Strengthening education in rehabilitation: Assessment technology and digitalization.

Rehabilitation is a discipline increasingly growing around the world due to several reasons, but probably the most important one is aging population and chronicity. A need to harmonize education has been identified, and although several International organizations such as the European Union of Medical Specialists (UEMS) and the International Society of Physical Medicine and Rehabilitation (ISPRM) have defined standards, given the quick growth of new evidence and assessment methods an urge to establish new ones arises. Functional assessment and tools used to do so are key in rehabilitation processes. This comprises self-reported questionnaires, conventional clinical evaluation but more notably high technology assessment methods, such as movement analysis systems, posturography, different types of dynamometers and kinesiologic electromyography among others. More recently, a wide range of wearable systems has been introduced in patient assessment. This is generating many published protocols as well as reliability and validity studies. The objective of this narrative review is to present main assessment technologies relevant to rehabilitation, its situation of this specific area in pre-graduate and post-graduate rehabilitation educational programs, and to elaborate a formative proposal including technological foundations of assessment and also highlighting the importance of solid reliability and validity of assessment methods comprehension. The main objective of this proposal is to provide basic knowledge about rehabilitation and methodologies for outcomes evaluation, including new technologies, to all health professionals, but especially to those who work or will work in the field of Rehabilitation.

Variabilidad interobservador del baremo de tráfico (Ley 35/2015) y utilidad de las pruebas biomecánicas en la valoración de las secuelas / Inter-observer variability of the traffic rate system (law 35/2015) and utility of biomechanical tests in the assessment of sequels

Introducción: la Ley 35/2015 valora daños y perjuicios en los accidentes de circulación y trata de garantizar una respuesta igualitaria ante situaciones idénticas. La valoración funcional biomecánica (VFB) es una prueba médica complementaria que aporta objetividad en la evaluación de la cervicalgia postraumática. Este estudio analiza la variabilidad interobservador del sistema de valoración de la Ley 35/2015 y estudia el efecto de la VFB y del perfil del evaluador en la determinación de secuelas.Material y métodospara ello, 49 profesionales de la valoración del daño corporal evaluaron 5 casos clínicos de accidentados con cervicalgia postraumática; un mes más tarde, 35 de los anteriores valoraron los mismos casos incluyendo informe de VFB.Resultadoshay una elevada variabilidad en la determinación de los días de perjuicio personal (coeficientes kappa entre 0,04 y 0,073) con o sin VFB; una elevada variabilidad interobservador en la valoración de las secuelas en los casos sin VFB (coeficientes kappa entre 0,022 y 0,044), que mejora discretamente con VFB (coeficientes kappa entre 0,128 y 0,26), aún mostrando concordancia débil. El resultado de la VFB tiene influencia en la determinación de las secuelas (p < 0,01), no así el perfil del evaluador. Más del 79,4% de los evaluadores encontraron útiles las pruebas para poner de manifiesto o confirmar sintomatología, recuperación o simulación.Conclusionesexiste variabilidad en la aplicación de la Ley 35/2015 para la valoración de los accidentados de tráfico con cervicalgia postraumática entre los profesionales del daño corporal. La VFB resulta de utilidad para los evaluadores y tiene influencia en la determinación de las secuelas. (AU)

Introduction: Law 35/2015 assesses damages in traffic accidents and tries to guarantee an equal response to identical situations. Biomechanical functional assessment (BFA) is a complementary medical test that provides objectivity in the evaluation of post-traumatic neck pain. This study analyzes the interobserver variability of the assessment system defined by Law 35/2015 and studies the effect of having BFA tests and the profile of the evaluator in determining sequelae.Materials and methodsTo do this, 49 professionals in the assessment of bodily injury evaluated 5 clinical cases of accident victims with post-traumatic neck pain; a month later, 35 of them assessed the same cases including a BFA report.ResultsThe results show high variability in determining the days of personal injury (Kappa coefficients between 0.04 and 0.073) with or without BFA; high interobserver variability in the assessment of sequelae in cases without BFA (Kappa coefficients between 0.022 and 0.044), which slightly improves with BFA (Kappa coefficients between 0.128 and 0.26), even showing weak concordance. The BFA has an influence on the determination of sequelae (p < 0.01), but the profile of the evaluator does not. More than 79.4% of the evaluators found the BFA tests useful to reveal or to confirm symptoms, recovery, or simulation.ConclusionsThere is variability in the application of Law 35/2015 for the assessment of traffic accidents among professionals of bodily injury. The BFA is useful for evaluators and influences the determination of sequelae. (AU)

Functional principal component analysis as a new methodology for the analysis of the impact of two rehabilitation protocols in functional recovery after stroke.

BACKGROUND: This study addressed the problem of evaluating the effectiveness of two protocols of physiotherapy for functional recovery after stroke. In particular, the study explored the use of Functional Principal Component Analysis (FPCA), a multivariate data analysis in order to assess and clarify the process of regaining independence after stroke. METHODS: A randomized double-blind controlled trial was performed. Thirteen subjects with residual hemiparesis after a single stroke episode were measured in both in- and outpatient settings at a district hospital. All subjects were able to walk before suffering the stroke and were hemodynamically stable within the first week after stroke. Control and target groups were treated with conventional physiotherapy for stroke, but specific techniques were added for treatment of the target group depending on patients' functional levels.Independence level was assessed with the Barthel Index (BI) throughout 7 evolution stages (hemodynamic stability, beginning of standing, beginning of physical therapy sessions in the physiotherapy ward and monthly assessment for 6 months after stroke). RESULTS: FPCA was applied for data analysis. Statistically significant differences were found in the dynamics of the recovery process between the two physiotherapy protocols. The target group showed a trend of improvement six months after stroke that was not present in the control group. CONCLUSIONS: FPCA is a method which may be used to provide greater insight into the analysis of the rehabilitation process than that provided by conventional parametric methods. So, by using the whole curves as basic data parameters, subtle differences in the rehabilitation process can be found.FPCA represents a future aid for the fine analysis of similar physiotherapy techniques, when applied in subjects with a huge variability of functional recovery, as in the case of post-stroke patients.

Rehabilitation of gait after stroke: a review towards a top-down approach.

This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity.The methods reviewed comprise classical gait rehabilitation techniques (neurophysiological and motor learning approaches), functional electrical stimulation (FES), robotic devices, and brain-computer interfaces (BCI).From the analysis of these approaches, we can draw the following conclusions. Regarding classical rehabilitation techniques, there is insufficient evidence to state that a particular approach is more effective in promoting gait recovery than other. Combination of different rehabilitation strategies seems to be more effective than over-ground gait training alone. Robotic devices need further research to show their suitability for walking training and their effects on over-ground gait. The use of FES combined with different walking retraining strategies has shown to result in improvements in hemiplegic gait. Reports on non-invasive BCIs for stroke recovery are limited to the rehabilitation of upper limbs; however, some works suggest that there might be a common mechanism which influences upper and lower limb recovery simultaneously, independently of the limb chosen for the rehabilitation therapy. Functional near infrared spectroscopy (fNIRS) enables researchers to detect signals from specific regions of the cortex during performance of motor activities for the development of future BCIs. Future research would make possible to analyze the impact of rehabilitation on brain plasticity, in order to adapt treatment resources to meet the needs of each patient and to optimize the recovery process.

[Reducing the pressure on heel and foot-sole areas by means of Allevyn Gentle, Gentle Border and Gentle Border Heel dressings]. / Reducir la presión en las zonas de antepié y talón.

INTRODUCTION: The study of plantar pressure distribution allows detecting possible overpressure in areas of the foot that could cause discomfort or even injury. The use of dressings is a possible measure for for proper management of pressure to prevent and treat pressure sores. MATERIALS AND METHODS: An experimental study was designed to calculate the pressure level with and without the use of Allevyn dressing: Allevyn Gentle and Gentle Border in the forefoot, and Allevyn Gentle Border Heel in the Heel of five healthy people. The measurements were performed with bare feet and with different dressings controlling gait speed to achieve uniform cadences. Biofoot/IBV V6.0., a system of instrumented insoles, was used to determine pressure in the forefoot and the heel. RESULTS: Allevyn Gentle Border Heel reduced 45% the average pressure and 42% the maximum pressure (p <0.05). Allevyn Gentle and Allevyn Gentle Border reduced 27% the average pressure and 23%-25% maximum pressures (p <0.05). DISCUSSION: Although our study has some limitations, such as the valuation based on healthy volunteers and walking with bare feet, we can establish that dressings studied, had a local lowering effect of pressure on the foot (heel and forefoot) during the gait cycle.

Reducir la presión en las zonas de antepié y talón mediante los apósitos Allevyn Gentle, Gentle Border y Gentle Border Heel / Reducing the pressure on heel and foot sole areas by means of allevyn gentle, gentle border and gentrle border heel dressing

Introducción: El estudio de la distribución plantar de presiones permite detectar posibles sobrepresiones en zonas de la planta del pie que podrían ocasionar disconfort o incluso lesiones. La utilización de apósitos constituye una medida para el manejo adecuado de aquellas en la prevención y tratamiento de las úlceras por presión. Material y métodos: Se diseñó un estudio experimental para calcular el nivel de presión con y sin los apósitos Allevyn Gentle y Allevyn Gentle Border en el antepié y Allevyn Gentle Border Heel en el talón de cinco personas sanas. Las mediciones se realizaron con el pie descalzo y con los diferentes apósitos controlando la velocidad de marcha para conseguir cadencias de marcha homogénea. Para determinar las presiones en el antepié y el talón se utilizó un sistema de plantillas instrumentadas, Biofoot/IBV V6.0. Resultados: La presencia del Allevyn Gentle Border Heel en el talón produjo una reducción de las presiones del orden del 45% para las medias y del 42% para las máximas (p <0.05). Allevyn Gentle Border y Allevyn Gentle en el antepié consiguieron una reducción de la presión media de un 27% y del 23-25% para la presión máxima (p<0.05). Discusión: Aunque nuestro estudio tiene algunas limitaciones, como la valoración basada en voluntarios sanos y marcha con pie descalzo, podemos establecer que los apósitos estudiados presentaron un efecto reductor local de la presión en el pie (talón o antepié) durante el ciclo de la marcha(AU)

The study of plantar pressure distribution allows detecting possible overpressure in areas of the foot that could cause discomfort or even injury. The use of dressings is a possible measure for for proper management of pressure to prevent and treat pressure sores. Materials and methods: An experimental study was designed to calculate the pressure level with and without the use of Allevyn dressing: Allevyn Gentle and Gentle Border in the forefoot, and Allevyn Gentle Border Heel in the Heel of five healthy people. The measurements were performed with bare feet and with different dressings controlling gait speed to achieve uniform cadences. Biofoot/IBV V6.0., a system of instrumented insoles, was used to determine pressure in the forefoot and the heel. Results: Allevyn Gentle Border Heel reduced 45% the average pressure and 42% the maximum pressure (p <0.05). Allevyn Gentle and Allevyn Gentle Border reduced 27% the average pressure and 23%-25% maximum pressures (p <0.05) Discussion: Although our study has some limitations, such as the valuation based on healthy volunteers and walking with bare feet, we can establish that dressings studied, had a local lowering effect of pressure on the foot (heel and forefoot) during the gait cycle(AU)