Efectos de un programa de rehabilitación temprana en el desarrollo y adquisición de hitos motores en un niño con síndrome de Down: un estudio de caso / Effects of an early rehabilitation program on the development and acquisition of motor milestones in a child with Down syndrome: A case study

Antecedentes y objetivo: La rehabilitación temprana en el síndrome de Down (SD) es una estrategia fisioterápica de utilidad, si bien la evidencia científica al respecto no es muy amplia. Este estudio de caso tuvo como objetivo aportar información sobre los efectos de un programa de rehabilitación temprana en el perfil de desarrollo y adquisición de hitos de un niño con SD. Materiales y métodos: Se realizó un estudio de caso único de medidas repetidas, en el que un niño con SD de 22 meses de edad realizó un programa de rehabilitación psicomotriz. Los contenidos incluyeron actividades de motricidad gruesa y fina, así como tareas de estimulación cognitiva. Para determinar los efectos del programa en el perfil de desarrollo y la adquisición de hitos motores, se emplearon el Inventario de Batelle y la batería «Peabody Motor Developmental Scale», respectivamente. Resultados: Tras completar un total de 10 sesiones se observó una evolución en las áreas personal/social, motoras, comunicativas y cognitiva del niño. El programa tuvo efectos positivos en la motricidad gruesa, si bien su impacto en la motricidad fina fue mucho menor (mejoras en 4 de los 8 ítems valorados). Conclusiones: La realización de un programa de rehabilitación temprana se tradujo en cambios positivos en el desarrollo y en la adquisición de hitos de la motricidad gruesa en un niño de 22 meses de edad con SD. Las mejoras en la motricidad fina son más complejas de lograr mediante este tipo de programas. (AU)

Background and objective: Early rehabilitation in Down syndrome (DS) is a useful physiotherapy strategy, although the scientific evidence in this respect is not very extensive. This case study aimed to provide information on the effects of an early rehabilitation program on the developmental profile and milestones’ acquisition in a child with DS. Materials and methods: A single case study of repeated measures was conducted, in which a 22-month-old child with DS underwent a psychomotor rehabilitation program. Sessions’ contents included gross and fine motor activities, as well as cognitive stimulation tasks. The Batelle Inventory and the Peabody Motor Developmental Scale Battery were used to determine the effects of the program on the developmental profile and the acquisition of motor milestones, respectively. Results: After completing a total of 10 sessions, a progressive evolution was observed in the personal/social, motor, communication and cognitive areas of the child. The program had positive effects on gross motor skills, although its impact on fine motor skills was minor (improvements in 4 of the 8 items assessed). Conclusions: The implementation of an early rehabilitation program resulted in positive developmental changes and in the acquisition of gross motor milestones in a 22-month-old child with DS. Improvements in fine motor skills are more complex to achieve through this type of programs. (AU)

Review of the utilisation of a university hospital in Barcelona (Spain): evolution 1992-1996.

BACKGROUND: To test the applicability of the appropriateness evaluation protocol (AEP) as a tool for reviewing hospital utilisation. To quantify and to compare the rate of inappropriate admissions and amount of in-hospital days, emphasising the main causes and factors in the hospital associated with inappropriateness during the studied periods of time. PATIENTS AND METHODS: Two retrospective studies were carried out, the first one in 1992, when 2048 clinical histories were analysed, and the second in 1996, with 1099 reviewed histories. The tool used for the evaluation of the level of hospital utilisation is the AEP. RESULTS: The proportion of admissions considered to be inappropriate was 25% (95% CI: 20.8-24.5) in 1992, and 16% (95% CI: 13.8-18.2) in 1996. Premature admission was the most frequent cause of inappropriateness in both periods. The logistic regression model built for the dependent variable admission showed the following variables to be associated to inappropriateness: scheduled admission (OR: 15; 95% CI: 10.8-20.7) and (OR: 10; 95% CI: 6-16.5), weekend admission (OR: 2; 95% CI: 1.3-1.2) and (OR: 2; 95% CI: 1.2-2.3), for 1992 and 1996, respectively. The rate of inappropriate in-hospital stays in 1992 was 29% (95% CI: 28.3-29.6), and 13.5% (95% CI: 12.7-14.3) in 1996. Hospital organisational problems were the main cause of inappropriate in-hospital days in 1992, and diagnostic/ therapeutical tests that could be performed ambulatorily ranked first in 1996. The logistic regression model built for the dependent variable in-hospital days had the following independent variables associated to its inappropriateness: discharge on weekdays (OR: 1.4; 95% CI: 1.2-1.8) and (OR: 0.6; 95% CI: 0.5-0.8) and length of stay (OR: 2; 95% CI: 1.8-2.4) and (OR: 2.4; 95% CI: 2.3-2.5), for 1992 and 1996 respectively, among other variables. CONCLUSION: Periodic checking of the utilisation levels with the application of methods such as the AEP will contribute towards adapting hospital management in the more competitive current setting.