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OBJECTIVE: To evaluate the efficacy of a gravity-supported, computer-enhanced device (Armeo® Spring) for upper limb rehabilitation in chronic stroke patients. MATERIAL AND METHODS: We included 23 chronic hemiparetic patients (chronicity: 328 ± 90.8 days; distribution: 17 men and 6 women) aged 54.6 ± 9.5 years, who had sustained ischaemic stroke (n=12) or haemorrhagic stroke (n=11). All patients completed 36 one-hour sessions using the Armeo® Spring system. Arm movement was assessed at the beginning and end of the treatment programme and once more 4 months later. Main outcome measurements covered structure, activity, and function, as per the International Classification of Functioning, Disability and Health: Modified Ashworth Scale, Motricity Index (MI), Fugl-Meyer Assessment Scale (FM), Motor Assessment Scale (MAS), Manual Function Test (MFT), and Wolf Motor Function Test (WMFT). RESULTS: Repeated measures ANOVA showed significant improvement (time effect) for all function scales (P<.01 for FM and MI) and activity scales (P<.01 for MAS, MFT and WMFT-ability, and P<.05 WMFT-time) without significant changes in muscle tone. The post-hoc analysis (Bonferroni) showed different evolutionary patterns for function and activity measurements, and clear benefits related to Armeo® Spring training, especially on activity scales. CONCLUSIONS: Armeo® Spring is an effective tool for rehabilitating the affected arm in patients with hemiparesis secondary to ictus, even in the chronic stage.
Asunto(s)
Paresia/rehabilitación , Modalidades de Fisioterapia/instrumentación , Rehabilitación de Accidente Cerebrovascular , Anciano , Análisis de Varianza , Enfermedad Crónica , Femenino , Humanos , Hemorragias Intracraneales/complicaciones , Hemorragias Intracraneales/rehabilitación , Masculino , Persona de Mediana Edad , Actividad Motora/fisiología , Movimiento/fisiología , Paresia/fisiopatología , Desempeño Psicomotor/fisiología , Recuperación de la Función , Accidente Cerebrovascular/fisiopatología , Resultado del Tratamiento , Extremidad Superior/fisiología , Interfaz Usuario-ComputadorRESUMEN
The aim of this work was to evaluate whether serum cytokines levels are associated with ovarian response in IVF. 149 patients were included in a retrospective study. Cytokines IL-2, IL-4, IL- 6, IL-8, IL-10, VEGF, IFNγ, TNFα, IL-1α, IL-1ß, MCP-1 and EGF were measured by sandwich immunoassay previously to ovarian stimulation. Performing hierarchical cluster analysis, we observed that the antral follicle count, the total oocytes recovered and the MII recovered are grouped in the same cluster as the cytokines IL-2-4-6-10-1α-1ß, IFNγ y TNFα. Then, we found that the ratio between IL and 6 and IL-10 was higher in low responder women (2.15 versus 1.55; p = 0.035). If we establish 0.9 as a cut-off for the IL-6/IL-10, we observed that above this value the risk of having a low response to ovarian stimulation was more than 3 times greater than below this value (22.9 % versus 6.0 %; p = 0.007). Also, the ratio IL-1ß/IL-4 was higher in patients with normal or suboptimal response (0.62 versus 0.34; p = 0.034) and any patient with low response had a value greater than 0.7 (p = 0.003). As a conclusion, the IL-6/IL-10 and IL-1ß/IL-4 ratios showed differences between normoresponder women and patients with low ovarian response.
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Interleucina-4 , Interleucina-6 , Femenino , Animales , Factor de Necrosis Tumoral alfa , Folículo Ovárico , Interleucina-10 , Estudios Retrospectivos , Interleucina-2 , Fertilización In Vitro , Inducción de la Ovulación , FertilizaciónRESUMEN
Human-mediated global change will probably increase the rates of natural hybridization and genetic introgression between closely related species, and this will have major implications for conservation of the taxa involved. In this study, we analyse both mitochondrial and nuclear data to characterize ongoing hybridization and genetic introgression between two sympatric sister species of mustelids, the endangered European mink (Mustela lutreola) and the more abundant polecat (M. putorius). A total of 317 European mink, 114 polecats and 15 putative hybrid individuals were collected from different localities in Europe and genotyped with 13 microsatellite nuclear markers. Recently developed Bayesian methods for assigning individuals to populations and identifying admixture proportions were applied to the genetic data. To identify the direction of hybridization, we additionally sequenced mtDNA and Y chromosomes from 78 individuals and 29 males respectively. We found that both hybridization and genetic introgression occurred at low levels (3% and 0.9% respectively) and indicated that hybridization is asymmetric, as only pure polecat males mate with pure European mink females. Furthermore, backcrossing and genetic introgression was detected only from female first-generation (F1) hybrids of European mink to polecats. This latter result implies that Haldane's rule may apply. Our results suggest that hybridization and genetic introgression between the two species should be considered a rather uncommon event. However, the current low densities of European mink might be changing this trend.
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Teorema de Bayes , Hurones/genética , Hibridación Genética/fisiología , Visón/genética , Animales , ADN Mitocondrial/genética , Femenino , Hurones/fisiología , Hibridación Genética/genética , Masculino , Repeticiones de Microsatélite/genética , Visón/fisiología , Datos de Secuencia Molecular , Cromosoma Y/genéticaRESUMEN
INTRODUCTION: The health pandemic brought about by SARS-CoV-2 (COVID-19) has limited access to neurorehabilitation programmes for many patients who have suffered stroke, traumatic brain injury or acquired brain damage due to some other cause. As telerehabilitation allows for the provision of care in situations of social distancing, it may mitigate the negative effects of confinement. The aim of this study was to determine the efficacy, adherence and usability of a teleneurorehabilitation intervention for patients with acquired brain injury. PATIENTS AND METHODS: All patients included in a face-to-face neurorehabilitation programme at the time of the declaration of the state of alarm in Spain due to COVID-19 and who agreed to participate in the study were included in a teleneurorehabilitation programme. The effectiveness of the programme, understood as an improvement in independence, was quantified with the Barthel index. Adherence to the programme and usability of the tool were explored through questionnaires. RESULTS: Altogether, 46 patients, accounting for 70.6% of the total, participated in the study. Participants significantly improved their independence and showed an improvement in the Barthel index between the start (77.3 ± 28.6) and the end of the programme (82.3 ± 26). Adherence to the intervention was very high (8.1 ± 2.2 out of 10) and the online sessions were the most highly rated content. The tool used showed a high usability (50.1 ± 9.9 out of 60) and could be used without assistance by more than half the participants. CONCLUSION: The teleneurorehabilitation intervention was found to be effective in improving patients' independence, and promoted a high degree of adherence and usability.
TITLE: Efectividad, adhesión y usabilidad de un programa de teleneurorrehabilitación para garantizar la continuidad de cuidados en pacientes con daño cerebral adquirido durante la pandemia originada por la COVID-19.Introducción. La pandemia sanitaria originada por el SARS-CoV-2 (COVID-19) ha limitado el acceso a programas de neurorrehabilitación de muchos pacientes que han sufrido ictus, traumatismos craneoencefálicos o un daño cerebral adquirido por otra causa. Dado que la telerrehabilitación permite la provisión de cuidados en situaciones de distanciamiento social, podría atenuar los efectos negativos del confinamiento. El objetivo de este estudio fue determinar la eficacia, la adhesión y la usabilidad de una intervención de teleneurorrehabilitación dirigida a pacientes con daño cerebral adquirido. Pacientes y métodos. Todos los pacientes incluidos en un programa de neurorrehabilitación presencial en el momento de la declaración del estado de alarma en España con motivo de la COVID-19 y que aceptaron participar en el estudio fueron incluidos en un programa de teleneurorrehabilitación. La eficacia del programa, entendida como una mejora en la independencia, se cuantificó con el índice de Barthel. La adhesión al programa y la usabilidad de la herramienta se investigaron mediante cuestionarios. Resultados. Un total de 146 pacientes, el 70,6% del total, participó en el estudio. Los participantes mejoraron significativamente su independencia y mostraron una mejoría en el índice de Barthel entre el inicio (77,3 ± 28,6) y el fin del programa (82,3 ± 26). La intervención tuvo una gran adhesión (8,1 ± 2,2 sobre 10) y las sesiones en línea fueron el contenido mejor valorado. La herramienta utilizada mostró una elevada usabilidad (50,1 ± 9,9 sobre 60) y pudo ser utilizada sin ayuda por más de la mitad de los participantes. Conclusión. La intervención de teleneurorrehabilitación resultó ser eficaz para mejorar la independencia de los pacientes, y promovió una elevada adhesión y usabilidad.
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Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/rehabilitación , COVID-19/complicaciones , Continuidad de la Atención al Paciente/organización & administración , Telerrehabilitación/organización & administración , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Cooperación del Paciente , Satisfacción del Paciente , Distanciamiento Físico , Evaluación de Programas y Proyectos de Salud , España/epidemiología , Encuestas y Cuestionarios/normas , Realidad VirtualRESUMEN
OBJECTIVE: To determine if APOE genotype is linked to memory function after moderate-severe traumatic brain injury (TBI). METHODS: Eighty-two patients in post-traumatic amnesia (PTA) and 107 patients who had emerged from PTA were selected from 239 consecutive patients admitted to the facility. Verbal memory assessments, including the Spanish version of the California Verbal Learning Test and the Working-Memory Index of the WAIS-III, were conducted immediately after PTA resolution or during the first week after admission for patients who were out of PTA. Both groups were reassessed 6 months after inclusion in a multidisciplinary rehabilitation programme. RESULTS: Patients with the APOE-epsilon 4 allele (n = 17 in the PTA group and n = 9 in the out of PTA group) entered rehabilitation at a more impaired level, but made remarkable progress during follow-up. Fifty-five patients from the initial sample emerged from PTA during the follow-up period. Age, GOAT at admission and chronicity, but not APOE genotype or initial trauma severity, were significant predictors of emergence from PTA. CONCLUSIONS: APOE genotype seems to be associated with the trajectory of cognitive recovery after TBI, but does not play a determinant role in the efficacy of memory rehabilitation in this population.
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Amnesia/genética , Apolipoproteínas E/genética , Lesiones Encefálicas/genética , Adulto , Alelos , Amnesia/fisiopatología , Amnesia/rehabilitación , Análisis de Varianza , Lesiones Encefálicas/fisiopatología , Lesiones Encefálicas/rehabilitación , Trastornos del Conocimiento , Femenino , Genotipo , Humanos , Masculino , Pruebas Neuropsicológicas , Recuperación de la Función/genética , Recuperación de la Función/fisiología , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION: Altered states of consciousness have traditionally been associated with poor prognosis. At present, clinical differences between these entities are beginning to be established. METHOD: Our study included 37 patients diagnosed with vegetative state/unresponsive wakefulness syndrome (UWS) and 43 in a minimally conscious state (MCS) according to the Coma Recovery Scale-Revised (CRS-R). All patients were followed up each month for at least 6 months using the CRS-R. We recorded the time points when vegetative state progressed from 'persistent' to 'permanent' based on the cut-off points established by the Multi-Society-Task-Force: 12 months in patients with traumatic injury and 3 months in those with non-traumatic injury. A logistic regression model was used to determine the factors potentially predicting which patients will emerge from MCS. RESULTS: In the UWS group, 23 patients emerged from UWS but only 9 emerged from MCS. Of the 43 patients in the MCS group, 26 patients emerged from that state during follow-up. Eight of the 23 patients (34.7%) who emerged from UWS and 17 of the 35 (48.6%) who emerged from MCS recovered after the time points proposed by the Multi-Society-Task-Force. According to the multivariate regression analysis, aetiology (P<.01), chronicity (P=.01), and CRS-R scores at admission (P<.001) correctly predicted emergence from MCS in 77.5% of the cases. CONCLUSIONS: UWS and MCS are different clinical entities in terms of diagnosis and outcomes. Some of the factors traditionally associated with poor prognosis, such as time from injury and likelihood of recovery, should be revaluated.
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Estado de Conciencia/fisiología , Estado Vegetativo Persistente/diagnóstico , Pronóstico , Adulto , Coma , Femenino , Humanos , Estudios Longitudinales , Masculino , Estado Vegetativo Persistente/fisiopatología , Reproducibilidad de los ResultadosRESUMEN
Introducción: La pandemia sanitaria originada por el SARS-CoV-2 (COVID-19) ha limitado el acceso a programas de neurorrehabilitación de muchos pacientes que han sufrido ictus, traumatismos craneoencefálicos o un daño cerebral adquirido por otra causa. Dado que la telerrehabilitación permite la provisión de cuidados en situaciones de distanciamiento social, podría atenuar los efectos negativos del confinamiento. El objetivo de este estudio fue determinar la eficacia, la adhesión y la usabilidad de una intervención de teleneurorrehabilitación dirigida a pacientes con daño cerebral adquirido. Pacientes y métodos: Todos los pacientes incluidos en un programa de neurorrehabilitación presencial en el momento de la declaración del estado de alarma en España con motivo de la COVID-19 y que aceptaron participar en el estudio fueron incluidos en un programa de teleneurorrehabilitación. La eficacia del programa, entendida como una mejora en la independencia, se cuantificó con el índice de Barthel. La adhesión al programa y la usabilidad de la herramienta se investigaron mediante cuestionarios. Resultados: Un total de 146 pacientes, el 70,6% del total, participó en el estudio. Los participantes mejoraron significativamente su independencia y mostraron una mejoría en el índice de Barthel entre el inicio (77,3 ± 28,6) y el fin del programa (82,3 ± 26). La intervención tuvo una gran adhesión (8,1 ± 2,2 sobre 10) y las sesiones en línea fueron el contenido mejor valorado. La herramienta utilizada mostró una elevada usabilidad (50,1 ± 9,9 sobre 60) y pudo ser utilizada sin ayuda por más de la mitad de los participantes. Conclusión: La intervención de teleneurorrehabilitación resultó ser eficaz para mejorar la independencia de los pacientes, y promovió una elevada adhesión y usabilidad.(AU)
Introduction: The health pandemic brought about by SARS-CoV-2 (COVID-19) has limited access to neurorehabilitation programmes for many patients who have suffered stroke, traumatic brain injury or acquired brain damage due to some other cause. As telerehabilitation allows for the provision of care in situations of social distancing, it may mitigate the negative effects of confinement. The aim of this study was to determine the efficacy, adherence and usability of a teleneurorehabilitation intervention for patients with acquired brain injury. Patients and methods: All patients included in a face-to-face neurorehabilitation programme at the time of the declaration of the state of alarm in Spain due to COVID-19 and who agreed to participate in the study were included in a teleneurorehabilitation programme. The effectiveness of the programme, understood as an improvement in independence, was quantified with the Barthel index. Adherence to the programme and usability of the tool were explored through questionnaires. Results: Altogether, 46 patients, accounting for 70.6% of the total, participated in the study. Participants significantly improved their independence and showed an improvement in the Barthel index between the start (77.3 ± 28.6) and the end of the programme (82.3 ± 26). Adherence to the intervention was very high (8.1 ± 2.2 out of 10) and the online sessions were the most highly rated content. The tool used showed a high usability (50.1 ± 9.9 out of 60) and could be used without assistance by more than half the participants. Conclusion: The teleneurorehabilitation intervention was found to be effective in improving patients independence, and promoted a high degree of adherence and usability.(AU)
Asunto(s)
Humanos , Masculino , Femenino , /complicaciones , Daño Encefálico Crónico/rehabilitación , Rehabilitación Neurológica/métodos , Accidente Cerebrovascular , Rehabilitación de Accidente Cerebrovascular , Cuarentena , Neurología , Enfermedades del Sistema Nervioso , España , /epidemiología , Rehabilitación/métodos , NeuropsicologíaRESUMEN
INTRODUCCIÓN: Los estados alterados de conciencia han sido considerados tradicionalmente como cuadros clínicos de pronóstico infausto. En la actualidad, sabemos que dichos estados engloban distintas entidades clínicas cuyo perfil diferencial empieza a reconocerse. MÉTODO: Se incluyeron 37 pacientes con el diagnóstico de estado vegetativo o síndrome de vigilia sin respuesta (SVSR) y 43 en estado de mínima conciencia (EMC) de acuerdo con la Coma Recovery Scale-Revised (CRS-R). Todos los pacientes fueron evaluados mensualmente con la CRS-R durante al menos 6 meses. Se evaluó el momento de superar cada estado considerando los puntos de corte de «irreversibilidad» (12 meses para los casos de origen traumático y 3 para los no traumáticos), tradicionalmente establecidos por la Multi-Society-Task-Force. Se empleó un modelo de regresión logística para determinar las variables predictoras de superar el EMC. RESULTADOS: Un total de 23 pacientes en SVSR superaron este estado, pero solo 9superaron el EMC. De los 43 pacientes en EMC al ingreso, 26 lograron superarlo. Ocho de los 23 (34,7%) pacientes que superaron el SVSR y 17 de los 35 (48,6%) que superaron el EMC lo hicieron más allá del punto de «irreversibilidad». La etiología (p < 0,01), la cronicidad (p = 0,01) y la puntuación en la CRS-R (p < 0,001) predijeron la salida de EMC en el modelo multivariante con un 77,5% de acierto. CONCLUSIONES: Tanto el SVRS como el EMC son entidades clínicamente diferenciadas en términos diagnósticos y pronósticos. Algunos criterios clásicos relacionados con el mal pronóstico de estos estados en términos de tiempo y posibilidades de recuperación deben ser reevaluados
INTRODUCTION: Altered states of consciousness have traditionally been associated with poor prognosis. At present, clinical differences between these entities are beginning to be established. METHOD: Our study included 37 patients diagnosed with vegetative state/unresponsive wakefulness syndrome (UWS) and 43 in a minimally conscious state (MCS) according to the Coma Recovery Scale-Revised (CRS-R). All patients were followed up each month for at least 6 months using the CRS-R. We recorded the time points when vegetative state progressed from 'persistent' to 'permanent' based on the cut-off points established by the Multi-Society-Task-Force: 12 months in patients with traumatic injury and 3 months in those with non-traumatic injury. A logistic regression model was used to determine the factors potentially predicting which patients will emerge from MCS. RESULTS: In the UWS group, 23 patients emerged from UWS but only 9 emerged from MCS. Of the 43 patients in the MCS group, 26 patients emerged from that state during follow-up. Eight of the 23 patients (34.7%) who emerged from UWS and 17 of the 35 (48.6%) who emerged from MCS recovered after the time points proposed by the Multi-Society-Task-Force. According to the multivariate regression analysis, aetiology (P < .01), chronicity (P = .01), and CRS-R scores at admission (P < .001) correctly predicted emergence from MCS in 77.5% of the cases. CONCLUSIONS: UWS and MCS are different clinical entities in terms of diagnosis and outcomes. Some of the factors traditionally associated with poor prognosis, such as time from injury and likelihood of recovery, should be revaluated
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Estado de Conciencia/fisiología , Estado Vegetativo Persistente/diagnóstico , Pronóstico , Coma , Estudios Longitudinales , Estado Vegetativo Persistente/fisiopatología , Reproducibilidad de los ResultadosRESUMEN
This article documents the addition of 396 microsatellite marker loci to the Molecular Ecology Resources Database. Loci were developed for the following species: Anthocidaris crassispina, Aphis glycines, Argyrosomus regius, Astrocaryum sciophilum, Dasypus novemcinctus, Delomys sublineatus, Dermatemys mawii, Fundulus heteroclitus, Homalaspis plana, Jumellea rossii, Khaya senegalensis, Mugil cephalus, Neoceratitis cyanescens, Phalacrocorax aristotelis, Phytophthora infestans, Piper cordulatum, Pterocarpus indicus, Rana dalmatina, Rosa pulverulenta, Saxifraga oppositifolia, Scomber colias, Semecarpus kathalekanensis, Stichopus monotuberculatus, Striga hermonthica, Tarentola boettgeri and Thermophis baileyi. These loci were cross-tested on the following species: Aphis gossypii, Sooretamys angouya, Euryoryzomys russatus, Fundulus notatus, Fundulus olivaceus, Fundulus catenatus, Fundulus majalis, Jumellea fragrans, Jumellea triquetra Jumellea recta, Jumellea stenophylla, Liza richardsonii, Piper marginatum, Piper aequale, Piper darienensis, Piper dilatatum, Rana temporaria, Rana iberica, Rana pyrenaica, Semecarpus anacardium, Semecarpus auriculata, Semecarpus travancorica, Spondias acuminata, Holigarna grahamii, Holigarna beddomii, Mangifera indica, Anacardium occidentale, Tarentola delalandii, Tarentola caboverdianus and Thermophis zhaoermii.
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Objetivo: Valorar la eficacia del sistema Armeo®Spring para la rehabilitación del miembro superior en pacientes crónicos que han presentado un ictus. Material y métodos: Veintitrés pacientes (17 varones y 6 mujeres), con una edad media ± desviación estándar de 54,6 ± 9,5 años, que presentaban una hemiparesia crónica (cronicidad de 328 ± 90,8 días) secundaria a ictus isquémico (n = 12) o hemorrágico (n = 11), se incluyeron en este estudio. Todos los pacientes completaron 36 sesiones de una hora de duración con el sistema Armeo®Spring y fueron valorados al inicio, al fin y 4 meses después de completar el tratamiento con escalas dirigidas a los dominios de estructura, función y actividad de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) incluyendo: Ashworth Modified Scale, Motricity Index (MI), Fugl-Meyer ssessment Scale (FM), Motor Assessment Scale (MAS), Manual Function Test (MFT) y Wolf Motor Function (WMFT). Resultados: Un ANOVA de medidas repetidas mostró una mejoría significativa (efecto tiempo) en todas las escalas de función (p < 0,01 en FM y MI) y actividad (p < 0,01 en MAS, MFT, WMFT Habilidad y p < 0,05 en WMFT-tiempo), sin que se apreciaran cambios significativos en el tono muscular. El estudio post hoc (Bonferroni) mostró un patrón de evolución diferente entre las escalas de función y las de actividad, con un beneficio directamente ligado al entrenamiento, especialmente en las escalas de actividad. Conclusiones: El Armeo®Spring constituye una herramienta eficaz para la rehabilitación del miembro superior afectado en pacientes con una hemiparesia debida a un ictus, incluso en estadios crónicos (AU)
Objective: To evaluate the efficacy of a gravity-supported, computer-enhanced device (Armeo®Spring) for upper limb rehabilitation in chronic stroke patients. Material and methods: We included 23 chronic hemiparetic patients (chronicity: 328 ± 90.8 days; distribution: 17 men and 6 women) aged 54.6 ± 9.5 years, who had sustained ischaemic stroke (n = 12) or haemorrhagic stroke (n = 11). All patients completed 36 one-hour sessions using the Armeo®Spring system. Arm movement was assessed at the beginning and end of the treatment programme and once more 4 months later. Main outcome measurements covered structure, activity, and function, as per the International Classification of Functioning, Disability and Health: Modified Ashworth Scale, Motricity Index (MI), Fugl-Meyer Assessment Scale (FM), Motor Assessment Scale (MAS), Manual Function Test (MFT), and Wolf Motor Function Test (WMFT). Results: Repeated measures ANOVA showed significant improvement (time effect) for all function scales (P < .01 for FM and MI) and activity scales (P<.01 for MAS, MFT and WMFT-ability, and P < .05 WMFT-time) without significant changes in muscle tone. The post-hoc analysis (Bonferroni) showed different evolutionary patterns for function and activity measurements, and clear benefits related to Armeo®Spring training, especially on activity scales. Conclusions: Armeo®Spring is an effective tool for rehabilitating the affected arm in patients with hemiparesis secondary to ictus, even in the chronic stage (AU)
Asunto(s)
Humanos , Accidente Cerebrovascular/complicaciones , Paresia/rehabilitación , Estadísticas de Secuelas y Discapacidad , Clasificación Internacional del Funcionamiento, de la Discapacidad y de la SaludRESUMEN
Objetivo. Identificar los predictores clínicos de marcha independiente en pacientes con traumatismo craneoencefálico (TCE) severo tras un programa de rehabilitación multidisciplinario y determinar la correlación entre los resultados de la rehabilitación y el estado neurológico del paciente al ingreso. Pacientes y métodos. Análisis retrospectivo de una muestra de 73 pacientes con TCE severo y sin capacidad de marcha al ingreso, seguidos longitudinalmente durante un período medio de 215,3±85,9 días. Todos ellos fueron clasificados en función de su estado neurológico al ingreso: estado vegetativo (EV, n=14), estado de mínima conciencia (EMC, n=16), amnesia postraumática (APT, n=30) y fuera de APT (n=13). Resultados. De forma general, el 41,1% de la muestra adquirió capacidad de marcha al finalizar el programa de rehabilitación multidisciplinario específico. En función del estado neurológico de los pacientes al ingreso, 3 pacientes (18,8%) del grupo de EMC, 17 pacientes (56,7%) del grupo de APT y 10 pacientes (76,9%) del grupo fuera de APT lograron realizar una marcha independiente. Ninguno de los pacientes clasificados inicialmente en EV fue capaz de andar de forma independiente. El modelo de regresión logística reveló que el estado neurológico general (p<0,001), la cronicidad (p=0,001) y la movilidad axial al ingreso evaluada con el Rivermead Mobility Index (p=0,02) fueron predictores independientes de marcha. Discusión. El estado neurológico general, el tiempo transcurrido desde la lesión y la movilidad general al ingreso pueden ayudar a predecir la recuperación de la capacidad de marcha independiente tras un programa de rehabilitación en esta población(AU)
Objective. To identify clinical predictors of independent ambulation in patients with severe traumatic brain injury (TBI) after a multidisciplinary rehabilitation program and to determine the correlation between rehabilitation outcomes and neurological status of the patient on admission. Patients and methods. A retrospective analysis of a sample of 73 patients with severe head injury and no ability to walk on admission, followed longitudinally for an average of 215.3±85.9days, was performed. All patients were classified into four groups based on their neurological status at admission: vegetative state (n=14), minimally conscious state (n=16), post-traumatic amnesia (PTA, n=30) and out-of-PTA (n=13). Results. Globally, 41.1% of the initial sample acquired gait abilities after specific multidisciplinary rehabilitation. Regarding neurological status at admission, three patients (18.8%) of the minimally conscious group, 17 patients (56.7%) of the PTA group, 10 patients (76.9%) of the out-of-PTA group, and none of the patients who were initially classified in the vegetative state group were able to walk independently after 6 months. The final multivariate logistic regression model revealed that global neurological status (p<0.001), chronicity (p=0.001), and Rivermead Mobility Index (p=0.02) were independent predictors of gait. Discussion. Global neurological status, time since injury, and global mobility at admission can help predict recovery of independent gait after six months of rehabilitation in this population(AU)