Influence of body mass index on psychological and functional outcomes in patients with multiple sclerosis: a cross-sectional study.

OBJECTIVES: To analyze the effect of weight on psychological and functional outcomes in multiple sclerosis (MS) patients, including self-perception, depression, functional level, fatigue, and self-rated health status. METHODS: One hundred and one (n = 101) patients with MS participated in this cross-sectional study. Outcomes were scores in the Beck Depression Inventory, NEO Five-Factor Inventory (NEOFFI), Functional Assessment of Multiple Sclerosis (FAMS), Fatigue Impact Scale, and Quality Short-Form Health Survey 36 (SF-36). Patients were classified as normal weight (18.5 < BMI < 24.9 kg/m(2)) or overweight (25.0 > BMI > 29.9 kg/m(2)). One-way analysis of covariance was conducted with gender, age, and years with disease as covariates. RESULTS: Depression levels were significantly higher in overweight versus normal-weight MS patients (F = 6.381; P = 0.013). NEOFFI scores were significantly higher in overweight versus normal-weight MS patients for extraversion (F = 6.331; P = 0.014), conscientiousness (F = 4.794; P = 0.034), and neuroticism (F = 5.422; P = 0.022) but not for openness (F = 2.174; P = 0.109) or agreeableness (F = 0.047; P = 0.829). The two groups did not significantly differ in fatigue (P > 00.5). Scores in general (F = 4.708; P = 0.032) and mental health (F = 4.583; P = 0.035) SF-36 domains were significantly lower in overweight versus normal-weight patients. Scores for FAMS domains of emotional well-being (F = 8.050; P = 0.006), general contentment (F = 7.967; P = 0.006), and family/social well-being (F = 7.662; P = 0.007) were significantly lower in overweight versus normal-weight patients. CONCLUSIONS: Overweight MS patients evidenced higher depression levels, lower functional capacity, and worse self-rated health status in comparison to normal-weight MS patients. These results suggest that weight control programs should be incorporated into the management of patients with MS.

Guías visuales como herramienta terapéutica en la enfermedad de Parkinson. Una revisión sistemática / Visual cues as a therapeutic tool in Parkinson's disease. A systematic review

Los estímulos o guías sensoriales se están utilizando como una herramienta terapéutica para la mejora de los trastornos de la marcha en los pacientes con enfermedad de Parkinson, pero la mayoría de los estudios parecen centrarse en el uso de estímulos auditivos. El objetivo del presente estudio fue realizar una revisión sistemática referente al uso de estímulos visuales sobre los trastornos de la marcha y la ejecución de tareas duales durante la misma, su influencia sobre los bloqueos motores y la incidencia de caídas en los pacientes con enfermedad de Parkinson, al objeto de poder extraer implicaciones terapéuticas. Se realizó una búsqueda bibliográfica sistemática en las principales bases de datos, como Cochrane Database of Systematic Reviews, TripDataBase, PubMed, Ovid MEDLINE, Ovid EMBASE, y Physiotherapy Evidence Database, durante el periodo 2005 al 2012, de acuerdo con las recomendaciones de la Consolidated Standards of Reporting Trials, valorando la calidad de los trabajos con el Quality Index de Downs y Black. Fueron incluidos 21 artículos en la presente revisión sistemática (con un total de 892 participantes), con calidad metodológica variable, obteniendo una puntuación media en el Quality Index de 17,27 puntos (rango: 11-21). Los estímulos visuales producen mejoras en parámetros temporoespaciales de la marcha, la ejecución de giros, disminuyendo la aparición de freezing y caídas en la enfermedad de Parkinson. Las tareas duales durante la marcha parecen beneficiarse mediante su uso, disminuyendo la interferencia de esta segunda tarea. Existe una necesidad de mayores estudios que determinen el tipo de estímulo preferente para cada estadio de la enfermedad(AU)

Sensory stimuli or sensory cues are being used as a therapeutic tool for improving gait disorders in Parkinson's disease patients, but most studies seem to focus on auditory stimuli. The aim of this study was to conduct a systematic review regarding the use of visual cues over gait disorders, dual tasks during gait, freezing and the incidence of falls in patients with Parkinson to obtain therapeutic implications. We conducted a systematic review in main databases such as Cochrane Database of Systematic Reviews, TripDataBase, PubMed, Ovid MEDLINE, Ovid EMBASE and Physiotherapy Evidence Database, during 2005 to 2012, according to the recommendations of the Consolidated Standards of Reporting Trials, evaluating the quality of the papers included with the Downs & Black Quality Index. 21 articles were finally included in this systematic review (with a total of 892 participants) with variable methodological quality, achieving an average of 17.27 points in the Downs and Black Quality Index (range: 11-21). Visual cues produce improvements over temporal-spatial parameters in gait, turning execution, reducing the appearance of freezing and falls in Parkinson's disease patients. Visual cues appear to benefit dual tasks during gait, reducing the interference of the second task. Further studies are needed to determine the preferred type of stimuli for each stage of the disease(AU)

[Visual cues as a therapeutic tool in Parkinson's disease. A systematic review]. / Guías visuales como herramienta terapéutica en la enfermedad de Parkinson. Una revisión sistemática.

Sensory stimuli or sensory cues are being used as a therapeutic tool for improving gait disorders in Parkinson's disease patients, but most studies seem to focus on auditory stimuli. The aim of this study was to conduct a systematic review regarding the use of visual cues over gait disorders, dual tasks during gait, freezing and the incidence of falls in patients with Parkinson to obtain therapeutic implications. We conducted a systematic review in main databases such as Cochrane Database of Systematic Reviews, TripDataBase, PubMed, Ovid MEDLINE, Ovid EMBASE and Physiotherapy Evidence Database, during 2005 to 2012, according to the recommendations of the Consolidated Standards of Reporting Trials, evaluating the quality of the papers included with the Downs & Black Quality Index. 21 articles were finally included in this systematic review (with a total of 892 participants) with variable methodological quality, achieving an average of 17.27 points in the Downs and Black Quality Index (range: 11-21). Visual cues produce improvements over temporal-spatial parameters in gait, turning execution, reducing the appearance of freezing and falls in Parkinson's disease patients. Visual cues appear to benefit dual tasks during gait, reducing the interference of the second task. Further studies are needed to determine the preferred type of stimuli for each stage of the disease.

Deficiencia, discapacidad, neurología y literatura. Réplica / Deficiency, disability, neurology and literature. Reply

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Pain in Parkinson disease: a review of the literature.

Parkinson's disease (PD) is a degenerative neurological disease presenting with motor and non-motor signs and symptoms. Approximately 30-50% of the patients experience pain. There is no consensus regarding the mechanisms and classification of pain in PD. This paper reviews current data on the possible mechanisms, classifications, evaluation and potential risk factors for pain in PD. Literature searches were performed to identify clinical trials and reviews covering patho-physiology, classification, type, evaluation and risk factors associated with pain in PD. Pain in PD could be related to pathologic changes in the anatomic structures involved in nociceptive mechanisms. Studies on pain mechanisms have been mostly conducted in animals. The mechanism of pain is complicated and influenced by different factors. There are several methodological differences between the studies trying to classify pain and to characterize its subtypes. Potential risk factors for pain in PD include: age, gender, and duration of the disease. Although pain is one of the non-motor symptoms most frequency experienced by patients, it is often under recognized and inadequately treated in contrast to motor symptoms Multicenter studies are needed that include a large cohort of subjects evaluated in multiple dimensions including pain in order to obtain more data and to allow improved management of pain in patients with PD.

Deficiencia, discapacidad, neurología y literatura / Deficiency, disability, neurology and literature

Introducción. La literatura siempre se ha sentido atraída por la patología neurológica, existiendo multitud de ejemplos que así lo demuestran. Asimismo, numerosos médicos se han dedicado a la literatura de ficción, plasmando sus conocimientos científicos en sus obras. Objetivos. Se aborda la aparición de la patología neurológica en una muestra de la literatura y se estudia la descripción de la enfermedad, el tratamiento, la visión del paciente y la relación de los profesionales de la salud con el entorno sociofamiliar.Desarrollo. Se han revisado algunas de las principales obras de la literatura de todos los tiempos que han abordado la patología neurológica, como El Quijote, Julio César, David Copperfield, El idiota o Miau, observando que, en muchas deellas, se ofrece una visión muy fidedigna de la enfermedad. Del mismo modo, se han revisado obras que son testimonio personal de pacientes o familiares de la vivencia de la enfermedad de origen neurológico y la discapacidad derivada, como La escafandra y la mariposa, Mi pie izquierdo o Una posibilidad entre mil. Conclusión. La literatura ha contribuido a dar una visión realista de las patologías de origen neurológico y de los profesionalessanitarios relacionados, existiendo múltiples ejemplos en los que se muestran las vivencias de los propios enfermos y se resalta la importancia del apoyo familiar (AU)

Introduction. Literature has always been attracted to neurological pathologies and the numerous works published on the subject are proof of this. Likewise, a number of physicians have been fiction writers and have drawn on their scientificknowledge to help develop their stories. Aims. The study addresses the appearance of neurological pathologies in a sample of literary works and examines thedescription of the disease, its treatment, the patient’s view and the relationship between healthcare professionals and the socio-familial milieu. Development. We review some of the greatest literary works of all times that deal with neurological pathologies, such asDon Quixote, Julius Caesar, David Copperfield, The Idiot or Miau, and many of them are seen to offer a very faithful portrayal of the disease. Similarly, we have also reviewed works that provide a personal account of life with neurological diseases and the ensuing disability written either by the patients themselves or by their relatives, examples being TheDiving Bell and the Butterfly, My Left Foot or One Chance in a Thousand.Conclusions. Literature has helped to offer a realistic vision of neurologically-based pathologies and the healthcare professionals who work with them; there are many examples that portray the experiences of the patients themselves and the importance of support from the family is a feature that is constantly underlined (AU)

Valoración y cuantificación de la espasticidad: revisión de los métodos clínicos, biomecánicos y neurofisiológicos / Evaluation and quantification of spasticity: a review of the clinical, biomechanical and neurophysiological methods

Introducción. La espasticidad es un trastorno sensitivomotor que afecta a cerca del 85% de los pacientes con esclerosis múltiple y entre el 65-78% con lesión medular, entre otras patologías neurológicas. Aunque generalmente la hipertoníasuele ser fácil de reconocer clínicamente, su cuantificación resulta bastante compleja. La gran cantidad de escalas clínicasexistentes y su subjetividad, la discrepancia entre la espasticidad percibida por el paciente y la medición clínica, así como la falta de correlación general entre las medidas neurofisiológicas y la hipertonía, otorgan una especial dificultad metodológica a la hora de realizar una medición válida y fiable del grado de espasticidad presente. Objetivo. Revisar los principales métodos de valoración de la espasticidad aparecidos en la literatura científica, realizando unadescripción y análisis crítico de sus ventajas, limitaciones y propiedades métricas en pacientes con patología neurológica.Desarrollo. Se revisan los diversos métodos descritos para la evaluación de la espasticidad, agrupándolos en tres grandesgrupos, las escalas clínicas específicamente diseñadas a tal efecto, las pruebas biomecánicas, así como los métodos neurofisiológicos. Conclusiones. Existe falta de consenso en la definición de la espasticidad, así como en la necesidad de formación y experiencia por parte de los evaluadores a la hora de evaluarla. Se recomienda utilizar una combinación entre los diferentesinstrumentos de valoración, como son las escalas, métodos biomecánicos y medidas neurofisiológicas descritos en elpresente trabajo, para realizar un diagnóstico general del grado de espasticidad presente en el paciente (AU)

Introduction. Spasticity is a sensory-motor disorder that affects about 85% of the patients with multiple sclerosis and between 65-78% of those with spinal cord injury, among other neurological conditions. Although hypertonia is generally easy to recognise clinically, quantifying it is quite a complex matter. The large number of clinical scales that exist and theirsubjectivity, the discrepancy between the spasticity perceived by the patient and the clinical measurement, as well as thelack of a general correlation between the neurophysiological measures and hypertonia, all make it especially difficult, inmethodological terms, to perform a valid, reliable measurement of the degree of spasticity presented by the patient. Aims. To review the main methods of evaluating spasticity published in the scientific literature and to carry out a description and critical analysis of their advantages, shortcomings and metric properties in patients with a neurological pathology. Development. The different methods described for evaluating spasticity are reviewed and classified in three broad groups,namely, clinical scales specifically designed for such a purpose, biomechanical tests and neurophysiological methods.Conclusions. There is little agreement on the definition of spasticity and the need for the evaluators’ training andexperience when it comes to evaluating it. We recommend using a combination of the different evaluation instruments, such as the scales, biomechanical methods and neurophysiological measures reported in this study, to carry out a general diagnosis of the degree of spasticity present in the patient (AU)

[Deficiency, disability, neurology and literature]. / Deficiencia, discapacidad, neurología y literatura.

INTRODUCTION: Literature has always been attracted to neurological pathologies and the numerous works published on the subject are proof of this. Likewise, a number of physicians have been fiction writers and have drawn on their scientific knowledge to help develop their stories. AIMS: The study addresses the appearance of neurological pathologies in a sample of literary works and examines the description of the disease, its treatment, the patient's view and the relationship between healthcare professionals and the socio-familial milieu. DEVELOPMENT: We review some of the greatest literary works of all times that deal with neurological pathologies, such as Don Quixote, Julius Caesar, David Copperfield, The Idiot or Miau, and many of them are seen to offer a very faithful portrayal of the disease. Similarly, we have also reviewed works that provide a personal account of life with neurological diseases and the ensuing disability written either by the patients themselves or by their relatives, examples being The Diving Bell and the Butterfly, My Left Foot or One Chance in a Thousand. CONCLUSIONS: Literature has helped to offer a realistic vision of neurologically-based pathologies and the healthcare professionals who work with them; there are many examples that portray the experiences of the patients themselves and the importance of support from the family is a feature that is constantly underlined.

[Evaluation and quantification of spasticity: a review of the clinical, biomechanical and neurophysiological methods]. / Valoracion y cuantificacion de la espasticidad: revision de los metodos clinicos, biomecanicos y neurofisiologicos.

INTRODUCTION: Spasticity is a sensory-motor disorder that affects about 85% of the patients with multiple sclerosis and between 65-78% of those with spinal cord injury, among other neurological conditions. Although hypertonia is generally easy to recognise clinically, quantifying it is quite a complex matter. The large number of clinical scales that exist and their subjectivity, the discrepancy between the spasticity perceived by the patient and the clinical measurement, as well as the lack of a general correlation between the neurophysiological measures and hypertonia, all make it especially difficult, in methodological terms, to perform a valid, reliable measurement of the degree of spasticity presented by the patient. AIMS: To review the main methods of evaluating spasticity published in the scientific literature and to carry out a description and critical analysis of their advantages, shortcomings and metric properties in patients with a neurological pathology. DEVELOPMENT: The different methods described for evaluating spasticity are reviewed and classified in three broad groups, namely, clinical scales specifically designed for such a purpose, biomechanical tests and neurophysiological methods. CONCLUSIONS: There is little agreement on the definition of spasticity and the need for the evaluators' training and experience when it comes to evaluating it. We recommend using a combination of the different evaluation instruments, such as the scales, biomechanical methods and neurophysiological measures reported in this study, to carry out a general diagnosis of the degree of spasticity present in the patient.

Thermal and mechanical pain thresholds in patients with fluctuating Parkinson's disease.

Study results evaluating pain thresholds in patients with Parkinson's disease (PD) vary widely. Thus, we designed our study to determine the effects of levodopa on the thresholds of pressure (PPT), heat (HPT) and cold pain (CPT) in PD patients with motor fluctuations (18 patients: 10 men, 8 women; age: 65 ± 10 years; mean disease duration: 11.6 ± 6 years), six of whom (33%) reported pain related to their disease. We compared these thresholds in patients in the ON and OFF states with those in 18 age- and sex-matched controls. Pain thresholds were assessed over: the frontal bones, C5-C6 zygapophyseal joints and second metacarpals (PPT); the dorsal aspect of the hand (HPT and CPT); and the tibialis anterior (TA) muscles. PD patients in the OFF state had lower PPT thresholds at all sites (P < 0.001) than healthy controls. Moreover, HPT and CPT thresholds were lower at all sites except over the TA muscle (P < 0.01). In the ON state, the PPT and CPT thresholds in PD patients were lower than in controls at all points, except over the TA (CPT) and the second metacarpals (PPT) P < 0.01. Pain thresholds were no different in PD patients in the ON or OFF state (P > 0.10), and the existence of pain did not influence the results. We detected mechanical and thermal pain hypersensitivity in PD patients in the OFF state, and levodopa administration did not increase these thresholds. Thus, while dopamine may modulate pain responses, other mechanisms are likely to be implicated in the modulation of these pain responses in PD patients.

Axial rigidity and quality of life in patients with Parkinson's disease: a preliminary study.

PURPOSE: Rigidity is a cardinal symptom of Parkinson's disease (PD) and is often clinically assessed by passively flexing and extending a patient's limb. Objective measurements had been employed to examine rigidity in PD subjects, including wrist, elbow, knee and trunk. This study aimed to investigate the relationship between an objective measurement of trunk rigidity and health-related quality of life (HRQoL) and functional status in patients with mild to moderate PD. METHODS: An isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 PD patients. HRQoL was assessed with the EuroQol-5D and Parkinson's Disease Questionnaire-39 items (PDQ-39). Functional status was measured with the Schwab and England scale. RESULTS: Trunk rigidity was correlated with the HRQoL assessed with the mobility, cognition and stigma PDQ-39 domains and the total PDQ-39 scores. No correlations were found among trunk muscle tone assessed with the isokinetic dynamometer and the EuroQoL-5D. Functional status was correlated with the trunk extensors rigidity at all angular velocities. CONCLUSION: The results from this study suggest that the axial motor impairments impact on QoL and functional status in patients with PD. Further studies are needed with quantitative devices for axial rigidity assessment to determine the relationship between trunk rigidity in PD patients with higher disease severity and HRQoL scales.

[Health-related quality of life in Parkinson's disease]. / Calidad de vida relacionada con la salud en la enfermedad de Parkinson.

Parkinson's disease is a disabling and progressive neurological condition characterized by multiple motor and non motor symptoms that contribute to deterioration in quality of life. The diversity of symptoms associated with the disease and its management affect the patients on their physical, social and mental quality of life. The aim of this study was to identify key dimensions of health related quality of life (HRQOL) in a population affected with Parkinson's disease with a degree of mild-moderate impairment. Thirty six patients with Parkinson were recruited. The Hoehn and Yarh scale, the Unified Parkinson's Disease Rate Scale, the scale of activities of daily life and Schwab & England Get Up & Go Test were applied. HRQOL was assessed with the EuroQol-5D and the specific questionnaire Parkinson's Disease Questionnaire-39 items. The dimensions of the PDQ-39, except the PDQ-39 Pain domain and the EuroQol-5D correlated significantly with the severity of the disease. HRQOL was correlated with the functional status of patients. Only the PDQ-39 pain domain correlated with the risk of falls. Our results suggest that the HRQOL of patients with PD, in a state of mild-moderate impairment, is strongly influenced by disease severity and functional status.

Calidad de vida relacionada con la salud en la enfermedad de Parkinson / Health-related quality of life in Parkinson's disease

La enfermedad de Parkinson (EP) es un trastorno neurológico, discapacitante y progresivo caracterizado por múltiples síntomas motores y no motores que contribuyen al deterioro en la calidad de vida del paciente. La diversidad de síntomas asociados a la enfermedad y su manejo afectan a la funcionalidad y las expectativas del individuo sobre su bienestar físico, social y mental, que son los componentes fundamentales de la calidad de vida relacionada con la salud (CVRS). El objetivo del presente trabajo fue identificar las principales dimensiones de la CVRS afectadas en una población con EP con un grado de afectación leve-moderado. Treinta y seis pacientes con EP completaron este estudio transversal. Se emplearon el estadio de Hoehn y Yarh, el Unified Parkinson's Disease Rate Scale, la escala de actividades de la vida diaria de Schwab y England y el Test Get Up & Go. La calidad de vida fue valorada con el EuroQoL-5D y con el cuestionario Parkinson's Disease Questionnaire-39 items. Las dimensiones del PDQ-39, excepto el dominio PDQ-39 Dolor, así como el cuestionario EuroQoL-5D se correlacionaron de manera significativa con la gravedad de la enfermedad. La CVRS se correlacionó con el estado funcional de los pacientes. Únicamente el dominio PDQ-39 Dolor se correlacionó con el riesgo de caídas. Nuestros resultados sugieren que la CVRS de los pacientes con EP, en un estado leve-moderado de afectación, está muy influenciada por la gravedad de la enfermedad y el estado funcional.

Parkinson's disease is a disabling and progressive neurological condition characterized by multiple motor and non motor symptoms that contribute to deterioration in quality of life. The diversity of symptoms associated with the disease and its management affect the patients on their physical, social and mental quality of life. The aim of this study was to identify key dimensions of health related quality of life (HRQOL) in a population affected with Parkinson's disease with a degree of mild-moderate impairment. Thirty six patients with Parkinson were recruited. The Hoehn and Yarh scale, the Unified Parkinson's Disease Rate Scale, the scale of activities of daily life and Schwab & England Get Up & Go Test were applied. HRQOL was assessed with the EuroQol-5D and the specific questionnaire Parkinson's Disease Questionnaire-39 items. The dimensions of the PDQ-39, except the PDQ-39 Pain domain and the EuroQol-5D correlated significantly with the severity of the disease. HRQOL was correlated with the functional status of patients. Only the PDQ-39 pain domain correlated with the risk of falls. Our results suggest that the HRQOL of patients with PD, in a state of mild-moderate impairment, is strongly influenced by disease severity and functional status.

Eficacia de los programas de educación terapéutica y de rehabilitación respiratoria en el paciente con asma / Effectiveness of Therapeutic Education and Respiratory Rehabilitation Programs for the Patient with Asthma

El asma es una enfermedad crónica compleja, heterogénea, con una gran variabilidad y que tiene un enorme impacto, no sólo en los pacientes que la padecen sino también en sus familias y en la sociedad en general. La educación del paciente asmático y su familia son el elemento esencial para la intervención terapéutica. A través de la educación, entendida como un proceso continuo, dinámico y adaptado, se van a poder conseguir cambios en las actitudes y conductas del paciente y su familia, que habrán de llevar, sin duda, a mejorar la calidad de vida de los mismos. Entre otras intervenciones no farmacológicas, la rehabilitación respiratoria representa una alternativa de tratamiento, y está dirigida fundamentalmente a los pacientes que padecen asma moderada y severa. Puesto que las últimas guías de práctica clínica publicadas en la literatura científica recomiendan ambas estrategias de tratamiento, pero los resultados de las publicaciones al respecto son diversos, el objetivo del presente trabajo fue describir la eficacia de los programas de educación terapéutica y el papel de la de rehabilitación respiratoria en el tratamiento del paciente asmático(AU)

Asthma is a chronic complex and heterogeneous disease, with great variability and has a huge impact, not only on patients who suffer the disease but also their families and society in general. The education of the asthmatic patient and their families is essential for therapeutic intervention. Through continuous, dynamic and adaptive education, changes in attitudes and behaviours of the patient and family can be achieved, and will undoubtedly lead to an improvement in their quality of life. Among other non-pharmacological interventions, respiratory rehabilitation is an alternative treatment, and is primarily aimed at patients with moderate to severe asthma. Although the latest clinical practice guidelines published in the scientific literature recommend two strategies for treatment, the results of relevant publications are diverse. The objective of this study was to describe the effectiveness of therapeutic and educational programs in respiratory rehabilitation of the asthmatic patient(AU)

[Effectiveness of therapeutic education and respiratory rehabilitation programs for the patient with asthma]. / Eficacia de los programas de educación terapéutica y de rehabilitación respiratoria en el paciente con asma.

Asthma is a chronic complex and heterogeneous disease, with great variability and has a huge impact, not only on patients who suffer the disease but also their families and society in general. The education of the asthmatic patient and their families is essential for therapeutic intervention. Through continuous, dynamic and adaptive education, changes in attitudes and behaviours of the patient and family can be achieved, and will undoubtedly lead to an improvement in their quality of life. Among other non-pharmacological interventions, respiratory rehabilitation is an alternative treatment, and is primarily aimed at patients with moderate to severe asthma. Although the latest clinical practice guidelines published in the scientific literature recommend two strategies for treatment, the results of relevant publications are diverse. The objective of this study was to describe the effectiveness of therapeutic and educational programs in respiratory rehabilitation of the asthmatic patient.

Valoración cuantitativa de la rigidez axial, estado funcional y calidad de vida relacionada con la salud en pacientes con enfermedad de Parkinson / Quantitative measurement of axial rigidity, functional status and health-related quality of life in patients with Parkinson’s disease

Introducción. La rigidez es uno de los síntomas motores característicos de la enfermedad de Parkinson (EP). Escasos estudios han valorado la rigidez axial mediante métodos objetivos en dicha enfermedad. Objetivos. Realizar una valoración objetiva de la rigidez del tronco en pacientes con EP y examinar su correlación con la gravedad de la enfermedad, los años desde su diagnóstico, la funcionalidad y la calidad de vida relacionada con la salud. Pacientes y métodos. Se empleó un dinamómetro isocinético tipo Biodex System 3 para valorar la rigidez de tronco en 36 pacientes. Se realizaron movilizaciones pasivas hacia la flexoextensión a tres velocidades angulares: 30º/s, 45º/s y 60º/s. Se administraron el estadio de Hoehn-Yahr, la Unified Parkinson’s Disease Rating Scale III (UPDRS-III), la escala de actividades de la vida diaria de Schwab y England, el European Quality of Life-5 Dimensions y la versión española del Parkinson’s Disease Questionnaire-39 items (PDQ-39). Resultados. Se encontraron correlaciones significativas entre la rigidez hallada en la musculatura extensora y flexora del tronco y el estadio de Hoehn-Yahr, la UPDRS-III, los años desde el diagnóstico, el estado funcional a 30°/s, 45°/s y 60°/s, así como diversos dominios del PDQ-39. Conclusiones. Las velocidades angulares utilizadas con esta metodología objetiva de valoración fueron válidas para evaluar la rigidez axial y se correlacionaron con la gravedad de la enfermedad, los años desde el diagnóstico, el estado funcional y la calidad de vida relacionada con la salud en los pacientes con EP (AU)

Introduction. Rigidity is a cardinal symptom of Parkinson’s disease (PD). Clinically, rigidity is usually assessed by passively flexing and extending a patient’s limb. Few studies have assessed rigidity in trunk muscles in PD patients. Aims. To develop an objective measurement to quantify trunk rigidity in PD patients, and to examine its relationship with disease severity using the Hoehn and Yahr staging score (H&Y) and the Unified Parkinson’s Disease Rating Scale III (UPDRS-III), disease duration, functional status with the Schwab & England activities of daily living scale and health related quality of life (HRQoL) was assessed with the European Quality of Life-5 Dimensions and Parkinson’s Disease Questionnaire-39 items (PDQ-39). Patients and methods. An isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 PD patients. Passive trunk flexion and extension at 3 angular velocities, 30°/s, 45°/s and 60°/s were applied and resistive torques were recorded as trunk flexor and extensors rigidity. Results. Significant correlations between trunk flexors-extensors tone and H&Y staging score, UPDRS-III, disease duration and functional status at 30°/s, 45°/s and 60°/s were obtained. Trunk rigidity was correlated with the HRQoL assessed with the PDQ-39. Conclusions. Our results suggest that the 30°/s, 45°/s and 60°/s angular velocities of this objective method was valid to assess trunk rigidity and was correlated with disease severity, disease duration, functional status and HRQoL in PD patients (AU)

[Quantitative measurement of axial rigidity, functional status and health-related quality of life in patients with Parkinson's disease]. / Valoración cuantitativa de la rigidez axial, estado funcional y calidad de vida relacionada con la salud en pacientes con enfermedad de Parkinson.

INTRODUCTION: Rigidity is a cardinal symptom of Parkinson's disease (PD). Clinically, rigidity is usually assessed by passively flexing and extending a patient's limb. Few studies have assessed rigidity in trunk muscles in PD patients. AIMS: To develop an objective measurement to quantify trunk rigidity in PD patients, and to examine its relationship with disease severity using the Hoehn and Yahr staging score (HY) and the Unified Parkinson's Disease Rating Scale III (UPDRS-III), disease duration, functional status with the Schwab & England activities of daily living scale and health related quality of life (HRQoL) was assessed with the European Quality of Life-5 Dimensions and Parkinson's Disease Questionnaire-39 items (PDQ-39). PATIENTS AND METHODS: An isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 PD patients. Passive trunk flexion and extension at 3 angular velocities, 30 degrees/s, 45 degrees/s and 60 degrees /s were applied and resistive torques were recorded as trunk flexor and extensors rigidity. RESULTS: Significant correlations between trunk flexors-extensors tone and HY staging score, UPDRS-III, disease duration and functional status at 30 degrees/s, 45 degrees/s and 60 degrees/s were obtained. Trunk rigidity was correlated with the HRQoL assessed with the PDQ-39. CONCLUSIONS: Our results suggest that the 30 degrees/s, 45 degrees/s and 60 degrees/s angular velocities of this objective method was valid to assess trunk rigidity and was correlated with disease severity, disease duration, functional status and HRQoL in PD patients.

[Telerehabilitation and neurology]. / Telerrehabilitación y neurología.

INTRODUCTION: Telemedicine is the application of telemedicine. There is not a new branch of medicine, but a way of exercising through systems that seek to alleviate the physical separation of its protagonists. There are many activities closely related to telemedicine, such as the telecare of socio-distance services, telehealth, which is responsible for increasing the welfare and health of individuals, teleeducation (health) and telesurgery. DEVELOPMENT: The neurorehabilitation is a process designed to reduce disability and social disadvantage suffered by a person as a result of a neurological disease, in which the telerehabilitation is positioning as a therapeutic measure. The telerehabilitation refers to the provision of rehabilitation services through electronic systems, based on information and communication technologies. CONCLUSIONS: The development of these technologies have made telemedicine a reality, enabling extended rehabilitative care beyond the hospitalarian process, in a ecologic environment, where new constraints detect and evaluate the effectiveness of the intervention, compared with the activities of daily living and quality of life of patients at a sustainable cost, is a challenge today. However, current evidence of telerehabilitation measures in neurological patients is scarce in our country, so is necessary a larger number of studies focusing on the validity, reliability, effectiveness and efficiency of the technique.

Is there muscular weakness in Parkinson's disease?

Controversy exists as to whether muscle weakness is present in Parkinson's disease (PD). Computerized literature searches identified clinical trials and reviews about muscular strength assessment in patients with Parkinson's disease, using the following databases: PubMed, Ovid MEDLINE, Ovid EMBASE, the Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database. Seventeen articles fulfilled all criteria for selection. These studies suggested that isokinetic muscle strength was decreased in patients with Parkinson's disease and that muscle weakness was not specifically related to tremor or rigidity. Bilateral asymmetrical muscle weakness was present in Parkinson's disease when presenting with clinical unilateral hemiparkinsonism. Recent studies using sensitive mechanical devices have provided evidence that muscle strength is reduced in patients with Parkinson's disease compared with age-matched controls. The specific cause of this weakness is not known. Questions under debate were whether this weakness was of central or peripheral origin and whether it was intrinsic to the disease or a secondary phenomenon.