Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury.

BACKGROUND: People with spatial neglect after stroke or other brain injury have difficulty attending to one side of space. Various rehabilitation interventions have been used, but evidence of their benefit is unclear. OBJECTIVES: The main objective was to determine the effects of non-pharmacological interventions for people with spatial neglect after stroke and other adult-acquired non-progressive brain injury. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (last searched October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL; last searched October 2020), MEDLINE (1966 to October 2020), Embase (1980 to October 2020), the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1983 to October 2020), and PsycINFO (1974 to October 2020). We also searched ongoing trials registers and screened reference lists. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of any non-pharmacological intervention specifically aimed at spatial neglect. We excluded studies of general rehabilitation and studies with mixed participant groups, unless separate neglect data were available. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Review authors categorised the interventions into eight broad types deemed to be applicable to clinical practice through iterative discussion: visual interventions, prism adaptation, body awareness interventions, mental function interventions, movement interventions, non-invasive brain stimulation, electrical stimulation, and acupuncture. We assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS: We included 65 RCTs with 1951 participants, all of which included people with spatial neglect following stroke. Most studies measured outcomes using standardised neglect assessments. Fifty-one studies measured effects on ADL immediately after completion of the intervention period; only 16 reported persisting effects on ADL (our primary outcome). One study (30 participants) reported discharge destination, and one (24 participants) reported depression. No studies reported falls, balance, or quality of life. Only two studies were judged to be entirely at low risk of bias, and all were small, with fewer than 50 participants per group. We found no definitive (phase 3) clinical trials. None of the studies reported any patient or public involvement. Visual interventions versus any control: evidence is very uncertain about the effects of visual interventions for spatial neglect based on measures of persisting functional ability in ADL (2 studies, 55 participants) (standardised mean difference (SMD) -0.04, 95% confidence interval (CI) -0.57 to 0.49); measures of immediate functional ability in ADL; persisting standardised neglect assessments; and immediate neglect assessments. Prism adaptation versus any control: evidence is very uncertain about the effects of prism adaptation for spatial neglect based on measures of persisting functional ability in ADL (2 studies, 39 participants) (SMD -0.29, 95% CI -0.93 to 0.35); measures of immediate functional ability in ADL; persisting standardised neglect assessments; and immediate neglect assessments. Body awareness interventions versus any control: evidence is very uncertain about the effects of body awareness interventions for spatial neglect based on measures of persisting functional ability in ADL (5 studies, 125 participants) (SMD 0.61, 95% CI 0.24 to 0.97); measures of immediate functional ability in ADL; persisting standardised neglect assessments; immediate neglect assessments; and adverse events. Mental function interventions versus any control: we found no trials of mental function interventions for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of mental function interventions on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. Movement interventions versus any control: we found no trials of movement interventions for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of body awareness interventions on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. Non-invasive brain stimulation (NIBS) versus any control: evidence is very uncertain about the effects of NIBS on spatial neglect based on measures of persisting functional ability in ADL (3 studies, 92 participants) (SMD 0.35, 95% CI -0.08 to 0.77); measures of immediate functional ability in ADL; persisting standardised neglect assessments; immediate neglect assessments; and adverse events. Electrical stimulation versus any control: we found no trials of electrical stimulation for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of electrical stimulation on spatial neglect based on immediate neglect assessments. Acupuncture versus any control: we found no trials of acupuncture for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of acupuncture on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. AUTHORS' CONCLUSIONS: The effectiveness of non-pharmacological interventions for spatial neglect in improving functional ability in ADL and increasing independence remains unproven. Many strategies have been proposed to aid rehabilitation of spatial neglect, but none has yet been sufficiently researched through high-quality fully powered randomised trials to establish potential or adverse effects. As a consequence, no rehabilitation approach can be supported or refuted based on current evidence from RCTs. As recommended by a number of national clinical guidelines, clinicians should continue to provide rehabilitation for neglect that enables people to meet their rehabilitation goals. Clinicians and stroke survivors should have the opportunity, and are strongly encouraged, to participate in research. Future studies need to have appropriate high-quality methodological design, delivery, and reporting to enable appraisal and interpretation of results. Future studies also must evaluate outcomes of importance to patients, such as persisting functional ability in ADL. One way to improve the quality of research is to involve people with experience with the condition in designing and running trials.

Rehabilitation in multiple sclerosis in 2021.

Patients with multiple sclerosis, despite advances in therapy, often suffer from locomotor impairment that limits their mobility and affect quality of life. Rehabilitation is part of the treatment of MS and has shown its beneficial effects in numerous studies. While traditional rehabilitation techniques remain in the limelight, new technologies are emerging and make it possible to improve the management of disabling symptoms. The aim of this update is to synthesize the new therapy techniques proposed in rehabilitation for patients with multiple sclerosis according to the symptoms as balance, gait, upper limb disorders, fatigue, spasticity and disease progression published over the past 5 years. With regard to balance and walking disorders, neuromotor rehabilitation, physical exercise, rhythmic auditory stimulation, gait robot training and exergaming are effective. Only physical exercise has shown a positive effect on fatigue management. Spasticity is improved by classic rehabilitation techniques however non-invasive brain stimulation are promising. The rehabilitation of upper limb dysfunctions uses various effective techniques such as the repetition of functional tasks in real or virtual situations. In case of a more severe disability, arm robots can be used to relearn the impaired movement. Action observation training in real or virtual situations is also effective. Finally, under certain conditions the constraint induced movement therapy is proposed. The effects of rehabilitation are not only positive on the pyramidal symptoms and fatigue but also increase neuroplasticity and perhaps a neuroprotective effect as shown in some studies.

Effects of a robot-aided somatosensory training on proprioception and motor function in stroke survivors.

BACKGROUND: Proprioceptive deficits after stroke are associated with poor upper limb function, slower motor recovery, and decreased self-care ability. Improving proprioception should enhance motor control in stroke survivors, but current evidence is inconclusive. Thus, this study examined whether a robot-aided somatosensory-based training requiring increasingly accurate active wrist movements improves proprioceptive acuity as well as motor performance in chronic stroke. METHODS: Twelve adults with chronic stroke completed a 2-day training (age range: 42-74 years; median time-after-stroke: 12 months; median Fugl-Meyer UE: 65). Retention was assessed at Day 5. Grasping the handle of a wrist-robotic exoskeleton, participants trained to roll a virtual ball to a target through continuous wrist adduction/abduction movements. During training vision was occluded, but participants received real-time, vibro-tactile feedback on their forearm about ball position and speed. Primary outcome was the just-noticeable-difference (JND) wrist position sense threshold as a measure of proprioceptive acuity. Secondary outcomes were spatial error in an untrained wrist tracing task and somatosensory-evoked potentials (SEP) as a neural correlate of proprioceptive function. Ten neurologically-intact adults were recruited to serve as non-stroke controls for matched age, gender and hand dominance (age range: 44 to 79 years; 6 women, 4 men). RESULTS: Participants significantly reduced JND thresholds at posttest and retention (Stroke group: pretest: mean: 1.77° [SD: 0.54°] to posttest mean: 1.38° [0.34°]; Control group: 1.50° [0.46°] to posttest mean: 1.45° [SD: 0.54°]; F[2,37] = 4.54, p = 0.017, ηp2 = 0.20) in both groups. A higher pretest JND threshold was associated with a higher threshold reduction at posttest and retention (r = - 0.86, - 0.90, p ≤ 0.001) among the stroke participants. Error in the untrained tracing task was reduced by 22 % at posttest, yielding an effect size of w = 0.13. Stroke participants exhibited significantly reduced P27-N30 peak-to-peak SEP amplitude at pretest (U = 11, p = 0.03) compared to the non-stroke group. SEP measures did not change systematically with training. CONCLUSIONS: This study provides proof-of-concept that non-visual, proprioceptive training can induce fast, measurable improvements in proprioceptive function in chronic stroke survivors. There is encouraging but inconclusive evidence that such somatosensory learning transfers to untrained motor tasks. Trial registration Clinicaltrials.gov; Registration ID: NCT02565407; Date of registration: 01/10/2015; URL: https://clinicaltrials.gov/ct2/show/NCT02565407 .

Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study.

BACKGROUND: Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation. METHODS: In this prospective case-control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category. RESULTS: Comparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70). CONCLUSION: The Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke. Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.

Exploration of Sensory Processing Difficulties among Children Attending Primary School in Denmark.

Current research shows that children with sensory processing (SP) difficulties have limited participation and enjoyment in their daily activities at school. The aim of this study was to explore the prevalence of SP difficulties among Danish children and to explore possible associated factors. Since SP difficulties can affect children's prerequisites for participation in school activities and learning possibilities, this study focused on primary school children. Method. The study was designed as a cross-sectional survey. The sample consisted of 1723 children age 5 to 11 years, who were attending Danish public school (45.5% girls, 53.2% boys). The parents or caregivers of the child completed a Short Sensory Profile (SSP) questionnaire and a demographic questionnaire. One-way ANOVA was used to examine differences between girls and boys regarding sports, geographic area, and parental level of education. Chi-square analysis was used to explore the relationship between sex and SPP scores in the different behavioral sections. Logistic regression analysis was used to investigate possible associations between SP difficulties and sex and the included demographics. Results. A total of 21.3% of the children had SSP scores suggesting SP difficulties. Boys had a higher probability of having SP difficulties than girls (odds ratio (OR) = 1.55, confidence level (Cl): 1.22, 1.97). An association was found between participating in sports outside of school and SP difficulties (OR = 0.55, Cl: 0.47, 0.65 (p ≤ 0.001)). Additionally, a slight association between SP difficulties and parental education level (OR = 0.80) was found. No association was found regarding geographic area, i.e., where in Denmark the children attended school (OR = 1.00). Conclusion. The study results suggest that approximately 20% of the children in Danish public schools might have SP difficulties and over 20% might be at risk of having SP difficulties. The results suggest that Danish schools should focus on both identifying children with SP difficulties and implement interventions such as sensory integration through occupational therapy to help children with SP difficulties, in order to improve their ability to participate and learn from school activities.

Investigating Therapies for Freezing of Gait Targeting the Cognitive, Limbic, and Sensorimotor Domains.

BACKGROUND: Freezing of gait (FOG) is arguably the most disabling motor symptom experienced with Parkinson's disease (PD), but treatments are extremely limited due to our poor understanding of the underlying mechanisms. Three cortical domains are postulated in recent research (ie, the cognitive, limbic, and sensorimotor domains), thus, treatments targeting these mechanisms of FOG may potentially be effective. Cognitive training, cognitive behavioral therapy (CBT, a well-known anxiety intervention), and proprioceptive training may address the cognitive, limbic, and sensorimotor domains, respectively. OBJECTIVE: To investigate whether these 3 treatments could improve functional outcomes of FOG. METHODS: In a single-blind, randomized crossover design, 15 individuals with PD and FOG were randomized into different, counterbalanced orders of receiving the interventions. Each consisted of eight 1-hour sessions, twice weekly for 4 weeks. FOG severity was assessed as the primary outcome using a novel gait paradigm that was aimed at evoking FOG when the cognitive, limbic, or sensorimotor domains were independently challenged. RESULTS: FOG severity significantly improved after the cognitive intervention, with strong trends toward improvement specifically in the baseline and cognitive-challenge assessment conditions. CBT, as the anxiety intervention, resulted in significantly worse FOG severity. In contrast, proprioceptive training significantly improved FOG severity, with consistent trends across all conditions. CONCLUSIONS: The cognitive and proprioceptive treatments appeared to improve different aspects of FOG. Thus, either of these interventions could potentially be a viable treatment for FOG. However, although the results were statistically significant, they could be sensitive to the relatively small number of participants in the study. Considering the significant results together with nonsignificant trends in both FOG and gait measures, and given equal time for each intervention, proprioceptive training produced the most consistent indications of benefits in this study. (clinicaltrials.gov NCT03065127).

Prediction of Balance After Inpatient Rehabilitation in Stroke Subjects with Severe Balance Alterations at the Admission.

BACKGROUND: Patients with severe motor alterations would be those on who the prediction of the expected motor response after inpatient rehabilitation programs is most required. OBJECTIVES: To analyze if the balance progress measured by the Berg Balance Scale and the time of hospitalization could be independent predictors of the Berg Balance at the end of a post stroke rehabilitation program in patients with severe balance alteration at the admission. Secondly, to compare a Berg Balance prediction model at the time of discharge based on the Berg Balance at the time of admission (model 1) to a Berg Balance prediction model at the time of discharge based on Berg Balance progress and the time of hospitalization (model 2). METHODS: Subjects suffering a first subacute supratentorial stroke admitted for inpatient rehabilitation between 2010 through 2018 were included to develop two linear regression models of predicted Berg Balance at discharge (n=149). RESULTS: According to model 1 (p < 0.0001, R2= 0.166), the Berg Balance at the admission would be a predictor of the Berg Balance at discharge from hospitalization. According to model 2 (p < 0.0001, R2= 0.993) the Berg Balance progress (ß= 1.026; p < 0.0001) and the hospitalization time (ß=-0.006; p < 0.0001) would be independent predictors of the Berg Balance at discharge. CONCLUSIONS: The motor response to the rehabilitation programs in subacute patients with severe motor alterations could be explained on the basis of balance condition at the admission, but this explanation may be improved considering the progress on the balance the patients achieve during inpatient rehabilitation irrespective the time of hospitalization.

Parosmia is Associated with Relevant Olfactory Recovery After Olfactory Training.

OBJECTIVE/HYPOTHESIS: This study aims to determine the association between parosmia and clinically relevant recovery of olfactory function in patients with post-infectious olfactory dysfunction (PIOD) receiving olfactory training. STUDY DESIGN: Retrospective cohort study. METHODS: This was a retrospective cohort study of patients with PIOD that received olfactory training. Adult patients with the major complaint of quantitative smell loss were recruited and treated at several ENT clinics in German between 2008 and 2018. The outcome was based on the association between smell-loss related factors (including parosmia and phantosmia) and clinically relevant changes in overall and subdimension olfactory function of threshold, discrimination, and identification using binary logistic regression analysis. RESULTS: A total of 153 participants with PIOD were included. Clinically relevant improvements in overall olfactory function were more likely in those that had lower baseline olfactory function. Relevant improvements in discrimination function were more likely in those that had lower baseline olfactory function and those that had parosmia at the initial visit. Similarly, relevant improvements in odor identification were more likely in those that had a lower baseline olfactory function and in those who had parosmia at the first visit. Clinically significant improvements in odor threshold were more likely in those who were older in age. CONCLUSIONS: This study demonstrated that the presence of parosmia is associated with clinically relevant recovery in olfactory discrimination and identification function in patients with PIOD receiving olfactory training. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:618-623, 2021.

Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019.

BACKGROUND: Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritised in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury. METHODS: To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability (YLDs) of 25 diseases, impairments, or bespoke aggregations of sequelae that were selected as amenable to rehabilitation. All analyses were done at the country level and then aggregated to seven regions: World Bank high-income countries and the six WHO regions (ie, Africa, the Americas, Southeast Asia, Europe, Eastern Mediterranean, and Western Pacific). FINDINGS: Globally, in 2019, 2·41 billion (95% uncertainty interval 2·34-2·50) individuals had conditions that would benefit from rehabilitation, contributing to 310 million [235-392] YLDs. This number had increased by 63% from 1990 to 2019. Regionally, the Western Pacific had the highest need of rehabilitation services (610 million people [588-636] and 83 million YLDs [62-106]). The disease area that contributed most to prevalence was musculoskeletal disorders (1·71 billion people [1·68-1·80]), with low back pain being the most prevalent condition in 134 of the 204 countries analysed. INTERPRETATION: To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need. FUNDING: Bill & Melinda Gates Foundation.

Evaluation of balance in children with sensorineural hearing loss according to age.

PURPOSE: Hearing is an important sensory skill for psychomotor development. As the cochlea and vestibule share the membranous labyrinth of the inner ear, children with sensorineural hearing loss (SNHL) may have vestibular dysfunction. This study aimed to evaluate static, dynamic, functional balance, and mobility as a whole in children with SNHL. MATERIAL AND METHODS: Eighty children, 40 with bilateral severe-to-profound SNHL (20 children between the ages of 6-10 were included in the Group 1, and 20 children between the ages of 11-15 were included in the Group 2) and 40 with normal-hearing (the Group 3 included 20 children between the ages of 6-10 and the Group 4 of 20 children between the ages of 11-15) were included in the study. The Single-Leg Stance (SLS) Test, Functional Reach Test (FRT), Time Up and Go (TUG) Test, and Pediatric Balance Scale (PBS) were used to evaluate the balance skills of children. RESULTS: The present study found out that children with SNHL in both age groups performed worse than those with normal-hearing in FRT, SLS, and PBS. In the TUG test, children with SNHL in the younger age group had lower performance compared to their peers with normal-hearing while the TUG performance of children with SNHL in the older age group was similar to their normal-hearing peers. CONCLUSION: It was concluded that the static, dynamic and functional balance skills of children with SNHL were impaired compared to their normal-hearing peers. Including balance assessment in the routine test battery in children with SNHL may be decisive for early diagnosis and rehabilitation of balance disorders. It may be beneficial to add static, dynamic and functional balance tests to the test battery in addition to mobility assessment, especially in children with SNHL in the older age groups.

Contributions of physical exercise to motor symptoms and the balance of people with Parkinson's Disease: a systematic review / Contribuciones del ejercicio físico para los síntomas motores y el equilibrio de las personas con Enfermedad de Parkinson: una revisión sistemática / Contribuições do exercício físico nos sintomas motores e no equílibrio de pessoas com Doença de Parkinson: uma revisão sistemática

OBJECTIVE: The aim of the study was to conduct a systematic review evaluating the effects of physical exercise on balance and motor symptoms of Parkinson's Disease. METHOD: The search was carried out on the PubMed, Scielo and PEDro databases. The articles were evaluated by two independent researchers, following the criteria: presenting a control group, having more than eight weeks of intervention, assessing motor symptoms (Unified Parkinson's Disease Rating Scale and Parkinson's Disease Questionnaire -39) and balance (Timed Up and Go and Berg Scale). RESULTS: The search resulted in 1377 articles, of which 11 were included in the study. The total number of participants was 925, in which 545 were allocated in the intervention groups and 380 in the control groups. The strength training and balance, performed alone or in combination, are highlighted in improvements related to balance. Exercise, regardless of type, improves motor symptoms. CONCLUSIONS: Thus, physical exercise has a positive effect on both balance and motor symptoms of Parkinson's Disease, strength and balance modalities stand out

OBJETIVO: El objetivo de este estudio fue conducir una revisión sistemática evaluando los efectos del ejercicio físico en el equilibrio y los síntomas motores de la Enfermedad de Parkinson. MÉTODO: Se realizó una búsqueda de artículos científicos en las siguientes bases: PubMed, Scielo y PEDro. Los artículos fueron evaluados por dos investigadores, siguiendo los criterios: presentar grupo control, contar con al menos ocho semanas de intervención, evaluar síntomas motores (Unified Parkinson's Disease Rating Scale y el Parkinson's Disease Questionnaire-39) y equilibrio (Timed Up and Go y Escala de Berg). RESULTADOS: Se revisaron un total de 1377 artículos, de estos, 11 fueron incluidos. El número total de participantes fue de 925, 545 en el grupo experimental y 380 en el grupo de control. Los entrenamientos de fuerza y de equilibrio, realizados juntos o separados, indujeron mejoras del equilibrio. El ejercicio, de cualquier tipo, mejora los síntomas motores. CONCLUSIONES: Así, el ejercicio físico tiene efecto positivo, tanto en el equilibrio como en los síntomas motores de la Enfermedad de Parkinson, destacándose el entrenamiento de fuerza y equilibrio

OBJETIVO: O objetivo do estudo foi conduzir uma revisão sistemática avaliando os efeitos do exercício físico no equilíbrio e nos sintomas motores da Doença de Parkinson. MÉTODO: Realizou-se a busca nas bases PubMed, Scielo e PEDro. Os artigos foram avaliados por dois investigadores independentes, seguindo os critérios: apresentar grupo controle, possuir mais de oito semanas de intervenção, avaliar sintomas motores (Unified Parkinson's Disease Rating Scale e Parkinson's Disease Questionnaire-39) e equilíbrio (Timed Up and Go e Escala de Berg). RESULTADOS: A busca resultou em 1377 artigos, destes, 11 foram incluídos no estudo. O total de participantes foi de 925, em que 545 alocados no grupo intervenção e 380 no grupo controle. Os exercícios de força e de equilíbrio, realizados de forma isolada ou combinada, se destacaram nas melhoras relacionadas ao equilíbrio. O exercício, independente da modalidade, melhora os sintomas motores. CONCLUSÕES: Assim, o exercício físico tem efeito positivo tanto no equilíbrio quanto nos sintomas motores da Doença de Parkinson, destaca-se as modalidades de força e equilíbrio

Intervención de terapia ocupacional en niños con dificultades de procesamiento sensorial: un estudio de caso múltiple en una escuela en Paris / Occupational therapy intervention for children with challenges in sensory processing: a multiple case study from a school in Paris

PROPÓSITO: El principal objetivo de este estudio fue describir el proceso y evaluar la eficacia de terapia ocupacional con abordaje de integración sensorial para 3 niños con dificultades de procesamiento sensorial, con el fin de ayudar a desarrollar modelos de practica apropiados en planificación e implementación de la intervención de terapia ocupacional. MÉTODO: Se utilizó un diseño de estudio de casos múltiples. Todos los participantes eran estudiantes de la misma escuela y fueron remitidos a terapia ocupacional debido a dificultades en escritura, torpeza motora y participación en clase. Los participantes recibieron sesiones individuales de 45 minutos de duración. La duración media de la intervención fue de 27 sesiones realizadas una vez por semana en el transcurso del año lectivo. Los niños fueron evaluados antes y después de la intervención con entrevistas a padres y maestros, observaciones clínicas y pruebas estandarizadas. RESULTADOS: Luego de la intervención se observaron mejores resultados en habilidades de desempeño de las evaluaciones estandarizadas Bruininks-Oseretsky Test of Motor Proficiency, Segunda Edición (BOT™-2) y Prueba de Desarrollo de la Percepción Visual - Tercera Edición (DTVP-3). Además, se observó mejora en la calidad de la escritura y la participación en los juegos de motricidad gruesa en todos los niños. CONCLUSIÓN: Los resultados de este estudio se adhieren a la literatura en el sentido de que la terapia ocupacional bajo un marco de integración sensorial parece ser un método efectivo para mejorar las habilidades de desempeño y la participación funcional de los niños con desafíos de procesamiento sensorial.

PURPOSE: The main purpose of this study was to describe the process and evaluate the effectiveness of occupational therapy under a sensory integration framework for 3 children with sensory processing challenges, in order to help develop models of good practice in planning and implementation of occupational therapy intervention. METHOD: A Multiple Case Study design was utilized. All participants were students at the same school and were referred to occupational therapy because of concerns with handwriting, clumsiness and class participation. Participants received individual, 45 minutes long intervention sessions. The mean length of intervention was 27 sessions delivered 1 time per week over the course of the academic year. Children were evaluated before and after intervention with parent/teacher interviews, clinical observations and standardized tests. RESULTS: After the intervention all participants obtained higher scores for performance skills in the standardized tests Bruininks-Oseretsky Test of Motor Proficiency, Second Edición (BOT™-2) and Developmental Test of Visual Perception ­ Third Edition (DTVP-3). Furthermore, improved handwriting quality and participation on gross motor games was reported for all participants. CONCLUSION: The results of this study adhere to the literature in that occupational therapy under a sensory integration framework seems to be an effective method for enhancing performance skills and functional participation of children with sensory processing challenges.

Patrones de procesamiento sensorial e intervención temprana en niños menores de 3 años: una revisión de la literatura / Sensory processing patterns and early intervention in children under 3 years of age: a review of the literature

La presente revisión se centra en proporcionar una visión general de la literatura que identifica estudios enfocados en definir los patrones de procesamiento sensorial en niños menores de 3 años y los enfoques de intervención identificados en esta población. Durante la última década ha existido un crecimiento constante de la literatura relacionada con el procesamiento sensorial en los niños pequeños, sin embargo, la información disponible entre las diferentes publicaciones es aún limitada y segmentada. En esta revisión se recopilaron 15 artículos sobre los patrones de procesamiento sensorial en los niños pequeños y 10 artículos relacionados con los enfoques de intervención para un total de 25 artículos publicados entre 2007 y 2017. Del análisis de la información obtenida acerca de los patrones de procesamiento sensorial, surgieron los siguientes temas: el diagnóstico y los factores de riesgo, el tipo de disfunción del procesamiento sensorial y el impacto funcional. Entre los temas que surgieron al analizar los enfoques de intervención, se destaca la importancia de la familia como un tema general que abarca subtemas de intervención, tales como: estrategias sensoriales, capacitación de los padres e intervenciones grupales. Si bien es necesario continuar desarrollando investigaciones que amplíen nuestro conocimiento en relación con estos temas en general, la evidencia apoya la efectividad de la intervención temprana.

La presente revisión se centra en proporcionar una visión general de la literatura que identifica estudios enfocados en definir los patrones de procesamiento sensorial en niños menores de 3 años y los enfoques de intervención identificados en esta población. Durante la última década ha existido un crecimiento constante de la literatura relacionada con el procesamiento sensorial en los niños pequeños, sin embargo, la información disponible entre las diferentes publicaciones es aún limitada y segmentada. En esta revisión se recopilaron 15 artículos sobre los patrones de procesamiento sensorial en los niños pequeños y 10 artículos relacionados con los enfoques de intervención para un total de 25 artículos publicados entre 2007 y 2017. Del análisis de la información obtenida acerca de los patrones de procesamiento sensorial, surgieron los siguientes temas: el diagnóstico y los factores de riesgo, el tipo de disfunción del procesamiento sensorial y el impacto funcional. Entre los temas que surgieron al analizar los enfoques de intervención, se destaca la importancia de la familia como un tema general que abarca subtemas de intervención, tales como: estrategias sensoriales, capacitación de los padres e intervenciones grupales. Si bien es necesario continuar desarrollando investigaciones que amplíen nuestro conocimiento en relación con estos temas en general, la evidencia apoya la efectividad de la intervención temprana.

Investigating the Effects of Vestibular Rehabilitation on Balance Function in Cochlear Implant Recipients.

BACKGROUND: Cochlear Implantation (CI) is an effective surgical approach to rehabilitate the severe to profound hearing-impaired patients. However, the insertion of CI electrodes into the cochlea may adversely affect vestibular receptors, resulting in vertigo or dizziness. The present study aimed to investigate the impacts of Vestibular Rehabilitation Therapy (VRT) exercises on dizziness symptoms of patients who underwent CI. METHODS: A total of 21 consecutive patients (age range: 28 to 61 years) with profound sensorineural hearing loss undergoing CI operation participated. The VRT therapy plan consisted of a habituation and adaptation exercises in combination with gait and balance exercises. The handicapping influences of dizziness was measured using a Dizziness Handicap Inventory (DHI) scale to measure the level of respondent's performance on physical, emotional, and functional dimensions. Visual Analogue Scale (VAS) was also conducted to assess the severity of dizziness symptoms. The DHI and VAS scales were conducted before VRT and at "oneweek", "two-week", and "four-week" following the last rehabilitation session. RESULTS: A repeated-measure analysis of variance demonstrated a significant decrement and a consequent improvement in DHI scores after vestibular exercises in all emotional, physical and functional domains (p < 0.001). We also found that the influence of implanted ear (p=0.076) and gender (p=0.094) variables on DHI scores were not statistically significant. The mean VAS score was 5.87 ± 2.27 at baseline stage and it reduced significantly during the course of the therapy (second week, 2.02 ±1.75, p < 0.001; and forth week, 1.51 ± 1.29, p < 0.001). CONCLUSION: The findings of this study showed that vestibular rehabilitation therapy has a positive impact on the symptoms of the patients who underwent CI surgery. These exercises lead to an improvement in balance and postural stability, and a reduction in the self-report measure of handicaps. These findings provide the basis for better pre-operative counseling and postoperative vestibular rehabilitation to CI recipients.

Efecto de la rehabilitación física en pacientes con ataxia espinocerebelosa hereditaria. Una revisión sistemática / Effect of physical rehabilitation in patients with hereditary spinocerebellar ataxia. A systematic review

Las evidencias sobre la efectividad de las intervenciones rehabilitadoras en las ataxias espinocerebelosas son escasas y variables. OBJETIVO: Recopilar las evidencias existentes sobre dicha efectividad. Material y MÉTODOS: Se han analizado todos los ensayos clínicos publicados hasta la fecha y evaluado los resultados obtenidos en cuanto a la mejora del equilibrio, marcha y realización de actividades diarias postratamiento. Encontramos una mejora significativa de la postura (p <0,008), marcha (p <0,02), así como una reducción de la puntuación de la subescala SARAg&p (marcha y postura) e índice SCAFI 8MW (velocidad de marcha) (p = 0,02). También observamos mejora en desórdenes del habla (p = 0,02), síntomas depresivos (p <0,0001) y caídas accidentales (p <0,005). CONCLUSIONES: A pesar de la controversia en aspectos relacionados con la intensidad, la temporalidad y la duración de las mejoras conseguidas, queda constatada la efectividad clínica del tratamiento rehabilitador en estos pacientes, especialmente en aspectos como la marcha y el equilibrio

Evidence of the effectiveness of rehabilitation interventions in spinocerebellar ataxia is scarce and variable. OBJECTIVES: The aim of this systematic review was to gather the existing evidence on the effectiveness of these interventions. MATERIAL AND METHODS: To do this, we analysed all the clinical trials published to date and assessed their results in terms of improved balance, gait, and performance of daily activities after treatment. Significant improvements were found for posture (P<.008) and gait (P<.02), as well as a reduction in the scores for the SARAg&p subscale (gait and posture) and SCAFI 8MW index (gait speed) (P=.02). We also observed improvements in speech disorders (P=.02), depressive symptoms (P<.0001) and accidental falls (P<.005)

Rehabilitation of older people with Parkinson's disease: an innovative protocol for RCT study to evaluate the potential of robotic-based technologies.

BACKGROUND: Parkinson's disease is one of the most frequent causes of disability among the older adults. It is a chronic-progressive neuro-degenerative disease, characterized by several motor disorders. Balance disorders are a symptom that involves the body axis and do not respond to dopaminergic therapy used in Parkinson's disease. Therefore, physiotherapy becomes an important intervention for the management of motor disorders. Originally, these rehabilitative approaches were based on empirical experiences, but several scientific evidences suggests that neuronal plasticity is exercise-dependent. In this context, robotic rehabilitation plays an important role because it allows to perform task-oriented exercises and to increase the number of repetitions and their intensity. This protocol study aims to evaluate the effectiveness of robotic-based intervention of the older adults with Parkinson's disease, designed to improve the gait and to reduce the risk of falling. METHODS: This study is a single-blinded randomized controlled trial. The primary outcomes are: risk of falling, gait performance and fear of falling measured through Performance-Oriented Mobility Assessment (POMA), instrumental gait analysis and Short Falls Efficacy Scale - International (FES-I), respectively. One hundred ninety-five patients with PD will be recruited and randomly divided into three groups, to receive a traditional rehabilitation program or a robotic rehabilitation using Tymo system or Walker View in addition to the traditional therapy. Assessments will be performed at baseline, at the end of treatment and 6 months, 1 year and 2 years from the end of the treatment. A 10-treatment session will be conducted, divided into 2 training sessions per week, for 5 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system. DISCUSSION: The final goals of the present study are to propose a new approach in the PD rehabilitation, focused on the use of robotic device, and to check the results not only at the end of the treatment but also in the long term. TRIAL REGISTRATION: NCT04087031, registration date September 12, 2019.

Técnicas sensoriales específicas y modificaciones sensoriales ambientales para niños y jóvenes con dificultades de integración sensorial: una revisión sistemática / Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: a systematic review

Este trabajo realiza una revisión sistemática de intervenciones sensoriales distintas de la Integración Sensorial de Ayres, realizando un análisis de investigaciones que utilizan técnicas sensoriales específicas y modificaciones ambientales, publicadas entre 2007 y 2015. De los trabajos analizados, 8 cumplen con los criterios de inclusión-exclusión. Excepto el masaje Qigong, con una evidencia de moderada a fuerte y la modificación ambiental de una clínica dental, con evidencia moderada, el resto de técnicas obtienen una evidencia limitada. De esta forma, los terapeutas ocupacionales deben realizar estudios con calidad metodológica suficiente que nos ayuden a delimitar la eficacia de las técnicas e intervención que se utilizan a nivel sensorial, elegir las técnicas de tratamiento que mejor evidencia tengan para ayudar a los clientes con dificultades sensoriales a mejorar su desempeño ocupacional y continuar formándose en Integración Sensorial

This paper carries out a systematic review of sensory interventions, different than Sensory Integration of Ayres, making an analysis of research using specific sensory techniques and sensory environmental modifications, between 2007 and 2015. At the end, 8 works meet the inclusion-exclusion criteria. Except Qigong massage, with moderate to strong evidence, and the environmental modification of a dental clinic, with moderate evidence, the rest of techniques show limited evidence. So occupational therapists must perform studies with methodological quality enough to help us to define the effectiveness of the techniques and interventions used for sensory disfunctions, to choose the best evidence treatment techniques to help clients with sensory difficulties to improve their occupational performance and as professionals, we must be trained in Sensorial Integration and other sensory techniques

Sensory retraining improves light touch threshold of the paretic hand in chronic stroke survivors: a single-subject A-B design.

Background: Light touch, one of the primary and basic sensations, is often neglected in sensory retraining programmes for stroke survivors.Objective: This study aimed to investigate the effects of sensory retraining on the light touch threshold of the hand, dexterity and upper limb motor function of chronic stroke survivors.Methods: Five chronic stroke survivors with sensory impairment participated in this single-subject A-B design study. In baseline (A) phase, they only received standard rehabilitation. In the treatment (B) phase, they received a 6-week sensory retraining intervention in addition to standard rehabilitation. In both phases, they were evaluated every 3 days. Light touch threshold, manual dexterity and upper limb motor function were assessed using Semmes-Weinstein Monofilaments, Box-Block Test and Fugl-Meyer Assessment, respectively. Visual analysis, nonparametric Mann-Whitney U test and, c-statistic were used for assessing the changes between phases.Results: All participants indicated changes in trend or slope of the total score of light touch or both between the two phases. The results of the c-statistic also showed the statistical difference in the total score of light touch between baseline and treatment in all participants (p < 0.001). Also, the results of the c-statistic and Mann-Whitney U test supported the difference of manual dexterity and motor function of the upper limb between baseline and treatment in all participants (p < 0.001).Conclusion: Current findings showed that sensory retraining may be an effective adjunctive intervention for improving the light touch threshold of the hand, dexterity and upper limb motor function in chronic stroke survivors.

Effects of hybrid-functional electrical stimulation (FES) rowing whole-body exercise on neurologic improvement in subacute spinal cord injury: secondary outcomes analysis of a randomized controlled trial.

STUDY DESIGN: Secondary outcome measures analysis of a randomized, controlled study. OBJECTIVE: To assess the effects of hybrid-functional electrical stimulation (FES) rowing on motor and sensory recovery in individuals with spinal cord injury (SCI) 6-18 months post injury. SETTING: Outpatient rehabilitation network. METHODS: 25 participants 6-12 months after SCI were randomly assigned to hybrid-FES rowing (n = 10) or standard of care (n = 15) groups. The hybrid-FES rowing group completed 6 months of rowing scheduled 3 times per week for 26 weeks at an exercise intensity of 70-85% of maximal heart rate. The standard of care group either participated in an arm ergometer exercise program (n = 6) or a waitlist without an explicit exercise program (n = 9). Changes in motor score and combined sensory score of the International Standards for Neurological Classification of SCI (ISNCSCI) were analyzed. RESULTS: Both groups demonstrated increases in motor and combined sensory scores, but no significant differences were noted between intervention groups (motor difference mean ↑1.3 (95% CI, -1.9 to 4.4), combined sensory difference mean ↓10 (-30 to 18)). There was an average of 63% adherence to the hybrid-FES rowing protocol, with no significant correlation in changes in motor or combined sensory score in the hybrid-FES rowing group with total distance or time rowed. CONCLUSIONS: No significant effects to neurologic improvement were found with hybrid-FES rowing when compared with standard of care interventions in individuals with SCI 6-18 months post injury.