Exercise interventions, gait, and balance in older subjects with distal symmetric polyneuropathy: a three-group randomized clinical trial.

OBJECTIVE: Older patients with a distal symmetric polyneuropathy are at markedly increase risk for falls and fall-related injuries. Despite this, few studies have investigated the effect of exercise regimens on gait and balance in this high-risk group. DESIGN: One hundred older patients with distal symmetric polyneuropathy were randomized to one of three interventions: functional balance training, Tai Chi, or education-only control. The subjects in each group received instruction in ten 1-hr weekly sessions. Outcome measures were determined at baseline and the end of the 10-wk intervention. Gait, balance, and falls self-efficacy were assessed with various well established clinical (Berg Balance Scale, 8 Foot Up and Go Test, and Modified Falls Efficacy Scale) and laboratory-based measures (three-dimensional gait analysis and NeuroCom limits of stability and sensory organization tests). RESULTS: The Tai Chi subjects demonstrated a decreased (faster) Timed Up and Go and increased stride length and time spent in single limb support at the end of intervention as compared with baseline. The functional balance training group demonstrated a significant increase in ankle plantar flexor power and near significant decreases in step width and step width variability. No changes in the education-only control group were observed. CONCLUSIONS: Older patients with distal symmetric polyneuropathy may benefit from Tai Chi and/or functional balance training, with the former improving functional mobility and gait and the latter possibly improving trunk stabilization and forward progression (Lythgo N, Cofré LE: Relationship between ankle plantar flexor power and EMG muscle activity during gait. 30th Annual Conference of Biomechanics in Sports [Melbourne, 2012]. Available at: https://ojs.ub.uni-konstanz.de/cap/article/viewFile/5320/4891). Whether these laudable changes can be maintained or translate into decreased risk for falls and fall-related injuries is unknown.

Farmacopuntura en la rehabilitación de neuropatía periférica epidémica / Pharmacopuncture in the rehabilitation of peripheral and epidemic neuropathy

Se realiza un estudio descriptivo, longitudinal, y retrospectivo en pacientes con polineuropatía periférica epidémica (PPE); que son rehabilitados por el método de farmacopuntura en la Clínica de Medicina Tradicional y Natural de Baracoa; con el objetivo de evaluar su evolución clínica en el período comprendido desde enero de 2000 a diciembre de 2009. Conforman la muestra de estudio 96 pacientes afectados. Las variables a utilizar son: edad, sexo y números de sesiones recibidos. La información se obtiene de la base de datos de archivo, los mismos son llevados a una planilla de vaciamiento procesados mediante técnicas computarizadas, analizados y plasmados en tablas de distribución de frecuencia, lo que permite concluir que la enfermedad tiene predominio en mujeres, en su primer período de vida adulta (20-40), llegando a demostrar la efectividad del método en la mayoría de los pacientes en estudio, por lo que se recomienda su aplicación(AU)

A descriptive, longitudinal and retrospective study is done in patients with peripheral polyneuropathy Epidemic, that were rehabilitated by the method of pharmacopuncture at the Clinic of Traditional and natural Medicine, with the aim of evaluating its clinical course during January 2000 to December 2009. In the study, sample was involved 96 patients. The variables were used: age, sex and numbers of received sessions. The information was obtained from the database file, they were taken to a form of emptying processed by computer techniques, analyzed and reflected in frequency distribution tables, which concluded that the disease was more common in women in their first adult life (20 - 40), coming to demonstrate the effectiveness of the method in most studied patients, and its application is recommended(AU)

[Evaluating efficiency of rehabilitation in patients with occupational vegetative sensory polyneuropathies caused by physical overstrain].

Analysis of medical and occupational rehabilitation efficiency in patients with occupational polyneuropathies caused by physical overstrain revealed that most patients show persistent symptoms and ineffective occupational rehabilitation in spite of regular medical and sanatorium-and-spa treatment.

Polineuropatía tardía secundaria a intoxicación por insecticidas organofosforados / Delayed polyneuropathy induced by organophosphorus insecticides poisoning

Los insecticidas organofosforados presentan como mecanismo tóxico más importante la inhibición directa de la acetilcolinesterasa.También pueden producir efectos tóxicos directos, un síndrome intermedio y con me-nor frecuencia una polineuropatía tardía, que afecta fundamentalmente a nervios periféricos y que puede evolucionar de forma retrógrada y ascendente, afectando al sistema nervioso central. Presentamos el caso de un paciente de 72 años, que dos semanas después de fumigar con insecticidas organofosforados inició un cuadro progresivo de disestesias, déficit de fuerza de predominio en extremidades inferiores y progresivo trastorno de la marcha, que desembocó en una tetraparesia flácida. El electromiograma confirmó una polineuropatía mixta motora y sensitiva, compatible con neuropatía desmielinizante con componente axonopático sensitivo grave. No existe tratamiento farmacológico específico para la polineuropatía tardía.Tras el tratamiento sintomático de las complicaciones en fase aguda, únicamente el tratamiento rehabilitador puede tener utilidad a la hora de minimizar las secuelas funcionales (AU)

The most important poisoning mechanism of organophosphorus insecticides is the direct inhibition of acetylcholinesterase.This may also cause direct toxicity, an intermediate syndrome and less frequently delayed polyneuropathy, which mainly affects peripheral nerves and may progress in an ascending retrograde way, compromising the central nervous system.We present the case of a 72-year old man who at two weeks of fumigating with organophosphorus insecticides developed a progressive picture of paresthesias, dysesthesias, lower limb weakness and gait disorders that resulted in flaccid tetraparesia.The electromyography confirmed the presence of mixed sensorimotor polyneuropathy in the lower limbs consistent with demyelinating neuropathy and severe axonopathy component.There is no specific pharmacological treatment for delayed polyneuropathy and once the symptomatic treatment has been provided in the acute phase, only rehabilitation has proven to be effective in minimizing functional sequelae of these patients (AU)

The oil-dispersion bath in anthroposophic medicine--an integrative review.

BACKGROUND: Anthroposophic medicine offers a variety of treatments, among others the oil-dispersion bath, developed in the 1930s by Werner Junge. Based on the phenomenon that oil and water do not mix and on recommendations of Rudolf Steiner, Junge developed a vortex mechanism which churns water and essential oils into a fine mist. The oil-covered droplets empty into a tub, where the patient immerses for 15-30 minutes. We review the current literature on oil-dispersion baths. METHODS: The following databases were searched: Medline, Pubmed, Embase, AMED and CAMbase. The search terms were 'oil-dispersion bath' and 'oil bath', and their translations in German and French. An Internet search was also performed using Google Scholar, adding the search terms 'study' and 'case report' to the search terms above. Finally, we asked several experts for gray literature not listed in the above-mentioned databases. We included only articles which met the criterion of a clinical study or case report, and excluded theoretical contributions. RESULTS: Among several articles found in books, journals and other publications, we identified 1 prospective clinical study, 3 experimental studies (enrolling healthy individuals), 5 case reports, and 3 field-reports. In almost all cases, the studies described beneficial effects - although the methodological quality of most studies was weak. Main indications were internal/metabolic diseases and psychiatric/neurological disorders. CONCLUSION: Beyond the obvious beneficial effects of warm bathes on the subjective well-being, it remains to be clarified what the unique contribution of the distinct essential oils dispersed in the water can be. There is a lack of clinical studies exploring the efficacy of oil-dispersion baths. Such studies are recommended for the future.

Rehabilitación de un paciente con miositis por cuerpos de inclusión / Rehabilitation of patient with inclusion bodies

La miositis por cuerpos de inclusión (MCI) es una de las miopatías inflamatorias idiopáticas menos frecuente y más desconocida. Se presenta el caso de un varón de 36 años con tetraparesia secundaria a MCI trasladado a nuestro hospital para tratamiento rehabilitador consistente en: tratamiento postural, cinesiterapia, electroestimulación, ortesis, terapia ocupacional y ayudas técnicas. El enfermo era dependiente para las actividades de la vida diaria (AVD), presentaba amiotrofia, no realizaba sedestación y se le diagnosticó además de polineuropatía del enfermo crítico en miembros inferiores. Al alta, era independiente para AVD básicas e instrumentales y realizaba marcha con una ortesis antiequina y una ayuda externa contralateral. Nuestra experiencia no coincide con la creencia generalizada de que no se puede realizar cinesiterapia activa en estos pacientes, mientras existan alteraciones de los parámetros de inflamación o de las enzimas musculares

Inclusion body myositis (IBM) is one of the less frequent and most unknown idiopathic inflammatory myopathies. The case of a 36 year old male is presented. He had tetraparesis secondary to IBM and was transferred to our hospital for rehabilitation treatment consisting in: postural treatment, kinesitherapy, electrostimulation, orthesis, occupational therapy and technical help. The patient was dependent for daily life activities (DLA), had amyotrophy, did not sit up and was also diagnosed of polyneuropathy of critical patient in lower limbs. On discharge, he was independent for basic and instrumental DLA and could walk with an anti-equine orthesis and external contralateral help. Our experience does not coincide with the generalized belief that active kinesitherapy cannot be done in these patients while there are alterations of the inflammation or muscular enzyme parameters

The thought translation device: a neurophysiological approach to communication in total motor paralysis.

A thought translation device (TTD) for brain-computer communication is described. Three patients diagnosed with amyotrophic lateral sclerosis (ALS), with total motor paralysis, were trained for several months. In order to enable such patients to communicate without any motor activity, a technique was developed where subjects learn to control their slow cortical potentials (SCP) in a 2-s rhythm, producing either cortical negativity or positivity according to the task requirement. SCP differences between a baseline interval and an active control interval are transformed into vertical or horizontal cursor movements on a computer screen. Learning SCP self regulation followed an operant-conditioning paradigm with individualized shaping procedures. After prolonged training over more than 100 sessions, all patients achieved self-control, leading to a 70-80% accuracy for two patients. The learned cortical skill enabled the patients to select letters or words in a language-supporting program (LSP) developed for inter-personal communication. The results demonstrate that the fast and stable SCP self-control can be achieved with operant training and without mediation of any muscle activity. The acquired skill allows communication even in total locked-in states.