Validation of a dual-task exercise program to improve balance and gait speed in older people (DualPro): a Delphi study.

Background: Most physical exercise programs for older people work the physical component in isolation, excluding cognitive aspects. Previous studies reported that both components (physical and cognitive) are necessary for correct functioning of older people in the society. Purpose: To create and validate a dual-task exercise program (DualPro) to improve balance and gait speed in older people. Methods: Expert consensus or the Delphi Method was used for validation. A group of 17 experts in neurorehabilitation and geriatrics was recruited to assess the proposed exercise program. They were selected taking into account their experience in clinical practice as well as their knowledge of the subject through the use of the expert competence coefficient (K). Online questionnaires were sent with a total of 11 exercises, which had to be rated using a "Likert" scale from 1 to 7. Results: Two rounds were conducted to achieve 100% consensus in all exercises. The interquartile range of each exercise in both rounds was stable. During the second round, the relative interquartile range was less than 15% in all the questions, thus demonstrating consensus among the experts. Conclusion: Experts in neurorehabilitation and geriatrics have concluded the validity of the progressive and systematized program of dual-task exercises focused on improving balance and gait speed for older people. This exercise program can help in the homogenization of the use of dual-task exercises in future studies and in professional practice.

Electrical Impedance Myography in Health and Physical Exercise: A Systematic Review and Future Perspectives.

Background: Electrical impedance myography (EIM) is a non-invasive method that provides information about muscle health and changes that occur within it. EIM is based on the analysis of three impedance variables: resistance, reactance, and the phase angle. This systematic review of the literature provides a deeper insight into the scope and range of applications of EIM in health and physical exercise. The main goal of this work was to systematically review the studies on the applications of EIM in health and physical exercise in order to summarize the current knowledge on this method and outline future perspectives in this growing area, including a proposal for a research agenda. Furthermore, some basic assessment principles are provided. Methods: Systematic literature searches on PubMed, Scopus, SPORTDiscus and Web of Science up to September 2020 were conducted on any empirical investigations using localized bioimpedance devices to perform EIM within health and physical exercise contexts. The search included healthy individuals, elite soccer players with skeletal muscle injury, and subjects with primary sarcopenia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used to develop the systematic review protocol. The quality and risk of bias of the studies included were assessed with the AQUA tool. Results: Nineteen eligible original articles were included in this review, which were separated into three tables according to the nature of the study. The first table includes six studies on the bioelectrical characterization of muscle. The second table includes five studies analyzing muscle changes in injured elite soccer players. The third table includes studies on the short-, medium-, and long-term bioelectrical adaptations to physical exercise. Conclusions: EIM has been used for the evaluation of the muscle condition in the clinical field over the last few years, especially in different neuromuscular diseases. It can also play an important role in other contexts as an alternative to complex and expensive methods such as magnetic resonance imaging. However, further research is needed. The main step in establishing EIM as a valid tool in the scientific field is to standardize the protocol for performing impedance assessments.

Development and Content Validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to Assess Physical Activity in Children between 5 and 7 Years.

Childhood is a critical period in the development and consolidation of healthy habits, such as the practice of physical activity (PA). It is essential to have valid instruments to measure PA from an early age. The aim of this study was to design and evaluate the content validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to measure the PA level in children aged 5-7 years. The first version of the questionnaire was tested by a 2-round Delphi study. It was established as a consensus criterion that the relative interquartile range (RIR) and/or the coefficient of variation (CV) were ≤20%. The most significant discrepancies in the Delphi survey (n = 11-13) were observed for items about hours of Physical Education or similar activities at school (item 7: RIR = 20, CV = 38.73) and for items about participation in Physical Education (item 8: RIR = 25, CV = 15.45). The cognitive interviews (n = 5) confirmed the version agreed by the experts. The results show that the PAQ-YC presents adequate content validity in terms of relevance, comprehensiveness and comprehensibility.

The Relationship between Resistance Exercise Performance and Ventilatory Efficiency after Beetroot Juice Intake in Well-Trained Athletes.

The assessment of ventilatory efficiency is critical to understanding the matching of ventilation (VE) and perfusion in the lungs during exercise. This study aimed to establish a causal physiological relationship between ventilatory efficiency and resistance exercise performance after beetroot juice (BJ) intake. Eleven well-trained males performed a resistance exercise test after drinking 140 mL of BJ (~12.8 mmol NO3-) or a placebo (PL). Ventilatory efficiency was assessed by the VE•VCO2-1 slope, the oxygen uptake efficiency slope and the partial pressure of end-tidal carbon dioxide (PetCO2). The two experimental conditions were controlled using a randomized, double-blind crossover design. The resistance exercise test involved repeating the same routine twice, which consisted of wall ball shots plus a full squat (FS) with a 3 min rest or without a rest between the two exercises. A higher weight lifted was detected in the FS exercise after BJ intake compared with the PL during the first routine (p = 0.004). BJ improved the VE•VCO2-1 slope and the PetCO2 during the FS exercise in the first routine and at rest (p < 0.05). BJ intake improved the VE•VCO2-1 slope and the PetCO2 coinciding with the resistance exercise performance. The ergogenic effect of BJ could be induced under aerobic conditions at rest.

Development, Reliability, and Testing of a New Rating Scale for Neonatal Encephalopathy.

OBJECTIVE: To develop and test the Neonatal Encephalopathy-Rating Scale (NE-RS), a new rating scale to grade the severity of neonatal encephalopathy (NE) within the first 6 hours after birth. STUDY DESIGN: A 3-phase process was conducted: (1) design of a comprehensive scale that would be specific, sensitive, brief, and unsophisticated; (2) evaluation in a cohort of infants with neonatal encephalopathy and healthy controls; and (3) validation with brain magnetic resonance imaging findings and outcome at 2 years of age. RESULTS: We evaluated the NE-RS in 54 infants with NE and 28 healthy infants. The NE-RS had excellent internal consistency (Cronbach alpha coefficient: 0.93 [95% CI 0.86-0.94]) and reliability (intraclass correlation coefficient in the NE cohort 0.996 [95% CI 0.993-0.998; P < .001]). Alertness, posture, motor response, and spontaneous activity were the top discriminators for degrees of NE. The cut-off value for mild vs moderate NE was 8 points (area under the curve [AUC] 0.99, 95% CI 0.85-1.00) and for moderate vs severe NE, 30 points (AUC 0.93, 95% CI 0.81-0.99). The NE-RS was significantly correlated with the magnetic resonance imaging score (Spearman Rho 0.77, P < .001) and discriminated infants who had an adverse outcome (AUC 0.91, 95% CI 0.83-0.99, sensitivity 0.82, specificity 0.81, positive predictive value 0.87, negative predictive value 0.74). CONCLUSIONS: The NE-RS is reliable and performs well in reflecting the severity of NE within the first 6 hours after birth. This tool could be useful when assessing clinical criteria for therapeutic hypothermia in NE.

Development and validation of a short version of the Female Sexual Function Index in the Spanish population.

BACKGROUND: The Female Sexual Function Index (FSFI) is a commonly used scale for the assessment of female sexual function. Our aim was to develop and validate a Spanish short version of the FSFI. METHODS: A parallel exploratory, sequential mixed-methods approach was used, involving 2 sites. The process consisted of 2 steps: (1) cognitive and content validation of the previously translated FSFI in the Spanish population, both through a focus group; and item selection based on the difficulty and discrimination parameters using item response theory (IRT), thereby obtaining a short version of the scale (sFSFI-sv); (2) assessment of test-retest reliability (intraclass correlation coefficient, ICC) of the sFSFI-sv. The presence or absence of a sexual disorder variable based on clinical interview was used on the Receiver Operating Characteristic (ROC) to establish the cut off point whose Area Under the Curve (AUC) based on sensibility and specificity was maximum. RESULTS: Specific modifications of the FSFI were made according to the focus group results. 114 women were included for IRT analysis. The initial IRT model pointed to the exclusion of items 1, 2, 5, 11, 18, and 19 (S-χ2 p < 0.001). Items 3, 9, 11, and 14 showed the best discrimination and difficulty parameters. On the basis of the IRT and focus group results, items 1, 3, 9, 12, 16, and 17 were included in the final sFSFI-sv. sFSFI-sv showed good reliability (ICC 0.91) in a group of 93 women. A total score ≤ 18 could indicate a higher risk of sexual disorder (sensitivity: 81.0%, specificity: 73.3%). CONCLUSION: A focus group and the IRT analysis allowed the development of a 6-item Spanish version of the FSFI, which showed good reliability in a group of Spanish women.

Effects of early intervention on parenting stress after preterm birth: A meta-analysis.

BACKGROUND: Preterm infants have a higher risk of development disorders. Prematurity can be considered a source of stress, in both children and their parents, due to the high number of interventions that they require. Early intervention (EI) programmes have shown to have a positive influence on the neurodevelopment of children with neurological risk. On the other hand, parenting stress has a negative influence on the development of any child. This systematic review aimed to identify the effect of EI programmes on decreasing parenting stress suffered by parents of preterm babies. METHODS: Systematic review and meta-analysis of experimental studies in accordance with the PRISMA declaration guidelines were applied in this work. RESULTS: Fifteen randomized clinical trials were included whose methodological quality was assessed using the PEDro scale. Stress data extraction was meta-analysed using the inverse variance method in a random effects model. Statistical heterogeneity was assessed with the I2 heterogeneity statistic. The domains most commonly reported in the trials were the childcare-related stress (Child Domain), personal discomfort (Parent Domain) and computation of both (Total Stress). The results showed significant (P < 0,05) and clinically relevant differences in favour of the EI programme group at 18 months and 5 years. CONCLUSIONS: This review found moderate to strong evidence of the impact of EI programmes on the reduction of parenting stress in parents of preterm babies. These findings offer useful insights regarding the delivery of current support and the development of future family interventions. Finally, recommendations are provided for future intervention evaluation studies in this area.

Validity and Reliability of the Satel 40 Hz Stabilometric Force Platform for Measuring Quiet Stance and Dynamic Standing Balance in Healthy Subjects.

BACKGROUND: A force platform must have validity and reliability for optimal use. The objective of this study was to analyze the validity and the reliability of the Satel 40 Hz stabilometric force platform. METHODS: A study of instrumental validity and reliability, involving a cross-sectional correlational and comparative analysis was performed. To determine the validity, four certified weights located on three axes were used and the ability of the stabilometric force platform to detect changes in the position of the different axes was observed. A test-retest was performed to analyze the reliability. Forty-two symptom-free volunteers participated in the study. Assessments were taken in a standing static position and in a dynamic position, with the eyes open and closed. Three measurements were taken and the intra-class correlation coefficient (ICC) was calculated. RESULTS: The validity increased as the weight increased for all the variables measured in the stabilometric parameters (p < 0.05). The reliability was shown to be good to excellent for the two visual conditions. The positional variables obtained a higher ICC. The variable with the best ICC was the Y mean in OE (ICC 0.874 and a p < 0.001). All the values showed an increase in a dynamic situation. CONCLUSION: The findings support the reliability and validity of the Satel 40 Hz stabilometric force platform. The platform could be recommended to evaluate static and dynamic standing balance in healthy adult individuals. Guidelines for treatment and the level of quality of stabilometry could be obtained from its use.

Effects of a home-exercise programme in childhood survivors of acute lymphoblastic leukaemia on physical fitness and physical functioning: results of a randomised clinical trial.

PURPOSE: The aim of this study was to evaluate the effects of a home-exercise programme on physical fitness indicators and physical functioning after completion of chemotherapy in children and adolescents diagnosed with acute lymphoblastic leukaemia (ALL). METHODS: Twenty-four survivors of ALL were assigned to usual care (control group, n = 12, 11.0 ± 3.7 years) or to a home-exercise programme (intervention group, n = 12, 11.8 ± 4.3 years). Peak oxygen uptake (VO2peak ml/kg/min), minute ventilation (VE L/min), output of carbon dioxide (VCO2 L/min), respiratory exchange ratio (RER), peak heart rate (beats/min), maximal load (W), VO2 at anaerobic threshold (VO2 at AT, ml/kg/min), pulse oxygen (PO2 ml/beat), heart rate at anaerobic threshold (beats/min), handgrip test (pounds), flexibility (cm), Timed Up & Go test TUG (s), and Timed Up and Down Stairs test (TUDS s) were measured at baseline and over 16 weeks of intervention. RESULTS: Adjusted mixed linear models revealed a significant group-time interaction + 6.7 (95% CI = 0.6-12.8 ml/kg/min; η2 partial = 0.046, P = 0.035) for VO2peak. Similarly, changes in mean values were observed after the home-exercise programme compared with baseline for VE (L/min) - 8.8 (3.0) (P = 0.035), VCO2 - 0.2 (0.08), (P = 0.041), maximal load (W) - 35.5 (12.8) (P = 0.024), TUDS (s) 0.8 (2.6) (P = 0.010), and TUG (s) 0.6 (0.1) (P = 0.001); however, the group-time interaction was not significant. CONCLUSION: The home-exercise programme resulted in changes in measures of VO2peak, VE, VCO2, and functional capacity during daily life activities (TUDS and TUG test). This is an interesting and important study that surely adds to the current body of knowledge/literature on the safety of exercise interventions, especially in children with haematological cancer.

Traducción y validación al español del módulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluación de la calidad de vida autopercibida por niños de 5-7 años con enfermedades neuromusculares y por sus padres / Spanish translation and validation of the Neuromuscular Module of the Pediatric Quality of Life Inventory (PedsQL): evaluation of the quality of life perceived by 5-7 years old children with neuromuscular disorders and by their parents

Introducción: Los recientes avances en el abordaje terapéutico de las enfermedades neuromusculares pediátricas han permitido un mejor pronóstico y, en consecuencia, surge la necesidad de medir la calidad de vida relacionada con la salud como parte de un abordaje integral. Es importante disponer de instrumentos válidos y específicos para su correcta valoración que contemplen la calidad de vida relacionada con la salud tanto autopercibida por los niños como por los padres. Objetivo: Evaluar la validez y la fiabilidad de la versión española del módulo neuromuscular de la Pediatric Quality of Life Inventory (PedsQL) para la medición de la calidad de vida autopercibida por niños de 5 a 7 años con enfermedades neuromusculares y la de sus padres. Sujetos y métodos: Con autorización de Mapi-Research-Trust, se procedió a la adaptación transcultural de la versión española de la escala. Posteriormente, se realizó un test-retest a 27 niños de 5 a 7 años y a 37 padres para evaluar la consistencia interna, la fiabilidad y la validez de constructo. Resultados: El coeficiente alfa de Cronbach mostró una consistencia interna buena para los niños y excelente para los padres. La correlación intraobservador indicó una excelente fiabilidad para ambos. La validez de constructo sugirió que una estructura de más dimensiones podría ser más adecuada y explicaría un mayor porcentaje de variabilidad. Conclusiones: La versión española del módulo neuromuscular de la PedsQL para evaluar calidad de vida de niños de 5 a 7 años con enfermedades neuromusculares y de sus padres tiene buena consistencia interna y fiabilidad

Introduction: The recent advances in the therapies for some neuromuscular disorders imply a better prognosis. As a consequence, health-related quality of life has emerged as a core outcome. It is particularly important to know both the self-perceived health-related quality of life by children, as soon as possible, as well as the parental perception. Therefore, it is essential to have valid and specific scales for proper assessment. Aim: To assess the validity and reliability of the Spanish version of Pediatric Quality of Life Inventory (PedsQL) Neuromuscular Module for self-perceived and parent perceived quality of life of children aged 5-7 with neuromuscular disorders. Subjects and methods: Cross-cultural validity of the Spanish version was carried out with the permission of the Mapi-Research-Trust. Subsequently, a test-retest was administered to 27 children aged 5-7 and 37 parents in order to evaluate internal consistency, intra-observer reliability and construct validity. Results: The Cronbach alpha coeffi cient showed good internal consistency for children and was rated as excellent by parents. Furthermore, the intra-observer correlation indicated an excellent reliability for both. Construct validity analysis suggested that a new scale structure with more dimensions might be more adequate. Moreover, said structure will also explain a greater percentage of variability. Conclusion: The Spanish version of PedsQL Neuromuscular Module for the self-perceived and parent-perceived quality of life of children aged 5-7 showed good internal consistency and reliability

Development and Validation of an Exercise Programme for Recovery Balance Impairments in Poststroke Patients.

BACKGROUND: Deterioration of balance is one of the most common and disabling physical-motor deficits in patients after a stroke that have a negative impact on quality of life and increase the risk of falls. Previous studies have evaluated the effectiveness of the exercises on specific aspects of balance. However, there is no structured exercise program divided by levels for balance impairment in poststroke patients. METHODS: Delphi method was used to design the exercise programme, and then a pilot study was performed. For the pilot study, we included 14 poststroke adults patients (n = 7 in each group), with balance impairment, without previous severe functional dependence, sensorial deficit or dementia. Our 4 weeks intervention (5 times/week) is based on 9 exercise of progressive difficulty, offering a multidimensional approach training (biomechanical constraints, stability limits, anticipatory, postural responses, and sensory orientation). Patients in the intervention arm received 45 minutes of usual rehabilitation plus 15 minutes of the intervention proposed. The usual-care arm received 60 minutes of usual rehabilitation. Balance impairment (Mini BESTest) was assessed at the baseline and at 4 weeks. Differences between groups were analysed using Mann-Whitney U test. RESULTS: The agreement for the intervention designed was reached after 2 rounds. Participants in pilot study were 69 (SD = 9.7) years, 21.4% females. Post-treatment, median improvements in Mini BESTest were 20 (SD = 8) and 11 (SD = 10) points, P < .01 for intervention and control group respectively. CONCLUSION: A multidimensional approach of balance impairments in poststroke patients through the validated exercise programme proposed, may improve balance deficits.

Shoulder muscle onset timing during clinical assessment movements is the same in elite handball players as non-athletes: Implications for clinical assessment.

OBJECTIVES: This study examines neuromuscular firing patterns in overhead athletes and non-athletes of the periscapular, prime-moving, and rotator cuff muscles during "clinical" cardinal plane physiological movements. DESIGN: Cohort prospective study. SETTING: EMG recordings were taken of the periscapular, prime-moving, and rotator cuff muscles during flexion, scaption, and abduction performed at fast, medium, and slow speeds with a loaded (3 kg) and unloaded arm. PARTICIPANTS: 14 Handball players and 20 non-athletes. Differences in firing patterns between groups were analyzed by fitting mixed linear models with random intercepts per subject, and fixed factors for group, muscle, movement type, speed, and load. MAIN OUTCOME MEASURES: No difference in timing of activation was seen between the professional athletes and non-athletes. RESULTS: Speed and load appear to independently vary muscle activation timing in a non-intuitive manner in both athletes and non-athletes. Onset timing of periscapular, prime movers and rotator cuff muscles are prior to movement in all scenarios studied, with rotator cuff muscles firing last. CONCLUSIONS: Onset activation patterns in overhead athletes are not different to non-athletes during cardinal plane movements.

Traducción y validación al español del módulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluación de la calidad de vida autopercibida por niños de 8-18 años con enfermedades neuromusculares y sus padres / Spanish translation and validation of the Neuromuscular Module of the Pediatric Quality of Life Inventory (PedsQL): evaluation of the quality of life perceived by 8-18 years old children with neuromuscular diseases and by their parents

Introducción. La calidad de vida relacionada con la salud de los niños con enfermedades neuromusculares pediátricas se estudia desde la perspectiva de la autopercepción y la percepción de sus padres. Por ello, es esencial disponer de instrumentos válidos, como el módulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL), para su correcta valoración. Objetivo. Evaluar la validez y fiabilidad de la versión española del módulo neuromuscular de la PedsQL para la medición de la calidad de vida autopercibida por niños de 8-18 años con enfermedades neuromusculares y por sus padres. Sujetos y métodos. Una vez autorizados por Mapi Research Trust, se procedió a la validación cognitiva de la versión española del módulo neuromuscular. Posteriormente, se realizó un test-retest a 90 niños, de los cuales 50 tenían entre 8 y 12 años y 40 tenían entre 13 y 18 años, y a 85 padres de dichos niños, lo que permitió evaluar la consistencia interna, la fiabilidad y la validez de constructo. Resultados. El coeficiente alfa de Cronbach y todos los de correlación interclase mostraron valores superiores a 0,8, lo que indica una consistencia y una fiabilidad excelentes. La validez de constructo sugirió que una estructura de más dimensiones podría ajustarse mejor que una de tres y explicaría un mayor porcentaje de variabilidad. Conclusiones. La versión española del módulo neuromuscular de la PedsQL para la autopercepción de la calidad de vida de niños de 8-18 años con enfermedades neuromusculares y percibida por sus padres presenta una excelente validez y fiabilidad

Introduction. The quality of life related to health of children with pediatric neuromuscular diseases is studied from the perspective of self-perception and parent-perception. It is therefore essential to dispose valid scales such as Pediatric Quality of Life inventory (PedsQL) Neuromuscular Module for its correct assessment. Aim. To assess the validity and reliability of the Spanish version of PedsQL Neuromuscular Module for self-perceived and parent-perceived quality of life of children aged 8-18 with neuromuscular disorders. Subjects and methods. The cognitive validity of the Spanish version of PedsQL was carried out with Mapi Research Trust permission. Subsequently, a test-retest was performed with 90 children volunteers with neuromuscular diseases, 50 aged 8-12 and 40 aged 13-18, and 85 of those children’s parents. This allowed an evaluation of PedsQL intra-observer concordance and internal consistency. Finally, construct validity was evaluated through factor analysis. Results. The Cronbach alpha and all correlation intra-observer coefficients were higher than 0.8, indicating excellent validity and reliability and a higher internal consistency. The construct validity analysis suggested that a new construct with more might be a better fit than three and it will be able to explain a higher percentage of variability. Conclusions. The Spanish version of PedsQL Neuromuscular Module for self-perceived and parent-perceived quality of life of children aged 8-18 presented excellent validity and reliability

Validation of the range of dry needling with the fascial winding technique in the carpal tunnel using ultrasound.

OBJECTIVES: To use ultrasound imaging to show how the needles in dry needling applied in the carpal tunnel can reach the transverse carpal ligament, acting on it in the form of traction-stretching when the fascial winding technique is performed. The potential associated risks are also assessed. DESIGN: Validation study. PARTICIPANTS: Healthy volunteers (n = 18). METHODS: Four dry needling needles were applied to the carpal tunnel, only using anatomical references, according to the original approach known as "four-pole carpal dry needling", and manipulating the needles following the so-called fascial winding technique according to the authors, in the form of unidirectional rotation. An ultrasound recording of the distance reached was then performed, and compared with the mechanical action achieved on the transverse carpal ligament. RESULTS: 93.1% of the needles placed came into contact with the transverse carpal ligament with traction-stretching of the ligament observed when the needles were manipulated with the fascial winding technique in 80.6%. The mean distance from the tip of the needle to the median nerve was 3.75 mm, with CI95% [3.10, 4.41] and it was 7.78 mm with CI95% [6.64, 8.91] to the ulnar artery. Pain immediately after the technique concluded was of mild intensity, almost nil 10 min later, and non-existent after one week. CONCLUSION: Dry needling with fascial winding technique in the carpal tunnel using the four-pole carpal dry needling approach is valid for reaching and traction of the transverse carpal ligament, and may stretch it and relax it. It is also safe with regard to the median nerve and ulnar artery, with a very mild level of pain.

Traducción y validación al español del módulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluación de la calidad de vida percibida por padres de niños de 2-4 años con enfermedades neuromusculares / Spanish translation and validation of the neuromuscular module of the Pediatric Quality of Life Inventory (PedsQL): evaluation of the quality of life perceived by the parents of 2-4-year-old children with neuromuscular diseases

Introducción. Las enfermedades neuromusculares pediátricas, que repercuten negativamente en la calidad de vida relacionada con la salud de los niños, son causa frecuente de consulta de los padres al fisioterapeuta. La sobrecarga de los padres desencadena una baja percepción de dicha calidad de vida. Por ello, es esencial disponer de instrumentos válidos, como el módulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL) para su correcta valoración. Objetivo. Evaluar la validez y fiabilidad de la versión española del módulo neuromuscular de la PedsQL para la medición de la calidad de vida percibida por padres de niños de 2-4 años con enfermedades neuromusculares. Sujetos y métodos. Una vez autorizados por Mapi Research Trust, se procedió a la validación cognitiva de la versión española del módulo neuromuscular. Posteriormente, se realizó un test-retest a 42 padres voluntarios de niños de 2-4 años con enfermedades neuromusculares, que permitió evaluar la consistencia interna y la concordancia intraobservador. Finalmente, la validez de constructo fue evaluada con un análisis factorial. Resultados. El coeficiente alfa de Cronbach y todos los de correlación interclase mostraron valores superiores a 0,8, lo que indica una consistencia y una fiabilidad excelentes. La validez de constructo explicó un 63,5% de la variabilidad y sugirió que una estructura de siete dimensiones podría ajustarse mejor que una de tres. Conclusiones. La versión española del módulo neuromuscular de la PedsQL para la percepción de la calidad de vida por los padres de niños de 2-4 años con enfermedades neuromusculares presenta una excelente validez y fiabilidad (AU)

Introduction. Paediatric neuromuscular disorders, which negatively impact on children’s health-related quality of life (HRQoL), are a frequent cause of parental consultation with a physiotherapist. Parents’ stress overload triggers a poor perception of their children’s HRQoL. For this reason, it is essential to have psychometrically sound instrument to measure parent’s perceptions such as the Pediatric Quality of Life Inventory (PedsQL) Neuromuscular Module. Aim. To assess the validity and reliability of the Spanish version of PedsQL Neuromuscular Module for parent perceived quality of life of children aged 2-4 with neuromuscular disorders. Subjects and methods. The cognitive validity of the Spanish version of PedsQL was carried out with Mapi Research Trust permission. Subsequently, a test-retest was performed with 42 parent volunteers of children aged 2-4 with paediatric neuromuscular disorders. This allowed an evaluation of PedsQL intra-observer concordance and internal consistency. Finally, construct validity was evaluated through factor analysis. Results. The Cronbach alpha and all correlation intra-observer coefficients were higher than 0.8, indicating excellent validity and reliability. The construct validity analysis presented 63.5% variability and such analysis suggested that a sevendimension construct might be a better fit than three. Conclusions. The Spanish version of PedsQL Neuromuscular Module for parent perceived quality of life of children aged 2-4 presented excellent validity and reliability (AU)

Treadmill interventions in children under six years of age at risk of neuromotor delay.

BACKGROUND: Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's exploration of the environment and can hinder cognitive and social-emotional development. Literature suggests that task-specific training, such as locomotor treadmill training, facilitates motor development. OBJECTIVES: To assess the effectiveness of treadmill interventions on locomotor development in children with delayed ambulation or in pre-ambulatory children (or both), who are under six years of age and who are at risk for neuromotor delay. SEARCH METHODS: In May 2017, we searched CENTRAL, MEDLINE, Embase, six other databases and a number of trials registers. We also searched the reference lists of relevant studies and systematic reviews. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effect of treadmill intervention in the target population. DATA COLLECTION AND ANALYSIS: Four authors independently extracted the data. Outcome parameters were structured according to the International Classification of Functioning, Disability and Health model. MAIN RESULTS: This is an update of a Cochrane review from 2011, which included five trials. This update includes seven studies on treadmill intervention in 175 children: 104 were allocated to treadmill groups, and 71 were controls. The studies varied in population (children with Down syndrome, cerebral palsy, developmental delay or at moderate risk for neuromotor delay); comparison type (treadmill versus no treadmill; treadmill with versus without orthoses; high- versus low-intensity training); study duration, and assessed outcomes. Due to the diversity of the studies, only data from five studies were used in meta-analyses for five outcomes: age of independent walking onset, overall gross motor function, gross motor function related to standing and walking, and gait velocity. GRADE assessments of quality of the evidence ranged from high to very low.The effects of treadmill intervention on independent walking onset compared to no treadmill intervention was population dependent, but showed no overall effect (mean difference (MD) -2.08, 95% confidence intervals (CI) -5.38 to 1.22, 2 studies, 58 children; moderate-quality evidence): 30 children with Down syndrome benefited from treadmill training (MD -4.00, 95% CI -6.96 to -1.04), but 28 children at moderate risk of developmental delay did not (MD -0.60, 95% CI -2.34 to 1.14). We found no evidence regarding walking onset in two studies that compared treadmill intervention with and without orthotics in 17 children (MD 0.10, 95% CI -5.96 to 6.16), and high- versus low-intensity treadmill interventions in 30 children with Down syndrome (MD -2.13, 95% -4.96 to 0.70).Treadmill intervention did not improve overall gross motor function (MD 0.88, 95% CI -4.54 to 6.30, 2 studies, 36 children; moderate-quality evidence) or gross motor skills related to standing (MD 5.41, 95% CI -1.64 to 12.43, 2 studies, 32 children; low-quality evidence), and had a negligible improvement in gross motor skills related to walking (MD 4.51, 95% CI 0.29 to 8.73, 2 studies, 32 children; low-quality evidence). It led to improved walking skills in 20 ambulatory children with developmental delay (MD 7.60, 95% CI 0.88 to 14.32, 1 study) and favourable gross motor skills in 12 children with cerebral palsy (MD 8.00, 95% CI 3.18 to 12.82). A study which compared treadmill intervention with and without orthotics in 17 children with Down syndrome suggested that adding orthotics might hinder overall gross motor progress (MD -8.40, 95% CI -14.55 to -2.25).Overall, treadmill intervention showed a very small increase in walking speed compared to no treadmill intervention (MD 0.23, 95% CI 0.08 to 0.37, 2 studies, 32 children; high-quality evidence). Treadmill intervention increased walking speed in 20 ambulatory children with developmental delay (MD 0.25, 95% CI 0.08 to 0.42), but not in 12 children with cerebral palsy (MD 0.18, 95% CI -0.09 to 0.45). AUTHORS' CONCLUSIONS: This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and developmental delay. Once efficacy is established, research should examine the optimal dosage of treadmill intervention in these populations.

Learning and memory disabilities in IUGR babies: Functional and molecular analysis in a rat model.

INTRODUCTION: 1Intrauterine growth restriction (IUGR) is the failure of the fetus to achieve its inherent growth potential, and it has frequently been associated with neurodevelopmental problems in childhood. Neurological disorders are mostly associated with IUGR babies with an abnormally high cephalization index (CI) and a brain sparing effect. However, a similar correlation has never been demonstrated in an animal model. The aim of this study was to determine the correlations between CI, functional deficits in learning and memory and alterations in synaptic proteins in a rat model of IUGR. METHODS: 2Utero-placental insufficiency was induced by meso-ovarian vessel cauterization (CMO) in pregnant rats at embryonic day 17 (E17). Learning performance in an aquatic learning test was evaluated 25 days after birth and during 10 days. Some synaptic proteins were analyzed (PSD95, Synaptophysin) by Western blot and immunohistochemistry. RESULTS: 3Placental insufficiency in CMO pups was associated with spatial memory deficits, which are correlated with a CI above the normal range. CMO pups presented altered levels of synaptic proteins PSD95 and synaptophysin in the hippocampus. CONCLUSIONS: 4The results of this study suggest that learning disabilities may be associated with altered development of excitatory neurotransmission and synaptic plasticity. Although interspecific differences in fetal response to placental insufficiency should be taken into account, the translation of these data to humans suggest that both IUGR babies and babies with a normal birth weight but with intrauterine Doppler alterations and abnormal CI should be closely followed to detect neurodevelopmental alterations during the postnatal period.

Long-term follow-up of a randomized controlled trial on additional core stability exercises training for improving dynamic sitting balance and trunk control in stroke patients.

OBJECTIVE: Analyse the effect of core stability exercises in addition to conventional physiotherapy training three months after the intervention ended. DESIGN: A randomized controlled trial. SETTING: Outpatient services. SUBJECTS: Seventy-nine stroke survivors. INTERVENTIONS: In the intervention period, both groups underwent conventional physiotherapy performed five days/week for five weeks, and in addition the experimental group performed core stability exercises for 15 minutes/day. Afterwards, during a three-month follow-up period, both groups underwent usual care that could eventually include conventional physiotherapy or physical exercise but not in a controlled condition. MAIN MEASURES: Primary outcome was trunk control and dynamic sitting balance assessed by the Spanish-Version of Trunk Impairment Scale 2.0 and Function in Sitting Test. Secondary outcomes were standing balance and gait evaluated by the Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Spanish-Version of Postural Assessment Scale for Stroke and activities of daily living using the Barthel Index. RESULTS: A total of 68 subjects out of 79 completed the three-month follow-up period. The mean difference (SD) between groups was 0.78 (1.51) points ( p = 0.003) for total score on the Spanish-Version of Trunk Impairment Scale 2.0, 2.52 (6.46) points ( p = 0.009) for Function in Sitting Test, dynamic standing balance was 3.30 (9.21) points ( p= 0.009) on the Berg Balance Scale, gait was 0.82 (1.88) points ( p = 0.002) by Brunel Balance Assessment (stepping), and 1.11 (2.94) points ( p = 0.044) by Tinetti Test (gait), all in favour of core stability exercises. CONCLUSIONS: Core stability exercises plus conventional physiotherapy have a positive long-term effect on improving dynamic sitting and standing balance and gait in post-stroke patients.

Traducción y validación de la escala Individualized Neuromuscular quality of life para la población española: evaluación de la calidad de vida para personas afectas de enfermedades neuromusculares / Translation and validation of the Individualised Neuromuscular Quality of Life scale for the Spanish population: quality of life assessment for persons with neuromuscular diseases

Introducción. La escala Individualized Neuromuscular Quality of Life (INQoL) es un cuestionario que valora la calidad de vida relacionada con la salud de personas adultas con enfermedades neuromusculares. Objetivo. Validar y analizar la fiabilidad de la versión española de la INQoL, como instrumento de medición de la calidad de vida relacionada con la salud en individuos con enfermedades neuromusculares. Pacientes y métodos. Se realiza una traducción-retrotraducción de la INQoL en la población española y, posteriormente, para el análisis de fiabilidad se llevan a cabo dos mediciones, test-retest, a 50 pacientes de 19 a 67 años. De este modo se evalúa la concordancia intraobservador y se evalúa la consistencia interna de la escala. Resultados. El estudio de la fiabilidad del índice de concordancia intraobservador tiene un valor de excelente en siete de las diez subdimensiones y en la puntuación total de la calidad de vida; de buena, en dos; y de moderada, en una. El análisis del alfa de Cronbach para las subdimensiones de la INQoL tiene un valor de excelente (> 0,818) en siete de ellas, así como en la puntuación total de la calidad de vida relacionada con la salud (0,928), un valor de buena consistencia interna en tres de las subdimensiones y de moderada en una. Conclusiones. La versión española de la INQoL es un instrumento válido y fiable como herramienta de medición de la calidad de vida en individuos adultos con enfermedades neuromusculares (AU)

Introduction. The Individualized Neuromuscular Quality of Life (INQoL) is a questionnaire that evaluates the quality of life related to the health of adults with neuromuscular diseases. Aim. To validate and analyze the reliability of the Spanish version of the INQoL scale as an instrument for measuring quality of life related to health in individuals with neuromuscular diseases. Patients and methods. A translation-back translation of the INQoL in the Spanish population is performed and, subsequently, for the analysis of reliability, two measurements are carried out; test retest, with 50 patients aged between 19 and 67 years. In this way we assess the intraobserver concordance and assess the internal consistency of the scale. Results. The study of the reliability of the intraobserver concordance index has a value of excellent in seven of the ten subdimensions as well as in the total score of the quality of life. It has a value of good in two and of moderate in one subdimension. The analysis of Cronbach’s alpha for the subdimensions of the INQoL has a value of excellent (> 0.818) in seven of them, as well as in the total score of the quality of life related to health (0.928), a value of good internal consistency in three of the subdimensions, and of moderate in one. Conclusions. The Spanish version of the INQoL is a valid and reliable instrument as a tool for measuring quality of life in adult patients with neuromuscular diseases (AU)

The Spanish version of the Alberta Infant Motor Scale: Validity and reliability analysis.

OBJECTIVES: Validity and reliability of the cross-cultural adaptive translation of the Alberta Infant Motor Scale (AIMS), to monitor gross motor development in infants from 0 to 18 months of age, were evaluated. METHODS: A cross-cultural translation was used to generate a Spanish version of the AIMS. Fifty infants at risk or with diagnosis of motor delay, 0-18 months of age, participated in this study. Two independent physical therapists scored infants on the AIMS. Concurrent validity was tested using the AIMS and the Bayley Scales of Infant and Toddler Development - III (Bayley - III). RESULTS: Reliability and the internal consistency were high (ICCs ranged from 0.94 to 1.00 and KR-20 ranged from 0.90 to 0.98, respectively). AIMS and Bayley - III scores correlated strongly (r = 0.97). CONCLUSION: The Spanish version of the AIMS presented excellent validity and reliability. Further studies are suggested in order to assess the AIMS in preterm babies.