Treatment patterns and outcomes in metastatic castration-resistant prostate cancer patients with and without somatic or germline alterations in homologous recombination repair genes.

BACKGROUND: Although germline BRCA mutations have been associated with adverse outcomes in prostate cancer (PC), understanding of the association between somatic/germline alterations in homologous recombination repair (HRR) genes and treatment outcomes in metastatic castration-resistant PC (mCRPC) is limited. The aim of this study was to investigate the prevalence and outcomes associated with somatic/germline HRR alterations, particularly BRCA1/2, in patients initiating first-line (1L) mCRPC treatment with androgen receptor signalling inhibitors (ARSi) or taxanes. PATIENTS AND METHODS: Data from 729 mCRPC patients were pooled for CAPTURE from four multicentre observational studies. Eligibility required 1L treatment with ARSi or taxanes, adequate tumour samples and biomarker panel results. Patients underwent paired normal and tumour DNA analyses by next-generation sequencing using a custom gene panel including ATM, BRCA1, BRCA2, BRIP1, CDK12, CHEK2, FANCA, HDAC2, PALB2, RAD51B and RAD54L. Patients were divided into subgroups based on somatic/germline alteration(s): with BRCA1/2 mutations (BRCA); with HRR mutations except BRCA1/2 (HRR non-BRCA); and without HRR alterations (non-HRR). Patients without BRCA1/2 mutations were classified as non-BRCA. Radiographic progression-free survival (rPFS), progression-free survival 2 (PFS2) and overall survival (OS) were assessed. RESULTS: Of 729 patients, 96 (13.2%), 127 (17.4%) and 506 (69.4%) were in the BRCA, HRR non-BRCA and non-HRR subgroups, respectively. BRCA patients performed significantly worse for all outcomes than non-HRR or non-BRCA patients (P < 0.05), while PFS2 and OS were significantly shorter for BRCA than HRR non-BRCA patients (P < 0.05). HRR non-BRCA patients also had significantly worse rPFS, PFS2 and OS than non-HRR patients. Exploratory analyses suggested that for BRCA patients, there were no significant differences in outcomes associated with 1L treatment choice (ARSi or taxanes) or with the somatic/germline origin of the alterations. CONCLUSIONS: Worse outcomes were observed for mCRPC patients in the BRCA subgroup compared with non-BRCA subgroups, either HRR non-BRCA or non-HRR. Despite its heterogeneity, the HRR non-BRCA subgroup presented worse outcomes than the non-HRR subgroup. Screening early for HRR mutations, especially BRCA1/2, is crucial in improving mCRPC patient prognosis.

Prevalence and distribution of hepatitis C virus genotypes in Spain during the 2000-2015 period (the GEHEP 005 study).

We report the largest study on the prevalence and distribution of HCV genotypes in Spain (2000-2015), and we relate them with clinical, epidemiological and virological factors. Patients from 29 hospitals in 10 autonomous communities (Andalusia, Aragon, Castilla-Leon, Catalonia, Galicia, Canary Islands, Madrid Community, Valencian Community, Murcia Region and Basque Country) have been studied. Annual distribution of HCV genotypes and subtypes, as well as gender, age, transmission route, HIV and/or HBV coinfection, and treatment details were recorded. We included 48595 chronically HCV-infected patients with the following characteristics: median age 51 years (IQR, 44-58), 67.9% male, 19.1% HIV-coinfected, 23.5% HBV-coinfected. Parenteral transmission route was the most frequent (58.7%). Genotype distribution was 66.9% GT1 (24.9% subtype 1a and 37.9% subtype 1b), 2.8% GT2, 17.3% GT3, 11.4% GT4 and 0.1% GT5 and 0.02% GT6. LiPA was the most widely HCV genotyping test used (52.4%). HCV subtype 1a and genotypes 3 and 4 were closely associated with male gender, parenteral route of infection and HIV and HBV coinfection; in contrast, subtype 1b and genotype 2 were associated with female gender, nonparenteral route and mono-infection. Age was related to genotype distribution, and different patterns of distribution and biodiversity index were observed between different geographical areas. Finally, we describe how treatment and changes in transmission routes may have affected HCV genotype prevalence and distribution patterns. We present the most recent data on molecular epidemiology of hepatitis C virus in Spain. This study confirms that genotype distributions vary with age, sex, HIV and HBV coinfection and within geographical areas and epidemiological groups.

Neurodevelopment in preschool idiopathic toe-walkers. / Desarrollo neuromadurativo en andadores de puntillas de edad preescolar.

INTRODUCTION: Idiopathic toe walking, a differential diagnosis for neurological and orthopaedic disorders, has been associated with neurodevelopmental alterations. Neurodevelopmental assessment at early ages using specific tests may improve management and follow-up of these patients. The aim of our study is to analyse the neurodevelopmental characteristics of preschool idiopathic toe-walkers (ITW) by comparing them to a control group. METHOD: Our descriptive cross-sectional study compared possible risk factors, neurodevelopmental characteristics, and scores on the Child Neuropsychological Maturity Questionnaire (CUMANIN) between a group of 56 ITWs aged 3 to 6 and a control group including 40 children. RESULTS: The proportion of males was significantly higher in the ITW group (P=.008). The percentage of patients with a family history (P=.000) and biological risk factors during the perinatal period (P=.032) was also higher in this group. According to the parents' reports, motor coordination in ITWs was significantly poorer (59%; P=.009). ITWs scored significantly lower on CUMANIN subscales of psychomotricity (=0,001) and memory (P=.001), as well as in verbal development (P=.000), non-verbal development (P=.026), and overall development (P=.004). Foot preference was less marked in the ITW group (P=.047). CONCLUSIONS: The neurodevelopmental characteristics of our sample suggest that idiopathic toe walking is a marker of neurodevelopmental impairment. However, further studies are necessary to confirm these findings.

Neuraxial anaesthesia in patients with cerebrospinal fluid shunts: A descriptive review.

Neuraxial anesthesia in patients with cerebrospinal fluid (CSF) shunt devices has traditionally been associated with a high risk of complications. In order to gather all available evidence, a structured search was conducted to include published studies involving users of these devices, undergoing any form of neuraxial technique for obstetric or surgical procedures unrelated to them. Effectiveness of the technique and perioperative complications were assessed. Only case series and case reports (n = 72) were identified. One patient was found to have insufficient anesthetic coverage, necessitating a modification of the technique, and another one had an intraoperative complication which compromised the subject's safety. No infection events or postoperative device dysfunction related to the anesthetic method were described. The evidence found is scarce and of low quality, preventing the establishment of significant conclusions. Nevertheless, patients may obtain benefit from an individualized evaluation.

Stromal disrupting effects of nab-paclitaxel in pancreatic cancer.

BACKGROUND: Nab-paclitaxel and gemcitabine have demonstrated a survival benefit over gemcitabine alone in advanced pancreatic cancer (PDA). This study aimed to investigate the clinical, biological, and imaging effects of the regimen in patients with operable PDA. METHODS: Patients with operable PDA received two cycles of nab-paclitaxel and gemcitabine before surgical resection. FDG-PET and CA19.9 tumour marker levels were used to measure clinical activity. Effects on tumour stroma were determined by endoscopic ultrasound (EUS) elastography. The collagen content and architecture as well as density of cancer-associated fibroblasts (CAFs) were determined in the resected surgical specimen and compared with a group of untreated and treated with conventional chemoradiation therapy controls. A co-clinical study in a mouse model of PDA was conducted to differentiate between the effects of nab-paclitaxel and gemcitabine. RESULTS: A total of 16 patients were enrolled. Treatment resulted in significant antitumour effects with 50% of patients achieving a >75% decrease in circulating CA19.9 tumour marker and a response by FDG-PET. There was also a significant decrement in tumour stiffness as measured by EUS elastography. Seven of 12 patients who completed treatment and were operated had major pathological regressions. Analysis of residual tumours showed a marked disorganised collagen with a very low density of CAF, which was not observed in the untreated or conventionally treated control groups. The preclinical co-clinical study showed that these effects were specific of nab-paclitaxel and not gemcitabine. CONCLUSION: These data suggest that nab-paclitaxel and gemcitabine decreases CAF content inducing a marked alteration in cancer stroma that results in tumour softening. This regimen should be studied in patients with operable PDA.

Modifications in family centered developmental care and in neonatal intensive care during the COVID-19 pandemic in a hospital in Spain: A qualitative study.

INTRODUCTION: Family centered developmental care (FCDC) are a philosophy of care in the neonatal care units (NICU), based on the control of sensory stimulation the adequate position and of newborn and the family involvement of cares. Nursing staff are the main providers of this care. Sanitary measure to control of the COVID-19, such as the use of masks, isolation of positive cases and capacity limit, conditioned the implementation of FCDC. OBJECTIVES: To understand the meaning of the experience of the nursing staff of a neonatal intensive care unit (NICU) on the implementation of the FCDC, under the sanitary measures imposed for the containment of COVID-19. METHODS: A qualitative study was conducted from the descriptive phenomenological paradigm in which NICU nurses were recruited. The qualitative data collection was carried out through open-ended and semi-structured interviews. These were analyzed respectively through a preliminary narrative analysis and a thematic analysis of the informant nurses' narratives and discourses. RESULTS: Three open-ended and 7 semi-structured interviews were conducted from which three main topics emerged: 1) changes in the FCDC derived from the sanitary restrictions implemented for the containment of COVID-19; 2) changes in interpersonal relationships in the context of a pandemic, and 3) transition to normality. CONCLUSIONS: The nurses of NICU perceived changes in the implementation of the FCDC due to the containment of COVID-19, that modified the relationship with the parents of NB, accelerating their training as caregivers, and involved the implementation of new measures such as video calls.

[Effectiveness of mirror therapy and action observation therapy in infantile cerebral palsy: a systematic review].

The aim of this review was to assess the effectiveness of mirror therapy (MT) and action observation therapy (AOT) on upper limb-related body structures, body functions, activity, and involvement in patients with infantile cerebral palsy (ICP). We carried out a systematic review of randomized controlled trials published over the past 10 years, in which MT or AOT was compared to other ICP-directed interventions. Nine studies met the inclusion criteria and we measured their methodological quality using the PEDro scale. MT or AOT seem to significantly improve upper limb-related body structures, body function, activity, and participation in comparison to other interventions for ICP. Both seem to improve overall quality of life, reduce their disability, and promote its functioning. Further studies with higher methodological quality need to be developed to confirm the long-term effectiveness of MT and AOT.

[Postural control and gait changes in subacute stroke patients after receiving interdisciplinary rehabilitation and related factors: a retrospective study]. / Cambios en el control postural y la marcha en pacientes con ictus en fase subaguda tras recibir rehabilitación interdisciplinar y factores relacionados: estudio retrospectivo.

INTRODUCTION: Although early post-stroke rehabilitation is essential to optimize recovery, its effects and prognostic factors are yet under discussion. OBJECTIVE: To assess postural control and gait changes in post-stroke patients who underwent interdisciplinary rehabilitation in subacute phase and evaluate potential associated factors. PATIENTS AND METHODS: An observational retrospective study that analyzed sociodemographic and clinical data, including Trunk Impairment Scale (TIS), Postural Assessment Scale for Stroke (PASS), Functional Ambulatory Categories (FAC) and Tinetti scale, at admission and two months after rehabilitation. RESULTS: Data were collected from 63 patients with stroke in subacute phase. Interdisciplinary rehabilitation had a moderate and relevant clinical impact (p < 0,01; d mayor de 0,5) in postural control and gait. Ambulatory rehabilitation, psychotropic medication absence and dislipemia absence were moderate associated factors (p < 0,05; d mayor de 0,5) with a greater evolution in postural control measured with TIS and PASS. TIS at admission showed significant association with all scales' results at two months after rehabilitation, except with PASS changing posture subscale. CONCLUSIONS: Interdisciplinary rehabilitation promotes moderate and clinically relevant changes in postural control and gait recovery in subacute stroke patients, after two-month rehabilitation period. Ambulatory rehabilitation, dyslipidemia absence and psychotropic medication absence were associated with patients' evolution, but further research is required to confirm their actual influence in larger samples.

TITLE: Cambios en el control postural y la marcha en pacientes con ictus en fase subaguda tras recibir rehabilitación interdisciplinar y factores relacionados: estudio retrospectivo.Introducción. La rehabilitación precoz tras el ictus resulta fundamental para optimizar la recuperación, pero sus efectos y los factores pronósticos están aún en discusión. Objetivo. Evaluar los cambios en el control postural y la marcha en los pacientes con ictus que reciben rehabilitación interdisciplinar en fase subaguda y valorar los posibles factores relacionados. Pacientes y métodos. Estudio observacional retrospectivo que analizó datos sociodemográficos y clínicos, incluyendo el control postural y la capacidad de marcha, mediante las escalas Trunk Impairment Scale (TIS), Postural Assessment Scale for Stroke (PASS), Functional Ambulation Categories (FAC) y de Tinetti, tanto en el inicio como a los dos meses de rehabilitación. Resultados. Se recogieron datos de 63 pacientes con ictus en fase subaguda. La rehabilitación interdisciplinar tuvo un impacto clínico moderado (p menor de 0,01; d mayor de 0,5) y relevante sobre el control postural y la marcha. Los factores asociados moderadamente (p menor de 0,05; d > 0,5) a una mayor evolución en el control postural evaluado con la TIS y la PASS fueron la rehabilitación ambulatoria, la ausencia de medicación psicótropa y la ausencia de dislipidemia. La TIS en el inicio se asoció significativamente (p menor de 0,05) con los valores de todas las escalas tras dos meses de rehabilitación, excepto con la PASS movilidad. Conclusiones. La rehabilitación interdisciplinar favorece cambios moderados y clínicamente relevantes en la recuperación del control postural y la marcha de pacientes con ictus subagudo tras dos meses de tratamiento. La rehabilitación ambulatoria y la ausencia de dislipidemia y de medicación psicótropa se asocian con la evolución, pero son necesarios más estudios para confirmar su influencia en muestras mayores.

Spanish translation and validation of the Scale for Contraversive Pushing to measure pusher behaviour.

INTRODUCTION: The aim of this study was to develop and validate a Spanish-language version of the Scale for Contraversive Pushing, used to diagnose and measure pusher behaviour in stroke patients. METHODS: Translation-back translation was used to create the Spanish-language Scale for Contraversive Pushing; we subsequently evaluated its validity and reliability by administering it to a sample of patients. We also analysed its sensitivity to change in patients identified as pushers who received neurological physiotherapy. RESULTS: Experts indicated that the content of the scale was valid. Internal consistency was very good (Cronbach's alpha of 0.94). The intraclass correlation coefficient showed high intra- and interobserver reliability (0.999 and 0.994, respectively). The Kappa and weighted Kappa coefficients were used to measure the reliability of each item; the majority obtained values above 0.9. Lastly, the differences between baseline and final evaluations of pushers were significant (paired sample t test), showing that the scale is sensitive to changes obtained through physical therapy. CONCLUSIONS: The Spanish-language version of the Scale for Contraversive Pushing is valid and reliable for measuring pusher behaviour in stroke patients. In addition, it is able to evaluate the ongoing changes in patients who have received physical therapy.

[Effectiveness of respiratory physiotherapy combined with postural education in children with chronic neurological diseases].

BACKGROUND: Children with chronic neurological diseases present motor disability and increased respiratory morbidity and mortality. The aim of this study was to assess whether children with chronic neurological impairment benefit from respiratory physiotherapy and postural hygiene. METHODS: Quasi-experimental study in which six fortnightly respiratory physiotherapy sessions and workshops on postural hygiene were carried out on children aged 0 to 6 years with chronic neurological disease and respiratory impairment. A PedsQL questionnaire assessed respiratory clinical variables, expectorated secretions, respiratory exacerbations and quality of life. Assessments were performed at baseline, post-intervention, and at a 3-month follow-up. RESULTS: After physiotherapy sessions, all participants (n=30) experienced a significant (p<0.001) improvement in average oxygen saturation (94.37 to 98.3%), heart rate (126.03 to 103.6 beats/minute) and respiratory rate (42.13 to 34.27 breaths/minute), as well as a decrease in secretions (from 45.33 to 28.17 mL). This improvement was maintained after a 3-month follow-up. The average respiratory exacerbations decreased (p<0.001) compared to the previous six months: hospitalizations (from 1.6 to 0.5), visits to the emergency department (from 2.59 to 1.53) and to primary care Pediatric consultations (from 7 to 5.03). The mean score on the PedsQL questionnaire demonstrated a significant increase (p<0.001) in the quality of life after the intervention for physical (27%, to 73.4) and mental health (12%, to 70.09%). CONCLUSION: Respiratory physiotherapy combined with postural hygiene is effective for the clinical status and quality of life in children with chronic neurological diseases, and therefore could be introduced in habitual clinical practice.

[Effectiveness of motor imagery in patients with multiple sclerosis: a systematic review]. / Eficacia de la imagen motora en la esclerosis múltiple: revisión sistemática.

INTRODUCTION: Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. Motor imagery (MI) has been proposed as a treatment to improve gait, fatigue and quality of life in these dysfunctions. AIM: To assess the effectiveness of MI, action observation therapy or mirror therapy approaches compared to other rehabilitation modality or no intervention, in MS. DEVELOPMENT: A systematic review of randomized controlled trials was conducted. Studies published in the last ten years investigating MI versus other interventions or no intervention in patients with MS were included. PEDro scale was used to assess methodological quality of included studies. Eight studies met the eligibility criteria. For fatigue, the MI and its combination with relaxation seem to be superior compared with other types of interventions or no intervention. The MI combined with music also showed significant improvements in gait and quality of life (QoL). CONCLUSIONS: MI and its combination with relaxation exercises have been shown to be effective in the treatment of fatigue, gait, balance, depression and QoL in patients with MS. The action observation therapy is useful in upper limb rehabilitation and improvement in attention, executive control and activation of sensorimotor networks. Further research with high methodological quality is needed to support these findings and to evaluate their effectiveness in long term.

TITLE: Eficacia de la imagen motora en la esclerosis múltiple: revisión sistemática.Introducción. La esclerosis múltiple (EM) es una enfermedad inflamatoria desmielinizante del sistema nervioso central. Se ha propuesto la imagen motora (IM) como tratamiento para mejorar la marcha, la fatiga y la calidad de vida en esta patología. Objetivo. Evaluar la eficacia del abordaje mediante IM, terapia de observación de acciones (AOT) o terapia en espejo, en comparación con una modalidad diferente de rehabilitación o la no intervención en la EM. Desarrollo. Se realizó una revisión sistemática de ensayos controlados aleatorizados. Se incluyeron estudios de los últimos 10 años que comparasen la IM frente a otras intervenciones o la no intervención en pacientes con EM. Se utilizó la escala PEDro para evaluar la calidad metodológica de los estudios incluidos. Ocho estudios cumplieron los criterios de elegibilidad. Para la fatiga, la IM y su combinación con la relajación parecen ser superiores en comparación con otros tratamientos o la no intervención. La IM combinada con música también mostró mejoras significativas en la marcha y en la calidad de vida. Conclusiones. La IM combinada con ejercicios de relajación ha demostrado eficacia en el tratamiento de la fatiga, la marcha, el equilibrio, la depresión y la calidad de vida en personas con EM. La AOT resulta útil en la rehabilitación del miembro superior y en la mejora de la atención, el control ejecutivo y la activación de las redes sensoriomotoras. Son necesarios estudios de mayor calidad metodológica que respalden estos resultados y valoren su efectividad a largo plazo.

Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study. / Características, evolución clínica y factores asociados a la mortalidad en UCI de los pacientes críticos infectados por SARS-CoV-2 en España: estudio prospectivo, de cohorte y multicéntrico.

BACKGROUND: The clinical course of COVID-19 critically ill patients, during their admission in the intensive care unit (UCI), including medical and infectious complications and support therapies, as well as their association with in-ICU mortality has not been fully reported. OBJECTIVE: This study aimed to describe clinical characteristics and clinical course of ICU COVID-19 patients, and to determine risk factors for ICU mortality of COVID-19 patients. METHODS: Prospective, multicentre, cohort study that enrolled critically ill COVID-19 patients admitted into 30 ICUs from Spain and Andorra. Consecutive patients from March 12th to May 26th, 2020 were enrolled if they had died or were discharged from ICU during the study period. Demographics, symptoms, vital signs, laboratory markers, supportive therapies, pharmacological treatments, medical and infectious complications were reported and compared between deceased and discharged patients. RESULTS: A total of 663 patients were included. Overall ICU mortality was 31% (203 patients). At ICU admission non-survivors were more hypoxemic [SpO2 with non-rebreather mask, 90 (IQR 83 to 93) vs. 91 (IQR 87 to 94); P<.001] and with higher sequential organ failure assessment score [SOFA, 7 (IQR 5 to 9) vs. 4 (IQR 3 to 7); P<.001]. Complications were more frequent in non-survivors: acute respiratory distress syndrome (ARDS) (95% vs. 89%; P=.009), acute kidney injury (AKI) (58% vs. 24%; P<10-16), shock (42% vs. 14%; P<10-13), and arrhythmias (24% vs. 11%; P<10-4). Respiratory super-infection, bloodstream infection and septic shock were higher in non-survivors (33% vs. 25%; P=.03, 33% vs. 23%; P=.01 and 15% vs. 3%, P=10-7), respectively. The multivariable regression model showed that age was associated with mortality, with every year increasing risk-of-death by 1% (95%CI: 1 to 10, P=.014). Each 5-point increase in APACHE II independently predicted mortality [OR: 1.508 (1.081, 2.104), P=.015]. Patients with AKI [OR: 2.468 (1.628, 3.741), P<10-4)], cardiac arrest [OR: 11.099 (3.389, 36.353), P=.0001], and septic shock [OR: 3.224 (1.486, 6.994), P=.002] had an increased risk-of-death. CONCLUSIONS: Older COVID-19 patients with higher APACHE II scores on admission, those who developed AKI grades ii or iii and/or septic shock during ICU stay had an increased risk-of-death. ICU mortality was 31%.

Numerical study on electrohydrodynamic multiple droplet interactions.

We present a numerical study of inviscid multiple droplet coalescence and break-up under the action of electric forces. Using an embedded potential flow model for the droplet hydrodynamics, coupled with an unbounded exterior electrostatic problem, we are able to perform computations through various singular events and analyze the effects of the electrical field intensity on droplet interactions. Laboratory experiments on the electrodynamics of droplet pairs show a much richer, and sometimes unexpected, behavior than that of isolated droplets. For example, it has been found that opposite charged droplets tend to repel each other when the electric field intensity is above a certain critical value. Although the mathematical model employed in this work incorporates very simple flow and electric assumptions, many of the droplet coalescence patterns seen in laboratory experiments can be reproduced. In this model, the interaction pattern of two droplets of radii R_{0} separated a distance D_{0}, depends on the ratio X_{0}=D_{0}/R_{0} and the applied uniform electric field intensity, E_{∞}. By performing a vast number of numerical simulations we are able to characterize the coalescence modes before and after drop merging as a function of these two parameters. The simulations predict that droplet repulsion occurs within a narrow interval of E_{∞} values, different for each X_{0}. Surprisingly, in this E_{∞} interval, a sharp transition between two power-law precoalescence flow regimes is seen. The evolution of several flow characteristics before and after coalescence, and the shape of the deformed droplets at coalescing time and the double cone angle, are also addressed and analyzed in detail. Cone angles below 35^{∘} lead to droplet coalescence for any X_{0} value, which is in accordance with previously reported studies. Finally, it is shown that the model and algorithm can handle multiple droplet interactions. The simulations qualitatively match results from water in oil experiments in microchannels, despite the fact that the exterior fluid is not considered in the mathematical model.

Effects of auditory cues on gait initiation and turning in patients with Parkinson's disease. / Efectos de los estímulos auditivos en la fase de iniciación de la marcha y de giro en pacientes con enfermedad de Parkinson.

OBJECTIVE: To review the available scientific evidence about the effectiveness of auditory cues during gait initiation and turning in patients with Parkinson's disease. METHODS: We conducted a literature search in the following databases: Brain, PubMed, Medline, CINAHL, Scopus, Science Direct, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Library Plus, CENTRAL, Trip Database, PEDro, DARE, OTseeker, and Google Scholar. We included all studies published between 2007 and 2016 and evaluating the influence of auditory cues on independent gait initiation and turning in patients with Parkinson's disease. The methodological quality of the studies was assessed with the Jadad scale. RESULTS: We included 13 studies, all of which had a low methodological quality (Jadad scale score≤2). In these studies, high-intensity, high-frequency auditory cues had a positive impact on gait initiation and turning. More specifically, they 1) improved spatiotemporal and kinematic parameters; 2) decreased freezing, turning duration, and falls; and 3) increased gait initiation speed, muscle activation, and gait speed and cadence in patients with Parkinson's disease. CONCLUSIONS: We need studies of better methodological quality to establish the Parkinson's disease stage in which auditory cues are most beneficial, as well as to determine the most effective type and frequency of the auditory cue during gait initiation and turning in patients with Parkinson's disease.

[Spanish translation and validation of the Burke Lateropulsion Scale to measure pusher behaviour]. / Traduccion y validacion al castellano de la Burke Lateropulsion Scale para la valoracion del comportamiento empujador.

INTRODUCTION: Pusher behaviour is an alteration of postural control and the perception of the midline which occurs in some patients after suffering a stroke and it has important functional consequences, so its evaluation is essential. AIM: To translate into Spanish and to validate the Burke Lateropulsion Scale (BLS), used to evaluate the signs of pusher behaviour in patients. PATIENTS AND METHODS: To achieve the proposed objectives, a translation-back translation into Spanish of the scale was performed and the validity and reliability of a sample of post-stroke patients was evaluated. In addition, sensitivity to change was evaluated in patients who turned out to be pushers and received physiotherapy treatment. RESULTS: The experts' answers indicated that the scale was valid in terms of its content to evaluate pusher behaviour in a sample of patients. Cronbach's alpha obtained a result of 0.91. The evaluation of inter-observer and intra-observer reliability gave an overall intraclass correlation coefficient result of 0.99. When the reliability of each item was evaluated by means of the weighted kappa coefficient, most of the results exceeded 0.9. Finally, on evaluating the sensitivity to change on the scale in the sample of pusher patients, the results showed that the BLS is sensitive to the changes which occur after receiving neurological physiotherapy treatment for items related to standing, transfers and walking. CONCLUSIONS: The BLS scale is valid and reliable for measuring pusher behaviour in patients who have suffered a stroke and is sensitive to changes after neurological physiotherapy treatment.

TITLE: Traduccion y validacion al castellano de la Burke Lateropulsion Scale para la valoracion del comportamiento empujador.Introduccion. El comportamiento empujador es una alteracion del control postural y la percepcion de la linea media que ocurre en algunos pacientes principalmente tras sufrir un ictus y tiene importantes consecuencias funcionales, por lo que su evaluacion resulta imprescindible. Objetivo. Traducir y validar al castellano la Burke Lateropulsion Scale (BLS), usada para evaluar los signos del paciente con comportamiento empujador. Pacientes y metodos. Se realizo una traduccion-retrotraduccion al castellano de la escala y se evaluo su validez y fiabilidad en una muestra de 50 pacientes que habian sufrido un ictus. Ademas, se evaluo su sensibilidad al cambio en los pacientes empujadores que recibieron tratamiento de fisioterapia neurologica. Resultados. Las respuestas de los expertos indicaron que la escala era valida en cuanto a su contenido para evaluar el comportamiento empujador. El alfa de Cronbach obtuvo un resultado de 0,91. La evaluacion de la fiabilidad interobservador e intraobservador dio como resultado global un coeficiente de correlacion intraclase de 0,99. Al evaluar la fiabilidad de cada item por medio del coeficiente kappa ponderado, la mayoria de los resultados fueron superiores a 0,9. La evaluacion de la sensibilidad al cambio de la escala en los pacientes empujadores demostro que la BLS resulta sensible a los cambios que se producen tras recibir tratamiento de fisioterapia neurologica en los items referidos a la bipedestacion, las transferencias y la marcha. Conclusiones. La BLS es valida y fiable para medir el comportamiento empujador en pacientes que han sufrido un ictus y resulta sensible a los cambios tras un tratamiento de fisioterapia neurologica.

[Translation and transcultural adaptation of the Toe Walking Tool: screening tool of toe walking patients]. / Traduccion y adaptacion transcultural de la Toe Walking Tool: herramienta para el cribado de la marcha de puntillas.

INTRODUCTION: The Toe Walking Tool (TWT) is a clinical screening instrument which helps in the differentiation of children with normal development, idiopathic toe-walking or toe-walking due to a medical cause. AIM: To carry out the translation and cross-cultural adaptation of the TWT for the Spanish pediatric population and to evaluate its content validity. SUBJECTS AND METHODS: This paper was carried out following an inverted method of translation and back-translation. Once the pre-final Spanish version was obtained, its analysis was conducted through the Delphi method by a panel of experts. The content validity of the tool explores its clarity, viability, applicability and usefulness. RESULTS: An expert panel composed by 15 professionals determine the content validity of the Spanish version of the TWT. The questionnaire translated and adapted transculturally into Spanish presented an excellent global content validity index (0.94) and the expert committee considered that the scale was easily understandable, viable, simple to apply and useful in the pediatric setting. CONCLUSIONS: The Spanish version of the TWT presents an excellent content validity and is an understandable, viable, simple and useful assessment tool. It is necessary to carry out future studies to analyze its psychometric properties with a Spanish pediatric population.

TITLE: Traduccion y adaptacion transcultural de la Toe Walking Tool: herramienta para el cribado de la marcha de puntillas.Introduccion. La Toe Walking Tool (TWT) es una herramienta clinica de cribado que permite discriminar a los niños con desarrollo normal de los que presentan marcha de puntillas idiopatica o marcha de puntillas de origen medico. Objetivo. Realizar la traduccion y adaptacion transcultural de la TWT para la poblacion infantil española y evaluar su validez de contenido. Sujetos y metodos. El proceso se realizo segun el metodo invertido de traduccion-retrotraduccion. Una vez obtenida la version prefinal en castellano, se llevo a cabo su analisis mediante el metodo Delphi por parte de un panel de expertos para analizar su validez de contenido, asi como la comprension, viabilidad, aplicabilidad y utilidad de la herramienta. Resultados. Se constituyo un panel de expertos compuesto por 15 profesionales que determinaron la validez de contenido de la version española de la TWT. El cuestionario traducido y adaptado transculturalmente al castellano presento un indice de validez de contenido global excelente (0,94). A traves del metodo Delphi se determino que la escala era comprensible, viable, de aplicacion sencilla y util en el ambito pediatrico. Conclusiones. La version en castellano de la TWT presenta una excelente validez de contenido y se considera un instrumento comprensible, viable, sencillo y util con aplicacion en la poblacion pediatrica española. En futuros estudios resulta necesario analizar sus caracteristicas psicometricas en niños con marcha de puntillas.

Neurorehabilitation and apps: A systematic review of mobile applications. / Apps en neurorrehabilitación. Una revisión sistemática de aplicaciones móviles.

INTRODUCTION: Mobile health or mHealth, defined as the provision of health information or healthcare by means of mobile devices or tablets, is emerging as a major game-changer for patients, care providers, and investors. An app is a program with special characteristics installed on a small mobile device, either a tablet or smartphone, with which the user interacts via a touch-based interface. The purpose of the app is to facilitate completion of a certain task or assist with daily activities. OBJECTIVE: The aim of this study was to conduct a systematic review of published information on apps directed at the field of neurorehabilitation, in order to classify them and describe their main characteristics. MATERIAL AND METHODS: A systematic review was carried out by means of a literature search in biomedical databases and other information sources related to mobile applications. Apps were classified into five categories: health habits, information, assessment, treatment, and specific uses. CONCLUSIONS: There are numerous applications with potential for use in the field of neurorehabilitation, so it is important that developers and designers understand the needs of people with neurological disorders so that their products will be valid and effective in light of those needs. Similarly, professionals, patients, families, and caregivers should have clear criteria and indicators to help them select the best applications for their specific situations.

Spanish translation and validation of the Scale for Contraversive Pushing to measure pusher behaviour. / Traducción y validación española de la Scale for Contraversive Pushing (SCP) para la valoración del comportamiento empujador.

INTRODUCTION: The aim of this study was to develop and validate a Spanish-language version of the Scale for Contraversive Pushing, used to diagnose and measure pusher behaviour in stroke patients. METHODS: Translation-back translation was used to create the Spanish-language Scale for Contraversive Pushing; we subsequently evaluated its validity and reliability by administering it to a sample of patients. We also analysed its sensitivity to change in patients identified as pushers who received neurological physiotherapy. RESULTS: Experts indicated that the content of the scale was valid. Internal consistency was very good (Cronbach's alpha of 0.94). The intraclass correlation coefficient showed high intra- and interobserver reliability (0.999 and 0.994, respectively). The Kappa and weighted Kappa coefficients were used to measure the reliability of each item; the majority obtained values above 0.9. Lastly, the differences between baseline and final evaluations of pushers were significant (paired sample t test), showing that the scale is sensitive to changes obtained through physical therapy. CONCLUSIONS: The Spanish-language version of the Scale for Contraversive Pushing is valid and reliable for measuring pusher behaviour in stroke patients. In addition, it is able to evaluate the ongoing changes in patients who have received physical therapy.

Eficacia de la terapia de espejo y terapia de observación de acciones en la parálisis cerebral infantil: revisión sistemática / Effectiveness of mirror therapy and action observation therapy in infantile cerebral palsy: a systematic review

El objetivo de esta revisión fue evaluar la eficacia de la terapia en espejo (TE) y terapia de observación de acciones (AOT) en estructuras y funciones corporales, actividad y participación, relacionadas con miembro superior en parálisis cerebral infantil (PCI). Se realizó una revisión sistemática de ensayos controlados aleatorizados publicados en los últimos diez años, que investigaran TE o AOT frente a otras intervenciones en PCI. La calidad metodológica de los nueve estudios incluidos se evaluó con la escala PEDro. El tratamiento con TE o AOT parece mostrar mejoras significativas en estructuras y funciones corporales, actividades y participación del miembro superior comparado con otras intervenciones en PCI. Ambas intervenciones parecen mejorar la calidad de vida al abarcar la globalidad del paciente, reducir la discapacidad y favorecer su funcionamiento. Se necesitan más estudios con mayor calidad metodológica para respaldar estas intervenciones a largo plazo.(AU)

The aim of this review was to assess the effectiveness of mirror therapy (MT) and action observation therapy (AOT) on upper limbrelated body structures, body functions, activity, and involvement in patients with infantile cerebral palsy (ICP). We carried out a systematic review of randomized controlled trials published over the past 10 years, in which MT or AOT was compared to other ICP-directed interventions. Nine studies met the inclusion criteria and we measured their methodological quality using the PEDro scale. MT or AOT seem to significantly improve upper limbrelated body structures, body function, activity, and participation in comparison to other interventions for ICP. Both seem to improve overall quality of life, reduce their disability, and promote its functioning. Further studies with higher methodological quality need to be developed to confirm the longterm effectiveness of MT and AOT. (AU)