Commercially available activity monitors such as the fitbit charge and apple watch show poor validity in patients with gait aids after total knee arthroplasty.

PURPOSE: The aim of this study is to determine the validity of consumer grade step counter devices during the early recovery period after knee replacement surgery. METHODS: Twenty-three participants wore a Fitbit Charge or Apple Watch Series 4 smart watch and performed a walking test along a 50-metre hallway. There were 9 males and 14 females included in the study with an average age of 68.5 years and BMI of 32. Each patient wore both the Fitbit Charge and Apple Watch while completing the walking test and an observer counted the ground truth value using a thumb-push tally counter. This test was repeated pre-operatively with no gait aid, immediately post operatively with a walker, at 6 weeks follow up with a cane and at 6 months with no gait aid. Bland-Altman plots were performed for all walking tests to compare the agreement between measurement techniques. RESULTS: Mean overall agreement of step count for pre-operative and at 6 months for subjects walking without gait aids was excellent for both the Apple Watch vs. actual and Fitbit vs. actual with bias values ranging from - 0.87 to 1.36 with limits of agreement (LOA) ranging between - 10.82 and 15.91. While using a walker both devices showed extremely little agreement with the actual step count with bias values between 22.5 and 24.37 with LOA between 11.7 and 33.3. At 6 weeks post-op while using a cane, both the Apple Watch and Fitbit devices had a range of bias values between - 2.8 and 5.73 with LOA between - 13.51 and 24.97. CONCLUSIONS: These devices show poor validity in the early post operative setting, especially with the use of gait aids, and therefore results should be interpreted with caution.

Improving Walking Path Generation Through Biped Constraint in Indoor Navigation System for Visually Impaired Individuals.

This paper introduces a walking path generation method specifically developed for the Smart Cane, which is a RNA (Robotic Navigation Assistance Device) aimed at enhancing indoor navigation for visually impaired individuals. The proposed approach combines the utilization of a LIPM (Linear Inverse Pendulum Model) and LFPC (Linear Foot Placement Controller) motion primitives to generate walking paths specifically designed for visually impaired individuals. The primary objective is to generate paths that conform to human motion constraints, thereby guaranteeing an efficient and natural navigation experience. Integrating autonomous navigation framework, the Smart Cane facilitates safe and effective guidance for visually impaired participants in the indoor environments. Furthermore, comparative experiments have been conducted to validate the effectiveness of the proposed method, providing evidence of its capability to generate walking paths that conform to human motion constraints. The experiment results indicate that the proposed walking path generation method is a promising solution to enhance the navigation experience of visually impaired individuals.

Efficient conversion of cane molasses into Tremella fuciformis polysaccharides with enhanced bioactivity through repeated batch culture.

Tremella fuciformis polysaccharide (TFPS) is a natural mushroom mucopolysaccharide widely used in health foods, medical care, cosmetic and surgical materials. In this study, we developed an efficient strategy for the repeated batch production of highly bioactive TFPS from the agro-industrial residue cane molasses. Cane molasses contained 39.92 % sucrose (w/w), 6.36 % fructose and 3.53 % glucose, all of which could be utilized by T. fuciformis spores, whereas, the TFPS production efficiency only reached 0.74 g/L/d. Corn cobs proved to be the best immobilized carrier that could tightly absorb spores and significantly shorten the fermentation lag period. The average yield of TFPS in eight repeated batch culture was 5.52 g/L with a production efficiency of 2.04 g/L/d. The average fermentation cycle after optimization was reduced by 61.61 % compared with the initial conditions. Compared to glucose as a carbon source, cane molasses significantly increased the proportion of low-molecular-weight TFPS (TFPS-2) in total polysaccharides from 3.54 % to 17.25 % (w/w). Moreover, TFPS-2 exhibited potent antioxidant capacity against four free radicals (O2-, ABTS+, OH, and DPPH). In conclusion, this study lays the foundation for the efficient conversion of cane molasses and production of TFPS with high bioactivity.

Plant-based hydrocolloids for efficient clarification of cane juices: rheological analysis and solidification studies.

The present study is designed to study the efficiency of plant-based hydrocolloids for the efficient clarification of sugarcane juice and subsequent production of non-centrifugal sugars (NCSs). NCSs are generally produced with lime or other inorganic solids as a clarification agent, often leading to products with a bland taste and dark color. This work is a first of its kind, where plant-based hydrocolloids such as starch, xanthan gum, and guar gum are used for clarification studies. Clarification efficiency was evaluated in terms of separation efficiency, turbidity removal, sucrose content, color transmittance, and rheology studies. Preliminary studies revealed that starch showed a better separation efficiency of 78% compared to other hydrocolloids, and further rheology studies of starch-clarified juice showed a favourable shear-thickening (dilatant, n = 1.382) behaviour, whereas the other two hydrocolloids showed an unfavourable shear-thinning (pseudo plastic, n < 0.9) behaviour. Eventually, starch was found to be a better clarification agent and is proposed as an alternative to lime-based clarification. Solidification studies were performed with starch at various concentrations (0.02-0.04%), pH (6.8-7.2), and temperature (80 °C-100 °C), and it was found that NCSs produced via starch clarification showed superior properties compared with traditional lime-based clarification processes.

Access to eye care and support services among adults from minority ethnic communities living with visual impairment in the United Kingdom.

Background: Despite an increased risk of certain eye conditions which can lead to visual impairment (V.I.), there is evidence of a greater delay to treatment-seeking among adults from minority ethnic communities (MEC). MEC adults may also be underrepresented on V.I. registers, within early intervention services, and among the beneficiaries of national V.I. charities. However, much of this evidence is outdated or anecdotal. Methods: This secondary analysis of V.I. Lives survey data explored use of eye health and support services and mobility aids among a matched control sample of 77 MEC and 77 adults aged 18 and over from white communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Additional subgroup analysis was conducted for Asian (n = 46) and black participants (n = 22). Results: There were no significant group differences in areas such as eye health service use, registration status, contact with charities, and level of practical support received. But MEC participants were significantly more likely than WC participants to have received direct payments from social services to cover their care needs, Χ2 (1, 154) = 8.27, p = 0.004, and to use apps on their mobile for mobility, Χ2 (1, 154) = 5.75, p = 0.017. In contrast, WC participants were significantly more likely to agree that they were getting the level of emotional support to get on with their life, U = 3,638, p = 0.010, to feel confident to ask their friends for support, U = 2,416, p = 0.040, and to have a guide dog for mobility, Χ2 (1, 154) = 3.62, p = 0.057, although the latter did not reach statistical significance. Within the MEC group, Asian participants were significantly more likely than black participants to use a long cane, Χ2 (1, 68) = 7.24, p = 0.007, but they were significantly less likely to agree that they had received the right level of support when they started to experience V.I., U = 236.5, p = 0.040. Conclusion: The preliminary findings suggests that there is scope to increase support provided by V.I. charities and the V.I. register, although, contrary to existing evidence, there were no statistically significant differences in eye health service use, registration status and use of wider support services. Further research is required to confirm these findings and explore reasons for differences.

Factores intrínsecos y extrínsecos asociados con caídas en adultos mayores: estudio de casos y controles en México / Intrinsic and extrinsic factors associated with falls in older adults: a case-control study in Mexico

Resumen Antecedentes: Las caídas tienen un origen multifactorial. Objetivo: Estimar el riesgo de caídas y su asociación con algunos factores intrínsecos y extrínsecos en adultos mayores. Métodos: Estudio de casos y controles que incluyó pacientes de ambos sexos con edades ≥ 60 años. Los casos fueron pacientes que ingresaron al servicio de urgencias de un hospital de segundo nivel, con diagnóstico de lesión o fractura secundaria a una caída; los controles fueron pacientes que acudieron a unidades de medicina familiar. El análisis estadístico que se realizó fue descriptivo, bivariante y multivariante. Se utilizó el programa SPSS versión 22.0. Resultados: Se incluyeron 342 pacientes (171 casos y 171 controles). La edad promedio fue 76.1 ± 8.8 años, el 66 % fueron mujeres y por autorreporte el 97.1 % tenían enfermedades crónicas. Se observaron diferencias en el índice de masa corporal, en la proporción de casos con deterioro cognitivo, uso de dispositivos para caminar y dependencia para realizar actividades básicas e instrumentales de la vida diaria. El análisis multivariante ajustado reveló asociación entre el evento caída con deterioro cognitivo y dependencia para realizar actividades instrumentales de la vida diaria. Conclusiones: El deterioro cognitivo y la dependencia para realizar actividades instrumentales de la vida diaria se asociaron al riesgo de caer.

Abstract Background: Falls have a multifactorial origin. Objective: To estimate the risk of falls and their association with some intrinsic and extrinsic factors in elderly. Methods: Case-control study that included individuals of both genders aged ≥ 60 years. Cases were patients who were admitted to the emergency department of a secondary care hospital diagnosed with injury or fracture secondary to a fall; the controls were patients who attended family medicine units. Descriptive, bivariate and multivariate statistical analysis was carried out. The SPSS program, version 22.0, was used. Results: Three-hundred and forty-two patients were included (171 cases and 171 controls). Mean age was 76.1 ± 8.8 years, 66 % were women and 97.1 % had self-reported chronic diseases. Differences were observed in body mass index, in the proportion of cases with cognitive impairment, use of walking devices and dependence to perform basic and instrumental activities of daily living. Adjusted multivariate analysis revealed an association between the fall event and cognitive impairment and dependence to perform instrumental activities of daily living. Conclusions: Cognitive impairment and dependence to perform instrumental activities of daily living were associated with the risk of falling.

Alterações cardiorrespiratórias em indivíduos hemiparéticos crônicos pós-acidente vascular cerebral / Cardiorespiratory changes in chronic post-stroke hemiparetic patients

Objetivo: Analisar a função cardiorrespiratória em pacientes he- miparéticos crônicos pós-acidente vascular cerebral. Métodos: Estudo retrospectivo, por meio da análise de dados de prontuários de pacientes submetidos ao teste de caminhada de 6 minutos e manovacuometria em uma clínica de fisioterapia de um centro universitário. Foram analisados os dados de sete prontuários. Re- sultados: A média de metros percorridos pelos participantes no teste de caminhada de 6 minutos foi de 199,5. Os valores percentuais da manovacuometria foram de -41,34 na pressão inspiratória máxima e de 57,85 na pressão expiratória máxima. Conclusão: Os dados desta pesquisa sugerem que indivíduos hemiparéticos crônicos apresentam fadiga respiratória e muscular, diminuição da capacidade funcional durante a marcha e fraqueza dos músculos respiratórios.

Objective: To analyze the cardiorespiratory function in chronic post-stroke hemiparetic patients. Methods: This is a retrospective study, through data analysis of medical records from patients who underwent the 6-minute walk test and manovacuometry, in a physical therapy clinic of a university center. Results: The mean number of meters walked by participants in the 6-minut walk test was 199.5 meters. The percentage values of manovacuometry were -41,34 in the maximun inspiratory pressure and 57.85 in the maximun expiratory pressure. Conclusion: The data from this survey suggest that chronic hemiparetic individuals have respiratory and muscle fatigue, decreased functional capacity during gait, and respiratory muscle weakness.

Paciente con amputación transfemoral derecha, clavo gamma y síndrome hemimotor derecho: valoración y manejo del proceso de protetización / Patient with a right transfemoral amputation, gamma nail, and right Hemi-motor syndrome: assessment and management of the prosthetic fitting

Introducción: la decisión de protetizar a un paciente amputado depende de: la etiología, nivel de amputación, uni o bilateralidad, comorbilidades, soporte sociofamiliar, capacidad funcional y motivación del paciente. Observación clínica: varón, 83 años, diabético, cardiopatía isquémica, accidente cerebrovascular con paresia braquial derecha residual en año 2000. Clavo gamma por fractura pertro-cantérea derecha en 2012 y amputación transfemoral derecha en 2018 de causa vascular. Se protetiza mediante encaje de contención isquiática CAT-CAM, sistema de suspensión tipo Kiss, rodilla de bloqueo a la extensión con adaptación del sistema de desbloqueo en porción antero-interna del encaje y pie Sach. Tras tratamiento fisioterápico, consigue deambulación autónoma con ayuda de un bastón y tercera persona por dificultad para agarre de MSD. Conclusión: los médicos rehabilitadores debemos apostar por dotar a nuestros pacientes de autonomía y funcionalidad, siempre que sea viable.

Introduction: prosthesis, an amputee patient, depends on etiology, level, uni or bilaterality, comorbidities, socio-family support, functional capacity, and motivation of the patient. Clinical observation: male, 83 years old, diabetic, ischemic heart disease, stroke with residual upper right limb (URL) paresis in 2000. Gamma nail due to the right trochanteric fracture in 2012, and right transfemoral amputation in 2018 of vascular cause. Prosthetic fitting CAD-CAM socket/interface, Kiss type suspension system, extension locking knee with an adaptation of the unlocking system in the antero-internal portion of the socket, and Sach foot. After physiotherapeutic treatment, he achieves independent walking with the help of 1 cane and third-person due to difficulty in the URL grip. Conclusion: rehabilitation doctors must bet on providing our patients with independency, and better function, whenever it is viable.

Uso de bastones contralaterales en artrosis de rodilla / Contralateral canes for knee osteoarthritis

INTRODUCCIÓN La artrosis de rodilla es un problema de salud relevante dada su alta prevalencia y discapacidad asociada. Dentro de las alternativas de manejo no farmacológico se ha planteado el uso de bastones, sin embargo no existe consenso en la literatura respecto a su indicación. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos tres revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, de los cuales, uno es ensayo aleatorizado. Concluimos que el uso de bastón contralateral en pacientes con artrosis de rodilla probablemente disminuye el dolor. Además, podría aumentar levemente la funcionalidad, pero la certeza de la evidencia es baja.

INTRODUCTION Knee osteoarthritis is a relevant health problem given its high prevalence and associated disability. Within the non-pharmacological management alternatives, the use of canes has been proposed, however, there is no consensus in the literature regarding its indication. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews including four studies overall, of which one was randomized trials. We conclude that the use of a contralateral cane in patients with knee osteoarthritis probably reduces pain. In addition, it could slightly increase function, but the certainty of the evidence is low.

Recomendações para prescrição de dispositivos auxiliares da marcha em idosos / Recommendations for prescribing walking aids in older adults

O uso de um dispositivo auxiliar da marcha (DAM), como bengala ou andador, pode auxiliar os idosos na realização de suas atividades diárias, mantendo-os funcionalmente independentes e relativamente ativos. Porém, a utilização inadequada, o mau estado e as dimensões incorretas do dispositivo, assim como erros na prescrição do tipo de dispositivo podem aumentar o risco de quedas nos idosos usuários de DAM. Diante da falta de recomendações quanto à sua prescrição, o objetivo desse artigo é discorrer sobre os pré-requisitos para a prescrição de cada dispositivo (bengala e andador), de acordo com a nossa experiência adquirida na Área de Fisioterapia em Gerontologia, no Centro de Reabilitação (CER) do Hospital das Clínicas de Ribeirão Preto, considerando as evidências científicas disponíveis até o momento. Assim, com a difusão das informações contidas nesse artigo para os profissionais da saúde que prestam assistência a idosos, espera-se aprimorar a prática de prescrição do DAM e de educação do idoso, de seus familiares e cuidadores, a fim de que sejam alcançados os benefícios do uso de um DAM e prevenidos os possíveis eventos adversos, como as quedas.

The use of a walking aid device (WAD), such as a cane or walker, can assist older adults in performing their daily activities, keeping them functionally independent and relatively active. However, improper use, poor condition and incorrect dimensions of the device, as well as errors in prescribing the type of device may increase the risk of falls in older people who use a WAD. Given the lack of recommendations on its prescription, the purpose of this article is to discuss the requirements for the prescription of each device (cane and walker), according to our experience obtained in the area of ​​Gerontology Physiotherapy in the Rehabilitation Center (CER) of the Hospital das Clínicas de Ribeirão Preto, considering the scientific evidence available at the moment. Thus, by disseminating the information contained in this article to health professionals who provide care to older people, it is expected to improve the practice of prescribing WAD and educating the older adults, their families and caregivers, in order to achieve the benefits of use a WAD and prevent possible adverse events such as falls.

Estudo comparativo de três tipos de andarilho em idosos institucionalizados: Desafios para enfermagem de reabilitação / A comparative study of three types of walker in institutionalized elderly: Challenges for rehabilitation nursing

O envelhecimento está associado a problemas agudos e crónicos, que podem afetar a mobilidade e independência da pessoa idosa nos autocuidados, pela deterioração dos sistemas que contribuem para o controlo do equilíbrio e marcha. Existem no mercado diversos tipos de andarilho com caraterísticas diferentes em termos de utilização e segurança, que devem ser adequadamente prescritos, consoante a capacidade funcional e cognitiva do utilizador, para prevenir limitações na mobilidade e episódios de queda. Este estudo pretende comparar o perfil do desempenho, funcionalidade e satisfação proporcionado pelos três andarilhos nas dimensões fixo, duas rodas e quatro rodas em pessoas idosas institucionalizadas, tendo em vista o uso de andarilhos seguros e fiáveis, que melhorem a segurança do utilizador. Desenvolveu-se, assim, um estudo quase experimental antes e após, de grupo único, em idosos institucionalizados, com a implementação de um protocolo de investigação. A amostra não aleatória por acidente é constituída por 40 idosos institucionalizados em 5 lares da área de Coimbra, com uso prévio de andarilho, entre abril e maio de 2018. Os dados foram recolhidos na sequência de um protocolo, que incluiu a realização do ?Expanded Timed Up and GoTest? com três tipos de andarilhos, e aplicação de um questionário de caraterização sociodemográfica e clínica, com aplicação de escalas que avaliam a funcionalidade, o medo de cair, a força e resistência dos membros superiores, o tempo, a velocidade da marcha, a frequência cardíaca, o custo energético e o nível de satisfação da pessoa. Nos resultados obtidos não se observam diferenças tanto no custo energético entre os 3 andarilhos (X2 = 2,177; p = 0.337), assim como na frequência cardíaca (X2 = 2,177; p = 0.680). Contudo, observam-se diferenças significativas no tempo (X2 = 15.80; p<0.001) e na velocidade de marcha entre os três tipos de andarilho (X2 = 15.80; p<0.001). Estas diferenças encontradas no tempo evidenciaram-se com o andarilho fixo e o andarilho de duas rodas (Z = -3,18, p <0.001), bem como o tempo entre o andarilho de duas rodas e o andarilho de quatro rodas (Z = -3,01, p <0.003). Na velocidade de marcha, as diferenças verificaram-se entre o andarilho fixo e o andarilho de duas rodas (Z = -2.25, p<0.001), assim como com o andarilho de quatro rodas (Z = - 2.50, p< 0.001). Também se observaram diferenças entre o andarilho de duas rodas e o andarilho de quatro rodas (Z = - 4.22, p< 0.000). Quanto ao custo energético e as diversas variáveis sociodemográficas e clínicas, apenas se encontrou uma correlação negativa significativa entre o custo energético com o andarilho de quatro rodas e o IMC (r = -0.401, p= 0.010), uma correlação positiva significativa entre o custo energético com o andarilho de quatro rodas e o tempo de utilização (r = 0.376, p = 0.010), uma correlação negativa significativa entre o custo energético com o andarilho de duas rodas e o nível escolar (rs = -0.327, p = 0.040), e uma correlação negativa significativa entre o custo energético com o andarilho fixo e a dominância da mão (rpb = -0.327, p = 0.039) e entre o custo energético com o andarilho de quatro rodas e a dominância da mão (rpb = -0.310, p = 0.052). Em relação à satisfação, apenas se observaram diferenças significativas nos itens ?estabilidade e segurança? (X2 = 13.02; p<0.001) e ?facilidade de uso? (X2 = 6.07; p<0.05), nomeadamente na satisfação entre o andarilho fixo e o andarilho de duas rodas (Z = -3.41, p <0.001). Em conclusão, os resultados obtidos podem contribuir para a melhoria dos cuidados de enfermagem de reabilitação à pessoa idosa e da segurança desta na utilização do andarilho, contribuindo para uma prescrição personalizada, realizada e acompanhada por um profissional de saúde especializado, assim como a realização de novos estudos que permitam o desenvolvimento e a inovação destes dispositivos.

Major Limb Replantation of Lower Leg Amputation with Ipsilateral Distal Femoral Comminuted Fracture in Old Age: A Case Report

The development of microsurgical techniques has also increased the success rate of replantation surgery. This paper reports the results of limb replantation performed on a lower extremity amputation that was associated with crush amputation and an ipsilateral comminuted fracture in and elderly patient. A 68-year-old female presented with a right distal tibia amputation due to a traffic accident. At that time, with a comminuted fracture in the distal femoral condyle, simple wound repair was recommended, but the caregivers strongly wanted replantation. Three years after surgery, normal walking was possible without a cane and the patient was satisfied with the function and aesthetics. What used to be contraindicated in limb replantation in the past are now indications due to the development of microsurgical techniques, surgical experience, and postoperative rehabilitation treatment. If the patient is willing to be treated, good results in contraindications can be obtained.

Functional Improvement Following Revision Surgery in a Patient with the Dual Disability of a Complicated Residual Limb and Contralateral Hemiplegia: A Case Report

The number of reported cases with dual disability is increasing for the past few decades. Currently, dual disability of lower limb amputation and motor weakness after stroke became a strong issue in public concern. The functional levels of patients have shown in the wide range from independent community ambulation to non-ambulation. Thus, it indicates that favorable outcomes for dual disability may depend upon adopted rehabilitative strategies. We present the case of a man with left below-knee amputation and severe right-sided weakness following a huge putaminal hemorrhage. He had suffered from extreme pain and misfit of the prosthetic socket and the complicated residual limb for three years prior to the stroke. Forty days post-stroke, we performed a revision surgery to resolve the complications of bony overgrowth, verrucous hyperplasia, and neuroma and applied an ankle foot orthosis (AFO). Two years post-stroke, he was able to ambulate outside his home and negotiate stairs using a cane. This is the first case with the dual disability of lower limb amputation and contralateral hemiplegia to undergo revision surgery. The results suggest that an early revision surgery and use of an AFO are crucial for achieving a higher level of mobility in such cases.

The Effect of Cane Height on Walking and Balance for Stroke Patients / 農村醫學 地域保健

OBJECTIVES: This study investigates the effects of using customized walking aids individualized for stroke patients by measuring the effects of different cane lengths to determine the ideal length of walking aids for stroke patients. METHODS: Cane lengths were determined from the greater trochanter with walking aids measured 5cm below, at the greater trochanter and 5cm above. All patients walked for ten meters with each cane length to measure speed. Then, we measured the opto gait, timed up go test, and electromyography three times each. Statistical analysis was performed using a linear mixed model, and in the case of significance, the p-value was corrected using the Bonferroni method. RESULTS: There was a statistically significant differences in time up and go test(TUGT), 10m walking, stride and speed between the groups. CONCLUSIONS: Long cane length increases body symmetry, stride, increasing muscle activity, and short cane length increases balance and walking.

Ayudas técnicas para personas mayores de 65 años y más: problema de salud AUGE N°36 / Technical aids for seniors 65 years of age and older: health problems AUGE N°36

OBJETIVO Generar recomendaciones basadas en la mejor evidencia disponible acerca de la entrega de ayudas técnicas a personas de 65 años y más con limitación en la movilidad. TIPO DE PACIENTES Y ESCENARIO CLÍNICO Está guía aborda aspectos relacionados entrega e indicación de ayudas técnicas a personas de 65 años y más con limitación en la movilidad. USUARIOS DE LA GUÍA Profesionales involucrados en los procesos de indicación, prescripción, entrenamiento en uso y seguimiento de ayudas técnicas para personas de 65 años y más con limitación en la movilidad: Médico, terapeuta ocupacional, kinesiólogo/a, y enfermero/a. METODOLOGÍA Las recomendaciones de esta Guía fueron elaboradas de acuerdo con el sistema "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE). Luego de priorizadas las preguntas a responder, se realizó la búsqueda y la síntesis de evidencia, para finalmente generar las recomendaciones a través del juicio del Panel de Expertos. La búsqueda y selección de la evidencia de esta Guía se basó en un método sistemático, transparente y reproducible. Una vez seleccionada la evidencia, se resumió en un formato claro y conciso que permitiera al Grupo Elaborador realizar los juicios respecto a la calidad de dicha evidencia, el balance entre los riesgos y beneficios asociados a la intervención o calidad de una prueba, un tratamiento, los valores y preferencias de los pacientes, y los costos derivados de su implementación.

Uso de bastón y caídas en adultos mayores chilenos de la comunidad / Cane use and falls in chilean community-dwelling older adults

RESUMEN Objetivo: Describir las características sobre el uso del bastón y la prevalencia de caídas en adultos mayores de la comunidad que han recibido ayuda técnica en un Centro de Salud Familiar. Material y método: Estudio cuantitativo, descriptivo y transversal. La muestra correspondió a 64 adultos mayores de entre 60 y 94 años. Para recolectar los datos se utilizó un cuestionario que evaluó variables sociodemográficas, de salud, uso de bastón y caídas. El análisis estadístico se realizó mediante el paquete SPSS. Se utilizó consentimiento informado, considerando los lineamientos sobre investigación y confidencialidad de la información dispuestos en Chile. Resultados: El 95,3% refirió saber el motivo de uso del bastón; el 7,8% utiliza el bastón cuando se moviliza dentro de la casa, el 45,3% cuando se moviliza fuera de la casa, el 46,9% cuando se moviliza por todas partes; y el 48,4% expresó que no le agrada utilizar el bastón. La prevalencia de caídas en los últimos seis meses fue de 73%; de quienes presentaron caídas el 61% no estaba usando el bastón al momento de caer, y el 94% expresó tener miedo de sufrir una caída. Conclusión: Los resultados muestran que un alto porcentaje de adultos mayores no está cumpliendo con el uso del bastón, por lo tanto el objetivo de su entrega no se está logrando. Se debe incluir la evaluación y educación del uso del bastón como una actividad que forme parte del control de salud del adulto mayor.

ABSTRACT Aim: To describe the characteristics of cane use and prevalence of falls in community-dwelling older adults who have received technical assistance in a Family Health Center. Method: Quantitative, descriptive and cross-sectional study. Sample consisted of 64 older adults between 60 and 94 years of age. A questionnaire addressing socio-demographics, health, cane use and fall-related information was used to collect the data. Statistical analysis was performed with SPSS. An informed consent form was delivered and designed in compliance with Chile's guidelines on research and confidentiality of information. Results: 95.3% of participants reported knowing the motives for cane use; 7.8% use a cane while walking within home; 45.3% use a cane while walking outdoors; 46.9% use a cane to walk anywhere; and 48.4% said that they do not like to use the cane. The prevalence of falls in the last six months was 73%; 61% of those who have fallen were not using a cane when they fell, and 94% expressed fear of falling. Conclusion: The findings show that a high percentage of older adults is not using a cane, and therefore the ultimate goal of delivering mobility devices is not being achieved. Cane use evaluation and education should be considered as an older adults' health control measure.

Child Abuse and the Eye in an African Population

PURPOSE: There is a paucity of data on child abuse and the eye in West Africa. Therefore, a need exists to determine the causes and circumstances surrounding these occurrences and their effects on the eye and vision in a pediatric population. METHODS: A 3-year study of consecutive cases of ocular features that presented to an eye clinic following a history suggestive of child abuse along with any associated eye injury was carried out. Socio-demographic characteristics were obtained, as were the presenting and posttreatment visual acuity, and a full clinical eye examination was also done. RESULTS: Fifty-six children with 56 affected eyes were examined. The male to female ratio was 1.8 : 1; the mean age was 8.25 ± 3.5 years; and the subjects were predominately primary school children 30 (53.6%). The most common ocular disorders were conjunctiva hyperemia (46.4%), corneal abrasion/ulcer (25.4%), hyphema/uveitis (42.9%), retinal detachment (7.1%), sclera rupture (7.1%), and globe perforation (21.4%). The intraocular pressure was raised in 17.9% of participants. Presenting versus posttreatment visual acuities showed normal vision in four (7.1%) vs. eighteen (32.1%), visual impairment in 12 (21.4%) vs. six (10.7%), severe visual impairment in 20 (35.7%) vs. 12 (21.4%), and blindness in 12 (21.4%) vs. 14 (25%), p < 0.001. The most common injurious agents were canes (25.0%) and sticks (17.9%). The people who inflicted the injuries were parents/relatives (uncles) in 35.7% of cases and the children themselves (accidents) in 21.4% of cases. Circumstances predisposing participants to eye injuries were child labor in 39.3% and beatings in 25.0%. Complications were cataracts (25.0%), corneal opacity (39.3%), and retinal detachment (7.1%). CONCLUSIONS: Injuries commonly resulted from canes and sticks used during beatings, as well as from child labor, corporal punishment, accidents, and assaults. Legislation and laws need to be enacted to prevent negative psychosocial and economic impacts on the child, family and country as a whole.

Informe de evaluación científica en la evidencia disponible: esclerosis lateral amiotrófica / Scientific evaluation report on the available evidence: amyotrophic lateral sclerosis

INTRODUCCIÓN: Las enfermedades neuromusculares son un grupo de patologías que afectan al sistema nervioso periférico en alguno de los componentes de la unidad motora: célula del asta anterior, nervio periférico, unión neuromuscular y/o músculo. Son causa importante de discapacidad y morbilidad y consiguientemente de alto gasto en salud. Dentro de este grupo, la Esclerosis Lateral Amiotrófica (ELA) es un desorden neurodegenerativo y sin una cura conocida que causa debilidad muscular, discapacidad y eventualmente la muerte. Se caracteriza por signos de degeneración de las neuronas motoras superiores e inferiores. Aunque aún no han sido identificadas las causas de esta enfermedad, se ha identificado que ésta es patofisiológicamente diversa, y que habría alguna predisposición genética a desarrollarla, mientras que una creciente cantidad de evidencia mostraría alguna asociación con ser fumador. La incidencia de ELA se ha estimado en un promedio de 1 por cada 50.000, y su prevalencia en 1 en 20.000. La mayoría de los casos se presentan de forma esporádica, no obstante una pequeña proporción son casos familiares. TECNOLOGÍAS SANITARIA DE INTERÉS: Apoyo profesional, ayudas técnicas y alimentación entera. EFICACIA DE LOS TRATAMIENTOS: Según la norma técnica N 0192 de la Evaluación científica de la evidencia elaborada por el Ministerio de Salud, que tiene como objetivo determinar el proceso de la misma, establece que en el caso de intervenciones cuya efectividad sea evidente sin necesidad de determinarla a través de estudios clínicos, se considerara a la vez significativa y con alta certeza en la evidencia. Por esta razón no se evalúa la eficacia del uso de ayudas técnicas en Esclerosis Lateral Amiotrófica. ALTERNATIVAS DISPONIBLES: Fisioterapia: La fisioterapia como tratamiento en los trastornos neuromusculares ayuda a mantener y aumentar, hasta donde sea posible, el nivel de función y movilidad actual niño. Sus propósitos principales son: proporcionar una valoración física, minimizar el desarrollo de contracturas, mantener la fuerza muscular y prolongar la movilidad y funcionalidad. Terapia Ocupacional: Este tipo de terapia, ayuda a desarrollar destrezas para mejorar la habilidad para bañarse, vestirse, cocinar, comer, jugar, trabajar, etc. Los objetivos específicos son: educación principalmente del paciente y familia; ayudar al niño con los problemas tempranos a nivel motor y favorecer las actividades de la extremidad superior relacionadas con el juego, propio cuidado y colegio; facilitar las ayudas técnicas necesarias para mantener la máxima independencia; valorar las modificaciones arquitectónicas necesarias para ayudar a su movilidad; mantener el rango de movimiento y uso de las extremidades superiores con los dispositivos ortopédicos necesarios; colaborar con el equipo interdisciplinario en lo referente a miembros inferiores y atención respiratoria. RESULTADOS DE LA BÚSQUEDA DE EVIDENCIA: No se encontró evidencia de evaluaciones económicas realizadas para ayudas técnicas en pacientes con ELA. CONCLUSIÓN: Para dar cumplimiento al artículo 28° del Reglamento que establece el proceso destinado a determinar los diagnósticos y tratamientos de alto costo con Sistema de Protección Financiera, según lo establecido en los artículos 7°y 8° de la ley N°20.850, aprobado por el decreto N°13 del Ministerio de Salud, se concluye que el presente informe de evaluación se considera favorable, de acuerdo a lo establecido en el Título III. de las Evaluaciones Favorables de la Norma Técnica N° 0192 de este mismo ministerio.

Guía metodológica para elaborar el diagnóstico fisioterapéutico según la Clasificación Internacional del Funcionamiento (CIF), de la discapacidad y de la salud / Methodological guide for preparing the physiotherapy diagnosis according to the International Classification of Functioning (CIF), disability and health

El presente artículo tiene como objetivo plantear una guía metodológica que permita a los estudiantes de la Carrera de Fisioterapia y Kinesiología unificar criterios para desarrollar los procesos diagnósticos desde el enfoque biopsicosocial, a partir de las evidencias obtenidas en la evaluación inicial y tomando como base la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF). La idea surge a raíz de las dificultades que se tiene en la formulación del diagnóstico fisioterapéutico, más allá del referente “enfermedad”, asumiendo una identidad propia desde su objeto de estudio como es la función - disfunción del movimiento humano. Se propone el uso de la CIF porque incorpora en su estructura categorías desde la perspectiva corporal, individual y social, los cuales tienen relación estrecha con la naturaleza y niveles de estudio de la Fisioterapia y Kinesiología. Solo así se provee un marco inicial que dinamiza la organización de datos y opiniones clínicas facilitando un sistema de clasificación de acuerdo con las funciones y estructuras corporales, las actividades corporales y la participación en las actividades de la vida diaria, así como la identificación de barreras o facilitadores en el entorno ambiental y las características individuales que forman parte del estado de salud de las personas.

This article aims to raise a methodological guide that allows students of the School of Physiotherapy and Kinesiology unify criteria to develop diagnostic processes from the biopsychosocial approach, based on the evidence obtained in the initial evaluation and based on the ranking International of Functioning, Disability and Health (ICF). The idea stems from the difficulties you have in the formulation of physiotherapy diagnosis, beyond the reference “disease”, assuming an identity from its subject as it is the function - dysfunction of human movement. The use of ICF is proposed that incorporates in its structure categories from body, individual and societal perspective, which are closely related to the nature and levels of study of physiotherapy and kinesiology. Only then an initial framework that streamlines the organization of data and clinical opinion facilitating a classification system according to body functions and structures, bodily activities and participation in activities of daily living, as well as identifying barriers is provided or facilitators in the ambient environment and the individual characteristics that are part of the health status of people.

Surgical Treatment of Undisplaced Femur Neck Fractures in Dementia Patients Using Proximal Femoral Nail Antirotation / 대한고관절학회지

PURPOSE: People with dementia have poor mobility and discharge outcomes following hip fractures. The purpose of this study was to evaluate the clinical and radiological results of internal fixation of undisplaced femur neck fractures (Garden types 1 and 2) by proximal femoral nail antirotation (PFNA) in dementia patients. MATERIALS AND METHODS: We studied retrospectively 19 patients with undisplaced femur neck fracture. All patients were over 70 years of age, walked independently with a cane or crutches and suffered moderate-to-severe dementia. Patients were treated with PFNA and followed-up for more than 2 years. Revision, loss of fixation, complications, and walking ability outcomes were measured. RESULTS: In walking-ability evaluation, patients showed an average decrease of just 0.2 points at the final follow-up. Walking ability was evaluated from before injury to 4 weeks after surgery and decreased by less than 0.5 points. Radiological bone union was achieved in 17 cases; the average time to bone union was 4.14 months (range, 2.5-7 months). Complications included non-union in two cases and femoral head avascular necrosis in one case of non-union. CONCLUSION: We found that for patients with osteoporotic bone tissues in their femoral heads or patients (e.g., those suffering dementia) for whom cooperating with medical workers for postoperative walking control or rehabilitation exercises is difficult, implanting a mechanically stable spiral blade for fixation of femoral neck fractures could facilitate walking after surgery.