Efectividad de una aplicación de telerrehabilitación para tableta en pacientes con fractura de extremo distal del radio / Effectiveness of a tablet telerehabilitation application in patients with distal radius fracture

Introducción: Evaluar si, en pacientes con fractura de extremo distal del radio, los ejercicios domiciliarios realizados en una pantalla táctil de dispositivos tableta reducen el consumo de recursos presenciales y mejoran la recuperación clínica, comparado con el programa convencional de ejercicios domiciliarios prescrito en papel. Material y métodos: Ensayo clínico pragmático, multicéntrico, paralelo, de dos grupos y controlado, con evaluador cegado y análisis por intención de tratar. Reclutados cuarenta y seis pacientes con fractura de extremo distal del radio en dos hospitales del Sistema Sanitario Público de Andalucía (SSPA). Los participantes de los grupos experimental y control recibieron el mismo tratamiento de sesiones presenciales de fisioterapia. El grupo experimental recibió un programa de ejercicios domiciliario utilizando la aplicación para tableta ReHand y el grupo control recibió un programa de ejercicios domiciliario en papel. Variable principal: número de sesiones de fisioterapia registradas en la base de datos electrónica del SSPA. Variables secundarias: número de consultas de rehabilitación presenciales con un médico rehabilitador y variables clínicas como la funcionalidad, la fuerza de prensión, la destreza manual, el dolor y la amplitud de movimiento. Resultados: El grupo experimental necesitó menos sesiones de fisioterapia (DM: −16,94; IC del 95%: −32,5 a −1,38) y consultas de rehabilitación (DM: −1,7; IC del 95%: −3,39 a −0,02) en comparación con el grupo control. Conclusión: En pacientes con fractura de extremo distal del radio, la prescripción de ejercicios realizados en una pantalla táctil de dispositivos tipo tableta a través de ReHand redujo el número de sesiones de fisioterapia y de consultas de rehabilitación.(AU)

Introduction: To assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. Material and methods: A multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. Results: The experimental group required fewer physiotherapy sessions (MD: −16.94; 95%CI: −32.5 to −1.38) and rehabilitation consultations (MD: −1.7; 95%CI: −3.39 to −0.02) compared to the control group. Conclusions: In patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.(AU)

Análisis de los parámetros ecográficos descritos en el estudio del síndrome del túnel del carpo. Una revisión sistemática / Analysis of the echographic parameters described in the study of carpal tunnel syndrome: A systematic review

El síndrome del túnel del carpo (STC) es la mononeuropatía por atrapamiento más frecuente; el diagnóstico se establece mediante pruebas electrodiagnósticas con un número sustancial de falsos positivos/negativos. Presentamos la siguiente revisión sistemática, cuyo objetivo es analizar la literatura más reciente en relación con los parámetros ecográficos descritos para estudiar el STC. Seleccionamos estudios que evaluasen parámetros ecográficos en pacientes con sospecha clínica, siguiendo las recomendaciones del manual Cochrane; incluimos revisiones sistemáticas, metaanálisis, estudios caso-control y de pruebas diagnósticas, valorando estudios retrospectivos y revisiones bibliográficas con buena calidad metodológica. La revisión se hizo de artículos publicados entre 2005-2019. Incluimos 8 artículos (2 revisiones sistemáticas/metaanálisis, 2 estudios caso-control, un estudio de pruebas diagnósticas, 2 revisiones literarias y un estudio retrospectivo). Los parámetros analizados fueron el área de sección transversa del nervio mediano, el índice muñeca-antebrazo, el índice entrada-salida, el rango de adelgazamiento del nervio mediano, el abombamiento del retináculo flexor y la vascularización/movilidad. La evidencia actual permite afirmar que la ecografía tiene utilidad en el cribado del STC.(AU)

Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy; the diagnosis is established by electrodiagnostic tests with until 34% of false positives/negatives. We present the following systematic review which objective is to analyze the most recent literature related to the ultrasound parameters described to study CTS. We selected studies that evaluated ultrasound parameters in patients with clinical suspicion following the Cochrane manual's recommendations. We include systematic reviews, meta-analyses, case–control studies and diagnostic tests, evaluating retrospective studies and bibliographic reviews with proper methodological quality. Articles published between 2005 and 2019. We included eight articles (two systematic reviews/meta-analyses, two case–control studies, one diagnostic test study, two literature reviews, and one retrospective). The parameters analyzed were cross-sectional area, wrist–forearm index, entry–exit index, thinning range, palmar bowing of the flexor retinaculum, and vascularity/mobility. Current evidence allows us to affirm that ultrasound is useful in screening for CTS.(AU)

[Effectiveness of a tablet telerehabilitation application in patients with distal radius fracture]. / Efectividad de una aplicación de telerrehabilitación para tableta en pacientes con fractura de extremo distal del radio.

INTRODUCTION: To assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. MATERIAL AND METHODS: A multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. RESULTS: The experimental group required fewer physiotherapy sessions (MD: -16.94; 95%CI: -32.5 to -1.38) and rehabilitation consultations (MD: -1.7; 95%CI: -3.39 to -0.02) compared to the control group. CONCLUSIONS: In patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.

[Analysis of the echographic parameters described in the study of carpal tunnel syndrome: A systematic review]. / Análisis de los parámetros ecográficos descritos en el estudio del síndrome del túnel del carpo. Una revisión sistemática.

Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy; the diagnosis is established by electrodiagnostic tests with until 34% of false positives/negatives. We present the following systematic review which objective is to analyze the most recent literature related to the ultrasound parameters described to study CTS. We selected studies that evaluated ultrasound parameters in patients with clinical suspicion following the Cochrane manual's recommendations. We include systematic reviews, meta-analyses, case-control studies and diagnostic tests, evaluating retrospective studies and bibliographic reviews with proper methodological quality. Articles published between 2005 and 2019. We included eight articles (two systematic reviews/meta-analyses, two case-control studies, one diagnostic test study, two literature reviews, and one retrospective). The parameters analyzed were cross-sectional area, wrist-forearm index, entry-exit index, thinning range, palmar bowing of the flexor retinaculum, and vascularity/mobility. Current evidence allows us to affirm that ultrasound is useful in screening for CTS.

Instrumentos predictores del éxito en la protetización de pacientes con amputaciones unilaterales mayores de miembro inferior / Objective measurement tools that predict success in the fitting of major unilateral lower limb amputations patients

El perfil del paciente que más frecuentemente sufre amputaciones de miembro inferior suele ser uno de edad avanzada y alta comorbilidad. Los médicos rehabilitadores precisamos en la valoración de estos pacientes de herramientas objetivas que predigan los resultados de los programas de protetización para aumentar la seguridad del paciente y eficiencia de los programas de rehabilitación protésica. Dada la necesidad de actualizar el conocimiento científico en este campo hemos realizado una revisión de la literatura con el objetivo de definir una propuesta de herramientas que faciliten la toma de decisiones en la indicación de rehabilitación protésica en estos pacientes. Para la realización de este trabajo se ha realizado una estrategia de búsqueda bibliográfica utilizando las bases de datos científicas PubMed, Web of Science, Scopus y Cochrane Library. La calidad de los artículos seleccionados se ha valorado según las herramientas propuestas por CASPe.(AU)

The profile of the patient who most frequently suffers lower limb amputations is usually an elderly patient with high comorbidity. Physiatrists need objective tools in the assessment of these patients that predict the results of prosthetic programs to increase patient safety and efficiency of prosthetic rehabilitation programs. Given the need to update scientific knowledge in this field, we have carried out a review of the literature with the aim of defining a proposal for tools that facilitate decision-making in the indication of prosthetic rehabilitation in these patients. A bibliographic search strategy has been carried out using the scientific databases PubMed, Web of Science, Scopus and Cochrane Library. The quality of the selected articles has been assessed according to the tools proposed by CASPe.(AU)

[Objective measurement tools that predict success in the fitting of major unilateral lower limb amputations patients]. / Instrumentos predictores del éxito en la protetización de pacientes con amputaciones unilaterales mayores de miembro inferior.

The profile of the patient who most frequently suffers lower limb amputations is usually an elderly patient with high comorbidity. Physiatrists need objective tools in the assessment of these patients that predict the results of prosthetic programs to increase patient safety and efficiency of prosthetic rehabilitation programs. Given the need to update scientific knowledge in this field, we have carried out a review of the literature with the aim of defining a proposal for tools that facilitate decision-making in the indication of prosthetic rehabilitation in these patients. A bibliographic search strategy has been carried out using the scientific databases PubMed, Web of Science, Scopus and Cochrane Library. The quality of the selected articles has been assessed according to the tools proposed by CASPe.

Tratamiento del equinismo con yesos progresivos / Treatment of equinus with serial casting

Introducción El pie equino en niños produce un patrón de marcha inestable e ineficiente y un inadecuado posicionamiento en silla de ruedas. El tratamiento mediante ciclo de yesos seriados mantiene el rango de movimiento, facilitando el desarrollo de patrones de movimiento normales. Su uso combinado con toxina botulínica tiene efectos beneficiosos demostrados, pero faltan pautas para establecer el protocolo de tratamiento óptimo. Objetivo Describir las características de la población con equinismo de diversa etiología y determinar la efectividad del tratamiento con yesos. Valorar su uso junto con toxina botulínica en pacientes con parálisis cerebral espástica. Material y método Estudio analítico longitudinal retrospectivo sobre una muestra de 95 tendones de Aquiles de niños atendidos en consulta de rehabilitación infantil entre 2012 y 2018, con flexión dorsal de tobillo menor de 10°, tratados mediante ciclo de yesos con o sin toxina botulínica. Variables analizadas: sexo, año de comienzo, edad, IMC, diagnóstico, tratamiento previo y/o posterior, espasticidad (Ashworth modificada), lateralidad, rango articular pasivo y activo de flexión dorsal y plantar junto con R1 (escala de Tardieu). Mediciones realizadas con inclinómetro mecánico antes del primer, segundo y tercer yeso, tras el tercer yeso y a los 2, 8 y 14 meses. Fue analizado estadísticamente mediante SPSS. Resultados Existe una mejora estadísticamente significativa de 10,02° (p<0,01) entre flexión dorsal pasiva previa al primer yeso y tras el tercero, manteniéndose en 6,66° (p=0,02) entre la previa y a los 14 meses. Conclusiones Los yesos progresivos son un método efectivo en el control del equinismo de cualquier etiología, con una tasa mínima de complicaciones (AU)

Introduction Equinus in children produces a pattern of unsteady gait and inefficient and inadequate positioning in the wheelchair. Treatment with a serial casting cycle maintains range of motion and facilitates the development of normal movement patterns. Its use in combination with botulinum toxin has proven benefits, but there is a lack of guidance on the optimal management protocol. Objective The aim of this study were to describe the characteristics of the population with equinus of diverse aetiology and to determine the effectiveness of treatment with serial casting. We also aimed to assess its use in conjunction with botulinum toxin in patients with spastic cerebral palsy. Material and method This longitudinal retrospective study included a sample of 95 Achilles tendons of children attended in a children's rehabilitation clinic between 2012 and 2018, with ankle dorsal flexion less than 10°, treated by a cycle of serial casts with or without botulinum toxin. The variables analysed were sex, year when treatment started, age, BMI, diagnosis, previous and/or later treatment, spasticity (modified Ashworth), laterality, active and passive joint range of dorsal and plantar flexion along with R1 (Tardieu). Measurements were carried out with a mechanical inclinometer prior to the first, second and third cast, after the third cast and at 2, 8 and 14 months. The statistical analysis was performed with SPSS®. Results There was a statistically significant improvement of 10.02° between passive dorsal flexion prior to the first cast and after the third cast, which remained at 6.66° (P=.02) between the former and after 14 months. Conclusions Serial casting is an effective method in the management of equinus of any aetiology and has a minimal complication rate (AU)

[Treatment of equinus with serial casting]. / Tratamiento del equinismo con yesos progresivos.

INTRODUCTION: Equinus in children produces a pattern of unsteady gait and inefficient and inadequate positioning in the wheelchair. Treatment with a serial casting cycle maintains range of motion and facilitates the development of normal movement patterns. Its use in combination with botulinum toxin has proven benefits, but there is a lack of guidance on the optimal management protocol. OBJECTIVE: The aim of this study were to describe the characteristics of the population with equinus of diverse aetiology and to determine the effectiveness of treatment with serial casting. We also aimed to assess its use in conjunction with botulinum toxin in patients with spastic cerebral palsy. MATERIAL AND METHOD: This longitudinal retrospective study included a sample of 95 Achilles tendons of children attended in a children's rehabilitation clinic between 2012 and 2018, with ankle dorsal flexion less than 10°, treated by a cycle of serial casts with or without botulinum toxin. The variables analysed were sex, year when treatment started, age, BMI, diagnosis, previous and/or later treatment, spasticity (modified Ashworth), laterality, active and passive joint range of dorsal and plantar flexion along with R1 (Tardieu). Measurements were carried out with a mechanical inclinometer prior to the first, second and third cast, after the third cast and at 2, 8 and 14 months. The statistical analysis was performed with SPSS®. RESULTS: There was a statistically significant improvement of 10.02° between passive dorsal flexion prior to the first cast and after the third cast, which remained at 6.66° (P=.02) between the former and after 14 months. CONCLUSIONS: Serial casting is an effective method in the management of equinus of any aetiology and has a minimal complication rate.

Rehabilitación médica y COVID-19: impacto actual y retos futuros en los servicios de rehabilitación / Medical rehabilitation and COVID-19: current impact and future challenges in rehabilitation services

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Tenotomía percutánea ecoguiada en entesopatía crónica de extensores de muñeca / Ultrasound-guided percutaneous tenotomy in chronic wrist extensor enthesopathy

La epicondilitis es una entidad que provoca discapacidad y tiende a cronificar. Histológicamente, existen lesiones degenerativas en el tendón extensor común del antebrazo, visibles mediante ecografía o resonancia magnética. Existen diversas medidas terapéuticas conservadoras, incluida la infiltración con corticoide por referencia anatómica; pero en ocasiones fracasan, y los pacientes son propuestos para cirugía. La ecografía como herramienta terapéutica permite realizar procedimientos sin apertura cutánea sobre los tendones. En 2006, se publicó la realización de una tenotomía percutánea ecoguiada para el tratamiento de la epicondilitis crónica. La técnica, mostrada hasta ahora por cirujanos y radiólogos, intenta transformar un proceso degenerativo crónico con fallo en la reparación, en un proceso inflamatorio agudo con perspectivas de autorregeneración. Nuestro objetivo es describir 5 casos clínicos de epicondilitis con fracaso de las medidas terapéuticas habituales, en los que se realiza una tenotomía percutánea ecoguiada en la propia consulta, con resultados favorables

Epicondylitis causes disability and tends to become chronic. Histologically, degenerative lesions are found in the common extensor tendon, which are visible on ultrasound or magnetic resonance imaging. Several conservative therapeutic measures are available, including corticosteroid infiltration by anatomical landmark. However, these measures sometimes fail, in which case patients are proposed for surgery. Ultrasound is a therapeutic tool that allows procedures on tendons to be performed without skin incisions. The technique of ultrasound-guided percutaneous tenotomy for the treatment of chronic epicondylitis was first reported in 2006. This procedure, demonstrated to date by surgeons and radiologists, attempts to transform a chronic degenerative process with failure to repair into an acute inflammatory process with self-regeneration. The aim of this study was to describe 5 cases of epicondylitis that failed to respond to routine therapeutic measures, in which we used ultrasound-guided percutaneous tenotomy with favourable results

[Ultrasound-guided percutaneous tenotomy in chronic wrist extensor enthesopathy]. / Tenotomía percutánea ecoguiada en entesopatía crónica de extensores de muñeca.

Epicondylitis causes disability and tends to become chronic. Histologically, degenerative lesions are found in the common extensor tendon, which are visible on ultrasound or magnetic resonance imaging. Several conservative therapeutic measures are available, including corticosteroid infiltration by anatomical landmark. However, these measures sometimes fail, in which case patients are proposed for surgery. Ultrasound is a therapeutic tool that allows procedures on tendons to be performed without skin incisions. The technique of ultrasound-guided percutaneous tenotomy for the treatment of chronic epicondylitis was first reported in 2006. This procedure, demonstrated to date by surgeons and radiologists, attempts to transform a chronic degenerative process with failure to repair into an acute inflammatory process with self-regeneration. The aim of this study was to describe 5 cases of epicondylitis that failed to respond to routine therapeutic measures, in which we used ultrasound-guided percutaneous tenotomy with favourable results.

[Ultrasound findings in chronic subacromal pain syndrome]. / Hallazgos ecográficos en el síndrome de dolor subacromial crónico.

OBJECTIVE: Subacromial pain syndrome is a clinical picture characterised by pain located around the acromion triggered or exacerbated by shoulder movements. Ultrasound is a suitable imaging technique to evaluate the soft tissues occupying the subacromial space. The aim of this study was to describe the ultrasound findings in patients diagnosed with chronic subacromial pain syndrome by age, sex, and time since onset. MATERIAL AND METHODS: We conducted a retrospective study of patients diagnosed with chronic SDS who underwent shoulder ultrasound. The variables studied were age, sex, affected side, time since onset, sonographic findings and ultrasound diagnosis. A descriptive study of the variables and statistical inference was performed with the chi-square test. RESULTS: A total of 253 clinical histories of patients who underwent shoulder ultrasound were reviewed. Of these, 100 were selected who met the pre-established criteria. Involvement was bilateral in 5 of them and consequently the total number of ultrasound scans reviewed was 105. Differences were found between ultrasound finding by age, but not by sex or time since onset. CONCLUSIONS: The findings of this study indicate that there is good clinical-radiological correlation between subacromial pain syndrome and ultrasound findings. The structure most frequently involved in the origin of the pain was the supraspinatus tendon. Differences were found by age but not by sex or the time since onset.

Hallazgos ecográficos en el síndrome de dolor subacromial crónico / Ultrasound findings in chronic subacromal pain syndrome

OBJETIVO: El síndrome de dolor subacromial es un cuadro clínico caracterizado por dolor localizado alrededor del acromion que se desencadena o se exacerba con los movimientos del hombro. La ecografía es una técnica de imagen adecuada para evaluar los tejidos blandos que ocupan el espacio subacromial. El objetivo de este trabajo es describir los hallazgos ecográficos en pacientes diagnosticados de síndrome de dolor subacromial crónico relacionándolos con el sexo, la edad y el tiempo de evolución. MATERIAL Y MÉTODOS: Estudio retrospectivo de pacientes diagnosticados de SDS crónico a los que se realiza ecografía de hombro. Las variables estudiadas han sido: edad, sexo, lado afecto, tiempo de evolución, hallazgos ecográficos y diagnóstico ecográfico. Se realiza una presentación descriptiva de las mismas y la inferencia estadística mediante el test de la Chi-cuadrado. RESULTADOS: Se revisan 253 historias clínicas de pacientes a los que se realizó una ecografía de hombro y se seleccionan 100 que cumplían los criterios prefijados; en 5 de ellos la afectación era bilateral, por lo que el total de ecografías revisadas es de 105. Se encuentran diferencias entre los hallazgos ecográficos en relación con la edad, no así con el sexo o el tiempo de evolución. CONCLUSIONES: De los datos encontrados se extrae que existe una buena correlación clínico-radiológica entre el síndrome de dolor subacromial y los hallazgos ecográficos, que la estructura más frecuentemente involucrada en el origen del dolor es el tendón del supraespinoso y que no existen diferencias en los hallazgos y diagnósticos ecográficos en función del sexo del paciente ni del tiempo de evolución, pero que sí existen en relación con la edad

OBJECTIVE: Subacromial pain syndrome is a clinical picture characterised by pain located around the acromion triggered or exacerbated by shoulder movements. Ultrasound is a suitable imaging technique to evaluate the soft tissues occupying the subacromial space. The aim of this study was to describe the ultrasound findings in patients diagnosed with chronic subacromial pain syndrome by age, sex, and time since onset. MATERIAL AND METHODS: We conducted a retrospective study of patients diagnosed with chronic SDS who underwent shoulder ultrasound. The variables studied were age, sex, affected side, time since onset, sonographic findings and ultrasound diagnosis. A descriptive study of the variables and statistical inference was performed with the chi-square test. RESULTS: A total of 253 clinical histories of patients who underwent shoulder ultrasound were reviewed. Of these, 100 were selected who met the pre-established criteria. Involvement was bilateral in 5 of them and consequently the total number of ultrasound scans reviewed was 105. Differences were found between ultrasound finding by age, but not by sex or time since onset. CONCLUSIONS: The findings of this study indicate that there is good clinical-radiological correlation between subacromial pain syndrome and ultrasound findings. The structure most frequently involved in the origin of the pain was the supraspinatus tendon. Differences were found by age but not by sex or the time since onset

[Measurement of the outcomes in acquired brain injury in a neurorehabilitation unit. A long-term study]. / Medicion de resultados en el daño cerebral adquirido en una unidad de neurorrehabilitacion. Estudio a largo plazo.

INTRODUCTION: Following sudden brain damage, there is a loss of capabilities that affects the person's autonomy. Recovery from the physical, psychic and cognitive sequelae requires the application of multiple therapies, the outcomes of which need to be measured objectively. Our aim is to analyse the application of standardised instruments in determining the therapeutic outcomes in acquired brain injury. PATIENTS AND METHODS: We conducted a retrospective descriptive observational study lasting 13 months. Both epidemiological and clinical data were analysed: elapsed time since onset, degree of independence (Barthel index), presence of spasticity and treatment with botulinum toxin. Outcomes were measured using Goal Attainment Scaling and the Rehabilitation Complexity Scale, pre- and post-treatment. RESULTS: We reviewed a total of 45 patients, 60% of them having suffered a stroke. Spasticity was present in 19 patients, and 42% were treated with botulinum toxin infiltration. All of them underwent goal-setting treatment; in 84% of the cases more than one goal was planned, and the most prevalent was gait re-education. With the use of the scales it was observed that the patients with the greatest initial complexity had more difficulty to achieve the goals that had been set, although there was a higher degree of improvement in comparison to their prior status. CONCLUSION: The initial situation in terms of dependence and the degree of complexity of the needs of patients with brain damage correlate with the final situation after a programme of neurorehabilitation therapy. This reflects the importance of using scales like Goal Attainment Scaling and the Rehabilitation Complexity Scale, pre- and post-treatment.

TITLE: Medicion de resultados en el daño cerebral adquirido en una unidad de neurorrehabilitacion. Estudio a largo plazo.Introduccion. Tras un daño cerebral brusco se produce una perdida de capacidades que afectan a la autonomia de la persona. La recuperacion de las secuelas fisicas, psiquicas y cognitivas requiere la aplicacion de multiples terapias cuyos resultados precisan una medicion objetiva. Nuestro objetivo es analizar la aplicacion de instrumentos estandarizados en la determinacion de resultados terapeuticos en el daño cerebral adquirido. Pacientes y metodos. Estudio observacional descriptivo retrospectivo de 13 meses de duracion. Analizamos datos epidemiologicos y clinicos: tiempo de evolucion, grado de independencia (indice de Barthel), presencia de espasticidad y tratamiento con toxina botulinica. Como medida de resultados se uso la Goal Attainment Scaling y la Rehabilitation Complexity Scale, pre y postratamiento. Resultados. Revisamos un total de 45 pacientes, el 60% debido a un ictus. La espasticidad estaba presente en 19 pacientes, y el 42% fue tratado con infiltracion de toxina botulinica. Todos realizaron tratamiento con planificacion de objetivos; en el 84% de los casos se planifico mas de un objetivo terapeutico, y el mas prevalente fue la reeducacion de la marcha. Con el uso de las escalas se observo que los pacientes con mayor complejidad inicial presentaban una mayor dificultad para lograr los objetivos establecidos, aunque existia un mayor grado de mejora en comparacion con su estado previo. Conclusion. La situacion de dependencia inicial y el grado de complejidad en las necesidades del paciente con daño cerebral se correlaciona con la situacion final tras un programa de tratamiento neurorrehabilitador, de ahi la importancia del uso de escalas como la Goal Attainment Scaling y la Rehabilitation Complexity Scale pre y postratamiento.

Dolor en el pie y cojera. Osteocondrosis del escafoides tarsiano / Foot pain and limp. Tarsal navicular osteochondrosis

El concepto nosológico de necrosis ósea presupone la existencia de un trastorno circulatorio, aunque este pueda no ser anatómicamente demostrable. La multitud de términos empleados para designar esta entidad demuestra la confusión existente acerca de sus mecanismos y características; incluso el término “necrosis avascular” es erróneo, ya que los vasos siguen estando presentes: el trastorno es circulatorio (funcional), no anatómico (estructural). El término osteocondrosis hace referencia al trastorno isquémico exclusivamente del hueso en crecimiento. El dolor en el pie y la cojera son síntomas comunes de presentación, y cuando la osteocondrosis se localiza en los huesos del pie el diagnóstico puede ser complicado si esa enfermedad no se tiene presente (AU)

The nosologic concept of bony tissue necrosis presupposes the existence of a circulatory derangement, even though this derangement may not be anatomically demonstrable. The multitude of terms used for designating this entity just demonstrate the prevailing confusion regarding its mechanisms and characteristics; even “avascular necrosis”, is erroneous, as the vessels themselves are still present: the derangement is a circulatory (functional), not a structural (anatomic) one. Osteochondrosis is a term used to describe a group of disorders that affect the growing skeleton. Foot pain and a limp are common presenting symptoms, and its diagnosis can be really challenging when ostechondrosis is located on foot bones and this condition is not in our mind (AU)

Resultados en salud a largo plazo de un programa estructurado de rehabilitación respiratoria en pacientes con enfermedad pulmonar obstructiva crónica / Long-term health results of a structured respiratory rehabilitation program in patients with COPD

Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) constituye una patología de gran impacto en nuestra sociedad siendo la disnea el síntoma principal. Los programas de rehabilitación respiratoria pretenden disminuir la morbimortalidad y aumentar la calidad de vida. Nuestro objetivo es analizar la efectividad a largo plazo de un programa de rehabilitación respiratoria en cuanto a calidad de vida, adherencia al tratamiento y morbimortalidad. Material y métodos. Estudio observacional transversal sobre una cohorte prospectiva. Incluye a pacientes con EPOC grado III y IV de GOLD estabilizados que han completado el programa de rehabilitación respiratoria. Se diseña un cuestionario recogiendo percepción de disnea, aparición de exacerbaciones, mortalidad, adherencia al tratamiento y calidad de vida medidas con los cuestionarios ansiedad-depresión, Saint George Respiratory Questionnaire (SGRQ) y Chronic Respiratory Questionary (CRQ) al inicio y al año del tratamiento. Resultados. Se aprecia disminución de la percepción de disnea al mes del tratamiento. La media del número de exacerbaciones fue 4,06 y el porcentaje de mortalidad del 5,9% al año de tratamiento. Un 78,9% de pacientes continuaron el entrenamiento domiciliario, obteniéndose mejores resultados al realizarlo más de 3 días en semana. La media de la mejoría de calidad de vida fue positiva en los cuestionarios ansiedad/depresión, en la escala SGRQ y en algunas áreas de la escala CRQ. Conclusiones. La intervención sanitaria centrada en un programa de rehabilitación respiratoria es útil a largo plazo para el beneficio en salud, observándose una mejoría en la autonomía para las actividades de la vida diaria y en la autopercepción de calidad de vida (AU)

Introduction. Chronic obstructive pulmonary disease (COPD) has a huge impact in Spain. The main symptom is dyspnea. Pulmonary rehabilitation aims to decrease morbidity and mortality and increase quality of life. The aim of our study was to assess the long-term effectiveness of a respiratory rehabilitation program in enhancing quality of life and treatment adherence and in reducing mortality and morbidity. Material and methods. A cross-sectional observational study was carried out in a prospective cohort of patients with stable grade III and IV COPD, as measured by the GOLD scale. The participants completed a pulmonary rehabilitation program. A questionnaire was designed to collect perceptions of dyspnea, exacerbations, mortality, treatment adherence, and quality of life, measured with anxiety-depression questionnaires, the Saint George Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Questionnaire (CRQ) before and 1 year after of treatment. Results. The perception of dyspnea decreased after a month of treatment. At 1 year, the number of exacerbations was 4.06 and mortality was 5.9%. A total of 78.9% of the patients continued training at home and obtained better results if they trained 3 days per week or more. Quality of life showed improvement in the anxiety-depression questionnaires, SGRQ scale, and in some areas of the CRQ scale. Conclusions. The pulmonary rehabilitation program produced long-term benefits for health, improving autonomy in activities of daily living and self-perceived quality of life (AU)

Tortícolis secundario a hipoplasia del esternocleidomastoideo / Torticollis secondary to sternocleidomastoid hypoplasia

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Valoración de la exactitud de la infiltración de toxina botulínica a ciegas en niños y adolescentes con parálisis cerebral / Blinded evaluation of the accuracy of botulinum toxin in children and adolescents with cerebral palsy

Objetivos. Evaluar la exactitud de la infiltración manual frente a la guiada con electroestimulación de los músculos distales o profundos de las extremidades. Material y método. Estudio prospectivo en el que se infiltran 289 músculos en 29 pacientes afectos de parálisis cerebral con edades comprendidas entre 1 y 19 años, comparándose la exactitud de la infiltración guiada por referencias anatómicas asociada a la reproducción del movimiento muscular frente a aquella realizada mediante guía con electroestimulación. Resultados. Se muestran los distintos patrones de espasticidad tratados y los porcentajes de aciertos obtenidos en cada músculo al realizar infiltración guiada mediante referencias anatómicas. Existe un porcentaje de aciertos inferior al 50% en 10 de los 16 músculos infiltrados. Conclusiones. La infiltración de los músculos pequeños, profundos y distales precisa de una guía instrumentada, de las cuales la electroestimulación es asequible y certera(AU)

Objective. To evaluate the accuracy of manual infilitration versus electrostimulation-guided of the distal or deep muscles of the limbs. Material and method. A prospective study was carried out in which 289 muscles were injected in 29 patients who had cerebral palsy (aged 1 to 19years). The accuracy of manual puncturing following anatomical references associated to the reproduction of muscle movement was compared to that guided by electrostimulation. Results. The spasticity patterns treated as well as the percentages of successful injections guided for anatomical reference for each muscle are shown. The percentage of successful injections was <50% in 10 out of the 16 muscles injected. Conclusions. To inject small, deep and distal muscles, an instrumental guide such as electrostimulation, which is both easily available and accurate, is required(AU)