[Rehabilitation during the lockdown]. / Rehabilitación en época de confinamiento.

The health system is facing a global pandemic due to coronavirus disease 2019. Emergency plans often fail to consider specific rehabilitation issues, whether inpatient or outpatient, although the World Health Organization advises the inclusion of rehabilitation professionals as soon as possible. The contingency plans of rehabilitation services must be carried out in coordination with the other healthcare areas. This review was prepared with the current available evidence on coronavirus disease 2019 and was based on the experience of a specific environment, to plan the continuity of rehabilitation care for all patients and to help rehabilitation teams in this period of lockdown and uncertain lifting of restrictions.

[The design of a population register on cerebral palsy: its application and analysis in Andorra and Navarre]. / Diseño de un registro de paralisis cerebral de ambito poblacional: aplicacion y analisis en Andorra y Navarra.

INTRODUCTION: Cerebral palsy describes a group of developmental and posture disorders, which cause a limitation of activity due to non-progressive damage occurring in the developing brain. A population register facilitates the identification of cerebral palsy cases within a specific geographic population. Its usefulness is recognized in the world literature but in Spain, published databases focus on the treatment or complications of cerebral palsy. AIMS: To propose a population register that can be useful in different areas of our environment and to evaluate its validity through its application in two differentiated and geographically delimited health areas. SUBJECTS AND METHODS: The registry consists of 124 items divided into seven sections: data on the child filiations, maternal history and parents' information, pregnancy and neonatal period data, diagnoses and classification, neuroimaging tests, therapeutic interventions and others. Patients attended in external consultations in Navarre and Andorra were included. RESULTS: In the register, 53 patients (52.8% females) were evaluated. 56.5% were premature. Spastic cerebral palsy is the most frequent presentation. 42% have associated epilepsy. CONCLUSIONS: The use of population registers allows a better knowledge of cerebral palsy as well as the evaluation and development of prevention strategies and optimization of care resources with objective data. It is necessary to generalize the use of this type of records in our environment.

TITLE: Diseño de un registro de paralisis cerebral de ambito poblacional: aplicacion y analisis en Andorra y Navarra.Introduccion. La paralisis cerebral describe un grupo de trastornos del desarrollo y la postura que causan una limitacion de la actividad debido a alteraciones no progresivas ocurridas en el cerebro en desarrollo. El registro poblacional facilita la identificacion de los casos de paralisis cerebral dentro de una poblacion geografica especifica. Esta reconocida su utilidad en la bibliografia, pero en España, las bases de datos publicadas se centran en el tratamiento o las complicaciones de la paralisis cerebral. Objetivos. Proponer un registro poblacional que pueda ser util en diferentes areas de nuestro entorno y evaluar su validez mediante su aplicacion en dos areas de salud diferenciadas y geograficamente delimitadas. Sujetos y metodos. El registro elaborado constaba de 124 items divididos en siete apartados: datos de filiacion del niño, historia materna e informacion de los padres, datos del embarazo y periodo neonatal, diagnosticos y clasificacion, pruebas de neuroimagen, intervenciones terapeuticas y otros. Se incluyo a los pacientes atendidos en consultas externas en Navarra y Andorra. Resultados. En el registro se evaluo a 53 pacientes (52,8% mujeres). El 56,5% fueron prematuros. La paralisis cerebral espastica es la presentacion mas frecuente. Un 42% asociaba epilepsia. Conclusiones. El uso de registros poblacionales permite un mejor conocimiento de la paralisis cerebral, asi como la evaluacion y el desarrollo de estrategias de prevencion y optimizacion de los recursos asistenciales con datos objetivos. Es necesaria la generalizacion del uso de este tipo de registros en nuestro entorno.

[Commentary on the original 'Adaptation and feasibility of the online version of the Fugl Meyer scale for the assessment of patients following cerebrovascular accidents']. / Comentario al original 'Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares.

TITLE: Comentario al original 'Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares.

Comentario al original ‘Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares / Commentary on the original 'Adaptation and feasibility of the online version of the Fugl Meyer scale for the assessment of patients following cerebrovascular accidents'

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[Is it too late to start orthopedic treatment for idiopathic scoliosis with Risser scores of 4?]. / Est-il trop tard pour entreprendre un traitement orthopédique pour scoliose idiopathique à Risser 4 ?

Orthopaedic treatment for idiopathic scoliosis in adolescence is indicated with a curve of > or =20 degrees and a Risser score< or =4, because progression of curve is low with Risser scores >4. We present the case of a young man with a left lumbar idiopathic scoliosis (T12-L4) with a curve of 10 degrees, which was stable from 13 years (Risser 0) to 16 years old (Risser 4). The scoliosis progressed quickly after a Risser score of 4 was achieved. The man had been wearing a lift on the left foot since he was 13, because of a leg length discrepancy, and had been under clinical and radiological monitoring. When the boy reached 17 years, the scoliosis rapidly progressed, to a curve of 22 degrees and a Risser score of >4. The scoliosis was effectively treated with a Boston brace. At 20 years, the Risser score was 5, and the left lumbar curve was 13 degrees after discontinuing the use of the brace. To our knowledge, no scientific reference indicates a time limit to orthopaedic treatment for idiopathic adolescent scoliosis. Despite the experts' recommendations, a brace might be indicated with a Risser score > or =4 to stop the progression of the curve.

[A comparative study of fibromyalgia treatment: ultrasonography and physiotherapy versus sertraline treatment]. / Etude comparative dans traitement de la fibromyalgie: ultrasons et kinésithérapie versus sertraline.

OBJECTIVE: To compare the efficacy of sertraline versus physical therapy (ultrasonography and physical therapy) in fibromyalgia. DESIGN: A 6-month comparative, prospective, randomised study of 70 female patients, aged 42 to 52, with fibromyalgia according to the criteria of the American College of Rheumatology. One group (N=36) underwent 6-month treatment with sertraline, 50 mg/24 h. The other group (N=34) received 15 sessions of 1 W/cm2 ultrasonography on the cervical trigger points plus physical therapy. Variables analyzed on a visual 10-point scale were pain and morning stiffness and sleep disorders by use of the sleep questionnaire of the Medical Outcome Study (MOS). Measurements were taken at the beginning of the study and at 3-month and 6-month follow-up. RESULTS: Pain significantly diminished in the sertraline group during the entire study (visual numeric scale: 7.2+/-1.1 initially, 5.3+/-?? at 3 months and 3+/-0.7 at 6 months, P<0.05). Morning stiffness and sleep disorder scores were positive only for the sertraline group during the entire 6 months (P<0.05). Results from the MOS questionnaire showed improvement only for the sertraline group. Of the Sertraline group, 83% evaluated the treatment as good or very good, as compared with only 6% of the ultrasonography group. No patient withdrew from the study. CONCLUSION: Patients treated with sertraline had a better outcome in terms of pain, morning stiffness and sleep disorders, than the group treated with ultrasonography and physical therapy.

Rehabilitación en época de confinamiento / Rehabilitation during the lockdown

El sistema sanitario se encuentra ante una pandemia mundial en relación con la enfermedad por coronavirus 2019 (COVID-19). Los planes de preparación para emergencias a menudo no consideran cuestiones específicas de rehabilitación para pacientes hospitalizados ni para ambulatorios, aunque la Organización Mundial de la Salud aconseja incluir a profesionales de rehabilitación lo antes posible. Los planes de contingencia de los Servicios de Rehabilitación deben realizarse en coordinación con las otras áreas asistenciales. En esta revisión, se ha resumido y analizado la información disponible basada en una búsqueda cuidadosa de la literatura científica de COVID-19 y en la experiencia de un entorno concreto, para planificar la continuidad asistencial de rehabilitación para todos los pacientes y para ayudar a los equipos de rehabilitación en este periodo de confinamiento /desconfinamiento incierto

The health system is facing a global pandemic due to coronavirus disease 2019 (COVID-19). Emergency plans often fail to consider specific rehabilitation issues, whether inpatient or outpatient, although the World Health Organisation advises the inclusion of rehabilitation professionals as soon as possible. The contingency plans of rehabilitation services must be carried out in coordination with the other healthcare areas. This review was prepared with the current available evidence on COVID-19 and was based on the experience of a specific environment, to plan the continuity of rehabilitation care for all patients and to help rehabilitation teams in this period of lockdown and uncertain lifting of restrictions

[Multiple pulmonary hyalinizing granuloma]. / Granuloma pulmonar hialinizante múltiple.

The causes of multiple pulmonary nodules are many, with metastasis being the most feared. A rare but possible etiology, however, is hyalinizing multiple granuloma. We present a case that allows us to review this condition and its course, as well as a variety of associated immunological changes and possible complications.

Knee isokinetic test-retest: a multicentre knee isokinetic test-retest study of a fatigue protocol.

AIM: The aim of this study was to establish the test-retest reliability of a knee extensor and flexor muscle fatigue protocol using a biodex system 3 isokinetic dynamometer. METHODS: Three-outpatient Rehabilitation Departments undertook the study. Fatigue was evaluated in the dominant knee of 90 healthy female volunteers, non-sportswomen, aged between 20 and 40. They performed 40 consecutive concentric knee flexions and extensions, at 120 degrees /s, on a Biodex 3 isokinetic dynamometer. Two evaluations were done over a period of seven days. Analysed variables were: maximal repetition of total work, maximal work repetition number, work to body weight ratio, total work, work during first and last third of the protocol, fatigue ratio, work fatigue. Statistical analysis determined mean values, medians and box-plots. Intraclass Correlation Coefficients (ICC) (confidence interval 95 %), t-test and one-way analysis of variance (ANOVA) evaluated reliability. Difference of means (di), standard error of measurement (SEM) and 95% of interval confidence (IC di) were also calculated (P<0.05). RESULTS: All participants completed the study. Reliability data were excellent (ICC>0.75) for total work (0.85), work during first third (0.80) and last third (0.80) in extension, and for total work in flexion. Reliability data were fair to good (ICC 0.4-0.75) for the rest of the variables. Median varied less than 20% in all cases during test-retest. CONCLUSION: This knee fatigue protocol is reliable for flexion and extension, above all when using the total work as a variable. The desirability of multicentre studies in rehabilitation and standardisation of protocols is emphasised.

Presentación infrecuente de síndrome de Frey bilateral, tratado con toxina botulínica / An unusual presentation of bilateral Frey syndrome treated with botulinum toxin

El síndrome de Frey o síndrome auriculotemporal, incluye sudoración facial al estímulo gustatorio, más frecuentemente después de cirugía de la glándula parótida. Describimos el caso de un síndrome de Frey bilateral, después de una cirugía unilateral de la glándula parótida, y su tratamiento exitoso con toxina botulínica tipo A. Se trata de una mujer de 54 años de edad, remitida para tratamiento a nuestro servicio de rehabilitación por referir sudoración en la mejilla durante la masticación, 2 años después de cirugía de la glándula parótida. En la valoración con el test de iodo/almidón, se observó un área de sudoración en ambas mejillas, mayor en la homolateral a la cirugía. Ambas áreas fueron tratadas con toxina botulínica, 50 unidades en cada una con un total de 100 unidades reconstituidas en 2 ml de solución salina estéril. A los 6 meses y al año de seguimiento, la paciente sigue asintomática. Nuestra paciente presentaba una forma inusual de síndrome de Frey y fue tratada con éxito con toxina botulínica. No hemos encontrado casos similares en la literatura de aparición en la edad adulta. La patofisiología del síndrome queda todavía por esclarecer (AU)

Frey syndrome, also known as auriculotemporal syndrome, includes facial gustatory sweating, mainly after surgery of the parotid gland. We describe a case of bilateral Frey syndrome after unilateral surgery and its subsequent successful treatment with type A botulinum toxin. A 54-year-old woman was referred for treatment to our physical medicine and rehabilitation department 2 years after parotid gland surgery complaining of sweating while eating in her ipsilateral cheek. When the affected area was assessed with the iodine and starch test, a hyperhydrotic area was revealed in both cheeks, which was greater in the ipsilateral cheek to surgery. Both areas were treated with botulinum toxin, 50 units in each, with a total of 100 units reconstituted with 2 ml sterile saline solution. Injections were performed following recommended protocols every 1 cm2. At 6 months and 1 year of follow up, the patient was asymptomatic. Our patient had an unusual form of Frey syndrome and was successfully treated with botulinum toxin. To the best of our knowledge, this is the first reported case of bilateral Frey syndrome beginning in adulthood. Further research is warranted to clarify the pathophysiology of this syndrome (AU)

Utility of using the ICF Core Sets in clinical practice / Utilidad del uso de los conjuntos básicos de la CIF en la práctica clínica

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La discapacidad: el desafío / Disability: The challenge

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An unusual clinical presentation of bilateral schizencephaly.

We present a case with a characteristic magnetic resonance image (MRI) of bilateral open-lipped schizencephaly and atypical clinical presentation. The patient is still alive and in good health in her forties, she has never presented seizures, and although the motor dysfunction is well correlated with cerebral lobe involvement, neurobehavioral dysfunction is not proportional to the MR image of the cerebral malformation.

Quistes de Tarlov: tres casos sintomáticos / Tarlov cysts: three symptomatic cases

Los quistes de Tarlov (quistes extradurales) son una ectasia del espacio perineural de las raíces nerviosas, situadas de manera habitual distalmente al ganglio dorsal o en la unión con éste. Suelen localizarse en la región sacra. En la mayoría de los casos son asintomáticos, aunque se pueden presentar como una lumbalgia o síntomas radiculares. Se presentan los casos de tres mujeres, entre 30 y 50 años, con una radiculopatía sacra. En todas las pacientes la exploración neurológica fue normal. El diagnóstico de quiste extradural sacro fue confirmado en todas las pacientes con una resonancia magnética (RM) de la columna vertebral lumbosacra. Los quistes eran más pequeños de 1,5 cm de diámetro. En un caso, el estudio electromiográfico fue normal. El tratamiento administrado fueron antiinflamatorios no esteroideos y un programa de rehabilitación. En 2 casos las pacientes tuvieron una recurrencia del dolor neuropático. Se les administró amitriptilina y gabapentina experimentando una remisión completa del dolor. Los quistes de Tarlov son una causa rara de radiculopatía y dolor de espalda bajo, pero deben ser considerados en la diagnóstico diferencial. La patogénesis de los quistes sintomáticos es polémica. Se sugiere que los pacientes con los quistes pequeños de Tarlov (< 1,5 cm) no requieren tratamiento quirúrgico e inicialmente el tratamiento es conservador (AU)