceed early, even when the child is asymptomatic.The therapist must be a competent professional, able to participate in a health care team and to make therapeutic decisions. Currently, the therapist is responsible for optimizing mucociliary clearance, but in, addition, their work has extended to education, aerosol therapy, physical activity recommendations, non-invasive ventilatory support, oxygen therapy.This article provides a general description of the chest therapist proceedings related to the integral management of cystic fibrosis

La kinesioterapia respiratoria es parte del tratamiento integral de la Fibrosis Quística. Con ella, apuntamos a retrasar el deterioro pulmonar y preservar la función física, mejorando la calidad de vida y los resultados a largo plazo. Es posible actuar de manera precoz, incluso cuando el niño es asintomático.Es de importancia que el kinesiólogo que trate a pacientes con Fibrosis Quística sea un profesional competente, con capacidad de formar parte de un equipo de salud y participar activamente en las decisiones terapéuticas requeridas, ya que en la actualidad, el kinesiólogo ha ampliado su labor, ya no solo circunscribiéndose a las técnicas manuales e instrumentales para optimizar el drenaje bronquial. Este articulo entrega una descripción general del actuar del kinesiólogo en el manejo integral del paciente con Fibrosis Quística

Cuidando de um filho com diagnóstico de paralisia cerebral: sentimentos e expectativas / Taking care of a child diagnosed with cerebral palsy: feelings and expectations / Cuidar a un niño com diagnóstico de parálisis cerebral: sentimientos y expectativas

Este estudo objetivou compreender a experiência da maternidade em mulheres que são mães de um filho com diagnóstico de Paralisia Cerebral. Participaram 26 mães, que responderam a uma entrevista semiestruturada. A Análise Textual Qualitativa da entrevista resultou nas categorias: "o momento do diagnóstico"; "a percepção em relação à maternidade"; "preocupações, dificuldades e desejos" e "expectativas para o futuro". Elas atribuíram a causa da Paralisia Cerebral ao erro médico ou à negligência dos profissionais da saúde durante o pré-parto e o parto, à precariedade de recursos do hospital ou à própria responsabilidade. Entre as preocupações, estão o temor de adoecer e morrer, a falta de capacitação de profissionais da saúde, o receio de que o filho sofra algum tipo de exclusão na escola e a necessidade de promover o máximo de autonomia. Quanto às dificuldades, elas apontaram que o transporte público para locomoção dos seus filhos, as situações em que o filho não é bem aceito ou sofre preconceitos, as críticas recebidas em relação ao cuidado exercido e a falta de respeito por parte das pessoas nas ruas. Quanto às expectativas sobre o futuro, as mães salientaram a aspiração de poder trabalhar, voltar a estudar, investir no cuidado pessoal e dispor de momentos de lazer. O exercício da maternidade requer constante adaptação às necessidades de cuidado do filho com paralisia cerebral, é explícita a importância do apoio familiar e da orientação que as mães recebem dos profissionais da saúde

This study aimed at understanding the maternity experience for women who are mothers of a child diagnosed with cerebral palsy. Twenty-six mothers answered a semi-structured interview. The qualitative textual analysis of the interview resulted in the following categories: "the diagnosis moment"; "the perception of motherhood"; "worries, difficulties and aspirations" and "expectations for the future". The interviewed mothers attributed the cause of Cerebral Palsy to medical error or to the negligence of health professionals during the pre-labor and labor phases, to the precariousness of resources in thehospital, or to their own fault. Among the concerns, the fear of becoming sick and dying, the lack of qualified health professionals, the worry that their child will suffer some kind of exclusion at school, and the need to promote the maximum autonomy possible. As for the difficulties, they mentioned public transportation for their children's locomotion, the situations in which their child is not well accepted or suffers with prejudice, the criticisms towards the way that they care for their children and the lack of respect from some people on the streets. Concerning the future expectations, the mothers revealed that they would like to be able to work, to go back to school, to invest in their personal care, and to be able to have leisure time. The results indicate that motherhood requires constant adaptation to the needs of the child with cerebral palsy and highlight the importance of family support and the advising that mothers receive from health professionals.

Este estudio tuvo como objetivo comprender la experiencia de la maternidad en las mujeres que son madres de un niño diagnosticado con parálisis cerebral. Se recolectaron los datos por intermedio de la aplicación de entrevista semiestructurada y la evaluación de la función motora gruesa. Participaron 26 madres que respondieron a una entrevista semiestructurada. Un análisis textual de la entrevista cualitativa resultó en las categorías: "El momento del diagnóstico"; "La percepción de la maternidad"; "Las preocupaciones, problemas y deseos" y "las expectativas para el futuro". Ellos atribuyeron la causa de la parálisis cerebral a un error o negligencia médica de los profesionales de la salud durante el preparto y el trabajo de parto, la precariedad de los recursos hospitalarios o de poseer responsabilidad. Entre las preocupaciones son el miedo a la enfermedad y la muerte, la falta de formación de los profesionales de la salud, el temor de que el niño sufre algún tipo de exclusión de la escuela y la necesidad de promover la máxima independencia. En cuanto a las dificultades, señalaron que el transporte público para el transporte de sus hijos, las situaciones en las que el niño no es bien aceptado o perjudicado, críticas recibidas en relación con el cuidado ejercido y la falta de respeto por parte de la gente en las calles. Lo que les gustaría hacer y no pueden por falta de tiempo, las madres destacaron la aspiración atrabajar, volver a la escuela, invertir en el cuidado personal y tener tiempo de ocio. Los resultados indican que el ejercicio de la maternidad requiere una adaptación constante a las necesidades de cuidado infantil, y explican la importancia del apoyo familiar y orientación que las madres reciben de los profesionales de la salud.

Conservative management of mallet injuries: A national survey of current practice in the UK.

INTRODUCTION: Mallet injuries are common and usually treated conservatively. Various systematic reviews have found a lack of evidence regarding the best management, and it is unclear whether this uncertainty is reflected in current UK practice. METHODS: An online survey was developed to determine the current practice for the conservative treatment of mallet injury among specialist hand clinicians in the UK, including physiotherapists, occupational therapists and surgeons. Clinician's views of study outcome selection were also explored to improve future trials. RESULTS: In total, 336 professionals completed the survey. Inconsistency in overall practice was observed in splint type choice, time to discharge to GP, and assessment of adherence. Greater consistency was observed for recommended duration of continuous immobilisation. Bony injuries were most commonly splinted for 6 weeks (n = 228, 78%) and soft tissue injuries for either 8 weeks (n = 172, 56%) or 6 weeks (n = 119, 39%). Post-immobilisation splinting was frequently recommended, but duration varied between 2 and 10 weeks. The outcome rated as most important by all clinicians was patient satisfaction. DISCUSSION: There is overall variation in the current UK conservative management of mallet injuries, and the development of a standardised, evidence-based protocol is required. Clinicians' opinions may be used to develop a core set of outcome measures, which will improve standardisation and comparability of future trials.

Conflitos bioéticos: atendimento fisioterapêutico domiciliar a pacientes em condição de terminalidade / Bioethical conflicts: in physiotherapy home care for terminal patients / Conflictos bioéticos: atención fisioterapéutica domiciliaria a pacientes en condiciones terminales

Resumo O debate bioético enseja reflexões que propiciam a compreensão da morte e da terminalidade de modo a assegurar a observância de princípios como respeito à autonomia, beneficência e não maleficência e os direitos humanos. O objetivo do estudo foi analisar conflitos bioéticos no trabalho de fisioterapeutas em atendimento domiciliar a pacientes em condição de terminalidade. Trata-se de estudo qualitativo e descritivo. Dez fisioterapeutas do Distrito Federal participaram, respondendo a entrevista semiestruturada. Duas categorias foram identificadas: "desafios da atuação em domicílio com pacientes em condição de terminalidade"; e "o fisioterapeuta entre o tecnicismo e o humanismo". O estudo descortina conflitos bioéticos potenciais no atendimento a esses pacientes e seus familiares, em que os limites para a utilização dos recursos terapêuticos se traduzem em posturas polarizadas -de aproximação ou distanciamento- e o desafio de promover cuidado pautado na humanização e na dignidade humana.

Abstract The bioethical debate gives rise to considerations that foster understanding of death and terminal illness, in order to ensure compliance with principles such as respect for autonomy, beneficence, not maleficence, and human rights. The objective of the study was to analyze bioethical conflicts related to physiotherapy home care for terminal patients. This is a qualitative descriptive study. Ten physiotherapists from the Federal District, Brazil, participated, answering a semi-structured interview. Two categories were identified: "challenges of home care for patients with terminal conditions"; and "polarization of physiotherapists between technicality and humanism". The study reveals potential bioethical conflicts in the care of these patients and their families, in which the limits for the use of therapeutic resources translate into opposite approaches -either attachment or detachment - and the challenge of promoting care guided by humanization and human dignity.

Resumen El debate bioético da lugar a reflexiones que propician la comprensión de la muerte y de la terminalidad, con el fin de garantizar el cumplimiento de los principios como el respeto a la autonomía, la beneficencia y la no maleficencia y los derechos humanos. El objetivo del estudio fue analizar los conflictos bioéticos en el trabajo de los fisioterapeutas en la atención domiciliaria a pacientes en situación de terminalidad. Se trata de un estudio descriptivo y cualitativo. Participaron diez fisioterapeutas del Distrito Federal, Brasil, respondiendo a una entrevista semiestructurada. Se identificaron dos categorías: "desafíos de la atención domiciliaria con pacientes en condición de terminalidad"; y "el fisioterapeuta entre el tecnicismo y el humanismo". El estudio revela posibles conflictos bioéticos en la atención de estos pacientes y sus familias, donde los límites para el uso de los recursos terapéuticos se traducen en posiciones polarizadas - de aproximación o distanciamiento -y el desafío de promover una atención basada en la humanización y la dignidad humana.

Systematic Clinical Reasoning in Physical Therapy (SCRIPT): Tool for the Purposeful Practice of Clinical Reasoning in Orthopedic Manual Physical Therapy.

Background and Purpose: Clinical reasoning is essential to physical therapist practice. Solid clinical reasoning processes may lead to greater understanding of the patient condition, early diagnostic hypothesis development, and well-tolerated examination and intervention strategies, as well as mitigate the risk of diagnostic error. However, the complex and often subconscious nature of clinical reasoning can impede the development of this skill. Protracted tools have been published to help guide self-reflection on clinical reasoning but might not be feasible in typical clinical settings. Case Description: This case illustrates how the Systematic Clinical Reasoning in Physical Therapy (SCRIPT) tool can be used to guide the clinical reasoning process and prompt a physical therapist to search the literature to answer a clinical question and facilitate formal mentorship sessions in postprofessional physical therapist training programs. Outcomes: The SCRIPT tool enabled the mentee to generate appropriate hypotheses, plan the examination, query the literature to answer a clinical question, establish a physical therapist diagnosis, and design an effective treatment plan. The SCRIPT tool also facilitated the mentee's clinical reasoning and provided the mentor insight into the mentee's clinical reasoning. The reliability and validity of the SCRIPT tool have not been formally studied. Discussion: Clinical mentorship is a cornerstone of postprofessional training programs and intended to develop advanced clinical reasoning skills. However, clinical reasoning is often subconscious and, therefore, a challenging skill to develop. The use of a tool such as the SCRIPT may facilitate developing clinical reasoning skills by providing a systematic approach to data gathering and making clinical judgments to bring clinical reasoning to the conscious level, facilitate self-reflection, and make a mentored physical therapist's thought processes explicit to his or her clinical mentor.

A qualitative study of older people's experience of living with neurogenic claudication to inform the development of a physiotherapy intervention.

PURPOSE: The aim of this study was to explore older people's experiences of living with neurogenic claudication (NC), their preferences for physiotherapy treatment provision and associated outcomes in order to inform an intervention to be tested in a clinical trial. METHOD: Patients with a diagnosis of NC and/or lumbar spinal stenosis were recruited through a UK NHS tertiary care center. Semi-structured interviews and self-report questionnaires were used to obtain data. A thematic analysis was conducted. RESULTS: 15 participants were recruited; half were classed as frail older adults. Pain and the threat of pain was a prominent feature of participants' experience of NC. This led to a loss of engagement in meaningful activities and sense of self. Discourses of ageing influenced experiences as well as treatment preferences, particularly the acceptability of walking aids. A combination of one-to-one and group setting for treatment was preferred. Outcome preferences related to re-engagement in meaningful activities and pain reduction. Limitations relate to generalisability of the findings for NC patients not under physiotherapy treatment. CONCLUSION: We have obtained important findings about older people's experiences of living with NC and preferences for physiotherapy treatment and outcomes. These will be incorporated into an evidence-based intervention and evaluated in a randomized controlled trial. Implications for rehabilitation Older people living with NC want to get back to meaningful activities and learn how to live with the threat of pain. Allied health professionals (AHPs) should be sensitive to the complex and ambiguous ways in which older people live with ageing and age-related decline. AHPs are in a position to support patients' successful transition to the use of walking aids thereby reducing stigmatizing effects and increasing activity. AHPs should consider a mixture of one-to-one and group classes to enable rehabilitation for older NC patients.