Guía: Principios básicos de la neurorrehabilitación del paciente con daño cerebral adquirido. Recomendaciones de la Sociedad Española de Neurorrehabilitación / Guidelines: Basic principles of neurorehabilitation for patients with acquired brain injury. Recommendations of the Spanish Society of Neurorehabilitation

Introducción: Guía para la práctica clínica en neurorrehabilitación de personas adultas con daño cerebral adquirido de la Sociedad Española de Neurorrehabilitación. Documento basado en la revisión de guías de práctica clínica internacionales publicadas entre 2013-2020. Desarrollo: Se establecen recomendaciones según el nivel de evidencia que ofrecen los estudios revisados referentes a aspectos consensuados entre expertos dirigidos a definir la población, características específicas de la intervención o la exposición bajo investigación. Conclusiones: Deben recibir neurorrehabilitación todos aquellos pacientes que, tras un daño cerebral adquirido, hayan alcanzado una mínima estabilidad clínica. La neurorrehabilitación debe ofrecer tanto tratamiento como sea posible en términos de frecuencia, duración e intensidad (al menos 45-60 minutos de cada modalidad de terapia específica que el paciente precise). La neurorrehabilitación requiere un equipo transdisciplinar coordinado, con el conocimiento, la experiencia y las habilidades para trabajar en equipo tanto con pacientes como con sus familias. En la fase aguda, y para los casos más graves, se recomiendan programas de rehabilitación en unidades hospitalarias, procediéndose a tratamiento ambulatorio tan pronto como la situación clínica lo permita y se puedan mantener los criterios de intensidad. La duración del tratamiento debe basarse en la respuesta terapéutica y en las posibilidades de mejoría, en función del mayor grado de evidencia disponible. Al alta deben ofrecerse servicios de promoción de la salud, actividad física, apoyo y seguimiento para garantizar que se mantengan los beneficios alcanzados, detectar posibles complicaciones o valorar posibles cambios en la funcionalidad que hagan necesario el acceso a nuevos programas de tratamiento.(AU)

Introduction: We present the Spanish Society of Neurorehabilitation's guidelines for adult acquired brain injury (ABI) rehabilitation. These recommendations are based on a review of international clinical practice guidelines published between 2013 and 2020. Development: We establish recommendations based on the levels of evidence of the studies reviewed and expert consensus on population characteristics and the specific aspects of the intervention or procedure under research. Conclusions: All patients with ABI should receive neurorehabilitation therapy once they present a minimal level of clinical stability. Neurorehabilitation should offer as much treatment as possible in terms of frequency, duration, and intensity (at least 45–60 min of each specific form of therapy that is needed). Neurorehabilitation requires a coordinated, multidisciplinary team with the knowledge, experience, and skills needed to work in collaboration both with patients and with their families. Inpatient rehabilitation interventions are recommended for patients with more severe deficits and those in the acute phase, with outpatient treatment to be offered as soon as the patient's clinical situation allows it, as long as intensity criteria can be maintained. The duration of treatment should be based on treatment response and the possibilities for further improvement, according to the best available evidence. At discharge, patients should be offered health promotion, physical activity, support, and follow-up services to ensure that the benefits achieved are maintained, to detect possible complications, and to assess possible changes in functional status that may lead the patient to need other treatment programmes.(AU)

[Rehabilitation in women with spinal cord injuries: thoughts for 8 March]. / La rehabilitación en la mujer con lesión medular: una reflexión para el 8 de marzo.

TITLE: La rehabilitación en la mujer con lesión medular: una reflexión para el 8 de marzo.

Guidelines: basic principles of neurorehabilitation for patients with acquired brain injury. Recommendations of the Spanish Society of Neurorehabilitation.

INTRODUCTION: We present the Spanish Society of Neurorehabilitation's guidelines for adult acquired brain injury (ABI) rehabilitation. These recommendations are based on a review of international clinical practice guidelines published between 2013 and 2020. DEVELOPMENT: We establish recommendations based on the levels of evidence of the studies reviewed and expert consensus on population characteristics and the specific aspects of the intervention or procedure under research. CONCLUSIONS: All patients with ABI should receive neurorehabilitation therapy once they present a minimal level of clinical stability. Neurorehabilitation should offer as much treatment as possible in terms of frequency, duration, and intensity (at least 45-60minutes of each specific form of therapy that is needed). Neurorehabilitation requires a coordinated, multidisciplinary team with the knowledge, experience, and skills needed to work in collaboration both with patients and with their families. Inpatient rehabilitation interventions are recommended for patients with more severe deficits and those in the acute phase, with outpatient treatment to be offered as soon as the patient's clinical situation allows it, as long as intensity criteria can be maintained. The duration of treatment should be based on treatment response and the possibilities for further improvement, according to the best available evidence. At discharge, patients should be offered health promotion, physical activity, support, and follow-up services to ensure that the benefits achieved are maintained, to detect possible complications, and to assess possible changes in functional status that may lead the patient to need other treatment programmes.

Describing post-polio syndrome.

INTRODUCTION: Patients presenting sequelae of poliomyelitis may present new symptoms, known as post-polio syndrome (PPS). OBJECTIVE: To identify the clinical and functional profile and epidemiological characteristics of patients presenting PPS. PATIENTS AND METHODS: We performed a retrospective study of 400 patients with poliomyelitis attended at the Institut Guttmann outpatient clinic, of whom 310 were diagnosed with PPS. We describe patients' epidemiological, clinical, and electromyographic variables and analyse the relationships between age of poliomyelitis onset and severity of the disease, and between sex, age of PPS onset, and the frequency of symptoms. RESULTS: PPS was more frequent in women (57.7%). The mean age at symptom onset was 52.4 years, and was earlier in women. Age at primary infection > 2 years was not related to greater poliomyelitis severity. The frequency of symptoms was: pain in 85% of patients, loss of strength in 40%, fatigue in 65.5%, tiredness in 57.8%, cold intolerance in 20.2%, dysphagia in 11.7%, cognitive complaints in 9%, and depressive symptoms in 31.5%. Fatigue, tiredness, depression, and cognitive complaints were significantly more frequent in women. Fifty-nine percent of patients presented electromyographic findings suggestive of PPS. CONCLUSIONS: While the symptoms observed in our sample are similar to those reported in the literature, the frequencies observed are not. We believe that patients' clinical profile may be very diverse, giving more weight to such objective parameters as worsening of symptoms or appearance of weakness; analysis of biomarkers may bring us closer to an accurate diagnosis.

Describiendo el síndrome pospolio / Describing post-polio syndrome

Introducción: Las personas con secuelas de poliomielitis pueden presentar nuevos síntomas que constituirían el síndrome pospolio (SPP). Objetivo Identificar el perfil clínico y funcional, y las características epidemiológicas de personas que padecen SPP. Pacientes y métodos: Estudio retrospectivo de 400 pacientes afectados de poliomielitis visitados en consulta externa del Institut Guttmann, de los cuales a 310 se les diagnosticó SPP. Se describieron variables epidemiológicas, clínicas y electromiográficas. Se analizó la relación entre edad de adquisición de la polio y gravedad de la misma, así como entre el sexo y la edad de aparición del SPP y la frecuencia de síntomas. Resultados: Se observó mayor frecuencia de SPP en mujeres (57,7%). La edad media de inicio de la clínica fue 52,4 años, más precoz en mujeres. Edad de primoinfección mayor de 2 años no se relacionó con mayor gravedad de la polio. La frecuencia de síntomas fue: dolor 85%, pérdida de fuerza 40%, fatiga 65,5%, cansancio 57,8%, intolerancia al frío 20,2%, disfagia 11,7%, quejas cognitivas 9%, síntomas depresivos 31,5%. La fatiga, el cansancio, la depresión y las quejas cognitivas fueron significativamente más frecuentes en mujeres. El 59% de los pacientes presentaban hallazgos electromiográficos sugestivos de SPP. Conclusiones: El tipo de sintomatología que presentaba nuestra muestra es similar a la publicada, no así en la frecuencia de la misma. Creemos que el perfil clínico de los pacientes podría ser muy diverso, y dar mayor peso a parámetros objetivos como el empeoramiento o la aparición de debilidad y el estudio de biomarcadores podría acercarnos más a un diagnóstico preciso. (AU)

Introduction: Patients presenting sequelae of poliomyelitis may present new symptoms, known as post-polio syndrome (PPS). Objective: To identify the clinical and functional profile and epidemiological characteristics of patients presenting PPS. Patients and methods: We performed a retrospective study of 400 patients with poliomyelitis attended at the Institut Guttmann outpatient clinic, of whom 310 were diagnosed with PPS. We describe patients’ epidemiological, clinical, and electromyographic variables and analyse the relationships between age of poliomyelitis onset and severity of the disease, and between sex, age of PPS onset, and the frequency of symptoms. Results: PPS was more frequent in women (57.7%). The mean age at symptom onset was 52.4 years, and was earlier in women. Age at primary infection > 2 years was not related to greater poliomyelitis severity. The frequency of symptoms was: pain in 85% of patients, loss of strength in 40%, fatigue in 65.5%, tiredness in 57.8%, cold intolerance in 20.2%, dysphagia in 11.7%, cognitive complaints in 9%, and depressive symptoms in 31.5%. Fatigue, tiredness, depression, and cognitive complaints were significantly more frequent in women. Fifty-nine percent of patients presented electromyographic findings suggestive of PPS. Conclusions: While the symptoms observed in our sample are similar to those reported in the literature, the frequencies observed are not. We believe that patients’ clinical profile may be very diverse, giving more weight to such objective parameters as worsening of symptoms or appearance of weakness; analysis of biomarkers may bring us closer to an accurate diagnosis. (AU)

Rehabilitación en régimen de ingreso en adultos en edad laboral tras un ictus isquémico: análisis clinicofuncional desde una perspectiva de género / Inpatient rehabilitation of working-age adults with ischemic stroke: comparing men and women clinical and functional characteristics at admission and predicting functionality

Introducción: El papel del género en la independencia funcional en las actividades de la vida diaria tras un ictus isquémico es aún controvertido. Proponemos: a) comparar características clínicas de hombres y mujeres en el momento del ingreso a rehabilitación hospitalaria; b) comparar su independencia funcional en el ingreso y en el alta, y c) identificar predictores de independencia funcional. Materiales y métodos: Estudio de cohortes retrospectivo observacional. Se incluyeron variables descritas en estudios previos en comparaciones ingreso-alta y en regresión lineal multivariante de la Functional Independence Measure (FIM) en el momento del alta, la ganancia, la eficiencia y la efectividad. Resultados: Se estudió a 144 pacientes (33%, mujeres) admitidos a rehabilitación en un centro español (= 3 semanas tras un ictus isquémico). Los hombres eran mayores (p = 0,003), un 19,6% diabéticos (un 6,4% de las mujeres; p = 0,03) y un 52,6% fumadores (un 72,3% de las mujeres; p = 0,02). No observamos diferencias significativas en la FIM en el momento del ingreso, del alta, la ganancia, la eficiencia ni la efectividad (FIM total, motora ni cognitiva). El análisis de regresión identificó el sexo (beta = –0,13), la gravedad (beta = –0,25) y la FIM total en el momento el ingreso (beta = –0,69) como predictores de la ganancia de la FIM total (R2 = 0,42). Las mismas variables predicen la FIM total en el alta: género (beta = –0,12), gravedad (beta = –0,23) y FIM total en el ingreso (beta = 0,59) (R2 = 0,51). La FIM en el ingreso (beta = –0,64), la gravedad (beta = –0,24), la edad (beta = –0,17) y el tiempo de estancia hospitalaria (beta = –0,45) predicen la eficiencia de la FIM total (R2 = 39,9). El modelo de efectividad de la FIM explica únicamente el 13,5% de la varianza. Conclusiones: No encontramos diferencias funcionales entre hombres y mujeres. El sexo es un predictor significativo, pero no explica la mitad de la varianza.(AU)

Introduction: The role of gender in functional independence for activities of daily living after ischemic stroke is still controversial. We aim to a) compare clinical characteristics of men and women at inpatient rehabilitation admission b) compare their functional independence at admission and discharge c) identify predictors of functional independence. Materials and methods: Retrospective observational cohort study. State-of-the-art variables were used for admission and discharge comparisons and to predict total FIM (Functional Independence Measure) at discharge, FIM gain, FIM efficiency and FIM effectiveness using multivariate linear regressions. Results: 144 patients (33% women) admitted to inpatient rehabilitation in a Spanish specialized center, with less than 3 weeks since ischemic stroke onset were included. Men were older (p = 0.039), 19.6% of men had diabetes mellitus (6.4% of women) (p = 0.038), with 52.6% of men being non-smokers (72.3% of women) (p = 0.022). No significant differences were observed in FIM at admission, discharge, FIM gain, efficiency or effectiveness (total, motor either cognitive FIM). Regression analysis identified sex (b = –0.13), stroke severity (b = –0.25) and admission total FIM (b = –0.69) as significant predictors of total FIM gain (R2 = 0.42). The same variables predicted discharge total FIM: sex (b = –0.12), severity (b = –0.23) and admission total FIM (b = 0.59) (R2 = 0.51). FIM efficiency was predicted by admission total FIM (b = –0.64), severity (b = –0.24), age (b = –0.17) and length of stay (b = –0.45) (R2 = 39.9%). FIM effectiveness model explained only 13.5% of the variance. Conclusions: No functional differences between men and women in any independence measure were found. Sex was a significant predictor but leaving half of the variance unexplained.(AU)

Inpatient rehabilitation of working-age adults with ischemic stroke: comparing men and women clinical and functional characteristics at admission and predicting functionality. / Rehabilitación en régimen de ingreso en adultos en edad laboral tras un ictus isquémico: análisis clinicofuncional desde una perspectiva de género.

INTRODUCTION: The role of gender in functional independence for activities of daily living after ischemic stroke is still controversial. We aim to a) compare clinical characteristics of men and women at inpatient rehabilitation admission b) compare their functional independence at admission and discharge c) identify predictors of functional independence. MATERIALS AND METHODS: Retrospective observational cohort study. State-of-the-art variables were used for admission and discharge comparisons and to predict total FIM (Functional Independence Measure) at discharge, FIM gain, FIM efficiency and FIM effectiveness using multivariate linear regressions. RESULTS: 144 patients (33% women) admitted to inpatient rehabilitation in a Spanish specialized center, with less than 3 weeks since ischemic stroke onset were included. Men were older (p = 0.039), 19.6% of men had diabetes mellitus (6.4% of women) (p = 0.038), with 52.6% of men being non-smokers (72.3% of women) (p = 0.022). No significant differences were observed in FIM at admission, discharge, FIM gain, efficiency or effectiveness (total, motor either cognitive FIM). Regression analysis identified sex (ß = -0.13), stroke severity (ß = -0.25) and admission total FIM (ß = -0.69) as significant predictors of total FIM gain (R2 = 0.42). The same variables predicted discharge total FIM: sex (ß = -0.12), severity (ß = -0.23) and admission total FIM (ß = 0.59) (R2 = 0.51). FIM efficiency was predicted by admission total FIM (ß = -0.64), severity (ß = -0.24), age (ß = -0.17) and length of stay (ß = -0.45) (R2 = 39.9%). FIM effectiveness model explained only 13.5% of the variance. CONCLUSIONS: No functional differences between men and women in any independence measure were found. Sex was a significant predictor but leaving half of the variance unexplained.

TITLE: Rehabilitación en régimen de ingreso en adultos en edad laboral tras un ictus isquémico: análisis clinicofuncional desde una perspectiva de género.Introducción. El papel del género en la independencia funcional en las actividades de la vida diaria tras un ictus isquémico es aún controvertido. Proponemos: a) comparar características clínicas de hombres y mujeres en el momento del ingreso a rehabilitación hospitalaria; b) comparar su independencia funcional en el ingreso y en el alta, y c) identificar predictores de independencia funcional. Materiales y métodos. Estudio de cohortes retrospectivo observacional. Se incluyeron variables descritas en estudios previos en comparaciones ingreso-alta y en regresión lineal multivariante de la Functional Independence Measure (FIM) en el momento del alta, la ganancia, la eficiencia y la efectividad. Resultados. Se estudió a 144 pacientes (33%, mujeres) admitidos a rehabilitación en un centro español (= 3 semanas tras un ictus isquémico). Los hombres eran mayores (p = 0,003), un 19,6% diabéticos (un 6,4% de las mujeres; p = 0,03) y un 52,6% fumadores (un 72,3% de las mujeres; p = 0,02). No observamos diferencias significativas en la FIM en el momento del ingreso, del alta, la ganancia, la eficiencia ni la efectividad (FIM total, motora ni cognitiva). El análisis de regresión identificó el sexo (beta = ­0,13), la gravedad (beta = ­0,25) y la FIM total en el momento el ingreso (beta = ­0,69) como predictores de la ganancia de la FIM total (R2 = 0,42). Las mismas variables predicen la FIM total en el alta: género (beta = ­0,12), gravedad (beta = ­0,23) y FIM total en el ingreso (beta = 0,59) (R2 = 0,51). La FIM en el ingreso (beta = ­0,64), la gravedad (beta = ­0,24), la edad (beta = ­0,17) y el tiempo de estancia hospitalaria (beta = ­0,45) predicen la eficiencia de la FIM total (R2 = 39,9). El modelo de efectividad de la FIM explica únicamente el 13,5% de la varianza. Conclusiones. No encontramos diferencias funcionales entre hombres y mujeres. El sexo es un predictor significativo, pero no explica la mitad de la varianza.

Neurorehabilitation in the times of Covid-19: insights from the Spanish Neurorehabilitation Society (SENR).

The entire world is experiencing an unprecedented global health crisis and Spain has been one of the most heavily affected countries within Europe. Unexpected rapid changes and reorganization of medical services that occurred during the pandemic lead to an impact in the practice of neurorehabilitation. The idiosyncrasies typical of neurorehabilitation management, specially in acute facilities, that makes it susceptible as a vector of dissemination of Covid but also because of the need of finding new wards and intensive care units for Covid patients, the interventions in neurorehabilitation has suffered enormous changes. There is a need for rethinking the future to treat a new wave of patients with neurorehabilitation necessities such as those recovering from Covid 19 with neurological sequelae but also of those neurorehab patients who were unable to access the health system during the locke down period. This article is intended to invite to reflect on and discuss the redesign of our current neurorehabilitation plans after the experience on the Covid 19 pandemic.

La rehabilitación en los tiempos del COVID-19 / Rehabilitation in the time of COVID-19

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Futuro de la neurorrehabilitación tras la pandemia por el SARS-CoV-2 / The future of neurorehabilitation after the SARS-CoV-2 pandemic

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Neurorrehabilitación del ictus en España, comparativa con Europa / Comparison of stroke neurorehabilitation in Spain and in Europe

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