Effects of Hippotherapy on Postural Control in Children With Cerebral Palsy: A Systematic Review.

PURPOSE: To summarize and update the current knowledge on the effectiveness of hippotherapy on postural control in children with cerebral palsy. METHODS: Using a systematic review methodology, the electronic databases PubMed, Virtual Health Library, PEDro, Scielo, Embase, and Web of Science were searched for eligible articles from 2011 up to September 2021. Quality assessment of eligible studies was performed using the PEDro scale. RESULTS: There were 239 identified studies. Eight clinical trials were selected. The total sample consisted of 264 individuals, with 134 allocated to the experimental group (hippotherapy) and 130 individuals to the control group (conventional therapy). Most studies had moderate to high methodological quality. CONCLUSIONS: Hippotherapy can be an effective intervention to improve several aspects related to postural control, such as static balance (especially in the sitting posture), dynamic balance, and alignment (body posture) in children aged 3 to 16 years, particularly with spastic hemiplegia or diplegia. WHAT THIS ADDS TO THE EVIDENCE: This review summarizes studies that explore potential effects of hippotherapy on postural control in children with cerebral palsy.

Noninvasive Neuromodulation Techniques in Difficult Tracheostomy Weaning of Patients With Spinal Cord Injury: Report of Two Cases.

High spinal cord injured patients (SCI) are susceptible to respiratory muscle impairments. Transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) may influence the diaphragm's central control, but until now they are not described as a therapeutic resource for difficult weaning. We present two case reports of SCI patients (P1 and P2) with long-term tracheostomy (>40 days) and hospital stay (>50 days). In association with respiratory exercise, P1 received a combined application of anodal tDCS over the supplementary motor area plus sensory PES in the thoracic-abdominal muscles, and P2 received isolated excitatory PES in the abdominal muscles, applied daily except on weekends. Maximum inspiratory/expiratory pressure, peak cough flow, diaphragm excursion, and thickening fraction were measured in the first and last days of the protocol. Both patients had improvements, with clinical impact such as cough effectiveness, decannulated after 15 applications of stimulation. Augmentation of neural respiratory drive and corticospinal excitability is suggested.

Aplicação simultânea de estimulação transcraniana por corrente contínua cerebelar anódica para reabilitação do equilíbrio na ataxia cerebelar: relato de caso / Application of add-on anodal cerebellar direct current stimulation for balance rehabilitation in cerebellar ataxia: a case report

INTRODUÇÃO: As ataxias cerebelares são um extenso grupo de doenças que causam diversos distúrbios na marcha e no equilíbrio, e que comprometem seriamente a qualidade de vida, sem opções de tratamento eficazes. A cinesioterapia é a base de programas multifacetados que incorporam mais de um enfoque, como o treinamento de coordenação e equilíbrio. Recentemente, a estimulação transcraniana por corrente contínua (tDCS) sobre o cerebelo surgiu como uma intervenção para melhorar os distúrbios do equilíbrio. OBJETIVO: Descrever a aplicação simultânea de tDCS anódica cerebelar e cinesioterapia, em sessões múltiplas diárias para reabilitação da ataxia cerebelar. MATERIAIS E MÉTODOS: Este relato de caso incluiu um paciente do sexo masculino, de 34 anos, com história de ataxia espinocerebelar há 10 anos. Seus principais objetivos eram melhorar a marcha e o equilíbrio. Ele apresentava ataxia axial e apendicular, dificuldades na marcha e no equilíbrio. O protocolo de estimulação do cerebelo consistiu na aplicação de tDCS por 20 minutos, 2mA, diariamente, durante duas semanas, com ânodo posicionado sobre o ínion e cátodo sobre o músculo deltóide direito. A cinesioterapia simultânea incluiu exercícios funcionais progressivos com objetivo principal de treinamento de equilíbrio. RESULTADOS: A melhora clínica foi particularmente evidenciada por uma redução de 4 pontos na Escala para Avaliação e Graduação da Ataxia após 10 sessões, enquanto a literatura recomenda a eficácia de uma nova terapia que retardaria a progressão da ataxia em 1 ponto por ano. CONCLUSÃO: Nossos resultados sugerem que a associação entre tDCS e cinesioterapia foi eficaz neste paciente; as sessões de tDCS foram seguras e bem toleradas e podem ter desempenhado um papel na melhora nos testes funcionais. Novos estudos controlados envolvendo um número maior de pacientes são necessários para analisar os benefícios destas técnicas combinadas para maximizar a reabilitação motora nesta população.

INTRODUCTION: Cerebellar ataxias are an extensive group of diseases, which cause many disorders in gait and balance that seriously impair quality of life, and without effective treatment options. Kinesiotherapy is the basis of multifaceted programs that incorporate more than one focus, such as coordination and balance training. Recently, transcranial direct current stimulation (tDCS) over the cerebellum has emerged as an intervention to improve balance disorders. OBJECTIVE: To describe a daily multiple session's simultaneous application of anodal cerebellar tDCS to kinesiotherapy for rehabilitation in cerebellar ataxia. MATERIALS AND METHODS: This case report included a 34-year-old male patient with a 10-year history of spinocerebellar ataxia. His main goals were to improve his walking ability and balance. He presented with axial and appendicular ataxia, impaired gait, and balance. The protocol used to stimulate the cerebellum consisted of twenty-minute tDCS, 2mA, daily applied, over two weeks, with anode positioned over the inion and cathode over the right deltoid muscle. Simultaneous kinesiotherapy included progressive functional exercises with the main objective of balance training. RESULTS: Clinical improvement was particularly evidenced by a 4-point reduction in the Scale for the Assessment and Rating of Ataxia after ten sessions, while literature recommends efficacy of a new therapy that would retard ataxia progression by 1 point per year. CONCLUSION: Our results suggest that the association between tDCS and kinesiotherapy was effective in this patient; tDCS sessions were safe and well-tolerated and may have played a role in improving functional tests. Further controlled studies involving a larger number of patients are needed to analyze the benefits of these combined techniques to maximize motor rehabilitation in this population.

Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19.

Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.

Relationship between availability of physiotherapy services and ICU costs.

OBJECTIVE: To determine whether 24-h availability of physiotherapy services decreases ICU costs in comparison with the standard 12 h/day availability among patients admitted to the ICU for the first time. METHODS: This was an observational prevalence study involving 815 patients ≥ 18 years of age who had been on invasive mechanical ventilation (IMV) for ≥ 24 h and were discharged from an ICU to a ward at a tertiary teaching hospital in Brazil. The patients were divided into two groups according to h/day availability of physiotherapy services in the ICU: 24 h (PT-24; n = 332); and 12 h (PT-12; n = 483). The data collected included the reasons for hospital and ICU admissions; Acute Physiology and Chronic Health Evaluation II (APACHE II) score; IMV duration, ICU length of stay (ICU-LOS); and Omega score. RESULTS: The severity of illness was similar in both groups. Round-the-clock availability of physiotherapy services was associated with shorter IMV durations and ICU-LOS, as well as with lower total, medical, and staff costs, in comparison with the standard 12 h/day availability. CONCLUSIONS: In the population studied, total costs and staff costs were lower in the PT-24 group than in the PT-12 group. The h/day availability of physiotherapy services was found to be a significant predictor of ICU costs.

Relationship between availability of physiotherapy services and ICU costs / Relação entre a disponibilidade de serviços de fisioterapia e custos de UTI

ABSTRACT Objective: To determine whether 24-h availability of physiotherapy services decreases ICU costs in comparison with the standard 12 h/day availability among patients admitted to the ICU for the first time. Methods: This was an observational prevalence study involving 815 patients ≥ 18 years of age who had been on invasive mechanical ventilation (IMV) for ≥ 24 h and were discharged from an ICU to a ward at a tertiary teaching hospital in Brazil. The patients were divided into two groups according to h/day availability of physiotherapy services in the ICU: 24 h (PT-24; n = 332); and 12 h (PT-12; n = 483). The data collected included the reasons for hospital and ICU admissions; Acute Physiology and Chronic Health Evaluation II (APACHE II) score; IMV duration, ICU length of stay (ICU-LOS); and Omega score. Results: The severity of illness was similar in both groups. Round-the-clock availability of physiotherapy services was associated with shorter IMV durations and ICU-LOS, as well as with lower total, medical, and staff costs, in comparison with the standard 12 h/day availability. Conclusions: In the population studied, total costs and staff costs were lower in the PT-24 group than in the PT-12 group. The h/day availability of physiotherapy services was found to be a significant predictor of ICU costs.

RESUMO Objetivo: Determinar se a disponibilidade de serviços de fisioterapia 24 h/dia reduz os custos de UTI comparada à disponibilidade padrão de 12 h/dia entre pacientes admitidos pela primeira vez na UTI. Métodos: Estudo de prevalência observacional, envolvendo 815 pacientes ≥ 18 anos de idade que estavam em ventilação mecânica invasiva (VMI) por ≥ 24 h e que tiveram alta de uma UTI para uma enfermaria em um hospital universitário terciário no Brasil. Os pacientes foram divididos em dois grupos de acordo com a disponibilidade de serviços de fisioterapia na UTI em h/dia: 24 h (PT-24; n = 332); e 12 h (PT-12; n = 483). Os dados coletados incluíram os motivos das internações hospitalares e das admissões na UTI; a pontuação Acute Physiology and Chronic Health Evaluation II (APACHE II); a duração da VMI; o tempo de permanência na UTI (TP-UTI); e o escore Ômega. Resultados: A gravidade da doença foi similar em ambos os grupos. A disponibilidade ininterrupta de serviços de fisioterapia foi associada a tempos menores de VMI e TP-UTI, bem como a menores custos (totais, médicos e com pessoal), comparada à disponibilidade padrão de 12 h/dia. Conclusões: Na população estudada, os custos totais e os custos com pessoal foram menores no grupo PT-24 do que no grupo PT-12. A disponibilidade em h/dia dos serviços de fisioterapia mostrou ser um preditor significativo dos custos de UTI.

Comparação de custos em diferentes processos de abastecimento de materiais de fisioterapia respiratória em um hospital público de porte extra / Costs comparison in different supply processes of respiratory physiotherapy materials in an extra public hospital

INTRODUÇÃO: Todos os anos, milhões de dólares são gastos para equipar e manter os centros de esterilização hospitalar no mundo. Materiais de terapia respiratória são essenciais para o suporte de vida e têm um grande impacto nas complicações clínicas. Fornecer materiais de terapia respiratória com higiene apropriada em um hospital é um desafio para os gestores devido ao impacto clínico e de custos. OBJETIVO: Comparar os custos de diferentes métodos de abastecimento de materiais de fisioterapia respiratória em um hospital geral, de porte extra, terciário e público. MÉTODOS: Consistiu em um estudo observacional, baseado em revisão documental e análise crítica de indicadores de gestão hospitalar, e analisou materiais utilizados em fisioterapia respiratória, classificados como semicríticos, incluindo ressuscitador manual, nebulizador, kit para pressão positiva contínua nas vias aéreas, circuito ventilatório para ventilação mecânica não invasiva e invasiva. RESULTADOS: Comparado ao processo de aquisição de materiais descartáveis, o processo de abastecimento no Centro de Material e Esterilização (CME) institucional gera uma economia anual com valores calculados em US$ 289.679,26; em comparação com o CME terceirizado, o processo de suprimento no CME institucional economiza um montante de US$ 257.041,11 por ano. CONCLUSÃO: Este foi o primeiro estudo brasileiro a realizar uma análise de custos nesse contexto. O processo de abastecimento com a higienização de materiais de fisioterapia respiratória na CME-INST mostrou-se mais vantajoso com menores custos quando comparado ao processo de abastecimento com higienização na CME-EXT ou custo de aquisição de MD. A economia anual estimada considerando o consumo médio mensal neste estudo ultrapassou US$ 250.000,00. A análise de custos detalhada fornece informações cruciais e pode permitir uma melhor gestão financeira. [AU]

INTRODUCTION: Every year millions of dollars are expended to equip and maintain the hospital sterilization centers in the world. Respiratory therapy materials are essential to life support, and have a major impact on clinical complications. To provide respiratory therapy materials with appropriate hygiene in a hospital is a challenge for manager due to clinical and costs impact. OBJECTIVE: To compare costs of different methods of providing respiratory therapy materials in a general, extra, tertiary and public hospital. METHODS: It consisted of an observational study, based on document review and critical analysis of hospital management indicators, and analyzed materials used in respiratory therapy, classified as semi-critical products, including manual resuscitator, nebulizer, kit for Continuous Positive Airway Pressure (CPAP), ventilatory circuit for non-invasive and invasive mechanical ventilation. RESULTS: Compared to the supply process of disposable materials acquisition, the supply process in the Institutional Central Sterilization Supply Department generates an annual savings with values calculated at US$ 289,679.26; while compared to the Outsourced Central Sterilization Supply Department the supply process in the Institutional Central Sterilization Supply Department saves an amount of US$ 257,041.11 annually. CONCLUSION: This was the first Brazilian study to conduct a cost analysis in this context. The supply process with the cleaning of respiratory physiotherapy materials in the Institutional Central Sterilization Supply Department was more advantageous with lower costs when compared to the Outsourced Central Sterilization Supply Department or cost of acquisition of disposable materials. The annual savings estimated considering the average monthly consumption in this study exceeded US $ 250,000.00. Detailed cost analysis provides crucial information and can enable better financial management. [AU]

Effect of photobiomodulation on connective tissue remodeling and regeneration of skeletal muscle in elderly rats.

The purpose of this study was to evaluate the effects of low-level laser therapy (LLLT) on morphological aspects, IL-6 and IL-1ß expressions, as well as the distribution and organization of collagen in the tibialis anterior (TA) muscle of elderly rats submitted to cryoinjury. Histological photomicrographs were taken of TA muscles stained with HE and picrosirius red. Immunohistochemistry was used for the evaluation of IL-6 and IL-1ß. Male Wistar rats, aged 20 months, were distributed into three groups: (1) control animals not injured or treated with LLLT (n = 5), (2) cryoinjury without LLLT treatment (n = 15), and (3) cryoinjury treated with infrared LLLT (n = 15). LLLT was applied to the TA 2 h after of the injury induction and consisted of daily applications until the sacrifice (1, 3, and 7 days). The following parameters were used: λ = 780 nm, power density 1 W/cm2, output power 40 mW, 10 s per point, 8 points, and 3.2 J of total energy. In the histomorphological analysis, the treated group exhibited a significant decrease in inflammatory infiltrate (p < 0.001) as well as an increase immature fibers and new blood vessels at 7 days compared to the untreated group (p < 0.05). Furthermore, treatment induced a better collagen distribution and organization at 7 days in comparison to the untreated group (p < 0.05). In conclusion, LLLT demonstrated a modulatory effect on the muscle repair process in elderly animals with regard to the collagen remodeling and morphological aspects of muscle tissue.

Quality of life and psychomotor profile of children with attention deficit hyperactivity disorder (ADHD).

The knowledge of psychomotor development of children with attention deficit hyperactivity disorder (ADHD) may help in defining therapeutic approaches in order to minimize losses in their quality of life. The study objectives were to evaluate the quality of life and psychomotor profile of children with ADHD and check your correlation. Fourteen children, from seven to ten years, with ADHD combined type were evaluate using the scales PedsQL™ and Motor Development Scale. Results showed adverse effects of ADHD on quality of life and a deficit in motor skills. Nine participants (64.2%) were classified in motor development as "Normal Medium", followed by the classification "Normal Low" in four (28.5%) and "Low" in one subject (7.1%). We observed a positive correlation between quality of life and psychomotor development of children with ADHD, especially in areas: fine motor and spatial organization with social and psychosocial aspects, gross motor control with the emotional and temporal organization with the emotional, psychosocial and overall quality of life.

Quality of life and psychomotor profile of children with attention deficit hyperactivity disorder (ADHD) / Qualidade de vida e perfil psicomotor de crianças com transtorno de déficit de atenção e hiperatividade (TDAH)

The knowledge of psychomotor development of children with attention deficit hyperactivity disorder (ADHD) may help in defining therapeutic approaches in order to minimize losses in their quality of life. The study objectives were to evaluate the quality of life and psychomotor profile of children with ADHD and check your correlation. Fourteen children, from seven to ten years, with ADHD combined type were evaluate using the scales PedsQL™ and Motor Development Scale. Results showed adverse effects of ADHD on quality of life and a deficit in motor skills. Nine participants (64.2 percent) were classified in motor development as "Normal Medium", followed by the classification "Normal Low" in four (28.5 percent) and "Low" in one subject (7.1 percent). We observed a positive correlation between quality of life and psychomotor development of children with ADHD, especially in areas: fine motor and spatial organization with social and psychosocial aspects, gross motor control with the emotional and temporal organization with the emotional, psychosocial and overall quality of life.

O conhecimento sobre desenvolvimento psicomotor das crianças com TDAH pode auxiliar nas propostas terapêuticas, a fim de minimizar os prejuízos em sua qualidade de vida. Os objetivos do estudo foram avaliar a qualidade de vida e o perfil psicomotor de crianças com TDAH e verificar sua correlação. Quatorze crianças, de sete a dez anos, com TDAH do tipo combinado foram avaliadas pelas escalas PedsQL™ e Escala de Desenvolvimento Motor. Os resultados mostraram impactos negativos do TDAH na qualidade de vida e déficit nas habilidades motoras. Nove participantes (64,2 por cento) se classificaram com desenvolvimento motor "normal médio", seguidos das classificações "normal baixo" em quatro (28,5 por cento) e "inferior" em um indivíduo (7,1 por cento). Observou-se correlação positiva entre qualidade de vida e o desenvolvimento psicomotor de crianças com TDAH, principalmente em: motricidade fina e organização espacial com os aspectos social e psicossocial, motricidade global com o aspecto emocional e organização temporal com os aspectos emocional, psicossocial e qualidade de vida total.