Transcranial direct current stimulation for post-stroke dysphagia: a meta-analysis.

BACKGROUND: Strokes may cause some swallowing difficulty or associated dysphagia in 25-80% of patients. This phenomenon has been linked to increased morbidity and mortality. Therefore, the aim of this study was to evaluate the efficacy of transcranial direct current stimulation in patients with dysphagia in post-stroke patients. METHODS: A systematic search in PubMed, Scopus, Web of Science and MEDLINE was conducted. The articles must have to evaluate an intervention that included transcranial direct current stimulation; the sample had to consist exclusively of patients with post-stroke dysphagia; and the experimental design consisted of randomized controlled trial. Difference in mean differences and their 95% confidence interval were calculated as the between-group difference in means divided by the pooled standard deviation. The I2 statistic was used to determine the degree of heterogeneity. RESULTS: Of the 9 investigations analyzed, all applied transcranial direct current stimulation in combination with conventional dysphagia therapy to the experimental group. All the studies analyzed identified improvements in swallowing function and meta-analysis confirmed their strong effect on reducing the risk of penetration and aspiration (Hedges's g = 0.55). The results showed that participants who received transcranial direct current stimulation significantly improved swallowing function. CONCLUSIONS: Transcranial direct current stimulation has positive effects in the treatment of poststroke dysphagia by improving swallowing function, oral and pharyngeal phase times and the risk of penetration and aspiration. Furthermore, its combination with conventional dysphagia therapy, balloon dilatation with catheter or training of the swallowing muscles ensures improvement of swallowing function. PROSPERO registration ID CRD42022314949.

Immediate Effects of Whole-Body versus Local Dynamic Electrostimulation of the Abdominal Muscles in Healthy People Assessed by Ultrasound: A Randomized Controlled Trial.

Dynamic electrostimulation consists of the application of local or global electrostimulation together with physical exercise. This study aimed to investigate the immediate effects of a dynamic electrostimulation session on the thickness of the abdominal musculature, inter-rectus distance, heart rate, blood pressure, and body temperature, and to identify possible differences in its form of application. A total of 120 healthy participants were divided into three groups: the whole-body electrostimulation group, the local electrostimulation group, and the control group without electrical stimulation. All groups performed a single session with the same dynamic exercise protocol. Muscle thickness and inter-rectus distance were evaluated ultrasonographically using the Rehabilitative Ultrasound Imaging technique both at rest and in muscle contraction (the active straight leg raise test) to find the post-intervention differences. The results showed significant differences in immediate post-intervention heart rate, with a smaller increase in the local electrostimulation group compared to the control and whole-body electrostimulation groups. No significant differences were identified between the groups after the interventions in the rest of the variables analyzed. Therefore, a local application, with the same effects as a global application on the abdominal musculature, has fewer contraindications, which makes its use more advisable, especially in populations with cardiorespiratory disorders, for which more research is needed.

Perineal Massage during Pregnancy for the Prevention of Postpartum Urinary Incontinence: Controlled Clinical Trial.

Background and objectives: Urinary incontinence is any involuntary loss of urine. It may result in anxiety, depression, low self-esteem and social isolation. Perineal massage has spread as a prophylactic technique for treating complications during labor. Acknowledged effects of perineal massage are reduction of incidence and severity of perineal tear and use of equipment directly related to the intrapartum perineal trauma. The aim of this study was to determine the effectiveness of massage in urinary incontinence prevention and identification of possible differences in its form of application (self-massage or by a physiotherapist), with the previous assumption that it is effective and that there are differences between the different forms of application. Materials and Methods: A controlled clinical trial with a sample of 81 pregnant women was conducted. The participants were divided into three groups: a group that received the massage applied by a specialized physiotherapist, another group that applied the massage to themselves, and a control group that only received ordinary obstetric care. Results: No differences were identified in the incidence or severity of urinary incontinence among the three groups. The severity of the incontinence was only affected by the body mass index and the weight of the baby at the time of delivery. Conclusions: A relationship between perineal massage interventions and development of urinary incontinence has not been observed.

Prevalence of Perineal Tear Peripartum after Two Antepartum Perineal Massage Techniques: A Non-Randomised Controlled Trial.

Perineal massage increases elasticity of myofascial perineal tissue and decreases the burning and perineal pain during labour, thus optimising child birth, although an application protocol has not been standardised yet. The objective of this study is to determine the efficiency of massage in perineal tear prevention and identification of possible differences in massage application. Total of 90 pregnant participants were divided into three groups: perineal massage and EPI-NO® device group, applied by an expert physiotherapist, self-massage group, where women were instructed to apply perineal massage in domestic household, and a control group, which received ordinary obstetric attention. Results: The results showed significant differences among the control group and the two perineal massage groups in perineal postpartum pain. Correlations in perineal postpartum pain, labour duration and the baby's weight were not statistically significant. Lithotomy posture was significantly less prevalent in the massage group than in the other two; this variable is known to have a direct effect on episiotomy incidence and could act as a causal covariate of the different incidence of episiotomy in the groups. Perineal massage reduces postpartum perineal pain, prevalence and severity of perineal tear during delivery.

Perceptions and Degree of Satisfaction with the Health Sciences University Educational Community Regarding the Measures Adopted for the Prevention of COVID-19 in the Academic Year 2020/2021.

The COVID-19 pandemic caused the start of the academic year 2020/2021 to be conditioned by health and safety regulations. The present research was defined with the aim of analyzing the degree of satisfaction and perceptions on the establishment of bubble groups and pairs and on the use of audiovisual platforms for the development of theoretical and practical university teaching in three degrees of health sciences. A cross-sectional descriptive study was carried out on a representative sample of students and teachers of health sciences in Ponferrada (n = 285). Specific questionnaires designed for this study were completed virtually during April and May 2021. The results indicate that that satisfaction was moderate-high. The perception of the influence of bubble pairs on the quality of teaching can be interpreted as very low. These results increase with the age and academic and professional experience of students and faculty members, respectively. However, the participants belonging to physiotherapy considered that the quality of teaching had worsened much more compared to their counterparts in nursing and podiatry.

Reliability and Validity of the Six Spot Step Test in People with Intellectual Disability.

Clinical tests for the evaluation of balance in people with intellectual disability that have been most commonly used depend on the subjective evaluation of the evaluator, easily reach the ceiling effect and are poorly sensitive to small changes; but new tests have been developed, such as the Six Spot Step Test. The aim of this study was to determine the validity and within-day and day-to-day test-retest reliability of the Six Spot Step Test in people with intellectual disability. A descriptive cross-sectional study was conducted with 18 people with intellectual disability. The participants conducted the Six Spot Step Test three times and a set of five clinical tests for the balance assessment. The relative reliability was excellent (Intraclass Correlation Coefficient (ICC) = 0.86 - 0.97), and the absolute reliability ranged between 4.7% and 7.3% for coefficient variation and between 0.6 and 1.2 for the standard error of measurement. Linear regression models showed that that test can explain the results of the Timed Up & Go, Four Square Step Test and the Berg Balance Scale. The Six Spot Step Test proved to be as valid and reliable for the evaluation of dynamic balance in people with intellectual disability as the most frequently used tests for the clinical evaluation of postural control.

Physical Activity, Resilience, Sense of Coherence and Coping in People with Multiple Sclerosis in the Situation Derived from COVID-19.

The confinement forced by COVID-19 can have repercussions on the health of people diagnosed with multiple sclerosis. The objective of this study is to analyze the relationships between physical activity, a sense of coherence, resilience and coping among people diagnosed with Multiple Sclerosis during the health emergency situation. To achieve this goal, this transversal descriptive study included 84 patients that belonged to multiple sclerosis associations during the period of confinement. Participants filled out the Physical Activity (IPAQ-SF), Sense of Coherence (SOC-13), Resilience Scale (ER-14) and coping (COPE-28) questionnaires. The results showed that the average age was 46.9 and that 67.9% had Relapsing Remittent Multiple Sclerosis diagnosed on average 13.9 years ago. They had a high degree (33.3%) and moderate degree (34.5%) of physical activity, high levels of resilience, while the level of a sense of coherence was average and the most commonly used strategies for coping were active confrontation and religion. Physical activity was not related to the rest of the studied variables, but there were correlations between the other variables. The people with multiple sclerosis who belong to patient associations have remained physically active during the obligatory confinement period and have elevated degrees of resilience and an average sense of coherence, as well as using suitable coping strategies, which is why the social-health resource of belonging to a patient association could be boosting these variables that are beneficial to their health.

Analysis of Postural Control in Sitting by Pressure Mapping in Patients with Multiple Sclerosis, Spinal Cord Injury and Friedreich's Ataxia: A Case Series Study.

The postural control assessments in patients with neurological diseases lack reliability and sensitivity to small changes in patient functionality. The appearance of pressure mapping has allowed quantitative evaluation of postural control in sitting. This study was carried out to determine the evaluations in pressure mapping and verifying whether they are different between the three sample groups (multiple sclerosis, spinal cord injury and Friedreich's ataxia), and to determine whether the variables extracted from the pressure mapping analysis are more sensitive than functional tests to evaluate the postural trunk control. A case series study was carried out in a sample of 10 adult patients with multiple sclerosis (n = 2), spinal cord injury (n = 4) and Friedreich's ataxia (n = 4). The tests applied were: pressure mapping, seated Lateral Reach Test, seated Functional Reach Test, Berg Balance Scale, Posture and Postural Ability Scale, Function in Sitting Test, and Trunk Control Test. The participants with Friedreich's ataxia showed a tendency to present a higher mean pressure on the seat of subject's wheelchair compared to other groups. In parallel, users with spinal cord injury showed a tendency to present the highest values of maximum pressure and area of contact. People with different neurological pathologies and similar results in functional tests have very different results in the pressure mapping. Although it is not possible to establish a strong statistical correlation, the relationships between the pressure mapping variables and the functional tests seem to be numerous, especially in the multiple sclerosis group.

Thermal Infrared Imaging to Evaluate Emotional Competences in Nursing Students: A First Approach through a Case Study.

During university studies of nursing, it is important to develop emotional skills for their impact on academic performance and the quality of patient care. Thermography is a technology that could be applied during nursing training to evaluate emotional skills. The objective is to evaluate the effect of thermography as the tool for monitoring and improving emotional skills in student nurses through a case study. The student was subjected to different emotions. The stimuli applied were video and music. The process consisted of measuring the facial temperatures during each emotion and stimulus in three phases: acclimatization, stimulus, and response. Thermographic data acquisition was performed with an FLIR E6 camera. The analysis was complemented with the environmental data (temperature and humidity). With the video stimulus, the start and final forehead temperature from testing phases, showed a different behavior between the positive (joy: 34.5 °C-34.5 °C) and negative (anger: 36.1 °C-35.1 °C) emotions during the acclimatization phase, different from the increase experienced in the stimulus (joy: 34.7 °C-35.0 °C and anger: 35.0 °C-35.0 °C) and response phases (joy: 35.0 °C-35.0 °C and anger: 34.8 °C-35.0 °C). With the music stimulus, the emotions showed different patterns in each phase (joy: 34.2 °C-33.9 °C-33.4 °C and anger: 33.8 °C-33.4 °C-33.8 °C). Whenever the subject is exposed to a stimulus, there is a thermal bodily response. All of the facial areas follow a common thermal pattern in response to the stimulus, with the exception of the nose. Thermography is a technique suitable for the stimulation practices in emotional skills, given that it is non-invasive, it is quantifiable, and easy to access.