Rehabilitación diaria de personas con secuela neurológica post-covid-19: scoping review / Rehabilitation in the day-to-day of people with post-covid-19 neurological sequelae: scoping review

Objetivo: Mapear las evidencias científicas disponibles sobre rehabilitación en el cotidiano de personas con secuela neurológica post covid-19. Metodología: Se trata de una scoping review según las directrices del Joanna Briggs Institute. Los estudios incluidos se basaron en la estrategia mnemónica participants/ problem (personas adultas con secuela neurológica), concept (rehabilitación en lo cotidiano) y context (pandemia covid-19), con espacio temporal de 2020 a 2022, disponibles en las siete bases de datos seleccionadas, en los idiomas portugués, inglés y español, recogidos y analizados según PRISMA-ScR. Resultados: Fueron recuperados 1.027 estudios, siendo que la muestra fue compuesta por 11 artículos que presentaron programas de rehabilitación para las secuelas: fatiga, anosmia, trastornos cognitivos y neuropsicológicos. Entre los principales programas de rehabilitación encontrados, destacan: caminata de progresión, ejercicios respiratorios; entrenamiento olfativo usando aceites esenciales y abordajes cognitivos. A partir de los hallazgos, el proceso de rehabilitación ha demostrado ser eficaz para el manejo de las secuelas neurológicas post-covid-19, debiendo ser iniciado precozmente. Conclusiones: Se recomienda que los programas de rehabilitación cuenten con la participación de un equipo multiprofesional, ya que la enfermedad presenta síntomas persistentes multisistémicos, que implican un enfoque holístico y abarcan aspectos de comportamiento relacionados con el autocuidado, rehabilitación física, apoyo emocional y educación en salud, promoviendo la recuperación y mejora de la calidad de vida de los individuos afectados por la enfermedad (AU)

Objetivo: Mapear as evidências científicas disponíveis sobre reabilitação no quotidiano de pessoas com sequela neurológica pós-COVID-19. Metodologia: Trata-se de uma scoping review segundo as diretrizes do Joanna Briggs Institute. Os estudos incluídos basearam-se na estratégia mnemônica participants/ problem (pessoas adultas com sequela neurológica), concept (reabilitação no quotidiano) e context (pandemia covid-19), com espaço temporal de 2020 a 2022, disponíveis nas sete bases de dados selecionadas, nos idiomas português, inglês e espanhol, coletados e analisados segundo o PRISMA-ScR. Resultados: Foram recuperados 1.027 estudos, sendo que a amostra foi composta por 11 artigos que apresentaram programas de reabilitação para as sequelas: fadiga, anosmia, distúrbios cognitivos e neuropsicológicos. Dentre os principais programas de reabilitação encontrados, destacam-se: caminhada de progressão, exercícios respiratórios; treinamento olfativo usando óleos essenciais e abordagens cognitivas. A partir dos achados, o processo de reabilitação tem se mostrado eficaz para o manejo das sequelas neurológicas pós-covid-19, devendo ser iniciado precocemente. Conclusões: Recomenda-se que os programas de reabilitação envolvam uma equipe multiprofissional, já que a doença apresenta sintomas persistentes multissistêmicos, envolvendo uma abordagem holística, que englobe aspectos comportamentais relacionados ao autocuidado, reabilitação física, suporte emocional e educação em saúde, promovendo a recuperação e melhora da qualidade de vida dos indivíduos afetados pela doença (AU)

Objective: To map available scientific evidence on rehabilitation in the daily lives of people with post-covid-19 neurological sequelae. Methodology: This is a scoping review according to the guidelines of the Joanna Briggs Institute. The included studies were based on the mnemonic strategy participants/ problem (adult people with neurological sequelae), concept (rehabilitation in everyday life) and context (covid-19 pandemic), with timeframe from 2020 to 2022, available in the seven selected databases, in Portuguese, English and Spanish, collected and analyzed according to PRISMA-ScR. Results: A total of 1,027 studies were recovered, and the sample consisted of 11 articles that presented rehabilitation programs for sequelae: fatigue, anosmia, cognitive and neuropsychological disorders. Among the main rehabilitation programs found, the following stand out: progression walking, breathing exercises; olfactory training using essential oils and cognitive approaches. From the findings, the rehabilitation process has been shown to be effective for the management of post-covid-19 neurological sequelae, and should be started early. Conclusions: Rehabilitation programs should involve a multidisciplinary team, since the disease presents persistent multisystemic symptoms, involving a holistic approach, which encompasses behavioral aspects related to self-care, physical rehabilitation, emotional support and health education, promoting recovery and improving the quality of life of individuals affected by the diseas (AU)

Research on a New Rehabilitation Robot for Balance Disorders.

The treatment of patients with balance disorders is an urgent problem to be solved by the medical community. The causes of balance disorders are diverse. An aging population, traffic accidents, stroke, genetic diseases and so on are all possible factors. It has brought great pain and inconvenience to patients and their families. At present, there are two main types of assisted rehabilitation training robots for patients with balance disorders: exoskeleton robots and end robots. The exoskeleton robot is generally installed on the outside of the patient's body to follow their movement, which can support the weight of the body and provide power support to help the patient train and recover lower limb ability. The use of end robots is usually to secure the patient's foot to the motion platform and control the pedal to drive the lower limbs to conduct gait training. Such passive training is more suitable for patients with severe disorders. The patient has low awareness of active participation. This paper focuses on research on end rehabilitation training robots for balance disorders. In this paper, a robotic system for rehabilitation training of patients with balance disorders is invented. The robot body is a 9 degree of freedom (DOF) redundant series-parallel hybrid motion platform. Two sets of motion platforms with symmetrical mirror images are used together to simulate different motion modes of the human body and drive the human body to move. Each set of motion platforms is composed of a 6-DOF vestibular parallel device and a 3-DOF proprioception parallel device. It has the advantages of DOF decoupling and fast response, proposing a new structural form for the design of proprioceptive and vestibular simulation platforms. The robot's functional level can be divided into a vestibular sense module and a proprioception module according to the structure. The two modules can work independently to achieve different functions or work together to achieve complex motion and multisensory fusion. This robot is a redundant mechanism device with 9 DOFs. Through a reasonable distribution of DOF and motion, the robot's working space can be increased, and the robot's flexibility and motion performance can be improved. In this paper, a trajectory tracking control algorithm for vestibular and proprioceptive simulation is proposed, which can provide unlimited body sense training for patients within the robot's limited motion range.

Global synergistic actions to improve brain health for human development.

The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.

Keeping it all in balance: a qualitative analysis of the role of balance outcome measurement in physical therapist decision-making and patient outcomes.

PURPOSE: The use of outcome measures (OMs) is a hallmark of contemporary physical therapy in the USA. The effect of OM utilization on patient care decisions and the results of PT services remain poorly understood. The purpose of this study is to explore PTs perceptions about the relationship between balance OMs and decision-making and how that interaction impacts patient outcomes, particularly for patients with acquired brain injury. MATERIALS AND METHODS: This qualitative study used semi-structured phone interviews with an interview guide. Maximum variation sampling was used. Thematic analysis was situated in a priori determined theory-based categories. RESULTS: Twenty-three physical therapists (PTs) from diverse geographic areas and practice settings participated. Therapists expressed diverse views on the impact of OM use on patient outcomes, but the majority perceived that using OMs improved rehabilitation outcomes. The use of OMs was related to the selection of optimal intervention type and intensity and justified continued high-frequency rehabilitation services. OMs were important to therapists' decision-making. CONCLUSIONS: In the present study, PTs reported that they believe the use of validated, clinically useful OMs may improve patient outcomes.Implications For RehabilitationBalance outcome measures are considered an important tool to the optimal management of the profound impact of balance impairments after brain injury.Most physical therapists in this study believe that using balance outcome measures results in better outcomes for patients with brain injury.In this study, physical therapists reported using outcome measures in wide-ranging ways to guide clinical decisions about balance in those with brain injury.

Robot-assisted rehabilitation for children with neurological disabilities: Results of the Italian consensus conference CICERONE.

BACKGROUND: The use of robotic technologies in pediatric rehabilitation has seen a large increase, but with a lack of a comprehensive framework about their effectiveness. OBJECTIVE: An Italian Consensus Conference has been promoted to develop recommendations on these technologies: definitions and classification criteria of devices, indications and limits of their use in neurological diseases, theoretical models, ethical and legal implications. In this paper, we present the results for the pediatric age. METHODS: A systematic search on Cochrane Library, PEDro and PubMed was performed. Papers published up to March 1st, 2020, in English, were included and analyzed using the methodology of the Centre for Evidence-Based Medicine in Oxford, AMSTAR2 and PEDro scales for systematic reviews and RCT, respectively. RESULTS: Some positives aspects emerged in the area of gait: an increased number of children reaching the stance, an improvement in walking distance, speed and endurance. Critical aspects include the heterogeneity of the studied cases, measurements and training protocols. CONCLUSION: Many studies demonstrate the benefits of robotic training in developmental age. However, it is necessary to increase the number of trials to achieve greater homogeneity between protocols and to confirm the effectiveness of pediatric robotic rehabilitation.

Exergame for the functional rehabilitation of adults over 55 with neurological diseases.

SUMMARY: Rehabilitation based on Exergame is showing a rapid evolution, with interesting applications for the recovery of mobility, balance, postural control, coordination and fine motor skills, and including home-based training. At present, there are no precise indications for Exergamebased rehabilitation of people over 55 affected by stroke, Parkinson's disease, or multiple sclerosis. This review examines the proposed modalities and the effectiveness of Exergame-based rehabilitation interventions for adults over 55 with stroke, Parkinson's disease or multiple sclerosis, highlighting the limitations, advantages, controversies and impact of this approach. We examined randomized controlled trials published between 2016-2020, with search in the databases of PubMed, Scopus, Cochrane Library, RehabData, selecting 24 studies. The study of patients with chronic or subacute stroke in outpatient treatment, and with small sample sizes, prevails. Wide variability characterizes the rehabilitation methods, the technological platforms used, the type and dose of exercise administered, the outcome measures. The adequacy and efficacy of Exergames remains uncertain in the neurological elderly, and the functional improvement in the neurological adult patient is not yet attested using this type of approach.

Realidad virtual de bajo coste. Una nueva aplicación para rehabilitación motora de los miembros superiores en patología neurológica: Estudio piloto / Low-cost virtual reality. A new application for upper extremity motor rehabilitation in neurological pathology: Pilot study

Antecedentes y objetivo: El objetivo de este estudio es presentar una nueva aplicación de realidad virtual (RV) de bajo coste basada en el dispositivo Leap Motion Controller (LMC) desarrollada para la rehabilitación motora de miembros superiores tras patología neurológica y mostrar su viabilidad clínica realizando una experiencia piloto. Material y métodos: El LMC permite la interacción con las aplicaciones virtuales mediante la captación de los movimientos de la mano. Se realizó una prueba piloto con cuatro pacientes con afectación de miembros superiores con Upper Extremity Motor Score (UEMS) mayor de 10. Se les valoró con los test Box and Block (BBT) y tarea de escritura del Jebsen-Taylor Hand Function (JTHF) antes y después de la intervención. Resultados: Los pacientes completaron el protocolo de nueve sesiones de 30 minutos de duración dividido en tres sesiones por semana. En el BBT pasaron de 38 (DE 20) cubos antes de la intervención a 44 (DE 21,72) cubos tras finalizarla. En el JTHF pasaron de 28,25 s (DE 8,61) a 26, 75 s (DE 21,72). No hubo diferencias estadísticamente significativas. La usabilidad del dispositivo se valoró con la escala Quebec User Evaluation of Satisfaction with assistive Technology, versión 2.0 (QUEST) siendo la seguridad, efectividad y facilidad de uso los aspectos prioritarios. Conclusión: Se presenta un nuevo desarrollo de RV basado en el dispositivo LMC y se ha comprobado su viabilidad clínica en pacientes neurológicos con afectación de los miembros superiores. Es preciso realizar un estudio clínico con una muestra amplia para valorar su posible efectividad clínica como elemento de tratamiento.(AU)

Background and objectives: The aim of this study is to present a new virtual reality (VR) low cost application based on Leap Motion Controller (LMC) device for upper extremity motor rehabilitation after neurological pathology and to demonstrate its clinical feasibility by carrying out a pilot experience. Material and methods: The LMC allows the interaction with virtual applications by capturing the patient's hand movements. A pilot study was carried out with 4 patients with upper limb impairment reflected with Upper Extremity Motor Score (UEMS) greater than 10. They were assessed using the Box and Block (BBT) and the writing task within the Jebsen-Taylor Hand Function (JTHF) before and after the intervention. Results: All patients completed the 9-session, 30-min protocol divided into 3 sessions per week. They went from an average result of 38 (SD 20) blocks in BBT before the intervention to 44 (SD 21.72) after it. They went from 28.25 s (SD 8.61) to 26.75 s (SD 21.72) in the JTHF. Statistically significant differences were no found. The device usability was assessed by the QUEST scale, being the security, effectiveness and ease to use the aspects that patients considered to be a priority. Conclusión: A new VR development based on the LMC device is presented and the clinical feasibility of its application in neurological patients with upper limb involvement has been proven. A clinical study with a large sample size is needed to assess its potential clinical effectiveness as a treatment element.(AU)

[Late neurological consequences of a SARS-CoV-2 infection]. / Neurologische Spätfolgen einer SARS-CoV-2-Infektion.

BACKGROUND: Persistent neurological late symptoms of SARS-CoV-2 infection are common and require regular follow-up treatment. In order to establish uniform therapy concepts, it is necessary to evaluate individual therapeutic approaches for long COVID and post-COVID-19 syndrome. ANAMNESE: A 62-year-old patient was admitted to our rehab clinic for follow-up treatment after severe SARS-CoV-2 infection with neurological symptoms. The initially extensive laboratory and imaging investigation did not reveal any organic cause for the sometimes apoplectiform, complex clinical picture, so that the patient was transferred directly to our rehabilitation clinic in the event of everyday restrictions and rollator dependency. EXAMINATION AND FINDINGS: Clinically, there was a reduced general condition and the mood was depressed. Neurological symptoms were gait ataxia, hand tremor, amnesic aphasia and reduced ability to concentrate. PET / CT showed no evidence of tumor or inflammation. THERAPY AND PROGRESS: A multimodal therapy program consisting of physiotherapy and occupational therapy as well as psychological support was carried out. In addition, off-label therapy with oral glucocorticoids and colchicine was initiated. In the course of the disease, there was a clear reduction in all symptoms with little residual hand tremor. CONCLUSIONS: Whole body and brain FDG PET can be helpful in long COVID and post-COVID-19 syndrome patients with neurological symptoms of unknown origin. These patients benefit from systematic rehabilitation. Glucocorticoids and colchicine appear to accelerate symptom reduction. The rehabilitative therapy should be continued on an outpatient basis.

[Questionnaire to Assess the Work-Related Orientation of Medical Rehabilitation from the Perspective of the Rehabilitants (WMR-R): Cross-Sectional Study Comparing the Short and Long Versions]. / Fragebogen zur Erfassung der medizinisch-beruflichen Orientierung der Rehabilitation aus der Perspektive der Rehabilitanden (MBOR-R): Querschnittsstudie zum Vergleich der Kurz- und Langversion.

BACKGROUND: The user perception of the work-related treatment is of great importance for the further development and success of work-related medical rehabilitation (WMR). The German Pension Insurance Fund (Deutsche Rentenversicherung DRV Bund) has therefore supported the development of the questionnaire WMR-R that can be used to assess the quality of the structure, process and results of work-related rehabilitation treatment from the patient's point of view. This paper presents a short version and compares it with the long version. METHODS: Based on a representative sample stratified by indication, employed rehabilitants up to the age of 65 were randomly selected to be questioned 6 months after their rehabilitation with a long version (N=28276) or a short version (N=6611) of WMR-R. In addition, routine data of the German Pension Insurance Fund were included. 27 items each of the long version and 8 items of the short version are added up to a total score and compared with regard to test statistical quality criteria and sample sensitivity. RESULTS: Participation rates were slightly higher in the short version (31%, N=2115) than in the long version (28%, N=8019). The processing quality in both versions is comparable. The short and long versions correlate with each other at r=0.96 (p<0.01). Both versions have similar validity characteristics and separate well between WMR and standard rehabilitation. Both versions are robust to demographic, disease-related and socio-medical risk factors. Rehabilitants with addiction and psychosomatic as well as neurological diseases rate their rehabilitation as significantly more work-oriented compared to other indications, especially pneumology. DISCUSSION: Due to the low survey effort and the simple evaluation and interpretation, the short version is particularly suitable for routine surveys of WMR care quality. The long version allows a differentiated recording of the WMR offer of rehabilitation facilities in the sense of strength/weakness analyses.

Health Promotion and Wellness in Neurologic Physical Therapy: Strategies to Advance Practice.

BACKGROUND AND PURPOSE: Neurologic physical therapy (PT) can assist people with neurologic conditions and injuries to optimize their health and well-being by addressing barriers at the individual, relationship, community, and societal levels. The purpose of this special interest article is to provide consensus-driven strategies to address barriers to implementing health promotion and wellness (HPW)-related neurologic PT practice. SUMMARY OF KEY POINTS: Environmental scan, literature review, and expert input were used to determine barriers and develop strategies. Barriers include lack of time; low knowledge, self-efficacy, and awareness; client complexity; and lack of HPW resources; as well as concerns regarding payment and scope of practice. Four key strategies emerged: (1) develop and disseminate a consensus-based scope of practice for HPW in neurologic PT; (2) increase knowledge of resources related to HPW; (3) promote delivery models for HPW-related neurologic PT; and (4) encourage advocacy, community building and partnership along the continuum of care. RECOMMENDATIONS FOR CLINICAL PRACTICE: Clinicians should practice to their full scope of HPW-related PT practice. This includes optimizing movement, including physical activity and fitness, as well as reinforcing the importance of healthy sleep, nutrition, stress, and smoking cessation. These activities address primary, secondary, and tertiary prevention. Clinicians are encouraged to report their experiences with HPW-focused delivery models and outcomes. Additional research is needed to understand the full impact of HPW on PT practice (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A364).

Outreach physiatry clinics in remote Manitoba communities: an economic cost analysis.

BACKGROUND: One in 5 people in Canada have a disability affecting daily activities, and, for rural patients, accessing lifelong physiatry care to improve function and manage symptoms requires complex and expensive travel. We compared the costs of new outreach physiatry clinics with those of conventional urban clinics in Manitoba. METHODS: Six outreach clinics were held from January 2018 to September 2019 in the remote communities of St. Theresa Point and Churchill, Manitoba. A general physiatry population was seen in these clinics, including patients with musculoskeletal and neurologic conditions seen in consultation and follow-up. We performed a societal cost-minimization analysis comparing outreach clinic costs to estimated costs of standard care at conventional outpatient clinics in Winnipeg. Outcomes of interest included direct costs to government health services and patients, and indirect opportunity cost of travel time. We calculated total costs, average cost per clinic visit and incremental costs for outreach clinics compared to conventional urban clinics. Costs were inflated to 2020 Canadian dollars. RESULTS: Thirty-one patients (48 visits) were seen at the outreach clinics. The total cost of providing outreach clinics, $33 136, was 21% of the estimated cost of standard care, $158 344. When only direct costs were included, outreach clinics cost an estimated 24% of conventional care costs. The average unit cost per outreach visit was $690, compared to $3299 per conventional visit, for an incremental cost of -$2609 per outreach visit. INTERPRETATION: An outreach physiatry visit in Manitoba cost an estimated 21% of a conventional urban outpatient visit, or 24% when only direct costs were included, with costs savings largely related to travel. Outreach physiatry care in this model provides substantial cost savings for the public health care system as the primary payer, and can reduce the travel cost burden for patients who do not have public travel funding.

Reciprocal Influence of Mobility and Speech-Language: Advancing Physical Therapy and Speech Therapy Cotreatment and Collaboration for Adults With Neurological Conditions.

Mobility and speech-language impairments and limitations in adults with neurological conditions manifest not in isolated anatomical components but instead in the individual-environment system and are task-dependent. Optimization of function thus requires interprofessional care to promote participation in meaningful life areas within appropriate task and environmental contexts. Cotreatment guidelines (ie, the concurrent intervention of disciplines) were established by the physical therapy, occupational therapy, and speech-language and hearing professional organizations nearly 2 decades ago to facilitate seamless interprofessional care. Despite this, cotreatment between physical therapy and speech therapy remains limited. The purpose of this Perspective article is to encourage physical therapists and speech-language pathologists to increase interprofessional collaboration through cotreatment in the management of adults with neurological conditions. Evidence from pediatrics and basic motor control literature points toward reciprocal interactions between speech-language and mobility. We provide recommendations for clinical practice with an emphasis on the gains each discipline can provide the other. This Perspective is rooted in the International Classification of Functioning, Disability and Health model and ecological theory. IMPACT: The goals of speech therapy and physical therapy are complementary and mutually supportive. Enhanced cotreatment, and collaboration more generally, between physical therapists and speech-language pathologists in the management of adults with neurological conditions can augment task-relevant conditions to improve function.

Hospitalized Patients With COVID-19 and Neurological Complications Experience More Frequent Decline in Functioning and Greater Rehabilitation Needs.

ABSTRACT: The coronavirus disease 2019 has been reported to cause various serious neurological sequelae. However, there is little information available about the impact of the disease and its complications on patients' functional status and their postacute needs. Hence, this study was performed to address the current gap in knowledge about the function and postacute needs of those with neurological complications of coronavirus disease 2019. A prospective chart review was completed for 319 patients admitted with coronavirus disease 2019 between March 4 and May 1, 2020. Primary outcomes included rate of new functional decline, discharge location, need for outpatient physical/occupational/speech therapy, need for durable medical equipment at discharge, and presence of dysphagia at discharge. Patients with neurological complications were compared with patients without neurological complications. Two hundred ninety-six cases were included in the final analysis, and 81 (27.4%) of these patients experienced neurological complications. Results indicated that hospitalized coronavirus disease 2019 patients with neurological complications exhibit a significantly longer length of stay, higher frequency of functional decline, higher mortality rate, and more frequent discharge to a subacute rehabilitation facility (all P < 0.0001). The findings of this study are expected to better prepare patients, providers, and health systems for the postacute needs of those with coronavirus disease 2019 and neurological complications.

Discontinuation or abandonment of mobility assistive technology among people with neurological conditions. / Interrupción o abandono en el uso de productos de apoyo para la movilidad en personas con afectación neurológica.

INTRODUCTION: Among other limitations, people with neurological conditions often experience problems with functional mobility. One of the intervention strategies employed to mitigate or compensate this limitation is the use of mobility assistive technology such as manual and electric wheelchairs, walkers, canes, crutches, etc. Although assistive technology is a commonly used intervention strategy among disabled people, the use of this technology is sometimes discontinued or abandoned due to a failure to meet the user's needs or a lack of training, among other reasons. PATIENTS AND METHODS: The sample used in this study comprises 80 users of mobility assistive technology, 14 of whom have abandoned or discontinued their use of Assistive Technology. The study variables include the Psychosocial Impact of Assistive Devices Scale for outcome measurement, as well as specific sociodemographic variables relating to the sample and the assistive device used. RESULTS: Significant values were obtained in the three subscales of the Psychosocial Impact of Assistive Devices Scale. 50% of abandonments of assistive technology occurred among people diagnosed with stroke. CONCLUSION: The Psychosocial Impact of Assistive Devices Scale can be a useful tool for assessing potential abandonment or non-use of Assistive Technology. More longitudinal studies are required to avoid this limitation on the use of assistive technology.

TITLE: Interrupción o abandono en el uso de productos de apoyo para la movilidad en personas con afectación neurológica.Introducción. Las personas con afectación neurológica suelen presentar, entre otras limitaciones, problemas en la movilidad funcional. Por ello, una estrategia de intervención para mitigar o compensar esta limitación es el uso de productos de apoyo para la movilidad, como sillas de ruedas tanto manuales como eléctricas, andadores, bastones, muletas, etc. Aunque los productos de apoyo son una estrategia habitual de intervención en personas con discapacidad, en ocasiones su uso es interrumpido o abandonado por no cubrir las necesidades del usuario o por falta de entrenamiento, entre otras causas. Pacientes y métodos. La muestra del análisis está formada por 80 usuarios de productos de apoyo para la movilidad, de los cuales 14 abandonaron o interrumpieron el uso del producto de apoyo. Las variables del estudio incluyen la escala Psychosocial Impact of Assistive Devices Scale (PIADS) como medida de resultados, además de variables sociodemográficas específicas de la muestra y del producto de apoyo empleado. Resultados. Se obtienen valores significativos en las tres subescalas de la PIADS. Un 50% de los productos de apoyo abandonados corresponde a personas con diagnóstico de ictus. Conclusiones. La PIADS puede ser una herramienta adecuada para evaluar el posible abandono o la falta de uso de los productos de apoyo. Aunque los productos de apoyo son una correcta estrategia de intervención para mitigar las limitaciones en la movilidad, algunos usuarios abandonan o interrumpen su uso por diferentes factores. Es necesario realizar más estudios longitudinales para evitar esta limitación en el uso de productos de apoyo.

Adult polyglucosan body disease – Management and evolution in an intensive rehabilitation program / Enfermedad con cuerpos de poliglucosanos del adulto. Tratamiento y evolución en un programa intensivo de rehabilitación

Adult polyglucosan body disease is a rare neuromuscular genetic disorder. It is characterized by accumulation of an abnormal structural form of glycogen, particularly in central and peripheral nervous system and muscles. Functional impairments and the rehabilitation approach of this entity is rarely reported. We present a case of a 65-year-old female with several years of undiagnosed symptoms. One year after the diagnosis, the patient was evaluated for the first time in a physical and rehabilitation consultation. We describe the inpatient rehabilitation program – an approach planned to achieve high levels of treatment intensity and with intervention of a multiprofessional and multidisciplinary team (AU)

La enfermedad con cuerpos de poliglucosanos del adulto (ECPA) es un trastorno genético neuromuscular raro, que se caracteriza por la acumulación de una forma estructural del glucógeno anormal, particularmente en el sistema nervioso central y periférico, y en los músculos. Raramente se reportan el deterioro funcional y el enfoque de rehabilitación de esta entidad. Presentamos el caso de una mujer de 65 años con síntomas no diagnosticados durante muchos años. Transcurrido un año del diagnóstico, la paciente fue evaluada por primera vez en una consulta de fisioterapia y rehabilitación. Describimos el programa de rehabilitación hospitalaria, un enfoque planteado para lograr altos niveles de intensidad terapéutica, con intervención de un equipo multi-profesional y multidisciplinario (AU)

Post-COVID 19 neurological syndrome: Implications for sequelae's treatment.

Study design Literature review. OBJECTIVES: Describe the implications of post-COVID syndrome due to neurological sequelae including treatment and the differences that may exist between this group of patients and those who present these events not associated with COVID-19. METHODS: A non-systematic review of the literature was carried out in PubMed and Science Direct databases, using the keywords "Post-acute COVID-19 syndrome"; "Neurological complications"; "Neurologic Manifestations" "COVID-19″ and "Rehabilitation", as well as synonyms, which were combined with the operators "AND" and "OR". RESULTS: The COVID-19 viral caustive agent, SARS-CoV-2, has a high affinity for human angiotensin-converting enzyme 2 receptor on type II pneumocytes. This receptor is also expressed in neurons and glial cells. Based on the foregoing and other not so clear mechanisms, it is stated that SARS-CoV-2 has tropism for the nervous system, being evident through the neurological manifestations observed in patients with mild, moderate and severe phenotype of the disease such as anosmia, ageusia, headache, cerebrovascular accidents, Guillain-Barré syndrome, seizures, and encephalopathy. This can generate severe sequelae and even fatal outcomes in those affected. CONCLUSIONS: Neurological complications caused by COVID-19 are frequent and represent a risk that compromises the functional capacity and the life of patients. The suspicion of these conditions, the strict control of metabolic alterations and cardiovascular risk factors, the effective and safe treatment of these entities, are a current challenge throughout the pandemic. The rehabilitation process in these patients is a challenge. This is due to the limitations generated by multi-organ damage, as well as risk of brain death.

Teleneurorehabilitation in the COVID-19 Era: What Are We Doing Now and What will We Do Next?

Dear Editor, [...].

Effectiveness of Telerehabilitation in Physical Therapist Practice: An Umbrella and Mapping Review With Meta-Meta-Analysis.

OBJECTIVE: Telerehabilitation is an option that should be adapted as soon as possible to face the crisis caused by coronavirus disease 2019. An umbrella and mapping review with meta-meta-analysis (MMA) of the available scientific evidence was performed to determine whether telerehabilitation could be an effective alternative to conventional rehabilitation in physical therapist practice. METHODS: A systematic review of reviews and a synthesis of the findings of all systematic evidence published to date with a visual map and a meta-meta-analysis (MMA) were performed. A systematic search was realized in Cochrane Database of Systematic Reviews, MEDLINE (PubMed), and Google Scholar. Two independent reviewers performed a data analysis and assessed the quality of the included reviews, assessing the risk of bias using ROBIS. RESULTS: Twenty-nine articles that met the inclusion criteria were selected and divided according to the type of patient targeted for rehabilitation (patients with cardiorespiratory, musculoskeletal, and neurological conditions). The MMA regarding physical function between telerehabilitation and usual care rehabilitation did not reveal a statistically significant difference for patients with cardiorespiratory and musculoskeletal conditions. For patients with neurological conditions, the MMA revealed a statistically significant but negligible effect size in 6 reviews in favor of telerehabilitation (standardized mean difference = 0.18; 95% CI = 0.03-0.34). CONCLUSION: The results of the present review showed that telerehabilitation offers positive clinical results, even comparable to conventional face-to-face rehabilitation approaches. IMPACT: The advantages of lower cost and less interference by the rehabilitation processes in patients' daily life could justify implementing telerehabilitation in clinical settings in the coronavirus disease 2019 era.