Ventilatory, phonatory and swallowing impairments in advanced neuromuscular disease patients / Alteraciones ventilatorias, fonatorias y deglutorias en pacientes con enfermedad neuromuscular avanzada

Purpose: To analyze the ventilatory, phonatory and swallowing impairments and their relation with physical status in a group of advanced Neuromuscular Disease (NMD).Methods: A cross-sectional observational study was utilized 48 participants from the Association of NMD of Granada (Granada, España), university clinical research, University of Granada. A total of 24 advanced NMD patients and 24 healthy controls matched for age and sex were recruited. Advanced NMD patients were divided in two groups according to the level of their overall physical status (NMD higher physical status group or NMD lower physical status group). Hand grip strength, ventilatory, phonatory and swallowing features were analyzed.Results: There were significant differences (p<.05) among NMDs groups in ventilatory function. There were significant differences (p<.05) between NMDs groups in ventilatory, phonatory and swallowing function. Finally, there were significant differences (p<.05) among advanced NMDs groups in swallowing function and orofacial evaluation. Conclusion: Patients with lower physical status have higher risk of suffer ventilatory, phonatory and swallowing complications after diagnosis of NMD.(AU)

Propósito: Analizar las alteraciones ventilatorias, fonatorias y deglutorias y su relación con el estado físico en un grupo de Enfermos Neuromusculares (ENM) avanzados.Métodos: Se realizó un estudio observacional transversal con 48 participantes de la Asociación de ENM de Granada (Granada, España), y de la facultad de ciencias de la salud de la Universidad de Granada. Se reclutaron un total de 24 pacientes con ENM avanzada y 24 controles sanos emparejados por edad y sexo. Los pacientes con ENM avanzada se dividieron en dos grupos según el nivel de su estado físico general (grupo de ENM de mayor estado físico o grupo de ENM de menor estado físico). Se analizó la fuerza de agarre de las manos y las características ventilatorias, fonatorias y deglutorias.Resultados:Se encontraron diferencias significativas (p<0,05) entre los grupos de ENM en la función ventilatoria. También, se observaron diferencias significativas (p<0,05) entre los grupos de ENM en la función fonatoria y deglutoria. Por último, existieron diferencias significativas (p<0,05) entre los grupos de ENM avanzados respecto a la condición miofuncional orofacial.Conclusiones: Los pacientes con menor estado físico tienen mayor riesgo de sufrir complicaciones ventilatorias, fonatorias y deglutorias tras el diagnóstico de ENM.(AU)

Balance Ability and Occupational Performance in Patients With Parkinson's Disease and On-Medication-State Freezing of Gait.

PURPOSE: The aim of this study was to examine balance ability and occupational performance in patients with Parkinson's disease (PD) and on-medication-state freezing of gait (FOG). DESIGN: A cohort study with three groups was conducted. METHODS: Seven patients with PD and on-medication-state FOG with optimized pharmacological therapy; seven patients with PD matched by age, gender, length of time since diagnosis, and Hoehn and Yahr stage; and seven controls were included. Outcomes included balance and occupational performance. Nonparametric analyses were used. FINDINGS: Significant differences were found between the two subgroups of patients with PD in the Timed Up & Go Test when adding a cognitive task, dual-task interference, and self-confidence in balance. CONCLUSIONS: Patients with PD and on-medication-state FOG had lower scores on dual-task interference and self-confidence than matched PD patients. CLINICAL RELEVANCE: The assessment and rehabilitation approach for patients with PD and on-medication-state FOG should include balance confidence and dual-task interference.

Effects of an active intervention based on myofascial release and neurodynamics in patients with chronic neck pain: a randomized controlled trial.

BACKGROUND: While neck pain can be severely disabling and costly, treatment options have shown moderate evidence of effectiveness. OBJECTIVE: The objective of this study was to explore the effects of a 4-week active program based on myofascial release and neurodynamics on trigger point (TrP) examination, pain, and functionality in patients with chronic neck pain. METHODS: Randomized controlled trial. A total of 40 patients with chronic neck pain were randomly allocated to an experimental or a control group (n = 20). The primary outcome measure was TrP examination. Secondary outcomes were pain, assessed with the Brief Pain Inventory and a visual analogue scale, and functionality, evaluated with the Neck Outcome Score. RESULTS: A between-group analysis showed significant differences (p < .05) in the percentage of active TrPs in the following muscles: suboccipital (50 vs. 92.4% in the right muscle and 37.5 vs. 89.6% in the left muscle), left scalene and levator scapulae. Significant differences (p < .05) were also found in pain severity, average pain, and functionality (i.e. symptoms, sleep, and participation). CONCLUSIONS: A 4-week self-administered program for patients with chronic neck pain was effective in reducing the presence of active TrPs. Pain severity, average pain, and some aspects of functionality also improved significantly after the intervention.

[Prevalence and repercussions of the locomotor syndrome in patients with chronic obstructive pulmonary disease]. / Prevalencia y repercusión del síndrome locomotor en el perfil clínico de la enfermedad pulmonar obstructiva crónica.

BACKGROUND: Patients with Chronic Obstructive Pulmonary Disease (COPD) suffer a progressive deterioration of functional status and a decrease in independence in activities of daily living. Locomotor Syndrome (SL) is the involvement of the musculoskeletal system due to the deterioration caused by age. AIM: In patients with COPD, to evaluate the prevalence in LS and assess its impact on functional status and quality of life. MATERIAL AND METHODS: Cross sectional assessment of 259 patients with COPD. LS was evaluated with the Geriatric Locomotive Function Scale (GFLS-25). Those with a score < 16 were classified as having LS. Functional status was evaluated with dynamometry, Five Times Sit-to-Stand test, and the Modified Baecke Physical Activity Questionnaire. Functional impairment was measured with the London Chest Activity of Daily Living, and the quality of life was evaluated with EuroQol-5D. RESULTS: LS was found in 139 patients (53%). Activity levels and muscle strength were lower in these patients. Also, they had a higher frequency of functional impairment and a lower quality of life perception. CONCLUSIONS: LS in patients with COPD impacts their functional status and quality of life.

Symptom severity is associated with signs of central sensitization in patients with asthma.

INTRODUCTION: Asthma is characterized by recurrent episodes of wheezing, dyspnoea, chest tightness and cough. In addition to respiratory symptoms, previous studies have reported the presence of pain. OBJECTIVE: To analyse the nociceptive processing of young adults with well-controlled asthma. METHODS: A cross-sectional case-control study was performed. Patients diagnosed with persistent well-controlled asthma were recruited from the 'Complejo Hospitalario Universitario' (Granada). Main outcomes included pain processing, measured by the pressure-pain thresholds (PPTs) and temporal summation and latency of pain; symptoms, including cough (Leicester Cough Questionnaire) and dyspnoea (Borg scale); and catastrophic cognitions about breathlessness, assessed by the Breathlessness Catastrophizing Scale (BCS). RESULTS: Seven-two participants were finally recruited in our study. Patients with asthma presented lower pressure thresholds (p < 0.05) and significant differences in latency and summation tests. These patients also presented a greater cough level, with significant differences in all subscales (p < 0.05). Significant differences were also found in the BCS between groups (p < 0.001). CONCLUSION: Our results show a decrease of PPTs and a greater pain intensity in latency and summation tests, suggesting an abnormal pain processing in patients with asthma.

The Caregiver Burden Inventory as a Sleep Disturbance Screening Tool for Parents of Children with Autism Spectrum Disorder.

PURPOSE: The study was conducted to explore the degree to which caregiver burden is associated with sleep quality in parents of children with autism spectrum disorder, and to determine a statistically valid cutoff score for the Caregiver Burden Inventory (CBI) in order to identify parents of risk of poor sleep quality. DESIGN AND METHODS: We conducted a cross-sectional analysis. We assessed caregiver burden with the CBI, sleep quality with the Pittsburgh Sleep Quality Index, emotional status with the Hospital Anxiety and Depression Scale, and impact on family with the Impact on Family Scale. Caregiver burden was evaluated with a logistic regression analysis. The best fit model was used in a receiver operating characteristic analysis. Likelihood ratios and post-test probabilities were calculated. RESULTS: A total of 116 parents were included in this study. Higher caregiver burden was associated with a reduction in sleep quality in the logistic regression analysis (p < 0.001). The area under the curve for the univariate burden test model (best fit) was 76.70 (p < 0.001). The cutoff score for poor sleep quality was caregiver burden ≥26.50. The post-test probability of poor sleep quality increased to 82.02% from a pre-test probability of 76.72%. CONCLUSIONS: Our findings suggest that caregiver burden is associated with sleep quality among parents of children with autism spectrum disorder. The findings suggest that a CBI cutoff score of 26.50 may help to detect risk of poor sleep quality in parents of children with autism spectrum disorder.

Impacts of tailored, rehabilitation nursing care on functional ability and quality of life in hospitalized elderly patients after rib fractures.

OBJECTIVES: We aimed to analyze the effects of a tailored rehabilitation nursing care program on functional ability and quality of life in patients with conservative treatment for rib fractures. DESIGN: Randomized controlled trial. SETTING: Inpatient rehabilitation hospital. SUBJECTS: Rib fracture patients treated conservatively were randomized into two groups (experimental and control group). INTERVENTIONS: Patients in control group received Treatment as Usual (TAU) and patients included in experimental group received TAU and an added tailored rehabilitation nursing care program (RNT). MAIN MEASURES: At baseline, and end of hospitalization treatment, the functional ability was assessed with the Barthel Index, and the quality of life was evaluated with the EuroQol-5D. Additionally, the outcomes were assessed at six-month follow-up. RESULTS: A total of 80 patients were included in the study, whose mean age was 77.19 SD 7.71 in the RNT group and 75.55 SD 9.46 in the TAU group. Our data showed a significant difference in the post-treatment gains in overall quality of life (74.25 SD 20.62 vs 60.28 SD 20.54), and functional ability (71.79 SD 23.85 vs 69.41 SD 24.30) between the RNT group and the TAU group (P < 0.05). Compared to the TAU group, the RNT group also showed a significant improvement in functional ability and quality of life at six-month follow-up. CONCLUSIONS: A tailored rehabilitation nursing care program added to the conservative treatment during hospitalization can improve the functional ability and quality of life of patients after rib fractures at discharge and at six-month follow-up. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT04168996.

Prevalencia y repercusión del síndrome locomotor en el perfil clínico de la enfermedad pulmonar obstructiva crónica / Prevalence and repercussions of the locomotor syndrome in patients with chronic obstructive pulmonary disease

Background: Patients with Chronic Obstructive Pulmonary Disease (COPD) suffer a progressive deterioration of functional status and a decrease in independence in activities of daily living. Locomotor Syndrome (SL) is the involvement of the musculoskeletal system due to the deterioration caused by age. Aim: In patients with COPD, to evaluate the prevalence in LS and assess its impact on functional status and quality of life. Material and Methods: Cross sectional assessment of 259 patients with COPD. LS was evaluated with the Geriatric Locomotive Function Scale (GFLS-25). Those with a score < 16 were classified as having LS. Functional status was evaluated with dynamometry, Five Times Sit-to-Stand test, and the Modified Baecke Physical Activity Questionnaire. Functional impairment was measured with the London Chest Activity of Daily Living, and the quality of life was evaluated with EuroQol-5D. Results: LS was found in 139 patients (53%). Activity levels and muscle strength were lower in these patients. Also, they had a higher frequency of functional impairment and a lower quality of life perception. Conclusions: LS in patients with COPD impacts their functional status and quality of life.

Speech and language therapy treatment on hypokinetic dysarthria in Parkinson disease: Systematic review and meta-analysis.

OBJECTIVE: To assess the effect of speech and language therapy (SLT) on Hypokinetic dysarthria (HD) in Parkinson's disease. DESIGN: Systematic review and meta-analysis of randomized controlled trials. METHODS: We performed a literature search of randomized controlled trials using PubMed, Web of Science, Science Direct and Cochrane database (last search October 2020). Quality assessment and risk of bias were assessed using the Downs and Black scale and the Cochrane tool. The data were pooled and a meta-analysis was completed for sound pressure levels, perceptual intelligibility and inflection of voice fundamental frequency. RESULTS: We selected 15 high to moderate quality studies, which included 619 patients with Parkinson's disease. After pooling the data, 7 studies, which compared different speech language therapies to no treatment, control groups and 3 of their variables, (sound pressure level, semitone standard deviation and perceptual intelligibility) were included in the analysis.Results showed significant differences in favor of SLT for sound pressure level sustained phonation tasks (standard mean difference = 1.79; 95% confidence interval = 0.86, 2.72; p ⩽ 0.0001). Significant results were also observed for sound pressure level and semitone standard deviation in reading tasks (standard mean difference = 1.32; 95% confidence interval = 1.03, 1.61; p ⩽ 0.0001). Additionally, sound pressure levels in monologue tasks showed similar results when SLT was compared to other treatments (standard mean difference = 0.87; 95% confidence interval = 0.46, 1.28; p ⩽ 0.0001). CONCLUSION: This meta-analysis suggests a beneficial effect of SLT for reducing Hypokinetic Dysarthria in Parkinson's disease, improving perceptual intelligibility, sound pressure level and semitone standard deviation.

Deficits underlying handgrip performance in mildly affected chronic stroke persons.

BACKGROUND: Knowledge of the deficits underlying handgrip performance is fundamental for the development of targeted interventions. OBJECTIVES: The purpose of this study was to evaluate maximal handgrip strength, fatigue resistance, grip work, and muscle fatigue in mildly affected stroke persons. METHODS: We conducted a prospective observational study. A total of 20 individuals after a first unilateral ischemic/hemorrhagic chronic stroke (months poststroke: mean 33.64 ± 19.60), mildly affected according to functional score (FIM: 112.71 ± 16.14) and with arm motor impairment (upper-extremity Fugl-Meyer score: mean 57.07 ± 7.82 on the contralesional side); and 20 sex and age-matched controls were included. The outcomes assessed were maximal handgrip strength evaluated through maximal voluntary contraction, fatigue resistance defined as the seconds during which grip strength dropped to 50% of its maximum and gripwork, which was calculated using the equation grip work = maximal grip strength * 0.75 * fatigue resistance. Muscle fatigue was assessed using surface electromyography during a sustained contraction over 50% of maximal voluntary contraction. RESULTS: Persons with stroke demonstrated significantly reduced handgrip performance regarding maximal handgrip strength, resistance to fatigue, grip work, and muscle fatigue for the contralesional hand. In addition, a reduced grip resistance and muscle fatigue was shown for the ipsilesional hand compared with controls. We found no effect of the hemispheric side of the lesion on the grip performance measures assessed. CONCLUSIONS: Our findings provide evidence that handgrip performance remain impaired after 6 months after stroke, and may serve as a target for interventions to improve these abilities after stroke.

Effects of an Individualized Comprehensive Rehabilitation Program on Impaired Postural Control in Women With Chronic Pelvic Pain: A Randomized Controlled Trial.

OBJECTIVE: To assess the effectiveness of an individualized comprehensive rehabilitation program (ICPR) on impaired postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain. DESIGN: Randomized controlled trial. SETTING: Women with chronic pelvic pain were recruited from the Gynecology Department of the University Hospital San Cecilio in Granada, Spain. PARTICIPANTS: Participants (N=38) who were randomly divided into 2 groups. INTERVENTIONS: The intervention group received an 8-week ICRP, and the control group received a leaflet with ergonomic information. MAIN OUTCOME MEASURES: The main outcomes included were postural control (Mini Balance Evaluation Systems [Mini BESTest] and timed Up and Go [TUG]), pain (Brief Pain Inventory), self-perceived health status (EuroQol 5 dimensions [EQ-5D]), and functionality (Oswestry Disability Index [ODI]). RESULTS: Significant differences were found between groups in the Mini BESTest and TUG scores with large effect sizes. The Brief Pain Inventory, EQ-5D, and ODI also presented significant differences in the between-groups analysis, with better scores in the intervention group after treatment. In the follow-up analysis, significant differences were found between groups in the Mini BESTest (P<.001), the cognitive TUG subscale (P=.032), interference of pain (P<.001), anxiety and depression (P=.001), and visual analog scale EQ-5D (P=.026) subscales, as well as the ODI (P<.001). CONCLUSIONS: Our results show significant improvements on postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain who received an 8-week ICRP.

Shared decision-making and patient engagement program during acute exacerbation of COPD hospitalization: A randomized control trial.

OBJECTIVE: To evaluate the effectiveness of a shared decision-making and patient engagement (SDM-PE) program concerning in-hospital stay during acute exacerbation of COPD and determine its impact on patients' perceived health status. METHODS: Patients were randomly allocated to a control group that received standard treatment or an intervention group that received an individualized SDM-PE program in addition to standard treatment. The SDM-PE program included personalized health care focused on information about the disease, healthcare management, and reinforcement of behaviors regarding nutrition and exercise taking into account patients' preferences. RESULTS: A comparative analysis between groups showed a significant improvement in perceived health status at discharge in patients included in the experimental group compared to those in the control group (60.28 ± 21.65 vs. 54.13 ± 22.69, p = 0.036). In addition, perceived health status, COPD knowledge, adherence to pharmacological treatment, general functionality, and healthy lifestyle measures were significantly better at 3-month follow-up in the intervention group. CONCLUSION: An SDM-PE program significantly enhanced all the clinical measures assessed during hospitalization at 3-month follow-up. PRACTICE IMPLICATIONS: COPD patients and professionals need to work together to select the best care and treatment model for patients, taking into account individual values and preferences.

Respiratory repercussions of neurological diseases and how best to manage them.

Introduction: The high incidence of respiratory impairments in patients with neurological diseases is recognized, but the design, dosage, and effectiveness of interventions to manage them are seen as an ongoing challenge.Areas covered: This article summarizes the evidence regarding the respiratory impairments in major neurological diseases, and how to best manage them.Expert opinion: On the balance of available evidence, respiratory impairments are part of the clinical profile of neurological diseases including Multiple Sclerosis, Stroke, and Parkinson's Disease, acquiring more importance as the pathologies progress. It is recognized that knowledge gaps remain in some areas of relevance related to respiratory function and further research is required. When considering the therapeutic options, the respiratory training emerges as the approach with most evidence. However, important questions remain unsolved: what kind, how much, and how to best include respiratory interventions is uncertain. At present, respiratory programs also fail to include clinically relevant factors such as ambulation and trunk stability.

Influence of Cardiorespiratory Clinical Placements on the Specialty Interest of Physiotherapy Students.

Clinical placements are an important part of health students' training. Whilst much value is placed on the clinical environment as a place to learn, there is a paucity of direct evidence about its effectiveness. The aim of this study was to compare the competence, importance, and interest in cardiorespiratory physiotherapy of students before and after one month of clinical practice. A pre- and post-placement questionnaire about students' interest in different physiotherapy subspecialties was used. The students with a cardiorespiratory clinical placement showed a significant change in their perception about the importance of the cardiorespiratory specialty (0.348 ± 1.01; p < 0.001), while no significant change was observed in the students without cardiorespiratory placement (-0.014 ± 0.825; p = 0.883). The presence or absence of clinical placements seems to have a definitive impact on students' choice of a specialty. This implies the need for developing a set of clinical placements in all the subareas of physiotherapy in order to give undergraduate students the opportunity to make a better decision.