The effect of aquatic physical therapy in patients with stroke: A systematic review and meta-analysis.

Objective: The purpose of this study was to evaluate the literature reports of qualitative and quantitative results of physical therapy treatments in the alternative aquatic setting for individuals affected by strokes. Method: PRISMA guidelines were used to carry out the systematic review and meta-analysis. Three bibliographic databases were searched: MEDLINE, PEDro, and the Cochrane Library. Papers included in the study were required to: (a) have a randomized controlled trial (RCT) design of research; and (b) be published in English; (c) be published during the last 10 years (2008-2018). Only randomized controlled trials were employed in the study. The quality of the clinical trials to be included was evaluated according to the Jadad scale. The internal validity was assessed according to the PEDro scale. Results: Eleven RCTs were initially identified in the systematic review. Eight of these were involved in the meta-analysis comparing outcomes and follow-up. Eight studies received a Jadad score of three, indicating a high level of quality. The remaining three studies achieved a lower score which indicated lower qualitative level. Nearly all of the results of the quantitative analysis were statistically significant (P < 0,05) and most of them favored of the experimental group subject to aquatic treatment. Conclusion: Aquatic physical therapy may be a valid means for the rehabilitation of people affected by stroke. The integration of this methodological approach with conventional physical therapy should be considered. However, more studies; a larger number of participants; and varying lengths of follow-up times are necessary.

A Water-Based Sequential Preparatory Approach vs. Conventional Aquatic Training in Stroke Patients: A Randomized Controlled Trial With a 1-Month Follow-Up.

Background: Many studies hypothesize that people who have suffered stroke could benefit from water-based exercises to improve their strength and ability to perform the activities of daily living. Objective: The study aim was to compare the effects of a water-based sequential preparatory approach (SPA) and conventional aquatic therapy in improving motor functions and quality of life in patients with chronic stroke. Methods: Thirty-three chronic stroke outpatients diagnosed with hemiplegia were recruited and randomly assigned to the experimental or control group. Subjects in the experimental group underwent a trial water-based SPA balance training, and patients in the control group were given traditional water balance training. Both groups of participants underwent 45 min of therapy twice a week for 4 weeks. All patients were evaluated before treatment (T0), after 4 weeks of training (T1), and 4 weeks after the end of training (T2) using the Berg balance scale (BBS), the modified Barthel index (MBI), the Tinetti balance and gait scale (TBG), the Stroke Specific Quality Of Life Scale (SS-QOL), and the modified Ashworth scale (MAS). Results: After the training, statistically significant differences (p < 0.05) were found between the groups in their score averages on the BBS (p = 0.01) and the SS-QOL scale (p = 0.03). Furthermore, the SPAg showed a significantly greater percentage of improvement on the BBS (p = 0.02) and the SS-QOL (p = 0.03). Both groups obtained a significantly improved MAS score (p < 0.01). Conclusion: Results indicate that water training based on an SPA is more effective than traditional aquatic training for balance rehabilitation of chronic poststroke patients.

Home, dirty home: effect of old nest material on nest-site selection and breeding performance in a cavity-nesting raptor.

The quality of a breeding site may have major fitness consequences. A fundamental step to understanding the process of nest-site selection is the identification of the information individuals use to choose high-quality nest sites. For secondary cavity-nesting bird species that do not add nest lining material, organic remains (faeces, pellets) accumulated inside nest cavities during previous breeding events may be a cue for high-quality nest-sites, as they contain information about past successful breeding and may improve thermal insulation of eggs during incubation. However, cavities in which breeding was successful might also contain more nest-dwelling ectoparasites than unoccupied cavities, offering an incentive for prospective parents to avoid them. We exposed breeding cavity-nesting lesser kestrels (Falco naumanni) to nestbox dyads consisting of a dirty (with a thick layer of organic substrate) and a clean nestbox (without organic material). Dirty nestboxes were strongly preferred, being occupied earlier and more frequently than clean ones. Hatching success in dirty nestboxes was significantly higher than in clean ones, suggesting a positive effect of organic nest material on incubation efficiency, while nestbox dirtiness did not significantly affect clutch and brood size. Nestlings from dirty nestboxes had significantly higher ectoparasite load than those from clean nestboxes soon after egg hatching, but this difference was not evident a few days later. Nest substrate did not significantly affect nestling growth. We concluded that nest substrate is a key driver of nest-site choice in lesser kestrels, although the adaptive value of such a strong preference appears elusive and may be context-dependent.

Spatial segregation of home ranges between neighbouring colonies in a diurnal raptor.

Enhancement of information transfer has been proposed as a key driver of the evolution of coloniality. Transfer of information on location of food resources implies that individuals from the same colony share foraging areas and that each colony can be associated to a specific foraging area. In colonial breeding vertebrates, colony-specific foraging areas are often spatially segregated, mitigating intercolony intraspecific competition. By means of simultaneous GPS tracking of lesser kestrels (Falco naumanni) from neighbouring colonies, we showed a clear segregation of space use between individuals from different colonies. Foraging birds from different neighbouring colonies had home ranges that were significantly more segregated in space than expected by chance. This was the case both between large and between small neighbouring colonies. To our knowledge, the lesser kestrel is the only terrestrial species where evidence of spatial segregation of home ranges between conspecifics from neighbouring colonies has been demonstrated. The observed spatial segregation pattern is consistent with the occurrence of public information transfer about foraging areas and with the avoidance of overexploited areas located between neighbouring colonies. Our findings support the idea that spatial segregation of exploited areas may be widespread among colonial avian taxa, irrespective of colony size.

Maintaining gait stability during dual walking task: effects of age and neurological disorders.

BACKGROUND: Dual task paradigm is a common mechanism of daily life, and it is often used for investigating the effect on cognitive processing of motor behavior. AIM: In the present study we investigate the dual task interference during walking on upright gait stability. DESIGN: Cross-sectional study. SETTING: Inpatient neurorehabilitation unit and children neurorehabilitation unit. POPULATION: Eighty-five subjects were enrolled, divided into five groups: healthy young, healthy elderly, children with typical development, children with cerebral palsy and adults with stroke in subacute phase. METHODS: All subjects had to walk through a pathway during which they had to hear a sound, turn the head to watch a number and verbalize it. Subjects wore an accelerometer on their lumbar spine to measure upright gait stability have been assessed by means of the Root Mean Square (RMS) of the trunk acceleration. RESULTS: All subjects showed a reduced speed when performing a dual task with respect to single task. This reduction was significantly different among groups (F(4,81)=12.253, P<0.001, effect size 0.377). The RMS appeared to be increased along the latero-lateral axis, and reduced along the anterio-posterior and the cranio-caudal axes during the dual task walking. CONCLUSIONS: These accelerations were significantly related to the changes in speed that were managed in a different way in subjects affected by cerebral palsy and stroke. CLINICAL REHABILITATION IMPACT: The information obtained in this study may be used to support specific rehabilitation techniques in subjects with poor balance ability.

Mismatch paciente-prótesis aórtica: Comparación alejada por eco-Doppler transtorácico versus el estimado en el preoperatorio / Comparison between Patient-Aortic Valve Prosthesis Mismatch Determined by Transthoracic Echo-Doppler at Late Follow-up versus Preoperative Estimation

Introducción El mismatch paciente-prótesis (MPP) aórtica se asocia con peor evolución posoperatoria. La utilización del área del orificio aórtico efectivo (AOE) para cada tipo de prótesis, indexado por la superficie corporal (SC) en el momento quirúrgico, puede permitir la elección de un tamaño de prótesis adecuado para cada paciente y así evitar el MPP. Objetivo Comparar la estimación de MPP por las AOE tabuladas con la diagnosticada en el posoperatorio alejado por eco-Doppler. Material y métodos Se analizaron retrospectivamente 57 pacientes, 43 hombres, con prótesis aórtica, operados más de 6 meses antes del estudio. Se calculó la SC del parte quirúrgico y el AOE indexada tabulada, el AOE posquirúrgica con eco-Doppler transtorácico por la ecuación de continuidad y se comparó el MPP prequirúrgico y posquirúrgico. Se consideró MPP aórtico un AOE indexada < 0,75 cm²/m². Resultados Se observó una prevalencia de MPP preoperatorio del 29,8% y posoperatorio del 54,4% (p = 0,029), con el 31% de MMP grave. La prevalencia de sobrepeso en la muestra estudiada fue del 80%. Conclusiones En este grupo de pacientes con alta prevalencia de sobrepeso, la estimación del AOE preoperatoria indexada por SC de cada tipo de prótesis para predecir el MPP posoperatorio mostró diferencias significativas entre el diagnóstico del MPP estimado en el preoperatorio y el calculado por eco-Doppler en el posoperatorio. En futuros estudios es necesaria la inclusión de un grupo poblacional mayor, así como la revisión del método de cálculo del área valvular (p. ej., del tracto de salida del ventrículo izquierdo).

Background Patient-aortic valve prosthesis mismatch (PPM) is associated with poor postoperative outcomes. Determination of aortic effective orifice area (EOA) indexed for body surface area (BSA) is useful to select suitable type and size of heart valve prosthesis in order to prevent patient-prosthesis mismatch. Objective The objective of this study was to compare the PPM estimated by indexed EOA with PPM determined by echo-Doppler at late follow-up. Material and Methods Fifty seven patients (43 men) who had undergone an aortic valve replacement in the previous 6 months were retrospectively assessed. After calculating BSA from the surgical report, indexed EOA, postoperative EOA (determined by the continuity equation with transthoracic echo-Doppler), preoperative and postoperative PPM were compared. An indexed EOA < 0.75 cm²/m² was considered aortic PPM. Results The prevalence of preoperative and postoperative PPM was 29.8% and 54.4%, respectively (p=0.029); 31% of MMP was severe. The prevalence of overweight in this sample was 80%. Conclusions In this group of patients with a high prevalence of overweight, the estimation of preoperative EOA indexed for BSA in order to predict postoperative PPM according to the type of prosthesis, showed significantly differences between preoperative PPM and postoperative PPM calculated by echo-Doppler. Further studies should not only include a larger sample, but should also check the method used for calculating valvular area (for example, in the left ventricular outflow tract).