Efectos de un programa intensivo de talasoterapia y terapia acuática en pacientes con ictus. Estudio piloto / Effects of an intensive thalassotherapy and aquatic therapy program in stroke patients. A pilot study

Introducción. El ictus es la principal causa de discapacidad adquirida. Su planificación y gestión (sanitaria y social) varía y, aunque la prevención resulta crucial, no es menos importante disponer de mejores tratamientos y estrategias para reducir la discapacidad. Objetivo. Analizar la eficacia de un programa intensivo de talasoterapia y terapia acuática en pacientes con ictus, valorando parámetros clínicos y escalas funcionales validadas. Pacientes y métodos. Se realizó un estudio prospectivo cuasi experimental con 26 pacientes con discapacidad leve-moderada postictus. Los pacientes fueron evaluados con las siguientes escalas: equilibrio de Berg, equilibrio dinámico/Timed Up & Go, marcha de 10 metros, seis minutos de marcha y escala visual analógica del dolor, antes y después de realizar tres semanas de tratamiento. Resultados. Finalizado el tratamiento programado, se obtuvieron diferencias significativas para todas las variables estudiadas. Conclusión. Un programa intensivo de talasoterapia y terapia acuática contribuye a mejorar el equilibrio, la marcha y la percepción del dolor en estos pacientes (AU)

Introduction. Stroke remains the leading cause of acquired disability. Health and social planning and management may vary and although prevention is crucial, having better treatments and strategies to reduce disability is needed. Aim. To determine the effect of an intensive program of thalassotherapy and aquatic therapy in stroke patients, valuing clinical parameters and functional validated scales. Patients and methods. A quasi-experimental prospective study consisting of a specific program assessed pre- and post- 3 weeks treatment to 26 stroke patients with a mild- moderate disability. The outcomes measured were: Berg Balance scale, Timed Up & Go test, 10-meter walking test, 6-minute walking test and pain Visual Analogue Scale. Results. After intervention, participants had a significant improvement in all outcomes measured. Conclusions. Our results suggest that an intensive program of thalassotherapy and aquatic therapy could be useful during stroke rehabilitation to improve balance, gait and pain (AU)

Efecto a largo plazo del policosanol en la recuperación funcional de pacientes con ictus isquémico no cardioembólico: estudio de un año / Long-term eff ect of policosanol on the functional recovery of non-cardioembolic ischemic stroke patients: a one year study

Introducción. El ictus es una causa principal de mortalidad y discapacidad. El policosanol ha sido efi caz en modelos de isquemia cerebral. Este estudio investiga si el tratamiento a largo plazo con policosanol, añadido a la terapia con ácido acetilsalicílico (AAS), dentro de los 30 días posteriores a un ictus, es mejor que el placebo + AAS en la recuperación de los pacientes. Pacientes y métodos. Estudio aleatorizado, doble ciego, controlado con placebo. Se incluyeron 80 pacientes (edad media: 69 años) que sufrieron un ictus en los 30 días previos y con una puntuación de 2-4 en la escala de Rankin modifi cada(mRS). Se distribuyeron aleatoriamente en dos grupos y recibieron policosanol + AAS o placebo + AAS durante 12 meses. Resultados. El tratamiento con policosanol + AAS disminuyó signifi cativamente la puntuación en la mRS desde el primer control intermedio (1,5 meses). El efecto del tratamiento incluso mejoró con la terapia a largo plazo. El número de pacientes que alcanzaron valores de mRS menores o iguales a 1 fue superior en el grupo de policosanol + AAS (87,5%) que en el de placebo + AAS (0%). El tratamiento con policosanol + AAS aumentó signifi cativamente el índice de Barthel, disminuyó el colesterol LDL y aumentó el colesterol HDL frente a placebo + AAS. Conclusiones. El tratamiento a largo plazo (12 meses) con policosanol + AAS fue más efectivo que el tratamiento con placebo + AAS en la recuperación funcional de los pacientes después de sufrir un ictus isquémico no cardioembólico de moderada gravedad (AU)

Introduction. Stroke is a leading cause of mortality and disability. Policosanol has been eff ective in brain ischemia models. The aim of this study is to investigate whether policosanol, added to aspirin therapy within 30 days of stroke onset, is better than placebo + aspirine for the long-term recovery of non-cardioembolic ischemic stroke subjects. Patients and methods. Randomized, double-blind, placebo-controlled study. Eighty patients (mean age: 69 years) within 30 days of onset, with a modifi ed Rankin Scale score (mRS) 2 to 4, were included. They were randomized in two groups (policosanol + aspirine or placebo + aspirine) for 12 months. Results. Policosanol + aspirine decreased signifi cantly mean mRS from the fi rst interim check-up (1.5 months). The treatment even improved after long-term therapy. More policosanol + aspirin (87.5%) than placebo + aspirine (0%) patients achieved mRSs ≤ 1. Policosanol + aspirine increased signifi cantly Barthel Index, lowered LDL-cholesterol and increased HDL-cholesterol versus placebo + aspirin. Conclusions. Long-term (12 months) administration of policosanol + aspirin given after suff ering non-cardioembolic ischemic stroke was shown to be better than placebo + aspirin in improving functional outcomes when used among patients with non-cardioembolic ischemic stroke of moderate severity (AU)

Terapia de Contensão Induzida na função do membro superior parético / Constraint-induced movement therapy in the paretic upper limb function

A reabilitação do membro superior do paciente com sequelas de acidente vascular encefálico é um dos desafios de maior complexidade para o fisioterapeuta. O objetivo deste estudo foi verificar o uso da Terapia de Contenção Induzida (técnica recente) isoladamente na melhora funcional do membro superior parético em pacientes pós-acidente vascular encefálico a partir de uma revisão sistemática sem metanálise das bases de dados PubMed,LILACS e SciELO, seguindo os critérios de inclusão: ano de publicação entre 2010 e 2015, estudos clínicos controlados e randomizados que avaliaram a funcionalidade do membro superior hemiparético, e estudos que utilizaram somente a Terapia de Contensão Induzida como técnica de tratamento no mesmo grupo estudado. Foram critérios de exclusão relativos à Terapia de Contensão Induzida: associada a outras técnicas de reabilitação no mesmo grupo estudado, modificada, realizada para fins que não para o membro superior parético, e realizada em crianças e adolescentes ou em pacientes com paralisia cerebral. Foram encontrados 352 artigos. Seis artigos se enquadraram nos critérios de inclusão e exclusão. Dos seis artigos, três apresentaram a comparação da Terapia de Contensão Induzida com outras técnicas, como Bobath, estimulação magnética transcraniana repetitiva de baixa frequência, terapia ocupacional e terapia intensiva bilateral. Dois artigos verificaram a Terapia de Contensão Induzida precoce e tardiamente; somente um avaliou o fluxo sanguíneo do hemisfério afetado durante tarefas motoras com e sem restrição. Conclui-se que a Terapia de Contensão Induzida utilizada precocemente oferece resultados satisfatórios quando comparados com técnicas mais tradicionais.

Upper limb rehabilitation in patients with stroke sequelae is one of the most complex challenges to the physiotherapist. The aim of this study was to investigate the use of constraint-Induced movement therapy (recent technique) alone in functional improvement of the paretic upper limb in post-stroke patients through a systematic review with no metanalysis of databases of PubMed, LILACS and SciELO. The inclusion criteria were: year of publication between 2010 and 2015; controlled and randomized clinical studies that evaluated the functionality of hemiparetic upper limb, and controlled and randomized clinical studies evaluating only the Constraint-induced Movement Therapy as a treatment technique in the same study group.Exclusion criteria related to the Constraint-induced Movement Therapy were: associated with other rehabilitation techniques in the same study group, modified, carried out for purposes other than for the paretic upper limb, and performed in children and teenagers or in patients with cerebral palsy. We found 352 articles. Six articles met the inclusion and exclusion criteria. Of the six articles, three had a comparison of Constraint-induced movement therapy with other techniques, such as Bobath,low-frequency repetitive transcranial magnetic stimulation,occupational therapy, and bilateral intensive therapy. Two articles observed early and late Constraint-induced Movement Therapy; only one evaluated the blood flow of the affected hemisphere during motor tasks with and without constraint. It was concluded that the Constraint-induced Movement Therapy use provides satisfactory results when compared with more traditional techniques

Potenciación del reaprendizaje motor y la recuperación funcional en pacientes con ictus: estrategias no invasivas de modulación del sistema nervioso central / Enhancement of motor relearning and functional recovery in stroke patients: non-invasive strategies for modulating the central nervous system

Introducción. La mayoría de los pacientes que han sufrido un ictus no recuperan el estado funcional basal de la extremidad superior afecta y sufren una grave limitación que permanece en la fase crónica de la enfermedad y que repercute de manera devastadora en su calidad de vida. Por ello, las estrategias de neurorrehabilitación tratan de evitar o minimizar las posibles disfunciones sensitivomotoras asociadas al ictus mediante la promoción de cambios plásticos en el sistema nervioso central. Desarrollo. La reorganización cerebral que tiene lugar tras el ictus puede promover la recuperación motora y funcional de los sujetos con ictus. No obstante, tras la lesión, también se pueden iniciar cambios neuroplásticos maladaptativos responsables del desarrollo de trastornos sensitivomotores, como el síndrome de espasticidad. Las estrategias no invasivas de estimulación cerebral, como la estimulación con corriente directa y la estimulación magnética transcraneal, son unas técnicas ampliamente utilizadas que, aplicadas sobre la corteza motora primaria, pueden modificar la excitabilidad de los circuitos neuronales y las funciones cognitivas, tanto en las personas sanas como en los pacientes con afectación neuroló- gica. Asimismo, los sistemas de interfaces cerebro-máquina también son capaces de generar esa reorganización por medio de la asociación contingente y simultánea entre la activación cerebral y la estimulación periférica. Conclusiones. Se evidencian los efectos positivos de las estrategias de neurorrehabilitación citadas previamente en la potenciación de la reorganización cortical después del ictus, así como en la paliación de los efectos adversos asociados al desarrollo de la espasticidad (AU)

Introduction. Most of the stroke survivors do not recover the basal state of the affected upper limb, suffering from a severe disability which remains during the chronic phase of the illness. This has an extremely negative impact in the quality of life of these patients. Hence, neurorehabilitation strategies aim at the minimization of the sensorimotor dysfunctions associated to stroke, by promoting neuroplasticity in the central nervous system. Development. Brain reorganization can facilitate motor and functional recovery in stroke subjects. Nonetheless, after the insult, maladaptive neuroplastic changes can also happen, which may lead to the appearance of certain sensorimotor disorders such as spasticity. Noninvasive brain stimulation strategies, like transcranial direct current stimulation or transcranial magnetic stimulation, are widely used techniques that, when applied over the primary motor cortex, can modify neural networks excitability, as well as cognitive functions, both in healthy subjects and individuals with neurological disorders. Similarly, brain-machine-interface systems also have the potential to induce a brain reorganization by the contingent and simultaneous association between the brain activation and the peripheral stimulation. Conclusion. This review describes the positive effects of the previously mentioned neurorehabilitation strategies for the enhancement of cortical reorganization after stroke, and how they can be used to alleviate the symptoms of the spasticity síndrome (AU)

Efectividad de la imaginería o práctica mental en la recuperación funcional tras el ictus: revisión sistemática / Effectiveness of motor imagery or mental practice in functional recovery after stroke: a systematic review

Introducción: En las últimas décadas han surgido diferentes métodos de tratamiento rehabilitador para pacientes con hemiparesia. Uno de ellos es la práctica mental (PM) del movimiento, consistente en la evocación de un movimiento o gesto por parte del sujeto con el fin de aprender o mejorar su ejecución. A pesar de que las técnicas de neuroimagen han demostrado que durante la PM se ejecutan patrones de activación neuronal similares a los que aparecen durante el movimiento, es necesario demostrar su efectividad clínica en la rehabilitación y recuperación funcional de pacientes. Desarrollo: Para ello, entre diciembre de 2011 y octubre de 2012 se realizó una búsqueda sistemática en las principales plataformas bibliográficas y bases, seleccionándose 23 ensayos clínicos referentes a distintos protocolos de PM en pacientes con hemiparesia. Conclusiones: La PM es efectiva cuando se combina con terapia convencional en la recuperación funcional del miembro tanto inferior como superior, así como para el entrenamiento de actividades y gestos cotidianos. Dada la heterogeneidad de los estudios en cuanto a la técnica de evocación mental, el volumen de entrenamiento, los sujetos incluidos…, se necesitan más estudios para determinar el tipo de paciente y el protocolo ideal de tratamiento

Introduction: In recent decades, many stroke rehabilitation methods have been developed. Mental practice (MP) is a dynamic state in which the subject evokes an imaginary representation of a motor action or skill in order to learn or perfect that action. Although functional imaging has shown that MP produces similar cortical activation patterns to those of movement, the clinical effectiveness of such methods in rehabilitation and functional recovery has yet to be demonstrated. Development: Systematic search of all clinical studies published in the main scientific databases between December 2011 and October 2012 concerning mental practice in stroke rehabilitation. We selected 23 clinical trials testing different MP protocols in patients with hemiparesis. Conclusions: MP is effective when used in conjunction with conventional physical therapy for functional rehabilitation of both upper and lower limbs, as well as for the recovery of daily activities and skills. Owing to the heterogeneity of the studies with regard to the intervention protocol, specific imagery technique, time spent practicing, patient characteristics, etc., more studies are needed in order to determine the optimal treatment protocol and patient profile

Eficácia da eletroestimulação neuromuscular no tratamento da disfagia orofaríngea em idosos acometidos por acidente vascular encefálico / Efficiency of neuromuscular electrical stimulation in the treatment of oropharyngeal dysphagia in elderly patients with stroke

Várias são as propostas para reabilitação da disfagia orofaríngea, sendo a eletroestimulação neuromuscular (EENM) uma nova modalidade de tratamento. Poucos são os trabalhos que comprovam a eficácia deste tratamento na reabilitação da disfagia e ainda não foram encontrados estudos que verificaram o efeito da EENM em idosos em fase tardia do acometimento vascular encefálico. Assim, o objetivo do presente trabalho foi verificar o efeito, a curto e médio prazo, da terapia da deglutição com EENM sensorial em idosos com sequelas de acidente vascular encefálico (AVE) que foram submetidos à terapia fonoaudiológica convencional sem sucesso, quanto ao nível de ingestão oral, ao quadro de disfagia orofaríngea e à qualidade de vida relacionada à deglutição. Para isto 10 indivíduos idosos, pósacidente vascular encefálico (AVE), que já haviam realizado terapia fonoaudiológica convencional foram classificados quanto ao nível de ingestão oral na escala funcional de ingestão oral (FOIS), submetidos à avaliação instrumental (videofluoroscopia) da deglutição utilizando-se líquido, alimento na consistência de pudim e sólido, a partir da qual foi analisado o grau da disfagia orofaríngea por meio da escala Dysphagia Outcome and Severity Scale (DOSS), realizada a classificação na escala de penetração e aspiração e na escala de resíduos. Também foi realizada a aplicação do protocolo de qualidade de vida relacionado à deglutição SWAL-QOL e aos procedimentos terapêuticos propostos, sendo que os exames foram repetidos imediatamente e três meses após a reabilitação. As sessões de terapia foram realizadas três vezes por semana e distribuídas em quatro semanas, totalizando 12 sessões. Cada sessão consistiu em duas etapas de 10 minutos de exercício, nas quais os pacientes foram solicitados a deglutirem a saliva com esforço, ou umapequena quantidade de água a cada 10 segundos durante a EENM. imediatamente após e três meses após as 12 sessões de terapia, todos os indivíduos...

There are several proposals for rehabilitation of oropharyngeal dysphagia, and the neuromuscular electrical stimulation (NMES) is a new type of treatment. There are few studies proving the efficiency of this treatment in oropharyngeal dysphagia, and studies verifying the effect of NMES in the elderly in late stage of cerebrovascular impairment haven´t been found yet. Thus, the objective of this study is to verify the short- and medium-term effect of the deglutition therapy with sensorial NMES in elderly patients with stroke sequelae, who underwent conventional speech therapy with no success, regarding the level of oral intake, the oropharyngeal dysphagia condition and the quality of life related to deglutition. In order to achieve such objective, 10 poststroke elderly patients, who had already undergone conventional speech therapy, were classified regarding the level of oral intake according to the functional oral intake scale (FOIS). They underwent swallowing instrumental assessment (fluoroscopy) with liquid, solid food and food in the consistency of pudding, their level of oropharyngeal dysphagia was analyzed by means of the Dysphagia Outcome and Severity Scale (DOSS), and they were rated by means of the penetration and aspiration scale and the waste scale. The SWAL-QOL outcomes tool was also applied regarding the quality of life in deglutition and the therapeutic procedures proposed. The sessions were performed three times per week for 4 weeks, a total of 12 sessions. One session consisted of two 10 minutes exercises with a 2 minutes rest period provided between exercises. Patients were asked to forcefully swallow their saliva or a small amount of water every 10 seconds during stimulation. The exams were repeated immediately and three months after rehabilitation. The results show there was an improvement in the deglutition rating for 4 out of the 10 patients immediately after the intervention and, after three months, one patient improved...

Eficácia da eletroestimulação neuromuscular no tratamento da disfagia orofaríngea em idosos acometidos por acidente vascular encefálico / Efficiency of neuromuscular electrical stimulation in the treatment of oropharyngeal dysphagia in elderly patients with stroke

Várias são as propostas para reabilitação da disfagia orofaríngea, sendo a eletroestimulação neuromuscular (EENM) uma nova modalidade de tratamento. Poucos são os trabalhos que comprovam a eficácia deste tratamento na reabilitação da disfagia e ainda não foram encontrados estudos que verificaram o efeito da EENM em idosos em fase tardia do acometimento vascular encefálico. Assim, o objetivo do presente trabalho foi verificar o efeito, a curto e médio prazo, da terapia da deglutição com EENM sensorial em idosos com sequelas de acidente vascular encefálico (AVE) que foram submetidos à terapia fonoaudiológica convencional sem sucesso, quanto ao nível de ingestão oral, ao quadro de disfagia orofaríngea e à qualidade de vida relacionada à deglutição. Para isto 10 indivíduos idosos, pósacidente vascular encefálico (AVE), que já haviam realizado terapia fonoaudiológica convencional foram classificados quanto ao nível de ingestão oral na escala funcional de ingestão oral (FOIS), submetidos à avaliação instrumental (videofluoroscopia) da deglutição utilizando-se líquido, alimento na consistência de pudim e sólido, a partir da qual foi analisado o grau da disfagia orofaríngea por meio da escala Dysphagia Outcome and Severity Scale (DOSS), realizada a classificação na escala de penetração e aspiração e na escala de resíduos. Também foi realizada a aplicação do protocolo de qualidade de vida relacionado à deglutição SWAL-QOL e aos procedimentos terapêuticos propostos, sendo que os exames foram repetidos imediatamente e três meses após a reabilitação. As sessões de terapia foram realizadas três vezes por semana e distribuídas em quatro semanas, totalizando 12 sessões. Cada sessão consistiu em duas etapas de 10 minutos de exercício, nas quais os pacientes foram solicitados a deglutirem a saliva com esforço, ou umapequena quantidade de água a cada 10 segundos durante a EENM. imediatamente após e três meses após as 12 sessões de terapia, todos os indivíduos...

There are several proposals for rehabilitation of oropharyngeal dysphagia, and the neuromuscular electrical stimulation (NMES) is a new type of treatment. There are few studies proving the efficiency of this treatment in oropharyngeal dysphagia, and studies verifying the effect of NMES in the elderly in late stage of cerebrovascular impairment haven´t been found yet. Thus, the objective of this study is to verify the short- and medium-term effect of the deglutition therapy with sensorial NMES in elderly patients with stroke sequelae, who underwent conventional speech therapy with no success, regarding the level of oral intake, the oropharyngeal dysphagia condition and the quality of life related to deglutition. In order to achieve such objective, 10 poststroke elderly patients, who had already undergone conventional speech therapy, were classified regarding the level of oral intake according to the functional oral intake scale (FOIS). They underwent swallowing instrumental assessment (fluoroscopy) with liquid, solid food and food in the consistency of pudding, their level of oropharyngeal dysphagia was analyzed by means of the Dysphagia Outcome and Severity Scale (DOSS), and they were rated by means of the penetration and aspiration scale and the waste scale. The SWAL-QOL outcomes tool was also applied regarding the quality of life in deglutition and the therapeutic procedures proposed. The sessions were performed three times per week for 4 weeks, a total of 12 sessions. One session consisted of two 10 minutes exercises with a 2 minutes rest period provided between exercises. Patients were asked to forcefully swallow their saliva or a small amount of water every 10 seconds during stimulation. The exams were repeated immediately and three months after rehabilitation. The results show there was an improvement in the deglutition rating for 4 out of the 10 patients immediately after the intervention and, after three months, one patient improved...

Tratamiento y rehabilitación de la disfagia tras enfermedad cerebrovascular / Treatment and rehabilitation of dysphagia following cerebrovascular disease

Introducción. La bronconeumonía es una complicación frecuente en los primeros días después de una enfermedad cerebrovascular y se asocia con una mayor tasa de mortalidad. Se produce en pacientes con el nivel de conciencia o el reflejo tusígeno alterado, y podría prevenirse con un programa temprano de rehabilitación de la disfagia. Objetivo. Revisar la literatura científica en relación con el tratamiento y rehabilitación de pacientes con disfagia tras sufrir un ictus, entre 2002 y 2012. Desarrollo. Las bases de datos PubMed, Cochrane, PEDro, CINAHL y ENFISPO ofrecieron 15 artículos que cumplieron los criterios de inclusión y los objetivos planteados, con información sobre 3.212 pacientes. Se describen distintos protocolos y técnicas para la reeducación de la disfagia, como estrategias compensatorias, terapia de regulación orofacial, musicoterapia, estimulación sensorial, entrenamiento muscular labial, de la lengua, faringe, laringe y aparato respiratorio, maniobra de Mendelsohn, estimulación eléctrica neuromu cular, estimulación magnética transcraneal repetitiva y acupuntura. Conclusiones. Los estudios incluidos en esta investigación afirman que el tratamiento de la disfagia tras ictus puede mejorar la función deglutoria (coordinación, velocidad, volumen), la calidad de vida y las relaciones sociales de las personas. Existe una labor pendiente para establecer o definir qué tipo de terapias, técnicas, ejercicios o maniobras son los más eficaces en la disfagia, y para elaborar protocolos de tratamiento o rehabilitación consensuados dentro de las unidades que abordan integralmente el ictus (AU)

Introduction. Bronchopneumonia is a frequent complication in the first days after a cerebrovascular disease and is linked with a higher rate of mortality. It occurs in patients with an altered level of consciousness or tussigenic reflex, and could be prevented with an early dysphagia rehabilitation programme. Aims. To review the scientific literature on the treatment and rehabilitation of patients with dysphagia after suffering a stroke, published between 2002 and 2012. Development. A search conducted in the PubMed, Cochrane, PEDro, CINAHL and ENFISPO databases yielded 15 papers that fulfilled eligibility criteria and the initial aims of the study, providing information about 3,212 patients. The different protocols and techniques for re-education in dysphagia are described and include compensatory strategies, orofacial regulation therapy, music therapy, sensory stimulation, lip muscle, tongue, pharynx, larynx and respiratory tract training, Mendelsohn manoeuvre, neuromuscular electrical stimulation, repetiti transcranial magnetic stimulation and acupuncture. Conclusions. The studies examined in this research claim that the treatment of dysphagia following a stroke can improve the function of deglutition (coordination, speed, volume), quality of life and people’s social relationships. Further work needs to be carried out to establish or define what kind of therapies, techniques, exercises or manoeuvres are the most effective in dysphagia. Generally agreed treatment or rehabilitation protocols also need to be drawn up within units that address stroke in an integrated manner(AU)

The addition of functional task-oriented mental practice to conventional physical therapy improves motor skills in daily functions after stroke

BACKGROUND: Mental practice (MP) is a cognitive strategy which may improve the acquisition of motor skills and functional performance of athletes and individuals with neurological injuries. OBJECTIVE: To determine whether an individualized, specific functional task-oriented MP, when added to conventional physical therapy (PT), promoted better learning of motor skills in daily functions in individuals with chronic stroke (13±6.5 months post-stroke). METHOD: Nine individuals with stable mild and moderate upper limb impairments participated, by employing an A1-B-A2 single-case design. Phases A1 and A2 included one month of conventional PT, and phase B the addition of MP training to PT. The motor activity log (MAL-Brazil) was used to assess the amount of use (AOU) and quality of movement (QOM) of the paretic upper limb; the revised motor imagery questionnaire (MIQ-RS) to assess the abilities in kinesthetic and visual motor imagery; the Minnesota manual dexterity test to assess manual dexterity; and gait speed to assess mobility. RESULTS: After phase A1, no significant changes were observed for any of the outcome measures. However, after phase B, significant improvements were observed for the MAL, AOU and QOM scores (p<0.0001), and MIQ-RS kinesthetic and visual scores (p=0.003; p=0.007, respectively). The significant gains in manual dexterity (p=0.002) and gait speed (p=0.019) were maintained after phase A2. CONCLUSIONS: Specific functional task-oriented MP, when added to conventional PT, led to improvements in motor imagery abilities combined with increases in the AOU and QOM in daily functions, manual dexterity, and gait speed. .

Empleo de la escala de calidad de vida para el ictus (ECVI-38) para cuantificar y medir las consecuencias de un ictus. Relación con variables demográficas y clínicas / Use of the stroke-specific quality of life scale (ECVI-38) to quantify and measure the consequences of a stroke. relation with demographic and clinical variables

Objetivo. Describir el perfil sociodemográfico, clínico y la calidad de vida relacionada con la salud (CVRS), según la encuesta ECVI-38 y su relación con las diferentes características sociodemográficas y clínicas. Material y método. Estudio descriptivo observacional. Participantes: pacientes que presentaban un ictus en el último año, que habían permanecido ingresados en una Unidad de Rehabilitación Neurológica y que cumplían unos criterios de inclusión. Mediciones: variables sociodemográficas, clínicas, la escala de comorbilidad de Charlson, el grado de dependencia funcional mediante la escala de Rankin modificada y el índice de Barthel. Tratamientos realizados: fibrinólisis, fisioterapia, terapia ocupacional, logopedia y valoración psiquiátrica. Se ha determinado la CVRS mediante la encuesta ECVI-38. Resultados. Se recogieron un total de 95 encuestas (72 procedentes del Hospital Universitario Miguel Servet y 23 del Hospital San Juan de Dios). 60 varones y 35 mujeres. La media de edad fue de 64,33 años (rango de edad: 24-90 años). Las actividades comunes de la vida diaria (ACVD), las actividades básicas de la vida diaria (ABVD), las funciones sociofamiliares (FSF) y el estado físico (EF) fueron las 4 dimensiones más afectadas en los pacientes del estudio, siendo los resultados estadísticamente significativos. Conclusiones. Los pacientes con ictus en nuestro estudio perciben una afectación leve en su calidad de vida (ECVI-38-Total: 35,59%). La edad, la situación funcional y el grado de dependencia son los parámetros que mejor se relacionan con la calidad de vida (AU)

Objective: To describe the sociodemographic data, clinical and health-related quality of life (HRQOL) profile according to the ECVI-38 scale and its relation to the different sociodemographic and clinical characteristics. Material and method: A descriptive, observational study was conducted. Participants: Patients who had suffered stroke in the last year, had been admitted to a Neurological Rehabilitation Unit and had fulfilled some inclusion criteria. Measurements: ociodemographic, clinical variables were gathered as well as the Charlson comorbidity scale, grade of functional dependence using the modified Rankin and Barthel index. Treatments performed were fibrinolysis, physiotherapy, occupational therapy, speech therapy, psychiatric evaluation. The CVRS was measured through the ECVI-38 survey. Results: A total of 95 surveys (72 from the University Miguel Servet Hospital and 23 from San Juan de Dios Hospital) were collected from 60 men and 35 women. Average age was 64.33 years (age range: 24-90 years). Common activities of the daily living (CADL), basic activities of the daily living (BADL), sociofamilial functions (SF) and physical condition (PC) were the four dimensions that were most affected in the study patients, with statistically significant results. Conclusions: The stroke patients in our study observed a mild affectation in their quality of life (ECVI-38-Total: 35.59%). Age, functional status and grade of dependence are the parameters that are best related to quality of life (AU)

Comparison of functional electrical stimulation associated with kinesiotherapy and kinesiotherapy alone in patients with hemiparesis during the subacute phase of ischemic cerebrovascular accident / Comparação da estimulação elétrica funcional associada à cinesioterapia com a cinesioterapia isolada em pacientes com hemiparesia na fase subaguda por acidente vascular cerebral isquêmico

Objective: To compare the functional electrical stimulation associated with functional kinesiotherapy alone in patients after ischemic cerebrovascular accident. Methods: The study included 20 patients who were divided into two groups: Group I (GI): functional electrical stimulation plus functional kinesiotherapy and Group II (GII): functional kinesiotherapy. We evaluated active and passive range of motion, in knee flexion and extension muscle strength, activities of daily living and quality of life. The evaluations were conducted in the pretreatment period, after 10 sessions and after 20 physical therapy sessions. Results: There was a significant improvement in all variables studied for both groups. However, significant improvements for the sub-items functional capacity and social aspects were seen only in the patients treated with associated functional electrical stimulation and kinesiotherapy. Conclusion: Although both groups of patients improved with the treatment, the association of functional electrical stimulation and kinesiotherapy showed superiority in two quality of life items, in the sub-items functional capacity and social aspects. .

Objetivo: Comparar a estimulação elétrica funcional associada à cinesioterapia com a cinesioterapia funcional isolada no membro inferior de pacientes em fase subaguda após acidente vascular cerebral isquêmico. Método: Participaram do estudo 20 pacientes divididos em 2 grupos: Grupo I (GI): eletroestimulação funcional mais cinesioterapia funcional e Grupo II (GII): cinesioterapia funcional. Foram avaliadas as amplitudes de movimento ativo e de movimento passivo em flexão e extensão do joelho, a força muscular, as atividades da vida diária e a qualidade de vida. As avaliaçães foram realizadas nos períodos pré-tratamento, após 10 e após 20 sessões de fisioterapia. Resultados: Houve melhora significativa em todas as variáveis estudadas para ambos os grupos. Contudo, melhorias significativas para os subitens capacidade funcional e aspectos sociais foram vistos apenas nos pacientes tratados com a estimulação elétrica funcional associada à cinesioterapia. Conclusão: Os dois grupos de pacientes melhoraram com o tratamento, mas a associação da estimulação elétrica funcional à cinesioterapia mostrou superioridade nos subitens capacidade funcional e aspectos sociais da qualidade de vida. .

Interés del uso clínico del tensor de difusión en la planificación del tratamiento rehabilitador en pacientes tras el primer ictus / Importance of the clinical use of the diffusion tensor in planning rehabilitation treatment in patients after the first stroke

Objetivo. Contrastar la utilidad predictiva de la RM en la modalidad del tensor de difusión (TD) en una muestra de pacientes que han presentado un ictus. Material y método. Estudio prospectivo sobre 7 pacientes de ambos sexos, ingresados para tratamiento rehabilitador intensivo tras primer episodio de ictus isquémico. Protocolo: 1) Valoración habilidades motoras: índice motor, prueba de control de tronco; 2) Capacidad de la marcha: functional assessment categories y capacidad funcional: índice de Barthel y Functional Independence Measure (FIM); 3) Estudio tractográfico: media y desviación estándar de fracción de anisotropía (FA) y coeficiente de difusión (CDA) aparente en cápsula interna, corona radiata y tracto protuberancial derecho e izquierdo; y 4) Estudio estadístico: representación de las relaciones 2 a 2 entre todas las variables en estudio, y comprobación de cada posible relación con modelo de regresión simple (lineal o logístico). Se han incluido resultados con un valor de p menor de 0,2. Resultados. Las relaciones con significatividad 2 a 2 son: 1) índice motor de la extremidad superior y FA en el tracto protuberancial; 2) índice motor de la extremidad inferior y la FA a nivel de la corona radiata; 3) FIM motor y cognitivo con el CDA aparente a nivel de la corona radiata; 4) FIM motor y cognitivo con la FA en el tracto protuberancial; 5) FIM cognitivo y la FA a nivel de la corona radiata; 6) FIM total con la FA en la cápsula interna; y 7) tracto protuberancial, así como con el CDA en el tracto protuberancial. Los resultados representan las conclusiones preliminares del empleo del TD en una muestra reducida de pacientes atendidos en una unidad de neurorrehabilitación en los que consideramos de utilidad el uso del TD en la predicción evolutiva del ictus (AU)

Objective. To compare the predictive value of the MR diffusion tensor (DT) imaging modality in a sample of stroke patients. Material and method. A prospective study was conducted on 7 inpatient subjects of both genders who were undergoing intensive rehabilitation after a first ischemic stroke. The protocol included: 1) motor skills evaluation by Motor Index, Trunk Control Test; 2) Walking capacity: functional assessment categories and functional capacity: Barthel Index and Functional Independence Measure (FIM); 3) Tractography study: mean and standard deviation for fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in internal capsule, corona radiata and right and left pontine tract; 4) Statistical analysis: projection of the data into a two-dimensional scatterplot matrix; verification of every possible link with a simple regression model (linear or logistic). Results with P-value <0.2 are included. Results. The relations with two pairs of variables that are significant are: 1) upper extremity motor skill and FA values in the pontine tract; 2) lower extremity motor skill and FA values at the corona radiate; 3) motor and cognitive FIM with ADC at the corona radiate; 4) motor and cognitive FIM with FA in the pontine tract; 5) Cognitive FIM and FA at the corona radiate; 6) FIM total and FA at the internal capsule and pontine tract and, 7) total FIM and ADC in the pontine tract. The results represent the preliminary findings of the use of DT in a small sample of stroke patients in a neurorehabilitation unit. We consider DT to be useful in the evolutive prediction of stroke (AU)

Brain stimulation used as biofeedback training for recovery of motor functions deteriorated by stroke / A estimulação cerebral em pacientes com acidente vascular cerebral está associada a melhoria no desempenho motor e a incremento de eficácia na função neuronal

According to World Health Organization, approximately 15 million people are affected by cerebrovascular accident in the world. We study the effect of brain stimulation plus an imaging procedure used as biofeedback training for recovery of motor functions impaired by CVA. Four individuals aged between 33 and 72 years were included in the study, of both genders, with hemiparesis on the left arm due to the CVA. They had their brain activity monitored by EEG. Functional tasks were evaluated according to an observational model proposed by the international classification of functioning and by runtime. The training was composed of 12 sessions of 30 minutes of stimulation by light and sound, as well as imaging procedures. Results revealed that improvements in the performance of the task, with regard to both the runtime and the functional quality of movements, are more related to the increase of effectiveness of neuronal function.

Segundo a Organização Mundial da Saúde, aproximadamente 15 milhões de pessoas no mundo sofrem acidente vascular cerebral (AVC). Estudaram-se os efeitos da estimulação cerebral associada à imagética, como treinamento de biofeedback, para a recuperação das funções motoras deterioradas pelo AVC. Foram incluidos 4 indivíduos com idade entre 33 e 72 anos, de ambos os gêneros, e com hemiparesia no braço esquerdo devido ao AVC. Esses pacientes tiveram a atividade cerebral monitorada por EEG. A tarefa funcional foi avaliada de acordo com o modelo de observação proposto pela Classificação Internacional de Funcionalidade e pelo tempo de execução. O treinamento consistiu de 12 sessões de 30 minutos de estimulação por luz e som associado à imagética. Os resultados revelaram melhoria no desempenho da tarefa, tanto em relação ao tempo de execução quanto à qualidade funcional do movimento, e que está mais relacionada com o incremento de eficácia da função neuronal.

Análise do controle postural após a aplicação da eletroestimulação funcional no acidente vascular encefálico / Analysis of postural control after the application of functional electrical stimulation in stroke patients

O Acidente Vascular Encefálico (AVE) é o principal acometimento neurológico em adultos no mundo. Pode resultar em déficits neuromotores e cognitivos. Entre os déficits neuromotores observa-se a espasticidade, esta interfere no planejamento dos movimentos e no controle da postura. O sistema de controle da postura é primordial para a independência funcional nas atividades de vida diária e, por isso, é um dos principais objetivos a se atingir em programas de reabilitação. Nestes, diversas condutas terapêuticas visam dar estímulos ao indivíduo para que consiga realizar mais eficientemente os movimentos e controlar a postura. E, entre tantas técnicas, está a estimulação elétrica neuromuscular, a qual contribui para diminuição da espasticidade, além de outros benefícios. Quando utilizada para tarefas funcionais é então denominada estimulação elétrica funcional conhecida como Functional Eletrical Stimulation (FES). Tendo em vista a importância do controle da postura nas atividades de vida diária e as contribuições advindas da FES. Objetivo: o objetivo do presente estudo foi de observar a resposta do controle postural em dois indivíduos com hemiparesia por AVE após a aplicação de FES em um curto período de tempo. Método: o protocolo experimental contou com quatro fases; A: pré FES; B: Imediatamente após a aplicação da FES; C: 45 minutos após a aplicação da FES; D: 90 minutos após aplicação da FES. Em cada fase o participante posicionava-se sobre uma plataforma de força e realizava por três tentativas a tarefa escolhida, o teste do terceiro dedo ao chão. Resultados: o software Matlab 7.0 forneceu a variável de Velocidade média do Centro de Pressão no sentido médio-lateral (Vmx) e ântero-posterior (Vmy). Dessa forma, foi possível constatar que mesmo quando os participantes apresentaram uma redução na Vmx e Vmy estas foram menores que 1%. Conclusão: isto possivelmente indique atividade regulatória postural semelhante a etapa pré FES, e, ainda uma menor atividade...

Strokes cause the main neurological impairments in adults around the world. They can result in neuromotor and cognitive deficits. Among the neuromotor deficits there is spasticity; this affects the planning of movements and posture control. The postural control system is essential for functional independence in daily life activities and is, therefore, one of the main goals to achieve in rehabilitation programs. These programs have various therapeutic elements aimed at providing stimulus to the individual, which help them control their movements and stance more efficiently. Among these techniques is neuromuscular electrical stimulation, which contributes to decreasing spasticity and other benefits. When used for functional tasks it is called Functional ElectricalStimulation (FES). Objective: The purpose of this study was to verify the response of the postural control in two individuals with hemiparesis by stroke after the application of the FES over a short period time. Method: the experimental protocol had four phases. A: pre-FES; B: Immediately after the application of FES; C: 45 minutes after the application of FES; D: 90 minutes after application of FES. In each phase, the participants were positioned on a force platform and made three attempts to do the chosen task: touching the fingertip-to-floor test. Results: The software Matlab 7.0 provided the variable center-of-pressure velocities along the mediolateral (Vmx) and anteroposterior (Vmy) axes. In this way it was possible to see that, even when the participants showed a reduction in Vmx and Vmy, it was by less than 1%. Conclusion: This may indicate postural regulatory activitysimilar to before the application of FES, and even less postural regulatory activity when the centerof-pressure velocities were greater at the start, even 90 minutes after the application of FES.

Estudio Ebrictus. Resultados funcionales, supervivencia y años potenciales de vida perdidos después del primer episodio de ictus / Ebrictus study. Functional results, survival, and potential years of life lost after the first stroke

Objetivo: Conocer la mortalidad, el grado de dependencia, la supervivencia y los años potenciales de vida perdidos (APVP) después de un primer episodio de ictus. Diseño: Estudio de cohorte fija. Emplazamiento: Base comunitaria. Participantes: Entre el 1/4/2006 y el 31/3/2008 fueron incluidas 553 personas entre 15-90 años, con un primer episodio de ictus definitivo o transitorio. Mediciones principales: Grado de dependencia según la escala de Barthel (EB) al año, APVP (1-70 años) a partir de las medias de las esperanzas de vida al nacer, análisis de supervivencia por curvas de Kaplan-Meier, bivariante entre pacientes fallecidos y supervivientes, y multivariante de Cox. Resultados: Edad media, 73,3; DE: 11,6 años. El tiempo medio de seguimiento fue 29,7; DE:13,4 meses, en el que un 26,6% de los pacientes fallecieron. El valor medio EB descendió > 20%, especialmente entre las mujeres. El 41,5% (IC 95% 30,6-52,8%) tenía una dependencia moderada o más. La probabilidad de supervivencia global acumulada fue de 0,96 (IC 95% 0,94-0,97) el primer mes y 0,69 (IC 95% 0,65-0,72) al final. La fibrinólisis mejoró significativamente la curva de supervivencia a los 3 años post-episodio, en particular entre las mujeres. Los factores pronósticos independientes para la supervivencia global fueron la edad (riesgo relativo [RR] 1,08, IC 95% 1,001-1,179) y la incidencia de un nuevo episodio cardiovascular (RR 6,97, IC 95% 2,23-21,7). La tasa de APVP fue 11,5/104, DE 7,2, significativamente mayor en los hombres. Conclusiones: La evolución funcional, la mortalidad y la tasa de APVP son diferentes por género. La incidencia de un nuevo episodio cardiovascular es un factor pronóstico independiente de la supervivencia(AU)

Aim: To determine the mortality, degree of dependence, survival, and years of life lost (YLL) after first episode of stroke. Design: Cohort study. Location: Community based register. Participants: A total of 553 subjects between 15-90 years with a first episode of definitive or transitory stroke were recruited between 01/04/2006 and 31/03/2008.MeasurementsThe analyses were performed with the use of time-to-event methods, according to the intention-to-treat principle. The level of dependency was assessed according to the Barthel Scale one year after stroke; YLL (1-70 years) from the mean life expectancies at birth; survival analysis by Kaplan-Meier's curves, bivariate analysis comparing the variables between patients who had survived and those who died, and Cox's multivariate.: Results: The mean age was 73.3 (±11.6 years. The mean time of follow-up was 29.7±13,4 months, during which 26.6% of the patients died. The mean Barthel score fell by >20%, particularly among women. There was moderate or greater dependence in 41.5% (95%CI 30.6-52.8%) of the subjects. The overall accumulative probability of survival was 0.96 (95% CI 0.94-0.97) in the first month and 0.69 (95% CI 0.65-0.72) in the fourth year. The thrombolytic treatment showed a protective effect on mortality, particularly among the women. The main predictive variables were, history of recurrent cardiovascular event (RR 6.7, 95% CI 2.2-21.7) and aging (RR 1.08, 95% CI 1.01-1.2). The average YLL was 11.5/10000/year SD7.2, and higher among men. Conclusion: There are differences in functional outcome, mortality, and potential years of life lost by gender. A new cardiovascular event is an independent prognostic factor of survival(AU)

Effects of the addition of functional electrical stimulation to ground level gait training with body weight support after chronic stroke / Efeitos da adição da estimulação elétrica funcional ao treino de marcha em piso fixo com suporte parcial de peso após acidente vascular encefálico crônico

BACKGROUND: The addition of functional electrical stimulation (FES) to treadmill gait training with partial body weight support (BWS) has been proposed as a strategy to facilitate gait training in people with hemiparesis. However, there is a lack of studies that evaluate the effectiveness of FES addition on ground level gait training with BWS, which is the most common locomotion surface. OBJECTIVE: To investigate the additional effects of commum peroneal nerve FES combined with gait training and BWS on ground level, on spatial-temporal gait parameters, segmental angles, and motor function. METHODS: Twelve people with chronic hemiparesis participated in the study. An A1-B-A2 design was applied. A1 and A2 corresponded to ground level gait training using BWS, and B corresponded to the same training with the addition of FES. The assessments were performed using the Modified Ashworth Scale (MAS), Functional Ambulation Category (FAC), Rivermead Motor Assessment (RMA), and filming. The kinematics analyzed variables were mean walking speed of locomotion; step length; stride length, speed and duration; initial and final double support duration; single-limb support duration; swing period; range of motion (ROM), maximum and minimum angles of foot, leg, thigh, and trunk segments. RESULTS: There were not changes between phases for the functional assessment of RMA, for the spatial-temporal gait variables and segmental angles, no changes were observed after the addition of FES. CONCLUSION: The use of FES on ground level gait training with BWS did not provide additional benefits for all assessed parameters.

CONTEXTUALIZAÇÃO: A adição da estimulação elétrica funcional (EEF) ao treino de marcha em esteira, com sistema de suporte parcial de peso corporal (SPPC), tem sido proposta como estratégia para melhorar a marcha em hemiparéticos. Entretanto, nenhum estudo verificou a eficácia da adição da EEF ao treino de marcha com SPPC em piso fixo, a superfície mais habitual de locomoção. OBJETIVO: Investigar os efeitos da adição da EEF do nervo fibular comum, ao treino de marcha com SSPC, em piso fixo, sobre os parâmetros espaço-temporais da marcha, ângulos segmentares e função motora. MÉTODOS: Participaram do estudo 12 hemiparéticos crônicos. O sistema adotado foi o A1-B-A2. A1 e A2 corresponderam ao treino em piso fixo com SPPC, e B, ao mesmo treino, associado à EEF. As avaliações foram realizadas por meio da Escala de Ashworth Modificada (EAM), da Categoria de Deambulação Funcional (CDF), da Avaliação Motora de Rivermead (AMR) e de filmagens. As variáveis cinemáticas analisadas foram: velocidade média de locomoção; comprimento do passo; comprimento, velocidade e duração da passada; duração dos períodos de apoio duplo inicial e final, apoio simples e balanço; ângulos máximos e mínimos e amplitude de movimento (ADM) dos segmentos pé, perna, coxa e tronco. RESULTADOS: Na AMR, não houve alterações entre as fases. Para as variáveis espaço-temporais e ângulos segmentares, não houve nenhuma alteração após a adição da EEF. CONCLUSÃO: A adição da EEF ao treino de marcha em piso fixo com SPPC não promoveu melhora adicional nos parâmetros mensurados.

Protocolo modificado de la terapia del movimiento inducido por restricción para un hospital de atención a crónicos y larga estancia / Modified protocol of constraint-induced movement therapy for a chronic and long term care hospital

Introducción. La terapia del movimiento inducido por restricción es una de las pocas terapias de rehabilitación del miembro superior que ha demostrado científicamente que tiene un impacto en las actividades de la vida diaria. El objetivo del ensayo clínico aleatorizado es comprobar si la modificación del protocolo original de la terapia del movimiento inducido por restricción mejora la elegibilidad del protocolo original y mantiene los beneficios del mismo. Material y método. Se realiza un estudio comparativo en una muestra de 32 pacientes que han sufrido un accidente cerebrovascular, divididos de manera aleatoria en un grupo experimental y otro control, para determinar si una modificación del protocolo original de la terapia del movimiento inducido por restricción tiene un impacto significativo en la mejora de las actividades de la vida diaria dentro del tratamiento global de pacientes ingresados en un Hospital de atención a crónicos y larga estancia, el Hospital «Pare Jofré» de la ciudad de Valencia. La técnica es comparada con el tratamiento tradicional de terapia ocupacional. Resultados. Se consigue aumentar la elegibilidad de un 1,6%, hasta un 26,22%. Se observa una mejora funcional en las actividades de la vida diaria por el impacto de la técnica dentro del período ingreso-alta con significación estadística (U de Mann-Whitney 0,001) y una diferencia significativa en los niveles de dependencia entre el grupo experimental y el grupo control, observándose que los pacientes que reciben la técnica tienen menores niveles de dependencia (Chi-cuadrado 0,038) y diferencias estadísticamente significativas para actividades de la vida diaria como la alimentación, el vestido, el aseo personal, la ducha, el uso del retrete las transferencias y el desplazamiento, por lo que podemos decir que se mantienen los beneficios del protocolo original. Conclusión. El protocolo modificado mejora la elegibilidad de los pacientes, así como los resultados de los pacientes en actividades de la vida diaria, tanto en alimentación, vestido, higiene, baño, uso del retrete y transferencias (AU)

Introduction. Constraint-induced movement therapy is one of the few therapies for upper limb rehabilitation that has been scientifically proven to have an impact on daily life activities. The purpose of this clinical trial is check whether the modification of the original protocol of constraint- induced movement therapy improves the eligibility restrictions of the original protocol and maintains the benefits. Material and methods. We performed a comparative study on a sample of 32 patients who had suffered a stroke. They were randomly divided into an experimental group and a control group to determine if a modification of the original protocol of constraint-induced movement therapy has a significant impact on improvement in daily living activities within the overall treatment of patients admitted to a chronic care, long stay, hospital, that is, the Hospital “Pare Jofre” of the city of Valencia. The technique was compared with the traditional treatment of occupational therapy. Results. Eligibility is increased from 1.6% to 26.22%. We observed functional improvement in activities of daily living with statistical significance (Mann-Whitney U Test: 0.001) and a significant difference in levels of dependence between the experimental and control group. It has been observed that patients receiving the technique have lower levels of dependency (Chi-square 0.038) and statistically significant differences for activities of daily life, such as eating, dressing, personal hygiene, showering, use of toilet, transfers and movements from one place to another, so we can say that the benefits of the original protocol are maintained. Conclusions. Eligibility is increased with this modified protocol and it has better results in activities of daily living, such as feeding, dressing, hygiene, bathroom, use of the toilet and transfers (AU)

Efectos de la toxina botulínica tipo A y electroestimulación en la espasticidad flexora distal de la extremidad superior en el ictus. Ensayo clínico aleatorizado / Effects of botulinum toxin type A and electrostimulation on distal flexor spasticity of the upper limb in stroke. Randomized clinical trial

Objetivo. Determinar la eficacia de la estimulación eléctrica neuromuscular (EENM) asociada a la toxina botulínica (TB) tipo A en la función motora, capacidad funcional y espasticidad de la mano y la muñeca en pacientes con ictus crónico. Pacientes y métodos. Ensayo clinico randomizado controlado en 25 pacientes con ictus de más de 6 meses de evolución. Tras infiltración de 200 unidades de TB en la musculatura flexora de muñeca y dedos, los participantes se asignaron en dos grupos: EENM en músculos extensores (grupo 1), electroestimulación placebo (grupo 2). Evaluación a las 4 y 16 semanas de la infiltración mediante diferentes escalas de función motora (Fugl-Meyer Motor Assessment [FMA], Medical Research Council Scale [MRC], Motricity Index for Motor Impairment after stroke and dynamometry), capacidad funcional de miembro superior (Chedoke Arm and Hand Activity Inventory [CAHAI], Box and Block Test [BBT]) y tono muscular (escala modificada de Ashworth [MAS]). Resultados. A las 4 semanas, se observa mejoría significativa en: FMA 2,43 (DE 4,08) en el componente para el MS, MRC 0,22 (DE 0,42), CAHAI 4,21 y BBT 1,47 (DE 3,3), así como una reducción de la MAS 0,96 (DE 0,88) en muñeca y 1,17 (DE 1,37) en dedos. A los 4 meses se mantuvo la mejoría en la función motora respecto a los valores basales, pero no de la espasticidad. No se observaron diferencias en ninguna de las variables de función motora y capacidad funcional del MS entre los dos grupos. Conclusiones. La infiltración de TB tipo A en la espasticidad flexora distal del MS mejora la función motora, capacidad funcional y espasticidad en el ictus crónico, pero añadir EENM de la musculatura extensora de la muñeca y dedos no muestra beneficios adicionales (AU)

Objective. To evaluate the efficacy of the Neuromuscular Electrical Stimulation (NMES) associated to Botulinum Toxin (TB) type A in motor function, functional capacity and spasticity in chronic post-stroke upper limb (UL) spasticity. Patients and methods. A randomized controlled clinical trial was performed in 25 ictus patients with more than 6 months evolution. After infiltration of 200 units of TB in the flexor muscle of the finger and wrist muscles, the patients were assigned to two groups: NMES in extensor muscles (group 1) and sham-stimulation (group 2). Patients were assessed at weeks 4/16 post-injection by standard motor function scales (Fugl-Meyer Motor Assessment (FMA), Medical Research Council Scale (MRC), Motricity Index for Motor Impairment after stroke and dynamometry), UL functional capacity (Chedoke Arm and Hand Activity Inventory (CAHAI), Box and Block Test (BBT) and muscular tone (Modified Ashworth Scale (MAS)). Results. At week 4, significant improvement was observed in FMA 2.4 (SD 4.1) in UL component, MRC 0.2 (SD 0.4), CAHAI 4.2 and BBT 1.5 (SD 3.3), as well as a reduction in MAS 1.0 (SD 0.9) in the wrist and 1.2 (SD 1.4) in the fingers. At month 4, this effect was maintained in motor function but not in spasticity. No significant differences were observed in UL motor function, functional capacity between the groups. Conclusions. TB type A injection in UL distal flexor spasticity enhances motor function, functional capacity and spasticity in chronic stroke patients. Adding a program of NMES for the extensor wrist/fingers muscles does not provide any additional benefits (AU)

Avaliação da mobilidade funcional do paciente com sequela de AVC após tratamento na piscina terapêutica, utilizando o teste Timed Up and Go / Evaluation of functional mobility of patients with stroke sequela after treatment in hydrotherapy pool using the Timed Up and Go Test

Objective: To evaluate the functional mobility of patients with stroke over 12 sessions of hydrotherapy. Methods: Ten stroke patients aged between 5 and 85 years were evaluated by means of the Timed Up and Go test, which contains some items, such as balance, walking speed, changing directions, and standing up from a seated position. The study patients performed the test before and after each hydrotherapy session (total of 12 sessions). Each individual was compared to him/herself both short-term (pre- and post-therapy) and long-term (after 12 therapy sessions). Result: Comparing baseline and after 12 sessions, it was noted that the 10 patients improved their performance, with a decrease in time to execute the Timed Up and Go test. Conclusion: An exercise program in a hydrotherapy pool was beneficial for functional mobility performance improvement in stroke patients.

Objetivo: Avaliar a mobilidade funcional de pacientes com acidente vascular cerebral no decorrer de 12 sessões de hidroterapia. Métodos: Foram avaliados 10 pacientes com acidente vascular cerebral com idades entre 5 e 85 anos por meio do teste Timed Up and Go, que contém itens como equilíbrio, velocidade da marcha, mudança de direção e transferência de sentado para em pé. Os pacientes do estudo realizaram o teste antes e depois de cada sessão de hidroterapia (total de 12 terapias). Cada indivíduo foi comparado com ele mesmo, a curto prazo (pré e pós-terapia) e a longo prazo (após 12 terapias). Resultado: Comparados no início e ao final das 12 sessões, verificou-se que os 10 pacientes melhoraram sua performance, apresentando diminuição do tempo na execução do teste Timed Up and Go. Conclusão: O programa de exercícios em piscina terapêutica foi benéfico para melhora da performance da mobilidade funcional de pacientes portadores de acidente vascular cerebral.

La experiencia psicosocial y espiritual de las personas mayoresen recuperación de un ictus / No disponible

No disponible